# N TRANSMITTA L o f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R 

### SAI D # : MOM^ Q •Date : ^"-^^0 ^ Address : [o??( S Ml'^fn-T . Lu <,/ X "B/vr l Remediatio n Contractor : PROFESSIONA L ENVIRONMENTAL ENGINEER S Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S ^y ^ Vide o ofpropert y (DVD ) ^ [ r

Executiv e Summar y 

# y 51 / SignedAcces s Agreemen t fo r

subject propert y O

r

Painting Agreemen t D Settlemen t document s (i.e. , fo r

damag e o r

t

o replac e plants , etc. ) n^ ^ Photograph s pfiA ^ ^ a/) d/^l4i> r ^ r Satisfactor y restoratio n signedb y Propert y Owne r [J

K

^Propert y close-ou t chec k

lis t signedb y EP A Propert y information fro mDougla s Count y Assessor' s Office ^ 

### confirmation tha t lea dpamphle t "Renovat e Right " was receivedb y P0 _ D D D 

# g . Professiona l ngineer s Signatur e 

### "T O


### i^^-^/i1UkiJ2^ ^ - ^ ^ 

### Ignatur e 3005619 5 Superfun d ^250 5 Nort h 24 ^ Suit e 21 9 Omaha , N E 6811 0 (402 ) 504-468 8 Fa x (402 ) 504-328 1 

## 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



### Lea dBas e Stabilizatio n Omaha , N e Clos e Ou t Report 200 9 SAID#4049 0 681 5 Minn e Lus aBlv d

•Date s worked : 07/0 1 t o 07/0 3 200 9 •Pr e propert y condition : Hous e ha s siding . Overal l tri maroun dth e hous e in fai r condition . Garag e in poo r conditio n wit h pain t flaking. •Problem s encountered : N/ A •Owne r request/concerns : None •Inspection/closeou t dates . Owne r signe dby 07/0 8 2009 . Inspecte dby EP A 07/1 7 2009 , N

o issues .

## 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-Ou t For m (Lead-BasedPain t Stabilizatio n EP A Contract EP-R7-08-06 ) SAID : qnq ^ 250 5 Nort h 24 % Suit e 21 9 Omaha , NE 6811 0 (402 ) 504-468 8 Fa x(402 ) 504-328 1



### Propert y Address : Lpgl g M ' HnC^
- LuSt K '^r ^ Owner' s Name : ^^ 1 i C J O ^ CJC \ \\OVOON J Performanc e Standards/Close-Ou t Criteri a YE S NO 1. Wa s th e entir e structure(s ) painte dwith th e exceptio nof th e stated , exclude d areas ? Thi s woul dinclud e paintin g of othe r associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an dexterio r surface s of ^ garages . 2. Wa s al l scrapin g an dothe r preparatio n wor k

complete dsatisfactorily ? ^ y 3. Wer e al l require darea s of th e structure(s ) prime das neede dan dpainte dwith tw o to p coats ? y 4. Wa s th e pain t product s utilize dequivalen t to a 30 year product/quality ? t ^ 5. Ar e al l of th e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y vacuimied / cleaned ? « ^ 6. Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s on th e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y Ly othe r generate ddebris ? 7. Is th e gras s are atha t surround s th e structure(s ) in reasonabl y goo dcondition ? «- ^ 8. Ar e al l item s suc h as polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . properl y removed ? 

## \y 9.Is ther e an y evidenc e ofpropert y damag e tha t was don e by th e contractor ? An y ^ propert y damag e heed s to be complete dprio rto th e EP A Close-Out . 10 .Ar e ther e an y propert y item s tha t wer e temporaril y re-locate dby th e contracto r l ^ tha t nee d to be move dback ? 11 . Ar e ther e an y (knovra ) lingerin g issue s with th e property owner(s ) tha t hav e bee n lef t unresolved ? 1 ^

__ Othe r Considerations/Property Owne r Discussions/Additiona l Wor k

tha t is Required :



### a^t^icc . 

# ijnl0 9 EP A CO RSignatur e Dat e '

## 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 y Respons e 

### Propert y Owne r

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

### SAID : L\rP t ^ O Propert y Address : ( D9>( S 

### A/I^On-f , ixi^ a1E ^ Owner' s Name : Tk\ \C A aCa\\nWn y Performanc e Standards/Close-Ou t Criteri a 2505 Nort h 24 % Suit e 21 9 Omaha , N E 6811 0 (402 ) 504-468 8 Fa

x(402 ) 504-328 1



### YE S N O 1 . Was the entir e structure(s ) painte dwit h the exception o f th e stated , excluded areas ? Thi s wouldinclud e paintin g of othe r

associate dfeature s includin g fascia , eaves , siding , all trim , porches , bo x beams , colimms , rails , andexterior surface s o f garages . 1 

### 2 . Was all scraping an dothe r

preparatio n wor k

completedsatisfactorily ? 

