### TRANSMITTA L of OMAHA LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R
SAI D # : ;pgt^ ^ Date : (=^j^ l -5<b/ n Address : j^f^- ? Mir-rr ^ /i v . Stabilizatio n Contractor : Pruden t Technologies , Inc
. Year : 2010
_ PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S IS ^ Vide o ofpropert y (DVD ) 0 ^ Executiv e Stimmar y mSigne dAcces s Agreemen t for subjec t propert y M Pre-Renovatio n For msigne db y Propert y Owne r D Pre-Renovatio n For mfor Occupant/Tenant , i f applicabl e S

l Paintin g Agreemen t D Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) y Renovatio n Recordkeepin g Checklis t signe db y Certifie dRenovato r y Photograph s M Satisfactory close-ou t chec k lis t signe db y Property Owne r y Property close-ou t chec k lis t signe db y EP A y Property informatio n fromDougla s County Assessor' s Offic e y Hazar danalysis , i f prepare d 3026004 5 D Safet y Audit 

# HW i D Othe r (describe) : Superfun d

Pruden t Technology , Inc
. Signatur e ' Dat e
P A CORSignatur e ^Daf e (after file folde r review )TECHNOLOGIES, ] 

## Propert y Summar y Date : 6/24/201 0 LB P STABILIZATIO N EP A CONTRAC T EP-R7-08-0 7 Mont h of : Jun e Propert y Address ; 164 7 Victo r Av
. SAI D # : 2815 5

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 : 04/01/2010 ii
. Wor k Began ; 04/17/2010 iii
. Close-Ou t Date : 04/19/201 0 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 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 h For m 10
. Pre-Stabilizatio n Propert y Safet y 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 n Agreemen t For m 15
. Propert y Close-Ou t Chec k Lis t Signe dB y EP A% 

# .Jpff l ia£S5!^lNe r 

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

conti-ac t (Contrac t #EP-R7-08-07 ) wit h th e U. S. Envirormienta l Protectio n Agency (EPA) to stabiliz e Lea dBasedPain t (LBP) at anumbe r

ofpropcrtie s locate d in Omaha , Nebraska , including th e propert y locate dat : 

# j.^^ ^

y/cn:¥e znz . The EP A request s you r

permissio n to allo w Pruden t to perfor mLB P Stabilizatio n at thi s property . By signing thi s form , th e propert y owne r

grant s permissio n to Pruden t to perfor mactivitie s relate d to LB P Stabilizatio n including scraping paint an dpaintin g ofth e referencedproperty . Further , th e owner/tenan t verifie s tha t they hav e receivedth e LB P pamphle t "Renovat e Right. " By signing thi s documen t I agre e to allo w an EP A contractor to conduct asoil cleanu pat my propert y following completio n of lead-base dpaint stabilization , ifth e soil cleanu p ha s not aheady been performed
. I understandtha t th e stabilizatio n contractor canno t provide assurance s of which contractor will be boim d

to th e soil cleanup
. I furthe r

understandtha t th e soi l cleanu p contractor will mak e all reasonabl e efforts to addres s concem s tha t I, as th e propert y owner , ma y hav e regarding soil cleanu p

at my property . (V ] Yes , I hav e rea dandimderstandthe paragraph above
. 

# -^-l-i o Proper t j/Owner s Signatur e Dat e Ifyo u hav e an y question s abou t th e LB P stabilizatio n planne dfo r

you r

property , pleas e contac t Prudent' s Custome r

Relations/Offic e Manage r

fo r

th e Lea dBasedPain t Stabilization , Mr
. Chandr a Shekar at 402

- 504-1004 or 402-889-3821
. Genera l question s abou t th e OmahaLea dSit e cleanu p ca n be directe d to th e EP A Publi c hiformation Center s at (402 ) 731-304 5 (Sout h Omahaofifice ) or (402 ) 991-958 3 (Nort h Omahaofifice)
. Propert v Acces s Grante dBy :



