TRANSMITTA L o f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R SAID# : :^^^Z^ ^ Date : iP^/clT y tPay^ P Address : rri2j 7 X . ^ ^ .T^ T Stabilizatio n Contractor : Pruden t Technologies , Inc . Year : 2010 _ PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S ]

/ Vide o ofproperty (DVD ) y Executiv e Simmiar y y Signe dAcces s Agreemen t fo r subjec t propert y 2 J Pre-Renovatio n For msigne db y Propert y Owne r D Pre-Renovatio n For mfo r Occupant/Tenant , if applicabl e y f Faultin g Agreement D Settlement document s (i.e. , fo r damag e o r t o replac e plants , etc. ) y Renovatio n Recordkeepin g Checklis t signe db y Certifie dRenovato r ^ Photograph s y Satisfactor y close-ou t chec k lis t signe db y Propert y Owne r y Propert y close-ou t chec k lis t signe db y EPA y Propert y infonnatio n fixtmDougla s Count y Assessor' s Offic e p D D Hazar danalysis , i f prepare d Safet y Audi t Other (describe) :

0 7 „ jden t TechnologyZ/lnc./Signatur e EP A CO RSienature (afte r file folde r review ) . /^/c^/cPaZz f Date ' 

# 1/7/ao V Dat e 3021785 5 

# ininiffi w Superfun dTBCHNQLOGIBS . IN C 

## Propert y Summar y Date : 7/19/201 0 LB P STABILIZATIO N EPA CONTRAC T EP-R7-08-0 7 Month of : Jul y Propert y Addres s : 1109 8 2 8 St . SAID # : 2104 9

A . Executiv e Summarv : a . Issue s Encountered : NON E b . Issue s Resolved : NON E c . Uniqu e Findings : NON E d . Othe r Relevan t Information : i . Acces s Date : 06/08/201 0 ii . Wor k Began : 06/23/201 0 iii . Close-Ou t Date : 06/23/201 0 B . Enclosures : 1 . Pre-Stabilizatio n Vide o 2 . Post-Stabilizatio n Vide o 3 . Signe dAcces s Agreemen t For m 4 . Pr e - Renovatio n For msigne db y Propert y Owne r 5 . Pr e - Renovatio n For msigne db y Occupant / Tenant , if applicabl e 6 . Advance-Notice , Stabilizatio n Vide o Agreemen t For m 7 . Propert y Pain t Matc h Form 8 . Propert y Acces s Assessment For m 9 . Renovatio n Recordkeepin g Checklis t signe db y Certifie dRenovato r 10 . Signe dPropert y Completio n Agreemen t For m 11 . Propert y Close-Ou t Chec k lis t Signe db y EPA 12 . Dougla s County Assesso r Propert y Informatio n 13 . Work-Sit e Hazard s Analysi s Checklis t 14 . Pre

- Stabilizatio n Propert y Hazar dAssessment Photograph s' TECHNOOLOCIBS . D4C. ~ Pruden t Technologies , Inc . (Prudent ) i s unde r

contrac t (Contract #EP-R7-08-07 ) wit h th e U . S . Enviroimienta l Protectio n Agency (EPA) to stabiliz e Lea dBasedPain t (LBP) a t antmibe r

ofpropertie s locate d in Omaha , Nebraska , includin g th e propert y locatedat : liOG f

^ Q ^ S^ — Th e EP A request s you r

pennissio n to allo w Pruden t t

o perfor mLB P Stabilizatio n a t thi s property . B y signing thi s form , th e propert y owne r

grant s pemiissio n to Pruden t t o perfonn activitie s relate dto LB P Stabilizatio n including scraping paint an dpaintin g ofth e referencedproperty . Further , th e owner/tenan t verifie s tha t they hav e receive dth e LB P pamphle t "Renovat e Right. " B y signing thi s documen t I agre e to allo w a n EP A contracto r

t

o conduct asoi l cleanu p a t m y propert y followin g completio n o f lead-base dpain t stabilization , ifth e soil cleanu p ha s no t alread y bee n perfonned . I imderstandtha t th e stabilizatio n contractor cannot provide assurance s o f which contractor will b e boun dt o th e soi l cleanup . I furthe r

understandtha t th e soi l cleanu p contractor wil l mak e all reasonabl e efforts t o addres s concem s tha t I , a s th e propert y owner , ma y hav e regardin g soil cleanu p a t m y property . 

