TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID: 27392 Date: 01/15/2009 

Address: 2615 PATRICK 

Stabilization Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERT Y FILE FOLDER DOCUMENTS 

2f Video of property (DVD) .' 

Bf Executive Summary 

Sf Signed Access Agreement for subject property 

of Painting Agreement 

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

D Photographs 

H Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

(Z Property infonnation from Douglas County Assessor's Office 

D 

D 

D 

Signatujfe Date 

40307758 pmflii 

Superfund 
PROPERTY SUMMARY 

Date: 01/15/2009 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Month of: JANUARY+ 

Property Address: 2615 PATRICK SAID: 27392 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered; 

A.2 Issues Resolved: 

A.3 Unique Findings: NONE. 

A.4 Other Relevant Information: 

Access Date; 10/18/08 

Work Began: 11/04/08 

Closeout Date: 11/21/08 

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 

TECHNOLOGIES, INC. 
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EI4VIR0NMENTAL& 

\ CX)NSTrRUCTION TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: ^^yf ^ l^oiOLv cVC. IVue ^'^' ' W^l^i-O ^ 

Phone: ^/" 7 'OCiCiLO BVID: Q"!^ ^ ^ 

Plant & Pennanent Landscaping To Remain In Place 

Item# 

Description and Location 

On Map 

Pre-Existing Condition of Structures 

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

Item# Description & Location 

On Map 

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Property Owner/'xj/ Prudent Emplo 

Signature: Signature: 

8080 Vtard Pailnray, Suite 40S 2506 N. 24** Streat, Sulta 308 U Medical Drive, Sulta 4260 

Kansas City, MO 64114 Omaha, Nabraska 88110 San Antonio, TX 78229 

Phona: (818) 383^703 
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Prudent Technologies, Inc. (Prudent) is under contract (Contract # EP-R7-08-07) wiflitiie U. S. 

Environmental Protection Agency (EPA) to stabilize Lead Based Paint (LBl^at a number of properties 

located in Omaha, Nebraska, including the property located at ^LQJ ^ V-^3cic(U cJi/^ \-tJQ. 

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

signing Ms form,titie property owner grants permission to Prudent to perform activities related to LBP 

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

verifies that they have received tiie 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 totiie EPA 

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

office). 

FlopetQr Aooeu Ormted By: Mu/^ /. SZ r/— 

(Please Print Name) 

Propeity Omwr Signature: /^4^ ^ 

PROPERTY INFORMATION 

CFo Iw coBpIct^bjrrei Meat and/orjanpcr^LeiiiBcr ­ please print) 

RESIDENT NAME:. Ranter 

RESIDENT ADDRESS: Jki^/'S 'T^^h^^^^ 

IF RENTAL, PROPERTY OWNED BY: 

OVmERTSMAIUNG ADDRESS; 

OWNER'S TELEPHONE NUMBER • HOME 

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: (I.E DOOS. ENTRY GATES, ETC.) / ^^f^-^^^ 

AUTHORTfY FOR ENVIRONMENTAL RESPONSE ACTIONS: The actNides to be iinpleincnted by EPA underlies agreement are purtnant to SectioD 104 

of CEROA. 42 U.S.C 9604. EPA'sright of access to the propetty is provided fbr io Section 104(c) of CERCLA. 42 U.S. C 9605(eX which provides entiy 

for "detennining Oe needforresponse, or ctaoosing ortaldng anyresponse action imder this title, or otherwise enforcing <^ 

i080 Ward Pariomy, Suite 405 2505 N. 24*^ Street, Suite 308 4242 Medical Drive, Suite 4250 

'.ansae city, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

•hone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9888 

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Current Sample Pre-fienovation Form 

EffacSve until April 2010. 

Confinnation of Receipt of Lead Pamphlet 

I have received a copy of the pamphlet. Renovate RighV Important Lead Hazanj ^ Infomrntion for FamSes, Child Care Pro\Mers and Schools informing me of 

the potential ri * of the lead hazard exposure from renovation activity to be 

performed in my dwelling uniU received this pamphlet before the work began. 

Self-Certiflcati6n Option (for tenant-occupied dwellings only) — 

If the lead pampMet was delivered but a tenant signature was not obtainable, 

you may checi< the appropriate box below. 

• Refusal to sign — I certily that I have made a good faith effort to deliver the 

pamphlet, Renovate Right: Important Lead Hazard Infonnation for FamSes, 

Chiki 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. 

