TRANSMITTAL OF OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: ::?^^^.. ^ Date: 

Address: JTcT' X ^ - ^ - P ^ ^T^ ' 

LBP Stabilization Contractor: PRUDEN T TECHNOLOGIES , INC. Year: 2009 

PAIN T STABILIZATIO N 

PROPERT Y FIL E FOLDE R DOCUMENT S 

^ Video of propertv (DVD): Pre-Stabilization & Post-Stabilization Videos 

\ y Executive Summary 

E^ Signed Access Agreement Form 

%l Advance Notice Form 

0' Pre-Stabilization Video Agreement Form 

1^ Access Tracking Form 

la Property Access Assessment Form 

V Neighbor Access Agreement Form 

K Paint Match Form 

K Pre-Stabilization Property Safety Assessment Form 

U Work-Site Hazards Analysis Checklist 

fir Photographs: Pre-Stabilization Prooertv Hazard Assessment Photographs 

H Douglas County Assessor Property information 

/ Property Completion Agreement Form Signed by Property Owner 

Property Close-Out Check List Signed By EPA 

Pruden t technologies, Inc . Sigi natur e Date 

>,j^,^,t^>Xce^ 4/7//0 

e Date 

30054907 

J l 

Superfund 
TECHNOLOCIBSL INC 

Property Summary 

Date: 11/~/2009 LBP STABILIZATION EPA CONTRACT EP-R7-08-07 Month of: Nov 

Property Address; 1317 S 27 St. SAID #: 20299 

A. Executive Summarv; 

a. Issues Encountered: NONE 

b. Issues Resolved: NONE 

c. Unique Findings: NONE 

d. Other Relevant Information: 

i. Access Date: 9/18/2009 

ii. Work Began: 9/21/2009 

iii. Close-Out Date: 9/23/2009 

B. Enclosures: 

1. Pre-Stabilization Video 

2. Post-Stabilization Video 

3. Signed Access Agreement Form 

4. Advance-Notice Form 

5. Pre-Stabilization Video Agreement Form 

6. Access Tracking Form 

7. Property Access Assessment Form 

8. Neighbor Access Agreement Form 

9. Property Paint Match Form 

10. Pre-Stabilization Property Safety Assessment Form 

11. Work-Site Hazards Analysis Checklist 

12. Pre- Stabilization Property Hazard Assessment Photographs 

13. Douglas County Assessor Property Information 

14. Signed Property Completion Agreement Form 

15. Property Close-Out Check List Signed By EPA 
m. 

iOVOGUS, ir<(c. 

Prudent Technologies, Inc. (Prudent) is under contract (Contract # EP-R7-08-07) with the U. S. Environmental Protection 

Agency (EPA) to stabilize LpadBas^d PaJnt (LBP) at a number ofproperties located in Omaha, Nebraska, including the 

property located at / ^ / f S^O J ^^d^'y " 

The EPA requests your permission to allow Prudent to perform LBP Stabilization at this property. By signing this form, the 

property owner grants permission to Prudent to perfonn activities related to LBP Stabilization including scraping paint and 

painting ofthe referenced property. Further, the owner/tenant verifies that they have received the LBP pamphlet "Renovate 

Right." 

By signing this document 1 agree to allow an EPA contractor to conduct a soil cleanup at my property following completion of 

lead-based paint stabilization, ifthe soil cleanup has not already been performed. I understand that the stabilization contractor 

cannot provide assurances ofwhich contractor will be bound to the soil cleanup. I further understand that the soil cleanup 

contractor will make all reasonable efforts to address concems that I, as the property owner, may have regarding soil 

cleanup at my property. 

^ 4 Yes, 1 have read and understand the paragraph above. 

Signature of Property Owner 

Date 

Ifyou have any questions about the LBP stabilization planned for your property, please contact Prudent's Customer 

Relations/Office Manager for the Lead Based Paint Stabilization, Mrs. Shannon Holt, at (402) 504-1004 or (402)812-0223. 

General questions about the Omaha Lead Site cleanup can be directed to the EPA Public Information Centers at (402) 731­

3045 (South Omaha office) or (402) 991-9583 (North Omaha office). 

