## TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R SAID# : 2829 5 Date : Novembe r 1 9 Address : 240 3 N 2 9 St . Remediatio n Contractor : Pruden t Technologie s Year : 200 8 PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S e

l Vide o o f propert y (DVD ) [ ^ Executiv e Simmiary H Signe dAcces s Agreemen t for subjec t property \J Paintin g Agreemen t D Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) D Photograph s [3 Satisfactory restoratio n signe db y Property Owne r D Property close-ou t chec k lis t signe db y EP A aProperty informatio n fromDougla s Covmt y Assessor' s Offic e D D D



## Si^tiS? " Dat e

4031062 4 

# Hil l Superfun d

### PROPERT Y SUMMAR Y Date : 10.08.0 8 LB P STABILIZATIO N EP A CONTRA T EP-R7-08-0 7 Mont hof : Octobe r Propert y Address : 240 3 N 2 9 St . SAID : 2829 5 

### A . EXECUTIVE SUMMAR Y A. 1 Issue s Encountered : None A. 2 Issue s Resolved : Non e

A. 3 Uniqu e Findings : None 122A. 4 Othe r Relevan t Information : Non e Acces s Date : 08/21/0 8 Work Bega n Date : 9/30/0 8 Closeout Date : 10/07/0 8 Enclosures ; 1 . Pre-Vide o 2 . Post-Vide o 

### 3 . Propert y Statu s Form 4 . SignedAcces s Agreemen t 5 . Pre-Renovatio n For m 6 . Pain t Matc hForm 7 . Trackin g Form 8 . Dougla s Count y Assesso r Propert y Informatio n Pag e 9 . EPA Propert y Closeou t for m 10 . Propert y Completio n Agreemen t

TECHNOLOGIES , INC .ENVIRONMENTA L& CONSTRUCTIO N 

## TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : ^tf^ S A/ - ^ ^ Date : "f/Xl^O y Phone : BVID : 

# ^^5~-'J77 ^ ^'EQ ^ 

# Vr Plant & Permanen t Landscaping To Remain In Plac e Item# Descriptio n andLocatio n On Ma p

/ / 

## P~-^xlstin St"''^'"^ " Pre-Existin g g

Conditio

Conditio n no

o f

f

Structure s Doe s your Basemen t hav e ahistor y

of leaking ? Ye s — No ~ Item# Descriptio n & Locatio n On Ma p



# II Propert y Owne r Pruden t Emp l Signature : 8080 Ward Parkway , Suit e 40 5 2606 N. 24* ^

street , Suit e 30 8 4242 Medica l Drive , Suit e 426 0 Kansa s City , MO 6411 4 Omaha , Nebraska 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-3703 Phone : (402)604-100 4 Phone : (210)822-968 8

# ;i^a9 ^

Pruden t Technologies , Inc . (Prudent) i s under contract (Contract #EP-R7-08-07 ) wit hth e U . S . Enviromnenta l Protectio n Agenc y (EPA ) t o stabiliz e Lea dBase dPaint (LBP ) at anumbe r

o f propertie s locatedi n Omaha, Nebraska , includin g tiie propert y locateda t g?T/? 3 A^ - '2'^Sf The EP Arequest s your pemiissio n t o allo w Pruden t t o perfon n LB P Stabilizatio n a t thi s property . B y signing thi s form, th e propert y owner grant s permissio n t o Pruden t t o perfonn activitie s relatedto LB P Stabilization including scrapin g paint andpaintin g o f th e referencedproperty . Further , th e owner/tenan t verifie s tha t they hav e receive dth e LB P pamphlet "Renovat e Rig^t " I f

you hav e an y question s about th e LB P stabilizatio n plannedfo r

your property , pleas e contact Prudent' s Administrative Cler k

fo r

th e Lea dBasedPaint Stabilization , Ms . Debora hAkerele-Johngon . a

t (402 ) 504-1004 . Genera l question s about th e OmahaLea dSit e cleanup ca n b e directe dt o the EP A Publi c Information Center s at (402 ) 731-304 5 (Sout hOmahaoffice) or (402 ) 991-958 3 (Nort hOmaha office) . Propot y Acce u Grante dBy :

