TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: ZCQ ^ Date: .S^/ ^ -ZO/ Q 

Address: 4^=g 4 ,^ . /8 ^ .<<{7 

Stabilizatioii Contnctor: Professional Environmental Engineers Year: 2010_ 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video ofproperty (DVD) 

Executive Summary 

X Signed Access Agreement for subject property 

Pre-Renovation Form signed by Property Owner 

D Pre-Renovation Form for Occupant/Tenant, if applicable 

Painting Agreement 

J " 

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

X 

D 

Renovation Recordkeeping Checklist signed by Certified Renovator 

Photographs pp ^ an d a\ ^ 

X Satis&ctory close-out check list signed by Property Owner 

X Property close-out check list signed by EPA 

Property information from Douglas County Assessor's OfBce 

; < 

Hazard analysis, if prepared D 

Safety Audit D 

Other (describe): D 

^^bimentu cngmfMBT Engmiieras Signatur Si e 

(afterfile folder review) 

30204095 

IHlHil 

Superfund 
2010 

PROFESSIONAL' 

2505 North 24«\ Suite 219 ENVIRONMENTAL ENGINEERS, INC. Oinaha.NE 68110 

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

Fax (402) 504-3281 

Consulting • Engineering Design • Remediation • At>atenieni • Emeigency Response 

EPA Close-Out Form 

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

SAID: 2£Ff) 

Property Address: 4S 3 •4- S . / 8 S i 

Owner's Name: \\/\dvC/\^ \JtJ(\ciO{t^ ^ 

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, ly ^ 

porches, box beams, columns, rails, and exterior surfaces of garages. 

2 y . Was all scraping and other preparation work completed satisfactorily? 

3. Were allrequired areas of the structure(s) primed as needed and painted with two top coats? 

y 

4. Was the paint products utilized equivalent to a 25 year product/quality? 

y ' 

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

y ^ cleaned? 

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

-

1roadways, alleyvrays, public access areas and alsoremove any other generated debris? 

7. Is tfae grass area tfaat surrounds the structure(s) inreasonably good condition? 

y 

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

properly removed? y 

9. Is there any evidence ofproperty damage that was done by the contractor? Any property 

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

10. Has the property owner signed the completion form? 

- ^ 

11. Are there any property items that were temporarilyre-located by the contractor that need to 

b -e moved back? 

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

t y ^ unresolved? 

Other Considerations/Property Owner Discussions/Additional Work that is Required: 

• 

EPA COR Signature 

Date 
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 • Remedialion • Ab^ileroenl • Eiii(V'9eni;v Response 

Property Owner Close-Out Form 

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

SAID: ?QPA 

Property Address: ii£Qd_2i_i2L ^ 

Owner's Name: -mm \!(U^y -

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? 

3. Were allrequiredareas of the structure(s) primed as needed and painted with 

two top coats? 

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? 

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 generated3debris debris?? 

7. Is the grass area that surrounds the structure(s) in reasonably good condition? 

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

barrier tape, etc. properly removed? 

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

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

10. Are there any property items that were temporarilyre-locatedby the contractor 

that need to be moved back? 

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

been left unresolved? 

Comments: 

0-/7~i^ 

Date 

A •^-/7-yr. ^ 

Professional Gnvtronmental Engineers Representative Date 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC.

"Providing cost-effective environmental solutions"

 ''° ' Trtlaht NE 68m 

 ^^^ jj^gj ^!j^ i 

Consulting • Engineering Design • Remedialion • Abalement • Emergency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

2010 

SAID#2059 

4534 S. 18 St 

• Dates worked: 05/17/10 to 05/17/10 

• Pre property condition: House has vinyl siding with painted wood trims that had 

flaking paint off on to the ground, front porch also poor. 

• Problems encountered: None. 

• Owner request/concerns: N/A 

• Inspection/closeout dates. Owner 05/25/10, inspected by PE project manager. 
SAID# 

Property Address 

Stories 

Garage? 

Access signed 

Pre-video 

Post video 

Contractor Assigned^ 

Date started 

Weather/temp 

Oate ended 

Paint used 

Prime used 

Poly used 

Tf'»w\ (mV 

EPA Paint Stabilization 2010 

L5 

J ^ 

5--Q5- 2b\0 

S>\4-^^l^ 

5-18-ZPlQ 

MC ^vvipe ^ 

f>M7liO 

n^ 

e.f mo , 

Problems/issues 
05/14/2tt0 08:36 #577 P.001/003 From: 

CONSENT FOR ACCESS TO PROPERTY 


OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID: ^^Qo* ^ PROPERTY ADDRESS: ^^f^-f !S ­. I& ^ S^ 

OWNERNAME: , , . . ^ 

y\/|^r.^ \lrx\aM'^. DAYTIME PHONE: 

E-MAIL: 

CELLPHONE: ~lCf \ JfOr^rl-l' 

OWNER'S ADDRESS IF DIFFERENT: . 

