## TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL EFOLDE R SAID : 149 6 Date : 12/26/200 8 Address : 582 4 S . 3 1 ST . Stabilizatio nContractor : Pruden t Technologie s Year : 200 8 PAIN T STABILIZATIO N• PROPERT Y FIL EFOLDE RDOCUMENT S e f Vide o o f

property (DVD ) 2 f Executiv e Summar

y sf Signe dAcces s Agreemen t for subjec t property IZf Paintin g Agreemen t D Settlemen t

document s (i.e. , for

damag e o r

t o replac e plants , etc. ) D Photograph s 2 1 Satisfactory restoratio n signe db y Property Owne r D Property close-ou t chec k lis t signe db y EP A 0 Property informatio n fromDougla s County Assessor' s Offic e D D D

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### PROPERT Y SUMMAR Y

Date : 12/27/0 8 LB PSTABILIZATIO NEP A CONTRA T EP-R7-08-0 7 Mont hof : Decembe r Propert y Address ; 582 4 S . 3 1 ST . SAD) : 149 6 A . EXECUTFV ^ SUMMAR Y A. 1 Issue s Encountered : A. 2 Issue s Resolved : A. 3 Uniqu e Findings : NONE . A. 4 Othe r

Relevan t

Information : Acces s Date : 10/31/0 8 Wor k Began : 11/03/0 8 Closeou t Date : 11/05/0 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 nFor 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 nAgreemen t

TECHNOLOCIES , INC .

## TECHNOLOGIES , INC . ENVIRONMENTA L& CONSTRUCTIO

N SERVICE S 

# Propert y Statu s For m Address : 3 ^ Ai 4 '^ - 3 \^ - Date : rj-j'/.^ p Phone : "^'^'2>-f e U ^ 7 " ) c < ~ BVID : iMQi ^ Itein # OalAa p plan t & Pennanen t

Landscapin g T o Remai nI nPlac e Descriptio nan dLocatio n



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Propo ^ Owne r Signature :

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## Pruden t Emplwe e Signtture: ^ /t ^

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### Pruden t Technologies , Inc . (Prudent ) i s unde r contrac t (ConUrac t #EP-R7-08-07 ) wit hth e U . S . Environmental Protectio n Agenc y (EPA ) t o stabiliz e Lea dBase dPain t (L^ ) a t anumbe r o f propertie s locate di nOmaha , Nebraska ^ includin g tfie property locate dat '^Q-'- j o . ^ \^!s\^ ' Th e EP A request s yoti r

permissio n t o allo w Pruden t t o perfor mLB PStabilizatio na t

thi s property . B y signin g thi s form , tihe propert y owne r grant s permissio nt o Pruden t t o perfor mactivitie s relate dt o LB P Stabilizatio nincludin g scr{q)in g pain t an dpaintin g o f

th e reference dproperty . Further , th e owner/tenan t verifie s tiiat

the y hav e receive dtiie LB Ppamphle t "Renovat e Right. " i 

### I f yo u hav e an y question s aljou t th e LB Pstabilizatio nplanne dfo r you r property , pleas e contac t

Prudent' s Ailminiatrativ e Clerk

fo r th e Lea dBase dPain t

Stabilization , Mrs . Debora hAkerele-Johnson . a t (402 ) S04-1004 . General ' question s abou t th e Omah aLeadSit e cleanu p ca nb e directe dt o th e EP A Publi c Inftmnatio n Center s ^ t (402 ) 731-304 5 (SouthOmah aoffice ) o r (402 ) 991-958 3 G^ort

hOmah a office) . PwaertvAtcMiQtantedBv : A-L^ , A J ^L ^ ^ > C^/ 0 j( i UA^A - j (Pleas e Print Name) PrmitttvOwiiaSigMliire : /<^^^^>ig»^/ ACUus^ ^ . . /O^^/'-^Y '

' ^ ~ ( y ' (Signature ) (Date ) PROPERT Y INFORMATION CT o b e complete db y rctldcn t

nd/o r propert y owne r

- (deas e print ) 

### REamewTtiAMB

i /4/ ^ yt/-Z_^/ < CP^DUf^^ A ^^©^o p Rente r RESIDEN T ADDRESS

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^ Z?^~gg-7 ^ I FRENTAL , PROPERT YOWNED BY : 

