## TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO NFIL EFOLDE R 

# SAID# : 23 3 Z" ^ Date : 

# ?/2.%^ f 

# Z40 5 M 2X \S\
- Address : Remediatio n Contractor : PROFESSIONA LENVIRONMENTA LENGINEER S Year : 200 8 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o ofpropert y (DVD ) 

# e

f Executiv e Sumiriar y Signe dAcces s Agreemen t for subjec t propert y 

# a / Paintin g Agreemen t D 

### Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) Photograph s Satisfactory restoratio n signe db y Propert y Owne r 

## D Propert y close-ou t chec k lis t signe db y EP A Propert y informatio n fromDougla s Count y Assessor' s Offic e 

## / D D

4031823 7 Superfun d 

# 7 / T5ite250 5 Nort h 24l ^ Suit e 21 9 Omaha , N E 6811 0 (402 ) 504-468 8 Fax(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 yResponse



### Lea dBas e Stabilizatio nOmaha , N e Clos e Ou t Repor t SAID #2832 9 240 5 N 2 9 St .

•Date s worke d12/2 6 t o 12/2 7 200 9 •Prio r hous e pain t was i n poo r conditio nwithflakin g an dpeelin g paint , bric k siding . Owne r i s goin g t o rechec k i n sprin g becaus e i t was col dwhe npainted . N o othe r complaint s o n property . •Inspecte db y PE projec t manage r

# 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 yRespons e 

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

# ^^.1.^' ^ Propert y Address : ^^0£/ V Q ^ ^ t Owner' s Name : Performanc e Standards/Close-Ou t Criteri a 250 5 Nort h 24' ^ Suit e 21 9 Omaha , N E 6811 0 (402 ) 504-468 8 Fa

x (402 ) 504-328 1



### YE S N O 1 . Wa s th e entir e 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 

# X garages . 2 . Wa s al l scrapin g an dothe r preparatio nwor k

complete dsatisfactorily ? 

# y 3 . Were al l require darea s ofth e structure(s ) prime da s neede dan dpainte dwith tw o to p coats ? 

# V 4 . Wa s th e pain t product s utilize dequivalen t t o a3 0 yea r product/quality ? 

# v 5 . Ar e al l ofth e area s wher e contaminate dmaterial s hav e bee nspille dthoroughl y r vacuumed / cleaned ? 6 . Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s o nth e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y othe r generate ddebris ? \ 

### 7 . I s th e gras s are athat surround s th e structure(s ) i n reasonabl 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 ? 

# y 9 . I s ther e an y evidenc e ofpropert y damag e that wa s don e b y th e contractor ? An y property damag e need s t o b e complete dprio r t o th e EP A Close-Out . ^ 

# X 10 . Are ther e an y property item s that wer e temporaril y re-locate db y th e contractor that nee dt o b e move dback ? 

# X 11 . Are ther e an y (known ) lingerin g issue s withth e property owner(s ) that hav e bee nlef t unresolved ? 

# X Comments : ^ 

# v."\^w>rv ^ M ~'^?'<^ ^ Property Owne r Signatur e Dat e 

# ^X/X A 1^-^9-0 ^ Professional EMoronmental Engineer s Representativ e Dat e

# CONSEN T OF RACCES S T O PROPERT Y OMAH A LEAD SIT EREMEDIALACTIO N- LEAD-BASED PAIN T STABILIZATIO N PROPERTYID : fki^'K^ ^ PROPERT Y ADDRESS : r^UO' ^ /{ ) Q. ^ .S'f
OWNE RNAME: 

