## TRANSMITTA L o f

OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R 

# SAI D # : ii3SVU

_Date : g- Z I • O ^ Address : Remediatio n Contractor : PROFESSIONA L ENVIRONMENTAL ENGINEER S Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S -B ^ Vide o ofpropert y (DVD ) '^Q ^ Executiv e Summar y SignedAcces s Agreemen t fo r

subject propert y \y' ^ Paintin g Agreemen t D Settlemen t document s (i.e. , fo r

dmnage o r

t

o replac e plants , etc. ) ^(J/^Photograph s b^tjfor ^ ^^ A /?f ^ ,,,.. , ^ , y Satisfactor y restoratio n signedby Propert y Owne r 0 Propert y close-out check lis t signedby EP A fi—^^^^^'^roperty information fro mDougla s Count y Assessor' s Office \ Z confirmation tha t lea dpamphle t "Renovat e Right " wa s receive dby P0 _ D n 3020386 0 

# 0 HZZZZIZZ^ZI I liliii i Superfun d


### Professio ngineer s Signatur e ^ - ^ ^ 

# ^m ^ >ignatur e

## PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC
. ''°'''oll^ t NE^BI! o "Providin g cost-effectiv e environmenta l solutions " ^ i^°^ | c^lto! ? ^

Fa x(402 ) 504-328 1 Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yRespons e



### LeadBas e Stabilizatio n Omaha , N e Clos e Ou t Report 200 9 SAID #6351 6 245 1 Fontenell e Bd .

•Date s worked : 08/1 3 t o 08/1 4 200 9 •Pr e propert y condition : Hous e ha dwoo dsidin g wit h woo dtrim s flaking an dchippin g pain t in ver y poo r conditio n woo dporc h floors an dtri mare awa s al l i n poo r condition . Pain t chip s in yard . Garag e ha dcement an dwoo dsidin g tha t i s painte dan din ver y poo r condition . Many vine s ha dt o b e remove don hous e prio r t o stabilizatio n process . •

Problem s encountered : None •

Owne r request/concerns : N/A . •Inspection/closeou t dates . Owne r signe d08/1 4 2009 . Inspecte dby PE projec t manager .\ •- » 

# CONSEN T FO RACCES S T O PROPERT Y OMAH A LEA D SIT E REMEDIA L ACTIO N - LEAD-BASE D PAIN T STABILIZATIO N PROPERT Y ID : ( OrVSllj ) PROPERT Y ADDRESS : ^^S\Tr\r\\ry\^\\ t T\K// ^ !:RNAME : Tf^r-T^ . V.anW\e. r DAYTIM E PHONE : ^^^3

- I^DTb CELL PHONE : E-MAIL : OWNER' S ADDRES S I FDIFFERENT : TENANT' S NAM E I FAPPLICABLE : 

### DAYTIM E PHONE : CEL L PHONE : E-MAIL : Professiona l Environmenta l Engineers , Inc . (PE ) i s unde r contrac t (#EP-R7-08-06 ) wit h th e U.S . Environmental Protectio n Agency (EPA ) t o stabiliz e leadbase dpain t (LBP ) o n residentia l structure s a t anumbe r o

f propertie s locate di n Omaha , Nebraska . Th e pain t stabilizatio n wor k

i s bein g don e t o protec t th e soil cleanup s tha t ar e bein g performe db y EP A contractors . Pain t stabilizatio n activitie s will include : scrapin g o f cracke do r flaking LB P fromstructures , applicatio n o f aprim e coat an dtw o (2 ) coat s o f paint . Movin g part s o f window s an ddoor s ar e no t include dan dwil l no t b e addressed . You r cooperatio n i s requeste di n giving permissio n t o thi s EPA contracto r (PE ) t o ente r an dhav e acces s t o thi s propert y for th e purpos e o f stabilizin g lea d-base dpain t a s outline do n th e propert y identifie dabove .

