## TRANSMITTA L o f

OMAH A LEAB SIT E PAINT STABILIZATION FILE FOLDE R
SAI D #: S^q^ l Date : |-lCg-l Q 

# 413 5 £rsbn ^ S t Address : Remediatio n Contractor : PROFESSIONA L ENVIRONMENTAL ENGINEER S Year : 200 9
PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S Video ofpropert y (DVD ) ' Exeoutive Simunaiy SignedAcces s Agreement fo r

subject propert y 

## X Painting Agreemen t 

## a Settlemen t document s (i.e. , fo r

d^nag e or t o replac e plants , etc. ) Photograph s pre. , /^r>f l p/^ 1 

# X

X Satisfiu;tor y restoratio n signedb y Propert y Owne r D 

### Propert y close-out chec k lis t signe dby EP A Propert y informatio n fromDoii^la s Coimt y Assessor' s Office confirmation that leadpamphlet "Renovat e Right " wa s receive db y PO D D D

Dat e 

# 4 ^ Sigoatur e 3005440 3 

# r Superfun d250 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 200 9
SAID#5795 1 473 5 Erskin e St.

•Date s worked : 08/2 8 t o 08/2 9 200 9
•Pr e propert y condition : Hous e ha s painte dtransi t sidin g wit h woo dtri mareas ; garag e ha dvery poo r flaking pain t tha t wa s flaking of T i n th e yard
. Pain t chip s al l ove r yar d
aroun dgarag e
•Problem s encountered : None
•Owne r request/concerns : N/ A
•Inspection/closeou t dates
. Owne r signe d08/3 L Inspecte db y P E projec t manager .

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

# ENVIRONMENTA L ENGINEERS , INC

. Omaha , NE 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 yResponse 

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

### SAID : ^Q\b\ Property Address : ^ 7 7^ ^ X^/ ^ <^>yl" ^ Owner'sName : Performanc e Standards/Close-Ou t Criteri a 1. Wa s th e entir e structure(s ) painte dwit hth e exceptio nof th e stated , exclude d areas ? Thi s woul dinclud e paintin g of othe r associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an dexterip r surface s of 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 of th e structure(s ) prime das neede dan dpainte dwith tw o to p coats ? 4. Wa s th e pain t product s utilize dequivalen t to a 30 year product/quality ? 5. Ar e al lof th e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y vacuumed / cleaned ? 6. Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s on th e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y othe r generate ddebris ? 7. Is th e gras s are atha t smround s th e structure(s ) in reasonabl y goo dcondition ? 8. Ar e al l item s suc has polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . properl y removed ?
.. 9. Is ther e an y evidenc e ofpropert y damag e that was don eby th e contractor ? An y property damag e need s to be complete dprio r to th e EP A Close-Out
. 10
. Ar e ther e an y property item s tha t wer e temporaril y re-locate dby th e contracto r tha t nee d to be move dback ? " ' 11
. Ar e ther e an y (known ) lingerin g issue s with th e property owner(s ) tha t hav e bee n lef t unresolved ? Comments :

Professional E^ronmenta l Engineer s Representativ e

# CONSEN T FO RACCES S T O PROPERT Y OMAHA LEA D SIT E REMEDIA L ACTIO N - LEAD-BASED PAIN T STABIUZATIO N PROPERT Y ED : S^ \^f S I PROPERT Y 

### ADDRESS : H ^ 3 S '^r^Z\\f ^ "K^

- OWNERNAME : , y ^^- X 7 DAYTIM E PHONE : < 5 S'X-'^T)^ ^ CELLPHONE : E-MAIL : OWNER' S ADDRES S I FDIFFERENT : TENANT' S NAME I FAPPLICABLE : DAYTIM E PHONE : CELLPHONE : E-MAIL : ProfessioDa l Environmental Engineers , In c (PE ) b nnde r contrac t (#EP-R7-08-06 ) wit h tii e U.S
. Environmental Protectio n Agenc y (EPA ) t o stabiliz e leadliase dpain t(LBP ) on residaitia l gtrnctnre s a t annmiie r of propertie s locate di n Omaiia , Nebrasloi
. Th e pain t stainlizatio n wori c i s bein g don e t o protec t th e so O deannp s tlia t ar e lidn g performe dliy EP A contractors . Pain t stabilizatio n activitie s wO l indnde : scrapin g of cracke do r fialdn g LB P firomstnictnres , applicatio n of aprim e coat an dtw o (2 ) coat s of pain t Movin g part s of window s an ddoor s ar e no t indnde dan dwill no t b e addressed
. Your cooperatio n i s requeste din givin g permissio n t o tli b EP A contracto r (PE ) t o ente r an dhav e acces s t o thi s propert y fo r tb e purpos e of stabilizin g lead-iMse dpain t a s outline do n th e property identifie dabove
. B y signin g thi s documen t I agre e t o allo w a n EPA oontracto r t o condnc t asof l cleanu p a t m y propert y foOowia g oompldio n o f I«id-base dpain t stabilization , i f th e so O deann p ha s no t alread y been performed
. I understan dfliat tfa e stabilizatio n contracto r ca

n no t provid e assurance s tfaa t tfa e soi l cleanu p contracto r wi O li e boun dtxi , I ftirtfaerunderstan dtha t th e sof l deann p contracto r will mak e al l reasonabl e effort s t o addres s concern s ttat I , a s th e propert y owner , ma y hav e regardin g sof l deanu p a t m

