TRANSMITTAL OF OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#:_3aai9 Pate; Qe^JAlj^iOti^ 

Address: ^U-L^ Si fiAomAN.^vT. 

LBP Stabilization Contractor: PRUDENT TECHNOLOGIES, INC. Year: 2009 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

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 Video of property (DVD): Pre-Stabilization & Post-Stabilization Videos 

 Executive Summary 

 Signed Access Agreement Form 

 Advance Notice Form 

 Pre-Stabilization Video Agreement Form 

 Access Tracking Form 

 Property Access Assessment Form 

 Neighbor Access Agreement Form 

 Paint Match Form 

 Pre-Stabilization Property Safety Assessment Form 

 Work-Site Hazards Analysis Checklist 

 Photographs: Pre-Stabilization Propertv Hazard'Assessment Photographs 

 Douglas County Assessor Property infonnation 

 Property Completion Agreement Form Signed by Property Owner 

 Property Close-Out Check List Signed By EPA 

PruaOTtTechnoiogies, Inc. Signature / ' Date 

*A Signature ' Date 

30055212 ii 

Superfund 
-nCHNOLOGIBS, INC 

Property Summary 

Date: 8<^/2009 | LBP STABILIZATION EPA CONTRACT EP-R7-08-07 | Month of; Aug, 

Property Address: 2442 Bauman St SAID #: 39979 

A. Executive Summarv; 

a. Issues Encountered; NONE 

b. Issues Resolved; NONE 

c. Unique Findings; NONE 

d. Other Relevant Information; 

i. Access Date: 8/19/2009 

ii. Work Began; 8/23/2009 

iii. Close-Out Date; 8/24/2009 

B. Enclosures; 

1. Pre-Stabilization Video 

2. Post-Stabilization Video 

3. Signed Access Agreement Form 

4. Advance-Notice Form 

5. Pre-Stabilization Video Agreement Form 

6. Access Tracking Form 

7. Property Access Assessment Form 

8. Neighbor Access Agreement Form 

9. Property Paint Match Form 

10. Pre-Stabilization Property Safety Assessment Form 

11. Work-Site Hazards Analysis Checklist 

12. Pre- Stabilization Property Hazard Assessment Photographs 

13. Douglas County Assessor Property Information 

14. Signed Property Completion Agreement Form 

15. Property Close-Out Check List Signed By EPA 
PTTITDOrTlIP''" lOUXSIBS. INC. 

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

Agency (EPA) to stabilize Lead B^ d Paint (LBP) at a number ofproperties located in Omaha, Nebraska, including the 

property located dX.^^ k4 "^'L^<!::yyu'yx^'y^ ^l^-'A--^ 

The EPA requests your permission to allow Prudent to perform LBP Stabilization at this property. By signing this form, the 

property owner grants permission to Prudent to perform activities related to LBP Stabilization including scraping paint and 

painting ofthe referenced property. Further, the owner/tenant verifies that they have received the LBP pamphlet "Renovate 

Right." 

By signing this document I agree to allow an EPA contractor to conduct a soil cleanup at my property following completion of 

lead-based paint stabilization, if the soil cleanup has not already been performed. I understand that the stabilization contractor 

cannot provide assurances of which contractor will be bound to the soil cleanup. 1fiirtherunderstand that the soil cleanup 

contractor will make all reasonable efforts to address concems that I, as the property owner, may have regarding soil 

cleanup at my property. 

JJ^Yes, I have read and understand the paragraph above. 

£lCA£i> ^ .y^a.'fyCi^ 

Signatur ienaturee ooff Pronert Propertyv Owne Owner r » 

Date 

Ifyou have any questions about the LBP stabiiization planned for your property, please contact Prudent's Customer 

Relations/OfRce Manager for the Lead Based Paint Stabilization, Mrs. Shannon Holt, at (402) 504-1004 or (402)812-0223. 

General questions about the Omaha Lead Site cleanup can be directed to the EPA Public Information Centers at (402) 731­

3045 (South Omaha office) or (402) 991-9583 (North Omaha office). 

Property Access Granted By: 

(Please Print Name) 

Property Owner Signature: d^^ytLJ< L ^>^r^ .^n^-^ (Signature) ^r'^

9 - ; ^ ' o .y 

(Date) 

180 Ward Parkway, Suite 405 2505 N. 24" Street, Suite 308 4242 Medical Drive, Suite 4250 

ansas City, MO 64114 Oniaha, Nebraska 68110 San Antonio, TX 78229 

\ione: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 C-v w /14AV r-»/% . (816) 363-3707 Fax: (402)504-1005 
*R 

PROPERTY INFORMATION 

(To be completed by resident and/or property owner — please print) 

RESIDENT NAME: Renter 

RESIDENT ADDRESS: 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

OWNER'S TELEPHONE NUMBER - HOME: {^^ ^ -^ ^ ^^^VTORK : J 1. 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: ( O NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER: 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHOM PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: 

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

12- X?-y ^ ay^^Tlp 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be implemented by EPA under this agreement are 

pursuant to Section 104 ofCERCLA, 42 U.S.C. 9604. EPA's right ofaccess to the property is provided for in Section 104(e) ofCERCLA. 

