## TRANSMITTA L o f OMAH A LEA B SIT E PAIN T STABILIZATIO N FIL E FOLDE R
SAI D # : 2^\l&fS M Date : ^/sja O

^ Remediatio n Contractor : PROFESSIONA L ENVIRONMENTA L ENGINEER S Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S Video ofpropert y (DVD ) ' Executiv e Summar y SignedAcces s Agreemen t fo r

subject propert y 0 " 

## Paintin g Agreemen t ettlemen t dociunent s (i.e. , fo r

damag e o r t

o replac e plants , etc. ) Photograph s Dfefcrg , ^A I n 

## 0 ^ Satisfactor y restoratio n signedby Propert y Owne r 

## 0 ^ Propert y close-ou t check lis t signe dby EP A Propert y informatio n fromDougla s Coimt y Assessor' s Office 0 ^ 

## confirmatio n tha t lea dpamphle t "Renovat e Right " wa s receive db y P O D D D

r ^ 

# J 4 ^ ProtessidiM hnvnoitokenta f

Engiheer s S ignatur e

iPA Sigiiatur e 3005461 8 

# J l """""' • Superfun d

# PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC
. ^'° ' ''om rN E eofi o "Providin g cost-effectiv e environmenta l solutions " ^ i^^| ^^t^ ! ^F£i x (402 ) 504-328 1 Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc y Respons e



## Lea dBas e Stabilizatio n Omaha , N e Clos e Ou t Repor t 200 9 SAID#2165 4 101 8 S
. 25* " Av e

• Date s worked : 09/2 1 t o 09/2 1 200 9 •Pr e propert y condition : Hous e ha s mostly viny l sidin g an dpainte dfoundatio n i n poo r condition
. Garag e ha s painte dwoo dsidin g in poo r conditio n wit h flaidng paint
. •Problem s encountered : None •Owne r request/concerns : N/ A
•Inspection/closeou t dates
. Owne r signe d09/2 8 2009
. EPA signe d11/17/0 9

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

## EP A Close-Out For m (Lead-BasedPain t Stabilizatio n EP A Contract EP-R7-08-06 ) 

# SAID : _2iijS!4
. PropertyAddress : lO/ o ^ Z>0 > fW ^ Owner' s Name : Ql'iAQV i M ^^t^ Q 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 Fax (402 ) 604-328 1



## YE S N O 1
. Was th e entir e structure(s ) painte dwit h th e exceptio n ofth e stated , excluded areas ? Thi s wouldinclude paintin g of othe r

associate dfeature s including fascia , eaves , siding , all trim , porches , box beams , columns , rails , an dexterior surface s of 

# A garages . 2
. Was all scraping an dothe r

preparatio n wor k

completedsatisfactorily ? 

# A 3
. Wer e all require darea s ofth e structure(s ) prime da s neededan dpainte dwit h tw o to p coats ? 

# A 4
. Was the pain t product s utilize dequivalen t t

o a3 0 yea r

product/quality ? A 5
. Ar e all ofth e area s wher e contaminatedmaterial s have bee n spille dthoroughly vacuimied / cleaned ? 

# A 6 . Didthe contractor collect/vacuumall falling an dscrapedpain t chip s on th e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y 

# A othe r

generateddebris ? 7
. I s the gras s are atha t surroimd s the structure(s ) i n reasonabl y goodcondition ? 

## y 8
. Ar e all item s suc h a s polyethylene sheeting , ladders , pain t brushes , cones , 

# y barrie r

tape , etc . properly removed ? 9
. I s ther e an y evidenc e ofpropert y damag e tha t was don e b y the contractor ? An y 

## y propert y damag e need s to b e completedprior t

o the EP A Close-Out
. 10
. Ar e ther e an y propert y item s tha t wer e temporarily re-locatedb y the contractor 

# y tha t nee dto b e movedback ? 11
. Ar e ther e an y (known) lingering issue s wit h the propert y owner(s ) tha t hav e 

# y bee n lef t unresolved ? Othe r

Considerations/Propert y Owne r

Discussions/Additiona l Wor k

tha t i s Required :



# llll l ib' ^ JSi.
. 

## EP A CO RSignatur e

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

## Propert y Owne r Close-Ou t For m (Lead-BasedPaint Stabilizatio n EP A Contirac t EP-R7-08-06 ) SAID : 

# 7.1 1 oS M Propert y Address : Owner' s Name : 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 Fax (402 ) 504-328 1



## YE S N O 1
. Was th e entir e structure(s ) painte dwit h th e exceptio n ofth e stated , excluded areas ? Thi s wouldinclud e paintin g o f

other associate dfeature s includin g fascia , eaves , siding , all trim , porches , bo x beams , colunms , rails , an dexterior surface s of 

# y garages . 2
. Wa s al l scraping andothe r

preparatio n wor k

completedsatisfactorily ? 

