## TRANSMITTA LO FOMAH A LEA D SIT E PAIN T STABILIZATIO NFIL EFOLDE R SAID# : l*?>^^2 . Date : Address : 

## ^.{O ^ 5 "h ^ ^ T LB PStabilizatio nContractor : PRUDEN T TECHNOLOGIES , INC . Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S k / y t e y y i* T w y i / t / 1 / y y y 1 1 Vide o ofpropert y CDVD) ; Pre-Stabilizatio n& Post-Stabilizatio nVideo s

Executiv e Summar y Signe dAcces s Agreemen t For m Advanc e Notic e For m Pre-Stabilizatio nVide o Agreemen t For m Acces s Trackin g For m Propert y Acces s Assessmen t For m Neighbo r Acces s Agreemen t For m Pain t Matc hFor m Pre-Stabilizatio nPropert y Safety Assessmen t For m Work-Sit e Hazard s Analysi s Checklis t Photographs : Pre-Stabilizatio nPropert v Hazar dAssessmen t Photograph s Dougla s Count y Assesso r Propert y informatio n Propert y Completio nAgreemen t For mSigne db y Propert y Owne r Propert y Close-Ou t Chec k Lis t Signe dB y EP A 

## y P ' y^y^.yyy^l^^*^^ ' Pruden t Technologies , Inc . Signatur e Dat e EPASignatur e DatF 3005510 0 

# nm Superfun dTECHNOUXSIBS , IN C 

# Propert y Summar y Date : 11/~/200 9 LB PSTABILIZATIO NEP A CONTRAC T EP-R7-08-0 7 Mont hof : No v Propert y Address : 210 5 S 3 3 St . SAI D # : 1819 2
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 : 9/18/200 9 ii . Wor k Began : 9/25/200 9 iii . Close-Ou t Date : 9/30/200 9 B . Enclosures : 1 . Pre-Stabilizatio nVide o 2 . Post-Stabilizatio nVide o 3 . Signe dAcces s Agreemen t For m 4 . Advance-Notic e For m 5 . Pre-Stabilizatio nVide o Agreemen t For m 6 . Acces s Trackin g For m 7 . Propert y Acces s Assessmen t For m 8 . Neighbo r Acces s Agreemen t For m 9 . Propert y Pain t Matc hFor m 10 . Pre-Stabilizatio nPropert y Safet y Assessmen t For m 11 . Work-Sit e Hazard s Analysi s Checklis t 12 . Pre - Stabilizatio nPropert y Hazar dAssessmen t Photograph s 13 . Dougla s Count y Assesso r Propert y Informatio n 14 . Signe dPropert y Completio nAgreemen t For m 15 . Propert y Close-Ou t Chec k Lis t Signe dB y EP APrudent Technologies , Inc . (Prudent ) i s unde r contrac t (Contrac t #EP-R7-08-07 ) wit hth e U . S . Environmental Protectio n Agenc y (EPA ) t o stabiliz e LeadBase dPaint (L5.P ) ^ ' ^ numbe r o f propertie s locate di nOmaha , Nebraska , includin g th e property locate da t V\rr ^ '^ . 'V? > 7> V Th e EP Arequest s you r permissio nt o allo w Pruden t t o perfor mLB PStabilizatio na t thi s property . B y signin g thi s form , th e property owne r grant s permissio nt o Pruden t t o perfor mactivitie s relate dto LB PStabilizatio nincludin g scrapin g pain t an d paintin g ofth e reference dproperty . Further , th e owner/tenan t verifie s that the y hav e receive dth e LB Ppamphle t "Renovat e Right. " B y signin g thi s documen t I agre e t o allo w a nEPA contracto r t o conduc t asoi l cleanu p a t m y property followin g completio no f lead-base dpain t stabilization , if th e soi l cleanu p ha s no t alread y bee nperformed . I understan dthat th e stabilizatio ncontracto r canno t provid e assurance s o f whic hcontracto r wil l b e boun dt o th e soi l cleanup . 1 fiirthe r understan dthat th e soi l cleanu p contracto r wil l make al l reasonabl e effort s t o addres s concern s that I , a s th e property owner , ma y hav e regardin g soi l cleanup at m y property . above . Signature ofpropert y Ovra Dat e If

yo u hav e any question s abou t th e LB Pstabilizatio nplanne dfor you r property , pleas e contac t Prudent' s Custome r Relations/Offic e Manage r for th e LeadBase dPaint Stabilization , Mrs . Shanno nHolt , at (402 ) 504-100 4 o r (402)812-0223 . General question s abou t th e Omah aLeadSite cleanu p ca nb e directe dt o th e EPAPubli c Informatio nCenter s at (402 ) 731
­ 304 5 (Sout hOmah aoffice ) o r (402 ) 99 1 -958 3 (Nort hOmah aoffice) . Propert y Acces s Grante dBy : 

