TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID: 5189 Date: 12/26/2008 

Address: 815 TURNER BLVD 

Stabilization Contractor: Prudent Technologies Year: 2008 

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PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Summary 

Signed Access Agreement for subject property 

Painting Agreement 

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

Photographs 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Property information from Douglas County Assessor's Office 

Signatui^ 

oz/oejoj 

)ate 

40307991 

iiiin 

Superfund 
PROPERTY SUMMARY 

Date: 12/29/08 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Month of: December 

Property Address: 815 TURNER BLVD SAID; 5189 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE. 

A.2 Issues Resolved: NONE. 

A.3 Unique Findings: NONE. 

A.4 Other Relevant Information: 

Access Date: 10/21/08 

Work Began: 10/28/08 

Closeout Date: 10/30/08 

Enclosures: 

1. Pre-Video 

2. Post-Video 

3. Property Status Form 

4. Signed Access Agreement 

5. Pre-Renovation Form 

6. Paint Match Form 

7. Tracking Form 

8. Douglas County Assessor Property Information Page 

9. EPA Property Closeout form 

10. Property Completion Agreement 

TECHNOLOCIES, INC. 
TECBNOLOGIES,WC. 

K INVIRONMENTAL« 

OONSTRUCnON 

F 7 ^ SBRVICBS 

Property Status Form 

Address: '^Slt!) TlLme r fJi^cC^ ^^8*«- ) \ - 6^^ oK 

Phone: 9(^0-5; ) 3 5 BVID: Sl'^i 

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N TV 

Item# 

OoMq) 

Plant & Permanent Landscaping T<^ p Mimii^ Tp piwy<> 

Description and Location 

A-

^E?^?^"P Condition of Stnictmea 

Does your Basement have a history of lealdng? Yes -— No ^ 

Iten« 

OnKbp 

Description & Location 

V-.£rc>H • c«>, ts-^- V^v" C ^ T^o - tn olJcofe .'o ^ -'G «ii-YV\c~ « <i:i ^ 

Propeity Owner 

Signature! 

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Prudent Employee 

Signatuic;y5^'^--^ ^ 
s\n 

Fiudent Tedmologies, Inc. (Prudent) is under contract (Contract # EP-R7-08-07) witli the U. S. 

Binnxonmeotal Protection /^enc y (EPA) to stabilize Lead Bas^dLPaint .(L£P) at a numbeLof properties 

located in Omalia, Nebraska, including the property located at pf D ^>^av\ g { ^CivqU" 

The EPA requests yotir pennission to allow Prudent to perform LBP Stabilization at this property. By 

tigning tins form, tiie property owner grants permission to Prudent to perform activities related to LBP 

Stainlization including scraping paint and paintmg of the referenced property. Further, tiie owner/tenant 

verifies tiiat tiiey have received tiie LBP pamphlet **Renovate Right" 

If you have any questions about the LBP stabiUzation planned for your property, please contact Prudent^s 

/iit|pinfg»nifive Clerk for tiie Lead Based Paint Stabilization, Mrs. Deborah AkerdMnhMntii 

at (402) 504-1004. General questions about tiie Omaha Lead Site cleanup can be directed to tiie ^ A 

Public Infonnation Centers at (402) 731-3045 (Soutii Omaha ofitce) or (402) 991-9S83 (North Omaha 

°^^^ - A y - ^ 

rl>HIBllyAtBeilOlMlBdBy! 

(Please Print Name) 

<:*<55^ ^ yyy y/tTL.. 

Prapeiiy Omcr Signatora: 

^^A4 y ^ //F^Foy 

(SiSMtute) Cy (Date) 

PROPERTY INFORMATION 

(To be coaplcted bx itiidcnt ndAnr pnpcitr owBcr > pIcMe prist) 

RESIDENTNAME: '^ ^ >fe>V»/<^< / Owner ^ ^ 

RE8I0EN fe f7K 'T^y^^r Sr^^^Aa^yy T ADDRESS: 

IP RENTAL, PROPERTY OWNED «v. A/y^y/^ FS^yJ ^ 

OWNERrSTELEPHONENUMBER.HOME: i¥e?y7^/^!>Z73 S WORK; ( \ 

NUMBER OP OCCUPANTS UNDER 7 YEARS OLD: .JL . NUMBER OP OCCUPANTS 7 YEARS OLD AND OLDER: .J ^ 

NUMBER OPCHILDREN UNDERT YEARS OLD WHO PLAY IN THE YARD FOR 8 HOURS OR MORE PER WEEK: / 

COHMENTSORSPECIALINSTRUCnONS: (LE DOOS. ENTRY QATES. ETC.) 

