## TRANSMITTALO FOMAHA LEAD SIT E PAINT STABILIZATIO NFIL EFOLDE R
SAI D # : ^'h'=^Z LDate : 0% | liil^eo ^ Address : Zl.??? . N A- 5 f\ V LB PStabilizatio n Contractor : PRUDEN T TECHNOLOGIES , INC . Year : 200 9 PAIN T STABILIZATIO N PROPERT V FIL EFOLDE RDOCUMENT S Sf

Vide o o f propert y (DVD) : Pre-Stabilizatio n& Post-Stabilizatio nVideo s K

Executiv e Summar y Signe dAcces s Agreemen t For m Advanc e Notic e For m / Pre-Stabilizatio n Vide o Agreemen t For m Acces s Trackin g For m \ Y Propert y Acces s Assessmen t For m y Neighbo r Acces s Agreemen t For m \y Pain t Matc hFor m y Pre-Stabilizatio n Propert y Safety Assessmen t For m ^ Work-Sit e Hazard s Analysi s Checklis t y Photographs : Pre-Stabilizatio nPropert v Hazar dAssessmen t Photograph s V ^ Dougla s Count y Assesso r Propert y infonnatio n 

# r/ Propert y Completio nAgreemen t For mSigne db y Propert y Owne r n Propert y Close-Ou t Chec k Lis t Signe dB y EP A
rutlen t Technologies , Inc . Signatur e * ' D signatur e ' ' Dat e 3005430 9 

# • ii l Superfun dTEOINOLOGIBS . IN C 

# Propert y Summar y Date ; 8^200 9 | LB PSTABILIZATIO NEP A CONTRAC T EP-R7-08-0 7 | Mont hof : Aug . Propert y Address : 273 2 N4 5 Av .| SAID # ; 63522
A .Ex^yntiv e Summary; a ^ Issue s Encountered ; NON E 1^

. Issue s Resolved ; NON E Q

, Uniqu e Findings ; NON E d . Othe r Relevant Information ; i . Acces s Date ; 8/10/2009 u . Wor k Began : 8/11/2009 iii . Close-Ou t Date ; 8/12/2009 B . Enclpsures ; 1 . ^re-Stabilizatio nVide o 2 . f ost-Stabilizatio n Vide o 3 . Signe dAcces s Agreemen t Form 4 . Advance-Notic e Form 5 . ^re-Stabilizatio nVide o Agreemen t Form 6 . Acces s Trackin g Form 7 . Propert y Acces s Assessment Form 8 . Neighbo r Acces s Agreemen t Form 9 . propert y Pain t Matc hForm 10

^ t|re-Stabilizatio n Propert y Safet y Assessment Form 11 , Work-Sit e Hazard s Analysi s Checklis t 12

^ ^re
- Stabilizatio nPropert y Hazar dAssessment Photograph s I• 

## 13 . Dougla s County Assessor Propert y Informatio n 14 . S^igne dPropert y Completio nAgreemen t Form 15 . Ijiopc i t y Clos e Ou t Chec k Lis t Signe dB y EPA

# %'>^^2 . TBCHNOUXSIBS . INC T 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 ) t o stabilize_L«id^Base5 i >iliz e LeadBase dPain t (LBP ) at anumbe r o f propertie s locate dinOmaha , Nebraska , includin g th e property locate dat _ Th e EPA request s you r permissio nt o allo w Pruden t t o performLB PStabilizatio nat thi s property . B y signin g thi s form , th e property owne r grant s permissio nt o Prudent t o perfor mactivitie s relate dt o LB PStabilizatio nincludin g scrapin g pain t an d paintin g ofth 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 1 agree t o allo w a nEPA contracto r t o conduc t asoi l cleanu p at m y property followin g completio n o f lead-base dpain t stabilization , i f th e soi l cleanu p ha s no t alread y bee nperformed . I understan ddiat 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 fiirther understan dthat th e soi l cleanu p contracto r wil l make al l reasonabl e effort s t o addres s concern s that 1 , a s th e property owner , ma y hav e regardin g soi l cleanup a t m y property . aan dunderstan dth e paragrap habove . 

