### PAIN T STABILIZATION FILE FOLDE R SAI D # : r^qO O Date : [g\\%\ m Address : ZZ\ ^ Oc}Af n c^f
Remediatio n Contractor : PROFESSIONA L ENVIRONMENTA L ENGINEER S Year ; 200 9 PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S B ^ Vide o of propert v (DVD ) S ? Executiv e Summar y [ FSigne dAcces s Agreemen t fo r subjec t propert y 

### [ FPaintin g Agreemen t QL-^' Settlemen t docimient s (i.e. , fo r

damag e o r to replac e plants , etc. ) \^r Photograph s p^^gfe ^ OA A QJ ^ B ^ Satisfactor y restoratio n signedby Propert y Owne r D Propert y close-out check lis t signedby EP A M Propert y information fromDougla s Coimt y Assessor' s Office S ^ confirmation tha t leadpamphlet "Renovat e Right " wa s receive dby P0 _ D D D 

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# miini i 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 • Atiatemen t • Emergenc yRespons e



### Lea dBas e Stabilizatio n Omaha , N e Clos e Ou t Repor t 200 9 SAID#3690 0 221 9 Ogde n S t

•Date s worked : 10/1 3 t o 10/1 5 200 9 •Pr e propert y condition : Hous e ha s stucc o sidin g with painte dwoo dtrims . Painte d area s wer e i n fai r t o poo r conditio n wit h some area s of flaking. •Problem s encountered : None . •Owne r request/concerns : N/ A •Inspection/closeou t dates . Owne r signe d10/1 9 2009 . Propert y inspecte dby P E projec t manager .P.00 1 13.10.200 9 10:4 8 A M dAOB . 3 / 4 

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### '"f^tv/viiiirt y {.vst'ettei.,iiv< i onviixmiKnW.i i wiuHona " " )'«x(402)504n32a i 

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. Ar c nil item s snch a apotyed)yl«n0 idieoting . ladders , paiii t bniiihcK , Gonofi , 

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# y " CONSEN T FO RACCES S T O PROPERT Y OMAHA LEAD SIT E REMEDIAL ACTIO N - LEAD-BASE D PAIN T STABILIZATIO N PROPERTY ID : PROPERTV ADDRESS : ^^ Q \<= ^ (^g^^y l 5^/ OWNE RNAME : 

### "^ g C-^-rv».o v ^



### ^\aiCJ\e r DAYTIM E PHONE : 

# f97^ Y ^^7-gyv v CELL PHONE : E-MAIL : 

### OWNER' S ADDRES S I FDIFFERENT: f ^^ 3 U/^ ^ ^ T C>/lOl^ST'CO . ^IP3 ^ TENANT' S NAM E I FAPPLICABLE : 

### DAYTIM E PHONE : CEL L PHONE : E-MAIL : Professiona l Environmental Engineers , Inc . (PE ) i s unde r contrac t (#EP-R7-08-06 ) wit h th e U.S . Environmental Protectio n Agenc y (EPA ) t o stabiliz e lea dbasedpain t (LBP ) o n residential structure s a t anumbe r o

f propertie s locate di n Omaha , Nebraska . Th e pain t stabilizatio n wor k

i s bein g don e t o protec t th e soil cleanup s tha t ar e bein g performe db y EP A contractors . Pain t stabilizatio n activitie s wil l include : scrapin g o f cracke do r flaking LB P fro mstructures , applicatio n ofaprim e coa t an dtw o (2 ) coat s o f paint . Moving part s of window s an ddoor s ar e no t include dan dwil l no t b e addressed . Your cooperatio n i s requeste di n givin g permissio n t o thi s EP A contracto r (PE ) to ente r an dhav e acces s t o thi s property for th e purpos e o f stabilizin g lea d-base dpain t a s outiine do n th e property identifle dabove . B

y signin g thi s document I agre e t o allow a n EP A contracto r t o conduc t asoil cleanu p a t m y property following completio n o f lead-base dpain t stabilization , ifth e soil cleanup ha s no t alread y bee n performed . I understan dtha t th e stabilizatio n contracto r ca

n no t provid e assurance s tha t th e soil cleanup contracto r wil l b e boun dto. I furthe r understan dtha t th e soil cleanu p contracto r wil l mak e al l reasonabl e effort s to addres s concern s tha t I , a s th e property owner , ma y hav e regardin g soil cleanu p a t m

y proper

PropertyOwne r Dat e ' I full y understan dtha t b

y signin g thi s Consent fo r Access , (I ) thi s acces s wil l remai n i n effec t unti l th e wor k