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# 'd L OWNER' S MAIUN O At»RE8S ; SnM b OWNER' S TELEPHONENUMBER ; HOME : ( \W9RK ; J \ _ NUMBE RO FOCCUPANT S UNDE R7 YEAR S OLD : ^ NUMBERO FOCCUPANT S 7 YEAR S OL D AN D OLDER : NUMBE ROFCHILORENUNDE R7 YEAR S OL D WH O PLA Y I NTH EYAR

D FO R6 HOUR S O RMOR EPE RWEE K COMMENT S O RSPECIA LINSTRUCTIONS : (LE . DOGS , ENTRY GATES , ETC. )

AUHiOIUTY FO

RENVIRONMENTALRESPONS B ACTIONS ; Th e activitie s t o b e implemente dt y EPAunde r iM aagreement are punoan t

t o Sectio n10

4 o f CERCLA , 4 2 U.&C.9M4 . EPA' s rigjitofaccea s t o (h e propert y b provide dfor

I nSectio n104(e ) ofCERCLA . 4 2 U^.C960S(e) . whichpiovide t entr y (br''detenninlngdi e nee dfor

response , jo T choosin g ortaldn g any respons e actionunde r thi s tide , o r oberwis e enlbtcin g ti e provision s o f dw tid^ ^



### OSOWkn l Paricway , Suit e 40 S 250 6 N . 24*^ Street , Suit e 30 8 424 2 Medica l Drive . Suit e 426 0 i .. . OO^J A »_

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## ?-H < 

# Curren t Sampl e Pre-Henovatio n For m Effecav e unti l Apri l 2010 . Conflnnatlo n o f Receip t o f Lea d ^unphie t k l \ hav e receive d a cop yo fth e pamphlet , Renovat e Rl^ t Importan t Lea d Hazar d AIntorrnsttio n fo rf^rr^Ses , (M d Car e Pronridv a an d S(iK(^Marrdingn\ e c A th e poterrtia i ris k

o fth e laa d hazar d o(pos(jr e froT i rerKivatio n activit yt o t) e perfonfne d I n m ydweSin g unit . I receive d thi s pamphle t tiefor e th e wor) < t)egan . Printe d nam e o frecipien t ' Dat e Signatur e o fn^^pen t T^Hr-lnTnrf i SeH-CertiflcatiQ n Optio n (fo rtenantioccuple d dwelling s onl ^ » I fth e lea d pamphle t wa s delivere d buti a tenan t signatur e wa s no t otjtainable , yo u ina ychec k

th e appropriat e bo xt)eicw . Q Refusa l t o sig n —{certif ytha t I hav e mad e a goo d M h effor t t o delive rth e pamphlet , Ranvat a Righ t Importan t Lea d Hazar d hrfannath n fo rFamSes , ChB d Car e Provlder a an d Schools , t o th e renta l dwellin g uni t liste d t)elowa 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 freceipt . I furthe rcertif ytha t I hav e lef t a cop yo fth e pamphle t a t th e uni t wit h th e occupan t Q Unawdlabi e fo rsignature— i certif ytha t I hav e mad e a goo d fait h effort t o delive rth e pamphlet , Renovat e Ft^t : Importan t Laa d Haxar d InformaOo n for Fam ^ Ch U Car e prwlder a m d Schods , 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 confinnatio n o freceipt , i furthe rcotlf ytha t I hav e lef t a cop yo f th e pamphle t a t th e uni t b yslidin g i t Attempte d delivery dateandtim e lea d pamphle t derivar

y Signatur e o fpereo n oMyin g lea d pamphle t deliver y 

# :^cP< / 6\3I ^ UmtAddres s ; ! Not e Regardin g Mailin g Optio n ~ A s a n alternativ e t o delivef yi n person , yo u ma yma O th e lea d pamf^e t t o th e owne rand/o rtenant . Pamphle t mus t b e niaile d a t leas t 7 day s befor e renovatio n (Poojmen t v ^ a certificat e o f mailin g fro m th e pos t office) .

