### TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R SAI D # : 4fif5^' ^ Date : 1-'Q\-Cr \ Address : f^OO ^ ^ 1 & f^ f Remediatio n Contractor : PROFESSIONALENVIRONMENTALENGINEER S Year : 200 9 PAINT STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S ^.^''^^ide o ofpropert y (DVD ) ^y"" ^ Executiv e Summar y Signe dAcces s Agreemen t fo r

subject propert y Q ^ Painting Agreemen t Sfittlemen t documents (i.e. , fo r

damag e o r

to replac e plants , etc. ) iay""' ^ Phot' JlrJt>OL . ograph s tK ^ Satisfactor y restoratio n signedb y Propert y Owne r B ^ Propert y close-ou t chec k

lis t signedb y EP A B ^ Propert y information fro mDouglas Count y Assessor' s Office IJ ^ confirmation tha t lea dpamphle t "Renovat e Right " was receivedb y P O D D 30203834 D Superfun d



### ProfessionaT l Engineers Signatur e 

# ^//o// o Signatur e at e

### PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC
. ''°'Tm'a' t N E ear n "Providin g cost-effectiv e environmenta l solutions " ^ Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yRespons e ^ i^^olc^tof ? Fax (402 ) 504-328 1



### LeadBas e Stabilizatio n Omaha , N e Clos e Ou t Report 200 9 SAID#4854 7 5002 S 1 8 S t

•Date s worked : 07/1 0 t o 07/1 1 200 9 •Pr e propert y condition : Hous e ha s siding . Woo dwindo w trim s i n poo r conditio n wit h pain t peeling . Bric k pain t aroun dth e hous e i n poo r condition . •Problem s encountered : N/ A •Owne r request/concerns : Not t o pain t hous e foundation . •Inspection/closeou t dates . Owne r signe d07/1 4 2009 . Inspecte dby EPA 07/1 7 2009 , N o issues .

## 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 

### EP A Close-Ou t For m (Lead-BasedPain t Stabilizatio n EP A Contract EP-R7-08-06 ) 

## SAID : 4^SL|C)

- Propert y Address : ^00c y 

# ^ If t 

# ?s-f . Owner' s Name : p^alTZ: ) Performanc e Standards/Close-Ou t Criteri a 250 5 Nortt i 24 % Suit e 21 9 Omatia , N E 6811 0 (402 ) 504-468 8 Fa

x (402 ) 504-328 1

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 siuface s o f i/ ^ garages . 2 . Wa s al l scrapin g an dothe r preparatio n wor k

complete dsatisfactorily ? y 3 . Wer e 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 othe r generate ddebris ? t ^ 7 . I s th e gras s are atha t surround s th e structure(s ) i n reasonabl y goo dcondition ? ^ 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 ? t/ ^ 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 . Ar e ther e an y property item s tha t wer e temporaril y re-locate db y th e contracto r tha t nee dt o b e move dback ? ^ 11 . Ar e ther e an y (known ) lingerin g issue s withth e property owner(s ) tha t hav e bee n lef t unresolved ? i X Othe r Considerations/Property Owne r Discussions/Additiona l Wor k

tha t i s Required :


# nhlo 9 y EP A CO RSignatur e Dat e

### V 

## PROFESSIONA L 250 5 Nortt i 24* , Suit e 21 9 

## ENVIRONMENTA L ENGINEERS , INC
. Omaha , NE 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 Stabilization EP A Contract EP-R7-08-06 ) SAID : MRS<4 ^ Propert y Address : tSO^ ^ S I S S b Owner' s Name : l^rT ) Plprf. ^ Performanc e Standards/Close-Ou t Criteri a YE S NO 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 gof othe r associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an dexterio r surface s of 

# V garages . 2. Wa s al l scrapin g an dothe r preparatio n wor k

complete dsatisfactorily ? y 3. Wer e al l require darea s ofth e structure(s ) prime d as neede dan dpainte dwith 

## y tw o to p coats ? 4. Wa s th e pain t product s utilize dequivalen tto a 30 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 

# y vacuumed/ cleaned ? 6. Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s on th e 

# y entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y othe r generate ddebris ? 7. Is th e gras s are atha t surround s th e structure(s ) in reasonabl y goo dcondition ? / 8. Ar e al l item s suc h as polyethylen e sheeting , ladders , pain t brushes , cones , ^ barrie r tape , etc . properl y removed ? 9. Is ther e an y evidenc e ofpropert y damag e tha t wa s don eby th e contractor ? An y 

