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

## SAID# : ( DS4^ S 

## Date : ^-QO-C ^ Address : .1? ^ b?
. T ^ 4 ^ /We
. Remediatio n Contractor : PROFESSIONA LENVIRONMENTALENGINEER S Year : 200 9 PAINT STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S t r

Video of propert y (DVD ) 7>Gs h C

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Executive Summar y ^y Signe dAcces s Agreemen t fo r

subjec t propert y sy ^ Painting Agreemen t D Sgltlemen t document s (i.e. , fo r

damage o r

t

o replac e plants , etc. ) Q/ ^ Photograph s P^hCL
. oy ^ Satisfactor y restoratio n signedb y Propert y Owne r U"^"" ^ Propert y close-ou t chec k

lis t signedb y EP A \^y ^ Propert y information fro mDouglas Count y Assessor' s Office ^ y confirmation tha t lea dpamphle t "Renovat e Right " wa s receivedby P0
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# 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 Form (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) SAID : -^xc\f\A^fc l VtW^ O Propert y Address : /S4tQ? N /[ ) V ^ /9-1 ^ Owner'sName : /j-f'lr ^ ^ S Performanc e Standards/Close-Ou t Criteri a 250 5 Nort h 24 ^ Suit e 21 9 Omaha , N E 6811 0 (402 ) 504-468 8 Fax(402 ) 504-328 1



### YE S N O 1
. Wa s th e entir e structure(s ) painte dwithth e exceptio n ofth e stated , exclude d areas ? Thi s woul dinclud e paintin g ofothe r associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an dexterio r surface s o f 

# y 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 o f th e structure(s ) prime da s neede dan dpainte dwith 

# y tw o to p coats ? 4
. Wa s th e pain t product s utilize dequivalen t t o a3 0 year product/quality ? ^ 

### 5
. Ar e al l ofth e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y 

# y vacuumed / cleaned ? 6 . Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s o n th e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y 

# y othe r generate ddebris ? 7
. I s th e gras s are atha t siuround s th e structure(s ) i n reasonabl y goo dcondition ? 

### y 8
. Ar e al l item s suc ha s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . properl y removed ? 

# y 9
. I s ther e an y evidenc e ofpropert y damag e that was don e b y th e contractor ? An y property damag e need s t o b e complete dprio r t o th e EP A Close-Out
. \ y 

### 10
. Ar e ther e an y property item s tha t wer e temporaril y re-locate db y th e contracto r \ y 

### that nee dt o b e move dback ? 11
. Ar e ther e an y (known ) lingerin g issue s withth e property owner(s ) tha t hav e bee n lef t utu-esolved ? Othe r Considerations/Property Owne r Discussions/Additiona l Wor k

tha t i s Required :


# d//Xyuy ^ 

# 1 I n lo f EP A CO RSignatur e Dat e . X

# PROFESSIONA L 250 5 Nort h 24 ^ Suit e 21 9 

# ENVIRONMENTA L ENGINEERS , INC
. Omaha , N E 6811 0 (402 ) 504-468 8 

### "Providin g cost-effectiv e environmenta l solutions " Fa x (402 ) 504-328 1 Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yRespons e 

### Propert y Owne r Close-Ou t For m (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) 

### SAID : ^^VV^Ato l P^WJ^ O 

### Property Address : Owner' s Name : Performanc e Standards/Close-Ou t Criteri a YE S N O 1
. Wa s th e entir e structure(s ) painte dwithth e exceptio n ofth e stated , exclude d areas ? Thi s woul dinclud e paintin g ofothe r associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an dexterio r surface s o f 

# X garages . 2
. Wa s al l scrapin g an dothe r preparatio n wor k

complete dsatisfactorily' / 3
. Wer e al l require darea s ofth e structure(s ) prime da s neede dan dpainte dwith tw o to p coats ? 

