# 0

of OMAH A LEA D SIT E PAM T STABILEZATIO N FIL E FOLDE R
SAID# : P4qfS" 1 Date : ^pj^o/zOl O Address : j^O l M
. S4 ^ ."NJ " Stabilizatio n Contractor : Professiona l EnvlroBimenta l Engineer s Year : PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S Vide o ofpropert y (DVD ) Executiv e Summar y SignedAcces s Agreemen t fo r

subject propert y Pre-Renovatio n For msigne dby Propert y Owne r Pre-Renovatio n For mfo r

Occupant/Tenant , i f applicabl e Paintin g Agreemen t Settlemen t document s (i.e. , fo r

damag e or to replac e plants , etc. ) Renovatio n Recordkeepin g Checklis t signe db y CertifiedRenovator Photograph s Satisfactor y close-out chec k lis t signedb y Propert y Owne r Propert y close-out chec k lis t signedb y EP A Propert y information fix)mDougla s Count y Assessor' s Office Hazar danalysis , i f prepare d Safet y Audit Othe r

(describe) : 

# ^W ^

EP A CORSignatur e TJate " (afte r file folde r review ) 3020419 4 

# i n Superfun dfessiona Environm e Professiopa l Environmenta l Engineers : EP A Pain t Stabilizatio n 201 0 SAID # Propert y Addres s f 5^ ^

N ^^ H ^ ^ Stories/Sidin g typ e l,S<rrOlj / I OlPPiAttJJt ^ rhl/fSd(o^ ^

O^l/yjOOt ^

T^l h Garage ? fTrfMCt/^^ ^ TO Hdu^i^ ^

Vc S Acces s signe d 

# \M\£ l Pre-vide o _ U? 

# i^j n Pos t vide o 

# Mi o Contracto rAssigne d fl y Dat e starte d 

## L>'11-1 0 Weather/tem p Dat e ende d 

# /^-/r-/ d Pain t use d 

# ^^p/u/cf
- ; .^g^ / /^Ji-Z o Prim e use d Poi y use d /_ Probiems/issue s 

## y\r{ ) Dr\\ ^

# m )m R CONSENT FO R ACCES S T O PROPERT Y OMAHA LEAD SIT E REMEDIA L ACTIO N - LEAD-BASE D PAIN T STABILIZATIO N PROPERT Y ID ; ft4-^ TV ] PROPERT Y ADDRESS ; | fSC)"~ i tsJ x fS 4 f ^ OWNE RNAM E DAYTIM E PHONE : yi^^->?//'^^r ^ CELLPHONE : E-MAIL : <^^^c// ? li^a/^/< ] Aohvi^il ' Cdyy j OWNER' S ADDRES S I F DIFFERENT : TENANT' S NAM E I F APPLICABLE : DAYTIM E PHONE ; CELLPHONE ; E-MAIL : Professiona l Environmenta l Engmeers , Inc
. (PE ) i s unde r contrac t (#EP-R7-08-06 ) wit h th e U.S
. Environmenta l Protectio n Agenc y (EPA ) t o stabiliz e lea dbase dpain t (LBP ) on residentia l structure s a t anumbe r o

f propertie s locate d I n Omaha , Nebraska
. Th e pain t stabilizatio n wor k

i s bein g don e t o protec t th e soil cleanup s tha t ar e bein g performe d b y EP A contractors . Pain t stabiiizatio n activitie s will include ; scrapin g o f cracke d o r flakin g LB P fro mstructures , applicatio n o f aprim e coat an d tw o (2 ) coat s o f pain t Movin g part s o f window s an d door s ar e no t include d an d wil l no t b e addressed
. Your 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 d hav e acces s t o thi s property for th e purpos e o f stabilizin g lea d-base dpain t a s outline do n th e property identifie dabove
. B y signin g thi s documen t I agre e t o allo w an EP A contracto r t o conduc t asoi l cleanu p a t m y property following completio n o f lead-base dpain t stabilization , i f th e soil cleanu p ha s no t alread y bee n performed
. I understan d tha 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 wil l b e boun d to. I furthe r understan d tha 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 soil cleanu p a t m

y property . ^es , I hav e rea d an d un0|rstan d th e paragrap h above

. fiJ-C& ^ Signatur e o f Propert yOwne r Dat e 

# y^2 k 

# ly^ A
1 full y understan dtha t by signin g thi s Consen t for Access , (1 ) thi s acces s wil l remai n i n effec t unti l th e wor k

