f 

TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID #: 7lcFlr{ \ Date: JZ/^/f ) 

Address: '\^f\( C 10 \ ^ ^~ ^ 

Stabilization Contractor: Professional Environmental Engineers Year: SOtLtl 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

Videoof property (DVD) 7

1 / 

Executive Summary 

Signed Access Agreement for subject property 

Q Pre-Renovation Form signed by Property Owner 

Pre-Renovation Form for Occupant/Tenant, if applicable 

1/ Painting Agreement 

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

Renovation Recordkeeping Checklist signed by Certified Renovator 

Photographs 

Satisfactory close-out check list signed by Property Owner 

Property close-out check list signed by EPA 

Property infonnation from Douglas County Assessor's Office 

0 Hazard analysis, if prepared 

Q Safety Audit 

ti Other (describe): 

~ ^ tJate 

{afterfile folder review) 

40377559 

Superfund 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC.

"Providing cost-effective environmental solutions" ^

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

''' ' TrSa'ht NEtano 

^ i^°^| fS^fof? 

 Fax (402) 504-3281 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

2011 

SAID# 26553 

1556 N. 19^" St 

• Dates worked: 10/14 to 10/14 2011 

• Pre property condition: House has mostly vinyl siding with painted wood trims, porch 

and foundation areas. Paint was flaking off in areas. 

• Problems encountered: None. 

• Owner request/concerns: N/A 

• Inspection/closeout dates. Owner 10/27/2011 
2011 

PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

"Providing cost-effective environmental solutions" 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Property Owner Close-Out Form 

(Lead-Based Paint Stabilization EPA Contract EP-R7-08-06) 

SAID: 2^55 3 

Property Address: /5^4-^A ^f 

Owner's Name: /o4</<^/' <f//^ M ^ $ j ­

2505 North 24^ Suite 219 

Omaha, NE 68110 

(402) 504-4688 

Fax (402) 504-3281 

Performance Standards/Close-Out Criteria YES NO 

I. Was the entire structure(s) painted with the exception ofthe 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. sL 

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

3. Were all required areas ofthe structure(s) primed as needed and painted with two top 

coats? 

4. Was the paint products utilized equivalent to a 25 year product/quality? 

5. Are all ofthe areas where contaminated materials have been spilled thoroughly 

vacuumed/ cleaned? / 

6. 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? 

7. Is the grass 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? 

9. Is there any evidence ofproperty damage that was done by the contractor? Any property 

damage needs to be completed prior to the EPA Close-Out. j / 10. Are you satisfied wdth the work performed? IZl 

11. Are there any property items that were temporarily re-located by the contractor that 

need to be moved back? v/ 

12. 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: 

4^^K»% ^ /d/:2 7 /^ / 

opCTtyOwner Signature Date 

S^WMV Is ; iii 3 ^ Professional EriV^rorii^ianL'tal Engineers Signature Date 
Professional EnvironmerUal Engineers: EPA Paint Stabilization 2011 

SAID# 

Property Address \mo v^ H ^-v­ stories/ Siding type ^<?s LQ~^. Transite Wood Vinyl Metal Stucco 

Garage?

Date access signed

Pre-video

 Yes

 \\- / \ 

 \\J \

 tio

V

 > 

1 

 Painted? 

Where? 

Yes 

Siding 

Trim 

No 

Post video 

Contractor Assigned

Date started

Weather Conditions 

 it^/hTu ? 

 ^O f 7^*// / f Date ended /^/l-'/// / 

Paint used O 

Prime used . S 

Poly used ^^' ^ 

Problems/Issues 
(effective April 2010) 

RENOVATION RECORDKEEPIN G CHECKLIS T 

Name of Firm: /^3>ArL ^ ^pA^^'^V -

Date and Location of Renovation: \ ^ T^ ^ ^*^ 

Brief Description of Renovation: ^^•¥\h i l^i ZJ^ / ^ 

Name of Assigned Renovator: C^/^/fc- /-tc/tfTUf^ 

Name(s) of Trained Workers: "pA^/^ "01- ^ f ^U* ^ ^^'- ^ 

Name of Dust Sampling Technician, Inspector, and/or Risk Assessor, if used: _ 

U Copies of renovator and dust sampling technician qualifications (training certificates, certifications) on file. 

D Certified renovator provided training to workers on (check all that apply): 

D Posting warning signs D Setting up plastic containment barriers 

D Maintaining containment D Avoiding spread of dust to adjacent areas 

D Waste handling D Post-renovation cleaning 

U Test kits used by certified renovator to determine whether lead was present on components affected by 

renovation (identify kits used and describe sampling locations and results: 

y Warning signs posted at entrance to work area. 

S'^Work area contained to prevent spread of dust and debris. 

Q-^ndows in and within 20 feet ofthe work area are closed 

-Spoors in and within 20 feet ofthe work areas are closed and sealed 

BDoors that must be used in the work area are covered to allow passage but prevent spread of dust. 

