### TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO NFIL EFOLDE R 

# SAID#: 3I<?0 3 Date : T/z/^ f Address : JlSjl B t x I'Sf P I Slvee T Remediatio nContractor : PROFESSIONALENVIRONMENTA LENGDHEER S Year : 200 8 PAINT STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S W

r Vide o ofpropert y (DVD ) Dg^K-g , (l\4 w I K Executiv e Summar y y Signe dAcces s Agreemen t fo r subjec t propert y WPaintin g Agreemen t . O

i Settlemen t document s (i.e. , fo r damag e o r t o replac e planfe , etc. ) S / ' Photograph s hi>^ ^ oJ^M y . B ^ Satisfactor y restoratio nsignedby Propert y Owne r B r

Propert y close-ou t chec k lis t signe db y EP A ^ Propert y informatio nfromDougla s Coimt y Assessor' s Oflfic e D



### Signatur e T5a! e

4031640 2 

# Iiillll l Superfun d, * 

# 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 yResponse



### Lea dBas e Pain t Stabilizatio nOmaha , N e Clos e Ou t Repor t SAID #3120 3 252 8 Bristo l S t

• Datesworke d10/1 0 t o 10/1 0 200 8 250 5 Nort h 24' ^ Suit e 21 9 Omaha , N E 6811 0 (402 ) 504-468 8 Fa

x(402 ) 504-328 1



### • Hous e was i n poo r condition , garag e was very poo r withstructur e damage . Vine s an d weed s wer e coverin g th e southsid e o f th e garag e that hadt o b e remove dprio r t o wor k

bein g started . Owne r wante dth e garag e colo r t o chang e s o i t woul dmatc hth e house . Owne r was please dwithth e jo b that was done .

• Inspecte d10/1 6 n o issues .

# 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 

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

# SlT-Q-^ S Property Address : "Z- S Z ^ &ri.s.-(o / Owner' s Name : J-Uc A \~\OLL^-\ O H 

### Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) painte dwithth e exceptio no f th 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 nwor k

complete dsatisfactorily ? 

### y L 3 . Were al l require darea s o f th e structure(s ) prime da s neede dan dpainte dwith tw o to p coats ? 

# y 4 . Wa s th e pain t product s utilize dequivalen t t o a3 0 yea r product/quality ? 

# y 5 . Ar e al l o f th e area s wher e contaminate dmaterial s hav e bee nspille dthoroughl y 

# y vacuumed / cleaned ? 6 . Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s o nth e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y othe r generate ddebris ? 7 . I s th e gras s are athat surround s th e structure(s ) i n reasonabl y goo dcondition ? y L 

### 8 . Ar e al l item s suc ha s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . properl y removed ? 

# y 9 . I s ther e an 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 . 10 . Ar e ther e an y property item s that wer e temporaril y re-locate db y th e contracto r that nee dt o b e move dback ? 

# y 11 . Ar e ther e an y (known ) lingerin g issue s wit hth e property owner(s ) that hav e ^ 

### bee nlef t unresolved ? Comments : 

# CV^uT V 1 ^ ' o -n-o' y JertjTOwne r Signatur e Date 

# y y-^ . Date Professional En>ifonmental Engineer s Representativ e

# 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 

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

# ^/XO ^ Propert y Address : Zs:2.'g > ShrK^\D \ Owner' s Name : 

# /-.(^ y v4Qut^4o n Performanc e Standards/Close-Ou t Criteri a 250 5 Nort h 24' ^ Suit e 21 9 Omaha , 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 no f th 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 

# y garages . 2 . Wa s al l scrapin g an dothe r preparatio nwor k

complete dsatisfactorily ? 

