### TRANSMITTA L o f

OMAHA LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R
SAID# : ^l^Rfa j Date : fi|X)q. |aoi n Address : ,^^* r Nir4WA < St
. Stabilizatio n Contractor : Pruden t Technologies , Inc
. Year : 2010
_ PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S E ^ Vide o o f propert y (DVD ) S

i Executiv e Summary W Signe dAcces s Agreemen t for subjec t propert y ^ Pre-Renovatio n For msigne db y Property Owne r D Pre-Renovatio n For mfor Occupant/Tenant , i f applicabl e \ y Paintin g Agreemen t D Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) sZ Renovatio n Recordkeepin g Checklis t signe db y Certifie dRenovato r S / Photograph s fi^ Satisfactory close-ou t chec k lis t signe db y Property Owne r B ^ Property close-ou t chec k lis t signe db y EP A Q^ Propert y informatio n fromDougla s County Assessor' s OfBc e wZ Hazar danalysis , i f prepare d D Safet y Audit 3026002 4

• (MerrdescH.. : illini l Superfun c

PrudSi t Te(;hno'logy/mc r Signatur e i\Sw s
(after file folde r review )TECHNOLOGIBS , 1 

## Propert y Summar y Date : 6/24/201 0 LB P STABILIZATIO N EP A CONTRAC T EP-R7-08-0 7 Mont h of : Jun e Propert y Address : 302 5 Nichola s St
. SAI D # : 2486 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 : 03/30/2010 ii
. Wor k Began : 04/12/2010 iii
. Close-Ou t Date : 04/12/201 0 B
. Enclosures : 1
. Pre-Stabilizatio n Vide o 2
. Post-Stabilizatio n Vide o 3
. Signe dAcces s Agreemen t For m• 4
. Advance-Notic e For m 5
. Pre-Stabilizatio n Vide 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 h For m 10
. Pre-Stabilizatio n Propert y Safet y Assessmen t For m 11
. Work-Sit e Hazard s Analysi s Checklis t 12
. Pre

- Stabilizatio n Propert y Hazar dAssessmen t Photograph s 13
. Dougla s Count y Assesso r Propert y Informatio n 14
. Signe dPropert y Completio n Agreemen t For m 15
. Propert y Close-Ou t Chec k Lis t Signe dB y EP A4afLOCIBS , IN C 

### Pruden t Technologies , Inc
. (Prudent ) i s unde r

contrac t (Contract #EP-R7-08-07 ) wit h th e U
. S
. Environmenta l Protectio n Agency (EPA) to stabiliz e Lea dBasedPain t (LBP) a t anumbe r

ofpropcrtie s locatedi n Omaha , Nebraska , including th e propert y locate dat : 

## 3^P. 5 hfVc|.g>l<a ^

<; f Th e EP A request s you r

permissio n t o allo w Pruden t t o perfor mLB P Stabilizatio n a t thi s property . B y signing thi s form , the propert y owne r

grant s permissio n t o Pruden t to perfor mactivitie s relate dto LB P Stabilizatio n including scraping paint an dpaintin g ofth e referencedproperty . Further , th e owner/tenan t verifie s tha t they hav e receive dth e LB P pamphle t "Renovat e Right. " B y signing thi s documen t I agre e to allo w a n EP A contractor to conduct asoi l cleanu p a t m y propert y following completio n of lead-basedpaint stabilization , ifth e soil cleanu p ha s no t alread y been performed
. I understandtha t th e stabilizatio n contractor cannot provide assurance s of which contractor will b e botm dto th e soil cleanup
. I furthe r

imderstan dtha t th e soil cleanu p contractor will mak e all reasonabl e efforts to addres s concem s tha t I , a s th e propert y owner , ma y hav e regarding soil cleanu p a t m y property . fx l Yes , I hav e rea dan dimderstan dth e paragraph above
. 

