TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID: 17734 Date: 12/26/2008 

Address: 2935 MARTHA 

Stabilization Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

l?r Video of property (DVD) 

[3 Executive Summary 

0^ Signed Access Agreement for subject property 

S^ Painting Agreement 

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

D Photographs 

0^ 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 

D 

D 

f/gjr/g'y 

Signatured Date 

40309874 

l!IE'"llllllil IIIIIE"I'-

Superfund 
PROPERTY SUMMARY 

Date: 12/23/08 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Month of: December 

Property Address: 2935 MARTHA SAID: 17734 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE. 

A.2 Issues Resolved: NONE. 

A.3 Unique Findings: NONE. 

A.4 Other Relevant Information: NONE. 

Access Date: 10/23/08 

Work Began: 10/30/08 

Closeout Date: 10/31/08 

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: ^^"^" ^ Mcu-Vv^c-^/S). - Date: /0>/^^/(Pj' 

BVK): ni^ M 

Phone: ^g ^ ~^%^ ^ 

Plant & Permanent Landscat>ing To Remain In Place 

Itein# 

Description and Location 

OnMq) ^ f)ciAh (OVA; cctA^r ofhao^-e - coyec. 

FrC'Existing Condition of Stnictures 

^ Does your Basement have a history of leaking? Yes — No 

liSXQ.§ Description & Location 

OaiAap 

PiopCTty Owner Prudent Empla 

Signature: \)uAiA^ ^^^ , Signature: U24^H^^ 'VtA^ i 

260S N. 24*^ Street. Suite 308 4242 Medical Orivft, Suita 4260 8080 Ward Ptrtewiy. SuHe 406 Omaha, Nebraska 68110 San Antonio, TX 78229 Kansas CHy, MO 64114 m——. . >JA<n jeAj.4AfWI 
Ml^ ^ 

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

Environmental Protection Agency (EPA) to stabilize Lead Based Paint (LBP) at a number ofproperties 

located in Omaha, Nebraska, includingtiie property located at J^ ^ 3 S> AA Ck r VA^t^ "^ ^ 

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

signing this form, die property owner grants permission to Prudent to perform activities related to LBP 

Stabilization including scnq)ing paint and painting of the referenced property. Further,tiie owner/tenant 

verifies that they have received tiie LBP pamphlet "Renovate Right." 

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

Administrative Clerk for tiie Lead Based Paint Stabilization, Mrs. Peborah Akerele^ohngon. 

at (402) 504-1004. General questions about the Omaha Lead Site cleanup can be directed totiie EPA 

Public Information Centers at (402) 731-3045 (Soutii Omaha office) or (402) 991-9583 (Nortii Omaha 

office). 

Property Aceea Onnted Bv: ^ J06t M (oA.^'Ci A 

(Please Print Name) 

PtopetQr Owner Signatuie: Y ^0(W^ ^Q-iM C-< r\ mQ3/oe 

(Signatuie) late) 

PROPERTY INFORMATION 

CTo be completed by reiident nd/o r property owner - please print) 

leSIDENTNAME: Ratrter 

RESIDEN 2fy r Mf^fA^s^ T ADDRESS: 

IF RENTAL. PROPERTY GWNED BY: 

Sa/yie OWNERFS MAIUNO ADDRESS; 

^ . M,^Sir^f^. CmHEKB TELEPHONE NUMBER J L 

i NUMBER OF OCCUPANTS UNDER 7 YEARS OLD:. NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER = / 

NUMBER OF CHILDREN UNDER 7 YEARS OLD VmO PLAY IN THE YARD FOR S HOURS OR MORE PER WEEK: 

COMMENTS OR SPECIAL INSTRUCTIONS: (LE. DOGS. ENTRY GATES, ETC.) 

