## TRANSMITTA LO FOMAHA LEAD SIT E PAIN T STABILIZATIO N FIL EFOLDE R SAID# : 694 Date : Oft ( u A Address : P.C;^ ^ eLl\SnN\^ V LB PStabilizatio n Contractor : PRUDEN T TECHNOLOGIES , INC . IJOO ^ 

### Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 0 Vide o of propert y (DVD) : Pre-Stabilizatlo n & Post-Stabilizatio n Video s IEExecutiv e Summary () /

SignedAcces s Agreement Form 1/

Advanc e Notic e Form ^ Pre-Stabilizatio nVide o Agreement Form M Acces s Trackin g Form S ? Property Acces s Assessmen t Form D Neighbo r Acces s Agreement Form i

/ Pain t Matc hFor m i

/ Pre-Stabilizatio n Propert y Safet y Assessmen t For m ^ Work-Site Hazard s Analysi s Checklis t 0 Photographs : Pre-Stabilizatio n Propert y Hazar dAssessmen t Photograph s i

/ Dougla s Count y Assessor Propert y informatio n 0 Property Completio n Agreement FormSignedb y Propert y Owne r n Propert y Close-Ou t Chec k Lis t SignedBy EP A PAiden t Technologies , Inc . Signatur e ' ' Dat e 

# 'M o Dat e 3005433 8 

# IPDM H Superfun dTBCHNOLOGIES . INC . 

# Propert y Summar y Date ; 8fit^200 9 \LB PSTABILIZATIO N EPA CONTRAC T EP-R7-08-0 7 | Monthof ; Au g Propert y Address ; 259 8 Elliso n Av . SAID # ; 69 6 A .Exftcutive Summary; Issue s Encountered ; NON E Issue s Resolved ; NON E 9

r

Uniqu e Findings ; NON E d . Othe r Relevan t Information ; i . Acces s Date ; 8/11/200 9 ii . Wor k Began ; 8/13/2009 iii . Close-Ou t Date ; 8/14/2009 B . Ej^cjpsures ; 1 . I^re-Stabilizatio n Vide o 2 . i^ost-Stabilizatio n Vide o 3 . Signe dAcces s Agreemen t Form 4 . Xdvance-Notic e Form 5 . F|re-Stabilizatio n Vide o Agreemen t Form 6 . .Reces s Trackin g Form 7 . Propert y Acces s Assessment Form 8 . lyeighbo r Acces s Agreemen t Form 9 . propert y Pain t Matc hForm 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 . jiropert y Close-Ou t Chec k Lis t Signe dB y EPA

### C>^C t

TBCHNOUXFIBS . INC T Pruden t Technologies , Inc . (Prudent ) i s unde r contract (Contract #EP-R7-08-07 ) wit hthe U . S . Environmenta l Protectio n Agenc y (EPA) t o stabilize Lea dBase dPain t (LBP) a t anumbe r o

f propertie s locatedi n Omaha, Nebraska , including the propert y locate da t ^S^ ^ £LL\<:o o Atvg ^ Th e EP A requests you r permission to allow Pruden t t

o perfor mLB PStabilization a t thi s property . B y signin g thi s form , th e propert y owne r grants permission t o Pruden t to perfor mactivitie s relatedto LB PStabilization includin g scraping pain t an d painting ofth e reference dproperty . 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 n EP A contracto r to conduct asoi l cleanu p a t m

y propert y followin g completio n o f lead-base dpain t stabilization , i f th

e soil cleanu p has no t alread y bee n performed . I understan dtha t th e stabilization contracto r canno t provid e assurance s of whic hcontracto r wil l be boun dto the soi l cleanup . I furthe r understan dtha t the soi l cleanu p contracto r wil l mak e al l reasonable effort s t o addres s concern s tha t 1 , as th e propert y owner, ma y hav e regardin g soi l cleanu p a t m y property . [ v^es , 1 hav e rea dan dunderstan dthe paragrap habove . ^^X^-0-t>yvgc ) (_J ^ Signatur e of Propert y Owne r Dat e I f yo u hav e 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>8t2-0223 . Genera l question s abou t the Omah aLea dSit e cleanu p ca n be directedt o the EP A Public Informatio n Centers a t (402 ) 73 1 ­ 3045 (Sout hOmah aoffice ) o r (402) 991-958 3 (Nort hOmah aoffice) . Propertyj^cces s Grante dBy : . i . (Pleas e Prin t Name ) Propert y Owne r Signature : yXArr t ^ J^ ^ (y „ v^'^Zc<_ v *>^X^<-g.'ff7t J 

