# 7 TRANSMITTA LO FOMAH A LEA D SIT E PAIN T STABILIZATIO NFIL EFOLDE R
SAID# : ni^^\ Date : Ci& j Si\' 2 fief ) Address : ifSl ^ ft»/^C^PTTF . C T . LB PStabilizatio nContractor : PRUDEN T TECHNOLOGIES , IN C Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f propert y (DVD) : Pre-Stabilizatio n& Post-Stabilizatio nVideo s 

# y 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 e f 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
Pruden t Technologies , Inc . Si ; Ignatur e 

# 4l:2jiji o ^

f Dat e 3005520 2 

# iHUIII I Superfun dTBCHNOLOCIBS , IN C 

# Propert y Summary Date : 8/3*7200 9 | LB PSTABILIZATIO NEP A CONTRAC T EP-R7-08-0 7 | Mont hof ; Aug. Propert y Address : 451 6 Burdett e St . SAI D # : 5799 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 : 7/20/200 9 ii . Wor k Began : 7/27/200 9 iii . Close-Ou t Date ; 8/18/200 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 Tracldn 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 Safety 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 AinSfNOLOGIBS . IN C 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 stabiUz e Lea dBase dPaiiit/LB ^ a t anumber ofpropertie s locatedi nOmaha, Nebraska , including the propert y locateda t A-^ i U ^Uuu&g ^ j r dAuMt. ^ fJ ^ Th e EP A request s you r permissionto allow Pruden t to perfor mLB PStabilizationa t thi s property . B y signing thi s form, the propert y owne r grant s permissionto Pruden t to perfor mactivitie s relatedto LB PStabilizationincluding scraping pain t an d painting ofth e referencedproperty . Further, the 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 asoil cleanu p a t m y propert y followin g completionof lead-basedpain t stabilization , if the soil cleanu p ha s not akead y bee nperformed . I understandtha t the stabilizationcontracto r canno t provide assurance s of whic hcontracto r wil l b e boun dto 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 . Yes , I have rea dan dunderstandthe paragrap habove .
atur e o f Propert y Owne r Dat e Ifyo u have an y question s abou t the LB Pstabilizationplannedfo 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 nHolt , 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 nb e directedto the EP A Public Informatio nCenters a t (402 ) 731
­ 3045 (Sout hOmahaoffice ) or (402 ) 991-958 3 (Nort hOmah aoffice) . Propert y Acces s Grmte dB y I S GrantedBy : ^ (Pleas e Prin t Name) Propert y Owne r Signature : 

# "? [^»/fl° l (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 Omatia , 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 7TECHNOLCXSIBS , IN C PROPERT YINFORMATIO N ^(T o be complete d byresiden t and/o rpropert yowne r—pleas e print ) RESIDEN TNAME : ^OpZ—ioCM 2 Owner^eitei O RESIDEN TADDRESS : ^S\( 0 G>Vjrc3€V\:€ . S ^ IF RENTAL OWMG L ,

, PROPERT

PROPERT Y Y 0WM5 D D BY BY : : / 

# fAi7^K^eslt\ 

# t OWNER' S MAIUN G ADDRESS ;
OWNER ' S TELEPHONE NUMBE R - HOME : tWlx - \ d X 4 CKTyWORK : (4Q2- ^ \0l) . "H H l ^ NUMBER OF OCCUPANT S UNDE R 7 YEAR S OLD : 2 . NUMBER 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 YIN TH E YAR D FO R 5 HOUR S OR MOR E PE R WEEK :
COMMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. ) 

## MO

AUTHORIT Y FO RENVIRONMENTA LRESPONS E ACTIONS : 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 . %04 . EPA' s righ t ofacces s to the propert y

is providedfo r in Sectio n 104(e ) ofCERCLA , 42 U.S . C 9605(e) , whic hprovide s entiy fo r "determining the nee dfo r response , or choosing or taking an y respons e action unde r thi s title ,or otherwis e enforcin g the provision s ofth e title. "

I 8080 Ward Parkway , Suit e 40 5 2505 N. 24' " Street , Suit e 308 4242 Medica l Drive , Suit e 425 0 ; Kansa s City , MO 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio ,TX 7822 9 i Phone : (816 ) 363-3703 I Fax:(816)363-370 7 Phone : (402)504-100 4 Fax : (402)504-100 5 Phone : (210)822-958 8 Fax:(210)579-657 7TECHNOLOGIES , INC . 

