Transmittal of Omaha Lead Site 

Paint Stabilization File Folder 

Said# J^Srjf^ 3 Date: <^^/3 -7 0 

Address: 3// ^ Poff/iL:k>\ /41 / _^ 

Contractor: Citv of Omaha Year: rP^^7 0 

Paint Stabilization 

Property File Folder Documents 

_l:^^ork Write Up 

Jx; Signed Access Agreement for subject property 

Pre-Renovation form signed by Property Owner 

Pre-Renovation Form for Occupant/Tenant, ifapplicable 

IXrainting Agreement/City of Omaha Purchase Order 

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

Renovation Recordkeeping Checklist signed by Certified Renovator 

Jl/Property information from Douglas County Assessor's Office 

Other (describe): V\\c/r^ 5 

City of Omaha Representative Signature Date 

EPA Representative Signature 

30262466 

iimiiji 

Superfund 
CITY OF OMAHA 

PURCHASING - ROOM 1003 

1819 FARNAM STREET 

OMAHA. NE 68183-1003 

FAX# 402-444-5423 

Purchase Order 

VENDOR: G & M PAINTING CO INC 

13707 CUMING ST • 

OMAHA, NE 68154 

f 

PURCHASE ORDER NO. 

1166121 

REVISION 

0 

PAGE ] 

1 

J 

SHIPTO: 

CITYOFOMAHA 

HOUSING & COMM DEV RM #1111 

1819 FARNAM STREET 

0MAHA,NE 68183 

J 

BILL TO: 

CITY OF OMAHA FINANCE 

DISBURSEMENTS ROOM #1007 

1819 FARNAM STREET 

OMAHA,NE 68183 

ORIGINAL PURCHASE ORDER • VENDOR'S COPY (SEE INSTRUCTIONS BELOW) 

CUSTOMER ACCOUNT NO. VENDOR NO. 

91298 

DATE OF ORDER/ BUYER 

27-MAY-10 H HURT 

REVISED DATE//BUYER 

PAYMENT TERMS 

IMMEDIATE 

SHIP VIA FiO.B. 

DESTINATION 

FREIGHT TERMS 

> 

REQUESTOR/DELIVER 

MARUCA, T MARIE Ik CONFIRM TO / TELEPHONE 

< ITEM PART NUMBER / DESCRIPTION DELIVERY DATE QUANTITY UNIT UNIT PRICE EXTENSION 

All prices and amounts on this order are express »d in : US Doi:ar 

EPA PAINT. STABILIZATIOtJ 

PROGRAM GROUP 116 3116: 

POPPLETON AV • • 

O SHIP TO: . i 

Address at. top of page 

NEEDED: 

27-MAY-lO 

3,130. CO.. N 

EPA PAINT STABILIZATION 

PROGRAM GROUP 116 3634i 

S 24TH ST 

O SHIP TO: 

Address at top of pa^e 

NEEDED: 

27-MAY-lO 

2,310.0 0 N 

SHIPTO: Address shown above. If shipment Is delayed or any Items not available, advise at once. Purchase order number must appear on all Invoices, packages, packing lists, bill of lading, and correspondence. 

iSHIPPING CHARGES TO BE PREPAID, IF APPLICABLE AND ADDED TO INVOICED, copy to be furnished with invoice. 

TAX EXEMPTION: The City of Omaha Is exempt from Federal Excise Taxes and the Nebraska and City of 

Omaha Sales Taxes. Federal I.D. 476006304; STATE I.D. 01-0316768; Fuel Dealers Lie. 91-0316768. 

Tota l C 5-^^°°° ) 

4d'k;)rU-l/V4 . • 

Cily Purchasing /nan( / Buyer 
Planning Department 

Omaha/Douglas Civic Center 

Inspector: Stev e Zivn y 1819 Famam Street, Suite 1003 

rioto- .I'n/i n Omaha, Nebraska 68183 

uate . 4,IJ,1U (402)444-5150 

Telefax (402) 546-0714 

Name: Luis M. Barajas R. E. Cunningham, RA, F.SAME 

City of Onnaha AJ J iii/'-r * IJ . A DirectorJim Suttle, Mayor Addrcss: 3116 Poppleton Av 

OMAHA EXTERIOR PAINT STABILIZATION PROGRAM 

FOR THE EPA OMAHA LEAD SITE 

The Contract bid documents consist ofthe following sections; 

• General Responsibilities for the Contractor and Occupant: 

• Lead Hazard Control Plan, Interim Control of Lead Based Paint Hazards. 

