TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID #: |QF>9 3 Date: -^-^Q-Q ^ 

Address: ^ 1 I? , CY 5 ^ 

Remediation Contractor: PROFESSIONAL ENVIRONMENTAL ENGINEERS 

Year: 2009 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

H ^ Video of property (DVD) 

Sr Executive Summary 

^/ Signed Access Agreement for subject property 

^r Painting Agreement 

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

5K Photographs pC ^ Ol A po&T 

^r Satisfactory restoration signed by Property Owner 

B*^*^Property close-out check list signed by EPA 

Wr Property information from Douglas County Assessor's Office 

^y""^ _confirmation that lead pamphlet "Renovate Right" was received by P0 _ 

D 

D 

Professional Environmental Engineers Signature Date 

/ a 'Mh iPA Signature Date 

30094364 

r\ 

Superfund A'"' 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. ''' ' Tm'aht NE ee?!? 

"Providing cost-effective environmental solutions " ^^^ [J°^j 52t328i 

Consulting • Engineering Design • Remedialion • Abaiement • Emeigency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

2009 

SAID# 10583 

2113 J St 

• Dates worked: 07/02/09 to 07/02/09 

• Pre property condition: Painted wood siding that was in poor condition, paint chips in 

yard and around house. Windows had plastic coverings on them, items needed to be 

removed prior to work starting. 

• Problems encountered: None 

• Owner request/concerns: Color change. 

• Inspection/closeout dates: Property signed 07/06, EPA 07/09/09 No issues 
PROFESSIONAL 

2505 Nonh 24"\ Suite 219 ENVIRONMENTAL ENGINEERS, INC. Omaha, NE 68110 

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

Consulting • Engineer ng Des.gn • Remod r,\ion • AbatRmenl ° Emeigency ReF.pon=:e 

EPA Close-Out Fonn 

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

SAID: |nfS5^?^ 

Property Address: j ^ 11' ^ C^~ t'^Y 

Owner's Name: 'y^J\/-f>n'hnC^ "^.ff ^ 

Performance Standards/Close-Out Criteria YES NO 

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 y ^ 

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 

y two top coats? 

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

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

uy 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 

y ^ other generated debris? 

7. Is the grass area that surrounds the structure(s) in reasonably good condition? yy ^ 

8. Are all items such as polyethylene sheeting, ladders, paint brushes, cones, 

barrier tape, etc. properly removed? y ^ 

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

Ly that need to be moved back? 

11. 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:

^?yJ,/^^ ^/^.f^yJL^J ^ 

EPA COR Signature 

 1 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

"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: Ins^"^ 

Property Address: P 11?^ ~ y S V 

Owner's Name: .JUV^ep-hnC^ "firZ-f^^ 

Performance Standards/Close-Out Criteria 

2505 North 24^ Suite 219 

Omaha, NE 68110 

(402) 504-4688 

Fax (402) 504-3281 

YES NO 

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. K 

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? t 

7. Is the grass area that surrounds the structure(s) in reasonably good condition? "y­ 8. Are all items such as polyethylene sheeting, ladders, paint brushes, cones, 

barrier tape, etc. properly removed? K 

9. Is there any evidence of property 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? 7 ^ 

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

been 1v left unresolved? 

Comments: 

-7^ 

'roperty' > Ignature Date 

Professional Environmental Engineers Representative Date 
A ^ 

CONSENT OFR ACCESS TO PROPERTY 

OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID: /^S^ 3 PROPER! rv ADDRESS: ^//? ^ ZT S" ^ 

OWNER NAME: 

^T^UP.r^-liAJ^ ^fe.-Z _ DAYTIMEPHONE: /S ^ * 3 ^ ^9 ' 

CELLPHONE: E-MAIL: 

OWNER'S ADDRESS IF DIFFERENT: 

TENANT'S NAME IF APPLICABLE: 

DAYTIME PHONE: 

CELLPHONE: E-MAIL: 

1 

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 stabilization work is being done to protect the soil cleanups that were performed by EIPA contractors. 

Paint stabilization activities will include: scraping ofcracked 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 identifled above. 

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

lead-based paint stabilization. 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 efforts to address 

concerns that I, as the property owner, may have regarding soil cleanup at my property. 

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, if applicable, 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", (3) 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 flnal 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-Isetts, EPA Remedial Project Manager 402-731-2454, or the 

EPA Public Information Centers at 402-991-9583 (North Omaha offlce) or 402-731-3045 (South Omaha offlce). 

' H Ye8,, Il grant access to my property and vns given the pamphlet D No, I do not grant access to my property and I was 

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

Care Providers, and Schpol^." Information for Families, Childe Care Providers, and Schools." 

