### TRANSMITTA L o f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R 

## SAID#:Z%€ M Date : 0^^-9( 1 Address : i^2D-M_^( ^ . ^ Stabilizatio n Coniractor : Professiona l Environmenta l Engineer s Year : ^0 1 | PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUIVIENT S 

## 0 / Vide o ofpropert y (DVD ) 

## * / Executiv e Summar y Signe dAcces s Agreemen t fo r subjec t propert y Pre-Renovalio n Fomi signe dby Property Owner 

## D Pre-Renovatio n For mfo r Occupant/Tenant , i f applicabl e Paintin g Agreemen t 

## D Settlemen t document s (i.e. , fo r damag e o r t

o replac e plants , etc. ) 

## 1

/ Renovatio n Recordkeepin g Checklis t signe db y Certifie dRenovato r Photograph s Satisfactory close-ou t chec k lis t signe db y Propert y Owne r Propert y close-ou t chec k lis t signe db y EP A 

# r / Property informatio n fro mDougla s Count y Assessor' s Offic e D 

### Hazardanalysis , if prepare d D 

### Safet y Audi t D - 

### Othe r (describe) : 

### >-S\jU L Prot e rorimepiita i Engineer s Signatur e ^


### EPA CO RSiSnalure / ^Dat e urn . v.^wrs . oi^uttLLii c 

### (after file folde r review ) 4037755 7 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



### LeadBas e Stabilizatio n Omaha , N e Clos e Ou t Repor t 201 1 SAID #2368 4 420 N 4 0 S t 250 5 Nort h 24»' , Suit e 21 9 Omaha , N E 6811 0 (402 ) 504-468 8 Fa x (402 ) 504-328 1



### •Date s worked : 6/ 1 t o 6/ 2 201 1 •Pr e propert y condition : Hous e an dgarag e hav e painte dwoo dshingl e sidin g wit h painte dwoo dtrim s tha t wer e i n poo r conditio n prio r to stabilization. . Pain t wa s flakin g of f

in areas . •Problem s encountered : None . •Owne r request/concerns : N/ A •Inspection/closeou t dates . Owne r 6/11/1 1 EP A 9/30/1 1

## PROFESSION ^ 250 5 Nort h 24 ^ Suite 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 

### 201 1 

### EP A Close-Ou t Form (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) SAID : 

# :^3^^ ^ Propert y Address : ^2 0 /\ / ^ 0 S' f Owner' s Name : 

# -IV-mv Q '^\iA C Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) painte dwit h th e exceptio n ofth 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 , columns , rails , an dexterio r surface s o f garages . 2 . Wa s al l scrapin g an dother preparatio n wor k

complete dsatisfactorily ? 3 . Were al l require darea s ofth e structure(s ) prime da s neede dan dpainte dwith tw o to p coats ? 

# i Z 4 . Wa s th e pain t product s utilize dequivalen t to a2 5 year product/quality ? 

# I Z 5 . Are al l ofth e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y vacuumed / l / 

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

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

# l y properl y removed ? 9 . I s ther e any evidenc e ofpropert y damag e tha t wa s don e b y th e contractor ? Any property damag e need s t o b e complete dprio r t o th e EPA Close-Out . 10 . Has th e propert y owne r signe dth e completio n form ? 11 .Ar e ther e an y property item s that wer e temporaril y re-locate dby th e contracto r that nee dt o i ^ 

### b e move dback ? 12 . Ar e ther e an y (known ) lingerin g issue s wit h th e property owner(s ) that hav e bee n lef t unresolved ? Othe r Considerations/Propert y Owne r Discussions/Additiona l Wor k

that i s Required : 

# m ^ EP A CO RSignatur e

## PROFESSIONA L 50 0 S
. Ewing , Suit e E 

## ENVIRONMENTA L ENGINEERS , INC
. St
. Louis , M O 6310 3 (314)531-006 0 "t'lUVidiii g UU^i-i.J!!fri.:i n t : <:i:'tvi:0!ilnei!tci ! iSOliliii>:i: / Fa x(314 ) 531-006 8 (.'••.iiis'.l!-!!.! . • hi.OV.n-.-,ii,; l ; l l ••.i-.l'. i • f: . '. 1 i ;'•.• • -:;i . •:l l • I'.ii ! 'i.j-'iV j 

# 20\ ) Property Owne r Close-Ou t For m (Lead-Base dPain t Stabilizatio n EPA Contrac t EP-R7-08-06 ) SAID : 

# P.3^^ V Property Address : ^ X- ^ ^ H ^ ^ ^ 

### Owner' s Name : fhCv^JA/A.^/ , (^^jh i ^

- Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) painte dwit h th e exceptio n ofth 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 , columns , rails , an dexterio r surface s o f garages . 

