## TRANSMITTA Lof OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R SAI D # : 2674 5 Address : 262 0 Decatu r S t Remediatio n Contractor : Pruden t Technologie s Year : 200 8 PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S g

f Vide o o f propert y (DVD ) ^ Executiv e Summary 

## [ /

SignedAcces s Agreemen t fo r

subject propert y w Painting Agreemen t D Settlemen t documents (i.e. , fo r

damag e or to replac e plants , etc. ) D Photograph s [FSatisfactor y restoratio n signedby Propert y Owne r D Propert y close-out chec k

lis t signedby EP A [ Z Property infonnatio n fromDougla s County Assessor' s Ofific e D D D 

### „A^ ^ Jl'ljo' * Signatur ^ Dat e

4031040 2 

# ni l 11 1 Superfun d

### PROPERT Y SUMMAR Y Date : 12/03/0 8 LB P STABILIZATIO N EPA CONTRAT EP-R7-0»-0 7 Monthof : December Propert y Address ; 262 0 Decatu r S t SAID ; 2674 5 A . EXECUTIV E SUMMAR Y A. 1 Issue s Encountered : None A. 2 Issue s Resolved : None

A. 3 Uniqu e Findings ; None 122A. 4 Othe r Relevan t Infomiation ; None Acces s Date ; 09/08/0 8 Wor k Bega n Date ; 09/17/0 8 Closeou t Date : 09/30/0 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 hFor m 7 . Tracldn g Form 8 . Dougla s County Assessor Propert y Informatio n Pag e 9 . EP A 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: ^(e^ O K/eC-iifjr ^ Date : V^/< ^ Phone : ^fo'gi^ ZH H ' <CTS5 ^ BVID : 

# 9t^7^S ^ Plan t & Pennanen t Landscapin g T o Remai nI nPlac e Item # Descriptio nan dLocatio n/ O nMap {\/ o p/c/A h cfcc^^rac l fc/i^^)^r<^ ^ ^'•'^^e' .

Pre-Existin g Conditio no f Structure s Doe s you r Basemen t have ahistory o f leaking ? Ye s — N o -^ ~ Item # Descriptio n& Locatio n^ O nMa p

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## Property Owne r Pruden t Employe e Signature^ Signature : fob^ljs C 'fc^s-***" * 808 0 War d ParKway , Suit e 40 5 260 5 N . 24* ^ Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City . M O 6411 4 Omaita , Nebrasic a 6811 0 Sa n Antonio , T X 7822 9 Phono : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-858 8

# ^Kol^ S Pruden t Technologies , Inc . (Prudent) is unde r

contract (Contract #EP-R7-08-07 ) wit hlh e U. S. Environmenta l Protectio n Agenc y (EPA ) to stabiliz e Lea dBase dPaint (LBP ) at anumbe r of propertie s located in Omaha, Nebraska , includin g th e propert y located at '2..it?^ J ~P).^^.^;{ r xf ' J^-f . Th e EP Arequest s you r

permissio nto allo w Pruden t to perfor mLB PStabilizatio n at thi s property . By signing thi s form, tiie propert y owne r

grant s permissionto Pruden t to perfonn activitie s related to LB P Stabilization including scrapin g paint andpainting ofth e referencedproperty . Further , th e owner/tenan t verifie s tha t they hav e receive dlh e LB Ppamphle t "Renovat e Right. " Ifyo u hav e an y question s about th e LB Pstabilizatio n plannedfo r

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

fo r

th e LeadBase dPaint Stabilization , Mrs . Debora hAkerele-Jolmsoii . at

(402) S04-1004 . Genera l question s about th e OmahaLea dSit e cleanu p ca n be directe d to the EP A Public Infonnation Center s at (402 ) 731-304 5 (Sout hOmahaofifice ) or (402 ) 991-958 3 (Nort hOmaha office) . ^ ^ 

# Bv: XL^f(l< ^ C)<^-^ t Properl y Acoe nGrante d (Pleas e Prin t Name ) 

# 9-'$'^,S ' Propen y Owne r Signature : (Signature ) (Date ) PROPERT / INFORMATIO N , ^ (T o o bs.£iHDpIete bs.£iHnpIete d d b b v

v reiiden t and/o r propert y oirae r n - plea M prin Q RE8IDENTNAME : A - / M /' -g . /^ ) ^ ^ C ^ COwne r ^i Rente r rSSIDEN TADDRESS : IP RENTAL . PROPERT YOWNE D BY : OWNER' S MAIUN G ADDRESS ; "^^/T t (S OWNER' S TELEPHON E NUMBE R - HOME : h(/SU'^\H~ ^ ^ S WORK : ( \ NUMBE R OP OCCUPANT S UNDE R 7 YEAR S OLD : D NUMBE R OF OCCUPANT S 7 YEAR S OL D AN D OLDER : _ L NUMBE R OF CHILDRE N UNDE R 7 YEAR S OL D WH O PUY IN TH E YAR D FO R 5 HOUR S OR MOR E PE R WEEK : 

