0 

f 

TRANSMITTAL of OMAH A LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID #: L Date: \\J\2.j\ l 

Address: 9.22. M UOp\^.f ^ 

Stabilization Contractor: Professional Environmental Engineers Year: 20X l 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Summary 

Signed Access Agreement for subject property 

Pre-Renovation Form signed by Property Owner 

Pre-Renovation Form for Occupant/Tenant, if applicable 

Painting Agreement / 

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

X 

Renovation Recordkeeping Checklist signed by Certified Renovator 

Photographs 

X Satisfactory close-out check list signed by Property Owner 

Property close-out check list signed by EPA 

Property information from Douglas County Assessor's Office 

Hazard analysis, if prepared 

a 

Safety Audit 

Other (describe): 

I Engineers Signature 

WCOR Si^ature ^ Date 

(after file folder review) 

40377558 

Superfund 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. ''"'Trlla'htNES^Io 

"Providing cost-effective environmental solutions" ^ Consulting • Engineering Design • Remediation • Abatement • Emergency Response ^ i^««!!21in!? 

 Fax (402) 504-3281 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

2011 

SAID# 29692 

2224 Maple St 

Dates worked: 8/16 to 8/16 2011 

Pre property condition: House has painted wood siding with painted wood trims and 

foundation areas. Paint was flaking off in areas. 

Problems encountered: None. 

Owner request/concerns: N/A 

Inspection/closeout dates. Owner 8/17/11 EPA 8/19/11 
2011 

PROFESSIONAAl f 

2505 North 24^ Suite 219 ENVIRONMENTAL ENGINEERS, INC. Omatia, NE 68110 

(402) 504-4688 "Providing cost-effective environmental solutions" Fax (402) 504-3281 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

EPA Close-Out Form 

(Lead-Based Paint Stabilization EPA Contract EP-R7-08-06) 

SAID: 

Property Address: 2.2.^M n<^pk ^ / 

Ovmer's Name: l4:^r>ir:)A<^vNf\ ZX^JP>X«^^ ^ 

Performance Standards/Close-Out Criteria YES NO 

1. Was the entire structure(s) painted v^th the exception ofthe stated, excluded areas? This 

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

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

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

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

4. Was the paint products utilized equivalent to a 25 year product/quality? 

5. Are all ofthe areas where contaminated materials have been spilled thoroughly vacuumed/ 

cleaned? L/ ^ 

6. Did the contractor collect/vacuum all falling and scraped paint chips on the entire property, 

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

7. Is the grass area that surrotmds the structure(s) in reasonably good condition? 

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

9. Is there any evidence ofproperty damage that was done by the contractor? Any property L ^ ' damage needs to be completed prior to the EPA Close-Out. 

10. Has the property owner signed the completion form? 

11. Are there any property items that were temporarily re-located by the contractor that need to 

be moved back? 

12. Are there any (known) lingering issues with the property owner(s) that have been left u y unresolved? 

Other Considerations/Property Owner Discussions/Additional Work that is Required: 

?//?/^0 

EPA COR Signattire Date 
PROFESSIONAL 

25J5 f;:':. 24 •. S^'.i 219 ENVIRONMENTAL ENGINEERS, INC. O-ar a ri^6£ i IC 

;4J2; 504-4530 

F-;' i4'.'2. 5J4-32 S 1 

2011 

Property Owner Close-Out Form 

(Lead-Based Paint Stabilization EPA Contract F.P-R7-08-06) 

SAID: _M£12 . 

