## TRANSMITTA Lof OMAHA LEA D SIT E PAIN T STABILIZATIO N FIL EFOLDE R SAID : 1526 8 Date : 12/26/200 8 Address : 282 0 S . 3 2 AVE . Remediatio n Contractor : Pruden t Technologie s Year : 200 8 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 0' Vide o o f propert y (DVD ) Q" Executiv e Summary B Signe dAcces s Agreemen t for subjec t property 3' 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 IS

f Satisfactory restoratio n signe db y Property Owne r D Property close-ou t chec k lis t signe db y EP A 3 Property informatio n fromDougla s County Assessor' s Offic e D D D 

### Signatur e ! Dat e

Superfun d

### PROPERT Y SUMMAR Y Date : 12/23/0 8 LB PSTABILIZATIO N EPA CONTRAT EP-R7-08-0 7 Monthof : Decembe r Propert y Address : 282 0 S . 3 2 AVE . SAID : 1526 8 A . EXECUTTST ESUMMAR 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 : 11/06/0 8 Wor k Began : 11/15/0 8 Closeou t Date : 11/18/0 8 Enclosures : 1 . Pre-Videb 2 . Post-Vide o 3 . Propert y Statu s Form 4 . Signe dAcces s Agreemen t 5 . Pre-Renovatio n Form 6 . Pain t Matc hForm 7 . Trackin g Form 8 . Dougla s County Assessor Propert y Informatio n Pag e 9 . EP A Propert y Closeou t for m 10 . Propert y Completio n Agreement

TECHNOLOGIES , INC .

## icll-jU^C ? Gr^c , ENVIRONMENTA Lft CONSTRUCTIO N 

## TECHNOLOGIES , INC . SERVICE S 

# Property Statu s For m Address : cP<&^C p Phone : -54 \•-T?U4C:: i BVTO : l52.U*$ j Plan t & Pennanen t Landscapinf f

Tn R,ftmai n In Plac e Item # Desdiptio n an dLocatio n OaMa p -^~0*N / 

## A

Pre-Existing Conditio n of Structure s Doe s y^u r Basement hav e ahistor y of leaking ? Ye s - ^ N o ^ Iteni # Desoi p do n & Locatio n ./V>.C30Cf e \sA.t > r^'V^o r oUc?o 4 

# G ay r 

## »^ e

ProperyOwne r Prudent Employe e SigBatne : Signaturcj^ijL ^ <X ^

. .• • . a*M «mK M 91 * fttraat. Suit e 30 8 4M 2 IMlM l OrtVt . Suftt 428 0

# \^2^C^f c Prudea t Tedmologies , Inc , (Prudait ) i s under contrac t (Contrac t #EP-R7-08-07 ) wit hth e U . S . Environmenta l Protectio n Agency (EPA ) t o stabiliz e Lea dBase dPaint (LBP ) a t anumbe r

ofpropertie s locatedin Omaha, Nebraska , includin g th e propert y locatedat o3^Q.C: > " ^ . ^ 2 A^i P The EP A requests your pehnissio n t o allo w Pruden t t o perfor mLB PStabilizatio n a t thi s property . B y signing thi s form, th e prop srt y ovme r

grant s permissio n t o Prudent t o perfor mactivitie s relatedt o LB P Stabilization including sc r |>ing pain t andpaintin g o f th e referencedproperty . Furtiier , th e owner/tenan t verifie s tha t tiiey hav e rec c ive d tiie LB Ppamphlet "Renovat e Right. " If

you have an y question s t bou t th e LB Pstabilizatio n plannedfo r

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

fo r

ti e LeadBase dPain t Stabilization , Mrs . Debora hAkerdeJnhniinn , a

t (402 ) 504-1004 . Gener ai question s about th e Omah aLea dSit e cleanup can b e directe dt o tiie EP A PubU c Infonnation Centersja t (402 ) 731-304 5 (Soutii Omahaoffice) or (402 ) 991-958 3 (Nort hOmaha office) . 

