# f
TRANSMITTA L o f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R 

## SAI D # : 7lcFlr{ \ 

# Date : JZ/^/f ) Address : '\^f\ ( C 1 0 \ ^ ^~ ^ Stabilizatio n Contractor : Professiona l Environmenta l Engineer s Year : SOtLt l PAINT STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S Videoo f propert y (DVD ) 

# 7 1 / Executiv e Summar y SignedAcces s Agreemen t fo r

subjec t propert y Q 

## Pre-Renovatio n For msignedb y Propert y Owne r Pre-Renovatio n For mfo r

Occupant/Tenant , if applicable 

# 1 / Paintin g Agreemen t Q 

## Settlemen t documents (i.e. , fo r

damag e o r

t

o replac e plants , etc. ) Renovatio n Recordkeeping Checklis t signedb y CertifiedRenovato r Photograph s Satisfactor y close-ou t chec k

lis t signedb y Propert y Owne r Propert y close-ou t chec k

lis t signe db y EP A Propert y infonnatio n fro mDouglas Count y Assessor' s Office 

## 0 Hazar danalysis , i f

prepared Q 

## Safet y Audi t t i Othe r

(describe) :

~ ^ tJate {afte r file folder review ) 4037755 9 Superfun d

# 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 

# ''' ' TrSa'h t NEtan o ^

i^°^ | fS^fof ? Fa x (402 ) 504-328 1



### Lea dBas e Stabilizatio n Omaha , N e Clos e Ou t Repor t 201 1 SAID #2655 3 155 6 N . 19^ " S t

•Date s worked : 10/1 4 t o 10/1 4 201 1 •Pr e propert y condition : Hous e ha s mostl y viny l sidin g wit h painte dwoo dtrims , porc h an dfoundatio n areas . Pain t wa s flakin g of f

i n areas . •Problem s encountered : None . •Owne r request/concerns : N/ A •Inspection/closeou t dates . Owne r 10/27/201 1

### 201 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 

## Property Owne r Close-Ou t For m (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) SAID : 

# 2^55 3 Propert y Address : 

# /5^4-^ A ^ f Owner' s Name : /o4</<^/ ' <f// ^ 

# M ^ $ j ­ 250 5 Nort h 24 ^ Suit e 21 9 Omaha , N E 6811 0 (402 ) 504-468 8 Fax (402 ) 504-328 1



### Performanc e Standards/Close-Ou t Criteri a YE S N O I . Wa s th e entir e structure(s ) painte dwit h th e exceptio n ofth e stated , exclude dareas ? Thi s woul dinclud e paintin g o f othe r associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an d exterio r surface s o f garages . 

# sL 2 . Wa s al l scrapin g an d othe r preparatio n wor k

complete dsatisfactorily ? 3 . Were al l require darea s ofth e structure(s ) prime da s neede dan d painte dwit h tw o to p coats ? 4 . Wa s th e pain t product s utilize dequivalen t t o a2 5 yea r product/quality ? 5 . Ar e al l ofth e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y vacuumed / cleaned ? / 

### 6 . Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain 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 ? 7 . I s th e gras s are athat surround s th e structure(s ) in reasonabl y goo dcondition ? ^ 

### 8 . Ar e al l item s suc h a s polyethylen e 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 wa s don e b y th e contractor ? Any propert y damag e need s t o b e complete dprio r t o th e EPA Close-Out . 

## j / 10 . Ar e yo u satisfie dwdt h th e wor k

performed ? 

# IZ l 11 . Ar e ther e an y property item s that were temporaril y re-locate db y th e contracto r that nee dt o b e move dback ? 

# v / 12 . Ar e ther e an y (known ) lingerin g issue s wit h th e property owner(s ) that hav e bee n lef t unresolved ? Othe r Considerations/Property Owne r Discussions/Additiona l Wor k

that i s Required :


# /d/: 2 7 /^ / 4^^K»% ^ 

### opCTtyOwne r Signatur e Dat e
S^WMV ; 

# I s ii i 3 ^ Professional EriV^rorii^ianL'ta l Engineer s Signatur e Dat e

### Professiona l EnvironmerUa l Engineers : EP A Pain t Stabilizatio n 201 1 SAID # Propert y Addres s 

# \m o v ^ H 

# ^-v
­ stories / Sidin g typ e ^<? s LQ~^ . Transit e Woo d Viny l Meta l Stucc o Garage ?
Dat e acces s signe d Pre-vide o Ye s
\\- / \ \\J \ ti o 

