## TRANSMITTA L of OMAHA LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R 

# SAID# : 7.7?S4-2
- Date : S^Zl
- IQ Address : ICS l 5,0
. 'SU' ^

^St'/'-e^d T 

## Stabilizatio n Contractor : Professiona l Environmenta l Engineer s Year : 2010 _ PAINT STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S 

# X Video ofpropert y (DVD ) Executiv e Summar y SignedAcces s Agreemen t fo r

subject propert y 

# X Pre-Renovation For msigned by Propert y Owne r Pre-Renovation For mfo r

Occupant/Tenant , if applicabl e D 

## Paintin g Agreemen t Settlemen t documents (i.e. , fo r

damage or to replace plants , etc. ) D 

## Renovation Recordkeepin p y CertifiedRenovato r ecordkeeping Checklis Checklis t signed b Photograph s 

# Jk>^^
. an d Q^hr - 

# X Satisfactor y close-ou t check lis t signed by Propert y Owne r 

# X Propert y close-ou t chec k

lis t signed by EP A D 

## Propert y information firo mDougla s Count y Assessor' s Office 

# ?^ Hazar danalysis , if prepared 0 

## Safet y Audi t 

## a Othe r

(describe) : D 

## Signatur e 

## rlA^t.6A.^Si^ ^ ignatur e (afte r file folder review ) de r 3020421 3 

# iiini n

Superfun dP - 1 PAG E 0 1 ELCARIB E 05/1B/201 0 23:2 3 1402592248 0

4 0 2 53 4 030 3 n a n 1 7 eOl O ll:53fl n DUNDE E ELEM f NTHf? Y PA& ^ 8 1 05/16/281 B 28:5 6 .1482592243 0 ELC*R:B E 

## MOF/SS^IONA L 9MLlMilnt,SuiM E 

## tNVlNONMENTA L ENGINEERS , INC
. i Sl.laul(.M0*l«0 3 ISt4)SS1-«0a » "Pwtoin g cbst'aifactiv amnvironmBr^ l solutions ' *u(ii4)s>i-«e M

• fMMWltMai K iigaiu y timtnnt
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### 201 0 Prc^iact y O^Wiaf f Clo4e-Ou t For m 

# }
. (Lead-BMi A Faiu t Stabilitftio n EP A Coi«nct£P.R7-08'0€ ) \ SAID ; Propen y Aidnt t Owner'iNH M 

### jjarfowMB W St—iar*i/Clot-Oa « CrlliiiS " 

### N O 

## vt s I . WM th t wti M «nietuk«(* ) Pointe dwithttie exceptio n ofth e nateit , exclude dtnu l Thi a woul diadlud e piinth i d f oAe r asioctne dftatutcs IncludiDB faict ^ eatvet , Bding , al l Tliilt , poioh»» . h w IwanM . cftlMnm . iwil» . "" dewrio r awfi^e i o f ganiei ' 2 . Wuid l an dWlhe r prcpewtio n wor k complete dmi>facii>rily ? 

## JSrii : 3 . Wer e « n nquke dareii s o f th e «tnieture(i ) prime da s neede dan dpainte dwithtw o to p 

# rpaf e ^jmlity T 4 . W M th i yafct t prodart i utiHae dcqwv«lwrt t o a2 5 ye n pto«w < 5 . Ar t al l o f ih r iiea i wher e eonteminMo dmttcriel s hav e bee n ipille dthoromhl y 

### ^ 6 . Di A th e ceouarto r coiUct/vacuu mal l fcHtng an dacwpe dpain t dferip ao n th e entli c property , reednMiys , alleyway* , publi c eeeci e area i *n deli o remove ! m y othe r lenerate d debris ? . . ' 7 . lith e 1 1 M M th t iwTouod i flte tmteaat^ii i i n tteiombl y goct dcondition ? i . Ar e al l i l suc hM ^lydhylen e shaaiing . ladden , pain t bnahi*« , oooei , banie r tiipe r etcpiopadyrttiovd ? 

# V 9 . I s tha w an y evidenc e ofpropert y damag e tha t W M don e b y di e contrector ? An y piopert y dimi B nwd ato b e comhlBte dwio r i ath aEP A Ckwe-Ow . ! 10 . Aieyowioiilic dwl< hth e woi k pcrlbemcd ? 