## l/f Y ] Yes , I hav e rea dandimderstandth e paragrap h above . 

# fy,^lqu^ . zri<Z^y o 6^-6t-T Q Propert y Owrier' s Signatur e Dat e Ifyo u hav e an y question s abou t th e LB P stabilizatio n plannedfo r

you r

property , pleas e contac t Pmdent' s Custome r

Relations/Offic e Manage r

fo r

th e Lea dBasedPain t Stabilization , Mr . Chandr a Sheka r a

t 402

- 504-100 4 o r 402-889-3821 . Genera l question s abou t th e OmahaLea dSit e cleanu p ca n b e du-ecte dto th e EP A Publi c Information Center s a t (402 ) 731-304 5 (Sout h Omahaoffice) o r

(402 ) 991-958 3 (Nort h Omahaoffice) . Propert v Acces s Grante dBv : Propert y Owner' s Signatiur e Dat e

Pleas e Prin t N^ e

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 KansasCity , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone:(816)363-370 3 Phone:(402)504-100 4 Phone:(210)822-958 8 Fax:(816)363-370 7 Fax : (402)504-100 5 Fax:(210)579-657 7TBCHNOLOCIBS . IN C PROPERT Y INFORMATIO N (T o b e complete db y residen t and/o r propert y owner — pleas e print ) RESIDENTNAME : \^/OCj g JXA^J ^ Owne r / Tenan t y RESIDEN T ADDRESS : \ \O ^ -Q p.% ^ ^f

- ( 3 K>.JU L YJ^f-T " 4 ^ © P '

I F RENTAL , PROPERT Y OWNE D BY : £-v\v^ : X ^,^. a 

## ^\(7(r^a ^ . ^ 

### ^pHy , ^^ ^ c>u.^oJU ^ OWNER' S MAILIN G ADDRESS : <= ; M 3 < , d
OWNER' S TELEPHON E NUMBER : Home : Work : 

### Cell:^t> l ^612

- (^2-^ ^ ? NUMBE RO F OCCUPANTS UNDE R7 YEARS OLD : Y J TOTA L NUMBE RO F OCCUPANTS : NUMBE RO F CHILDRE N UNDE R7 YEAR S OL D WH O PLA Y I N TH E YAR D FO R5 HOUR S O

RMOR E PE RWEEK : COMMENT S O RSPECIA L INSTRUCTION S (suc h a s dogs , entr v gates , etc.) :

AUTHORIT Y FO RENVIRONMENTA L RESPONS E ACTIONS : Th e activitie s to b e implemented by EP A unde r

thi s agreemen t ar e pursuan t t o Sectio n 10 4 of CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f

acces s to th e propert y i s provide dfo r

in Sectio n 104(e) of CERCLA , 4 2 U.S . C 9605(e) , which provide s entr y fo r

"detenninin g th e needfo r

response , o r

choosing o r

takin g an y respons e actio n unde r thi s title, or otherwis e enforcing th e provision s ofth e title." Propert y Owne r

Signatur e (Signature ) Dat e 808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 KansasCity , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone:(816)363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816)363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7^l«»NaiLOCIB&INC . 

### PR E & POST PAIN T STABILIZATIO N VIDE O AN D PICTURE S I understan d tha t pruden t Technologie s (Prudent ) wil l b e connin g ou t t o shoo t a Pre Stabilizatio n vide o an d t o tak e picture s o f my property . Pruden t wil l us e th e video s an d picture s t o documen t th e curren t propert y status/condition . Also , Pruden t wil l shoo t a vide o sho t followin g th e completio n o f th e pain t stabilization . I give permissio n t o video s an d picture s o f m y property . Pleas e lis t an y specia l condition s tha t Pruden t employee s nee d t o b e awar e of before shootin g a vide o (suc h a s pets , prio rnotice , etc.) .

