TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: MIP3. I Date: ^///^ ^ 

Address: ^D2/ f /^Vy^^/? ^ 5(re ^ 

Remediation Contractor: PROFESSIONAL ENVIRONMENTAL ENGINEERS Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

y Video of property (DVD) |>>-4>r^ OlUt r 

Executive Summary 

y Signed Access Agreement for subject property 

y Painting Agreement . . 

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

y Photographs \ydrt^^^ oi^ f 

y Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

y Property information from Douglas Coimty Assessor's Office 

jignature 

40316373 Iiiiiii 

Superfund 
y PROFESSIONAL 

2505 North 24*, Suite 219 ENVIRONMENTAL ENGINEERS, INC. Omaha, NE 68110 

(402) 504-4688 "Providing cost-effective environmental solutions" Fax (402) 504-3281 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

SAID# 24631 

4024 Cuming St 

• Datesworked 09/24to 10/01 2008 

• Plywood flooring on front porch is rotting, south side of porch a piece of wood is missing on 

the ceiling. Broken window on west and north side of house. East side of property AC unit 

has major dents, windows on east and west side has paint on them. 

• Inspected 10/02 Returned to scrape and paint interior window trim, paint porch. Vacuum 

and pick up paper and tape from house. 10/06 Issues resolved 
PROFESSIONAL 

2505 North 24'^ Suite 219 ENVIRONMENTAL ENGINEERS, INC. Omaha, NE 68110 

(402) 504-4688 "Providing cost-effective environmental solutions" Fax (402) 504-3281 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Property Owner Close-Out Form 

(Lead-Based Paint Stabilization EPA Contract EP-R7-08-06) 

SAID: 24631 

Property Address: 4024 Cuming Street 

Owner's Name: Gustavo Flores 

Performance Standards/Close-Out Criteria YES NO 

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

areas? This would include painting of other associated features including fascia, V ^ ' 

eaves, siding, all trim, porches, box beams, columns, rails, and exterior surfaces of 

garages. 

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

3. Were all required areas of the structure(s) primed as needed and painted with \ y ^ 

two top coats? 

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

5. Are all of the areas where contaminated materials have been spilled thoroughly V ^ 

vacuumed/ cleaned? 

6. 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? 

7. Is the grass area that surrounds the structure(s) in reasonably good condition? 

8. Are all items such as polyethylene sheeting, ladders, paint brushes, cones, 

barrier tape, etc. properly removed? 

9. 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 xy^^ 

that need to be moved back? 

11. Are there any (known) lingering issues with the property owner(s) that have 

been left unresolved? 

Comments: 

C{iOhcx\ A' -t-hf)eS: 10 W0(!f 

Property Owner Signature Date 

^^ ^ / o -ff:L-or 

S^r ProfessionafEnvironmental Engineers Representative Date 
PROFESSIONAL 

2505 North 24'^ Suite 219 ENVIRONMENTAL ENGINEERS, INC. Omaha, NE68110 

(402) 504-4688 "Providing cost-effective environmental solutions" Fax (402) 504-3281 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

EPA Close-Out Form 

(Lead-Based Paint Stabilization EPA Contract EP-R7-08-06) 

SAID: ^^G>?^ \ 

Property Address: ^O^ ^ W ( X^<y\ K C\ 

^ 

Owner's Name: C -^ ;• y.Ss4<-.. > n \ ^ l o (^ ^ 

Performance Standards/Close-Out Criteria YES NO 

1. 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 { y 

garages. 

2. Was all scraping and other preparation work completed satisfactorily? y 

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

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

5. Are all of the areas where contaminated materials have been spilled thoroughly 

vacuumed/ cleaned? 

6. 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? 

7. Is the grass area that surrounds the structure(s) in reasonably good condition? y 

8. Are all items such as polyethylene sheeting, ladders, paint brushes, cones, 

barrier tape, etc. properly removed? y 

9. 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 y that need to be moved back? 

11. Are there any (known) lingering issues with the property owner(s) that have 

been left unresolved? 

Other Considerations/Property Owner Discussions/Additional Work that is Required: 

no* 

, ^ 2 C M 

" |£ic4n\ 64t>r fccct docK- -0*^ C^liV cV L 

'- £c^CLpJ\o!7cL.~u^ rY-gwV>iJesi-SiAiL Vint.) LJt(V\/vvJ nQutlp^/tY 

\o. 

ju rv/c /o^ 

EPA COR Signature /Date 
CONSPN \mn T FOR ACCCESS TO PROPE 
 ' OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION '\r„ y 

PROPERTYID: ^UL,'K \ PROPERTY ADDRESS: HO ^ H Cuj^^^^y^x 

OWNER'S NAME: 

DAY-TIME PHONE: C^ O 5^ , S" " 1 ^ (X? 

