### TRANSMITTA L of OMAHA LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R SAID# : 7V 1 1 1 I Date : 

# r)jn/i o Address : ^?>5 Rlv\ > P h ^ S'T . Stabilizatio n Contractor : Professiona l Environmenta l Engineer s Year : 201 0

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# X

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### PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S Vide o ofpropert y (DVD ) Executiv e Simunar y Signe dAcces s Agreemen t fo r

subject propert y Pre-Renovatio n For msigne db y Propert y Owne r Pre-Renovation For mfo r

Occupant/Tenant , if applicabl e Paintin g Agreemen t Settlemen t dociunent s (i.e. , fo r

damag e or to replac e plants , etc. ) Renovation Recordkeepin g Checklis t signedby CertifiedRenovator Photograph s A^/rVi f

^A A df-k ^ Satisfactor y close-out check lis t signedby Propert y Owne r Propert y close-out check lis t signedb y EP A Propert y information fix>mDougla s Count y Assessor' s Office Hazar danalysis , i f prepare d Safet y Audit Othe r

(describe) :

Professioiia l Env^nntenta i Engmeer s Signatur e EPACORSignatur e (afte r file folde r review ) 3020423 5 

# H Superfun d

## PROFESSIONA L 500 S.Evying , Suit e E 

## yj ^

ENVIRONMENTA L ENGINEERS , INC
. St
. Louis , M O 6310 3 (314 ) 531-006 0 

### [|3 | "Providin g cost-effectiv e environmenta l solutions ' Fa x (314 ) 531-006 8 Consiillinc)»Eiigiriueriiii ] DI>JK|I I • r-icitnediaiiai t • Atiateinen l • Eineicjenc y iidspons R 

### 201 0 Propert y Owne r Close-Ou t For m (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) SAID : 

# sni u Propert y Address: ^ S^S RK 1 2/i) ^ cSf " Owner'sName : ( | jejn\^S€ ^ L- hJaWaC" ^ Performanc e Standards/Close-Ou t Criteri a YE S 

### N O 1 . Wa s th e entir e structure(s ) painte dwith th e exceptio n ofth e stated , exclude dareas ? Thi s woul dinclud e paintin g o f othe r associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , colunms , rails , an dexterio r surface s o f garages . 2 . Wa s al l scrapin g an dothe r preparatio n wor k

complete dsatisfactorily ? 3 . Wer e all require darea s ofth e structure(s ) prime da s neede dan dpainte dwit h tw o to p coats ? 4 . Wa s th e pain t product s utilize dequivalen t t o a2 5 year product/quality ? 

### J L S . Ar e al l ofth e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y vacuumed / cleaned ? 

# J ^ 6 . Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s o n th e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y othe r generate d debris ? 

# J L 7 . I s th e gras s are atha t surround s th e structure(s ) i n reasonabl y goo dcondition ? 8 . Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . properl y removed ? 

# 1 9 . I s ther e an y evidenc e ofpropert y damag e tha t wa s don e b y th e contractor ? An y propert y damag e need s t o b e complete dprio r t o th e EP A Close-Out . 

# 4 ^ C l).l.v ^ 10 . Ar e yo u satisfie dwith th e wor k

performed ? 11 . Ar e ther e an y propert y item s tha t wer e temporaril y re-locate db y th e contracto r tha t nee dt o b e move dback ? 

# X 12 . Ar e ther e an y (known ) lingerin g issue s wit h th e propert y owner(s ) tha t hav e bee n lef t unresolved ? 

