### TRANSMITTA L o f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R SAI D # : ?^^' \Date : ^ \O O | O ^ Address : o? M 3)5 ; j^^^lSa S Aj ^ Remediatio n Contractor : PROFESSIONA L ENVIRONMENTAL ENGINEER S Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S B^ ^ Vide o of propert y (DVD ) W ^ Executiv e Summar y V

r

SignedAcces s Agreemen t fo r

subjec t propert y 0 ^ Paintin g Agreemen t D Settlemen t document s (i.e. , fo r

ddmage o r

t

o replac e plants , etc. ) B ^ Photograph s bejn( ^ ^.p da^ ^ B ^ Satisfactor y restoratio n signedb y Propert y Owne r D ^ Propert y close-ou t chec k

lis t signedb y EP A B ^ Propert y information fro mDougla s Count y Assessor' s Office M confirmation tha t lea dpamphle t "Renovat e Right " wa s receive dby P0 _ D D D



### Professiona l Environmenta l Engineer s Signatur e Dat e 

# ^/;^// o ignatw-dDate ' 3005619 9 

# nnMnii Superfun d250 5 Nort h 24 ^ Suit e 21 9 Omaha , N E 6811 0 (402 ) 504-468 8 Fax (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 y Respons e



### Lea dBas e Stabilizatio n Omaha , N e Clos e Ou t Report 200 9 SAID#3889 9 243 5 Kansa s Av e

•Date s worked : 06/1 5 t o 06/1 7 200 9 •Pr e propert y condition : pain t o n windo w trim s an dgarag e wer e i n very poo r conditio n wit h flaking paint . Jun k an dremodelin g item s i n propert y tha t ha dt o b e remove d prio r t o stabilizatio n process . Garag e doo r badl y damage dan dstructur e wa s unstable . •Problem s encountered : None •Owne r request/concerns : N/ A •Inspection/closeou t dates : Owne r signe d07/17 , EP A 07/14/0 9 N o issues .

# 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 y Respons e 

### EP A Close-Ou t For m (Lead-BasedPain t Stabilizatio n EP A Contract EP-R7-08-06 ) 

## SAID : Si^fe^' ^ Propert y Address : 9^43 5 VTrinSCl S AV ^ Owner' s Name : '^CXC\^OirO ^ (l/lYV\p\^^\ [ Performanc e Standards/Close-Ou t Criteri a 250 5 Nort h 24 ^ Suit e 21 9 Omaha , N E 6811 0 (402 ) 504-468 8 Fa x (402 ) 504-328 1



### YE S N O 1 . Was the entir e structure(s ) painte dwit h the exception of the stated , excluded areas ? Thi s wouldinclude paintin g o f

othe r

associate dfeature s includin g fascia , eaves , siding , all trim , porches , box beams , columns , rails , andexterior surface s of 

# y garages . 2 . Wa s all scraping andothe r

preparatio n wor k

completedsatisfactorily ? i ^ 

### 3 . Wer e all require darea s o f

the structure(s ) prime da s neededan dpainte dvdt h u ^ tw o top coats ? 4 . Wa s th e pain t product s utilize dequivalen t to a3 0 yea r

product/quality ? i ^ 

### 5 . Ar e all of the area s wher e contaminate dmaterial s have bee n spille dthoroughly vacuumed / cleaned ? y 

### 6 . Didthe contractor collect/vacuumall falling an dscrapedpaint chip s o n th e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y ^ y 

### othe r

generateddebris ? 7 . I s the gras s are atha t surround s the structure(s ) i n reasonably goo dcondition ? y 

### 8 . Ar e all item s suc h a s polyethylene sheeting , ladders , pain t brushes , cones , i y 

### barrie r

tape , etC ; properly removed ? 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 damag e need s t o b e complete dprior to th e EP A Close-Out . t — 

### 10 . Ar e ther e an y propert y item s tha t wer e temporarily re-locate db y th e contractor 1 ^ tha t needto b e movedback ? 11 . Ar e ther e an y (known) lingering issue s wit h the propert y owner(s ) tha t hav e ^ 

### been lef t unresolved ? Othe r

Considerations/Propert y Owne r

Discussions/Additiona l Wor k

tha t i s Required :

( Ei» A CO RSignatur e 'Date '

# 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 y Respons e 

## Propert y OAvne r

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

# 38&3 ^ Propert y Address : SjOj^ S jChrtSQ S /JV- L Owner' s Name : feart^rTV T/S t t^:p>|V&| l Performanc e Standards/Close-Ou t Criteri a 250 5 Nort h 24"' , Suit e 21 9 Omaha , N E 6811 0 (402 ) 504-468 8 Fa

x (402 ) 504-328 1



### YE S N O 1 . Wa s th e entir e structure(s ) painte dwit h th e exceptio n of th e stated , exclude d areas ? Thi s wouldinclude paintin g of othe r

associate dfeature s includin g fascia , eaves , siding , all trim , porches , box beams , columns , rails , andexterior surface s of garages . 

