• # • • 

TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID: 5610 Date:

Address: 814 S 33 ST 

 12/27/2008 

Remediation Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

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 Video of property (DVD) 

 Executive Summary 

 Signed Access Agreement for subject property 

 Painting Agreement 

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

 Photographs 

 Satisfactory restoration signed by Property Owner 

 Property close-out check list signed by EPA 

 Property information from Douglas County Assessor's Office 

»ienatuce Date 

40308003 

Superfund 
PROPERTY SUMMARY 

Date: 12/27/08 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Month of: December 

..,... , .. ,„„..,. . ... . . . . . .,., ... . 

Property Address: 814 S 33 ST SAID: 5610 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: None 

A.2 Issues Resolved: None 

A.3 Unique Findings: None 

A.4 Other Relevant Information: None 

Access Date: 9/30/2008 

Work Began: 10/18/2008 

Closeout Date: 12/5/2008 

Enclosures: 

1. Pre-Video 

2. Post-Video 

3. Property Status Form 

4. Signed Access Agreement 

5. Pre-Renovation Form 

6. Paint Match Form 

7. Tracking Form 

8. Douglas County Assessor Property Information Page 

9. EPA Property Closeout form 

10. Property Completion Agreement 

TECHNOLOCIES, INC. 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: ^/ M ^ Z' ^ '^ ^ • Date: /^^// ^ 

Phone:(^^crL) 341-30^1 ) BVID: ^Ul d 

Plant & Permanent Landscaping To Remain In Place 

Item# 

Description and Location 

On Map 

• V.n^5 ccis.U7c}-e <=>7 s^rccf^ 

Pre-Existing Condition of Structures 

Does your Basement have a history of leaking? Yes — No 

Item# Description & Location 

On Map • L/ijhi^-^ j/u.inj' cli-y^ Gt/\. Stdimt j C^/utuiir1u/n J L^t.^ . 

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hcLf\jclLn(^ i ^ ^(t//ll h Jk / 2^/&d)/v do/A1/e^r^ 

Property Owner Prudent Employee j-x^ iTfaJi^ <^H 

Signature: Signature: 

8080 Ward Parlcway, Suite 405 250S N. 24** Street, Suite 308 4242 Medical Drive, Sulta 4250 

Kansas CHy. MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 3634703 Phone: (402) 504-1004 Phone: (210) 822-«588 

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Prudent Technologies, Inc. (Prudent) is under contract (Contract # EP-R7-08-07) with the U. S. 

Environmental Protection Agency (EPA) to stabilize Lead Based Paint (LBP) at a number ofproperties 

located in Omaha, Nebraska, including the property located at c^/^/ "> 3 3 5V^-

The EPA requests your pennission to allow Prudent to perform LBP Stabilization at this property. By 

signing this form, the property owner grants permission to Prudent to perform activities related to LBP 

Stabilization including scraping paint and painting of the referenced property. Further, the owner/tenant 

verifies that they have received the LBP pamphlet "Renovate Right." 

If you have any questions about the LBP stabilization planned for your property, please contact Prudent's 

Administrative Clerk for the Lead Based Paint Stabilization, Mrs. Deborah Akerele-Johnson. 

at (402) 504-1004. General questions about the Omaha Lead Site cleanup can be directed to the EPA 

Public Information Centers at (402) 731-3045 (South Omaha office) or (402) 991-9583 (North Omaha 

office). 

Pfopeity Access Granted By: "^ C^jST^A ^ [}().. fP^V^J^' ^ 

A/1 y.\ ' IrtPlease Print Name) 

Propeity Owner Signalure: 

(Signature) 

PROPERTY INFORMATION 

(To be completed by resident and/or property owner - please print) 

RESIDENT NAME: Owner Renter 

RESIDENT ADDRESS: S/^l 6c ^ 3 ^ ^ 

IF RENTAL, PROPERTY OWNED BY: 

Sccm.e^ OWNER'S MAILING ADDRESS; 

.fl&Z^ 3^/-^f3, OWNER'S TELEPHONE NUMBER - HOME WORK: J L 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD . NUMBER QF OCCUPANTS 7 YEARS OLD AND OLDER:. y 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: 

COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS, ENTRY GATES, ETC.) 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS; The activities to be inqjlemented by EPA under this agreement are puisuant to Section 104 

ofCERCLA, 42 U.S.C. 9604. EPA's right of access to Ihe property isprovided for in Section 104(e) ofCERCLA, 42 U.S. C 9605(e), which provides entiy 

for "detenniningthe need for response, or choosing ortaking any response action under this title, or otherwise enforcing the provisions of the title." 

:080 Ward Parlcway, Suite 405 2505 N. 24*^ Street, Suita 308 4242 Medical Drive, Suite 4250 

iansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

•hone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

3x: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
Current Sample PreHenovation Form 

Effecth/e until April 2010. 

Confimnation of Receipt of ijead Pamphiet 

ai/l have received a copy of the pamphlet. Renovate Right: Important Lead Hazard 

Infonnation for Families, Child Care Providers and Schools informing me erf 

the potential risk of the lead hazanJ exposure from renovation activity to be 

perfomied in my dwelling unit. I received this pamphlet before tiie work began. 

Yf^^1(?^ ^,^u^ ^ lol \ ]o ^ 

Date 

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Signature of recipient 

Self-Certification Option (for tenant-occupied dweiiings only) — 

tf tiie lead pamphlet was delivered but a tenant signature was not obtainable, 

you may check ttie appropriate box below. 

