TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID #: 40C^? n Date: rS-n-7r)l( ^ 

Address: 24 1 \ T^-eVs'^prj ' AV^, / 

Stabilization Contractor: Professional Environmental Engineers Year: 2010_ 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

y C Video ofproperty (DVD) 

p . . Executive Summary 

^ Signed Access Agreement for subject property 

Jf C Pre-Renovation Form signed by Property Owner 

D Pre-Renovation Form for Occupant/Tenant, if applicable 

D Painting Agreement 

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

1S^ Renovation Recordkeeping Checklist signed by Certified Renovator 

^ Photographs b^O/ P /}[\A oJpl w 

^8; ^ Satisfactory close-out check list signed by Property Owner 

D Property close-out check list signed by EPA 

^ Property information from Douglas Coimty Assessor's Oflice 

a Hazard analysis, if prepared 

a Safety Audit 

D Other (describe): 

Professional EnViir^mental Engineers Signatiue ^ 

3(LiirCt. JLa6 ^( M lO 

Eure Date 

(after file folder review) 

30204236 I 

Superfund 
0 | PROFESSIONAL 

500 S. Ewing, Suite E ENVIRONMENTAL ENGINEERS, INC. St. Louis. MO 63103 

(314)531-0060 [|ll | "Providing cost-effective environmental solutions' Fax (314) 531-0068 

Coi'isiilliiici •• EiigiiiBeriii!! Di;sJ!;iii * f-:aneillaiion • At-aittmttni« Eineigsncy ri^.siAjiif..-; 

2010 

Property Owner Close-Out Form 

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

SAID: ^60 n 

Property Address: ^Mt| fsf/.wftarf AnK. 

Owner's Name: (i<\Mf(i WOb.s 

Performance Standards/Close-Out Criteria 

YES NO 

1. 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. 

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

V/" 

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? 

^y 

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

vacuumed/ cleaned? v/ 

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? 

x / 

8. Are all items such as polyethylene sheeting, ladders, paint brushes, cones, barrier tape, ^ 

etc. properiy removed? 

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

damag / e needs to be completed prior to the EPA Close-Out. 

10. Are you satisfied with the work performed? 

>^ 

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

/ need to be moved back? 

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: 

Property Owner Signature 

Professional EnvitvnmwlfaT Engineers Signature 

v/ 

06U\l[o 

Date 

S-JJ^jO 

Date 
PROFESSIONAL 

2505 North 24". Suite 219 ENVIRONMENTAL ENGINEERS, INC. Omaha. NE 68110 

"Providing cost-effective environmental solutions" ^^^ jjjgj IJJiJ ^ 

Consulting • Engineering Oesign • Remediation • Abatement • Emergency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

2010 

SAID# 40087 

2411 Newport Ave. 

• Dates worked: 05/07/10 to 05/07/10 

• Pre property condition: House and garage have vinyl siding with painted wood trims 

and foundation areas. Paint was flaking ofTfrom wood trims on to the ground. 

• Problems encountered: None 

• Owner request/concerns: N/A 

• Inspection/closeout dates. Owner signed 05/11/10, Inspected by PE project manager. 
SAID# 

Property Address 

Stories 

Garage? 

Access signed 

Pre-vldeo 

Post video 

Contractor Assigned, 

Date started 

Weatherftemp 

Date ended 

Paint used 

Prime used 

Poiy used 

/

S^ 

EPA Paint Stabiiization 2010 

'2A-\\ ^icv<i^or+ A/ ^ 

X 5 

^es 

4-15-ZOIO 

4'IU-TOIO 

5/>7/?^/c^ 

•5-v' 

5/1/ Z^/^ 

/f^^ 

/

2i4li^ - ^ 

S'^A^^^ 

Problems/Issues 
CONSEN'>mr T >rai FOR ACCESS TO PROreRTY 

OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID: 4^^ 1 PROPERTY ADDRESS: SAW NetOpflH ? a V -

OWNER NAME: ,. ^ 

DAYTIME PHONE: (^02 ^ A^S'^C ^ 

CELL PHONE: fiii'.^Q.^/^ E-MAIL: Aviiiw feg p ro)c. Mgr 

OWNER'S ADDRESS IF DIFFERENT: 

TENANT'S NAME IF APPLICABLE: 

DAYTIME PHONE: 


CELL PHONE: E-MAIL: 


