TRANSMITTA L o f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R 

### SAI D # : ^^Q^ S Date : nj^Z^/^o/ O Address : 5^5 ^ f^W-t.\r\Cr^ . K^V ^ Stabilizatio n Contractor : Professiona l Environmenta l Engineer s Year : 201 0 PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S D Vide o o f propert y (DVD ) D Executiv e Summary B*" ^ Signe dAcces s Agreemen t fo r subjec t propert y E ' Pre-Renovatio n For msigne db y Propert y Owne r D Pre-Renovatio n Formfor Occupant/Tenant , i f applicabl e EB"'^ ^ Paintin g Agreemen t D Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) B- Renovatio n Recordkeepin g Checklis t signe db y Certifie d Renovato r D Photograph s ly" ^ Satisfactory close-ou t chec k lis t signe d b y Property Owne r D Property close-ou t chec k lis t signe db y EP A H-- ^ Propert y informatio n fro mDougla s County Assessor' s Offic e D Hazar danalysis , i f prepare d D Safet y Audi t D Othe r (describe) :

^ 

# m m ?A~(jt:) K sie r (afte r file folde r review ) at e 3021744 7 Superfun d

### 201 0 

## 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 • Abatennen t • Emergenc y Respons e 

### EP A Close-Ou t For m (Lead-Based Pain t Stabilizatio n EP A Contract EP-R7-08-06 ) SAID : 

## ^^Co?^ S Propert y Address : 

## -^^^C Q 

# £hf£nc^_&c / Ovmer'sName : 

## M ^ )
. PmpgrAjp A Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Was the entir e structure(s ) paintedwit h th e exceptio n ofth e stated , excludedareas ? Thi s woul dinclud e paintin g o f othe r

associate dfeature s including fascia , eaves , siding , all trim , 

# i^ " porches , box beams , columns , rails , an d exterior surface s o f garages . 2 . Was all scraping an dothe r

preparatio n wor k

completedsatisfactorily ? 

# T ^ 3 . Wer e all require darea s ofth e structure(s ) primeda s neededan dpainte dwit h tw o to p coats ? " C ^ 

### 4 . Wa s the pain t product s utilize dequivalen t t

o a2 5 yea r

product/quality ? ^ 

### 5 . Ar e all ofth e area s wher e contaminatedmaterial s hav e bee n spille dthoroughl y vacuumed / / 

### L ^ cleaned ? 6 . Di dth e contractor collect/vacuumall falling andscrapedpain t chip s on th e entir e property , roadways , alleyways , publi c acces s area s an d als o remove an y othe r

generateddebris ? 

# W 7 . I s the gras s are atha t surround s th e structure(s ) i n reasonabl y goodcondition ? 8 . Ar e all item s suc h a s polyethylene sheeting , ladders , pain t brushes , cones , barrie r

tape , etc . properl y removed ? ^ ' 

### 9 . I s ther e an y evidenc e ofpropert y damag e tha t wa s done by th e contractor ? An y propert y 

# l y damag e need s t o b e complete dprio r

to the EP A Close-Out . 10 . Has th e propert y owne r

signedth e completion form ? 

# i:^ " 11 . Ar e ther e an y propert y item s tha t wer e temporarily re-locate dby the contractor tha t need t o U > 

### b e move d back ? 12 . Ar e ther e an y (known ) lingering issue s wit h th e propert y owner(s ) tha t have bee n lef t unresolved ? 

# u Othe r

Considerations/Propert y Owne r

Discussions/Additiona l Wor k

tha t i s Required : 

# P L 

# /I/ / f/2/j6/ 0 EP A CO RSignatur e )at e

### 201 0 

## 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 y Respons e 

### Propert y Owne r

Close-Out For m (Lead-BasedPain t Stabilizatio n EP A Contract EP-R7-08-06 ) SAID : 

