TRANSMITTAL OF OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: ^f^U- O Date: gjll [^no g 

Address: ,^1 1 1 ^/^WPftg T Av 

LBP Stabilization Contractor: PRUDENT TECHNOLOGIES, INC. Year: 2009 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

Videoof property (DVD): Pre-Stabilization & Post-Stabilization Videos 

A 

Executive Summary 

Signed Access Agreement Form 

Advance Notice Form 

Pre-Stabilization Video Agreement Form 

A 

Access Tracking Form 

Property Access Assessment Form 

Neighbor Access Agreement Form 

Paint IMatch Form 

d Pre-Stabilization Property Safety Assessment Form 

/ Work-Site Hazards Analysis Checklist 

A Photographs: Pre-Stabilization Property Hazard Assessment Photographs 

Douglas County Assessor Property information 

A Property Completion Agreement Form Signed by Property Owner 

D Property Close-Out Check List Signed By EPA 

Prudent Technologies, Inc. Signature 

Date 

'A Signature 

DatT 

30054689 I 

Superfund 
TECHNOLOGIBS, INC 

Property Summary 

Date; 8/^J/2009 | LBP STABILIZATION EPA CONTRACT EP-R7-08-07 | Month of; Aug. 

Property Address; 2717 Newport Av. SAID #; 40040 

A. Executive Summarv; 

a. Issues Encountered; NONE 

b. Issues Resolved; NONE 

c. Unique Findings: NONE 

d. Other Relevant Information: 

i. Access Date: 7/13/2009 

ii. Work Began: 7/22/2009 

iii. Close-Out Date; 7/23/2009 

B. Enclosures; 

1. Pre-Stabilization Video 

2. Post-Stabilization Video 

3. Signed Access Agreement Form 

4. Advance-Notice Form 

5. Pre-Stabilization Video Agreement Form 

6. Access Tracking Form 

7. Property Access Assessment Form 

8. Neighbor Access Agreement Form 

9. Property Paint Match Form 

10. Pre-Stabilization Property Safety Assessment Form 

11. Work-Site Hazards Analysis Checklist 

12. Pre- Stabilization Property Hazard Assessment Photographs 

13. Douglas County Assessor Property Information 

14. Signed Property Completion Agreement Form 

15. Property Close-Out Check List Signed By EPA 
Jul 13 2009 17:35 Sog|| Omaha Real Estate 402^ 2 7055 
 p . 3 

Jul 13 2009 12siePn PRUDENT TECHNOLOGIES 4025041005 p . 3 

PROPERfY INRJRMAIIOM 

^.^^ (T*beMM]MMtbf MMtdortaaMr print) 

Ownor 

RESnprr ADDRESS: Pe^^-s^^ ? 

•FM^fr/^PfKUeRTYIJIimEDBYl , , i 

ut^c 

^ MWnk n OP OCCUPANTS UNDER f YEARS OLD: l^fl^zliSHsa . OP 

^ 

OCCUPANTS 7 YEARS OLD AND OLDER: 

J^ IWIISI ^ OF CWLINIEN UNDER 7 YEAmOUaWK M PLAY IN THE YARD POR B NOURS OR MORE PER WEEK: 

X

t 

1 

 COMMENTS OR SPECIAL MSTRUCTIONS: <^B. DOQS, SNimr GATES. ETC.) 

_ J fc(£ 

i 

AUIHoklTY FOR B4VnCNMENTitL RESPONSE ACTIONS: ThsacllvillccioMtavlemeBledbyEPABiiierfhisi 

panuan^toSeeKoii I04tfCZXCLA,43USJC.9604. EPA'lilgiitora0CM»t»fliepK«artr toymvMDdfbrlaSeedoo 10<(e)oTCERCLA, 

42 tl.Sl 9'6<'^*V M M fravito «B(i7 fbr "Manlnhig thft iwed fbr MapoBi^ ot clwMisf <v ti^ ^ 

otlMnriic tnibicingthe piwUau ofihe tUs," 

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i 

• M Wwd PMitHrajr. Sute «W n n N. 14^ StTML 8UII» M l 4341 MMfloar Oi|««, 8llll» 43M 

:«nM» City. MO 1(4114 Omah^NebiMkaatllO •M I Antonio, r x 78329 

1iow:(81l)S«a4rO Phem: (4M| KM-IOM PlionK (MO) •224MW 

«i:(eie}3W-9ro> PM : (4l»t)flM-10M PMi;(f10)B7».«877 
Jul 13 2009 17:35 Sot Omaha Real Estate 402 ,332 7055 p.2 

