TRANSMITTAL OF OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: _3L3_S3_ _ Date; n'bj/iS.joacP, 

Address: ^l^O,J^ \/At4 ^ ^ 7 

LBP Stabilization Contractor: PRUDENT TECHNOLOGIES, INC. Year: 2009 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

y Video of property (DVD): Pre-Stabilization A rust-3taUllLi.atiuu Vidtua 

y Executive Summary 

y Signed Access Agreement Form 

y Advance Notice Form 

^ Pre-Stabilization Video Agreement Form 

y Access Tracking Form 

y Property Access Assessment Form 

y Neighbor Access Agreement Form 

y Paint Match Form 

y Pre-Stabilization Property Safety Assessment Form 

y Work-Site Hazards Analysis Checklist 

y Photographs: Pre-Stabilization Propertv Hazard Assessment Photographs 

y Douglas County Assessor Property information 

y Property Completion Agreement Form Signed by Property Owner 

D Property Close-Out Check List Signed By EPA 

Prudent Technologies, Inc. Signature Date 

44iU> "f/^y/f'lot . A Signature / Date 

30055426 iuni 

Superfund 
TECHNOLOGIES, INC 

Property Summary 

Date: 8/03/2009 | LBP STABILIZATION EPA CONTRACT EP-R7-08-07 | Month of: Aug 

Property Address; 2432 Vane St SAID #: 41353 

A. Executive Summarv; 

a. Issues Encountered: NONE 

b. Issues Resolved: NONE 

c. Unique Findings: NONE 

d. Other Relevant Information; 

i. Access Date: 7/10/2009 

ii. Work Began: 7/17/2009 

iii. Close-Out Date: 7/19/2009 

B. Enclosures; 

1. Pre-Stabilization Video 

2. Post-Stabilization Video 

3. Signed Access Agreement Form 

4. Advance-Notice Form 

5. Pre-Stabilization Video Agreement Form 

6. Access Tracking Form 

7. Property Access Assessment Form 

8. Neighbor Access Agreement Form 

9. Property Paint Match Form 

10. Pre-Stabilization Property Safety Assessment Form 

11. Work-Site Hazards Analysis Checklist 

12. Pre- Stabilization Property Hazard Assessment Photographs 

13. Douglas County Assessor Property Information 

14. Signed Property Completion Agreement Form 

15. Property Close-Out Check List Signed By EPA 
?'P3:sKrTM;7.B'i".scr3:32Jc;=t."iT r.::;-^,:r7--'^t,-,:rj,r:r;v' r;:-^^-^.^r-^-.-..'-•-••-.•v'^,. -.^r.-y-v.'.v*•••.-.:-r'-T^*:.':^.""^V".*V i -rr 

*R 

TECHNOLCXFIBS. INC. 

Prudent Technologies, Inc. (Prudent) is under contract (Contract # EP-R7-08-07) with the U. S. Environmental Protection 

Agency (EPA) to stabilize Lead Based Paint (LBP) at a number ofproperties located in Omaha, Nebraska, including the 

property located at l.f3 Z V'*'^*' 5-^ ^ 

The EPA requests your permission to allow Prudent to perfomi LBP Stabili2:ation at this property. By signing this form, the 

property owner grants permission to Prudent to perform activities related to LBP Stabilization including scraping paint and 

painting ofthe referenced property. Further, the owner/tenant verifies that they have received the LBP pamphlet "Renovate 

Right." 

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, ifthe soil cleanup has not already been performed. I understand that the stabilization contractor 

cannot provide assurances of which contractor will be bound to the soil cleanup. I further understand that the soil cleanup 

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

cleanup at my property. 

[l^fYes, Lhave read andunderstand the paragraph above. 

Signature of Property Owner 

Date 

Ifyou have any questions about the LBP stabilization planned for your property, please contact Pmdent's Customer 

Relations/Office Manager for the Lead Based Paint Stabilization, Mrs. Shannon Holt, at (402) 504-1004 or (402)812-0223. 

General questions about the Omaha Lead Site cleanup can be directed to the EPA Public Information Centers at (402) 731­

3045 (South Omaha office) or (402) 991-9583 (North Omaha office). 