ha s bee n satisfactoril y completed , (2 ) tha t th e Property Owner o r Tenant , i f applicable , wil l b e give n th e Housin g an dUrba n Developmen t (HUD ) an dEP A pamphlet , "Renovat e Right , Importan t Lea dHazar dinformatio n for Families , Da y Car e Providers , an d Schools" , (3 ) th e Property Owne r o r tenan t wil l remov e al l obstruction s fro msurface s t o b e painted , (4 ) wil l abid e b y healt h an d safet y guidanc e provide db y EPA , (5 ) wil l allo w photograph y o f property befor e an dafter th e pain t stabilizatio 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 ) iagre e not to obstruc t o r tampe r wit h any ofth e LB P stabilizatio n actions , an d(8 ) wil l participat e I n fina l property inspectio n an dsign th e Completio n Agreement an d Property Owne r Satisfactio n Survey . Shoul dyo u hav e any question s abou t th e plane dLea dBased-Paint stabilizatio n activitie s for you r property , pleas e contac t Professiona l Environmental Engineers , Inc . Projec t Manager , Willi e Cla y A t 402-504-4688 . Genera l question s abou t th e Omah a Lea dSit e cleanu p ca n b e directe dt o Paulett aFrance-Isetts , EP A Remedia l Projec t Manage r 402-731-2454 , o r th e EP A Publi c InformatioQ^Center s a t 402-991-958 3 (Nort h Omah aofTice ) o r 402-731-304 5 (Sout h Omah aoffice) . res , I gran t acces s t o m ypropert yan d wa s give n th e pamphle t D No , I d o no t gran t acces s t o m ypropert yan d I wa s "Renovat e Right , Importan t Lea d Informatio n fo rFamilies , Chil d give n th e pamphle t "Renovat e Right , Importan t Lea d Car e Providers , an d Schools. " Informatio n fo rFamilies , Child e Car e Providers , an d Schools. " Dat e Signatur e Dat e SPECIA L INSTRUCTION S AN D CONSIDERATION S

## PAIN T STABILIZATIO N PRE-PROPERT Y PAIN T MATC H ASSESSMEN T PROPERT Y ADDRESS : ^g?( 9 LJc^cle n SJ " DATE : 10^ 3 '0 ^ BVID :

AREA(S ) T O B E PAINTED : HOUS E PROPER : 

# 3^ ^ K£>0~ i 9 COLOR : HOUS E TRIM : 

# s w ^Q O P ) R . COLOR : GARAGE : COLOR : GARAG E TRIM : _ COLOR : PORCH : COLOR : PORC H TRIM : COLOR : (COMPLET E AL L SECTION , YES , NO , O R NON-APPLICABLE )



### 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 : PROPERT Y OWNE R SIGNATURE : P E ACCESO R StGNATUR E 

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### Dougla s County Accoun t Informatio n Pag e 1 of 3 

# sa^r ^ Dougla s County , Nebrask a Propert yRecor d - R183883000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f 52n d S t - ViavyO n Ma P Informatio n i s vali d a s o f 2009-9- 3 Treasurer' s Ta xRepor t Ne w Featur e -•-•- • Aut o Sale s Searc h Owne r KLAUSNE R JEFFRE Y J P O BO X 48 6 GILCRES T C O 80623-000 0 Propert yInformatio n Ke yNumber : 388 3 000 0 1 8 Accoun t Type : Residentia l Parce l Numbe r 183883000 0 Parce l Address : 221 9 OGDE N S T 

# ^MOT^ M OieiAHAN E 68110-000 0 Lega l Description : NEWTO N AD D LOT 7 BLOC K3 5 0 X 140. 8 Valu e Informatio n 

### 2009 200 8 200 7 

### 200 6 200 5 200 4 Lan d $2,700.0 0 $2,700.0 0 $2,700.0 0 $2,700.0 0 $2,700.0 0 $2,700.0 0 Improvemen t $62/100.0 0 $62,100.0 0 

### $63,ooo;o o $63,000.0 0 $63,000.0 0 $34,400.0 0 Tota l $64,800.0 0 $64,800.0 0 $65,700.0 0 $65,700.0 0 $65,700.0 0 $37,100.0 0 Sale s Informatio n Sale s Date : 2007-05-1 8 Dee d Type : Price : W D $66,000.0 0 Book : 200 7 Page : I 06151 9 Grantor : AMBASSADO R REA L E STAT E C O Grantee : KLAUSNE R JE FFRE Y J Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 

### 2007-02-2 1 Dee d Type : W D Book : 200 7 Page : \ 03259 9 Price : $ 60,465.0 0 Grantor : NELSE N RACHE L 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno= R18.. . 9/11/200 9

### Dougla s County Accoun t Informatio n Pag e 2 o f 3 Grantee : AMBASSADO R REA L ESTAT E COMPAN Y Valid/Invalid : invali d Exclusio n Reason : Remode l o rAdd n Afte rSal e .± . Sale s Date : ! 1994-09-1 2 Dee d Type : D Book : ! 198 7 Page : < 32 1 Price : $32,841.0 0 Granto r Grantee : Valid/Invalid : vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 6 7000. 0 1. 0 140. 0 50. 0 N o Improvemen t Informatio n Buildin g 1 O p
22t80GOENS r

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CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1479. 0 Percen t Complet e 100.0 % Perimete r 0. 0 Qualit y Averag e Uni t Type : Condition : Averag e

Buil t As : 2 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 6. 0 Exterior : Fram e Stucc o 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. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : i 0. 0 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R l 8.. . 9/1 1 /200 9(vVA<Lx£ j ."- ^ 

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## Professiona l Environmenta l Engineers , Inc . SAFET Y AUDI T Projec t Nome : -^- ^ /' ^ ( ^ ^Ji < ^ ^- r Dot e o f Audit : /^-/"j5 ^ ^ f Primar yHealt h Hazards : A^c A 6 y ^

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### PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC . DAIL Y SAFET Y MEETIN G Date : //? - I ^ ^ - ^ Project : Omah a Pain t Stabilizatio n Projec t Location : V j f / f ^'^J^ n r/ - Site Activity : Dail yTasks : 

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## ^AJj-^^-QM^^ ^ 1 0 -tfe>~o< p Sit e Healt h & Safet ySignatur e Dat e181 6 Missour i Av e Omah a NE . (402 ) 504-846 4 

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