### TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R 

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

# 30/2 . [)aJ c Sh-J

Remediatio n Contractor : PROFESSIONALENVIRONMENTALENGINEER S Year : 200 8 PAINT STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S
^ W Ij / H D N Z \ ^ M M 

# B ^

Vide o o f propert y (DVD ) bfiioc ^ Cjj^^kr ' Executiv e Summar y ­ . SignedAcces s Agreemen t fo r

subject propert y Paintin g Agreemen t Settlemen t docxunent s (i.e. , fo r

damag e or t

o replac e plants , etc. ) : Photograph s be>[rv.g . Q^^^L ^

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

lis t signedby EP A Propert y information fromDougla s Count y Assessor' s Office 

# C.\ l $e<Vic^ 5 u')(i^\L.<?iiiJ r ' - .

D • • • • ' • ' • • " • • • ' • • • 

### signatur e " ~ ~ " f Dat e

## PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC
. ''° ' ""oma' t N^e's m "Providin g cost-effectiv e environmenta l solutions " ^ Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yRespons e 

### ^ |j°^ | l°1't^l^ , Fa x(402 ) 504-328 1



### Lea dBas e Pain t Stabilizatio n Omaha , N e Clos e Ou t Repor t SAID #1508 8 301 2 Oa k S t

•Date s worke d12/0 5 t o 12/0 5 200 8 •Larg e house , pain t o n front porc hwa s poo r an dflakin g off . Hous e ha s viny l an dstucc o siding , windo w trim s wer e painte dan dvery poor . Garag e pain t was very poo r an dprio r pain t was foun do n al l windows . N o issue s durin g stabilization . •Inspecte d12/08 , n o issue s

# PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC
. "Providin g cost-effectiv e environmenta l solutions " Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yRespons e 

### Propert y Owne r Close-Ou t For m (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) SAID : / OO^'? ^ Property Address : 

# Soix - CJCX' L S 

# ^ Owner' s Name : C.}<r\Cjcr [ 

## e l/o ^ <^ l 

## ^ Performanc e Standards/Close-Ou t Criteri a 250 5 Nort h 24' ^ Suit e 21 9 Omaha , N E 6811 0 (402 ) 504-468 8 Fax(402 ) 504-328 1



### 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 garages . 

# Y 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 tw o to p coats ? < 

### 4 . Wa s th e pain t product s utilize dequivalen t t o a3 0 year product/quality ? 

## 'X 5 . Are al l o f th e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y 

# K 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 any 

# K othe r generate ddebris ? 7 . I s th e gras s are atha t surround s th e structure(s ) i n reasonabl y goo dcondition ? 

# X 8 . Are 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 any evidenc e o f property damag e that was don e b y th e contractor ? Any property damag e need s t o b e complete dprio r t o th e EP A Close-Out . 

# Y 10 . Are ther e any property item s that wer e temporaril y re-locate db y th e contracto r that nee dt o b e move dback ? 

# X 11 . Are ther e any (known ) lingerin g issue s withth e property owner(s ) that hav e bee n lef t unresolved ? 

# X Comments :

Property Owne r Signatur e Dat e Professionakenvironmenta l Engineer s Representativ e Dat e

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

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

### "Providin g cost-effectiv e environmenta l solutions " Fa x(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 ) 

# /503 Z SAID : Property Address : Owner' s Name : 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 Z ^ 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 tw o to p coats ? iy 

### 4 . Wa s th e pain t product s utilize dequivalen t t o a3 0 yea r product/quality ? i ^ 

### 5 . Ar e al l o f th e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y 

## 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 ? i / 

### 7 . I s th e gras s are atha t surround s th e structure(s ) i n reasonabl y goo dcondition ?

­ 

### 8 . Are 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 any evidenc e o f property damag e that was 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 . i ^ 

### 10 .Ar e ther e any property item s that wer e temporaril y re-locate db y th e contracto r ^ 

### that nee dt o b e move dback ? 11 .Are ther e an y (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 :



## ifii/i/^.^/^cy^^^^^ ^ EP A CO RSignatur e Dat e

### C V Service s Propert yAddres s Star t Dat e 

# iQ-'^-^ y Dat e Complet e Dat e 

# /y0- o 

# .

Prim e (Gallons ) 

