TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID #: 25182 Date: 12/03/08 

Address: 1316 N 42 St 

Remediation Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Video of property (DVD) 

^ Executive Siumnary 

1^ Signed Access Agreement for subject property 

a Painting Agreement 

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

D Photographs 

^ Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

B Property information from Douglas County Assessor's Office 

D 

D 

a 

Signature Date 

40310374 

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Superfund 
PROPERTY SUMMARY 


1 Date: 12/03/08 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Montli of: December 1 

1 Property Address: 1316 N 42 St SAID: 25182 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: None 

A.2 Issues Resolved: None 

A.3 Unique Findings: None 

122A.4 Other Relevant Infonnation: None 

Access Date: 10/02/08 


Worli Began Date: 10/08/08 


Closeout Date: 11/10/08 


Enclosures: 

1. Pre-Video 

2. Post-Video 

3. Property Status Form 

4. Signed Access Agreement 

5. Pre-Renovation Form 

6. Paint Matcli Form 

7. Tracking Form 

8. Douglas County Assessor Property Information Page 

9. EPA Property Closeout form 

10. Property Completion Agreement 

TECHNOLOCIES, INC. 

ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: | ^ | 0 / J ^ Z S+ . Date: jlj'^'6 ^ 


Phone: [ mr O 5 5 te - Jl^?>M BVID: ^^ 3 / g2 _ 


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Plant & Permanent Landscaping To Remain In Place 

Item# 

Description and Location 

On Map 

UJ^^t ^ u // 

Pre-Existing Condition of Structures 

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

Item# Description & Location 

On Map 

ljJ6^t- ll ll 

Property Owner Prudent Emg] 

Signature: Signature 

8080 Ward Parkway, Suit* 405 

Kansas City, MO 64114 

2605 N. 24*" Streat, Suite 308 

Omaha, Nebraska 68110 

4242 Medical Drive, Suits 4260 

. San Antonio, TX 78229 

Phone: (816) 36M703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 679-6677 
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Prudent Technologies, Inc. (Prudent) is under contract (Contract # EP-R7-08-07) with the U. S. 

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

located in Omaha, Nebraska, incl\iding the property located at ; 

The EPA requests your permission to allow Prudent to perform LBP Stabilization at this property. By 

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

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

verifies that they, have received the LBP pamphlet "Renovate Right," 

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

AdtT^inistrative Clerk for the Lead Based Paint Stabilization, Mrs. Deborah Akerele-Johngon. 

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

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

office). 

Property Access Granted I 

(Please Print Name) 

Property Owner Signature: / X ^^"'-^y /X/iy ^ N^^X' X/ 

'i—" ' (Sfgnetute) / / (Date) 

PROPERTY INFORMATION 


(To be completed by reiident and/or property oiwner — please print) 


RESIDENT NAME:''n^/^A^ > /:>KV^A0^V—^ " (owfj ^ Renter 

RESIDENT ADDRESS: 

IF RENTAL, PROPERTY OWNED BY: *Py J^-^-^ r 

OWNER'S MAILING ADDRESS; c> rTT^ ^ 

OWNER'S TELEPHONE NUMBER - HOMEE:: .^SL^^^I^^RK : d/2^ ^"^ ^ 1S^ ^ 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: tt ^ NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER: 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: 

COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DO^S, ENTRY GATES, ETC.) x 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be implemented by EPA under this agreement are pursuant to Section 104 

of CERCLA, 42 U.S.C. 9604. EPA'sright ofaecess to Ihe property is provided fbr in Section 104(e) of CERCLA, 42 U.S. C 9605(e), which provides entry 

for "determining the needforresponse, or choosing ortaking any response action under this title, or oflierwise enforcing the provisions oftiie title." 

i080 Ward Paikway, Suite 405 2505 N. 24*^ Street, Suite 308 4242 Medical Drive, Suite 4250 

[ansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

'hone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

ax: (816) 363-3707 Fax: (402) 504-1005 Fax: (210) 579-6577 
Current Sample Pre-Renovation Fomi 

Effective until April 2010. 

Confirmation of Receipt of laati Pamplilet 

Qh\ have received a copy of the pamphlet, fienovate FVght: Important Lead Hazard 

y Information for Families, CNld Care Providers and Schools infbnming me of 

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

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

T^SU^ ppiji^ K 

SignatiW^recpertl 

Self-Certification Option (for tenant-occupied dwellings only) — 


If the lead pamphlet was deliverad 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, FWtovate Right: Important Lead Hazard Infonnation for FamiSes, 


CNld Cara Prnvidars and Schods, to the rental dwelling unit listed below at the 


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


of receipt. I further certify 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 faith effort to 

deliver the pamphlet, Renovate FVght: Important Lead Hazaxi Infbnnation for 

FamiSes, ChUd Care providers and Schools, to the rental dwelling unit listed 

beiow 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 theAxjr. ^ i 

M ^ fM^d^///r^ /^-^-^/ M''3(rfm 

Prirrted name ol person certifying Attempted delivery 


date and time 


lead pamphlet delivery 


Signature of personCcertifying lead pamphlet delivery 

/J/^ /t/-^"^ 

Unit Address 

Note Regaiding Mailing Option — As an altemative to delivery in person, you 

may maii the lead pamphlet to the owner and/or tenant. Pamphlet must be mailed 

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

post office). 
Paint matching form^?'""^ -"atch :*mn: if{k & 

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i-»uugiiis *.>ouniy Account a n^rmi ation Page 1 of3 

