### TRANSMITTA L o f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R
SAID# : QOryb ^ Date : 8'0?0n ^ Address : 

### Remediatio n Contractor : PROFESSIONA L ENVIRONMENTAL ENGINEER S Year : 200 9 PAINT STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S ^0'' ^ Vide o o f propert y (DVD ) D Executiv e Summar y Q""" ^ SignedAcces s Agreemen t fo r

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

damag e or t

o replac e plants , etc. ) b - ^ Photograph s dfh& r /z,.^/^ ^ &iu ^ (UteJU^rt^ \ ^ y Satisfactor y restoratio n signedby Propert y Owne r ^ y Propert y close-out chec k

lis t signedb y EP A y ^ Propert y information fro mDougla s Count y Assessor' s Office ^y ^ confirmation tha t lea dpamphle t "Renovat e Right " wa s receive dby P0
_ D D D 

# mlo' ^ ProT^S^hnvIm5BiintefEngineer e Signatur e me i

tP A Signatur e . __ 3005500 5 Superfun d250 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 y Respons e



### Lea dBas e Stabilizatio n Omaha , N e Clos e Ou t Repor t 200 9 SAID #2200 2 91 7 S . 2 7 St .

•Date s worked : 08/0 6 t o 08/0 6 200 9
•Pr e propert y condition : Pain t o n propert y wa s i n poo r conditio n o n th e porch , tri m an dgarag e areas . Hous e i s mostl y side dan dha s painte dporc h an dtri mareas . Garag e pain t wa s i n ver y poo r conditio n prio r t o wor k starting
. •Problem s encountered : Non e •Owne r request/concerns : N/A
•Inspection/closeou t dates : Owne r signe d08/07 , Inspecte db y EP A 08/11/0 9 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 : aaoo a Propert y Address : ^1-7 " ^ ^ 7 S T Owner' s Name : |^rcU^UP / }f ) f^J^jt y Performanc e Standards/Close-Ou t Criteri a 250 5 Nort h 24 ^ Suit e 21 9 Omaha , N E 6811 0 (402 ) 504-468 8 Fa x (402 ) 504-328 1



### YE S N O 1 . Was the entir e structure(s ) paintedwit h the exceptio n ofth e stated , excluded areas ? Thi s wouldinclude painting ofothe r associate dfeature s including fascia , eaves , siding , all trim , porches , box beams , columns , rails , an dexterior surface s o f 

# y garages . 2 . Was all scraping an dothe r

preparation wor k

completedsatisfactorily ?


# .y 3 . Wer e all require darea s ofth e structure(s ) prime da s neededan dpainte dwit h tw o to p coats ? 

# y 4 . Was the pain t product s utilize dequivalen t t

o a3 0 yea r

product/quality ? 

# y 5
. Ar e all ofth e area s wher e contaminatedmaterial s hav e bee n spille dthoroughly 

# y vacuumed / cleaned ? 6 . Didthe contractor collect/vacuumal l falling an dscrapedpain t chip s on the entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y 

## l y othe r

generateddebris ? 7 . I s the gras s are atha t surround s the structure(s ) i n reasonabl y goodcondition ? 

# y 8 . Ar e all item s such a s polyethylene sheeting , ladders , pain t brushes , cones , ^ y 

### barrie r

tape , etc . properly removed ? 9 . Istherean y evidenc e ofpropert y damag e tha t wa s don e b y the contractor ? An y propert y damag e need s t o b e completedprior t

o the EP A Close-Out
. 

# y 10 . Ar e ther e an y propert y item s tha t wer e temporarily re-locate db y the contractor l y 

### tha t needto b e movedback ? 11 . Ar e ther e an y (known ) lingering issue s wat h the propert y ovmer(s ) tha t have y bee n lef t unresolved ? Othe r

Considerations/Propert y Owne r

Discussions/Additiona l Wor k

tha t i s Required :

y^^^i ^ 

# J ^ ^/ii lif t Dat e2505 Nort h 24"^ , Suit e 21 9 

### "Providin g cost-effectiv e environmenta l solutions " Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yRespons e 

## Propert y Owne r

Close-Out For m (Lead-BasedPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) SAID : 

# ^Ql^OQ
. Propert y Addres s 

# l' ^ ? ^ a ^ ?,+ Owner' s Nam e 

# rV]^Me
. ^nr-fr\^e r Performanc e Standards/Close-Ou t Criteri a 1 . Wa s the entir e structure(s ) painte dwit h the exception ofth e stated , excluded areas ? Thi s wouldinclude paintin g o f

othe r

associatedfeature s includin g fascia , eaves , siding , all trim , porches , box beams , columns , rails , an dexterior surface s of garages . 2 . Wa s all scraping an dothe r

preparatio n wor k

completedsatisfactorily ? 3 . Wer e all requiredarea s ofth e structure(s ) prime da s neededandpainte dwit h tw o to p coats ? 4 . Was the pain t product s utilize dequivalen t to a3 0 yea r