# X 2 . Was all scraping andothe r

preparatio n wor k

complete dsatisfactorily ? \ 

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

# 7 4 . Was the pain t product s utilize dequivalen t t

o a3 0 yea r

product/quality ? 

# f 5 . Ar e all of the area s wher e contaminate dmaterial s hav e been spille dthoroughly vacuumed / cleaned ? 

# X 6 . Di dthe contractor collect/vacuumall falling andscrapedpaint chip s o n th e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y othe r

generateddebris ? > 

### 7 . I s the gras s are atha t surround s th e structure(s ) i n reasonably goo dcondition ? 

# H ^ 8 . Ar e all item s suc h a s polyethylen e sheeting , ladders , paint brushes , cones , barrie r

tape , etc . properly removed ? ^ 

### 9 .Istherean y evidenc e ofpropert y damag e tha t wa s don e b y the contractor ? An y ^ ^ 

### propert y damag e need s t o b e complete dprio r to th e EP A Close-Out . 10 , Ar e ther e an y propert y item s tha t wer e temporarily re-locate db y th e contractor tha t needto b e movedback ? • f 11 . Ar e ther e an y (known) lingerin g issue s wit h th e propert y owner(s ) tha t hav e ^ 

### bee n lef t unresolved ? Comments :

Jwne r

Signatur e Dat e ivifonme n Professiona l Envifonmenta l Engineer s Representativ e Dat e

# CONSEN T OF R ACCES S T O PROPERT Y OMAHA LEAD SIT E REMEDIA L ACTIO N - LEAD-BASE D FAIN T STABILIZATIO N PROPERT Y ID : ^^^'j ^ PROPERT Y ADDRESS : c^V J S " '/^/?S^ ^ /9 U OWNERNAME : 

## >6^y6a-ro ^ Cj)r\o\^\ \DAYTIM E PHONE: 

## 4^S h ^OS'S T CELLPHONE : ^__ ^ E-MAIL : OWNER' S ADDRES S I F DIFFERENT : TENANT' S NAME I F APPLICABLE : DAYTIME PHONE : CELLPHONE : E-MAIL : Professiona l Environmenta l Engineers , Inc . (PE ) i s unde r contrac t (#EP-R7-08-06 ) wit h th e U.S . Environmenta l Protectio n Agenc y (EPA ) t o stabiliz e iea dbase dpain t (LBP ) on residentia l structure s a t anumbe r o

f propertie s locate din 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 were performe db y EPA contractors . Pain t stabilizatio n activitie s will include : scrapin g of cracke do r flaking LB P fromstructures , applicatio n of aprim e coat an d tw o (2 ) coat s o f pain t Movin g part s o f window s an ddoor s ar e no t include dan dwill 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 ) t o ente r an dhav e acces s t o thi s propert y fo r th e purpos e o f stabilizin g lead-base dpain t a s outline do n th e propert y identifie dabove . B y signin g thi s documen t I agre e t o allo w an EP A contracto r t o conduc t asoi l cleanu p a t m y propert y following completio n o f lead-base dpain t stabilization . I understan dtha t th e stabilizatio n contracto r can no t provid e assurance s tha t th e soi l cleanu p contracto r will b e boun dto . I furthe r understan dtha t th e soi l 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 propert y owner , ma y hav e regardin g soi l cleanu p a t m y property . I full y understan dtha t b y signin g thi s Consen t fo r Access , (1 ) th b acces s wil l remai n i n effec t unti l th e work ha s been satisfactoril y completed , (2 ) tha t th e Propert y Owne r o r Tenant , if applicable , wil l b e given 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 dSchools" , (3 ) th e Propert y Owne r o r tenan t wil l remov e al l obstruction s fromsurface s t o b e painted , (4 ) will abid e b y healt h an dsafet y guidanc e provide db y EPA , (5 ) wil l allo w photograph y ofpropert y before 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 in advanc e of startin g work , (7 ) agre e no t to obstruc t o r tamper wit h an y of th e LB P stabilizatio n actions , an d(8 ) wil l participat e in fina l propert y inspectio n an d sign ttie Completio n Agreement an dPropert y Owne r Satisfactio n Survey . Shoul dyo u hav e an y question s abou t th e plane dLeadBased-Pain t stabilizatio n activitie s for you r property , pleas e contac t Professiona l Environmenta l Engineers , Inc . Projec t Manager , Willi e Clay At 402-504-4688 . Genera l question s abou t th e Omah aLea dSite cleanu p can b e directe dto Paulett aFrance-Isetts , EPA Remedial Projec t Manage r 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 , I gran t acces s t o m ypropeit yan d wa s give n th e pamphle t D No , I d o no t gran t acces s t o m ypropMt yan d i wa s Renw^tarli ^ Importan t Lea d Infomiatio n forFamilies , ChI M give n th e pamphle t "Renovat e RigM , Importan t Lea d Informatio n forFamliles , Chlid e Car e Provlden , an d Schools. '

