### TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO NFIL EFOLDE R SAID# : -gSnQ O Date : & / M j 0O [ Address : ^^ H f J M 9 ^ 5 + Remediatio n Contractor : PROFESSIONALENVIRONMENTALENGINEER S Year : 200 9 PAINT STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S D^^'^ide o ofpropert y (DVD ) p/^sj " Executiv e Summar y %y ^ SignedAcces s Agreemen t fo r

subject propert y ^y ^ Painting Agreemen t D Settlemen t documents (i.e. , fo r

damag e o r

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o replac e plants , etc. ) tL-'''^^Photograph s ftcJoro . H

" Satisfactor y restoration signe db y Propert y Owne r ^r

Propert y close-ou t chec k

lis t signedb y EP A ^"^" ^ Propert y information fro mDouglas Coimt y Assessor' s Offic e (D' ^ confirmation tha t lea dpamphle t "Renovat e Right " was receivedb y P0 _ D 

# ° ^ 3020385 1 

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### Professioiia l Eiwironmenta l Engineers Signatur e ^ ^ 

# W ^ EP A Signatur e

## PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC . ''' ' ""olli t N E esft o "Providin g cost-effectiv e environmenta l solutions " ^ Sc«too! ? ^

Fax(402 ) 504-328 1 Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yRespons e



### LeadBas e Stabilizatio n Omaha , N e Clos e Ou t Report 200 9 SAID#8508 0 2720 N4 8 S t

•Date s worked : 07/1 5 t o 07/1 7 200 9 •Pr e propert y condition : Hous e ha dvynal sidin g wit hwoo dtrim s on basemen t window s an dwoo dside dgarage . All painte darea s hadflaking pain t an dwer e in poo r condition . •Problem s encountered : None •Owne r request/concerns : N/ A •Inspectioii/closeou t dates . Owne r signe d07/15 , EP A signe d07/2 3 2009 , n o issues .

# 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 Stabilization EP A Contract EP-R7-08-06 ) 

# SAID : Z'^Dl^ O 1l2, 0 J O U^^ ^ Propert y Address : Owner'sName : Rober V ^OI f S>P^ O 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 Fax(402 ) 504-328 1



### YE S N O 1 . Wa s th e entir e structure(s ) painte dwithth e exceptio nofth 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 v ^ garages . 2 . Wa s al l scrapin g an dothe r preparatio nwor k

complete dsatisfactorily ? 

# y 3 . Were al l require darea s ofth e structure(s ) prime da s neede dan dpainte dwith 

# y tw o to p coats ? 4 . Wa s th e pain t product s utilize dequivalen t t o a3 0 year product/quality ? 

# y 5 . Ar e al l ofth 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 an y 

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

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

# y barrie r tape , etc . properl y removed ? 9 . I s ther e an y evidenc e ofpropert y damag e that was don e b y th e contractor ? An 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 wer e temporaril y re-locate db y th e contracto r % ^ 

### that nee dt o b e move dback ? 11 . Ar e ther e an y (known ) lingerin g issue s withth e property owner(s ) that hav e 

# > y bee n lef t unresolved ? Othe r Considerations/Property Owne r Discussions/Additiona l Wor k

that i s Required :



# y^Jj:^^:>^.^^l^i^^XeC t EP A CO RSignatur e 'Date '

# 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 " Fax(402 ) 504-328 1 Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yResponse 

## Propert y Owne r

Close-Out For m (Lead-Base dPain t Stabilizatio nEP A Contrac t EP-R7-08-06 ) SAID : 

# ISOM . s ^ Property Address : 

# nnr o A ) u s Owner' s Name : 

# P^pb^ vF/3f^fvv^/ ] 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 nofth 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 , colimms , rails , an dexterio r surface s o f garages . 2 . Wa s al l scrapin g an dothe r preparatio nwor k

complete dsatisfactorily ? 

### j y 3 . Wer e al l require darea s ofth e structure(s ) prime da s neede dan dpainte dwith tw o to p coats ? 4 . Wa s th e pain t product s utilize dequivalen t t o a3 0 year product/quality ? 5 . Ar e al l ofth e area s wher e contaminate dmaterial s hav e bee nspille dthoroughl 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 grass are atha t surround s th e structure(s ) i nreasonabl y goo dcondition ? 