# 0 3
. Wer e all require darea s ofth e structure(s ) prime da s neededandpainte dwit h 

# 0 tw o top coats ? 4
. Wa s the pain t product s utilize dequivalen t t

b a3 0 yea r

product/quality ? 

## i l 5
. Ar e all ofth e area s wher e contaminate dmaterial s have been spille dthoroughly 

# J vacuumed / cleaned ? 6 . Didth e contractor collect/vacuumall fallin g andscrapedpaint 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

generateddebris ? 

# 7 7
. I s the gras s are atha t surround s th e structure(s ) i n reasonabl y goo dcondition ? 

# J 8
. Ar e all item s such a s polyethylene sheeting , ladders , pain t brushes , cones , 

# J barrie r

tape , etc . properly removed ? 9
. I s ther e an y evidenc e ofpropert y damag e tha t wa s done b y th e contractor ? An y propert y damag e need s t o b e completedprio r to th e EP A Close-Out
. 10
. Ar e ther e an y propert y item s tha t wer e temporarily re-locate db y tiie contractor tha t needt o b e movedback ? 

# A 11
. Ar e ther e an y (known) lingerin g issue s wit h th e propert y owner(s ) tha t hav e \ ) 

## bee n lef t unresolved ? Comments :


# J

^ 

# -A7 ^ 3rtyO \ j ^ 

## Propert y Owne r

Signatur e Da t -^? ^ 

# 5 1 '^- o r 9-^A~^ 9 Professiona l Enviromnenta l Engineer s Representativ e Dat e 

# 7

## OMAM A LEA D SIT E REMEDIA L ACTIO N - LEAD-BASED PAIN T STABILIZATIO N PROPERT Y ID : 27\U5 ^ PROPE I IT Y ADDRESS : ?0) ^ OWNE RNAME ! , A \ -v ^ DAYTIMEPHONE : _ CELLPHONE : W^^? ' 3/f'/fJ^/ ^ E-MAIL : OWNER' S ADDRES S I FDU'VERENT : TENANT' S NAM E I FAPPLICABLE : DAYTIMEPHONE : 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 Agenc y (EPA ) t o stabiliz e lea dbase dpain t (LBP ) o n residentia l structure s a t anumbe r o f propertie s tocatedi n Omaha , 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 ar e bein g performe db y EP A contractors . Pain t stabilizatio n activitie s wil l include : scrapin g o f cracke do r flakin g LB P fro mstructures , applicatio n of aprim e coa t an dtw o (2 ) coat s o f paint
. Movin g part s o f window s an ddoor s areno 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 identifie dabove
.

_.. * B y signin g thi s documen t I agre e t o allo w a n EP A contractbi ; t o conduc t asoi l cleann p a t m y propert y followin g completio n o f lead-base dpain t stabilization , i f th e soi l cleanu p ha s no t alread y bee n performed
. I understan dtha t th e stabilizatio n contracto r ca n no 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 . Yes , I havp-raa dan dunderstandth e paragrap h above
. Slgnahir e o f Propert y Owne r Dat e I frilly understan dtha t b y signin g thi s Consen t fo r Access , (1 ) thi s acces s wil l remai n i n 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 , i f 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 , Da y Car e Providers , an d Schools" , (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 ) will abid e b y healt h an d safet y guidanc e provide db y EPA , (5 ) wil l allo w photograph y o f propert y befor e an dafte r th e pain t stabilizatio n work , (6 ) wil l b e contacte db y aP E representativ e approximatel y 4 8 hour s i n advanc e o f startin g work , (7 ) agre e no t t o obstruc t o r tampe r wit h an y o f th e LB P stabUizatio n actions , an d(8 ) wil l participat e i n fina l propert y inspectio n an dsig n th e Completio n Agreemen t an d Propert y Owne r Satisfactio n Survey
. Shoul dyo u hav e an y question s abou t th e plane dLea dBased-Pain t stabilizatio n activitie s fo r you r property , pleas e contac t Professiona l Environmenta l Engineers , Inc
. Projec t Manager , WiUi e Cla y A t 402-S04-4688
. Genera l question s abou t th e Omah a Lea dSit e cleanu p ca n b e directe dt o Paulett aFrance-lsetts , 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 h Omah aoffice ) o r 402-731-304 5 (Sout h Omah aoffice)
. 

