## TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO NFIL EFOLDE R SAID : 3451 0 Date : 12/26/200 8 s 

### Address : 450 4 N2 1 AV E Stabilizatio nContractor : Pruden t Technologie s Year : 200 8 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S B' Vide o o f propert y (DVD ) [?

r Executiv e Summar y Signe dAcces s Agreemen t fo r subjec t propert y 0 Paintin g Agreemen t D Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) D Photograph s H

r Satisfactor y restoratio nsigne db y Propert y Owne r D Propert y close-ou t chec k lis t signe db y EP A I ZPropert y informatio nfromDougla s Cotmt y Assessor' s OfSc e D D D



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### PROPERT Y SUMMAR Y Date : 12/29/0 8 LB PSTABILIZATIO NEP A CONTRA T EP-R7-08-0 7 Mont hof : Decembe r Propert v Address : 450 4 N2 1 AV ESAID : 3451 0 

### A . EXECUTIV ESUMMAR Y A. 1 Issue s Encountered : NONE . A. 2 Issue s Resolved : NONE . A. 3 Uniqu e Findings : NONE . A. 4 Otlie r Relevant Information : Acces s Date : 10/30/0 8 Wor k Began : 11/03/0 8 Closeout Date : 11/07/0 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 nForm 6 . Pain t Matc hForm 7 . Trackin g Form 8 . Dougla s Count y Assessor Propert y Infonnatio nPag e 9 . EP A Propert y Closeout for m 10 . Propert y Completio nAgreement

TECHNOLOGIES , INC .ENVIRONMENTA L& CONSTRUCTIO N 

## TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : ^^'^ ^ /0-^v:>^^, ^ Date : ^ o/-J f Phone : BVID : 3^S'i ^ Plant & Pennanent T.ar>dacapinp , TnRamainInPlac e ItSQi # 

## Descriptio nan dLocation OnM ^ 

# yVJcn-e .

Pre-Existing Conditio no f Structure s 

# f Doe s you r Basement hav e ahistor y o f leaking ? Ye s — N o Item # Descriptio n& Locatio n OnM ^

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## Propert y Owner Prudent Employe e Signature : C?4^ ' •.*^^ 

## Signature:y5C/^--^ci—'C ^ 

# \l^r^^i ^ 

# L - X »n 6 N . 24 * Streot , Suit e S0 8 4M 2 Medica l Drtve , SuMa 428 0 808 0 Wki d Parkway , Suit e 40 6 Omaha , Nebraek a 6811 0 Sa n Antonio , TX 7832 9 Kansa s CHy . M O 6411 4 lt< n SAJ.4AA J

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Pruden t Technologies , Inc . (Prudent ) is unde r contrac t (Contrac t #EP-R7-08-07 ) withth eU. S. Environmenta l Protectia nAgenc y (EPA ) to stabiliz e Lea dBase dPaintjLBP ) at anumbe r er f propertie s locate d inOmaha , Nebraska , includin g tiie property locate dat l4Sf)t- J /[ / ^ ^ nvC * Th e EPA request s you r permissio n to allo w Pruden t to perfor mLB PStabilizatio nat thi s property . By signin g thi s form , th e propert y owne r grant s permissio nto Pruden t to perfor mactivitie s relate d to LB P Stabilizatio nincludin g scmpin g pain t an dpaintin g of th e reference dproperty . Further , th e owner/tenai t verifie s Aat &e y hav e receive dtiie LB Ppamphle t "Renovat e Right. " If

youihav e any question s abo mtiie LB Pstabilizatio nplamie dfo r you r property , pleas e contac t Pruder f s ^t^miiiistrfltive Clerk fo r th e Lea dBase dPain t Stabilization , Mra , Debora hAkereie-Johnson , at

(402 ) 504-1004 . Genera l question s abou t th e Omah aLeadSit e cleanu p ca n be directe dto the EP A Publicjlnfonnatio nCenter s at (402 ) 731-304 5 (Souti i Omah aoffice ) or (402 ) 991-958 3 (Nort hOmaha . ofScej. . (Pleas e Prin t Name ) 

### Propert yOwne rSigBituw : -'€^ii'i;^^j ( Jjf^Hr^'S^^C^ ' iZ-7^Z-o 8 ! / (Sigiyrfiue ) (Date ) PROPERT YINFORMATIO N I(T o be conplete dbj r reiiden t ud/o r propert] ' owne r - pleas e print ) RESnefTNAME : ^f'^ ^ '^o^^o ^ W Owne r 

## //^"^ ^ AJ , P/^ ^ y-^iZ : RESIDEN TAD0RE88 : 

### W RENTAL . PROPBIT YOWNE D BY : .^^A-frvNt p fi<^r.j^'V(-t OWNERfSMAUNOAOORESS ; /"^^ ^ AJ - 5^Al ^

Cr<>g^W OWNERT S TELEPHON E NUMBE R • HOME : ( > WORK : J L

: ^ NUMBE NUMBE R R O

O P OCCUPANT OCCUPANT S 7 YEAR YEAR 8 0L P AM P OLDER ; J j NUMB » OF OCCUPANT S UNDE R 7 YEAR S OLD : '= ' F S 7 S OL D AN D OLDE R i i 