ha s been satisfactoril y completed , (2 ) tha t th e Property Owne r o r Tenant , i f applicable , wil l b e give n th e Housin g an d Urban Developmen t (HUD ) an d EP A pamphlet , '^Renovat e Right , Importan t Lead Hazar d informatio n for 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 h an d safet y guidanc e provide db y EPA , (5 ) wil l allo w photograph y o f property befor e an d afte r th e pain t stabilizatio n work , (6 ) will b e contacte db y aP E representativ 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 any o f th e LB P stabilizatio n actions , an d (8 ) wil l participat e i n final property inspectio n an dsign th e Completio n Agreement an d Property Owne r Satisfactio n Survey
. Shoul d yo u hav e any question s abou t th e plane d Lea dBased-Paint stabilizatio n activitie s for 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 d Site cleanu p ca n b e directe d t o Paulett aFrance-lsetts , 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 h Omah aoffice ) o r 402-731-304 5 (Sout h Omah aoffice)
. 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 forFamilies , Chil d give n th e pamphle t "Renovat e Right , Importan t Lea d Car e Providers , an d Sc h Informatio n fb rFamilies , Child e Car e Providers , an d Schools. " 

# y y 0 S2b
_ Signatur e i / Dat e Signatur e Dat e SPECIA L INSTRUCTION S AN D CONSIDERATION S

## PAIN T STABILIZATIO N PRE-PROPERT Y PAIN T MATC H ASSESSMEN T
PROPERT Y ADDRESS : /5b 7 

# p.s f 

# ^ - DATE : y9-/ d BV.D : ^1-9^ 7

AREA(S ) T O B E PAINTED : HOUS E PROPER : Ih^S^/^^' j /A31 > COLOR : 1^0 ^



## '-/

— SM^( S
HOUS E TRINI : (^60 0 1 ^ ^ COLOR : ^ GARAGE : -Vygg g / W^ > f-^fty^-P O COLOR :
GARAG E TRIM : (I rCOLOR :
PORCH : H* - {-j^of L CEJl^eh- ^ COLOR : N 

### Q \ PORC H TRIM : / W COLOR : (COMPLETE 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 T CHANG E TH E ABOV E SELECTE D COLORS : PROPERT Y OWNE R SIGNATURE : PE ACCESO R SIGNATURE :

### PRE-RENOVATIO N FOR M - OWNE R Thi s for mi s to b e use db y th e firms contracte db y th e Environmenta l Protection Agency-Region 7 to perfor mLead-Based Pain t stabilization activitie s a t th e OmahaLea dSite , Omaha , Nebraska
. Owne r Confirmatio n Pamphle t Receip t D I have received acop y o f the lea dhazar dinformatio n pamphlet , Renovat e Right : Important Lea d Hazar d Information fo r Families , Chil d Car e Provider s an dSchools , informin g m e o f th e potentia l ris k o f th e lea d hazar d exposur e fix)mrenovatio n activit y to b e performe din/o n m y dwellin g unit
. 1 received thi s pamphle t befor e the wor k

began
. Owne r Acknowledgmen t D (A ) I confir mtha t I ow n an dliv e i n thi s property , tha t no child unde r th e ag e o f 6 reside s here , tha t n o pregnan t woma n reside s here , an d tha t thi s propert y i s not achild-occupie dfacility
. Note : A chil dreside s i n the primar y residenc e o f his/he r custodia l parents , lega l guardians , foste r parents , or informa l caretake r i

f th e childlive s an dsleep s most of tim e a t the caretaker' s residence
. Note : A child-occupiedfacilit y i s apre-197 8 building visited regularl y b y the sam e child , unde r 6 year s of age , o n a t leas t tw o differen t day s within an y week , fo r a

t leas t 3 hour s eac h day , provided tha t th e visit s tota l a t leas t 6 0 hour s annually
. D (B ) I understand tha t th e renovation firm, contracte d b y the Environmenta l Protection Agency (EPA) , will b e using lead

saf e wor k

practice s requiredb y EPA' s Renovation , Repai r an d Painting Rule
. 

# ^y]^r() ^ iy^^ < Printe dNam e ofOwner-Occupan t

Signatur e ofOwner-Occupan t Dat e

### Dougla s Coimt y Accoun t Informa|io n Pag e 1 of 4

• f ^ 

# H^'\5 n ^ Dougla s County , Nebrask a Propert y Recor d - R241007000 0 Prin t Reoor t Vie w Interactiv e GI S Ma o Infbrmatio n i s vali d a s o f 2010-5-2 8 Treasurer' s Ta x Reoor t Ne w Featur e ->-•- • Subdivisio n Sale s Searc h Owne r KNAP E AARO N P blA L 1507N54S T ^ v , > Q . ^ ^ OMAHAN E 68104-000 0 Q^ A iLn i ) { Propert y Informatio n Ke y Number