~ ^L(Pleif c Print Name) Propert y Owne r S

i ^ (Date ) / ^ PROPERT Y INFORMATION (T o b e complete db y reiiden t udAi r propert y owae r - pleas e print ) RESIDEN T NAME:/5//f^ ^ \ fi^ (it/* ^ (^^ ^

Rente r RBIIDENTADDRMa^ g /^_g ^

/ \ /

^^^7 ^ f^ S I F RENTAL , PROPERT Y OWNE D BY : '^^*^(^V ^ OWNER' S MAIUN O ADDRESS : cL^^/T^iys ^ ? [ ^ OWNER' S TELEPHON E NUMBER-HOME : < \ //4 4 " T WORK : ( ) NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OL^j^ H NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDER : h i PO'Z L ^ A< ^ NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLA Y I N TH E YAR D FO R 6 HOUR S O R MOR E PE R WEEK : 0 COMMENT S O R SPECIA L INSTRUCTIONS : O-E . DOGS , ENTR Y GATES , ETC. ) 

# ^^tfi/h ag^^f . -g/- ^ Ci^ H f6//izi tjjtH i ^Sk^M^ic^ . AtmiORIT Y FO RENVIRONMENTA LRESPONS EACTIONS ; Th e activilie s t o b e implemente db y EPAunde r dri s agreement are punuan t t o Sectio n10 4 o f

CERCLA . 4 2 U.S.C . 9604 . EPA' s righ t o f

acces s t o di e propert y i s provide d fiw nSectio n104(e ) o f CERCLA . 4 2 U.S . C 9605(e) . wbicb provide s enti y for "detenniningdi e nee d for response , o r choosin g ortakin g any respons e actionunder (hi s title , o r odierwis e enforcin g (h e provision s o f (h

e title. "

«8 0 War d Paricway , Suit e 40 5 260 6 N . 24* ^ Street , Suit e 30 8 424 2 Medica l Drive , Sult a 425 0 lansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 0

# Curren t Sampl e Pre-nenovatio n For m 

# f e Effectiv e unti l Apri l 2010 . Confimnatio n o f Receip t o f Lea d Pamphle t 

# X I hav e receive d a cop yo f th e pamphlet , Renovat e fiigh t Importan t Laa d Hazar d Informatio n fo rFamilies , Chil d Car e f^rovider s an d S^moi s infomnin 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 perfonne d i n m ydwellin g unit . I receive d thi s pamphle t befor e th e wor k began ^

Self-Certlflcatlo 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 ma ychec k th e appropriat e bo xbelow . Q Refusa l t o sig n —I certif ytha t I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , Fi&novate Ri^ : Importan t Lea d Hazar d Infonnatio n fb rFamilies , CNl d Cara Providers 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 confinnatio n o f receipt . I furthe rcertil ytha t i hav e lef t a cop yo f th e pamphle t a t th e uni t wit h th e occupant. Q Unavailabl e fo rsignatur e —I certif ytha t I hav e mad e a goo d lait h effor t t o delive rth e pamphlet . Renovat e Right : importan t ijea d Hazar d Infonnatio n fb r Famines , Chil d Car e provider s an d Schoo/s , 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 confinnatio n o f receipt . I fgme rcertifytha t I hav e left a cop yo f th e pamphle t a t th e uni t t> yslidin g i t unde rth e door . , ^ 

# % i mmui f Printe d naf m o f perso n certliyin g Attempte d deliver y dat e an d tim e lea d pamphle t deliver y 

# _/^^2nZ l m certliyin g lea d pamphle t deliver y 

# PV/ J /[/ • P^*'~ ^ Uni t Addres s Not e Regardin g Mailin g Optio n —A s a n altemativ e 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 . 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) .

# pain t matc h for m Pain t matchin g form : _j- — Propert yaddress : /i^/j 3 AJ - M ^ BVID : ^^^^ ^ ^ ^ 

# Area: M (lov^^" ^ ^^^\QV:^O£Pei\/^^ Q 

# SlfJ^J^ ^ 

# z^Mlmi : Ffi"'^!'po"^ foil' s ^Mhf) ^ mf^'^ '

Area : colo r Explanation :

Area : colo r Explanation : Area : Colo r Explanation : I agre e t o thes e color s a s listed . Onc e paintin g start s I ca n no t chang e thes e selecte d colors . Homeowne r signatur i Pag e 1

