## 1 2 

## TRANSMITTA Lo f

OMAHA LEAD SIT E PAIN T STABILIZATIO N FIL E FOLDE R SAID : 3176 8 Date : 01/12/200 9 Address : 2508PINKNEY Remediation Contractor : Pruden t Technologie s Year : 200 8 PAINT STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S \ 7 Vide o of propert y (DVD ) aExecutiv e Summar y \ 7 SignedAcces s Agreemen t fo r

subject propert y ^ Painting Agreemen t D Settlemen t document s (i.e. , fo r

damag e o r

to replac e plants , etc. ) D Photograph s E

l Satisfactor y restoratio n signedby Propert y Owne r w Propert y close-out chec k

lis t signedby EP A Propert y information fromDougla s Count y Assessor' s Office D D D

fL ^ JL.. ^ 3j3j0% ^ 

## Signatur ^ Dat e

4030797 9 

# niui i Superfun d

### PROPERT Y SUMMAR Y Date : 01/12/200 9 LB P STABILIZATIO N EP A CONTRA T EP-R7-08-0 7 Mont hof : Decembe r Propert y Address ; 2508PINKNE Y SAEP ; 3176 8 A . EXECUTIV E SUMMAR Y A. 1 Issue s Encountered : Non e A. 2 Issue s Resolved : Non e

A. 3 Uniqu e Findings : Non e A. 4 Othe r Relevan t Information : Non e Acces s Date : 10/09/0 8 Wor k Began : 10/26/0 8 Closeou t Date : 10/28/0 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 For m 6 . Pain t Matc hFor m 7 . Trackin g For m 8 . Dougla s Count y Assesso r Propert y Informatio n Pag e 9 . EP A Propert y Closeou t for m 10 . Propert y Completio n Agreemen t

TECHNOLOCIES , INC .ENVKONMENTAL & CONSTRUCTION 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Addittss:2SOB ' PfnknJLO j SI . Date : /^^^/ ^ Phone : ^(^O^^Cjjy ^ BVID : 3/76 ? Plan t & Permanen t Landscapin g T o Remai n I n Plac e Item # Descriptio n an dLocatio n O n Ma p ^ ^c^^^ i ^ Tpl<//ii- > (C&fci&f ^ -..C^O^ r

' j?c/s^5 . C^ct^H-^ - CoJe r



## Pre-Existin g Conditio n o f Structure s 

# y Doe s you r Basemen t hav e ahistory o f leaking ? Ye s —N o - Item # Description & Locatio n OnMf^ ) 

# • ^ruc/r^ f l acoAcre^ e F'^i-i^ A f^u ) Cy>rA^ r • dtiA f t?i ^ cMitfit^e y ^i^icJrs .

Property Owne r Pruden t Emp l 

# L Signature:X^*/W^^,^tJ^ ^ Signature :

so wWv d Paifcwty , Sult t 40 5 Kansa s CKy . MO 6411 4 Phonr . (816 ) 363470 3 260 6 N . 24* ^ Street , Suit e 30 8 Omaha , Nebraska 6811 0 424 2 Medica l Ortvt , Suite 4260 SanAnlonI n Tyfo* —

# 3/^6. ? Pruden t Technologies , Inc . (Prudent) i s unde r

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

ofpropertie s locatedi n Omaha , Nebraska , includin g th e propert y locate da t 'Z^D 2 Pi.n)7nil \ yTh e EP A request s your permissio n t o allo w Pruden t t o perfor mLB P Stabiliz^o n at^fli^ property . By " signing M s form, th e propert y owne r

grant s permissio n t o Pruden t t o perfonn activitie s relate dt 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 dth e LB P pamphlet "Renovat e Right. " If

you hav e an y question s abou t th e LB P stabilizatio n planne dfo r

your property , pleas e contact Prudent' s AdTninisfrfltiv e Cler k

fo r

th e Lea dBase dPaint Stabili^tion , Mrs . Debora hAkerele-Johmon . a

t (402) 504-1004 . Genera l question s about th e OmahaLea dSit e cleanup can b e directe dt o th e EP A Publi c Information Center s at (402 ) 731-304 5 (Sout hOmahaoffice) or (402 ) 991-958 3 (Nort hOmaha office) . Propert y Acces s Qnnte dBy: . '(Pleas e Prin t Name ) Piopeti y Owne r Signature : (Signature ) PROPERT Y INFORMATIO N trrvu r (T o b e completei^ ^ residen t and/o r propert y owne r - pleas e prin Q ietedjiyresi c RESIDEN T NAME : ^A^SCA£ J (