# 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 . 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 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 ? 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 yo u hav e an y pet s tha t resid e i nyard ? Notic e needed : 

# r - z K m^u ^ Numbe r t o cal l t o giv e notice : '^ ^ 6- ^ * ^ l\J \ Who mw e ar e givin g notic e to : J^ ^ f ^ ' b ( a? Hom e 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 7^^'"'''^ ^ R TECHNOLOGIES , INC . 

## PRE-STABILIZATIO NVIDE O FOR M I UNDERSTAND THA T PRUDENT TECHNOLOGIE S WIL LB ECOMIN G OU T T O SHOO T A PRE-STABILIZATIO NVIDE 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 NO FSTABILIZATION . OWNERSNAME : ^AQ^ K ^T^sVe ^ ^S\Q> ^oTfd^U e ^ \ PROPERT Y ADDRES S : BVID/SAID : S7^^ 1 HOMEOWNER S SIGNATURE : PRUDEN T REPRESENTATIV ESIGNATURE : 

# 0^£i± H ^ AN Y CONDITION S NEED T O B EAWAREO FBEFOR ESHOOTIN G VIDEO : (LE . PETS , NOTIC ENEEDED) : 

# ^ujliAS^ ^

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-STwsnj ; 

# (2 ) 

# % a

y TECHNOLOGIES , IN C 

## ACCES S INFORMATIO NTRACKIN GSHEE T BVID : 5 7^9 1 PROPERT Y ADDRESS : M S | G RU3Z.(^€AX C 

## S d 

# l%i k fyfaW t 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 ) DATE TIM E ACCE ! SSO R CONRAC T DETAI L £iOc\uL . 

# a| n .^'p ^ 

# vnis m OYtrp^y ^ tOi^ A4(S4Aft«Afe 

## VtM^Jl ^ 

# l\v>\ n W'iS^r ) Kh^v^ ' 

# ^r^h- J ^ 7 fiv!>>\M^. 

## 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 Assessment 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 ?
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 ?
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 , 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 , 1 

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

yes , describ e locatio nof garage . Doe s thi s propert y hav e aluminu msiding ? 

## yKj: ) I f

yes , i s i t origina l factory finis ho r ha s i t beenpainte 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 ? t>c<uy0 7 -—o / Ar e ther e an y pet s a t thi s property ? Ar e ther e an y low hangin g power 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 7TECHNOLOGIBS , 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 NPROCESS ? 

# y ^ I FI T IS , GE T ACCES S FRO M ALLREQUIRE 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 7TEC3INOLOGIBS , ] 

# PAIN T MATCHIN GFORM : T O B EFILLE D OUT ONLY I FMATCHIN GCOLO R PROPERT Y ADDRESS : ^5IG > fburde^tl e 6 + BVID : Sl^^ t I UNDERSTAN D SHERWINWILLIAM S WIL LMATC H M Y CURRENT COLORS . Homeowner signatur e

# LMM^jd ^

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, ] 

## PRE-STABILIZATIO NPROPERT Y SAFET Y ASSESSMENT FOR M PROPERT Y ADDRESS : BVID/SAID : 

# Sl^^f l PRUDENT ASSESSMENT REPERSENTATIVE :



## ******IFSAFET Y RIS K PROPERT Y MUS T B ETURNED OVE RT O KATH Y ROTHE RBEFOR EI T CA NB EASSIGNED 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 , 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 

# Checklis t fo r th e Worksit e Hazar dAnalysi s Addres s 

# • .^J^l k Crew : Date : Ite m Hazar d Correctiv e Action Overhea dLine s 

# fe^E In-transi t Vehicle Clearanc e Level s aroundhighwire s Vehicl e Oearanc e around hig hwire s whenworkin 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 nPropert y 01 ^ Neighbo r Acces s Require d U^O—CJA^dayxji ^ "^K^utAJ t 

