### TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL EFOLDE R SAID# : 236^ 4 Date : 7^% ^ f Address : ^^312 . (IctS S S f Remediatio nContractor : PROFESSIONA LENVIRONMENTALENGDVEERS Year : 200 8 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S M Vide o o f propert y (DVD ) US ' Executiv e Simimar y M SignedAcces s Agreemen t fo r

subject propert y ^ Paintin g Agreemen t D Settlemen t document s (i.e. , fo r

damag e or t o replac e plants , etc. ) M Photograph s 'Q

l Satisfactor y restoratio n signedb y Propert y Owne r M Propert y close-out check lis t signe db y EP A WPropert y information fromDougla s Coimt y Assessor' s OfGc e



# i^d^250 5 Nort h 24 ^ Suit e 21 9 Omaha , N E 6811 0 (402 ) 504-468 8 Fa

x(402 ) 504-328 1 

# 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



### Lea dBas e Stabilizatio nOmaha , N e Clos e Ou t Repor t SAID #2384 4 431 2 Cas s S t

•Date s worke d03/2 4 t o 03/2 5 200 9 •Hous e hadmostl y sidin g an dth e front porc hwa s painte da s wel l a s th e windo w trims , pain t o n porc hwa s very poo r an dflakin g off . Garag e wa s als o painte dan dwas als o i n poo r conditio n withflaking paint . • Inspecte d04/2 2 N o issue s

# 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 : r;??)g W Property Address : ^317 2 C/^S> 5 -^ ^ Owner' s Name : LjQui^ J A ^ Mg^T&i^g / 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 nofth 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 garages . 2 . Wa s al l scrapin g an dothe r preparatio nwor k

complete dsatisfactorily ? 

# i ^ 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 yea r product/quality ? 5 . Ar e al l ofth e area s wher e contaminate dmaterial s hav e bee nspille dthoroughl y 

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

# y othe r generate ddebris ? 1 . I s th e gras s are athat surround s th e structure(s ) i nreasonabl y goo dcondition ? 8 . Ar e al l item s suc ha s polyethylen e sheeting , ladders , pain t brushes , cones , 

# y barrie r tape , etc . properl y removed ? 9 . I s ther e any evidenc e ofpropert y damag e that was don e b y th e contractor ? An y 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 were 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 ) that hav e bee nlef t unresolved ? Comments :

PrtJ^ert y Owe r Signatur e 

## J> ' /^-^ f Professional Environmenta l Engineer s Representativ e Date

# 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 Form (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) SAID : 

# ai^^^ ^ Property Address : Owner' s Name : Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entire structure(s ) painte dwithth e exceptio nofth 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 / 

### garages . 2 . Wa s al l scrapin g an dothe r preparatio nwor 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 . Are al l ofth e area s wher e contaminate dmaterial s hav e bee nspille dthoroughl y vacuumed / cleaned ? 

# y 6 . Di dth e confractor collect/vacuu mal l fallin g an dscrape dpain t chip s o nth e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e any othe r generate ddebris ? / 

### 7 . I s th e gras s are athat surround s th e structure(s ) i n reasonabl y goo dcondition ? / 

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

### 9 . I s ther e an y evidenc e ofpropert y damag e that wa s 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 . Are ther e an y property item s tha t wer e temporaril y re-locate db y th e confracto r that nee dt o b e move dback ? 

# y 11 . Are ther e an y (known ) lingerin g issue s wdt hth e propert y owner(s ) tha t hav e bee nlef t unresolved ? Othe r Considerations/Property Owne r Discussions/Additiona l Wor k

that i s Required :



# d6J,/fy..^y!.K^<.J^t£t ^ 

# "^h^fo i P A CO RSignature

## CONSEN T OF RACCES S T O PROPERT Y OMAH A LEA D SIT EREMEDIA LACTIO N - LEAD-BASE D PAIN T STABILIZATIO N PROPERT Y ID : ^2::>bi- ^ PROPERT Y ADDRESS : 

## ^Si Zc^^ ^ ^ OWNE RNAME : ly(XA/ t XuiK^/^jr^r y DAYTIM EPHONE : 33"< ^ " 9<^ ^ ^ CELLPHONE : {^oj ) ^^^-^OG ^ E-MAIL : 5"/ ^ " 6 7? / OWNER' S ADDRES S I FDIFFERENT : 

