## TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO NFIL EFOLDE R 

# SAID# : 3200"= ^ Date : 

# 7///g 9 Address : 

# £JdS^£van 3 S-Zre^pJ
Remediatio nContractor : PROFESSIONALENVIRONMENTALENGDVEER S Year : 200 8 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 

# s y Vide o ofpropert y (DVD ) beJtVe . CJ^ C 

# y Executiv e Summar y 

# y SignedAcces s Agreemen t fo r

subject propert y 

# y Paintin g Agreemen t . , D 

## Settlement documents (i.e. , fo r

damag e or t o replac e plants , etc. ) Photograph s \^QJ^ ^ C^^^ C 

# y Satisfactor y restoratio n signedb y Propert y Owne r Propert y close-out chec k

lis t signedb y EP A Propert y informationfromDougla s Count y Assessor' s Office D D 

## Signatur e 

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4031640 5 

# II I Superfun d250 5 Nort h 24' ^ Suit e 21 9 Onnaha , N E 6811 0 (402 ) 504-468 8 Fa x(402 ) 504-328 1 

# PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC . "Providin g cost-effectiv e environmenta l solutions " Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yRespons e



### Lea dBas e Pain t Stabilizatio nOmaha , N e Clos e Ou t Repor t SAID #3200 9 210 5 Evan s S t

•Date s worke d09/3 0 t o 10/0 7 200 8 •Pain t o n hous e wa s very poo r an dchippin g off , area s o f th e soffit wer e missin g som e o f th e boards , som e windo w trim s were bare , appear s owner s wer e testin g pain t o nhous e becaus e ther e wer e som e pain t smear s o nhous e o f othe r colors . Garag e pain t wa s poor , structur e looke dok . •Inspecte d10/1 0 botto mo f tri mha dt o b e painted , touche dup wes t doo r an dpainte d undersid e o f porc hledge . 10/1 6 issue s resolved .

# PROFESSIONA L 250 5 Nort h 24' ^ Suit e 21 9 

# ENVIRONMENTA L ENGINEERS , INC . Omaha , N E 6811 0 (402 ) 504-468 8 

## "Providin g cost-effectiv e environmenta l solutions " Fa x (402 ) 504-328 1 Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yRespons e 

## Property Owne r Close-Ou t Form (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) SAID : 3200 9 Property Address : 210 5 Evan s Stree t Owner' s Name : Jasmin e Preiksaiti s Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) painte dwithth e exceptio no f th e stated , exclude d areas ? Thi s woul dinclud e paintin g o f othe r associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an dexterio r surface s o f 

# X garages . 2 . Wa s al l scrapin g an dothe r preparatio nwor k

complete dsatisfactorily ? 3 . Were al l require darea s o f th e structure(s ) prime da s neede dan dpainte dwith tw o to p coats ? 4 . Wa s th e pain t product s utilize dequivalen t t o a3 0 year product/quality ? 5 . Ar e al l o f th e area s wher e contaminate dmaterial s hav e bee nspille dthoroughl y vacuumed / cleaned ? 6 . Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s o nth e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e any 

# X othe r generate ddebris ? 7 . I s th e gras s are athat surround s th e structure(s ) i n reasonabl y goo dcondition ? ^ 

### 8 . Ar e al l item s suc ha s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . properl y removed ? 

# X 9 . I s ther e any evidenc e ofpropert y damag e that was don e b y th e contractor ? An y property damag e need s t o b e complete dprio r t o th e EPA Close-Out . ^ 

# X 10 . Are ther e an y property item s that wer e temporaril y re-locate db y th e contracto r that nee dt o b e move dback ? 

# 1 11 . Are ther e an y (known ) lingerin g issue s withth e property owner(s ) that hav e 

# V bee nlef t unresolved ? Comments : 

# jfly i 

# ^i) ^ /A--7-A ? rty Owne r Signatur e Dat e 

# A /0-a7'(? t Professional En^iromf?enta l Engineer s Representativ e Dat e

## PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC . "Providin g cost-effectiv e environmenta l solutions " Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yResponse 

### EP A Close-Ou t For m (Lead-Base dPain t Stabilizatio nEP A Contrac t EP-R7-08-06 ) 

## SAID : 5200 Q Property Address : 

# 2./O S £u^r) ^ S ^ Owner' s Name : Performanc e Standards/Close-Ou t Criteri a 250 5 Nort h 24 % Suit e 21 9 Omaha , N E 6811 0 (402 ) 504-468 8 Fax(402 ) 504-328 1



### YE S N O 1 . Wa s th e entir e structure(s ) painte dwit hth e exceptio no f th e stated , exclude d areas ? Thi s woul dinclud e paintin g o f othe r associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , andexterio r surface s o f / 

### garages . 2 . Wa s al l scrapin g an dothe r preparatio nwor k

complete dsatisfactorily ? 