(yii--^w9 

Signature Date 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
•©©(mifoiMosifeoTi ©if r^®(g®opG © f L®§ldl FgiOlTDplhlisft 

ADDRESS m CODE. 

PROPERIY ADDRESS OF OWNER IF DIFFERENT THAN PROPERTY BEING PAINTED: 

PROPERTY ADDRESS a P CODE 

I have received a copy of the pamphlet. Ranovsta RleM : Important Laad Ham d InfofmaSon For Famlllaa, 

C h M Ca n Prnvlda n An d Schoola informing me of the potential risk of the lead hazard exposure from 

renovation activity to be perfomned on dwelling unit. I received this pamphlet before the iwork began. 

:».;^,K)nr^Q Pg:R£-2.^/7£/£^ 

y HATI / ^ PRIN PRINTET D NAME OF RECIPIENT "^ DATE 

L2QNM-UR E OF RECIPIENT </ 

Self-CortHlcatlon OpHon (For Tenant-Occupied Dwellings Only) 

If the lead pamphlet was delivered but a tenant signature was not obtainable, you may check the appropriate box 

below: 

[ ] Refusal To Sign - 1 certify that I have made a good faith effort I D deliver the pamphlet. renovalB right important 

lead hazanl Infonnalfon for famities. ohlM care providere and schools; to the rental dwelling unit listed above at the 

dale and time Indicated and that the occupant refused to sign the confinnation of leceipL I further certify ttiat I 

have toll a oopy of ttie pamphlet at the unit wtth occupant 

Unavailable For Slgnitur s - 1 certify ttiat I have made a good faitti effort to deliver ttie pamphlet, renovate right 

Important lead hazard infomiation for families, chikl care provideis and schools, to ttie rental dwelling unit listed 

bakw and ttiat ttie occupant was unavaflable to sign ttie confirmation of receipt I further certify ttiat I have left a 

copy of ttie pamphlet at ttie unit by sliding it under ttie door or somewhere on ttie premises. 

PRINTED NANEOFRRSON E OF I raUONCERTIFYINQ ATTEMPfB)

 DeUVERT DATE AND TIME LEAD 

PAMPHLET DEUVERY 

a \ '?WKJ^ ' 

SIONATURE ORPGRSON CERTIFYING LEAD PAMPHLET DEUVERY: 

Note R^iadlng Mailing OpIkM - as an aMsmattve to dsimry ki person, you may rnal ttw toad pamphlet to ttw owner 

andHortanant Pamphtot must be maitod at bast 7 dsys before renovation. (Dimumant wllh a oartliicBte of tiidhg froni ihe post 

onto). 

CONFIRMATIONOFRBCEIPr OF LEAD PAMPHLET OaDB 
Qii 

^ , 1 

^w^ T rsj- DATE 

BVID 

AR£ACS]) HO BE PAINITEDi k)e^c/te.ry 

.GOIJOBL ] 

HousmoM. .GOLORL /-z- /^r^A^ 

cwt^^^'^"^'^''^ 

GARAO^ JOOUNL 

GARAGE TRIM. JQOLORL 

POROi. .GOUML 

PORCH TRIML COLOR. 

(GOMPUfE A a SECnOHr YESir NQ, OR NON-APPUCABLE) 

I AfiRiE TO THE GOLORS LISTED ABOVE. ONCE PAINnNG BEGINS I 

UNDERSTAND I CAN NOT CHANGE THE ABOVE SELECTED COLORS: 

PROPBRYOMBinQNAIlIRe: 

/\^Q...H.id ^ X'h ^ -^ ^ 
. Douglas County Account Information Page 1 of 2 

/oss^ 

Douglas County, Nebraska Property Record - R0416670000 1 

Print Report 

NEW Feature - Parcel Dimensions available ffl scale 0-50 ft west of 52nd St - Vie w O n Ma D Information is valid as of 2009-6-3 Treasurer's Tax Report 

1 New Feature «^ H^ -• Auto Sales Search 

1 Owner I 

PEREZ JUVENTINO CLM ^ H j 

ETAL ' 

