TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID #: 3-^^S l Date: ^-||-ZD) 0 

Address: ^^iP . t J • 1^ ^ ^-t& -

Stabilization Contractor: Professional Environmental Engineers Year: 2010_ 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

B ^ Video ofproperty (DVD) 

Sr Executive Summary 

^r Signed Access Agreement for subject property 

D Pre-Renovation Form signed by Property Ovmer 

U ^ Pre-Renovation Form for Occupant/Tenant, if applicable 

Sr Painting Agreement 

D Settlement documents (i.e., for damage or to replace plants, etc.) 

B^" Renovation Recordkeeping Checklist signed by Certified Renovator 

ffl^ Photographs jymro. m A aPj ^ 

V^*"^'"^ Satisfactory close-out check list signed by Property Ovmer 

D Property close-out check list signed by EPA 

^r Property informationfi"omDouglas County Assessor's Office 

D Hazard analysis, if prepared 

D Safety Audit 30204034 

• 0«,er«.escHbe,: liilHi 

Superfund 

oAm 

Professional Env{fon^ne^;ital Hngineere Signature tDati 

Signatur Ignature ' Date 

(afterfilefolder review review)

) \aer 
PROFESSIONAL 

2505 North 24^ Suite 219 ENVIRONMENTAL ENGINEERS, INC. Omaha, NE 68110 

(402) 504-4688 "Providing cost-effective environmental solutions" Fax (402) 504-3281 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Property Owner Close-Out Form 

(Lead-Based Paint Stabilization EPA Contract EP-R7-08-06) 

SAID: 5 3 557 

Property Address: f^^/ 8 " ^ / ^ ' 

Owner's Name: (y) f L hm- A ^C^ ^ 

Performance Standards/Close-Out Criteria YES NO 

1. Was the entire structure(s) painted with the exception of the stated, excluded 

areas? This would include painting of other associated features including fascia, 

eaves, siding, all trim, porches, box beams, columns, rails, and exterior surfaces of 

garages. < 

2. Was all scraping and other preparation work completed satisfactorily? -4­ 3. Were all required areas of the structure(s) primed as needed and painted with 

two top coats? • X, 

4. Was the paint products utilized equivalent to a 30 year product/quality? 

5. Are all of the areas where contaminated materials have been spilled thoroughly ^ 

vacuumed/cleaned? __js_ 

6. Did the contractor collect/vacuum all falling and scraped paint chips on the 

entire property, roadways, alleyways, public access areas and also remove any 

other generated debris? ^ 

7. Is the grass area that surrounds the structure(s) m reasonably good conditi 

8. Are all items such as polyethylene sheeting, ladders, paint brushes, cones, 

barrier tape, etc. properly removed? X 

9. Isthereany evidence ofproperty damage that was done by the contractor? Any . 

property damage needs to be completed prior to the EPA Close-Out. ^1 

10. Are there any property items that were temporarily re-located by the contractor 

that need to be moved back? j ^ 

11. Are there any (known) lingering issues with the property owner(s) that have . 

been left unresolved? /f 

Comments: 

U) AV^./Qii^^ 4 - iS ' fey 

Property Owner Signature 

"^^^ 4 ^ Date 

Professional Environnrental Engineers Representative 

Date 
2505 North 24'", Suite 219 

Omaha, NE 68110 

(402) 504-4688 

Fax (402) 504-3281 

PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

"Providing cost-effective environmental solutions" 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

2010 

SAID# 33557 

3918 N 19 St. 

• Dates worked: 04/15/10 to 04/16/10 

• Pre property condition: House and garage have painted wood and in poor condition, 

garage paint is the worse and is flaldng ofT ail over the yard and sidewalk. Prior paint 

splatters on sidewalks. 

