### TRANSMITTA L of OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R 

### SAI D

#: 3-^^S l Date : ^-||-ZD) 0 Address : ^^iP . t J • 1^ ^ ^-t&
- Stabilizatio n Contractor : Professiona l Environmenta l Engineer s Year : 2010_ PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S B ^ Vide o ofpropert y (DVD ) Sr

Executiv e Summar y ^r Signe d Acces s Agreemen t fo r

subject propert y D Pre-Renovatio n For msigned by Propert y Ovme r U ^ Pre-Renovatio n For mfo r

Occupant/Tenant , if applicabl e Sr Paintin g Agreemen t D Settlemen t document s (i.e. , fo r

damag e or to replac e plants , etc. ) B^ " Renovatio n Recordkeeping Checklis t signed by CertifiedRenovator 

## ffl^ Photograph s jymro . m A aPj ^ V^*"^'" ^ Satisfactor y close-ou t chec k

lis t signed by Propert y Ovme r D Propert y close-out chec k

lis t signed by EP A ^r Propert y information fi"om Dougla s Count y Assessor' s Office D Hazar d analysis , if prepare d D Safet y Audit 30204034
• 0«,er«.escHbe, : liilH i Superfun d 

# oA m Professiona l Env{fon^ne^;ita l Hngineer e Signatur e tDati Signatur e Ignatur ' Dat e (afte r file folde r review review ) ) \ae r

## PROFESSIONA L 250 5 Nort h 24 ^ Suit e 21 9 

## ENVIRONMENTA L ENGINEERS , INC . Omaha , N E 6811 0 (402 ) 504-468 8 "Providin g cost-effectiv e environmenta l solutions " Fa x (402 ) 504-328 1 Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc y Respons e 

### Propert y Owne r

Close-Out For m (Lead-Based Paint Stabilizatio n EP A Contrac t EP-R7-08-06 ) SAID : 

# 5 3 55 7 Propert y Address : f^^ / 8 " ^ / ^ ' Owner' s Name : (y ) f L hm
- A ^C^ ^ Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Was th e entir e structure(s ) painte d wit h th e exceptio n o f th e stated , exclude d areas ? Thi s would include paintin g o f othe r

associate dfeature s including fascia , eaves , siding , all trim , porches , bo x beams , columns , rails , an dexterior surface s o f garages . < 

### 2 . Was all scraping an d othe r

preparatio n wor k

complete dsatisfactorily ? 

## -4 ­ 3 . Wer e all require d area s o f th e structure(s ) primeda s neededan dpaintedwit h tw o to p coats ? • X , 4 . Wa s th e paint product s utilize d equivalen t t

o a3 0 yea r

product/quality ? 5 . Ar e all o f th e area s wher e contaminate dmaterial s hav e been spille d thoroughly ^ vacuumed/cleaned ? __js _ 6 . Did th e contractor collect/vacuumall falling an d scrapedpain t chip s on th e entir e property , roadways , alleyways , publi c acces s area s an dals o remove an y othe r

generate d debris ? ^ 

### 7 . I s th e gras s are atha t surround s th e structure(s ) mreasonabl y goodcondit i 8 . Ar e all item s suc h a s polyethylene sheeting , ladders , pain t brushes , cones , barrie r

tape , etc . properl y removed ? 

# X 9 . Istherean y evidenc e ofpropert y damag e tha t wa s don e by th e contractor ? An y . propert y damag e need s t o b e complete d prior t

o th e EP A Close-Out . ^ 1 10 . Ar e ther e an y propert y item s tha t wer e temporarily re-locate d b y th e contractor tha t need to b e moved back ? j ^ 11 . Ar e ther e an y (known) lingerin g issue s wit h th e propert y owner(s ) tha t hav e . bee n lef t unresolved ? / f Comments :



# U ) AV^./Qii^ ^ 4 - iS ' fe y Propert y Owne r

Signatur e 

# "^^ ^ 4 ^ Dat e Professiona l Environnrenta l Engineer s Representativ e Dat e250 5 Nort h 24'" , Suit e 21 9 Omaha , N E 6811 0 (402 ) 504-468 8 Fa x (402 ) 504-328 1 

## PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC . "Providin g cost-effectiv e environmenta l solutions " Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc y Respons e



### Lea d Bas e Stabilizatio n Omaha , Ne Clos e Ou t Repor t 201 0 SAID#3355 7 391 8 N 1 9 St .

•Date s worked : 04/15/1 0 t o 04/16/1 0 •Pr e propert y condition : Hous e an dgarag e hav e painte dwoo dan di n poo r condition , garag e pain t i s th e wors e an d i s flaldng of T ai l over th e yar dan d sidewalk . Prio r pain t splatter s o n sidewalks . • Problem s encountered : None • Owne r request/concerns : N/ A •Inspection/closeou t dates . Owne r signe d 04/15/10 , inspecte db y P E projec t manager .EP A Pain t Stabilizatio n 201 0 SAID # Propert y Addres s 

# i,<^\ % M v n ^ ^ i- 3 Storie s Garage ? 

# ^e s Accesssigne d O Q I H O Pre^We o ^-^'l O 

# 4-11.-1 0 Pos t vide o Contracto r Assigne d f\hAPL & \^Ati^ii ^ Co\v\Ok^*Y ^ Dat e starte d ^ ^/C ^

'2c>/ 0 Weather/tem p C ^

1 Dat e ende d ^ - /j ^ - 2^/C ^ Pain t use d ^ q A- L Tf t / Iv y Prim e use d /0^.4^ 0 Pol y use d / ^ Problems/Issue s 

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## Jm X PROra ] CONSEN T FO

FO R RACCES ACCES S S T T O O PROPERT Y OMAH A LEA D SIT E REMEDIA L ACTIO N - LEAD-BASE D PAIN T STABILIZATIO N PROPERT Y ID : ^'b^^* l PROPER ! rv ADDRESS : 2S ^ S< OWNE RNAME : /> . , DAYTIM E PHONE : _ CEL L PHONE : E-MAIL : OWNER' S ADDRES S IF DIFFERENT : TENANT' S NAM E IF APPLICABLE : DAYTIM E PHONE : _ CEL L PHONE : E-MAIL : Professiona l Environmenta l Engineers , Inc . (PE ) is unde rcontrac t (#EP-R7-08-06 ) wit h th e U.S . Environmenta l Protectio n Agenc y (EPA ) to stabiliz e lea d base d pain t (LBP ) on residentia l structure s at a numbe r of propertie s locate d in Omaha , Nebraska . Th e pain t stabilizatio n wor k is bein g don e to protec t th e soi l cleanup s tha t ar e bein g performe d by EP A contractors . Pain t stabilizatio n activitie s wil l include : scrapin g of cracke d orflakin g LB P fro m structures , applicatio n of a prim e coa t an d tw o (2 ) coat s of paint . Movin g part s of window s an d door s ar e no t include d an d wi| l no tbe addressed . You rcooperatio n is requeste d in givin g permissio n to thi s EP A contracto r(PE ) to ente ran d hav e acces s to thi s propert y fo rth e purpos e of stabilizin g lea d -base d pain t as outline d on th e propert y identifie d above . By signin g thi s documen t I agre e to allo w an EP A contracto r to conduc t a soi l cleanu p at my propert y followin g completio n of lead-base d pain t stabilization , if th e soi l cleanu p ha s no t alread y bee n performed . I understan d tha t th e stabilizatio n contracto r ca n no t provid e assurance s tha t th e soi l cleanu p contracto rwil l be boun d to . I furthe runderstan d tha t th e soi l cleanu p contracto rwil l mak e al l reasonabl e effort s to addres s concern s tha t I, as th e propert y owner , ma y hav e regardin g soi l cleanu p at my property Yes , I hav e rea d an d underetan d th e paragrap h above . 

