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

# SAI D #: ^IIXIS LDate : ^'^^0 ^

Add..ss : ^^02 ^ H ^ S ^ ^ Remediatio n Contractor : PROFESSIONA LENVIRONMENTALENGINEER S Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o ofpropert y (DVD ) Executiv e Sununar y 

# \y SignedAcces s Agreemen t fo r

subject propert y Painting Agreemen t D Settlemen t documentsJi.e. oment s (i.e. , fo r

danag e o

r to replac e plants , etc. ) Photograph s Satisfactor y restoratio n signed by Propert y Owne r 

# y Propert y close-out check lis t signed by EP A 

# y Propert y information fromDougla s Count y Assessor' s Office confumation tha t lea dpamphle t "Renovat e Right " wa s received by PO D D D



### Professiona l Envirorunenta l Engineer s Signatur e Dat e

^ EP A Signatur e ' T)at e 3005626 5 

# ilUH i Superfun d

## PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC . ''° ' Trllah t NEe's m "Providin g cost-effectiv e environmenta l solutions " ^ j^°^ | !2f"t!! ? ^Fax (402 ) 504-328 1 Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yRespons e



### LeadBas e Stabilizatio n Omaha , N e Clos e Ou t Report 200 9 SAID#3242 2 370 2 N 2 3 S t

•Date s worked : 07/1 3 t o 07/1 3 200 9 •Pr e propert y condition : Pain t o n propert y wa s in poo r conditio n wit hflakin g paint . All woo dsiding . Prio r damag e t o garag e door . •Problem s encountered : Complain t o f

trample dplant s an dmissin g downspou t on gutter . Pr e picture s indicat e downspou t wa s missin g prio r t o work . •Owne r request/concerns : Plants , downspouts . •Inspection/closeou t dates : Owne r signe d07/15 , EP A 07/14/0 9 N o issues .

# 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 " Fax(402 ) 504-328 1 Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yRespons e 

### EP A Close-Ou t For m (Lead-BasedPain t Stabilization EP A Contract EP-R7-08-06 ) SAID : 

# Z^y\^.^ ^ Propert y Address : 

# 3.ncr L A) . 21 ^ s- f Owner' s Name : ^'^'^V N 

### ^f\c\ts,«v-^ n 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 o f othe 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 . Were al l require darea s ofth e structure(s ) prime da s neede dan dpainte dwith tw o to p coats ? 

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

# y 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 grass are atha t surround 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 o f propert 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 . \ ^ 

### 10 . Ar e ther e an y property item s that wer e temporaril y re-locate db y th e contracto r tha t nee dt o b e move dback ? w ^ 

### 11 . Ar e ther e an y (known ) lingerin g issue s withth e property owner(s ) tha t hav e 

# y bee n lef t unresolved ? Othe r Considerations/Property Owne r Discussions/Additiona l Wor k

tha t i s Required :



### y^^hCO RSignatur e ' Dat e

# -4C^ - ^13" ^ 3©-7 3 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 " Fax (402 ) 504-328 1 Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yRespons e 

## Propert y Owne r

Close-Out For m (Lead-BasedPain t Stabilizatio n EP A Contract EP-R7-08-06 ) SAID : 

# 3;^w^^ ­

- Propert y Address : 

## 37<9 X A J 2Z S/ Owner'sName : 

## JJTs^i^x K T/qck.S^D/ 7 S/
- Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Was th e entir e structure(s ) paintedwit hthe exception ofth e stated , excluded areas ? Thi s wouldinclude paintin g of othe r

associatedfeature s including fascia , eaves , siding , all trim , porches , box beams , columns , rails , an dexterior surface s o f garages . 2 . Was all scraping an dothe r

preparatio n wor k

completedsatisfactorily ? 3 . Wer e all requiredarea s ofth e structiu"e(s ) primedas neededan dpainte dwit h tw o top coats ? 4 . Was the pain t product s utilize dequivalen t to a3 0 yea r

product/quality ? 5 . Ar e all ofth e area s wher e contaminatedmaterial s hav e been spille dthoroughly vacuumed / cleaned ? 6 . Didthe contractor collect/vacuumall falling an dscrapedpaint chip s on the entir e property , roadways , alleyways , publi c acces s area s an dals o remove an y othe r

generateddebris ? 7 . I s th e gras s are atha t surroimd s th e structure(s ) in reasonably goo dcondition ? 

