TRANSMITTAL OF OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID #: ^'h'=^Z L Date: 0%| liil^eo ^ 

Address: Zl.??? . N A- 5 f\V 

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

PAINT STABILIZATION 

PROPERTV FILE FOLDER DOCUMENTS 

Sf Video of property (DVD): Pre-Stabilization & Post-Stabilization Videos 

K Executive Summary 

Signed Access Agreement Form 

Advance Notice Form 

/ Pre-Stabilization Video Agreement Form 

Access Tracking Form 

\Y Property Access Assessment Form 

y Neighbor Access Agreement Form 

\ y Paint Match Form 

y Pre-Stabilization Property Safety Assessment Form 

^ Work-Site Hazards Analysis Checklist 

y Photographs: Pre-Stabilization Propertv Hazard Assessment Photographs 

V ^ Douglas County Assessor Property infonnation 

r/ Property Completion Agreement Form Signed by Property Owner 

n Property Close-Out Check List Signed By EPA 

rutlent Technologies, Inc. Signature * ' D 

signature ' ' Date 

30054309 

•iil 

Superfund 
TEOINOLOGIBS. INC 

Property Summary 

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

Property Address: 2732 N 45 Av. | SAID #; 63522 

A. Ex^yntive Summary; 

a^ Issues Encountered; NONE 

1^. Issues Resolved; NONE 

Q, Unique Findings; NONE 

d. Other Relevant Information; 

i. Access Date; 8/10/2009 

u. Work Began: 8/11/2009 

iii. Close-Out Date; 8/12/2009 

B. Enclpsures; 

1. ^re-Stabilization Video 

2. f ost-Stabilization Video 

3. Signed Access Agreement Form 

4. Advance-Notice Form 

5. ^re-Stabilization Video Agreement Form 

6. Access Tracking Form 

7. Property Access Assessment Form 

8. Neighbor Access Agreement Form 

9. property Paint Match Form 

10^ t|re-Stabilization Property Safety Assessment Form 

11, Work-Site Hazards Analysis Checklist 

12^ ^re- Stabilization Property Hazard Assessment Photographs 

I • 

13. Douglas County Assessor Property Information 

14. S^igned Property Completion Agreement Form 

15. Ijiopci ty Close Out Check List Signed By EPA 
%'>^^2 . 

TBCHNOUXSIBS. INCT 

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

Agency (EPA) to stabilize_L«id^Base5 >ilize Lead BasediPaint (LBP) at a number of properties located in Omaha, Nebraska, including the 

property located at_ 

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 1 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 understand diat the stabilization contractor 

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

contractor will make all reasonable efforts to address concerns that 1, as the property owner, may have regarding soil 

cleanup at my property. 

a and understand the paragraph above. 

cA/w/ JS ^ 

signature of Property Owner r 

Date 

Ifyou 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 die 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: Aije^^^ ^ Cyyy? 

(Signature) f ^ 

S^/O^r 

(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 
TBCHNOLOGIBS. INC 

PROPERTY INFORMATION 

(To be completed by resident and/or property owner — pjpue^rint) 

RESIDENT NAME: pujQ k /^^jn^^i Owner J Renter 

RESIDENT ADDRESS: 

ff/.?;?- N ' H ^ fy£ 

IF RENTAL, PROPERTY OWNED BY: 

^ •ii£-

OWNER'S MAILING ADDRESS; ^^e 

OWNER'S TELEPHONE NUMBER - HOME: { \ 6^ 3 " ' ^ ' 3 WORK: _± \ 

NUMBE NUME R OF OCCUPANTS UNDER 7 YEARS OLD: Q NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER: 

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

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

Uo P^f^i 

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

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

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 Medicai Drive, Suite 4250 

Kansas City, MO 64114 

Phone: (816) 363-3703 

Fax: (816) 363-3707 

Omaha, Nebraska 68110 

Phone: (402)504-1004 

Fax: (402)504-1005 

San Antonio, TX 78229 

Phone: (210)822-9588 

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? AJA 

Notice needed: ^7 ^ ^ ^ / 

Number to call to give notice: 

^3 - -^073 

Whom we are giving notice to: 

/j^/oOf\-

Home Owner's Signature 

CM.^^Z<. 