# 3-3 h 

# ID ( y Signatur eo f Propert y Owne r Dat e I full y understan d tha t by signin g thi s Consen t fo rAccess , (1 ) thi s acces s wil l remai n in effec t unti l th e wor k ha s bee n satisfactoril y completed , (2 ) tha t th e Propert y Owne r orTenant , if applicable , wil l be give n th e Housin g an d Urba n Developmen t (HUD ) an d EP A pamphlet , "Renovat e Right , Importan t Lea d Hazar d informatio n fo rFamilies , Da y Car e Providers , an d Schools" , (3 ) th e Propert y Owne r ortenan t wil l remov e al l obstruction s fro m surface s tobe painted , (4 ) wil l abid e by healt h an d safet y guidanc e provide d by EPA , (5 ) wil l allo w photograph y of propert y befor e an d afte rth e pain t stabilizatio n work , (6 ) wil l be contacte d by a PE representativ e approximatel y 48 hour s in advanc e of startin g work , (7 ) agre e no t to obstruc t ortampe rwit h an y of th e LB P stabilizatio n actions , an d (8 ) wil l participat e in final propert y inspectio n an d sig n th e Completio n Agreemen t an d Propert y Owne rSatisfactio n Survey . Shoul d yo u hav e an y question s abou t th e plane d Lea d Based-Pain t stabilizatio n activitie s fo ryou rproperty , pleas e contac t Professiona l Environmenta l Engineers , Inc . Projec t Manager , Willi e Cla y At 402-504-4688 . Genera l question s abou t th e Omah a Lea d Sit e cleanu p ca n be directe d to Paulett a France-lsetts , EP A Remedia l Projec t Manage r402-731-2454 , orth e EP A Publi c Informatio n Center s at 402-991-958 3 (Nort h Omah a office ) or402-731-304 5 (Sout h Omah a office) .

'Yes , I gran t access to my propert y an d wa s give n th e pamphle t D No , I do no t gran t access to my propert y an d I wa s "Renovate Right , Importan t l.ea d Informatio n fo rFamilies , Chil d give n th e pamphle t "Renovate Right , Importan t Lea d Car e Provldere , an d Schools. " Informatio n fo rFamilies , Child e Car e Provldere , an d Schools. ' 

## (ALK ^ 3(h^\-t O Signarur e Dat e Signatur e Dat e SPECIA L INSTRUCTIONS AN D CONSIDERATION S

### PAIN T STABILIZATIO N PRE-PROPERT Y PAIN T MATC H ASSESSMEN T PROPERT Y ADDRESS : "Sff/g- M l9^/':?M(Lr . U * DATE : ^"^^^^t O BVID : 3 3 5 5 ^

AREA(S ) T O B E PAINTED : HOUS E PROPER : _ COLOR : HOUS E TRinA : COLOR : ^L O ^D-7? V
GARAGE :

_COLOR : 

# i^^tlr h
GARAG E TRIM :

_ COLOR : 

### fjoWi^ _ PORCH :

_COLOR: . PORC H TRIM :

_COLOR: . 

### <bc- 0 -7^-Z 3 (COMPLET E AL L SECTION , YES , NO , O R NON-APPLICABLE )


### I AGRE E T O TH E COLOR S LISTE D ABOVE . ONC E TH E PAINTIN G BEGINS . I UNDERSTAN D I CA N NO T CHANG E TH E ABOV E SELECTE D COLORS : PROPERT Y OWNE R SIGNATURE : P E ACCESO R SIGNATURE : 

# K

## PRE-BNOVATIO N FOR M - OCCURN T Thi s for mi s to b e use d b y th e firms contractedb y th e Environmenta l Protection Agency-Region 7 to perfor mLead-Based Pain t stabilizatio n activitie s a t the OmahaLea dSite , Omaha , Nebraska . Occupan t Confirmatio n Pamphle t Receip t D I hav e received acop y of th e lea dhazar dinformatio n pamphlet . Renovat e Right : Important Lead Hazar d Information fo r Families , Chil d Care Provider s an dSchools , informin g m e of th e potentia l risk of th e lea d hazar d exposur e fro mrenovatio n activit y to b e performe din/o n m y dwellin g unit . 1 received thi s pamphle t befor e the wor k

