TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID; 20171 Date: 12/27/2008 

Address: 1329 S 26 ST 

Remediation Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

ET Video of property (DVD) 

B^ Executive Summary 

[j Signed Access Agreement for subject property 

B^ Painting Agreement 

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

• Photographs 

w Satisfactory restoration signed by Property Owner 

• Property close-out check list signed by EPA 

W Property information from Douglas County Assessor's OfRce 

D 

D 

D 

„£L^i& ^ Qik3loi 

Signature* Date 

40307956 

HiJlItt 

Superfund 
PROPERTY SUMMARY 

Date: 12/27/08 LBP STABILIZATION EPA CONTRAT EP-R7-08-07 Month of: December 

Property Address: 1329 S 26 ST SAID. 20171 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: None 

A.2 Issues Resolved: None 

A.3 Unique Findings: None 

A.4 Other Relevant Information: None 

Access Date: 10/30/2008 

Work Began: 11/8/2008 

CloseoutDate: 12/11/2008 

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. 
ENVIRONMENTAL A 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: \'^-^( ^ S ^U ? S ^ Date: l0/2^Jo ^ 

Phone: •SM'^ '7CJ/G - BVID: DO' S \ 4 

Plant & Permanent Landscaping To Remain In Place 

Itein# 

Description and Location 

On Map fcu^L. y^^/c^A i^^ c^'^^ ^^ 

Pre-Rxistinp Condition of Structures 

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

Item# Description^ Location 

On Map 

o f h^>Me. 

Property Prudent EmpL^ ^ 

Signature^: kijV\'. ^(^ir Signature: Ka/jlh 

8080 Wud PaitaMy, Suit* 408 2608 N. 24* Street, Suite 308 4242 MedlMl Drive. Suite 4260 
•^CbSlNMf 

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

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

located in Omaha, Nebraska, including the property located at / ?)";^ ^ S ^-^ \i? S:J . 

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

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

Stabilization including scnq)ing pamt and paintmg of the referenced property. Further, the owner/tenant 

verifies that tiiey have received the LBP pamphlet "Renovate Right." 

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

/krlpiinistrative 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 to the EPA 

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

office). . 

PrepnQr AcocuOfnlcd By:; X 1) -klT^Aiiy..e^^ ^ ^ _ (Please Printllaine) 

.y

V 0^ -W.W(L^ /-•^<;o ^ 

Piopeily Owner Sigmtuie; (SidatM) (Date) 

PROPERTY INFORMATION 

(To be cenplcted bjr rctldent ud/o r property owner - picue prist) 

RE8IDEMTNAIIE! 17. Kt'^Z^fi^'^l\€C (Jvner) Renter 

/3 5 9 ^ . TiO U. RE8IDEHT ADDRESS: 

F RENTAL, PROPERTY GWNEC >BY: . 

S^, Yi^-e 

GWNERW HAUNO ADDRESS; 

OWHEirS TELEPHONE NUMBER. HOME,: jMlJlLie^WORK t7i^'^ \ ^ " ^^'^VIORK i: J I

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: ^ NUMBER OP OCCUPANTS 7 YEARS OLD AND OLDER: / 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 6 HOURS OR MORE PER WEEK: 

COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOOS, ENTRY GATES, ETC.) 

^ c< , ^ ^«^/-> . /msicl ^ 

AUffiORTrY FOR BNVIRONMBNTAL RESPONSE ACTIONS; The ictlvftiet to be Implemented by EPA under tUs agreement are purmint to Sectam 104 

of CERCLA. 42 UA C 9604. EPA'i right of aooett to the property bprovidedfor ki Section 104(e) of CERCLA, 42 U.S. C 960S(e), which provides e itiy 

Ibr''detennhihig (he need (br response, or clwoeuig ortaktag any response acdon under this title, or olwiwlw enfi>rebig tie provUt^ 

«80 Wild PailNMy, Suite 408 2808 N. 244* * Street, Suite 308 4242 Medical Drive, Suite 4280 , «M4.- •B««««4l4 « ^.. . _•. . »a.a . 
ACCESS if^FOt^HficrioNTR^OmiOStmET 

Wi3£^l9_^ ^ 73;?? i . -^^ . 

BflfMlyOniMBy: 

MROoMD n 

^^^^^...^ ^ ^ r ^- • '•'' \ 

^-/-.^ ^ Wt:^^^^.^^^^^^^ 
Current Sample Pre-Renovation Fomn 

Effective imtll April 2010. 

ConflrmaUon of Receipt of Lead Pamphlet 

Q I have received a copy of the pamphlet,/?9novafefliiig/7^'J!rnp(vi^ 

Infonnation for FamBles, CNId Care Prwkiera and Schools informing me of 

the potential risk of the lead hazard exposure from reriovatlon activity to be 

perfomied in my dwelling unit. I received this pamphlet before the work tsegan. 

• • • • Dat e 

Signature of recipient 

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

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

you may dieck the appropriate box below. 

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

pamphlet, Renovate Right: Important Lead Hazard InfonnOkin fbr FamHes, 

Ct M Cara Providers end S(^KX3b, to the rental dwelling unit listed beiow 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 forslgnature — i certify that I have made a good feltheffott to 

deliver the pamphlet, Renovate Rls^t: Important Lead Hazsrd Information for 

Fait^Bes, (M i Cara providers and Schools, to the rental dwelling unit listed 

below and that the occupant was unavailable to sign the confirmation of receipt. 

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

under the dOQi<;< 

Printed name of person certifyin certifyingg Attempted delivery 

date and time 

lead pamphlet delivery 

Signature of person ceoHyfng lead pamphlet delivery . 

