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### TRANSIVIITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL EFOLDE R 

## SAI D # : HS^ I Date : 5?>Q M 0 ^ Address : .^fS.^' ^ Pin ^ " ^ Remediatio n Contractor : PROFESSIONA LENVIRONMENTA LENGINEER S 

### Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S y ^ Vide o o f property (DVD ) (S ^ Executiv e Summar y 0 Signe dAcces s Agreemen t fo r subjec t properl y \j f

Paintin g Agreemen t D Settlemen t document s (i.e. , fo r ddmag e o r t

o replac e plants , etc. ) y ^ Photograph s VCe_ ^ OA A f^Ql W &

r Satisfactor y restoratio n signe db y Propert y Owne r 

### By
- Property close-ou t chec k lis l signe db y EP A M Propert y informatio n fromDougla s Count y Assessor' s Offic e E/ ^ _confirmatio n tha t lea dpamphle t "Renovat e Right " wa s receive db y P0 _ H ^ ^g•(^ ^ i?4^' ^ D D


## ^IZ ' ^ ^ 

### te

4iP A Signature Date ' '' ^ ~ 3009440 3 Superfun d

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

# ENVIRONMENTA L ENGINEERS , INC . Omaha . N E 6811 0 

### "Providin g cost-effectiv e environmenta l solutions "p^ ^

jj^g ! llt32T ^ Consultin g • Engineerin g Desig n • Remedialio n • Abaieinen t • Eincrgonc yRespons e



### Lea dBas e Stabilizatio nOmaha , Ne Clos e Ou t Repor t 200 9 SAID #1942 1 353 3 Pin e S t

•Date s worked : 07/1 5 t o 07/1 6 200 9 •Pr e propert y condition : Hous e ha dwoo dsiding , overal l i n fai r condition . Garag e wa s in poo r condition ; doo r pain t wa s flakin g an dchipping . •Problem s encountered : Owne r claime dther e wa s pain t o n plant s an don e drai nspou t damaged . •Owne r request/concerns : Owne r state dtha t h e wa s no t presen t whe n th e wor k wa s 

### bein g don e an dh e doe s no t kno w i f

i t

wa s prime dan dth e tw o coat s o f pain t applied . Issue s wer e resolved . •Inspection/closeou t dates . Owne r signe d07/2 3 2009 . Inspecte dby EP A 07/2 3 2009 .

# PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC . "Providin g cost-effectiv e environmenta l solutions " CcrsultTK , • Enginpc i nc i Do s fj n • Roincr l ,'itio n • Ajj'itt'n'pii l • flmeig'^nr yFrspoii'- o 

## EPA Close-Ou t For m (Lead-Base dPain l Stabilizatio nEP A Conlrac i EP-R7-08-06 ) SAID : 

# iqM2 l Propert y Address : f^S?) 3 P i O'P , ^ j Owner' s Name : VrAiM H " /0'P>Qnin-P . Performanc e Standards/Close-Ou t Criteri a 250 5 Nort h 24'" . Suit e 21 9 Omaha , NE6811 0 (402 ) 504-468 8 Fa x(402 ) 504-328 1



### YE S N O 1 . Wa s th e entir e slruclure(s ) painte dwilhlli e exceptio no f th e staled , exclude d areas ? Thi s woul dinclud e paintin g o f olhe r associale dfeature s includin g fascia , eaves , siding , all trim , porches , bo x beams , columns , rails , andexterio r surface s o f 

# y garages . 2 . Wa s all scrapin g andolhe r preparalio nwor k

complete dsatisfactorily ? 

