### TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL EFOLDE R SAID# : MIP3. I 

### Date : ^///^ ^ Address : ^D2/ f /^Vy^^/? ^ 5(re ^ Remediatio n Contractor : PROFESSIONALENVIRONMENTA LENGINEER S Year : 200 8 PAINT STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 

# y Vide o o f propert y (DVD ) |>>-4>r ^ OlUtr Executiv e Summar y 

# y SignedAcces s Agreemen t fo r

subject propert y Paintin g Agreemen t . . 

# y D Settlement docimient s (i.e. , fo r

damag e or to replac e plants , etc. ) 

# y Photographs \ydrt^^ ^ oi^ f 

# y Satisfactor y restoratio n signedby Propert y Owne r Propert y close-out chec k

lis t signedb y EP A 

# y Propert y information fromDougla s Coimt y Assessor' s Office

jignatur e

4031637 3 

# Iiiiii i Superfun d

# y 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 " Fax(402 ) 504-328 1 Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yRespons e



### Lea dBas e Stabilizatio n Omaha , N e Clos e Ou t Repor t SAID #2463 1 402 4 Cumin g S t

•Datesworke d09/24t o 10/0 1 200 8 •Plywoo dfloorin g o n front porc hi s rotting , sout hsid e o f porc hapiec e o f woo di s missin g o n th e ceiling . Broke n windo w o n wes t an dnorthsid e o f house . Eas t sid e o f property A C uni t ha s major dents , window s o n eas t an dwes t sid e ha s pain t o n them . • Inspecte d10/0 2 Returne dt o scrap e an dpain t interio r windo w trim , pain t porch . Vacuu m an dpic k up pape r an dtap e fromhouse . 10/0 6 Issue s resolve d

# 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 " Fax(402 ) 504-328 1 Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yRespons e 

## Property Owne r Close-Ou t Form (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) SAID : 2463 1 Property Address : 402 4 Cumin g Stree t Owner' s Name : Gustav o Flore s Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) painte dwithth e exceptio n o f th e stated , exclude d areas ? Thi s woul dinclud e paintin g o f othe r associate dfeature s includin g fascia , 

# V ^ ' eaves , siding , al l 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 ? 3 . Wer e al l require darea s o f th e structure(s ) prime da s neede dan dpainte dwith 

## \ y ^ tw o to p coats ? 4 . Wa s th e pain t product s utilize dequivalen t t o a3 0 year product/quality ? 5 . Ar e al l o f th e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y V ^ 

### vacuumed/ cleaned ? 6 . Di dth e contractor 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 an y 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 . Ar e 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 an y evidenc e o f property damag e tha t wa s don e b y th e contractor ? An y 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 an y property item s that wer e temporarily re-locate db y th e contracto r xy^ ^ that nee dt o b e move dback ? 11 . Are ther e an y (known ) lingerin g issue s withth e property owner(s ) tha t hav e bee n lef t unresolved ? Comments : 

# C{iOhcx \A ' -t-hf)eS : 1 0 W0(! f Property Owne r Signatur e Dat e ^^ ^ 

## / o -ff:L-o r S^ r 

### ProfessionafEnvironmenta l Engineer s Representativ e Dat e

# PROFESSIONA L 250 5 Nort h 24' ^ Suit e 21 9 

# ENVIRONMENTA L ENGINEERS , INC . Omaha , NE6811 0 (402 ) 504-468 8 

### "Providin g cost-effectiv e environmenta l solutions " Fax(402 ) 504-328 1 Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yRespons e 

### EP A Close-Ou t For m (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) SAID : ^^G>?^ \ Property Address : ^O^ ^ W( X^<y \K C \ ^ 

### Owner' s Name : C - ^ ;

• y.Ss4<-. . > n \ ^ l o (^ ^ Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) painte dwithth e exceptio n o f th e stated , exclude d areas ? Thi s woul dinclud e paintin g o f othe r associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an dexterio r surface s o f { y 

### garages . 2 . Wa s al l scrapin g an dothe r preparatio n wor k

complete dsatisfactorily ? 

### y 3 . Were al l require darea s o f th e structure(s ) prime da s neede dan dpainte dwith 

### y tw o to p coats ? 4 . Wa s th e pain t product s utilize dequivalen t t o a3 0 year product/quality ? 5 . Are al l o f th e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y vacuumed/ cleaned ? 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 an y 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 ? y 

### 8 . Ar e al l item s suc ha s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . properl y removed ? y 

### 9 . I s ther e an y evidenc e o f property damag e that wa s don e b y th e contractor ? An y « / 

### property damag e need s t o b e complete dprio r t o th e EP A Close-Out . 10 . Are ther e any property item s that were temporaril y re-locate db y th e contracto r y 