B^round covered by plastic sheeting extending 10 feet from work area - plastic anchored to the 

building and weighted down by heavy objects. 

0 Ifnecessary, vertical containment installed to prevent migration of dust and debris to adjacent 

/property. 

0 Waste contained on-site and while being transported off-site. 

Renovation Recordkeeping Checklist Omaha Lead Site 
(effective April 2010) 

\ ^Work site properly cleaned after renovation. 

All chips and debris picked up, protective sheeting misted, folded dirty side inward, and taped for 

removal. 

• "Work area HEPA vacuumed to get paint chips from ground surface, ifnecessary. 

W Certified renovator performed post-renovation cleaning verification (describe results): 

I certify upder penalty of law that the above infomiation is true and complete. 

/^A^ /o 

Name and Title Date 

Renovation Recordkeeping Checklist Omaha Lead Site 
CON^ T FOR ACCESS TO PROPERTY 

OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID: 'JJ^O^K^r ^ PROPERTY ADDRESS: If^^ O \M \M. ""C^"^ 

CELLPHONE: E-MAIL: 

OWNER'S ADDRESS IF DIFFERENT: 

TENANT'S NAME IF APPLICABLE: 

DAYTIME PHONE: 

CELLPHONE: E-MAIL: 

Professional Environmental Engineers, Inc. (PE) is under contract (#EP-R7-08-06) with the U.S. Environmental Protection 

Agency (EPA) to stabilize lead based paint (LBP) on residential structures at a number of properties located in Omaha, 

Nebraska. The paint stabilization work is being done to protect the soil cleanups that are being performed by EPA contractors. 

Paint stabilization activities will include: scraping ofcracked or flaking LBP from structures, application of a prime coat and two 

(2) coats of paint. Moving parts of windows and doors are not included and will not be addressed. 

Your cooperation is requested in giving permission to this EPA contractor (PE) to enter and have access to this property for the 

purpose of stabilizing lead -based paint as outlined on the property identified above. 

By signing this document I agree to allow an EPA contractor to conduct a soil cleanup at my property following completion of 

lead-based paint stabilization, if the soil cleanup has not already been performed. I understand that the stabilization contractor 

can not provide assurances that the soil cleanup contractor will be bound to. I further understand that the soil cleanup 

contractor will make all reasonable efforts to address concerns that I, as the property owner, may have regarding soil cleanup at 

my property. 

D Yes, I have' /o//¥/// 

Signature of Property Owner ^ ' Date' 

I fully understand that by signing this Consent for Access, (1) this access will remain in effect until the work has been 

satisfactorily completed, (2) that the Property Owner or Tenant, if applicable, will be given the Housing and Urban Development 

(HUD) and EPA patnphlet, "Renovate Right, Important Lead Hazard information for Families, Day Care Providers, and 

Schools", (3) the Property Owner or tenant will remove all obstructions from surfaces to be painted, (4) will abide by health and 

safety guidance provided by EPA, (5) will allow photography ofproperty before and after the paint stabilization work, (6) will be 

contacted by a PE representative approximately 48 hours in advance of starting work, (7) agree not to obstruct or tamper with 

any ofthe LBP stabilization actions, and (8) will participate in final property inspection and sign the Completion Agreement and 

Property Owner Satisfaction Survey. 

Should you have any questions about the planed Lead Based-Paint stabilization activities for your property, please contact 

Professional Environmental Engineers, Inc. Project Manager, NVillie Clay or KeMey Sanders At 402-504-4688. General questions 

about the Omaha Lead Site cleanup can be directed to Pauietta France-Isetts, EPA Remedial Project Manager 402-73J-2454, or 

the EPA Public Information Centers at 402-991-9583 (North Omaha office) or 402-731-3045 (South Omaha office). 

D Yes, I grant access to my property and was given the pamphlet D No, I do not grant access to my property and I was 

"Renovate Right, Ipi^onant Lead Information for Families, Child given the pamphlet "Renovate Right, Important Lead 

Care Ffovideixanc^chools.'' / , y Information for Families, Childe Care Providers, and Schools." 

Signature Date 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

/S'6(^ /V. /<f- PROPERTY ADDRESS: DATE: 

BVID: 0-C>^^' ^ 

**Please indicate changes, f everything is to remain the same color write "Match" in color section 

AREA(S) TO BE PAINTED: 

'please indicate areas of exposed paint 

HOUSE PROPER: COLOR: 


HOUSE TRIM: COLOR: \.N)V\l^ . 

