## TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL EFOLDE R SAID# : 19S7 ^ Date : /A^/^ f Address : 3^7 3 M h^ ^?f " Remediatio nContractor : PROFESSIONA LENVIRONMENTALENGINEER S Year : 20» 8 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 5

/ Vide o o f propert y (DVD ) t

/ Executiv e Suimriar y y SignedAcces s Agreemen t fo r

subject propert y M Paintin g Agreemen t D Settlemen t document s (i.e. , fo r

damag e or t o replac e plants , etc. ) B Photograph s . _ y Satisfactor y restoratio n signedb y Propert y Owne r y Propert y close-out check lis t signe db y EP A M Propert y information fromDougla s Count y Assessor' s Office 

# ^yy^yM.^yy ^ yihsM - Signatur e Dat e 

# Iiiii i Superfun d

# PROFESSIONA L 

# p 250 5 Nort h 24' ^ Suit e 21 9 

# ENVIRONMENTA L ENGINEERS , INC
. Omaha , N E 6811 0 

# J ^

• H (402 ) 504-468 8 

### "Providin g cost-effectiv e environmenta l solutions " Fa x(402 ) 504-328 1 

# • 

# 1

1 ^ 

### m

Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emei-genc yRespons e



### Lea dBas e Stabilizatio nOmaha , N e Clos e Ou t Repor t SAID #1957 7 351 8 Pin e S t

•Date s worke d12/1 2 t o 12/1 3 200 8 •Larg e hom e that i s mostl y side dan dsoffit s wer e painted . Area s aroun dth e gutter s wer e i n poo r conditio n du e t o som e wate r damage . Damag e t o som e ofth e tri mareas . •Inspecte d11/1 7 N o issue s

# PROFESSiONA L 250 5 Nort h 24'" , Suit e 21 9 

# ENVIRONMENTA L ENGINEERS , INC
. Omaha , N E 6811 0 (402 ) 504-468 8 

## "Providin g cost-effectiv e environmenta i solutions " Fa x(402 ) 504-328 1 Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • EmergencyRespons e 

## Propert y Owne r Close-Ou t Form (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) SAID : I^S1~ 7 Property Address : 3 S I ^ P i 0 ^ S ^ Owner' s Name : ^VkeNvO A f^.Y- V ^ /^CV>Q ^ Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) painte dwithth e exceptio nofth e stated , exclude d areas ? 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 dexterio r surface s o f garages . 2 . Wa s all scrapin g an dothe r preparatio nwor k

complete dsatisfactorily ? 3 . Were al l require darea s ofth e structure(s ) prime da s neede dan dpainte dwith tw o to p coats ? 4 . Wa s th e pain t product s utilize dequivalen t t o a3 0 yea r product/quality ? 5 . Ar e al l ofth e area s wher e contaminate dmaterial s hav e bee nspille dthoroughl y vacuumed/ cleaned ? 6 . Di dth e contractor collect/vacuu mal l fallin g an dscrape dpain t chip s o nth e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y othe r generate ddebris ? 7 . I s th e gras s are athat surround s th e structure(s ) i nreasonabl y goo dcondition ? 

# Ji . 8 . Ar e al l item s suc ha s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . properl y removed ? 

# X 9 . I s ther e any evidenc e ofpropert y damag e that wa s don e b y th e contractor ? An y property damag e need s t o b e complete dprio r t o th e EP A Close-Out . 

## A , 10 . Ar e ther e an y property item s that were temporaril y re-locate db y th e contractor tha t nee dt o b e move dback ? 

# X 11 . Are ther e any (known ) lingerin g issue s withth e property owner(s ) that hav e bee n lef t unresolved ? / 

### Comments :



## ' K r 

# QJ njyy- y 

# ^^y PropiBrt y Owne r Signatur e Dat e 

# yy-y y - ^ Professional Environmenta l Engineer s Representativ e Dat e

# PROFESSiONA L 250 5 Nort h 24 " Suit e 21 9 

# ENVIRONMENTA L ENGINEERS , INC
. Omaha
. N E 6811 0 (402 ) 504-468 8 

### Providm g t-o-st'eifec'ttv e ef-<i.-u-onmenia i soiuiioni> ' Fa x(402 ) 504-328 1 

## EP A Close-Ou t For m (Lead-BasedPain t Stabilization EP A Contract EP-R7-08-06 ) 

# SAID : /9S7 7 Propert y Address : 2^S ~ I " ^ r//! ^ S J ^ Owner' s Name : CYlO\ve-. V ^ y\^^C^er Performanc e Standards/Close-Ou t Criteri a 1 . Wa s th e entir e structure(s ) painte dwithth e exceptio nofth e stated , exclude d areas ? Thi s woul dinclud e paintin g o f other associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an dexterio r surface s o f garages . 2 . Wa s all scrapin g an dothe r preparatio nwor k