lVC>c i 

## 7 y<k ^ Propert y Addres s 

## F}ir-r\<St^X ^ ^^I'l^y d 

# 6< i 

# O ^ '^ d 

# y Owner' s Nam € Signature Dat e 

### ADVANC E NOTIC E REQUIREMEN T Afte rsignin g th e acces s yo u allo w Pruden t t o begi n Lead Base d Pain t Stabilization . Al l Plants , weed s an d an y vehicle s o ritem s o n ope n porc h (enclose d porche s wil l NO T b e stabilized ) must b e remove d prio rt o stabilization . Al l Pets must b e ou t of yard durin g stabilization . Pleas e indicat e below ho w muc h advance notic e yo u nee d t o have th e above mentione d task s completed . I f yo u are a landlor d yo u wil l nee d t o contac t th e tenan t a s Pruden t wil l onl y infor m th e propeil y owners . D o yo u have an y pets tha t resid e i n yard : Notic e needed : Phon e numbe rt o cal l t o giv e notice : Who m w e are givin g notic e to :

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 KansasCity , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax:(210)579-657 7

### PRE-RENOVATIO N FOR M - OWNE R Thi s for mi s to b e use db y the firms contracte db y th e Environmenta l Protection Agency-Region 7 t o perfor mLead-Based Pain t stabilizatio n activitie s a t th e Omah aLea dSite , Omaha , Nebraska . Owne r Confirmatio n Pamphle t Receip t D I hav e receivedacop y ofth e lea dhazar dinformatio n pamphlet . Renovat e Right : Importan dLeadHazar dInformation fo r Families , Chil d Care Provider s an dSchools , informin g m e ofth e potentia l ris k ofth e lea dhazar dexposur e fk» mrenovation activit y to b e performe din/on m y dwellin g unit . I receive dthi s pamphle t befor e the wor k

began . Owne r Acknowledgmen t D(A ) I confir mtha t I ow n an dliv e i n thi s property , tha t no chil dunde r the ag e o f 6 reside s here , tha t n o pregnan t woma n reside s here , an dtha t thi s propert y i s no t achild-occupie dfacility . Note : A childreside s i n th e primar y residenc e of his/he r custodia l parents , lega l guardians , foste r parents , or informa l caretake r ifth e chil dlive s an dsleep s most o f tim e a t the caretaker' s residence . Note : A child-occupie dfacilit y i s apre-197 8 buildin g visite dregularl y b y th e sam e child , unde r 6 year s o f age , o n a t leas t tw o differen t day s within an y week , fo r a

t leas t 3 hour s eac h day , providedtha t th e visit s tota l a t leas t 6 0 hour s annually . D (B ) 1 understandtha t the renovation firm , contracte db y th e Environmenta l Protectio n Agency (EPA) , will b e using lead

saf e wor k

practice s requiredb y EPA' s Renovation , Repai r an dPainting Rule .

Printe dNam e o f Owner-Occupan t

Signatur e o f Owner-Occupan t Dat eBIBS , IN C PAIN T MATCHIN G FORM : 1. TO BE FILLE D OU T ONLY IF MATCHIN G COLO R PROPERT Y ADDRESS : kl O ^ 4 X- ^ ^ T BVID : Th e followin g note s ar e fo r th e benefi t of pain t cre w only . Pain t Yes Pain t No Locatio n Pain t Descriptio n Siding 

# y Soffi t ^ Fasci a 

# v Come r Tri m 

# y Window Trim s 

# y Doo r Trim s ^ Fron t Porc h Ceiling 1 / Fron t Porc h Ceiling Beam s 1 / Fron t Porc h Floor Z r- . - i -

—- / 1/ 

# y • Otrp ^ Fron t Porc h Railing s 

# y Fron t Porc h Step s 

### 7v^Y» e Siding Baseboard s 

# y Foundation 

# Z

•k- i* Garage/Shed ^ 

### n/?^< ^

" . • I UNDERSTAN D SHERWI N WILLLAM S WIL L MATC H

MY CURREN T COLORS . Homeowner signature : ^ryy y 1 Cjj^/^ ^ ^ l/2.xfVlKj Q Date:/^<; S Q" ^ / ^ Parkwav . 808 0 War d Parkway , Suit e 40 6 250 5 N . 24' " Street , Suit e 30 8 . 424 2 Medica l Drive , Suit e 425 0 KansasCity , MO 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax ; (402)504-100 5 Fax:(210)579-667 7~ - - I I I M l rI ;CHNOU>&IES,IN C 

