TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: /5'0^ 6 Date: /^j^/o^ 

Address: 30/2. [)aJc Sh-JRemediation Contractor: PROFESSIONAL ENVIRONMENTAL ENGINEERS Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

^

W

Ij/

H

D

NZ

\ ^

M

M

B^

 Video of property (DVD) bfiioc^ Cjj^^kr' 

 Executive Summary ­ .

 Signed Access Agreement for subject property 

 Painting Agreement 

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

 Photographs be>[rv.g. Q^^^L^ 

 Satisfactory restoration signed by Property Owner 

 Property close-out check list signed by EPA 

 Property information from Douglas County Assessor's Office 

 C.\l $e<Vic^5 u')(i^\L.<?iiiJr 

' -. 

D • • • • ' • ' • • " • • • ' • • • 

signature " ~~ " f Date 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. ''° ' ""oma't N^e'sm 

"Providing cost-effective environmental solutions" ^

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

^ |j°^| l°1't^l^, Fax (402) 504-3281 

Lead Base Paint Stabilization Omaha, Ne 

Close Out Report 

SAID# 15088 

3012 Oak St 

• Dates worked 12/05 to 12/05 2008 

• Large house, paint on front porch was poor and flaking off. House has vinyl and stucco 

siding, window trims were painted and very poor. Garage paint was very poor and prior 

paint was found on all windows. No issues during stabilization. 

• Inspected 12/08, no issues 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

"Providing cost-effective environmental solutions" 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Property Owner Close-Out Form 

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

SAID: / OO^'? ^ 

Property Address: Soix- CJCX'L S ^ 

Owner's Name: C.}<r\Cjcr[ e l/o ^ <^l 

^ 

Performance Standards/Close-Out Criteria 

2505 North 24'^ Suite 219 

Omaha, NE 68110 

(402) 504-4688 

Fax (402) 504-3281 

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 

garages. Y 

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 

two top coats? < 

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

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

vacuumed/ cleaned? K

6. Did the contractor collect/vacuum all falling and scraped paint chips on the 

entir

other

e

 generate

 property

d

, roadways

 debris? 

, alleyways, public access areas and also remove any K

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

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. Y 

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

that need to be moved back? 

X 

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

been left unresolved? X 

Comments: 

Property Owner Signature Date 

Professionakenvironmental Engineers Representative Date 
c^ 

PROFESSIONAL 

2505 North 24'^ Suite 219 ENVIRONMENTAL ENGINEERS, INC. Onnaha, 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: /503Z 

Property Address: 

Owner's Name: 

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 

Z ^ 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 

two top coats? i y 

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

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

vacuumed/ cleaned? y

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? i / ­

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. i ^ 

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 with the property owner(s) that have ^ been left unresolved? 

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

ifii/i/^.^/^cy^^^^^^ 

EPA COR Signature 

Date 
CV Services 

Property Address 

Start Date iQ-'^-^y 

Date 

Complete Date 

/y0-o . 

Prime (Gallons) 

Amount Of Prime And Paint Used 

SI 

Poly (Boxes) 

Paint (Color) 

Paint (Color) 

y 

i^/hl tci. ^ { d l 

Amount (Gallons) 

Amount (Gallons) 

/ D 

2^ 

Paint (Color) Amount (Gallons) 

Paint (Color) Amount (Gallons) 

Paint (Color) Amount (Gallons) 
CONSENT OFR ACCESS TO PROPERTY 

' OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY IP: //$?y^^ ^ PROPERTY ADDRESS: JT^X ^ <0/gy ^ S^ ^ 

OWNE WrNtR

K NAME: fNAMK: 

DAYTIME PHONE: f^ ^ ' (^pO ' <^^B^ y 

CELLPHONE: "fdX- ^?^-x^f^S^7 _ E-MAH.: C^^i^f^Cc)^. A^/" 

OWNER'S ADDRESS IF DIFFERENT: 3C?i ^ C>^^^ T f 

TENANT'S NAME IF APPLICABLE: 

DAYTIME 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 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 stabilization activities will include: scraping of cracked or flaking LBP from structures, application of a prime coat and 

two (2) coats of paint Moving parts of windows and doors are not included and will not be addressed. 