- -

* B y signin g thi s documen t I agre e t o allo w an EP A contracto r t o conduc t asoi l cleanu p a t m y property followin g completio n o f lead-base dpain t stabilization , if th e soil cleanup ha s no t alread y been performed . I understan dtha t th e stabilizatio n contracto r ca

n no t provid e assurance s tha t th e soii cleanup contracto r will b e boun dto . I furthe r understan dtha t th e soil cleanu p contracto r wil l mak e al l reasonabl e effort s t o addres s concern s tha t I , a s th e propert y owner , ma y hav e regardin g soi l cleanu p a t

Signatur e o f Propert yOwne r Dat e 

## ^-I b I full y understan dtha t by signin g thi s Consent for Access , (1 ) thi s acces s will remai n in effec t unti l th e wor k

ha s bee n satisfactoril y completed , (2 ) tha t th e Propert y Owner o r Tenant , i f applicable , will b e give n th e Housin g an dUrba n Development (HUD ) an dEP A pamphlet , '^Renovat e Right , Importan t Lea dHazar dinformatio n fo r Families , Da y Car e Providers , an d Schools" , (3 ) th e Propert y Owne r o r tenan t wil l remov e al l obstruction s fromsurface s t o b e painted , (4 ) wil l abid e b y health an d safet y guidanc e provide db y EPA , (5 ) wil l allo w photograph y ofpropert y before an dafte r th e pain t stabilizatio n work , (6 ) will b e contacte db y aPE representativ e approximatel y 4 8 hour s i n advanc e o f startin g work , (7 ) agre e no t t o obstruc t o r tampe r wit h an y ofth e LB P stabilizatio n actions , an d(8 ) wil l participat e in final propert y inspectio n an dsign th e Completio n Agreemen t an d Propert y Owne r Satisfactio n Survey . Shoul dyo u hav e an y question s abou t th e plane dLeadBased-Pain t stabilizatio n activitie s for you r property , pleas e contac t Professiona l Environmenta l Engineers , Inc . Projec t Manager , Willi e Cla y A t 402-504-4688 . General question s abou t th e Omah a LeadSit e cleanup can b e directe dt o Paulett aFrance-Isetts , EP A Remedia l Projec t Manage r 402-731-2454 , o r th e EP A Publi c Informatio n Center s a t 402-991-958 3 (Nort h Omah aoflice ) o r 402-731-304 5 (Sout h Omah aoffice) . I&^l l Yes , I gran t acces s t o m ypropert yan d wa s give n th e pamphle t D No , I d o no t gran t acces s to m ypropert yan d I wa s "Renovat e Right , Importan t Lea d Infonnatio n forFamilies , Chil d give n th e pamphle t "Renovat e Right , Importan t Lea d Car e Projtidefs , an d Schools. ' Infonnatio n for Families , Chlld e Car e Providers , an d Schools. " SIgnahir e Dat e SPECIA L INSTRUCTION S AN D CONSIDERATION S

## PAIN T STABILIZATIO N PRE-PROPERT Y PAIN T MATC H ASSESSMEN T

AREA(S ) T O B E PAINTED : HOUS E PROPER : COLOR : 

# y^ s i^i ^ M (

HOUS E TRIM : COLOR : 

# ^

S 

# 707 5 ^ GARAGE : 

# i& S COLOR : 

# B.y/0^ ,
GARAG E TRIM : COLOR :
PORCH : COLOR : 

# : 

# imf ^ 7/Jg , \ 

# 7/97^- ^ PORC H TRIM : COLOR : ^ (COMPLET E AL L SECTION , YES , NO , O R NON-APPLICABLE )



### I AGRE E T O TH E COLOR S LISTE D ABOVE
. ONC E TH E PAINTIN G BEGINS , I UNDERSTAN D I CA N NO T CHANG E TH E ABOV E SELECTE D COLORS : PROBERTYVDWNE R SIGNATURE : P E ACCESO R SIGNATURE : 

# 1

# PROFESSIONA L 250 5 NkHt h 24«<
. Suit e 21 9 

# ENVIRONMENTA L ENGINEERS , INC
. Omaha , N E 6811 0 (402)504-468 8 

### "Providin g cost-effectiv e environmenta l solutions " Fa x (402 ) 504-328 1 miiamaaamm^emma^^mim^ammtammmmmmammimiimB/BmmaBmammmiaaaaK i Consultin g • Engineerin g Desig n * Remediatio n • Abatemen t • Emergenc y Respons o 

### Propert y Owne r Close-Ou t For m (Lead-BasedPaint Stabilizatio n EP A Contrac t EP-R7-08-06 ) SAID : (p^B' l ( Q ^ Propert y Address : ?AB\MllJO^^vS aK ^ Owner'sName : ^C\r^^$(\ilV " Performanc e Standards/Ciose-Ou t Criteri a YE S N O 1 . Was th e entii e structure(s ) painte dwit h th e excq)tio n ofth e stated , exclude d areas ? Thi s woul dinclude paintin g ofothe r associate dieatin« s includin g fiiscia, 1 ^ 

