## TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R SAID : 3456 3 Date : 01/15/200 9 Address : 451 4 N 4 1 S T Stabilizatio n Contractor : Pruden t Technologie s Year : 200 8 PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S ^ Vide o of propert y (DVD ) Bi Executiv e Summar y IZ

TSignedAcces s Agreemen t fo r

subject propert y J Paintin g Agreemen t D Settlemen t document s (i.e. , fo r

damag e o r

to replac e plants , etc. ) D Photograph s 0 Satisfactor y restoratio n signedby Propert y Owne r D Propert y close-out chec k

lis t signedb y EP A \ 3 Propert y information fromDougla s Count y Assessor' s Office D D D 

## Signaturo / Dat e

4030779 0 

# ilii l Superfun d

### PROPERT Y SUMMAR Y Date : 01/15/2009 LB P STABILIZATIO N EP A CONTRAT EP-R7-08-0 7 Mont h of : JANUARY + Propert y Address : 451 4 N 4 1 S T SAID : 3456 3 A . EXECUTIVE SUMMAR Y A. 1 Issue s Encountered : A. 2 Issue s Resolved : A. 3 Uniqu e Findings : NONE . A. 4Otiie r Relevan t Information : Acces s Date : 10/08/0 8 Wor k Began : 10/10/0 8 Closeou t Date : 10/10/0 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 n For m 6 . Pain t Matc hFor m 7 . Trackin g Form 8 . Dougla s Count y Assesso r Propert y Informatio n Pag e 9 . EPA Propert y Closeou t for m 10 . Propert y Completio n Agreemen t

TECHNOLOCIES , INC .ENVIRONMENTA L& CONSTRUCTIO N 

## TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : ^^ V M QlS T ^^^e : j D "1-7) 1 Phone : ^^- ^ mAi/^IJ^02l O ^"^ ^ ^'0^ 3 Plant & Pennanent Landscaping T o Remain I n Plac e Item# Descriptio n andLocatio n O

n Ma p 

# ueA
- I ' l l 61)71 7 - » " Ivoidi i - " ' ' d/AAA . ^ " " Pre-Existin g Conditio n o f Structure s Doe s your Basemen t hav e ahistor y o f leaking ? Ye s —N o Item# Descriptio n & Locatio n OnMa p 

# i/ue^t- - ^^

Propert y Owne r 

# llfff ^ bjdo ^ (i l m/^if e l l 

## l l I I ) i Pruden t Emp^ye e 

# Sigaa^:^C^ : Signature : 808 0 Ward Parinvay , Suit e 40 5 A250 5 N . 24** Street , Suit e 30 8 4242 Medica l Drive , Suit e 425 0 Omaha , Nebra6ka 6811 0 Sa n Antonio , T X 7822 9 Kansa s City . MO 6411 4 Phone : (402)504-100 4 Phone : (210)822-958 8 Phone : (816 ) 363^70 3 Fax : (402 ) S04.iftn'i : Fax : (816 ) 363-3707

# 3Q^'(^ 3 Pruden t Technologies , Inc . (Prudent ) i s unde r

contrac t (Contract #EP-R7-08-07 ) wit hth e U . S . Environmenta l Protectio n Agenc y (EPA) t o stabiliz e Lea dBasedPaint (LBP) at anumbe r

ofpropertie s locatedi n Omaha , Nebraska , includin g th e propert y locate da t H'A'l U A J Ql^i t Th e EP A request s you r

permissio n t o allo w Pruden t to perfonn LB P Stabilizatio n a t thi s property . B y signing thi s form , th e propert y owne r

grant s pennissio n to Pruden t t o perfor mactivitie s relate dt o LB P Stabilizatio n includin g 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 P pamphlet "Renovat e Right. " If

you hav e an y question s about th e LB P stabilizatio n plaimedfo r

you r

property , pleas e contact Prudent' s Administrativ e Cler k

fo r

th e Lea dBasedPaint Stabilization , Mrs . DeborahAkerele-Johnson . a

t (402 ) 504-1004 . Genera l question s abou t th e OmahaLea dSit e cleanu p ca n b e directe dt o th e EP A Publi c Infonnatio n Center s a t (402 ) 731-304 5 (Sout h Omahaoffice) or (402 ) 991-958 3 (Nort hOmaha Propert y Acces s GrantedBy : (Pleas e Prin t Name) Propeit y Owne r Signature : 

