TRANSMITTAL of OMAHA LEAD SITE 


PAINT STABILIZATION FILE FOLDER 


SAID #: 26618 Date: 12/02/08 

Address: 2421 Decatur St 

Remediation Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Video of property (DVD) 

H Executive Summary 

m Signed Access Agreement for subject property 

IZ Painting Agreement 

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

D Photographs 

0^ Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

[7 Property information from Douglas County Assessor's Office 

D 

D , 

D 

_ $//f/oj 

ignafiir^ Date 

40310379 

111 


Superfund 
PROPERTY SUMMARY 


Date: 12.02.08 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Month of: December 

Property Address: 2421 Decatur St SAID: 26618 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: None 

A.2 issues Resolved: None 

A.3 Unique Findings: None 

122A.4 Other Relevant Information: None 

Access Date: 10/15/08 

Work Began Date: 

Closeout Date: 11/20/08 

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. 

ENVIRONMENTAL & 

CONSTRUCTION TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: '^QZI r_c..^_^^ri^ T::i£C^aiW. OT 31- Date *^»V^:. I/^V^"'^ W r y -
? 

Phone: %2Mq ^ j^.p^I^JQ-^WTD: ^ZL?U>i? 


Plant & Pennanent Landscaping To Remain In Place 

Item# 

Desc ription and Location 

On Map (i M l^o0'l\ - foo/jc 

Pre-Existing Condition of Structures 

Does yo^ Basement have a history of leaking? Yes ^ - No 

Item# Descript on & Location 

On Map 

il n 

U \p(fS < ^ ' 

tl u 

J^QTC ^ 

Prudent Empjoj^ee 

Signature: 'k^A^_­ 8080 Ward Parlovay, Slits 405 2605 N. 24** Street, Sulta 308 t. 4242 Medical Drive, SuHe 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phona: (816) 363-3703 Phone: (402) 504-1004 Phone: (210) 822-9588 

Fax: (816) 363-3707 
Z(-e(^l% 

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 of properties 

located in Omaha, Nebraska, includingtiie property located at 'Z.QZ-I T-Vryt^LLr ,S-f 

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

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

Stabilization including scraping paint and painting ofthe referenced property. Further, the owner/tensnt 

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

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

Administrative Clerk for tiie Lead Based Paint Stabilization, Mrs. Deborah Akerele-Johngnn^ 

at (402) 504-1004. General questions about the Omaha Lead Site cleanup can be directed to the EPA 

Public Infonnation Centers at (402) 731-3045 (Soutii Omaha office) or (402) 991-9583 (Nortii Omaha 

office). . y 

Propeity Access Gitnted By: 
 lise Print Name) 


Propeity Owner Sigaatuie: Qcddj^^:! ^ 

PROPERTY INFORMATION 

c completed by resident and/or property owner - please print) 

RESIDENT NAME: Renter 

RESIDENT ADDRESS: 

IF RENTAL, PROPERTY OWNED BY; 

OWNER'S MAIUNG ADDRESS; ••i^?^=^( ^o.(^^< ^ ' 

OWNER'S TELEPHONE NUMBER. HOME: (^^ J ^3 ^ Y * .f*»*»'**<= (49 L \ S Q ^" ^ f ^ 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: # NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER: 5L ^ 

> t >-- ^ 

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.) 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be implemented by EPA under tKs agreement are pursuant to Section 144 

of CERCLA, 42 U.S.C. 9604. EPA's right ofaecess to the property is provided fbr h Section 104(e) of CERCLA, 42 U.S. C 9605(e), which provides entry 

for "determining the need for response, or choosing ortaking any response acfion under this title, or otherwise enforcing fee provisions ofthe title." 

4242 Medical Drive, Suite 4250 2505 N. 24* Street, Suite 308 0 Ward Partnvay, Suite 405 

Omaha San Antonio, TX 78229 , Nebraska 68110 nas City, MO 64114 

Phone Phone: (210)822-9588 : (402)504-1004 me: (816) 363-3703 Fax Fax: (210) 679-6577 : (402)504-1005 : (816) 363-3707 
Current Sample Pre#enovation Form 

Effective until April 2010. 

Conflnmalion of Receipt cf Lead Pamphlet 

j ^ I have received a copy of the pamphlet. Renovate FVght Important Laad Hazani 

Infbrmation for Families, Child Cam Rnowders and Sdmds infonnning me of 

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

performed in my dwelling unit. I received this pamphlet before the work began. 

^^^f<^cA$2>/^ ,£l// ^/^ ^ 

Printed name of reolpient,-	 Date / 

^/ l fl^ . (^C.^-rJfQl9''•y\| 

Signature of recipient ^ 

Self-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. 


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


pamphlet, Remavate FVght Important Lead Hazard Intonnation for FamSies, 


Child Cam Providers and Schools, to the rental dwelling unit listed below at the 


date and time indicated and tiiat 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, flenovate Right Important Lead Hazard Intonnation for 


F^amMes, Child Cam providers and Schods, to the rental dwelling unit listed 


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


I fuill ^ certify VreX I have left a copy of the pamphlet at the unit by sliding it 


nu%i(>/j/f/r.	 i/)'K-d9 //-/fifm 

Printed name of pdr^n certifying Attempted delivety 


date and time 


lead pamphlet delivery 


Signature of persorVoertifying lead pamphlet delivery 

ava.1 parA-htP ^r -

Unit Address 

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


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


at least 7 days before renovation (Document v\nth a certificate of mailing from the 


post office). 

paint match form' Q^$li0^l 

Paint matching form: «^ / 

property address: ^y^ / 0^^ ^ ^ f . ^ r , 

Area • M e Heme color: Sf^ic M ^ a-h"-'^ 

Explanation: ^Pfn'l^ 

I?-0-/1 fiy^ 

Area: Color: 

Explanation:^ 

Area: color: 

Explanation: 

Area: Color: 

Explanation: 

Area: color: 

Explanation: 

Page 1 

ACCBSS typo RM ATI or/TRA OKING SHEET 

sm. 

