## TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL EFOLDE R SAI D # : 20e(y> ^ Date : 7/j^^D ^ 

# Address : 2Sl!ff ^ I leTCe ^ S f Remediatio nContractor : PROFESSIONA LENVIRONMENTALENGEVEERS Year : 200 8 PAEV T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S y Vide o ofpropert y (DVD ) ^ Executiv e Sununar y 0 SignedAcces s Agreemen t fo r

subject propert y U Paintin g Agreemen t D t

Settlemen t document s (i.e. , fo r

damag e or to replac e plants , etc. ) y Photograph s . _ Satisfactor y restoratio n signedb y Propert y Owne r D Propert y close-out chec k

lis t signe db y EP A W. ' Propert y information fromDougla s Count y Assessor' s Office 

# ^l^^^^d^k^Xg ^ iJy<^o f Si^atur e ' Dat e

4031834 8 

# Iiil l Superfun d

# PROFESSIONA L 

# i 1 250 5 Nort h 24" \ Suit e 21 9 

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

### "Providin g cost-effectiv e environmenta l solutions "^ |^°^ | c^Mof ? ^ Fax(402 ) 504-328 1 

# 1 

# 1

Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc yRespons e



### Lea dBas e Stabilizatio nOmaha , N e Clos e Ou t Repor t SAID #2086 3 256 9 Pierc e S t

•Date s worke d12/2 9 t o 12/3 0 200 8 •Hous e was i n poo r conditio n al l over , pain t wa s comin g of f o n al l areas , broke nwindows , broke n cabl e box , damag e t o sidin g an dgutte r areas , Garag e hadextensiv e damag e al l over includin g th e mai n door s that were badl y damaged . •Inspecte db y PE projec t manage r

# 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 l solutions " Fa x(402 ) 504-328 1 Consultin g • Engineerin g Desig n » Remediatio n • Abatemen t • Emergenc yResponse 

### Propert y Owne r Close-Ou t For m (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-06 ) 

## SAID : 7^Jv^(X' J S c o ^ t ~ Property Address : 

# 2SG ^ 9,^j^- & Owner' s Name ; 

# ypzco: ^ Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entire 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 al l 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 year product/quality ? 

## T ^ ' 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 entire property , roadways , alleyways , publi c acces s area s an dals o remov e any othe r generate ddebris ? 7 . I s th e gras s are athat surround s th e structure(s ) i nreasonabl y goo dcondition ? 8 . Are al l item s suc ha s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . properl y removed ? 9 . I s ther e any evidenc e ofpropert y damag e that wa s don e b y th e contractor ? Any property damag e need s t o b e complete dprio r t o th e EPA Close-Out . 10 . Are there any property item s that wer e temporaril y re-locate db y th e contracto r that nee dt o b e move dback ? 11 . Are there any (known ) lingerin g issue s withth e property owner(s ) that hav e bee nlef t unresolved ? Comments :



# j^yy^kij c ^ ^7 Property Owner Signature 

# /- y Dat e 

# -^ ^

Professional Environmefual Engineer s Representativ e 

# y' ^ Dat e 

## ^<y yKfA' . 1 2 0 8 02:47 p 

### Eduian dScot t 402344348 8 p. 2


# CONSENT OF R ACCES S T O PROPERT Y OMAH A LEA D SIT EREMEDIA LACTIO N - LEAD-BASE D PAIN T STABILIZATIO N PROPERT Y BD : yt:i(yoZ ^ PROPERT Y ADDRESS : 