product'quality ? 5
. Ar e all ofth e area s wher e contaminatedmaterial s have bee n spille dthoroughl y vacuumed / cleaned ? 6 . Didthe contractor collect/vacuumall falling andscrapedpaint chip s on the entir e property , roadways , alleyways , publi c acces s areeis an dals o remov e an y othe r

generateddebris ? 7 . I s the gras s are atha t surround s fh e structure(s ) i n reasonabl y goo dcondition ? 8 . Ar e all item s suc h a s polyethylene 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 tha t was don e by the contractor ? An y propert y damage need s to b e completedprior to th e EP A Close-Out
. 10 . Ar e ther e an y propert y item s tha t wer e temporaril y re-locate dby the contractor tha t nee dt o b e movedback ? 11 . Ar e ther e an y (known) lingering issue s wit h the propert y owner(s ) tha t have bee n lef t unresolved ? Coirunents :



# . y ^"fet

- Propert y Owne r

Signatur e Dat e Omaha , N E 6811 0 (402 ) 504-468 8 Fa x(402 ) 504-328 1



### YE S N O 

# y U 0 \ ) 

## y 

# J 1 / 

# v ; W 

# u \ J


# ^yyy^ ^ s-~o7-c y Professiona l Environiftenta l Engineer s Representativ e Dat e

# CONSENT FO R ACCES S T O PROPERT Y OMAH A LEA D SIT E REMEDIA L ACTIO N - LEAD-BASE D PAIN T STABILIZATIO N PROPERTY ID : J<> ^ O O o 2 PROPER T Y ADDRESS : ^ i " ^ ^ © t " f ^ " T DAYTIM E PHONE : CELL PHONE : E-MAIL : OWNER' S ADDRES S I FDIFFERENT : TENANT' S NAM E I FAPPLICABLE : DAYTIM E PHONE : CELL PHONE : E-MAIL : Professiona l Environmenta l Engineers , Inc
. (PE ) i s unde rcontrac t (#EP-R7-08-06 ) wit h th e U.S
. Environmenta l Protectio n Agenc y(EPA ) t o stabiliz e lea d base d pain t (LBP ) o n residentia l structure s a t a numbe ro 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 soi l cleanup s tha t ar e bein g performe d b y EP A contractors
. Pain t stabilizatio n activitie s wil l include : scrapin g o f cracke d o rflakin g LB P fro m structures , applicatio n of a prim e coa t 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
. You rcooperatio n i s requeste d i n givin g permissio n t o thi s EP A contracto r(PE ) t o ente ran d hav e acces s t o thi s propert yfo rth e purpos e o f stabilizin g lea d -base d pain t a s outline d o n th e propert y identifie d above
. B ysignin g thi s documen t I agre e t o allo w a n EP A contracto rt o conduc t a soi l cleanu p a t m y propert y followin g completio n o f lead-base d pain t stabilization , ifth e soi l 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 rwil l b e boun d to
. I furthe runderstan d tha t th e soi l cleanu p contracto rwil l mak e al l reasonabl e effort s t o addres s concern s tha t I , a s th e propert yowner , ma yhav e regardin g soi l cleanu p a t m y property
.

• Y e Yes , I hav e rea d 

## 1^\s|o 7 ^ lat e I full y understan d tha t b ysignin g thi s Consen t fo rAccess , (1 ) thi s acces s wil l remai n i n effec t unti l th e wor k ha s bee n satisfactoril y completed , (2 ) tha t th e Propert yOwne ro rTenant , i f applicable , wil l b e give n th e Housin g an d Urba n Developmen t (HUD ) an d EP A pamphlet , ''Renovat e Right , Importan t Lea d Hazar d informatio n fo rFamilies , Da y Car e Providers , an d Schools" , (3 ) th e Propert yOwne ro rtenan t wil l remov e al l obstruction s fro m surface s t o b e painted , (4 ) wil l abid e b y healt h an d safet y guidanc e provide d b yEPA , (5 ) wil l allo w photograph yo f propert y befor e an d afte rth e pain t stabilizatio n work , (6 ) wil l b e contacte d b y a P E representativ e approximatel y4 8 hour s i n advanc e o f startin g work , (7 ) agre e no t t o obstruc t o rtampe rwit h an yofth e LB P stabilizatio n actions , an d (8 ) wil l participat e i n final propert y inspectio n an d sig n th e Completio n Agreemen t an d Propert y Owne rSatisfactio n Survey
. Shoul d yo u hav e an y question s abou t th e plane d Lea d Based-Pain t stabilizatio n activitie s fo ryou rproperty , 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 Sit e cleanu p ca n b e directe d t o Paulett a France-Isetts , EP A Remedia l Projec t Manage r402-731-24S4 , o rth e EP A Publi c Informatio n Center s a t 402-991-958 3 (Nort h Omah a office ) o r402-731-304 5 (Sout h Omah a office)
.
^

