• 

TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: 25050 Date: Oct. 27 

Address: 1215 N 35 St. 

Remediation Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

7 V i dec of property (DVD) 

0 Executive Summary 

0 Signed Access Agreement for subject property 

B Painting Agreement 

D Settlement documents (i.e., for damage or lo replace plants, etc.) 

D Photographs 

ffl Salisiaclory restoration signed by Property Owner 

D Property close-oul check list signed by EPA 

111 Property information from Douglas County Assessor's Office 

D 

D 

D 

Signature > - & ^ 

40310671 iiiili 

Superfund 
PROPERTY SUMiVIARY 

Date: 9/9/08 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Month of: September 

Property Address: 1215 N. 35 St. SAID: 25050 

A. EXECUTIVE SUMMARY 

A.l Issues Encountered: None 

A.2 Issues Resolved: None 

A.3 Unique Findings: None 

122A.4 Other Relevant Information 

Access Date: 8/11/08 

Work Began Date: 8/20/08 

Cioseout Date: 8/25/08 

Enclosures: 

1. Pre-Video 

2. Post-Video 

3. Property Status Form 

4. Signed Access Agreement 

5. Pre-Renovation Form 

6. Paint Match Form 

7. Tracldng Form 

8. Douglas County Assessor Property Information Page 

9. EPA Property Cioseout form (not required) 

10. Property Completion Agreement 

TECHNOLOGIES, INC. 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: /^/5 " /t/! 55"^-^/- Date: ^'(^^^ ^ 

Phone: *'70^-'^fO ^7i/ l ^^^^'- d^y^F^ ^ 

Plant & Permanent Landscaping To Remain In Place 

Item# 

Description and Location 

On Map 

^re ^ iJJ^>^/ <:iwJc l ^c^^ e /^(ohk^ . 

Pre-Existing Condition of Structures 

DoesyourBasementhaveahistory of leaking? Yes -— No - ^ 

Item# 

On Map . Do^OAQCji i o 4fa,r\j ' SfO£p ptll^f^ y bcxS^ ^^'^cJ /^ , 

' /eaC ^\ 0,i/\JiOi4J ^Cr<,^i'\C^'^i^ * fax^j-O^ xxii>^dJS. Cs^o/K> 

« SofO^ cJotAQ^e C^c,f4)* 6^^k^ .i\^L¥f7oineg^e.C'^(^t-ih) 

siotitj- i-o pcy'cik QA r\atfhf-'\tie <fci/^<^Cfer^ Iv^kJiyicvi^ >^ci>/, A ^ 

Ji.M\c^o^p^chC/\or^h ^ (7to hi i'v u^ i 

Property Osm^] Prudent Emplo^' 

Signature: ( , Signature: . ^ , 

M 

8080 Ward Parkway, Suite 405 2505 N. 24*^ street, Suite 308 4242 IMedical Drive, Suite 4250 

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

Pliona: f402) 504-1004 Phone: f210) 822-9588 
Z5050 

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 (LBf) at a number of OTOperties 

located in Omaha, Nebraska, including the property located at /v,/.* ^ N ' .y ^ OTT" 

The EPA requests your pennission to allow Prudent to perform LBP Stabilization at this property. By 

signing this form, the property owner grants pennission to Prudent to perform activities related to LBP 

Stabilization including scraping paint and painting of the referenced property. Further, the owner/tenant 

verifies that they have received the LBP pamphlet "Renovate Right." 

If you have any questions about the LBP stabilization planned for your property, please contact Prudent's 

Administrative Clerk for the Lead Based Paint Stabilization, Mrs. Deborah Akerele-Johnson. 

at (402) 504-1004. General questions about the Omaha Lead Site cleanup can be directed to the EPA 

Public Infonnation Centers at (402) 731-3045 (South Omaha office) or (402) 991-9583 (North Omaha 

office). 

iBv: / ^'SJ M ^<^^^-^ T^^O^b£ryv^ C^^v^'ic-^ 

Property Owner Signature 

PROPERTY INFORMATION 

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

RESIDENT NAME: C-^H^l I lA/9/iA.D^Olri ( Owner ^ Renter 

RESIDENT ADDRESS: 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; s^mc 

OWNER'S TELEPHONE NUMBER - HOME: [Kf^\^^'T'ii i WORK: i 1 

n 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: C> NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER: 


NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: _ 
a

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


AUTHORrrY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be implemented by EPA under this agreement are pursuant to Section 104 

of CERCLA, 42 U.S.C. 9604. EPA's right of access to the property is providedforh Section I(M(e) of CERCLA, 42 U.S. C 9605(e), which provides entry 

ibr "decennining the need for response, or choosing ortaking any response action under this title, or oiherwise enforcing ihe provisions of the title." 

tlSO Ward Partcway, Suite 405 2505 N. 24*^ Street, Suite 308 4242 Medical Drive, Suite 4250 

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

«.­ .^n-.. cn^.^nn^ Phone : (210)822-9588 
Current Sample PrijPenovation Form 

Effective until April 2010. 

Confirmation of Receipt of Lead Pamplilet 

"Q I have received a copy of the pamphlet, Renovate Right: Important Lead Hazard 

Information for Families, 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. 

SigrWre.''«5f rlci^ent 

Self-Certificatio srtif n Option (for tenant-occupied dwellings only) — 

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

you may check the appropriate box below. 

Q Refusal to sign — 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 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 ol the pamphlet at the unit by sliding it 

under the door, -n 

/^r^- •e/e^s 

Printed name of personj:ertifying Attempted delivery 

date and time 

lead pamphlet delivery 

jMaMje^^T'— 

Signature of person celtifying lead pamphlet delivery 

7:xlS M IB' iV^ 

C>/)/^ceh^^ A^^ 

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). 
paint match form ,fj ^ , 2 

Paint matching form: . _

Property address: /^/ f /i7 3i^

BVID: 7^^ 0^ 0 

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Page 1 
ACCESS INFORMATION TRACKING SHEET 

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CONTACT DETAIL 

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... 5Vf7.7 daou-^c^ du t To <:7oryf\ yea^s^) Ca/7 A. ^^7^..v ^ 
Douglas County Account In|Mjrnatio n|Mjrne n Page 1 of 3 

• 

Douglas County, Nebraska Property Record - R0608120004 

Print Report 

NEW Feature - Paicel Dimensions available @ scale 0-50 ft west of 90lh St - VJeW On Ma p Information is valid as of 2008-6-19 Treasurer's Tax Report 

New Feature ->->- * Auto Sales Search 

Owner 

THOMPSON ERIC M 

ETAL 

1215 N 35 ST 

OMAHA NE 68131-0000 

Property Information 

Key Number: 0812 0004 06 

Account Type: Residential 

Parcel Number: 0608120004 

Parcel Address: 1215 N 35 ST 

OMAHA NE 68131-0000 

Legal Description: BEMIS PARK LOT 7 BLOCK 5 -EX N 95 FT- LT 7 52 X 52.5 

Value Informatio n 

Land Improvement Total 

2008 $1,700.00 $56,100.00 $57,800.00 

2007 $1,700.00 $56,100 00 $57,800.00 

2006 $1,700.00 $56,100.00 $57,800.00 

2005 $1,700.00 $56,100.00 $57,800.00 

2004 $1,700.00 $38,700.00 $40,400.00 

2003 $1,700.00 $38,700.00 $40,400.00 

Sales Informatio n 

Sales Date: 2002-09-20 

Deed Type: WD Book: i 2223 Page: 338 

Price: $62,000.00 

Grantor: 

Grantee: 

Valid/Invalid: valid 

Exclusion Reason: 

Sales Date: 1998-10-23 

Deed Type: Book: 2111 Page: 183 

Price: $46,000.00 

Grantor: 

u«._.// j 1, 
Douglas County Account Inimnatio t^Mjm£ n Page 2 of 3 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Valid 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

1997-08-06 

$35,000 00 

Book: I 2073 Page: \ 250 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Valid 

Land Information 

Acres 

0.06 

SF 

2756.0 

Units 

1.0 

Depth 

53.0 

Width 

52.0 

Vacant 

No 

Improvement

Building 1 

 Informatio n 

TW O STORY 

1215 N 35 ST 

F(rst Floor 

650 Osq ft. 

Second Floor 

550.0 sq. a 

Bvait Slack a II 

6&D D «q. II. 

