TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID #: 27081 

Address: 4303 Patrick Ave 

Remediation Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

1^ Video of property (DVD) 

0 Executive Summary 

H' Signed Access Agreement for subject property 

ffl^ Painting Agreement 

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

D Photographs 

Bf Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

H' Property information from Douglas Coimty Assessor's Office 

D 

D 

D 

Signature . TJate 

40310399 I H 


Superfund 
PROPERTY SUMMARY 


Date: 12/03/08 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Month of: December 

Property Address; 4303 Patrick Ave SAID: 27081 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: None 

A.2 Issues Resolved: None 

A.3 Unique Findings: None 

122A.4 Other Relevant Information: None 

Access Date: 10/20/08 


Work Began Date: 11/02/08 


Closeout Date: 11/13/08 


Enclosures: 


1. Pre-Video 

2. Post-Video 

3. Property Status Form 

4. Signed Access Agreement 

5. Pre-Renovation Form 

6. Paint Match Form 

7. Tracking Form 

8. Douglas County Assessor Property Information Page 

9. EPA Property Closeout form 

10. Property Completion Agreement 

TECHNOLOCIES. INC. 

H) INVIRONMBNTALA 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICIS 

r Property Status Form 

Date Date: A*^= VSi^S f^clfiVt : /^'.P^?~^ /^'^^?~^ TT

BVID: ^^o9 f 

Plant & Pennanent Landscaping To Remain In Place 

Description and LocatioQ OnMq) 

UB6 ^ ­ tl V 

n li 

/ / / / 

Does your Basement have a history of leaking? Yes —- No 

Item^ Dracription & Location 

O&Map 

i^M5 ijjodd 4m^ ^ 

1/ 

V 


ll 

Propeity Owaer Prudent Empi 

Signature;

'nmA'd^ Signature: ^ ^ 
^^/9<r / 


Pmdent Technolo^es, Inc. (Pnident) is under contract (Contract # EP-RT-OS-OT) with the U. S. 

Emironmental Protection Agency (EPA) to stabilize Lead Based Pahit OL/BF) at a number of properties 

located m Omaha, Nebraska, including die property located at T>?^ 3 P^tfyick A^ ^ 

The EPA requests your permission to allow Prudent to perform LBP Stabilization attiiis property. By 

signbgtiiis form,tiie property owner grants permission to Prudent to perform activities related to LBP 

Stabilization indudmg scraping paint and pamting oftiie referenced property. Furtiier,tiie owner/tenant 

verifies tint tiuy have received the LBP pamphlet '^Renovate Right" 

Ifyou have any questions about tiie LBP stabilization planned for your property, please contact Prudent*s 

^%ii^|gt^ve Clerk for the Lead Based Paint Stabilization, Mrs. Deborah hXeenAaJLtAktamn^ 

at (402) S04»1004. Cenerai questions abouttiie Omaha Lead Site cleanup can be du:ected totiie EPA 

Public hiformation Centers at (402) 731-3045 (Soutii Omaha office) or (402) 991-9583 (Nortii Omaha 

I (Plnse Print Nni ^ 

PlopciQ^ One r SiiniBirK 

^ (Signtfurd^ (Date) 

PROPERTY INFORMATION 

(To be ceaplettd by rtiidcit tid/er pnpcrtjr omifr - plcue prtaQ 

ReSIDOirNAME: ftl ^ ^ ' [" ^ /^cJ.4hT< ^ (^ ^ Rmter 

RESDBIT ADDRESS: 

IPREIITAL,PROPERTYOWNEDBY: ^ ^ 17 ^ 

OWNERra MAIUNO A0DRS88; -^Jtf ^ /o<Sh/^J^^ 

OWNBTSTOfPHONENUMBER.HOME: r^fi^'^r~W/ / WORK; I \ 

NUMBER OP OCCUPAHTS UNDER 7 YEARS OLQ^; ^ NUMBER OP OCCUPArfTS 7 YEARS OLD AND OLOI 

NUIBBROPCHILOREN UNDGRT YEARS OU>VVHO PlAY IN THE YARD FOR 8 HOURS OR MORE PER VVEB^ 

COHHEKnORSPECUkLINSTmiCTIONS: (LE. DOGS, ENTRY QATES, ETC.) 

AW 

AUTHOimY FOR ENVKONMEOTAL KESPOr^ ACTIONS; Tlw MHvWet to be fanplem^^ 

erCSRCLA.42UAC96M. EPA'tri8btoraooeNtoAepnpei9i>piovi(MibriaSecilonl04(e)ofCBRCLA,42U.S.C9605(eXi>bM 

fbr'^dttBimtalsilhe oeod Ibr niponi^ or cfaoMittf ortd±is «iy ictpon^ 
Current Sample Pre-Renovation Form 

EffeoiiMunaiApiflzoio. 

