TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID: 23820 Date: 12/27/2008 

Address: 347 N 35 ST 

Remediation Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

4 • Video of property (DVD) 

1^ Executive Summary 

SI Signed Access Agreement for subject property 

a Painting Agreement 

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

D Photographs 

0 Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

[F Property information from Douglas County Assessor's Office 

D 

D 

D 

Signatur^ Date 

40310423 

iMilHIil 

Superfund 
PROPERTY SUMMARY 

Date: 12/27/08 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Month of: December 

Property Address: 347 N 35 ST I SAID: 23820 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: None 

A.2 Issues Resolved: None 

A.3 Unique Findings: None 

A.4 Other Relevant Information: None 

Access Date: 11/13/2008 

Work Began: 11/15/2008 

Closeout Date: 12/9/2008 

Enclosures: 

1. Pre-Video 

2. Post-Video 

3. Property Status Form 

4. Signed Access Agreement 

5. Pre-Renovation Form 

6. Paint Match Form 

7. Tracking Form 

8. Douglas County Assessor Property Information Page 

9. EPA Property Closeout form 

10. Property Completion Agreement 

TECHNOLOGIES. INC. 
ENVIRONMENTAL & 

CONSTRUCTION TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: -3^ ^ ^ ) 3S~ S f Date: M-] T-^ f 

Phone: J? / - g^^"^ BVID: -Z^fe O 

Plant & Pennanent Landscaping To Remain In Place 

Item# 

Description and Location 

OnM^ 

tOo r^ e 

Pre-Existing Condition of Structures 

Does your Basement have a history of leaking? Yes — 

Item# Description & Location 

On Map 

Property Owner Prudent Employee 

Signatmc SignaturcyO^—^<^2'^-^^ ' 

8080 VMrd PaikMny, Suite 408 2505 N. 2»7;;^lleet, Suits 308 4242 Medical Drive, Suits 4260 

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

Phona: (81«t 863-3703 
23f32) 

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 (LBP^ at a number of properties 

located in Omaha, Nebraska, includingtiie property located at ^Q ^ /O f ^ .S/~ 

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

signingtiiis form,ttie property owner grants permission to Prudent to perform activities related to LBP 

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

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

Ifyou 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 abouttiie Omaha Lead Site cleanup can be directed to the EPA 

Public Information Centers at (402) 731-3045 (Soutii Omaha office) or (402) 991-9583 (Nortii Omaha 

office). 

Property Access Granted By: fiSl^/i)/^ 0 // d B t C I "^ ^ f i 

Propeity Owner Signature: j/-/3-dr 

(Date) 

PROPERTY iNFORMATION 

CTo lie completed by resident and/or property owner - please print) 

RESIDENT MAME: C^A- T M K l H ^ ^H^l^b< i Owner f^ ^ 

RESIDENT ADDRESS: 3^ 7 /i J 6 '' ^ 5~ " S / ' 

IF RENTAI., PROPERTY OWNED BY: ^-^/ ? 7 v A r Q ^ A ) C T / [ /"^-^/ ^ 

OVWNER'SMAIUNG ADDRESS; / ^ I 7 A J /-^ / <3 6 5 / 

OWNER'S TELEPHONE NUMBER-HOME: 1^^ ^ .^'^A/'^^WORK : f \ ' 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: O NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER: __2 > 

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

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

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

of CERCLA, 42 U.S.C. 9604. EPA'sright of access to (he property is provided for in Section 104(e) of CERCLA. 42 U.S. C 9605(e). which provides entry 

for "determining the needfor response, or choosing ortaldng any response aclion under thistitle, or otherwise enforcing fce provisicns of the title." 

2505 N. 24*^ Street, Suite 308 4242 Medical Drive, Suite 4250 080 Ward Parkway, Suite 405 Omaha, Nebraska 68110 San Antonio, TX 78229 ".ansas City, MO 64114 

Phone: (402) 504-1004 Phone: (210)822-9588 hone: (816) 363-3703 

Fax: (402)504-1005 Fax: (210) 579-6577 ax: (816) 363-3707 
Effective urrtil April 2010. 

