TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: 733 Date: Oct. 7 

Address: 2617 Poppleton Ave. 

Remediation Contractor: Prudent Technologies Inc. Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

\ / Video of property (DVD) 

Q' Executive Summary 

0' Signed Access Agreement for subject property 

a' Painting Agreement 

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

D Photographs 

\y Satisfactory restoration signed by Property Owner 

D' Property close-out check list signed by EPA 

0^ Property information firom Douglas County Assessor's Office 

D 

D 

D 

Signatur&Z Date 
Date: 9/02/08 

PROPERTY SUMMARY 

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

Property Address: 2617 Poppleton Ave. SAID: 733 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: P.O. called & said the crew had broken her gutter. 

A.2 Issues Resolved: Corrected 9/02/08 

A.3 Unique Findings: None 

122A.4 Other Relevant Infomiation: None 

Access Date: 8/21/08 

Work Began Date: 8/28/08 

Closeout Date: 9/18/08 

Enclosures: 

1. Pre-Video 

2. Post-Video 

3. Property Status Form 

4. Signed Access Agreement 

5. Pre-Renovation Form 

6. Paint Match Form 

7. Tracking Form 

8. Douglas County Assessor Property Information Page 

9. EPA Property Closeout form 

10. Property Completion Agreement 

TECHNOLOCIES. INC. 
TECHNOLOGIES, INC. 

ENVIRONMENTAL & 

CONSTRUCTION 

SERVICES 

/) Property Status Form 

^hnHfpm^m Date: fhi/fif 

Phone:^/ ;M-/>5V 7 BVID: ,^^ ^ 

Address: 

Item# 

On Map 

Plant & Permanent Landscaping To Remain In Place 

Description and Location 

0if f lllifMI- H^^(' 

Vr^- ^7-^ y 

Pre-Existing Condition of Structures 

Does your Basement have a history of leaking? Yes — No — 

Item# 

On Map 

Description & Location 

8080 Ward Parkway, Suite 405 

Kansas City, MO 64114 

Phons: (816) 363-3703 

Fax:(816)363-3707 

Omaha, Nebraska 68110 

Phone: (402)604-1004 

Fax: (402)504-1005 

4242 Medical Drive. Suite 4250 

San Antonio, TX 78229 

Phone: (210)822-9588 

Pax: (210) 579-6577 
73^ 

Prudent Technologies, Inc. (Pnident) is under contract (Contract # EP-R7-08-07) with the U. S. 

Enviromnental Protection Agency (EPA) to stabilize Lead Based Paint (LBP\At a nuuAer ofproperties 

located in Omaha, Nebraska, including the property located at ^hl'7 ' rPppiCJp/ l /\u^ ' 

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

signing this form, tiie 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." 

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

Administrative Clerk for the Lead Based Paint Stabilization, Ms. Deborah Akerele-Jnhngnw^ 

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

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

office). 

PropetorAcoessGrantedBy: ^^^O^^'^n )OV"orh V J \ ^V ^ l^ -

I (ndasePrimNdne) 

Propeity Owner Signature: 

^ ^ (^ignadre) 7\ (Date) 

PROPERTY INFORMATION 

(To be comnlcted by reddcnt and/or property owner - please print) 

RESIDENT NAME: jP/ 9 rork y '^Ar^/'g - (^^^ ) Renter 

RESIDENT ADDRESS: ji/( ? / 7 FcJ-fep/^fo w rr^C 

IF RENTAL, PROPERTY OWNED BY; 

OWNER'S MAILING ADDRESS; 

OWNER'S TELEPHONE 

Sc\ in^ ^ 

NUMBER.HOME: «/to?5^-jfoi / ^'^^ U ^^ O "05^^ 7 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: ^ 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: ^ 

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

AUTHORITY FOR ENVIRO>tMENTAL RESPONSE ACTIONS; Tbe activicies to be implemented by EPA under this agreement are pursuant to Section 104 

of CERCLA. 42 U.SC. 9604. EPA's right of access to tfie property is provided for ii Section 104(e) of CERCLA, 42 U.S. C 9tiOS(e), which provides entry 

fisr "deteimiaingttK need for response, or choosing ortaking any response action under diis title, or otherwise enforcis^ tbe provisions of dw title." 

i080 Ward Partcway. Suits 405 2605 N. 24" Street, Suite 308 4242 Medical Drive, Suits 4250 

lansa s City. MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

•hone'(816) 363-^703 Phone: (402)504-1004 Phone: (210)822-8588 

ax- (816) 363-3707 Fax: (402) 604-1005 Fax: (210J 579-8577 
d,hlJ PoppM. 

