TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: 7.7?S4-2- Date: S^Zl - IQ 

Address: ICS l 5,0. 'SU' ^ ^St'/'-e^d T 

Stabilization Contractor: Professional Environmental Engineers Year: 2010_ 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

X 

Video ofproperty (DVD) 

Executive Summary 

Signed Access Agreement for subject property 

X Pre-Renovation Form signed by Property Owner 

Pre-Renovation Form for Occupant/Tenant, if applicable 

D Painting Agreement 

Settlement documents (i.e., for damage or toreplaceplants, etc.) 

D Renovation Recordkeepin ecordkeeping Checklis Checklist signep d b 

y Certified Renovator

Photographs Jk>^^. and Q^hr-

X 

Satisfactory close-out check list signed by Property Owner

X Property close-out check list signed by EPA D 

Property information firom Douglas County Assessor's Office ?^ 

Hazard analysis, if prepared 

0 

Safety Audit 

a 

Other (describe): 

D 

Signature 

rlA^t.6A.^Si^^ 

ignature 

(afterfilefoldederr review)

30204213 

iiinin 

Superfund 
P - 1 

PAGE 01 ELCARIBE 05/1B/2010 23:23 14025922480 

4 0 2 53 4 030 3 n a n 17 eOl O ll:53fl n DUNDEE ELEMf NTHf?Y 

PA&^ 81 05/16/281B 28:56 .14825922430 ELC*R:BE 

MOF/SS^IONAL 9MLlMilnt,SuiME tNVlNONMENTAL ENGINEERS, INC. i Sl.laul(.M0*l«03 

ISt4)SS1-«0a» "Pwtoing cbst'aifactiva mnvironmBr^l solutions' *u(ii4)s>i-«eM 

• fMMWltMaiK iigaiuy timtnnt­ 2010 

Prc^iacty O^Wiaff Clo4e-Out Form }. (Lead-BMiA Faiut Stabilitftion EPA Coi«nct£P.R7-08'0€) \ 

SAID; 

Propeny Aidntt 

Owner'iNHM 

jjarfowMBW St—iar*i/Clot-Oa« CrlliiiS" vts NO 

I. W M tht wtiM «nietuk«(*) Pointed with ttie exception ofthe nateit, excluded tnu l Thia 

would iadlude piinthi df oAer asioctned ftatutcs IncludiDB faict^ eatvet, Bding, all Tliilt, 

poioh»». hw IwanM. cftlMnm. iwil». ""d ewrior awfi^ei of ganiei' 

2. Wuidl and Wlher prcpewtion work completed mi>facii>rily JSrii: ? 

3. Were «n nquked areiis of the «tnieture(i) primed as needed and painted with two top 

4. W M thirpaf yafcte t prodarti utiHaed cqwv«lwrt to a 25 yen pto«w^jmlity < T 

5. Art all of ihr iieai where eonteminMod mttcriels have been ipilled thoromhly ^ 

6. DiA the ceouartor coiUct/vacuum all fcHtng and acwped paint dferipa on the entlic 

property, reednMiys, alleyway*, public eeecie areai *nd elio remove! my other lenerated 

debris? . . ' 

7. lithe 11 MM th t iwTouodi flte tmteaat^iii in tteiombly goctd condition? 

i. Are all il such M ^lydhylene shaaiing. ladden, paint bnahi*«, oooei, banier tiiper 

etcpiopadyrttiovd? V 

9. Is thaw any evidence ofproperty damage that WM done by die contrector? Any pioperty 

dimi B nwda to be comhlBted wior ia tha EPA Ckwe-Ow. ! 

10. Aieyowioiilicd wl<h the woik pcrlbemcd? :i c 11. Al* tttre my propei^ iiemt thai were temporarily re-located by the contractor that 

needtobcmovedbaek? • I 

12. A K thm my (known) lingering inues with tlie propeny ownetis) tbmx have been lefl 

unwDlvd? j X 

Other CoMideiMloM^rolpttty Ownn Diaeuiiiom/Additimal Woite that is Required:' 

.4^ ^ ^i^^C*i S=A2JSL Pnipeny OWMT Slgna(w« Date 

Ii/Z:^ 

Engineer* Sigmture Oite 
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 Oesign • Remediation • Ak>alemenl • Emergency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

2010 

SAID# 22342 

707 s. ae'" St. 

