TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

^ 1 

Address: 

Stabilization Contractor: Professional Environmental Engineers Year: iZOl | 

PAINT STABILIZATION 

PROPERTV FILE FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Summary 

Signed Access Agreenient for subject property 

['re-Renovation Form signed by Propeity Owner 

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

Painting Agreement 

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

Renovation Recordkeeping Checklist signed by Certified Renovator 

Photographs 

Satisfactory close-out check list signed by Property Owner 

Properly close-out check list signed by EPA 

Property information from Douglas County Assessor's Office 

n Hazard analysis, if prepared 

•Ll Safety Audit 

Ll Other (describe): 

J, EPACORSianature" 

(after file folder re view) 

40377554 

Superfund 
2505 North 24*, Suite 219 

Omaha, NE 68110 

(402) 504-4688 

Fax (402) 504-3281 

PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

"Providing cost-effective environmental solutions" 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

2011 

SAID# 84716 

2912 Fontenelle Blvd 

• Dates worked: 7/22 to 7/22 2011 

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

foundation areas. Garage is painted wood. Paint was flaking off in areas. 

• Problems encountered: None. 

• Owner request/concerns: N/A 

• Inspection/closeout dates. Owner 7/26/11 Ef^ ^^^^/] \ 
2011 

PROFESSIOr#L 

2505 North 24*, Suite 219 ENVIRONMENTAL ENGINEERS, INC. 

Omaha, 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: ff7/£ 

Property Address: _2SIA Kiu,.ffM.Am Bl.^ . 

Owner's Name: 

HmMm Oalnn 

Performance Standards/Close-Out Criteria 

YES NO 

1. Was the entire structure(s) painted with 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 reqtiired 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? 

6. Did the contractor collect/vacuimi 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. 

properly removed? y 

9. Isthereany evidence ofproperty damage that was done by the contractor? Any property y 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 vdth the property owner(s) that have been left 

/ imresolved? 

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

iXl ^ JJ ^ 

it/9/lf 

EPA COR Signature Date 
Jul . 26. 2011 4:39PM ^ ^ ' -No. 0648 ^ P, 1 t f i 

PROFESSIONAL 

2505 NorW 241'. Suite 219 ENVIRONMENTAL ENGINEERS, INC. Omeha.NE 68110 

(402) 504-4688 "Providing cost-effective environmentBl solutions' Fax (402) S04-3281 

2011 

Property Owne r ClDse-Out Form 

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

SAID: ^f7/d 

Property Address: SJ^ j 2L'''4^:>Jk^^.£ A ^L ^ 

Owner's Name: f-^^^^ C^au^^/^ . 

Performance Standards/Close-Out Criteria YES NO 

\. Was the entire structure(s) painted with the exc«ption of the stated, excl tided areas? This 

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

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

3.

2.

 Wer

 Was

e

 al

 al

l scrapin

l require

a

d

 an

 area

d oflie

s ofth

r preparatio

e stTUCture(s

n wor

) prime

k complete

d as neede

d satisfactorily

d and painte

? 

d with two top i

coats? 

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

S. Arc all ofthe areas whetc contaminated materials have been spilled thoroughly 

vacuumed/ cleaned? ^ 

6. Did the contractor collect/vacuum all failing 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 surrounds the sifucturg(s) in reasonably good condition? 

8. Are all items such as polyethylene sheeting, ladders, paint brushes, cones, barrier tape. 

etc. propgrly removed? 

9. Is there any evidence of property damage that was done by the coniractor? Any property 

damage needs to be completed prior to the EPA Close-Out. ^__ K 

jO. Are you satisfied with the work performed? 

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

need to be moved back? K

12. Are there any (known) lingering issues with the property owncr(s) that have been left 

unresolved? X 

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

Professional Envirotunental Engineers Signature 
Professional Environmental Engineers: EPA Paint Stabilization 2011 

Proper., Aaaress lPi\' ^ '^Cf\\m^\\ P ^Mf ^ 

Stories/ Siding type / ^M V JY V Transite Wood Vinyl iWetal Stucco 

Garage? 

Date access sigr

Yes ^--tJo 

l ^ \ 

"TllOM l 

^ 

Painted? 

Where? 

Yes 

Siding 

Trim 

No 

Pre-video 

Post video 

Contractor Assigned A^)^^^^' ^ ^ ^ tf^ 

Date started " ^ / ^ ^ Date ended '^fZ~2-/ i / 

Weather Conditions 

Paint used \^ O 

Prime used 

Poly used '~^r€>C> 

Problems/Issues 
(effective April 2010) 

RENOVATION RECORDKEEPIN G CHECKLIST 

Name of Firm: Uhj^r-r^^'j^h^J ^ 

Date and Location of Renovation: 

Brief Description of Renovation: J-J.,7 ^ CfT^i ^ Z.<ytL^-^-

Name of Assigned Renovator: ci^ ^ if> ^^^fc^ 

Name(s) of Trained Workers: y I unr ^ h^-^Zi rfi^U> hi^: > 

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

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

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

D Posting warning signs D Setting up plastic containment barriers 

D Maintaining containment D Avoiding spread of dust to adjacent areas 

D Waste handling D 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: 

^/'SNVaming signs posted at entrance to work area. 