## 1 <TNK A

## Or;^A<v DAYTIM EPHONE : ( I J ^ i f S f CELLPHONE : E-MAIL : OWNER' S ADDRES S I FDIFFERENT : TENANT' S NAM EI FAPPLICABLE : DAYTIM EPHONE : CELLPHONE : E-MAIL : Professiona l Environmenta l Engineers , Inc . (PE ) i s unde r contrac t (#EP-R7-08-06 ) wit hth e U.S . Environmenta l Protectio n Agenc y (EPA ) t o stabiliz e lea dbase dpain t (LBP ) o nresidentia l structure s a t anumbe r o f propertie s locate di nOmaha , Nebraska . Th e pain t stabilizatio nwor k i s bein g don e t o protec t th e soi l cleanup s tha t wer e performe db y EP A contractors . Pain t stabilizatio nactivitie s will include : scrapin g o f cracke do r flakin g LB Pfro mstructures , applicatio no f aprim e coa t an d tw o (2 ) coat s of paint . Movin g part s o f window s an ddoor s ar e no t include dan dwil l no t b e addressed . You r cooperatio n i s requeste di ngivin g permissio n t o thi s EP A contracto r (PE ) t o ente r an dhav e acces s t o thi s propert y fo r th e purpos e of stabilizin g lea d-base dpain t a s outline do nth e propert y identifie dabove . B y signin g thi s documen t I agre e t o allo w a nEP A contracto r t o conduc t asoi l cleanu p a t my propert y followin g completio no f lead-base dpain t stabilization . I understan dtha t th e stabilizatio ncontracto r ca nno t provid e assurance s tha t th e soi l cleanu p contracto r wil l b e boun dto . I furthe r understan dtha t th e soi l cleanu p contracto r will mak e al l reasonabl e effort s t o addres s concern s tha t I , a s th e propert y owner , ma y hav e regardin g soi l cleanu p a t my property . I fully understan dtha t b y signin g thi s Consen t fo r Access , (1 ) thi s acces s will remai nineffec t unti l th e wor k ha s bee n satisfactoril y completed , (2 ) tha t th e Propert y Owne r o r Tenant , if applicable , will b e give nth e Housin g an dUrba n Developmen t (HUD ) an dEP A pamphlet , "Renovat e Right , Importan t Lea dHazar dinformatio nfo r Families , Day Car e Providers , an dSchools" , (3 ) th e Propert y Owne r o r tenan t wil l remov e al l obstruction s fro msurface s t o b e painted , (4 ) will abid e b y healt han dsafety guidanc e provide db y EPA , (5 ) will allo w photograph y o f propert y befor e an dafte r th e pain t stabilizatio n work , (6 ) wil l b e contacte db y aP Erepresentativ e approximatel y 4 8 hour s i nadvanc e o f startin g work , (7 ) agre e no t t o obstruc t o r tampe r wit han y o f th e LB Pstabilizatio nactions , an d(8 ) will participat e i nfmal propert y inspectio nan d sig nth e Completio nAgreemen t an dPropert y Owne r Satisfactio nSurvey . Shoul dyo u hav e an y question s abou t th e plane dLea dBased-Pain t stabilizatio nactivitie s fo r you r property , pleas e contac t Professiona l Environmenta l Engineers , Inc . Projec t Manager , Willi e Cla y A t 402-504-4688 . Genera l question s abou t th e Omah aLea dSit e cleanu p ca nb e directe dt o Paulett aFrance-Isetts , EP A Remedia l Projec t Manage r 402-731-2454 , o r th e EP A Publi c Informatio nCenter s a t 402-991-958 3 (Nort hOmah aoffice ) o r 402-731-304 5 (Sout hOmah aoffice) . D Yes , I gran t acces s t o m ypropert yan d wa s give n th e pamphle t D No , I d o no t gran t acces s t o m ypropert yan d I wa s "Renovat e Right , Importan t Lea d Informatio n fo rFamilies , Chil d give n th e pamphle t "Renovat e Right , Importan t Lea d Car e Providers , an d Schools. " p > Informatio n fo rFamilies , Child e Car e Providers , an d Schools. " r e rroviaers , an a acnoois . r s % , ignatur e Dat e Signatur e Dat e SPECIA L INSTRUCTION S AN D CONSIDERATION S

# infirmatio n Of Receip tOf Lea d FaruDp^Q(i i

PROPERTYADDRES S ^ZI P CODE . PROPERTYADDRES S OF OWNE R IF DIFFEREN TTHA N PROPERT YBEIN G PAINTED : PROPERTYADDRES S ^ZI P COD E I hav e receive d a cop y of th e pamphlet , Renovat e Right : Importan t Lea d Hazar d Informatio n Fo rFamilies , Chil d Car e Provider s An d School s informin g me of th e potentia l risk of th e lea d hazar d exposur e fro m renovatio n activit y to be perfonne d on dwellin g unit . I receive d thi s pamphle t befor e th e wor k began .

PRINTE D NAM E OF RECIPEN T^ OAT E

C^IGNATUR E OF RECIPIEN T

Self-Certificatio n Optio n (Fo rTenant-Occupie d Dwelling s Only ) If th e lea d pamphle t wa s delivere d bu t a tenan t signatur e wa s no t obtainable , yo u maychec k th e appropriat e bo x below : yRefusa l To Sig n - 1 certif ytha t I hav e mad e a goo d fait h eflbr t to delive rth e pamphlet , renovat e right: importan t lea d hazard infonnatio n fo rfamilies , chil d car e provider s an d schools ; to th e renta l dwellin g uni t liste d abov e at th e dat e an d tim e indicate d an d tha t th e occupan t refuse d to sig n th e confinnatio n of receipt . I furthe rcertif ytha t I hav e left a cop yof th e pamphle tat th e uni t wit h occupant . 

# D Unavailabl e Fo rSignatur e - 1 certif ytha t I hav e mad e a goo d fait h effort to delive rth e pamphlet , renovat e right; importan t lea d hazar d infonnatio n fo rfamilies , chil d car e provider s an d schools , to th e renta l dwellin g uni t liste d belo wan d tha t th e occupan t wa s unavailabl e to sig n th e confinnatio n of receipt . I furthe rcertifytha t I hav e lef t a cop y of th e pamphle t at th e uni t byslidin g it unde rth e doo rorsomewher e on th e premises .

