## TRANSMITTA Lof OMAHA LEA D SIT E PAIN T STABILIZATIO N FIL EFOLDE R SAI D # : 2503 0 , Date : 12/02/0 8 Address : 316 5 Myrtl e Ave Remediation Contractor : Pruden t Technologie s Year : 200 8 PAINT STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S ^ Video o f propert y (DVD ) B

^ Executiv e Sximmai y B ^ SignedAcces s Agreemen t fo r

subject propert y [ FPainting Agreemen t D Settlemen t docimients (i.e. , fo r

damag e o r

to replac e plants , etc. ) D Photograph s 0

^ Satisfactor y restoratio n signedby Propert y Owne r D Propert y close-out chec k

lis t signedby EP A \ £Propert y information fromDougla s Count y Assessor' s OfBc e D D D 

## Signatur ^ Dat e

4031037 8 

# imniM i Superfun d

### PROPERT Y SUMMAR Y Date : 12.02.0 8 LB PSTABILIZATIO N EPA CONTRAT EP-R7-08-0 7 Monthof : December Propert y Address : 316 5 Myrtl e Ave SAID : 2503 0 A . EXECUTIV ESUMMAR Y A. 1 Issue s Encountered : None A. 2 Issue s Resolved : None

A. 3 Uniqu e Findings : None 122A. 4 Othe r Relevan t Information : None Acces s Date : 09/03/0 8 Wor k Bega n Date : Closeou t Date : 10/22/0 8 Enclosures : 1 . Pre-Vide o 2 . Post-Vide o 3 . Propert y Statu s Form 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 County 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 .ENVIRONMENTA L & 

# mjM K CONSTRUCTIO N TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : 3l^ f tOCf^ WfiVt^ Date : ^(3/0 ? BVID : ^d3 6 Phone 

# •^1 1 /^^hl6f ( Plant & Permanen t Landscaping T o Remain I n Plac e Item # On Ma p Descriptio n andLocatio n i 

# ' 6 I 

# a Pre-Existinp r

r,nnditio n o f Structure s Doe s your Basement hav e ahistor y o f leaking ? Ye s —N o ~ Item # Descriptio n & Localio n O

n Ma p 

# 6/M eu^oJ { ^/i/i/k^ e l l 1 / 

# / I l l Propert y Owne r Prudent Emplo y Signature : 

# ''^^xM^i^k ^ 808 0 Ward Parkway , Suit e 40 5 2505 N . 24* ^

Street , Suit e 30 8 Medica l Drive , Suit e 425 0 Kansa s City . M O 6411 4 Omaha , Nebraska 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)604-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-6577

# 25o:5 C

Pruden t Technologies , Inc . (Prudent) i s unde r

contrac t (Contrac t #EP-R7-08-07 ) wit hth e U . S . Environmenta l Protectio n Agency (EPA) t o stabiliz e Lea dBasedPaint (LBP) a t anumbe r

o f propertie s locatedi n Omaha , Nebraska , incltidin g th e propert y locate da t '^((p^ Dfl(Lri-[<^ - /QjJ . Th e EP A request s you r

pennissio n t o allo w Prudent t o perfor mTB PStabilizatiyii a ttiais property . B y signing thi s form , th e propert y owne r

grant s permissio n t o Pruden t t o perfor mactivitie s relate dt o LB P Stabilizatio n including scraping 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 Ppamphlet "Renovat e Right. " Ifyo u hav e an y question s about th e LB Pstabilizatio n plannedfo r

your property , pleas e contac t Prudent' s Adminigtrative Cler k

fo r

th e Lea dBase dPaint Stabilization , Mrs . Debora hAkerele-Johnsnn ^ a

t (402 ) 504-1004 . Genera l question s abou t th e Omah aLea dSit e cleanu p ca n b e directe dt o th e EP A Publi c Information Center s a t (402 ) 731-304 5 (Sout hOmahaoffice) o r

(402 ) 991-958 3 (Nort hOmah a office) . Propert y Acces s GrantedBy : (Pleas e Prin t Name) Propeit y Owne r Signatuie ; (Signature) ~ ' '(bate) PROPERT Y INFORMATIO N • (T o b e complete dby residen t tnd/o r properl y o^ner—pleas e print ) (RESIDEN T^4AME : Rente r 

# • sii^< : <>N'y j FiESIDENTADOi^S S I F RENTAL , PROPERT YOWNE D BY : OWNER' S MAIUN G ADDRESS ; OWNER' S TELEPHON E NUMBE R - HOME : 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 : 7 NUMBE R O F CHILDRENUNDE R 7 YEAR S OL D WH O PLA Y I NTH 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. ) 