Qw^ork area contained to prevent spread of dust and debris. 

B-'Wmdows in and within 20 feet ofthe work area are closed 

/Spoors in and within 20 feet ofthe work areas are closed and sealed 

B't5oors that must be used in the work area are covered to allow passage but prevent spread of dust. 

ja<jround covered by plastic sheeting extending 10 feet from work area - plastic anchored to the 

building and weighted down by heavy objects. 

r>-frnecessary, vertical containment installed to prevent migration of dust and debris to adjacent 

operty. 

Waste contained on-site and while being transported off-site. 
(effective April 2010) 

Work site properly cleaned after renovation. 

S-pCll chips and debris picked up, protective sheeting misted, folded dirty side inward, and taped for 

removal. 

J3-Work area HEPA vacuumed to get paint chips from ground surface, ifnecessary. 

0L]ertified renovator performed post-renovation cleaning verification (describe results): 

Hlcert i fy under penalty of law that the above information is true and complete. 

Name and Title Date 

/ 

/ 

/I 
5/26/2011 ^ Dauglas County Account Information ^

, g^llG 

} Douglas County, Nebraska Prapert Y Record - R2402080000 ^ 

Print Report 

Infonnation is valid as of 2011-5-16 View Interactive GIS Map 

Treasurer's Tax Report 

New Feature ->-•' » Subdivision Sales Search 

Owner 

QUINN KEVIN R 

2912 FONTENELLE BLVD 

OMAHA NE 68104-0000 Q^'^ ' ^S'^^H f 9^ ' cQ ^ 19 

Property Information 

Key Number: 0208 0000 24 

Account Type: Residential 

Parcel Number: 2402080000 

Parcel Address: 2912 FONTENELLE BLVD 

OMAHA NE 68104-0000 /9PC) \ 

Legal Description: VINELAND LOT 13 BLOCK 1 40 X 125 

Value Information 

Land Improvement Total 

2011 $5,700.00 $73,100.00 $78,800.00 

2010 $5,700.00 $73,100.00 $78,800.00 

2009 $5,700.00 $73,100.00 $78,800.00 

2008 $5,700.00 $73,800.00 $79,500.00 

2007 $5,700.00 $73,800.00 $79,500.00 

2006 $5,700.00 $73,800.00 $79,500.00 

Show All Transactions 

Land Information 

Acres SF Units Depth Widtii Vacant 

0.11 5000.0 1.0 125.0 40.0 No 

Improvement Information 

Building 1 

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

J.-l."' ,<.1LH..LIIC' 

Second Hoof 

Fira Fhaai aseosq ft 

2 STORY 

;M'.ti.. n 

CLICK TO ENLARGE IMAGE 

CLICK TO ENLARGE IMAGE 

Square Footage: 1390.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: AvAerage 

Unit Type: Condition: Average 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 6.0 

Exterior: Frame Vinyl Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 2.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1925 0% 1925 85 

Detail Type Deta/7 Description Units 

Add On Fence Chain Link 1.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 704.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 252.0 

Porch End Screen 198.0 

Porch End Sdid Wall 112.0 

...mapping-online.com/.../accountinfo.j.. 2/3 
Jo, 0641 P. 2 

Jul . 18. 2011 11:45AM 

CONSENT FOR ACCESS TO PROPERTY 

OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID: . ^4li ^ PROPERTY ADDRESS: ^.3PMa . X^^r^\^'&.\\ ^ { ^ 

^^^^^^^ye^/A/&a//VA ^ DAYTIME PHO^E: ^^ ^ l9r^JLC// ^ 

CELLPHONE: V0Xj7±Zl!iI ^ E-MAIL: K^^/AI . fi ' <} U//\/ ^ ^ 

u5Ace.AieAV 

OWNER'S ADDRESS IF DiFFERENTi 

TENANT'S NAME IF APPLICAULE: 

DAYTJME PHONE; 

CELLPHONE! E-MAIL; 

Profeulonal Environinental Engineers, Inc. (PE) )s under contract (>*£P-R7-08-06) with the U.S. Environmental Protection 

Agency <EPA) to st&biliu lead based point (LBP) on residential structures at a number or propertien located ih Omaliai, 

Nebraska. Tbe paint st>ibili2'jrlort worU \i being done ca protect the MW cleanups that are being performed by EPA contnicton. 

Paint stabilization activities will lociude; ^scraping of cracked or flaking LBP from structures, application of a prime coat and two 

(2) coats of paint. Moving parts of windows and duors are nut iududed and will nor be addressed. 

