## TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL EFOLDE R SAID#: f I IS M Date : ^-g.l-0° l Address : r9( 3 D t fi -H T S T Remediatio n Contractor: PROFESSIONA LENVIRONIVIENTALENGINEER S Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f property (DVD ) Executiv e Summar y Signe dAcces s Agreemen t fo r

subjec t propert y Paintin g Agreemen t Settlemen t document s (i.e. , ib r damag e o r l o replac e plants , etc. ) Photograph s pHg
- /2AC ( Pog T Satisfactor y restoratio n signe db y Propert y Owne r Propert y close-ou t chec k lis t signe db y EP A Propert y informatio n fro mDougla s Count y Assessor' s Offic e ^ 

### _confirmatio n tha t lea dpamphle t "Renovat e Right " wa s receive dby P O ^ D D



### Professional Environmental Engineer s Signature Date

EP A Signature 

# M ^

3009436 5 Superfun c

## PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC . ''' ' 'Sma^N E e'sn o "Providin g cost-effectiv e environmenta l solutions " ^ Consultin g • Engineerin g Desig n • Remediatio n • Aljatecnen t • Emergenc y Respons e 

### ^ S^oo ! =^!'QOO ? Fa x (402 ) 504-328 1



### Lea dBas e Stabilizatio n Omaha , Ne Clos e Ou t Repor t 200 9 

### SAID#113 4 220 6 I S t

Date s worked : 07/0 9 t o 07/1 1 200 9 Pr e propert y condition : Hous e ha dmostl y viyn l sidin g wit hwoo dtri mareas . Fron t porc han dsoffit s ha dflakin g pain t an dwer e i n poo r condition . Garag e pain t in very poo r conditio n an dwa s flaking off . Pain t chip s i n yar d Problem s encountered : Non e Owne r request/concerns : Inspection/closeou t dates . Owne r signe d07/1 3 EPA close dou t 07/17 , n o issues .

# PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC . "Providiti g cost-effectiv e environmenta l solutions " Consultin g • Engineerin g De s g n • Remcc i utio n • Abatemen t • Emergenc yReRpniis p 

### EP A Close-Ou t For m (Lead-BasedPain t Stabilization EP A Contrac t EP-R7-08-06 ) SAID : 

# lll?> U Propert y Address : QdDLt Z U CST : Owner' s Name : [ \iCfM S f^rY\7 l Performanc e Standards/Close-Ou t Criteri a 250 5 Nort h 24'" , Suit e 21 9 Ornaha , N E 6811 0 (402 ) 504-468 8 Fa

x(402 ) 504-328 1



### YE S N O 1 . Wa s th e entir e structure(s ) painte dwit hth e exceptio n ofth 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 , andexterio r surface s o f 

# y garages . 2 . Wa s all scrapin g andothe r preparatio n wor k

complete dsatisfactorily ? y ^ 

### 3 . Were all require darea s ofth e structure(s ) prime da s neede dandpainte dwit h tw o to p coats ? 

## y 4 . Wa s th e pain t product s utilize dequivalen t to a3 0 yea r product/quality ? 5 . Are all ofth e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y y 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 andals o remov e any 

# ^y other 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 all item s suc ha s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . properl y removed ? 

## ^ y 9 . I s there any evidenc e o f property damag e tha t wa s don e by th e contractor ? Any property damag e need s t o b e complete dprio r to th e EPA Close-Out . « / 

### 10 . Are ther e any property item s that wer e temporaril y re-locate db y th e contracto r y ^ 

### tha t nee dt o b e move dback ? 11 .Are ther e any (known ) lingerin g issue s wit hth e property owner(s ) that hav e l y ' 

### been lef t unresolved ? Other Considerations/Property Owne r Discussions/Additional Wor k

tha t i s Required : 

# y^i%Ai^ ^ EP A CO RSienatur e

# PROFESSIONA L 250 5 Norl 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 " Fa x(402 ) 504-328 1 Consultin g • Engineerin g De s g n • Rpmedutio n • Abatemen t - Emeigenc yResponf e 

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

# m^ M Propert y Address : ^o^^^ ^ 1 ^ ^ ^ Owner' s Name : Uj i Ca: S Or+j?
- Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) painte dwit hth e exceptio n ofth 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 , andexterio r surface s o f ^ 

### garages . 2 . Wa s all scrapin g andothe r preparatio n wor k

complete dsatisfactorily ? J ^ ^ 

### 3 . Wer e al l require darea s ofth e structure(s ) prime da s neede dan dpainte dwith tw o to p coats ? 

# n 4 . Wa s th e pain t product s utilize dequivalen t to a3 0 yea r product/quality ? q ^ 

### 5 . Are all ofth e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y vacuumed / cleaned ? 

# t6 . Didth e contracto r collect/vacuu mal l fallin g andscrape dpain t chip s o n th e entire property , roadways , alleyways , publi c acces s area s andals o remov e an y 

# r other 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 , 

# r ^ barrie r tape , etc . properl y removed ? • ^ 

### 9 . I s there any evidenc e o f property damag e that wa s don e by th e contractor ? Any property damag e need s t o b e complete dprio r t o th e EPA Close-Out . 

