## TRANSMITTA LO FOMAH ALEA D SIT E PAIN T STABILIZATIO NFIL EFOLDE R SAID# ; ^fe3t4> ^ Date : e[l l | S/V^^ Address : 111.9 mmjAi^ ^ /^ v LB PStabilizatio nContractor : PRUDEN T TECHNOLOGIES , INC . Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S a f \ v ^ M ^ A

^ s

/ M A y i A A A s 7 D

Videoo f property (DVD) : Pre-Stabilizatio n& Post-Stabilizatio nVideo s Executiv e Summary SignedAcces s Agreement Form Advanc e Notic e Form Pre-Stabilizatio nVideo Agreement For m Acces s Trackin g For m Property Acces s Assessmen t For m Neighbo r Acces s Agreement For m Pain t Matc hForm Pre-Stabilizatio nPropert y Safet y Assessmen t For m Work-Site Hazard s Analysi s Checklis t Photographs : Pre-Stabilizatio nPropert v Hazar dAssessmen t Photograph s Dougla s Count y Assessor Property informatio n Property Completio nAgreement FormSignedb y Property Owner Property Close-Out Chec k Lis t SignedB y EP A Pruden t Technologies , Inc . Signatur e Dat e Signatur e Dat e 3005469 9 

# IM I Superfun dTECHNOLOGIBS , IN C 

# Propert y Summary Date : 8/^^009 [ LB PSTABILIZATIO NEP ACONTRAC T EP-R7-08-0 7 [ Mont hof: Au g Propert y Address : 171 2 Militar y A v SAI D # : 2634 5

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 : 7/17/200 9 ii . Wor k Began : 7/22/200 9 iii . Close-Ou t Date : 7/24/200 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 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 ATECHNOLOGIES . INC . Pruden t Teciinologies , Inc . (Prudent ) is unde r contrac t (Contrac t #EP-R7-08-07 ) witli tii eU. S. Environmental Protectio n Agenc y (EPA ) to stabiliz ^| ^in^LBJf^^ anumbe r of propertie s locate d inOmaha , Nebraslca , includin g th e tili e LeadBase d dRaint^LBP ) a t i property locate dat _ Th e EPArequest s you r permissio n to allo w Pruden t to perfor mLB PStabilizatio nat thi s property . By signin g thi s form , th e property owne r grant s permissio n to Pruden tto perfor mactivities relate d to 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. " By signin g thi s documen t I agree to allo wanEPA contracto rto conduc t asoi l cleanu p at my property followin g completio nof iead-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 of whic hcontracto r wil l be boun d to th e soi l cleanup . I further understan dthat th e soi l cleanu p contracto r wil l mak e ai l reasonable effort s to addres s concem s that 1, as th e property owner , may hav e regardin g soi l cleanu p at my property . 

# '7A/7A7)^ Date 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 or (402)812-0223 . General question s abou t th e Omah aLeadSite cleanu p canbe directe dto th e EPAPubli c Informatio nCenter s at (402 ) 73 1 ­ 304 5 (SouthOmah aoffice ) or (402 ) 991-958 3 (NorthOmah aoffice) . F*ropert y Acces s Grante dBy :

Property Owne r Signature : 

## ^/^7/? f (Date )

808 0 War d Parkway , Suit e 40 5 250 5 N. 24' " Street , Suit e 30 8 424 2 Medical Drive , Suit e 425 0 Kansa s City , MO 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••.5J?T;yr?:-»' ^ <v.'»» r ••••"-i r

TECHNOLOGIES . INCi " PROPERT YINFORMATIO N (T o b e complete d b yresiden t and/o rpropert yowne r—pleas e print ) RESIDEN TNAME : LIUJ AKimJi J Owne r Rente r RESIDEN TADDRESS : 

## 17/ ^ /Hi/j-Mru/^j y A)MJ^/I)E

## Cy9^l U I F RENTAL , PROPERT YOWNE D BY : 

# sci r OWNER' S MAILIN G ADDRESS ; 

## 5^/^g ^ OWNER' S TELEPHON E NUMBE R - HOME : { ) g? ^

3-3^/ 7 WORK : _1 1 . NUMBE R O F OCCUPANTS 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 HOURS O R MOR E PE R WEEK : UM B 