AUTHORmr FOR ENVntiONMENTAL RESPONSE ACTIONS; The activities to be implemented l>y EPA under das agraement are pursuant to Section 104 

of CERCLA, 42 U.S.C 9604. EPA's right ofacoess to die ptopetty isprovided fbr in Section 104(e) of CERCLA, 42 U.S. C 960S(e), which provides entry 

fbT'deteiminingflie needfi>r response, or dioosing ortaldng any respoise action under this tide, or oflierwise enfbrcing fte provisicns ofthe tftle." 

«80 wsard Parinvay, Sidta 405 2506 N. 24* Straet, Sulta 308 4242 Medical Drtva, Suite 4250 

:ansas CHy. MO 64114 Omaha, Nabtaalai 68110 San Antonio, TX 78229 
Sampge 

Effective until April 2010. 

Confinnation of Receipt of Lead Pamphlet 

la I have received a copy of the pamphlet, Renovate F^ght: important Lead Hazard 

Information for Families, Child Care Providers and ScivMis informing me of 

the potential risk of the lead hazard exposure from renovation activity to be 

performed in my dw^eiling unit. I received this pamphlet before the work began. 

Printed name of recipient ^ Date 

X AUtM^ (.^i-A/tr-T.. I.C. 

Signature of recipient 

Self'Certificatlon 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. 

a Refusal to sign — I certify that I have made a good faith effort to deliver the 

pamphlet, Renovate Right: important Lead Hazard information fbr Families, 

Child Care Pnyviders and Schools, to the rental dwelling unit listed below 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 

the occupant. 

Q Unavailable for signature — I certify that I 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 

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

I further certify that I hav^eft a copy of the pamphlet at the unit by sliding it 

underthedoor. / y ^ —r / ) 

Printed name of person certil^ng Attempted delivery 

date and time 

lead pamphlet delivery 

/ . 'je;i0Mf^ 

Signature of person certifying/ead pamphlet de^very . 

SFslr /il,r/M -y 

'T^a/k... /iieUnit Address 

Note Regarding Mailing Option — As an alternative 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). 
pai nt match form ^J—-^ - Paint matching form: , - - , ., property address: fd:m ^ 9f^5'Ma^r^^^- BVID: /775^ ^ ^ , y 

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Explanation: 

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Page 1 

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Douglas county , Nebraska Property Record - R0814800000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 90th St - VJeW OH Ma p Information is valid as of 2008-9-4 Treasurer's Tax Report 

New Feature -*-*- > Auto Sales Search 

Owner 

GARCIA JUAN P 

ETAL 

2935 MARTHA ST 

OMAHANE 68105-0000 

Property Information 

Key Number: 11480 0000 08 

Account Type: Residential 

Parcel Number: 0814800000 

Parcel Address: 2935 MARTHAST 

OMAHANE 68105-0000 

Legal Description: CLARKS PLACE LOT 43 BLOCK 0 1/2 VAC ALLEY ADJ & 50 X 86 

Value Informatio n 

Land Improvement Total 

2008 $5,400.00 $74,800.00 S80.200.00 

2007 $5,400.00 $74,800.00 $80,200.00 

2006 SMOO.OO $70,600.00 $76,000.00 

2005 $Mdo.oo $70~66o.OO $76,000.00 

2004 $5,400.00 $70,600.00 $76,000.00 

2003 $5,400.00 $29,200.00 $34,600.00 

Sales Informatio n 

Saies Date: 2006-02-10 

Deed Type: • Q C Boole > 2006 

i Page: 016060 

Price: $38,000.00 

Grantor: Juan P Garcia 

Grantee: • Juan P Garcia etal 

Valid/invalid: : Invalid 

Exclusion Reason: ; Non Bono with Doc Stamps 

Sales Date: 2005-09-28 

Deed Type: i WD Book: •• 2005 Page: i 126021 

Price: i $82,300.00 

Grantor: ; Grace J Groves 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R08... 10/1/2008 
Douglas County AccounUntormatio i^t( n rage z oi J 

Oranteoi ' jugn T Osrcio 

Valid/lnvalid: \ Valid 

Exclusion Reason: 

