TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID: 35098 Date: 12/23/2008 

Address: 2515 TempletonSt 

Remediation Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

0' 

Video of property (DVD) 

Executive Summary 

Signed Access Agreement for subject property 

Painting Agreement 

Settlement docimients (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 

D 

D 

D 

A'eun 

Signa' 

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40309890 in 

Superfund 
PROPERTY SUMMARY 

Date: 12/23/08 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Month of: December 

Property Address: 2515 Templeton St SAID: 35098 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: None 

A.2 Issues Resolved: None 

A.3 Unique Findings: None 

A.4 Other Relevant Information: None 

Access Date: 09/26/08 

Work Began: 09/30/08 

Closeout Date: 10/14/08 

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. 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: ^/ 5 T^rnpU fo^n 5 f Date: V^W^ ^ 

Phone: M^ ^ ^4^1 0 BVID: 35>0^ g 

Plant & Permanent Landscaping To Remain In Place 

Itein# 

Description and Location 

On Map 

ok 

Pre-Existing Condition of Stnictures 

Does your Basement have a history of leaking? Yes — No.v:r 

Item# Description & Location 

On Map ^ i^tcJ h totf^etc Ue^i, ^ J^<me>^ ^ ^ ^ Corrtt-l ^ 

Property Owner Prudent Employ; 

Signatuie Signature: lib^i*^^ 

1^^^ ^ ^y/>i ^ 

8080 Vtard Pariamy, Suite 405 2505 N. 24*^ Street Suita 308 4242 Madical Drive, Sulta 4250 

Kansas CHy, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phom: (816) 363-3703 Phone: (402)504-1004 Phona: (210)822-6588 ««A4 i ««V« «AA a Eav (91 m KI^AKTt 
'T/^Of'S 

Pnident Technologies, Inc. (Pnident) is under contract (Contract # EP-R7-08-07) with the U. S. 

Environmental Protection Agency (EPA) to stabilize Lead Based Paint (LBP) at a niunber ofproperties 

located in Omaha, Nebraska, including the property located at 

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

signing this form,tiie property owner grants pennission to Prudent to perform activities related to LBP 

Stabilization including scraping paint and painting of the referenced property. Further, the owner/tenant 

verifies that they have received tiie LBP pamphlet "Renovate Right." 

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

Administrative Clerk for the Lead Based Paint Stabilization, Mrs. Deborah Akerele-Johnson. 

at (402) 504-1004. General questions abouttiie Omaha Lead Site cleanup can be directed to the EPA 

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

ofifice). . ^ 

Piq>erty Access Granted By: 

Print Nanw) 

^6/ - oi- Property Owner Signature: ± 

(Date) 

PROPERTY INFORMATION 

(To be completed by reiident and/or property owner^- pleaae print) 

RESIDENT NAME: hff^eL fpitct/lj- Renter 

RESIDENT ADDRESS: '2SI5' Je^tvjkM ^-^ 

IF RENTAL, PROPERTY OWNED BY: 

Sd/Ae OWNER'SMAIUNOADDRESS; 

OWNER'S TELEPHONE NUMBER-HOME .HOME:j5^faLi2£l : I "^ O '^- ^ '" " WORK ^ : J _ JL 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER: 3 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: 

COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS. ENTRY GATES, ETC.) 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS; The activitieg to be implemented by EPA under das agreement are pursuant to Section 104 

OfCERCLA, 42 U.S.C. 9604. EPA's right of access to tiie propeity isprovided for in Section 104(e) ofCERCLA, 42 U.S. C 960S(e), which pfoivides entry 

for "detenniningthe need for response, or choosing ortaking any response action under this title, or oAerwise enforcing (he provisions of the title." 

:080 Ward Paricway, Sulta 405 2505 N. 24*^ Street, Suite 308 4242 Medical Drtve, Suita 4250 

lansas City, MO 64114 

'hone: (816) 363-3703 

Omaha, Nebraska 68110 

Phone: (402)504-1004 

San Antonio, TX 78229 

Phone: (210)822-9588 

.sw. ia4e \ q« 4 OTAT 
Current Sample PrARenovation Form 

Effective until Aprii 2010. 

Zrmation of Receipt of Lead Pamphlet 

ave received a copy of the pamphlet, Renovate Fti^t: Important Lead Hazard 

Infbrmation for Families, Child Care Providers and Schools informing me of 

the potential risl< of the lead hazard exposure from renovation activity to be 

parformod in m\/ ^fcwalling unft. i received tliia pamphlet iaefore the vvor(< began. 

Printe fid nameLDfjBcipien nam^jpfjBcipient /y / / Dat ^ e

Signatars of rsciplent 

Self-Certification Option (fbr tenant-occupied dweilings onl ^ — 

If the lead pamphlet was delivered but a tenant signature was not obtainable, 

you may check the appropriate box below. 

Q Refusal to sign — I certify that i have made a good M h effort to deliver ttie 

pamphlet, Renovate fVght: Important Ljead Hazard Information for Families, 

Child Care Providers and Schools, to the rental dwelling unit listed t)eiow at the 

date and time indicated and that the occupant refused to sign the confinmation 

of receipt. I further certify that I have left a copy of the pamphlet at the unit with 

the occupant. 

Q Unavaiiable for signature — I certify that I have made a good faith effort to 

deliver the pamphlet, Ftenovate fVght: Important Lead Ha^uid Infonnation for 

Fijnilies, CNId Care providers and Schools, to the rental dweiiing unit listed 

below and that the occupant was unavailable to sign the confirmation of receipt. 

