### TRANSMITTA L o f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R
SAID # Addres s Stabilizatio n Contractor : Professiona l Environmenta l Engineer s Year : 2011 _ PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUIVIENT S
^ Vide o ofpropert y (DVD )

^ aExecutiv e Summar y Signe dAcces s Agreemen t fo r subjec t property Pre-Renovatio n For msigne dby Property Owne r D Pre-Renovatio n For mfo r Occupant/Tenant , if applicabl e M Paintin g Agreemen t D Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) Renovatio n Recordkeepin g Checklis t signe db y Certifie dRenovato r Photograph s Satisfactory close-ou t chec k lis t signe dby Property Owne r D y . Property close-ou t chec k lis t signe db y EPA S

S Property informatio n fromDougla s Coimt y Assessor' s Offic e D Hazardanalysis , if prepare d D Safet y Audi t D Othe r (describe) :

Professional Erii3i»i'H^ntaWEngineer s Signatur e 

# mk/ ^ EPA CC5 R

### Signatur e ^ f Dat e (after file folde r review ) Superfun d

## PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC
. ''° ' Tm'a'h t NEe'sn o "Providin g cost-effectiv e environmenta l solution s " ^ ^ jj^g j SM^S I Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yRespons e



### Lea dBas e Stabilizatio n Omaha , N e Clos e Ou t Repor t 201 1 SAID #2521 8 361 8 Lafayett e A v

•Date s worked : 7/2 0 t o 7/2 0 201 1
•Pr e propert y condition : Hous e ha s mostl y viny l sidin g wit h painte dwoo dtrim s foundatio n areas . Garag e i s painte dwoo dan dwa s i n poo r condition . Pain t wa s flaking of f i n areas . •Problem s encountered : None . •Owne r request/concerns : N/ A
•Inspection/closeou t dates . Owne r 7/25/1 1 £p( ^ il(5|( l

### 201 1 

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

# ENVIRONMENTA L ENGINEERS , INC
. Omaha , N E 6811 0 (402 ) 504-468 8 

### "Providin g cost-effectiv e environmenta l solutions " Fax (402 ) 504-328 1 Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc y Respons e 

### EP A Close-Ou t For m (Lead-Base dPaint Stabilizatio n EP A Contrac t EP-R7-08-06 ) SAID : SSSI ^ Propert y Address : XlS—laPl^err r Oin^x . 

### Owner' s Name : Jitmt A Rt^.^A . 

### Performanc e Standards/Close-Ou t Criteri a YES N O 1 . Wa s th e entir e structure(s ) painte dwit h th e excepitio n ofth e stated , excludedareas ? Thi s woul dinclude paintin g o f othe r

associate dfeature s mcludin g fascia , eaves , siding , all trim , 

# J porches , bo x beams , colunms , rails , an dexterior surface s of garages . 2 . Wa s al l scraping an dothe r

preparatio n wor k

completedsatisfactorily ? y / 

### 3 . Wer e all require darea s ofth e structure(s ) primeda s neededan dpainte dwit h tw o to p coats ? / 

### 4 . Was th e paint product s utilize dequivalen t to a2 5 yea r

product/quality ? i / 

### 5 . Ar e all ofth e area s wher e contaminate dmaterial s have bee n spille dthoroughl y vacuumed / cleaned ? 

# V 6 . Di dth e contractor collect/vacuumall falling an dscrapedpaint chip s on the entir e property , roadways , alleyways , publi c acces s area s an dals o remove an y othe r

generateddebris ? / 

### 7 . I s th e gras s are atha t surrotmd s the structiire(s ) in reasonabl y goodcondition ? ^ 

### 8 . Are all item s suc h a s polyethylene sheeting , ladders , pain t brushes , cones , barrie r

tape , etc . properl y removed ? 

# y 9 . I s there an y evidenc e ofpropert y damag e tha t was don e by th e contractor ? An y propert y ^ 

### damag e need s to b e complete dprior t o th e EP A Close-Out . 10 . Ha s th e propert y owne r

signe dth e completio n form ? ^ 

### 11 . Ar e ther e an y propert y item s tha t wer e temporarily re-locatedb y the contractor tha t needt o b e move dback ? 

