TRANSIVIITTAL of OiMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID #: Kf\^9 ) Date: (;^;X ^ 

Address: 9_\V ^ ^^tTT^ T S T 

Stabilization Contractor: Professional Environmental Engineers Year: ^011 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

^0- ^ Video of property (DVD) 

-H Executive Summary 

^ y Signe(J Access Agreenient for subject property 

^ Fre-Renovation Form signed by Property Owner 

SK Pre-Renovation Fonn for Occupant/Tenant, if applicable 

&^ Painting Agreement 

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

[v/ Renovation Recordkeeping Checklist signed by Certified Renovator 

D Photographs 

Ql Satisfactory close-out check list signed by Property Owner 

D Property close-out check list signed by EPA 

S/ Property information from Douglas County Assessor's Office 

D Hazard analysis, if prepared 

D Safety Audit 

D Other (describe): 

ProfessionaiEfivrPwirne 

EPA COR Signature ' iJate 

(after file folder review) 

40377553 

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 • Engineering Design • Remediation • Abatement • Emergency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

2011 

SAID# 30738 

2108 Spencer St 

• Dates worked: 6/1 to 6/2 2011 

• Pre property condition: House has mostly vinyl siding with painted wood trims and 

foundation areas. Paint was flaking off in areas. There were prior paint splatters on 

siding. 

• Problems encountered: None. 

• Owner request/concerns: N/A 

• Inspection/closeout dates. Owner 6/6/11 
2011 

PROFESSIONAL 

2505 North 24'^ Suite 219 ENVIRONMENTAL ENGINEERS, INC. Omaha, NE 68110 

(402) 504-4688 "Providing cost-effective environmental solutions" Fax (402) 504-3281 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Property Owner C lose-Out Form 

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

SAID: .^^7-3 ^ 

Property Address: ^ Qi^gitegz. 9 ^ 

Owner's Name: ^5/)HCyA^ fj^AC ^ 

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? K 

4. Was the paint products utilized equivalent to a 25 year product/quality? - ^ 

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

vacuumed/ cleaned? K 

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 J > ^ 

debris? 

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

8. Are all items such as polyethylene sheeting, ladders, paint brushes, cones, barrier tape, K etc. properly removed? ' 

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

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

10. Are you satisfied wdth the work performed? 

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

need to be moved back? 

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

unresolved? 

Other Considerations/Property Owner Discussions/Additional Work that is Required: 

{y^^ju,^^^UJ^'^^ ^ fej 

Property Owner Signature 

ProfessioiiaiEsvironmental Engineers Signature 
PROFESSfOMAL 

500 5. Ewing, Suite E ^ ENVIRONMENTAL EERS, SMC. St. Louis, MO 63103 

(314)531-0060 'Providing uosi-efiectivi^ envirofiinentai soiuilons Fax (314) 531-0068 I lii j i»Mji..jm.i...»ji».'. n 

20\) 

Property Owner Close-Out Form 

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

SAID: ^3fif^V 

Property Address: ^ ^1 3 U ^ 0 ^ t 

Owner's Name: fhCYJArA^r^j ^^f/^ / lf\. 

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< 

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

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 25 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? 

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

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

^ etc. properly removed? 

9. Is there any evidence of property damage that was done by the contractor? Any property K

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

10. Are you satisfied with the work performed? ^ T 

11. Are there any property items that were temporarily re-located by the contractor that C^ 

need to be moved back? 

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

unresolved? (X 

Other Considerations/Property Owner Discussions/Additional Work that is Required: 

p ^ 

jip^mAA (}l^/ 

Property Owner Signature Date ' 

m 

Professional Emcin Engineers Signature I Date 
• 

Professional Environmental Engineers: EPA Paint Stabilization 2011 

Property Address 9\^<P \ SjTPfWPj - f ^ 

Stories/Siding type A J f O Transite Wood Vinyl Metal Stucco 

Garage? Yes No Painted? Yes No 

1 

Where? Siding 

Date access signed (iD/ ( Co/ l I 

r— /,- / l l 1 Trim 

Pre-video 

Post video 

Contractor Assigned 

Date started 0// Date ended M 

Weather Conditions 

Paint used 

Prime used 

Poly used 

Problems/Issues 
(effective April 2010) 

RENOVATION RECORDKEEPIN G CHECKLIS T 

Name of Firm: SiyJT if.^^Z ^/iMTit/ ^ 

Date and Location of Renovation: 

Brief Description of Renovation: 

Name of Assigned Renovator: lH-(^-^^^^ ^ 

Name(s) of Trained Workers: 

Name of Dust Sampling Technician, Inspector, and/or Risk Assessor, if used: 

^ Copies of renovator and dust sampling technician qualifications (training certificates, certifications) on file. 

a- Certified renovator provided training to workers on (check all that apply): 

SaTosting warning signs El, Setting up plastic containment barriers 

(^ Maintaining containment &• A voiding spread of dust to adjacent areas 

pELWaste handling ^ Post-renovation cleaning 

^ Test kits used by certified renovator to determine whether lead was present on components affected by 

renovation (identify kits used and describe sampling locations and results: 

(^ Warning signs posted at entrance to work area. 

