## TRANSMITTALO FOMAHA LEAD SIT E PAIN T STABILIZATIO NFIL EFOLDE R SAID# : ::?^^^.. ^ Date : Address : JTcT' X ^ - ^ - P^ ^T^ ' LB PStabilizatio nContractor : PRUDEN TTECHNOLOGIES , INC . Year : 200 9 PAINTSTABILIZATION PROPERT Y FILEFOLDERDOCUMENT S ^ Vide o o f propert v (DVD) : Pre-Stabilizatio n& Post-Stabilizatio nVideo s \y Executiv e Summary E

^ SignedAcces s Agreement For m %

l Advanc e Notic e For m 0' Pre-Stabilizatio nVideo Agreement For m 1 ^ Acces s Trackin g Form l aPropert y Acces s Assessmen t For m V Neighbo r Acces s Agreement For m K

Pain t Matc hForm K

Pre-Stabilizatio nPropert y Safet y Assessmen t For m U Work-Site Hazard s Analysi s Checklis t fir Photographs : Pre-Stabilizatio nProoert v Hazar dAssessmen t Photograph s H Dougla s Count y Assesso r Propert y informatio n / 

### Propert y Completio nAgreemen t For mSigne db y Propert y Owne r Propert y Close-Ou t Chec k Lis t Signe dB y EP A Prudent technologies , Inc . Sig i natur e Dat e 

# >,j^,^,t^>Xce ^ 4/7// 0 e Dat e 3005490 7 

# J l Superfun dTECHNOLOCIBS LIN C 

# Propert y Summar y Date : 11/~/200 9 LB PSTABILIZATIO NEP A CONTRAC T EP-R7-08-0 7 Mont hof : Nov Propert y Address ; 131 7 S 2 7 St . SAID # : 2029 9 A . Executiv e Summarv ; a . Issue s Encountered : NON E b . Issue s Resolved : NON E c . Uniqu e Findings : NON E d . Othe r Relevan t Information : i . Acces s Date : 9/18/2009 ii . Work Began : 9/21/2009 iii . Close-Ou t Date : 9/23/2009 B . Enclosures : 1 . Pre-Stabilizatio nVide o 2 . Post-Stabilizatio nVide o 3 . Signe dAcces s Agreemen t Form 4 . Advance-Notic e Form 5 . Pre-Stabilizatio nVide o Agreemen t Form 6 . Acces s Trackin g Form 7 . Propert y Acces s Assessment Form 8 . Neighbo r Acces s Agreemen t Form 9 . Propert y Pain t Matc hForm 10 . Pre-Stabilizatio nPropert y Safet y Assessment Form 11 . Work-Sit e Hazard s Analysi s Checklis t 12 . Pre
- Stabilizatio nPropert y Hazar dAssessment Photograph s 13 . Dougla s County Assessor Propert y Informatio n 14 . Signe dPropert y Completio nAgreement Form 15 . Propert y Close-Ou t Chec k Lis t Signe dB y EP A

# m. iOVOGUS , ir<(c . Prudent Technologies , Inc . (Prudent ) i s unde r contrac t (Contrac t #EP-R7-08-07 ) wit hth e U . S . Environmental Protectio n Agenc y (EPA ) t o stabiliz e LpadBas^ dPaJn t (LBP ) a t anumbe r ofpropertie s locate di nOmaha , Nebraska , includin g th e property locate dat / ^ / f S^ O J ^^d^'y " Th e EP A request s you r permissio nt o allo w Pruden t t o perfor mLB PStabilizatio nat thi s property . B y signin g thi s form , th e property owner grant s permissio nt o Prudent t o perfon nactivities relate dt o LB PStabilizatio nincludin g scrapin g pain t an d paintin g ofth e reference dproperty . Further , th e owner/tenan t verifie s that the y hav e receive dth e LB Ppamphle t "Renovat e Right. " B y signin g thi s documen t 1 agre e t o allo w a nEPA contracto r t o conduc t asoi l cleanu p at m y property followin g completio no f lead-base dpain t stabilization , ifth e soi l cleanu p ha s no t already bee nperformed . I understan dthat th e stabilizatio ncontracto r canno t provid e assurance s ofwhic hcontracto r wil l b e boun dt o th e soi l cleanup . I further understan dthat th e soi l cleanu p contracto r wil l make al l reasonabl e effort s t o addres s concem s that I , a s th e property owner , ma y hav e regardin g soi l cleanup a t m y property . ^4 Yes , 1 hav e readan dunderstan dth e paragrap habove .