# cA/w /

JS ^ signature o f Property Owne r 

# r

Dat e Ifyo 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 Manage r 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 ca nb e directe dt o di e EPA Publi c Informatio nCenter s at (402 ) 73 1 ­ 304 5 (Sout hOmah aoffice ) o r (402 ) 991-958 3 (NorthOmah aoffice) . Propert y Acces s Grante dBy : (Pleas e Prin t Name ) Propert y Owner Signature : 

## Aije^^^ ^ Cyyy ? (Signature ) 

# f ^ S^/O^ r (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 , 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 7TBCHNOLOGIBS . IN C PROPERT YINFORMATIO N (T o b e complete d b yresiden t and/o rpropert yowne r—pjpue^rint ) RESIDEN TNAME : Owne rJ Rente r 

# pujQ k /^^jn^^ i RESIDEN TADDRESS : 

# ff/.?;?- N ' H ^ fy£ I F RENTAL , PROPERTYOWNE D BY : ^ 

# •ii£ - OWNER' S MAILIN G ADDRESS ; 

# ^^ e OWNER' S TELEPHON E NUMBER - HOME : { \ 6^ 3 " ' ^ ' 3 WORK : _±\ NUMBE R O F OCCUPANT S UNDE R 

### NUM E 7 YEAR S OLD : Q NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDER :



### NUMBE R O F CHILDRENUNDE R 7 YEAR S OL D WHO M PLA Y I NTH E YAR D FO R 5 HOUR S O R MOR E PE R WEEK : UM B 

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

# U o P^f^ i

AUTHORIT Y FO RENVIRONMENTA LRESPONSEACTIONS : Th e activitie s t o be implemente db y EP A unde r thi s agreemen t ar

e pursuan t t

o Sectio n 10 4 ofCERCLA , 42 U.S.C . 9604 . EPA' s righ t o

f acces s t o the propert y i s provide dfo r i

n Sectio n 104(e ) ofCERCLA , 4

2 U.S . C 9605(e) , whic hprovide s entr y fo r "determining the nee dfo r response , o r choosin g o r taking an y respons e actio n unde r thi s title , o r otherwis e enforcin g the provision s ofth e title. "

808 0 War d Parkway , Suit e 405 250 5 N . 24' " Street , Suit e 30 8 4242 Medica i Drive , Suit e 425 0 Kansas City , M O 6411 4 Phone : (816) 363-3703 Fax : (816) 363-3707 Omaha , Nebrask a 6811 0 Phone : (402)504-100 4

Fax : (402)504-100 5 Sa n Antonio , T X 7822 9 Phone : (210)822-958 8 Fax:(210)579-657 7TECHNOLOGIES , INC . 

# Advance dnotic e needed . After signin g th e acces s you allo w Pruden t to begi nLea dBase d Pain t Stabilization . Al l Plants , weed s an dan y vehicle s or item son openporc h(enclose dporche s wil l NO Tbe stabilized ) mus t be remove dprio r to stabilization . All Pet s mus t be ou t of yar ddurin g stabilization . Ho w muc hnotic edo you nee dto hav e abov e mentione dtask s completed ?If you ar e alandlor dyou wil l nee d to contac t th e tenan t as Pruden t Technologie s wil l only infor myou . Do you hav e an y pet s tha t resid e in yard ? AJ A Notic e needed : ^7 ^ ^ ^ / Numbe r to cal l to giv e notice : 

# ^3
- 

# -^07 3 Who m we ar e givin g notic e to : 

# /j^/oOf\ - Home Owner' s Signatur e CM.^^Z< .

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 , MO 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 FOR M I UNDERSTAN D THA T PRUDENT TECHNOLOGIE S WIL LB ECOMIN G OUT T O SHOO T A PRE-STABILIZATIO NVIDE O AT MY PROPERTY . TH EVIDE O I S JUS T A TOO LUSE D T O DOCUMENT TH ECURREN T PROPERT Y STATUS/CONDITION . A POS T VIDE O WIL LALS O B E SHO T PRIO RT O COMPLETIO NO FSTABILIZATION . OWNER S NAM E 

# = l-i'^fif i ^^ ^ PROPERT Y ADDRESS : 

# ^1S ^ M ^ ^ ^ ^ BVID/SAID : ^5i"p ^ HOMEOWNER S SIGNATURE : C^^^^^^^VLJBLe ^ C^/ i PRUDENT REPRESENTATIV ESIGNATURE : AN Y CONDITION S NEED T O B EAWAR EO FBEFOR ESHOOTIN G VIDEO : (I.E . PETS , NOTIC ENEEDED) : 

# /O^ 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 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 7TBCHNOLOGIBS, ] 

## ACCES S INFORMATIO N TRACKIN GSHEE T BVID : ^^^S^ ^ Propert y Owne dBy : (I f new propert y owner ) PROPERT Y ADDRESS : 