# A 10 . Are there any property item s that wer e temporaril y re-locate dby th e contracto r that nee dt o b e move dback ? 

## 2 ^ 11 . Are ther e any (known ) lingerin g issue s wit hth e property owner(s ) that hav e bee n lef t unresolved ? ^ 

### Comments : 

# V/<^/4/?// 9 o/9^ / 7-[3-0 Q Property Owner Signature Date 

# 7-/3-0 9 Professional Efy^onmenta l Engineer s Representativ e Date

# CONSEN T OF R ACCES S T O PROPERTY OMAH A LEA D SIT EREMEDIA LACTIO N - LEAD-BASE D PAIN T STABILIZATIO N PROPERT Y ID : 11 1 ^M PROPERT Y ADDRESS : XjlX^V p 1\ ^ ^Z ^ OWNE RNAME : DAYTIM EPHONE : CEL LPHONE : E-MAIL : OWNER' S ADDRES S I FDIFFERENT : TENANT' S NAM EI FAPPLICABLE : 

### DAYTIM E PHONE : f.^OJ ? ) g't^^ / -^ 1 <^^ l 

# 5 " CEL L PHONE : E-MAIL : 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 Agenc y (EPA ) t o stabiliz e lea dbase dpain t (LBP ) o n residentia l structure s a t anumbe r o f propertie s locate di n Omaha , Nebraska . Th e pain t stabilizatio n wor k i s bein g don e t o protec t th e soi l cleanup s tha t wer e performe db y EP A contractors . Pain t stabilizatio n activitie s wil l include : scrapin g ofcracke do r flakin g LB Pfro mstructures , applicatio n o f aprim e coa t an d tw o (2 ) coat s o f paint . Movin g part s o f window s an ddoor s ar e no t include dan dwil l no t b e addressed . You r 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 fo r th e purpos e o f stabilizin g lea d-base dpain t a s outiine do n th e propert y identifie dabove . B y signin g thi s documen t I agre e t o allo w a n EP A contracto r t o conduc t asoi l cleanu p a t my propert y followin g completio n o f 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 soi l cleanu p contracto r wil l b e boun dto . I furthe r understan dtha t th e soi l cleanu p contracto r wil l mak e 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 fully understan dtha t b y signin g thi s Consen t fo r Access , (1 ) thi s acces s wil l remai n i n effec t unti l th e wor k ha s bee n satisfactoril y completed , (2 ) tha t th e Propert y Owne r o r Tenant , if applicable , wil l b e give n th e Housin g an dUrba n Developmen t (HUD ) an dEP A pamphlet , "Renovat e Right , Importan t Lea dHazar dinformatio n fo r Families , Da y Car e Providers , an dSchools" , (3 ) th e Propert y Owne r o r tenan t will remov e al l obstruction s fro msurface s t o b e painted , (4 ) wil l abid e b y healt han dsafety guidanc e provide db y EPA , (S ) wil l allo w photograph y o f propert y befor e an dafte r th e pain t stabilizatio n work , (6 ) wil l b e contacte db y aP Erepresentativ 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 ofth e LB Pstabilizatio n actions , an d(8 ) will partkipat e i n fmal propert y inspectio n an d sig n th e Completio n Agreemen t an dPropert y Owne r Satisfactio n Survey . Shoul dyo u hav e an y question s abou t th e plane dLea dBased-Pain t stabilizatio n activitie s fo r 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 qnestion s abou t th e Omah aLea dSit e cleanu p ca n b e directe dt o Paulett aFrance-Isetts , EP A Remedia l Projec t Manage r 402-731-2454 , o r th e EP A Publi c Informatio n Cente n a t 40^991-958 3 (Nort hOmah aofTice) o r 402-73U04 5 (Sout hOmah aoflice) . ^

Yes , I gran t accas a t o m ypropert yan d w n give n th e pamphle t D No , I d o no t gran t accet i t o m ypropert yan d I vn s 'Renovat e mght , Importan t Lea d Informatio n forFamlliet , Chil d give n th a pamphle t "Ranovat e Right , Importan t Laa d Car e Providers , an d Schools. ' Informatio n forFamlllee , Child e Car e Providere , an d Schools. " 