. 100 7 000 0 2 4 Accoun t Type : Residentia l Parce l Numbe r 241007000 0 Parce l Address : 150 7 N 5 4 S T OMAHAN E 68104-000 0 Lega l Description : WASHINGTO N HIL L LO T 2 BLOC K3 N 6 3 1/ 2 W 13 6 FT 6 3 1/ 2 X 13 6 Valu e Informatio n Lan d Improvemen t Tota l 201 0 $13,700.0 0 $121,500.0 0 $135,200.0 0 200 9 $13,700.0 0 $121,500.0 0 $135,200.0 0 200 8 $13,700.0 0 $121,500.0 0 $135,200.0 0 200 7 $13,700.0 0 $121,500.0 0 $135,200.0 0 200 6 $13,700.0 0 $104,900.0 0 $118,600.0 0 200 5 $13,700.0 0 $104,900.0 0 $118,600.0 0 Sale s Informatio n Sale s Date : 2006-07-1 3 Dee d Type : W D Soofr : 200 6 Page : 08157 7 Price : $ 143,000.0 0 Granto r Maybell-Grasse rMarsh a J Grantee : J nap e Aaro n P ETA L Valld/lnvalld : Vali d Exclusio n Reason : Sale s Date : 2004-11-1 2 Dee d Type : W D Book : 200 4 Page : 15030 3 Price : $ 138,500.0 0 Grantor : NEILLMOLLAR D


### http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R241..
. 6/5/201 0Dougla s County Accoun t Inform ; Pag e 3 of 4 

### i^i ^

1 1/ 2 Stor y F m

K< i 37 S

» » » « fw^rta r tKB- f ^• ^ =* " BI ? >.LJ ?

I't f CPT ' S* K"J : W

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

Buil t As :

HVAC : Exterior : Interior : Roo f Cover :

Roo f Type : Floorcover : 1266. 0 0. 0
1 1/ 2 Stor y Fi n Centra l Ai rt o Ai r Masonr y Commo n Bric k Drywal l Compositio n Shingl e Gabi e Allowanc e Percen t Complete : 100.0 % Quality : | Averag e Condition : \ Averag e Cond o Squar e Footage : 0. 0 Rooms : 6. 0

Units : 1. 0 Baths : 1. 5 Bedrooms : 2. 0 Stories : 1. 5 Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 year Su// t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 194 0 194 0 6 9 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Applianc e Basemen t Sprinkle rSyste m Allowanc e Bsmn t Bloc k 8 f t 1. 0 1. 0 896. 0 Fixtur e Fixtur e Fixtur e Garag e Porc h Porc h Porc h Bas e Fixture s Bat h Ful l Bat h Hal f Attache d Sla b w/Step s Sla b w/Step s Woo d Dec k 1. 0 1. 0 1. 0 220. 0

60. 0 16. 0 168. 0

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R241.
. . 6/5/201 0(effectiv e Apri l 2010 ) 

# 0 0

RENOVATIO N RECORDKEEPIN G CHECKLIS T

Nam e

of Firm : 

# fO'f/hf y Dat e an dLocation of Renovation : ^ ^ I f -^ l O Brie f Descriptio n of Renovation yyfy\j(yiQJ /UAJyu 

### y pt
- 

### fl^iv t : yyfAjjy^ ^ 

### {Uyiy^ Nam e

of AssignedRenovator : 

## : , ^JXuuJyj lyrX^ ^ Name(s ) of Traine d Workers : !p T (XffJjfi^ ^ IZ«y ^ LpL-fi ^ ^A^a'cPrin-i^y

Nam e

of Dus t Sampling Technician , Inspector , and/or Risk Assessor , if used : Q^ Copie sof renovator an ddus t samplin g technicia n qualification s (trainin g certificates , certifications ) on file
. IB^Certifie drenovator provide d trainin gto worker s on (chec k

al l tha t apply) : (^Postin g wamin g sign s Q-Settin g

up plasti c containmen t barrier s [YMqintflinin g containmen t [TAvoiding sprea d

of dus t to adjacen t area s Q-Wast e handlin g •^ost-renovatio n cleanin g
n Tes t kit s used by certifiedrenovator to determine whethe r

lea dwa s presen t on component s affecte d

by renovatio n (identif y kit s usedanddescrib e samplin g location s an dresults :

Beamin g sign s poste d at entranc e to wor k

area . Q^ork are acontaine d to preven t sprea d

of dus t an ddebris
. Hwindow sin an dwithi n 20 fee t of th e wor k

are aar e closed Q^Door s in an dwithi n 20 fee t of th e wor k

area s ar e close dandsealed H^oor s tha t mus t be use d in th e wor k

are aar e covered to allo w passag e bu t preven t sprea dofdust
. B-^oun d covered by plasti c sheetin g extending 10 fee t fromwor k

are a- plasti c anchore d to th e buildin g an dweighte ddown by heavy objects
. DIf necessary , vertica l containmen t installedt o preven t migratio n ofdus t anddebri s to adjacen t property . Q-^ast e containedon-sit e an dwhil e bein g transporte doff-site
.

