TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID: 1496 Date: 12/26/2008 

Address: 5824 S. 31 ST. 

Stabilization Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION • 

PROPERTY FILE FOLDER DOCUMENTS 

ef Video of property (DVD) 

2f Executive Summary 

sf Signed Access Agreement for subject property 

IZf Painting Agreement 

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

D Photographs 

21 Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

0 Property information from Douglas County Assessor's Office 

D 

D 

D 

iffam J^ ^ Q^Jo3fo y 

Signature^ Date 

40308041 

Superfunc 
PROPERTY SUMMARY 

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

Property Address; 5824 S. 31 ST. SAD): 1496 

A. EXECUTFV^ SUMMARY 

A.1 Issues Encountered: 

A.2 Issues Resolved: 

A.3 Unique Findings: NONE. 

A.4 Other Relevant Information: 

Access Date: 10/31/08 

Work Began: 11/03/08 

Closeout Date: 11/05/08 

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 

TECHNOLOCIES, INC. 
TECHNOLOGIES, INC. 

ENVIRONMENTAL & 

CONSTRUCTION 

SERVICES 

Property Status Form 

Address: 3 ^ Ai4 '^- 3\ ^ - Date: rj-j'/.^p 

Phone: "^'^'2>-f e U ^7 ") c <~ BVID: iMQi ^ 

Itein# 

OalAap 

plant & Pennanent Landscaping To Remain In Place 

Description and Location 

fcM^i/e 'litres iiH^ Mk'/^'J 

Pre'Existing Condition of Structures 

Does your Basement have a history of leaking? Yes -~- No 

Itein# 

On Map 

Description & Location 

^JM6 / W qJt/n/^5 

Propo ^ Owner 

Signature: 

QC'C^yX ^ f^x^^.C^.*'-*-*^. 

Prudent Emplwee 

Signtture: ^ /t ^ 

» « > ki «j » a»p.. i «IIHM M M 4242 MadlMl Mvt, Suit* 4260 
»M-\^7 

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

Environmental Protection Agency (EPA) to stabilize Lead Based Paint (L^ ) at a number of properties 

located in Omaha, Nebraska^ including tfie property located at '^Q-'-j o . ^ \ ^!s\^' 

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

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

Stabilization including scr{q)ing paint and painting of the referenced property. Further, the owner/tenant 

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

i 

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

Ailminiatrative 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 

Public Inftmnation Centers ^t (402) 731-3045 (South Omaha office) or (402) 991-9583 G^orth Omaha 

office). 

PwaertvAtcMiQtantedBv: A-L^ , AJ ^L ^ ^ > C^/ 0 j(i UA^A -

j (Please Print Name) 

PrmitttvOwiiaSigMliire: /<^^^^>ig»^/ A CUus^ ^ .. /O^^/'-^Y ' 

'^ ~ ( y ' (Signature) (Date) 

PROPERTY INFORMATION 

CTo be completed by rctldcnt nd/or property owner - (dease print) 

REamewTtiAMBi /4/ ^ yt/-Z_^/< CP^DUf^^A ^^©^op Renter 

RESIDENT ADDRESS: -^ 0 o?4 ^ ^ ? / ^ Z?^~gg-7^ 

IF RENTAL, PROPERTY OWNED BY: 6L 'dL 

OWNER'S MAIUNO At»RE8S; SnMb 

OWNER'S TELEPHONE NUMBER; HOME: ( \ W9RK; J \_ 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: ^ NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER: 

NUMBER OFCHILOREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 6 HOURS OR MORE PER WEEK 

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

AUHiOIUTY FOR ENVIRONMENTAL RESPONSB ACTIONS; The activities to be implemented ty EPA under iMa agreement are punoant to Section 104 

of CERCLA, 42 U.&C.9M4. EPA's rigjitofacceas to (he property b provided for In Section 104(e) ofCERCLA. 42 U^.C960S(e). which piovidet entry 

(br''detenninlngdie need for response, joT choosing ortaldng any response action under this tide, or oberwise enlbtcing tie provisions of dw tid^^ 

OSOWknl Paricway, Suite 40S 2506 N. 24*^ Street, Suite 308 4242 Medical Drive. Suite 4260 

i .. . OO^JA »_ _ ltmJkm.^\m. TWS<l«l k 
Current Sample Pre-Henovatio ?-H< n Form 

Effecave until April 2010. 

Conflnnatlon of Receipt of Lead ^unphiet 

k l \ have received a copy of the pamphlet, Renovate Rl^ t Important Lead Hazard 

A Intorrnsttion for f^rr^Ses, (M d Care Pronridva and S(iK(^Marrdingn\e cA 

the poterrtiai risk of the laad hazard o(pos(jre froTi rerKivation activity to t)e 

perfonfned In my dweSing unit. I received this pamphlet tiefore the wor)< t)egan. 

Printed name of recipient ' Date 

Signature of n^^pent 

T^Hr-lnTnrfi 

SeH-CertiflcatiQn Option (for tenantioccupled dwellings onl ^ » 

If the lead pamphlet was delivered butia tenant signature was not otjtainable, 

you inay check the appropriate box t)eicw. 

