TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID: 35601 Date 01/12/09 

Address: 3721 Saratoga St. "i^L 

Remediation Contractor: Prudent Technologies Year: 2008 A 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS '^ 

0' Video of property (DVD) 

y Executive Summary 

0' Signed Access Agreement for subject property 

y Painting Agreement 

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

D Photographs 

y Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

0' Property information from Douglas County Assessor's Office 

D 

D 

D 

Signatured Date 

40307996 

nil l 

Superfund 
PROPERTY SUMMARY 

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

Property Address: 3721 Saratoga St. SAID: 35601 | 

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: 11/24/2008 

Work Began: 11/26/2008 

Closeout Date: 1/6/2009 

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 

TECHNOLOCIES. INC. 
i 

GB ENVIRONMENTAL AND CONSTRUCTION 

GARY JENKINS 

4302 MAPLE ST PH. 402-880-9100 

OMAHA, NE 68111 

PAY /

TOTWE 

ORD|a-OE, 

First Nolional Bankk / IS

^U Doage SInct • Omlie, NE «ai97 3*^/ F^'- M' E .^yMiiLLA7maa02ii±Fl^~^ uy7 

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PROPERTV SUMMARY _. 

Date: ? a ­ / / | LBP STABILIZATION EPA CONTRAT EE417-08-07 

„ a .. . 

1 Proper^ Addrew: SI S i S «^' c^+ CJ.-. C

A. EXECUTIVE SUMMARY 

Al bsnes Enconntered: <>U.«.oSi t>orc»>~^ Gd>\.<sr AJit-i 

1 Month of: | 

1 

A2 bsneiRcsolvecl: 

A3 Uniqae Findings: 

122^4 Odier Rdcrant Infonnation: 

En^mnta; 
AtXBSS i^^i^ORHATicr^TRAOKING SHEET 

VnfffilOwAvf* /^gy/t keiAky 

iVBNIwOflHMDR E^^enitMB I taeaspr CourMcroemn. : 

l^/4| f->y / T j fM€)- oton^y cd- j^y^€A)/v. 

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iup.//uougiasne.mapni|c-onIine.com/DouglasCoNe/static/accountinfo )n^' ­ . 

Douglas County, Nebraska Property Record - R0804950000 

Print Report 

NEW Feature - Parcel Dimensions available © scale 0-50 ft west of 9Dtin St - VJeW OH Ma p Information is valid as of 2008-11-5 

Treasurer's Tax Report 

New Feature -»-*- » Auto Sales Search 

Owner 

KEITHLEY ROBERT A 

ETAL 

i 3721 SARATOGA ST 

i OMAHA NE 68111-0000 

Property Informatio n 

Key Number: 0495 0000 08 

1 

i 

i 

1 

Account Type: Residential 

Parcel Number: 0804950000 

Parcel Address: 3721 SARATOGA ST 

OMAHA NE 68111-0000

Legal Description: ; CENTRAL PARK LOT 5 BLOCK 19 60 X 125 

| 

i 

i 

Value Informatio n i 

2008 

i Land 1 

$5,300.00 

Improvement 

$12,700.00 

Total 

$18,000.00 

2007 $5,300.00 $12,700.00 $18,000.00 ; 

2006 $5,300.00 $12,700.00 $18,000.00 1 

2005 $5,300.00 $4,600.00 $9,900.00 

2004 

2003 

$5,300.00 

$5,300.00 

$4,200.00 

$4,200.00 $9,500.00 

$9,500.00 

Sales Informatio n 

Sales Date: \ 2007-06-29 1 

1 

Deed Type: : QC M j SooAr: 2007 Page: : 073972 

Price: \ $0.00 

Grantor: KEITHLEY ROBERT 

1 

Grantee: . KEITHLEY ROBERT A ETAL 

Valid/Invalid:

Exclusion Reason:

 Invalid

 Multiple Parcel Sale 

j 

[ 

Sales Date: 2007-05-21 1 

Deed Type: QC M Book: j 2007 Page: \ 059941 

Price: : $11,000.00 

Grantor: ! REESE ERMA E 

Grantee: \ KEITHLEY ROBERTA 

Valid/Invalid: | Invalid 

Exclusion Reason: : Multiple Parcel Sale 

1 of 2 11/24/2008 11:18 AM 
nnp://clouglasne.mapni|tt-online.com/DouglasCoNe/static/accountinfo. 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.17 7500.0 1.0 125.0 60.0 No 

Improvemen t Informatio n 

A40.0 so f. 