# .ldMJL.ltL^. . ^73 ^ ^
­ ^^^^^ '

Owner s Phon e No's : 

# . . ^^ ' 

# 107 s Home : —~­ —Work : Cell : Fax : — Acces s Contractor : AS WPDA ME S P EOthe r (Prudent ) 

# f 0 

## DAT E 

# 'l^-d' f TIM E 

# 3'^3 dp M r ACCESSO R % 

# 7 CONRA C J DETAI L 

# S/^1^ 4

Comments : 

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

808 0 War dParkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medical 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 7TECHNQQLOGIBS. ] 

# Acces s Assessment Form : (Mus t b e complete dfor ever y property . Informatio n mus t b e obtaine dfromapropert y wal k thru , no t given by 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 n a 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 n area s wher e paintin g i s required ? 

# 1/^- 6 Doe s thi s propert y hav e an y significan t structura l damage ? 

# um f ( M 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 7

# E [aLOGIES,IN C 

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

# r ^ Ifyes , describ e locatio no f garage . / ^ / J L' J Doe s thi s propert y hav e aluminu msiding ? Ifyes , 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 ? (Le . roo f shingle s a s siding) ? Ifyes , EXPLAIN ?
I s thi s propert y vacan t o r pccupiedj ^ 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 ? 

# m . 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 s 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 , IN C 

## NEIGHBORHOO D PROPERT Y ACCES S FOR M I S THER EA NEIGHBORIN GPROPERT Y THA T NEED S T O B EACCESSED ALONG WIT H ASSIGNE D PROPERT Y T O COMPLET ESTABILIZATIO NPROCESS ? 

# lif O I FI T IS , GE T ACCES S FRO M AL LREQUIRE D 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 7TECHNOIOGIBSIIN C 

## PAINT MATCHIN GFORM : 1 . T O B EFILLE D OU T ONL Y I FMATCHIN GCOLO R PROPERT Y ADDRESS : Q-13'3 . ^ . f/5 ^ ;^, ^ BVID : y^O ^ ^* ^ Th e followin g note s ar e fo r th e benefi t o f pain t cre w only . Pain t Yes Pain t N o Locatio n Pain t Descriptio n Sidin g ^ ^ Soffi t 

# i / Fasci a i / Come r Tri m 

# t y Windo w Trim s 

# y /fe/ttiSM T Doo r Trim s Front Porc hCeilin g 

# f l^t i fif ^ ^i„ ^ 

# y Fron t Porc hCeilin g Beam s 

# y Front Porc hFloo r 

# y Fron t Porc hRailing s 

# y Front Porc hStep s 

# y Sidin g Baseboard s 

# y Foundatio n 

# u / 

# M i fff' Ck^Oi €/6erpi ' /^m \/^^ < '/)liJfi//: ^ IUI/ I 7^>f t

/>/o(jjf J XI" I ^' ^ /^/i?^

­ \ 

### I UNDERSTAN D S _ WILLIAMIiWIL LMATC H M Y CURREN T COLORS . Homeowne r si^nati^ ^ C^yt . / ^ 

# .AOVMC ^ Dat^ ^ d-a ? 

# 5 ^

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 7aOLOGIBSi i INC . 

## 2 . T O B EFILLE D OUT ONL Y I FCHANGIN GCOLO R PROPERT Y ADDRESS : BVID : Locatio n Pain t Descriptio n Pain t Ye s Pain t N o Sidin g Soffit Fasci a Come r Tri m Windo w Trim s Doo r Trim s Fron t Porc hCeilin g Fron t Porc hCeilin g Beam s Front Porc hFloo r Fron t Porc hRailing s Fron t Porc hStep s Sidin g Baseboard s Foundatio n



## I AGRE ETO TH ECOLOR S INDICATE D ABOVE . I UNDERSTAN T THA T I CANNO T CHANG ETH ESELECTE D COLOR S LATE RO NAS PRUDEN T WOUL D HAV EPURCHASE D TH EPAIN T SPECIFICALL Y FO RTH E REFERENCE D PROPERTY . ALS O I UNDERSTAN D THA T COLORS SELECTE D MA Y NOT LOOK EXACTL Y A S I T IS SHOW NO NSWATCHE S AFTE R PAINTIN GO NM Y PROPERTY . Homeowner 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 , 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 NPROPERT Y SAFET Y ASSESSMENT FORM PROPERT Y ADDRESS : ^L*^ ^ /i)

- ^ ^ ^^ ^ BVID/SAID : 