# • s^'e-y-z-Zt D Propertj^wnqir s Signatur e Dat e

Pleas e Prin in

t t Nam e /

808 0 War d Paricway , Suit e 40 5 250 5 N. 24* ^ Street , Suit e 30 8 424 2 Medica i Drive , Suit e 425 0 Kansa s City , MO 6411 4 Omaha , Nebrasic a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phona : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7%
TBCHNOLOCIBS
. IN€r ~ 

### PROPERT Y INFORMATIO N (T o b e complete db y residen t and/o r property , owne r ~ pleas e print ) RESIDEN T NAME : 

## K^ Y Lzyir j As^eM ) Tenan t RESIDEN T ADDRES S 

# : /^^ 7 //c:// ^ Ji/ ^

IFRENTAL , PROPERT Y OWNE D BY : /l^ / ^y?y j /k^/^Z/ l OWNER' S MAILING ADDRESS : [s^ f /Z
. 3^Sr ~
OWNER' S TELEPHON E NUMBER : Home : ({Z)l^€hl,^fi ] Work : ¥6 ^ ^l^^9/j 6 Cell : NUMBE RO FOCCUPANT S UNDE R7 YEAR S OLD : TOTA L NUMBE RO FOCCtJPANTS : NUMBE RO FCHILDRE N UNDE R7 YEAR S OL D WH O PLA Y I N TH E YAR D FOR5 HOUR S O

RMOR E PE RWEEK : _ ^ COMMENT S O RSFECIA L INSTRUCTION S (suc h a s does , entr v gates , etc.) ;

AUTHORIT Y FORENVIRONMENTA L RESPONS E ACTIONS : Th e activitie s t o b e implemented by EP A unde r

thi s agreemen t ar e pursuan t to Section 10 4 o f CERCLA , 4 2 U.S.C
. 9604
. EPA' s righ t of

acces s t o th e propert y i s provide dfo r

in Section 104(e) of CERCLA , 4 2 U.S
. C 9605(e) , which provide s entr y fo r

"determinin g th e needfo r

response , or choosing or takin g an y respons e actio n unde r thi s title , or otherwis e enforcing the provision s ofth e title. " Propert y Owne r

Signature : (Signagjte ) ( Z 

# /2^jr "/-h/C s Dat e 808 0 War d Paricway , Suit e 40 5 250 5 N
. 24' " Street , Suit e 30 8 424 2 Medica i 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% TECHNOLOClBSklNC
. 

### PR E & POST PAIN T STABILIZATIO N VIDE O AN D PICTURE S I understan d tha t pruden t Technologie s (Prudent ) wil l b e comin g ou t t o shoot a Pre Stabilizatio n vide o an d t o take picture s o f m yproperty
. Pruden t wil l us e th e video s an d picture s t o documen t th e curren t propert ystatus/condition
. Also , Pruden t wil l shoo t a vide o sho t followin g th e completio n ofth e pain t stabilization , i give permissio n t o video s an d picture s o f m yproperty
. Pleas e lis t an yspecia l condition s tha t Pruden t employee s nee d t o b e awar e o f befor e shootin g a vide o (suc h a s pets , prio r notice , etc.)
. 

# MV 7 

# /y-/ ^ Propert yAddres s Owner' s Name ' Signature / / yDat e 

### ADVANC E NOTIC E REQUIREMEN T Afte rsignin g th e acces s yo u allo w Pruden t t o begi n Lead Base d Pain t Stabilization
. Al l Plants , weed s an d an yvehicle s o ritem s o n ope n porc h (enclose d porche s wil l NO T b e stabilized ) must b e remove d prio rt o stabilization
. Al l Pets must b e ou t o f yard durin g stabilization
. Pleas e indicat e below ho w muc h advanc e notic e yo u nee d t o have th e above mentione d tasks completed
. I f yo u are a landlor d yo u wil l nee d t o contac t th e tenan t a s Pruden t wil l onl yinfor m th e propert yowners . D o yo u have an ypet s tha t resid e i n yard : " ^

/VC Z Notic e needed : 