### NUMBB R OPCHILDRE N UNDE R 7 YEAR S OL D W H O PLA Y IN TH E YAR D FO R 5 HOUR S OR MOR E PE R WEEK : ^ j OOHMENTSORSPECIALINSTRUCnONS : (LE . DOQS . ENTR YQATES , ETC. )

AUTHORrrYFO RENVIRONMBNTALRBSPONS B ACTIONS ; Hi e icttvkie i to be impletneiite d by EP Aunde r Ms agieemen t veponaa m to SectfHi 104 efCERCLA, « U& C 9604 . EPA' Irigh t of loces s lo lh e property isprovide dfor inSectio n104(e ) of CERCLA , 42 U.S . C 9605(e) . whid i provide s eit v fbr

""detepdnin g th e nee dIb r response , or chooein g ortaUn g an y lesponi e actio nunde r thi s title , or olherwii e c

# Curren t Sampl © W©-Ren©vatio n For m Effectiv e unti l Apri l 2010 . Confinnatio n o f Receip t o f Lea d Pamphle t ^

i haw s received a cop yo fth e pamphlet . Ftenovat e Pi^ : Importan t Lea d Hazar d Intommlto n fa rftrnffies; CNl d Car e Provkler s an d School s infofmin g m e o f th e potantia t risk o fth e lea d hazar d e^q^osur e firo m renovatio n activit yt o b e perfomie d In m ydwellin g unit . I received thi s pamphle t befor e th e worl < began . Printe d rame o f redpient,>4^ ' Dat e SignatMreo frecipient Self-CertlflcatiQ n Optio n (Ib rtenant-occupie d dwelling s only ) — I fth 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 xbeiow . Q Refusa l t o sig n — I certif ytha t I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , /tenovat e fljgM; Importan t Lea d Hazar d Infonnatio n torFamSes , Ch%fCar e f^ovider s an d Sc/KX7te , t o th e renta l dweinn g uni t Sste d b ^ 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 freceqst. i furthe rcertif ytha t i hav e lef t a cop yo f th e pamphle t a t th e uni t wit h tii e occupant . Q lAiavailabI a fb rsignatur e — I certif ytha t I hav e mad e a goo d fait h effort t o defive rth e pamphlet , Aisnovat e R^t Importan t Laa d Hazan i Intonnatio n tor FamSea , ChU d Ca m provkier B an d Schools , t o th e 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 th e confimnatio n o freceipt . I furthe rcertif ytha t I hav e lef t a cop yo f th e pampMe t a t th e uni t b yslidin g i t underthedoor . f-ye'^f^ M ^^IIAVOL-J A Printe d nam e o fperso n certifyin g At^mpte d deiivery dat e an d tim e Signatur e o fperso n certifyin g lea d pamphle t deliver y 

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# rv^^-^X^ . A J s ^ UnitAddres s Not e Regardin g Mailin g Optio n — A s a n alternativ e t o deliveryi 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 be ^

renovatio n (Documen t wit h a certificat e o f mailin g fro m th e postoffice) .

# pain t matc h form: Pain t matchin g form : ^ . ~ Propert yaddress : H^O 4 ^ ^^.^^-yi^ ^ BVID : 54SV 0 ^W^^ - ^--^^' ^ .•5. < 

# Area : color : ^ .^J , Explanation : Area : color : Explanation : Area : Color : Explanation : Area : color : Explanation : 

# Area : * color : Pag e 1

# ACCES S INFORMATIO N TRACKIN G SHEE T PROPERT Y,,^,, w^ U ^ . BVID : 3^^/ ^ ADDRESS : "^'^' > ^ AJ - ^'^^X^c T Propert y Owne dBy:/4-i^\c > >/>
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na u nmmri v nummr i - ^ (I f ne w propert y tmrm ) 

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## C'tsfs-a . Owner s Phon e No's : Home:-r5' 5 6 5 H H Work : Cell : Fax : 

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## , W Acces s Contractor :ASW FD AME S P E 

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Ck^mments :

Pl^is e write legitOy lnctp://aougJasnejnapping-online.com/DougiasCoNe/static/accountinfo . Dougla s County , Nebrasic a Propert yRecor d ~ R020209000 0 Prin t Repor t i NE W Featur e - Parce l Dimension s availabl e @ se a e 0-5 0 f t wes t o f 90t h S t - Vle W O H IVIa p | Infonnatio 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 PIGNOTT I S R ANTONI O G ETA L T R 142 1 N SADDL E CREE KR D OMAH AN E 68132-000 0 Propert yInformatio n Ke yNumber : 020 9 000 0 0 2 Accoun t Type : Residentia l Parce l Number . 020209000 0 Parce l Address : 450 4 N 2 1 A V OMAH AN E 68110-000 0 Lega l Description : LAND S SEC-TWN-RG E 03-15-1 3 S 42.4 2 W 10 7 FTSU B LT1 TA X LT1 8 - 42.4 2 X10 7 Valu e Informatio n Lan d Improvemen t 

