## TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R SAID : 1773 4 Date : 12/26/200 8 Address : 293 5 MARTH A Stabilizatio n Contractor : Pruden t Technologie s Year : 200 8 PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S l?

r Vide o o f propert y (DVD ) [3 Executiv e Summary 0^ Signe dAcces s Agreemen t fo r subjec t property S ^ Paintin g Agreemen t D Settlemen t docimient s (i.e. , for damag e o r t o replac e plants , etc. ) D Photograph s 0 ^ Satisfactory restoratio n signe db y Property Owne r D Property close-ou t chec k lis t signe db y EP A mProperty informatio n fromDougla s County Assessor' s Offic e D D D

f/gjr/g' y 

### Signature d Dat e

40309874 l!IE'"lllllli lIIIIIE"I' - 

### Superfun d

### PROPERT Y SUMMAR Y Date : 12/23/0 8 LB P STABILIZATIO N EPA CONTRAT EP-R7-08-0 7 Monthof : Decembe r Propert y Address : 293 5 MARTHA SAID : 1773 4 A . EXECUTIV E SUMMAR Y A. 1 Issue s Encountered : NONE . A. 2 Issue s Resolved : NONE . A. 3 Uniqu e Findings : NONE . A. 4 Othe r Relevan t Information : NONE . Acces s Date : 10/23/0 8 Wor k Began : 10/30/0 8 Closeou t Date : 10/31/0 8 Enclosures : 1 . Pre-Vide o 2 . Post-Vide o 3 . Propert y Statu s Form 4 . SignedAcces s Agreemen t 5 . Pre-Renovatio n Form 6 . Pain t Matc hFor m 7 . Trackin g Form 8 . Dougla s County Assessor Propert y Informatio n Pag e 9 . EPA Propert y Closeout for m 10 . Propert y Completio n Agreemen t

TECHNOLOGIES , INC .ENVIRONMENTA L& CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Property Statu s Form Address : ^^"^" ^ Mcu-Vv^c-^/S) . - Date : /0>/^^/(Pj ' 

# BVK) : ni^ M Phone : ^g ^ ~^%^ ^ Plan t & Permanen t Landscat>in g T o Remai n I n Plac e Itein # Descriptio n an dLocatio n OnMq ) 

# ^ f)ciA h(OVA ; cctA^ r

ofhao^- e - coyec .

FrC'Existin g Conditio n o f Stnicture s ^ 

### Doe s you r Basemen t hav e ahistor y o f leaking ? Ye s — 

## N o liSXQ. § 

### Descriptio n & Locatio n OaiAa p

PiopCTt y Owne r Pruden t Empl a Signature : \)uAiA ^ ^^^ , Signature : U24^H^ ^ 'VtA ^ 

# i 260S N . 24* ^

Street . Suit e 30 8 424 2 Medica l Orivft , Suit a 426 0 808 0 War d Ptrtewiy . SuH e 40 6 Omaha , Nebraska 6811 0 Sa n Antonio , T X 7822 9 Kansa s CHy , M O 6411 4 m——. . >JA< n jeAj.4AfW I

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

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

ofpropertie s locatedin Omaha, Nebraska , includin g tiie propert y locateda t J ^ ^ 3 S > A A C k

r

VA^t^ "^ ^ Th e EP A request s you r

permissio n t o allo w Pruden t t o perfor mLB P Stabilizatio n a t thi s property . B y signing thi s form, di e propert y owner grant s permissio n t o Prudent t o perfor mactivitie s relatedt o LB P Stabilization including scnq)in g pain t andpaintin g of th e reference dproperty . Further , tiie owner/tenan t verifie s tha t they hav e receive dtiie LB P pamphlet "Renovat e Right. " I f

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

your property , pleas e contact Prudent' s Administrative Cler k

fo r

tiie LeadBase dPaint Stabilization , Mrs . Pebora hAkerele^ohngon . a

t (402 ) 504-1004 . Genera l question s about th e OmahaLea dSite cleanup can b e directedto tiie EP A Publi c Informatio n Center s a t (402 ) 731-304 5 (Soutii Omahaoffice) or (402 ) 991-958 3 (Nortii Omaha office) . Property Acee aOnnte dBv : ^ J06tM (oA.^'Ci A (Pleas e Prin t Name ) PtopetQ r Owne r Signatuie : 

## Y ^0(W ^

^

Q-i M C- < r \ 

# mQ3/o e (Signatuie ) late ) PROPERT Y INFORMATIO N CT

o b e complete db y reiiden t nd/or propert y owne r - pleas e print ) leSIDENTNAME : Ratrte r 

# 2fyr Mf^fA^s ^ RESIDENT ADDRESS : I F RENTAL . PROPERT Y GWNE D BY : 

# Sa/yi e OWNERF S MAIUN O ADDRESS ; 

# ^ . M,^Sir^f^ . J CmHEK B TELEPHON ENUMBE R L 

# i 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 OLDE R = / NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D Vm O PLA Y I N TH E YAR D FO R S HOUR S O R MOR E PE R WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (LE . DOGS . ENTR Y GATES , ETC. )

AUTHORm r FORENVntiONMENTA LRESPONS EACTIONS ; Th e activitie s t o b e implemente dl> y EP A unde r da s agraemen t ar e pursuan t t o Sectio n10 4 o f

CERCLA , 4 2 U.S. C 9604 . EPA' s righ t ofacoes s t o di e ptopett y isprovide dfbr i nSectio n104(e ) o f CERCLA , 4 2 U.S . C 960S(e) , whic hprovide s entr y fbT'deteiminingfli e nee d fi>rresponse , o r dioosin g ortaldn g an y respois e actio nunde r thi s tide , o r oflierwis e enfbrcin g fte provisicn s ofth e tftle."

