### TRANSIVIITTA L o f OiMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R SAI D # : Kf\^9 ) Date : (;^;X ^ Address : 9_\V ^ ^^tTT^ T S T Stabilizatio n Contractor : Professiona l Environmenta l Engineer s Year : ^01 1 PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S ^0- ^ Vide o o f property (DVD )

- H Executiv e Summary ^ y Signe( J Acces s Agreenien t fo r subjec t property ^ Fre-Renovatio n For msigne db y Property Owner S K Pre-Renovatio n Fon n fo r Occupant/Tenant , if applicabl e & ^ Paintin g Agreemen t D Settlemen t (document s (i.e. , fo r damag e o r t

o replac e plants , etc. ) [v

/ Renovatio n Recordkeepin g Checklis t signe db y Certifie dRenovato r D Photograph s Q

l Satisfactory close-ou t chec k lis t signe dby Property Owne r D Propert y close-ou t chec k lis t signe db y EP A S /

Property informatio n fromDougla s Count y Assessor' s Offic e D Hazardanalysis , if prepare d D Safet y Audi t D Othe r (describe) :

ProfessionaiEfivrPwirn e EP A CO RSignatur e ' iJate (after fil e folde r review ) 4037755 3 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 yResponse



### Lea dBas e Stabilizatio n Omaha , N e Clos e Ou t Repor t 201 1 SAID #3073 8 210 8 Spence r S t

•Date s worked : 6/ 1 t o 6/ 2 201 1 •Pr e propert y condition : Hous e ha s mostl y viny l sidin g wit h painte dwoo dtrim s an d foundatio n areas . Pain t wa s flakin g of f i n areas . Ther e wer e prio r pain t splatter s o n siding . •Problem s encountered : None . •Owne r request/concerns : N/A •Inspection/closeou t dates . Owne r 6/6/1 1

## 201 1 

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

# ENVIRONMENTA L ENGINEERS , INC
. Omaha , N E 6811 0 (402 ) 504-468 8 

### "Providin g cost-effectiv e environmenta l solutions " Fax(402 ) 504-328 1 Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yRespons e 

## Propert y Owne r

C lose-Ou t For m (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) 

## SAID : .^^7-3 ^ Property Address : ^ 

# Qi^gitegz
. 9 ^ Owner' s Name : ^5/)HCyA ^ fj^AC ^ Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) painte dwit h th e exceptio n ofth e stated , exclude dareas ? 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 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 ofth e structure(s ) prime da s neede dan dpainte dwith tw o to p coats ? 

# K 4 . Wa s th e pain t product s utilize dequivalen t t o a2 5 yea r 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 ? 

# K 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 any othe r generate d 

### J > ^ debris ? 7 . I s th e grass are athat surround s th e structure(s ) i n reasonabl y goo dcondition ? 

# X 8 . Are al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , 

# K 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 EPA Close-Out . • ^ 

### 10 . Ar e yo u satisfie dwdt h th e wor k

performed ? 11 . 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 ? 12 . Ar e ther e any (known ) lingerin g issue s wit h th e property owner(s ) that hav e bee n lef t unresolved ? Othe r Considerations/Property Owne r Discussions/Additiona l Wor k

tha t i s Required : 

# {y^^ju,^^^UJ^'^^ ^ fej Property Owne r Signature
ProfessioiiaiEsvironmenta l Engineer s Signatur e

## PROFESSfOMA L 50 0 5 . Ewing , Suit e E 

## ^

ENVIRONMENTA L EERS , SMC
. St
. Louis , M O 6310 3 (314)531-006 0 

### 'Providin g uosi-efiectivi ^ envirofiinenta i soiuilon s Fa x(314 ) 531-006 8 I lii j i»Mji..jm.i...»ji».'. n 

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

## SAID : ^3fif^ V Property Address : ^ ^1 3 U ^ 0 ^ t Owner' s Name : fhCYJArA^r^ j ^^f/^ /

lf\ . Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) painte dwit h th e exceptio n ofth e stated , exclude dareas ? 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 garages . 

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

complete dsatisfactorily ? 

