## TRANSMITTA L of OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R 

# Date : AOLM l

Stabilizatio n Contractor : Professiona l Environmenta l Engineer s Year : 2DX l PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUIVIENT S 0 ^ Vide o ofpropert y (DVD ) Executiv e Summar y Signe dAcces s Agreement fo r subjec t propert y Pre-Renovatio n For msigne db y Property Owne r Pre-Renovatio n For mfo r Occupant/Tenant , i f applicabl e Paintin g Agreement t J Settlemen t document s (i.e. , fo r damag e o r to replac e plants , etc. ) Renovatio n Recordkeepin g Checklis t signe dby Certifie dRenovato r 

## A T Photograph s Satisfactor y close-ou t chec k lis t signe db y Property Owner Propert y close-ou t chec k lis t signe db y EPA Propert y informatio n fro mDougla s Count y Assessor' s Offic e Hazardanalysis , if prepare d 4037756 0 

### QSafet y Audi t 

# Hilil l t s Other (describe) : Superfun d



### IDate ' 

# 4 i ^ t
EPAfcoiCSI g lature (after file folde r review )250 5 Nort h 24* , Suit e 21 9 Omaha , N E 6811 0 (402 ) 504-468 8 Fa x(402 ) 504-328 1 

# PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC . "Providin g cost-effectiv e environmenta l solutions " Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yRespons e



### Lea dBas e Stabilizatio n Omaha , N e Clos e Ou t Repor t 201 1 SAID #3984 8 244 9 Bauma n Av

•Date s worked : 9/2 1 t o 9/2 2 201 1 • Pr e propert y condition : Hous e an dgarag e hav e painte dwoo dsidin g wit h painte d woo dtrim s an dfoundatio n areas . Pain t wa s flakin g of f

i n areas . • Problem s encountered : None . • Owne r request/concerns : Colo r change . • Inspection/closeou t dates . Owne r 9/22/1 1 ^Of ^ 1/2^// /

### 201 1 

# PROFESSION) ^ 250 5 Nort 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 " Fax(402 ) 504-328 1 Consultin g • Engineerin g Desig n • Remediatio n • Abatement • Emergenc yResponse 

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

# im ^ Propert y Address : 299 ^ L>C(l/f1^0h Owner' s Name : y\^8\!l| 0 ^%^V\C ^ Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) painte dwit h th e exceptio n ofth e stated , exclude dareas ? 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 , an dexterio r surface s o f garages . 2 . Wa s al l scrapin g an dothe r preparatio n wor k

complete dsatisfactorily ? 3 . Were al l require darea s ofth e structure(s ) prime da s neede dandpainte dwith tw o to p coats ? 4 . Wa s th e pain t product s utilize dequivalen t t o a2 5 yea r product/quality ? 5 . Are al l ofth e area s where contaminate dmaterial s hav e bee n spille dthoroughl y vacuumed / 

## i X cleaned ? 6 . Di dth e contractor collect/vacuu mal l fallin g an dscrape dpain t chip s o n th e entir e property , 

# y roadways , alleyways , publi c acces s area s an dals o remov e any othe r generate ddebris ? 7 . I s th e gras s are atha t surround s th e structure(s ) i n reasonabl y goo dcondition ? 

# y 8 . Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . 

## t / properl y removed ? 9 . I s ther e any evidenc e ofpropert y damag e tha t wa s don e b y th e contractor ? Any property damag e need s t o b e complete dprio r t o th e EPA Close-Out .

