## TRANSMITTA LO FOMAH A LEA D SIT E PAIN T STABILIZATIO NFIL EFOLDE R SAID# : fiO \ Date : R^u[^nQ« ^ 

### Address : ^f^t^ \. ^ I S S T LB PStabilizatio n Contractor : PRUDEN T TECHNOLOGIES , INC . Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S s f ^ 9 9 X 1 ^ 3 & ^ ^ M M ^ M m

Video o f property (DVD) : Pre-Stabilizatio n& Post-Stabilizatio nVideo s Executiv e Summar y SignedAcces s Agreement For m Advanc e Notic e For m Pre-Stabilizatio n Vide o Agreement Form Acces s Trackin g For m Propert y Acces s Assessmen t Form Neighbo r Acces s Agreement For m Pain t Matc hFor m Pre-Stabilizatio n Propert y Safet y Assessmen t For m Work-Site Hazard s Analysi s Checklis t Photographs : Pre-Stabilizatio nPropert y Hazar dAssessmen t Photograph s Dougla s Count y Assessor Propert y informatio n Property Completio n Agreement For mSignedb y Propert y Owne r Propert y Close-Out Chec k Lis t SignedB y EPA Pruden t Technologies , Inc . Signatur e Dat e
EP A Signatur e Dat T 3005468 6 

# ili l Superfun dTECHNOLOGIBSi , IN C 

# Propert y Summar y Date ; 8/^^/200 9 | LB PSTABILIZATIO NEPA CONTRAC T EP-R7-08-0 7 | Mont hof ; Aug . Propert y Adtlress ; 250 1 S 1 2 S t SAID # ; 60 1 A . Executiv e Summary; a . Issue s Encountered : NON E b . Issue s Resolved ; NON E c . Uniqu e Findings ; NON E d . Othe r Relevan t Information : i . Acces s Date : 7/13/2009 ii . Work Began : 7/22/2009 iii . Close-Ou t Date ; 7/24/2009 B . Enclosures ; 1 . Pre-Stabilizatio n Vide o 2 . Post-Stabilizatio n Vide o 3 . Signe dAcces s Agreemen t Form 4 . Advance-Notic e Form 5 . Pre-Stabilizatio n Vide o Agreement Form 6 . Acces s Trackin g Form 7 . Propert y Acces s Assessment Form 8 . Neighbo r Acces s Agreemen t Form 9 . Propert y Pain t Matc hForm 10 . Pre-Stabilizatio n Propert y Safet y Assessment Form 11 . Work-Sit e Hazard s Analysi s Checklis t 12 . Pre
- Stabilizatio n Propert y Hazar dAssessment Photograph s 13 . Dougla s County Assessor Propert y Informatio n 14 . Signe dPropert y Completio n Agreement Form 15 . Propert y Close-Ou t Chec k Lis t Signe dB y EP AlS»~:'.\,;i.....":;:i-'-i.--!Tf"'..:j.'ii«.«I=r.: j r-r:rr.yn7rrr^.' "

TECHNOLOGIES . UMC . Pruden t Teciinologies , Inc . (Prudent ) i s unde r contract (Contract #EP-R7-08-07 ) wit hthe U . S . Environmenta l Protection Agenc y (EPA) to stabiliz e Lea dBase dPain t (LBP) a t anumbe r o

f propertie s locate di n Omaha, Nebraska , including the propert y locateda t JL^O l ^ )' ^ g , b Th e EP A requests you r permission to allow Pruden t t

o perfor mLB PStabilization a t thi s property . By signing thi s form, the propert y owne r grant s permission to Pruden t to perfor mactivitie s relatedto LB PStabilization including scraping pain t an d painting ofth e referencedproperty . Further, the owner/tenan t verifie s tha t the y have receivedth e LB Ppamphle t "Renovat e Right. " B