# (o-7ry . (Date ) PROPERT Y INFORMATIO N /- ) . ^ (T o l) e complete db y residen t and/o r proper ^ owne r — pleas e print ) RESIOEN T NAM E : L> ^ LA\ ) \\E.A77C ( A/C j /^wneT ^ Rente r RESIDEN T ADDRES S 

# HSiXLXldsXAA. 

# sei q I F RENTAL . PROPERT Y OWNED BY : OWNER' S MAILIN G ADDRESS ; 

# XSHLAAiAb l ^23 ^ 3'\oy32. & xy^/ l OWNER' S TEL£PH0N E NUMBER-HOME : f \ - ^ ^ 7 \ . WORK : J 1 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 : 

# .A l 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 : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS . ENTR Y GATES , ETC. ) 

# AXOi^ E

AUTHORrr Y FO RENVIRONMENTA LRESPONS E ACTIONS ; The activitie s to b e in^lementedb y EP A unde r thi s agreemen t ar

e pursuan t t o Sectio n 10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s right of

acces s t o flic propert y isprovide dfor i n Sectio n 104(e ) o f CERCLA, 4 2 U.S . C 9605(e) . whichprovide s entr y fo

r "determining the needfo r response , or choosing ortaking an y respons e actio n unde r thi s title , o r otherwis e enfiarcin g «i e provision s ofth e titte. "

250 5 N . 24 * Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 '08 0 War d Paricway , Suit e 40 5 Omaha , Nebrask a 6B11 0 Sa n Antonio , T X 7822 9 '.ansa s City , M O 6411 4 Phone : (402)504-100 4 Phone : (210)822-956 8 • tione : (816 ) 363-370 3 Fax : (402)504-100 5 Fax : (210 ) 579-657 7 8x : (816 ) 363-370 7

# wviifc^ii L ociiiipit ; j^e-nenovatio n hor m Effeciiv e unti l Apri l 2010 . Confinmatio n o f Receip t o f Lea d Pamphle t O

J 1 hav e receive d a cop yC3 f th e pamphlet , ftenoi/ate ftig/>t/mportanf Z.eat f Haza ^ . : " . / \

Irriormatio 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 wor k began . 

# fxry j Ae^lfo/ A lOzA-^ Q Printe d nanp ^

o f recipiept' / ^ 'Otst e Signatur S o f recipien t 7 7 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 , flenowate Right : Importan t Lea d Hazar d Infonnatio n fo rFamilies , Chil d Car e Providers an d Schools , t o th e renta l dweiiin g uni t liste d belo w a 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 confimiatio n o f receipt . I furthe rcertifytha t I hav e left a cop yo f th e pamphle t a t th e uni t wit h th e occupant . Q Unavailabl e fo rsignatur e —i certif ytha t I hav e mad e a goo d fait h effort t o delive rth e pamphlet , Renovat e Rght : Importan t Lea d Hazar d Informatio n fo r Families , Chil d Care 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 v/a s unavailabl e t o sig n th e confirmatio n o f receipt . I furttie rcertifyttia t I hav e lef t a cop yo f th e pamphle t a t tfi e uni t b yslidin g i t

m rtn e aofx . , I i 

# fill CM// A/AHLAXAp^ ' 3

d nam e o f perso n catifyjn gAttempte d deliver y dat e an d time lea d pamphle t deliver y Signatur e o f persotusertifyin g lea d pamphle t deliver y 

# -T^/ V AjA ' UnitAddres s Not e Regardin g Mailin g Optio n — A s a n altemativ e t o deliver yi n person , yo u ma ymai l th e lea d pamphle t t o th e ovme 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) .

