TRANSMiTTA L of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID #: 2?9K 1 Date: Cv{2^^\\\ 

Address: M?>^M C^S. ^ ^ 

Stabilization Contractor: Professional Environmental Engineers Year: ^01 

PAINT STABILIZATION 

PROPERTV FILE FOLDER DOCUMENTS 

Video ofproperty (DVD) 

Executive Summary 

(\/ Signed Access Agreement for subject property 

CT Pre-Renovation Form signed by Propeity Owner 

D Pre-Renovation Fonn for Occupant/Tenant, if applicable 

M Painting Agreement 

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

^ Renovation Recordkeeping Checklist signed by Certified Renovator 

^"^ Photographs 

S^ Satisfactory close-out check list signed by Property Owner 

D Property close-out check list signed by EPA 

S/ Property information from Douglas County Assessor's Office 

• Hazard analysis, if prepared 

D Safety Audit 

D Other (describe): 

.l/T/^lJ^ 

EPA CbR Sfenature 

(after file folder review) 

40377563 

Superfund 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

"Providing cost-effective environmental solutions" 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

2505 North 24"^, Suite 219 

Omaha, NE 68110 

(402) 504-4688 

Fax (402) 504-3281 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

2011 

SAID#23837 

4324 Cass St 

• Dates worked: 6/6 to 6/6 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: Color changes. 

• Inspection/closeout dates. Owner 6/7/11 
PROFESSJONAL 

500 S. Ewing, Suite E ENVIRONMENTAL ENGINEERS, INC. St. Louis, MO 63103 

(314} 531-0060 "f-'tUVldliig aUi'i'-'.^/.'^C'.'/''i.-: irii'vinililii^nt^:).! S:)Uliiu.i:~ Fax (314) 531-0068 

20h 

Property Owner Close-Out Form 

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

SA.D: y.^^^-. ^ 

Property Address: ^' ^ Pl^ / (J^S S StOwner's Name: fi y^ S / / S fy^T^ 

Performance Standards/Close-Out Criteria YES NO 

1. Was the entire structure(s) painted with the exception of the 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? C ^ . 

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 1 / vacuumed/ cleaned? 

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 y debris? 

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

etc

8. Ar

. properl

e all item

y removed

s such a

? 

s polyethylene sheeting, ladders, paint brushes, cones, barrier tape, X

9

damag

. Is ther

e need

e an

s

y

 t

 evidenc

o be complete

e ofpropert

d prio

y

r

 damag

 to the EP

e tha

A Close-Out

t was done

. 

 by the contractor? Any property w

\ 0. Are you satisfied with the work performed? -v^ 

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 

unresolved? 

Other Considerations/Property Owner Discussions/Additional Work that is Required: 
Professional Environmental Engineers : EPA Paint Stabilization 2011 

SAID. 7^96^ 

Property Address MJAZ H C Ol^ ^ O T 

Stories/ Siding type 111l'l' 2 / Transite \A(oppdd Vinyl Metal Stucco 

Garage? \YeYeB o Yes^^ No s NNo Painted Painted?? J^^. ^ 

J \ Where? Sidfng J 

Date access signed ?^/3wii ::: 

Pre-video 

Post video 

Contractor Assigned 

Date started ^J P ^ CP- ^ / / Date ended Qp "^C/^ ^^ f 

Weather Conditions 9^ 

Paint used 

Prime used 

/7a ^fJkJ.Oq./^/U^^^ ^^/-< ^ 

Poly used _V / ^ 

Problems/Issues 
(efTective April 2010) 

RENOVATION RECORDKEEPIN G CHECKLIST 

Name of Firm,: /V6 ?}W/(^l . Date and Location of Renovation: ^^&' " / / yJoly^iPyS S S'f 

Brief Description of Renovation: 

Name of Assigned Renovator: / / y / 

Name(s) of Trained Workers: (..jr/Sf/Ci./ ? / /^'^It Q 

Name of Dust Sampling Technician, Inspector, and/or Risk Assessor, if used: Ay// 4 ^^ 

D^'Copies of renovator and dust sampling technician qualifications (training certificates, certifications) on file. 

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

/Q Posting warning signs [Z3etting up plastic containment barriers 

^j2^aintaining containment •/'Avoiding spread of dust to adjacent areas 

0" Waste handling & Post-renovation cleaning 

D 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: A//V ^ 

Q'^Waming signs posted at entrance to work area. 

^B'^Work area contained to prevent spread of dust and debris. 

p^indows in and within 20 feet ofthe work area are closed 

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

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

jZfGround covered by plastic sheeting extending 10 feet from work area - plastic anchored to the 

/building and weighted down by heavy objects. 

• Ifnecessary, vertical containment installed to prevent migration of dust and debris to adjacent 

property. 

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

Renovation Recordkeeping Checklist Omaha Lead Site 
I OilWork site properly cleaned after renovation. 

L/AII chips and debris picked up, protective sheeting misted, folded dirty side inward, and taped for 

Removal. 

TfWork area HEPA vacuumed to get paint chips from ground surface, ifnecessary. 

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

y ^ Iceuify under penalty of law that the above information is true and complete. 

