TRANSMITTAL of OMAHA LEAD StTE 

SASDU: 7il£2£l . Date: J2mU^__ _ 

Remediation Contractor: PROFESSIONAL ENVIRONMENTAL ENGINEERS Year: 200 9 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

fe/^ Video ofproperty (DVD) .' 

&" Executive Summary 

E>^ Signed Access Agreement for subject property 

y Paintmg Agreement 

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

D Photographs i>y ^ /?./JA /^yf^ 

E / Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

y Property information firom Douglas County Assessor's Office 

y confirmation that lead pamphlet "Renovate Right" was received by P0_ 

D 

D 

D 

Professional BnvuonmcKital Engineers Signature IDate 

30054671 nil 

Superfund 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC.

"Providing cost-effective environmental solutions"

 ''° ' Tm'a'ht NE 68?!o 

 p^ jj^gj 504^281 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

2009 

SAID# 40530 

6137 Florence Blvd 

• Dates worked: 10/13 to 10/19 2009 

• Pre property condition: House and garage have painted wood siding that was in poor 

condition prior to stabilization work begun. Owner requested we paint inside of porch 

because he plans on removing the siding and exposing the porch. Paint chips in yard. 

• Problems encountered: N/A 

• Owner request/concerns: Porch and color changes. 

• Inspection/closeout dates. Owner signed 10/19 2009. Property inspected by PE project 

manager. 
2505 North 24% Suite 219 

"Providing cost-effective environmental solutions' 

Consulting • Engineering Design • Remediation»Abatement« Emergency Response 

Property Owner Close-Out Form 

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

SAID: Hnss n 

PropertyAddress: I o\R'=t '^Ir^/^hTf ^ PJ\> 4 

Owner'sName: 'J?J^'(Y\eS < A&S' ~ 

Performance Standards/Close-Out Criteria 

1. Was the entire structure(s) painted with the exception ofthe stated, excluded 

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

eaves, siding, all trim, porches, box beams, columns, rails, and exterior surfaces of 

garages. 

2. Was all scraping and other preparation work completed satisfactorily? 

3. Were all required areas ofthe structure(s) primed as needed and painted with 

two top coats? 

4. Was the paint products utilized equivalent to a 30 year product/quality? 

5. Are all ofthe areas where contaminated materials have been spilled thoroughly 

vacuumed/ cleaned? 

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

entire property, roadways, 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 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. Are there any property items that were temporarily re-located by the contractor 

that need to be moved back? 

11. Are there any (known) lingermg issues with the property owner(s) that have 

been left unresolved? 

Comments: 

-yp-^ 10 /¥

Propmy Owner Signature Date 

Professiona ionall Environmentrf-fengngineer i s Representative Date

Omaha, NE 68110 

(402) 504-4688 

Fax (402) 504-3281 

YES NO 

X 

y 

X 

A 

X 

X 

A 

X 

X 

X 

X 

O l 
CONSENT FOR ACCESS 

OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASE© PAINT STABILIZATION 

PROPERTY ID; ^C5^ ^ PROPERTYADDRESS: i cR rS| Yl'Cif'^Cjt y 'BlX/^t 

^^^fyj^ ^ I .; tSf- DAYTIME PHONE: ^1 ~ 85DP S 

CELLPHONE: E-MAIL: 

OWNER'S ADDRESS IF DIFFERENT: 

TENANT'S NAME IF APPLICABLE: 

DAYTIME PHONE: 

CELLPHONE: E-MAIL: 

Professional Environmental Engineers, Inc. (PE) is under contract (#EP-R7-08-06) with the U.S. Environmental Protection 

Agency (EPA) to stabilize lead based paint (LBP) on residential structures at a number of properties located in Omaha, 

Nebraska. The paint stabiUzation work is being done to protect the soil cleanups that are being performed by EPA contractors. 

Paint stabilization activities will include: scraping of cracked or flaking LBP from structures, application ofa prime coat and two 

(2) coats of paint. Moving parts of windows and doors are not included and will not be addressed. 

Your cooperation is requested in giving permission to this EPA contractor (PE) to enter and have access to this property for the 

purpose of stabilizing lead -based paint as outlined on the property identified above. 

By signing this document I agree to allow an EPA contractoK to conduct a soil cleanup at my property following completion of 

lead-based paint stabilization, if the soil cleannp has not already been performed. I understand that the stabilization contractor 

can not provide assurances that the soil cleanup contractor will be bound to. I further understand that the soil cleanup 

contractor will make all reasonable eflbrts to address concerns that I, as the property owner, may have regarding soil cleanup at 

my property. 

Yes, I havmad and u^erstandIfliyiaragr theparagrap B h above. 

5^1 - yi> <^9 

[nature of Property Owner ~ ^ Date 

I fully understand that by signing this Consent for Access, (1) this access will remain in effect until the work has been 

satisfactorily completed, (2) that the Property Owner or Tenant, ifapplicable, will be given the Housing and Urban Development 

(HUD) and EPA pamphlet, "Renovate Right, Important Lead Hazard information for Families, Day Care Providers, and 

Schools", P ) the Property Owner or tenant will remove all obstructions from surfaces to be painted, (4) will abide by health and 

safety guidance provided by EPA, (5) will allow photography of property before and after the paint stabilization work, (6) will be 

contacted by a PE representative approximately 48 hours in advance of starting work, (7) agree not to obstruct or tamper with 

any ofthe LBP stabilization actions, and (8) will participate in final property inspection and sign the Completion Agreement and 

Property Owner Satisfaction Survey. 

