TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: H M 9,SC 3 Date: K/M/QU^ 

Address: iHffl ^ AfOf- S Pt\f^ . 

Remediation Contractor: PROFESSIONAL ENVIRONMENTAL ENGINEERS Year: 2009 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

hy ^ Video of property (DVD) 

-F o^r 

y ^ Executive Summary 

\sy' ^ Signed Access Agreement for subject property 

^y ^ Painting Agreement 

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

\ y Photographs '\)Q:WP_ Qf\A CtYliy 

Vy^ Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

^Si^"""^ Property information from Douglas County Assessor's Office 

y ^ confirmation that lead pamphlet "Renovate Right" was received by P0_ 

D 

D _ ^ 

D 

Professional lental Engineers Si \i IDate ngmeers Signature 

m/fp signature 

30056272 imffii 

Superfund 
2505 North 24"', Suite 219 

Omaha. NE 68110 

(402) 504-4688 

Fax (402) 504-3281 

PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

"Providing cost-effective environmental solutions" 

Consulting • Engineering Design • Remediation • Abatement 'Emergency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

2009 

SAID# 34282 

1463 Ames Ave 

• Dates worked: 07/17 to 07/18 2009 

• Pre property condition: Property was in poor condition and paint was flaking off the 

house. House has wood siding and a wood garage. All paint was in poor condition. 

• Problems encountered: 

• Owner request/concerns: Color change on trim 

• Inspection/closeout dates. Owner signed 07/27 2009. Inspected by PE project manager. 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

"Providing cost-effective environmental solutions" 

Consulting * Engineering Design • Remediation • Abatement • Emergency Response 

Property Owner Close-Out Form 

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

SAID: 

?msf.9^ 

PropertyAddress: I41A? ) 0U(TH^ ^ ^1> C 

Owner'sName: (TXlXyi \jj\0b\f i 

Performance Standards/Close-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? /J 

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

two top coats? y

4. Was the paint products utilized equivalent to a 30 year product/quality? f5. 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 L 

other generated debris? 

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

8. Axe all items such as polyethylene sheeting, ladders, paint brushes, cones, >c 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. )^ 

10. Are there any property items that were temporarily re-located by the contractor 

that need to be moved back? )C 

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

)C been left unresolved? 

Comments: 

myyAKMd/ 7-Z-7- tn 

Property Owner Signature Date 

y-y^7'op 

Professional Envir^liental Engineers Representative Date 
CONSENT FOR ACCESS TO PROPERTY 

OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY IP: '^Q^'^0 ^ PROPERTYADDRESS: /V/ > S /ffOf ^ AU L 

OWNERNAME:^^^^ ^ / . , A/^/ ^ DAVTn«E PHONE: ^ g ? " S" ^ ^ ^ 

CELL PHONE: E-MAEL: 

OWNER'S ADDRESS IF DIFFERENT: 

TENANT' •JANT'SS NAM NAMEE IFIF; APPUCABLE: 

DAYTIME PHONE: 

CELL PHONE: aa^ E-MAIL: 

Professional 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 -based 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 understand 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. 

Yes, I have read and ui ndthe lOve. 

4i 4dyL ^ tf^oi/o^ 

nature of Property Owner 

I fully understand that by signing this Consent for Access, (1) this access will remain in effect until the work has been 

satisfactorily completed, (2) that the Property Owner or Tenant, if applicable, will 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 will remove all obstructions from surfaces to be painted, (4) will abide by health and 

safety guidance provided by EPA, (5) will allow photography ofproperty before and after the paint stabilization work, (6) will be 

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

any ofthe LBP stabilization actions, and (8) will participate in final 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 property, 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 office) or 402-731-3045 (South Omaha office). 

XYes, I grant access to my property and tms given the pamphlet D No, I do not grant access to my property and I was 

Renovate Right, Important Lead Information fbr Families, Child ghren the pamphlet "Renovate Right, Important Lead 

Care Provldeis, and Schools.' Information for Families, Childe Care Providers, and Schools." 