# y 12 . Ar e ther e an y (known) lingering issue s wit h the propert y owner(s ) tha t have been lef t ^ 

### unresolved ? Othe r

Considerations/Propert y Owne r

Discussions/Additiona l Wor k

tha t i s Required :

>Cfe> ? ^ 

## ilhll i EP A CO RSignatur e Dat e

### 201 1 

## PROFESSIONA L 250 5 Nort h 24' \ Suit e 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 Consultiri y • Erigineenn g Desig n • Rirnedia'.io n • Aoaiarne m • Ei-iergenc y Resuons e 

### Propert y Owne r Close-Ou t For m (Lead-BasedPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) SAID : ^ 5 2 1 % Propert y Address : 3^/ ^ Llfy^ A \/tljr ^ Y\\M^ y Owner' s Name : J/Hvtf= < /V I 3f^(Ayi=rf - Performanc e Standards/Close-Ou t Criteri a 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 dothe r preparatio n wor k

complete dsatisfactorily ? 3 . Were al l require darea s ofth e structure(s ) prime da s neede dan dpainte dwit h tw o to p coats ? 4 . Wa s th e pain t product s utilize dequivalen t to a2 5 yea r product/quality ? 5 . Are 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 on th e entir e property , roadways , alleyways , publi c acces s area s andals o remov e any othe r generate d debris ? 7 . I s th e gras s are athat surround s th e structure(s ) i n reasonabl y goo dcondition ? 8 . Are al l item s suc h a s polyethylen e sheeting , ladders , paint brushes , cones , barrie r tape , etc . properl y removed ? 9 . I s ther e an y evidenc e ofpropert y damag e tha t wa s don e by th e contractor ? Any property damag e need s t o b e complete dprio r t

p th e EP A Close-Out . 10 . Ar e yo u satisfie dwith th e wor k

performed ? 11 . Are ther e any property item s tha t were temporaril y re-locate db y th e contracto r tha t nee dt o b e move dback ? 12 . Are ther e any (known ) lingerin g issue s wit h th e propert y owner(s ) tha t hav e bee n lef t unresolved ? Othe r Considerations/Property Owne r Discussions/Additiona l Wor k

tha t i s Required : YE S N O 

# K t / .(7^ . ^ X ^

^ . ^ 

## ( X
^ 

## K 

# o f 

# o (

^

^ ^ = ^ ^ 

### Propen( Y Owne r Signatur e 

# ^^:e^-^^- ^ ^ -X^ ' ( f Professional EnviKmfiental Engineer s Signatur e Dat e

### Professiona l Environmenta l Engineers : EP A Pain t Stabilizatio n 2011 SAID # 

# 2f)Zlf t Propert y Addres s PlCpif t litfa^eUP./W
. Stories / Sidin g typ e | ' \2
. Transit e Woo d Viny l Meta l Stucc o Garage ?
Dat e acces s signe d Pre-vide o ^ j J H ( I Ye s 

## 1 m l / 1 

# n (D N o Painted ? Where ? Ye s Sidin g Tri m N o

Pos t vide o Contracto rAssigne d Dat e starte d Weathe rCondition s 

## ^/^/ K Dat e ende d 

# y m/' /

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


### RENOVATIO N RECORDKEEPIN G CHECKLIS T
Nam e o f Firm : Dat e an dLocatio n o f Renovation : Brie f Descriptio n o f Renovation : Name o f Assigne dRenovator : Name(s ) o f Traine dWorkers : Name o f Dus t Samplin g Technician , Inspector , and/o r Ris k Assessor , if used :

^ Copie s o f renovato r an ddus t samplin g technician qualification s (trainin g certificates , certifications ) on file. S^Certifie drenovato r provide dtrainin g t o worker s on (chec k al l that apply) : ^Postin g warnin g sign s ^ Settin g u p plasti c containmen t barrier s SjMaintainin g containmen t ^ Avoidin g sprea do f dus t t o adjacent area s R^Wast e handlin g (STPost-renovatio n cleanin g U~"Tes t kit s use db y certifie drenovato r t o determin e whethe r lea dwa s presen t o n component s affecte db y renovatio n (identif y kit s use dan ddescrib e samplin g location s andresults :
0 ] Warnin g sign s poste da t entranc e t o wor k

area . M Wor k

are acontaine dt o preven t sprea do f dus t an ddebris . Jg

P Window s in an dwithi n 2 0 fee t o f th e wor k

are aar e close d E " Door s i n an dwithi n 2 0 fee t ofth e wor k

area s ar e close dan dseale d ( 0 Door s tha t mus t b e use di n th e wor k

are aar e covere dt o allo w passag e bu t prevent sprea do f dust . QTGroun dcovere dby plasti c sheetin g extendin g 1 0 fee t fro mwor k

are a- plasti c anchore dto th e buildin g an dweighte ddow n by heav y objects . ^ Ifnecessary , vertica l containmen t installe dto preven t migratio n o f dus t an ddebri s to adjacent property . &-Wast e containe don-sit e an dwhil e bein g transporte doff-site .(effectiv e Apri l 2010 )


