TRANSMITTAL OF OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: 3ftqi5 _ Date: &)u|i)flfl^ 

Address: SlU]-^ kj^t^yiA-M /^M 

LBP Stabilization Contractor: PRUDENT TECHNOLOGIES, INC. Year: 2009 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

y Videoof property (DVD): Pre-Stabilization & Post-Stabilization Videos 

IZ Executive Summary 

M Signed Access Agreement Form 

A Advance Notice Form 

Pre-Stabilization Video Agreement Form 

s/ Access Tracking Form 

s7 Property Access Assessment Form 

S/ Neighbor Access Agreement Form 

A Paint Match Form 

•iZ Pre-Stabilization Property Safety Assessment Form 

1/ Work-Site Hazards Analysis Checklist 

5/ Photographs: Pre-Stahilization Propertv Hazard Assessment Photographs 

^ Douglas County Assessor Property information 

M Property Completion Agreement Form Signed by Property Owner 

D Property Close-Out Check List Signed By EPA 

Prudent Technologies, Inc. Signature Date 

i//LA,^:UU£JLa^ M^7 p 

Ignature ' Date 

30054703 

inim 

Superfund 
1ECHNOLOGIBS, INC 

Property Summary 

Date: 8/^</2009 LBP STABILIZATION EPA CONTRACT EP-R7-08-07 | Month of; Aug. 

Property Address; 2415 Kansas Av SAID #: 38912 

A. Executive Summarv: 

a. Issues Encountered: NONE 

b. Issues Resolved: NONE 

c. Unique Findings; NONE 

d. Other Relevant Information; 

i. Access Date; 7/16/2009 

ii. Work Began; 7/24/2009 

iii. Close-Out Date; 7/27/2009 

B. Enclosures; 

1. Pre-Stabilization Video 

2. Post-Stabilization Video 

3. Signed Access Agreement Form 

4. Advance-Notice Form 

5. Pre-Stabilization Video Agreement Form 

6. Access Tracking Form 

7. Property Access Assessment Form 

8. Neighbor Access Agreement Form 

9. Property Paint Match Form 

10. Pre-Stabilization Property Safety Assessment Form 

11. Work-Site Hazards Analysis Checklist 

12. Pre- Stabilization Property Hazard Assessment Photographs 

13. Douglas County Assessor Property Information 

14. Signed Property Completion Agreement Form 

15. Property Close-Out Check List Signed By EPA 
"^ y •" 

77 

id 7 

TECHNOIOCmS. INC. 

PROPERTY INFORMATION 

(To be completed by resident and/or property owner — please print) 

RESIDENT NAME: ^wnep / Renter 

RESIDENT ADDRESS: 

:^'-\\y^,^^^cK£ 'W ^ 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

OWNER'S TELEPHONE NUMBER - HOME: l^ ? ) 7OO-2i^£> \ WORK: _J \ 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: ^ NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER: 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHOM PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: 

/ 

COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS, ENTRY GATES, ETC.) 

— ^ t/^.s— 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be implemented by EPA under this agreement are 

pursuant to Section 104 of CERCLA, 42 U.S.C. 9604. EPA's right of access to the property is provided for in Section 104(e) of CERCLA, 

42 U.S. C 9605(e), which provides entry for "determining the need for response, or choosing or taking any response action under this title, or 

otherwise enforcing the provisions ofthe title." 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone:(816)363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax:(816)363-3707 Fax: (402)504-1005 Fax:(210)579-6577 
7:«A'-i.-*i* :ti;i^ V^ "-^j:.. ' 

-HBCHNOIXXSIBS. IN C 

Prudent Technologies, Inc. (Prudent) is under contract (Contract # EP-R7-08-07) witii the U. S. Environmental Protection 

Agency (EPA) to stabilize Lead Based Paint (LBP) at a number of properties located in Omaha, Nebraska, including the 

property located at 2 . «•< / jT Keti^ ^ €*. ^ / f V« -

The EPA requests your permission to allow Prudent to perform LBP Stabilization at this property. By signing this form, the 

property owner grants permission to Prudent to perform activities related to LBP Stabilization including scraping paint and 

painting ofthe referenced property. Further, the owner/tenant verifies that they have received the LBP pamphlet "Renovate 

Right." 

