## TRANSMITTA Lo f OMAHA LEAD SIT E PAIN T STABILIZATIO N FIL EFOLDE R SAID : 1749 5 Date : 12/22/200 8 Address : 230 6 S 3 1 S t Remediatio n Contractor : Pruden t Technologie s Year : 200 8 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S S ^ Vide o o f propert y (DVD ) [ y Executiv e Summar y I FSigne dAcces s Agreemen t fo r subjec t propert y [ y Paintin 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 ffl^ Satisfactor y restoratio n signe db y Propert y Owne r D Propert y close-ou t chec k lis t signe db y EP A WPropert y informatio n fromDougla s Count y Assessor' s Offic e D D D



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4030952 7 

# IMHWH i Superfun dPROPERT Y SUMMAR Y Date : 12/22/0 8 LB PSTABILIZATIO N EP A CONTRA T EP-R7-08-0 7 Mont hof : Decembe r Propert y Address : 230 6 S 3 1 S t SAID : 1749 5 

### A . EXECUTIV ESUMMAR Y A. 1 Issue s Encountered : None A. 2 Issue s Resolved : None

A. 3 Uniqu e Findings : None 122A. 4 Othe r Relevan t Information : None Acces s Date : 11/15/0 8 Wor k Began : 11/18/0 8 Closeou t Date : 12/09/0 8 Enclosures : 1 . Pre-Vide o 2 . Post-Vide o 3 . Propert y Statu s Form 4 . Signe dAcces s Agreemen t 5 . Pre-Renovatio n Form 6 . Pain t Matc hFor m 7 . Trackin g Form 8 . Dougla s County Assessor Propert y Infonnatio n Pag e 9 . EPA Propert y Closeou t for m 10 . Propert y Completio n Agreemen t

TECHNOLOCIES . INC .INVIRONMDirrAL * 

### coNsmucno N TECHNOtOGIES , INC . SIRVICE S 

# Property Statu s For m Addiess : A^C U "3 . 3 1 ' ^ ^ 

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# Phone : 55l>-5<ia / BVID : rWJp G plan t & Permanen t Landscapi«f f T* ^ Pyn^'s^ nI nPlac e Itci&# DesGiiptio o an dLocatio n QnM ^

Pt»Exi8tingCmiditiQnofStnictmB S 

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# ^ ' DJinc^ou J P»u^c^r. ^ C^^rf, ^ Propert y Owoe r Pnideo t Emplo ; Signature : 

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Pniden t Tedmolo^es , Inc . (Prudent ) i s under contract (Contract #EP-R7-08-07 ) wit hth e U . S . Environmenta l Protectio n Agenc y (EPA ) t o stabiliz e Lea dBasedPaint (LBP ) at anuml^o f propertie s locatedin Omaha , Nebraska , includin g tiie propert y locatedatcATSl Q P) . 'b \o^ ' The EP A lequests your permissio n t o allo w Pruden t t o perfor mLB PStabilizatio n a ttiiis propeity . B y sigiun g thi s form, tiie propert y owner grant s pennissio n t o Prudent t o perfor mactivitie s lelabsdt o LB P Stal^lizatio n including sorapin g pain t an dpainting o f tiie referencedproperty . Furtiier , tiie owner/tenan t verifie s tiiattiiey hav e received tiie LB Ppamphle t "Renovat e Right* * If

you hav e an y question s abou t th e LB Pstabilization plannedfo r

your property , pleas e contac t Pnident* s ^ Apif^|HirBt|v e Cler k

for th e Lea dBase dPaint Stabilization , Mrs , Drtwra hAkerde-Johnson . at

(402) 504-1004 . Genera l question s abouttiie OmahaLea dSite cleanup can b e directedt o tiie EP A Ptiblic Infonnatio n Center s at (402 ) 731-304 5 (Soutii Omah aoffice) or (402 ) 991-958 3 (Nort hOmaha office) . 

# 9«^A^ti.M»eA^ . X ^MJiuJ-e ^ T:::edij\Oi ^ (Pleas e Prin t Name ) 

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### ^ ? Pnpd ^ Omc r Sigutue : V (Sigrwtae) ^ "^ ^2 5 PROPERT Y INFORMATION ^ ^ ^OT o b e coaplcte dIq r reffdei t nd/o r propert y wnle r « • RESIOEN TADDRESS : 