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

deliver the pamphlet, Ftenovate Right Important Laad Hazard Infonnation for 

FemSes, ChSd 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 ce|$fy that I have left a copy of the pamphlet at the unit by sliding it 

under 1 

Printed nam^B eooff perso personn certiiyin certiiying 

g Attempted delivery 

date and time 

lead pamphlet delivery 

Signature of iiying lead pamphlet delivery 

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Unit Address . 

Note Regarding Mailing Option — As an aitemat'rve to delivery In person, you 

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

at least 7 days belbre renovation (Document with a certificate of ma'ling from the 

|308t office). 
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Page 1 of 2 

Douglas County, Nebraska Property Record - R2000850000 

i 

I Print Report I NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 90th St - ViCW On Ma p Information is valid as of 2008-9-4 

Treasurer's TaxBe^ort 

New Feature -»-»- * Auto^Saies Search 

Owner 

SCOTT NANCY L 

2615 PATRICK AVE 

OMAHA NE 68111-0000 

Property Informatio n 

Key Number: 0085 0000 20 

Account Type: Residential 

Parcel Number: 2000850000 

Parcel Address: 2615 PATRICK AV 

OMAHA NE 68111-0000 

Legal Description: PATRICKS ADD LOT 4 BLOCK 4 W 40 FT 

Value Information 

Land Improvement Total 

2008 $1,100.00 $31,700.00 $32,800.00 

2007 $1,100.00 $31,700.00 $32,800.00 

2006 £1,100,00 $31,700.00 $32,800.00 

2005 $1,100.00 $31,700"00" _$32,800.00 

2004 

2003 

$1,100.00 

$1,100.00 

-). $10,200.00 

$10,200.00 

$11,300.00 

$11,300.00 

Sales Information 

Sales Date: 2006-08-04 

Deed Type: WD j 

Price: \ $37,900.00 

Grantor: Rjch Tamara M 

Grantee: Scott H Nancy L 

Valid/Invalid: Valid 

Exclusion Reason: 

Book: 2006 Page: 092094 

Land Information 

Acres SF 

0,12 """ 5280,0 

Units 

1,0 

Depth 

132,0 

WIdm 

40,0 

Vacant 

No 

Improvement Informatio n 

http://douglasne.mapping-online.comi/DougIasCoNe/static/accountinfo.jsp?accountno=R20,,. 10/1/2008 
Page 2 of 2 

Building 1 

Square Footage; 

Perimeter 

Unit Type: 

Built As: 

HVAC: 

Exterior: 

Interior: 

Roof Cover: 

Roof Type: 

1081.0 

o.o""" 

1 1/2 Story Fin 

Central Air to Air 

Frame Siding 

Drywall 

Composition Shingle 

Gable 

Floorcover: I Allowance 

Year Percent Year Built Remodeled Remodeled 

1913 

Detail Type 

Add On 

Appliance 

Appliance 

Basement 

Fixture 

Fixture 

Porch 

Porch 

User 

0% 

Detail Description 

Stone Trim 

Allowance 

Security System 

Bsmnt Block 8 ft 

Base Fixtures 

Bath Full 

\ End Screen 

I End Screen 

Attic Full Finish 

2615 Patrick Av 

'•Ti-:' Si d 

...—« J 

1 11^2 Srcfv Fin 

CLICK TO JNyaLRGE IMAGE 

Percent Complete; 100.0% 

Quality: ; Average 

Condition: Fair 

Condo Square Footage: ^ 0.0 

Rooms: 6.0 

Units: 1.0 

Baths: i 1.0 

Bedrooms: 2£__ Stories: {I 

Foundation: Block 

Sprinkler Square Footage: 0.0 

Adjusted Year Physical Age Built 

1913 95 

Units 

150.0 

1.0 

1.0 

624.0 

1.0 

1.0 

63,0 

168,0 

408.0 

http://dougIasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R20... 10/1/2008 
Prudent Propeity Close-Out Form (Lead-Based Paint Stabilization) 

SAID: J2'73l ^ . p 

Property Address: X'(^/5 " /ar/y^/^jt" >^<2. 

Owner's Name: /U^U^rc^ Sra-/ ^ 

Performance Standards/close-Out Criteria 

YES NC 

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 work completed satisfaaorily? 

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

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

5. Are all of the 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? 

zl 

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 of property damage that was done by the contractor? Any property damage / 

needs to be completed prior to the EPA Close-Out. V 

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

1 ^ V 

that need to be moved back? 

-y 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 

~1 

Prudent Representative Signature: /r/K^ 

Date (I'S-O^^ 

Property Owner Signature:/ 

Date: