## TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL EFOLDE R SAID : 2339 2 Date : 12/22/200 8 Address : 341 9 Davenpor t S t Remediation Contractor : Pruden t Technologie s Year : 200 8 PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S 0 ' Video o f propert y (DVD ) [ZTExecutiv e Suminar y mSignedAcces s Agreemen t fo r

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

damag e o r

t

o replac e plants , etc. ) D Photograph s B ^ Satisfactor y restoratio n signedby Propert y Owne r D Propert y close-out chec k

lis t signedby EP A WPropert y information fromDougla s Count y Assessor' s Office D D D ijni/o f 

## Dat e

4030952 0 

# |n i Superfun d

### PROPERT Y SUMMAR Y Date : 12/22/0 8 LB PSTABILIZATIO N EP A CONTRA T EP-R7-08-0 7 Mont hof : Decembe r Propert y Address : 341 9 Davenpor t S t SAID : 2339 2 A . EXECUTIV E SUMMAR Y A. 1 Issue s Encountered : Non e
A. 2 Issue s Resolved : Non e

A. 3 Uniqu e Findings : Non e
122A. 4 Othe r Relevan t Infonnation : Non e Acces s Date : 12/04/0 8 Wor k Began : 12/10/0 8 Closeou t Date : 12/17/0 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

TEChhlOLOCIES . INC .ENVIRONMENTA L& CONSTRUCTIO N 

## TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : 34 1 ^ *T>C^\*4Jjn^X/>r ^ 34 . Date : /;? ^ '3-(P ? Phone : 

# BVID : p339 p iJJf^v k ' ^frO' ^ " ^H?^ ' 36S I Plant & Permanen t Landscaping T o Remai n In Plac e Item# Descriptio n andLocatio n O

n Ma p

Pre-Existing Conditio n o f Structure s Doe s your Basemen t hav e ahistor y o f

leaking ? Ye s — N o - ^ Item# Descriptio n & Locatio n On Ma p ^ /fern ' M^ i r?e)^i ^ < , kx^ii- ^ ^i^i^i>i- )

Propert y Owne r Prudent Employe e Signature : Signature : a,^i;<. l .Ar . 7i : .c.n c 808 0 Vlter d Parkmy , Suit e 40 5 250 5 N . 24* ^

Street , Suit e 30 8 424 2 Medica l Drive , Sult a 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)604-100 4 Phone : (210)822-058 8 JJAn \ eA J 4AA K Ba v <9i mi:7Q.Af;7 7

# 2".V3^ Z

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

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

ofpropertie s locatedin Omaha, Nebraska , includin g the propert y locateda t ^h/' Y /^^^f'/ i /iGf-y
- 2^ . Th e EP A requests your permissio n t o allo w Pruden t t o perfor mLB PStabilizatio n a t thi s property . B y signing thi s form , tiie propert y owner grant s permissio n to Pruden t t o perfonn activitie s relatedto LB P Stabilization includin g scrapin g paint andpaintin g ofth e referencedproperty . Furtiier , th e owner/tenan t verifie s tha t they hav e receive dtiie LB Ppamphlet "Renovat e Right. " If

yo u have an y question s about th e LB Pstabilizatio n plannedfo r

you r

property , pleas e contact Prudent' s Administrative Cler k

fo r

th e Lea dBasedPain t Stabilization , Mrs . Debora hAkerele^ohnson. , a

t (402 ) 504-1004 . Genera l question s abou t the OmahaLea dSit e cleanup ca n b e directedt o the EP A Public Information Center s at (402 ) 731-304 5 (Soutii Omah aoffice) or (402 ) 991-958 3 (Nort hOmaha office) . r Propetty Acoes s Qiante dBy : (Pleas e Prin t Name ) Propeity Owner Signatore : A/s'O.j ^ ^ . .oi u ;? . r\yi..Y\ r {cy>>/(y< ^ ^ ' ' (Signature ) ' (Kte ) PROPERT Y INFORMATIO N (T o b S complete dly y residen t and/o r propert y omie r - pleas e prin Q RESIDEMTNAME : /(A9i'J^/tAd f ^.^f<ig> t C > ( ^ Owngr^ i Rente r RESIDENTADDRESS : 

