## TRANSMITTA Lo f

OMAHA LEA D SIT E PAIN T STABILIZATIO N FIL EFOLDE R SAI D # : 2518 2 Date : 12/03/0 8 Address : 131 6 N 4 2 S t Remediation Contractor : Pruden t Technologie s Year : 200 8 PAINT STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S
^ Video of propert y (DVD ) ^ Executive Siumnar y 1 ^ Signe dAcces s Agreemen t fo r

subject propert y aPainting Agreemen t D Settlemen t document s (i.e. , fo r

damag e or to replac e plants , etc. ) D Photograph s ^ Satisfactor y restoratio n signedb y Propert y Owne r D Propert y close-out chec k

lis t signedby EP A B Propert y information fromDougla s Count y Assessor' s Office D D 

## a Signature Dat e

4031037 4 

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### PROPERT Y SUMMAR Y 1 Date : 12/03/0 8 LB PSTABILIZATIO N EPA CONTRAT EP-R7-08-0 7 Montl i of : December 1 1 Propert y Address : 131 6 N 42 S t SAID : 2518 2 A . EXECUTIV ESUMMAR Y A. 1 Issue s Encountered : None A. 2 Issue s Resolved : None

A. 3 Uniqu e Findings : None
122A. 4 Othe r Relevan t Infonnation : None Acces s Date : 10/02/0 8 Worl i Bega n Date : 10/08/0 8 Closeou t Date : 11/10/0 8 Enclosures : 1 . Pre-Vide o 2 . Post-Vide o 3 . Propert y Statu s Form 4 . Signe dAcces s Agreemen t 5 . Pre-Renovatio n For m 6 . Pain t Matcl i For m 7 . Trackin g For m 8 . Dougla s County Assesso r Propert y Informatio n Pag e 9 . EP A Propert y Closeou t for m 10 . Propert y Completio n Agreemen t

TECHNOLOCIES , INC .ENVIRONMENTA L& CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : | ^ | 0 / J ^ ZS+ . Date : jlj'^'6 ^ Phone : [ mr O 5 5 t e - Jl^?> M BVID : ^^ 3 / g2 _ 

# g^^i!^m ^ Plant & Permanen t Landscaping T o Remai n I n Plac e Item# Descriptio n andLocation O

n Ma p


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Pre-Existin g Conditio n o f Structure s Doe s your Basemen t hav e ahistor y o f leaking ? Ye s —No Item # Descriptio n & Locatio n On Ma p 

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Propert y Owne r Pruden t Emg ] Signature : Signatur e 808 0 Ward Parkway , Suit * 40 5 Kansa s City , M O 6411 4 260 5 N . 24* " Streat , Suit e 30 8 Omaha , Nebraska 6811 0 424 2 Medica l Drive , Suit s 426 0

. Sa n Antonio , T X 7822 9 Phone : (816 ) 36M70 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-3707 Fax : (402)504-100 5 Fax : (210 ) 679-667 7

# QS l ^Z -
Pruden t Technologies , Inc . (Prudent ) i s unde r

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

o f propertie s locatedi n Omaha , Nebraska , incl\iding th e propert y locateda t ; The EP A request s your permissio n t o allo w Pruden t t o perfor mLB PStabilizatio n a t thi s property . B y signing thi s form , th e propert y owne r

grant s permissio n to Pruden t to perfonn activitie s relate dt o LB P Stabilizatio n including scraping paint andpaintin g ofth e referencedproperty . Further , th e owner/tenan t verifie s tha t they , hav e receive dth e LB Ppamphle t "Renovat e Right, " If

you hav e an y question s abou t th e LB Pstabilizatio n planne dfo r

you r

property , pleas e contac t Prudent' s AdtT^inistrativ e Cler k

fo r

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

t (402 ) 504-1004 . Genera l question s abou t th e Omah aLea dSit e cleanu p ca n b e directe dt o th e EP A Publi c Infonnatio n Center s a t (402 ) 731-304 5 (Sout hOmahaoffice) or (402 ) 991-958 3 (Nort hOmaha office) . Propert y Acces s GrantedI (Pleas e Print Name) Propert y Owne r Signature : /X ^^"'-^ y /X/iy ^ N^^X ' X / 'i— " ' (Sfgnetute) / / (Date) PROPERT Y INFORMATIO N (T o b e complete dby reiiden t and/o r propert y oiwne r —pleas e print ) RESIDEN T NAME:''n^/^A^ > /:>KV^A0^V—^ " (owfj ^ Rente r RESIDEN T ADDRESS : I F RENTAL , PROPERT Y OWNE D BY : *P yJ^-^-^ r OWNER' S MAILIN G ADDRESS ; c> rTT^ ^ OWNER' S TELEPHON E NUMBE R - HOME : 