began . Occupan t Opt-ou t Acknowledgmen t D(A ) I confir mtha t I ow n an dliv e i n thi s property , tha t no chil d unde r the ag e of 6 reside s here , tha t n o pregnan t woma n reside s here , an d tha t thi s propert y i s no t achild-occupied facility . Note : A childreside s i n the primar y residenc e of his/he r custodia l parents , lega l guardians , foste r parents , or informa l caretake r i

f the chil dlive s an dsleep s most of tim e a t th e caretaker' s residence . Note : A child-occupie dfacilit y i s apre-197 8 building visite d regularly b y th e sam e child , unde r 6 year s of age , on a t leas t tw o differen t day s within an y week , fo r a

t leas t 3 hour s eac h day , provided tha t th e visit s tota l a t leas t 6 0 hour s annually . D (B ) I understand tha t th e renovation firm, contracted b y the Environmenta l Protection Agency (EPA) , will b e using lead
saf e wor k

practice s require db y EPA' s Renovation , Repai r an d Paintin g Rule . Printe d Nam e o f Occupan t Signatur e o f Occupan t Dat e Renovator* s Self-Certificatio n Optio n (fo r tenant-occupie d dwelling s only ) Instruction to Renovator : I f the lea dhazar dinformatio n pamphle t wa s delivere d t o th e owne r but atenant signatur e wa s no t obtainable , yo u ma y chec k

th e appropriat e box below . • Declined - 1 certif y tha tI hav e mad e agoodfait h offe r t

o delive r th e lea d hazar d information pamphle t to the renta l dwelling unit listed below a t th e dat e an dtim e indicated an d tha t th e occupan t declined to sign th e confinnatio n o f receipt . I furthe r certif y tha t I hav e lef t acop y of th e pamphle t a

t th e uni t wit h the occupant . D Unavailabl e fo r signatur e - 1 certif y tha t I have mad e agood fait h effor t t o delive r th e lea dhazar dinformation pamphlet t o th e renta l dwelling uni t liste dbelo w an dtha t th e occupan t wa s unavailabl e t o sig n th e confirmation receipt . I furthe r certif y tha t I have lef t acop y o f th e pamphle t a

t the uni t b

y slidin g i t unde r th e doo r or b

y (fil l i

n ho w pamphle t wa s left ) 

# 2e ^ Ps ^ Sv^^^^c M PrintedNam e of i Perso n Certi^n g Deliver y AttemptedDeliver y Tim e Signatur e o f PerHp n Certifyin g Lea dPamphle t Deliver y Dat e Uni t Addres s

## - -- -~~ -~~ ~ ~ Douglas County Account Information Page 1 of 

### 2

NEW Feature - Parcel Dimensions avallable @ scale 0-50 R went of 52nd St 

### - View On Map is valid as of 201 0-3-16 

# / Treasurer's Tax Report 

# i I ! New Feature -) -) 

### + Auto Sales Search 

# 1 I

..... .............. ---- ~- 

# -

~~ ~~ ~~ ~ ~~ ~ pwner

-- i ALLEN WILMA i ! 

# ! 3918N 19ST 

### ! OMAHA NE 681 10-0000 I

. -~- -~ 

# C-~ ~~ ~

I--~ Property Information

~- ~

Key Number: ' 0092 0000 07

. ..... &

-- - -- - - Account Type: Residential

.......... ............. MAHA NE 681 10-0000 DLOT4 BLOCK6S40FT40X120

- Value Information



### -
- -- ~- - ~ . .. 

## : Land Improvement Total

I I Land Information L
. - , .---- 

### - .., ...... ~~~ ~ ~~ ~~ ~ ~ ~ ~

~ ~ ~~ , - Acres 1 SF Units Depth Width Vacant

~~ ~ ..~. 4.

