TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: 361 Date: October 29 

Address: 2003 Pinkney St. 

Remediation Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

[if Video of property (DVD) 

gf Executive Summary 

l?f Signed Access Agreement for subject property 

5/ Painting Agreement 

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

D Photographs 

[?r Satisfactory restoration signed by Property Owne r 

D Property close-out check list signed by EPA 

w Property information from Douglas County Assessor's Office 

D 

D 

D 

-Bun^f^ 'Lbjm- Signatuse- HDate 

40310322 

urn 

Superfund 
PROPERTY SUMMARY 

Date: 9/4/08 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Month of: September 

Property Address: 2003 Pinkney St SAD): 361 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: None 

A.2 Issues Resolved: None 

A.3 Unique Findings: None 

122A.4 Other Relevant Information 

Access Date: 8/21/08 

Work Began Date: 9/04/08 

Closeout Date: 10/01/08 

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 

SERVICES 

Property Status Eorm 

Address: ^ ^ fi^j^^. ^f^ Date: Tj^/^ p 

Phone: ^^S^-'^^f^ BVID: S6/ ' 

Plant & Pennanent Landscaping To Remain In Place 

Item# 

Description and Location 

On Map 

Pre-Existing Condition of Structures 

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

Item# Description & Location 

On Map 

SdMi^ pmfi ^ 

1/ 

ll 

u 

/ / 

IJ 

jifi ^ DMM W- Property Owner Prudent Emi 

Signature: 

y.4^^,xyi/) cl)/>j//nJ ^ 

8080 Ward Parkway, Suite 40j 2505 N. 24*" Street. Suite 308 4242 Medical Drive, Suite 4250 

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

Phone: (816) 363-3703 Phone: (402)504-1004 

Fax: (816) 363-3707 
31^1 

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 (LBPlat a number ofproperties 

located in Omaha, Nebraska, including the property located at R00 3 rl HkjVJJ ^ h • 

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

signing this form,tiie property owner grants permission to Prudent to perform activities related to LBP 

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

verifies that they have received ti\e LBP pamphlet "Renovate Right." 

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-Johnson. 

at (402) S04-1004. Creneral 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). 

Property Access Granted Bv: A ^ ^ O M , \ dJ-^U . U'~ ^ 

7 (Signaturey' 7 1 (Date) 

PROPERTY INFORMATION 

f (To be Cfiifipleted by natdeflt and/or propertyjgvn^^i^ease print) 

RESIDEHTNANE f^A{\ftl\^\ H^tJkJ I 1^° ^ Renter 

RESIDENT ADDRESS: 

IF RENTAL, PROPERTY OWNED BY,:: 5# 

OWNER'S MAILING ADDRESS; ^nMC ' 

OWNER'S TELEPHONE NUMBER-HOME: < 1HS^^ ' I d ^PwORK: 1 L 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: U NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER: _j _ 

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

COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS, ENTRY GATES, ETC.) 

/^m 

AUTHOIUTY FOR ENVIRONMENTAL RESPONSE ACTIONS; The activities to be implemented by EPA under this agreement aie pursuam to Section 104 

of CERCLA. 42 U.S.C. 9604. EPA's right of access to the property is provided fbr in Section 104(e) of CERCLA. 42 U.S. C 960S(e), ivhicfa provides entry 

for "determining the needfor response, or choosing ortaking any response action under Ihis title, or otfierwise enforcingtfie provisions of Itae tide." 

:080 Ward Parkway, 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) S04.inrui 
Current Sample Pi#-Renovation Form 

Effective until April 2010. 

Confinmatlon of Receipt of Lead Pamphlet 

^ I have received a copy of the pamphlet, Renovate Right: Important Lead Hazard 

Intormation tor Families, Child Care Providers and Schools Infomning me of 

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

performed in my dwelling unit. 1 received this pamphlet before the work began. 

Printedname of recipien recipient ^,,, ^ 

Date 

>yy ^ 'A 

ire of recipient 

Printed nam ^^--r?

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 beiow. 

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

pamphlet, Renovate Right Important Lead Hazard Intormation for Families, 

Child Care Providers and Schools, to the rental dwelling unit listed below at the 

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

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 elTort to 

deliver the pamphlet, Renovate Right: Important Lead Hazard Intormation for 

Families, Child Care provides and Sdiools, to the rental dwelling unit listed 

beiow and that the occupant was unavailable to sign the confirmation of receipt. 

