## TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R SAI D # : 2184 2 Date : 12/08/200 8 Address : 90 6 S 3 8 S t Remediation Contractor : Pruden t Technologie s Year : 200 8 PAINT STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S Video of propert y (DVD ) Executiv e Summar y SignedAcces s Agreemen t fo r

subject propert y Painting Agreemen t D 

## Settlemen t documents (i.e. , fo r

damag e o r

to replac e plants , etc. ) D 

## Photograph s Satisfactor y restoratio n signedby Propert y Owne r D 

## Propert y close-out chec k

lis t signedby EP A [ / 

## Propert y information fromDougla s Count y Assessor' s Office D D D


## ^a<,^ ^ zlzslo' i Signatur e Dat e

4030982 6 

# iHll l Superfun d

### PROPERT Y SUMMAR Y 1 Date : 12/08/0 8 LB P STABILIZATIO N EP A CONTRA T EP-R7-08-0 7 

### 1 Monthof : Decembe r 1 1 Propert y Address : 90 6 S 3 8 S t SAID : 2184 2 

### A . EXECUTIV E SUMMAR Y A. 1 Issue s Encountered : None A. 2 Issue s Resolved : None

A. 3 Uniqu e Findings : None
122A. 4 Othe r Relevan t Infomiation : None Acces s Date : 09/13/0 8 Wor k Bega n Date : 10/10/0 8 Closeou t Date : 10/31/0 8 Enclosures ; 1 . Pre-Vide o 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 hFor m 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 Agreemen t

TECHNOLOGIES , INC
.ENVIRONMENTAL & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S



# . , / Propert y Statu s For m Address : ^i h 5 5 ^ ^5 Y Date : ^^/^-^ f 

# Phone : ^/fi-//f / BVID : ;^/fV ^ Plant & Pennanent Landscaping T o Remain I n Plac e Item # Descriptio n andLocatio n OnM ^

Pre-Existin g Conditio n of Structure s Doe s you r

Basemen t hav e ahistor y o f leaking ? Ye s —N o — Item # Descriptio n & Locatio n On Ma p

Propert y Owne r Prudent Em i Signatur e Signature : 808 0 Ward Parkway , Suit e 40 5 Kansa s City , M O 6411 4 Phone : (816 ) 363^70 3 250 6 N
. 24* ^

street , Suit e 30 8 Omaha , Nebraslc a 6811 0 Phone : (402)504-100 4 424 2 Medica l Drive , Suit e 42S 0 Sa n Antonio , T X 7822 9 Phone : r2i m aoo-oco o Fax : (816 ) 363-370 7

## Pruden 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 ) t o stabiliz e Lea dBase dPaint (LBP ) at anumbe r

o f propertie s locate di n Omaha , Nebraska , includin g ^ e propert y locateda t ^t)lc > ^ . "3^^ ^ ^ - The EP A request s you r

permissio n t o allo w Pruden t t o perfor mLB P Stabilizatio n a t thi s property . B y signing thi s form, tiie propert y owne r

grant s permissio n t o Pruden t t o perfor mactivitie s relate dt o LB P Stabilization including scrapin g paint andpaintin g o f th e referencedproperty . Further , th e owner/tenan t verifie s tha t they hav e receive dth e LB Ppamphle t "Renovat e Right " If

you hav e an y question s about th e LB Pstabilizatio n plannedfo r

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

fo r

th e Lea dBase dPaint Stabilization , Mrs . Debora hAkerele-Johnson , a

t (402 ) 504-1004 ; Genera l question s aboutth e OmahaLea dSit e cleanup ca n b e directe dt o th e EP A Publi c Information Center s a t (402 ) 731-304 5 (Sout hOmahaoffice) or (402 ) 991-958 3 (Nort hOmaha office) . Property Acces s Onnte d 

## Bv : Wesle y (Pleas e Prin t Name ) Property Owne r Signature : 

# 9-IZ-C H (SignatureT" ' (Date ) PROPERT Y INFORMATIO N iinpletc^%g(^rtsiden t and/o r propert y oirae r - plet K print ) RESIDEN TNAME : Rente r 

# ^O^ S 

# 3 ^ S f


# , : Sel Q RESIDEK TADDRESS : I F RENTAL
. PROPERT Y OWNE D BY : OWNER' S MAIUN G ADDRESS ; TlX*^- ^ OWNER' S TELEPHON E NUMBE R - HOME : f^Q2>/{Q'W^ i WORK : t \ NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : C ^

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 Y I N TH E YAR D FO R 5 HOUR S O R MOR E PE R WEEK : C J COMMENT S O R SPECIA L INSTRUCTIONS : (I.E
. DOGS , ENTR YGATES , ETC. ) 