# ^ ^ P 3" ^ Propert y Address : Owner' s Name : 

### ffu^o/u: ^ /yj/ma4^i!u ^ Performanc e Standards/Ciose-Ou t Criteri a YE S N O 1 . Was th e entir e structure(s ) paintedwit h th e exceptio n o f

the stated , excludedareas ? Thi s wouldinclude paintin g of othe r

associate dfeature s including fascia , eaves , siding , all trim , ^ 

### porches , box beams , columns , rails , an dexterior surface s of garages . 2 . Was all scraping an dothe r

preparatio n wor k

completedsatisfactorily ? t-- ~ 

### 3 . Wer e all require darea s ofth e structure(s ) primeda s neededan dpainte dwit h tw o top coats ? « — 

### 4 . Was th e paint product s utilize dequivalen t t

o a2 5 yea r

product/quality ? 1 

### 5 . Ar e all ofth e area s wher e contaminatedmaterial s hav e bee n spille dthoroughl y vacuumed/cleaned ? i^ ^ 

### 6 . Didth e contractor collect/vacuumall falling an dscraped pain t chip s o n th e entir e property , roadways , alleyways , publi c acces s area s an d als o remove an y othe r

generated 1/ ^ 

### debris ? 7 . I s th e gras s are atha t surround s th e structure(s ) i n reasonabl y goodcondition ? t — 

### 8 .Ar e all item s suc h a s polyethylene sheeting , ladders , pain t brushes , cones , barrie r

tape , - ^ 

### etc . properly removed ? 9 . I s ther e an y evidenc e ofpropert y damag e tha t was don e b y the contractor ? An y propert y damag e need s to b e completedprior t

o th e EP A Close-Out . L ^ 10 . Are ; yo u satisfiedwit h th e wor k

performed ? v ^ 11 . Ar e ther e an y propert y item s tha t wer e temporarily re-locate db y th e contractor tha t u ^ nee dto b e movedback ? 12 . Ar e ther e an y (knovm ) lingering issue s wit h th e propert y owner(s ) tha t hav e bee n lef t 

## w ­ unresolved ? Othe r

Considerations/Propert y Owne r

Discussions/Additiona l Wor k

tha t i s Required :



# 1 7 I D Dat e 

# ^.-f-i d Professiona l ngineer s Signatur e Dat e250 5 Nort h 24"' , Suit e 21 9 Omaha , N E 6811 0 (402 ) 504-468 8 Fa x (402 ) 504-328 1 

## PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC
. "Providin g cost-effectiv e environmenta l solutions " Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc y Respons e



### Lea dBas e Stabilizatio n Omalia , N e Clos e Ou t Repor t 201 0 SAID#3363 5 393 6 Florenc e Bd .

•Date s worked : 07/02/1 0 t o 07/02/1 0 •Pr e propert y condition : Hous e ha s painte dwoo dshingle s wit h painte dwoo dtrim s tha t ha d flaking paint , Pain t chip s aroun dhouse . •Problem s encountered : Non e •Owne r request/concerns : Colo r changes . •Inspection/closeou t dates : Owne r 07/07/10 , inspecte db y P E projec t manager .

# h

Professiona l Environmenta l Engineers : EP A Pain t Stabilizatio n 201 0 SAID # .^.^/p3 5 ^
_ Propert y Addres s .893(i > TlOrAnfjp
. R>N/C ) Stories/Sidin g typ e /. 5 tS4r)r y Garage ? 

# j ^ Acces s signe d \^<^. S {JSIl O Pre-vide o 

# lp|ifs]i n Pos t vide o Contracto rAwlgne J tV^ C
. f^PfSTNG^^ ^ Dat e starte d 

# 2J\ 0 WeathiBr/tem p 

# ^Oo ' Dat e ende d 

# m Pain t use d 

# 'I'l- ^ (oW b h^o^\^^'''^\ ^ \^< ^ Prim e use d Pol y use d / \X^)( \ Problems/Issue s

# :m »^' ; 

# CONSEN T FO R ACCES S TO PROPERT Y OMAH A LEA D SIT E REMEDIA L ACTIO N - LEAD-BASE D PAIN T STABILIZATIO N PROPERT Y ID ; ^^r^-G^j^ ^ PROPERT Y ADDRESS ; ^^^ C -f/Hpti^C C ^/yifi/ ' OWNE RNAME ; DAYTIIVI E PHONE ; CEL L PHONE : ji^oZ } &^f-f^OJ i E-MAIL ; 