PRINTE O NAM E F RSO N CERTIFYIN G EO PE F AnEMPTE D DELIVER YDAT E AN D TIM E LEA D PAMPHLE TDELIVER Y

OFsPERSO PAMPHL I SIGNATUR E OFPERSO N CERTIFYIN CERTIFYIN G LEA D PAMPHLE TDELIVERY : Not e Regardin g Mailin g Optio n - as an altemativeto deliver y

in person , yo u ma ymai l th e lead pamphle t to th e owne r and/o rtenan t Pamphle t mus t be maile d at leas t 7 days befor e renovation . (Documen t witt i a certificat e

of mailin g from th e pos t office) . CONFIRIWIATIONOF RECEIP T

OF LEA D PAMPHlT r08/0 8

# PAIN TSTABILIZATIO N PRE-PROPERT YASSESSMEN T

PLAN T& PERMANEN TLANDSCAPIN G T O B E REMOVE ? IF , YE S WHERE : N O [jX ] 

## YE S 

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PRE-EXISnjN G CONDirUll i O F FOUNDATION/STRUCTURE , i.e . BASEMEN TLEAKING ? N O ' ' YE S '-''^— ^

IF , YE S WHERE : 'PL C jQpAe rCsrvc^ ^

IK/arzXi ^ s­ ^ayr a ^(T)<y ; 

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EXISTIN G PAIN TO N WINDOWS , DOORS , FOUNDATION , SIDEWALKr C LE.) ? N0|— | YE S [ ^

IF , YE S WHERE : t^\X^Utj / (o'^^i ^ 

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VISUA L DESCRIPTIO N O F PROPERTY/STRUCTURE/GARAGE , (I.E.) : (US E NECESSARY ) BAC KSID E I F

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# PAIN TSTABILIZATIO N PRE-FROPERTY PAIN TMATC H ASSESSMEN T

PROPERT YADDRESS : 

### DAT E BVI D - AREA(S ) T O B E PAINTED : HOUS E PROPER : U.'ryi.< , COLO R HOUS E TRI M 

# MA>^K ^ COLOR .
GARAGE . _COLOK . GARAG E TRI M .COLOR ^ PORCH . .COLO R

PORCHTRIM . .COLOR . (COMPLET E AL L SECTION , YES , NO , O R NON-APPLICABLE ) 

# I AGRE E T O TH E COLOR S LISTE D ABOVE . ONC E PAINTIN G BEGINS , I UNDERSTAND I CA NNO T CHANG E TH E ABOV E SELECTE D COLORS : PROPERT Y OWNE R SIGNATURE : 

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PAIN TMATC H FOR M 08/0 8

### T)ougla s County Accoun t Informatio n Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R103579000 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 - ViO W O O Ma p Informatio n i s vali d a s o f 2008-9- 4 Treasurer' s Ta xRepor t Ne wFeatur e - » - • - • Aut o Sale s Searc h Owne r DUN N EMMI T ETA L 240 5 N 2 9 S T OIVIAHAN E 68111-000 0 

## 1-/S3>-72.(^1
­ 7/ g '71^ ^ Propert yInformatio n Ke yNumber : 357 9 000 0 1 0 Accoun t Type : Residentia l Parce l Number : 103579000 0 Parce l Address : 240 5 N 2 9 S T OIVIAHAN E 68111-000 0 Lega l Description : FAIRMOUN TPLAC E LOT2 5 BLOC K0 S 1/ 2 3 0 X 12 1 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $900.0 0 $8,200.0 0 $9,100.0 0 200 7 $900.0 0 $8,200.0 0 $9,100.0 0 200 6 $900.0 0 $8,200.0 0 $9,100.0 0 200 5 $900.0 0 $8,200.0 0 $9,100.0 0 200 4 $900,0 0 $3,500.0 0 $4,400.0 0 200 3 $900.0 0 $3,500.0 0 $4,400.0 0 Sale s Informatio n Sale s Date : 2002-07-0 1 Dee d Type : W D Book : 221 5 

### Page : JQG Price : $ 2,250.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 8 3630. 0 1. 0 121. 0 30. 0 N o Improvemen t Informatio n 

### http://dougIasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R10. . . 11/5/200 8

### Dougla s County Accoun t Informatio n Pag e 2 o f 2
Buildin g 1 

# "EZ l

« 6B0.0S«.|P't . Rand ) evor t Biw d a « 1$

4 0S( 1 « CLIC KTO ENLARG E IMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : 850. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Fai r

Buil t As : Ranc h Cond o Squar e Footage : 0. 0

HVAC : Force d Ai r Rooms : 5. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 2. 0

Roo f Type : Gabl e Stories : 1. 0 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 188 5 0 0 % 188 5 12 3 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Bric k Venee r 300. 0 Applianc e Allowanc e 1. 0 Applianc e Radi o Interco m 1. 0 Basemen t Bsmn t Bloc k 8 f t 850. 0 Basemen t Outsid e Entranc e 1. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h En d Scree n 48. 0 Porc h Woo d Dec k 154. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R10. . . 11/5/200 8