# 0 

# f
TRANSMITTA L o f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R SAI D # : 

# L Date : \\J\2.j\ l Address : 9.22. M UOp\^.f ^ Stabilizatio n Contractor : Professiona l Environmenta l Engineer s Year : 20X l PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S Vide o o f property (DVD ) Executiv e Summar y Signe dAcces s Agreemen t fo r subjec t property Pre-Renovatio n For msigne db y Property Owner Pre-Renovatio n For mfo r Occupant/Tenant , i f applicabl e Paintin g Agreemen t / 

### Settlemen t document s (i.e. , fo r damag e or t o replac e plants , etc. ) 

# X Renovatio n Recordkeepin g Checklis t signe dby Certifie dRenovato r Photograph s Satisfactor y close-ou t chec k lis t signe db y Propert y Owne r 

# X Property close-ou t chec k lis t signe db y EP A Property informatio n fromDougla s Count y Assessor' s Offic e Hazar danalysis , i f prepare d 

# a Safet y Audi t Othe r (describe) :

I Engineer s Signatur e WCO RSi^atur e ^ Dat e (after file folde r review ) 4037755 8 

### Superfun d

## PROFESSIONA L ENVIRONMENTA L ENGINEERS , INC . ''"'Trlla'htNES^I o "Providin g cost-effectiv e environmenta l solutions " ^ Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc y Respons e 

### ^ i^««!!21in! ? Fa x (402 ) 504-328 1



### Lea dBas e Stabilizatio n Omaha , N e Clos e Ou t Repor t 201 1 SAID #2969 2 222 4 Mapl e S t

Date s worked : 8/1 6 t o 8/1 6 201 1 Pr e propert y condition : Hous e ha s painte dwoo dsidin g wit h painte dwoo dtrim s an d foundatio n areas . Pain t wa s flakin g of f

i n areas . Problem s encountered : None . Owne r request/concerns : N/ A Inspection/closeou t dates . Owne r 8/17/1 1 EP A 8/19/1 1

## 201 1 

# A f PROFESSIONA l 250 5 Nort h 24 ^ Suit e 21 9 

# ENVIRONMENTA L ENGINEERS , INC . Omatia , N E 6811 0 (402 ) 504-468 8 

### "Providin g cost-effectiv e environmenta l solutions " Fa x (402 ) 504-328 1 Consultin g • Engineerin g Desig n • Remediatio n • Abatemen t • Emergenc y Respons e 

## EP A Close-Ou t Form (Lead-BasedPain t Stabilizatio n EP A Contract EP-R7-08-06 ) SAID : Propert y Address : 

# 2.2.^ M n<^p k ^ / Ovmer' s Name : l4:^r>ir:)A<^vNf\ ZX^JP>X«^^ ^ 

### Performanc e Standards/Close-Ou t Criteri a YE S NO 1 . Wa s the entir e structure(s ) paintedv^t h the exception ofth e stated , excludedareas ? Thi s woul dinclud e paintin g o f othe r

associatedfeature s including fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an d exterior surface s of garages . 2 . Wa s all scraping an dothe r

preparatio n wor k

completedsatisfactorily ? 3 . Wer e all require darea s ofth e structure(s ) primeda s neededan dpaintedwit h tw o top coats ? 4 . Was the pain t product s utilize dequivalen t t

o a2 5 yea r

product/quality ? 5 . Ar e all ofth e area s wher e contaminatedmaterial s have bee n spilledthoroughl y vacuumed / cleaned ? 

# L/ ^ 6 . Didth e contractor collect/vacuumall falling an dscrapedpain t chip s on the entir e property , ^ ' 

### roadways , alleyways , publi c acces s area s an dals o remove an y othe r

generateddebris ? 7 . I s the gras s are atha t surrotmd s th e structure(s ) i n reasonabl y goodcondition ? 8 . Ar e all item s suc h a s polyethylene sheeting , ladders , pain t brushes , cones , barrie r

tape , etc . 