# t m : ruJiAJ t 

# "p^ r Hig hTralfi c Are a Garag e 

# fc Structur e '^<7^r,ry Drivewa y Sidewalk Foundatio n 

### •<a" > Retainin g Wall s roi^o-^^ife*^'V ^ 

## b^u^A^p L >t - du:- ^

Qft>/-._Sk- ^ 

### Fence s 

# ^^^2^^ ^ Tree s Foliag e Genera l Conditio nof yar d 

### O i ^ Damage dAreas : sink ff^ 

# a- ­ holes/rotte dwood Sprinkle r Syste m Pet s Insect s Weathe r Condition s Unsaf e drivin g condition s Unsaf e neighborhoo d 

# ^dcL< j dCL^r ^

r)^^r ^ dc^o y Cre w ice r

8118 O War d Parkway . Suit e 40 5 250 5 N . 24 " Street , Suit e 30 8 424 2 Medica l Driv/e , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 F lone : '816 ) 363-370 3 Phone : (402)501-100 4 Phone : (210 ) 822-958 8 F.!X(8i-3 ) 363-370 7 Fax : (402)504-100 6 Fax : (210)579-657 7

# 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 patnphlet , Renovat e Right : Importan t Lea d Hazar d Informatio 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 o f th e lea d hazard 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 . 

# 1 ^ >^ . C A \^^CK . &inte 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 . Q 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 rFamilies , 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 . ij^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 , 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 rcertifytha 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 . 

## gonj^el : fiA\M)c&h^ 

# 7-17 - 

# o t 30 1 Attempte d deliver y PrinteoTnam e o f perso n certifyin g 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 of mailin g fro m th e pos t office) .

### Dougla s Count y Accoun t Infoj(»tio n Pag e 1 of 3 Dougla s County , Nebrask a Propert yRecor d - R053301000 0 !«*«,«,-,•;« « ; » w-,i; ^ ^ o « * onn o Informatio n i s vali d a s o f 2009 c -6-1 6

-i e .vE W Fesi ur a - Parce l Dimens Prin t Repor t ion s availabl e @ scal e 0-5 0 tt wes t of 52n d S t - Viewo n Ma p Treasurer' s Ta xRepor t Xs'j y: Scij-^r s ->-5- > Aut o Sale s Searc h Owne ry \ BRESLE YMAR KE 1446 8 TIBBLE S S T OMAH AN E 68116-000 0 '^*-' \ ^ ^

^ J v^/ \ V \ f ­ 

# ^n^' M Propert yInformatio n Ke yNumber : 3301000 0 0 5 Accoun t Type : Residentia l Parce l Number : 0533010OO O Parce l Address : 451 6 BURDETT E S T OMAH AN E 68104-000 0 Lega l Description : BAKE R PLAC E LO T2 2 BLOC K5 4 4 X 12 8 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $6,000.0 0 $55,700.0 0 $ 61,700.0 0 200 8 $6,000.0 0 $55,700.0 0 $ 61,700.0 0 200 7 $6,000.0 0 $55,700.0 0 $ 61,700.0 0 200 6 $6,000.0 0 $55,700.0 0 $ 61,700.0 0 200 5 $6,000.0 0 $53,700.0 0 $ 59,700.0 0 200 4 $6,000.0 0 $53,700.0 0 $ 59,700.0 0 Sale s Informatio n Sale s Date : 2006-08-1 4 Dee d Type : SW D Book : 200 6 Page : 09794 1 Price : $51,300.0 0 Grantor : Cente xHom e EquityCompan y Grantee : Bresle yMar k E eta l Valid/Invalid : vali d Exclusio n Reason : SalesDate : 2006-01-0 5 Dee d Type : TR D Book : 200 6 Page : 00291 0 Price : $64,000.0 0 Grantor : Eri cH Lindquis t 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R053.. . 7/7/2009f s^'S,':^^'Vr ' n'-^y * w/i.i^-'iti.A'J * --w--*'' ! '*'''^«fi"-^-7fr.' ' •• • 'f^'i.^^'tr^i'iifcT,??!* ' 