• ^ 

### 10 . Ha s th e propert y owne r signe dth e completio n form ? 11 . Ar e ther e an y propert y item s tha t wer e temporaril y re-locate db y th e contracto r that nee dt o b e move dback ? 12 . Ar e ther e an y (known ) lingerin g issue s wit h th e property owner(s ) that hav e bee n lef t unresolved ? Other Considerations/Property Owne r Discussions/Additiona l Wor k

that i s Required :

EP A CO RSignatur e ' Dat e

# PROFESSIONA L 250 5 Nort 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 Desig n • Remediatio n • Abatemen t • Emergenc yRespons e 

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

## Propert y Address . ^^^T , . j^^^l^k T ^'J ^ Owner' s Name : T " ^^VW ^'W ^ I ­ p- j •r- ^



### Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) painte dwith th 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 , an dexterio r surface s o f ^ 

### garages . 2 . Wa s al l scrapin g an dothe r preparatio n wor k

complete dsatisfactorily ? / 

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

# K 4 . Wa s th e pain t product s utilize dequivalen t t o a3 0 year producL'quality ? < 

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

# K 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 an dals o remov e any ^ 

### othe r generate ddebris ? 7 . I s th e gras s are atha t surround s th e structure(s ) i n reasonabl y goo dcondition ? < 

### 8 . Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , \ 

### barrie r tape , etc . properl y removed ? 9 . Istherean y evidenc e ofpropert y damag e that wa s don e b y th e contractor ? Any property damag e need s t o b e complete dprio r t o th e EP A Close-Out . 

# K 10 . Ar e ther e an y property item s tha t wer e temporaril y re-locate db y th e contracto r tha t nee dt o b e move dback ? < 

### 11 . Ar e ther e an y (known ) lingerin g issue s wit h th e property owner(s ) tha t hav e 

## A J L bee n lef t unresolved ? Comments : 

# ^A>// / Property Owne r Signatur e Dat e 

# lA w Professional Enviroimiental Engineer s Representativ e Dat e

### Professiona l Environmenta l Engineers : EP A Pain t Stabilizatio n 201 1 

# sAiD # :^fflM8 J Propert yAddres s 

# n m

# hmn ^ Au Stories/Sidin g typ e 

# ] kTransit e Viny l Meta l Stucc o \ I L Woo d Garage ? Ye s N o Painted ? Ye s N o Where ? Sidin g Dat e acces s signe d 

### 0/l^/ n 

# M / 0 Tri m Pre-vide o 4{|/^l| l Pos t vide o Contracto rAssigne d / l j4i/M.jQ ^ Oat e starte d 9' ^

"/" ^ Dat e ende d ^ ' I'X-7 ] Weathe rCondition s

Pain t use d Prim e use d Pol yuse d Problems/Issue s(ci'rci;i.i\ e Apri l 2iD10)


### RENOVATIO N RECORDKEEPIN G CHECKLIS T
Nam e o f Firm : 

# Sl^\^fe/LA£ 7 ^ikfTid^ , Dat e an dLocatio n o f Renovation : Brie f Descriptio n o f Renovaiion ; Nam e o f Assigne dRenovator ; /VyHM^g^A ^ 0^7' . Name(s ) o f Traine dWorkers : Nam e o f Dus t Samplin g Technician . Inspector , and/o r Risk Assessor , i f used : A Copie s o f renovato r an ddus t samplin g technician qualification s (trainin g certitlcates . certincations ) o n fi l 'T~

- Certifie drenovato r provide dtrainin g t o worker s o n (chec k al t tha t apply)

­ ^Postin g warnin g sign s 7 Settin g u p plasti c containjnen t harrier s '{('Maintainin g containmen t ^Avoidin g spreadof dus t t

o adjacen t area s 3,^VVast e handlin g '/^Post-renovatio n cleanin g ij^r—Tes t kit s use db y certifie drenovato r t

o determin e whether lea dwa s presen t o n component s affecte db > renovatio n (identif y kit s use dan ddescrib e sam.plm g location s andresults .
5 ^ Warnin g sign s poste da t entranc e t o wor k

area . .feC^or k

are acontaine dt o preven t spreadof dus t an ddebri s ^Window s i n andwithi n 2 0 fee t ofth e wor k

are aar e close d j /

Door s i n an dwithi n 2 0 fee t ofth e wor k

area s ar e close dan dseale d ^Door s tha t mus t be use di n the wor k

are aare covere dt o allo w passag e bu t prevent sprea do f dust . vGroun dcovere db y plasti c sheetin g extendin g 1 0 fee t fro mwor k

are a- plasti c anchore dt o the nuildin g an dweighte ddow n by heavy objects . Ifnecessary . vertica l contairunen t installe dt o prevent migratio n o f dus t an ddebri s t o adjacen t dro perty . ?—Wast e containe don-sit e an dwhil e bein s transporte dotT-sit eijiiectiv'. ' .^\prii 2010 ) 

