## TRANSMITTA Lof OMAHA LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R SAID : 3986 3 Date : 12/26/200 8 Address : 242 1 BAUMA N Remediation Contractor : Pruden t Technologie s Year : 200 8 PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S ^ Video of propert y (DVD ) 0 ' Executiv e Summar y [?

f Signe dAcces s Agreement fo r subjec t propert y [ ^ Paintin g Agreement D Settlemen t documents (i.e. , fo r

damag e or to replac e plants , etc. ) D Photograph s 0

^ Satisfactor y restoratio n signedby Propert y Owne r D Propert y close-out chec k

lis t signedby EP A B

^ Propert y information fromDougla s Count y Assessor' s Office D D D ' 

## Signatur e LDat e

4030982 1 

# DiH I Superfun d

### PROPERT Y SUMMAR Y Date : 12/23/0 8 LB PSTABILIZATIO N EPA CONTRAT EP-R7-08-0 7 Monthof : Decembe r Propert y Address : 242 1 BAUMA N SAD) : 3986 3 A . EXECUTIV E SUMMAR 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 Information : NONE . Acces s Date : 09/29/0 8 Wor k Began : 10/08/0 8 Closeou t Date : 10/13/0 8 Enclosures : 1 . Pre-Vide o 2 . Post-Vide o 3 . Propert y Statu s For m 4 . Signe dAcces s Agreemen t 5 . Pre-Renovatio n For m 6 . Pain t Matc hFor m 7 . Trackin 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

TECHNOLOGIES , INC .ENVIRONMENTA L& CONSTRUCTION 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : o)M'^^ \T^J^^ ^ 

### mOwjC X ArvC ^ Date : Phone : Plan t & Pennanen t Landscapi^ p T o RprmAi n TT ^ Pl^c e Iteni # Descriptio n an dLocatio n O n Map

Pre-Existin g Conditio n o f Structure s Doe s you r Basemen t hav e ahistor y o f leaking ? Ye s —N o - X Itein # OnM ^ Descriptio n & Locatio n

Propert y Owne r Pruden t Employe e Signature ^ : ^ 

# dSudtkA- i 8080 War dParicway , Suit e 40 5 260 5 N . 24** StTMt , Suite 30 8 424 2 Medica l Drtva , Sult a 426 0 Kansa s City , M O 6411 4 Omaha , Nebraska6811 0 Sa n Antonio , T X 7822 8 Phom : (816 ) 303470 3

# • 5Q^^ 3

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

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

o f propertie s locatedi n Omaha , Nebraska , includin g th e propert y locate da t ^V^ / ^ iij.4^truij ^ /^>- ^ > Th e EP A request s your permissio n t o allo w Pruden t t o perfor mLB P Stabilizatio n a t thi s property . B y signxa g thi s form , tiie propert y owne r

grant s permissio n to Pruden t t o perfor mactivitie s relate dto LB P Stabilization including scrapin g pain t andpaintin g o f th e referencedproperty . Further , th e owner/tenan t verifie s tiiattiiey hav e receive dtiie LB Ppamphlet "Renovat e Right. " If

you hav e an y question s about tiie LB Pstabilizatio n planne dfo r

your prop^ty , pleas e contact Prudent' s AHminiirtrativ e Cler k

for th e Lea dBase dPaint Stabilization , Mrs . Deboral i AkerelfrJohnson . a

t (402 ) 504-1004 . Genera l question s about th e Omah aLea dSite cleanup can b e directe dt o th e EP A Public Informatio n Center s at (402 ) 731-304 5 (Sout hOmahaoffice) or (402 ) 991-958 3 (Nort hOmaha office) . Piopen y Acoe nOtante dBy-. . OPIease Prin t Name ) ^ ^ CSigna&ffc ) f f (Date ) CT

o b e complete d PROPEFCTY INFORMATIO N b y midcat and/o r propert y onme r ­ pleas e print ) RESIDEN TNAME : f\f ^

C^ ^

Ovme rRente r RESIDENT ADDRESS : I FRENTAL , PROPERT Y OINNB ) BY : 

# •?f?i^6 ^ /) . P)u4hA-0fi! ^ OWNER'SMAIUNOADDRESS ; J^' ^ / ^^U T £r/lQ D I lnOJ . 

### OVWER- S TELEPHON E NUMBER. HOME : t ^ \'?^^A ^ X I ^'*°^ ' *<^ > h')i^rS ^ "7 ^ 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 : ^ NUMBE R OFCHILDRE N UNDE R 7 YEAR S OL D WH O PLA YI N TH E YAR D FO R 5 HOURS O R MOR E PE R WEEK : e? ? COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOOS , ENTR Y GATES . ETC. )