## /UTwg ^ AUTHORTT Y FO RENVIRONMENTA LRESPONS EACTIONS : The activitie s to b e implemente dby EP A unde r thi s agreemen t ar

e pursuan t t o Sectio n 10 4 of

CERCLA, 4 2 U.S.C . 9604 . EPA' s righ t ofaeces s t o fte propert y isprovide d for i n Section 104(e ) o f CERCLA, 4 2 U.S . C 9605(e) , whichprovide s entr y fb

r "determining the need for response , o r choosing ortaldn g an y respons e actio n unde r thi s title , o r otherwis e enforcing «i e provisicn s ofth e title. "

424 2 Medica l Drive , Suit e 425 0 250 5 N . 24 * Street , Suit e 30 8 080 War d Partwray , Suit e 40 5 Sa n Antonio , T X 7822 9 Omaha , Nebrask a 6811 0 ansa s City , M O 6411 4 Phone : (210)822-958 8 Phone : (402)504-100 4 hone : (816 ) 363-370 3 Fax : (210 ) 579-657 7 Fax : (402)504-100 5 ax : (816 ) 363-370 7

# • t Curren t Sampl e Pre-Renovatio n Forn i Effectiv e unti l Apri l 2010 . Confinmatio n o f Receip t o f Lea d Pamphle t Q-fflav e receive d a cop yo f th e pamphlet , Renovat e FV^t : Importan t Lea d Hazar d Infbmnatb n fo rFamilies , CNl d Car e Provider s an d Schod s infomnin g m e o f th e potentia l ris k o f th e lea d 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 pamphle t befor e th e wort < began . Printe d nam e o f recipien t ^t e / 

# :::^. : //^.^ j Signatur e o f recipien t Self-Certificatio n Optio n (fo rtenant-occupie d dwelling s onl ^ — 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 ma ychec k th e appropriat e bo xbelow . D Refusa l t o sig n —I certifytha t I hav e mad e a goo d fait h effbrt t o delive rth e pamphlet , flenovate FVght - Importan t Leex i Ham d Intormatio n fo rFamilies , CNl d Ca m F^vlder s an d Schods , 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 oocupan t refuse d t o sig n th e confimnatio 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. •Unavailabl e fb rsignatur s —I certifytha t I hav e mad e a goo d fait h effort to delive rth e pamphlet , Renovat e FVght : Importan t Lea d Hazar d Infonnatio n fo r Families , Chil d Ca m 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 left a cop yo f th e pamphle t a t th e uni t b yslidin g i t "vth e door . 

# 'MjjhmM L 'f/s/d f ^-i/if/ n Attempte d deliver y dat e an d tim e lea d pamphle t deliver y Signatur e o f pereo n certifyin g lea d pamphle t deliver y 

# ?/.^ r



# mu^ M liF . Uni t Addres s Not e Regardin g Mailin g Optio n —A s a n altemativ e t o deliver yi n person , yo u ma ymal 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 o f mailin g fro m th e pos t office) .

# ^ i^56/< ^ 0 6<tfi dfed - n ff^d pa i n t matc h f brm" ^

. . J ^r(i)fol l Pain t matchin g form : / /

. Propert yaddress : 3>iL^f^ijP-v ^

pl^ ^ BVID : ^^^j ^ 

# Are a : U^/ e ;^^'^^^^^^olor : ^ . 5-/ ^ 

# Explanation : 

# jS ' ^ d ^ft^/lw^ fiPP^^^' Area : Color : Explanation : Ariea : Color : Explanation : Area : color : Explanation : Area : Color : Explanation : Pag e 1

# Acces s INFORmm WTTtACfOW GSHEE T 

# am . p.<;/i3 6 3om » 3U ^ Mi^U'l/ e fk t pin|M|yOiiM4By ! (illVfRpi|flM 4



## OMMrOoiMNo e Homa : ^^l ' 7 ^^ T wbrt c 

# Cd b LS l - 10^ 1 te 

# moept milu miiw^ ' i/t/h e 

# 1 on e I I W I teww 

# Conne r DEm L 'f/ j \ii--6 6 

# W f^eAAjfedbt , tt/tjoj/jt ^



# ^ ^ hll < ny/ic £M l TfTM i mcsl'idS l f

i we^k - due f l ^ro/y^ i M ) A44/-- P

# -;^d- f l 4 i fkfu hj/iitl^ . ,

## Dougla s Count y Accoun t Information Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R18032S0006: : " - - - - " Prin t Repor t NE W Featur e - Parce l Dimension s a^ilabl e @ scal e 0-5 0 ft wes t o f 90t h S t - yj.ew..OrLMag | Informatio n i s vali d a s o f 2008-7-1 4 Treasurer' s ta xRepor t Ne wFeatur e - 4 - » • • Aut o Sale s Searc h Owne r WORTIWA N TERR I E 

