### TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL EFOLDE R 

# SAID# : )3lplo' ^ Date : 

# 4 4 o ^ Address : 

### Remediatio n Contractor : PROFESSIONA LENVIRONMENTA LENGINEER S Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S y' ^ Vide o o f property (DVD ) ^y ^ Executiv e Summar y ^ y Signe dAcces s Agreemen t fo r subjec t property ( HPaintin g Agreemen t D Settlemen t document s (i.e. , fo r damag e o r to replac e plants , etc. ) Q-/ ^ Photograph s [B^ ^ Satisfactory restoratio n signe dby Propert y Owne r n Property close-ou t chec k lis t signe db y EPA ^ r

Propert y informatio n fro mDougla s Count y Assessor' s Offic e HI—^ confirmatio n tha t lea dpamphle t "Renovat e Right " wa s receive db y P0 _ D D D



### Engineer s Signature ^ ^ 

# y^Jt-/t^}^Jyi44rf, . \i^7 £ tl* A Signatur e ' D'at e 3009437 5 

# iiiiii i Superfun d

# PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC
. ''° ' ""ZZMEVU I "Providin g cost-effectiv e environmenta l solutions " ^ |^°^ | l?!t't^l^ . ^

Fax(402 ) 504-328 1 Consullin g • Engineerin g Desig n • Rerneamlio n • Anaiemen t • Frnprcjcnc vRespons e



### Lea dBas e Stabilizatio n Omaha , Ne Clos e Ou t Repor t 200 9 SAID #1266 7 391 4 S 9 S t

•Date s worked : 07/0 6 t o 07/0 6 200 9 •Pr e propert y condition : Hous e ha s viny l sidin g withwoo dtri mtha t hav e flaking paint , woo dporc hfloors an dtri mwer e all in poo r condition . Pain t chip s i n yard . •Problem s encountered : N/ A •Owne r request/concerns : Non e •inspection/closeou t dates . Owne r signe d07/2 7 2009 , inspecte db y i* Eprojec t manager .

# 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 Consultin g • Engineerin g Desig n • Remediatio n • Aliaiemen t • Emergenc yResponse 

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

## SAID : IQlolo ^ Property Addres s 

# ^qi H s . 

# q

# .-s f Owner •sName : Pen-Cf" . 5>ri ^ I'.p O n,"^fc y Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) painte dwit hth e exceptio n ofth 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 n wor k

complete dsatisfactorily ? 

# - y 3 . Were all 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 a3 0 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 ? 

## i / 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 

# t X othe r generate ddebris ? 7 . I s th e gras s are athat surround s th e structure(s ) i n 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 ? Any ^ 

### 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 ^ 

### that nee dt o b e move dback ? ^ 

### 11 . Are ther e any (known ) lingerin g issue s wit hth e property owner(s ) that hav e i ^ bee n lef t unresolved ? Comments : 

# 1k-\^g' ^ Property Owne r Signatur e Dat e Professional Dat e ia

l Environmentaf t Engineer s Representativ e ^»iC S : 2 /00 2 07/01.'2C0 5 

# CONSEN T FO RACCES S T O PROPERT Y OMAHA LEA D SIT EREMEDIA LACTIO N - LEAD-BASED PAIN T STABILIZATIO N PROPERT Y ID : /^( ^ U ~] PROPERT Y ADDRESS : 

# 2m^.^S73^i ^ L ^ l CELLPHONE : (jj^^7 ^Z^^(6 ^ E-MAIL: ^ OWNER' S ADDRES S I FDIFFERENT : _^_ _ TENANT' S NAME I FAPPLICABLE : DAYTIM EPHONE : CEL LPHONE : E-MAIL : Professiona l Euvironmenta l Engineers . Inc . (P£ ) i s unde r contrac t (#EP-R7-08-06 ) wit hth e U.S . Environinenta l Pratectio n Agenc y (EPA ) t o stabiliz e leadbase 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 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 dby EPA contractors . Pain t stabilizatio n activitie s will include : scrapin g ofcracke do r flaking LB Pfro mstructures , applicatio n ofaprim e coat an dtw o (2 ) coat s o f pain t 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 n t o thi s EPA 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 lead-base dpain t a s outline dou th e propert> ' identifie dabove . B y signin g thi s documen t I agre e to > allo w a n EP.' V contracto r t o conduc t asoi l cleanu p a t m y propert y following completio n of lead-base dpain t stabili2ation , i f 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

- <all-1ro^p^avide assurances'that-thcTioi l cieanup-contmcto r wH i be ^ boun dto . I firrttrer~Ilnder.nan( l tha t th e soiTcleanup contracto r wil l mak e ai i reasonabl e effort s t o addres s concem s tha t I , a s th e propert y owner , may hav e regardin g soi l cleanu p a t ray promrrty . 