By signing this document I agree to allow an EPA contractor to conduct a soil cleanup at my property following completion of 

lead-based paint stabilization, if the soil cleanup has not already been performed. I understandtiiat the stabilization contractor 

cannot provide assurances of which contractor will be bound to the soil cleanup. I further understand that the soil cleanup 

contractor will make all reasonable efforts to address concems that I, as the property owner, may have regarding soil 

cleanup at my property. 

[ ] Yes, 1 have read and understand the paragraph above. 

AJJa*,^ ^/Hi/ZtiiynyAL. 

Signature of Property Owner 

7-ii> -o<\ 

Date 

If you have any questions about the LBP stabilization planned for your property, please contact Prudent's Customer 

Relations/Office Manager for the Lead Based Paint Stabilization, Mrs. Shannon Holt, at (402) 504-1004 or (402)812-0223. 

General questions about the Omaha Lead Site cleanup can be directed to the EPA Public Information Centers at (402) 731­

3045 (South Omaha office) or (402) 991-9583 (North Omaha office). 

Property Access Granted By: 

(Please Print Name) 

Property Owner Signature: A^yft/u^ y^^^^^^e.^^ 

(Signature) 

I.IC - O ^ 

(Date) 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone:(816)363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax:(816)363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNOLOGIES, INC 

Advanced notice needed. 

After signing the access you allow Prudent to begin Lead Based 

Paint Stabilization. All Plants, weeds and any vehicles or items on 

open porch (enclosed porches will NOT be stabilized) must be 

removed prior to stabilization. All Pets must be out of yard during 

stabilization. How much notice do you need to have above 

mentioned tasks completed? If you are a landlord you will need to 

contact the tenant as Prudent Technologies will only inform you. 

Do you have any pets that reside in yard? 

Notice needed: 

^t4- h r 

Number to call to give notice: 

Whom we are giving notice to: 

Oa-xs-y ^'VOIWC/A, 

Home Owner's Signature 

e&iar-..y^i£^iau^tCu.. 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNOLOGIES, INC 

PRE-STABILIZATION VIDEO FORM 

I UNDERSTAND THAT PRUDENT TECHNOLOGIES WILL BE COMING 

OUT TO SHOOT A PRE-STABILIZATION VIDEO AT MY PROPERTY. 

THE VIDEO IS JUST A TOOL USED TO DOCUMENT THE CURRENT 

PROPERTY STATUS/CONDITION. A POST VIDEO WILL ALSO BE 

SHOT PRIOR TO COMPLETION OF STABILIZATION. 

OWNERS NAME: Rub^- O M\ Yaf^ c3a . 

'X^\S ^Caf^^a^ ^^ ^ PROPERTY ADDRESS: 

BVID/SAID: ?> ^^ \ ^ 

HOMEOWNERS SIGNATURE: 

^J ^ ma,u^ 

PRUDENT REPRESENTATIVE SIGNATURE: ]:NTATIVE siGr^i 

(7>yy7 

ANY CONDITIONS NEED TO BE AWARE OF BEFORE SHOOTING 

VIDEO: (LE. PETS, NOTICE NEEDED): 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax:(210)579-6577 
" ^ 

TECHNOLOGIES,] .<< ^ 

ACCESS INFORMATION TRACKING SHEET 

BVID: 2^ ^ I 7- PROPERTYADDRESS: Zl^^ "b Vy^r^^^^^ /W ^ 

[luh^jA Ni\raroO[ _ Property Owned By: 

(If new property owner) 

Owners Phone No's: Home: Work: 

Cell: Fax: ~ 

Access Contractor: ASW PDA MES PE Other (Prudent) 

DATE TIME ACCESSOR CONRACT DETAIL 

n \s]o'^ ^ P/M K A rv I <I- «- V (J^>v\ y-y-ij i -^ A\^.y-.y 

J ' 

Comments: 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone:(816)363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
J ,•• iT( ^ * •.. 

TECHNOLOGIES^ 1 

Access Assessment Form: (Must be completed for every property. 

Information must be obtained from a property walk thru, not given 

by owner) 

Is the property stucco or asbestos? . 

If yes, is any ofthe stucco or asbestos damaged or cracked? 