Conflmnaon of Receipt of Load Pamphlet 

J P I >iewreceiveda copy d the pannphlei.fi9noyalofl(ghfc<fT^port8frt Lead H ^ 

^^ trtjmafaifarftmfflb^ChgtfOafB/^ ^ 

ths potanilalrisKof lhe leed hazard espoBure ftoin renovation activity perfcimed In tny dwelling unit. I received this pamphlet befbre the vvork began. 

Printed nametfrectalent . /^ Date 

Signaiure or recipient'^ 

8eH<!erailc8Hon OpDon (Ibr tenant<«ccupied dweHlnga only) — 
 If ths lead painphlet VV88 delivered but a tenant signature was not obtainable, 
 you may checK the appropriate box below. 


Q Refusal to sign—I certify that I have made a good M h effort to deOverlhe 

panpPiBt, Renovate fVghblnvxxlant Leed Hazani hfonnetion tor Fe^ ^ 

C W care flwIblflfgantfScrtoote, to the rental dwelling unft listed 

date and tkne kxfcated and that the occupant relused to sign the confirmation 

cf leoeipL I Affther cartily that I have left a copy of the pemphiet at the urtt with 

inaoccuponi. 

Q UnawalUble (Or aignahra •- 1 certify that I have made a good faith effort to 

deOw the pamphlet./%mv«to n!g/)t; lirnpor ^ 

Amlss i CMd O m pnovttera arxy Sc/wofe, to the rerital d^ ^ 

below and tiiat the occupant was unavailable to sign the confimiation of reosipt. I fUrttjer ceitity that I have left a copy of the pamphlet at the unit by sliding it 

% %^/> . 

sonoertHying Attempted dellveiy / i dateandtime 

/h^ lead pamphlet delivery 

^6tA-­

Signature ofipmo fiOersonn certHying lead pamphlet delivery 

^S/)J W^/?ic^ ^ 

IMtAddiws 

Note Regaiding Mailing Option—As an aitemativa to deHvoy In person, you 

may mal the lead pamphlet to the owner and/or tenanL Pamphlet must be mailed 

at least 7 da ^ before renovation (Document vvith a certificate of mailing from the 

postoliios). 
0 0 ni,fic£ 0 i^n d3>mp/i^^ 


'^ - "/^"S fd^c^ five ly^ sMij 

Are.; Uik 0<0'^i^'{,^„ U l i^,„ ^^, 


Area: 

Color: 


Explanation: 

Area: 

Color: 


^lanation : 

Area: 

Color: 


Explanation: 

IMPORHfiiTi oNTi^AGKM G SHBS T 

PfiopcerV n^ ^ ^ ^7^37 'ir£ f^i^ 

fRprijfOnrtOf s fh^/^ilju Heifdi^k 

OwMMito HBBwt 5^^-,7V// VfrK 

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tBC I tessor cnnncroeiwi. e _ J^ _ 
Page 1 of2 

3^9-061 


Douglas County, Nebraska Property Record - R0819710000 

Print Report 

NEW Feature - Parcel Dimensions avaiiabie @ scale 0-60 ft west of 90th St - Vle W OH Ma p Information is valid as of 2008-9-4 Treasurer's Tax Report 

New Feature -•-+- > Auto Sales Search 

Owner 

HETRICK MARILYN 

4303 PATRICK AVE 

OMAHA NE 68111-0000 ^^3^/1 


Property Informatio n 

Key Number: -. 19710000 08 

Account Type: : Residential 

Parcel Number: \ 0819710000 

Parce/Address: 4303 PATRICK AV 

OMAHA NE 68111-0000 

Legal Description: \ CLIFTON HILL LOT 1 BLOCK 15 50 X 82 

Value Informatio n 

V 

Land I Improvement Total 

2008 $5,300.00 ] $34,960.06 $40,200.00 

2007 $5,300.00 : $34,900.66 $40,266.06 

2006 $5,300.00 $40,200.60 

2005 $5,300.00 I $11.~800.6o $17.100.00 

2004 $5,300.00 : $10,700.66 "$16,660.00 

2003 $5,300.00 I $10,700.00 $16,000.00 

Land Informatio n 

•• :

Acres

0.09 

 [••"• • 

 \ SF 

4100.0 

"T " 

Units 

1.0 

Deptii 

82.0 

( Width 

v 50.0 

Vacant 

No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.eom/DouglasCoNe/static/accountinfo.j sp?accountno=R08... 10/9/2008 
> | '

CLICK TO_E;JLARGE IMAGE J 

Square Footage: 1040.0 

Perimeter 6.0 

Unit Type: 

Built As : Ranch 

HVAC: I Forced Air ! 

Exterior: ! Frame Siding ! 

(-.. 

