### • # • • 

## TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO NFIL EFOLDE R SAID : 561 0 Date : Address : 81 4 S 3 3 S T 12/27/200 8 Remediatio nContractor : Pruden t Technologie s Year : 200 8 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 0

^ ^ ^ 0 ^ 0 ^ D D M D [ ^ D 

# • D 

### Vide o o f property (DVD ) Executiv e Summary Signe dAcces s Agreemen t for subjec t property Paintin g Agreemen t Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) Photograph s Satisfactory restoratio nsigne db y Property Owne r Property close-ou t chec k lis t signe db y EP A Property informatio nfromDougla s County Assessor' s Offic e

»ienatuc e Dat e

4030800 3 Superfun d

### PROPERT Y SUMMAR Y Date : 12/27/0 8 LB PSTABILIZATIO NEP A CONTRA T EP-R7-08-0 7 Mont hof : December

..,... , . . ,„„..,. . ... . . . . . .,. , ... . 

### Propert y Address : 81 4 S 3 3 S T SAID : 561 0 A . EXECUTIV ESUMMAR Y A. 1 Issue s Encountered : Non e A. 2 Issue s Resolved : Non e

A. 3 Uniqu e Findings : Non e A. 4 Othe r Relevan t Information : Non e Acces s Date : 9/30/200 8 Wor k Began : 10/18/200 8 Closeou t Date : 12/5/200 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 nPag e 9 . EP A Propert y Closeou t for m 10 . Propert y Completio nAgreemen t

TECHNOLOCIES , INC .ENVIRONMENTA L& CONSTRUCTIO N 

## TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : ^/ M ^ Z' ^ '^ ^ • Date : /^^// ^ Phone:(^^crL ) 341-30^1 ) BVID : ^Ul d Plant & Permanen t Landscaping T o Remai nInPlac e Item# Descriptio nan dLocation O

nMa p



## • V.n^ 5 ccis.U7c}- e <=> 7 s^rccf ^ Pre-Existing Conditio no f

Structure s Doe s your Basemen t hav e ahistor y o f leaking ? Ye s —No Item# Descriptio n& Locatio n O

nMa p • L/ijhi^- ^ j/u.inj ' cli-y ^ Gt/\ . Stdimt j C^/utuiir1u/ nJ L^t.^ . 

## ' /?((n / Ot \'i'/o/i* t Luine^ ^ 7i-c>^M^i, scteeyi i / - UJIi^icTcuy ^ a/^^^^c ) f>en^-e^yt ^ c? 7 I^^PC^- C 

## . • l-OiHic e <.lc(/y\c(y^< J eas f </ ^ f\or/l ^ o/ ) f^rcJ i . hcLf\jclLn( ^ i ^ ^(t//llhJk /

2^/&d)/ v do/A1/e^r ^ Propert y Owne r Prudent Employe e j-x^ iTfaJi ^ <^ H Signature : Signature : 808 0 War d Parlcway , Suit e 40 5 250 S N . 24* * Street , Suit e 30 8 424 2 Medica l Drive , Sult a 425 0 Kansa s CHy . M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363470 3 Phone : (402 ) 504-100 4 Phone : (210 ) 822-«58 8 #«AA% VA J 4AA e C a v(9 1 n t RTOitST T

# ^Ui O Pruden t Technologies , Inc . (Prudent ) i s unde r

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

ofpropertie s locatedinOmaha , Nebraska , including the propert y locateda t c^/^ / "> 3 3 5V^ - Th e EP A request s you r

pennissio n t o allo w Pruden t t o perfor mLB PStabilizationa t thi s property . B y signing thi s form , th e propert y owne r

grants permissio n to Pruden t to perfor mactivitie s relate dto LB P Stabilizationincluding scraping paint an dpaintin g o f th e referencedproperty . Further , th e owner/tenan t verifie s tha t they hav e receivedth e LB Ppamphle t "Renovat e Right. " I f

you have an y question s abou t th e LB Pstabilizatio nplannedfo r

you r

property , pleas e contact Prudent' s Administrative Cler k

fo r

th e Lea dBasedPain t Stabilization , Mrs . DeborahAkerele-Johnson . a

t (402 ) 504-1004 . Genera l question s abou t th e OmahaLea dSit e cleanu p ca nb e directedto th e EP A Publi c InformationCenter s a t (402 ) 731-304 5 (Sout hOmahaoffice) or (402 ) 991-958 3 (Nort hOmaha office) . Pfopeit y Acces s Grante dBy : "^ C^jST^A ^ [}(). . fP^V^J^' ^ A/ 1 y. \' I rtPleasePrin t Name ) Propeit y Owne r Signalure : (Signature ) PROPERT Y INFORMATIO N (T o b e complete db y residen t and/o r propert y owne r - pleas e print ) RESIDEN TNAME : Owne r Rente r 

