### TRANSMITTA L o f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R SAID# : _Sa^^3_^

_ Date : &j^ H j oc^lr ^ Address : ^^1 3 M lg^ S.-T . Stabilizatio n Contractor : Pruden t Technologies , Inc . Year : 2010
_ PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S S /

Vide o ofpropert y (DVD ) pfig

­ ^Q

­ pfg l 0 Executiv e Summar y 0 Signe dAcces s Agreemen t fo r subjec t propert y 0 Pre-Renovatio n For msigne db y Propert y Owne r D Pre-Renovatio n For mfo r Occupant/Tenant , i f applicabl e M Paintin g Agreemen t D Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) K

Renovatio n Recordkeepin g Checklis t signe db y Certifie dRenovato r 0 ^ Photograph s y Satisfactor y close-ou t chec k lis t signe db y Propert y Owne r M Propert y close-ou t chec k lis t signe db y EP A y Propert y informatio n fro mDougla s Count y Assessor' s Ofifice S

r Hazar danalysis , i f prepare d n D

Safety Audi t Othe r (describe) : 3020395 5 

# nil Superfun d 

### PradMi t Technology , Inc . Signatur e oe^i n
'A CO RSignatur e (afie r file folae r review ) 

## ^^jH^t^CM-^JLcTt . lO/cJ/ oTECHNOLOGIBS, ] 

## Propert y Summar y Date : 6/24/201 0 LB P STABILIZATIO N EP A CONTRAC T EP-R7-08-0 7 Mont h of : Jun e Propert y Address : 391 3 N 1 8 St . SAI D # : 3361 3
A . Executiv e Summary ; 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 : 03/29/201 0 ii . Wor k Began : 04/15/201 0 iii . Close-Ou t Date : 04/16/201 0 B . Enclosures : 1 . Pre-Stabilizatio n Vide o 2 . Post-Stabilizatio n Vide o 3 . Signe dAcces s Agreemen t Form 4 . Advance-Notic e Form 5 . Pre-Stabilizatio n Vide o Agreemen t Form 6 . Acces s Trackin g For m 7 . Propert y Acces s Assessment Form 8 . Neighbo r Acces s Agreemen t Form 9 . Propert y Pain t Matc h Form 10 . Pre-Stabilizatio n Propert y Safet y Assessment Form 11 . Work-Sit e Hazard s Analysi s Checklis t 12 . Pre
- Stabilizatio n Propert y Hazar dAssessment Photograph s 13 . Dougla s County Assesso r Propert y Informatio n 14 . Signe dPropert y Completio n Agreemen t Form 15 . Propert y Close-Ou t Chec k Lis t Signe dB y EPA©»»« «

40IiOCIBS > INC. ' 

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

contrac t (Contract #EP-R7-08-07 ) v^dt h the U . S . Environmenta l Protectio n Agenc y (EPA) t o stabiliz e Lea dBasedPain t (LBP) a t anumbe r

of propertie s locatedin Omaha , Nebraska , including the propert y locate dat : "^^1 % f\i I o S ^ Th e EP A request s you r

permissio 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 permissio n t o Pruden t t o perfor mactivitie s relate dt o LB P Stabilization including scraping pain t an dpainting ofth e referencedproperty . Further , th e owner/tenan t verifie s tha t the y hav e receivedth 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 contractor t o conduct asoil cleanu p a t m y propert y following completion of lead-base dpain t stabilization , i f th e soil cleanu p ha s not alread y bee n performed . I understandtha t the stabilizatio n contractor cannot provid e assurance s o f which contractor will b e boun dto the soil cleanup . I fiirther imderstandtha t the soil cleanu p contractor wil l mak e all reasonabl e efforts to addres s concern 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 . t>^Yes , I hav e rea dan dunderstandthe paragraph above . 