# V^ A 'Z^/ Propert y Owner' s Signatur e Dat e Ifyo u hav e an y question s abou t the LB P stabilizatio n plaimedfo r

you r

property , pleas e contact Prudent' s Custome r

Relations/Offic e Manage r

fo r

th e Lea dBasedPain t Stabilization , Mr
. Chandr a Shekar a

t 402

- 504-100 4 o r 402-889-3821
. Genera l question s abou t the OmahaLea dSit e cleanu p ca n b e directe dto the EP A Publi c Information Center s a t (402 ) 731-304 5 (Sout h Omahaoffice) or (402 ) 991-958 3 (Nort h Omahaoffice)
. Propert v Acces s Grante dBv :

Topert y Owner' s Signatur e Dat e 

# y^/?//zz S X/i/ A Pleas e Prin t Nam e

808 0 War d Parkway , Suit e 40 5 250 5 N
. 24* ^ Street , Suit e 30 8 424 2 IMedica 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

# Tm n TBCHNOLOCIBS , IN C LfHi l 

### PROPERT Y INFORMATIO N (T o b e complete db y residen t and/o r propert y owner — pleas e print ) RESIDEN T NAME : Anrtt^< ; f^\\\J( K (.Owne r Tenan t RESIDEN T ADDRESS : r \D K A ) i r Jn olo s S f 

# Cn)aln ^ Al E &^i M
I FRENTAL , PROPERT Y OWNE D BY : OWNER' S MAILIN G ADDRESS :
OWNER' S TELEPHON E NUMBER : Home : lQb2\70'\'^57JWoTk : Cell: yO^-S^O ^ NUMBE RO FOCCUPANTS UNDE R7 YEAR S OLD : O iLnU j Jlu^
. 'Xjne
. 3 l0)0 j TOTA L NUMBE RO FOCCUPANTS : _2
. NUMBE RO FCHILDRE N UNDE R7 YEAR S OL D WH O PLA Y I N TH E YAR D FOR5 HOUR S O

RMOR E PE RWEEK : jl^aL j A u € , Tu)r^r
. ?, j JoLO' ) COMMENT S O RSPECIA L INSTRUCTION S (suc h a s does , entr y gates , etc.) ;

AUTHORIT Y FORENVIRONMENTA L RESPONS E ACTIONS : Th e activitie s to b e implemented by EP A unde r

thi s agreemen t ar e pursuan t to Section 10 4 o f CERCLA , 4 2 U.S.C
. 9604
. EPA' s right ofacces s to th e propert y i s provide dfo r

in Section 104(e) o f CERCLA , 4 2 U.S
. C 9605(e) , which provide s entr y fo r

"determinin g th e needfo r

response , or choosing o r

taking an y respons e actio n unde r thi s title , o r

otherwis e enforcing th e provision s ofth e title. "
Propert y Owne r

Signature : (Signature ) Dat e 808 0 War dParkway , 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"nCHNGILOGIBai,IN C 

### PR E & POS T PAIN T STABILIZATIO N VIDE O AN P PICTURE S I understan d tha t pruden t Technologie s (Prudent ) wil l b e comin g ou t t o shoot a Pre Stabilizatio n vide o an d t o tal<e picture s of m yproperty
. Pruden t wil l us e th e video s an d picture s t o documen t th e curren t propert ystatus/condition
. Also , Pruden t wil l shoo t a vide o sho t followin g th e completio n o f th e pain t stabilization
. I give permissio n t o video s an d picture s of m yproperty
. Pleas e lis t an yspecia l condition s tha t Pruden t employee s nee d t o b e awar e of before shootin g a vide o (suc h as pets , prio rnotice , etc.)
.



# :^Aa ^ M\rhr>la ^ ,9/
. nr>,ah A NF
. &EI3 I Propert yAddres s 

# An/drP S .ClvJ Q Owner' s Nam e Signature ^af e
ADVANC E NOTIC E REQUIREMEN T Afte rsignin g th e acces s yo u allo w Pruden t t o begi n Lead Base d Pain t Stabilization
. Al l Plants , weed s an d an yvehicle s o ritem s o n ope n porc h (enclose d porche s wil l NO T b e stabilized ) mus t b e remove d prio rt o stabilization
. Al l Pets must b e ou t of yard durin g stabilization
. Pleas e indicat e below ho w muc h advanc e notic e yo u nee d t o have th e above mentione d tasks completed
. I f yo u are a landlor d yo u wil l nee d t o contac t th e tenan t a s Pruden t wil l onl yinfor m th e propert yowners . D o yo u have an ypets tha t resid e i n yard : hJ Q Notic e needed : I —D
. rJlQu S Phon e numbe rt o cal l t o give notice : '~/0^ ~ 3CoO ^ Who m w e are givin g notic e to : KCXT\€ ^

