## TRANSMITTA L of OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL EFOLDE R 

## SAID#: (34 7 Date : (^/^^[G ^ Address : 4l4 0 S / 3 Str£^ f Remediatio nConlractor : PROFESSIONALENVIRONMENTALENGINEER S Year : 200 8 PAINT STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S B ^ Vide oof propert y (DVD ) ['WoTg , ol^ ^ 0 Executiv e Summar y y SignedAcces s Agreemen t fo r

subject propert y y Paintin g Agreemen t D Settlemen t documents (i.e. , fo r

damag e or to replac e plants , etc. ) D Photograph s i>^f ^ QJ^JT


## y Satisfactor y restoratio n signed by Propert y Owne r y Propert y close-ou t chec k

lis t signed by EP A y Propert y information fromDougla s Count y Assessor' s Office



## VUt/n-oJ Ignatur e c C

Dat Dat e e

4031632 0 

# iliil l Superfun d

# PROFESSIONA L 250 5 Nort h 24" \ Suit e 21 9 

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

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



### Lea dBas e Stabilizatio nOmaha , N e Clos e Ou t Repor t SAID #134 7 474 0 S 1 3 S t

•Date s worke d11/1 0 t o 11/1 1 200 8 •Hous e pain t adstructur e wa s i n very poo r conditio nan dhadpain t withred , white , an dblu e colors . Owne r ha dth e colo r change dt o whit e an dgre y colors . Th e hous e ha s painte d asbesto s sidin g an dwa s damage di n areas . Th e gutter s an dsoffit wer e deterioratin g an di n very poo r condition . Owne r hadtoo k ou t awindo w an dcovere dit withwoo dthat wa s painte dover . • Inspecte d10/02 , Returne dt o re-scrap e fron t steps . 10/0 3 issue s resolve d

# 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 yRespons e 

### Propert y Owne r Close-Ou t For m (Lead-Base dPain t Stabilizatio nEP A Contrac t EP-R7-08-06 ) 

# /JV 7 SAID : Property Address : 

# y/^ ^ S . /J ^ ^ Owner' s Name : /Tl/'^I^C t t

g / Lh/y^e^- ^ 7 X 

### Performanc e Standards/Close-Ou t Criteri a 250 5 Nort h 24 ^ Suit e 21 9 Omaha , N E 6811 0 (402 ) 504-468 8 Fa

x (402 ) 504-328 1



### YE S N O 1 . Wa s th e entir e structure(s ) painte dwithth e exceptio no f th e stated , exclude d areas ? 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 nwor k

complete dsatisfactorily ? 

## v r 3 . Were al l require darea s o f th e structure(s ) prime da s neede dan dpainte dwith 

## V tw o to p coats ? 4 . Wa s th e pain t product s utilize dequivalen t t o a3 0 year product/quality ? ^ 

### 5 . Ar e al l o f th e area s wher e contaminate dmaterial s hav e bee nspille dthoroughl y

• ^ 

### vacuumed / cleaned ? 6 . Di dth e contracto r collect^vacuu mal l fallin g an dscrape dpain t chip s o nth e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y ^ 

### othe r generate ddebris ? 7 . I s th e gras s are athat surround s th e structure(s ) inreasonabl y goo dcondition ? V" ^ 8 . Ar e al l item s suc ha s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . properl y removed ? 

# r 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 EP A Close-Out . / 

### 10 . Ar e ther e an y property item s that wer e temporaril y re-locate db y th e contracto r K that nee dt o b e move dback ? 11 . Are ther e an y (known ) lingerin g issue s withth e property owner(s ) that hav e bee n lef t unresolved ? Comments :

Property Owne r Signatur e -= ^ C Professional Environmental'Mgineer s Representativ e 

# /2
- -E~c) t Dat e 

## J 2 ' 

# D'^ F Dat e 

## X

# 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 " Fa x (402 ) 504-328 1 Consuitin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yRespons e 

