TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID #: 26745 

Address: 2620 Decatur St 

Remediation Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

gf Video of property (DVD) 

^ Executive Summary 

[/ Signed Access Agreement for subject property 

w Painting Agreement 

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

D Photographs 

[F Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

[Z Property infonnation from Douglas County Assessor's Ofifice 

D 

D 

D 

„A^^ Jl'ljo'* 

Signatur^ Date 

40310402 


nil 111 


Superfund 
PROPERTY SUMMARY 


Date: 12/03/08 LBP STABILIZATION EPA CONTRAT EP-R7-0»-07 Month of: December 

Property Address; 2620 Decatur St SAID; 26745 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: None 

A.2 Issues Resolved: None 

A.3 Unique Findings; None 

122A.4 Other Relevant Infomiation; None 

Access Date; 09/08/08 


Work Began Date; 09/17/08 


Closeout Date: 09/30/08 


Enclosures; 


1. Pre-Video 

2. Post-Video 

3. Property Status Form 

4. Signed Access Agreement 

5. Pre-Renovation Form 

6. Paint Match Form 

7. Tracldng Form 

8. Douglas County Assessor Property Information Page 

9. EPA Property Closeout form 

10. Property Completion Agreement 

TECHNOLOCIES, INC. 

ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: ^(e^O K/eC-iifjr^ Date: V^/< ^ 

Phone: ^fo'gi^ ZHH ' <CTS5^ BVID: 9t^7^S^ 

Plant & Pennanent Landscaping To Remain In Place 


Item# 


Description and Location /


On Map {\/o p/c/Ah cfcc^^racl fc/i^^)^r<^ ^ ^'•'^^e'. 

Pre-Existing Condition of Structures 

Does your Basement have a history of leaking? Yes — No -^~ 

Item# Description & Location ^ 

On Map 

{yfiait l 

Property Owner Prudent Employee 


Signature^ Signature: fob^ljsC 'fc^s-***"* 


8080 Ward ParKway, Suite 405 2605 N. 24*^ Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City. MO 64114 Omaita, Nebrasica 68110 San Antonio, TX 78229 

Phono: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-8588 
^Kol^S 


Prudent Technologies, Inc. (Prudent) is under contract (Contract # EP-R7-08-07) with lhe U. S. 

Environmental Protection Agency (EPA) to stabilize Lead Based Paint (LBP) at a number of properties 

located in Omaha, Nebraska, including the property located at '2..it?^J ~P).^^.^;{r xf' J^-f. 

The EPA requests your permission to allow Prudent to perform LBP Stabilization at this property. By 

signing this form,tiieproperty owner grants permission to Prudent to perfonn activities related to LBP 

Stabilization including scraping paint and painting ofthe referenced property. Further, the owner/tenant 

verifies that they have received lhe LBP pamphlet "Renovate Right." 

Ifyou have any questions about the LBP stabilization planned for your property, please contact Prudent's 

Administrative Clerk for the Lead Based Paint Stabilization, Mrs. Deborah Akerele-Jolmsoii. 

at (402) S04-1004. General questions about the Omaha Lead Site cleanup can be directed to the EPA 

Public Infonnation Centers at (402) 731-3045 (South Omaha ofifice) or (402) 991-9583 (North Omaha 

office). ^ ^ 

Properly Acoen Granted Bv:X L^f(l<^ C)<^-^t

(Please Print Name) 

Propeny Owner Signature: 
 9-'$'^,S' 

(Signature) (Date) 

PROPERT/ INFORMATION 

, ^ (Too bs.£iHDpIete bs.£iHnpIetedd bbvv reiiden n t and/or property oiraer - pleaM prinQ 

RE8IDENTNAME: A - / M /' -g. /^ ) ^ ^ C ^ COwner ^i Renter 

rSSIDENT ADDRESS: 

IP RENTAL. PROPERTY OWNED BY: 

OWNER'S MAIUNG ADDRESS; "^^/T t (S 

OWNER'S TELEPHONE NUMBER - HOME: h(/SU'^\H~ ^ ^ S WORK: ( \ 

NUMBER OP OCCUPANTS UNDER 7 YEARS OLD: D NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER: _ L 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PU Y IN THE YARD FOR 5 HOURS OR MORE PER WEEK:

. 13 

COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS. ENTRY GATES. ETC.) 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS; The activities to be implemented by EPA under tUs agreement are pursuant to Section 104 

of CERCLA, 42 U.S.C. 9604. EPA's right ofaecess to the propeity is provided for in Section 104(e) of CERCLA, 42 U.S. C 9605(e). which provides entry 

for "determining the need tor response, or choosfaig ortaking any response aclion under this title, or otherwise enforcing the proviiior* of lhe title." 