'fi/d^/' C:-^^-// 

Name and Title Date 

Renovation Recordkeeping Checklist Omahci Lead Si'ie 
5/26/2011 ^)ouQlas County Account Information ^ #?.^RT/ 

Douglas County, Nebraska Pro ^t y Record - R2018370000 

Print Report 

View Interactive GIS Map Infonnation is \alid as of 2011-5-16 Treasurer's Tax Report 

New Feature ->->-> Subdivision Sales Search 

Owner 

KYES LISBETH A 

4324 CASS ST 

OMAHA NE 68131-0000 

Property Information 

Key Number: 1837 0000 20 

Account Type: Residential 

Parcel Number: 2018370000 

Parcel Address: 4324 CASS ST ^O O /\J 

OMAHA NE 68131-0000 

Legal Description: POPPLETON PARK LOT 15 BLOCK 12 50 X 122.69 

Value Infomiation 

2011 

2010 

2009 

2008 

2007 

2006 

Land 

$6,400.00 

$6,400.00 

$6,400.00 

$6,400.00 

$6,400.00 

$6,400.00 

Improvement 

$94,600.00 

$88,300.00 

$88,300.00 

$88,300.00 

$83,200.00 

$83,200.00 

Total 

$101,000.00 

$94,700.00 

$94,700.00 

$94,700.00 

$89,600.00 

$89,600.00 

Sales Information 

Sales Date: 1992-11-12 

Deed Type: 

Price: 

Grantor­

$50,000.00 

Book: 1937 Page; 559 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Information 

Acres 

0.14 

SF 

6150.0 

Units 

1.0 

Depth 

123.0 

Widtii 

50.0 

Vacant 

No 

Improvement Information 

.mapping-online.com/.../accountJnfb.j. 1/3 
5/26/2011 Douglas County Account Information 

Building 1 

1 1/2 Story 4324 Cass St 

KV |*'3 ^^\ *m" 

,.^ol secon d Ftoof „-.„ 

First Floor 

En::IS4tK3Aal 

I'M 4^ I 

SiimBlxt^cf l 95i;0:q ^ 

CLICK TO ENLARGE IMAGE 

Square Footage: 1404.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

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

HVAC: Central Air to Air Rooms: 6.0 

Exterior: Frame Siding Units: 1.0 

interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year 

year Built Physical Age Remodeled Remodeled Built 

1925 0% 1925 86 

Detail Type Detail Description Units 

Add On Fence Chain Link 1.0 

I Appli lance Allowance 1.0 

Basement Bsmnt Block 8 ft 960.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 396.0 

Porch End Solid Wall 144.0 

...mapping-online.com/.../accountinfo.j... 2/3 
CONSENT FOR ACCESS TO PROPERTY 

OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID «I PROPERTY ADDRESS 

OWNER NAiVlE 

DAYTIME PHONE 

CELL PHONE: rXO ip S ^ (JD E-MAIL 

OWNER'S ADDRESS IF DIFFERENT: 

TENANT'S NAME IF APPLICABLE: 

DAYTIME PHONE: 

CELL PHONE: E-MAIL: 

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

Agency (EPA) to stabilize lead based paint (LBP) on residential structures at a number of properties located in Omaha, 

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

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

(2) coats of paint. Moving parts of windows and doors are not 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 the 

purpose of stabilizing lead -based paint as outlined on the property identified above. 

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

lead-based paint stabilization, if the soil cleanup has not already been performed. I understand that the stabilization contractor 

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

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

my property. 

'Yes.lhav 

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

satisfactorily completed, (2) that the Property Owner or Tenant, if applicable, 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, (5) will allow photography of property before and after the paint stabilization work, (6) will be 

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

any of the LBP stabilization actions, and (8) will participate in fmal property inspection and sign the Completion Agreement and 

Property Owner Satisfaction Survey. 

Should you have any questions about the planed Lead Based-Paint stabilization activities for your property, please contact 

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 Project Manager 402-731-2454, or 

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

h i Ves, I grant access to my property and was given the pamphlet D No, I do not grant access to my property and 1 was 

^novat e Right, Important Lead Information for Families, Child given the pamphlet "Renovate Right, Important Lead 

Care Rn/viders,,and Schools." Information for Families, Childe Care Providers, and Schools.' 

Signature Date 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
PRE-RENOVATION FORM ~ OWNER 

This form is to be used 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 Confirmation 

Pamphlet Receipt 

iXrlhave received a copy ofthe lead hazard information pamphlet, Renovate Right: Important Lead Hazard Information for 

tarnilies. Child Care Providers and Schools, informing me ofthe potential risk ofthe lead hazard exposure from renovation 

activity to be performed in/on my dwelling unit. 1 received this pamphlet before the work began. 

Owner Acknowledgment 

[A) I confirm that I own and live in this property, that no child under the age of 6 resides here, that no pregnant woman 

rdfeides here, and that this property is not a child-occupied facilit>'. 

Note: A child resides in the primary residence of his/her custodial parents, legal 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-1978 building visited regularly by the same child, under 6 years of age, on at 

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

annually. 

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

I i^l.^,fA A. Vyc, 

Printed Name of Owner-Occupant 

^-^j-l l 

Signature df Owner-Occupant \ j Date 
PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

PROPERTY ADDRESS: ^3oC ^ U^^ S $ 7 OATE: G-^/'J I 

BVID: 23B3'7 

AREA(S) TO BE PAINTED: 

HOUSE PROPER: o COLOR: syQ^^DO g. ^ I 

TT 

HOUSE TRIAA: £S. COLOR: UJm ; ' 4J ^ 

^ 

GARAGE: \Ln COLOR: f)u\[p^no ^.^e­

^ ^ ULUM^^ 5- ^ 

PORCH: A^ fe^ COLOR : --^ vO (^"^^O K ^ 

PORCH TRir COLOR , ^ IJVAV4 g./^ 

GARAGE TRIM: v^k COLOR: :

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

I AGREE TO THE COLORS LISTED ABOVE. ONCE THE PAINTING 

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

PROPERTY OWNER SIGNATURE: PE ACCESOR SIGNATURE: 

^X 

T ^