### EP A Close-Ou t For m (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) SAID : 

# l^M 7 Property Address : 

# m^ o S
­ 1 ^ s ^ Owner' s Name : Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) painte dwithth e exceptio no f th e stated , exclude d areas ? Thi s woul dinclud e paintin g o f othe r associate dfeature s includin g fascia , eaves , siding , all 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 nwork complete dsatisfactorily ? ^ 

### 3 . Were al l require darea s o f th e structure(s ) prime da s neede dan dpainte dwith . ^ 

### tw o to p coats ? i ^ 

### 4 . Wa s th e pain t product s utilize dequivalen t t o a3 0 year product/quality ? 5 . Are al l o f th e area s wher e contaminate dmaterial s hav e bee nspille dthoroughl y 

# y vacuumed / cleaned ? 6 . Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s o nth e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y ^ 

### othe r generate ddebris ? 7 . I s th e gras s are athat surround s th e structure(s ) in reasonabl y goo dcondition ? > ^ 

### 8 . Are al l item s suc ha s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . properl y removed ? ^ 

### 9 . I s ther e any 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 EP A Close-Out . .- ^ 

### 10 . Ar e ther e any property item s that wer e temporaril y re-locate db y th e contracto r i y 

### that nee dt o b e move dback ? 11 . Ar e ther e an y (known ) lingerin g issue s withth e property owner(s ) that hav e bee nlef t unresolved ? 

# y Othe r Considerations/Property Owne r Discussions/Additiona l Wor k

that i s Required : 

# y^/o r iP A CO RSignatur e

# CONSEN T OF RACCES S T O PROPERT Y OMAH A LEA D SIT EREMEDIA LACTIO N - LEAD-BASE D PAIN T STABILIZATIO N
PROPERT Y ID : /3V 7 PROPERT Y ADDRESS : ^7^ 0 

# S , / 3 J / OWNE RNAME : 

### P(\ l cWxe^ V A J I ^ ^^ ^ '^^ ^ DAYTIM E PHONE : CEL LPHONE : E-MAIL : OWNER' S ADDRES S I FDIFFERENT : TENANT' S NAM EI FAPPLICABLE : DAYTIM EPHONE : CEL LPHONE : 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 din Omaha , Nebraska . Th e pain t stabilizatio nwor k i s bein g don e t o protec t th e soi l cleanup s tha t wer e performe db y EP A contractors . Pain t stabilizatio nactivitie s wil l include : scrapin g o f cracke do r flakin g LB P fro mstructures , applicatio n o f aprim e coa t an d tw 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 di n givin g permissio nt 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 no f lead-base dpain t stabilization . I understan dtha t th e stabilizatio ncontracto 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 my property . I fully understan dtha t b y signin g thi s Consen t fo r Access , (1 ) thi s acces s wil l remai n i n effec t unti l th e wor 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 nth e Housin g an dUrba n Developmen t (HUD ) an dEP A pamphlet , "Renovat e Right , Importan t Lea dHazar dinformatio nfo r Families , Day Car e Providers , an dSchools" , (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 ) will abid e b y healt han dsafety 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 i n advanc e o f startin g work , (7 ) agre e no t t o obstruc t o r tampe r withan y o f th e LB Pstabilizatio nactions , an d(8 ) wil l participat e i n flnal propert y inspectio n an d sig n th e Completio nAgreemen t an dPropert y Owne r Satisfactio nSurvey . Shoul dyo u hav e an y question s abou t th e plane dLea dBased-Pain t stabilizatio nactivitie s fo r you r property , pleas e contac t Professiona l Environmenta l Engineers , Inc . Projec t Manager , Willi e Cla y 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 Paulett aFrance-lsetts , EP A Remedia l Projec t Manage r 402-731-2454 , o r th e EP A Publi c Informatio nCenter s a t 402-991-958 3 (Nort hOmah aoffice ) o r 402-731-304 5 (Sout hOmah aoffice) . D Yes , 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 Providers , an d Schools. " Informatio n fo rFamilies , Child e Care Providers , an d Schools. " signatur e Signatur e Dat e SPECIA L INSTRUCTION S AN D CONSIDERATION S