^^^•^.^•rjir'"' ^^nfNfSarir *^*^"\rkKo*T7;ss 

Phone: (402) 504-1004 Phone: (210) 822-9588 ansa hone s: (816 city)

. MO 363-370 64113 4 °r.T!-!: .InSTcnAfinnk Phone:(210)822.9588
Current Sample Pre-Renovation Form 

Innatlon of Receipt of Lead Pamphlet 

^1 have received a copy of the pamphlet, flenovate Rl^ t Important Laad Hazard 

Infbnnation for Families, Child Care Provkiars and Schools informing me of 

the potential risk of the lead hazard exposure from renovation activity to be 

perfomied in my dwelling unit. I received this pamphlet before the work began. 

AL//(e. l^e-ct 

Print^dLname of recipient le 01 recipient. •? . 

Signature of recipient 


Self-Certification Option (fbr tenant-occupied dwellings only) — 


If the lead pamphlet was delivered but a tenant signature was not obtainable, 


you may check the appropriate box below. 


a Refusal to sign — I certify that I have made a good faith effort to deliver the 

pamphlet, Fienovate FSght Important Laad Hazard Infonnation for Families, 

CNki Care Providers and Schools, to the rental dwelling unit listed beiow at the 

date and time indicated and that the occupant refused to sign the confirmation 

of receipt. I furttier certify that I have left a copy of the pamphlet at the unit with 

the occupant. 

•	 Unavailable fbr signature — I certify that I have made a good faith effort to 

deliver the pamphlet. Renovate Rgh t Important Lead Hazani Infomnation for 

f^mtSes, Child Care pmviders and Schools, to the rental dwelling unit listed 

below and that the occupant was unavailable to sign the confirmation of receipt. 

I further certify that I have left a copy of the pamphlet at the unit by sliding it 

Printed name of pei^ n certifying Attempted delivery 


date and time 


lead pamphlet delivery


A^^^^-— 

Signature of person Bertifyin deiiver irson bertityingg lea leadd pamphle pamphlet

t deliveryy 

1 

Unit Address 

Note Regarding Mailing Option — As an altemative to delivery in person, you 

may mail the lead pamphlet to tiie owner and/or tenant. Pamphlet must be mailed 

at least 7 days before renovation (Document with a certificate of nnailing from the 

postoffice). 
paint match form 

Paint matching form: 

Propert p^tt^e y ^_ L y address: i?^i?d^ ii^c^u^^f^ 

BVID: ^(^7^ f 

Area: ^/cAnc. Color: uJh,4e 

Explanation: 

Area: Color: 

Explanation: 

Area: Color: 

Explanation: 

Area: Color: 

Explanation: 

Area: color: 


Explanation: 


K 

Page 1 

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A)DH'^ C^UU r\G^ (^IAA acc^D^^y^ ^j.^\ . JIA ..t/^ i . / -\. .i ^ v^ htl *. . - /^ I 
Douglas County Account Info^^i tion Page 1 of2 

Douglas County, Nebraska Property Record - R1946q4000O 

Z~_ Print Report 

NEW Featur* - Parcel Dlmentloni available Q scale 0-50 tt west of 90tti St - Viev y O n Ma p Information is valid as of 2008-7-14 I.reasure,r's.T.ax .Report 

New Feature -•••• • Auto Sales.Search. 

Owner 

BECK LILLIE G 

v\A f f ^ 


2620 DECATUR ST 

OMAHA NE 68111-0000 

Property Informatio n 

Key Number: 4604 0000 19 

Account Type: Residential 

Parcel Number: 1946040000 

Parcel Address: 2620 DECATUR ST 

OMAHA NE 68111-0000 

Legal Description: PARKERS ADD LOT 11 BLOCK 9 W1/2 30 X 126 

Value Informatio n 

2008 

2007 

2006 

2005 

2004 

2003 

Lancf 

$900.00 

$900.00 

$900.00 

$900.00 

$900.00 

$900.00 

Improvement 

$49,100.00 

$49,100.00 

$49,100.00 

$49,100.00 

$10,100.00 

$10,100.00 

Total 

$50,000.00 

$50,000.00 

$50,000.00 

$50,000.00 

$11,000.00 

$11,000.00 

Land Informatio n 

Acres 

0.08 

SF 

3780,0 

Unita 

1.0 

Depth 

126.0 

Widtii 

30.0 

Vacant 

No 

Improvemen t Info rmatio n

Building 1 

i..i^-.// j I ...., . •\^i%a^wMt r%«^lt ^r>Tv./r^/Mirr1ooPr»>J»»/ctntir'./nor.f>iintinfn i<!n'?ap.r:nnntnf>=R 1Q... 8/76/^00 8 
Douglas County Account Infc^^tion Page 2 of2 

ZeZOOECATURtf 

lisjit ftXf Cbuw. C4> . .nil . 