# ^35"^ ^ PRUDEN T ASSESSMEN T REPERSENTATIVE :

REPERSENTATIV EREMARKS/FINDINGS : (POWER-LINEPROXIMIT Y T O PROPERTY , SCAFFOLDING / LADDERS / LIFT S NEEDED , UNSAF EAREAS , UNSAF ENEIGHBORHOOD...ETC. ) 

# 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 7

### TECHNCnXXHBS;] 

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

# P.te ; T-U- ^ 

# -/dlh ^ Ite m 

### OK ? Correctiv e Actio n Overhea dLine s 

# : 5 £)U>Jl/ ^ 

# kJc'S^W^ ^ 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 Ga s Lin e Wate r Lin e Sewe r Lin e Septi c Tan k Propane/Butan e Acces s to/o nPropert y 

## (juCA^ ^

Cft|;:j( k <J ^ Neighbo r Acces s Require d Hig hTrafli c Are a Ol W ^ 

### Garag e Structure s 

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

### Drivewa y 

# " M Sidewal k Foundatio n 

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

### Retainin g Wall s Fence s Tree s Foliag e 

# IEJ^^^ S 'c,,.^Ji^ ^ Genera l Conditio no f yar d 

# 'fe^'ff^^r^^ ^ 

# I Damage dAreas : sin k holes/rotte dwoo d 

# &ik . Sprinkle r Syste m Pet s Insect s 

# a i JtH ^ 

# T T JLA>\r<^^y ' JSQ > Weathe r Condition s Unsaf e drivin g condition s Unsaf e neighborhoo d Cre w Foreman / Siib-Contracto r it e Safet y Office r

808 0 War d Parkway , Suit e 40 5 250 5 N . 24* " street . Suit e 30 8 fedica 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 7

# t^ ^

# Curren t Sampl e Pre-Renovatio n For m Effectiv e unti l Apri l 2010 . Confirmatio n o f Receip t o f Lea d Pamphle t mI hav e receive d a copyo f th e pamphlet , Renovate Right : Importan t Lea d Hazar d /

^

Informatio n fo rFamilies , Chil d Car e Provider s an d School s informin g m e o f th e potentia l ris k of th e lead hazar d exposur e fro m renovatio n activit yt o b e performe d i n m ydwellin g unit . I receive d thi s pamphlet befor e th e wor k began . Printe d nam/o f r^ipien t *s \ p>yDate •^"TYL^ ^ Signattlf e b f recipien t Self-Certificatio n Optio n (fo rtenant-occupie d dwelling s only ) — I f th e lead pamphlet was delivere d bu t a tenan t signatur e was not obtainable , yo u ma ychec k th e appropriat e boxbelow . •Refusa l t o sig n — I certif ythat I hav e mad e a goo d fait h effor t t o 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 , t o th e renta l dwellin g uni t liste d belowa t th e dat e an d tim e indicate d an d that th e occupan t refuse d t o sig n th e confirmatio n o

f receipt . I furthe rcertif ythat I hav e lef t a copyof th e pamphlet a t th e uni t wit h th e occupant . G Unavailabl e fo rsignatur e — I certif ythat I hav e mad e a goo d fait h effor t t o 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 , t o th e renta l dwellin g uni t liste d belowan d that th e occupan t wa s unavailabl e t o sig n th e confirmatio n o f receipt , jrthe rcertif ythat I hav e lef t a copyo f th e pamphlet a t th e uni t b yslidin g i t Printe d nam e of perso n certifyin g Attempte d deliver y dat e an d tim e lead pamphlet deliver y Signatur e o f perso n oJrtifyln g lead pamphlet deliver y 

# ^77 ^ AJ . 

# ^ ^ m Uni t Addres s Not e Regardin g Mailin g Optio n — As a n alternative t o deliver yi n person , yo u ma ymai l th e lead pamphlet t o th e owne rand/o rtenant . Pamphlet mus t b e maile d a

t leas t 7 day s befor e renovatio n (Documen t wit h a certificat e o f mailin g fro m th e post office) .Dougla s Couniy Account Infonnatio n http://douglasne.inaDping-online.com/DouglasCoNe/static/accountinfo. . i.tnanp i Dougla s County , Nebrask a Propert yRecor d - R081160000 0 Prin t Repor t NE W Featur e - Parce l Dimensjon s availabl e ©scal e 0-5 0 ftv^es t o f 52n( ] S t - VIC W O H Ma P Informatio n i s vali d a s o f 2009-7-2 0 Treasurer' s Ta xRepor t Ne wFeatur e ••->- • Aut o Sale s Searc h Owne r EMG E LIND A 