If yes, stop as we can't stabilize this property. It requires special preparation 

techniques. It will be returned to EPA and they will assign at a later date. 

ry:> 

Does this property require lots of scrapping? 

y 

Does this property require a lift or scaffolding to reach upper levels? 

Does this property have lots of plants or items in areas where painting is 

required? 

Does this property have any significant structural damage? 

If yes, EXPLAIN? 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax:(816)363-3707 Fax: (402)504-1005 Fax:(210)579-6577 
TECHNOLOGIES, INC 

Does this property have a garage? 

If yes, describe location of garage. 

Wet lyj k/M" ^ 

Does this property have aluminum siding? 

If yes, is it original factory finish or has it been painted over? 

Does this property have any other type of structural components? (I.e. roof 

shingles as siding)? 

If yes, EXPLAIN? 

Is this property vacant or occupied? 

7) U^^ ^ "-^^^ 

yA M 7 y ^^^ r 

Are there any pets at this property? 

Are there any low hanging power lines? 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone:(816)363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax:(816)363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNOLOGIES. INC 

NEIGHBORHOOD PROPERTY ACCESS FORM 

IS THERE A NEIGHBORING PROPERTY THAT NEEDS TO BE ACCESSED ALONG 

WITH ASSIGNED PROPERTY TO COMPLETE STABILIZATION PROCESS? 

K^O 

IF IT IS, GET ACCESS FROM ALL REQUIRED NEIGHBORHOOD PROPERTIES. 

K)0 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNOLOGIES, INC 

PAINT MATCHING FORM: 

TO BE FILLED OUT ONLY IF MATCHING COLOR 

PROPERTYADDRESS; :^C\\ S NCCV^SJC^ £ (\\l <L 

BVID; •3>e.O\'X 

I UNDERSTAND SHERWIN WILLIAMS WILL MATCH MY CURRENT COLORS. 

Homeowner signature; 

\f\30jA)js jj: ^ 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
77 

TECHNOLOGIES. INC 

PRE-STABILIZATION PROPERTY SAFETY ASSESSMENT FORM 

PROPERTY ADDRESS: 'X^ \ S K<\^^CKC , P[^f <L 

BVID/SAID: S ^ ^ \ X 

PRUDENT ASSESSMENT REPERSENTATIVE: 

******IF SAFETY RISK PROPERTY MUST BE TURNED OVER TO 

KATHY ROTHER BEFORE IT CAN BE ASSIGNED TO A CREW/SUB. 

REPERSENTATIVE REMARKS/FINDINGS; 

(POWER-LINE PROXIMITY TO PROPERTY, SCAFFOLDING/ LADDERS/ LIFTS 

NEEDED, UNSAFE AREAS, UNSAFE NEIGHBORHOOD...ETC.) 

REQUIRES K.ROTHER APPROVAL YES/NO 

SUBMITTED TO K.ROTHER ON; 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax:(210)579-6577 
TECHNOLOGIES. INC 

% ^ 

Checklist for the Worksite Hazard Analysis 

Address; ^ ^ ^ ^ ^^7^^^ ^ 

Crew: Date: 

Item ^ OK? I JHazard o Corrective Action 

Overhead Lines A3& ^ U^^)7H < - \Jy(\G:t^Lef UJtyj^ f~­ ( J \y^A\JL o 'd^-^^AiT ^ ^fv,rrT*,;.-t5t-t > <jy^lhi9 ^ In-transit Vehicle Clearance 

Levels around high wires 

Vehicle Clearance around 

high wires when working 

Phone lines 

Cable lines <i:s.k-ti,l 

Gas Line 

Water Line 

Sewer Line 

Septic Tank 

Propane/Butane 

Access to/on Property l\Ci/y i H'S t^r , , \ / . /

^ 

Neighbo ^ ^ r Access Required 

High Traffic Area 

Garage ^^2y^LxtA^^^ (Utyy^^ h^> ^ 

Structures sj^^^y^^^ ^ 

Drivewa c:c inrjf-»< y cM O G iTKs 

Sidewalk 

Foundation (VvA^^^j L <5>/, , ^ •-\y>jy}77^^juX'U/-{yA>Jru^ ~^^^^27 ^ 

Retaining Walls ^-1—7). ty' . oi y-^0,. Fences : (>y<^^^^ErPaJy i.(hpM "E^m^^ ^ 

Trees AAt ^ 

Foliage 

General Condition of yard hjiyjy7ry\K 

Damaged Areas: sink 

holes/rotted wood OAjtrlyy/ L 

Sprinlder System 

Pets 

Insects 

Weather Conditions 

Unsafe driving conditions 

Unsafe neighborhood 

Crew Fo b-Contractor fety Officer 

8080 Ward WrkwayTSuite 405 2505 N. 24'" street. Suite 308 4X42 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 63110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax:(816)363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 