«8 0 wsar d Parinvay , Sidt a 40 5 250 6 N . 24 * Straet , Sult a 30 8 424 2 Medica l Drtva , Suit e 4250 :ansa s CHy . M O 6411 4 Omaha , Nabtaala i 6811 0 Sa n Antonio , T X 7822 9

# Sampg e Effectiv e unti l Apri l 2010 . Confinnatio n o f Receip t o f Lea d Pamphle t l a I hav e receive d a cop yo f th e pamphlet , Renovat e F^ght : importan t Lea d Hazar d Informatio n fo rFamilies , Chil d Car e Provider s an d ScivMi s informin 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 ydw^eilin g unit . I receive d thi s pamphle t befor e th e wor k began . Printe d nam e o f recipien t ^ Dat e X AUtM ^ (.^i-A/tr-T. . I.C . Signatur e o f recipien t Self'Certificatlo 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 . a Refusa l t o sig n —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 fb rFamilies , Chil d Car e Pnyviders 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 left a cop yo f th e pamphle t a t th e uni t wit h th e occupant . Q Unavailabl e fo rsignatur e —I certifytha t I hav e mad e a goo d fait h effort t o delive rth e pamphlet . Renovat e Right : Importan t Lea d Hazar d Infomnatio 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^ef t a cop yo f th e pamphle t a t th e uni t b yslidin g i t underthedoor . /y^ — r/ ) Printe d nam e o f perso n certil^n g Attempte d deliver y dat e an d tim e lea d pamphle t deliver y / .



## 'je;i0Mf^ Signatur e o f perso n certifying/ea d pamphle t de^ver y. 

# SFsl r/il,r/ M - y 'T^a/k.. . /iie 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 ma ymai 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) .

# pa i n t matc hfor m^J—-^ - Pain t matchin g form : , - - , ., propert yaddress : fd:m ^

9f^5'Ma^r^^^ - BVID : /775 ^ ^ ^ , y fo.. h fcr.m^ ^^^<^ ^

^'^7 ^ ^ J , 

# Explanation : Area : Sk, J fn ^ color : ^" ^ ^'J^' ^ r

_, If / t.6/ » ' • 

# Explanation : , ^^^^ y 

# / D Area : color : Explanation : . - ^ ^^.r<::^v^ Area : color : Explanation : Area : color : Explanation :

Vi.< ^ Cmy^f^CiL . 

# Pag e 1

# ACt^S S /A/ro/?HAT'IoNTn/^CKBi G SHEE T 

# m3' / ^ ^ 293 y ^^//^'- ^ -^Z - SB . \JL/a/ i Ga/^Cic e

PlRI(6ll|fORlMQf !



## OmrCoMMHo t Honw . VAf K Crt ; ^^y;?-^^-cf<^y 5 Rr f

• \ yvHKW V WHP^RMWf f 

## CcOncrOETM L uss a 

# M '^^ 1 ; ^ I ife ^ r^u^ne ^ oc t pnpfier^fU /

^

{^ryeoLi^ner ^

^ i kf^ . A^Ac h

m

## jL>ougia s uoimiy Accoimyniormaiio n rag e I UL J Dougla s county , Nebrask a Propert yRecor d - R081480000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t of 90t h St - VJe W OH Ma p Informatio n is vali d as of 2008-9- 4 Treasurer' s Ta xRepor t Ne wFeatur e -*-*- > Aut o Sale s Searc h 

## Owne r GARCI AJUA N P ETA L 293 5 MARTH A ST OMAHAN E 68105-000 0 Propert yInformatio n Ke yNumber : 1148 0 000 0 08 Accoun t Type : Residentia l Parce l Number : 081480000 0 Parce l Address : 293 5 MARTHAS T OMAHAN E 68105-000 0 Lega l Description : CLARK S PLAC E LO T 43 BLOC K0 1/ 2 VA C ALLE Y AD J & 50 X 86 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $5,400.0 0 $74,800.0 0 S80.200.0 0 200 7 $5,400.0 0 $74,800.0 0 $80,200.0 0 200 6 SMOO.O O $70,600.0 0 $76,000.0 0 200 5 

### $Mdo.o o $70~66o.O O $76,000.0 0 200 4 $5,400.0 0 $70,600.0 0 $76,000.0 0 200 3 $5,400.0 0 $29,200.0 0 $34,600.0 0 Sale s Informatio n Saie s Date : 

