TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: 3200"=^ Date: 7///g9 

Address: £JdS^£van3 S-Zre^pJRemediation Contractor: PROFESSIONAL ENVIRONMENTAL ENGDVEERS Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

sy Video ofproperty (DVD) beJtVe . CJ^ C 

y Executive Summary 

y Signed Access Agreement for subject property 

y Painting Agreement . , 

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

Photographs \^QJ^ ^ C^^^ C 

y Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Property information from Douglas County Assessor's Office 

D 

D 

Signature 

vL^^iUuj^-hy^ 7/1 0^7 

batfe 

40316405 

III 

Superfund 
2505 North 24'^ Suite 219 

Onnaha, 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 Paint Stabilization Omaha, Ne 

Close Out Report 

SAID# 32009 

2105 Evans St 

• Dates worked 09/30 to 10/07 2008 

• Paint on house was very poor and chipping off, areas of the soffit were missing some of the 

boards, some window trims were bare, appears owners were testing paint on house because 

there were some paint smears on house of other colors. Garage paint was poor, structure 

looked ok. 

• Inspected 10/10 bottom of trim had to be painted, touched up west door and painted 

underside of porch ledge. 10/16 issues resolved. 
PROFESSIONAL 

2505 North 24'^ Suite 219 ENVIRONMENTAL ENGINEERS, INC. Omaha, NE 68110 

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

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Property Owner Close-Out Form 

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

SAID: 32009 

Property Address: 2105 Evans Street 

Owner's Name: Jasmine Preiksaitis 

Performance Standards/Close-Out Criteria YES NO 

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

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

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

garages. 

2. Was all scraping and other preparation work 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 equivalent to a 30 year product/quality? 

5. Are all of the areas where contaminated materials have been spilled thoroughly 

vacuumed/ cleaned? 

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? X

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

8. Are all items such as polyethylene sheeting, ladders, paint brushes, cones, 

barrier tape, etc. properly removed? X 

9. Is there any evidence ofproperty damage that was done by the contractor? Any 

property damage needs to be completed prior to the EPA Close-Out. ^ X 

10. Are there any property items that were temporarily re-located by the contractor 

that need to be moved back? 1 

11. Are there any (known) lingering issues with the property owner(s) that have 

been left unresolved? V

Comments: 

jflyi ^i) ^ /A--7-A? 

rty Owner Signature Date 

A /0-a7'(?t 

Professional En^iromf?ental Engineers Representative Date 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

"Providing cost-effective environmental solutions" 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

EPA Close-Out Form 

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

SAID: 5200Q 

Property Address: 2./OS £u^r)^ S ^ 

Owner's Name: 

Performance Standards/Close-Out Criteria 

2505 North 24% Suite 219 

Omaha, NE 68110 

(402) 504-4688 

Fax (402) 504-3281 

YES NO 

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

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

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

garages. 

2. Was all scraping and other preparation work completed satisfactorily? y 3. Were all required areas of the structure(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 of the areas where contaminated materials have been spilled thoroughly / vacuumed/ cleaned? 

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 structure(s) in reasonably good condition? / 

8. Are all items such as polyethylene sheeting, ladders, paint brushes, cones, 

barrier tape, etc. properly removed? / 

9. Is there any evidence ofproperty damage that was done by the contractor? Any 

property damage needs to be completed prior to the EPA Close-Out. / 

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 

y been left unresolved? 

Other Considerations/Property Owner Discussions/Additional Work that is Required: 

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A^^. w^-^^ ^J»^^- PA COR Signature 
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CONSENT FOR ACCCESS TO PROPERTY 


OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION "< r«cl'-


PROPERTY ID: 
 VOD^ 

PROPERTY ADDRESS: 


•' -^^JOS tmi h ^r t 

OWNER'S NAMI 

_DAY-TIME PHONE: VW- 7/0 7

CELL PHONE: si4^ yyy E-MAIL ' 

OWNER'S ADDRESS IF DIFFERENT: 

TENANT'S NAME IF APPLICABLE: 

.DAY-TIME PHONE: 

CELL PHONE: E-MAIL 

Professional Environmental Engineers, Inc. (PE) is under contract (#EP-R7-08-06) with the U. S. Environmental Protection Agency (EPA) 

to stabilize exterior 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 were perfonned by EPA contractors. 

Paint stabilizations activities will include: scraping of cracked or flaking LBP from structures, application of a prime coat and two (2) coats 

of paint. Any moving parts of windows and door are not included in the activities and will not be addressed. 