# Glt^X s CALI^ W Pnpctl y Afioct t Onnto dBy : (Pleas e Prin t Name ) 

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# . .^owHl^7fcAK«RK . /^OVG:^^-(>»X: > >/V^ ^ NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : 

# _i l NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDER : 

# ± NUMBE R OFOHILDRB N UNDE R 7 YEAR S OL D WH O PU YI N TH E YAR D FO R 6 HOUR S O R MOR E PE R WEEK : 

# o COMMENT S ORSPECIA L INSTRUCIfONS : QJB . DOGS , ENTR YOATES , ETC. )



## f^i > Do c ^ AUTHOSn Y FO RENVIRONMENTA LHBSPONS EACTIONS ; Ttt e aetivftie s t o It e impiemcntedtr y EP A vndcrtfaitagceeneB t at e ponoan t t o Seetio o 104 ofCERCLA,42U^C9604 . EPA'tri^tfaoce u t o flic pnpettyispnMde dIb r inSectio n104(e ) ofCERO ^ 4 2 U3X960S(e),w]]idipiDnde s enti y Ibr''dcleniiiiiingtii e nee d for leeponse ; o r dnosin g ortakin g an y lespoos e actio nmde r ifa ^

250 S N . 24 * StTMt . Sult a 30 8 424 2 MecHca i Drive , Suit e 42S 0 « a o VAir d Paitany , Stdt e 40 5 :ansMCKy . M O 6411 4 Omaha . NebTMk a 6811 0 Sal t Antonto.T X 7822 8 Phnna * fM9 1 nU. 1 Al U

# Curren t Sampl e ffe-TO i 

# novatio n Fon n Eftaeavsiint n Apri l 20i a Conflnnatio n o f Receip t o f Lea d P t imphle t Qflhaw e recelvQd a cop yo ftl wpa m )hl8t , Aarnvat e R^-llmportan r 1 ^ Irifomiallo n fo rFaniiies,Ct M Ca n tProvldar a an d School s JF/tonrki g m e d l th e potentia l ris k d th e lee d haza ri exposur e fror n iBnovaUo n ac:tlvityt o b e perfomie d i n tn ydweHn g mit . I r e »ive d thi s pamphle t beft)r e th e wor k t)egan . 

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# 5:r r Satf-CertHleaUo n Optio n (Ib rtenanf-occuple d dwelling a only ) — • I fth e lea d pamphle t wa s delivere d I bi t a tenan t signatur e wa s no t obtainabfe , yo u ma ychec k th e appropriat e bo x bebw . Refusa l t o sig n •-- 1 certif ytha t I HsM e niad e a goo d M h effort t o dellvs rth e pamphlet , Aanovat e Right : import i m t Lea d Hazar d IrtformaSo n fo rFemXes , t o th e renta l dwellin g uni t liste d belo wa l th e dat e an d tim e Indicate d an d tha t t l e occupan t refuse d t o sig n th e confirmatio n o fraoeipt . I furthe rcertil ytha t I h a «lef t a cop yo fth e pamphle t a t th e uni t wit h thaoccxpant i Q Unavailabl e fo rsignature— I o e tifytha t I hav e mad e a goo d f ^ eflbi t t o deH wth e pamphlet , Renovat e fViih t importan t Lee d Hazar d tnfdnttttio n fo r FamKeStdiUCaeproiMeraen c ScAoofe . t o th e renta l dweOin 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 freceipt . I furthe rcertil ytha t I hav e lef t a C O 3yo f th e pamphle t a l th e uii t b yslidin g I t underthedoor . 

### ^^g£cM^^_^iJl:iA : g^-w ^ Printe d nam e o fperso n certifyin g Mempltadde/SNer f dateandtim e lea d pamphle t deliver y Signatu e o fperso n certifyin g lea d pdmphle t deliver y



## n^^^. ^ /U ^ 4 ^ « a UnltAddree s Not e Regaidln g MaiUn g OpUo n — ^ a n altemativ e t o deliveryI n person , yo u ma ymai l th e lea d pamphle t t o th e o\/ne r and/o rtenairt . Pamphle t mus t b e maile d atleas t 7 day s beibr e renovatio n (Dojximen t wit h a certilicat e o fmaifn g from th e postoflioe) .' K y^ \

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## Pag e 2 of 2

2 1.' 2 STOR YFINISHE D

CLIC KT Q ENLARG E IMAG E Squar e Footage : I 2134. 0 Percen t Complete : : 100.0 % Perimete r; 0, ( Quality : ; Averag e Uni t Type : j Condition : • Averag e

BuiitAs : I 2 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : i CeitralAirtoAi r Rooms : 8. 0 Exterior : | IW a sonr yCommo n Bric k Units : 1. 0 Interior : ; Drjwal i Baths : 1. 0 Roo f Cover : i C o npositio n Shingl e Bedrooms :

Roo f Type : j Hi p Stories : 2. 5 Floorcover : -' Allcwanc e Foundation : Blocl < Sprinkle rSquar e Footage : 0. 0 yea r ] Percen t Adjuste d Yea r YearBuil t Physica l Ag e Remo t lele d I Remodele d Buil t 190 5 

