TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID: 17495 Date: 12/22/2008 

Address: 2306 S 31 St 

Remediation Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

S^ Video of property (DVD) 

[y Executive Summary 

IF Signed Access Agreement for subject property 

[y Painting Agreement 

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

D Photographs 

ffl^ Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

W Property information from Douglas County Assessor's Office 

D 

D 

D 

•4s^2 'Hi . 

40309527 

IMHWHi 

Superfund 
PROPERTY SUMMARY 

Date: 12/22/08 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Month of: December 

Property Address: 2306 S 31 St SAID: 17495 

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: 11/15/08 

Work Began: 11/18/08 

Closeout Date: 12/09/08 

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 Infonnation Page 

9. EPA Property Closeout form 

10. Property Completion Agreement 

TECHNOLOCIES. INC. 
INVIRONMDirrAL* 

coNsmucnoN 

TECHNOtOGIES, INC. SIRVICES 

Property Status Form 

Addiess: A^CU "3. 31 ' ^ 

^ v(i^ Phone: 55l>-5<ia / BVID: rWJp G 

plant & Permanent Landscapi«ff T*^ Pyn^'s^n In Place 

Itci&# 

DesGiiptioo and Location 

QnM ^ 

Pt»Exi8tingCmiditiQnofStnictmBS 

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

Description & Location 

On Map 

i?a^qf^ ^ -> </tuc/Lyre ^c^CiJ 

^ ' DJinc^ouJ P»u^c^r.^ C^^rf,^ 

Property Owoer Pnideot Emplo; 

Signature: '%»uX^fi^ Signature: 
inm^ 

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

Environmental Protection Agency (EPA) to stabilize Lead Based Paint (LBP) at a numl^of properties 

located in Omaha, Nebraska, includingtiie property located atcATSlQ P). 'b\ o^ ' 

The EPA lequests your permission to allow Prudent to perform LBP Stabilization attiiis propeity. By 

sigiung this form,tiie property owner grants pennission to Prudent to perform activities lelabsd to LBP 

Stal^lization including soraping paint and painting oftiie referenced property. Furtiier,tiie owner/tenant 

verifiestiiattiiey havereceivedtiie LBP pamphlet "Renovate Right** 

If you have any questions about the LBP stabilization planned for your property, please contact Pnident*s 

^ Apif^|HirBt|ve Clerk for the Lead Based Paint Stabilization, Mrs, Drtwrah Akerde-Johnson. 

at (402) 504-1004. General questions abouttiie Omaha Lead Site cleanup can be directed totiie EPA 

Ptiblic Infonnation Centers at (402) 731-3045 (Soutii Omaha office) or (402) 991-9583 (North Omaha 

office). 

9«^A^ti.M»eA^. X ^MJiuJ-e^ T:::edij\Oi^ 

(Please Print Name) 

y 0Q \ \i\K t Q ^ ? 

Pnpd ^ Omcr Sigutue: 

V (Sigrwtae)^ "^ ^2 5 

PROPERTY INFORMATION 

^ ^ ^OTo be coaplcted Iqr reffdeit nd/or property wnler «• 

RESIOENT ADDRESS: 9^3ry^ ^> .^l ^ c 

IF RECTAL, PROPERIY OWNED eV : 

OWMEffSIIAUNOAODRBSS; —jl ! 

OWNBTSTEIBPHONB NUMBER .HOME: J^E^L^ZZ^WORK: ±, 

NUMBER OP OCCUPANTS UNDER7 YEARS OLD: NUMBER OF OCCUPANTS 7 YEARS OLD AND OLPgR: CT ^ 

NUMBER OPCHILDREN UNDB17 YEARS OLD WHO PUAY IN THE YARD FOR 6 HOURS OR MORE PER WEEK: _. _ 

COMMENTSORSPECIALINSTRUCnONS: (LE DOGS, ENTRY OATES, ETC.) 