# ,..^.no.^i>m^foctxyysy,^i ^ {7 , pain t matc hfor m ' 4 ^ pain t matchin g form : ^ <AMA

# /T'T^&fiPl^ i propert yaddress : ^^/ ^ // . V/^ ^ D^''" ^ ^^"^^ ^ » BVID : 

# 5*/^<^ ^

Area : Explanation :
Area : Explanat i on : Area : Explanat i on : Area : Explanation : 

# X (rXJy^ ' colo r

color :

color :

color :

pag e 1• jSaS a 

# ACCES S MFOi^HATioiiTtiACmi G SHEE T looaMB i 

# pfiopcer V 

# « a3^^ n 7S^ ^ Vr/ V /V
- ^ / 

# < r AAA > .1^/,/^/ W

OmrOoiMlt e Home : ^T?
- f P^ ^ Wh t

Jf ^ - A?. ? ? ^ "/^ l 31 k ^ 'I7(>1/J T MBMOOM K 

# 7lK7t7hj4 ' SA m ^ 

## CcUTKTDEm L 

# W-^\1' M 7 1 X^i^A dk V/^/^f- ^

^MXnA j /Jc 7 /Sjl } 7^ 6 AJ4J6S -

BB Hj-/uugia i ^uum y /T.ucuuil^UlIUIiIiailUI l 

### Fag e 1 ot 2 Dougla s County , Nebrask a Propert yRec i 3r d - R232983000 0 1 Prin t Repor t r e - Parce l Dimension s availabl e @ scal e 0-5 0 f t \ ves t o

f 90t h S t - Vie wO n Ma p Informatio n i s vali d a s of 2008-9- 4 1 '*^ ^

''^^* " Treasurer' s TaxRepor t Ne w Featur e - * - * - > Aut o SaLe s Searc h Owne r JENKIN S BRIA N D 451 4 N 4 1 S T OMAH A N E 68111-00 0 

# . 

# • ^ r Propert yInfor m a t Ke yNumber : Accoun t Type : Parce l Number : Parce l Address : Lega l Description : Valu e 200 8 200 7 200 6 200 5 200 4 200 3 Sale s Informatio n i Lan d

i j

Informatio n Sale s Date : Dee d Type : Price : Grantor : Grantee : Valid/Invalid : Exclusio n Reason : Lan d Informatio n Acre s S F 0.1 2 io n 298 3 OOO O 2 3 Residentia l 232983000 0 451 4 N 4 1 S T OMAH A N E 68111-000 0 TUTTLE S SU B DI V LOT 9 BLOC K0 N 4 2 S 19 4 W 133, 5 E 163. 5 FT-42X133. 5
; Impr o $ 4,500.0 0 $ 4,500.0 0 1 $ 4,500.0 0 i $ 4,500.0 0 1 $ 4,500.0 0 $ 4,500.0 0

2006-03-1 4 W D $50,000,0 0 : Sall yM Burkhiser , T R : Bria n Jenkin s 1 Vaii d

1 Unit s 5586. 0 1. 0 vemen t $31,500.0 0 $31,500.0 0 $31,500,0 0 $14,900.0 0 $13,500.0 0 $13,500.0 0 i

Tota l $36,000.0 0 $36,000.0 0 $36,000.0 0 $19,400.0 0 $18,000.0 0 $18,000.0 0

Book : 200 6 Page : 02987 5

j Deptf i Widt h Vacan t 133. 0 1 42. 0 N o Improvemen t Informatio n 

### http://douglasne.mapping-online.coiii/DouglasCoNe/static/accountinfo.jsp?accountno=R23 . 9/24/200 R

### Pag e 2 of 2 Buildin g 1

S5 4 i•. ^ ft, ; ; I l.'l-Fi M

HIMIl.-li«.J.I.I.g.l.ilM»..M.|.lli!i.'J?a:?3:!?rT ; ' " ' l CLIC KT O ENLARG E IMAG E CLIC KTO ENLARG E IMAG E Percen t Complete : 100.0 % Quality ; ; Fai r Condition : Averag e Cond o Squar e Footage : 0. 0 Rooms : 6, 0

