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

## SAID# : 315^ 4 Date : ^^ l l^^TjOlJ ^ Address : ^^\ ^ N1 . \/O ^ ^ ^ 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 of propert y (DVD ) B Executiv e Summar y E^'^ ^ Signed Acces s Agreemen t fo r

subject propert y D Pre-Renovatio n For msignedb y Propert y Owne r B^*^ ^ Pre-Renovatio n For mfo r

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

damag e o r

to replac e plants , etc. ) \E

r

Renovatio n Recordkeeping Checklis t signedb y CertifiedRenovator B ^ Photograph s A^/v ^ OA A ^pjf ^ [fe

^ Satisfactor y close-ou t chec k lis t signe d b y Propert y Owne r D Propert y close-ou t chec k lis t signe d b y EP A ^ r

Propert y informatio n firomDougla s Count y Assessor' s Offic e D Hazar danalysis , i f prepare d 

# 0 r::i. ^ m S

Professiona l Environmenta l Engineer s Signatur e
(afte r file folde r review )

## ^ PROFESSIONA L SC O S.Ewlng , Suit e E 

## ENVIRONMENTA L ENGINEERS , INC
. St
. Louis , MO 6310 3 (314)531-006 0 

### • ^ "Providin g cost-effectiv e environmenta l solutions " Fa x (314 ) 531-006 8 Consultin g • Engineerin g Desig n • Remedialio n • Abatemen t • Emergenc y Respons e 

### 201 0 

### Propert y Owne r

Close-Out For m (Lead-BasedPain t Stabilizatio n EP A Contract EP-R7-08-06 ) 

### SAID : 0\ 0 0 ^ Propert y Address^^^\ ^ \ 0 \C 0 "^ ^ Owner' s Name : ^\(^^3C\\C K AO . \C X ^O^ ^ Performanc e Standards/Close-Ou t Criteri a YE S NO 1. Was th e entir e structure(s ) painte d wit h th e exceptio n of th e stated , exclude dareas ? Thi s wouldinclude paintin gof othe r

associate d feature s including fascia , eaves , siding , al l trim , porches , box beams , columns , rails , an dexterior surface sof garages . 

# X 2. Wa s all scraping an dothe r

preparatio n wor k

complete dsatisfactorily ? 

# X 3. Wer e all require darea sof th e structure(s ) prime d as neededan dpainte dwit h tw o to p coats ? 

# y. 4. Was th e paint product s utilize dequivalen t to a 25 yea r

product/quality ? 5. Ar e all of th e area s wher e contaminate dmaterial s hav e been spille dthoroughly vacuumed / cleaned ? 

# X 6. Did th e contractor collect/vacuumal l falling an d scrapedpain t chip son th e entir e property , roadways , alleyways , publi c acces s area s an dals o remove an y othe r

generate d 

# X debris ? 7. Is the gras s are atha t surround s th e structure(s )in reasonabl y goodcondition ? 

# X 8. Ar e all item s such as polyethylene sheeting , ladders , pain t brushes , cones , barrie r

tape , etc . properl y removed ? 

# X 9. Is ther e an 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 to be complete dprior to th e EP A Close-Out . 10 . Ar e yo u satisfiedwit h th e wor k

performed ? 11 . Ar e ther e an y propert y item s tha t wer e temporarily re-locate d by th e contractor tha t need to be moved back ? 12 . Ar e ther e an y (knovm ) lingerin g issue s wit h th e propert y owner(s ) tha t hav e been lef t imresolved ? Othe r

Considerations/Propert y Owne r

Discussions/Additiona l Wor k

tha t is Required : 

# ^\^m\ ) Propert Signatur e ipert y y Owne

Owne r r

Si^iatu r Dat e
Professiona l Environmenml-Engineers Signatur 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 ResfTons e



### Lea dBas e Stabilizatio n Omaha , N e Clos e Ou t Repor t 201 0 SAID#3135 4 331 5 N . 1 6 S t

•Date s worked : 04/14/1 0 t o 04/16/1 0 •Pr e propert y condition : Hous e ha s woo dsidin g wit h pain t in very poo r condition . Pain t wa s flaking of f

al l over . Hous e ha s broke n windo w in th e back . • Problem s encountered : Non e •Owne r request/concerns : Colo r changes . •Inspection/closeou t dates . Owne r signe d04/20/10 , inspecte db y P E projec t manager .EP A Pain t Stabilizatio n 201 0 SAID # 

# S1SS 4 Propert y Addres s 

# 331 5 K1 . II# ^ c5{red " Storie s 

# 2

- Garage ? 