# Z ^ 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 ? 

# V 9 . Istherean y evidenc e ofpropert y damag e that wa s don e b y th e contractor ? An 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 propert y item s tha t wer e temporaril y re-locate db y th e contractor that nee dt o b e move dback ? 

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

# X " bee n lef t unresolved ? Comments :

Dat e / 

# 7-J^-o p Professional Ens«tfbrmienta l Engineer s Representativ e Dat e

# CONSEN T FO RACCES S T O PROPERT Y OMAHA LEAD SIT EREMEDIALACTIO N - LEAD-BASE D PAINT STABILIZATIO N PROPERT Y ID : ^SO^ ^ PROPERT Y ADDRESS : o?^Q O ] 4 H> 5 ^ DAYTIM EPHONE : ^^f \~ M03> ^ CELLPHONE : E-MAIL : OWNER' S ADDRES S I FDIFFERENT : TENANT' S NAM EI FAPPLICABLE : DAYTIM EPHONE : CELLPHONE : E-MAIL : Professiona l Environmenta l Engineers , Inc . (PE ) i s unde r contrac t (#£P-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 nresidentia l structure s a t anumbe r o f propertie s locate di nOmaha , Nebraska . Th e pain t stabilizatio n worh : i s bein g don e t o protec t th e soi l cleanup s tha t ar e bein g performe db y EP A contractors . Pain t stabilizatio nactivitie s will include : scrapin g o f cracke do r flakin g LB Pfro mstructures , applicatio no f aprim e coa t an dtw o (2 ) coat s o f paint . Movin g part s o f window s an ddoor s ar e no t include dan dwill no t b e addressed . You r cooperatio ni s requeste di ngivin g permissio nt 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 outline do nth e propert y identifie dabove . B y signin g thi s documen t I agre e t o allo w a nEP A contracto r t o conduc t asoi l cleanu p a t my propert y followin g completio no f lead-base dpain t stabilization , ifth e soi l cleanu p ha s no t alread y bee nperformed . I understan dtha t th e stabilizatio ncontracto r ca nno t provid e assurance s tha t th e soi l cleanu p contracto r will 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 my property .

' Yes , I hav e readan dunderstandth e paragrap habove . Signatur e o f Propert yOwne r I full y understan dtha t b y signin g thi s Consen t fo r Access , (1 ) thi s acces s wil l remai ni neffec 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 nth e Housin g an dUrba nDevelopmen t (HUD ) an dEP A pamphlet , '^Renovat e Right , Importan t Lea dHazar dinformatio nfo r Families , Da y Car e Providers , an d Schools" , (3 ) th e Propert y Owne r o r tenan t wil l remov e al l obstruction s fro msurface s t o b e painted , (4 ) wil l abid e b y healt han d safet y guidanc e provide db y EPA , (5 ) wil l allo w photograph y o f propert y befor e an dafte r th e pain t stabilizatio nwork , (6 ) wil l b e contacte db y aP Erepresentativ e approximatel y 4 8 hour s i nadvanc e o f startin g work , (7 ) agre e no t t o obstruc t o r tampe r wit h an y ofth e LB Pstabilizatio n actions , an d(8 ) wil l participat e i nfina l propert y inspectio nan dsig nth e Completio nAgreemen t an d Propert y Owne r Satisfactio nSurvey . Shoul dyo u hav e an y question s abou t th e plane dLea dBased-Pain t stabilizatio nactivitie 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-S04-4688 . Genera l question s abou t th e Omah a Lea dSit e cleanu p ca nb 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 Center s a t 402-991-958 3 (Nort hOmah aoffice ) o r 402-731-304 5 (Sout hOmah aoffice) . Yes , I gran t acces s t o m ypropert yan d wa s give n th e pamphle t D No , I d o no t gran t acces s t o m ypropert yan d I was 

## F Y « ' "mnovat e Riglit , Importan t Lea d Infonnatio n fo rFamilies , Chil d give n th e pamphle t "Renovat e Right , Importan t Lea d

