TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: 2S'0OtS Date: y/c^ih 

Address: 4DZf Ufuj&lXe, A/. 

Remediation Contractor: PROFESSIONAL ENVIRONMENTAL ENGINEERS Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

m Video ofproperty (DVD) \ 

y Executive Summary 

K Signed Access Agreement for subject property 

yX Painting Agreement . 

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

y Photographs . • ' 

W • Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

M Property information from Douglas Coimty Assessor's Office 

O . 

7/y/Jo9 
i PROFESSIONAL 1 

2505 North 24»\ Suite 219 1 ENVIRONMENTAL ENGINEERS, INC. Omaha, NE 68110 

(402) 504-4688 "Providing cost-effective environmental solutions" Fax (402) 504-3281 1L ^

Consulting • Engineering Design «• Remediation • Abatement • Emergency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

SAID# 25005 

4027 Lafayette Av 

• Dates worked 01/01 to 01/02 2009 

• House and garage paint was poor and flaking off, garage had damage to door and some of 

the siding. Owner wanted us to come back in the spring and do some touch ups on the porch 

and garage areas in the spring as it was too cold to do them at that time. Owner called the pic 

line in early spring to request we come back out. Many attempts were made to contact owner 

and phone calls were unretumed. 

• Inspected by Willie Clay as EPA was unable. 
PROFESSIONAL 

2505 North 24'^ Suite 219

ENVIRONMENTAL ENGINEERS, INC. Omaha, NE 68110 

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

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Property Owner Close-Out Form 

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

SAID: .U'ycx)^ 

Property Address: ^Q2^ jL..{i.yjiHjz 

Owner's Name: '2,^Ac^\c ^ ft^ , A ^jp^ky 

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 

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 1^ 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) m reasonably good T 

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

barrier tape tape, etc etc. properly removed removed?

? T

r , . prooerlv

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) lingering issues with the property owner(s) that have 

been left unresolved? 

Comments:-

jdyyJiy zip xh ^ fpicJiy ^ JW ^ AxUxyiidy'^i 

1h PM^ y p iryual/^-=rL 

Property Owner Signature Date 

J ~X ^'Of ^ 

Professional Envifonmenta Envifonm l Engineers Representative Date
CONSENT ©FE ACCESS TC' PEOFEET¥ 

LEAB SITE EEMEKLAL ACTION - LEAB-KASEP PAINT STABILEZAI 

PROPERTYID: X^.1X2P^y~ PROPERTY ADDRESS: "^J^. ^ y^yy^y^/K ^ ,^ y 

OWNER NAME: 

"^^^J^^^ . A/> rilhJl^vi^r ^ DAYTIME PHONE: ^j- y -^jQ-^?i^< y 

CELL PHONE: E-MAH.: 

OWNER'S ADDRESS IF DIFFERENT: 

TENANT'S NAME IF APPLICABLE: 

DAYTIME PHONE: 


CELL PHONE: 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 stabilization work is being done to protect the soil cleanups that were performed by EPA contractors. 

Paint stabilization activities will include: scraping of cracked or flaking LBP from structures, application of a 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 contractor to conduct a soU cleanup at my property foUowing completion of 

lead-based paint stabilization. I understand that the stabilization contractor can not provide assurances that the soil cleanup 

contractor wiO 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 ofproperty 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-Isetts, 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 office). 

Yes, I grant access to my property and was given the pamphlet D No, I do not grant access to my propefty and I was 

"Renovate Right, Important Lead bifbrmaikHifor Families, Child given the pamphlet "Renovate Right, Important Lead 

Care Providers, and Schools." ^- ^ ^ InformatkHi for Families, Childe Care Provklers, and Schools." 

iTgna^re Date Signataire Date 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
€9mMmwlmm ©IF [RisistBopli: Off Lsacf] PnovypGitefi 

PROPERTY ADDRESS. ^^j y /^T^y,^/ ^ ^ A/ m POPE yfyy / 

PROPERTY ADDRESS OF OWNER IF DIFFERENT THAN PROPERTY BEING PAINTED: 

PROPERTY ADDRESS ^ZIP CODE 

I have received a copy of the pamphlet, Renovate Right: Important Lead Hazard Information For families, 

Child Care Providers And Schools informing me of the potential risk of the lead hazard exposure from 

renovation activity to be perfomied on dwelling unit. I received this pamphlet t)efore the work began. 

PRINTED NAME OF RECIPIENT ^ DATE 

'x. 