### f T c . A I Qr^i^ . 

# iL U 

# s m Slgnahir e Oat o 

### «sia i Signatair e Dat e

SPECIA L INSTRUCTION S AN D CONSIDERATION S 

# V

# ©©iraifOFiJisiitoooi i ©I F(^©©©Bpf i ©I FL®&i ^ PmmphM

I E IPROFERT YADDRES S O F Om m I F DIFFEREN THm N PROPERT YBEIN G PAINTED : PROPERT YADDRES S ZI P COD E I hav a reoeived a oop yo f Ih e pamphlet , Ranovat o R/sfii t Importan t Laa d Hsms d liOBmetlo n Fo rFamlltea , ChO d Ca n PnwUa n An d Scftoo b JnliDnnIn g m e o f th e potonlia l risk o f th e lea d hazan l exposur e fro m renovation activit yt o b e peifonne d o n dwellin g unit , i reoeive d thi s pamphle t befbr e th e wor k began . 

# {"'y , "rii ^ \^it)(^li^y ^ liiTB n UAU C A E bBnninf rl ^ nar c 

# A i PRINTE D NAM E O F RECIPIEIlf r^ OAT E 

## fr<f_A l /?rh ^ IGNATUR E O F RECIPIEN T LttGN /

SslNCertHlcaHo n Optio n (ForTenantOocupla d Dwelling s Only ) I fth e lea d pamphle t wa s delivere d bu t a tenan t signatur e wa s no t obtainable , yo u ma ychac k th e appropriat e bo x below : [ J Rafusa l T o Sig n - 1 oeitil ytha t I hav e mad e a goo d fait h eior t b delive rth e pamphlet , lenaval e righ t importan t lea d hazan l Infonnatto n fo rfsmiiies , ohii d car e provider e an d schools ; I D th e rental dwellin g uni t liste d abov e a t th e dai s an d lim e Indicate d an d tha t th e occupan t reihise d to sig n th e oonflmialio n o f recdpt . I fuilhe roertH ytha t I hav e lef t a oop yo fth e pamphle t a t th e uni t wH h oocupan l 

# D UnamllaM a Fo ragnataii * - 1 certif ytha t I hav e mad e a goo d fait h efibr t to delive rth e pamphlet , renovat e right ; Importan t lea d hazan l Infonnatto n forfamiltos . ditt o car e provMer a an d schools , to th e rental dwellin g uni t liste d beto wan d tha t th e oooipan t wa s unavaDabt o to sig n th e oonfirmaHo n o f leoeip L I furthe rcertif ytha t I hav e lef t a cop yo fth a 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 . 

## ^^^a(D^<V:iQ y 5k PRINTE D NAH E O F PERSO N CERTIFYIN O ATTEMPTE D DELIVER yDAT E AN D TIM E LEA D PAMPHLE TDBJMER Y

ATUR E OFffiOO N CERTIFYIN O LEA D PAMPHLE T Hol s Rsgstdln g Btnllln g Opiio n - a s a n altomallwe to deivBr yi n pereon . yo u mayma l th e taa d pamphls t to th e owne r andtortanan L PamphtBt mustbsmsiladsttoas t 7 dsy s befor e renovation. (DoumBntuMiaoarillatBofinBllngfroinihspos t

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## I AfiRE E TO TH E COLOR S USTE D ABOVE . ONC E PAINnN G BEGINS ^ I UNDERSTAN D I CA N NO TCHANG E TH E ABOV E SEUECTE D COLORS : 

## frt^ , Orl\^ . PAKermraHPOReafiOfo s

### Dougla s Cdimt y Accoim t Information Pag e 1 of3 

# U 5 

# 1

tt > Dougla s County , Nebrask a Propert yRecor d - R041790000 1 j Prin t Reoor t NE W Featur e - Parce l Dimension s availabl e S i scal e 0-5 0 f t wes t o f 52n d S t - ViewO n MB D 1 Informatio n i s vali d a s o f 2009-6- 3 Treasurer' s Ta xReoor t Ne wFeatur e -•••• • Aut o Sale s Searc h 1 i Owne r| 1 ORTI Z LUCA S

220 6 IS T1 ' 1 "^ ^ 1 OMAH AN E 68107-000 0 |

Propert yInformatio n Ke yNumbe r 179 0 000 1 0 4 1 Accoun t Type : Residentia l Parce l Numbe r 041790000 1 1 Parce l Address : 220 6 1 S T OMAH AN E 68107-000 0 Lega l Description : SOUT H OMAH ACITYLOT S LO T8 BLOC K13 4 W 6 0 FT Valu e Informatio n | Lan d Improvemen t 