# 9^3ry ^ ^ > .^ l ^ c I FRECTAL , PROPERI YOWNE D eV : OWMEffSIIAUNOAODRBSS ; —jl ! OWNBTSTEIBPHON B NUMBE R 

## .HOME: J^E^L^ZZ^WORK : ± , NUMBE R O P OCCUPANT S UNDER 7 YEAR S OLD : NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLPgR : CT ^ NUMBE R OPCHILDRE N UNDB1 7 YEAR S OL D WH O PUA YI N TH E YAR D FO R 6 HOUR S O R MOR E PE R WEEK : _. _ COMMENTSORSPECIALINSTRUCnONS : (L E DOGS , ENTRYOATES , ETC. )

AOIHORTT V FO RENVIRONMBNTALRESPONS B ACTIONS : TTi o »cclvMei»teliiyleiBeiitedt y BP Aunde r tHiegwewantwepgnaB t t o Sccdcii W orCERCU . 4 3 U.S. C 96M . BPA' l risitt o f aeoe nt o th e pnpeit y ispnvide dfb r i nSeetto a104(e ) o f CBRO^ ^ « U.S . C 9^ ^ Ib r

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# Curren t Sampl e Pre-Renovatio n Forn i eitaeslMun n Apri l 2010 . Ouufbiiurtk n ofReceip t ofLaa d Prnphto t Q I hSMrecehw l a cop yd th e penvNet,f?eriovat8R(gfit:lrrqxytan t Lea d Hazar d Mbrnutlb n fb rRvnHas , C/i M Car e ProvfciBr e ar ^ th e poietTtia l tIa Kd tti e lea d hazan j escposui a froni renovaQ(m activit y petlbmie d In nvdvveinn g unit . I rece^«d thi s pvnphle t tie^br e th e vvorf cbegan . Signatur e o(i;^c ^ L/ 8elM#«rtifle8llo n OpOo n (fo rtenant-occupie d dweillng a only) — Ifth a lea d pempHa t wa s delivere d bu t a tenan t Signatur e wa s no t obtainable , yo u ma ychec k th e appropriat e bo xbelQw . Q Ralbaa l to sign— I carw ytha t I hav e mad e a goo d fBWiellbr t to delive rth e peniphlaL/%nn«l e Ab'it'Irrvxiresn t Lee d Hazar d iMbm» ^ CMcf C ^ Aovfcfer e arx yScftoofa , to th e renta l dwellin g uni t lIs M dat e en d tim e Indicate d an d tha t th e occupan t retfuse d to sig n th e confitmatio n ofraceip LI luthe rcertif ytha t I hav e lef t a cop y ofth e pamphle t at th e uni t vvlt h tnaocoupB m Q IJnavrilsbt o ft rsignatui e •- 1 cettfl ytha t t hav e mad e a goo d fait h eflior tto deBvwth e pamphlet , ftanovat e R^t;/mporfan t Lea d Hasn yMl^ ^ Amiss i CfiftyCsr e jsrovMisra arx/ScfxMfe , to t ^ belo wan d tha t ttie occupan t wa s unavailabl e to sig n th e conlimiallo n ofrec^t . I tethercerti ^ tha t I hav e lef t a cop y ofth e pamphle t at th e uni t bysllding^l t unde rth e dootw ^ mnte d nam e ofperso n certifyin g Attempte d deliver deliver y y e an e dat dat e an d d tim

tim e lea d pamphle t delivei y 

## ijzQ/ieiA^ — agnetur e ofperBonoeraiym g lea d pamphle t deliver y, 

# Om,dbka. , A/i ^ UnltAddres s Not e Regardln a Mailin g Optio n •- > As an altemstiv e to deliveryIn person , yo u rns yma l Ih e lea d pamrMe t to th e owne rand/c rtenant . PampMa t mus t be maile d at leas t 7 day s befbr e renovado n (Pocumen t vvit h a certilicat e of m ^ fro m th e postoflio ^

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### Dougla s Count y Accoun t In1|^fiatio n 

## r Dougla s COuniy , nebrask o Propert y llaeor d- R090419000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e O-S O f t wes t o f 90t h S t - Vje W O n Ma p Informatio n i s vali d a s o f 2008-9- 4 Ne wFeatur e 

### Owne r ZADIN AJAMI E R 230 6 S 3 1 S T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : Accoun t Type : Parce l Number : Parce l Address : Lega l Description : Valu e Informatio n i Lan d 200 8 200 7 200 6 200 5 200 4 200 3 Sale s Informatio n Sale s Date : Dee d Type : Price : Grantor : Grantee : Valid/Invalid : Exclusio n Reason : Sale s Date : Dee d Type : Price : 

### Grantor : 041 9 000 0 0 9

[ Residentia l ; 0904190,00 0 • 2306S31s f ; OMAH AN E 68105-000 0 ' • CREIGHTON S 1S TAD D LO T3 BLOC K4 4 7 X 12 0 j Improvemen t $11,300.0 0 j $lT,300.0 0 i $11,300,0 0 1 $11,300.0 0 $11,300.0 0 $11,300.0 0 2003-10-0 6 \