CELLPHONE: (4f>L ^ C^ H ^'^^ ^ E-MAIL (^ t ^"s Cif\e«!:5^ gp ^ V.O-WIA<VX \ • rnv ^ 

OWNER'S ADDRESS IF DIFFERENT: •• • I 

TENANT'S NAME IF APPLICABLE: 

DAY-TIME PHONE: 

CELL PHONE: E-MAIL 

Professional Environmental Engineers, Inc. (PE) is under contract (#EP-R7-08-06) with the U. S. Environmental Protection Agency (EPA) 

to stabilize exterior lead-based paint (LBP) on residential structures at a number of properties located in Omaha, Nebraska. The paint 

stabilization work is being done to protect the soil cleanups that were performed by EPA contractors. 

Paint stabilizations activities will include: scraping of cracked or flaking LBP from stmctures, application of a prime coat and two (2) coats 

of paint. Any moving parts of windows and door are not included in the activities and will not be addressed. 

Your cooperation is requested in giving permission to this EPA contractor (PE, Inc.) to enter and have access to this property for the 

purpose of stabilizing lead-based paint as outlined on the property identified above. 

I fully understand that by signing this Consent For Access, (1) this access will remain in effect until the work has been satisfactorily 

completed (2) that as the Property Owner or tenant, if applicable, will be given the Housing and Urban Development (HUD) and EPA 

pamphlet, "Renovate Right, Important Lead Hazard Information for Families, Child Care Providers and Schools" (3) the Property Owner or 

tenant will removal of obstructions from surfaces to be painted, (4) will abide by health and safety guidance provided by EPA, and (5) will 

allow photography of property before and after the paint stabilization work, (6) I will be contacted by a PE representative approximately 

48 hours in advance of starting work to (7) agree not to obstruct or tamper with any of the LBP stabilization activities or equipment used to 

perform any LBP actions, (8) will participate in final property inspection and sign the Completion Agreement and Property Owner 

satisfaction Survey. 

Should you have any questions about the planned Lead Based-Paint stabilization activities for your property, please contact: Professional 

Environmental Engineers, Inc., Project Manager, Herman Hanner at 402-884-1185. General questions about the Omaha Lead Site 

cleanup can be directed to Pauletta France-Isetts, EPA Remedial Project Manager 402-731-2454, or the EPA Public Infonnation Centers 

at (402) 991-9583 (North Omaha office) or (402) 731-3045 (South Omaha office). 

JYes, I grant access to my property and was given [] No, I do not grant access to my property and I was 

. amphlet "Renovate Right, Important Lead Hazard given the pamphlet "Renovate Right, important Lead Information 

for Families, Child Care Providers and Schools. Hazard Information for Families, Child Care Providers and 

Schools. 

G jtZ^a^^ ^ ^/>cnj- ^ S^o ^ j y Signature Date Signature Bate 

SPECIAL INSTRUCTIONS AND/OR CONSIDERATIONS: 
•••••i ,:«.i--,.-<^-'Wl»^^t 1 •: 

PAINT STOILIZATION PRE-PROPETTT »ST^ Y 

PAINT MATCH ASSESSMENT 

PROPERTY ADDRESS: MC^^ M LuLWlJ.>t4/K^ DATE 

BVID ^^(.3 

AREA(S) TO BE PAINTED: 


HOUSE PROPER. ^ : \l P^S - COLOR^ Jd^-^ YHOUSE TRIM 

\)£,S 

COLOR u^Actv 

GARAGE 	 fN/0 
 COLOR 


GARAGE TRIM ^ /\)0 	 COLOR 


PORCH 

v; ^-^s COLOR Q^V^^. , 

^ 

PORCH TRIM 

Y ^ COLOR by-Azt A. ^ 

(COMPLETE ALL SECTION, YES, NO, OR NON-APPLICABLE) 

I AGREE TO THE COLORS LISTED ABOVE. ONCE PAINTING BEGINS, I 


UNDERSTAND I CAN NOT CHANGE THE ABOVE SELECTED COLORS: 


PROPERTY OWNER SIGNATURE: 	 PE ACCESSOR SIGNATURE: 

H^SLIT W 7/^j-^y^ IVW^ 

PAINT MATCH FORM 08/08 
, -IjlH^'-f..-^-'- •..», i - ^ - i^ p -"-'•1'-,:^!!--:i:;J»ii''(llS;<^f-T; .i*!-., . '!» 

PAINT STABILIZATION PRE-PROPERTY ASSESSMENT 

~1 

PROPERTY ADDRESS: V H ^ 4 ( .j i >VU.^f1 CU DATE ?/^ / ^ ^ 

(OM X ^) ^ /r,{^i3/ BVID ^Hto^l 

PLANT & PERMANENT UNDSCAPING TO BE REMOVE? NO KZ} YES CD 

IF YES WHERE: '^X 

fivc\H,( 

PRE-I EXISONG CONDIUQN OF FOUNDATION/STRUCTURE, i.e. BASEMENT LEAKING? 