### Amoun t O f Prim e An d Pain t Use d 

# S I
Pol y(Boxes ) Pain t (Color ) Pain t (Color ) 

# y i^/h l 

# tci . ^ { d l Amoun t (Gallons ) Amoun t (Gallons ) 

# / D 

# 2 ^ Pain t (Color ) Amoun t (Gallons ) Pain t (Color ) Amoun t (Gallons ) Pain t (Color ) Amoun t (Gallons )

# CONSEN T OF RACCES S T O PROPERT Y
' OMAHA LEA D SIT EREMEDIA LACTIO N - LEAD-BASED PAIN T STABILIZATIO N PROPERT Y IP : //$?y^^ ^ PROPERT Y ADDRESS : JT^X ^ <0/gy ^ S^ ^ OWNE RNAME : WrNt K fNAMK : DAYTIM E PHONE : f^ ^ ' (^pO ' <^^B^ y 

### CELLPHONE: "fdX

- ^?^-x^f^S^ 7 E-MAH. : 

### _ C^^i^f^Cc)^ . A^/ " OWNER' S ADDRES S I FDIFFERENT : 3C? i ^ C>^^ ^ T f TENANT' S NAM E I FAPPLICABLE : 

### DAYTIM E PHONE : CEL L PHONE : E-MAIL : Professiona l Environmental Engineers , Inc . (PE ) i s unde r contrac t (#EP-R7-08-06 ) wit hth e U.S . Environmental Protectio n Agency (EPA ) t o stabiliz e leadbase dpain t (LBP ) on residential structure s a t anumbe r of propertie s locate din Omaha , Nebraska . Th e pain t stabilizatio n work i s bein g don e t o protec t th e soil cleanup s tha t wer e performe dby EP A contractors . Pain t stabilizatio n activitie s will include : scrapin g of cracke do r flaking LB P fromstructures , applicatio n o f aprim e coat an d tw o (2 ) coat s of pain t Moving part s of window s an ddoor s ar e no t include dan dwill no t b e addressed . Your cooperatio n i s requeste din givin g permissio n t o thi s EPA contracto r (PE ) t o ente r an dhav e acces s t o thi s propert y for th e purpos e o f stabilizin g lead-base dpain t a s outline do n th e propert y identifie dabove . B y signin g thi s document I agre e t o allo w a n EP A contracto r t o conduc t asoi l cleanu p a t m y propert y following completio n o f lead-base dpain t stabilization . I understan dtha t th e stabilizatio n contracto r can no t provid e assurance s tha t th e soi l cleanu p contracto r will b e boun dto . I furthe r understan dtha t th e soi l cleanu p contracto r wil l make al l reasonabl e effort s t o addres s concern s tha t I , a s th e propert y owner , ma y hav e regardin g soi l cleanu p a t m y property . I full y understan dtha t b y signin g thi s Consen t for Access , (1 ) thi s acces s will remai n in effect unti l th e wor k