0-Work area contained to prevent spread of dust and debris. 

P'Windows in and within 20 feet ofthe work area are closed 

\|^ Doors in and within 20 feet ofthe work areas are closed and sealed 

t^TDoors that must be used in the work area are covered to allow passage but prevent spread of dust. 

\0 Groimd covered by plastic sheeting extending 10 feet from work area - plastic anchored to the 

building and weighted dov^ by heavy objects. 

^Ifnecessary, vertical containment installed to prevent migration of dust and debris to adjacent 

property. 

0-~.Waste contained on-site and while being transported off-site. 

Renovation RecoriJkeeping Checklist Omaha Lead Site 
(effective April 2010) 

0 Work site properly cleaned after renovation. 

S^All chips and debris picked up, protective sheeting misted, folded dirty side inward, and taped for 

removal. 

T?! Work area HEPA vacuumed to get paint chips from ground surface, ifnecessary. 

Q Certified renovator performed post-renovation cleaning verification (describe results): 

lj2> I certify under penalty of law that the above infonnation is true and complete. 

'JHJ^f^ 

Name and Title Date 

Renovation Recordkeeping Checklist Omaha Lead Site 
4/27/2011 mw^ 

Douglas County, Nebraska Pro pR. y Kecurd - R1527490000 

Douglas County Account Information 3200 A) 

Print Report 

View Interactive GIS Map Infonnation is \alid as of 2011-4-13 Treasurer's Tax Report 

New Feature -^ Subdivision Sales Search 

Owner 

ROACH SANDRA L 

2108 SPENCER ST 

OMAHA NE 68110-0000 ^^2-^ST-SK7 9 V^a-r^^^-^667 

Property Information 

Key Number: 2749 0000 15 

Account Type: Residential 

Parcel Number: 1527490000 

Parcel Address: ^1.08_S£ENC.ER_SJJ 

' rOMA'HA"NE'68.11 OrOOOO? 

Legal Description: KOUNTZE PLACE LOT 13 BLOCK 20 W 40 FT 40 X124 

Value Information 

Land Improvement Total 

2010 $4,300.00 $44,200.00 $48,500.00 

2009 $4,300.00 $44,200.00 $48,500.00 

2008 $4,300.00 $44,200.00 $48,500.00 

2007 $4,300.00 $39,900.00 $44,200.00 

2006 $4,300.00 $39,900.00 $44,200.00 

2005 $4,300.00 $39,900.00 $44,200.00 

Land Information 

Acres SF Units Depth Width Vacant 

0.11 4960.0 1.0 124.0 40.0 No 

Improvement Information 

Building 1 

,mapping-online.com/.../accountinfb.j. 1/3 
4/27/2011 Douglas County Account Information 

2108 Spencer 

itt ^ i 

ni ­ FtrtFloor 

TWSSdFl A , 

'sw.oric FIOM 

6'6CS» Fl 

2 1/2 Story Unfin 69nrteki>«« r'iCSc Fl 

CUCK TO ENLARGE IMAGE 

CLICK TO ENLARGE IMAGE 

Square Footage: 1326.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

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

HVAC: Central Air to Air Rooms: 6.0 

Exterior: Frame Vinyl Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Hip Stories: 2.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1909 0% 1909 101 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Appliance Security System 1.0 

Basement Bsmnt Block 8 ft 710.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Porch End Solid Wall 176.0 

...mapping-online.com/.../accountinfo.j... 2/3 
, # 

/ 

CONSENT FOR ACCESS TO PROPERT »M^ Y 


OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID: ^^^01.2JJrS PROPERTY ADDRESS: ^LSOQ 'SCP^^^C^'T ^ ~ ' ~ 

)WNER NAiVIE: 

DAYTIME PHONE; 

CELL PHONE(J^^)^^A^ZJ% . E-MAIL: 

OWNER'S ADDRESS IF DIFFERENT: sS- TENANT'S NAME IF APPLICABLE: 

DAYTIME PHONE: 

CELL PHONE: 4>ii ^ E-MAIL: 

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

Agency (EPA) to stabilize 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 are being performed by EPA contractors. 

