### TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO NFIL EFOLDE R 

## SAI D # : 335'9 \Date : "//jlA m 

# Address : ^^1 ? Flor&nce
. B(t o Remediatio n Contractor : PROFESSIONA LENVIRONMENTA LENGINEER S Year : 200 8
PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o ofpropert y (DVD ) Executiv e Summary I FSigne dAcces s Agreemen t fo r subjec t propert y D Paintin g Agreemen t D Setdemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) 0 Photograph s M Satisfactory restoratio n signe db y Propert y Owne r M Propert y close-ou t chec k lis t signe db y EP A [ FPropert y informatio n fromDougla s Count y Assessor' s Ofific e

D

Ignatur e / Dat e

4031819 6 Superfun d250 5 Nort h 24" \ Suit e 21 9 Omaha , N E 6811 0 (402 ) 504-468 8 Fax(402 ) 504-328 1 

## 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

Lea dBas e Stabilizatio nOmaha , N e Clos e Ou t Repor t
SAID #3359 1 391 9 Florenc e B d

•Date s worke d10/0 9 t o 10/2 7 200 8
•Viny l siding , pain t i n fair conditio nbefore stabilization , bac k sid e i n poo r condition
. Garag e damag e i n uppe r wes t side
. •Inspecte d10/3 1 Uppe r an dlowe r eas t sid e windo w tri mscrap e an dpaint
. Ba y northsid e windo w pain t undemeath
. Vacuu mafte r scraping
. 11/0 5 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 : .V^g9 / Property Address : h9 l j F^lnre^yycc^ /^l^ i Owner' s Name : VPJAI ^ /^'^S- S Performanc e Standards/Close-Ou t Criteri a 250 5 Nort h 24* , Suit e 21 9 Omaha , NE 6811 0 (402 ) 504-468 8 Fax(402 ) 504-328 1

YE S NO 1. Wa s th e entir e structure(s ) painte dwithth e exceptio n ofth e stated , exclude d areas ? Thi s woul dinclud e paintin gof othe r associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an dexterio r surface s of / garages . 2. Wa s al l scrapin g an dothe r preparatio nwor k

complete dsatisfactorily ? , / 3. Were al l require darea s ofth e structure(s ) prime d as neede dan dpainte dwith 

# J tw o to p coats ? 4. Wa s th e pain t product s utilize dequivalen t to a 30 year product/quality ? y 5. Are al l ofth e area s wher e contaminate dmaterial s hav e bee nspille dthoroughl y vacuumed / cleaned ? 

# y 6. Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s on th e entire property , roadways , alleyways , publi c acces s area s an dals o remov e any

- othe r generate ddebris ? 7. Is th e gras s are athat surround s th e structure(s ) in reasonabl y goo dcondition ? / 8. Are al l item s suc h as polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . properl y removed ? 

# y 9. Is ther e any evidenc e ofpropert y damag e that wa s don eby th e contractor ? An y property damag e need s to be complete dprio r to th e EP A Close-Out
. 

# y 10
. Are ther e any property item s that wer e temporaril y re-locate d by th e contracto r that nee dto be move dback ? 

# y 11
. Are ther e any (known ) lingerin g issue s withth e property owner(s ) that hav e bee nlef t unresolved ? 

## \y Comments :
y ' 

### \ y ^ I I 

# (ijeT '

Property Owner Signatur e Dat e 

## /t,Jy/ Au //^9-o y Professiona l l imienta l Engineer s Representativ e ssiona EnvircJn m Dat e 

### 1

## PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC

. "Providin g cost-effectiv e environmenta ! solutions " Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yRespons e EP A Close-Ou t For m (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) 

## SAID : 3^S^ \ Property Address : Owner' s Name : 

## yA<r\( ye> . ^ ^ 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 dwit hth e exceptio nofth 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 / garages . 2
. Wa s al l scrapin g an dothe r preparatio nwor k

complete dsatisfactorily ? s / 3
. Were al l require darea s ofth 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 utilize dequivalen t t o a3 0 year product/quality ? ^ 5
. Are al l ofth e area s wher e contaminate dmaterial s hav e bee nspille dthoroughl y vacuumed / cleaned ? / 6
. Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s o n th e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y 

## y othe r generate ddebris ? 7
. I s th e gras s are athat surround s th e structure(s ) i n reasonabl y goo dcondition ? i / 8
. Ar e 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 ofpropert y damag e that wa s 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
. 10
. Ar e ther e any property item s that wer e temporaril y re-locate db y th e contractor y that nee dt o b e move dback ? 11
. Ar e ther e an y (known ) lingerin g issue s withth e property owner(s ) that hav e / bee nlef t unresolved ? Othe r Considerations/Property Owne r Discussions/Additiona l Wor k

that i s Required : 