Yes , 1 gran t access t o m ypropert y an 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 was "Renovat e Right , Importan t Lea d Infonnatio n fo rFamilies , Chil d give n th e pamphle t "Renovat e Right , Importan t l.ea d Car e Provident? q( n Schools. ' ools. " / Informatio n forFamilies , Chlld e Car e Provldere , an d Schools. " 

# jL L 

# ^ 

# 4d ^ Sigiianir e Dat e Signatur e Dat e 

### sig h Da l SPECIA L IMSTRUCTION S AN D CONSIDERATION S

# PAIN T STABILIZATIO N PRE-PROPERT Y PAIN T MATC H ASSESSMEN T
PROPERT Y ADDRESS : C\\ ^

' S 3 ^ *!>(
- DAT E fi-S^Q^ BVI D AREA(S ) T O B E PAINTCD : HOUS E PROPER : COLOR, .
HOUSETRI M COLO R

GARAG E COLO R

GARAG E TRI M COLO R
PORC H -COLO R '/h/^ / f Sff /

PORC H TRIM
_ COLO R (COMPLET E AL L SEdlON , YES , NO , O R NON-APPUCABLE ) 

# I AGRE E T O TH E COLOR S USTE D ABOVE . ONC E PAINTIN G BEGINS , I UNDERSTAN D I CA NNO T CHANG E TH E ABOV E SELECTE D COLORS :

PAIN T MATC H FOR M 08/0 8

### ^Dougla s Count y Accoun t Infonnatio n Pag e 1 of 3 

# # zzooz . Dougla s County , Nebrask a Propert yRecor d - R171344000 0 Prin t Reoor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t o t 52n d S t - VlO W O H Ma P Informatio n i s vali d a s o f 2009-7-2 0 Treasurer' s Ta xRepor t Ne w Featur e ->-•- • Aut o Sale s Searc h Owne r FORESTE R MICHELL E L 91 7 S 2 7 S T OMAH A N E 68105-000 0 

# ^9, - 4q?i \ -XSO'IM^ I Propert yInformatio n Ke yNumbe r 134 4 00001 7 Accoun t Type : Residentia l Parce l Numbe r 171344000 0 Parce l Address : 91 7 S 2 7 S T OMAH A N E 68105-000 0 Lega l Description : MARSH S AD D LO T 1 0 BLOC K4 5 0 X 124. 5 Valu e Informatio n I Lan d 200 9 200 8 200 7 200 6 2005 ^

i 200 4 y

.. . -1 . Sale s Informatio n $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 $89,300.0 0 $89,300.0 0 $89,300.0 0 $84,300.0 0 $84,300.0 0 $84,300.0 0 Tota l $94,100.0 0 $94,100.0 0 $94,100.0 0 $89,100.0 0 $89,100.0 0 $89,100.0 0
Sale s Date : 2002-02-2 5 Dee d Type : j W D Book : 221 3 Page : 73 9 Price : I $87,000.0 0 Grantor
. Grantee : Valld/lnvalld : Vali d Exclusio n Reason : Sale s Date : 2000-07-2 6 Dee d Type : i D Sooir : 215 9 Page : 02 6 Price : $ 77,000.0 0 Granto r 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accoxmtinfo.jsp?accountno=R l 7.. . 7/31/200 9

### ^ Dougla s Count y Accoun t Information Pag e 2 of3
Grantee : Valid/Invalid : vali d Exclusio n Reason : Sale s Date : \ 1998-03-0 5 Dee d Type : \ D Book : 208 4 Page : i6 8 Price : $ 48,850.0 0 Granto r 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 6200. 0 1. 0 124. 0 50. 0 N o Improvemen t Informatio n Buildin g 1

no r 3« « ic r 

# r Fntnee r M2. 0 Bu
. P t



## TW O STOR Y Squar e Footage : I 1672. 0 Percen t Complete : ' 100.0 % Perimete r' 0. 0 Quality : Averag e Uni t Type : Condition : Goo d

Buil t As : 2 Stor y Cond o Squar e Footage : 0. 0 HVAC : I Centra l Ai rt o Ai r Rooms : | 7. 0 Exterior : ' Fram e Viny l Units : ] 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : \ Compositio n Shingl e Bedrooms : 4. 0 Roo f Type : j Hi p Stories : 2. 0 Floorcover : I Allowanc e Foundation : i Bloc k Sprinkle rSquar e Footage : 0. 0 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17..
. 7/31/200 9

### IGI T PropertyAddres s J/ T ^oli'-^ l Dat e StartPat e €ig/o£/^ ^

EndDat e QS/TI'^I'X) ^ 

### Amoun t O f Prim e An d Pain t Use d Prim e (Gallons ) 

# 3 0<^ i

Pol y(Boxes ) S ^

So:<re-g > Pal m (Color ) ^ O f ^

Amoun t (Gallons ) / ^ Cv^ l Pain t (Color )
_ ^ Amoun t (Gallons ) Pain t (Color ) Amoun t (Gallons ) Pain t (Color) Amoun t (Gallons ) _^ 

### '*^'"^<Color ) Amoun t (Gallons )