PAINT STABILIZATION FILE FOLDER 

SAID #: r^qO O Date: [g\\%\ m 

Address: ZZ\ ^ Oc}Af n c^fRemediation Contractor: PROFESSIONAL ENVIRONMENTAL ENGINEERS Year; 2009 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

B^ Video of propertv (DVD) 

S? Executive Summar y 

[F Signed Access Agreement for subject property 

[F Painting Agreement 

QL-^' Settlement docimients (i.e., for damage or to replace plants, etc.) 

\^r Photographs p^^gfe^ OAA QJ ^ 

B^ Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

M Property information from Douglas Coimty Assessor's Office 

S ^ confirmation that lead pamphlet "Renovate Right" was received by P0_ 

D 

D 

D 

i4ifca 

^flaf^^Afu<xk^- 4mo 

EPA Signature /Datfe 

30054985 miinii 

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 • Atiatement • Emergency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

2009 

SAID# 36900 

2219 Ogden St 

• Dates worked: 10/13 to 10/15 2009 

• Pre property condition: House has stucco siding with painted wood trims. Painted 

areas were in fair to poor condition with some areas of flaking. 

• Problems encountered: None. 

• Owner request/concerns: N/A 

• Inspection/closeout dates. Owner signed 10/19 2009. Property inspected by PE project 

manager. 
P.001 

13.10.2009 10:48 AM 
 dAOB. 3/ 4 


l!l4il*.«jr-'iirif^$i|lf:»!n!i/^i*.. 


SSWS North £M<'-,aufto2t0 

Omafm.NEamio 

'"f^tv/viiiirty {.vst'ettei.,iiv<i onviixmiKnW.ii wiuHona" " )'«x(402)504n32ai 

Pix^xaty Owner Close-Out Form 

(I.A3ad-i)m(ttd I'uim Stahili/iakTn iiPACuntnici]ir-K7-t)$-l)6i 

sAn>: 3U^^(0D. 

PiopedyAdtiress: /7.1 M 0^ ( Wi ^ ..Ili— . 

Ow.icf's Nunu:: J(C.n<^F[7^ \ 0 L(.jJQ.?^'f_ .. . 

Pfcrfeniomicc Slawdard<»/Cl<»M>iif CViteriiit |7 YKH NO 

I. Waa tbe «niihe sUuctitfeTs) pgdntcd with tho exuopUon of Una slated, eiduded 

areui? T7i!:> would include psinting of other assuda^cd fcatim» including rtutoin, 

C8V0S, sidii^ all trim, p<nvh«tc, box beams, columns, ndiit, and cxiurior sutfaccs of i . ^ 

2^ Was KI) Ncntplng and nlhcr pty^nr4til<>n wnri ocHn])itfi<3d iHdi.Nr«()i(tti]y7 

3. W«(t aii requind aroas of thu .Mrvt:iuns(8) jirinxed as nwded^aDd pooitedwith 

t»n4tipBOttt^; • ••'•• ... ,.. .._'__ _. , 

4. Wastitepqiotproduct-votili/adoquivaiontU>tWyarpf-xJuct/nualiiy'/ 

5. Arc all of ifie arees wbere co&taminated in«tcr!alK have bo«n xjflkd thun^u^y 171 yocuamed/cileaocd? ^^ 

6, Did ths ctnlra^ior coilud/vacuuoi ^felling «td iKi^jed pabl t^lpis on die y 

eoluo propwtyt madways, atlej^woyx, publicfioeess 9nt» and also remove any 

other itottorrtod dgbris? 

7. Isthegnwttwttfeataufrpuadgdie5tructiiBc(8)inreawpablygoodcoadiikm^ T ^ o A__iTti i 1.* .'...L.-tt i _ . j ii_. . «'j. i ' ••!?';'T^^ — X. Arc nil items snch aa potyed)yl«n0 idieoting. ladders, paiiit bniiihcK, Gonofi, 

bgtriar t^Kt, cto. pwgwly tumttved? -A ^ Ts tine any evidtme of property damage tW ww done by Sie conUaciot? Aiiy 

pTopqty danugCjMvdRJobo coinplctod pfior to the RP A Clc»9^)ui y

10. Arefliere any property Uctns that iwofaoiporintyre-iooated by t ^ y

^t^E*'^y^y'?j!^^'!^y?!^... 