S\\\/( K

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

# Curren t Sampl e Pre-RenovSio n For m Effectiv e unti l Apri l 2010
. Confirmatio n o f Receip t o f Lea d Pamphle t j£ j hav e receive d a cop yo f th e pamphlet , Renovate Right : Importan t Lea d Hazar d Z Infomnatio 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 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 e o f replpien t ^ Date Signatur e o f recipien t Self-Certificatio n Optio n (fo rtenant-occupie d dwelling s only ) — I f th e lead pamphlet wa s delivere d bu t a tenan t signatur e wa s not obtainable , yo u ma ychec k th e appropriat e bo xbelow
. •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 Infomnatio n fo rFamilies , Chil d Car e Provider s an d Schools , t o th e renta l dwellin g uni t liste d below a 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 rcertif ytha t I hav e lef t a cop yo f th e pamphlet a t th e uni t wit h th e occupant
. Q 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 Hazard informatio n fo r Families , Chil d Car e providers an d Schools , t o th e renta l dwellin g uni t liste d below an d tha t th e occupan t wa s unavailabl e t o sig n th e confirmatio n of receipt
. I furthe rcertif ytha t I hav e lef t a cop yo f th e pamphlet at th e uni t b yslidin g i t unde rth e door
. 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 certifyin g lead pamphlet deliver y

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 lea d pamphle t t o th e owne rand/o rtenant
. Pamphlet must 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)
.SDSLINC
. 

### PAIN T MATCHIN G FORM : 1
. T O B E FILLE D OU T ONLY I FMATCHIN G COLO R PROPERT Y ADDRESS : 3/0^ 5 )\f.^/-k/of.a<= ^ J> t BVID : 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 Siding ^ Soffi t i ^ LAI20 9 Fores t 3 Fasci a 

# y Come r Tri m 

# io^ 5 U<C:M^ ^ u ^ Window Trim s 

### u ^ Doo r Trim s 

# z^{dC ^ Cis[o c u ^ Fron t Porch Ceiling 

# « x Fron t Porc h Ceiling Beams ^ Fron t Porch Floor ^ Fron t Porc h Railing s t / ' Fron t Porc h Step s t ^ Siding Baseboard s w ^ Foundation 

# Cjz^^ry\er\\ ' s X (j)r^Cir^ P



# ^^a. r \:>pr\ c

- ^



### • I UNDERSTAN D SHERWI N WILLIAM S WIL L MATC H M Y CURREN T COLORS
.
Homeowne r signa l 808 0 War d Parkway , Suit e 40 5 Kansa s City , M O 6411 4 Phone : (816 ) 363-370 3 Fax : (816 ) 363-370 7 250 5 N
. 24* ^ Street , Suit e 30 8 Omaha , Nebrask a 6811 0 Phone : (402)504-100 4

Fax : (402)504-100 5 424 2 Medica l Drive , Suit e 425 0 Sa n Antonio , T X 7822 9 Phone : (210)822-958 8 Fax : (210 ) 579-657 7