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.] 

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 

= l-i'^fifi ^^ ^ 

PROPERTY ADDRESS: ^1S^ M ^ ^ ^ ^ 

BVID/SAID: ^5i"p ^ 

HOMEOWNERS SIGNATURE: C^^^^^^^VLJBLe^ C^/ i 

PRUDENT REPRESENTATIVE SIGNATURE: 

ANY CONDITIONS NEED TO BE AWARE OF BEFORE SHOOTING 

VIDEO: (I.E. PETS, NOTICE NEEDED): 

/O^m 

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 
TBCHNOLOGIBS,] 

ACCESS INFORMATION TRACKING SHEET 

BVID: ^^^S^ ^ 

Property Owned By: 

(If new property owner) 

PROPERTY ADDRESS:

.ldMJL.ltL^.. 

 ^73 ^ ^ ­ ^^^^^ ' 

Owners Phone No's: .. ^^ ' 107s Home: —~­— Work: 

Cell: Fax: — 

Access Contractor: ASW PDA MES PE Other (Prudent) 

f

0 

DATE 

'l^-d'f 

TIME 

3'^3d pM 

r 

ACCESSOR 

% 

7 

CONRAC J DETAIL 

S/^1^4 

Comments: ^:I^JLji^J!Ml.. 

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 
TECHNQQLOGIBS.] 

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 of the 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. 

Does this property require lots of scrapping? < 

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? 1/^-6 

Does this property have any significant structural damage? 

umf (M 

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 
E 

[aLOGIES,INC 

Does this property have a garage? r ^ 

Ifyes, describe location of garage. /^ / JL ' J 

Does this property have aluminum siding? 

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

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

shingles as siding)? 

Ifyes, EXPLAIN? 

Is this property vacant or pccupiedj^ 

Are there any pets at this property? 

Are there any low hanging power lines? 

m. m 

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

lifO 

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

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 
TECHNOIOGIBSIINC 

PAINT MATCHING FORM: 

1. TO BE FILLED OUT ONLY IF MATCHING COLOR 

PROPERTY ADDRESS: Q-13'3 . ^ . f/5^ ;^, ^ 

BVID: y^O^ ^* ^ 

The following notes are for the benefit of paint crew only. 

Paint Yes Paint No Location Paint Description 

Siding ^ ^ 

Soffit i/ 

Fascia i / 

Comer Trim ty 

Window Trims /fe/ttiSMT y

Door Trims 

Front Porch Ceiling f l^ti fif^ ^i„ ^ y 

Front Porch Ceiling Beams y 

Front Porch Floor y 

Front Porch Railings y 

Front Porch Steps y 

Siding Baseboards y 

Foundation u/ 

Mifff' Ck^Oi €/6erpi' /^m\ /^^< 

'/)liJfi//:^ IUI/I 7^>ft />/o(jjfJ XI" I ^'^ /^/i?^ ­

\ 

I UNDERSTAND S_ WILLIAMIiWILL MATCH MY CURRENT COLORS. 

Homeowner si^nati^^ C^yt. / .AOVMC ^ ^ Dat^^ d -a ? 5 ^ 

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 
aOLOGIBSii INC. 

