TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID #: /-K3/ 7 Date: (p/so//)' ^ 

Address: 30l ^ SS 3 ^^CeJ c 

Remediation Contractor: PROFESSIONAL ENVIRONMENTAL ENGINEERS Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

P Video of property (DVD) ^^W ^ Qj^kx' 

M Executive Summary 

M Signed Access Agreement for subject property 

U Painting Agreement 

D Settlement documents (i.e., for damage or to replace plant's, etc.) 

W Photographs D^Xtye.. 

W Satisfactory restoration signed by Property Owner 

B ^ Property close-out check list signed by EPA 

B ^ Property informationfi-om Douglas County Assessor's Office 

a 

^-i^lk^^ . ^/W ^ 

40316336 

Superfund 
2505 North 24^ Suite 219 

Omaha, NE 68110 

(402) 504-4688 

Fax (402) 504-3281 

PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

"Providing cost-effective environmental solutions" 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

SAID# 14317 

3072 S 33 St 

• Dates worked 11/12 to 11/20 2008 

• House had poor paint on the windows and trim areas, areas of the home had to be washed 

prior to working on it due to the dirt buildup on the bottom of the foundation. Garage had 

very poor paint in areas and painter had to return several times to completely scrape the 

areas completely to prevent new paint from coming off in the future. 

• Inspected 11/17 returned to repaint bottom trim on south side window, touch up paint on 

areas of garage, clean overspray on fence on south side of house. 12/02 all issues resolved. 
PROFESSIONAL 

2505 North 24'^ Suite 219 ENVIRONMENTAL ENGINEERS, INC. Omaha, NE 68110 

(402) 504-4688 "Providing cost-effective environmental solutions" Fax (402) 504-3281 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Property Owner Close-Out Form 

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

SAID: /•^.yvy 

Property Address: 3oy ^ X^ c5?7 c5? 

Owner's Name: 14, ?^/\>? >^t/­ '''0/^} airPerformance 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 including fascia, r\ eaves, siding, all trim, porches, box beams, columns, rails, and exterior surfaces of 

garages. 

2. Was all scraping and other preparation work completed satisfactorily? / \ 

3. Were all required areas of the structure(s) primed as needed and painted with 

two top coats? < 

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

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

vacuumed/ cleaned? t 

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

othe

entir

r

e

 generate

 property

d

, roadways

 debris? 

, alleyways, public access areas and also remove any X

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

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

barrier tape, etc. properly removed? < 

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. v^ ' 

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

that need to be moved back? <'' ' 

bee

11. Ar

n lef

e

t

 ther

 unresolved

e any (known

? 

) lingering issues with the property owner(s) that have 

X

Comments: 

P 1 

L i _ ^A-g^ ^ /2 - 'i-o ^ 

Property Owner signature 

Date 

Professional Environmenta mr l Engineers Representative 

Date 
PROFESSIONAL 

2505 North 24". Suite 219 ENVIRONMENTAL ENGINEERS, INC. Omaha. NE 68110 

(402) 504-4688 Providing cost-eftecOve erwironmemai solutions" Fax (402) 504-3281 

EPA Close-Out Form 

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

SAID: A/S/7 

Property Address: 

Owner's Name: 

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 including fascia, 

eaves, siding, all trim, porches, box beams, columns, rails, and exterior surfaces of i / 

garages. 

2. Was all scraping and other preparation work completed satisfactorily? z / 

3. Were all required areas of the structure(s) primed as needed and painted with 

two top coats? 

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

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

vacuumed/ cleaned? 

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 i ^ 

other generated debris? 

7. Is the grass area that surrounds the structure(s) in reasonably good i ^ 

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

9. Is there any evidence of property damage tliat 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 temporarily re-located by the contractor ^ 

that need to be moved back? 

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

been left unresolved? 

