TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID: 24471 Date: 12/26/2008 

Address: 820 N 42 ST 

Stabilization Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

[?f Video of property (DVD) 

^ Executive Summary 

[/ Signed Access Agreement for subject property 

^ Painting Agreement 

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

D Photographs 

m Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

[F Property information from Douglas County Assessor's Office 

D 

D 

D 

Signaturo^ Date 

40310434 

iinn 

Superfund 
PROPERTY SUMMARY 

Date: 12/29/08 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Month of: December 

Propertv Address: 820 N 42 ST SAID: 24471 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: Issues to be resolved in the spring. 

A.2 Issues Resolved: NONE. 

A.3 Unique Findings: NONE. 

A.4 Other Relevant Information: 

Access Date: 10/23/08 

Work Began: 11/07/08 

Closeout Date: 11/16/08 

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. 
KNVIRONMENTALA 

CONSTRUCnON 

TECBNOLOGIES, INC. 8IRVICI8 

Property Status Form 

JAddiws:'?Ac:, K\. M?^^ . Date: /n^/^^/^ ^ 

Phone: BVID: ^UU I \ 

^'^(o-(')ll.Z>C\ 

Plant & Permanent Landscaping To Remait> In pja ^ 

Itm# 

Descfiption and Location ,

OaMap ^ I'.k ^ .^e.s>0 -^"^^^ ^'^^ ^>''^ •^''^' • 

Pro.Exi8ting Condition of Stnieturea 

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

Propeily Ownor Pnident Emplweek 

I Signature; y /i / , Signature: /^J/l^iA^^ ^ 
,c^m-^\\ 

t TedmologieB, Inc. (Prudent) ia under contract (Contract # EP-R7-08-07) with the U. S. 

juneotal Protection Agency (EPA) to stabilire Lead Baj ^ Paint (LBP) at a number ofptoperties 

locatek in Omaha, Nebraska, including the property located atfS ^ L\. 4;^^ , 

The EJPA requests your pennission to allow Prudent to perform LBP Stabilization at this property. By 

sibling this form, the property owner grants pennission to Prudent to perfonn activities relatod to LBP 

StaWliTytf^ infhTf*^"g *«riying paint and panting of the referenced property. Further, the ownerAeoant 

vosStitiutt they hanre received the LBP pamphlet '*Renovate Right." 

Ifyou have any questions about the LBP stabilization planned for your property, please contact Prudent*8 

A#il!liff**Tit'Y^ CleA for the Lead Based Paint Stabilization, Mra. Deborah Akereie-Johnscn. 

at (4t)2) 504*1004. General questions about the Omaha Lead Site cleanup can be directed to the EPA 

Pubjc Infonnation Centeis at (402) 731-3045 (South Omaha ofiice) or (402) 991-9583 (North Omaha 

office). 

Ropci^AoowOnBiodBy; vJr^rv Su 

(Ple«e Print Nsne) 

loj^ijoe Prapi^OwBcrSiiuuiK, (SigMtmtii 

PROPCRTY INFORMATION 

(To be wpktr t by mMcnt wJ^ f n upctty we r » phu t prial) 

flnMCf , Owrar Rvfilaf 

3^0 hJ ii2 ^ 

IF pmL . PROPERTY OWNB) 8Y: 

^CL^-t O^NSVeiUllMOAOOReaS; 

OMMBTSTeUPHONENUMBER.HOMB; rffo?\^^'^'^'^^ \ WORK! t I 

MIMBEROPOCCUPANTB UNOER 7 YEARS Ot.O:j2 . NUMBER OP OCCUPANTS 7 YEARS OLD ANO OLOER,.: 3 

l^niBBR OFOHnACN imOER 7 YBAR8 OLD VVHO PlAY IN THE YARD FOR S HOURS OR MORE PER W 

COWIWITS OROPECIAl WWTWUCTIOWO; (LEDOOSi ENTRY GATES, ETC.) 

AUTBOanY FOR BNVIIU>NMB^^AL KBSPOraB ACnCVO; Tbo iwtiytiei tD be bnplem^ ^ 

orCBROiA, 42 VAC 960i EPA'I fight ofaoMit 10 Ihe prapnty It pnvided fbrto Section 104(e) of CBRO ^ 

*VeMnhita|te need Ibr iMponi^ or cbooftes ortridog «iy mpooN wfio^ r 
Curreiit Sample Pre-Renovation Fomn 

enwivaun M April 8010. 

vmiiiiiuuMi Ol iivuoi|JC VI ftjoao rwii|Jiiief 

O lt«»reeelMdaoopyo(lh9perTf]Net,f]erioi«teR|^:Jn^ ^ 

WbfWBa|yjlyf»r<lw,OirfOawftro^ ^ 

thBpott^tfM tick olths lead haggrclwposurofrtjffiwiwvaaoo activitytob9 

performad h my dwelng (jnit I reQe^«d this parrniNet before the w ^ 

I Oplfc)n(IOft6oanbK)coupled dwellings only)— If the lead peni|Me( wndejKm d t M a ten ^ 

you nMyjohsck Ihe appropriate txjK beiow. 

I to Sign—I certliy thai I have made a good faith oRdrt to deihnr the , ftnovato AigM: Ifnpartarrt tsacf Hazartf Mbmiafl ^ 

f O m Aoitlari and St/xxMs. to the lental dwel ^ 

dstajond tkns indteated and that the occupant relused to sign the conliimation 

of receipt i Mher oertHy that t have left a copy of the penphlet at the unit with 

Ihaoocupant 

Q UiUMllaMefer^ ^ 

dsflwr ths paniphlatt/%n(M!(i9 AJghtr Irqxrtsnt tead/ia^ ^ 

AnilM^ CViiarOOTpnovjicferB arx/$c/xx)l!9, to 

M m and that the oocupam vvas una>«liable to ^ the confim i 

I lUftheroertiy thatj have isit a copy of the pamphlet at the utft t ^ 

underrihadoor. 

