TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: 26745 Date: October 28 

Address: 2620 Decatur St. 

Remediation Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

ef Video of property (DVD) 

0 Executive Stimmary 

H Signed Access Agreement for subject property 

a Painting Agreement 

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

D Photographs 

y Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

y Property information from Douglas County Assessor's Office 

D 

D 

D 

Signature >• ^ Date 

40310360 

ilHI 

Superfund 
PROPERTY SUMMARY 

Date: 10/22/08 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Montli of: September 

. « h • J rr - .. . , -t - t . .^%v---

Property Address: 2620 Decatur St. SAID: 26745 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: None 

A.2 Issues Resolved: None 

A.3 Unique Findings: None 

122A.4 Other Relevant Information 

Access Date: 9/08/08 

Work Began Date: 9/17/08 

Closeout Date: 9/30/08 

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 

TECHNOLOCIES. INC. 
ENVIRONMENTAL & 

CONSTRUCTION TECHNOLOGIES, INC. 

SERVICES 

Property Status Form 

Address: ^^^ O /JtC-iti-yf^ Date: ^/^/O ^ 

Phone: ^foU - :^HH " ^^S'S ' BVID: "^^7 y^ " 

Plant «fe Permanent Landscaping To Remain In Place 

Item# 

Description and Location On Map i*#^^ - /^d>y /idf^^Se. 

Item# 

On Map 

Pre-Existing Condition of Structures 

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

Descaiption&, Location x 

, s^c>r/yi tvc^ch'^ /^>^^**^f cgtts.i-y 

• 0ri)kc^ oumcHoLU CmrthJ

 . 

^ Jacks Ilk c./cci- ^ ^u^^^^^ 

ft/^ tea^i. p Sc/^eetiF 

Property Owner Prudent Employee 

Signature; Signature: /:. 

8080 Ward Parkway, Suite 405 2505 N. 24^ Street, Suite 308 4242 tfledical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78220 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
^^1^5 

Prudent Technologies, Inc. (Prudent) is under contract (Contract # EP-R7-08-07) with the U. S. 

Enviromnental Protection Agency (EPA) to stabilize Lead Based Paint (LBP) at a number ofproperties 

located in Omaha, Nebraska, including the property located at ''.Z.6?2'> T^-^^dlia-{f-> P -^"^ 

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

signing this form, the property owner grants permission to Prudent to perform activities related to LBP 

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

verifies that they have received lie LBP pamphlet "Renovate Right." 

If you have any questions about the LBP stabilization plaimed for your property, please contact Prudent's 

Administrative Clerk for the Lead Based Paint Stabilization, Mrs. Deborah AkereifrJohnsoii, 

at (402) 504-1004: General questions about the Omaha Lead Site cleanup can be directed to the EPA 

Public Infonnation Centers at (402) 731-3045 (South Omaha office) or (402) 991-9583 (Nortii Omaha 

office). -. / ^ .-

Property Access Granted By: A - O r / / /<5.- /__^^' ^ JL 

,_V ~ T (Please Print Name) 

Property Owner Signature: ^ .(y yU/LA ^ (/^ 

(Signature) (Date) 

PROPERTY INFORMATION 

. ^ (To b^f^npletedtty resident and/or property owner-please print) 

RESIDENT NAME: L i K - ( ll(~ I U ~ee Z^^g . /^ 3 ^ ^ -- f^r~- (TS Owner ^^ Renter

RESIDENT ADDRESS: ^ 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; "^^f H € ^ 

OWNER'S TELEPHONE NUMBER-HOME: (V^ ^ o'r-t ^ / ^ 5 WORK: ( \ 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: U NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER: _ L 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: 

COMMENTS OR SPECIAL INSTRUCTIONS: (LE. DOGS, ENTRY GATES, ETC.) 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be implemented by EPA under tids agreement are pursuant to Section 104 

ofCERCLA. 42 U.S.C. 9604. EPA's right ofaccess to the property is provided for ii Section 104(e) of CERCLA. 42 U.S. C 9605(e). which provides entry 

for "determining the needforresponse,or choosing ortaldng any response action under this title, or otherwise enforcing «K provisicns ofthe title." 

. _ ^ »,»...«« 9<;o^ N 24* Street Suite 308 4242 Medical Drive, Suite 4250 

080 Ward Pariway, Suite 405 y^yy^^^^^yr San Antonio, TX 78229 

ansas City. MO 64114 Omaha. N^braste e^^i^^ ^^^^^ ^ 

hone: (816) 363-3703 Si S 504-1005 Fax:(210)579.8577 

ax: (816) 363-3707 Fax. (40Z) sua nous 
Current Sample Pre-Renovatio s. n Form 

Effective until April 2010. 

/ Confirmation of Receipt of Lead Pamphlet 

QM have received a copy of tlie pamphlet, Renovate Right Important Lead Hazard 

Infbnnationtor Families, Child Cam F'roviders and Sc/joo/s informing me of 

the potentialrisl< of the lead hazard exposure fromrenovation activity to be 

perfomied in my dwelling unit. Ireceived this pamphlet before the worl< began. 

Print^name of recipient./? , Date 7 

7C?\>z.- n^ ^ 

Signature of recipient 

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

if the lead pamphlet was delivered but a tenant signature was not obtainable, 

you may checi< the appropriate box below. 

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

pamphlet, Renovate FS^t Important Lead Hazard Infbrmation fbr FamSies, 

Child Cam Pmviders and Schools, to therental dwelling unit listed beiow at the 

date and time indicated and that the occupant refused to sign the confirmation 

ofreceipt.I further certify that I have left a copy of the pamphlet at the unit with 

the occupant. 