The Contractor Shall: 

• Comply with HUD's "Guidelines for the Evaluation and Control of Lead-Based 

Paint Hazards in Housing." (Copies are available at the Planning Department.) 

• Comply with Standards called for in the "Construction and Rehabilitation 

Specifications, Housing and Community Development Division, City of Omaha, 

Nebraska." (Copies are available at the Plarming Departmerit.) 

• Comply with the State of Nebraska Health and Human Services Regulation and 

Licensure, Title 178 Chapter 23 Lead Base Paint Regulations. 

• Coordinate daily construction schedule with the occupant 

• Submit information cut sheets for all substitutions or approved equals prior to 

vvritten approval of the Consfruction Specialist. 

•. Repair or replace all items damaged or disturbed during paint stabilization 

activities. 

• Keep work site and surrounding area free from accumulations of waste materials 

or mbbish caused by the work at all times. 

• Upon daily completion of work: clean up all rubbish, excess material, equipment, 

and etc., that is connected with the work, and leave all parts ofthe work areas in a 

neat, sanitary, lead safe and presentable condition. 

• Complete this project within 30 calendar days. 

The Occupant/OwTier Shall 

• Rerhoveandstoreaway any personal property within twenty (20) feet ofthe area 

to be remediated. 

• Provide access to electricity and water throughout the paint stabilization process. 

• Ensure that all household members stay at least teri feet away from all work areas 

and also keep all pets at least ten feet away at all times until the vvork has been 

completed and the area has passed a visual in.spection. ^ 

lnitialsj^_4;^._. 
3116 Poppleton Av (Continued) 

Lead Hazard Gontrol Plan 

Interim Control of Lead based Paint Hazards 

Paint Stabilization 

• Stabilize all previously painted exterior wood, brick, metal or concrete 

surfaces ofthe dwelling to include but not liniited to the siding, fascia, 

eaves, trim, window'trim, shutters, gutters, railings, downspouts, door frim 

and foundation. DO NOT INCLUDE WINDOWS OR MAN DOORS. 

• Stabilize all previously painted exterior wood, brick, metal or concrete 

surfaces ofthe garage to include but not limited to the siding, fascia, 

eaves, frim, window frim, shutters, gutters, railings, downspouts, door trim 

and foundation. DO NOT INCLUDE WINDOWS OR MAN DOORS. 

INCLUDE VEHICLE DOORS. 

• Prepare and paint all previously painted surfaces by following the Safe 

Work Practices protocol for EPA exterior lead based paint stabilization. 

• All paint colors to match existing paint pattem. Prime and apply two 

coats of approved finish coat. (Refer to Plarming Dept. approved paint 

list). 

• IF SPRAYED, ONE COAT SHALL BE BACK-BRUSHED OR 

BACK-ROLLED. 

Lead Based Paint Waste 

Lead-based paint waste must be handled as follows 

. • All paint chips and component debris must be double bagged for disposal. 

• . Clean paint chips from ground around perimeter of dwelling before 

starting, during and after the project. 

• . All lead painted components and debris must be removed from the site 

daily unless otherwise approved by the construction specialist. 

• All lead-based paint debris (chips and components) must be disposed of in 

a municipal solid waste landfill. 

J v^> in f>(r/r^^:C- o^J/^/70 

Property Owner Date 

Property Owner Date 

Witness Date 

Occupant (i f applicabl e) Date 

Occupant (i f applicabl e) Date 
Exterior Lead-based Paint Stabilization Program Managed by the City of 

Omaha for EPA Region 7 

Omaha Lead Site 

The purpose of this program is to prevent yards where lead-contarhinated soil is cleaned 

up from becoming re-contaminated by deteriorating exterior lead-based pairit. This is 

not a home repair program. 

Which Homes Are Eligible? 

• Homes where soil clean-up has been or will be done and an EPA contractor has 

identified, deteriorating exterior lead-based paint. 