# y 3 . Were al l require darea s o f th e structure(s ) prime da s neede dan dpainte dwith tw o to p coats ? / 

### 4 . Wa s th e pain t product s utilize dequivalen t t o a3 0 yea r product/quality ? / 

### 5 . Ar e al l o f th e area s wher e contaminate dmaterial s hav e bee nspille dthoroughl y / 

### vacuumed / cleaned ? 6 . Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s o nth e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e any othe r generate ddebris ? / 

### 7 . I s th e gras s are athat surround s th e structure(s ) inreasonabl y goo dcondition ? / 

### 8 . Ar e al l item s suc ha s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . properl y removed ? / 

### 9 . I s ther e an y evidenc e ofpropert y damag e that wa s don e b y th e contractor ? An y property damag e need s t o b e complete dprio r t o th e EPA Close-Out . / 

### 10 . Ar e ther e any property item s that wer e temporaril y re-locate db y th e contracto r that nee dt o b e move dback ? / 

### 11 . Are ther e any (known ) lingerin g issue s withth e property owner(s ) that hav e 

## y bee nlef t unresolved ? Other Considerations/Property Owne r Discussions/Additiona l Wor k

that i s Required : 

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# CONSENT FO R ACCCES S T O PROPERT Y

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### OMAH ALEA D SIT E REMEDIA L ACTIO N - LEAD-BASE D PAIN TSTABILIZATIO N PROPERT Y ID : 

# VOD ^ PROPERT Y ADDRESS : 

# • -^^JOS ' tmi h^r t OWNER' S NAM I 

# VW
- 7/0 7 _DAY-TIM E PHONE : 

# si4 ^ yy y CEL L PHONE : E-MAI L ' OWNER' S ADDRES S I F DIFFERENT : TENANT' S NAM E I F APPLICABLE : .DAY-TIM E PHONE : CEL L PHONE : E-MAI L Professiona l Environmenta l Engineers , Inc . (PE ) i s unde rcontrac t (#EP-R7-08-06 ) wit h th e U . S . Environmenta l Protectio n Agenc y(EPA ) t o stabiliz e exterio rlead-base d pain t (LBP ) o n residentia l structure s a t a numbe ro fpropertie s locate d i n Omaha , Nebraska . Th e pain t stabilizatio n wor k i s bein g don e t o protect th e soi l cleanup s tha t wer e perfonne d b yEP Acontractors . Pain t stabilization s activitie s wil l include : scrapin g o f cracke d o rflakin g LB P fro m structures , applicatio n o f a prim e coa t an d tw o (2 ) coat s o fpaint . An ymovin g part s o fwindow s an d doo rar e no t include d i n th e activitie s an d wil l no t b e addressed . You rcooperatio n i s requeste d i n givin g permissio n t o thi s EP Acontracto r(PE , Inc. ) t o ente ran d hav e acces s t o thi s propert yfo rth e purpos e o fstabilizin g lead-base d pain t a s outline d o n th e propert yidentifie d above . I full yunderstan d tha t b ysignin g thi s Consen t Fo rAccess , (1 ) thi s acces s wil l remai n i n effect unti l th e wor k ha s bee n satisfactoril y complete d (2 ) tha t a s th e Propert yOwne ro rtenant , i f applicable , wil l b e give n th e Housin g an d Urba n Developmen t (HUD ) an d EP A pamphlet , "Renovat e Right , Importan t Lea d Hazar d Infonnatio n fo rFamilies , Chil d Car e Provider s an d Schools " (3 ) th e Propert yOwne ro r tenan t wil l remova l o fobstruction s fro m surface s t o b e painted , (4 ) wil l abid e b yhealt h an d safet yguidanc e provide d byEPA , an d (5 ) wil l allo wphotograph yo f propert ybefor e an d afte rth e pain t stabilizatio n work , (6 ) I wil l b e contacte d bya P E representativ e approximatel y 4 8 hour s i n advanc e o fstartin g wor k t o (7 ) agre e no t t o obstruc t o rtampe rwit h an yo fth e LB P stabilizatio n activitie s o requipmen t use d t o perfom i an yLB P actions , (8 ) wil l participat e i n fina l propert yinspectio n an d sig n th e Completio n Agreemen t an d Propert yOwne r satisfactio n Survey . Shoul d yo u hav e an yquestton s abou t th e planne d Lea d Based-Pain t stabilizatio n activitie s fo ryou rproperty , pleas e contact : Professiona l Environmenta l Engineers , Inc. , Projec t Manager , Hemia n Hanne ra t 402-884-1185 . Genera l question s abou t th e Omah a Lea d Sit e cleanu p ca n b e directe d t o Paulett a France-Isetts , EP ARemedia l Project Manage r402-731-2454 , o rth e EP APubli cInfomiatio n Center s a t (402 ) 991-958 3 (Nort h Omah a office ) o r(402 ) 731-304 5 (Sout h Omah a office) . 