# 5 ^ 2 . Wa s al l scrapin g an dothe r preparatio n wor k

complete dsatisfactorily ? 

# 4 ^ 3 . Were al l require darea s ofth e structure(s ) prime da s neede dandpainte dwit h tw o to p coats ? 4 . Wa s th e pain t product s utilize dequivalen t t o a2 5 yea r product/quality ? 5 . Ar e al l ofth e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y vacuumed / cleaned ? < 

### 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 an y othe r generate d debris ? 1 . I s th e grass are athat surround s th e structure(s ) i n reasonabl y goo dcondition ? 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 ? 9 . I s ther e an y evidenc e o f property damag e that wa s don e by th e contractor ? An y property 

# K damag e need s t o b e complete dprio r t o th e EPA Close-Out . 10 . Ar e yo u satisfie dwit h th e wor k

performed ? ^ 

### 11 . Ar e ther e any property item s tha t were temporaril y re-locate db y th e contracto r that C ^ nee dt o b e move dback ? 12 . Ar e ther e any (known ) lingerin g issue s wit h th e property owner(s ) tha t hav e bee n lef t unresolved ? 

# ( X Othe r Considerations/Property Owne r Discussions/Additiona l Wor k

that i s Required : 

# /> C 

# (JXMMAA . 0(1^ / Propert y Owne r Signatur e Date ' 

# £d k Professional ineer s Signatur e \Dat eProfessiona l Environmenta l Engineers : EP A Pain t Stabilizatio n 201 1 

# mo? h SAID # Propert yAddres s 

# n A J M O ^- v Stories / Sidin g typ e Transit e Woo d Viny l IVIeta l Stucc o Garage ? Ye s N o Painted ? Ye s N o Where ? Sidin g 

### x%.{ n 

### 1 I I I Tri m Dat e acces s signe d ^ ^ Pre-vide o D/J//// / Pos t vide o Contracto rAssigne d Dat e starte d 0 ^ \ ( Dat e ende d 

# W
Weathe rCondition s

Pain t use d Prim e use d Pol yuse d Problems/Issue s(efTectiv e Apri l 2010 )



### RENOVATIO N RECORDKEEPIN G CHECKLIS T
NameofFimi : A jrfheA^/l ^ ^^iUT\\J( ^ Dat e an dLocatio n o f Renovation : Brie f Descriptio n o f Renovatio n Nam e o f Assigne dRenovator : f^v^/^itif J (J/f^~ ^ Name(s ) o f Traine dWorkers : Nam e o f Dus t Samplin g Technician , Inspector , and/o r Ris k Assessor , if used : S ' Copie s o f renovato r an ddus t samplin g technician qualification s (trainin g certificates , certifications ) on file . 'Q ^ Certifie drenovato r provide dtrainin g to worker s on (chec k all tha t apply) : H^Posting warnin g sign s i ^ Settin g u p plasti c containmen t barrier s si/Maintainin g containmen t ^ Avoidin g sprea do f dus t t o adjacent area s 5^^ast e handlin g Q/Post-renovaiio n cleanin g ' 0 Tes t kit s use db y certifie drenovato r to determin e whether lea dwa s presen t o n component s affecte db y rehovatio n (identif y kit s use dan ddescrib e samplin g location s an dresults :

Warnin g sign s poste da t entranc e t o wor k

area . ^llWor k are acontaine dto preven t sprea do f dus t an ddebris . J^

r

Window s in an dwithi n 2 0 fee t ofth e wor k

are aar e close d j p Door s i n an dwithi n 2 0 fee t o f th e wor k

area s are close dan dseale d Q

* Door s tha t mus t b e use di n th e wor k

are aare covere dt o allo w passag e bu t preven t spreado f dust . S/Groun dcovere dby plasti c sheetin g extendin g 1 0 fee t fro mwor k

are a- plasti c anchore dt o th e buildin g andweighte ddow n b y heav y objects . O^I f necessary , vertical containmen t installe dt o preven t migratio n o f dus t an ddebri s to adjacent property . & Waste containe don-sit e andwhil e bein g transporte doff-site .

Renovatio n Recordkeepin g Checklis t Omah a Lea d Sit e(LM' L



### ^ Wor k

sit e properl y cleane dafte r renovation . /5^A1 1 chip s an ddebri s picke dup , protectiv e sheetin g misted , folde ddirt y sid e inward , an dtape dfor removal . ^ Wor k

are aHEP A vacuume dt o ge t pain t chip s fromgroun dsurface , ifnecessary . ^ Certifie drenovato r performe dpost-renovatio n cleanin g verificatio n (describ e results) : p£ ^ 1 certif y unde r penalt y o f la w tha t th e abov e informatio n i s true an dcomplete .

