TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID: 3020 Date: 12/26/2008 

Address: 4123 R ST. 

Stabilization Contractor: Prudent Technologies Year: 2008 

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PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Summary 

Signed Access Agreement for subject property 

Painting Agreement 

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

Photographs 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Property information from Douglas County Assessor's Office 

Signature /- DSe" 

40310509 

Superfund 
PROPERTY SUMMARY 

1 Date: 12/27/08 I LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Montli of: December 

1 Property Address: 4123 R ST. SAID: 3020 | 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: 

A.2 Issues Resolved: 

A.3 Unique Findings: NONE. 

A.4 Otiier Relevant Information: 

Access Date: 11/04/08 

Worl( Began: 11/18/08 

Closeout Date: 11/22/08 

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. 
TECHNOLOGIES, INC. 

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Property Status Form 

Addnss: A.\Xt ^ IN.'S^ . Date: //^ ^-O^S 

Phone:'2>\9-Ml5B4 BVID: ^70: ^ 

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Plant &, Permanent Landscafang To Reriiain In Place 

Description and LocBtioQ 

rcovv-f ^3cr-V \ V Q V X "* ft 

Pfe-Existing ConMon of Stmrtmeg 

Does your Basement h8ve a history ofleaking? Yes -~ No 

i(em# 

On Map 

Deseription & Location 

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Property Ownor 

Signatue: >(\^_^ 

Prudent Enqployee 

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

Environmental Protection Agency (EPA) to stabili2» Lead Based Pai « (LB ^ a ^ 

located In Omaha, Nebraska, including the property located at ^^ ^ ^ ' ^^'^ •, 

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

sigidng this form, the property owner grants permission to Prudent to perform activities related to LBP 

StabilizatioQ inciudmg scnqnng paint and painting of the referenced property. Further, the ownerAetiant 

verifies diat they hanre received the LBP pamphlet "Renovate Right.** 

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

/k<!n»in}ytrnffvc Ctek foT the Lead Based Paint Stabilization, Mrs. Dcborgh; Akftraii>Jnim««tn, 

at (402) S04-1004. General questions about the Omaha Lead Site cleanup can be directed to the EPA 

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

ofBce). 

(Rease Print Nam) 

PHMttNOwiMffflMilnm: ^--+>' ^ .1^ ^ L}JjZ3xiI5v -

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PROPeRTY INFORMATION 

(To be coaplcled bjr ittldnt nd/ior propcrtjr omcr - pkaw prioO 

IP RENTM., PROPERTY OWNS) BY: 

OWNERWIUUNOAOOReSS; ^>C^\J\r-J^ 

OWNERfamEPHONENUMBeR.HOMB: ^0^ 1 !^\^ "^^f^ ^ WORK! Hi:^ \ ^^I^^JC Q 

NUIIBER0F0CCtlPAtlTSUNDER7YEAR8OL0;^^NUIIBER0P0CCUPANT87yeAR8OLDANDOLDeR! / 

NUIIBERW€HIU)Rai(mDeR7YeAR80UVVHOPUYINTHEYARDFOR6HOUmORI ^ C ^ 

COMHENTSORSPECIAUINSTRUCnONS: (LE 0008, ENTRY QATES, ETC.) 

AtJilw«lTYP(»ENVlRaNMBflTALItBSPOWSBACT10W;The>cttTMe>tobplin^^ 

orcSRO^ 43 U.S.a 9604. EPA'f riglit of aoem to te pnpeity bimviiM br fa Scctfon 1^^ ^ 

te^lBtriniWii|fleiie8dlbrwiponi>.ofCliooiiitgcrtiidng«iyi«^ 
Current Sample Pre-Renovation Fomn 

eftaeSwunHl April 2010. 

CmiHiiration of ftocelpt of UMd Pamphlet 

:af I hat« ieceh«d a (X!py of the panvriet. f^rxTt^atB Right: ImportB^ 

Mbmiaflbn (br Amiss. GSMtf Oara ftavM m 

thB poieniiai risk of the lead hazard eKposin from renovation actlv^ 

pertorned In my dwenng unit I received this pamphlet t^etbie the vvork b^ ^ 

&>r^C-g . "^^fMa^:^ Jl -- ^ -0^ _ 

PrWednemertredplert/ ^ Date 

iQpecipieni 1 / 

Seif-CertifleaSon Option (for tenan^occuplad dwemnge only)— 

if the lead penvNet was delivered txjt a tenart sigralure VV38 not ol)tain8^ 

you may check the appiopriate box t)elow. 