# X othe r Considerations/Propert y Owne r Discussions/Additiona l Wor k

tha t i s Required : / 

## A 

# q"-n-/C ) Property Owne r Signatur e Dat e 

### '«^/4 ' 

# •^-//v ^ Envirom r Dat e Professional Enviroimienta i Engineer s Signatur e

## PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC
. ''° ' ''Sli rN E ^?! o "Providin g cost-effectiv e environmenta l solutions " ^ j*°^ | !^i^! ? ^Fax (402 ) 504-328 1 Consullin g • Engineerin g Desig n • Remediatio n • Abalemen t • Emergenc y Respons e



### LeadBas e Stabilizatio n Omaha , N e Clos e Ou t Report 201 0 SAID#3711 1 533 8 N . 26" * St.

•Date s worked : 05/07/1 0 t o 05/10/1 0 •Pr e propert y condition : Hous e ha dwoo dan dtransi t siding . Pain t wa s in ver y poo r conditio n o n trim s an dporc h areas , garag e ha s concret e an dsome woo dsidin g tha t i s als o ver y poo r wit h flakin g paint . •Problem s encountered : None . • Owne r request/concerns : N/ A •Inspection/closeou t dates . Owne r 05/11/10 , inspecte dby PE projec t manager .EP A Pain t Stabilizatio n 201 0 SAID # 5111 1 Propert y Addras s 533g > >\ > Zb ^ Str^c t Storie s I • O Garage ? N' ^ Acces s signe d S-04'"2X)I D Pra-vide o 5 - 0 4 ' Z O [ d Pos t vide o 6- ^ \^^UUV ^ Contracto r 

## Assigne d Q/^nrY ^ ^mlin i OHM . Dat s starta d S~/- ) / 'Z
. OtC J Weather/tsm p ^ ^ Dat s ende d S/^ O /T^O/ a Pain t use d Prim s use d Pol y use d /c)^ f 7 Probiems/issue s

) ^

# imr )re ] 

# CONSm T FO R ACCES S T O PROTERT Y OMAHA LEAD SIT E REMEDIAL ACTIO N - LEAD-BASE D PAIN T STABILIZATIO N PROPERTY ID : S1\\ \ PROPERT V ADDRESS ; A 3 > 5 I v\ (
. fil(^ ^" p OAVNE R NAIVIE : . | \ A -©i^TIIM E PHONE : f*- / Q;) \ ^

O 2i- ^ ^ S ^ CEL L PHONE : 1\ ( ( ) ^ ( C 

### E-IMAIL : M 0 A ( £ OWNER' S ADDRES S I F DIFFERENT : TENANT' S NAM E I F APPLICABLE : DAVTIM E PHONE : CEL L PHONE : E-MAIL : Proressiona i Environmenta l Engineers , Inc
. (PE ) i s unde rcontrac t (#EP-R7-08-06 ) wit h th e U.S
. Environmenta l Protectio n Agenc y (EPA ) t o stabiliz e lea d base d pain t (LBP ) o n residentia l structure s a t a numbe ro f propertie s locate d i n Omaha , Nebraska
. Th e pain t stabilizatio n wor k i s bein g don e t o protec t th e soi l cleanup s tha t ar e bein g performe d b y EP A contractors . Pain t stabilizatio n activitie s wil l include : scrapin g ofcracke d o rflakin g LB P fro m structures , applicatio n of a prim e coa t an d tw o (2 ) coat s o f paint
. Movin g part s o f window s an d door s ar e no t include d an d wil l no t b e addressed
. You rcooperatio n i s requeste d i n givin g permissio n t o thi s EP A contracto r(PE ) t o ente ran d hav e acces s t o thi s propert y fo rth e purpos e o f stabilizin g lea d -base d pain t a s outline d o n th e propert y identifie d above
. B y signin g thi s documen t I agre e t o allo w a n EP A contracto rt o conduc t a soi l cleanu p a t m y propert y followin g completio n o f lead-base d pain t stabilization , i f th e soi l cleanu p ha s no t alread y bee n 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 rwil l b e boun d to . I furthe runderstan d tha t th e soi l cleanu p contracto rwil l mak e ai l reasonabl e effort s t o addres s concern s Iha t I , a s th e propert y owner , ma y hav e regardin g soi l cleanu p a t m y property . ^Ywjhav e rsttLan d undarstan d th e paragnp h above
. ( \ f