ProfeuioDai EnviroBmental Engineers, Inc. (PE) b under contract (#EP-R7-<W-06) with the U.S. Environmental Protection 

Agency (EPA) to stabilize lead based paint (LBP) on residentiai structures at a numlMr 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 wiil include: scraping ofcracked or flaking LBP fh>m structures, application ofa prime coat and two 

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

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

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

By signing this document I agree to aliow an EPA contractor to conduct a soil cleanup at my property folk>wing completion of 

lead-lmscd paint stabilization, if the soil deannp 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 eflbrts to address conceras that I, as the property owner, may have regarding soil cleanup at 

my property. 

iP^cs, I hawraad and undtntnid the pangiaph haboM. o^lisho 

Signabira orPnpeft f I y rOmncr 

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

satbfactorily completed, (2) that the Property Owner or Tenant, if applicable, will lw given the Housing and Urlmn Development 

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

Schoob", (3) the Property Owner or tenant wiii remove all obstmetions flrom surfaces to be painted, (4) will abide by health and 

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

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

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

Property Owner Satbhction Survey. 

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

Professional Environmental Engineen, Inc. Project Manager, Willie Cfaiy At 402-504-4688. General questions about the Omaha 

Lead Site cleanup can be directed to Pauletta France-lsetts, EPA Remedfail Project Manager 402-731-2454, or the EPA Public 

Information Centers at 402-991-9583 (North Omaha oflice) or 402-731-3045 (Sonth Omaha office). 

B Yet, I grant aooesa to my property and IMS gimn tht pamphbt D NOildonotgrsntaooaMtomyprepaityindlvMS 

"Ranovate IQglit, knpoitnt Load InfonrnHon for Fanrinat, Child fllMn tlie pmiphM 'RBnonte Wgh^ hnportant Laad 

Cara Providan, and Schools." intonnilkHi for Famllba, Childe Cara Pnwidtn, and Schoob.* 

Signatura O Date Signatura Date 

eocriAi iMffrmirrirMSAMnrniittinrPATiniK 
Current Sample Pre-Renovation Form 

Effective untii April 2010. 

Confirmation of Receipt of Lead Pamphlet 

a n have received a copy of ttie pamptiiet, Renovate Ri^t: Important Lead Hazard 

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

ttie potentiai risi< of ttie lead hazard exposure from renovation activity to iDe 

perfonned in my dwelling unit. I received this pamphlet before the wort< t)egan. 

AnHn^A WllkAc 04- if\-fO 

Printed name of recipient ; Date 

Signature of recipient Cl 

Self-Certification Option (fbr tenant-occupied dwellings only) — 

If the lead pamphlet was delivered txit a tenant signature was not obtainable, 

you may checit the appropriate tx>x below. 

Q Refusal to sign — I certify that I have made a good faith effort to deliver the 

pamphlet. Renovate Right: important Lead Hazard Infonnation for Families, 

CNkl Care Providers and Schools, to the rental dwelling unit listed tielow 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 copv of the pamphlet al the unit with 

the occupant. 

• Unavailable for signature -• I codify !!Vh •'-ivp -•"od^ n 3:;:^:: fr;:-'; ^^.••jr\ to 

deliver tlie pamphlet. Renovate Right: linponinii Load Hazard Information for 

Fctmilies, Qiild Caiv pru-.'iJora and SJiijuL, iu iho JufIILS; dwoiiing uriii lisiod 

belov.' jincl th^^l t'-ecccup/int v/n:^ u-nvnihl^!'^ ^c :'j ' !*•-• ;o^rT-nritioi- of 'cceipt. 

I fuiIhG'i' certify ll'icii I have lo'i u copy of iliu piJiVip!uii'i u i il'A Ui'iit L-y S^iu.riC; .'i 

undc-r the door. 

Printed name of peroon certifying Artcmp^od ^ci^'cr; 

date and time 

lead pamphlet derfivfirySignature of person certifying lead pamphlet delwer,' 

Unit Address 

Note Regarding Mailing Option — As an aiternalive to oeiivc-ry in person, you may mail the 

lead pcinipltlet lo llis ownerand/'oi lonanl. Painpliiei liiusi be(iiaiieJ at idast 7 days befoic 

renovation Pocurricnt with a cciificalc of mailing 'ror: the post offics:. 
Future Sample Pre-Renovation Form 

This sample form may be used by renovation firms to document compliance with the 

Federal pre-renovatlon education and renovation, repair, and painting regulallons. 