AUniOnrr FOR EtwaU>NMBKrAL KESPONSB ACTIONS; Tlw wthrWet to be UnptemeaMly ^ 

of CBRCU. 43 UAC 9604. BPA'i right of aoeen to flw preperty bproWded Ibr ta Section 104(e) of CERCIJ^. 42 

Ar'^deleniMBi the need (br mpoBi^ or eboeeiiig ortricbv n y tctpenw 1 ^ 
Current Sample Pre-Renovation Fonn 

eriMiMuntn April 2010. 

ConflmHUQn of Receipt of Load Pamphlot 

1Sif\hBNet9e(t>iedaco(rfdlthef)ernriieil, Renovate fVghtlnyjo ^ 

haixrnibn1drFmBes,ChBdCaeProvkJer8andSchool8MarrrlDqme^ 

ths potantU ttak o( the leed hazard eMpootn (iforn renos«aon activity to t)e 

pettarwd In rty dwelling wItMieoeKwd this paniphlet beftye Ihe work begari. 

Printed name of recipient ^ Dote 

Signature of recipient FJ 

SeifOertWcadon Opttoit (for tenant-occupied dwoHlnge only) — 

If the lead parnphlet was delivered but a tenant algreture was not obtainable, 

you mey check the eppropriate box below. 

Q Refusal to sign—I certify that I have made a good MhelRxt to deliver the 

pemphlet, nenovale /%M : Inportant Lesd Hezerd brfomwtion for f^liee , 

CMkf Care Aodblers and SCfiooyis, to the rental dwelling unit 1 ^ 

date end time indcated and that the oocupant refused to 8lgn the confimiation 

of reoeipL I llvther oertuy that I have iell a copy of the pemphlet at the unit with 

ttieoooupant 

Q Unavailable Ibr signattva--1 certify that I have made a good faith eflbrt to 

dallvw ths pamphlet./?arx}v«ld nig/it: ArrportEnf testf/'^ ^ 

/^•98 ^ C W CSare protdblara and Sc/x)ofe, to the rental dwein^ 

below and that the occupant was unavailable to aign the confitrnation of receipt. 

llUlher certity that I have left a copy of the pamphlet at the unit by sliding it 

underthedoor. 

(^^cyrA^ C\y.vJv-^ ^ y\'U-o g /^»& 

Printed name cf perBon oeitiiying Attempted deHvoy 

dateandtime 

I y II A* ^ / lead pamphlet delivery 

Sfgna&jre of pereon certilying lead pamphlet ddnvery 

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IMtAddees 

Note Ragardins Maliing Option-> As an alternative to deBvery in person, you 

may mal 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 fjfom the 

postoffice). 
Mo O.^- - • w^e(T) 

paint match rferm: 

Paint matching form: _ ~ JN 

Property address:"^O \iuryw.( ^oX/d^ 

BVID: 51"^ 

Area: £.u , <..^^M. S>- - color: l'^ ., 

Explanation: 

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Explanation: 

Area: color: 

Explanation: 

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Area: color: 

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Doujias county, Nebraska Property Record - Rl72265000 0 

Information is valid as of 2008-9-4 

Print Repojrt 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of SOth St - Vig W pn.Ma p 

