# 4 TRANSMITTA L o f

OMAH A LEAD SIT E PAIN T STABILIZATIO N FIL E FOLDE R 

# SAID#:'?KZ^Z Da,e : . W ( ^ Address : ^^^fr/ n U>-kxN(p-Me, ftv Stabilizatio n Contractor : Professiona l Environmenta l Engineer s Year : 2DttJ
- PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUIVIENT S Vide o ofpropert y (DVD ) 

## D a Executiv e Summar y Signe dAcces s Agreemen t fo r subjec t property Pre-Renovatio n For msigne dby Property Owne r Pre-Renovatio n Fon n fo r Occupant/Tenant , i f applicabl e Paintin g Agreemen t Settlement document s (i.e. , fo r damag e o r t o replac e plants , etc. ) Renovatio n Recordkeepin g Checklis t signe db y Certifie dRenovato r 

## 0 Photograph s ^ Satisfactory close-ou t chec k lis t signe db y Property Owne r / 

### Propert y close-ou t chec k lis t signe db y EP A Property informatio n fi-omDougla s County Assessor' s Offic e 

# fl Hazar danalysis , i f prepare d Safet y Audi t Q 

### t l Othe r (describe) :
PrbfessioiiaInn\di3rimei|ita l Engineer s Signatur e ^ ^ 

# D , EP A CO RSignatur e (after file folde r review ) 4037755 5 

### ^ f Dat e
Superfun d

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

## ENVIRONMENTA L ENGINEERS , INC . Omaha , N E 6811 0 

## "Providin g cost-effectiv e environmenta l solutions " p ^

J^^g j 124-^28 ? Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc y Respons e



### LeadBas e Stabilizatio n Omaha , N e Clos e Ou t Repor t 201 1 SAID#2523 2 350 6 Lafayett e A v

Date s worked : 6/ 4 to 6/ 4 201 1 Pr e propert y condition : Hous e ha s mostly viny l sidin g wit h painte dwoo dtrim s an d foundatio n areas . Pain t wa s flakin g of f

in areas . Problem s encountered : None . Owne r request/concerns : N/ A Inspection/closeou t dates . Owne r 6/6/1 1 Ey H

### 201 1 

# 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 " Fax (402 ) 504-328 1 Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc y Response 

## EPA Close-Out For m (Lead-Base dPaint Stabilizatio n EP A Contrac t EP-R7-08-06 ) SAID : SSZ32 . 

### Propert y Address : J^so d UtPttl/trT f Que . \ 3 0 ^ ( ^ 

### Owner' s Name : LuL a HittaiL . 

### Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) painte dwit h th e exception ofth e stated , excludedareas ? Thi s woul dinclude paintin g o f othe r

associate dfeature s including fascia , eaves , siding , al l trim , porches , bo x beams , colunms , rails , an dexterior surface s of garages . / 

### 2 . Wa s all scraping an dothe r

preparatio n wor k

completedsatisfactorily ? / 

### 3 . Wer e all require darea s ofth e structure(s ) primeda s neededan dpainte dwit h tw o top coats ? / 

### 4 . Wa s th e paint product s utilize dequivalen t to a2 5 yea r

product/quality ? 

# • 5 . Ar e al l ofth e area s wher e contaminate dmaterial s have bee n spille dthoroughl y vacuumed / cleaned ? / 

### 6 .Di dth e contractor collect/vacuumall falling an dscrapedpaint chip s on the entir e property , / 

### roadways , alleyways , publi c acces s area s an dals o remove an y othe r

generateddebris ? 7 . I s th e gras s are atha t surrotmd s the structure(s ) in reasonabl y goodcondition ? / 

### 8 . Are al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , bame r tape , etc . properl y removed ? 

# X 9 . I s there an y evidenc e ofpropert y damag e tha t was don e b y the contractor ? An y propert y damag e need s to b e complete dprio r

t o th e EP A Close-Out . 

# y 10 . Ha s th e propert y owne r

signedth e completio n form ? 

# y 11 . Ar e ther e an y propert y item s tha t wer e temporarily re-locate dby th e contractor tha t needto / 

### b e move dback ? 12 . Ar e ther e an y (known) lingerin g issue s wit h th e propert y owner(s ) tha t have been lef t 

# y unresolved ? Othe r

Considerations/Propert y Owne r

Discussions/Additiona l Wor k

tha t i s Required :

_PS M XM«* — l'|W/ ( 

### tur ^ EP A CO RSignatur ( Dat e50 0 S . Ewing , Suir e E 

## ENVIRONR/IENTA L ENGINEERS , MC . St , Louis , M O 6310 3 (314)531-006 0 

### ''!~'i'uvidii'i g Gosi-eiieciivi d er>viroiit!ient.alsolui:ions ' Fa x (314 ) 531-006 8 —"•-•• - ' • —'I.! . I..L..I. . I . II' - J.lll . . l.-.L..».'l«iCT1.1l t MJ.l^il . Ll l l»J..>lll»ll.<..Jl«. . 1 