42 U.S. C 9605(e), which provides entry for "determining the need for response, or choosing or taking any response action under this title, or 

otherwise enforcing the provisions ofthe title." 

)80 Ward Parkway, Suite 405 2505 N. 24" Street, Suite 308 4242 Medical Drive, Suite 4250 

ansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Xhone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

k\ : (816) 363-3707 Fax: (402)504-1005 Fax: iyin \ <;7Q-fi<?77 
TECHNOLOGIBS. INC 

Advanced notice needed. 

After signing the access you allow Prudent to begin Lead Based 

Paint Stabilization. All Plants, weeds and any vehicles or items on 

open porch (enclosed porches will NOT be stabilized) must be 

removed prior to stabilization. All Pets must be out of yard during 

stabilization. How much notice do you need to have above 

mentioned tasks completed? Ifyou are a landlord you will need to 

contact the tenant as Prudent Technologies will only inform you. 

Do you have any pets that reside in yard? 

^ X7U-X7\J 

Notice needed: 

/ /U^Y 

Number to call to give notice: 

h H^:^' ^^ 3 -^^ ^ ^ 

Whom we are giving notice to: 

Home Owner's Signature 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNOLOGIES. INC. 

PRE-STABILIZATION VIDEO FORM 

I UNDERSTAND THAT PRUDENT TECHNOLOGIES WILL BE COMING 

OUT TO SHOOT A PRE-STABILIZATION VIDEO AT MY PROPERTY. 

THE VIDEO IS JUST A TOOL USED TO DOCUMENT THE CURRENT 

PROPERTY STATUS/CONDITION. A POST VIDEO WILL ALSO BE 

SHOT PRIOR TO COMPLETION OF STABILIZATION. 

OWNER 6th^\ r<^a-^vM^ S NAME: 

AVJ^^a B>Aorwcx»^ Av^< ^ PROPERTY ADDRESS: 

BVID/SAID: 3^17 ^ 

HOMEOWNERS SIGNATURE: 

ExOUZ '^yui^a.^A/^ 

PRUDENT REPRESENTATIVE SIGNATURE: 

ANY CONDITIONS NEED TO BE AWARE OF BEFORE SHOOTING 

VIDEO: (LE. PETS, NOTICE NEEDED): 

8080 Ward Parkway, Suite 405 2505 N. 24" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone:(816)363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNOLOGIES, INC 

«aL??! 

ACCESS INFORMATION TRACKING SHEET 

BVID: "I'^^'^O PROPERTY ADDRESS: 2UM:i ^Vjma O fWC 

Property Owned By: 

(If new property owner) 

Owners Phone No's: 

Home: Work: 

Cell: Fax: -

Access Contractor: ASW PDA MES PE Other (Prudent) 

DATE TIME ACCESSOR CONRACT DETAIL 

^jlllO f T^Pi^ (^^fLt ^ [f U fr^ess^e ^ S£ ^ ^ /A^¥H^ 

f^l^^l" ^ I'P' A ^ '^-^cJ^ ^S/^a ^ ,i^^ ^ 1 

Comments: 

8080 Ward Parkway, Suite 405 2505 N. 24" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax:(816)363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNOLOGIES. INC 

Access Assessment Form: (Must be completed for every property. 

Information must be obtained from a property walk thru, not given 

by owner) 

Is the property stucco or asbestos? 

If yes, is any ofthe stucco or asbestos damaged or cracked? 

If yes, stop as we can't stabilize this property. It requires special preparation 

techniques. It will be returned to EPA and they will assign at a later date. 

Does this property require lots of scrapping? 

Does this property require a lift or scaffolding to reach upper levels? 

Does this property have lots of plants or items in areas where painting is J:f 

Does this property have any significant structural damage? 

If yes, EXPLAIN? 

8080 Ward Parkway, Suite 405 2505 N. 24" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNOLOGIES. INC 

Does this property have a garage? 

If yes, describe location of garage. 

Does this property have aluminum siding? 

If yes, is it original factory finish or has it been painted over? 

Does this property have any other type of structural components? (I.e. roof 

shingles as siding)? 

If yes, EXPLAIN? 

Ay) 

Is this property vacant or occupied? 

Are there any pets at this property? 

Are there any low hanging power lines? 