Current Sample Pre-Renovation Form 

Effective until April 2010. 

Confirmation of Receipt of Lead Pamphlet 

a I have received a copy of the pamphlet, Renovate Right: Important Lead Hazard 

Information for Families, Child Care Providers and Schools informing me of 

the potential risk of the lead hazard exposure from renovation activity to be 

performed in my dwelling unit. I received this pamphlet before the work began. 

Rjf, e # \ A l iils\vidt^. 

7»l(,'0 ^ 

Printed name of recipient 

Date 

Signature of recipient 

Self-Certification Option (for tenant-occupied dwellings only) — 

If the lead pamphlet was delivered but a tenant signature was not obtainable, 

you may check the appropriate box below. 

• Refusal to sign — I certify that I have made a good faith effort to deliver the 

pamphlet, Renovate Right: Important Lead Hazard Information for Families, 

Child Care Providers and Schools, to the rental dwelling unit listed below at the 

date and time indicated and that the occupant refused to sign the confirmation 

of receipt. I further certify that I have left a copy of the pamphlet at the unit with 

the occupant. 

Q- Unavailable for signature — I certify that I have made a good faith effort to 

deliver the pamphlet, Renovate Right: Important Lead Hazard Information for 

Families, Child Care providers and Schools, to the rental dwelling unit listed 

below and that the occupant was unavailable to sign the confirmation of receipt. 

I further certify that I have left a copy of the pamphlet at the unit by sliding it 

under the door. 

1'Vt'<? ^ 6-9 ^ 

Printed name of person certifying Attempted delivery 

(y ^ i­ date and time 

lead pamphlet delivery 

Signature of person certifying lead pamphlet delivery 

Unit Address 

Note Regarding Mailing Option — As an alternative to delivery in person, you 

may mail the lead pamphlet to the owner and/or tenant. Pamphlet must be mailed 

at least 7 days before renovation (Document with a certificate of mailing from the 

post office). 
Douglas County Account In|Bmatio n|Bma n Page 1 of3 

Douglas County, Nebraska Property Record - R0600720000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west ot 52nd St - Vle W O n Ma p Information is valid as of 2009-6-16 Treasurer's Tax Report 

New Feature -> -» -^ Auto Sales Search 

Owner 

MIRANDA RUBEN 

ETAL 

2415 KANSAS AVE 

OMAHA NE 68111-0000 ph-J^m^.S Qj)h^/f<n/) Mfc^/-I3^ 

Property Informatio n 

Key Number 0072 0000 06 

Account Type: Residential 

Parcel Number 0600720000 

Parcel Address: 2415 KANSAS AV 

OMAHA NE 68111-0000 

Legal Description: BELLE ISLE LOT 5 BLOCK 1 E 1/2 LT 6 & ALL 67.5 X 136.49 

Value Informatio n 

2009

2008

2007

2006

2005

2004

Land 

'

 $3,200.00 

 $3,200.00 

 $3,200.00 

 $3,200.00 

 $3,200.00 

 $3,200.00 

Improvement 

$56,500.00 

$56,500.00 

$49,900.00 

$49,900.00 

$49,900.00 

$44,900.00 

Total 

$59,700.00 

$59,700.00 

$53,100.00 

$53,100.00 

$53,100.00 

$48,100.00 

Sales Informatio n 

Sales Date: 2009-02-18 

Deed Type: 

Price: 

WD

$45,000.00 

 Book: 2009 Page: 015190 

Grantor: KH INVESTMENT PROPERTIES INC ETAL 

Grantee: MIRANDA RUBEN ETAL 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 1997-06-30 

