TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID #: 21842 Date: 12/08/2008 

Address: 906 S 38 St 

Remediation Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Summary 

Signed Access Agreement for subject property 

Painting Agreement 

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

D Photographs 

Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

[ / Property information from Douglas County Assessor's Office 

D 

D 

D 

^a<,^ ^ zlzslo'i 

Signature Date 

40309826 

iHlll 

Superfund 
PROPERTY SUMMARY 

1 Date: 12/08/08 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 1 Month of: December 1 

1 Property Address: 906 S 38 St SAID: 21842 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: None 

A.2 Issues Resolved: None 

A.3 Unique Findings: None 

122A.4 Other Relevant Infomiation: None 

Access Date: 09/13/08 

Work Began Date: 10/10/08 

Closeout Date: 10/31/08 

Enclosures; 

1. Pre-Video 

2. Post-Video 

3. Property Status Form 

4. Signed Access Agreement 

5. Pre-Renovation Form 

6. Paint Match Form 

7. Tracking Form 

8. Douglas County Assessor Property Information Page 

9. EPA Property Closeout form 

10. Property Completion Agreement 

TECHNOLOGIES, INC. 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

. , / Property Status Form 

Address: ^i h 5 5 ^ ^5 Y Date: ^^/^-^f 

Phone: ^/fi-//f/ BVID: ;^/fV ^ 

Plant & Pennanent Landscaping To Remain In Place 

Item# 

Description and Location 

OnM^ 

Pre-Existing Condition of Structures 

Does your Basement have a history of leaking? Yes — No — 

Item# Description & Location 

On Map 

Property Owner Prudent Emi 

Signature Signature: 

8080 Ward Parkway, Suite 405 

Kansas City, MO 64114 

Phone: (816) 363^703 

2506 N. 24*^ street, Suite 308 

Omaha, Nebraslca 68110 

Phone: (402)504-1004 

4242 Medical Drive, Suite 42S0 

San Antonio, TX 78229 

Phone: r2im aoo-ocoo 

Fax: (816) 363-3707 
Prudent Technologies, Inc. (Prudent) is under contract (Contract # EP-R7-08-07) with the U. S. 

Environmental Protection Agency (EPA) to stabilize Lead Based Paint (LBP) at a number of properties 

located in Omaha, Nebraska, including ^ e property located at ^t)lc> ^ . "3^^ ^ ^ -

The EPA requests your permission to allow Prudent to perform LBP Stabilization at this property. By 

signing this form,tiie property owner grants permission to Prudent to perform activities related to LBP 

Stabilization including scraping paint and painting of the referenced property. Further, the owner/tenant 

verifies that they have received the LBP pamphlet "Renovate Right" 

If you have any questions about the LBP stabilization planned for your property, please contact Prudent's 

Administrative Clerk for the Lead Based Paint Stabilization, Mrs. Deborah Akerele-Johnson, 

at (402) 504-1004; General questions about the Omaha Lead Site cleanup can be directed to the EPA 

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

office). 

Property Access Onnted Bv: Wesle y 

(Please Print Name) 

Property Owner Signature: 9-IZ-CH 

(SignatureT"' (Date) 

PROPERTY INFORMATION 

iinpletc^%g(^rtsident and/or property oiraer - pletK print) 

RESIDENT NAME: Renter 

^O^S 3 ^ Sf 

,: SelQ 

RESIDEKT ADDRESS: 

IF RENTAL. PROPERTY OWNED BY: 

OWNER'S MAIUNG ADDRESS; TlX*^- ^ 

OWNER'S TELEPHONE NUMBER - HOME: f^Q2>/{Q'W^ i WORK: t \ 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: C ^ NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER: ^ ^ 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: C J 

COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS, ENTRY GATES, ETC.) 

