## TRANSMITTA Lof OMAHA LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R SAID# : 2956 0 Date : November s Address : 383 6 Maple St . Remediation Contractor : Pruden t Technologie s Year : 200 8 PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S 2

1 Video of propert y (DVD ) [?f

Executiv e Summar y B

f Signe dAcces s Agreemen t fo r subjec t propert y 0 Paintin g Agreemen t D Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) D Photograph s H ' Satisfactor y restoratio nsigne db y Propert y Owne r D Propert y close-ou t chec k lis t signe db y EP A ^ Propert y informatio nfromDougla s Count y Assessor' s Offic e D D D 

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4031061 4

# i Superfun dPROPERT Y SUMMAR Y Date : 10/12/0 8 LB P STABILIZATIO N EP A CONTRA T EP-R7-08-0 7 Mont hof : Octobe r Propert y Address : 383 6 Mapl e St . SAID : 2956 0 

### A . EXECUTIV E SUMMAR Y A. 1 Issue s Encountered : None A. 2 Issue s Resolved : None

A. 3 Uniqu e Findings : None 122A. 4 Othe r Relevan t Information : None Acces s Date : 09/17/0 8 Wor k Bega n Date : 9/24/0 8 Closeou t Date : 10/31/0 8 Enclosures ; 1 . Pre-Vide o 2 . Post-Vide o 3 . Propert y Statu s For m 4 . Signe dAcces s Agreemen t 5 . Pre-Renovatio n Form 6 . Pain t Matc hFor m 7 . Trackin g For m 8 . Dougla s Count y Assessor Propert y Informatio n Pag e 9 . EPA Propert y Closeou t for m 10 . Propert y Completio n Agreemen t

TECHNOLOCIES , INC .ENVIRONMENTA L& CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : 3^3 0 <^^ k ^ ^ - Date : f-/&-0 ^ Phone : ^/Q-^ ^ 35 1 ' ^^" f I BVID : 

# 2^1 5 W Plant & Permanen t Landscapin g T o Remain In Plac e Item # Descriptio n andLocatio n On Ma p

Pre-Existin g Conditio n o f Structure s Doe s your Basement hav e ahistor y o f leaking ? Ye s — N o Item# Descriptio n & Locatio n .^escnpaon e c L/Ocauo n O n Ma p V ^ Clacks.i A c<5/0>^/ / '^'^'^"^'^ y ^^^'^'f- ^

Propert y Owne r Pruden t Emplo y Signatur e Signature : 808 0 Ward Parkway , SuH e 40 5 Kansa s City , M O 6411 4 Phone : (816 ) 363-3703 250 5 N . 24'(s^et , Suit e 30 8 Omaha , mbrask a 6811 0 Phone : (402)504-100 4 4242 Medica l Drive , Suit e 426 0 Sa n Antonio , T X 7822 9 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402 ) 604-100 5V > 

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Pruden t Technologies , Inc . (Prudent) i s unde r

contract (Contract #EP-R7-08-07 ) wit hth e U . S . Enviromnenta l Protectio n Agenc y (EPA ) t o stabiliz e Lea dBasedPaint (LBP ) a t anumbe r

of properti ( locatedin Omaha, Nebraska , includin g th e propert y locateda t gy?) ^ YVX/OjCil o .S / 

## e s Th e EP Arequest s you r

permissio n t o allo w Pruden t to perfon n tlfii p St^ilization^iii s propCTty. By " signing thi s form, th e propert y owner grant s permission to Prudent t o perfor mactivitie s relatedt o LB P Stabilization including scrapin g paint andpaintin g o f th e referencedproperty . Further , th e owner/tenan t verifie s tha t they hav e receive dtiie LB P pamphle t ''Renovat e Right. " I f

you have an y question s about tiie LB P stabilizatio n plannedfo r

your property , pleas e contact Prudent' s i^^minlgh-ntiv e Cler k

fo r

th e LeadBase dPaint Stabilization , Mrs . Debora hAkerelis.Tnhn!tnn , at

(402) S04-1004 . Genera l question s about tiie OmahaLea dSite cleanup ca n b e directe dto the EP A Publi c Informatio n Center s at (402 ) 731-304 5 (Soutii Omah aoffice) or (402 ) 991-958 3 (Nort hOmaha office) . r ^ \ Prapcft y Acce nOrauie d] (Pleas e Pri^ame ) Propeity Owner Signauie : 7 (Signature ) f \(pate ) PROPERT Y INFOFMATIO N (T o li e coaplcte db y rttlden t uid/o r propert y owBc r - picaa e print ) RESIDEN TNAME : 