y signing thi s documen t I agree to allow a n EP A contracto r to conduct asoi l cleanu p a t m y propert y followin g completionof lead-basedpain t stabilization , i f the soi l cleanu p has no t alread y bee n performed . I understan dtha t the stabilizationcontracto r canno t provid e assurance s of whic hcontracto r wil l be boun dto the soi l cleanup . I furthe r understan dtha t the soi l cleanu p contracto r wil l mak e all reasonable effort s to addres s concems tha t I , as th e propert y owner, ma y have regarding soi l cleanu p a t m y property . [y \Yes , I hav e rea dan dunderstan dthe paragrap habove . Signatur e of Prop © Dat e I f yo u have an y question s abou t the LB Pstabilization plannedfo r you r property , pleas e contact Prudent' s Custome r Relations/Office Manage r fo r th e Lea dBase dPain t Stabilization , Mrs . Shanno n Holt , a t (402 ) 504-100 4 o r (402)812-0223 . Genera l question s abou t the Omah aLea dSit e cleanu p ca n be directedto the EP A Public Informatio n Centers a t (402 ) 731
­ 3045 (Sout hOmah aoffice ) o r (402 ) 991-958 3 (Nort hOmah aoffice) . Propert y Acces s 

# t inte dBy : Pleas e Prin t Name) Propert y Owne r Signature : 

# l-<]y H (Date)

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , IVI O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Pax : (402)504-100 5 Fax:(210)579-657 7TECHNOLOCnSS . IN C PROPERT YINFORMATIO N (T e and/o rpropert yowne r—please print ) y ^ (I p p b be complete complete d db

by

yresiden

residen t t ai RESIDEN TNAME : Owne r^ Rente r RESIDEN TADDRESS : 

# r-<^ . x: ^ cS v IF RENTAL , PROPERT YOWNE D BY :
OWNER' S MAILIN G ADDRESS ; OWNER' S TELEPHON E NUMBE R - HOME : 7~fO\ \ ^tt^V^^ViOR^ : ( ^M T I/1~SI~7 T NUMBER OF OCCUPANT S UNDE R 7 YEAR S OLD : ^ NUMBER OF OCCUPANT S 7 YEAR S OL D AN D OLDER : 

# .3 - NUMBER OF CHILDRE N UNDE R 7 YEAR S OL D WHO M PLA YIN TH E YAR D FO R 5 HOUR S OR MOR E PE R WEEK :
COMMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONSE ACTIONS : Th e activitie s to be implemente d

by EP A unde r thi s agreemen t ar

e pursuan t to Sectio n 10 4

of

CERCLA,42 U.S.C . 9604 . EPA' s righ t of acces sto the propert y

is providedfo r in Sectio n 104(e )of CERCLA, 42 U.S . C 9605(e) , whic hprovide s entr y fo r "determining the nee dfo r response ,or choosin g

or taking an y respons e actio n unde r thi s title , or otherwis e enforcin g the provision s ofth e title. "

8080 Ward Parkway , Suit e 405 250 5

N. 24' " Street , Suit e 308 4242 Medica l Drive , Suit e 425 0 Kansa s City , MO 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816) 363-3703 Fax : (816) 363-3707 Phone : (402)504-100 4 Fax : (402)504-100 5 Phone : (210)822-958 8 Fax : (210)579-657 7TECHNOLOGIES ^ IN C 

# Advance dnotic e needed . After signin g th e acces s you allo w Pruden t t o begi n Lea dBase d Pain t Stabilization . All Plants , weed s an dan y vehicle s o r item s o n ope nporc h(enclose dporche s wil l NO T b e stabilized ) mus t b e remove dprio r t o stabilization . Al l Pet s mus t b e ou t of yar ddurin g stabilization . Ho w muc hnotic e d o yo u nee dt o hav e abov e mentione dtask s completed ? I f yo u ar e alandlor dyo u wil l nee dt o contac t th e tenan t a s Pruden t Technologie s wil l onl y informyou . D o you hav e an y pet s tha t resid e i n yard ? fO Q Notic e needed : 5' 3 A^nAT S Numbe r t o cal l t o giv e notice : ^/"]
- ^li ' Who mw e ar e givin g notic e to : (^_jXQ ) 'V ^ Hom e Owner' s Signatur e

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax:(816)363-370 7 Fax : (402)504-100 5 Fax:(210)579-657 7TECHNOLOGIES , 1 