2113JST ^"KS - IZI^ I 

1 OMAHA NE 68107-0000 IO O ^ | 

1 Property Informatio n | 

Key Number 1667 0000 04 1 

Account Type: Residential 

Parcel Number 0416670000 

Parcel Address: 2113 J ST 

OMAHA NE 68107-0000 | 

1 Legal Description: SOUTH OMAHA CITY LOTS LOT 15 BLOCK 127 E 44 W 94 FT LT 16 & E 44 W 94 

N31 FTLT15 44X61 | 

Value Informatio n 

Land /mprovemenf Total 1 

2009 

2008 

2007

2006 

2005 

2004

 I 

I 

$4,600.00 

$4,600.00 

$4,600.00 

$4,600.00 

$4,600.00 

$4,600.00 

$36,600.00 

$36,600.00 

$36,600.00 

$36,600.00 

$33,500.00 

$33,500.00 

$41,200.00 

$41,200.00 

$41,200.00

$41,200.00

$38,100.00 

$38,100.00

 1 

1 

1 

Sales Informatio n | 

Sales Date: 2001-06-27 1 

Deed Type: WD Book: 2003 Page: 197930 1 

Price: $25,000.00 1 

Grantor RICHARD MARQUEZ 

Grantee: JUVENTINO PEREZ ETAL | 

Valid/invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres 1 SF Units Depth 1 Width Vacant { 

0.07 1 3080.0 1 1.0 70.0 i 44.0 No 1 

Improvemen t Informatio n 

http://dougIasne.mapping-online.com/DougIasCoNe/static/accountinfo.jsp?accountno=R041... 6/9/2009 
Douglas County Accoimt Information Page 2 of2 

1 1/2 Story Fin 2113 J St 

mvtn 

BiiiWSfetfcSn SM.lScjF) 

CLICK TO ENLARGE IMAGE _CUCKTOJgJLAJRg£IIJjlgg_ 

Square Footage: 888.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

Built As: 1 1/2 Story Fin Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 6.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywali Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1885 0% 1885 124 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 594.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Porch End Solid Wall 126.0 

Porch Slab w/Steps 80.0 

User See Notes 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R041... 6/9/2009 
JC Painting 

Property Address oL\\3 T "^ ^ Date '^ - 03L - <o Cj 

Start Date "^ r^. jy ­ Ci T Complete Date 

Amount Of Prime And Paint Used 

Prime (Gallons) 

Poly (Boxes) 

^ 

a. 

•Paint (Color) 

Paint (Color) 

(o4- -^n 

if>^3 ^ 

Amount (Gallons) 

Amount (Gallons)

I O 

^ 

Paint (Color) Amount (Gallons) 

Paint (Color) Amount (Gallons) 

Paint (Color) Amount (Gallons) 
Professional Environmental Engineers, Inc. 

INTERVENCION DE SEGURIDAD 

Nombre del Proyecto: 21 I?, S 'J^-T 

Fecha de la Intervencion: ' -_2=- - c ? 

Peligros de Salud Prinnordial: Oi'n &uiuc OS.-P 

Preocupaciones Primordiales de H & S: 

Tareas Diarias: 1. Scrg^gr 

2. prL«^f ­

3. pCLlA . 

Equipo Usado en el Lugar de Traabjo: 

Casco Duro Escalera X 

Gafas de Seguridad X Elevadores 

Zapatos % GFCI ^ 

Guantes de Trabajo ___^_ _ Chalecos de Seguridad X 

Generadores K Otro X 

Equipo Listo para Respuesta de Emergencia a Disposicion Inmediata: 

Conducir Reunion Diaria de Seguridad ^ 

Estuche de Primeros Auxilios X 

Procedimientos de Emergencia X 

Politica de Salud y Seguridad de la Companfa X 

GFCI en sitio X 

Deficiencias: 

Acciones Corretivos: 

Interventor: AniOrio-nii y^lcanTqV y^lcantgvoi Fecha: 1 ^ 2 ~ o 9 

Supervisor del Sitio: ^AU^kfi^scI^^eirAaaPo Fecha: M, - fa 2 - n C 
PROFESSIONAL ENVIRONMENTAL ENGINEERS, INC. 

REUNION DIARIA DE SEGURIDAD 

Fecha: V - 2 .- oH

Proyecto: Omaha Paint Stabilization Proiect 

Lugar: ^// ^ J ^4 

Sitio de Actividad: ZII ^ \ :S,4 

Tareas Diarias: 

1. ^<^rcfCa c 

2. h^rO)y?gr 

3. VlY&n f 

Primordial/Peligros Potenciales: 

1. Cables. H e rrtyryiTf^ 3. Sft / c a u'tr K7 r^ 

2. ^ s <-r, /g/-/! Q. 4. 

Herramientas de Trabajo: 

2. brorhci ^ A. '\\r\iu y g 

Practicas del Trabajo/Acciones Correctivas: 

1. Uina llaa g7fa6' fc7fa6'=>03^ 3. 

2. 4. 

Llamadas previas: 

1. 3. 

2. 4. 

Firma de Registro del Empleado: 

3.. 

4., 

6.. 

8. 

us^ ^ r^2-(5 ^ 

Firma de Salud y Seguridad del Sitio Fecha