## TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R SAID : 2020 8 Date : 12/26/200 8 Address : 132 0 TURNE RBLV D Stabilizatio n Contractor : Pruden t Technologie s Year : 200 8 PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S Vide o o f property (DVD ) ' Executiv e Siimmar y Signe dAcces s Agreemen t for subjec t property Paintin g Agreemen t > U Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) 

# u Photograph s 

# u Satisfactory restoratio n signe db y Property Owne r D 

### Property close-ou t chec k lis t signe db y EP A Property informatio n fro mDougla s County Assessor' s Offic e D D D

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### PROPERT Y SUMMAR Y Date : 12/27/0 8 LB P STABILIZATIO N EP A CONTRA T EP-R7-08-0 7 Mont hof : Decembe r Propert y Address : 132 0 TURNE RBLV D SAID : 2020 8| A . EXECUTIV E SUMMAR Y A. 1 Issue s Encountered : Propert y wil l nee dt o b e finishedi n Sprin g o f 2009 . A 2 Issue s Resolved : A 3 Uniqu e Findings : NONE . A. 4Othe r Relevan t Information : Acces s Date : 11/15/0 8 Wor k Began : 11/23/0 8 CloseoutDate : 11/28/0 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

TECHNOLOGIES , INC .ENVIRONMENTA L & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S



# _Propert y Statu s For m Address : / 3'? 0 l^^rns^i f f5Wc( - Date : //V ^ ' <^ ^ Phone : , , ^ _ ^- 7 BVID : 20'20 3 

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m^^fz-^lf ^ Plan t & Permanen t Landscaping T o Remain I n Plac e Item# Descriptio n andLocation , O

n Ma p

Pre-Existing Condition o f

Structure s Doe s your Basemen t have ahistor y of leaking ? Ye s -— No - ~ Item # Descriptio n & Location O

n Ma p

Propert y Owne r Pruden t Employee

imploye Signaturer>^ ^ .., , ^ . . Signature : ^Zz^; ^ /ty^Z^^^i^^i ^ 808 0 War d Parkway , Sidt 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 DK.<«n* . I'iAI WOi l n«s a

# 2C20 ? Pruden t Technologies , Inc . (Prudent ) i s unde r

contract (Contract #EP-R7-08-07 ) wit hthe U . S . Environmenta l Protection Agency (EPA) to stabiliz e Lea dBasedPain t (LBP) a t anumbe r

o

f

propertie s locatedi n Omaha, Nebraska , including the propert y locateda t I ^Z7 0 TZx-fr^ f f2\\j(\ . Th e EP A request s you r

permissio n to allo w Pruden t to perfor mLB P Stabilization a t thi s property . B y signing thi s form, the propert y owne r

grant s permissio n t o Pruden t t

o perfor mactivitie s relatedt o LB P Stabilization including scraping paint an dpainting of the referencedproperty . Further , th e owner/tenai t verifie s tha t the y have receive ddi e LB P pamphle t "Renovat e Right. " If

you have an y question s about th e LB P stabilizatio n plannedfo r

you r

property , pleas e contact Prudent' s Administrative Cler k

fo r

th e Lea dBasedPain t Stabilization , Mrs . DeborahAkereie-Johnson . a

t (402 ) 504-1004 . Genera l question s abou t the OmahaLea dSit e cleanu p ca n b e directedt o the EP A Public Information Center s a t (402 ) 731-304 5 (Sout hOmah aoffice) or (402 ) 991-958 3 (Nort hOmah a office) . ^ \ 

# iBv: /

z^ryn k ->'• - R[:Zy2iLU o Propert y Acces s Grante dI ^ (Pleas e ?rint Name ) < ^

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# / / ^ 7 Propert y Owne r Signalure : 

# • tZ l ////^/^. ^ (Signature) ../ / '(Date ) PROPERTY INFORMATIO N (T o be complete db y resident and/o r property owne r - pleas e print ) RESIDEN T NAME : Owner Rente r RESIDEm * ADDRESS : 

## Z37 0 lyrnC Z 0/jc^ . I F RENTAL , PROPERT Y OWNE D BY : 

# •fzank J ^ /l^^^cA ) OWNER' S MAILIN G ADDRESS ; /^ ^

Zl/ZZl^T ^M ' , CMokc^^ , /Vz f Zy^/O f 

# £f l M,ui-lr A WORK : J NUMBER O F OCCUPANT S UNDE R 7 YEAR S OLD : NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDER : 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. ) OWNER' S TELEPHON E NUMBE R - hiOlBlE : _ i L

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s t o b

e implemente db y EP A unde r thi s agreemen t ar

e pursuan t t o Sectio n l-

M of

CERCLA , 4 2 U.S.C . 9604 . EPA' S righ t o

f acces s to th e propert y is provide dfo r i

n Sectio n 104(e ) o

f CERCLA , 4

2 U.S . C 9605(e) , whic hprovide s entr y fo

r "determinin g th e nee dfo r response , or choosing ortaking an y respons e actio n unde r thi s title , o r otherwise enforcin g th e provisicn s o f th

e tide."

