TRANSMITTAL off OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: ^20-^^ 5 Date: /9.\lCoiC)q 

Address: 13l 5 S ^ O flV ^ 

Remediation Contractor: PROFESSIONAL ENVIRONMENTAL ENGINEERS Year: 2009 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

g^^^-^Video ofproperty (DVD) ' 

'Q/ ^ Executive Summary 

JET Signed Access Agreement for subject property 

•ET^ Painting Agreement 

D Settiement documents (i.e., for damt^e or to replace plants, etc.) 

a Photographs i^efer^ I2fui ^d4^jr 

sA Satisfectory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

0 ^ Property infomiationfixim Douglas County Assessor's Office 

B ^ confirmation that lead pamphlet "Renovate Right" was received by PO 

D 

D 

D 

Professional En^ironn^e^tal Engineers Signature 

ISL &M 

Signature 

30054613 

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 

2009 

SAID# 20263 

1315 S. 30 Ave 

• Dates worked: 10/24 to 10/26 2009 

• Pre property condition: house has transit siding with painted wood trims. Front porch 

is painted and was ih very poor condition prior to stabilization work. Many areas of 

damage to siding and structure. Foundation was painted and had areas of cracking 

and paint flaking off all over. 

• Problems encountered: None 

• Owner request/concerns: N/A 

• Inspection/closeout dates. Owner signed 10/27 2009. Property inspected by PE project 

manager. 
PROFI 

2505 North 24^ Suite 219 

Omaha. NE 68110 

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

Consulting • Engineering Design • RemedlaUon • Abatement • Emergericy Response 

Property Owner Close-Out Form 

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

SAID: ^QZID S 

PropertyAddress: l^l' S f^ ^f ^ /% ^ (^Ao ^ «oV<o- SbQ ^ 

Owner's Name: rJOrJ C ^YY) > j'^ ^ 

Performance Standards/Close-Out Criteria YES NO 

1. Was the entire structure(s) painted with the exception ofthe stated, excluded 

areas? TMs would include painting of other associated features including fascia, 

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

garages. 

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

3. Were all required areas ofthe structiu«(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 ofthe areas where contaminated materials have been spilled thoroughly 

vacuumed/ cleaned? 7

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? 

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

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

propert

9. Is ther

y damag

e any evidenc

e needs

e

 t

 o

o b

f propert

e complete

y damag

d prio

e

r

 tha

 to th

t wa

e EP

s don

A Close-Out

e by the contractor

. ? Any A

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 IA been left unresolved? 

Comments: 

Property Ovmer Signature Date 

Professional Environklental Engineers Representative Date 
DCT-9-2009 03:19P FROM: TO:5043281 P.2 

y ytr»m^' I f yi/-r« »;#«'flv ^<i/«y m V ^f^ -

CONSENT FOR ACCESS TO PROPERTY 

OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID: 'ZO'Z-Lft S PROPE RTV ADDRESS: /j^jr S ^S- .-^ ^ f^4> . 

DAYTIME PHONE: UO'X^ ??/ ' ^7o / 

CELL PHONE: A"'^- Cf/U - lit 6 ^ E-MAIL: ^L€n^I'i'S£>u/iHe/s^-^A> ^ ,t^ ^ 

OWNER'S ADDRESS IF DIFFERENT: 

TENANrS NAME IF APPUCABLE: 

DAYTIME PHONE: 

CELLPHONE: E-MAIL: 

i 

Profesaionai Environmental Engineers, lac. (PE) is under contract («EP-R7-08-06) with the U.S. Environmental Protection 

Agency (BPA) 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 contractor^. 

I 

Paint stabilization activities will include: scraping of cracked or flaking LBP from structures, application ofa prime coat and two 

(2) coats of paint. Moving parts of windows and doors ^fc 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 tl|e 

purpose of stabilizing lead -based paint as outlined on the property Identified ab^ve. i 

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 stabilizatk>n 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 efTorts to address concerns that I, as the property owner, may have regarding soil cleanup at 

my property. 

tUtt Dal . e 

j 

I fkilly 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 Developm^t 

(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 a^d 

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

contacted by a PE representative approximately 48 hours in advance of starting worli, (7) agree not to obstruct or tamper witl) 

any ofthe LBP stabilization actions, and (8) will participate in final property inspection and sign the Completion Agreement and 

Property Owner Satisfaction Survey. i 

Should you have any questions about the planed Lead Based-Paint stflbilbation 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 Publi^ 

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

B Yn, I gnmt access to my propoty and w» given the psmphlet D No, I do not grant access to my property and! was 

"Renovila Right. Important Lead Infomiationfor FamlliSB, Child given the pamphM "Renovate Right Important Lead 

tnfomiatton for Famlllea, Childa Care Pravidara, and Schools.' 

Slgnfturs Date Signature Date 

SPECIAL MSTRUCnONS AND CONSIDERATIONS 
DCT-9-2009 03:19P FROM: 
 TO:5043281 P.3 


PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

PROPERTY ADDRESS: \1^\ ^ 5 . .g^ ^ f^^ y DATE: |0/I S 

BVID: 

AREA(S) TO BE PAINTED: 

HOUSE PROPER: Y^4_ COLOR: C?/^t/ 

HOUSE TRIM: ye5 COLOR: &j^f y 

GARAGE: yo COLOR:

GARAGE TRIM: _ Uo COLOR:

PORCH: ^loo ^ Jo COLOR:

PORCH TRIM: ^ o COLOR: Lt^OJ

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

\ AGREE TO THE COLORS LISTED ABOVE. ONCE THE PAINTING 

BEGINS, t UNDERSTAND I CAN NOT CHANGE THE ABOVE SELECTED COLORS: 