AMI ^ 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be implemented by EPA under di s agreement are pursuant to Section 104 

of CERCLA, 42 U.S.C. 9604. EPA's ri^ of access to Hie property isprovidedfiwn Section 104(e) of CERCLA, 42 U.S. C 9605(e), wtuch provides entry 

fat "determiningflie need fbr response, or dioosing ortaking «ny response action under dus title, or otherwise enfiwcing the provisicns of 4 e title." 

2505 N. 24*^ Street, Suite 308 4242 Medical Drive, Suite 4250 080 Ward Pailmay, Suite 405 Omaha San Antonio, TX 78229 , Nebraska 68110 ansas City, MO 64114 Phone: f2ini »90.OBPO Phone : (402)504-1004 hone: (816) 363-3703 

ax: (816) 3634707 
Current Sample Pre-Renovation Form 

Effective until April 2010. 

Confirmation of Receipt of Lead Pamphlet 

O l have receivecl a copy of the pamphlet, Renovate Rtjght: Important Lead Hazard 

Infonnation for Families, Child Careftovicfera and Schools informing me of 

the potentialrisk of the lead hazard exposure from renovation activity to be 

performed in my dwelling unit. I received this pamphlet before the work began. 

Printed namemtecipientV Date 

Slgnatuti»^ recipient 

Self-Certification Option (fbr tenant-occupied dwellings only) — 

If the lead pamphlet was delivered but a tenant signature was not obtainable, 

you may check the appropriate box below. 

• Refusal to sign — I certify that I have made a good faith effort to deliver the 

pamphlet, Fienovate FV^t: Important Lead Hazard Infonnation for FamSies, 

Child Care Pmviders and SchooHs, to tiie rental dwelling unit listed below at the 

date and time indicated and that the occupant refused to sign the confinnation 

of receipt. I further certify that I have left a copy of the pamphlet at the unit with 

the occupant. 

Q Unavailable for signature — I certify that I have made a good faith effort to 

deliver the pamphlet. Renovate FVght: Important Lead HazmJ information fbr 

Families, Child Care providers and S(^xx}ls, to the rental dwelling unit listed 

below and that the occupant v/as unavailable to sign the confirmation of receipt. 

I lufp^wr certify that I have left a copy of the pamphlet at the unit by sliding it 

Printed narne ofparson certifypg Attempted delivery 

date and time 

lead pamphlet delivery 

Signature of persc^certifying lead pamphlet delivery 

Unit Address 

Note Regarding Mailing Option — As an attemative 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 fiom the 

post office). 
paint match form 

Paint matching form: 

Property address: ^^^ ^, s^ ^ ^ ^ 

BVID: ^i^^: i 

Explanatio^^^ ^^ J 

Area: /^/ ^(^i^ ^ f T^ Color:^^^ ^ (jfYr/Mf < ^ ^/^ / 

Explanation: 

Area: Color: 

Explanation: 

Area: Color: 

Explanation: 

Area: Color: 

anation: 

Page 1 
[ 

AC^S S WroRMAiroiV TRACfONG SHEET 

P(M7 ssg£^ ^j^ ^.jj'^^ r BWft 

PrapBilyOintfBfi 

OinerOonMHK Home; Wdrtc 

Odfc g?/^-//^ / te 

mODBIBElK ivpait^ 

ooNmcroemL 

%9\^^^\JC 6£mtu/^ bq /t/doJ/ur^ 

diiL 
Douglas County Account Ii^winatio j^um a n Page 2 of2 

Building 1 

gift 

'»,..-_ H O 

I' D 

it«<!«|ll 

Iff ' FmRaec 

•"MO :i9 

JSU­

:»» 

ji C » rWOSfORY 

Square Footage: 1408.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type Condition: Average 

Built As 2 Story Condo Square Footage: 0.0 

HVAC Central Air to Air Rooms: 8.0 

Exterior Frame Siding Units: 1.0 

Interior Drywall Baths: 2.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type Hip Stories: 2.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

YearBuilt Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1911 0% 1911 97 

Detail Type Detail Description Unita 

Appliance Allowance 1.0 

Basement Bsmnt Cone 8 ft 688.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 2.0 