Paint stabilization activities will include: scraping of cracked or flaking LBP from structures, application of a prime coat and two 

(2) coats of paint. Moving parts of windows and doors are not included and will not be addressed. 

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

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

By signing this document I agree to allow an EPA contractor to conduct a soil cleanup at my property following completion of 

lead-based paint stabilization, if the soil cleanup has not already been performed. 1 understand that the stabilization contractor 

can not provide assurances that the soil cleanup contractor will be bound to. I further understand that the soil cleanup 

contractor will make all reasonable efforts to address concerns that I, as the property owner, may have regarding soil cleanup at 

my property. 

DK es, I have reaidan^nderstan d an d the paragraoh above. 

Signature of Property Owner I Oate 

I fully understand that by signing this Consent for Access, (I) this access will remain in effect until thework has been 

satisfactorily completed, (2) that 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, Day Care Providers, and 

Schools", (3) the Property Owner or tenant will remove all obstructions from surfaces to be painted, (4) will abide by health and 

safety guidance provided by EPA, (5) will allow photography of property before and after the paint stabilization work, (6) will be 

contacted by a PE representative approximately 48 hours in advance of starting work, (7) agree not to obstruct or tamper with 

any ofthe LBP stabilization actions, and (8) will participate in flnal property inspection and sign the Completion Agreement and 

Property Owner Satisfaction Survey. 

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

Professional Environmental Engineers, Inc. Project Manager, Willie Clay or Kelley Sanders At 402-504-4688. General questions 

about the Omaha Lead Site cleanup can be directed to Pauietta 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). 

/es, I grant access to my property and was given the pamphlet D No, I do not grant access to my property and I was 

"Renovate Right, Important Lead Information for Families, Child given the pamphlet "Renovate Right, Important Lead 

Care Prpvlders, and Schools." Information for Families, Childe Care Providers, and Schools." 

Signature pate ' Signature Date 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
t 1 

PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

AREA(S) TO BE PAINTED: 

HOUSE PROPER: COLOR: J2,AJL^J::L'''^ 

HOUSE TRIIM: . COLOR: /^lei/J^ JLLOI^ J Sk;6 - j 5^ 

GARAGE: ^ COLOR: 

GARAGE TRIM: fO h^ COLOR: 

SU) Q\S^ 

PORCH: . COLOR: /^/tA^ Aute^^ 

5W($i^5ij PORCH TRIM: iCl^A^t /(Uji^e'^n^ COLOR: /2/iyiA JUAJI?^ . 

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

I AGREE TO THE COLORS LISTED ABOVE. ONCE THE PAINTING 

BEGir^, I UNDERSTAND L^ N NOT CHANGE THE ABOVE SELECTED COLORS: 

i ^ 

PROPERTY OWNER SIGNATU UrtE: PE ACCESOR SIGNATURE 
PRE-RENOVATION FORM - OWNER 

This form is to be used by the firms contracted by the Environmental Protection Agency-Region 7 to perform Lead-Based 

Paint stabilization activities at the Omaha Lead Site, Omaha, Nebraska. 

Owner Confirmation 

Pamphlet Receipt 

ty[ have received a copy ofthe lead hazard information pamphlet. Renovate Right: Important Lead Hazard Information for 

Families, Child Care Providers and Schools, informing me ofthe potential risk ofthe lead hazard exposure from renovation 

activity to be performed in/on my dwelling unit. I received this pamphlet before the work began. 

Owner Acknowledgment 

D (A) I confirm that I own and live in this property, that no child under the age of 6 resides here, that no pregnant woman 

resides here, and that this property is not a child-occupied facility. 

Note: A child resides in the primary residence of his/her custodial parents, legal guardians, foster parents, or 

informal caretaker if the child lives and sleeps most of time at the caretaker's residence. 

Note: A child-occupied facility is a pre-1978 building visited regularly by the same child, under 6 years of age, on at 

least two different days within any week, for at least 3 hours each day, provided that the visits total at least 60 hours 

annually. 

ICKB) I understand that the renovation firm, contracted by the Environmental Protection Agency (EPA), will be using leadsafe work practices required by EPA's Renovation, Repair and Painting Rule. 

^^AW^^ L^ /C^j ^ 

Printed Name of Owner-Occupant 

Of^AiA^ 2 Pif-f^(Ul^ 

Signature of Ovmer-Occupant Date