TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID: 47036 Date: 12/26/2008 

Address: 3418UST. 

Stabilization Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Video of property (DVD) 

m Executive Summary 

a Signed Access Agreement for subject property 

m Painting Agreement 

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

D Photographs 

[F Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

W Property infonnation from Douglas Coimty Assessor's Office 

D 

D 

D 

Ignature^ Date 

40310497 

IIIIIHiilli 

Superfund 
• 

PROPERTY SUMMARY 

Date: 12/27/08 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Month of: December 

Property Address: 3418 U ST. SAD); 47036 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: 

A.2 Issues Resolved: 

A.3 Unique Findings: NONE. 

A.4 Other Relevant Information: 

Access Date: 11/01/08 

Wor k Began: 11/04/08 

Closeout Date: 11/10/08 

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 

TECHNOLOGIES, INC. 
ENVIRONMENTAL « 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address:d^l'^ ^.:^ . Date: //-A^ f 

OIO -WW3W o>r Plume: BVTO: AnD>>l p 

Plant & Pennaneiit I^and^scapinp J n Rftmnin In Place 

Iliein# 

Description and LocatioD OaMap 

P»-Existing Condition of Stnictures 

Does your Basement have a history of lealdng? Yes —- No 

Dcmipbon^Location . ^^^^^ ) ^^^^y ^ SJAC)!^ S 

OnMq> 

rc3»rtl<it f€> 

Property Owner Prudent Emplo; 

Signature: 
4-' \^<^ 

Pnident Technologies, Inc. (Prudent) is under contract (Contract # EP-R7-08-07) with the U. S. 

Emrironmeotal Protection Agency (EPA) to stabilize Lead Base^aim (LBP) a^Jiumber of propertiea 

located in Omaha, Nebraska, including the property located at OMr\ o U CBr » 

The EPA requests your permission to allow Prudent to perfonn LBP Stabilization at this property. By 

signing tfiis form, the property owner grants permission to Prudent to perform activities rolatod to LBP 

Stabilization including scrapuag pamt and painting ofthe referenced property. Further, the owner/tenant 

verifies thatfliey hove received die LBP pamphlet "Renovate Right." 

If you have any questions about the LBP stabilization planned for your property, please contact Prudert*s 

/irfn^ii|f<rtn^five Clerk for the Lead Based Paint Stabilization, Mrs. Deborah Akerele-Johnson. 

at (402) S04'1004. General questions about the Omaha Lead Site cleanup can be directed to the EPA 

PubUc Infomiation Centeis at (402) 731-3045 (South Omaha office) or (402) 991-9583 (North Omaha 

office). 

Piopntf AoocN OiMod Byi 

(Please Print Niffi^ 

PrapeiV Owner Sigutun: • ! i^^'>'^-'^>t>'^^N&..^<r / /><—gi.—kL- ^ / / / <^ 

{Zvffiat^ yy ^ /CD W 

^ PROPERTY INFOrtWTION 

^ (To be coaplettd by reildcBt nd/or property ofwner-plcaie prtat^ 

RESIDENTNAME: ' Owner cy'^mdr j 

F RENTAL, PROPERTY OWNED BY: ^ /Il^i^okct^'l Sckk^. 

,. /y2?7 Uoyy^eyice- ^^iC. OIWrERfS MAUNO ADDRESS; 

, ,/^.^/-?.^ / OWNERTSTELEPHONBNUMBER.HOMB: t/ ^ \ ^ " ^^^ ' WORK! J I 

NUMBER OFOCCUPANTS UNDER 7 YEARS OLO: NUMBER OP OCCUPANTS 7 YEARS OLO ANO OLDER:. 

NUMBBROPCHILDREN UNDER 7 YEARS OLO WHO PLAY IN THE YARD FOR 9 HOURS OR MORE PER WEEK: . 

OONMENTB OR SPECIAL INSTRUCTIONS: 0.E. DOOS. ENTHY OATES, ETC.) 

AUTHORnY POit ENVIRONMBNTAL RBSPONSB ACtlONS; Iiw aotlvldee to be implememed hy EPA under t M 

Of CEKOJ^ 43 U.S.C 9604. BPA'I rigm ofaooeii 10 the propeny b piovlded fbr ID Section 104(e) of CERCLA, 42 U.S. C 9605(^^^ 

Ibr•'detinnlnlni tbe needftr roepooM, or cboof iBg ortaUiv any iMpowe letf on lader Iliil titie^ or cA^ ^ 

aamtkm ftl <t jtt i Q* , 42A2 UMlleal Drtva. Suita 4260 
Current Sample Pre-Renovation Fonn 

enecavs unai Apm 2010. 