Signature o f Property Owne r
Date Ifyo u hav e any question s abou t th e LB Pstabilizatio nplanne dfor you r property , pleas e contac t Prudent' s Custome r Relations/Offic e Manage r fo r th e LeadBase dPaint Stabilization , Mrs . Shanno nHolt , at (402 ) 504-100 4 o r (402)812-0223 . General question s abou t th e Omah aLeadSite cleanu p ca nb e directe dt o th e EPA Publi c Informatio nCenter s at (402 ) 731
­ 304 5 (Sout hOmah aoffice ) o r (402 ) 991-958 3 (Nort hOmah aoffice) . Propert y Acces s Grante dBy : 

# it'/I / l.£ftn/S/f-cM ^ (Pleas e Prin t Name ) Propert y Owne r Signature (Signature )
(Date )

\ 808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 \ Kansa s City , M O 6411 4 Omaha , Nebraska6811 0 Sa n Antonio , T X 7822 9 llPhone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-1005 Fax : (210 ) 579-657 7' TECHNOLOGIBS . IN C " PROPERTYINFORMATIO N (T o be complete d byresiden t and/o rpropert yowne r—please print ) RESIDEN TNAME : A l S ^ i ^ /i/A/^ ^ //T/^^/ ^ Owne rf Rente r RESIDEN TADDRESS :
I F RENTAL , PROPERTYOWNE D BY : 

## Ajn ^ ^^e^'*0*^^^i€> ^ OWNER' S MAILIN G ADDRESS ; 

# 3 ^/S - _r« D S y,. ^ 6 «*/^- 7 OWNER' S TELEPHON E NUMBE R - HOME : (f*^ ) 7 5 ^S^^^\NORK : ^di . ) ^ 5 9^' " ^^ ^

Y NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : _i

_ / NUMBER O F OCCUPANT S 7 YEAR S OL D AN D OLDER :
NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WHO M PLA YI 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 YGATES , ETC. ) 

### />df^ ^

AUTHORITY FO RENVIRONMENTA LRESPONS EACTIONS : Th e activilie. s t o b e implemente dby EP A under thi s agreemen t ar e pursuant to Sectio n10 4 ofCERCLA , 4 2 U.S.C . 9604 . EPA" s righ t ofacces s t o th e property i s provide dfo r i

nSectio n104(e ) o f CBRCl.A , 4 2 U.S . C 9605(e) , whic hprovide s entr y fo r "determinin g th e nee dfo r response , o r choosin g o r takin g any respons e actio nunder thi s tille . o r otherwis e entbrcin g th e provision s ofth e title. "

808 0 War d Parkway , Suit e 405 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 4250 KansasCity , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Fax : (816 ) 363-3707 Phone : (402)504-100 4 Fax : (402)504-100 5 Phone : (210)822-958 8 Fax : (210 ) 579-657 7TECHNOLOGIES. ] 

# Advance dnotic e needed . Afte r signin g th e acces s yo u allo w Pruden t t o begi nLea dBase d Pain t Stabilization . Al l Plants , weed s an dan y vehicle s o r item s o n ope nporc h(enclose dporche s wil l NO T b e stabilized ) mus t b e remove dprio r t o stabilization . Al l Pet s mus t be ou t o f yar ddurin g stabilization . Ho w muc hnotic e d o yo u nee dt o hav e abov e mentione dtask s completed ? I f yo u ar e alandlor dyo u wil l nee dt o contac t th e tenan t a s Pruden t Technologie s wil l onl y infor myou . D o yo u hav e an y pet s tha t resid e i nyard ? ^ ^ S Notic e needed : J altLe^fA ^ Numbe r t o cal l t o giv e notice : C%^
- ^ 7ol ^ 

