## TRANSMITTA LO FOMAHA LEAD SIT E PAIN T STABILIZATIO NFIL EFOLDE R SAID# ; f?3o.=^ l Date ; ^ R| nLQ>)gloa ^ Address : li ) ^ "^ B S l LB PStabilizatio nContractor : PRUDEN T TECHNOLOGIES , INC . Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S ^ -V

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### Vide o o f propert y (DVD) : Pre-Stabiiizatio n & Pusi-atabiriAatiun-Vtdeo y Executiv e Summary SignedAcces s Agreement Form Advanc e Notic e Form Pre-Stabilizatio nVide o Agreement Form Acces s Tracidn g Form Propert y Acces s Assessment Form Neiglibo r Acces s Agreement Form Pain t Matc hForm Pre-Stabilizatio nPropert y Safet y Assessment Form Work-Sit e Hazard s Analysi s Checklis t

Photographs : Pre-Stabilizatio nPropert v Hazar dAssessment Photograph s Dougla s County Assessor Propert y informatio n Propert y Completio nAgreemen t For mSigne db y Propert y Owne r Propert y Close-Ou t Chec k Lis t Signe dB y EP A Pniden t Technologies , Inc . Signatur e Dat e

EP A Signatur e Date " 3005539 8 

# • H I Superfun dTECHNOLOGIES , INC . 

# Propert y Summar y Date : 8/03/200 9 | LB PSTABILIZATIO NEP A CONTRAC T EP-R7-08-0 7 | Mont hof : Au g Propert y Address ; 11 1 S 3 8 S t SAI D # : 2303 1
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 : 7/07/200 9 ii . Wor k Began : 7/14/200 9 iii . Close-Ou t Date : 7/16/200 9 B . Enclosures : 1 . Pre-Stabilizatio nVide o 2 . Post-Stabilizatio nVide o 3 . Signe dAcces s Agreemen t For m 4 . Advance-Notic e For m 5 . Pre-Stabilizatio nVide 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 hFor m 10 . Pre-Stabilizatio nPropert y Safety Assessmen t For m 11 . Work-Sit e Hazard s Analysi s Checklis t 12 . Pre - Stabilizatio nPropert y Hazar dAssessmen t Photograph s 13 . Dougla s Count y Assesso r Propert y Informatio n 14 . Signe dPropert y Completio nAgreemen t For m 15 . Propert y Close-Ou t Chec k Lis t Signe dB y EP ATECHNOLOGIES . IIMC . PROPERT YINFORMATIO N (T o b e complete d b yresiden t and/o rpropert yowne r—please print ) RESIDEN TNAME : 

## .N AfnauHr ^ CLLL . Owne r RESIDEN TADDRESS :

AL . PROPERTY,OWNE D BYj : ^>^y v&^6 tU^ , 

## rC^<./ . OWNER' S MAILIN G ADDRESS ; 

## L,XlS ( OWNER' S TELEPHON E NUMBER - HOME : 1^07- ) ^/tz > 7^ytoW0RK : _J 1 . NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : NUMBER O F OCCUPANT S 7 YEAR S OL D AN D OLDER :
NUMBER O F CHILDRE N UNDE R 7 YEAR S OL D WHO M PLA YI N TH E YAR D FO R 5 HOUR S O R MOR E PE R WEEK : ^ COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s t o b e implemente db y EP A unde r thi s agreemen t ar e pursuan t t o Sectio n104 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f

acces s t o th e property i s provide dfor inSectio n104(e ) ofCERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry fo r "determinin g th e nee dfor response , o r choosin g o r takin g an y respons e actio nunde r thi s title , o r otherwis e enforcin g th e provision s ofth e titie. "

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 7TECHNOLOCIBS . INC . Pruden t Technologies , Inc . (Prudent ) i s unde r contract (Contract #EP-R7-08-07 ) wit hthe U . S . Environmenta l Protection Agenc y (EPA) to stabiliz e Lea ^ Base dPaui t (LB£).a t anumbe r of propertie s locate di n Omaha, Nebraska , including the propert y locateda t // / ^ ' ^f i ^ T Th e EP A requests you r permissiont o allow Pruden t to perfor mLB PStabilizationa t thi s property . B y signing thi s form, the propert y owne r grants permissionto Pruden t to perfor mactivitie s relatedto LB PStabilizationincluding scraping pain t an d painting ofth e referencedproperty . Further, the owner/tenan t verifie s tha t the y have receivedthe LB Ppamphle t "Renovat e Right. " By signing thi s documen t I agree to allow a nEP A contracto r to conduct asoi l cleanu p a t m y propert y followin g completionof lead-basedpain t stabilization , ifth e soi l cleanu p has no t alread y bee nperfonned . I understan ddia t the stabilizationcontracto r canno t provid e assurance s of whic hcontracto r wil l be boun dto the soi l cleanup . I furthe r understan dtha t the soi l cleanu p contracto r wil l mak e al l reasonable effort s to addres s concems tha t I , as the propert y owner, ma y have regarding soi l cleanu p a t m y property . es , I have rea dan dunderstan dth e paragrap habove > ^ Owne r 