Conllrmatlon ot Receipt ot Lead Pamphlet 

^hBMxeGsMiiaoop f dlVmpB^%ltls^, Renovate FVghvkriportant Lead ttezard 

irfontttlOantor FarrSlea, Chtd Cam Pmvklem and Schoola \irikxrTii\Q me d 

the pctetidal il8k of the leed Iiazard estpoaure frorn rerMvatlon activity to be 

periCnned in rny dweHrig unK. I leceived this pamphlet betora the vvor1< began. 

yf../,.^y^a:ie^ ^y/U r 

signature of recli 

SeH-Cartiffeatfon Option (fbr tenant-occupied dwellings only) — 

tf the iasd pamphlet was delivered btjt a tenant signature was not obtainable, 

you may checl< the apprepriale box below. 

Q Refusal to sign—I oertHy that I have made a good M h effort to deliver lhe 

pamphlet, Anovafe ASgfif: Drnportanf Itaaxi Hazard htonnaOon fbr ^mSea, 

Chtd Can Proi/lden and Schoola, to the rerrtal dwelling unit listed below at the 

date and time Indicated and that the occupant refused to sign the confirmation 

of rece^ I ftalher certify that I have left a copy of the pamphlet at the unit with 

theoccupanL 

Q llnavallidMa for ^nature--- I certify that I have made a good faith efTort to 

delfrar (he paniphlet,/terxTrate njgftf; ilrnporiarrt Laed Hazand 

/%rni9S, (>ifcf Care provMars and Scfxx)b, to the rental dwelling unft 

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

I further certify that I have left a copy of the pamphlet at ths unit by sliding It 

underHedoor. / y ^ r ^ 

Printed name of person certHying Attempted delivery 

dateandtime 

lead pamphlet delivery 

Signature of person ertif ^ lead pamphlet deRvay 

£^Mciha.. /O ^ 

UnitAMees 

Itole Rogaidiris Mailing Option •--As an alternative to delivery In pereon, you 

may mal thetoad pemphiet to the owner and/br tenant. Pamphlet must be mailed 

at least 7 days before renovation (Document with a certificate of mailing lifom the 

postolllo^ 
Paint matching fon?f^"* "'**'='' %•» By!^-^ ^ 

Area: ^*^//>^/6ii-/^'^^*^/'^^d'^"^^'^ ,. ; ' ' t color: oJhi'l-ir 

Explanation: i f^/lonJ' 

^^ r^^d\ Plooy - t7oft)-^i^ rear 7^7V 

^^®^- color: 

Explanation: 

y P<L/io^S' 

Area: '^''^'^^-^-"^-/^«-J^^^-f-'f- :^^w T 

Explanation: '' ^""""^ 

Area: Color: 

Explanation: 

Color: 

Page 1 
•MM 

AC(SB8£ lUFOt^Hm-ioNTi^AGIQNO SHBET 

ffKty)o6a. ^^341? . (\ ^ 

MicJii^-e/ ^^yykleAj 

smxMm HomK m-^^ y f&r/ V^^K 

£ £ . 

/yi/cl-eyiy 

tMB I taasor Conner OETAIL 

ii& 

: ) ^ ^/^( T gX^^-^/" >^ ^ >iW 7?d/rdV 

OBOVbi 

I ' 
Douglas County Account It^cnation Page 1 ol2 xAgms 

Douglas County, Nebraska Propeit y Record - R2248170000 

Print Report 

NEW Feature - Parcel Dimensions avaiiabie ® scala 0-50 ft west of OOth St - Vie w O n Ma p Inforination is valid as of 2008-9-4 Treasurer's Tax Report 

New Feature '*-*• * Auto Sales Search 

Owner 

ECKLEY MICHAEL j ~ 

ETAL TR 

1507 LAWRENCE LN 

BELLEVUE NE 68005-0000 

Property Information 

Key Number: 4817 0000 22 

Account Type: [ Residential 

Parcel Number: ; 2248170000 

Parcel Address: 3418 U ST 

; OIVIAHANE 68107-0000 

Legal Description: • SULLIVANS ADD TO SO OIVIAHA LOT 21 BLOCK 0 40 X 100 

Value Information 

i Land Improvement Total 

2008 1 $3,900.00 $39,000.00 $42,900.00 

2007 f 

! $3,900.00 $39,000.00 $42,900.00 

2006 1 $3,900.00 $39,000.00 $42,900.00" 