# X 4
. Wa s th e pain t product s utilize dequivalen t t o a3 0 year product/quality ? 5
. Ar e al l ofth e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y ^ 

### vacuumed / cleaned ? 6 . Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s o n th e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y othe r generate ddebris ? 7
. I s th e gras s are atha t surround s th e structure(s ) i n reasonabl y goo dcondition ? 8
. Ar e al l item s suc ha s polyethylen e sheeting , ladders , pain t brushes , cones , 

# X barrie r tape , etc . properl y removed ? 9
. I s ther e an y evidenc e ofpropert y damag e tha t wa s don e b y th e contractor ? An y 

# X property damag e need s t o b e complete dprio r t o th e EP A Close-Out
. 10
. Ar e ther e an y property item s that wer e temporaril y re-locate db y th e contracto r 

# K tha t nee dt o b e move dback ? 11
. Ar e ther e an y (known ) lingerin g issue s wit hth e property owner(s ) tha t hav e bee n lef t imresolved ? 

# K Comments :



# 'Ktf^^i^ r '^'-li' ^ Property Owne r Signatur e Dat e 

# yy y-o ? Professional Enjrtfonmenta l Engineer s Representativ e Dat e••f i f
- 

# CONSEN T FO RACCES S T O PROPERT Y OMAH A LEA D SIT EREMEDIA LACTIO N - LEAD-BASE D PAIN T STABILIZATIO N PROPERT Y ID ; CQ^ ^ ^S " PROPERT Y ADDRESS ; 4^V^- ^ / V ^ S ^ ^ OWNERNAME : v . <->CsPstf,J ^ ^ 

# •efso n DAYTIM E PHONE : S^C o "J?. ? 9^4 ^ CELLPHONE : ft^Q " <gi6? / 7 E-MAIL : OWNER' S ADDRES S I FDIFFERENT ; TENANT' S NAM E I FAPPLICABLE : DAYTIMEPHONE : 

### h ^ ^ ^ lb<i ^ CELLPHONE E-MAIL : 

# c a l G71-3^3 ^ Professiona l Environmental Engineers , Inc
. (PE ) i s unde r contrac t (#EP-R7-08-06 ) wit hth e U.S
. Environmental Protectio n Agency (EPA ) t o stabiliz e lea dbase dpain t (LBP ) o n residential structure s a t anumbe r o

f propertie s locate di n Omaha , Nebraska
. Th e pain t stabilizatio n wor k

i s bein g don e t o protec t th e soil cleanup s tha t ar e bein g performe dby EP A contractors . Pain t stabilizatio n activitie s will include : scrapin g o f cracke do r flakin g LB P fromstructures , applicatio n o f aprim e coat an dtw o (2 ) coat s o f paint
. Moving part s o f window s an ddoor s ar e no t include dan dwil l no t b e addressed
. Your cooperatio n i s requeste din giving permissio n t o thi s EP A contracto r (PE ) t o ente r an dhav e acces s to 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 property identifie dabove
. By signin g thi s document I agre e t o allo w an EP A contracto r t o conduc t asoil cleanup a t m y propert y followin g completio n o f lead-base dpain t stabilization , i f th e soil cleanup ha s no t alread y been performed
. I understan dtha t th e stabilizatio n contracto r ca

n no t provid e assurance s tha t th e soil cleanup contracto r wil l b e boun dto . I furthe r understan dtha t th e soil cleanup contracto r will make al l reasonabl e effort s t o addres s concern s tha t I , a s th e property owner , ma y hav e regardin g soil cleanup a t m

y property . H Yes , I hav e rea d an d understan d th e paragrap h above
. •4\A
. A U A > r^t x/r t / ^ 1 ^ Z* ^ Signatur e o fPropert yOvvne r« ^

