## TRANSMrrTA L o f

OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R
SAI D # : -^"^lU? ? Date : i3.\n\nQ | 

# Add.^ : ^0T ^ u ^'rA ^ is\

- Remediatio n Confractor : PROFESSIONA LENVIRONMENTALENGINEER S Year : 200 9
PAIN T STABILIZATIO N PROPERT V FIL E FOLDE RDOCUMENT S tU ^ Vide o o f propert y (DVD ) EA'^^ Executiv e Summar y Q 7 SignedAcces s Agreemen t fo r

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

damag e or to replac e plants , etc. ) Q^ ^ Photograph s OCi^y ^ Oyv d/lf/& r ^ y Satisfactor y restoratio n signedby Propert y Owne r D Propert y close-out check lis t signedby EP A
^^

r

Propert y information fromDougla s Count y Assessor' s Office ^7 ^ confirmation tha t lea dpamphle t "Renovat e Right " wa s receive dby P O D D D 

# ym ^ Professiona l E i Ignatur e

>ignatur e Dat e 3005465 9 

# ni l Superfun d250 5 Nort h 24 ^ Suit e 21 9 Omaha , N E 6811 0 (402 ) 504-468 8 Fa x(402 ) 504-328 1 

# 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



## Lea dBas e Stabilizatio n Omaha , N e Clos e Ou t Report 260 9
SAID#3316 8 402 3 N
. 45* " S t

•Date s worked : 10/0 1 t o 10/02 200 9
•Pr e propert y condition : Hous e ha s painte dtransi t sidin g wit hpainte dwoo dtrims
. Soffi t an deaves . Garag e ha s woo dsidin g an dha s pain t flakin g off
. Soffi t ha s visibl e lea dpain t wit hman y area s o f

damage dnoted
. • Problem s encountered : Non e
• Owne r request/concerns : Colo r change s t o trim s on garage . •Inspection/closeou t dates
. Owne r signe d10/1 3 2009
. Propert y inspecte dby P E projec t manager .250 5 Nort h 24 % Suit e 21 9 

### "Providin g cost-effectiv e environmenta l solutions " Consultin g » Engineerin g Desig n » Remediatio n • Abatemen t • Emergenc yRespions e 

## Propert y Owne r Close-Ou t For m (Lead-BasedPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) SAID : 

# •^31/0) ? Propert y Address : 

# MOiJr SKl U 5 ^"h Owner' s Name : 

# \m( ^ Y V^ l g\)€n ; Performanc e Standards/Close-Ou t Criteri a 1. Wa s the entir e stnicture(s ) painte dwit hth e exception ofth e stated , excluded areas ? Thi s wouldinclude paintin g of other associate dfeature s includin g fascia , eaves , siding , all trim , porches , box beams , columns , rails , an dexterior surface s of garages . 2. Wa s all scraping andothe r

preparatio n wor k

completedsatisfactorily ? 3. Wer e all reqmredarea s ofth e structure(s ) prime d as neededandpainte dwit h tw o top coats ? 4. Was the pain t product s utilize dequivalen t to a 30 yea r

product/quality ? 5. Ar e aU ofth e area s wher e contaminate dmaterial s have been spille dthoroughly vacuumed / cleaned ? 6. Didthe contractor collect/vacuumall falling andscrapedpaint chip s on th e entir e property , roadways , alleyways , publi c euxjess area s andals o remov e an y othe r

generateddebris ? 7. Is the gras s are atha t surround s th e structure(s ) in reasonably goo dcondition ? 8. Ar e all item s such as polyethylene sheeting , ladders , paint brushes , cones , barrie r

tape , etc . properly removed ? 9. Is ther e an y evidenc e of propert y damag e tha t wa s done by th e contractor ? An y propert y damage need s tobe completedprior to th e EP A Close-Out
. 10
. Ar e ther e an y propert y item s tha t wer e temporarily re-locate d by th e contractor tha t nee d

to be movedback ? 11
. Ar e ther e an y (known ) lingerin g issue s wit h th e propert y owner(s ) tha t hav e bee n lef t unresolved ? Comments : Omaha , NE 6811 0 (402 ) 504-468 8 Fa x(402 ) 504-328 1



