Transmittal of Omaha Lead Site 

Paint Stabilization File Folder 

Said # :7.-&B6y Date: E'-^- 7 0 

Address: S^S ~ A) H 7 /^(7 

Contractor: City of Omaha Year: '^ ^ 7 0 

Paint Stabilization 

Property File Folder Documents 

V^or k Write Up 

_^^Signed Access Agreement for subject property 

Pre-Renovation form signed, by Property Owner 

Pre-Renovation Form for OCcupantAFenant, ifapplicable 

Painting Agreement/City of Omaha Purchase Order 

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

Renovation Recordkeeping Checklist signed by Certified Renovator 

Property information from Douglas County Assessor's Office 

i./Othe r (describe): fmH s 

City of Omaha Representative Signature Date 

V]r^ f{.Ll ^ JL/XOIX. 

EPA Representative Signature / Date._ • 

30262477 

Superfund 
CITY OF OMAHA 

PURCHASING - ROOM 1003 Purchase Order . ' 1819 FARNAM STREET 

PURCHASE CRDER HO. 

OMAHA, NE 68183-1003 

1156939 FAX# 402-444-5423 

SHIP TO: 

CITYOFOMAHA 

HOUSING & COMM DEV RM #1111 

1819 FARNAM STREET 

. 0MAHA.NE 68183 

VENDOR MARCOS PROFESSIONAL PAINTING : >. BILL TO: 

CITY OF OMAHA FINANCE 

MAFiCO A SALAZAR 

2514 J ST DISBURSEMENTS ROOM #1007 

OMAHA. NE 68107 1819 FARNAM STREET 

OMAHA,NE 68183 

ORIGINAL PURCHASE ORDER • VENDOR'S COPY (SEE INSTRUCTIONS BELOW) 

CUSTOMER ACCOUNT NO. VENOOR NO. DATE OF ORDER/ BUYER REVISED DATE//BUYER 

81569 29-JUN-10 H HURT 

PAYMENT TERMS SHIP VIA F.O.B. 

IMMEDIATE DESTINATION 

FREIGHTTERMS REQUESTOR/DELIVER TO CONFIRM TO / TELEPHONE 

MARUCA, T MARIE 

> ITEM PART NUMBER/DESCRIPTION • DELIVERY DATE QUANTITY UNIT UNIT PRICE EXTENSION 

All prices, and amounts on this order are express sd.in : US Doi; ar. 


NEEDED: 1,477.00 N 

30-JUN-lO 


EPA PAINT STABILIZATION 


PROGRAM GROUP 14 3 1006: 


S 2 6TH ST 


o SHIP TO: 


Address at top of page 


NEEDED: 1,577.00 N 

30-JUN-lO 

EPA .PAINT STABILIZATION' 


PROGRAM GROUP 143 505 K 


41ST AV 


O SHIP TO: 


Address at top of page 


SHIP TO: Address shown above. If shipment is delayed or any items not available, advise at once. Pur­

chase order number must appear on all invoices, packages, packing lists, bill of lading, and correspondence. Tota 3,054.00 

SHIPPING CHARGES TO BE PREPAID. IF APPUCABLE AND ADDED TO INVOICED, copy to be fur­ l C J

nished with invoice. . 

TAX EXEMPTION: The Cily of Omahais exempt from Federal Excise Taxes and the Nebraska and City of 

Omaha Sales taxes. Federal I.D.. 476006304; STATE 1.0.01-0316768; Fuel Dealers Lie. 91-0316768. ' Licit Alll^^.^^^ 

Cily Purchasing Ajenl / Buffer •v J ^ 
Planning Department 

, _, _ . Omaha/Douglas Civic Center 

Inspector: Steve Zivn y . 1819 Parnam Street. Suite 1003 

Date : 5/12/10 • Omaha, Nebraska 68183. 

(402)444-5150 

Telefax (402) 546-0714 

Name : Gregory L. Schaneman R. E: Cunningham, R.^F.SAME 

jSaXo r Address: 505 N4r^ Ave .^--

OMAHA EXTERIOR PAINT STABILIZATION PROGRAM 

FOR THE EPA OMAHA LEAD SITE 

The Contract bid documents consist ofthe following sections: 

• General Responsibilities lor tlie Contractor and Occupant. 

• Lead Hazard Control Plan, Interim Control of Lead Eased Paint Hazards. 