T T Art Ihsn tity (kftfrwn) Ftagctiag '(«miiei<^wi% (h« properiy Qwicr(8J Owt have"~ 

\y baeotoft w»e«QlvKi? 

Qinunsnt»: 

Mjii/n ... Date ate ' 

Piofessioasi Eavitonmentai Engioemv Reprawmtativi; Dtite 

u.^ - 1— • -T ri~ vff.'rrr 'J"-.""­
y " CONSENT FOR ACCESS TO PROPERTY 

OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID: PROPERTV ADDRESS: ^^ Q \<=^ (^g^^yl 5^/ 

OWNER NAME: 

"^ g C-^-rv».ov ^\aiCJ\e ^ r DAYTIME PHONE: 

f97^Y ^^7-gyvv 

CELL PHONE: E-MAIL: 

OWNER'S ADDRESS IF DIFFERENT: f ^^ 3 U/^ ^ ^ T C>/lOl^ST'CO. ^IP3 ^ 

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 of cracked or flaking LBP from structures, application ofa 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 outiined on the property identifled 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, ifthe 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 proper 

Property Owner Date ' 

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) iagree not to obstruct or tamper with 

any ofthe LBP stabilization actions, and (8) 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 Based-Paint stabilization activities for your property, please contact 

Professional Environmental Engineers, Inc. Project Manager, Willie Clay At 402-504-4688. General questions about the Omaha 

Lead Site cleanup can be directed to Pauletta France-Isetts, EPA Remedial Project Manager 402-731-2454, or the EPA Public 

InformatioQ^Centers at 402-991-9583 (North Omaha ofTice) or 402-731-3045 (South Omaha office). 

res, I grant access to my property and was given the pamphlet D No, I do not grant access to my property and I was 

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

Care Providers, and Schools." Information for Families, Childe Care Providers, and Schools." 

Date Signature Date 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

PROPERTY ADDRESS: ^g?( 9 LJc^cle n SJ " DATE: 10^ 3 '0 ^ 

BVID: 

AREA(S) TO BE PAINTED: 

HOUSE PROPER: 3^^ K£>0~i 9 COLOR: 

HOUSE TRIM: s w ^QO P ) R . COLOR: 

GARAGE: COLOR: 

GARAGE TRIM: _ COLOR: 

PORCH: COLOR: 

PORCH TRIM: 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 StGNATURE 

fci^^^ ^ ^ y /^^ 
Douglas County Account Information Page 1 of3 

sa^r ^ 

Douglas County, Nebraska Property Record - R1838830000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - Viav y O n Ma P Information is valid as of 2009-9-3 Treasurer's Tax Report 

New Feature -•-•- • Auto Sales Search 

Owner 

KLAUSNER JEFFREY J 

P O BOX 486 

GILCREST CO 80623-0000 

Property Informatio n 

Key Number: 3883 0000 18 

Account Type: Residential 

Parcel Number 1838830000 

Parcel Address: 2219 OGDEN ST ^MOT^M 

OieiAHANE 68110-0000 

Legal Description: NEWTON ADD LOT 7 BLOCK 3 50 X 140.8 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$2,700.00 

$2,700.00 

$2,700.00 

$2,700.00 

$2,700.00 

$2,700.00 

Improvement 

$62/100.00 

$62,100.00 

$63,ooo;oo 

$63,000.00 

$63,000.00 

$34,400.00 

Total 

$64,800.00 

$64,800.00 

$65,700.00 

$65,700.00 

$65,700.00 

$37,100.00 

Sales Informatio n 

Sales Date: 2007-05-18 

Deed Type: 

Price: 

WD 

$66,000.00 

Book: 2007 Page: I 061519 

Grantor: AMBASSADOR REAL ESTATE CO 

Grantee: KLAUSNER JEFFREY J 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 2007-02-21 

Deed Type: WD Book: 2007 Page: \ 032599 

Price: $60,465.00 

Grantor: NELSEN RACHEL 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R 18... 9/11/2009 
Douglas County Account Information Page 2 of 3 

Grantee: AMBASSADOR REAL ESTATE COMPANY 

Valid/Invalid: invalid 

Exclusion Reason: Remodel or Addn After Sale 

.±. 