. INSTRUCTION S AN D CONSIDERATION S

## (D@[jiiffl[fwasitio@in i @f (^@©(s6pl t ©i f L®iid l FiioinipIhiDdf i 

# j^a^ppimADDRES S Z^:^ s V^r\nsa s frV^vOPCOD E PROPERTVADDRES S OF OWNE R IF DIFFEREN T THA N PROPERT Y BEIN G PAINTED ; PROPERT Y ADDRES S ZI P COD E I hav B reoavBd a cop y of ih e pamphlet . Ranoi/al a Righ t hnportan t Laa d Haaai d Infonnado n Fo rFamlllaa , ChB d Ca n Piwhh n An d School a informin g me of ttie potentia l risic of th e lea d hazar d exposur e fro m renovatio n activit y to t e perfomie d on dwellin g uni t I leoeive d thi s pamphle t befor e th e wor k began . 

# ^^LL^t^hsJ C 

# j%,^2k£ ­ Seff-CartMcallo n Opdo n (Fo rTonantOixtip M DweHing s Only ) if th e lea d pamphle t wa s deliveiB d bu t a tenan t signatur e wa s no t obtainable , yo u ma yched t th e appropriat e beloM T ~l RBhisa l To Sign- 1 oertii ytha t I hav e mad e a goo d fait h elfor t to delive rth e pamphlet , renovat e right importan t tead hazai d infomiatfo n fo rfenriltes , chil d car e providei B an d sehoote ; to th e rent d dwellin g uni t lis M dat e an d tim e indicate d an d tha t th e occupan t refuse d to sig n th e conflnnatlo n of reoelp L I furthe roertH ytha t I h a w toft a cop y of th e pamphte t at th e un H wR h occupan t 

# D Unavdtabt e Fo rSHinaliii B - i certif ytha t I hav e mad e a goo d f&dt h effor t to deliva rth e pamphtet . renovat e I importan t tead hazan l infomiatio n fo rfiamiHes . chH d car e pravMer s an d sehoote , to th e renta l dwsHin g uni t liste d belo w an d tha t th e occupan t wa s unavaOabt o to sig n fh e oonflnnallo n of receip t I furthe rcertif ytha t I hav e teft a cop y Gf th e pamphte t at th e uni t byslidin g it unde rth e doo r orsomewher e on fh e premises . PRHTGDNAMEOFmONCERnFYM Q ATTEMPfE D DEUVEm rDAT E AN D TM E LEA D PAMPHLE T DBJVER Y

8»IUTIIi E dli^ERSO N CERTFVIN O LEA LEA D D PAMPME T DEUVERY : ATUREORffiRSO CERHFYIN PH U Not e Rsginfln s BflaHIn g Optio n - as an altomaliw B to delver y in person , yo u ma yrnaf l itt s totd psmpl M to th e owne r andfo rbrun t P&npMs t mus t be maHs d at toast 7 day s befor e renovflHon . (CkiGumentwIlhaGarttcBteofinaBiigfiraiittiepos t oiflos) . OONnRMATKlNOFReCEIPrOFLEAOPAMPHLET 0M »

# pm mMM mkmEmm i

. 9^?^ ^ Ya^sa ^ fW ^ DA1E 

# (-•inr'^g i BVI D - AREA(S ) TO B E inmncD s HOUS E PROPER : .G0IJ08 L HOUS E TRIM . .COLOR , GARAO ^ JOOUM L GARAfiBIRIM . 

## GOLO R 

# T PORCH .

PORC H TRIM L GOLOR _



## IMRE E T O TH E CXILOR S USTE D ABOV E ONC E PAnmN G BEGIIiSi p I UNDERSTAN D I CA N NO T CHANG E TH E ABOV E SELECTE D GOLORS :

pMSftaATBHraeeaee m

### Dougla s Count y Accoun t Informatio n Pag e 1 of 2 Dougla s County , Nebraslc a Propert y Recor d - R060077000 0 Prin t Repor 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 - VlO W O H Ma P Informatio n i s vali d a s o f 2009-6- 3 Treasurer' s Ta x Repor t Ne w Featur e -•-•- • Aut o Sale s Searc h Owne r CAMPBEL L BARBAR A J ETA L 

