### TRANSMITTA LO FOMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R SAI D # : ^^?y^> ^ Date : 7|cS3|n2fiQ ^ Address : /^ / 5)
- fv J ."^ U ^^ T LB P Stabilizatio n Contractor : PRUDEN T TECHNOLOGIES , INC . Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S i

/ Q^ 0 ^ K B ^ ^ i y Sr ^ B ^ & ^ e ^ ffi^ a ^ D Vide o of propert y (DVD) : Pre-Stabilizatio n & Post-Stabilizatio n Video s Executiv e Summary Signe dAcces s Agreemen t Form Advanc e Notic e Form Pre-Stabilizatio n Vide o Agreement Form Acces s Trackin g Form

Propert y Acces s Assessmen t For m Neighbo r Acces s Agreemen t For m Pain t Matc hFor m Pre-Stabilizatio n Propert y Safet y Assessmen t For m Work-Sit e Hazard s Analysi s Checklis t Photographs : Pre-Stabilizatio n Propert v Hazar dAssessmen t Photograph s Dougla s Count y Assesso r Propert y infonnatio n Propert y Completio n Agreemen t For mSigne db y Propert y Owne r Propert y Close-Ou t Chec k Lis t Signe dB y EP A Pruden t Technologies , Inc . Signatur e Dat e y^^ c 

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### Date " 30055374 

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Superfun dTECHNOLOGIBS , IN C 

## Propert y Summar y Date ; 7/23/200 9 | LB P STABILIZATIO N EP A CONTRAC T EP-R7-08-0 7 | Monthof : Jul y Propert y Address : 141 2 N 3 4 S T SAI D # : 2558 5 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 : 6/24/200 9 u . Wor k Began : 7/01/2009 iii . Close-Ou t Date : 7/15/2009 B . Enclosures : 1 . Pre-Stabilizatio n Vide o 2 . Post-Stabilizatio n Vide o 3 . Signe dAcces s Agreemen t Form 4 . Advance-Notic e Form 5 . Pre-Stabilizatio n Vide o Agreemen t Form 6 . Acces s Trackin g Form 7 . Propert y Acces s Assessment Form 8 . Neighbo r Acces s Agreemen t Form 9 . Propert y Pain t Matc h Form 10 . Pre-Stabilizatio n Propert y Safet y Assessment For m 11 . Work-Sit e Hazard s Analysi s Checklis t 12 . Pre - Stabilizatio n Propert y Hazar dAssessment Photograph s 13 . Dougla s County Assessor Propert y Informatio n 14 . Signe dPropert y Completio n Agreemen t Form 15 . Propert y Close-Ou t Chec k Lis t Signe dB y EPA

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Pruden t Technologies , Inc . (Prudent) i s unde r contract (Contract #EP-R7-08-07 ) wit h th e U . S . Environmenta l Protection Agenc y (EPA) t o stabiliz e Lea dBase dPain t (LBF ) a t anumbe r ofpropertie s locate di n Omaha, Nebraska , includin g th e propert y locate da t /^/o l N - 3 j ^Y^ ^ Th e EP A requests you r permission t o allow Pruden t t

o perfor mLB P Stabilization a t thi s property . B y signing thi s form, the propert y owne r grant s permission to Pruden t t

o perfor mactivitie s relatedto LB P Stabilization includir ^ scraping pain t an dpainting ofth e referencedproperty . Further , the owner/tenan t verifie s tha t the y hav e received the LB P pamphle t "Renovat e Right. " By signing thi s documen t I agree t o allow a n EP A contractor to conduc t a soi l cleanu p a t m y propert y following completion o f lead-basedpain t stabilization . I understandtha t the stabilization contracto r cannot provide assurance s tha t the soi l cleanu p contractor will b e boun dto . I furthe r understan dtha t th e soil cleanu p contractor wil l mak e all reasonable efforts to addres s concem s tha t I , a s the propert y owner, ma y have regarding soi l cleanu p a t m y property . Ifyou hav e an y question s abou t th e LB P stabilization plannedfo r you r property , pleas e contact Prudent' s Custome r Relations/OfTic e Manage r fo r the Lea dBase dPain t Stabilization , Mrs . Shanno n Holt , 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 n be directedto the EP A Public Informatio n Center s a t (402X211-3^ 5 (Sout h Omah aoffice) o r (402 ) 991-958 3 (Nort h Omah aoffice) . Propert yAccess Grante d By : Propert y Owne r Signature : (Date ) \ PROPERT Y INFORMATIO N (T o be complete d b yresiden t and/o rpropert yowne r- pleas e print ) RESIOENTNAME : //$^ / Owne r Rente r RESIDEN T ADDRESS : 

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I F RENTAL , PROPERT Y OWNE D B Y OWNER' S MAILIN G ADDRESS ; — J . jf ^ 