Sales Date: ! 1994-09-12 

Deed Type: D Book: ! 1987 Page: < 321 

Price: $32,841.00 

Grantor 

Grantee: 

Valid/Invalid: valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.16 7000.0 1.0 140.0 50.0 No 

Improvemen t Informatio n 

Building 1 O p 

22t80GOENSr 

" r •=' I Second Ftaor ' L f 736.0 ill), fl nd First floor ,, „ 

>« M3.0s«. « P "" ; 

L ,...*" J 

i 7SU 

2 1/2 STORY UNFIN 

Bsmnt Block e It a24Dsq.4l 

CLICK TO ENLARGE IMAGE 

CLICK TO ENLARGE IMAGE 

Square Footage: 1479.0 Percent Complete 100.0% 

Perimeter 0.0 Quality Average 

Unit Type: Condition: Average 

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

HVAC: Central Air to Air Rooms: 6.0 

Exterior: Frame Stucco Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 2.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: i 0.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl 8... 9/11 /2009 
(vVA<Lx£j ."-^ 

JC Painting 

Propertv Address 

Start Dntp 

Prime (Gtiltons) 

Poly (Boxes) 

Paint (Color)

Paint (Color)

Paint (Color) 

Paint (Color) 

Paint (Color) 

Date tQ~ t^-c ^ 

Complete Date jQ -^1^ — Q O 

Amount Of Prime And Paint Used 

5 

 ^c U (^Q l ^ Amount (Gallons) | Q) g 

 ^o J j/ O ^ ^ Amount (Gallons) ^ Q 

Amount (Gallons) 

Amount (Gallons) 

Amount (Gallons) 
Professional Environmental Engineers, Inc. 

SAFETY AUDIT 

Project Nome: -^-^ /' ^ (^ ^Ji < ^ ^-r 

Dote of Audit: /^-/"j5 ^ ^ f 

Primary Health Hazards: A^c A 6 y ^ ^^/^.c-c^ 

Primary H&S Concerns: JAo r d^ V 

Dally Tasks: 1. /"r C yc^f t'a^ y 

2. ^Oj-t>mV* ^ 

3. f>Cvx4^\^ 

Equipment Used at Jobsite: 

Hard Hat \/ Ladder ^ / 

Safety Glasses y Boom Lifts 

Steel Toed Shoes J GFCI y^/ 

Work Gloves ^/. Safety Vests . 

Generators y Other ( / 

Equipment Ready for Emergency Response at Immediate Disposal: 

Doily Safety Meeting Conducted \ / 

First Aid Kit ^ / 

Emergency Procedures y 

Company Health and Safety Policy V / 

GFCI on-site ^ / 

Deficiencies: '^/ A 

Corrective Actions: K/A 

Auditor: ^^^W^/' H C^f/^Z Date: \0- ' i ^ O ^ 

Site Supen/isor: •^^L^^e>ii»<L^'R^^aOfcA^ Date: / O -13—g>7 
PROFESSIONAL ENVIRONMENTAL ENGINEERS, INC. 

DAILY SAFETY MEETING 

Date: //? - I ^^ - ^ 

Project: Omaha Paint Stabilization Project 

Location: V j f / f ^'^J^ n r/ -

Site Activity: 

Daily Tasks: 

1. CrC^cf.^\' 

2. p y('fn.t'r^v 

3. Pi't^^u ^ 

Primary/Potential Hazards: 

1. l^C^ho ^ Cx^j-u^ . ^ . ^ 3. UQ^ ^ y 

Work Tools: 

/^// ^ 3. 

4. 

Work Practices/Connective Actions: 

1.. 3. 

2. 4. 

Previous Close Calls: 

/^/ ^ 3. 

4. 

Employee Sign In Log: 

h. 3. 

2. 4. 

5.. 6. 

7. 8. 

^AJj-^^-QM^^ ^ 10 -tfe>~o<p 

Site Health & Safety Signature Date 
1816 Missouri Ave 

Omaha NE. 

(402) 504-8464 J s C Painting Ilo. [tax]402 932-7493 

IWeb addi«ss]Jandcpaintlngnc®llve.com 

Fax 

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