The Contractor Shall: 

• Comply with HUD's "Guidelines for the Evaluation and Control of Lead-Based 

Paint Hazards in Housing." (Copies are available at the Plarming Department.) 

• Comply with Standards called for in the "Construction and Rehabilitation 

Specifications, Housing and Community Development Division, City of Omaha, 

Nebraska." (Copies are available at the Planning Department.) 

•. Comply with the State ofNebraska Health and Human Services Regulation and 

Licensure, Title 178 Chapter 23 Lead Base Paint Regulations. 

• Coordinate daily construction schedule with the occupant 

• Submit information cut sheets for all substitutions or approved equals prior to 

written approval of the Construction-Specialist. 

• Repair or replace all items damaged or disturbed during paint stabilization 

activities. 

• Keep work site and surrounding area free from accumulations of waste materials 

or rubbish caused by the work at all times. 

• • Upon daily completion of work: clean up all rubbish, excess material, equipment, 

and etc., that is connected v/ith the v/ork, and leave all parts of the-work areas in a 

. neat, sanitary, lead safe and presentable condition. 

• Complete this project within 30 caleiidar days,. 

The Occupant/Owner Shall 

• Remove and store away any personal property within twenty (20) feet of the area 

to be remediated. 

• Provide access to electricity and water throughout the paint stabilization process. 

• Ensure' that all household members stay at least ten feet away from all work areas 

and also keep all pets at least ten feet away at all times until the work has been 

completed and the area has passed a visual inspection. .. 

. • . . Initials QLS • 
505 N 41 st Ave (Continued) 

Lead Hazard Control Plan 

Interim Control of Lead based Paint Hazards 

Paint Stabilization 

• Stabilize all previously painted exterior wood, brick, metal, concrete 

surfaces ofthe dwelling to include but not limited to the siding, fascia, 

eaves, trim, window trim, shutters, gutters, railings, downspouts, door trim 

and foundation. DO NOT INCLUDE WINDOWS OR MAN DOORS. 

DO NOT INCLUDE STUCCO SIDING. 

• Prepare and paint all previously painted surfaces by following the Safe 

Work Practices protocol for EPA exterior lead based paint stabilization. 

• All paint coloirs to match existing painl pattern. Prime and apply two . 

coats of approved finish coat. (Refer to Planning Dept. approved paint 

list). 

• IF SPRAYED, ONE COAT SHALL BE BACK-BRUSHED OR 

BACK-ROLLED. 

Lead Based Paint Waste 

Lead-based paint waste must be handled as follows 

• All paint chips and component debris must be double bagged for disposal. 

• Clean paint chipsfrom ground around perimeter of dwelling before 

starting, during and after the project. 

• All lead painted components and debris must be removed from the site 

daily unless otherwise approved by the construction specialist. 

• All lead-based paint debris (chips and components) must be disposed of in 

a municipal solid waste laridfill. 

Property Ovraer Date 

Property Owner Date 

Witness - Date 

Occupant (ifapplicable) Date 

Occupant (if applicable) Date 
Exterior Lead-based Paint Stabilization Program Managed by the City of 

Omaha for EPA Region 7 

Omaha Lead Site 

The purpose of this program is to prevent yards where lead-contaminated soil is cleaned 

up from becoming re-contaminated by deteriorating exterior lead-based paint. This is 

not a home repair program. 

Which Homes Are Eligible? 

• Homes where soil clean-up has been or will be done and an EPA contractor has 

identified deteriorating exterior lead-based paint. 

• Homes are eligible only by referral from the EPA. 

What work will be done? 

• Loose and flaking lead-based paint will be removed safely from fascia, eaves, 

siding, trim, window trim, door triih and foundation. 

• Surfaces will be primed and painted to match existing paint color as closely as 

possible. 

What will not be done? 

• Surfaces which have no paint will not be treated. 

• Windows or doors will not be included. 

• Rotten wood will not be replaced, 

• No housing repair will be done. 

Who will perform the work? 

• EPA contractors will test paint on exterior house surfaces and give the resiilts to 

the City of Omaha Paint Stabilization Program. 

• City Construction Specialists will prepare a work plan and contact the property 

owner for permission to proceed. 

• Work will be competitively bid by approved, trained contractors. 

When will the work be done? 

• This program began in 2007 and will continue for several years. 

• The City staff will prioritize homes based on the presence of children under age 

six if known'and the severity of the problem. 