### 5!S-\V'or k

site properl y cleane dafte r renovation . I^Al l chip s an ddebri s picke dup . protectiv e sheetin g misted , foldeddirt y sid e inward , andtape dfo r rem.ovai . ^ Wor k

are aHEPA vacuume dt o ge t paint chip s fro mgroun dsurface , ifnecessary . (Z

S Certifie drenovato r performe dposi-renovatio n cleanin g verificatio n (describ e results) '

^ ! cenif y unde r penalt y o f la

w tha t th e abov e informatio n is tru e an dcomplet e

Nam e an dTitle Dat e

# m B Dougla s County , Nebrask a Propert yRecor d - R174994000 0 Prin t Repor t Vie w Interactiv e GI S Ma o Infomiatio n i s vali d a s o f 2011-7-2 9 Treasurer' s Ta xRepor t Ne w Featur e -•-*- > Subdivisio n Sale s Searc h Owne r 

### ^^r<xM ^ ^' U STARK S KEVI N D ETA L 244 9 BAUMA N AV E OMAH A N E 68112-000 0 

# (uoz] qS7-^^7 ^ f^oz ] Hf^i-Ho ^ Propert yInfomiatio n Ke yNumber : 499 4 000 0 1 7 Accoun t Type : Residentia l Parce l Number : 174994000 0 Parce l Address : 244 9 BAUMA N A V OMAH A N E 68112-000 0 Lega l Description : MINN E LUS A LO T 1 7 BLOC K8 4 2 X12 0 Valu e Informatio n Lan d Improvemen t Tota l 201 1 $ 5,700.0 0 $ 83,500.0 0 $ 89,200.0 0 201 0 $ 5,700.0 0 $ 83,500.0 0 $ 89,200.0 0 200 9 $ 5,700.0 0 $ 83,500.0 0 $ 89,200.0 0 200 8 $ 5,700.0 0 $ 83,500.0 0 $ 89,200.0 0 200 7 $ 5,700.0 0 $ 70,400.0 0 $ 76,100.0 0 200 6 $ 5,700.0 0 $ 70,400.0 0 $ 76,100.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 1 5040. 0 1. 0 120. 0 42. 0 N o Improvemen t Informatio n Buildin g 1244 9 Bauma n Av « 1 I G S»of yF=i n 'JB^ ^ 0 J if b t^t r itf f •* e T D 1 1 D U l r Srssis ­ ? » 'I * ' » M r T n ?

CUC KTO ENUkRG E IMAG E Squar e Footage : 1647. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

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 : 5. 0 Exterior : Fram e Shingl e Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Stiingl e Bedrooms : 2. 0

Roo f Type : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 191 8 0 % 191 8 9 1 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Applianc e Fireplac e Masonr y 1. 0 Basemen t Bsmn t Bloc k 8 f t 1080. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 360. 0 Porc h En d Soli d Wal l 132. 0

## CONSEN T FO RACCES S T O PROPERT Y OMAH A LEA D SITE REMEDIA L ACTION - LEAD-BASE D PAIN T STABILIZ.\TIO N PROPERT Y I D PROPERT V ADDRESS ; 

# J2.MMQ

. . _ 

# _

Um w ^v T IWN'ERNAA l 

### DAYTIM E PHONE : H^^'H^7-^OZ 3 

# MT^v^- ^ CELLPHONE: ^0 1 -R§C^'M7 a/ E-MAIL : d:2L'in/jJi Z ( g r^)^ , i^^f - OWNER' S ADDRES S I FDIFFERENT : S^h l ^ TENANT' S NAM E I FAPPLICABLE : 