# : ^ Z2>4 Z Phon e numbe rt o cal l t o give notice : TO ^

QC/ ^

^7A ^ Who m w e are givin g notic e to : /% ^

808 0 War d Parkway , Suit e 40 5 250 5 N
. 24" * Street , Suit e 30 8 424 2 Medica i Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrasic 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 7I 

# Curren t Sampl e Pre-Renovatio n For m Effectiv e unti l Apri l 2010
. Confirmatio n of Receip t of Lea d Pamphle t V I hav e receive d a cop y of th e pamphlet , Renovate Right : Importan t Lea d Hazar d infomnatio n fb rFamilies , Chil d Car e Provider s an d School s informin g me of th e potentia l ris k of th e lead hazar d exposur e fro m renovatio n activit y to be performe d in mydwellin g unit
. I receive d thi s pamphlet befor e th e wor k began
.

o of redlpient ' Date Printe d nam e recipien t 7 / 

## y Z Signatur e of recipien t Self-Certificatio n Optio n (fo rtenant-occupie d dwelling s oniy ) — If th e lea d 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
. Q 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 Infomnatio 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 tha t th e occupan t refuse d to sig n th e confinnatlo n of receipt , I furthe rcertif ytha t I hav e lef t a cop y of th e pamphlet at th e uni t wit h th e occupant , Q Unavailabl 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 Lead'Hazard infonmatio n fo r Families , Chil d Car e providers an d Schools , to th e renta l dwellin g uni t liste d belo w an d tha t th e occupan t wa s unavailabl e to sig n th e confirmatio n of receipt
. I furthe rcertif ytha t I hav e lef t a cop y of th e pamphlet at th e uni t byslidin g It unde rth e door
. 

# K± Z//i n Zl-sk&f,- ) Printe d nam e o o f

f p<

perso n dertlfyin g Attempte d deliver y dat e an d tim e lead pamphlet deliver y 

# £^e£u r Signatur eof pdreo n certifyin g lea d pamphlet deliver y 

# fZ^C/ n iZ/cZzTy ^ A/
. 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 lea d pamphlet to th e owne rand/o rtenant
. Pamphle t must be maile d at least 7 days befor e renovatio n (Documen t wit h a certificat eof mailin g fro m th e pos t office)
.% 2
.T O B E FILLE D OU T ONL Y I FCHANGIN G COLO R PROPERT Y ADDRES S 

# : I0(Z1 lIcLr^ v BVID ; Pam t Pain t Locatio n Pain t Descriptio n Yes N o Siding 

### y' A^S-ft i CC^
. Soffi t 

### A^i; ^ Ay///y^ ^ 

# y Fasci a 

# ^/y/z/ y y Come r Tri m \ y ^ Window Trim s 

# y Doo r Trim s 

# Mi k ^ y Fron t Porc h Ceilin g 

# WK A

^£ x \ y Fron t Porc h Ceiling Beam s 

# y Fron t Porc h Floor 

# y Fron t Porc h Railing s 

### u ^ wot - p<?v*ryHc < Fron t Porc h Step s 

### y ^ Siding Baseboard s 

# r'^ y forj" ^ i^ixf^z,': ? {

- y Foundation y ^ 

# SiX > (r,^^r Z><)S//ia s &7Ci>(y i 

### su ) (z^^^S Z — CoS/HS ^ 

# \ y 

# W ^ ^IA ) (p5 ^ ^C6Siyr) S X^a.c\< - (pg>rg A S^a-tt^t
. A S F —(pg>rr K y ^

•I AGRE E T O TH E COLOR S INDICATE D ABOVE
. I UNDERSTAN T THA T I CANNO T CHANG E TH E SELEaE D COLOR S LATE R O N A S PRUDEN T WOUL D HAV E PURCHASE D TH E PAIN T SPECIFICALL Y FO R TH E REFERENCE D PROPERTY
. ALS O I UNDERSTAN D THA T COLOR S SELECTE D MA Y NO T LOO KEXAaL Y A S I T I S SHOW N O N SWATCHE S AFTE R PAINTIN G O N M Y PROPERTY
.
Homeowne r signatur e 