### eaves , siding , al l trim , poicfaes , bo x beams , colimms , rails , andexterio r surface s o f garages . 2 . Was al l scraping andothe r

preparatio n wor k

completedsatisfactorily ? 3 . Were al l require darea s o f & e structure(s ) prime da s neede dandpainte dwit h tw o to p coats ? 4 . Wa s di e paint product s utilize dequivalen t t o a3 0 yea r

product/quality ? 5 . Ar e al l ofth e area s wher e contaminate dmaterial s hav e been spille dthoroughly vacumned/cleaned ? 6 . Di dth e contractor collect/vacuim i al l fidling andscrapedpaint chip s on th e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y 

# y othe r

generateddebris ? 7 . I s th e gras s are atha t sunound s th e structure(s ) in reasonably goo dcondition ? 

## y 8 . Ar e al l item s suc h a s polye&ylene sheeting , ladders , paint brushes , cones , barrie r

tape , etc . properly removed? 9 . I s there an y evidenc e ofpropert y damag e tha t wa s don e by th e contractor ? An y propert y damag e need s t o b e completedprio r t o & e EP A Close-Ou t 10 . Are there an y propert y itep s tha t wer e temporarily re-locate db y th e contractor tha t nee dt o b e movedback ? 11 . Ar e tiiere an y (known) lingerin g issue s wit h th e propert y owner(s ) tha t hav e 

# y bee n lef t unresolved ? Comments : 

## j'-'^/f^'" ) Dat e 

# ^yyy . _^y±-a p Dat e Professiona l En^nmienta l Engineer s Representativ e

### Dougla s County Accoun t Informatio n Pag e 1 of 2 

# " 1 ^__ua6i u Dougla s County , Nebrask a Propert y Recor d - R081154000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t o f 52n d S t - Vle W O H Ma p Informatio n i s vali d a s o f 2009-6-1 6 Treasurer' s Ta xRepor t Ne w Featur e •*••- • Aut o Sale s Searc h 

### Owne r BANTNE R JOH N S ETA L 245 1 FONTENELL E BLV D 

## C^'b'^

- l^O O OMAH A N E 68104-000 0 Propert yInformatio n Ke yNumbe r 115 4 000 0 0 8 

# A 

# L Accoun t Type : Residentia l Parce l Number : 081154000 0 

### LAJ^);) - 

## CiX^-^^ ^

CJC ^ Parce l Address : I 245 1 FONTENELL E BD , -OMAHA-NE-68' 1 W-OUO O Lega l Description : CLAIRMON T LO T 3 2 BL0CKs 3 5 0 X 12 5 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $ 6,400.0 0 $ 63,700.0 0 $ 70,100.0 0 200 8 $ 6,400.0 0 $ 63,700.0 0 $ 70,100.0 0 200 7 $ 6,400.0 0 $ 63,700.0 0 $ 70,100.0 0 200 8 $ 6,400.0 0 $ 63,700.0 0 $ 70,100.0 0 200 5 $ 6,400.0 0 $ 44,400.0 0 $ 50,800.0 0 200 4 $ 6,400.0 0 $ 40,400.0 0 $ 46,800.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 4 6250. 0 1.0 125. 0 50. 0 N o Improvemen t Informatio n Buildin g 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R081. . . 7/9/200 9

### Dougla s County Accoun t Informatio n Pag e 2 of 2

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aiHXSOlSPto w 3SE

r :m< t £15 0 51? . i . i i StO ' 2STOR Y

CLIC KT O ENLARG E IMAG E Squar e Footage : 1439. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 2 Stor y Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 5. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 5 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0 

### Roo f Type : Gabl e Stories : 2. 0 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 5 0 % 191 5 9 4 Detai l Typ e Deta/ 7 Descriptio n Unit s Ad d O n Fenc e Chai n Lin k 1. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 624. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Fixtur e Bat h Hal f 1. 0 Garag e Detache d 240. 0 Porc h En d Scree n 180. 0 Porc h Sla b Roo f Cei l 192. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R081. . . 7/9/200 9

## M C Services , LL C PrcpenvAddres s %VS\^^'A^
. MM ^

Da. e ^H-Cf l Star t Date 

### Amoun t O f Prim e An d Pain t Use d Prim e (Gallons ) / „

Pol y (Boxes) / Pain t (Color ) |L3 | W Amoun t (Gallons ) ^ Pain t (Color ) K^^oif ) Amoun t (Gallons ) /^c S Pain t (Color ) ^ Amoun t (Gallons ) Pain t (Color ) Amoun t (Gallons ) Pain t (Color ) ^^^ ^

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