# ^sr^ q y i e r 

# c-e > Sl
­ 1 0WN'£RNAM'£ : 

## 4 AuJTMc ) ^'i:^^'^' ^ OAYTiM I I PHONE : 

## ^L|
- 

# 2>^? ^ C£L LPHONE : E-MAIL : OWNER' S ADDRES S I FDIFFERENT : TENANT' S NAM EB FAPPLICABLE : 

## | l CELLPHONE : DAYTIM EPHONE : E-MAIL : 

# 1 Profassuoaa l EaviroomcntA J EnguiMrs , iDC . (PE ) i s unde r contrac t (#EP-R7-0S-06 ) wit b tb e U.S . Eaviraomenu l Protectio n Ageoe y (EPA ) t o ttabilix e lea diMue dpain i (LBP ) A Uresidenti* ! structure s a t anumbe r of propertie s locate di nOmaka , Nebraska . Tb e pain t stabilizatio o wor k i s bein g don e i o protec t che soi l cleanup s tba t wer e perforate db y EP A coatractor^ . Pain t stabilizatio n activitie s wil l include : scrapin s o f cracke do r flakini ; LB Pfro mstructures , aipplkatio nn f aprim e coa t an d tw o (2 ) coat s a f paint . Movin g parti i o f window s an ddoor s ar e no t include daa dwil l no t b e addressed . You r cnoperatio ai s requeste di n givin g permissio nt o thi s EP A contracto r (PE ) t o ente r an dhav e acces s t u th b propert y fo r th e purpos e o f stabilizin g lead-base dpain t a s outline do n th e propert y identifie dabove . B y signin g thi s documen t 1 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 rollowio g completio n o f lead-base dpaio t stabilization . 1 understan dtha t th e stabilizatio n contracto r ca o no t provid e SBSurance s tba t th e soi l cleanu p contracto r wil l b e bouo dto . f furthe r nnders'tan dtiia t th e soi l cleanu p contraeto r wil l mak e al l reasonabl e effort s t o addres s concern s tba t I , a s th e propert y owner , ma y hav e regardin g soi l ckanu p a t my property . I full y understan dtha t b y signin g tbi s Conten t to r Access , (1 ) thi s acces s wil l remai n i neffec t unti l th e wor k ba s bee n sati»fxcturil y completed , (2 ) lha t th e Propert y Owne r o r Tenant , i f applicable , wil l b e give ntb 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 dSchooU" , (3 ) tb e Propert y Owne r o r tenan t wil l remov e al l obstruction s firomsurface s t o b e painted , (4 ) wil l abid e b y heaU hna dsafet y guidanc e provide db y EPA , (5 ) wU I aUo w photograph y ofpropert y befor e an dafte r th e pain t stabilizatio nwork , (6 ) wil l b e contacte db y aP Erepresentativ e upproiimatel y 4 8 hour s i n advanc e of startin g work , (7 ) agre e no t t o obstruc t o r tampe r wit han y ofth e LB Pstabilizatio aactions , an d(8 ) wil l participat e i nflnal propert y inspectio n an d sig n th e Completio nAgreemen t an dPropert y Owne r Satisfactio nSurvey . Shoul dyo u hav e an y question s abou t tb e plane dLea dBased-Pain t stabilizatio aactivitie s fo r you r property , pleas e contac t Professiona l Environmentt I Engineers , Inc . Projec t Manager , Willi e CU y A t 402-S04-468S . Genera l question s abou t th e Omah aLea dSit e cteanii p ca n b e directe dt o Paulett aFrance-Isetts , EP A Remedia l Projec t Manage r 4Q2-731-24S4 , o r th e EP A Publi c Informatio nCenter s a t 402-991-958 3 (Nort hOmah aoffice ) o r 402-731004 5 (Sout hOmah aoffice) . D Ves , I anut t acces s fai m y propert y m dm s give nth e panphle t D No , I d o no t gran t acces s ( 0 m ypropett yan d I W l "Renovat e Right, knportn t Lea dInfonnati M (o r Families , Chil d givef l th e pamphle t "Renovit a Right , Importin t Laa d CarePravHinvandSchooIr ^ ^ Infoffflallof l ferFamKlas , ChlM * Ca n Providen , an d Sctwolt. ' Sisnahir e Dat a Signatur e Dat e SPECIA L INSTRUCTION S AN D CONSIDERATION S

50/3 8 3EW d Sy33NI9N 3 yiAN 3 JOH d OQOQTCr.f.T C n ^ "rtr tNov , 1 2 0 8 02 : 48 p Eduuar d Scot t 402344348 8 p . 3 