_ Omer ^ Rente r RESIDEN T AOORESS : I F RENTAL , PROPERT Y OWNE D BY : OWNER' S MAIUN G ADDRESS ; 

## Sct^- ^ OWNER' S TELEPHON E NUMBER-HOME : F ^\^J^ " ^^^ 7 WORK : J . NUMBER O F OCCUPANT S UNDE R 7 YEAR S OLD : . NUMBE R O F OCCUPANT S 7 YEAR S OL O AN D OLDER : 

# X NUMBER O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLA Y I N TH E YAR D FO R 5 HOUR S O R MOR E PE R WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : {I.E . DOGS . ENTR Y GATES . ETC. )

AUrHORTT Y FO RENVIRONMENTA LRESPONS EACTIONS ; Tb e activitie s t o b e inqilemente db y EP A unde r tM s agreemen t ar e pursuan t t o Sectio n104 ofCERCLA,42U.S.C.9604 . EPA' s righ t o f

acoessioto e propert y isprovide dfor taSectio nlM(e ) o f CHICI A 4 2 U.S . C9605(e),'whichprovide s enti y for "detenniningth e nee dfo r response , o r dioosin g ortakin g an y respons e actio nunde r to title , o r otherwis e en&rdn g th e provjsicn s o f 4 e tide. "

424 2 Medica l Drive , Suit e 425 0 250 5 N . 24* " Street , Suit e 30 8 )8 0 War d Parlnray . Suit e 40 5 Ontaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 ansa s City , M O 6411 4 Phone : (402)504-100 4 Phone : (210)822-958 8 hone : (816 ) 363-370 3 P o vIMW , CA 4 ^nn e JX : (816 ) 363-370 7

# v/urren i ^ampi e (gje-Kenovatio n hor m Effeciiv e unti l Apri l 2010 . Confirmatio n o f Receip t o f Lea d Pamphle t QHTiav e receive d a cop yof th e pemphlet , Renovat e ffigW; Importan t Lea d Hazar d Infonnatio n fo rFerrates , Chik i Car e Provkier s an d School s informin g m e o f tti e potentia l risk o f th e lea d tiazar d exposur e fro m renovatio n activit yt o b e performe d i n m ydvreilin g unit . I receive d thi s pamphle t befor e th e wor1 < began . 

# K£/iJ a 4fl^y>-.c ^

/// - ^'^f>9 ' Printe d nanrep f recipien t Dat e Signatur e o f recipien t Setf-Certificatio n Optio n (fo rtenant-occupie d dweiiing 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 maychecl < th e appropriat e bo xbelow . Q Refusa l t o sig n —i certifytha t I hav e mad e a goo d W n effort t o delive rth e pamphlet , AerTOvaf e K^ t Importan t Lea d Hazar d Infonnatio n fo rFamiies, OTil d Care Provkier s an d Schools , t o th e renta l dwellin g uni t liste d belo wa t th e dat e arK i 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 left a cop yo f th e pamphle t a t th e uni t wit h th e occupant . Q Unavailabl e fo 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 Kgh t Importan t Lea d Hazar d Infonnatio n fo r Farrulies , CNk i Care provkier 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 rcertil ytha t I hav e te^ a cop yo f th e pamphle t a t th e uni t b yslidin g i t unde rttie door . 77 . - ^ / p 

# M 

# ^ ­ o^eA ^ /o ) 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 

## 9^^ ^ nak^ y <97M.e(JlcL 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 1 ^ 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 witt i a certificat e o f mailin g fro m th e pos t office) .

# pain t matc h form " Pain t matchin g form : propert yaddress : H^o ^ BVID : 5/ 7 (^< f ^ ^ KtcTrAiey ^ / f i ^ ^ < ^ /Cay-i/if ­ ­ ^^ ^ ^.-r^r-^hrTTT^ ^ 

# Area : ->'^,>7 o Explanation : 

# color : ­ . r / o Q'ct77r^<; . 

# Area : ^^^ , Explanation : Color : ^^^ ^ ^^^^ ^ / ^ ^^//^ ^

Area : '^" ^ Exp l anat i on : color : ^^^/V e ^ 7 '^^^' ^ ^ Area : Explanation : Color :