## ACCES S ASSESSMENI T FORM : 1^0' ^

C U ? C( ^ Hous e sidin g (circl e al l applicable ) *Transit e i s sam e a s asbesto s **Als o calle d aluminu m sidin g ***Als o calle d roo f shingle s Ifth e sidin g i s aluminu m (metal) , i s i t origina l factor y finis h o rpainte d over ? Circl e one . I f th e sidin g i s Wood/Asphalt/Roof shingles , i s i t painted ? Circl e one . Doe s thi s propert y requir e lot s o f scrapping ? Doe s thi s propert y requir e a lif t o rscaffoldin g t o reac h uppe rlevels ? Doe s thi s propert y hav e lot s of plants/iv y o ritem s i n th e area s where,paintin g i s required ? I f ye s explain . Doe s thi s propert y hav e an y significan t structura l damage ? I f yes , EXPLAIN ? Doe s thi s propert vhav e a : Garag e / She d Garage : Ye s //No / Shed : Yes/^ T I f yes , describ e th e locatio n & sidin g materia l of garag e / shed . I s thi s propert y vacan t o roccupie d - circl e on e Ar e there an y pets a t thi s property ? I f ye s explain . Ar e ther e an y lo w hangin g powe rlines ? , D o we nee d neighbor' s access ? I f ye s pleas e explai n an d ge t neighbor' s propert y addres s an d owne rinformation . /Wood^ / Transite * / Viny l / Pre-finishe d Metal* * / wi w I Concret e / Concret e block s / woo d shingle s / Asphal t shingles** * / Stucco / Origina l Factor y Finis h Painte d Ove rj i / ^ Shingle s painte d Shingle s no t painte d n ' ^e^ l N o Yes//( © YeslfQ )

Yes/ ^ Garage : Attache d / Detache d Garag e siding : Woo d / Transite * / Viny l / Pre finishe d Metal* * / Bric k /

Concret e / Concret e block s / woo d shingle s / Asphal t shingles** * / Stucco / rccdupiest/Vacant Yesl^o J "^e^H o 

### Yes/fe )

808 0 War d Parkway . Suit e 40 5 250 5 N . 24'- ' Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 KansasCity , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816)363-370 3 Phone : (402 ) 504-100 4 Phone : (210)822-958 8 Fax:(816)363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7

# TDRIID H C\.«^ ' i=»-^y 

# J & . p«ot€ > 

## ACCES S INFORMATIO N BVID : PROPERT Y ADDRESS : //^- ^ -^

- ^< r yj ^ Propert y Owne dBy : (I f new propert y owner )

Owner s Phon e No's : Home : Work : CeW:-^'-^--•^^^

- Fax: ~ 

### Acces s Contractor : AS W PD A ME S P E Othe r (Prudent ) DATE TIM E ACCESSO R CONRAC T DETAI L f0(fy/9jf7/ o ^ZZj^Z^f ^ - . '• ^ / ^" i "



### Comments :

808 0 War d Parkway , Suit e 40 5 250 5 N , 24' " street . Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : <210)822-958 8 Fax:(816)363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7(effectiv e Apri l 2010 ) # # RENOVATIO N RECORDKEEPIN G CHECKLIS T Nameo f Fir m 

# Tru^Mi - Dat e an dLocation of Renovation : Star t Date:t o 'o^ ^ V* ^ En dDate : L'^3zc > Location ://( 9 9 ^ ' ^ - ^ Brief Descriptio n of Renovation : j^^J^^/^ggy ^ g^^y/ ^ ^T^^,.^...-—"^y^ ^ Nam e o f AssignedRenovator : /yfiyyyyj / /f>^y''<iyf^j> ^ Name(s ) o f TrainedWorkers : />^^>t>-tyt_-^{^L^ ^ yzy^jJUly j &^^^^X^^-Jo . Cr^pAyicJ^l^^ ^ Nam e o f Dus t Sampling Technician , Inspector , and/or Risk Assessor , i f used : Copie s of renovator an ddus t sampling technicia n qualification s (trainin g certificates , certifications ) o n file. g^JScrtifie d renovato r