# Acces s INFOfMMTTO N TRACfOM G SMEE T pROpan v BfP i 

# 3^7^ ^ ^V^ 3 A/ . ^ Si- . 

# /i/A? £Te aLP . HSBBl-ei ^ OilMTwOlMtNO C 

# wort c

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# M L P M



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# // ^ p ^ I /g ^ IUffmce/m'/^.,A / / f j{ ^

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### Dougla s Count y Accoun t Infonn^o n Pag e 1 of 2 ni^ c Dougla s County , Nebrask a Propert yRecor d - R103577000 0 j 

### Prin t Repor t NE W FMtu n - Parce l Oimenslon t availabl e @ scal e 0-5 0 n wes t o f SOt h S t - Vle W O n Ma p 

### Informatio n i s vali d a s o f 2008-7-1 4 ! Treasurer' s Ta xRepor t Ne wFeatur e - • - • ^ Aut o Sale s Searc h Owne r 

### siwMS KATHLEI N R 240 3 N 2 9 S T OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : 1357 7 00001 0 Accoun t Type : Residentia l Parce l Number : 103577000 0 Parce l Address : 240 3 N 2 9 S T OMAH AN E 68111-000 0 Lega l Description : \ FAIRMOUN T

### PLAC E LO T2 4 BLOC K0 5 0 X 12 1 Valu e Info rmatio n 200 8 200 7 ^0 6 200 5 200 4 200 3 ! Lan d $1,200.0 0 $1,200.0 0 $1,200.0 0 

### iiiT2bojO( r $1,200.0 0 $1,200.0 0 I mprovemen t $31,600.0 0 $31,600!0 0 $31,600.00 " 

### ~"$3i,6o6.o b $6,900.00 $6,900.00 Tota l $32,800.0 0 $32,800.0 0 _$32^800.'00 ^ $32T800'60 ~ $8,ioo.bo ~ $8,100.0 0 Lan d Infor matio n Acre s 

## ~o.^T ~ i S F Unit e 6050. 0 1. 0 Dept h 

### 121. 0 Widt h Vacan t 50. 0 N o Improvemen t Info n rmatio Buildin g 1

nf'4Y%*///i/\ii/Tlnnvt AifY%nii\t^tii%r r/\«^li*^ a rt/\»v*/T^/Mir»lf»fi/^rfcXTrt/n+o+i/»/«**/»/»i^*»+*'^-f** «#*«i»0# » *•«**••••»*• • #,^T > 1 A 0 / 1 fs/^f\n o

### Pag e 2 of 2

vMSKiPc ;

',.1 , SHEI > »ieoaq.r< . • 49 sa « 

### Dougla s Count y Accoun t Inform^io n im^ K

Squar e Footage : 1276. 0 Perimete r 0. 0 Uni t Type : - I -

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

Roo f Type : Gabl e Floorcover : Allowanc e i YearBull t Yea r Remodele d Percen t Remodele d 192 3 0% Detei l Typ e ' Detei l Descriptio n Ad d On 

### T'she d Applianc e ' Allowanc e Applianc e ! Securit ySyste m Basemen t Bsmn t Bloc k 8 ft Basemen t Walkou t Fixtur e '' Bas e Fixture s Fixtur e ' Bat h Ful l Garag e Detache d Porc h En d Scree n Use r LA P SIDIN G i : ^ nuifii M 1W«0So,F » :. : 1 i/2STorj y 6ua m Sbe k 8 tt

.'*'• * 

# TM J

CLIC K JO ENLARG E IMAG E Percen t Complete : Quality : Condition : Cond o Squar e Footage : Rooms : 

# _4r'*s = Baths : Bedrooms : Stories : Foundation : Sprinkle rSquar e Footage : Adjuste d Yea r Physica l Ag e Buil t 192 3 85 Unit e 

### 140. 0 1. 0 

### _1. 0 888. 0 1. 0

_

""- ^ 

## i. o 216. 0 140. 0 1. 0 100.0 % Fai r Averag e 

# "b. o ao 

## ^ id " 

# To]"" " 40 ~ ' 1 5 "

Bloc k 

### 0. 6

httn'//rfr»nolaon< » ma r •\t'V»/ l Irti,/TIonOr,\ra/n+r.+.rt/r./»««..•%+J».'^i. » Zr^^mO ^ . i. . r» 1 f\