# ^ u P:^^^ ^ ^ - T\K\)^^Op . y ^ (Pleas e Prin t Name ) Propert y Owne r Signature : 

# l / l 

# S^/ ^ ^ (Date )

808 0 War d Parltway , Suit e 40 5 2505 N. 24* ^ Street , Suit e 30 8 4242 Medica l Drive , Suit e 425 0 Kansas City , IM O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone:(816)363-370 3 Fax:(816)363-370 7 Phone ; (402)504-100 4 Fax : (402)504-100 5 Phone : (210)822-958 8 Fax : (210 ) 579-6577TECHNOUXSIES . INCT " PROPERT YINFORMATIO N (T o b e complete d b yresiden t and/o rpropert yowne r—pleas e print ) RESIDEN TNAME : mner yRente r RESIDEN TADDRESS :

I F RENTAL , PROPERTYOWNE D BY :
OWNER' S MAILIN G ADDRESS ; OWNER' S TELEPHON E NUMBE R - HOME : (^lOZ. ) '>^1^-^lin^/ifeKK : {HUI A^|Z-77^'* ^ ; R O F OCCUPANT S UNDE R 7 YEAR S OLD : ^ 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 YI N TH E YAR D FO R 5 HOUR S O R MOR E PE R WEEK : 

# Z . COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. )

AUTHORITY FO RKNVIRGNMENTALRESPONSI ^ ACTIONS : Th e actlviiie s to b e implemente dby i£P A under thi s agreement ar c pursuant to Sectio n10 4 ofCERCLA , 4 2 U.S.C . 9604 . EP A " s righ t ofacces s to th e property i s provide dfo r i

nSectio n104(e ) ofCERCLA . 4 2 U.S . C 9605(e) , whic hprovide s entr y fo r "determinin g th e nee dfo r response , o r choosin g o r takin g any respons e actio nunder thi s title , or otherwis e enlbrcin g th e provision s ofth e title.' "

808 0 War d Parl^way , 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 . IVIO 6411 4 Omaha , Nebrasl( a 6811 0 Sa n Antonio , TX 7822 9 Plione : (816 ) 363-370 3 Fax : (816 ) 363-370 7 Phone : (402)504-100 4 Fax : (402)504-100 5 Phone : (210)822-958 8 Fax : (210 ) 579-657 7^lOINOLOGIES , IN C ^,iSt i 

## Advance dnotic e needed . Afte r signin g th e acces s yo u allo w Pruden t t o begi nLea dBase d Pain t Stabilization . Al l Plants , weed s an dan y vehicle s o r item s o n 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 o f yar ddurin g stabilization . Ho w muc hnotic e d o yo u nee dt o hav e abov e mentione dtask s completed ? I f yo 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 infor myou . D o yo u hav e an y pet s tha t resid e i nyard ? i \V \ 

# y ^ vvj > ycxyry ^ \fy\:ji^^^,^ x , V2Jv A(j^:€S > CLA ^ Notic e needed : Numbe r t o cal l t o giv e notice : Who mw e ar e givin g notic e to : Home Owner' s Signatur e

808 0 War d Parl(way , Suit e 40 5 250 5 1^. 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)822-968 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 679-667 7TECHNOLOGIES . INC . 