## PRE-STABILIZATIO N VIDE O FOR M I UNDERSTAN D THA T PRUDENT TECHNOLOGIE S WIL LB ECOMIN G OU T T O SHOO T A PRE-STABILIZATIO NVIDE O A T M Y PROPERTY . TH EVIDE O I S JUS T A TOO LUSED T O DOCUMENT TH ECURREN T PROPERT Y STATUS/CONDITION . A POS T VIDE O WIL LALS O B E SHO T PRIO RT O COMPLETIO NO FSTABILIZATION . OWNER S NAME : 

# yf \ PROPERTYADDRESS : ^S5 1 ^ ' 1 ^ ^ BVID/SAID : 6^ 1 HOMEOWNER S SIGNATURE : PRUDEN T REPRESENTATIV ESIGNATURE : 

# [}/7il^ H AN Y CONDITION S NEED T O B EAWAREO FBEFOR ESHOOTIN G VIDEO : (LE . PETS , NOTIC ENEEDED) : A p ^

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone:(816)363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax:(816)363-370 7 Fax : (402)504-100 5 Fax:(210)579-657 7STt o sr4 ; V> ^ TECHNOLOGIES , IN C .& ( pno1 ^ 

# ACCES S INFORMATIO NTRACKIN GSHEE T 

# : 60 1 . 2 5o a^ ^ ^ 

# s l BVI D PROPERT Y ADDRESS : ^ Propert y Owne dBy : (I f ne w propert y owner )

Owner s Phon e No's : Home : ------ i ---- ' Work : Cell : Fax : Acces s Contractor : AS WPD A ME S P EOthe r (Prudent ) DAT E TIM E ACCESSO R CONRAC T DETAI L 

# 7 H /.prv , k*aoi< u t 

# ^ri^ c c\\^y ^ I

Comments :

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax:(210)579-657 7TECHNOLOGIES i 1 

## Acces s Assessmen t Form : (Mus t b e complete dfo r ever y property . Informatio nmus t b e obtaine dfro mapropert y wal k thru , no t give n b y owner )
I s th e propert y stucc o o r asbestos ? I f

yes , i s an y ofth e stucc o o r asbesto s damage do r cracked ? I f

yes , sto p a s w e can' t stabiliz e thi s property . I t require s specia l preparatio n techniques . I t wil l b e returne dt o EP A an dthe y wil l assig n a t alate r date . 

## N O Doe s thi s propert y requir e lot s o f scrapping ? Doe s thi s propert y requir e alif t o r scaffoldin g t o reac huppe r levels ? Doe s thi s propert y hav e lot s o f plant s o r item s i n area s wher e paintin g i s required ? 

# y ' Doe s thi s propert y hav e an y significan t structura l damage ? 

## (A ) I f

yes , EXPLAIN ? Nl O

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7TECHNOLOGIES . IN C 

## Doe s thi s propert y hav e agarage ? I f

yes , describ e locatio no f garage . 

# 1)A4 O Doe s thi s propert y hav e aluminu msiding ? ^J 0 I f

yes , i s i t origina l factor y finis ho r ha s i t bee npainte dover ? Doe s thi s propert y hav e an y othe r typ e o f structura l components ? (I.e . roo f shingle s a s siding) ? I f

yes , EXPLAIN ? I s thi s propert y vacan t o r occupied ? )iU! ^ W ) i.- ^ C«v(U/ ^

^ ^c-VA^es^ , 

## Ar e ther e an y pet s a t thi s property ? So^i^"\ ­ (5 ^ (fr»v^ ^

"u , \=.Yr^Q^ _ } ^ §r»vti * |VtAi9- » jy ? ^/,C4.^< : s-- ^ ^ ^ yt:^1py ^ _cr ^ 5/^ « 

## Ar e ther e an y lo w hangin g powe r lines ?

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7TECHNOLOGIES , INC . 