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## uougia s Louniy Accoun t iniflonatio n tafaja ^ rag e i o r / Dougla s County , Nebrask a Propeit yRecor d - R093782000 2 Informatio n i s vali d a s o f 2008-9- 4 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t of SOt h S t - Vje W Or i Ma_ p Treasurer' s Ta xRepor t Ne wFeatur e - ^

- ^ - > Aut o Sale s Searc h Owne r ORDUN AALONZ A ETA L 582 4 S 3 1 S T OMAH AN E 68107-000 0 Propert yInformatio n ;

Ke yNumber : 378 2 000 2 0 9 Accoun t Type : Residentia l Parce i Number : 093782000 2 Parce l Address : 582 4 S 3 1 S T

OMAH AN E 68107-000 0 Lega l Description : DREW S HIL L AD D LO T2 0 BLOC K3 LT S 18-1 9 & 2 0 10 7 X 12 4 Valu e Informatio n

! Lan d 200 8 i i 

### 200 7 1 200 6 I 200 5 200 4 200 3 i

.. ! $8,000,0 0

$8,000.0 0 $8,000.0 0 $8,000.0 0 $8,000,0 0 $8,000.0 0 Improvemen t $49,800.0 0 $49,800.0 0 $49,800,0 0 $46,200.0 0 $42,000,0 0 $42,000.0 0 Tota l $57,800.0 0 $57,800.0 0 $57,800.0 0 $54,200.0 0 $50,000.0 0 $50,000.0 0 Sale s Informatio n

Sale s Date : Dee d Type : Price : Grantor : Grantee : Valid/Invalid : Exclusio n Reason : 1995-03-2 0 D $42,500.0 0 Book : 200 1 

### Page : 40 3

Vali d Lan d Informatio n Acre s S F 0.3 1 13803, 0 Unit s 1. 0 Dept h 

### 107. 0 Widt h

129. 0 Vacan t N o Improvemen t Informatio n 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R09.. . 10/1/200 8Buildin g 1 rag e J . u i J .

1 1, 2 StoryFi n 582 4 S 3 1 St

CLIC KT O ENLARG E IMAG E CLLCKX O ENLARG E IMAG E Squar e Footage : 130 1 0 Perimete r0 0 Uni t Type : Buil t As : , 1 1/

2 Stor yFi n HVAC : I Force d Ai r Exterior : j Fram e Stucc o Interior : Drywal l Percen t Complete : 100.0 % Quality : Averag e Condition : Fai r Cond o Squar e Footage : 0. 0

Rooms : I 5. 0 Units : 1. 0 Batiis : 1. 0



### htt p ://douglasne.mapping-online . com/DouglasCoNe/static/accountinf o . j sp?accountno=R09.. . 10/1/200 8

## Pruden t PropertyClose-Ou t For m (Lead-Base d Pain t StabUlzation )

SAID ! / ^ 9 ^ ^ / Propert y&Hrin,cc . ^

^^ U 5 . 'Jj :i f J T Owner' s isiame : /^/tfA/T n /)t-nU/ ^ 

## Performance Standards/dose-Ou t Criteri a YE S N O 1 . Wa s tii e entir e structure(s ) painte d wit h tli e exceptio n o f tii e stated , exclude d areas ? Tiii s woul d includ e paintin g o f ottie rassociate d feature s includin g fascia , eaves , siding , ai i trim , porches , bo x beams , columns , rails , an d exterio rsurface s o f garages . 

# X 2 . Wa s al l scrapin g an d othe rpreparattio n wori < complete d satisfactorily ? ^ 3 . Wer e al l require d areas o f th e structure(s ) 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 equivalen t t o a 3 0 yea rproduct/quality ? 

# X 5 . Ar e al l o f th e area

s wher e contaminate d material s hav e bee n spiiie d thoroughl yvacuumed /

cleaned ? 

# V 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 areas an d also remove anyothe rgenerate d debris ? 

# X 7 . I s th e gras

s are a tha t surround s th e structure(s } I n reasonabl ygoo d condition ? 

# 2 8 . Ar e al l item s suc h a

s polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e etc . properl yremoved ? 

# y 9 . I s there anyevidence o f propert ydamag e tha t wa s don e b yth e contractor ? An ypropert ydamag e needs t o b e complete d prio rt o th e EP AClose-Out . 

# X 10 . Ar e ther e anypropert yitem s tha t wer e te.nnporatil yre-locate d b yth e contracto r tha t need t o b e move d back? 

# k 11 . Ar e ther e any(known ) lingerin g issues wit h th e propertyowner(s ) tha t hav e bee n lef t unresoh/ed ? Othe rConsiderations?propert yOwne rDIscu5slons?Addition3 l Wor k tha t i s Require d 

# X

Pruden t Representativ e ~ Date |\^q.«,^o 9 

# n ^