8080 Ward Parkway, Suite 405 2505 N. 24" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
OOLOGIES, IN C 

PAINT MATCHING FORM: 

1. TO BE FILLED OUT ONLY IF MATCHING COLOR 

PROPERTY ADDRESS: ^MM X ftgOmcxO ftV^ 

BVID; 39^7 6 

The following notes are for the benefit of paint crew only. 

Paint Yes Paint No Location 

Paint Description 

S^OCOO ^ A\mon\Jrv ^ {iJUJ^ ^ ^Vuc<u3 1^ \ irw\Oi^ i J "v ^ Siding 

toooo / (hlO £ ') Soffit 

i^i>*J Ch\if^ ) Fascia 

Comer Trim J w^^y a?o< 

Window Trims 

Door Trims 

v / 

Front Porch Ceiling 

Front Porch Ceiling Beams 

Front Porch Floor 

Front Porch Railings 

Front Porch Steps 

u JO TTT^ni ^ Siding Baseboards 

Foundation 

e i<cU^ . •o 

r ^ 

 A ^ 

u:>o^TTM i ^ ^-<l-v<.*vJf* '\- •n­

• I UNDERSTAND SHERWIN WILLIAMS WILL MATCH MY CURRENT COLORS. 

c 

Homeowner signature: y^^T^Jk^ ^ ^-:::=^ Art.^^yiyi ^ Date: ^ ^ '^- ^ '^ J 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNOLOGIES,] 

NEIGHBORHOOD PROPERTY ACCESS FORM 


IS THERE A NEIGHBORING PROPERTY THAT NEEDS TO BE ACCESSED ALONG 

WITH ASSIGNED PROPERTY TO COMPLETE STABILIZATION PROCESS? 

Y ^ 

IF IT IS, GET ACCESS FROM ALL REQUIRED NEIGHBORHOOD PROPERTIES. 

f .O A/­

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone:(816)363-3703 Phone: (402) 504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNOLOGIES,] 

PRE-STABILIZATION PROPERTY SAFETY ASSESSMENT FORM 

PROPERTY ADDRESS : £ tK-c i F'rCK-ZL.\-(>>t 

BVID/SAID: ^ ^ 3"? 9 

PRUDENT ASSESSMENT REPERSENTATIVE: 

REPERSENTATIVE REMARKS/FINDINGS: 

(POWER-LINE PROXIMITY TO PROPERTY, SCAFFOLDING/ LADDERS/ LIFTS 

NEEDED, UNSAFE AREAS, UNSAFE NEIGHBORHOOD...ETC.) 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 


Current Sample Pre-Renovation Form 

Effective until April 2010. 

Confirmation of Receipt of Lead Pamphlet 

On have receivecl a copy of the pamphlet, Renovate Right: Important Lead Hazard 

Information for Families, Child Care Providers and Schools informing me of 

the potential risk of the lead hazard exposure from renovation activity to be 

performed in my dwelling unit. I received this pamphlet before the work began. 

^ ^ h ^ / ,/^H Ct.-^)^h 

Printed name of recipient Date 

Signature of recipient 

Self-Certification Option (for tenant-occupied dwellings only) — 

If the lead pamphlet was delivered but a tenant signature was not obtainable, 

you may check the appropriate box below. 

Q Refusal to sign — I certify that I have made a good faith effort to deliver the 

pamphlet, Renovate Right: Important Lead Hazard Information for Families, 

Child Care Providers and Schools, to the rental dwelling unit listed below at 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. 

QTAJnavailable for signature — I certify that I have made a good faith effort to 

deliver the pamphlet. Renovate Right: Important Lead Hazard Information for 

Families, Child Care providers and Schools, to the rental dwelling unit listed 

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

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

under e door under ththe QOOT. . 

f:^\^-o^ 

Printed name of person certifyincertifying »^ Attempted delivery

date and time 

lead pamphlet delivery 

Signature of person certifying lead pamphlet delivery 

Unit Address 

Note Regarding Maiiing Option — As an alternative to delivery in person, you 

may mail the lead pamphlet to the owner and/or tenant. Pamphlet must be mailed 

at least 7 days before renovation (Document with a certificate of mailing from the 

post office). 
Douglas Coimty Account Information Page 1 of2 tijl^t 

Douglas County, Nebraska Property Record - R1749660000 

PriOtReport 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - Vjey y On Ma p Infomnation is valid as of 2009-8-3 Treasurer's Tax Report 