Property Access Granted By: 

it'/I/ l.£ftn/S/f-cM^ 

(Please Print Name) 

Property Owner Signature 

(Signature) 

(Date) 

\ 8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

\ Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

llPhone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
' TECHNOLOGIBS. IN C " 

PROPERTY INFORMATION 

(To be completed by resident and/or property owner — please print) 

RESIDENT NAME: A l S ^ i ^ /i/A/^ ^ //T/^^/ ^ Owner f Renter 

RESIDENT ADDRESS: 

IF RENTAL, PROPERTY OWNED BY: 

Ajn ^ ^^e^'*0*^^^i€>^ 

OWNER'S MAILING ADDRESS; 

3 ^/S - _r«D S y,. ^ 6 «*/^-7 

OWNER'S TELEPHONE NUMBER - HOME: (f*^ ) 7 5 ^S^^^\NORK : ^di . ) ^ 5 9^'" ^^ ^ Y 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: _i / 

_ NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER: 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHOM PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: 

COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS, ENTRY GATES, ETC.) 

/>df^ ^ 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activilie.s to be implemented by EPA under this agreement are 

pursuant to Section 104 ofCERCLA, 42 U.S.C. 9604. EPA"s right ofaccess to the property is provided for in Section 104(e) of CBRCl.A, 

42 U.S. C 9605(e), which provides entry for "determining the need for response, or choosing or taking any response action under this tille. or 

otherwise entbrcing the provisions ofthe title." 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

KansasCity, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 

Fax: (816) 363-3707 

Phone: (402)504-1004 

Fax: (402)504-1005 

Phone: (210)822-9588 

Fax: (210) 579-6577 
TECHNOLOGIES.] 

Advanced notice needed. 

After signing the access you allow Prudent to begin Lead Based 

Paint Stabilization. All Plants, weeds and any vehicles or items on 

open porch (enclosed porches will NOT be stabilized) must be 

removed prior to stabilization. All Pets must be out of yard during 

stabilization. How much notice do you need to have above 

mentioned tasks completed? If you are a landlord you will need to 

contact the tenant as Prudent Technologies will only inform you. 

Do you have any pets that reside in yard? ^ ^ S 

Notice needed: J altLe^fA^ 

Number to call to give notice: C%^ - ^ 7ol ^ 

93^-T-Sm (^w\e. OY l L'ocio A^lor) 

Ter^G^sVs 

Whom we are giving notice to: /p ' 

Home Owner's Signature 

-^C^. 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

KansasCity, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNOLOGIES.] 

PRE-STABILIZATION VIDEO FORM 

I UNDERSTAND THAT PRUDENT TECHNOLOGIES WILL BE COMING 

OUT TO SHOOT A PRE-STABILIZATION VIDEO AT MY PROPERTY. 

THE VIDEO IS JUST A TOOL USED TO DOCUMENT THE CURRENT 

PROPERTY STATUS/CONDITION. A POST VIDEO WILL ALSO BE 

SHOT PRIOR TO COMPLETION OF STABILIZATION. 

L eJ(ry^^»i.cM. j^on't^^d 

OWNERS NAME: 

h^l ^ 7? n n <> 

PROPERTY ADDRESS: 

20-^^ BVID/SAID: 

HOMEOWNERS SIGNATURE: /fc ^ c^^^*^^^^e^^ 

PRUDENT REPRESENTATIVE SIGNATURE: 

ANY CONDITIONS NEED TO BE AWARE OF BEFORE SHOOTING 

VIDEO: (I.E. PETS, NOTICE NEEDED): 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

KansasCity, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNraXX;iE&] 

ACCESS INFORMATION TRACKING SHEET 

 ]1iJ S 1>^ ^ BVID: % O 'X ^ ^

 PROPERTY ADDRESS ,

Property Owned By: 

(If new property owner) 

Owners Phone No's: Home: ~ Work: 

Cell: Fax: ~ 

Access Contractor: ASW PDA MES PE Other (Prudent) 

DATE TIME ACCESSOR CONRACT DETAIL 

^lii] ^ ^^f=­ ^ 

Comments: 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

KansasCity, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone:(816)363-3703 Phone: (402) 504-1004 Phone: (210)822-9588 

Fax:(816)363-3707 Fax: (402)504-1005 Fax:(210)579-6577 
TECHNOLOGIES.] 

Access Assessment Form: (Must be completed for every property. 

Information must be obtained from a property walk thru, not given 

by owner) 

Is the property stucco or asbestos? 

KOo-( S'^ W 

If yes, is any ofthe stucco or asbestos damaged or cracked? 

