TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: 2.231^ 

Date: 7/JH//)'7 

Address: iz\ S ZS- A/^ 

Remediation Coniractor: PROFESSIONAL ENVIRONMENTAL ENGDJEERS Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video ofproperty (DVD) - ^_ 

Executive Summary 

Signed Access Agreement for subject property 

n / 

Painting Agreement 

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

Photographs . • '_ 

Satisfactory restoration signed by Property Owner 

B ^ Property close-out check list signed by EPA 

&y. Property information from Douglas County Assessor's Office 

D 

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yy/d^j/^^^

 / Sigiiature 

^ ^xii^^y^ '==k^x^ m^ 

40318256 

Superfund 
r 

2505 North 24"\ Suite 219 

Omaha, NE 68110 

(402) 504-4688 

Fax (402) 504-3281 

PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

"Providing cost-effective environmental solutions" 

Consulting • Engineering Design • Remediation « Abatement • Emergency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

SAID# 22377 

721 S 25 Av 

• Dates worked 11/28 to 11/28 2008 

• House had many rotting boards, damage to roofing areas, paint in very poor condition all 

over, basement windows are in poor condition with ripped screens and broken glass. Old 

paint on the windows and foundation areas. 

• Inspected 12/08 retumed to repaint south and east sides. 12/16 issues resolved 
PROFESSIONAL 

2505 North 24". Suite 219 ENVIRONMENTAL ENGINEERS, INC. Omaha, NE 68110 

(402) 504-4688 "Providing cost-effective environmentai solutions' Fax (402) 504-3281 

Consulting • Enqinecring Design • Remediation • Abatement • Emergency Response 

Property Owner Close-Out Form 

(Lead-Based Paint Stabilization EPA Contract EP-R7-08-06) 

SAID: 2^X 7 7 

Property Address: 7(y^( ^ . cy S ^XT^^^Z— 

Owner's Name: \/iC^fO(^ P(L^C ^ 

Performance Standards/Close-Out Criteria YES NO 

1. Was the entire structure(s) painted with the exception ofthe 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. 

2. Was all scraping and other preparation work completed satisfactorily? i / 

3. Were all required areas ofthe structure(s) primed as needed and painted with 

two top coats? X 

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

5. Are all ofthe areas where contaminated materials have been spilled thoroughly 

vacuumed/ cleaned? X 

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 

othe 'y r 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? 

9. Is there any evidence ofproperty 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 temporarily 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 Kl' left unresolved? 

Comments: , 

J ! • 

1 : ' , 7 iL O'^ ^ *^ ^—.t^r IZ / K M li_ Property Owner Signature Date 

/h-]^-^ t /y 4,/ ^ 

Professional Environmental Engineers Representative Date 
PROFESSIONAL 

2505 North 24'^ Suite 219 ENVIRONMENTAL ENGINEERS, INC. Omaha, NE 68110 

(402) 504-4688 "Providing cost-effective environmental solutions" Fax (402) 504-3281 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

EPA Close-Out Form 

(Lead-Based Paint Stabilization EPA Contract EP-R7-08-06) 

SAID: ZZ^-7 7 

Property Address: yz i <;•. 2 s y^ o 

Owner's Name: ( )-.cC^'^0 A ^ Pey^y-( 

Performance Standards/Close-Out Criteria 

1. Was the entire structure(s) painted with the exception ofthe 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. 

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

3. Were all required areas ofthe structure(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 all ofthe 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? 

9. Is there any evidence ofproperty 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 temporarily 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 Considerations/Property Owner Discussions/Additional Work that is Required: 

)0-IILP-1^^ ^ resoluUl 

YES 

^ 

^ 

^ 

y 

^ 

^ 

vX 

^ / 

NO 

^ 

y 

/ 

dx^Ayxii^ /^/-€ y 

EPA COR Signature /bate ' 
CONSEMT OFM ACCESS T€i> PEOPEETY 

OMAHA LEA® SITE MEMEDIAL ACTION - LEAP-BASED PAINT STABILIZATION 

1 PROPERTY ID: ^J^O^ T PROPERTY ADDRESS: "^cP. / c ^ ^ ^ < 5 " x^ZX 1 

OWMER NAMM"^ 

DAYTIME PHONE: C"^^!] lXA(^ ' L\x X 1 

CELLPHONE: • E-MAIL: 1 

OWNER'S ADDRESS IF DIFFERENT: 

TENANT'S NAME IF APPLICABLE: 

DAYTIME PHONE: 

CELLPHONE: E-MAIL: 

1 1 

Professional Environmental Engineers, Inc. (PE) is under contract (#EP-R7-08-06) with the U.S. Environniental Protection 

Agency (EPA) to stabilize lead based paint (LBP) on residential structures at a number of properties located in Omaha, 

Nebraska. The paint stabilization work is being done to protect the soil cleanups that were performed by EPA contractors. 