Property .Address: D.pj^? \ /VU^LgT ^ 

Owner's Name: i^i\OiS CAUUy^l^^ 

Performance Standards/Close-Out Criteria i NFS ! NO 

1. Was the entire structure(s) painted with the exception ofthe stated, excluded areas? This j I 

would include painting of other associated features including fascia, eaves, siding, al! trim, i ^ ^ | 

porches, box beams, columns, rails, and exterior surfaces of garages. ^ _ |_ 

2. Was all scraping and other preparation work completed satisfactorily? • V ] 

3. Were all required areas of the structure(s) primed as needed and painted with two top i /y I 

coats? _^ _\ ^ ; 

4. Was the paint products utilized equivalent to a 25 vear product/quality? ' ^ I _i 

5. Are all of the areas where contaminated materials have been spilled thoroughl) iS/ ^ i 

vacuumed/ cleaned? : ^ i 

6. Did the contracior colloct.'\acuuni all falling and scraped paint chips on the entire ' 

property, roadways. alle> wa>s. public access areas and also remove an> other generated Hy • 

debris? 

^- 1. Is the grass area that surrounds the structure(s) in reasonabK good condition? 

8. /\je all items such as polyethylene sheeting, ladders, paint brushes, cones, barrier tape. I ­

etc. properly remosed? _ _ K 

9. Is there any evidence of propert) damage that was done b} the contractor? An\ properts , jy 

damage needs to be completed prior to the EPA Close-Out. _^ _^ ___ 

10. Are you satisfied with the work perfonned? ' ^ ^ \ 

11. Are there an> propert) items that were temporarily re-located b> the contractor that 

need to be moved back? 

t. 

12. Are there an\ (knovsn) lingering issues with the propert> owner(s) that have been lett 

i unresolved? _ _ "x , 

; Other Considerations.'PropertN Owner Discussions'.Additional Work that is Required: j 

¥^ n/jif 

Properi) Owner Signature Date 

rn-M 

Protessionaf Fnuivnmental Eniiineers Signature r*^'­
Professional Envir^pmental Engineers: EPA Paint Stabilization 2011 

SAID# 

Properw Address 9 9 9 . M UCTi ^ ? ^ 

Stories/ Sidinq type / / ^ Transite

1

 Wood

 1 

 Vinyl Metal Stucco 

Garage?

Date access signed

 Yes

 fZ) 1 1 

 t/o 

V 

Painted? 

Where? 

1 

Yes 

Siding 

Trim 

No 

Pre-video V S 1 11 

Post video 

Contractor Assigned / , , 

Date started

Weather Conditions 

 ^// / / ^ Date ended 'RliL 

I

1

 / 

^ 

Paint used 

Prime used 

Poly used 

Problems/issues 
(etTeciive April 2010) 

RENOVATION RECORDKEEPIN G CHECKLIST 

Name of Firm: QuT(CM^I ^ ^1(^1^ ^ 

Date and Location of Renovation: 

Brief Description of Renovation: 

Name of Assigned Renovator: ^^^R^Qj^h^ 

Name(s) of Trained Workers: 

Name of Dust Sampling Technician, Inspector, and/or Risk Assessor, if used: 

jTCopies of renovator and dust sampling technician qualifications (training certificates, certifications) on file. 

•^Certified renovator provided training to workers on (check all that apply): 

(^ Posting warning signs (S^ Setting up plastic containment barriers 

vZMaintaining containment ^Avoiding spread of dust to adjacent areas 

y^ Waste handling p/^'ost-renovation cleaning 

^ Test kits used by certified renovator to determine whether lead was present on components affected by 

renovation (identify kits used and describe sampling locations and results: 

)^' Warning signs posted at entrance to work area. 

(S, Work area contained to prevent spread of dust and debris. 

2" Windows in and within 20 feet ofthe work area are closed 

ryDoors in and within 20 feet ofthe work areas are closed and sealed 

/ ^ Doors that must be used in the work area are covered to allow passage but prevent spread of dust. 

H'Ground covered by plastic sheeting extending 10 feet from work area - plastic anchored to the 

building and weighted down by heavy objects. 

Z Ifnecessary, vertical contairunent installed to prevent migration of dust and debris to adjacent 

property. 

^ Waste contained on-site and while being transported off-site. 

Renovation Recordkeeping Checklist Omaha Leao Site 
ItflTective April 2010) 

^ Work site properly cleaned after renovation. 

5^ All chips and debris picked up, protective sheeting misted, folded dirty side inward, and taped for 

removal. 