Ifyes, stop as we can't stabilize this property. It requires special preparation 

techniques. It will be returned to EPA and they will assign at a later date. 

Does this property require lots of scrapping? 

Does this property require a lift or scaffolding to reach upper levels? 

Does this property have lots of plants or items in areas where painting is 

required? 

Does this property have any significant structural damage? 

^>0 

Ifyes, EXPLAIN? 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

KansasCity, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNOLOGIES.] 

Does this property have a garage? 

Ifyes, describe location of garage. 

Does this property have aluminum siding? 

A.>\ y 

Ifyes, is it original factory finish or has it been painted over? 

Does this property have any other type of structural components? (I.e. roof 

shingles as siding)? 

Ifyes, EXPLAIN? 

Is this property vacant oi^occupied? 

Are there any pets at this property? 

y Jl yo^'^'^ ^ ^ ^ f /cWr 

Are there any low hanging power lines? 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

KansasCity, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax:(816)363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNOLOGIES.] 

NEIGHBORHOOD PROPERTY ACCESS FORM 

IS THERE A NEIGHBORING PROPERTY THAT NEEDS TO BE ACCESSED ALONG 

WITH ASSIGNED PROPERTY TO COMPLETE STABILIZATION PROCESS? 

A / ^ 

IF IT IS, GET ACCESS FROM ALL REQUIRED NEIGHBORHOOD PROPERTIES. 

A /D 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

KansasCity, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax:(816)363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
• • 

40L0GIES. INC. 

PAINT MATCHING FORM: 

1. TO BE FILLED OUT ONLY IF MATCHING COLOR 

PROPERTV ADDRESS: l^i* ^ S iTf^-^j ^ 

BVID: J^O^ ^ 

The foUowing notes are for the benefit of paint crew only. 

Location 

Siding 

Soffit 

Fascia 

Comer Trim 

Window Trims 

Door Trims 

Front Porch Ceiling 

Front Porch Ceiling Beams 

Front Porch Floor 

Front Porch Railings 

Front Porch Steps 

Siding Baseboards 

Foundation 

01CX3Z^(£. 

^ J 

Paint Description 

foo{ Cx^^X^C, 

U300c3 (UDViWe") 

ooooh (toh'ik N 

Paint Yes 

W ^ 

V 

Paint No 

\ ^ 

0006 ^

U>cc>6

 l.toN^^H) 

IU^VNW"^ 

\ y 

\ ^ 

^G0 6

\KeL^ 

— 

^ei 

^ 

9 ^ 

( MJW>4<>> \ ^ 

x ^ 

\ y ^ 

^ 

An y^lfoi^i^K V^ 

• I UNDERSTAND SHERWIN WILLIAMS WILL MATCH MY CURRENT COLORS. 

Homeowner signature;: /\<f ^ (^-C^S^^^s. ^ Date: 2:/^l^_ r 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

KansasCity, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone:(816)363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax:(816)363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
/S?^""^ ^ 

TECHNOLOGIBS. INC 

PRE-STABILIZATION PROPERTY SAFETY ASSESSMENT FORM 

PROPERTY ADDRESS: | ?» ' 7 S 1^ ' ^ ' 

BVID/SAID: >^i-^ ^ 

PRUDENT ASSESSMENT REPERSENTATIVE: 

^ 

REPERSENTATIVE REMARKS/FINDINGS: 

(POWER-LINE PROXIMITY TO PROPERTY, SCAFFOLDING/ LADDERS/ LIFTS 

NEEDED, UNSAFE AREAS, UNSAFE NEIGHBORHOOD—ETC.) 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402) 504-1004 Phone: (210) 822-9588 

Fax:(816)363-3707 Fax: (402)504-1005 Fax:(210)579-6577 
Current Sample Pre-Renovation Form 

Effective until April 2010. 

Confirmation of Receipt of Lead Pamphlet 

^ I have received a copy of the pamphlet, Renovate Right: Important Lead Hazard 

Information for Families, Child Care Providers and Schools informing me of 

the potential risk of the leacj hazarcj exposure from renovation activity to be 

performed in my dwelling unit. I received this pamphlet before the work began. 

n ^ T-ZS-'b? 

Printed name of recipient Date 

Signature of recipient 

Self-Certification Option (for tenant-occupied dwellings only) — 

If the lead pamphlet was delivered but a tenant signature was not obtainable, 

you may check the appropriate box below. 