# n 

# /k k Dat e I full y understan dtha t by signin g thi s Consen t fo r Access , (I ) tfais acces s will remai n i n effect unti l th e wor k

ha s bee n satisfactoril y completed , (2 ) tha t tb e Propert y Owne r o r Tenant , i f applicable , will b e give n th e Housin g an dUrba n Developmen t (HUD ) an dEPA pamphlet , '^Renovate Right , Importan t Lea dHazar dinformatio n fo r Families , Da y Car e Providers , an d School.«" , (3 ) th e Propert y Owne r o r tenan t will remov e al l obstruction s fromsurface s t o b e painted , (4 ) will abid e b y healthan d safety guidanc e provide db y EPA , (5 ) will 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 dby aP Erepresentativ 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 wid i an y o f th e LB Pstabilizatio n actions , an d(8 ) will 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 Surveiy . Shoul dyou 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 Clay At 402-5(M-468S . Genera l question s abou t th e Omah a Lea dSH e cleanu p ca n b e directe dt o Paulett aFrance-Isetts , EPA 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 (SouthOmah aoffice) . Yes , I gran t acces s t o m ypropert yan d wa s give n th e pamphle t D No , id o no t gran t acces s t o m ypropert yan d I wa s Renovat e Right , Importan t Lea d Infonnatio n fo rFamilie$ , Chil d give n th e pamphle t "Renovat a Right , importan t Lea d Provideis , an d Schools. * informatio n forFamilies , Child e Car e Providen , an d Schools. ' 

# "l/ljo l Signatur e \ C I Dat e Slgnahir e Dat e SPECIA L INSTRUaiON S AN O CONSIDERATION S

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

# 39/ ^ 

# X y - DATE :

HOUS E PROPER:
. HOUS E TRIM :
GARAGE :
GARAG E TRIM :
PORCH :
PORC H TRIM : (COMPLET E AREA(S ) T O B E PAINTED : COLOR :
COLOR :

_COLOR : _

_COLOR : _

_COLOR : _

_COLOR : _ 

### BVID : /^////f ^ 

# pnaidl o 

# f —



# r ^ ^ 

# L y

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 BEGINS , I UNDERSTAN D I CA N NO T CHANG E TH E ABOV E SELECTE D COLORS : PROPERTY OWNE R SIGNATURE : P E ACCESO R SIGNATUR E

## Dougla s Coimt y Accoim t Information Pag e 1 of3 • 

# =f r |2UU' > Dougla s County , Nebrask a Propert yRecor d - R234697000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e ( S scal e 0-5 0 f t wes t of 52n d S t - VlO W O n Ma D Informatio n i s vali d a s o f 2009-6- 3 Treasurer' s Ta xReoor t ' Ne wFeatur e -i^- * -* Aut o Sale s Searc h \ Owne r SCHIPANSK Y RENE E 391 6 8 9 S T OMAH AN E 69107-000 0 Propert yInformatio n Ke yNumber : 469 7 OOO O 2 3 Accoun t Type : Residentia l Parce l Numbe r 234697000 0 Parce l Address : 391 4 S 9 S T OMAH AN E 68107-000 0 Lega l Description : VA N CAMP S AD D LO T 1 6 BLOC K3 N 1/ 2 LT S 1 5 & 62. 5 X 9 8 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $ 4,900.0 0 $ 89,300.0 0 $ 94,200.0 0 200 8 $ 4,900.0 0 $ 67,100.0 0 $ 72,000.0 0 200 7 $ 4,900.0 0 $ 67,100.0 0 $ 72,000.0 0 200 6 $ 4,900.0 0 $ 67,100.0 0 $ 72,000.0 0 200 5 $ 4,900.0 0 $ 47,100.0 0 $ 52,000.0 0 200 4 $ 4,900.0 0 $ 42,700.0 0 $ 47,600.0 0 Sale s Informatio n Sale s Date : 2006-08-1 4 1 Dee d Type : W D Book : 200 6 Page : 09345 7 Price : $ 97,000.0 0 Granto r HAIZLI P JO N R ETA L Grantee : SCHIPANSK YRENE E Validnnvalid : Vali d Exclusio n Reason : Sale s Date : 2004-01-1 5 Dee d Type : W D Book : 200 4 Page : 00923 5 Price : $ 76,000.0 0 Granto r Ros e M Dwora k 

## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R234.. . 6/9/2009

### Dougla s County Accoun t Informatio n Pag e 2 of 3
Grantee : Jo n R Haizii p eta l Valld/lnvalld : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 

### 0.1 4 6174. 0 1. 0 98. 0 63. 0 

### N o Improvemen t Informatio n Buildin g 1 1 1/ 2 FINISHE D STOR Y » « S » S T [ Firs t Floo r 

### r858.0 ' '* « Secon d Floo rt i' i S12.C r BMtt t C« K8 «

CLIC KT O ENLARG E IMAG E ii£U&!L!i2i£Ilii£SSyS!£S L Squar e Footage : 1152. 0 Percen t Complete : 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 Viny l Units : 1. 0 Interior : Drywal i Baths : 1. 5 Roo f Cover : Compositio n Shingl e Bedrooms : 2. 0

Roo f Type : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : 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 189 0 200 6 0 % 

### 191 9 90 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 858. 0 Basemen t Fai rFinis h 527. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accoiintno=R234. . . 6/9/200 9