## NEIGHBORHOO D PROPERT Y ACCES S FOR M I S THER EA NEIGHBORIN GPROPERT Y THA T NEED S T O B EACCESSED ALON G WIT H ASSIGNED PROPERT Y T O COMPLET ESTABILIZATIO N PROCESS ? W O 

### I FI T IS , GE T ACCES S FRO M ALLREQUIRE D NEIGHBORHOO D PROPERTIES . ^ty O

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax:(210)579-657 7TECHNOLOGIES , IN C 

## PAIN T MATCHIN GFORM : T O B EFILLE D OUT ONLY I FMATCHIN GCOLO R PROPERTYADDRESS ; J^bO l 5 II . St 

## BVID ; (^C> 1 1 UNDERSTAN D SHERWIN WILLIAM S WIL LMATC H MY CURREN T COLORS . Homeowner signaturi 

# uOil l CA1 \ aJf V to ^ jy ^ ^ ^'' ^

808 0 War d Parkway , Suit e 40 5 250 5 N . 24* " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 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)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7TECHNOLOGIES. ] 

### PRE-STABILIZATIO NPROPERT Y SAFET Y ASSESSMEN T FOR M PROPERT Y ADDRES S 

# : 

# :x9o \^ 

# ^ a^ + BVID/SAID : (o d PRUDENT ASSESSMENT REPERSENTATIVE : 

# i^oy i ^^^ ­ ******I FSAFET Y RIS K PROPERT Y MUS T B ETURNE D OVE RT O KATH Y ROTHE RBEFOR EI T CA N B EASSIGNE D T O A CREW/SUB . REPERSENTATIV EREMARKS/FINDINGS ; (POWER-LIN EPROXIMIT Y T O PROPERTY , SCAFFOLDING / LADDERS / LIFT S NEEDED , UNSAF EAREAS , UNSAF ENEIGHBORHOOD...ETC. )

REQUIRE S K.ROTHE RAPPROVAL YES/N O SUBMITTED T O K.ROTHE RON ;

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax:(816)363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7TBCHNOLOCIBS . IN C 

# Checklis t fo r th e Worksit e Hazar dAnalysi s Adtiress : ^<S^ [ Q i ^ Q T Crew : Date : Ite m OK ? 1 Hazar d Correctiv e Actio n Overhea dLine s SaiT M ^ iXe ^ li^yr^^y^— ' In-transi t Vehicl e Clearanc e Level s aroun dhig hwire s Vehicl e Clearanc e aroan d hi^ hwire s whe nworkin g Phon e line s . 

### Cabl e line s Ga s Lin e . - 

### Wate r Lin e ^__^. ^ 

### Sewe r Lin e Septi c Tan k ^..
­ 

### Propane/Butan e Acces s to/o nPropert y 

## n o pdLYKiVA
­ 

# iCfsf^L-t
- Neighbo r Acces s Require d .jl/T\.SfHi l W i SrXn^OfLMtk ^ Hig hTraffi c Are a 

# r 

# T^ ^ Garag e 

# Kr.cL/ u )rtO(dl ' ' Structure s 

## (2/2Sb^?Vc f * 1 a Drivewa y KAz>k« ^ 

## )t^K(AU... ^ . Sidewalk Q}t.u}^ ^
- U^Oy>&<\^A ^ 6 I i ^ ^ I Foundatio n Ppj^X^ft ^ 

### ZVC8J U OXJ.^OJLACU ^ 

### 3wu ^ 5^y<\M.\^&y6f'^^Lwid>i^ \ Retainin g WaUs Fence s • A A 1 1 1 

### Tree s S ty^--- ^ 

## t^uQ^/i^ i 

# uJ.cuA^iy^Jl . h- o Foliag e / Genera l Conditio nof yar d 

# e> C Damage dAreas : sink ^ 

### holes/rotte dwoo d 

# -(Wh^ Q ^ 

### Sprinkle r System v . ^ ^ 

### Pet s 

## PAT
- Insect s Weathe r Condition s - ^ 

### Unsaf e drivin g condition s .— 

### Unsaf e neighborhoo d 

### Forenmn ^ Sub-Contracto r
108

0 Ward Mrkway , Suit e 40 5 2505 N . 24* " street , Suit e 308 irive , Suit e 425 0 Kansa s dtp , MO 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 >hone : (816) 363-3703 Phone : (402)504-100 4 Phone : (210)822-958 8 ^ax : (816) 363-3707 Fax : (402)504-100 5 Fax : (210 ) 579-6577^^- ,