y property . '^^Yes.lhmsrea d 

## ^-72^'7f' ^ Dat e I full y understan d tihat b y signin g th b Consen t fo r Access , (1 ) thi s acces s wfl l remai n i n effect nntf l th e wori t ha s been satisfactoril y completed , (2 ) tha t th e Propert y Owne r o r Tenant , if appUcable , wfl l b e given th e Housin g an dUrba n Devdopmen t (HUD ) an dEPA pamphk ^ "Renovat e lUght , Importan t LeadHazar dInfonnatio n fo r F^uiflies , Da y Car e Providere , an d Schools" , (3 ) th e Propert y Owner o r tenan t wi n remov e a U olAtruction s fit>msurfooe s t o b e pahited , {fS ) wfl l abid e b y healfli an d safet y gnidanc e provide dby EPA , (5 ) wi O aUo w photograph y ofpropert y before an dafte r A e pafai t stabflizatio n woric , (6 ) wfl l b e contacte dby aP E representativ e approximatel y 4 8 hour s b i advanc e o f startfai g worit , (7 ) agre e no t t o obstruct o r tampe r with an y of th e LB P stabflizatio n actions , an d(8 ) wfl l partkJpat e i afina l propot y inflectio n an dsig n tfa e Completfon Agreemen t an d Propert y Owne r Satisfoctio n Survey
. Shoul dyo n hav e an y qnestion s abou t th e pfaue dLeadBased-Paint stabflizatio n activitie afo r yon r prvqierty , pleas e contac t Professiona l Envuronmenta l Engfaieers , Inc
. Projec t Manager , Wfllie Oa y A t 402-504-4688
. Genera l questkm s abon t th e Omah a LeadSit e cleannp can b e directe dt o Paulett aFrance-Isetts , EP A Rmnedu dProjec t Manage r 402-731-2454 , o r th e EP A Publi c Informatio n Center s a t 402-991-958 3 (Nortf aOmah aofflce) o r 402-731-304 5 (Skiutf aOmafa aoffice)
. QY ( Yes, I gran t acces s t o m y piopei ^ an dwa s gtv mth e pamphle t D No,ldonotBr«itacoesttoinypniparfyandlw n 'Renovat e ngh ^ Importan t Laa dInfonnallo p fo r FamBas, Ch U gtm n th e pamph M Itenovri e reght, impoitan t Lea d CarePio v tafnmation Co r RunBea , OiBd a(>H s Piovidera
. an dSchools. ' 

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## PAIN T STABIL8ZATB0 N PRE-PROPERT Y PAIN T MATC H ASSESSMEN T PROPERT Y ADDRESS : M^V?^ ^ €fsL\ n t F ^ DATE : ^^ l-Xi^C ^ BVID :

AREA(S ) TO BE PAINTED :
HOUS E PROPER : COLOR : 

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(COMPLET E AL L SECTION , YES , NO , OR NON-APPLICABLE )



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PROPERT Y OWNE R SIGNATUR E PE ACCESO R SIGNATURE : 

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### Dougla s Coimt y Accoun t Information Pag e I of 2
Dougla s County , Nebrask a Propert yRecor d - R053238000 0 Prin t Reoor t NE W Featur e - Parce l Dimension s availabl e & scal e 0-5 0 f t wes t o f 52n d S t - ViO W O n MS D Informatio n i s vali d a s o f 2009-8- 3 Treasurer' s Ta xRepor t Ne w Featur e -•-•• • Aut o Sale s Searc h Owne r FITZLE R LARR Y L ETA L 473 5 ERSKIN E S T OMAH A N E 68104-000 0 Propert yInformatio n Ke yNumbe r 323 8 000 0 0 5 Accoun t Type : Residentia l Parce l Number : 053238000 0 — Parce l Address : 473 5 ERSKIN E S T OMAH A N E 681 0 4-000 0 Lega l Description : BAKE R PLAC E LO T 1 0 BLOC K2 5 0 X 12 8 Valu e Informatio n Lan d Improv e mon t Tota l y 200 9 200 8 200 7 200 6 200 5 200 4 $6,400.0 0 $6,400.0 0 $6,400.0 0 $6,400.0 0 $6,400.0 0 $6,400.0 0 $48,500.0 0 $48,500.0 0 $48,500.0 0 $48,500.0 0 $33,100.0 0 $33,100.0 0 $54,900.0 0 $54,900.0 0 $54,900.0 0 $54,900.0 0 $39,500.0 0 $39,500.0 0 Lan d Informatio n Acrs s S F U nit s Dept h Widt h Vacan t 0.1 4 6400. 0 1. 0 128. 0 50. 0 N o Improvemen t Informatio n Buildin g 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountao=R05..
. 8/21/2009

### Dougla s County Accoun t Informatio n Pag e 2 o f 2

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CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 844. 0 Percen t Complete : 100.0 % Perimete ri 0. 0 Quality : \ Fai r Uni t Type : Condition : Averag e Buil t As : 1 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : 

## - r Centra l Ai rt o Ai r Rooms : 5. 0 Exterior : Fram e Sidin g Units : , 1. 0 Interior : Drywal l Baths : ' 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 2. 0

Roo f Type : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : i 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 2 Oeta/ 7 Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 840. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 212. 0 Porc h Sla b Roo f Cei l 112. 0 Porc h Woo d Dec k 100. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R05.
.. 8/21/200 9

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