TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID #: 4Z.4D 0 Date: S-2n-lC ) 

Address: HIH S >A . Z^ ^ cS^h 

Stabiiization Contractor: Professional Environmental Engineers Year: 2010_ 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

y ^ Video of property (DVD) 

* ^ Executive Sunmiary 

J ^ Signed Access Agreement for subject property 

D Pre-Renovation Form signed by Property Owner 

D Pre-Renovation Form for Occupant/Tenant, if applicable 

" ^ Painting Agreement 

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

G( Renovation Recordkeeping Checklist signed by Certified Renovator 

y£. Photographs 

^ Satisfactory close-out check list signed by Property Owner 

^ Property close-out check list signed by EPA 

^ Property information finom Douglas Cotmty Assessor's OfBce 

D Hazard analysis, if prepared 

° *^^"*'

D Other (describe):

4 M "^^yuJL ^

Professioiial Envtr^nmental Engineers Signature InvlF^Amental Engineers Signature

 inniliii 

 ''"•""pSSn d 

 CAMS 

^ Dote 

EPA COR Signature Date" 

(after file folaer review) 
2010 

PROFESSIONAL' 

2505 North 24^ Suite 219 ENVIRONMENTAL ENGINEERS, INC. Omaha. NE 68110 

(402) 504-4688 "Providing cost-effective environmental solutions" 

Fax (402) 504-3281 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

EPA Close-Out Form 

(Lead-Based Paint Stabilization EPA Contract EP-R7-08-06) 

SAID: V J ^lOO 

Property Address: 70>i 

Owner's Name: 

Performance Standards/Close-Out Criteria YES NO 

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

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

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

4. Was the paint products utilized equivalent to a 25 year product/quality? 

5. Are all ofthe areas where contaminated materials have been spilled thoroughly vacuumed/ 

cleaned? 

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? 

7. Is the grass area that surrounds the structure(s) in reasonably good condition? 

8. Are all items such as polyethylene sheeting, ladders, paint brushes, cones, barrier tape, etc. 

properly removed? 

9. Is there any evidence ofproperty damage that was done by the contractor? Any property 

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

10. Has the property owner signed the completion form? 

11. Are there any property items that were temporarily re-located by the contractor that need to 

be moved back? 

12. Are there any (known) lingering issues with the property owner(s) that have been left 

imresolved? 

Other Considerations/Property Owner Discussions/Additional Work that is Required: 

(Vt/zo - HOUSL, AtJ ejAt&Y' ' loo**- &f^ li^* 5 ^i* k ia iMiu|' aY<A^ 

^^fL^jUAUiJ^j:^^. 4 ^ 10_ COR Signature Date 
PROFESSIONAL 

2505 North 24^ Suite 219

ENVIRONMENTAL ENGINEERS, INC. Omaha, NE 68110 

(402) 504-4688 "Providing cost-effective environmental solutions" 

Fax (402) 504-3281 

Consulting * Engineering Design • Remediation • Abatement • EiTi6igeni.:v Response ZD\0 

Property Owner Close-Out Form 

(Lead-Based Paint Stabilization EPA Contract EP-R7-08-06) 

SAID: W66 

Property Address: 770-? (^. Z(^^ . 

Owner's Name: M\i ^ ^m(j 

Performance Standards/Close-Out Criteria YES NO 

1. Was the entire structure(s) painted with the exception ofthe 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 y

garages. y­ 2. Was all scraping and other preparation work completed satisfactorily? 

3. Were all required areas ofthe structure(s) primed as needed and painted with -y 

two top coats? 

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

5. Are all ofthe areas where contaminated materials have been spilled thoroughly 

vacuimied/ cleaned? y 

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

entire property, roadways, alleyways, public access areas and alsoremoveany y other generated debris? y - Is the grass area that surrounds the structure(s) inreasonablygood condition? 

8. Are all items such as polyethylene sheeting, ladders, paint brushes, cones, 

barrier tape, etc. properly removed? yy

9. Isthereanyevidenceofpropertydamagethat was done by the contractor? Any y ^ property damage needs to be completed prior to the EPA Close-Out. 

10. Are there any property items that were temporarilyre-locatedby the contractor 

that need to be moved back? _^ ^ 

11. Are there any (known) lingering issues with the property owner(s) that have 

been left unresolved? ^_ ^ 

Comments: //t-UuiJL. jMt S f^Pcct I I 

S'lq-zn 

Propert jrtyv Owne Ownerr Signatur Signaturee d O ^ Date

-^-yp-yy^ 

Professioiia ssionll Exivirdfunenta uivii l Engineers Representative Date 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. ''°'TrSa'tNE68?!o 

"Providing cost-effective environmental solutions" ^^^ jjjgj 504-3281 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

2010 

SAID# 42400 

7705 N. 29"' St 

• Dates worked: 05/13/10 to 05/15/10 

• Pre property condition: House has wood siding with paint in poor condition all over; 

paint was coming off in big chunks. Paint chips in yard. 