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# I -. 0.11 4800.0 0.0 0.0 No C ~- ~~ ~ ......... . ~- ~ - ... j Improvement Information L~ 

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~ ~ ~Dougla s Count y Accoun t Informatio n Pag e 2 of 2

UmilHWIIIWHIIIIIIli l CLIC KT O ENLARG E IMAG E Squar e Footage : ! 884. 0 Perimete r 0. 0 Uni t Type :

Buil t As : 1 1/ 2 Stor y Fi n HVAC : Force d Ai r Exterior : Fram e Sidin g Interior : Drywal l Roo f Cover : Compositio n Shingl e

Roo f Type : Gabl e Floorcover : Allowanc e Yea r Percen t Yea rBuil t Remodele d Remodele d 192 0 0 % Oeta/ 7 Typ e Detai l Descriptio n Applianc e Allowanc e Basemen t Bsmn t Bloc k 8 f t Fixtur e Bas e Fixture s Fixtur e Bat h Ful l Garag e Detache d Porc h En d Scree n SE T v-AJlAj C JMSOF T fwiXHot r BUO '

1 M21 m 1 £«C I WiW t I t I Mi r L _.i M CLIC KT O ENLARG E IMAG E Percen t Complete : 100.0 % Quality : Fai r Condition : ; Averag e Cond o Squar e Footage : 0. 0 Rooms : 6. 0

Units : 1. 0 Baths : 1. 0 Bedrooms : 3. 0 Stories : 1. 5 Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Adjuste d Yea r Bu m Physica l Ag e 192 0 8 9 Unit s 1. 0 884. 0 1. 0 288. 0 176. 0

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R07. . . 3/29/201 0(effectiv e Apri l 2010 ) 

### RENOVATIO N RECORDKEEPIN G CHECKLIS T Nam e of Firm : f\D^rk S ^/ \[ i^^/AJ ^ Dat e an d Locatio n o f Renovation : /f/Q/^>C- ^ / ^ LO t ^ Brief Descriptio n of Renovation : '^CtJA-fi'ic^ , PlTit^i-d , (^.M>5/>- ^ 

### Nam e of Assigned Renovator : ^_3A/-< . 

### A<fA-^< ^ Name(s ) o f Traine d Workers : /^/!^e*u i ^AT'TU ^ 

### ^A-f^^ ^ G^o''^-2^/f2< ^ Nam e of Dus t Sampling Technician , Inspector , and/or Risk Assessor , i f used : _
n Copie s o f renovator an d dus t sampling technicia n qualification s (trainin g certificates , certifications ) on file. D Certified renovator provide d trainin g t o worker s on (chec k

all tha t apply) : D Postin g warning sign s D Settin g up plasti c contairmien t barrier s D Maintainin g contairmien t D Avoidin g sprea dofdus t to adjacen t area s D Wast e handlin g D Post-renovatio n cleaning D Tes t kit s use d b y certified renovator to determin e whethe r

lea dwa s presen t o

n component s affecte dby renovation (identif y kit s use d an d describ e samplin g location s an dresults : iS'^Waming sign s poste d a t entranc e t o wor k

area . Bwork are acontaine d to preven t sprea d ofdus t an ddebris . ^B^indow s i n an d within 2 0 fee t of th e wor k

are aar e closed B^oor s in an d withi n 2 0 fee t of th e wor k

area s ar e closedan dseale d O^EJoor s tha t mus t b e use d i n th e wor k

are aar e coveredt o allo w passag e but preven t sprea d of dust . J^^jroun d covered b y plasti c sheeting extending 1 0 fee t fromwor k

are a- plasti c anchore dto th e buildin g an d weighted down b y heav y objects . D I f

necessary , vertica l containmen t installe dt o preven t migratio n ofdus t an ddebri s to adjacen t property . n Wast e contained on-sit e an d while being transporte doff-site .

Renovatio n Recordkeepin g Checklis t Omah a Lea d Sit e(effectiv e Apri l 2010 )


### Swork sit e properl y cleane d afte r

renovation . ffl^ll chip s an d debri s picked up , protectiv e sheeting misted , folde ddirt y side inward , an dtaped fo r removal . 0^ork are aHEP A vacuumed t o ge t pain t chip s fro mgroun dsurface , i f necessary . D Certified renovator performed post-renovatio n cleaning verification (describ e results) : 

### ^/i/£ . A^/^^^ ^ B'^ertif y unde r

penalt y o f

la

w tha t th e abov e informatio n i s tru e an dcomplete . 

## /u/^o/ o Nam e an d Titl e Dat e

Renovatio n Recordkeepin g Checklis t Omah a Lea d Sit e