# m IKHNOUXnBS b IN C 

### ACCES S ASSESSMEN T FORM : 

# 3 ^ "2- 5 I s th e propert ystucc o o rasbestos ? I f yes , i s an yo f th e stucco o rasbesto s damage d o 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 d t o EP A an d the ywil l assig n at a late rdate
. Doe s thi s propert yrequire lot s o f scrapping ? Doe s thi s propert yrequire a lif t o rscaffoldin g t o reac h uppe rlevels ? Doe s thi s propert yhave lot s o f plant s o ritem s i n area s where paintin g i s required ? Doe s thi s propert yhave an ysignifican t structura l damage ? I f yes , EXPLAIN ? Doe s thi s propert yhave a garage ? I f yes , descritj e locatio n o f garage . Doe s thi s propert yhave aluminu m siding ? I f yes , i s i t origina l factor yfinis h o rha s i t bee n painte d over ? Doe s thi s propert yhave an yothe rtyp e o f structura l components ? (I.e
. roof shingle s a s siding) ? I f yes , EXPLAIN ? I s thi s propert yvacan t o roccupied ? Ar e ther e an ypet s a t thi s property ? Ar e ther e an ylow hangin g powe rlines ? D o w e nee d neighbor' s access ? I f ye s pleas e explai n an d ge t neighbor' s propert yaddres s an d owne r information
. I f possible , ge t signature fro m th e neighbor
. 

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# X^ s N< 9

808 0 War d Parkway , Suit e 40 5 250 5 N
. 24' " Street , Suit e 30 8 4242 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 Fax:(816)363-370 7 Phone : (402)504-100 4 Fax : (402)504-100 5 Phone : (210)822-958 8 Fax : (210 ) 579-657 7

# f/^^T ^ —f l !r>=.)ys-r_ s 5^ M "VO^^IQ ^ 

# E-s.- U - 

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# S^S^' L - ^•^^r-: ^ f\l\ ^ -X^^Q^^ , ^(effectiv e Apri l 2010 )


### RENOVATIO N RECORDKEEPIN G CHECKLIS T
Nam e

of Firm : ^ Dat e an dLocatio n of Renovation : APJ ^ xJ^O^^CA ^ ^ ^ Brief Descriptio n of Renovation : ^ ^ f^^A^ D \V ^ ^0\.\f^'\^C ^ Nam e

of Assigne dRenovator : C-AStv.' ^ ^^g'^PO Q Name(s ) of TrainedWorkers : J^j ^ .^AtVUl/l i ^rj^l^i ^ <fo*C^V M,.J0^V V 

### fc^/^ , ^^^HT Wl/tJ^J H NameofDus t Sampling Technician , Inspector , and/or Ris k Assessor , if used : 

# ^— ^P ^^ ^ Copie sof renovator anddus t sampling technicia n qualification s (training certificates , certifications )on file. Ii

3 Copie sof renovator anddus t sampling techn i 0Ce i Certifiedrenovator provide dtrainin gto worker s on (chec k

all tha t apply) : IZTosting wamin g sign s ^TSettin g

up plasti c contaimnen t barrier s ^^Maintainin g containmen t ja^yoidin g sprea d

of dus t to adjacen t area s [^/wast e handling <ZfPost-renovatio n cleaning D Tes t kit s use d by certifiedrenovato determine whethe r

lea dwa s presen t on components affecte d

by ^ato r r t t o o ( renovatio n (identif y kit s usedan ddesgrib e sampling location s an dresults : esgribe ! 

# vx ^ 

# y \L

\Warmn g sign s poste d at entranc e to wor k

area . \Z Wor k

are acontained to preven t sprea d

of dus t an ddebris
. [Z

T Widow sin an dwithin 20 fee t ofth e wor k

are aar e closed

" rsin andwithin 20 fee t ofth e wor k

area s ar e closedan dsealed rs tha t mus t be use d in th e wor k

are aar e covered to allo w passag e but preven t sprea d

of dust
. 

# Z

^oun dcovered by plasti c sheeting extending 10 fee t fro mwor k

are a- plasti c anchored to the buildin g andweighteddown by heavy objects
. P

If necessary , vertica l containmen t installe d to preven t migratio n of dus t an ddebri sto adjacen t iroperty
. Wast e containe don-sit e an dwhil e bein g transporte doff-site
.

Renovatio n Recordkeepin g Checklis t Omah a Lea d Sit e(effectiv e Apri l 2010 )



### Wor k

site«^operly cleane dafte r

renovation
. All chip s an ddebri s picke dup , protectiv e sheeting misted , folde ddirt y side inward , andtapedfo r removal
. ( • Wor k

are aHEP A vacuumedto ge t paint chip s fro mgroundsurface , if necessary . 0 Certifiedrenovator perfom^ dpost-renovatio n cleaning verification (describ e results) : 

# z . c

ertif y unde r

penalt y o f

la w tha t th e abov e informatio n i s tru e an dcomplete
. 