Dat e I full y understan dtha t b

y signin g thi s Consent for Access , (1 ) thi s acces s wil l remai n i n effec t unti l th e wor k

ha s been satisfactorily completed , (2 ) tha t th e Propert y Owner o r Tenant , i f applicable , wil l b e give n th e Housin g an dUrban Development (HUD ) an dEP A pamphlet , "Renovat e Right , Importan t LeadHazar dinformatio n for Families , Da y Car e Providers , an d Schools" , (3 ) th e Property Owner o r tenan t wil l remov e al l obstruction s fro msurface s t o b e painted , (4 ) wil l abid e by healt han d safet y guidanc e provide dby EPA , (5 ) wil l allow photograph y ofpropert y befor e an dafter th e pain t stabilizatio n work , (6 ) will b e contacte dby aPE representativ e approximatel y 4 8 hour s in advanc e of startin g work , (7 ) agre e no t t o obstruc t o r tampe r wit h an y o f th e LB Pstabilizatio n actions , an d(8 ) wil l participat e i n fina l propert y inspectio n an dsign th e Completio n Agreement an d Propert y Owner Satisfactio n Survey
. Shouldyo u hav e an y question s abou t th e plane dLeadBased-Paint stabilizatio n activitie s for you r property , pleas e contac t Professiona l Environmental Engineers , Inc
. Projec t Manager , Willi e Cla y At 402-S04-4688
. Genera l question s abou t th e Omah a LeadSite cleanup ca n b e directe dt o Paulett aFrance-Isetts , EP A Remedia l 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 hOmah aoffice ) o r 402-731-304 5 (Sout hOmah aoffice)
. ^Ves , I gran t acces s t o m ypropert yan d wa s give n th e pamphle t D No , I d o no t gran t acces s t o m ypropert yan d I wa s "Renovat e Righ t Importan t Lea d Informatio n forFamilies , Chil d give n th e pamphle t "Renovat e Right , Importan t Lea d Car e I Infonnatio n forFamilies , Chlid e Car e Providers , an d Schoois. " Signa l Dat e Signatur e Dat e SPECIA L INSTRUCTION S AN D CONSIDERATION SI;l
. • 

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### Dougla s County Accoimt Informatio ; Pag e 1 of 2 

# V Q^-^^t ^ Dougla s County , Nebrask a Propert yRecor d - R081119000 0 Prin t Repor t NE W FGature - Parce l Dimension s avaiiabi e (8 t scal e 0-5 0 f t wes t of 52n d S t - Vle W O n Ma D Informatio n i s vali d a s o f 2009-6-1 6 Treasurer' s Ta xReoor t Ne wFeatur e - ^ -* -* Aut o Sale s Searc h Owne r PETERSO N RICHAR D L ETA L 246 3 N 4 5 AV E OMAH AN E 6810 4 Propert yInformatio n Ke yNumber : 111 9 000 0 0 8 Accoun t Type : Residentia l Parce l Number : 081119000 0 Parce l Address : 246 3 N 4 5 A V OMAH AN E 68104-000 0 Lega l Description : CLAIRMON T LO T 3 8 BLOC K2 5 0 X 12 5 Valu e Informatio n Lan d Improvemen t Tota l 200 9 200 8 200 7 200 6 200 5 200 4 $6,400.0 0 $6,400.0 0 $6,400.0 0 $6,400.0 0 $6,400.0 0 $6,400.0 0 $65,200.0 0 $65,200.0 0 $65,200.0 0 $65,200.0 0 $58,200.0 0 $52,900.0 0 $71,600.0 0 $71,600.0 0 $71,600.0 0 $71,600.0 0 564,600.0 0 559,300.0 0 Sale s Informatio n Sale s Date : 2000-05-1 5 Dee d Type : D Book : 215 2 Page : 15 9 Price : $ 61,000.0 0 Granto r Grantee : Valid/Invalid : Vali d

• Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 4 6250. 0 1. 0 125. 0 50. 0 N o Improvemen t Informatio n


### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R08.
. . 7/13/200 9

### Dougla s Count y Accoun t Informatio n
Buildin g 1

Squar e Footage : Perimete r Uni t Type :

Buil t As :

HVAC : Exterior : Interior : Roo f Cover :