# M/ A DAYTIM E PHONE : /U/ ^ CELLPHONE : E-MAIL : /t/// r 

# MA . Professiona l Environtnenta l Engineers , Inc . (PE ) i s unde rcontrac t (**EP-R7-08-06 ) wit h tti e U.S . Environmenta l Protectio n Agency(EPA ) t o stabiliz e lea d base d pain t (LBP ) o n residentia l structure s a t a nutnbe ro f propertie s locate d i 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 ar e bein g performe d b yEP A contractors . Pain t Stabilizatio n activitie s wil l include : scrapin g ofcracke d o rflakin g LB P fro m structures , applicatio n o f a prim e coa t an d tw o (2 ) coat s o f paint . Movin g part s o f window s an d door s ar e no t include d an d wil l no t b e addressed . You rcooperatio n i s requeste d i n givin g permissio n t o thi s EP A contracto r(PE ) t o ente ran d hav e acces s t o thi s propert yfo rth e purpos e o f stabilizin g lea d -base d pain t a s outline d o n th e propert yidentifie d above . B

ysignin g thi s documen t I agre e t o allo w a n EP A contracto rt o conduc t a soi l cleanu p a t m ypropert j followin g completio n o f lead-base d pain t stabilization , i f th e soi l cleanu p ha s no t alread ybee n performed . 1 understan d tha t th e stabilizatio n contracto r ca n no t provid e assurance s tha t th e soi l cleanu p contracto rwil l b e boun d to . 1 furthe runderstan d tha t th e soi l cleanu p contracto rwil l mak e al l reasonabl e effort s t o addres s concern s tha t I , a s th e propert yowner , ma yhav e regardin g soi l cleanu p a t m yproperty . 

## pGes , 1 hav e rea d a i understan d th e paragrap h ab o 

# V<^ / t l Signatur e o f Propert yOwne r Dat e I full yunderstan d tha t b ysignin g thi s Consen t fo rAccess , (I ) thi s acces s wil l remai n i n effec t unti l th e wor k ha s bee n satisfactoril ycompleted , (2 ) tha t th e Propert yOwne ro rTenant , i f applicable , wil l b e give n th e Housin g an d Urba n Developmen t (HUD ) an d EP A pamphlet , "Renovat e Right , Importan t Lea d Hazar d informatio n fo rFamilies , Da yCar e Providers , an d Schools" , (3 ) th e Propert yOwne ro rtenan t wil l remov e al l obstruction s fro m surface s t o b e painted , (4 ) wil l abideli yhealt h an d safetyguidanc e provide d b yEPA , (5 ) wil l allo w photograph yo f propert ybefor e an d afte rth e pain t stabilizatio n work , (6 ) wil l b e contacte d b ya P E representativ e approximatel y4 8 hour s i n advanc e o f startin g work , (7 ) agre e no t t o obstruc t o rtampe rwit h an yo f th e LB P stabilizatio n actions , an d (8 ) wil l participat e i n final propert yinspectio n an d sig n th e Completio n Agreemen t an d Propert yOwne rSatisfactio n Survey . Shoul d yo u hav e an yquestion s abou t th e plane d Lea d Based-Pain t stabilizatio n activitie s fo ryou rproperty , pleas e contac t Professiona l Environmenta l Engineers , Inc . Projec t Manager , Willi e Cla yo rKelle ySander s A t 402-504-4688 . Genera l question s abou t th e Omah a Lea d Sit e cleanu p ca n b e directe d t o Pauiett a France-Isetts , EP A Remedia l Projec t Manage r402-731-2454 , o r th e EP A Publi c Informatio n Center s a t 402-991-958 3 (Nort h Omah a office ) o r402-731-304 5 (Sout h Omah a office) . Yes , I gran t access t o m ypropert yand wa s give n th e pamphle t D No , I do no t gran t acces s to m ypropert yan d 1 wa s Renovat e Right , Importan t Lea d Informatio n fo rFamilies , Chil d give n th e pamphle t "Renovat e Right , Importan t Lea d Car e Providers , an d Schools. ' Informatio n fo rFamilies , Child e Car e Providers , an d Schools. " 