### Dougla s County Accoun t Infoj^fctio n Pag e 2 o f 3 Grantee : Valid/Invalid : Exclusio n Reason : Cente xHom e Equitie s invali d sal e t o Mortgag e - Ban k SalesDate : Dee d Type : Price : Grantor : 1998-04-3 0 D | $55,889.0 0 Book : 209 0 Page : 32 1

Grantee : Valid/Invalid : Exclusio n Reason : Vali d SalesDate : Dee d Type : Price : Grantor :1997-06-1 2 D I $27,574.0 0 Book : 208 8 Page : 13 0

Grantee : Valid/Invalid : Exclusio n Reason : Vali d Lan d Informatio n Acre s 0.1 2 S F 5632. 0 Unit s 1.0 Dept h 128. 0 Widt h 44. 0 Vacan t N o Improvemen t Informatio n Buildin g 1

» r '•"a\v^ ' y l':iu

W{j^iB CLIC KT O ENLARG E IMAG E Squar e Footage : 844. 0 Percen t Complete : 100.0 % Perimete r1 0. 0 Quality : Fai r 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R053. . . 7/7/200 9

### Dougla s Count y Accoun t Infogfctio n Page 3 of 3 

# W Uni t Type : Condition : Averag e

Buil t As : 1 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o 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. 5 Floorcover : Allowanc e Foundation : Bloc ! c Sprinkle rSquar e Footage : 0. 0 w.a ra„n t ^®^' ' Percen t rearaun i Remodele d Remodele d 

## '"'•tS'/' " '^y-""*^ ' 192 5 198 9 0 % 192 5 8 5 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Unfinishe d Atti cW/floo r 824. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 824. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 216. 0 Porc h Sla b Roo f Cei l 100. 0 Porc h Woo d Dec k 144. 0



### http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R053.. . 7/7/2009TECHNOLOGIBS . INC . 

### EP AClose-Ou t For m (Lead-Base d Pain t Stabilization ) BVID : .'ll'^^ l Propert yAddress : Lj^ U ilurJ^y ^ C ^ Owner' s Name : T^l^r k 'Rr^sl^ y 

### S.N O Performanc e Standards/close-Ou t Criteri a 1 Wa s 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 , ai l trim , porches , bo x beams , columns , rails , an d exterio rsurface s o f garages . 2 Wa s ai i scrapin g an d othe rpreparatio n wori ccomplete d satisfactorily ? 3 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 ? 4 Ar e al l ofth e area s wheri e contaminate d material s hav e bee n spille d thoroughl yvacuumed / cleaned ? 5 Di d th e contracto rcollect/vacuu m ai 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 ? 6 I s th e gras s are a tha t surround s th e structure(s ) i n reasonabl ygoo d condition ? 7 Wa s th e pain t product s utilize d equivalen t t o a 3 0 yea r product/quality ? 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 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



### EP ACOR / Representativ e Signatur^ii^^^^pj/^^-^^^^^VcAfl ^ 

## Date : ^/tt>lo' J Ye s ^ 

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# y 7TECHNOLOGIES . INC . 

### Pruden t Propert yClose-Ou t For m (Lead-Base d Pain t Stabilization ) SAID : £11^ 1 Propert yAddress : 

# v.r/ z IS/jfiJf ^ g F Owner' s Name : /^Mife l f^/?S<kr {

S.N O Performanc e Standards/close-Ou t Criteri a 1 Was th e entir e structure(s ) painte d wit h th e exceptio n o f 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 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 ofth 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 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 ? 6 I s th e gras s are a tha t surround s th e structure(s ) i n reasonabl ygoo d condition ? 7 Was th e pain t product s utilize d equivalen t t o a 3 0 yea r product/quality ? 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 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 Ye s 

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# i t X X X 

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### Pruden t Representativ e Signatur e Date : Propert yOwne rSignature : 

# Date : ^If^f o 

# 7 80a 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 , Nebrasl< 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 : (813 ) 363-370 7 Fax : (402)504-100 5 Fax : (210)579-657 7