Roo f Type : Floorcover :
Yea rBuil t Remodele d Remodele d 192 3 Detai l Typ e Ad d O n Applianc e Basemen t Fixtur e Fixtur e Fixtur e Garag e Porc h Porc h 1456, 0 0. 0 2 Stor y Centra l Ai rt o Ai r Fram e Sidin g Drywal l Compositio n Shingl e Hi p Allowanc e yea r Percen t

0 0 % Detai l Descriptio n Fenc e Chai n Lin k Allowanc e Bsmn t Bloc k 8 ft Bas e Fixture s Bat h Ful l Bat h Hal f Detache d En d Scree n En d Scree n 

### Pag e 2 o f 2

S«c-oo*Fk>a r FifStFlO W 72 8 0 sq . ft 72 a Os q «

S^i ' l-K K ,. i 2 STOR Y

CLIC KT O ENLARG E IMAG E Percen t Complete : , 100.0 % Quality : Condition : Cond o Squar e Footage : Rooms :

Units : Baths : Bedrooms : Stories : Foundation : Sprinkle rSquar e Footage : Adjuste d Yea r Averag e Fai r 0. 0 6. 0 1. 0 1. 5 3. 0 2. 0 Bloc k 0. 0 Physica l Ag e Buil t 192 3 8 6 Unit s 1. 0 1. 0 728. 0 1. 0 1. 0 1. 0 260. 0

80. 0 112. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R08.
. . 7/13/200 9

### M C Services , LL C Propert yAddres s QAlT)? ^ P
. ^ D [\fe
. Dat e H ~ WO ^ Star t Date I ' I Q " Cr A End Date 

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

# 1

Pol y(Boxes ) 

# \lh
Pain t (Color ) Amoun t (Gallons ) 

# A^iiiis e 

# K i
Pain t (Color ) 

# MM Amoun t (Gallons ) 

# ' D Pain t (Color ) Amoun t (Gallons ) 

# M i
Pain t (Color ) Amoun t (Gallons ) Pain t (Color ) Amoun t (Gallons )

## Professioncs l Environmenta l Engineers , Inc
. INTERVENCi6 N D E SEGURIDA D Nombr e de l Provecto:£A(o! ^ V-^sA;^{W ^ Fech a d e l a Intervencion : 1 ^

\ O v-J ^ Pellgro s d e Salu d Prinnordial : \tSCA( 3 — — Preocupaclone s Primordlale s d e H & S : Tarea s Diarias : 1
. S T Y^QppW^O V
3
. 

# o\mn\T^o \ Equlp o Usad o e n e i Luga rd e Traabjo : Casc o Duro Bcaler a y Gafa s d e Segurida d > < Elevadore s X Zapato s GFC I y Guante s d e Trabaj o . Chaleco s d e Seguridod^ ^ Generadore s yOtr o ^**= ^ Equlp o Usto par a Respuest a d e Emergenci a a Disposicio n inmedlata : Conduci rReunio n Diari a d e Segurida d )y Estuch e d e Primero s Auxilio s ><C ) Procedimiento s d e Emergenci a fi<l Politic a d e Salu d ySegurida d d e l o Companf a - ^ GFC I e n siti o y Deficiencias: , Accione s Corretivos :

Interventor : C cyp ^

/ g r/Zo^r^'s ' Fecha:
. Superviso rde l Sitio : Fecha :

### PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC
. REUNI6 N DIARI AD E SEGURIDA D 

## Fecha : H-l^-Q^ ^ Proyecto : Omah a Pain t Stabilizatio n Project
Siti o d e Actividad:
. Tarea s Diarias :

Primordial/Peligro s Potenciales : 

## 2. \i{y( \^^YT\a\V ^ 4 Herramienta s d e Trabajo : 

# ^^.V ^ ^ 3. %crc\pQc r 

# ^4 i Practica s de l Trabajo/Accione s Correctivas : 1
. 3.
_ 2
. ; 4
. Llamada s previas : 1
. 3
. 2
. 4
. Firm a d e Registr o de l Empleado : 

## 1
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