Property Access Granted By: 

5^UtAKr»^e 5c^»o(?ar?/o ^ 

Please Brint Name) 

Property Owner Signature: 

(Signature) 

7 /io/of 

(Date) 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax:(816)363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
•mm 

TECHNOIOGIES. INC. 

PROPERTY INFORMATION 

(To be completed by resident and/or property owner — please print) 

RESIDENT NAME: Renter 

RESIDENT ADDRESS: jyfS^^i^^ ^ . 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

OWNER'S TELEPHONE NUMBER - HOME: (lioL'AiyrHi^oRK ( "<- W -^ ' l^ ^ ' ' WORK:: t^dLii'^^'^^'- CtrUC-\ i 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: / NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER: 

2^ 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHOM PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: i 

COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS, ENTRY GATES„ ETC.) / 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be implemented by EPA under this agreement are 

pursuant to Section 104 ofCERCLA, 42 U.S.C. 9604. EPA's right of access to the property is provided for in Section 104(e) ofCERCLA, 

42 U.S. C 9605(e), which provides entry for "detennining the need for response, or choosing or taking any response action under this title, or 

otherwise enforcing the provisions ofthe title." 

8080 Ward Parkway, Suite 405 2605 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816)363-3707 Fax: (402) 504-1005 Fax: (210)579-6577 
TECHNOLOGIES.] 

Advanced notice needed. 

After signing the access you allow Prudent to begin Lead Based 

Paint Stabilization. All Plants, weeds and any vehicles or items on 

open porch (enclosed porches will NOT be stabilized) must be 

removed prior to stabilization. All Pets must be out ofyard during 

stabilization. How much notice do you need to have above 

mentioned tasks completed? Ifyou are a landlord you will need to 

contact the tenant as Prudent Technologies will only inform you. 

Do you have any pets that reside in yard? i^<^ C /'^^^' ^^ c?^ ^ 

Notice needed: / i 

^ 

Number to call to give notice: 

Whom we are giving notice to: ^ 

Home Owner's Signature C^ 

8080 Ward Parkway, Suite 405 2505 N. 24*" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone:(816)363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816)363-3707 Fax: (402)504-1005 Fax:(210)579-6577 
TECHNOLOGIES. ] 

^ 

K S ^ 

PRE-STABILIZATION VIDEO FORM 

I UNDERSTAND THAT PRUDENT TECHNOLOGIES WILL BE COMING 

OUT TO SHOOT A PRE-STABILIZATION VIDEO AT MY PROPERTY. 

THE VIDEO IS JUST A TOOL USED TO DOCUMENT THE CURRENT 

PROPERTY STATUS/CONDITION. A POST VIDEO WILL ALSO BE 

SHOT PRIOR TO COMPLETION OF STABILIZATION. 

OWNERS NAME [piCc/ Q.*^JUL<if^M, J cM/>r^herrv-e* i ' 

PROPERTY ADDRESS ' 2/^JZ \A/vJe 5"/ 0^ ^ 

BVID/SAID: ^^'^6'X 

HOMEOWNERS SIGNATURE •izm. 

PRUDENT REPRESENTATIVE SIGNATURE: 

ANY CONDITIONS NEED TO BE AWARE OF BEFORE SHOOTING 

VIDEO: (I.E. PETS, NOTICE NEEDED): / ­

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax:(210)579-6577 
m 

TECHNOLOGIES,] 

ACCESS INFORMATION TRACKING SHEET 

BVID: A\^5 3 

PROPERTYADDRESS: 2^'b ^ Van e st . 

IX^C-M __5_^V26nb_e_t_oe_r_ Property Owned By: 

(If new property owner) 

Owners Phone No's: 

Home: Work: 

Cell : —^y . Fax: 

Access Contractor: ASW PDA MES PE Other (Prudent) 

DATE TIME ACCESSOR CONRACT DETAIL 

^\\0^o q \aprv \ ^<xr\\-eje-\. ^.Q coS ^ c^vaOiV ^ -NKeoe.\^^\^-^>oc>. \ 

Comments: 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone:(816)363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNOLOGIES.] 

Access Assessment Form: (Must be completed for every property. 

Information must be obtained from a property walk thru, not given 

by owner) 

Is the property stucco or asbestos? 