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# [r^r^( 7 rowner j Rente r 

# -ZQ^i^ fActf U s^ . RESIDEN T ADDRESS : I F RENTAL , PROPERT Y OWNE D BY : OWNER' S MAIUN G ADDRESS ; 

# SuM t OWNER' S TELEPHON ENUMBE R• HOME : V • \ 

# .m^ : jB^^LJll L NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : O NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDER : L_ NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLA YI N TH E YAR D FO R 8 HOUR S O R MOR E PE R WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y OATES , ETC. )

AUTHDRIT Y FO RENVIRONMENTALRESPONS EACTIONS ; Th e activWe s t o twlnvlemento db y EP Aunde r tfcii agreemen t ar e punnB l t o SoetJo o 104 o f

CERCLA . 4 2 U.S. C 9604 . EPA' S righ t o f

acces s t o th e propert y isptovide dfbr n Sectio n104(e ) o f CERCLA . 4 2 U.S . C 960S(e) , whic hprortJe s entry for ''<lirtBmi«f"g«« « iiMM i torrcipoMa , O f choosin y ortaldn g an y respons e aclio nunder (hi s title , o r otoemit e enforcin g fte proviiion s o f <fa

e tifle. "

250 5 N . 24 * Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 War dPari»ray > SuH e 40 5 Omaha , Nebraslt a6811 0 Sa n Antonio , T X 7822 & « s City , M O 6411 4 Phone : (402)504-100 4 ie:(816)36»70 3 iaAa \ %tL\.vttr t

# Curren t Sampl e Pre-Renovatio n Fonti ^ Eftoeih wunti l Apri l 2010 . Conlbmano n o fRecdp t o fLea d Pamphle t Q/ | hav e receive d a cop yo fth e pamphlet , Fienovat e Righ t Importan t Lea d Hazen J informatio n fo rFamSies , CNl d Car e Provider s an d School s infonnin g m e o f th e potentia l ris k o fth e lea d hazar d exposur e fro m renovatio n activit yt o b e perfonne d in m ydwellin g unit . I receive d thi s pamphle t belfoi e th e v\;or k t>egan . ofrsdpien t y j ->> ^ Dat e o frecipien t Self-Certiflcatio n Optio n (fo rtenant-occupie d dwelling s only ) — I fth e lea d pamphle t wa s delivere d txj t a tenan t signatur e wa s no t otitainable , yo u ma ychec k th e appropriat e bo xbelow . Q Rehisa l t o sig n — I certif ytha t I hav e mad e a goo d faK h effor t t o delive rth e pamphlet , ^?anovaf e F^gh t Impoitu n Lea d Hazar d Infonnatio n fo rFiamKes , ChK d Car e Pmvlder s an d Schools , t o th e renta l dwellin g uni t liste d belo wa t th e dat e an d tim e indicate d an d tha t th e occupan t relused t o sig n th e conflnnatio n o frec^ I furthe rcertif ytha t I hav e lef t a cop yo fth e pamphle t a t th e uni t wit h th e occupant . Q Unavailabl e fb rsignatur e — I certif ytha t I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , Fienovat e Fiigh t Importan t Lea d Hazan J Infonnatio n fb r Fgnaiee , ChOd Car e pmvlder s an d Schools , t o th e renta l dwellin g uni t liste d belo wan d tha t th e occupan t wa s unavailabl e t o sig n th e confinnatio n o freceipt . I ^rthe roeitH ytha t I hav e lef t a cop yo fth e pamphle t a t th e uni t b yslidin g it unde rth e ( 