Occupant Confirmation 

Pamphlet Receipt 

a I have received a copy of the lead hazard information pamphlet infonning me of the 

potential ri8i< of the lead hazard exposure from renovation activity to be performed in 

my dwelling unit. I received this pamphlet before the wor1< began. 

Owner-occupant Opt-out Acknowledgment 

lv(A) I confirm that I own and live in this property, that no child under the age of 6 

resides here, that no pregnant woman resides here, and that this property is not a 

child-occupied facility. 

Note: A child resides in the primary residence of his or her custodial parents, legal 

guardians, foster parents, or informal caretaker if the child lives and sleeps most of the 

time at the caretaker^ residence. 

Note: A child-occupied facility is a pre-1978 building visited regularly t>y tlie same 

child, under 6 years of age, on at least two different days within any week, for at least 

3 hours each day. provided that the visits total at least 60 hours annually 

If Box A is checked, check either Box B or Box C, but not both. 

SftB) I request that the renovation firm use the lead-safe work practices required 

by EPAIs Renovation, Repair, and Painting Rule; or 

•

 (C) I understand that the finn performing the renovation will not be required to use the 

lead-safe work practices required by EPA!s Renovation, Repair, and Painting Rule. 

Printed Name of Owner-occupant /) , ',1 , \'A A ..I f 

Signaiure of Owner-occupant Signature (Date V 

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. 

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

information pamphlet to the rental dwelling unit listed t)elow at the date and time 

indicated and that the occupant declined to sign the confirmation of receipt. I further 

certify that I have left a copy of the pamphlet at the unit with ttie occupani. 

• Unavailable for signature -1 certify that I have made a good faith effort to deliver 

the lead hazard information pamphlet to the rental dwelling unit listed tielow and that 

the occupant was unavailable lo sign the confinnation of receipt. I fulher certify that 

I have left a copy of the pamphlet at the unit tyy sliding it under the door or by (fill in 

how pamphlet was left) 

Printed Name of Person Certifying Delivery Attempted Delivery Date 

Signature of l^rson Certifying Lead Pamphiet Delivery 

Unit Address 

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

lead hazard infbrmation pamphlet to the owner and/or tenant. Pamphlet must be mailed at 

least seven days before renovation. Mailing must t>e documented try a certificate of mailing 

from the post office. 

Note: This form is not effective until April 2010. 
CONISNT FOR ACCESS TO PROTERTY 

OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

1 PROPERTY ID: PROPERTY ADDRESS: 

OWNERNAME: 

DAYTIME PHONE: 

CELLPHONE: E-MAIL: 

OWNER'S ADDRESS IF DIFFERENT: 

TENANTS NAME IF APPLICABLE: 

DAYTIME PHONE: 

CELLPHONE: E-MAIL: 

Professional Environmental Engineers, Inc. (PE) b 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, 

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

Paint stabiiization activities will include: scraping ofcracked or flaking LBP from structures, application ofa prime coat and two 

(2) coats of paint Moving parts of windows and doors arc 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 wiii be bound to. I further understand that the soil cleanup 

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

my property. 

D Yes,! have laad and undentand the paragraph above. 

Signahira of Propeity Oimer Date 

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

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

(HUD) and EPA pamphlet, "Renovate RJght, Important Lead Hazard infonnation for Faniilies,.Day Care Providen, 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 Unal property inspectron and sign the Completion Agreement and 

Property Owner Satisfaction Survey. 

Shouki you have any questmns about the planed Lead Based-Paint stabilizatkin activities for your property, please contact 

Professional Environmental Engineers, Inc. Project Manager, Willie CUy At 402-504-4688. General questions about the Omaha 

Lead Site cleanup can be directed to Pauletta France-lsetts, EPA Remedial Project Manager 402-731-2454, or the EPA Public 

Informatwn 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 gm t access to my property and I was 

'Renovate iOght, Important i.ead InformaHon for Familias. Child giventtie pamphM 'Ranovate Right, hnportant Laad 

Care ProvMere. and Schools." Infonnation for Families, ChlMc Care ProvUers, and Schools." 