Q ReAnai to sign---1 oertny that I have made a good tMi^fort to deliver the 

panfihlet, flenorafe flisM; trvjoftant Leecf Hazart/Aiftyrnatlbn 

O W O m AwUsra OTKf Sichooiiff, to the rental (Mra ^ 

date and time Indcated and that the occupant reiused to sigi the contlrmation 

of receipt I ftffther oeitHy that t have left a copy of the pamphlet at the unit with 

the occupant 

Q tAiaraBabie fcr aHinatuie--• I certlty that i have made a good M h effort to 

deOvsr the pamphlet,/)6rni«(9 njgfvt: Anportvtf ZM d 

Amiss i cyiftf care prevfcfers and Schoob, to the nrrtd 

below and that the occupant was unavailabie to sign the conflmration of receipt. 

I fcrther certify that I have left a copy of the pamphlet 81 the unit by slldng It 

under the door. 

Rtttad name of person certuying Attempted delivery 

date and time 

^^^JiJ 

lead pemphlet delivery 

Signature of person certnying lead pannphlet delivery 

4tA- 3 i^ . fbAIMtAdctaas 

Kots RBQaRflno Mailing Option •--As an alternative to deOvery In person, ycu 

may mal the lead pamphlet to the owner and/or tenant Pamphlet must be maBed 

at least 7 days before rencvatior) (Pocunfiert vvitt) a oertilicate of m ^ Iro^ 

postoflto^. 
Paint matching forSiV""" ""'=' ' ^ ^ 

Area: c^^ ^ 'ZT'^lt' ' color: ^-~- ^^^ ^ '^^-' 

Explanation: 

Area; fe^fa- fe--'-'-- ° c.:\.v,;u:tt;»e a^^;^ u^Cve . n, ,_( 

Explanation: IV%„^-^ 

Explanation: ^"^ ""^'^^ 

Area:^^.,^;^,,^ ^ color: B..;. ux;^. -^-.^ 

Explanation: 

'^'•*«' color: 

Explanation: 
if^PO^HATioNTRAOKMG SHEET 

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Douglas County Account In|Mination i^acraa Page 1 of3 

Douglas County, Nebraska Property Record - R1634860000 

Information is valid as of 2008-9-4 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of goth St - Vle W OH Ma p 

Treasurer's Tax Report 

New Feature ->->-> Auto Sales Search 

Owner 

JONES BRUCE E 

ETAL 

4123 R ST 

OMAHA NE 68107-0000 

Property Information 

Key Number: : 3486 0000 16 

Account Type: \ Residential 

Parcel Number: ^ 1634860000 

Parcel Address: I 4123 R ST 

i OMAHA NE 68107-0000 

Legal Description: i LOGAN PLACE LOT 6 BLOCKS SOX 125 

Value Information 

i Ijmd 

2008 

2007 

2006 

$6,400,00 

$6,400.00 

$6,400.6b 

I Improvement 

$72,900.00 

$72,900.00 

$72,900.00 

7ota/ 

I 

1 

200^ l?!*^^!:?'! 

2004 i $6,400.00 

2003 $6,400.00 

$38,800.00 

$35,300.00 

$35,300.00 

$79,300.00 

$79,300.00 

$79'3o6.6o" 

"$45,20000 

$41,700.00 

$41,700.00 

Sales Information 

Sales Date: : 2004-08-05 

Deed Type: '. WD Book: I 2004 Page: ) 107912 

Price: ; $85,800.00 

Grantor: \ ROBERT G DETAVERNIER ETAL 

Grantee; BRUCE E JONES ETAL 

Valid/Invalid: ' Valid 

Exclusion Reason: 

Sales Date: ; 2004-02-27 

Deed Type: i WD 

Price: 

Book: \ 2004 I 

! f.. 

Page: j 025860 

$55,000.00 

Grantor: ; CENTEX HOME EQUITY CO LLC 

http://douglasne.mapDine-online.r.nm/nniifTiocr^/^xT^/^ 
Douglas County Account In|Mpiatio n|uina n Page 2 of 3 

Grantee; , ROBERT G DETAVERNIER ETAL 

Valid/Invalid: . invalid 

Exclusion Reason: 

Sales Date: 2003-06-24 

Deed Type: ' TRD 

Price: ; $26,333.00 

Grantor; ; ERIC LINDQUIST 

Grantee: ' CENTEX HOME EQUITY CORP 

BooAr; 2003 Page: \ 156687 

Valid/Invalid: \ invalid 

Exclusion Reason: ] Foreclosure 

Sales Date: : 1999-03-22 

Deed Type: ] D | 

Price: • $39750.00 

Grantor: \ 

Grantee: 

