## TRANSMITTA LO FOMAHA LEAD SIT E PAIN T STABILIZATIO NFIL EFOLDE R SAI D # : 9>L}^S ^ Date : 09 . )<\i ^ |,StaO ^ Address : /^^ ^ 2 > N 0* 7 A v LB PStabilizatio n Contractor : PRUDEN T TECHNOLOGIES , INC . Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S M Videoo f propert y (DVD) : Pre-Stabilizatio n& Post-Stabilizatio nVideo s 1 ^ Executiv e Summary y SignedAcces s Agreement Form y Advanc e Notic e Form t ^ Pre-Stabilizatio n Vide o Agreement Form y Acces s Trackin g Form £ y Propert y Acces s Assessment Form y Neighbo r Acces s Agreement Form y Pain t Matc hForm y Pre-Stabilizatio n Propert y Safet y Assessment Form y Work-Sit e Hazard s Analysi s Checklis t y Photographs : Pre-Stabilizatio nPropert v Hazar dAssessment Photograph s y Dougla s Count y Assessor Propert y informatio n y Propert y Completio n Agreement FormSignedby Propert y Owne r D Propert y Close-Ou t Chec k Lis t SignedB y EPA Pruden t Technologies , Inc . Signatur e Dat e EPASignatur e i /Dat e ,3005541 7 Superfun dTEOINOLOGIBS . INC . 

# Propert y Summar y Date : 8/03/2009 | LB PSTABILIZATIO NEP A CONTRAC T EP-R7-08-0 7 | Monthof : Au g Propert y Address : 292 3 N47 A v SAI D # : 8472 4
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 : 7/09/2009 ii . Wor k Began : 7/17/2009 iii . Close-Ou t Date : 7/22/2009 B . Enclosures : 1 . Pre-Stabiiizatio nVide o 2 . Post-Stabilizatio nVide o 3 . Signe dAcces s Agreemen t Form 4 . Advance-Notic e Form 5 . Pre-Stabilizatio nVide o Agreement Form 6 . Acces s Tracidn g Form 7 . Propert y Acces s Assessment Form 8 . Neighbo r Acces s Agreemen t Form 9 . Propert y Pain t Matc hForm 10 . Pre-Stabilizatio nPropert y Safet y Assessment Form 11 . Work-Sit e Hazard s Analysi s Checklis t 12 . Pre
- Stabilizatio nPropert y Hazar dAssessment Photograph s 13 . Dougla s County Assessor Propert y Infonnatio n 14 . Signe dPropert y Completio nAgreement Form 15 . Propert y Close-Ou t Chec k Lis t Signe dB y EP ATBCHNOLOGIES . INC ~ Pruden t Technologies , Inc . (Prudent ) i s unde r contract (Contract #EP-R7-08-07 ) wit hthe U . S . Environmenta l Protection Agenc y (EPA) to stabiliz e Lea dBase dPain t (LBP) a t anumbe r ofpropertie s locatedi n Omaha, Nebraska , including the propert y locateda t pS'^. g A J V7 ^ /{v^ . Th e EP A request s you r permissionto allow Pruden t to perfon n LB PStabilization a tthi s property . B y signing thi s form, the propert y owne r grant s permission t o Pruden t t

o perfon n activitie s relatedto LB PStabilization including scraping pain t an d painting ofth e referencedproperty . Further, th e owner/tenan t verifie s tha t the y have receivedthe LB Ppamphle t "Renovat e Right. " B y signing thi s documen t I agree to allow a nEP A contracto r t o conduct asoi l cleanu p a t m y propert y followin g completionof lead-basedpain t stabilization , ifth e soil cleanu p ha s no t ah-ead y bee n performed . I understandtha t the stabilizationcontracto r canno t provid e assurance s of whic hcontracto r wil l be boun dt o the soil cleanup . I furthe r understandtha t the soil cleanu p contracto r wil l mak e all reasonable efforts to addres s concems tha t I , as the propert y owner, ma y have regarding soil cleanu p a t m y property . \sA [ Yes , I have rea dan dunderstandthe paragrap habove . Signatur e of Propert y Owne r 

# 7/^^" ^ Dat e Ifyo u have an y question s abou t the LB Pstabilization plannedfo r you r property , pleas e contact Prudent' s Custome r Relations/Office Manage r fo r the Lea dBase dPain t Stabilization , Mrs . Shanno n Holt , a t (402 ) 504-100 4 o r (402)812-0223 . Genera l question s abou t the Omah aLea dSit e cleanu p ca n b e directedto the EP A Public Informatio nCenters a t (402 ) 731