F« l Roci !.,:.i ' 612.0 sqU , - , _j y L. .... -:, 1 ""1 r"" 1 1 1 ^-7 STORy !•'' • • • 

1 " •.. i Simm • —

 Baxk « * «:2.llKi.11. 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: ; 1052.0 Percent Complete: i 100.0% 

Perimeter i 0.0 Quality: Fair 

Unit Type: Condition: Fair -H 

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

HVAC: 

+• Central Air to Air Rooms: j 6.0 

Exterior: Frame Aluminum Units: I 1.0 

Interior: Drywaii Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: \ Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: ; 0.0 

YearBuilt Year

Remodeled

 \

 \

 Percent

 Remodeled 

\ Adjusted Year 

Built Physical Age 

1908 0 0 % ; 1908 101 I 

Detail Type ; Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 612.0 ' 

Fixture Base Fixtures 1.0 1 

Fixture Bath Full 1.0 ! 

Garage Attached 322.0 1 

Porch i End Screen 102.0 ; . L. • 

Zof 11/24/2008 11:18 AM 2 
Current Sample Pr^enovation Fonn 

Effective until April 2010. 

Confinnation of Receipt of l.ead Pamphlet 

Q i have rec^ved a copy of the pamphlet, Renovate R^/7t;//nportanr Lead HazarcT 

/nfcrmattjn for Families, C M Care Provkiers and Schools infbmiirig me of 

the potential risk of the lead hazard exposure from renovation activity to be 

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

Printednaiteofr^lptent V/ •, j / Date ' 

hl'p;\\ Signature of recipie 

t

Saif-CettHication 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. 

a Rsfiisal to sign — I certify that I have made a good faith eRbrt to deliver the 

pamphlet, F^novate Right knportant Leed Hazani Infonnation for FamSies, 

Chiki Cam Provkiers and Schoois, to the rental dwelling unit listed below at the 

date and time Indicated and that the occupant refused to sign the confirmation 

of rec^pt. I further certify that I have left a copy of the pamphlet at the unit with 

thte occupant. 

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

defiver the pamphlet, Renovate FSg^t Important Leed Hazard Information for 

Raises, Ct M Cam provkiers said Schools, to the rental dweii'mg unit listed 

l3^aw ffiid thiat the occupant was unavailedite to sign the confirmation of receipt, 

i further certify that I have left a copy of the pamphiet at the unit by sliding it 

under the dooe 

F'rinted name ofF persopersonn g certifyin certifying 

 Attempted delive^

dateandtime 

lead pamphlet deiivery 

Signature of per^n ceilffying lead pamphlet defivery WWII wwruijiii ^ i^AMJ poiiipiiiaf c U9llVdjr f 

7!?/fj//.7^Q. /U t 

Unit Address 

Note Regarding Mailing Option — As an alternative to delivery In person, you 

tnay iTiail the lead pamphlet to the ovmer and/or tenant Parnphlet must be rnailed 

at least 7 days before renovab'on (Document with a certificate of mailing from the 

post office). 
Sou 6/ 

Prudent Technologies, Inc. (Prudent) is under contract (Contract # EP-R7-08-07) withtiie 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 "^'7 O> Fr» nc^-F^ (\6 FV . 

The EPA requests your pennission to allow Prudent to perform LBP Stabilization attiiis pr^jerty. By 

signingtibis form,tiie property owner grants pennission to Prudent to perform activities related to LBP 

Stabilization mcluding scrqmig paint and painting oftiie referenced property. Furtiier, tiie owner/^iait 

verifiestiiattiiey have received tiie LBP pamphlet "Renovate Right" 

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

l^rfmifitatTfttlve Clerk for the Lead Based Paint Stabilization, Mrs. Deborah Akerele-Jnhimnn, 

at (402) 504-1004. Graeral questions abouttiie Omaha Lead Site cleanup can be directed totiie EPA 

Public Information Centers at (402) 731-3045 (Soutii Omaha office) or (402) 991-9583 (Norfli Omaha 

office). 