# : imx L iZiMijr \

(ly?,ji ri>.t. : 3-^-/-Z 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 7

### ACCES S ASSESSMEN T FORM : \(^L( 1 H \ I s th e propert ystucc o o rasbestos ? I f yes , i s an yo f th e stucc o o rasbesto s damage d o 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 d t o EP A an d the ywil l assig n a t a late rdate
. Doe s thi s propert yrequir e lot s o f scrapping ? Doe s thi s propert yrequir e a lif t o rscaffoldin g t o reac h uppe rlevels ? Doe s thi s propert yhav e lot s o f plant s o ritem s i n area s wher e paintin g i s required ? Doe s thi s propert yhav e an ysignifican t structura l damage ? I f yes , EXPLAIN ? Doe s thi s propert yhav e a garage ? I f yes , describ e locatio n o f garage . Doe s thi s propert yhav e aluminu m siding ? I f yes , i s i t origina l factor yfinis h o rha s i t bee n painte d over ? Doe s thi s propert yhav e an yothe rtyp e o f structura l components ? (I.e
. roo f shingle s a s siding) ? Ifyes , EXPLAIN ? I s thi s propert yvacan t o roccupied ? Ar e ther e an ypet s a t thi s property ? Ar e ther e an ylo w hangin g powe rlines ? D o w e nee d neighbor' s access ? I f ye s pleas e explai n an d ge t neighbor' s propert yaddres s an d owne r Information
. I f possible , ge t signatur e fro m th e neighbor
.

808 0 War d Parkway , Suit e 40 5 2505 N
. 24* ^

Street , Suit e 30 8 Kansa s City , M O 6411 4 Omaha , Nebraska 6811 0 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 % 

### C^ C P^ ^ 

# SUrcc p r^? ^ n< y 

# •k ^ 1

> J < ^ 

## y^c ^ 

# y 4 a -Y^ O 

# > S --J^^-^Co X \ i c 

# ( D X o /<' $



# ^ i ,

4242 Medica l Drive , Suit e 425 0 Sa n Antonio , T X 7822 9 Phone : (210)822-958 8 Fax : (210 ) 579457 7• TBCHNOLOGIES. 1 

# ACCES S INFORMATIO NTRACKIN G SHEE T PROPERT Y ADDRESS : ^^^' Z y^C^'^^Z t yny 

## BVID : Propert y Owne dBy : (I f new propert y owner )

Owner s Phon e No's : Home : Work : Cell : - - Fax : - Acces s Contractor : AS W PD A ME S P E Othe r (Prudent )
DAT E TIM E ACCESSO R CONRAC T DETAI L 

## 4-'yfr j .</^A ^ 

## Z"^^ ^ '



### Comments :

808 0 Ward Parkway , Suit e 40 5 250 5 N
. 24* ^

Street , Suit e 30 8 4242 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 Fax:(816)363-370 7 Phone : (402)504-100 4 Fax : (402)504-100 5 Phone : (210)822-958 8 Fax : (210 ) 579-657 7(effectiv e April 2010 ) % 

### RENOVATIO N RECORDKEEPIN G CHECKLIS T
irm:fe^f^nf D S?^< ^ (C ^ UW< ^ Dat e an dLocatio n of Renovation : ^r t Hu-Jl^yi Q Brief Descriptio n o f Renovation : ^C^Crx^Q ^ \'^\v(\l\ H (Jts ^ ^\J^,^A^nf\ A Nam e o f Assigne dRenovator : yj^^dir Q<if^J) ^ Name(s ) of Traine dWorkers : ^^ ^ ^li^e^l^iyXi ^ 9iv?JSF)^UJ' ^ ^PQ|tVwVA^gv>p i vkp>AJflp ^ Nam e o f Dus t Sampling Technician , Inspector , and/or Ris k Assessor , i f used : Nam e o f Fir m