# X T XO^ O Propert y OwneT B Signutui o Dat e I f

yo u hav e an y question s abou t the LB P stabilizatio n plaimedfo r

you r

property , pleas e contact Prudent' s Custome r

Relations/Offic e Manage r

fo r

th e Lea dBasedPain t Stabilization , Mr . Chandr a Shekar a

t 402

- 504-100 4 o r 402-889-3821 . Genera l question s abou t the OmahaLea dSit e cleanu p ca n b e directe dt o the EP A Publi c Information Center s a t (402 ) 731-304 5 (Sout h Omahaoffice) or (402 ) 991-958 3 (Nort h Omahaofifice) . Propert y Acces s Grante dBy : 

# 3 P. ^ IsLO/cf Propert y uwne r s Signatur e Dat e 

# K)ay\(yr^ CjtnxasA o Pleas e Prin t Nam e

808 0 War d Parkway , Suit e 40 5 250 5 N
. 24' " Street , Suit e 30 8 424 2 lUledica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebraslt 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

### iiaLociBs , n^i c PROPERT Y INFORMATIO N (T o b e complete dby residen t and/o r propert y owne r ~ pleas e print ) RESIDEN T NAME : Tenan t RESIDEN T ADDRESS : (jW/ 3 A / 16 ^

I FRENTAL , PROPERT Y OWNE D BY : OWNER' S MAILIN G ADDRESS :
EPHON E NUMBER : 

# Q.dlOM° i Cell : NUMBE RO FOCCUPANTS UNDE R7 YEAR S OLD : V^^HJ ^ \ TOTA L NUMBE RO FOCCUPANTS : 3 NUMBE RO FCHILDRE N UNDE R7 YEAR S OL D WH O PLA Y I N TH E YAR D FOR5 HOUR S O

RMOR E PE RWEEK : | COMMENT S O RSPECIA L INSTRUCTION S (suc h a s does , entr y 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 to Section 10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f

acces s to th e propert y i s providedfo r

in Section 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , which provide s entr y fo r

"determining the needfo r

response , or choosing or takin g an y respons e actio n imde r thi s title , or otherwis e enforcing the provision s ofth e title. " 

# jhy^c?^ ^ Propert y Owne r

Signature : ^ (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 Kansa s City , IM 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[OLOCIBS , IN C 

### 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 comin g ou t t o shoot a Pre Stabilizatio n vide o an d t o take picture s o f m yproperty . Pruden t wil l us e th e video s an d picture s t o documen t th e curren t propert ystatus/condition
. Also , Pruden t wil l shoo t a vide o shot followin g th e completio n of th e pain t stabilization
. I give permissio n t o video s an d picture s o f m yproperty . Pleas e lis t an yspecia l condition s tha t Pruden t employee s nee d t o b e awar e o f before shootin g a vide o (suc h as pets , prio rnotice , etc.)
. 

# Z3I3J / iss-l

- Propert yAddres s 

# ^JQ . ^ l::ioi ^ Owner' s Nam e Signature Date 

### ADVANC E NOTIC E REQUIREMEN T Afte rsignin g th e acces s yo u allow Pruden t t o begi n Lea d Base d Pain t Stabilization
. Al l Plants , weed s an d an yvehicle 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 mus t b e ou t o f yar d 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 as Pruden t wil l onl yinfor m th e propert yowners . D o yo u have an ypets tha t resid e i n yard : 