2005 $3,900.00 " $24^00.00" $'27,96o_o6 

2004 $3,900.00 $21,800.00 $25,700.00 

2003 $3,900.00 $21,800.00 $25,700.00 

Sales Information 

Sales Date: i 2004-06-03 

Deed Type: ' WD M Book: i 2004 Page: • 076035 

Price: : $0.00 

Grantor: ; Michael Eckley Etal 

Grantee: Michael Eckley Etal Tr. 

Validflnvalld: ' invalid 

Exclusion Reason: Family Sale 

Land Information 

Acres • SF •• Unita j Depth ; Widtii Vacant 

"'r - I "0^9 • ~ 4000.0 1.0 J 100.0 40.0 No 

Improvement Informatio n 

.'/J - -..>» /r^r.-nr.lncir~*/\XTo/o+n+ir»/'>r»r»r*nnf infr* ipr»'7Qr»/^r\iiri+nr\=:T?00 1 n/1 nnr\fi 
Douglas County Account In^patio n Page 2 of 2 

Building 1 

^M ^ 1 1'2 stoiy Unfin 3418 us t 

CLICK TO ENLtlRGE jjVIAGE : 

Square Footage: j 876.0 Percent Complete: : 100.0% 

Perimeter | 0.0 Quality: • Average 

Unit Type: \ Condition: ; Fair 

BuiitAs: i 1 1/2 Story Unfin Condo Square Footage: 0.0 

HVAC: ' Central Air to Air Rooms: . 5.0 

Exterior: i Frame Aluminum Units: ' 1.0 

Interior: j Drywall Baths: : 1.0 

Roof Cover: i Composition Shingle Bedrooms: 2.0 

Roof Type: • Gable Stories: 1.0 

Floorcover: i Allowance Foundation: Block 

Sprinider Square Footage: 0.0 

Year Percent AdjustadYear \ p^y,i,„^g , Year Buitt Remodeled Remodeled 

1910 0% 1910 ; 96""'" 

Detail Type Detail Description Unita 

Add On Fence Chain Link __; ji.o 

Appliance Allowance 

Fixture Base Fixtures j 1.0 

Fixture Bath Full i i.oPorch Slab Roof Ceil ] 48.0' 

Porch Slab Roof Ceil • 9^.0 

User Crawl 876,0 
PriLdent Propeity Close-Out Form (Lead-Based Paint Stabilization) 

Projierty Address; ^^^ ^ O '>'^ 

Owrter'sWame! f^C <!A^ou.e: I ^C^vUtej/ 

Peiformance Standards/close-Out Criteria 

YES 1^ 

1. ^35 the entire structure(s) painted with the exception of the stated, excluded areas? This would 

liiclude painting of other associated features including fascia, eaves, siding, all trim, porches, box 

/

t|eams, columns, rails, and exterior surfaces of garages. 

2. Was all scraping and other preparattion work completed satisfactorily? y 

3. Vyjiere all required areas of the structure(s) primed as needed and painted with two top coats? y 

4. \ft^s the paint products utilized equivalent to a 30 year product/quality? J L 

5. A|e all of the areas where contaminated materiais have been spilled 

tiiibroughly vacuumed/ cleaned? y

6. Oib the contractor collect/vacuum all failing and scraped paint chips on the entire property, •i 

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

rr 

7. Is the grass area that surrounds the structure(s) in reasonably good condition? y 

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

pr<|iperly removed? 

9.

 Is tiljere any evidence of property damage that was done by the contractor? Any property damage 

ne^dsto be completed prior to the EPA Close-Out. X

10. Arelthere any property items that were temporatiiy re-located by the contractor X th ^ need to be moved back? 

11. Are there any (known) lingering issues with the property owner(s) that have been left unresolved? 

/ Oth^rConsideratlons?property Owner Discusslons?Additional Work that is Required 

.- yy 

OuhJLt^ 

Prudeht Representative : (^U-/^-^ 

Date l^^x^-a ^ w^<^ ^ /