TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: iMLoS q Date: _g|^y_|_Q3 _ 

Address: ^SC^QQ S T^C^ A f 

Remediation Contiactor: PROFESSIONAL ENVIRONMENTAL ENGINEERS Year: 2009 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

B''^^^^ideo of property (DVD) 

y ^ Executive Summary 

\^— Signed Access Agreement for subject property 

^y ^ Painting Agreement 

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

Ok'-^'^Photographs pX ^ . np A TY^VT 

[B ^ Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

^Sr' Property information from Douglas County Assessor's Office 

G y _confirmation that lead pamphlet "Renovate Right" was received by P0_ 

D 

D 

"^mm 

ProfessionaltoivTroAmental Engineers Signature ' Date 

/ ' EPA SiglTature 'Date 

30094379 iiiiii 

Superfund 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. ''° ' 'ol'nrNEesno 

"Providing cost-effective environmental solutions" ^

Consulting • Engineenng Design • Remediation • At^nteincnt • Emeiyencv Response 

^ 1^°^| fn^oo!! 

 Fax (402) 504-3281 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

2009 

SAID# 14659 

3022 S 33 St 

• Dates worked: 07/20 to 07/22 2009 

• Pre property condition: House had wood siding in fair condition with some spots wliere 

paint was flaking. Trim and brick on garage and around the house in good condition 

overall. 

• Problems encountered: N/A 

• Owner request/concerns: Owner commented he wished painters would have taped off 

and covered the windows before painting, also did not prime any bare spots of wood. 

Issues solved. 

• Inspection/closeout dates. Owner signed by 07/24 2009. Inspected by PE project 

manager 07/24 2009. 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

"Providing cost-effective environmental solutions" 

Consulting • Engineering Design • Remed'ation • Abatement« F.meigency Response 

Property Owner Close-Out Form 

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

SAID: NloF.^ 

Property Address: SCk)<2 S J^ S y T 

Owner's Name: iDcm l <:C (, • Ikmrsl," ^ 

Performance Standards/Ciose-Out Criteria 

2505 North 24"\ Suite 219 

Omaha, NE 68110 

(402) 504-4688 

Fax (402) 504-3281 

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? t

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

two top coats? 7

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

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

vacuumed/ cleaned? J 

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 J. other generated debris? 

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

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

barrier tape, etc. properly removed? 7 

9. 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. J 

10. Are there any property items that were temporarily re-located by the contractor J v/ that need to be moved back? 

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

been left unresolved? 

Comments: Q /HJ^M ~ - - / ^ - - i i

MMy,ysr^ y-^'i-Qc^ 

Property Owner Signature Date 

/g/^ ^ y-^^'J-op 

Professional Envircsmnental Engineers Representative Date 
CONSENT FOR ACCESS TO PROPERTY 

OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY iP: )^lt;>*N^ PROPERTY ADDRESS: '2>097oK. ^Qchf-K SSf t 

OWNEij^NAm^ ^ fhl^SL-B-Y DAYTIMEPHONE: G ^ 3^1 ~9S iS' 

CELL PHONE: {HCfX) (y^I •~3ZJT / E-MAIL: Y^'j'i\)U^d\Z.^( k AOL . COM 

OWNER'S ADDRESS IF DIFFERENT: 

TENANT'S NAME IF APPLICABLE: 

DAYTIME PHONE: 

CELL PHONE: E-MAIL: 

Professional Environmental Engineers, Inc. (PE) is under contract (#EP-R7-08-06) witl i 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 wor k is being done to protect the soil cleanups that are being performed by EPA contractors. 

Paint stabilization activities wil l include: scraping ofcracked or flaking LBP from structures, application of a prime coat and two 

(2) coats of paint. Movin g parts of windows and doors are not included and wil l 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 -based paint as outlined on the property identifled 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, ifth e soil cleanup has not already been performed. I understand that the stabilization contractor 

can not provide assurances that the soil cleanup contractor wil l be bound to. I further understand that the soil cleanup 

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

my property. 

