## TRANSMnTA L o f OMAH A LEA D SOT E PAIN T STABU^IZATIO N FIL E FOLDE R SATO* : /8S52 ^ Date : //m m 

# A^ : 

# )q3 i So . ^4 ^ 

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# I Remediatio n Contractor : PROFESSIONA L ENVIRONMENTA L ENGINEER S Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S Oy ^ Vide o ofpropert y (DVD ) t l Executiv e Simunaiy ^ y Signe dAcces s Agreeinen t fo r subjec t propert y S""" ^ Paintin g Agreemen t D Settlemen t document s (i.e. , fo r dainag e o r t o replac e plants , etc. ) - ^ ^ Photograph s h^y?j j q-f ^ . 

### a^^^adsfector y restoratio n signedb y Propert y Owne r (B|l r Propert y close-out chec k lis t signe dby EP A I & Properl y informatio nfiwmDougla s Count y Assessor' s Offic e y _confiimatio ntha t lea dpamphle t "Renovat e Right " wa s receive db y PO _ 

## a ^ D D

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### Professiona l Eim(^ninenta i Engineer s Signatur e 

# i i 

# mE P ASignatur e 

# 4 ^ 3005499 7 Superfun d

## PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC . ''° ' ""ol'tN E 6'8?! o "Providin g cost-effectiv e environmenta l solutions " ^ \t?^ , c^too ? * * Fa x(402 ) 504-328 1 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 200 9 SAID ^ 1883 2 193 1 S 3 4 St .

•Date s worked : 10/1 9 t o 10/2 4 200 9 •Pr e propert y condition : Larg e home wit h woo dan dslat e sidin g tha t wa s i n poo r condition . Sidin g ha darea s o f

damag e an di t appear s a s i f

homeowner i s doin g renovation s t o property . Bac k garag e wa s no t painte ddu e t o owne r doin g work an di t wa s no t previousl y painted . •Problem s encountered : None •Owne r request/concerns : N/ A •Inspection/closeou t dates : Owne r signe d10/27 , Inspecte db y P E projec t manager. .

# PROFESSIONA 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-effective environmenta l solutions " Fax(402 ) 504-328 1 Consultin g ° Engineerin g Desig n • Remediatio n ' Abatemen t • Emergenc yRespons e 

## Propert y Owne r

Close-Out For m (Lead-BasedPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) 

# SAID : / S S^2 ^ Propert y Address : J^V^i , ^ ^^ 4 < ^ Owner' s Name : j^TjT\C\< ^ J T O/^N^ ^ 3 ^ - 4( ^ 0 3 Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s the entir e structm'e(s ) painte dwit h th e exception ofth e stated , exclude d areas ? Thi s wouldinclude paintin g o f

other associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an dexterior sturfaces o f garages . 

# X 2 . Was all scraping andothe r

preparatio n wor k

completedsatisfactorily ? 

# T 3 . Wer e all require darea s ofth e structure(s ) prime da s neededandpainte dwit h tw o top coats ? [ 

# X ? 4 . Was the paint product s utilize dequivalen t t o a3 0 yea r

product/quality ? 5 . Ar e all ofth e area s wher e contanoinate dmaterial s have been spille dthoroughly vacuiuned / cleaned ? 

# y 6 . Didthe contractor collect/vacuumall falling andscrapedpain 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

generateddebris ? 

# X 7 . I s the gras s are atha t svuroimds th e structm'e(s ) i n reasonabl y goo dcondition ? 

# y 8 . Ar e all item s suc h a s polyethylene sheeting , ladders , paint brushes , cones , barrie r

tape , etc . properly removed ? 

# X 9 . I s ther e an y evidenc e ofpropert y damag e tha t wa s don e by th e contractor ? An y propert y damage need s t o b e completedprio r t o th e EP A Close-Out . 

# M , 1 

# g ^ 10 . Ar e ther e an y propert y item s tha t wer e temporarily re-locate dby th e contractor tha t needto b e movedback ? 

# i 11 . Ar e ther e an y (known) lingering issue s wit h th e propert y owner(s ) tha t hav e bee n lef t unresolved ? 

# y Comments :



## yO'^7'0 / Professiona l Envir^imental Engineer s Representativ e Dat e

# CONSEN T FO RACCES S T O PROPERT Y OMAH A LEA D SIT E REMEDIA L ACTIO N - LEAD-BASE D PAIN T STABILIZATIO N PROPERTV ID : ^ K5)'2> ^ PROPERTV ADDRESS : /^3 / * ^ ^ 4 'Sj ' O^jN^iyVjE:. ^ ^ Rlalce . DAYTIM E PHONE : >^^'-^4P ' V(^^? 3 CELL PHONE : V^c^ ' V^/ ^ ' SV^ ^ E-MAIL : . OWNER' S ADDRES S I FDIFFERENT : TENANT' S NAM E I FAPPLICABLE : DAYTIM E PHONE : ^ CELL PHONE : E-MAIL : .- Proressiona l Environmental Engineers , Inc . (PE ) i s unde r contrac t (#EP-R7-08-06 ) wit h th e U.S . Environmental Protectio n Agency (EPA ) t o stabiliz e lea dbase dpain 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 flakin g LB P fro mstructures , applicatio n ofaprim e coat an dtw o (2 ) coat s o f paint . Moving part s o f window s an ddoor s ar e no t include dan dwil l not b e addressed . Your cooperatio n i s requeste di n givin g permissio n t o thi s EP A contracto r (PE ) t o 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 outline do n th e property identifie dabove . B