### that nee dt o b e move dback ? 11 . Are ther e any (known ) lingerin g issue s withth e property owner(s ) that hav e bee n lef t unresolved ? Othe r Considerations/Property Owne r Discussions/Additiona l Wor k

tha t i s Required : no * , ^ 2 C M

" |£ic4n \64t> r fccct docK
- -0* ^ C^li V c V L



### '
- £c^CLpJ\o!7cL.~u ^ rY-gwV>iJesi-SiAi LVint. ) LJt(V\/vv J 

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# rv/ c /o ^ EP A CO RSignature /Dat e

# \m n CONSPN T FO R ACCCES S T O PROP E
' OMAH ALEA D SIT E REMEDIA L ACTIO N - LEAD-BASE D PAIN TSTABILIZATIO N '\r„ y PROPERTYID : ^UL,'K \ PROPERT YADDRESS : 

# H O ^ H Cuj^^^^y^ x OWNER' S NAME : DAY-TIM E PHONE : C^ O 5^ , S " " 1 ^ (X ? CELLPHONE : (4f>L ^ C^ H ^'^^ ^ E-MAI L (^ t ^"s Cif\e«!:5 ^ gp ^

V.O-WIA<V X\ • rnv ^ OWNER' S ADDRES S I F DIFFERENT : • • • I TENANT' S NAM E I F APPLICABLE : DAY-TIM E PHONE : CEL L PHONE : E-MAI L Professiona l Environmenta l Engineers , Inc . (PE ) i s unde rcontract (#EP-R7-08-06 ) wit h th e U . S . Environmenta l Protectio n Agency(EPA) t o stabiliz e exterio rlead-base d pain t (LBP ) o n residentia l structure s at a numbe ro fpropertie s locate d i n Omaha , Nebraska . Th e pain t stabilizatio n wor k i s bein g don e t o protect th e soi l cleanup s tha t wer e performe d byEPAcontractors . Pain t stabilization s activitie s wil l include : scrapin g o f cracke d o rflakin g LB P fro m stmctures , applicatio n o f a prim e coa t an d tw o (2 ) coat s o fpaint . An ymovin g part s o fwindow s an d doo rar e no t include d i n th e activitie s an d wil l no t b e addressed . You rcooperatio n i s requeste d i n givin g permissio n t o thi s EPAcontracto r(PE , Inc. ) t o ente ran d hav e acces s t o thi s propertyfo rth e purpos e o fstabilizin g lead-base d pain t a s outline d o n th e propertyidentifie d above . I full yunderstan d tha t b ysignin g thi s Consen t Fo rAccess , (1 ) thi s acces s wil l remai n i n effec t unti l th e wor k ha s bee n satisfactoril y complete d (2 ) tha t a s th e PropertyOwne ro rtenant , i f applicable , wil l b e give n th e Housin g an d Urba n Developmen t (HUD ) an d EP A pamphlet , "Renovat e Right , Importan t Lea d Hazard Informatio n fo rFamilies , Chil d Care Providers an d Schools " (3 ) th e PropertyOwne ro r tenan t wil l remova l o f obstruction s fro m surface s t o b e painted , (4 ) wil l abid e b yhealt h an d safetyguidanc e provide d byEPA , an d (5 ) wil l allo wphotograph yo f propertybefor e an d afte rth e pain t stabilizatio n work , (6 ) I wil l b e contacte d b ya P E representativ e approximatel y 4 8 hours i n advanc e ofstartin g wor k t o (7 ) agre e not t o obstruct o rtampe rwit h an yo fth e LB P stabilizatio n activitie s o requipmen t use d t o perfor m an yLB P actions , (8 ) wil l participat e i n fina l propertyinspectio n an d sig n th e Completio n Agreemen t an d PropertyOwne r satisfactio n Survey . Shoul d yo u hav e an yquestion s abou t th e planne d Lea d Based-Pain t stabilizatio n activitie s fo ryou rproperty , pleas e contact : Professiona l Environmenta l Engineers , Inc. , Project Manager , Herma n Hanne ra t 402-884-1185 . Genera l question s abou t th e Omah a Lea d Sit e cleanu p ca n b e directe d t o Paulett a France-Isetts , EPARemedia l Project Manage r402-731-2454 , o rth e EP APubli cInfonnatio n Centers a t (402 ) 991-958 3 (Nort h Omah a office ) o r(402 ) 731-304 5 (Sout h Omah a office) . 