\ 

## J 3 . orY\iao ^ |/l/ ally/i^ ^ Signatur e o f Propert y Oime r Dat e I full y understan d tha t b y signin g thi s Consen t fo rAccess , (I ) thi s acces s wil l remai n i n effec t unti l th e wor k ha s bee n satisfactoril y completed , (2 ) tha t th e Propert y Owne ro rTenant , i f applicable , wil l b e give n th e Housin g an d Urba n Developmen t (HUD ) an d EP A pamphlet , "Renovat e Right , Importan t Lea d Hazan i informatio n fo rFamilies , Da y Car e Providers , aa d Schoob" , (3 ) tb e Propert y Owne ro rtenan t wil l remov e al l obstruction s fro m surface s t o b e painted , (4 ) wii i abid e b y healt h an d safet y guidanc e provide d b y EPA , (5 ) wil l allo w photograph y o f propert y liefor e an d afle rth e pain t stabilizatio n work , (6 ) wil l b e ^eontacte d b y a P E representativ e approximatel y 4 8 hour s i n advance^o f startin g work , (7 ) agre e no t t o obstruc t o rtampe rwit h

an y ofth e LB P stabilizatio n actions , an d (8 ) wil l participat e i n Tma l propert y inspectio n an d sig n th e Completio n Agreemen t an d Propert y Owne rSatisfactio n Survey
. Shoul d yo u hav e an y question s abou t th e plane d Lea d Based-Pain t stabilizatio n activitie s fo ryou rproperty , pleas e contac t Professiona l Environmenta l Engineers , Inc
. Projec t Manager , Willi e Cla y A t 402-504-4688
. Genera l question s abou t th e Omah a Lea d Sit e cleanu p ca n b e directe d t o Paulett a France-lsetts , EP A Remedia l Projec t Manage r402-731-2454 , o rth e EP A Publi c Informatio n Center s a t 402-991-958 3 (Nort h Omah a oflice ) o r402-731-304 5 (Sout h Omah a oflice)
. J Q Yet , I gran t accat t t o m y propert y an d wa t give n th t pamph M D No , I d o no t gran t accet t t o m y propert y an d h 'Ranovat e Right , impoiten t LM d Informatio n forFamilias , Chi M give n th e pamphle t 'Renovat e Right , Impoiten t Laa d Car a Providert , an d Schoolt. "
. informatio n forFamiliet , ChlM e Car e Providert , an d Schools. ' Signatair e Dat e Signatur e Oat e SPECIA L INSTRUCTION S AN D CONSIDERATION S

### PAIN T STABILIZATIO N PRE-PROPERT Y PAIN T MATC H ASSESSMEN T PROPERT Y ADDRESS : S ?>' ^ ^ \ f ^ ^ ^

S f DATE : S~ Q -j O BViD :

AREA(S ) T O B E PAINTE D HOUS E PROPER : 

# 4/£ ^ COLO R 

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HOUS E TRIM : U ^ S 

### .COLOR : Ui/ l r f f

GARAGE : COLO R 

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GARAG E TRIIM : / / c ^ C COLOR : 

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## {/ ^ f (COMPLET E AL L SECTION , YES , NO , O R NON-APPLICABLE )



### I AGRE E T O 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 : 

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### -KE l PRE-ffENOVATIO N FOR M - OCCUPAN T Tiii s for mi s t o b e use db y the firms contractedb y tli e Environmenta l Protectio n Agency-Region 7 to perfor mLead-Based Pain t stabilization activitie s a t the Omah aLea dSite , Omaha , Nebraska . Occupan t Confirmatio n Pamphle t Receip t D I hav e receivedacop y ofth e lea dhazar dinformatio n pamphlet . Renovat e Right : Important LeadHazar dInformation fo r Families , ChildCar e Provider s an dSchools , informin g m e ofth e potentia l ris k

ofth e lea dhazar dexposur e fro mrenovatio n activit y t o b e performe din/o n m y dwellin g unit . I receivedthi s pamphle t befor e the wor k

began . Occupan t Opt-ou t Acknowledgmen t (A ) I confir mtha t I ow n an dlive i n thi s property , tha t no childunde r the age o f 6 reside s here , tha t n

