## TRANSMITTA Lof OMAHA LEAD SIT E PAIN T STABILIZATIO NFIL EFOLDE R SAID : 2213 2 Date : 12/26/200 8 Address : 442 7 LEAVENWORT H Stabilizatio nContractor : Pruden t Technologie s Year : 200 8 PAIN TSTABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S iz

f Vide o o f propert y (DVD ) g TExecutiv e Summar y 0 Signe dAcces s Agreemen t fo r subjec t propert y aPaintin 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 a' 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 ^ Propert y informatio nfromDougla s Count y Assessor' s Offic e D D D



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### PROPERT Y SUMMAR Y 1 Date : 12/27/0 8 | LB PSTABILIZATIO NEP A CONTRAT EP-R7-08-0 7 Monthof : Decembe r | 1 Propert y Address : 4427 LEAVENWORT H SAID : 2213 2| A . EXECUTIV ESUMMAR Y A. 1 Issue s Encountered : A. 2 Issue s Resolved : A. 3 Uniqu e Findings : NONE . A. 4 Othe r Relevan t Information : Acces s Date : 10/08/0 8 Wor k Began : 10/14/0 8 Closeout Date : 10/16/0 8 Enclosures : 1 . Pre-Vide o 2 . Post-Vide o 3 . Propert y Statu s Form 4 . Signe dAcces s Agreement 5 . Pre-Renovatio nForm 6 . Pain t Matc hForm 7 . Trackin g Form 8 . Dougla s County Assessor Propert y Informatio nPag e 9 . EP A Propert y Closeout for m 10 . Propert y Completio nAgreemen t

TECHNOLOCIES , INC .ENVIRONMENTA L& CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : ^^Z H L-ta^M. niA/(rri hDate:/^- ^ ^-^^ ^ BVE) : 'X'^^3T ^ 

## Phone : ^7 . ^^ ^ ^^z^ - Plan t & Pennanen t Lands^flpinf f T o Remai nI nPlac e 

## Itein # Descriptio nan dLocatio n O nMap 

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Pre-Existin p Conditio no f Structure s Doe s you r Basemen t hav e ahistor y o f leaking ? Ye s —­ ^ N o Item # OnM ^ 

# (i^m e Descriptio n& Locatio n

Propert y Owne r Pruden t Em ] Signature : Signature : 808 0 Wu d Parfcmy . Suit t 40 5 '* * Street , Suit e 30 8 424 2 Medica l Drive , Suit e 426 0 Kans M City , M O 6411 4 Nebrasic a 6811 0 Sa n Antonio , T X 7822 9 Phon» : (816) 363-3703 (402 ) 604-1004 Phone : (210)822468 8 B.V . 14/191 wu.inn R Fax:(210)679-667 7

# 5a\?> ^

Pruden t Tedmologies , Inc . (Prudent ) is unde r contrac t (Contrac t #EP-R7-08-07 ) wit hth e U. S. Environmenta l Protectio nAgenc y (EPA ) to stabiliz e Lea dBase dPain t (LBP ) at anumbe rof propertie s locate dmOmaha , Nebraska , includin g th e property locate d at Th e EP A request s you r pennissio n to allo w Pruden t to performLB PStabilizatio n at tiiis propaty . By signin g thi s form , th e propert y owne r grant s permissio n to Pruden t to perfor mactivitie s related to LB P Stabilizatio nincludin g scn^nn g pain t an dpaintin g of tiie referencedproperty . Further , th e owner/tenan t verifie s tiiat tiiey hav e receive dtiie LB Ppamphle t "Renovat e Right. " If

yo u hav e an y question s abou t th e LB Pstabilizatio nplanne dfo r you r property , pleas e contac t Prudent^ s Administrativ e Clerk for th e Lea dBase dPain t Stabilization , Mrs . Debora hAkereleJohnson . at

(402 ) S04-1004 . (jenera l question s abou t tiie Omah aLea dSit e cleanu p ca n be directe d to tiie EP A Publi c Informatio nCenter s at (402 ) 731-304 5 (Souti i Omah aoffice ) or (402 ) 991-958 3 QNlort hOmah a office) . Propert y Acoets aime dBy : • '(Pleas e Prin t Name ) Proper ^ Owne r Signature : //I/I6i r J / A 7^iLy^ { ^- ^ / ^ / / (Date (Date ) "7 PROPERTY INFORMATIO N (T o be eodVlete d by resldeat and/o r property oirnc r - plcai e prin Q RESIDENFNAME : ^^i ^

A/<g^/ " Q^ „ RESIDEN TADDRESS : ^^? ' ^^f/g>^^^?/ g ^ < ^ v IF RENTA U PROPERT YOWNE D BY : /^/CJ>/J^^I. ^ JpUJC^-^^^^t ^ 