### Tota l 1 200 9 $4,500.0 0 $75,500.0 0 $80,000.0 0 1 200 8 $4,500.0 0 $75,500.0 0 $80,000.0 0 200 7 $4,500.0 0 $75,500.0 0 $80,000.0 0 1 200 6 $4,500.0 0 $75,500.0 0 $80,000.0 0 1 200 5 $4,500.0 0 $43,200.0 0 $47,700.0 0 1 200 4 $4,500.0 0 $43,200.0 0 $47,700.0 0 j Sale s Informatio n 1 Sale s Date : 2004-06-1 1 1 Dee d Type : 

### W D 1 Book : 1 200 4 Page : | 07803 7 1 Price : $85,950.0 0 1 Granto r NEBRASKA-IOWAPRO P LC 1 Grantee : LUCA S ORTI Z 1 Valid/Invalid : Vali d 1 Exclusio n Reason : Sale s Date : 2004-03-0 4 1 Dee d Type : TR D Book : 

### 1 200 4 Page : 03691 8 i Price : $45,001.0 0 1 Granto r Eri cLindquis t 

### http://dougIasne.mapping-onIine.com/DougIasCoNe/static/accountinfo.jsp?accountno=R041.. . 6/8/2009

### Dougla s County Accoun t Informatio n Pag e 2 o f 3 < ^ Grantee : NE-I APropertie s Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 1991-10-1 4 Dee d Type : Book : 191 2 Page : 52 8 Price : $37,750.0 0 Granto r Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 

### 0.0 6 3000. 0 

### 1. 0 50. 0 60. 0 N o Improvemen t Informatio n Buildin g 1 1 1/ 2 St« yFi n 220 6 1 S t imm n lilta H » « tttr­

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tXtlS I ei.r.«»«,*, H ituBSiif l »«•»».»•««• . 1 CLIC KTO ENLARG E IMAG E 1 Squar e Footage : 1152. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Ver yGoo d Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 6. 0 Exterior : Fram e Viny l Units : 

### 1. 0 interior : Drywal i Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 

### http://douglasne.mapping-online.eom/DouglasCoNe/static/accountinfo. j sp?accountno=R041.. . 6/8/200 9

### JC Paintin g 

## G ^Cv i 

# "^^ c Propert yAddres s Start Dat e <3 3 0/r > v^ ­ Q ' q _ ~X Z

o q S TDat e Complet e Dat e >- ^ ­ O^ - '"/" - 1 1 ­ ^ C)C ^ £ > C f 

### Amoun t Of Prim e An d Pain t Use d Prim e (Gallons )

Pol y(Boxes ) o ^ Pain t (Color ) 

# fe>n^ Amoun t (Gallons ) 

# 5 ^ Pam t (Color ) 

### \.A.)WAo - Amoun t (Gallons ) ^ ^ Pain t (Color ) 

# ^\n ^ Amoun t (Gallons ) Porc\l r Pain t (Color ) Amoun t (Gallons ) Pain t (Color ) Amoun t (Gallons )

## Professiona l Environmenta l Engineers , Inc . SAFET YAUDI T Ptojec t Nome : ry^cyy ? G J- ^ y ' Dat e o f Audit : ~ ^ - f ^ " ^ 7 Primar yHealt h Hazards : T'0< T/)A^ Primar yH & S Concerns : Dail yTasks : 1 . .3C--rq^f'« y 

## 2 . p g /M. ^ y T 

# 3._dVil± . Equipmen t Use d a t Jobsite : Her d Ha t Ladde r Safet yGlasse s 4 > Boo m Lifts Stee l Toe d Shoe s J-y - GFC I ^ Wor k Glove s Safet yVest s Generator s j ^ Othe r _ ^ 

## 'y f 

## ^ Equipmen t Read yfo rEmergenc yRespons e a t Immediat e Disposal : Dail ySafet yMeetin g Conducte d ly. . Firs t Ai d Ki t / / Emeigenc yPtocedure s y ^ Compan yHealt h an d Safet yPolic yy GFC I on-sit e l / Deficiericie b 

# •.yJ A (...orie c liv e Actions . A l I A

Auditor : NiC^Acf ^ (A^r>y^/« rDate : ^ - /^ ' ' O / Sit e Suoervisor. ^ ':i^/U...JtyU^J^falU*.o ^ Date : ^ - 1 o - (5< ^

### PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC . REUNIO N DiARi AD E SEGURIDA D Proyecto : Omah a Pain t Stabilizatio n Proiec t 

## Lugar : &c^o C ^ 3 r Siti o d e Actividad : Tareas Diarias : 

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# 1 . N U 

# 3. 2 . 4 . Llamada s previas : ] . ^>/ 4 3 . 2 . 4 . Firm a d e Registr o de l Empleado : 

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