Interior: j Drywall I 

Roof Cover: Composition Shingle 

Roof Type: Gable 

Floorcover: Allowance 

Year Percent YearBuilt Remodeled Remodeled 

1895 6% 

Detail Type i Detail Description 

Add On" ' "_ ; Fence Chain Link 

Appliance Allowance 

Basement I Bsmnt Block 8 ft 

Fixture i Base Fixtures 

Fixture i Bath Full_ 

Porch ; Wood Deck 

User Partial Basement 

Page 2 of2 

.x..-*.. ^ .-.v..'"'. *v 

10*0.0 !.<! »:. 

RANCH 

 VtJ"****" " 

CLICK TO ENLARGE IMAGE 

Percent Complete: !. 100.0% 

Quality: 1 Fair 

Condition: I Fair 

Condo Square Footage: : 0.0 

Rooms: ! 5.0 

_ Units: ; 1.0 

Baths: I 1.0 

Bedrooms: 1.0 

Stories: 1:6 

Foundation: Block 

-h 

Sprinkler Square Footage: ' 0.0 

Adjusted Year Physical Age Built 

1895 113 

Unita 

i"o 

-..„, . 

520.0 

••-J ­

1~0 

25.0 

520.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?aceountno=R08... 10/9/2008 
dER>V 


Jun e 26,200 8 (latest revtsion) 

EPA Propeity Close-Out Form (Lead-Based Paint Stabilizatioii) 

Stack iBd VeUdiiPtPDMrtylDNBmbM Ffoporty ID NamI : ' 

PrapertjrAddiCM: 

OirBer*9ffasie:. 

Perfomiance Standards/Qose-Ont Criteria yes no 

I.	 Waste «Bliiefiiaotara(s)i»iBtedwi& the exceftioo cf tbe stated, exchid^ Thiswoold iodadepabitiag of odier associited (batnres including tbscia, esves, siding, all trim, porches, box 

beiBa8.coliimM,ndb. and extcrtwsurfiwes of garages.	 , / 

2.	 WnaUKiq)ing tnd otiterprepsradon woik completed satisfiutority? ^ 

3.	 WwiHwffllwd areas offlie«troc<ure(8)prtoed as needed and p ^ ^ 

A,	 WsitepaiatpiOduetSQtiJisQdequhndeiittoaSOyearpR^^ t / 

5.	 Are ail of die areas where cootanuDated materials have been spilled thoroughly vacuuned'cleaned? y 

6.	 IHdtte contractor eollect/vacnum all &Uing and scraped paint chips on the entire property, 
 wad»a!ys,slleywtys.poblicacc<iS5 areas aiKl also remove any otfawgBoe^^ y 


7.	 bibognws m that snmmnds die stroctare(8) in reasonably good condition? y 

8.	 An iDitensstidiBspdyo^lew sheeting, ladders, paint Imabes, cones, barrier ta^^ t / 

IMMWO/.	 , • - ; 

9.	 bflwo any evidence of property damage that was done by the contractor? Any piroperty damage 

< / needs to be completed prior to die EPA Clos^Om.	 . . 

10. Alt diere any piopeity items diat were temporarityre'Iocated by tbe contractor tiiat need to be 

t y novedbadc? 

11. AiedMO any (known) lingering issues widi die property ownisr(s) diat have been left imresoived? t y 

O&erCnisideiHtions/Pioperty Owne r Discussions/Additional Work that is Required 

BPA Jpoi/n J&eu.t* GdR/iRepvesentative ,,_.^ 

hat e uh/09 
Prudent Property Close-Out Form (Lead-Based Paint Stabilization) 

SAlk HAI J ^ . I . Proberty Address; M ^ C^O^ n^V/g C N U > 

Owi^er's Name; IA^>-*l\«iy\ ^A^Vt'^lt^^ 

Perfbrmance Standards/ciose-Out Criteria 	 YES NO 

Was the entire structure(s) painted with the exception of the 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. i

2.	 w ^ all scraping and other preparattion work completed satisfactorily? 

3.	 Wpre all required areas of the 5tructure(s) primed as needed and painted with two top coats? X. 4.	 Was the paint products utilized equivalent to a 30 year product/quality? X 

5.	 Ane all of the areas where contaminated materials have been spilled 


thproughly vacuumed/ cleaned? 
 )L 

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? 
 X 

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

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


properiy removed? 
 i 

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


neqds to be completed prior to the EPA Close-Out. 
 X 

10.	 Arepere any property items that were temporatily re-located by the contractor 


that need to be moved back? 
 1 

11.	 Are there any (known) iingering issues with the property owner(s) that have been left unresolved? 

Othg Consid6rations?property Owner Discussions?Additional Work that is Required y

Ccu\JLy JL^ 

esentative 

C^ '(^MA^^-^ ^ / . 

iy^/r1