# L 

# Confirmatio n O f Receip t O f Lea d Pamphle t BVI D PROPERT / ADDRES S ^/4^ ^

^ - / 3 S ^ ZI P COD E PROPERTYADDRES S O F OWNE R I F DIFFEREN TTHA N PROPERTYBEIN G PAINTED : PROPERTYADDRES S ^ZI P COD E I hav e receive d a cop yo f th e pamphlet , Renovat e Right : Importan t Lea d Hazar d Informatio n Fo rFamilies , Chil d Car e Provider s An d School s informin g m e o f th e potentia l ris k o f th e lea d hazar d exposur e fro m renovatio n activit yt o b e performe d o n dwellin g unit . I receive d thi s pamphle t befor e th e wor k began . 

# ^41^^Art . / } kjfuffh-r^^Tt \ ^ i\ l ^A r PRINTE D NAM E OF RECIPIEN T L ) QAT E

Self-Certlficatlo n Optio n (Fo rTenant-Occupie d Dwelling s Only ) I f th e lea d pamphle t wa s delivere d bu t a tenan t signatur e wa s no t obtainable , yo u ma ychec k th e appropriat e bo x below : yRefusa l T o Sig n - 1 certif ytha t I hav e mad e a goo d fait h effort t o delive rth e pamphlet , renovat e right: importan t lea d hazar d infonnatio n fo rfamilies , chil d car e provider s an d schools ; t o th e renta l dwellin g uni t liste d abov e a t th e dat e an d tim e indicate d an d tha t th e occupan t refuse d t o sig n th e confirmatio n o f receipt . I furthe rcertif ytha t I hav e left a cop yo f th e pamphle t a t th e uni t wit h occupant . 

# D Unavailabl e Fo rSignatur e - 1 certifytha t I hav e mad e a goo d fait h effort t o delive rth e pamphlet , renovat e right; importan t lea d hazar d infomiatio n fo rfamilies , chil d car e provider s an d schools , t o th e renta l dwellin g uni t liste d belo wan d tha t th e occupan t wa s unavailabl e t o sig n th e confinnatio n o f receipt . I furthe rcertifytha t 1 hav e left a cop yo f th e pamphle t a t th e uni t b yslidin g i t unde rth e doo ro rsomewher e o n th e premises .

PRINTE D NAM E O F PERSO N CERTIFYIN G AHEMPTE D DELIVER YDAT E AN D TIM E LEA D PAMPHLE TDELIVER Y

SIGNATUR E O F PERSO N CERTIFYIN G LEA D PAMPHLE TDELIVERY : Not e Regardin g Mailin g Optio n - as a n aitemative t o deliver yi n person , yo u ma ymai l th e lead pamphle t t o th e owne r and/o rtenant . Pamphle t mus t b e maile d a t leas t 7 day s befor e renovation . (Documen t with a certificat e o f mailin g fro m th e pos t office) . CONFIRMATIO N O F RECEIPTO F LEA D PAMPHLE T08/0 8

# PAIN TSTABILIZATIO N PRE-PROPERT YASSESSMEN T

PROPERT YADDRESS : 

## DAT E Rvi n 

### PUVN T& PERMANEN TLANDSCAPIN G TO B E REMOVE ? N O [^ 3 YE S r IF , YE S WHERE :

PRE-EXISIIN G CONDIIIO N O F FOUNDATION/STRUCTURE , i.e . BASEMEN TLEAKING ? i n I 1 VB C I 1 T EVBCUfUBDC
- 

### N O YE S IF , YE S WHERE :

EXISTIN G PAIN TO N WINDOWS , DOORS , FOUNDATION , SIDEWALK, ( I.E.) ? N0 | YE S [I ^

IF , YE S WHERE :

VISUA L DESCRIPTIO N O F PROPERTY/STRUCTURE/GARAGE , (I.E.) : (US E BAC KSID E I F NECESSARY )

# PAIN TSTABILIZATIO N PRE-PROPERT Y PAIN TMATC H ASSESSMEN T
PROPERT YADDRESS 

# .- 

# V7y ^ S /, 5 .5 ^ DAT E BVI D - 

## AREA(S ) T O B E PAINTED : HOUS E PROPER : COLO R
HOUS E TRI M COLO R

GARAG E COLO R
GARAG E TRI M COLO R
PORC H COLOR
.