• Problems encountered: None 

• Owner request/concerns: N/A 

• Inspection/closeout dates. Owner signed 04/15/10, inspected by PE project manager. 
EPA Paint Stabilization 2010 

SAID# 

Property Address i,<^\% M vn ^^ 

i-3 Stories 

Garage? ^es 

Accesssigned O Q I H O 

Pre^Weo ^-^'l O 

4-11.-10 Post video 

Contractor Assigned f\hAPL& \^Ati^ii ^ Co\v\Ok^*Y^ 

Date started ^ ^/C ^ '2c>/0 

Weather/temp C^ 1 

Date ended ^ - /j ^ - 2^/C^ 

Paint used ^ q A-L Tf t / Ivy 

Prime used /0^.4^0 

Poly used / ^ 

Problems/Issues 

^hin^^it^ 5^*^^]^ <^q(>^/ bgic^ 5ioaf>^ "^/^^ 
CONSENJmXT FOFORR ACCES ACCESSS TTOO PROra] PROPERTY 

OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID: ^'b^^* l PROPER!rv ADDRESS: 2S ^ S< 

OWNER NAME: /> . , 

DAYTIME PHONE: _ 

CELL PHONE: E-MAIL: 

OWNER'S ADDRESS IF DIFFERENT: 

TENANT'S NAME IF APPLICABLE: 

DAYTIME PHONE: _ 

CELL PHONE: E-MAIL: 

Professional Environmental Engineers, Inc. (PE) is under contract (#EP-R7-08-06) with the U.S. Environmental Protection 

Agency (EPA) to stabilize lead based paint (LBP) on residential structures at a number of properties located in Omaha, 

Nebraska. The paint stabilization work is being done to protect the soil cleanups that are being performed by EPA contractors. 

Paint stabilization activities will include: scraping of cracked or flaking LBP from structures, application of a prime coat and two 

(2) coats of paint. Moving parts of windows and doors are not included and wi|l not be addressed. 

Your cooperation is requested in giving permission to this EPA contractor (PE) to enter and have access to this property for the 

purpose of stabilizing lead -based paint as outlined on the property identified above. 

By signing this document I agree to allow an EPA contractor to conduct a soil cleanup at my property following completion of 

lead-based paint stabilization, if the soil cleanup has not already been performed. I understand that the stabilization contractor 

can not provide assurances that the soil cleanup contractor will be bound to. I further understand that the soil cleanup 

contractor will make all reasonable efforts to address concerns that I, as the property owner, may have regarding soil cleanup at 

my propertyYes, I have read and underetand the paragraph above. 3-3h ID 

( y Signature of Property Owner Date 

I fully understand that by signing this Consent for Access, (1) this access will remain in effect until the work has been 

satisfactorily completed, (2) that the Property Owner or Tenant, if applicable, will be given the Housing and Urban Development 

(HUD) and EPA pamphlet, "Renovate Right, Important Lead Hazard information for Families, Day Care Providers, and 

Schools", (3) the Property Owner or tenant will remove all obstructions from surfaces to be painted, (4) will abide by health and 

safety guidance provided by EPA, (5) will allow photography of property before and after the paint stabilization work, (6) will be 

contacted by a PE representative approximately 48 hours in advance of starting work, (7) agree not to obstruct or tamper with 

any of the LBP stabilization actions, and (8) will participate in final property inspection and sign the Completion Agreement and 

Property Owner Satisfaction Survey. 

Should you have any questions about the planed Lead Based-Paint stabilization activities for your property, please contact 

Professional Environmental Engineers, Inc. Project Manager, Willie Clay At 402-504-4688. General questions about the Omaha 

Lead Site cleanup can be directed to Pauletta France-lsetts, EPA Remedial Project Manager 402-731-2454, or the EPA Public 

Information Centers at 402-991-9583 (North Omaha office) or 402-731-3045 (South Omaha office). 

'Yes, I grant access to my property and was given the pamphlet D No, I do not grant access to my property and I was 

"Renovate Right, Important l.ead Information for Families, Child given the pamphlet "Renovate Right, Important Lead 

Care Provldere, and Schools." Information for Families, Childe Care Provldere, and Schools.' 

(ALK^ 3(h^\-tO 

Signarure Date Signature Date 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

PROPERTY ADDRESS: "Sff/g- M l9^/':?M(Lr. U* DATE: ^"^^^^t O 

BVID: 3 3 5 5 ^ 

AREA(S) TO BE PAINTED: 

HOUSE PROPER: _ COLOR: 

HOUSE TRinA: COLOR: ^LO ^D-7? V 

GARAGE: _ COLOR: i^^tlrh 

GARAGE TRIM: _ COLOR: fjoWi^_ 

PORCH: _ COLOR:. 