^S^Yes, I have read and uKdjerstand^ pMfgrapl 

Signature of Property Owner Date 

I fully understand that by signing this Consent for Access, (1) this access wil l remain in effect unti l the wor k has been 

satisfactorily completed, (2) that the Property Owner or Tenant, if applicable, wil l be given the Housing and Urban Development 

(HUD) and EPA pamphlet, "Renovate Right, Important Lead Hazard information for Families, Day Care Providers, and 

Schools", (3) the Property Owner or tenant wil l remove all obstructions fro m surfaces to be painted, (4) wil l abide by health and 

safety guidance provided by EPA, (5) wil l allow photography of property before and after the paint stabilization work , (6) wil l be 

contacted by a PE representative approximately 48 hours in advance of starting work , (7) agree not to obstruct or tamper with 

any ofth e LBP stabilization actions, and (8) wil l participate in flnal property inspection and sign the Completion Agreement and 

Property Owner Satisfaction Survey. 

Should you have any questions about the planed Lead Based-Paint stabilization activities for your properly, please contact 

Professional Environmental Engineers, Inc. Project Manager, Willie Clay At 402-504-4688. General questions about the Omaha 

Lead Site cleanup can be directed to Pauletta France-Isetts, EPA Remedial Project Manager 402-731-2454, or the EPA Public 

Information Centers at 402-991-9583 (North Omaha offlce) or 402-731-3045 (South Omaha offlce). 

Yes, I grant access to my property and was given the pamphlet D No, I do not grant access to my property and I was •^ 

"Renovate Right, Important Lead Information for Families, Child given the pamphlet "Renovate Right, Important Lead 

Care Prpvjders, and Schools." Information for Families, Childe Care Providers, and Schools." 

l-IS-cff 

Signature Signature Date 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

PROPERTY ADDRESS: 3 0 9,0^ JOgfK oJ->r^ DATE : 7-/5-Q9 

BVID: 

(^ 0 r^ i 1^3 AREA(S) TO BE PAINTED: 

HOUSE PROPER: Vkfe-i'm^UlU WilV K COLOR: U ^ 1 'IM\J\ L Wu' i K ' 

f^\0'i v\\^2i— ^ 

HOUSE TRIM: BJ/k?^ ^/ ^ C^OOQ COLOR: 

/>A Dr>^ 11^9—SUAL 

GARAGE: *^^g^l^ij|U Vj^'i-T^ COLOR: 

GARAGE TRIM: B^Ac H BE/ W ^QO ^ COLOR: (AorY\\\f\ Q^ SU M 

PORCH: M, prialyiQ 5ofO COLOR: fApmtina -So N 

PORCH TRIM: 6\^c ^ Be/>-M ioo/ ^ COLOR: MorK\iino> -S^/g 

(COMPLETE ALL SECTION, YES, NO, OR NON-APPLICABLE) 

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: 

y)0^<^ ^ 
Douglas County Account Information Page 1 of2 

*_i!^£a 

Douglas County, Nebraska Property Record - R1942520000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - VICW O n Ma P Information is valid as of 2009-6-16 Treasurer's Tax Report 

New Feature ••-•- • Auto Sales Search 

Owner 

HEMSLEY DONALD L %,rv ^^ V 

ETAL Co^^ 

3022 S 33 ST 

OMAHA NE 68105-0000 ^;jJ€(Ji_ 9<^r^ 341-^^^16 

Property informatio n ^i^ ^ v^ ^ c,iX'ic.£> 

Key Number 4252 0000 19 

Account Type: Residential 

Parcel Number 1942520000 


Parce/ Address: 3022 S 33 ST 

OMAHA NE 68105-0000 

Legal Description: PARKVALE LOT 6 BLOCK 4 40 X 130 

Vaiue Informatio n 

Land Improvement Total 

2009 $5,800.00 $107,600.00 $113,400.00 

2008 $5,800.00 $107,600.00 $113,400.00 

2007 $5,800.00 $107,600.00 $113,400.00 

2006 $5,800.00 $93,400.00 $99,200.00 

2005 $5,800.00 $93,400.00 $99,200.00 

2004 $5,800.00 $93,400.00 $99,200.00 

Sales Informatio n 

Sales Date: 1992-03-11 

Deed Type: Book: 1924 Page: 749 

Price: $40,000.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.11 5200.0 1.0 130.0 40.0 No 