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

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

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. I understand that the stabilization contractor can not provide assurances that the soil cleanup 

contractor will be bound to. I further understand that the soil cleanup contractor will make all reasonable efforts to address 

concerns that I, as the property owner, may have regarding soil cleanup at my property. 

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 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, Day Care 

Providers, and Schools", (3) the Property Owner or tenant will remove all obstructions from surfaces to be painted, (4) will 

abide by health and safety guidance provided by EPA, (5) will allow photography of property before and after the paint 

stabilization work, (6) will be contacted by a PE representative approximately 48 hours in advance of starting work, (7) agree 

not to obstruct or tamper with any of the LBP stabilization actions, and (8) will participate in final property inspection and 

sign the Completion Agreement and Property Owner Satisfaction Survey. 

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

Professional Environmental Engineers, Inc. Project Manager, Willie Clay At 402-504-4688. 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 Information Centers at 402-991-9583 (North Omaha office) or 402-731-3045 (South Omaha office). 

es, t grant access to my property and was given the pamphlet D No, I do not grant access to my property and I was > "Renovate Right, Important Lead Infonnation for Families, ChHd given the pamphlet "Renovate Right, Important Lead 

Care Providers, and Schools." Information for Families, Childe Care Providefs, and Schools.' 

.<^^" / V //-/^-^^ 

Signature Date Signature Date 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
C@BiiriTiati@ii Of R©©@lpt Off L©a(^ Fiio^^pGulsu: 

BVID X ^ i y ccf ' 

PROPERTY ADDRESS 3(py ^ ^S3^ ^ S ^ ZIP CODE ^O^^ ^ 

PROPERTY ADDRESS OF OWNER IF DIFFERENT THAN PROPERTY BEING PAINTED: 

PROPERTY ADDRESS ZIP CODE 

J 

I have received a copy of the pamphlet. Renovate Right: Important Lead Hazard Information For Families, 

Child Care Providers An d Schools informing me of the potential risk of the lead hazard exposure from 

renovation activity to be perfonmed on dwelling unit. I received this pamphlet before the work began. 

PRINTED NAME OF RECIPIENT DATE 

,,;X^' / ^ 

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: 

( J Refusal To Sign - 1 certify that I have made a good faith effort to deliver the pamphlet, renovate right: important 

lead hazard infomnation for ^milies, 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 confirmation of receipt I further certify that I 

have left a copy of the pamphlet at the unit with occupant. 

G Unavailable For Signature - 1 certify that I have made a good faith effort to deliver the pamphlet, renovate right 

important lead hazard infonnation 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. I 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. 

u-^/^^^T^^ y-/s^^^ 

PRINTED NAME OF PERSON CERTIFYING AHEMPTED DELIVERY DATE AND TIME LEAD 

PAMPHLET DELIVERY 

SIGNATUR STON, E OF PERSON CERTIFYING LEAD PAMPHLET DELIVERY: 

Note Regarding Mailing Option - as an ^temative to delivery in person, you may mall the lead pamphlet to the owner 

and/or tenant. Pamphlet must tie mailed at least 7 days t)efore renovation. (Document with a certHicatB of mailing from the post 

office). 

CONFIIRMATION OF RECEIPT OF LEAD PAMPHLET 08/08 
- -

PAINT STABILIZATION PRE-PROPERTY ASSESSMENT 

^ ^ ^ y/'ys-(^ V PROPERTYADDRESS : JO/^. DATEBViD /Jf'^^ ^ 

PLANT & PERMANENT LANDSCAPING TO BE REMOVE? NO p< i YES rn 

IF, YES WHERE: ^ 

PRE-EIOSPJNG CONDECEON OF FOUNDATION/STRUCTURE, i.e. BASEMENT LEAKING? 