## ^"^ ^ E

: .^SL^^^I^^RK : d/2 ^ 1S^ ^ NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : tt ^

NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDER : NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLA YI N TH E YAR D FO R 5 HOURS O R MOR E PE R WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DO^S , ENTR Y GATES , ETC. ) x

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s t o b e implementedb y EP Aunde r thi s agreemen t ar

e pursuan t to Section10 4 o f

CERCLA, 4 2 U.S.C . 9604 . EPA' s right ofaeces s t o Ih e propert y i s providedfb r i

nSection104(e ) of CERCLA, 4 2 U.S . C 9605(e) , whichprovide s entr y for "determining th e need for response, o r choosing ortaking an y respons e actionunde r thi s title , or oflierwise enforcing the provision s o f tiie title. "

i08 0 War d Paikway , Suit e 40 5 250 5 N . 24* ^ Street , Suit e 30 8 4242 Medica l Drive , Suit e 425 0 [ansa s City , M O 6411 4 Omaha , Nebraska 6811 0 Sa n Antonio , T X 7822 9 'hone : (816 ) 363-3703 Phone : (402)504-100 4 Phone : (210)822-958 8 ax : (816 ) 363-370 7 Fax : (402 ) 504-1005 Fax : (210 ) 579-657 7

# Curren t Sampl e Pre-Renovatio n Fom i Effectiv e unti l Apri l 2010 . Confirmatio n o f Receip t o f laat i Pamplile t Qh \ hav e received a cop yo f th e pamphlet , fienovate FVght : Importan t Lea d Hazar d yInformatio n fo rFamilies , CNl d Car e Provider s an d School s infbnmin g m e o f th e potentia l ris k o f th e lea d hazar d exposur e fro m renovation activit yt o b e perfbrme d i n m ydwellin g unit . I receive d thi s pamphle t befor e th e wor k began . 

# T^SU ^ ppiji ^ K SignatiW^recpert l Self-Certificatio n Optio n (fo rtenant-occupie d dwelling s only ) — I f th e lea d pamphle t wa s delivera 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 effort t o delive rth e pamphlet , FWtovat e Right : Importan t Lea d Hazar d Infonnatio n fo rFamiSes , CNl d Cara Prnvidars an d Schods , 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 confirTnatio n o f receipt . I furthe rcertif 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 fait h effor t t o delive rth e pamphlet , Renovat e FVght : Importan t Lea d Hazax i Infbnnatio n fo r FamiSes , ChU d Car e provider s an d Schools , t o th e renta l dwellin g uni t liste d beio 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 a t th e uni t b yslidin g i t unde rtheAxjr . ^ i 

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Uni t Addres s Not e Regaidin g Mailin g Optio n —A s a n altemativ e t o deliver yi n person , yo u ma ymai i 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 o o f mailin g fro m th e pos t office) .

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### i-»uugiii s *.>ouni y Accoun t a

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### atio n Pag e 1 of 3 Dougla s County , Nebrasic a Propert yRecor d - R240879000 0 Prin t Repor t NE W Featur e - Parce l Oimensions'avairabl e ® scal e 0-5 0 f t wes t c f SOt h S t - VieW..On.Ma. P Informatio n i s vaii d a s o f 2008-9- 4 Treasurer' s fa xRepor t Ne wFeatur e ->-*• • Aut o Sale s Searc h Owne r OKRIN ABRA D ETA L 131 6 N 4 2 S T OMAH AN E 68131-000 0 Propert yInformatio n Ke yNumber : 087 9 000 0 2 4 Accoun t Type : Residentia l Parce l Number : 240879000 0 Parce l Address : 131 6 N 4 2 S T OIVIAHAN E 68131-000 0 Lega l Description : WALNU THIL L LO T4 BLOC K2 4 S 7 8 F TLT S 1-2- 3 & 7 8 X 20 0 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $4,200.0 0 $127,400.0 0 

