TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID #: ^IIXISL Date: ^'^^0 ^ 

Add..ss: ^^02 ^ H ^ S ^ ^ 

Remediation Contractor: PROFESSIONAL ENVIRONMENTAL ENGINEERS Year: 2009 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video ofproperty (DVD) 

Executive Sununary 

\y Signed Access Agreement for subject property 

Painting Agreement 

D 

Settlement documentsJi.e. oments (i.e., for danage orto replace plants, etc.) 

Photographs 

Satisfactory restoration signed by Property Owner 

y Property close-out check list signed by EPA 

y Property information from Douglas County Assessor's Office 

confumation that lead pamphlet "Renovate Right" was received by PO 

D 

D 

D 

Professional Envirorunental Engineers Signature 

Date 

^ EP A Signature ' T)ate 

30056265 

ilUHi 

Superfund 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. ''° ' Trllaht NEe'sm 

"Providing cost-effective environmental solutions" ^ j^°^| !2f"t!!? 

^ Fax (402) 504-3281 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

2009 

SAID# 32422 

3702 N 23 St 

• Dates worked: 07/13 to 07/13 2009 

• Pre property condition: Paint on property was in poor condition with flaking paint. All 

wood siding. Prior damage to garage door. 

• Problems encountered: Complaint of trampled plants and missing downspout on 

gutter. Pre pictures indicate downspout was missing prior to work. 

• Owner request/concerns: Plants, downspouts. 

• Inspection/closeout dates: Owner signed 07/15, EPA 07/14/09 No issues. 
PROFESSIONAL 

2505 North 24% Suite 219 ENVIRONMENTAL ENGINEERS, INC. Omaha, NE 68110 

(402) 504-4688 "Providing cost-effective environmental solutions" Fax (402) 504-3281 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

EPA Close-Out Form 

(Lead-Based Paint Stabilization EPA Contract EP-R7-08-06) 

SAID: Z^y\^.^^ 

Property Address: 3.ncrL A). 21 ^ s-f 

Owner's Name: ^'^'^V N ^f\c\ts,«v-^n 

Performance Standards/Close-Out Criteria YES NO 

1. Was the entire structure(s) painted with the exception ofthe stated, excluded 

areas? This would include painting of other associated features including fascia, 

eaves, siding, all trim, porches, box beams, columns, rails, and exterior surfaces of y garages. 

2. Was all scraping and other preparation work completed satisfactorily? y 

3. Were all required areas ofthe structure(s) primed as needed and painted with 

two top coats? \y 

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

5. Are all ofthe areas where contaminated materials have been spilled thoroughly 

vacuumed/ cleaned? y 

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 y other generated debris? 

7. Is the grass area that surrounds the structure(s) in reasonably good condition? y 8. Are all items such as polyethylene sheeting, ladders, paint brushes, cones, 

barrier tape, etc. properly removed? y 

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. \ ^ 

10. Are there any property items that were temporarily re-located by the contractor 

that need to be moved back? w ^ 

11. Are there any (known) lingering issues with the property owner(s) that have 

y been left unresolved? 

Other Considerations/Property Owner Discussions/Additional Work that is Required: 

y^^ h COR Signature ' Date 
-4C^ - ^13" ^ 3©-7 3 

PROFESSIONAL 

2505 North 24% Suite 219 ENVIRONMENTAL ENGINEERS, INC. Omaha, NE 68110 

(402) 504-4688 "Providing cost-effective environmental solutions" Fax (402) 504-3281 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Property Owner Close-Out Form 

(Lead-Based Paint Stabilization EPA Contract EP-R7-08-06) 

SAID: 3;^w^^­ - Property Address: 37<9X AJ 2 Z S/ 

Owner'sName: JJTs^i^xK T/qck.S^D/7 S/-

Performance Standards/Close-Out Criteria YES NO 

1. Was the entire structure(s) painted with the exception ofthe stated, excluded 

areas? This would include painting of other associated features including fascia, 

eaves, siding, all trim, porches, box beams, columns, rails, and exterior surfaces of 

garages. 

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

3. Were all required areas ofthe structiu"e(s) primed as needed and painted with 

two top coats? 

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

5. Are all ofthe areas where contaminated materials have been spilled thoroughly 

vacuumed/ cleaned? 

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 surroimds the structure(s) in reasonably good condition? 2 

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

barrier tape, etc. properly removed? K 

9. Isthereany evidenceofproperty damage that was done by the contractor? Any 

property damage needs to be completed prior to the EPA Close-Out. P 

10. Are there any property items that were temporarily re-located by the contractor }C that need to be moved back? 

11. Are there any (known) lingering issues with the property owner(s) that have 

been left unresolved? 