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

## lOt ) (l/i< ^ 

# AcA[7l-ii ^ 7o/AluAf c.aJU.^Ajyjy lAi ^ Ucfa>A/L^ AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s t o b e implemente db y EP Aunde r thi s agreemen t ar e pursuan t t o Sectio n104 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s right o f acces s t o th e property i s provide dfor inSectio n104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry for "determinin g th e nee dfor response , o r choosin g o r takin g an y respons e actio nunde r thi s title , o r otherwis e enforcin g th e provision s ofth e title. "

1808 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 b 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 you nee dt o hav e abov e mentione dtask s completed ? I f yo u ar e alandlor dyou wil l nee dt o contac t th e tenan t a s Pruden t Technologie s wil l only informyou . D o you hav e an y pet s tha t resid e i nyard ? hhtJ £ Notic e needed : 3L^h y 

# Numbe r t o cal l t o giv e notice : Q77'^-3^ i V Who mw e ar e givin g notic e to : A/nde ^ 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 , 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• ^ " • ^ ' " ^ ^ TECHNOLOGIES ^ IN C 

## 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 ; l^/iJ a^^mj j PROPERT Y ADDRES S 

# : /^/xnijhTa ^ ^ ^
BVID/SAID ; 0^5^ ^ HOMEOWNER S SIGNATURE ; / ]y7lA t PRUDEN T REPRESENTATIV ESIGNATURE ; AN Y CONDITION S NEED T O B EAWAR EO FBEFOR ESHOOTIN G VIDEO ; (LE . PETS , NOTIC ENEEDED) :



# CA\i l Jnf rCP77O-''/0% ^

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 7S^tosr^ , 

# ii^ y • ^ TECHNOLOGIES , IN C 

## ACCES S INFORMATIO NTRACKIN GSHEE T 

# /7/ ^ /?}///7hi\ /

7^ - BVID ; f ^ ^VS ~ PROPERT Y ADDRESS ; 

# L/IA7)7 ) Em^ l Propert y Owne dBy ; (I f new propert y owner )

Owner s Phon e No's ; Home ; ^Jyl'Ul. . Work ; Cell ; Fax ; 

## Acces s Contractor ; AS WPDAME S P EOthe r (Prudent ) DATE TIM E AJ^ESSO R CONRAQ T RETAI L 

# -7-77-/1 ^ 

# ?^76/^ A / % 

# A'.7^4iAk J ^ \



# p Q ki^ . A/A/lCy t Comments ; 

# "BZilclt 

# '^zmt
­ MJJ^L±.. 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 , 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 or/^bestos? /
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 Aan 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 ? 

# 7 6 Ifyes,EXPLAnsi ?

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 ? ^ 

# /\I 0 

# . , 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 ? 

# y y I s thi s propert y vacan t o r occupie c

occupied / Ar e ther e an y pet s a t thi s property ? AUT / Ar e ther e an y lo w hangin g powe r lines ? 

## 7(A7)fi.m i 

# y 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 7TECHNOLOGIES . IN C 

## NEIGHBORHOO D PROPERT Y ACCES S FOR M I S THER EANEIGHBORIN GPROPERT Y THA T NEED S T O B EACCESSED ALON G WIT H ASSIGNED PROPERT Y T O COMPLET ESTABILIZATIO NPROCESS ? 

