TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: 7V 1 11 I Date: r)jn/io 

Address: ^?>5 R lv\> P h ^ S'T . 

Stabilization Contractor: Professional Environmental Engineers Year: 2010 

D 

X 

D 

X 

D 

A 

D 

D 

D 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video ofproperty (DVD) 

Executive Simunary 

Signed Access Agreement for subject property 

Pre-Renovation Form signed by Property Owner 

Pre-Renovation Form for Occupant/Tenant, if applicable 

Painting Agreement 

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

Renovation Recordkeeping Checklist signed by Certified Renovator 

Photographs A^/rVif ^A A df-k ^ 

Satisfactory close-out check list signed by Property Owner 

Property close-out check list signed by EPA 

Property informationfix>m Douglas County Assessor's Office 

Hazard analysis, if prepared 

Safety Audit 

Other (describe): 

Professioiial Env^nntentai Engmeers Signature 

EPACORSignature 

(afterfile folder review) 

30204235 

H 

Superfund 
PROFESSIONAL 

500 S.Evying, Suite E yj ^ ENVIRONMENTAL ENGINEERS, INC. St. Louis, MO 63103 

(314) 531-0060 [|3 | "Providing cost-effective environmental solutions' Fax (314) 531-0068 

Consiillinc)»Eiigiriueriiii] DI>JK|II • r-icitnediaiiait • Atiateinenl • Eineicjency iidsponsR 

2010 

Property Owner Close-Out Form 

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

SAID: sniu 

Property Address:^ S^S R K 1 2/i) ^ cSf" 

Owner'sName: ( | jejn\^S€^ L- hJaWaC" ^ 

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, colunms, 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? 

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

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

vacuumed/ cleaned? J^ 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? JL 

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

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

etc. properly removed? 1 

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. 4 ^ C l).l.v^ 

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? X 

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

unresolved? 

X 

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

/

A 

q"-n-/C) 

Property Owner Signature Date 

'«^/4' •^-//v^ 

Professional Enviroimienta Enviromr i Engineers Signature Date 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. ''° ' ''Slir NE ^?!o 

"Providing cost-effective environmental solutions" ^ j*°^| !^i^!? 

^ Fax (402) 504-3281 

Consulling • Engineering Design • Remediation • Abalement • Emergency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

2010 

SAID#37111 

5338 N. 26"* St. 

• Dates worked: 05/07/10 to 05/10/10 

• Pre property condition: House had wood and transit siding. Paint was in very poor 

condition on trims and porch areas, garage has concrete and some wood siding that is 

also very poor with flaking paint. 

• Problems encountered: None. 

• Owner request/concerns: N/A 

• Inspection/closeout dates. Owner 05/11/10, inspected by PE project manager. 
EPA Paint Stabilization 2010 

SAID# 5111 1 

Property Addrass 533g > >\ > Zb ^ Str^ct 

Stories I • O 

Garage? N' ^ 

Access signed S-04'"2X)ID 

Pra-video 5- 04 ' ZO [d 

Post video 6-^ \^^UUV^ 

Contractor Assigned Q/^nrY^ ^mlin OHMi . 

Dats startad S~/-) / 'Z. OtCJ 

Weather/tsmp ^ ^ 

Dats ended S/^O /T^O/a 

Paint used 

Prims used 

Poly used /c)^f 7 

Probiems/issues 

) ^ 
CONSmimr T FOR ACCESS TO PROTERT )re] Y 


OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID: S1\\ \ PROPERTV ADDRESS; A 3> 5 Iv \( . fil(^ ^" p 

OAVNER NAIVIE: . |\ A 

-©i^TIIME PHONE: f*-/ Q;) \ ^ O 2i- ^ ^ S ^ 

CELL PHONE: 1\( () ^( C E-IMAIL: M 0 A( £ 

OWNER'S ADDRESS IF DIFFERENT: 

TENANT'S NAME IF APPLICABLE: 

DAVTIME PHONE: 

CELL PHONE: E-MAIL: 

Proressionai 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 ofcracked or flaking LBP from structures, application ofa prime coat and two 

(2) coats of paint. Moving parts of windows and doors are not included and will not be addressed. 

Your cooperation is 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 this 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 ail reasonable efforts to address concerns Ihat I, as the property owner, may have regarding soil cleanup at 

my property. 