## y "0 % 190 5 ?0 3 Detai l Typ e ; Detai l Descriptio n Unit a Ad d O n • Fenc e Cliai n Linl t 1. 0

.. . ,.^. ^ Applianc e i Allowanc e Basemen t ; Bsmn t Bloc k 8 f t 910. 0 Fixtur e i Additiona l Fixture s 1. 0 .„, . Fixtur e : Bas e Fixture s 1. 0 Fi)ctur e ; Batl i Ful l 1. 0 Garag e ; Detaciie d 216. 0 Porci i Sla b Roo f Cei l •\~9Z 0 Porc h ^ Woo d Dec k 192 ^



## http://douglasne.mapping-on ine.com/DouglasCoNe/static/accountinfo.jsp?accountno=R14.. . 10/1/200 8

### Pag e 1 o f 2 Dougla s County , Ne b 

### ira s sk a Propeit yRecor d - R140955000 0 Prin t Report NE W Featur e - Parce l Dimension s availabl e @ scal e Q-5 Q f t wes t o f 90t h S t - VJe W O n Ma p Informatio n i s vali d a s o f 2 0 )8-9-: 4 Treasurer' s Ta xRepor t Ne wFeatur e -* - * - 4 A_ut o Sale s Searc h Owne r CADDYGRE G T ETA L 282 0 S 3 2 AV E OMAHAN E 68105-000 0 Propert yInformatio n Ke yNumber : i 09 5 5 000 0 1 4 Accoun t Type : Relsidentia l Parce l Number : 14)955000 0 Parce l Address : 28;!0S32A V OMAHAN E 68105-000 0 Lega l Description : ' R AD D LO T5 BLOC K3 5 0 X 114. 5

• IL E Valu e Informatio n : Lan d Improvemen t Tota l 200 8 $6,00JD.00 

### $135,500.00 $141,500.0 0 200 7 $6,0 0 ).6 o $135,500.0 0 $141,500.0 0 200 6 $6,00) . 0 0 __$116,400.0 0 $122,400.0 0 200 5 $6, ^

).0 0 

### $116,400.00 $122i40ao6 " 200 4 ; $6,0 0 ).0 0 

### $ii6,46ab o $122,400.0 0 200 3 ' $6,000.0 0 

### $116,400.0 0 $122,400.0 0 Lan d Informatio n Acre s : S F \ Unit a I Dept h Widti i Vacan t 0.1 3 5700. C 1. 0 

### 114. 0 50. 0 N o 

### Improvemen t Informatio n Buildin g 1



### http://douglasne.mapping-onime.com/DouglasCoNe/static/accoiintinfo.jsp?accountno=R14. . . 10/1/200 8• •



## Priiden t PropertyClose-Ou t For m (Lead-Base d Pain t Stafoiilzation ) SAID : \Sr^t/'* l Property^Mro^^-^^^^C ^ < ; 1 2h J t4(/j ? . Owner' s Name : ^'^^ ^ ^ fi^^^ M 

## Peiiformance Standards/close-Ou t Criteri a YE S N O 1 .Wa s th e entir e structure{s ) painte d wrt h th e exceptio n o f th e stated , exclude d areas ? Thi s woul d ihclud e paintin g o f othe rassociate d feature s includin g fascia , eaves , siding , ai l trim , porches , bo x tieams , columns , rails , an d exterio rsurface s o f garages . 2 .Wa s al l scrapin g an d othe rpreparattio n wor k 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 .

V/a s th e pain t product s utilize d equivalen t t o a 30 yea rproduct/quality ? 

# i Ar

e al i ofth e areas wher e contaminate d material s hav e bee n spille d I 

### tljoroughl y vacuumed / cleaned ? 5 .Dt 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 als o remove an yothe rgenerate d debris ? 7 .

I s i:h e gras s are a tha t surround s th e structure(s ) i n reasonabl ygoo d condition ? 8 .Arl e ai l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e etc . properl yremoved ? 

# X 9 .I s ther e anyevidence o f propert ydamag e tha t was don e b yth e contractor ? An ypropert ydamag e 

# X / nejedsto be complete d priort o th e EP AClose-Out . 10 . Ar e ther e anypropert yitem s tha t wer e temporatil yre-locate d b yth e contracto r thai t nee d t o b e move d back? 

# Q C 11 .Are ! ther e any(known ) lingerin g issues wit h th e propert yowner(s ) tha t hav e bea n lef t unresolved ? Othis rConsiderations?propert yOwne rDiscussions?Additiona l Wor k tha t i s Require d

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## Pruden t Representativ e Date /i3_'2-0 7