TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: ZZS4 ^ Date: 7 j I j(f ) 

Address: 3S&( ^ ^/LJCXSO/\ SJVWT 

Remediation Contractor: PROFESSIONAL ENVIRONMENTAL ENGINEERS Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

B^ Video of property (DVD) De(er£.. Oti^-^r . . 

; €r Executive Summary 

M Signed Access Agreement for subject property 

W Painting Agreement . . 

0 Settlement documents (i.e., for damage or to replace planfe, etc.) 

Photographs QJASJC 

W •- Satisfactory restoration signed by Property Owner 

^ ^ Property close-out check list signed by EPA /dcTT ^ / <5 X/^D Or Oif ^ leM ^ 

Property information from Douglas County Assessor's Office 

y ("^tS^rtAAityc reyy'l '^fii^n^/^LhL^la\A' UtiX pa/Kpfikr 

7 

D 

D 

Signature 

40316363 

Superfund 
PROFESSIONAL 

2505 Noi1h24% 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 

Lead Base Paint Stabilization Omaha, Ne 

Close Out Report 

SAID#22544 

3566 Jackson St 

• Dates worked 10/29 to 11/02 2008 

• Owner wanted some color changes that we did for her, there were areas that had heavy caulk 

that could not be removed. Owner followed workers around telling them what to do during 

the painting process. After work was completed owner was dissatisfied with the work and 

contractors had to go back and redo areas with a supervisor watching to please the owner. 

• Inspected 11/04 supervisor was there during completion. No issues 
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: Z^SMM 

Property Address: ZS^( ^ Jc.c^Ls^^ 

Owner's Name: ficLxr\&V^ lA^ ^ b j P_^n 

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. A

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

3. Were all required areas of the structure(s) primed as needed and painted with 

two top coats? K. 

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

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

vacuumed/ cleaned? JL 

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? K 

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

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

barrier tape, etc. properly removed? JC 

9. Is there any evidence of property 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 temporarily re-located by 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: 

Professional Envipmmiental Engineers Representative 
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 

EPA Close-Out Form 

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

SAID: zz^qq 

Property Address: 3SG G Tac^So n ^S^ 

Owner's Name: Vb^O\Q\CX ^^xbg^ P 

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 all required areas 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 generated debris? 

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

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

barrier tape, etc. properly removed? 

9. Is there any evidence of property 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 temporarily re-located by 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? 

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

EPA COR Signature Date 
CONSENT OFR ACCESS TO PROPERTY 

OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID: 2-2- S ^ ^ PROPERTY ADDRESS: 3i^^ ^ yi:Z^/^Sii? ^ ST ^ 

OWiNfER NAiVlE: 

DAYTIME PHONE: yyO - oc3^C?Z^ 

CELL PHONE: E-MAIL: 

*' 

OWNER'S ADDRESS IF DIFFERENT: 

TENANT'S NAME IF APPLICABLE: . • '• * 

DAYTIME PHONE: 

CELL PHONE: E-MAIL: 

1 

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 were performed by EPA contractors. 

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

two (2) coats of paint Moving parts of windows and doors are not included and will 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. 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 property. 

I fiilly 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 aU 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-Isetts, 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 ofBce). 

D 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 Lead information for Families, ChiM given the pamphlet "Renovate Right, Important Lead 

ndSclv^ls." biformatkm for Families, Chikle Care Providers, and Schools.' 

y^y?-^/ ^ 

Signature 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
Confirmation Of Receipt Of Lead Pamphlet 

BVID 22SH M 

PROPERTY ADDRESS ^5^ ^ L/4g;^^<^^ J ^ ZIP CODE <^^/a< r 

PROPERTY ADDRESS OF OWNER IF DIFFERENT THAN PROPERTY BEING PAINTED: 

PROPERTY ADDRESS _ ^ ^ZIP CODE 

I have received a copy of the pamphlet, Renovate Right: Important Lead Hazard Infonnation For Families, 

Child Care Providers And Schools informing me of the potential risk of the lead hazard exposure from 

ition activity to be perfomned on dwelling unit. I received this pamphlet before the work began. 

^ yy^yy 

PRINTED NAME OF RECIPIENT DATE 

C^ZiH'^^ 

'RECIPIENT 

- . • •. •• .1 ' ' , i . • • * • • 

Self-Certificatlon Option (For Tenant-Occupied Dwellings Only) 

If the lead pamphlet was delivered but a tenant signature was not obtainable, you may check the appropriate box 

r­ below: 

D Refusal To Sign - 1 certify that I have made a good faith effort to deliver the pamphlet, renovate right: important 

lead hazard infonnation for families, child care providers and schools; to the rental dwelling unit listed above at the 

date and time indicated and that the occupant refused to sign the confinnation of receipt. I further certify that I 

have left a copy of the pamphlet at the unit with occupant. 

D Unavailable For Signature - 1 certify that I have made a good faith effort to deliver the pamphlet, renovate right; 

important lead hazard infomiation for families, child care provider and schools, to the rental dwelling unit listed 

below and that the occupant was unavailable to sign the confinnation of receipt. I further certify that I have left a 

copy of the pamphlet at the unit by sliding it under the door or somewhere on the premises. 

\>z/r^^ ^^2y^ '2'^y^ y^^3-^^^ 

PRINTED NAME OF PERSON CERTIFYING AHEMPTED DELIVERY DATE AND TIME LEAD 

PAMPHLET DELIVERY 

: ^ 

SIGNATUI R ^F PERSON CERTIFYING LEAD PAMPHLET DELIVERY: 

Note Regarding Mailing Option - as an altemative to delivery in person, you may mall the lead pamphlet to the owner 

and/or tenant. Pamphlet must be mailed at least 7 days before renovation. (Document with a certificate of mailing lirom the post 

office). 

