### TRANSMITTA L o f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R SAID# : ZSGLI G

### Date : P/^ ? / { d Address : ^4^ 2 C^f\lC^Q C SJ

Stabilizatio n Contractor : Professiona l Environmenta l Engineer s Year : 2010_ PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S ^ . 

### Vide o of propert y (DVD ) Executiv e Summar y ^'^ f Signe d Acces s Agreemen t fo r

subject propert y 0"' ^ Pre-Renovatio n For msignedb y Propert y Owne r D Pre-Renovatio n For mfo r

Occupant/Tenant , if applicabl e ^ [ Paintin g Agreemen t D Settlemen t document s (i.e. , fo r

damag e or t

o replac e plants , etc. ) D Renovation Recordkeeping Checklis t signedb y CertifiedRenovato r ^^^ 1 Photograph s •_ D Satisfactor y close-ou t chec k

lis t signedb y Propert y Owne r J?r Propert y close-ou t chec k

lis t signedb y EP A ^ ^ Propert y information fromDougla s Coimt y Assessor' s Office D Hazar d analysis , i f prepared D Safet y Audi t D Othe r

(describe) :

(afte r file folde r review ) 3021743 5 

# mm. Superfun d-- J

Professiona l Environmenta l Engineers : EP A Pain t Stabilizatio n 201 0 SAID # Propert y Addres s stories/Sidin g typ e Garage ? Acces s signe d 

# Lo M : : Pre-vide o _ 

# U 

# (14/1, 6 Pos t vide o (_ 

# 2-ol D Contracto rAssigned.^\^vl
. Dat e starte d 

# ilqii o —. Weather/tem p Dat e ende d Pain t use d 

# oiO qLnhMf. . . . Prim e use d Poi y use d 

# a ; Problems/Issue s



## QVfi^jl / i n ar>? 4 rcw)A\^h'^
.

### 201 0 

## PROFESSIONA L 250 5 Nort h 24"^ , Suit e 21 9 

## ENVIRONMENTA L ENGINEERS , INC
. Omaha , N E 6811 0 (402 ) 504-468 8 "Providin g cost-effectiv e environmenta l solutions " Fax (402 ) 504-328 1 Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc y ResF>ons e 

### EP A Close-Out For m (Lead-Based Pain t Stabilizatio n EP A Contract EP-R7-08-06 ) SAID : 

## g^CaVC p U^Q V ^WiCA.o, Q S l Propert y Address : M.^* ^ L_C_XAiC^cv < Owner' s Name : ^\Cx\f\ ^ ^c^CX.f\^Of ^ Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) painted wit h the exceptio n ofth e stated , excludedareas ? Thi s would includ e paintin g o f othe r

associate d feature s including fascia , eaves , siding , all trim , porches , box beams , columns , rails , an d exterior surface s of garages . 2 . Wa s all scraping an d othe r

preparatio n wor k

completedsatisfactorily ? 

# c^ ^ 3 . Wer e all require d area s ofth e structure(s ) primeda s neededan dpainte dwit h tw o to p coats ? 4 . Was th e pain t product s utilize d equivalen t to a2 5 yea r

product/quality ? 

# J7 ^ 5 . Ar e all ofth e area s wher e contaminate d material s hav e bee n spille d thoroughl y vacuumed / 

# c/ ^ cleaned ? 6 . Did th e contractor collect/vacuumall falling an dscrapedpain t chip s on th e entir e property , roadways , alleyways , publi c acces s area s an dals o remove an y othe r

generateddebris ? 

# ly ^ 7 . I s th e gras s are atha t surround s th e structure(s ) in reasonabl y goodcondition ? 

# l y 8 . Ar e all item s suc h a s polyethylene sheeting , ladders , pain t brushes , cones , barrie r

tape , etc . properl y removed ? 

## L^ ^ 9 . I s ther e an y evidenc e ofpropert y damag e tha t was done b y th e contractor ? An y propert y damag e need s t o b e completed prior t

o th e EP A Close-Out . 

# u ­ 10 . Has th e propert y owne r

signed th e completio n form ? 