## PRE-STABILIZATIO NVIDE O FORM I UNDERSTAN D THA T PRUDENT TECHNOLOGIE S WIL LB ECOMIN G OUT T O SHOO T APRE-STABILIZATIO NVIDE O AT MY PROPERTY . TH EVIDE O I S JUS T A TOO LUSE D T O DOCUMENT TH ECURRENT PROPERT Y STATUS/CONDITION . APOS T VIDE O WIL LALS O B E SHO T PRIO RT O COMPLETIO NO FSTABILIZATION . OWNER S NAME : 

# Jos ^ 

# P; . t r 2.

f

0 5 S i i 

# -• ' 

# s h PROPERT Y ADDRESS : BVID/SAID : 

# 1^/ 1 

# 2 ^ HOMEOWNER S SIGNATURE : PRUDEN T REPRESENTATIV ESIGNATURE : AN Y CONDITION S NEED T O B EAWAR EO FBEFORESHOOTIN G VIDEO : (I.E . PETS , NOTIC ENEEDED) :

808 0 War d Parl(way , 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)604-100 5 Fax : (210 ) 579-657 7TBOINOLOGIBS. ] 

# ACCES S INFORMATIO NTRACKIN GSHEE T BVID : 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 AME S P EOthe r (Prudent ) DAT E TIM E ACCESSO R CONRAC T DETAI L 

# f//r/ M \L-*\ X<«—y ^ 

# ^^c^^—^ ^ ' ( ' I * ^ j 

# /r ^ ( J

Comnients :

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 , INC . 

## Acces s Assessmen t Form : (Mus t b e complete dfo r ever y property . Informatio nmus t b e obtaine dfro mapropert y wal k thru , no t give n b y owner ) I s th e propert y stucc o o r asbestos ? If

yes , i s an y ofth e stucc o o r asbesto s damage do r cracked ? If

yes , sto p a s w e can' t stabiliz e thi s property . I t require s special preparatio n techniques . I t will b e returne dt o EPA an dthe y will assig na t alate r date . y\y: > 

## Doe s thi s propert y requir e lot s o f

scrapping ? Doe s thi s propert y requir e alif t o r scaffoldin g to 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 ? If

yes , EXPLAIN ?

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 ? ^{J o O ^ ^w<—ty I f

yes , describ e locatio no f garage . 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 npainte dover ? 

# r^y d 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 ? I s thi s propert y vacan t o r Ar e ther e an y pet s a t thi s property ? 

# w 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)604-100 5 Fax : (210 ) 579-657 7OOLOGIES . INC . 

### PAIN T MATCHIN GFORM : 1 . T O B EFILLE D OUT ONL Y I FMATCHIN GCOLO R PROPERTV ADDRESS : J^IOf i S ^^ T S i BVID : }<^l^^ ^ Th e following note s ar e for th e benefit o f

pain t cre w only . Locatio n Sidin g Soffi t Fascia Corne r Tri m Windo w Trims Doo r Trims Fron t Porc hCeiling Fron t Porc hCeiling Beam s * f Fron t Porc hFloo r Fron t Porc hRailing s Fron t Porc hStep s Sidin g Baseboards Foundatio n^'^^^<X^)J ^ 

## i^yMn ^ "^jfkh^ ^ ^^ft^* Y t ^ ^ r n ^ObifMJl ^ ^>^y•*^ ) ^ O i 

### Pain t Descriptio n
too * AC^VWc" ^ <^oo * dS^uc^VK^y ^ i^ifi ^ [(^CCih.' J u?ooJ [^coU;Kr 7 Uoc J [^cjLJik l 

## ^^*;£:cj>u:k j coo*- > (^cji-^'-k l 

## C'^^C'^'^ J (oo.. ) C'5"**^I 1

4»V^C^ ^ C'^n-CA. ' 

## c^- ^ 09^*^ 3 f^^ J (^'-*>^ J lif^^^C'^k.'it j ^^^JCV-* ^ 

# -^cl c 

# porct^ _ " ^ 

### Pain t Ye s Pain t N o \ y u- * u - ^ y ^ ^ ^ \ ^ ^ y 

### \ y 

# \

y

u— v<- ^ 

### u- ^ i ^ *

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### • I UNDERSTAN D SHERWIN/WILLJAMS WIL LMATC H M Y CURREN T COLOR S Homeowne r

signature : Date : 

# mi m

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 , 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 ) 679-667 7TECHNOLOGIES; ] 

## NEIGHBORHOO D PROPERT Y ACCES S FORM I S THER EANEIGHBORIN GPROPERT Y THA T NEED S T O B EACCESSE D ALON G WIT H ASSIGNE D PROPERT Y T O COMPLET ESTABILIZATIO NPROCESS ? 

### i > ^ / 

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

808 0 War d Paritway , 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 7TBCHNOLOGIB S ir<K: . 