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

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

### 5 . Are al l o f th e area s wher e contaminate dmaterial s hav e bee nspille dthoroughl y vacuumed/ cleaned ? y 6 . Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s o nth e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e any 

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

### 8 . Ar e al l item s suc ha s polyethylen e sheeting , ladders , pain t brushes , cones , ^ 

### barrie r tape , etc . properl y removed ? 9 . I s ther e any evidenc e ofpropert y damag e that wa s don e b y th e contractor ? An y 

## y property damag e need s t o b e complete dprio r t o th e EP A Close-Out . 10 . Ar e ther e an y property item s that were temporaril y re-locate db y th e contracto r y that nee dt o b e move dback ? 11 . Are ther e any (known ) lingerin g issue s withth e property owner(s ) that hav e y bee nlef t unresolved ? Othe r Considerations/Property Owne r Discussions/Additiona l Wor k

that i s Required :



# /o//6>/s t iP

A CO RSignatur e ^ Dat e

# CONSEN T FO R ACCCES S T O PROPERT Y OMAH ALEA D SIT E REMEDIA L ACTIO N - LEAD-BASE D PAIN TSTABILIZATIO N PROPERTYID : ^, ^

_PROPERT YADDRESS : 

# ^S-^S ' &rl-hy3 l OW.ER.SNAME : ^_^ ^

^^ O fsV ^ DAY-TIME PHONE : L4 ^

y^FY S 

### CELLPHONE : "'If KZO ^ E-MAI L OWNER' S ADDRES S I F DIFFERENT : TENANT' S NAM E I F APPLICABLE : DAY-TIM E PHONE : CEL L PHONE : E-MAI L Professiona l Environmenta l Engineers , Inc . (PE ) i s unde rcontract (#EP-R7-08-06 ) witf i th e U . S
. Environmenta l Protectio n Agenc y(EPA ) t o stabiliz e exterio rlead-base d pain t (LBP ) o n residentia l structure s a t a numbe ro fpropertie s locate d i n Omaha , Nebraslta . Th e pain t stabilizatio n wor k i s bein g don e t o protect th e soi l cleanup s tha t wer e perfonne d b yEP Acontractors . Pain t stabilization s activitie s wil l include : scrapin g o f cracke 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 fpaint . An ymovin g part s o fwindow s an d doo rar e no t include d i n th e activitie s an d wil l no t b e addressed . You rcooperatro n i s requeste d i n givin g pennissio n t o thi s EP Acontracto r(PE , Inc. ) t o ente ran d hav e acces s t o thi s propert yfo rth e purpos e o fstabilizin g lead-base d pain t a s outline d o n th e propert yidentifie d above . I full yunderstan d tha t b ysignin g thi s Consen t Fo rAccess , (1 ) thi s acces s wil l remai n i n effect unti l th e wor k ha s bee n satisfactoril y complete d (2 ) tha t a s th e PropertyOwne 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 , Chil d Car e Provider s an d Schools " (3 ) th e Propert yOwne ro r tenan t wil l remova l o fobstruction s fro m surface s t o b e painted , (4 ) wil l abid e byhealt h an d safet yguidanc e provide d byEPA , an d (5 ) wil l allo wphotograph yo f propertybefor e an d afte rth e pain t stabilizatio n work , (6 ) I wril i b e contacte d b ya P E representativ e approximatel y 4 8 hours i n advanc e o fstartin g wori ct o (7 ) agre e no t t o obstruc t o rtampe rwit h an yo fth e LB P stabilizatio n activitie s o requipmen t use d t o peribn n an yLB P actions , (8 ) wil l participat e i n fina l propertyinspectio n an d sig n th e Completio n Agreemen t an d Propert yOwne r satisfactio n Survey
. Shoul d yo u hav e an yquestion s abou t th e planne d Lea d Based-Pain t stabilizatio n activitie s fo ryou rproperty , pleas e contact : Professiona l Environmenta l Engineers , Inc. , Project Manager , Hemia n Hanne ra t 402-884-1185 . Genera l question s abou t th e Omah a Lea d Sit e cleanu p ca n b e directe d t o Paulett a France-Isetts , EP ARemedia l Project Manage r402-731-2454 , o rth e EP APubli cInfonnatio n Centers a t (402 ) 991-958 3 (Nort h Omah a office ) o r(402 ) 731-304 5 (Sout h Omah a office)
. I Yes , I gran t acces s t o m ypropert yan d wa s give n I I No , I d o no t gran t acces s t o m ypropert yan d I was amphle t "Renovat e Right , Importan t Lea d IHazar d give n th e pamphle t "Renovat e Right , Importan t Lea d informatio n fo rFamilies , Chil d Care Provider s an d Schools
. Hazar d Informatio n fo rFamilies , Chil d Care Provider s an d Schools
. Sianatur e "- ' ^ ' " Uat e Signatur e Dat e SPECIA L INSTRUCTION S AND/O R CONSIOERATIONS ;y-^^-^-" * - ' - 