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/f , o fper r \ ­9 so n certifyin g Attempte d delivery dat e an d tim e lea d pamphle t delivery Signatur e o fperso n certifyin g lea d oamphle t delivei y 

# 0/r\dhcc , fu ^ UnltAddiBS s Not e Regardin g Mailin g Optio n —A s a n altemativ e t o deliver yI n person , yo u ma ymal l th e lea d pamphle t t o th e owne rand/o rtenant . Pamphle t mus t b e maile d a t leas t 7 day s befor e renovatio n (Documen t wit h a certificat e o fmailin g fro m th e pos t office) .

# pain t matc h for m Pain t matchin g form : propert yaddress : ^0"5 G f^i ^

s-f . BVID : 7f^C? o Area : ^^^.r€ . ^aru ^

^^^o^ - ^^^^c..)U^ < Explanat i on : Area : color : Explanat i on : Area : color : Explanat i on : Area : Color : Explanation : Area : Color : Explanation : Pag e 1

# [ Acces s INFmHATIO N TRACKIN G SHEE T PROPBim r 

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### Dougla s Count y Accoun t Informatio n Pag e 1 of 2 

# f Dougla s County , Nebrask a Propert yRecor d - Rl61iS74K>000 - | Prin t Rfpor t NE W FMtui w• Parc M Dimanilo m •vailabi a Q teal s 0-5 0 ft was t o f SOD ) S t • VIe W O n Ma p Infonnatio n i s vali d a s o f 2008-7-1 4 Treasurefl^TaxReppr t 1 Ne wFeatur e -»-•• • Aut Q Sale s Sffa.rc h | Owne r| CUDJ O LOI S 1 383 6 MAPLE S T {i\\^\V{v' ^ OMAH A N E 68111-0000 Y ^

' • • • \ • 1 Propert yInformatio n KeyNumtte n 257 7 000 0 1 6 Accoun t Type : Residentia l i Parce l Number : 162577000 0 Parce l Address : 383 6 MAPL E S T OMAH AN E 68111-000 0 Lega l Description : LINCOL N HEIGHT S LO T 1 6 BLOC K1 4 4 0 X 12 0 Valu e Informatio n { Lan d //nprovemen t Tota l 200 8 $ 2,300.0 0 $48,200.0 0 $ 50,500.0 0 200 7 $ 2,300.0 0 $48,200.0 0 $50,500.0 0 200 6 $ 2,300.0 0 $48,200.0 0 $50,500.0 0 200 5 $ 2,300.0 0 $18,400.0 0 $20,700.0 0 200 4 $ 2,300.0 0 $16,700.0 0 $ 19,000.0 0 200 3 $ 2,300.0 0 $16,700.0 0 $ 19,000.0 0 Sale s Informatio n Sale s Date : 2004-06-2 8 Dee d Type : W D Booir ; 200 4 1 Page : 08605 6 Price : $ 50,000.0 0 1 Grantor : 1 Gertrud e A McCarrel l Grantee : LoisCudj o Validnnvaiid : Vali d 1 Exclusio n Reason :

Lan d Informatio n 1 Acre s 

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### 1 Unit e Deptf i Widti i Vacan t 4800. 0 [ 1. 0 120. 0 

## L 0-1 1 40. 0 N o [improvemen t Informatio n 

### http://douslasne.manr>inp-nnlm*»*'Am/r»/x««i""r<..xT-#. . . • .uougla s Count y Accoun t Informatio n Pag e 2 of 2 

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CUC KT O ENLARG E IMAG E Squar e Footage : 1214. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality . Fai r 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 : 

### 6. 0 Exterior : Fram e Aluminu m 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 Sprinide 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 192 6 0 % 192 6 8 2 Detai l Typ e Detai l Descripti'o n Unit e Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 ft 860. 0 Fixtur e Bas e Fixture s 1.0 Fixtur e Bat h Ful l 

