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

## SAID#: ZZS4 ^ Date : 7 j I j(f ) Address : 3S&( ^ ^/LJCXSO/ \

## SJVW T Remediatio n Contractor : PROFESSIONALENVIRONMENTA L ENGINEER S Year : 200 8 PAINT STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S B ^ Vide o o f propert y (DVD ) De(er£. . Oti^-^ r . . ; € r

Executiv e Summar y M Signe dAcces s Agreemen t fo r

subject propert y WPaintin g Agreemen t . . 0 Settlement document s (i.e. , fo r

damag e or t o replac e planfe , etc. ) Photograph s QJASJ C 

### W •- Satisfactor y restoratio n signedby Propert y Owne r ^ ^ Propert y close-out chec k

lis t signe db y EP A /dcT T ^ / < 5 X/^ D O r Oif ^ leM ^ Propert y information fromDougla s Count y Assessor' s Office 

## y ("^tS^rtAAityc reyy' l '^fii^n^/^LhL^la\A ' Uti X pa/Kpfik r 

# 7

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### D
Signatur e

4031636 3 Superfun d

## PROFESSIONA L 250 5 Noi1h24 % 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 " Fax(402 ) 504-328 1 Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yRespons e



### Lea dBas e Pain t Stabilizatio n Omaha , N e Clos e Ou t Repor t SAID#2254 4 356 6 Jackso n S t

•Date s worke d10/2 9 t o 11/0 2 200 8 •Owne r wante dsom e colo r change s that w e di dfor her , ther e wer e area s that ha dheav y caul k tha t coul dno t b e removed . Owne r followe dworker s aroun dtellin g the mwhat t o d o durin g th e paintin g process . After wor k

wa s complete downe r was dissatisfie dwithth e wor k

an d contractor s ha dt o g o bac k an dred o area s withasuperviso r watchin g t o pleas e th e owner .

• Inspecte d11/04 superviso r was ther e durin g completion . N o issue s

# 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 " Fax(402 ) 504-328 1 Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yResponse 

### Propert y Owne r Close-Ou t For m (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) SAID : 

# Z^SM M Property Address : ZS^( ^ Jc.c^Ls^ ^ Owner' s Name : ficLxr\&V^ lA^ ^ b j P_^ n Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) painte dwit h th e exceptio n o f th e stated , exclude d areas ? Thi s woul dinclud e paintin g o f othe r associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an dexterio r surface s o f 

# A garages . 2 . Wa s al l scrapin g an dothe r preparatio n wor k

complete dsatisfactorily ? 

# t 3 . Wer e al l require darea s o f th e structure(s ) prime da s neede dan dpainte dwit h tw o to p coats ? 

# K . 4 . Wa s th e pain t product s utilize dequivalen t t o a3 0 yea r product/quality ? 

# X 5 . Ar e al l o f th e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y vacuumed/ cleaned ? 

# J L 6 . Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s o n th e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e any othe r generate ddebris ? 

# K 7 . I s th e gras s are athat surround s th e structure(s ) i n reasonabl y goo dcondition ? 

# T 8 . Are al l item s suc ha s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . properl y removed ? 

# J C 9 . I s ther e any evidenc e o f property damag e that wa s don e b y th e contractor ? An y property damag e need s t o b e complete dprio r t o th e EP A Close-Out . 10 . Ar e ther e any property item s that wer e temporaril y re-locate db y th e contractor that nee dt o b e move dback ? 11 . Are ther e any (known ) lingerin g issue s withth e property owner(s ) that hav e bee n lef t unresolved ? Comments :

Professional Envipmmienta l Engineer s Representativ e

# 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 " Fax(402 ) 504-328 1 Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yRespons e 

