TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: f I ISM Date: ^-g.l-0° l 

Address: r9(3 Dt fi -HT S T 

Remediation Contractor: PROFESSIONAL ENVIRONIVIENTAL ENGINEERS Year: 2009 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Summary 

Signed Access Agreement for subject property 

Painting Agreement 

Settlement documents (i.e., ibr damage or lo replace plants, etc.) 

Photographs pHg- /2AC( Pog T 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Property information from Douglas County Assessor's Office 

^ _confirmation that lead pamphlet "Renovate Right" was received by PO 

^ 

D 

D 

Professional Environmental Engineers Signature Date 

EPA Signature M^ 

30094365 

Superfunc 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. ''' ' 'Sma^NE e'sno 

"Providing cost-effective environmental solutions" ^ Consulting • Engineering Design • Remediation • Aljatecnent • Emergency Response ^ S^oo! =^!'QOO? 

 Fax (402) 504-3281 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

2009 

SAID#1134 

2206 I St 

Dates worked: 07/09 to 07/11 2009 

Pre property condition: House had mostly viynl siding with wood trim areas. Front 

porch and soffits had flaking paint and were in poor condition. Garage paint in very 

poor condition and was flaking off. Paint chips in yard 

Problems encountered: None 

Owner request/concerns: 

Inspection/closeout dates. Owner signed 07/13 EPA closed out 07/17, no issues. 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

"Providitig cost-effective environmental solutions" 

Consulting • Engineering Des gn • Remcci ution • Abatement • Emergency ReRpniisp 

EPA Close-Out Form 

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

SAID: lll?> U 

Property Address: QdDL t ZU CST: 

Owner's Name: [ \ iCfMS f^rY\7l 

Performance Standards/Close-Out Criteria 

2505 North 24'", Suite 219 

Ornaha, NE 68110 

(402) 504-4688 

Fax (402) 504-3281 

YES NO 

1. Was the entire structure(s) painted with the exception ofthe 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 y garages. 

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

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

two top coats? y 

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

5. Are all ofthe areas where contaminated materials have been spilled thoroughly yy 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 ^y 

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? ^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 temporarily re-located by the contractor 

y ^ that need to be moved back? 

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

been l y ' left unresolved? 

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

y^i%Ai^^ 

EPA COR Sienature 
PROFESSIONAL 

2505 Norlh 24'", Suite 219 ENVIRONMENTAL ENGINEERS, INC. Omaha, NE 68110 

(402) 504-4688 "Providing cost-effective environmental solutions" Fax (402) 504-3281 

Consulting • Engineering Des gn • Rpmedution • Abatement - Emeigency Responfe 

Property Owner Close-Out Form 

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

SAID: m^M 

Property Address: ^o^^^ ^ 1 ^ ^ ^ 

Owner's Name: Uj i Ca: S Or+j? -

Performance Standards/Close-Out Criteria YES NO 

1. Was the entire structure(s) painted with the exception ofthe 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? J ^ ^ 

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

two top coats? 

n 

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

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

vacuumed/ cleaned? 

t6. 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? r

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, r^ 

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. A 

10. Are there any property items that were temporarily re-located by the contractor 

that need to be moved back? 

2 ^ 

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

been left unresolved? 

^ Comments: 

V/<^/4/?//9 o/9^ / 7-[3-0Q 

Property Owner Signature Date 

7-/3-09 

Professional Efy^onmental Engineers Representative Date 
CONSENT OFR ACCESS TO PROPERTY 


OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID: 111 ^ M PROPERTY ADDRESS: XjlX^Vp 1\ ^ ^Z ^ 

OWNER NAME: 

DAYTIME PHONE: 

CELL PHONE: E-MAIL: 

OWNER'S ADDRESS IF DIFFERENT: 

TENANT'S NAME IF APPLICABLE: 

DAYTIME PHONE: f.^OJ? ) g't^^/ -^1 <^^5l " 

CELL PHONE: E-MAIL: 


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 ofcracked or flaking LBP from structures, application 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 outiined 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 fully 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 all obstructions from surfaces to be painted, (4) will 

abide by health and safety guidance provided by EPA, (S) 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 ofthe LBP stabilization actions, and (8) will partkipate in fmal 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 qnestions 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 Centen at 40^991-9583 (North Omaha ofTice) or 402-73U045 (South Omaha oflice). 