I fyrljier certify that I have left a copy of the pamphlet at the unit by sliding it 

f/m 

3^^-^F S'SM 

Printed person oaiifying 

Attempted delivery 

date and time 

lead pamphlet delivery 

Signature of pftBon certifying lead pamphlet delivery 

^^^3 PJ^jf^l ^ 

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: 

property address: ^^ J h/^m ^ ^ 

BVID: 5// 7 

Area: M^/ ^ /^^^ ^ Color: (^ ^ ^/^'pfe 

Explanation: ^--^m ^ 

Area: ^ Pom\f^^^f,- ^ 6 ^ ^ ^ ^^ ^ 

Explanation: S^kl06 

Area: Color: 

Explanation: 

Area: Color: 

Explanation: 

I agree to these colors as listed , once painting 

starts I can not change these selected colors. 

Homeowner sijgnature: 

Page 1 
Acces s INFORUATKM TRACfONG SHEET 

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2003 Pinkney 

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yi-i-.. SKcroPca •'••'-I iTt est. Ft. I 

2 Story t'.s^r^cu'^'?'; a" 

CLICK TO ENLARGE IMAGE D CLICK TO ENLARGE IMAGE 

Square Footage: 1750.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Fair 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 7.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Hip Stories: 2.0 

Floorcover: Allowance Foundation: i Block 

Sprinlder Square Footage: ! 0.0 

year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

99 "1909 0% 1909 

Detail Type ! Detail Description Units 

Appliance • Allowance ~i.o 

Basement Bsmnt Block 8 ft 872J0 

Fixture i Base Fixtures "io 

Fixture Bath Full 1.0 

Porch : End Solid Wall 52.0 

Porch Tinc l Solid Wall 140.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R15... 8/19/2008 
Page 1 of2 

Douglas County, Nebraska Property Record - Rl52889000 0 

Print Report 

NEW Feature - Parcel Dimensions availabie Q scale 0-50 ft west oT 90th St - Vie W O n Ma p Information is valid as of 2008-7-14 Treasurer's Tax Report 

New Feature -»-»- > Auto Sales Search 

Owner 

BRUNT NAOMI V 

2003 PINKNEY ST 

OMAHA NE 68110-0000 

Property Informatio n 

Key Number: \ 2889 OOOO 15 

Account Type: Residential 

Parcel Number: 1528890000 

Parcel Address: ; 2003 PINKNEY ST 

i OMAHA NE 68110-0000 

Legal Description: \ KOUNTZE PLACE LOT 1 BLOCK 33 N 1/2 62 X 74 

Value Informatio n 

Land Improvement Total 

2008 $500.00 j;i4,oob.oo $14,500.00 

2007 $5~00.00 $15,200.60 $15,700.00 

2006 $500.00 $15,200.00 ^isjoo-oo" 

2005 $500.00 $15,200.00 $15,700.00 

2004 $500.00 $22,900.00 $23,400.00 

2003 $500.00 $22,900.00 $23,400.00 

Land Information 

Acres SF Units Depth Widtii Vacant 

0.11 4792.0 1.0 0.0 0.0 I No 

Land Attributes 

Attribute Attribute Description 

Negative Influence Traffic 1 

Improvement Informatio n 

Building 1 

http://douglasne.mapping-online.coni/D(iuglasCoNe/static/accotmtinfo.jsp?accountno=R15... 8/19/2008 
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Page 1 of2 

WhitePages.com' 

search, find, connect. 

Listing Detail 

# Naomi V Brunt 

2003 Pinkney St 

Omaha, NE 68110 

(402) 453-7098 

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Do you know your Credit Score? 

Copyright 01996-200 8 WhltePages.com. All rights reserved. 

http://www.whitepages.com/virth/map?firstname=Naomi+V&country=US&state=NE&lat... 8/19/2008 
Prudent Property Close-Out Form (Lead-Based Paint Stabilization) 

SAID: 3CP I ^ /) ' b ^ L 

Property Address: fk O Q .2> n</IL kkJi ^ ^ 

Owner's Name: '(\ l ifp'V^'^ IDhjJyA ^ 

Performance Standards/ciose-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, afl trim, porches, box 

/ beams, columns, rails, and exterior surfaces of garages. 

2. Was all scraping and other preparattion work completed satisfactorily? 

3. Were all required areas of the 5tructure(s) primed as needed and painted with two top coats? £. 4.

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

S Are ail of the 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) in reasonably good condition? 

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

properly removed? X. 

. y 

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. 

i^"­ 10.

 Are there any property items that were temporatiiy re-located by the contractor 

that need to be moved back? 

X^ 

II . Are there any (known) lingering Issues with the property owner(s) that have been left unresolved? 

Other Considerations?property Owner Discusslons?Addit!onal Work that is Required 

^Y]^^<:^^^yy^ ^J/LXi^^i^-^ icjo'i/o ^ 

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Prucient R esentative///^