### EP A Close-Ou t For m (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) 

# zz^q q SAID : Property Address : 

# 3SG G Tac^So n ^S ^ Owner' s Name : Vb^O\Q\C X ^^xbg^ P Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) painte dwithth e exceptio n o f th e stated , exclude d areas ? Thi s woul dinclud e paintin g o f othe r associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an dexterio r surface s o f garages . 2 . Wa s al l scrapin g an dothe r preparatio n wor k

complete dsatisfactorily ? 3 . Were al l require darea s o f th e structure(s ) prime da s neede dan dpainte dwith tw o to p coats ? 4 . Wa s th e pain t product s utilize dequivalen t t o a3 0 yea r product/quality ? 5 . Ar e al l o f th e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y vacuumed / cleaned ? 6 . Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s o n th e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e any othe r generate ddebris ? 7 . I s th e gras s are athat surround s th e structure(s ) i n reasonabl y goo dcondition ? 8 . Are al l item s suc ha s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . properl y removed ? 9 . I s ther e any evidenc e o f property damag e that wa s don e b y th e contractor ? Any property damag e need s t o b e complete dprio r t o th e EP A Close-Out . 10 . Ar e ther e any property item s that wer e temporaril y re-locate db y th e contracto r that nee dt o b e move dback ? 11 . Ar e ther e an y (known ) lingerin g issue s withth e property owner(s ) that hav e bee n lef t unresolved ? Other Considerations/Property Owne r Discussions/Additiona l Wor k

that i s Required :

EP A CO RSignatur e Dat e

# CONSEN T OF RACCES S T O PROPERT Y OMAHA LEA D SIT E REMEDIA LACTIO N - LEAD-BASED PAIN T STABILIZATIO N PROPERT Y ID : 2-2- S ^ ^ 

### PROPERT Y ADDRESS : 3i^^ ^ yi:Z^/^Sii? ^ ST ^ OWiNfE RNAiVlE : 

### DAYTIM E PHONE : yyO

- oc3^C?Z ^ CEL LPHONE : E-MAIL : *' OWNER' S ADDRES S I FDIFFERENT : TENANT' S NAM E I FAPPLICABLE :

. • '• * DAYTIME PHONE : CEL LPHONE : E-MAIL : 

# 1 Professiona l Environmenta l Engineers , Inc . (PE ) i s unde r contrac t (#EP-R7-08-06 ) wit hth e U.S . Environmenta l Protectio n Agency (EPA ) t o stabiliz e leadbase dpain t (LBP ) on residential structure s a t anumbe r o

f propertie s locate din Omaha , Nebraska . Th e pain t stabilizatio n wor k

i s bein g don e t o protec t th e soil cleanup s tha t wer e performe db y EP A contractors . Pain t stabilizatio n activitie s will include : scrapin g of cracke do r flakin g LB P fromstructures , appUcatio n of aprim e coat an d tw o (2 ) coat s o f pain t Movin g part s of window s an ddoor s ar e no t include dan dwill no t b e addressed . Your 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 dhav e acces s t o thi s propert y for th e purpos e o f stabilizin g lead-base dpain t a s outline don th e propert y identifie dabove . B y signin g thi s document I agre e t o allo w a n EP A contracto r t o conduc t asoil cleanu p a t m y propert y following completio n of lead-base dpain t stabilization . I understan dtha t th e stabilizatio n contracto r ca n no t provid e assurance s tha t th e soil cleanu p contracto r will b e boun dto . I furthe r understan dtha t th e soil cleanu p contracto r will make 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 m y property . I fiill y understan dtha t by signin g thi s Consen t for Access , (1 ) thi s acces s will remai n i n effec t unti l th e work ha s been satisfactoril y completed , (2 ) tha t th e Propert y Owner o r Tenant , i f applicable , will b e given th e Housin g an dUrba n Developmen t (HUD ) an dEPA pamphlet , "Renovat e Right , Importan t Lea dHazar dinformatio n for Families , Da y Car e Providers , an dSchools'' , (3 ) th e Propert y Owner o r tenan t will remov e a U obstruction s fromsurface s t o b e painted , (4 ) will abid e by healt han dsafet y guidanc e provide dby EPA , (5 ) will allo w photograph y of propert y befor e an dafte r th e pain t stabilizatio n work , (6 ) will b e contacte dby aPE representativ e approximatel y 4 8 hour s in advanc e o f startin g work , (7 ) agre e no t t o obstruc t o r tampe r wit han y o f th e LB P stabilizatio n actions , an d(8 ) will participat e in fina l propert y inspectio n an d sign th e Completio n Agreement an dPropert y Owne r Satisfactio n Survey . Shoul dyou hav e an y question s abou t th e plane dLeadBased-Pain t stabilizatio n activitie s for 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 aLeadSite cleanu p can b e directe dt o Paulett aFrance-Isetts , EP A Remedial 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 hOmah aoffice) o r 402-731-304 5 (Sout hOmah aofBce) . D Yes , I gran t acces s t o m ypropert yan d was give n th e pamphle t D No , I d o no t gran t acces s to m ypropert yan d I was "Renovat e Right , Importan t Lea d informatio n forFamilies , Chi M give n th e pamphle t "Renovat e Right , Importan t Lea d ndSclv^ls. " biformatk m forFamilies , Chikl e Car e Providers , an d Schools. ' 

