### TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R SAI D # : |QF>9 3 Date : -^-^Q-Q ^ Address : ^ 1 I? , C Y 5 ^ Remediatio n Contractor : PROFESSIONA LENVIRONMENTA LENGINEER S 

### Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S H ^ Vide o o f property (DVD ) S r Executiv e Summar y ^ /

Signe dAcces s Agreemen t fo r

subjec t property ^ r

Paintin g Agreemen t D Settlemen t document s (i.e. , fo r

damag e o r to replac e plants , etc. ) 5 K Photograph s pC ^ Ol A po& T ^ r

Satisfactor y restoratio n signe dby Propert y Owne r B*^*^Propert y close-ou t chec k lis t signe db y EP A W

r Propert y informatio n fro mDougla s Count y Assessor' s Offic e ^y"" ^ _confirmatio n tha t lea dpamphle t "Renovat e Right " wa s receive db y P0 _ D D

Professiona l Environmenta l Engineer s Signatur e Dat e

/ a 

# 'M h iP A Signatur e Dat e 3009436 4
r \ Superfun d A'" '

## PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC . ''' ' Tm'ah t N E ee?! ? "Providin g cost-effectiv e environmenta l solution s " ^^ ^

[J°^ j 52t328 i Consultin g • Engineerin g Desig n • Remedialio n • Abaiemen t • Emeigenc yRespons e



### Lea dBas e Stabilizatio nOmaha , Ne Clos e Ou t Repor t 200 9 SAID #1058 3 211 3 J S t

•Date s worked : 07/02/0 9 t o 07/02/0 9 •Pr e propert y condition : Painte dwoo dsidin g tha t wa s i npoo r condition , pain t chip s in yar dan daroun dhouse . Window s ha dplasti c covering s o nthem , item s neede dt o b e remove dprio r t o wor k starting . •Problem s encountered : Non e •Owne r request/concerns : Colo r change . •Inspection/closeou t dates : Propert y signe d07/06 , EP A 07/09/0 9 N o issue s

# PROFESSIONA L 250 5 Non 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 Consultin g • Enginee rn g Des.g n • Remo d r,\io n • AbatRmen l ° Emeigenc yReF.pon=: e 

### EP A Close-Ou t Fon n (Lead-BasedPain t Stabilization EP A Contrac t EP-R7-08-06 ) SAID : |nfS5^? ^ Propert y Address : j ^11' ^ C^ ~ t'^Y Owner' s Name : 'y^J\/-f>n'hnC ^ "^.ff ^ Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) painte dwit hth e exceptio nofth e stated , exclude d areas ? 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 , andexterio r surface s o f y ^ garages . 2 . Wa s al l scrapin g an dothe r preparatio nwor k

complete dsatisfactorily ? ^ 

### 3 . Wer e all require darea s ofth e structure(s ) prime da s neede dandpainte dwit h 

### y tw o to p coats ?
t 

### 4 . Wa s th e pain t product s utilize dequivalen t t o a3 0 yea r product/quality ? ^ 

### 1 5 . Ar e al l ofth e area s where contaminate dmaterial s hav e bee nspille dthoroughl y u y vacuumed / cleaned ? 6 . Di dth e contracto r collect/vacuu mall fallin g an dscrape dpain t chip s o n th e entir e property , roadways , alleyways , publi c acces s area s andals o remov e any 

### y ^ other generate ddebris ? 7 . I s th e gras s are athat surround s th e structure(s ) i n reasonabl y goo dcondition ? yy ^ 

### 8 . Are all item s suc ha s polyethylen e sheeting , ladders , pain t brushes , cones , barrier tape , etc . properl y removed ? y ^ 

### 9 . I s there any evidenc e o f property damag e tha t wa s don e by th e contractor ? Any l y 

### property damag e need s t o b e complete dprio r t o th e EPA Close-Out . 10 . Are ther e any property item s that were temporaril y re-locate db y th e contracto r L y that nee dt o b e move dback ? 11 . Are ther e any (known ) lingerin g issue s wit hth e property owner(s ) that hav e ^ 

### bee nlef t unresolved ? Othe r Considerations/Property Owner Discussions/Additional Wor k

tha t i s Required :



## ^?yJ,/^ ^ ^/^.f^yJL^J ^ EP A CO RSignatur e 1

# PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC . "Providin g cost-effectiv e environmenta l solutions " Consultin g • Engineerin g Desig n • Remediatio n • Abatement • Emergenc yResponse 

## Propert y Owne r

Close-Out For m (Lead-Base dPain t Stabilizatio n EPA Contrac t EP-R7-08-06 ) SAID : 

# Ins^" ^ Propert y Address : P11? ^ ~ y S V Owner' s Name : .JUV^ep-hnC ^ "firZ-f^ ^ Performanc e Standards/Close-Ou t Criteri a 250 5 Nort h 24 ^ Suit e 21 9 Omaha , N E 6811 0 (402 ) 504-468 8 Fa

x(402 ) 504-328 1



### YE S N O 1 . Wa s th e entir e structure(s ) painte dwit hth e exceptio nofth e stated , exclude d areas ? 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 . 