# i^ : 11 , Ar e ther e an y propert y item s tha t wer e temporaril y re-locate db y th e contractor tha t needto ( y ^ 

### b e move d back ? 12 . Ar e ther e an y (known) lingerin g issue s wit h th e propert y owner(s ) tha t have bee n lef t 

# y unresolved ? Othe r

Considerations/Propert y Owne r

Discussions/Additiona l Wor k

tha t i s Required :



# 7/Jo/O EP A CO RSignatur e

### 201 0 

## PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC
. "Providin g cost-effectiv e environmenta l solutions " Consultin g • Engineerin g Desig n • Remediatio n • Alsatemen l • Emergenc y Respons e 

### Propert y Owne r Close-Ou t For m (Lead-Based Paint Stabilizatio n EP A Contrac t EP-R7-08-06 ) SAID : AP>IQ\I Q 

### Propert y Address : C^UO ^ CO^\<^c^c,< ^ ^ ^ Owner' s Name : f\a1^j . P . .S ^ v!y ^ Oi'^ ^ O n 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 Fa x (402 ) 504-328 1



### YE S N O 1 . Wa s th e entir e structure(s ) painte d wit h th e exceptio n ofth e stated , exclude dareas ? Thi s would include paintin g o f othe r

associate d feature s including fascia , eaves , siding , all trim , 

# 1^ porches , box beams , columns , rails , an d exterior surface s of garages . 2 . Was all scrapin g and othe r

preparatio n wor k

completed satisfactorily ? \ 

### 3 . Wer e all require d area s ofth e structure(s ) prime da s needed an dpainte dwit h tw o top coats ? 

### A 4 . Was the paint product s utilize d equivalen t to a2 5 yea r

product/quality ? 

### X 5 . Ar e all ofth e area s wher e contaminate d material s have bee n spille dthoroughly 

### X vacuumed / cleaned ? 6 . Did th e contractor collect/vacuumall falling andscrapedpaint chip s on th e entir e property , roadways , alleyways , publi c acces s area s an dals o remove an y other generate d X debris ? 7 . I s th e gras s are atha t surround s th e structure(s ) in reasonabl y goodcondition ? X 8 . Ar e all item s such a s polyethylen e sheeting , ladders , pain t brushes , cones , barrier tape , etc . properl y removed ? X 

### 9 . I s ther e an y evidenc e ofpropert y damag e tha t wa s don e by th e contractor ? An y propert y damag e need s t o b e completed prior t o th e EP A Close-Out . # > ^ 

### 10 . Ar e yo u satisfied wit h th e wor k

performed ? < 

### 11 . Ar e ther e an y propert y item s tha t wer e temporarily re-locatedb y th e contractor tha t need t o b e moved back ? 

### T 12 . Ar e ther e an y (known) lingerin g issue s wit h th e propert y owner(s ) tha t hav e been lef t % 

### unresolved ? Othe r

Considerations/Propert y Owne r

Discussions/Additiona l Wor k

tha t i s Required :

'M

­ / r 

### Propert y Owne r

Signatur e Dat e 

# ^€^ ^ ^'7J-7 ^ nta l Engineer s Signatur e Professiona l E n vifonHl§rit £ Dat e 

### X(eflFectiv e Apri l 2010 ) 

### RENOVATIO N RECORDKEEPIN G CHECKLIS T Nam e OfFirm : c^^.0 • prunTpi m/ 1 C Dat e an d Locatio n o f Renovation : l| q || 0 ^^0^ 1 rh^.\CQjOif ) S^ . Brief Descriptio n o f Renovation : 5r(nLp P . ^ ^^^iTVVO . ^ ^Yj A i ^ Nam e of Assigned Renovator: ^ (YWCVXM J UfVfalJi s 

### Name(s ) o f

Traine d Workers : (Q S 0 0 i\\idiXl^CiM2Q.S^X^ ' Ws&LkliS}j£o ^ Nam e of Dus t Sampling Technician , Inspector , and/or Risk Assessor , i f used : |\ j 1p[q'' Copie s of renovator and dus t sampling technicia n qualification s (trainin g certificates , certifications ) o n file. Certified renovator provide d trainin g to worker s o n (check all tha t apply) : {^Postin g warnin g sign s (gettin g u p plasti c containmen t barrier s Maintainin g containmen t 0 * Avoidin g sprea dof dus t t o adjacen t area s