TENANT'S NAME ff APPLICABLE: 

nnr--liin DAYTIME PHONE: If/mih^z- CELLPHONE .ic^-\o%^. E-MAIL: 

Profenlonal Environmental Engineen, Inc. (PE) it under contract (#EP-R7-08.4)6) with the U.S. EnvlronnenttI Protection 

Agency (EPA) to ttabilize lend bated paint (LBP) on residential itructurei at a aunber of properties located in Omaha, 

Nebnuka. The paint stabllliation worl( it being done to protect the soli cleanups that are being performed by EPA contractors. 

Paiat stabiltatation activities will include: tcraping of cracked or flaking LBP from ttnictures. application of a prime coat and two 

(2) coats of paint Moving parts of windows and doors arcnyt included and will not be addressed. 

Your cooperation is requested in giving permiuion to thb EPA contractor (PE) to enter and have to thb property fbr the 

purpose ofstabilldng lead -based paint as outlined on the property identlfled above. 

By signing thb document I agree to allow an EPA contractor to conduct a soil cleanup at my propertyfollowing completion of 

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

can not provUe auuranees that the soil cleanup contractor will be bound to. I further understand that the soil cleaaup 

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

my property. 

DYSS, ! id thsjpnMiaph aliovs. 5hL I O 

SI|a«ino(Piap««( Ms 

1 fully understand that by signing thb Consent for Access, (i) thb access will remain in effect until the work hat been 

satbfactorily completed, 9 ) that the Property Owner or Tenant, if applicable, wUI be given the Housing and Urban Development 

(HUD) and EPA pamphbt, "Renovate Right. Important Lead Haxard information far Fknllba, Day Care ProvUers, and 

Schoob", (3) tbe Property Owner or tenant will remove all obstructions from surhccs to be palntml, (4) wiU abide by health and 

nfety guUance providedfay EPA, (5) wiU iltow photography of property before aad after the palat stabUtaMlon work, (6) wUI be 

contacted by a PB repnaentativc approiimately 4S houn in advance of starting worit, (7) agree not to obstract or tamper with 

any of the LBP ttabllliatlon actions, and (8) will participate bi fhial property inspection and sign tfae Cempletton Agreement and 

Property Owner Satbfiutkm Survey. 

ShonM yon have aay qneitloat about tfae planed Lead Based-Paint itabilbation activities for your property, please contact 

Profenlonal Environmental Engineers, Inc Project Manager, WiUie Clay At 4(0404-4688. General questions about the Omaha 

Lead She cleanup can be directed to Pauletta France-lsetts, EPA Remedial Project Manager 402r73l-24S4, or the EPA Public 

Infonnation Centers at 402-991-9S83 (North Omaha office) or 402-731-3045 (South Omaha offlce). 

 YeSilgnntaocsastoiivprapeitirandiMsgiMnthspsfflphtat D lto,ldonatarantieceietomypnparfysndlwas 

•RBnonta RVi ^ fanpertnlLBad bibmHlon fBrFaniite, Child gbMHw puiphM-RmamtaMght hnportntlMd 

wore MUVNIMI, i m oUHIWi. MDnMUontor Famlltaa, ChlMe Cm PrevUm, and Schoob." 

DMe Slonsture Date 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 

0
05/14/2fii 1 2 ^ p 08:36 #577 P.002/003 
 From: 


PAJNT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

PROPERTY ADDRESS:. A-'rM JS> i r sv _DATE : 5-5-10 

BVID:_ 

AREA(S) TO BE PAINTED: 

HOUSE PROPER:_: m COLOR: ^\Y:V \ 

L lom T X HOUSETRIIW: ^\'^ ^ ^ V(Vi\m Q C1f\nC\YCAbLOR:_

i^yyyyyyiyz^ yyxnr) L. 

GARAGE: .TjJ ^ '. COLOR: 

GARAGE TRIM m. COLOR: 

PORCH: £ ^ COLOR: z. JZ. PORCH TRIM: m. COLOR: 

(COMPLETE ALL SECTION. YES. NO. OR NON-APPUCABLE) 

I AGREE TO THE COLORS USTED ABOVE. ONCE THE PAINTING 


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

From: .^^ 05/14/2fil0 08:37 fbl l P.003/003 f 

PRE-RENOVATION FORM - OCCUPANT 

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

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

Occupant Confirmation 

Pamphlet Receipt 

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

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

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

Occupant Opt-out Acknowledgment 

D(A) I conflnn 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 primaiy 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. 

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

KlacVixr. ^Q-^v.-^w-? 

Printed lilame of Occupant 

_tfiAjJ y,mjA. 6 S^'C^ 

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. 

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

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

fiirther certify that 1 have left a copy of die pamphlet at die unit widi the occupant. 