## ^32occ<y^ S s/ r TENANT' S NAM EI FAPPLICABLE : DAYTIM EPHONE : CEL LPHONE : E-MAIL : Professiona l Environmenta l Engineers , Inc . (PE ) i s unde r contrac t (#EP-R7-08-06 ) witi i tli e U.S . Environmenta i 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 din Omaha , Nebraslta . Tli 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 wer e performe db y EP A contractors . Pain t stabilizatio n activitie s wil l include : scrapin g o f cracke do r flakin g LB Pfro mstructures , applicatio n o f aprim e coa t an d tw o (2 ) coat s o f paint . Thi s progra mi s fre e an dn o cos t wil l b e incurre db y propert y owner . Movin g part s o f window s an d door s ar e no t include dan dwil l no t b e addressed . You r cooperatio n i s requeste dingivin 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 . I understan dtha t th e stabilizatio n contracto r ca nno t provid e assurance s tha t th e soi l cleanu p contracto r wil l 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 m y property . I fully understan dtha t b y signin g thi s Consen t fo r Access , (1 ) thi s acces s wil l remai n in 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 , if 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 nfo r Families , Day Car e Providers , an dSchools" , (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 ) wil l abid e b y healt han dsafety guidanc e provide db y EPA , (5 ) wil l 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 in advanc e o f startin g work , (7 ) agre e no t t o obstruc t o r tampe r wit han y ofth e LB Pstabilizatio nactions , an d(8 ) wil l participat e in fina l propert y inspectio nan d sig n th e Completio n Agreemen t an dPropert 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 aLea 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) . 1 ^

Yes , 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 Right , 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 ProvldeK , an d Schpols. " Informatio n fo rFamilies , Child e Car e Providers , an d Schools. " Signatur e VJ Dat e Signatur e Dat e SPECIA L INSTRUCTION S AN D CONSIDERATION S

### 0@oi]lfoEr[nii]i!to@[ff l ©f f [i(i(g©op t © f L(iiid ] FaoiiTipCiDdi t

PROPERT YADDRES S OF OWNE R IF DIFFEREN TTHA N PROPERT YBEIN G PAINTED : PROPERT YADDRES SZI P COD E hav e receive d a copy of th e pamphlet , Renovat e l^ght : Importan t L@a d H§mr d Informatio n Fo rFamilies , Chil d Car e Providw s An d School s informin g meof th e potentia l risk of th e lead hazar d exposur e fro m renovatio n activit y

to be performe don dwellin g unit . I receive d thi s pamphle t t)efor e th e vrar k

t)egan .

L' HAT I PRINTE D NAM E OF RECIPIEN T.^ OAT E 

# y

CsiGNATUREOFRECin E

Self-Certificatio n Optio n (Fo rTenant-Occupie d Dweliing s Only ) If th e lea d pamphle t was delivere d bu t a tenan t signature was no t obtainable , yo u ma ychec k th e appropriate bo x below : I J Refusa l To Sig n - 1 certif ythat I hav e mad e a goo d fait h effor tto delive rtti e pamphlet , renovat e right: importan t lead hazar d informatkM i fo rfamilies , chik l car e provider s an d schools ; to th e renta l dwellin g uni t liste d abov e at th e dat e an d tim e Indicate d an d that th e occupan t refuse d to sig n th e confirmatio n of receipt . I fiirthe rcertif ytha t I hav e lef t a cop y

of th e pamphlet at th e uni t wit h occupant . Ll Unavailabl e Fo rSignatur e - 1 certif ythat I hav e mad e a goo d fait h effor t to delive rth e pamphlet , renovate right; importan t lead hazar d infonnatio n forfamilies , chil d care provkler s an d schools , to th e renta l dwellin g uni t liste d belo wan d tha t th e occupan t was unavailabl e to sig n th e confimiatb n of receipt . I furthe rcertif ytha t I have lef t a cop y

of th e pamphle t at th e uni t byslidin g it unde rth e doo r orsomewher e on th e premises .

