TRANSMITTAL of OMAHA LEAD SITE 

PABVT STABILIZATION FILE FOLDER 

SAID#: £5'7f f Date: ^/l/d^ 

Address: /5? ^ A J 4 d SJCC^ 

Remediation Contractor: PROFESSIONAL ENVIRONMENTAL ENGINEERS Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

W Video of property (DVD) Kgr^YV^ OJhle y 

W Executive Summary 

M Signed Access Agreement for subject property 

W Painting Agreement . 

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

BT Photographs ZPrH ^ 

W Satisfactory restoration signed by Property Owner 

M Property close-out check list signed by EPA 

P ^ Property information from Douglas County Assessor's Office 

. D 

• " ' D . • • .• 

Signature ' Date 

40316386 

Superfund 
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 Paint Stabilization Omaha, Ne 

Close Out Report 

SAID#25799 

1514 N 40 St 

• Dates worked 10/14 to 10/16 2008 

• Some damaged area to trim on bottom of house, Overall house was in good condition. 

Garage looks newer and in good condition, no issues during stabilization process 

• Inspected 11/05 no issues. 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

"Providing cost-effective environmental solutions" 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Property Owner Close-Out Form 

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

SAID: cgS^QT , 

Property Address: l^j- ^ /o qo^ ^ 

Owner's Name: V^OWJ: \ 'S<y <-^(^<^ cKg r^ 

Performance Standards/Close-Out Criteria 

2505 North 24^ Suite 219 

Omaha, NE68110 

(402) 504-4688 

Fax (402) 504-3281 

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, all trim, porches, box beams, columns, rails, and exterior surfaces of 

garages. 

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

y 

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

two top coats? 

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

5. Are all of the areas where contaminated materials have been spilled thoroughly y 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 y 

other generated debris? 

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

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

9. Is there any evidence ofproperty damage that was done by the contractor? Any y 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 y 

that need to be moved back? 

11. Are there any (known) lingering issues with the property owner(s) that have y been left unresolved? 

Comments: ..^^^ ^ ^ ^ .^ ^ .yj ^ K ^ (M ^l/Ufu ^ 

/^-J- O 

Property Owner Signature 

Date 

-^yy^ y y? 

y/:>-S-oy 

ProfessionaltnvlTOnmenta Date l Engineers Representative 
PROFESSIONAL 

2505 North 24^ Suite 219 ENVIRONMENTAL ENGINEERS, INC. Omaha, NE68110 

(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: XlS-^^QQ^ 

,^- Property Address: I 5 ^ ^ N 3 U Q 

Owner's Name: -^^-.o\0(£x \ ^Sy^h^Xf^^^^ e <^ 

Performance Standards/Close-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, all trim, porches, box beams, columns, rails, and exterior surfaces of / 

garages. 

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

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

two top coats? y

4. Was the paint products utilized equivalent to a 30 year product/quality? y 5. Are all of the areas where contaminated materials have been spilled thoroughly y 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 y

other generated debris? 

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

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

9. Is there any evidence ofproperty damage that was done by the contractor? Any y 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? y 

11. Are there any (known) lingering issues vsdth the property owner(s) that have 

been left unresolved? 

y

Other Considerations/Property Owner Discussions/Additional Work that is Required: 

- S £ ^<ts^<r^ S*uU_ "Slit, 5-c<-cup«. * ^ai-^-<r 

OzuAj/y-^ ^^hLc^\JiLM^ 

A COR Signature ' Date 
--'•';;•»*"•>««* ' 


CONSENEN
TT FOR ACCCESS TO PROPERTY 


OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION \ ^ y 

PROPERTYID: PROPERTY ADDRESS: . j , 

^%0 ^ /SI?) K( . MO' ^ 

OWNER'S NAME 

Sri o t i tywft^ CA i ri >^ Ph t>7. TCgJckjO/d i^uu^K^wx. ^b DAY-TIME PHONE: S1^''0\1CJ P 

CELL PHONE: E-MAIL. 

OWNER'S ADDRESS IF DIFFERENT

'^rSgc ^ nn.o^ic^i^M^. f^gl 

TENANT'S NAME IF APPLICABLE: 

_DAY-TIME PHONE: 

CELL PHONE: E-MAIL 

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

to stabilize exterior lead-based paint (LBP) on residential structures at a number of properties located in Omaha, Nebraska. The paint 

stabilization vi/ork is being done to protect the soil cleanups that were perfonned by EPA contractors. 

Paint stabilizations activities /nil include: scraping of cracked or flaking LBP from structures, application of a prime coat and two (2) coats 

of paint. Any moving parts of windows and door are not included in the activities and will not be addressed. 

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

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

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

completed (2) that as 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, Child Care Providers and Schools" (3) the Property Owner or 

tenant will removal of obstructions from surfaces to be painted, (4) will abide by health and safety guidance provided by EPA, and (5) will 

allow photography of property before and after the paint stabilization work, (6) I will be contacted by a PE representative approximately 

48 hours in advance of starting work to (7) agree not to obstruct or tamper with any of the LBP stabilization activities or equipment used to 

perfomi any LBP actions, (8) will participate in final property inspection and sign the Completion Agreement and Property Owner 

satisfaction Survey. 

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

Environmental Engineers, Inc., Project Manager, Hemian Hanner at 402-884-1185. 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 Infomiation Centers 

at (402) 991-9583 (North Omaha office) or (402) 731-3045 (South Omaha office). 

I'es, I grant access to my property and was given ]No, I do not grant access to my property and I was 

liepiamphlet "Renovate Right, Important Lead Hazard given the pamphlet "Renovate Right, Important Lead Information 

for Families, Child Care Providers and Schools. Hazard Information for Families, Child Care Providers and 

Schools. 