Book: i 2116 Page: • 612 

Valid/Invalid: . Valid 

Exclusion Reason: 

Land Information 

Acres \ SF ! Units 

0.14 6250.0 1.0 

I Depth 

i ^ 

; 125.0 

Width Vacant 

••(• • 

50.0 No 

Improvement Information 

Building 1 

1 1/2 Story Unfm 4123 R Si 

fr. •••[••.•.••l,t! j'«".'5; , i ; 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: : 965.0 

Perimeter ! 0.0 

Percent Complete: 100.0% 

Quality: Average 

http://douglasne.maDt)inp-nn1 i n p m m 

A~\/Mirt1r,cr'~XT_/_i-... : . / 
Douglas County Account 1 n£uini ation Page 3 of 3 

Unit Type: j ; 

BuiltAs:j 1 1/2 Story Unfin '\ 

HVAC: i Central Air to Air 1 

Exterior: •• Frame Aluminum 

, . 1 .. . . i 

interior: ) Drywall | 

Roof Cover: ! Composition Shingle 

Roof Type: \ Gable : 

Floorcover: ' Allowance 

! i 

Year Built * ^^' ' 1 '*ercent i reartsuin | Remodeled Remodeled 

1921 - 1 0 0% j 

i 

Detail Type \ Detail Description 

Add On ' Unfinished Attic W/floor 

Appliance : Allow^ance 

Basement ' Bsmnt Block 8 ft 

Fixture ] Base Fixtures 

Fixture '• Bath Full 

Garage | Detached 

Porch [ Cvrd Wood Deck 

Porch : End Solid Wall 

Porch : Slab Roof Ceil 

Condition: 

Condo Square Footage: 

Rooms: 

Units: 

Baths: 

Bedrooms: 

Stories: 

Foundation: 

Sprinlder Square Footage: 

; Average 

•"o'.'o""" 

' 5.0 

: 1.0 

I'zo 

; •'•5 

; Block 

. 0.0 

4<4»«d.ye,r ; p,^,^.,^, . 

1921 I 

! 

i 

1 

88 

Units 

672.0 

1.0 

888.0 

1.0 

1.0 

240,0 

144.0 

140.0 

91.0 

http://dougIasne.maDDine-on1inR r.nm/rirKiinr}-,cn^-\T. 
PROPERTY SUMMARY 

Date: LBP STABIUZATION EPA CONTRAT EPJl7-084)7 1 Month of: 

. . . , . • 

1 Property Address: 

A. EXECimVE SUMMARY 

A l bsaes Encoantered: 

A.2 bsoea Resolved: 

A3 Unique Findings: 

122A^ Other Rdevant Information: 

Endosnres; 

ECHNOLOCIES, INC. 
i'^ i 

Pmdsjst Property Ci^ss-Qyt Form (Lssd-Bsssd Pairst SiaibJIisstk 

PrcsserSv Addrass: M^^S 1>L S"^ 

Cnsfftsrs Sestne; ^<->j cue. tl3owg..3 

Fsrformancs Stand®rps/d©se-Oyt Criteria Y£S iNC i 

1—M 

Wss the entire structure(sj|pa5ntsd with the exception of the statad, exdudsd areas? This would 

Include painting of other assciated features induding fascia, eaves, siding, aU trin?., porches, box 

beatns, columns, rails, and fitterior surfeces of garages. W 

|2. Was all scraping and other preparattion work completed satisfactoriiy? 

13. vVsre aii required areas of tne strjcturefs) prim.ed as needed and painted with two top coats? 

|4. Was the paint products utiitqed equivaient to a 30 year product/quality? 

'3. Are ail ofthe areas where cdntaminated materials have been spiiied 

I thoroughly vacuumed/ deanj^d? 

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^ 

15. Did the contractor coliect/vafcuum aii -fSiiing and scraped paint chips en the entire property, 

I roadways, siteyways, public ajpcess areas and also remove any other generated debris? Ji 

b. is the grass area that surrounps the structureCs) in reasonably good condition? JU. 

jS. Are all items such as polyethyjene sheeting, ladders, pairrt brushes, cones, barrier tape etc. 

i properly removed? Jd 

is. Is there any evidence of property damage that was done by the contractor? .Any property damage 

< U 

s needs to bs compieted prior ^p the EPA Close-Out. \M 

ilO. .Are there any property items niat were temporatily re-located by the contractor 

i that need to be moved back?'; \ W 

111. Are there any {k.f.own) lingerip.g issues with th& orooerty ownerfs) that have been isft unreserved? 

Other Ccnsideratigns?propertyiOvi>ner S!5cussions?Adaitionsi Work that is Recsuired in 

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