TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID: 15268 Date: 12/26/2008 

Address: 2820 S. 32 AVE. 

Remediation Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

0' Video of property (DVD) 

Q" Executive Summary 

B Signed Access Agreement for subject property 

3' Painting Agreement 

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

D Photographs 

ISf Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

3 Property information from Douglas County Assessor's Office 

D 

D 

D 

Signature ! Date 

Superfund 
PROPERTY SUMMARY 

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

Property Address: 2820 S. 32 AVE. SAID: 15268 

A. EXECUTTSTE SUMMARY 

A.1 Issues Encountered: NONE. 

A.2 Issues Resolved: NONE. 

A3 Unique Findings: NONE. 

A.4 Other Relevant Information: NONE. 

Access Date: 11/06/08 

Work Began: 11/15/08 

Closeout Date: 11/18/08 

Enclosures: 

1. Pre-Videb 

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. 
icll-jU^C? Gr^c, 

ENVIRONMENTAL ft 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: cP<&^Cp 

Phone: -54 \ •-T?U4C::i BVTO: l52.U*$ j 

Plant & Pennanent Landscapinff Tn R,ftmain In Place 

Item# 

Desdiption and Location 

OaMap 

-^~0*N / A 

Pre-Existing Condition of Structures 

Does y^ur Basement have a history of leaking? Yes - ^ No ^ 

Iteni# Desoip don & Location 

./V>.C30Cfe G \sA.t> r^'V^o r oUc?o4 ayr »^e 

ProperyOwner Prudent Employee 

SigBatne: Signaturcj^ijL^ <X ^ 

. .•• . a* M «mKM 91 * fttraat. Suite 308 4M2 IMlMl OrtVt. Suftt 4280 
\^2^C^fc 

Prudeat Tedmologies, Inc, (Prudait) 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, including the property located at o3^Q.C:> "^ . ^ 2 A^iP 

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

signing this form, the prop srty ovmer grants permission to Prudent to perform activities related to LBP 

Stabilization including scr |>ing paint and painting of the referenced property. Furtiier, the owner/tenant 

verifies thattiiey have recc ivedtiie LBP pamphlet "Renovate Right." 

If you have any questions t bout the LBP stabilization planned for your property, please contact Prudent's 

Administrative Clerk for ti e Lead Based Paint Stabilization, Mrs. Deborah AkerdeJnhniinn, 

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

PubUc Infonnation Centersjat (402) 731-3045 (Soutii Omaha office) or (402) 991-9583 (North Omaha 

office). 

Pnpctly Afioctt Onntod By: Glt^Xs CALI^W 

(Please Print Name) 

Ptopeity Owner Sigutun: U\uU^ 

(Date) 

PROPERTY INFORMATION 

>>-j fFo be c(i|fi)9letcdiir)r resident nd/o r property ormier-> please prist) 

RESIDENT NAME: Renter ler 

RESIDENT ADDRESS: ^1 ^ ^ ^V^4, 

IF RENTAU PROPERTY OWNED BY i 

OWNERfS HAIUNO ADDRESS; _ s Q-r^g^ 

OWNER'S TELEPHONE NUMBER . t OME.: .^owHl^7fcAK«RK. /^OVG:^^-(>»X:> >/V^ ^ 

NUMBER OF OCCUPANTS UNDER 7YEARS OLD : _il NUMBER OF OCCUPANTS 7 YEARS OL D AND OLDER: ± 

NUMBER OFOHILDRBN UNDER 7 YEARS OLD WHO PU Y IN THE YARD FOR 6 HOURS OR MORE PER WEEK: o 

COMMENTS ORSPECIAL INSTRUCIfONS: QJB. DOGS, ENTRY OATES, ETC.) 

f^i> Doc 

^ 

AUTHOSnY FOR ENVIRONMENTAL HBSPONSE ACTIONS; Ttte aetivfties to Ite impiemcntedtry EPA vndcrtfaitagceeneBt ate ponoant to Seetioo 104 

ofCERCLA,42U^C9604. EPA'tri^tfaoce u to flic pnpettyispnMded Ibr in Section 104(e) ofCERO ^ 42 U3X960S(e),w]]idipiDndes entiy 