# 20\ ] Propert y Owne r Close-Ou t For m (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) SAID : Propert y Address : 35C^( p 1 a%\(eV\ C ^V ^ Owner' s Name : f^\r\n r L( ) I CX . Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) painte dwit h th e exceptio n ofth e stated , exclude dareas ? Thi s woul dinclud e paintin g o f othe r associate dfeature s includin g fascia , eaves , siding , al l trim , 

# Q ^ 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 n wor k

complete dsatisfactorily ? ^ 

### 3 . Were al l require darea s ofth e structure(s ) prime da s neede dandpainte dwit h tw o to p coats ? ^ 

### 4 . Wa s th e pain t product s utilize dequivalen t t o a2 5 yea r product/quality ? ^ 

### 5 . Ar e al l ofth e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y vacuumed / cleaned ? \ ^ 

### 6 . Di dth e contractor collect/vacuu mal l fallin g an dscrape dpaint 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 d ^ 

### debris ? 7 . I s th e grass are athat surround s th e structure(s ) i n reasonabl y goo dcondition ? 8 . Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . properl y removed ? 

# V L 9 . I s ther e an y evidenc e ofpropert y damag e that wa s don e by 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 . 10 . Ar e yo u satisfie dwith th e wor k

performed ? 

## Jtl . 11 . Ar e ther e any property item s tha t wer e temporaril y re-locate db y th e contracto r tha t nee dt o b e move dback ? ^ 

### 12 . Ar e ther e an y (known ) lingerin g issue s with th e property owner(s ) tha t hav e bee n lef t 

# S^ unresolved ? Other Considerations/Propert y Owne r Discussions/Additiona l Wor k

that i s Required :

Propert y Owne r Signatur e Dat e 

# UkJAf i Clk^ : G-Q-l f Professional Environmenta l Engineer s Signatur e Dat eProfessiona l Environmenta l Engineers : EP A Pain t Stabilizatio n 201 1 Propert y Addres s Stories / Sidin g typ e Garage ?
Dat e acces s signe d Pre-vide o Pos t vide o Contracto rAssigne d Dat e starte d Weathe rCondition s
Pain t use d Prim e use d Pol y use d ?.F)0( 0 L(>fai\[fH # l4l / Transit e Woo d Viny l Meta l Stucc o
Ye s 

# m\ \ N o i

^ ^ ^ Painted ? Where ? Ye s Sidin g Tri m N o



# Lk/ i L L Dat e ende d <^/v/^ /


## 3 cJ-O ^ Problems/Issue s(efTective Apri l 2010 ) 

### RENOVATIO N RECORDKEEPIN G CHECKLIS T Name o f Firm : ^Z>y^^ ^ /-^A^/jY.^^ f Dat e an dLocatio n o f Renovation : Brie f Descriptio n o f Renovation : STA^ / OZTf^fCi O Name o f Assigne dRenovator : C-;M/£ 1 r>^/iy ^ Name(s ) o f Traine dWorkers : j^fiskl o Qt^j o , ZfltA ^ f^i'^J o Nam e o f Dus t Samplin g Technician , Inspector , and/o r Ris k Assessor , i f used : U Copie s o f renovato r an ddus t samplin g technician qualification s (trainin g certificates , certifications ) o n file. n Certifie drenovato r provide dtrainin g t o worker s o n (chec k al l tha t apply) : D Postin g warnin g sign s D Settin g u p plasti c containmen t barrier s D Maintainin g containmen t D Avoidin g sprea do f dus t t o adjacent area s D Wast e handlin g D Post-renovatio n cleanin g D Tes t kit s use db y certifie drenovato r to determin e whether lea dwa s presen t o n component s affecte db y renovatio n (identif y kit s use dan ddescrib e samplin g location s an dresults :
Bv/amin g sign s poste da t entranc e to wor k area . 

## dw c Wor k

are acontaine d t o preven t sprea do f dus t an ddebris . ^^-S^indovv s i n andwithi n 2 0 fee t ofth e wor k

are aare close d 0l5oor s in an dwithi n 2 0 fee t ofth e wor k

area s are close dandseale d ^^JBuooT S tha t mus t b e use di n th e wor k

are aar e covere dto allo w passag e but preven t spreado f dust . B'tjroun dcovere d b y plasti c sheetin g extendin g 1 0 fee t fro mwor k

are a- plasti c anchore dt o th e buildin g an dweighte ddow n b y heav y objects . n/I f necessary , vertical containmen t installe d t o preven t migratio n o f dus t an d debri s to adjacent perty . Wast e containe don-sit e andwhil e bein g transporte doff-site .