# J 3 . Wer e all require darea s o f th e structure(s ) prime da s neede dandpainte dwit h \ / 

### tw o top coats ? 4 . Was th e pain t product s utilize dequivalen t to a3 0 yea r

product/quality ? 

# \ l 5 . Ar e all of the area s wher e contaminate dmaterial s hav e been spille dthoroughly vacuxamed / cleaned ? / 

### 6 . Di dthe contractor collect/vacuumall falling andscrapedpaint chip s on th e entir e property , roadways , alleyways , publi c acces s area s andals o remov e an y 

### V othe r

generateddebris ? 7 . I s the gras s are atha t surround s th e structure(s ) in reasonably goo dcondition ? / 

### 8 . Ar e all item s suc h a s polyethylen e sheeting , ladders , paint brushes , cones , / 

### barrie r

tape , etc . properly removed ? 9 . I s ther e an y evidenc e ofpropert y damag e tha t wa s done by th e contractor ? An y propert y damag e need s t o b e complete dprior 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 th e contractor tha t needto b e movedback ? 11 . Ar e ther e an y (known) lingerin g issue s wit h th e propert y owner(s ) tha t hav e 

### J bee n lef t unresolved ? Conmients :



### -€ i 

# Y/o&(<i f Propert y Owne r

Signatur e 1 ^ Dat e 

# ^miQ ] Professiona l Enviroimienta l Engioeer s Representativ e Dat e 

### 0

# z ^^^^ \ CONSEN T OF R ACCES S T O PROPERT Y OMAHA LEAD SIT E REMEDIA L ACTIO N - LEAD-BASED PAIN T STABILIZATIO N PROPERT Y ID : MOM^O " PROPERT Y ADDRESS : ^K/. C /^/>t)/t' ^ ^^Z ^ /X 7 OWNERNAME : 

### ftg.]l^c ^ CT/C^ l l^^^<> . DAYTIM E PHONE : Vi ) / ' V ^ ^ 2 _ CELL PHONE : E-MAH. : OWNER' S ADDRES S I FDIFFERENT : TENANT' S NAME I FAPPLICABLE : DAYTIME PHONE : CELLPHONE : E-MAIL : Professiona l Environmenta l Engineers , Inc . (PE ) i s unde r contrac t (#EP-R7-08-0 Q wit h th e U.S . Environmenta l Protectio n Agenc y (EPA ) t o stabiliz e leadbase dpain t (LBP ) o n residentia l structure s a t anumbe r o

f propertie s locate di n Omaha , Nebraska . Th e pain t stabilizatio n work i s bein g don e t o protec t th e soi l cleanup s tha t wer e performe db y EP A contractors . Pain t stabilizatio n activitie s will include : scrapin g of cracke do r flakin g LB P fromstructures , applicatio n of aprim e coa t an d tw o (2 ) coat s of pain t Moving part s of window s an ddoor s ar e no t include dan dwill 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 for 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 an EPA contracto r t o conduc t asoi l cleanu p a t m y propert y following completio n of lead-base dpain t stabilization . I understan dtha t th e stabilizatio n contracto r can no t provid e assurance s tha t th e so U cleanu p contracto r will b e boun dto . I jfiirthe r understan dtha t th e soi l cleanu p contracto r will make 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 . I full y understan dtha t by signin g thi s Consen t fo r Access , (1 ) thi s acces s will remain i n effec t unti l th e work 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 given th e Housin g an dUrba n Developmen t (HUD ) an dEPA pamphlet , "Renovat e Right , Importan t Lea dHazar dinformatio n for Families , Da y Car e Providers , an dSchools" , (3 ) th e Propert y Owne r o r tenan t wil l remove al l obstruction s fromsurface s t o b e painted , (4 ) wil l abid e by healt h an dsafet y guidanc e provide db y EPA , (5 ) wil l allo w photograph y ofpropert y before an dafte r th e pain t stabilizatio n work , (6 ) will b e contacte db y aPE representative approximatel y 4 8 hour s in advanc e o f startin g work , (7 ) agre e no t t o obstruc t o r tampe r wit h an y of th e LB P stabilizatio n actions , an d(8 ) wil l participat e i n final propert y inspectio n an d sign th e Completio n Agreement an dPropert y Owne r Satisfactio n Survey . Shoul dyou hav e an y question s abou t th e plane dLeadBased-Pain t stabilizatio n activitie s for you r property , pleas e contac t Professiona l Environmenta l Engineers , Inc . Projec t Manager , Willi e Cla y A t 402-504-4688 . Genera l question s abou t th e Omah aLeadSite cleanu p can b e directe dt o Paulett aFrance-Isetts , EP A Remedial 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) . I Yes , I gran t acces s to m ypropait yan d «M 8 give n th e pamphle t D No , I d o no t gran t acces s to m ypropait yan d I «w » "Renovat e Right , Importan t Laa d Infomiatio n forFamilies , Chil d give n th e pamphle t 'Renovat e Right , Importan t Lea d Car s ProyUera , an d Schools. ' Informatio n forFamilies , Chlid e Car e Provldere , an d Schools. " 

