## TRANSMITTA LO FOMAH A LEA D SIT E PAIN T STABILIZATIO NFIL EFOLDE R SAI D # : 

# £ a Date : Pgj.^ljp^X: ^ Address : 

### t)i¥R \ .<?PAMt-r>i/vr ^

.<:-f . LB PStabilizatio nContractor : PRUDEN T TECHNOLOGIES , INC . Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Videoo f propert y (DVD) : Pre-Stabilizatio n& Post-Stabilizatio nVideo s Executiv e Summar y 

# 7 Signe dAcces s Agreemen t For m 

# 7 Advanc e Notic e For m 

# 7 Pre-Stabilizatio nVide o Agreemen t For m ^ Acces s Trackin g For m 

# 7 Propert y Acces s Assessmen t For m 

# 7 Neiglibo r Acces s Agreemen t For m 

# 7 Pain t Matc hFor m 

# 7 Pre-Stabilizatio nPropert y Safety Assessmen t For m 

# 7 Work-Sit e Hazard s Analysi s Checklis t 

# y Photographs : Pre-Stabilizatio nPropert v Hazar dAssessmen t Photograph s 

# y Dougla s Count y Assesso r Propert y infonnatio n 

# y Propert y Completio nAgreemen t For mSigne db y Propert y Owne r 

## a Propert y Close-Ou t Chec k Lis t Signe dB y EP A Pruden t Technologie s ,Inc . Si ] ignatur e 

# ^H^'M^a e

EP A Signatur e 

## J^ ^ 

# z ^ Dat e 3005521 0 

# I Superfun dTEOMNOLOGIBS , IN C 

# Propert y Summary Date : 8^200 9 | LB PSTABILIZATIO NEPA CONTRAC T EP-R7-08-0 7 | Mont hof : Au g Propert y Address ; 243 1 Spauldin g St . SAI D # : 57 1 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 : 8/17/2009 ii . Work Began : 8/20/2009 iii . Close-Ou t Date : 8/21/2009 B . Enclosures : 1 . Pre-Stabilizatio nVide o 2 . Post-Stabilizatio nVide o 3 . Signe dAcces s Agreemen t Form 4 . Advance-Notic e Form 5 . Pre-Stabilizatio nVide o Agreemen t Form 6 . Acces s Trackin 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-Site Hazard s Analysi s Checklis t 12 . Pre - Stabilizatio nPropert y Hazar dAssessment Photograph s 13 . Dougla s County Assessor Propert y Informatio n 14 . Signe dPropert y Completio nAgreement Form 15 . Propert y Close-Ou t Chec k Lis t Signe dB y EPATECHNOLCXSIBS , IN C Prudent 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 dPain t (LBP ) at anumbe r ofpropertie s locate dinOmaha , Nebraska , includin g th e property locate datcR^3 \<^0^^((/U« ? if ^ Th e EP A request 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 owner grant s permissio nt o Pruden t t o perfor mactivitie s relate dt o 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 agree 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 , i f 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 . I fiirther understan dthat th e soi l cleanu p contracto r wil l make al l reasonable effort s t o addres s concem s that 1 , a s th e property owner , may hav e regardin g soi l cleanu p at m y property . ] Yes , I hav e rea dan dunderstan dth e paragrap habove . 

# yf ^ 

# A Signature o f Property Owne r Dat e Ifyo 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 fo r 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 EPA Publi c Informatio nCenter s at (402 ) 73 1 ­ 304 5 (Sout hOmah aoflfice ) o r (402 ) 991-958 3 (NorthOmah aoffice) . Propert y Acces s Grante dBy : (Pleas e Prin t Name ) Propert y Owne r Signature : (Signature ) 

# o^\n(cy ^ (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 7^^^^^^^^gllg0^^^^iaLbGTBs, i [QLOGIBS . IN C PROPERTYINFORMATIO N (T o b e complete d b yresiden t and/o rpropert yowne r— please print ) RESIDEN TNAME : V CJ L Co . . ^