## :i c 11 . Al * tttre m y propei ^ iiem t tha i wer e temporaril y re-locate db y th e contracto r tha t needtobcmovedbaek ? • I 12 . A K th mm y (known ) lingerin g inue s withtli e propen y ownetis ) tbm x hav e bee n lef l unwDlvd ? j 

## X Othe r CoMideiMloM^rolpttt y Own n Diaeuiiiom/Additima l Woite tha t i s Required: '

.4^ ^ 

### ^i^^C* i 

## S=A2JS L Pnipen y OWM T Slgna(w « Dat e 

# Ii/Z: ^ Engineer * Sigmtur e Oit e250 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 Oesig n • Remediatio n • Ak>alemen l • Emergenc yResponse



## LeadBas e Stabilizatio n Omaha , N e Clos e Ou t Report 201 0
SAID #

## 2234 2 70 7 s . ae' " St
.



## •Date s worked : 04/11/1 0 t o 04/14/1 0 •Pr e propert y condition : Hous e ha s painte dwoodsidin g an daporc harea , al l pain t wa s in poo r conditio n prio r t o stabilization . Pain t chip s i n yard . •Problem s encountered : None •Owne r request/concerns : N/ A •Inspection/closeou t dates . Owne r 05/07/10 , inspecte dby PE projec t manager .

### EPAPain t Stabilizatio n 201 0 SAIDf f PropertyAddres s Storie s 

# Z - S Garage ? 

# fe Accesssigne d A-\^' ' 2-01 0 Pre-vide o 4 " Z- ^ ' O Pos t vide o Z ) ' ^ \ ' \ 0 Contracto rAssigne d \A C 

### , SPNT M 

### \ C^ ^ Dat e starte d 

# M/I//1 0 Weathertem p 

# lo i Dat e ende d 

# 1^( 1 Ali o ^ 

# P.ln.,«d \t0VM | • ^UV^\A ^
Pol yuse d \ 

# m Problems/Issue s 

# OjAOoi e tx > -(Tjlo g "pt^li^ s p rfx3c. cjy f l rVi ­

### P- 1 Rp r 2 8 201 0 7:55HI 1 DU"iOE E ELEMENTAR Y 40 2 55 4 030 3 yOE l 

# CONSEN T FO RACCES S T O PROPERT Y OMAH A LEA D SIT E REMEDLi LACTIO N - LEAD-BASE D PAIN T STABIUZATIO N PROPERT Y IP ; TSL'^'^l ^ PROPERT Y APDRESS ; in l <; . 3 fpfi ^ <^ - n^^fry^j ' OWNERNAME ; 

### DAYTIM E PHONE: C'^O^' ) 3 ^6-^o'J^ 9 CEL L PHONE : (^02 ^

Cg»9-Q7:^ Q E-MAIL : ^iUalnlr^nr ^ toG> n g ) tnrv^i n .COn n OWNER' S ADDRES S I FDIFIERINT : . r s NAM E I FAFPUCABLE : 

### TE N <^y\wn>r t UDVYV
. CEL LPHONE :

# , (^<^-Cf\? 5 DAYTIM E PHONE : E-MAIL : Profeeiiona l Enviroanienta l Eoglneen , Inc
. <PE ) i t unde reoelnic t (#EP-R7-0S-06 ) wit h tfa e US
. Environmenta l Protectio n Ageaq r(EPA ) t o itibllh e len d baec d pain t (LBP ) o n midentlR l ftrueture s a t a aumbe rorpropertic s locate d I n Onaha , Ncbratkii
. Tb e paia t itabllintlo a wor k b bein g don e t o protec t th e toi l cleanup * tha t ar e bein g perfonne d b yEP Acontractori L Pain t ttabilintio n aetivitie a wil l iDcIude : acrapin g o f cracke d o rflakin g LB P fh>n i atructurc* , applicatio n o f a prim e coa t an d tw o (2 ) coat s o f pain t Movin g part i o f wiadaw > an d doo n uufi t include d an d wil l no l b e addrcMed
. Yon rcooperatio n b roqueate d i n givin g permiuio n t o thi a EP Acontracto r(PE ) t o ente ran d hav e acce u t o thi i propert yfo rth e purpos e o f stabllUn g lea d -base d paia t a i oudine d o n th e propert yideatiflc d above
. B yiigain g thi s docnmen t I agre e t o allo wa n EP Aoontracto rt o conduc t a soi l cleanu p a t m ypropert yfollowin g completio n o f lead-base d pain t staUllcatlon , i f th e soi l eleanu p ha s no t alread ybee n performed
. 1 undentan d tha t th e stabilliatki n contracto r ca n no t provid e aiiHraace a tha t th e toi l cleanu p contracto rwil l b e boun d to . I furthe rundentan d tha t th e sol i cleanu p contracto rwil l mak e al l reasonabl e effort s t o addres s concern s tha t I , a s th e propert yowner , ma yhav e regardin g aoi l cleanu p a t m yproperty . SfVaa ^ I hsp s lee d an d uaderaiaii d th s paragrapl i above
. 

