## TRANSMITTALO FOMAHALEAD SIT E PAINT STABILIZATIO NFIL EFOLDE R SAID# : JP^f^^/ ^ Date : 

### Address : tT.^iT^L TA / ^< y.^y . LB PStabilizatio nContractor : PRUDEN T TECHNOLOGIES , INC . Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S
^ Videoo f property (DVD) : Pre-Stabilizatio n& Post-Stabilizatio nVideo s M Executiv e Summar y Q eSignedAcces s Agreement For m Q

^ Advanc e Notic e For m M Pre-Stabilizatio nVideo Agreement For m mAcces s Trackin g Form u Property Acces s Assessmen t For m nNeighbo r Acces s Agreement For m t

/ Pain t Matcl i For m M Pre-Stabilizatio nProperty Safet y Assessmen t For m 0 ^ Work-Site Hazard s Analysi s Checklis t B ^ Photographs : Pre-Stabilizatio nPropert v Hazar dAssessmen t Photograph s B Dougla s Count y Assessor Property informatio n 0 Property Completio nAgreement FormSignedb y Propert y Owner l y Property Close-Out Chec k Lis t SignedB y EP A 

# jf\ ^ ^^^^^.^'^'^ ^ Pruden t Tecnnologiesnnc . Signatur e 

# ^ — Dat e

' ' Dat T
3005492 5 

# • H I Superfun dTRCHNOLOGIBS b IN C 

# Propert y Summary Date : 11/~/200 9 LB PSTABILIZATIO NEP A CONTRAC T EP-R7-08-0 7 Mont hof: No v Propert y Address : 393 3 N2 3 St . SAI D # : 3364 3
A . Executiv e Summary ; 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 : 9/23/200 9 u . Wor k Began : 9/28/200 9 iii . Close-Ou t Date : 9/29/200 9 B . Enclosures ; 1 . Pre-Stabiiizatio nVide o 2 . Post-Stabilizatio nVide o 3 . Signe dAcces s Agreemen t For m 4 . Advance-Notic e For m 5 . Pre-Stabilizatio nVide o Agreemen t For m 6 . Acces s Trackin 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 nPropert y Safety Assessmen t For m 11 . Work-Sit e Hazard s Analysi s Checklis t 12 . Pre
- Stabilizatio nPropert 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' TBCHNCaxXilBS . INC . ~ Prudent Technologies , Inc . (Prudent ) i s unde r contrac t (Contrac t #EP-R7-08-07 ) wit hth e U . S . Environmental Protectio n Agenc y (EPA ) to stabiliz e LeadBase dPaint (LBP ) at anumbe r o f propertie s locate dinOmaha , Nebraska , includin g th e property locate da t 3 ^ 3 3 ^ 2-^^i i 5 ^ , 0\f \^ K « , W ^ C=
- Th e EP Arequest s you r permissio nt o allo w Pruden t t o perfor mLB PStabilizatio nat thi s property . B y signin g thi s form , th e property owner grant s permissio nt o Pruden t t o perfor mactivities relate dto LB PStabilizatio nincludin g scrapin g pain t an d paintin g o f th 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 nEP Acontracto r t o conduc t asoi l cleanu p at m y property followin g completio no f lead-base dpain t stabilization , i f th e soi l cleanu p ha s no t alread y bee nperfonned . I understan dthat th e stabilizatio ncontracto 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 will make al l reasonabl e effort s t o addres s concem s that I , a s th e property owner , ma y hav e regardin g soi l cleanu p at m y property . [/( ] Yes , 1 hav e rea dan dunderstan dth e paragrap habove .

Signature o f Property Owne r
Date I f yo u hav e any question s abou t th e LB Pstabilizatio nplanne 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 nHolt , at (402 ) 504-100 4 o r (402)812-0223 . General question s abou t th e Omah aLeadSite cleanu p canb e directe dt o th e EPA Publi c Informatio nCenter s at (402 ) 731
­ 304 5 (Sout hOmah aoflHce ) o r (402 ) 99 1 -958 3 (NorthOmah aoffice) . Propert y Acces s Grante dBy : * (Pleas e Print Name ) Propert y Owne r Signature : 

# YAL . 

# i}.% h (Signature )
(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 , Nebraslt a 6311 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 7IBS , INC . PROPERT YINFORMATIO N (T o b e complete d b yresiden t and/o rpropert yowne r— pleas e print ) 