Confirmation of Receipt of Lead Pampliist 

^ have received a copy of the pampiilet, flenovate Right: Important Lead HazardInformation for Fanfftes, t^il d Cara F>ro\riders and Sc^wols informing me of • • 

tJie potentialri8l< of the lead hazard exposure from renovation activity to be 

perfbrmed in my dwelling unit. I received this pamphlet before the wori< began. 

Printed name of recipierit ^ , ^ Date 

Signature of recipient / ^ 

Seif-Certlfication Option (fbr tenant-occupied dwellings onl ^ — 

if the lead pamphlet was delivered but a tenant signature was not obtainable, 

you may chack the appropriate box below. 

• Refusal to sign — I certify that I have made a good faith effort to deliver tho 

paniphlSt, /%/V)v<at9 R^ h Important Lead Hazard Infonnation for Families, 

Child Care Providers and Schools, to the tentai dwelling unit listed below at the 

date and time indicated and that the occupant refused to sign the confirmation 

of rec^pt. I further certify that 1 have left a copy of the pamphlet at the unit with 

the occupant. 

Q Unavailable for signature — 1 certify that I have made a good faith effort to 

deliver the pamphlet. Renovate Ftiglht Important Lead Ham d Information for 

FamiSes, C/wtof Cae pmwders and Schods, to the rental dwelling unit listed 

below and thiat the occupant was unavailable to sign the confirmation of receipt. 

I ^irther certify tiiat I have left a copy of the pamphlet at tlie unit by sliding it 

underthedoor. 

Get-oAi) QulA^xv I f- i 3 "OS oS%0 

Printed name of person certifying Attempted delivery 

date end time 

lead pamphlet delivery 

HuiJrx-y-— 

Signature of person certifying lead pamphlet delivery 

rJrv-o->vo«^ J^ g c=>^i^ I 

UnitAddress 

Note Regarding Mailing Option — As an altemative to delivery in person, you 

may mall the lead pamphlet to the owner and/or tenant. Pamphlet must be mailed 

at least 7 days before renovation (Document with a certificate of maifing from the 

postoffice). 
Vvjcy 

paint match form- Paint maitching form" 

Property address: 3^f7 JO- 3S^^^ 5f_ BVID: p^^^o 

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Page 2 of2 

CUCK TO ENU\RG^^ IMAGE 

Square Footage: ; 1156.0 

Perimeter ; 0.0 

Unit Type: ' 

Built As: I 1 1/2 Story Unfin 

HVAC: ! Central Air to Air 

Exterior: ! Frame Siding 

interior: ! Drywall 

Roof Cover: [ Composition Shingle 

Roof Type: j Gable 

Floorcover: j Allowance 

1 

Year Built 

1925 

,,..4.. 

Year 

Remodeled 

Percent 

Remodeled 

" 0% 

Detail Type ; Detail Description 

Appliance \ Allowance 

Basement i Bsmnt Block 8 ft 

Fixture ' Base Fixtures 

Fixture fBath Full 

Garage ! Detached 

Porch ! End Screen 

Porch ; Slab Roof Ceil 

Porch i Wood Deck 

User ! Attic 1/2 Finish 

1 1/2 Story Unfin 

347 N 35 St Mij^rv; 

ttifWBlMkeit 

i rifst F)r.or i < 155,0 »B R, 

Percent Complete: ; 100.0% 

Quality: ; Average 

Condition: ; Average 

Condo Square Footage: i 0.0 

Rooms: : 7.0 

Unite: 1.0 

TM Baths^lj.O 

Bedrooms: ] 3.0 

Stories: 1.5 

Foundation: i Block 

Sprinkler Square Footage: \ 0.0 

Adjusted Year Physical Age Built 

1925 83 

Units 

1.0 

1156.0 

J.O 

1.0 

2I6.O 

36.0 

112,0 

200.0 

227.0 

http://douglasne.mapping-onlme.com/DouglasCoNe/static/accountinfo.jsp?accouiitno=R13... 9/24/2008 
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3 Results matching "347 N 35 St, Omaha, NE" 

Sort by: - SelectCatherine M Shields 

SPCt<SOH-iD •; :NK? 

