## TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL EFOLDE R SAID# : 2,^ % 7 Date : y/juj^ j Address : 4'20(/: > Ujirj ' S v 

## Remediatio nContractor : PROFESSIONA LENVIRONMENTALENGINEER S Year : 200 8 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S yi / Vide o o f propert y (DVD ) M Executiv e Summar y SignedAcces s Agreemen t fo r

subject propert y Paintin g Agreemen t D Settlemen t document s (i.e. , fo r

damag e or t o replac e plants , etc. ) B Photograph s B ^ Satisfactor y restoratio n signedb y Propert y Owne r H Propert y close-out check lis t signe dby EP A M Propert y information fromDougla s Coimt y Assessor' s Office

a \ • . • 

## D Signatur e / Dat e

4031819 1 

# iiiiii i Superfun d

# PROFESSIONA L 250 5 Nort h 24 ^ Suit e 21 9 

# ENVIRONMENTA L ENGINEERS , INC . 

# J 

# r i Omaha , N E 6811 0



# 3 (402 ) 504-468 8 

## "Providin g cost-effectiv e environmenta l solutions " 

# k H Fa x(402 ) 504-328 1 Consultin g • Engineerin g Desig n • Remediafio n • Abatemen t • Emergenc yRespons e



### Lea dBas e Stabilizatio n Omaha , N e Clos e Ou t Repor t SAID #2996 7 420 6 Wir t S t

• Date s worke d12/0 3 t o 12/1 1 200 8

• Hous e hadman y damage darea s o n soffit an deaves . Missin g board s an dgutters . Transi t wa s damage di n area s an dhadsom e cracks . Lattic e was broke ni n area s na dfoundatio n ha d crack s i n it al l over . Windo w trim s were i n very poo r conditio n withflakin g paint .

• Inspecte d12/1 7 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 

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

# SAID : J^^ J <i ? 1 Propert y Address : 'fQ^ GUJlE^ i Owner' s Name : Mi'M// ^ M ^ L)OO^LFC ^ 

### 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 dwithth 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 

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

complete dsatisfactorily ? V ^ 3 . Were al l require darea s ofth e structure(s ) prime da s neede dan dpainte dwith tw o to p coats ? 

# U 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 n spille dthoroughl y vacuumed / cleaned ? 

# \y ^ 

### 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 an y 

# L
­ 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 ? 

# V- - 

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

# U
9 . I s ther e an y evidenc e o f property 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 were temporaril y re-locate db y th e contracto r that nee dt o b e move dback ? / _ 

### 11 . Are ther e an y (known ) lingerin g issue s wit hth e property owner(s ) that hav e bee n lef t unresolved ? < - 

### Comments : 

# ^M UM ^

# .; . 

# IhK .

Property Owne r Signatur e Date ional^nvfron n Professio n onmenta l Engineer s Representativ e Date

# PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC . 250 5 Nort h24' ^ Suite 21 9 Omaha , N E6811 0 

## "Providin g cost-effectiv e environmenta l solutions " (402 ) 504-468 8 Fa

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

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

# 29^(o i Property Address : 

# QloC o iJ^ n { h Owner' s Name : C{\> <\ ) r^ v >. e fY\c
- ( ^ o ^ f ^ t f 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 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 

# y garages . 2 . Wa s al l scrapin g an dothe r preparatio n wor 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 ? ,t / 5 . Ar e al l ofth e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y vacuumed/ cleaned ? 

# y 6 . Di dth e contractor 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 

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

### 8 . Are 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 o f property 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 . L ^ 

### 10 .Ar e ther e any property item s that wer e temporaril y re-locate db y th e contractor \ y 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 :

EP A CO RSignatur e ' Date '

### 1 

# CONSEN T CF RACCES S T O PROPERT Y OMAH A LEAD SIT EREMEDIALACTIO N - LEAD-BASED PAIN T STABILIZATIO N PROPERT Y ID : Q^^Co l 

### PROPERT Y ADDRESS : , 'O'r^ O 0 > Li J i r "^ SfOWNE RNAME : 

# EC?; ^ (W^O«,.i^ , DAYTIM EPHONE : n^S^' ^ 'Q^'^E CELLPHONE : E-MAIL : OWNER' S ADDRES S I FDIFFERENT : _ TENANT' S NAM EI FAPPLICABLE : DAYTIM EPHONE : CELLPHONE : 