### Total 200 8 $ 2,300.0 0 $ 34,200.0 0 $ 36,500.0 0 200 7 $ 2,300.0 0 $ 34,200.0 0 $ 36,500.0 0 200 6 $ 2,300.0 0 $ 34,200.0 0 $ 36,500.0 0 200 5 $ 2,300.0 0 $ 16,500.0 0 $ 18,800.0 0 200 4 $ 2,300.0 0 $ 15,000.0 0 $ 17,300.0 0 200 3 $ 2,300.0 0 $ 15,000.0 0 $ 17,300.0 0 Sale s Informatio n Sale s Data : 2006-03-0 8 Deec f Type : Q C Book : 200 6 Page : 07164 2 

# «_ J Price : $0.0 0 Grantor : Pignott i Antoni o G S r Grantee : Pignott i Antoni o G S reta l Valid/Invalid : Invali d Exclusio n Reason : Famil ySal e Lan d Informatio n Acre s S F Unit s Dept h Widti i Vacan t 

## 1 0. 1 ^ 4494. 0 1. 0 107. 0 42. 0 N o 1 Improvemen t Informatio n 1 Buildin g 1

l o f 3 12/23/200 8 1:1 9 P M

### nnp://aouglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.. .

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### 2 of : 12/23/200 8 1:1 9 P M,iaav..oiNe/static/accountinfo. . Squar e Footage : 1028. 0 Perimete r 0. 0 Uni t Type :

Buil t As : 1 1/ 2 Stor yUnfi n HVAC : Centra l Ai rt o Ai r Exterior : Fram e Sidin g Interior : Drywal l Roo f Cover : Compositio n Shingl e

Roo fType : Gabl e Floorcover : Allowanc e YearBuil t Yea r Remodele d .._^_ _ Percen t Remodele d 192 5 0 % Detai l Typ e Detai l Descriptio n Ad d O n Fenc e Chai n Lin k Applianc e Allowanc e Basemen t Bsmn t Bloc k 8 f t Fixtur e Bas e Fixture s Fixtur e Bat h Ful l Garag e Detache d Porc h En d Scree n ! Use r Atti cFul l Finis h Percen t Complete : '• • 100.0 % Quality : ' Low Condition : ] Fai r Cond o Squar e Footage : ; 0. 0 Rooms : 5. 0

Units : 1. 0

_Baths : ; 1. 0 Bedrooms : ; 2. 0 Stories : 1. 5 Foundation : , Bloc k Sprinkle rSquar e Footage : i 0. 0 Adjuste d Yea r Physica l Ag e Buil t 192 5 ; 8 1 Unit a 1. 0 1. 0 728. 0

_1.0 _ I.o ' 224. 0 133. 0 ; 280. 0 .

12/23/200 8 1:1 9 P M of :

## Pruden t Propert yClose-Ou t For m (Lead-Base d Pain t Stabiiization ) SAID : 3^-^/Z > Propert yAddress : HSO" ^ A? - ^1'' ^ A^ ^ Ownerf s Name : -Ar-^^g>>% . t o r * \ cM ^ "< ^ '^ 

## Performanc e Standards/close-Ou t Criteri a YE S 

### N O 1 .Wa s th e entire structure{s ) painte d wit h th e exceptio n of th e stated , exclude d areas ? Thi s woul d includ e paintin g o f othe rassociate d feature s includin g fascia , eaves , siding , al l trim , porches , bo x bea'ms , 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 ? < 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 ? 

# x r 4 .

WaS;th e pain t product s utilize d equivalen t t o a 3 0 yea rproduct/quality ? 

### • < r 5 .Ar e jai l o f th e area s where contaminate d materials ' hav e bee n spille d thonoughl yvacuumed/ cleaned ? < ' 6 .

Di d th e contracto rcollect/vacuu m al l fallin g an d scrape d pain t chips o n th e entir e property , roadways , alleyways , publi cacces s area s an d also reniove anyothe rgenerate d debris ? ^ 7 .

I s thj e gras s area tha t surround s th e structure(s ) i n reasonabl ygoo d condition ? < 8 .

Ar e al l item s such a s polyethylen e sheeting , ladders , pain t brushes,'cones , barrie rtap e etc . prop|erl yremoved ? r < 9 .

I s ther e anyevidence o f propert ydamag e tha t wa s don e b yth e contractor ? An ypropertydamag e I need s t o be complete d prio rt o th e EP AClose-Out . 

# y 10 .Ar e ther e anypropertyitem s tha t wer e temporatil yre-locate d b yth e contracto r 

## X thatlnee d t o be move d back ? 11 .Ar e ther e any(known ) lingerin g issues wit h th e propertyowner(s ) tha t hav e bee n lef t unresoived ? 

# / C Othe rConsiderations?propert yOwne rDiscussion5?AddltiQna l Wor k tha t i s Require d 

## Prudeh t Representativ e Signature-.^y^c.^. ^ 

# Dat e ! ' V^'-A't r



# ..A/&S^/ ^/^ ^ ProperjtyOwne rSignatur e Date : i/z-Z2-<^S ^