J l

.- m^v HHBHK'^^ LB 

# K I

• i ft 

## 'uBk '''r l 'A^^$ 

# 1 

# 1

# Curren t Sampl e Pre-Renovatio n For m Effectiv e unti l Apri l 2010 . Confirmatio n o f Receip t o f Lea d Pamphle t & I hav e receive d a cop yo f th e pamphlet , Renovat e Right : Importan t Lea d Hazar d Informatio n fo rFamilies , Chil d Car e Provider s an d School 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 ydwellin g unit . I receive d thi s pamphle t befor e th e v\/or k began . 

# ^-^-rf f Signatur e o f recipifen 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 effor t t o delive rth e pamphlet , Renovat e Right : Importan t Lea d Hazar d Informatio n fo rFamilies , Chil d Car e Provider s 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 lef t a cop yo f th e pamphle t at th e uni t wit h th e occupant . • • Unavailabl e fo rsignatur e — I certifytha 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 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 e lef t a cop yo f th e pamphle t at th e uni t b yslidin g i t unde rth e doo r 

# '^ari\^ \f^\t'^ A 'It-^C^^O ^ ^ Printe a nam e o f perso n certifyin g Attempte d deliver y dat e an d tim e 

## yl^^ K lea d pamphle t deliver y Signatur e o f perso n certifyin g lea d pamphle t deliver y

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 maymai 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) .

### Douglas Count y Accoun t In£anatio n Page 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R070423000 0 Prin t Repor t ,_r

_4„

_ • „ ,„I: J t nr\f\ n e ^ e NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t o f 52n d S t - Vie W O H Ma p informatio n i s vali d a s o f 2009-6-1 6 Treasurer' s Ta xRepo S Ne wFeatur e ->-»- > Aut o Sale s Searc h Owne r SMIT H JASO N A\ y\ \ 

# P ^ Go \ 250 1 

## 8 1 2 S TY\0 ^



## \ W OMAH AN E 68108-000 0 \ V ^

\ ^ Propert yInformatio n Ke yNumbe r042 3 000 0 0 7 Accoun t Type : Residentia l Parce l Numbe r070423000 0 Parce l Address : 250 1 8 1 2 S T OMAH AN E 68108-000 0 Lega l Description : BOWER YHIL L LO T7 BLOC K8 LT S 6 & 7 13 2 X 13 8 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $11,400.0 0 $ 92,600.0 0 $104,000.0 0 200 8 $11,400.0 0 $ 92,600.0 0 $104,000.0 0 200 7 $11,400.0 0 $ 92,600.0 0 $104,000.0 0 200 6 $11,400.0 0 $ 77,200.0 0 $88,600.0 0 200 5 $11,400.0 0 $ 77,200.0 0 $88,600.0 0 200 4 $11,400.0 0 $ 77,200.0 0 $88,600.0 0 Sale s Informatio n Sale s Date : 2004-01-2 0 Dee d Type : W D Book : 200 4 Page : 03607 2 Price : $97,500.0 0 Granto rDavi d J Zenchu k Grantee : jaso n A8mith eta l Valid/Invalid : vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Deptf i Widt h Vacan t 0.4 1 18216. 0 1. 0 138. 0 132. 0 N o Improvemen t Informatio n 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R070.. . 7/7/2009*.Ij/.^CO'S ' .WW""l^''^^•'''.t'^'f'^'^^A-M.jf^v.'fU^.ty f • !..^!,f • ^-' •'V.ti.y y '?r'•"-•T;'rt'••"•;•. ^ 

### Dougla s County Accoun t In£|^atio n Pag e 2 of 2
Buildin g 1 :'M i sn^'o t I'Li^STO^YUNFI N

. : E*-,.- - 0 ! • ••i•' ^ 0 :- n

CLIC KT O ENLARG E IMAG E Squar e Footage : 1738. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Fai r

Buil t As : 2 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 7. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 4. 0

