TRANSMITTAL OF OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: 32.'?<?' Date: 

Oj^l^ N %Z. ^ T Address; 

LBP Stabilization Contractor: PRUDENT TECHNOLOGIES, INC. Year: 2009 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

Videoof property (DVD): Pre-Stabiiization & Post-Stabilization Videos 

/ Executive Summary 

/ Signed Access Agreement Form 

Advance Notice Form 

/ Pre-Stabilization Video Agreement Form 

1/ Access Tracldng Form 

: / Property Access Assessment Form 

Neiglibor Access Agreement Form 

Paint Matcli Form 

/ 

Pre-Stabilization Property Safety Assessment Form 

Work-Site Hazards Analysis Checklist 

Photographs: Pre-Stabilization Propertv Hazard Assessment Photographs 

Douglas County Assessor Property information 

Property Completion Agreement Form Signed by Property Owner 

Property Close-Out Check List Signed By EPA 

Prudent Technologies, Inc. Sign ature 

Date 

VLA'iCcAjtsr^^fii ^ 

Signature 

4 ^ ^ 

30055131 iW 

Superfund 
-IE(9INaLOGIBS,INC. 

Property Summary 

Date: 11/~/2009 LBP STABILIZATION EPA CONTRACT EP-R7-08-07 Month of: Nov 

Property Address: 3818 N 22 St. SAID #: 32961 

A. Executive Summarv; 

a. Issues Encountered: NONE 

b. Issues Resolved: NONE 

c. Unique Findings: NONE 

d. Other Relevant Information: 

i. Access Date: 9/23/2009 

ii. Work Began: 9/29/2009 

iii. Close-Out Date: 10/01/2009 

B. Enclosures: 

1. Pre-Stabilization Video 

2. Post-Stabilization Video 

3. Signed Access Agreement Form 

4. Advance-Notice Form 

5. Pre-Stabilization Video Agreement Form 

6. Access Tracking Form 

7. Property Access Assessment Form 

8. Neighbor Access Agreement Form 

9. Property Paint Match Form 

10. Pre-Stabilization Property Safety Assessment Form 

11. Work-Site Hazards Analysis Checklist 

12. Pre- Stabilization Property Hazard Assessment Photographs 

13. Douglas County Assessor Property Information 

14. Signed Property Completion Agreement Form 

15. Property Close-Out Check List Signed By EPA 
m. 

INC. 

Prudent Technologies, Inc. (Prudent) is under contract (Contract # EP-R7-08-07) with the U. S. Environmental Protection 

Agency (EPA) to stabilize Lead Based Paint (LBP) at a number ofproperties located in Omaha, Nebraska, including the 

property located at "^ R }<?! t^( 7_7-' ^ S f , Oyf^c^k<^ , W £ 

The EPA requests your permission to allow Prudent to perform LBP Stabilization at this property. By signing this form, the 

property owner grants permission to Prudent to perform activities related to LBP Stabilization including scraping paint and 

painting ofthe referenced property. Further, the owner/tenant verifies that they have received the LBP pamphlet "Renovate 

Right." 

By signing this document 1 agree to allow an EPA contractor to conduct a soil cleanup at my property following completion of 

lead-based paint stabilization, if the soil cleanup has not already been performed. I understand that the stabilization contractor 

cannot provide assurances of which contractor will be bound to the soil cleanup. I further understand that the soil cleanup 

contractor will make all reasonable efforts to address concerns that 1, as the property owner, may have regarding soil 

cleanup at my property. 

p(j Yes, i have read and understand the paragraph above. 

Signatur hire

p n Prnnprtv Oumpr ' of

f Property Owner 

Date 

Ifyou have any questions about the LBP stabilization planned for your property, please contact Prudent's Customer 

Relations/Office Manager for the Lead Based Paint Stabilization, Mrs. Shannon Holt, at (402) 504-1004 or (402>812-0223. 

General questions about the Omaha Lead Site cleanup can be directed to the EPA Public Information Centers at (402) 731­

3045 (South Omaha office) or (402) 991 -9583 (North Omaha office). 