Care Providers , an d School ; Informatio n fb rFamilies , Child e Care Providers , an d Schools. " 

# j<m ^ d^idm/}^^ , Signatur e / / Da l Signatur e SPECIA L INSTRUCTION S AN D CONSIDERATION S

## PAIN TSTABILIZATIO N PRE-PROPERT Y PAIN TMATC H ASSESSMEN T PROPERT YADDRESS : 2^QC > f J > ^ 8 !^ TDATE : BVID :

AREA(S ) TO B E PAINTED : HOUS E PROPER :
HOUS E TRIM :
GARAGE :
GARAG E TRIM : _ PORCH :
PORC H TRIM : 

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### Dougla s County Accoun t Informatio n Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R241656000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t of 52n d S t - VlO W O H Ma P Informatio n i s vali d a s o f 2009-6-1 6 Treasurer' s Ta xRepor t Ne wFeatur e ->-•- • Aut o Sale s Searc h Owne r FORSMA N ROBERT A ETA L 272 0 N 4 8 S T OMAH AN E 68104-000 0 Propert yInformatio n Ke yNumber . 165 6 000 0 2 4 Accoun t Type : Residentia l Parce l Numbe r 241656000 0 Parce l Address : 272 0 N 4 8 S T OMAH AN E 68104-000 0 Lega l Description : WEARN E PAR KLO T6 BLOC K1 4 0 X 106. 4 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $5,400.0 0 $67,200.0 0 $72,600.0 0 200 8 $5,400.0 0 $67,200.0 0 $72,600.0 0 200 7 $5,400.0 0 $67,200.0 0 $72,600.0 0 200 6 $5,400.0 0 $67,200.0 0 $72,600.0 0 200 5 $5,400.0 0 $27,200.0 0 $32,600.0 0 200 4 $5,400.0 0 $27,200!0 0 $32,600.0 0 Sale s Informatio n Sale s Date : 1993-06-0 6 Dee d Type :a Book : 195 7 Page : 16 8 Price : Granto r $29,500.0 0 Grantee : Valid/Invalid : Exclusio n Reason : Vali d Lan d Informatio n Acre s S F ' Unit s Dept h Widt h Vacan t i 0.0 9 4240. 0 1. 0 106. 0 1 40. 0 N o Improvemen t Info r matio n 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno==R241.. . 7/8/200 9

### Dougla s Count y Accoun t Informatio n Pag e 2 of 2
Buildin g 1 1 1/ 2 Stor yFi n 272 0 N 4 8 St

l i

En d Sflw * »va i 10

4 »4 » CLIC KTO ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1315, 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 : Force d Ai r Rooms : 6. 0 Exterior : Fram e Viny l Units : 1. 0 Interior : Drywal l Batlis : 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 Sprinlde 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 6 0 % 191 6 9 0 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 912. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 242. 0 Porc h En d Soli d Wal l 104. 0 Porc h Woo d Dec k 100. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R241. . . 7/8/200 9

### M C Services , LL C Propert yAddres s Start Dat e En d Dat e 

# 7-1 5 -O Q Amoun t O f Prim e An d Pain t Use d Prim e (Gallons )

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# Ml\S^\ e Amoun t (Gallons ) 

# _s Amoun t (Gallons ) Amoun t (Gallons ) Amoun t (Gallons ) Amoun t (Gallons )

## Professiona l Environmenta l Engineers , Inc . INTERVENCI6 N D E SEGURIDA D Nombre de l Proyecto : Q/ 1 l ^

N YP'O ^ Fech a d e l a Intervencion : ( - " 1W~Q ^ Pellgro s d e Salu d Primordial ; 

# McK ^ Preocupaclone s Primordlale s d e H & S: _ Tarea s Diarias : 

# >.m m s^^m ^ >.p\ TM Equlp o Usad o e n e l Luga rd e Traabjo : 

# y Casc o Duro Bcaler a Gafa s d e Segurida d 

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# 3 ^



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# A Estuch e d e Primero s Auxilio s 

# i c Procedimiento s d e Emergenci a ^ 

### GFC I e n siti o > 

### Deficiencias : Accione s Corretivos :

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