2. TO BE FILLED OUT ONLY IF CHANGING COLOR 

PROPERTY ADDRESS: 

BVID: 

Location Paint Description 

Paint 

Yes 

Paint 

No 

Siding 

Soffit 

Fascia 

Comer Trim 

Window Trims 

Door Trims 

Front Porch Ceiling 

Front Porch Ceiling Beams 

Front Porch Floor 

Front Porch Railings 

Front Porch Steps 

Siding Baseboards 

Foundation 

I AGREE TO THE COLORS INDICATED ABOVE. I UNDERSTANT THAT I 

CANNOT CHANGE THE SELECTED COLORS LATER ON AS PRUDENT 

WOULD HAVE PURCHASED THE PAINT SPECIFICALLY FOR THE 

REFERENCED PROPERTY. ALSO I UNDERSTAND THAT COLORS SELECTED 

MAY NOT LOOK EXACTLY AS IT IS SHOWN ON SWATCHES AFTER 

PAINTING ON MY PROPERTY. 

Homeowner signature:. 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,] 

PRE-STABILIZATION PROPERTY SAFETY ASSESSMENT FORM 

PROPERTY ADDRESS: ^L*^ ^ /i)- ^ ^ ^^ ^ 

BVID/SAID: 

^35"^^ 

PRUDENT ASSESSMENT REPERSENTATIVE: 

REPERSENTATIVE REMARKS/FINDINGS: 

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

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

O l 

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 
TECHNCnXXHBS;] 

Checklist for the Worksite Hazard Analysis 

Address: 

Crew: P.te; T-U- ^ -/dlh^ 

Item OK? Corrective Action 

Overhead Lines :5 £)U>Jl/^ kJc'S^W^ ^ 

In-transit Vehicle Clearance 

Levels around high wires 

Vehicle Clearance around 

high wires when working 

Phone lines 

Cable lines 

Gas Line 

Water Line 

Sewer Line 

Septic Tank 

Propane/Butane 

Access to/on Property (juCA^^ Cft|;:j(k <J ^ 

Neighbor Access Required 

High Traflic Area 

Garag OlW ^ e 

Structures 4 ^i/^c ^ ^ luLc^^ - ^ Lj:>i2M> ^ 

Driveway 

"M 

Sidewalk 

Foundation 

^K\hfe:^:^^-S.-iro^vM^^ ^ ^ ; 

Retaining Walls 

Fences 

Trees 

Foliage IEJ^^^ S 'c,,.^Ji^^ 

General Condition of yard 

'fe^'ff^^r^^ ^ I

Damaged Areas: sink 

holes/rotted wood &ik. 

Sprinkler System 

Pets 

Insects ai JtH^ TT JLA>\r<^^y' JSQ> 

Weather Conditions 

Unsafe driving conditions 

Unsafe neighborhood 

Crew Foreman/ Siib-Contractor ite Safety Officer 

8080 Ward Parkway, Suite 405 2505 N. 24*" street. Suite 308 fedical 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 
t^^ 



Current Sample Pre-Renovation Form 

Effective until April 2010. 

Confirmation of Receipt of Lead Pamphlet 

m 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. 

Printed nam/of r^ipient *s\ p>y Date 

•^"TYL^^ 

Signattlfe bf 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. 

G 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, 

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

Printed name of person certifying Attempted delivery 

date and time 

lead pamphlet delivery 

Signature of person oJrtifylng lead pamphlet delivery 

^77^ AJ. ^ ^ m 

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 Couniy Account Infonnation http://douglasne.inaDping-online.com/DouglasCoNe/static/accountinfo. i.tnanpi .

Douglas County, Nebraska Propert y Record - R0811600000 

Print Report 

NEW Feature - Parcel Dimensjons available ©scale 0-50 ftv^est of 52n(] St - VICW OH Ma P Information is valid as of 2009-7-20 Treasurer's Tax Report 

New Feature ••->- • Auto Sales Search 

Owner 

EMGE LINDA 

2732 HDfr ]ibft^^lav£ij. N 45 AVE 

OMAHA NE 68104-0000 

Propert y Informatio n 

Key Number: 1160 0000 08 

Account Type: Residential 

Parcel Number: 0811600000 

Parcel Address: 2732 N 45 AV 

OMAHA NE 68104-0000 

Legal Description: CLAIRMONT LOT 6 BLOCK 4 50 X 125 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$6,400.00 