## lawe Yes , I gian t acces s t o m y propert y an dwa s give n th e pamphle t D No , I d o no t gran t acces s t o m y propert y and ! wa s "Renovat e Right , Importan t Lea dInfonnatio n for Families , Chil dgive n th e pamphle t "Renovat e Right , Importan t Lea d Car e Providers , an dSchools. " Informatio n for Families , Chlld e Car e Providers , an dSchools. " 

## % A...y^
. /Tyj
. f'/r^^ T Slgnahir e Dat e Signatur e SPECIA LINSTRUCTION S AN D CONSIDERATION S1 t 

## PAIN T STABILIZATIO N PRE-PROPERT Y PAIN T MATC H ASSESSMEN T cj.^q.QC ^ PROPERTYADDRESS: )0\F i 7 \ Z S 

# •ft7 ^ DATE : BVID :

AREA(S ) T O B E PAINTED : HOUS E PROPER : COLOR : /' ? ^^ 7 1^ ^

HOUS E TRIM : vJW»^ 

## COLOR : hir:\.)r/l^ ^

AA^Vrd-^ '

1 GARAGE : \|^< ? COLOR : «-|- W ACUS ^

GARAG E TRIM : ^ ^ 

## COLOR : h maOTi k "(H^f t U^SP
.
PORCH : COLOR :
PORC H TRIM : COLOR : (COMPLET E AL L SECTION , YES , NO , O R NONiJAPPLICABLE ) -



## I AGRE E T O TH E COLOR S LISTE D ABOVE
. ONC E TH E PAINTIN G BEGINS , I UNDERSTAN D t CA N NO T CHANG E TH E ABOV E SELECTE D COLORS : PROPERT Y OWNE R SIGNATURE : P E ACCESO R SIGNATURE : 

# J ^ ^ ^

## Dougla s Count y Accoun t Information Pag e 1 of 2 

# c5i6s- q Dougla s County , Nebrask a Propert y Recor d - R171410000 0 Prin t Reoor t NE W Featur e - Parce l Dimension s availalH e m scal e 0-5 0 ft wes t o f 52n d S t - ViO W O O Ma D Informatio n i s vali d a s o f 2009-9- 3 Treasurer' s Ta xReoor t Ne w Featur e -•-•- • Aut o Sale s Searc h Owne r ALEJ O S R JUA N M ETA L 101 8 S 2 5 AV E OMAH A N E 68105-000 0

—- Propert y Informatio n Ke y Numbe r 141 0 000 0 1 7 Accoun t Type : Residentia l Parce l Number : 171410000 0 Parce l Address : 'l018S25AV i '^OMAHAN E 68105-000 0 Lega l Description : MARSH S AD D LO T 5 BLOC K8 8 1 3 5/1 2 FT L T 4 & N 2 5 7/1 2 FT 3 9 X 124. 5 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $4,300.0 0 $93,900.0 0 $98,200.0 0 200 8 $4,300.0 0 $93,900.0 0 $98,200.0 0 200 7 $4,300.0 0 $93,900.0 0 $98,200.0 0 200 6 $4,300.0 0 1 $83,000.0 0 $87,300.0 0 200 5 $4,300.0 0 1 $83,000.0 0 $87,300.0 0 — 200 4 $4,300.0 0 $83,000.0 0 $87,300.0 0 Sale s Informatio n Sale s Date : 1988-01-0 7 Dee d Type : W D Book : j 200 6 Page : 01792 2 Price : $0.0 0 Grantor : Jua n M Alej o Grantee : Jua n M Alej o S reta l Valid/Invalid : Invali d Exclusio n Reason : Famil y Sal e Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 1 4836. 0 1. 0 124. 0 39. 0 N o Improvemen t Informatio n 

## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl7..
. 9/11/200 9

### Dougla s Count y Accoun t Infomiatio n Pag e 2 of 2
Buildin g 1 1 1/ 2 STOR Y FINISHE D

.. . e...3.i»
.

u 200 7 DOUGLA S COUNT V AS S CLIC KT O ENLARG E IMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : 1728. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : i Averag e

Buil t As : , 1 1/ 2 Stor y Fi n Cond o Squar e Footage : : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 8. 0 Exterior : Fram e Viny l Units : 1. 0 Interior : Drywal l Baths : 2. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 4. 0

Roo f Type : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea rBuil t yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 192 0 192 0 Detai l Typ e I Detai l Descriptio n Unit s Ad d O n Fenc e Chai n Lin k 1. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 988. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 2. 0 Garag e Detache d 216. 0 Porc h En d Scree n 42. 0 Porc h En d Scree n 42. 0 Porc h En d Scree n 208. 0 Use r Ma y b e 2 ap t 1. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17.
. . 9/11/200 9

## IGI T PropertyAddres s star t Dat e

Prim e (Gallons )

Pol y(Boxes) Pain t (Color ) Pain t (Color ) Pain t (Color ) Pain t (Color ) Pain t (Color ) lol ^ S e 3 S > A 0 V_ 

# t e ql?.\jf) 9 En d Dat e 

## Amoun t O f Prim e An d Pain t Use d
^ft<^>^p ^ 

# 6A^3
. 

# M l Amoun t (Gallons ) Amoun t (Gallons ) Amoun t (Gallons ) Amoun t (Gallons ) Amoun t (Galtons ) 

# i s gd /