• Dates worked: 04/11/10 to 04/14/10 

• Pre property condition: House has painted wood siding and a porch area, all paint was 

in poor condition prior to stabilization. Paint chips in yard. 

• Problems encountered: None 

• Owner request/concerns: N/A 

• Inspection/closeout dates. Owner 05/07/10, inspected by PE project manager. 
EPA Paint Stabilization 2010 

SAIDff 

Property Address 

Stories Z - S 

Garage? fe 

Accesssigned A-\^' ' 2-010 

Pre-video 4 " Z- ^ ' O 

Post video Z ) ' ^ \ ' \ 0 

Contractor Assigned \A C , SPNT M \ C^ ^ 

Date started M/I//10 

Weathertemp loi 

Date ended 1^(1 Alio ^ 

P.ln.,«d \t0VM| • ^UV^\A^ 

Poly used \ m 

Problems/Issues 

OjAOoie tx> -(Tjlog "pt^li^s pr fx3c.c jyf lr Vi ­
Rpr 28 2010 7:55HI1 DU"iOE yOEl 
 E ELEMENTARY 402 554 0303 
 P-1 


CONSENT FOR ACCESS TO PROPERTY 

OMAHA LEAD SITE REMEDLiL ACTION - LEAD-BASED PAINT STABIUZATION 

PROPERTY IP; TSL'^'^l ^ PROPERTY APDRESS; in l <;. 3 fpfi ^ <^ - n^^fry^j ' 

OWNERNAME; 

DAYTIME PHONE: C'^O^') 3 ^6-^o'J^ 9 

CELL PHONE: (^02 ^ Cg»9-Q7:^ Q E-MAIL: ^iUalnlr^nr^ toG>n g ) tnrv^in .COn n 

OWNER'S ADDRESS IF DIFIERINT: . 

TEN r s NAME IF AFPUCABLE: 

<^y\wn>rt UDVYV . 

CELL PHONE: , (^<^-Cf\?5 

DAYTIME PHONE: 

E-MAIL: 

Profeeiional Enviroaniental Eoglneen, Inc. <PE) it under eoelnict (#EP-R7-0S-06) with tfae US . Environmental Protection 

Ageaqr (EPA) to itibllh e lend baecd paint (LBP) on midentlRl ftruetures at a aumber orpropertics located In Onaha , 

Ncbratkii. Tbe paiat itabllintlo a wor k b being done to protect the toi l cleanup* that are being perfonned by EPA contractoriL 

Paint ttabilintio n aetivitiea wil l iDcIude: acraping of cracked or flaking LBP fh>ni atructurc*, application of a prime coat and two 

(2) coats of pain t Moving part i of wiadaw> and doo n uufi t included and wil l nol be addrcMed. 

Yonr cooperation b roqueated in giving permiuion to thia EPA contractor (PE) to enter and have acceu to thi i property for the 

purpose of stabllUng lead -based paiat a i oudined on the property ideatiflcd above. 

By iigaing this docnment I agree to allow an EPA oontractor to conduct a soil cleanup at my property following completion of 

lead-based paint staUllcatlon, if the soil eleanup has not already been performed. 1 undentand that the stabilliatkin contractor 

can not provide aiiHraacea that the toi l cleanup contractor wil l be bound to. I further undentand that the soli cleanup 

contractor wil l make all reasonable efforts to address concerns that I, as the property owner, may have regarding aoil cleanup at 

my property. 

SfVaa^ I hsps leed and uaderaiaiid ths paragrapli above. 

"tmAa/y v-/q-/o Slgaebaa of Prapaity Ownar 

I fhlly underttand that by signing this Consent for Access, (1) this access wil l remaia in effect unti l the wor k has been 

satfsfBctorily completed, (2) that the Property Owner or Tenant, if applicable, wil l be given the Hoasing and Urln n Development 

(HUD) and EPA pamphlet, "Rtaovate RJgbt, Inpoiian t Laad Haaard InformatioB Ibr Familisa, Day Care Providers, and 

Schoolt", (3) ths Property Owner o r tenant wii l remove all obstruction! fhtm sarftees to be paintad, (4) wil l abide by health and 

safety guidance provided by EPA, (5) wil l allow photography of property befbre aad after the paint stabilization work , (6) wil l be 

contacted by a PE representative approximately 48 hours In advance o f starting work, (7) agree not to obstruct or tamper with 

any ofthe LBP stablitaation actions, and (8) wil l participate in Tmal properly Inspection and sign tbe Completion Agreement aad 

Property Owner Satisfaction Survey. 