o pregnan t woma n ^ ide s here , an dtha t thi s propert y i s no t achild-occupiedfacility . 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 the childlive s an dsleep s mos t o f tim e a t the caretaker' s residence . Note : A child-occupie dfacilit y i s apre-197 8 building visitedregularl y b y th e sam e child , unde r 6 year s o f age , o n a t leas t tw o differen t day s withi n an y week, fo r a

t leas t 3 hour s eac h day , providedtha t th e visit s tota l a t leas t 6 0 hour s annually . > D (B ) I understan dtha t th e renovation firm, contracte db y the Environmenta l Protection Agenc y (EPA) , will b e usin g lead

sWf e wor k

practice s requiredb y EPA' s Renovation , Repai r an dPainting Rule . Printe dNam e o f Occupan t Signatur e o f Occupan t Dat e Renovator' s Self-Certificatio n Optio n (fo r tenant-occupie ddwelling s only ) Instruction to Renovator : I f the lea dhazar dinformatio n pamphle t was deliveredt o the owne r bu t atenan t signatur e wa s not obtainable , yo u ma y chec k

th e appropriat e bo x below . P Decline d- 1 certif y tha t I hav e mad e agoodfait h offe r to delive r the lea dhazar dinformation pamphle t to the renta l dwellin g uni t listedbelow a t th e dat e an dtim e indicatedan dtha t the occupan t declinedto sign the confirmatio n o f receipt . I furthe r certif y tha t I hav e lef t acop y ofth e pamphle t a

t th e uni t wit h the occupant . D Unavailable fo r signatur e - 1 certif y tha t I have mad e agood fait h effor t t o delive r th e lea dhazar dinformation pamphle t to the renta l dwelling uni t listedbelo w an dtha t the occupan t wa s unavailabl e t o sig n th e confirmation receipt . I furthe r certif y tha t I have lef t acop y ofth e pamphle t a

t the uni t b

y slidin g i t unde r the doo r or b

y (fill i n ho w pamphle t wa s left ) 

# 'JhmrA O PrintedNam e ofPerso n Certifying Deliver y AttemptedDeliver y Tim e Signatur e ofPerso n Certifying Lea dPamphle t Deliver y Dat e 

# ^ji^ino ^ hjc^n^. . M - Uni t Addres s."sff^." ^ •• • . Dougla s Count y Accoun t Informatio n Pag e 1 of 3 

# 5n\\ \ Dougla s County , Nebrasic a Propert y Recor d - R220273000 0 Informatio n i s vali d a s o f 2010-4-1 6 Ne w Featur e Owne r \NALUKC E J R EDWAR D L ETA L 533 8 N 2 6 S T OMAHAN E 68111-000 0 Propert y Informatio n Ke y Number : 027 3 000 0 2 2 Accoun t Type : Residentia l Parce l Number : 220273000 0 Parce l Address : 533 8 N 2 6 S T OIVIAHAN E 68111-000 0 Lega l Description : SEYMOUR S AD D LO T 3 BLOC K2 4 9 X 12 4 Valu e Informatio n 200 9 200 8 200 7 200 6 200 5 200 4 Lan d $2,500.0 0 $2,500.0 0 $2,500.0 0 $2,500.0 0 $2,500.0 0 $2,500.0 0 Improvemen t $31,000.0 0 $31,000.0 0 $32,300.0 0 $32,300.0 0 $32,300.0 0 $14,000.0 0 Lan d Informatio n Acre s 0.1 3 S F 6076. 0 U nit s 1. 0 Dept h 124. 0 Improvemen t Informatio n Buildin g 1



### • Prin t Repor t Vie w Interactiv e Gi S Ma p

Treasurer' s Ta x Repor t " > " • Subdivisio n Sale s Searc h

Tota l $33,500.0 0 $33,500.0 0 $34,800.0 0 $34,800.0 0 $34,800.0 0 $16,500.0 0 Widt h 49. 0 Vacan t N o