;^/ NT /^/mjr 0M r M 

nraxi nnameofpereonoertliying Attempted 

date and time 

lead pamphlet delivery 

SMUure cf pereo30n oeAtyin oe^'fitying lead pamphle pamphlet deBver y

c^g^ 10. ^/7i ^/­

/Ornr-A., , fy.r 

3Ad(fee68 

m Ragardkio MalDng Option • > As an altemative to deBveiy in per ^ 

Rie|y mal the lead pamphlet to tha oimer and/or tenant. Panvhlet must be malM 

atlsBst 7 deys before renovation (pocuniem with a oertiflc^ 

pOROffloe). 
Paint matching form:

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Explanation: ^V.^ cew, 

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Douglas County Account Information j Page 1 of2 

Douglas County, Nebraska Property Record - R2016610000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-SO ft west of 90th St - VJeVlf OH IWap Inforination is valid as of 2008-9-4 Treasurer's Tax Report 

New Feature -*-*- * Auto Sales Search 

Owner 

WAfrS DARELL W 

ETA. 

820 N 42 ST 

OM4HAN E 68131-0000 

Property Information 

Key Number: 1661 0000 20 

Account Type: Residential 

Parcel Number: 2016610000 

Parcel Address: 820 N 42 ST 

OMAHA NE 68131-0000 

Legal Description: ] POPPLETON PARK LOT 18 BLOCK 2 50 X 128 

Value Information 

i Land ; Improvement Total 

2009 $6,400.00 $53,200.00 $59,600.00 

200 $6,400.00 $51,900.00 $58,300.00 

 $51,900.00 

2005 $6,400.00 I __ ^1,900.00 $"58,300.00 

200 $6,400.00 • $39,000.00 $45,400.00 

2003 i $6,400.00 i $39,000.00 $45,400.00 

Land Information 

Acres • SF ; L/n/te Depth Width Vacant 

0.14 . 6400.0 '^- ' I.o" ' 128."o" 50.0 No 

Improvement Informatio n 

Building 1 

$6,400.00 •'

$58,300.00 
Douglas County Account Information Page 2 of2 

Two Story 820 N 42 S« 

(I.T. ^\t%t ZtctM Ktu 

CLICK TO ENLARGE CMAGE CLICKTOENLARGE IMAGE 

Square Footage: 1546.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: ; Fair 

Built As: 2 Story Condo Square Footage: '. 0.0 

HVAC: Forced Air Rooms: 6.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: ; 1.0 

Roof Cover: Composition Shingle Bedrooms: ' 3.0 

Roof Type: Gable Stories: ' 2.0 

Floorcover: ! Allowance Foundation: Block 

Sprinicler Square Footage: . 0.0 

Year Percent Adjusted Year YearBuilt Physical Age Remodeled Remodeled Built 

1895 0% 1895 113 

Detail Type Detail Description Unite 

App lance Allowance "To " 

Appliance Security System 1.0 

Bas ament Bsmnt Block 8 ft 806.0 

Fixt jre Base Fixtures 1.0 

Fixt jre BathFuii 1.0 

Porch End Solid Wall 96.0 

Porch Slab Roof Ceil 154.0 

User Dry rot, eaves bad I.o' 

4 . . .V I J 1 . ' 'T*^t^-mtr*lf\r^i^r>\Jr\fr\-ir>-^^nlrtrtr\r\tfn-t-%v\-pr% m**Oor»rtr»iirifr»/%:^l ? 0 0 in/mnns 
Prudent Property Close-Out Form (Lead-Based Paint Stabilization) 

PropertyAririrp^- _ f^ ^ to- ^^'A^ H 

Owner's ^ame^JM££3JIIM 

Performance Standards/ciose-Out Criteria YES NO 

1. Was the entire structure(s) painted with the exception of the stated, excluded areas? This would 

indue e painting of other associated features including fascia, eaves, siding, all trim, porches, box 

beams, columns, rails, and exterior surfaces of garages. I 

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

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

4. Was t'^ie paint products utilized equivalent to a 30 year product/quality? 

Are all of the areas where contaminated materials have been spilled 

thorojjghly vacuumed/ cleaned? 1 

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

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

Is thei|grass area that surrounds the structure(s) in reasonably good condition? 

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

propel'ly removed? X 

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

needi to be completed prior to the EPA Close-Out. y 

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

that r eed to be moved back? 

y 

11. Aretl- ere any (known) lingering issues with the pr'operty owner(s) that have been left unresolved? 

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

Prudenjt Representative Signature: Iffi^ 

Date 

'Vv 

Properly Owner Signature: -i>' ^ -

k\.....W^-

Date: ra -^ c^ Ci 

I 
if% ERA 

Property Completion Agreement 

Tl is agreement documents the completion of lead based stabilization activities performed on the below 

listed property. The property owner's signature indicates that the property owner is satisfied with the 

restoration of the subject property, and that no items are in question, now, or at any time in the future, 

excluding any remaining warranty except those items listed below, if any. 

^AID: py^7 / 

l[roperty Address; ^^ ^ j/ j • L^NO ^ ^T ~ 

9'wner: Uff ^ 

I hone: 

Restoration Items in Question: 

Item: Hdt^r p&^eij HeP^fK-s ^ CidiN(\ : <6K,fs 6ij pcic^ 

Item: 

Item: 

Item: 

Item: 

:em: 

Required corrections to complete the property: 

; & ^)p/e'A>^ jSr-pi? /iSco^ jUftiS 

I agree restoration is completed, except as noted above. 

I^J I do not agree restoration is completed 

Owner's Signature Date '