I further certify that l^ave left a copy of the pamphlet at the unit by sliding it 

under the door. 

V' i^^ertJ fW<^ 

Printed name of person certifying Attempted delivery 

date and time 

lead pamphlet delivery 

Signature of person ceniiying lead pamphlet delivety 

^.^^/ M 

Unit Address 

Note Regarding Mailing Option — As an alternative to delivery in person, you 

may maii 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 the 

postofRce). 
pai nt match Jorm­ paint matching form: 

property address: :?5>'^ /e^kihn 

BVID: 3'^09^ 

Explanation: -f^

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Area: 

Explanation: 

Color: 

Area: 

Explanation: 

color: 

Area: 

Explanation: 

color: 

Area: 

Explanation: 

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color: 

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Douglas County, Nebraska Property Record - R1644390000 

Print Report 

NEW Feature - Parcel Dimensions avaiiabie @ scale 0-SO ft west of 90th St - Vie.!|W_On .MSP. Information is valid as of 2008-9-4 Treasurer's fax Report 

New Feature -•->• • Auto Sales Search 

Owner 

GRANT ALIWAN 

2515 TEMPLETON ST 

OIVIAHANE 68111-0000 

Property Informatio n 

Key Number: 4439 0000 16 

Account Type: Residential 

Parcel Number: 1644390000 

Parcel Address: 2515 TEMPLETON ST 

OMAHANE 68111-0000 

Legal Description: LUKE & TEMPLETONS LOT 37 BLOCK 0 LT 36 & W 10 FT 60 X 132 

Value Infor matio n

2008 

2007 

2006 

2005 

2004 

2003 

Land 

$2,900.00 

$2,900.00 

$2,900.00 

$2,900.00 

$2,900.00 

$2,900.00 

Improvement 

$20,300.00 

$20,300.00 

$20,300.00 

$13,600.00 

$12,300.00 

$12,300.00 

Total 

$23,200.00 

$23,200.00 

$23,200.00 

$16,500.00 

$15,200.00 

$15,200.00 

Land Infor matio n 

Acres 

0.18 

SF Unita 

7920.0 1.0 

Depth Width 

132.0 

Vacant 

60.0 No 

Improvemen t Info rmatio n

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R16... 9/24/2008 
. J . .ww«./i.uii. xiiivjiuiatiuii Page 2 of2 

Bit 

y^::i-^y:.:^ ^!i^!^S^^,M'^^^^^^ 

1 gU.CK.ia..ERLAS^EIMAQE | 

Square Footage: 

Perimeter 

Unit Type: 

BuiitAs: 

HVAC: 

Exterior: 

interior: 

Roof Cover: 

Roof Type: 

Floorcover: 

yearSwft 

1522.0 

0.0 

1 1/2 Story Fin 

Forced Air 

Frame Vinyl 

Plaster 

Composition Shingle 

Gable 

Allowance 

Year 

Remodeled 

1895 0 

OetaiV Type 

Appliance 

Basement 

Fixture 

Fixture 

Porch 

Porch 

User 

Percent 

Remodeled 

0% 

OefaiV Description 

Allowance 

Bsmnt Block 8 ft 

Base Fixtures 

Bath Full 

End Soiid Wall 

Slab w/Steps 

SOURCE 2 

.•«ij '. 

tea* 

?• i _ 

fir 1 MJ.or ; ( _ HI «« * 

i 

1i-kP<»r*w*N«.4«.-« 

[ 

nut I UO 

I J3J>. J 

CUCK.mE.N-y^8G!E..I!y!AGE

Percent Complete: 

Quality; 

Condition: 

Condo Square Footage: 

Rooms: 

Units: 

Baths: 

Bedrooms: 

Stories: 

Foundation: 

Sprinlder Square Footage: 

| 

100.0% 

Fair 

Poor 

0.0 

8.0 

1.0 

1.0 

4.0 

1.5 

0.0 

Adjusted Year 

Built 

1895 

Physical Age r 

113 

Units 

1.0 

912.0 

1.0 

1.0 

154.0 

70.0 

1.0 

http://douglasne.mapping-oiiline.coin/DouglasCoNe/static/accountiiifo.jsp?accountno=R16... 9/24/2008 
Prudent Property Ciose-Out Form (Lead-Based Paint Stabiiization) 

SAID:36-(??g 

Property AAAressi ^SiS ' ^Je^yi^yl ^ ) ^ ­

Owner's Name: 

Performance Standards/ciose-Out Criteria YES 

NO 

1. Was the entire structure(s) painted with the exception of the stated, excluded areas? This wouid 

inciude painting of other assodated features inciuding fascia, eaves, siding, all trim, porches, box ^ 

beams, coiumns, rails, and exterior surfaces of garages. 

2. Was ail scraping and other preparattion woric 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 equivaient to a 30 year product/quality? 

Are all ofthe areas where contaminated materials have been spiiied 

thoroughly vacuumed/ deaned? 

Did the contractor collect/vacuum all falling and scraped paint chips on the entire property, 

roadvtfays, alleyways, public access areas and also remove any other generated debris? < 

7. is the grass area that surrounds the structure(s) in reasonably good condition? 2L 

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

properiy removed? K

9. 

Is there any e^dence of property damage that was done by the contractor? Any property damage 

> ^ needs to be compteted prior to the EPA Close-Out 

10. 

Are there any property items that were temporatily re-located by the contractor 

that need to be moved bade? <

11. 

Are there any (known) lingering issues with the property owner(s) that have been left unresolved? 

Other Considerations?property Owner Discussions?Additlonal Woric that is Required X

jtiA'^^