# S/^ l 

# 6 c ^ 3 ^ ^ RESIDEN TADDRESS : I F RENTAL , PROPERT YOWNED BY : 

# Sccm.e ^ OWNER' S MAILIN G ADDRESS ;



# . fl&Z^ 3^/-^f3 , OWNER' S TELEPHON E NUMBE R - HOM E WORK : J L NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OL D . NUMBE R Q F OCCUPANT S 7 YEAR S OL D AND OLDER: . 

# y NUMBER 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. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS ; Th e activitie s t o b e inqjlemente db y EP Aunde r thi s agreemen t ar e puisuan t t o Sectio n104 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s right o f

acces s t o Ih e propert y isprovide dfo r i nSectio n104(e ) ofCERCLA , 4 2 U.S . C 9605(e) , whic hprovide s enti y fo r

"detenniningth e nee dfo r response, o r choosin g ortakin g an y response actio nunde r thi s title , o r otherwis e enforcin g th e provision s o f th e title. "

:08 0 War d Parlcway , Suit e 40 5 250 5 N . 24* ^ Street , Suit a 30 8 424 2 Medica l Drive , Suit e 425 0 iansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 •hone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 3x : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7

# Curren t Sampl e PreHenovatio n For m Effecth/ e unti l Apri l 2010 . Confimnatio n o f Receip t o f ijea d Pamphie t ai/ l hav e receive d a cop yo f th e pamphlet . Renovat e Right : Importan t Lea d Hazar d Infonnatio n forFamilies , Chil d Car e Provider s an d School s informin g m e er f th e potentia l ris k o f th e lea d hazan J exposur e fro m renovatio n activit yt o b e perfomie d i n m ydwellin g unit . I received thi s pamphle t befor e tiie wor k began . 

# Yf^^1(? ^ ^,^u^ ^

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# AiiAf/ ^ Signatur e o f recipien t Self-Certificatio n Optio n (fo rtenant-occupie d dweiiing s only ) — t f tiie lea d pamphle t wa s delivere d bu t a tenan t signatur e wa s no t obtainable , yo u maychec k ttie appropriat e bo xbelow . Q Refusa l t o sig n — 1 certifytiiat I hav e mad e a goo d fait h effor t t o delive rttie pamphlet . Renovat e Right : importan t Lea d Hazar d Informaiio n forFamilies , Chil d Car e Providers an d Sch(X)ls , t o th e renta l dwellin g uni t liste d belo wa t tiie dat e an d time indicate d an d tha t th e occupan t refuse d t o sig n th e confimnatio n o f receipt . I furthe rcertifytiiat 1 hav e left a cop yo f ttie pamphle t a t ttie uni t witt i ttie occupant . Q Unavailabl e fo rsignatur e —I certifytiiat I hav e mad e a goo d faiti i effor t t o delive rth e pamphlet , Renovat e Right : Importan t Lea d Hazir d Infomnatio n for Families , Chil d Car e provider s an d Schools , t o ttie 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 ttie confirmatio n o f receipt . I furthe rcertifytha t 1 hav e left a cop yo f th e pamphle t a t th e uni t b yslidin g i t underthedoor . / 7 . ^ / / 

## jcs>7^ ' -p^^eyjs: /0/Gj/ £ /o/G^/(D ? Printe d nam e o f perso n certifyin g Attemp t }te 6 deliW y dat e an d time lea d pamphle t deliver y 

### /ij2A£'<y^ — Signatur e o f perso n certifyin g lea d pamphle t deliver y 

## ^/O/kcikc ^

iO ^ 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 ttie owne rand/o rtenant . Pamphle t mus t b e maile d a t leas t 7 day s before renovatio n (Documen t wrftt i a certificat e o f mailin g fro m ttie pos t office) .