Property Access Granted By: 

Ch^ndr^ P- Uri^Jrh^ll 

(Please Print Name) 

Property Owner Signature: X CAA^ i). (Signature) 

(Date) 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
40L0GIBS. CMC 

PROPERTY INFORMATION 

(To be completed by resident and/or property owner — please print) 

RESIDENT NAME: P^jTv ^^uar i Owner RenterJ f 

RESIDENT ADDRESS 

IFREjfTAL^^OPER^^^D^y^ jJ^^A^^^Jj ^[Jry^/^.^// -Jh^PT K tjli j Ul , 

OWNER'S MAILING ADDRESS; i _ , ^ / . ^ , n i , ^ 

OWNER'S TELEPHONE NUMBER - HOME [WORK: 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER: 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHOM PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: 

COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS, ENTRY GATES, ETC.) 

AlJIHORIl'Y FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities lo be implemenied by EPA under this agreement arc 

pursuant to Section 104 ofCERCLA. 42 U.S.C. 9604. EPA"s righl ofaccess to the property is provided for in Section 104(e) ofCERCLA, 

42 U.S. C 9605(e), which provides entry for "determining the need for response, or choosing or taking any response action under this title, or 

otherwise enforcing the provisions ofthe title." 

v: U^/V^A. (X 

' e/^sh") 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNOLOGIES. INC 

Advanced notice needed. 

After signing the access you allow Prudent to begin Lead Based 

Paint Stabilization. All Plants, weeds and any vehicles or itenis on 

open porch (enclosed porches will NOT be stabilized) must be 

removed prior to stabilization. All Pets must be out of yard during 

stabilization. How much notice do you need to have above 

mentioned tasks completed? Ifyou are a landlord you will need to 

contact the tenant as Prudent Technologies will only inform you. 

Do you have any pets that reside in yard? 

NO 

Notice needed: ^.U fjgjy^r ^ 

Number to call to give notice: 

Whom we are giving notice to: 

Ch^ndr^^ iLanol/or 

Home Owner's Signature 

>i/AxA...Kj. g|^?/^'> 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 

Fax: (816) 363-3707 

Phone: (402)504-1004 

Fax: (402)504-1005 

Phone: (210)822-9588 

Fax: (210) 579-6577 
IXCHNQLOGIBS,] 

PRE-STABILIZATION VIDEO FORM 

I UNDERSTAND THAT PRUDENT TECHNOLOGIES WILL BE COMING 

OUT TO SHOOT A PRE-STABILIZATION VIDEO AT MY PROPERTY. 

THE VIDEO IS JUST A TOOL USED TO DOCUMENT THE CURRENT 

PROPERTY STATUS/CONDITION. A POST VIDEO WILL ALSO BE 

SHOT PRIOR TO COMPLETION OF STABILIZATION. 

OV/NERS NAME: U)ri^}\i^^/I J0r\'\r^3~^^'hj Ll (L. 

PROPERTY ADDRESS: 3&l ^ ^ 2- ^ ^ ^ 

BVID/SAID: 3 ^ "? ^ / 

HOMEOWNERS SIGNATURE: __K/^AA>^ ^ IV . ^h/M/ \ ^hsjo^ 

PRUDENT REPRESENTATIYE SIGNATURE: Q I o^^i^^ct S>he ^c> r 

ANY CONDITIONS NEED TO BE AWARE OF BEFORE SHOOTING 

VIDEO: (I.E. PETS, NOTICE NEEDED): 

U-^ 

8080 Ward Parkway, Suite 405 2S0S N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 679-6577 
TBCHNCnjOGIBSk IN C 

ACCESS INFORMATION TRACKING SHEET 

BVID: ?>%^6 \ PROPERTY ADDRESS : '^<2)S ^J 'i-'^ ^ t 

Property Owned By: 

(If new property owner) 

Owners Phone No's: 

Home: Work: 

Cell: Fax: ~ 

Access Contractor: ASW PDA MES PE Other (Prudent) 

D>ATE TIME _ ACCESSOR CONRACT DETAIL 

q a-blo-i "Tf^- l2eM^t-^or Vt^V-* ^ • 

1 

0

V 

Comments: 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
40L0GIES,INC 

PAINT MATCHIN G FORM : 

1. TO BE FILLED OUT ONLY IF MATCHING COLOR 

N ^ PROPERTY ADDRESS: •T>5R^/^ K TTT ^ S \ Omal ^ 

BVID: ^ Z ^ ^ I 

The following notes are for the benefit of paint crew only. 