Land Information 

Acres : SF Unita j DepfAi ly/tff/} Vacant 

0.09 i 4300.0 1.0 86.0 50.0 No 

Land Attributes 

AUribute Attribute Description 

Negative Influence Traffic 2 

Improvement Informatio n 

Building 1 

•Ssccro rioci 

iioa 0 K- tt 

I ies'i:.')rtvH:h'i.i-;hr> 

atBa!lJJHMii.iii.i..ic.«.i.i;iy»jaa: 

&LICK TO ENLARGE IMAGE 

Square Footage: j 1237.0 Percent Complete: ^00.0% 

Perimeter ! 0.0 Quality: Fair 

UnitType: ' Condition: Average 

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

HVAC: j Central Air to Air Rooms: 6.0_ 

Exterior: j Frame Aluminum Units: 1.0 

Interior: j Drywall Baths: 1.0 

Roof Cover: | Composition Shingle Bedrooms: 3.0 

RoofType: i Gable - ­ ' I I II 

Stories: -l'^ _ Floorcover: j Allowance Foundation: Block 

Sprinkler Square Footage: [ 0.0 

YearBuilt year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1916 0% 1916 92 

Detail Type , Detail Description Unita 

Appliance Allowance 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R08... 10/1/2008 
uou^iaa \^o\miy AccounijDionnanon rage :> oi J 

Basement

Fixture

Fixture

Garage

Porch

Porch

Porch

User

 • Bsmnt Block 8 ft 

 ; Base Fixtures 

 : Bath Full 

 i Detached 

 ; EncI Solid Wall 

 ! Slab Roof Ceil 

 : Wood Deck 

 , Attic Full Finish 

816.0 

1.0 

l o " 

216.0 

52.0 

132.0 

"Teio 

408.0 

http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R08... 10/1/2008 
'

Prudsm Propertv Cios£-Oyt rO??n i Lsad-Bsssd Pmm StafeirisstI 

D'A-nsrs ftiame: (Tt/- ^ /pa/^f(3 . 

Performance Stgndards/ciose- 'fm Critsris 

I YES INO ! 

;1. Vv'as tha ert-re structijre{s) painted with the exception of the ststEd, exduded areas? This wouid 

j Irsdude csinting of other sssccisted fsaturss including fascia, saves, siding, all trim, c-orches, box 

isams, coiumr.s,raiis, and exterior surfaces cf garages. 

2. was ail scraping and other preparsttion work compieted safeisfactorily? Tvl kl-J 

3. Were ai! required areas ofthe structureis) primed as needed and painted with two top costs? WVl 

j4. Was ths paint products utiiifed equivaient to a 50 year product/qua'Ity? \ ^ 

!­ .Aje aii ofthe areas where contarrsinated materials have beers, spiiiad 

thoroughly vaeuumsd/ deaned? i vT 

|5. Did the co.ntractor coliect/vacuutT! all fsiling and scraped pai.nt chips en the entire property, 

1 roadways, aiieyways, public Recess areas and also remove any other generated debris? 

is the grass area that surrount^s the structureis) in reasonably good conditloTi? i/i I 

S. kre ail Items such as polyethylene sheeting, !adde.rs, paint brushes, cones, barrier taoe etc. 

properly removed? j 

9.

 Is there any evidence of p.fx>pterty damage that v^as dona by the contractor? .Any p.foperty damage 

needs to bs eompisted prior p the SPA Close-Out. 

10. .4r5 there any property rtems that ws."e te.~por3tiiv re-socated by the contractor 

that need to be moved backri 

ill. Are there anv (known) Hngering issues with the orocerty owner*s'i that have been -eft unresolved r 

I • i 

« Other Considerations?property Ov.'nsr Oiscusslonsf-^aditionai Wo.rk that ss Requi.rea 

-^-<->s. 

! V •'i^' ' V>-l.f" •.— 

Prudent Rq9fese?^tative 

Ja^e