, Wast e handlin g 0=4*ost-renovatio n cleaning D Tes t kit s used by certified renovator to determin e whethe r

lea dwas present,^ n component s affecte d b y renovation (identif y kit s used an d describ e samplin g location s an d results :
/ y Warnin g sign s poste d a t entranc e to wor k

area . /S ^ Wor k

are acontaine d to preven t sprea d o f dus t an ddebris . 1 3 Window s i n an d within 2 0 fee t ofth e wor k

are aar e closed /biPoor s i n and withi n 2 0 fee t ofth e wor k

area s ar e close dan dseale d ^Door s tha t mus t b e use d i n th e wor k

are aar e covered t o allo w passag e but preven t sprea d ofdust . c^Groim d covere d by plasti c sheetin g extendin g 1 0 fee t firomwor k

are a- plasti c anchore dto th e buildin g and weighte d down by heav y objects . d

^ I f

necessary , vertica l containmen t installed.to preven t migratio n ofdus t an ddebri s t o adjacen t property . M . Wasie containe d on-sit e and whil e bein g transporte doff-site .

Renovatio n Recordkeepin g Checklis t Omah a Lea d Sit e(effectiv e Apri l 2010 )

0 Wor k

sit e properl y cleane d after renovation . C

J Al l chip s an ddebri s picke d up , protectiv e sheetin g misted , folde d dirt y sid e inward , an dtape d fo r removal. (Q,Wor k

are aHEP A vacuume d t o ge t pain t chip s fi-omgroun d surface , i f necessary . D Certifie d renovato r performe d post-renovatio n cleanin g verificatio n (describ e results) : ( ^ 1 certif y unde r penalt y ^]a w tha t th e above informatio n i s tru e an d complete . 

# ihlif ) Nam e an d Titl e Dat e

Renovatio n Recordkeepin g Checklis t Omah a Lea d Sit e

## PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC
. "Providin g cost-effectiv e environmenta l solution s " 

## ''° ' ""omah t NE^ m p ^ jjjg j 504^ 1 Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc y Respons e



### Lea d Bas e Stabilizatio n Omaha , N e Clos e Ou t Repor t 201 0 SAID#2361 6 440 2 Chicpg o St .

•Date s worked : 07/09/1 0 t o 07/09/1 0 •Pr e propert y condition : Hous e ha s woo dsidin g wit h painte dwoo dtrim s tha t ha d flaking paint ; garag e als o ha s painte dwoo dsidin g i n poo r condition . Pain t chip s i n yard . •Problem s encountered : A vehicl e ra n int o th e garag e ove r th e weeken dafte r th e pain t wa s done . Damag e appear s o n pictures , bu t wa s unrelate dt o stabilization . •Owne r request/concerns : N/ A P'Pt ^ Q-\-V O •Inspection/closeou t dates : Owne r 07/13/10 , inspecte db y P E projec t manager .

# TMi CONSEFW'O RACCES S TO FROFffliT Y OMAH A LEA © SIT E REMEDIAL ACTIO N - LEAD-IBASE B PAIN T STABILIZATIO N PROPERT Y ED : 

### [j 3 ^ I (o PROPERT Y ADDRESS: 4^ 0 ^^ (ll^jCQq A T^ . 

### IO C ypWNERNAME : ^

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

- S£'/

- ¥/ ^ CEL L PHONE : E-MAIL : OWNER' S ADDRES S IF DIFFERENT : TENANT' S NAM E IF APPLICABLE : DAYTIM E PHONE : CEL L PHONE : E-MAIL : Professiona l Environmental Engineers , Inc . (PE ) is unde r contrac t (#EP-R7-08-06 ) wit h th e U.S . Environmental Protectio n Agency (EPA ) to stabiliz e leadbase d pain t (LBP ) on residentia l structure s at anumbe r of propertie s locate d in Omaha , Nebraska . Th e pain t stabilizatio n wor k

is bein g don eto protec t th e soi l cleanup s tha t ar e bein g performe d by EP A contractors . Pain t stabilizatio n activitie s will include : scrapin g of cracke d or flakin g LB P fro mstructures , applicatio n of aprim e coa t an d tw o (2 ) coat s of pain t Movin g part s of window s an ddoor s ar e no t include d an dwil l no t be addressed . Your cooperatio n b requeste d in givin g permissio nto thi s EP A contracto r (PE ) to ente r an d hav e acces s to thi s property fo r th e purpos e of stabilizin g lea d-base d pain t as outline d on th e propert y identifie d above . By signin g th u document I agre e to allo wan EP A contracto r to conduc t asoi l cleanu p at my property followin g completio n of lead-base d pain t stabilization , if th e soi l cleanu p ha s no t alread y been performed . I understan d tha t th e stabilizatio n contracto r ca

