## TRANSMITTA Lof OMAHA LEA D SIT E PAIN T STABILIZATIO NFIL EFOLDE R SAID : 3560 1 Dat e 01/12/0 9 Address : 372 1 Saratog aSt . "i^ L Remediatio n Contractor : Pruden t Technologie s Year : 200 8 A PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S '^ 0' Vide o o f propert y (DVD ) y Executiv e Summary 0 ' Signe dAcces s Agreemen t for subjec t property y Paintin g Agreemen t y Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) D Photograph s y Satisfactory restoratio n signe db y Property Owne r D Property close-ou t chec k lis t signe db y EP A 0 ' Property informatio n fromDougla s County Assessor' s Offic e D D D 

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### PROPERT Y SUMMAR Y Date : 12/23/0 8 LB PSTABILIZATIO NEP A CONTRA T EP-R7-08-0 7 Mont hof : Decembe r Propert y Address : 372 1 Saratog aSt . SAID : 3560 1 | 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 : 11/24/200 8 Wor k Began : 11/26/200 8 Closeou t Date : 1/6/200 9 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 n Pag e 9 . EP A Propert y Closeou t for m 10 . Propert y Completio n Agreemen t

TECHNOLOCIES . INC .

# i GB ENVIRONMENTA L AN D CONSTRUCTIO N GAR YJENKIN S 430 2 MAPL E STPH . 402-880-910 0 OMAHA , NE 6811 1 PA

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HWMipw.'-ww'.WMKag n)n^' ­ iup.//uougiasne.mapni|c-onIine.com/DouglasCoNe/static/accountinfo . Dougla s County , Nebrask a Propert yRecor d - R080495000 0 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 9Dti n S t - VJe W O H Ma p Informatio n i s vali d a s o f 2008-11- 5 Treasurer' s Ta xRepor t Ne wFeatur e -»-*- » Aut o Sale s Searc h Owne r KEITHLE YROBER TA ETA L i 372 1 SARATOG AS T i OMAH AN E 68111-000 0

Propert yInformatio n Ke yNumber : 049 5 000 0 0 8 1 i i 1 Accoun t Type : Residentia l Parce l Number : 080495000 0 Parce l Address : 372 1 SARATOG AS T OMAH AN E 68111-000 0 Lega l Description : ; CENTRA L PAR KLO T5 BLOC K1 9 6 0 X 12 5 | i i Valu e Informatio n 

## i 200 8 i Lan d 1 $5,300.0 0 Improvemen t $12,700.0 0 Tota l $18,000.0 0 200 7 $5,300.0 0 $12,700.0 0 $18,000.0 0 ; 200 6 $5,300.0 0 $12,700.0 0 $18,000.0 0 1 200 5 $5,300.0 0 $4,600.0 0 $9,900.0 0 200 4 200 3 $5,300.0 0 $5,300.0 0 $4,200.0 0 $4,200.0 0 $9,500.0 0 $9,500.0 0 Sale s Informatio n Sale s Date : \ 2007-06-2 9 1 1 Dee d Type : : Q C M j SooAr : 200 7 Page : : 07397 2 Price : \ $0.0 0 Grantor : KEITHLE YROBER T 1 Grantee : . KEITHLE YROBER TAETA L Valid/Invalid : Exclusio n Reason : Invali d Multipl e Parce l Sal e j [ Sale s Date : 2007-05-2 1 

## 1 Dee d Type : Q C M Book : j 200 7 Page : \ 05994 1 Price : : $11,000.0 0 Grantor : ! REES E ERM AE Grantee : \ KEITHLE YROBERT A Valid/Invalid : | Invali d Exclusio n Reason : : Multipl e Parce l Sal e

1 o f 2 11/24/200 8 11:1 8 A Mnnp://clouglasne.mapni|tt-online.com/DouglasCoNe/static/accountinfo . Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 7 7500. 0 1. 0 125. 0 60. 0 N o Improvement Informatio n

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CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : ; 1052. 0 Percen t Complete : i 100.0 % Perimete ri 0. 0 Quality : Fai r Uni t Type : Condition : Fai r - H

Buil t As : ; 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : + • Centra l Ai rt o Ai r Rooms : j 6. 0 Exterior : Fram e Aluminu m Units : I 1. 0 Interior : Drywai i Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : \ Gabl e Stories : 1. 5 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 190 8 0 0 % ; 190 8 10 1 I Detai l Typ e ; Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 612. 0 ' Fixtur e Bas e Fixture s 1. 0 1 Fixtur e Bat h Ful l 1. 0 ! Garag e Attache d 322. 0 1 Porc h i En d Scree n 102. 0 ;