Ifyes, is any ofthe stucco or asbestos damaged or cracked? 

Mo 

Ifyes, stop as we can't stabilize this property. It requires special preparation 

techniques. It will be returned to EPA and they will assign at a later date. 

fviO 

Does this property require lots of scrapping? 

Does this property require a lift or scafiTolding to reach upper levels? 

Does this property have lots of plants or items in areas where painting is 

required? 

Does this property have any significant structural damage? 

^40 

Ifyes, EXPLAIN? 

tAO 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNOLOGIES. ] 

Does this property have a garage? 

Ifyes, describe location of garage. 

^;^^^Q JUaA .^.<^^-^M. 1^ ^ ^ 

Does this property have aluminum siding? \J ^-J^ r\ VTL.^ 

Ifyes, is it original factory finish or has it been painted over? 

Does this property have any other type of structural components? (I.e. roof 

shingles as siding)? 

i\30 

Ifyes, EXPLAIN? 

MO 

i'>) "b<=V<L\SIs this property vacant or occupied? 

JA 

Are there any pets at this property? 

r^i 

Are there any low hanging power lines? 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNOLOGIES, INC 

NEIGHBORHOOD PROPERTY ACCESS FORM 

IS THERE A NEIGHBORING PROPERTY THAT NEEDS TO BE ACCESSED ALONG 

WITH ASSIGNED PROPERTY TO COMPLETE STABILIZATION PROCESS? 

VJO 

IF IT IS, GET ACCESS FROM ALL REQUIRED NEIGHBORHOOD PROPERTIES. 

NO 

8080 Ward Parkway, Suite 405 2S05 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNOLOGIES, INC 

PAINT MATCHING FORM: 

TO BE FILLED OUT ONLY IF MATCHING COLOR 

PROPERTYADDRESS: 2^"b:X Vao ^ ^V 

BVID: Ml^G?) 

I UNDERSTAND SHERWIN WILLIAMS WILL MATCH MY CURRENT COLORS. 

Homeowner signature: 

8080 Ward Parkway, Suite 405 2505 N. 24'" Streat, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax:(816)363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
^"^' ^ 

TECHNOLOGIES.] 

PRE-STABILIZATION PROPERTY SAFETY ASSESSMENT FORM 

PROPERTYADDRESS: :x^'h ^ Vane . S ^ 

BVID/SAID: A 1-^53 

PRUDENT ASSESSMENT REPERSENTATIVE: 

******IF SAFETY RISK PROPERTY MUST BE TURNED OVER TO 

KATHY ROTHER BEFORE IT CAN BE ASSIGNED TO A CREW/SUB. 

REPERSENTATIVE REMARKS/FINDINGS: 

(POWER-LINE PROXIMITY TO PROPERTY, SCAFFOLDING/ LADDERS/ LIFTS 

NEEDED, UNSAFE AREAS, UNSAFE NEIGHBORHOOD...ETC.) 

REQUIRES K.ROTHER APPROVAL YES/NO 

SUBMITTED TO K.ROTHER ON: 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
• • 

TECHNOLOGIES, ] 

Checklist for the Worksite Hazard Analysis 

Address: CxC. f^^(^7~'^ 

Crew: Date: 

