## TRANSMITTA Lof OMAH A LEAD SIT E PAIN T STABILIZATIO NFIL EFOLDE R 

# SAID# : H^O^
- Date : 

# W ^ Address : 

# S552 . Pin p S.-fr y Remediatio n Contractor : PROFESSIONA LENVIRONMENTA LENGDVEER S Year : 200 8 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S B ^ Vide o o f propert y (DVD ) bg^€
- Of ^ 

# r ® ^ Executiv e Summary Signe dAcces s Agreemen t fo r subjec t propert y y Paintin g Agreemen t . 

## 0 Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) Photograph s D^DC ^ (X\^ ^ Satisfactory restoratio n signe db y Propert y Owne r 

# y Propert y close-ou t chec k lis t signe db y EP A 

# y Propert y informatio n fromDougla s Count y Assessor' s Offic e 

# y /

"^/^^y y 

### !^r/g-<::^C ^

# PROFESSIONA L 

# • | 250 5 Nort h 24 ^ Suit e 21 9 

# ENVIRONMENTA L ENGINEERS , INC . Omaha , N E 6811 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



### Lea dBas e Stabilizatio nOmaha , N e Clos e Ou t Repor t SAID #1960 4 333 2 Pin e S t

•Date s worke d11/1 2 t o 11/1 3 200 8 •Garag e haddamag e t o mai n doo r a

t th e bottom , possibl y rottin g wood . Pain t was flakin g of f al l ove r withpain t chip s everywhere , ther e was prio r damag e t o som e o f th e sidin g an dsoffit areas , window s wer e broke n o n th e garage , Hous e hadsom e rippe dscreens , damag e t o cellar doo r an dpain t chip s al l over yardfrompoo r flakin g pain t o nhouse . • Inspecte d11/1 7 returne dt o re-pain t bac k door , re-d o eas t sid e o f garage , an dt o re-vacuu m pain t chips . 12/0 2 issue s resolved .

# 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 : Rl,O q Property Address : Owner' s Name : 

# ^A:ycc A ^ ^7c^' , j U 11 ^ 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 Fa

x (402 ) 504-328 1



### YE S N O 1 . Wa s th e entir e structure(s ) painte dwithth e exceptio no f th e stated , exclude d areas ? Thi s woul dinclud e paintin g o f othe r associate dfeature s includin g fascia , 

# V eaves , siding , al l trim , porches , bo x beams , columns , rails , an dexterio r surface s o f garages . 2 . Wa s al l scrapin g an dothe r preparatio nwor k

complete dsatisfactorily ? ^ • ? 

### 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 ? > 

### 5 . Are al l o f th e area s wher e contaminate dmaterial s hav e bee nspille dthoroughl y V vacuumed / cleaned ? 6 . Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s o nth e \ 

### entir e property , roadways , alleyways , publi c acces s area s an dals o remov e any othe r generate ddebris ? 7 . I s th e grass are athat surround s th e structure(s ) i n reasonabl y goo dcondition ? V 

### 8 . Are al l item s suc ha s polyethylen e sheeting , ladders , pain t brushes , cones , 

# Y barrie r tape , etc . properl y removed ? 9 . I s ther e an y evidenc e o f property damag e that wa s don e b y th e contractor ? An y Y property damag e need s t o b e complete dprio r t o th e EP A Close-Out . 10 . Are ther e any property item s that wer e temporaril y re-locate db y th e contracto r 

## y . that nee dt o b e move dback ? 11 . Ar e ther e any (known ) lingerin g issue s withth e property owner(s ) that hav e N : 

### bee nlef t unresolved ? Comments :



# ^--J^(-^c^ <t ^

i k [y y Property Owne r Signatur e Dat e Professional ^^ironmenta l Engineer s Representativ e Date

# PROFESSIONA L M 250 5 Nort h 24' rSuit e 21 9 

# ENVIRONMENTA L ENGINEERS , INC . Omaha , N E 6811 0 (402 ) 504-468 8 

### H H 

## Providm g cost-effectiv e - imenia i solutions ' Fa x(402 ) 504-328 1 

## EP A Close-Ou t For m (Lead-BasedPain t Stabilization EP A Contract EP-R7-08-06 ) 

# SAID : /9^/9 V Propert y Address : 

# 331> a P;n ^ Sf Owner'sName : ^<^^0>\:y^ f V -^KtoWu 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 no 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 

# y garages . 2 . Wa s all scrapin g an dothe r preparatio nwork complete dsatisfactorily ? y 3 .

Were al l require darea s o f th e structure(s ) prime da s neede dan dpainte dwith 

