## TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL EFOLDE R 

# SAID# : HM 9,SC 3 

# Date : 

# K/M/QU ^ Address : iHffl ^ AfOf- S Pt\f ^ . Remediatio n Contractor : PROFESSIONALENVIRONMENTALENGINEER S Year : 200 9 PAINT STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S hy ^ Video o f propert y (DVD )


# - F o^ r y ^ Executiv e Summar y \sy' ^ SignedAcces s Agreemen t fo r

subject propert y ^y ^ Painting Agreemen t D SettKrnen t document s (i.e. , fo r

damag e o r

t

o replac e plants , etc. ) \y Photograph s '\)Q:WP

_ 

## Qf\ A CtYli y Vy ^ Satisfactor y restoratio n signedby Propert y Owne r D Propert y close-ou t chec k

lis t signedb y EP A ^Si^""" ^ Propert y information fro mDouglas Count y Assessor' s Office y ^ confirmation tha t lea dpamphle t "Renovat e Right " was receivedb y P0 _ D D _ ^ D



## Professiona l lenta l Engineers S i \ i IDat e ngmeers Signatur e 

# m/f p signatur e 30056272 

# imffi i 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 yRespons e



## LeadBas e Stabilizatio n Omaha , N e Clos e Ou t Report 200 9 SAID#3428 2 146 3 Ame s Ave

•Date s worked : 07/1 7 t o 07/1 8 200 9 •Pr e propert y condition : Propert y wa s in poo r conditio n an dpain t wa s flaking of f

th e house . Hous e ha s woo dsidin g an dawoo dgarage . All pain t wa s in poo r condition . •Problem s encountered : •Owne r request/concerns : Colo r chang e on tri m •Inspection/closeou t dates . Owne r signe d07/27 2009 . Inspecte dby PEprojec t manager .

# 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 yResponse 

### Propert y Owne r Close-Ou t For m (Lead-BasedPain t Stabilization EP A Contract EP-R7-08-06 ) SAID : 

# ?msf.9 ^ PropertyAddress : I41A? ) 0U(TH^ ^ 

### ^1> C 

## Owner'sName : (TXlXy i \jj\0b\f i 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 Fax(402 ) 504-328 1



### YE S N O 1 . Wa s th e entir e structure(s ) painte dwithth e exceptio n ofth e stated , exclude d areas ? Thi s woul dinclud e paintin g o f othe r associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an dexterio r surface s o f ) ^ 

### garages . 2 . Wa s al l scrapin g an dothe r preparatio n wor k

complete dsatisfactorily ? 

## / J 3 . Were al l require darea s ofth e structure(s ) prime da s neede dan dpainte dwith 

# y tw o to p coats ? 4 . Wa s th e pain t product s utilize dequivalen t t o a3 0 year product/quality ? 

# f5 . Ar e al l ofth e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y vacuumed/ cleaned ? % 

### 6 . Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s o n th e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y 

# L othe r generate ddebris ? 7 . I s th e grass are atha t surround s th e structure(s ) i n reasonabl y goo dcondition ? C 8 . Ax e al l item s suc ha s polyethylen e sheeting , ladders , pain t brushes , cones , 

# > c barrie r tape , etc . properl y removed ? 9 . I s ther e an y evidenc e ofpropert y damag e that was don e b y th e contractor ? An y property damag e need s t o b e complete dprio r t o th e EP A Close-Out . ) ^ 

### 10 . Ar e ther e an y property item s that wer e temporaril y re-locate db y th e contracto r that nee dt o b e move dback ? 

# )C 11 . Ar e ther e an y (known ) lingerin g issue s withth e property owner(s ) that hav e 

## ) C bee n lef t unresolved ? Comments : 

# myyAKMd / 7-Z-7

- t n Propert y Owne r

Signatur e Dat e 

# y-y^7'o p Professiona l Envir^lienta l Engineers Representativ e Dat e

# CONSEN T FO RACCES S TO PROPERT Y OMAH ALEA D SIT EREMEDIA LACTIO N- LEAD-BASE D PAIN T STABILIZATIO N PROPERT Y IP : '^Q^'^0 ^ PROPERTYADDRESS : /V/ > S /ffOf ^ AUL OWNERNAME:^^^^ ^ 

## / . , A/^/ ^ 

## DAVTn« EPHONE : ^ g ? " S" ^ ^ ^ CEL LPHONE : E-MAEL : OWNER' S ADDRES S IFDIFFERENT : TENANT' •JANT' S S

NAM NAM E E

IF IF ; APPUCABLE : DAYTIM EPHONE : CEL LPHONE : 