## "tmAa/ y 

# v-/q-/ o Slgaeba a o f Prapait yOwna r I fhll yunderttan d tha t b ysignin g thi s Consen t fo rAccess , (1 ) thi s acces s wil l remai a i n effec t unti l th e wor k ha s bee n satfsfBctoril ycompleted , (2 ) tha t th e Propert yOwne ro rTenant , i f applicable , wil l b e give n th e Hoasin g an d Urln n Developmen t (HUD ) an d EP Apamphlet , "Rtaovat e RJgbt , Inpoiian t Laa d Haaar d Informatio B Ib rFamilisa , Da yCar e Providers , an d Schoolt" , (3 ) th s Propert yOwne ro rtenan t wii l remov e al l obstruction ! fht m sarftee s t o b e paintad , (4 ) wil l abid e b yhealt h an d safet yguidanc e provide d b yEPA , (5 ) wil l allo wphotograph yo f propert ybefbr e aa d afte rth e pain t stabilizatio n work , (6 ) wil l b e contacte d b ya P E representativ e approximatel y4 8 hour s I n advanc e o f startin g work , (7 ) agre e no t t o obstruc t o rtampe rwit h an yofth e LB P stablitaatio n actions , an d (8 ) wil l participat e i n Tma l properl yInspectio n an d sig n tb e Completio n Agreemen t aa d Propert yOwne rSatisfactio n Survey
. Shoal d yo u hav e an yquestion s abon t th e plane d Lea d Based-Pain t stabilbatio n activitie s fb ryou rproperty , pleas e eontae t Professiona l Environmenta l Bnglneers , Ine
. Projec t Manager , Willi e Cla yA t 402-8044688
. Genera l questloa s abon t th e Omah a Lea d Sit e cleanu p ca n b e directe d t o Panlett a France-lsetts , EP ARemedb l Projec t Manage r402-731-2454 , o rth e EP APnbli c Informatio n Center s a t 402-991-958 3 (Nort h Omah a office ) o r40Z-73t-304 S (Sout h Omab a office)
. 

## H j Yse , I gran t accse s l b m ypropert ysn i M M giva n A a pamph M O Ne , I d o ne t gn M acces s ton ypropeil yan d I M M • RMOsat e RgM , hapoitmtLN d intaniaUo n fo rFunlUts , Ch M ghfs n th e pamphlat'Renovat e Mgh t Impoftan t Lea d C H S Prevldsm i sn d Schools
. InfaiiwHe n torFamDIie , ChBd i Ca m Pravldm , an d Sctnoli. ' 

# ^-n-i o Slgnahir e Signatur e Dsts SKCU L INSTRUCTION S AN D CONSIDERATION BAp r2 8 201 0 7:55fl M DUhUlE E ELEMEMTnR Y 40 2 55 4 030 3 p. 2 

### irm E


## PAIN T STABILIZATIO N PRE-PROPERT Y PAIN T MATC H ASSESSMEN T PROPERT Y ADDRESS : 70 7 e ^

^G* ^

<Vl - DATE : 

# V-Z^'/ o BVID :
AREA(8 ) T O B E PAINTED : HOUS E PROPER : COLOR : ^ Ir^y - " ' - HOUS E TRIM : COLOR : whif g ^ ^^\l\r\r\ c
GARAOE : COLOR:
.