^ Yes, I grant accasa to my property and w n given the pamphlet D No, I do not grant acceti to my property and I vns 

'Renovate mght, Important Lead Information for Famlliet, Child given tha pamphlet "Ranovate Right, Important Laad 

Care Providers, and Schools.' Information for Famlllee, Childe Care Providere, and Schools." 

f T c. AI Qr^i^ . iLU sm 

«siaSlgnahire Oato i Signataire Date 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 

V 
©©iraifOFiJisiitoooii ©IF (^©©©Bpfi ©IF L®&i^ Pmmph M 

IE 

IPROFERTY ADDRESS OF Om m IF DIFFERENT Hm N PROPERTY BEING PAINTED: 

PROPERTY ADDRESS ZIP CODE 

I hava reoeived a oopy of Ihe pamphlet, Ranovato R/sfiit Important Laad Hsmsd liOBmetlon For Famlltea, 

ChOd Ca n PnwUa n An d Scftoob JnliDnnIng me of the potonlial risk of the lead hazanl exposure from 

renovation activity to be peifonned on dwelling unit, i reoeived this pamphlet befbre the work began. 

{"'y, "rii ^ \^it)(^li^y ^ 

A liiTBn UAUC AE bBnninfr l^ narc PRINTE i D NAME OF RECIPIEIlfr ^ OATE 

fr<f_Al /?rh ^ 

LttGNIGNATUR / E OF RECIPIENT 

SslNCertHlcaHon Option (ForTenantOocuplad Dwellings Only) 

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

below: 

[ J Rafusal To Sign - 1 oeitily that I have made a good faith eiort b deliver the pamphlet, lenavale right important 

lead hazanl Infonnatton for fsmiiies, ohiid care providere and schools; ID the rental dwelling unit listed above at the 

dais and lime Indicated and that the occupant reihised to sign the oonflmialion of recdpt. I fuilher oertHy that I 

have left a oopy of the pamphlet at the unit wHh oocupanl 

D UnamllaMa For agnataii* - 1 certify that I have made a good faith efibrt to deliver the pamphlet, renovate right; 

Important lead hazanl Infonnatton for familtos. ditto care provMera and schools, to the rental dwelling unit listed 

betow and that the oooipant was unavaDabto to sign the oonfirmaHon of leoeipL I further certify that I have left a 

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

^^^a(D^<V:iQy 5k 

PRINTED NAHE OF PERSON CERTIFYINO ATTEMPTED DELIVERy DATE AND TIME LEAD 

PAMPHLET DBJMERY 

ATURE OFffiOO N CERTIFYINO LEAD PAMPHLET 

Hols Rsgstdlng Btnlllng Opiion - as an altomallwe to deivBry in pereon. you may mal the taad pamphlst to the owner 

andtortananL PamphtBt mustbsmsiladsttoast 7 dsys before renovation. (DoumBntuMiaoarillatBofinBllngfroinihspost 

00NHP<UATI0N0FRBCBPrOFl£AOPAtff>HLET 0»D8 
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f ^ ^ Q.q-\/V JQOUUL • ^44 ^ 

COLOR 

(CONPlSfB jyjL SECnOII^ YESir NOir OR NON-AIVUIQIBLE) 

I AfiREETO THE COLORS USTED ABOVE. ONCE PAINnNG BEGINS^ I 

UNDERSTAND I CAN NOT CHANGE THE ABOVE SEUECTED COLORS: 

frt^ , Orl\^. 

PAKermraHPOReafiOfos 
Douglas Cdimty Accoimt Information Page 1 of3 

U5 

1

tt> Douglas County, Nebraska Property Record - R0417900001 j 

Print Reoort 

NEW Feature - Parcel Dimensions available Si scale 0-50 ft west of 52nd St - Vie w O n MB D 1 Information is valid as of 2009-6-3 Treasurer's Tax Reoort 

New Feature -•••• • Auto Sales Search 1 

i Owner | 

1 ORTIZ LUCAS 

2206 IST 1 ' 1 "^ ^ 

1 OMAHA NE 68107-0000 | 

Property Informatio n 

Key Number 1790 0001 04 1 

Account Type: Residential 

Parcel Number 0417900001 1 

Parcel Address: 2206 1 ST 

OMAHA NE 68107-0000 

Legal Description: SOUTH OMAHA CITY LOTS LOT 8 BLOCK 134 W 60 FT 

Value Informatio n | 

Land Improvement Total 1 

2009 $4,500.00 $75,500.00 $80,000.00 1 

2008 $4,500.00 $75,500.00 $80,000.00 

2007 $4,500.00 $75,500.00 $80,000.00 1 

2006 $4,500.00 $75,500.00 $80,000.00 1 

2005 $4,500.00 $43,200.00 $47,700.00 1 

2004 $4,500.00 $43,200.00 $47,700.00 j 

Sales Informatio n 1 

Sales Date: 2004-06-11 1 

Deed Type: WD 1 Book: 1 2004 Page: | 078037 1 

Price: $85,950.00 1 

Grantor NEBRASKA-IOWA PROP LC 1 

Grantee: LUCAS ORTIZ 1 

Valid/Invalid: Valid 1 

Exclusion Reason: 

