TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID #: ^^Q^ S Date: nj^Z^/^o/ O 

Address: 5^5 ^ f^W-t.\r\Cr^. K^V ^ 

Stabilization Contractor: Professional Environmental Engineers Year: 2010 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

D Video of property (DVD) 

D Executive Summary 

B*"^ Signed Access Agreement for subject property 

E' Pre-Renovation Form signed by Property Owner 

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

EB"'^^ Painting Agreement 

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

B- Renovation Recordkeeping Checklist signed by Certified Renovator 

D Photographs 

ly"^ Satisfactory close-out check list signed by Property Owner 

D Property close-out check list signed by EPA 

H--^ Property information from Douglas County Assessor's Office 

D Hazard analysis, if prepared 

D Safety Audit 

D Other (describe): 

^ 

?A~(jt:)K sier mm 

(after file folder review) ate 

30217447 

Superfund 
2010 

PROFESSIONAL 

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

(402) 504-4688 "Providing cost-effective environmental solutions" Fax (402) 504-3281 

Consulting • Engineering Design • Remediation • Abatennent • Emergency Response 

EPA Close-Out Form 

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

SAID: ^^Co?^ S 

Property Address: -^^^C Q £hf£nc^_&c/ 

Ovmer'sName: M ^ ). PmpgrAjpA 

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, i^" 

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

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

3. Were all required areas ofthe structure(s) primed as needed and painted with two top coats? " C ^ 

4. Was the paint products utilized equivalent to a 25 year product/quality? ^ 

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

L ^ cleaned? 

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? W 

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

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

properly removed? ^ ' 

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

ly damage needs to be completed prior to the EPA Close-Out. 

10. Has the property owner signed the completion form? i:^" 

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

U > be moved back? 

12. Are there any (known) lingering issues with the property owner(s) that have been left 

unresolved? u 

Other Considerations/Property Owner Discussions/Additional Work that is Required: 

PL /I/ / f/2/j6/0 

EPA COR Signature )ate 
2010 

PROFESSIONAL 

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

(402) 504-4688 "Providing cost-effective environmental solutions" 

Fax (402) 504-3281 

Consulting * Engineering Design • Remediation • Abatement • Emergency Response 

Property Owner Close-Out Form 

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

SAID: ^ ^ P 3"^ 

Property Address: 

Owner's Name: 

ffu^o/u:^ /yj/ma4^i!u^ 

Performance Standards/Ciose-Out Criteria 

YES NO 

1. Was the entire structure(s) painted with the exception of the 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? 

t--~ 

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? 

1 

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

vacuumed/cleaned? i^ ^ 

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 1/ ^ 

debris? 

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

t — 

8. Are all items such as polyethylene sheeting, ladders, paint brushes, cones, barrier tape, - ^ etc. properly removed? 

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

damage needs to be completed prior to the EPA Close-Out. L ^ 

10. Are; you satisfied with the work performed? 

v ^ 

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

u ^ need to be moved back? 

12. Are there any (knovm) lingering issues with the property owner(s) that have been left 

w­ unresolved? 

Other Considerations/Property Owner Discussions/Additional Work that is Required: 

1 7 ID 

Date 

^.-f-i d 

Professional ngineers Signature 

Date 
2505 North 24"', Suite 219 

Omaha, NE 68110 

(402) 504-4688 

Fax (402) 504-3281 

PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

"Providing cost-effective environmental solutions" 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Lead Base Stabilization Omalia, Ne 

Close Out Report 

2010 

SAID#33635 

3936 Florence Bd. 

• Dates worked: 07/02/10 to 07/02/10 

• Pre property condition: House has painted wood shingles with painted wood trims that 

had flaking paint, Paint chips around house. 

• Problems encountered: None 

• Owner request/concerns: Color changes. 

• Inspection/closeout dates: Owner 07/07/10, inspected by PE project manager. 
h 

Professional Environmental Engineers: EPA Paint Stabilization 2010 

SAID# .^.^/p3 5 ^ _ 

Property Address .893(i> TlOrAnfjp. R>N/C) 

Stories/Siding type /. 5 tS4r)ry 

Garage? j ^ 

Access signed \^<^.S {JSIl O 

Pre-video lp|ifs]in 

Post video 

Contractor AwlgneJ tV^ C . f^PfSTNG^^ ^ 

Date started 2J\0 

WeathiBr/temp ^Oo ' 

Date ended m 

Paint used 'I'l-^ (oWb h^o^\^^'''^\^ \^<^ 

Prime used 

Poly used / \X^)(\ 

Problems/Issues 
:m CONSENT FOR ACCESS TO PROPERT »^' ; Y 


OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID; ^^r^-G^j^ ^ PROPERTY ADDRESS; ^^^ C -f/Hpti^CC ^/yifi/' 