Jul 13 2008 lEtlSPH PRUDENT TECHNOLOGIES 402SO41005 p . 2 

PraiM THluologin, b e CPnidgnt) it under cootnct (Centrwt f EP-RT-OS-OT} wUft tt* U. S. Eavinmiiwala] Protselia 

Affeiicy ffiPA) to itaMlbe Leiii BMB^ Plrinl rLBW at A mmiher nf prepartiM heaiad fa Omat*, MAra«lni, i«>^i^nit Hlf 

«oaert»locB«dai H.'^ n KJftfJpO«: ft>/ 

11ieBl(AreqmMiyonrp«niriHiintoillawPnidaatopefftnnLBP8ti^ilixadoaatth^ Bgr tifnint tbk fenob fbs 

pi«p«ft^ ownor i^ M pmniiskn t» Friidatt lo p«rlbtm aetivMea fdtted to LBP Snl^ ^ 

painting ofteieftmcedprapaty. Furtbor.tfae owaer/teiuntvariftN thatlkey haiv»f«ceiv«d te LBP p«mphlBt"lUnov«tB 

By ripthnditodwuiaeiitl •jreetoaflowraBBPA eontwctortecoadBcf lofl fihimiip ^mtyftepMyfullemiingtmi^h^hri of 

leBd^|ied]Mi]MstabilbBtioa.irtiieMilclHnBpteaottlnadlrlM«nptt^^ IindanlndinttlwMdillialioneeDtiMlcr 

caaot provide MsvMcesofwliUicoiiinKtar wfll te bound to tbe soO cleaanp. IflatheruDdenUndihattlieaoilclMiHip 

eemaiyaf wfll miiia 11 twwnwhlw aJfcrta te IMM M cmusfiAtHM 1^ aa iha |wap*rty tiwnar, may IMW pujawHlHg iftfl 

cbMUp at ny prafWfty. 

^I'^c h I have lead and lodnatawl Ite pangia^ above./ 

Siyutiira of Frov«i^ Owner ' 

Date 

Ifyoiliave aiiy tjuettioiia about the LAP stabilfeeatifln planned ftar yonr propeity, eleaae oontact ftudon'e Cuaon^ 

BflhlhihiiTfflh* MMiMar Ite tte utt i Bawd Faint siiMladon, Mni IftmiMi fffWI •* f4SI) atu.ino4 ap<4nfl>ai2.«ia3. 

Oanecal qoeidoas aboai tke Oxnate Lead Site cleanqp oaa te tftected to to EPA Pdilte bfar m 

3045 Oioudi Oante office) or (402) 9»l-95tt (Nonh Ondia office). 

FroiMitJr Aeoeaa Granted By: 

LU-H^ / 

<Pleaie Print Nana) 

PrafMlifr Owner Si^aoupa: 

(Sigflitute) ^ ^ 

(PaiB) 

I

I 

i. NM VMH« Parfwte. 8uil* 4«S tioft N. aa* atTMt, suiia aas 4X42 Me<llai Qrlvi^ Sulle 4180 

lanMeCKy, MO 94114 Oinate,Nobnrii>a»110 8anAnioniOkTX783M 

(210)8SMna Ptenr. (402)604.1004 

:«x: i8i«) aa>«7elr P«ic:(210>B7»ai7T Pam t4U)BIM-iaeB 

J 
Jul 13 2009 17:36 Soj Omaha Real Estate 402 12 7055 
 p.4 

Jul 13 2009 iStlSPH PRUDENT TECHNOLOGIES 4025041005 p.4 


- Advanced no0e« needed. 

After signing the aecess yon allow Prudent to begin Lead Based 

^aint Stabilization. All Plants, weeds and any vehicles or items on 

o|ien porch (enclosed porches will NOT be stabilized) must be 

removed prior to stabilization. All Pets most be ont of yard during 

stabilization. How much notice do yon need to have above 

n^entioned tasks completed? If you are a landlord you will need to 

contact the tenant as Prudent Technologies will only inform you. 

% Po you have any pets that reside in yard? 

i NO 

X NoticeDeeded:Cd«X^-^ ^ Ji^rtm ^ UJ^ ^ 07H'3^7 O 

/ Number io call to give notice: 

^ l^o m we are giving notice to: ^ooYNcvfs V ^ 

^ liome Owner's Signature 

^.^j^^&iTyttiLniiy 

eoao Weill plarlnHy. SUH* 408 UOS N. S4* Stract. 8uH» 308 4242 Medieel Or<¥». SuNe 4380 

KaMMCRy^ MO 84114 Omehe.Ntbra«kaBBll0 Sen AniMiia,TX 78338 

l>itom:<t16)J8»-V8> PtwiM: (401) IIK<tD04 Pliona: (210) 822.8888 

Rar. (814) taw m FH : <4<»} 884-1008 FaR:(2tO)8r»4Sn 
Jul 13 2009 17:36 SOJ Omaha Real Estate 402 2 7055 
 p.5 

# 

Jul 13 2009 12tl8PH PRUDENT TECHNOLOGIES 4025041005 p.5 


FRE-STABILIZATION VIDEO FORM 

IjUNDERSTAND THAT PRUDENT TECHNOLOGIES WILL BE COMING 

C|UT TO SHOOT A PRE-STABILIZATION VIDEO AT MY PROPERTY. 