Signatere Date Slgnahire Date 

fippriAi iu«T«imrtMS AunrnusirwoATiniifi 
Douglas County Account Information Page 1 of3 

^0011 m

Douglas County, Nebraska Property Record - R1749790000 

Print Report 

View Interactive GIS Mao Information is valid as of 2010-4-16 Treasurer's Tax Report 

New Feature -^ •* •^ Subdivision Sales Search 

Owner 

WILKES ANDREA Y t^^bSi i fe ^QOX . AJ ^ 

2411 NEWPORT AVE

OMAHANE 68112-0000

 Z/C" ^ ^/^-? O 

 ^^Z ) '^yOS v 

Property In f ormati i } n 

KeyN umber: 4979 0000 17 

Account Type: Residential 

Parcel Number 1749790000 

Parcel Address: 2411 NEWPORT AV 

OIVIAHANE 68112-0000 

Legal Description: l\/IINNE LUSA LOT 27 BLOCK 7 44 X 120 

Value Informatio n 

Land Improvement Total 

2009 $5,900.00 $53,700.00 $59,600.00 

2008 $5,900.00 $53,700.00 $59,600.00 

2007 $5,900.00 $54,900.00 $60,800.00 

2006 $5,900.00 $54,900.00 $60,800.00 

2005 $5,900.00 $54,900.00 $60,800.00 

2004 $5,900.00 $49,800.00 $55,700.00 

Sales Informatio n 

Sales Date: 2002-09-30 

Dee( rf Type: 

Price: 

Grantor: 

WD

$72,777.00 

i Book: 2223 Page: 479 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 1998-06-12 1 

Deed Type: 

Price: 

Grantor. 

° 

$44,500.00 

Book: 2098 Page: 030 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17... 4/22/2010 
Douglas County Account Information Page 2 of3 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.12 5280.0 1.0 120.0 44.0 No 

Improvemen t Informatio n 

Building 1 

241t Newport Ave 1 1/2aorvlMin 

"Sratr" '•It!?? Ml ^ 1 • V 

Wtt 

*« jgjsrti«. 

nff 

£»r+» •« •BVB5M* 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 980.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Average 

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

HVAC: Central Air to Air Rooms: 4.0 

Exterior: Frame Aluminum Units: 1.0 

Interior: Drywall Baths: 2.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Biocic 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

0% 1930 79 

= < 

Deta'k, Detail Description Units 

Add On Unfinislied Attic W/floor 204.0 

Applianc Allowance 1.0 

Appliancj Fireplace Masonry 1.0 

Basemei Bsmnt Blocis 8 ft 980.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17... 4/22/2010 
(eifective April 2010) 

RENOVATION RECORBKEEPING CHECKLIST 

Name of Finn: 0(itms ?fliOlin^ 

Date and Location of Renovation: Z^) / /VCWpC^f/Wf, 

BriefDescriptionofRenovation: \t.Cv(i St(M)ill7jGA)Qn 

Name of Assigned Renovator: (f>0^t iM(\f(\^ 

Name(s) of Trained Workers: jjei ^ Si c i<. CA/ijc, A ' ^AJO^-C ,' 

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 • Setting up plastic containment barriers 

a Maintaining containment D Avoiding spread ofdust to adjacent areas 

D Waste handling D Post-renovation cleaning 

D Test kits used by certified renovator to determine whether lead was pi«sent on components affected by 

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

Seamin g signs posted at entrance to work area. 

B^^ork area contained to prevent spread ofdust and debris. 

j>Wuidows in and within 20 feet ofthe work area are closed 

...-elSoors in and within 20 feet of tfae work areas are closed and sealed 

^^.Sf^/^ tfaat must be used in tfae woik area are covered to allow passage but prevent spread of dust. 

)und covered by plastic sheeting extending 10 feet from work area - plastic anchored to the 

building and weighted down by heavy objects. 

D If necessary, vertical containment installed to prevent migration ofdust and debris to adjacent 

property. 

Qwast e contained on-site and while being transported off-site. 

Renovation Recordl»eplng Checlclist Omaha Lead Site 
(effective April 2010) 

f ] Work site properly cleaned after renovation. 

•e'Alfchips and debris picked up, protective sheeting misted, folded diriy side inward, and taped for 

removal. 

^^^B'^rk area HEPA vacuumed to get paint chips from ground surface, if necessary. 

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

[^^„./tcertjiy under penalty of law that the above information is true and complete. 

ctfit.- r>yL- ^ "S// 1 / v-.cf^ 

Name and Title Date 

Renovation Recordlieeping Checklist Omaha Lead Site