# 2 8 . Ar e all item s suc ha s polyethylene sheeting , ladders , paint brushes , cones , barrie r

tape , etc . properl y removed ? 

# K 9 . Istherean y evidenceofpropert y damag e tha t was done by th e contractor ? An y propert y damag e need s to b e completedprior to th e EP A Close-Out . 

# P 10 . Ar e ther e an y propert y item s tha t wer e temporarily re-locate dby the contractor 

# } C tha t needto b e movedback ? 11 . Ar e ther e an y (known) lingering issue s wit hthe propert y owner(s ) tha t have bee n lef t unresolved ?

Propert y Owne r

Signatur e Dat e 

# ^yy ^ 7-y^-o p Professiona l En ' enta l Engineer s Representativ e Dat e^ % 

# CONSEN T FO RACCES S T O PROPERT Y OMAHA LEAD SIT EREMEDIA LACTIO N - LEAD-BASED PAIN T STABILIZATIO N PROPERT Y ID : 

### 2tol*-^0
- PROPER T Y ADDRESS : 3 700- ^ OWNE RNAlVffi : DAYTIMEPHONE : 

# ^syro^9 y CEL LPHO^fE : E-MAH. : (y\^n ^ 

# ^\^cyy^^ n OWNER' S ADD ! flES S I FDIFFERENT : TENANT' S NA ^IE I FAPPLICABLE : DAYTDVn : PHONE : CEL LPHONE : E-MAIL :

- Professiona l Environmenta l Engineers , Inc . (PE ) i s unde r contrac t (#EP-R7-08-06 ) wit hth e U.S . Environmenta l Protectio n Agenc y (EPA ) t o stabiliz e lea dbase dpain t (LBP ) o n residentia l 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 soi l cleanup s tha t ar e bein g performe db y EP A contractors . Pain t stabilizatio n activitie s will include : scrapin g o f cracke do r flakin g LB Pfro mstructures , applicatio n o f aprim e coa t an dtw o (2 ) coat s o f paint . Movin g part s o f vnndow s an ddoor s ar e no t include dan dwil l no t b e addressed . You r cooperatio n i s requeste di n givin g permissio n t o thi s EP A contracto r (PE ) t o ente r an dhav e acces s t o thi s propert y fo r th e purpos e o f stabilizin g lea d-base dpain t a s outline do n th e propert y identifie dabove . B y signin g thi s documen t I agre e t o allo w a n EP A contracto r t o conduc t asoi l cleanu p a t my propert y followin g completio n o f lead-base dpain t stabilization , if th e soi l cleanu p ha s no t alread y bee n performed . I understan dtha t th e stabilizatio n contracto r ca n no t provid e assurance s tha t th e soi l cleanu p contracto r will b e boun dto . I furthe r understan dtha t th e soi l cleanu p contracto r wil l mak e al l reasonabl e effort s t o addres s concern s tha t I , a s th e propert y owner , ma y hav e regardin g soi l cleanu p a t my property . 

# 7-/0- ? Signatur e o fPropert yOwne r/ Dat e I full y understan dtha t b y signin g thi s Consen t fo r Access , (1 ) thi s acces s wil l remai n i n effec t unti l th e wor k ha s bee n satisfactoril y completed , (2 ) tha t th e Propert y Owne r o r Tenant , i f applicable , wil l b e give n th e Housin g an dUrba n Developmen t (HUD ) an dEP A pamphlet , "Renovat e Right , Importan t Lea dHazar dinformatio n fo r Families , Da y Car e Providers , an d Schools" , (3 ) th e Propert y Owne r o r tenan t wil l remov e al l obstruction s fro msurface s t o b e painted , (4 ) will abid e b y healt han d safet y guidanc e provide db y EPA , (5 ) will allo w photograph y ofpropert y befor e an dafte r th e pain t stabilizatio n work , (6 ) wil l b e contacte db y aP Erepresentativ e approximatel y 4 8 hour s i n advanc e o f startin g work , (7 ) agre e no t t o obstruc t o r tampe r wit h an y ofth e LB P stabilizatio n actions , an d(8 ) wil l participat e i n fina l propert y inspectio n an dsig n th e Completio n Agreemen t an d Propert y Owne r Satisfactio n Survey . Shoul dyo u hav e an y question s abou t th e plane dLea dBased-Pain t stabilizatio n activitie s fo r you r property , pleas e contac t Professiona l Environmenta l Engineers , Inc . Projec t Manager , Willi e Cla y A t 402-504-4688 . Genera l question s abou t th e Omah a Lea dSit e cleanu p 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) . iniori ] Yes , I gran t acces s t o m yproper ^ an 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 0Ye s "Renovat e Righ t Importan t Lea d Informatio n fo rFamilies , Chil d give n th e pamphle t "Renovat e Right , Importan t Lea d Car e Providere , an d Schoois. " / informatio n forFamilies , Child e Car e Providere , an d Schoois. " Signatur e 1 / Dat e Signatur e Dat e SPECIA L INSTRUCTION S AN D CONSIDERATION S