# w " properl y removed ? 9 . I s ther e an y evidenc e ofpropert y damag e tha t was don e b y the contractor ? An y propert y 

## L ^ ' damage need s to b e complete dprio r

to the EP A Close-Out . 10 . Has the propert y owne r

signedthe completion form ? 11 . Ar e ther e an y propert y item s tha t wer e temporaril y re-locatedb y the contractor tha t nee dt o b e move dback ? 12 . Ar e ther e an y (known) lingering issue s wit h the propert y owner(s ) tha t have bee n lef t u y unresolved ? Othe r

Considerations/Propert y Owne r

Discussions/Additiona l Wor k

tha t i s Required :


# ?//?/^ 0 EP A CO RSignattir e Dat e

## PROFESSIONA L 25J 5 f;:': . 2 4 • . S^'. i 21 9 

## ENVIRONMENTA L ENGINEERS , INC . O-ar a ri^6£ i I C ;4J2 ; 504-453 0 F-; ' i4'.'2 . 5J4-32 S 1 

### 201 1 Propert y Owne r Close-Ou t For m (Lead-Base dPaint Stabilizatio n EP A Contrac t F.P-R7-08-06 ) 

# SAID : _M£12 . Propert y .Address : D.pj^? \/VU^Lg T ^ Owner' s Name : i^i\Oi S CAUUy^l^ ^ Performanc e Standards/Close-Ou t Criteri ai NF S ! N O 1 . Wa s th e entir e structure(s ) painte dwit h the exceptio n ofth e stated , exclude dareas ? Thi s j I woul dinclud e paintin g o f other associate dfeature s includin g fascia , eaves , siding , al ! trim , i ^ ^ | porches , bo x beams , columns , rails , andexterio r surface s o f garages . ^ _ |_ 2 . Wa s al l scrapin g an dothe r preparatio n wor k

complete dsatisfactorily ? • V ] 3 . Were all require darea s o f th e structure(s ) prime da s neede dan dpainte dwit h tw o top i / y I coats ? _^ _\ ^ ; 4 . Wa s th e paint product s utilize dequivalen t t

o a25 vea r product/quality ? ' ^ I _i 5 . Ar e all o f th e area s wher e contaminate dmaterial s hav e been spille dthoroughl ) iS / ^ i vacuumed / cleaned ? : ^ i 6 . Di dth e contracio r colloct.'\acuun i all fallin g an dscrape dpaint chip s o n th e entir e ' property , roadways . alle> wa>s . publi c acces s area s an dals o remov e an > othe r generate d H y • debris ? ^- 1 . I s th e gras s are atha t surround s the structure(s ) i n reasonab K goo dcondition ? 8 . /\j e al l item s suc h a s polyethylen e sheeting , ladders , paint brushes , cones , barrie r tape . I ­ 

### etc . properl y remosed ? __ 

# K 9 . I s ther e any evidenc e o f propert ) damag e tha t wa s don e b } th e contractor ? An\propert s , j y damag e need s t o b e complete dprio r t

o th e EP A Close-Out . _^ _^ __ _ 10 . Ar e yo u satisfie dwit h th e wor k

perfonned ? ' ^ ^ \ 11 . Ar e ther e an > propert) item s tha t were temporarily re-locate db > the contracto r tha t nee dt o b e move dback ? 

# t . 12 . Ar e ther e an \(knovsn ) lingerin g issue s wit h the propert > owner(s ) tha t hav e been let t i unresolved ? __" x , ; Othe r Considerations.'Propert N Owne r Discussions'.Additional Wor k

tha ti s Required : j 

# ¥ ^

n/ji f Properi ) Owne r Signatur e Dat e 

# rn- M Protessiona f Fnuivnmenta l Eniiineer s Signatur e r*^'
­

### Professiona l Envir^pmenta l Engineers : EP A Pain t Stabilizatio n 201 1 SAID # Proper w Addres s 9 9 9 . M UCTi ^ ? ^ Stories / Sidin q typ e / / ^ Transit e 1 Woo d 1 Viny l Meta l Stucc o Garage ?