# M Y 1 Yes , I gran t acces B t o m ypropel ^ an d wa s ghre n I [No , I d o no t gran t acces s t o m ypropert yan d I wa s tlie$amphle t "Renovat e Right , Importan t Lea d Hazai d ghre n th e pamphle t "Renovat e Right , Importan t Lea d Informatio n fo rFamilies , Chil d Care Provider s an d Schools . Hazard Informatio n fo rFamilies , Chil d Car e Provider s an d Schools . S&datur e Dat e Signature Date ECIA L INSTRUCTION S AND/O R CONSIDERATIONS :

# Confirmatio n O f Receip t O f Lea d Pamphle t BVI D .3AD0( J PROPERT YADDRES S C^ ) 0- 5 fj/ ^

S't ZI P CODE fl2 d / /( ) PROPERTYADDRES S O F OWNE R I F DIFFEREN TTHA N PROPERTYBEIN G PAINTED : PROPERTYADDRES S ^ZI P COD E I hav e receive d a cop yo f th e pan^iphlet , Renovat e Right : Importan t Lea d Hazar d Informatio n Fo rFamilies , Chil d Car e Provider s An d School s informin g m e o f th e potentia l ris k o f th e lea d hazar d exposur e fro m renovatio n activit yt o b e perfonne d o n dwellin g unit . I receive d thi s pamphle t befor e th e wor k began .

PRINTE D NAM E O F RECIPIEN TDAT E 

# ua . 

# finK^A s MATUR E O F RECIPIEN T Self-Certificatio n Optio n (Fo rTenant-Occupie d Dwelling s Only ) I f th e lea d pamphle t wa s delivere d bu t a tenan t signatur e wa s no t obtainable , yo u maychec k th e appropriat e bo x below : \_

\ Refusa l T o Sig n - 1 certif ytha t I hav e mad e a goo d fait h effort t o delive rth e pamphlet , renovat e right : importan t lea d hazar d infonnatio n fo rfamilies , chil d car e provider s an d schools ; t o th e renta l dwellin g uni t liste d abov e a t th e dat e an d tim e indicate d an d tha t th e occupan t refuse d t o sig n th e confinnatio n o f receipt . I furthe rcertif ytha t I hav e left a cop yo f th e pamphle t a t th e uni t wit h occupant . 

# D Unavailabl e Fo rSignatur e - 1 certifytha t I hav e mad e a goo d fait h effort t o delive rth e pamphlet , renovat e right ; importan t lea d hazar d infonnatio n fo rfamilies , chil d car e provider s an d schools , t o th e renta l dweilin g uni t liste d belo wan d tha t th e occupan t wa s unavailabl e t o sig n th e confinnatio n o f receipt . I furthe rcertifytha t I hav e left a cop yo f th e pamphle t a t th e uni t b yslidin g i t unde rth e doo ro rsomewher e o n th e premises .

PRINTE D NAM E O F PERSO N CERTIFYIN G AHEMPTE D DELIVER YDAT E AN D TIM E LEA D PAMPHLE TDELIVER Y

SIGNATUR E O F PERSO N CERTIFYIN G LEA D PAMPHLE TDELIVERY : Not e Regardin g Mailin g Optio n - as a n altemative t o deliver yi n person , yo u ma ymai l th e lead pamphlet t o th e owne r and/o rtenant . Pamphle t mus t b e maile d a t least 7 day s befor e renovation . (Documen t with a certificat e o f mailin g fro m th e pos t office) . CONFIRMATIO N O F RECEIP TO F LEA D PAMPHLE T08/0 8

# PAIN TSTABILIZATIO N PRE-PROPERT YASSESSMEN T

PLAN T& PERMANEN TLANDSCAPIN G T O B E REMOVE ? N O r i YE S r i IF , YE S WHERE : 

# 1 PRE-EXISIIN G CONDmO N O F FOUNDATION/STRUCTURE , i.e . BASEMEN TLEAIQNG ? N O ' ' YE S ' ' IF , YE S WHERE :

EXISTIN G PAIN TO N WINDOWS , DOORS , FOUNDATION , SIDEWALK, ( I.E.) ? NO | 1 YE S 1— 1 IF , YE S WHERE :