### (Sign^e ) $-i/-o' ) (Date)

308 0 War d Parkway , Suit e 40 S 2S0 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 <ansasCJty , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Shone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 -ax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 4 .S7<>-fi.<;7 7TBCHNOLOCIBS . INCr ~ PROPERT Y INFORMATIO N (T o b e complete db y residen t and/o r propert y owne r — pleas e print ) RESIDEN T NAME : Owne n Rente r RESIDEN T ADDRESS :
I F RENTAL , PROPERT Y OWNE D BY : OWNER' S MAILIN G ADDRESS ; OWNER' S TELEPHON E NUMBE R - HOME : i^^l ) MSl-3*?0 7 WORK : _( I . 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 : \ NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WHO M PLA Y I N TH E YAR D FO R 5 HOURS O R MOR E PE R WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. ) C O 

# f<^-f ^

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s t o b e implemente db y EP A unde r thi s agreemen t ar e pursuan t t o Sectio n 10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f acces s t o th e property i s provide dfo r in Sectio n 104(e ) o f CERCLA . 4 2 U.S . C 9605(e) , whic hprovide s entry fo r "determinin g th e nee dfor response , o r choosin g o r takin g an y respons e actio n under thi s title , o r otherwis e enforcin g th e provision s ofth e title. "

08 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 .ansasCity , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 hone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 ax : (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 open porc h(enclose dporche s wil l NO T b e stabilized ) mus t b e remove dprio r t o stabilization . All Pet s mus t b e ou t of yar ddurin g stabilization . Ho w muc hnotic e d o you nee dt o hav e abov e mentione dtask s completed ? If yo u ar e alandlor dyo u wil l nee dto contac t th e tenan t a s Pruden t Technologie s wil l only infor myou . D o you hav e an y pet s tha t resid e in yard ? Notic e needed : An ^ ^irrje . 

# Numbe r t o cal l t o giv e notice : U 5 \- =>^^l Who mw e ar e givin g notic e to :

^ Home Owner' s Signatur 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 , 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 

## PRE-STABILIZATIO N VIDE O FORM I UNDERSTAN D THA T PRUDENT TECHNOLOGIE S WIL LB ECOMIN G OUT T O SHOO T A PRE-STABILIJ^ATIO N VIDE O A T M Y PROPERTY . TH EVIDE O I S JUS T A TOO LUSE D 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 N O FSTABILIZATION . f \otcT^c e VAict:€tso ^ 

## OWNER S NAME ; PROPERT Y ADDRESS : 2.S^ S tLL>sor > Ave . 

## BVID/SAID : ^ ^ C HOMEOWNER S SIGNATURE : PRUDENT REPRESENTATIV ESIGNATURE : AN Y CONDITION S NEED T O B EAWAR EO F BEFOR ESHOOTING VIDEO : (LE . PETS , NOTIC ENEEDED) :

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 

## 7TECHNOLOGIES , IN C 

## ACCES S INFORMATIO N TRACKIN GSHEE T BVID : ^<^ C PROPERT Y ADDRES S 

# : 

# a6^ S t 

# K^«' ' rV ^ Propert y Owne dBy : (I f ne w propert y owner )

Owner s Phon e No's : Home : Work : Cell : Fax : - Acces s Contractor : AS WPD A ME S P EOthe r (Prudent ) DAT E TIM E ^ACCESSO R CONRAC T DETAI L 

# ^fnlo ^ A-9 ^ K>v- | t^-cyy - 

## ^r^.A'^^-J ' t ^ eiC)i'-tV ^ i . y \ 

### ' /



## Comments :

808 0 War dParkway , Suit e 40 5 250 5 N . 24* " Street , Suit e 30 8 424 2 Medical Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a6811 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. ] 

# Acces s Assessment Form : (Mus t b e complete dfor ever y property . Informatio n mus 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 ? I f

yes , i s an y ofth e stucc o o r asbesto s damage do 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 dt o EP A an dthe y wil l assig n a t alate r date . Doe s thi s propert y requir e lot s o f scrapping ? r*>aJ C\A'J\

_ H , 

## 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 i n area s wher e paintin g i s required ? Doe s thi s propert y hav e an y significan t structura l damage ? I f

yes , EXPLAIN ?

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medical 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 

## Doe s thi s propert y hav e agarage ? I f

yes , describ e locatio n o f garage . 