CONFIRMATION OF RECEIPT OF LEAD PAMPHLET 
PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

PROPERTY ADDRESS :yS^< ^ y^^aCPyi c5?^ DATE /0~gi3-0 ^ 

BVID 2yjs^ ^ 

AREA(S) TO BE PAINTED: 

HOUSE PROPER: f^S couoRf7j/7Jf^y^ ^^^<-y^^^ ^ 

''fcr-; 

HOUSE TRIM y g ^ COLOR ny7.'y-3^ - a.^. . /3^^/:< 

GARAGE___^i[0_ COLOR. 

GARAGE TRIM f\l O COLOR. 

PORCH M6,D/=. COLOR. ny7y(^P 

PORCH fZyz^;^ TRIM J^ ^ COLOR 

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

I AGREE TO THE COLORS LISTED ABOVE. ONCE PAINTING BEGINS, I 


UNDERSTAND I CAN NOT CHANGE THE ABOVE SELECTED COLORS: 


PROPERTY OWNER SIGNATURE: 

^AM-ty^ 

>^ (^^ ^ ^^e ^ ^^>-^^ii:^ ^^y^^^L^ /P^^^^:^^^^ '^p yi^^^yifC 

PAINT MATCH FORM 08/08 
PAINT STABILIZATION PRE-PROPERTY ASSESSMENT 

PROPERTY ADDRESS: J^<^ ^ L^^^::;^!^/; vJ?^ DATE ^' ^ " ^?- ^ ^ ^ 

BVID ^^^Z2-SH H 

PLANT & PERMANENT LANDSCAPING TO BE REMOVE? NO h ^ YES r ^ 

IF, YES WHERE: / "^ 

0f^ 

PRE-EXISTING CONOmON OF FOUNDATION/STRUCTURE, i.e. BASEMENT LEAKING? 

NO ' ' YES 4(— ' IF, YES WHERE: 

Ncniii^ d^ua-/^ ^ ^» r 

EXISTING PAINT ON WINDOWS, DOORS, FOUNDATION, SIDEWALK,( I.E.)? NOn ^ 

YES ra IF, YES WHERE: 

^^:^^eoe/c^ A-/-e/^<^ \s^\yp Y\acx\Ju Cyi(^\\l 

^^r\\^A V r_a r^^^^J•^ y^ ^ y^f^O^y ^ 

VISUAL DESCRIPTION OF PROPERTY/STRUCTURE/GARAGE, (I.E.): (USE BACK SIDE IF 

NECESSARY) 

-Vo uYM ^ i^^'lOcx ^r Wc^rA -vo /^y ^ y^y^ i2fc£_ 

^ (])/ ^ Vxa^ "yyi^^^yxoo^ pL^y i-^ ocx,y\~ 

^ r y^ y -^^ Pb.>Wjrx^:.>^ cc^a-ec^^-::, ^ 

'yyL^ ^(xVv^^A^'VicrL 

PROPERTY OWNER SIGNATUI 

.. Douglas County Account Information Page 2 of 3 

Grantee: John Clark Etal 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.15 6600.0 1.0 132.0 50.0 No 

Improvemen t Informatio n 

Building 1 

^ 

'j.,„i»J 

m a« 

"—Mr— 

Twotlery 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1507.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: End Condition: Fair 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 6.0 

Exterior: Frame Siding Units: 2.0 

Interior: Drywall Baths: 2.0 

Roof Cover: Composition Shingle Bedrooms: 4.0 

Roof Type: Gambrel Stories: 2.0 

Floorcover: Allowance Foundation: Blocic 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1905 0% 1905 102 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 9 ft 548.0 

Fixture Additional Fixtures 1.0 

Fixture Base Fixtures 1.0 

http://douglasne.mapping-online.com/DouglasCoN e/static/accountinfo.jsp?accountno=R2... 10/20/2008 
Douglas County Account Information Page 1 of3 

Douglas County, Nebraska Property Record - R2339730000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 90th St - Vie W O n Ma p Information is valid as of 2008-9-4 Treasurer's Tax Report 

New Feature -*-»- > Auto Sales Search 

Owner 

HUBER PAMELA L 

ETAL 

3566 JACKSON ST 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 3973 0000 23 

Account Type: Multiple Res 

Parcel Number: 2339730000 

Parcel Address: 3566 JACKSON ST 

OMAHA NE 68105-0000 

Legal Description: UNION SQUARE LOT 7 BLOCK 0 1/2 VAC ALLEY ADJ ON N & 50 X 132.25 

Value Informatio n 

2008 

2007 

2006 

2005 

2004 

2003 

Land Improvement 

$6,500.00 $57,200.00 

$6,500.00 $57,200.00 

$6,500.00 $41,000.00 

$6,500.00 $41,000.00 

$6,500.00 $41,000.00 

$6,500.00 $41,000.00 

Total 

$63,700.00 

$63,700.00 

$47,500.00 

$47,500.00 

$47,500.00 

$47,500.00 

Sales Informatio n 

Sales Date: 2004-05-17 

Deed Type: 

Price: 

Grantor: 

WD 

$92,450.00 

John Clark Etal 

Book: 2004 Page: \ 082810 

Grantee: Pamela Huber 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 2003-10-17 

Deed Type: 

Price:

Grantor: 

WD 

 I $50,000.00 

Harry Weiner 

Book: \ 2003 Page: 206912 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2... 10/20/2008