# K 2 . Wa s al l scrapin g an dothe r preparatio nwor 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 t o a3 0 yea r product/quality ? 5 . Ar e al l ofth e area s wher e contaminate dmaterial s hav e bee nspille dthoroughl y vacuumed / cleaned ? \ 

### 6 . Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s o nth e entir e property , roadways , alleyways , publi c acces s area s andals o remov e any othe r generate ddebris ? 

# t 7 . I s th e gras s are athat surround s th e structure(s ) inreasonabl y goo dcondition ? 

## "y

­ 8 . Ar e al l item s suc ha s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . properl y removed ? 

# K 9 . I s ther e any evidenc e o f property damag e that 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 EP A Close-Out . ^ 

### 10 . Are ther e any property item s that were temporaril y re-locate db y th e contracto r that nee dt o b e move dback ? 

# 7^ 11 . Are ther e an y (known ) lingerin g issue s wit hth e property owner(s ) that hav e 

## 1 v bee nlef t unresolved ? Comments : 

# -7 ^ 'roperty ' > Ignature Dat e Professional Environmental Engineer s Representativ e Dat e

# A ^ CONSEN T OF RACCES S T O PROPERT Y OMAH A LEA D SITEREMEDIALACTIO N - LEAD-BASE D PAINT STABILIZATIO N PROPERTY ID : /^S^ 3 PROPER ! 

### r

v ADDRESS : ^//? ^ Z T S" ^ OWNE RNAME :



### ^T^UP.r^-liAJ ^ ^fe.-Z _ DAYTIMEPHONE : /S ^ * 3 ^ ^9 ' CELLPHONE : E-MAIL : OWNER' S ADDRES S I FDIFFERENT : TENANT' S NAM EI FAPPLICABLE : DAYTIM EPHONE : CELLPHONE : E-MAIL : 

# 1 Professiona l Environmenta l Engineers , Inc . (PE ) i s unde r contrac t (#EP-R7-08-06 ) wit hth e U.S . Environmenta l Protectio n Agenc y (EPA ) t o stabiliz e lea dbase dpain t (LBP ) o nresidentia l structure s a t anumbe r o f propertie s locate dinOmaha , 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 wer e performe db y EIP A contractors . Pain t stabilizatio n activitie s wil l include : scrapin g ofcracke do r flaking LB Pfro mstructures , applicatio n of aprim e coa t an d tw o (2 ) coat s o f paint . Movin g part s of 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 di n 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 fo r th e purpos e o f stabilizin g lea d-base dpain t a s outline do n th e propert y identifle dabove . B y signin g thi s documen t I agre e t o allo w a nEP A contracto r t o conduc t asoi l cleanu p a t m y propert y followin g completio n o f lead-base dpain t stabilization . I understan dtha t th e stabilizatio n contracto r ca nno 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 t o 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 . I fully understan dtha t b y signin g thi s Consen t fo r Access , (1 ) 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 , wil l 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 , Day Car e Providers , an dSchools" , (3 ) th e Propert y Owne r o r tenan t wil l remov e al l obstruction s fro msurface s t o b e painted , (4 ) wil l abid e b y healt han dsafet y guidanc e provide db y EPA , (5 ) wil l allo w photograph y of propert y befor e an dafte r th e pain t stabilizatio n work , (6 ) will b e contacte db y aP Erepresentativ e approximatel y 4 8 hour s in advanc e o f startin g work , (7 ) agre e no t t o obstruc t o r tampe r withan y ofth e LB Pstabilizatio nactions , an d(8 ) will participat e i n flnal propert y inspectio nan d sig n th e Completio n Agreemen t an dPropert y Owne r Satisfactio nSurvey . Shoul dyo u hav e an y question s abou t th e plane dLea dBased-Pain t stabilizatio nactivitie s fo r you r property , pleas e contac t Professiona l Environmenta l Engineers , Inc . Projec t Manager , Willi e Cla y 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 Paulett aFrance-Isetts , EP A 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 hOmah aofflce ) o r 402-731-304 5 (Sout hOmah aofflce) . ' H Ye8, , l I gran t acces s t o m ypropert yan d vn s give n th e pamphle t D No , I d o no t gran t acces s t o m ypropert yan 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 Schpol^. " Informatio n fo rFamilies , Child e Car e Providers , an d Schools. " 