Nam e an dTitle Dat e

Renovatio n Recordkeepin g Checklis t ' Omah a Lea d Sit e5/26/201 1 Jougla s Count yAccount Informatio n 

# ^o'hQ m Dougla s County , Nebrask a Propert yRecor d - R201940000 0 Prin t Repor t Vie w Interactiv e GI S Ma p Informatio n i s vali d a s o f 2011-5-1 6 Treasurer' s Ta xRepor t Ne w Featur e - » • ^ * > Subdivisio n Sale s Searc h Owne r ALTI C BARBARA J ETA L 42 0 N 4 0 S T OMAH A N E 68131-000 0 Propert yInformatio n Ke yNumber : 194 0 000 0 2 0 Accoun t Type : Residentia l Parce l Number : 201940000 0 Parce l Address : 42 0 N 4 0 S T OMAH A N E 68131-000 0 Lega l Description : POPPLETO N PAR KL0T 4 BLOC K1 9 53X111. 5 Valu e Infonnatio n Lan d Improvemen t Tota l 201 1 $6,200.0 0 $128,700.0 0 $134,900.0 0 201 0 $6,200.0 0 $120,400.0 0 $126,600.0 0 200 9 $6,200.0 0 $120,400.0 0 $126,600.0 0 200 8 $6,200.0 0 $120,400.0 0 $126,600.0 0 200 7 $6,200.0 0 $98,800.0 0 $105,000.0 0 200 6 $6,200.0 0 $98,800.0 0 $105,000.0 0 Sale s Informatio n Sale s Date : 2005-03-2 8 Dee d Type : W D Book : 200 5 Page : 12916 0 Price : $100,000.0 0 Grantor : SONJ A D HANSE N Grantee : BARBARA J ALTI C ETA L Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 2002-06-2 1 Dee d Type : W D Boo^c ; 221 5 Page : 37 9 Price : $85,000.0 0 Grantor : .mapping-online.com/.../accountinfb.j..
. 1/ 45/2§/201 1 Dougla s Count yAccount Informatio n Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widti i Vacan t 0.1 3 5883. 0 1. 0 111. 0 53. 0 N o Lan d Attribute s Attribut e Attribut e Descriptio n Negativ e Influence Traffi c 1 Improvemen t Informatio n Buildin g 1 1 1/ 2 Stor yFi n 42 0 N 4 0 St

IS O Kl i

• v > 0 C«»ik

Mul l SWOTd Flo w BTI1. D S^
. R 1127. 0 sq.n . «a ^ j w " ' To ] f»f f

8tn«i?t>(iiai ! i'^7i>^< i f l CUC KTD ENLARG E IMAG E CUC K TO BttARG E milAG E Squar e Footage : 1997. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 7. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 2. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 193 4 0 % 193 4 7 7 Detai l Typ e Detai l Descriptio n Unit s

. mapping-online.com/.../accountinfo.j.
. 2/ 4

## 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 ID PROPERT V ADDRES S 

# Ml ) IOHP ^ OWNE RNAM E t NAME : I A ] { t 

### DAYTIM E PHONE : ^ ^ j /T ^ '5 T CEL L PHONE : E-MAIL : OWNER' S ADDRES S I FDIFFERENT : TENANT' S NAM E I FAPPLICABLE : 

### DAYTIM E PHONE : CEL L PHONE : E-MAIL : Professiona l Environmenta l Engineers , Inc . (PE ) i s unde r contrac t (#EP-R7-08-06 ) with tli e U.S . Environmenta l Protectio n Agenc y (EPA ) t o stabiliz e lea dbasedpain t (LBP ) o n residentia l structure s a t anumbe r o f propertie s locate din 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 db y EP A contractors . Pain t stabilizatio n activitie s wil l include : scrapin g ofcracke do r flakin g LB P fro mstructures , applicatio n o f 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 for th e purpos e o f stabilizin g lea d-base dpain t a s outline don th e propert y identifie dabove . B

y signin g thi s documen t I agre e t o allo w a n EPA contracto r t o conduc t asoi l cleanu p a t m y propert y followin g completio n of lead-base dpain t stabilization , i f th e soi l cleanu p ha s no t alread y bee n perrormed . I understan dtha t th e stabilizatio n contracto 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 to 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 m

y property . 