# 16 ^ \Of,V \ 316 5 MYRTL E AV E OMAH AN E 68131-000 0 Propert yInformatio n Ke yNumber : 032 8 000 0 1 8 Accoun t Type : Residentia l Parce l Number : 180328000 0 Parce l Address : 316 5 MYRTL E A V OMAH AN E 68131-000 0 Lega l Description : MONTCLAI R AD D LO T12 0 BLOC K0 95.1 5 X 96. 9 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $3,500.0 0 $94,700.0 0 $98,200.0 0 200 7 $3,500.0 0 $94,700.0 0 $98,200.0 0 200 6 $3,500.0 0 $94,700.0 0 $98,200.0 0 200 5 $3,500.0 0 $94,700.0 0 $98,200.0 0 200 4 $3,500.0 0 $33,900.0 0 $37,400.0 0 200 3 $3,500.0 0 $33,900.0 0 $37,400.0 0 Sale s Informatio n Sale s Date : 1996-10-2 3 Dee d Type : Book : 204 6 Page : 66 2 Price : $ 30,000.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widti i Vacan t 0. 2 9120. 0 1. 0 96. 0 95. 0 

### N o Improvemen t Informatio n 

## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?acco\]ntno=R18.. . 8/26/200 8

### Dougla s County Accoun t Infcrmatio n

[i^ r Pag e 2 of 2 Buildin g 1 1 1/ 2 Stor yEhi! ^ 316 5 Myrtl e A v ^^, ^ DtlGing t

i Ru t noo r. 

### IS^I ^

. 0 : »

• I M

SO O 34r i FkiBuitn u hal o Mi»au CLIC KTO ENLABGEJM.Aa E CLIC KTO ENLARG E IMAG E Squar e Footage : 1814. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : 

### Condition : Averag e

Buil t As : 1 1/ 2 Stor yFi 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 : 2. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 4. 0

Roo f Type : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r YearBuil t Physica l Ag e Remodele d Remodele d Buil t 192 1 0 % 192 1 8 7 Detai l 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 ft 1160. 0 Basemen t Finishe d 

### 600. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 2. 0 Garag e Detache d 360. 0 Porc h En d Soli d Wal l 

### 160. 0 Porc h Woo d Dec k 400. 0 Use r 

### Se e Note s 1. 0



### http://douglasne.niapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R18. . . 8/26/200 8

## Pruden t Propert yCiose-Ou t For m (Lead-Base d Pain t Stabilization } Owner' s Name ; "JhiriJ ^ 'U^^r f fY\A\ } 

## Performanc e Standards/ciose-Ou t Criteri a YE S N O Wa s th e entir e stnjcture(s } painte d wft h th e exceptio n ofth e stated , exclude d areas ? Thi s woul d indud e paintin g o f othe rassodate d feature s inciudin g fasda , eaves , siding , al i trim , porches , box beams , columns , rails , an d exterio rsurfece s o f garages . ^ 

# 5 2 .Wa s al l scrapin g an d othe rpreparattio n wori t complete d satisfactorily ? 3 .Were al t required areas o f th e structurefs ) prime d a s neede d an d painte d wit h tw o to p coats ? 4 .Wa s th e pain t product s utilize d equivaien t t o a 3 0 yea rproduct/quaiity ? - y ^ Are ai! ofth e areas wher e contaminate d material s hav e bee n spille d thoroughl yvacuumed / deaned ? ^ 5 .

Di d tiie contracto rcoliect/vacuum . ai l failin g an d scrape d pain t chip s o n th e entir e property , roodvifays , alleyways , publi cacces s areas an d als o remove an yothe rgenerate d debris ? 

# y 7 .

I s th e gras s are a tha t surround s th e strjcture(s } i n reasonabl ygoo d condition ? < 8 .

Are al l iteni s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e etc . properl yremoved ? ^ ^ 

# y I s ther e an yevidence o f propert ydamag e tha t was don e b yth e contractor ? An ypropert ydamag e / need s t o b e complete d prio rt o th e EP AClosa-Out . 10 .Are ther e an ypropert yitem s tha t wer e temporatil yre-locate d b yth e contracto r / tha t nee d t o b e move d bactc ? 11 . fi^^e ther e an y(known ) lingerin g issues wit h th e propert yovmer{s ) tha t hav e bee n lef t unresolved ? 

# x ^ Othe rConslderatiorts?propert yOwne rDiscussions?Add!tions l Wor k tha t i s Require d



## Cri,j,^^£ y^a/^dJo-H A 

# R yt ^ Pruden t R < esentativ e P^A ^

}]Urv{)J!i ^