## A 

# meWSmiiBLIimTOOij ^ F[^i#»IFi^ WM 

# mm T pmpmnfABemsi , 

# . 

# ?.no ^ A ) 

# o\^ ^ BVR ) DAH . PUUITftPEIIIIAIIBIITUyiOSCAPSiraTOiiRENOlIf ^ IF,YeSVimERE l N O 

## YES •

n o ^-V f YE S ^.— ' g^YgWHERE ;

PAIII T O N WMMVWra ^

DOORSl IQUNDAIIOl i SIDEMrAlJ ^

VISUA L DBSOOrnO N O P HIO>eRTY/flTOtfCniRg/flAiU>«i,(LE.) t



# sj^Ns^'^SoJ ^\ 

## PAIN TSTABILIZATIO N PRE-PROPERT Y PAIN TMATC H ASSESSMEN T PROPERTYADDRESS : 5^^ ^

U O 3' ^

^ DATE : BVID : ^^^^- ^

AREA(S ) TO B E PAINTED : HOUS E PROPER : COLOR : UJ^c ^ 

# -^y ^

HOUS E TRIM : 

### COLOR : CV^>ic h JlAjih/i U - ^ ^ GARAGE : COLOR :
GARAG E TRIM : _ COLOR :
PORCH : COLOR :
PORC H TRIM : COLOR : (COMPLET E AL L SECTION , YES , NO , O R NON-APPLICABLE )



### I 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 TCHANG E TH E ABOV E SELECTE D COLORS : PROPERT Y OWNE R SIGNATUR E P E ACCESO R SIGNATURE :

### 'Dougl ^ County Accoun t Informatio n Pag e 1 of 2 

# '_J ±

_ S3JA22 Dougla s County , Nebrask a Propert yRecor d - R201509000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabi e @ scal e 0-5 0 f t wes t o f 52n d S t - Vle W O P Ma P Informatio n i s vali d a s o f 2009-6-1 6 Treasurer' s Ta xRepor t Ne wFeatur e -•••- • Aut o Sale s Searc h Owne r JACKSO N ISAIA H ETA L 370 2 N 2 3 S T OMAH AN E 68110-000 0 

# u^i - u^<^ ^ Propert yInformatio n Ke yNumbe r 150 9 000 0 2 0 Accoun t Type : Residentia l Parce l Number : 201509000 0 Parce l Address : 370 2 N 2 3 S T OMAH AN E 68110-000 0 Lega l Description : PLAINVIE W LO T6 BLOC K1 2 5 0 X 12 4 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $7,000.0 0 $37,400.0 0 $44,400.0 0 200 8 $7,000.0 0 $37,400.0 0 $44,400.0 0 200 7 $7,000.0 0 $37,400.0 0 $44,400.0 0 200 6 $7,000.0 0 $37,400.0 0 $44,400.0 0 200 5 $7,000.0 0 $13,300.0 0 $20,300.0 0 200 4 $7,000.0 0 $12,100.0 0 $19,100.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t [.. . 0.1 4 6200. 0 1. 0 124. 0 50. 0 N o

Improvement Informatio n Buildin g 1



### http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo. j sp?accountno=R201.. . 7/9/200 9

### 'DouglEis County Accoun t Informatio n

CLIC KT O ENLARG E IMAG E Squar e Footage : 1416. 0 Perimete r 0. 0 Uni t Type :

BuiitAs : 2 Stor y HVAC : Force d Ai r Exterior : Fram e Sidin g Interior : Drywal l Roo f Cover : Compositio n Shingl e 

### Roo f Type : Hip/Gabl e Floorcover : Allowanc e Yea r Percen t Yea rBuil t Remodele d Remodele d 191 0 197 4 0 % Detai l Typ e Detai l Descriptio n Applianc e Allowanc e Basemen t Bsmn t Bloc k 8 ft Fixtur e Bas e Fixture s Fixtur e Bat h Ful l Garag e Detache d Porc h En d Scree n 