# JV/ ^

i7^u^eAfic/: / ^ - I F REKTAt. . PROPERT YOWNE D BY : OWNER' S MAIUN G ADDRESS ; 

# ^Me , OWNER' S TELEPHON E NUMBER . HOME : (/^-^ t 7^ 0 ^^ ' f WBORK ! if*'^ \ -^ ^ 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 : / NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLA YI 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 YGATES . ETC. )

AUTHORrr V FO RENVIRONMENTA LRESPONS EACnONS ; Tl w aetivitie t t o b e implemente db y EP Aunde r da s agreemen t ar e puman t t o Sectio n104 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s right o f

acoes s t o di e property i s provide d fot inSectio n104(e ) ofCERCLA . 4 2 U.S . C 960S(e) , wfiicii provide s entry ftr

"detenniningdi e nee d for lesponse . o r choosin g ortakin g any respons e actio nunde r thi s title , o x odwiwis e enfincin g ti e provision s o f di e title. "

i08 0 Wai n Pattovay , Sult a 40 5 250 5 N . 24* ^ Straet , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 'ansa * CH yM O 6411 4 Oinaha , Nebrasic a 6811 0 Sa n Antonio , T X 7622 9 'hone-(816 ) 363-3703 Plione : (402)504-100 4 Plione : (210)822-958 8

# Curren t Sampl e TO-Renovation For m Effectiv e unti l Apri l 2010 . Confirmatio n o f Receip t o f Lea d Pamphle t Q I hav e receive d a cop yo f th e pamphlet , Renovat e Right : Importan t Lea d Hazar d Infonnatio n fo rFamilies , Chil d Car e Provider s an d School s infoimin 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 tjefor e th e w/or k t»egan . Printe d nam e o f recipien t. Dat e 

# y , ;-7..->r . -^ . y. \n c. Signatur e o f recipien t Self-Certificatio 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 . • Refusa l t o sig n —I certifytha t i hav e mad e a goo d fait h effort t o delive rth e

pamphlet , fienovate F^ht : Importan t Lea d Hazar d Infbrmatto n fo rFamilies , 0)3 d Ca m Pmviders 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 raffuse d t o sig n th e confirmatio n o f receipt . I furthe rcertifytha t I hav e lef t a cop yo f th e pamphle t a t th e uni t wit h th e occupant . Q Unavailabl e forsignatur e —I certif ytha t I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , Renovat e Fiight : importan t Lea d Hazar d Infonnatio n for Families , Chil d Ca m pmvider 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 ftjrthercertifytha t I hav e left a cop yo f th e pamphle t a t th e uni t b yslidin g i t underthedoor . ^ 

# J ^ r Ipe^^n s/? " 3'-€>^ Printe d nam e o f perso n certifyin g Attempte d deliver y dat e an d tim e lea d pamphle t deliver y Signatur e o f person'certifyin g lea d pamphle t deliver y 

# /PtA^h^ , 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 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). .

# Pain t matchin g form ; Propert yaddress : 3W9/:^eyi/i^r) f BVID : 533? ^ '^ Area : Color : Explanation : /S^/vA//^^ 

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## uougia s uouQi y Accoun t iciormatio n Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R130512000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-S O f t wes t o f 90t h S t - Vie W O n Ma p Informatio n i s vali d a s o f 2008-9- 4 Treasurer' s fa xRepjor t Ne wFeatur e -»-*- » Aut o Sale s Searc h Owne r TAPIA-SALAZA R MAURILI O •?(J J - '^C / 341 9 DAVENPOR TS T199 " /^l l OMAH AN E 68131-000 0 Propert yInformatio n Ke yNumber : 051 2 000 0 1 3 Accoun t Type : Residentia l Parce l Number : 130512000 0 Parce l Address : 341 9 DAVENPOR TS T OMAH AN E 68131-000 0 Lega l Description : HAWTHORN E AD D LO T5 BLOC K8 4 8 X 110. 6 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $5,800.0 0 $59,500.0 0 $ 65,300.0 0 200 7 $5,800.0 0 $49,700.0 0 $ 55,500.0 0 200 6 $5,800.0 0 $ 49,700.0 0 $ 55,500.0 0 200 5 $ 5,800.0 0 $ 49,700.0 0 $ 55,500.0 0 200 4 $5,800.0 0 $ 49,700.0 0 $ 55,500.0 0 200 3 $ 5,800.0 0 $ 32,000.0 0 $ 37,800.0 0 Sale s Informatio n Sale s Date : 1996-05-2 0 Dee d Type : D Book : 203 4 Page : 25 2 Price : $ 35,900.0 0 Grantor : Grantee : Validllnvalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Depti i Widti i Vacan t 0.1 2 5280. 0 1. 0 110. 0 48. 0 N o Improvemen t Informatio n 

## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R13.. . 9/24/200 8

## ijougia s L^ouni y Accoun t miormatio n Pag e 2 of 2 Buildin g 1 2 1/ 2 Stor yUnfi n 34t S Daver.pot t S t

•'•-"• j I Firs t Floo l 770. 0 s q f t Sec50r. d Flo e 672. 0 S. F

•Jt. 0 31»lf«i)!m/)it T CLIC KT O ENLARG E IMAG ^ CLIC KT O ENLARG E IMAG E Squar e Footage : Perimete r Uni t Type :

Buil t As :

HVAC : Exterior : Interior : Roo f Cover :

Roo f Type : Floorcover : 1442. 0 0. 0 2 1/ 2 Stor yUnfi n Force d Ai r Fram e Aluminu m Drywal l Conipositio n Shingl e Allowanc e Percen t Complete : Quality : Condition : Cond o Squar e Footage : Rooms :

Units : Baths : Bedrooms : Stories : Foundation : 100.0 % Averag e Averag e 0. 0 6. 0 1. 0 1. 5 3. 0 2. 5 Bloc k Yea rBuil t Yea r Remodele d Percen t Remodele d Sprinkle rSquar e Footage : 0. 0 Adjuste d Yea r Buil t Physica l Ag e 192 1 0 % 192 1 8 7 Detai l Typ e Detai l Descriptio n Uni ^ Ad d O n Applianc e Basemen t Basemen t Fixtur e Fixtur e Fixtur e Garag e Porc h Unfinishe d Atti cW/floo r Allowanc e Bsmn t Bloc k 8 ft Minima l Finis h Bas e Fixture s Bat h Ful l Bat h Hal f Detache d Sla b Roo f Cei l 672. 0 1. 0 672. 0 200. 0 1. 0 1. 0 1. 0 160. 0 160. 0



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## 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 of th e stated , exclude d areas ? Thi s woul d includ e paintin g o f othe rassociate d feature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an d exterio rsurface s of garages . 2 .Was ; al l scrapin g an d othe rpreparattio n wor k complete d satisfactorily ? 3 .Wer e al l require d area s o f th e structure(s ) prime d a s neede d an d painte d wit h tw o to p coats ? 4 .Was.th e pain t product s utilize d equivalen t t o a 3 0 yea rproduct/quality ? 5 .Ar e ;al l o f th e area s where contaminate d material s hav e bee n spille d t thoroughl yvacuumed / cleaned ? 6 .Di d th e contracto rcollect/vacuu m al l fallin g an d scrape d pain t chips o n th e entir e property , roadways , alleyways , publi cacces s area s an d also remov e anyothe rgenerate d debris ? I s th e gras s area tha t surround s th e structure(s ) i n reasonabl ygoo d condition ? 

## y 8 .Ar e al l item s such a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e etc . proprerlyremoved ? 9 .

I s ther e anyevidenc e o f propertydamag e tha t wa s don e b yth e contractor ? An ypropertydamag e needs t o be complete d prio rt o th e EP AClose-Out . _ ^ 10 . Ar e ther e anypropertyitem s tha t were temporatii yre-locate d b yth e contracto r that'nee d t o be move d back ? 11 .Ar e ther e an y(known ) lingerin g issues wit h th e propertyowner(s ) tha t hav e bee n lef t unresolved ? Othe rConsiderations?propert yOwne rDiscussions?Addltiona i Wor k tha t i s Require d 

## Pruden t Representativ e Signature : 

# /^fiy/o< t Dat e i/^J/c^^'''^^ ^ ProperjtyOwne rSignature : 

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