## PRE-STABILIZATIO NPROPERT Y SAFET Y ASSESSMENT FORM PROPERT Y ADDRESS : 

# 2\o ^ 5 ?>^^' ^ ^ ^ BVID/SAID : / S ' ^ ^ PRUDEN T ASSESSMEN T REPERSENTATIVE : 

# ^. 4 /\M^h ^ 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 , T X 7822 9 Phone : (816 ) 363-i370 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• • TECHNOLOGIBS . 

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

# ^[a S J . 33A dJet Crew : Date :



# E^e K Ay^oXf ^ Cre w Foc£inan / Siib-Contracto r ^ ^ 

### CLt^ 

# cM^

808 0 War d Parl<way , Suit e 40 5 250 5 N . 2 4 Street , Suit e 30 8 • 424 2 M^ica 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

# Curren t Sampl e Pre-Renovatio n For m Effectiv e unti l Apri l 2010 . Confirmatio n o fReceip t o fLea d Pamphle t V J 1 hav e receive d a cop yo fth e pamphlet , Renovate Right : Importan t Lea d Hazar d Cjn^formatio n fo rFamilies , Chil d Car e Provider s an d School s informin g m e o f th e potentia l ris k ofth e lead hazar d exposur e fro m renovatio n activit yt o be performe d i n m ydwellin g unit . I receive d thi s pamphlet befor e th e v\/or k

began . :ed>o6rBiex5 frejzSiiienr ^

v~yyDate ' ' Printe d Signatur e ofrecipien t Self-Certificatio n Optio n (fo rtenant-occupie d dwelling s only ) — If th e lead pamphlet wa s delivere d bu t a tenan t signatur e was no t obtainable , yo u ma ychec k th e appropriat e bo xbelow . •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 date 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 copyo fth e pamphlet a t 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 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 that 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 doo r* ^ / , . Printe d nam e o fperso n certifyin g / Attempte d deliver y dat e an d tim e lead pamphlet deliver y Signatur e ofperso n certifyin g lead pamphlet deliver y

Unit 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 o f mailin g fro m th e post office) .Dougla s County Accoun t Inform ; Pag e 1 of 3 Dougla s County , Nebrask a Propert yRecor d - R220006000 0 Prin t ReDort NE WFeatur e - Parce l Dimension s availabl e & . scal e 0-5 0 f t wes t of52n d S t - ViOW O n MS D Informatio n i s vali d a s o f 2009-9-1 5 Treasurer' s Ta xRepor t Ne wFeatur e • * - ¥- ¥Aut o Sale s Searc h Owne r -. 1 FINNEGA N JOSEP H P / ^ ^ 7 " ^

' ^ ­ < 210 5 S 3 3 S T\l' ' OMAH AN E 68105-000 0 T^* ^ Propert yInformatio n Ke yNumber : 000 6 000 0 2 2 Accoun t Type : Residentia l Parce l Numbe r 220006000 0 Parce l Address : 210 5 S 3 3 S T OMAH AN E 68105-000 0 Lega l Description : SCOTT& HILL S SU B DI V LO T7 BLOC K0 5 0 X 10 0 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $ 5,700.0 0 $ 121,900.0 0 $ 127,600.0 0 200 8 $ 5,700.0 0 $ 121,900.0 0 $ 127,600.0 0 200 7 $ 5,700.0 0 $ 121,900.0 0 $ 127,600.0 0 200 6 $ 5,700.0 0 $ 90,500.0 0 $ 96,200.0 0 200 5 $ 5,700.0 0 $ 90,500.0 0 $ 96,200.0 0 200 4 $ 5,700.0 0 $ 90,500.0 0 $ 96,200.0 0 Sale s Informatio n Sale s Date : 2007-04-2 0 Dee d Type : W D Book : 200 7 Page : 04449 6 Price : $159,000.0 0 Granto r HEADLE YCYNTHI AAETA L Grantee : FINNEGA N JOSEP H P ETA L Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 1991-02-2 3 Dee d Type : D Book : 189 3 Page : 58 7 Price : $64,500.0 0 Grantor : http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R220006000 0 9/16/200 9Dougla s Count y Accoun t Infor m ^•M l Pag e 2 of 3 Grantee : Valid/Invalid : Exclusio n Reason : Vali d Lan d Informatio n Acre s 0.1 1 S F 5000. 0 Unit s 1. 0 Dept h 100. 0 Improvemen t Buildin g 1 Informatio n