Renovatio n Recordkeepin g Checklis t Omah a Lea d Sit e(effectiv e Apri l 2010 ) 

# 0 0

^JA^r k sit e properl y cleane dafter renovation
. QAl l chip s an ddebri s picke dup , protectiv e sheetin g misted , folde d dirt y sid e inward, an d tape d fo r removal
. 0work are aHEPA vacuume dt o ge t pain t chip s fromgroun d surface , i f necessary . D Certifie d renovato r performe dpost-renovatio n cleanin g verificatio n (describ e results) :

LL

K

I certif y unde r penalt y o f la w tha t the abov e informatio n i s tru e an d complete
. 

# y/y y Nam e an d Titl e Dat e

Renovatio n Recordkeepin g Checklis t Omah a Lea d Sit e•« 

## PROFESSIONA L 250 5 Nort h 24 ^ Suit e 21 9 

## ENVIRONMENTA L ENGINEERS , INC

. Omaha , N E 6811 0 

### "Providin g cost-effectiv e environmenta l solutions "^ ^ jj^g ! 5M^28 ? Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc y Respons e



### Lea dBas e Stabilizatio n Omaha , N e Clos e Ou t Repor t 201 0
SAID#8495 7 150 7 N 5 4 St
.

•Date s worked : 06/17/1 0 t o 06/18/1 0
•Pr e propert y condition : Hous e lia s bric k sidin g wit h painte d woo dtrim s tha t ha d flaking pain t an di n fai r t o poo r condition
. Fe w visibl e pain t chip s i n yard
. •Problem s encountered : None
. •Owne r request/concerns : N/ A
•Inspection/closeou t dates : Owne r 06/22/10 , inspecte db y P E projec t manager .

# 0 , # 

## PROFESSIONAL
­ 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 i • Emergenc y Respons e 

## 201 0 Propert y Owne r Close-Ou t For m (Lead-BasedPain t Stabilizatio n EP A Contract EP-R7-08-06 ) SAID : 

# ^ff^ ^ Propert y Address : /6d ^ /if-^YS f Owner' s Name : Jp//)/ { j^y) ar> l Performanc e Standards/Close-Ou t Criteri a YE S N O 1
. Was th e entir e structure(s ) painte d wit h th e exceptio n o f th e stated , exclude dareas ? Thi s wouldinclude paintin g o f othe r

associate dfeature s includin g fascia , eaves , siding , all trim , porches , box beams , columns , rails , andexterior surface s of garages . 

# X 2
. Was all scraping an dothe r

preparatio n wor k

complete dsatisfactorily ? . ^ ^ 

### 3
. Wer e all require darea s o f th e structure(s ) primeda s neededan dpainte dwit h tw o to p coats ? 

# K 4
. Was th e paint product s utilize dequivalen t to a2 5 yea r

product/quality ? 

### ^ 1 5
. Ar e all of th e area s wher e contaminate dmaterial s hav e bee n spille d thoroughly vacuumed / cleaned ? 

# X 6
. Didth e contractor collect/vacuumall falling an dscrapedpain 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 d debris ? 

# X 7
. I s the gras s are atha t surround s th e structure(s ) in reasonably goodcondition ? ^ < ^ 

### 8
. Ar e all item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r

tape , etc . properl y removed ? 

# 2 L 9
. I s ther e an y evidenc e ofpropert y damag e tha t wa s done by th e contractor ? An y propert y damag e need s to b e complete dprio r t

o th e EP A Close-Out
. 

# X 10
. Ar e you satisfiedwit h th e wor k

performed ? : ^ 

### 11
. Ar e ther e an y propert y item s tha t wer e temporarily re-locate dby th e contractor tha t needto b e moved back ? 

# X

- Yl
. Ar e ther e an y (known) lingerin g issue s wit h the propert y owner(s ) tha t hav e been lef t unresolved ? 

# y Othe r

Considerations/Propert y Owne r

Discussions/Additiona l Wor k

tha t i s Required :



## "^rC^/ I 

# l A ^ ^ I Q ropert y Owne r

^i^atur e Dat e 

### /'X^-/i ? ^ ^ 

### Professiona l Envifonni^ta l Engineer s Signatur e Dat e