AOIHORTTV FOR ENVIRONMBNTAL RESPONSB ACTIONS: TTio »cclvMei»teliiyleiBeiitedty BPA under tHiegwewantwepgnaBt to SccdciiW 

orCERCU. 43 U.S.C 96M. BPA'l risitt of aeoen to the pnpeity ispnvided fbr in Seettoa 104(e) of CBRO^^ « U.S. C 9^ ^ 

Ibr "detennkdiiite need Ibr relpolll^ er cboo ^ ortddng n y mponn Bcfion n 
Current Sample Pre-Renovation Forni 

eitaeslMunn April 2010. 

Ouufbiiurtkn of Receipt of Laad Prnphto t 

Q I hSMrecehwl a copy d the penvNet,f?eriovat8R(gfit:lrrqxytant Lead Hazard 

Mbrnutlbn fbr RvnHas, C/iM Care ProvfciBre ar ^ 

the poietTtial tIaK d ttie lead hazanj escposuia froni renovaQ(m activity petlbmied In nv dvveinng unit. I rece^«d this pvnphlet tie^bre the vvorfc began. 

Signature o(i;^c ^ L/ 

8elM#«rtifle8llon OpOon (for tenant-occupied dweillnga only)— 

If tha lead pempHat was delivered but a tenant Signature was not obtainable, 

you may check the appropriate box belQw. 

Q Ralbaal to sign—I carwy that I have made a good fBWiellbrt to deliver the 

peniphlaL/%nn«le Ab'it'Irrvxiresnt Leed Hazard iMbm» ^ 

CMcf C ^ Aovfcfere arxy Scftoofa, to the rental dwelling unit lIs M 

date end time Indicated and that the occupant retfused to sign the confitmation 

of raceipL I luther certify that I have left a copy of the pamphlet at the unit vvlth 

tnaocoupBm 

Q IJnavrilsbto ftr signatuie •- 1 cettfly that t have made a good faith efliort to 

deBvw the pamphlet, ftanovate R^t;/mporfant Lead Hasny Ml^ ^ 

Amiss i CfiftyCsre jsrovMisra arx/ScfxMfe, to t ^ 

below and that ttie occupant was unavailable to sign the conlimiallon of rec^t . 

I tether certi^ that I have left a copy of the pamphlet at the unit by sllding^lt 

under the dootw^ 

mnted name of person certifying Attempted deliver delivery 

y date an e

date andd timtime lead pamphlet deliveiy 

ijzQ/ieiA^— 

agneture of perBonoeraiymg lead pamphlet delivery , 

Om,dbka., A/i^ 

UnltAddress 

Note Regardlna Mailing Option •-> As an altemstivetodelivery In person, you 

rnsy mal Ihe lead pamrMettothe owner and/cr tenant. PampMat must be mailed 

at least 7 days befbre renovadon (Pocument vvith a certilicate of m ^ from the 

postoflio^ 
Area: ^^^z-*^ ^ -^/^»r 

Area; ^^^^'^'^/^.>^^^^y^^/c?.->^4) 

non ; 

/ fH/-

Area; 

Area; 

I 

Page i 
AG<^SS /l^PO/^Hi^ior^Ti^AGKaiQ SHEET 

^ ^ :^:.Mn ty.Z\ ^ -

OacOgMtNot HOWK ^^-Sr3 - ^fS- / vfru 

Oft .&U. 

MBRIIVVMVBDBM yi/denf-
Douglas County Account In1|^fiation 

r Douglas COuniy, nebrask o Property llaeord - R0904190000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale O-SO ft west of 90th St - Vje W O n Ma p Information is valid as of 2008-9-4 

New Feature

Owner 

ZADINA JAMIE R 

2306 S 31 ST 

OMAHA NE 68105-0000 

Property Information 

Key Number:

Account Type: 

Parcel Number: 

Parcel Address: 

Legal Description:

Value Information 

i Land 

2008 


2007 


2006 


2005 

2004 

2003 

Sales Information 

Sales Date:

Deed Type:

Price:

Grantor:

Grantee:

Valid/Invalid:

Exclusion Reason: 

Sales Date:

Deed Type:

Price:

Grantor: 

