## TRANSMITTA L o f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R 

# SAID# : 2S'0Ot S Date : 

# y/c^i h 4DZ f

Ufuj&lXe , A/ . Address : 

### Remediatio n Contractor : PROFESSIONA LENVIRONMENTAL ENGINEER S Year : 200 8 PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S mVide o ofpropert y (DVD ) \ y Executiv e Summar y K

Signe dAcces s Agreemen t fo r

subject propert y y

X Paintin g Agreemen t . Q

l Settlement document s (i.e. , fo r

damag e or t o replac e plants , etc. ) y Photograph s . • ' W• Satisfactor y restoratio n signedb y Propert y Owne r D Propert y close-out check lis t signe db y EP A M Propert y information fromDougla s Coimt y Assessor' s Office

O
. 

# 7/y/Jo 9

# i PROFESSIONA L 1 250 5 Nort h 24» \ Suit e 21 9 

## ENVIRONMENTA L ENGINEERS , INC
. Omaha , N E 6811 0 

# 1 (402 ) 504-468 8 

### "Providin g cost-effectiv e environmenta l solutions " Fa x(402 ) 504-328 1 ^ 

# 1 L

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 SAID #2500 5 402 7 Lafayett e A v

•Date s worke d01/0 1 t o 01/0 2 200 9 •Hous e an dgarag e pain t was poo r an dflakin g off , garag e ha ddamag e t o doo r an dsom e o f th e siding . Owne r wante du s t o com e bac k i n th e sprin g an dd o som e touc h up s o n th e porc h an dgarag e area s i n th e sprin g a s i t was to o col dt o d o the ma t tha t time . Owner calle dth e pi c lin e i n earl y sprin g t o reques t w e com e bac k out . Many attempt s wer e mad e t o contac t owne r an dphon e call s wer e unretumed . •Inspecte db y Willi e Clay a s EP A wa s unable .

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

# ENVIRONMENTA L ENGINEERS , INC
. Omaha , NE 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 yRespons e 

### Propert y Owne r Close-Ou t For m (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) 

# .U'ycx) ^ SAID : Property Address : 

### ^Q2 ^ jL..{i.yjiHj z Owner' s Name : '2,^Ac^\c ^ ft^ , A ^jp^k y Performanc e Standards/Close-Ou t Criteri a YE S NO 1. Wa s th e entir e structure(s ) painte dwith th e exceptio n ofth e stated , exclude d areas ? Thi s woul dinclud e paintin gof othe r associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an dexterio r surface s of garages . 2. Wa s al l scrapin g an dothe r preparatio n wor k

complete dsatisfactorily ? • ^ 

### 3. Wer e al l require darea s ofth e structure(s ) prime d as neede dan dpainte dwith 

# 1^ tw o to p coats ? 4. Wa s th e pain t product s utilize dequivalen t to a 30 year product/quality ? : ^ 

### 5. Ar e 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 an dals o remov e an y othe r generate ddebris ? 7. Is th e gras s are atha t surround s th e structure(s ) mreasonabl y goo d 

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

# T r , . prooerl v 9. Is ther e an y evidenc e ofpropert y damag e that wa s don e by th e contractor ? Any property damag e need s to be complete dprio r to th e EP A Close-Out . 10 . Ar e ther e any property item s that wer e temporaril y re-locate d by th e contracto r that nee dtobe move dback ? 11 . Ar e ther e an y (known ) lingerin g issue s wit h th e property owner(s ) that hav e bee n lef t unresolved ? Comments:

- 

# jdyyJi yzi p xh ^ fpicJi y^ 

# JW ^

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# 1 hPM ^ y p iryual/ ^ -=r L 

### Property Owne r Signatur e Dat e J 

### ~X ^'Of ^ Envifon m Dat e Professional Envifonmental Engineer s Representativ e

# CONSEN T ©F E ACCES S TC ' PEOFEET ¥ LEA B SIT E EEMEKLA L ACTIO N - LEAB-KASE P PAIN T STABILEZA I PROPERTYID : X^.1X2P^y ~ PROPERT Y ADDRESS : "^J^. ^ y^yy^y^/K ^ ,^ y OWNE RNAME : "^^^J^^^ . A/ > rilhJl^vi^r ^ DAYTIME PHONE : ^j- y -^jQ-^?i^< y CEL L PHONE : E-MAH. : OWNER' S ADDRES S I FDIFFERENT : TENANT' S NAM E I FAPPLICABLE : 

