TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: ZSGLI G Date: P/^? / {d 

Address: ^4^2 C^f\lC^QC SJStabilization Contractor: Professional Environmental Engineers Year: 2010_ 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ . 

Video of property (DVD) 

Executive Summary 

^'^ f Signed Access Agreement for subject property 

0"'^ Pre-Renovation Form signed by Property Owner 

D Pre-Renovation Form for Occupant/Tenant, if applicable 

^ [ Painting Agreement 

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

D Renovation Recordkeeping Checklist signed by Certified Renovator 

^^^1 Photographs •_ 

D Satisfactory close-out check list signed by Property Owner 

J? r Property close-out check list signed by EPA 

^ ^ Property information from Douglas Coimty Assessor's Office 

D Hazard analysis, if prepared 

D Safety Audit 

D Other (describe): 

(afterfile folder review) 

30217435 

mm. Superfund 
--J 

Professional Environmental Engineers: EPA Paint Stabilization 2010 

SAID# 

Property Address 

stories/Siding type 

Garage? 

Access signed LoM : : 

Pre-video _ U (14/1,6 

Post video (_ 2-olD 

Contractor Assigned.^\^vl . 

Date started ilqiio — . Weather/temp 

Date ended 

Paint used oiOq LnhMf.. . . Prime used 

Poiy used a; 

Problems/Issues 

QVfi^jl/ in ar>?4 rcw)A\^h'^. 
2010 

PROFESSIONAL 

2505 North 24"^, Suite 219 ENVIRONMENTAL ENGINEERS, INC. Omaha, NE 68110 

(402) 504-4688 "Providing cost-effective environmental solutions" Fax (402) 504-3281 

Consulting • Engineering Design • Remediation • Abatement • Emergency ResF>onse 

EPA Close-Out Form 

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

SAID: g^CaVCp 

Property U^QV ^WiCA.o,Q Sl Address: M.^* ^ L_ C_XAiC^cv< 

Owner's Name: ^\Cx\f\ ^ ^c^CX.f\^Of^ 

Performance Standards/Close-Out Criteria 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? c^^ 

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

4. Was the paint products utilized equivalent to a 25 year product/quality? J7^ 

5. Are all ofthe areas where contaminated materials have been spilled thoroughly vacuumed/ c/^ 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 other generated debris? ly^ 

7. Is the grass area that surrounds the structure(s) in reasonably good condition? ly 8. Are all items such as polyethylene sheeting, ladders, paint brushes, cones, barrier tape, etc. 

properly removed? L^^ 

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. u­ 10. Has the property owner signed the completion form? 

i^: 

11, Are there any property items that were temporarily re-located by the contractor that need to 

( y ^ be moved back? 

12. Are there any (known) lingering issues with the property owner(s) that have been left y unresolved? 

Other Considerations/Property Owner Discussions/Additional Work that is Required: 

7/Jo/O 

EPA COR Signature 
2010 

PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

"Providing cost-effective environmental solutions" 

Consulting • Engineering Design • Remediation • Alsatemenl • Emergency Response 

Property Owner Close-Out Form 

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

SAID: AP>IQ\I Q 

Property Address: C^UO ^ CO^\<^c^c,<^ ^ ^ 

Owner's Name: f\a1^j . P . .S^ v!y^ Oi'^^ O n 

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, 1^ porches, box beams, columns, rails, and exterior surfaces of garages. 

2. Was all scraping and other preparation work completed satisfactorily? 

\ 

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

coats? A 

4. Was the paint products utilized equivalent to a 25 year product/quality? 

X 

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

vacuumed/ cleaned? X

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 X debris? 

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

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

etc. properly removed? X 

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 you satisfied with the work performed? 

< 

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

need to be moved back? T 

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

unresolved? 

%

Other Considerations/Property Owner Discussions/Additional Work that is Required: 

'M­ / r Property Owner Signature 

Date 

^€^ ^ 

^'7J-7^ 

Professional En vifonHl§ritnta£ 

l Engineers Signature Date 

X 
(eflFective April 2010) 

RENOVATION RECORDKEEPING CHECKLIST 

Name OfFirm: c^^.0 • prunTpi m / 1 C 

Date and Location of Renovation: l| q || 0 ^^0^ 1 rh^.\CQjOif) S^ . 