# 7-7-0 9 Dat e Ifyou have an y question s abou t the LB Pstabilizationplanne dfo r you r property , pleas e contact Prudent' s Custome r Relations/Office Manage r fo r th e Lea dBase dPain t Stabilization , Mrs . Shanno nHolt , a t (402 ) 504-100 4 o r (402)812-0223 . Genera l question s abou t the Omah aLea dSit e cleanu p ca nbe directedto the EP A Public Informatio nCenters a t (402 ) 731
­ 3045 (Sout hOmah aoffice ) o r (402 ) 991-958 3 (Nort hOmah aoffice) . Propert y Acces s Grante dBy : 

## rf0,k A (Pleas e Prin t Name ) Propert y Owne r 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 IFax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax:(210)579-657 7TECHNOLOGIES , INC . 

# Advance dnotic e needed . After signin g th e acces s you allo w Pruden t t o begi nLea dBase d Pain t Stabilization . Al l Plants , weed s an dan y vehicle s o r item s on ope nporc h(enclose dporche s wil l NO T b e stabilized ) mus t b e remove dprio r t o stabilization . Al l Pet s mus t b e ou t ofyar ddurin g stabilization . Ho w muc hnotic e d o you nee dt o hav e abov e mentione dtask s completed ? Ifyo u ar e alandlor dyo u wil l nee dt o contac t th e tenan t a s Pruden t Technologie s wil l onl y informyou . D o you hav e an y pet s tha t resid e i nyard ? 

# 2^ ^ • 5 

# Notic e needed : Numbe r t o cal l t o giv e notice : Who mw e ar e givin g notic e to : 

# ""TM°""""'"'" " ^

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^S^^"*" ^ ('^ \ TECHNOLOGIES , INC . 

## PRE-STABILIZATIO NVIDE O FOR M I UNDERSTAN D THA T PRUDEN T TECHNOLOGIE S WIL LB ECOMIN G OU T T O SHOO T A PRE-STABILIZATIO NVIDE O A T M Y PROPERTY . TH EVIDE O I S JUS T A TOO LUSE D T O DOCUMEN T 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 NAME : - 6 ^ 

# 67^tc ^ r-ecLAj ^ 

## PROPERT Y ADDRESS : 

# // / 

# 5 S Z S+ BVID/SAID : %30S l HOMEOWNER S SIGNATURE : PRUDEN T REPRESENTATIV ESIGNAT U AN Y CONDITION S NEE D T O B EAWAR EO FBEFOR ESHOOTIN G VIDEO : (LE . PETS , NOTIC ENEEDED) : '^^(K^ r

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 7A^l""''- ! TECHNOLOGIES . INC . 

# ACCES S INFORMATIONTRACKINGSHEE T BVI D 

# : ms l PROPERT Y ADDRESS : Propert y Owne dBy : (I f ne w propert y owner )

Owner s Phon e No's : Home : Work : 

# C.XV.MtJmL
- Fax: - Acces s Contractor : AS WPD A ME S P EOthe r (Prudent ) DAT E TIM E M:CESSO R CONRAC LDETAI L 

# 1-1-0 ^ "^'.0 0 p ^ i<fAi ^ 

# M^Alk J - Q-^k £/[lafiCf . 

# ^M Co mI 

# M&sii^Z.,j£^QS:jfj^MmjLe-.4^ ^ •f a

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 7TECHNOLOGIES . ] 

# Acces s Assessment Form : (Mus t b e complete dfo r every property . Informatio nmus t b e obtaine dfro mapropert y wal k thru , no t give n b y owner ) I s th e propert y stucc o o r asbestos ? I f

yes , i s an y ofth 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 special preparatio n techniques . I t wil l b e returne dt o EP A an dthe y wil l assig na t alate r date . Doe s thi s propert y requir e lot s of scrapping ? . J

n ' \ 

## Doe s thi s propert y requir e alif t o r wafTolding^t o reac huppe r levels ? Doe s thi s propert y hav e lot s o f

plant s o r item s inarea s wher e paintin g i s / required ? ^ ^JOUJUC ^ (jj ) I I CM \0^0 1 J^ . Doe s thi s propert y hav e an y significant structura l damage ? " / /L/ A J , j 