# h^c ^ w^5;^«. . i h ^ -c^ ^ Doe s thi s propert y hav e aluminu msiding ? I f

yes , i s i t origina l factor y finis ho 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 ? (I.e . roo f shingle s a s siding) ? I f

yes , EXPLAIN ? Cr\e>r< L 

## I s thi s propert y vacan t o r occupied ? <,Ar^ e ^ 

# ^^^^ M 

# , Ar e ther e an y pet s a t thi s property ? Ar e ther e an y lo w 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 7

# ^F ^
TECHNOLOGIES. ] 

## NEIGHBORHOO D PROPERT Y ACCES S FORM I S THER EA NEIGHBORIN GPROPERT Y THA T NEED S T O B EACCESSED ALONG WIT H ASSIGNE D PROPERT Y T O COMPLET ESTABILIZATIO N PROCESS ?

I FI T IS , GE T ACCES S FRO M AL LREQUIRE D NEIGHBORHOO D PROPERTIES .

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 7fOLOGIBSi . IN C 

### 2 . T O B EFILLE D OUT ONLY I FCHANGIN GCOLO R PROPERT Y ADDRESS : rVo^e.r>ce . V^• ^ r•\ireUor ^ 

## BVID : ^ 3 G Pain t Pain t Locatio n Pain t Descriptio n Ye s N o ^ SC O <i&Z 5 Sidin g w ­ 

### '^'^B ^ c€:x^o:\r * ffeacV » SC O CSi- ^ Soffit \ ^ Fasci a Come r Tri m Windo w Trim s |2.0buJ£.- V C\<OiYsi\< ^ V ^ Doo r Trim s Front Porc hCeilin g Fron t Porc hCeilin g Beam s -^ Front Porc hFloo r 1 ^ Front Porc hRailing s

— - Front Porc hStep s .— ^ Sidin g Baseboard s Foundatio n i —



### <5«,K-^ < ^ictJ ^ L - ^ 

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### ^icaJU ^ tMs^ejJC l ^ 

### I AGRE ET O TH ECOLOR S INDICATE D ABOVE . I UNDERSTAN T THA T I CANNO T CHANG ETH ESELECTE D COLORS LATE RO N AS PRUDEN T WOUL D HAV EPURCHASE D TH EPAIN T SPECIFICALL Y FO RTH E REFERENCE D PROPERTY . ALS O I UNDERSTAN D THA T COLOR S SELECTE D MA Y NOT LOOK EXACTL Y AS I T IS SHOW N O N SWATCHE S AFTE R PAINTIN GO N M Y PROPERTY . Homeowner signature : l^^^^^'^^^^-^g ^ /?S% ^ \i^X^/ ^ ^^"^Z/-^ P9 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/^^ ' TECHNOLOGIES . IN C 

### PRE-STABILIZATIO N PROPERT Y SAFET Y ASSESSMEN T FOR M PROPERT Y ADDRESS : 2 S ^ ^ ^ l>^ ^ ^ ° ^ *V>A ^ BVID/SAID : 

## G ^ ^ PRUDENT ASSESSMENT REPERSENTATIVE : 

## ^£^'^Y~ ^ i^Uy^ ^ REPERSENTATIV EREMARKS/FINDINGS : (POWER-LINEPROXIMIT Y T O PROPERTY , SCAFFOLDING / LADDERS / LIFT S NEEDED , UNSAF EAREAS , UNSAF ENEIGHBORHOOD...ETC. )

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% TEQINOLOGIBS , IN C 

## Checklis t fo r th e Worksit e Hazar dAnalysi s Address :



# ^.^VrvJ^vfi/jW ^ 7 ^ t>x<J /

o.-^^ ^ CrewTpreman/SiU)-Contracto r

808 0 War d Parla(ay , Suit e 40 5 250 5 N 24" " Street , Suit e 30 8 Medica l Drive , Suit e 425 0 Kansa s City , hn ) 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 Fax1210)579-657 7imT ^ :*:? • 

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# 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 Q^l hav e receive d a cop yo f th e pamphlet , Renovate Right : Importan t Lea d Hazar d Informatio n fo r Families , Chil d Car e Provider s an d School s informin g m e of th e potentia l ris k of th e lead 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 pamphlet befor e th e wor k began . Printe d nam e o f recipien tDate Signatur e of recipien t Self-Certificatio n Optio n (fo rtenant-occupie d dwelling s only ) — I f th e lead pamphlet was delivere d bu t a tenan t signatur e was not 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 Informatio n fo rFamilies , Chil d Car e Provider s an d Schools , t o th e renta l dwellin g uni t liste d belowa t th e dat e an d tim e indicate d an d that th e occupan t refuse d t o sig n th e confirmatio n o

f receipt . I furthe rcertif ythat I hav e lef t a cop yo f th e pamphlet a t th e uni t wit h th e occupant . li^^navailabl 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 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 beiowan 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 ythat I hav e lef t a copyo f th e pamphlet a t th e uni t b yslidin 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 

# r)/^ ^ 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 lead pamphlet 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 of mailin g fro m th e pos t office) .