Property Owner Signature Date 

^yy^ 7-y^-op 

Professional En' ental Engineers Representative Date 
^ % 

CONSENT FOR ACCESS TO PROPERTY 

OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID: 2tol*-^0 - PROPERT Y ADDRESS: 3 700-^ 

OWNER NAlVffi: 

DAYTIME PHONE: ^syro^9y 

CELL PHO^fE: E-MAH.: (y\^n ^ ^\^cyy^^n 

OWNER'S ADD! flESS IF DIFFERENT: 

TENANT'S NA^ IE IF APPLICABLE: 

DAYTDVn : PHONE: 

CELL PHONE: E-MAIL: -

Professional Environmental Engineers, Inc. (PE) is under contract (#EP-R7-08-06) with the U.S. Environmental Protection 

Agency (EPA) to stabilize lead based paint (LBP) on residential structures at a number of properties located in Omaha, 

Nebraska. The paint stabilization work is being done to protect the soil cleanups that are being performed by EPA contractors. 

Paint stabilization activities will include: scraping of cracked or flaking LBP from structures, application of a prime coat and two 

(2) coats of paint. Moving parts of vnndows and doors are not included and will not be addressed. 

Your cooperation is requested in giving permission to this EPA contractor (PE) to enter and have access to this property for the 

purpose of stabilizing lead -based paint as outlined on the property identified above. 

By signing this document I agree to allow an EPA contractor to conduct a soil cleanup at my property following completion of 

lead-based paint stabilization, if the soil cleanup has not already been performed. I understand that the stabilization contractor 

can not provide assurances that the soil cleanup contractor will be bound to. I further understand that the soil cleanup 

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

my property. 

7-/0- ? 

Signature of Property Owner / Date 

I fully understand that by signing this Consent for Access, (1) this access will remain in effect until the work has been 

satisfactorily completed, (2) that the Property Owner or Tenant, if applicable, will be given the Housing and Urban Development 

(HUD) and EPA pamphlet, "Renovate Right, Important Lead Hazard information for Families, Day Care Providers, and 

Schools", (3) the Property Owner or tenant will remove all obstructions from surfaces to be painted, (4) will abide by health and 

safety guidance provided by EPA, (5) will allow photography ofproperty before and after the paint stabilization work, (6) will be 

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

any ofthe LBP stabilization actions, and (8) will participate in final property inspection and sign the Completion Agreement and 

Property Owner Satisfaction Survey. 

Should you have any questions about the planed Lead Based-Paint stabilization activities for your property, please contact 

Professional Environmental Engineers, Inc. Project Manager, Willie Clay At 402-504-4688. General questions about the Omaha 

Lead Site cleanup can be directed to Pauletta France-Isetts, EPA Remedial Project Manager 402-731-2454, or the EPA Public 

Information Centers at 402-991-9583 (North Omaha office) or 402-731-3045 (South Omaha office). iniori] 

0YeYess , I grant access to my proper^ and was given the pamphlet D No, I do not grant access to my property and I was 

"Renovate Right Important Lead Information for Families, Child given the pamphlet "Renovate Right, Important Lead 

Care Providere, and Schoois." / information for Families, Childe Care Providere, and Schoois." 

Signature 1 / Date Signature Date 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
A meWSmiiBLIimTOOij^ F[^i#»IFi^W M mmT 

pmpmnfABemsi, . ?.no^ A) o\^ ^ 

BVR) 

DAH. 

PUUITftPEIIIIAIIBIITUyiOSCAPSiraTOiiRENOlIf ^

IF,YeSVimEREl 

 NO YES • 

no ^-Vf YES ^.—' g^YgWHERE; 

PAIIIT ON WMMVWra^ DOORSl IQUNDAIIOli SIDEMrAlJ^ 

VISUAL DBSOOrnON OP HIO>eRTY/flTOtfCniRg/flAiU>«i,(LE.)t 

sj^Ns^'^SoJ^ 
\ 

PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

PROPERTYADDRESS: 5^^ ^ U O 3' ^ ^ DATE: 

BVID: ^^^^- ^ 

AREA(S) TO BE PAINTED: 

HOUSE PROPER: COLOR: UJ^c ^

-^y^ 

HOUSE TRIM: COLOR: CV^>ich JlAjih/iU 

- ^ ^ 

GARAGE: COLOR: 

GARAGE TRIM: _ COLOR: 

PORCH: COLOR: 

PORCH TRIM: COLOR: 

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

I AGREE TO THE COLORS LISTED ABOVE. ONCE THE PAINTING 

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

PROPERTY OWNER SIGNATURE PE ACCESOR SIGNATURE: 
'Dougl^ County Account Information Page 1 of2 

'_J ±_ S3JA22 

Douglas County, Nebraska Property Record - R2015090000 

Print Report 

NEW Feature - Parcel Dimensions availabie @ scale 0-50 ft west of 52nd St - Vle W OP Ma P Information is valid as of 2009-6-16 Treasurer's Tax Report 

New Feature -•••- • Auto Sales Search 

Owner 

JACKSON ISAIAH 

ETAL 

3702 N 23 ST 

OMAHA NE 68110-0000 u^i- u^<^^ 

Property Informatio n 

Key Number 1509 0000 20 

Account Type: Residential 

Parcel Number: 2015090000 

Parcel Address: 3702 N 23 ST 

OMAHA NE 68110-0000 

Legal Description: PLAINVIEW LOT 6 BLOCK 12 50 X 124 

Value Informatio n 

Land Improvement Total 

2009 $7,000.00 $37,400.00 $44,400.00 

2008 $7,000.00 $37,400.00 $44,400.00 

2007 $7,000.00 $37,400.00 $44,400.00 

2006 $7,000.00 $37,400.00 $44,400.00 

2005 $7,000.00 $13,300.00 $20,300.00 

2004 $7,000.00 $12,100.00 $19,100.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