# HDf r

]ibft^^lav£ij . 273 2 N 4 5 AV E OMAH AN E 68104-000 0 Propert yInformatio n Ke yNumber : 116 0 000 0 0 8 Accoun t Type : Residentia l Parce l Number : 081160000 0 Parce l Address : 273 2 N 4 5 A V OMAH AN E 68104-000 0 Lega l Description : CLAIRMON TLO T6 BLOC K4 5 0 X 12 5 Valu e Informatio n 200 9 200 8 200 7 200 6 200 5 200 4 Lan d $6,400.0 0 $6,400.0 0 $6,400.0 0 $6,400.0 0 $6,400.0 0 $6,400.0 0 Improvemen t $66,000.0 0 $66,000.0 0 $66,000.0 0 $66,000.0 0 $56,200.0 0 $51,100.0 0 Lan d Informatio n Acre s 0.1 4 S F 6250. 0 U nit s 

### 1. 0 Dept h 125. 0 Improvement Buildin g 1 Informatio n 

## fv ^ 

# 0 ^

Tota l $ 72,400.0 0 $ 72,400.0 0 $ 72,400.0 0 $ 72,400.0 0 $ 62,600.0 0 $ 57,500.0 0 Widt h Vacan t 50. 0 N o

Io f 2 7/31/200 9 9:3 0 A MDougla s Count y Account Information http://douglasne.mqpping-onIine.com/DouglasCoNe/static/accountinfo. . .rnano i

Squar e Footage : 1368. 0 Perimete r 0. 0 Uni t Type :

Buil t As : 1 1/ 2 Stor yFi n HVAC : Centra l Ai rt o Ai r Exterior : Fram e Sidin g Interior : Drywal l Roo fCover : Compositio n Shingl e

Roo f Type : Gabl e Floorcover : Allowanc e Yea rBuil t Yea r Remodele d Percen t Remodele d 191 6 0 % Detai l Typ e Detai l Descriptio n Ad d O n Fenc e Chai n Lin k Applianc e Allowanc e Basemen t Bsmn t Bloc k 8 f t Fixtur e Bas e Fixture s Fixtur e Bat h Ful l Garag e Detache d Porc h Sla b Roo f Cei l Porc h Sla b Roo f Cei l 2732N44AV 430X 1 I t Sacon d Floc r S12. 0 * H tt. F M Floa r -" J BI T Iff ti r B V 12 1 1 1/ 2 STOR Y

• S2J>*4.I . SUARoo t C M

CLIC KTO ENLARG E IMAG E Percen t Complete : 100.0 % Quality : Averag e Condition : Averag e Cond o Squar e Footage : 0. 0 Rooms : 7. 0

Units : 1. 0 Baths : 1. 0 Bedrooms : 3. 0 Stories : 1. 5 Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Adjuste d Yea r Physica l Ag e Buil t 191 6 9 3 Unit s 1. 0 1. 0 832. 0 1. 0 1. 0 360. 0 184. 0 45. 0

2 o f 2 7/31/200 9 9:3 0 A MTECHNCMXX;iBS . INC . 

## Pruden t Propert yClose-Ou t For m (Lead-Base d Pain t Stabilization ) SAID : 1^3 ? 9 ^ Propert yAddress : 

# m > Mfgfe/ Owner' s Name : jJlJDt S [^fft6 ^

S.N O 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 includin g fascia , eaves , siding , al l trim , porches , bo x 

# y beams , columns , rails , an d exterio rsurface s o f garages . 2 Wa s al l scrapin g an d othe rpreparatio n wor k complete d 

# y satisfactorily ? 3 Wer e ai l require d area s o f th e structure(s ) prime d a s neede d an d 

# y painte d wit h tw o to p coats ? 4 Ar e al l o f th e area s wher e contaminate d material s hav e bee n spille d 

# y thoroughl yvacuumed / cleaned ? 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 

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

# y condition ? 

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

# y th e EP AClose-Out . 1 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 ? 

# l y 1 1 Ar e ther e an y(known ) lingerin g issue s wit h th e propert yowner(s ) 

# y tha t hav e bee n lef t unresolved ? 1 2 Othe rConsiderations ? Propert yOwne rDiscussions ? Additiona l 

# l y Wor k tha t i s Require d 

### Pruden t Representativ e Signature : jO W 

# Da« : %-\^-i AJ- ^ Propert yOwne rSignature : 

## >^--d'-^ ^ VjSr>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