# AER ^ Jun e 26,200 8 (lates t revtoton ) 

# BP A Propeity Close-Ont For m(Lead-Base dPain t Stabillzatioii) BhekandVeatdiVtenaitrIDWaMbc n rSi4liJO A T PnpatjrAddrai : 

# . -^^0 3 /v/29S f

. h " V 

# , k V s

^ Performance Standard s /Oose-On t

Criteri a 1 . Wast e entir e stnictarKs)pBii>todwifl i th e emeptio ao f U » Tfaiswool d ye an o faidiide paistin g o f othe r associaie dftatiaet {Qctudin g fittda, e s bflMif c cohmwi ^ lafls i an dearterio r stnftce ao f gauges . 

## y 1 WaiaUiaqiingtiidotherpreparallonwoifceoQvIetedsatisfiwt^ ^ 3 . Wo e dlnqobe darea s ofdiestroetui«(s)inrinie da s neede dan dpaiiite ^ i / ' 

### 4 Wa s th e pd mproduct s otilizedeqidvalen t t o B 3 0 yea r prodnct/qudhy ? t ^ 

### 5 .

A na O o f tin area s vrtier e oontamioate dmaterial s hav e beenspille ddioroa{^ y vacuumed'cleaned ? 6 .DidtecootrectorooIlect/vaGm mal l Min g andsoape dpeimdup s o ntb e en ^ wad»a»8.all«way8.piJ>li c acces s area s an dals o remov e any otiMrwoetate d ^ 

### 7 . btegns s are aAatstOTonndstfiestnictnteCs ) i n reasonably goo dcondition ? %

, ited l item s siid i a s po^yediyleDedieeting.ladden , paint brashes , cones , banke r tape , etc . pro^ ^ 9 .I s ftere an y evidenc e ofpropert y damag e that wa s d(»i e b y ^centractoi ? An y proper ^ damag e needstpb e coMolete dprio r t o th e BP AC^o»^Ont . t ^ 

### 10 . Aietiiereaq y propeit y item s tint wer e temporaril y re>Iocatedb y th e contFBCte T tint nee dt o b e movedbade ? 11 . Antiiereai9Oaio^iio0BriO8issoM^ti i tiie propeit y o«ner(s)tiur t hav e bee nlef t nnresoh ^ Ofte r Conddefatioss/Propert y Owne r Discussions/Additiona l Wor k tha t i s Require d

EPAGOR/Repcesemativ e Mf* m<vn'i<ii y

## Pruden t PropertyClose-Ou t For m (Lead-Base d Pain t Stabilization ) SAID : 

## ^ ^3lgi V V " ^ PropertyAdrfrp..^^</0: ? A f .Z94 L S^i^ll P Owner' s Name : (?// 9 7 Q . 7i ^ IGI/ D 

### ^ 

## Performance 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 beams , columns , rails , an d exterio rsurface s o f garages . 

# K 2 .Wa s al l scrapin g an d othe rpreparattio n wor k complete d satisfactorily ? 3 .Were al l require d areas o f th e structure(s ) prime d a s neede d an d painte d wit h tw o to p coats ? 4 .

Wa s th e pain t product s utilize d equivalen t t o a 3 0 yea rproduct/quality ? 

# K 5 .Ar e al l o f th e areas wher e contaminate d material s hav e bee n spille d thoroughl yvacuumed / cleaned ? 

# t 5 .Ol d th e contracto rcollect/vacuu m al l failin g an d scrape d pain t chip s o n th e entir e property , roadways , alleyways , publi cacces s areas an d als o remove an yothe rgenerate d debris ? / \ 7 .I s th e gras s are a tha t surround s th e structure{s ) i n reasonabl ygoo d condition ? 

# z 8 .Are al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e etc . properl yremoved ? 

# i 9 .

I s ther e an yevidence 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 . > ' 10 . Ar e ther e anypropert yItem s tha t wer e temporatil yre-locate d b yth e contracto r tha t nee d t o b e move d back? > 11 .Ar e ther e an y(known ) lingerin g issues wit h th e propert yowner(s ) tha t have bee n lef t unresolved ? Othe rConsideratlons?propert yOwne rDiscussions?Additlona l Wor k tha t i s Require d " ^ 

# R ^ 

## z ^ Pruden t R e esentativ e 0 Dat e