### TRANSMITTA LO FOMAH A LEA D SIT E PAIN T STABILIZATIO NFIL EFOLDE R SAI D # : ^^^JPnC r Date : 0.^-^7 0 "cPCC^ ^ Address : ^ ^ ^ ^ A / cT ^ 4^ty . LB PStabilizatio n Contractor : PRUDEN T TECHNOLOGIES , INC . Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S X

l Video o f propert v (DVP) ; Pre-Stabilizatio n& Post-Stabilizatio nVideo s iir

/ Executiv e Summary y SignedAcces s Agreement For m y Advanc e Notic e For m n Pre-Stabilizatio n Video Agreement For m \ v Acces s Tracldn g For m s /

Property Acces s Assessmen t Form U

/ Neighbo r Acces s Agreement Form i

/ Pain t Matc hFor m \

/ Pre-Stabilizatio n Propert y Safet y Assessmen t Form y Work-Site Hazard s Analysi s Checklis t M Photographs : Pre-Stabilizatio nPropert v Hazar dAssessmen t Photograph s WDougla s Count y Assessor Property informatio n IV^Property CompletionAgreement FormSigne db y Property Owner IJProperty Close-Out Check List Signe dBy EPA
Prnden t Technologies , Inc . Signatur e ' " ' '^Dat e 

# A7i,J,jA-^4^^i-^ . A^:r4 LA^Jl o EPASignatiir e * Date ^
30054733 

# M l Superfun dTECHNOLOGIES , IN C 

# Propert y Summar y Date : 9^/200 9 | LB PSTABILIZATIO NEP A CONTRAC T EP-R7-08-0 7 | Mont hof: Se p Propert y Address : 461 5 N3 4 Av . SAI D # : 4920 3

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 : 8/27/200 9 ii . Wor k Began : 9/04/200 9 il

LClose-Ou t Date : 9/05/200 9 B . Enclosures ; 1 . Pre-Stabilizatio n Vide o 2 . Post-Stabilizatio n Vide o 3 . Signe dAcces s Agreemen t For m 4 . Advance-Notic e For m 5 . Pre-Stabilizatio n Vide o Agreemen t For m 6 . Acces s Tracldn g For m 7 . Propert y Acces s Assessmen t For m 8 . Neighbo r Acces s Agreemen t For m 9 . Propert y Pain t Matc hFor m 10 . Pre-Stabilizatio n Propert y Safety Assessmen t For m 11 . Work-Sit e Hazard s Analysi s Checklis t 12 . Pre
- Stabilizatio n Propert y Hazar dAssessmen t Photograph s 13 . Dougla s Count y Assesso r Propert y Informatio n 14 . Signe dPropert y Completio nAgreemen t For m 15 . Propert y Close-Ou t Chec k Lis t Signe dB y EP A^^CHNraSXXSIBS wINC. ' Prudent Technologies , Inc . (Prudent ) i s unde r contrac t (Contrac t #EP-R7-08-07 ) witii tli e U . S . Environmental Protectio n Agenc y (EPA ) t o stabiliz e LeadBase dgai m(LBP^a t anumbe r o f propertie s locate din Omaha , Nebraska , includin g th e property locate dat ^ f j S /v
- Ar niJc^ > Th e EPA request s you r permissio n t o allo w Pruden t t o perfor mLB PStabilizatio n at thi s property . B y signin g thi s form , th e propert y owner grant s permissio n t o Pruden t t o perfor mactivitie s 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 I agree t o allo w a n EPA 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 alread y bee n performed . I understan dthat th e stabilizatio n contracto r canno t provid e assurance s o f whic 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 , may hav e regardin g soi l cleanup at m y property . Yes , I hav e rea dan dunderstan dth e paragrap habove . 

# / * ^ "^ / yhy ^ CM- ^ /2>iA( 4 lignature o f Property Owne r 

# x i Dat e Ifyo u hav e any question s abou t th e LB Pstabilizatio n planne dfo r you r property , pleas e contac t Prudent' s Custome r Relations/OfFic e Manager fo r th e LeadBase dPaint Stabilization , Mrs . Shanno n Hol t 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 n Center s at (402 ) 731
­ 304 5 (Sout hOmah aoffice ) o r (402 ) 99 1 -958 3 (NorthOmah aoffice) .
Propert yAcces s Grante d By : 