### DAYTIM E PHONE : CEL L PHONE : E-MAIL : Professiona l Environmenta l Engineers , Inc . (PE ) i s unde r contrac t (#EP-R7-08-06 ) wit h th e U.S . Environmenta l Protectio n Agency (EPA ) t o stabiliz e leadbase dpain t (LBP ) o n residentia l structure s a t anumbe r of propertie s locate din Omaha , Nebraska . Th e pain t stabilizatio n work i s bein g don e t o protec t th e soi l cleanup s tha t wer e performe dby EP A contractors . Pain t stabilizatio n activitie s wil l include : scrapin g of cracke do r flakin g LB P fromstructures , applicatio n of aprim e coat an d tw o (2 ) coat s of pain t Moving part s of window s an ddoor s ar e no t include dan dwil l no t b e addressed . Your cooperatio n i s requeste din givin g permissio n t o thi s EPA contracto r (PE ) t o ente r an dhav e acces s t o thi s propert y for th e purpos e o f stabilizin g lead-base dpain t a s outline do n th e propert y identifie dabove . B y signin g thi s document I agre e t o allo w a n EPA contracto r t o conduc t aso U cleanu p a t m y propert y foUowin g completio n o f lead-base dpain t stabilization . I understan dtha t th e stabilizatio n contracto r ca n no t provid e assurance s tha t th e soil cleanu p contracto r wi O b e boun dto . I furthe r understan dtha t th e soi l cleanu p contracto r will make 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 full y understan dtha t by signin g thi s Consen t for Access , (1 ) thi s acces s will remai n i n effect unti l th e work ha s been satisfactoril y completed , (2 ) tha t th e Propert y Owne r o r Tenant , if applicable , will b e given th e Housin g an dUrba n Development (HUD ) an dEP A pamphlet , "Renovat e Right , Importan t Lea dHazar dinformatio n for Families , Da y Car e Providers , an dSchools" , (3 ) th e Propert y Owner o r tenan t wil l remov e al l obstruction s fromsurface s t o b e painted , (4 ) will abid e by healt h an dsafet y guidanc e provide dby EPA , (5 ) will allo w photograph y ofpropert y before an dafte r th e pain t stabilizatio n work , (6 ) will b e contacte db y aPE representativ 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 wit h an y ofth e LB P stabilizatio n actions , an d(8 ) wil l participat e i n fina l propert y inspectio n an d sign th e Completio n Agreement an dPropert y Owne r Satisfactio n Survey . Shoul dyou hav e any question s abou t th e plane dLeadBased-Pain t stabilizatio n activitie s for you r property , pleas e contac t Professiona l Environmental Engineers , In c Projec t Manager , Willi e Clay A t 402-504-4688 . Genera l question s abou t th e Omah aLeadSit e cleanup can b e directe dt o Paulett aFrance-Isetts , EPA Remedial 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 (North Omah aoffice) o r 402-731-304 5 (Sout h Omah aoffice) . Yes , I gran t acces s t o m ypropert yan d was give n th e pamphle t D No , I d o no t gran t acces s t o m ypropeft yan d I was "Renovat e Right , Importan t Lea d bifbrmaikH i forFamilies , Chil d give n th e pamphle t "Renovat e Right , Importan t Lea d Care Providers , an d Schools. " ^ - ^ ^ InformatkH i fo rFamilies , Child e Car e Provklers , an d Schools. " iTgna^r e Dat e Signatair e Dat e SPECIA L INSTRUCTION S AN D CONSIDERATION S

## €9mMmwlm m ©I F [RisistBopli : Of f Lsacf ] PnovypGitef i

PROPERT Y ADDRESS
. 

# ^^j y/^T^y,^/ ^ A/ m POP E yfyy / ^ PROPERT Y ADDRES S O F OWNE R I F DIFFEREN T THA N PROPERT Y BEIN G PAINTED : PROPERT Y ADDRES S ^ZI P COD E I have receive d a copyo f th e pamphlet , Renovat e Right : Importan t Lea d Hazar d Informatio n Fo rfamilies , Chil d Care Provider s An d School s informin g m e o f th e potentia l risk o f th e lea d hazar d exposur e fro m renovatio n activit yt o b e perfomie d o n dwellin g unit
. I receive d thi s pamphlet t)efor e th e work began
.

PRINTE D NAM E O F RECIPIEN T ^ DAT E 

# 'x . {NATUR E O F RECIPIEN T Self-Certificatio n Optio n (Fo rTenant-Occupie d Dwelling s Only ) I f th e lea d pamphlet was delivere d bu t a tenan t signatur e was not obtainable , yo u ma ychec k th e appropriat e bo x below : I J Refusa l T o Sig n - 1 certif ythat I have mad e a goo d fait h effor t t o delive rth e pamphlet , renovate right: importan t lea d hazar d infomiatto n fo r^miiies , chil d care provider s an d schools ; t o th e renta l dwellin g uni t liste d abov e at th e dat e an d tim e indicate d an d that th e occupan t refuse d t o sig n th e confinnatio n of receipt
. I furthe rcertif ythat I hav e lef t a copyo f th e pamphlet a t th e uni t wit h occupant . L l Unavailabl e Fo rSignatur e - 1 certif ythat I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , renovat e right; importan t lead hazar d infomnatb n fo rfamilies , chil d care provider s an d schools , t o th e renta l dwellin g uni t liste d belo w an d tha t th e occupan t was unavailabl e t o sig n th e confirmatio n o f receip t I furthe rcertif ythat I hav e lef t a cop yof th e pamphle t a t th e uni t b yslidin g i t unde rth e doo ro rsomewher e o n th e premises
. 