# V

> 

# 1 Painted ? Where ? Ye s Sidin g Tri m N o

Pos t vide o Contracto rAssigne d Dat e starte d Weathe rCondition s it^/hTu ? ^O f 7^*// / f Dat e ende d /^/l-'/// /

Pain t use d O Prim e use d . S Pol y use d ^^' ^ 

### Problems/Issue s(effectiv e Apri l 2010 )


### RENOVATIO N RECORDKEEPIN G CHECKLIS T
Name o f Firm : /^3>ArL ^ ^pA^^'^V
- Date an dLocatio n o f Renovation : \^ T^ ^ ^* ^ Brie f Descriptio n o f Renovation : ^^•¥\h i l^ i ZJ^ / ^ Name o f Assigne dRenovator : C^/^/fc
- /-tc/tfTUf ^ Name(s ) o f Traine dWorkers : "pA^/ ^ "01- ^ f ^U* ^ ^^'- ^ Nam e o f Dus t Samplin g Technician , Inspector , and/o r Ris k Assessor , i f used : _ U Copie s o f renovato r an ddus t samplin g technicia n qualification s (trainin g certificates , certifications ) o n file. D Certifie drenovato r provide dtrainin g to worker s o n (chec k al l that apply) : D Postin g warnin g sign s D Settin g up plasti c containmen t barrier s D Maintainin g containmen t D Avoidin g sprea do f dus t t o adjacen t area s D Wast e handlin g D Post-renovatio n cleanin g U Tes t kit s use db y certifie drenovato r t o determin e whethe r leadwa s presen t o n component s affecte d b y renovatio n (identif y kit s use dan ddescrib e samplin g location s an dresults :

y Warnin g sign s poste da t entranc e to wor k

area . S'^Work are acontaine dt o preven t sprea do f dus t an ddebris . Q-^ndow s i n an dwithi n 2 0 fee t ofth e wor k

are aare close d -Spoor s i n an dwithi n 2 0 fee t ofth e wor k

area s ar e close dan dseale d BDoor s that mus t b e use di n th e work are aare covere dt o allo w passag e but preven t sprea do f dust . B^roun dcovere db y plasti c sheetin g extendin g 1 0 fee t fro mwor k

are a- plasti c anchore dt o th e buildin g an dweighte ddow n by heav y objects . 0 Ifnecessary , vertica l containmen t installe dto preven t migratio n o f dus t an ddebri s t o adjacen t /property . 0 Wast e containe don-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 )


### \ ^ 

### Wor k

sit e properl y cleane dafte r renovation . Al l chip s an ddebri s picke dup , protectiv e sheetin g misted , folde ddirty sid e inward , an dtape dfo r removal .
• "Wor k

are aHEP A vacuume dto get pain t chip s fro mgroun dsurface , ifnecessary . W Certifie drenovato r performe dpost-renovatio n cleanin g verificatio n (describ e results) :
I certif y upde r penalt y o f la

w tha t the above infomiatio n i s true an dcomplete . 

# /^A ^ 

# / o Nam e an dTitl e Dat e

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

# CON^ T FO RACCES S T O PROPERT Y OMAH A LEA D SIT E REMEDIA L ACTIO N - LEAD-BASE D PAIN T STABILIZATIO N PROPERT Y ID : 'JJ^O^K^r ^ PROPERT Y ADDRESS : If^^ O \ M \M . ""C^" ^

CELLPHONE : E-MAIL : OWNER' S ADDRES S I F DIFFERENT : TENANT' S NAM E I F APPLICABLE : DAYTIM E PHONE : CELLPHONE : E-MAIL : Professiona l Environmenta l Engineers , 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 dbasedpain t (LBP ) o n residentia l structure s a t anumbe r o f propertie s locate di 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 db y EP A contractors . Pain t stabilizatio n activitie s wil l include : scrapin g ofcracke do r flakin g LB P fro mstructures , applicatio n o f aprim e coa t an dtw o (2 ) coat s o f paint . Movin g part s o f window s an ddoor s ar e no t include dan dwil l no t b e addressed . You r 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 dhav e acces s t o thi s propert y fo r th e purpos e of stabilizin g lea d-base dpain t a s outline do n th e propert y 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 propert y followin g completio n o f lead-base dpain t stabilization , if th e soi l cleanu p ha s no t alread y bee n performed . I understan dtha t th e stabilizatio n contracto r can no t provid e assurance s tha t th e soi l cleanu p contracto r wil l b e boun dto . I furthe r understan dtha 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 soi l cleanu p a t m

y property . D Yes , I have ' 