## Confirmatio n O f Receip t O f Lea d Pamphle t BVt D .yxyiCay > ^ 

# (y § /O S PROPERT YADDRESS . OPCODE . PROPERT YADDRES S O F OWNE R I F DIFFEREN TTHA N PROPERT YBQN G PAINTED : PROPERT YADDRES S .ZI P COD E

hav e received a cop ^ o f th e pamphlet , Renovat e Kght Importan t Lea d Hazar d Infwma^o n Po rFamilies , C W d Car e Provider s An d Schoo l Informin g m e o f th e potenfia l risk o f tiie tead hazar d exposur e fro m renovatio n activit yt o b e perfbrme d o n dweilin g uni t I receive d thi s pamphle t befor e th e wori cbegan . 

# //v/?op r /^PmNTE D NAM E Q F RECIPIEN T> 

# oZ . DAT E

Sdf-Certificalio n Optio n (ForTenant*Occupi« d DwBlling s Only ) I fIh e lea d pamphle l wa s delivere d bu t a tenan t signatur e wa s no t obtainable , yo u ma ychec k th e appropriat e bo x below : 

# D Refusa l T o Sig n - 1 certif y^a t I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , renovat e righ t importan t lea d hazar d infonnatio n fo rAmities , & M car e provider s an d schools ; to th e renta l dwelin g uni t liste d abov e a t th e dat e an d tim e indk^ite d an d tha t th e occupan t refuse d t o sig n th e oonfirmatk m o f receipt . I furthe rcertif ytKa t 1 hav e lef t a cop yo f ^ e pam^le t a t th e uni t wit h occupan t 

# D Unavailabl e Fo rSignatur e - 1 oettif ytha t I hav e mact o a goo d fait h effor t t o delh/e rth e pamphlet , renovat e right ; importan t lea d hazar d infbrmatio n fo rfamilies , chil d car e provider s an d schools , t o flte renta l dwellin g uni t liste d beki wan d tha t th e occupan t wa s unavailabl e to sigr \ Oi e oonfirmatia n o f receipt . I furthe rcert'ifytha t I hav e lef t a cop yo t th e pamphie t a t th e uni t b yslidin g r t unde rth e doo ro rsomewher e o n th e premises . 

# XVB U

# ^^"SaAAiit- ^ I l nj ^ PRINTE D NAM E O F PERSO N CERnFYIN G AnBHPTE D OEUVERYOAT E AN O TIM E LEA D PAMPHLE TDEUVER Y

SICNATUREO F PERSOM^ERTIFYI IN G LEA O PAMPHLE TDELIVERY : Not e RagartHn g Maiin g Optio n ~ a s a n alternativ e to deliver yi n person , yo u maymai l th e lea d pamphte t to th e owne r and/o rtenan t Pamphle t mus t b e maile d a t leas t 7 day s b^r e renovation . (Documen t wit h a cetiiricaif i o fmaain g fro m th e pos t office } CONFIRMATIO N O F RECEIP TOF LEA D PAMPIHLE T 08/0 8 CQ /C Q -XM J CU-miTru.!- ! SI T«n- lNov i 1 2 0 8 02:48 p Edujan d Scot t 402344348 8 p. 4 

# PAIN TSTABILIZATIO N PRE-PROPERT YASSESSMEN T PROPERT YADDRES S 

# , A^rf i P.PI^ P .^ f DATE
- 

## f l iy(os < 

# y}r>?:( y BVI D 

### PLAir rft PERHANEN TLANDSCAPIN G T O B E REMOVE ? N O d D YE S f— 1 IF , YE S WHERE :

i PRE'BOSEEfi GOONDXZIQ M O FFOUNDATION/STRUCTURE r i.« . BASEMEN T LEAKING ? N O ^^- J YE S ' ' IFrYESWHERE :