Z

^ Copie s o f renovator anddus t sampling technicia n qualification s (trainin g certificates , certifications ) on file
. j3 ' Certifiedrenovator provide dtrainin g t o v*rorker s on (check all that apply) : ^Postin g waming sign s ^[Zaettin g u p plasti c containmen t barrier s ^Maintainin g contairmien t - ^ / D Avoiding sprea dofdus t t o adjacen t area s Z

l Wast e handling B' Post-renovatio n cleanin g JH ' Tes t kit s use dby certifiedrenovator t o determine whethe r

lea dwa s present on component s affecte dby renovatio n (identif y kit s usedan ddescrib e sampling location s andresults : ^

\ ^ 

### 0 ^ Waming sign s poste da t entranc e t o wor k

area . ^ Wor k

are acontaine dto preven t sprea dofdus t an ddebris
. JS'Window s i n an dwithin 20 fee t ofth e wor k

are aar e closed ca'Doors i n an dwithin 20 fee t ofth e wor k

area s ar e closedandseale d [i

f

Door s tha t mus t b e use di n th e wor k

are aar e coveredt o allo w passag e but preven t sprea dofdust
. B^Groun dcoveredb y plasti c sheeting extending 1 0 fee t firomwor k

are a- plasti c anchoredto the buildin g an dweighteddown by heavy objects
. [yl f necessary , vertica l containmen t installe dto preven t migratio n ofdus t anddebri s t o adjacen t property . D Wast e containe don-sit e andwhil e bein g transporte doff-site
.

Renovatio n Recordkeepin g Checklis t Omah a Lea d Sit e(effective April 2010) % 

### S'wor k sit e properly cleane dafte r

renovation
. yAl l chip s anddebri s picke dup , protectiv e sheeting misted , folde ddirt y side inward , an dtapedfo r removal
. D Wor k

are aHEP A vacuimiedt o get paint chip s fro mgroundsurface , i f necessary . B ^ Certifiedrenovator performedpost-renovatio n cleanin g verification (describ e results) : Vt^'>\tC^^ 6 

### [p I certif y unde r

penalt y o f

la w tha t th e abov e informatio n i s tru e an dcomplete
.

Nam e an dTitl e Dat e

Renovatio n Recordkeepin g Checklis t Omah a Lea d Sit eTECHNOiLOGIlSi , IN C 

## Checklis t fo r th e Worksit e Hazar dAnalysi s Address : /^^ P .Izi^Cl^-^^ r nrW 

## Crew: ^ C hJ^ ^ Date:_yrv2rZ ^ Ite m OK ? Hazar d Correctiv e Actio n Overhea dLine s In-transi t Vehicl e Clearanc e 

### ~y ^ Level s aroun dhig h wire s Vehicl e Clearanc e aroun d hig h wire s whe n workin g Phon e line s Cabl e line s Gas Lin e 

# z : Wate r Lin e Sewer Lin e Septi c Tan k ~ ^ Propane/Butan e Acces s to/o n Propert y Neighbo r Acces s Require d Hig h Traffi c Are a Garag e 

## 's>i J Avf^ y /i<t^7^* ^ al /

t^y-^t-*^ y structure s Drivewa y Sidewalk Foundatio n Retainin g Wal b 

## l y l y ~i y ^ ^ 

### C£>/> i 

## my j 

# ^I^^^?A^L : Fence s Tree s 

## ~y \ Foliag e Genera l Conditio n o f yar d ^ Damage dAreas : sin k holes/rotte dwoo d Sprinkle r System Pet s Insect s Weathe r Condition s Unsaf e drivin g condition s Unsaf e neiglfcorhoo d
Crew F Subcontracto r

808 0 Ward Pa i 250 5 N
. 24 ^ Street , Suit s 308 4242 Medica l Drive , Suit e i Kansa s CityJM O 64)1 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-37 1 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