• Homes are eligible only by referral from the EPA. 

What work will be done? 

• Loose and flaking lead-based paint will be removed safely from fascia, eaves, 

siding, trim, window trim, door trim and foundation. 

• Surfaces will be primed and painted to match existing paint color as closely as 

possible. 

What v/ill not be done? 

• Surfaces which have no paint will not be freated. 

• Windows or doors will not be included. 

• Rotten wood will not be replaced. 

• No housing repair will be done. 

Who will perform the work? 

• EPA confractors will test paint on exterior house surfaces and give the results to 

the City of Omaha Paint Stabilization Program. 

• City Construction Specialists will prepare a work plan and contact the property 

owner for permission to proceed. 

• Work will be competitively bid by approved, trained confractors. 

When will the work be done? 

• This program began in 2007 and will continue for several years. 

• The City staff will prioritize homes based on the presence of children under age 

six if known and the severity of the.problem. 

Paint Stabilization is voluntary and will be done only with permission ofthe owner. 

Initialsi-,^ 0 ? 
Consent for Accesiis to Property 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consents to and authorizes the United States Environmental Protection 

Agency (USEPA) or its authorized representatives, collectively the Grantee, to enter and perform 

certain environmental response activities upon.the following described premises: 

Owner's Name: 

Owner Name(s): Luis M Barajas 

Davtime Phone: 

342-4994 

Addresses of Properties Covered by this Agreement 

Property Address 

3116 Poppleton Ave. 

City/State/Zip Code 

Omaha, NE 68105 

Grantor imderstands that this grant does not limit EPA's right of access under the Comprehensive 

Environmental Response and Liabilitv Act fCERCLAl 42 USC. & 9601-9675. or anv other law. 

PURPOSE OF ACCESS 

The purpose of the response action is to stabilize loose or flaking exterior lead-based paint on 

residential properties, including day-care facilities, where remediation of lead contaminated soil has 

or will take place. Sampling of soil may be conducted. This consent shall allow Grantee orito 

Grantor's property and fiulher, provides the Grantee the right to perform any and all enviromnental 

response actions and activities it deems appropriate. 

ENVIRONMENTAL RESPONSE ACTIONS 

The environmental response actions to be performed on subject property may include the following 

activities: 

1. Locating equipment and/or machinery on subject property in preparation for and in the course of 

the response activities. 

2. Obtaining samples from Grantor's property. 

tmnnm 
Address: 3116 Poppleton Ave. 

Consent for Access to Propertv ("Page 2) 

3. Plarming and implementing the response action on the Grantor's property. This will include 

1) removal of loose or flaking paint identified by EPA using lead-safe methods in compliance 

with HUD/EPA regulations and 2) repainting according to the attached specifications. 

TERM 

This access agreement shall be operable for the period of time it takes to complete the 

envirorunental response activities. Upon completion of the response actions, all rights and 

privileges given by the Grantor shall cease on that date, unless extended by a subsequent 

agreement. 

AGREEMENT NOT TO INTERFERE 

Grantor agrees not to interfere with any of the activities undertaken by Grantee at the Property, 

tamper yvith any of Grantee's property, or take any actions regarding the use ofthe Property which 

will endanger human health or welfare or the environment, or allow others to use the Property in 

such marmer during the term of this consent. Grantor agrees to provide notice and a copy of this 

agreement to prospective purchasers, lessees, assigns, or grantees of the property or any portion of 

it. Grantor agrees to provide 30-day notice to EPA prior to any transfer of ownership rights to the 

property. 

SAMPLING RESULTS 

Grantee agrees to provide Grantor with, the results of any and all sampling and/or analysis resulting 

from Grantee's response activities on the property. 

PRIOR CONDITIONS AGREEMENT 

The grantor agrees to the condition of the property prior to remediation and indicates on Page 3 any 

items to be removed by the Grantor before activities commence. 