?J Work area HEPA vacuumed to get paint chips from ground surface, ifnecessary. 

jZ! Certified renovator performed post-renovation cleaning verification (describe results): 

_> ! certify under penalty of law that the above information is true and complete. 

^.(/V^ %j'Ji^ 

Name and Title Date 

Renovation Recordkeeping Checklist Omaha Lead Site 
08/11/11 09:02AM PDT lontach Investments, LLC -> 4025043281 

CONSITOT FOR ACCESS TO PRoHlRTY 

OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTV IDj^j^StflS^ PROPERTY ADDRESS: ''/'ZZ^__\^0^\^ _ ? ^ 

OWNER NAME: , 

.•X^rAc:! ^ SL(v(.yrtVii^J . UL ^ DAYTIME PHONEr (^1 - I «f^.^^5» ° 

CELL PHONE: E-MAIL: CifffirHAAiSeiUTy fe &MA/L . Co/r 

OW\ER'S ADDRESS IF DrFFERENT: P-^ A^Jt )|//<fv o/fA/-^ M£ Cintf 

TENANT'S NAME IF APPLICABLE: ..^ j \ .-7 , . ^^. 

l-'^UM^A IV^^A/ DAYTIME PHONE: [^^'-} 1^%-' ^^^7 

Prorewional Environmental Engineers, Inc. (PE) is under contract (#EP-R7-08-06) with the L.S. Environmcnisl Protection 

Agency (EPA) to stabilize ivad based paint (LBP) on re«idcntial structures at a number of properties located in Omaha, 

Nebraska. The paint stabilization work is being done tA protect the soil cleanups that are being perrormed by EPA contractors. 

Paint stabilization activities will include: scraping ofcracked or rtaking LBP from structures, application of a prime coat and iwn 

(2) coats of paint. Moving parts of windows and doors are n^t included and will not be addressed. 

Your cooperation is requested in giving permission to this EPA contractor (PE) to enter and have access to this property for tbe 

purpose oTstabiiizlng lead -based paint as outlined on the pniperty identined above. 

By signing this document I agree to allow an EPA contraiMor to conduct a soil cleanup at my property following completion of 

iead'based paint stabilization, if the soil cleanup has not already been performed. I understand that (he stabilization contractor 

can not provide assurances that the soil cleanup contracior will be bound to. I further understand that the soil cleanup 

contractor will make all reasonable efforts to address concerns that L as the properly owner, may have regarding soil cleanup at 

my property. 

p/Ves, I have read and understand the panataph abOMr j j r^ "z? / I 

Signature of Property Owner Oate 

I fully understand that by signing this Consent for Access, (I) this access wilt remain In effect until the work has been 

satisfactorily completed. (2) that the Property Owner or Tenant, if applicablev will be given the Housing and Urban Development 

(HUD) and EPA pamphlet, "Renovate Right, Important Lead Hazard information for Families, Day Care Providers, and 

Schools", (3) the Property Owner or tenant will remove all obstructions from surfaces to be painted, (4) will abide by health and 

safety guidance provided by EPA, (S) will allow photography ofproperty before and after the paint st^blliMitiAn work, (6) will be 

contacted by a PE representative approiimalely 48 hours in advance of starting worli, (7) agree not to obstruct or tamper with 

any ofthe LBP stabilization actions, and (S) will participate In final property inspection and sign the Completion Agreement and 

Property Owner Satisfaction Survey. 

Should you have any questions about the planed Lead Hased>Paint stabilizatiflu activities for yoitr properly, please conlaci 

Professional Environmental Engineers, inc. Project Manager, Willie Clay or Kelley Sanders At 402-504-4688. General questions 

about the Omaha Lead Site cleanup can be directed to Pauietta France-Isetts, EPA Remedial Pmjcci Manager 402-731-2454, or 

the EPA Public Information Centers at 402-991-9583 (North Omaha office) or 402<T3I^04? (South Omaha office). 