n no t provid e assurance s tha t th e soi l cleanu p contracto r will be boun d to. I furthe r understan d tha t th e soil 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 soil cleanu p at my property . IS Yes , I Mv e m| i an d undeptamttoa paragrap h above . ^//a// a ( \ Signatur Signatur e e o

o f

f Propert yOwne r

Prope l Dat e 1 full y understan d tha t by signin g thi s Consen t fo r Access , (1 ) thi s acces s wil l remai n in effect unti l th e wor k

ha s bee n satisfactoril y completed , (2 ) tha t th e Propert y Owneror Tenant , if

applicable , wil l be given th e Housin g an d Urba n Development (HUD ) an d EP A pamphlet , "Renovat e Right , Importan t Lea d Hazar dinformatio n for Families , Da y Car e Providers , an d Schools" , (3 ) th e Property Owne r or tenan t wil l remov e al l obstruction s fro msurface s to be painted , (4 ) will abid e by health an d safet y guidanc e provide d by EPA , (5 ) wil l allo w photograph y ofpropert y befor e an d afte r th e pain t stabilizatio n work , (6 ) will be contacte d by a PE representativ e approximatel y48 hour s in advanc e of startin g work , (7 ) agre e no t to obstruc tor tampe r wit h an y ofth e LB P stabilizatio n actions , an d (8 ) wil l participat e in fina l propert y inspectio n an d sig n th e Completio n Agreemen t an d Propert y Owne r Satisfactio n Survey . Shoul dyo u hav e any question s abou t th e plane d Lead Based-Pain t stabilizatio n activitie s fo r you r property , pleas e contac t Professiona l Environmental Engineers , Inc . Projec t Manager , Willi e Cla y

At 402-504-4688 . Genera l question s abou t th e Omah a Lea d Site cleanup ca n

be directe dto Paulett e France-Isetts , EP A Remedia l Projec t Manage r 402^731-2454 , or th e EP A Publi c Informatio n Center s at 402-991-958 3 (Nort h Omah aoffice) or 402-731-304 5 (Sout h Omah aoffice) . X% Ye« , I gran t acces s to mypropert yan d tm s give n th e pamphle t 0 No , I do no t gran t acces s to mypropeit yan d I wa s "Renovat e Right , Importan t Lea d Infbrmatto n for Families , Chil d give n th e pamphle t "Renovat e Right , Importan t Ijea d Car e Provldere , an d Schools. ' Infomiatio n for Families , Chlld e Car e Provldere , an d Schools. ' Signatur e SPECIA L INSTRUCTION S AN D CONSIDERATION S

### PAIN T STABILIZATIO N PRE-PROPERT Y PAIN T MATC H ASSESSMEN T PROPERT Y ADDRES S 

## M^h! ^ ('_WirnnA< ^ DATE : 

## f.//A// n 

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

AREA(S ) TO B E PAINTED : HOUS E PROPE R COLOR : 

# lila^U m

HOUS E TRIM : ^ COLOR : 

# yflrVk\N^ W

GARAGE : 

# £ ^ COLOR : 

# w ^ |£JS
. 

# f/\o\ck GARAG E TRIM : COLOR :
PORCH : COLOR : ^ 

# lyfe K

PORC H TRIM : COLOR : 

# kf x 

# l^fe "

(COMPLET E AL L SECTION , YES , NO , O R NON-APPLICABLE )



### I AGRE E TO TH E COLOR S LISTE D ABOVE
. ONC E TH E PAINTIN G BEGINS , I UNDERSTAN D I CA N NO T CHANG E TH E ABOV E SELECTE D COLORS : PROPERT Y OWNE R SIGNATURE : P E ACCESO R SIGNATURE : 