ha s been satisfactoril y completed , (2 ) tha t th e Propert y Owner o r Tenant , i f applicable , wil l b e given th e Housin g an dUrba n Developmen t (HUD ) an dEPA pamphlet , "Renovat e Right , Importan t Lea dHazar dinformatio n fo r Families , Da y Car e Providers , an dSchools" , (3 ) th e Propert y Owne r o r tenan t wil l remov e al l obstruction s fromsurface s t o b e painted , (4 ) will abid e b y healt han dsafet y guidanc e provide db y EPA , (5 ) will allo w photograph y o f propert y before an dafte r th e pain t stabilizatio n work , (6 ) will b e contacte db y aP Erepresentativ e approximatel y 4 8 hour s i n advanc e o f startin g work , (7 ) agre e no t t o obstruc t o r tampe r wit han y o f th e LB P stabilizatio n actions , an d(8 ) will participat e i n fina l propert y inspectio n an d sign th e Completio n Agreement an dPropert y Owne r Satisfactio n Survey . Shoul dyou hav e any question s abou t th e plane dLea dBased-Pain t stabilizatio n activitie s for you r property , pleas e contac t Professiona l Environmental Engineers , Inc . Projec t Manager , Willi e Clay At 402-504-4688 . Genera l question s abou t th e Omah aLeadSit e cleanup can b e directe dt o Paulett aFrance-Isetts , EPA Remedial Projec t Manage r 402-731-2454 , o r th e EP A Publi c Informatio n Center s a t 402-991-958 3 (Nort hOmah aoffice) o r 402-731-304 5 (Sout hOmah aoffice) . es , t gran t acces s t o m ypropert yan d wa s give n th e pamphle t D No , I d o no t gran t acces s to m ypropert yan d I wa s > "Renovat e Right , Importan t Lea d Infonnatio n forFamilies , ChH d give n th e pamphle t "Renovat e Right , Importan t Lea d

Car e Providers , an d Schools. " Informatio n forFamilies , Child e Car e Providefs , an d Schools. ' 

# .<^^ " / V //-/^-^ ^ Signatur e Dat e Signatur e Dat e SPECIA L INSTRUCTION S AN D CONSIDERATION S

## C@BiiriTiati@i i O f R©©@lpt Of f L©a( ^

Fiio^^pGulsu : BVI D X ^ i yccf ' PROPERT Y ADDRES S 3(py ^ ^S3^ ^ S ^ ZI P COD E ^O^^ ^ PROPERT Y ADDRES S OF OWNE R I F DIFFEREN T THAN PROPERT YBEIN G PAINTED : PROPERT YADDRES S ZI P COD E 

# J 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 risk o f th e lea d hazar d exposur e fro m renovatio n activit yt o b e perfonme d o n dwellin g unit
. I receive d thi s pamphle t befor e th e wor k began
.

PRINTE D NAM E O F RECIPIEN TDAT E 

# ,,;X^ ' / ^ SIGNATUR E O F RECIPIEN T Self-Certificatio n Optio n (Fo rTenant-Occupie d Dwelling s Only ) I f th 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 x below : ( J Refusa l T o Sig n - 1 certif ytha t I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , renovat e right: importan t lea d hazar d infomnatio n fo r^milies , 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 confirmatio n o f receip t I furthe rcertif ytha t I hav e lef t a cop yo f th e pamphle t a t th e uni t wit h occupant . 

# G Unavailabl e Fo rSignatur e - 1 certif ytha t I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , renovat e right importan t lea d hazar d infonnatio 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 wan d tha t th e occupan t wa s unavailabl e t o sig n th e confinnatio n o f receipt
. I furthe rcertif ytha t I hav e lef t a cop yo 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
. 

# u-^/^^^T^ ^ y-/s^^ ^ PRINTE D NAM E O F PERSO N CERTIFYIN G AHEMPTE D DELIVERYDAT E AN D TIM E LEA D PAMPHLE TDELIVERY

STON , SIGNATUR E O F PERSO N CERTIFYIN G LEA D PAMPHLE TDELIVERY :
Not e Regardin g Mailin g Optio n - a s a n ^temativ e t o deliver yi n person , yo u ma ymal l th e lea d pamphle t t o th e owne r and/o rtenant . Pamphle t mus t ti e maile d a t leas t 7 day s t)efor e renovation
. (Documen t wit h a certHicat B o f mailin g fro m th e post office)
. CONFIIRMATIO N OF RECEIP TO F LEA D PAMPHLE T08/0 8- - 

# PAIN T STABILIZATIO N PRE-PROPERT Y ASSESSMEN T


# ^ ^ ^ y/'ys-(^ V PROPERTYADDRES S 

# : 

# JO/^ . DATE 

## BVi D /Jf'^^ ^ PLAN T& PERMANEN TLANDSCAPIN G T O B E REMOVE ? N O p< i YE S 

# r n IF , YE S WHERE : ^

PRE-EIOSPJN G CONDECEO N O F FOUNDATION/STRUCTURE , i.e
. BASEMEN TLEAKING ? M n L^^ J vp « I 1 IF , YE S WHERE : N O YE S