# . 13 COMMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS . ENTRYGATES . ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS ; Th e activitie s to be implemente d by EP Aunde r tU s agreemen t ar e pursuan t to Sectio n10 4 of

CERCLA , 42 U.S.C . 9604 . EPA' s right ofaeces s to th e propeit y is provide dfo r inSectio n104(e ) of CERCLA , 42 U.S . C 9605(e) . whic hprovide s entr y for "determinin g th e nee dtor response , or choosfai g ortakin g an y respons e aclio nunde r thi s title , or otherwis e enforcin g th e proviiior * of lh e title. " 

# ^^^•^.^•rjir'" ' ^^nfNfSari r

*^*^"\rkKo*T7;s s Phone : (402 ) 504-100 4 Phone : (210 ) 822-958 8 ansa s city . MO 6411 4 °r.T!-! : .InSTcnAfinn k Phone:(210)822.958 8 hone : (816 ) 363-370 3

# Curren t Sampl e Pre-Renovatio n For m Innatlo n of Receip t of Lea d Pamphle t ^1 hav e receive d a cop y ofth e pamphlet , flenovate Rl^t Importan t Laa d Hazar d Infbnnatio n fo rFamilies , Chil d Car e Provkiar s an d School s informin g me of th e potentia l risk ofth e lea d hazar d exposur e fro m renovation activit y to be perfomie d in mydwellin g unit . I receive d thi s pamphle t befor e th e wor k began . 

# AL//(e . l^e-c t Print^dLnam e of recipien t le01 recipient . •? . Signatur e of recipien t Self-Certificatio n Optio n (fb rtenant-occupie d dwelling s only ) — Ifth 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 xbelow . a Refusa l to sig n —I certif ytha t I hav e mad e a goo d fait h effor t to delive rth e pamphlet , Fienovat e FSgh t Importan t Laa d Hazar d Infonnatio n fo rFamilies , CNk i Car e Provider s an d Schools , to th e renta l dwellin g uni t liste d beio w at th e dat e an d tim e indicate d an d tha t th e occupan t refuse d to sig n th e confirmatio n ofreceipt . I furttie rcertif ytha t I hav e lef t a cop y ofth e pamphle t at th e uni t wit h th e occupant . •Unavailabl e fb rsignatur e —I certif ytha t I hav e mad e a goo d fait h effor t to delive rth e pamphlet . Renovat e Rgh t Importan t Lea d Hazan i Infomnatio n fo r f^mtSes , Chil d Car e pmvider s an d Schools , to th e renta l dwellin g uni t liste d belo wan d tha t th e occupan t wa s unavailabl e to sig n th e confirmatio n ofreceipt . I furthe rcertif ytha t I hav e lef t a cop y ofth e pamphle t at th e uni t byslidin g it Printe d nam e ofpei^ n certifyin g Attempte d deliver y dat e an d tim e lea d pamphle t deliver y 

# A^^^^- — Signatur e ofperso n Bertifyin deiiver irso n bertityin g g lea

lea d d pamphle

pamphle t t deliver y y 

# 1 Uni t Addres s Not e Regardin g Mailin g Optio n — As an altemativ e to delivery in person , yo u ma ymai l th e lea d pamphle t to tii e owne rand/o rtenant . Pamphle t mus t be maile d at leas t 7 day s befor e renovatio n (Documen t wit h a certificat e ofnnailin g fro m th e postoffice) .

# pain t matc h for m Pain t matchin g form : p^tt^e y ^_ L 

# Propert yaddress : i?^i?d ^

ii^c^u^^f ^ 

# BVID : ^(^7^ f Area : ^/cAnc . Color : 

# uJh,4 e Explanation : Area : Color : Explanation : 

# Area : Color : Explanation : Area : 

# Color : Explanation : 

# Area : color : Explanation : 

# K Pag e 1

# [ Acces s WRMMMIIO N TRACKIN GSHEE T 3<f.7y. r 

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## Douglas Count y Accoun t Info^^ i tio n Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R1946q4000 O Z~

_Prin t Repor t NE W Featur * - Parce l Dlmentlon i availabl e Q scal e 0-5 0 tt wes t of 90tt i S t - VievyO n Ma p Informatio n i s vali d a s o f 2008-7-1 4 I.reasure,r's.T.a x.Repor t Ne wFeatur e -•••• • Aut o Sales.Search . Owne r BEC KLILLI E G 

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# f f ^ 262 0 DECATU R S T OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : 

### 460 4 000 0 1 9 Accoun t Type : Residentia l Parce l Number : 194604000 0 Parce l Address : 262 0 DECATU R S T OMAH AN E 68111-000 0 Lega l Description : PARKER S AD D LOT1 1 BLOC K9 W1/ 2 3 0 X 12 6 Valu e Informatio n 200 8 200 7 200 6 200 5 200 4 200 3 Lancf 