# ^ 1 / ^ T (^ ^ I S WfTim . 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 , 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 7TECHNOLOGIES ^ IN C 

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

# ^ 0 I f

yes , describ e locatio no f garage . Doe s thi s propert y hav e aluminu msiding ? I f

yes , 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 ? (I.e . roo f shingle s a s siding) ? I f

yes , EXPLAIN ? I s thi s propert y vacan t o f occupied ^ 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 ? 

# ^d^ ^ 

# 4

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 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 ALON G WIT H ASSIGNED PROPERT Y T O COMPLET ESTABILIZATIO NPROCESS ? 

# AlO I FI T IS , GE T ACCES S FRO M ALLREQUIRE 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 , 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 7TECHNOLOGIES , IN C 

# PAIN T MATCHIN GFORM : T O B EFILLE D OU T ONLY I FMATCHIN GCOLO R PROPERTYADDRESS : // / S S > ^ ^ BVID : 

# ^63 1 I UNDERSTAN D SHERWINWILLIAM S WIL LMATC H MY CURRENT COLORS . Homeowner signature :

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^ ^ TECHNOLOGIES ; IN C 

## PRE-STABILIZATIO NPROPERT Y SAFET Y ASSESSMENT FOR M PROPERTYADDRESS : // / $ ^ ^^' ^ <^( f 

## BVID/SAID : ^26 ^ ' PRUDENT ASSESSMENT REPERSENTATIVE :



## ******IFSAFET Y RIS K PROPERT Y MUS T B ETURNED OVE RT O KATH Y ROTHE RBEFOR EI T CA NB EASSIGNED T O A CREW/SUB . REPERSENTATIV EREMARKS/FINDINGS : « . 

### (POWER-LIN EPROXIMIT Y T O PROPERTY , SCAFFOLDING/LADDERS/LIFT S NEEDED , UNSAF EAREAS , UNSAF ENEIGHBORHOOD...ETC. )

REQUIRE S K.ROTHE RAPPROVAL SUBMITTED T O K.ROTHE RON :

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 7TECHNOLOGIES , INC . 

# Checklis t fo r

th e Worksite HazardAnalysi s B^ i Address : l \\ Crew : Date : "7 [ ?^ | Ot^ft ^ Ite m OK ? Hazar d Correctiv e Actio n Overhea dLine s i ^ -V^ 

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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 7J«a* ^ 

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# 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 

# V^ I hav e receive d a cop yo f th e pamphlet , Renovat e 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 o f th e lea d 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 pamphle t befor e th e wor k began . 

# tr^.uj l f^GL A 

# y-i-o" ! e o f recipien t Dat e Signatur e o f recipien t Self-Certificatio n Optio n (fo rtenant-occupie d dwelling s only ) — I f th e lea d pamphle t wa s delivere d bu t a tenan t signatur e wa s no t obtainable , yo u maychec k th e appropriat e bo xbelow . •Refusa l t o sig n —I certifytha t I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , Renovat e 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 belo wa t th e dat e an d tim e indicate d an d tha t th e occupan t refuse d t o sig n th e confirmatio n o f receipt . I furthe rcertifytha t I hav e lef t a cop yo f th e pamphle t at th e uni t wit h th e occupant . •Unavailabl e fo rsignatur e —I certifytha t I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , Renovat e 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 belo wan d tha t th e occupan t wa s unavailabl e t o sig n th e confirmatio n o f receipt . I furthe rcertifytha t I hav e lef t a cop yo f th e pamphle t at th e uni t b yslidin g i t i t th e door . 

# m 7'7'd 9 Attempte d deliver y dat e an d tim e lea d pamphle t deliver y Signatur e otperso n certifyin g lea d pamphle t deliver y 

# /// ^-3^^ ^ <f f Uni t Addres s Not e Regardin g Mailin g Optio n —A s a n alternativ e t o deliver yi n person , yo u maymai l th e lea d pamphle t t o th e owne rand/o rtenant . Pamphle t 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 pos t office) .