^fes , I gram access to my property and was given the pamphlet G No, I do not gi«nt access to my propeity and I was 

'Renovate ftigm, impoftam Lead intormation tor Families, Child 9lven tht pamphlet "Renovita Right, hiportint Lead 

Care Provltferv, and Schools." InfomiaUoA for Famit<ea, Chltde Care Providers, and Schools.* 
08/11/11 09:02AM PDT lontach Investments, LLC -> 
 4025043281 


^^ ''^ "PAINWTABILIZATIO IHTABILIZATIONN PRE-PROF^ PRE-PROR»iTk Y 

PAINT MATCH ASSESSMENT 

PROPERTY ADDRESS• i m \k\^VA DATE: 

BVIDBrni 

AREA(S) TO BE PAINTED: 

HOUSE PROPER: COLOR: '^:u>SlVv 

HOUSE TRIMi COLOR: 

GARAGE: COLOR: 

GARAGE TRIM: COLOR: 

PORCH: COLOR: 

PORCH COLOR: 

(COMPLETE ALL SECTION, YES, NO, OR NON-APPLICABLE) 

"•!-:*v;;'rt>^.r'T:l:;'-': .•'••! ••••'T - •••'•,:i'i-:[v: 

I AGREE TO THE COLORS LISTED ABOVE. ONGE THE PAINTING 

BEGINS, i UNDERSTAND i CAN NOT CHANGE THE ABOVE SELECTED COLORS: 

PROPERTY OWNER SIGNATURE: PE ACCESOR SIGNATURE: 

i X "^S^^^^ 

• ^ . 
^ d . ^^S(a^ a , 

Douglas County, Nebraska Property Record - R0920810000 

Information is valid as of 2011-7-29 

New Feature «> ^- ^

Print Report 

View Interactive GIS Map 

Treasurer's Tax Report 

 Subdivision Sales Search 

Owner 

lONTACH INVESTMENTS LLC 

POBOX111160 

OMAHA NE 68111-0000 

Property Information 

Key Number: 

Account Type: 

Parcel Number: 

2081 0000 09 

Residential 

0920810000 

Parcel Address: 

Legal Description: 

???4 MAPLE ST 

OMAHA NE 68110-0000 

DENISES ADD LOT 7 BLOCK 3 50 X122 

Value Information 

2011 

2010 

2009 

2008 

2007 

2006 

Land 

$4,800.00 

$4,800.00 

$4,800.00 

$4,800.00 

$4,800.00 

$4,800.00 

/mprov^emenf 

$11,000.00 

$11,000.00 

$11,000.00 

$12,300.00 

$22,200.00 

$22,200.00 

Total 

$15,800.00 

$15,800.00 

$15,800.00 

$17,100.00 

$27,000.00 

$27,000.00 

Sales Information 

Sales Date: 2010-08-27 

Deed Type: 

Price: 

Grantor: 

Grantee: 

WD Boolr; 

$20,000.00 

CAPITAL EQUITIES ONE LTD 

lONTACH INVESTMENTS LLC 

2010 Page: 079549 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 2005-10-05 

Deed Type: 

Price: 

C3rantor: 

WD 

$18,500.00 

Estate of Clay tx jm W moore 

Boolr: 2005 Page: 138041 
H ^ ^ 

Granfee; Caring Network Inc 

Valid/lnvalid: Valid 

Exclusion Reason: 

Show All Transactions 

Land Information 

Acres SF Units Depth Widtii Vacant 

0.14 6100.0 1.0 122.0 50.0 No 

Improvement Information 

Building 1 

2224 Maple 

• « f 

o •••' 

i £ . 