# X 3 . Were al l require darea s ofth e structure(s ) prime da s neede dan dpainte dwit h tw o to p coats ? 4 . Wa s th e pain t product s utilize dequivalen t t o a2 5 yea r product/quality ? 5 . Ar e al l ofth e area s where contaminate dmaterial s hav e bee n spille dthoroughl y vacuumed / cleaned ? < 

### 6 . Di dth e contractor collect/vacuu mal l fallin g an dscrape dpaint chip s o n th e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y othe r generate d debris ? 7 . I s th e gras s are athat surround s th e structure(s ) i n reasonabl y goo dcondition ? 8 . Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , 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 ? Any property 

# K damag e need s t o b e complete dprio r t o th e EPA Close-Out . 10 . Ar e you satisfie dwit h th e wor k

performed ? 

## ^ T 11 . Ar e ther e any property item s tha t were temporaril y re-locate dby th e contracto r tha t C ^ nee dt o b e move dback ? 12 . Are ther e any (known ) lingerin g issue s with th e property owner(s ) that hav e bee n lef t unresolved ? 

# ( X Other Considerations/Property Owne r Discussions/Additiona l Wor k

that i s Required : 

# p ^ 

# jip^mA A (}l^ / Propert y Owne r Signatur e Dat e ' 

# m Professional Emci n Engineer s Signatur e I Dat e• Professiona l Environmenta l Engineers : EP A Pain t Stabilizatio n 201 1 

### Propert yAddres s 9\^<P \ SjTPfWPj - f ^ Stories/Sidin g typ e A J f O Transit e Woo d Viny l Meta l Stucc o Garage ? Ye s N o Painted ? Ye s N o 

## 1 Where ? Sidin g Date acces s signe d (iD / ( Co/ l I r—/, - / l l 1 Tri m Pre-vide o Pos t vide o Contracto rAssigne d Dat e starte d Dat e ende d 

# 0/ / 

# M Weathe rCondition s
Pain t use d Prim e use d Pol yuse d Problems/Issue s(effectiv e Apri l 2010 )



### RENOVATIO N RECORDKEEPIN G CHECKLIS T
Nam e o f Firm : 

## SiyJ T if.^^ Z ^/iMTit/ ^ Date an dLocatio n o f Renovation : Brie f Descriptio n o f Renovation : Nam e o f Assigne dRenovator : lH-(^-^^^^ ^ Name(s ) o f Traine dWorkers : Nam e o f Dus t Samplin g Technician , Inspector , and/o r Ris k Assessor , if used :

^ Copie s o f renovato r an ddus t samplin g technician qualification s (trainin g certificates , certifications ) o n file. a- Certifie drenovato r provide dtrainin g to worker s o n (chec k al l tha t apply) : SaTostin g warnin g sign s El , Settin g u p plasti c containmen t barrier s ( ^ Maintainin g containmen t & • A voidin g sprea do f dus t t o adjacent area s pELWaste handlin g ^ Post-renovatio n cleanin g
^ Tes t kit s use db y certifie drenovato r t o determin e whethe r leadwa s presen t o n component s affecte db y renovatio n (identif y kit s use dan ddescrib e samplin g location s an dresults : ( ^ Warnin g sign s poste da t entranc e t o wor k

area . 0-Wor k are acontaine dt o preven t sprea do f dus t an ddebris . P'Window s i n an dwithi n 2 0 fee t ofth e wor k

are aare close d \| ^ Door s i n an dwithi n 2 0 feet ofth e wor k

area s are close dan dseale d t^TDoor s that mus t b e use di n th e wor k

are aar e covere dt o allo w passag e bu t preven t sprea do f dust . \ 0 Groim dcovere db y plasti c sheetin g extendin g 1 0 fee t fro mwor k

are a- plasti c anchore dto th e buildin g an dweighte ddov ^ b y heav y objects . ^Ifnecessary , vertical containmen t installe dt o preven t migratio n o f dus t an ddebri s t o adjacent property . 0-~.Waste containe don-sit e an dwhil e bein g transporte doff-site .