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R22. . . 4/27/201 0Dougla s County Accoun t Informatio n Pag e 2 of 3
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1 CLIC KT O ENLARG E IMAG E | CLIC KT O ENLARG E IMA ( 

### S L Squar e Footage : 986. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Fai r

Buil t As : 1 1/ 2 Stor y Fi n Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 5. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 0 i Roo f Cover : Compositio n Shingl e Bedrooms : 2. 0

Roo f Type : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Blocl ( 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 190 7 0 % 190 7 10 3 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fenc e Chai n Linl < 1. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 592. 0 Additiona l Fixture s 1. 0 Bas e Fixture s 1. 0 Bat h Ful l 1. 0 Gare^ l Detache d 352. 0 PorcFl r En d Scree n 128. 0 >uo« y \ Par k I ^IVa p Satellit e Hybri d coTerrai n y ' Elliso n Av e ElUso n Av e Elliso n Ave

T O o : > z I O z 

# i z 3 ! • 3 - JaynesS t z 05 http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R22. . . 4/27/201 0(efTectiv e Apri l 2010 ) 

## RENOVATIO NRECORDKEEPING CHECKLIS T
Nam e o f Firm : (\Aa\(^ \ft\hlinc| Dat e andLocatio n o f Renovation : ^_

_OJi ^ ftl 7^-f h .S i • BriefDescriptionofRenovation : [[a< i ^JfqDUlTjOiAia O Nam e o f Assigne dRenovator : (fa\ \(Adfl.T O Name(s ) o f Traine dWorkeis : /^i^^fr J /^r^^Aj . ^in< ^ ^/tvC ^ sJO ^ AiJ/t^T , Nam e o f Dus t Sampling Technician , Inspector , and/or Ris k Assessor , if used : U Copie s o f renovator anddus t samplin g technicia n qualification s (trainin g certificates , certifications ) o n file . D Certifiedrenovator provide dtrainin g to worker s o n (chec k

all tha t apply) : D Postin g Avamin g sign s • Settin g up plasti c containmen t barrier s D Maintaining containmen t • Avoidin g sprea dofdus t to adjacen t area s D Wast e handlin g • Post-renovatio n cleaning D Tes t kit s use dby certifie drenovator t o determin e whethe r

lea d wa s present o n component s affecte db y renovation (identif y kit s usedan ddescrib e samplin g location s an dresults : 

### jyihjrm . /amin g sign s poste da t entranc e to wor k

area . P/^rk are acontaine dto preven t sprea dofdus t anddebris . -B^^indow s i n an dwithi n 2 0 fee t ofth e wor k

are aare closed ^Bi5ooi s i n an d^tfai n 2 0 ftet o f tfa e wori c area s are close dandseale d ars . tfaa t mus t b e use di n tiie wor k

are aare covere dt o allo w passag e bu t prevent sprea dofdust . -B^droun dcovere dby plasti c sheetin g extendin g 1 0 fee t fiomwor k

are a- plasti c anchore dt o th e buildin g andweighte ddown b y heav y objects . D/'ifnecessary , vertica l containmen t installe dt o preven t migratio n ofdus t anddebri s t o adjacen t property . 

# ^p/ ^ ast e containe don-site an dwhil e bein g transporte doff-site .

Renovatio n Recordkeepin g Checklis t Omali a Lea d Sit e(eifectiv e Apri l 2010 )
Q'Woi ^ sit e properl y cleane dafte r renovation. eTflfcHip s an ddebri s picke dup , protectiv e sheetin g misted , folde ddirt y sid e inward, an dtape dfo r removal. CUWfiflTare aHEP A vacuume dt o ge t pain t chip s fro mgroun dsurface , i f necessary . (Ht^fie drenovato r perfonne dpost-renovatio n cleanin g verificatio n (describ e results):

J3'^Tcertif y unde r penalt y o f la

w tha t the above infonnation i s tru e an dcomplete . 

# ^ ) ^ /l>//^9 ^ ^^^t^/to/siy ^ - S j n r2^oi 6 Nam e an dTitl e Dat e

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