^Ywjhav e rsttLand undarstand the paragnph above. (\ f\ 

J 3 . orY\ia o ^ |/l/a lly/i^^ 

Signature of Property Oimer Date 

I fully understand that by signing this Consent for Access, (I) 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 Hazani information for Families, Day Care Providers, aad 

Schoob", (3) tbe Property Owner or tenant will remove all obstructions from surfaces to be painted, (4) wiii abide by health and 

safety guidance provided by EPA, (5) will allow photography of property liefore and afler the paint stabilization work, (6) will be 

^eontacted 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 Tmal 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 Pauletta France-lsetts, EPA Remedial Project Manager 402-731-2454, or the EPA Public 

Information Centers at 402-991-9583 (North Omaha oflice) or 402-731-3045 (South Omaha oflice). 

JQ Yet, I grant accatt to my property and wat given tht pamphM D No, I do not grant accett to my property and h 

'Ranovate Right, impoitent LMd Information for Familias, ChiM given the pamphlet 'Renovate Right, Impoitent Laad 

Cara Providert, and Schoolt." . information for Familiet, ChlMe Care Providert, and Schools.' 

Signataire Date Signature Oate 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

PROPERTY ADDRESS: S ?>'^ ^ \f ^ ^^ Sf DATE: S~Q -jO 

BViD: 

AREA(S) TO BE PAINTED 

HOUSE PROPER: 4/£^ COLOR •.h/JiAi 

HOUSE TRIM: U ^ S .COLOR: Ui/ l r f f 

GARAGE: y ^^ COLOR : Wh-^ f ^ 

GARAGE TRIIM: / / c^ C COLOR: U l f] i-1 <^ • • - ^ 

PORCH: f^^ . COLOR: _Ui]q_,jL£_ 

porc h V OPT Qf^y 

\DOI J TBIkfl . I , . O ( C / PORCH TRIM {/ COLOR: K/]q.'^ - ^ ^ f 

(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: 

^^^',..^.\^alliiu^ i-.\vS^yi 
• -KEl PRE-ffENOVATION FORM - OCCUPANT 

Tiiis form is to be used by the firms contracted by tlie Environmental Protection Agency-Region 7 to perform Lead-Based 

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

Occupant Confirmation 

Pamphlet Receipt 

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

Families, ChildCare 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. 

Occupant Opt-out Acknowledgment 

(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 

^ ides 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 of time 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. 

>D (B) I understand that the renovationfirm, contracted by the Environmental Protection Agency (EPA), will be using leadsWfe work practices required by EPA's Renovation, Repair and Painting Rule. 

Printed Name of Occupant 

Signature of Occupant Date 

Renovator's Self-Certification Option (for tenant-occupied dwellings only) 

Instruction to Renovator: If the lead hazard information pamphlet was delivered to the owner but a tenant signature was not 

obtainable, you may check the appropriate box below. 

P Declined - 1 certify that I have made a good faith offer to deliver the lead hazard information pamphlet to the rental 

dwelling unit listed below at the date and time indicated and that the occupant declined to sign the confirmation of receipt. I 

further certify that I have left a copy ofthe pamphlet at the unit with the occupant. 

D Unavailable for signature - 1 certify that I have made a good faith effort to deliver the lead hazard information pamphlet 

to the rental dwelling unit listed below and that the occupant was unavailable to sign the confirmation receipt. I further 

certify that I have left a copy ofthe pamphlet at the unit by sliding it under the door or by (fill in how pamphlet was left) 

'JhmrAO 

Printed Name ofPerson Certifying Delivery Attempted Delivery Time 

Signature ofPerson Certifying Lead Pamphlet Delivery Date ^ji^ino^ hjc^n^. . M -

Unit Address 
."sff^."^ ••• . 

