# ^ r TRANSMITTA L o f

OMAHA LEAD SIT E PAIN T STABILIZATIO N FIL E FOLDE R SAID#:?.'Z\ m 

# Date : J2i2DU l

Stabilizatio n Contractor : Professiona l Environmenta l Engineer s Year : 2DXl - PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S Vide o o f property (DVD ) Executiv e Summar y Signe dAcces s Agreemen t fo r subjec t property Pre-Renovatio n For msigne db y Property Owne r Pre-Renovatio n For mfo r Occupant/Tenant , i f applicabl e Paintin g Agreemen t Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) Renovatio n Recordkeepin g Checklis t signe dby Certifie dRenovato r Photograph s Satisfactory close-ou t chec k lis t signe db y Property Owne r 

### 0 , Property close-ou t chec k lis t signe db y EPA Property informatio n fromDougla s County Assessor' s Offic e Hazar danalysis , i f prepare d Q 

### Safet y Audi t & 

### Othe r (describe) : 

# W ­ )at e 

# AMMJ ^ (after file folde r review ) 4037756 5 Superfun d

## 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 

## ''° ' Tm'a' t NEe's?! ' ^

^t°^ | !^1to! ? Fax(402 ) 504-328 1



### Lea dBas e Stabilizatio n Omaha , N e Clos e Ou t Repor t 201 1 SAID #3210 4 257 0 Evan s S t

•Date s worked : 9/2 6 t o 9/2 8 201 1 •Pr e propert y condition : Hous e ha s mostl y viny l sidin g wit h painte dwoo dtrim s an d foundatio n areas . Garag e i s painte dwoo dan di n poo r condition . Pain t wa s flakin g of T i n areas . •Problem s encountered : None . •Ownjer request/concerns : N/ A •Inspection/closeou t dates . Owne r 10/21/1 1

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

# ENVIRONMENTA L ENGINEERS , INC . Omatia , 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 

## 201 0 Propert y Owne r

Close-Out For m (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) 

# SAID : 3^i0 4 Property Address : 

# aS-7 D ^\/A/\/ S Owner' s Name : X^^f^'^l<J ^ 6 A-g ^ P<'f^.C> ^ Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) painte dwith th e exceptio n o f th e stated , exclude dareas ? 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 , colimms , rails , an dexterio r surface s o f garages . 2 . Wa s al l scrapin g an dothe r preparatio n wor k

complete dsatisfactorily ? 

# X 3 . Were al l require darea s ofth 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 a2 5 year prodiict/quality ? 

# 1 5 . Ar e al l ofth e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y vacuumed / cleaned ? 

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

# t 7 . I s th e grass are atha t surround s th e structure(s ) i n reasonabl y goo dcondition ? 

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

# X 9 . I s ther e an y evidenc e ofpropert y damag e tha t wa s don e b y th e contractor ? Any propert y damag e need s t o b e complete dprio r t o th e EP A Close-Out . 

# X 10 . Ar e yo u satisfie dwith th e wor k

performed ? 

# X 11 . Are ther e any propert y item s tha t wer e temporarily re-locate db y th e contractor tha t nee dt o b e move dback ? 

# y 12 . Ar e ther e an y (known ) lingerin g issue s v/it h th e property owner(s ) tha t hav e bee n lef t uru-esolved ? 

# y Othe r Considerations/Propert y Owne r Discussions/Additiona l Wor k

thati s Required : 

