TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID: 22132 Date: 12/26/2008 

Address: 4427 LEAVENWORTH 

Stabilization Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

izf Video of property (DVD) 

gT Executive Summary 

0 Signed Access Agreement for subject property 

a Painting Agreement 

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

D Photographs 

a' Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

^ Property information from Douglas County Assessor's Office 

D 

D 

D 

„. SLr^^J^yt^ 9/10tot 

Signature /-- T)ate 

40310449 

illHIHIIII 

Superfund 
PROPERTY SUMMARY 

1 Date: 12/27/08 | LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Month of: December | 

1 Property Address: 4427 LEAVENWORTH SAID: 22132 | 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: 

A.2 Issues Resolved: 

A.3 Unique Findings: NONE. 

A.4 Other Relevant Information: 

Access Date: 10/08/08 

Work Began: 10/14/08 

Closeout Date: 10/16/08 

Enclosures: 

1. Pre-Video 

2. Post-Video 

3. Property Status Form 

4. Signed Access Agreement 

5. Pre-Renovation Form 

6. Paint Match Form 

7. Tracking 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: ^^Z H L-ta^M.n iA/(rrih Date:/^-^ ^-^^ ^ 

BVE): 'X'^^3T ^ 

Phone: ^7 . ^^ ^ ^^z^ -

Plant & Pennanent Lands^flpinff To Remain In Place 

Itein# 

Description and Location 

On Map 

ffsrut /USHfil - fJ m 

Pre-Existinp Condition of Structures 

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

Item# 

OnM ^ (i^me Description & Location 

Property Owner Prudent Em] 

Signature: Signature: 

8080 Wud Parfcmy. Suitt 405 '** Street, Suite 308 4242 Medical Drive, Suite 4260 

KansM City, MO 64114 Nebrasica 68110 San Antonio, TX 78229 

Phon»: (816) 363-3703 (402) 604-1004 Phone: (210)8224688 

B.V. 14/191 wu.innR Fax:(210)679-6677 
5a\?>^ 

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

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

located m Omaha, Nebraska, including the property located at 

The EPA requests your pennission to allow Prudent to perform LBP Stabilization at tiiis propaty. By 

signing this form, the property owner grants permission to Prudent to perform activities related to LBP 

Stabilization including scn^nng paint and painting of tiie referenced property. Further, the owner/tenant 

verifies tiiat tiiey have received tiie LBP pamphlet "Renovate Right." 

If you 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 AkereleJohnson. 

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

Public Information Centers at (402) 731-3045 (Soutii Omaha office) or (402) 991-9583 QNlorth Omaha 

office). 

Property Acoets aimed By: 

•'(Please Print Name) 

Proper^ Owner Signature: //I/I6i r J / A 7^iLy^{ ^- ^ / ^ 

/ /"7 (Date (Date)

PROPERTY INFORMATION 

(To be eodVleted by resldeat and/or property oirncr - plcaie prinQ 

RESIDENFNAME: ^^i ^ A/<g^/ " Q^ „ 

RESIDENT ADDRESS: ^^? ' ^^f/g>^^^?/ g ^ < ^ v 

IF RENTAU PROPERTY OWNED BY: /^/CJ>/J^^I. ^ JpUJC^-^^^^t ^ 

OWNER'SHAIUN0ADDRE8S; /^'^ ' ^^' ^ /^^ ^ ^ . fJjff/PH4. ^\/^> ^^/ d ^ 

OWNER'S TELEPHONE NUMBER. HOME: (4f^ l <^f ^'^/2<(^mC i i^0Z ^ 4^^"^^^ ^ 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: I^^NUMBE R OF OCCUPANTS 7 YEARS OLD AND OLDER:^ ^ 

NUMBBR OPCHILDREN UNDER 7 YEARS OLD WHO PUY IN THE YARD FOR 6 HOURS OR MORE PER WEEK: ^ 

COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS, ENTRY GATES, ETC.) /^Af//trrj^-t ^ /A/f / 