Brief Description of Renovation: 5r(nLp P .^ ^^^iTVVO. ^ ^Yj A i^ 

Name of Assigned Renovator:^ (YWCVXMJ UfVfalJis 

Name(s) of Trained Workers: (Q S 0 0 i\\idiXl^CiM2Q.S^X^ ' Ws&LkliS}j£o ^ 

Name of Dust Sampling Technician, Inspector, and/or Risk Assessor, if used: |\j 1p[q'' 

Copies of renovator and dust sampling technician qualifications (training certificates, certifications) on file. 

Certified renovator provided training to workers on (check all that apply): 

{^Posting warning signs (getting up plastic containment barriers 

Maintaining containment 0* Avoiding spread of dust to adjacent areas 

, Waste handling 0=4*ost-renovation cleaning 

D Test kits used by certified renovator to determine whether lead was present,^n components affected by 

renovation (identify kits used and describe sampling locations and results: 

/y Warning signs posted at entrance to work area. 

/S^ Work area contained to prevent spread of dust and debris. 

13 Windows in and within 20 feet ofthe work area are closed 

/biPoors in and within 20 feet ofthe work areas are closed and sealed 

^Doors that must be used in the work area are covered to allow passage but prevent spread ofdust. 

c^Groimd covered by plastic sheeting extending 10 feetfirom work area - plastic anchored to the 

building and weighted down by heavy objects. 

d^ If necessary, vertical containment installed.to prevent migration ofdust and debris to adjacent 

property. 

M. Wasie contained on-site and while being transported off-site. 

Renovation Recordkeeping Checklist Omaha Lead Site 
(effective April 2010) 

0 Work site properly cleaned after renovation. 

CJ All chips and debris picked up, protective sheeting misted, folded dirty side inward, and taped for 

removal. 

(Q,Work area HEPA vacuumed to get paint chipsfi-om ground surface, if necessary. 

D Certified renovator performed post-renovation cleaning verification (describe results): 

(^ 1 certify under penalty ^]aw that the above information is true and complete. 

ihlif) 

Name and Title Date 

Renovation Recordkeeping Checklist Omaha Lead Site 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC.

"Providing cost-effective environmental solutions "

 ''° ' ""omaht NE^m 

 p^ jjjgj 504^1 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

2010 

SAID#23616 

4402 Chicpgo St. 

• Dates worked: 07/09/10 to 07/09/10 

• Pre property condition: House has wood siding with painted wood trims that had 

flaking paint; garage also has painted wood siding in poor condition. Paint chips in 

yard. 

• Problems encountered: A vehicle ran into the garage over the weekend after the paint 

was done. Damage appears on pictures, but was unrelated to stabilization. 

• Owner request/concerns: N/A P'Pt^ Q-\-V O 

• Inspection/closeout dates: Owner 07/13/10, inspected by PE project manager. 
CONSEFW'OR ACCESS TO FROFffliT TMi Y 

OMAHA LEA© SITE REMEDIAL ACTION - LEAD-IBASEB PAINT STABILIZATION 

PROPERTY ED: [j 3 ^ I (o PROPERTY ADDRESS: 4^ 0 ^^ (ll^jCQqA T^ . IOC 

ypWNERNAME: 

^ J£UiJA/& ^ . S^A//lyi<.5r,, A^ DAYTIME PHONE: ^f^^^- S£'/ - ¥/ ^ 

CELL PHONE: E-MAIL: 

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) 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 b 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 thu 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. 

IS Yes, I Mve m|i and undeptamttoa paragraph above. 

^//a// a 

( \ Signatur Signaturee ooff Propert Propel y Owner Date 

1 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 Paulette 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). 

X% Ye«, I grant access to my property and tms given the pamphlet 0 No, I do not grant access to my propeity and I was 

"Renovate Right, Important Lead InfbrmattonforFamilies, Child given the pamphlet "Renovate Right, Important Ijead 

Care Provldere, and Schools.' InfomiationforFamilies, Chllde Care Provldere, and Schools.' 

