TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: 342Sg ^ Date: :S-|| - I f^ 

Address: 2.f^ll A^"^ ^ TW ^ 

Stabilization Contractor: Professional Environmental Engineers Year: 2010_ 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

IT Video of property (DVD) ^ _ 

IT Executive Summary 

^^""""^ Signed Access Agreement for subject property 

D Pre-Renovation Form signed by Property Owner 

Sy ^ Pre-Renovation Form for Occupant/Tenant, if applicable 

B"''^ Painting Agreement 

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

I&y- Renovation Recordkeeping Checklist signed by Certified Renovator 

sr Photographs /6i?^ ^ /?/j ^ flf^r 

^Sr^ Satisfactory close-out check list signed by Property Owner 

^ir Property close-out check list signed by EPA 

^y ^ Property information from Douglas County Assessor's Office 

D Hazard analysis, if prepared 

D Safety Audit 302040,35_ 

D Other (describe): 

Superfund 

1 Engmeers Signature 

'A UOR Signature 

(after file folder review) 
2010 

S I PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

M^ "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 

Property Address: 

Owner's Name: C^Ur+ l .S M- ^ I hjV^ ­

5(K)S.Ewlng, Suite E 

St Louis, MO 63103 

(314)531-0060 

Fax(314)531-(X)68 

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, colunms, rails, and exterior surfaces of garages. y

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 25 year product/quality? 

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

cleaned? A ^ 

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

roadways,, alleyways alleyways,, publi publicc acces accesss area areass anandd als alsoo remov removee ananyy othe otherr generate generatedd de 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. Has the property owner signed the completion form? 

t ^ 

11. Are there any property items that were temporarily re-located by the contractor that need to 

be moved back? 6 ^ 

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

unresolved? 

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

Ef»A COR Signature 

'Date^ 
i

PROFESSIONAL 

^ 0 5 Norm 24*. Slits 219 ENVIRONMENTAL ENGINEERS, INC. Onnha.NE68110 

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

amammmmtmaiBmmamamaiaaammamiimmmmmmmatmmmmBmmaKaua 

Consuttino « Engirieering Oastgn • RamedMion « Abaternem • EmergerKy Response 

Property Owner Close-Out Fonn 

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

_>SAID: 2-^\ \ WQS . 

 Property Address: /o^9, Q r 

Owner's Name: \\j X \ \ o VitW^ 

FerfDrmance Standards/Close-Oirt Criteria YES NO 

1. Was the entire stnictiire(s) painted witfa tiie exception of tiie stated, excluded 

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

eaves, siding, all trim, porches, box beams, columns, tails, and exterior surfeces of i^ ^ 

2. Was aU scraping and oAerprqiarationworic completed satisfactorily? 

3. Were aUrequiisd areas ofthestructure(s) primed as needed and painted with 

two top coats? 

4. Was die paint products utilized equivalaittp a 30 year produd/quality? a y 

5. Are all of the areas vAnae contaminated materials have been spilled Aorou^hly ^ vacuumed/cleaned? 

6. Did Ae contractor collect^racuumsdlfitUing and scraped paint chips on ^ 

entire property, roadways, alleyways, public access areas and also ronove any 

othe ^ r generated debris? 

7. Is the grass area fliat sunounds the stnicture(s) in reasonably good condition? i} y 

8. Are all items such as polyediyloie sheeting, ladders, paint brushes, cones, l y ^ barrier tape, etc. property removed? 

9. Is there any evidence ofproperty damage that was done by tbe extractor? Any 

property damage needs to be conqjleted prior to the EPA Close-Out [ y ^ 

10. Are there any pjq)ertyiteijM that wore tonponirily re-located by tiie contractor 

that need to be moved badk? 

11. Are dierB any (known) lingering issues with the property owner(s) Oat have 

been left unresolved? 

Comments: 

i-!$'/() Prepeily Owner SigEuture Date 

^-r^ ^ ' ^0I£ ? 

Professio )fessionarEnw}iimen i i ital Engineers Representative Date 
2505 North 24»', Suite 219 

Omaha, 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 Stabilization Omaha, Ne 

Close Out Report 

2010 

SAID# 34258 

2511 Ames Ave. 

• Dates worked: 04/12/10 to 04/13/10 

• Pre property condition: House has painted wood siding that has many areas of 

structure and cosmetic damages. Paint is also very poor and flaking off all over the 

yard. 

• Problems encountered: None 

• Owner request/concerns: N/A 

• Inspection/closeout dates. Owner signed 04/13/10,EPA 04/19/10 
SAID# 

Property Address 

Stories 

Garage? 

Access signed 

Pre-video 

Post video 

Contractor Assigned 

Date started 

Weather/temp 

Date ended 

Paint used 

Prime used 

Poly used 

EPA Paint Stabilization 2010 

?>42Sft 

'5,1 \ AVWes 7^-g-^ 

1^ 

4-Dl-J(:> 

4-1/,'20(0 

H(l2/lO 

^ 

2. : 

Problems/issues 
04/81/2010 09:15 4025728570 CURT MELTON PAGE 01 


CONSFN r K m ACX;I?:SS T O PHOPtiRTY 

OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

OWNER NAMEy. « ­

(Jifg.Tr.S /Vlea^-R)yi DAYTIME PHOFVE: ^74 . ^Vl/A 

CELL PHONE : Ayi-J7/L £ r^lAlL 

OWNER'S APDRiaS IF PIFFtRKNT: ^ A?A/ Uk<r/:X^^ OrV\iAtf ^ hI(=4J^ff/ 

TENANT'S NAME IF APPLICABLE: 

DAYTIME PHONE: 

CELL PHONE: E-.MAIL; 

ProfeMkHt*! B0vtroniii*iital Eiigiii«*rt, Inc. (PC) to ua«l«r contract («KP'R7-08-Otf) wHh the U.S. EnvirpniBCDtol Protcctioa 

Ageacy (EPA ) to atat>IUt« M M b«scil paint (LBP) on mkiciittel ttrvctarcs at a number of properties located In Omalia, 

N«brafkt. Tb* paint ««»bitixation work n beiai done to protect tkc soil cleanups that arc being performed by CFA contractors. 

Paint staMKnitioa aciirities wtN inclodc; scraping of cracked or flaking LBP from ttructares. applicatkkn of* prime coat and two 

(2) c«««» «l paint. Mofing part* of wtitdow* and doors ^jSJOSi ivclMded and will not be addressed. 

Yowr (6«peratk>a is rM)iM«tcd in giving pemissioa to this EPA contrsetnr (PE) to •nt«r and havt aecMs to tkls property for tk« 

purpose of stabMttiiog lead -based paint as ootlined on the property (denttfled above. 

By signing this dMumcnt I agree to aliow an EPA contraelor to conduct a soil rl«anup at my property foitowing coatplttioa of 

lead-based paint TtnMifa>tk>ii, if the soil cleanup itas not already been performed. I uodentand tbat the stabiiization contractor 

can not provkic assnraaccs that tb« «oil cleanup contractor will be bound to. I further anderstand that the soil cleaatip 

contractor will malic pli raasunable cfTons to adrtrasa concerns thai I, as the property owner, may have regarding soil clennap at 

my property. 

Yes.ihatMitad 

^-/- / ^ 

I fully under*taod tbat by signing this CoiiscNt for Accas^ (I) tbi* access wiU remain in effect until the work has been 

satisfactorily completed. (2) that the Property Owner or Ycnaot, if Hppiicjbte, will be given the Housing and Urban Owetopmeot 

(HUD) and EPA pamphlet, -Renovate Right, f mportnnt Le«4 llMsurd irjurmation fbr PamlUes, Day Care Provklen, and 

Schools'*, P) the Property Owner or tenant will remove all obst^iiclioav ttom siirl'aeev to he painted. (4) win abide by beahh and 

snfcQr guidance provMad by EPA, (S) will alktw phoi«t««phv of pro «r. ^;' - \ and afler the paint stnbiliaatton work, («) wIN h* 

contnctad by a PE representative approximately 4S hours in advance ol starting work, (7) agree not (o obstntot or lampar with 

any of tbe LBP stabilisntNm actions, aotf (8) wiW participate in final properly inspectioii aad sign Ihe Completion Agreement and 

Property Owner Satisfaction Survey. 

ShouM you have an.v «|acetions about the planed Lend Based-Pbiot subilixalion activities for your property, please contact 

ProfMSkmal Environmental Engineers, Inc. Project Manager. Willie Clay At 402-S04-4688. Cmcral questions about the Omalia 

Lead Site cleanup can be directed to Pauletta France>lsetis, EPA Remedial Project Maaager 402-731 2494. or the EP A Publir 

laformatton Centers at 402-991-9SE3 (North Omaha office) or 402-751.3049 (South Omaha office). 

^ Yes, I grant eceeee to my mopatty aiitf tms glMM the pampMM D NoiidonotgmfitactaestemypropaftyandtwM 

ItsaoiMis MgM, Impottsm Lead tntofmaiion Hr «iim>hH. Ctiua 9Kreo Pie pMnptilet -flanovale (tight, hnpotUrv. Lead 

Care Prwndsd, end Schools.* Infemiadon ler Famies, Chitde Care Providers, end 

fl4J±4>yyh^...^u=dL. SiioShH Sloaature t "^ Osia 

SliCClAL HSTIWCTIONS iMB COMSMIMTKMS 
CURT MELTON 
 PAGE 02 
 04/01/2010 09:15 4025728570 


PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

PROPERTY ADDRESS: 2-gM Ar-wi> /U^L 

BV10;.^42S1 

AREA(«) TO W PAINTED: 

Mouse PROPfR: /e. j COLOR; UJH I T<2. 