PORC H TRIM . COLO R (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 PAINTIN G BEGINS , I UNDERSTAN D I CA NNO T CHANG E TH E ABOV E SELECTE D COLORS : PROPERT YOWNE R SIGNATURE : P E ACCESSO R SIGNATURE : 

# lAfyuu U /) • Ui A

PAIN TMATC H FOR M 08/0 8

## C V Service s Propert yAddres s 

# ^7//6 7 5 73^- ^ Dat e Start Dat e // ~ /o^'^O ^ Complet e Dat e / /

Prim e (Gallons )

Pol y(Boxes ) Pain t (Color ) Pain t (Color ) Pain t (Color ) Pain t (Color ) Pain t (Color ) 

## Amoun t O f Prim e An d Pain t Use d 

# 2 . Amoun t (Gallons ) Amoun t (Gallons ) Amoun t (Gallons ) Amoun t (Gallons ) Amoun t (Gallons ) / ^ ^

### Dougla s County Accoun t Informatio n Pag e 1 o f 3 

# I Dougla s County , Nebrask a Propert yRecor d - R171920000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t of 90t h S t - VIe W O M Ma p Informatio n i s vali d a s of 2008-9- 4 Treasurer' s Ta xRepor t Ne wFeatur e -•->- > Aut o Sale s Searc h Owne r WILBERGE R MICHAE L D ETA L 336 2 TAMIVI YS T BELLEVU E N E 68123-000 0 

# A<=\\ - (a\'3P \ Propert yInformatio n Ke yNumber : 192 0 000 0 1 7 Accoun t Type : Residentia l Parce l Number : 171920000 0 Parce l Address : 474 0 8 1 3 S T OMAH AN E 68107-000 0 

### -+

- Lega l Description : MAXWEL L & FREEMAN S AD D LO T8 BLOC K3 4 0 X 12 0 Valu e Informatio n 200 8 200 7 200 6 200 5 200 4 200 3 Lan d $5,600.0 0 $5,600.0 0 $5,600.0 0 $5,600.0 0 $5,600.0 0 $5,600.0 0 Improvemen t $62,200.0 0 $62,200.0 0 $50,400.0 0 $50,400.0 0 $50,400.0 0 $39,700.0 0 Tota l $67,800.0 0 $67,800.0 0 $56,000.0 0 $56,000.0 0 $56,000.0 0 $45,300.0 0 Sale s Informatio n Sale s Date : 2004-03-1 5 Dee d Type : W D Book : 200 4 Page : 03398 6 

### Price : $38,000.0 0 Grantor : Monumen t Stree t Fundin g I I LL C Grantee : Micliae l D Wilbarge r Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 2004-01-2 9 Dee d Type : TR D Book : 200 4 Page : 01508 3 Price : $ 57,864.0 0 Grantor : STEFF I SWANSO N T R 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17. . . 11/5/200 8

### Dougla s County Accoun t Informatio n Pag e 2 o f 3
Grantee : MONUMEN TSTREE TFUNDIN G I I LL C Valid/Invalid : \ invali d Exclusio n Reason : i Foreclosur e Sale s Date : 1997-10-0 9 Dee d Type : Book : 207 7 Page : \ 66 9 

### Price : $ 45,000.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 1 4800. 0 1. 0 120. 0 40. 0 N o Improvemen t Informatio n Buildin g 1

$«caiieFioe r 2?2t^ R a w

M « ( f t i WB -

M * ' Si ^ m 

### 1 l, Q Stor y &s« M ita * £ ft »6JS»
. « . 

# iM0ir-'-M^ ^ MMfri i

lilW*l.l*«[.MIM»,Wt^.!li.'t.'<.M.-IAU.l: . *«#» . <^t^m»m ^ CLIC KT O ENLARG E IMAG E ! CLIC KT O ENLARG E IMAG E | Squar e Footage : | 1028. 0 Percen t Complete : i 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

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

Roo f Type : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k 

### http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R17. . . 11/5/200 8 

# i