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11/24/200 8 11:1 8 A M Zof 2

# Curren t Sampl e Pr^enovatio n Fon n Effectiv e unti l Apri l 2010 . Confinnatio n of Receip t of l.ea d Pamphle t Q i hav e rec^ved a cop y ofth e pamphlet , Renovat e R^/7t;//nportan rLea d Hazarc T /nfcrmattj n fo rFamilies , C M Car e Provkier s an d School s infbmiiri g me of th e potentia l risk ofth e lea d hazar d exposur e fro m renovatio n activit y to be polbrma d in mydwellin g unit . I receive d thi s pamphle t befor e th e wor k began . Printednaiteofr^lpten t V/ •, j / Dat e ' 

# hl'p;\ \ 

# t Signatur e ofrecipi e Saif-CettHicatio n Optio n (fo rtenant-occupie d dwelling s only ) — Ifth e lea d pamphle t wa s delivere d bu t a tenan t signatur e wa s no t obtainable , yo u ma ychec k th e appropriat e bo xbelow . a Rsfiisa l to sig n —I certif ytha t I hav e mad e a goo d fait h eRbr t to delive rth e pamphlet , F^novat e Righ t knportan t Lee d Hazan i Infonnatio n fo rFamSies , Chik i Ca m Provkier s an d Schoois , to th e renta l dwellin g uni t liste d belo w at th e dat e an d tim e Indicate d an d tha t th e occupan t refuse d to sig n th e confirmatio n ofrec^pt . I furthe rcertif ytha t I hav e lef t a cop y ofth e pamphle t at th e uni t wit h thte occupant . Q Unavailabl e fO rsignatur e — I certif ytha t t hav e mad e a goo d fait h effor t to defive rth e pamphlet , Renovat e FSg^ t Importan t Lee d Hazar d Informatio n for Raises , Ct M Ca m provkier s sai d Schools , to th e renta l dweii'm g uni t liste d l3^a wffiid thia t th e occupan t wa s unavailedit e to sig n th e confirmatio n ofreceipt , i furthe rcertif ytha t I hav e lef t a cop y of th e pamphie t at th e uni t byslidin g it unde rth e doo e F n g Attempte d delive ^ F'rinte d nam e of perso perso n certifyin certifyin g dateandtim e lea d pamphle t deiivery Signatur e ofper^ n ceilffyin g lea d pamphle t defivery WWI I wwruijiii ^ i^AM J poiiipiiiaf cU9llVdj rf 

# 7!?/fj//.7^Q . /Ut Uni t Addres s Not e Regardin g Mailin g Optio n — As an alternativ e to deliveryIn person , yo u tna yiTiai l th e lea d pamphle t to th e ovme rand/o rtenan t Parnphle t mus t be rnaile d at leas t 7 day s befor e renovab'o n (Documen t wit h a certificat e ofmailin g fro m th e pos t office) .

# So u 

# 6 /

Pruden t Technologies , Inc . (Prudent ) i s unde r

contract (Contract #EP-R7-08-07 ) wit h tiie U . S . Environmenta l Protectio nAgenc y (EPA ) t o stabiliz e Lea dBasedPaint (LBP ) at anumbe r

ofpropertie s locatedi n Omaha , Nebraska , includin g the propert y locateda t "^' 7 O > Fr » nc^-F ^ (\ 6 FV . The EP Arequests your pennissio nt o allo w Pruden t t o perfor mLB PStabilizatio na t tiiis pr^jerty . B y signing tibis form, tiie propert y owner grant s pennissio n t o Pruden t t o perfor mactivitie s relatedt o LB P Stabilizationmcluding scrqmi g pain t andpainting of tiie referencedproperty . Furtiier , tiie owner/^iai t verifie s tiiattiiey hav e receive dtiie LB Ppamphle t "Renovat e Right " If

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

your property , pleas e contac t Prudert' s l^rfmifitatTfttlv e Cler k

fo r

th e Lea dBase dPain t Stabilization , Mrs . Debora hAkerele-Jnhimnn , a

t (402) 504-1004 . Graera l question s abou t tiie OmahaLea dSite cleanup ca nb e directedto tiie EP A Public Informatio nCenter s at (402 ) 731-304 5 (Soutii Omah aoffice) or (402 ) 991-958 3 (Norfl i Omah a office) . Pnpn ^ AcosnOmtc d 03^ : 