# r-^4LJ^ ^^^C2y ^ (Pleas e Print Name ) Propert y Owne r Signature ; (Signature ) 

# g ;-^^/^ 7

/ (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 , 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• TECHNOILOGIBS . IP-rcT " PROPERT YINFORMATIO N KKUKCKI TinruKin/ ^ (To^b e i^^$^en t rpropert yowne r—please print ) ^yA^— \ A(T o becomplete complete d d b

by

yr^$^en t and/o and/o rproDe i RESIDEN TNAME : L>/f/€ / .>^^ . / /T/ / ftOf/i C J Owne r/ Rente rJ RESIDEN TADDRESS :

IF RENTAL , PROPERT».OWNE D BY : 

# AM .Tiic . OWNER' S MAILIN G ADDRESS ; 

# y^/ ^ //
. 

# .-34 AU S 1 

# w-m f OWNER' S TELEPHON E NUMBE R - HOME : 1 .WORK : _ j I. 

# 0 NUMBE R OF OCCUPANT S UNDE R 7 YEAR S OLD : NUMBE R OF OCCUPANT S 7 YEAR S OL D AN D OLDER : N

NUMBE R OF CHILDRE N UNDE R 7 YEAR S OL D WHO M PLA Y IN TH E YAR D FO R 5 HOUR S OR MOR E PE R WEEK :

COMMENT S OR SPECIA L INSTRUCTIONS : (I.E
. DOGS , ENTR YGATES , ETC. ) 

# Al / DM

AU THORir V FORENVIRONMENTA LRESPONS EACTIONS : Th e activitie s lo be implemente d by EPA under thi s agreemen t ar e pursuant to Sectio n 10 4 ofCERCLA , 42 U.S.C . 9604 . EPA' s righ t of

acces s to th e property is provide dfo r inSectio n 104(e ) ofCERCLA , 42 U.S . C 9605(e) , whic hprovide s entry fo r "determinin g th e nee dfo r response , or choosin gor takin g any respons e actio nunder thi s title , or otherwis e enforcin 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 4242 Medica l Drive , Suit e 425 0 Kansa s City , MO 6411 4 Phone : (816 ) 363-370 3 Fax ; (816) 363-3707 Omaha , Nebrask a 6811 0 Phone : (402)504-100 4

Fax : (402)504-100 5 Sa n Antonio ,TX 7822 9 Phone : (210)822-958 8 Fax : (210) 579-6577

# m TBCHNOLOGIES w INC . 

## Advance dnotic e needed . Afte r signin g th e acces s yo u allo w Pruden t t o begi n Lea dBase d Pain t Stabilization . Al l Plants , weed s an dan y vehicle s o r item s o n ope n porc 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 b e 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 n yard ?
Notic e needed : 

# :^ ^ A S&i /

imi^ t

4 € tiiqi A k^e e Numbe r t o cal l t o giv e notice : fwff^ ^ /o , j Who mw e ar e givin g notic e to : / U/fj) ^(aOo4 > UitN>Q y Home Owner' s Signatur e 

# 7 'Al<b<A. ~

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 , TX 7822 9 Phone:(816)363-370 3 Fax:(816)363-370 7 Phone : (402)504-100 4 Fax : (402)504-100 5 Phone : (210 ) 822-958 8 Fax:(210)579-657 7TBCHNOfljOGIESi, ] 

## ACCES S INFORMATIO N TRACKIN GSHEE T PROPERT Y ADDRESS : ^} ^ BVID : /f4fs^o 2 ^ / / ^ ^ Propert y Owne dBy : 

# ALM ^ 

# . . (I f new propert y owner )

Owner s Phon e No's : Home : 

# . Mi.fH.C . Work : CeU : Fax : —• 

# AM ( 45i'Si9 j A,, a^^^ A Acces s Contractor : AS WPDA ME S P EOthe r (Prudent ) DAT E TIM E ^CESSO R COJVRACTDETAIL 

# 'ilTrU ^'OOf M (^/H^. ^ 1 

# k ^ I 

# 1 n

Comments : jii£ii:_i.-.i!&^-A._dm_J^S'^5:^ . 