>« \ 3*9 

'Ofn.tMaX Fta i ICtODSgn 

aui X ! Sff • ' 

n o 

M MW r 

": a» r 2 1/2 Story Unfir 

CLICK TO ENLARGE IMAGE CUCK TO ENLARGE IMAGE 

Square Footage: 1778.0 Percent Complete: [ 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Fair 

Built As: 2 1/2 Story Unfin Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: : 10.0 

Exterior: ! Frame Siding Units: 1.0 

Interior: ' Drywall Baths: 3.0 

Roof Cover: Composition Shingle Bedrooms: 6.0 

Roof Type: Gable Stories: 2.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: j 0.0 

Year Percent Adjusted Year 

year Built Physical Age Remodeled Remodeled Built 

1900 0% 1900 110 

Detail Type Detail Description Units 

Appliance Allowance 

Basement Bsmnt Block 8 ft 782.0 

1.0 
08/11/11 09:02AM PDT lontachlnvestments. LLC ->
 4025043281 

Pg 4/4 
 PIIPRENOVATION FORM - OwMiR 

This form is to be us«d by the firms contracted by the Environmental Protection Agency-Region 7 to perform Lead-Based 

Paint stabilization activities at the Omaha Lead Site, Omaha, Nebraska. 

Owner Conflrmation 

Pamphlel Receipt 

r^f have received a copy ofthe lead hazard information pamphlet, Renovate Right: Important Lead Hazard Information for 

Tamilies, • CA/W:<:Vire: J?r?j#»iS!^ from rwioyation 

activity to be performed InAm my dweJilngutilt^ I received^^is jpiamirf^irt 1b«lore Ihel wbili beiim^ 

Owner Acknowledgment 

n (A) I confinn that I own and live in this property^ that no child under the age of 6 resides here, that no pregnant woman 

resides here, and that this property Is not a child-occupied facility. 

^fote: A child resides in the primary residence of his/her custodial parents, le^l guardians, foster parents, or 

informal caretaker if the child lives and sleeps most of time at the caretaker's residence. 

Note: A child-occupied facility is a pre-197S building visited regularly by the same child, under 6 years of age, on al 

least two different days within any week, for at least 3 hours each day, provided that the visits total at least 60 hours 

annually. 

L.IZtB) I understand that the renovation firm, contracted by the Environmental Protection Agency (EPA), will be using leadsafe work practices required by EPA's Renovation, Repair and Painting Rule. 

IMM, C-M J^'ilM 

Printed Name of Owner-Oeeapant 

f^^. w ^/li h i 

S ignature of Owner-OecBpart- Date 

-3^fcmpY)\e4afe \e^-VQV propmy c^^i^c. 
Sample Pre-Renovation Form 

This sample form may be used byfirmsto document compliance with the requirements ofthe Federal 

Lead-Based Paint Renovation, Repair, and Painting Program. 

Occupant Confirmation 

Pamphlet Receipt 

I have receiveid a copy ofthe lead hazard information pamphlet infomiing me ofthe potential risk ofthe 

lead hazard exposure from renovation activity to be performed in my dwelling unit. I received this 

pamphlet before the work began. 

Printed Name of Owner-occupant 

Signature of Owner-occupant Signature Date 

Renovator's Self Certification Option (for tenant-occupied dwellings only) 

Instructions to Renovator: If the lead hazard information pamphlet was delivered but a tenant signature was not 

obtainable, you may check the appropriate box below. 

Declined - I certify- that I have made a good faith effort to deliver the lead hazard information pamphlet 

to the rental dwelling unit listed below at the date and time indicated and that the occupant declined to 

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

the occupant. 

Unavail.ibic for signature-I certify that I have made a good faith eflbil to deliver the lead hazard 

information pamphlet to the rental dwelling unit listed below and that the occupant was unavailable to 

sign the confirmation of receipt. I further certify that I have left a copy ofthe pamphlet at the unit by 

sliding it under the door or by (fill in how pamphlet was left). 

m&i 

Printed Name ooff Perso Personn Cenityia Cenifviai^, Deliverv Delivery-- Attempted Delivery Date

Signature of Person Cb|[tifying Lead Pamphlet Delivery 

9.20M MnplPPif 

Unit Address 

Note Regarding Mailing Option — As an alternative to deliver) in person, you may mail the lead 

hazard information pamphlet to the owner and/or tenant. Pamphlet must be mailed at least 7 days 

before renovation. Mailing must be documented by a certificate of mailing from the post office. 

25