TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID #: 335'9\ Date: "//jlAm 

Address: ^^1? Flor&nce. B(to 

Remediation Contractor: PROFESSIONAL ENVIRONMENTAL ENGINEERS Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video ofproperty (DVD) 

Executive Summary 

IF Signed Access Agreement for subject property 

D Painting Agreement 

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

0 Photographs 

M Satisfactory restoration signed by Property Owner 

M Property close-out check list signed by EPA 

[F Property information from Douglas County Assessor's Ofifice 

D 

Ignature / Date 

40318196 

Superfund 
2505 North 24"\ Suite 219 

Omaha, NE 68110 

(402) 504-4688 

Fax (402) 504-3281 

PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

"Providing cost-effective environmental solutions'' 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

SAID# 33591 

3919 Florence Bd 

• Dates worked 10/09 to 10/27 2008 

• Vinyl siding, paint in fair condition before stabilization, back side in poor condition. Garage 

damage in upper west side. 

• Inspected 10/31 Upper and lower east side window trim scrape and paint. Bay north side 

window paint undemeath. Vacuum after scraping. 11/05 Issues resolved. 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

"Providing cost-effective environmental solutions" 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Property Owner Close-Out Form 

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

SAID: .V^g9 / 

Property Address: h9 l j F^lnre^yycc^ /^l^i 

Owner's Name: VPJAI^ /^'^S-S 

Performance Standards/Close-Out Criteria 

2505 North 24*, Suite 219 

Omaha, NE 68110 

(402) 504-4688 

Fax (402) 504-3281 

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, 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? J

4. Was the paint products utilized equivalent to a 30 year product/quality? y 

5. Are all ofthe areas where contaminated materials have been spilled thoroughly 

vacuumed/ cleaned? y 

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? y

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

that need to be moved back? y 

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

been left unresolved? \y 

Comments: 

y ' 

\ y ^

I I (ijeT' 

Property Owner Signature Date 

/t,Jy/A u //^9-oy 

Professiona ssional l EnvircJnimienta m l Engineers Representative Date 

 1 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

"Providing cost-effective environmenta! solutions" 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

EPA Close-Out Form 

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

SAID: 3^S^ \ 

Property Address: 

Owner's Name: yA<r\(y e> . ^ ^ 

Performance Standards/Close-Out Criteria 

2505 North 24'^ Suite 219 

Omaha, NE 68110 

(402) 504-4688 

Fax (402) 504-3281 

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, columns, rails, and exterior surfaces of / 

garages. 

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

3. Were all required areas ofthe structure(s) primed as needed and painted with 

y two top coats? 

4. Was the paint products utilized equivalent to a 30 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 y other generated debris? 

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

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

barrier tape, etc. properly removed? y

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 there any property items that were temporarily re-located by the contractor 

y that need to be moved back? 

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

/ been left unresolved? 

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

10/3/' uMw u)ini^rw> e«^/- ^i< _ '^tTC^IpCiiA.-r -fri/i^ Ui(\(itir(\e.c^U^ 

^^^^'<-^ - EPA COR Signature I E)ate 

.X 
m.,ML£{myL6/fd, 

tlmpt sSfi^iJ 
CONSENT FOR ACCCESS TO PROPERTY 


OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

.^35''^ J ^^/ f nkt/)it s// y 

PROPERTY ID: V I \ PROPERTY ADDI 

OWNER'S NAME: 

_DAY-TIMEPHONE: ^lO A ^3 3 ^^(^ ( 

CELL PHONE: U ^ ^ Ub^X^ E-MAIL 

OWNER'S ADDRESS IF DIFFERENT: 

TENANT'S NAME IF APPLICABLE: 

.DAY-TIME 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 exterior lead-based paint (LBP) on residential structuros at a number of properties located in Omaha, Nebraska. The paint 

stabilization worl< is being done to protect the soil cleanups that were perfonned by EPA contractors. 

Paint stabilizations activities will include: scraping of cracked or flaking LBP from stmctures, application of a prime coat and two (2) coats 

of paint. Any moving parts of windows and door are not included in the activities and will not be addressed. 

Your cooperation is requested in giving pemiission to this EPA contractor (PE, Inc.) to enter and have access to this property for the 

purpose of stabilizing lead-based paint as outlined on the property identified above. 

I fully understand that by signing this Consent For Access, (1) this access will remain in effect until the work has been satisfactorily 

completed (2) that as the Property Owner or tenant, if applicable, will be given the Housing and Urban Development (HUD) and EPA 

pamphlet, "Renovate Right, Important Lead Hazard Infomiation for Families, Child Care Providers and Schools" (3) the Property Owner or 

tenant will removal of obstructions from surfaces to be painted, (4) will abide by health and safety guidance provided by EPA, and (5) will 

allow photography of property before and after the paint stabilization work, (6) I will be contacted by a PE representative approximately 

48 hours in advance of starting work to (7) agree not to obstruct or tamper with any of the LBP stabilization activities or equipment used to 

perfonn any LBP actions, (8) will participate in final property inspection and sign the Completion Agreement and Property Owner 

satisfaction Survey. 