# dUist-lMl

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 , 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. ] 

## PRE-STABILIZATIO N VIDE O FORM 1 UNDERSTAN D THA T PRUDENT TECHNOLOGIE S WIL LB ECOMIN G OUT T O SHOO T A PRE-STABILIZATIO N VIDE O A T MY 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 . OWNER S NAME : ^ ^ J^^ ^ PROPERT Y ADDRESS : 

# y^/ r/f/
. 

# ? t ^ • BVID/SAID : 

# ^^^ 3 HOMEOWNER S SIGNATURE : T<T.a ^ 

## PRUDEN T SENTATIV ESIGNATURE : AN Y CONDITION S NEED T O B EAWAR EO FBEFORESHOOTIN G VIDEO : (LE . PETS , NOTIC ENEEDED) : 

# /UdN l

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 7TECHNOLOGIBS, ] 

# Acces s Assessment Form : (Mus t b e complete dfo r every property . Informatio n mus 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 ?
I f

yes , i s an y o f th e stucc o o r asbesto s damage do r cracked ?
I f

yes , 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 scrapOing ?
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 ? / / ^ 

## I f

yes , 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 Kansa s City , 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 7TECHNOLO^ ^ 

## Doe s thi s propert y hav e agarage ? 

# /J d I f

yes , describ e locatio no f garage . Doe s thi s propert y hav e aluminu msiding ? ^ ' 

# m I f

yes , i s i t origina l factor y finis ho 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) ?
I f

yes , EXPLAIN ?
I s thi s propert y vacan t o r o c 

# ft/I /^'J^ i Ar e ther e an y pet s a t thi s property ? 

# /Q a Ar e ther e an y lo w hangin g powe r lines ? 

# iyie/n.

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 7TECHNOLOGIBS, ] 

### 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 N PROCESS ? 

# I\j d I FI T IS , GE T ACCES S FRO M ALLREQUIRE D NEIGHBORHOO D PROPERTIES .

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 , 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 7OOLOGIES . IN C 

### PAIN T MATCHIN GFORM : 1 . T O B EFILLE D OUT ONL Y I FMATCHIN GCOLO R PROPERTY ADDRESS : ^l> K // • ^4 fi/^ 

# BVID : H4^ 3 Th e following note s ar e for th e benefit o f

pain t crew only . Pain t Ye s Pain t N o Locatio n Pain t Descriptio n Sidin g 

# A Soffi t 

# y Fascia 

# y Come r Tri m 

# y Windo w Trims 

# y Doo r Trims 

# y
J l J 1 1 

### Fron t Porc hCeiling 

# /H I

# uh k 

# A Fron t Porc hCeiling Beam s 

# y Fron t Porc hFloo r 

# sm / y I Fron t Porc hRailing s 

# y Fron t Porc hStep s 

# y Sidin g Baseboards 

# y y ^ , Foundatio n 

# (APfiAi ^ o^ k 1 ^ -f^^^ M ' l/ou^ t / 

# (4l44 t

6uik^i

- i %i^iJ^p>^i^ f^ £%/^e J /UlEMlof K 

# A 

# lyA- ^ / 

# J / r ­ ^ 

### I UNDERSTAN D SHERWI N WILLIAM S WIL LMATC H M Y CURREN T COLORS . Homeowner signature : ^^0*^*7.,^—'h H ^'^=Jj^nJyilP _ Date:^^t>2^^dl ^

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 ) 579-667 7TECHNOLOGIBS, ] 

## PRE-STABILIZATIO N PROPERT Y SAFET Y ASSESSMENT FORM PROPERT Y ADDRESS : H(ff ^ /^ ' S T ^^ ' BVID/SAID : 

# ^^Qi0 3 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. ) 

# 6t ^

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 ) 579-667 7# TECHNCKX)GIBS . 

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

# ^ 1 ^ A/ , AA^4v ^ Address : Crew : Date : Ite m Haza r Overhea dLine s kL4L 

# i r^/ i " ^ he e 

# i ^ ^ ySx^LAJL , O In-transi t Vehicl e Clearanc e Level s aroun dhig hwire s Vehicl e Clearanc e aroun d hig hwire s whe n workin g Phon e line s Cabl e line s Ga s Lin e Wate r Lin e Sewe r Lin e Septi c Tan k Propane/Butan e Acces s to/o nPropert y 

# .-tdAKx^C^Jt:^c n 3^ ^ 4i^y^- ^ Neighbo r Acces s Require d Hig hTraffi c Are a 

## y / ^ Garag e 

### ^Atr O Structure s 

### uOo-ertJl ^7rv5sUiJ , •b->t^f.-A^jt^ ^ Z^tc ^ 

## .^cn^ ^ Drivewa y < ^ ^ Sidewal k t/yy£^ue'r-~ > Foundatio n Retainin g Wall s 

## y^y i Fence s 

### 'A-i7>S^(AtAyL,A-4 i ^SiJji^uy^' ^ shTf O Tree s Foliag e 

### 7p^^S^777 : Genera l Conditio n o f yar d Damage dAreas : sin k holes/rotte dwoo d Sprinkle r Syste m Pet s Insect s Weathe r Condition s Unsaf e drivin g condition s Unsaf e neighborhoo d, , ^^JjJiJU ^ Cre w Foreman / Sub-Contracto r Sit e Safet y Office r 