# rS'^./ ^ / / Dat e
Professional ental Engineer s Signatur e

### Professiona l Environmenta l Engineers : EP A Pain t Stabilizatio n 201 1 

# 3- . m m Propert yAddres s 

# 96nc ^ K.(yP ) 3 V Stories / Sidin g typ e / / Z

_Transit e Woo d Viny l Meta l Stucc o Garage ?
Dat e acces s sig r Yes ^ t^- ^ 

# n/lrr/ / 1 N o Painted ? Where ? Ye s Sidin g Tri m N o

Pre-vide o Pos t vide o Contracto rAssigne d Gat e starte d Weathe rCondition s 

# /l-Di^ryn ^ /^/v^ ' f/2^6 . A ^ Dat e ende d 

# 9 

# A^/ ^

Pain t use d ^ ^ Prim e use d Pol yuse d 

# A . 3^> d

Problems/Issue si-'-'isciv e Apri l 2010, 1


### RENOVATIO N RECORDKEEPIN G CHECKLIS T
Nam e o f Firm : 

# /k)^^ ^ t^y^fx^^^C ^ Dat e andLocatio n o f Renovation ; gl
- 6 / ^ " " £ ^ O A-* ' ^ Brie f Descriptio n o f Renovation : Sy ^ ^
- ^ Z ^ ^ — Nam e o f Assigne dRenovator : C^ ^ ^ ^ ^^^^^ ^ Name(s ) o f Traine dWorkers : ^yj~d^ y ^^^^'"^ . LJQ C 

### 6^*^ , $?U / ^^U,^>^ Nam e o f Dus t Samplin g Technician . Inspector , and.'or Risk Assessor , i f used :

- - Copie s o f renovato r an ddus t samplin g technician qualification s (trainin g certificates , cenifications ) on tile . Certifie drenovato r provide dtrainin g t o worker s o n (chec k al l tha t apply )

~. Postin g warnin g sign s 7 Settin g u p plasti c containjrtent barrier s Maintainin g containmen t Z Avoidin g spreadof dus t t

o adjacen t area s '. ' Waste handlin g '_Post-renovatio n cleanin g

_Tes t kit s use db y certifie drenovato r t

o determin e whether lea dua s presen t o

n component s affecte db > rcno\atio n (identif y kit s usedan ddescrib e sam.plm g location s an dresult.^ . ;
Warnin g sign s poste da t entranc e t o wor k

area .

. Wor k

are acontaine dt o prevent spreado f dus t an ddebri s "I/Window s i n andwithi n 2 0 fee t ofth e vvor k

are aar e close d

. ' Door s i n an dwithi n 20 tee t o t th e wor k

area s ar e close dan dseale d /Door s tha t mus t b

e use di n th e uor k are aare co\ere dt o allo u passag e bu t prevent sprea do f dust . (^Groun dcovere db y plasti c sheetin g extendin g I U fee t fro mwor k

are a- plasti c anchore dt o th e buildin g an dweighte ddow n b v heavy objects . Z Ifnecessary . vertica l contain.ment installe dt o prevent m.igration o f dus t an ddebri s t o adiacen' . property . .Wasterontainedon-stt e an dvvhlle'beih atransporte ddff-sTt e - - - •i-.-i^iL-iiv c .Apri ; 2UI0 l

v ^1 1 chip s an ddebri s picke dup . protectiv e sheetin g misted , folde ddirt y sid e inward , an dtape dfo r ^ Wor k sit e properl properl y cleane dafte r renovation . 

### -A v

Wor k are aHEP A vacuume dto get pain t chip s fro mgroun dsurface , ifnecessary , ^Ce n ifie drenovato r performe dpost-renovatio n cleanin averificatio n (describ e results )

certif y undeiypt?nalr > oria\< . that th e abov e inforniatio n is tru e an dcomplete 

# '?(^f^ . Nam e an dTitl e Dat e

# 3 ^ Dougla s County , Nebrask a Propert yRecor d ­ R210059000 0 Informatio n i s vali d a s o f 2011-7-2 9 Ne w Featur e •*-•- > Prin t Repor t Vie w Interactiv e GI S Ma p Treasurer' s Ta xRepor t Subdivisio n Sale s Searc h Owne r BARFIEL D DWAYN E ETA L 257 0 EVAN S S T OMAH A N E 68111-000 0 Propert yInformatio n Ke yNumber : 005 9 000 0 2 1 Accoun t Type : Residentia l Parce l Number : 210059000 0 Parce l Address : 257 0 EVAN S S T OMAH A N E 68111-000 0 Lega l Description : REDICKS-CLARK-AD D LO T 2 2 BLOC K2 46.2 3 X 12 4 Valu e Informatio n 201 1 201 0 200 9 200 8 200 7 200 6 Lan d $2,500.0 0 $2,500.0 0 $2,500.0 0 $2,500.0 0 $2,500.0 0 $2,500.0 0 Improvemen t $43,600.0 0 $45,100.0 0 $45,100.0 0 $45,100.0 0 $38,600.0 0 $38,600.0 0 Tota l $46,100.0 0 $47,600.0 0 $47,600.0 0 $47,600.0 0 $41,100.0 0 $41,100.0 0 Sale s Informatio n Sale s Date : 2003-12-0 2 Dee d Type : Price : Grantor : Grantee : Valid/Invalid : W D $50,000.0 0 Jo yJone s Dwayn e Barfiel d eta l Vali d Book : 200 3 Page : 24850 8

Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 3 5704. 0 1. 0 124. 0 46. 0 N o Improvemen t Informatio nBuildin g 1 Tw o Story 257 0 Evan * S t

fkMflUi r/] <

milie u

BMraKfitoLkfi ) mMlir.qF t CLIC KTO ENLARG E IMAG E Squar e Footage : 1308. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

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 Viny l Units : 1. 0 Interior : Drywal l Baths : 1. 5 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Hi p Stories : 2. 0 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 190 9 0 % 190 9 10 2 Detai l Typ e Oefa/ 7 Descriptio n Unit s Ad d O n Fenc e Chai n Lin k 1. 0 Applianc e Allowanc e 1. 0 Basemen t i Bsmn t Bloc k 8 ft 684. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Fixtur e Bat h Hal f 1. 0 Garag e Detache d 280. 0 Porc h En d Soli d Wal l 36. 0 Porc h En d Sdi d Wal l 160. 0

## CONSEN T FO RACCES S T O PROPERT Y OMAH A LEA D SIT E REMEDIA L ACTIO N - LEAD-BASE D PAIN T STABILIZATIO N PROPERT Y I I 

# 3z m PROPERT Y ADDRESS : O^'f O ^^/^ P ^ ^ OWNE R NAME : A DAYTIiVI E PHONE : H/ ^ ^ - S O I -O^^g" ? CEL L PHONE : E-MAIL : OWNER' S ADDRES S I FDIFFERENT : TENANT' S NAM E I FAPPLICABLE : DAYTIM E PHONE : CELLPHONE : E-MAIL : 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 lea d base d pain t (LBP ) o n residentia l structure s a t a numbe ro f propertie s locate d i n Omaha , 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 d b y EP A contractors . Pain t stabilizatio n activitie s wil l include : scrapin g ofcracke d o rflakin g LB P fro m structures , applicatio n o f a prim e coa t an d tw c (2 ) coat s o f paint . Movin g part s o f window s an d door s ar e no t include d 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 A contracto r(PE ) t o ente ran d hav e acces s t o thi s propert yfo rth e purpos e o f stabilizin g lea d -base d pain t a s outline d o n th e propert yidentifie d above B ysignin g thi s documen t I agre e t o allo w a n EP A contracto rt o conduc t a soi l cleanu p a t m ypropert yfollowin g completio n o f lead-base d pain t stabilization , i f th e soi l cleanu p ha s no t alread ybee n performed . I understan d tha t th e stabilizatio n contracto r ca n no t provid e assurance s tha t th e soi l cleanu p contracto rwil l b e boun d to . I furthe runderstan d tha t th e soi l cleanu p contracto rwil l mak e al l reasonabl e effort s t o addres s concern s tha t I , as th e propert yowner , ma yhav e regardin g soi l cleanu p a t m yproperty . S'Yes , I hav e rea d ani ^