Shoald you have any questions abont the planed Lead Based-Paint stabilbation activities fbr your property, please eontaet 

Professional Environmental Bnglneers, Ine. Project Manager, Willie Clay At 402-8044688. General questloas abont the Omaha 

Lead Site cleanup can be directed to Panletta France-lsetts, EPA Remedbl Project Manager 402-731-2454, or the EPA Pnblic 

Information Centers at 402-991-9583 (North Omaha office) or 40Z-73t-304S (South Omaba office). 

H j Yse, I grant accses lb my property sni MM givan Aa pamphM O Ne, I do net gnM access ton y propeily and I MM 

•RMOsate RgM, hapoitmtLNd intaniaUon for FunlUts, ChM ghfsn the pamphlat'Renovate Mght Impoftant Lead 

C HS Prevldsmi snd Schools. InfaiiwHen tor FamDIie, ChBdi Cam Pravldm, and Sctnoli.' 

^-n-io 

Slgnahire Signature Dsts 

SKCUL INSTRUCTIONS AND CONSIDERATIONB 
Apr 28 2010 7:55flM DUhUlEE ELEMEMTnRY 402 554 0303 p. 2 irmE 

PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

PROPERTY ADDRESS: 70 7 e^ ^G* ^ <Vl- DATE: V-Z^'/o 

BVID: 

AREA(8) TO BE PAINTED: 

HOUSE PROPER: COLOR: ^ Ir^ y 

- " ' -

HOUSE TRIM: COLOR: whif g ^ ^^\l\r\r\c 

GARAOE: COLOR:. 

1^VNr>AcxV>C^n - VKcf^cy \ 

carport , ., •TRIli: COLOR: y/hit r 

PORCH: COLOR: wKf'4y 

PORCH TRIM: COLOR: v^/lM•U 

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

1 AGREE TO THE COLORS LISTED ABOVE. ONCE THE PAINTING 

BEGINS, I UNDERSTAND I CAN NOT CHANGE THE ABOVE SELECTED COLORS: 

PROPERTY OWNER SIONATURE: PE ACCESOR SIGNATURE: 
Apr 28 2010 7:55flM DUMIIEE ELEMENTHRY 402 554 0303 p. 3 i 

PRE-RENOVATION FORM ~ OWNER 

This form is to be used by the firms eontncted by the Environmental Protection Agency-Region 7 to perform Lead-Baaed 

Paint stabilization activities at the Omaha Lead Site, Omaha, Nebraska. 

Owner Confirmation 

Pamphlet Receipt 

VL I have received a copy of the lead hazani information pamphlet, Renovate Right: Importand Lead Hazard Information for 

Faadlies, Child Care Provkiers and Schools, informing me ofthe potential risk ofthe lead hazard exposure fiom renovation 

activity to be perfivmed in/on my dwelling unit. I received this pamphlet before the worlc began. 

Owner Acknowledgment 

9^A) I confirm that I own and iive in this property, that no child under the age of 6 resides here, that no pregnant woman 

resides here, and that this property is not a child-occupied facility. 

Note: A child resides in the primary residence of his/her custodial parents, legal guardians, foster parents, or 

informal caretaker if the child lives and sleeps most of time at the caretaker's residence. 

Note: A child-occupied facility is a pre-l97S building visited regularly by the same child, under 6 years of age, on at 

least two dii!erent days within any week, for at least 3 hours each day, provided that the visits total at least 60 hours 

annually. 

'S.^B) I understand that the renovation firm, contracted by the Environmental Protection Agency (EPA), will be using leadsafe work practices required by EPA's Renovation, Repair and Painting Rule. 