Item OK? Hazard Corrective Action f Overhead Lines 

In-transit Vehicle Clearance 

Levels around high wires y 

Vehicle Clearance around 

high wires when working 

y

Phone lines 

M 

Cable lines .A_ 

Gas Line 

Water Line 

Sewer Line 

Septic Tank 

Propane/Butane 

Access to/on Property Luti ^jiM. ' vkjuiyNeighbor Access Required >fc ^ 

High Traffic Area 

Garage 

Structures 

Driveway 

Sidewalk c<?f7ry-e-fKi;.^i:> s^-^U/rt^^ y < 

Foundation ^Lt -

Retaining Walls 

Fences ^hu^^ l S^Tnr^'ft^'--ry—^lJ±^L'^a^urv^v^p ^ 

Trees 

Foliage 

General Condition ofyard 

Daniaged Areas: sink 

holes/rotted wood 

Sprinkler System 

Pets 

Insects J-v^g^ fy*>^ j ^ i-u^J^^^ ^ 

Weather Conditions 

Unsafe driving conditions 

Unsafe neighborhood 

^ CAWJW - h4 ^ i ^ oJUL frv<^ 6u^W=^^ 

CrewJForeman/ Sub-Contractocj Officer 

^/JLK::^ 

8080 Ward Parkwl 405 2505 N. 24'" Street, Suite 308 242 Medical Drive, Saite.4250 

Kansas City, MO Omaha, Nebraska 68110 San Antonio, TX 78223 

Phone:(816)363-370 Phone: (402) 504-1004 Phone: (210)822-9588 

Fax:(816)363-3707 Fax: (402)504-1005 Fax:(210)579-6577 







Current Sample Pre-Renovation Form 

Effective until April 2010. 

Confirmation of Receipt of Lead Pamphlet 

^rVnave received a copy of the pamphlet, Renovate Right: Important Lead Hazard 

Information for Famiiies, Child Care Providers and Schools informing me of 

the potential risk of the lead hazard exposure from renovation activity to be 

performed in my dwelling unit. I received this pamphlet before the work began. 

Ji^T^z/nt J<^M£t^(:&rxc^ 

7//^A? 

Printed name of'fep^ient 

Date 

Signature of recipient 

Self-Certification Option (for tenant-occupied dwellings only) — 

If the lead pamphlet was delivered but a tenant signature was not obtainable, 

you may check the appropriate box below. 

• Refusal to sign — I certify that I have made a good faith effort to deliver the 

pamphlet, Renovate Right: Important Lead Hazard Information for Famiiies, 

Child Care Providers and Schools, to the rental dwelling unit listed below at the 

date and time indicated and that the occupant refused to sign the confirmation 

of receipt. I further certify that I have left a copy of the pamphlet at the unit with 

the occupant. 

• Unavailable for signature — I certify that I have made a good faith effort to 

deliver the pamphlet, Renovate Right: Important Lead Hazard Information for 

Families, Child Care providers and Schools, to the rental dwelling unit listed 

below and that the occupant was unavailable to sign the confirmation of receipt. 

I further certify that I have left a copy of the pamphlet at the unit by sliding it 

under the door. 

Printed name of person certifying Attempted delivery 

date and time 

lead pamphlet delivery 

Signature of person certifying lead pamphlet delivery 

Unit Address 

Note Regarding Mailing Option — As an alternative to delivery in person, you 

may mail 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 from the 

post office). 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

RcDC 

^^^^t.oc _

To: Tracy Schonberner 

From: Mr. Chandra Shekar 

Fax: 402-451-2847 

Pages: 1 + 

Phone: 402-451-2847 

Date: 7/8/09 

Re: 2432 Vane St, Omaha, NE 

Tracy: 

Prudent Technologies (Prudent) is EPA contractor for painting exterior of the houses in 

Omaha. Your property located at: 

• 2432 Vane St, Omaha, NE. 

is assigned to Prudent by EPA. We have to get your signature for accessing your 

property. Therefore, please call our office at 402-504-1004 to set up a meeting. A 

Prudent representative will: 

• come and visit with you at the property (2432 Vane St) 

• explain the scope of work and 

• will answer any questions you have 

Please note that EPA pays for painting your house. That means it is free for you. 

Sincerely, 

c Q O 3^- -

\i 

Mr. Chandra Shekar, P.E. ^< ^ 

Project Manager ^ -

P.S.: 

1. 

If you have any questions regarding 'EPA's Omaha Lead Based Paint 

Stabilization Program' please feel free to call: 

• EPA Public Information Center at 402-991-9583. 

You can reach Prudent representative Ranji on his cell phone: 402-212-6921 at 

anytime. 