# AMI ^
AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s t o b e implemente db y EP A unde r di s agreemen t ar e pursuan t t o Sectio n104 o f

CERCLA , 4 2 U.S.C . 9604 . EPA' s ri^ o f acces s t o Hie propert y isprovide d fiw nSectio n104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , wtuc hprovide s entr y fa t

"determiningfli e nee dfb r response , o r dioosin g ortakin g «ny respons e actio nunde r du s title , o r otherwis e enfiwcin g th e provisicn s o f 4 e title. "

2505 N
. 24* ^ Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 080 War d Pailmay , Suit e 40 5 Sa n Antonio , T X 7822 9 Omaha , Nebrask a 6811 0 ansa s City , M O 6411 4 Phone : f2in i »90.OBP O Phone : (402)504-100 4 hone : (816 ) 363-3703 ax : (816 ) 363470 7

# 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 O l hav e receivecl a copyo f th e pamphlet , Renovat e Rtjght : Importan t Lea d Hazar d Infonnatio n fo rFamilies , Chil d Car e ftovicfera an d School s informin g m e o f th e potentia l risk o

f th e lead hazar d exposur e fro m renovatio n activit yt o be performe d i n m ydwellin g unit
. I receive d thi s pamphle t befor e th e wor k began
. Printe d namemtecipient VDat e Slgnatuti» ^ recipien t Self-Certificatio n Optio n (fb rtenant-occupie d dwelling s only ) — I f th e lead pamphle t wa s delivere d bu t a tenan t signatur e wa s not obtainable , yo u ma ychec k th e appropriate bo xbelow
. •Refusa l t o sig n —I certif ythat I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , Fienovat e FV^t : Importan t Lea d Hazar d Infonnatio n fo rFamSies , Chil d Car e Pmvider s an d SchooHs , t o tiie renta l dwellin g uni t liste d belo wa t th e dat e an d tim e indicate d an d that th e occupan t refuse d t o sig n th e confinnatio n of receipt
. I furthe rcertif ythat I hav e lef t a copyof th e pamphle t a t th e uni t wit h th e occupant . Q Unavailabl e fo rsignatur e — I certif ythat I hav e mad e a goo d fait h effor t t o delive rth e pamphlet
. Renovat e FVght: Importan t Lea d Hazm J informatio n fb r Families , Chil d Car e provider s an d S(^xx}ls , t o th e renta l dwellin g uni t liste d belo wan d that th e occupan t v/as unavailabl e t o sig n th e confirmatio n o f receipt
. I lufp^wrcertif ytha t I hav e lef t a copyo f th e pamphle t a t th e uni t b yslidin g i t Printe d narn e ofparso n certifyp g Attempte d deliver y dat e an d tim e lead pamphle t deliver y Signatur e o f persc^certifyin g lead pamphlet deliver y

Uni t Address Not e Regardin g Mailin g Optio n — As a n attemativ 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 certificate o f mailin g fio m th e post office)
.

# pain t matc h for m Pain t matchin g form : Propert yaddress : ^^ ^ ^ , s^ ^ ^ ^ BVID : ^i^^: i


# Explanatio^^ ^ ^^ J
Area : /^ / ^(^i^ ^ f T ^ Color:^^^ ^ (jfYr/M f < ^

^/^ / Explanation :
Area : Color : Explanation : Area : Color : Explanation : Area : Color : anation : Pag e 1

# [ AC^S S WroRMAiroiV TRACfON GSHEE T 

# P(M 7 ssg£ ^ ^j ^ ^.jj'^^ r BWf t PrapBilyOintfBf i

OinerOonMH KHome ; Wdrt c 

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## Dougla s Count y Accoun t Ii^winatio n Pag e 2 of 2
Buildin g 1

gif t '»,..-
_ H O I' D it«<!«|l l Iff ' FmRae c •"M O :i 9 JSU ­ :» » ji C » rWOSfOR Y
Squar e Footage : 1408. 0 Percen t Complete : 

### 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Typ e Condition : Averag e

Buil t A s 2 Stor y Cond o Squar e Footage : 0. 0 HVA C Centra l Ai rt o Ai r Rooms : 8. 0 Exterio r Fram e Sidin g Units : 

### 1. 0 Interio r Drywal l Baths : 2. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Typ e Hi p Stories : 2. 0 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 YearBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 191 1 0 % 191 1 9 7 Detai l Typ e Detai l Descriptio n Unit a Applianc e Allowanc e 1. 0 Basemen t Bsmn t Con e 8 ft 688. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 2. 0 Porc h Sla b Roo f Cei l 

