TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: 28295 Date: November 19 

Address: 2403 N 29 St. 

Remediation Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

el Video of property (DVD) 

[^ Executive Simmiary 

H Signed Access Agreement for subject property 

\J Painting Agreement 

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

D Photographs 

[3 Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

a Property information from Douglas Covmty Assessor's Office 

D 

D 

D 

Si^tiS?" Date 

40310624 

Hill 

Superfund 
PROPERTY SUMMARY 

Date: 10.08.08 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Month of: October 

Property Address: 2403 N 29 St. SAID: 28295 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: None 

A.2 Issues Resolved: None 

A.3 Unique Findings: None 

122A.4 Other Relevant Information: None 

Access Date: 08/21/08 

Work Began Date: 9/30/08 

Closeout Date: 10/07/08 

Enclosures; 

1. Pre-Video 

2. Post-Video 

3. Property Status Form 

4. Signed Access Agreement 

5. Pre-Renovation Form 

6. Paint Match Form 

7. Tracking Form 

8. Douglas County Assessor Property Information Page 

9. EPA Property Closeout form 

10. Property Completion Agreement 

TECHNOLOGIES, INC. 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: ^tf^ S A/- ^ ^ Date: "f/Xl^O y 

Phone: BVID: ^^5~-'J77^ ^'EQ^Vr 

Plant & Permanent Landscaping To Remain In Place 

Item# 

Description and Location 

On Map 

/ / 

P~-^xlstin Pre-Existingg Conditio Conditionn ooff Structure St"''^'"^"s 

Does your Basement have a history of leaking? Yes — No ~ 

Item# Description & Location 

On Map 

II 

Property Owner Prudent Empl 

Signature: 

8080 Ward Parkway, Suite 405 2606 N. 24*^ street, Suite 308 4242 Medical Drive, Suite 4260 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)604-1004 Phone: (210)822-9688 
;i^a9^ 

Prudent Technologies, Inc. (Prudent) is under contract (Contract # EP-R7-08-07) with the U. S. 

Enviromnental Protection Agency (EPA) to stabilize Lead Based Paint (LBP) at a number of properties 

located in Omaha, Nebraska, includingtiie property located at g?T/?3 A^- '2'^SfThe EPA requests your pemiission to allow Prudent to perfonn LBP Stabilization at this property. By 

signing thisform, the property owner grants permission to Prudent to perfonn activities related to LBP 

Stabilization including scraping paint and painting of the referenced property. Further, the owner/tenant 

verifies that they have received the LBP pamphlet "Renovate Rig^t" 

If you have any questions about the LBP stabilization planned for your property, please contact Prudent's 

Administrative Clerk for the Lead Based Paint Stabilization, Ms. Deborah Akerele-Johngon. 

at (402) 504-1004. General questions about the Omaha Lead Site cleanup can be directed to the EPA 

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

office). 

Propoty Acceu Granted By: ~ ^ L (Pleifc Print Name) 

Property Owner Si ^ (Date) / ^ 

PROPERTY INFORMATION 

(To be completed by reiident udAir property owaer - please print) 

RESIDENT NAME:/5//f^ ^ \ fi^ (it/*^ (^^ ^ Renter 

RBIIDENTADDRMa^g /^_g ^ / \ / ^^^7 ^ f^S 

IF RENTAL, PROPERTY OWNED BY: '^^*^(^V ^ 

OWNER'S MAIUNO ADDRESS: cL^^/T^iys ^ ?[ ^ 

OWNER'S TELEPHONE NUMBER-HOME: < \ //4 4 "T WORK: ( ) 

NUMBER OF OCCUPANTS UNDER 7 YEARS OL^j^ H NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER: h i PO'ZL ^ A< ^ 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 6 HOURS OR MORE PER WEEK: 0 

COMMENTS OR SPECIAL INSTRUCTIONS: O-E. DOGS, ENTRY GATES, ETC.) 

^^tfi/h a g^^f. -g/-^ Ci^H f6//izi tjjtHi ^Sk^M^ic^. AtmiORITY FOR ENVIRONMENTAL RESPONSE ACTIONS; The activilies to be implemented by EPA under dris agreement are punuant to Section 104 

of CERCLA. 42 U.S.C. 9604. EPA's right of access to die property is providedfiwn Section 104(e) of CERCLA. 42 U.S. C 9605(e). wbicb provides entiy 

for "detenniningdie needfor response, or choosing ortaking any response action under (his title, or odierwise enforcing (he provisions of (he title." 