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_'^tTC^IpCiiA.- r -fri/i ^ Ui(\(itir(\e.c^U ^

^^^^'<-^ - EPA CO RSignatur e I E)at e . X

# m.,ML£{myL6/fd , tlmp t sSfi^i J

## CONSEN T FOR ACCCES S T O PROPERT Y OMAH ALEA D SIT E REMEDIA L ACTIO N - LEAD-BASE D PAIN TSTABILIZATIO N 

# .^35'' ^ J ^^/ f nkt/)i t s// y PROPERT YID : V I \ PROPERT YADD I OWNER' S NAME : _DAY-TIMEPHONE : ^lO A^3 3 ^^(^ ( CEL L PHONE : 

# U ^ ^ Ub^X ^ E-MAI L OWNER' S ADDRES S I F DIFFERENT : TENANT' S NAM E I F APPLICABLE : .DAY-TIM E PHONE : CEL L PHONE : E-MAI L
Professiona l Environmenta l Engineers , Inc
. (PE ) i s unde rcontrac t (#EP-R7-08-06 ) wit h th e U
. S

. Environmenta l Protectio n Agenc y(EPA ) t o stabiliz e exterio rlead-base d pain t (LBP ) o n residentia l structuro s a t a numbe ro fpropertie s locate d i n Omaha , Nebraska
. Th e pain t stabilizatio n worl < i s bein g don e t o protec t th e soi l cleanup s tha t wer e perfonne d b yEP Acontractors
. Pain t stabilization s activitie s wil l include : scrapin g o f cracke d o rflakin g LB P fro m stmctures , applicatio n o f a prim e coa t an d tw o (2 ) coat s o fpaint
. An ymovin g part s o fwindow s an d doo rar e no t include d i n th e activitie s an d wil l no t b e addressed
. You rcooperatio n i s requeste d i n givin g pemiissio n t o thi s EP Acontracto r(PE , Inc. ) t o ente ran d hav e acces s t o thi s propert yfo rth e purpos e o fstabilizin g lead-base d pain t a s outline d o n th e propert yidentifie d above
. I full yunderstan d tha t b ysignin g thi s Consen t Fo rAccess , (1 ) thi s acces s wil l remain i n effec t unti l th e wor k ha s bee n satisfactoril y complete d (2 ) tha t a s th e Propert yOwne ro rtenant , i f applicable , wil l b e give n th e Housin g an d Urba n Developmen t (HUD ) an d EP A pamphlet , "Renovat e Right , Importan t Lea d Hazar d Infomiatio n fo rFamilies , Chil d Car e Provider s an d Schools " (3 ) th e Propert yOwne ro r tenan t wil l removal o fobstruction s fro m surface s t o b e painted , (4 ) wil l abid e b yhealt h an d safet yguidanc e provide d b yEPA , an d (5 ) wil l allo wphotograph yo f propert ybefor e an d afte rth e pain t stabilizatio n work , (6 ) I wil l b e contacte d b ya P E representative approximatel y 4 8 hour s i n advanc e o fstartin g wor k t o (7 ) agre e no t t o obstruc t o rtampe rwit h an yo fth e LB P stabilizatio n activitie s o requipmen t use d t o perfon n an yLB P actions , (8 ) wil l participat e i n fina l propert yinspectio n an d sig n th e Completio n Agreemen t an d Propert yOwne r satisfactio n Survey

. Shoul d yo u hav e an yquestion s abou t th e planne d Lea d Based-Pain t stabilizatio n activitie s fo ryou rproperty , pleas e contact : Professiona l Environmenta l Engineers , Inc. , Projec t Manager , Henna n Hanne ra t 402-884-1185
. Genera l question s abou t th e Omah a Lea d Sit e cleanu p ca n b e directe d t o Paulett a France-Isetts , EP ARemedia l Projec t Manage r402-731-2454 , o rth e EP APubli cInfonnatio n Center s a t (402 ) 991-958 3 (Nort h Omah a office ) o r(402 ) 731-304 5 (Sout h Omah a office)

. [s ^ Yes , I gran t acces s t o m ypropertyan d wa s give n [ ] No , I d o no t gran t acces s t o m ypropertyan d I wa s mepamphle t "Renovat e Right , importan t Lead Hazar d ghre n th e pamphlet "Renovate Right , Importan t Lead Infbrmatio n fo rFamilies , ChildJCar e Providers an d Schools