W D * \ $133,500.0 0 | Nanc yADal yeta l

., Jami e R Zadin a • invali d 1994-10-2 0 : D : $64,000.0 0 $135,20b.00 " 3135,200.0 0 $108,700.00 " $ 108,700.0 0 $108,700.0 0 $ 76,400.0 0



### Book : I 200 3 Treasurer' s Ta xRepor t -»-*- > Aut o Sale s Searc h

, Tota l $146,500.0 0 $ 146,500.0 0 $ 120,000.0 0 $ 120,000.0 0 , i

I $120,000.0 0 I $ 87,700.0 0 Page : \ 21485 9

Page : ; 49 5 BooAr: : 199 3

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### mannino-nn1ine.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R09.. . 10/1/200 8

### Dougla s Count y Accoun t In|^|i ; atio n rag e ^ U l -f Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s I Dept h i Widt h Vacan t i • 0.1 2 5640. 0 

### 1. 0 120. 0 47. 0 

### N o Improvemen t Informatio n Buildin g 1

I --.'.VJ ' 'frri^ a 744, 0 SF . Scco M Foa r 7ii.CS F

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.... ) TW O STOR Y Btarr t Hec k 4 fl M 4 0 s r CUCj C T O ENl^RG E liyiAG E CUC KT O ENLARG E IMAG E 

## ._i Squar e Footage : i 1488. 0 Percen t Complete : : 100.0 % Perimete r^ 0. 0 Quality : ' Averag e Uni t Type : I Condition : : Goo d

Buil t As : ! 2 1/ 2 Stor yUnfi n Cond o Squar e Footage : : 0. 0

• 1 HVAC : 1 Centra l Ai rt o Ai r Rooms : ! 8. 0 Exterior : i Fram e Stucc o Units : ; 1 0 Interior : ; Drywal l Baths : , 1. 0 Roo f Cover : ! Compositio n Shingl e Bedrooms : • 4. 0

Roo f Type : j Gabl e Stories : i 2. 5 Floorcover : i Allowanc e Foundation : i Bloci ( JL. . t Sprinlde rSquar e Footage : i 0. 0 yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t I 0 % 190 5 ~10 3 Detai l Typ e : Detai l Descriptio n Unit s Ad d O n ! Fenc e Chai n Lini c 

## i. o Ad d O n i Unfinishe d Atti cW/floo r Applianc e i Allowanc e ]_1. 0 Basemen t ' Bsmn t Bloc k 8 ft 744. 0

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### ianniTia-nnline.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=R09.. . 10/1/200 8 190 5

744. 0

### Douglas county Accoun t l :

n^jm ;atio n rag e J o r

J FiJdur e i Bas e Fixture s Fixtur e BathFul l 1. 0 Garag e 1 Attache d 408. 0 Garag e • Detache d 213. 0 Porc h : Sla b Roo f Cei l i 160. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accomitno=R09.. . 10/1/200 8

## Pruden t Propert y Close-Out For m(Lead-Base dPaint Stabilization ) SAID : n^-f^b ^ Propert y Address : 03<^l f 6 . 3 1 ^ Owner' s Name : ^ lfl/^. 1 f 'Z'fiflit^y 

### Performanc e Standards/close-Ou t Criteri a YE S N O 1 .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 inciudin g fascia , eaves , siding , ai t trim , porches , bo x beams , columns , rails , an d exterio rsurface s o f garages . 

# X 2 .Wa s al l scrapin g an d othe rpreparattio n wor k complete d satisfactorily ? 

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

# y 4 .

Wa s th e pain t product s utilize d equivalen t t o a 3 0 yea rproduct/quality ? 

# y 5 .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 ? 6 .Di d th e contracto rcollect/vacuu m ai l fallin g an d scrape d pain t chip s o n th e entir e property , roacways , alleyways , publi cacces s area s an d als o remov e an yothe rgenerate d debris ? 

# X 7 .I s th e gras s are a tha t surround s th e structure(s ) i n reasonabl ygoo d condition ? 

# y 8 .Ar e al l item s suc h a s polyethylen e sheeting , iadders , pain t brushes , cones , barrie rtap e etc . properl yremoved ? 

# X 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 th e EP AClose-Out . 

# y 10 . Ar e ther e an ypropert yitem s tha t wer e temporatii yre-locate d b yth e contracto r

tha t nee d t o b e hiove d back ? 

### i ; 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 ? 

# t

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

## Pruden t Representativ e Signature : |( ^ 

# Dat e i^'^ Pry ^ ; ^ Propert y Owne r

Signauire : ^(i^Mf y V