## RESIDEN TNAME : R^ymr TDc j Moor o Owne r{ Rente r RESIDEN TADDRESS : __^ ^ 1



## • RENTAL^I^T YOWN^r^BY^^ ^ ^ ^^^ ^

(^^0^^! ! JrW^jJpO^rdl , ll ^
IWNER' S MAILIN G ADDRESS ; ^ h r s ^ / i o .i i ^ 

# IPJoS nDc^y^^Pr . (7ml)^ . M f

loVl ^ I OWNER' S TELEPHON E NUMBE R - HOME : NUMBE R O F OCCUPANT S UNDE R 7 YEAR S 0LD:X 7 NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDER :

NUMJBE R O F CHILDRE N UNDE R 7 YEAR S OL D WHO M PLA YI N TH E YAR D FO R 5 HOUR S O R MOR E PE R WEEK : MJB I

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

# r^ry^r l yar d

AUTHORITY FORENVIRONMENTALRESPONS EACTIONS : Th e activitie s to b e implemente dby EPA under thi s agreemen t ar c pursuant to Sectio n10 4 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f

acces s t o th e property i s provide dfor inSectio n104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry fo r "determinin g th e nee dfo r response , or choosin g or takin g any respons e actio nunder thi s title , or otherwis e enforcin g th e provision s o f th e title. "

^ 

# /X M 

# ^ . % M el-^^lo' f

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 7TECHNOLOGIES, ] 

# Advance dnotic e needed . Afte r

signin g th e acces s you allo w Pruden t t o begi nLea dBase d Pain t Stabilization . All Plants , weed s an dan y vehicle s o r item s on openporc h(enclose dporche s wil l NO T b e stabilized ) mus t b e remove dprio r t o stabilization . All Pet s mus t b e ou t o f

yar ddurin g stabilization . How muc hnotic e d o you nee dt o hav e abov e mentione dtask s completed ? If you ar e alandlor dyou wil l nee dto contac t th e tenan t a s Pruden t Technologie s wil l only infor myou . D o you hav e an y pet s tha t resid e i nyard ? 

# N O Notic e needed:^ ^ /^^ ^ Nofjcuz ^ Numbe r to cal l to giv e notice : Who mw e ar e givin g notic e to : Hom e Owner' s Signatur e 

# x^3 C 

# ^ • t!J2-s j o 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 , 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 NVIDE O FORM I UNDERSTAN D THA T PRUDENT TECHNOLOGIE S WIL LB ECOMIN G OUT T O SHOO T APRE-STABILIZATIO NVIDE O AT M Y PROPERTY . TH EVIDE O I S JUS T ATOO LUSE D T O DOCUMENT TH ECURRENT PROPERT Y STATUS/CONDITION . APOS T VIDE O WIL LALS O B E SHO T PRIO RT O COMPLETIO NO FSTABILIZATION . 

# OWNER S NAME : UcUhi^^ H JD^^^T^^^ ^ 

# ^^ ^ U 1x 1 

# Z3^ " 5! - PROPERT Y ADDRES S 

# : 3 ^ 3 3 BVID/SAID : 3 3 ^^ ^ HOMEOWNER S SIGNATURE : K/^^^w w ^ PRUDEN T REPRESENTATIV ESIGNATURE : Ck^ ^ J<^ ^ She.k<^ r AN Y CONDITION S NEED T O B EAWAR EO FBEFORESHOOTIN G VIDEO : (LE . PETS , NOTIC ENEEDED) :

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 nAntonio , 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 7TECHNOLOGIES; ] 

## ACCES S INFORMATIO NTRACKIN GSHEE T BVID : ?>b&M 3 PROPERT Y ADDRESS : '^^^'b ^ ^ ^ ^ Propert y Owne dBy : (I f ne w propert y owner )

Owner s Phon e No's : Home : Work : Cell : Fax : - Acces s Contractor : AS WPDAME S PEOthe r (Prudent ) DAT E TIM E ACCESSO R CONRAC T DETAI L 

# ^I'^ h ^' ^ 

# uz^^ ^ ^fTwf- ^ •

1 1 ypf f 

# J > •



## Comments :

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 7TECHN09LOGIES » 1 

# Acces s Assessment Form : (Mus t b e complete dfo r ever y property . Informatio nmus t b e obtaine dfro mapropert y wal k thru , no t given b y 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 scrapping ?
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 ? 