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

deliver the pamphlet, Renovate Rght Important Lead Hazard Intonnation for 

FamlSes, Child Cam pmviders and Schools, to therental dwelling unit listed 

below and tfiat the occupant was unavailable to sign the confimnation of receipt, 

t further certify that I have left a copy of the pamphlet at the unit by sliding it 

under the dpO^ ^^ ^ / 

'^i<f^ P>&/ ^ " en s 

Printed name of peijpn certifying Attempted delivery 

date and time 

lead pamphlet delivery 

Signature of person s^rtifying ieadpamphlet delivery 

(^/VVcc^qt . /O ^ 

Unit Address 

Note Regatding Mailing Option — As an alternative to delivery in person, you 

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

at least 7 days before renovation (Document with a certificate of mailing from the 

post office). 
ACCESS INFORUATION TRAOONQ SHEET 

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Mcdci[ ^ i'ff/y\ , ^Lnt^kr^ VL>/ ^cAVle^< 
paint match form 

Paint matching form: /p, ' /} 

Property address: ^^a^^ //e^u-f-^A ^\W.H^-_ L 

BVID: ^(^7^ f 

Area: ^^^Z.-?^ Color: uyh*4f 

Explanati on: 

Area: Color: 

Explanation: 

Area; color: 

Explanation: 

Area: color 

Explanation: 


Area: Color: 

Explanation: 

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Page 1 
Douglas Cotinty Account InfMmatio mm n Page 1 ot l a 

Douglas County, Nebraska Property Record - R1946040000 

; HI".'.' Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-SO ft west of SOth St - Vlje w pri._Ma p Information is valid as of 2008-7-14 Treasurer's fax Report 

New Feature ->">- » Auto Sales Search 

Owner 

BECK LILLIE G fi<¥> 

2620 DECATUR ST 

OiWAHANE 68111-0000 'S ^ 

Property Informatio n 

Key Number: 4604 0000 19 

Account Type: Residential 

Parcel Number: 1946040000 

Parcel Address: 2620 DECATUR ST 

OIWAHANE 68111-0000 

Legal Description: PARKERS ADD LOT 11 BLOCK 9 W 1/2 30 X 126 

Value Informatio n 

Land improvement Total 

2008 $900.00 $49,100.00 $50,000.00 

2007 $900.00 $49,100.00 $50,000.00 

2006 $900.00 $49,100.00 $50,000.00 

2005 $900.00 $49,100.00 $50,000.00 

2004 $900.00 $10,100.00 $11,000.00 

2003 $900.00 $10,100.00 $11,000.00 

Land Informatio n 

Acres SF Unite Depth Widtii Vacant 

0.08 3780.0 1.0 126.0 30.0 No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19... 8/26/2008 
1

Douglas County Account Infijnnatio ifojpis n Page 2 of2 

W ' "-'­

slftiSiB • 

 CLICK TO ENLARGE IMAGE n a 1 

1

Square Footage: 

Perimeter 

Unit Type: 

Buiit As: 

HVAC: 

Exterior: 

Interior: 

Roof Cover: 

Roof Type: 

Floorcover: 

1017.0 

0.0 

1 1/2 Story Unfin 

Forced Air 

Frame Siding 

Drywall 

Composition Shingle 

Gable 

Allowance 

Year Built 

1900 

Detail Type 

Add On 

Appliance 

Basement 

Fixture. 

Fixture 

Porch 

Porch 

year Percent 

Remodeled ' Remodeled 

0 0% 

Detaii Description 

Unfinished Attic W/floor 

Allowance 

Bsmnt Block 8 ft 

Base Fixtures 

Bath Full 

Slab Roof Ceil 

Wood Deck 

J620DECATUR.SI 

1,1V ::.-z . .: p-a war c&at eai 

•J>ur 

- .X...-i 

 STORY tWFIN 

 CLICKJO ENLARGE IMAGE | 

Percent Complete: 100.0% 

Quality: Fair 

Condition: Average 

Condo Square Footage: 0.0 

Rooms: 5.0 

Units: 1.0

Baths: 1.0 

Bedrooms: 2.0 

Stories: 1.5 

Foundation: Block 

Sprinkler Square Footage: 0.0 

Adjusted Year Physical Age Buiit 

1900 108 

Unite 

880.0 

1.0 

960.0 

1.0 

1.0 

30.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19... 8/26/2008 

 1 

90.0 
Prudent Property Close-Out Form (Lead-Based Paint Stabilization) 

SAID: 2 L l ^ T 

Property Aildress; .^ L XC';- X"^ gy^^v>tUA 

OwTfif'sNamei ^'i/// b . ISXdki . 

Performance Standards/close-Out Criteria 

YES INO 

1. Was the entire structure(s) painted with the exception of the stated, excluded areas? This wouid I 

hclude painting of other associated features including fascia, eaves, siding, ali trim, porches, box 

beams, columns, rails, and exterior surfaces of garages. 

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

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

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

Are all of the areas where contaminated materials have been spilled 

t-ioroughly vacuumed/ cleaned? y 

6. Did the contractor collect/vacuum all falling and scraped paint chips on the entire property, 

noadways, alleyways, public access areas and also remove any other generated debris? K 

7. Is the grass area that surrounds the structure(s) in reasonably good condition? L 

8. fr e all items such as polyethylene sheeting, ladders, paint brushes, cones, barrier tape etc. 

properly removed? ^ t 

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

reeds to be completed prior to the EPA Close-Out. X 

10. Are there any property Items that were temporatiiy re-located by the contractor 

t.iat need to be moved back? 

X 

11. Art there any (known) lingering issues with the property owner{s) that have been left unresolved? 

Other Conslderations?property Owner Dlscusslons?Additional Work that is Required > 

R 

Prudent Reiptesentative ff{CoA/pWny^^ 'e^Q' ^ 

Date 9 ^ 7 0 --<^V