£3 

— "t^-ilp:' — 

1*3 

11/2 STOKY UNFIN 

giLCKT.Q,.El!llARg£JMASE CLICK; T<;i.iNI-ARGE IMAGE 

Square Footage: 1017.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Average 

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

HVAC: Forced Air Rooms: 5.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year YearBuilt Physical Age Remodeled Remodeled Built 

1900 0% 1900 108 

Detail Type Detail Description Unita 

Add On Unfinished Attic W/floor 880.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 960.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Porch Slab Roof Ceil 30.0 

Porch Wood Deck 90.0 

1.X4.... // J 1-^-. , '««<*«<*««^«^ /^•^ll* ^ A rtf\-rv% /n/Mi/TlQoPr»M*»/otQtir>/anf rtiintinfn i<!n?arp.f»nntnn=l? 1 0 8/76/7008 
&EPk 


Jun e 26,200 8 (faHwt nvlfteB) 

EPA Property CloseOnt Form (Lead-Based Paint StatifliaitioB) 

BMkn d VcMdi Prapwtgr ID Nimben 

Perftrmance Standards/gpse^nt Criteria 	 yti IW 

inebdopaiBtiqg of oihar MMciBted ftatim iMhkBog ftseia, e

/ bwBfccolninnfciaib. and exterior wrfbcM of gawaw. 

2. WiianicnpiBgndotherpnpamiloavmkeonpletedntisfiut^^ 

/ 

3. Wminf«qQbedneisofdid«nietn«(f)piDwdisiweded^ y 

A, Wto1liepabitpiodiiel$iitUi»deqiiiv8lemtoi30yMrim)dac^ y 

5.	 iteinofibeanas wha t coDtantiDatedanterialsi^ y i 

iBadiiwi.ilhywp8.wa)1teMCBwawa8adalwremovoBy 	 y 

7.	 bil»SB»a«iea Ihat SMwuuds the 8tnictnw(5)tateasoBri)ly good condltkm^ <y 

t	 ib«an{i8DUiiichaipolyediyleoesheet&ig,l8dden,paintbrasb0S^ c ^ 


WBMWd? 


9.	 btfamaoyevideoeeofimypertydaiaage that was done by the cvofract^ Any property damage 

' ^ / aeedstoboooiBPtetedprioTtotfaeEPAClose-Om. 

IOL AwHwotay proper^ Hems that wr e tempofarily W'locaied by the contractor that need to be 

novedbaA? 	 H./ 

11. Aie(faeresyOaown)IhigefioglssneswHbthepiopettyo«n«r(8)tfaath^ 	 1 - ^ 

Odier i??^firair. Owner Disoussioiu/Additional Wcnk that is Required 

^ 


BPAOOR/RflFMentative. Ik '&£i. l^f ^ 
Prudent Property Close-Out Form (Lead-Based Pair)t Stabilization) 

SAID: g (. 1 ^ r 

Property Addmss: 2 4> ^C'. £'^ IXVv>tUA_ 

Owner's Namct ^'i/// L IS^dk . 

Performance Standards/close-Out Criteria YES NO 

1. Was the entire structure(s) painted with the exception of the 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. I 

2. Was all scraping and other preparattion work completed satisfactorily? 

^ 

3. Were all required areas of the structure(s) primed as needed and painted with two top coats? 2L 

4 Was the paint products utilized equivalent to a 30 year product/quality? X 

5. Are all of the areas where contaminated materials have been spilled 

thoroughly vacuumed/ cleaned? y 

6. Did the contractor collect/vacuum all falling and scraped paint chips on the entire property, 

roadways, alleyways, public access areas and also remove any other generated debris? X 

7. Is the grass area that surrounds the structure{s) In reasonably good condition? i. 8. Are all items such as polyethylene sheeting, ladders, paint brushes, cones, banrier tape etc. 

properly removed? ­ y 

Is there any evidence of property damage that was done by the contractor? Any property damage 

needs to be completed prior to the EPA Close-Out. 

IC. Are there any property Items that were temporatily re-located by the contractor 

that need to be moved back? X 

11. Are there any (known) lingering Issues with the property owner(s) that have been left unresolved? 

Other Consideratlons?property Owner Discussions?Additlonal Work that Is Required > 

£a flBoio^ 

Prudent R< 

Date ^- 7 0-<^V