TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID: 20214 Date: 12/27/2008 

Address: 1325 S 26 ST 

Remediation Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Video of property (DVD) 

?f Executive Summary 

w Signed Access Agreement for subject property 

0^ Painting Agreement 

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

D Photographs 

Sf Satisfactory restoration signed by Property Owner 

0 Property close-out check list signed by EPA 

H' Property information from Douglas County Assessor's Office 

D 

D 

D 

Ott*» 3(& y 02/02/0') 

"Signa^Se Date 

40308007 

Superfund 
PROPERTY SUMMARY 

Date: 12/27/08 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Month of: December 

^ ,.^ . , ,, , ..,„.v-..x..y^.v....«««.:i-. : • . . ..**-.... 

Property Address: 1325 S 26 ST SAID: 20214 

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: 11/17/2008 

Work Began: 11/19/2008 

Closeout Date: 12/1/2008 

Enclosures: 

1. Pre-Video 

2. Post-Video 

3. Property Status Form 

4. Signed Access Agreement 

5. Pre-Renovation Form 

6. Paint Match Form 

7. Tracldng Form 

8. Douglas County Assessor Property Information Page 

9. EPA Property Closeout form 

10. Property Completion Agreement 

TECHNOLOCIES, INC. 
• • 

Alc^ O^-j s ' AJo JV^ ^ 

ENVIRONMENTAL^ 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address:/33^^ S 3iQ S ' Date: 

Phone: BVID: aoa N 

3H$-"7 5 1.5' 

Plant & Pennanent Landscaping To Remain In Place 

Iteiii# 

Description and Location 

On Map f-r<>vv*V- i^<2y> ^ 

<Tv^ ^ 

Pre-Existing Condition of Stmctures 

- Does your Basement have a history of leaking? Yes — No :^< 

Ilein# Description & Location 

On Map er 

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Property Owner Prudent Employee 

Signature^ Signature: 

8080 Wtard ParkMy, Suite 40S 2608 N. 24*" Strtat, Sifib 308 4242 Medical Oitve, Suite 4280 

nmah a MAhrasIra M11A San Antnnln TVTe490 
QG)a\M 

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

Environmental Protectian Agency (EPA) to stabilize Lead Based Paint (LBP) at a number of propertie.^ 

located in Omaha, Nebraska, including the property located at__l225_ S ^^ . ' ^ 

The EPA requests your pennission to allow Prudent to perform LBP Stabilization at Ais property. By 

signing this form, ^ e property owner grants pennission to Prudent to perform activities related to LBP 

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

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

If you have any questions about the LBP stabilization planned for your property, please contact Pruder.1's 

/^rfminii^tive Clerk for the Lead Based Pamt Stabilization, Mrs. Deborah Akerele^ohnson. 

at (402) S04-1004. General questions about tiie Omaha Lead Site cleanup can be directed to the EPA 

Public hifonnation Centers at (402) 731-3045 (Soutii Omaha office) or (402) 991-9583 (North Omaha. 

office). 

(Please'PrintNtunll 

PfMiMtvOwnerStoudmr. 2y^^JJ^t^-^i^U^ ^y^.^'d^ ^ U

(Signature) ^ U

 ' ( 7 'O H 

 (Date) 

PROPERTY INFORMATION 

(To be cenplelcd bjr rcttdCBt aad/or property owner ­ please priDt) 

HminEOTMAMe! ^ro^wo^'^ C^>/- ^ sg= w '^QMat^ R«nter 

BBMPaiTADPREaS! l"^^* ? ^ ^t ^ ^ ^4 -

IP RENTAL, PROPERTY OWNED BY: 

OWNER«IIAIIINOAODRE88; ^^- ^ <^ 

OWNER'S TELEPHONE NUMBER. HOME: <Voa> ? ^ "T-75'/^RK ! J )_ 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: O NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER: <3> 

NUMBER OPCHILDREN UNDER 7 YEARS OLD WHO PU Y IN THE YARD FOR 8 HOURS OR MORE PER WEEK: ^ 

COMMENT80R8PECIAL INSTRUCTIONS: (l-E. DOOS, ENTRY OATES, ETC.) 