### TAl ^ (Pleas eI>rintNan« ) Propo ^ Otne rSignilBie ;

- * y(Signature ) T j /(Date) / PROI>ERT YINFORMATIO N (T o b e complete d b yraldcat tad/o rpropcrtjrowiier-pleaa e print ) 

### neaiPHinrmiie . Q^\7 t >W?/^./^v / A^ ^

Rante r 

# 2fS L i P RENTAL , PROPERT YOWNE D BY : 

### OWNERfSHABJNOAWRESS : -y^tlmx t OWNER' S TELEPHON E NUIiaeR . HOME : t'^ ^

^ ^"T^WCmK' . t \ NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : ^ NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDER : U P 

# :2. . NUMBE R OPCHILDRE N UNDE R 7 YEAR S OL D WH O PUYI N TH E YAR D FO R 6 HOUR S O R MOR E PE R WEEK : C0MMBIT 8 O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YOATES , ETC. )

AUmORTT YFOR ENVIRONMBNTA L RESPONS E ACTKJNS ; Th e aeti^e e tpb e impleineniedbyEP Aunde rdiaegreenMntafepunuin t t o Seclb n 10 4 o fCERCLA , 42 U.& C 9604 . BPA' i rigb t o faooes s l o flwpropert yitprovlde d for ia Sectio n 104(e ) o fCERCLA , 4 2 U.S . C 9605(e) . wiilc b ptovid M eM y fb r^fctnnninliigfl R nee d (b r(oiponie , o rcliooain g ortakin g an yletpons e actio n unde rftii tide , o rodietir i

QSOWhi d Partcway . Suit s 40 6 260 8 N . 24 * Straot , Sutt e 30 8 424 2 fWodicalOflva . Suit * A^ mENVIRONMENTA LA COl^iSTRUCnO N 

### TECHNOLOGIES , INC . SERVICE S 

# Property Statu s Form Phone: <|/55--7(^^ qBVED:5<5(tO | Plan t & Permanen t I .anA^capinpr T o Rei^ai n I n Plac e 

## Item ^ Descriptio nan dLocatio n O nMa p 

## fiC^J LA/C^ ^ 

## A ^ hr^iA^ e tAJ>U.eA ) h afef s hten/ie^ 

# /the ? c7hyt4*A<y ^ lif/d-i : /emc>LA^ .

Pre-^^^s^ g Conditio no f Structure s Doe s you r Basemen t hav e ahistor y o f leaking ? Ye s —N o Item # Descriptio n& Locatio n OnMi ^ » torM^ " ke^d ^ m»S"^»/1 ^ t<7 ^ Ccryie A



## Pruden t Employe e Signature : 

# y^'fyi/j/^ ^ Isign-ure : '^/J/fiU^-^J 424 2 Madlcal Diive . Sutt a426 0 260 6 N . 24 * StaMt , Suit e 30 8 808 0 War dP«tamy , Sidt o 40 6 Omaha , Nabmi a6611 0 Sa nAntonio , T X 7822 9 Kmn s City . M O 6411 4 

# L

## Pruden t Propert yClose-Ou t For m ( Lead-Base d Pain t Stabiiization ) SAID: ^If O / y Propeit yAddress : 21X I ,^fi^m/^/{ ^ ^ Owner' s Name ; fisftlj^L. /TtyTTJl - — — 

# f a Performanc e Standards/close-Ou t Cnteri a YE S N O

' ' 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 . Wa s th e entir e structure(s ) painte d wit h th e exceptio n o f th e statsd , exclude d areas ? Thi s woul d

2 .Wa s al l scrapin g an d othe rpreparattio n wor k 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 .Wa s th e pain t product s utilize d equivalen t t o a 3 0 yea rproduct/quality ? Ar e al l o f th e area s wher e contaminate d material s hav e bee n spille d thoroughl yvacuumed / cleaned ? 6 .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 , 

### y roadways , alleyways , publi cacces s area s an d als o remov e an yothe rgenerate d debris ? 1 .I s th e gras s are a tha t surround s th e structure(s ) i n reasonabl ygoo d condition ? 

# y " 8 .Ar e al l item s suc h as polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e etc . 

# y properl 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 

# y need s t o b e complete d prio rt o th e EP AClose-Out . 10 .Ar e ther e an ypropert yitem s tha t wer e temporatii yre-locate d b yth e contracto r / 

### \ y tha t nee d t o b e move d back ? 11 .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 ? 

# - 7 y Othe rConsiderations?propert yOwne rDiscussions?Additioria l \A/or k tha t i s Require d 

## Pruden t Representativ e Signature : Dat e Propert yOwne rSignature : >2 ^ Date : i _ ^ -o ^