### S L Notice needed : 

# ^- M Phon e numbe rt o cal l t o give notice : 

### ;0n^ - 0^^ ^ Who m w e are givin g notic e to: 

### ^(Lntir a C4kxv\0LcL o

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

# Curren t Sampl e Pre-Renovatio n For m Effectiv e unti l Apri l 2010
. Confirmatio n o f Receip t o f Lea d Pamphle t 

# t l hav e receive d a cop yof th e pamphlet , Renovate Right : Importan t Lea d Hazar d Informatio n fo rFamilies , Chil d Car e Provider s an d School s informin g m e of th e potentia l risl < of th e lead hazar d exposur e fro m renovatio n activit yt o b e performe d i n mydwellin g unit
. I receive d thi s pamphlet befor e th e wor k began
. Printe d riamQ o f recipien tDat e Signatur e of recipien t Self-Certificatio n Optio n (fo rtenant-occupie d dwelling s only ) —- I f th e lead pamphlet wa s delivere d bu t a tenan t signatur e wa s no t obtainable , yo u ma ychec k th e appropriat e boxbelow
. •Refusa l t o sig n —I certif ythat I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , Renovate Right : Importan t Lea d Hazar d Infonvatlo n fo rFamilies , Chil d Car e Provider s an d Schools , t o th e renta l dwellin g uni t liste d below at th e dat e an d tim e indicate d an d tha t th e occupan t refuse d t o sig n th e confirmatio n of receipt
. I furthe rcertif ythat I hav e lef t a cop yo f th e pamphlet at th e uni t wit h th e occupant . •Unavailabl e fo rsignatur e — I certif ythat I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , Renovate Right : Importan t Leadtiazar d Informatio n fo r Families , Chil d Car e provider s an d Schools , t o th e renta l dwellin g uni t liste d below an d that th e occupan t wa s unavailabl e t o sig n th e confirmatio n of receipt
. I furthe rcertii ythat I hav e lef t a cop yo f th e pamphlet a t th e uni t byslidin g i t unde rth e door
. Printe d nam e o f perso n certifyin g Attempte d deliver y dat e an d tim e lead pamphlet deliver y Signatur e of perso n certifyin g lead pamphlet deliver y

Uni t Addres s Not e Regardin g Mailin g Optio n — A s a n alternative t o deliver yi n person , yo u ma ymai l th e lea d pamphlet t o th e owne rand/o rtenant . Pamphle t must b e maile d a

t leas t 7 day s befor e renovatio n (Documen t wit h a certificat e of mailin g fro m th e post office)
.

# m n?e r 

### PAIN T MATCHIN G FORM : 1 . T O B E FILLE D OU T ONLY I FMATCHIN G COLO R PROPERT Y ADDRESS : "^^/ S ^ / f ^ ^ ^ 

### BVID : 33^1 3 Th e followm g note s ar e fo r th e benefi t o f pain t cre w only . Locatio n Siding Soffi t Fasci a Come r Tri m Window Trim s Doo r Trim s Fron t Porch Ceiling Fron t Porc h Ceiling Beams Fron t Porc h Floo r Fron t Porc h Railing s Fron t Porc h Step s Siding Baseboard s Foundation 

## L-^H^'/li ^ 

# t f C-Lw(^ c N o 6^«>ro ^ Pain t Descriptio n 

## fl.5k,.^Ujs/lJ^«»J'

T{iP ^ (p^*v-U i \ 

## <:::Aiyn. ^

o Pain t Yes Pain t N o 

## x

y l y \y ^ 

# y \

/

- • 

# y y y 

# y" y 

# y

^ 

## kCti l 

## :s 

# y y ^ 

## y

^

• I UNDERSTAN D SHER \ ^I N WILLIAM S WIL L MATC H M Y C URREN T CO ] LORS .
Homeowner signature : 

## Date : JIS.^/j2.CP/ ^
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• IQLOGnSblNC
. 

### ACCES S ASSESSMEN T FORM : I s th e propert ystucc o o rasbestos ? I f yes , i s an yo f th e stucc o o rasbesto s damage d o r cracked ? I f yes , sto p a s w e can' t stabiliz e thi s property . I t require s specia l preparatio n techniques
. I t wil l b e returne d t o EP A an d the ywil l assig n a t a late rdate
. Doe s thi s propert yrequir e lot s o f scrapping ? Doe s thi s propert yrequir e a lif t o rscaffoldin g t o reac h uppe rlevels ? Doe s thi s propert yhav e lot s o f plant s o ritem s i n area s wher e paintin g i s required ? Doe s thi s propert yhav e an ysignifican t structura l damage ? I f yes , EXPLAIN ? Doe s thi s propert yhav e a garage ? I f yes , describ e locatio n o f garage . Doe s thi s propert yhav e aluminu m siding ? I f yes , i s i t origina l factor yfinis h o rha s i t bee n painte d over ? Doe s thi s propert yhav e an yothe rtyp e o f structura l components ? (I.e
. roo f shingle s a s siding) ? I f yes , EXPLAIN ? I s thi s propert yvacan t o roccupied ? Ar e ther e an ypet s a t thi s property ? Ar e ther e an ylo w hangin g powe rlines ? D o w e nee d neighbor' s access ? I f ye s pleas e explai n an d ge t neighbor' s propert yaddres s an d owne r information
. I f possible , ge t signatur e fro m th e neighbor
. 