# A^^ ^ ^ ..JL^ ^ '^/loh i Signatur e ' Dat e Signatur e Dat e SPECIA L INSTRUCTION S AN D CONSIDERATIONS

## PAIN T STABILIZATIO N PRE-PROPERT Y PAIN T MATC H ASSESSMEN T PROPERT Y ADDRESS : 2-HM. ^ "B/Wfn/ ^

/\\J) b DAT E 

# ^/)DA / BVI D 

# :i9 m 3^( 7 (vjo i i^twzTU t pr^^'& M -^iR€t/a s \x^^ z ^fwj^s i AREA(S ) TO B E PAINTED : HOUS E PROPER : / ^ COLOR : 

# blu e Q^e^SuxM ) •• f HOUS E TRIM : COLOR : 

# jiAH ^

GARAGE : 

# r

. COLOR : ml^ e ) 

# U k

GARAG E TRIM : M ^ .COLOR : jlJhrr ^ 

# M i

# fPORCH : // . COLOR : /l/Z/ t

PORC H TRIM : 

# f ^ COLOR : 

# lOhih c (COMPLET E AL L SECTION , YES , NO , O R NON-APPLICABLE )



### I AGRE E T O TH E COLOR S LISTE D ABOVE . ONC E TH E PAINTIN G BEGINS , I UNDERSTAN D I CA N NO T CHANG E TH E ABOV E SELECTE D COLORS : PROPERT Y OWNE R SIGNATUR E P E ACCESO R SIGNATURE :

: ^ - ^ ^ ^ . ^ ^

~

## PRE-RENOVATIO N FOR M ~ OWNE R Thi s for mi s t o b e use db y th e firms contracte db y th e Environmental Protectio n Agency-Regio n 7 t o perfor mLead-Base d Pain t stabilizatio n activitie s at th e Omah aLea dSite , Omaha , Nebraska . Owne r Connrmatio n Pamphle t Receip t ^ttJiSLve receive dacop y ofth e lea dhazardinformatio n pamphlet . Renovate Right : Importan t Lea dHazar dInformatio n fo r Families , Chil dCar e Provider s an dSchools , informin g m e ofth e potential ris k ofth e lea dhazardexposur e fro mrenovatio n activit y t o b e perfonne din/o n m y dwellin g unit . I receive dthi s pamphle t before th e wor k

began . Owne r Acknowledgmen t "5J)(A ) I confir mthat I ow n an dliv e i n thi s property , tha t n o chil dunder th e ag e o f 6 reside s here , that n o pregnan t woma n reside s here , an dthat thi s property i s no t achild-occupie dfacility . Note : A chil dreside s i n th e primar y residenc e o f his/her custodial parents , lega l guardians , foster parents , o r informa l caretake r if th e chil dlive s andsleep s mos t o f tim e a t th e caretaker' s residence . Note : A child-occupie dfacilit y i s apre-197 8 buildin g visite dregularl y by th e sam e child , unde r 6 year s o f age , on a t leas t tw o different day s withi n any week , for a

t leas t 3 hour s eac h day , provide dtha t th e visit s total a t leas t 6 0 hour s annually . ^B ) 1 understan dtha t th e renovatio n firm, contracte dby th e Environmental Protectio n Agenc y (EPA) , wil l b e usin g lead

saf e wor k

practice s require dby EPA' s Renovation , Repai r andPaintin g Rule . 

# Keu](\ } 7) . Srmc s Printe dNam e o f Owner-Occupan t 

# /7 . .Mu,^._ . V/o/ u

- r Signatur e o f Owner-Occupan t Dat e