# y^y?-^/ ^ Signatur e SPECIA L INSTRUCTION S AN D CONSIDERATION S

# Confirmatio n O f Receip t O f Lea d Pamphle t BVI D 22SH M PROPERT Y ADDRES S 

## ^5^ ^

L/4g;^^<^ ^ J ^ ZI P COD E <^^/a< r PROPERT Y ADDRES S O F OWNE R I F DIFFEREN T THA N PROPERT Y BEIN G PAINTED : PROPERT Y ADDRES S
_ ^

^ZI P COD E I hav e receive d a cop yo f th e pamphlet , Renovat e Right : Importan t Lea d Hazar d Infonnatio n Fo rFamilies , Chil d Car e Provider s An d School s informin g m e o f th e potentia l ris k o f th e lea d hazar d exposur e fro m itio n activit yt o b e perfomne d o n dwellin g unit
. I receive d thi s pamphle t befor e th e wor k began
. 

# ^ yy^y y PRINTE D NAM E O F RECIPIEN T DAT E C^ZiH'^ ^

'RECIPIEN T

- . • • . • • .1 ' ' , i
. • • * • • Self-Certificatlo n Optio n (Fo rTenant-Occupie d Dwelling s Only ) I f th e lea d pamphle t wa s delivere d bu t a tenan t signatur e wa s no t obtainable , yo u ma ychec k th e appropriat e bo x 

# r ­ below : 

# D Refusa l T o Sig n - 1 certif ytha t I hav e mad e a goo d fait h effort t o delive rth e pamphlet , renovate right : importan t lea d hazar d infonnatio n fo rfamilies , chil d car e provider s an d schools ; t o th e renta l dwellin g uni t liste d abov e a t th e dat e an d tim e indicate d an d tha t th e occupan t refuse d t o sig n th e confinnatio n o f receipt
. I furthe rcertif ytha t I hav e lef t a cop yo f th e pamphle t a t th e uni t wit h occupant . 

# D Unavailabl e Fo rSignatur e - 1 certif ytha t I hav e mad e a goo d fait h effort t o delive rth e pamphlet , renovat e right ; importan t lea d hazar d infomiatio n fo rfamilies , chil d car e provide ran d schools , t o th e renta l dwellin g uni t liste d belo wan d tha t th e occupan t wa s unavailabl e t o sig n th e confinnatio n o f receipt. I furthercertif ytha t I hav e lef t a cop yo f th e pamphle t a t th e uni t b yslidin g i t unde rth e doo ro rsomewher e o n th e premises
. 