Your caoperation is requested In giving permission to this EPA contractor (ft) lo enter and have access to this property for tbe 

purpose of stabilizing lead -based palm as outlined on the property Idontifled above. 

By signing this document I agree to allow an EPA contractur to cooduci a iioll cleanup at my property following completion of 

lead-based paint stabilization, If the aoH cleanup has not already been p«rrorm<:d. 1 understand (hat the stabilization contractor 

can not provide uasuraBCea that the soi) cleanup contractor will be bound to. 1 further understand ttiat the soil cleanup 

contractor will make all reasonable effortjjo address concerns thai I, as the property owner, may have regarding soli cleanup at 

ray property. 

r-//'// 

Data 

I hilly understand that by aigiilng this Cdnscnt for Access, (1) this access will remain in effect until the work ha« been 

jiatlsfactorily completed, (2) that the Property Owner or Tenant, if applicable, will be given the Houiing and Urban Development 

(HlJD) and EPA pamphlet, "Rtuovata Right, Important Lead Kaxard iofbrmatloa for Families, Day Care Providers, and 

Schools", (3) the Property Owner or tenant will remove ail obstructioos from surTaces to be painted, (4) will abide by healtb and 

safety guidance provided by EPA, (5) will allow photography ofproperty before and after the paint stabiiiaacion 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 final pruperiy Inspection and sign the Completion Agreement and 

Property Owner Satisfictlon Survey. 

Should you have any questionii about the planed Lead """I-""!! ! ••^T''"''nl'''^'V"' "'' fi rmiT-"r"'f1'i C!^ " contact 

Professional Envirtinmefltal Engineers, inc. Project Managftc^lllle Chav or KelUy Sanders At 402-504-4688. degiaul questions 

aboDt tbe Omaha Lead Site cleanup can be directed to Paulatta Fnmee-betts, EPA RemtdiaTrroject manager 402-731-2454, or 

the EPA Public Informatloh Centers at 402-991-!>5a3 (North Omaha office) or402-73l.3045 (South Omaha office), 

AI Yea, I giant acceK4dn^ropeny and W2« given the pamphlet G Ho, I do not srani access to my property and I was 

/ ''Renov^p^ht. U^MM)iM«Me^ ^ FainiUsi, Chliti given the pampbitt 'Raaevate RigM, tntpettanl Lead 

Carafmiders.^Bd'fgQeols.'' > tntomiatlen for Families, Childe Cire Provklen, end Schools.' 

Signaturs Date 

SPECIAL INSTftUCTIONS AND CONSIDERATIONS 
Jul . 18. 201 1 11;45A M Jo. 064 1 P. 3 

PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

PROPERTY ADDRESS: ^Q\9_ _ '^?S^W\'^y\\^rw. , 

BVIDgfOK^ 

7if^ TXri.v.^iP rr.i^^ ^.ir,^i^^\ ha/^^ j i 

AREA{S) TO BE PAINTED; 

HOUSE PROPER: .COLOR: 

HOUSE TRIM:. Y£i COLORE lA)l[,f P ­

GARAGE: ^ ,COLOR : IJIAJ:^_ 

GARAGE TRIM ~SL COLOR . ^/kff^ 

POROHl •fKjlQl\lf^ ' y<3>S COLOR: Ij j i / ^ . 

PORCH TRIM: y&y(^^ti\ , COLOR^

: uikti' 

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

I AGREE TO THE COLORS LISTED ABOVE. ONCE THE PAINTING 

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

PEACCE80R SIGNATURE: 

^^^^- ^ 
No. 0641 P. 4 Jul . 18. 201 :45AM 

PRE-RENOVATION FORM - OWNER 

This form is to be used by the firms contracted by the Environmeacai Protection Agency-Region 7 to perform Lead-Bas^d 

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

Owne r Confinnation 

Pamphlet Receipt 

K l h^vc received a copy ofthe lead hazard information pamphlet, Rinu\a[e Right: Imponani Lead Hazard Information for 

Families, Child Care Providers and Schools, informing me of the potential risk of che lead hazard exposure firotn renovation 

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

Owne r AckuoYVledgment 

/ ^ (A) 1 confirm that I own and live in this propeny, that no child under the age of 6 resides here, that no pregnant vwimaii 

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

Mote: A child resides in the prlma^' residence of his/her custodial parents, legal guardians, foster parents, or 

informal caretaker if the child lives and sleeps most of time at the C3n»taker's residence. 

Noto! A child-occupied faclHty 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, fbr at least 3 hours each day, provided thai the visits total At least 60 hours 

annually. 

Na'{B) 1 understand that the renovation firm, coniracced by the Environmental Protection Agency (EPA), will be using lead4afe work practices required by EPA's Renovation, R^alr snd Painting Rule. 

§^/^y A^ 

Printed Name o^wner-Occupan i 

Signature of Owne^Occupanl Date