Trea_surer's Tax Report 

New Feature -» ^ -V Auto Sales Search 

Owner 

GOETZ MARK 

ETAL 

5634 PARKER ST 

OMAHA NE 68104-0000 

Propert y Informatio n 

Key Number: 2265 OOOO 17 

Account Type: Residential 

Parcel Number: 1722650000 

Parcel Address 815 TURNER BD 

OMAHA NE 68105-0000 

Legal Description: MAYNE PLACE LOT 25 BLOCK 1 S 36 FT 36 X 125 

Valu e Informatio n 

Land 

2008 

2007 

2006 

2005 

2004 

2003 

$5,400.00 

$5,400.00 

$5,400.00 

$5,400.00 

$5,400.00 

$5,400.00 

Improvement 

$61 

Total 

$61 

$72 

$72 

$72 

$72 

200,00 

200.00 

200.00 

200.00 

200.00 

200.00 

$66,600.00 

$66,600.00 

$77,600.00 

$77,600.00 

$77,600.00 

$77,600.00 

Sales Informatio n 

Sales Date: 2007-03-06 

Deed Type: WD j 

Price: $44,900.00 

Grantor: Western Financial 

Grantee: Qoetz Mark etal 

Valid/Invalid: Valid 

Exclusion Reason: 

Book: 2007 Page: \ 025408 

Sales Date: 2006-05-03 

Deed Type: WD j 

Price: $50,000.00 

Grantor: DAVID A THOMPSON ETAL 

Book: I 2006 1 Page: \ 050463 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17... 10/1/2008 
J-V/AlllCtllWl l Page 2 of 3 

oramee: WESTERN FINANCIAL LLC 

Valld/lnvalld: Valid 

Exclusion Reason: \ 

Land Information 

Acres 

0.1 

SF Units 

4500.0 1.0 

Depth 

125.0 

I VV/dtfi Vacant 

36.0 No 

Improvement Information 

Building 1 

iiS*'"!^ ' 

f'. -(-.^^Ai** 

iSeconcFlocr 

664 G &q t 

2 1f2 .STORY UI'sFINiSI-ED 

£irrn: Soc* « ft 

CLICK J O ENLARGE IMAGE 

CLICK TO ENLARGE IMAGE 

Square Footage: 

Perimeter 

Unit Type: 

Built As: 

HVAC: 

Exterior: 

interior: 

Roof Cover: 

Roof Type: 

Floorcover: 

1373.0 

0.0 

2 1/2 Story Unfin 

Forced Air 

Frame Siding 

Plaster 

Composition Shingle 

Gable 

Aliowance 

Percent Complete; 100.0% 

Quality: Average 

Condition: Good 

Condo Square Footage: 

Rooms: 

Units: 

Baths: 

Bedrooms: 

Stories: 

Foundation: 

Sprinkler Square Footage: 

0.0 

6.0 

1.0 

1.0 

3.0 

2.5 

Block 

0.0 

YearBuilt 

1900 

Year 

Remodeled 

Percent 

Remodeled 

0% 

Adjusted Year 

Built 

1900 

Physical Age 

107 

Detail Type 

Add On 

Appliance 

Basement 

Fixture 

Detail Description 

Unfinished Attic W/floor 

Allowance 

Bsmnt Block 8 ft 

Base Fixtures 

Units 

266.0 

1.0 

664.0 

1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.isp?accountno=R17... 10/1/2008 
Page 3 of 3 

Porch 

Porch 

Bnth Fu« 

End Solid Wall 

End Solid Wall 

i 

- - - -- - — -- —; -

1.0 

35.0 

140.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17... 10/1/2008 
Prudent Property Close-Out Form (Lead-Based Paint Stabilization) 

SAID: y t ^ ^ 

Property Address: %' I S '"1". ^ v- fN-F.v ^\y J 

Owner's Name: r^c-cV:. G ^ gA g— 

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, ail trim, porches, box 

beams, columns, rails, and exterior surfaces of garages. y 

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

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

^ 

A F 

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

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

thoroughly vacuumed/ cleaned? ^ ^ V 

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 other generated debris? >7 

Is the grass area that surrounds the structure(s) in reasonably good condition? 3 ^ ' 

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

properly removed? ^ > C. 

9. Is there any evidence of property damage that was done by the contractor? Any property damage 

needs to be completed prior to the EPA Close-Out. X 

10. Are there any property Items that were temporatiiy re-located by the contractor 

that need to be moved back? xr 

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

Other Considerations?property Owner Discussions?Additional Work that is Required 

Prudent Representative Signature 'ayZ.^f^y~t.A^-»y 

Date i ^ , '/ 3ol oy 

Property Owner Signature: ;^yF^ / 7^ 

Dat a• I^JZoJoli e 

>r