TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID: 3104 Date: 12/26/2008 

Address: 2447 CROWN POINT 

Remediation Contractor: Prudent Technologies Year: 2008 

PAIN T STABILIZATIO N 

PROPERT Y FIL E FOLDE R DOCUMENT S 

0 Video of property (DVD) 

ET Executive Summary 

[?r Signed Access Agreement for subject property 

izf Painting Agreement I 

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

D Photographs 

H^ Satisfactory restoration signed by Property Owne r 

D Property close-out check Ust signed by EPA 

0^ Property information from Douglas Coimty Assessor's OfBce 

D 

D 

D 

Signature / Dat( 

to 9 

ate 

40309842 11 ill 

Superfund 
PROPERTY SUMMARY 

Date: 12/23/08 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Month of: December 

r 

Property Address: 2447 CROWN POINT SAID: 3104 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE. 

A.2 Issues Resolved: NONE. 

A.3 Unique Findings: NONE. 

A.4 Other Relevant Information: NONE. 

Access Date: 09/29/08 

Work Began: 10/14/08 

Closeout Date: 10/16/08 

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. 
TECHNOLOGIES, INC. 

ENVIRONMENTAL A 

CONSTRUCTION 

SERVICES 

Property Status Form 

Address: ^Q^- j (TrovA/oT^omf /^ate : 

Phone: BVID: 3/O M 

Item# 

On Map 

Plant & Pennanent L-flndscapinpr To Remain In Place 

Description and Location 

"-yUP'^ 

Pre-Existing Condition of Structures 

Does your Basement have a history of leaking? Yes -i ^ No 

Item# 

OnM^ 

Description & Location 

Property Owner 

Signajimr 

^JJST.JJM^ 

Prudent Employee 

Signature: 

\lLYvmM^.^ic^ i 

8080 Vtard Paricway, Suite 405 

Kansas City. MO 64114 

Plione: (816) 363-3703 

Fax: (816) 363-3707 

2505 N. 24*^ Street. Suite 308 

Omaha, Nebraslca 68110 

Phone: (402)504-1004 

Pay i»tn\ RnA.innc 

4242 Medl(»l Drive, Suite 4260 

San Antonio, TX 78229 

Phone: (210)822-9588 
3loM 

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 ofproperties 

located in Omaha, Nebraska, including the property located at ^^^ ^ ^rAJj\yn fn]nrt' /?-<•/€-. 

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 ofthe 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^ohngon. 

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 

ofifice). 

Property Access Granted By 

^ OPIease Print Name) 

Propeity Owner Signature: 

RESIDENT NAME: 

r /hyc^yu^ 

(Signature) (Date) 

PROPERTY INFORMATION 

(To be completed by reiident and/or property owner - please print) 

- D f-^ F 

Owner Renter 

RESIDENT ADDRESS:. 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

OWNER'S TELEPHONE NUMBER . HOME 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD 

: d{CS, If 5 ^ > WORK: J L 

. 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: 

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

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be iinplemented by EPA under this agreement are pursuant to Section 104 

of CERCLA, 42 U.S.C. 9604. EPA's ri ^ of access to flie property isprovided for ii Section 104(e) of CERCLA, 42 U.S. C 9605(e), which provides entry 

for "determining the need for response, or choosing ortaldng any response action under this title, or oflierwise enforcing flie provisicns of tlie title." 

1080 Ward Paricway, Suite 405 

iansas Clly, MO 64114 

'hone: (816) 363-3703 

ax: (816) 363-3707 

2505 N. 24*" Street, Suite 308 

Omaha, Nebraska 68110 

Phone: (402)504-1004 

4242 Medical Drive, Suite 4250 

San Antonio, TX 78229 

Phone: (210)822-9588 

r.» . t*tMm 
Current Sample Pre-Renovatio . « . n Form 

EfTectlve until April 2010. 

Confirmation of Receipt of Lead Pamphlet 

l3|[ i have received a cc^y of the pamphlet. Renovate flight: Important Lead Hazanj 

' m/bmiatfon fbr Families, Child Care Providers and Schoofe IrTfonnlng me of 

tha potential risl< of the lead hazard exposure from renovation activity to be 

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

C/^/Pf^ Kl^^cL ^O^r^f^ 

PrintecLnameof reclplertt ; Date 

^^:;2zSlgnature of recipient 

Self-Certification Option (for tenant-occupied dweilings onl ^ — 

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

you msy checl< the appropriate box below. 

Q Refusal to sign — I certify that I have made a good M h effort to deliver the 

pamphlet, RsncmHe FSght: important Lead Hazard Irrfbrmatkm for Families, 

Child Care Providers and Schools, to the rental dwelling unit listed below at the 

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

of receipt. I fiirtiier certify tiiat I have left a copy of tiie pamphlet at the unit witii 

the occupant. 

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

deliver ttie pamphlet, Fienovate FVght Important Lead Hazard infonnation for 

Families, ChUd Care providers and School, to tiie rental dwelling unit listed 

below and tiiat the occupant was unavailable to sign tiie confirmation of receipt. 