### OWNER'SHAIUN0ADDRE8S ; /^'^ ' ^^' ^ /^^ ^ ^ . fJjff/PH4 . ^\/^> ^^/ d ^ OWNER' S TELEPHON E NUMBER . HOME : (4f^ l <^ f^'^/2<(^mC i i^0Z ^ 4^^"^^^ ^ NUMBE R OF OCCUPANT S UNDE R 7 YEAR S OLD : I^^NUMBE ROF OCCUPANT S 7 YEAR S OL D AN D OLDER:^ ^ NUMBB R OPCHILDRE N UNDE R 7 YEAR S OL D WH O PU Y IN TH E YAR D FO R 6 HOUR S OR MOR E PE R WEEK : ^ COMMENT S

OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. ) /^Af//trrj^-t ^

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AUTHORrr Y FO RENVIRONMENTA LRESPONS EACnONS ; Th e aetlviti M to be inylenwrtedl y EP Aurolefftbagwenie mar e purwan t to Sectio o 10 4 of CERCLA . 42 U^ C 9604 . EPA' t rigb t of aoce n to Ifa e propert y isprovide d fi>rinSection104(e ) of CERCLA , 42 U.S . C 9605(e) , whic hprovide s entr y fb

r "deteiiiiiiungihe needIbr leaponse , or choosin g ortaldn g an y respons e actio nunde r Ibi s title , or otberwis e enforci ^

108

0 War d Pailcway , Suit e 40 6 250 5N. 24* ^ Street , Suit e 30 8 424 2 Medica l Drive , Suit e 426 0 lanea a CHy ,MO 6411 4 Omaha , Nebraek a 6811 0 Sa n Antonio , TX7822 9 •hone : (816 ) 363-3703 \ ^ Phone : (402)504-100 4 Phone:(210)822-958 8

## ^ i 

# Curren t Sampl e Pre^enovatio n For m EtfecXJ m unti l Apri l 2010 . Confirmatio n o f Receip t o fLea d Pamphle t O^ l hav e toceivec i a cop yo f th e pamphlet , Fienovat e Right : Importan t Lea d Hazan j ^^Infonnatio n fo rfiamllies , CNl d Car e Provider s an d SctKJol s informin g m e o f th e potentia l ri8l < o f th e lea d hazar d exposur e fro m renovatio n activit yt o l3e perfbrme d i n m ydwellin g unit . I received.this pamphle t befor e th e woii < began . Printe d nam e of/recipletjto^.^'-' O / / - - Dat e ^ Signatur e ofrecipien t Self-CertiflcatiQ n Optio n (fer^tenant-occuple d dwelling s onl ^ — 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 ychect < th e appropriat e bo xbelow . 1 3 Refusa l t o sig n —I certifytha t i hav e mad e a goo d M h effbrt t o delive rth e pamphlet , ASnovat e RigjtA : Importan t Lea d Hazar d Infonnatio n fo rF^amlBes. Chil d Ca m Providers an d Sciiools , 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 confimnatio n o f receipt . I furthe rcertifytlia t I hav e left a cop yo fth e pamphle t a t th e uni t wit h th e occupant. Q Unavailabl e fo rsignatur e —I certifytha t I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , fienovat e FVght : Importan t Lea d Hazar d Infbnnatio n fb r Families , Chil d Car e provider s an d Schods , t o th e renta l dwellin g uni t liste d Iseiowan d tha t tti e occupan t wa s unavailabl e t o sig n th e confinnatio n o freceipt . I furUie rcertifytha t I hav e left a cop yo f th e pamphle t a t th e uni t b yslidin g i t Attempte d deliver y dat e an d tim e iM d pamphle t delivefy Signatur e o f p^ n certifyin g lea d pamphle t deliver y 

# ^^^ 1 Um^M M 5 ^ Uni t Addres s Not e Regardin g Mailin g Optio n —A s a n altemativ e t o deliver 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 before renovatio n ((Documen t wit h a certificat e o f mailin g fro m th e postoffice) .

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### uo n Pag e 1 of 3 Dougla s County , Nebrask a Propert yRecor d - R1616700000 :



### - Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t o f SOt h S t - VJe W O n Ma p Infonnatio n i s vali d a s o f 2008-9- 4 Treasurer' s fa xRepor t Ne wFeatur e f»!* » Aut o Sale s Searc h Owne r DUDZiNSK I MICHAE L J P O BOX 609 2 OMAH AN E 68106-000 0 

# m^^ ^ Propert yInformatio n Ke yNumber : 

### 167 0 000 0 1 6 Accoun t Type : Residentia l Parce l Numb&r : 161670000 0 Parce l Address : M2 7 LEAVENWORT H S T OMAH AN E 68105-000 0 Lega l Description : LEAVENWORT H HEIGHT S LO T2 6 BLOC K0 4 5 X 112. 8 Valu e Informatio n Lancf Improvemen t Tota l 200 8 $5,700.0 0 $129,600.0 0 $135,300.0 0 200 7 $5,700.0 0 $129,600.0 0 $135,300.0 0 