## eici\f ? Nam e ancwTitl e

Renovatio n Recordkeepin g Checklis t Omah a Lea d Sit eTBCHNOLOGIES , IN C 

## ACCES S INFORMATIO N TRACKIN G SHEE T
BVID : PROPERT Y ADDRESS : Propert y Owne dBy : (I f ne w propert y owner )

Owner s Phon e No's : Home : Work : Cell : - Fax : - Acces s Contractor : AS W PD A ME S P E Othe r (Prudent )
DAT E TIM E ACCESSO R CONRAC T DETAI L <

^ JQb^(i ^ T,)0 ^ M ^^AA*r--J ^ (_

p yf j ^' ' 

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### Comments :

808 0 Ward Parkway , Suit e 40 5 2505 N
. 24* ^

Street , Suit e 30 8 4242 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 ) 579-6577

## Checklis t fo r th e Worksit e Hazar dAnalysi s Address : Crew : Date : 0^ [ 0^(2.010
. Ite m OK ? Hazar d Correctiv e Actio n Overhea dLine s tE*« 3 V ^

A/O i 

# f ffbltAi. i*JL— , be AUA K In~transi t Vehicl e Clearanc e ^ Sov ^ tAl / Level s aroun dhig h wire s Vehicl e Clearanc e aroun d hig h wire s whe n woridn 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 n Propert y Neighbo r Acces s Require d J ^ Hig h Traffi c Are a 4 J ^ Garag e "jVviA A M—< \^\ ^ tn \b<vfcV^—a l HT H (o^nr^^, , b * fkjilr
. ^ ^ Structure s -tJ ^ Drivewa y Sidewal k Foundatio n Retainin g Wall s nW^ i I , ^^^ , \^.^i1<0 ^ Fence s Tree s Foliag e Genera l Conditio n o f yar d Damage dAreas : sin k holes/rotte dwoo d Sprinkle r Syste m Pet s Insect s Weathe r Condition s Unsaf e drivin g condition s Unsaf e neig h 

### Site Safet y Office r 

# 9
. J^<^^ ^ 808&y/ar d PbrkV4iy , Suit e 40 5 250 5 N
. 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s CW , M O 6411 4 Omaha , Nebrask a 6611 0 Sa n Antonio , T X 7822 9 Phone : (810 ) 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

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.TECHNOLOGIBS , IN C 

### Pruden t Propert yClose-Ou t For m (Lead-Base d Pain t Stabilization ) SAID : c5^9>G \ Propert yAddress : hCO S A\^m
. <S' V Owner' s Name : }Ca ^ S|I\ M 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 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 

# 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 ? 

# V 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 ? 

# V 4 Ar e al l ofth e area s wher e contaminate d material s hav e bee n spille d thoroughl yvacuumed / cleaned ? 

# X 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 c acces s area s 

# V 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 X L 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 l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e et c properl 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 EPA Close-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 ? 

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

# > r 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 

# V
Pruden t Representativ e Signatur e • ^ 

### Date :^/iXkcI O Propert yOwne rSignatur e 

# /M^ o Date:Wu/J^Ol O 808 0 War d Parkway , Suit e 40 5 2505 N
. 24' " Street , Suit e 308 4242 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 Fax : (816 ) 363-370 7 Phone : (402)504-100 4 Fax : (402)504-100 5 Phone : (210)822-958 8 Fax : (210 ) 579-6577