# J Yes , I gran t acces s t o m ypropert yan d wa s give n [ ] No , I d o no t gran t acces s t o m ypropert yan d I wa s

. amphle t "Renovat e Right , Importan t Lea d Hazard give n th e pamphle t "Renovat e Right , importan t Lea d Informatio n fo rFamilies , Chil d Care Provider s an d Schools . Hazard Informatio n forFamilies , Chil d Care Provider s an d Schools . G jtZ^a^^ ^ ^/>cnj- ^ 

## S^o ^ j y Signatur e Dat e Signature Bat e SPECIA L INSTRUCTION S AND/O R CONSIDERATIONS :••••• i ,:«.i--,.-<^-'Wl»^^t 1 • : 

# PAIN TSTOILIZATIO N PRE-PROPETTT Y 

# »ST ^ PAIN TMATC H ASSESSMEN T
PROPERT YADDRESS : MC^^ M LuLWlJ.>t4/K ^ DAT E BVI D 

# ^^(. 3 AREA(S ) T O BE PAINTED : HOUS E PROPER : . ^



## \ l P^ S - COLOR ^ 

# Jd^- ^ 

# Y \)£, S 

# u^Act v HOUS E TRI M COLO R 

# fN/ 0 GARAG E COLO R
GARAG E TRI M ^ 

# /\) 0 COLO R
PORC H 

# v ; 

# ^-^s COLO R 

# Q^V^^. , ^ 

# by-Azt A . PORC H TRI M COLO R 

# Y ^ ^ (COMPLET E AL L SECTION , YES , NO , O R NON-APPLICABLE ) 

# I AGRE E T O TH E COLOR S LISTE D ABOVE . ONC E PAINTIN G BEGINS , I UNDERSTAN D I CA NNO T CHANG E TH E ABOV E SELECTE D COLORS : PROPERT Y OWNE R SIGNATURE : P E ACCESSO R SIGNATURE : 

## H^SLIT W 

# 7/^j-^y ^ 

# IVW ^

PAIN TMATC H FOR M 08/0 8, -IjlH^'-f..-^-' - •..» , i - ^ - i^ p -"-'•1'-,:^!!--:i:;J»ii''(llS;<^f-T ; .i*!-., . '! » 

# PAIN TSTABILIZATIO N PRE-PROPERT YASSESSMEN T ~1 PROPERT YADDRESS : V H ^ 4 ( . j i >VU.^f 1 C U DAT E ?/^ / ^ ^ 

# (OM X ^) ^

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BVI D ^Hto^ l PLAN T& PERMANEN T UNDSCAPIN G T O B E REMOVE ? N O KZ } YE S C D I F YE S WHERE : '^ X 

# fivc\H,(

PRE- I EXISON G CONDIUQ N O F FOUNDATION/STRUCTURE , i.e . BASEMEN T LEAKING ? N O .. _J? ^

YE S ' ' IF , YE S WHERE : 

# Sy\\ \^^.I g 4 '(}}A^- af^cc-^r A uXiCrMs mig^'^v/P , if \arW. .XV\M(VA^
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# r____. v EXISTIN G PAIN T O N WINDOWS , DOORS , FOUNDATION , SIDEWALIC ( I.E.) ? N YE S I .^ ^ I F YE S WHERE ' 

### OV A

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,pry?rVv^ - ^ i\< ? IO^VYW . LV-\I V W A

# uvi a dlgi\\ S "\^-^^V . M ^ m\ o uv^dcu^ m-^r, ^ s<c O ,/iAl n f}^\vlV(i? A

VISUA L DESCRIPTIO N O F PROPERTY/STRUCTURE/GARAGE , (I.E.) : (US E BAC KSID E I F NECESSARY ) 

# o, l 

# lar^ A ayc\ ^ \i \lt^'(^hy x c\ ^ ^V , Icc y S S^IK A

# \ac> v

PROPERTYOWNE R SIGNATUR E

# Confirmatio n OWeceip t O f Lea d Pamph W ^ f BVI D Wiol^ i ," PROPERTYADDRES S HCs M {_L1JMM\ QZI P COD E ^S^ / 3 1 PROPERTYADDRES S O F OWNE R I F DIFFEREN TTHA N PROPERTYBEIN G PAINTED : PROPERTYADDRES S ^ZI P COD E I hav e receive d a cop yo f th e pamphlet , Renovat e Right : Importan t Lea d Hazar d Informatio n Fo rFamilies , Chil d Car e Provider s An d School s informin g m e o f th e potentia l ris k o f th e lea d hazar d exposur e fro m renovatio n activit yt o b e perfomie d o n dwellin g uni t I receive d thi s pamphle t befor e th e wor k began . 