### 1. 0 Garag e Detache d 324. 0 Porc h En d Soli d Wal l 140. 0 Use r Atti cFul l Finis h 354. 0

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### 3 . Wd e i&n^dn diuea s o f di e ainictarej(s)prims di s iwede dcaid;^ ^ 'ividi.tw&'tcf p c<cm3^ / 

### 4 . Wii'tt e i»iiii t product s utilizief de(tiiivalen t t o a.30'year prddiiiiift/qusilit;^ ?

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### 5 . An&nofthe'sreat } wh ^ cootsminate dnMoriaiihav e b^spill^<thoroug h 6 . DidtbeoooaractOTOoUixtMKwma UMin g Ol ds^ ^ : ,.niadiwy».i«ll<»yTfc^twblteaccessat ^ 7 . bfhegrmareailintsoifiDmubtiiestfo^ ^ rccnaditioh ? vacumni[9i'cl(»n:ed7 : ;...:.; . / 

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### 8 . Aniflitemsmidiaspolyethylaeshdedog,ladders^paintbrosbiftficdn^.b'arria'tape,etc.propeirt y WBiBy ^ 

### 9 . I s dier e 81 9 evidenc e o f propert y daniag e that VVK S 

### don e by th e cl»ntra:ctor 7 An y prop<nftydamag e Beedttbbe.oroiplrtedprior.totoEPA.ClfMfr'Out. . , _., . ....•:.. . ,,^. , 10. . AnidKJean y prtiiiefty'ltemi s tiiat wer e ten^Mnril y re^ldcBtedby.&i s cbiitreigidir dia t n^eo dt o ti e ' nov M oacK r fc «..>. ­ Mi:.* * • * '• • • .*.*f-i.. H ,.KA.4 . y s ->.^.,rtfc^j:v-'.jav.. . / / / 

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### Pruden t Propert yClose-Ou t Forir ^

(Lead-Base d Pain t StabUlzation ) Owner' s Name : ^^Q-^ ^ Ctt/^j'/i- ^ 

### Performanc e Standards/close-Ou t Criteri a YE S 1 .Wa s th e entir e strjcture{s } painte d wit h th e exceptio n o f th e stated , exclude d arees ? Thi s woul d iridud e paintin g o f othe ressociate d feature s indudin g fascie , eaves , siding , a! i trim , porches , bo x beams , columns , rails , an d exterio rsurface s o f garages . 

# 1 2 .Wa s al l scrapin g an d othe rpreparattio n wor k complete d satisfactonly ? 3 .

Were al l require d areas o f th e structur6(s } prime d a s neede d an d painte d wit h tw o to p coats ? 

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th e pain t product s utilize d equivaien t t o a 3 0 yea rproduct,^ai!Bl!ty ? 

# i£-_ J Are ai! o f th e area s wher e conteminate d material s hav e bee n spille d thoroughl yvacuumed / deaned ? 

# t Di d tiie contracto rcollect/vacuu m ai ! fsUin g an d scrape d pain t chip s o n th e entir e property , roadways , alleyways , publi cacces s areas an d als o remove an yothe rgenerate d debris ? 

# ) L i s th e gras s are a tha t surround s th e structure(s ) i n reasonabl ygoo d condition ? 

# i i Are al l stem s suc h a s poiyethylsn e sheeting , ladders , pain t brushes , cones , barrie rtap e etc . properl yremoved ? 

# 1 i s ther e anyevidence o f propert ydamag e tha t was den s byth e contractor ? An ypropert ydamag e ne4d s t o b e complete d prio rt o th e EP AClose-Out . 

# X I 10 . Are.there anypropert yite.T s tha t wer e tenr.poratil yre-iocate d b yth e contrecto r

tha t nee d t o b e move d back? 

# X 11 .Ar e ther e an y(known ) lingerin g Issues wit h th e propert yovif?>er(s ) tha t hav e bee n lef t unresolved ? Othe rConsiderations?propert yOv/ne rDiscussiop=s?.AddJtIon5 J Wsri < tha t i s .Requii-s d 

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