### 126. 0 Porc h 

### WoodDec k 24. 0

http://douglasne.mapDine-online.com/nnimlf)sr.nN(»/«tatiV/Qrf>r«iiTiti-»,f x;r.-o. .n|Km s Dougla s Count y Accoun t InJKmatio n Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R252153000 0 "~2 i Prin t Repor t NE W Featur e - Parce l Dimension s availabl e ® scal e 0-5 0 f t wes t o f SOt h S t - Vie W O n Ma p Infonnation i s valida s o f 2008-7-1 4 Treasurei^ s Ta xRepor t Ne wFeatur e «>-*- > Aut o Sale s Searc h Owne r DACU S WESLE Y R 

# 7 

# iT^J^rw} ^ Y\ D 90 6 S 3 8 S T OMAHAN E 68105-000 0 Propert yInformatio n Ke yNumber : 215 3 000 0 2 5 Accoun t Type : Residentia l Parce l Number : 252153000 0 Parce l Address : 90 6 S 3 8 S T OMAHAN E 68105-000 0 Lega l Description : WES T OMAH ALO T 1 BLOC K2 3 W 13. 5 E 11 0 N 3 5 FT & S 3 8 N 7 3 E 11 0 F T 13. 5 X 35-38X11 0 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $9,300.0 0 $94,400.0 0 $103,700.0 0 200 7 $9,300.0 0 $81,900.0 0 $91,200.0 0 200 6 $9,300.0 0 $81,900.0 0 $91,200.0 0 200 5 $9,300.0 0 $79,700.0 0 $89,000.0 0 200 4 $9,300.0 0 $79,700.0 0 $89,000.0 0 200 3 $9,300.0 0 $79,700.0 0 $89,000.0 0 Sale s Informatio n Sale s Date : 2005-10-0 7 Dee d Type : W D Book : 200 5 Page : 12887 6 Price : $105,000.0 0 Grantor : JA N ERI C PUSC H ETA L Grantee : WESLE Y R DACU S Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit a Dept h Widti i Vacan t 0. 1 4674. 0 1. 0 123. 0 38. 0 N o Improvemen t Informatio n httD://douelasne.maDDine-online.com/Doi]plasr,nNf»/«!t3tiV./florr.iintinfr > ionO o ,,r^+».«—DO C 0/'»^/'^nAf »

## Pruden t Propert yCiose-Ou t For m (lead-Base d Ifain t Stabilization ) S&iP : y- l 6 TJ - PropertyAddress : (O Kt^ ' O d 0= » ' Owner' s Name : {jUsP ^ ThC U <: . 

## Performanc e Standards/close-Ou t Criteri a lYE S V/s s th s entir e structure{s ) painte d wrt h th e exceptio n ofth e sta t >d , exclude d areas ? Thi s woul d includ e paintin g o f ethe rassociate d feature s Indudin g fascia , sav { s , siding , al i trim , porches , bo x 

# y 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 satisfsct criiy ? 3 .

Wer e ai l require d areas o f th e stpjcture{s ) prime d a s neede d an d i ainte d wit h tw o to p coats ? 

## V 4 .Wa s th e pain t product s utilize d equivaien t t o a 3 0 yea rproduet/q u siity ? 

## V .Ar

e ai l ofth e areas wher e ccntanrsinate d material s have bee n spille d thoroughl yvacuumed / cleaned ? 6 .

Di d th s contracto rcollert/vacuu m al l failin g an d scrape d pain t chip s e n th s entir e property , roadways , alleyways , publi cacces s areas an d als o remov e an yoth e rgenerate d debris ? i s th e gras s are a tha t surround s th e structure{s ) I n reasonabl ygoo c condition ? 8 .Are al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e etc . properi yremoved ? 9 .I s ther e an yevidenc e o f propert ydamag e tha t was don e b yth e co r tractor ? An yps-opeit ydamag e need s t o b e com.olete d orio rt o th e EP AClose-Out
. i 10 . Ar e ther e an ypropert yItem s tha t wer e temporatil yre-locate d byti^ e contracto r 

# i T I tha t nee d t o b e move d bacic ? [11
. Ar e ther e an y(known ) lingerin g issues wit h th e propert yowner(s ) tpa t have bee n lef t unresolved ? 

# \ X Othe rConsiderations?propertyOwne rDiscussions?Addition5 i Wor k tha t i s Require d



## Pyd0y^^4\
. Ct,.:»rJ ^ ^^^t^h^c^J^ m 

# \m t Prucfen t Re^esentative , '^ 

# Date/o/3/y^ f