AtJTHOIUTY FOR ENVIR(>NMErn'AL RBSPOHSB ACTIONS; Tin aettvUet to be implcmentetf l>y 

OfCERCLA, 42 U.&C. 9604. EPA's right of access to the property isprovided Ibr in Section 104(e) ofCERCLA. 42 U.S. C 9605(e). which pnvides eetv 

fbr "deteimining the need (br lesponsc, or dumlflg ortaUog any lesponse action under Ihis title, or otherwise ei ^ 
if^.=^c \ 

paint match .ferm: 

Paint matching form: -7 

Property address: \^^S '^ sv^ ^ . BViD:5oaiU 

^oJ r t v ^ OOV^.Ve: t\.-.:>-.^n -u-:.^,^---5; ^jci^ ; 

Area;^^!^^;/.^ J ^:^^^Ttcr.s color: f^ ^ ^ q^c^l 

Explanation: 

PJ\C«-<::' telArea: v^^-*^ >w^ ^ ?-o^l;.. b col or: \^^' T 

Explanati on: 

Area: Color: 

Explanation: 

Area: color: 

Explanation: 

Area: Color: 

Explanation: 

Page 1 
Current Sample Pre-Renovation Form 

Effective until April 2010. 

Confinmatlon of Receipt of Lead Pamphlet 

^ I have received a copy of the pannphlet, Fienovate Right: Important Lead Hazard 

InfonnationforFamBies, CNId Care Providers and Schools infonning me of 

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

perfomied in my dwelling unit, i received this pamphiet tjefore the work began. 

r/'<auAog:S Ga>-y.^y:>e:.^ /t ' / I - O & 

Printed name of recipient Date 

signature of recipient // ^ 

Seif-Certiflcatlon Option (for tenant-occupied dwellings only) — 

If the lead pamphlet was deliveted but a tenant signature was not obtainable, 

you may check the appropriate box betow. 

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

pamphlet, flenovate F^t : Important Lead Hazard informationforFamSes, Chad Care Providers and Schools, to the rental dweiiing unit listed below 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 v ^ 

the occupant. 

Q Unavaiiablefbrsignature—I certify that I have made a good faith effort to 

deliver the pamphlet, Renovate Right Important Lesd Hazard Inkmatfon for 

FamSes, CNki Care provldera and Schods, to the rental dwelling unit listed 

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

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

underthedoor. 

(jpg^aAi l QLov.y^Va^yv //-/'? -Ofi /C3 0 

Printed name of person certifying Attempted deliver delivery 

dateandtimee 

lead pamphiet delivery

A-.x/ro- ^ 

Signature of person certifying lead pamphlet delivery 

130-- ^ <>• ^^^- ^ S ^ 

(^r^.J^.. ^ .M^ (^^iO ^ 

UnitAddress 

Note Regarding Mailing Option — As an aitematlve to delivety in person, you 

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

at least 7 days befbre renovation (Document vvith a ceitlficate of mailing from the 

postoflice). 
ACCESS lM(=ORt^/>ariaiTR^GKIHQ SHEET 

pfiopcerv nr.-^\a TSS:^^ MP'S -^-o/. s^. 

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M. 

ABOMOBMOR Jjj^rug^<--;VN,4­

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Douglas County Account Information http://douglasne.mi a|A|g-a|fei e.com/DouglasCoNe/static/ECCOuntinfo., 

Douglas County, Nebraska Property Record -- R221S900000 

j Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 90th St - Vie W OP iVIap * Informatio r 1 is valid as of 2008-11-5 Treasurer's Tax Report i 

New Feature -*-*' * Auto Sales Search !.__. 

Owner 

CAMPSEY FRANCES 

ETAL 1 

1325 S 26 ST 

OMAHA NE 68105-0000 i 

Property Informatio n j 

Key/Vumber: 1 1890 0000 22 | 

Account Type: Residential 1 

Parcel Number: \ 2218900000 

Parcel Address: 1325 S 26 ST 

OIVIAHANE 68105-0000 

Legal Description: SHULLS 2ND ADD LOT 16 BLOCK 10 50 X 127 1 ­ I 

Value Informatio n 

1 Land > Improvement i Total 

2008 $4,900.00 $75,000.00 $79,900.00 

2007 $4,900.00 ' $75,000.00 $79,900.00 , „ ' 

2006 1 $4,900.00 $63,600.00 1 $68,500.00 

2005 $4,900.00 $63,600.00 ! $68,500.00 

2004 ! $4,900.00 $63,600.00 1 $68,500.00 j 

2003 $4,900.00 $63,600.00 $68,500.00 

'• • •" • ­ 1 

Land Informatio n 

Acres 1 SF 1 Units j Depth 1 Width , Vacant 

0.14 i 6350.0 1.0 ' 127.0 50.0 1 No 

Improvemen t Informatio n 

Building 1 ] 
w-w Douglas County Account Information http://douglasne.ma||gi e.com/DouglasCoNe/static/accountinfo., 

Square Footage: 1520.0 Percent Complete: 100.0% ; J 

Perimeter 0.0 Quality: i Average 

Unit Type: . Condition: Average 

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

HVAC: Central Air to Air j Rooms: ' 8.0 

Exterior: Frame Shingle Units: 1 1.0 

Interior: Piaster \ Baths: ; 2.0 

Roof Cover: Composition Shingle ! Bedrooms: : 3.0 

Roof Type: Gable | Stories: ! 1-5 

Floorcover: Allowance \ Foundation: ^ Block 1 

i „, „ _ .1 ! 1 

j Sprinkler Square Footage: i0.0 

YearBuilt \ „ ^^^ ^ ^ i /^'T! ^ Remodeled 1 Remodeled 1 '"r.i"'' ' ; '^^'«'-«- ! 