### JL L uptAt^l,^/Off9^r ^ >CK»u»/^dia» a OWNER' S ADDRES S IFDIFFERENT ; /CX!?/C f S' ' /S ^ S^rig ^ Bc//6Mfit ^ 

### A^C'f/ ^ TENANT' S NAM E IF APPLICABLE : 

## Mrr ^ ^1 ^ DAYTIM E PHONE : CELLPHONE : ^QZ "^^J ' -T^"? ^ E-MAIL ; Professiona l Environinenta l Engineers , Inc . (PE ) is unde r contrac t (#EP-R7-08-06 ) wit h th e U.S . Environmenta l Protectio n Agenc y (EPA ) to stabiliz e lea d base dpain t (LBP ) on residentia l structure s at anumbe r of propertie s locate d in Omaha , Nebraska . Th e pain t stabilizatio n wor k is bein g don e to protec t th e soi l cleanup s tha t ar e bein g performe d by EP A contractors . Pain t stabilizatio n activitie s wil l include ; scrapin gof cracke d or flakin g LB P fro mstructures , applicatio nof aprim e coa t an d tw o (2 ) coat s of paint . Movin g part s of window s an ddoor s ar e no t include d an d wil l no t be addressed . \ You r cooperatio n is requeste d in givin g permissio n to thi s EP A contracto r (PE ) to ente r an d hav e acces s to thi s propert y fo r th e purpos eof stabilizin g lea d -base d pain t as outline don th e propert y identifie dabove . By signin g thi s documen t I agre e to allo w an EP A contracto r to conduc t asoi l cleanu p at my propert y followin g completio n of lead-base dpain t stabilization , if th e soi l cleanu p ha s no t alread y bee n performed . I understan d tha t th e stabilizatio n contracto r ca n no t provid e assurance s tha t th e soi l cleanu p contracto r wil l be boun d to . I furthe r understan d tha t th e soi l cleanu p contracto r wil l mak e al l reasonabl e effort s to addres s concern s tha t I, as th e propert y owner , ma y hav e regardin g soi l cleanu p at my property . 

### S^, l ) an para a ibove
. Yes , I hav e read red ap d d underetan d 

# 2^ ^ g —

Signatur e diPropert y Owne r Dat e I full y understan dtha t by signin g thi s Consen t fo r Access , (1 ) thi s acces s will remai nin effec t unti l th e wor k ha s bee n satisfactoril y completed , (2 ) tha t th e Propert y Owne r or Tenant , if applicable , wil l be give n th e Housin g an d Urba n Developmen t (HUD ) an dEP A pamphlet , "Renovat e Right , Importan t Lea dHazar d informatio n fo r Families , Da y Car e Providers , an d Schools" , (3 ) th e Propert y Owne r or tenan t will remov e al l obstruction s fro msurface s to be painted , (4 ) wil l abid e by healt h an d safet y guidanc e provide dby EPA , (5 ) wil l allo w photograph y of propert y befor e an dafte r th e pain t stabilizatio n work , (6 ) wil l be contacte dby a PE representativ e approximatel y 48 hour s in advanc e of startin g work , (7 ) agre e no t to obstruc t or tampe r wit h an y ofth e LB P stabilizatio n actions , an d (8 ) wil l participat e in fina l propert y inspectio n an dsig n th e Completio n Agreemen t an d Propert y Owne r Satisfactio n Survey . Shoul dyo u hav e an y question s abou t th e plane d Lea d Based-Pain t stabilizatio n activitie s fo r you r property , pleas e contac t Professiona l Environmenta l Engineers , Inc . Projec t Manager , Willi e Cla y At 402-504-4688 . Genera l question s abou t th e Omah a Lea dSit e cleanu p ca n be directe d to Paulett aFrance-Isetts , EP A Remedia l Projec t Manage r 402-731-2454 , or th e EP A Publi c Informatio n Center s at 402-991-958 3 (Nort h Omah aoffice ) or 402-731-304 5 (Sout h Omah aoffice) . 

### fl'^lgr fes , I gran t acces s to my propert y an d wa s give n th e pamphle t D No , I do no t gran t acces s to my propert y an d I wa s "Renovat e Right , Importan t Lea d Infbrmatlo n fb rFamilies , Chil d give n th e pamphle t "Renoydf e Right , Importan t Lea d Car e Provldere , an d Schools. " Informatio n fo rFamillQtfJZnim^Car e Provldere , an d Schools. " Signatur e SPECIA L INSTRUCTION S AN D CONSIDERATION S

### PAIN T STABILIZATIO N PRE-PROPERT Y PAIN T MATC H ASSESSMEN T PROPERT Y ADDRESS : ^*^J C -fYeHTUiCe ^ E/i> / DATE : ^/fffc ? ^/^W ^ A ^ ^f/(r ? BVID :

AREA(S ) TO B E PAINTED : HOUS E PROPER : 'TA-A ^

(
. ^ / COLOR : 

# 7 ^ ^ (QW ^
HOUS E TRIM : ///H-tT ^

( tAf<, ) COLOR : 