# y<A Doe s thi s propert y hav e an y significan t structura l da^mage ?
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 7TECHNOUWIES, ] 

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

yes , describ e locatio no f garage . Doe s thi s propert y hav e aluminu msiding ?
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 propertVvacannb r Ar e ther e an y pet s a t thi s property ?
Ar e ther e an y lo w hangin g powe r lines ?

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)822-968 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 679-657 7TECHNGIJOGIBS ; ] 

## 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 NPROCESS ? 

# (0 0 I FI T IS , GE T ACCES S FRO M AL LREQUIRED 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 7aaijOGiEs.iN C 

## PAIN T MATCHIN GFORM : 1 . T O B EFILLE D OUT ONL Y I FMATCHIN GCOLO R PROPERTY ADDRESS : '^^'^ 5 M 2.^^ ^ S l ^ O vo«K« , W^ BVID ; 33 6 ^ " ^ 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 P\\hr\^r\\\}cx \ y y Soffi t VJOVN\K _ ^ 

### Fascia 

# S ^ \ y Come r Tri m Windo w Trims C^tCW ^ f ft^OLC\^ \ ^ 

### Doo r Trims 

# °f^ ^ < ^\ac\ ^ \ ^ 

### Fron t Porc hCeiling

- 

### Fron t Porc hCeiling Beams r " Fron t Porc hFloo r

- 

### Fron t Porc hRailing s

- 

### Fron t Porc hStep s f^-uy ^ \ ^ 

### Sidin g Baseboards Foundatio n 

## uCrVv AV C WOVN S K _ 

## ^^oy^<i . i^J«'--fi | \ ^ 

### ^JrwjL i 

## L ^ 

# o 4 

# 0 ^ ^T^- V OLA^^ V . 

## JfA ^ imV( ^ \V( L 

# e.'/.\^V{» ^ cj6\ci r ' \f

• I UNDERSTAN D SHERWI NWILLIAMS WIL LMATC H M Y CURREN T COLORS . Homeowne r

signature : >C/y%w ^ d ^ /h(/[A mDate : 6/:2-^/o 9

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 7TECHNOIJOGIBS, ] 

## PRE-STABILIZATIO N PROPERT Y SAFET Y ASSESSMEN T FOR M ADDRESS : U t r e U < f cW . J- x Wrt^ S^ ^ . PROPERT Y BVID/SAID : 2>' b C» ^ 3 PRUDEN T ASSESSMEN T REPERSENTATIVE : 

# eonje^ t (\A<Y ^ REPERSENTATIV EREMARKS/FINDINGS : (POWER-LINEPROXIMIT Y T O PROPERTY , SCAFFOLDING / LADDERS / LIFT S NEEDED , UNSAF EAREAS , UNSAF ENEIGHBORHOOD...ETC. )

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

# Curren t Sampl e Pre-Renovatio n For m Effectiv e unti l Apri l 2010 . Confirmatio n ofReceip t ofLea d Pamphle t ^ 1 hav e receive d a copy ofth e pamphlet . Renovate Right : Importan t Lea d Hazar d / Informatio n fo rFamilies , Chil d Car e Provider s an d School s infomiin g me of th e potentia l ris k of th e lead hazar d exposur e fro m renovatio n activit yto be performe din mydwellin g unit . I receive d thi s pamphlet befor e th e wor k began . ofrecipien t / , ^-- ^ Date Rrinte d d nam

nam e e c Signatur e

ofrecipien t Self-Certificatio n Optio n (fo rtenant-occupie d dwelling s only ) — Ifth 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 boxbelow . •Refusa l to sig n —I certif ythat I hav e mad e a goo d fait h effor t to 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 , to th e renta l dwellin g uni t liste d below at th e dat e an d tim e indicate d an d that th e occupan t refuse d to sig n th e confirmatio n ofreceipt . I furthe rcertif ythat I hav e lef t a copy ofth e pamphlet at th e uni t wit h th e occupant . i^i^navailabl e fo rsignatur e —I certif ythat I hav e mad e a goo d fait h effor t to 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 , to th e renta l dwellin g uni t liste d belowan d that th e occupan t wa s unavailabl e to sig n th e confirmatio nof receipt . I furthe rcertif ythat I hav e lef t a copy ofth e pamphlet at th e uni t byslidin g It unde rth e doo r Printe d nam e ofperso n certifyin g Attempte d deliver y «

f\ dat e an d tim e ^J JtiiJli^ ^

'®^ ^

pamphlet deliver y Signatur e

ofperso n certifyin g lead pamphlet deliver y

Uni t Addres s Not e Regardin g Mailin g Optio n — As an alternative to deliver y

in person , yo u ma ymai l th e lead pamphletto th e owne rand/o rtenant . Pamphlet must be maile d at 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) .