Renovatio n Recordkeepin g Checklis t Omah a Lea d Sit e(L-I"l . 

### Wor k

sit e properl y cleane dafter renovation . 2^1 1 chip s an ddebri s picke dup , protectiv e sheetin g misted , folde ddirty sid e inward , andtape dfor removal . D~Wor k

are aHEPA vacuume dto get pain t chip s fromgroun dsurface , ifnecessary . "^rTt^rtifie drenovato r performe dpost-renovatio n cleanin g verificatio n (describ e results) :
I certifyjjjide; ; penalt y of la w tha t th e abov e informatio n i s tru e an dcomplete .

Nam e an dTitl e Dat e

Renovatio n Recordkeepin g Checklis t On^iati a Lea d Sic e5/26/201 1 Dougla s Count y Accoun t Informatio n 

# =^7513 1 >pe r Dougla s County , Nebrask a Propert y Recor d - R060790000 0 Prin t Repor t Vie w Interactiv e GI S Ma p Infomiatio n i s vali d a s o f 2011-5-1 6 Treasurer' s Ta x Repor t Ne w Featur e ->->- • Subdivisio n Sale s Searc h Owne r MINO R LUL A M 350 6 LAFAYETT E AV E OMAH A N E 68131-000 0 Propert y Informatio n Ke y Number : 079 0 000 0 0 6 Accoun t Type : Residentia l Parce l Number : 060790000 0 Parce l Address : 350 6 LAFAYETT E A V 

## Y^^C O 

## N ^ OMAH A N E 68131-000 0 Lega l Description : BEMI S PAR KLO T 1 6 BLOC K3 4 0 X 162.8 4 Valu e Infomiatio n Lan d Improvemen t 

### Tota l 201 1 $2,500.0 0 $57,000.0 0 $59,500.0 0 201 0 $2,500.0 0 $57,000.0 0 $59,500.0 0 200 9 $2,500.0 0 $57,000.0 0 $59,500.0 0 200 8 $2,500.0 0 $57,000.0 0 $59,500.0 0 200 7 $2,500.0 0 $57,000.0 0 $59,500.0 0 200 6 $2,500.0 0 $57,000.0 0 $59,500.0 0 Lan d Informatio n 

### Acre s S F Unit s Depti i Widti i Vacan t 0.1 4 6480. 0 1. 0 162. 0 40. 0 N o Improvemen t Informatio n Buildin g 1

... mapping-online.com/.../accountinfo.j.. . 1/ 31 1 5/26/201 1 J)ougla s Count y Accoun t Informatio n 

# ifel . 

# 1 1

••H0 « 

# I^^H^B i 

# •nsVa " 1

CLIC KTO ENLARG E IMAG E 1 Squar e Footage : 1488. 0 Perimete r 0. 0 Uni t Type :

Buil t As : 2Stot y

HVAC : Centra l Ai rt o Ai r Exterior : Fram e Viny l Interior : Drywal l Roo f Cover : Compositio n Shingl e

Roo f Type : Gabl e Floorcover : Allowanc e yea r Percen t Yea rBuil t Remodele d Remodele d 1903 0 0 % Deta/ 7 Typ e Detai l Descriptio n Applianc e Allowanc e Applianc e Security Syste m Basemen t Bsmn t Bloc k 8 ft Fixtur e Bas e Fixture s Fixtur e Bat h Ful l Porc h Sla b Roo f Ceilin g i
tntr u

.. ^ CLIC KTO ENLARG E IMAG E | Percen t Complete : 100.0 % Quality : A\Aerage Condition : Averag e Cond o Squar e Footage : 0. 0 Rooms : 6. 0

Units : 1. 0 Baths : 1. 0 Bedrooms : 3. 0 Stories : 1. 5 Foundation : Sprinkle rSquar e Footage : 0. 0 Adjuste d Yea r Physica l Ag e Buil t 190 3 10 7 Unit s 1. 0 1. 0 740. 0 1. 0 1. 0 176. 0

... mapping-online.com/. ../accountinfo.j . 2/3

## CONSEN T FO RACCES S T O PROPERT Y OMAH A LEA D SIT E REMEDIA L ACTIO N - LEAD-BASE D PAIN T STABILIZATIO N PROPERT Y ID 

### : QM^'i
- PROPERT Y ADDRESS : _2fiO^_lj:(A^f^f/i 6 ^ . OWNE RNAME : '^^^^ffZ. y 

### DAYTIM E PHONE:(3^g 3 )
- 5^/-/77- 7 ^^^^ : y>7 . ^^ : E-MAIL : 

### CEL L PHONE:r4>2^ 2 3 7o7
- ^'^fi l OWNER' S ADDRES S I F DIFFERENT : TENANT' S NAM E I F APPLICABLE : DAYTIM E PHONE : CEL L PHONE : E-MAIL : Professiona l Environmenta l Engineers , Inc . (PE ) i s unde r contrac t (#EP-R7-08-06 ) wit h th 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 din Omaha , Nebraska . Th e pain t stabilizatio n wor k 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 EPA contractors . Pain t stabilizatio n activitie s wil l include : scrapin g of cracke do r flakin g LB P fro mstructures , applicatio n o f aprim e coa t an dtw o (2 ) coat s o f paint . Movin g part s o f window s an ddoor s ar e no t include dan dwil l no t b e addressed . You r cooperatio n i s requeste din givin g permissio n t o thi s EP A contracto r (PE ) to ente r an dhav e acces s t o thi s propert y for 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 EPA contracto r t o conduc t asoi l cleanu p a t m y propert y followin g completio n of 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 can 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 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 . 0\Yes , I hav e an dunderstan dthe paragrap h above . 

## 0 5 . J/
- / / Signatur e o f Propert y Owne r Dat e I full y understan dtha t b y signin g thi s Consen t fo r Access , (I ) 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 , will 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 ) wil l abid e b y healt h an 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 ) will b e contacte db y aP E representativ e approximatel y 4 8 hour s in advanc e o f startin g work , (7 ) agre e no t t o obstruc t o r tampe r wit h an y o f th e LB P stabilizatio n actions , an d(8 ) wil l participat e i n fmal 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 o r Kelle y Sander s At 402-504-4688 . Genera l question s abou t th e Omah aLea dSit e cleanu p ca n b e directe dt o Pauiett aFrance-Isetts , 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 h Omah aoffice ) o r 402-731-304 5 (Sout h Omah aoffice) . 0[^Yes , I gran t acces s t o m y propert y an d wa s give n th e pamphle t D No , I d o no t gran t acces s t o my propert y an dI wa s "Renovat e Right , Importan t Lea d Informatio n fo rFamilies , Chil d give n th e pamphle t "Renovat e Right , Importan t Lea d Car e Providers , an d Schools. " Informatio n fo r Families , Child e Car e Providers , an dSchools. " Signatur e Oate Signatur e Date SPECIA L INSTRUCTION S AN D CONSIDERATION S

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

# :^650( b Ui{^a\fHk^ . A^ . PROPERT Y ADDRES S DATE : 

## BV,D : QPQ^ l

AREA(S ) T O B E PAINTED : HOUS E PROPER : COLOR : A?^ . 

# /.. A

HOUS E TRIM : COLOR : GARAGE : COLOR : GARAG E TRIM : COLOR : PORCH : COLOR : PORC H TRIM : COLOR : (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 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 : 

# .^^^C ^ v^ . Y)\-^^ ^

## PRE-RENOVATIO N FOR M - OWNE R Thi s for mi s t o b e use dby th e firm s contracte db y th e Environmental Protectio n Agency-Regio n 7 to perfor mLead-Base d Pain t stabilizatio n activitie s a t th e Omah aLea dSite , Omaha , Nebraska . Owne r Confirmatio n Pamphle t Receip t JSC I hav e receive dacop y ofth e lea dhazardinformatio n pamphlet , Renovate Right : Importan t Lea dHazar dInforniatio n fo r Families , Chil dCar e Provider s an dSchools , informin g m e ofth e potential ris k ofth e lea dhazar dexposur e fro mrenovatio n activit y t o b e performe din/o n m y dwellin g unit . I receive dthi s pamphle t befor e th e wor k

began . Owne r Acknowledgmen t D (A ) I confir mtha t 1 ow n an d liv e i n thi s property , tha t no chil dunde r th e ag e o f 6 reside s here , tha t no pregnan t woma n reside s here , an d tha t thi s property i s no t achild-occupie dfacility . Note : A chil dreside s i n th e primar y residenc e o f his/he r custodia l parents , lega l guardians , foste r parents , o r informa l caretake r if th e chil dlive s and sleep s mos t o f tim e a t th e caretaker' s residence . Note : A child-occupie dfacility ' i s apre-197 8 buildin g visite dregularl y by th e same child , under 6 year s o f age , on a t leas t tw o differen t day s withi n any week , fo r a

t leas t 3 hour s eac h day , provide dtha t th e visit s total a t leas t 6 0 hour s annually . 1^(B ) I understan dtha t th e renovatio n firm , contracte d b y th e Environmental Protectio n Agenc y (EPA) , wil l b e usin g lead
saf e wor k

practice s require db y EPA' s Renovation , Repai r an dPaintin g Rule . 

# ^ . x ^ ^ n /I//;ii/i^f . Printe dNam e o f Owner-Occupan t

Signatur e o f Owner-Occupan t Dat e