provide dtrainin g to worker s on (chec k

al l tha t apply) : ^^^^^-Postin g waming sign s ^"^ttin g u p plasti c containmen t barrier s ^^Maintainin g containmen t ^^-Avoidin g sprea dofdus t to adjacen t area s '^-Wast e handling Post-renovatio n cleaning Tes t kit s usedb y certifiedrenovator t

o determine whethe r

lea dwa s presen t o n component s affecte d b y renovatio n (identif y kit s use dan ddescrib e sampling location s an dresults : ^i^f^man g sign s poste da t entranc e to wor k

area . ^..^Wor k

are acontainedt o preven t sprea dofdus t an ddebris . t-^Window s in an dwithin 2 0 fee t ofth e wor k

are aar e closed /C^^lSoor s i n an dwithin 2 0 fee t ofth e wor k

area s ar e closedan dsealed ^^Door s tha t mus t b e use di n th e wor k

are aar e covere dt o allo w passag e but preven t sprea dofdust . Groun dcoveredb y plasti c sheeting extending 1 0 fee t fi-omwor k

are a- plasti c anchoredto the buildin g an dweighteddown b y heavy objects ! Ifnecessary , vertica l containmen t installe dto preven t migratio n ofdus t an ddebri s to adjacen t property . Wast e containedon-sit e an dwhil e being transporte doff-site .

Renovatio n Recordkeepin g Checklis t Omah a Lea d Sit e(effectiv e Apri l 2010 ) # # t-W6r k

sit e properl y cleane dafte r renovation . ^-"AlTchip s an ddebri s picke dup , protectiv e sheetin g misted , folde ddirt y sid e inward, an dtape d fo r removal .

c.WWk'are aHEP A vacuume dt o ge t pain t chip s fro mgroun dsurface , ifnecessary . Certifie drenovato r perfonne dpost-renovatio n cleanin g verificatio n (describ e results) :

1 certif y unde r penalt y o f la w tha t th e above informatio n i s tru e an dcomplete . 

# Yo-^3'-Z2 ) Nam e an dTitl e Dat e

Renovatio n Recordkeepin g Checklis t Omah a Lea d Sit e# # ENVIRONMENTA L & CONSTRUCTIO N 

# J^^^^^^ 2 TECHNOLOGIES , INC . SERVICE S 

### OMAH A LEA D BASE D PAIN T REMEDIATIO N 201 0 

### Propert y Owne r Close-Ou t For m (Lead-Base dPain t Stabilizatio n EP A Confrac t EP-R7-08-07 ) SAID : ^•Tg^^C; ^ Property Address : y-fiZ? ^ A^ . :? ^ .^^ . Owner' s Name : ^A,//fZ^fy ^

/^Z . Z-^yiiAyZ>Z > Performanc e Standards/Close-Ou t Criteri a YE S N O I . Was th e entir e stmcture(s ) painte dwit h th e exceptio n ofth e stated , excludedareas ? Thi s wouldinclud e paintin g o f othe r

associate dfeature s including fascia , eaves , siding , al l trim , porches , box beams , columns , rails , andexterior surface s o f garages . 2 . Was all scraping an dothe r

preparatio n wor k

completedsatisfactorily ? 3 . Wer e all require darea s ofth e stmcture(s ) primeda s neededan dpainte dwit h tw o top coats ? 4 . Was th e pain t product s utilize dequivalen t to a2 5 yea r

product/quality ? 5 . Ar e all ofth e area s wher e contaminate dmaterial s hav e bee n spille dthoroughly vacuumed / cleaned ? 6 . Didth e contractor collect/vacuumall falling an dscrapedpain t chip s on th e entir e property , roadways , alleyways , publi c acces s area s an dals o remove an y othe r

generateddebris ? 7 . I s th e gras s are atha t surround s th e stmcture(s ) i n reasonabl y goodcondition ?