Slgnatui Date Signature Date 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

PROPERTY ADDRESS: IMIQ ^ AoQe S />A4 ^ DATE 

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

AREA(S) TO BE PAINTED: 

HOUSE PROPER:. — S COLOR: fy\\<J ^ ^ 

HOUSE TRIM: COLOR: SU J * Gc\0 ^ -^rGARAGE: ^Isu^ COLOR: 

'O 

GARAGE TRIM: _ COLOR: 

- ^ ^ ^ 

PORCH: pA COLOR: 

PORCH TRIM: K^R COLOR: 

(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: 

lV>l^/J 0 ^ ^ 

\ 
Douglas County Account Information Page 1 of2 

" J ^j^M^^a 

Douglas County, Nebraska Property Record - R1839640000 

Print Report 

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

New^ Feature ->-•- • Auto Sales Search 

Owner 

LINCOLN THEDA J 

ETAL 

5503 N 3 ST 

OMAHA NE 68110-0000 ( Mf^-TS'^^?s ^ ^ 

Property Informatio n 

nfkr Key Number 3964 0000 18 

Account Type: Residential 

V^*% ^ 

Parcel Number 1839640000 


Parcel Address: 1463 AMESAV 

OMAHA NE 68110-0000 

Legal Description: 

NIELS ADD LOT 20 BLOCK 0 TRIANG- 61 X 125 ^ £ ^ 

Value Informatio n 

Land Improvement Total 

2009 $2,600.00 $27,000.00 $29,600.00 

2008 $2,600.00 $27,000.00 $29,600.00 

2007 $2,600.00 $27,000.00 $29,600.00 

2006 $2,600.00 $27,000.00 $29,600.00 

; 2005 $2,600.00 $11,500.00 $14,100.00 

2004 $2,600.00 $10,400.00 $13,000.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.14 6500.0 1.0 125.0 52.0 No 

Improvemen t Informatio n 

Building 1 

cn 

/'/7 / ^e y 

http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R183... 7/9/2009 
Douglas County Account Information Page 2 of 2 

1.«3*«ESAV t ^ lAs^mis s^XiM^e :%24mrt 

' tmti^tMWM ' 

a ii Ht^t • 

First Flaot 

MS.Ssq ft 

1 1/2 Story UnSn 

MB Osq « 

CLICK TO ENLARGE IMAGE 

Square Footage: 648.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality; Fair 

Unit Type: Condition: Fair 

Built Asi ^ 1 1/2 Story Unfin Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 4.0 

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: Block 

Sprinlder Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1906 0% 1906 103 

Detail Type Detail Description Units 

Add On Fence Chain Link 1.0 

Add On Unfinished Attic W/floor 648.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 648.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 324.0 

Porch End Solid Wall 144.0 

Porch End Solid Wall 144.0 

Storage Wood 121.0 

User DOGS 1.0 

http://douglasne.mapping-online.com/DougIasCoNe/static/accountinfo.jsp?accountno=Rl83... 7/9/2009 
FD Associates 

PropertyAddress Date 

Start Date / - /y-y End Date 7yr^9 

f 

Amount Of Prime And Paint U sed 

Prime (Gallons) 

Poly (Boxes) 

Paint (Color) 

Paint (Color) 

y 

Amount (Gallons) 

Amount (Gallons) 

16 

3 

Paint (Color) Amount (Gallons) 

Paint (Color) Amount (Gallons) 

Paint (Color) Amount (Gallons) 
Professional Environmental Engineers, Inc. 

SAFETY AUDIT 

Project Name: 

Date of Audit: 

Primary Health Hazards: 

Primary H & S Concerns: 

Daily Tasks: 1. 

2. 

3. 

Equipment Used at Jobslte: 

Hard Hat 

Safety Glasses 

Steel Toed Shoes 

Work Gloves 

Generators 

Ladder 

Boom Lifts 

GFCI 

Safety Vests 

Other 

Equipment Ready for Emergency Response at Immediate Disposal: 

Daily Safety Meeting Conducted 

First Aid Kit 

Ennergency Procedures 

Company Health and Safety Policy 

GFCI on-site 

Deficiencies: 

Corrective Actions: 

Auditor: Date: 

Site Suoervisor: ^ C ^ "^ Date: