TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID: 36896 Date: 12/26/2008 

Address: 2223 OGDEN 

Remediation Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

a' Video of property (DVD) 

\^ Executive Summary 

W Signed Access Agreement for subject property 

m Painting Agreement 

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

D Photographs 

0 Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

M Property infonnation from Douglas County Assessor's Ofifice 

D 

D 

D 

ignature> Date 

40309848 in 

Superfund 
PROPERTY SUMMARY 

Date: 12/23/08 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Month of: December 

Property Address: 2223 OGDEN SAID: 36896 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: None 

A.2 Issues Resolved: None 

A.3 Unique Findings: None 

A.4 Other Relevant Information: None 

Access Date: 10/31/08 

Work Began: 11/04/08 

Closeout Date: 11/05/08 

Enclosures: 

1. Pre-Video 

2. Post-Video 

3. Property Status Form 

4. Signed Access Agreement 

5. Pre-Renovation Form 

6. Paint Match Form 

7. Tracking Form 

8. Douglas County Assessor Property Information Page 

9. EPA Property Closeout form 

10. Property Completion Agreement 

TECHNOLOGIES, INC. 
ENVIRONMENTAL & 

CONSTRUCTION TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: D^l-^-^ 

Phone: ^5 5 '/^C g BVID: '3>ai.b7U 

Plant & Pennaneiit Landscaping To Remtun In Place 

Iteiii# 

Lption and Location 

On Map 

0 J ^ 

Pre'^dsting Condition of Structures 

Does ybur Basement have a history of leaking? Yes — No 

Itein# Descrii tion & Location 

OnMi^ 

ip^ Im ^^^^^ 

Proper y O^ner Prudent Emplo; 

Signatire Signature: 

8080 Wkid Parkwiy, Siitt 405 2608 N. 24* Straet, suite 308 4242 Medical Ditvt, Suit* 4280 

A M Aiil«inla.TX 78229 
3u'6'^b 

Prudent Technologies, Incl (Prudent) is under contract (Contract # EP-R7-08-07) with the U. S. 

Environmental Protection Agency (EPA) to stabilize Lead Based Paint (LBP) at a number ofproperties 

located in Omaha, Nebrasla, including the property located at ^3^ 3 QC'v Aft Y^ S 1 . 

The EPA requests your pe mission to allow Prudent to perform LBP Stabilization atHhis property. By 

signing this form,tiie prop srty owner grants pennission to Prudent to perform activities related to LBP 

Stabilization including scr iping paint and painting ofthe referenced property. Further, the owner/tenant 

verifies that they have received tiie LBP pamphlet "Renovate Right." 

If you have any questions about the LBP stabilization planned for your property, please contact Prudent's 

AriministTfltive Clerk for ti e Lead Based Paint Stabilization, Mrs. Deborah Akerele^ohnson. 

at (402) 504-1004. Genera I questions about the Omaha Lead Site cleanup can be directed totiie EPA 

Public Infonnation Centen at (402) 731-3045 (South Omaha office) or (402) 991-9583 (North Omaha 

office). 

Property Acoeis Gianted By: /yj ^ / / C jCyj^l^ S 

(Please Print Name) 

Propeity Owner Signature; •QUI-QMHPP^^ ^ /r^/j/M^^ 

<(Date)" I "— (^ignature) 

PROPERTY INFORMATION 

CIiLfee completed by mident and/or property owner - please print) 

RESIOENT NAME,J!J£1 : L < ^/z S 

RESIDENT ADDRESS: =-2=2* ' I v3 0/fl^4} 

IF RENTAL, PROPERTY OWNED B^:_^ki : £ 

OWNER'S MAIUNG ADDRESS; S ^ 

OWNER'S TELEPHONE NUMBER. HOME: f4 ^ ></c5S~y Tc^j^HK! 1462^-^^ ^ S ^ J^^S S Li> 

NUMBER OF OCCUPANTS UNDER ' YEARS OLD: ^ NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER: 

NUMBER OF CHILDREN UNDER 7 Y EARS OLD WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: O 

COMMENTS OR SPECIAL INSTRUC TIONS: (I.E. DOGS. ENTRY GATES, ETC.) 

AUTHORirY FOR ENVIRONMENTAL UBSFONSE ACTIONS; The activities to be implemented by EPA under dis agreement are pursuant to Section 104 

of CERCLA. 42 U.S.C. 9604. EPA's right of access to dw property isprovided for in Section 104(e) of CERCLA. 42 U.S. C 960S(eX which provides entry 

for''determining the needfiw response, or loosin g ortaldng iny response action under this title, or otfierwise eiilbicin^ 

i080 Ward Paitavay. Suits 405 250$ N. 24*^ StTMt. SUHB 308 4242 Medical Drive, SuKa 4250 

lansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

'hon0:(816)36M7O3 Phone: (402)504-1004 Phone: (210)822-9588 

«v. /e4«\ «A9 vt m 
Current Sampte P re^enovation Form 

Effective until April 2010. 

Confimiation of Receipt of Lead P4niphlet 

I have received a copy of the pamibhiet,, /^novate fl^f ; Important Lead Hazard 

Information fix families. Child Can >Providers and Schools irrforming me of 

the potential risk of the lead hazarqi exposure from renovation acttvity to be 

performed in my dwelling unit. I received this pamphlet before the work began. 

A/t//^lo/7eS 

/C Is/ lb 5r 

Printed riame of recipient 

Date 

JQ^U ^ * * 3 ^ - Signature of recipient 

Self-Certification Option (for tenant-occupied dwellings only) — 

If the lead pamphlet was deitveredI bit a tenant signature was not obtainable, 

you may check the appropriate box tielow. 

Q Refusal to sign — I ceilify tiiat I tjave made a good M h effort to deliver the 

pamphlet, /^novate /%/if: Importifnt Lead Hazanj Infonnation for FamSes, 

CNId Care Providers and Schools to the rental dwelling unit listed below at the 

date and time indicated and that tie occupant refused to sign tiie confirmation 

of receipt. I further certify that II ha releft a copy of the pamphlet at the unit with 

the occupant, 

Q Unavailable for signature — I cetify that I have made a goodfeutheffort to 

deliver the pamphlet, Ftenovate Important Lead Haard infonnation for 

f^mitHes, ChBd Care pnyvidersanc Schools,to the rental dwelling unit listed 

below and that the occupant was unavailable to sign the confinnation of receipt, 

1 turthercertify that I have left a of the pamphlet at the unit by sliding it 

Printed name of person certifying 

Attempted delivery 

date and time 

lead pamphlet delivery 

Signature in certifying lead p imphlet delivery 

^ ^ /O^J^TW 

UnltAddress 

Note Regarding Mailing Option — As an altemative to delivery in person, you 

may mail the lead pamphlet to the owner arxj/or tenant. Pamphlet must be mailed 

at least 7 days before renovation (Document with a certificate of mailing from the 

post office). 
/ ^ 0f/O£ 

mm 

Paint match! "g fori??^'"^ "'^^^^ *?m: Property addles 

BVID: ^f,j. ^ 

AU 

Explanation^ ^ 

{l,f^ii/^6i 000^ ^ ^ il l I 

w \ &mc S]^'' '^^f^ ^^^^^ ^^i^^^'^^ ^­ Expla.^'t^df 

Area; 
 Color: 

Explanation: 


Area: 
 Color: 

Explanation: 


Area: 


Color: 

Explanation: 

Page l 
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Acces s /fJPORHAT,OfiTRACKINQ SHEET 
Page 1 of2 

Douglas County, Nebnsk a Property Record - R1838840000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ii west of 90th St - VieW Oh Map Information is valid as of 20( i8-9-4 Treasurer's Tax Report 