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

n not provid e assurance s tha t th e soil cleanu p 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 t o addres s concern s tha t I , a s th e property owner , ma y hav e regardin g soi l cleanu p a t m

y property . I hav e am i understan d th e ^Y" . 

### WLAI ^ Signatur e o f Pro | Dat e I full y understan dtha t b

y signin g thi s Consent for 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 LeadHazar dinformatio n for Families , Da y Car e Providers , an d Schools" , (3 ) th e Property Owner 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 allow photography ofpropert y befor e an dafte r 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 ) agre e no t t o 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 Owner 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 . General question s abou t th e Omah a Lea dSit e cleanu p ca n b e directe dto Paulett aFrance-Isetts , EP A Remedia l Projec t Manager 402-731-2454 , o r th e EP A Publi c Informatio n Center s a t 402-991-958 3 (Nort h Omah aoffice ) o r 402-731-304 5 (Sout h Omah aoffice) .

» ^ Yes , 1 grah t acces s t o m ypropert yan d wa s give n th e pamphle t D No , t d o no t gran t acces s t o m ypropert yan d I wa s

Renovat e Right , Importan t Lea d Infomiatio n fo rFamilies , Chil d give n th e pamphle t "Renovat e Right ; Importan t Lea d Care-Providers , an d Schools. " Informatio n fo rFamilies , Child e Car e Providers , an d Schools. " 

# %i^ //)/^ m Signatur e Signatur e Dat e SPECIA L INSTRUCTION S AN D CONSIDERATION S

## \ y\ PAIN T STABILIZATIO N PRE-PROPERT Y PAIN T MATC H ASSESSMEN T PROPERTYADDRESS : \ ^^ \ S 3 ^ c^ j DATE : 10' ^ BVID : / O c5 ^ Z .

AREA(S ) T O B E PAINTED : HOUS E PROPER : J a M^iB^^if- s I/ H ^ COLOR : 

### HOUS E TRIM : ly/^y ^ COLOR : (iJA/Jy ^
GARAGE : ///: ) COLOR : 

# K-Jlc ^ /2 ^

^^.j^^^^/f/ ^ \^J^.J^^ GARAG E TRIM : 

# J U COLOR : //y > PORC H 

## : iMyyCOLOR : (^yj/J^, ^ • ^y).y>£^ ^ jd^A^j2 ^ ^?-A^^2^^ y^ ^

^yyy/ii^y y:j^.^^ j PORC H TRIM : COLOR : (COMPLET E AL L SECTION , YES . NO , O R NON-APPLICABLE )


### I AGRE E T O TH E COLOR S LISTE D ABOVE . ONC E TH E PAINTIN G BEGINS , I UNDERSTAN D I CA N NO TCHANG E TH E ABOV E SELECTE D COLORS : PROPERT Y OWNE R SIGNATURE : P E ACCESO R SIGNATURE : 

# ^.So/ 1

### Dougla s Count y Accoim t Information Pag e 1 of 3 

# ^ /835 7 I. s 1 \_ yfc-^ Dougla s County , Nebrask a Propert yRecor d - R254087000 0 Prin t Reoor t NE W Featur e - Parce l Dimension s availabl e ® scal e 0-5 0 f t wes t o f 52n d S t - VIS W O H Ma O Informatio n i s vali d a s o f 2009-9-1 5 Treasurer' s Ta xReoor t Ne w Featur e -•-•- • Aut o Sale s Searc h Owne r BLAK E PATRICI A J OMiHA^Il8105-000 0 J^-lS " H^oO ^ Q % ' S7<^ C Propert yInformatio n WISC X ^IZ- ^ Ke yNumbe r 408 7 OOO O 2 5 ^ Accoun t Type : Residentia l Parce l Numbe r 254087000 0 Parce l Address : 1931 8 3 4 S T OMAH i ^NE681 ( D5-000 0 Lega l Description : WIND S JO R PLA C : E LO T 3 9 BLOC K0 N 44. 5 W 9 5 F T LO T 3 9 44. 5 X 9 5 Valu e Informatio n Lan d fmprovemen t Tota l 200 9 $5,400.0 0 $101,100.0 0 $106,500.0 0 200 8 $5,400.0 0 $101,100.0 0 $106,500.0 0 200 7 $5,400.0 0 $101,100.0 0 $106,500.0 0 200 6 $5,400.0 0 $79,800.0 0 $85,200.0 0 200 5 $5,400.0 0 $79,800.0 0 $85,200.0 0 200 4 $5,400.0 0 $79,800.0 0 $85,200.0 0 Sale s Informatio n Sale s Date : 1995-09-2 6 Dee d Type : D Book : 201 8 Page : 06 4 Price : $58,0 0 0.0 0 Grantor : Grantee : Valid/invalid : Vali d Exclusio n Reason : Sale s Date : 1991-10-0 4 Dee d Type : D Book : 191 3 Page : 74 3 Price : $42,950.0 0 Granto r 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=R25.. . 9/20/200 9