[... 0.14 6200.0 1.0 124.0 50.0 No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.j sp?accountno=R201... 7/9/2009 
'DouglEis County Account Information 

CLICK TO ENLARGE IMAGE 

Square Footage: 1416.0 

Perimeter 0.0 

Unit Type: 

BuiitAs: 2 Story 

HVAC: Forced Air 

Exterior: Frame Siding 

Interior: Drywall 

Roof Cover: Composition Shingle 

Roof Type: Hip/Gable 

Floorcover: Allowance 

Year Percent Year Built Remodeled Remodeled 

1910 1974 0% 

Detail Type Detail Description 

Appliance Allowance 

Basement Bsmnt Block 8 ft 

Fixture Base Fixtures 

Fixture Bath Full 

Garage Detached 

Porch End Screen 

Page 2 of 2 

3702t<23§t. 

^SSSq f t 

' 

6„ 

aa jjir 

a * L- ni) 

F n-sr 

M « 

J^sr 

'.StOTf 

CLICK TO ENLARGE IMAGE 

Percent Complete: 100.0% 

Quality: Fair 

Condition: Average 

Condo Square Footage: 0.0 

Rooms: 8.0 

Units: 1.0 

Baths: 1.0 

Bedrooms: 4.0 

Stories: 2.0 

Foundation: Block 

Sprinl<ler Square Footage: 0.0 

Adjusted Year Physical Age Built 

1910 99 

Units 

1.0 

696.0 

1.0 

1.0 

308.0 

133.0 

http://douglasne.mapping-online.com/DougIasCoNe/static/accountinfo.jsp?accountno=R201... 7/9/2009 
PropertyAddress

StartDate

Prime (Gallons) 

Poly (Boxes) 

Paint (Color) 

Paint (Color) 

Paint (Color) 

Paint (Color) 

Paint (Color) 

JC Painting 

 S" ^ 0^ 3 r 4 QL 3 ST " Date 

^ — J ^ "" O S Complete Date 

Amount Of Prime And Paint Used 

:L 

^^oht^Pr 

Amount (Gallons) iSs 

n"^3LPi 

Amount (Gallons) 

Amount (Gallons) 

Amount (Gallons) 

Amount (Gallons) 
PROFESSIONAL ENVIRONMENTAL ENGINEERS, INC. 

REUNI6N DIARIA DE SEGURIDAD 

Fecha; . H ' (3-C>^ . 

Proyecto: Omaha Paint Stabilization Project 

Lugar: ^ Q O 2 - U ^ 3 S T 

Sitio de Actividad: 'HlO' ^ ^-J ^-3 ^ 

Tareas Diarias; 

I. ^<jrj^ y 

2. 

3. fpo^^y^ 

Primordial/Peligros Potenciales: 

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

4. 

Herramientas de Trabajo: 

3.„_e^Ai-te 

2. hrp*^/»=>-? 4. y^^A/^f^-^y^l _ 

Practicas del Trabajo/Acciones Correctivas: 

y}d=- 3. 

4. 

Llamadas previas: 

lll±^ 3. 

2. 4. 

Firma de Registro del Empieado: 

3. 

2. .(y^-6r Amcay^-zi^^--. 4. 5.3^0ona c 4rgp.^-fe 6. 

8. 

4^^^fc::=rp^4^^^ 

ma de Salud y Seguridad del Sitio Fecha 
Professional Environmental Engineers, Inc. 

INTERVENCI6N DE SEGURIDAD 

Nombre del Proyecto: .^" ^ C)'•^ M 9- 3 ^T ^ 

Fecha de la Intervencion: M "" ^ i^ - O '^ 

Peligros de Salud Primordial: _t-!O.T__DA ^ 

Preocupaciones Primordiales de H & S: 

Tareas Diortas: I. ^Cjr^^ ^ 

2. priO^.€v" 

3. __'9^rvk 

Equipo Usado en el Lugar de Traabjo: 

Casco Duro Escalera 

Gafas de Seguridad A>--^ Elevadores 

Zapatos i^ ^ GFCI jy ^ 

Guantes de Trabajo ^^^_ Chalecos de Seguridad *" 

Generadores l y Otro ly!^^ 

Equipo Listo para Respuesta de Emergencia a Disposiclon Inmediata: 

Conducir Reuni6n Diaria de Seguridad ^•' ^ 

Estuche de Primeros Auxilios j.^< y 

Procedimientos de Emergencia ^^ y 

Politico de Salud y Seguridad de la Compania '- -^ 

GFCI en sitio ^^^^''''^• 

Deficiencias: Kly 

Acciones Corretivas: A/i ^ 

Intetvenloryl AKCOLA S MO^f^lCS " Fecha ^ ^ ^ 13 ^ O ^ 

Supervisor del ^\\\o. ry.a^y ^ fi^U^fjgi^ Fecha; "H - 13 - O J