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

"//7 "^oic^ Sick- W\^o\A^­ ti*/^©^-!^"^ '^^c^pcut^-^ 

' 4-0 w£. 

i^LAdi re : 

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EPA COR Signatiu-e ' Date 
CONSENT OFR ACCESS TO PROPERTY 

OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID: / V ^ ' 7 ' PROPER TY ADDRESS: _ S. 3 3 Sf 

OWNER NAME: 

DAYTIMl ] PHONE: 

CELL PHONE: E-MAIL: 

OWNER'S ADDl [lESS IF DIFFERENT: 

TENANT'S NAM [E IF APPLICABLE: 

V 

DAYTIMl : PHONE: 

CELL PHONE: E-MAIL: -

Professional 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 were performed by EPA contractors. 

Paint stabilization activities will include: scraping of cracked or flaking LBP from structures, application of a 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. 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 all reasonable efforts to address 

concerns that I, as the property owner, may have regarding soil cleanup at my property. 

I fully understand that by signing this Consent for Access, (1) 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 Hazard information for Families, Day Care 

Providers, and Schools", (3) the Property Owner or tenant will remove all obstructions from surfaces to be painted, (4) will 

abide by health and safety guidance provided by EPA, (5) will allow photography of property before and after the paint 

stabilization work, (6) will be contacted by a PE representative approximately 48 hours in advance of starting work, (7) agree 

not to obstruct or tamper with any of the LBP stabilization actions, and (8) will participate in final 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-Isetts, EPA Remedial Project Manager 402-731-2454, or the 

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

D Yes, I grant access to my property and was given the pamphlet D No, I do not grant access to my property and I was 

"Renovate Right, Important Lead Information for Families, Child given the pamphlet "Renovate Right, Important Lead 

Car^^rovi^ers, and Schools." Information for Families, Childe Care Providers, and Schools." 

^A^-^iUx ll-r-oK 

Hate Signature Date 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
I 

Confirmation Of Receipt Of Lead Pamphlet 

BviD /s^ n 

PROPERTY ADDRESS H^Ql ^ S - 3 3 ap CODE Lg Q l O ^ 

PROPERTY ADDRESS OF OWNER IF DIFFERENT THAN PROPERTY BEING PAINTED 


PROPERTY ADDRESS ^ZIP CODE 


i have received a copy of the pamphlet, Renovate Right: Important Lead Hazard Information For Families, 

Child Care Providers And Schools informing me of the potential risk of the lead hazard exposure from 

renovation activity to be perfomied on dwelling unit. I received this pamphlet l)efore the work began. 

PRINTED NAME OF RECIPIENT ^ DATE 

SIGNATURE OF RECIPIENT 

Self-Certification Option (For Tenant-Occupied Dwellings Only) 

If the lead pamphlet was delivered but a tenant signature was not obtainable, you may check the appropriate box 

below: 

I J Refusal To Sign - 1 certify that I have made a good faith effort to deliver the pamphlet, renovate right: important 

lead hazard infonnation for families, child care providers and schools; to the rental dwelling unit listed above at the 

date and time indicated and that the occupant refused to sign the confirmation of receipt. I further certify that I 

have left a copy of the pamphlet at the unit with occupant. 

D Unavailable For Signature - 1 certify that I have made a good faith effort to deliver the pamphlet, renovate right; 

important lead hazard infonnation for families, child care providers and schools, 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 under the door or somewhere on the premises. 

PRINTED NAME OF PERSON CERTIFYING ATTEMPTED DELIVERY DATE AND TIME LEAD 

PAMPHLET DELIVERY 

SIGNATURE OF PERSON CERTIFYING LEAD PAMPHLET DELIVERY: 

Note Regarding Mailing Option - as an alternative to delivery 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 from ttie post 

office). 

CONFIRMATION OF RECEIPT OF LEAD PAMPHLET

.Ji^,.. ....il3LL^ 

 08108 
PAINT STABILIZATION PRE-PROPERTY ASSESSMENT 

PROPeferYADDKESS!_ 3071- s - 2.:^ S^ DATE 

Rvin /V2)/7 

PLANT & PERMANENT LANDSCAPING TO BE REMOVE? NO ft^ ^ YES r n 

IF, YES WHERE: 

PRE-EXISaiNG C0NDmOfeK>F FOUNDATION/STRUCTURE, i.e. BASEMENT LEAKING? 