# PAIN TSTABILIZATIO N PRE-PROPERT Y PAIN TMATC H ASSESSMEN T PROPERT YADDRESS : ^^7:? % J^)^]ji ) ^- ' DAT E 

# )(0/.^/D ^ BVI D - AREA(S ) T O B E PAINTED : HOUS E PROPER : COLOR
. HOUS E TRI M COLOR
.
GARAGE
. COLOR
. GARAG E TRI M COLOR
. ^ . ; 

### PORC H COLOR
.
PORC H TRIM , COLOR
. (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 PAINTIN G BEGINS , I UNDERSTAN D I CA NNO T CHANG E TH E ABOV E SELECTE D COLORS : PROPERT Y OWNE R SIGNATURE : 

# li(ii^b&W V

PAIN TMATC H FOR M 08/0 8

# PAIN TSTABILIZATIO N PRE-PROPERT YASSESSMEN T PROPERT YADDRESS : ^ ' ^ 5^ ^

Rfl^; ) ^ DAT E |0p/ ^ 

# HK^w g z^^^zii n BVI D 3)/2o: ^ PLAN T& PERMANEN TLANDSCAPIN G T O B E REMOVE ? N O |— | YE S IF , YE S WHERE : 

# G^if\c ^

V^Ar-^ ^

vJC-^vg ^ OU- yy.>€y-ay ^ c 3
PRE - CONDmO N O F FOUNDATION/STRUCTURE , i.e . BASEMEN TLEAKING ? N O YE S VP « ' ' IF , YE S WHERE :

EXISTIN G PAIN TO N WINDOWS , DOORS , FOUNDATION , SIDEWALK, ( I.E.) ? N O YE S ^ ^

IF , YE S WHERE :

VISUA L DESCRIPTIO N O F PROPERTY/STRUCTURE/GARAGE , (I.E.) : (US E BACKSID E I F NECESSARY ) 

## /C>9//».-?- ^ y u^^' ^ Doo r^Sv^rye/e^- yZyii^./-^-^c::/_ ^

PROPEijm rOWNE R SIGNATUR E 

# 1' •7--m- - ^--T", - 

# Confirmatio n O f Receip t O f Lea d Pamphle t BVI D ' PROPERT YADDRES S ^^QS ^

n/vMU l .\ i ZI P COD E 

# ^59rS£/^^MS 4 PROPERT YADDRES S O F OWNE R I F DIFFEREN TTHA N PROPERT YBEIN G PAINTED : PROPERT YADDRES S ^ZI P COD E I hav e receive d a cop yo f th e pamphlet , Renovat e Right : Importan t Lea d Hazar d Informatio n Fo rFamilies , Chil d Care Provider s An d School s Informin g m e o f th e potentia l risk of th e lea d hazar d exposur e fro m renovatio n activit yt o b e performe d o n dwellin g unit . I receive d thi s pamphle t befor e th e wor k began . 

# Lvtf g -Uou^W^ . PRINTE D NAM E O F RECIPIEN TDAT E 

# f^ii(nttiste\
. SUGNATUR E O F RECIPIEN T Self-Certificatio n Optio n (Fo rTenant-Occupie d Dwelling s Only ) I f th e lea d pamphle t was delivere d bu t a tenan t signatur e was no t obtainable , yo u ma ychec k th e appropriat e bo x below : [_

] Refusa l T o Sig n - 1 certif ythat I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , renovate right: importan t lea d hazar d informatio n fo rfamilies , chil d car e provider s an d schools ; t o th e renta l dwellin g uni t liste d abov e a t th e dat e an d tim e indicate d an d that th e occupan t refuse d t o sig n th e confinnatio n o f receipt . I furthe rcertif ythat I have lef t a cop yo f th e pamphlet at th e uni t wit h occupant . 