Area : Explanation : Color :

pag e 1

# c i s a 

# ACCES S MFO/^HATioNTRAOKOIGSHBET

.^/'^' g Tiifoh/ra A

OOTBrOoMtN K

Hom a^;?--yi ^ 

# W t ­ f/^J Wtr k 

# =B L

JVttHODHBB K \



# ^ F '^fvm ^ 

# C K

^ T^ii ^ (7U^iiej7 ^ 

# ccuncroEm i jlH^UfJ/jZu^y o \fmi7t(\r^ i 

## 77 ^ ^t . A&7rC£ ' ^S t

... . . . .._.-., . « • ^ . ..... . .1 , 

# < 7 \/W\/^^\7/ 7 I 1 71/1^C^u7AeA ^ ^ myi f ^^QT^y r cJ^je..-m//^ * M7(AC > 

# ' ^ ^ ^ U •}i

e /fe e t//^€ ^ ^ ^^tf,^ ^ /^i^/ ^ 7^<Axy7k) . M/ L __jSd^A ^ G^^co /

^/b i IA(^U>S^ . 

# < ^ M^fm^j.,t^*-^^ L a^l l (7i7h^-~^L^i9/ R' LUJOI U

### Dougla s Count y AccounBliformatio n rag e 1 Ul ^ 

### Dougla s county , Nebrask aPropert y Recor d- RZIO100000 0 Prin t Repor t NE

WFeatur e - Parcel Dimension s availabl e @ scal e 0-5 0 ft wes t o

f SOt hS t - Vle Wo n Ma p Infomiatio n i s vali d a s o f 2008-9- 4 Treasurer' s Ta xRepor t Ne wFeatur e ->-»- > Aut o Sale s Searc h 

### Owne r ANDERSO N ELV AV ETA L 

## \.r.r^\jF^7 F 250 8 PINKNE Y S T yi > y OMAH AN E 68111-000 0 

### c Propert yInformatio n Ke yNumber : 010 0 OOO O 2 1 Accoun t Type : Residentia l Parce l Number : 210100000 0 Parce l Address : 250 8 PINKNE Y S T OMAH AN E 68111-000 0 Lega l Description : REDICK S -CIJ\RK-AD D EX T LO T 4 BLOC K2 4 6 X 10 0 Valu e Informatio n i l-an d Improvemen t 

### Tota l 200 8 I $2,300.0 0 -J . 

### $55,600,0 0 $57,900.0 0 200 7 $2,300.0 0 $65,100.0 0 $67,400.0 0 200 6 i

_ $2,300.0 0 $65,100.0 0 367,400.0 0 200 5 _ 1 . _$2,300.0 0 __$65,100.0 0 $67^00.0 0 200 4 j $2,300.0 0 $15,400.0 0 $17,700.0 0 200 3 * $2,300.0 0 $15,400.0 0 $17,700.0 0 Lan dInformatio n Acre s S F Unit s Dept h Widt h 

### Vacan t 0. 1 4600. 0 

### 1. 0 100. 0 46. 0 N o 

### Improvemen t Informatio n Buildin g 1

### Dougla s Count y Accouri^iformatio n Pag e 2 o f 2 ri^ f Tvv o Stor y 250 8 Pinkne y S t

H M

i rimpttt r s*t»-art»a t

.4' " '^...'^...^'.^Ive . Mmai t ^^i.^^.r0 l «* : I'^-i f n |.'.V:im.j.|l!.',.'|.M!!lf.' , CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1704. 0 Percen t Complete : 100.0 % Perimete r0. 0 Quality ; Fai r Uni t Type : Condition : Goo d

Buil t As : 2 Stor y Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o 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 : i 4. 0

Roo f Type : Gabl e Stories : 2. 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 191 5 0 0 % 191 5 9 4 Defa/ 7 Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1, 0 Applianc e Fireplac e Masonr y 1, 0 Basemen t Bsmn t Bloc k 8 f t 830. 0 Fixtur e Bas e Fixture s 1, 0 Fixtur e Bat h Ful l 2. 0 Porc h Sla b Roo f Cei l 88, 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R21. .. 9/24/200 8

### Jun e 26,200 8 (lates t revision ) 

# EP A Propeit y Close-Ou t For m(Lead-Base dPain t StabUi2»tioji ) Bh A m dVg«teli Pmpert r TO Namhe n Prapol j AdditM ! r^sn o P,-oi^ne ^ ^ 

### Ownar* ! Name : 

# Performanc e Standard s /Oose-On t Criteri a y ^ a q 1 .Wa s flw eoiin«iiiotnn(t ) painte dwifliae«xc«p6o n o f tfaostat ^ Thiswonl d iDdnd e paintin g o f ofte r aasociate dfintnres loehidiB g fiaeia, eaves , siding s al l trim , porches , bo x bemi . cobinins . mPa . an dexterio r wrface ao f garages . 