PROPERTY OWNE^IGNATURE «E^IGNATURE r\ :: A
Douglas County Accoimt Information Page 1 of2 

Z02.G3 

Douglas County, Nebraska Property Record - R1237910000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of S2nd St - Vie w O n Ma P Information is valid as of 2009-9-3 Treasurer's Tax Report 

New Feature -•-•- • Auto Sales Search 

Owner I 

SMITS JACK L 

ETAL 

535344 COOPE COOPERR RRDD Pk M I I ^r^ t I / 

ASHLAND NE 68003-5505 MHH'o^OoS S S I ' ^10 ' UCA 

Property Informatio n 

Key Number 3791 0000 12 

Account Type: Residential 

Parcel Number: 1237910000 

Parcel Address: 1315S30AV__i 

~t)U?iAHANE 68105-0000 

Legal Description: HANSCOM PLACE LOT 19 BLOCK 11 50 X 150 

Value Informatio n 

Land Improvement Total 

2009 

2008 

$6,800.00 

$6,800.00 

$58,500.00 

$58,500.00 -i ­ $65,300.00 

$65,300.00 

2007 $6,800.00 $58,500.00 $65,300.00 

2006 $6,800.00 $60,200.00 $67,000.00 

2005 $6,800.00 $60,200.00 $67,000.00 

2004 $6,800.00 $60,200.00 $67,000.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.17 7500.0 1.0 150.0 50.0 No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl 2... 9/11/2009 
Douglas County Account Information Page 2 of2 

aifaet TWO STORY I 

SJO 

49«r 

law 

CLICK TO ENLARGE IMAGE 

Square Footage: 

Perimeter 

1940.0 

0.0 

Unit Type: 

Built As: I 2 Story 

HVAC: i Forced Air 

Percent Complete: 100.0% 

Quality: Average 

Condition: Average 

Condo Square Footage: 0.0 

Rooms: i 9.0 

Exterior: Frame Shingle Units: 2.0 

Interior: Drywall Baths: 2.0 

Roof Cover: Composition Shingle Bedrooms: 4.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: ! 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1883 0% 1883 126 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 934.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 2.0 

Porch Slab Roof Ceil 149.0 

Porch Slab Roof Ceil 56.0 

User 2 UNIT CONVERSION 1.0 

User codei 25tomodel 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R12... 9/11/2009 
f^P<(^C ^ -=p=^ ^lJ0^h3 

PropertyAddress

Si art D.nr

Prune (G.illons) 

Poly (B0K«} 

Paint (Color) 

' Pntnt (Color) 

P.imt (Coior) 

P,-iint (Color) 

Paint (Color) 

JC Painting 

 ) 31 S S ' 3d'f' ^ /^(/^ ­ Date 

_ I Q ­— ^? ^ — O <=> Complete D.ne 

Amount Of Prime And Paint Used 

_^ . 

Q^ 

S«-Aj U J "fv^ *?"«?— Amount (Gallons) vQQ 

Amount (Gdiloiis) 

Amount (Gallons) 

^v-. o M.t)Vo'"X_ Amount (Gallons) V Q f&^

Amount (Gallons) 

 Q t 

J2 Sfor- j >>^0( ^ 

,.3 ' 
Professional Environmental Engineers, Inc. 

SAFETY AUDIT 

Project Name: A3 > /5^ 3o sl 

Date of Audit: IS -/"V -^ f 

Primary Health Hazards: 7[sckt! ^-g e^>^^>-> 

Primary H & S Concerns: J;3' <L^^ ^ 

Dally Tasks: 1. ^-Sarcy p / p T 

2 Qyjmer' 

I n h^-TT 3. ^ 

Equipment Used at Jobsite: 

Hard Hat Ladder 

Safety Glasses Boom Lifts 

Steel Toed Shoes j ^ GFCI 

Work Gloves ^^^ Safety Vests 

Generators ^^.^ Other 

Equipment Ready for Emergency Response at Immediate Disposal: 

Daily Safety Meeting Conducted /^y ^ First Aid Kit 

Emergency Procedures -A^ Company Health and Safety Policy "^^AA 

GFCI on-site I ^ ^ 

Deficiencies: - N\^i^ 

Corrective Actions: i^ 

Auditor: M,Q..9v/.'t^l .^JUJT- ^ Date: ^ A - 10 ^ O ^ 

SiteSupen/isor: 'Ar^*^'e>ii7^^^^o>c&-4!*Ki Date: '^o-^Co^C i <^ 
PROFESSIONAL ENVIRONMENTAL ENGINEERS, INC. 

DAILY SAFETY MEETING 

Date: j2^--/^^'^7 

Project: Omaha Paint Stabilization Project 

Location: /3l S "3 Q 5 / 

Site Activity:. 

Daily Tasks: 

3! 'p/' n ^' ^ - ^ 

Primary/Potential Hazards: 

3<- <^^o^ 3. ^S<Axera<^ 

2. CL&So\e. 

Work Tools: 

.^^S>Gy>Xe tzx- 3. 'Q'=''VV\.'?> o-^ 

2. JPXO^VvQw 4. \C,«. vtgJ^-OL^.q'< Q ^ 

Work Practices/Corrective Actions: 

1- vj\<V 3. 

2. 4. 

Previous Close Calls: 

3. 

2. 4. 

Employee Sign In Log: 

l.<!>g><gt3.r me^r\do'u>'^ 3. 

4. 

^/l/To ^!l>-oT- 6. 

7. 8. 

Site Health & Safety Signature Date