## y property damag e need s to be complete dprio r to th e EP A Close-Out . 10 . Ar e ther e an y property item s tha t wer e temporaril y re-locate d by th e contracto r 

## y tha t nee dto be move dback ? 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 ? Comments :

/ ^ (• '^^K,^\^Z Propert O^

ropert y y Owne r

Signatur e Dat e ita l Engineer s Representativ e Dat e

# CONSEN T OF R ACCES S TO PROPERTY OMAH A LEA B SIT E REMEDIA LACTIO N - LEAD-BASE D PAIN T STABILIZATIO N
PROPERTY ID : ^^SM" ^ PROPERT Y ADDRESS : 

# SMEsnr ^ OWNE RNAME : 

### "j^dr Q p-loJ^-t ^ DAYTDVt E PHONE : S^U -\S^ S CELLPHONE : __ ^ E-MAIL : OWNER' S ADDRES S IFDIFFERENT : TENANT' S NAME IFAPPLICABLE : DAYTIME PHONE : CELLPHONE : E-MAIL : Professiona l Environmental Engineers , Inc . (PE ) is unde r contrac t (#EP-R7-08-06 ) wit hth e U.S . Environmental Protectio n Agenc y (EPA ) to stabiliz e lea dbase dpain t (LBP )on residentia l structure s at anumbe r of propertie s locate d in Omaha , Nebraska . Th e pain t stabilizatio n wor k

is bein g don e to protec t th e soil cleanup s tha t were performe d by EPA contractors . Pain t stabilizatio n activitie s will mclude : scrapin g of cracke d or flaking LB P fromstructures , applicatio n of aprim e coat an d tw o (2 ) coat s of pain t Moving part s of window s an ddoor s ar e no t include dan dwil l no t be addressed . You r cooperatio n is requeste d in giving pennissio n to thi s EP A contracto r (PE ) to ente r an dhav e acces s to thi s propert y for th e purpos e of stabilizin g lea d-base dpain t as outline d on th e propert y identifie dabove . By signing thi s documen t I agre e to allo wan EPA contracto rto conduc t asoi l cleanup at my propert y following completio n of lead-base dpain t stabUization . I understan dtha t th e stabilizatio n contracto r can no t provid e assurance s tha t th e soi l cleanu p contracto r will be boun dto . I furthe r understan dtha t th e soi l cleanu p contracto r wil l make aU reasonabl e effort s to addres s concern s tha t I, as th e property owner , ma y hav e regardin g soi l cleanu p at my property . I full y understan dtha t by signin g thi s Consen t fo r Access , (1 ) th b acces s will remain in effec t unti l th e work ha s been sfltisfoctoril y completed , (2 ) tha t th e Propert y Owne r or Tenant ,if applicable , wil l be given th e Housin g an dUrba n Developmen t (HUD ) an dEP A pamphlet , ''Renovat e Right , Importan t Lea dHazar dinformatio n for Families , Da y Car e Providers , an dSchoob" , (3 ) th e Propert y Owne ror tenan t wil l remove al l obstraction s fromsurface s to be painted , (4 ) will abid eby healt han dsafet y guidanc e provide dby EPA , (5 ) wil l allo w photograph y of propert y befor e an dafte r th e pain t stabilizatio n work , (6 ) willbe contacte d by a PE representative approximatel y48 hour s hi advanc e of startin g work , (7 ) agre e no t to obstruc t or tampe r wit han y ofth e LB P stabilizatio n actions , an d(8 ) wil l participat e in final propert y Inspectio n an d sign th e Completio n Agreement an dPropert y Owne r Satisfactio n Survey . Shouldyo u hav e an y question s abou t th e plane dLeadBased-Pain t stabilizatio n activitie s fo r you r property , pleas e contac t Professiona l Environmenta l Enghieers , In c Projec t Manager , Willi e Chi y At 402-504-4688 . Genera l question s abou t tiie Omah aLeadSite cleanup can be directe dto Paulett aFrance-Isetts , EP A Remedial Projec t Manage r 402-731-2454 , or th e EP A Publi c Informatio n Center s at 402-991-958 3 (Nort hOmah aoffice) or 402-731-304 5 (Sout hOmah aoffice) .
^