OiRBrOoiflKtHQC Home: ^5^-i^ M vAric 

Euoajf 

QRIC I TIME I taoessor CcimiCrOETMl 

0'/^il^lQ k 6rf/\M /y 11/AOJ^£Q, 


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OUMrtK A^ k l/Ai am. A w -b diV 
^^*^unty Account Infwination Page 1 of2 

jias County, Nebraska Property Record - R1946530000 

Print Report 

NEW Faature - Parcel Dimensioni available @ scale 0-SO ft west of 90th St - VleVir On Ma p jrmation is valid as of 2008-9-4 Treasurer's Tax Report 

New Feature -* -> -^ Auto Sales Search 

Owner 

JACKSON ANDREW" 

2421 DECATUR ST 

Or\/IAHANE68111-0000 

Property Information 

Key Number:, 4653 0000 19 

Account Type: : Residential 

Parcel Number: \ 1946530000 

Parcel Address. 2421 DECATUR ST 

OMAHA NE 68111-0000 

Legal Description: , PARKERS ADD LOT 4 BLOCK 12 W1/2 30 X 128 

Value Information 

LancT Improvement Total 

2008 $900.00 " $50,600.00 $51,500.00 

2007 i $900.00 • ' $50,600,00 $51,500.00 

_2006_ _ ; 5900.00 $50,600.00 $51,500.00 

2005~ " $900.00 '] $50^600.00 $51,500.00 

2004 $900.00 $7,900.00 $8,800.00 

2003 $900.00 $7,900.00 $8,800.00 

Land Information 

Acres ] SF Units Depth width -
'
 Vacant 

0.08 3840.0 1.0 m.o 30.0 No 

Improvemen t Informatio n 

Building 1 
Douglas County Account In^^iation Page 2 of2 

!*: • p';';.i-'t,» ",•? 

T>,VO ''.TORV 

Square Footage: | 1344.0 Percent Complete: ; 100.0% 

Perimeter ; 0.0 Quality: ; Fair 


Unit Type: ' Condition: i Fair 


Built As: f 2 Story Condo Square Footage: ; 0.0 


HVAC: i Forced Air Rooms: ; 6.0 

Exterior: 1 Frame Siding Units: • 1.0 

Interior: j Drywall Bathsj^: 1.0 

Roof Cover: | Composition Shingle Bedrooms: '. 3.0 

Roof Type: | Gable Stories: : 2.0 

Floorcover: ; Allowance Foundation: ' Block 

Sprinider Square Footage: \ 0.0 

Year Percent Adjusted Year YearBuilt Physical Age Remodeled i Remodeled Built 

1888 • 0 % 1888 120 

Detail Type Detail Description Units 

Appliance Allowance T.o 

Basement Bsmnt Block 8 ft 686.0 

Fixture Base Fixtures 

Fixture Bath Full 

Porch Encl Solid Wail 140.0 

Porch Slab Roof Ceil 30.0 

User Partial Basement 329.0 

./r\.^„^i„„#^„xTTM/-,*„*:TM/„„«„,,_+:_^« ;„.»o^ .•.-^.MA—T > 1 ( \ n/^4nrv\o 

1.0 
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Prudent Property Close-Out Form (Lead-Based Paint Stabilization) 

SAtP; ^/nfpl Y J ^ 

PropertyAririra<«. f^QO.! hs>r^TU r .S t 

OVWI !r*S Name; J^/p/KJ^*^ ^MC'^'\6i J 

Performance Standards/close-Out Criteria 	 IYET NO 

V ^as the entire structure{s) painted with the exception of the stated, excluded areas? This would 1. ir dude painting of other associated features including fascia, eaves, siding, ali trim, porches, box 


b^ams, columns, rails, and exterior surfaces of garages. 
 1 

IS all scraping and other preparattion work completed satisfactorily? X 

re all required areas of the structure(s) primed as needed and painted with two top coats? 

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

5.	 AI e aii ofthe areas where contaminated materials have been spilled 


thproughly vacuumed/ cleaned? 
 X 

DH the contractor collect/vacuum all faiiing and scraped paint chips on the entire property, 


roadways, alleyways, public access areas and also remove any other generated debris? 
 X 

7.	 is ^he grass area that surrounds the structure{s) in reasonably good condition? t 

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


prj>perly removed? 
 K 

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


nqeds to be completed prior to the EPA Close-Out 
 1 

10.	 Are there any property items that were temporatily re-locsted by the contractor 


that need to be moved back? 
 X 

11.	 Ari there any (known) iingering issues with the property owner(s) that have been left unresoived? 


Otner Considerations?property Owner Discussions?Addition5l Work that is Required 
 X 

^ 

Prucfeint Re^esentative 

.CAA^r^--^^(\ 	 / n~zo~^f Date \il ' 2J J ' 0 \