### TRANSMITTA L o f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R

^ 1 Address : Stabilizatio n Contractor : Professiona l Environmenta l Engineer s Year : iZOl | PAIN T STABILIZATIO N PROPERT V FIL E FOLDE RDOCUMENT S Vide o o f property (DVD ) Executiv e Summar y Signe dAcces s Agreenien t fo r subjec t propert y ['re-Renovatio n For msigne db y Propeity Owner D 

### Pre-Renovaiio n Fon n fo r Occupant/Tenant , i f applicabl e Paintin g Agreemen t D 

### Settlemen t document s (i.e. , fo r damag e o r lo replac e plants , etc. ) Renovatio n Recordkeepin g Checklis t signe db y Certifie dRenovato r Photograph s Satisfactory close-ou t chec k lis t signe dby Property Owne r Properl y close-ou t chec k lis t signe db y EP A Propert y informatio n fro mDougla s Count y Assessor' s Offic e 

## n Hazardanalysis , i f prepare d •L

l 

### Safet y Audi t L l 

### Othe r (describe) :



# J , EPACORSianature " (after fil e folde r r e view ) 4037755 4 Superfun d250 5 Nort h 24* , Suit e 21 9 Omaha , N E 6811 0 (402 ) 504-468 8 Fa x (402 ) 504-328 1 

# PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC . "Providin g cost-effectiv e environmenta l solutions " Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yRespons e



### Lea dBas e Stabilizatio n Omaha , N e Clos e Ou t Repor t 201 1 SAID #8471 6 291 2 Fontenell e Blv d

•Date s worked : 7/2 2 t o 7/2 2 201 1 • Pr e propert y condition : Hous e ha s mostl y viny l sidin g wit h painte dwoo dtrim s an d foundatio n areas . Garag e i s painte dwood . Pain t wa s flaking of f

i n areas . •Problem s encountered : None . •Owne r request/concerns : N/A •Inspection/closeou t dates . Owne r 7/26/1 1 Ef ^ ^^^^/]\

### 201 1 

# PROFESSIOr# L 250 5 Nort 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 "

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

### EP A Close-Ou t For m (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) SAID : ff7/ £ 

### Propert y Address : _2SI A Kiu,.ffM.A mBl.^ . 

### Owner' s Name : HmM mOaln n 

### Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) paintedwit h the exception ofth e stated , excludedareas ? Thi s woul dinclude paintin g o f othe r

associate dfeature s including fascia , eaves , siding , all trim , porches , bo x beams , columns , rails , an dexterior surface s of garages . 2 . Was all scraping an dothe r

preparatio n wor k

completedsatisfactorily ? / , 

### 3 . Wer e al l reqtiire darea s ofth e structure(s ) primeda s neededandpainte dwit h tw o to p coats ? / 

### 4 . Wa s th e paint product s utilize dequivalen t t

o a25 yea r

product/quality ? / 

### 5 . Ar e all ofth e area s wher e contaminate dmaterial s have bee n spilledthoroughl y vacuumed / / 

### cleaned ? 6 . Di dth e contractor collect/vacuim i all falling an dscrapedpaint chip s o n the entir e property , roadways , alleyways , publi c acces s area s an dals o remove an y othe r

generateddebris ? / 

### 7 . I s th e gras s are atha t surrotmd s th e structure(s ) i n reasonabl y goodcondition ? / 

### 8 . Ar e al l item s such a s polyethylene sheeting , ladders , pain t brushes , cones , barrie r

tape , etc . properl y removed ? 

# y 9 . Istherean y evidenc e ofpropert y damag e tha t wa s don e by th e contractor ? An y propert y 

# y damag e need s t o b e completedprior t o th e EP A Close-Out . 10 . Ha s th e propert y owne r

signedthe completion form ? / 

### 11 . Ar e ther e an y propert y item s tha t wer e temporaril y re-locatedby th e contractor tha t needt o / 

### b e move dback ? 12 . Ar e ther e an y (known) lingering issue s vdt h th e propert y owner(s ) tha t have been lef t / 