# (yii--^w 9 Signatur e Dat e SPECIA L INSTRUCTION S AN D CONSIDERATION S

## • ©©(mifoiMosifeoT i ©i fr^®(g®op G ©f L®§ld l FgiOlTDplhlisf t
ADDRES S mCODE . PROPERI YADDRES S O F OWNE R I F DIFFEREN TTHA N PROPERT YBEIN G PAINTED : PROPERT YADDRES S a P COD E I hav e received a cop yo f th e pamphlet . Ranovst a RleM : Importan t Laa d Ham d InfofmaSo n Fo rFamlllaa , C h M Ca n Prnvlda n An d School a informin g m e o f th e potentia l ris k o f th e lea d hazar d exposur e fro m renovatio n activit yt o b e perfomne d o n dwellin g unit . I receive d thi s pamphle t befor e th e iwor k began . 

### :».;^,K)nr^ Q Pg:R£-2.^/7£/£ ^ yHAT I PRINTE D NAM E O F RECIPIEN T /

^

PRIN T " ^ DAT E

L2QNM-UR E O F RECIPIEN T< /

Self-CortHlcatlo n OpHo n (Fo rTenant-Occupie d Dwelling s Only ) I fth e lea d pamphle t wa s delivere d bu t a tenan t signatur e wa s no t obtainable , yo u ma ychec k th e appropriat e bo x below : [ ] Refusa l T o Sig n - 1 certif ytha t I hav e mad e a goo d fait h effor t I D delive rth e pamphlet . renoval B right importan t lea d hazan l Infonnalfo n forfamities . ohl M car e provider e an d schools ; to th e rental dwellin g uni t liste d abov e a t th e dal e an d time Indicate d an d tha t th e occupan t refuse d to sig n th e confinnatio n o f leceip L I furthe rcertif yttiat I hav e toll a oop yo fttie pamphle t a t th e uni t wtt h occupan t Unavailabl e Fo rSlgnitur s - 1 certif yttiat I hav e mad e a goo d faitt i effor t to delive rttie pamphlet , renovat e right Importan t lea d hazar d infomiatio n forfamilies , chik l car e providei s an d schools , to ttie rental dwellin g uni t liste d bak wan d ttiat ttie occupan t wa s unavaflabl e to sig n ttie confirmatio n o freceip t I furthe rcertif yttiat I hav e lef t a cop yo fttie pamphle t a t ttie uni t b yslidin g it unde rttie doo ro rsomewher e o n ttie premises . EOFRRSON I raUONCERTIFYINQ DeUVER TDAT E AN D TIM E LEA D PRINTE D NAN E O F ATTEMPfB ) PAMPHLE TDEUVERY 

# a \ '?WKJ^ ' SIONATUR E ORPGRSO N CERTIFYIN G LEA D PAMPHLE TDEUVERY : Not e R^iadln g Mailin g OpIk M - a s a n aMsmattve to dsimr yk i person , yo u ma yrnal ttwtoad pamphle t to ttwowne r andHortanan t Pamphto t mus t b e maito d a t bas t 7 dsy s befor e renovation. (Dimuman t wll h a oartliicBte oftiidh g froni ih e pos t onto) . CONFIRMATIONOFRBCEIP r O F LEA D PAMPHLE TOaD B

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### . Douglas Count y Accoun t Information Page 1 o f

2 

# /oss ^ Dougla s County , Nebrask a Propert yRecor d - R041667000 0 1 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e ffl scal e 0-5 0 f t wes t of 52n d S t - ViewO n Ma D Informatio n i s vali d a s o f 2009-6- 3 Treasurer' s Ta xRepor t 1 Ne wFeatur e «^ H

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- • Aut o Sale s Searc h 1 Owne rI

PERE Z JUVENTIN O CLM ^

H j ETA L ' 

## 2113JS T^"KS - IZI^ I 1 OMAH AN E 68107-000 0 IO O ^ | 1 Propert yInformatio n | Ke yNumbe r 166 7 000 0 0 4 1 Accoun t Type : Residentia l Parce l Numbe r 041667000 0 Parce l Address : 211 3 J S T OMAH AN E 68107-000 0 | 1 Lega l Description : SOUT H OMAH ACITYLOT S LOT1 5 BLOC K12 7 E 4 4 W 9 4 FTLT1 6 & E 4 4 W 9 4 N3 1 FTLT1 5 44X6 1 | Valu e Informatio n Lan d /mprovemen f Tota l 1 200 9 200 8 200 7 200 6 200 5 200 4 I