## YE S NO

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# rP/yZ-lS.^ 7/J?O f Propert y Owne r

Signatur e Dat e 

# m -1 -n ? Professiona iona l l Environmen&^ng i ngineer s Representativ e Dat e

## OMAHA LEAD SIT E REMEDIA LACTIO N - LEAD-BASED PAIN T STABILIZATIO N PROPERT Y IP : yS I (J ^ PROPERTYADDRESS : LjDP S K I ^S ^ <St ~ 

## ^?VY??Kv / K J B^-f^r ^ DAYTIM E PHONE : HJT V ^0^ 3 CEL LPHONE : E-MAIL : OWNER' S ADDRES S I FDIFFERENT : TENANT' S NAM E I FAPPLICABLE : DAYTIM E PHONE : CELLPHONE : E-MAIL : Professiona l Environmenta l Engineers , In c (PE ) i s unde r contrac t (#EP-R7-D8-06 ) wit hth e U.S
. Environmenta l Protectio n Agenc y (EPA ) t o stabiliz e lea dbase dpain t (LBP ) o n residentia l structure s a t anumbe r o f propertie s locate di n Omaha , Nebraska
. Th e pain t stabilizatio n worl i i s bein g don e t o protec t th e soi l cleanup s tha t ar e bein g performe db y EP A contractors . Pain t stabilizatio n activitie s wil l include : scrapin g o f cracke do r flakin g LB P fro mstructures , applicatio n of aprim e coa t an dtw o (2 ) coat s o f paint
. Movin g part s o f window s an ddoor s areno t include dan dwill no t b e addressed
. You r cooperatio n i s requeste di n givin g permissio n t o thi s EP A contracto r (PE ) t o ente r an dhav e acces s t o thi s propert y fo r th e purpos e o f stabilizin g lea d-base dpain t a s outline do n th e propert y identifie dabove
. B y signin g thi s documen t I agre e t o allo w a n EP A contractbi ! t o conduc t asoi l cleanu p a t m y propert y followin g completio n o f lead-base dpain t stabilization , i f th e soi l cleanu p ha s no t alread y bee n performed
. I understan dtha t th e stabilizatio n contracto r ca n no t provid e assurance s tha t th e soi l cleanu p contracto r wil l b e boun dto . I furthe r understan dtha t th e soi l cleanu p contracto r wil l mak e al l reasonabl e eflbrt 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 . 

### 0 > Yesilhf f jbove

. Dat e I full y understan dtha t b y signin g thi s Consen t fo r Access , (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 completed , (2 ) tha t th e Propert y Owne r o r Tenant , i f applicable , wil l b e give n th e Housin g an dUrba n Developmen t (HUD ) an dEP A pamphlet , "Renovat e Right , Importan t Lea dHazar dinformatio n fo r Families , Da y Car e Providers , an d Schools" , (3 ) th e Propert y Owne r o r tenan t wil l remov e al l obstruction s fro msurface s t o b e painted , (4 ) will abid e b y healt han d safet y guidanc e provide db y EPA , (5 ) wil l allo w photograph y ofpropert y befor e an dafte r th e pain t stabilizatio n work , (6 ) wil l b e contacte db y aP E representativ 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 h an y ofth e LB P stabilizatio n actions , an d(8 ) wil l participat e i n final propert y inspectio n an dsig n th e Completio n Agreemen t an d Propert y Owne r Satisfactio n Survey
. Shoul dyo u hav e an y question s abou t th e plane dLea dBased-Pain t stabilizatio n activitie s fo r you r property , pleas e contac t Professiona l Environmenta l Engineers , Inc
. Projec t Manager , Willi e Cla y A t 402-504-4688
. Genera l question s abou t th e Omah a Lea dSit e cleanu p ca n b e directe dt o Paulett aFrance-lsetts , EP A Remedia l 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)
. 0 Yes , I gran t acces s t o m ypropert yan d vm s give n th e pamphle t D No , I d o no t gran t acces s t o m ypropert yand ! wa s "Renovat e Right , Importan t Lea d Infbnnatio n fb rFamilies , Chil d ghre n th e pamphle t "Renovat e Right , Importan t Lea d Car e Providers , an d Schools. " Infbrmatlo n fo rFamilies , Chlld e Car e Providers , an d Schools. ' ^ 