## \ y 3 . Were al l require darea s ofth e struclure(s ) prime da s neede dandpainte dwit h tw o to p coals ? 

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

# y 5 . Are all ofth e area s wher e contaminate dmaterial s hav e bee nspille dthoroughl y vacuumed / cleaned ? 

# y 6 . Di dth e contracto r collect/vacuu mal l fallin g andscrape dpain l chip s o nth e entir e properly , roadways , alleyways , publi c acces s area s andals o remov e any \ y ^ 

### olhe r generate ddebris ? 7 . I s th e gras s are athat surround s th e slruclure(s ) i nreasonabl y goo dcondition ? y 

### 8 . Are all ilem s suc ha s polyelhylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . properl y removed ? \y 

### 9 . I s there any evidenc e o f properl y damag e tha t wa s don e by th e contractor ? Any y property damag e need s t o b e complete dprio r to th e EP A Close-Out . 10 . Are ther e any property item s tha t were temporaril y re-locate dby th e contracto r y ^ tha t nee dl o b e move dback ? 11 . Are ther e any (known ) lingerin g issue s wilhth e property owner(s ) ihal hav e bee n lef t unresolved ? y 

### Olhe r Considerations/Properl y Owne r Discussions/Additional Wor k

that i s Required :



### /^yyJyyfTJ ^ 

# -^/^/ o W EPA CO RSignalure Dal e

## • 55 ^ '43A W 

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

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

### "Providin g cost-effectiv e environmenta l solutions " Fa x(402 ) 504-328 1 Ocr-^.jti'- g • Engiroo rIT ] DOE.CJ' T• Romc d L t;."> n • Alw. criiiMi t • Frn ri- i <^C' ^ Pc-ifi i i^ f 

### Propert y Owne r Close-Ou t For m (Lead-Base dPain l Stabilizatio n EP A Contrac t EP-R7-08-06 ) 

## SAID : (qMc^^ l Propert y Address : 96"? ^ "P' y H- e ^f " Owner' s Name : fi>ij|a]\ l . Q ' .\^f>r)n-P. I I Performanc e Standards/Close-Ou t Criteri a YE S NO 1. Wa s th e entir e slructure(s ) painte dwit hth e exceptio nofth e staled , exclude d areas ? Thi s woul dinclud e paintin gof othe r associale dfeature s includin g fascia , 

# y eaves , siding , all trim , porches , bo x beams , columns , rails , andexierio r surface s of garages . 2. Wa s al l scrapin g andolhe r preparatio nwor k

complete dsatisfactorily ? 3. Wer e all require darea s of ih e slruclure(s ) prime d as neede dandpainte dwilh tw o to p coals ? 4. Wa s th e pain l product s utilize dequivalen t lo a 30 yea r product/quality ? 

# y^ 5. Are all ofth e area s where contaminate dmaterial s hav e bee nspille dthoroughl y vacuumed / cleaned ? 6. Di dth e contracto r collect/vacuu mall fallin g andscrape dpain l chip sonth e \ y 

### entir e properly , roadways , alleyways , publi c acces s area s andals o remov e any olhe r generate ddebris ? hSo\
- tt^V.y>c\i^ - ujfldfigi up ti o



### fio.pjrA r Aap i tUu f )i Oi 

### iL . pt>.p7r4--Wp f 

### sonaD y c dcondi 7. Is th e gras s are athat surround s ih e struclure(s ) inreasAnaol goo dition ? 8. Are all item s suc has polyethylen e sheeting , ladders , paint brushes , cones , barrier tape , etc . properl y removed ? ^or -^K L^nti- i pur- i U-/^ 9. Is there any evidenc eof properl y damag e Iha l wa s don e by th e contrador ? Any 

### 1 

# y property damag e need s tobe complete dprio r to th e EP A Close-Out . cV^iO n S/'<?u f 

### 10 . Are ther e any properl y ilem s tha t were temporaril y re-locale d by th e contracto r thai nee d tobe move dback ? 11 . Ar e ther e any (known ) lingerin g issue s wit hth e property owner(s ) tha t hav e been lef l unresolved ? Comments : - t ^^^j^ i hiK ^ Ai ni^;iA) ( [A^Ct ^ hV'n^cUA ( So rt c\gl ^