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### Dougla s County Accoun t InfonMjio n fag e 1 0 1 J . njM^ o Dougla s County , Nebrask a Propert yRecor d - R172247000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t of 90t h S t - VIe W O O Ma p Informatio n i s vali d a s o f 2008-9- 4 Treasurer' s Ta xRepor t Ne wFeatur e -»-•- •Aut o Sale s Searc h Owne r THOMA S CHESTE R H ETA L 81 4 S 3 3 S T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 224 7 000 0 1 7 Accoun t Type : Multipl e Re s Parce l Number : 172247000 0 Parce l Address : 81 4 S 3 3 S T OMAH AN E 68105-000 0 Lega l Description : MAYN E PLAC E LO T8 BLOC K1 5 0 X 12 5 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $ 8,000.0 0 $ 98,300.0 0 $ 106,300.0 0 200 7 $ 8,000.0 0 $ 98,300.0 0 $ 106,300.0 0 200 6 $ 8,000.0 0 $ 87,000.0 0 $ 95,000.0 0 200 5 $ 8,000.0 0 $ 87,000.0 0 $ 95,000.0 0 200 4 $ 8,000.0 0 $ 87,000.0 0 $95,000.0 0 200 3 $ 8,000.0 0 $ 87,000.0 0 $ 95,000.0 0 Sale s Informatio n Sale s Date : 1991-09-2 9 Dee d Type : Book : 191 2 Page : 72 1 

### Price : $ 38,200.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widti i Vacan t 0.1 4 6250. 0 1. 0 125. 0 50. 0 N o Improvemen t Informatio n 

### http://douglasne.mapping-online.coin/DouglasCoNe/static/accountinfo.jsp?accountno=R17. . . 9/24/200 8irma t 

### Pag e 2 of 2 i^uugia s v^uuiii y Accoun i iniormatio n Buildin g 1

- w ^ m a t u ; 77 7 0 sq t t Rrs t Floo r 8400sq.f t KIT 

# —^' 7 ....»]?J!Si? . 

## 2 STOR Y Bhxliai l ^^^.ts^.* . CUC KTO ENLARg E IMAO E CUCO0„ENLARG E IMAG E Squar e Footage : 1616. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : En d Condition : Goo d

Buil t As : 2 Stor y Cond o Squar e Footage : i 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 10. 0 Exterior : Fram e Aluminu m Units : 2. 0 

### Interior : Drywal l Baths : 2. 5 Roo f Cover : Compositio n Shingl e Bedrooms : 4. 0

Roo f Type : Hi p Stories : 2. 0 Floorcover : Allowanc e Foundation : ; Bloc k Sprinkle rSquar e Footage : I 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 190 5 0 % 190 5 10 3 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Applianc e Fireplac e Masonr y 1. 0 Basemen t Bsmn t Bloc k 8 ft 777. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 2. 0 Fixtur e Bat h Hal f 1. 0 Garag e Detache d 460. 0 Garag e Detache d 264. 0 Porc h En d Soli d Wal l 189. 0 Porc h Sla b Roof Cei l 147. 0 Use r Apartment s 2. 0 Use r code i 2 5 t o mode l 1. 0 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo. j sp?accountno= R17.. . 9/24/200 8

## Pruden t Propert yClose-Ou t For m (Lead-Base d Pain t StabHizatior) } SAID ; ^(^Ij )^ . Propert yAddres : 9 1 ^ ^' ^

^ Owner' s Name t clt\-es7e vmorr\a ^ 

## Performanc e Standards/close-Ou t Criteri a YES 

### N O Wasth e entir e stnjcture{s ) painte d wit h th e exceptio n o f th e stated , exclude d areas ? Thi s woui d includ e paintin g o f othe rassociate d feature s inciudin 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 rpreparattio n wor k complete d satisfactorily ? 

# s 3 .Were 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 .

Wasth e pain t product s utilize d equivalen t t o a 5 0 yea rproduct/quality ? Ar

e ai l o f th e areas wher e contaminate d material s hav e bee n spille d thoroughl yvacuumed / cleaned ? 6 .

Di d ths contracto rcollect/vacuum , al ! failin g an d scrape d pain t chips o n th e entir e property , roadways , alleyvwys , publi caccess areas an d als o rem.ov e an yothe rgenerate d debris ? 

# A 7 .

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

# T 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 ? 9 .

I s ther e anyevidence o f propert ydamag e tha t was don e b yth e contractor ? An ypropert ydamag e needs t o b e complete d prio rt o th e EP AClose-Ou t 10 .Ar e ther e anypropert yitem s tha t wer e temporatii yre-locate d b yth e contracto r tha t need t o b e move d back? 11 . Ar e ther e any(known ) lingerin g issues wit h th e p.ropert yowner{s ) tha t hav e bee n lef t unresolved ? Othe rConsiderations?propert yOwne rDiscu5sions?Addition5 l Wor k tha t i s Require d 

# %S \ • 4 ^ O '• \<iX>^ A 

## LuJlx^T ^ 

## Pruden t tentativ e 

# J^¥/o ^ Dat e i-^l H 0 %