## y tw o to p coats ? 4 . Wa s th e pain t product s utiUzedequivalen t t o a3 0 yea r product/quality ? y 5 . Ar e al l o f th e area s wher e contaminate dmaterial s hav e bee nspille dthoroughl y y vacuumed / cleaned ? 6 . Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s o nth e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y 

# X othe r generate ddebris ? 7 . I s th e gras s are athat surround s th e structure(s ) inreasonabl 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 ? \ y 9 . I s ther e an y 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 . i / 

### 10 . Are ther e any property item s that were temporaril y re-locate db y th e contracto r 

# y that nee dt o b e move dback ? 11 . Are ther e any (known ) lingerin g issue s withth e property owner(s ) that hav e bee nlef t unresolved ? Othe r Considerations/Property Owner Discussions/Additiona l Wor k

that i s Required : 

## lyn
- ^Cic y ^oro LSCjrti^a>^i^y k 

## l^^-issue s fesoi^t J

'EP A CO R^natur e Dat e

### P. 2 No v0 9 0 8 10:28 p Tra d & Bo b Kell y 402345280 2


# CONSEN T OF R ACCES S T O PROPERT Y OMAHA LEAD SIT EREMEDIA LACTIO N- LEAD-BASED PAINT STABILIZATIO N PROPERT Y ID : /'?6'0 ^ PROPERT Y ADDRES S 

# : ^^,^2
- pm ^ S h OWNERNAME : \ DAYTIM EPHONE : ^ CEL LPHONE : E-MAIL : OWNER' S ADDRES S I FDIFFERENT : TENANT' S NAM EI FAPPLICABLE : DAYTIM EPHONE : CELLPHONE : E-MAIL : I'rofessiona ) EnviroDiPcnta l Engineers , Inc . <P£ ) i s unde r contrac t (#£P-K7-(}8-0<i ) wit b th e U.S . EnviroQ(n«;iitii l Proicctiu n Ag«Mc y (EPA ) t o stabiliz e lea dbase dpaia t (LBP ) o ari^iileatifl l structure s a t anumbe r o f propertie s locate du i Omaha , Nebraska . Th e pain t stabilizatio nworki t beiD g don e t o protec t th e soi t cteaoup s tha t wor e pertorine db y EP A coatractors . Pain t stabiiizatioi i activitie s wil l include : scmpia g o f cracke do r flakio g LB Pfro mstructures , applicatio u o f aprim e coa t an d tw o (2 ) coat » o f paint . Movin g part s At window s an ddoor s ar e no t includcd j aa dwtt i no t b e addressed . You r cooperatio ni s requeste di ngrvin g permissio n t o thi s EP A coatracto r (PE ) t o ente r aa dbav e acce^i s t o thi s propert y for th e purpos e o f stabilizin g lea d-base dpain t a s outline du n tb e propert y identifie dabove . B y signin g tbi s documen t I agre e t o allo w a nEP A contracto r t o conduc t asai l cleanu p a t m y propert y followia g comploUo no f lead-base dpain i :>tabilizatiDn . T underiitaD dtha t th « stabilizatla u contracto r ca nno 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 dtba t tb e soi l cleanu p contracto r wil l mak e al l reasonabl e elTort s l o ad<lres< j concern s tha t I , a s th e propert y owner , ma y hav e regardin g soi l cleanu p a t my property . I full y understan dtha t b y signin g thi s Con&en t fo r Access , (I ) tbi s acces s wil l remai n i neffec 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 , if applicable , wil l b e give nth e Housin g an dLrba a Developmen t (HLD ) an dEP A 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 tennn i wil l remov e al l obstruction s fro msurface s t o b e painted , (4 ) wil l abid e b y healt han dsafet y guidanc e provide db y EPA , (5 ) wil l allo w photograph y o f propert y befor e an dafte r tb e pain t stabilizatio nwork , (6 ) wil l b e cantacte db y aP £representativ e approximatel y 4 8 hour s i nadvanc e o f startin g work , (7 ) agre e no t t o obsLruct : o r tampe r wieb an y o f th e LB Pstabilizatio nactions , an d(8 ) wil l participa u i nfina l propert y inspectio nan d sig nth e Completio nAgreeman t an dPropert y Owne r Satisfactio n Survey . Shoul dyu u hav e an y qniistion s abou t th e plane dLea dliascd-Pain t stabtli2atjo u activitie s fo r yoo r property , pleas e conbic t Professiona l Eavironmenta l Engineers , Inc . Projec t Manager , Willi e Cla y A t 402-S04-46Sft . Genera l question s abou t th e Omah aLea dSit e cleanu p ca nb e directe dt o Paulett aFraoce-lselts , EP A Remedia l Projec t Manage r 4(C-731-2454 , o r th e EP A Publi c Informatio n Center s a t 402-99.1-958 3 (Nort hOmah aoHice ) o r 402-731-304 5 (Sout hOmah aofliee) . ^^ , I grant Bcces * to m y propert y an dwa s give nth e pamphle t D No, I d o no t gran t acces s t o m y prapeit y an i i wa s '^Renovat e RiBht , Jnportao t Lea dInfomiatSo nfor Families , Chil d give n Ihe pamphki t "Renovat e RI{|Kt , impaiton t Lea d Car e Proviitefs , andSchool s Infonnatla nforFamlHes , Child e Cxrs Providers , an dSchools. " Signature Dil e Signatur e Dal e