# /o//¥// / Signatur e o f Propert y Owne r^ ' Date ' I full y understan dtha t b y signin g thi s Consen t fo r Access , (1 ) thi s acces s wil l remai n in effec t unti l th e wor k ha s bee n satisfactoril y completed , (2 ) tha t th e Propert y Owne r o r Tenant , i f applicable , wil l b e give n th e Housin g an dUrba n Developmen t (HUD ) an dEP A patnphlet , "Renovat e Right , Importan t Lea dHazar dinformatio n fo r 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 ) wil l abid e b y healt h an d safety guidanc e provide db y EPA , (5 ) wil l allo w photograph y ofpropert y befor e an dafte r th e pain t stabilizatio n work , (6 ) wil l b e contacte db y aP E representativ e approximatel y 4 8 hour s in advanc e o f startin g work , (7 ) agre e no t t o obstruc t o r tampe r wit h an y ofth e LB P stabilizatio n actions , an d(8 ) wil l participat e i n final propert y inspectio n an dsig n th e Completio n Agreemen t an d Propert y Owne r Satisfactio n Survey . Shoul dyo u hav e an y question s abou t th e plane dLea dBased-Pain t stabilizatio n activitie s fo r you r property , pleas e contac t Professiona l Environmenta l Engineers , Inc . Projec t Manager , NVilli e Cla y o r KeMe y Sander s A t 402-504-4688 . Genera l question s abou t th e Omah aLea dSit e cleanu p ca n b e directe dt o Pauiett aFrance-Isetts , EP A Remedia l Projec t Manage r 402-73J-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) . D Yes , I gran t acces s to m y propert 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 y propert y an d I wa s "Renovat e Right , Ipi^onan t Lea d Informatio n fo rFamilies , Chil d give n th e pamphle t "Renovat e Right , Importan t Lea d Car e Ffovideixanc^chools.' ' / , y Informatio n fo rFamilies , Child e Care Providers , an d Schools. " Signatur e Dat e SPECIA L INSTRUCTION S AND CONSIDERATION S

## PAIN T STABILIZATIO N PRE-PROPERT Y PAIN T MATC H ASSESSMEN T 

# /S'6( ^ /V . /<f - PROPERT Y ADDRESS : DATE : BVID : 0-C>^^' ^ **Pleas e indicat e changes , f everythin g i s to remai n th e sam e colo rwrit e "Match " i n colo rsectio n AREA(S ) TO B E PAINTED : 'pleas e indicat e area s o f expose d pain t 

### HOUS E PROPER : COLOR :
HOUS E TRIM : COLOR : 

# \.N)V\l^ .
GARAGE : COLOR : 

# W.\AV\nx \ '^^1 ^

l[^.-VnW\cV \ A\\ o IgcfvJ ^ GARAG E TRIM : COLOR :
PORCH : COLOR :
PORC H TRIM : COLOR : (COMPLET E 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 PAIN T I S ORDERED , I UNDERSTAN D 1 CA N NO T CHANG E TH E ABOV E SELECTE D COLORS : ^ ^ PROPERT Y OWNE R SIGNATURE : / P E ACCESO R SIGNATURE : 

# ^y^..^>^ ^ y^ ^

# Sampl e Pre-Renovatio n For m Thi s sampl e for mma y be usedb y firms t o document complianc e wit h the requirement s ofth e Federa l Lead-Base dPaint Renovation , Repair , an dPaintin g Program . Occupan t Confirmatio n 

# X^ amphle t Receip t
' ^ 1 hav e receive dacopy ofth e lea dhazar dinformatio n pamphle t infonnin g m e ofth e potentia l ris k ofth e f dexposur e fro mrenovatio n activit y t o be performedi n m y dwellin g unit . I receive dthi s the wor k

besan . 