Squar e Footage : 1857. 0 Perimete r 0. 0 Uni t Type : BuiitAs : 2 1/ 2 Stor yUnfi n HVAC : Centra l Ai rt o Ai r Exterior : Fram e Sidin g Interior : Drywal l Roo f Cover : Compositio n Shingl e

Roo f Type : Gabl e Floorcover : Allowanc e Yea rBuil t Yea r Remodele d Percen t Remodele d 191 0 198 4 0 % Detai l Typ e Detai l Descriptio n Ad d O n Fenc e Kro y(Vinyl ) Ad d O n Unfinishe d Atti cW/floo r Applianc e Allowanc e Applianc e Fireplac e Masonr y Widt h Vacan t 50. 0 N o

m

e J a n

SaeaMFta r rreoS q ft. Mi rsse r n.OSq.R.j | to n

" l i Mi r 1( 1 21/2STORYUNRN . B m t BMCKV « 77«0Sq.R . CLIC KT O ENLARG E IMAG E Percen t Complete : 100.0 % Quality : Averag e Condition : Averag e Cond o Squar e Footage : 0. 0 Rooms : 7. 0

Units : 1. 0 Baths : 1. 0 Bedrooms : 4. 0 Stories : 2. 5 Foundation : Bloc k Sprinlde rSquar e Footage : 0. 0 T Adjuste d Yea r Physica l Ag e Buil t 191 0 9 9 Unit s 1. 0 776. 0 1. 0 1. 0 http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R220006000 0 9/16/200 9Dougla s County Accoun t Inform ; atm a Pag e 3 of 3 Basemen t Bsmn t Bloc k 8 ft 776. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 276. 0 Porc h Sla b Roo f Cei l 176. 0

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accoimtao=R220006000 0 9/16/200 940L0GIES.INC . 

### 2 . T O B EFILLE D OU T ONL Y I FCHANGIN GCOLO R PROPERT Y ADDRESS : BVID : 

### Locatio n Pain t Descriptio n Pain t Ye s Pain t N o Sidin g Soffi t Fascia Come r Tri m Windo w Trims Doo r Trims Fron t Porc hCeiling Fron t Porc hCeiling Beam s Fron t Porc hFloo r

• 

### Fron t Porc hRailing s Fron t Porc hStep s Sidin g Baseboards Foundatio n

I AGRE ET O TH ECOLOR S INDICATE D ABOVE . I UNDERSTAN T THA T I CANNO T CHANG ETH ESELECTE D COLOR S LATE RONA S PRUDEN T WOULD HAV EPURCHASE D TH EPAIN T SPECIFICALL Y FO RTHE REFERENCE D PROPERTY . ALS O I UNDERSTAN D THA T COLOR S SELECTE D MA Y NO T LOO K EXACTL Y A S IT I S SHOWNO NSWATCHE S AFTER PAINTIN GO NM Y PROPERTY . Homeowne r signature : Date : 808 0 War d Parkway , Suit e 40 5 260 5 N . 24* ^ Street , Suit e 30 8 424 2 Medica l Drive , Suit e 426 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 7TBCHNaLOGIBS ; INC ~ 

## Pruden t Propert yClose-Ou t For m (Lead-Base d Pain t Stabilization ) SAID : \Sm ^ Propert yAddres s 

# . . u^ - y j Owner' s Nam e

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 Was al l scrapin g an d othe rpreparatio n wor k complete d satisfactorily ? 

# 0 ^ 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 ? 

# D C 4 Ar e al l ofth e area s wher e contaminate d material s hav e bee n spille d thoroughl yvacuumed / cleaned ? 

# \ L 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 , alleyvrays , publi cacces 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(8 ) i n reasonabl ygoo d condition ? ^ 7 Was th e pain t product s utilize d equivalen t t o a 30 yea r product/quality ? 

# K 8 Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , 

# K 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 th e EP AClose-Out . 

# i ^ ^ ^ 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 ) 

# y 

# f tha t hav e bee n lef t unresolved ? 

# P 1 2 Othe rConsiderations ? Propert yOwne rDiscussions ? Additiona l - ^ Wor k tha t I s Require d y 

# y Pruden t Representativ e Signatur e Date : PropertyOwne rSignature : 

## Date : %\yy)\p \ 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 426 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