I[H £ VIDEO IS JUST A TOOL USED TO DOCUMENT THE CURRENT 

ROPERTY STATUS/CONDITION, A POST VIDEO WILL ALSO BE 

^O T PRIOR TO COMPLETIO N OF STABILIZATION. 

^ OWNERSNAME: ^ ^ f5T»/2«^4J^)'*^^ 

PROPERTYADDRESS: 2.111 N<tti3poirt Rv. 

B{VID/SAID: ^ OO^ O 

I^OMEOWNERS SIGNATURE: 

i 

PJRUDENT REPRESENTATIVE SIGNATURE: 

/ AjNY CONDITIONS NEED TO BE AWARE OF BEFORE SHOOTING 

VJIDEO: (I.E. P£TS» NOTICE NEEDED): 

8M0 Wetd Rariiwiv. BuHa 406 1808 N. M " Streat, SuHs 308 4242 Msdlcel Oitva, 8uN» 4280 

Kansas City 8K} 84114 Omete. Nebnska 18110 Sen Anlanlft^TX 78238 

PteiM! (Oil] 1114701 Phena: (403)804-1004 Plienr. (3181032.8888 

Fax: 1818) 388-»«7 Fax: (403> 884-1008 Fax-(21 Ot 878-8877 

i 
l-f .iiL " 

TECHNOLOGIES, INC 

ACCESS INFORMATION TRACKING SHEET 

BVID: A00^ 0 PROPERTYADDRESS: il H >ie«^?o^'^ ^^ ^ 

Property Owned By: 

(If new property owner) 

Owners Phone No's: Home: Work: 

Cell: ~ Fax: ~ 

Access Contractor: ASW PDA MES PE Other (Prudent) 

DATE TIME ACCESSOR CONRACT DETAIL . 

v%09tA KavJ^-cc 1 tw-^ J ^ p&/ ffTit^^yi if6J(vM\, i^M / ' ^^ 1 / 

1 J 

Comments: 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebrasl^a 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax:(210)579-6577 
TECHNOLOGIBS^ INC. 

Access Assessment Form: (Must be completed for every property. 

Information must be obtained from a property walk thru, not given 

by owner) 

Is the property stucco or asbestos? 

If yes, is any of the stucco or asbestos damaged or cracked? 

s\y^ 

If yes, stop as we can't stabilize this property. It requires special preparation 

techniques. It will be returned to EPA and they will assign at a later date. 

Does this property require lots of scrapping? 

Does this property require a lift or scaffolding to reach upper levels? 

Does this property have lots of plants or items in areas where painting is 

required? 

too 

Does this property have any significant structural damage? 

^70 

If yes, EXPLAIN? 

8080 Ward Parkway, Suite 405 2505 N. 24*^ Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNOLOGIBSb INC 

Does this property have a garage? 

If yes, describe location of garage. 

Does this property have aluminum siding? 

AM3 [fe^^c t e^uooaj s-^^^ ^ 

If yes, is it original factory finish or has it been painted over? 

Does this property have any other type of structural components? (I.e. roof 

shingles as siding)? 

If yes, EXPLAIN? 

Is this property vacant or occupied? 

Are there any pets at this property? 

Are there any low hanging power lines? 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNOLOGIES. INC 

NEIGHBORHOOD PROPERTY ACCESS FORM 

IS THERE A NEIGHBORING PROPERTY THAT NEEDS TO BE ACCESSED ALONG 

WITH ASSIGNED PROPERTY TO COMPLETE STABILIZATION PROCESS? 

NO 

IF IT IS, GET ACCESS FROM ALL REQUIRED NEIGHBORHOOD PROPERTIES. 