PRMTE O NAM E O F F PERSO N CERTIFYM G EO PER I AHEMPTE O DELIVER YDAT E AN D TIM E LEA D PAMPHLE TDELIVER Y 

# y\\ \

"^'r^^/KcU- ' ToRP E SIGNATUR E OFyPERSO N CERTIFYIN O LEA D PAMPHLE TDELIVERY : Isgirdiei g filin g Op& m - as an aHemativ e

to deliver y

in person , yo u ma ymai l th e lea d pamphle t to th e owne r aiid/o rtenarit Pamphte S mus t te maii©i: l at teasi 7 daj ^ tefore iinorata . (Documen t wdJ h a csrtitoi ®

ofmailin g fro m the pos t

CONFIPxMATlO W

OF RECEIP TOFLEA D PAMPHLE T08/0 8

# pmm'BTimmmjm M PREyM@PEm Y mBEBBmwm

DATl BVI D 

# Z3^H 4
PLAN T& PERMANEN Tyi^DSCAPie<«©T ®

B E REMOVE ? N O n> n 

## YE S 

## r n IF , YE S WHERE : 

# 1 . '. ! 

### PRE-EmnN G CONDmO N O F FOUNDATION/STRUCTUR E i.e . BASEMEN TLEAKING ? | N O ^^^- ^ YE S ' ' IF , YE S WHERE :

EXISTIN G PAIN TO N WINDOW^ , DOORS , FOUNDATION , SIDEWALK, ( LE.) ? N O CI } YESl ^ IF , YE S WHERE :

VISUA L DESCRIPTIO N O F PROPERTY/STRUCniRE/GARAGE , (LE.) : (US E BAC KSID E I F NECESSARY )

# .ft.-* •

• S^f^'; ! 

# pmm i mmc u mBEBBME m

^^^H M BVI D 

### AREA(S ) T O B i PAINUD s HOUS EPROPERS ____ _ COLO R 

## So ^ HOUS ETRI M COLO R

GARAGE . COLO R

GARAG ETRIM . .GOLOR^

PORCH . .GOUM L


### 3c&'T^-^ — PORCHTRIM . .COLOR . (COMPLET EAL LSECTION , YES , NO , OR) NON-APPUCABLE ) 

# I AGRE E T O TH E COLOR S USTE D ABOVE . ONC E PAINTIN G BEGIN S I UNDERSTAND I CA NNO T CHANG E TH E ABOV E SELECTE D COLORS :JiS!^ . j^cM i 

### Dougla s County Accoun t Informatio n Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R201840000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t of 90t h S t - VIS W O n Ma p Informatio n i s vali d a s o f 2008-9- 4 Treasurer' s Ta xRepor t Ne wFeatur e -•->« • Aut o Sale s Searc h 

### Owne r RUTHERFOR D DAV ] 432 0 CAS S S T 

### 5"SG-°{C)CP ^ OMAH AN E 681 3 Propert yInformati o Ke yNumber : 184 0 000 0 2 0 Accoun t Type : Residentia l Parce l Number : 201840000 0 Parce l Address : 431 2 CAS S S T OMAH AN E 68131-000 0 Lega l Description : POPPLETO N PAR KLOT1 8 BLOC K1 2 5 0 X 122.8 5 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $6,400.0 0 $79,600.0 0 $86,000.0 0 200 7 $6,400.0 0 $75,400.0 0 $81,800.0 0 200 6 $6,400.0 0 $75,400.0 0 $81,800.0 0 200 5 $6,400.0 0 $75,400.0 0 $81,800.0 0 200 4 $6,400.0 0 $54,700.0 0 $61,100.0 0 200 3 $6,400.0 0 $54,700.0 0 $61,100.0 0 Sale s Informatio n Sale s Date : 1995-04-2 3 Dee d Type : D Book : \ 200 5 Page : 56 I 

### Price : $52,900.0 0 Grantor : 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 6150. 0 1. 0 123. 0 50. 0 N o Improvemen t Informatio n 

### littp://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R20.. . 11/5/200 8

### Dougla s County Accoun t Informatio n Pag e 2 of 2
Buildin g 1 11/ 2 Stor y 431 2 Cas s S t

'!ii''**^ s

» « WnttCtoit f « » H S*tmtftto t i» » 7MS«4 t

«: r

»!mtis»<*.i K nno- m1 CLIC KT O ENLARG E IMAG E CLJCKjr O ENLARG E IMAG E Squar e Footage : 1252. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : Ranci i Cond o Squar e Footage : 0. 0

HVAC : Centra l Ai rt o Ai r Rooms : 6. 0 Exterior : Fram e Aluminu m Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 2. 0

Roo f Type : Gabl e Stories : 1. 0 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 192 0 0 % 192 0 8 8 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 ft 756. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 324. 0 Porc h Sla b Roo f Cei l 128. 0 Use r Fence,do g 1. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R20. . . 11/5/200 8