TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID: 39863 Date: 12/26/2008 

Address: 2421 BAUMAN 

Remediation Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Video of property (DVD) 

0' Executive Summary 

[?f Signed Acces s Agreemen t for subject property 

[ ^ Painting Agreemen t 

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

D Photographs 

0^ Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

B^ Property information from Douglas County Assessor's Office 

D 

D 

D ' 

Signature L Date 

40309821 

DiHI 

Superfund 
PROPERTY SUMMARY 

Date: 12/23/08 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Month of: December 

Property Address: 2421 BAUMAN SAD): 39863 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE. 

A.2 Issues Resolved: NONE. 

A.3 Unique Findings: NONE. 

A.4 Other Relevant Information: NONE. 

Access Date: 09/29/08 

Work Began: 10/08/08 

Closeout Date: 10/13/08 

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 

TECHNOLOGIES, INC. 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: o)M'^^ \ T^J^^ ^ mOwjCX ArvC^ Date: 

Phone: 

Plant & Pennanent Landscapi^p To RprmAin TT^ Pl^ce 

Iteni# 

Description and Location 

On Map 

Pre-Existing Condition of Structures 

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

Itein# 

OnM ^ 

Description & Location 

Property Owner Prudent Employee 

Signature^ 

: ^ dSudtkA-i 

8080 Ward Paricway, Suite 405 2605 N. 24** StTMt, Suite 308 4242 Medical Drtva, Sulta 4260 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78228 Phom: (816) 3034703 
•5Q^^3 

Prudent Technologies, Inc. (Prudent) is under contract (Contract # EP-R7-08-07) with the U. S. 

Environmental Protection Agency (EPA) to stabilize Lead Based Paint (LBPlat a number of properties 

located in Omaha, Nebraska, including the property located at ^V^ / ^ iij.4^truij^ /^>-^ > 

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

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

Stabilization including scraping paint and painting of the referenced property. Further, the owner/tenant 

verifiestiiattiiey have received tiie LBP pamphlet "Renovate Right." 

If you have any questions abouttiie LBP stabilization planned for your prop^ty, please contact Prudent's 

AHminiirtrative Clerk for the Lead Based Paint Stabilization, Mrs. Deborali AkerelfrJohnson. 

at (402) 504-1004. General questions about the Omaha Lead Site cleanup can be directed to the EPA 

Public Information Centers at (402) 731-3045 (South Omaha office) or (402) 991-9583 (North Omaha 

office). 

Piopeny Acoen Otanted By-.. 

OPIease Print Name) 

^ ^ CSigna&ffc) f f (Date) 

CTo be completed

PROPEFCTY INFORMATION 

by midca t and/or property onmer ­ please print) 

RESIDENT NAME: f\f ^ C^ ^ Ovmer Renter 

RESIDENT ADDRESS: 

IF RENTAL, PROPERTY OINNB) BY: •?f?i^6^ /). P)u4hA-0fi!^ 

OWNER'SMAIUNOADDRESS; J^' ^ / ^^U T £r/lQ D I lnO J . 

OVWER-S TELEPHONE NUMBER. HOME: t ^ \'?^^A ^ X I ^'*°^ ' *<^> h')i^rS ^ "7 ^ 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: ^ NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER: ^ 

NUMBER OFCHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: e?? 

COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOOS, ENTRY GATES. ETC.) 

AUTHORTTY FOR ENVIRONMENTAL RESPONSE ACTIONS; The activitiei to Iwimpleinemed by EPA under Has agneoKiit ate punuant to Section 104 

of CERCLA, 42 U.SC 9604. EPA's right ofaccess to the piopeily isprovided fbr in Se<4ion 104(e) ofCSRO A 42 U.S. C96QS(eXwluebprDvkletta^ 

£)r "(teteniiiniiig tlie iieed fo icsponse, or ctaooting ortaldng atiy response aclioa under this title, or olberwi^ 

80 war d Parkway. 8i« e 405 2606 N. 24*" Street, Suite 308 4242 Meditnl DrIva, Sulta 4250 

naaa CHy, MO 64114 Omaha, Nebraska 68110 San Antonio. TX 7B22» 

one: (816) 363^703 Phnnn< I»M \ KI\* <»»• 
Curren =?R< t Sample Pre-Renovation Form 

Effective until April 2010. 

Confinnation of Receipt of Lead Pamphlet 

0T\- have received a copy of the pamphlet, Renovate Right: Important Lead Hazard 

informaVonfor Families, Child Care Providers and Schools informing me of 

the potential risk of the lead fiazard exposure from renovation activity to be 

performed in my dwelling unit. I received this pamphlet before the work began. 

i^nfe * name of recipient^ / i '^yste/ ' 

Signature of recipient 

Setf-Certiftcation Option (for tenant-occupied dwellings only) — 

If the lead pamphlet v^as delivered but a tenant signature was not obtainable, 

you may check the appropriate box below. 

Q Refusal to sign —I certify that! have made a good faith effort to deliver the 

pamphlet,fienovateftig/Jt Important Lead Hazard Informationfor Families, 

Child Care F'roviders and Schools, to the rental dv^^ling unit listed below at the 

date and time indicated and that Vne occupant refused to sign the confirmation 

of receipt. 1 further certify tfiat I have left a copy of ttie pamphlet at the unit with 

the occupant. 