HOUaBTRlM; V G S .. - .CO.OR, HtZti J r-^ (;^^5sJ ^ 

OARAOE: Al ^ eoi OBOMiAae TRIML /1// ^ cat OR: 

PORCH: Ye.s COLOR: U/A^mo. 

PO^CHTRim: /fe. r ,.«>.«: <?«„,^ i^s m 

(COMPLETE AUL SECTION, ¥68, NO. *?« NON-itpPlJCABLI!) 

I AaRElS r o THE COLORS USTEO ABGiTE. ONCE THE PAINTIN; * 

BEGINS, I UNOCftSTAND i CAN NOT CriANOts IHE ABOVE SELEC'Igl) vOLOKS. 

•oa^snsiciJ*?:: 1 as-B^TBM as*: sim^mMHatMl I pnoPcnTv owMBit atoNArunc! 

huikl— 
PRE-BNOVATION FORM - OCCURNT 

This form is to be used by thefirms contracted by the Environmental Protection Agency-Region 7 to perform Lead-Based 

Paint stabilization activities at the Omaha Lead Site, Omaha, Nebraska. 

Occupant Confirmation 

Pamphlet Receipt 

D I have received a copy of the lead hazard information pamphlet, 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 performed in/on my dwelling unit. I received this pamphlet before the work began. 

Occupant Opt-out Aclmowledgment 

n(A) I confirm that I own and live in this property, that no child under the age of 6 resides here, that no pregnant woman 

resides here, and that this property is not a child-occupied facility. 

Note: A child resides in the primary residence of his/her custodial parents, legal guardians, foster parents, or 

informal caretaker if the child lives and sleeps most of time at the caretaker's residence. 

Note: A child-occupied facility is a pre-1978 building visited regularly by the same child, under 6 years of age, on at 

least two different days within any week, for at least 3 hours each day, provided that the visits total at least 60 hours 

annually. 

• (B) I understand that the renovationfirm, contracted by the Environmental Protection Agency (EPA), will be using leadsafe work practices required by EPA's Renovation, Repair and Painting Rule. 

Printed Name of Occupant 

Signature of Occupant Date 

Renovator's Self-Certification Option (for tenant-occupied dwellings only) 

Instruction to Renovator: If the lead hazard information pamphlet was delivered to the owner but a tenant signature was not 

obtainable, you may check the appropriate box below. 

D Declined -1 certify that I have made a good faith offer to deliver the lead hazard information pamphlet to the rental 

dwelling unit listed below at the date and time indicated and that the occupant declined to sign the confirmation of receipt. I 

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

D Unavailable for signature - 1 certify that I have made a good faith effort to deliver the lead hazard information pamphlet 

to the rental dwelling unit listed below and that the occupant was unavailable to sign the confirmation receipt. I further 

certify that 1 have left a copy of the pamphlet at the unit by sliding it under the door or by (fill in how pamphlet was left) 

Printed Name qf PersojnCn Certifyin e g Delivery Attempted Delivery Time 

Signature of Pereon Certifying Lead Pamphlet Delivery Date 

Unit Address 
Douglas County Accoimt Information Page 1 of2 rmatK 

a^Z58 

Douglas County, Nebraska Property Record - R1420080000 

Print Reoort 

NEW Feature - Parcel Dimensions available m scale 0-50 ft west of 52nd St - Vle W O n MB D Information is valid as of 2010-3-16 Treasurer's Tax Report 

New Feature ••-•- • Auto Sales Search 

Owner • • - — — - — 

MELTON JR CURTIS A 

ETAL 

PO BOX 111512 

OMAHA NE 68111-0000 

Property Informatio n 

Key Number: 2008 0000 14 

Account Type: Residential 

Parcel Number: 1420080000 

Parcel Address: 2511 AMES AV 

OMAHA NE 68111-0000 

Legal Description: ISABEL ADD LOT 3 BLOCK 2 45 X 125.5 

Value Informatio n 

Land //nproi^ement Total 

2009 

2008 

2007 

2006 

2005 

2004 

$2,500.00 

$2,500.00 

$2,500.00 

$2,500.00 

$2,500.00 

$2,500.00 

$24,400.00 

$24,400.00 

$24,400.00 

$24,400.00 

$8,800.00 

$8 ,000.00 

$26,900.00 

$26,900.00 

$26,900.00 

$26,900.00 

$11,300.00 

$10,500.00 

Sales Informatio n 

Sales Date: 2003-08-26 

Deed Type: WD Book: 2003 Page: 206196 1 

Price: $29,000.00 

Grantor: John Hauschild Etal 

Grantee: Curtis Melton Jr. Etal 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.12 5625.0 1.0 125.0 45.0 No 