VISUA L DESCRIPTIO N O F PROPERTY/STRUCTURE/GARAGE , (I.E.) : (USE BAC KSID E I F 1 NECESSARY )

-

PROPERT YOWNE R SIGNATUR E P E ACCESSE R SIGNATUR E

## PAIN TSTABILIZATIO N PRE-PROPERT Y PAIN TMATC H ASSESSMEN T

AREA(S ) TO B E PAINTED : HOUS E PROPER : COLO R HOUS E TRI M COLO R

GARAG E COLO R

- 

### GARAG E TRI M COLO R PORC H COLO R

PORC H TRI M COLO R (COMPLET E AL L SECnON , YES , NO , O R NON-APPLICABLE ) 

## I AGRE E T O TH E COLOR S LISTE D ABOVE . ONC E PAINTIN G BEGINS , I UNDERSTAN D I CA N NOTCHANG E TH E ABOV E SELECTE D COLORS :

PROPERT YOWNE R SIGNATURE : P E ACCESSO R SIGNATURE : 

# I I

PAIN TMATC H FOR M 08/0 8

### Douglas Count y Accoun t Information Pag e 2 of 3 ,5-
- 

### # . ... . 

# 0 -€>2DC^ ' Grantee : Valid/Invalid : Exclusio n Reason : Sale s Date : Dee d Type : 

### Price : Grantor : Grantee : Valid/Invalid : Exclusio n Reason : Lan d Informatio n Acre s S F \ Jame s G . Wile y

Invali d Famil ySal e 2001-08-0 8 W D $ 15,000.0 0

invali d Financin g Sellor/Specia l 

### Unit s Book : 219 0 

### Page : 50 2
*

Dept h Widt h Vacan t 70. 0 47. 0 N o

210 5 Evan s

Secon d Flpg r 462. 0 Sq.n .
16 " 1 1/ 2 Stor yFi n BumEicct'e nGS4Crs< : F t

CLIC KT O ENLARG E IMAG E Percen t Complete : 100.0 % Quality : Fai r Condition : Averag e Cond o Squar e Footage : 0. 0 Rooms : 

### 6. 0

Units : 1. 0 Baths : 1. 0 Bedrooms : 3. 0 Stories : 1. 5 Foundation : Bloc k Buildin g 1

Squar e Footage : Perimete r Uni t Type :

Buil t As :

HVAC : 

### Exterior :

Interior : Roo f Cover :

Roo f Type : Floorcover : 0.0 7 3290. 0 1. 0 Improvemen t Informatio n

1162. 0 0. 0 1 1/ 2 Stor yFi n Force d Ai r Fram e Sidin g Drywal l Compositio n Shingl e Gabl e Allowanc e 

### http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R15. . . 6/27/200 8

### Dougla s County Accoun t Infomatio n Pag e 1 of 3

nfom a Dougla s County , Nebrasl< a Propert yRecor d - R153G26000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t of 90t h S t - ViewO H Ma p Informatio n i s vali d a s o f 2008-6-1 9 Treasurer' s Ta xRepor t Ne wFeatur e -•-•- • Aut o Sale s Searc h Owne r PREIKSAITI S JASMIN E L ETA L 210 5 EVAN S S T OMAH AN E 68110-000 0 Propert yInformatio n Ke yNumber : 302 6 000 0 1 5 Accoun t Type : Residentia l Parce l Number : 153026000 0 Parce l Address : 210 5 EVAN S S T OMAH AN E 68110-000 0 Lega l Description : KOUNTZ E PLAC E LOT2 BLOC K4 1 N 7 0 FT4 7 X 7 0 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $4,000.0 0 $11,000.0 0 $15,000.0 0 200 7 $4,000.0 0 $15,800.0 0 $19,800.0 0 200 6 $4,000.0 0 $15,800.0 0 $19,800.0 0 200 5 $4,000.0 0 $15,800.0 0 $19,800.0 0 200 4 $4,000.0 0 $5,000.0 0 $9,000.0 0 200 3 $4,000.0 0 $5,000.0 0 $9,000.0 0 Sale s Informatio n Sale s Date : 2005-11-0 8 Dee d Type : Q C Book : 200 5 Page : 14791 7 Price : \ $o.O O Grantor : Jasmin e L Preiksaiti s eta l Grantee : Jasmin e L Preiksaiti s eta l Valid/lnvalid : Invali d Exclusio n Reason : Famil ySal e Sale s Date : 2003-02-1 9 Dee d Type : Q C Booilr : 223 5 Page : 15 2 Price : $0.0 0 Grantor : Jame s G . Wile yEta l 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R15. . . 6/27/200 8