# yy^yyyyA ' T4 ^ // ~ /^-i^ y PRINTE D NAM E O F PERSO N CERTIFYIN G AHEMPTE D DELIVERY DAT E AN D TIM E LEA D PAMPHLE T DELIVERY

SIGNATUR E O F PERSO N CERTIFYIN G LEA D PAMPHLE T DELIVERY : Not e Regardin g Mailin g Optio n - a s an altemativ e to deliver yi n person , yo u ma ymai l th e lea d pamphle t to th e owne r and/o rtenant . Pamphle t mus t l) e maile d a t leas t 7 day s befor e renovation
. (Documen t wit h a certificat e o f mailin g fro m th e pos t office)
. CONFIRMATIOt^ l OF RECEIP T O F LEA D PAyPHLE T 06/0 8 

# L

## PM m MMC U ASSESSMEN T

AREA(S ) TO B E PAINTED : HOUS E PROPER : / COLOR ^ lyMjj f 

# A HOUS E TRI M JAjt d COLO R 

# dynQy A

GARAGE
. COLO R 

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GARAGETRI M 'jy COLO R 

## j^^y K
PORCH
. 

## iMx L .COLOR
. 

# jxlM ^ h i /

PORC H TRI M 

## COLO R /yb/jy^ A (COMPLET E AL L SECTION , YES , NO , O R NON-APPUCABLE ) 

## I AGRE E T O TH E COLOR S USTE D ABOVE
. ONC E PAINTIN G BEGINS , I UNDERSTAN D I CA N I40 T CHANG E TH E ABOV E SELECTE D COLORS :

PROPERT YOWNE R SIGNATURE : P E ACCESSO R SIGNATURE :

, 1 

# yy.^^ ^ rAlxik^ TT " PAiN T»AATC H FORD/ ) 08/0 8

### -Dougla s County Accoun t Informatio n Pag e 1 o f 3 Dougla s County , Nebrask a Propert yRecor d - R240671000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t of 90t h St - Vie W O n IVIa p Informatio n i s vali d a s o f 2008-9- 4 Treasurer' s Ta xRepor t Ne w Featur e -¥-*- * Aut o Sale s Searc h Owne r POINDEXTE R ZEDEK AN 402 7 LAFAYETT E AV E OMAH AN E 68131-000 0 •- > Cx ^

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Xpc^^iiyi / Propert yInformatio n Ke yNumber : 067 1 000 0 2 4 Accoun t Type : Residentia l Parce l Number : 240671000 0 Parce l Address : 402 7 LAFAYETT E A V OMAH A N E 68131-000 0 Lega l Description : WALNU T HIL L LO T 7 BLOC K1 4 4 0 X 15 0 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $2,500.0 0 $67,500.0 0 $70,000.0 0 200 7 $2,500.0 0 $67,500.0 0 $70,000.0 0 200 6 $2,500.0 0 $67,500.0 0 $70,000.0 0 200 5 $2,500.0 0 $51,000.0 0 $53,500.0 0 200 4 $2,500.0 0 $51,000.0 0 $53,500.0 0 200 3 $2,500.0 0 $51,000.0 0 $53,500.0 0 Sale s Informatio n Sale s Date : \ 2006-05-1 6 Dee d Type : Q C Book : 200 6 Page : 05435 7 Price : $1.0 0 Grantor : Velm a P Poindexte r Grantee : Zedek a N Poindexte r Valid/Invalid : Invali d Exclusio n Reason : Famil ySal e Sale s Date : 2005-10-2 6 Dee d Type : Q C Book : 200 5 Page : 13504 7 Price : $0.0 0 Grantor : Velm a P Poindexte r 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R24. . . 11/5/200 8

### ^Dougla s County Accoun t Informatio n Pag e 2 o f 3
Grantee : Velm a P Poindexte r Valid/Invalid : Invali d Exclusio n Reason : Famil ySal e Sale s Date : 1997-09-2 9 Dee d Type : Book : \ 207 2 Page : 48 6 Price : $51,350.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 3 6000. 0 1. 0 150. 0 40. 0 N o Improvemen t Informatio n Buildin g 1

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### [7

_ CLICK.T O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1602. 0 Percen t Complete : 100.0 % Perimete r0 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 2 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 8. 0 Exterior : Fram e Sidin g Units : 1. 0 

### Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 4. 0

Roo f Type : Hi p Stories : 2. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.js p ?accountno=R24.. . 11/5/200 8