# aa ^ E-MAIL : Professiona l Environmenta l Engineers , Inc . (PE ) is unde r contrac t (#EP-R7-08-06 ) wit hth e U.S . Environmenta l Protectio n Agenc y (EPA ) to stabiliz e lea dbase dpain t (LBP ) onresidentia l structure s at anumbe r of propertie s locate dinOmaha , Nebraska . Th e pain t stabilizatio nwor k is bein g don e to protec t th e soi l cleanup s tha t ar e bein g performe d by EP A contractors . Pain t stabilizatio nactivitie s will include : scrapin g of cracke d or flakin g LB Pfro mstructures , applicatio nof aprim e coa t an dtw o (2 ) coat s of pain t Movin g part s of window s an ddoor s ar e no t include dan dwill no t be addressed . You r cooperatio n is requeste dingivin g permissio n to thi s EP A contracto r (PE ) to ente r an dhav e acces s to thi s propert y fo r th e purpos eof stabilizin g lea d-base dpain t as outline d onth e propert y identifie dabove . By signin g thi s documen t I agre e to allo w anEP A contracto r to conduc t asoi l cleanu p at my propert y followin g completio nof lead-base dpain t stabilization , if th e soi l cleanu p ha s no t alread y bee nperformed . I understan dtha t th e stabilizatio ncontracto r ca nno t provid e assurance s tha t th e soi l cleanu p contracto r wil l be 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 to addres s concern s tha t I, as th e propert y owner , ma y hav e regardin g soi l cleanu p at my property . Yes , I hav e rea d an d ui ndth e lOve . 

# 4i 4dyL ^ 

# tf^oi/o^ natur e ofPropert yOwne r I full y understan dtha t by signin g thi s Consen t fo r Access , (1 ) thi s acces s will remai nineffec t unti l th e wor k ha s bee n satisfactoril y completed , (2 ) tha t th e Propert y Owne r or Tenant , if applicable , wil l be give nth e Housin g an dUrba nDevelopmen t (HUD ) an dEP A pamphlet , "Renovat e Right , Importan t Lea dHazar dinformatio nfo r Families , Da y Car e Providers , an d Schools" , (3 ) th e Propert y Owne r or tenan t wil l remov e al l obstruction s fro msurface s to be painted , (4 ) will abid e by healt han d safet y guidanc e provide d by EPA , (5 ) will allo w photograph y ofpropert y befor e an dafte r th e pain t stabilizatio nwork , (6 ) wil l be contacte dby a PErepresentativ e approximatel y 48 hour s inadvanc eof startin g work , (7 ) agre e no t to obstruc t or tampe r wit h an y ofth e LB Pstabilizatio nactions , an d(8 ) wil l participat e infina l propert y inspectio nan dsig nth e Completio nAgreemen t an d Propert y Owne r Satisfactio nSurvey . Shoul dyo u hav e an y question s abou t th e plane dLea dBased-Pain t stabilizatio nactivitie s fo r you r property , pleas e contac t Professiona l Environmenta l Engineers , Inc . Projec t Manager , Willi e Cla y At 402-504-4688 . Genera l question s abou t th e Omah a Lea dSit e cleanu p ca n be directe d to Paulett aFrance-Isetts , EP A Remedia l Projec t Manage r 402-731-2454 , or th e EP A Publi c Informatio nCenter s at 402-991-958 3 (Nort hOmah aoffice ) or 402-731-304 5 (Sout hOmah aoffice) . 

# X Yes , I gran t acces s to mypropert yan d tm s give n th e pamphle t D No , I do no t gran t acces s to mypropert yan d I wa s

Renovat e Right , Importan t Lea d Informatio n fb rFamilies , Chil d ghre n th e pamphle t "Renovat e Right , Importan t Lea d Car e Provldeis , an d Schools. ' Informatio n fo rFamilies , Child e Car e Providers , an d Schools. " Slgnatu i Dat e Signatur e Dat e SPECIA L INSTRUCTION S AN D CONSIDERATION S

## PAIN TSTABILIZATIO N PRE-PROPERT Y PAIN TMATC H ASSESSMEN T PROPERT YADDRESS : IMIQ ^



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### DATE BVID : 'T^QQ? ^ 9^- ^

AREA(S ) TO B E PAINTED : HOUS E PROPER:
. 