Paint Yes Paint No Location Paint Description 

Siding oooo<J jiX^Wi^t \ 

Soffit 

K£iOtd i^ 7 

Fascia 

Comer Trim 

Window Trims 

Door Trims 

Front Porch Ceiling 

Front Porch Ceiling Beams 

Front Porch Floor 

Front Porch Railings 

Front Porch Steps 

Siding Baseboards 

Foundation 

^ 

&-y^AJ> ; ^

J- 3^ • ^ > ' - S ^ \i C 

s^ q—^'v­

¥^..^^ :xp 

No 

v P 

^r­ ^^^cfy:j'j^/^^^^e^' 

^" ^ ^ ^ <r^ iS^^t^^^< ^ ^ ^ C^O 

I UNDERSTAND SHERWIN WILLIAMS WILL MATCH MY CURRENT COLORS. 

Homeowner signature: y(_}lhN^ OJ . jlh/l/l/ l y Date: gj>-?JQ9 

8080 Ward Parkway, Suite 405 2505 N. 24*" Street, Suite 308 4242 Medical Drive, Suite 4260 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax:(816)363-3707 Fax: (402)504-1005 Fax: (210) 679-6677 
TECHNOLOGIES, INC 

Access Assessment Form: (Must be completed for every property. 

Information must be obtained from a property walk thru, not given 

by owner) 

Is the property stucco or asbestos? 

If yes, is any of the stucco or asbestos damaged or cracked? 

If yes, stop as we canH stabilize this property. It requires special preparation 

techniques. It will be returned to EPA and they will assign at a later date. 

\y- ^ 

Does this property require lots of scrapping? 

fAo^ v>^ V ^ -

Does this property require a lift or scaffolding to reach upper levels? 

Does this property have lots of plants or items in areas where painting is 

required? 

- Y^ 

Does this property have any significant structural damage? 

If yes, EXPLAIN? 

8080 Ward Parkway, Suite 405 2505 N. 24"* Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone:(816)363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNOLOGIES. 1 

Does this property have a garage? 

rsJO 

If yes, describe location of garage. 

Does this property have aluminum siding? 

If yes, is it original factory finish or has it been painted over? 

Does this property have any other type of structural components? (I.e. roof 

shingles as siding)? 

If yes, EXPLAIN? 

Is this property vacant o/occupied? 

Are there any pets at this property? 

Are there any low hanging power lines? 

M^ 

8080 Ward Parkway, Suite 405 2505 N. 24*^ Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-«577 
TECHNOLOGIES;] 

NEIGHBORHOOD PROPERTY ACCESS FORM 

IS THERE A NEIGHBORING PROPERTY THAT NEEDS TO BE ACCESSED ALONG 

WITH ASSIGNED PROPERTY TO COMPLETE STABILIZATION PROCESS? 

r^O 

IF IT IS, GET ACCESS FROM ALL REQUIRED NEIGHBORHOOD PROPERTIES. 

rOO 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNOLOGIES, INC 

PRE-STABILIZATION PROPERTY SAFETY ASSESSMENT FORM 

PROPERTY ADDRESS: 3*^)9 '^ *^ ^ -=*'' 

BVID/SAID: ^ 2- ^ ^ I 

PRUDENT ASSESSMENT REPERSENTATIVE: 

^a^M - fi^^^ 

REPERSENTATIVE REMARKS/FINDINGS: 

(POWER-LINE PROXIMITY TO PROPERTY, SCAFFOLDING/ LADDERS/ LIFTS 

NEEDED, UNSAFE AREAS, UNSAFE NEIGHBORHOOD...ETC.) 

8080 Ward Parkway, Suite 405 2505 N. 24*" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TBCHfiOLOGTBS, 

Checklist for the Worksite Hazard Analysis 

Address: 3^1 S h). Q^n^Jj : 

Crew: Date: 

Item OK? TvM^ azard Corrective /Action ^ 

Overhead Lines uJt^g ^ (/L^^t^ ^ Ky^Cys^ ^ O 

In-transit Vehicle Clearance ^-t/yaf^<=>^-^ LPvYt::^ 

Levels around high wires 

Vehicle Clearance around 

high wires when working 

Phone lines 

Cable lines OjiSk i^ 

Gas Line 

Water Line 

Sewer Line 

Septic Tank 

Propane/Butane 

Access to/on Property 

Neighbor Access Required ^-/ ^ S^Lil^^ 

High Traffic 4^re: 

IC Area 

<;aT5g? 