Ibr''dcleniiiiiingtiie needfor leeponse; or d nosing ortaking any lespoose action mder ifa^ 

250S N. 24 * StTMt. Sulta 308 4242 MecHcai Drive, Suite 42S0 « a o VAird Paitany , Stdte 405 

:ansMCKy . MO 64114 Omaha. NebTMka 68110 Salt Antonto.TX 78228 

Phnna* fM91 nU. 1 AlU 
Current Sample ffe-TOi novation Fonn 

Eftaeavsiintn April 20i a 

Conflnnation of Receipt of Lead Pt imphlet 

QflhawerecelvQd a copy of tlw pam )hl8t, Aarnvate R^-llmportanr 1 ^ 

Irifomiallon for Faniiies,CtM Can tProvldara and Schools JF/tonrkig me dl 

the potential risk d the leed hazar i exposure frorn iBnovaUon ac:tlvity to be 

perfomied in tny dweHng mit. I re »ived this pamphlet beft)re the work t)egan. 

6^-(. I: M^^ 

\ l \u 08 

Printed Date ^jx : 

Signature of 5:rr 

Satf-CertHleaUon Option (Ibr tenanf-occupled dwellinga only) —• 

If the lead pamphlet was delivered I bi t a tenant signature was not obtainabfe, 

you may check the appropriate box bebw. 

Refusal to sign •--1 certify that I HsMe niade a good M h effort to dellvsr the 

pamphlet, Aanovate Right: importi mt Lead Hazard IrtformaSon for FemXes, 

to the rental dwelling unit listed below al the 

date and time Indicated and that t le occupant refused to sign the confirmation 

of raoeipt. I further certily that I ha «left a copy of the pamphlet at the unit with 

thaoccxpanti 

Q Unavailable for signature—I oe tify that I have made a good f ^ eflbit to 

deHw the pamphlet, Renovate fViiht important Leed Hazard tnfdnttttion for 

FamKeStdiUCaeproiMeraenc ScAoofe. to the rental dweOing unit listed 

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

I further certily that I have left a CO 3y of the pamphlet al the uiit by sliding It 

underthedoor. 

^^g£cM^^_^iJl:iA: g^-w^ 

Printed name of person certifying Mempltadde/SNerf 

dateandtime 

lead pamphlet delivery 

Signatue of person certifying lead pdmphlet delivery 

n^^^. ^ /U^ 4^ «a 

UnltAddrees 

Note Regaidlng MaiUng OpUon — ^ an altemative to delivery In person, you 

may mail the lead pamphlet to the o\/ner and/or tenairt. Pamphlet must be mailed 

atleast 7 days beibre renovation (Dojximent with a certilicate of maifng from the 

postoflioe). 
' Ky ^ \ « N—t ^ 4 • f. «ob^ ^ 

'1 

Kp"lr? ?9 form^f^"* "Wch *M ^ f fSi"S t-c BVTnf 5^ address: 

/^-^^feg >4 

*vt / "T'-'» '*>-, RreJ k 

Color.-^-^^^^ 5Wf-, BU. s^ i ^'\ Explanation: 

Area: M»„,. C. c-T^.i * "3* ^ 

color: 5>^ <.^v^ ^i^-^5 B(o. s^ ^ 

^Planatlon: 

Area: 

Color: 

Explanation: 

Area: 

Color: 

Explanation 

Area: 

Color: 

Explanation: 

Page i 
ihJPOR HATf oNTRAOKm Q SHEET 

GI^^AAT!^ ^ 

 HPWBt OnvOoiMH ^kov-'^^)^7bt/x) vj ^ 4ov-t^»\-(0 ^ v ^2-0 9 I 

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AsBMOoMii ^{ - vjJw,f- WWiv^v^oj; 
Page 2 of2 

2 1.'2 STORY FINISHED 

CLICK TQ ENLARGE IMAGE 

Square Footage: I 2134.0 Percent Complete: : 100.0% 

Perimeter ; 0,( Quality: ; Average 

Unit Type: j Condition: • Average 

BuiitAs: I 2 1/2 Story Fin Condo Square Footage: 0.0 

HVAC: i CeitralAirtoAir Rooms: 8.0 

Exterior: | IWa sonry Common Brick Units: 1.0 

Interior: ; Drjwali Baths: 1.0 

Roof Cover: i Co nposition Shingle Bedrooms: 