## COLOR : fy\\<J ^ 

# — S ^

HOUS E TRIM : 

## COLOR : SU J * Gc\0 ^ 

# -^rGARAGE : COLOR : 

# ^Isu^ ' O GARAG E TRIM : _ COLOR : - ^ ^ ^ PORCH : 

# p A COLOR :

PORC H TRIM : 

## K^ R COLOR : (COMPLET E AL L SECTION , YES , NO , O R NON-APPLICABLE )



### I AGRE E T O TH E COLOR S LISTE D ABOVE
. ONC E TH E PAINTING BEGINS , I UNDERSTAN D I CA N NO TCHANG E TH E ABOV E SELECTE D COLORS : PROPERT YOWNE R SIGNATURE : P E ACCESO R SIGNATURE : 

### 0 ^ ^ 

# lV>l^/ J \Dougla s Count y Accoun t Informatio n Pag e 1 of 2 

# " J ^j^M^^ a

Dougla s County , Nebrask a Propert yRecor d - R183964000 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 n Ma P Informatio n i s vali d a s o f 2009-6-1 6 Treasurer' s Ta xRepor t New ^

Featur e ->-•- • Aut o Sale s Searc h Owne r LINCOL N THED AJ ETA L 550 3 N 3 S T OMAH AN E 68110-000 0 

# ( Mf^-TS'^^?s ^ ^ Propert yInformatio n 

# nfk r Ke yNumbe r 396 4 000 0 1 8 Accoun t Type : Residentia l 

# V^*% ^ Parce l Numbe r 183964000 0 Parce l Address : 146 3 AMESA V OMAH AN E 68110-000 0 Lega l Description : NIEL S AD D LO T2 0 BLOC K0 TRIANG - 6 1 X 12 5 

# ^ £ ^ Valu e Informatio n Lan d Improvemen t Tota l 200 9 $ 2,600.0 0 $ 27,000.0 0 $ 29,600.0 0 200 8 $ 2,600.0 0 $ 27,000.0 0 $ 29,600.0 0 200 7 $ 2,600.0 0 $ 27,000.0 0 $ 29,600.0 0 200 6 $ 2,600.0 0 $ 27,000.0 0 $ 29,600.0 0 ; 200 5 $ 2,600.0 0 $ 11,500.0 0 $ 14,100.0 0

200 4 $ 2,600.0 0 $ 10,400.0 0 $ 13,000.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 4 6500. 0 1. 0 125. 0 52. 0 N o Improvemen t Informatio n Buildin g 1 

# c n 

# /'/7 / ^e y

http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R183. . . 7/9/200 9

### Dougla s Count y Accoun t Informatio n Pag e 2 o f 2

1.«3*«ESA V t ^ lAs^mi s s^XiM^e :%24mr t

' tmti^tMW M ' ai i Ht^ t •

Firs t Flaot MS.Ssq ft

1 1/2 Stor yUnS n M B Os q « CLIC KT O ENLARG E IMAG E Squar e Footage : 648. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality ; Fai r Uni t Type : Condition : Fai r

Buil t Asi ^

1 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 4. 0 Exterior : Fram e Sidin g Units : 

### 1.0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 2. 0

Roo f Type : Gabl e 

### Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinlde rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 

### 190 6 0 % 

### 190 6 10 3 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fenc e Chai n Lin k 

### 1.0 Ad d O n Unfinishe d Atti cW/floo r 648. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 ft 648. 0 Fixtur e Bas e Fixture s 

### 1.0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 324. 0 Porc h En d Soli d Wal l 144. 0 Porc h En d Soli d Wal l 144. 0 Storag e Woo d 121. 0 Use r DOG S 1. 0



### http://douglasne.mapping-online.com/DougIasCoNe/static/accountinfo.jsp?accountno=Rl83. . . 7/9/200 9

## F D Associate s PropertyAddres s Dat e Star t Dat e / En d Dat e - 

# /y- y 7yr^ 9 f 

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

Pol y(Boxes ) Pain t (Color ) Pain t (Color ) 

# y

Amoun t (Gallons ) Amoun t (Gallons ) 

# 1 6 3 Pain t (Color ) Amoun t (Gallons ) Pain t (Color ) Amoun t (Gallons ) Pain t (Color ) Amoun t (Gallons )

## Professiona l Environmenta l Engineers , Inc
. SAFET YAUDI T Projec t Name : Dat e o f Audit : Primar yHealt h Hazards : Primar yH & S Concerns : Dail yTasks : 1 . 2 . 3 . Equipmen t Use d a t Jobslte : Har d Ha t Safet yGlasse s Stee l Toe d Shoe s Wor k Glove s Generator s Ladde r Boo m Lift s GFC I Safet yVests Othe r Equipmen t Read yfo rEmergenc yRespons e a t Immediat e Disposal : Dail ySafet yMeetin g Conducte d Firs t Ai d Kit Ennergenc yProcedure s Compan yHealt h an d Safet yPolicy GFC I on-sit e Deficiencies : Correctiv e Actions :

Auditor : Date : Sit e Suoervisor : ^ C ^ " ^ Date :