# Transmitta l o f

Oniah aLeadSite Pain t Stabilizatio n Fil e Folde r

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### Said#^^^OX

- Date : Address : 33^2

- UJ«^6-^C ^ St Contractor : CityofOmah a Year : P-^'= ? 

# Pain t Stabilizatio n Propert y Fil e Folde r Document s j/wor k Writ e U p t<^Signe dAcces s Agreemen t fo r

subject propert y Pre-Renovation for msignedb y Propert y Owne r Pre-RenovationFor mfo r

Occupant/Tenant , ifapplicabl e l^^?a.\ntmRAgreement/Cit y o f

Omah aPurchas e Orde r Settlemen t documents (i.e. , fo r

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o replac e plants , etc. ) Renovation Recordkeepin g Checklis t signe db y Certifie dRenovato r J ^ Propert y information from Douglas Count y Assessor' s Offic e ^ Othe r

(describe) : I jloh' i

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# t^--^- ^ 3^/j-^ / Cit y of OitiahaRepresentative Signatur e Dat e 

# -tJcv i EP A Representative Signatur e Dat e 3026244 1 

# • iimiii i Superfun dJun , 25 . 200 9 12:33P M No . 664 9 P . 2

Plannin g Departmen t Inspector : To mRoz a Omihi/Doiigl M Cii-i c Cente r 181 9 PatnM A Succt , Suit e 1003 Pate ; 6/18/0 9 OnMha,Ncbnsl(a68lB 3 (402 ) W-515 0 Telefi u (402 ) 546-071 4 

## Name : Iva n Anderso n SMv« n N . Jcmcn . AICP , LA . CilyofOmah * 

## Address : 332 2 Webste r

SU'ee t Directo r Ji mSntili! , Mayo r 

## OMAH A EXTERIO RPAIN T STABILIZATIO N PROGRA M FO RTH E EPA OMAH A LEA D SIT E Th e Contrac t bi ddocument s consis t ofth e followin g sections ; •Genera l Responsibilitie s fo r th e Contracto r an dOccupant , •Lea dMazar dContro l Plan , Interi mContro l o f Lea dOase dPain t Hazards , Th e Contracto r Sliall : •Compl y wit hHUD' s "Guideline s fo r th e Evaluatio n an dContro l o f Lead-Base d Pain t Hazard s i n Housing. " (Copie s ar c availabl e at th e Plannin g Department. ) •Compl y wit hStandard s calle dfo r i n tli e "Constructio n an dRehabilitatio n Specifications , Housin g an dCommunit y Developmen t Division , Cit y o f Omaha , Nebraska. " (Copie s ar e availabl e at th e Plannin g Department. ) •Compl y wit hth e Stat e ofNebrask aHealt han dHuma n Service s Regulatio n an d Licensure , Titl e 17 8 Chapte r 2 3 Lea dBas e Pain t Regidaiions . « Coordinat e dail y constructio n schedul e wit hth e occupan t •Submi t informatio n cu t slieet s fo r al l substitution s o r approve dequal s prio r t o writte n approva l ofth e Constmctio n Specialist . •Repai r o r replac e al l item s damage do r disturbe ddunn g pain t stabilizatio n activities . •Kee p work sit e an dsurroundin g are afree fromaccumulation s o f wast e material s o r

rubbisl i cause db y th e work a t al l times . •Upo n dail y completio n o f work : clea n u p al l rubbish , exces s material , equipment , an detc. , that i s connecte dwit hth e work , an dleav e al i part s o f th e work area s i n a neai , sanitary , lea dsaf e an dpresentabl e condition . •Complet e thi s projec t withi n 3 0 calenda r days . Tli e Occupant/Owne r Shal l • Remov e an dstor e awa y an y persona l propert y withi n twent y (20 ) fee t oflh e are a t o b e remediated . • Provid e acces s t o electricit y an dwate r throughou t th e pain l stabilizatio n process . • Ensur e that al l househol dmember s sta y at leas t te n fee t awa y fro mal l work area s an dals o kee p al l pet s at leas t te n feet awa y at al l lime s unti l th e work ha s bee n complete dan dth e are aha s passe davisua l inspection . I _ hiitiai s \I^J \