# K S Acces s signe d 

# 4-\^-^0\ 6 4-/5'ZO/ 0 Pre-vide o 

# 4-2i-2ot o Pos t vide o Contracto rAssigne d y\ L j l&CV / ^CQS i Dat e starte d 

# m^ii o Weather/tem p 

# I D ^ Dat e ende d Pain t use d 

# XQ(y \

rn^ff i ?)(y\ OiA( ^ Prim e use d Poi y use d 

# ito L Problems/Issue s

## CONS]J^ r FO RACCES S T O PROWRT Y m ] OMAHA LEA D SIT E REMEDIA L ACTIO N - LEAD-BASE D PAIN T STABILIZATIO N PROPERT Y I D 

### 3fi^j\PROPERT Y ADDRESS ; "btSx P W \ 0 trS\ ' OWN E ERNAME : i , ^r p 

### DAYTIM E PHONE;>b\'Z' ' 0\?) 0 CEL L PHONE : E-MAIL : OWNER' S ADDRES S I F DIFFERENT : TENANT' S NAM E I F APPUCABLE : DAYTIM E PHONE : CELLPHONE : E-MAIL : Professiona l Environmenta l Engineers , Inc . (PE ) i s unde r contrac t (#EP-R7-08-06 ) wit h th e U.S . Environmenta l Protectio n Agenc y (EPA ) t o stabiliz e lea d base d pain t (LBP ) o n residentia l structure s a t anumbe r o f propertie s locate di n Omaha , Nebraska . Th e pain t stabilizatio n wor k i s bein g don e t o protec t th e soi l cleanup s tha t ar e bein g performe d b y EP A contractors . Pain t stabilizatio n activitie s wil l include : scrapin g o f cracke d o r flaldn g LB P fro mstructures , applicatio n o f aprim e coa t an d tw o (2 ) coat s o f paint . Movin g part s o f window s an d door s ar e no t include d an dwil l no t b e addressed . You r cooperatio n i s requeste di n givin g permissio n t o thi s EP A contracto r (PE ) t o ente r an d havi e acces s t o thi s propert y fo r th e purpos e o f stabilizin g lea d-base d pain t a s outline d o n th e propert y identifie dabove . B y signin g thi s documen t I agre e t o allo w a n EP A contracto r t o conduc t asoi l cleanu p a t my propert y followin g completio n o f lead-base d pain t stabilization , i f th e soi l cleanu p ha s no t alread y bee n performed . I understan dtha t th e stabilizatio n contracto r ca n no t provid e assurance s tha t th e soi l cleanu p contracto r wil l b e boun dto . I furthe r understan dtha t th e soi l cleanu p contracto r wil l mak e al l reasonabl e effort s t o addres s concern s tha t I , a s th e propert y owner , ma y hav e regardin g soi l cleanu p a t my property . HYes , I hav e rea d an d understan d th e paragrap h above
. • g?acy - Signatur e o f Propert y Ovme r Dat e I full y understan dtha t b y signin g thi s Consen t fo r Access , (1 ) thi s acces s wil l remai n i n effec t unti l th e wor k ha s bee n satisfactoril y completed , (2 ) tha t th e Propert y Owne r o r Tenant , i f applicable , will b e give n th e Housin g an d Urba n Developmen t (HUD ) an dEP A pamphlet , "Renovat e Right , Importan t Lea d Hazar d informatio n fo r Families , Da y Car e Providers , an d Schools" , (3 ) th e Propert y Owne r o r tenan t wil l remov e al l obstruction s fro msurface s t o b e painted , (4 ) will abid e b y healt h an d safet y guidanc e provide db y EPA , (5 ) will allo w photograph y o f propert y befor e an d afte r th e pain t stabilizatio n work , (6 ) will b e contacte d b y aP E representativ e approximatel y 4 8 hour s i n advanc e o f startin g work , (7 ) agre e no t t o obstruc t o r tampe r wit h an y o f th e LB P stabilizatio n actions , an d(8 ) wil l participat e i n final propert y inspectio n an d sig n th e Completio n Agreemen t an d Propert y Owne r Satisfactio n Survey . Shoul d yo u hav e an y question s abou t th e plane d Lea dBased-Pain t stabilizatio n activitie s fo r you r property , pleas e contac t Professiona l Environmenta l Engineers , Inc . Projec t Manager , Willi e Cla y A t 402-504-4688 . Genera l question s abou t th e Omah a Lea dSit e cleanu p ca n b e directe dt o Paulett aFrance-lsetts , EP A Remedia l Projec t Manage r 402-731-2454 , o r th e EP A Publi c Informatio n Center s a t 402-991-958 3 (Nort h Omah aoffice ) o r 402-731-304 5 (Sout h Omah aoffice) . '^Yes , I gran t acces s t o m y propeil y an d wa s give n th e pamphle t D No , I d o no t gran t acces s t o m y propert y an d I wa s "Renovat e Right , Importan t Lea d Informatio n forFamilies , Chil d give n th e pamphle t "Renovat e Right , Importan t Lea d Car e Providers , an d Schools. " Informatio n forFamilies , Child e Car e Providers , an d Schools. " signatur e Dat e Signatur e Dat e SPECIA L INSTRUCTION S AN D CONSIDERATION S