­ 3045 (Sout hOmah aoffice ) o r (402 ) 991-958 3 (Nort hOmah aoffice) . Propert y Acces s GrantedBy : (Pleas e Prin t Name) Propert y Owne r Signature : 

# (M^r.AL^ y (Signature) 

# ^/a^ ?

(Date)

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 , 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)579-657 7TECHNOLOGIBS . INC . PROPERT YINFORMATIO N I (T (T oo bb

ee

completecomplete dd bb

yyr

residen t and/o rpropert yowne r—pleas e print ) RESIDEN TNAME : ^wnerj ) Rente r RESIDEN EN

T T ADDRES S

ADDRESS : , , ,„^j J V
IF RENTAL , PROPERT YOWNE D BY : OWNER' S MAILIN G ADDRESS ; OWNER' S TELEPHON E NUMBE R - HOME : {^(Si \ ^/O-^VJ^yNORK : i^UJ i > ^l^~^9^ f NUMBE R OF OCCUPANTS UNDE R 7 YEAR S OLD : a < NUMBE R OF OCCUPANT S 7 YEAR S OL D AN D OLDER :
NUMBE R OF CHILDRE N UNDE R 7 YEAR S OL D WHO M PLA Y

IN TH E YAR D FO R 5 HOURS OR MOR E PE R WEEK : ^ _ COMMENT S

OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. ) 

## 3 D0Q^< ^

^ Gk^

_>h-EorktjQ^ J

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s to be implemente d

by EP A unde r thi s agreemen t ar

e pursuan t to Sectio n 10 4 ofCERCLA , 42 U.S.C . 9604 . EPA' s right of acces s to the propert y

is providedfo r inSectio n104(e ) ofCERCLA , 42 U.S . C 9605(e) , whic hprovide s entr y fo r "detennining the nee dfo rresponse, or choosin g

or taking an y respons e actionunde r thi s title , or otherwis e enforcin g the provision s ofth e title. "

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 , 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 ) 579-657 7TECHNOLOGIBS , IN C 

# Advance dnotic e needed . After signin g th e acces s you allo w Pruden t t o begi n Lea dBase d Pain t Stabilization . Al l Plants , weed s an dan y vehicle s o r item s on ope nporc h(enclose dporche s wil l NO T b e stabilized ) mus t b e remove dprio r t o stabilization . Al l Pet s mus t b e ou t ofyar ddurin g stabilization . Ho w muc hnotic e d o you nee dt o hav e abov e mentione dtask s completed ? Ifyo u ar e alandlor dyo u wil l nee dt o contac t th e tenan t a s Pruden t Technologie s wil l onl y informyou . D o you hav e an y pet s tha t resid e in yard ? Ye s Notic e needed : 2 hoM.f s Numbe r t o cal l t o giv e notice : N02 j 2'^ ' hf'^ i Who mw e ar e givin g notic e to : fi^oy n (jf o S ^ 

# Hom e Owner' s Signatur e 

# ....^^^..C-Aett:: .

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 , 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 ) 579-657 7<tE O STi , s^" ' ' ^
TECHNOLOGIES , IN C 

## PRE-STABILIZATIO N VIDE O FOR M I UNDERSTAND THA T PRUDEN T TECHNOLOGIE S WIL LB ECOMIN G OU T T O SHOO T A PRE-STABILIZATIO NVIDE O A T MY PROPERTY . TH EVIDE O I S JUS T A TOO LUSED T O DOCUMEN T TH ECURREN T PROPERT Y STATUS/CONDITION . A POS T VIDE O WIL LALS O B E SHO T PRIO RT O COMPLETIO NO FSTABILIZATION . 

## #_ C Gr^ssA ^ f.Scked; ^ OWNER S NAME 

## : PROPERTYADDRESS : 3L^Q. 3 

## / J V7—/m l BVID/SAID : '2>MiaM HOMEOWNER S SIGNATURE : PRUDEN T REPRESENTATIV ESIGNATURE : 

# (X^iH ^ AN Y CONDITION S NEED T O B EAWAREO FBEFOR ESHOOTIN G VIDEO : (LE . PETS , NOTIC ENEEDED) : Q ^^ ^ r\a^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 7