Your cooperation is requested in giving permission to this EPA contractor (PE, Inc.) to enter and have access to this property for the 

purpose of stabilizing lead-based paint as outlined on the property identified above. 

I fully understand that by signing this Consent For Access, (1) this access will remain in effect until the work has been satisfactorily 

completed (2) that as the Property Owner or tenant, if applicable, will be given the Housing and Urban Development (HUD) and EPA 

pamphlet, "Renovate Right, Important Lead Hazard Infonnation for Families, Child Care Providers and Schools" (3) the Property Owner or 

tenant will removal of obstructions from surfaces to be painted, (4) will abide by health and safety guidance provided by EPA, and (5) will 

allow photography of property before and after the paint stabilization work, (6) I will be contacted by a PE representative approximately 

48 hours in advance of starting work to (7) agree not to obstruct or tamper with any of the LBP stabilization activities or equipment used to 

perfomi any LBP actions, (8) will participate in final property inspection and sign the Completion Agreement and Property Owner 

satisfaction Survey. 

Should you have any questtons about the planned Lead Based-Paint stabilization activities for your property, please contact: Professional 

Environmental Engineers, Inc., Project Manager, Hemian Hanner at 402-884-1185. General questions about the Omaha Lead Site 

cleanup can be directed to Pauletta France-Isetts, EPA Remedial Project Manager 402-731-2454, or the EPA Public Infomiation Centers 

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

MY 1Yes, I grant accesB to my propel^ and was ghren I [No, I do not grant access to my property and I was 

tlie$amphlet "Renovate Right, Important Lead Hazaid ghren the pamphlet "Renovate Right, Important Lead Information 

for Families, Child Care Providers and Schools. Hazard Information for Families, Child Care Providers and 

Schools. 

S&dature Date Signature Date 

ECIAL INSTRUCTIONS AND/OR CONSIDERATIONS: 
Confirmation Of Receipt Of Lead Pamphlet 

BVID .3AD0( J 

PROPERTY ADDRESS C^ ) 0- 5 fj/ ^ S' t ZIP CODE fl2d / /( ) 

PROPERTY ADDRESS OF OWNER IF DIFFERENT THAN PROPERTY BEING PAINTED: 

PROPERTY ADDRESS ^ZIP CODE 

I have received a copy of the pan^iphlet, Renovate Right: Important Lead Hazard Information For Families, 

Child Care Providers And Schools informing me of the potential risk of the lead hazard exposure from 

renovation activity to be perfonned on dwelling unit. I received this pamphlet before the work began. 

PRINTED NAME OF RECIPIENT DATE 

ua. finK^As 

MATURE OF RECIPIENT 

Self-Certification Option (For Tenant-Occupied Dwellings Only) 

If the lead pamphlet was delivered but a tenant signature was not obtainable, you may check the appropriate box 

below: 

\_\ Refusal To Sign - 1 certify that I have made a good faith effort to deliver the pamphlet, renovate right: important 

lead hazard infonnation for families, child care providers and schools; to the rental dwelling unit listed above at the 

date and time indicated and that the occupant refused to sign the confinnation of receipt. I further certify that I 

have left a copy of the pamphlet at the unit with occupant. 

D Unavailable For Signature - 1 certify that I have made a good faith effort to deliver the pamphlet, renovate right; 

important lead hazard infonnation for families, child care providers and schools, to the rental dweiling unit listed 

below and that the occupant was unavailable to sign the confinnation of receipt. I further certify that I have left a 

copy of the pamphlet at the unit by sliding it under the door or somewhere on the premises. 

PRINTED NAME OF PERSON CERTIFYING AHEMPTED DELIVERY DATE AND TIME LEAD 

PAMPHLET DELIVERY 

SIGNATURE OF PERSON CERTIFYING LEAD PAMPHLET DELIVERY: 

Note Regarding Mailing Option - as an altemative to delivery in person, you may mail 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 post 

office). 

CONFIRMATION OF RECEIPT OF LEAD PAMPHLET 08/08 
PAINT STABILIZATION PRE-PROPERTY ASSESSMENT 

PLANT & PERMANENT LANDSCAPING TO BE REMOVE? NO r i YES r i 

IF, YES WHERE: 

1 

PRE-EXISIING CONDmON OF FOUNDATION/STRUCTURE, i.e. BASEMENT LEAIQNG? 