1890 j 0 j 0% \ 1890 i1 118 1j 

i Defa/7 Type 1 Detail Description Units] 

i Appliance \ Allowance „ . .-"-oJ 

Basement Bsmnt Block 8 ft 966.0 ; 

Basement 1 Finished 600.0 1 

Fixture 1 Base Fixtures 1 1.0 

Fixture Bath Full 2.0 ! 1 ^ Garage Detached i 384.0 : 

Porch Solid Wall ; 120.0 

User Attic Full Finish 554.0J L. 

I 1 /»'>i'^/\/\ 0 •I'^.r* ^ T^» M 
Douglas County Account Infonnation http://douglasne.manwog-Mliie.com/DouglasCoNe/static/accountinfo. aoHog-^ljiii ,

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First Floor See.Oiq t?. 

1 

i= f 

Secoral Floor 55< 0 sq n 

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its 

1 1/2 STORY FINISHED 

CLICK TO ENLARGE IMAGE 

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Jtiiie 26 , 2008 Oatcst revision) 

EPA Property Close-Out Form (Lead-Based Paint Stabilization) 

Blick and Veitch Property ID Nnnit>en . ^ ^ ^ 

Prop«Tty AdJim* 

OwniR^iiNaaMi: 

Perfofmatice Standards /Close-Otit Criteria .._______ yes no 

1. Wai to attire stmcture(s) painteid whh the exc«ption of (bt stated, cxcludtd areas? This would 

include painting of other associated foaturei including fascia, caves, siding, all triin, porches, box 

/ ..

 baBtt.ooltinntt,ndla.^and exterior surfaces of garages. ' 

2. WiaaUscraiHiQ snd Other preparation work cotnpletedsatis&ctori / 

3. Wen aU required apeias of the stroctupe(s) primed as needed and painted with two top coats? / 

4. Wii the paint products utilized equiv-alcnt tc a 30 ysai produa/qualiry? / 

5. Art all of tlie areas where contamiiraitcd materials have been spilled thoroughly vacuumed'cleaned? / 

6. Dkl Ibe ctintrectiorcoUect/vaciiam all Min g and scraped paim chips on the entire i»^ ^ / nMdwgyg.allq^^imys.pnblte access areas and also remove any otiiCT generated debi^ 

7. b fte grass ve a that stntounds die stracture(s) in reasonably good condition? / 

8, Ara aU Items such as polyethylene sheeting, ladders, paint brushes, cones, barrier tape, etc. properly 

/ rtOJovcd?. _ •

 - ... .. _ . 

9. U there any evidence of property damage that was done by the contractor? Any propetty damage 

/ " . . Jeate to ti» ewnpliited prior to die EPA Close-Out . 

10. An tiiat any propeity hems that were temporarilyre>located by the contractor that need to be 

/ ntovedbadc? 

lli Arethere any (known) Ungenitg issues with tbe propcm- ownsr^s) Lhat have been left unresolved? / 

Other Considerations/Property Owne r Discussions/Additional Work that is Required 

EPA COR/RcSpt^s^entatiVie ,^^,..-,,-A a 

Date. ..jxi./.'//o:i-. 
• • 

Prudent Property Close>Out Form (Lead-Based Paint Stabilization) 

SAID:_J04t j 

Property Address; 13RS ^ S ' ^U > S"T~ 

Owner's Name; ^Ku>yvC£.S . <C!^.inr\J3SPJU 

Performance Standards/close-Out Criteria 

YES NO 

Was the entire structure(s) painted vi/rth the exception of the stated, excluded areas? This would 

l y include painting of other associated features including fascia, eaves, siding, all trim, porches, box 

beams, colunnns, rails, and exterior surfaces of garages. 

2. Was all scraping and other preparattion vtfork 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? l^ 

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

thoroughly vacuumed/ cleaned? u

6. Did the contractor collect/vacuum all falling and scraped paint chips on the entire property, 

L ^ 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? 

L.*::^ 

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

properly removed? 

9. Is there any evidence of property damage that was done by the contractor? Any property damage m L' 

needs to be completed prior to the EPA Close-Out. 

10. Are there any property items that were temporatiiy 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? L ^ 

Other Considerations?property Owner Discussions?Additional Work that is Required 

CLJ\JW <gX^ 

esentative 

/a-^ 

/u^>^^ 77