# '^27 ^ Signatur e Dat e Signatur e SPECIA L INSTRUCTIOM S AN D CONSIDERATION S

## PAIN T STABILIZATIO N PRE-PROPERT Y PAIN T MATC H ASSESSMEN T
PROPERT Y ADDRESS : _ 

# ^0^ 5 

# h i 4S ^

S + DATE : 

# <l|« D BVID :

AREA(S ) TO B E PAINTED :
HOUS E PROPER : 

# I OLOR : ( y

PORC H TRIM : COLOR : 

# lyo ^ 

# f ^

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



## I AGRE E TO TH E COLOR S LISTE D ABOVE

. ONC E TH E PAINTIN G BEGINS , I UNDERSTAN D I CA N NO T CHANG E TH E ABOV E SELECTE D COLORS : PROPERT Y OWNE R SIGNATURE : P E ACCESO R SIGNATURE : 

# A^Ui ^ Nj^esL>(^3- ^ ^N "

## Douglas Count y Accoun t Information Pag e 1 of 2 

# 5Z\(o 2 Dougla s County , Nebrask a Propert yRecor d - R l 12910000 0 Prin t Repor t Informatio n i s vali d a s o f 2009-9- 3 " TM '"'*"TM " ''^"^ ' °''"«n«i°" » ^--i'^^i e @ scal e c^5 o f

t wes t o

t 52n d s t - Vie wo n Ma p Treasurer s Ta xReoor t 1 Ne wFeatur e ~> • ^ - > Aut o Sale s Searc h i Owne r "BYER S TIMOTH Y W

hIA L 402 3 N 4 5 S T J Inr - R/\a" ? OMAH AN E 68104-000 0 ^D O ~ lU ^

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### Propert yInformatio nQ \^^J ^ I - ' 3/ ) - 2 Ke yNumbe r291 0 000 0 1 1 Accoun t Typo : Residentia l Parce l Numbe r 112910000 0 Parce l Address : 402 3 N 4 5 S T OMAH AN E 68104-000 0 Lega l Description : FONTENELL E PAR KLOT 26 7 BLOC K0 1/ 2 VA C ALLE Y AD J & Valu e Informatio n

' Lan d Improvemen t Tota l 200 9 $4,200.0 0 $55,300.0 0 $59,500.0 0 200 8 $4,200.0 0 $55,300.0 0 $59,500.0 0 ^ 200 7 $4,200.0 0 $55,300.0 0 $59,500.0 0 200 6 $4,200.0 0 $55,300.0 0 $59,500.0 0 200 5 $4,200.0 0 $25,600.0 0 $29,800.0 0 200 4 $4,200.0 0 $23,200.0 0 $27,400.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 1 0. 1 ' 4680. 0 1. 0 117. 0 40. 0 N o Improvemen t Info r matio n Buildin g 1



## http://dougIasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R l 1..
. 9/11/2009

### Dougla s County Accoun t Informatio n Pag e 2 of 2

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. i«AOS , F i f. , fisimtUodii msosit^ t 1 1/ 2 STOR Y" •

CLIC KTO ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1369. 0 Percen t Complete : 100.0 % Perimete r0. 0 Quality : Fai r Uni t Type : Condition : Averag e

Buil t As : I 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 6. 0 Exterior : Frann e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Gabl e Stories : 1. 5 Floorcover : I Allowanc e Foundation : Blocl ^ 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 192 2 0 % 192 2 8 7 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fenc e Chai n Lin k 

### 1. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 816. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h En d Scree n 160. 0 Use r Atti c1/ 2 Finis h 163. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R l 1..
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