### imresolved ? Othe r

Considerations/Propert y Owne r

Discussions/Additiona l Wor k

tha t i s Required :

iXl ^ JJ ^ 

### it/9/l f 

### EP A CORSignatur e Dat e

### Jul . 26 . 201 1 4:39P M 

### ^ ^ ' -No . 064 8 ^ P, 1 t 

# f 

# i PROFESSIONA L 250 5 Nor W 241' . Suit e 21 9 

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

### "Providin g cost-effectiv e environmentB l solutions ' Fax(402 ) S04-328 1 

### 201 1 Propert y Owne r ClDse-Ou t For m (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) SAID : ^f7/ d Propert y Address : SJ^ j 2L'''4^:>Jk^^.£ A ^L ^ Owner' s Name : f-^^^ ^ C^au^^/^ . Performanc e Standards/Close-Ou t Criteri a YE S NO \. Wa s th e entir e structure(s ) painte dwithth e exc«ptio nof th e stated , exc l tide dareas ? Thi s woul dinclud e paintin g of othe r associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , colmnns , rails , an dexterio r surface s of garages . 2. Wa s al l scrapin aan doflier preparatio n work complete dsatisfactorily ? 

# i 3. Wer e al l require darea s ofth e stTUCture(s ) prime d as neede dan dpainte dwit htw o to p coats ? 4. Wa s th e pain t product s utilize dequivalen tto a 25 yea r product/quality ? 

# I: S. Ar c al l ofth e area s whet c contaminate dmaterial s hav e bee n spille dthoroughl y vacuumed / cleaned ? ^ 6. Di dth e contracto r collect/vacuu mal l failin g an dscrape dpain t chip s on th e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y othe r generate d debris ? ' 7. Is th e gras s are atha t surround s th e sifucturg(s ) in reasonabl y goo dcondition ? 8. Ar e al l item s suc h as polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape . etc . propgrl y removed ? 9. Is ther e an y evidenc eof propert y damag e tha t wa s don e by th e coniractor ? An y propert y damag e need s to be complete dprio r to th e EP A Close-Out . ^_ _ 

# K jO . Ar e yo u satisfie dwit hth e work performed ? 11 . Ar e ther e an y propert y item s tha t wer e temporaril y re-locate d by th e contracto r tha t 

# ? K nee d to be move dback ? 12 . Ar e ther e an y (known ) lingerin g issue s wit hth e propert y owncr(s ) tha t hav e bee n lef t unresolved ? 

# X Othe r Considerations/Propert y Owne r Discussions/Additiona l Wor k tha tis Required :

Professiona l Envirotunenta l Engineer s Signatur e

### Professiona l Environmenta l Engineers : EP A Pain t Stabilizatio n 201 1 Proper. , Aaares s lPi\' ^ '^Cf\\m^\\ P ^Mf ^ Stories / Sidin g typ e / ^M V J Y V Transit e Woo d Viny l iWeta l Stucc o Garage ?
Dat e acces s sig r Ye s ^--tJ o l ^ \ 

## "TllOM l

^ Painted ? Where ? Ye s Sidin g Tri m N o

Pre-vide o Pos t vide o Contracto rAssigne d A^)^^^^' ^ ^ ^ tf^ Dat e starte d " ^ / ^ ^ Dat e ende d '^fZ~2-/ i / Weathe rCondition s
Pain t use d \ ^

O Prim e use d Pol yuse d '~^r€>C > Problems/Issue s(effectiv e Apri l 2010 )


### RENOVATIO N RECORDKEEPIN G CHECKLIS T
Name o f Firm : Uhj^r-r^^'j^h^J ^ Dat e an dLocatio n o f Renovation : Brie f Descriptio n o f Renovation : J-J.,7 ^ CfT^i ^ Z.<ytL^-^
- Name o f Assigne dRenovator : ci^ ^ if > ^^^fc ^ Name(s ) o f Traine dWorkers : y I unr ^ h^-^Z i rfi^U > hi^: > Name o f Dus t Samplin g Technician , Inspector , and/o r Ris k Assessor , if used : D Copie s o f renovato r an ddus t samplin g technician qualification s (trainin g certificates , certifications ) o n file. U Certifie drenovato r provide dtrainin g to worker s on (chec k al l tha t apply) : D Postin g warnin g sign s D Settin g up plasti c containmen t barrier s D Maintainin g containmen t D Avoidin g sprea do f dus t to adjacent area s D Waste handlin g D Post-renovatio n cleanin g D Tes t kit s use db y certifie drenovato r t