New Feature ->-*- > Auto Sales Search 

Owner 

JONES JESSE 

ETAL 

2223 OGDEri ST 

OMAHANE 68110-0000 

Property Informatio n 

Key Number: [ 38*4 0000 18 

Account Type: Re; Mdential 

Parcel Number: 18:8840000 

Parcel Address: 22: 3 OGDEN ST 

, ON/AHANE 68110-0000 

Legal Description: \ N E WTON ADD LOT 8 BLOCK 3 50 X 140.8 

Value Informatio n 

Land Improvement Total 

2008 ... $2.7(0.00 $5'3,200.00 $55,900.00 

2007 $2,7C 6.00 $55,000.00 $57,700.00 

2006 $2,7C0.00 _$55.000.00 "$57,70b.60 

2005 $2~7C0M isi.ooo.oo $'57700.00 

2004 $2,700.00 $33,56(j.'00 $36,200.00 

2003 I $2,70 D.OO $33,500.00 $36,200.00 

Land Informatio n 

Acres • SF Unita i Depth Width Vacant 

0.16 : 7000,0 1.0 l 140F 50.0 No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-on' ine.com/DouglasCoNe/static/accountinfo .j sp?accountno=Rl 8... 10/1/2008 
Page 2 of2 

WAO<StiS;:si 

••«3 C <o r 

2 ?;2 STORY UNFIN 

CLICK TO ENUtRGEIMApg' 

Square Footage: : 1:67.0 Percent Complete: 100.0% 

Perimeter 1 0. Quality: ] Average 

Unit Type: | Condition: : Average 

BuiitAs: ! 2 ft/2 Story Unfin Condo Square Footage: ; 0.0 

HVAC: j Fc reed Air Rooms: . 6.0 

Exterior: \ Frame Vinyl Units: ': 1.0 

Interior: i Dr/wall Baths^i 1.0 

Roof Cover: i Cc mposition Shingle Bedrooms: ; 3.0 

Roof Type: ; GJ ble Stories: ': 2.5 

Floorcover: -, Albwance Foundation: Block 

1 Sprinkler Square Footage: 0.0 

Add On 

Yetr Percent j Adjusted Year YearBuilt Physical Age Remoi 'eled Remodeled \ Built 

1910 0% r 1910 "" 99 

Detail Type : Detail Description Units 

Appliance 

Basement 

Fixture 

Fixture 

Garage 

Porch 

Porch 

Porch 

•'Unfinished Attic W/floor 

' Allowance 

i Bsmnt Block 8 ft 

] Base Fixtures 

• Bath Full 

; Detached 

; End Soiid Wall 

End Solid Wall 

Slab Roof Ceil 

264,0 

"i. o 

624.0 

1 ^ 

1.0 

308.0 

112.0 

192.0 

40.o' 

http://douglasne.mapping-on ine.com/DouglasCoNe/static/accountinfo .jsp?accountno=Rl 8... 10/1 /2008 
Prudent Property Close-Out Form (Lead-Based Paint Stabilization) 

PropertyAririn»«i ^ A 9^3 (X^dpjr) C:>dr^ _ 

owier-swnmi.. n^/j . , Uh^ & / Je.^S/ ^J J^ne S 

Performance Standards/close-Out Criteria 

YES INO 

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 K 

biearre, columns, rails, and exterior surfaces of garages. 

2. Was all scraping and other preparattion work completed satisfactorily? X 

3. Vien all required areas of the structure(s) primed as needed and painted with two top coats? IT 

4. Wjas the paint products utilized equivalertt to a 30 year product/quality? 

A[e all ofthe areas where contaminated materials have been spiiied 

thjoroughly vacuumed/ cleaned? 

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

V^ rokdways, 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 ail items such as polyethylene sheeting, ladders, paint brushes, cones, barrier tape etc 

properly removed? < 

9. Is tiiere any evidence of property damage that was done by the contractor? Any property damage 

ne^sto be completed prior to the EPA Ciose-Out. 

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

i ^ thqt need to be moved back? 

11. Areithere any (known) lingering issues with the property owner{s) that have been left unresolved? 

i 

Gthler Considerations?property Owner Discusslons?Addltional Work that is Required 

Cta\JL^ .JS^^ 

.J ^ I^Slo^ 

sentative 

V I 

^ H