TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID #: 311 Date: November 20 

Address: 1818 Pinkney St. 

Remediation Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

B Video of property (DVD) 

ET Executive Summary 

^ Signed Access Agreement for subject property 

y Painting Agreement 

D Settlement documents (i.e., for damage or to replace plants, eic.) 

D Photographs 

B' Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

y Property information from Douglas County Assessor's Office 

D 

D 

D 

f)^A ^ ^le/o^ 

Signatured Date 

40310645 

ililHi 

Superfund 
Date: 

PROPERTY SlIMMARY 

LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Month of: November 

Property Address: 1818 Pinkney St. SAID: 311 

A. EXECUTIVE SUMMARY 

A.l Issues Encountered: None 

A.2 Issues Resolved: None 

A..3 Unique Findings: None 

122A.4 Other Relevant Information: None 

Access Date: 09/29/08 

Work Began Date: 10/18/08 

Cioseout Date: 11/05/08 

Eniciosures: 

1. Pre-Video 

2. Post-Video 

3. Property Status Form 

4. Signed Access Agreement 

5. Pre-Renovation Form 

6. Paint Match Form 

7. Tracking Form 

8. Douglas Count>' Assessor Property' Information Page 

9. EPA Property Cioseout form 

10. Property'Completion Agreement 

TECHNOLOGIES, INC. 
TECHNOLOGIES, INC. 

ENVIRONMENTAL & 

CONSTRUCTION 

SERVICES 

Property Status Form 

Address: Kl ^ P,Vil^m.Cr ^ Date: ^-^f-0" ? 

Phone;, 4^'<r5'-/ 7 7 f BVID: 3/ ^ "^W/l %§f'MJ^yAl 

Item# 

On Map 

Plant & Permanent Landscaping To Remain In Place 

Description and Location 

(ifiM6t ' de'f\^J'ufJ /^r<Mj ^if^toi '^oli ^f6mf\6C 

Pre-Existing Condition of Structures 

DoesyourBasementhaveahistory of leaking? Yes — No 

Item# 

On Map 

Description & Location 

1)di[t uj^^i-i dm^i 

If 

/ ' 

f/ 

If 

/f 

jf 

Property Owner 

Signature:^ ^i&yf . J<^ ' 

Prudent Employee 

Signature: 

8080 Ward Parkway, Suite 405 

Kansas City, MO 641U 

Phone:(816)363-3703 

Fax: (816) 363-3707 

2505 N. 24"^ Street, Suite 308 

Omaha, Nebraska 68110 

Phone: (402)504-1004 

Fax: <402\ SOd-innR 

4242 NIedical Drive, Suite 4250 

San Antonio, TX 78229 

Ptione: (210)822-9588 
Prudent Technologies, Inc. (Prudent) is under contract (Contract # EP-R7-08-07) with the U. S. 

Environmental Protection Agency (EPA) to stabilize Lead Based Paint (LE|P) at a number ofproperties 

located in Omaha, Nebraska, including the property located at |^[ ^ Pinl/ni? U \ i 

The EPA requests your permission to allow Pmdent to perform LBP Stabilization at this property. By 

signing this form, the property owner grants permission to Prudent to perform activities related to LBP 

Stabilization including scraping paint and painting of the referenced property. Further, the owner./tenant 

verifies that they have received llie LBP pamphlet "Renovate Right." 

If you have any questions about the LBP stabilization planned for your property, please contact Prudent's 

Administrative Clerk for the Lead Based Paint Stabilization, Mrs. Deborah Akerele-Johnson. 

at (402) 504-1004. General questions about the Omaha Lead Site cleanup can be directed to the EPA 

Public Information Centers at (402) 731-3045 (South Omaha office) or (402) 991-9583 (North Omaha 

oifice). 