o determin e whethe r lea dwa s presen t o n component s affecte db y renovatio n (identif y kit s use dan ddescrib e samplin g location s an dresults :
^/'SNVamin g sign s poste da t entranc e t o wor k area . Qw^or k are acontaine dto preven t sprea do f dus t an ddebris . B-'Wmdow s i n an dwithi n 2 0 fee t ofth e wor k

are aare close d /Spoor s in an dwithi n 2 0 fee t ofth e wor k

area s ar e close dan dseale d B't5oor s tha t mus t b e use di n th e wor k

are aare covere dt o allo w passag e bu t preven t sprea do f dust . ja<jroun dcovere db y plasti c sheetin g extendin g 1 0 fee t fro mwor k

are a- plasti c anchore dto th e buildin g an dweighte ddow n by heav y objects . r>-frnecessary , vertical containmen t installe dto preven t migratio n o f dus t an ddebri s t o adjacent operty . Wast e containe don-sit e an dwhil e bein g transporte doff-site .(effectiv e Apri l 2010 )


### Wor k

site properl y cleane dafte r renovation . S-pCl l chip s an ddebri s picke dup , protectiv e sheetin g misted , folde ddirty sid e inward , an dtape dfor removal . J3-Wor k

are aHEPA vacuume dt o ge t pain t chip s fro mgroun dsurface , ifnecessary . 0L]ertifie drenovato r performe dpost-renovatio n cleanin g verificatio n (describ e results) :
Hlcert i f y unde r penalt y o f la w tha t th e abov e informatio n is true an dcomplete .

Nam e an dTitle Dat e

/ / 

### / I5/26/201 1 ^ D augla s Count y Account Informatio n ^ 

# , g^ll G } Dougla s County , Nebrask a Praper tY Recor d - R240208000 0 ^ Prin t Repor t Infonnatio n i s vali d a s o f 2011-5-1 6 Vie w Interactiv e GI S Ma p Treasurer' s Ta xRepor t Ne w Featur e ->-•' » Subdivisio n Sale s Searc h Owne r QUIN N KEVI N R 291 2 FONTENELL E BLV D 

### OMAH A NE 68104-000 0 Q^'^ ' ^S'^^ H f 9^ ' cQ ^

1 9 Propert y Informatio n Ke y Number : 020 8 000 0 2 4 Accoun t Type : Residentia l Parce l Number : 240208000 0 Parce l Address : 291 2 FONTENELL E BLV D 

### OMAH A N E 68104-000 0 /9PC) \ Lega l Description : VINELAN D LOT 1 3 BLOC K1 4 0 X 12 5 Valu e Informatio n Lan d Improvemen t Tota l 201 1 $5,700.0 0 $73,100.0 0 $78,800.0 0 201 0 $5,700.0 0 $73,100.0 0 $78,800.0 0 200 9 $5,700.0 0 $73,100.0 0 $78,800.0 0 200 8 $5,700.0 0 $73,800.0 0 $79,500.0 0 200 7 $5,700.0 0 $73,800.0 0 $79,500.0 0 200 6 $5,700.0 0 $73,800.0 0 $79,500.0 0 Sho w Al l Transaction s

Lan d Informatio n Acre s S F Unit s Dept h Widti i Vacan t 0.1 1 5000. 0 1. 0 125. 0 40. 0 N o Improvemen t Informatio n Buildin g 1

.. mapping-online.com/.../accountinfo.j.. . 1/ 35/26/201 1 Dougla s Count yAccoun t Informatio n
J.-l." ' ,<.1LH..LIIC '

Secon d Hoo f Fir a Fhaa i aseos q ft

2 STOR Y ;M'.ti. . n

CLIC KTO ENLARG E IMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : 1390. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : AvAerag e Uni t Type : Condition : Averag e

Buil t As : 2 Stor y Cond o Squar e Footage : 0. 0

HVAC : Centra l Ai rt o Ai r Rooms : 6. 0 Exterior : Fram e Viny l Units : 1. 0 Interior : Drywal l Baths : 1. 0 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 rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 192 5 0 % 192 5 8 5 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 ft 704. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 252. 0 Porc h En d Scree n 198. 0 Porc h En d Sdi d Wal l 112. 0

