TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: 2JI^'^ ^ Date: Alj-l//Di 

Address: 43'40 Parker S t 

Remediatioii Contractor: PROFESSIONAL ENVIRONMENTAL ENGINEERS Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

0 ^ Video of property (DVD) 

wA Executive Summary 

S/ Signed Access Agreement for subject property 

M Painting Agreement 

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

B^ Photographs 

M Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

M Property information from Douglas County Assessor's Office 

D , ^_ _ 

Q • ' • • • • - ' " 

Signature Date 

40318287 

Uliif 

Superfund 
2505 North 24«\ Suite 219 

Omaha, NE 68110 

(402) 504-4688 

Fax (402) 504-3281 

PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

"Providing cost-effective environmental solutions" 

Consulting • Engineenng Design • Remediation • Abatement • Emergency Response 

Lead Base Paint Stabilization Omaha, Ne 

Close Out Report 

SAID#26945 

4340 Parker St 

• Dates worked 12/28 to 12/29 2008 

• House had cracks in concrete siding and the back screen door was tom. The front porch was 

weak in areas and the paint was in poor condition. 

• Inspected 12/30 by PE project manager. EPA was unavailable for inspection. 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

"Providing cost-efiBctive enviivnmeiitai solutions" 

Consulting = Engineering Design <> Remediation » Abatement = Emergency Response 

Property Ovmer Close-Out Form 

(Lead-Based Paint Stabilization EPA Contract EP-R7-08-06) 

SAID: 1/^ 9'AS 

Property Address: i^l^O /hm:n P 

2505 North 24*, Suite 219 

Onnaha, NE 68110 

(402) 504-4688 

Fax (402) 504-3281 

Owner's Name: Hay /B&MniUL pu 59S^^3^ 

1 Performance Standards/Close-Out Criteria YES NO 

1. Was the entire structure(s) painted with the exception ofthe stated, excluded 

areas? This would include painting of other associated features including fascia, 

eaves, siding, all trim, porches, box beams, columns, rails, and exterior surfaces of / 

garages. 

2. Was all scraping and other preparation work completed satisfactorily? / 

3. Were all required areas ofthe structure(s) primed as needed and painted with /

two top coats? 

4. Was the paint products utilized equivalent to a 30 year product/quality? ./ ' 

5. Are all ofthe areas where contaminated materials have been spilled thoroughly 

vacuumed/cleaned? / 

6. Did the contractor collect/vacuum all falling and scraped paint chips on the 

entire property, roadways, alleyways, public access areas and also remove any 

other generated debris? 

/ 

1 7. Is the grass area that surrounds the structure(s) in reeisonably good condition? / 

8. Are all items such as polyethylene sheeting, ladders, paint brushes, cones, 

barrier tape, etc. properly removed? / 

9. Is there any evidence ofproperty damage that was done by the contractor? Any 

property damage needs to be completed prior to the EPA Close-Out. 

A 

10. Are there any property items that were temporarily re-located by the contractor 

that need to be moved back? / 

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

been left unresolved? 

/ 

1 Comments: 1 

* ' 

Ci'U..M.Aj<^ X I LJM- Property Owner Signature Date 

Vz/^ 

Professional Environmental Engineers Representative Date 
CONSENT FOR ACCCESS TO PROPERTY 


OMAHA •".r,,:-.*- LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID: PROPERTY ADDRESS: 

ACf^Hf Jy5W Pari^ SA ^ 

OWNER'S NAME: TTr>Ai C<\cxLLK\.cp. _DAY-TiME PHONE: 59?' J^^Ti 

CELL PHONE: E-MAIL 

OWNER'S ADDRESS IF DIFFERENT: 

TENANT'S NAME IF APPLICABLE: 

_DAY-TIME PHONE: 

CELL PHONE: E-MAIL 

Professional Environmental Engineers, Inc. (PE) is under contract (#EP-R7-08-06) with the U. S. Environmental Protection Agency (EPA) 

to stabilize exterior lead-based paint (LBP) on residential structures at a number of properties located in Omaha, Nebraska. The paint 

stabilization work is being done to protect the soil cleanups that were performed by EPA contractors. 

Paint stabilizations activities will include: scraping of cracked or flaking LBP from structures, applicatron of a prime coat and two (2) coats 

of paint Any moving parts of windows and door are not included in the activities and will not be addressed. 