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 anumbCT_of pro] 

located in Omaha, Nebraska, including the property located at /c^/C^f ^^ ^ " 

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

signing this form, tiie property owner grants permission to Prudent to perfonn 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" 

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-Jnlinignn^ 

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 (Soutii Omaha office) or (402) 991-9583 (North Omaha 

office). 

Property Access Granted By: 

Propeity Owner Signature: 

RESIDENT NAME: 

please Print Name) 

(Date) 

PROPERTY INFORMATION 

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

Owner Renter 

RESIDENT ADDRESS: 

IF RENTAL. PROPERTY OWNED BY: 

OWNER'S MAIUNG ADDRESS; 

OWNER'S TELEPHONE NUMBER-HOME: J L .WORK: J L 

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

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

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

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS; The activities to be in^lementiedby EPA under this agreement are puisuant to Secdon 104 

of CERCLA, 42 U.S.C. 9604. EPA's right of access to the property is provided for in Section 104(e) of CERCLA. 42 U.S. C 9605(e). whidi provides entry 

for "determining the need for response, or choosing ortaking any response action under this title, or otherwise enforcing the provisions ofthe title." 

080 Ward Parkway, Suite 405 

ansas City. MO 64114 

hone: (816) 363-3703 

ax: (816) 363-3707 

2506 N. 24* Street. Suite 308 

Omaha, Nebraska 68110 

Phone: (402)504-1004 

Fax: (402)504-1005 

4242 Medical Drive, Suite 4250 

San Antonio, TX 78229 

Phone: (210)822-9588 

Fax: (210) 579-6577 
Current Sample Pre^enovatlpn Form 

Effective until April 2010. 

Confirmation of Receipt of Lead Pamphlet 

pr I have received a copy of the pamphlet, Ftermvate Right: Important Lead Hazard 

Information for Families, Child Care Providers and Schools infomning me of 

the potential risl< of the lead hazard exposure from renovation activity to be 

perfomied in my dwelling unit. I received this pamphlet before the wort< began. 

P^rtee^^ame of reofojant ./ y , Date 

Signature of recipient I / / 

Self-Certification Option (for tenant-occupied dwellings onl ^ — 

If the lead pamphlet was 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, FtenavatB Fiight: Important Lead Hazard information for Families, 

Child Care f^vlders 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. 

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

deliver the pamphlet, Renovate Right important Lead Ha^ud infomiation for 

Families, Child Care providers and Sdioois, to the rental dwelling unit listed 

below and that the occupant was unavailable to sign the confimnation of receipt. 

I furth^ certify that I have left a copy of the pamphlet at the unit by sliding It 

Printed name of perBon certifying 

m^/?o/e 

Attempted delivery 

date and time 

lead pamphlet delivery 

Signature of penson certifying lead pamphlet delivery 

3//7 f^nff/rtnJl^ 

Unit Address 

Note Regarding Mailing Option — As an altemative 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 fiom the 

post ofiice). 
paint match form 

Paint matching form: . 

property address: ^/ 1 f^^j ^ ^ ^ ^ ^ 

BVID: 73^5 

Area: ^a/htf jH&f&y-^'X/zf/WoTor-. % , i l 

Explanation: 

Area: color: 

Explanation: ^ , i . ri ,^ 

Area: Color 

Explanation: 

Area: Color 

Explanation: 

I agree to these colors as listed, once painting 

starts I can not change these selected colors. 

Homeowner signature 

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Jidy 30: New Hcnising Bill Passed! 

Find out how it can benefit you! 

CGciXcurState (Xtcj.'four^te Cik^.Cntdit Type 

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Listing Detail 

V..., 

' ^ Dorothy M Kargle 

2617 Poppleton Ave 

Omaha, NE 68105 

(402) 932-8024 

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http://www.wWtepages.com/virth/map?firstname=Dorothy+M«&;country=US&state=NE&l... 8/19/2008 
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Square Footage: | 960.0 Percent Complete: ; 100.0% 

Perimeter I 0.0 

- - -1 

Unit Type; j 

Quality: : Average 

Condition: i Average 

BuiitAs: I 1 1/2 Story Unfin 

HVAC: ! Central Air to Air 

Exterior: { Frame Aluminum 

interior: Piaster 

Condo Square Footage: \ 0.0 

Rooms: j 5.0 

Units: I 1.0 

Roof Cover: 

Roof Type: 

Floorcover: 

••-r -

I Baths: : 1.0 

Composition Shingle 

Gable 

Allowance 

Bedrooms: ; 2.0 

Stories: i 1.5 

Foundation: i Blocl< 

Sprinlder Square Footage: > 0.0 

YearBuiit 

1912 

Year 

Remodeled 

Percent . 