... mapping-online.com/.../accountinfo.j. . 2/3Jo , 064 1 P . 2 Jul . 18 . 201 1 11:45A M 

## CONSEN T FO RACCES S T O PROPERT Y OMAH A LEA D SIT E REMEDIA LACTIO N - LEAD-BASE D PAIN T STABILIZATIO N PROPERT Y ID : . ^4li ^ PROPERT Y ADDRESS : ^.3PMa . X^^r^\^'&.\\ ^ { ^ 

## ^^^^^^^ye^/A/&a//VA ^ DAYTIM E PHO^E : ^^ ^ l9r^JLC// ^ CELLPHONE : V0Xj7±Zl!iI ^ E-MAIL : K^^/A I 

## . f i ' < } U//\/ ^ ^ u5Ace.AieA V OWNER' S ADDRES S I FDiFFERENT i TENANT' S NAM E I FAPPLICAULE : DAYTJM E PHONE ; CELLPHONE ! E-MAIL ; Profeulona l Environinenta l Engineers , Inc . (PE ) ) s unde r contrac t (>*£P-R7-08-06 ) wit h th e U.S . Environmenta l Protectio n Agenc y <EPA ) t o st&bili u lea dbase dpoin t (LBP ) o n residentia l structure s a t anumbe r o r propertie n locate di h Omaliai , Nebraska . Tb e pain t st>ibili2'jrlor t worU \ i bein g don e c aprotec t th e MWcleanup s tha t ar e bein g performe db y EP A contnicton . Pain t stabilizatio n activitie s wil l lociude ; ^scrapin g o f cracke do r flakin g LB P fro mstructures , applicatio n o f aprim e coa t an dtw o (2 ) coat s o f paint . Movin g part s o f window s an dduor s ar e nu t iudude dan dwil l no r b e addressed . You r caoperatio n i s requeste dIn givin g permissio n t o thi s EP A contracto r (ft ) l o ente r an dhav e acces s t o thi s propert y fo r tb e purpos e o f stabilizin g lea d-base dpal ma s outline do n th e propert y Idontifle dabove . B y signin g thi s documen t I agre e t o allo w a n EP A contractu r t o cooduc i aiiol l cleanu p a t m y propert y followin g completio n o f lead-base dpain t stabilization , I f th e ao H cleanu p ha s no t alread y bee n p«rrorm<:d . 1 understan d(ha t th e stabilizatio n contracto r ca n no t provid e uasuraBCe atha t th e soi ) cleanu p contracto r wil l b e boun dto . 1 furthe r understan dttia t th e soi l cleanu p contracto r wil l mak e al l reasonabl e effortjj o addres s concern s tha i I , a s th e propert y owner , ma y hav e regardin g sol i cleanu p a t ray property . 

# r-//'/ / Dat a I hill y understan dtha t b y aigiiln g thi s Cdnscn t fo r Access , (1 ) thi s acces s wil l remai n i n effec t unti l th e wor k ha « bee n jiatlsfactoril y completed , (2 ) tha t th e Propert y Owne r o r Tenant , i f applicable , wil l b e give n th e Houiin g an dUrba n Developmen t (HlJD ) an dEP A pamphlet , "Rtuovat aRight , Importan t Lea dKaxar diofbrmatlo afo 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 ai l obstructioo s fro msurTace s t o b e painted , (4 ) wil l abid e b y healt b an d safet y guidanc e provide db y EPA , (5 ) wil l allo w photograph y ofpropert y befor e an dafte r th e pain t stabiiiaacio n work , (6 ) wil l b e contacte db y aP E 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 o f th e LB P stabilizatio n actions , an d(8 ) wil l participat e i n fina l pruperi y Inspectio n an dsig n th e Completio n Agreemen t an d Propert y Owne r Satisfictlo n Survey . Shoul dyo u hav e an y questioni i abou t th e plane dLea d"""I-""!! ! ••^T''"''nl'''^'V" ' "' ' f i rmiT-"r"'f1' i C!^ " contac t Professiona l Envirtinmeflta l Engineers , inc . Projec t Managftc^llll e Cha v o r KelU y Sander s A t 402-504-4688 . degiau l question s aboD t tb e Omah aLea dSit e cleanu p ca n b e directe dt o Paulatt aFnmee-betts , EP A RemtdiaTrrojec t manage r 402-731-2454 , o r th e EP A Publi c Informatlo h Center s a t 402-991-!>5a 3 (Nort h Omah aoffice ) or402-73l.304 5 (Sout h Omah aoffice) , A I Yea , I giant acceK4dn^ropen y an dW2 « give n the pamphle t G Ho, I d o no t sran i acces s t o m y propert y andI was / ''Renov^p^ht . U^MM)iM«Me^ ^ FainiUsi , Chlit i give n th e pampbit t 'Raaevat e RigM, tntpettan l Lea d Carafmiders.^Bd'fgQeols.' ' > tntomiatle n fo r Families , Child e Cir e Provklen , en dSchools. ' Signaturs Dat e SPECIA LINSTftUCTION S AN D CONSIDERATION SJul . 18 . 201 1 11;45A M Jo . 064 1 P . 3


