TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: Zl^iy ^ Date: 7^^/^^ 

Address: &2S ^ S 3 ^ Sf " 

Remediation Contractor: PROFESSIONAL ENVIRONMENTAL ENGINEERS Year: 20a8 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

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 Video of property (DVD) 

 Executive Suimnary 

 Signed Access Agreement for subject property 

 Painting Agreement 

 Settlement documents (i.e., for damage or to replace planfe, etc.) 

 Photographs ._ 

 Satisfactory restoration signed by Property Owner 

 Property close-out check list signed by EPA 

 Property information from Douglas Coimty Assessor's Office 

s/ .\AC. Pnin'tinj^ Li e VA^V. dnear 

Signature ^ / Date 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. ''°'"^ol'ht NE?8m 

"Providing cost-effective environmental solutions" ^ ll^^c^ltoo^ 

^ Fax (402) 504-3281 

Consulting • Engineering Design • Remediation • Abatemeiit • Emergency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

SAID# 21969 

825 S 36 St 

• Dates worked 09/18 to 09/19 2008 

• Prior house paint was in poor condition with flaking and peeling paint, paint chips in yard 

• Inspected 11/12 Retumed to re-scrape paint on porch and under window trims and to 

vacuum paint chips. 11/17 No issues 
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 

Property Owner Close-Out Form 

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

SAID: X.I9 C 9 

Property Address: S-^^ S i C si 

Owner's Name: Co->^ctic<^ ShccLl 

^ 

Performance Standards/Close-Out Criteria YES 

1. Was the entire structure(s) painted with the exception ofthe 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. 

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

3. Were all required areas ofthe structure(s) primed as needed and painted with 

two top coats? 

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

5. Are all ofthe 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? / 

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

barrier tape, etc. properly removed? 

9. Is there any evidence ofproperty 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 with the property owner(s) that have 

been left unresolved? 

Comments: 

Property Owner Si^amre Date 

M^f^ //-^H'^ S 

Professional Eryimronmenta ivmo l Engineers Representative Date 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

"Providing cost-effective environmental solutions" 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

EPA Close-Out Form 

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

SAID: ^ ) 9^ 9 

Property Address: S'^S S 3 ^ ^^ 

Owner's Name: Coyy^x^c- ShockU^ 

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

3. Were all required areas ofthe 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? y 

5. Are all ofthe 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 y 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, y barrier tape, etc. properly removed? 

9. Is there any evidence ofproperty 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? 

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: 

' ivitcLuf JDCKCI^ . I ID L 4 L^y^^^'i^^ 

'S-Siie^ ri^/}lu 

'^yryyj^^u-.^ JW/~ llMIOfy 

PA COR Signature 
CONSENT OFR ACCESS TO PROPERTY 

OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID: r Q |Q(z3 ^ PROPERTY ADDRESS: ^^5 ' LJ^ J?< ^ L5~/^ 

OWNER NAME: 

^ DAYTIME PHONE: 9yf?y^/o 

CELLPHONE: E-MAIL: 


OWNER'S ADDRESS IF DIFFERENT: 

TENANT'S NAME IF APPLICABLE: 

DAYTIME PHONE: 


CELLPHONE: 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 untU the work has been 

satisfactorily completed, (2) that the Property Owner or Tenant, if applicable, will be given the Housmg 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 ofproperty 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 obstmct or tamper with any ofthe 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 PubUc Information Centers at 402-991-9583 (North Omaha office) or 402-731-3045 (South Omaba office). 

^ ^ Yes, I grant access to my property and was given the pamphlet D No, I do not grant access to my property and I vwas 

/"RSnovate Right, Important LeM InformatkHiibr Fanrilies, ChiM given the pamphl^ "Renovate Right, Important Lead 

' Caie)Providers,\and^hoois.''\ biformatkHi for Families, Chikle Capp Providers, and Schoois." 

y7- y-oS ' 

Date 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
Confirmation Of Receipt Of Lead Pamphlet 

BVID y)n(o ^ 

^ f J^^^ V ^ ZIP CODE ^fy^ . 

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 Provider And Schools infonning me of the potential risk of the lead hazard exposure from 

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

(^yui y^^ocykij yy ^ 

PRINTED NAME OF RECIPIENT I A I\ ' DATE 

-W 'BAgnil g/M:i 

SIGNATURE OF RECIPIENT 

Self-Certification Option (For Tenant-Occupied Dweliings Only) 

If the lead pamphlet was delivered but a tenant signature was not obtainable, you may check the appropriate box 

below: 

I J Refusal To Sign - 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 above at the 

date and time indicated and that the occupant refused to sign the confinnation of receipt I further certify that I 

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

n 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. 

y^T::^^^ yyS^^^ ^ yy-y^o ^ 

PRINTED NAME OF PERSON CERTIFYING AHEMPTED DELIVERY DATE AND TIME LEAD 

PAMPHLET DELIVERY 

-y^.^.,^yyf^- SIGNATURE OF PERSON CERTIFYING LEAD PAMPHLET DELIVERY: 

Note Regarding Mailing Option - as an alternative to delivery in person, you may mail the lead pamphlet to the owner 

and/or tenant Pamphlet must 1)6 mailed at least 7 days before renovation. (Document with a certificate of mailing from the post 

office). 