### 200 6 $5,700.0 0 $129,600.0 0 $135,300.0 0 200 5 $5,700.0 0 $85,300.0 0 $91,000.0 0 200 4 $5,700.0 0 $85,300.0 0 $91,000.0 0 200 3 $5,700.0 0 $85,300.0 0 $91,000.0 0 Sale s Informatio n Sale s Date : 2006-10-1 7 Deec f Type : W D Book : 200 6 Page : 11964 4 

### Price : $0.0 0 Grantor : TAN D D INVESTMENT S Grantee : DUDZINSK I MICHAE L J Valid/Invalid : Invali d Exclusio n Reason : Sale s Date : 1992-11-3 0 Dee d Type : Book : 

### 193 8 Page ; 67 9 

### Price : $45,000.0 0 Grantor : 

### http://douglasne.nmppmg-online.coin/DouglasCoNe/static/accountinfo.jsp?accountno=R16. . . 9/24/200 8. ...WWMAJ.! . a.±X2.\Jl.JL±lCU,lKJl l 

## Pag e 2 of3 Grantee : Valldnnvalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 

### 0.1 1 5085. 0 

### 1. 0 113. 0 45. 0 N o Improvemen t Informatio n Buildin g 1 ivwna p '• • 

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. iWMS F CLIC KJ O gHU^RqjJMAS E CLIC KTO ENLARG E IMAG E Squar e Footage : 

### 1819. 0 Percen t Complete : 

### 100.0 % Perimete r 0. 0 Quality . Averag e Uni t Type : Condition : Averag e



### Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r 

### Rooms : 7. 0 Exterior : Fram e Aluminu m Units : 

### 1. 0 Interior : 

### Drywal l Baths : 

### 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Gabl e 

### Stories : 1. 5 Floorcover : Allowanc e 

### Foundation : 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 

### 192 0 0 % 

### 192 0 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 

### 1.0 Applianc e Fireplac e Masionr y 

### 1.0 Basement . Bsmn t Bloc k 8 ft 

### 1140. 0 Fixture . Bas e Fixture s 

### 1. 0 

## http://douglasne.inapping-online.com/DouglasCoNe/static/accoiintinfo.jsp?accountno=R16.. . 9/24/200 8. wu^i.<.tv > ^^Kjuiii y j-iV/CUlUil . ii m i^oa i 

## ,uo n Page 3 of3 Fixtur e Bat h Ful l 1. 0 Garag e Attache d "'• ­ ­ 220. 0 Porc h En d Scree n 240. 0 Use r 200 2 BO E 68 7 1. 0 Use r Atti c1/ 2 Finis h 649. 0



## http://d6uglasne.ma:ppingK)nline.com/DouglasCoNe/static/accountinfo.jsp?accountno=R16.. . 9/24/200 8

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SV — 

## Performanc e StanjiaEras/cyose-Oy t Criteri s YS S J?« C i i i I 

## i1 ll . Wa s th e entir e structure(s]l,painte d wit h th e exceptio n o fth e stated , exciuda d araas ? Thi s woul d \ inciad s paintin g o f othe rsicdste d fisature s indudin g fascia , aaves , siding , a! ! trim , porches , bo x i beams , columns , rails , an d ^e-rio rsurfece s o fgarages . 

# i \2 .Wa s ai i scrapin g an d othe rpreparattio n wori ccomplete d satisfactoniy ? 

## JL A |3 .vVsr e ai l require d areas o f tq e structure(s ) prime d a s neede d an d painte d wit h tw o to p coats ? j4 . Wss th e pain t product s utiliqs d equr^.-aient t o s 5 0 yea rproduct/quarny ? 

# .i- i Are ai i ofth e areas wher e contaminate d materiai s hav e bee n spille d 

## r thorought yvacuumed / deai|pd ? 

# i l l 15 .Di d th e contracto rcoliect/vsi,cuu m al ! fs'iin g an d scrape d pain t chip s c n th e entir e property , 1

roadways , alleyways , publi cyces s area s an d also remove an yothe rgenerate d debris ? 

# lA l i s th e gras s are a tha t surrounp s th e strurture(s } i n reasonabt ygoo d condition ? 

### n . 

# / i sS.Ar e al l item s suc h a s polyethvlen e shgetlng , ladders , pain t brushes , cones , barrie rtap e etc . ! propsri yremoved ? 

# \i \ 19 . I s ther e an yevidence o f propert ydamag e tha t was don e byth s contractor ? .^n ypropert ydamag e \ needs t o b e complete d prio rt p th e EP ACiose-Out . 

# \ n jlC .Ar e tJier e anypropertyitem s ma t were temporatil yre-locate d b yth e contracto r Itha t nee d t o b e move d backr l 

# f- \ jii .Ar e *er e an y(icnownj lingerini t issues wit h th e Drooert yowrje.ns) tha t hav e bea n Sef t unresolved ? I i T 

# i/ i ' .Othe rConsiderations?property|Owne rDiscussion5?.Aaaitioria i Woii ctha t i s Require d



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