# i^^ l '^^^ s 612 9 N 2 4 S T OMAH A N E 68110-000 0 

## ft»^^W Propert y Informatio n Ke y Numbe r 007 7 000 0 0 6 

## Uoc A nnorA)t ^ Accoun t Type : Residentia l Parce l Numbe r 060077000 0 Parce l Address : 243 5 KANSA S A V OMAH A N E 68111-00 0 Lega l Description : BELL E ISL E LO T 1 0 BLO C Valu e Informatio n Lan d Improvemen t Tota l 200 9 200 8 200 7 200 6 $2,500.0 0 $2,500.0 0 $2,500.0 0 $2,500.0 0 $80,400.0 0 $80,400.0 0 $68,600:0 0 $68,600.0 0 $82,900.0 0 $82,900.0 0 $71,100.0 0 $71,100.0 0 200 5 $ 2,500.0 0 $ 68,600.0 0 $ 71,100.0 0 200 4 $ 2,500.0 0 $ 36,400.0 0 $ 38,900.0 0 Sale s Informatio n Sale s Date : 2005-10-0 1 Dee d Type : Q C Book : 200 5 Page : 12439 0 Price : $0.0 0 Granto r BARBAR A J CAMPBEL L Grantee : BARBAR A J CAMPBEL L ETA L Valid/Invalid : Invali d Exclusio n Reason : Famil y Sal e Lan d Informatio n Acre s S F

- U Unit s Dept h Widt h Vacan t 0.1 4 6120. 0 1. 0 136. 0 45. 0 N o Improvemen t Informatio n 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R060. . . 6/8/200 9

### Dougla s County Accoun t Informatio n Pag e 2 of 2 Buildin g 1 2sc r 16,0? i2o r izc r SO ' •34.0^ 1 Ui. Q 3 4 0 ' 28,0 ' 2B. S TWO^STOR Y iS.f f 280 ' §.0 ; EnclS«SdW ^ 1144. 0 CLIC KT O ENLARG E IMAG E Squar e Footage : 209 6 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Averag e

BuiitAs : 2 Stor y Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 9. 0 Exterior : Fram e Viny l Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 4. 0

Roo f Type : Gabl e 

### Stories : 1. 5 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 191 8 0 0 % 191 8 9 0 Detai l Typ e Detai l [descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 1144. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 432. 0 Porc h En d Scree n 224. 0 Porc h Ope n Sla b 168. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R060. . . 6/8/200 9

## IGI T PropertVAddres s A l 3 S KAKCC ^ < ; AV^ . Dat e O^//fl/c ^ StartDat e ig^\ S "0 ^

En d Date U " W " 0 M 

### Amoun t O f Prim e An d Pain t Use d Prim e (Gallons ) 

### 6 ^

(^(7 1 Pol y (Boxes) 

## r?? . Pain t (Color ) Amoun t (Gallons ) jS^ ^ ^ C L ( 

### L^ i n (M g Pain t (Color ) 

# ^^f ^ Amoun t (Gallons ) ^ ^

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## Feclia : 0^/J3/0 9 Proyecto : Omah apain t stabilizatio n projec t Lugar : Siti o d e actividad : 

# :o?45SKiHSa s Tarea s dianas : 1 . Sit e preparation/scrying . 2 . Pa i nting . 3.Clean-up . PrimordiaJ/Peligro s Potenciales : 1 . Persona l lea dcontaminatio n 2 . Sit e lea dcontamination . Herramienta s d e trabajo : 1 . Ste p letter. . 2 . Knife . Practica s d e Trabajo/Accione s Correctivas : 1 . 2 . Llamada s Previas : 1 . 2 . Firm ad e registr o de l Empieado : 

# A^' ^ ^ ^ 34o2Biv^^ioH^ f

S.Eletricity . 4.Falls . 3 . Pain t spry machines . 4 . Others . 3 . 4 . 3 . 4 . 

## 1 . :v.a.u.d.'a.(.f.eA;..s.^C.^..e£i-;:.i;... . n. . 2 . di^z^^i^..,0^ff<i,:i:yj:}.. ^ 3...£,e...<S'v+9...^.^.4-"'.?-<^<^^^^^^ ' 

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### 12. . 13. . .14. . 

## 16., 17. . 19. , 20. , 21. . 22. . 

# .cU-OhS Fiim ad e salu d de l Siti o Fech a#

PROFESSIONA L ENVIROMENTA L ENGINEERS,INC . REUNIO N DL\RI A D E SEGURIDA D Fecha;daWeWe9^- 4 I ^ ^ Proyecto : Omah apain t stabilizatio n projec t Lugar : 

# IHci^^' ^ 

# 9i ~

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# .0.W/i/Q.. 3 Fech a