### ' ^ Wor k

site properl y cleane dafte r renovation . JZAl l chip s an ddebri s picke dup , protectiv e sheetin g misted , folde ddirt y sid e inward , an dtape dfo r removal .
" ^ Wor k

are aHEPA vacuume dt o get pain t chip s fromgroun dsurface , ifnecessary . S Certifie drenovato r performe dpost-renovatio n cleanin g verificatio n (describ e results) : •
I certif y unde r penalt y of la w tha t th e abov e informatio n i s true an dcomplete .

Nam e an dTitle Dat e

### ^K c ** Dougla s County , Nebrask a ^Vpert y Recor d - R211488000 0 Prin t Repor t Vie w Interactiv e GI S Ma p Informatio n is vali d asof 2011-7- 5 Treasurer' s Ta xRepor t Ne w Featur e *>•*- + Subdivisio n Sale s Searc h Owne r BECHTE L JAME S M 361 8 LAFAYETT E AV E OMAH A NE 68131-000 0 Propert y Informatio n Ke y Number : 

### 148 8 000 0 21 Accoun t Type : Residentia l Parce l Number : 211488000 0 Parce l Address : 361 8 LAFAYETT E AV OMAH A NE 68131-000 0 Lega l Description : RESERVOI R SU B DI V LO T

24 BLOC KA ALLE Y AD J S 27 1/ 2FT LT 5 & N 138 FT 50X180. 5 Valu e Informatio n 201 1 201 0 200 9 200 8 200 7 200 6 Lan d $3,000.0 0 $3,000.0 0 $3,000.0 0 $3,000.0 0 $3,000.0 0 $3,000.0 0 Improvemen t $68,200.0 0 $68,200.0 0 $68,200.0 0 $68,200.0 0 $68,200.0 0 $68,200.0 0 Tota l $71,200.0 0 $71,200.0 0 $71,200.0 0 $71,200.0 0 $71,200.0 0 $71,200.0 0 Sale s Informatio n Sale s Date : 1996-10-1 1 Dee d Type : Price : Grantor : $38,000.0 0 Book : 204 6 Page : 

### 71 0

Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s SF Unit s Dept h Widti i Vacan t 9000. 0 

### 1.0 180. 0 50. 0 No 0. 2"Improvemen t Informatio n Buildin g 1
361 4 LAFAYETT E A V " ^ 30 2 I ] S q r i
iiy^ f 03 f :EI«: - nssoFTiaisz i TWO STOR Y

CLIC KT O ENLARG E IMAG E CLIC KT D ENLARG E IMAG E Squar e Footage : ; 1248. 0 Percen t Complete : I 100.0 % Perimete r0. 0 Quality : Averag e Uni t Type : Condition : { Averag e

Buil t As : 1 1/ 2 Stor y Fi 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 : 2. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : i Gambre l Stories : 1. 5 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 5 0 % 1905 10 3 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fenc e Woo d 1. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 688. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 2. 0 Garag e Detache d 256. 0 Porc h En d Soli d Wal l 36. 0 Porc h Sla b Roo f Ceilin g 176. 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 ID : ;Z5 ^ 11 5 PROPERT Y ADDRESS : :3^/5 ^ CPl^AS^TT' e AM B Centwt ^ fa/uxS i IH8^
- 00O0'2 J OWNE RNAME : 

### DAYTIM E PHONE : HD2
- Jxb ^ -^312 . CELLPHONE : ^-^ ' E-MAIL : fJ-A
OWNER' S ADDRES S I FDIFFERENT : /i.ann p TENANT' S NAM E I FAPPLICABLE : DAYTIM E PHONE : N.fi . CELLPHONE : fJ.A . E-MAIL : N-A ~ 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 yEP A contractors . Pain t stabilizatio n activitie s wil l include : scrapin g o f cracke d o rflaking LB P fro m structures , applicatio n o f a prim e coa t an d tw o (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 y fo rth e purpos e o f stabilizin g lea d -base d pain t a s outline d o n th e propert y identifie d above
. B y signin 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 y bee 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 , a s th e propert y owner , ma yhav e regardin g soi l cleanu p a t m y property , /i;^:^ ; ih ^ ^A^etLeXtl i -Uoi^£e/vt*>e-w ^

f<iA^^(djUii,^l ^ ^ 2£e(^2oo* i D Yes , I hav e rea d an d understan d th e paragrap h above , 