# m 308 0 War d Parl<way , Suit e 40 5 2S0 5 N . 24' " Street , Suit e 30 8 V.424 2 M^bfca 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 V/ 1 hav e receivec i 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 of th e lead hazar d exposur e fro m renovatio n activit yt o be performe d i n mydwellin g unit
. I receive d thi s pamphlet befor e th e wor k began
. ite d nam e o f recipien tDate " ^ atur e of recipien t -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
. •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 belowa 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 belowan d that th e occupan t wa s unavailabl e t o sig n th e confirmatio n o f receipt
. I fupthe rcertif ythat I hav e lef t a copyof th e pamphlet a t th e uni t b yslidin g i t i rth e dcjo r Printe d (nam e p ^

perso n certifyin g Attempte d deliver y dat e an d tim e lead pamphlet deliver / Signatur e of perso n certifyin g lead pamphlet deliver y 

# Y^/ r

# /j,3 4 /^
. Uni t Addres s Not e Regardin g Mailin g Optio n —As 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 mus t 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)
.

### Dougla s Coimt y Accoun t Informatio n Pag e 1 of 2 im^t : Dougla s County , Nebrask a Propert yRecor d - R180155000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t of 52n d S t - VJe W O n Ma p Infomiatio n i s vali d a s o f 2009-8- 3 Treasurer' s Ta xRepor t Ne wFeatur e ••-»- • Aut o Saje s Searc h 

### Owne r CLU B INCORPORATE D 

## 4.<\7J> 5 461 5 N 3 4 AV E OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : 015 5 00001 8 Accoun t Type : E xCharitabl e Parce l Number : 180155000 0 Parce l Address : 4615N34A V OMAH AN E 68111-000 0 Lega l Description : MONMOUT H PAR KLO T1 4 BLOC K5 S 5 0 W 3 0 F TLT1 2 & 8 5 0 FTLT1 3 & AL L LT1 4 5 0 X 8 0 & 4 7 X 12 8 Valu e Informatio n 200 9 200 8 200 7 200 6 200 5 200 4 Lan d $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 Improvemen t $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 Tota l $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 Lan d Informatio n Acre s 

### 0.1 6 S F 7296. 0 U nit s 0. 0 Dept h 1 14. 0 Widt h 64. 0 Vacan t Ye s Improvement Informatio n Buildin g 1

N o Skotc h Availabl a



### http://douglasne.mapping-online.coin/DouglasCoNe/static/accoimtinfo.jsp?accountno=R18. . . 8/25/200 9

### Dougla s County Accoun t Infocaatio n Pag e 2 of 2 iCJl^ t

Squar e Footage : 1692. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 2 Stor y 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. 5 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Stories : 2. 0 Floorcover : Allowanc e Foundation : Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 188 0 0 % 188 0 12 6 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 ft 832. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Fixtur e Bat h Hal f 1. 0 Porc h Sla b Roo f Cei l 208. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R18. . . 8/25/200 9#
TECHNOLOGIBS ^ IN C 

## Pruden t Propert yClose-Ou t For m (Lead-Base d Pain t Stabilization ) 

# SAID : Vfe^ g 

# VA/ r

ly

- sr ni A/ Propert yAddress : Owner' s Name : 

# /']n hA.ir Mf^j-R,l \^M dKfiFMheU dM m S.N O Performanc e Standards/close-Ou t Criteri a Ye s N O 1 Was th e entir e structure(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 

# J 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 ? 

# J 3 Were 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 ? 

# i / 4 Ar e al l o f th e area s wher e contaminate d material s hav e bee n spille d thoroughl yvacuumed/cleaned ? 

# A 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 

# J an d als o remov e an yothe rgenerate d debris ? 1 6 I s th e gras s are a tha t surround s th e structure(s ) i n reasonabl ygoo d 

# J condition ? 7 Was th e pain t product s utilize d equivalen t t o a 30 yea r 

# x / product/quality ? 8 Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , 

# J cones , barrie rtap e et cproperl 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 

# A 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 

# A contracto rtha t nee d t o b e move d back ? 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 ? 

# i / 1 2 Othe rConsiderations ? Propert yOwne rDiscussions ? Additiona l Wori ctha t i s Require d 

# A
Pruden t Representativ e Signature : 

## Date: ^-S'-d ^ Propert yOwne rSignature : ^ Date :^^^- ^ ^ 808 0 War d Parkway , Suit e 40 5 250 6 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