### PAIN T STABILIZATIO N PRE-PROPERT Y PAIN T MATC H ASSESSMEN T PROPERT Y ADDRES S 

# :^8\P) V \ln ^- V BVID :

AREA(S ) T O B E PAINTED :



# - R
. HOUS E PROPE R 

# : \\t S , ^ COLOR : 

# .^A . 

# ^oVcr^-u:>W^..? g HOUSE TRIM : y f ^ ^ 9 ^ 

### COLOR : VJ\^1W ^ i' S ^

GARAGE : .COLOR : (n?^ % ^ H 

# Ve^(-^A - GARAG E TRIIW : \K ^ \

^ / ^ 

### COLOR : U3h\U>,g^ ^
PORCH : ^J-eV ^ 5 / ^ COLOR :

PORC H TRIM : 

# N^ ^ 5 ^ COLOR : (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 : 

### Qj-rrk ^ 

## JJ P 

# M- ­

## PRE-^koVATIO N FOR M - OCC U Av T Thi s for mi s to b e use db y the firms contracte db y th e Environmenta l Protection Agency-Region 7 to perfor mLead-Based Pain t stabilization activitie s a t the OmahaLea dSite , Omaha , Nebrasica . Occupan t Confirmatio n Pamphle t Receip t D I hav e received acop y of the lea dhazar dinformatio n pamphlet , Renovat e Right : Importan d Lea d Hazar d Information fo r Families , Chil d Care Provider s an dSchools , informin g m e of the potentia l risk of th e lea d hazar d exposur e fixj mrenovation activit y to b e performe din/o n m y dwellin g unit . I received thi s pamphle t befor e the wor k

began . Occupan t Opt-ou t Acknowledgmen t n(A ) I confir mtha t I ow n an dlive i n thi s property , tha t no child unde r the ag e o f 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-occupie d facility . Note : A chil d reside s i n the primar y residenc e o f his/he r custodia l parents , lega l guardians , foste r parents , or informa l caretake r i

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

t least 3 hours eac h day , provided tha t th e visit s tota l a t least 6 0 hour s annually . H^B ) I understand tha t the renovation firm, contracte d b y the Environmenta l Protection Agency (EPA) , wil l b e using lead

saf e wor k

practice s requiredb y EPA' s Renovation , Repai r an d Painting Rule . Printe d Nam e o f Occupan t ignatur e o f Occupan t Dat e tenovator' s Self-Certificatio n Optio n (fo r tenant-occupie d dwelling s only ) struction to Renovator : I f the lea dhazar dinformatio n pamphle t was deliveredt o th e owne r bu t atenan t signatur e was no t sbtainable , yo u ma y check th e appropriat e bo x below . D Declined - 1 certif y tha t I have mad e agoodfait h offe r t

o delive r th e lea d hazar d informatio n pamphle t to th e renta l Iwellin g uni t listed below a t the dat e an dtim e indicated an d tha t the occupan t declined to sign th e confirmation o f receipt . I • urthe r certif y tha t 1 have lef t acop y o f the pamphle t a

t th e uni t wit h the occupant . E Unavailable fo r signatur e - 1 certif y tha t I have mad e agoo d fait h effor t to delive r the lea d hazar d informatio n pamphle t t o the renta l dwellin g uni t listedbelow an dtha t the occupan t was unavailable t o sig n the confirmation receipt . I furthe r certif y tha t 1 have lef t acop y o f the pamphle t a

t the uni t b

y sliding i t unde r th e doo r o

r b

y (fil l i n how pamphle t wa s left )

Printed Nam e o f Person Certifying Deliver y Attempted Deliver y Tim e Signatur e of Perso n Certifying Lea dPamphle t Deliver y Dat e Uni t Addres s

### -Dougla s Count y Accoun t Infomiation Pag e 1 of 3

' ' m [

# V 

# 5ibs q ' i Dougla s County , Nebrask a Propert y Recor d - R224909000 0 Prin t ReDort NE W Featur e - Parce l Dimension s availabl e m scal e 0-5 0 f t wes t o f 52n d S t • ViO W O H Ma O Informatio n i s vali d a s o f 2010-3-1 6 Treasurer' s Ta x Repor t Ne w Featur e -•-•- • Aut o Sale s Searc h Owne r D E L A ROS A SIDONI A 131 7 S 2 8 S T OMAH A N E 68105-000 0 Propert y Informatio n Ke y Numbe r 490 9 000 0 2 2