NO ' ' YES ' ' IF, YES WHERE: 

EXISTING PAINT ON WINDOWS, DOORS, FOUNDATION, SIDEWALK,( I.E.)? NO| 1 

YES 1—1 IF, YES WHERE: 

VISUAL DESCRIPTION OF PROPERTY/STRUCTURE/GARAGE, (I.E.): (USE BACK SIDE IF 1 

NECESSARY) 

-

PROPERTY OWNER SIGNATURE PE ACCESSER SIGNATURE 
PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

AREA(S) TO BE PAINTED: 

HOUSE PROPER: COLOR 

HOUSE TRIM COLOR 

GARAGE COLOR 

-

GARAGE TRIM COLOR 

PORCH COLOR 

PORCH TRIM COLOR 

(COMPLETE ALL SECnON, YES, NO, OR NON-APPLICABLE) 

I AGREE TO THE COLORS LISTED ABOVE. ONCE PAINTING BEGINS, I 

UNDERSTAND I CAN NOT CHANGE THE ABOVE SELECTED COLORS: 

PROPERTY OWNER SIGNATURE: PE ACCESSOR SIGNATURE: 

II 

PAINT MATCH FORM 08/08 
Douglas County Account Information Page 2 of3 

,5-- # . .... 0 -€>2DC^' 

Grantee:

Valid/Invalid: 

Exclusion Reason: 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

Grantee: 

Valid/Invalid:

Exclusion Reason:

Land Informatio n 

Acres SF 

\ James G. Wiley 

Invalid 

Family Sale 

2001-08-08 

WD 

$15,000.00 

 invalid 

 Financing Sellor/Special 

Units 

Book: 2190 Page: 502 

* 

Depth Width Vacant 

70.0 47.0 No 

2105 Evans 

Second Flpgr 

462.0 Sq.n . 

16" 

1 1/2 Story Fin 

BumEicct'en GS4Crs<: Ft 

CLICK TO ENLARGE IMAGE 

Percent Complete: 100.0% 

Quality: Fair 

Condition: Average 

Condo Square Footage: 0.0 

Rooms: 6.0 

Units: 1.0 

Baths: 1.0 

Bedrooms: 3.0 

Stories: 1.5 

Foundation: Block 

Building 1 

Square Footage: 

Perimeter 

Unit Type: 

Built As: 

HVAC: 

Exterior: 

Interior: 

Roof Cover: 

Roof Type: 

Floorcover: 

0.07 3290.0 1.0 

Improvemen t Informatio n 

1162.0 

0.0 

1 1/2 Story Fin 

Forced Air 

Frame Siding 

Drywall 

Composition Shingle 

Gable 

Allowance 

http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R15... 6/27/2008 
Douglas County Account Infomatio nfoma n Page 1 of3 

Douglas County, Nebrasl<a Property Record - R153G260000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 90th St - Vie w OH Ma p Information is valid as of 2008-6-19 Treasurer's Tax Report 

New Feature -•-•- • Auto Sales Search 

Owner 

PREIKSAITIS JASMINE L 

ETAL 

2105 EVANS ST 

OMAHA NE 68110-0000 

Property Informatio n 

Key Number: 3026 0000 15 

Account Type: Residential 

Parcel Number: 1530260000 

Parcel Address: 2105 EVANS ST 

OMAHA NE 68110-0000 

Legal Description: KOUNTZE PLACE LOT 2 BLOCK 41 N 70 FT 47 X 70 

Value Informatio n 

Land Improvement Total 

2008 $4,000.00 $11,000.00 $15,000.00 

2007 $4,000.00 $15,800.00 $19,800.00 

2006 $4,000.00 $15,800.00 $19,800.00 

2005 $4,000.00 $15,800.00 $19,800.00 

2004 $4,000.00 $5,000.00 $9,000.00 

2003 $4,000.00 $5,000.00 $9,000.00 

Sales Informatio n 

Sales Date: 2005-11-08 

Deed Type: QC Book: 2005 Page: 147917 

Price: \ $o.OO 

Grantor: Jasmine L Preiksaitis etal 

Grantee: Jasmine L Preiksaitis etal 

Valid/lnvalid: Invalid 

Exclusion Reason: Family Sale 

Sales Date: 2003-02-19 

Deed Type: QC Booilr: 2235 Page: 152 

Price: $0.00 

Grantor: James G. Wiley Etal 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R15... 6/27/2008