Renovatio n RecoriJkeepin g Checklis t Omah a Lea d Sit e(effectiv e Apri l 2010 )



### 0 Wor k

sit e properl y cleane dafte r renovation . S^All chip s an ddebri s picke dup , protectiv e sheetin g misted , folde ddirty sid e inward , an dtape dfo r removal . T?! Wor k

are aHEP A vacuume dt o get pain t chip s fromgroun dsurface , ifnecessary . Q Certifie drenovato r performe dpost-renovatio n cleanin g verificatio n (describ e results) : lj2

> I certif y unde r penalt y o f la

w tha t the above infonnatio n i s tru e an dcomplete . 'JHJ^f ^ Nam e an dTitl e Dat e

Renovatio n Recordkeepin g Checklis t Omah a Lea d Sit e4/27/201 1 

# mw ^ Dougla s County , Nebrask a Pr o pR. yKecur d - R152749000 0 Dougla s Count yAccount Informatio n 

# 320 0 A ) Prin t Repor t Vie w Interactiv e GI S Ma p Infonnatio n i s \ali d a s of 2011-4-1 3 Treasurer' s Ta xRepor t Ne w Featur e - ^ Subdivisio n Sale s Searc h 

### Owne r ROAC H SANDRA L 210 8 SPENCE R S T OMAH A N E 68110-000 0 

## ^^2-^ST-SK7 9 

# V^a-r^^^-^66 7 Propert y Informatio n Ke yNumber : 274 9 000 0 1 5 Accoun t Type : Residentia l Parce l Number : 152749000 0 Parce l Address : ^1.08_S£ENC.ER_SJ J ' rOMA'HA"NE'68.1 1 OrOOOO ? Lega l Description : KOUNTZ E PLAC E LO T 1 3 BLOC K2 0 W 4 0 F T 4 0 X12 4 Valu e Informatio n Lan d Improvemen t Tota l 201 0 $4,300.0 0 $44,200.0 0 $48,500.0 0 200 9 $4,300.0 0 $44,200.0 0 $48,500.0 0 200 8 $4,300.0 0 $44,200.0 0 $48,500.0 0 200 7 $4,300.0 0 $39,900.0 0 $44,200.0 0 200 6 $4,300.0 0 $39,900.0 0 $44,200.0 0 200 5 $4,300.0 0 $39,900.0 0 $44,200.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 1 4960. 0 1. 0 124. 0 40. 0 N o Improvemen t Informatio n Buildin g 1

,mapping-online.com/.../accountinfb.j
. 1/ 34/27/201 1 Dougla s Count yAccoun t Informatio n 210 8 Spence r it t ^ i
ni ­ FtrtFloo r TWSSdF l A , 'sw.ori c FIO M 6'6CS » F l

2 1/ 2 Stor yUnfi n 69nrteki>« « r'iCS c F l CUC KTO ENLARG E IMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : 1326. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 2 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 6. 0 Exterior : Fram e Viny l Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Hi p Stories : 2. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 yea rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 190 9 0 % 190 9 10 1 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Applianc e Securit ySyste m 1. 0 Basemen t Bsmn t Bloc k 8 ft 710. 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 176. 0

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

# »M ^ CONSEN T FO R ACCES S T O PROPERT Y OMAH A LEA D SIT E REMEDIALACTIO N - LEAD-BASE D PAINT STABILIZATIO N PROPERT Y ID : ^^^01.2JJrS PROPERT Y ADDRESS : ^LSO Q 'SCP^^^C^' T ^ ~ ' ~ )WNE RNAiVIE : DAYTIM E PHONE ; 

### CEL L PHONE(J^^)^^A^ZJ% . E-MAIL : OWNER' S ADDRES S I FDIFFERENT : 

# sS - TENANT' S NAM E I FAPPLICABLE : DAYTIM E PHONE : CEL L PHONE : 

# 4>ii ^ E-MAIL : Professiona l Environmenta l Engineers , Inc . (PE ) i s unde r contrac t (#EP-R7-08-06 ) withth 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 di n 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 ar e bein g performe db y EP A contractors . Pain t stabilizatio n activitie s wil l include : scrapin g o f cracke do r flaking LB P fro mstructures , applicatio n o f aprim e coa t an dtw o (2 ) coat s o f paint . Movin g part s o f window s an ddoor s ar e no t include dan dwil l no t b e addressed . You r cooperatio n i s requeste din 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 o f 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 m y propert y followin g completio n o f lead-base dpain t stabilization , if th e soi l cleanu p ha s no t alread y bee n performed . 1 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 wil l 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 m

y property . 