Deed Type: D SooAr: 2064 Page: 423 

Price: $46,000.00 

Grantor: 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountiiifo.jsp?accountno=R060... 7/7/2009 
Douglas County Account InjjBiation Page 2 of3 

Grantee: 

Valid/Invalid: valid 

Exclusion Reason: 

Sales Date: 1997-04-11 

Deed Type: D j Book: 2061 Page: 507 

Price: $37,000.00 

Grantor: 

Grantee: 

Valid/Invalid: Invalid 

Exclusion Reason: 

Invalid Sale 

Land Informatio n 

Acres j .SF' Units Depth Width Vacant 

0.21 9248.0 1.0 1360 68.0 No 

Improvemen t Informatio n 

Building 1 

TWO STORY 

End &Dl-3l;'i)all4(y 

24 0 o i a 12 0' 

14 0' 

J, Firs: FK-nf i 

o S52 0 "^ 

& 12.0' 10 

I i«.e 26,0­

26 0 f. : (-.SecondFbDt 

6ncl ScrM Wall 

132 0 

:6 0' 

CLICK TO ENLARGE IMAGE 

Square Footage: 1704.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Fair 

Built As: 2 story Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 6.0 

Exterior: 1 Frame Siding Units: 1,0 

i- Baths: 1.0 Interior: Drywall 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 2.5 

Floorcover: Allowance Foundation: Block 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R060... 7/7/2009 
Douglas County Account Ini^aiatio ni^ais n Page 3 of3 

Year Built 

1915 

Detail Type 

Appliance 

Appliance 

Basement 

Fixture 

Fixture 

Fixture 

Garage 

Porch 

Porch 

Year 

Remodeled 

0 

Percent 

Remodeled 

0% 1 

Detail Description 

Allowance 

Fireplace Masonry 

Bsmnt Block 8 ft 

Additional Fixtures 

Base Fixtures 

Bath Full 

Detached 

End Screen 

End Screen 

Sprinkler Square Footage: 0.0 

AdjustedYear p,ys,calAge 

1915 93 

Units 

1.0 

1.0 

852.0 

1.0 

1.0 

1.0 

440.0 

182.0 

24.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accoiintinfo.jsp?accountno=R060... 7/7/2009 
TECHNOLOGIES. INC 

!j't.,o<' ^ 

Prudent Property Close-Out Form (Lead-Based Paint Stabilization) 

SAID: i^"^! ^ 

Property Address: /T' 3 7^r\ricx ^ ^A'C ^ J — 

Owner's Name: piiCxfA /A^IThVldi ^ 

S.NO 

Performance Standards/close-Out Criteria Yes NO 

Was the entire structure(s) painted with the exception of the stated, 

excluded areas? This would Include painting of other associated 

features including fascia, eaves, siding, all trim, porches, box / . t ^ beams, columns, rails, and exterior surfaces of garages. 

Was all scraping and other preparation work completed 

satisfactorily? 

% ^ Were all required areas of the structure(s) primed as needed and 

painted with two top coats? M 

Are all of the areas where contaminated materials have been spilled 

thoroughly vacuumed/ cleaned? % ^ 

Did the contractor collect/vacuum all falling and scraped paint chips 

on the entire property, roadways, alleyways, public access areas 

and also remove any other generated debris? H ^ 

Is the grass area that surrounds the structure(s) in reasonably good 

condition? J ^ 

Was the paint products utilized equivalent to a 30 year 

product/quality? ^ Are all items such as polyethylene sheeting, ladders, paint brushes, 

cones, barrier tape etc properly removed? j ^ Is there any evidence of property damage that was done by the 

contractor? Any property damage needs to be completed prior to 

the EPA Close-Out. m 

10 Are there any property items that were temporarily re-located by the 

contractor that need to be moved back? iQ_ 11 Are there any (known) lingering issues with the property owner(s) 

that have been left unresolved? J2 

12 

Other Considerations? Property Owner Discussions? Additional 

Work that is Required 

m. 

Prudent Representative Signature: 

Date: 

Property Owner Signature: /''Ajbt&syi rUytgi^Jt'^ ' 

Date: 9^Z9''0<i 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone:(816)363-3703 Phone: (402) 504-1004 Phone: (210)822-9588 

Fax: (816)363-3707 Fax: (402)504-1005 Fax: (210)579-6577