### Jun , 25 . 200 9 12:33P MNo . 664 9

332 2 Webste r S t (continued ) 

# Lea dHazar dContro l Pla n InterimContro l o f Lea dbase dPaint Hazard s Pain t Stabilizatio n •House : Prepar e an dpain t AL Lpreviousl y painte dWOO D AN D STUCC O sarface a^ INCLUD E FOUNDATIO N WINDOWS/TRIM . « D O NO T FAIN T WINDOW S AND DOOR S excep t a s state dabove . •Al l pain t color s t o matc hexistin g pain t pattern . Prim e bar e area s an d appl y tw o coats . •Se e plannin g Department' s lis t o f approve dpain t product s fo r lead projects . 

## LeadBase dPain t Waste Lead-base dpain t wast e mus t b e handle da s follow s •Ai l pain t chip s an dcomponen t debri s mus t b e doubl e baggedfor disposal . •Clea n pain t chipsfro mgroundaroun dperimeter o f dwellin g befor e starting , durin g an dafte r th e project . •Al l lea dpainte dcomponent s anddebri s mus t b e remove dfro mth e site daily unles s otherwis e approve db y th e constructio n specialist . •Al l lead-base dpaint debri s (chip s andcomponents ) mus t b e dispose do f in iinicipa l soli dwaste landfill . 

# r,l7s-loo i Dat e Propert y Owne r Date Witnes sDate Occupan t (ifapplicable ) Date Occupan t (ifapplicable )Dat e Witnes sDat e

## Jun . 25 . 200 9 12:33P M• No . 664 9 P . 4

332 2 Webste r S t (contmued ) 

## Exterio r Lead-base dPain t Stabilizatio nProgra mManage db y th e Cit y o f Omah afo r EP A Regio n7 Omah aLea dSit e th e puipos e o f thi s progra mi s t o preven t yard s wher e lead-contaminate dsoi l i s cleane d u p frombecomin g re-contaminate db y deterioratin g exterio r lead-base dpaint . Thi s i s no t ahom e repai r program . Whic hHome s Ar e Eligible ? •Home s wher e soi l clean-u p ha s bee no r wil l b e don e an da nEP A contracto r ha s identifie ddeterioratin g exterio r lead-base dpaint , •Home s ar e eligibl e onl y b y referra l fromth e EPA . Wha t wor k wil l b e done ? •Loos e an dflaking lead-base dpain t wil l b e remove dsafel y fro mfascia , eaves , siding , trim , windo w trim , doo r tri man dfoundation . •Surface s wil l b e prime dan dpainte dt o matc hexistin g pain t colo r a s closel y a s possible . Wha t wil l no t b e done ? •Surface s whic hhav e n o pain t wil l no t b e treated . •Window s o r door s wil l no t b e mcluded . •Rotte nwoo dwil l no t b e replaced . •N o housin g repai r wil l b e done . Wh o wil l perfor mtiie work ? •EP A contractor s wil l tes t pain t o nexterio r hous e surface s an dgiv e th e result s t o th e Cit y o f Omah aPain t Stabilizatio nProgram . •Cit y Constructio nSpecialist s wil l prepar e awor k pla nan dcontac t th e propert y owne r fo r permissio nt o proceed . •Wor k wil l b e competitivel y bi db y approved , traine dcontractors . Whe nwil l th e wor k b e done ? •Thi s progra mbega ni n200 7 en dwil l continu e fo r severa l years . •Th e Cit y staf f wil l prioritiz e home s base do nth e presenc e ofchildre nunde r ag e si x i f know nan dth e severit y ofth e problem . Pain t Stabilizatio ni s voluntai y an dwil l b e don e onl y wit hpermissio no f th e owner . 