 0419 0000 09 

[ Residential 

; 0904190,000 

• 2306S31s f 

; OMAHA NE 68105-0000 

•' CREIGHTONS 1ST ADD LOT 3 BLOCK 4 47 X 120 

j Improvement 

$11,300.00 j

$lT,300.00 i

$11,300,00 1

$11,300.00 

$11,300.00 

$11,300.00 

 2003-10-06 

 \ WD * 

 \ $133,500.00 

 | Nancy A Daly etal 

., Jamie R Zadina 

 • invalid 

 1994-10-20 

 : D 

 : $64,000.00 

 $135,20b.00" 

 3135,200.00 

 $108,700.00" 

$108,700.00 

$108,700.00 

$76,400.00 

Book: I 2003 

Treasurer's Tax Report 

 -»-*- > Auto Sales Search 

, Total 

$146,500.00 

$146,500.00 

$120,000.00 

$120,000.00 ,i 

I $120,000.00 

I $87,700.00 

Page: \ 214859 

BooAr: Page: ; 495 : 1993 

I.**—IIA^.,n)i c mannino-nn1ine.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R09... 10/1/2008 
Douglas County Account In|^|i; ation 

rag e ^ Ul -f 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Information 

Acres SF Units 

I Depth i Width Vacant 

i • 0.12 5640.0 1.0 120.0 47.0 No 

Improvement Informatio n 

Building 1 

I --.'.VJ ' 'frri^a 

744,0 SF. SccoM Foar 7ii.CSF 

•.'ilUCfieiii 

' I 

....) TWO STORY 

Btarrt Heck 4 fl 

M4 0 s r 

CUCjC TO ENl^RGE liyiAGE CUCK TO ENLARGE IMAGE ._ i 

Square Footage: i 1488.0 Percent Complete: : 100.0% 

Perimeter ^ 0.0 Quality: ' Average 

Unit Type: I Condition: : Good 

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

HVAC: 1 Central Air to Air Rooms: ! 8.0 

Exterior: i Frame Stucco Units: ; 10 

Interior: ; Drywall Baths: , 1.0 

Roof Cover: ! Composition Shingle Bedrooms: • 4.0 

Roof Type: j Gable Stories: i 2.5 

Floorcover: i Allowance 

Foundation: i Bloci( JL. . 

t Sprinlder Square Footage: i 0.0 

year Percent Adjusted Year Year Built 

Physical Age Remodeled Remodeled Built 

I 0% 1905 ~103 

Detail Type : Detail Description 

Units 

Add On ! Fence Chain Linic i.o 

Add On i Unfinished Attic W/floor 

Appliance i Allowance ]_1.0 

Basement ' Bsmnt Block 8 ft 744.0 

!-*+»» • / //^ i-^-i 1 rri o c ianniTia-nnline.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=R09... 10/1/2008 

1905 

744.0 
Douglas county Account l: n^jm; ation rage J or J 

FiJdure i Base Fixtures 

Fixture BathFull 1.0 

Garage 1 Attached 408.0 

Garage • Detached 213.0 

Porch : Slab Roof Ceil i 160.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accomitno=R09... 10/1/2008 
Prudent Property Close-Out Form (Lead-Based Paint Stabilization) 

SAID: n^-f^b ^ 

Property Address: 03<^lf 6 . 3 1 ^ 

Owner's Name: ^ lfl/^.1 f 'Z'fiflit^y 

Performance Standards/close-Out Criteria 

YES NO 

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

include painting of other associated features inciuding fascia, eaves, siding, ait trim, porches, box 

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

2. Was all scraping and other preparattion work completed satisfactorily? t 

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

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

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

\ thoroughly vacuumed/ cleaned? 

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

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

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

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

properly removed? X 

9. 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. y 

10. Are there any property items that were temporatiiy re-located by the contractor 

that need to be hioved back? i; 

11. Are there any (known) lingering issues with the property owner(s) that have been left unresolved? t Other Considerations?property Owner Discussions?Additional Work that is Required 

PI 

Prudent Representative Signature: |( ^ 

Date i^'^P ry^ ; ^ 

Property Owner Signauire: ^(i^Mf y V