^ Rente r RESIDEN TADDRESS : I F RENTAL , PROPERTYOWNE D BY : OWNER' S MAILIN G ADDRESS ; OWNER' S TELEPHON E NUMBE R - HOME : {^^ \ ^liXXjl ' WORK : (H*^^ ) 99/ ^ 5> > > > NUMBE 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 UNOE 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 : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s to b e implemente db y EP Aunde r thi s agreemen t ar e pursuan t to Sectio n10 4 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s righ t ofacces s t o th e property i s provide dfor inSectio n104(e ) ofCERCLA , 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 any respons e actio nunde r thi s title , o r otherwis e enforcin g th e provision s ofth e title. "

808 0 Ward Parkway , Suit e 405 250 5 N . 24* ^

Street , Suit e 308 4242 Medica l Drive , Suit e 4250 Kansas City , MO 6411 4 Onnaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816) 363-3703 Fax : (816) 363-3707 Phone : (402)504-100 4 Fax : (402)504-100 5 Phone : (210)822-958 8 Fax : (210 ) 579-6577TECHNOLOCIB S ] 

# Advance dnotic e needed . After signin g th e acces s you allo w Pruden t t o begi nLea dBase d Pain t Stabilization . All Plants , weed s an dan y vehicle s o r iteni s on ope nporc h(enclose dporche s wil l NO T b e stabilized ) mus t b e reniove dprio r t o stabilization . All Pet s mus t b e ou t o f

yar 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 only informyou . Do you hav e an y pet s tha t resid e i nyard ? Notic e needed : pj'^ 2 ^' ^ ^ Numbe r t o cal l t o giv e notice : ^lt-v>% y I Who mw e ar e givin g notic e to : C^ ^ ^" ^ 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 , 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, ] 

## PRE-STABILIZATIO NVIDE O FOR M I UNDERSTAN D THA T PRUDENT TECHNOLOGIE S WIL LB ECOMIN G OUT T O SHOO T A PRE-STABILIZATIO NVIDE O AT MY PROPERTY . TH EVIDE O I S JUS T A TOO LUSE D T O DOCUMENT 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 . ^^(XVA K

# ^et'Ue^ ^ OWNER S NAME : \^pcAuVcli ^ ^ ^ PROPERT Y ADDRESS : *^ M ^ BVID/SAID : 

# 57 ) HOMEOWNER S SIGNATURE : , ^ ^ 

## PRUDENT REPRESENTATIV ESIGNATURE : AN Y CONDITION S NEEt f T O B EAWAR EO FBEFOR ESHOOTIN G VIDEO : (LE . PETS , NOTIC ENEEDED) : 

# ^ ^ A

# f . //»7t ^

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' ^ Str«et , 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 , INC . <ih i 

# ACCES S INFORMATIO NTRACKIN GSHEE T 

# J^^ ^ $fyvJi/fy- ^ ^ f BVID : 5 7 / PROPERT Y ADDRES S 

# : 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 

# ^llJl^ ^I^Ul 10 0 ^ 

# IU,^,^ v » / " x /J^'T.n^^— ^ /



## 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 , 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, ] 

# Acces s Assessment Form : (Mus t b e complete dfo r ever y property . Informatio nmus t b e obtaine dfromapropert y wal k thru , no t given by 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 na t alate r date . 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 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 narea s wher e paintin g i s required ? 

# A- . 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 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 7TBCHNOIJOGIBS , INC . 

## Doe s thi s propert y hav e agarage ? 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 ? 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 occupied ? 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 7TECHNOLOGIES, ] 

## NEIGHBORHOO D PROPERT Y ACCES S FOR M I S THEREA NEIGHBORIN GPROPERT Y THAT NEED S T O B EACCESSED ALONG WIT H ASSIGNE D PROPERT Y T O COMPLET ESTABILIZATIO NPROCESS ? 

# h) 0 I FI T IS , GE T ACCES S FRO M AL LREQUIRE D NEIGHBORHOO D PROPERTIES . 

# /O 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 , 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 740L0GIBS , INC . 