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

Ter^G^sV s Who mw e ar e givin g notic e to : / p ' Home Owner' s Signatur e 

# -^C^ .

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 KansasCity , M O 6411 4 Omaha , Nebrask a 6811 0 San Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7TECHNOLOGIES. ] 

## PRE-STABILIZATIO NVIDE O FORM I UNDERSTAN D THA T PRUDENT TECHNOLOGIE S WIL LB ECOMIN G OUT T O SHOO T A PRE-STABILIZATIO NVIDE O AT M Y PROPERTY . TH EVIDE O I S JUS T A TOO LUSE D T O DOCUMENT TH ECURRENT PROPERT Y STATUS/CONDITION . A POS T VIDE O WIL LALS O B E SHO T PRIO RT O COMPLETIO NO FSTABILIZATION . L eJ(ry^^»i.cM . 

# j^on't^^ d OWNER S NAME : 

# h^l ^ 7 ? 

# n n <> PROPERT Y ADDRESS : 

# 20-^ ^ BVID/SAID : HOMEOWNER S SIGNATURE : 

# /fc ^

c^^^*^^^^e^ ^ PRUDEN T REPRESENTATIV ESIGNATURE : AN Y CONDITION S NEED T O B EAWAR EO FBEFORESHOOTIN G VIDEO : (I.E . PETS , NOTIC ENEEDED) :

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 KansasCity , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7TECHNraXX;iE& ] 

# ACCES S INFORMATIO NTRACKIN GSHEE T 

# ]1i J S 

# 1>^ ^ BVID : % O 'X ^ ^PROPERT Y ADDRES S 

# , Propert y Owne dBy : (I f ne w propert y owner )

Owner s Phon e No's : Home : ~ Work : Cell : Fax : ~ Acces s Contractor : AS WPD A ME S P EOthe r (Prudent ) DAT E TIM E ACCESSO R CONRAC T DETAI L 

# ^lii] ^ 

# ^^f= ­ ^



## Comments :

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 KansasCity , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone:(816)363-370 3 Phone : (402 ) 504-100 4 Phone : (210)822-958 8 Fax:(816)363-370 7 Fax : (402)504-100 5 Fax:(210)579-657 7TECHNOLOGIES. ] 

# Acces s Assessment Form : (Mus t b e complete dfo r ever y property . Informatio nmus t b e obtaine dfro mapropert y wal k thru , no t given by owner )
I s th e propert y stucc o o r asbestos ? KOo- ( S'^ W I f

yes , i s an y ofth e stucc o o r asbesto s damage do r cracked ? Ifyes , sto p a s w e can' t stabiliz e thi s property . I t require s specia l preparatio n techniques . I t wil l b e returne dt o EP A an dthe y wil l assig na t alate r date . Doe s thi s propert y requir e lot s o f scrapping ? Doe s thi s propert y requir e alif t o r scaffoldin g t o reac huppe r levels ? Doe s thi s propert y hav e lot s o f plant s o r item s i narea s wher e paintin g i s required ? Doe s thi s propert y hav e an y significan t structura l damage ? 

# ^> 0 Ifyes , EXPLAIN ?

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 KansasCity , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7TECHNOLOGIES. ] 

## Doe s thi s propert y hav e agarage ? Ifyes , describ e locatio no f garage . Doe s thi s propert y hav e aluminu msiding ? A.>\ y 

## Ifyes , i s i t origina l factor y finisho r ha s i t bee npainte dover ? Doe s thi s propert y hav e an y othe r typ e o f structura l components ? (I.e . roo f shingle s a s siding) ? Ifyes , EXPLAIN ? I s thi s propert y vacan t oi^occupied ? Ar e ther e an y pet s a t thi s property ? 

# yJ l yo^'^' ^ ^ ^ ^ f /cW r Ar e ther e an y lo w hangin g powe r lines ?

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 KansasCity , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax:(816)363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7TECHNOLOGIES. ] 

## NEIGHBORHOO D PROPERT Y ACCES S FOR M I S THEREA NEIGHBORIN GPROPERT Y THA T NEED S T O B EACCESSED ALONG WIT H ASSIGNE D PROPERT Y T O COMPLET ESTABILIZATIO NPROCESS ? 