. Hazar d Informatio n for Families , Chil d Car e Providers an d Schools

. J^^ ^ 

# ^A^Ao y Signature Date Signatur e Date SPECIA L INSTRUCTION S AND/O R CONSIDERATIONS :

## Confirmatio n Of Receip t Of Lea d Pamphle t BV.D^lS5iZ___

_ PROPERT YADDRES S sJ^/ f ^00:^ 1 ^^C / ZI P CODE /^//// ^ PROPERT YADDRES S OF OWNE R I F DIFFEREN TTHA N PROPERT YBEIN G PAINTED : PROPERT YADDRES S ^ZI P COD E I hav e receive d a cop yo f th e pamphlet , Renovat e Right : importan t Lea d Hazar d Informatio n Fo rFamilies , Chil d Car e Provider s An d School s infomiin 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 unit
. I receive d thi s pamphle t befor e th e wor k began
.

PRINTE D NAM E O F RECIPIEN TDAT E 

# ^y/^^ y SIGNATUR E O F RECIPIEN T Self-Certificatio n Optio n (Fo rTenant-Occupie d Dwelling 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 bo x below : 

# D Refusa l T o Sig n - 1 certif ytha t I hav e mad e a goo d fait h effort t o delive rth e pamphlet , renovat e right : importan t lea d hazar d infonnatio n fo rfamilies , chil d car e provider s an d schools ; t o th e renta l dwellin g uni t liste d abov e a t th e dat e an d tim e indicate d an d tha t th e occupan t refuse d t o sig n th e confirmatio n o f receipt
. I furthe rcertif ytha t I hav e left a cop yo fth e pamphle t a t th e uni t wit h occupant
. 

# D Unavailabl e Fo rSignatur e - 1 certif ytha t I hav e mad e a goo d fait h effort t o delive rth e pamphlet , renovat e right ; importan t lea d hazar d infonnatio n fo rfamilies , chil d car e provider s an d schools , t o th e renta l dwellin g uni t liste d belo wan d tha t th e occupan t wa s unavailabl e t o sig n th e confirmatio n o freceipt
. I furthe rcertif ytha t I hav e lef t a cop yo fth e pamphle t a t th e uni t b yslidin g i t unde rth e doo ro rsomewher e o n th e premises
.

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

SIGNATUR E O F PERSO N CERTIFYIN G LEA D PAMPHLE TDELIVERY : Not e Regardin g Mailin g Optio n - as a n altemative t o deliver yi n person , yo u ma ymai l th e lea d pamphlet t o th e owne r and/o rtenant
. Pamphlet must b e maile d at least 7 days before renovation. (Document with a certificat e o fmailin g fro m th e pos t office)

. CONFIRMATIO N O F RECEIP TO F LEA D PAMPHLE T08/0 8Dougla s County Accoun t Informatio n 

### pag e 2 of 2

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CLIC KT O Ed^LARG E IMAG E Squar e Footage : 1221. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Fai r

Buil t As : 1 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. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Hip/Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 191 8 0 % 191 8 9 0 DeUii l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 ft 727. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 286. 0 Porc h En d Scree n 185. 0

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R07.
. . 6/27/200 8Dougla s County Accoun t Informatio n Pag e 1 of 2
Dougla s County , Nebrask a Propert yRecor d - R070104000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t ot 90tt i St - Vle W O n Ma p Informatio n i s vali d a s of 2008-6-1 9 Treasurer' s Ta xRepor t Ne wFeatur e ->->- • Aut o Sale s Searc h Owne r BAS S VELM AR 391 9 FLORENC E BLV D OMAH AN E 68110-000 0 Propert yInformatio n Ke yNumber : 010 4 000 0 0 7 Accoun t Type : Residentia l Parce l Number : \ 070104000 0 Parce l Address : 391 9 FLORENC E B D OMAH AN E 68110-000 0 Lega l Description : ! BOULEVAR D PAR KAD D LO T1 4 BLOC K6 N 1 0 FTLO T1 3 & S 3 0 FT4 0 X 12 0 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $7,000.0 0 $40,700.0 0 $47,700.0 0 200 7 $7,000.0 0 $40,700.0 0 $47,700.0 0 200 6 $7,000.0 0 $40,700.0 0 $47,700.0 0 200 5 $7,000.0 0 $17,000.0 0 $24,000.0 0 200 4 $7,000.0 0 $15,400.0 0 $22,400.0 0 200 3 $7,000.0 0 $15,400.0 0 $22,400.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 1 4800. 0 1. 0 120. 0 40. 0 N o Impro t vemen Informatio n Buildin g 1

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. . 6/27/200 8