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

tape , etc . properly removed ? 9 . Isthereanyevidenceofpropert y damag e tha t wa s don e b y th e contractor ? An y propert y damag e need s to b e completed prior to th e EP A Close-Out . 10 . Ar e yo u satisfiedwit h th e wor k

performed ? 11 . Ar e ther e an y propert y item s tha t wer e temporarily re-locate dby th e contractor tha t need t o b e movedback ? 12 . Ar e ther e an y (known) lingering issue s wit h th e propert y owner(s ) tha t hav e bee n lef t unresolved ? Othe r

Considerations/Propert y Owne r

Discussions/Additiona l Wor k

tha t i s Required :



### E>n^G^i/c,^^'SQ^a ^ Propart y OwnerSign i Dat e 

# I t C>^<^ 3 -y d K-> ^ den t Technologies , In^^^ignatur e Dat e

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " street . Suit e 21 8 424 2 Medica l Drive , Suit e 425 0 KansasCity , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816)363-370 7 Fax : (402)504-100 5 Fax:(210)579-657 7ENVIRONMENTA L & CONSTRUCTIO N TECHNOLOGIES , INC . SERVICE S

OMAH A LEA D BASE D PAIN T REMEDIATIO N EP A Close-Ou t For m 

### 201 0 (Lead-BasedPain t Stabilizatio n EP A Confrac t EP-R7-08-07 ) SAID : 

# 3\0^' 1 ] h Propert y Address : 

# )io< f . ^ /sg:" " ,'? F Owner' s Name : Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e striicture(s ) painte dwit h th e exceptio n ofth e stated , exclude d areas ? Thi s wouldinclude paintin g o f othe r

associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an dexterior surface s o f 

# 1 / garages . 2 . Wa s al l scrapin g andothe r

preparatio n wor k

complete dsatisfactorily ? 

# -y 3 . Wer e all require darea s ofth e structure(s ) prime da s neede dandpainte dwit h tw o to p coats ? 4 . Wa s th e paint product s utilize dequivalen t t o a2 5 yea r

product/quality ? 

## -iy

­ 5 . Ar e al l ofth e area s wher e contaminate dmaterial s hav e been spille dthoroughly 

# y vacuumed / cleaned ? 6 . Di dth e contractor collect/vacuumall falling andscrapedpaint chip s o n th e entir e property , roadways , alleyways , publi c acces s area s andals o remov e an y 

# y othe r

generate ddebris ? 7 . I s th e gras s are atha t surroimd s th e stmcture(s ) i n reasonably goo dcondition ? 

# ^ y

. Ar e al l iteni s such a s polyethylen e sheeting , ladders , paint bmshes , cones , 8 

# \ y barrie r

tape , etc . properly removed ? 9 . I s ther e an y evidenc e ofpropert y damag e tha t wa s done b y th e contractor ? An y propert y damag e need s t o b e complete dprio r t o th e EP A Close-Out . 10 . Ha s th e Propert y Owne r

signe dth e completio n form ? 

## y 11 . Ar e ther e an y propert y item s tha t wer e temporarily re-locate db y th e contractor 

## y tha t needt o b e movedbaick ? 12 . Ar e ther e an y (known) lingerin g issue s wit h th e propert y owner(s ) tha t hav e 

## y been lef t unresolved ? othe r Considerations/Propert y Owne r

Discussions/Additiona l Wor k

tha t i s Required : '^/lIl D - \J(yC-lCitaf^' ^ pO^lrt T ckiCy ^ flf»aA«L \uruJSA ^ L ^ (ant^iL r da^i ) 

## Js:soe! > HeioiiA j dB?h'\^f Q 

# 0 ^ bJJe y 9 mm w EP A CO RSignatilr e

808 0 War d Parkway , Suit e 40 5 250 5 N . 24* " street . Suit e 21 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax:(210)579-657 7# TBCHNOLOCIBS , INC T 

### Checklis t fo r th e Worksit e Hazar dAnalysi s Address : Crew : Date : Ite m OK ? Hazar d Correctiv e Actio n Overhea dLine s 1 /M- i V\ n «-iC»,

- W 9 /j > c= > t^ : ^ r f V «/ • zD'- > In-transi t Vehicl e Clearanc e Level s aroun dhig h wire s 