Porch Slab Roof Ceil 126.0 

Porch Wood Deck 24.0 

http://douglasne.mapDine-online.com/nnimlf)sr.nN(»/«tatiV/Qrf>r«iiTiti-»,fx ;r.-o.. 
Douglas County Account InJKmatio n|Kms n Page 1 of2 

Douglas County, Nebraska Property Record - R2521530000 

"~2i Print Report 

NEW Feature - Parcel Dimensions available ® scale 0-50 ft west of SOth St - Vie W O n Ma p Infonnation is valid as of 2008-7-14 Treasurei^s Tax Report 

New Feature «>-*- > Auto Sales Search 

Owner 

DACUS WESLEY R 

7

Y\D 

iT^J^rw}^ 

906 S 38 ST 

OMAHANE 68105-0000 

Property Informatio n 

Key Number: 2153 0000 25 

Account Type: Residential 

Parcel Number: 2521530000 

Parcel Address: 906 S 38 ST 

OMAHANE 68105-0000 

Legal Description: WEST OMAHA LOT 1 BLOCK 23 W 13.5 E 110 N 35 FT & S 38 N 73 E 110 FT 13.5 

X 35-38X110 

Value Informatio n 

Land Improvement Total 

2008 $9,300.00 $94,400.00 $103,700.00 

2007 $9,300.00 $81,900.00 $91,200.00 

2006 $9,300.00 $81,900.00 $91,200.00 

2005 $9,300.00 $79,700.00 $89,000.00 

2004 $9,300.00 $79,700.00 $89,000.00 

2003 $9,300.00 $79,700.00 $89,000.00 

Sales Informatio n 

Sales Date: 2005-10-07 

Deed Type: WD Book: 2005 Page: 128876 

Price: $105,000.00 

Grantor: JAN ERIC PUSCH ETAL 

Grantee: WESLEY R DACUS 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Unita Depth Widtii Vacant 

0.1 4674.0 1.0 123.0 38.0 No 

Improvemen t Informatio n 

httD://douelasne.maDDine-online.com/Doi]plasr,nNf»/«!t3tiV./florr.iintinfr> ionOo ,,r^+».«—DO C 0/'»^/'^nAf » 
Prudent Property Ciose-Out Form (lead-Based Ifaint Stabilization) 

S&iP: y- l 6 TJ -

Property Address: (O K t^ ' O d 0=» ' 

Owner's Name: {jUsP ^ ThC U <:. 

Performance Standards/close-Out Criteria 

lYES 

V/ss ths entire structure{s) painted wrth the exception ofthe stat >d, excluded areas? This would 

include painting of ether associated features Induding fascia, sav{ s, siding, ali trim, porches, box 

y 

beams, columns, rails, and exterior surfaces of garages. 

2. Was all scraping and other preparattion work completed satisfsctc riiy? 

3. Were ail required areas of the stpjcture{s) primed as needed and i ainted with two top coats? V 

4. Was the paint products utilized equivaient to a 30 year produet/qu siity? V 

.Are ail ofthe areas where ccntanrsinated materials have been spilled 

thoroughly vacuumed/ cleaned? 

6. Did ths contractor collert/vacuum all failing and scraped paint chips en ths entire property, 

roadways, alleyways, public access areas and also remove any othe r generated debris? 

is the grass area that surrounds the structure{s) In reasonably gooc condition? 

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

properiy removed? 

9.

 Is there any evidence of property damage that was done by the cor tractor? Any ps-opeity damage 

needs to be com.oleted orior to the EPA Close-Out. 

i 10. Are there any property Items that were temporatily re-located by ti^e contractor 

iT I that need to be moved bacic? 

[11. Are there any (known) lingering issues with the property owner(s) tpat have been left unresolved? \X Other Considerations?property Owner Discussions?Addition5i Work that is Required 

Pyd0y^^4\. Ct,.:»rJ^ ^^^t^h^c^J^ m \mt 

Prucfent Re^esentative, '^ 

Date/o/3/y^f