Improvemen t Informatio n 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R194... 7/9/2009 
Douglas County Account Information Page 2 of2 

Building 1 

First Floor 8S7 0Gq.ft. 

s«canttftoar 

68S.0»Q.ft 

2 STORY 

^.tnKliu.^t 

•"iBw ^ 

CLICK TO ENLARGE IMAGE 

Square Footage: 1575.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 8.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywali Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 2.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1916 0% 1916 92 

Detail Type Detail Description Units 

Add On Fence Chain Link 1.0 

Appliance Allowance 1.0 

Appliance Fireplace Masonry 1.0 

Basement Bsmnt Block 8 ft 880.0 

Basement Minimal Finish 100.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 320.0 

Porch End Solid Wall 64.0 

Porch Slab Roof Ceil 18.0 

Porch Wood Deck 105.0 

http://douglasne.mapping-onIine.com/DouglasCoNe/static/accotmtinfo.jsp?accoimtno=R194... 7/9/2009 
Property Address

Start Date

Prime (Gallons) 

Poly (Boxes 

,Paint (Color 

Paint (Color 

Paint (Color 

Paint (Color 

Paint (Color 

JC Painting 

 Hd^ ^ -s . 5 3 ^4- Date ^-{I r -0 ^ 

1 " 9 0 ^ 0 ^ Complete Date >n- a:z-o 

Amount Of Prime And Paint Used 

3L 

5IA 3 

t l ^ 

Amount (Gallons) |t^ a 

Amount (Gallons) jO 

^ 

Amount (Gallons) 

Amount (Gallons) 

Amount (Gallons) 
Professional Environmental Engineers, Inc. 

INTERVENCION DE SEGURIDAD 

Nombre Cii?! Proyei,to .5^^ ^ 333 T 

Fecho de la Inlervencion: 0//yi/ ^ 

Peligros de Salud Primordial: 

Preocupaciones Primordiales de H & S: 

Tareas Didricis: '<L 

2. pc/^^C^ 

3 /y^'y^y^ 

Equipo Usado en el Lugar de Traabjo: 

Equipo Listo para Respuesta de Emergencia a Disposicion Inmediata: 

Casco Duro Escoleta 

Gates de Seguridad 

Zapatos 

Guantes de Trabajo 

Generadores 

^y 

X 

Elevadore y s 

GFCI y:.. . . 

Ctiolecos de Seguridad

Otro 

y 

y . 

Conducir Reunion Diaria de Seguridad 

Estuche de Primeros Auxilios 

Procedimientos de Emergencia 

Politica de Salud y Seguridad de la Compania 

GFCI en sitio 

Deficiencias: 

Acciones Corretivos. 

Iritefveriioi. f^/cj?^ & 'fl Urro-^v recnu. 

Supervisor del Sitio: U -cc^tJ L pt^hi** ^ Fecho: ^Jy-^/^/y f 
PROFESSIONAL ENVIRONMENTAL ENGINEERS, INC. 

REUNION DIARIA DE SEGURIDAD 

Fecho. D]/^'A ^ 

Proyecto" Omoho Point Stabilization Proiect 

Lugor: ^^^ 3 Z 3 <^'l 

Sitio de Actividad' 

Tareas Dianas" 

I 

2. p r / /Jh.er' r 

3. ' p ay / 

Primordial/Peligros Potenciales: 

3 

2. .__ _ . 4. 

Herramientas de Trabajo: 

y I. d'snU^fi ,_ _ 3. 

2 _!^.A Q.y7n/y-. c>^/^ ^ 'e^/t. 4 

Practicas del Trabajo/Acciones Correctivas 

> ^ 3. 

2. b//L/1>^&^ 4. 

Llamadas previas: 

3 l . _ _ 4. 2. 

Firma de Registro del Empleado: 

3. 

4. 

6. 7 M - ^ ^Ua>- y 7^ ^ *^ ^_ir' c / 8. 

Firma de Salud y Seguridad del Sitio Fecha