## PAINT MATCHIN GFORM : 1 . T O B EFILLE D OUT ONL Y I FMATCHIN GCOLO R PROPERT Y ADDRESS : i^M2^ \^pniti\dl ' 

## BVID : 57 1 ^ 

# s t Th e following note s ar e for th e benefit o f

pain t crew only . Locatio n Pain t Descriptio n Pain t Ye s Pain t N o Sidin g -r*v^ ^ Soffit <T^v > Fasci a Come r Tri m Windo w Trim s Doo r Trim s 

## t^<-^J- v , 

# {jr ^ ^h>6/ ^ <5|/-A^- ^ Fron t Porc hCeilin g — 

### Front Porc hCeilin g Beam s — 

### Front Porc hFloo r ^ . 

### Fron t Porc hRailing s ^.. . 

### Front Porc hStep s 

## <^yt^u^ . Sidin g Baseboard s Foundatio n 

## '[fx^.e ^ .

• I UNDERSTAN D SHERWI NWILLIAM S WIL LMATC H M Y CURREN T COLORS . Homeowner signature : 

# y^'-^-^ ' Date : ^ ^ 

# iilnU l

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 

## PRE-STABILIZATIO NPROPERT Y SAFETY ASSESSMENT FOR M PROPERT Y ADDRESS : '2 - M ^ 1 ^ f ^ IAIXN- ^ 

## X j — BVID/SAID : ^ 7 / PRUDEN T ASSESSMENT REPERSENTATIVE : 

# ^^W f[t^[c ^ 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 Oniaha , 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

# Jic D Ai TBCHNOLOGIBS , INC . 

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

## Date :

t>^ 2 

## ^'^/cafj( ^ — bct+^ ^ S, ^ - ^ \xi^^r^teSafeyyfBc« r ^ ^

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

# ^i^'-'-^^l^'^fe . 

# ^ J ^ 

# 1 • ! •

# Curren t Sampl e Pre-Renovatio n For m Effectiv e unti l Apri l 2010 . Confirmatio n of Receip tof Lea d Pamphle t ^ 1 hav e receivec l a copy of 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 me of th e potentia l ris k of th e lead hazar d exposur e fro m renovatio n activit y

to be performe d In mydwellin g unit . I receive d thi s pamphlet befor e th e wor k began . 

# ^^/n<r ^ S>^th ' o^ll?/^ ^ Printe d nam e of recipien t Date Signatur e

of recipien t Self-Certificatio n Optio n (fo rtenant-occupie d dweliing s only ) — If 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 bo xbelow . •Refusa l to sig n —I certif ythat I hav e mad e a goo d fait h effor t to 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 , to th e renta l dwellin g uni t liste d below at th e dat e an d tim e indicate d an d that th e occupan t refuse d to sig n th e confirmatio n of receipt . I furthe rcertif ythat I hav e lef t a copy ofth e pamphlet at th e uni t wit h th e occupant . id^navailabl e fo rsignatur e — I certif ythat I hav e mad e a goo d fait h effor tto 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 , to th e renta l dwellin g uni t liste d belowan d that th e occupan t wa s unavailabl e to sig n th e confirmatio n ofreceipt . I furthe rcertif ythat I hav e lef t a cop y of th e pamphlet at th e uni t byslidin git unde rth e dooc unoermeaoo u ., „ . 

# jilf^/ ' i. Printe d nanrf e

of perso n pertif/h g Attempte d deliver y dat e an d tim e lead pamphlet deliver y Signatur e

ofperso n n certifyin g lead pamphlet deliver y

Unit Addres s Not e Regardin g Mailin g Optio n — As an alternative to deliver y

in person , yo u ma ymai l th e lead pamphletto th e owne rand/o rtenant . Pamphlet must be maile d at 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) .