New Feature r^ *4> r# Auto Sales Search 

Owner 

FRAZIER ETHEL 

2442 BAUMAN AVE 

OMAHA NE 68112-0000 

Property Informatio n 

Key Number: 4966 OOOO 17 

Account Type: Residential 

Parcel Number: 1749660000 

Parcel Address: 2442 BAUMAN AV 

OMAHA NE 68112-0000 

Legal Description: MINNE LUSA LOT 13 BLOCK 7 44 X 120 

Value Informatio n 

Land Improvement Total 

2009 $5,900.00 $78,900.00 $84,800.00 

2008 $5,900.00 $78,900.00 $84,800.00 

2007 $5,900.00 $57,100.00 $63,000.00 

2006 $5,900.00 $57,100.00 $63,000.00 

2005 $5,900.00 $57,100.00 $63,000.00 

2004 $5,900.00 $39,100.00 $45,000.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.12 5280.0 1.0 120.0 44.0 No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.coni/DouglasCoNe/static/acco\mtinfo.jsp?accountno=R17... 8/10/2009 
Douglas County Account Information Page 2 of 2 •ijl^t 

2442 Bauman Ave. 1 l/2 9to>yHn 

aol p* 

raits t$tt 

M*«tn •« 

liff 

CLICK TO ENLARGE IMAGE 

Square Footage: 1820.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Fair 

Built As: 1 1/2 Story Fin Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 7.0 

Exterior: Franne Aluminum Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 4.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1917 0% 1917 92 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Appliance Fireplace Masonry 1.0 

Basement Bsmnt Block 8 ft 1196.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 216.0 

Porch EncI Screen 140.0 

User Finished Attic 624.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17... 8/10/2009 
ENVIRONMENTAL «& 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

August 11,2009 

Ethel Frazier 

2442 Bauman Ave 

Omaha, NE 68112 

Re: 2442 Bauman Ave, Omaha, NE. 

Dear Ms. Frazier: 

Prudent Technologies Inc. (Prudent), is under Contract with the US Environmental 

Protection Agency (EPA), Contract # EP-R7-08-07, to conduct Lead Based Paint (LBP) 

Stabilization at up to 2400 properties in Omaha, Nebraska. EPA has tested the exterior 

paint of your property and has identified it as containing LBP. 

EPA has assigned us your property to conduct LBP Stabilization. The stabilization 

activity includes scraping loose and peeling paint, applying a coat of primer and painting 

the exterior ofthe house with two coats of latex paint. EPA has specified a very high 

quality of paint. The paint specified comes wdth a manufacturer's warranty of 25 years. 

Most importantlv, EPA pavs for all the costs associated with paint stabilization. That 

means that there is no charge to vou, as the homeowner. 

We need your written permission to access your property to complete the LBP 

Stabilization. Therefore, please contact Prudent as soon as you receive this letter. We 

are requesting your speedy response because we have a deadline to complete LBP 

stabilization of your property. As of now, Prudent has completed over 850 properties in 

Omaha. We would be happy to answer any questions and provide references of other 

property owners in your neighborhood. 

Ifyou have any questions please feel free to call Mr. Chandra Shekar at 402-504-1004 or 

call EPA Public Information Center at 402-991-9583. You can also visit the EPA 

website www.epa.gov/lead/pubs/leadinfo.htm for additional information. 

Sincerely, 

.^jL 

Mr. Chandra Shekar, P.E. 

Project Manager 

Cell: 402-889-3821 

8080 Ward Parkway, Suite 405 2505 N. 24*" Street, Suite 218 4242 Medical Drive, Suite 7250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNOLOGIBS. INC. 

Prudent Propeiiy Close-Out Form (Lead-Based Paint Stabilization) 

SAID:.I ^ 47-# 

Property Address: ^ .L f CJ' ^ A J\X^ /A A-^- ^ 

Owner's Wame'.SJ f U<^ ^ X^flf^' P ^ y T i 

S.NO 

Performance Standards/close-Out Criteria Yes NO 

Was the entire structure(s) painted with the exception of the stated, 

excluded areas? This would include painting of other associated 

features including fascia, eaves, siding, all trim, porches, box 

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

Was all scraping and other preparation work completed 

satisfactorily? y 

Were all required areas of the structure(s) primed as needed and 

painted with two top coats? 

Are ail of the areas where contaminated materials have been spilled 

thoroughly vacuumed/ cleaned? y^ 

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? 

Is the grass area that surrounds the structure(s) in reasonably good 

condition? uy : 

Was the paint products utilized equivalent to a 30 year 

product/quality? y.^ Are all items such as polyethylene sheeting, ladders, paint brushes, 

cones, barrier tape etc properly removed? 

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. 

10 Are there any property items that were temporarily re-located by the 

contractor that need to be moved back? 

11 Are there any (known) lingering issues w'th the property owner(s) 

that have been left unresolved? 

12 Other Considerations? Property Owner Discussions? Additional 

Work that is Required y 

Prudent Representative Signature: 

Date: 

Property Owner Signature: ^^XU b ^''^'^^^*^'^^^- ^ 

Date: ^ - ^ -ij, - C> y 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577