understan d tlyaoiaragrap h above . Signatur e o j Propert yOwne r ' oa( e I full yunderstan d tha i b ysignin g thi s Consen t fo rAccess , (I ) thi s acces s wil l remai n i n effec t unti l th e wor k ha s bee n satisfactoril ycompleted , (2 ) tha t 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 informatio n fo rFamilies , Da yCar e Providers , an d Schools" , (3 ) th e Propert yOwne ro rtenan t wil l remov e al l obstruction s fro m surface s t o b e painted , (4 ) wil l abid e b yhealt h an d safet yguitianj e provide d b y EPA , (5 ) wil l allo w photograph yo f propert ybefor e an d afte rth e pain t stabilizatio n work , (6 ) wil l b e contacte d b y a-P E representativ e approximatel y4 8 hour s i n advanc e o f startin g work , (7 ) agre e no t t o obstruc t o rtampe rwit h an yofth e LB P stabilizatio n actions , an d (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 rSatisfactio n Survey . Shoul d yo u hav e an yquestion s abou t th e plane d Lea d Based-Pain t stabilizatio n activitie s fo ryou rproperty , pleas e contac t , Professiona l Environmenta l Engineers , Inc . Projec t Manager , Willi e Cla yo rKelle ySander s A t 402-504-4688 . Genera l question s abou t th e Omah a Lea d Sit e cleanu p ca n b e directe d t o Pauiett a France-Isetts , EP A Remedia l Projec t Manage r402-731-2454 , o r th e EP A Publi c Informatio n Center s a t 402-991-958 3 (Nort h Omah a office ) o r402-731-304 5 (.Sout h Omah a office) . 9 - Yes , I gran t access t o m ypropert yan d vira 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 vra 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 Car e ProvidesB , an d Schools. " Informatio n fo rFamilies , Child e Car e Providers , an d Schools. " Signatur e / \

[fet e Signatur e Date SPPCIA I INSTHIirTinw c Au n rnuciPiCDATinn e

## PRE-RENOVATIO N FORi M - OWNE R Thi s for mi s to b e use db y th e firm s contracte db y th e Environmental Protectio n Agency-Regio n 7 to perfonn Lead-Base d Pain t stabilizatio n activitie s a t th e Omah aLea dSite . Omaha . Nebrask a Owne r Confirmatio n Pamphle t Receip t S O hav e receive dacop y ofth e lea dhazar dinformatio n pamphlet . Renovat e Riglii : Important LeadHazar dInfonuadonfo r 'Families , Chil dCar e Provider s an dSchools , informing m e ofth e potential ris k ofth e lea dhazar de.^cposur e fro mrenovatio n activit ) t o b e performe din/on m y dwellin g unit . I receive dthi s pamphlet befor e th e wor k

began . Ow ne r Acknowledgmen t G (A ) 1 conrirmthat 1 own an dliv e i n thi s propens . tha t n

o chil dunder th e ag e o f 6 reside s here , tha t n

o pregnan t uoma n reside s here , andthat thi s propert y i s not acliild-occupie dfacility . Note : A chil dreside s i n the primar v residenc e of his/her custodial parents , lega l guardians , foste r parents , o r informa l caretake r i

f th e chil dlive s andsleep s mos t o f time a t the caretaker' s residence . Note : A child-occupie dfacilit y i s apre-197 S buildin g \isite dregularl y b y the same child , luide r 6 year s o f age , o n a t leas t tw o different day s withi n an y week , fo r a

t leas t 3 hour s each day , provide dtha t th e visit s tota l a t leas t 6 0 hour s annually . J^iB ) I understan dtha t the renovatio n firm , contracte db > the F.n \ironmenta l Protectio n .Agenc v (F.PA) . wil l be usin g lead
saf e uor k practice s require dh > HPA' s Renovation , Repair andPaintin g Rule .

Printe dNam e o f Owner-Occupan l



# . ^ 9-^^'i ^ Signatur e ofOwier-Occupan l / Dat e

## PAIN T STABILIZATIO N PRE-PROPERTY PAIN T MATC H ASSESSMEN T PROPERT Y ADDRESS : QJSl ^ 

## i£ifM-/LS . DATE : ^ ' / 7-1 ^ 

## BVID : ?^9.lO Y

AREA(S ) T O B E PAINTED : 

## CXuJCO L HOUS E PROPER : COLOR :
HOUS E TRIM : "^^ J 

### COLOR : <;< ^ n^cT ^

-"^^ ^
GARAGE : COLOR : 

## U ) 

## ^tt . 5V/ * ^
GARAG E TRIM : COLOR : 

### ^C9G>2
-
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 . ONG E TH E PAINTIN G BEGINS , I UNDERSTAN D I CA N NO T CHANG E TH E ABOV E SELECTE D COLORS : PROPERT Y OWNE R SIGNATURE : P E ACCESO R SIGNATURE :