# M7 , TECHNOLOGIES . IN C 

# ACCES S INFORMATIO NTRACKIN GSHEE T PROPERT Y ADDRESS : Propert y Owne dBy : (I f ne w propert y owner )

Owner s Phon e No's : Home : iw,,.^.lO-.?33. & Work : Cell : .to.-..^il:.§?.°.l- . Fax : ~ Acces s Contractor : AS WPD A ME S P EOthe r (Prudent ) DAT E TIM E ACCESSO R CONRAC T DETAI L ««>I6 « co.'«* K^»a-W« « » o VA.^J.'Mc r 

# :2/ ^ M'^7^< ^ ^or\)^ \ 1

\ ^1Q° I M?>Oprv N 

## Qaoje-e V <^T^or>V«, < 

# " ^ J .

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 7TECHNOLOGIES ^ IN C 

# Acces s Assessmen t Form : (Mus t b e complete dfo r every property . Informatio nmus t b e obtaine dfro mapropert y wal k thru , no t given b y owner )
I s th e propert y stucc o o r asbestos ? Ifyes , i s an y ofth e stucc o o r asbesto s damage do r cracked ? Ifyes , sto p a s w e can' t stabiliz e thi s property . I t require s special preparatio n techniques . I t wil l b e returne dt o EP A an dthe y wil l assig na t alate r date . Doe s thi s propert y requir e lot s of scrapping ? Doe s thi s propert y requir e alif t o r scaffoldin g t o reac huppe r levels ? Doe s thi s propert y hav e lot s o f

plant s o r item s inarea s wher e paintin g i s required ? . Doe s thi s propert y hav e an y significant structura l damage ? K ^ 

## Ifyes , EXPLAIN ? 1^ 4

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 , 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 ) 579-657 7TECHNOLOGIES . IN C 

## Doe s thi s propert y hav e agarage ? Ifyes , describ e locatio n of garage . Doe s thi s propert y hav e aluminu msiding ? Ifyes , i s i t origina l factory finisho r ha s i t bee n painte dover ? Doe s thi s propert y hav e an y othe r typ e o f

structura l components ? (Le . roo f shingle s a s siding) ? K/ V 

# ® Ifyes , EXPLAIN ? M 0 

## I s thi s propert y vacan t o r occupied ? 

# ScAui ^ (n3 i < f

ffeUnvO , Ar e ther e an y pet s a t thi s property ? 

## 0'^ ^ $(, ^ /y^Ai^

­ '\^ ^ Ar e ther e an y low hangin g powe r lines ?

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 , 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 ) 579-657 7TEOINOLOGIBS , IN C 

# PAIN T MATCHIN GFORM : T O B EFILLE D OU T ONLY I FMATCHIN GCOLO R PROPERTYADDRESS : 1^1 ^ o ^ U l P^T^ . BVID : sma q I UNDERSTAN D SHERWINWILLIAM S WIL LMATC H MY CURRENT COLORS . Homeowner signature : 

# .i2^..£.^dtt^. .

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 7TECHNOLOGIBS b IN C 

## NEIGHBORHOO D PROPERT Y ACCES S FOR M I S THER EA NEIGHBORIN GPROPERT Y THA T NEED S T O B EACCESSED ALON G WIT H ASSIGNED PROPERT Y T O COMPLET ESTABILIZATIO N PROCESS ? 

# 7 M I FI T IS , GE T ACCES S FRO M ALLREQUIRE D NEIGHBORHOO D PROPERTIES . 

# i^Ui WCm'kd ' f\^^k>ti^s^

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 7Stiosii S
TECHNOLOGIES . IN C 

### PRE-STABILIZATIO NPROPERT Y SAFET Y ASSESSMEN T FOR M PROPERTYADDRESS : aei> > M M ^ Av ^ BVID/SAID : S^7a ^ PRUDENT ASSESSMENT REPERSENTATIVE : 

## ^orjeJi i /^cfL-ic^ ^ ******I FSAFET Y RIS K PROPERT Y MUS T B ETURNE D OVE RT O KATH Y ROTHE RBEFOR EI T CA NB EASSIGNE D T O A CREW/SUB . REPERSENTATIV EREMARKS/FINDINGS : (POWER-LIN EPROXIMIT Y T O PROPERTY , SCAFFOLDING / LADDERS / LIFT S NEEDED , UNSAF EAREAS , UNSAF ENEIGHBORHOOD...ETC. )

REQUIRE S K.ROTHE RAPPROVAL YES/N O SUBMITTED T O K.ROTHE RON :

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 , 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 ) 579-657 7# • TECHNOLOGIES . IN C 