AUTHORTT Y FO RENVIRONMENTA LRESPONS EACTIONS ; Th e activitie i t o Iwimpleineme db y EP A unde r Ha s agneoKii t at e punuan t t o Sectio n104 o f

CERCLA , 4 2 U.S C 9604 . EPA' s righ t ofacces s t o th e piopeil y isprovide dfb r inSe<4io n104(e ) ofCSRO A 4 2 U.S . C96QS(eXwluebprDvkletta ^ £) r

"(teteniiiniii g tli e iiee dfo icsponse , o r ctaootin g ortaldn g ati y respons e aclio aunde r thi s title , o r olberwi ^

8 0 war dParkway . 8i« e 40 5 260 6 N . 24* " Street , Suit e 30 8 424 2 Meditn l DrIva , Sult a425 0 naa aCHy , M O 6411 4 Omaha , Nebrask a6811 0 Sa n Antonio . TX 7B22 » one : (816 ) 363^70 3 Phnnn < I»M\KI\ * <»» •

# =?R < Curren t Sampl e Pre-Renovatio n For m Effectiv e unti l Apri l 2010 . Confinnatio n o f Receip t o f Lea d Pamphle t 0T\ - hav e received a copyo f th e pamphlet , Renovat e Right : Importan t Lea d Hazar d informaVo n forFamilies , 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 lead fiazar d exposur e fro m renovatio n activit yt o b e performed i n m ydwellin g unit . I receive d thi s pamphle t befor e th e wor k began . i^nfe * nam e o f recipient^ / i '^yste / ' Signatur e o f recipien t Setf-Certiftcatio n Optio n (fo rtenant-occupie d dwelling s only ) — I f th e lead pamphle t v^a s delivere d bu t a tenan t signatur e wa s not obtainable , yo u ma ychec k th e appropriate bo xbelow . Q Refusa l t o sig n — I certif ythat ! hav e mad e a goo d fait h effor t t o delive rth e pamphlet , fienovate ftig/Jt Importan t Lea d Hazar d Informatio n forFamilies , Chil d Car e F'rovider s an d Schools , t o th e renta l dv^^lin g uni t liste d belo wa t th e date an d tim e indicate d an d that Vn e occupan t refused t o sig n th e confirmatio n o

f receipt . 1 furthe rcertif ytfia t I hav e lef t a copyo f tti e pamphle t at th e uni t wit h th e occupant . Q Unavailabl e fo rsignatur e —1 certif ythat I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , fienovate FVght : Importan t Lea d Hazar d Informatio n for Fam'^es , Chil d Car e provider s an d Sdiools , 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 confinnatio n o f receipt . I furthe rcertif ythat i hav e lef t a copyo f th e pamphle t a t th e uni t byslidin g i t underthedoor,.-— ^ Printe d nam e o f perso n certifyin g Atten/ipte d deliver y dat e an d tim e lead pamphle t deliver y 'ypyyjyTLjd^^ — g^tatur e o f perso n certilyin g lea d pamphlet deliver y 

## .^44? / i^cuTja ^ y^^'-e ^ Uni t Address Not e Regardin g Mailin g Optio n —A s a n aitemaliv B t o delwer yi n person , yo u ma ymai l th e lea d pamphle t t o th e owne rand/o rtenant . Pamphle t must b e maile d at leas t 7 day s befor e renovatio n (Documen t wit h a certificate of mailin g fifo m th e pos t office) .

# ACCES S iMf^ORHfinrioNTRAOimi G SHEE T i^ftopcerv ^f^^^ Aooffes a J^Y^ J ^^>^^ ^

/U< ^ pnpMtOnrtOr : , .^,7?^r7r ? %^^< ^

OmrOaMN KHowe ; /57-/^^ ^ WDT K ^



## Conne rDETO L 

# 1^;^ ^ I P 

# ± O P

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# o; C fe^ 6^>i . ^ce^-iL . 

# ^9.^3-^)^^ /

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# If,^^ ^ pain t matc h rfet^n r Pain t matchin g form : Propert yaddress : ^y^ / BVID : 3^^^ 3 

# Area : Explanation : Area : Explanation : Area : Explanation : Area : Explanation : Area : Explanation : 

# i^iMhA-l ^ ^ — txiuyn/iy i f^ ^ 

# Color :

Color :

Color :

color :

color : Pag e 1

### Pag e 1 of 3 Dougla s County Accoun t Infc^fciti ition Dougla s County , Nebrask a Propert yRecor d - R175002000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f 90t h S t - V.ieW...Q. n MS R Infonnatio n i s vali d a s o f 2008-9- 4 Treasurer' s Ta xRepor t Nevt f Featur e -•••* • Aut o Sale s Searc h Owne r BUTLER-CO X KATRO N D ETA L 