OJJJS\ , 

### —1 ) ^\K.iKK . 

### 7-J.3-<g ^ PropertyT©wne r Si g Date 

## -/'^S-0^ Professional Environmental Engineer s Representativ e Dal e

# CONSENT FO RACCES S T O PROPERT Y OMAH A LEA D SIT EREMEDIA LACTIO N- LEAD-BASE D PAIN T STABILIZATIO N PROPERT Y ID : 

# ^Ra T PROPERT Y ADDRESS : 'P^'S^' ^ '•P\ ' H't LS ^ JQWNERNAME : ^ , ^ i i 

### DAYTIM EPHONE : 3^4 ^ H'^ Q ij > CEL LPHONE : E-MAIL : OWNER' S ADDRES S I FDIFFERENT : TENANT' S NAM EI FAPPLICABLE : DAYTIM EPHONE : CELLPHONE : E-MAIL : Professiona l Environmenta l Engineers , Inc . (PE ) i s unde r contrac t (#EP-R7-08-06 ) withth e U.S . Environmenta l Protectio n Agenc y (EPA ) t o stabiliz e lea dbase dpain t (LBP ) o n residentia l structure s a t anumbe r of propertie s locate dinOmaha , Nebraska . Th e pain t stabilizatio n wor k i s bein g don e t o protec t th e soi l cleanup s tha t ar e bein g performe db y EP A contractors . Pain t stabilizatio n activitie s wil l include : scrapin g ofcracke do r flakin g LB Pfro mstructures , applicatio nof aprim e coa t an dtw o (2 ) coat s o f paint . Movin g part s o f window s an ddoor s ar e no t include dan dwil l no t b e addressed . You r cooperatio n i s requeste din givin g permissio n t o thi s EP A contracto r (PE ) t o ente r an dhav e acces s t o thi s propert y fo r th e purpos e o f stabilizin g lea d-base dpain t a s outline do n th e propert y identifie dabove . B y signin g thi s documen t I agre e t o allo w a n EP A contracto r t o conduc t asoi l cleanu p a t my propert y followin g completio n o f lead-base dpain t stabilization , ifth e soi l cleanu p ha s no t alread y bee nperformed . I understan dtha t th e stabilizatio ncontracto r ca n no t provid e assurance s tha t th e soi l cleanu p contracto r wil l b e boun dto . I furthe r understan dtha t th e soi l cleanu p contracto r wil l mak e al l reasonabl e effort s t o addres s concern s tha t I , a s th e propert y owner , ma y hav e regardin g soi l cleanu p a t my property . D Yes , I hav e rea d an d understan d th e paragrap h above . Signatur e o f Propert y Owne r Dat e I fully understan dtha t b y signin g thi s Consen t fo r Access , (1 ) thi s acces s wil l remai n ineffec t unti l th e wor k ha s bee n satisfactoril y completed , (2 ) tha t th e Propert y Owne r o r Tenant , if applicable , wil l bc give nth e Housin g an dUrba n Developmen t (HUD ) an dEP A pamphlet , "Renovat e Right , Importan t Lea dHazar dinformatio nfo r Families , Da y Car e Providers , an d Schools" , (3 ) th e Propert y Owne r o r tenan t wil l remov e al l obstruction s fro msurface s t o b e painted , (4 ) wil l abid e b y healt han d safety guidanc e provide db y EPA , (S ) wil l allo w photograph y o f propert y befor e an dafte r th e pain t stabilizatio n work , (6 ) wil l b e contacte db y aP Erepresentativ e approximatel y 4 8 hour s in advanc e o f startin g work , (7 ) agre e no t t o obstruc t o r tampe r wit h an y ofth e LB Pstabilizatio n actions , an d(8 ) wil l participat e in flnal propert y inspectio nan dsig n th e Completio n Agreemen t an d Propert y Owne r Satisfactio nSurvey . Shoul dyo u hav e an y question s abou t th e plane dLea dBased-Pain t stabilizatio n activitie s fo r you r property , pleas e contac t Professiona l Environmenta l Engineers , Inc . Projec t Manager , Willi e Cla y A t 402-504-4688 . Genera l question s abou t th e Omah a Lea dSit e cleanu p ca n b e directe dt o Paulett aFrance-Isetts , EP A Remedia l Projec t Manage r 402-731-2454 , o r th e EP A Publi c Informatio n Center s a t 402-991-958 3 (Nort hOmah aoffice ) o r 402-731-304 5 (Sout hOmah aofflce) . / , Yes , I gran t acces s t o m ypropert yan d wa s give n th e pamphle t D No , I d o no t gran t acces s t o m ypropert yan d I wa s "Renovat e Right , Importan t Lea d Informatio n fo rFamilies , Chil d give n th e pamphle t "Renovat e Right , Importan t Lea d Care Providers , an d Schools. " Informatio n fo rFamilies , Child e Car e Providers , an d Schools. " 