CLICK TO ENtJ»RGE,IMAG^ 

Square Footage: 1300.0 

Perimeter 0.0 

Unit Type: 

Built As: 2 Story 

HVAC: Central Air to Air 

Exterior: Frame Siding 

Interior: Drywall 

Roof Cover: Composition Shingle 

Roof Type: Gambrel 

Floorcover: Allowance 

CtJC.K.ICLENLA8gjEJ.Ma&E 

Percent Complete: 100.0% 

Quality. , Average 

Condition: j Average 

Condo Square Footage: | 0.0 

Rooms: ; 6.0 

Units: i 1.0 

Baths: 1.0 

Bedrooms: > 3.0 

Stories: 2.0 

Foundation: 

U**n rf—, X T - l/Ar>^^n^^,r<^' ^ 
Douglas County Account InfiMjiation Page 3 of 3 

1 

1 \ Sprinkler Square Footage: j 0.0 

year 6u(7t Year 

Remodeled 

Percent

Remodeled

 Adjusted Year

 Built

 i oh„^i^=i A^ ^ 

 Physical Age 

1924 0 0% 1924 ; 84 

Detail Type Detail Description Units 

Appliance j Allowance 1.0 

Basement ! Bsmnt Block 8 ft 650.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Porch Slab Roof Ceil 1 120.0 

.—on/: ^nnnr\r\9 
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;;ejr;'-, 'T., ! con5 Results matching "Eric Thompson, Omaha, NE" 

Display: ® All (5) O Home (4) O Work{1) Sort by: " SelectEric M & Emily J 

SPONSORED LINKS Thompson Eric Thompson - More Info Available 

1215 N 35th St View Background Records - Eric Thompson 

Omaha, NE 68131-1310 Search School Yearbooks in Omaha NE 

(402) 933-4172 

Listing Details 

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Eric J & Candace A 

SPONSORED LINKS Thompson Eric Thompson - More Info Available 12712 Chandler CIr View Background Records - Eric Thompson 

Omaha, NE 68138-5905 Search School Yearbooks m Omaha NE 

(402)991-2802 

Listing Details 

Eric Thompson 

SPONSORED LINKS 6510 Pine St Eric Thompson - More Info Available 

Omaha, NE 68106-2853 View Background Records - Eric Thompson 

phone number unavailable Search School Yearbooks in Omaha NE 

Listing Details 

Nancy J & Eric M 

SPONSORED LINKS Thompson Age: 35-39 Nancy Thompson - More Info Available 15123 Adams St View Background Records - Nancy Thompson 

Omaha. NE 68137-3833 Search School Yearbooks in Omaha NE 

(402) 934-4163 

Listing Details 

Rick Thompson 

SPONSORED LINKS 700 S 72nd St Job title: unavailable Rick Thompson - More Info Available Omaha, NE 68114-4614 Company: Nebraska View Background Records - Rick Thompson Furniture Mart (402) 397-6100 Search School Yearbooks in Omaha NE 

Listing Details 

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..1 . _....! 1. o. /• i'\r\i'^r\no 
Prudent Property Close-Out Form (Lead-Based Paint Stabilization) 

SAID: 7S"Oh"n ^, , / 

Property Address: L^ 1 ^ AJ SS .3fOwner's Name: ^/n//i j linr.nin'yi n 

i 

Performance Standards/close-Out Criteria 

YES NO 

1. Was the entire structure(s) painted with the exception of the 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. 

2. Was all scraping and other preparattion worl< completed satisfactorily? / 

3. Were all required areas of the structure{s) primed as needed and painted with two top coats? / 

4. Was the paint products utilized equivalent to a 30 year product/quality? Z' 

b. Are all of the areas where contaminated materials have been spilled 

thoroughly vacuumed/ cleaned? y 

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? / 

Is the grass area that surrounds the structure(s) in reasonably good condition? r 

8. Are all items such as polyethylene sheeting, ladders, paint brushes, cones, barrier tape etc. 

properly removed? / 

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 te.mporatily re-located by the contractor 

that need to be moved back? / • 

11. 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 

/ ' 

Prudei^ Representative yc/LiyL^ i 7T':yio^Kj^ 

Date qS-O^