## hitials lU A

### Jun . 25 . 200 9 12:33P M 10.664 9 P. 5

Consen t fo r Acces s t o Propert y RIGH T O FENTR Y T O PREMISE S Granto r (th e propert y owner ) consent s t o an dauthorize s th e Unite dState s Environmenta l Protectio n Agenc y (USJEPA ) o r it s authorize drepresentatives , collectivel y th e Grantee , t o ente r an dperform certai nenvironmenta l respons e activitie s upo nth e followin g describe dpremises : Owner' s Name : Daytim e Phone : Owne r Name(s) : Iva nAnderso n 402-212-984 8

Addresse s o f Propertie s Covere db y thi s Agreemen t Piopert y Addres s City/State/Zi p Cod e ] ^32 2 Webste r St . Omaha , N E6813 1 . , j

Granto r understand s tha t thi s erau t doe s no t limi t EPA' s right o f acces s unde r th e Comprehensiv e Environmenta l Respons e an dLiabilit v Ac t rCERCLA') . 4 2 USC . fc 9601-9673 . o r an v othe r law . PURPOS EO FACCES S Th e purpos e o f th e respons e actio ni s t o stabiliz e loos e o r flaking exterio r lead-base dpain l o n residentia l properties , includin g day-car e facilities , wher e remediatio np f lea dcontaminate dsoi l ha s o r

wil l tak e place . Samplin g o f soi l ma y b e conducted . Thi s consen t shal l allo w Grante e ont o Grantor' s propert y an dfijtther , provide s th e Grante e th e right t o perfon nan y an dal l environmenta l respons e action s an dactivitie s i t deem s appropriate . ENVIRONMENTA LRESPONS EACTION S Th e environmenta l respons e action s t o b e performe do nsubjec t propeit y ma y includ e th e followin g activities : 1 .

Locatin g equipmen t and/o r machiner y o nsubjec t propert y i npreparatio nfo r an di nth e cours e o f th e respons e activities . 2 . Obtamin g sample s fromGrantor' s property . 

# I^ A

### Jun.-25 . 200 9 12:33P MNo . 664 9 P . 6

Address : 332 2 Webste r St . Consen t fbr Acces s t o Propert v fPap e 2 ) 3 .Plannin g an dimplementin g th e respons e actio n o n th e Grantor' s property , Thi s wil l mclud e 1 ) removal o f loos e o r flaking paui t identifie db y EP A usin g lead-saf e method s i n complianc e wit hHUD/EP A regulation s an d2 ) repaintin g accordin g t o th e attache dspecifications . TER M Thi s acces s agreemen t shal l b e operabl e fo r th e perio do f tim e i t take s t o complet e the environmenta l respons e activities . Upo n completio n o f th e respons e actions , al l right s and privilege s give n b y th e Granto r shal l ceas e o n tha t date , unles s extende db y asubsequen t agreement . AGREEMEN T NO T T O INTERFER E Granto r agree s no t t o interier e wit han y o f th e activitie s undertake n b y Grante e at th e Propeity , tampe r wit han y o f Grantee' s property , o r tak e an y action s regardin g th e us e ofth e Propert y whic h wil l endange r huma n healt ho r welfar e o r th e environment , o r allo w other s t o us e th e Propert y i n suc hmanne r durin g th e ter mo f thi s consent . Granto r agree s t o provid e notic e an dacop y o f thi s agreemen t t o prospectiv e purchasers , lessees , assigns , o r grantee s ofth e propert y o r an y portio n o f it . Granto r agree s t o provid e 30-da y notic e t o EP A prio r t o an y transfe r o f ownershi p right s l o th e property . SAMPLIN GRESULT S Grante e agree s t o provid e Granto r wit hth e result s o f an y an dal l samplin g and/o r analysi s resultin g firo mGrantee' s respons e activitie s o n th e property . PRIO RCONDITION S AGREEMEN T Th e granto r agree s t o th e conditio n ofth e propert y prio r t o remediation an dindicate s o n Pag e 3 an y item s t o b e remove db y th e Granto r befor e activitie s commence . RESTORATIO N O FPROPERT Y Excep t fb r th e abov e state dpain t stabilization , th e Grante e agree s tha t sai dpropert y wil l b e restored a s nearl y a s possibl e t o it s origina l stat e an dconditio n a s foun dimmediatel y precedin g th e beginnin g o f activitie s authorize db y thi s Agreement , followin g completio n o f th e respons e activities . 