«80 Ward Paricway, Suite 405 2606 N. 24*^ Street, Suite 308 4242 Medical Drive, Sulta 4250 

lansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78220 
Current Sample Pre-nenovatio fe n Form 

Effective until April 2010. 

Confimnation of Receipt of Lead Pamphlet 

X I have received a copy of the pamphlet, Renovate fiight Important Laad Hazard 

Information for Families, Child Care f^roviders and S^mois infomning me of 

the potential risk of the lead hazard exposure from renovation activity to be 

perfonned in my dwelling unit. I received this pamphlet before the work began^ 

Self-Certlflcatlon 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. 

Q Refusal to sign — I certify that I have made a good faith effort to deliver the 

pamphlet, Fi&novate Ri^ : Important Lead Hazard Infonnation fbr Families, 

CNld Cara Providers and Schools, to the rental dwelling unit listed below at the 

date and time indicated and that the occupant refused to sign the confinnation 

of receipt. I further certily that i have left a copy of the pamphlet at the unit with 

the occupant. 

Q Unavailable for signature — I certify that I have made a good laith effort to 

deliver the pamphlet. Renovate Right: important ijead Hazard Infonnation fbr 

Famines, Child Care providers and Schoo/s, to the rental dwelling unit listed 

below and that the occupant was unavailable to sign the confinnation of receipt. 

I fgmer certify that I have left a copy of the pamphlet at the unit t>y sliding it 

under the door. ,^ 

%i mmuif 

Printed nafm of person certliying Attempted delivery 

date and time 

lead pamphlet delivery 

_/^^2nZl 

m certliying lead pamphlet delivery 

PV/J /[/• P^*'~ ^ 

Unit Address 

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 be mailed 

at least 7 days before renovation (Document with a certificate of mailing from the 

post office). 
paint match form 

Paint matching form: _j-— 

Property address: /i^/j3 AJ- M ^ 

BVID: ^^^^ ^ ^ ^ 

Area: M (lov^^"^ ^^^\QV:^O£Pei\/^^ Q SlfJ^J^ ^ 

z^Mlmi: Ffi"'^!'po"^ foil's ^Mhf)^ mf^'^' 

Area: color 


Explanation: 


Area: color 


Explanation: 


Area: Color 


Explanation: 


I agree to these colors as listed. Once painting 


starts I can not change these selected colors. 


Homeowner signaturi 


Page 1 

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Douglas County Account Infonn^o ni^ c n Page 1 of2 

Douglas County, Nebraska Property Record - R1035770000 

j Print Report NEW FMtun - Parcel Oimenslont available @ scale 0-50 n west of SOth St - Vle W O n Ma p Information is valid as of 2008-7-14 ! Treasurer's Tax Report 

New Feature - • -• ^ Auto Sales Search 

Owner 

siwMS KATHLEIN R 

2403 N 29 ST 

OMAHA NE 68111-0000 

Property Informatio n 

Key Number: 13577 000010 

Account Type: Residential 

Parcel Number: 1035770000 

Parcel Address: 2403 N 29 ST 

OMAHA NE 68111-0000 

Legal Description: \ FAIRMOUN T PLACE LOT 24 BLOCK 0 50 X 121 

Value Information 

2008 

2007 

^0 6 

2005 

2004 

2003 

! Land 

$1,200.00 

$1,200.00 

$1,200.00 

iiiT2bojO(r 

$1,200.00 

$1,200.00 

Improvement 

$31,600.00 

$31,600!00 

$31,600.00" 

~"$3i,6o6.ob 

$6,900.00 

$6,900.00 

Total 

$32,800.00 

$32,800.00 

_$32^800.'00^ 

$32T800'60~ 

$8,ioo.bo~ 

$8,100.00 

Land Information 

Acres

~o.^T~ 

 i SF Unite 

6050.0 1.0 

Depth 

121.0 

Width Vacant 

50.0 No 

Improvement Info rmatio n

Building 1 

nf'4Y%*///i/\ii/TlnnvtA ifY%nii\t^tii%rr /\«^li*^ a rt/\»v*/T^/Mir»lf»fi/^rfcXTrt/n+o+i/»/«**/»/»i^*»+*'^-f** «#*«i»0#» *•«**••••»*•• #,^T> 1 A 0 / 1 fs/^f\n o 
Page 2 of2 

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Douglas County Account Inform^io im^K n

Square Footage: 1276.0 

Perimeter 0.0 

Unit Type: 