Dat e acces s signe d Ye s
fZ ) 1 1 t/ o V Painted ? Where ? 1 Ye s Sidin g

Tri m N o

Pre-vide o V S 1 1 1 Pos t vide o Contracto rAssigne d / , , Dat e starte d Weathe rCondition s ^// / / ^ Dat e ende d 'RliL I 1 / ^

Pain t use d Prim e use d Pol y use d Problems/issue s(etTeciiv e Apri l 2010 )


### RENOVATIO N RECORDKEEPIN G CHECKLIS T
Nam e o f Firm : 

# QuT(CM^I ^ ^1(^1^ ^ Dat e andLocatio n o f Renovation : Brief Descriptio n o f Renovation : Name o f Assigne dRenovator : ^^^R^Qj^h ^ Name(s ) o f Traine dWorkers : Nam e o f Dus t Samplin g Technician , Inspector , and/o r Ris k Assessor , i f

used : jTCopie s o f renovato r an ddus t samplin g technician qualification s (trainin g certificates , certifications ) o n file.

• ^Certifie drenovato r provide dtrainin g t o worker s on (chec k all tha t apply) : ( ^ Postin g warnin g sign s (S ^ Settin g u p plasti c containmen t barrier s vZMaintainin g containmen t ^Avoidin g sprea do f dus t t o adjacent area s y ^ Waste handlin g p/^'ost-renovatio n cleanin g
^ Tes t kit s use db y certifie drenovato r to determin e whethe r lea dwa s presen t o n component s affecte db y renovatio n (identif y kit s use dan ddescrib e samplin g location s an dresults : )^ ' Warnin g sign s poste d a t entranc e to wor k

area . (S , Wor k

are acontaine d t o preven t sprea do f dus t an ddebris . 2 " Window s i n an dwithi n 2 0 fee t ofth e wor k

are aare close d ryDoor s i n an dwithi n 2 0 fee t ofth e wor k

area s ar e close dandseale d / ^ Door s that mus t b e use d i n th e wor k

are aar e covere dto allo w passag e but preven t sprea do f dust . H'Groun dcovere db y plasti c sheetin g extendin g 1 0 fee t fro mwor k

are a- plasti c anchore dt o the buildin g an dweighte ddow n by heav y objects . Z Ifnecessary , vertical contairunen t installe dto preven t migratio n o f dus t anddebri s t o adjacen t property . ^ Waste containe don-sit e andwhil e bein g transporte doff-site .

Renovatio n Recordkeepin g Checklis t Omah a Lea o Sit eItflTectiv e Apri l 2010 )



### ^ Wor k

site properl y cleane dafte r renovation . 5 ^ All chip s an ddebri s picke dup , protectiv e sheetin g misted , folde ddirt y sid e inward , an dtape dfo r removal . ? J Wor k

are aHEP A vacuume d t o get pain t chip s fro mgroun dsurface , ifnecessary . jZ ! Certifie drenovato r performe dpost-renovatio n cleanin g verificatio n (describ e results) :

_> ! certif y unde r penalt y o f la

w that th e abov e informatio n i s tru e andcomplete . 

# ^.(/V ^ 

# %j'Ji ^ Nam e an dTitl e Date

Renovatio n Recordkeepin g Checklis t Omah a Lea d Sit e08/11/1 1 09:02A M PD T lontac h Investments , LL C -> 402504328 1 