Douglas County, Nebrasica Property Record - R2408790000 

Print Report 

NEW Feature - Parcel Oimensions'avairable ® scale 0-50 ft west cf SOth St - VieW..On.Ma.P Information is vaiid as of 2008-9-4 Treasurer's fax Report 

New Feature ->-*• • Auto Sales Search 

Owner 

OKRINA BRAD 

ETAL 

1316 N 42 ST 

OMAHA NE 68131-0000 

Property Informatio n 

Key Number: 0879 0000 24 

Account Type: Residential 

Parcel Number: 2408790000 

Parcel Address: 1316 N 42 ST 

OIVIAHANE 68131-0000 

Legal Description: WALNUT HILL LOT 4 BLOCK 24 S 78 FT LTS 1-2-3 & 78 X 200 

Value Informatio n 

Land Improvement Total 

2008 $4,200.00 $127,400.00 $131,600.00 

2007 $4,200.00 $127,400.00 $131,600.00 

2006 K200.00 $127,400.00 $131,600.00 

2005 $4,200.00 $86,100.00 $90,300.00 

2004 $4,200.00 $86,100.00 $90,300.00 

2003 K200.00 $86,100.00 $90,300.00 

Saies Informatio n 

Sales Date: 1996-07-10 

lyeed Type: D Book: 2040 Page: 675 

Price: $78,500.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 1994-07-01 

Deed Type: Book: 1982 Page: 440 

Price: $74,500.00 

Grantor: 

http://douglasne.mapping-online.com/DouglasCoNe/statid/accountinfo.jsp?accountno=R24... 9/24/2008 / 
uougias uounty Account 1flRmiation Page 3 of3 

YearBuilt 

1880 

Detail Type 

Add On 

Appliance 

Appliance 

Basement 

Fixture 

Fixture 

Fixture 

Garage 

Porch 

Porch 

Year 


Remodeled 


0 


Percent 

Remodeled 

0% 

Detail Description 

Fence Wood 

Allowance 

Fireplace Masonry 

Bsmnt Block 8 ft 

Base Fixtures 

Bath Full 

Bath Half 

Detached 

End Screen 

Open Slab 

Adjusted Year Physical Age : Built 

---1880 128 

Units 

1.0 

1.0 

1.0 

1352.0 

1.0 

2.0 

1.0 

480.0 

112.0 

200.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R24... 9/24/2008 
i^ougias uounty Account l fllHniiation Page 2 of3 

Grantee: 


Valid/Invalid: Valid 


Exclusion Reason: 


Sales Date: 1992-05-11 

Deed Type: Book: 1928 Page: 149 

Price: $63,000.00 


Grantor: 


Grantee: 


Valid/Invalid: Valid 


Exclusion Reason: 


Land Informatio n 

Acres SF Units Depth Width Vacant 

0.06 2964.0 1.0 38.0 78.0 No 

Improvemen t Informatio n 

Building 1 

ma 

ur iH 

r t t 1«JI Mi 

l « 

CLICK CLICK TO ENLARGE IMAGE TO ENLARGE IMAGE 

Square Footage: 2795.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Good 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 8.0 

Exterior: Frame Aluminum Units: 1.0 

interior: Drywall Baths: 2.5 

Roof Cover: Composition Shingle Bedrooms: 4.0 

Roof Type: Gable Stories: 2.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

http://douglasne.rnapping-online.corn/DouglasCoNe/static/accountmfo.jsp?accovintno=R24... 9/24/2008 
Prudent Propert Prop y Close-Out Form (Lead-Based Paint Stabiiization)

SAID; Q^Slx^ 

Property Address ^rjT'^Ah.^si­ Owner's Name; 

Performance Standards/ciose-Out Criteria YES HO 

Was the entire structure{s) painted with the exception of the stated, exduded areas? This would 

include painting of other assodated features Inciuding fascia, eaves, siding, all trim, porches, box 

beams, columns, rails, and exterior surfaces of garages. N(, 

2. Was all scraping and other preparattion woric completed satisfactorily? ^ 

3. Were all required areas of the structur6(s) primed as needed and painted with two top coats? ^ 

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

5. Are aii ofthe areas where contaminated materiais have been spilled 

thoroughly vacuumed/ cleaned? ^___ _ yC 

Kd 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? A 

7. Is the grass area that surrounds the structure{s) in reasonably good condition? ik 

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

properly removed? ^^_ ^ 

9. Is there any evidence of property damage that was done by the contractor? Any prope.ty damage 

)L 

needs to be completed prior to the EPA Close-Out. - < 

10. Are there any property items that vrere temporatily re-located by the contractor 

that need to be moved bacic? X 

11. Are there any (Icnown) iingering issues with the property owner(s) that have been left unresolved? 

Other Consideratlons?property Owner Discussions?Additional Woric that is Required b^ 

•' 1

'naU-Q . rM/jna ^ 

Pruden t R< esentative/ H-IU'O'd 

^^" 1