N 0 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone:(816)363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
Jul 13 2009 17:36 
 >c^ ^ Omaha Real Estate 402,^3 2 ^ ; 2 7055 P . 6 

Jul 13 2009 12:18PN PRUDENT TECHNOLOGIES 402504100 5 p . 6 

I^AINT MATCHING FORM: 

i 

l b BE V1LLED OITT ONLY IF MATCHING COLOR 

i 

TllOPERTY ADDRESS; 1.111 tv)d UOpO^i f>V<. I 

flVID: ^00^ 0 

IJUNDERSTAND SHERWIN WILLIAMS WILL MATCH MY CURRENT COLORS. 

t 

i 

I

1 

I 

8080 WafJ PMnray, SuNa 408 3808 N. 34"' SlMel»S«IU 308 4343 Medlcel Drive, 8uit»438C 

Kanaaa CM, aK> 84114 Omata,NalMaake 88110 8enAnionio,TX7023e Pteee:(81i|)3a»4701 Flraiw: (4O2>SO4.1O04 Ptiona: (t18)03r8S8e Pex:|810)ia88-97Or Pes: (408)804.1088 FaK(210)»78-887; 
TECHNOLOGIES,] 

Checklist for the/Worksit the AVorks e Hazard Analysis 

Address: 7111 fjieApiMy^ 

Crew: Date: 

Item . OK? t Hazara Corrective Action

Overhead Lines 

In-transit Vehicle Clearance 

Levels around high wires 

Vehicle Clearance around 

high wires when working 

Phone lines 

Cable lines 

Gas Line 

Water Line 

Sewer Line 

Septic Tank 

Propane/Butane 

Access to/on Property 

Neighbor Access Required fJffM:>pi^iiAtr-^ 

High Traffic Area 

Damaged Areas: sink 

holes/rotted wood 

Sprinkler System 

Pets 

Insects 

Weather Conditions 

Unsafe driving conditions 

Unsafe neighborhood 

- y 

Crew Foreman/ ontractor 

8080 Ward Par>w3yrsuite 405 2505 N. 24'" street, Suite 308 42'f8-Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Plione: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax:(816)363-3707 Fax: (402)504-1005 Fax; (210)579-6577 

11111111 


Current Sample Pre-Renovation Form 

Effective until April 2010. 

Confirmation of Receipt of Lead Pamphlet 

CsTl have received a copy of the pamphlet, Renovate Right: Important Lead Hazard 

Information for Families, Child Care Providers and Schools inforining me of 

the potential risk of the lead hazard exposure from renovation activity to be 

performed in my dv^elling unit. I received this pamphlet before the work began. 

Prinlqt^ name of recipient Date / 

Signature of recipient 

Self-Certification Option (for tenant-occupied dwellings only) — 

If the lead pamphlet was delivered but a tenant signature was not obtainable, 

you may check the appropriate box below. 

• Refusal to sign — I certify that I have made a good faith effort to deliver the 

pamphlet, Renovate Right: Important Lead Hazard Information for Families, 

Child Care Providers and Schools, to the rental dwelling unit listed below at the 

date and time indicated and that the occupant refused to sign the confirmation 

of receipt. I further certify that I have left a copy of the pamphlet at the unit with 

the occupant. 

or Unavailable for signature — I certify that I have made a good faith effort to 

deliver the pamphlet, Renovate Right: Important Lead Hazard Information for 

Families, Child Care providers and Schools, to the rental dwelling unit listed 

below and that the occupant was unavailable to sign the confirmation of receipt. 

I further certify that I have left a copy of the pamphlet at the unit by sliding it 

under the door. 

::;)l'H|oq M 1.0 piM 

Printeea namI e of person certifying Attempted delivery 

date and time 

lead pamphlet delivery 

Signature of person certifyingTead pamphlet delivery 

Unit Address 

Note Regarding Mailing Option — As an alternative to delivery in person, you 

may mail the lead pamphlet to the owner and/or tenant. Pamphlet must be mailed 

at least 7 days before renovation (Document with a certificate of mailing from the 

post office). 
Douglas County Account Inf^s; ation Page 1 of3 

Douglas County, Nebraska Property Record - R1753090000 

Information is valid as of 2009-6-16 

Owner 

REAL PROPERTY HOLDINGS LLC ^ 

OKOMAHA REAL ESTATE CO \ 

3715 S 16 ST 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - VlO W O n Ma p 

Treasurer's Tax Report 

New Feature ->-+-> Auto Sales Search 

OMAHA NE 68107-0000 % ^ 

Property Informatio n CA 

Key Number 

Account Type: 

Parcel Number: 

Parcel Address: 

Legal Description: 

Value Informatio n 

Land 

2009 

2008 

2007 

2006 

2005 

2004 

Sales Informatio n 

Sales Date: 

Deed Type: 

Price: 