N.._O J? ^ YES ' ' IF, YES WHERE: 

Sy\\\ ^^.Ig 4 '(}}A^- a f^cc-^rA uXiCrMs mig^'^v/P, if\ ar W . 

.XV\M(VA^ - ^ 

r ____.v 

EXISTING PAINT ON WINDOWS, DOORS, FOUNDATION, SIDEWALIC( I.E.)? N 

YES I .^^ IF YES WHERE' 

OVA yn'^^.yh! r\ ,pry?rVv^- ^ i\<? IO^VYW. LV-\IV W A uvia 

dlgi\\S "\^-^^V. M^ m\o uv^dcu^ m -^r,^ s<cO ,/iAln f}^\vlV(i?A 

VISUAL DESCRIPTION OF PROPERTY/STRUCTURE/GARAGE, (I.E.): (USE BACK SIDE IF 

NECESSARY) 

o,l 

lar^A ayc\^ \i\ lt^'(^hyx c\^ ^V, Iccy S S^IKA \ac>v 

PROPERTY OWNER SIGNATURE 
Confirmation OWeceipt Of Lead PamphW ^ f 

BVID Wiol^ i , " 

PROPERTY ADDRESS HCsM {_L1JMM\Q ZIP CODE ^S^ / 3 1 

PROPERTY ADDRESS OF OWNER IF DIFFERENT THAN PROPERTY BEING PAINTED: 

PROPERTY ADDRESS

 ^ZIP CODE 

I have received 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 

perfomied on dwelling unit I received this pamphlet before the work began. 

Cus^TA^o r^^^-^ 

^-^•o2 ^ 

PRINTED NAME OF RECIPIENT 

DATE 

^^^.u^^oZr^y^ JA J 

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: 

D 

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 above at the date and 

time indicated and that the occupant refused to sign the confimiation of receipt. I further certify that I have left a copy of the 

pamphlet at the unit with occupant. 

D Unavailable 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 confinnation of receipt. 1 further certify that I have left a copy of the 

pamphlet at the unit by sliding It under the door or somewhere on the premises. 

L-on Hill 

q-s-os 

PRINTED NAME OF PERSON CERTIFYING ATTEMPTED DELIVERY DATE AND TINE LEAD PAMPHLET 

DELIVERY 

^o< . IJ-JO 

SIGNATURE OF PE PERSON CERTIFYING LEAD PAMPHLET DELIVERY: 

Note Regarding Mailing Option - as an altemative to delivery in person, you may mail the lead pamphlet ID the owner and/or tenant. 

Pamphlet must tie mailed at least 7 days t)efore renovation. (Document with a certificate of mailing from the post office). 

CONFIRMATION OF RECEIPT OF LEAD PAMPHLET 08/08 
Douglas County Account Information Page 3 of3 uorn 

e^.v 

tat u 1 

"^t ' 

F "{ 

CLICK TO ENLARGE IMAGE 

Square Footage: 1976.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: End Condition: Poor 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 9.0 

Exterior: Frame Siding Units: 2.0 

Interior: Drywall Baths: 3.5 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 2.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1894 0% 1894 112 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 957.0 

Fixture Additional Fixtures 1.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 3.0 

Fixture Batfi Half 1.0 

Garage Detacfied 468.0 

Porch End Screen 280.0 

Porch Enci Screen 40.0 

Porch End Screen 70.0 

littp://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R24... 6/27/2008 
Douglas County Account Information Page 1 of3 

Douglas County, Nebraska Property Record - R2404580000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 90th St - Vie w O n IMa p Information is valid as of 2008-6-19 Treasurer's Tax Report 

New Feature -•-•- • Auto Sales Search 

Owner 

FLORES GUSTOVA 

ETAL 

12905 PAXTON ST 

PACOIMACA 91331-0000 

Property Informatio n 

Key Number: 0458 0000 24 

Account Type: Multiple Res 

Parcel Number: 2404580000 

Parcel Address: 4024 CUMING ST 

OMAHA NE 68131-0000 

Legal Description: WALNUT HILL LOT 11 BLOCK 1 -EX S 25.8 FTValue Informatio n 

Land Improvement Total 

2008 $11,200.00 $26,500.00 $37,700.00 

2007 $11,200.00 $26,500.00 $37,700.00 

2006 $11,200.00 $26,500.00 $37,700.00 

2005 $12,400.00 $26,500.00 $38,900.00 

2004 $12,400.00 $26,500.00 $38,900.00 

2003 $12,400.00 $26,500.00 $38,900.00 

Sales Informatio n 

Sales Date: ! 2006-06-02 

Deed Type: WD Book: 2006 Page: 074092 

Price: $66,000.00 

Grantor: GOODWIN MARY JO ETAL 

Grantee: FLORES GUSTAVO ETAL 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 2005-02-07 

Deed Type: QC 8oo^; 2005 Page: 018796 

Price: $0.00 1 

Grantor: Bruce Goodwin 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R24... 6/27/2008