EXISTIN G PAIN TO N WINDOWS , DOORS , FOUNDATION , SIDEWALK, ( I.E.) ? N0JS< 1 YE S i^ H IF , YE S WHERE : ' ^

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

! •

PROPERTYOWNE R SIGIMTUR E 

# 1



# 1

## PA f ASSESSMEN T
PROPERT YADDRES S 

## , y^^/ip l (^^ ^ JT ^ DAT E /^-yj^^ ^ 

# /s^r ^ BVI D AREA(S ) T O B E PAINTED : HOUS E PROPER : //i f COLOK
. HOUS E TRI M _COLOK
. 

## i/yj^ir^ . ^ ^


### GARAGE
. 

# )^A ± COLO R 

## U/tf/Tf U/hfj i GARAG E TRI M 

## 10 ^ ^ 

### COLOR
. PORC H COLO R i<y/^'T / 

# - m

PORC H TRIM
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# Yi > COLO R U/ff'T ^ (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 N HO T CHANG E TH E ABOV E SELECTE D COLORS :

PROPERT YOWNE R SIGNATURE :

PAIN TMATC H FOR M 08/0 8

### Dougla s County Accoun t Informatio n Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R230049000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f 90t h S t - Vie W O n IVIa p Informatio n i s vali d a s of 2008-9- 4 Treasurer' s Ta xRepor t Ne wFeatur e -•"-•- > Aut o Sale s Searc h Owne r VOGE L CHARLE S W ETA L 301 2 OA KS T OMAH AN E 68105-000 0 

# gLl0,-^{^ O Propert yInformatio n Ke yNumber : \ 004 9 000 0 2 3 Accoun t Type : Residentia l Parce l Number : | 230049000 0 Parce l Address : 301 2 OA KS T 4 - OI\/IAHAN E 58105-000 0 Lega l Description : I SUMMI T AD D LO T 1 6 BLOC K4 48. 4 X 128.2 5 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $6,300.0 0 $87,400.0 0 $93,700.0 0 200 7 $6,300.0 0 $87,400.0 0 $93,700.0 0 200 6 $6,300.0 0 $83,700.0 0 $90,000.0 0 200 5 $6,300.0 0 $83,700.0 0 $90,000.0 0 200 4 $6,300.0 0 $83,700.0 0 $90,000.0 0 200 3 $6,300.0 0 $83,700.0 0 $90,000.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 4 6144. 0 1. 0 128. 0 48. 0 N o Improvement Informatio n Buildin g 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R23. . . 11/5/200 8

### . ^ Dougla s County Accoun t Informatio n Pag e 2 o f 2 

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. 

# WT M ; M J^ ^ *WgK : 11/ 2 STOR Y FWIS^C O CLIC KT O ENLARG E IMAG E Squar e Footage : 1808. 0 Perimete r 0. 0 Uni t Type :

Buil t As : 1 1/ 2 Stor yFi n HVAC : Force d Ai r Exterior : | Fram e Sidin g Interior : Drywal l Roo f Cover : Compositio n Shingl e

Roo f Type : Gabl e Floorcover : Allowanc e Yea rBuil t Yea r Remodele d Percen t Remodele d 190 0 0 % Percen t Complete ; 100.0 % Quality : Averag e Condition : Fai r Cond o Squar e Footage : 0. 0 Rooms : 8. 0

Units : 1. 0 Baths : 1. 0 Bedrooms : 4. 0 Stories : 1. 5 Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Adjuste d Yea r Buil t Physica l Ag e 190 0 10 9 Detai l Typ e Ad d O n Applianc e Basemen t Fixtur e Fixtur e Garag e Porc h Porc h Porc h Detai l Descriptio n Fenc e Chai n Lin k Allowanc e Bsmn t Bloc k 8 ft Bas e Fixture s Bat h Ful l Detache d Ope n Sla b Sla b Roo f Cei l Sla b Roof Cei l Unit s 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. . . 11/5/200 8