## CONSITO T FO RACCES S 

# T O PRoHlRTY OMAH A LEA D SIT E REMEDIA L ACTIO N - LEAD-BASE D PAIN T STABILIZATIO N PROPERT V

IDj^j^StflS ^ PROPERT Y ADDRESS : ''/'ZZ^__\^0^\^

_ ? ^ OWNE RNAME : , .•X^rAc:! ^ SL(v(.yrtVii^ J . UL ^ DAYTIM E PHONE r(^1 - I «f^.^^5» ° CEL L PHONE : E-MAIL : CifffirHAAiSeiUT y fe &MA/ L . Co/ r OW\ER' S ADDRES S I F DrFFERENT : P- ^ A^Jt )|//<f v o/fA/- ^ M£ Cint f TENANT' S NAM E I F APPLICABLE : .. ^ j \.- 7 , . ^^ . l-'^UM^ A IV^^A / DAYTIM E PHONE : [^^'- } 1^%- ' ^^^ 7 Prorewiona l Environmenta l Engineers , Inc . (PE ) i s unde rcontrac t (#EP-R7-08-06 ) wit h th e L.S . Environmcnis l Protectio n Agenc y (EPA ) t o stabiliz e iva d base d pain t (LBP ) o n re«idcntia l structure s a t a numbe ro f propertie s locate d i n Omaha , Nebraska . Th e pain t stabilizatio n wor k i s bein g don e tA protec t th e soi l cleanup s tha t ar e bein g perrorme d b y EP A contractors . Pain t stabilizatio n activitie s wil l include : scrapin g ofcracke d o rrtakin g LB P fro m structures , applicatio n o f a prim e coa t an d iw n (2 ) coat s o f paint . Movin g part s o f window s an d door s ar e n^ t include d an d wil l no t b e addressed . You rcooperatio n i s requeste d i n givin g permissio n t o thi s EP A contracto r(PE ) t o ente ran d hav e acces s t o thi s propert y fo rtb e purpos e oTstabiiizln g lea d -base d pain t a s outline d o n th e pnipert y identine d above . B y signin g thi s documen t I agre e t o allo w a n EP A contraiMo rt o conduc t a soi l cleanu p a t m y propert y followin g completio n o f iead'base d pain t stabilization , i f th e soi l cleanu p ha s no t alread y bee n performed . I understan d tha t (h e stabilizatio n contracto r ca n no t provid e assurance s tha t th e soi l cleanu p contracio rwil l b e boun d to . I furthe runderstan d tha t th e soi l cleanu p contracto rwil l mak e al l reasonabl e effort s t o addres s concern s tha t L a s th e properl y owner , ma y hav e regardin g soi l cleanu p a t m y property . p/Ves , I hav e read an d understan d th e panatap h abOM rj j r^ "z ? / I Signatur e o f Propert y Owne rOat e I full y understan d tha t b y signin g thi s Consen t fo rAccess , (I ) thi s acces s wil t remai n I n effec t unti l th e wor k ha s bee n satisfactoril y completed . (2 ) tha t th e Propert y Owne ro rTenant , i f applicable vwil l b e give n th e Housin g an d Urba n Developmen t (HUD ) an d EP A pamphlet , "Renovat e Right , Importan t Lea d Hazar d informatio n fo rFamilies , Da y Car e Providers , an d Schools" , (3 ) th e Propert y Owne ro rtenan t wil l remov e al l obstruction s fro m surface s t o b e painted , (4 ) wil l abid e b y healt h an d safet y guidanc e provide d b y EPA , (S ) wil l allo w photograph y ofpropert y befor e an d afte rth e pain t st^blliMitiA n work , (6 ) wil l b e contacte d b y a P E representativ e approiimalel y 4 8 hour s i n advanc e o f startin g worli , (7 ) agre e no t t o obstruc t o rtampe rwit h an y ofth e LB P stabilizatio n actions , an d (S ) wil l participat e I n fina l propert y inspectio n an d sig n th e Completio n Agreemen t an d Propert y Owne rSatisfactio n Survey . Shoul d yo u hav e an y question s abou t th e plane d Lea d Hased>Pain t stabilizatifl u activitie s fo ryoit rproperly , pleas e conlac i Professiona l Environmenta l Engineers , inc . Projec t Manager , Willi e Cla y o rKelle y Sander s A t 402-504-4688 . Genera l question s abou t th e Omah a Lea d Sit e cleanu p ca n b e directe d t o Pauiett a France-Isetts , EP A Remedia l Pmjcc i Manage r402-731-2454 , o r th e EP A Publi c Informatio n Center s a t 402-991-958 3 (Nort h Omah a office ) o r402<T3I^04 ? (Sout h Omah a office) . ^fes , I gra m acces s t o m y propert y an d was give n th e pamphle t G No , I d o no t gi«n t access t o my propeity an d I wa s 'Renovat e ftigm , impofta m Lea d intormatio n to rFamilies , Chil d 9lve n th t pamphlet "Renovit a Right , hiportin t Lea d Car e Provltferv , an d Schools. " InfomiaUo A fo rFamit<ea , Chltd e Car e Providers , an d Schools. *08/11/1 1 09:02A M PD T lontac h Investments , LL C -> 402504328 1 

# ^^ '' ^ " IHTABILIZATIO 

# PRE-PROF^ k PAINWTABILIZATIO N 

# N PRE-PROR»iT Y PAIN T MATC H ASSESSMEN T PROPERT Y ADDRES S 

# • i m\k\^VA DATE : BVI D 

# Brni

AREA(S ) TO BE PAINTED : HOUS E PROPER : COLO R 

# : '^:u>SlVv

HOUS E TRIM i COLOR :
GARAGE : COLOR :
GARAG E TRIM : COLOR :
PORCH : COLOR :
PORC H COLOR : (COMPLET E AL L SECTION , YES , NO , OR NON-APPLICABLE )