# IL-A

### Jun . 25 . 200 9 12:33P M No . 664 9 • P . 1

Address : 332 2 Webste r St. , Omaha . NE , 6813 1 CURREN T CONDITION / PROPOSE D RESPONS E ACTTVITIE S Th e puipos e o f thi s sectio n i s t o provid e amutua l agreemen t a s t o condition s o f propert y prio r to contracto r activities . Thi s wil l als o serv e a s documeniatio n fo r th e puipos e o f assurin g tha t restoratio n activitie s ar e complete dt o th e satisfactio n o f th e propert y owne r an dth e Unite dState s Environmenta l Protectio n Agenc y (EPA) . Item s t o b e remove db v propert y ovme r prio r t o th e response activities : 1 . 2 . 3 . 4 . . 5 . Item s NO T t o b e remove db v contracto r durin g remova l activities : 1 . 2 . 3 . 4 . 5 . ADDITIONA LCOMMENTS :

I hav e readth e foregoin g documen t an dunderstan dtha t i t i s a n agreemen t grantin g pennissio n t o th e Grante e t o ente r th e abov e describe dpremise s fo r th e puipos e o f conductin g environmenta l respons e activities , an dI agre e t o it s term s an dconditions . I acknowledg e tha t I hav e receive dth e pamphle t "Renovat e Right" . Grantor' s 

## Signature ; _^^5yO^ ^ Datc^j^T ^Dougla s County.'\ccouii t Informatio n htl:p:/./douglasne.mapping-online.coin/Dougla.sCoNe.'siatic/accoiintinr6. . Dougla s County , Nebrask a Propert yRecor d ^ R193897000 0 Prin t Report ViewInteractiv e GI S Ma o Informatio n i s vali d a s p f 2012-2-2 8 Treasurer' s Ta xRepoc t Ne wFeatur e -*•*- » Subdivisio n Sale s Searc h Owne r ANDERSO N IVA N 332 2 WEBSTE R S T OMAH AN E 68131-000 0 Propert yInformatio n Key h lumber - 389 7 000 0 1 9 Accou i I t Type : Residentia l Parce l A lumbe r 193897000 0 Parce l A ddress : '332 2 WEBSTE R S T OMAH AN E 68131-000 0 Lega l Description : PAR KPLAG E LO T 7 BLOC K2 E 42. 5 N 159.2 5 S 189.2 5 FT 42. 5 X 159.2 5 Valu e Informatio n Lan d Improvemen t Tota l 201 1 $6,500.0 0 $92,600.0 0 $99.1.00.0 0 201 0 $6,500.0 0 $92,600.0 0 $99,100.0 0 200 9 $6,500.0 0 $96,900.00 ' $103,400.0 0 200 8 $6,500.0 0 $96,900.0 0 $103,400.0 0 200 7 $6,500.0 0 $90,500.0 0 $97,000.0 0 200 6 $6,500.0 0 $90,500.0 0 $97,000.0 0 Sale s Inforniatio n Sale s Date : Dee d Type : Price : Grantor : Grantee : Valld/lnvalld : Exclusio n Reason : Sale s Date : Dee d Type : Price : Grantor : Grantee : Valid/Invalid : 2006-09-1 5 W D Book : 200 6 Page : 10753 9 $105,000.0 0 Bruc h Lor i Aeta l Anderso n Iva n Vali d 1999-05-1 0 . D Socl e 212 2 Page : 12 0 $65,000.0 0

Vali d

1 of 4 3/14./20I 2 11:0 0 A MDougla s Count y Accoun t Inrormatio n hltp://douglasne.niapping-online.convDouglasCoNe/sliitic.'accoiintinro... . Exclusio n Reason : \ SalesDate : \ 1998-08-3 1 Dee d Type : D Book : 210 0 Page : \ 24 6 Price : \ $40,000.0 0 Grantor : \ Grantee : ' • Valid/lnvalid : Vali d Exclusio n Reason : Sale s Date : 1993-04-1 9 Dee d Type : \ D Book : ; 195 8 Page : : 00 2 Price : I $46,000.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n .Acre s S F Unit s Dept h Widt h Vacan t 0.1 5 6837. 0 1. 0 159. 0 43. 0 N o Improvemen t Informatio n Buildin g 1 2 1/ 2 Storf Unfa i 332 2 Wabste t a