### TKMNOLOGIBS^INC . 

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

# ^^ ^ M • &ti & O t . Crew : Date : Ite m OK ? Hazar d Correctiv e Actio n Overhea dLine s In-transi t Vehicl e Clearanc e Level s aroun dhig hwire s Vehicl e Clearanc e aroun d hig hwire s whe nworkin g Phon e line s Cabl e line s : ^ 

## - (U>y^'W\p^^ ^ ^ ^ ^ZSZ " LOUJO ^ 

## QiH^r^'^ciWd^l ^ Ga s Lin e Wate r Lin e -^=3 ^ 

### Sewe r Lin e Septi c Tan k Propane/Butan e Acces s to/o nPropert y Neighbo r Acces s Require d Hig hTraffic Are a Garag e Structure s UXxuLyyir ^ '/^juckur^ . 

## ^6fy^r4h^^Z Z Driveway 

# ci- ^ Sidewal k Foundatio n Retainin g Wail s Fence s Tree s Foliag e Genera l Conditio no f yar d 

## t.€rtt/w3 ^ :- UL>J-i^J^(jdJA.lyy ^ Damage dAreas : sin k holes/rotte dwoo d ( ^ ^ ^ ^ ^ Sprinkle r Syste m



## Cyfetracto r fficer

808 0 War d Parkw j 250 5 N . 24' " Street , Suit e 30 8 424 2 lltedica l Drive , Suit e 425 0 Kansa s City , Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 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

# :l i ¥/ M

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# y. . ^ijj^ ^Dougla s County Accoun t Informatio n Pag e 1 o f 3 Dougla s County , Nebrask a Propert yRecor d ^ R201361000 0 Prin t Reoor t NE WFeatur e - Parce l Dimension s availabi e & . scai e 0-5 0 ft wes t of 52n d S t - VlO W O H MS P Informatio n i s vali d a s o f2009-9-1 5 Treasurer' s Ta xReoor t Ne wFeatur e • • -* ' ^ Aut o Sale s Searc h Owne r WRIGHTSEL L INVESTMENT S LL C ETA L 1265 7 DEE R CREE KD R OMAH AN E 68142-000 0 Propert yInformatio n Ke yNumber : 1361000 0 2 0 Accoun t Type : Residentia l Parce l Number : 201361000 0 Parce l Address : 393 3 N 2 3 S T OMAH AN E 68110-000 0 Lega l Description : PLAINVtE W LO T1 8 BLOC K3 5 0 X 12 4 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $7,000.0 0 $32,700.0 0 $39,700.0 0 200 8 $7,000.0 0 $32,700.0 0 $39,700.0 0 200 7 $7,000.0 0 $32,700.0 0 $39,700.0 0 200 6 $7,000.0 0 $32,700.0 0 $39,700.0 0 200 5 $7,000.0 0 $12,700.0 0 $19,700.0 0 200 4 $7,000.0 0 $11,500.0 0 $18,500.0 0 Sale s Informatio n Sale s Date : 2006-01-2 3 Dee d Type : QC M Book : 200 6 Page : 00779 6 Price : $0.0 0 Grantor : Latrel l Wrightsel l eta ! Grantee : Wrightsel l Investment s Valid/Invalid : Invali d Exclusio n Reason : Famil ySal e Sale s Date : 2006-01-0 9 Dee d Type : QC M Book : 200 6 Page : 00269 4 Price : $0.0 0 Grantor : Wrightsel l Investment s
http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R201361000 0 9/16/200 9Dougla s Count y Accoun t Informatio n Pag e 2 of 3 Grantee : Latrel l Wrightsel l eta l Valid/Invalid : Invali d Exclusio n Reason : Conrective Dee d Sale s Date : 2006-01-0 6 Dee d Type : QC M Book : 200 6 Page : 00200 4 Price : $0.0 0 Grantor : WRIGHTSEL L INVESTMENT S LL C Grantee : LATREL L WRIGHTEL L ETA L Valid/Invalid : Invali d Exclusio n Reason : Multipl e Owne r- Trad e Sale s Date : 2004-11-1 6 Dee d Type : QC M Book : 200 4 Page : 16076 7 Price : $0.0 0 Grantor : LATREL L WRIGHTSEL L ETA L Grantee : WRIGHTSEL L INVESTMENT S LL C Valid/Invalid : Invali d Exclusio n Reason : Multipl e Parce l Sal e Sale s Date : 2001-01-0 5 Dee d Type : D Book : 217 1 Page : 65 3 Price : $23,000.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 4 6200. 0 1. 0 124. 0 50. 0 N o Improvemen t Informatio n Buildin g 1