Grantor 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

5309 0000 17 

Residential 

1753090000 

2717 NEWPORT AV 

OMAHA NE 68112-0000 

MINNE LUSA LOT 26 BLOCK 24 44 X 120 

$5,900.00 

$5,900.00 

$5,900.00 

$5,900.00 

$5,900.00 

$5,900.00 

2008-12-30 

TRD 

$0.00 

Improvement 

$26,900.00 

$26,900.00 

$33,300.00 

$33,300.00 

$33,300.00 

$32,400.00 

Book: 2008 

PETERSON TREVTR 

REAL PROPERTY HOLDINGS LLC 

Invalid 

1997-10-23 

D Book: 2075 

$29,000.00 

^-^ ^ . A n 

L 

y 

Total 

$32,800.00 

$32,800.00 

$39,200.00 

$39,200.00 

$39,200.00 

$38,300.00 

Page: 121876 

Page: 292 

http://douglasne.mapping-online.com/DouglasCoNe/static/accoiintinfo.jsp?accountno=R175... 7/7/2009 
^V"l\^i'^::^••*^ :'•"••'•••'*^J^ «*'l:'^T^'W^W.iinVy"'? ^ ••jKT.^^i.ri' *.'!^. Ti - -ii»>'M': •":**••*.!> "^-'.'; 

Douglas County Account Infl^[iation Page 2 of 3 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth VV/df/} Vacant 

0.12 5280.0 1.0 120.0 44.0 No 

Improvemen t Informatio n 

Building 1 

1 1,': Stnty Unfin 

^'1 ;?;?T: r 

•:' I 

^'fyi^' ^ 

CLICK TO ENLARGE IMAGE 

Square Footage: 704.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Fair 

Built As: 1 1/2 Story Unfin Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 4.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 1.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1923 0 0% 1923 85 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 704.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.j sp?accountno=R 175... 7/7/2009 
Douglas Cotmty Account In^^jiation ^ ^ Page 3 of 3 

Garage Detached 280.0 

Porch End Solid Wall 176.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R175... 7/7/2009 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Fax 

To: Dale Hahn From: Mr. Chandra Shekar 

Fax: 402-932-7055 Pages: 1 + 

Phone: 402-932-7007 Date: 7/13/09 

Re: 2717 Newport Ave, Omaha, NE 

Dale: 

Prudent Technologies (Prudent) is EPA contractor for stabilizing lead based paint 

(LBP). The referenced property has been assigned to us. Please sign on the access 

agreement and fax it back to us. 

If you have any questions, please feel free to call me at 402-504-1004. 

Sincerely, 

71—^>^— -

Mr. Chandra Shekar, P.E. 

Project Manager 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 218 4242 Medical Drive, Suite 7250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
iMl TECHNOLOGIES;, INC. 

Prudent Property Close-Out Form (Lead-Based Paint Stabilization) 

SAID: ^00(^0 

Property Address: A j [ y T^S^M^dyJUi A v 

isysL ^>^^^A77. H»^<^t^ , Owner's Name: 

S.NO 

Performance Standartls/close-Out Criteria Yes NO 

1 Was the entire structure(s) painted with the exception of the stated, 

excluded areas? This would include painting of other associated 

features including fascia, eaves, siding, all trim, porches, box 

beams, columns, rails, and exterior surfaces of garages. 

2 Was all scraping and other preparation work completed 

satisfactorily? 

3 Were all required areas of the structure(s) primed as needed and 

painted with two top coats? 

4 Are all of the areas where contaminated materials have been spilled 

thoroughly vacuumed/ cleaned? 

5 

Did the contractor collect/vacuum all falling and scraped paint chips 

on the entire property, roadways, alleyways, public access areas 

and also remove any other generated debris? 

6 Is the grass area that surrounds the structure(s) in reasonably good 

condition? 

7 Was the paint products utilized equivalent to a 30 year 

product/quality? 

8 Are all items such as polyethylene sheeting, ladders, paint brushes, 

cones, barrier tape etc properly removed? 

9 Is there any evidence of property damage that was done by the 

contractor? Any property damage needs to be completed prior to 

the EPA Close-Out. 

10 Are there any property items that were temporarily re-located by the 

contractor that need to be moved back? 

11 Are there any (known) lingering issues with the property owner(s) 

that have been left unresolved? 

12 Other Considerations? Property Owner Discussions? Additional 

Work that is Required 

Prudent Representative Signature 

Date: / i \ V 

Property Owner Signature: ^^sr\j(T{yf^^(XK (JLVU^-C , 

Date 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816)363-3703 Phone: (402) 504-1004 Phone: (210)822-9588 

Fax: (816)363-3707 Fax: (402)504-1005 Fax:(210)579-6577