RESTORATION OF PROPERTY 

Except for the above stated paint stabilization, the Grantee agrees that said property will be restored 

as nearly as possible to its original state and condition as found immediately preceding the 

beginning of activities authorized by this Agreement, following completion of the response 

activities. 

n \ 2/12/2007 
Address: 3116 Poppleton Ave., Omaha, NE, 68105 

CURRENT CONDITION / PROPOSED RESPONSE ACTIVITIES 

The purpose of this section is to provide a mutual agreement as to conditions of property prior to 

contractor activities. This will also serve as documentation for the purpose of assuring that 

restoration activities are completed to the satisfaction of the property owner and the United States 

Envirorunental Protection Agency (EPA). 

Items to be removed bv propertv owner prior to the response activities: 

I. 

2 . • 

3. 

4. 

5 . . • 

Items NOT to bis removed bv confractor during removal activities: 

1. 

2. 

3. 

4. 

5. 

ADDITIONAL COMMENTS: 

I have read the foregoing document and understand that it is an agreement granting permission to 

the Grantee tO enter the above described premises for the purpose of conducting environmental 

response activities, and I agree to its terms and conditions. I acknowledge that I have received the 

pamphlet "Renovate Right". 

Grantor's Signature: Jgr^ ^ . ^ 0rrpk^(?-I ^ ^^'^ n%//^/7(P 

('>,\ . 2I\2I2001 
Douglas County Account Information Page 1 of2 

Douglas County, Nebraska Property Record - R0957250000 

Information is valid as of 2009-12-31 

Print Report 

NEW Feature - Parcel Dimensions svailable ffl) scale 0-50 ft west of 52nd St - Vie W OH Ma p 

Treasurer's Tax Report 

New Feature ->-•- > Auto Sales Search 

Owner 

BARAJAS LUIS M 

blAL 

3116 POPPLETON AVE 

OMAHA NE 68105-0000 

Property Information 

Key Number: 

Account Type: 

Parcel Number: 

Parcel Address: 

Legal Description: 

5725 0000 09 

Residential 

0957250000 

3116 POPPLETON AV 

OMAHA NE 68105-0000 

DUNDY-E S JR-SUB DIV(HANSCOM PLACE) LOT 3 BLOCK 0 37.5 X 100 

.Value Information 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$5,100.00 

$5,100.00 

$5,100.00 

$5,100.00 

$5,100.00 . 

$5,100.00 

Improvement 

$82,000.00 

$82,000.00 

$82,000.00 

$88,400.00 

$88,400.00 

$88,400.00 

Total 

. $87,100.00 

• $87,100.00 

$87,100.00 

$93,500.00 

$93,500.00 

$93,500.00 

Sales Information 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

Grantee: 

Valld/lnvalld: 

Exclusion Reason: 

1993-03-16 

D Book: 1950 Page; .510 

$37,000.00 

Valid 

Land Information 

Acres 

0.08 

SF 

3800.0 

Units 

1.0 

Depth 

100.0 

Width 

38.0 

Vacant 

No 

Improvement Information 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accounmo=R09... 1/25/2010 
Douglas County Account Information Page 2 of2 

Building 1 

2 1/2 STORY UNFINtSMED 

'MOK n 

%.^—n^ ' j3^ I 

9S48Kt t 

lat-iiT"'" 

CLICK TO ENLARGE IMAGE 

Square Footage: 1905.0 

Perimeter 0.0 

Percent Complete: 100.0% 

Quality: Good 

Unit Type: End Condition: Average 

Built As: 

HVAC: 

2 1/2 Story Unfin 

Forced Air 

Condo Square Footage: 0.0 

Rooms: 6.0 

Exterior: 

Interior: 

Roof Cover: 

Roof Type: 

Frame Siding 

Drywall 

Units: 1.0 

Baths: 2.0 

Floorcover: 

Composition Shingle 

Gable 

Bedrooms: 

Stories: 

3.0 

2.5 

Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

1890 

Percent 

Remodeled 

Adjusted Year 

Built 

0% 1890 

Physical Age 

118 

Detail Type 

Add On 

Appliance 

Basement 

Fixture 

Detail Description 

Unfinished Attic W/floor 

Allowance 

Bsmnt Block 8 ft 

Units 

939.0 

1.0 

939.0 

Fixture 

Additional Fixtures 

Base Fixtures 

1.0 

1.0 

Fixture Bath Full 2.0 

308.0 

193.0 

Garage 

Porch 

Detached 

Slab Roof Ceiling 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R09... 1/25/2010