# oO^rr ^

GARAGE : j/l/yy ^ COLOR : ..^^ ^
GARAG E TRIM : _ S^j^ ^

COLOR : 

# A ^ -
PORCH : fA^ ^ COLOR : *J2 ? y^^C^t/s ^
PORC H TRIM : 

# cn//^rr^ ^ (yoUff ^ (y^ J ''°'-°'' = (COMPLET E AL L SECTION , YES , NO , O R NON-APPLICABLE )



### I AGRE E TO TH E COLOR S LISTE D ABOVE
. ONC E TH E PAINTIN G BEGINS , I UNDERSTAN D I CA N NOT CHANG E TH E ABOV E SELECTE D COLORS : PROPERT Y OWNE R SIGNATURE : P E ACCESO R SIGNATURE :

### PRE-RENOVATIO N FOR M - OWNE R Thi s for mi s to b e use db y th e firms contractedb y th e Environmenta l Protection Agency-Region 7 to perfor mLead-Based Pain t stabilization activitie s a t th e Omah aLea dSite , Omaha , Nebraska . Owne r Confirmatio n Pamrfde t Receip t a i hav e receivedacop y ofth e lea dhazar dinformatio n pamphlet . Renovat e Right : Important Lead Hazar d Information fo r Families , Chil dCar e Provider s an dSchools , informin g m e ofth e potentia l risi c ofth e lea d hazar d exposur e firo mrenovation activit y t o b e performe din/o n m y dwelling unit . I received thi s pamphle t befor e the wor k

began . Own^r^knowledgmen t n(A ) I confir mtha t I ow n an dlive i n thi s property , tha t n

o child unde r the ag e of 6 reside s here , tha t no pregnan t woma n reside s here , an dtha t thi s propert y i s no t achild-occupied facility . Note : A chil dreside s i n the primar y residenc e of his/he r custodia l parents , lega l guardians , foste r parents , o r informa l caretake r i

f th e childlive s an dsleep s most oftim e a t th e caretaker' s residence . Note : A child-occupie dfacilit y i s apre-197 8 building visited regularl y b y the sam e child , unde r 6 year s o f age , o n a t lea^ t tw o differen t day s withi n an y week , fo r a

t leas t 3 hour s eac h day , provided tha t th e visit s tota l a t leas t 6 0 hour s >dnnually . [>(B ) I understandtha t th e renovation firm , contracted b y th e Environmenta l Protection Agency (EPA) , will b e using lead

saf e wor k

practice s require db y EPA' s Renovation , Repai r an d Painting Rule .

Printe dNam e o f Owner-Occupan t


### VOt — 

# ^/r//< ^ Signatur e o f Owner-Occdpan t Dat e' ' Dougla s Count y Accoun t Informa t Pag e 1 of 3 

# w 3 3 if i 3 5 Dougla s County , Nebrask a Propert y Recor d ­ R201303000 0 Informatio n i s vali d a s o f 2010-5-2 8 Ne w Featur e -•-»- > Prin t Reoor t Vie w Interactiv e GI S Ma o

Treasurer' s Ta x Reoor t Subdivisio n Sale s Searc h Owne r N AN D L PROPERT Y MANAGEMEN T L 1001 6 S 1 3 S T BELLEVUEN E 68123-000 0 Propert y Informatio n Ke y Number : 130 3 000 0 2 0 Accoun t Type : Residentia l Parce l Numbe r 201303000 0 Parce l Address : Lega l Description : 393 6 FLORENC E B D OMAH A N E 68110-000 0 PLAINVIE W LO T 2 BLOC K1 5 0 X 12 4 Valu e Informatio n 201 0 200 9 200 8 200 7 200 6 200 5 Lan d $7,000,0 0 $7,000.0 0 $7,000.0 0 $7,000.0 0 $7,000.0 0 $7,000.0 0 Improvemen t $34,500.0 0 $39,900.0 0 $39,900.0 0 $39,900.0 0 $39,900.0 0 $10,100.0 0 Tota l $41,500.0 0 $46,900.0 0 $46,900.0 0 $46,900.0 0 $46,900:0 0 $17,100.0 0 Sale s Informatio n Sale s Date : 2006-09-1 1 Dee d Type : Price : Grantor : W D Book : $63,000.0 0 Freedo n Rea l Estat e Investment s 200 6 Page : 10512 6