### 5 - S.-c ^ Vehicl e Clearanc e aroun d hig h wire s whe n workin g 

### \5< ? C_aCc£ . - tAS< * *7 . 9 0 ^ dirf j fl ih^y ^ * ^ Phon e line s 

### e)c47.^n/ ',Sr>$ : y Cabl e line s Ga s Lin e / Wate r Lin e / Sewe r Lin e \ Septi c Tan k \ Propane/Butan e 

# ] Acces s to/o n Propert y Neighbo r Acces s Require d Hig h Traffi c Are a 

# { \ Garag e ' " •NDnjt ? - — — _-_ ^ Structure s Drivewa y Sidewal k Foundatio n > Retainin g Wall s / Fence s / Tree s Foliag e \ Genera l Conditio n o f yar d \ Damage dAreas : sin k holes/rotte dwoo d Sprinkle r Syste m Pet s Insect s \ Weathe r Condition s Unsaf e drivin g condition s Unsaf e neighborhoo d 

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### Sit e Safet y Office r oAq/?^rc ? 808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 KansasCity , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402 ) 504-100 4 Phone : (210)822-958 8 Fax:(816)363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7n£3mi 8 Dougla s Count y Accoun t liifiannation Pag e 1 of 4 Dougla s County , Nebrask a Propert y Recor d - R123490000 0 Prin t Reoor t Vie w Interactiv e GI S Ma o Informatio n i s vali d a s o f 2010-5-2 8 Treasurer' s Ta x Reoor t Ne w Featur e •^•4« # Subdivisio n Saie s Searc h Owne r ELIZOND O ENRIQU E 542 6 S 2 0 S T OMAH A N E 68107-000 0 Propert y Informatio n Ke y Number : 349 0 000 0 1 2 Accoun t Type : Residentia l Parce l Number : ^jae^poeeee-—^....^^^^ Parce l Address / /fl09S28S T ^" ^ OMAH A N E 68105-000 0 J Lega l Description : >IANGCO M rLAert:Of2 2 BLOC K1 N 4 0 FT 4 0 X 15 0 Valu e Informatio n Lan d Improvemen t Tota l 201 0 $4,600.0 0 $54,100.0 0 $58,700.0 0 200 9 $4,600.0 0 $56,400.0 0 $61,000.0 0 200 8 $4,600.0 0 $56,400.0 0 $61,000.0 0 200 7 $4,600.0 0 $56,400.0 0 $61,000.0 0 200 6 $4,600.0 0 $54,600.0 0 $59,200.0 0 200 5 $4,600.0 0 $54,600.0 0 $59,200.0 0 Sale s Informatio n Sale s Date : Dee d Type : Price : Granto r 1999-11-1 2 D $38,950.0 0 : SooAt : 213 8 Page : 71 2

Grantee : Valid/Invalid : Exclusio n Reason : Vali d Sale s Date : Dee d Type : Price : Granto r 1999-05-1 4 D $20,000.0 0 ; Book : 212 2 Page : 55 7

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n ^ a Grantee ; Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Serie s S F Unit s Dept h Widt h Vacan t 0.1 3 6000. 0 1. 0 150. 0 40. 0 N o Lan d Attribute s Attribut e Attribut e Descriptio n Negativ e Influenc e Vie w Negativ e Influenc e Traffi c 5 Improvemen t Informatio n Buildin g 1

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### Ranc h CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 770. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

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

HVAC : Force d Ai r Rooms : 3. 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 Fioorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 187 5 199 9 0 % 193 7 7 3 Detai l Typ e Detai l Descriptio n Unit s http://douglasne.mapping-online.eom/DouglasCoNe/static/accountinfo.j sp?accountno= R 123.. . 6/3/201 0Dougla s Count y Accoun t Informatio n Pag e 3 of4

nfiM T Applianc e Basemen t Basemen t Fixtur e Fixtur e Porc h Porc h Allowanc e Bsmn t Bloc k 8 f t Finishe d Bas e Fixture s Bat h Ful l Sla b Roo f Ceilin g Sla b Roo f Ceilin g 1. 0 770. 0 510. 0 1. 0 1. 0 119. 0 208. 0

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