iignatura SPECIA L WSTftDCTIOHSAK D CONSIOERATION S



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# Confirmatio n O f Receip t O f Lea d Pamphle t PROPERT YADDRES S ^ 3 3'2 ^ Tij^ ^ St . zi p COD E 6 9 i 0' ^ PROPERT YADDRES S O F OWNE R I F DIFFEREN TTHA N PROPERT YBEIN G PAINTED : PROPERT YADDRES S ZI P COD E I hav e receive d a cap / o f Ih e pamphlet , /7»norat o Rigb t Im^oitrn t Lea d Hazar d lahumaSo n Fo rFamilies , Cl^l d Car e Prowder s An d School s informin g m e o f th e potentia l ris k o f th e lea d hazar d exposur e fro m renovatio n activit yt o b e performe d o n dwellin g uni t [ receive d thi s pamphle t befor e th e wor k Ixgan , 

# K/Kt.ye^ i Q . bi/L i Jr . UbAJe-zv U 1/"^^^' ^ 0 ^ ^ PRINTE D NAM E O F REaPIEN T DAT E 

# T SeH-CflrtiRcatio n Optio n (Fo rTanant-Occupie d DwelKng s Only ) I fth 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 txi x below : Refusa l T o Sig n - 1 certif ytha t I hav e mad e a goo d fait h effor t to delive rth e pamphlet , renovat e right : importan t 

# D lea d hazarej infairoatio n forfemilies, chii d car e provider s an d schoote ; t o th e renta l dwellin g uni t liste d abov e a t th e dal e an d tim e indicate d an d tha t th e ocoipai t refuse d t o sig n th e confirmatio n o f receipt . I furthe rcertri ytha t I hav e lef t a cop yo fth e pamphle t a t tht e uni t wit h occupant . 

# D Unavailabl e Fo rSignatur e - 1 certi ^ tha t I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , nenovat B right; Importan t lea d hazar d infomiatio n fo rfannilies , chil d car e provider s an d schools , t o th e renta l dvi^llin g uni t liste d belo wan d tfial th e occupan t wa s unavailabl e t o sig n th e ctyirinnatio n o f leceip t I Eithe rceitif ytha t I hav e lef t a cop yo f th e pamphle t a t th e Lni t b yslidin g i t unde rth e doo ro rsomewher e o n th e preiTMses .

PRINTE D NAM E O F PERSO N CERTIFYIN G AHEMPTE D DELIVER YDAT E AN D TIM E LEA D PAMPHLE TDEUVER Y

SIGNATUR E O F PERSO N CERTIFYIN G LEA D PAMPHLE TDELIVERY : Mot e Reganjin g Mailifl g Optio n - a s a n altemativ e t o delver yi n pBison , yo u ma ymai l th e lea d pamphle t t o th e owne r and/o rtenan t Pamphle t mus t b e maile d a t leas t 7 day s befor e renQvalior . (Docurtien l wit h a osftikai e ofmailin g from tti e post office ) CONFIRMATIO N O F RECEIP TO F LEAD PAMPHLE T 

## w m 90/E S 3D7 d Sy33NI9N 3 aiAN 3 30a d I1':8 8 2382/i2/S 0 

### asaeiesfT eNo v09 0 8 10:29 p Trac i & Bo b Kell y 402345280 2 

### P. 4


## PAIN TSTABILIZATIO N PRE-PROPERT YASSESSMEN T 

# y e -o v mOPERr rADDRESS.- . DATE 

# PVxo-Vvc ^

r09 . Cp^lQ b BVI D 

# iqcpO M
PLAN T& PERMANEN TUUHOSCANN G T O B E REMOVE ? N O 

## YES 

## c n IF , YE S WHERE :

PRE-EOSXtMCXONEimQI I O F POUNDATION/SniUCnjil ^ i^ . BASEMEN TLEAIQNG ? N O ^—y \ YE S •— ^ IF , YE S WHERE :

EXISTIN G PAIN TO N WINDOWS , DOORS , FOUNDATION , SIDEWALK^ ( LE.) ? N O YE S CZ ] IF , YE S WHERE :