Paint stabilization activities will include: scraping of cracked or flaking LBP from structures, application of a prime coat and 

two (2) coats of paint Moving parts of windows and doors are not included and will not be addressed. 

Your cooperation is requested in giving permission to this EPA contractor (PE) to enter and have access to this property for 

the purpose of stabilizing lead -based paint as outlined on the property identified above. 

By signing this document I agree to allow an EPA contractor to conduct a soil cleanup at my property foUowug completion of 

lead-based paint stabilization. I understand that the stabilization contractor can not provide assurances that the soil cleanup 

contractor will be bound to. I further understand that the soil cleanup contractor will make all reasonable efforts to address 

concerns that I, as the property owner, may have regarding soil cleanup at my property. 

I fully understand that by signing this Consent for Access, (1) this access will remain in effect until the work has been 

satbfactorily completed, (2) that the Property Owner or Tenant, if applicable, will be given the Housing and Urban 

Development (HUD) and EPA pamphlet, "Renovate Right, Important Lead Hazard information for Families, Day Care 

Providers, and Schools", (3) the Property Owner or tenant will remove all obstructions from surfaces to be painted, (4) will 

abide by health and safety guidance provided by EPA, (5) will allow photography ofproperty before and after the paint 

stabilization work, (6) wUI be contacted by a PE representative approximately 48 hours in advance of starting work, (7) agree 

not to obstruct or tamper with any ofthe LBP stabilization actions, and (8) will participate in final property inspection and 

sign the Completion Agreement and Property Owner Satisfaction Survey. 

Should you have any questions about the planed Lead Based-Paint stabilization activities for your property, please contact 

Professional Environmental Engineers, Inc. Project Manager, Willie Clay At 402-504-4688. General questions about the 

Omaha Lead Site cleanup can be directed to Pauletta France-Isetts, EPA Remedial Project Manager 402-731-2454, or the 

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

D Yes, I grant access to my property and w n given the pamphlet D No, I do not grant access to my property and I was 

novate Right bnpoitant Lead InfbimatkMi fbr Families, Child given the pamphlet "Renovate Right, Important Lead 

t Provlders,,aR(t'Schools.' Infonnatkm for Families, Childe Care Provklers, and Schools." 

Signature Date Signature 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
PROPERTY ADDiESS. "^.y y r V ^5 ' ^ ^ m CODE ^^/(P. T 

f

PROPERTY ADDRESS OF OWNER IF DIFFERENT THAN PROPERTY BEING PAINTED: 

PROPERTY ADDRESS ZIP CODE 

I have received a copy of the pamphlet, Renovate Right: Important Lead Hazard Information For Families, 

Child Care Pmviders And Schools informing me of the potential risk of the lead hazard exposure from 

renovation activity to be perfonned on dwelling unit. I received this pamphlet before the work began. 

PRIDiTEDNAMEOFRECfPIENT DATE 

V ^ 

SIGNATURE OF RECIPIENT 

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 

below: 

I J Refusal To Sign - 1 certify that I have made a good faith effort to deliver the pamphlet, renovate right: important 

lead hazard infonnation for ^milies, child care pmviders and schools; to the rental dwelling unit listed above at the 

date and time indicated and that the occupant refused to sign the confinnation of receipt. I further certify that I 

have left a copy of the pamphiet at the unit with occupant. 

D Unavailable For Signature - 1 certify that I have m^e a good faith effort to deliver the pamphlet, renovate right; 

important lead h^ard infonnation for families, child care providers and schools, to the rental dwelling unit listed 

below and that the occupant was unavailable to sign the confinnation of receipL I further certify that I have left a 

copy of the pamphlet at the unit by sliding it under the door or somewhere on the premises. 

PRINTED NAME OF PERSON CERTIFYING AHEMPTED DELIVERY DATE AND TIME LEAD 

PAMPHLET DEUVERY 

SIGNATURE OF PERSON CERTIFYING LEAD PAMPHLET DELIVERY: 

Note Regarding RAailing 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 certificatB of mailing from the post 

office). 

CONFIRMATION OF RECEIPT OF LEAD PAMPHLET 08/08 
IT STi-AOJLuy4=#iy LIOIKI [r''iME=PROPERTY ASSESSMENT 

PROPERTf ADDRESS ..y^/y^r-y^ DATEBVID 

PLANT & PERMANENT LANDSCAPING TO BE REMOVE? NO p7^ YES m 

IF, YES WHERE: 

PRE -EXmXliG CONDIUQN OF FOUNDATION/STRUCTURE, i.e. BASEMENT LEAKING? 

