## TRANSMITTA Lo f

OMAHA LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R SAID : 3509 3 Date : 12/26/200 8 Address : 472 8 N . 3 8 ST . Remediatio n Contractor : Pruden t Technologie s Year : 200 8 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S g

f Vide o o f propert y (DVD ) H ' Executiv e Summary [3 Signe dAcces s Agreemen t for subjec t property ^ Paintin g Agreemen t D Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) D Photograph s 0 ^ Satisfactory restoratio n signe db y Property Owne r D Property close-ou t chec k lis t signe db y EP A 0 ^ Property informatio n fromDougla s County Assessor' s Ofific e D D D 

### Signatur e i T)ate

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### PROPERT Y SUMMAR Y Date : 12/23/0 8 LB PSTABILIZATIO N EP A CONTRAT EP-R7-08-0 7 Monthof : Decembe r Propert v Address : 472 8 N . 3 8 ST . SAID : 3509 3 A . EXECUTIV ESUMMAR Y A. 1 Issue s Encountered : NONE . A. 2 Issue s Resolved : NONE . A. 3 Uniqu e Findings : None A. 4 Othe r Relevan t Infomiation : None Acces s Date : 10/16/0 8 Wor k Began : 11/04/0 8 Closeou t Date : 11/05/0 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 n Form 6 . Pain t Matc hForm 7 . Trackin g Form 8 . Dougla s Count y Assessor Propert y Informatio n Pag e 9 . EP A Propert y Closeou t for m 10 . Propert y Completio n Agreemen t

TECHNOIOCIES , INC .ENVIRONMENTA L A CONSTRUCTION 

## TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m i Address : q7^ & M - 3 8 5t . ^^' ' ^^MA ^ Phone: . i^ D S^S'I/^^"^^' ^ ®^ - 3509 3 Plant & Permanen t Landscaping T o Remai n I n Plac e Iteai # Desoiptio n an dLocatio n O

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# Doe s you r Basemen t hav e ahistory o f leaking ? Ye s —N o 

# v/ ' Descriptio n & Locatio n , . , y 

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## Signature Signature : lOM ^ '

v mWu dParkiiMy i Si't * 40 5 250S N . 24 * StTMl . Suit s 30 8 4242 NMIca l Drive . Sult a 426 0 w—i —MU- . U A •J4 4 J Omaha . NabrMk a 6811 0 Sa n Antonio , T X 7822 9

# ^ ^5o? 3

Pruddi t Technologies , Inc . (Prudent) i s unde r

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

of propertie s locate ^ i n Omaha, Nebraska , includin g tiie propert y locateda t ^^7^^ ^ A > 3 ^ ^I r - The EP A requests your permissio n t o allo w Pruden t t o perfor mLB PStabilizatio n a t thi s property . B y signii % tills form, tiie propert y owner grant s permissio n t o Pruden t t o perfor mactivitie s relatedt o LB P Stabilization including scrapin g pain t andpaintin g o f th e referencedproperty . Furtiier , th e owner/tenan t verifie s tha t the y hav e receive dtiie LB P pamphle t "Renovat e Right. " If

you ; have an y question s abou t th e LB P stabilizatio n plannedfo r

your property , pleas e contact Prudent' s iv e Cler k

fo r

th e LeadBase dPaint Stabilization , Mrs . Debora hAkerele-Johnson . a

t (40ji) 504-1004 . Genera l question s about th e OmahaLea dSite cleanu p ca n b e directedt o the EP A Publi< f

Infomiation Center s at (402 ) 731-304 5 (Soutii Omah aoffice) or (402 ) 991-958 3 (Nort hOmaha office) . r\j PiopeilyiAeoei s Otante dBy : / - ^ (L\ \^^^^jj^^'^y ^ Piopeit] ^ Owne r Signature : PROPERT Y INFORMATIO N (F o b e eoniplctc db y midca t and/o r property onme r - pleai c print ) J_ RESIDENTNAME : *' - Ovme rRente r RE8l0^AO0RE88: . 