424 2 Medica l Drive , Suit e 425 0 250 5 N . 24 * Street , Suit e 30 8 : 0 War d Parkway , Suit e 40 5 Sa n Antonio , TX 7822 9 Omaha , Nebrask a 6811 0 isasCity , M O 6411 4 Phone : (210 ) 822-95S R Phone : (402)504-100 4 jne : (816 ) 363-370 3

# Curren t Sampl e Pre-Bfenovatio n For m Effectiv e unti l Apri l 2010 . Confirmatio n of Receip t of Lea d Pamphle t • I hav e receive d a cop y of th e pannphlet , 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 me of th e potentia l ris k of th e lea d hazar d exposur e fro m renovatio n activit y tobe performe din mydwellin g unit . I receive d thi s pamphle t befor e th e woi1 < began . PrintedigriiejB f recipien t "~)..^T ^ .^ Dat e 

# /

,^iy ^ >-y^z>^y; ^ Signatur e of recipien t Self-Certificatio n Optio n (fo rtenant-occupie d dwelling s only ) — If 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 . •Refusa l to sig n —I certifytha t I hav e mad e a goo d fait h effor t to delive rth e pamphlet . Renovat e Right : Importan t Lea d Hazar d Infonnatio n fo rFamilies , Chil d Care Providers an d Schools , to th e renta l dwellin g uni t liste d belo w at th e dat e an d tim e Indicate d an d tha t th e occupan t refuse d to sig n th e confirmatio n of receipt . I furthe rcertifytha t I hav e left a cop y of th e pamphle t at th e uni t wit h th e occupant . •Unavailabl e fo rsignatur e —I certifytha t I have mad e a goo d fait h effor tto 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 , to th e renta l dwellin g uni t liste d belo wan d tha t th e occupan t wa s unavailabl e to sig n th e confimnatio n of receipt . I furthe rcertif ythat I have lef t a cop y of th e pamphle t at th e uni t byslidin g it unde rth e dMf c^ Printe d nam e of perso n certifyin g Attempte d deliver y ^ ydat e an d tim e " ^ lea d pamphle t deliver y Signatur eof persorfcertifyin delive i iOnrcertitying g

lea

lea d d pamphle

pamphle t t deliver v 

### / S o^ O JlZy/yieZ ^ side ) Z^Z\^<LhcL y/^ ^ Uni t Addres s Not e Regardin g Mailin g Optio n — As an alternativ e to deliver y

in person , yo u ma ymai l th e lea d pamphle t to th e owne rand/o rtenant . Pamphle t mus tbe maile d at leas t 7 days before renovatio n (Documen t wit h a certificat eof mailin g fro m th e pos t office) .

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# pain t matc h form ' /(af^n c c^ Pain t matchin g form : ^ — ^ Propert yaddress : /^;z?c z -fZjrd^ y^/.'J . BVID : ^dSZO ^ . V Area : ;^*^"' ^ / ^ / ' Color : . , , , , Explanation : ^<J^'^ ^ 

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### Dougla s Count y Accoimt Inforowtio n Pag e 1 o f 2 Tjl^ l Dougla s County , Nebrask a Propert yRecor d - R122073000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t of 90t h St - Vje w O n Ma p Informatio n i s vali d a s of 2008-9- 4 Treasurer' s TaxReport Ne wFeatur e ->-»- > Aut o Sale s Searc h 

### Owne r RIZZUTO FRAN KJ ETA L 132 6 TURNE R BLV D OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 207 3 000 0 1 2 Accoun t Type : Multipl e Re s Parce l Number : 122073000 0 Parce l Addres s 132 0 TURNE R B D OMAH AN E 68105-000 0 Lega l Description : GRIFFI N & SMITH S 1STSU B LO T4 BLOC K2 6 2 X 116. 7 Valu e Informatio n Lan d Improvemen t Tota l 200 8 j $ 6,800.0 0 $ 143,200.0 0 $ 150,000.0 0 200 7 $ 6,800.0 0 $ 143,200.0 0 $ 150,000.0 0 200 6 $ 6,800.0 0 $ 142,900.0 0 $ 149,700.0 0 200 5 $ 6,800.0 0 $ 159,600.0 0 $ 166,400.0 0 200 4 $ 6,800.0 0 $ 61,300.0 0 $68,100.0 0 200 3 $ 6,800.0 0 $ 61,300.0 0 $ 68,100.0 0 Sale s Informatio n Sale s Date : 2001-12-2 2 Dee d Type : Q C Book : 219 9 Page : 35 6 Price : $i.0 0 Grantor : Grantee : Valid/Invalid : invali d Exclusio n Reason : NQ H Bon o wit h Do cStamp s Lan d Informatio n Acre s ' S F . Unit s Dept h Widt h Vacan t 0.1 6 7192. 0 1. 0 116. 0 62. 0 N o Improvemen t Informatio n

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### Dougla s Count y Accoun t InforjMtio n Pag e 2 o f 2 rjMi i Buildin g 1

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2 STOR Y

• ;'•!)C m ' CUC KT O ENLARG E IMAG E CUO KJ O E N L ARG E IMAG E Squar e Footage : 2642. 0 Percen t Complete : 100 0 % Perimete r 0. 0 Quality : Averag e Uni t Type : En d Condition : Fai r

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 : 2. 0 Interior : Plaste r Baths : 3. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Hi p Stories : 2. 5 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 0 0 0 % 191 0 9 8 Deta/7 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 Applianc e Fireplac e Masonr y 1. 0 Basemen t Bsmn t Bloc k 8 ft 1260. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 3. 0 Porc h Sla b Roo f Cei l 308. 0 Porc h Sla b Roof Cei l 66. 0 Use r Apartment s 2. 0 Use r C/ Aunit s 2. 0 Use r Furnac e 2. 0 Use r Meters (Elec. ) 2. 0

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