PORCH TRIM: _ COLOR:. <bc-0 -7^-Z 3 

(COMPLETE ALL SECTION, YES, NO, OR NON-APPLICABLE) 

I AGREE TO THE COLORS LISTED ABOVE. ONCE THE PAINTING 

BEGINS. I UNDERSTAND I CAN NOT CHANGE THE ABOVE SELECTED COLORS: 

PROPERTY OWNER SIGNATURE: PE ACCESOR SIGNATURE: 

K 
PRE-BNOVATION FORM - OCCURNT 

This form is to be used by thefirms contracted by the Environmental Protection Agency-Region 7 to perform Lead-Based 

Paint stabilization activities at the Omaha Lead Site, Omaha, Nebraska. 

Occupant Confirmation 

Pamphlet Receipt 

D I have received a copy of the lead hazard information pamphlet. Renovate Right: Important Lead Hazard Information for 

Families, Child Care Providers and Schools, informing me of the potential risk of the lead hazard exposure from renovation 

activity to be performed in/on my dwelling unit. 1 received this pamphlet before the work began. 

Occupant Opt-out Acknowledgment 

D(A) I confirm that I own and live in this property, that no child under the age of 6 resides here, that no pregnant woman 

resides here, and that this property is not a child-occupied facility. 

Note: A child resides in the primary residence of his/her custodial parents, legal guardians, foster parents, or 

informal caretaker if the child lives and sleeps most of time at the caretaker's residence. 

Note: A child-occupied facility is a pre-1978 building visited regularly by the same child, under 6 years of age, on at 

least two different days within any week, for at least 3 hours each day, provided that the visits total at least 60 hours 

annually. 

D (B) I understand that the renovationfirm, contracted by the Environmental Protection Agency (EPA), will be using leadsafe work practices required by EPA's Renovation, Repair and Painting Rule. 

Printed Name of Occupant 

Signature of Occupant Date 

Renovator*s Self-Certification Option (for tenant-occupied dwellings only) 

Instruction to Renovator: If the lead hazard information pamphlet was delivered to the owner but a tenant signature was not 

obtainable, you may check the appropriate box below. 

• Declined - 1 certify that I have made a good faith offer to deliver the lead hazard information pamphlet to the rental 

dwelling unit listed below at the date and time indicated and that the occupant declined to sign the confinnation of receipt. I 

further certify that I have left a copy of the pamphlet at the unit with the occupant. 

D Unavailable for signature - 1 certify that I have made a good faith effort to deliver the lead hazard information pamphlet 

to the rental dwelling unit listed below and that the occupant was unavailable to sign the confirmation receipt. I further 

certify that I have left a copy of the pamphlet at the unit by sliding it under the door or by (fill in how pamphlet was left) 

2e^ Ps^ Sv^^^^cM 

Printed Name ofi Person Certi^ng Delivery Attempted Delivery Time 

Signature of PerHpn Certifying Lead Pamphlet Delivery Date 

Unit Address 
 -- -~~ ~ -~~~ 

Douglas County Account Information Page 1 of 2 

NEW Feature - Parcel Dimensions avallable @ scale 0-50R went of 52nd St - View On Map is valid as of 2010-3-16 / Treasurer's Tax Report i 

I ! New Feature -) -) + Auto Sales Search 1 I ..... .............. ---- ~~ ~~ ~~ ~ ~~ 

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OMAHA NE 681 10-0000 . -~--~ 

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Property Information ~- ~ 

Key Number: ' 0092 0000 07 . ..... &-- - -- - -

Account Type: Residential .......... ............. 


MAHA NE 681 10-0000 

DLOT4 BLOCK6S40FT40X120 

-

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Value Information - -- ~- - ~ 

. .. 