"•!-:*v;;'rt>^.r'T:l:;'-' : .•'•• ! ••••'T
- •••'•,:i'i-:[v : 

### I AGRE E TO TH E COLOR S LISTE D ABOVE . ONG E TH E PAINTIN G BEGINS , i UNDERSTAN D i CA N NO T CHANG E TH E ABOV E SELECTE D COLORS : PROPERT Y OWNE R SIGNATURE : PE ACCESO R SIGNATURE : 

# i X 

# "^S^^^^

• ^ .^ 

### d 

# . ^^S(a^ a , Dougla s County , Nebrask a Propert y Recor d - R092081000 0 Informatio n i s vali d a s o f 2011-7-2 9 Ne w Featur e « > ^- ^ Prin t Repor t Vie w Interactiv e GI S Ma p Treasurer' s Ta x Repor t Subdivisio n Sale s Searc h Owne r lONTAC H INVESTMENT S LLC POBOX11116 0 OMAH A N E 68111-000 0 Propert y Informatio n Ke y Number : Accoun t Type : Parce l Number : 208 1 000 0 0 9 Residentia l 092081000 0 Parce l Address : Lega l Description : ??? 4 MAPL E S T OMAH A N E 68110-000 0 DENISE S AD D LOT 7 BLOC K3 5 0 X12 2 Valu e Informatio n 201 1 201 0 200 9 200 8 200 7 200 6 Lan d $4,800.0 0 $4,800.0 0 $4,800.0 0 $4,800.0 0 $4,800.0 0 $4,800.0 0 /mprov^emen f $11,000.0 0 $11,000.0 0 $11,000.0 0 $12,300.0 0 $22,200.0 0 $22,200.0 0 Tota l $15,800.0 0 $15,800.0 0 $15,800.0 0 $17,100.0 0 $27,000.0 0 $27,000.0 0 Sale s Informatio n Sale s Date : 2010-08-2 7 Dee d Type : Price : Grantor : Grantee : W D Boolr ; $20,000.0 0 CAPITA L EQUITIE S ON E LT D lONTAC H INVESTMENTS LLC 201 0 Page : 07954 9

Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 2005-10-0 5 Dee d Type : Price : C 3rantor : W D $18,500.0 0 Estat e o f Cla y t

x

j m W moor e Boolr : 200 5 Page : 13804 1

# H ^ ^ Granfee ; Carin g Networ k In c Valid/lnvalid : Vali d Exclusio n Reason : Sho w Al l Transaction s

Lan d Informatio n Acre s S F Unit s Dept h Widti i Vacan t 0.1 4 6100. 0 1. 0 122. 0 50. 0 N o Improvemen t Informatio n Buildin g 1 222 4 Mapl e

• « f o ••• ' i £ . >

« \ 3* 9 'Ofn.tMa X Fta i ICtODSg n au i X ! Sf f • ' n o M W M r 

### " : a» r 2 1/ 2 Stor y Unfi r

CLIC KTO ENLARG E IMAG E CUC KTO ENLARG E IMAG E Squar e Footage : 1778. 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 y Unfi n Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : : 10. 0 Exterior : ! Fram e Sidin g Units : 1. 0 Interior : ' Drywal l Baths : 3. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 6. 0

Roo f Type : Gabl e Stories : 2. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : j 0. 0 Yea r Percen t Adjuste d Yea r yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 190 0 0 % 190 0 11 0 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e Basemen t Bsmn t Bloc k 8 f t 782. 0 1. 008/11/1 1 09:02A M PD T lontachlnvestments . LL C - > 402504328 1 P g 4/ 4 

## PIIPRENOVATIO N FOR M 

# - OwMi R Thi s for mi s t o b e us« dby th e firms contracte db y th e Environmental Protectio n Agency-Regio n 7 t o perfor mLead-Base d Paint stabilizatio n activitie s a t th e Omah aLea dSite , Omaha , Nebraska . Owne r Conflrmatio n 