Grantee : Valid/Invalid : Nguye n Hie n T eta l Vali d Exclusio n Reason : • Sale s Date : 2006-01-0 5 Dee d Type : Price : Grantor : W D $27,500.0 0 JR G LL C Book : 200 6 Page : 00280 1

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R201. . . 6/4/201 0Dougla s Count y Accoun t Informatio n Pag e 2 o f 3 

# i

Grantee : Lengendoife rProperties-Managemen t Valid/Invalid : Vali d Exclusio n Reason : Sho w Al l Transaction s 1 Lan d Informatio n i Acre s S F Unit s i Dept h Widt h Vacan t 0 1 4 620 0 0 1, 0 124. 0 50. 0 N o Improvemen t Informatio n Buildin g 1 

# • mZS
. Florwic s Bd , ^^^^^m^^^^T'" ' ^^^SHJ^^^^^^^^H^H^S^^^^^ I ^

. : ' • Hj^B P j ^ V.t i

f 

# f 

# ^ M I 

# fer."-- ^ m 

# • ^^HHB^ B 11.( 2 STORY FI N ; ' /
^

- ~ ^ ' * ^ ' ^^Mri S j CLIC KT O ENLARG E IMAG E 1 CLJc k t o EiNILAFlG E iWIAG E 1 Squar e Footage : 1126. 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 y Fi n Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 6. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k 

## 1 Sprinkle rSquar e Footage : 0. 0 yearSu/7 t Yea r Remodele d Percen t Remodele d Adjuste d Yea r

Buil t Physica l Ag e 191 4 198 8 0 % 191 4 9 6 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 724. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R201. . . 6/4/201 0(effectiv e Apri l 2010 )


### RENOVATIO N RECORDKEEPIN G CHECKLIS T
Nam e

of Finn : H( . ^YJW ^ Dat e an dLocation of Renovation : ( \^ i \ ^ Brief Descriptio n of Renovation : VO\tV\

- ^^^[QL ^ 

### Nam e

of AssignedRenovator : Name(s ) of Traine d Workers : WrV-tC^ Q Nam e

of Dus t Sampling Technician , Inspector , and/or Ris k Assessor , if used : O (iT X ^3<:;opie sof renovator anddus t sampling technicia n qualification s (trainin g certificates , certifications ) on file. I^X^ertified renovator provide d trainin gto worker son (chec k

all tha t apply) : ^"--J D Postin g wamin g sign s BsSettin g

up plasti c containmen t barrier s "B-Maintainin g containmen t i5*Avoidin g sprea dofdus t to adjacen t area s ^"•^4lWast e handlin g ^>Post-renovatio n cleanin g ^"^ S Tes t kit s used by certifie drenovator to determine whethe r

lea dwa s present on component s affecte d

by renovatio n (identif y kit s usedand describ e sampling location s an d results : 1 1 (( ^

^^—U ^ Wamin g sign s poste d at entranc e to wor k

area . O^ork are acontaine d to preven t sprea d

of dus t an ddebris . "BvWindow sin andwithi n 20 fee t ofth e wor k

are aar e closed ^""T^I^or sin andwithi n 20 fee t ofth e wor k

area s ar e closedan dseale d ^""BvDoor s tha t mus t be use d in th e wor k

are aare covere dto allo w passag e but prevent sprea d ofdust . ^^Bsproun dcovere d by plasti c sheetin g extending 10 fee t fi-om wor k

are a- plasti c anchored to th e buildin g an dweighte ddown by heavy objects . - ^ 1 f I I f

necessary , vertica l containmen t installedt o preven t migratio n ofdus t anddebri s to adjacen t prop i 

### dperty . ^D-Wast e contained on-site andwhil e bein g transporte doff-site .

Renovatio n Recordkeepin g Checklis t Omah a Lea d Sit e(effectiv e Apri l 2010 )

^OxWor k sit e properl y cleane dafter renovation . '^^Al l chip s an ddebri s picke dup , protectiv e sheetin g misted , folde d dirt y sid e inward, an d tape d fo r

removal . D^ork are aHEP A vacuume dt o ge t pain t chip s fromgroun d surface , i f necessary . "^"-QjCertifie drenovato r performe dpost-renovatio n cleanin g verificatio n (describ e results) :

"^"o- ^ certif y unde r penalt y o f la w tha t th e abov e informatio n i s tru e an d complete . 

# ^(9.II O Naitii e Dat e

Renovatio n Recordkeepin g Checklis t Omah a Lea d Sit e