Should you have any questions about the planned Lead Based-Paint stabilization activities for your property, please contact: Professional 

Environmental Engineers, Inc., Project Manager, Hennan Hanner at 402-884-1185. General questions about the Omaha Lead Site 

cleanup can be directed to Pauletta France-Isetts, EPA Remedial Project Manager 402-731-2454, or the EPA Public Infonnation Centers 

at (402) 991-9583 (North Omaha office) or (402) 731-3045 (South Omaha office). 

[s ^ Yes, I grant access to my property and was given [] No, I do not grant access to my property and I was 

mepamphlet "Renovate Right, important Lead Hazard ghren the pamphlet "Renovate Right, Important Lead Infbrmation 

for Families, ChildJCare Providers and Schools. Hazard Informationfor Families, Child Care Providers and 

Schools. 

J^^ ^ ^A^Aoy Signature Date Signature Date 

SPECIAL INSTRUCTIONS AND/OR CONSIDERATIONS: 
Confirmation Of Receipt Of Lead Pamphlet 

BV.D^lS5iZ____ 

PROPERTY ADDRESS sJ^/ f ^00:^ 1 ^^C / ZIP CODE /^//// ^ 

PROPERTY ADDRESS OF OWNER IF DIFFERENT THAN PROPERTY BEING PAINTED: 

PROPERTY ADDRESS ^ZIP CODE 

I have received a copy of the pamphlet, Renovate Right: important Lead Hazard Information For Families, 

Child Care Providers And Schools infomiing me of the potential risk of the lead hazard exposure from 

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

PRINTED NAME OF RECIPIENT DATE 

^y/^^y 

SIGNATURE OF RECIPIENT 

Self-Certification Option (For Tenant-Occupied Dwellings Only) 

If the lead pamphlet was delivered but a tenant signature was not obtainable, you may check the appropriate box 

below: 

D Refusal To Sign - 1 certify that I have made a good faith effort to deliver the pamphlet, renovate right: important 

lead hazard infonnation for families, child care providers and schools; to the rental dwelling unit listed above at the 

date and time indicated and that the occupant refused to sign the confirmation of receipt. I further certify that I 

have left a copy of the pamphlet at the unit with occupant. 

D Unavailable For Signature - 1 certify that I have made a good faith effort to deliver the pamphlet, renovate right; 

important lead hazard infonnation for families, child care providers and schools, to the rental dwelling unit listed 

below and that the occupant was unavailable to sign the confirmation of receipt. I further certify that I have left a 

copy of the pamphlet at the unit by sliding it under the door or somewhere on the premises. 

PRINTED NAME OF PERSON CERTIFYING ATTEMPTED DELIVERY DATE AND TIME LEAD 

PAMPHLET DELIVERY 

SIGNATURE OF PERSON CERTIFYING LEAD PAMPHLET DELIVERY: 

Note Regarding Mailing Option - as an altemative to delivery in person, you may mail the lead pamphlet to the owner 

and/or tenant. Pamphlet must be mailed at least 7 days before renovation. (Document with a certificate of mailing from the post 

office). 

CONFIRMATION OF RECEIPT OF LEAD PAMPHLET 08/08 
Douglas County Account Information 

page 2 of2 

Secnn 1 Floor 

420 a U\.1t. 

i : i 

1 0 > t 7 

FcstBooT " m l 

8D1.0«q * U > j 

v ^ I I! tJ 

'31 

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Sn. : ^.;rMst i r 

CLICK TO Ed^LARGE IMAGE 

Square Footage: 1221.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Fair 

Built As: 1 1/2 Story Fin Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 6.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Hip/Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built 

Physical Age Remodeled Remodeled Built 

1918 0% 1918 90 

DeUiil Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 727.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 286.0 

Porch End Screen 185.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R07... 6/27/2008 
Douglas County Account Information Page 1 of2 

Douglas County, Nebraska Property Record - R0701040000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west ot 90tti St - Vle W On Ma p Information is valid as of 2008-6-19 Treasurer's Tax Report 

New Feature ->->- • Auto Sales Search 

Owner 

BASS VELMA R 

3919 FLORENCE BLVD 

OMAHA NE 68110-0000 

Property Informatio n 

Key Number: 0104 0000 07 

Account Type: Residential 

Parcel Number: \ 0701040000 

Parcel Address: 3919 FLORENCE BD 

OMAHA NE 68110-0000 

Legal Description: ! BOULEVARD PARK ADD LOT 14 BLOCK 6 N 10 FT LOT 13 & S 30 FT 40 X 120 

Value Informatio n 

Land Improvement Total 

2008 $7,000.00 $40,700.00 $47,700.00 

2007 $7,000.00 $40,700.00 $47,700.00 

2006 $7,000.00 $40,700.00 $47,700.00 

2005 $7,000.00 $17,000.00 $24,000.00 

2004 $7,000.00 $15,400.00 $22,400.00 

2003 $7,000.00 $15,400.00 $22,400.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.11 4800.0 1.0 120.0 40.0 No 

Impro vemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R07... 6/27/2008