Paint Stabilization is voluntary and will be done only with permission ofthe owner. 

Initials G t ^ 
Consent for Access to Property 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consents to and autiiorizes the United States Environmental Protection 

Agency (USEPA) or its authorized representatives, collectively the Grantee, to enter and perform 

certain environmental response activities upon the following described premises: 

Owner's Name: Daytime Phone: 

Owner Name(s): Gregory L Schaneman 850-0350 

Addresses of Properties Covered by this Agreement 

Property Address City/State/Zip Code • 

505 N. 41st Av. Omaha, NE 68131 

, 

Grantor understands that this grant does not limit EPA's right of access under the Comprehensive 

Environmental Response and Liabilitv Act (CERCLA\ 42 USC. & 9601-9675. or anv other law. 

PURPOSE OF ACCESS 

The purpose of the response action is to stabilize loose or flaking exterior lead-based paint on 

residential properties, including day-care facilities, where remediation of lead contaminated soil has 

or will take place. Sampling of soil may be conducted. This consent shall allow Grantee onto 

Grantor's property andfiirther, provides the Grantee the right to perform any and all environmental 

response actions and activities it deems appropriate. 

ENVIRONMENTAL RESPONSE ACTIONS 

The environmental response actions to be performed on subject property may include the following 

activities: 

1, Locating equipmeht and/or machinery on subject property in preparation for and in the course of 

the response activities. 

2. Obtaining samples from Graiitor's property. 

2/12/2007 (1) 
Address: 505N. 4lstAv. 

Consent for Access to Propertv (Tage 2) 

3. Plaiming and implementing the response action oh the Grantor's property. This will include 

1) removal of loose orflaking paint identified by EPA using lead-safe methods in compliance 

with HUD/EPA regulations and 2) repainting according to the attached specifications. 

TERM 

This access agreement shall be operable for the period of time it takes to complete the 

environmental riesponse activities. Upon completion of the response actions, all rights and 

privileges given by the Grantor shall cease on that date, unless extended by a subsequent 

agreement. 

AGREEMENT NOT TO INTERFERE 

Grantor agrees not to interfere vyith any of the activities undertaken by Grantee at the Property, 

tamper with any of Grantee's property, or take any actions regarding the use of the Property which 

will endanger human health or welfare or the environment, or allow others to use the Property in 

such maimer during the term of this consent. Grantor agrees to provide notice and a copy of this 

agreement to prospective purchasers, lessees, assigns, or grantees of the property or any portion of 

it: Grantor agrees to provide 30-day notice to EPA prior to any transfer of ownership rights to the 

property. 

SAMPLING RESULTS 

Grantee agrees to provide Grantor with the results of any and all-sampling and/or analysis resulting 

from Grantee's response activities bn the property. 

PRIOR CONDITIONS AGREEMENT 

The grantor agrees to the condition ofthe property prior to remediation and indicates on Page 3 any 

items to be removed by the Grantor before activities commence. 

RESTORATION OF PROPERTY 

Except for tiie above stated paint stabilization, the Grantee agreestiiat said property will be restored 

as nearly as possible to its original state and condition as found immediately preceding the 

beginning of activities authorized by this Agreement, following completion of the response 

activities. 

2/12/2007 (2) 
Address: 505 N. 41st Av., Omaha, NE, 68131 

CURRENT CONDITION / PROPOSED RESPONSE ACTIVTTIES 

The purpose of this section is to provide a mutual agreement as td conditions of property prior to 

contractor activities. This will also serve as documentation for the purpose of assuring that 

restoration activities are completed to the satisfaction of the property owner and the United States 

Environmental Protection Agency (EPA). 

Items to be removed bv propertv owner prior to the response activities: 

• 1 . 

2. . 

3. 

4. 

5 - . • : 

Items NOT to be removed bv contractor during removal activities: 

1­

2 . ' 

3. 

.4. 

5. 

ADDITIONAL COMMENTS: 

I have read the foregoing document and understand that it is an agreenient granting permissiori to 

the Grantee to enter the above described premises for the purpose of conducting environmental 

response activities, and I agree to its terms and conditions. I acknowledge that I have received the 

pamphlet ."Renovate Right". 

Grantor's Signature: vH-lr.Ac^*o2.^->nxv^ . Date ^-^^I Q 

(3^ 2/12/2007