complete dsatisfactorily ? 3 . Were al l require darea s ofth e structure(s ) prime da s neede dan dpamte dwith tw o to p coats ? 4 . Wa s th e pain t product s utilize dequivalen t t o a3 0 yea r product/quality ? 5 . Are al l ofth e area s wher e contaminate dmaterial s hav e bee nspille dthoroughl y vacuumed / cleaned ? 6 . Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s o nth e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y othe r generate ddebris ? 1 7 . I s th e gras s are atha t surroimd s th e structure(s ) i nreasonabl y goo dcondition ? 8 . Ar e al l item s suc ha s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . properl y removed ? 19 . I s ther e any evidenc e ofpropert y damag e that wa s don e b y th e contractor ? An y property damag e need s t o b e complete dprio r t o th e EP A Close-Out . 10 . Are ther e any property item s that were temporaril y re-locate db y th e contracto r that nee dt o b e move dback ? 11 . Are ther e any (known ) lingerin g issue s withth e property owner(s ) that hav e bee n lef t unresolved ? Othe r Considerations/Property Owner Discussions/Additiona l Wor k

that i s Required : YE S 

## y y ^ 

## y ^ 

### y

y y l y ' i . y 

## NO 

## 1

y ^ 

## y 

# A 1 

# l[ln y TP A CO RSignatur e Dat e

# CONSEN T OF RACCES S T O PROPERT Y OMAH A LEAD SIT EREMEDIALACTIO N - LEAD-BASE D PAINT STABILIZATIO N PROPERTYID : /QST l PROPERTY ADDRESS : 3S" / ^ 

# P,n ^ ^ y OWNE RNAME : 

## \jcx^\e. V f rV^f^cVse^ r DAYTIM EPHONE : 

# Tyy ^ -09J 6 CEL LPHONE : E-MAIL : OWNER' S ADDRES S I FDIFFERENT : TENANT' S NAM EI FAPPLICABLE : DAYTIM EPHONE : CEL LPHONE : E-MAIL : Professiona l Environmenta l Engineers , Inc . (PE ) i s unde r contrac t (#EP-R7-08-06 ) wit hth e U.S . Environmenta l Protectio n Agenc y (EPA ) t o stabiliz e lea dbase dpain t (LBP ) o n residentia l structure s a t anumbe r o f propertie s locate din 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 wer e performe db y EP A contractors . Pain t stabilizatio n activitie s wil l include : scrapin g of cracke do r flaking LB Pfro mstructures , applicatio nof aprim e coa t an d tw o (2 ) coat s of 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 nth e propert y identifie dabove . B y signin g thi s documen t I agre e t o allo w a n 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 . I understan dtha t th e stabilizatio n contracto r ca n 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 my property . I fully 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 , if applicable , wil l b e give nth e Housin g an dUrba n Developmen t (HUD ) an dEP A pamphlet , "Renovat e Right , Importan t Lea dHazar dinformatio n fo r Families , Da y Car e Providers , an dSchools" , (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 ) will abid e b y healt han dsafety guidanc e provide db y EPA , (5 ) wil l allo w photograph y o f propert y befor e an dafte r th e pain t stabilizatio n work , (6 ) wil l b e contacte db y aP Erepresentativ e approximatel y 4 8 hour s i nadvanc e o f startin g work , (7 ) agre e no t t o obstruc t o r tampe r wit han y o f th e LB Pstabilizatio n actions , an d(8 ) will participat e in final propert y inspectio n an d sig n th e Completio n Agreemen t an dPropert y Owne r Satisfactio nSurvey . Shoul dyo u hav e an y question s abou t th e plane dLea dBased-Pain t stabilizatio nactivitie s fo r you r property , pleas e contac t Professiona l Environmenta l Engineers , Inc . Projec t Manager , Willi e Cla y 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 Paulett aFrance-Isetts , EP A Remedia l Projec t Manage r 402-731-2454 , o r th e EP A Publi c Informatio n Center s a t 402-991-958 3 (Nort hOmah aoffice ) o r 402-731-304 5 (Sout hOmah aoffice) . D Yes , I gran t acces s t o m ypropert yan d wa s give n th e pamphle t D No , I d o no t gran t acces s t o m ypropert yan d I wa s "Renovat e Right , Importan t \^jg^mij&o n fo rFamilies , Chil d give n th e pamphle t "Renovat e Right , Importan t Lea d Car>PraT)ders , an d Sch g Informatio n fo rFamilies , Child e Care Providers , an d Schools. " 