Your cooperation is requested in giving pennission to this EPA contractor (PE, Inc.) to enter and have access to this property for the 

purpose of stabilizing lead-based paint as outlined on the property identified above. 

I fully understand that by signing this Consent For Access, (1) this access will remain in effect until the work has been satisfactorily 

completed (2) that as the Property Owner or tenant, if applicable, will be given the Housing and Urban Development (HUD) and EPA 

pamphlet, "Renovate Right, Important Lead Hazard Information for Families, Child Care Providers and Schools" (3) the Property Owner or 

tenant will removal of obstructions from surfaces to be painted, (4) will abide by health and safety guidance provided by EPA, and (5) will 

allow photography of property before and after the paint stabilization work, (6) I will be contacted by a PE representative approximately 

48 hours in advance of starting work to (7) agree not to obstmct or tamper with any of the LBP stabilization activities or equipment used to 

perfomi any LBP actions, (8) will participate in final property inspection and sign the Completion Agreement and Property Owner 

satisfaction Survey. 

Should you have any questions about the planned Lead Based-Paint stabilization activities for your property, please contact: Professional 

Environmental Engineers, Inc., Project Manager, Hemian Hanner at 402-884-1185. General questions about the Omaha Lead Site 

cleanup can be directed to Pauletta France-Isetts, EPA Remedial Project Manager 402-731-2454, or the EPA Public Information Centers 

at (402) 991-9583 (North Omaha office) or (402) 731-3045 (South Omaha office). 

Yes, I grant access to my property and was given ]No, I do not grant access to my property and i was 

ipiiiet "Renovate Rigiit, important Lead Hazard given tlie pampliiet "Renovate Rigiit, Important Lead Information 

for Families, Ciiiid Care Providers and Sciioois. Hazard Informationfor Families, Ciiiid Care Providers and 

Sciiools. 

"T/K ^Z^S^-^^CcJi^ 

Signature \ \ \> Date Signature Date 

SPECIAL INSTRUCTIONS AND/OR CONSIDERATIONS: 
Confirmation Of Receipt Of Lead Pamphlet 

BVID ^GP^V S 

PROPERTY ADDRESS Q^^ o P/-y.^/ s / ZIP CODE & m 

PROPERTY ADDRESS OF OWNER IF DIFFERENT THAN PROPERTY BEING PAINTED: 

PROPERTY ADDRESS ^ZIP CODE 

I have received a copy of the pamphlet, Renovate Right: Important Lead Hazard Information For Families, 

Child Care Providers And Schools informing me of the potential risk of the lead hazard exposure from 

renovation activity to be peifoimed on dwelling unit. I received this pamphlet before the work began. 

/M^u.Y,\^ TY^c^ /o-lho ^ 

PRINTED NAME OF RECIRENT DATE 

"'"^^^g^<^>^c ^ 

SIGNATURE OF RECIPIENT 

Self-Certification Option (For Tenant-Occupied Dwellings Only) 

If the lead pamphlet was delivered but a tenant signature was not obtainable, you may check the appropriate box 

below: 

I J Refusal To Sign - 1 certify that 1 have made a good faith effort to deliver the pamphlet, renovate right: important 

lead hazard infomnation for families, child care providers and schools; to the rental dwelling unit listed above at the 

date and time indicated and that the occupant refused to sign the confirmation of receipt. I further certify that I 

have left a copy of the pamphlet at the unit with occupant. 

I-I Unavailable For Signature - 1 certify that I have made a good faith effort to deliver the pamphlet, renovate right; 

important lead hazard infomiation for families, child care providers and schools, to the rental dwelling unit listed 

below and that the occupant was unavailable to sign the confirmation of receipt I further certify that I have left a 

copy of the pamphlet at the unit by sliding it under the door or somewhere on the premises. 

-Keileu ^nJ^ d )o/j/ld& 

PRINTED NAME OF PERSON CERTIFYING AHEMPTED DELIVERY DATE AND TIME LEAD 

PAMPHLET DELIVERY 

SIGNATURE ORPERSON CERTIFYING LEAD PAMPHLET DELIVERY: 

Note Regarding Mailing Option - as an altemative to delivery in person, you may mail the lead pamphlet to the owner 

and/or tenant. Pamphlet must be mailed at least 7 days before renovation. (Document with a certificate of mailing from the post 

office). 