## A / ^ I FI T IS , GE T ACCES S FRO M AL LREQUIRE D NEIGHBORHOO D PROPERTIES . 

## A / D

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 KansasCity , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax:(816)363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7• • 40L0GIES . INC . 

## PAIN T MATCHIN GFORM : 1. TO BEFILLE D OUT ONL Y IFMATCHIN GCOLO R PROPERTV ADDRESS : l^i* ^ S iTf^-^j ^ 

## BVID : J^O^ ^ Th e foUowin g note s ar e fo r th e benefit of pain t crew only . Locatio n Sidin g Soffi t Fasci a Come r Trim Windo w Trim s Door Trim s Front PorchCeilin g Front PorchCeilin g Beam s Front PorchFloo r Front PorchRailing s Front PorchStep s Sidin g Baseboard s Foundatio n 

## 01CX3Z^(£ . 

# ^ J Pain t Descriptio n 

## foo { Cx^^X^C , U300c 3 (UDViWe" )

oooo h(toh'ikN Pain t Ye s

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## Pain t No \ ^



## 0006 ^ U>cc> 6 l.toN^^H ) IU^VNW" ^ \ y \ ^


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• I UNDERSTAN D SHERWI NWILLIAMS WIL LMATC H

MY CURREN T COLORS . Homeowne r

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

808 0 War d Parkway , Suit e 40 5 250 5N. 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 KansasCity , MO 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone:(816)363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax:(816)363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7/S?^""^ ^ TECHNOLOGIBS . IN C 

## PRE-STABILIZATIO NPROPERT Y SAFET Y ASSESSMEN T FOR M PROPERT Y ADDRESS : | ?» ' 7 S 1 ^ ' ^ ' BVID/SAID : >^i-^ ^ PRUDEN T ASSESSMEN T REPERSENTATIVE :

^ 

### REPERSENTATIV EREMARKS/FINDINGS : (POWER-LIN EPROXIMIT Y T O PROPERTY , SCAFFOLDING / LADDERS / LIFT S NEEDED , UNSAF EAREAS , UNSAF ENEIGHBORHOOD—ETC. )

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402 ) 504-100 4 Phone : (210 ) 822-958 8 Fax:(816)363-370 7 Fax : (402)504-100 5 Fax:(210)579-657 7

# Curren t Sampl e Pre-Renovatio n For m Effectiv e unti l Apri l 2010 . Confirmatio n o f Receip t o f Lea d Pamphle t ^

I hav e receive d a copyo f th e pamphlet , Renovate Right : Importan t Lea d Hazar d Informatio 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 leac j hazarc j exposur e fro m renovatio n activit yt o be performe d i n m ydwellin g unit . I receive d thi s pamphlet befor e th e wor k began . 

# T-ZS-'b ? 

# n ^ Printe d nam e o f recipien t Dat e Signatur e o f recipien t Self-Certificatio n Optio n (fo rtenant-occupie d dwelling s only ) — If th e lead pamphlet wa s delivere d bu t a tenan t signatur e wa s not obtainable , yo u ma ychec k th e appropriat e bo xbelow . L l Refusa l t o sig n —I certif ythat I hav e mad e a goo d fait h effor t t o delive rth e pamphlet . Renovate Right : Importan t Lea d Hazar d Informatio n fo rFamilies , Chil d Car e Provider s an d Schools , t o th e renta l dwellin g uni t liste d belo wa t th e dat e an d tim e indicate d an d that th e occupan t refuse d t o sig n th e confirmatio n o

f receipt . I furthe rcertif ythat I hav e lef t a copyof th e pamphlet a t th e uni t wit h th e occupant . ^Unavailabl e fo rsignatur e —I certif ythat I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , Renovate Right : Importan t Lea d Hazar d Informatio n fo r Families , Chil d Car e provider s an d Schools , t o th e renta l dwellin g uni t liste d belo wan d that th e occupan t wa s unavailabl e t o sig n th e confirmatio n o f receipt . ! furthe rcertif ythat I hav e l^f t a copyof th e pamphlet a t th e uni t b yslidin g i t uixle rth e doo r-.//» , i i Printe d nam e o f perso n certifyin g / J Attempte d deliver y dat e an d tim e lead pamphlet deliver y Signatur e o f persiWcertifyin g lead pamphlet deliver y

Unit Addres s Note . Regardin g Mailin g Optio n —A s a n alternative t o deliver yi n person , yo u ma ymai l th e lead pamphlet t o th e owne rand/o rtenant . Pamphle t must b e maile d a

t leas t 7 day s befor e renovatio n (Documen t wit h a certificat e of mailin g fro m th e post office) .