• Problems encountered: EPA inspected property and saw there were areas that needed 

more attention. Owner then started maldng complaints and would not let painters 

back on property. She also claimed painter moved air conditioner unit and broke the 

cap that holds Freon. PE is taking care of repairs. 

• Owner request/concerns: Owner wanted repairs to A/C unit and complained about the 

paint only after EPA inspected property. She was happy with the paint and wrote good 

comments on closeout form. 

• Inspection/closeout dates. Owner 05/19/10, EPA 06/01/10 house needed morc work, reinspected 06/08/10 issues resolved. 
EPA Paint Stabilization 2010 

sAiD# ^3>^Q O 

Property Address H IP S K) - ^ ^ ^ ^ 

Stories V J ^ 

Garage? V^s 

Access signed A-~Cf?y^]C^ 

Pre-video 4'0^-1 6 

Postvidso 5 "^" ^ I Q 

Contractor Assigned (VinmS h\f^im 

Date started .^/ / ^^2^//^ 

WeatheiTtsmp ^ ^ * 

Date ended 

Paint used SLSQA-L 

Prime used IA 

Poly used (Q Q 

Problems/Issues 

t^> nt- -P-kadc'^nC) ^ ^Q\nV^din\ p s o v^ruv^cji to <Ji< ^e, ^^ , 
CONSENT FOR ACCESS TO PROPERT >rai Y 

OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID: ^^Qd O PROPERTY ADDRESS: T 1 O S A / gK? v5^^. 

OWNER NAIVIE: >, 

DAYTIIVIE PHONE: ('VOSL)^?< / - 0~y<y 7 

CELL PHONE: AJOA/fi _ E-MAIL: Ajpyy c 

OWNER'S ADDRESS IF DIFFERENT: Spyt ^ 

TENANT'S NAME IF APPLICABLE: 

RQ^mrUi DAYTIME PHONE: 

CELLPHONE: _ - E-MAIL: 

Profenlonal Environmental Engineers, Inc. (PE) is under contract (#EP-R7-08-06) with the U.S. Environmental Protection 

Agency (EPA) to stabilize lead based paint (LBP) on residential structures at a number of properties located in Omaha, 

Nebraska. The paint stabilization work is being done to protect the soil cleanups that are being performed by EPA contractors. 

Paint stabilization activities will Include: scraping of cracked or flaking LBP from structures, application of a prime coat and two 

(2) coats of paint. Moving parts of windows and doors are not included and will not be addressed. 

Your cooperation is requested In giving permission to this EPA contractor (PE) to enter and have access to this property for the 

purpose of stabilizing lead -tiased paint as outlined on the property identified above. 

By signing this document I agree to allow an EPA contractor to conduct a soil cleanup at my property following completion of 

lead-based paint stabilization, if the soil cleanup has not already been performed. I understand that the stabilization contractor 

can not provide assurances that the soil cleanup contractor will be bound to. I further undentand that the soil cleanup 

contractor will make all reasonable efforts to address concerns that I, as the property owner, may have regarding soil cleanup at 

my property. 

D Yet4nv e raad and underttand tha paragraph abova. 

^'^'/ O 

^ y SIgnatum of Property Owner ^ ^ 

I fully understand that by signing this Consent for Access, (I) this access will rem 

satisfactorily completed, (2) that the Property Owner or Tenant, if applicable, wii 

(HUD) and EPA pamphlet, "Renovate Right, Important Lead Hazard informatio 

Schools", (3) the Property Owner or tenant will remove ail obstructions from sur 

safety guidance provided by EPA, (5) will allow photography of property before f 

contacted by a PE representative approximately 48 hours in advance of starting v 

any ofthe LBP stabilization actions, and (8) will participate in Tinal property insp 

Property Owner Satisfaction Survey. 