### Dougla s County Accoun t Infooaatio n Pag e 1 of 3 )ij|^ t Dougla s County , Nebrask a Propert yRecor d - R171473000 0 Prin t Repor t r.'E W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t of52n d S t - Vie WO H Ma p Informatio n i s vali d a s o f 2009-8- 3 Treasurer' s Ta xRepor t Ne wFeatur e ->->- > Aut o Sale s Searc h Owne r NABULS I AN D SERHA N INVES TLL C / 7£l< , CoV^ ? UU ^ C/

O ZAHE R ASERHA N 1652 9 WEI R S T OMAH AN E 68135-000 0 Propert yInformatio n Ke yNumber : 147 3 OOO O 1 7 Accoun t Type : Residentia l Parce l Number : 171473000 0 Parce l Address : 243 1 SPAULDIN G S T OMAH AN E 68111-000 0 Lega l Description : MARYSVILL E AD D LO T8 BLOC K1 5 0 X 12 8 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $ 2,600.0 0 $ 21,700.0 0 $ 24,300.0 0 200 8 $ 2,600.0 0 $ 21,700.0 0 $ 24,300.0 0 200 7 $ 2,600.0 0 $ 21,700.0 0 $ 24,300.0 0 200 6 $ 2,600.0 0 $ 21,700.0 0 $ 24,300.0 0 200 5 $ 2,600.0 0 $ 12,900.0 0 $ 15,500.0 0 200 4 $ 2,600.0 0 $ 11,700.0 0 $ 14,300.0 0 Sale s Informatio n Sale s Date : 2009-04-2 1 Dee d Type : Q C Book : 200 9 Page : 03885 2 Price : $0.0 0 Grantor : SERHA N ZAHE R AETA L Grantee : NABULS I & SERHA N INVESTMENT S LL C Valid/Invalid : Invali d Exclusio n Reason : Famil ySal e Sale s Date : 2003-02-0 3 Dee d Type : W D Book : 223 4 Page : 60 6 Price : $ 12,000.0 0 Grantor : 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinf o .jsp?accountno=R l 7.. . 8/10/200 9

### Dougla s Count y Accoun t Inforjaatio n Pag e 2 of 3 ijljl^ t 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 4 6400. 0 1. 0 128. 0 50. 0 N o Improvemen t Informatio n Buildin g 1

MstsnuiMas T CMMM«D«I < 

# gs s nj r» • 955. 0 x f dtcon a noo r li e STOR YR N wa * tasda r CT ISo w w « CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1503. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Fai r

Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 6. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Gabl e Stories : 1. 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 190 0 190 0 10 9 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fenc e Chai n Lin k 1. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 ft 885. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17. . . 8/10/200 9

## Douglas Count y Accoun t Infonaatio n Page 3 of 3 ijH^ t Porc h Cvrd Woo d Dec k 74. 0 Porc h Enc I Soli d Wal l 110. 0 Use r SOURC E 3 1. 0



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17.. . 8/10/2009TEOHNOLOGIES . INC . 

## Pruden t Propert yClose-Ou t For m (Lead-Base d Pain t Stabilization ) SAID:,<7 / Propert yAddress : ^ 'i'SXSPf^i.^ifU ^ Owner' s Name : ^^0-/,^^ ^ ^fPlri ^ S.N O Performanc e Standards/ciose-Ou t Criteri a Ye s Wa s th e entir e structure(8 ) painte d witl i th e exceptio n o fth e stated , exclude d areas ? Thi s woul d includ e paintin g o fothe rassociate d feature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an d exterio rsurface s o fgarages . Wa s al l scrapin g an d othe rpreparatio n wori ccomplete d satisfactorily ? Wer e 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 ? Ar e al l ofth e area s wher e contaminate d material s hav e bee n spille d thoroughl yvacuumed / cleaned ? 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 s th e gras s are a tha t surround s th e structure(s ) i n reasonabl ygoo d condition ? Wa s th e pain t product s utilize d equivalen t t o a 3 0 yea r product/quality ? Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e et cproperl yremoved ? 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 . 

### 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 : </^V^t>tvc/ ' vix^<<*^«*~< V Date : ^'^/'(^t ) Propert yOwne rSignature : 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 , 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