Ofi/jclhcL , /V^ 

UnttAddress 

Note Regarding Mailing Option — As an alternative to delivery in.per5on, 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). 
paint match rform 

paint matching form: ^ r 

property address:

BVID: 70'^ fi 

Area: 

Explanation: 

Area: 

Explanation: 

Area: 

Explanation: 

Area: 

Explanation: 

Area: 


Explanation: 


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Color: 

10 ftl/oi^s: 

color: 

Color: 

color: 


color: 


Page 1 

Douglas County Account InfoM^tion Page 1 of 2 cm^t 

Douglas County, Nebraska Property Record - R2218900000 

Print Report 

NEW Feature - Parcel Dimenstons available @ scale 0-50 ft west of 90th St - VJeW. QD Ma p Information is valid as of 2008-9-4 Treasurer's Tax Repart 

New Feature -*-*- * Auto Sales Search 

Owner 

CAMPSEY FRANCES 

ETAL 

1325 3 26 ST 

OIVIAHANE 68105-0000 

Property Information 

Key Number: 1890 0000 22 

Account Type: Residential 

Parcel Number: 2218900000 

Parcel Address: 1325 S 26 ST 

OMAHA NE 68105-0000 

Legal Description: SHULLS 2ND ADD LOT 16 BLOCK 10 50 X 127 

Value Information 

Land Improvement Total 

2008

2007

 j 

i 

$4,900.00 

$4,900,00 

f­ $75,000.00 

$75,000.00 

$79,900.00 

$79,900.00 

2006 ^ $4,900.00 $63,600.00 368,500.00 

2005 $4,900.00 $63,600.00 $68,500.00 

2004 $4,900,00 $63,600,00 $68,500.00 

2003 $4,900.00 $63,600.00 $68,500.00 

Land Information 

Acres SF Units Depth Width Vacant 

0.14 6350.0 1.0 127.0 50.0 No 

Improvement Informatio n 

Building 1 

v.ttr>-//rir>iirrincnp mnnnina.nnlinp: r.nm/nnnp]asCoNe/static/accountinfo.isD?accountno=R22... 10/1/2008 
Douglas County Account Informatio Mjm n Page 2 of 2 a 

CLICK TO ENLARGE IMAGE 

Square Footage: 1432.0 

Perimeter 0.0 

Unit Type: 

Built As: 2 Story 

HVAC: Forced Air 

Exterior: Frame Shingle 

Interior: Plaster 

Roof Cover: Composition Shingle 

Roof Type: Hip 

Fioorcover: Allowance 

Year Built Year 

Remodeled 

Percent 

Remodeled 

1888 0% 

Detail Type Detail Description 

Add On Fence Chain Link 

Appliance Allowance 

Basement Bsmnt Block 8 ft 

Fixture Additional Fixtures 

Fixture Base Fixtures 

Fixture Bath Full 

Porch Slab Roof Ceil 

TWO STORY 

CLICK TO ENLARGE IMAGE 

Percent Complete. 100.0% 

Quality: Average 

Condition: Fair 

Condo Square Footage: 0.0 

Rooms: 8.0 

Units: 1.0 

Baths: 2.0 

Bedrooms: 5.0 

Stories: 2.0 

Foundation: 

Sprinkler Square Footage: 0.0 

Adjusted Year 

Built 

1888 

Physical Age 

120 

Units 

1.0 

1.0 

976.0 

"T.O 

z o 

160.0 

Iittn'//Hrtna1acnf» TTiannina.r>n1in«» rr»m/nr>iiola<!r'n'IMp/<!tntir/nrrr>iintinfn iQn9nr>rr>iintnn=R9? 10/1 /OOOfl 
Pmdsm jPropertv Ci®^e-Oyt ¥o^m {isad-Bsssd Pmm Stato!iteato©ii| 

jYaS INC 

WEsthe entire structure(3)ipaint6d with the sxcacstlon of the stated., exciudsd sreas? Tnis wouid 

Include psinting of ether aspcciated features inciuding fssde, eaves, siding,, all trim, porches, box A 

bsstns, columns, raiSs, and fxtenor siirfeess of garages. I 12.

 Was eli scraping and other fyeparattic-n work completed saftisfactoriiy? 

•nTt­ l3.

 Were ell required areas of t'ne structurefs) prin-ied as needed and painted with trwo top costs? 

14. Was the paint products utjti^ed equrvsient to = 30 year product/quaiity? 

ii. .Are ais ofthe areas \«here cdntaminated materials have been spiiisd 

i thoroughly vacuumed/dearj^d? 

iS. Did t^ie contractor coliect/vacuum a!" fsllsng and scraped paint chips en the entire property, 

V\ roadways, aKeyways, public sccess areas and slsc remove any other generated debr-s? 

p 

t7. is the grass area that surrou.nps the structurefs) ir; reasonably good conditiori? 

|S. Are all Items such as polyethijien sth4 e sheeting, ladders, paint brushes, cones, barrier tape etc. 

= \ 

I propsriy removed? jl 

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

; needs to be eompietsd prior fe the SPA dose-Out. 

ilC. A.TM there any property items |r.3t were tempcratily re-iocated bv the contractor 

1 that need to be moved back?-1 

! \ rt r : ~~—: 

111. .iire there any (k.f:Own) fsngsring Issues with tne sropert*; ow.-isn,S} triat nave £ee.r-i :eft unresoh/ed? 

ether Con5'tder3tigns?prope!ty|ov.?ner DiscussionsT.Adaitlonai Work that is Required 

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