# ,C w ^rif > FiySoJ A I F RENTAL . PROPERT YOWNE D BY : . 

### OWNEivSMAIUNGADORESS ; f O Bo / ^^O^il , D/jJ^fl^. , >t> ^ C?^/^^ J 

# iolj^£ii^i ^ {i^r^\^^ o r ^ ' WORK : J OWNER' S TELEPHON E NUMBE R - HOME : L NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDER: . i NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WH O 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 : (L E DOOS , ENTR Y GATES , ETC. ) /

AUTHORTT Y FO RENVIRONMENTA LRESPONS EACTIONS i Th e aetivkiei to b e hnplementedby BP A unde r tU

f igreeiMn t a n punuan tt o Sectio n 10 4 o f

CERCLA . 4 2 U.S.C . 9604 . EPA' I righ t o f

accc u t o (he propert y i

f provided for i nSectio n 104(e) o f CERCLA . 4 2 US . C 9605(e) , whic hprovide i erti y Ibr

"degermlningth e nee dfb r response , o r dioosin s ortakin g an y respons e actio n unde r Ihi s titie . o r otherwis e enfbrcing (h e provisicn s ofth e title. "

108 0 War d Partway . Suit e 40 5 2S0 5 N . 24* ^ Street , Suit e 30 8 424 2 Medica l Drive , Suit e 4200 lanta a CHy , M O 6411 4 Omaha . Nebrask a 6811 0 Sa n Antonio , T X 78229

# rCTRi Curreh t Sampl e Pre-Renovatio n Forn i Effectiv e unti l Apri l 2010 . I j Copllmiatioi n o f Receip t o f Lea d Pamphle t I hav e rBpeive d a cop yo f th e pamphlet , ftenovat e Right : Importan t Lea d Hazar d Informatio n fo rFamilies , Chil d Car e Provider s an d School s infonnin g m e o f th e poteritia 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 .

Signatur e o f recipien t Self-Certlfipatlo 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 ma ycnec k th e appropriat e bo xbekm . 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 , Fienovat e Right : Importan t Lea d Hazar d Informatio n forFamSes , Chil d Car e Pmviders 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 tha t th e occupan t refuse d t o sig n th e confirmatio n o f tBcelpit . 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 th e occupant . Q Unavailabl e fo rsignatur e —I certif ytha t I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , Fienovat e Right : Importan t Lea d Hazar d Informatio n for FamlSes' , ChU d Care pmvider s an d Schools , t o th e renta l dwellin g uni t liste d belo waiy j tha t th e occupan t wa s unavailabl e t o sig n th e confirmatio n o f receipt . I furthericertif ytha t I hav e left a cop yo f th e pamphle t a t th e uni t b yslidin g i t unde rth e 

# f&'^r ^ S^i^^n^ /^/r(^oj ' Printe d naiin e o f perso n certifyin g Attempte d deliver y dat e an d tim e lea d pamphle t deliver y Signatur e o f perso n i»rtifyin g lea d pamphle t deliver y 

# Oucf^lf^.^ . (IJ/ ^ 

# f - Uni t Addres s I Not e ReQEUdIn g Mailin g Optio n —A s a n aitemativ e t o del/ver yi 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 befor e renovatio n (Documen t wit h a certificat e o f mailin g fro m th e pos t offic^) .

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## Dougla s Count y Accoun t 

# In4|h ; ation Page 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R160291000 0 1 Prin t Repor t NE W FMtur e - Panca l Oimen«ion < availaU a Ascal e O^ O ft wai t o f 90t h S t - Vie wO n IMa p Informatio n i s vali d a s o f 2008-9- 4 Treasurer' s Ta xRepor t Ne wFeatur e ••••- • Aut o Sale s Searc h Owne r PUSC H JA N ERI C P 0 BOX 54043 2 OMAHAN E 68154-000 0 Propert yInformatio n Ke yNumber : 029 1 000 0 1 6 ; Accoun t Type : Residentia l ; Parce l Number : 160291000 0 i Parce l Address : 472 8 N 3 8 S T i OMAHAN E 68111-000 0 Lega l Description : LAK E VIE W AD D LO T6 BLOC K1 N 3 FTL T7 & AL L 5 3 X 12 7 1 • Vaiii e Informatio n 1 Lan d Improvemen t Tota l 200 8 $3,200.0 0 $46,500.0 0 $49,700.0 0 200 7 $3,200.0 0 $46,500.0 0 $49,700.0 0 200 6 $3,200.0 0 $46,500.0 0 $49,700.0 0 200 5 $3,200.0 0 $18,100.0 0 $21,300.0 0 200 4 $3,200.0 0 $16,400.0 0 $19,600.0 0 200 3 $3,200.0 0 $16,400.0 0 $19,600.0 0 1 L^n d Informatio n Acre s S F Unit a Dept h Widti i Vacan t ; 0.1 5 6731. 0 1. 0 127. 0 53. 0 N o Imi^rovemen t Informatio n Builjdin g 1