# Cus^TA^ o r^^^- ^ ^-^•o2 ^ PRINTE D NAM E O F RECIPIEN T DAT E 

### ^^^.u^^oZr^y ^

JA J SIGNATUR E O F RECIPIEN T Self-Certificatio n Optio n (Fo rTenant-Occupie d Dwelling s Only ) I fth e lea d pamphle t wa s delivere d bu t a tenan t signatur e wa s no t obtainable , yo u ma ychec k th e appropriat e bo xbelow : 

# D Refusa l T o Sig n - I certif ytha t I hav e mad e a goo d fait h effort t o delive rth e pamphlet , Renovat e Right : Importan t Lea d Hazar d Informatio n fo rFamilies , Chil d Car e Provider s an d Schools ; t o th e renta l dwellin g uni t liste d abov e a t th e dat e an d tim e indicate d an d tha t th e occupan t refuse d t o sig n th e confimiatio n o f receipt . I furthe rcertif ytha t I hav e lef t a copyo fth e pamphle t a t th e uni t wit h occupant . 

# D Unavailabl e Fo rSignatur e - i certifytha t I hav e mad e a goo d fait h effort t o delive rth e pamphlet , Renovat e Right ; Importan t Lea d Hazar d Informatio n fo rFamilies , Chil d Car e Provider s an d Schools , t o th e renta l dwellin g uni t liste d belo w an d tha t th e occupan t wa s unavailabl e t o sig n th e confinnatio n o f receipt . 1 furthe rcertif ytha t I hav e lef t a copyo f th e pamphle t a t th e uni t b yslidin g I t unde rth e doo ro rsomewher e o n th e premises . 

# L-o n Hil l q-s-o s PRINTE D NAM E O F PERSO N CERTIFYIN G ATTEMPTE D DELIVER YDAT E AN D TIN E LEA D PAMPHLE T DELIVER Y 

# ^o< . IJ-J O SIGNATUR E O F P E PERSO N CERTIFYIN G LEA D PAMPHLE TDELIVERY : Not e Regardin g Mailin g Optio n - as a n altemative t o deliver y

in person , yo u ma ymai l th e lead pamphlet ID th e owne rand/o rtenant . Pamphle t mus t ti e maile d a t least 7 day s t)efor e renovation . (Documen t with a certificat e o fmailin g from th e pos t office) .

08/0 8 CONFIRMATIO N O F RECEIP TO F LEA D PAMPHLE T

### Dougla s County Accoun t Informatio n Pag e 3 of 3 uor n e^. v

ta t u 1
"^t ' 

# F " {

CLIC KT O ENLARG E IMAG E Squar e Footage : 1976. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : En d Condition : Poo r

Buil t As : 2 Stor y Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 9. 0 Exterior : Fram e Sidin g Units : 2. 0 Interior : Drywal l Baths : 3. 5 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Gabl e Stories : 2. 0 Floorcover : Allowanc e Foundation : Bloc k 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 4 0 % 189 4 11 2 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 ft 957. 0 Fixtur e Additiona l Fixture s 1. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 3. 0 Fixtur e Batf i Hal f 1. 0 Garag e Detacfie d 468. 0 Porc h En d Scree n 280. 0 Porc h Enc i Scree n 40. 0 Porc h En d Scree n 70. 0



### littp://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R24.. . 6/27/200 8

### Dougla s County Accoun t Informatio n Pag e 1 of 3 Dougla s County , Nebrask a Propert yRecor d - R240458000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t of 90t h S t - ViewO n IMa p Informatio n i s vali d a s o f 2008-6-1 9 Treasurer' s Ta xRepor t Ne wFeatur e -•-•- • Aut o Sale s Searc h Owne r FLORE S GUSTOVA ETA L 1290 5 PAXTO N S T PACOIMAC A91331-000 0 Propert yInformatio n Ke yNumber : 045 8 000 0 2 4 Accoun t Type : Multipl e Re s Parce l Number : 240458000 0 Parce l Address : 402 4 CUMIN G S T OMAH AN E 68131-000 0 Lega l Description : WALNU THIL L LO T 1 1 BLOC K1 -E X S 25. 8 FT Valu e Informatio n Lan d Improvemen t Tota l 200 8 $ 11,200.0 0 $ 26,500.0 0 $ 37,700.0 0 200 7 $ 11,200.0 0 $ 26,500.0 0 $ 37,700.0 0 200 6 $ 11,200.0 0 $ 26,500.0 0 $ 37,700.0 0 200 5 $ 12,400.0 0 $ 26,500.0 0 $ 38,900.0 0 200 4 $ 12,400.0 0 $ 26,500.0 0 $ 38,900.0 0 200 3 $ 12,400.0 0 $ 26,500.0 0 $ 38,900.0 0 Sale s Informatio n Sale s Date : ! 2006-06-0 2 Dee d Type : W D Book : 200 6 Page : 07409 2 Price : $ 66,000.0 0 Grantor : GOODWI N MARYJ O ETA L Grantee : FLORE S GUSTAV O ETA L Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 2005-02-0 7 Dee d Type : Q C 8oo^ ; 200 5 Page : 01879 6 Price : $0.0 0 1 Grantor : Bruc e Goodwi n 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R24. . . 6/27/200 8