### Dougla s County Accoun t loiMmatio n Pag e 1 of 2

Tjittm s 

# i^^ G Dougla s County , Nebrask a Propert yRecor d - R l 13472000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t of 52n d S t - VleW_„On_Ma p Informatio n i s vali d a s o f 2009-8- 3 Treasurer' s Ta xRepor t Ne wFeatur e r ^

r

^

,t4 > Aut o Sale s Searc h Owne r HICKERSO N FLORENC E ETA L 259 8 ELLISO N AV E OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : 

### 347 2 000 0 1 1 Accoun t Type : Residentia l Parce l Number : 113472000 0 Parce l Address : '259 8 ELLISO N A V ' OMAH AN E 68111-000 0 Lega l Description : FOR TVIE W AD D LO T2 BLOC K0 S 66. 5 FTLT1 & S 66. 5 W 1 0 FT66. 5 X 6 0 Valu e Infor n matio 200 9 200 8 200 7 200 6 200 5 200 4 Lan d I $2,400.0 0 $2,400.0 0 $2,400.0 0 $2,400.0 0 $2,400.0 0 $2,400.0 0 mprovemen t $36,000.0 0 $36,000.0 0 $30,400.0 0 $30,400.0 0 $30,400.0 0 $13,600.0 0 Tota l $38,400.0 0 $38,400.0 0 $32,800.0 0 $32,800.0 0 $32,800.0 0 $16,000.0 0 Lan d Infor m a n tio Acre s 

### 0. 1 S F Unit s 4620. 0 

### 1. 0 Dept h Widt h 66. 0 Vacan t 70. 0 N o Improvement Info n rmatio Buildin g 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R l 1.. . 8/10/200 9

### Dougla s County Accoun t In^Mmatio n Pag e 2 o f 2 TjStrt m

289 8 aLISO N A V
Mi r
FnlHoo r Mi r M O OlK M 1" " Mf f 

### RANC H CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 964. 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 194 9 0 % 194 9 5 9 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Canop y 44. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 ft 964. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0



### http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno==R l 1.. . 8/10/200 9TECHNOLOGIES , IN C 

## Pruden t Propert yClose-Ou t For m (Lead-Base d Pain t Stabilization ) SAID : U^ O Propert yAddress : 

## '^f ? A/;/.>/x y(^ ^ Owner' s 

## Name : N t /Jf/^L ^ f/ / ^ j^f^^/T^ J S.N O Performanc e Standards/close-Ou t Criteri a j Ye sNO 1 Wa s th e entir e structure(s ) painte d wit h th e exceptio n of th e stated , exclude d areas ? Thi s woul d includ e paintin g of othe rassociate d j yC feature s includin g fascia , eaves , siding , al l trim , porches , bo x; | beams , columns , rails , an d exterio rsurface s of garages . 1 2 1 Wa s al l scrapin g an d othe rpreparatio n wor k complete d / ! satisfactorily ? "^

, 3 1 1 Wer e al l require d area s of th e structure(s ) prime d as neede d an d painte d wit h tw o to p coats ? j / ^ 4 Ar e ai l of 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 , { on th e entir e property , roadways , alleyways , publi cacces s area s j J ! an d als o remov e an yothe rgenerate d debris ? i !6 Is th e gras s are a tha t surround s th e structure(s ) in reasonabl ygoo d i / condition ? \ v; ; 7 { Wa s th e pain t product s utilize d equivalen t to a30 yea ri > T j product/quality ? | v : 8 Ar e al l item s suc h as polyethylen e sheeting , ladders , pain t brushes , Y : cones , barrie rtap e et cproperl yremoved ? ' 9 j Is ther e an yevidenc e of propert ydamag e tha t wa s don e byth e > contractor ? An ypropert ydamag e need s to be complete d prio r to i \ / th e EP AClose-Out . \

• 1 0 Ar e ther e an ypropert yitem s tha t wer e temporaril yre-locate d byth e j ' \ / contracto rtha t nee d to be move d back ? \ \ 11 Ar e ther e an y(known ) lingerin g issue s wit h th e propert yowner(s ) 1 ) tha t hav e bee n lef t unresolved ? ^ ! 12 Othe rConsiderations ? Propert yOwne rDiscussions ? Additiona l { ! ; Wort ctha t is Require d 1 v Pruden t Representativ e Signature : IQ ^ l \ 

# Da.e:HV^^f J - Propert yOwne rSignature : ^"^^^^^^^-- ^ ^ ' /'^^^^f^j,,...^^ ^ 

## Date : -J^-^/^^^ f 308 0 war d Parkway , Suit e 40 5 250 5N. 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 7