### PAIN T STABILIZATIO N PRE-PROPERT Y PAIN T MATC H ASSESSMEN T PROPERT Y ADDRESS: ^Q\9_

_'^?S^W\'^y\\^rw. , 

# BVIDgfOK ^ 7if ^

TXri.v.^i P rr.i^ ^ ^.ir,^i^^ \ ha/^^ j i AREA{S ) T O B E PAINTED ; HOUS E PROPER : .COLOR : HOUS E TRIM: . 

### COLOR E lA)l[,f P ­ 

# Y£ i

GARAGE : ^ ,COLO R 

# : IJIAJ:^ _ GARAG E TRI M 

# ~S L COLO R 

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POROH l •fKjlQl\lf^ ' y<3> S COLOR: Ij j 

# i / ^ . PORC H TRIM : 

# y&y(^^ti \

, COLOR : 

# ^ uikti ' (COMPLET E AL L SECTION , YES , NO , O R NON-APPUCABLE )



### I AGRE E TO 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 : PEACCE80 R SIGNATURE :

^^^^- ^No . 064 1 P . 4 Jul . 18 . 20 1 :45A M



### PRE-RENOVATIO N FOR M - OWNE R Thi s for mi s t o b e use db y th e firm s contracte dby th e Environmeaca i Protectio n Agency-Regio n 7 t o perfor mLead-Bas^ d Paifl t stabilizatio n activitie s a t th e Omah aLea dSite , Omaha , Nebraska . Owne r Confinnatio n Pamphle t Receip t K l h^v c receive dacop y ofth e lea dhazar dinformatio n pamphlet , Rinu\a[ e Right : Imponan i Lea dHazar dInformatio n fo r Families , Chil dCar e Provider s an dSchools , informin g m e o f th e potentia l ris k o f ch e lea dhazar dexposur e firotn renovatio n activit y t o b e performe din/o n my dwellin g unit . I receive dthi s pamphle t befor e th e work began . Owne r AckuoYVledgmen t / ^ (A ) 1 confir mtha t I ow n an dliv e i n this propeny , tha t n o chil dunde r th e ag e o f 6 reside s here , tha t n o pregnan t vwimai i reside s here , an dtha t thi s propert y i s no t achild-occupie dfacility . Mote : A chil dreside s i n th e prlma^ ' residenc e o f his/he r custodia l parents , legal guardians , foste r parents , o r informa l caretake r i f

th e chil dlive s an dsleep s mos t o f tim e at th e C3n»taker' s residence . Noto ! A child-occupie dfaclHt y i s apre-197 8 buildin g visite dregularl y b y th e sam e child , unde r 6 year s o f age , o n a t leas t tw o differen t day s withi n an y week , fbr at

leas t 3 hour s eac h day , provide dtha i th e visit s tota l A t leas t 6 0 hour s annually . Na'{B ) 1 understan dtha t th e renovatio n firm , coniracce db y th e Environmenta l Protectio n Agenc y (EPA) , wil l b e usin g lead
4af e wor k practice s require db y EPA' s Renovation , R^al r sn dPaintin g Rule . 

# §^ 

# /^ y

# A ^
Printe dNam e o^wner-Occupan i

Signatur e o f Owne^Occupan l Dat e