Improvemen t Informatio n 

http://douglasne.mapping-online.eom/DouglasCoNe/static/accountinfo.jsp?accountno=Rl4... 3/29/2010 
Douglas County Account Information Page 2 of2 

:S11 AMES * v 

tt/—-'i 

sir 

UMf t».K" '.t**!! ; 

2 Story 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE

Square Footage: ! 1238.0 Percent Complete: 100.0% 

Perimeter i 0.0 Quality: Average 

Unit Type: End Condition: , Fair 

Built As: 2 Story Condo Square Footage: i 0.0 

HVAC: Forced Air Rooms: 6.0 

Exterior: ! Frame Siding Units: 2.0 

Interior: Drywall Baths: ' 2.0 

Roof Cover: ; Composition Shingle Bedrooms: ' 2.0 

Roof Type: Gambrei Stories: 2.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1900 0% 1900 110 

Defa/7 Type Deta/7 Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 637.0 

Fixture Additional Fixtures 1.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 2.0 

Porch Slab Roof Ceiling 21.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R14... 3/29/2010 
(effective April 2010) 

RENOVATION RECORDKEEPING CHECKLIST 

Name of Firm: 

Ht kfi/icc'b 

Date and Location of Renovation: ^-^13^10 ^ ^6/ / M/iAX^ ^ /\\JCC 

Brief Description of Renovation: /?^/'/?-r 'h\M)\\\tCa'\0\ 0 

Name of Assigned Renovator: X / / t>Tt C^V) M^CXfl vO 

Name(s) of Trained Workers: -

Name of Dust Sampling Technician, Inspector, and/or Risk Assessor, if used: MIA 

D Copies of renovator and dust sampling technician qualifications (training certificates, certifications) on file. 

^ ^ Certified renovator provided training to workers on (check all that apply): 

fflTosting warning signs ISCSetting up plastic contairmient barriers 

"^Maintaining containment Q^Avoiding spread ofdust to adjacent areas 

^ Waste handling "S^Post-renovation cleaning 

D Test kits used by certified renovator to determine whether lead was present on coniponents affected by 

renovation (identify kits used and describe sampling locations and results: /L//yT 

S^Waming signs posted at entrance to work area. 

ScWork area contained to prevent spread ofdust and debris. 

D Windows in and within 20 feet of the work area are closed 

• Doors in and within 20 feet of the work areas are closed and sealed 

D Doors that must be used in the work area are covered to allow passage but prevent spread ofdust. 

D Ground covered by plastic sheeting extending 10 feet from work area - plastic anchored to the 

building and weighted down by heavy objects. 

D If necessary, vertical containment installed to prevent migration ofdust and debris to adjacent 

property. 

"S^aste contained on-site and while being transported off-site. 

1 

Renovation Recordkeeping Checklist Omaha Lead Site 
(effective April 2010) 

Yl Work site properly cleaned after renovation. 

1S>A11 chips and debris picked up, protective sheeting misted, folded dirty side inward, and taped for 

^Qhioval. 

'^Work area HEPA vacuimied to get paint chips from groimd surface, if necessary. 

D Certified renJvvato i r performed post-renovation cleaning verification (describe results): 

\ 1 J^rtily under penalty of law that the above information is true and complete. 

Name and Title Date 

Renovation Recordkeeping Checklist Omaha Lead Site 
Pfofesstenal Eiwitonmeittat EntHneets. Inc. 

25(»N. 24th street Tel: 402-504-4688 Toll-free: 1888 7813999 

Omaha^ NE 68110 ^MmS^SOlMiOl www.pe-engrs.com 

Remediation « Environmental Consulting e Abatement of Hazardous N4aterials • Emeigency Response 

HubZone, SDB, MB^ D6E certified with more than 20yeais experience! 

FAX SHEET 

TO: (jji.tUs (iV^V)0> FROM; J^Np \V/3. ^:^2MNclLe^A 

COMPANY # OF PG8: H ^ C 0<>^ ^ 

PAX: f^yjL -^5*70 DATE: ^/2^ t 

PHONE: RE: ^^=^n Q P' . P^V^A-g^A^ 

D Urflent D For Reviow D Please Comment D Please Reply D Please Recycle 

• Commonts: 

VV.<<X^-NXC J C cn ^ d> 

Professional, Cost-Effective Sohitions!