# ^ p ^MMH I
t% ENVIRONMENTA L & CONSTRUCTIO N TECHNOLOGIES , EVC
. SERVICE S 

### OMAH A LEA D BASE D PAIN T REMEDIATIO N Propert y Owne r Close-Ou t For m 201 0 (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-07 ) SAID : 

### oi^Sl^g " Property Address : lA^- i \i\^-rr^Ay l Owner' s Name : 

## |<A y fcyW/kfcg w Performanc e Standards/Close-Ou t Criteri a YE S N O 1
. Wa s th e entir e structure(s ) painte dwit h th e exceptio n ofth e stated , exclude dareas ? Thi s woul dinclud e paintin g o f odie r associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an dexterio r surface s o f garages . 2
. Wa s all scrapin g an dothe r preparatio n work complete dsatisfactorily ? ^ - ^ 3
. Wer e al l require darea s ofth e structure(s ) prime da s neede dan dpainte dwit h tw o to p coats ? 

## , y 4
. Wa s th e pain t product s utilize dequivalen t t o a2 5 year product/quality ?
.. ^ 5
. Ar e al l ofth e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y vacuumed/ cleaned ? y ^ 6
. Di dth e contracto r collect/vacuu mall fallin g an dscrape dpain t chip s o n th e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y othe r generate ddebris ? 

## y 7
. I s di e grass are atha t surroimd s th e structure(s ) i n reasonabl y goo dcondition ? 

## y 8
. Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . y properl y removed ? 9
. I s ther e an y evidenc e ofpropert y damag e tha t wa s don e b y th e contractor ? An y propert y 

## y damag e need s t o b e complete dprio r t o th e EP A Close-Out
. 10
. Ar e yo u satisfie dwit h th e work performed ? y 11
. Ar e ther e an y propert y item s tha t wer e temporarily re-locate db y th e contractor tha t nee d 

### y t o b e move dback ? 12
. Ar e ther e an y (known ) lingerin g issue s with th e propert y owner(s ) tha t hav e bee n lef t 

## y imresolved ? Othe r Considerations/Propert y Owne r Discussions/Additiona l Work tha t i s Required :



# z ^ y ^z-2^ja^ , f - 4^-/f ~ / Q Proper^Owne r Signatur e Dat e Pruden t TScJmologies , Inc
. Signatur e Dat e
808 0 War d Parkway , Suit e 40 5 2505 N
. 24" * Street , Suit e 21 8 4242 Medica i Drive , Suit e 425 0 Kansa s City , M O 8411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 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 ) 579-6577ENVIRONMENTA L & CONSTRUCTIO N 

# UMJ E TECHNOLOGIES , INC
. SERVICE S 

### OMAH A LEA D BASE D PAIN T REMEDIATIO N 201 0 (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-07 ) 

### EP A Close-Ou t For m SAID : ^S m Property Address : 

# (i^/l i \f:J ^ Av/ ' Owner' s Name : 

### Performanc e Standards/Close-Ou t Criteri a YE S N O 1
. Was th e entir e structure(s ) painte dwit h the exceptio n ofth e stated , exchided areas ? Thi s woul dinclude paintin g of othe r

associate dfeature s including fascia , 

### y eaves , siding , all trim , porches , bo x beams , columns , rails , an dexterior surface s o f garages . 2
. Wa s all scraping an dothe r

preparatio n wor k

completedsatisfactorily ? 

### y 3
. Wer e all require darea s ofth e structure(s ) primeda s neededan dpainte dwit h tw o to p coats ? y 

### 4
. Was th e paint product s utilize dequivalen t to a2 5 yea r

product/quality ? y 

### 5
. Ar e all ofth e area s wher e contaminate dmaterial s hav e been spille dthoroughly y vacuumed / cleaned ? 6
. Di dth e contractor collect/vacuumall falling andscrapedpaint chip s on the entir e property , roadways , alleyways , publi c acces s area s andals o remove an y y 

### othe r

generate ddebris ? 7
. I s th e gras s are atha t surround s the structure(s ) i n reasonably goodcondition ? y 8
. Ar e all item s such a s polyethylene sheeting , ladders , paint brushes , cones , y 