Q Unavailable for signature — 1 certify that I have made a good faith effort to 

deliver the pamphlet,fienovate FVght: Important Lead Hazard Information for 

Fam'^es, Child Care providers and Sdiools, to the rental dwelling unit listed 

below and that the occupant was unavailable to sign the confinnation of receipt. 

I further certify that i have left a copy of the pamphlet at the unit by sliding it 

underthedoor,.-—^ 

Printed name of person certifying Atten/ipted delivery 

date and time 

lead pamphlet delivery 

'ypyyjyTLjd^^— 

g^tature of person certilying lead pamphlet delivery 

.^44?/ i^cuTja^ y^^'-e^ 

Unit Address 

Note Regarding Mailing Option — As an aitemalivB to delwery in person, you 

may mail the lead pamphlet to the owner and/or tenant. Pamphlet must be mailed 

at least 7 days before renovation (Document with a certificate of mailing fifom the 

post office). 
ACCESS iMf^ORHfinrioNTRAOimiG SHEET 

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paint match rfet^nr 

Paint matching form:

Property address: ^y^ /

BVID: 3^^^ 3 

Area:

Explanation: 

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 Color: 

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Page 1 
Dougla Page 1 of3 s County Account Infc^fcititioi n 

Douglas County, Nebraska Property Record - R1750020000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 90th St - V.ieW...Q.n MS R Infonnation is valid as of 2008-9-4 Treasurer's Tax Report 

Nevtf Feature -•••* • Auto Sales Search 

Owner 

BUTLER-COX KATRON D 

ETAL 

\^\A 

\^' ^ 

OMAHA NE 68112-0000 

Property Informatio n 

Key Number: 5002 000017 

Account Type: Residential 

Parcel Number: 1750020000 


Parcel Address: 2421 BAUIVIAN AV 

OIMAHANE 68112-0000 

Legal Description: l\AiNNE LUSA LOT 25 BLOCK 8 44 X 120 

2421 BAUIWIAN AVE 

Value Informatio n 

Land improvement Total 

2008 $5,900.00 $67,700.00 $73,600.00 

2007 $5,900.00 $42,500.00 $48,400.00 

2006 $5,900.00 $42,500.00 $48,400.00 

2005 $5,900.00 $42,500.00 $48,400.00 

2004 $5,900.00 $36,300.00 $42,200.00 

2003 $5,900.00 $36,300.00 $42,200.00 

Sales Informatio n 

Sales Data: 2005-05-19 

Deed Type: QC Book: 2005 l^ge: 059981 

Price: $0.00 

Grantor KATRON D BUTLER ETAL 

Grantee: KATRON D BUTLER ETAL 

Valid/invalid: invalid 

Exclusion Reason: Family Sale 

Sales Date: 1994-07-20 

Deed Type: Book: 1986 Page: 397 

Price: $42,500.00 

Grantor: 

http://douglasne,mappmg-online.comyDouglasr.nNp/ct!Jti^/or •i-i»«+."~^~ ; — o ­
Dougla Page 2 of3 s County Account lo^pii ation 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

L^nd Informatio n 

Acres SF Units Depth Widtii Vacant 

0.12 5280.0 1.0 120.0 44.0 No 

Improvemen t Informatio n 

Building 1 

2421 Saimin Ave. 11caoryRn 

.JML 

.&'d2!*f. "t t 

^^ir ^rssiss**" 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1448.0 Percent Compiete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Fair 

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

HVAC: Central Air to Air Rooms: 6.0 

Exterior: Frame Stucco Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Slate Bedrooms: 3.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

YearBuilt Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1923 0% 1923 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Appliance Fireplace Masonry 1.0 

Basement Bsmnt Block 8 ft 1188.0 

Fixture Base Fixtures 1.0 

http://douglasne.mapping-online.eom/DouslasCoNe/sTatiV/Q 
Douglas Coimty Account Ii^fcnatio i^teia n Page 3 of3 

Fixture Bath Full 1.0 

Garage Detached 324.0 

Porch End Screen 126.0 

Porch End Solid Wall 48.0 

http://douglasne.mapping-onIine.com/DouelasCoNp/ctof,v/o., 
Prudent Property Close-Out Form (Lead-Based Paint Stabilization) 

Property AMr^ - M M BAM4YU ^ UO ^ • 

Ortmer's Nama IX^AJn u J). jSuJ^'-CU ^ 

Performance Standards/ciose-Out Criteria 

YES NO 

1. Was tfie entire struaure(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. 

2. Was ail scraping and other preparattion work completed satisfactorily? 

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

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

5. Are ail of the areas where contaminated materials have been spilled 

thoroughly vacuumed/ cleaned? 

6. Did the contractor collect/vacuum all failing and scraped paint chips on the entire property, 

roadways, alleyways, public access areas and also remove any other generated debris? 

7, 

7. Is the grass area that surrounds the structure(s) in reasonably good condition? ¥. 8.

 Are all items such as polyethylene sheeting, iadders, paint brushes, cones, barrier tape etc. 

properly removed? 

7

Is there any evidence of property 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 temporatily re-located by the contractor 17 

that need to be moved back? 

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

Other Considerations?property Owner Discussions?Additional Work that is Required 

r>.^4....cA^: "k^mbfli^K^f 

Prucient Reipiresentative