Roof Type: j Hip Stories: 2.5 

Floorcover: -' Allcwance Foundation: Blocl< 

Sprinkler Square Footage: 0.0 

year ] Percent Adjusted Year YearBuilt Physical Age Remot leled I Remodeled Built 

1905 y "0 % 1905 ?03 

Detail Type ; Detail Description Unita 

Add On • Fence Cliain Linlt 1.0 ... ,.^.^ 

Appliance i Allowance 

Basement ; Bsmnt Block 8 ft 910.0 

Fixture i Additional Fixtures 1.0 .„, . 

Fixture : Base Fixtures 1.0 

Fi)cture ; Batli Full 1.0 

Garage ; Detaciied 216.0 

Porcii Slab Roof Ceil •\~9Z0 

Porch ^ Wood Deck 192^ 

http://douglasne.mapping-on ine.com/DouglasCoNe/static/accountinfo.jsp?accountno=R14... 10/1/2008 
Page 1 of 2 

Douglas County, Neb iras ska Propeit y Record - R1409550000 

Print ReportNEW Feature - Parcel Dimensions available @ scale Q-5Q ft west of 90th St - VJeW O n Ma p Information is valid as of 20 )8-9-:4 Treasurer's Tax Report 

New Feature -* -* -4 A_uto Sales Search 

Owner 

CADDY GREG T 

ETAL 

2820 S 32 AVE 

OMAHANE 68105-0000 

Property Informatio n 

Key Number: i 095 5 0000 14 

Account Type: Relsidential 

Parcel Number: 14)9550000 

Parcel Address: 28;!0S32AV 

OMAHANE 68105-0000 

Legal Description: '• R ADD LOT 5 BLOCK 3 50 X 114.5 ILE 

Value Informatio n 

: Land Improvement Total 

2008 $6,00JD.00 $135,500.00 $141,500.00 

2007 $6,00 ).6o $135,500.00 $141,500.00 

2006 $6,00). 00 __$116,400.00 $122,400.00 

2005 $6, ^ ).00 $116,400.00 $122i40ao6" 

2004 ; $6,00 ).00 $ii6,46abo $122,400.00 

2003 ' $6,000.00 $116,400.00 $122,400.00 

Land Informatio n 

Acres : SF \ Unita I Depth Widtii Vacant 

0.13 5700.C 1.0 114.0 50.0 No 

Improvement Information 

Building 1 

http://douglasne.mapping-onime.com/DouglasCoNe/static/accoiintinfo.jsp?accountno=R14... 10/1/2008 
• • 

Priident Property Close-Out Form (Lead-Based Paint Stafoiilzation) 

SAID: \Sr^t/'* l 

Property ^Mro^^-^^^^C ^ <; 1 2h J t4(/j? . 

Owner's Name: ^'^^ ^ ^ fi^^^ M 

Peiiformance Standards/close-Out Criteria 

YES NO 

1. Was the entire structure{s) painted wrth the exception of the stated, excluded areas? This would 

ihclude painting of other associated features including fascia, eaves, siding, ail trim, porches, box 

tieams, columns, rails, and exterior surfaces of garages. 

2. Was all scraping and other preparattion work completed satisfactorily? 

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

4. V/as the paint products utilized equivalent to a 30 year product/quality? 

Are ali ofthe areas where contaminated materials have been spilled 

i I 

tljoroughly vacuumed/ cleaned? 

5. Dtd 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 i:he grass area that surrounds the structure(s) in reasonably good condition? 

8.

 Arle ail items such as polyethylene sheeting, ladders, paint brushes, cones, barrier tape etc. 

properly removed? 

X 

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

X

/ 

nejedsto be completed priorto the EPA Close-Out. 

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

thait need to be moved back? 

QC 

11. Are! there any (known) lingering issues with the property owner(s) that have bean left unresolved? 

Othisr Considerations?property Owner Discussions?Additional Work that is Required 

\ (jUrJi y 

Prudent Representative 

Date /i3_'2-07