• - ~ Accoun t Type : Residentia l Parce l Number : 224909000 0 Parce l Address : 331 5 N 1 6 S T OMAH A N E 68110-000 0 Lega l Description : SULPHU R SPRIN G LO T 1 0 BLOC K2 52. 8 X 12 4 ' Valu e Informatio n 200 9 200 8 200 7 200 6 200 5 200 4 Lan d $2,600.0 0 $2,600.0 0 $2,600.0 0 $2,600.0 0 $2,600.0 0 $2,600.0 0 Im provemen t $43,000.0 0 $43,000.0 0 $46,700.0 0 $30,300.0 0 $30,300.0 0 $4,200.0 0 Tota l $45,600.0 0 $45,600.0 0 $49,300.0 0 $32,900.0 0 $32,900.0 0 $6,800.0 0 Sale s Informatio n Sale s Date : 2006-06-0 6 Dee d Type : Price : Granto r Grantee : Q C $33,000.0 0 Pete rT Grayso n Sidoni a d e l a Ros a Book : 200 6 Page : 06355 3

Valid/Invalid : Invali d Excl Reason : usio n No n Bon o wit h Do c S tamp s Sale s Date : 2004-09-0 4 Dee d Type : Price : Grantor : C O $6,800.0 0 Pete rT Grayso n Book : 200 4 Page : 11887 9

'•'• •



### http://douglasne.mapping-onIine.eom/DouglasCoNe/static/accountinfo.jsp?accountno=R22.. . 3/29/201 0Dougla s Count y Accoun t Informatio n Pag e 3 o f 3

331 5 N 1 6 S t TW O STOR Y
itai s

2Stoi y

CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : i 2014. 0 Percen t Complete : 100.0 % Perimete r0. 0 Quality : ; Fai r Uni t Type : Condition : Averag e

Buil t As : 2 Stor y Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 8. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 2. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Gabl e Stories : 2. 0 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 191 0 200 5 0 % 192 9 8 1 Detai l Typ e Defai V Descriptio n Unit s Applianc e Allowanc e 1.0 Basemen t Bsmn t Bloc k 8 f t 1058. 0 Basemen t Finishe d 1058. 0 Basemen t Outsid e Entranc e 1. 0 Fixtur e Additiona l Fixture s 1. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 2. 0 Garag e Detache d 360. 0 Porc h Sla b Roo f Ceilin g 96. 0

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R22. . . 3/30/201 0(effectiv e Apri l 2010 )



### Nam e o f Firm : MO . ^W\Cg % Dat e andLocatio n o f Renovation : ^ 1 l* ^ | \ v J Brief Descriptio n O f

Renovation : T) Q \(W p c4:0i^ ^ i 0!7 . CXA->( Q V A Nam e o f AssignedRenovator : ( V^\S>rV-\OvY~ \ Name(s ) o f Trained Workers : Nam e o f Dus t Sampling Technician , Inspector , and/or Risk Assessor , i f used : f > \Q y U Copie s o f renovator anddus t samplin g technicia n qualification s (trainin g certificates , certifications ) o n file.

' 3-Certifie drenovator provide dtrainin g to worker s on (check all tha t apply) : l>Postin g warnin g sign s XlSettin g u p plasti c containmen t barrier s Qltlaintainin g containmen t Ds^voidiii g sprea do f

dus t t o adjacen t area s ^b^ast e handlin g X f ost-renovatio n cleaning H Tes t kit s usedb y certifie drenovator t o determin e whethe r

lea dwa s presen t on component s affecte d b y renovation (identif y kit s usedan ddescrib e samplin g location s an d results : Y " ) ^
J Warnin g sign s poste da t entranc e t o wor k

area . 3^Wor k

are acontaine dt o preven t sprea dof dus t an ddebris . ^ Window s in andwithi n 2 0 fee t of th e wor k

are aar e closed ^Door s i n andwithi n 2 0 fee t o f th e wor k

area s are closedan dseale d IDiDoor s tha t mus t b e usedin th e wor k

are aare covere dto allo w passag e but prevent sprea dofdust . "Rproun dcovere db y plasti c sheetin g extendin g 1 0 fee t firomwor k

are a- plasti c anchore dto th e buildin g andweighte ddown by heav y objects . ^ If necessary , vertica l containmen t installe dt o preven t migratio n ofdus t and debri s t o adjacen t property . H Wast e containe don-site an dwhil e bein g transporte doff-site .

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

^ ' or k

sit e properl y cleane dafter renovation . D Al l chip s an ddebri s picke dup , protectiv e sheetin g misted , folde ddirt y sid e inward, an d tape d fo r removal . D Wor k

are aHEP A vacuume dt o ge t pain t chip s firomgroun dsurface , i f necessary . ^ H Certifie d renovato r performe dpost-renovatio n cleanin g verificatio n (describ e results) :

U I certi & unde r penalt y o f la w tha t th e above informatio n i s tru e an d complete . 

# ^feoii o Nam e an dTitl e Dat e

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