12

TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID: 31768 Date: 01/12/2009 

Address: 2508PINKNEY 

Remediation Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

\7 Video of property (DVD) 

a Executive Summary 

\7 Signed Access Agreement for subject property 

^ Painting Agreement 

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

D Photographs 

El Satisfactory restoration signed by Property Owner 

w Property close-out check list signed by EPA 

 Property information from Douglas County Assessor's Office 

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Signatur^ Date 

40307979 

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Superfund 
PROPERTY SUMMARY 

Date: 01/12/2009 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Month of: December 

Property Address; 2508PINKNEY SAEP; 31768 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: None 

A.2 Issues Resolved: None 

A.3 Unique Findings: None 

A.4 Other Relevant Information: None 

Access Date: 10/09/08 

Work Began: 10/26/08 

Closeout Date: 10/28/08 

Enclosures: 

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 County Assessor Property Information Page 

9. EPA Property Closeout form 

10. Property Completion Agreement 

TECHNOLOCIES, INC. 
ENVKONMENTAL& 

CONSTRUCTION TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Addittss:2SOB' PfnknJLOj SI . Date: /^^^/ ^ 

Phone: ^(^O^^Cjjy ^ BVID: 3/76 ? 

Plant & Permanent Landscaping To Remain In Place 

Item# 

Description and Location 

On Map ^ ^c^^^i ^ Tpl<//ii-> (C&fci&f^ -..C^O^ r 

' j?c/s^5. C^ct^H-^- CoJe r 

Pre-Existing Condition of Structures 

y Does your Basement have a history of leaking? Yes — No -

Item# Description & Location 

OnMf^) • ^ruc/r^f la coAcre^e F'^i-i^A f^u) Cy>rA^r 

• dtiAf t?i^ cMitfit^ey ^i^icJrs. 

Property Owner Prudent Empl 

L 

Signature:X^*/W^^,^tJ^ ^ Signature: 

sow Wvd Paifcwty, Sultt 405 

Kansas CKy. MO 64114 

Phonr. (816) 3634703 

2606 N. 24*^ Street, Suite 308 

Omaha, Nebraska 68110 

4242 Medical Ortvt, Suite 4260 

SanAnlonIn Tyfo*— 
3/^6.? 

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 (LBP) at a number ofproperties 

located in Omaha, Nebraska, including the property located at 'Z^D 2 Pi.n)7nil\ yThe EPA requests your permission to allow Prudent to perform LBP Stabiliz^on at^fli^ property. By" 

signing Ms form, the property owner grants permission to Prudent to perfonn activities related to LBP 

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

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

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

AdTninisfrfltive Clerk for the Lead Based Paint Stabili^tion, Mrs. Deborah Akerele-Johmon. 

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 

office). 

Property Access Qnnted By:. 

'(Please Print Name) 

Piopetiy Owner Signature: 

(Signature) 

PROPERTY INFORMATION trrvur 

(To be completei^^ resident and/or property owner - please prinQ ietedjiyresic 

RESIDENT NAME: ^A^SCA£J (_ Omer ^ Renter 

RESIDENT AOORESS: 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAIUNG ADDRESS; Sct^- ^ 

OWNER'S TELEPHONE NUMBER-HOME: F ^\^J^ " ^^^ 7 WORK: J . 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: . NUMBER OF OCCUPANTS 7 YEARS OLO AND OLDER: X 

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.) 

AUrHORTTY FOR ENVIRONMENTAL RESPONSE ACTIONS; Tbe activities to be inqilemented by EPA under tMs agreement are pursuant to Section 104 

ofCERCLA,42U.S.C.9604. EPA's right of acoessiotoe property isprovided for ta Section lM(e) of CHICIA 42 U.S. C9605(e),'whichprovides entiy 

for "detenniningthe need for response, or dioosing ortaking any response action under to title, or otherwise en&rdng the provjsicns of 4 e tide." 

2505 4242 Medical Drive, Suite 4250 N. 24*" Street, Suite 308 )80 Ward Parlnray. Suite 405 Ontaha, Nebraska 68110 San Antonio, TX 78229 ansas City, MO 64114 Phone: (402)504-1004 Phone: (210)822-9588 hone: (816) 363-3703 P o v IMW, CA4 ^nne JX: (816) 363-3707 
v/urreni ^ampie (gje-Kenovation horm 

Effeciive until April 2010. 

Confirmation of Receipt of Lead Pamphlet 

QHTiave received a copy of the pemphlet, Renovate ffigW; Important Lead Hazard 

Infonnation for Ferrates, Chiki Care Provkiers and Schools informing me of 

ttie potential risk of the lead tiazard exposure from renovation activity to be 

performed in my dvreiling unit. I received this pamphlet before the wor1< began. 

K £/iJa 4fl^y>-.c^ ///- ^'^f>9' 

Printed nanrepf recipient Date 

Signature of recipient 

Setf-Certification Option (for tenant-occupied dweiiings only) — 

if the lead pamphlet was delivered but a tenant signature was not obtainable, 

you may checl< the appropriate box below. 

Q Refusal to sign — i certify that I have made a good W n effort to deliver the 

pamphlet, AerTOvafe K^ t Important Lead Hazard Infonnation for Famiies, 

OTild Care Provkiers and Schools, to the rental dwelling unit listed below at the 

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

of receipt. 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, Fienovate Kght Important Lead Hazard Infonnation for 

Farrulies, CNki Care provkiers and Schools, to the rental dwelling unit listed 

below and that the occupant was unavailable to sign the confirmation of receipt. 