Signature Date Signature Date 

SPECIAL INSTRUCTIONS AND/OR CONSIDERATIONS: 
 

i 

T'.W^'^^'^ isih-f 

Confirmation Of Receip KSC t Of Lead Pamphlet 

BVID A5'^QS ^ 

PROPERTY ADDRESS iSl? ) Kl H O S""t ZIP CODE Cp^U ] 

PROPERTY ADDRESS OF OWNER IF DIFFERENT THAN PROPERTY BEING PAINTED: 

PROPERTY ADDRESS 9^^(f^ V^\A\tii> ^ K J ZIP CODE /p^ / 3 ^ 

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

Providers And Schools Informing me of the potential risk of the lead hazard exposure from renovation activity to be 

performed on dwelling unit. I received this pamphlet before the work began. 

^ ?--/ % -Ov 

PRINTED NAME OF RECIPIENT 

DATE 

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: 

D Refusal To Sign - I certify that I have made a good faith effort to deliver the pamphlet. Renovate Right: Important Lead 

Hazard Information for Families, Child Care Providers and Schools; to the rental dwelling unit listed above at the date and 

time indicated and that the occupant refused to sign the confimiation of receipt. I further certify that I have left a copy of the 

pamphlet at the unit with occupant. 

D Unavailable For Signature - I certify that I have made a good faith effort to deliver the pamphlet. Renovate Right; 

Important Lead Hazard Infonmation 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 receipt, 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. 

Lori \X\\\ 

PRINTED NAME OF PERSON CERTIFYING 

AHEMPTED DELIVERY DATE AND THK LEAD PAMPHLET 

DELIVERY 

-^y) irJQ 

SIGNATURE OF PE PERSON CERTIFYING LEAD PAMPHLET DELIVERY: 

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). 

CONFIRMATION OF RECEIPT OF LEAD PAMPHLET 06/08 
--.- ' •;^^v-.—TTMI.^.--3—.Trpr,y-^ 

PAINT STABILIZATION PRE-PROPERTY 

PAINT y-*^. MATCH ASSESSMENT 

PROPERTY ADDRESS: IQ[^ U . HO S t DATE q/iiLJor 

Orr^cW ^J^ ^iiii- BVID as^o^ 

AREA(S) TO BE PAINTED: 

HOUSE PROPER: K|_ Q COLOR 

HOUSE TRIM U£i COLOR (/A. it?. 

^ 

GARAGE. 1 COLOR ^ i[JAMJ 

GARAGE TRIM (xi^ COLOR uAldTk. 'if 

PORCH \M.A COLOR iUP^ 

^ 

PORCH TRIM A ^COLOR 

^ 

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

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


UNDERSTAND I CAN NOT CHANGE THE ABOVE SELECTED COLORS: 


PROPERTY OWNER SIGNATURE: PE ACCESSOR SIGNATURE: 

^ iSMiiJu^W^ P dC^ ^Jip 

PAINT MATCH FORM 08108 
Douglas County Account Information Page 1 of2 

Douglas County, Nebraska Pro^rt y Record - R1921620000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 90th St - Vie w OP Ma p Information is valid as of 2008-6-19 Treasurer's Tax Report 

New Feature ->-»-> Auto Sales Search 

Owner 

SCHUMACHER ROBERT 

ETAL 

9536 MILITARY RD 

OMAHA NE 68134-0000 

Property Informatio n 

Key Number: 2162 0000 19 

Account Type: Residential 

Parcel Number: 1921620000 

Parcel Address: 1513 N 40 ST 

OMAHA NE 68111-0000 

Legal Description: ORCHARD HILL LOT 14 BLOCK 5 S 40 FT LTS 13 & 40 X 100 

Value Informatio n 

Land Improvement Total 

2008 $2,100.00 $44,800.00 $46,900.00 

2007 $2,100.00 $44,800.00 $46,900.00 

2006 $2,100.00 $44,800.00 $46,900.00 

2005 $2,100.00 $25,300.00 $27,400.00 

2004 $2,100.00 $25,300.00 $27,400.00 

2003 $2,100.00 $25,300.00 $27,400.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.09 4000.0 1.0 100.0 40.0 No 

Improvemen t Informatio n 

Building 1 

Two Story 1513 N 40 St 

± VFrsn«or 

y 

e-.iTvrBICICltet 4J70s?f ; 

CLICK TO ENLARGE IMAGE 

Square Footage: 1365.0 Percent Complete: 100.0% 

k' ttp://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl 921620000 7/8/2008 
Douglas County Account Information Page 2 of2 

Perimeter 0.0 ^ W 

Unit Type: 

Built As: 2 Story 

HVAC: Forced Air 

Exterior: Frame Siding 

Interior: Drywall 

Roof Cover: 1 Composition Sfiingle 

Roof Type: Gable 

Floorcover: Allowance 

Percent 

^-'•«"' « Remodeled Remodeled 

1916 0 0% 

Detail Type Detail Description

Add On Fence Chain Link 

Appliance Allowance 

Basement Bsmnt Block 8 ft 

Fixture Base Fixtures 

Fixture Bath Full 

Garage Detached 

Porcti Slab Roof Ceil 

^^Quality: Average 

Condition: Average 

Condo Square Footage: 0.0 

Rooms: 6.0 

Units: 1.0 

Baths: 1.0 

Bedrooms: 3.0 

Stories: 1.5 

Foundation: Block 

Sprinkler Square Footage: 0.0 

Adjusted Year 

Built Physical Age 

1916 90 

 Units 

1.0 

1.0 

672.0 

1.0 

1.0 

240.0 

192.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl 921620000 7/8/2008