O Unavailable fbr signature - 1 certify that I have made a good faith effort to deliver the lead hazard infiumadoa pamphlet 

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

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

A<:x<W'^a Rar^-vlrt-^^ 4-fZ-/ 6 

Printed Name of Person Certifying Deliveiy Attempted Delivery Time 

Signature of Person Certifying Lead Pamphlet Deliveiy Date 

Unit Address 
Douglas County Account Information Page 1 of3 

^OS^ 

Douglas County, Nebraska Property Record - R1755610000 

Print Report 

View Interactive GIS Map Information is valid as of 2010-4-16 Treasurer's Tax Report 

New Feature - • • • -> Subdivision Sales Search 

Owner 

VALADEZ MARIA 

2710 ALBERTA AVE 

BELLEVUE NE 68147-0000 ^^ ^ VGOP^^S 

Property Informatio n 

Key Number: 5561 0000 17 \ r^(y ^ ^ ^ 0%>' ^ 

Account Type: Residentiai 

Parcel Number 1755610000 ^ 

Parcel Address: [4534 S 18 Sl l 

OMAHANE 68107-0000 

Legal Description: MISSOURI AVE PARK LOT 9 BLOCK 1 40 X 130 

Value Informatio n 

Land Improvement Total 

2009 $5,800.00 $58,800.00 $64,600.00 

2008 $5,800.00 $58,800.00 $64,600.00 

2007 $5,800.00 $58,800.00 $64,600.00 

2006 $5,800.00 $50,500.00 $56,300.00 

2005 $5,800.00 $50,500.00 $56,300.00 

2004 $5,800.00 $50,500.00 $56,300.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.11 5200.0 1.0 130.0 40.0 No 

Improvemen t Infor mation 

Building 1 

http://douglasne.mapping-onIine.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17... 4/30/2010 
Douglas County Account Information 

Square Footage: 1412.0 

Perimeter 0.0 

Unit Type: 

Built As: "Tl72 Story Fin 

HVAC: Forced Air 

Exterior: Frame Vinyl 

Interior: Drywall 

Roof Cover: Composition Shingle 

Roof Type: Gambrei 

Floorcover: Allowance 

Year Percent Year Built Remodeled Remodeled 

1890 0% 

Detail Type Detail Description 

Add On Fence Chain Link 

Allowance 

Bsmnt Block 8 ft 

Base Fixtures 

FixtL' Bath Full t) PorcF Slab Roof Ceiling 

» 

HSt HSI 

Unity Park 

1 ISt 

Page 2 of3 

*SS<S1SST 

4«US4R^ 

latf id 

i t 

• as 

! 

M*.D3«n. ler 

1 1/2 Story 

BwMltockSIt I* or 

CLICK TO ENLARGE IMAGE 

Percent Complete: 100.0% 

Quality: Average 

Condition: Average 

Condo Square Footage: 0.0 

Rooms: 6.0 

Units: 1.0 

Baths: 1.0 

Bedrooms: 2.0 

Stories: 1.5 

Foundation: Block 

Sprinkler Square Footage: 0.0 

Adjusted Year Physical Age Built 

1890 120 

Units 

1.0 

1.0 

616.0 

1.0 

1.0 

108.0 

f " Map Satellite | Hybrid | Ten-ain | 

9 

V) S 

lurch' !' at 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17... 4/30/2010 

V 
(efTective April 2010) 

RENOVATION RECORDKEEPING CHECKLIST 

Name of Firm: \j[C <^^\(l' ^ 

Date and Location of Renovation: jDfl // j U 

Brief Description of Renovation: JWf ^ 9^Y)\\]tO;\\{^r ) 

Name of Assigned Renovator: CLY" \^\ i Q\l\ M Q Vli^ 

Name(s) of Trained Workers: )^\'^y£SIj ^ 

Name of Dust Sampling Technician, Inspector, and/or Risk Assessor, if used: Y\{Q 

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

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

1^ Posting waming signs R Setting up plastic containment barriers 

^ Maintaining contaiimient b^voiding spread ofdust to adjacent areas 

IS^ Waste handling QyPost-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: Yil^K 

G^ Waming signs posted at entrance to work area. 

IJ] Work area contained to prevent spread ofdust and debris. 

\ D Windows in and within 20 feet of the work area are closed 

-{^ Doors in and within 20 feet of the work areas are closed and sealed 

Q Doors that must be used in the work area are covered to allow passage but prevent spread ofdust. 

a Ground covered by plastic sheeting extending 10 feet from work area - plastic anchored to the 

building and weighted down by heavy objects. 

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

property. 

ni Waste contmned on-site and while being transported ofF-site. 

Renovation Recordkeeping Checldist Omaha Lead Site 
(effective April 2010) 

S^ Work site properly cleaned after renovation. 

KAI I chips and debris picked up, protective sheeting misted, folded dirty side inward, and taped for 

removal. 

(\Work area HEPA vacuumed to get paint chips from ground surface, if necessary. 

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

13 (/:ertiiy under penalty of law that the above infonnation is tme and complete. 

Name and Title Date 

Renovation Recordkeeping Checklist Omaha Lead Site