### TECHNOliOGIBS , 

## Checklis t fo r th e Worksit e Hazar dAnalysi s 

# IS\ 1 J 

# ^i^I r Address : Crew : Date : Ite m OK? . Hazar d Correctiv e Actio n Overhea dLine s

—U.M^7 A 

# a.^ ^ In-transi t Vehicl e Clearanc e 

## (>iKs>KHcn Level s aroun dhig hwire s Vehicl e Clearanc e aroun d hig hwire s whe nworkin g 

# Zd o li«/»v 

### Phon e line s 

### \iLu(xJ< ^ Cabl e line s Ga s Lin e Wate r Lin e Sewe r Lin e Septi c Tan k Propane/Butan e 

## V ^ ^ ^ > Acces s to/o nPropert y Neighbo r Acces s Require d 

### O^S l jt^^- ^ 

### Hig hTraffi c Are a\.Jf.y . > Garag e yl/Y ^ 

### C^ov-zJir- . U>€^j..J ^ c>>M— ~ 

## ^dboi h Structure s 

## toiKY(/\iy ^ /to , Driveway Sidewal k Foundatio n h^^iuXi J UtyrHs^r*
- 

# — OuuLJa^J . -yu ^ Retainin g Wall s Fence s Tree s 

# tefofe^ jayu^-pr< ^ .^M
- ivi^v-T^^^v^C ^ Foliag e Genera l Conditio no f yar d —T/ L

### 1 . <^/ ^ ^ ^ A . ^ Damage dAreas : sin k — VlD-^'>--^--^T)Uwe7-ey ^ holes/rotte dwoo d 

## i^22±^^±?2 L SfU,f<iu
- 

## -J^^^cJUh ^ Sprinkle r Syste m Pet s 

## dba f sf-^'THe'tM^ , V A 3ig^ ^ ^ ^^^a.- v Insect s ^ 

# t |:i±f>^^ ' /^a-o^y/*^^^'
- Weathe r Condition s Unsaf e drivin g condition s Unsaf e neighborhoo d 

## TPOT^TP^J ^ Crew Foreman / Sub-Contracto r ffice r -^^^^ ^ 

# ^a A
808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 I Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 ne : (210)822-958 8 Fax:(816)363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7

# T HPO 

# T^ M

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## 1 

# mDougla s Count y Accoun t Informati iw ^ Pag e 1 of 3 Dougla s County , Nebrask a Propert yRecor d - R221869000 0 Prin t Reoor t NE W Featur e - Parce l Dimension s availabl e & . scal e 0-5 0 ft wes t of 52n d S t • Vle W O H Ma D Informatio n i s vali d a s o f 2009-9-1 5 Treasurer' s Ta xRepor t Ne wFeatur e -•"•• * Aut o Sale s Searc h Owne r LEIMBAC H RONNAL D L ETA L 381 8 S 3 4 S T^ ^ OMAH AN E 68107-000 0 Propert yInformatio n Ke yNumber : 186 9 000 0 2 2 Accoun t Type : Residentia l Parce l Number : 221869000 0 Parce l Address : 131 7 S 2 7 S T OMAH AN E 68105-000 0 Lega l Description : SHULL S 2N D AD D LO T1 8 BLOC K9 N 4 0 F T4 0 X 12 7 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $4,400.0 0 $18,500.0 0 $22,900.0 0 200 8 $4,400.0 0 $18,500.0 0 $22,900.0 0 200 7 $4,400.0 0 $18,500.0 0 $22,900.0 0 200 6 $4,400.0 0 $30,700.0 0 $35,100.0 0 200 5 $4,400.0 0 $30,700.0 0 $35,100.0 0 200 4 $4,400.0 0 $30,700.0 0 $35,100.0 0 Sale s Informatio n Sale s Date : 2008-07-2 5 Dee d Type : Q C Book : 200 8 Page : 08100 2 Price : $0.0 0 Grantor : Leimbac h Ronnal d L Grantee : Leimbac h Ronnal d L 1 K Valid/Invalid : Invali d Exclusio n Reason : Sale s Date : 2003-04-0 1 Dee d Type : Q C Book : 223 8 Page : 65 4 Price : $0.0 0 Grantor : CONNI E S LEIMBAC H
http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R221869000 0 9/16/200 9Dougla s Count y Accoun t Informati Pag e 2 of 3 Grantee : RONAL D L LEIMBAC H Valid/Invalid : Invali d Exclusio n Reason : Sale s Date : 1995-10-2 2 Dee d Type : Book : 201 8 Page : 64 4 Price : $18,500.0 0 Granto r Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 1 5080. 0 1. 0 127. 0 40. 0 N o Improvemen t Informatio n Buildin g 1