8080 Ward Parkway, Suite 405 2505 N. 24*^ Street, Suite 218 4242 Medical Drive, Suite 7250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
Douglas County Account Inforn^ion Page 1 of2 rn^ c 

Douglas County, Nebraska Property Record - R1748200000 

Print Report 

MEW Foature - Parcel Dimensions availabie @ scale 0-50 ft west of 52nd St - Vle W Otl Ma p Information is valid as of 2009-6-16 Treasurer's Tax Report 

New Feature -^ -• -> Auto Sales Search 

Owner ^r/\A> 

SCHONBERNER TRACY D 

ETAL ^^ ^ i^A \>tAs3 

2432 VANE ST mJ W Ph: 

OMAHA NE 68112-0000 ' 

Property Informatio n 

Key Number

Account Type:

Parcel Number

Parcel Address:

Legal Description:

Value Informatio n 

' Land 

2009 '

2008 ;

2007

2006

2005 '

2004

Sales Informatio n 

Saies Date:

Deed Type:

Price:

Grantor: 

Grantee: 

Valid/Invalid:

Exclusion Reason:

Land Informatio n 

Acres SF

0.18

 : 4820 OOOO 17 

<(' ' 

< Residential 

 , 1748200000 

 2432 VANE ST 

OMAHA NE 68112-0000 

' MINNE LUSA LOT 6 BLOCK 1 W 1/2 LT 5 & ALL & ALL VAC READ ST ADJ ON W 

 $5,800.00 

 $5,800.00 

 $5,800.00 

 $5,800.00 

 $5,800.00 

 $5,800.00 

Improvement Total 

$119,600.00 $125,400.00 

$119,600.00 $125,400.00 

$100,300.00 $106,100.00 

$100,300.00 $106,100.00 

$100,300.00 $106,100.00 

$84,300.00 $90,100.00 

 1999-11-01 

D Book: 2137 Page: 426 

 $24,750.00 

 invalid 

 Sale by Govt Agency 

 Units ' Depth Width Vacant 

 8170.0 1.0 86.0 95.0 No 

Improvemen t Informatio n 

http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R174... 7/7/2009 
-;ti.;T;,:t„ • ;,:r:. ^M^t»ii./'J#^imi.^'.-..^^;S!(:'.if;f-.. 

Douglas County Account Infonj^|io n|^|i n Page 2 of2 c 

Building 1 

2*^2 vane SJt 

Ranch 

.rS!!!"J'», 

Tfrf* r;** "Cf: : ^ f I 

CjLICK TO ENLARGE IMAGE 

Square Footage: 1728.0 Percent Complete: 100.0% 

Perimeter ; 0.0 Quality: Average 

Unit Type: Condition: Average 

Built As: Ranch Condo Square Footage: 0.0 

HVAC: ^ Central Air to Air Rooms: 6.0 

Exterior: Franne Siding Units: 1.0 

Interior: Drywall Baths: 3.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.0 ...j... 

Floorcover: Allowance Foundation: | Block 

Sprinkler Square Footage: i 0.0 

Year Percent Adjusted Year YearBuiit Physical Age Remodeled Remodeled Built 

1920 0 0% 1920 88 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Appliance Fireplace Masonry 2.0 

Basement Bsmnt Block 8 ft 1728.0 

Basement Finished 1000.0 

Fixture Additional Fixtures 1.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full „ 3.0 

Garage Attached 200.0 

Porch Open Slab 322.0 

Porch Slab Roof Ceil 80.0 

http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R174... 7/7/2009 
• • 

TECHNOLOGIES, INC. 

Prudent Property Close-Out Form (Lead-Based Paint Stabilization) 

SAID: ^/2>5 Z 

Property Address: ^H'i' l \/^XALC^ ^JT ' 

Owner's Name: / n/ua,J Sa^A/Z^svgfleir 

S.NO 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. A 1 

2 Was all scraping and other preparation work completed 

satisfactorily? / 

3 Were all required areas of the structure(s) primed as needed and 

painted with two top coats? J 

4 Are all of the areas where contaminated materials have been spilled 

thoroughly vacuumed/ cleaned? / 

5 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? y 

6 Is the grass area that surrounds the structure(s) in reasonably good 

7 

condition? 

Was the paint products utilized equivalent to a 30 year 

/ 

product/quality? i / 

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

cones, barrier tape etc properly removed? 1/ 

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? y 

11 

12 

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 

y 

A 

Prudent Representative Signature •A y 

Date 

Property Owner Signature:-<rjJ^;^t<n<j6^>t.4/^>''^ 

Date 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, WIO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone:(816)363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816)363-3707 Fax: (402)504-1005 Fax: (210) 579-6577