Douglas County Account Information Page 1 of3 

5n\\\ 

Douglas County, Nebrasica Property Record - R2202730000 

Information is valid as of 2010-4-16 

New Feature 

Owner 

\NALUKCE JR EDWARD L 

ETAL 

5338 N 26 ST 

OMAHANE 68111-0000 

Property Informatio n 

Key Number: 0273 0000 22 

Account Type: Residential 

Parcel Number: 2202730000 

Parcel Address: 5338 N 26 ST 

OIVIAHANE 68111-0000 

Legal Description: SEYMOURS ADD LOT 3 BLOCK 2 49 X 124 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$2,500.00 

$2,500.00 

$2,500.00 

$2,500.00 

$2,500.00 

$2,500.00 

Improvement 

$31,000.00 

$31,000.00 

$32,300.00 

$32,300.00 

$32,300.00 

$14,000.00 

Land Informatio n 

Acres 

0.13 

SF 

6076.0 

Units 

1.0 

Depth 

124.0 

Improvemen t Informatio n 

Building 1 

• 

Print Report 

View Interactive GiS Map 

Treasurer's Tax Report 

"> " • Subdivision Sales Search 

Total 

$33,500.00 

$33,500.00 

$34,800.00 

$34,800.00 

$34,800.00 

$16,500.00 

Width 

49.0 

Vacant 

No 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R22... 4/27/2010 
Douglas County Account Information Page 2 of3 

V!lh|hjikSEHK!BiBtUh'H'Vi'''\Ji[^W'^i^^^^^^HiHII n S338N26St 

PofKti.ntw^ 

^^^^ 1 • 

1 CLICK TO ENLARGE IMAGE | CLICK TO ENLARGE IMA( SL 

Square Footage: 986.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Fair 

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

HVAC: Forced Air Rooms: 5.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 i 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Blocl( 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1907 0% 1907 103 

Detail Type Detail Description Units 

Add On Fence Chain Linl< 1.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 592.0 

Additional Fixtures 1.0 

Base Fixtures 1.0 

Bath Full 1.0 

Gare^l Detached 352.0 

PorcFlr End Screen 128.0 

>uo«y 

\ 

Park 

I ^IVap Satellite Hybrid coTerrain 

y ' Ellison Ave ElUson Ave Ellison Ave 

TO 

o: 

> 

z 

IO 

z 

i 

z 

3! 

• 3 -

JaynesSt 

z 

05 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R22... 4/27/2010 
(efTective April 2010) 

RENOVATION RECORDKEEPING CHECKLIST 


Name of Firm: (\Aa\(^\ ft\hlinc| 

Date and Location of Renovation: ^_ _ OJi ^ ftl 7^-fh .Si • 

BriefDescriptionofRenovation: [[a<i ^JfqDUlTjOiAiaO 

Name of Assigned Renovator: (fa\\ (Adfl.TO 

Name(s) of Trained Workeis: /^i^^frJ /^r^^Aj . ^in< ^ ^/tvC ^ sJO ^ AiJ/t^T, 

Name of Dust Sampling Technician, Inspector, and/or Risk Assessor, if used: 

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

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

D Posting Avaming signs • Setting up plastic containment barriers 

D Maintaining containment • Avoiding spread ofdust to adjacent areas 

D Waste handling • Post-renovation cleaning 

D Test kits used by certified renovator to determine whether lead was present on components affected by 

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

jyihjrm/amin. g signs posted at entrance to work area. 

P/^r k area contained to prevent spread ofdust and debris. 

-B^^indows in and within 20 feet ofthe work area are closed 

^Bi5oois in and ^tfain 20 ftet of tfae woric areas are closed and sealed 

ars. tfaat must be used intiie work area are covered to allow passage but prevent spread ofdust. 

-B^dround covered by plastic sheeting extending 10 feet fiom work area - plastic anchored to the 

building and weighted down by heavy objects. 

D/'ifnecessary, vertical containment installed to prevent migration ofdust and debris to adjacent 

property. 

^p/^ aste contained on-site and while being transported off-site. 

Renovation Recordkeeping Checklist Omalia Lead Site 
(eifective April 2010) 

Q'Woi^ site properly cleaned after renovation. 

eTflfcHips and debris picked up, protective sheeting misted, folded dirty side inward, and taped for 

removal. 

CUWfiflTarea HEPA vacuumed to get paint chips from ground surface, if necessary. 

(Ht^fie d renovator perfonned post-renovation cleaning verification (describe results): 

J3'^Tcertify under penalty of law that the above infonnation is true and complete. 

^ ) ^ /l>//^9^ ^^^t^/to/siy^ -S j n r2^oi6 

Name and Title Date 

Renovation Recordkeeping Checklist Omaha Lead Site