Ll Refusal to sign — I certify that I have made a good faith effort to deliver the 

pamphlet. Renovate Right: Important Lead Hazard Information for Families, 

Child Care Providers and Schools, to the rental dwelling unit listed below at the 

date and time indicated and that the occupant refused to sign the confirmation 

of receipt. I further certify that I have left a copy of the pamphlet at the unit with 

the occupant. 

^Unavailable for signature — I certify that I have made a good faith effort to 

deliver the pamphlet, Renovate Right: Important Lead Hazard Information for 

Families, Child Care providers and Schools, to the rental dwelling unit listed 

below and that the occupant was unavailable to sign the confirmation of receipt. 

! further certify that I have l^ft a copy of the pamphlet at the unit by sliding it 

uixler the door -.//» , i i 

Printed name of person certifying /J Attempted delivery 

date and time 

lead pamphlet delivery 

Signature of persiWcertifying lead pamphlet delivery 

Unit Address 

Note. Regarding Mailing Option — As an alternative to delivery in person, you 

may mail the lead pamphlet to the owner and/or tenant. Pamphlet must be mailed 

at least 7 days before renovation (Document with a certificate of mailing from the 

post office). 
TECHNOliOGIBS, 

Checklist for the Worksite Hazard Analysis 

Address: IS\1 J ^i^I r 

Crew: Date: 

Item OK? . Hazard Corrective Action 

Overhead Lines — U.M^7A a.^ ^ In-transit Vehicle Clearance (>iKs>KHcn 

Levels around high wires 

Vehicle Clearance around 

high wires when working Zdo li«/»v 

Phone lines \iLu(xJ<^ 

Cable lines 

Gas Line 

Water Line 

Sewer Line 

Septic Tank 

Propane/Butane 

Access to/on Property 

V ^ ^ ^ >

Neighbor Access Required O^Sl jt^^- ^ 

High Traffic Area \.Jf.y. > 

Garage yl/Y^ C^ov-zJir-. U>€^j..J ^ c>>M— ~ 

Structures ^dboi toiKY(/\iy h ^ /to, 

Driveway 

Sidewalk 

Foundation h^^iuXiJ UtyrHs^r*- — OuuLJa^J. -yu^ 

Retaining Walls 

Fences 

Trees .^M- ivi^v-T^^^v^C tefofe^ ^ jayu^-pr<^ 

Foliage 

General Condition of yard —T/L 1. <^/^ ^ ^ A . ^ 

Damaged Areas: sink — VlD-^'>--^--^T)Uwe7-ey^ 

holes/rotted wood i^22±^^±?2L SfU,f<iu- -J^^^cJUh ^ 

Sprinkler System 

Pets dba f sf-^'THe'tM^, VA 3ig^ ^ ^ ^^^a.-v 

Insects t /^a-o^y/*^^^' ^ -|:i±f>^^' 

Weather Conditions 

Unsafe driving conditions 

Unsafe neighborhood 

TPOT^TP^J ^ 

Crew Foreman/ Sub-Contractor fficer -^^^^ ^ ^aA 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 I Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 ne: (210)822-9588 

Fax:(816)363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 



T HPOT^M 

\ 

^ -

• 1 

/ 

^ ^ m 1

Douglas County Account Informati iw ^ Page 1 of3 

Douglas County, Nebraska Property Record - R2218690000 

Print Reoort 

NEW Feature - Parcel Dimensions available &. scale 0-50 ft west of 52nd St • Vle W OH Ma D Information is valid as of 2009-9-15 Treasurer's Tax Report 

New Feature -•"•• * Auto Sales Search 

Owner 

LEIMBACH RONNALD L 

ETAL 

3818 S 34 ST ^ ^ 

OMAHA NE 68107-0000 

Property Informatio n 

Key Number: 1869 0000 22 

Account Type: Residential 

Parcel Number: 2218690000 

Parcel Address: 1317 S 27 ST 

OMAHA NE 68105-0000 

Legal Description: SHULLS 2ND ADD LOT 18 BLOCK 9 N 40 FT 40 X 127 

Value Informatio n 

Land Improvement Total 

2009 $4,400.00 $18,500.00 $22,900.00 

2008 $4,400.00 $18,500.00 $22,900.00 

2007 $4,400.00 $18,500.00 $22,900.00 

2006 $4,400.00 $30,700.00 $35,100.00 

2005 $4,400.00 $30,700.00 $35,100.00 

2004 $4,400.00 $30,700.00 $35,100.00 

Sales Informatio n 

Sales Date: 2008-07-25 

Deed Type: QC Book: 2008 Page: 081002 

Price: $0.00 

Grantor: Leimbach Ronnald L 

Grantee: Leimbach Ronnald L 1K 

Valid/Invalid: Invalid 

Exclusion Reason: 