# Checklis t fo r th e Worksit e Hazar dAnalysi s
Crew : Date : Ite m Overhea dLine s In-transi t Vehicl e Clearanc e Level s aroun dhig hwire s Vehicl e Clearanc e aroun d hig hwire s whe n workin g Phon e line s 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 hTraffi c Are a Garag e Structure s Drivewa y Sidewal k Foundatio n Retainin g Wall s Fence s Tree s Foliag e Genera l Conditio n ofyar d Daniage 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 

# 2^.* . ^OK ? / Hazar d Correctiv e Actio n 

### MJl^'^T. ^ ist*^» ^ 9<^^^^>^^ ^ 

## 0 ^ 

# ni A Ai/ A 

# '-^r

­ 4 " /tV ^ 

# X

—

— .pf^Jt^JU ^ AJWW—fiKi^*-U ^ 

### 'Ua^-J^a i 0 9»^t^>v

— ^ fu > 0 ( i i 1 / ) / } 

### rbt>f\-nJ i TyKJ
- dury i J-jUj^uji ^ i UOa^r-'^'f^ ifys l ^ ^•^ ^ 8 / ^ /Vl>\+ ^ J 

### iX«^-*- ^ b/\/5^dL , i

- ' Lthey^y&x^ ^ *



### o i ^ 

## .1 / np^^ ^ ',^4- ^ ^— . AAA ^ 

## dtZ ^

—

1 

### Otfi ^ — '

— • •— ' ' , . • 

### ite S^etyA9fficer

808 0 War d Parkwa y 250 5 N . 24' " Street , Suit e 30 8 a l Drive , Suit e 425 0 Kansa s City , M O 64 1 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• "/•mmmmmmmiimmmi m mmmmamma mI ^^'''''''ffTm T I v m

# 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 ^

I hav e receive d a cop yo f th e pamphlet , Renovat e Right : Imporlan t Lea d Hazar d Informatio n fo rFamilies , Chil d Car e Provider s an d School s infornnin g m e o f th e potentia l ris k o f th e lea d hazar d exposur e fro m renovatio n activit yt o b e performe d i n m ydwellin g unit . I receive d thi s pamphle t befor e th e wor k began . 

## fj&L. ^ C . Gn^SL S 

# Z M :aa» ? Printe d nam e o f recipien t Dat e Signatur e o f recipien t Self-Certificatio n Optio n (fo rtenant-occupie d dwelling s only ) — I f 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 xbelow . •Refusa l t o sig n —I certifytha t I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , Renovat e Right : Importan t Lea d Hazar d Informatio n fo rFamiiies , Chil d Car e Provider 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 refuse d t o sig n th e confirmatio n o f receipt . I furthe rcertifytha t I hav e lef t a cop yo f th e pamphle t at th e uni t wit h th e occupant . Q^Unavailabl e fo rsignatur e —I certifytha t I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , Renovat e Right : Importan t Lea d Hazar 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 belo wan d tha t th e occupan t wa s unavailabl e t o sig n th e confirmatio n o f receipt . I furthe rcertif ytha t I hav e lef t a cop yo f th e pamphle t at th e uni t b yslidin g i t unde rth e door . 

## Ron^^^\ . fi<^WN\Le? ^ 

# 9 h lo ^ Printe d nam e o f perso n certifyin g Attempte d deliver y dat e an d tim e lea d pamphle t deliver y Signatur e o f perso n certifyin g lea d pamphle t deliver y

Uni t Addres s Not e Regardin g Mailin g Optio n —A s a n alternativ e t o deliver yi n person , yo u maymai 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 f mailin g fro m th e pos t office) .

### Dougla s Count y Accoun t Infoij^tio n Page 1 of3 Dougla s County , Nebrask a Propert yRecor d - R240216000 0 Prin t Repor t i-f-,TM » —„ , ~i: ^ .., « ... * nnn n e i e NEWFeature - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t of 52n d St-Vie W O n Ma p informatio n i s vali d a s o f 2009-6-1 6 Treasurer' s Ta xRepo S Ne wFeatur e ->->- » Aut o Sale s Searc h Owne r SCHECHiNGE R ALLISO N E y\ ^ 292 3 N 4 7 AV E \ V ^