Roo f Type : Hi p Stories : 2. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 189 5 0 % 189 5 11 4 Deta/ 7 Typ e Detai l Descriptio n Unit s Ad d O n Unfinishe d Atti cW/floo r 864. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 864. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 360. 0 Porc h En d Scree n 160. 0 Porc h Ope n Sla b 112. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R070. . . 7/7/200 9

# t

TECHNOLOGIBS . IN C 

## Pruden t Propert yClose-Ou t For m (Lead-Base d Pain t Stabilization ) SAID : 

# M . Propert yAddress : 2-770 1 ^ ' J< ^

S ^ Owner' s Name : d^Ol J j Ufi^dlu7\ ) C/HlHf

S.N O 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 o f 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 o f garages . 2 Wa s al l scrapin g an d othe rpreparatio n worl ( 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 Ar e al l ofth e area s wher e contaminate d material s hav e bee n spille d thoroughl yvacuumed / cleaned ? 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 area s an d als o remov e an yothe rgenerate d debris ? 6 I s th e gras s are a tha t surround s th e structure(s ) i n reasonabl ygoo d condition ? 7 Wa s th e pain t product s utilize d equivalen t t o a 3 0 yea r product/quality ? 8 Ar e al l Item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e et cproperl yremoved ? 9 I s ther e an yevidenc e o f propert ydamag e tha t wa s don e b yth e contractor ? An ypropert ydamag e need s t o b e complete d prio rt o th e EP AClose-Out . 1 0 Ar e ther e an ypropert yitem s tha t wer e temporaril yre-locate d b yth e contracto rtha t nee d t o b e move d bacWf 1 1 Ar e ther e an y(Itnown ) lingerin g issue s wit h th e propert yowner(s ) tha t hav e bee n lef t unresolved ? 1 2 Othe rConsiderations ? Propert yOwne rDiscussions ? Additiona l Worl ( tha t i s Require d 

### Pruden t Represenftativ e Signature : 

# Date :7/W ^ Propert yOwfie rSignature^ 

# Date : 2^7/4 " 808 0 War d Parkway , Sui t 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax:(210)579-657 7TECHNOLOGIBS , IN C 

## EP AClose-Ou t For m (Lead-Base d Pain t Stabilization ) BVID : AC> \ Propert yAddress : D^O ] S / 2 - S l Owner' s Name : Ct ^ Cr>L ^ 3"*^'^ ' ' ^ 

### S.N O Performanc e Standards/close-Ou t Criteri a 1 Wa s th e entir e structure(s ) painte d wit h th e exceptio n o f 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 o f garages . 2 Wa s al l scrapin g an d othe rpreparatio n wor k complete d satisfactorily ? 3 Wer e al l require d area s o f th e structure(8 ) prime d a s neede d an d painte d wit h tw o to p coats ? 4 Ar e al l ofth e area s wher e contaminate d material s hav e bee n spille d thoroughl yvacuumed / cleaned ? 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 area s an d als o remov e an yothe rgenerate d debris ? 6 I s th e gras s are a tha t surround s th e structure(s ) i n reasonabl ygoo d condition ? 7 Wa s th e pain t product s utilize d equivalen t t o a 3 0 yea r product/quality ? 8 Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e et cproperl yremoved ? 9 I s ther e an yevidenc e o f propert ydamag e tha t wa s don e b yth e contractor ? An ypropert ydamag e need s t o b e complete d prio rt o th e EP AClose-Out . 1 0 Ar e ther e an ypropert yitem s tha t wer e temporaril yre-locate d b yth e contracto rtha t nee d t o b e move d back ? 1 1 Ar e ther e an y(known ) lingerin g issue s wit h th e propert yowner(s ) tha t hav e bee n lef t unresolved ? 1 2 Othe rConsiderations ? Propert yOwne rDiscussions ? Additiona l Wor k tha t i s Require d



### EP ACOR / Representativ e 

# ^'^yy/oM^-^-^^^*^^'^ ^ Dat e 

# ^lAo i Ye s 

# y y y

. y 

# y y y y N O



# y y 

# y y