I further certily that I have te^ a copy of the pamphlet at the unit by sliding it 

under ttie door. 77. - ^ /p 

M ^­ o^eA^ /o) 

Printed name of person certifying Attempted delivery 

date and time 

lead pamphlet delivery 

Signature of person 

9^^ ^ nak^y 

<97M.e(JlcLy ^^^ / -

Unit Address 

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

may mail the 1 ^ pamphlet to the owner and/or tenant. Pamphlet must be mailed 

at least 7 days before renovation (Document witti a certificate of mailing from the 

post office). 
paint match form" 

Paint matching form:

property address: H^o^

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Douglas County AccounBliformation rag e 1 Ul ^ 

Douglas county, Nebraska Property Record - RZIO1000000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of SOth St - VleW o n Ma p Infomiation is valid as of 2008-9-4 Treasurer's Tax Report 

New Feature ->-»- > Auto Sales Search 

Owner 

ANDERSON ELVA V 

ETAL \ .r.r^\jF^7F 

2508 PINKNEY ST y i >y 

OMAHA NE 68111-0000 c 

Property Informatio n 

Key Number: 0100 OOOO 21 

Account Type: Residential 

Parcel Number: 2101000000 

Parcel Address: 2508 PINKNEY ST 

OMAHA NE 68111-0000 

Legal Description: REDICK S -CIJ\RK-ADD EXT LOT 4 BLOCK 2 46 X 100 

Value Information 

i l-and Improvement Total 

2008 I $2,300.00 

-J. $55,600,00 $57,900.00 

2007 $2,300.00 $65,100.00 $67,400.00 

2006 i_ $2,300.00 $65,100.00 367,400.00 

2005 _ 1. _ $2,300.00 __$65,100.00 $67^00.00 

2004 j $2,300.00 $15,400.00 $17,700.00 

2003 * $2,300.00 $15,400.00 $17,700.00 

Land Information 

Acres SF Units Depth Width Vacant 

0.1 4600.0 1.0 100.0 46.0 No 

Improvement Information 

Building 1 
Douglas County Accouri^iformatio ri^ f n Page 2 of 2

Tvvo Story 2508 Pinkney St 

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CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1704.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality; Fair 

Unit Type: Condition: Good 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 8.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 2.0 

Roof Cover: Composition Shingle Bedrooms: i 4.0 

Roof Type: Gable Stories: 2.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year 

year Built Physical Age Remodeled Remodeled Built 

1915 0 0% 1915 94 

Defa/7 Type Detail Description Units 

Appliance Allowance 1,0 

Appliance Fireplace Masonry 1,0 

Basement Bsmnt Block 8 ft 830.0 

Fixture Base Fixtures 1,0 

Fixture Bath Full 2.0 

Porch Slab Roof Ceil 88,0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R21... 9/24/2008 
Jun e 26,2008 (latest revision) 

EPA Propeity Close-Out Form (Lead-Based Paint StabUi2»tioji) 

BhA md Vg«teli Pmpertr TO Namhen 

Prapolj AdditM! r^sn o P,-oi^ne^ 

^ 

Ownar*! Name: 

Performance Standards /Oose-Ont Criteria 

y ^ aq 

1. Wasflw eoiin«iiiotnn(t) painted wifliae«xc«p6on of tfaostat^ Thiswonld 

iDdnde painting of ofter aasociated fintnres loehidiBgfiaeia, eaves, sidings all trim, porches, box 

bemi. cobinins. mPa. and exterior wrfacea of garages. y 

2. Was all scraping and otter preparation work completed satlsfactority? y 

3. WmiUnqdnd areas ofdMBliucSui«(8) primed as needed and painted Witt t w y 

4. Wattepafot products ndlizedeqaivalent to a 30 year prodoct/qoality? y 

5. Ars an of tte areas where contaminated materials have been spilled thoroughly vacuumed'cleaned? y 

6. Did tte contractor oollect/vacuum allfelling and scraped paint chips on the entire property, 

roadways, alleyways, public access areas and alao remove any otter generated debris? y 

7. bihegnM area ttstsctrrounds tte 8tnicture(s) in reasonably good condition? y 

8. AnaD itaiBs sncb as polyettyleiie sheettig, ladders, paint brashes, cones, barrier tape, etc. properly F KOovedT __^ ^_ 

,9. btiwre any evidence of property damage that was done by the contractor? Any property damage 

needs to be completed prior to tte EPA Clo3^0vt 

JFL 

10. Arettero any prppoty items that were temporarily re>located by tte contractor that need to be 

moved back? y

n . Aiettneaoy Omown) lingering issoea witt tte propetty ownet<s) ttat have been left unresolved? y 

OflMfConsidaadons/Propeity Owner Discussioi^s/AdditiDna! Work (hat is Required 

BPA COR/RepiMmtoUve. rn- '^•y 
Prudent Property Close-Out Form ( Lead-Based Paint Stabiiization) 

SA.D:_ii74i ^ ^ . 

Property Address: ,^ C D ^ lF^.^dc^ryu^ S ^ 

Owner's Name: ^ -^^L '/' [A7^ Ar\,j^.-y \ ^r\de>rFoF n 

Performance Standards/ciose-Out Criteria 

YES NO 

1. Was the entire structure(s) painted w;ith the exception of the stated, excluded areas? This would 

include painting of other associated features including fascia, eaves, siding, all trinn, porches, box 

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

2. Was all scraping and other preparattion vjorV. completed satisfactorily? 

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

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? !C 

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? t. 7.

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

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

propjerly removed? t 

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. 7. 10.

 Are there any property items that were temporatiiy re-located by the contractor 

that need to be moved back? t. 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 X, 

Prudent Representative Signature: 

Date //j^f 

Property Owner S^gn^turer, \ 

txDate: ^ '' -i ^ 

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