^ 

# I iti^izq - OiVIAHAN E 68104-000 0 * Propert yInformatio n Ke yNumber : Accoun t Type : Parce l Number : Parce l Address : Lega l Description : Valu e Informatio n Lan d 200 9 200 8 200 7 200 6 200 5 200 4 Sale s Informatio n Sale s Date : Dee d Type : Price : Granto r Grantee : Valid/Invalid : Exclusio n Reason : Sale s Date : Dee d Type : Price : Grantor : 021 6 000 0 2 4 Residentia l 240216000 0 292 3 N 4 7 A V OMAH AN E 68104-000 0 VINELAN D LO T2 1 BLOC K1 4 0 X 12 5 Improvemen t Tota l $ 5,700.0 0 $ 5,700.0 0 $ 5,700.0 0 $ 5,700.0 0 $ 5,700.0 0 $ 5,700.0 0

2007-03-0 6 W D $ 94,000.0 0 Pierso n Eri cJ Schecliinge rAlliso n E Vali d 1998-07-2 4 D $ 48,100.0 0 $ 83,300.0 0 $ 89,000.0 0 $ 58,500.0 0 $ 64,200.0 0 $ 58,500.0 0 $ 64,200.0 0 $ 58,500.0 0 $ 64,200.0 0 $ 60,400.0 0 $ 66,100.0 0 $ 54,900.0 0 $ 60,600.0 0

Book : 200 7 Page : 02754 9

Book : 209 6 Page : 65 8



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R240.. . 7/7/2009i*'>';l!|'J.'«««:iV^Tl^tt»>*t^'<?-'TM.'^S»*^-?f ^ S!»»*««f»iW.»**.f(<*.!i{W!4*)-r : 

### Dougla s County Accoun t Infon^tic n Pag e 2 of 3 Grantee : Valid/Invalid : vali d Exclusio n Reason : Sale s Date : 1990-06-2 3 Dee d Type : I D l Book : 188 0 

### Page : 51 2 Price : $46,000.0 0 Granto r Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s \ S F Unit s Dept h Widt h Vacan t 0.1 1 ' 5000. 0 1.0 125. 0 40. 0 N o Improvemen t Informatio n Buildin g 1

at . s^, , ek.^i,<> » tW^iSw.MiMtWJfiflrJegftm s J CLIC KTO ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1200. 0 Percen t Complete : 10 0 0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Goo d

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 : j 6. 0 Exterior : Fram e Viny l Units : 1.0 Interior : Drywal l Baths : 2. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

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

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R240. . . 7/7/200 9

### Dougla s Count y Accoun t Infon^tio n Page 3 of3

YearBuii t 191 2 Detai l Typ e Ad d O n Applianc e Basemen t Basemen t Fixtur e Fixtur e Garag e Porc h Porc h Use r Yea r Remodele d 200 6 Percen t Remodele d 0 % Detai l Descriptio n Fenc e Chai n Lin k Allowanc e Bsmn t Bloc k 8 ft Walkou t Bas e Fixture s Bat h Ful l Detache d Enc I Scree n Sla b Roo f Cei l ML S UPDAT E Sprinkle rSquar e Adjuste d Yea r Buil t 195 0 Footage : 0. 0 Physica l Ag e 5 9 Unit s 1. 0 1. 0 720. 0 1. 0 1. 0 2. 0 192. 0 192. 0 48. 0

1. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R240.. . 7/7/2009• • 

# Hs o ^^^ , 

# pK/\ 

# isgj ) TECHNOLOGIES , INC . 

## Pruden t Propert yClose-Ou t For m (Lead-Base d Pain t Stabiiization ) SAID : -TH I ^ 4 Propert yAddress : 25ll ^

Ni - Ml'^* ^ gCfA^TJ H Owner' s Name : CL<Lix^CY\ C= ^

n s 5 > s S.N O Performanc e Standards/close-Ou t Criteri a Ye s N O 1 Was th e entir e structure(s ) painte d wit h th e exceptio n ofth 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 ? 

# y 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 cacces s area s an d als o remov e an yothe rgenerate d debris ? 

# i / 6 I s th e gras s are a tha t surround s th e structure(s ) i n reasonabl ygoo d 

# A condition ? 7 Wa s th e pain t product s utilize d equivalen t t o a 3 0 yea r product/quality ? 

# y 8 Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e et cproperl 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 ypropert ydamag e need s t o b e complete d prio rt o 

# 1 / th e EP AClose-Out . 1 0 Ar e ther e an ypropert yitem s tha t wer e temporaril yre-locate d b yth 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 Signature : ^^5iwM>N-«- » CW-^'^-<_ y 

# Date : ^\^^ ] M^" ) Propert yOwne rSignature : (JJI^^,^ . 

### :^^(ff ^ Dat e 808 0 Wnr 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 Oniaha , 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