# j^ . CW ^ i A . 

# t Signahir e Dat a SPECIA L INSTRUCTION S AN D CONSIDERATION S

## •: O(0)i^i(mrasittfl@ini ©I Fll(S(g(iDpi t ©i f L®aid l [PiioiniplhiD© ^
PROPERT V ADDRES S OPCODE
. PROPSO Y ADDIO S OF OWNg R IF DlfTirei T mA N raOP^ PROP^T Y ADDRES S aPCOD E I hav e reoeivBd a cop y of ih e pamphlet , Ranavat a Righ t Importan t Laa d Haxa/ d InfomaSo n Fo rFamlltea , ChI M Ca n PiwUa n An d School a informin g me of th e potentia l risic of th e lea d hazar d exposur e fro m renovation activit y to be peribrme d on dwellin g uni t I receive d thi s pamphle t befor e th e wortcbegan . 

# K/^At(ll ai^dipudCU U \y
- ^-!'h-C\ q /^pmNTE D NAM E OF RECIPIEN T ^ ^ DAT E
REOFRECmEN T ^ 

### SeifCeiflfleallo n Optto n (Fo r TomnlOociip M Dwelllng B On ^ If th e lea d pamphle t wa s delivere d bu t a tenan t signatur e wa s no t obtaindUe . yo u ma ychecl ( th e q)proprtat e bo x below : [ J RflAna l To Sign- I certif ytha t I ha m mad e a goo d fM h effor t I D delivB rth e pamphle t lenovat o righting lea d hazan l Infonnatlo n for families , chil d car e piDvider e an d schools ; to th e rente d dwelHn g uni t Os M dat e an d tim e Indicato d an d tha t th e occupan t letuse d to sig n th e twnnmiatiui i of receipt I furthe rcertif ytha t I hav e tsf t a cop y of th e pamphle t at th e un R wN h occupan t 

# D Uiwvallabf o Fo rSHinalui*-- 1 certif ytha t I hav e mad e a goo d fM h effor t to delive rth e pamp h Importan t lea d hazai d InfonnaHo n for fiamilles
. chli d car e provlder e en d schools , to th e renta l dwelDn g uni t listo d belo wan d tha t th e occupan t wa s unavalafal e to sig n th e oonHrmatio n of receip t I furthe rcertif ytha t I hav e toft a cop y of th e pampMe t at th e uni t byslidin g It unde rth e doo r orsomewher e on th e premises .
PRMTEDNAN E EOPFERBON I

OP PERSO N CERHFYM Q ATTEHPIE D DBJVEm rDAT E AN D TIM E LEA D MHPHUErDBJVEm r
anNATUR E OMIRO N CpniFYB CpniFYB n LEA DPAMPHLE T DEUVERY : ATUR MERSO PAMPH U

• I Not e RsgwdlR g lUOn g Optto n - tt an altamailv e to dslvar yin person , yo u ma ymsf l Ih ^ anVortanan t PampMs t mus t be maHa d at leas t 7 day s befor e renovaiion . (DnantentiMaoeifliGateafroaainef m olios)
. OCMFIRMATIONOFRECEiPrOFlEADPAMPHljE T (010 8

# L"pl 5 pA^^y^[us^B O DAT l

(OOMMff E AIJ L SBCnOH rYBii rNQ rO R NON-APfUCMnE ) 