### $131,600.0 0 200 7 $4,200.0 0 $127,400.0 0 $131,600.0 0 

### 200 6 

### K200.0 0 $127,400.0 0 

### $131,600.0 0 200 5 $4,200.0 0 $86,100.0 0 $90,300.0 0 200 4 $4,200.0 0 $86,100.0 0 $90,300.0 0 200 3 

### K200.0 0 $86,100.0 0 $90,300.0 0 Saie s Informatio n Sale s Date : 

### 1996-07-1 0 lyee d Type : 

### D Book : 204 0 

### Page : 67 5 Price : $78,500.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 1994-07-0 1 Dee d Type : Book : 198 2 Page : 44 0 Price : $ 74,500.0 0 Grantor : 

### http://douglasne.mapping-online.com/DouglasCoNe/statid/accountinfo.jsp?accountno=R24. . . 9/24/200 8 /

## uougia s uount y Accoun t 1

flRmi atio n Pag e 3 of3
YearBuil t 188 0 Detai l Typ e Ad d O n Applianc e Applianc e Basemen t Fixtur e Fixtur e Fixtur e Garag e Porc h Porc h Yea r Remodele d 0 Percen t Remodele d 0 % Detai l Descriptio n Fenc e Woo d Allowanc e Fireplac e Masonr y Bsmn t Bloc k 8 ft Bas e Fixture s Bat h Ful l Bat h Hal f Detache d En d Scree n Ope n Sla b Adjuste d Yea r Physica l Ag e : Buil t ---188 0 12 8 Unit s 1. 0 1. 0 1. 0 1352. 0 1. 0 2. 0 1. 0 480. 0 112. 0 200. 0



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R24.. . 9/24/200 8

## i^ougia s uounty Accoun t l fllHnii atio n 

## Pag e 2 of3 Grantee : Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 

### 1992-05-1 1 Dee d Type : Book : 192 8 Page : 14 9 Price : 

### $ 63,000.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 6 

### 2964. 0 1. 0 38. 0 78. 0 N o Improvemen t Informatio n Buildin g 1

m a

u ri H r 

# t t 1«J I M i l «

CLIC KTO ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 2795. 0 Percen t Complete : 

### 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : 

### Goo d

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 Aluminu m Units : 

### 1. 0 interior : Drywal l Baths : 2. 5 Roo f Cover : Compositio n Shingl e Bedrooms : 4. 0

Roo f Type : Gabl e Stories : 2. 0 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 

## http://douglasne.rnapping-online.corn/DouglasCoNe/static/accountmfo.jsp?accovintno=R24.. . 9/24/200 8

## Propert yClose-Ou t For m (Lead-Base d Pain t Stabiiization ) Pruden t Pro p SAID; Q^Slx ^ Propert yAddres s 

# ^rjT'^Ah.^si
­ Owner' s Name ; 

## Performanc e Standards/ciose-Ou t Criteri a YE S 

### HO Wa s th e entir e structure{s ) painte d wit h th e exceptio n of th e stated , exdude d areas ? Thi s woul d includ e paintin g of othe rassodate d feature s Inciudin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an d exterio rsurface s of garages . 

## N( , 2. Wa s al l scrapin g an d othe rpreparattio n wori ccomplete d satisfactorily ? ^ 3. Were al l require d areas of th e structur6(s ) prime d as 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 to a 30 yea rproduct/quality ? 5. Are ai i ofth e areas wher e contaminate d materiai s hav e bee n spille d thoroughl yvacuumed / cleaned ? ^___ _ 

# yC Kd th e contracto rcollect/vacuu m al l fallin g an d scrape d pain t chip son th e entir e property , roadways , alleyways , publi cacces s areas an d also remove an yothe rgenerate d debris ? 

# A 7. Is th e gras s are a tha t surround s th e structure{s ) in reasonabl ygoo d condition ? 

# ik 8. Are al i item s suc h as polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e etc . properl yremoved ? ^^_ ^ 9.Is ther e an yevidence of propert ydamag e tha t wa s don ebyth e contractor ? An yprope.t ydamag e 

# )L need s to be complete d prio r to th e EP AClose-Out . - < 10 . Are ther e an ypropert yitem s tha t vrere temporatil yre-locate d byth e contracto r tha t nee d to be move d bacic ? 

# X 11 . Ar e ther e an y(Icnown ) iingerin g issues wit h th e propert yowner(s ) tha t hav e bee n lef t unresolved ? Othe rConsideratlons?propert yOwne rDiscussions?Additiona l Wori ctha t is Require d 

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