Remodeled 

0% " 

Adjusted Year 

Built 

1912 

Physical Age 

' "'"'96 

Detall Type 

Add On 

Add On 

Appliance 

Basement 

I Detaii Description 

\ Fence Chain Link 

i Unfinished Attic W/floor 

j _ _ 

; Allowance 

•' Bsmnt Blocl< 8 ft 

Unita 

1.0 

384.0 

1.0 

960.0 

Fixture 

Fixture 

Garage 

Base Fixtures 

Bath Full 

Detached 

1.0 

1.0 

'180.0 

Porch End Solid Wall 192.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo .jsp?accountno=R22... 8/19/2008 
^^vrvUXb T JL XVW\JlUX t XI U Page 1 ot2 

Douglas County, Nebraska Property Record - R2218730000 

Infonnation is valid as of 2008-7-14 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-SO ft west of 90th St - Vle W OH Ma p 

Treasurer's Tax Report 

New Feature -*->- > Auto Sales Search 

Owner 

KARGLE ROBERT L 

ETAL 

2617 POPPLETON AVE 

OIMAHANE 68105-0000 

Property Information 

Key Number \ 1873 0000 22 

Account Type: I Residential 

Parcel Number i 2218730000 

Parcel Address: i 2617 POPPLETON AV 

; OMAHA NE 68105-0000 

Legal Description: , SHULLS 2ND ADD LOT 22 BLOCK 9 M 1/3 LTS 21 & 42 1/3 X 100 

Value Information 

' Land 

2008 

2007 

2006 

$4,000.00 

$4,000.00 

$4,000.00 

2005 

2004 

2003 

I improvement 

$50,800.06 

j _ $50,800.00 

i $5'2,300.bo 

Total 

$54,800^00 

$54,800.00 

$56,300.00 

$4,000.00 

$4,000.00 

$4^000.00 

$52.30000 

$52^300.66 

$52,300.00 

$56,300.00 

$56,300.00 

$56,300.00 

Land Information 

/lores j SF 

0.09 4200.0 

Unita Depth 

1.0 100.0 

Width Vacant 

42.0 No 

Improvement Information 

Building 1 

http://douglasne.mapping-online.com/DougIasCoNe/static/accoimtinfo.jsp?accountno=R22... 8/19/2008 
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Jun e 26,200 8 (latMt miitoo ) 

EPA Property CloseOut Form (Lead-Based Paint Stabilization) 

VMknd VcMch Piqpartj m Nmbm . 

jl^) ! Po/>jy.^. 1166 

OlHMI^IinMt, 

Perfermance Standards/gose-Ont Criteria j2» 

1. ViifI»catbestrootan(8)paiiMwtttOM«(cep(^ TUiwooU 

iiKtadepdntfaig of other iMsoctaied fbatom iDchiding fbcia, earns, 8 ^ 

bMM.o6liinBii>ndls.and<actwiorwiftoc8ofeBMM. 

1 Wai«nsonpin8iiidofhflrpiti»ntioniffQikoQ09l^ 

3. W<w lfl wquiwdaioMoflhBflnict«o(»)primBdM needed and pd ^ 

4* Walliepafttp(odaet8iitiUxedeqaivalenttoi30yearproduct/quality? 

9. itavdloftbe anas where cooninlnBtedmataiato have been s^^ 

d DidihBecntiactorcoliect/vacaimanBflMngandKrBpedpaIrt 

wrtwpi.dleyww8.iiia>Hpaece3sawa8aai«l»oitinovoawotfaw 

7. b1l»9«ssarealh8t8amniid8lhe8inictiira(i)innasoiiablygDodeoD^^ 

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11. An(hao«r90nown)Ihigeriog{ssaeswi(b1heimpettyomer(s)1luabaw 

O&er OonsidefatioDfl/Pioperty Owner Discussioos/Additional Work that is Requhred 

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Prudent Property Close-Out Form (Lead-Based Paint Stabilization) 

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Performance Standards/close-Out Criteria YES NO 

1. Was the entire $tructure(s) painted with the exception of the stated, excluded areas? This would 

indude painting of other associated features including fescia, eaves, siding, all trim, porches, box 

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

/ 

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

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

7 

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

5. Are all ofthe areas where contaminated materials have been spitted 

thoroughly vacuumed/ cleaned? 

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

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

7. Is the grass area that surrounds the structure{s) In reasonably good condition? 

8. Are all Items such as polyethyiene sheeting, ladders, paint brushes, cones, barrier tape etc. 

property removed? _ ^ 

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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 aose-Out. 

10. Are there any property items that were temporatiiy 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 Conslderatlons?property Owner Dlscusslons?Addltlonal Work that Is Required 

Prudent R< 

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