: Land Improvement Total 

I 

I Land Information 

L. -, .---- - .., ...... ~~~ ~ ~~ ~~ ~ ~ ~ ~ 

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Acres 1 SF Units Depth Width Vacant ~~ ..~.4. ~ I ~ ~~ ~ -. 0.11 4800.0 0.0 0.0 No C ~- ~~ ~ ......... . ~- ~ - ... 

j Improvement Information 

L~I.~~"ildin~1 

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Douglas County Account Information Page 2 of2 

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CLICK TO ENLARGE IMAGE 

Square Footage: ! 884.0 

Perimeter 0.0 

Unit Type: 

Built As: 1 1/2 Story Fin 

HVAC: Forced Air 

Exterior: Frame Siding 

Interior: Drywall 

Roof Cover: Composition Shingle 

Roof Type: Gable 

Floorcover: Allowance 

Year Percent Year Built Remodeled Remodeled 

1920 0% 

Oeta/7 Type Detail Description 

Appliance Allowance 

Basement Bsmnt Block 8 ft 

Fixture Base Fixtures 

Fixture Bath Full 

Garage Detached 

Porch End Screen 

SET v-AJlAjC 

JMSOFT 

fwiXHotr 

BUO' 

1 M21m 1 £«CI WiWt 

It I Mi r 

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CLICK TO ENLARGE IMAGE 

Percent Complete: 100.0% 

Quality: Fair 

Condition: ; Average 

Condo Square Footage: 0.0 

Rooms: 6.0 

Units: 1.0 

Baths: 1.0 

Bedrooms: 3.0 

Stories: 1.5 

Foundation: Block 

Sprinkler Square Footage: 0.0 

Adjusted Year 

Bum Physical Age 

1920 89 

Units 

1.0 

884.0 

1.0 

288.0 

176.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R07... 3/29/2010 
(effective April 2010) 

RENOVATION RECORDKEEPING CHECKLIST 

Name of Firm: f\D^rk S ^/ \ [ i^^/AJ ^ 

Date and Location of Renovation: /f/Q/^>C-^ / ^ LOt ^ 

Brief Description of Renovation: '^CtJA-fi'ic^, PlTit^i-d, (^.M>5/>- ^ 

Name of Assigned Renovator: ^_3A/-<. A<fA-^<^ 

Name(s) of Trained Workers: /^/!^e*ui ^AT'TU^ ^A-f^^^ G^o''^-2^/f2<^ 

Name of Dust Sampling Technician, Inspector, and/or Risk Assessor, if used: _ 

n Copies of renovator and dust sampling technician qualifications (training certificates, certifications) on file. 

D Certified renovator provided training to workers on (check all that apply): 

D Posting warning signs D Setting up plastic contairmient barriers 

D Maintaining contairmient D Avoiding spread ofdust to adjacent areas 

D Waste handling D Post-renovation cleaning 

D Test kits used by certified renovator to determine whether lead was present on components affected by 

renovation (identify kits used and describe sampling locations and results: 

iS'^Waming signs posted at entrance to work area. 

Bwor k area contained to prevent spread ofdust and debris. 

^B^indows in and within 20 feet of the work area are closed 

B^oors in and within 20 feet of the work areas are closed and sealed 

O^EJoors that must be used in the work area are covered to allow passage but prevent spread of dust. 

J^^jround covered by plastic sheeting extending 10 feet from work area - plastic anchored to the 

building and weighted down by heavy objects. 

D If necessary, vertical containment installed to prevent migration ofdust and debris to adjacent 

property. 

n Waste contained on-site and while being transported off-site. 

Renovation Recordkeeping Checklist Omaha Lead Site 
(effective April 2010) 

Swor k site properly cleaned after renovation. 

ffl^ll chips and debris picked up, protective sheeting misted, folded dirty side inward, and taped for 

removal. 

0^or k area HEPA vacuumed to get paint chips from ground surface, if necessary. 

D Certified renovator performed post-renovation cleaning verification (describe results): 

^/i/£. A^/^^^^ 

B'^ertify under penalty of law that the above information is true and complete. 

/u/^o/o 

Name and Title Date 

Renovation Recordkeeping Checklist Omaha Lead Site