AUTHORrrY FOR ENVIRONMENTAL RESPONSE ACnONS; The aetlvitiM to be inylenwrtedly EPA urolefftbagweniem are purwant to Sectioo 104 

ofCERCLA. 42 U^C 9604. EPA't rigbt ofaocen to Ifae property isprovidedfi>rin Section 104(e) of CERCLA, 42 U.S. C 9605(e), which provides entry 

fbr "deteiiiiiiungihe need Ibr leaponse, or choosing ortaldng any response action under Ibis title, or otberwise enforci^ 

1080 Ward Pailcway, Suite 406 2505 N. 24*^ Street, Suite 308 4242 Medical Drive, Suite 4260 

laneaa CHy, MO 64114 Omaha, Nebraeka 68110 San Antonio, TX 78229 

•hone: (816) 363-3703 \ ^ Phone: (402)504-1004 Phone:(210)822-9588 
Current Sample Pre^enovatio ^ i n Form 

EtfecXJm until April 2010. 

Confirmation of Receipt of Lead Pamphlet 

O^l have toceiveci a copy of the pamphlet, Fienovate Right: Important Lead Hazanj 

^^Infonnation for fiamllies, CNld Care Providers and SctKJols informing me of 

the potential ri8l< of the lead hazard exposure from renovation activity to l3e 

perfbrmed in my dwelling unit. I received.this pamphlet before the woii< began. 

Printed name of/recipletjto^.^'-'O / / -- Date ^ 

Signature ofrecipient 

Self-CertiflcatiQn Option (fer^tenant-occupled dwellings onl ^ — 

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

you may chect< the appropriate box below. 

13 Refusal to sign — I certify that i have made a good M h effbrt to deliver the 

pamphlet, ASnovate RigjtA: Important Lead Hazard Infonnation for F^amlBes. 

Child Cam Providers and Sciiools, to the rental dwelling unit listed below at the 

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

of receipt. I further certify tliat I have left a copy of the pamphlet at the unit with 

the occupant. 

Q Unavailable for signature — I certify that I have made a good faith effort to 

deliver the pamphlet, fienovate FVght: Important Lead Hazard Infbnnation fbr 

Families, Child Care providers and Schods, to the rental dwelling unit listed 

Iseiow and that ttie occupant was unavailable to sign the confinnation of receipt. 

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

Attempted delivery 

date and time 

iMd pamphlet delivefy 

Signature of p^ n certifying lead pamphlet delivery 

^^^1 Um^MM 5^ 

Unit Address 

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

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

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

postoffice). 
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Area: Color: 

Explanation: 

Area: Color: 

Explanation: 

Area: Color: 

Explanation: 

Area: color: 

Explanation: 

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Douglas County, Nebraska Property Record - R1616700000: 

- Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of SOth St - VJeW O n Ma p Infonnation is valid as of 2008-9-4 Treasurer's fax Report 

New Feature f»!* » Auto Sales Search 

Owner 

DUDZiNSKI MICHAEL J 

P O BOX 6092 

OMAHA NE 68106-0000 m^^^ 

Property Informatio n 

Key Number: 1670 0000 16 

Account Type: Residential 

Parcel Numb&r: 1616700000 

Parcel Address: M27 LEAVENWORTH ST 

OMAHA NE 68105-0000 

Legal Description: LEAVENWORTH HEIGHTS LOT 26 BLOCK 0 45 X 112.8 

Value Informatio n 

Lancf Improvement Total 

2008 $5,700.00 $129,600.00 $135,300.00 

2007 $5,700.00 $129,600.00 $135,300.00 

2006 $5,700.00 $129,600.00 $135,300.00 

2005 $5,700.00 $85,300.00 $91,000.00 

2004 $5,700.00 $85,300.00 $91,000.00 

2003 $5,700.00 $85,300.00 $91,000.00 

Sales Informatio n 

Sales Date: 2006-10-17 

Deecf Type: WD Book: 2006 Page: 119644 

Price: $0.00 

Grantor: T AND D INVESTMENTS 

Grantee: DUDZINSKI MICHAEL J 

Valid/Invalid: Invalid 

Exclusion Reason: 