NNOn I I YPYES S ' ^ ^ I IFIFYPCWHFRF , YES WHERE:; 

_iZ^ 'jj ' ^^d' 

EXISTING PAINT ON WINDOWS, DOORS, FOUNDATION, SIDEWALK,( I.E.)? Nor ^ 

YES I—1 IF, YES WHERE: 

1 

VISUAL DESCRIPTION OF PROPERTY/STRUCTURE/GARAGE, (I.E.): (USE BACK SIDE IF 

NECESSARY) 

*•" •* 

1

• • ' -•' • 

1 
PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

PROPERTY ADDRESS •- p^ia- s.y ^ S-f DATE 

BVID - fM^l-7 

AREA(S) TO BE PAINTED: 

HOUSE PROPER: pvS ^ COLOR •srHOUSE TRIM Ov-0_O COLOR UJVO^ 

GARAGE COLOR k]\AyvkL — - ^ 

GARAGETRIM [/\J\JJQ> _ —B^- — COLOR 

{ 

PORCH _COLOR^ 

PORCH TRIM. COLOR_ 

(COMPLETE ALL SECTION, YES, NO, OR NON-APPLICABLE) 

I AGREE TO THE COLORS LISTED ABOVE. ONCE PAINTING BEGINS, I 


UNDERSTAND I CAN NOT CHANGE THE ABOVE SELECTED COLORS: 


PROPERTY OWNER SIGNATURE: 


.^ ^ 

PAINT MATCH FORM 08/08 
Douglas County Account Information Page 1 of2 IM'SLI^I 

Douglas County, Nebraska Property Record - R1942920000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 90th St - Vie W OQ Ma p Information is valid as of 2008-9-4 Treasurer's Tax Report 

New Feature -•->- > Auto Sales Search 

Owner 

BANNER BRIAN T 

ETAL 

3072 S 33 ST 

OMAHA NE 68105-0000 5M\-'?>0^ ^ 

Property Informatio n 

Key Number: 4292 0000 19 

Account Type: Residential 

Parcel Number: > 1942920000 

Parcel Address: 3072 S 33 ST 

OMAHA NE 68105-0000 

Legal Description: \ PARKVALE LOT 6 BLOCK 8 41 X 130 

Value Informatio n 

Land Improvement Total 

2008 $5,900.00 $80,300.00 $86,200.00 

2007 $5,900.00 $80,300.00 $86,200.00 

2006 $5,900.00 $67,800.00 $73,700.00 

2005 $5,900.00 $67,800.00 $73,700.00 

2004 $5,900.00 $67,800.00 $73,700.00 

2003 $5,900.00 $68,100.00 $74,000.00 

Sales Informatio n 

Sales Date: 1997-05-14 

Deed Type: D Book: \ 2065 Page: 373 

Price: $69,950.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.12 5330.0 1.0 130.0 41.0 No 

Improvemen t Informatio n 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl 9... 11 /5/2008 
, Douglas County Account Information Page 2 of2 

Building 1 

SecoMJFteM' 6330«l ft 

ssj 

1 ,,. »Bl»»« M J 

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CLICK TO ENLARGE IMAGE 

Square Footage: 1097.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

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

HVAC: Central Air to Air Rooms: 5.0 

Exterior: Frame Stucco Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1918 0% 1918 90 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 624.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 228.0 

Porch End Solid Wall 160.0 

User 1/2 Stucco & 1/2 Shingle 1.0 

User Attic Full Finish 464.0 

User Shed - NV 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19... 11/5/2008 
JC Painting 

Property Address J^IQ . ^^N, ?> R ^T ' Date 11 - 12. ­ 0% ^ 

Start Date j j ­ I X- Q ^ Complete Date J j — l ^ -­ CyO, 

Amount Of Prime And Paint Used 

Prime (Gallons) 

Poly (Boxes) ^ 

Paint (Color) (jQhti g Amount (Gallons) j f*) 

Paint (Color) ^tx> C? i^ O tWgj? ^ Amount (Gallons) ^ 

Paint (Color) ,^, _, ( ^ ^i Q T>g^^r'i^^ Amount (Gallons) Q 

Paint (Color) Amount (Gallons) 

Paint (Color) Amount (Gallons)