{NATURE OF RECIPIENT 

Self-Certification Option (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: 

I J Refusal To Sign - 1 certify that I have made a good faith effort to deliver the pamphlet, renovate right: important 

lead hazard infomiatton for ^miiies, child care providers and schools; to the rental dwelling unit listed above at the 

date and time indicated and that the occupant refused to sign the confinnation of receipt. I further certify that I 

have left a copy of the pamphlet at the unit with occupant. 

L l Unavailable For Signature - 1 certify that I have made a good faith effort to deliver the pamphlet, renovate right; 

important lead hazard infomnatbn for families, child care providers and schools, to the rental dwelling unit listed 

below and that the occupant was unavailable to sign the confirmation of receipt I further certify that I have left a 

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

yy^yyyyA' T4^ //~ /^-i^y 

PRINTED NAME OF PERSON CERTIFYING AHEMPTED DELIVERY DATE AND TIME LEAD 

PAMPHLET DELIVERY 

SIGNATURE OF PERSON CERTIFYING LEAD PAMPHLET DELIVERY: 

Note Regarding Mailing Option - as an altemative to delivery in person, you may mail the lead pamphlet to the owner 

and/or tenant. Pamphlet must l)e mailed at least 7 days before renovation. (Document with a certificate of mailing from the post 

office). 

CONFIRMATIOt^l OF RECEIPT OF LEAD PAyPHLET 06/08 

L 
PM m MMC U ASSESSMENT 

AREA(S) TO BE PAINTED: 

HOUSE PROPER: / COLOR^ lyMjj A f 

HOUSE TRIM JAjtd COLOR dynQyA 

GARAGE. COLOR h y iMdL 

GARAGETRIM 'j y COLOR j^^yK 

PORCH. iMxL .COLOR. jxlM^ h i / 

PORCH TRIM COLOR /yb/jy^ A 

(COMPLETE ALL SECTION, YES, NO, OR NON-APPUCABLE) 

I AGREE TO THE COLORS USTED ABOVE. ONCE PAINTING BEGINS, I 

UNDERSTAND I CAN I40T CHANGE THE ABOVE SELECTED COLORS: 

PROPERTY OWNER SIGNATURE: PE ACCESSOR SIGNATURE: 

,1 

rAlxik^ yy.^^^ 

TT" 

PAiNT »AATCH FORD/) 08/08 
-Douglas County Account Information Page 1 of 3 

Douglas County, Nebraska Property Record - R2406710000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 90th St - Vie W On IVIap Information is valid as of 2008-9-4 Treasurer's Tax Report 

New Feature -¥-*- * Auto Sales Search 

Owner 

POINDEXTER ZEDEKA N 

4027 LAFAYETTE AVE 

OMAHA NE 68131-0000 •-> Cx ^ ­ X^S<::^4X^ f Q ^ Xpc^^iiyi/ 

Property Informatio n 

Key Number: 0671 0000 24 

Account Type: Residential 

Parcel Number: 2406710000 

Parcel Address: 4027 LAFAYETTE AV 

OMAHA NE 68131-0000 

Legal Description: WALNUT HILL LOT 7 BLOCK 14 40 X 150 

Value Informatio n 

Land Improvement Total 

2008 $2,500.00 $67,500.00 $70,000.00 

2007 $2,500.00 $67,500.00 $70,000.00 

2006 $2,500.00 $67,500.00 $70,000.00 

2005 $2,500.00 $51,000.00 $53,500.00 

2004 $2,500.00 $51,000.00 $53,500.00 

2003 $2,500.00 $51,000.00 $53,500.00 

Sales Informatio n 

Sales Date: \ 2006-05-16 

Deed Type: QC Book: 2006 Page: 054357 

Price: $1.00 

Grantor: Velma P Poindexter 

Grantee: Zedeka N Poindexter 

Valid/Invalid: Invalid 

Exclusion Reason: Family Sale 

Sales Date: 2005-10-26 

Deed Type: QC Book: 2005 Page: 135047 

Price: $0.00 

Grantor: Velma P Poindexter 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R24... 11/5/2008 
^Douglas County Account Information Page 2 of 3 

Grantee: Velma P Poindexter 

Valid/Invalid: Invalid 

Exclusion Reason: Family Sale 

Sales Date: 1997-09-29 

Deed Type: Book: \ 2072 Page: 486 

Price: $51,350.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.13 6000.0 1.0 150.0 40.0 No 

Improvemen t Information 

Building 1 

ie* -/mnmf*m as* 

[7_ CLICK.TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1602.0 Percent Complete: 100.0% 

Perimeter 0 0 Quality: Average 

Unit Type: Condition: Average 

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

HVAC: Central Air to Air Rooms: 8.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 4.0 

Roof Type: Hip Stories: 2.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp ?accountno=R24... 11/5/2008