### E-MAIL : 1 

# 1 1 Professiona l Environmenta l Engineers , Inc . (PE ) i s unde r contrac t (#EP-R7-08-06 ) witi i th e U.S . Environmenta l Protectio n Agenc y (EPA ) t o stabiliz e lea dbase dpain t (LBP ) o n residentia l structure s a t anumbe r o f propertie s locate din 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 wer e performe db y EP A contractors . Pain t stabilizatio n activitie s will include : scrapin g o f cracke do r flakin g LB Pfro mstructures , applicatio n o f aprim e coa t an d tw o (2 ) coat s of 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 n i s requeste di n givin g permissio n t 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 of stabilizin g lea d-base dpain t a s outline do n th e propert y identifie dabove . B y signin g thi s documen t I agre e t o allo w a n EP A contracto r t o conduc t asoi l cleanu p a t my propert y followin g completio n o f lead-base dpain t stabilization . I understan dtha t th e stabilizatio n contracto r ca n no t provid e assurance s tha t th e soi l cleanu p contracto r wil l b e boun dto . I furthe r understan dtha t th e soi l cleanu p contracto r will 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 . I fully understan dtha t b y signin g thi s Consen t fo r Access , (1 ) thi s acces s wil l remai n i n effec 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 n th e Housin g an dUrba n Developmen t (HUD ) an dEP A pamphlet , "Renovat e Right , Importan t Lea dHazar dinformatio n fo r Families , Da y Car e Providers , an dSchools" , (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 ) will abid e b y healt han dsafety guidanc e provide db y EPA , (5 ) will allo w photograph y o f propert y befor e an dafte r th e pain t stabilizatio n work , (6 ) wil l b e contacte db y aP Erepresentativ e approximatel y 4 8 hour s i n advanc e o f startin g work , (7 ) agre e no t t o obstruc t o r tampe r wit han y o f th e LB Pstabilizatio n actions , an d(8 ) wil l participat e i n final propert y inspectio nan d sig n th e Completio n Agreemen t an dPropert y Owne r Satisfactio n Survey . Shoul dyo u hav e an y question s abou t th e plane dLea dBased-Pain t stabilizatio n activitie 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 402-504-4688 . Genera l question s abou t th e Omah aLea dSit e cleanu p ca n b 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 was give n th e pamphle t D No , I d o no t gran t acces s t o m ypropert yan d I wa s

'"Renovat e Right , Importan t Lea d Infomiatio n fo rFamilies , Chil d give n th e pamphle t "Renovat e Right , Importan t Lea d Care Providers , an d Schools. " Informatio n fo rFamilies , Child e Care Providers , an d Schools. " ( Signatur e Dat e N ^ Signatur e Dat e SPECIA L INSTRUCTION S AN D CONSIDERATION S

# Confirmatio n O f Receip t O f Lea d Pamphle t BV1D^5Q967__ _ PROPERT YADDRES S ^/SOT n Lj ^

•' ^

^

S/ ~ ZI P CODE . PROPERTYADDRES S O F OWNE R I F DIFFEREN TTHA N PROPERTYBEIN G PAINTED : PROPERTYADDRES 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 Car e Provider s An d School s informin g m e o f th e potentia l ris k o f th e lea d hazar d exposur e fro m renovatio n activit yt o b e perfomie d o n dwellin g unit . I receive d thi s pamphle t befor e th e wor k began . 

# IK^A h7A-y / 

# / ; '^ o -o S \^/l A^A^fi- ^ PRINTE D NAM E O F RECIPIEN T DAT E 

# JA^L^ . KcjQ ^ ^ IGNATUR 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 wa s delivere d bu t a tenan t signatur e wa s no t obtainable , yo u maychec k th e appropriat e bo x below : 

# D Refusa l T o Sig n - 1 certif ytha t I hav e mad e a goo d fait h effort t o delive rth e pamphlet , renovat e right : importan t lea d hazar d infonnatio 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 tha t th e occupan t refuse d t o sig n th e confirmatio n o f receipt . I furthe rcertif ytha t I hav e left a cop yofth e pamphle t a t th e uni t wit h occupant . 

# D Unavailabl e Fo rSignatur e - 1 certif ytha t I hav e mad e a goo d fait h effort t o delive rth e pamphlet , renovat e right ; importan t lea d hazar d infonnatio 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 wa s unavailabl e t o sig n th e confinnatio n o f receipt . I furthe rcertif ytha t I hav e left a cop yo f 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 . 