### QAes , I hav e rea d j^ d undcy^tan d th e paragrap h above
. ad an d undYSt : A4IL , / / Signatur e o f Propert y Owne r Date I full y understan dtha t b y signin g thi s Consen t fo r Access , (I ) thi s acces s wil l remai n in effec 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 , will b e give n th e Housin g an dUrba n Developmen t (HUD ) an dEP A pamphlet , "Renovat e Right , Importan t Lea dHazar dinformatio n fo r Families , Da y Car e Providers , an d Schools'' , (3 ) th e Propert y Owne r o r tenan t will remov e al l obstruction s fro msurface s t o b e painted , (4 ) wil l abid e b y healt h an d safet y guidanc e provide db y EPA , (5 ) wil l allo w photograph y o f propert y befor e an dafte r th e pain t stabilizatio n work , (6 ) will b e contacte db y aP E representativ e approximatel y 4 8 hour s i n 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 P stabilizatio n actions , an d(8 ) wil l participat e in fmal propert y inspectio n an dsig n th e Completio n Agreemen t an d Propert y Owne r Satisfactio n Survey . 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 o r Kelley Sander s A t 402-504-4688 . Genera l question s abou t th e Omah aLea dSit e cleanu p ca n b e directe dt o Pauiett aFrance-Isetts , EPA 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 h Omah aoffice ) o r 402-731-304 5 (Sout h Omah aoffice) . [^XeS i I gran t acces s t o m y propert y an d wa s give n th e pamphle t D No , I d o no t gran t acces s t o m y propert y an 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 Car e Providers , an d Schools. " Informatio n fo rFamilies , Child e Car e Providers , an d Schools. " 

# )^,k- ^ Oi!^ o ^If l I n Signatur e Signatur e Date SPECIA L INSTRUCTION S AN D CONSIDERATION S

## PRE-RENOVATIO N FOR M - OWNE R Thi s for m

is to be use d by th e firm s contracte d by th e Environmental Protectio n Agency-Regio n 7 to perfonn Lead-Base d Pain t stabilizatio n activitie s at th e Omah aLea dSite , Omaha , Nebraska . Owne r Conrirmatio n Pamphle t Receip t (M hav e receive dacop y ofth e lea dhazardinformatio n pamphlet , Renovate Right : Importan t Lea dHazar dInformatio n fo r Families , Chil dCar e Provider s an dSchools , informin g me ofth e potential ris k ofth e lea dhazardexposur e fro mrenovatio n activit y to be perfonne din/o n my dwellin g unit . 1 receive dthi s pamphle t befor e th e wor k

began . Owne r Acknowledgmen t 'D (A ) 1 confir mthat 1 ow n an dliv e in thi s property , tha t no chil dunder th e ag e of 6 reside s here , tha t no pregnan t woma n reside s here , andtha t thi s property is no t achild-occupie dfacility . Note : A chil dreside s in th e primar y residenc e of his/her custodial parents , lega l guardians , foste r parents , or informa l caretake r if th e chil dlive s andsleep s mos t of tim e at th e caretaker' s residence . Note : A child-occupie dfacilit y

is apre-197 8 buildin g visite dregularl y by th e same child , under 6 year s of age ,on at leas t tw o different day s withi n any week , fo r at leas t 3 hour s eac h day , provide dtha t th e visit s total at leas t 60 hour s annually . 

## M( E I understan dtha t th e renovatio n Firm , contracte d by th e Environmental Protectio n Agenc y (EPA) , wil l be usin g lead

(B ) saf e wor k

practice s require d by EPA' s Renovation , Repai r andPaintin g Rule . 

# ^/lAan ^ A/// ^ Printe dNam e of Owner-Occupan t 

# SAJIA^ . /M 

# a ^ 

# ^ 6/^//n Signatur e of Owner-Occupan t Dat e

### PAIN T STABILIZATIO N PRE-PROPERT Y PAIN T MATC H ASSESSMEN T PROPERT YADDRESS : H ^ N ^ O ST
— DATE : S/( ^ f

^Z BVID : 3^ 3 ^^^ J

AREA(S ) TO BE PAINTED : HOUS E PROPER : COLOR : f^lM.J - j^^-j-fL k
.
HOUS E TRIM : ^**^*'^ ^ bokzh j COLOR : 

### 5hMl[M^4 ' <!o_a/Lf: s 7 7/ ^

yL^cc^;pi r7^ ^

\,fHy\J O GARAGE : COLOR : P^^flj^S c 

# ^JuJ ^ GARAG E TRIM : (xJ^^J^^^J ^ COLO R
PORCH : 

# fl^of ^ -f :i^o ^ fdtj^^gjc i COLOR : 0^ firo^ n

UL>UJ(AJ U U PORC H TRIM : U>K(AJ COLO R (COMPLET E AL L SECTION , YES , NO , OR NON-APPLICABLE )



### I AGRE E TO TH E COLOR S LISTE D ABOVE
. ONC E TH E PAINTIN G BEGINS , I UNDERSTAN D I CA N NO TCHANG E TH E ABOV E SELECTE D COLORS : PROPERT Y OWNE R SIGNATURE :PE ACCESO R SIGNATURE :