GARAGE: COLOR: 


W.\AV\nx\ '^^1 ^ l[^.-VnW\cV\ A\\o IgcfvJ^ 

GARAGE TRIM: COLOR: 


PORCH: COLOR: 


PORCH TRIM: COLOR: 

(COMPLETE ALL SECTION, YES, NO, OR NON-APPLICABLE) 

I AGREE TO THE COLORS LISTED ABOVE. ONCE THE PAINT IS ORDERED, 

I UNDERSTAND 1 CAN NOT CHANGE THE ABOVE SELECTED COLORS: 

^ ^ 

PROPERTY OWNER SIGNATURE: / PE ACCESOR SIGNATURE: 

^y^..^>^ ^ y^ ^ 
Sample Pre-Renovation Form 

This sample form may be used byfirms to document compliance with the requirements ofthe Federal 

Lead-Based Paint Renovation, Repair, and Painting Program. 

Occupant Confirmation 

X^amphlet Receipt 

'^ 1 have received a copy ofthe lead hazard information pamphlet infonning me ofthe potential risk ofthe 

fd exposure from renovation activity to be performed in my dwelling unit. I received this 

the work besan. 

-r^o m 

of Owner-occupant 

^Z.;.: . I y(/'cJ..j- /^_/-f// '• 

Signature of Owner-occupant ^ Signature Date 

Renovator''s Self Certification Option (for tenant-occupied dwellings only) 

Instructions to Renovator: If the lead hazard information pamphlet was delivered but a tenant signature was not 

obtainable, you may check the appropriate box below. 

Declined - 1 certify that 1 have made a good faith effort to deliver the lead hazard infonmation pamphlet 

to the rental dwelling unit listed below at the date and time indicated and that the occupant declined to 

sign the confirmation of receipt. I fiirther certify that I have left a copy ofthe pamphlet at the unit with 

the occupant. 

Unavailable for signature-I certify that I have made a good faith efTbrt to deliver the lead hazard 

information pamphlet to the rental dwelling unit listed below and that the occupant was unavailable to 

sign the confirmation of receipt. I further certify that 1 have left a copy ofthe pamphlet at the unit by 

sliding it under the door or by (fill in how pamphlet was left). 

Printed Name of Person Certifying Delivery Attempted Delivery Date 

Signature of Person Certifying Lead Pamphlet Delivery 

Unit Address 

Note Regarding Mailing Option — As an alternative to delivery in person, you may mail the lead 

hazard infomiation pamphlet to the owner and/or tenant. Pamphlet must be mailed at least 7 days 

before renovation. Mailing must be documented by a certificate of mailing from the post office. 

-25­
4 

Douglas County, Nebrasica Property Record - R2229300002 

Print Reoort 

View Interactive GIS Map Information is valid as of 2011-10-13 Treasurer's Tax Reoort 

New Feature -»-•- > Subdivision Sales Search 

Owner 

HODGE RUBY L 

ETAL 

1556 N 19 ST 

OMAHA NE 68110-0000 

Property Information 

Key Number: 2930 0002 22 

Account Type: Residential 

Parcel Number: 2229300002 

Parcel Address: 1556 FLORENCE BLVD / Ip^Xl f Vv \ Q 0 1 \ 

OMAHA'NE68ri(H)000 ( 1 JOM ^ '^^ Ol, ) 

Legal Pescription: SMfmS -E V- ADD LOT 3 BLOCK 17 1/2 VAC ALLEY ADJ & 8 1 FT & ALL LT 2 & 

N33FTLT3BLK17 

Value Information 

Land frnprove/nent Total 

2011 $1,100.00 $59,100.00 $60,200.00 

2010 $1,100.00 $59,100.00 $60,200.00 

2009 $1,100.00 $59,100.00 $60,200.00 

2008 $1,100.00 $59,100.00 $60,200.00 

2007 $1,100.00 $42,300.00 $43,400.00 

2006 $1,100.00 $42,300.00 $43,400.00 

Sales Information 

Sales Date: 1992-12-18 

Deed Type: D BooJr: 1940 Page; 570 

Price: $22,000.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Excluaon Reason: 

Land Information 

Acres SF Units Depth Width Vacant 

0.32 14000.0 1.0 140.0 100.0 No 

1 
4 

Improvemen t Informatio n 

Building 1 

1560 FLORENCE BO 

f Fl«t Floor 

••"• 785.0 »q. It, Scoonil Floor 

815.0 sq ft 

i6g laaQM^i 

2 1/2 STORY UNFIN B^mnl Block S t 

CLICK TO ENUVRGE IMAGE gugKTp^NtAR$Ei>/)^<;p 

Square Footage: 1600.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

Built As: 2 1/2 Story Unfin Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 8.0 

Exterior: Frame Vinyl Units: 1.0 

Interior: \ Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 4.0 

Roof Type: Hip Stories: 2.5 

Floorcover: 1 Allowance Foundation: [ Block 

Sprinkler Square Footage: i 0.0 

Year Built 

Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1919 0% 1919 91 

Deta/7 Type Detail Description Units 

Add On Unfinished Attic W/floor 200.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 785.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Porch End Screen 60.0 

Porch Slab Roof Ceiling 168.0 

Porch Wood Deck 36.0