## y 2 .

Wa s all scrapin g an dotte r preparatio n wor k

complete dsatlsfactority ? 

## y 3 .

WmiUnqdn darea s ofdMBliucSui«(8 ) prime da s neede dan dpainte dWit t t w 

## y 4 .

Wattepafo t product s ndlizedeqaivalen t to a3 0 yea r prodoct/qoality ? 

## y 5 .Ar s a n o f tte area s wher e contaminate dmaterial s hav e bee n spille dthoroughly vacuumed'cleaned ? 

## y 6 .Di dtte contracto r oollect/vacuu mal l felling an dscrape dpain t chip s on the entire property , roadways, alleyways , publi c acces s area s an dala o remov e an y otte r generate ddebris ? 

## y 7 .

bihegn M are attstsctrrounds tte 8tnicture(s ) in reasonabl y goo dcondition ? 

# y 8 .Ana D itaiB s snc b a s polyettyleii e sheettig , ladders , pain t brashes , cones , barrie r tape , etc . properl y 

# F KOoved T __ ^ ^_ ,9 . btiwre an y evidenc e o f property damag e tha t wa s don e b y th e contractor ? An y propert y damage need s t o b e complete dprio r t o tte EP A Clo3^0v t 

### JF L 10 . Arettero any prppot y item s tha t were temporaril y re>locate dby tte contractor tha t needt o b e 

# y move dback ? n .

Aiettneao y Omown) lingerin g issoe awit t tte propett y ownet<s) ttat hav e bee n lef t unresolved ? y OflMfConsidaadons/Propeit y Owne r Discussioi^s/AdditiDna ! Wor k (ha t i s Require d

BP A COR/RepiMmtoUve . 

## rn - 

## '^• y

## Pruden t Propert yClose-Ou t For m ( Lead-Base d Pain t Stabiiization ) SA.D:_ii74i ^ ^ . PropertyAddress : , ^ C D ^ lF^.^dc^ryu ^ S ^ Owner' s Name : ^ ^

'/' ^

Ar\,j^.-y F



## ^r\de>rFo n -^

L[A7 \ Performanc e Standards/ciose-Ou t Criteri a YES 

### N O 1 .Wa s th e entire structure(s ) painte d w;it h th e exceptio n of 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 trinn , porches , bo x 

# K beams , columns , rails , an d exterio rsurface s o f garages . 2 .

Wa s al l scrapin g an d othe rpreparattio n vjorV . complete d satisfactorily ? 3 .

Weri e al l require d area s o f tii e structure(s ) prime d a s neede d an d painte d wit h tw o to p coats ? 

# J l 4 .Wa s th e pain t product s utilize d equivalen t t o a 30 yea rproduct/quality ? 5 .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 ? 

# !C 6 .Di d th e contracto rcollect/vacuu m al l fallin g an d scraped pain t chips o n th e entir e property , roadways , alleyways , publi cacces s area s an d also remov e an yothe rgenerate d debris ? 

# t . 7 .

I s th e gras s area tha t surround s th e structure(s ) i n reasonabl ygoo d condition ? 

# X 8 .

Ar e al l item s such a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e etc . propjerl yremoved ? 

# t 9 .

I s ther e an yevidenc e o f propert ydamag e tha t wa s don e b yth e contractor ? An ypropertydamag e needs t o b e complete d prio rt o th e EP AClose-Out . 

# 7. 10 . Ar e ther e anypropertyitem s tha t wer e temporatii yre-locate d b yth e contracto r tha t nee d t o be move d back ? 

# t . 11 .Ar e ther e any(known ) lingerin g issues wit h th e propertyowner(s ) tha t hav e bee n left unresolved ? Othe rConsiderations?propert yOwne rDiscussions?Additiona l Wor k tha t i s Require d 

# X, Pruden t Representativ e Signature : Dat e 

# //j^ f Propert yOwne rS^gn^turer , \ tx 

### Date : ^ ' ' -i ^ 

# 7-'Vi l