EXXSIIN S PADi T O N WINDOWS ^ DOORS , FOUNDATION , SIDEWALKr C Z^E*) ? N O z n 

### YES [2 3 IF,YESWHER & / / 

## ^i^y^t ^ ^ny y yy/yi ^ y 7tt}ui e

VISUA LDESCRIPTIO NO FPROPERTY/STRUCTURE/GARAGE r Cl-E.) : (US EBAC K

5IO EI F NECESSARY ) 

# (^^nyo^ LnL7 s (j/i^^ K iaii<,iAa/ly/w y r(^y,y ^ Z K /^/)rsf<^'y' t ytn/ I aLuL . i^i^-^ f/y^ ^ ^/>i/^/.yr

S9/f 9 39V d Sa3a^I9N 3 yiAN 3 -n>w aannTCCk.Tc - r\- , .«# •how-,1 2 0 8 02:48 p Edwar d Scot t 402344348 8 p . 5 

## PAiN TSTABILIZATIO N PRE-PROPERT Y PAIN TMATC H ASSESSMEN T oonPfOTYAnDiiess. ' .Q^Co ^ Y'lgic yS h DATE _ 

# II I I' Lh i BVI D yy:\'Pry>y > AREA(S ) T O B E PAINTED : HOUS E PROPER : COLOR . 

### HOUS E TRIM . _COlJOR L
GARAGE - .COLOR . GARAG ETRIM . .COLOR ^ 

### PORCH . _COLOR^

PORCHTRIM . .COLOR . (COMPLETEAL LSECTION , YES , PlO r O RNON-APPUCABLE ) 

## I AGRE E T O TH E COLOR S USTE D ABOVE . ONC E PAINTIN G BEGINS , I UNDERSTAN D I CA N NOTCHANG E TH E ABOV E SELECTE D COLORS :

PAIN TMATC H KMI M OBNt t 

### se/s e 39Vd Sa33NI9N 3 iJlAN 3 JOy d nqOflTPChT C nr-0 0

### Dougla s County Accoun t Informatio n Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R221821000 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 Of l 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 SCOTTEDWAR D 256 9 PIERC E S T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : I 182 1 000 0 2 2 Accoun t Type : Residentia l Parce l Number : 221821000 0 Parce l Address : Lega l Description : 256 9 PIERC E S T OMAH AN E 6810 SHULL S 2N D AD 5-000 0 D LOT 4 BLOC K8 E 5 0 FT Valu e Informatio n 200 8 200 7 200 6 200 5 200 4 200 3 Lan d $5,400.0 0 $5,400.0 0 $5,400.0 0 $5,400.0 0 $5,400.0 0 $5,400.0 0 Impro vemen t $65,500.0 0 $65,500.0 0 $62,200.0 0 $62,200.0 0 $62,200.0 0 $62,200.0 0 Tota l $70,900.0 0 $70,900.0 0 $67,600.0 0 $67,600.0 0 $67,600.0 0 $67,600.0 0 Lan d Informatio n Acre s 0.1 9 S F 8400. 0 Unit s 1. 0 Dept h 168. 0 Widt h 50. 0 Vacan t N o Improvement Informatio n Buildin g 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R22. . . 11/5/200 8

### 'Dougla s Count y Accoun t Informatio n Pag e 2 o f 2

*' 1 F*S t Floo r , rs»:<»* 3 Roa rL , i, \

I03<0sq n Ljf 2 0sq,fl . P !» » I • *
1 m STOR YFirsllSHE D

CLIC KTO ENLARG E IMAG E Squar e Footage : \ 1604. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Fai r

Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 7. 0 Exterior : Fram e Shingl e Units : 1. 0 Interior : Plaste r Baths : 2. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Gabl e Stories : 1. 5 Floorcover : I 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 0 0 % 191 0 9 8 Detai l Typ e Deta/ 7 Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 1034. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 2. 0 Garag e Detache d 440. 0 Porc h Sla b Roo f Cei l 165. 0 Use r Atti cFul l Finis h 570. 0



### http://douglasne.mapping-online.com/DougIasCoNe/static/accountinfo.js p ?accountno=R22.. . 11/5/200 8