# \>z/r^ ^ ^^2y ^ 

# '2'^y^ 

# y^^3-^^ ^ PRINTE D NAM E O F PERSO N CERTIFYIN G AHEMPTE D DELIVERY DAT E AN D TIM E LEA D PAMPHLE T DELIVERY : ^ SIGNATU I 

### R ^ F PERSO N CERTIFYIN G LEA D PAMPHLE T DELIVERY :
Not e Regardin g Mailin g Optio n - a s a n altemative t o deliver yi n person , yo u ma ymal l th e lea d pamphlet t o th e owne r and/o rtenant . Pamphlet mus t b e maile d a t least 7 day s befor e renovation
. (Documen t wit h a certificat e o f mailin g lirom th e pos t office)
. CONFIRMATION O F RECEIP T O F LEA D PAMPHLE T

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

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y^^aCPy i c5? ^ DAT E /0~gi3-0 ^ BVI D 

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# PAIN T STABILIZATIO N PRE-PROPERT Y ASSESSMEN T
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# BVI D ^^^Z2-SH H PLAN T & PERMANEN T LANDSCAPIN G TO B E REMOVE ? N O h ^ YE S r ^ IF , YE S WHERE : / "^ 0f

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. BASEMEN T LEAKING ? N O ' ' YE S 4(— ' IF , YE S WHERE : 

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### VISUA L DESCRIPTIO N O F PROPERTY/STRUCTURE/GARAGE , (I.E.) : (US E BAC KSID E I F NECESSARY ) 

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### . . Dougla s County Accoun t Informatio n Pag e 2 o f 3
Grantee : Joh n Clar k Eta l Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 5 6600. 0 1. 0 132. 0 50. 0 N o Improvemen t Informatio n Buildin g 1

^ 'j.,„i» J

m a « "—Mr— Twotler y CLIC KT O ENLARG E IMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : 1507. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : En d Condition : Fai r

Buil t As : 2 Stor y Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 6. 0 Exterior : Fram e Sidin g Units : 2. 0 Interior : Drywal l Baths : 2. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 4. 0

Roo f Type : Gambre l Stories : 2. 0 Floorcover : Allowanc e Foundation : Bloci c Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 190 5 0 % 190 5 10 2 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 9 ft 548. 0 Fixtur e Additiona l Fixture s 1. 0 Fixtur e Bas e Fixture s 1. 0 

### http://douglasne.mapping-online.com/DouglasCo N e/static/accountinfo.jsp?accountno=R2.. . 10/20/200 8

### Dougla s County Accoun t Informatio n Pag e 1 of 3 Dougla s County , Nebrask a Propert yRecor d - R233973000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t of 90t h S t - Vie W O n Ma p Informatio n i s vali d a s o f 2008-9- 4 Treasurer' s Ta xRepor t Ne wFeatur e -*-»- > Aut o Sale s Searc h Owne r HUBE R PAMELAL ETA L 356 6 JACKSO N S T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 397 3 000 0 2 3 Accoun t Type : Multipl e Re s Parce l Number : 233973000 0 Parce l Address : 356 6 JACKSO N S T OMAH AN E 68105-000 0 Lega l Description : UNIO N SQUAR E LO T 7 BLOC K0 1/ 2 VA C ALLE Y AD J O N N & 5 0 X 132.2 5 Valu e Informatio n 200 8 200 7 200 6 200 5 200 4 200 3 Lan d Improvemen t $6,500.0 0 $57,200.0 0 $6,500.0 0 $57,200.0 0 $6,500.0 0 $41,000.0 0 $6,500.0 0 $41,000.0 0 $6,500.0 0 $41,000.0 0 $6,500.0 0 $41,000.0 0 Tota l $63,700.0 0 $63,700.0 0 $47,500.0 0 $47,500.0 0 $47,500.0 0 $47,500.0 0 Sale s Informatio n Sale s Date : 2004-05-1 7 Dee d Type : 

### Price : Grantor : W D $92,450.0 0 Joh n Clar k Eta l Book : 200 4 Page : \ 08281 0

Grantee : Pamel a Hube r Valid/Invalid : Vali d Excl Reason : usio n Sale s Date : 2003-10-1 7 Dee d Type : Price : Grantor : W D I $50,000.0 0 Harr yWeine r Book : \ 200 3 Page : 20691 2



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2. . . 10/20/200 8