Sales Date: 1992-11-30 

Deed Type: Book: 1938 Page; 679 

Price: $45,000.00 

Grantor: 

http://douglasne.nmppmg-online.coin/DouglasCoNe/static/accountinfo.jsp?accountno=R16... 9/24/2008 
. ...WWMAJ.!. a.±X2.\Jl.JL±lCU,lKJll Page 2 of3 

Grantee: 

Valldnnvalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.11 5085.0 1.0 113.0 45.0 No 

Improvemen t Informatio n 

Building 1 

ivwnap '• • 

«Cb «* •** 

.^»m 

tUr 

" '"sasr 

•Tr 

1 j^sTQBt pii«a»eo BunA liDcfc B n . iWMS F CLICK JO gHU^RqjJMASE CLICK TO ENLARGE IMAGE 

Square Footage: 1819.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality. Average 

Unit Type: Condition: Average 

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

HVAC: Central Air to Air Rooms: 7.0 

Exterior: Frame Aluminum Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year YearBuilt Physical Age Remodeled Remodeled Built 

1920 0% 1920 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Appliance Fireplace Masionry 

1.0 

Basement. Bsmnt Block 8 ft 1140.0 

Fixture. Base Fixtures 

1.0 

http://douglasne.inapping-online.com/DouglasCoNe/static/accoiintinfo.jsp?accountno=R16... 9/24/2008 
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Fixture Bath Full 1.0 

Garage Attached "'•­ ­ 220.0 

Porch End Screen 240.0 

User 2002 BOE 687 1.0 

User Attic 1/2 Finish 649.0 

http://d6uglasne.ma:ppingK)nline.com/DouglasCoNe/static/accountinfo.jsp?accountno=R16... 9/24/2008 
PTisdsfst Property Cloks-Out For-m (isad-Bssed P^nt Stgtejrisstloni 

SASP: ^^\^Q- 1' 

FroBsrtvfl.ddrass: ^VA--*) UW,..wrg_>^vj.^f A ^ SV— 

Performance StanjiaEras/cyose-Oyt Criteris 

YSS J?«C i 

i i 

I i

 1 ll . Was the entire structure(s]l,painted with the exception of the stated, exciudad araas? This would 

\ inciads painting of other sicdsted fisatures induding fascia, aaves, siding, a!! trim, porches, box 

i beams, columns, rails, and ^e-rior surfeces of garages. i 

\2. Was aii scraping and other preparattion woric completed satisfactoniy? JLA 

|3. vVsre ail required areas of tqe structure(s) primed as needed and painted with two top coats? 

j4. Wss the paint products utiliqsd equr^.-aient to s 50 year product/quarny? .i-i 

Are aii ofthe areas where contaminated materiais have been spilled 

r thoroughty vacuumed/ deai|pd? i l l 

15. Did the contractor coliect/vsi,cuum al! fs'iing and scraped paint chips cn the entire property, 

1 roadways, alleyways, public ycess areas and also remove any other generated debris? lAl 

is the grass area that surrounps the strurture(s} in reasonabty good condition? 

n. 

/ i 

sS. Are all items such as polyethvlene shgetlng, ladders, paint brushes, cones, barrier tape etc. 

! propsriy removed? \i \ 

19. Is there any evidence of property damage that was done by ths contractor? .^ny property damage 

\ needs to be completed prior tp the EPA Ciose-Out. 

\n 

jlC. Are tJiere any property items mat were temporatily re-located by the contractor 

I that need to be moved backrl f-\ 

jii . Are *ere any (icnownj lingerinit issues with the Drooerty owrje.ns) that have bean Seft unresolved? 

I iT i/i '.

 Other Considerations?property|Owner Discussion5?.Aaaitioriai Woiic that is Required 

\JjfZL^ 

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