## 2006-02-1 0 Dee d Type : • Q C Bool e > 200 6 i Page : 01606 0 Price : $38,000.0 0 Grantor : Jua n P Garci a Grantee : • Jua n P Garci a eta l Valid/invalid : : Invali d Exclusio n Reason : ; No n Bon o wit h Do cStamp s Sale s Date : 2005-09-2 8 Dee d Type : i WD Book : •• 200 5 Page : i 12602 1 Price : i $82,300.0 0 Grantor : ; Grac e J Grove s 

## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R08.. . 10/1/200 8

### Dougla s County AccounUntormatio n i^t ( rag e z o i J Oranteo i ' jug n T Osrci o Valid/lnvalid : \ Vali d Exclusio n Reason : Lan d Informatio n Acre s : S F Unit a j DepfA i ly/tff/ } Vacan t 0.0 9 i 4300. 0 1. 0 86. 0 50. 0 N o Lan d Attribute s AUribut e Attribut e Descriptio n Negativ e Influenc e Traffi c2 Improvemen t Informatio n Buildin g 1

•Ssccr o rioc i iio a 0 K - tt I ies'i:.')rtvH:h'i.i-;hr >

atBa!lJJHMii.iii.i..ic.«.i.i;iy»jaa : &LIC KTO ENLARG E IMAG E Squar e Footage : j 1237. 0 Percen t Complete : ^00.0 % Perimete r! 0. 0 Quality : Fai r UnitType : ' Condition : Averag e

Buil t As : ! 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : j Centra l Ai rt o Ai r Rooms : 6.0 _ Exterior : j Fram e Aluminu m Units : 1. 0 Interior : j Drywal l Baths : 1. 0 Roo f Cover : | Compositio n Shingl e Bedrooms : 3. 0

RoofType : i Gabl e

- ­ ' I I I I Stories : 

# -l'^ _

Floorcover : j Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : [ 0. 0 YearBuil t yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 191 6 0 % 191 6 9 2 Detai l Typ e , Detai l Descriptio n Unit a Applianc e Allowanc e 1. 0 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R08. . . 10/1/200 8

## uou^ia a\^o\mi y AccounijDionnano n rag e : > o i J Basemen t Fixtur e Fixtur e Garag e Porc h Porc h Porc h Use r • Bsmn t Bloc k 8 ft ; Bas e Fixture s : Bat h Ful l i Detache d ; Enc I Soli d Wal l ! Sla b Roo f Cei l : Woo d Dec k

, Atti cFul l Finis h 816. 0 1. 0 l o " 216. 0

52. 0 132. 0 

## "Tei o

408. 0



## http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R08.. . 10/1/200 8

### ' 

## Pruds mPropertv Cios£-Oyt rO?? n i Lsad-Bsss dPm mStafeirisst I D'A-nsr s ftiame: (Tt/- ^ /pa/^f(3 . 

## Performance Stgndards/ciose - 'f m Critsri s I YE S IN O ! 

### ;1 .

Vv'a s th aert-r e structijre{s ) painte dwit hth e exception o f th e ststEd , exdude dareas ? Thi s wouid j Irsdud e csintin g o f othe r ssscciste dfsaturs s includin g fascia , saves , siding , al l trim , c-orches , bo x isams , coiumr.s , raiis, an dexterior surface s c f garages . 2 .

wa s ai l scrapin g andothe r preparsttio n wor k

compiete dsafeisfactorily ? 

# Tv l kl- J 3 . Wer e ai ! requiredarea s ofth e structureis ) primeda s neede dandpainte dwit htw o to p costs ? 

# WV l j4 . Wa s th s paint product s utiiifedequivaient t o a5 0 yea r product/qua'Ity ? \^ ! ­ 

### .Aj e ai i ofth e area s wher e contarrsinatedmaterial s hav e beers , spiiia d thoroughl y vaeuumsd / deaned ? 

# i v T |5 . Di dth e co.ntracto r coliect/vacuutT ! al l fsiling andscrapedpai.n t chip s en th e entire property , 1 roadways , aiieyways , publi c Reces s area s andals o remov e an y other generate ddebris ? i s th e gras s are atha t surrount^ s th e structureis ) i n reasonably goodconditloTi ? 

# i/ i 

# I S .kr e ai l Item s suc ha s polyethylen e sheeting , !adde.rs , pain t brushes , cones , barrier tao e etc . properl y removed ? j 9 .

I s ther e an y evidenc e o f p.fx>ptert y damag e tha t v^a s don ab y th e contractor ? .An y p.fopert y damag e need s t o b s eompiste dprior p th e SP A Close-Out . 10 . .4r 5 ther e an y propert y rtem s tha t ws." e te.~por3tiiv re-socatedb y th e contracto r tha t needt o b e move dbackr i ill . Ar e ther e an v (known ) Hngerin g issue s wit hth e orocert y owner*s' i tha t hav e bee n -ef t unresolve dr I • i « Othe r Considerations?propert y Ov.'ns r Oiscusslonsf-^aditiona i Wo.r k

tha t s

s Requi.re a

-^-<->s . 

### !V

• 'i^' ' V>-l.f " •. — 

## Pruden t Rq9fese?^tative Ja^ e