Q Refusal to sign —{certify that I have made a good M h effort to deliver the 

pamphlet, Ranvata Right Important Lead Hazard hrfannathn for FamSes, 

ChBd Care Provldera and Schools, to the rental dwelling unit listed t)elowat 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 Unawdlabie for signature—i certify that I have made a good faith effort to 

deliver the pamphlet, Renovate Ft^t: Important Laad Haxard InformaOon for 

Fam ^ ChU Care prwldera m d Schods, to the rental dwelling unit listed 

below and that the occupant was unavailable to sign the confinnation of receipt, 

i further cotlfy that I have left a copy of the pamphlet at the unit by sliding it 

Attempted delivery 

dateandtime 

lead pamphlet derivary 

Signature of pereon oMying lead pamphlet delivery 

:^cP</ 6\3I ^ 

UmtAddress ; 

! 

Note Regarding Mailing Option ~ As an alternative to delivefy in person, you 

may maO the lead pamf^et to the owner and/or tenant. Pamphlet must be niailed 

at least 7 days before renovation (Poojment v ^ a certificate of mailing from the 

post office). 
&icmH£ .^dm ^ J/^^mTMlti 

Area:///W 4^.^^/^/J^' ^ .) /? , 

Area: 

Explanation: 

Area: 

Explanation: 

Area: 

Explanation: 

Area: 

Explanation: 

Color: 

Color: 

Color: 

Color: 

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• 1 
uougias Louniy Account iniflonatio tafaja^ n rage i or / 

Dougla s County , Nebrask a Propeit y Recor d - R093782000 2 

Information is valid as of 2008-9-4 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of SOth St - Vje W Ori Ma_p 

Treasurer's Tax Report 

New Feature -^ -^ -> Auto Sales Search 

Owne r 

ORDUNA ALONZA 

ETAL 

5824 S 31 ST 

OMAHA NE 68107-0000 

Propert y Informatio n ; 

Key Number: 3782 0002 09 

Account Type: Residential 

Parcei Number: 0937820002 

Parcel Address: 5824 S 31 ST 

OMAHA NE 68107-0000 

Legal Description: DREWS HILL ADD LOT 20 BLOCK 3 LTS 18-19 & 20 107 X 124 

Valu e Informatio n 

! Land 

2008 i 

i 

2007 1 

2006 I 

2005 

2004 

2003 

i 

..! 

$8,000,00 

$8,000.00 

$8,000.00 

$8,000.00 

$8,000,00 

$8,000.00 

Improvement 

$49,800.00 

$49,800.00 

$49,800,00 

$46,200.00 

$42,000,00 

$42,000.00 

Total 

$57,800.00 

$57,800.00 

$57,800.00 

$54,200.00 

$50,000.00 

$50,000.00 

Sales Informatio n 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

1995-03-20 

D 

$42,500.00 

Book: 2001 Page: 403 

Valid 

Lan d Informatio n 

Acres SF 

0.31 13803,0 

Units 

1.0 

Depth 

107.0 

Width 

129.0 

Vacant 

No 

Improvemen t Informatio n 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R09... 10/1/2008 
Building 1 

rag e J. ui J. 

1 1,2 Story Fin 5824 S 31 St 

CLICK TO ENLARGE IMAGE CLLCKXO ENLARGE IMAGE 

Square Footage: 1301 0 

Perimeter 0 0 

Unit Type: 

Built As: , 1 1/2 Story Fin 

HVAC: I Forced Air 

Exterior: j Frame Stucco 

Interior: Drywall 

Percent Complete: 100.0% 

Quality: Average 

Condition: Fair 

Condo Square Footage: 0.0 

Rooms: I 5.0 

Units: 1.0 

Batiis: 1.0 

http ://douglasne.mapping-online. com/DouglasCoNe/static/accountinfo .j sp?accountno=R09... 10/1/2008 
Prudent Property Close-Out Form (Lead-Based Paint StabUlzation) 

SAID! / ^ 9 ^ ^ / 

Property &Hrin,cc. ^ ^^ U 5 . 'Jj :i f J T 

Owner's isiame: /^/tfA/T n /)t-nU/ ^ 

Performance Standards/dose-Out Criteria YES NO 

1. Was tiie entire structure(s) painted with tlie exception of tiie stated, excluded areas? Tiiis would 

include painting of ottier associated features including fascia, eaves, siding, aii trim, porches, box 

beams, columns, rails, and exterior surfaces of garages. X 

2. Was all scraping and other preparattion wori< completed satisfactorily? ^ 

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

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

5. Are all of the areas where contaminated materials have been spiiied 

thoroughly vacuumed/ cleaned? V 

5. 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? X 

7. Is the grass area that surrounds the structure(s} In reasonably good condition? 2 

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

properly removed? y 

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. X 

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

that need to be moved back? k 

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

Other Considerations?property Owner DIscu5slons?Addition3l Work that is Required X 

Prudent Representative ~ 

Date |\^q.«,^o9 

n^