I $4,600.0 0 $4,600.0 0 $4,600.0 0 $4,600.0 0 $4,600.0 0 $4,600.0 0 $36,600.0 0 $36,600.0 0 $36,600.0 0 $36,600.0 0 $33,500.0 0 $33,500.0 0 $41,200.0 0 $41,200.0 0 $41,200.0 0 $41,200.0 0 $38,100.0 0 $38,100.0 0 1 1 1 Sale s Informatio n | Sale s Date : 2001-06-2 7 1 Dee d Type : W D Book : 200 3 Page : 19793 0 1 Price : $ 25,000.0 0 1 Granto r RICHAR D MARQUE Z Grantee : JUVENTIN O PERE Z ETA L | Valid/invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s 1 S F Unit s Dept h 1 Widt h Vacan t { 0.0 7 1 3080. 0 1 1. 0 70. 0 i 44. 0 N o 1 Improvemen t Informatio n 

### http://dougIasne.mapping-online.com/DougIasCoNe/static/accountinfo.jsp?accountno=R041.. . 6/9/2009

### Dougla s County Accoimt Informatio n Pag e 2 of 2

1 1/ 2 Stor yFi n 211 3 J S t
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Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 

### 6. 0 Exterior : Fram e Sidin g Units : 

### 1. 0 Interior : Drywal i 

### Baths : 1. 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 r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 188 5 0 % 188 5 12 4 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 ft 

### 594. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h En d Soli d Wal l 126. 0 Porc h Sla b w/Step s 80. 0 Use r Se e Note s 1. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R041. . . 6/9/200 9

### JC Paintin g Propert yAddres s oL\\ 3 T"^ ^ Dat e '^ - 03L - < o C j Start Dat e " ^ r^ . j y­ C i T Complet e Dat e 

### Amoun t O f Prim e An d Pain t Use d Prim e (Gallons )

Pol y(Boxes ) ^ 

# a. •Pain t (Color ) Pain t (Color ) 

## (o4 - -^ n if>^3 ^ Amoun t (Gallons ) Amoun t (Gallons ) 

## I O ^ Pain t (Color ) Amoun t (Gallons ) Pain t (Color ) Amoun t (Gallons ) Pain t (Color ) Amoun t (Gallons )

## Professiona l Environmenta l Engineers , Inc . INTERVENCIO N D E SEGURIDA D Nombr e de l Proyecto : 2 1 I? , S 'J^-T Fech a d e l a Intervencion : ' -_2= - - c ? Peligro s d e Salu d Prinnordial : Oi' n &uiu c OS.- P Preocupacione s Primordiale s d e H & S : Tarea s Diarias : 1 . Scrg^g r 2 . prL«^f ­ 3 . pCLlA . Equip o Usad o e n e l Luga rd e Traabjo : Casc o Dur o Escaler a X Gafa s d e Segurida d X Elevadore s Zapato s % GFC I ^ Guante s d e Trabaj o ___^_

_Chaleco s d e Segurida d X Generadore s KOtr o X Equip o List o par a Respuest a d e Emergenci a a Disposicio n Inmediata : Conduci rReunio n Diari a d e Segurida d ^ Estuch e d e Primero s Auxilio s X Procedimiento s d e Emergenci a X Politic a d e Salu d ySegurida d d e l a Companf a X GFC I e n siti o X Deficiencias :
Accione s Corretivos :

Interventor : AniOri i ^ 

## o-n i y^lcanTqV o 

## y^lcantgv i Fecha : 1 2 ~ o 9 Superviso rde l Sitio : ^AU^kfi^scI^^eirAaaP o Fecha : M , - fa 2 - n C

### PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC . REUNIO N DIARI A DE SEGURIDA D 

## V - 2 .

- oH Fecha : Proyecto : Omah a Pain t Stabilizatio n Proiect 

## Lugar : ^// ^ J ^4 Siti o de Actividad : ZI I ^ \ :S 

# ,4 Tarea s Diarias : 

### 1. ^<^rcfC ac 2. h^rO)y?g r 

### 3. VlY& n f Primordial/Peligro s Potenciales : 1. Cables . H e rrtyryiTf^ 3. Sf t / c au't r K7 r^ 2. ^ s <-r, /g/-/ ! Q. 4. 

### Herramienta s de Trabajo : 

## 2. brorhci ^ A. '\\r\i u yg Practica s de l Trabajo/Accione s Correctivas : 

### 1. Uin a l 

### l a 

### a

g7fa6 ' 

### fc7fa6'=>03^ 3. 2. 4. Llamada s previas : 1. 3. 2. 4. Firm a de Registr o de l Empleado : 3. . 4. , 6. . 8. 

# us^ ^ r^2-(5 ^ Firm a de Salu d ySegurida d de l Siti o Fech a