# £ ^ 

# anri p r ,

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

CERTIFYIN G LEA D PAMPHLE TDELIVERY : Not e Regardin g Mailin g Optio n - as a n altemative t o deliver yi n person , yo u ma ymai l th e lead pamphle t t o th e owne r and/o rtenant . Pamphle t mus t b e maile d a t least 7 day s befor e renovation . (Documen t with a certificat e o f mailin g fro m th e pos t office) . CONFIRMATIO N OF RECEIP TOF LEA D PAMPHLE T

# PAIN TSTABILIZATIO N PRE-PROPERT YASSESSMEN T PROPERT YADDRESS : y^OC n CJ/r f J^ / DAT E RVi n 

### PLAN T& PERMANEN TLANDSCAPIN G T O B E REMOVE ? N O [ ^ YE S [— I IF , YE S WHERE :

PRE-EXISUN G CONDIUQ N O F FOUNDATION/STRUCTURE , 

### i.e . BASEMEN TLEAKING ? N O ' ' YE S ' ' IF , YE S WHERE :

EXISTIN G PAIN TO N WINDOWS , DOORS , FOUNDATION , SIDEWALK, ( LE.) ? NOrtO Q 

### YE S t m IF , YE S WHERE :

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

• *

. PROPERT YOWNE R SIGNATUR E 

# V1W\...... . \^C\0o. ^

# PAIN TSTABILIZATIO N PRE-PROPERT Y PAIN TMATC H ASSESSMEN T PROPERT YADDRESS : ^^^^C ? Lji r^ S ^ DAT E 

# c-^9^r . -/ BVI D — 

### AREA(S ) TO B E PAINTED : 5 ^ C O j'< y HOUS E PROPER : ^LL . COLOK . 

# J 

# ^^^^ v f a ^ 

# fbaY l HOUS E TRI M COLO R

GARAGE . COLO R 

### GARAG E TRI M COLOR . PORC H COLOR .

PORC H TRI M 

### .COLO R (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 YOWNE R SIGNATURE : P E ACCESSO R SIGNATURE : 

### C / 

# <\^u u

PAIN TMATC H FOR M 08/0 8

### Dougla s Count y Accoun t Informatio n Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R171187000 0 

### Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t of 90t h S t - Vie W Of l Ma p Informatio n i s vali d a s of 2008-9- 4 Treasurer' s Ta xRepor t Ne wFeatur e -•->- • Aut o Sale s Searc h Owne r M C DOUGL E EFFI E L ETA L 420 6 WIR TS T OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : j 118 7 000 0 1 7 Accoun t Type : \ Residentia l Parce l Number : 171187000 0 Parce l Address : Lega l Description : 420 6 WIR TS T OMAH AN E 68111-000 0 MAPLEWOO D LO T3 BLOC K1 W 53. 1 FTLT S 2 & Valu e Informatio n 200 8 200 7 200 6 200 5 200 4 200 3 Lan d $5,600.0 0 $5,600.0 0 $5,600.0 0 $5,600.0 0 $5,600.0 0 $5,600.0 0 Improvemen t $47,700.0 0 $47,700.0 0 $47,700.0 0 $23,700.0 0 $21,500.0 0 $21,500.0 0 Tota l $53,300.0 0 $53,300.0 0 $53,300.0 0 $29,300.0 0 $27,100.0 0 $27,100.0 0 Lan d Informatio n Acre s 0.1 1 S F 4876. 0 Unit s 1. 0 Dept h 92. 0 Widt h 5 3. 0 Vacan t N o Improvement Informatio n Buildin g 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17. . . 11/5/200 8

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

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CLIC KT O ENLARG E IMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : j 1276. 0 Percen t Complete : 

### 100.0 % Perimete r 0. 0 

### Quality : Fai r Uni t Type : 

### Condition : Averag e

Buil t As : I 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : i Force d Ai r Rooms : 6. 0 Exterior : Fram e Sidin g Units : 

### 1.0 Interior : Drywal l Baths : 

### 1.0 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : i Gabl e Stories : 

### 1. 5 Floorcover : i Allowanc e Foundation : Bloc k Sprini^ie 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 

### 192 3 0 0 % 

### 192 3 8 5 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 

### 816. 0 Fixtur e Bas e Fixture s 

### 1. 0 Fixtur e Bat h Ful l 

### 1.0 Porc h En d Soli d Wal l 

### 128. 0 Use r Atti cFul l Finis h 332. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17. . . 11/5/200 8