-1 

Should you have any questions about the planed Lead Based-Paint stabilization a 

Professional Environmental Engineers, inc. Project Manager, Willie Clay At 402-

Lead Site cleanup can be directed to Pauletta France-lsetts, EPA Remedial Proje« 

Information Centers at 402-991-9583 (North Omaha office) or 402-731-3045 (Sou 

M Yes, I grant accatt to my proptrty and w n given tha pamphM D No,ldonot| 

moifflte Mght, Impoituit Laad Inforaiation for FamHIat, Child given the pampt 

Care Froviden, and Schoolt." Infonnation for F-amiiiet, i.niiae uare rrovioere, ana scnooit.* 

J/M>A ^ . U^^^-,S'/ 0 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 

Signature Date 
PAINT STABIUZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

PROPERTY ADDRESS •.zn^^ii^=± DATE: ^fi'^'Xoi o 

BVID 

AREA(S) TO BE PAINTED: 

[HOUSE PROPER: Si ^ ^/^^^ ^ COLOR: B^/''^^ A b/ f fM-Hf P 

HOUSE TRIM: ^ t J Q? J Cff O COLOR: p^i T gri/^?a L 

GARAGE: 6? / 2^ ^ COLOR: 

GARAGE TRIM: COLOR: 

IPORCH: COLOR: 

PORCH TRIM: COLOR: 

(COMPLETE ALL SECTION. YES. NO, OR NON^PPLICABLE) 

I AGREE TO THE COLORS LISTED ABOVE. ONCE THE PAINTING 

BEGINS, I UNDERSTAND I CAN NOT CHANGE THE ABOVE SELECTED COLORS: 

PROPERTY OWNER SIGNATURE: PE ACCESOR SIGNATURE: 

• ^N^^> . J ^ 
This sample form may be used by renovation firms to clocunient compliance with the 

Federal pre-i^iovation education aiid renovation, repair, and painting regulations. 

Occupant Confirmation 

Pamphlet Receipt 

Q I have received a copy ot the lead haiaiid information pamphier iirfoirning me of the 

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

nry dwelling unit. I received this pamphlet before the worK began. 

Owner-occupant Opt-out Acknowledgment 

Q (A) I confirm that I own arid live in this properly, that no child under the age of 6 

resides here, that no pi«gnant woman resides here, and tiiat this propeity is not a 

child-OL;cupida lacility. 

Note: A child resides in the primary residence of his or her custodial parents, legal 

guardians, foster parents, or informal caretaker if the child lives and sleeps most of the 

time at the caretaker^ residence. 

Note: A child-occupied facility is a pre-1978 building visited regularly by the same 

child, undei 6 years of age, on at least two diflerenl days within any week, for at least 

3 hours each day. provided that the visits total al least 60 riours annually. 

If Box A is checked, check either Box B or Box C. but not both. 

a (B) I request that the renovation finn use the lead-safe work praclices rbquired 

by EPA's Renovation, Repair, and Painting Rule; or 

(J (C) I understand tliat the firm perfomiing the renovation will not be reqiiired to use ttie 

lfead-.safe work practices recjuired t)y EPAIs Renovation, Repair, and Painting Rule. 

Primed Name of Owtiei-occupani 

Signciture ot Owner-oixupant Signature Date 

Renovator's Self Certification Option (for tenant-occupied dwellinga only) 

Instnjctions to Renovator: If the lead hazard information pamphlet was deliveiBd 

but a tenant signature was not obtainable, you may check the approjjriate box below. 

Q Declined - 1 certify that I have made a good faith effort to deliver the lead hazard 

infomiation pamphlet to the rental dwelling unit listed below at the date and time 

indicated and that the occupuiit declined to sign the confirmation of receipt. I furthei 

certify chat t have left a copy of tfie painphlet at the unit with the occupant. 

Q Unavailable for signature - 1 certify that I have made a good faith effort to deliver 

the lead hazard Infbrmation pamphlet to the nantai dwelling unit listed t>elow and that 

tfie occupant wcis unavallablo to .sign the confimialion of rte<:eipt. I furtlier certify that 

I have left a (xipy ut ttie pampttlet at tfie unit by sliding it unftei the door ur by (fill in 

howpaniphie swparnphiet . t wa wass left) left). __! 

Printeed Name 9f* Person Certifyin Certifying Deliver Delivery Attempte Attempted Deliver Delivery Date

Signature q^ Person Certiiying Lead Pamphlet Delivery T ^ > T 

• S^^J^; ^ 

Unit Address 

Note Regarding Mailing Option — As an alternative to delivery in ixsrson. you may mail the 

lead hazard infornnation pamphlet to the owner and/oi teiianl. Pamphlet musi be mailed at 

leasl sevHn days before renovatinn. Mailing musi tie d<v;uiiHjiiii::ii hy a o^^rtifiuale of mailiixi 

fiorn Itw rx'Sl office. 