$6,400.00 

$6,400.00 

$6,400.00 

$6,400.00 

$6,400.00 

Improvement 

$66,000.00 

$66,000.00 

$66,000.00 

$66,000.00 

$56,200.00 

$51,100.00 

Land Informatio n 

Acres 

0.14 

SF 

6250.0 

Units 

1.0 

Depth 

125.0 

Improvemen t

Building 1 

 Informatio n 

fv^ 

 0^ 

Total 

$72,400.00 

$72,400.00 

$72,400.00 

$72,400.00 

$62,600.00 

$57,500.00 

Width Vacant 

50.0 No 

Iof 2 7/31/2009 9:30 AM 
Douglas County Account Information http://douglasne.mqpping-onIine.com/DouglasCoNe/static/accountinfo.. .rnanoi 

Square Footage: 1368.0 

Perimeter 0.0 

Unit Type: 

Built As: 1 1/2 Story Fin 

HVAC: Central Air to Air 

Exterior: Frame Siding 

Interior: Drywall 

Roof Cover: Composition Shingle 

Roof Type: Gable 

Floorcover: Allowance 

Year Built Year 

Remodeled 

Percent 

Remodeled 

1916 0% 

Detail Type Detail Description 

Add On Fence Chain Link 

Appliance Allowance 

Basement Bsmnt Block 8 ft 

Fixture Base Fixtures 

Fixture Bath Full 

Garage Detached 

Porch Slab Roof Ceil 

Porch Slab Roof Ceil 

2732N44AV 430X1 It Sacond Flocr 

S12.0 *H tt. 

FM Floar -" J 

BIT 

If f 

tir 

BV 

121 

1 1/2 STORY 

•S2J>*4.I. SUA Root CM 

CLICK TO ENLARGE IMAGE 

Percent Complete: 100.0% 

Quality: Average 

Condition: Average 

Condo Square Footage: 0.0 

Rooms: 7.0 

Units: 1.0 

Baths: 1.0 

Bedrooms: 3.0 

Stories: 1.5 

Foundation: Block 

Sprinkler Square Footage: 0.0 

Adjusted Year Physical Age Built 

1916 93 

Units 

1.0 

1.0 

832.0 

1.0 

1.0 

360.0 

184.0 

45.0 

2 of 2 7/31/2009 9:30 AM 
TECHNCMXX;iBS. INC. 

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

SAID: 1^3? 9 ^ 

Property Address: m > Mfgfe/ 

Owner's Name: jJlJDt S [^fft6 ^ 

S.NO Performance Standards/close-Out Criteria Yes NO 

1 

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 

y beams, columns, rails, and exterior surfaces of garages. 

2 Was all scraping and other preparation work completed 

y satisfactorily? 

3 Were ail required areas of the structure(s) primed as needed and 

painted with two top coats? 

y

4 Are all of the areas where contaminated materials have been spilled 

thoroughly vacuumed/ cleaned? y

5 

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

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

and also remove any other generated debris? 

6 

condition

Is the gras

? 

s area that surrounds the structure(s) in reasonably good y

y / 7 Was the paint products utilized equivalent to a 30 year 

product/quality? 

8 Are all items such as polyethylene sheeting, ladders, paint brushes, 

cones, barrier tape etc properly removed? 

y

9 Is there any evidence of property damage that was done by the 

contractor

the EPA Close-Out

? Any propert

. 

y damage needs to be completed prior to 

y

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

contractor that need to be moved back? ly 

11 Are there any (known) lingering issues with the property owner(s) 

that have been left unresolved? 

y

12 Other Considerations? Property Owner Discussions? Additional 

Wor ly k that is Required 

Prudent Representative Signature: jO W 

Da«: %-\^-iA J- ^ 

Property Owner Signature: >^--d'-^ ^ VjSr>N-" 

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