Sales Date: 2004-03-04 1 

Deed Type: TRD Book: 1 2004 Page: 036918 i 

Price: $45,001.00 1 

Grantor Eric Lindquist 

http://dougIasne.mapping-onIine.com/DougIasCoNe/static/accountinfo.jsp?accountno=R041... 6/8/2009 
Douglas County Account Information Page 2 of 3 

< ^ 

Grantee: NE-IA Properties 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 1991-10-14 

Deed Type: Book: 1912 Page: 528 

Price: $37,750.00 

Grantor 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.06 3000.0 1.0 50.0 60.0 No 

Improvemen t Informatio n 

Building 1 

1 1/2 St«y Fin 2206 1 St 

immn 

liltaH 

»« tttr­

«•) t r Ml trnmult^. 134 

a? 

•wt.Bwrcw^a 

tXtlSI 

ei.r.«»«,*,H ituBSiifl 

»«•»».»•««• . 

1 CLICK TO ENLARGE IMAGE 1 

Square Footage: 1152.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Very Good 

Built As: 1 1/2 Story Fin Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 6.0 

Exterior: Frame Vinyl Units: 1.0 

interior: Drywali Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

http://douglasne.mapping-online.eom/DouglasCoNe/static/accountinfo.j sp?accountno=R041... 6/8/2009 
JC Painting 

G^Cvi "^^c 

Property Address

Start Date

 <3 3 0/r>

 v^ ­ Q ' q _

 ~XZ

 o q

 S T Date

 Complete Date

 >-^ ­ O^ -

'"/"- 11 ­ ^

 C)C^ 

 £> Cf 

Amount Of Prime And Paint Used 

Prime (Gallons) 

Poly (Boxes) o^ 

Paint (Color) fe>n^ Amount (Gallons) 5 ^ 

Pamt (Color) \.A.)WAo- Amount (Gallons) 

^ ^ 

Paint (Color) ^\n ^ Amount (Gallons) Porc\l r 

Paint (Color) Amount (Gallons) 

Paint (Color) Amount (Gallons) 
Professional Environmental Engineers, Inc. 

SAFETY AUDIT 

Ptoject Nome: ry^cyy? G J-^ y ' 

Date of Audit: ~ ^ - f ^ " ^ 7 

Primary Health Hazards: T'0<T /) A ^ 

Primary H & S Concerns: 

Daily Tasks: 1. .3C--rq^f'«y 

2. p g /M.^ yT 

3._dVil±. 

Equipment Used at Jobsite: 

Herd Hat Ladder 

Safety Glasses 4 > Boom Lifts 

Steel Toed Shoes J-y- GFCI ^ 

Work Gloves Safety Vests 

Generators j ^ Other _ ^ 

'yf ^ 

Equipment Ready for Emergency Response at Immediate Disposal: 

Daily Safety Meeting Conducted ly.. 

First Aid Kit / / 

Emeigency Ptocedures y ^ 

Company Health and Safety Policy y 

GFCI on-site l / 

Deficiericieb •.yJA 

(...oriec live Actions. A l I A 

Auditor: NiC^Acf ^ (A^r>y^/«r Date: ^ - /^ ' ' O / 

Site Suoervisor.^ ':i^/U...JtyU^J^falU*.o^ Date: ^ - 1 o - (5<^ 
PROFESSIONAL ENVIRONMENTAL ENGINEERS, INC. 

REUNION DiARiA DE SEGURIDAD 

Proyecto: Omaha Paint Stabilization Proiect 

Lugar: &c^oC ^ 3 r 

Sitio de Actividad: 

Tareas Diarias: 

1. ^ dsaf. 

2. /^)Vt/\.-r^ r 

3. rO^ry l -fPrimordial/Peligros Potenciales: __, 

]. .///->>/ /)^ ^ 3. Cyitln ( ^ n^_ yJ-^.'^:JcL/ 

2. C^'^dt:^ ' (J. ilr,('^/.^y~ 4. 

Herramientas de Trabajo: 

1. 't^C^- c va--? 3. if o OU-a. ( 

Practicas del Trabajo/Acciones Correctivas: 

1. N U 3. 

2. 4. 

Llamadas previas: 

]. ^>/ 4 3. 

2. 4. 

Firma de Registro del Empleado: 

1. ^cSov^ A ^l'^\f[UT(? - 3. 

2. /t;i'Cj|o-3 /H^-^U T 4. 

5. c77,r^A,^ ^) \ap-o - 6. 

7. /<:^^barcL^ Y^O^W la.fi/) 8. 

Firma de Salud y Seguridad del Sitio Fecha