# D Unavailabl e Fo rSignatur e - 1 certif ythat I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , renovate right; importan t lead hazar d infomiatio n fo rfamilies , chil d car e provider s an d schools , t o th e renta l dwellin g uni t liste d belo wan d tha t th e occupan t was unavailabl e t o sig n th e confimiatio n of receipt . I furthe rcertif ythat I hav e lef t a cop yof th e 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 .

PRINTE D NAM E O F PERSO N CERTIFYIN G AHEMPTE D DELIVER YDAT E AN D TIM E LEA D PAMPHLE TDELIVER Y

SIGNATUR E O F PERSO N CERTIFYIN G LEA D PAMPHLE TDELIVERY : Not e Regardin g Mailin g Optio n - a s a n altemativ e to deliver yi n person , yo u ma ymai l th e lea d pamphle t t

o th e owne r and/o rtenant . Pamphle t mus t ti e maile d a t leas t 7 day s t)efor e renovation . (Documen t wit h a certificat e o fmailin g fro m th e pos t office)
. CONFIRMATIO N O F RECEIP TO F LEA D PAMPHLE T08/0 8

### Dougla s County Accoun t Informatio n Pag e 2 of 3

itorm a 

# t Grantee : Barfiel d Jacki e L Valid/invalid : Invali d Exclusio n Reason : Lan d Contract - Agreemen t Sale s Date : 2005-03-0 3 Dee d Type : C O Book : 200 5 Page : 12635 1 Price : $12,236.0 0 Grantor : Rober t William s Grantee : Jacki e Bacfiel d Valid/Invalid : Invali d Exclusio n Reason : Lan d Contract - Agreemen t Sale s Date : 2004-04-1 3 Page : Dee d Type : D E Book : 200 4 04676 5 Price : $0.0 0 Grantor : Estat e o f Dand a L Patterso n Grantee : Rober t N William s J r Valid/invalid : Invali d Exclusio n Reason : Famil ySal e Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 5 6600. 0 1. 0 132. 0 50. 0 N o Improvemen t Informatio n Buildin g 1 1 1/ 2 Stor y 252 8 Bristo l St 

### r M P
I f

lAf i i ; $»n n 

### ITs r <19. 0 

### \ M ^ « c A i t ^ ift d
12IIIIS1I R BimBbcKS t toeios q R CLIC KT O ENLARG E IMAG E Squar e Footage : 1697. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R13. . . 6/27/200 8

### Dougla s County Accoun t Informatio n Pag e 1 of 3 Dougla s County , Nebrask a Propert yRecor d - R130320000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t of got h S t - Vie W O n Ma p Informatio n i s vali d a s of 2008-6-1 9 Ne wFeatur e Treasurer' s Ta xRepor t -+-•- • Aut o Sale s Searc h Owne r HOUSTO N LUC I T ETA L 1 252 8 BRISTO L S T OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : 032 0 000 0 1 3 Accoun t Type : Residentia l Parce l Number : 130320000 0 Parce l Address : Lega l Description : 252 8 BRISTO L S T OMAH AN E 68111-000 0 HAWE S AD D LO T7 BLOC K0 E 5 0 F T5 0 X 13 2 Valu e Informatio n 200 8 200 7 200 6 200 5 200 4 200 3 Lan d $2,600.0 0 $2,600.0 0 $2,600.0 0 $2,600.0 0 $2,600.0 0 $2,600.0 0 Improvemen t $46,700.0 0 $39,900.0 0 $39,900.0 0 $39,900.0 0 $19,500.0 0 $19,500.0 0 Tota l $49,300.0 0 $42,500.0 0 $42,500.0 0 $42,500.0 0 $22,100.0 0 $22,100.0 0 Sale s Informatio n Sale s Date : 2007-10-3 1 Dee d Type : Price : Grantor : Q C $25,000.0 0 BARFIEL D JACKI E L Book : 200 7 Page : 12325 0

Grantee : MOUSTO N LUC I TETA L Valid/Invalid : Invali d Exclusio n Reason : Famil ySal e Sale s Date : 2007-05-0 4 Dee d Type : Price : Grantor : Q C $12,236.0 0 William s Rober t J r Book : 200 7 Page : 08871 9



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R13. . . 6/27/200 8