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# 1-

CLIC KT O ENLARG E IMAG E «^4l l l p JQ V h.'VtHA- » CUC KT O ENIJVRG E IMAG E Squar e Footage : 2026. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 2 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 9. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 2. 0

2 o f 4 3/14/201 2 11:0 0 A MDougla s Count y ,A.ccouii t Infonnatio n http://douglasne.mapping-onIine.coin/Doiigla.sCoNe/siatic/accoiintinro. . Roo f Cover : Compositio n Shingl e Bedrooms : ..5. 0

Roo f Type : Hi p Stories : 2. 5 Floorcover : YearBo/7 f Allowanc e Yea r Remodele d : Percen t Remodele d : Foundation : Sprinkle rSquar e Footage : Adjuste d Yea r Buil t Physica l Ag e 1 192 0 0 0 % 192 0 9 1 Detai l Typ e Oefa/ 7 Descriptio n Unit s Applianc e Allowanc e 1. 0 Applianc e . Fireplac e Masonry 1. 0 Basemen t Bsmn t Bloc k 8 f t 852. 0 Fixtur e Additiona l Fixture s 1. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 2. 0 Garag e Detache d 216. 0 Porc h Sla b Roo f Ceilin g 152. 0 Porc h Sla b Roo f Ceiliri g 36. 0

3/I4./201 2 11:0 0 A M 3or 4

# CIT Y O F OMAH A PURCHASIN G - ROO. M 100 3 

## Purchas e Order .

• 181 9 FARNA M STREE T OMAHA . N E 68183-100 3 FAXi ¥402-444-542 3 PURCHAS E ORDE R NO . 115908 8 SHI P TO :

CIT Y O F OMAH A HOUSIN G & COM M DE V R M #111 1 181 9 FARNA M STREE T OMAHA.N E 6818 3 VENDOR: - G B ENVIRONMENTA L SERVICE S LL C 430 2 MAPL E ST ' OMAHA . N E 6811 1 

# k BIL L TO :

CIT Y O F OMAH AFINANC E DISBURSEMENT S ROO M #100 7 181 9 FARNA M STREE T OMAHA.N E 6818 3 , • <

ORIGINA L PURCHAS E ORDE R • VENDOR' S COP Y (SE E INSTRUCTION S BELOW ) CUSTOME R ACCOUN T NO . VENDO R NO : DATEO F ORDER/ BUYE R REVISE D DATE//BUYE R 8141 6 20-JUL-0 9 P BURK E 21-JUL-0 9 P BURK E PAYMEN T TERM S SHI P VI A F.O.B . DESTINATIO N FREIGH T TERM S REQUESTOR/DELIVE R T O CONFIR M T O / TELEPHON E MARUCA , T MARI E >­ -< ITE M . PAR T NUMBER/DESCRIPTIO N DELIVER Y DAT E QUANTIT Y UNI T UNI T PRIC E EXTENSIO N IMPORTANT D O NO T STAR T WOR K UNTI L PROCEE D NOT I C E I S ISSUE D B V THE PLANNIN G DEPARTMEN T - PE R GROU P 4 7 BI D DATE D 7/15/0 9 Al l price s an d amount s o n thi s orde r ar e expres s d i n : U S Do l NEEDED : 2,300.0 0 N 19-JUL-0 9 EP APAIN T STABILIZATIO N PROGRA M - GROU P 4 7 - 3322-WEBSTE R S T O SHI P TO : Addres s a t to p o f pag e

_. SHIPTO : ' Addres s show n above . I f shipmen t I s delaye d o ran yitem s not available , advls'ea t once . Purchas e orde rnumbe rmus t appea ro n al l Invoices , packages , packin g lists , bil l o f lading , an d correspondence . SHIPPIN G CHARGE S T O B E PREPAID,.I F APPLICABL E AN D ADDE D T O INVOICED , cop yt o be furnishe d with , invoice . TA X EXEMPTION : Th e Cityo f Omah a i s exemp t fro m Federa l Excis e Taxe s an d th e Nebrask a an d Cityo l Omah a Sale s Taxes . Federa l I.D . 476006304 ; STATEI.D . 01-0316768 ; Fue l Dealers Lie . 91-0316768 .