## 0<^V^AA ^^M^O ^ Dat e Signatur e Dat e SPECIA L INSTRUCTION S AN D CONSIDERATION S

## PAIN TSTABILIZATIO N PRE-PROPERT Y PAIN TMATC H ASSESSMEN T PROPERT YADDRESS : i ^ 3 3 -Rn- e 

# ^- h DATE : BVID :

AREA(S ) T O B E PAINTED : HOUS E PROPER: . 

## COLOR : OTYJJLJA

HOUS E TRIM : COLOR : ^^^^JiJ^TTi} ^
GARAGE : 

## COLOR : ^31) ^
GARAG E TRIM : _ 

## COLOR : \^^^5CEJ ^

PORCH : COLOR : PORC H TRIM : COLOR : (COMPLET E AL L SECTION , YES , NO , O R NON-APPLICABLE )



### I AGRE E T O TH E COLOR S LISTE D ABOVE . ONC E TH E PAINTIN G BEGINS , I JJMJ£RSTAN D I CA N NO TCHANG E TH E ABOV E SELECTE D COLORS : P E ACCESO R SIGNATURE :

### Douglas Coimt y Accoun t Information Page 1 of 2 

# _*La^z A Dougla s County , Nebrask a Propert yRecor d - R103877000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabi e @ scal e 0-5 0 f t wes t of 52n d S t - ViewOr t Ma P Informatio n i s vali d a s o f 2009-6-1 6 Treasurer' s Ta xRepor t Ne wFeatur e -•«•- •Aut o Sale s Searc h Owne r ODONNEL L PAULAN 

# 9 ^ -S'sos 353 3 PIN E S T OMAH AN E 68105-000 0 

# i k ^ 

# n Propert yInformatio n Ke yNumber : 387 7 00001 0 ^ 

# ^^f ^ Accoun t Type : Residentia l 

# iX - Parce l Numtie r 103877000 0 Parce l Address : 353 3 PIN E S T OMAH AN E 68105-000 0 Lega l Description : FIEL D CLU B TERRAC E LO T4 BLOC K0 4 9 X 12 9 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $6,300.0 0 $107,300.0 0 $113,600.0 0 200 8 $6,300.0 0 $107,300.0 0 $113,600.0 0 200 7 $6,300.0 0 $107,300.0 0 $113,600.0 0 200 6 $6,300.0 0 $100,500.0 0 $106,800.0 0 200 5 $6,300.0 0 $100,500.0 0 $106,800.0 0 200 4 $6,300.0 0 $100,500.0 0 $106,800.0 0 Sale s Informatio n Sale s Date : 1990-05-0 9 Dee d Type : D Book : \ 187 7 Page : 53 8 Price : $ 57,500.0 0 Granto r Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 3 6076. 0 1. 0 124. 0 49. 0 N o Improvemen t Informatio n 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R l 03.. . 7/8/2009

### Dougla s County Accoun t Informatio n Pag e 2 of 2 Buildin g 1

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DBtitr«xiijuM, K «• « f) S f 