>*?hQnnnn Rordfr 

Printed Name of Owner-Occupant 

Signature of Owner-Occupant Date 
V 

Douglas County Account Information Page 1 of3 

'

r " ; •' F O-T^^M ^

Douglas County, Nebraska Property Record - R14196G0000 

Print Reoort 

NEW Feature - Parcel Dimensions available & scale 0-50 ft west of 52nd St - VJOW OH Ma P Information is valid as of 2010-4-5 Treasurer's Tax Report 

New Feature -4 • • >» Auto Sales Search 

Owner 

ROEDER SHANNON M 

OMAHANE 68105-0000 '^S^'G^' ^ M 

Property Informatio n 

Key Number: 1960 0000 14 

Account Type: Residential 

Parcel Number: 1419600000 

Parcel Address: 707 S 36 ST 

OMAHANE 68105-0000 

Legal Description: ISAACS & SELDENS ADD LOT 4 BLOCK 13 S 42 N 82 W 24 FT LT 3 & S 42 N 82 

FTLT4 

Value Informatio n 

Land Improvement Total 

2009 $5,200.00 $75,200.00 $80,400.00 

2008 $5,200.00 $75,200.00 $80,400.00 

2007 $5,200.00 $75,200.00 $80,400.00 

2006 $5,200.00 $72,300.00 $77,500.00 

2005 $5,200.00 $72,300.00 $77,500.00 

2004 $5,200.00 $72,300.00 $77,500.00 

Sales Informatio n 

Sales Date: 2001-03-02 

Deed Type: D Boole: 2175 Page: 089 

Price: $74,000.00 

Grantor 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 1999-10-15 

Deed Type: D Book: 1 2139 Page: \ 191 

Price: $69,000.00 

Grantor 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R14... 4/12/2010 
Douglas County Account Information Page 2 of 3 

Grantee: 

Valid/Invalid: \ valid 

Exclusion Reason: 

Land Informatio n 

Acres 

0.08 

SF 

3864.0 

Units 

1.0 

Depth 

92.0 

Widtii 

42.0 

Vacant 

No 

Improvemen t

Building 1 

 Informatio n 

'i 

CLICK TO ENLARGE IMAGE 

Square Footage: 1362.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

Built As: 2 1/2 Story Unfin Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 6.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.5 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 2.0 

Floorcover Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1918 2003 0% 1931 78 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 720.0 

Carport Attached 372.0 

Fixture Base Fixtures 1.0 

http://clouglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R14... 4/12/2010 
(effective April 2010) 

RENOVATIO N RECORDKEEPIN G CHECKLIS T 

Name of Firm: 

Date and Location of Renovation 

Ml\l\o 

Brief Description of Renovation: PfAVA V '=^^V:)\\i7.aV\n/ l 

Name of Assigned Renovator: 

Name(s) of Trained Workers: p^\v^.V ^ 

Name of Dust Sampling Technician, Inspector, and/or Risk Assessor, if used: P j f CX 

•sCopies of renovator and dust sampling technician qualifications (training certificates, certifications) on file. 

iQsCertified renovator provided training to workers on (check all that apply): 

Kfosting waming signs ' ^ Setting up plastic containment barriers 

D^Vfaintaining containment ^Avoiding spread ofdust to adjacent areas 

l3\Waste handling ^ Post-renovation cleaning 

H Test kits used by certified renovator to determine whether lead was present on components affected by 

renovation (identify kits used and describe sampling locations and results: ^\C X __ ^ 

Qs^amlng signs posted at entrance to work area. 

" ^ Work area contained to prevent spread ofdust and debris. 

bvWindows in and within 20 feet ofthe work area are closed 

'Dspoors in and within 20 feet of the work areas are closed and sealed 

ns^poois that must be used in the work area are covered to allow passage but prevent spread ofdust. 

Q^Ground covered by plastic sheeting extending 10 feet horn work area - plastic anchored to the 

building and weighted down by heavy objects. 

" ^ If necessary, vertical containment installed to prevent migration ofdust and debris to adjacent 

property. 

S Waste contained on-site and while being transported off-site. 

Renovation Recordkeeping Checklist Omaha Lead Site 
(effective April 2010) 

D \ Work site properly cleaned after renovation. 

13 All chips and debris picked up, protective sheeting misted, folded dirty side inward, and taped for 

refnoval. 

nNj/ork area HEPA vacuumed to get paint chips from ground surface, if necessary. 

DsQertified renovator performed post-renovation cleaning verification (describe results): ^_ ^ 

D I certify under penalty of law that the above information is true and complete. 

Name and Title Date 

Renovation Recordkeeping Checklist Omaha Lead Site