Lookup Bacltorour.'tt Info for Catherine­ 347 N 35th St Houseliold: Tyrone, John 

Siiields. 

Omaha, NE 68131-2403 Sea Wha: Cathr.ririB Siirglds's Hcnx> is Worh 

(402) 344-3041 Firtd Schooi Information on Catherine Shielas 

Listing Details lot ;v\fvu;r,s 

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John Shields 

Lookup Background Info for Joiin Shieids. 347 N 35th St 

hiouseiioid: Catherine, 

Tyrone 

Se3 W.hat Jolm ShieSds s Ho^ie is VVofth Omaha, NE 68131-2403 Pind Schoo: Ipformation on John Shieids 

(402) 344-8041 

^(!rsf\iii;y;s" Listing Details 

See What John Shleids's Home i? Worth 

Tyrone Shields 

\ r>,>l<;^ip Ry^fcnfpund Irifo for Tyrone Shields. 347 hiousehoid: Catherine, N 35th St SftG What fvrorie SI'ieids's Hoir.e. ia Wnrth John Omaha, NE 68131-2403 

Find Scficol irfotmation on Tyrone Shielda 

(402) 344-8041 

iicriNrVviXT^V 

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Privacy Policy Legal Notice sro Terms ..)nn«r which ihis aorvicfi is r.ioviOcci to j 

M^cicsort WapPoln; IgimsjsfJJse and EovKy-SJaSgroent. 

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Douglas County, Nebraska Property Record - R1304540000 

Print Report 

Information Is valid as of 2008-9-4 *'^*' ''*'*"'*" P^f^' Dimensions available @ seals 0-50 fl west of 90th St - View on Map 

' Treasurer's Tax Report 

! New Feature -^ -^ -> Auto Sales Search 

Owner 

SKRADETAL 

1817 N 100 ST 

OMAHA NE 68114-0000 

Property Informatio n 

Key Number: 0454 000013 

Account Type: i Residential 

Parcel Number: ' 1304540000 

Parcel Address: j 347 N 35 ST 

; OMAHA NE 68131-0000 

Legal Description: ' HAWTHORNE ADD LOT 28 BLOCK 3 N 40 W 90 FT LT 27 & S 5 W 90 FT 45 X 90 

Value Information 

I Land ; Improvement ' Total 

2008 I $5,300.00 I $64,700.00 $70,000.00 

2007 I $5,300.00 $51,66o.OO ' 556,900.00 

2006 i $5,306.06 i $51,600.00 \ $56,900.00 

2005 ' $5,300.00 ' $51,600.00 $56,900.00 

2004 ! $5,300.00 ; $51,600.00 $56,900.00 

2003 I $5,300.00 \ $36,300.00 $41,600.00 

Land Information 

Acres ] SF i Units i Depth \ Width '• Vacant 

0.09 ; 4050.0 i 1.0 ; 90.0 j 45.0 No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R13... 9/24/2008 
Pruddnt Property Close-Out Form ( Lead-Based Paint Stabilization) 

SAID: :23fA6 ^ 

Property Address: ^^" ^ P ^-T 5 ^ 

Owner's Name: HS^Wl^JP . ^ly^ff ^ 

Perfor^mance Standards/close-Out Criteria 

1. Wasthe 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 

bearws, columns, rails, and exterior surfaces of garages. 

2. Was all scraping and other preparattion work completed satisfactorily? 

3. Wereiall 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? 

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

thordughly vacuumed/ cleaned? 

6. Did the contractor collect/vacuum all falling and scraped paint chips on the entire property, 

roacvyays, alleyways, public access areas and also remove any other generated debris? 

7.

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

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

properly removed? 

Is there any evidence of property damage that was done by the contractor? Any property damage 

needi to be completed prior to the EPA Close-Out. 

10. Are there any property items that were temporatily re-located by the contractor 

that rieed 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 

Prudent Representative Signature: 

Date f^'<:^'aS' 

Property/Owner Signature: J^/i^Mt/yA ^ 

I 

Date: i/J-f-^? 

YES NO 

/ 

X 

y 

y 

y 

y 

X 

k 

/ 

X 

X