### $900.0 0 $900.0 0 

### $900.0 0 $900.0 0 $900.0 0 $900.0 0 Improvemen t $49,100.0 0 $49,100.0 0 $49,100.0 0 $49,100.0 0 $10,100.0 0 $10,100.0 0 

## Tota l $50,000.0 0 $50,000.0 0 $50,000.0 0 $50,000.0 0 $11,000.0 0 $11,000.0 0 Lan d Informatio n 

## Acre s 0.0 8 S F 3780, 0 Unit a 1. 0 Dept h 126. 0 Widti i 30. 0 Vacan t N o Improvemen t Info n rmatio Buildin g 1

i..i^-.// j I ...., . •\^i%a^wM t r%«^l t ^r>Tv./r^/Mirr1ooPr»>J»»/ctntir'./nor.f>iintinf n i<!n'?ap.r:nnntnf>= R 1Q.. . 8/76/^00 8

## Dougla s Count y Accoun t Infc^^tio n Page 2 of 2

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—"t^-ilp:' — 1*3 11/ 2 STOK Y UNFI N giLCKT.Q,.El!llARg£JMAS E CLICK ; T<;i.iNI-ARG E IMAG E Squar e Footage : 1017. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Averag e

Buil t As : 1 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 5. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 2. 0

Roo f Type : Gabl e Stories : 

### 1. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r YearBuil t Physica l Ag e Remodele d Remodele d Buil t 190 0 0 % 190 0 10 8 Detai l Typ e Detai l Descriptio n Unit a Ad d O n Unfinishe d Atti cW/floo r 880. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 ft 960. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 

### 1. 0 Porc h Sla b Roo f Cei l 30. 0 Porc h Woo d Dec k 90. 0

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# &EP k Jun e 26,200 8 (faHw t nvlfteB ) 

# EP A Propert y CloseOn t Form(Lead-Base dPain t StatifliaitioB ) BMkn dVcMd i Prapwtg r I D Nimbe n 

# Perftrmanc e Standards/gpse^n t Criteri a yt i 

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iteinofibeana s wha t coDtantiDatedanterialsi ^ y i 

## iBadiiwi.ilhywp8.wa)1teMCBwawa8adalwremovoB y y 

## 7 .bil»SB»a«ie aIhat SMwuud s th e 8tnictnw(5)tateasoBri)l y goo dcondltkm ^ < y 

## t ib«an{i8DUiiichaipolyediyleoesheet&ig,l8dden,paintbrasb0S ^ c ^ 

## WBMWd ? 9 .btfamaoyevideoeeofimypertydaiaag e tha t wa s don e by the cvofract ^ An y property damag e ' ^ / 

## aeedstoboooiBPtetedprioTtotfaeEPAClose-Om . IO

LAwHwota y proper ^ Hem s tha t wr e tempofaril y W'locaiedb y th e contracto r tha t nee dt o b e novedbaA ? 

# H. / 11 . Aie(faeresyOaown)IhigefioglssneswHbthepiopettyo«n«r(8)tfaath ^ 1 - ^ 

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## i??^firair . Owne r Disoussioiu/Additiona l Wcn k tha t i s Require d ^

BPAOOR/RflFMentative . 

# I k '&£i . l^f ^

## Pruden t Propert yClose-Ou t For m (Lead-Base d Pair) t Stabilization ) SAID : g (. 1 ^ r PropertyAddmss : 2 4 > ^C' . £' ^ IXVv>tUA _ Owner' s Namc t ^'i/// L IS^dk . 

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

### N O 1 . Wa s th e entir e structure(s ) painte d wit h th e exceptio n o f 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 , box beams , columns , rails , an d exterio rsurface s o f garages . 

# I 2 . Wa s al l scrapin g an d othe rpreparattio n wor k complete d satisfactorily ? 

### ^ 3 . Wer e al l require d areas o f th e structure(s ) prime d a s neede d an d painte d wit h tw o to p coats ? 

# 2 L 4 Wa s th e pain t product s utilize d equivalen t t o a 3 0 yea rproduct/quality ? 

# X 5 . Ar e al l o f th e areas wher e contaminate d material s hav e bee n spille d thoroughl yvacuumed / cleaned ? 

# y 6 . 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 caccess areas an d als o remove an yothe rgenerate d debris ? 

# X 7 . I s th e gras s are a tha t surround s th e structure{s ) I n reasonabl ygoo d condition ? 

# i . 8 . Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , banrie rtap e etc . properl yremoved ? ­ 

# y I s ther e an yevidence 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 . IC . Ar e ther e an ypropert yItem s tha t wer e temporatil yre-locate d b yth e contracto r tha t need t o b e move d back? 

# X 11 . Ar e ther e any(known ) lingerin g Issues wit h th e propertyowner(s ) tha t have bee n lef t unresolved ? Othe rConsideratlons?propert yOwne rDiscussions?Additlona l Wor k tha t I s Require d 

### > 

# £ a flBoio ^ Pruden t R

< Dat e ^- 7 0-<^ V