Yes , I gran t acces s to mypropert yan d wi s give n th a pamphle t D No , I do no t gran t acces s to mypropert yan d I wa s "Renovat e Righ t Importan t Lea d Infbnnalio n fb rFamilies , Chil d ghre n th e pamphle t "Renovat e Right , Importan t Lea d Car s ProvMera , an d Schools. ' informatio n for Famillas , Chlld e Ca n Provldere , ah d Schools. ' 

### UlAWcV^' g ' Sionatur Dat e

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- b w^sr aPGOB E PROPERT YADDRES S O F OWINE R I F DIFFEREN T1IIA N PROPER S PROPERI YADDRES S aPCOD E I hav e iBoeivB d a cop yo f th e pamphlet , /iMioMt o Righ t Importan i Lta d HtEar t Infonimlk m Fo rfmllhs , CM U Ca n Pimlda n An d Setno h infomiin g m e o f th e potentia l risk o f th e lea d hazar d exposur e fro m renovatio n acdvil yt o b e perfbmie d o n dwsDIn g uni t I reoeived thi s pamphle t befor e th e vvoriciiegan
.

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# • Unavailabl e Fo rSignalii n - 1 certif ytha t I ha wmad e a goo d fiaiih effor t to delive rth e pam ^ Importan t ba d hazan l infonnatio n fo rfamilies , chO d car e provlder e an d schools , to th e rental dwellin g uni t Hato d belo wan d tha t th e occupan t wa s unavaBaU e to sig n th e confinnatio n o f receipt I furthe roeriif ytha t I hav e lef t a cop yo fth a pamphle t a t th e uni t b yendin g i t unde rth e doo ro raomewher e o n th e ixemlses
.

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f/mftasawnsaomi tDougla s County Accoun t Informatio n Pag e 1 of 2 

# l- S Dougla s County , Nebrask a Propert yRecor d - R041375000 2 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t o f 52n d S t - VJO W O n Ma P Informatio n i s vali d a s o f 2009-6- 3 Treasurer' s Ta xRepor t Ne wFeatur e -•"•" • Aut o Sale s Searc h Owne r 

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# '^in-ig^ b Propert yInformatio n Ke yNumber : 137 5 000 2 0 4 Accoun t Type : Residentia l Parce l Number : 041375000 2 Parce l Address : 500 2 S 1 8 S T OMAH AN E 68107-000 0 Lega l Description : SOUT H OMAH ACITY LOT S LOT 2 BLOC K10 5 AL L LO T 1 & N 1/ 2 LO T 2 BL K 10 5 65X13 0 Valu e Informatio n 2009 200 8 200 7 200 6 200 5 200 4 Lan d $4,800.0 0 $4,800.0 0 $4,800.0 0 $4,800.0 0 $4,800.0 0 $4,800.0 0 Improvemen t $34,000.0 0 5,700.0 0 $40,000.0 0 $40,000.0 0 $40,000.0 0 $40,000.0 0 Tota l $38,800.0 0 $40,500.0 0 $44,800.0 0 $44,800.0 0 $44,800.0 0 $44,800.0 0 Lan d Informatio n Acre s 0.1 9 S F 8450. 0 Unit s 1. 0 Dept h 130. 0 Widt h 65. 0 Vacan t N o Improvemen t Informatio n Buildin g 1

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R041. .. 6/9/200 9Dougla s County Accoun t Informatio n Pag e 2 o f 2

CLIC KT O ENLARG E IMAG E ; I.,.TM
. Squar e Footage : 1170. 0 Perimete r 0. 0 Uni t Type :

Buil t As : 1 1/ 2 Stc 5r

yFi n HVAC : Force d Ai r Exterior : Fram e Siciin g Interior : Drywal l Roo f Cover : Compo s itio n Shingl e

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Units : 1. 0 Baths : 1. 0 Bedrooms : 4. 0 Stories : 1. 5 Foun d ation : Sprinkle rSquar e Fo e>tage : 0. 0 Adjuste d Yea r Buil t Physica l A g e 190 0 0 9 Unit s 1. 0 712. 0 1. 0 1.0 ; 1. 0 120. 0 :

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