Property .Access Granted. 1 By: An^^djh AUJ^4^^ 

Prtiperty Owner Signature: 

'0/^l ^ 

(Please Print Name) 

I " ^ (Signature) (paie) 

RESIDENT NAME 

RESIDENT ADDRESS 

PROPERTY INFORMATION 

V (To be completed bv resident and/or propert>' owgp:-..^leas e e print) 

Renter 

/f/^/y: f\..K^ -y 5/. i^ 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS: 

3ei^ 

S^y)2£^ 

OWftJER'S TELEPHONE NUMBER - HOME: (^^^ ) ^X^y V ^.^fwORK : i^CZ ^ ^ ^ D " ^ ^ 0/J!S 

NUMBER OF OCCUPANTS UNDER 7 YEARS O\Si\0O - NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER: / 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: / 

COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS, ENTRY GATES. ETC.) /-^ ^ 

.'VUTHORrrV FOR ENVIRONMENTAL RESPONSE ACTIONS; The activities to be implemented by EP.^ under this agreement :ire puisuant to Section 104 

of CERCLA, 42 U.S.C. 9604. EPA's right of access to the property is provided for in Section 104(e) of CERCLA, 42 U.S. C 9605(e), which provides entry 

for "determining the need for response, or choosing ortaking any response action under this title, or otherwise enforcing the provisicos of fte title." 

080 Werd Parkway, Suite 405 

.ansas City, MO 64114 

•hons: (816) 363-3703 

sx: (815) 363-3707 

2505 N. 24'" Street, Suite 308 

Omaha, Nebraska 68110 

Phone: (402)504-1004 

Fax: (402)504-1005 

4242 Medical Drive, Suite 4250 

San Antonio, TX 78229 

Phone: (210)322-9538 

Fax: (21 OJ 579-6577 
v^ciiip<c;iii ociiii|jit; rre-nenovation horm 

Effective until April 2010. 

Confirmation of Receipt of Lead Pamphlet 

M1 have received a copy of tlie pamphlet, Renovate Right: Important Lead Hazard. 

^ l Information for Families. Child Care Providers and Schools informing me of 

the potential risk of the lead hazard exposure from renovation activity to be 

peri'ormed in my dwelling unit. I received this pamphlet before the work began. 

Printed name of recipient \IL ^ ^^'^ 

Signatiire of recipient 

Self-Certification 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 below. 

Q Refusal to sign — I certify that I have made a good faith effort to deliver the 

psfTiphlet, Renovate Right: Important Lead Hazard Information for Famine, 

Child Care Provid&s and Schools, to the rental dwelling unit listed below at the 

date and time indicated and that the occupant refused to sign the confirmation 

of iBceipt. I further certify that I have left a copy of the pamphlet at the unit with 

the occupant. 

Q Unavailable for signature — i certify that I have made a good faith effort to 

deliver the pamphlet, Renovate Right: Important Lead Hazard Information for 

Fanilies, Child Care providers and Schools, to the rental dwelling unit listed 

below^d tinat the occupant was unavailable to sign the confirmation of receipt. 

I fijFfnar certify that I have left a copy of the pamphlet at the unit by sliding it 

UF(de/the door, j i \ 

PnntExJ name of persoii'Certrlying J Attempted delivery 

date and time 

lead pamphlet delivery 

Signiiture of person cert|f^ng lead pamphlet delivery 

f^iy P'^^i^., 

Unit Address 

Note Regarding Mailing Option — As an alternative to delivery in person, you 

may mail 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 from the 

posl office). 
• . . 1 r« - • /'•' A life / ^ - f ^-f"^ >-

paint match farm /yfrt "(' ^ x 

F'aint matching form: ' — ^ 

FToperty address: /f/ / ^/j^^-^ ' 

I5VID: 5// f I ^ 

Expla(»)C^^ ^ /^'^^ ^//W W^^:^ 

Area: f^^/i'/f^MH -ffiofi Color: /^'^^/ /^/d/^f ^oJOtSO 

Expl anati on: / ' /-l ^ pik'- -

Area: ^,uM/cvJ^-iydfiil(f^^f^^^^^ Och^ldc 

Expl anati on: o"' F (jfillot^^ fijjpi^ 

Area: color: 

Explanation: 

Area: Color: 

Explanation: 

y / /y] u<tf ^- ^ ^ 

Page 1 
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MBUffH 
uougias L-ouncy Accouni miormaiio rnanc n fage 1 or ..i 

Dougla s County , Nebrask a Propert y Recorc 

Information is valid as of 2008-9-4 "^^''"'""' • 

Owne r 

WATSON MARSHALLE A 

1818 PINKNEY ST ^ ' 

OMAHA NE 68110-0000 

Propert y Informatio n 

Key Number: 

Account Type: 

Parcel Number: 

Parcel Address: 

Legal Description: 

Valu e Informatio n 

Land 

2008 

2007 ' 

2006 ' 

2005 ! 