NO L/l J YES ' ' IF, YES WHERE: 

EXISTING PAINT ON WINDOWS, DOORS, FOUNDATION, SIDEWALKrC I.E.)? NO |]ztl 

YES n m IF, YES WHERE: 

VISUAL DESCRIPTION OF PROPERTY/STRUCTURE/GARAGE, (LE.): (USE BACKSIDE IF 

NECESSARY) 

OWNER SIGNATURE 

«^>^^^ ^ 
SmiBLBlATIOi^ PRE«PIROPE^T¥ 

PAIIIT mKmU /ASSESSMENT 

PROPERTY ADDRESS: 7^/ S ^ s Ay DATE /Ay^y^^^ 

BVID —<^^x^'y y 

AREA(S) TO BE PAINTED: 

HOUSE PROPER: 

"I COLOK. iJh^L v <P.X\<:L i ^ 

HOUSE TRIM £LS ^ XOL0R_JD£AJLL ^i(\di^c j 

V 

GARAGE. ey COLOR pnoJcyL k £iZid. 

GARAGE TRIM COLOR. nnc^icA W.w\p. 

PORCH I C$ COLOR /Tya^(^,(/ iti v ^Xiy\n<x u-li ^ 

PORCH TRIM £ ^ COLOR. /^Mf.lv pXfrllAg) 

(COMPLETE ALL SECTION, YES, NO, OR NON-APPLICABLE) 

I AGREE TO THE COLORS LISTED ABOVE. ONCE PAINTING BEGINS, I 

UNDERSTAND I CAN MOT CHANGE THE ABOVE SELECTED COLORS: 

PROPERTY OWNER SIGNATURE: 

If d r ^ 

PAINT MATCH FORM 08/08 
Douglas County Account Information 

Page 1 of2 

Douglas County, Nebraska Property Record - R1426890000 

Print Report 

, , .• • ,•. rinn o r. .. NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 90th St - Vie w o n Ma p 

Information is valid as of 2008-9-4 Treasurer's Tax Report 

New Feature - • - • -# Auto Sales Search 

Owner 

PERALTA VICTOR P 

71 S 25 AVE -^yy ^ x X/1 / ^ 

OMAHA NE 68105-0000 O'T ^ ^ ^ y6^' 7 ( M^^^X^ i / 

-r- Property Informatio n 

Key Number: 2689 0000 14 

Account Type: Residential 

Parcel Number: 1426890000 

Parcel Address: 721 S 25 AV 

OMAHA NE 68105-0000 

Legal Description: 

JOHNSON ADD REPLAT LOT 9 BLOCK 0 S 5 FT SUB LT 2 & ALL SUB LT 3 OF 

33.13X132 

Value Informatio n 

Land Improvement T"ota/ 

2008 $5,400.00 $53,200.00 $58,600.00 

2007 $5,400.00 $53,200.00 $58,600.00 

2006 $5,400.00 $28,600.00 $34,000.00 

2005 $5,400.00 $28,600.00 $34,000.00 

2004 $5,400.00 $28,600.00 $34,000.00 

2003 $5,400,00 $28,600.00 $34,000.00 

Sales Informatio n 

Sales Date: \ 2008-06-11 

Deed Type: WD Soolr: 2008 

Page: 058269 

Price: $29,000.00 

Grantor: GODBERSON MARTIN ETAL 

Grantee: PERALTA VICTOR P 

Valid/Invalid: Valid 

Exclusion Reason: 

, 

Land Information 

Acres SF Units DeptAi Width Vacant 

0.1 ' 4356.0 1.0 132.0 33.0 No 

Improvemen t Informatio n 

1 •• • 1 

http://douglasne.mapping-onHne.com/DouglasCoNe/static/accountinfo.jsp?accountno=R14... 11/5/2008 
Douglas County Account Information Page 2 of 2 

Building 1 

,1,__M, 

I 

^ 3 

„a?„.. L.,„1. *»,,„.! 

CLICK TO ENLARGE IMAGE 

Square Footage: ; 1695.0 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: 10.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 5.0 

Roof Type: Gable Stories: 2.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1885 0 0% 1885 122 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 823.0 

Fixture Base Fixtures 1.0 

Fixture Batti Full 1.0 

Garage Attached 

440.0 

Porch Slab Roof Ceil 

64.0 

Porch Slab Roof Ceil 

72.0 

http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp ?accountno=R14... 11/5/2008 
JC Painting 

Property Address M^ l 51 Slf i Av/ ­ Date / / ­ ^ 8 ­ O ^ 

Start Date / / — JZ g ' ^ f ? Complete Date / / ^ 0.^-0 ^ 

Amount Of Prime And Paint Used 

Prime (Gallons) ^ 

Poly (Boxes) 3 

Paint (Color) ^u:> QJ j Q t? Amount (Gallons) | ^ 

Paint (Color) 3co__fcj3_^2] Amount (Gallons) | 

Paint (Color) Q\^v^^| porc K Amount (Gallons) 3 

Paint (Color) Amount (Gallons) 

Paint (Color) Amount (Gallons)