EnotStMVt M * » ao r li r 

# H FWFI w eucs r 

# RANC H 2 5 0 - MSOS F t o

CLIC KTO ENLARG E IMAG E j Squar e Footage : 648. 0 Percen t Complete ; 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Fai r

Buil t As : Ranc h Cond o Squar e Footage : 0. 0

HVAC : Force d Ai r Rooms : 6. 0 Exterior : Fram e Sidin g Units : 1. 0 interior : Plaste r Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Gabl e Stories : 1. 0 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R221869000 0 9/16/200 9Dougla s County Accoun t Informat i [Wj ^ Pag e 3 of 3
Yea rBuil t 188 5 Detai l Typ e Applianc e Basemen t Fixtur e Fixtur e Garag e Porc h Use r Use r Yea r Remodele d 0 Percen t Remodele d 0 % Detai l Descriptio n Allowanc e Bsmn t Bloc k 8 ft Bas e Fixture s Bat h Ful l Detache d Enc I Soli d Wal l Ne wRoo f Sidin g - Rol l Com p Adjuste d Yea r Physica l Ag e Buil t 188 5 12 4 Unit s 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=R221869000 0 9/16/200 9\OLOGnXS,lN C 

## Pruden t Propert yClose-Ou t For m (Lead-Base d Pain t Stabilization ) SAID : CSOA^^^ Propert yAddress : /^^ ^ 5 c>l 7 ^/- * .. Owner' s Name : fl^/ ^

Le^»*i,^^C'k^_ ^ S.N O Performanc e Standards/close-Ou t Criteri a Ye s N O 1 Wa s th e entir e 8tructure(s ) painte d wit h th e exceptio n ofth 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 

# X beams , columns , rails , an d exterio rsurface s o f garages . 2 Wa s al l scrapin g an d othe rpreparatio 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 4 Ar e al l ofth e area s wher e contaminate d material s hav e bee n spille d thoroughl yvacuumed / cleaned ? 

# X 5 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 , roadways , alleyways , publi cacces s area s an d als o remov e an yothe rgenerate d debris ? 

# X 6 I s th e gras s are a tha t surround s th e structure(s ) i n reasonabl ygoo d condition ? 

# X 7 Wa s th e pain t product s utilize d equivalen t t o a 3 0 yea r product/quality ? / 

# K 8 Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e et cproperi 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 need s t o b e complete d prio rt o th e EP AClose-Out . / 1 0 Ar e ther e an ypropert yitem s tha t wer e temporaril yre-locate d b yth e contracto rtha t nee d t o b e move d back ? 

# X 1 1 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 ? 

# X 1 2 Othe rConsiderations ? Propert yOwne rDiscussions ? Additiona i Wor k tha t i s Require d 

# K Pruden t Representativ e Signature : Date : PropertyOwne rSignature : ^ ^ y* " /

808 0 War d Parkway , Suit e 40 5 250 5 N . 24^" street . Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 KansasCity , MO6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone:(816)363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7