# n

• £!tnflMi< a 

## m^p ^ Signatur e o f Propert y Owne r^^. . Dat e I full y understan d tha t b y signin 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 y completed , (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 y Car 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 y healt h an d safet y guidanc e provide d b y EPA , (5 ) wil l allo w photograph y ofpropert 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 y 4 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 y ofth 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 y Owne rSatisfactio n Survey
. Shoul d yo u hav e an y question 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 y Sander 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)
. "Q^Yes , I gran t acces s t o m ypropert yan d wa s give n th e pamphle t D No , I do no t gran t access t o m y propert y an d I vra s "Renovat e Right , Importan t Lea d Infomiatio 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. " Signatur e ^- ^ Dat e Signatur e Dat e SPECIA L INSTRUCTIONS AN D CONSIDERATIONS

## PAIN T STABILIZATIO N PRE-PROPERT Y PAIN T MATC H ASSESSMEN T PROPERT Y ADDRESS : _3 ^

^ KLPlf^^^jf^yV^J^I ^ DATE : -^-l-F-j K BVI D 

# Mi
HOUS E PROPER : A'-/?
. ( Sl£Unn \ COLOR : -> * j ^ ^ T
HOUS E TRIM : COLOR : 

# ^ ^

4^^ \

GARAGE : 

## COLOR : ^1A / CJUJ ^
GAFIAGETRIM : 

### .COLOR : .^ ^

C^ 3^ S i
PORCH : 

### f=CQO ^ COLOR : 5 ^ ^A3 ) 

## {{ff\McOA£^J L ^e.^tf<\//^AJL j PORC H TRIM : COLOR :



### Jf^^^JcJ( L

^[M d (COMPLET E AL L Sfe ( CTION , YES , NO , O R NON-APPLICABLE )



### I AGRE E T O TH E COLOR S LISTE D ABOVE
. ONC E TH E PAINTIN G BEGINS , I UNDERSTAN D I CA N NO T CHANG E TH E ABOV E SELECTE D COLORS : PRJ?9tRT Y OWNE R SIGNATURE : P E ACCESO R SIGNATURE :

### PRE-RENOVATIO N FOR M - OWNE R Thi s for mi s t o b e use db y tli e firm s contracte db y th e Environmentai Protectio n Agency-Regio n 7 to perfor mLead-Base d Pain t stabilizatio n activitie s al th e Omah aLea dSite , Omaha , Nebraska . Owne r Confirraatio n Pamphle t Receip t p ( l hav e receive d/cop y ofth e lea dhazardinformatio n pamphlet , Renovate Right : Importan t Lea dHazar dInformatio n fo r f Families , Chil dCar e Provider s an dSchools , informin g m e ofth e potential ris k ofth e lea dhazar dexposur e fro mrenovatio n activit y t o b e performe din/o n m y dwellin g unit . 1 receive dthi s pamphle t befor e the wor k

began . Owne r Acknowledgmen t ^(A ) I confir mtha t 1 own an dliv e i n thi s property , tha t no chil dunder th e ag e o f 6 reside s here , tha t no pregnant woma n beside s here , andthat thi s propert y i s no t achild-occupie dfacility . Note : A chil dreside s i n th e primary
- residenc e o f his/her custodial parents , lega l guardians , foste r parents , o r informa l caretake r i

f th e chil dlive s an dsleep s mos t o f tim e a t th e caretaker' s residence . Note : A child-occupie dfacilit y i s apre-197 8 buildin g visite dregularl y b y th e same child , under 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 eac h day , provide dtha t th e visit s tota l a t leas t 6 0 hour s annually . V(B ) I understan dtha t th e renovatio n firm, contracte dby th e Environmental Protectio n Agenc y (EPA) , wil l b e usin g lead
­ ' saf e wor k

practice s require db y EPA' s Renovation , Repair an dPaintin g Rule .



### Printe dName o f Owner-Occupan t 

# y-n-i i Signatur e o f Owner-Occupan t Dat e