### Asfe^s/^«2>S,VJ* ^
^ ^


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# y o 

# y^ ^ y^ o -n o X c ? 

## OCO^x& A
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# ^ks
. \ i o -f-SJT^ i I^EL C

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 7TEC31NOLOGIES» 1 

## ACCES S INFORMATIO N TRACKIN G SHEE T BVID : ZSSI 3 PROPERT Y ADDRES S : 3^1 3 N f ^ Sf

Propert y Owne dBy : (I

f

ne w propert y owner )

Owner s Phone No's : Home : -i-?.i-'-?-^-?Vork : Cell : -JL0J,,.^C1±U- ^ Fax : - Acces s Contractor : AS W PD A MES P E Other (Prudent) DATE TIM E ACCESSO R CONRAC T DETAI L * 

# zW' i \{D\0( > 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 Plione : (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
Nam e o f

Firm . i(j^0LfA l (j) ' . 

### Dat e an dLocatio n o f

Renovation : ^u6'// ^ S^/ 3 4 / BriefDescriptionofRenovation : ^J^A^j/P^m ^ / f^iAjt ^ ^^EM-l/f i Nam e o f

AssignedRenovator : -I^LJ (^//j(^(\/p{ ^ / /uS^l^tj/ ^ /jj . Name(s ) o f TrainedWorkers : P/)f/if^lj- i (.^fi^/ijii d Nam e o f

Dust Sampling/^chnician , Inspector ^ ami/o r

Rig k

Assessor , i f used :

r 0 Copie s of renovato r

an ddus t sampling technicia n qualification s (training certificates , certifications ) o n file. y Certifie drenovato r

providedtrainin g t o worker s o n (chec k

all tha t apply) : zTPostin g warning sign s ^H Setting u p plasti c containmen t barrier s ^a^aintainin g containmen t JZ^voidin g sprea dofdus t t

o adjacen t area s JZwast e handling Q^ost-renovatio n cleaning D Test kit s use db y certifiedrenovato r

to determine whethe r

lea dwa s presen t o

n components affecte db y renovation (identif y kit s use dan ddescrib e sampling location s an dresults :
/ Q Warnin g sign s posteda t entranc e t o wor k

area . n Wor k

are acontainedto preven t sprea dofdus t an ddebris . D Window s i n an dwithin 20 fee t ofth e wor k

are aar e closed D Doors in an dwithin 20 fee t ofth e wor k

area s ar e closedan dsealed D Doors tha t must b e usedi n the wor k

are aar e coveredto allo w passag e bu t preven t sprea dofdust . IZuroun dcoveredby plasti c sheeting extending 1 0 fee t fro mwor k

are a- plasti c anchoredt o th e building an dweighteddow n b y heav y objects . D I f

necessary , vertica l contaimnen t installedt o preven t migration ofdus t an ddebri s to adjacen t property . 

# y Wast e containedon-sit e an dwhile being transportedoff-site .

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

### / /'P ^ o(effectiv e Apri l 2010 ) 

# y fL

X Wor k

sit e properl y cleane dafter renovation . DAI I chip s an ddebri s picke dup , protectiv e sheetin g misted , folde ddirty sid e inward , an dtape dfor 'Removal . ^ZiWork are aHEP A vacuimie d to ge t pain t chip s fro mgroimdsurface , if necessary . Certifie^i^n^v^o post-renovatkj cleaningyverificajiy (describ e results) : M M Certified^ndva(to r r performe

performe d dpost-renovatio n n cleaning.verifica|w) n n (des j 

# i/eMi'Ai l aifl

I certif y unde r penalt y

of la

w tha t the above informatio n

is tru e an dcomplete .