OWNER NAME; 

DAYTIIVIE PHONE; 

CELL PHONE: ji^oZ} &^f-f^OJi E-MAIL; JLLuptAt^l,^/Off9^r^ >CK»u»/^dia»a 

OWNER'S ADDRESS IF DIFFERENT; /CX!?/Cf S' ' /S ^ S^rig ^ Bc//6Mfit^ A^C'f/ ^ 

TENANT'S NAME IF APPLICABLE: 

Mrr^ ^1 ^ DAYTIME PHONE: 

CELLPHONE: ^Q Z "^^J ' -T^"? ^ E-MAIL; 

Professional Environinental Engineers, Inc. (PE) is 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, 

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

Paint stabilization activities will include; scraping of cracked or flaking LBP from structures, application of a prime coat and two 

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

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

my property. 

S^, l ) an paraa Yes, I haveread red apdd underetand ibove.

2^^ g — 

Signature diProperty Owner Date 

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

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

(HUD) and EPA pamphlet, "Renovate Right, Important Lead Hazard information for Families, Day Care Providers, 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 of property 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 final property inspection and sign the Completion Agreement and 

Property Owner Satisfaction Survey. 

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

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

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

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

fl'^lgr fes, I grant access to my property and was given the pamphlet D No, I do not grant access to my property and I was 

"Renovate Right, Important Lead Infbrmatlon fbr Families, Child given the pamphlet "Renoydfe Right, Important Lead 

Care Provldere, and Schools." Information for FamillQtfJZnim^Care Provldere, and Schools." 

Signature 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

PROPERTY ADDRESS: ^*^J C -fYeHTUiCe^ E/i>/ DATE: ^/fffc ? 

^/^W ^ A ^ ^f/(r ? BVID: 

AREA(S) TO BE PAINTED: 

HOUSE PROPER: 'TA-A ^ (. ^ / COLOR: 7 ^ ^ (QW ^ 

HOUSE TRIM: ///H-tT ^ ( tAf<,) COLOR: oO^rr ^ 

GARAGE: j/l/yy ^ COLOR: ..^^ ^ 

GARAGE TRIM: _ S^j^ ^ COLOR: A ^ -

PORCH: fA^ ^ COLOR: *J2? y^^C^t/s ^ 

PORCH TRIM: cn//^rr^^ (yoUff^ (y^ J ''°'-°''= 

(COMPLETE ALL SECTION, YES, NO, OR NON-APPLICABLE) 

I AGREE TO THE COLORS LISTED ABOVE. ONCE THE PAINTING 

BEGINS, I UNDERSTAND I CAN NOT CHANGE THE ABOVE SELECTED COLORS: 

PROPERTY OWNER SIGNATURE: PE ACCESOR SIGNATURE: 
PRE-RENOVATION FORM - OWNER 

This form is to be used by the firms contracted by the Environmental Protection Agency-Region 7 to perform Lead-Based 

Paint stabilization activities at the Omaha Lead Site, Omaha, Nebraska. 

Owner Confirmation 

Pamrfdet Receipt 

a i have received a copy ofthe lead hazard information pamphlet. Renovate Right: Important Lead Hazard Information for 

Families, Child Care Providers and Schools, informing me ofthe potential risic ofthe lead hazard exposure firom renovation 

activity to be performed in/on my dwelling unit. I received this pamphlet before the work began. 

Own^r^knowledgment 

n(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/her custodial parents, legal guardians, foster parents, or 

informal caretaker if the child lives and sleeps most oftime at the caretaker's residence. 

Note: A child-occupied facility is a pre-1978 building visited regularly by the same child, under 6 years of age, on at 

lea^t two different days within any week, for at least 3 hours each day, provided that the visits total at least 60 hours 

>dnnually. 

[>(B) I understand that the renovation firm, contracted by the Environmental Protection Agency (EPA), will be using leadsafe work practices required by EPA's Renovation, Repair and Painting Rule. 

Printed Name of Owner-Occupant 

VOt — ^/r//<^ 

Signature of Owner-Occdpant Date 
'' Douglas County Account Informat Page 1 of3 w 3 3 ifi 3 5 

Douglas County, Nebraska Property Record ­ R2013030000 

Information is valid as of 2010-5-28 

New Feature -•-»- >

Print Reoort 

View Interactive GIS Mao 

Treasurer's Tax Reoort 

 Subdivision Sales Search 

Owne r 

N AND L PROPERTY MANAGEMENT L 

10016 S 13 ST 

BELLEVUENE 68123-0000 

Property Informatio n 

Key Number: 1303 0000 20 

Account Type: Residential 

Parcel Number 2013030000 

Parcel Address: 

Legal Description: 

3936 FLORENCE BD 

OMAHA NE 68110-0000 

PLAINVIEW LOT 2 BLOCK 1 50 X 124 

Value Informatio n 

2010 

2009 

2008 

2007 

2006 

2005 

Land 

$7,000,00 

$7,000.00 

$7,000.00 

$7,000.00 

$7,000.00 

$7,000.00 

Improvement 

$34,500.00 

$39,900.00 

$39,900.00 

$39,900.00 

$39,900.00 

$10,100.00 

Total 

$41,500.00 

$46,900.00 

$46,900.00 

$46,900.00 

$46,900:00 

$17,100.00 

Sales Informatio n 

Sales Date: 2006-09-11 

Deed Type: 

Price: 

Grantor: 

WD Book: 

$63,000.00 

Freedon Real Estate Investments 

2006 Page: 105126 

Grantee: 

Valid/Invalid: 

Nguyen Hien T etal 

Valid 

Exclusion Reason: • 

Sales Date: 2006-01-05 

Deed Type: 

Price: 

Grantor: 

WD 

$27,500.00 

JRG LLC 

Book: 2006 Page: 002801 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R201... 6/4/2010 
Douglas County Account Information Page 2 of 3 i 

Grantee: Lengendoifer Properties-Management 

Valid/Invalid: Valid 

Exclusion Reason: 

Show All Transactions 

1 Land Informatio n 

i Acres SF Units iDepth Width Vacant 

0 14 6200 0 1,0 124.0 50.0 No 

Improvemen t Informatio n 

Building 1 

• 

mZS. Florwics Bd, 

^^^^^m^^^^T'"' ^^^SHJ^^^^^^^^H^H^S^^^^^I 

^ . : ' • Hj^BP j ^ V.ti 

f

f ^ M I 

fer."-- ^ m • ^^HHB^B 11.(2 STORY FIN ; ' / 

^ - ~ ^ ' *^ ' ^^MriS 

j CLICK TO ENLARGE IMAGE 1 CLJck t o EiNILAFlGE iWIAGE 1 

Square Footage: 1126.0 Percent Complete: 100,0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Fair 

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

HVAC: Forced Air Rooms: 6.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

1 Sprinkler Square Footage: 0.0 

yearSu/7t Year 

Remodeled 

Percent

Remodeled

 Adjusted Year 

 Built Physical Age 

1914 1988 0% 1914 96 

Detail Type Deta/7 Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 724.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R201... 6/4/2010 
(effective April 2010) 

RENOVATION RECORDKEEPING CHECKLIST 

Name of Finn: H( . ^YJW ^ 

Date and Location of Renovation: ( \ ^ i \ ^ 

Brief Description of Renovation: VO\tV\ - ^^^[QL ^ 

Name of Assigned Renovator: 

Name(s) of Trained Workers: WrV-tC^ Q 

Name of Dust Sampling Technician, Inspector, and/or Risk Assessor, if used: O (iTX 

^3<:;opies of renovator and dust sampling technician qualifications (training certificates, certifications) on file. 

I^X^ertified renovator provided training to workers on (check all that apply): 

^"--JD Posting waming signs BsSetting up plastic containment barriers 

"B-Maintaining containment i5*Avoiding spread ofdust to adjacent areas 

^"•^4lWaste handling ^>Post-renovation cleaning 

^"^S Test kits used by certified renovator to determine whether lead was present on components affected by 

renovation (identify kits used and describe sampling locations and results: 1 1 (( ^ 

^^—U^Waming signs posted at entrance to work area. 

O^or k area contained to prevent spread of dust and debris. 

"BvWindows in and within 20 feet ofthe work area are closed 

^""T^I^ors in and within 20 feet ofthe work areas are closed and sealed 

^""BvDoors that must be used in the work area are covered to allow passage but prevent spread ofdust. 

^^Bspround covered by plastic sheeting extending 10 feetfi-omwork area - plastic anchored to the 

building and weighted down by heavy objects. 

- ^ 1 IIff necessary, vertical containment installedto prevent migration ofdust and debris to adjacent 

propdperty i . 

^D-Waste contained on-site and while being transported off-site. 

Renovation Recordkeeping Checklist Omaha Lead Site 
(effective April 2010) 

^OxWork site properly cleaned after renovation. 

'^^All chips and debris picked up, protective sheeting misted, folded dirty side inward, and taped for 

removal. 

D^or k area HEPA vacuumed to get paint chips from ground surface, if necessary. 

"^"-QjCertified renovator performed post-renovation cleaning verification (describe results): 

"^"o-^ certify under penalty of law that the above information is true and complete. 

^(9.IIO 

Naitiie Date 

Renovation Recordkeeping Checklist Omaha Lead Site