### D K es , I hav e rea d a n idan^nderstan d th e paragrao h above . Signatur e o f Propert y Owne r I Oate I fully understan dtha t b y signin g thi s Consen t fo r Access , (I ) thi s acces s wil l remai n in effec t unti l thewor 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 d Schools" , (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 ) wil l abid e b y healt h an d safet y guidanc e provide db y EPA , (5 ) wil l 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 E representativ e approximatel y 4 8 hour s in advanc e o f startin g work , (7 ) agre e no t t o obstruc t o r tampe r with an y ofth e LB P stabilizatio n actions , an d(8 ) wil l participat e i n flnal propert y inspectio n an dsig n th e Completio n Agreemen t an d Propert 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 o r Kelle y Sander s 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 Pauiett 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) . /es , I gran t acces s t o m ypropert yan d wa s 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 Informatio n fo rFamilies , Chil d give n th e pamphle t "Renovat e Right , Importan t Lea d Care Prpvlders , an d Schools. " Informatio n fo rFamilies , Child e Care Providers , an d Schools. " Signatur e pat e ' Signatur e Dat e SPECIA L INSTRUCTION S AN D CONSIDERATION St 1 

## PAIN T STABILIZATIO N PRE-PROPERT Y PAIN T MATC H ASSESSMEN T

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

# J2,AJL^J::L''' ^

HOUS E TRIIM : 

## . COLOR : /^lei/J ^ JLLOI^ J 

## Sk; 6 - j 5 ^

GARAGE : ^ COLOR :
GARAG E TRIM : 

# f O h ^ COLOR : 

### SU ) Q\S ^ PORCH : 

## . COLOR : /^/tA ^ Aute^ ^ 5W($i^5i j PORC H TRIM : 

## iCl^A^ t /(Uji^e'^n ^ COLOR : /2/iyi A JUAJI?^ . (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 TH E PAINTIN G BEGir^ , I UNDERSTAN D L^ N NO T CHANG E TH E ABOV E SELECTE D COLORS : 

## i ^ PROPERT Y OWNE R SIGNAT U UrtE : P E ACCESO R SIGNATUR E

## PRE-RENOVATIO N FOR M - OWNE R Thi s for mi s t o b e use db y th e firm s contracte dby th e Environmental Protectio n Agency-Regio n 7 t o perfor mLead-Base d Paint stabilizatio n activitie s at th e Omah aLea dSite , Omaha , Nebraska . Owne r Confirmatio n Pamphle t Receip t ty [ hav e receive dacop y ofth e lea dhazardinformatio n pamphlet . Renovat e Right : Importan t Lea dHazar dInformatio n fo r Families , Chil dCar e Provider s an dSchools , informin g m e ofth e potential ris k ofth e leadhazardexposur e fromrenovatio n activity t o b e performe din/o n m y dwellin g unit . I receive dthi s pamphle t before th e wor k

began . Owne r Acknowledgmen t D (A ) I confir mtha t I ow n an dliv e i n thi s property , tha t n o chil dunde r th e ag e o f 6 reside s here , that n o pregnan t woma n reside s here , an dthat thi s property i s no t achild-occupie dfacility . Note : A chil dreside s i n th e primar y residenc e o f his/he r custodial parents , lega l guardians , foster parents , o r informa l caretake r i f th e chil dlive s an dsleep s mos t o f tim e at th e caretaker' s residence . Note : A child-occupie dfacility i s apre-197 8 buildin g visite dregularl y by th e same child , unde r 6 year s o f age , on at leas t tw o different day s withi n an y week , fo r a

t leas t 3 hour s eac h day , provide dtha t th e visit s total a t leas t 6 0 hour s annually . ICKB) I understan dthat th e renovatio n firm , contracte dby th e Environmental Protectio n Agenc y (EPA) , wil l b e usin g lead

saf e wor k

practice s require db y EPA' s Renovation , Repai r an dPaintin g Rule . 

## ^^AW^ ^ L ^ /C^j ^ Printe dNam e o f Owner-Occupan t 

# Of^AiA ^ 2 Pif-f^(Ul ^ Signatur e o f Ovmer-Occupan t Dat e