Note: Hilt toiin \f> nol eftsttwt! unti! /\)jrii 5CilO. 
Douglas County Account Infomiation Page 1 of2 

^540 ^ 

Douglas County, Nebraska Property Record - R1104380000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - Vie w O n Ma p Information is valid as of 2010-3-16 Treasurer's Tax Report 

New Feature ->-+-> Auto Sales Search 

Owner 

SLEDGE KELLI A yoof^q 

7705 N 29 ST 

OMAHANE 68112-0000 9,'^^-oiHn 

Property Informatio n 

Key Number: 0438 0000 11 

Account Type: Residential 

Parcel Number 1104380000 

Parcel Address: 7705 N 29 ST 

OI^AHANE 68112-0000 

Legal Description: FLORENCE LOT 7 BLOCK 81 W 1/2 ALLEY ADJ & 66 X 142 

Value Infornnation 

Land Improvement Total 

2009 $7,700.00 $42,500.00 $50,200.00 

2008 $7,700.00 $42,500.00 $50,200.00 

2007 $7,700.00 $42,500.00 $50,200.00 

2006 $7,700.00 $38,900.00 $46,600.00 

2005 $7,700.00 $37,300.00 $45,000.00 

2004 $7,700.00 $37,300.00 $45,000.00 

Sales Informatio n 

Sales Date: 2002-10-11 

Deed Type: WD Book: 2224 Page: 750 

Price: $66,500.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.21 9372.0 1.0 142.0 66.0 No 

Improvemen t Informatio n 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl 1... 3/29/2010 
Douglas County Account Inforrnation Page 2 of2 inatK 

sua nocr ceu c raticn 

FInl Pi«ar 

7M0sq.fl. 

1.5 STORY UNFINISHED 

Bsmnt Block 8 ft 768 0 &q. ft 

CLICK TO ENLARGE IMAGE 

Square Footage: | 768.0 Percent Complete: 100.0% 

Perimeter ' 0.0 Quality: Average 

Unit Type: Condition: Fair 

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

HVAC: I Forced Air Rooms: 5.0 

- 1 - 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: 

Sprinkler Square Footage: 0.0 

year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1916 0% 1916 94 

DetaiY Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 768.0 

Fixture Additional Fixtures 1.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Attached 352.0 

Porch End Screen 168.0 

Porch End Screen 40.0 

Porch Slab Roof Ceiling 96.0 

User UNFIN. ATTIC NONCACULATED 0.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rll... 3/29/2010 
(efTective April 2010) 

RENOVATION RECORDKEEPING CHECKLIST 

Name of Firm: [M\[lfl fidrimS kf]k fll/IHD , 

^ 

Date and Location of Renovation: "? ICQ ^/. ZQti) i>\-

Brief Description of Renovation: Ua A j{nVi \ I7(lk 160 

Name of Assigned Renovator: (oflil CmOiff\\ 

Name(s) of Trained Workers: p'd ^ (^hffAJ. C ^' ^ I^YVA^ ^ 

Name of Dust Sampling Technician, Inspector, and/or Risk Assessor, if used: 

D Copies of renovator and dust sampling technician qualifications (training certificates, certifications) on file. 

D Certified renovator provided training to workers on (check all that apply): 

D Posting waming signs D Setting up plastic contaiiunent bairiers 

a Maintaining contaiiunent D Avoiding spread of dust to adjacent areas 

D Waste handling D Post-renovation cleaning 

n Test kits used by certified renovator to determine whether lead was present on components affected by 

renovation (identify kits used and describe sampling locations and results: 

D/^amin g signs posted at entrance to work area. 

Q/Work area contained to prevent spread ofdust and debris. 

p^indow s in and within 20 feet ofthe work area are closed 

J^f'Dpfits in and within 20 feet ofthe work areas are closed and sealed 

D Doprs that must be used in the work area are covered to allow passage but prevent spread ofdust. 

Q^round covered by plastic sheeting extending 10 feet from work area - plastic anchored to the 

building and weighted down by heavy objects. 

D If necessary, vertical containment installed to prevent migration ofdust and debris to adjacent 

property. 

J^^ast e contained on-site and while being transported ofF-site. 

Renovation Recordkeeping Checklist Omaha Lead Site 
(efTective April 2010) 

'0'Wor k site properly cleaned after renovation. 

^^XhAlH:hips and debris picked up, protective sheeting misted, folded dirty side inward, and taped for 

' removal. 

^^.•"Work area HEPA vacuumed to get paint chips from ground surface, if necessary. 

Certified renovator performed post-renovation cleaning verification (describe results): 

I certify under penalty of law that the above information Is true and complete. ^ . 

B^/j2 

Name and Title Date 

Renovation Recordkeeping Checklist Omaha Lead Site