Should you have any questions about the planed Lead Based-Paint stabilization activities for your property, please contact 

Professional Environmental Engineers, Inc. Project Manager, Willie Clay At 402-504-4688. General questions about the Omaha 

Lead Site cleanup can be directed to Pauletta France-lsetts, EPA Remedial Project Manager 402-731-2454, or the EPA Public 

Information Centers at 402-991-9583 (North Omaha office) or 402-731-3045 (South Omaha ofiice). 

Q^es, I grant access to my property and was given the pamphlet D No, I do not grant access to my property and I was 

"Renovate Right Important Lead Infbnnation for Families, Child given the pamphlet "Renovate Right, Important Lead 

Care Providers, and Schools." Infomiation for Families, Chllde Care Providers, and Schools.' 

^ 

Signature Date Signature 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
• . - > » 

PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

PROPERTY ADDRESS: tj^?? A /hs/^AA7 £ DATE: AAA ~ 7 ^(7^ ' 

BVID: yO^^—Cy 

AREA(S) TO BE PAINTED: / / 

HOUSE PROPER: /Ay7 COLOR: 

(USE TRIM: 7/7$/ 7770 

,^ ' 

as -Vr\m s\L^ 

COLOR: 

GARAGE: COLOR: TAW 

GARAGE TRIM: COLOR: JZM 

< ^ y 

W^ 

PORCH: COLOR: ^ ^ 

Z ^ ^ 

PORCH TRIM: COLOR: / 

ry77 

^ ^ 'W 

OMPLETE ALL SECTION, YES, NO, OR NON-APPLICABLE) 

I AGREE TO THE COLORS USTED ABOVE. ONCE THE PAINTING 


BEGINS, I UNDERSTAND I CAN NOT CHANGE THE ABOVE SELECTED COLORS: 


PROPERTY OWNER SIGNATURE: PE ACCESQR SIGNATURE 

^i^ 

I 
Douglas County Account Information Page 1 of2 

Douglas County, Nebraska Property Record - R1947360000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 tt west of 52nd St - VJeW OO Ma P Information is valid as of 2009-9-3 Treasurer's Tax Report 

New Feature ->->-+ Auto Sales Search 

Owner i)CiK-%^^ -

LIEST JAIVIES K 

6731 FLORENCE BLVD 

OMAHA NE 68112-0000 ^^\ - "i-ScA^ 

1 

Property Informatio n 

Key Number 4736 0000 19 

AccountType: 1 Residential 

Parcel Number 1947360000 

Parcel Address: 6731 FLORENCE BD 

OMAHA NE 68112-0000 

Legal Description: PARKW00DL0T19BL OCK 1 W 140 FT LOT 18 & W 140 FT N 1/2 66.06X140 

Value Informatio n 

Land Imprt ivement Totaf 

2009 $7,600.00 $54,300.00 $61,900.00 

2008 $7,600.00 $54,300.00 1 $61,900.00 

2007 $7,600.00 $51,000.00 $58,600.00 

2006 $7,600.00 $51,000.00 $58,600.00 

2005 $7,600.00 $51,000.00 $58,600.00 

2004 $7,600.00 $51,800.00 $59,400.00 

Sales Informatio n 

Sales Date: 1997-08-28 

Deed Type: D Book: 2078 Page: n o 

Price: $46,000.00 

Grantor 

Grantee: • 1 

f . — . . 

Valid/Invalid: Valid 

^

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.21 £1240.0 1.0 140.0 66.0 No 

Improvemen t Info i mation 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl9... 9/11 /2009 
Douglas County Account Information Page 2 of2 

Building 1 

8TJ1 FLORENCE BD 

... t ' 

First Flow SMDMFlaor 

TS4 0 iq . ft. 7t80s q J^ a

 • J? it 

L ..:^yy 

2 STORY Bsmrt Bkick a « 

7W 0 iq. 11. 

CLICK TO ENLARGE IMAGE 

Square Footage: 1480.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Fair 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 10.0 

Exterior: Frame Siding Units: 1.0^ 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Siiingle Bedrooms: 3.0 

Roof Type: Gable Stories: I 1.5 

Floorcover: Allowance Foundation: | Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1915 0% 1915 94 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Appliance Fireplace Masonry 1.0 

Basement Bsmnt Blocl< 8 ft 764.0 

Basement Fair Finish 60.0 

Fixture Base Fixtures 1 ^ 

Fixture Batii Full 1.0 

Garage Detaclied 324.0 

Porch End Screen 184.0 

Porch Slab Roof Ceil 30.0 

http://douglasne.mapping-online.com/DougIasCoNe/static/accountinfo.jsp?accountno=R19... 9/11/2009 
MC Services, LLC 

PropertyAddress (1]° { %^(f i HM A Date lN^(^lm 

Amount Of PHme And Paint Used 

f 

Prime (Gallons) 10 

Poiy (Boxes) 4 

Paint (Coior) ii2- Amount (Gallons) CP)'\'\ 

Paint (Color) (s\^V) Amount (Gallons) . & 

Paint (Color) Co\AC^ Amount (Gallons) \ 

Paint (Color) Amount (Gallons) 

Paint (Color) Amount ((aallons)