MNO n L^^J vpYE«

S I 1 IF, YES WHERE: 

EXISTING PAINT ON WINDOWS, DOORS, FOUNDATION, SIDEWALK,( I.E.)? N0JS<1 

YES i^H IF, YES WHERE: ' ^ 

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

NECE^ARY) 

! • 

PROPERTY OWNER SIGIMTURE 

1 

1 
PAf 

ASSESSMENT 

PROPERTY ADDRESS , y^^/ipl (^^ ^ JT ^ DATE /^-yj^^ ^ 

BVID /s^r ^ 

AREA(S) TO BE PAINTED: 

HOUSE PROPER: //if COLOK. 

HOUSE TRIM _COLOK. i/yj^ir^. ^ ^ 

GARAGE. )^A± COLOR U/tf/Tf 

U/hfj i GARAGE TRIM 10^ ^ COLOR. 

PORCH COLOR i<y/^'T / -m 

PORCH TRIM _ Yi> COLOR U/ff'T ^ 

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

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

UNDERSTAND I CAN HOT CHANGE THE ABOVE SELECTED COLORS: 

PROPERTY OWNER SIGNATURE: 

PAINT MATCH FORM 08/08 
Douglas County Account Information Page 1 of2 

Douglas County, Nebraska Property Record - R2300490000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 90th St - Vie W On IVIap Information is valid as of 2008-9-4 Treasurer's Tax Report 

New Feature -•"-•-> Auto Sales Search 

Owner 

VOGEL CHARLES W 

ETAL 

3012 OAK ST 

OMAHA NE 68105-0000 gLl0,-^{^O 

Property Informatio n 

Key Number: \ 0049 0000 23 

Account Type: Residential 

Parcel Number: | 2300490000 

Parcel Address: 3012 OAK ST 

4-

OI\/IAHANE 58105-0000 

Legal Description: I SUMMIT ADD LOT 16 BLOCK 4 48.4 X 128.25 

Value Informatio n 

Land Improvement Total 

2008 $6,300.00 $87,400.00 $93,700.00 

2007 $6,300.00 $87,400.00 $93,700.00 

2006 $6,300.00 $83,700.00 $90,000.00 

2005 $6,300.00 $83,700.00 $90,000.00 

2004 $6,300.00 $83,700.00 $90,000.00 

2003 $6,300.00 $83,700.00 $90,000.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.14 6144.0 1.0 128.0 48.0 No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R23... 11/5/2008 
.^ Douglas County Account Information Page 2 of 2 

m;wi 

/ t ' 

p* ! 

-•rmniii,. 

WTM ;M J^^ *WgK: 

11/2 STORY FWIS^CO 

CLICK TO ENLARGE IMAGE 

Square Footage: 1808.0 

Perimeter 0.0 

Unit Type: 

Built As: 1 1/2 Story Fin 

HVAC: Forced Air 

Exterior: | Frame Siding 

Interior: Drywall 

Roof Cover: Composition Shingle 

Roof Type: Gable 

Floorcover: Allowance 

Year Built Year 

Remodeled 

Percent 

Remodeled 

1900 0% 

Percent Complete; 100.0% 

Quality: Average 

Condition: Fair 

Condo Square Footage: 0.0 

Rooms: 8.0 

Units: 1.0 

Baths: 1.0 

Bedrooms: 4.0 

Stories: 1.5 

Foundation: Block 

Sprinkler Square Footage: 0.0 

Adjusted Year 

Built Physical Age 

1900 109 

Detail Type 

Add On 

Appliance 

Basement 

Fixture 

Fixture 

Garage 

Porch 

Porch 

Porch 

Detail Description 

Fence Chain Link 

Allowance 

Bsmnt Block 8 ft 

Base Fixtures 

Bath Full 

Detached 

Open Slab 

Slab Roof Ceil 

Slab Roof Ceil 

Units 

1.0 

1.0 

1174.0 

1.0 

1.0 

234.0 

189.0 

270.0 

84.0 

http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R23... 11/5/2008