CONFIRMATION OF RECEIPT OF LEAD PAMPHLET 08/08 
 i 

PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

PROPERTY ADDRESS: ^^ ^ U O ^ S^ ^ _ DATE /^ y-^ ^

BVID — 

AREA(S) TO BE PAINTED: 

HOUSE PROPER: \)dK y COLOR J £il 

HOUSE TRIM A COLOR ^r^ 7W^ 

GARAGE AUL COLOR 

GARAGE TRIM COLOR. 4 ^ 

PORCH COLOR. \X^\\^ r:^y/^^rj •kA=^ 

PORCH TRIM Wlk-y COLOR \A\\y^ 

(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: 

LiM^JjUi ^ ^ V ^ i ^ 

'y^<o<^ \k W^^b oic O^V^\AV^ \)^\yt^xy\ \y to^-t^ii 

PA.NTMATbHFORM08/08,0>^ VOl ^'A6\0lAi^ tU D " 0 A \ 1 lOl^ W W^/ H ^ ^ 
PAINT STABILIZATION PRE-PROPERTY ASSESSMENT 

PROPERTYADDRESS•• j3?,<r .ry< ^ s ^ DATE yyy ~ (^j r 

BVID 

PLANT & PERMANENT LANDSCAPING TO BE REMOVE? NO YES 

IF, YES WHERE: ^ 

PRE-EXISmiG CONDIUQN OF FOUNDATION/STRUCTURE, i.e. BASEMENT LEAiQNG? 

NO y ^ YES ' ' IF, YES WHERE: 

EXISTING PAINT ON WINDOWS, DOORS, FOUNDATION, SIDEWALK,( I.E.)? N0|—| 

YES I ^ IF, YES WHERE: 

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ypy^.r - y^ -^^yy^^y^ . 

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

NECE^ARY) 

KLL 

PROPERT rem IY vmnc OWNERn aniraM SIGNATUR i uni^E <-\ 
^ Douglas County Account Information Page 1 of3 

Douglas County, Nebraska Property Record - R103832000Q 

Print Report 

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

New Feature -»-*- • Auto Sales Search 

Owner 

SHOCKLEY CANDICE D 

825 S 36 ST 

OMAHA NE 68105-0000 Sy-9^c 

Property Information 

Key Number: 3832 0000 10 

Account Type: Residential 

Parcel Number: 1038320000 

Parcel Address: 825 S 36 ST 

OMAHA NE 68105-0000 

Legal Description: FEARON PLACE LOT 25 BLOCK 0 32 X 125 

Value Informatio n 

Land Improvement Total 

2008 $5,300.00 $56,900.00 $62,200.00 

2007 $5,300.00 $56,900.00 $62,200.00 

2006 $5,300.00 $38,600.00 $43,900.00 

2005 $5,300.00 $38,600.00 $43,900.00 

2004 $5,300.00 $38,600.00 $43,900.00 

2003 $5,300.00 $38,600.00 $43,900.00 

Sales Information 

Sales Date: 2005-12-09 

Deed Type: WD Book: 2005 Page: 1571I6 

Price: $45,000.00 

Grantor: 

Vision 55, LLC 

Grantee: Candice D Shockley 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 2002-12-20 y 

Deed Type: WD Book: 2231 Page: 434 

Price: $45,000.00 

Grantor: 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl... 10/20/2008 
JDouglas County Account Infomiation Page 2 of 3 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Valid 

Sales Date:

Deed Type:

Price:

Grantor: 

 I 1994-07-20 

 I D 

 $25,500.00 

Book: 1985 Page: 306 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Valid 

Land Informatio n 

Acres 

0.09 

SF 

4000.0 

Units 

1.0 

Depth 

125.0 

Width 

32.0 

Vacant 

No 

Improvemen t

Building 1 

 Information 

M 

RANCH 

CLICK TO ENLARGE IMAGE 

Square Footage: 752.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Average 

Built As: Ranch Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 3.0 

Exterior: Frame Siding Units: 1.0 

Interior: i Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 1.0 

Roof Type: Gable Stories: 1.0 

Floorcover: Allowance Foundation: Block 

/^i y^ 

http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp ?accountno=Rl... 10/20/2008 
J&C Painting LLC 

Property Address & A S S - 3( b ^" ^ Date j )-• nCo" CP, 

Start Date 11~ OCQ- Q 9^ Complete Date 

Amount Of Prime And Paint Used 

Prime (Gallons) 

Poly (Boxes) 

Paint (Color) \JjeAiO ^ Amount (Gallons) / 0 

Paint (Color) ^hif- c pf.^^/ i Amount (Gallons) / 

Paint (Color) Amount (Gallons) 

Paint (Color) Amount (Gallons) 

Paint (Color) Amount (Gallons)