### barrie r

tape , etc . properly removed ? 9
. I s ther e an y evidenc e ofpropert y damag e tha t wa s done by the contractor ? An y y 

### propert y damag e need s to b e completedprior to th e EP A Close-Out
. 10
. Ha s th e Propert y Owne r

signedthe completio n form ?
• - ^ 

### 11
. Ar e ther e an y propert y item s tha t wer e temporarily re-locate dby th e contractor • ^ 

### tha t needto b e movedback ? 12
. Ar e ther e an y (known) lingerin g issue s wit h th e propert y owner(s ) tha t hav e y 

### been lef t unresolved ? Othe r

Considerations/Propert y Owne r

Discussions/Additiona l Wor k

tha t i s Required :

^ 1EP A CO RSignatur e

808 0 War d Parkway , Suit e 40 5 250 5 N
. 24' " Street , Suit e 21 8 424 2 Medica i 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 7Douglas Count y Accoun t Info i inj^o n Pag e 1 of 3 \ Dougla s County , Nebrask a Propert yRecor d - R240194000 0 Prin t Reoor t NE W Featur e - Parce l Dimension s availabl e i B scal e 0-5 0 ft wes t o f 52n d S t - Vie w Of l Ma o Informatio n i s vali d a s o f 2010-3-1 6 Treasurer' s Ta xRepor t Ne w Featur e - > * > « > Aut o Sale s Searc h Owne r ASKE W KA Y L ^ , >:^o | 6509N36S T Wo 3 - ol\ ^ ' *\n \ b OMAH A N E 68112-000 0 ^ " ^ Propert yInformatio n Ke yNumbe r 019 4 000 0 2 4 Accoun t Type : Residentia l Parce l Number : 240194000 0 Parce l Address : 164 7 VICTO R A V OMAH A N E 68110-000 0 Lega l Description : VICTO R PLAC E LO T 3 8 BLOC K0 4 0 X 8 5 Valu e Informatio n Lan d //nprovemen f Tota l 200 9 $1,900.0 0 $6,200.0 0 $8,100.0 0 200 8 $1,900.0 0 $6,200.0 0 $8,100.0 0 200 7 $1,900.0 0 $7,700.0 0 $9,600.0 0 200 6 $1,900.0 0 $7,700.0 0 $9,600.0 0 200 5 $1,900.0 0 $7,700.0 0 $9,600.0 0 200 4 $1,900.0 0 $6,400.0 0 $8,300.0 0 Sale s Informatio n Sale s Date : 2008-02-1 1 Dee d Type : QC M Sooi^ : 200 8 Page : 01288 6 Price : $0.0 0 Grantor : FERGUSO N JAY A Grantee : ASKE W KAY L Valid/Invalid : Invali d Exclusio n Reason : Multipl e Parce l Sal e Sale s Date : 2007-08-1 3 Dee d Type : QC M BooAr : 200 7 Page : 09230 7 Price : $0.0 0 Grantor : PRIE D MICHAE L J R
http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2401940000 3/23/201 0Dougla s Count y Accoun t Inf on^^o n Pag e 2 of 3 % Grantee : RRIE D MICHAE L J R Valid/Invalid : Exclusio n Reason : Invali d Multipl e Parce l Sal e Sale s Date : Dee d Type : Price : Grantor : Grantee : Valid/Invalid : Exclusio n Reason : 2003-06-0 4 W

D $10,000.0 0 WALLY D ORTI Z KA Y LYN N ASKE W Vali d Book : 200 3 Page : 10652 7

Lan d Informatio n Acre s 0.0 7 S F 3440. 0 Unit s 1. 0 Dept h 86. 0 Widt h 40. 0 Vacan t N o Improvemen t Buildin g 1 Informatio n

n< r » M 1 4 *
L • 164 7 Victo rAv e

j w *u t

wflto n 1 1/ 2 Stor yUnft n •aaagBcKo n ttooa q R

CLIC KT O ENUVRG E IMAG E Squar e Footage : Perimete r Uni t Type :