### Pag e 2 o f 2

3702t<23§t .
^SSS q f t ' 6 „ a ajji r a * 

### L- ni ) F n-s r M « J^s r '.StOT f

CLIC KT O ENLARG E IMAG E Percen t Complete : 100.0 % Quality : Fai r Condition : Averag e Cond o Squar e Footage : 0. 0 Rooms : 8. 0

Units : 1. 0 Baths : 1. 0 Bedrooms : 4. 0 Stories : 2. 0 Foundation : Bloc k Sprinl<le rSquar e Footage : 0. 0 Adjuste d Yea r Physica l Ag e Buil t 191 0 9 9 Unit s 1. 0 696. 0 1. 0 1. 0 308. 0 133. 0



### http://douglasne.mapping-online.com/DougIasCoNe/static/accountinfo.jsp?accountno=R201. . . 7/9/200 9PropertyAddres s StartDat e

Prim e (Gallons )

Pol y(Boxes ) Pain t (Color ) Pain t (Color ) Pain t (Color ) Pain t (Color ) Pain t (Color ) 

### J C Paintin g S" ^ 0^ 3 r 4 QL 3 ST " Dat e
^

—J ^ " " O S Complet e Date 

### Amoun t O f Prim e An d Pain t Use d



# : L ^^oht^P r Amoun t (Gallons ) 

# iS s n"^3LP i Amoun t (Gallons ) Amoun t (Gallons ) Amoun t (Gallons ) Amoun t (Gallons )

### PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC . REUNI6 N DIARI AD E SEGURIDA D Fecha ; . H ' (3-C>^ . Proyecto : Omah a Pain t Stabilizatio n Project Lugar : ^ Q O 2 - U ^ 3 S T Siti o d e Actividad : 'HlO' ^ ^- J ^-3 ^ Tareas Diarias ; I . ^<jrj^ y 2 . 3 . 

## fpo^^y^ Primordial/Peligro s Potenciales : 

## t4o-r . pft^) ^ 1 . 3 . 4 . 

### Herramienta s d e Trabajo : 

# 3.„_e^Ai-t e 2 . hrp*^/»=>- ? 

## 4. y^^A/^f^-^y^l _ Practica s de l Trabajo/Accione s Correctivas : 

# y}d=
- 3 . 4 . 

### Llamada s previas : 3 . 

# lll± ^ 2 . 4 . 

### Firm a d e Registr o de l Empieado : 3 . 

# 2. .(y^-6 r

Amcay^-zi^^-- . 4 . 5.3^0on a c4rgp.^-f e 6 . 8 . 

# 4^^^fc::=rp^4^^ ^ m a d e Salu d ySegurida d de l Siti o Fech a

## Professiona l Environmenta l Engineers , Inc . INTERVENCI6 N D E SEGURIDA D Nombr e de l Proyecto : .^" ^ C)'• ^ M 9- 3 ^T ^ Fech a d e l a Intervencion : M " " ^ i^ - O ' ^ Peligro s d e Salu d Primordial : _t-!O.T__DA ^ Preocupacione s Primordiale s d e H & S : Tarea s Diortas : I . ^Cjr^^ ^ 

### 2 . priO^.€v " 

# 3. __'9^rv k Equip o Usad o e n e l Luga rd e Traabjo : Casc o Dur o Escaler a Gafa s d e Segurida d A>-- ^ Elevadore s Zapato s i^ ^ GFC I jy ^ Guante s d e Trabaj o ^^^

_Chaleco s d e Segurida d * " Generadore s l yOtr o ly!^ ^ Equip o List o par a Respuest a d e Emergenci a a Disposiclo n Inmediata : Conduci rReuni6 n Diari a d e Segurida d ^•' ^ Estuch e d e Primero s Auxilio s j.^< y Procedimiento s d e Emergenci a ^^y Politic o d e Salu d ySegurida d d e l a Compani a ' - - ^ GFC I e n siti o ^^^^''''^ • Deficiencias : 

# Kl y
Accione s Corretivas : 

# A/i ^

Intetvenlory l AKCOLA S MO^f^lCS " Fecha ^ ^ ^ 13 ^ O ^ Superviso rde l ^\\\o . ry.a^y ^

fi^U^fjgi^ Fecha ; "H - 13 - O J