### Pamphle l Receip t r^ f hav e receive dacop y ofth e lea dhazar dinformatio n pamphlet , Renovate Right : Importan t Lea dHazar dInformatio n fo r Tamilies , • CA/W:<:Vire: J?r?j#»iS! ^ fro mrwioyatio n activit y t o b e performe dInA mm y dweJilngutilt^ I received^^i s jpiamirf^ir t 1b«lor e Ihe l wbil i beiim ^ Owne r Acknowledgmen t n (A ) I confin n tha t I ow n an dliv e i n thi s property ^ that n o chil dunder th e ag e o f 6 reside s here , that n o pregnan t woman reside s here , andtha t thi s propert y I s no t achild-occupie dfacility . ^fote : A chil dreside s i n th e primar y residenc e o f his/he r custodial parents , le^ l guardians , foster parents , o r informa l caretake r i f

th e chil dlive s an dsleep s mos t o f tim e a t th e caretaker' s residence . Note : A child-occupie dfacilit y i s apre-197 S buildin g visite dregularl y by th e sam e child , unde r 6 year s o f age , o n a l leas t tw o different day s withi n any week , fo r a

t leas t 3 hour s eac h day , provide dtha t th e visit s total a t leas t 6 0 hour s annually . L.IZtB ) I understan dtha t th e renovatio n firm , contracte db y th e Environmental Protectio n Agenc y (EPA) , wil l b e usin g lead
saf e wor k

practice s require dby EPA' s Renovation , Repai r an dPaintin g Rule . 

# IMM , C-M J^'il M Printe dNam e o f Owner-Oeeapan t 

# f^^. w 

# ^/l i h i S ignatur e o f Owner-OecBpart
- Dat e 

# -3^fcmpY)\e4af e \e^-VQ V propm y c^^i^c .

## Sampl e Pre-Renovatio n For m Thi s sampl e for mma y

be used by firms to documen t complianc e wit h the requirement s ofth e Federa l Lead-Base dPaint Renovation , Repair , an dPaintin g Program . Occupan t Confirmatio n Pamphle t Receip t I hav e receivei dacopy ofth e lea dhazar dinformatio n pamphlet infomiin g me ofth e potentia l risk ofth e lea dhazar dexposur e fro mrenovatio n activit y

to be performed in my dwellin g unit . I receive dthi s pamphlet befor e the wor k

began .
Printe dName of Owner-occupant Signature of Owner-occupant Signatur e Dat e Renovator' s Self Certificatio n Optio n (fo r tenant-occupie ddwelling s only ) Instruction s to Renovator : If th e lea dhazar dinformation pamphle t wa s delivere dbu t atenan t signature wa s no t obtainable , you ma y chec k

the appropriat e bo x below . Decline d- I certify
- tha t I have mad e agoo dfait h effor t to delive r th

e lea dhazar dinformation pamphlet to th e renta l dwellin g unit listedbelo w at the dat e an dtim e indicate dan dtha t th

e occupant decline d to sign the confirmatio n of receipt . I furthe r certif y tha t I hav e left : acopy ofth e pamphle t at the unit wit h the occupant . Unavail.ibi c fo r signature- I certif y tha t I hav e mad e agoo dfait h eflbi l to deliver th e lea dhazar d informatio n pamphlet to the renta l dwellin g uni t listedbelo w an dtha t th e occupan t wa s unavailabl e to sign the confirmatio n of receipt . I furthe r certif y tha t I hav e lef t acopy ofth e pamphle t at the unit by slidin git unde r th e door or by (fil l in ho w pamphlet wa s left) . 

# m& i Cenifviai , Deliverv
- AttemptedDeliver y Dat e Printe dNam e o

o f

f Perso Person n Cenityia ^ Delivery
- Signature of Perso n Cb|[tifyin g Lea dPamphle t Deliver y 

# 9.20 M MnplPPi f Uni t Addres s Not e Regardin g Mailin g Optio n — As an alternativ e to deliver ) in person , yo u ma y mai l the lea d hazar dinformatio n pamphle t to th e owne r and/or tenant . Pamphle t mus t be mailed at leas t 7 day s befor e renovation . Mailin g mus t be documente d by acertificat e of mailin g fro mth e pos t office .

25