Structures \;L)cy^^ OM^f^sj^J •^/tf(jt>^7i3)Q A O Cry icxsidk. uJ^ ^ 

Drivewa i^5 ^ y * A -

Sidewalk 

}jytJ?y^^) ^ 

Foundation hXj^ ' 

Retaining Walls VA^L/:j2n7^ ^ Uyc^r^JioC ^ 

Fences ^f^\jJ ^ <L,JU^ 

Trees 

Foliage 

General ConOition of yard 

Damaged Areas: sink A 

holes/rotted wood iai7\JUM^4-r^W efi^^^ . cJ^> 

Sprinkler System r

Pets 

Insects ^Lfiti I S? ^ ,cipA3^ 

^ Weather Conditions 

Unsafe driving conditions 

Unsafe neighborhood 

^^id ^ \jD^d^ b^V£ ^ ^re^ ^ b(^ ^ 

Crew Foreman/ Sub-Contractor 

8080 Ward Parkwi 2505 N. 24'" Street, Suite 308 Sical Drive, Suite 4250 

Kansas City, MOW4111 Omaha, Nebraska 68110 &an Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 'hone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 

"" . * 

9i 

JF'/'^/S^^^^^^^^^^^^^H B 

1 
1 .^^ ^ ^''^f^-''''^iKIKKk 

c\ 
Current Sample Pre-Renovation Form 

Effective until April 2010. 

Confirmation of Receipt of Lead Pamphlet 

^ 1 have received a copy of the pamphlet, Renovate Right: Important Lead Hazard 

'Information for Families, Child Care Providers and Schools infoiming me of 

the potential risk of the lead hazard exposure from renovation activity to be 

performed in my dwelling unit. I received this pamphlet before the work began, 

Priated name of r^iplenj, ;—^ Date 

Signature of recipient 

Self-Certification Option (for tenant-occupied dwellings only) — 

If the lead pamphlet was delivered but a tenant signature was not obtainable, 

you may check the appropriate box below. 

• Refusal to sign — I certify that I have made a good faith effort to deliver the 

pamphlet, Renovate Right: Important Lead Hazard Information for Families, 

Child Care Providers and Schoois, to the rental dwelling unit listed below at the 

date and time indicated and that the occupant refused to sign the confirmation 

of receipt. I further certify that I have left a copy of the pamphlet at the unit with 

the occupant. 

ijH^navailable for signature — I certify that I have made a good faith effort to 

deliver the pamphlet. Renovate Right: Important Lead Hazard Information for 

Families, Child Care providers and Schools, to the rental dwelling unit listed 

below and that the occupant was unavailable to sign the confirmation of receipt. 

I further certify that I have left a copy of the pamphlet at the unit by sliding it 

under the door. 

Printed name of person certifying Attempted delivery 

date and time 

lead pamphlet delivery 

Signature of person certifying lead pamphlet delivery 

Unit Address 

Note Regarding Mailing Option — As an alternative to delivery in person, you 

may mail the lead pamphlet to the owner and/or tenant. Pamphlet must be mailed 

at least 7 days before renovation (Document with a certificate of mailing from the 

post office). 
Douglas County Account Information Page 1 of3 

Douglas County, Nebraska Property Record - R2014040000 

Print Report 

NEW Feature - Parcel Dimensions available &. scale 0-50 ft west of 52nd St - VIG W OH MS D Information is valid as of 2009-9-15 Treasurer's Tax Report 

New Feature -^rtr * Auto Sales Search 

Owner 

WRIGHTSELL INVESTMENTS LLC 

C/O LATRELL WRIGHTSELL 

12657 DEER CREEK DR 

OMAHA NE 68142-0000 

Property Informatio n 

Key Number 1404 0000 20 

Account Type: Residential 

Parcel Number 2014040000 

Parcel Address: 3818 N 22 ST 

OMAHA NE 68110-0000 

Legal Description: PLAINVIEW LOT 4 BLOCK 6 S 25 FT 25 X 124 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$7,000.00 

$7,000.00 

$7,000.00 

$7,000.00 

$7,000.00 

$7,000.00 

Improvement 

$28,900.00 

$28,900.00 

$28,900.00 

$28,900.00 

$5,800.00 

$5,300.00 

Total 

$35,900.00 

$35,900.00 

$35,900.00 

$35,900.00 

$12,800.00 

$12,300.00 

Sales Informatio n 

Sales Date: 2006-01-23 

Deed Type: 