Sales Date: 2003-04-01 

Deed Type: QC Book: 2238 Page: 654 

Price: $0.00 

Grantor: CONNIE S LEIMBACH 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2218690000 9/16/2009 
Douglas County Account Informati Page 2 of3 

Grantee: RONALD L LEIMBACH 

Valid/Invalid: Invalid 

Exclusion Reason: 

Sales Date: 1995-10-22 

Deed Type: Book: 2018 Page: 644 

Price: $18,500.00 

Grantor 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.11 5080.0 1.0 127.0 40.0 No 

Improvemen t Informatio n 

Building 1 

EnotStMVtM *» 

aor 

li r 

H FWFIw 

eucs r RANCH 25 0-

MSOSF 

to 

CLICK TO ENLARGE IMAGE j 

Square Footage: 648.0 Percent Complete; 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Fair 

Built As: Ranch Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 6.0 

Exterior: Frame Siding Units: 1.0 

interior: Plaster Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 1.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2218690000 9/16/2009 
Douglas County Account Informati [Wj ^ Page 3 of3 

Year Built 

1885 

Detail Type 

Appliance 

Basement 

Fixture 

Fixture 

Garage 

Porch 

User 

User 

Year 

Remodeled 

0 

Percent 

Remodeled 

0% 

Detail Description 

Allowance 

Bsmnt Block 8 ft 

Base Fixtures 

Bath Full 

Detached 

EncI Solid Wall 

New Roof 

Siding - Roll Comp 

Adjusted Year Physical Age Built 

1885 124 

Units 

1.0 

648.0 

1.0 

1.0 

360.0 

120.0 

1.0 

1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accoimtno=R2218690000 9/16/2009 
\OLOGnXS,lNC 

Prudent Property Close-Out Form (Lead-Based Paint Stabilization) 

SAID: CSOA^^^ 

Property Address: /^^ ^ 5 c>l 7 ^/- * .. 

Owner's Name: fl^/ ^ Le^»*i,^^C'k^_^ 

S.NO 

Performance Standards/close-Out Criteria Yes NO 

1 

Was the entire 8tructure(s) painted with the exception ofthe stated, 

excluded areas? This would include painting of other associated 

features including fascia, eaves, siding, all trim, porches, box 

X 

beams, columns, rails, and exterior surfaces of garages. 

2 Was all scraping and other preparation work completed 

satisfactorily? / 

3 Were all required areas of the structure(s) primed as needed and 

painted with two top coats? 

X 

4 

Are all ofthe areas where contaminated materials have been spilled 

thoroughly vacuumed/ cleaned? 

X 

5 

Did the contractor collect/vacuum all falling and scraped paint chips 

on the entire property, roadways, alleyways, public access areas 

and also remove any other generated debris? 

X 

6 Is the grass area that surrounds the structure(s) in reasonably good 

7 Wa

condition

s the pain

? 

t products utilized equivalent to a 30 year 

X

product/quality? 

/

K 8 

Are all items such as polyethylene sheeting, ladders, paint brushes, 

cones, barrier tape etc properiy removed? 

9 Is there any evidence of property damage that was done by the 

contractor? Any property damage needs to be completed prior to 

the EPA Close-Out. / 

10 Are there any property items that were temporarily re-located by the 

11 Ar

contracto

e there an

r tha

y (known

t need t

)

o

 lingerin

 be move

g issue

d back

s wit

? 

h the property owner(s) 

X

that have been left unresolved? 

X 

12 

Other Considerations? Property Owner Discussions? Additionai 

Work that is Required 

K 

Prudent Representative Signature: 

Date: 

Property Owner Signature: ^ ^ y*" / 

8080 Ward Parkway, Suite 405 2505 N. 24^" street. Suite 308 4242 Medical Drive, Suite 4250 

KansasCity, MO64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone:(816)363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577