I furtiier certify tiiat I have left a copy of the pamphlet at tiie unit by sliding it 

under tiie door. / 

Printed name of person certifying Attempted delivery 

<2. 

date and time 

lead pamphlet delivery 

Sl^tur e of person certifying lead pamphlet delivery 

(-/ 

.^^^ ^ /^yn^^ /^/^ ^ n^/ ^ 

Unit Address 

Note Regarding IMailing Option — As an attemative to delivery in person, you 

may mail tiie lead pamphlet to ttie owner and/or tenant. I=>amphlet must be mailed 

at least 7 days before renovation (Document witii a certificate of mailing from tiie 

post office). 
paint match fonrr^ 

Paint matching form: —/^$ ^ 

Property address: L^- j a 

ovTn BVID*: i/ I 

Area: color: 

Explanation: 

Area: color: 

Explanati on: 

Area: Color: 

Explanation: 

Area: color: 

Explanati on: 

Area: Color: 

Explanation: 

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OfflMte. 
Douglas County Account InfoMation :amaa Page 1 of2 

Douglas County, Nebraska ProperlY Record - R1613720000 

Information is valid as of 2008-9-4 

Print Report 

NEW FMtuie - Parcel Dimensions avaHable @ scale 0-50 ft west of 90th St - VieVtf O n Ma p 

Treasurer's Tax Report 

New Feature -•.-•' * Auto Sales Search 

Owner 

KNOWLES ADRIAN 

ETAL 

2447 CROWN POINT AVE 

OIVIAHANE 68111-0000 

T? ^pyO ^ 

;v>c> ^ r ^ 

Property Information 

Key Number: 1372 0000 16 

Account Type: Residential 

Parcel Number: 1613720000 

Parcel Address: 2447 CROWN POINT AV 

OMAHANE 68111-0000 

Legal Description: IJ^URELTON AD D LOT 13 BLOCK 3 45 X 120 

Value Information 

Land Improvement Total 

2008 $2,500.00 $35,400.00 $37,900.00 

2007 $2,500.00 $37,300.00 $39,800.00 

2006 $2,500.00 $37,300.00 $39,800.00 

2005 $2,500.00 $37,300.00 $39,800.00 

2004 $2,500.00 $23,500.00 $26,000.00 

2003 $2,500.00 $23,500.00 $26,000.00 

Land Information 

Acres SF Unita Depth Widtii Vacant 

0.12 5400.0 1.0 120.0 45.0 No 

Improvement Information 

Building 1 

http://douglasne.maDDine-online.com/DouelasCoNe/static/accoi)ntiTifn isTi9nrrT.iintnn=P i n anAnnns 
Douglas County Account In&|matio n&cma n Page 2 of2 

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Square Footage: 

Perimeter 

Unit Type: 

Built As: 

HVAC: 

Exterior: 

Interior: 

Roof Cover: 

Roof Type: 

Floorcover: 

YearBuilt 

1915 

1406.0 

0.0 

1 1/2 Story Fin 

Forced Air 

Frame Siding 

Drywall 

Composition Sliingle 

Gable 

Allowance 

year 

Remodeled 

0 

Detail Type 

Appliance 

Basement 

Fixture 

Fixture 

Garage 

Porcii 

Porch 

User 

Percent Complete: 

Quality: 

Condition: 

Condo Square Footage: 

Rooms: 

Units: 

Baths: 

Bedrooms: 

Stories: 

Foundation: 

Sprinkler Square Footage: 

Percent 

Remodeled 

0% 

Adjusted Year 

Built 

1915 

100.0% 

Fair 

Fair 

0.0 

7.0 

1.0 

1.0 

4.0 

1.5 

Block 

0.0 

Physical Age 

94 

Detail Description 

Allowance 

Bsmnt Block 8 ft 

Base Fixtures 

Batli Full 

Detaclied 

End Screen 

Slab Roof Ceil 

Attic Full Finisii 

Unita 

1.0 

960.0 

1.0 

1.0 

528.0 

192.0 

50.0 

384.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.isT)?ar,nniintnr.=p i A O/O/I nnr\o 
Prudent Property Close-Out Form ( Lead-Based Paint Stabilization) 

SAID: 3iby_ 

Property Address: XQ^f l Kr^Mn J pJUtT t Ui/ i 

Owner's Name; <„^Yv/yyc^ fy/Yvr^j4sy> ^ 

Performance Standards/close-Out Criteria YES NO 

1. Was tiie entire structure(s) painted with tiie exception of the stated, excluded areas? This would 

inciude painting of other associated features including fascia, eaves, siding, ali trim, porches, box 

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

2. Was all scraping and other preparattion work completed satisfactorily? 

3. Were all required areas ofthe structure(5) primed as needed 3nd painted with two top coats? 

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

5. Are ali of the areas where contaminated materials have been spilled 

thoroughly vacuumed/ cleaned? 

X E i 

X 

1 5. Did the contractor collect/vacuum ai! falli.ng and scraped paint chips on the entire property, 

roacways, alleyways, public access areas and also remove any other generated debris? 

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, bar.ner tape etc. 

properly removed? 

Jd 

IX 

9. Is there any evidence of property 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 temporatily re-located by the contractor 

that need to be moved back? pr 

11, Are there any (known) lingering issues with the property ownsr(s) that have been left unresolved? 

Other Considerations?propertY Owner Discussions?Additional Work that is Required 

Prudent Representative Signature://^^^^,^^^^^^^^^^ 

Property Owner Signature: ^^>yO^<n ^ h^^^ a 

Date: (7-17-^ ^ 

) ^