# -r^ o m o f

Owner-occupant 

# ^Z.;.: . I y(/'cJ..j - /^_/-f/ / '• Signatur e o f Owner-occupan t ^ Signatur e Dat e Renovator'' s Self Certificatio n Optio n (fo r tenant-occupie ddwelling s only ) Instruction s to Renovator : I f th e lea dhazar dinformatio n pamphlet wa s delivere dbu t atenan t signature wa s not obtainable , you ma y check the appropriat e bo x below . Decline d- 1 certif y tha t 1 have mad e agoo dfait h effor t t

o delive r the lea dhazar dinfonmatio n pamphlet t o th e renta l dwellin g unit listedbelow a t the dat e an dtim e indicate dan dtha t th e occupant decline dt o sign the confirmatio n o f receipt . I fiirthe r certif y tha t I hav e lef t acopy ofth e pamphlet a

t the unit wit h the occupant . Unavailabl e for signature- I certif y tha t I have mad e agoo dfait h efTbr t t

o deliver the lea dhazar d informatio n pamphlet to the renta l dwellin g uni t liste dbelo w an dtha t the occupant wa s unavailabl e t o sign the confirmatio n o f receipt . I furthe r certif y tha t 1 hav e lef t acop y ofth e pamphlet a

t the unit b

y slidin g i t unde r the door o r b

y (fil l i

n ho w pamphlet wa s left) .

Printe dName o f Person Certifyin g Deliver y Attempte dDeliver y Dat e Signature o f Person Certifyin g Lea dPamphle t Deliver y

Uni t Addres s Not e Regardin g Mailin g Optio n —A s a

n alternativ e t o deliver y i n person , yo u ma y mail th e lea d hazar dinfomiatio n pamphlet t

o the owne r and/or tenant . Pamphle t must b

e maile da t leas t 7 day s befor e renovation . Mailin g mus t be documente db y acertificat e o f mailing fro mthe pos t office .

-25 ­

# 4 Dougla s County , Nebrasic a Propert y Recor d - R222930000 2 Prin t Reoor t Vie w Interactiv e GI S Ma p Informatio n i s vali d a s o f 2011-10-1 3 Treasurer' s Ta x Reoor t Ne w Featur e -»-•- > Subdivisio n Sale s Searc h Owne r HODG E RUB Y L ETA L 155 6 N 1 9 S T OMAH A N E 68110-000 0 Propert y Informatio n Ke y Number : 293 0 000 2 2 2 Accoun t Type : Residentia l Parce l Number : 222930000 2 Parce l Address : 155 6 FLORENC E BLV D / Ip^Xl f V v\

Q 0 1 \ OMAHA'NE68ri(H)00 0 ( 1 JOM ^ '^ ^

Ol, ) Lega l Pescription : SMfm S - E V - AD D LO T 3 BLOC K1 7 1/ 2 VA C ALLE Y AD J & 8 1 F T & AL L L T 2 & N33FTLT3BLK1 7 Valu e Informatio n Lan d frnprove/nent Tota l 201 1 $1,100.0 0 $59,100.0 0 $60,200.0 0 201 0 $1,100.0 0 $59,100.0 0 $60,200.0 0 200 9 $1,100.0 0 $59,100.0 0 $60,200.0 0 200 8 $1,100.0 0 $59,100.0 0 $60,200.0 0 200 7 $1,100.0 0 $42,300.0 0 $43,400.0 0 200 6 $1,100.0 0 $42,300.0 0 $43,400.0 0 Sale s Informatio n Sale s Date : 1992-12-1 8 Dee d Type : D BooJr : 1940 Page ; 57 0 Price : $22,000.0 0 Grantor : Grantee : Valid/Invalid : Vali d Excluao n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.3 2 14000. 0 1. 0 140. 0 100. 0 N o 1

# 4
Improvemen t Informatio n Buildin g 1

156 0 FLORENC E B O

f Fl« t Floo r ••" • 785. 0 »q . It , Scooni l Floo r 815. 0 s q f t

i6 g laaQM^ i 2 1/ 2 STOR Y UNFI N B^mn l Bloc k S t

CLIC KTO ENUVRG E IMAG E gugKTp^NtAR$Ei>/)^<; p Squar e Footage : 1600. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 2 1/ 2 Stor y Unfi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 8. 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 : Hi p Stories : 2. 5 Floorcover : 1 Allowanc e Foundation : [ Bloc k Sprinkle rSquar e Footage : i 0. 0 Yea rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 191 9 0 % 191 9 9 1 Deta/7 Typ e Detai l Descriptio n Unit s Ad d O n Unfinishe d Atti c W/floo r 200. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 785. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h En d Scree n 60. 0 Porc h Sla b Roo f Ceilin g 168. 0 Porc h Woo d Dec k 36. 0