# PMJD E ENVIRONMENTA L & CONSTRUCTIO N TECHNOLOGIES , INC
. SERVICE S



### OMAH A LEA D BASE D PAIN T REMEDIATIO N EP A Close-Ou t For m 201 0 (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-07 ) SAID : tl A S ^ I Propert y Address : 3 < ^ ^ S ' X tV,) ^ |g > < ^ ^ ^ Owner' s Name : Performanc e Standards/Close-Ou t Criteri a YE S N O 1
. Wa s th e entir e structure(s ) painte dwith th e exceptio n ofth e stated , exclude d areas ? Thi s woul dinclud e paintin g o f othe r associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an dexterio r surface s o f u ^ garages . 2
. Wa s al l scrapin g an dothe r preparatio n work complete dsatisfactorily ? u ^ 3
. Wer e al l require darea s ofth e structure(s ) prime da s neede dan dpainte dwith tw o to p coats ? t ^ 4
. Wa s th e pain t product s utilize dequivalen t t o a2 5 year product/quality ? u ^ 5
. Ar e al l ofth e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y vacuumed/ cleaned ? *x ' 6
. Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s o n th e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y t ^ othe r generate ddebris ? * ^ 7
. I s th e gras s are atha t surround s th e structure(s ) i n reasonabl y goo dcondition ? 8
. Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . properl y removed ? f ^ 9
. Istherean y evidenc e ofpropert y damag e tha t wa s don e b y th e contractor ? An y property damag e need s t o b e complete dprio r t o th e EP A Close-Out
. 1 ^ 10
. Ha s th e Property Owne r signe dth e completio n form ? , ^ 11
. Ar e ther e an y propert y item s tha t wer e temporaril y re-locate db y th e contracto r tha t nee dt o b e move dback ? w ^ 12
. Ar e ther e an y (known ) lingerin g issue s with th e propert y owner(s ) tha t hav e 

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808 0 War d Parkway , Suit e 40 5 250 5 N
. 24' " Street , Suit e 21 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 7Douglas Count y Accoun t Infonnation Pag e 1 of3
Dougla s County , Nebrask a Propert yRecor d - R180394000 0 Prin t Reoor t NE W Featur e - Parce l Dimension s availabl e ( B scal e 0-5 0 f t wes t o f S2n d S t - VlO W O n Ma O Informatio n i s vali d a s o f 2010-3-1 6 Treasurer' s Ta xRepor t Ne w Featur e - ¥r ¥•• ¥Aut o Sale s Searc h Owne r SILV A ANDRE S D 302 5 NICHOLA S S T ' OMAH A N E 68131-000 0 Propert yInformatio n Ke yNumber : 039 4 OOO O 1 8 Accoun t Type : Residentia l Parce l Numbe r 180394000 0 Parce l Address : 302 5 NICHOLA S S T OMAH A N E 68131-000 0 Lega l Description : MONTCLAI R AD D LO T 18 0 BLOC K0 4 7 X 12 0 Valu e Informatio n Lan d Improvemen t Tota l 200 9 200 8 200 7 200 6 200 5 200 4 $2,500.0 0 $2,500.0 0 $2,500.0 0 $2,500.0 0 $2,500.0 0 $2,500.0 0 $72,600.0 0 $72,600.0 0 $72,600.0 0 $72,600.0 0 $72,600.0 0 $43,900.0 0 $75,100.0 0 $75,100.0 0 $75,100.0 0 $75,100.0 0 $75,100.0 0 $46,400.0 0 Sale s Informatio n Sale s Date : 2009-09-1 4 Dee d Type : W D BooAr : 200 9 Page : 11339 5 Price : $90,000.0 0 Grantor : FENNEL L MADALIN E L Grantee : SILV A ANDRE S D ETA L Vaiid/lnvaiid : Vali d Exclusio n Reason : Sale s Date : 1995-12-2 3 Dee d Type : D Book : 202 6 Page : 52 3 Price : $41,000.0 0 Grantor :
http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R1803940000 3/23/201 0Dougla s County Accoun t Informatio n Pag e 2 of 3
Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 2 5640. 0 1. 0 120. 0 47. 0 N o Improvemen t Informatio n Buildin g 1 »i:sM(aat»s i TWOSTOH Y 

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Buil t As : 2 Stor y Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 8. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Siiingl e Bedrooms : 3. 0

Roo f Type : Hi p Stories : 2. 0 Floorcover : Allowanc e Foundation : Bloc k Sprinitle 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 192 0 0 % 192 0 9 0 Detai Y Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 840. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0
http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R l 80394000 0 3/23/201 0Douglas Count y Accoun t Infonnatton Page 3 of3 Garag e Detache d 252. 0 Porc h Cvr d Woo d Dec k 166. 0 Porc h Woo d Dec k 28. 0

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