# K

### PRE-RENOVATIO N FOR M - OWNE R Thi s for mi s to b e use db y th e firms contracte db y th e Environmenta l Protection Agency-Region 7 to perfor mLead-Based Pain t stabilizatio n activitie s a t th e OmahaLea d Site , Omaha , Nebraska . Owne r Confinnatio n Pamphlet Receip t D I hav e received acop y ofth e lea d hazar d informatio n pamphlet . Renovat e Right : Important Lead Hazar d Information fo r Families , Chil dCare Provider s an d Schools , informin g m e ofth e potentia l ris k ofth e lea d hazar d exposur e fro mrenovatio n activit y t o b e performe d in/o n m y dwellin g unit . I received thi s pamphle t befor e the wor k

began . Owne r Acknowledgmen t D (A ) I confir mtha t I ow n an d liv e i n thi s property , tha t no child unde r the ag e o f 6 reside s here , tha t n o pregnan t woma n reside s here , an d tha t thi s propert y i s no t achild-occupie d facility . Note : A chil dreside s i n th e primar y residenc e o f his/he r custodia l parents , lega l guardians , foste r parents , or informa l caretake r i

f th e child live s an d sleep s most oftime a t the caretaker' s residence . Note : A child-occupie d facilit y i s apre-197 8 building visited regularl y b y the sam e child , unde r 6 year s of age , o n a t leas t tw o differen t day s within an y week , fo r a

t leas t 3 hour s eac h day , provided tha t th e visit s tota l a t leas t 6 0 hour s annually . \

/ (B ) I understand tha t th e renovation firm, contracte d b y the Environmenta l Protection Agency (EPA) , wil l b e using lead

­ ^saf e wor k

practice s requiredb y EPA' s Renovation , Repai r an d Painting Rule . 

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

Printe d Nam e o f Owner-Occupan t 

### i >



### '//^// a Signatur e o f Owner-Occupan t " Dat e

### Dougla s Count y Accoun t Information Pag e 1 of 3 -.•' * ­ 

# m 1 

## W M C^JG?[C P Dougla s County , Nebrask a Propert y Recor d - R201884000 0 Prin t Reoor t Vie w Interactiv e GI S Ma o 1 nfbmfiatio n i s vali d a s o f 2010-5-2 8 Treasurer' s Ta x Reoor t Ne w Featur e • ^ " * - ¥Subdivisio n Sale s Searc h Owne r SWANSO N ELAIN E E blA L 440 2 CHICAG O S T / ^ 2" - \ / i , , i A OMAH A N E 68131-000 0 O ! D I " H VH( J Propert y Informatio n Ke y Numlie r 188 4 000 0 2 0 Accoun t Type : Residentia l Parce l Numbe r 201884000 0 Parce l Address : 440 2 CHICAG O S T OMAH A N E 68131-000 0 Lega l Description : POPPLETO N PAR KLO T 2 0 BLOC K1 5 E 4 0 F T LT 4 0 X 12 8 Valu e Informatio n Lan d Improvemen t Tota l 201 0 $5,700.0 0 $58,900.0 0 $64,600.0 0 200 9 $5,700.0 0 $58,900.0 0 $64,600.0 0 200 8 $5,700.0 0 $58,900.0 0 $64,600.0 0 200 7 $5,700.0 0 $55,700.0 0 $61,400.0 0 200 6 $5,700.0 0 $55,700.0 0 $61,400.0 0 200 5 $5,700.0 0 $55,700.0 0 $61,400.0 0 Lan d Informatio n Acra s S F Unit s Dept h Widt h Vacan t 0.1 1 5120. 0 1. 0 128. 0 40. 0 N o Improvemen t Informatio n Buildin g 1



### http://douglasne.mapping-online.eom/DouglasCoNe/static/accoimtinfo. j sp?accountno=R201.. . 6/5/201 0Dougla s Count y Accoun t Inf^mano n Pag e 2 o f 3 ^n|au o
1 1/ 2 Stof y Unfi n 440 2 Chicag o S t

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nv 7WJa^,n .

5labRx4C«rin 6 vim *

t4 4 ScFt'nBwriKlindtr.iiMnii j CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 750. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Averag e Buil t As : 1 1/ 2 Stor y Unfi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 5. 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. 0 Floorcover : Allowanc e Foundation : I Bloc k Sprinkle 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 192 0 0 % 192 0 9 0 Deta/ 7 Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 750. 0 Basemen t Finishe d 144. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 216. 0 Porc h Sla b Roo f Ceilin g 91. 0 Porc h Sla b w/Step s 66. 0

http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R201. . . 6/5/201 0