- I -

Built As: 1 1/2 Story Fin 

HVAC: Central Air to Air 

Exterior: Frame Siding 

Interior: Drywall 

Roof Cover: Composition Shingle 

Roof Type: Gable 

Floorcover: Allowance 

i 

YearBullt Year 

Remodeled 

Percent 

Remodeled 

1923 0% 

Deteil Type ' Deteil Description 

Add On T'shed 

Appliance ' Allowance 

Appliance ! Security System 

Basement Bsmnt Block 8 ft 

Basement Walkout 

Fixture '' Base Fixtures 

Fixture ' Bath Full 

Garage Detached 

Porch End Screen 

User LAP SIDING 

i : ^ 

nuifiiM 

1W«0So,F» 

:.: 

1 i/2STorjy 

6uam Sbek 8 tt 

.'*'• *

TMJ 

CLICK JO ENLARGE IMAGE 

Percent Complete: 

Quality: 

Condition: 

Condo Square Footage: 

Rooms: 

_4r'*s= 

Baths: 

Bedrooms: 

Stories: 

Foundation: 

Sprinkler Square Footage: 

Adjusted Year Physical Age Built 

1923 85 

Unite 

140.0 

1.0 

_1.0 

888.0 

1.0 

_ ""-^ 

i.o 

216.0 

140.0 

1.0 

100.0% 

Fair 

Average 

"b.o 

ao ^ 

id" 

To]""" 

40 ~ 

' 1 5 " 

Block 

0.6 

httn'//rfr»nolaon<» ma r •\t'V»/l Irti,/TIonOr,\ra/n+r.+.rt/r./»««..•%+J».'^i. » Zr^^mO^ . i. . r» 1 f\ 
AER^ 

Jun e 26,200 8 (latest revtoton) 

BPA Propeity Close-Ont Form (Lead-Based Paint Stabillzatioii) 

BhekandVeatdiVtenaitrIDWaMbcn rSi4liJOA T 

PnpatjrAddrai: . -^^03 /v/29Sf 

.h "V ,k 

V 

s^ Performance Standards /Oose-Ont Criteria 

1. Waste entire stnictarKs)pBii>todwifli the emeptioa of U» Tfaiswoold 

yea n o 

faidiide paisting of other associaied ftatiaet {Qctuding fittda, es 

bflMifc cohmwi^ laflsi and earterior stnftcea of gauges. y 

1 WaiaUiaqiingtiidotherpreparallonwoifceoQvIetedsatisfiwt^^ 

3. Woe dlnqobed areas ofdiestroetui«(s)inrinied as needed and paiiite^ i / ' 

4 Was the pdm products otilizedeqidvalent to B 30 year prodnct/qudhy? t ^ 

5. An aO oftin areas vrtiere oontamioated materials have been spilled dioroa{^y vacuumed'cleaned? 

6. DidtecootrectorooIlect/vaGmm all Ming and soaped peimdups on tbe en ^ 

wad»a»8.all«way8.piJ>lic access areas and also remove any otiMrwoetated ^ 

7. btegns s area AatstOTonndstfiestnictnteCs) inreasonably good condition? 

%, ited l items siidi as po^yediyleDedieeting.ladden, paint brashes, cones, banker tape, etc. pro^ ^ 

9. Isftere any evidence ofproperty damage that was d(»ie by ^centractoi? Any proper^ damage 

needstpbe coMoleted prior to the BPA C^o»^Ont. t ^ 

10. Aietiiereaqy propeity items tint were temporarilyre>Iocated by the contFBCteT tint need to be 

moved bade? 

11. Antiiereai9Oaio^iio0BriO8issoM^tii tiie propeity o«ner(s)tiurt have been left nnresoh ^ 

Ofter Conddefatioss/Property Owne r Discussions/Additional Work that is Required 

EPAGOR/Repcesemative Mf*m <vn'i<iiy 
Prudent Property Close-Out Form (Lead-Based Paint Stabilization) 

SAID: ^ ^3lgi V V" ^ 

Property Adrfrp..^^</0:? Af .Z94 L S^i^ll P 

Owner's Name: (?//9 7 Q . 7i ^ IGI/ D ^ 

Performance Standards/close-Out Criteria 

YES NO 

1. Was the entire structure(s) painted with the exception of the 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 preparattion work completed satisfactorily? 

3. Were all required areas of the structure(s) primed as needed and painted with two top coats? 

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

5. Are all of the areas where contaminated materials have been spilled 

thoroughly vacuumed/ cleaned? t 

5. Old the contractor collect/vacuum all failing 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) in reasonably good condition? z 

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

properly removed? 

i 

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 temporatily 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? 

Other Consideratlons?property Owner Discussions?Additlonal Work that is Required " ^ 

R z ^ ^

Prudent Re esentative 0 

Date