Units : 1. 0 Baths : 1. 0 Bedrooms : 3, 0 Stories : 1. 5 Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Adjuste d Yea r Physica l Ag e Buil t 

# r.... :

192 4 84 Unit s ^

1. 0 832. 0 1. 0 1. 0 1, 0 240. 0 128. 0 Squar e Footage : Perimete r Uni t Type :

Buil t As : „HVAC : Exterior : Interior : Roo f Cover :

Roo f Type : Floorcover : Yea rBuil t 192 4 Detai l Typ e Applianc e Basemen t Basemen t Fixture Fixtur e Garag e Porc h 1272. 0 0. 0 1 1/ 2 Stor yFi n Force d Ai r Fram e Sidin g Drywal l Compositio n Siiingl e Gabl e Allowanc e Yea r Percen t Remodele d Remodele d 

# i 0 0 % Detai l Descriptio n Allowanc e Bsmn t Bloc k 8 f t Outsid e Entranc e Bas e Fixture s Bati i Ful l Detache d En d Soli d Wal l



### http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.isp?accountno=R23, , , 9/24/200 8

## Prudent Propertv diss-Ou t ?o?m{Lsad-Bsss dPairst StsfeMisatlon l leJD : Dv.-sr= 3 Name : Bf^^Ai } D-.TeriMKT S 

## Fsrformance Standarps/doss-Ou t Criteri a ;YE S IN O 1 .Wa s th e entire structure(s^lps!nte dwrt!^ , th e exception o f th e statad , exciuds dsraas ? Tni s woul d s 

### Includ e paintin g c f othe r associate dfeature s includin g fascie , eaves , siding , al l tri?n , porches , bo x 

# ^y beams , coiun^ns , rails , an d^epio r surface s o f gareges . 2 .Wa s all , scrapin g andothe r greparattio n wor k

compietedsatisfactorily ? 

# TT T 3 . War e ai l requiredarea s o f tq e structure(s ) primeda s neede dan dpai.nte dwit h tw o to p coats ? 

# y r j4 . Wa s th e pain t product s utiiiqedsquh/aient t o a3 0 yea r product/quality ? 

# y r is . Ar e ai l ofth e area s where cdntaminate dmatsriai s have bea n spliis d thoroughl y vacuunf^ed / dearilpd ? 

# \y \ |£ . Di dth e contractor coliect/vsicuu mai i fa'iing andscrapedpaint chip s e n th s entire property , ! roadways , aiieyways , publi c apces s area s andals o remov e an y other generate ddebris ? 

# A
tl . 

### i s th e gras s are atha t surrourifi s th e stpjctureis ) i n reasonably goo dcondition 

# y i is .

Ar e ai l items suc h a s polyethy|en e sheeting , ladders , paint brushes , cones , barrie r tap s etc . • ,properl y removed ? ; 1 

# \ y iS . i s ther e an y evidenc e o f property damag e tha t wa s don s b y th s contractor ? ,An y proper^/ damag e need s t o b e compietedpric
- t| p th e SP A Close-Ou t 

# K ilC . .Ar e there an y propert y item s tt'.a t were te.mporatil y .re-iocate db y th s contracto r \ that nee dt o b e move dbacic? ; 1 

# \ x

. • I . 

### 111 .Ar e ther e an y (known ) 'ingerin aissue s svit hth e propert y owner(s ) tha t have bss n ief t unresolved ? ; / Othe ? Consideratigp.s?property'|Owne r Di5Cussions?.&ddition8 i Wori c tha t i s Recui.'e d



# llbi'- l JA^AJLMA. ^ CICAUL A

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