Signature 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

PROPERTY ADDRESS M^h!^ ('_WirnnA< ^ DATE: f.//A// n 

Dy0W>^Mg.(^^|'^l BV,D: J3L 1 

AREA(S) TO BE PAINTED: 

HOUSE PROPER COLOR: lila^Um 

HOUSE TRIM: ^ COLOR: yflrVk\N^W 

GARAGE: £ ^ COLOR: w^ 

GARAGE TRIM: |£JS. COLOR: f/\o\ck 

PORCH: ^ COLOR: lyfeK 

PORCH TRIM: kfx COLOR: l^fe" 

(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: 

K 
PRE-RENOVATION FORM - OWNER 

This form is to be used by thefirms contracted by the Environmental Protection Agency-Region 7 to perform Lead-Based 

Paint stabilization activities at the Omaha Lead Site, Omaha, Nebraska. 

Owner Confinnation 

Pamphlet Receipt 

D I have received a copy ofthe lead hazard information pamphlet. Renovate Right: Important Lead Hazard Information for 

Families, Child Care Providers and Schools, informing me ofthe potential risk ofthe lead hazard exposure from renovation 

activity to be performed in/on my dwelling unit. I received this pamphlet before the work began. 

Owner Acknowledgment 

D (A) I confirm that I own and live in this property, that no child under the age of 6 resides here, that no pregnant woman 

resides here, and that this property is not a child-occupied facility. 

Note: A child resides in the primary residence of his/her custodial parents, legal guardians, foster parents, or 

informal caretaker if the child lives and sleeps most oftime at the caretaker's residence. 

Note: A child-occupied facility is a pre-1978 building visited regularly by the same child, under 6 years of age, on at 

least two different days within any week, for at least 3 hours each day, provided that the visits total at least 60 hours 

annually. 

\ / (B) I understand that the renovation firm, contracted by the Environmental Protection Agency (EPA), will be using lead­

^safe work practices required by EPA's Renovation, Repair and Painting Rule. 

y jTA/f/y^ ^ sn^A^/,<^y 

Printed Name of Owner-Occupant 

i> '//^// a 

Signature of Owner-Occupant " Date 
Douglas County Account Information 

Page 1 of3 

-.•'* ­ m 

C^JG?[CP 

1W M

Douglas County, Nebraska Property Record - R2018840000 

Print Reoort 

View Interactive GIS Mao 1 nfbmfiation is valid as of 2010-5-28 Treasurer's Tax Reoort 

New Feature •^ "* -¥ Subdivision Sales Search 

Owner 

SWANSON ELAINE E 

blAL 

4402 CHICAGO ST / ^ 2"- \ / i , , i A 

OMAHA NE 68131-0000 O ! D I " H VH( J 

Property Informatio n 

Key Numlier 1884 0000 20 

Account Type: Residential 

Parcel Number 

2018840000 

Parcel Address: 

4402 CHICAGO ST 

OMAHA NE 68131-0000 

Legal Description: POPPLETON PARK LOT 20 BLOCK 15 E 40 FT LT 40 X 128 

Value Informatio n 

Land Improvement Total 

2010 $5,700.00 $58,900.00 $64,600.00 

2009 $5,700.00 $58,900.00 $64,600.00 

2008 $5,700.00 $58,900.00 $64,600.00 

2007 $5,700.00 $55,700.00 $61,400.00 

2006 $5,700.00 $55,700.00 $61,400.00 

2005 $5,700.00 $55,700.00 $61,400.00 

Land Informatio n 

Acras SF Units Depth Width Vacant 

0.11 5120.0 1.0 128.0 40.0 No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.eom/DouglasCoNe/static/accoimtinfo.j sp?accountno=R201... 6/5/2010 
Douglas County Account Inf^manon Page 2 of 3 ^n|auo 

1 1/2 Stofy Unfin 4402 Chicago St 

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CLICK CLICK TO ENLARGE IMAGE TO ENLARGE IMAGE 

Square Footage: 750.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Average 

Built As: 1 1/2 Story Unfin Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 5.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.0 

Floorcover: Allowance Foundation: I Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1920 0% 1920 90 

Deta/7 Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 750.0 

Basement Finished 144.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 216.0 

Porch Slab Roof Ceiling 91.0 

Porch Slab w/Steps 66.0 

http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R201... 6/5/2010