### Dougla s County Accoun t Informatio n Pag e 2 o f 3 Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 9 4275. 0 1. 0 95. 0 45. 0 N o Improvemen t Informatio n Buildin g 1 1 1/ 2 STOR Y UNFINISHE D

IJlUUSi i M

' 7

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• .SaallioF i CLIC KTO ENLARG E IMAG E Squar e Footage : ' 1205. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 1 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 4. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : j Drywal l Baths : 1. 0 Roo f Cover : ' Compositio n Shingl e Bedrooms : i 2. 0

Roo f Type : ; Hi p Stories : 1. 5 Floorcover : Allowanc e Foundation : I Bloc k 

### f- Sprinkle rSquar e Footage : | 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 190 7 0 % 190 7 10 2 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Unfinishe d Atti c W/floo r 1205. 0 Applianc e Allowanc e 1. 0 Applianc e Fireplac e Masonr y 1. 0 1205. 0 Basemen t Bsmn t Bloc k 8 f t 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R25. . . 9/20/200 9

## H^^maiV y J

C Paintin g Propert yAddres s tC\?> V S ­ 7^4 ^ sr\ ­ Dat e 1 Q — '^ S-0< ^ Start Dat e [ 0 ~ 1 ^ ­ O Q Complet e Dat e 

## 0-^4-o<^ . |_ 

### Amoun t O f Prim e An d Pain t Use d Prim e (Gallons ) ~S ^ Pol y(Boxes ) <3 ^ Pain t (Color ) 

## S^ ^ Pain t (Color ) Pain t (Color ) Pain t (Color ) Pain t (Color ) Amoun t (Gallons ) Amoun t (Gallons ) ^ ^ 

# Q j Amoun t (Gallons ) 

## r ^ g 

## fi^^l ^-^^ ^ Amoun t (Gallons ) Amoun t (Gallons ). '^ 

## Professiona l Environmenta l Engineers , Inc . SAFET Y AUDI T Projec t Name : //f^ / h ~^^/.^- h Dat e o f Audit : f O " ^ O -O f Primar yHealt h Hazards : 4^/:A ? 

### o y^e f r.{/<~: ^ Primar yH 8 . S Concerns : COO J ^^y Dall yTasks : 1 es6->^ff'r ^ ^ 

## 2 . P-yj ' <rm ' c^ y 

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.s 4 3 . ¥n4^ ^ Equipmen t Use d a t Jobsite : Har d Ha t P/ " Ladde r^ / Safet yGlasse s ^ / Boo m Lift s ___ ^ Stee l Toe d Shoe s ^ / GFC I ^ / Wor k Glove s / Safet yVest s / Generator s \ / Othe ry Equipmen t Read yfo rEmergenc yRespons e a t Immediat e Disposal : Dail ySafet yMeetin g Conducte d y Firs t Ai d Ki t '/ . Emergenc yProcedure s y ^ Compan yHealt h an d SafetyPolicy GFC I on-sit e 

# t

Deficiencies : 

## xy'/y^ Correctiv e Actions : 

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Auditor : ^^/-. x\^(/1 \ Cyr^T ^ Date : /f ) -^- O -ig> f Site Supervisor : '^^.t„.,^iLQ^\r.\...t ^ Date : t Q-3-i-c^c ^

### PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC . DAIL Y SAFET Y MEETIN G Date : / ^ - ^ d " ^ ^ Project : Omah a Pain t Stabilizatio n Projec t Location : / f 1 ? I ^ ^V.^ ^ Sit e Activity : Dail yTasks : 1 . ^^Cyp^pyc/ ^ 1 ^ 2 . / P l rI )7^f> i y 

## 3 . y/< 7 V^^ ^ Primary/Potentia l Hazards : 

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## ] . w/y ^ 3 . 2 . 4 . Employe e Sig n I n Log : 

## 1 . yycj- y(y i 1 ^ r.yo' ^ 3 . 

## 2 . LrpHC / 4 . 5 . ffl^f^^ > - 6 . 7 8 . Sit e Healt h & Safet ySignatur e 

## h)rv^y h a ^

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