# \^\A \^' ^ OMAH AN E 68112-000 0 Propert yInformatio n Ke yNumber : 

### 500 2 00001 7 Accoun t Type : Residentia l Parce l Number : 175002000 0 Parce l Address : 242 1 BAUIVIA N A V OIMAHAN E 68112-000 0 Lega l Description : l\AiNN E LUS ALO T 2 5 BLOC K8 4 4 X 12 0 242 1 BAUIWIA N AV E

Valu e Informatio n Lan d improvemen t Tota l 200 8 $ 5,900.0 0 

### $67,700.00 $ 73,600.0 0 200 7 $5,900.0 0 $ 42,500.0 0 $ 48,400.0 0 

### 2006 $5,900.00 $ 42,500.0 0 $ 48,400.0 0 200 5 $5,900.0 0 $ 42,500.0 0 $ 48,400.0 0 200 4 $ 5,900.0 0 $ 36,300.0 0 $ 42,200.0 0 200 3 $ 5,900.0 0 $ 36,300.0 0 $ 42,200.0 0 Sale s Informatio n Sale s Data : 2005-05-1 9 Dee d Type : Q C Book : 200 5 l^ge : 05998 1 Price : $0.0 0 Granto r KATRO N D BUTLE R ETA L Grantee : KATRO N D BUTLE R ETA L Valid/invalid : invali d Exclusio n Reason : Famil ySal e Sale s Date : 1994-07-2 0 Dee d Type : Book : 198 6 Page : 39 7 Price : $ 42,500.0 0 Grantor :

• i-i»«+."~^ ~ ; —o ­ 

### http://douglasne,mappmg-online.comyDouglasr.nNp/ct!Jti^/o r

### Pag e 2 of 3 Dougla s County Accoun t lo^pi i atio n Grantee : Valid/Invalid : Vali d Exclusio n Reason : L^n d Informatio n Acre s S F Unit s Dept h Widti i Vacan t 

### 0.1 2 5280. 0 1. 0 120. 0 44. 0 

### N o Improvemen t Informatio n Buildin g 1 242 1 Saimi n Ave . 11caoryR n

.JM L .&'d2!*f . "t t 

## ^^i r ^rssiss** "

CLIC KT O ENLARG E IMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : 1448. 0 

### Percen t Compiete : 100.0 % Perimete r 0. 0 

### Quality : Averag e Uni t Type : 

### Condition : Fai r



### 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 : 6. 0 Exterior : Fram e Stucc o Units : 

### 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Slat e Bedrooms : 3. 0

Roo f Type : Gabl e Stories : 

### 1.5 Floorcover : Allowanc e Foundation : 

### Bloc k Sprinkle rSquar e Footage : 0. 0 YearBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 192 3 0 % 192 3 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Applianc e Fireplac e Masonr y 1. 0 Basemen t Bsmn t Bloc k 8 f t 1188. 0 Fixtur e Bas e Fixture s 1. 0 

### http://douglasne.mapping-online.eom/DouslasCoNe/sTatiV/ Q

## Dougla s Coimt y Accoun t Ii^fcnatio n Pag e 3 of3

i^tei a Fixtur e Bat h Ful l 1. 0 Garag e Detache d 324. 0 Porc h En d Scree n 126. 0 Porc h En d Soli d Wal l 48. 0



## http://douglasne.mapping-onIine.com/DouelasCoNp/ctof,v/o. ,

## Pruden t Propert yClose-Ou t For m (Lead-Base d Pain t Stabilization ) PropertyAMr^ - M M BAM4YU ^ UO ^



### • Ortmer' s Nam a IX^AJn u J) . jSuJ^'-CU ^ 

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

### N O 1 .

Wa s tfi e entir e struaure(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 , bo x beams , columns , rails , an d exterio rsurface s o f garages . 2 .Wa s ai l scrapin g an d othe rpreparattio 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 ? 

# V , 4 .

Wa s th e pain t product s utilize d equivalen t t o a 3 0 yea rproduct/quality ? 5 .Ar e ai l o f th e area s wher e contaminate d material s hav e bee n spille d thoroughl yvacuumed / cleaned ? 6 .Di d th e contracto rcollect/vacuu m al l failin 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 ? 

# 7, ¥ . 7 .I s th e gras s are a tha t surround s th e structure(s ) i n reasonabl ygoo d condition ? 8 .Ar e al l item s suc h a s polyethylen e sheeting , iadders , pain t brushes , cones , barrie rtap e etc . 

# 7 properl yremoved ? 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-Ou t 10 .Ar e ther e an ypropert yitem s tha t wer e temporatil yre-locate d b yth e contracto r 

# 1 7 tha t nee d t o b e move d back ? 11 . 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 ? 

# fT l Othe rConsiderations?propert yOwne rDiscussions?Additiona l Wor k tha t i s Require d 

# r>.^4....cA^ : "k^mbfli^K^ f Prucien t Reipiresentativ e