# 7\} o 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 , 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

### I:! i 

# fisie^^PSi d TECHNOLOGIES, ] 

# 7/ ^ PAIN T MATCHIN GFORM : T O B EFILLE D OUT ONLY I FMATCHIN GCOLO R PROPERT Y ADDRESS : 

# »

: /7/ ^ /Hl/Mi j M BVID : ilT^S^ ^ I UNDERSTAN D SHERWINWILLIAM S WIL LMATC H MY CURRENT COLORS . Homeowner signature : 

# /^ys U &ii^ ^f7/i>^^^ '

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 1 1 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 b IN C 

## PRE-STABILIZATIO NPROPERT Y SAFET Y ASSESSMENT FOR M PROPERTYADDRESS : /7/ ^ fl^l/W^ U /^ ^ BVID/SAID : ^(j^H ^ PRUDENT ASSESSMENT REPERSENTATIVE : / ^

*** * 

## **I FSAFET Y RIS K PROPERT Y MUS T B ETURNED OVE RT O KATH Y ROTHE RBEFOR EI T CA NB EASSIGNED T O ACREW/SUB . REPERSENTATIV EREMARKS/FINDINGS : (POWER-LIN EPROXIMIT Y T O PROPERTY , SCAFFOLDING / LADDERS / LIFT S NEEDED , UNSAF EAREAS , UNSAF ENEIGHBORHOOD...ETC. ) 

# dl ^
REQUIRE S K.ROTHE RAPPROVAL YE l 

# spo/ 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 , 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

## 7^"'^7'"' A
TECHNOLOGIES . 1 

## Checklis t fo r th e V^orksit e Hazar dAnalysi s Address : / / \(y \ Crew : Date : Ite m I OK ? I Ha^r d/ ~ Correctiv e Actio n Overhea dLine s In-transi t Vehicl e Clearanc e Level s aroun dhig hwire s Vehicl e Clearanc e aroun d hig hwire s whe nworkin 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

Structure s 

## < ; —[QI ^ C> ^ 

## r^ { 

## r\fi«X ^ t»g^dL>.^v)^ ^ # Drivewa y Sidewal k Foundatio n |[\jOjoe.c3t . 

## .3g^• ^

fo^v\r[ "^.J^IUKQ/ I ^ W

## Vjifco " Retainin g Wall s Fence s ^ ^ Tree s Foliag e Genera l Conditio no f yar d 

## O K-^YKiHf^ Damage dAreas : sin k holes/rotte dwoo d Sprinkle r Syste m Pet s Insect s Weathe r Condition s Unsaf e drivin g condition s Unsaf e neighborhoo d Cre w Foreman / Sub-Contracto r

8 08 0 WSrtrP a rkw.3y , 250 5 N . 24' " street , Suit e 30 8 JrjVe , Suit e 425 0 Kansa s City , M O 6 4 Omaha , Nebrask a 6811 0 itonio , 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

# m l
'-'/^S P ^'\.'^ £

^ . • 

# W-

# Curren t Sampl e Pre-Renovatio n For m Effectiv e unti l Apri l 2010 . Confirmatio n o fReceip t o fLea d Pamplile t J^ l hav e receive d a cop yo fth e pamphlet , 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 fth 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 wor k began . 

## /^//}J/ i y-irr)^ / 

# '^In/n ^ Printe d Dat e

Self-Certificatio n Optio n (fo rtenant-occupie d dwelling s only ) — I fth 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 . • 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 wat 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 freceipt . I furthe rcertifytha t I hav e lef t a cop yo fth e pamphle t at th e uni t wit h th e occupant . •Unavailabl e fo rsignatur e —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 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 freceipt . I furthe rcertifytha t I hav e lef t a cop yo fth e pamphle t at th e uni t b yslidin g i t 

### j r

in e aoor. ^ 

# iu (H I C7)lA7y . 7-77-/7> 9 ?^/7^AA ^ Printe d nanre o fperso n certifyin g Attempte d deliver y dat e an d tim e lea d pamphle t deliver y Signatur e o fperson^certifyin g lea d pamphle t deliver y 

# 1711 k iVl77yej ^ H i AT . 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 o fmailin g fro m th e pos t office) .