### Dougla s Count y Accoun t Infi^natio n Page 1 of 3 Dougla s County , Nebrask a Propert yRecor d - R142356000 0 Prin t Repor t Informatio n i s vali d a s of 2009-6-1 6 '*^' ^ '"'"TM ' "'"^ ^

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# Z303 ) 331 7 BUR TS T# 1 OMAH AN E 68131-000 0 Propert yInformatio n Ke yNumber : 235 6 OOO O 1 4 Accoun t Type : Residentia l Parce l Number : 142356000 0 Parce l Address : 11 1 S38S T OMAH AN E 68131-000 0 Lega l Description : ! JEROM E PAR KLOT3 BLOC K1 0 4 5 X 16 7 1 Vaiu e Informatio n Lan d Improvemen t Tota l 200 9 $13,100.0 0 $134,800.0 0 $147,900.0 0 200 8 $13,100.0 0 $134,800.0 0 1 $147,900.0 0 200 7 $13,100.0 0 $134,800.0 0 $147,900.0 0 200 6 $13,100.0 0 $81,500.0 0 $94,600.0 0 200 5 $13,100.0 0 $81,500.0 0 $94,600.0 0 200 4 $13,100.0 0 $81,500.0 0 $94,600.0 0 Sale s Informatio n Sale s Date : 2004-05-1 0 Dee d Type : W D Book : 200 4 Page : 13129 4 Price : $120,000.0 0 Grantor : Thoma s VanBell e Eta l Grantee : Benjami n Gaudrea u Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 1996-01-2 6 Dee d Type : D Book : 202 5 Page : 21 5 Price : $ 76,000.0 0 Grantor : 

### http://douglasne.mapping-online.eom/DouglasCoNe/static/accountinfo. j sp?accountno=R l 42.. . 7/7/2009^ "i*» , •••">''' * ••f?r^ " ' ..^•'tfttttf-l.
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### Dougla s County Accoun t Infi^aatio n Pag e 2 o f 3 Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F 

### (/n/t s Dept h W/dfA i Vacan t 0.1 7 7515. 0 1. 0 167. 0 45. 0 N o Improvemen t Informatio n Buildin g 1 2 1 2 Sl^l^^ liiiishc d

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### . J' " It.. * I*".' ­

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Fi nEHWN( * (nc l InI i v Ariei i « i .i | l i CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 2250. 0 Percen t Complete : 100.0 % Perimete r, 0. 0 Quality : Goo d Uni t Type : Condition : Averag e

Buil t As : 2 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : I Force d Ai r Rooms : 15. 0 Exterior : •^ - Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 3. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 5.0 _

Roo f Type : Stories : 2. 5 Floorcover : Allowanc e Foundation : Blocl < Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t I 190 5 0 % 190 5 10 2 Detai l Typ e Detai l Descriptio n Unit s 1. 0 Basemen t Bsmn t Blocl < 8 f t Applianc e Allowanc e 960. 0 Basemen t Finishe d 400. 0 Fixtur e Additiona l Fixture s 1. 0 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accoimtno=R142. . . 7/7/200 9

### Dougla s Count y Accoun t In£^jiation^ ^ Page 3 o f 3 Fixtur e Fixtur e Porc h Porc h Use r Use r Use r Bas e Fixture s Bat h Ful l Sla b Roo f Cei l Sla b Roo f Cei l 2n d floo r Atti cFul l Finis h windo wN C 1. 0 3. 0 140. 0

16. 0 910. 0 356. 0 1. 0



### http://douglasne.mapping-online.coni/DouglasCoNe/static/accoxmtinfo.jsp?accoimtno=R142.. . 7/7/2009

# PlUD ] TECHNOLOGIES , INC . 

## Pruden t Propert yClose-Ou t For m (Lead-Base d Pain t Stabilization ) SAID : ^OS f Propert yAddress : 

# // /

^ . ,?p'5< r Owner' s Name : ^ N 6^U/)I?CAL (

S.N O Performanc e Standards/close-Ou t Criteri a 1 Wa s th e entir e structure(s ) painte d wit h th e exceptio n ofth 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 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 satisfactorily ? 3 Were al l require d area s o f th e structure(s ) prime d a s neede d an d 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 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 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 condition ? 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 i item s suc h a s polyethylen e sheeting , ladders , pain t brushes , 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 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 ? 1 1 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 ? 1 2 Othe rConsiderations ? Propert yOwne rDiscussions ? Additiona l Wor k tha t i s Require d 

### Pruden t Representativ e Signatur e 

# pi f Date : 7-/^-^ f Propert yOwne rSignatur e Date :7 ^ // , , ^ ^ Ye s N O 

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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 , WI 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