2004 1 

2003 

2982 0000 15 

Residential 

1529820000 

1818 PINKNEY ST 

OMAHA NE 68110-0000 

1 - R152982000 0 

Parcel Dimensions available @ seal 

New Feature 

V-L'J-?'^ 

y^^^ 

KOUNTZE PLACE L0T11 BLOCK 38 50 X 125 

. Improvement 

S4.800 GO 

$4,800.00 

$4,800.00 

$4,800.00 

$4,800.00 

$4,800.00 

$38,500 00 

$34,500 00 

$34,500.00 

$34,500.00 

$14,000.00 

$14,000.00 

Print Report 

e 0-50 ft west of Goth St - VIew on Map 

Treasurer's Tax.Report 

->->- > Auto Sales Search 

Total 

$43,300.00 

$39,300.00 

$39,300.00 

$39,300.00 

$18,800.00 

$18,800 00 

Sales Informatio n 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Lan d Informatio n 

Acres SF 

0.14 

2002-03-08 

QC Soolf; 2204 

$1 00 

Invalid 

Non Bono with Doc Stamps 

; Units 

6250 0 1.0 

Depth Width 

125.0 50.0 

Page: 729 

\^acant 

No 

' Improvemen t Informatio n 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno==Rl5... 9/24/2008 
uougias county Account inrorrnatio Tiaiic n rage z ui .i 

Building 1 

1318 Finkncy 

=. >- -InIK,, n ^c • 

CLICK TO ENLARGEJMAGE 

1.-2Slory Unfin 

CUCKJO_EJiLA.RGEJMAG.E 

Square Footage: 

Perimeter 

Unit Type: 

Built As: 

HVAC: 

Exterior: 

Interior: 

Roof Cover: 

Roof Type: 

1374.0 

0.0 

2 1/2 Story Unfin 

Forced Air 

Frame Siding 

Drywall 

Composition Shingle 

Hip 

Floorcover: Allowance 

Percent Complete: 100.0% 

Quality • Average 

Condition: Average 

Condo Square Footage: 0.0 

Rooms: 7.0 

Units,: 1 0 

Baths.: 2.0 

Bedrooms: 3.0 

Stories: 2.5 

Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built 

1910 

Year 

Remodeled 

0 

Percent 

Remodeled 

0% 

Adjusted Year 

Built 

1910 

Physical Age 

98 

Detail Type 

Appliance 

Basement 

Basement 

Fixture 

Fixture 

Garage 

Porch 

Porch 

Porch 

Porch 

Detail Description 

Allowance 

Bsmnt Block 8 ft 

Finished 

Base Fixtures 

Bath Full 

Detached 

End Solid Wall 

End Solid Wall 

Open Slab 

Slab Roof Ceil 

Units 

1.0 

696.0 

300.0 

1.0 

2.0 

440.0 

136 0 

136.0 

200.0 

192.0 

http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=Rl5... 9/24/2008 
Prudient Property Ciose>Out Form (Lead-Based Paint Stabilization) 

SAID;' 8iC 

iM. 

^ 

Property Address: 

Owner's Name: lAaY^sir^Ajlf . A^CUd^d"> 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, ell trim, porches, box 

beams, columns, rails, and exterior surfaces of garages. y 

1. Wajs all scraping and other preparattion worl< completed satisfactorily? 

3. Were all required areas of tiie structure(s) primed as needed and painted with two top coats? 

4. Wajs 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? 

<y 

5. 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' 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? _ ^ c^ y 

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 te.mporatily re-located by the contractor 

that need to be moved back? c/i 

11. Are there any (known) lingering issues with the property owner(sl that have been left unresolved? 

Otlier Considerations?property Owner Discussions?Addltionsl Work that is Required y 

Pruoent Rei^esentatlv 

Oate'v/^^-d^'g 

I 

rr.v^i^^fA^^^ ^ y ^ '^.'j^^^^jL ^ //-&y.^'