Nanie an dTitle s Dat e

Renovatio n Recordkeepin g Checklis t Omah a Lea d Sit e• • TECHNOLOGIBS . IN C 

## Checklis t fo r th e Worksit e Hazar dAnalysi s Address : ^2 ^ I ^ 71 . i S --4= r ^ Crew : 

## Date; H^l^lC i Ite m OK ? Hazar d Correctiv e Actio n Overhea dLine s 

## y In-transi t Vehicl e Clearanc e 

### y Level s aroun dhig h wire s Vehicl e Clearanc e aroun d hig h wire s whe n workin g / y Phon e line s Cabl e line s y ^ Ga s Lin e 

# y Wate r Lin e 

# y Sewe r Lin e y ^ Septi c Tan k T 

## y Propane/Butan e 

## y Acces s to/o n Propert y y Neighbo r Acces s Require d y Hig h Traffi c Are a y • Garag e y Structure s y Drivewa y 

# y Sidewal k 

# y Foundatio n 

# y Retainin g Wall s y Fence s 

# y- Tree s ^ y Foliag e c Genera l Conditio n o f yar d y y Damage dAreas : sin k holes/rotte dwoo d 

# y Sprinkle r Syste m y Pet s y Insect s -^z
- Weathe r Condition s y Unsaf e drivin g condition s ^ ^ • •

^.. • Unsaf e neighborhoo d Crew/Foremaiv f Sub-Contracto r 

# hui ^ & 6 808 0 WaP d Park\f&y , 2505'N
. 24' " Street , Suit e 30 8 ! Medicalprive , 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 Phoiie : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax:(210)579-657 7• # TECHNOLOGIBS . IN C 

### Pruden t Propert yClose-Ou t For m (Lead-Base d Pain t Stabilization ) SAID : "^ZL l 3 Propert yAddress : S4^ 3 A/ • ^ ^

^ Owner' s Name :

S.N O Performanc e Standards/close-Ou t Criteri a 1 Wa s th e entir e 8tructure(s ) painte d wit h th e exceptio n o f th e stated , exclude d areas ? Thi s woul d includ e paintin g o f othe rassociate d feature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an d exterio rsurface s o f garages . 2 Wa s al l scrapin g an d othe rpreparatio n wor k complete d satisfactorily ? 3 Were al l require d area s o f th e structure(s ) prime d a s neede d an d painte d wit h tw o to p coats ? 4 Ar e al l o f th e area s wher e contaminate d material s hav e bee n spille d thoroughl yvacuumed / cleaned ? 5 Di d th e contracto rcollect/vacuu m al l fallin g an d scrape d pain t chip s o n th e entir e property , roadways , alleyways , publi c acces s area s an d als o remov e an yothe rgenerate d debris? 6 I s th e gras s are a tha t surround s th e structure(s ) i n reasonabl ygoo d condition ? 7 Wa s th e pain t product s utilize d equivalen t t o a 3 0 yea r product/quality ? 8 Ar e al l Item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e et c properi yremoved ? 9 I s ther e an yevidenc e o f propert ydamag e tha t wa s don e b yth e contractor ? An yproperi ydamag e need s t o b e complete d prio rt o th e EP A Close-Ou L 1 0 Ar e ther e an ypropert yitem s tha t wer e temporaril yre-locate d byth e contracto rtha t nee d t o b e move d back ? 1 1 Ar e ther e an y(known ) lingerin g issue s wit h th e propert yowner(s ) tha t hav e bee n lef t unresolved ? 1 2 Othe rConsiderations ? Propert yOwne rDiscussions ? Additiona l Wor k tha t i s Require d Pruden t Representativ e Signatur e 

## m(^ii'Cii/ ^ Date : y^ i [ ^ Propert yOwne rSignat u Dat e 

# HIIGI^ O Ye s N O • 

# i X i X X



# i X 

# i i 

# X

X

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 7ENVIRONMENTA L & CONSTRUCTIO N TECHNOLOGIES , INC . SERVICE S



### OMAHA LEAD BASE D PAIN T REMEDIATIO N EP A Close-Ou t For m 201 0 (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-07 ) 