### Dougla s Count y Accoun t Info^atio n Pag e 1 of3 Dougla s County , Nebrask a Propert yRecor d - R214655000 0 Prin t Repor t 1 „*«,«,«•:«. , : „ ,,«i: ^ « « ^t'inn a ct o NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o t 52n d S t - Vie wO n Ma p Informatio n , s vali d a s of2009-6-1 6 Treasurer' s Ta xRepo S Ne wFeatur e ->->- • Aut o Sale s Searc h Owne r RIME L LIND AL 

# a &3A- 5 171 2 MILITAR YAV E OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumbe r465 5 000 0 2 1 AccountType : Residentia l Parce l Numbe r214655000 0 Parce l Address : 171 2 MILITAR YA V OMAH AN E 68111-000 0 Lega l Description : SAUNDER S & HIMEBAUGH S AD D LO T2 1 BLOC KB 5 0 X 159. 7 Valu e Informatio n Lan d Improvemen t Tota l 200 9 200 8 200 7 200 6 200 5 200 4 $7,000.0 0 $7,000.0 0 $7,000.0 0 $7,000.0 0 $7,000.0 0 $7,000.0 0 $72,300.0 0 $72,300.0 0 $72,300.0 0 $72,300.0 0 $32,100.0 0 $32,100.0 0 $79,300.0 0 $79,300.0 0 $79,300.0 0 $79,300.0 0 $39,100.0 0 $39,100.0 0 Sale s Informatio n Sale s Date : 2003-02-2 5 Dee d Type : W D Book : 223 7 Page : 51 0 Price : $72,900.0 0 Granto rGREGOR YACOLLIN S ETA L Grantee ; LIND AL RIME L Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 1997-01-1 1 Dee d Type : D Book : 205 5 Page : 31 9 Price : $33,500.0 0 Granto r 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R214.. . 7/7/2009

### Dougla s County Accoun t lnf|[^|atio n Pag e 2 o f 3
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 8 7950. 0 1. 0 159. 0 50. 0 N o Lan d Attribute s Attribut e Attribut e Descriptio n Negativ e Influenc e Traffi c1 Improvement Informatio n Buildin g 1

i,'T,u.i!ikj,i.i.M.i.iiiri»:Mj.iii.'t.-fua3a:?ar , ! CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1477. 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 HVAC : Centra l Ai rt o Ai r Rooms : 

### 2^ 0 Exterior : Fram e Sidin g Units : 1 0 Interior : Drywal l Baths : 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 3. 0

Roo fType : Gabl e Stories : 1. 6 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 0 0 % 190 0 10 8 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fenc e Chai n Lin k 1. 0 

### http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R214. .. 7/7/200 9

### Dougla s Count y Accoun t Inf||^|atio n^ ^ Page 3 o f 3 Applianc e Basemen t Fixtur e Fixtur e Porc h Porc h Allowanc e Bsmn t Bloc k 8 ft Bas e Fixture s Bat h Ful l Sla b Roo fCei l Woo d Dec k 1. 0 816. 0 1. 0 1. 0 144. 0 120. 0



### http://douglasne.mapping-oiiline.com/DouglasCoNe/static/accountinfo.jsp?accountno=R214.. . 7/7/2009TECHNOLOGIES , INC . 

## Pruden t Propert yClose-Ou t For m (Lead-Base d Pain t Stabilization ) SAID : 6lC>i^ ^ Propert yAddress : /7/ Z H^P ^

As/ C Owner' s Name : lyytd At7}yt M -

S.N O Performanc e Standards/close-Ou t Criteri a Ye s N O 1 Wa s th e entir e structure(s ) painte d wit h th e exceptio n o fth e stated , exclude d areas ? Thi s woult j 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 . 

# y 2 Wa s al l scrapin g an d othe rpreparatio n wor k complete d satisfactorily ? 

# y 3 4 Were al l require d area s o fth 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 ? 

# y A 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? 

# y 6 7 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 ? 

# l y 

# A 8 Ar e ai l Item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e et cproperl yremoved ? 

# y 9 I s ther e an yevidenc e o fpropert 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 . 

# y 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 ? 

# y 1 2 Othe rConsiderations ? Propert yOwne rDiscussions ? Additiona l Wor k tha t i s Require d 

# y Pruden t Representativ e Signatur e 

# Date : ^ /^l^/o f Propert yOwne rSignatu n Date : 803 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 IVIedica l Drive , Suit e 425 0 Kansa s City . WI 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