4 

TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#:'?KZ^Z Da,e: . W (^ 

Address: ^^^fr/n U>-kxN(p-Me, ftv 

Stabilization Contractor: Professional Environmenta l Engineers Year: 2DttJ -

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUIVIENTS 

D Video ofproperty (DVD) 

a Executive Summary 

Signed Access Agreement for subject property 

Pre-Renovation Form signed by Property Owner 

Pre-Renovation Fonn for Occupant/Tenant, if applicable 

Painting Agreement 

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

Renovation Recordkeeping Checklist signed by Certified Renovator 

0 Photographs ^ 

Satisfactory close-out check list signed by Property Owner 

/ Property close-out check list signed by EPA 

Property information fi-om Douglas County Assessor's Office 

fl Hazard analysis, if prepared 

Q 

Safety Audit 

t l Other (describe): 

PrbfessioiiaInn\di3rimei|ital Engineers Signature ^ ^ 

D, 

EPA COR Signature 

(after file folder review) 

40377555 

^ f Date 

Superfund 
p 

PROFESSIONAL 

2505 North 24 ^ Suite 219 ENVIRONMENTAL ENGINEERS, INC. Omaha, NE 68110 

"Providing cost-effective environmental solutions" p ^ J^^gj 124-^28? 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

2011 

SAID# 25232 

3506 Lafayette Av 

Dates worked: 6/4 to 6/4 2011 

Pre property condition: House has mostly vinyl siding with painted wood trims and 

foundation areas. Paint was flaking off in areas. 

Problems encountered: None. 

Owner request/concerns: N/A 

Inspection/closeout dates. Owner 6/6/11 EyH 
2011 

PROFESSIONAL 

2505 North 24'^ Suite 219 ENVIRONMENTAL ENGINEERS, INC. 

Omaha, NE 68110 

(402) 504-4688 "Providing cost-effective environmental solutions" Fax (402) 504-3281 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

EPA Close-Out Form 

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

SAID: SSZ32. 

Property Address: J^sod UtPttl/trTf Que. 

\ 3 0 ^ (^ 

Owner's Name: 

LuLa HittaiL. 

Performance Standards/Close-Out Criteria 

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, colunms, 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 25 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 surrotmds the structure(s) in reasonably good condition? / 

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

properly removed? X 

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. Has the property owner signed the completion form? y 11. Are there any property items that were temporarily re-located by the contractor that need to 

/ be moved back? 

12. Are there any (known) lingering issues with the property owner(s) that have been left 

unresolved? y

Other Considerations/Property Owner Discussions/Additional Work that is Required: 

_PSM XM«*— 

l'|W/( 

EPA tur^ COR Signatur( Date 
500 S. Ewing, Suire E ENVIRONR/IENTAL ENGINEERS, MC. St, Louis, MO 63103 

(314)531-0060 ''!~'i'uvidii'ig Gosi-eiieciivid er>viroiit!ient.alsolui:ions' Fax (314) 531-0068 —"•-•• - '• —'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\] 

Property Owner Close-Out Form 

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

SAID: 

Property Address: 35C^( p 1 a%\(eV\ C ^V^ 

Owner's Name: f^\r\n r L() I CX. 

Performance Standards/Close-Out Criteria 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, Q^ 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 25 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? VL 

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 you satisfied with the work performed? Jtl. 11. Are there any property items that were temporarily re-located by the contractor that 

need to be moved back? ^ 

12. Are there any (known) lingering issues with the property owner(s) that have been left S^ unresolved? 

Other Considerations/Property Owner Discussions/Additional Work that is Required: 

Property Owner Signature Date 

UkJAfi Clk^: G-Q-lf 

Professional Environmental Engineers Signature Date 
Professional Environmental Engineers : EPA Paint Stabilization 2011 

Property Address

Stories/ Siding type 

Garage? 

Date access signed 

Pre-video 

Post video 

Contractor Assigned 

Date started 

Weather Conditions 

Paint used 

Prime used 

Poly used 

 ?.F)0( 0 L(>fai\[fH # l4l / 

Transite Wood Vinyl Metal Stucco 

Yes

m\\ 

 No

i ^ 

 ^ ^ Painted? 

Where? 