http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=R201361000 0 9/16/200 9Dougla s Count y Accoun t Informatio n Pag e 3 of 3 

# i

3«33N23a . o r

CLIC KTO ENLARG E IMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : 936. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Poo r

Buil t As : Ranc h Cond o Squar e Footage : 0. 0

HVAC : Centra l Ai rt o Ai r Rooms : 5. 0 Exterior : Fram e Viny l Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo fType : Gabl e Stories : 1. 0 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 190 4 0 % 190 4 10 5 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fenc e Chai n Lin k 1. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 461. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 480. 0 Porc h En d Scree n 60. 0 Porc h En d Scree n 133. 0

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R201361000 0 9/16/200 9IBS , INC . 

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

## SAID : 336^ 3 Propert yAddress : 3^36 ) ^ J °^ ^ SA Owner' s Name : cA^JtAo/rg j i > ^^vQC^U-^ l

S.N O Performanc e Standards/close-Ou t Criteri a Ye s N O Wa s th e entir e structure(s ) painte d wit h th e exceptio n o fth e stated , ' exclude d areas ? Thi s woul d Includ e paintin g o fothe rassociate d feature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an d exterio rsurface s o fgarages . 

# A 1 2 Wa s al l scrapin g an d othe rpreparatio n wor k complete d i satisfactorily ? 

# n 3 Wer e al l require d area s o fth e structure(s ) prime d a s neede d an d i painte d wit h tw o to p coats ? 

# X 1 4 Ar e al l o fth e area s wher e contaminate d material s hav e bee n spille d thoroughl yvacuumed / cleaned ? 

# X • 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 

### i 

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

# y 1 

### 1 7 Wa s th e pain t product s utilize d equivalen t t o a 3 0 yea r i product/quality ? 

# y 1 | 8 Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , : 

# y cones , barrie rtap e et cproperl yremoved ? : 9 i s ther e an yevidenc e o fpropert 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 ACiose-Ou t 

# X i

, 0 Ar e ther e an ypropert yitem s tha t wer e temporaril yre-locate d b yth e contracto rtha t nee d t o b e move d back ? 

# y 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 ? 

# x \ il 2 Othe rConsiderations ? Propert yOwne rDiscussions ? Additiona l i Wor k tha t i s Require d 1 

# x 4 Pruden t Representativ e Signature : Date : Propert yOwne rSignature : (j^y\/\/ ^ O C

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 San 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 7TBCHKOIXXSIBS ^ IN C 

### EP AClose-Ou t For m (Lead-Base d Pain t Stabilization ) BVID : "^ B ^ ^ ? Propert y Address : 

# u s ^ Owner' s Name : 

# vJAc|li\ket i U o Performanc e Standards/close-Ou t Criteri a 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 , bo x beams , columns , rails , an d exterio rsurface s o f garages . Wa s al l scrapin g an d othe rpreparatio n wor k complete d satisfactorily ? 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 ? 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 ? 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 an d als o remov e an yothe rgenerated.debris ? I s th e gras s are a tha t surround s th e structure(s ) i n reasonabl ygoo d condition ? Wa s th e pain t product s utilize d equivalen t t o a 3 0 yea r product/quality ? Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e et cproperi 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 ACiose-Out . Ar e ther e an ypropert yitem s tha t wer e temporaril yre-locate d b yth e contracto rtha t nee d t o b e move d back ? 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 ? Othe rConsiderations ? Propert yOwne rDiscussions ? Additiona l Wor k tha t i s Require d 

### S.N O 1
2 3 4 5 6 7 8 9 1 0 1 1 1 2 

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### y v

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### y y N O

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### EP ACOR/ Representativ e Signatur e Date : ////^ ^