Pnpn ^ AcosnOmtcd 03^: 

T A l ^ (Please I>rintNan«) 

Propo^ Otner SignilBie; 

- * y (Signature) Tj /(Date)/ 

PROI>ERTY INFORMATION 

(To be completed by raldcat tad/or propcrtjrowiier-pleaae print) 

neaiPHinrmiie. Q^\7 t >W?/^./^v / A^ ^ Ranter 

2fSL 

iP RENTAL, PROPERTY OWNED BY: 

OWNERfSHABJNOAWRESS: -y^tlmxt 

OWNER'S TELEPHONE NUIiaeR. HOME: t'^ ^ ^ ^"T^WCmK' . t \ 

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

NUMBER OPCHILDREN UNDER 7 YEARS OLD WHO PU Y IN THE YARD FOR 6 HOURS OR MORE PER WEEK: :2.. 

C0MMBIT8 OR SPECIAL INSTRUCTIONS: (I.E. DOGS, ENTRY OATES, ETC.) 

AUmORTTY FOR ENVIRONMBNTAL RESPONSE ACTKJNS; The aeti^ee tpbe impleineniedbyEPA under diaegreenMntafepunuint to Seclbn 104 

of CERCLA, 42 U.&C 9604. BPA'i rigbt of aooess lo flw property itprovlded for ia Section 104(e) of CERCLA, 42 U.S. C 9605(e). wiilcb ptovidM eMy 

fbr ^fctnnninliigflR need (br (oiponie, or cliooaing ortaking any letponse action under ftii tide, or odietiri 

QSOWhid Partcway. Suits 406 2608 N. 24* Straot, Sutte 308 4242 fWodicalOflva. Suit* A^m 
ENVIRONMENTAL A 

COl^iSTRUCnON TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Phone: <|/55--7(^^ q BVED:5<5(tO| 

Plant & Permanent I .anA^capinpr To Rei^ain In Place 

Item^ 

Description and Location 

On Map 

fiC^J LA/C^ ^ A ^ hr^iA^e tAJ>U.eA) ha fef s hten/ie^ 

/the? c7hyt4*A<y^ lif/d-i: /emc>LA^. 

Pre-^^^s^g Condition of Structures 

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

Item# Description & Location 

OnMi^ 

» torM^ " ke^d ^ m»S"^»/1^ t<7 ^ CcryieA 

Prudent Employee 

Signaturey^'fyi/j/^ : 

^ Isign-ure: '^/J/fiU^-^J4242 Madlcal Diive. Sutta 4260 2606 N. 24* StaMt, Suite 308 8080 Ward P«tamy, Sidto 406 Omaha, Nabmi a 66110 San Antonio, TX 78229 Kmn s City. MO 64114 

L 
Prudent Property Close-Out Form ( Lead-Based Paint Stabiiization) 

SAID: ^If O / y 

Propeity Address: 21X I ,^fi^m/^/{ ^ ^ 

Owner's Name; fisftlj^L. /TtyTTJl - — —

a f

Performance Standards/close-Out Cnteria YES NO 

'' 

include painting of other associated features including fascia, eaves, siding, all trim, porches, box 

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

Was the entire structure(s) painted with the exception of the statsd, excluded areas? This would 

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

3. Were all required areas of the structure(s) primed as needed and painted with two top coats? 

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

Are all of the 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, 

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

1. Is the grass area that surrounds the structure(s) in reasonably good condition? y" 

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

 ^ 

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. y

10. Are there any property items that were temporatiiy 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? -7 

y Other Considerations?property Owner Discussions?Additiorial \A/ork that is Required 

Prudent Representative Signature: 

Date 

Property Owner Signature: >2 ^ 

Date: i _ ^ -o ^