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# • 1 1 Squar e Footage : Perimete r Uni t Type :

Buil t As :

HVAC : Exterior : interior : Roo f Cover :

Roo f Type : Floorcover : 1 YearBuil t

! ; 190 0 Detai l Typ e Applianc e Basemen t Fixtur e Fixtur e Gardig e Porc h Porc h 1661. 0 0. 0 1 1/ 2 Stor yFi n Centra l Ai rt o Ai r Fram e Aluminu m Drywal l Compositio n Shingl e Gabl e Allowanc e yea r Percen t Remodele d Remodele d 0 0 % Detai l Descriptio n Allowanc e Bsmn t Bloc k 8 ft Bas e Fixture s Bat h Ful l Detache d En d Scree n En d Scree n •-.•••- I • • t-.i - :.,{ ' " • 1/ 2 STOR Y • iimnltiKit* * lOM.iiq.* . C.y.CKTQJ.HLA.R6EJMAg E Percen t Compiete : Quality : Condition : Cond o Squar e Footage : Rooms :

Units : Baths : Bedrooms : Stories : Foundation : Sprinkle rSquar e Footage : Adjuste d Yea r ] 100.0 % Averag e Fai r 0. 0 6. 0 1. 0 1. 0 3. 0 1. 5 Bloc k 0. 0 Physica l Ag e Buil t 190 0 10 6 Unit a 1. 0 1048. 0 1. 0 1. 0 252. 0

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## httD://douelasne.mat)DinB-online.com/DouslasCoNe/static/accountinfo.isD?accountno=R16.. . 9/24/200 8

# pain t match.farm ; Pain t matchin g form : — propert y address : */7;z ^ N ^ p^Sf ^ BVID: ;?^^7 5 Area : ^^^-/ ^ ^^^^^ ^ Explanation : Area: color : Exi)l anat i on : Ar0a : Color : Explanation : 

# Area: color : Explanation : i 

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## i YS S iN C ­ ji . Ws s th e entir e striicture{s ) painte d w'itr i th e exceptio n o f th s stated , sxdude d areas ? Thi s woul d induc e psi.nti.n g o f othe rssscdate d fssture s indudln g fascia , eaves , siding , a! i trim , porches , bo x ( bs3ins , eoiurr!r.s , rails , an d exterio rsuHaces o f gsrsges . |2 .Wa s Si ! scrapin g an d othe rpjreparattio n wor k complete d satssfactoriiy ? 

# w |3 . vVer e al l require d areas ofth e stnicturets ) prime d a s neede d an d painte d wit h tw o to p costs ? 

## V l I j ­ 

## v T s4 . Wa s th e pain t product s utiiiae d equivaten t t o a 3 0 yea rproduct/oijaiity ? 15 .Are al l o f th e areas wher e co ntaminste d material s hav e bee n soiiie d 

# y^ \ jthoroLghh yvacuumed / deane d j5 . Di d th e contracto rcoliect/vactju m al t falsin g an d scrape d pain t chip s e n th e entir e oroserty , i \ I roadways , aiieyways , publi cacces s area s an d als o remove an yothe rgenerate d debns ? 7 .isth e gras s are a tha t surround s t.h e stpjcture(s ) i n reasor^abl ygoo d condition ? S .Ar e ai l item s suc h a s poiyethylen e sheeting , iadders , pain t brushes , cor.es , barrie rtap e etc . 

## V- f properi yremoved ? j^ 3 .

I s ther e anyevidence o f propert ydamag e tha t wa s don e b yth e contrsctor ? .An ypropert ydamag e need s t o b e complete d prio rt o th e EPA . C'osa-Out . \ ' ^ 10 . Ar e ther e an ypropert yItem s fha t wer e terrsporatil yrs-ioc=te d b yth s co.'ttrsctc r tha t nee d t o b e move d bacJc? ; 11 ..Aj" e ther e any(known ) lingerini g Issue s wit h th s propert yownerisj tha t hav e tse- n ;gf ; un.fesoived ? 

# {^y ­ iOthe rConsidersticnsPpropert yOAT.e rOiscussionsT.gjdditloria i Wori ctha t i s Require d

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