Q Refusal to sign — 1 certify tiiat I have made a good faith effort to deliver ttie 

pamphlet. Renovate Right: important Lead Hazard Informaiion for Families, 

Child Care Providers and Sch(X)ls, to the rental dwelling unit listed below at tiie 

date and time indicated and that the occupant refused to sign the confimnation 

of receipt. I further certify tiiat 1 have left a copy of ttie pamphlet at ttie unit witti 

ttie occupant. 

Q Unavailable for signature — I certify tiiat I have made a good faitii effort to 

deliver the pamphlet, Renovate Right: Important Lead Hazird Infomnation for 

Families, Child Care providers and Schools, to ttie rental dwelling unit listed 

below and that the occupant was unavailable to sign ttie confirmation of receipt. 

I further certify that 1 have left a copy of the pamphlet at the unit by sliding it 

underthedoor. / 7 . ^ / / 

jcs>7^' -p^^eyjs: /o/G^/(D /0/Gj/£ ? 

Printed name of person certifying Attemp}tet 6 deliWy 

date and time 

lead pamphlet delivery 

/ij2A£'<y^— 

Signature of person certifying lead pamphlet delivery 

^/O/kcikc^ iO ^ 

Unit Address 

Note Regarding Mailing Option — As an alternative to delivery in person, you 

may mail the lead pamphlet to ttie owner and/or tenant. Pamphlet must be mailed 

at least 7 days before renovation (Document wrftti a certificate of mailing from ttie 

post office). 
Paint matching form?^"* "'^^'^^ '^°^"' 7^' y - ^ 

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Douglas County Account InfonMjion njM^o fag e 1 01 J. 

Douglas County, Nebraska Property Record - R1722470000 

Print Report 

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

New Feature -»-•- • Auto Sales Search 

Owner 

THOMAS CHESTER H 

ETAL 

814 S 33 ST 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 2247 0000 17 

Account Type: Multiple Res 

Parcel Number: 1722470000 

Parcel Address: 814 S 33 ST 

OMAHA NE 68105-0000 

Legal Description: MAYNE PLACE LOT 8 BLOCK 1 50 X 125 

Value Informatio n 

Land Improvement Total 

2008 $8,000.00 $98,300.00 $106,300.00 

2007 $8,000.00 $98,300.00 $106,300.00 

2006 $8,000.00 $87,000.00 $95,000.00 

2005 $8,000.00 $87,000.00 $95,000.00 

2004 $8,000.00 $87,000.00 $95,000.00 

2003 $8,000.00 $87,000.00 $95,000.00 

Sales Informatio n 

Sales Date: 1991-09-29 

Deed Type: Book: 1912 Page: 721 

Price: $38,200.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Widtii Vacant 

0.14 6250.0 1.0 125.0 50.0 No 

Improvemen t Informatio n 

http://douglasne.mapping-online.coin/DouglasCoNe/static/accountinfo.jsp?accountno=R17... 9/24/2008 
i^uugias v^uuiiiy Accouni iniormatio irmat n Page 2 of2 

Building 1 

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t u ; 777 0 sq tt 

Rrst Floor 8400sq.ft KIT 

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2 STORY Bhxliail 

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CUCK TO ENLARgE IMAOE CUCO0„ENLARGE IMAGE 

Square Footage: 1616.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: End Condition: Good 

Built As: 2 Story Condo Square Footage: i 0.0 

HVAC: Central Air to Air Rooms: 10.0 

Exterior: Frame Aluminum Units: 2.0 

Interior: Drywall Baths: 2.5 

Roof Cover: Composition Shingle Bedrooms: 4.0 

Roof Type: Hip Stories: 2.0 

Floorcover: Allowance Foundation: ; Block 

Sprinkler Square Footage: I 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1905 0% 1905 103 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Appliance Fireplace Masonry 1.0 

Basement Bsmnt Block 8 ft 777.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 2.0 

Fixture Bath Half 

1.0 

Garage Detached 460.0 

Garage Detached 

264.0 

Porch End Solid Wall 189.0 

Porch Slab Roof Ceil 

147.0 

User Apartments 

2.0 

User codei 25 to model 

1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.j sp?accountno=R 17... 9/24/2008 
Prudent Property Close-Out Form (Lead-Based Paint StabHizatior)} 

SAID; ^(^Ij ) ^ . 

Property Addres: 9 1 ^ ^' ^ ^ 

Owner's Namet clt\-es7e v morr\a ^ 

Performance Standards/close-Out Criteria 

YES NO 

Wasthe entire stnjcture{s) painted with the exception of the stated, excluded areas? This wouid 

include painting of other associated features inciuding fascia, eaves, siding, all trim, porches, box 

beams, columns, rails, and exterior surfaces of garages. 

2. Was all scraping and other preparattion work completed satisfactorily? s 

3. Were all required areas of the structure(s) primed as needed and painted with two top coats? 

4. Wasthe paint products utilized equivalent to a 50 year product/quality? 

Are ail of the areas where contaminated materials have been spilled 

thoroughly vacuumed/ cleaned? 

6. Did ths contractor collect/vacuum, al! failing and scraped paint chips on the entire property, 

roadways, alleyvwys, public access areas and also rem.ove any other generated debris? A 

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

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 

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

that need to be moved back? 

11. Are there any (known) lingering issues with the p.roperty owner{s) that have been left unresolved? 

Other Considerations?property Owner Discu5sions?Addition5l Work that is Required 

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Prudent tentative J^¥/o^ 

Date i-^lH 0%