## SAID : 3 3 6|-^ Property Address : 

# 3-7) 3 

# W ^ ^ i h



# 3 f Owner' s Name : Performanc e Standards/Close-Ou t Criteri a YE S N O L Wa s th e entir e structure(s ) painte dwith th e exceptio n ofth 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 y garages . 2 . Wa s al l scrapin g an dothe r preparatio n wor k

complete dsatisfactorily ? y 3 . Wer e al l require darea s ofth e structure(s ) prime da s neede dan dpainte dwith y tw o to p coats ? 4 . Wa s th e pain t product s utilize dequivalen t t o a2 5 year product/quality ? y 5 . Ar e al l ofth e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y vacuumed/ cleaned ? y 6 . Di dth e contracto r collect/vacuvm i al l fallin g an dscrape dpain t chip s o n th e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y y othe r generate ddebris ? 7 . I s th e grass are atha t surround s th e structure(s ) i n reasonabl y goo dcondition ? * y 8 . Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , y barrie r tape , etc . properl y removed ? 9 . I s ther e an y evidenc e ofpropert y damag e tha t was don e b y th e contractor ? An y y property damag e need s t o b e complete dprio r t o th e EP A Close-Out . 10 . Has th e Property Owne r signe dth e completio n form ? 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 nee dt o b e move dback ? 12 . Ar e ther e an y (knovm ) lingerin g issue s with th e propert y owner(s ) tha t hav e y bee n lef t unresolved ? Othe r Considerations/Property Owne r Discussions/Additiona l Work tha t i s Required :

EP A CO RSignatur 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 7Dougla s County Accoun t Informatio n Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R070144000 0 Prin t Reoor t NE W Featur e - Parce l Dimension s availabl e &
. scal e 0-5 0 ft wes t o f 52n d S t - VIe W O n Ma P Infbrmatio n i s vali d a s o f 2010-3-1 6 Treasurer' s Ta xRepor t Ne w Featur e -»!*• * Aut o Sale s Searc h Owne r SANDER S WILLI S ETA L C/ 0 SANDR A CAMACH O L/ C 391 1 N 1 8 S T OMAH A N E 68110-000 0 Propert yInformatio n Ke yNumbe r 014 4 000 0 0 7 Accoun t Type : Residentia l Parce l Numbe r 070144000 0 Parce l Address : 391 3 N 1 8 S T OMAH A N E 68110-000 0 Lega l Description : BOULEVAR D PAR KAD D LO T 1 4 BLOC K8 N 1 0 FT LO T 1 3 & S 3 0 F T LO T 1 4 4 0 X12 5 Valu e Informatio n 200 9 200 8 200 7 200 6 200 5 200 4 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 $13,200.0 0 $15,800.0 0 $15,800.0 0 $15,800.0 0 $14,000.0 0 $12,700.0 0 Tota l $20,200.0 0 $22,800.0 0 $22,800.0 0 $22,800.0 0 $21,000.0 0 $19,700.0 0 Sale s Informatio n Sale s Date : 2008-10-2 7 Dee d Type : Q C Book : 200 8 Page : 10635 9 Price : $17,500.0 0 Granto r SANDER S WILLI S Grantee : CAMACH O SANDR A Valid/Invalid : Invali d Exclusio n Reason : Famil ySal e Lan d Informatio n Acre s S F Unit s Deptf i Widt h Vacan t 0.1 1 5000. 0 1. 0 125. 0 40. 0 N o Improvemen t Informatio n
http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R070144000 0 3/23/201 0Dougla s County Accoun t Infonnatio n Pag e 2 of 2 # Buildin g 1

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. "*" * I i* * F M Floo r 734. 0 n I . ZIQSTQimjNn N NnMBlMkl l nun* ' 

# L CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IIVIAG E Squar e Footage : 1440. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Poo r

Buil t As : 2 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 8. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 2. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 4. 0

Roo f Type : Hi p Stories : 2. 5 Floorcover : 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 191 2 0 % 191 2 9 7 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Unfinishe d Atti c W/floo r 672. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 724. 0 Fixtur e Additiona l Fixture s 1. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 2. 0 Garag e Detache d 228. 0 Porc h Cvr d Woo d Dec k 112. 0 Porc h Enc I Scree n 20. 0 Use r fram e type-asbesto s 1. 0

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R070144000 0 3/23/201 0