# // - 

# U 7 Siiatur e ^ Oate Signatur e SPECIA L INSTRUCTION S AN D CONSIDERATION S

# Confirmatio n O f Receip t O f Lea d Pamphie t BVI D iQsn n PROPERTYADDRES S 2>5\ ^

VvO ^ S a ^ZI P CODE
. PROPERTYADDRES S O F OWNE R I F DIFFEREN TTHA N PROPERTYBEIN G PAINTED : PROPERTYADDRES S ^ZI P COD E I hav e receive d a cop yo f th e pamphlet , Renovat e Right : Importan t Lea d Hazar d Informatio n Fo rFamilies , Chil d Car e Provider s An d School s informin g m e o f th e potentia l risk o f th e lea d hazar d exposur e fro m renovatio n activit yt o b e perfomie d o n dwellin g unit . I receive d thi s pamphle t befor e th e wor k began . 

# N / p4A l /.y-// y y /yi ^ XW / //^"y-y ) r /^PRINTE D NAM E OF RECIPIEN Ty/y ^

DAT E

SIGNATUR E O F RECIPIEN T Self-Certificatio n Optio n (Fo rTenant-Occupie d Dwelling s Only ) I f th e lea d pamphle t wa s delivere d bu t a tenan t signatur e wa s no t obtainable , yo u maychec k th e appropriat e bo x below : W Refusa l T o Sig n - 1 certif ytha t I hav e mad e a goo d fait h effort t o delive rth e pamphlet , renovat e right: importan t lea d hazard infomiatio n fo rfamilies , chil d car e provider s an d schools ; t o th e renta l dwellin g uni t liste d abov e a t th e dat e an d tim e indicate d an d tha t th e occupan t refuse d t o sig n th e confirmatio n o f receipt . I furthe rcertif ytha t I hav e left a cop yo f th e pamphle t a t th e uni t wit h occupant . 

# D Unavailabl e Fo rSignatur e - 1 certif ytha t I hav e mad e a goo d fait h effort t o delive rth e pamphlet , renovat e right; importan t lea d hazar d infomiatio n fo rfamilies , chil d car e provider s an d schools , t o th e renta l dwellin g uni t liste d belo wan d tha t th e occupan t wa s unavailabl e t o sig n th e confimiatio n o f receipt . I furthe rcertifytha t I hav e left a cop yo f th e pamphle t a t th e uni t b yslidin g i t unde rth e doo ro rsomewher e o n th e premises .

PRINTE D NAM E O F PERSO N CERTIFYIN G AHEMPTE D DELIVER YDAT E AN D TIM E LEA D PAMPHLE TDELIVER Y

SIGNATUR E O F PERSO N CERTIFYIN G LEA D PAMPHLE TDELIVERY : Not e Regardin g Mailin g Optio n - as a n altemative t o deliver yi n person , yo u ma ymai l th e lead pamphle t t o th e owne r and/o rtenant . Pamphle t mus t b e maile d a t least 7 day s befor e renovation . (Document with a certificat e o f mailin g fro m th e pos t office)
. CONFIRMATIO N O F RECEIPTO F LEA D PAMPHLE T08/0 8

# PAIN TSTABiLiZATIO N PRE-PROPERT YASSESSIVIEN T

PROPERT YADDRESS : _ 

# B-sv ^ DAT E Rvi n 

### PLAN T& PERMANEN TLANDSCAPIN G T O B E REMOVE ? N O |— | YE S 

# r~ l | ; IF , YE S WHERE :

, 

### PRE-EXISinN G CONDIHGA I O F 

### FOUNDATION/STRUCTUR E Le . BASEMEN TLEAKING ? N O ' ' YE S ' ' IF , YE S WHERE :

EXISTIN G PAIN TO N WINDOWS , DOORS , FOUNDATION , SIDEWALK, ( LE.) ? NOj— | YE S CZ I IF , YE S WHERE :