VISUA L DESCRIPTIO N O F PROPERTY/STRUCniRE/eARAGE , (LE.] : (US E BACKSIO E I F NECESSARy ) ( O . n rJ 

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# y ^ y y{^yl j 

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### p, 5



## PAIN TSTABILIZATIO N PRE-PROPERT Y PAIN TMATC H ASSESSMEN T

n FROPeRJ YADDRESS: . ^^' ^ 

# ^.^ ^ S ^ DATE 

# 0)fw-.vr- ^ M L rn^in ^ BVI D - 

# iqG>0 M AR£A(5 ) T O B E PAINTED : HOUS E PROPER : ^>- f COLO R ^^i-^^^^f . HOUS E TRI M LiJ ^ COLO R ^/ Z ^

COLO R GARAG E
rSARAS E TRI M COLO R I . DAOr H COLO R

POBCHTRI M COLO R (COMPLET E AL L SECTION . YES , NO , O R NON-APPLICABLE ) 

## I AGRE E T O TH E COLOR S USTE D ABOVE . ONC E PAINTIN G BEGINS , I UNDERSTAN D I CA N NOTCHANG E TH E ABOV E SELECTE D COLORS :

PROPEfCr YOVmE R SIGNATURE : PE ACCaSO R StONATURE : 

# yiiu^0ikM,/h .

PAIN TMATCH FOR M OMi e Sa33NI9N 3 yiAN 3 JD^ d 89G0TE;S1?T e Tf-S © ZBBZ/iZ/Z Q Cn/q H 39Wel

### , Dougla s Count y Accoun t Informatio n Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R122096000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t of 90t h S t - VJe W O n Ma 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 KELL YJ R ROBER TO ETA L 

# To^T c 333 2 PIN E S T OMAH AN E 68105-000 0 

# r3^vS-^0 V I (G^CP-GPQUV ^ Propert yInformatio n Ke yNumber : \ 209 6 000 0 1 2 Accoun t Type : Residentia l Parce l Number : Parce l Address : Lega l Description : 122096000 0 333 2 PIN E S T OMAH AN E 68105-000 0 GRIFFI N & SMITH S 1STSU B LO T1 1 BLOC K5 5 9 X 12 8 Valu e Informatio n 200 8 200 7 200 6 200 5 200 4 200 3 Lan d $6,900.0 0 $6,900.0 0 $6,900.0 0 $6,900.0 0 $6,900.0 0 $6,900.0 0 Improvemen t $168,700.0 0 $168,700.0 0 $96,200.0 0 $96,200.0 0 $96,200.0 0 $96,200.0 0 Tota l $175,600.0 0 $175,600.0 0 $103,100.0 0 $103,100.0 0 $103,100.0 0 $103,100.0 0 Sale s Informatio n Sale s Date : \ 2000-04-1 3 Dee d Type : Price : Grantor : D $103,000.0 0 Soolt ; \ 215 3 Page : i 20 1

Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s 0.1 7 S F 7552. 0 Unit s 1. 0 Dept h 128. 0 Widt h 59. 0 Vacan t N o Improvement Informatio n 

### http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R12. . . 11/5/200 8

### ^Dougla s Count y Accoun t Infomiatio n Pag e 2 o f 2

Buildin g 1

ThtnlFteor 39 6 0 Boo r Sf f aj " Fir « Floo r «* 1 '• 6*0 0

2 r C S'OR Y FWSHE D

CLIC KT O ENLARG E IMAG E Squar e Footage : 246 8 0 Percen t Complete : 10 0 0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 2 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 6. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 5 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Gabl e Stories : 2. 5 Floorcover : Allowanc e Foundation : Bloc k 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 191 7 0 0 % 191 7 9 1 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 1264. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Fixtur e Bat h Hal f 1. 0 Garag e Detache d 288. 0 Porc h Sla b Roo f Cei l 24. 0 Porc h Sla b Roo f Cei l 192. 0 Use r Atti cFul l Finis h 396. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R12. . . 11/5/200 8

## JC Paintin g Propert yAddres s :5^?>SL^>n J -^" ^

°^* ^

/ / ­ / 3 . ­ Q fi Star t Dat e 1 | ­ i/Q.-g^f i Complet e Dat e | j —13- 0 Q 

## Amoun t O f Prim e An d Pain t Use d Prim e (Gallons )

Pol y(Boxes ) 5_ Pain t (Color ) U J V\^^\-^ ^ Amoun t (Gallons ) c ^ 0 Pain t (Color ) Ao A W Amoun t (Gallons ) j Pain t (Color ) Amoun t (Gallons ) Pain t (Color ) Amoun t (Gallons ) Pain t (Color ) Amoun t (Gallons )