Price: 

QCM 

$0.00 

Book: 2006 Page: 007796 

Grantor 

Grantee: 

Valld/lnvalld: 

Latrell Wrightsell etal 

Wrightsell Investments 

Invalid 

Exclusion Reason: Family Sale 

Sales Date: 2006-01-11 

Deed Type: 

Price: 

WD 

$0.00 

Book: 2006 Page: 004537 

Grantor GILBERT L CAIN 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2014040000 9/16/2009 
Douglas County Account Information Page 2 of3 lation 

Grantee: LATRELL WRIGHTSELL ETAL 

Valid/Invalid: 

Exclusion Reason: 

Invalid 

Corrective Deed 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

2006-01-09 

QCM 

$0.00 

Wrightsell Investments 

Latrell Wrightsell etal 

Invalid 

Corrective Deed 

Book: 2006 Page: 002694 

Land Informatio n 

Acres 

0.07 

SF 

3100.0 

Units 

1.0 

Depth 

124.0 

Width 

25.0 

Vacant 

No 

Improvemen t

Building 1 

 Informatio n 

3»18N22a. 

MtiMn 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1127.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Poor 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 6.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 2.0 

Floorcover: Allowance Foundation: Block 

Sprinlder Square Footage: 0.0 

http;//douglasne.mapping-online.com/DouglasCoNe/static/accountmfo.jsp?accountno=R2014040000 9/16/2009 
Douglas County Account Informatio lation n Page 3 of3

Year Built Year 

Remodeled 

1925 0 

Detail Type 

Appliance 

Basement 

Fixture 

Fixture 

Garage 

Porch 

Porch 

Percent 

Remodeled 

0% 

Detail Description 

Allowance 

Bsmnt Block 8 ft 

Base Fixtures 

Bath Full 

Detached 

End Screen 

End Screen 

Adjusted Year 

Built 

1925 

Physical Age 

84 

Units 

1.0 

684.0 

1.0 

1.0 

440.0 

25.0 

144.0 

http://douglasne.mapping-onlme.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2014040000 9/16/2009 
Prudent Property Close-Out Form (Lead-Based Paint StabiJ.ization) 

SAID: <B^96 / 

Property Address: v3g/ 8 A / ;22/7o^ S h 

Ov^ner's Name: '^^VW ^ [mve^U^ersH ^ U c 

\ S.NO 

1 "* 

1 

! 

2 

! 3 

i 

: 4 

i 

! 5 

1 

; 6 

• 7 

|8 

1 

! 9 

1

1 

|10 

1 11 

! 

,12 

i 

1 

Perfonnance Standards/close-Out Criteria Yes LN O ; 

Was tt»9 entire structure(s) painted with the exception cf the stated, 

excluded areas? This would include painting of other associated 

features including fascia, eaves, siding, all trim, porches, box A 

beams, columns, rails, and exterior surfaces of garages. y Was all scraping and other preparation work completed 

satisfactorily? i/^ 

Were all required areas of the structure(s) primed as needed and 

painted with two top coats? y

Are all of the areas where contaminated materials have been spilled 

thoroughly vacuumed/ cleaned? i / 

Did the contractor collect/vacuum all falling and scraped paint chips 

on the entire property, roadways, alleyways, public access areas 

and also remove any other generated debris? c/ 

Is the grass area that surrounds the structure(s) in reasonably good 

condition? 

Was the paint products utilized equivalent to a 30 year 

product/quality? ^ . : 

Are all Items such as polyethylene sheeting, ladders, paint brushes, / 

cones, barrier tape etc properly removed? 

Is there any evidence of property damage that was done by the 

contractor? Any property damage needs to be completed prior to 

the EPA Close-OuL 

Are there any property items that were temporarily re-located by the 

contractor that need to be moved t)ack? / 

Are there any (known) lingering issues with the property owner(s) 

that have been left unresolved? ^ \ 

Other Considerations? Property Owner Discussions? Additional 

Work that is Required 

Prudent Representative Signature 

Date: 

Property Owner Signature: C/frv ^ ^ " 'f^rtJI r 

^^•10/1/CM 

8080 Ward Parkway. Suite 405 2505 N. 24" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha. Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone; (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402) 504-1005 Fax: (210> 579-6577