## I AfiRE E T O tH E COLORS USTE D ABOVE
. ONC E PAUfnil G BEGIliS ^ I UNDERSTAN D I CA N NO T CHANG E TH E ABOV E SEUECTE D COLORS :

p/ttsreaATOHPORssosfo s

### Dougla s Count y Accoun t Information Pag e 1 of 3 iDougla s County , Nebrask a Propert yRecor d - R17507 < lOOO O Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ s c Informatio n i s vali d a s o f 2009-6- 3 al e 0-5 0 tt wes t o

f szn d S t - Vie w O n IMa p Treasurer' s Ta xRepni t Ne w Featur i »-»-»- » Aut o Saie s Searc h Owne r CALLOWAY FELICI A ETA L 681 5 MINN E LUS A BLV D 1 OMAH A N E 68112-000 0 1 Propert y Informatio n 1 1 1 Ke y Numbe r Accoun t Type : Parce l Numbe r Parce l Address : Lega l Description : Valu e Informatio n Lan d 1 —. ...... . 1507 4 000 0 1 7

Residentia l 175074000 0 681 5 r IINNEL U S A B D OMAI - I A N E 68 1 12-000 0 1 MINN I E LUS A L C

3

T 1 3 BLOC K1 2 47.3X12 0

200 9 $6,000. 0 0 200 8 $6,000. 0 0 200 7 $6,000. 0 0 200 6

• $6,000. 0 0 200 5 $6,000.0 0 200 4 $6,000.0 0 Sale s Inforn r latio n L Sal e s Date : Dee d Type : L 

# 1 Price :

• 1 Granto r L Grantee : 1 Valid/Invalid : Exclusio n Reason : 1 L 

# L Sale s Date : 1 

# L ' ' ' Dee d Type : | Price : L - G r anto rj L 2004-11-0 5 W D 1 1 $96,00 ( ).0 0 FAIT H A WH I FELICI A CA L Vali d
2004-11-0 5 W D $0.0 0 - Improvemen t $97,900.0 0 I $97,900.0 0 i „ , j $8 4 ] $8 4 ,600.0 0 ,600.0 0 $84,600.0 0 $55,900.0 0 1 Tota l

Book : 1 200 4 T E ETA L LOWA Y
•—

FELICI A CALLO WfA Y •- ] 1
| 1 1

1 | { $103,900.0 0 1 $103,900.0 0 $90,600.0 0 $90,600.0 0 1 $90,600.0 0 $61,900.0 0 1 Page : ' 14628 0

-

1
1 Book : 200 4 Page : 14542 9



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R175.. . 6/9/200 9Dougla s Count y Accoun t Informatio n Pag e 2 o f 3
Grantee : i FELICI A CALLOWAY ETA L Valid/Invalid : ; invali d Exclusio n Reason : Famil y Sal e Sale s Date : Dee d Type : Price : Grantor : Grantee : 1997-02-0 6 $45,850.0 0 Book : 205 8 Page : 66 3

Valid/Invalid : Exclusio n Reason : Vali d Sale s Date : Dee d Type : Price : Granto r Grantee : Valid/Invalid : Exclusio n Reason : 1992-01-3 1 D $44,500.0 0

Vali d Book : 192 1 Page : 02 9

Lan d Informatio n Acre s S F 0.1 2 5640. 0 Improvemen t Informatio n Buildin g 1 Unit s 1. 0 Dept h 120. 0 Widt h 47. 0 Vacan t N o

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unwi^j.i.tj.MiMi'.t-w.iiiJb.-MTArrgB! ? CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1248. 0 Percen t Complete : 100.0 % Perimete r0. 0 Quality : Averag e http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R175. .. 6/9/200 9IGI T Propert yAddres s ^^^g T M^^ f h/SG ( Dat e Star t Date ^|Oun ^

En d Date 

### Amoun t O f Prim e An d Pain t Use d Prim e (Gallons ) 

# 5 

# (^^ (

Poly(Boxes) 

# X . Pain t (Color ) 

### -IM - 

## l^i/f . €

- Amoun t (Gallons ) Pain t (Color ) 

## Oer. k (S\ n 

# Y - Amoun t (Gallons ) 

## X Gr? / Pain t (Color ) Amoun t (Gallons ) Pain t (Color ) Amoun t (Gallons ) Pain t (Color ) Amoun t (Gallons )