VISUA L DESCRIPTIO N O F PROPERTY/STRUCTURE/GARAGE , (I.E.) : (US E BAC KSID E I F HECESSARY )

# PAiN TSTABiLiZATIO N PRE-PROPERT Y PAIN TMATC H ASSESSIMEN T PROPERT YADDRESS : j>^\ ^

V i^P ^ S> ^ DAT E 

### ^ n h 

# iQ^ n BVI D 

### AREA(S ) T O B E PAINTED : 

## HOUS E PROPER : COLO R
HOUS E TRI M COLO R

GARAG E COLO R
GARAG E TRI M COLO R
PORC H COLO R

PORC H TRIM . COLOR . 

### (COMPLET E AL L SECTION , YES , NO , O R NON-APPUCABLE ) 

# I AGRE E T O TH E COLOR S USTE D ABOVE . ONC E PAINTIN G BEGINS , I UNDERSTAN D I CA NNO T CHANG E TH E ABOV E SELECTE D COLORS : P E ACCESSO R SIGNATURE :

i ! l PAiN TMATC H FOR M 08/0 8

### Dougla s County Accoun t Informatio n Pag e 1 o f 3 Dougla s County , Nebrask a Propert yRecor d - R122122000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t of 90t h S t - VJe W O n Ma p Informatio n i s vali d a s of 2008-9- 4 Treasurer' s Ta xRepor t Ne wFeatur e -•-•- * Aut o Sale s Searc h Owne r ERLBACHE R DANIE L R ETA L 351 8 PIN E S T OMAH AN E 68105-000 0 

# MWb-Qq^Q: > Propert yInformatio n Ke yNumber : \ 212 2 000 0 1 2 Accoun t Type : Residentia l Parce l Number : 122122000 0 Parce l Address : 351 8 PIN E S T OMAH AN E 68105-000 0 Lega l Description : GRIFFI N & SMITH S 1S TSU B LOT1 7 BLOC K6 E 4 4 F TL T1 6 & W 6 FT5 0 X 12 8 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $6,400.0 0 $212,200.0 0 $218,600.0 0 200 7 $6,400.0 0 $212,200.0 0 $218,600.0 0 200 6 $6,400.0 0 $93,500.0 0 $99,900.0 0 200 5 $6,400.0 0 $93,500.0 0 $99,900.0 0 200 4 $6,400.0 0 $93,500.0 0 $99,900.0 0 200 3 $6,400.0 0 $93,500.0 0 $99,900.0 0 Sale s Informatio n Sale s Date : 2002-12-2 0 Dee d Type : W D Book : 223 2 Page : 47 0 Price : $169,950.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : I 1990-09-1 7 Dee d Type : \ D Book : 188 4 Page : I 68 0 Price : $43,000.0 0 Grantor : 

### littp://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R12.. . 11/5/200 8

### Dougla s County Accoun t Informatio n Pag e 2 o f 3
Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 4 6400. 0 1. 0 128. 0 50. 0 N o Improvement Informatio n Buildin g 1

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CLIC KTO ENLARG E IMAG E Squar e Footage : 2334. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Goo d

Buil t As : 2 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 8. 0 Exterior : Fram e Aluminu m Units : 1. 0 Interior : Drywal l Baths : 2. 5 Roo f Cover : Compositio n Shingl e Bedrooms : 5. 0

Roo f Type : Gabl e Stories : 2. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r YearBuil t Physica l Ag e Remodele d Remodele d Buil t 191 5 0 % 191 5 9 3 Deta/ 7 Typ e Detai l Descriptio n Unit s Ad d O n Fenc e Chai n Lin k 1. 0 Applianc e Allowanc e 1. 0 Applianc e Fireplac e Masonr y 1. 0 Basemen t Bsmn t Bloc k 8 ft 940. 0 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.js p ?accountno=R12.. . 11/5/200 8

## J C Paintin g Propert yAddres s '5 5 I fi ^crLO
. <r P Dat e M n v/ i 3 Star t Dat e KIQV / \S LComplet e Dat e KlQ>s ^ \ " ^ 

## Amoun t O f Prim e An d Pain t Use d Prim e (Gallons )

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_ Pain t (Color ) (r^ifZi ^ Pain t (Color ) Pain t (Color ) Pain t (Color ) Amoun t (Gallons ) Amoun t (Gallons ) |_ Amoun t (Gallons ) Amoun t (Gallons ) Amoun t (Gallons )