Yes 

Siding 

Trim 

No 

Lk/i L L Date ended <^/v/^ / 

3 

cJ-O^ 

Problems/Issues 
(efTective April 2010) 

RENOVATION RECORDKEEPIN G CHECKLIST 

Name of Firm: ^Z>y^^ ^ /-^A^/jY.^^ f 

Date and Location of Renovation: 

Brief Description of Renovation: STA^ / OZTf^fCiO 

Name of Assigned Renovator: C-;M/£1 r>^/iy^ 

Name(s) of Trained Workers: j^fisklo Qt^j o , ZfltA^ f^i'^Jo 

Name of Dust Sampling Technician, Inspector, and/or Risk Assessor, if used: 

U Copies of renovator and dust sampling technician qualifications (training certificates, certifications) on file. 

n Certified renovator provided training to workers on (check all that apply): 

D Posting warning signs D Setting up plastic containment barriers 

D Maintaining containment D Avoiding spread of dust to adjacent areas 

D Waste handling D Post-renovation cleaning 

D Test kits used by certified renovator to determine whether lead was present on components affected by 

renovation (identify kits used and describe sampling locations and results: 

Bv/aming signs posted at entrance to work area. 

dwWor c k area contained to prevent spread of dust and debris. 

^^-S^indovvs in and within 20 feet ofthe work area are closed 

0l5oors in and within 20 feet ofthe work areas are closed and sealed 

^^JBuooTS that must be used in the work area are covered to allow passage but prevent spread of dust. 

B'tjround covered by plastic sheeting extending 10 feet from work area - plastic anchored to the 

building and weighted down by heavy objects. 

n/If necessary, vertical containment installed to prevent migration of dust and debris to adjacent 

perty. 

Waste contained on-site and while being transported off-site. 

Renovation Recordkeeping Checklist Omaha Lead Site 
(L-I"l. 

Work site properly cleaned after renovation. 

2^11 chips and debris picked up, protective sheeting misted, folded dirty side inward, and taped for 

removal. 

D~Work area HEPA vacuumed to get paint chips from ground surface, ifnecessary. 

"^rTt^rtified renovator performed post-renovation cleaning verification (describe results): 

I certifyjjjide;; penalty of law that the above information is true and complete. 

Name and Title Date 

Renovation Recordkeeping Checklist On^iatia Lead Sice 
5/26/2011 Douglas County Account Information =^75131 

Douglas County, Nebraska Propert >per y Record - R0607900000 

Print Report 

View Interactive GIS Map Infomiation is valid as of 2011-5-16 Treasurer's Tax Report 

New Feature ->->- • Subdivision Sales Search 

Owner 

MINOR LULA M 

3506 LAFAYETTE AVE 

OMAHA NE 68131-0000 

Property Information 

Key Number: 0790 0000 06 

Account Type: Residential 

Parcel Number: 0607900000 

Parcel Address: 3506 LAFAYETTE AV Y^^CO N^ 

OMAHA NE 68131-0000 

Legal Description: BEMIS PARK LOT 16 BLOCK 3 40 X 162.84 

Value Infomiation 

Land Improvement Total 

2011 $2,500.00 $57,000.00 $59,500.00 

2010 $2,500.00 $57,000.00 $59,500.00 

2009 $2,500.00 $57,000.00 $59,500.00 

2008 $2,500.00 $57,000.00 $59,500.00 

2007 $2,500.00 $57,000.00 $59,500.00 

2006 $2,500.00 $57,000.00 $59,500.00 

Land Information 

Acres SF Units Deptii Widtii Vacant 

0.14 6480.0 1.0 162.0 40.0 No 

Improvement Information 

Building 1 

...mapping-online.com/.../accountinfo.j... 1/3 
1

1 

5/26/2011 J)ouglas County Account Information 

ifel. 1 1 

••H0« I^^H^Bi •nsVa" 1 

 CLICK TO ENLARGE IMAGE 

1

Square Footage: 1488.0 

Perimeter 0.0 

Unit Type: 

Built As: 2Stoty 

HVAC: Central Air to Air 

Exterior: Frame Vinyl 

Interior: Drywall 

Roof Cover: Composition Shingle 

Roof Type: Gable 

Floorcover: Allowance 

year Percent Year Built Remodeled Remodeled 

1903 0 0% 

Deta/7 Type Detail Description 

Appliance Allowance 

Appliance Security System 

Basement Bsmnt Block 8 ft 

Fixture Base Fixtures 

Fixture Bath Full 

Porch Slab Roof Ceiling 

i 

tntru 

..^ 

 CLICK TO ENLARGE IMAGE | 

Percent Complete: 100.0% 

Quality: A\Aerage 

Condition: Average 

Condo Square Footage: 0.0 

Rooms: 6.0 

Units: 1.0 

Baths: 1.0 

Bedrooms: 3.0 

Stories: 1.5 

Foundation: 