## 1^VNr>AcxV>C^ n - VKcf^cy \ carpor t , . , • TRIli : COLOR : y/hit r PORCH : COLOR : wKf'4 y PORC H TRIM : COLOR : v^/lM• U (COMPLET E AL L SECTION , YES , NO , O R NON-APPLICABLE )

1 AGRE E T O TH E COLOR S LISTE D ABOVE
. ONC E TH E PAINTIN G BEGINS , I UNDERSTAN D I CA N NO T CHANG E TH E ABOV E SELECTE D COLORS : PROPERT Y OWNE R SIONATURE : P E ACCESO R SIGNATURE :Ap r2 8 201 0 7:55fl M DUMIIE E ELEMENTHR Y 40 2 55 4 030 3 p. 3 

# i

PRE-RENOVATIO N FOR M ~ OWNE R Thi s for mi s t o b e usedby th e firm s eontncte dby th e Environmenta l Protectio n Agency-Regio n 7 t o perfor mLead-Baae d Pain t stabilizatio n activitie s a t th e Omah aLea dSite , Omaha , Nebraska . Owne r Confirmatio n Pamphle t Receip t V

LI hav e receive dacop y o f th e lea dhazani information pamphlet , Renovat e Right : Importan dLea dHazar dInformatio n fo r Faadlies , Chil dCar e Provkier s an dSchools , informing me ofth e potential ris k ofth e lea dhazardexposure fio mrenovatio n activit y t o b e perfivmedin/o n my dwellin g unit . I receive dthi s pamphlet befor e th e worl c began . Owne r Acknowledgmen t 9^A ) I confir mtha t I own andiiv e i n thi s property , tha t n

o chil dunde r th e ag e o f 6 reside s here , tha t n o pregnant woma n reside s here , an dthat thi s propert y i s no t achild-occupie dfacility . Note : A chil dreside s i n th e primar y residenc e o f his/he r custodia l parents , lega l guardians , foste r parents , o r informa l caretaker i f

th e chil dlive s an dsleep s mos t o f time a t th e caretaker' s residence . Note : A child-occupie dfacilit y i s apre-l97 S buildin g visite dregularly by th e same child , unde r 6 year s o f age , o n at leas t tw o dii!eren t day s withi n an y week , for at leas t 3 hour s eac hday , provide dthat th e visit s total at leas t 6 0 hour s annually . 'S.^B ) I understan dthat th e renovatio n firm , contracte db y th e Environmenta l Protectio n Agenc y (EPA) , wil l b e usin g lead
saf e wor k

practice s require dby EPA' s Renovation , Repai r andPaintin g Rule . 

## >*?hQnnn n Rordf r Printe dNam e o f Owner-Occupan t

Signatur e o f Owner-Occupan t Dat e

## V Douglas Count y Accoun t Information Pag e 1 of3 

# ' r " ; •' F 

# O-T^^M ^ Dougla s County , Nebrask a Propert yRecor d - R14196G000 0 Prin t Reoor t NE W Featur e - Parce l Dimension s availabl e & scal e 0-5 0 f t wes t of 52n d S t - VJO W O H Ma P Informatio n i s vali d a s o f 2010-4- 5 Treasurer' s Ta xRepor t Ne wFeatur e - 4 • • > » Aut o Sale s Searc h Owne r ROEDE R SHANNO N M
OMAHAN E 68105-000 0 '^S^'G^' ^

M Propert yInformatio n Ke yNumber : 196 0 000 0 1 4 Accoun t Type : Residentia l Parce l Number : 141960000 0 Parce l Address : 70 7 S 3 6 S T OMAHAN E 68105-000 0 Lega l Description : ISAAC S & SELDEN S AD D LO T 4 BLOC K1 3 S 4 2 N 8 2 W 2 4 F T LT 3 & S 4 2 N 8 2 FTLT 4 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $5,200.0 0 $75,200.0 0 $80,400.0 0 200 8 $5,200.0 0 $75,200.0 0 $80,400.0 0 200 7 $5,200.0 0 $75,200.0 0 $80,400.0 0 200 6 $5,200.0 0 $72,300.0 0 $77,500.0 0 200 5 $5,200.0 0 $72,300.0 0 $77,500.0 0 200 4 $5,200.0 0 $72,300.0 0 $77,500.0 0 Sale s Informatio n Sale s Date : 2001-03-0 2 Dee d Type : D Boole : 217 5 Page : 08 9 Price : $ 74,000.0 0 Granto r Grantee : Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 1999-10-1 5 Dee d Type : D Book : 1 213 9 Page : \ 19 1 Price : $ 69,000.0 0 Granto r 

## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R14.. . 4/12/201 0

### Dougla s County Accoun t Informatio n Pag e 2 o f 3
Grantee : Valid/Invalid : \ vali d Exclusio n Reason : Lan d Informatio n Acre s 0.0 8 S F 3864. 0 Unit s 

### 1. 0 Dept h 92. 0 Widti i 42. 0 Vacan t N o Improvemen t Buildin g 1 Informatio n



# ' i

CLIC KTO ENLARG E IMAG E Squar e Footage : 

### 1362. 0 Percen t Complete : 

### 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 2 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 6. 0 Exterior : Fram e Sidin g Units : 

### 1. 0 Interior : Drywal l Baths : 

### 1. 5 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Gabl e Stories : 2. 0 Floorcove r Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 191 8 200 3 0 % 

### 193 1 7 8 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 720. 0 Carpor t Attache d 372. 0 Fixtur e Bas e Fixture s 

### 1. 0 

### http://clouglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R14. . . 4/12/201 0(effectiv e Apri l 2010 )


### RENOVATIO N RECORDKEEPIN GCHECKLIS T
Nam e o f Firm : Dat e an dLocatio n o f Renovatio n 

# Ml\l\ o Brie f Descriptio n o f Renovation : PfAVA V '=^^V:)\\i7.aV\n/ l Nam e o f Assigne dRenovator : Name(s ) o f Traine dWorkers : p^\v^.V ^ Nam e o f Dus t Samplin g Technician , Inspector , and/o r Ris k Assessor , i f used : P j f C X

• sCopie s o f renovato r an ddus t samplin g technicia n qualification s (trainin g certificates , certifications ) o n file. iQsCertifie drenovato r provide dtrainin g t o worker s o n (chec k al l that apply) : Kfostin g wamin g sign s ' ^ Settin g u p plasti c containmen t barrier s D^Vfaintaining containmen t ^Avoidin g sprea dofdus t t o adjacent area s l3\Wast e handlin g ^ Post-renovatio n cleanin g H Tes t kit s use db y certifie drenovato r t o determin e whethe r leadwa s presen t o n component s affecte db y renovatio n (identif y kit s use dan ddescrib e samplin g location s an dresults : ^\CX __ ^ Qs^amln g sign s poste da t entranc e t o wor k

area . " ^ Wor k

are acontaine dt o preven t sprea dofdus t an ddebris . bvWindow s i n an dwithi n 2 0 fee t ofth e wor k are aar e close d 'Dspoor s i n an dwithi n 2 0 feet o f th e work area s ar e close dan dseale d ns^pooi s tha t mus t b e use di n th e work are aar e covere dt o allo w passag e bu t preven t sprea dofdust . Q^Groun dcovere db y plasti c sheetin g extendin g 1 0 feet hor n wor k

are a- plasti c anchore dt o th e buildin g an dweighte ddow n b y heav y objects . " ^ I f necessary , vertica l containmen t installe dt o preven t migratio n ofdus t an ddebri s t o adjacent property . S Wast e containe don-sit e an dwhil e bein g transporte doff-site .

Renovatio n Recordkeepin g Checklis t Omah a Lea d Sit e(effectiv e Apri l 2010 )



### D\Wor k

sit e properl y cleane dafter renovation . 13 Al l chip s an ddebri s picke dup , protectiv e sheetin g misted , folde ddirty sid e inward , an dtape dfo r refnoval . nNj/ork are aHEP A vacuume dt o ge t pain t chip s fro mgroun dsurface , i f necessary . DsQertifie drenovato r performe dpost-renovatio n cleanin g verificatio n (describ e results) : ^_ ^

D I certif y unde r penalt y of la w tha t the above informatio n i s tru e an dcomplete .

Nam e an dTitl e Dat e

Renovatio n Recordkeepin g Checklis t Omah a Lea d Sit e