## TW O STOR Y CLIC KTO ENLARG E IMAG E 

### 9F'^T9I1!^'^9F'"*9 ^ Squar e Footage : 1352. 0 Percen t Complete : 

### 100.0% Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Fai r

Buil t As : 2 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 

### HVAC: Centra l Ai rt o Ai r Rooms : 6. 0 Exterior : Fram e Sidin g Units : 1. 0 

### Interior : Drywal i Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Hi p Stories : 2. 5 

### Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 192 5 0 % 192 5 8 3 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Unfinishe d Atti cW/floo r 676. 0 Applianc e Allowanc e 1. 0 Applianc e Fireplac e Masonr y 1. 0 Basemen t Bsmn t Bloc k 8 ft 676. 0 Fixtur e Bas e Fixture s 

### 1. 0 Fixtur e Bat h Ful l 

### 1. 0 Garag e Detache d 324. 0 Porc h Sla b Roo f Cei l 208. 0 Use r Need s TL C 

### 1. 0

http://douglasne.mapping-onIine.com/DouglasCoNe/static/accoimtinfo.jsp?accoimtno=R103. . . 7/8/200 9

# T C Propert yAddres s J ^ 3 3 l ^ i /^-f i :S T 

### Date n~l<- ^ Q Start Dat e " ^ ~ I S -o ^ En d Dat e 

### Amoun t O f Prim e An d Pain t Use d Prim e (Gallons )

Pol y(Boxe s 

# J L Pain t (Colo r .3(^ j i,x.i> ) ; V, ^ Amoun t (Gallons ) 

## i S 

## Q Pain t (Colo r Amoun t (Gallons ) Pain t (Colo r Amoun t (Gallons ) Pain t (Color ^ Amoun t (Gallons ) Pain t (Colo r Amoun t (Gallons )PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC . REUNIO N DIARI AD E SEGURIDA D 

# .-ocha. 7 -n^o ^ Pioyecto . Omoh o Ram i Stabilizalio n PiOje_c 1
Siti o d e Activida d Tarea s Dianas : 

### 2 . Pv^ t vy ^ o<X ~ 3 P'lVX^^ Z_- - ­ Primordial/Peligro s Potenciales : 

# 1 ..Bo-- ^ da y . 3 . COible.^—4<_i6lec-V<\ctclcici . 4. "T.ecW o d. e cc>-6cv . Herramienta s d e Trabajo : 

## 3 . ferooWcx^ 2 . _poY\poy2 > 

## 4 Oie^'e-'rc?^ciov^et > Practica s de l fiobajo/Accione s Correctivos : 

## M / ^ 3 4 Llomada s previas : 

## 1 _ M A . _ 3 . 2 . 4 . Firm o d e Registr o de l Empleado : 3 . 2 . Da:^.!!i.<: ^ tv^u.^Z-_ _ 4 . 5 . LO\(i^.<^i r<:)^./v-i^rv<Sp . 6 . 8 . 

## ::rf , . l^^/diiy^. _ ^ - SL ^ —O ^ Firm a d e SSlu d ySegurida d de l Siti o Fecl^ o

## Professiona l Environmenta l Engineers , Inc . INTERVENCIO N DE SEGURIDA D Nombif e de l Pi'OyCCto . 7 ) »! > 0~i ^ . » .^^^ ^ t?T. i Fech o d e l o Intervencio n _7jjr . if ' Z. ^ / Peligro s d e Saiu d Primordial : Ho + c i cx y Preocupacione s Primordiale s d e H & S : Tarea s Diarias : 1 . ^t ) OTO ^

^CKf. . 2 . P/^N^ATIC^V I 3 . P^kA^i^^V ^ Equip o Usad o e n e l Luga rd e Traabjo : 

### K Gafa s d e Segurido d Zapoto s Guante s d e Trabaj o Generodore s >c . X ­ >C , _Elevadore s GFC I . ^. . Chaleco s d e Segundo d Otr o J c -^ . Equip o List o par a Respuest a d e Emergenci a a Disposicio n Inmediata : Conduci rReunio n Diari a d e Segurida d .. . "/ • Estuch e d e Primero s Auxilio s -y ^ Procedimiento s d e Emergenci a v: _ Politic a d e Salu d ySegurida d d e l o Compani a y _ GFC I e n siti c>L . Deficiencias : 

## M/ ^

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