Sprinkler Square Footage: 0.0 

Adjusted Year Physical Age Built 

1903 107 

Units 

1.0 

1.0 

740.0 

1.0 

1.0 

176.0 

...mapping-online.com/.../accountinfo.j. 2/3 
CONSENT FOR ACCESS TO PROPERTY 

OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID : QM^'i- PROPERTY ADDRESS: _2fiO^_lj:(A^f^f/i 6 ^ . 

OWNER NAME: 

'^^^^ffZ.y DAYTIME PHONE:(3^g3 )- 5^/-/77- 7 

^^^^ : y>7. ^^ : 

E-MAIL: 

CELL PHONE:r4>2^2 3 7o7 - ^'^fil 

OWNER'S ADDRESS IF DIFFERENT: 

TENANT'S NAME IF APPLICABLE: DAYTIME PHONE: 

CELL PHONE: 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 are being 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, if the soil cleanup has not already been performed. 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. 

0\Yes, I have and understand the paragraph above. 

0 5. J/- // 

Signature of Property Owner Date 

I fully understand that by signing this Consent for Access, (I) this access will remain in effect until the work has been 

satisfactorily completed, (2) that the Property Owner or Tenant, if applicable, will be given the Housing 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 obstruct or tamper with 

any of the LBP stabilization actions, and (8) will participate in fmal 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 or Kelley Sanders At 402-504-4688. General questions 

about the Omaha Lead Site cleanup can be directed to Pauietta France-Isetts, EPA Remedial Project Manager 402-731-2454, or 

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

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

"Renovate Right, Important Lead Information for Families, Child given the pamphlet "Renovate Right, Important Lead 

Care Providers, and Schools." Information for Families, Childe Care Providers, and Schools." 

Signature Oate Signature Date 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

PROPERTY ADDRESS :^650(b Ui{^a\fHk^. A^. DATE: 

BV,D: QPQ^ l 

AREA(S) TO BE PAINTED: 

HOUSE PROPER: COLOR: A?^ . /..A 

HOUSE TRIM: COLOR: 

GARAGE: COLOR: 

GARAGE TRIM: COLOR: 

PORCH: COLOR: 

PORCH TRIM: COLOR: 

(COMPLETE ALL SECTION, YES, NO, OR NON-APPLICABLE) 

I AGREE TO THE COLORS LISTED ABOVE. ONCE THE PAINTING 

BEGINS, I UNDERSTAND I CAN NOT CHANGE THE ABOVE SELECTED COLORS: 

PROPERTY OWNER SIGNATURE: PE ACCESOR SIGNATURE: 

.^^^C^ v^. Y)\-^^^ 
PRE-RENOVATION FORM - OWNER 

This form is to be used by the firms contracted by the Environmental Protection Agency-Region 7 to perform Lead-Based 

Paint stabilization activities at the Omaha Lead Site, Omaha, Nebraska. 

Owner Confirmation 

Pamphlet Receipt 

JSCI have received a copy ofthe lead hazard information pamphlet, Renovate Right: Important Lead Hazard Inforniation for 

Families, Child Care Providers and Schools, informing me ofthe potential risk ofthe lead hazard exposure from renovation 

activity to be performed in/on my dwelling unit. I received this pamphlet before the work began. 

Owner Acknowledgment 

D (A) I confirm that 1 own and live in this property, that no child under the age of 6 resides here, that no pregnant woman 

resides here, and that this property is not a child-occupied facility. 

Note: A child resides in the primary residence of his/her custodial parents, legal guardians, foster parents, or 

informal caretaker if the child lives and sleeps most of time at the caretaker's residence. 

Note: A child-occupied facility' is a pre-1978 building visited regularly by the same child, under 6 years of age, on at 

least two different days within any week, for at least 3 hours each day, provided that the visits total at least 60 hours 

annually. 

1^(B) I understand that the renovation firm, contracted by the Environmental Protection Agency (EPA), will be using leadsafe work practices required by EPA's Renovation, Repair and Painting Rule. 

^ .x ^ ^ n /I//;ii/i^f. 

Printed Name of Owner-Occupant 

Signature of Owner-Occupant Date