CONFIRMATION OF RECEIPT OF LEAD PAMPHLET 08/08 
PAINT STABILIZATION PRE-PROPERTY ASSESSMENT 

PROPERTY ADDRESS: ^i^ O fhc^Up / i " / DATE l^/llp^ 

CV\C^Kc.^ i^ ^ (j)%\\l BVID S.CoQ^ ^ 

PLANT & PERMANENT LANDSCAPING TO BE REMOVE? NO fTTI YES [ -2 

IF, YES WHERE: 

PRE-EXISDJ^G CONDmOM OF FOUNDATION/STRUCTURE, i.e. BASEMENT LEAKING? 

M^ NOk I L ,A K I VBYECS I 1 TE VBCUrUPDC ' IF, YES WHERE: 

EXISTING PAINT ON WINDOWS, DOORS, r FOUNDATION, SIDEWALK,( LE.)? NOfXl 

YES 1—1 IF, YES WHERE: 

[rr?(c.v. fbo / Lj^^ll 1^7 S^^^3 

/^i?./q^K^ ') n r^jn f^^i^ SrML ^ 

V ) 

VISUAL DESCRIPTION OF PROPERTY/STRUCTURE/GARAGE, (I.E.): (USE BACKSIDE IF 

NECESSARY) ^^^ r 

,!^/^c/^ $^^r:^A -A^o^^ 

PROPERTY OWNER SIGNATURE iCCES^ER SIGNATURE 

IQM 

i 
PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

PROPERTY ADDRESS : lAH^Ci

Orvy^W^^ A) ^

 PAJLLIA r 

 CnU 

DATE 

BVID 

to///k

/Qfn^^S 

AREA(S) TO BE PAINTED: 

HOUSE PROPER: COLOR 

HOUSE TRIM 

GARAGE. 

_COLOR_ 

_COLOR^ 

\/^Ay(^y(/'^ 

M()NA 

i^fe

7# ^//W i,-^. 

 S- ^ Gf}\\(j>ji 

^ ' ^»lk^ 

GARAGE TRIM COLOR. 

PORCH COLOR. 

PORCH TRIM . COLOR. . ' ' 1

(COMPLETE ALL SECHON, YES, NO, OR NON-APPLICABLE) 

I AGREE TO THE COLORS LISTED ABOVE. ONCE PAINTING BEGINS, I 


UNDERSTAND I CAN NOT CHANGE THE ABOVE SELECTED COLORS: 


PROPERTY OWNER SIGNATURE: PE ACCESSOR SIGNATURE: 

>-^^>^_^-"^t 

PAINT MATCH FORM 08/08 
Douglas County Account Information Page 2 of 2 

,.j^" " 

—as?*' 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1241.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

Built As: 1 1/2 Story Fin Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 6.0 

Exterior: ; Frame Stucco Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: \ Composition Shingle Bedrooms: 2.0 

Roof Type: \ Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinider Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1916 0% 1916 92 

Deta/7 Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 708.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 336.0 

Porch End Screen 50.0 

Porch Slab Roof Ceil 184.0 

Porch Wood Deck 150.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp ?accountno=RO... 10/11/2008 
Douglas County Account Information Page 1 of2 

Douglas County, Nebraska Property Record - R0906030000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 90th St - Vie W On IVIap Information is valid as of 2008-9-4 Treasurer's Tax Report 

New Feature -*-*- • Auto Sales Search 

Owner 

JAY MAURICE 

ETAL 

4340 PARKER ST 

OMAHA NE 68111-0000 

Property Informatio n 

Key Number: 0603 0000 09 

Account Type: Residential 

Parcel Number: 0906030000 

Parcel Address: 

Legal Description: 

4340 PARKER ST 

OMAHA NE 68111-0000 

CREIGHTONS 2ND ADD LOT 19 BLOCK 1 50 X 130 

Value Informatio n 

2008 

2007 

2006 

2005 

2004 

2003 

Land 

$6,400.00 

$6,400.00 

$6,400.00 

$6,400.00 

$6,400.00 

$6,400.00 

Improvement 

$43,300.00 

$43,300.00 

$43,300.00 

$43,300.00 

$43,300.00 

$43,300.00 

Total 

$49,700.00 

$49,700.00 

$49,700.00 

$49,700.00 

$49,700.00 

$49,700.00 

Land Informatio n 

Acres 

0.14 

SF 

6500.0 

Units 

1.0 

Depth 

130.0 

Width 

50.0 

Vacant 

No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO... 10/11/2008