Buil t As :

HVAC : Exterior : Interior : Roo f Cover :

Roo f Type : Floorcover : 978. 0 0. 0 Ranc h Force d Ai r Fram e Stucc o Drywal l Compositio n Shingl e Gabl e Allowanc e Percen t Complete : Quality : Condition : Cond o Squar e Footage : Rooms :

Units : Baths : Bedrooms : Stories : Foundation : Sprinide rSquar e Footage : 100.0 % Fai r Averag e 0. 0 5. 0 1. 0 1. 0 2. 0 1. 0 Bloc k 0. 0 http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R240194000 0 3/23/201 0Douglas Count y Accoun t Info i irn^io n Pag e 3 of3 % Yea rBuil t 191 7 Detai l Typ e Applianc e Applianc e Basemen t Fixtur e Fixtur e Fixtur e Garag e Porc h Porc h Use r Yea r Remodele d 0 Percen t Remodele d 0 % Detai l Descriptio n Allowanc e Fireplac e Masonr y Bsmn t Bloc k 8 f t Additiona l Fixture s Bas e Fixture s Bat h Ful l Detache d En d Scree n Sla b w/Step s Need s ne w roo f Adjuste d Yea r Physica l Ag e Buil t 191 7 9 3 Unit s 1. 0 1. 0 978. 0 1. 0 1. 0 1. 0 160. 0 192. 0 20. 0

1. 0

http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R2401940000 3/23/201 0% ENVIRONMENTAL * CONSTRUCTIO N TECHNOLOGIES , INC
. SERVICE S Marc h 25 , 201 0 Ka yAske w 650 9 N 3 6 S t Omaha , N E 6811 2 Re : 164 7 Victori a Ave , Omaha , NE
. Dea rKa yAskew : Pruden t Technologie s Inc
. (Prudent) , i s unde rContrac t wit h th e U S Environmenta l Protectio n Agenc y(EPA) , Contrac t # EP-R7-08-07 , t o conduc t Lea d Base d Pain t (LBP ) Stabilizatio n a t u p t o 200 0 propertie s i n Omaha , Nebraska
. EP A ha s teste d th e exterio r pain t o f you rpropert yan d ha s identifie d i t a s containin g LBP
. EP A ha s assigne d u s you rpropert yt o conduc t LB P Stabilization
. Th e stabilizatio n activit yinclude s scrapin g loos e an d peelin g paint , applyin g a coa t o f prime ran d paintin g th e exterio ro f th e hous e wit h late xpaint
. EP A ha s specifie d a veryhig h qualit yo f paint
. Th e pain t specifie d come s wit h a manufacturer' s warrant yo f 2 5 years . Mos t importantly
. EP A pay s fo ral l th e cost s associate d wit h pain t stabilization
. Tha t mean s ther e i s n o charg e t o you , a s a homeowner
. W e nee d you rpermissio n t o acces s you rpropert yt o complet e th e LB P Stabilization
. Therefore , pleas e dro p b you roffic e betwee n 9:3 0 A M an d 5:0 0 P M t o sig n th e acces s agreements
. Ou roffic e i s locate d i n Omah a Smal l Busines s Networ k (OSBN ) a t th e 4 t h intersectio n o f 24' " & Lak e Stree t i n Omaha , NE
. Ou roffic e addres s is : 250 5 N 24' " St , Suit e 308 , Omaha
. N E 68110
. I f yo u hav e an yquestion s pleas e fee l fre e t o cal l Mr
. Chandr a Sheka ra t 402-889-382 1 o rcal l EP A Publi c Informatio n Cente ra t 402-991-9583
. Yo u ca n als o visi t th e EP A websit e www.epa.qoy/lead/pubs/leadinfo.ht m fo radditiona l information
. Sincerely , ^^k ^ Mr
. Chandr a Shekar , P.E
. Projec t Manage r Cell : 402-889-382 1 

### Email : cshekar(S)pru(Jentweb.co m
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 725 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 7