## HOME : i^^L^l^lpiU^y^ : ^^ ( TA ^ -jf^C f OWNER' S TELEPHON E NUMBE R NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OL D : C J NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDER : ^^l l NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WHO M PLAY I 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 Y GATES , ETC. ) 'r f ^• ^ • ^ ^ AUTHORIT Y FO R ENVIRONMENTA L RESPONS E ACTIONS : Th e activitie s t o b e implemente d b yEP Aunde rthi s agreement ar e pursuan t t o Sectio i 10 4 ofCERCLA , 42 U.S.C . 9604 . EPA' s righ t o f acces s t o th e propert yi s provide d fo ri n Sectio n 104(e) ofCERCLA . 42 U.S . C 9605(e) , whic h provide s enti y fo r"'determinin g th e nee d fo rresponse , o rchoosin g o rtalcin g anyrespons e actio n unde rthi s title , o rotherwis e enforcin g th e provision s ofth e title. "

aibso War d Parkway , Suit e 40 5 Kansa s City , M O 6411 4 250 5 N . 24' " Street , Suit e 30 8 Omaha , Nebraslc a 6811 0 424 2 IVIedica l Drive , Suit e 425 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402 ) 504-100 4 Phone : (210)822-958 8 Pa v/fl1fi ) 7fi?-:^7n 7 Pa v//ino i <;n/i.inri c

# Advance dnotic e needed . Afte r

signin g th e acces s yo u allo w Prudent t o begi n Lea d Base dPaint Stabilization . Al l Plants , weed s an dan y vehicle s or item s o n open porc 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 out ofyar ddurin g stabilization . Ho w muc hnotic e do yo u nee dt o hav e abov e mentione dtask s completed ? Ifyo u are alandlor d yo u wil l nee dt o contac t th e tenant a s Prudent Technologie s wil l only infor myou . D o yo u hav e any pet s tha t

resid e i n yard ? \j^c , Notic e needed : ^ y ^"^ ^ Numbe r

t o cal l t o giv e notice : Whomw e are givin g notic e to : Hom e Owner' s Signature

TKISrrCONDrTTONST^t U r u blTAWWKto rBtruK t iTiu u IIINV 3 viutu; ­ (I.E . PETS , NOTIC E NEEDED) :

# i PRE-STABILIZATIO N VIDE O FOR M I UNDERSTAN D THA T PRUDENTTECHNOLOGIE S WIL L BE COMIN G OU T TO SHOO T A PRE-STABILIZATIO N VIDE OAT MY PROPERTY . TH E VIDE O IS JUS T ATOO L USE D TO DOCUMEN T TH E CURREN T PROPERT Y STATUS/CONDITION . APOS T VIDE O WIL L ALS O BE SHOT PRIO R TO COMPLETIO NOF STABILIZATION . OWNER S NAM E 

# •• /?J(iE i m^^ ^ PROPERTYADDRESS : .// M n '^(f ^ P BVID/SAID : ^^S^ ^ HOMEOWNER S SIGNATURE : PRUDENTREPRESENTATIV E SIGNATURE : % \ 

### k m CONDITION S NEE D TO BE AWAR E OF BEFOR E SHOOTIN G VIDEO : (I.E . PETS , NOTIC E NEEDED) :

## ACCES S INFORMATIO N TRACKIN G SHEE T
PROPERT Y BVI D 

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# /9/ ^ /j-srs T ADDRESS . PropertyOwne d By : 

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Owner s Phon e No's : Work , Hom e 

# : (,11'Hoa i ^»: tif^-nsn-fi ^ Fax ;
Acces s Contractor . AS W FD AME S F E Othe r fOW e One ; DAT E TIM E Accesso r COMTAC T DETAI L % 

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# ^ ^ k ^ /oaZ/Af , Kdf L A^ 6N-fd0 l Comments :

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### Acces s Assessment Form : (Mus t b e completedfo r

ever y property . Information mus t b e obtaine dfrom apropert y wal k

thru , hot given by owner) I s th e propert y stucc o o r asbestos ? . If

yes , i s an y ofth e stucc o o r asbesto s damagedor cracked ? I f

yes , stop a s w e can' t stabiliz e thi s property . It require s specia l preparatio n techniques . It will b e retume dt o EP A an dthe y will assign a t alate r

date . Doe s thi s propert y require lot s o f scrapping ? / Doe s thi s propert y requir e alif t o r scaffolding t o reac h uppe r

levels ? Doe s thi s propert y hav e lot s o f plant s o r

item s i n area s where paintin g i s required ? Doe s thi s propert y hav e an y significan t structura l damage ? If

yes , EXPLAIN ? Doe s thi s propert y hav e agarage ? 

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yes , describ e locatio n o f garage .

### Doe s thi s propert y hav e aluminumsiding ? \J'^~ ^ -^Vk/^ l \/IM ^ 

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yes , i s it origina l factor y finis h or ha s i t bee n painte dover ?

Doe s thi s propert y hav e an y other 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 vacant or/occupied ^

Ar e ther e an y pet s a t thi s property ? / ^ 

### Ar e there an y lo w hangin g power lines ? 

# /ifli^i^H /

### I s ther e aneighborin g propert y tha t need s t o b e accesse dalon g with assigne d propert y t o complet e stabilizatio n process ? I f

so , ge t asigne dacces s fro mal l necessary neighborin g properties .

### TO B E FILLE D OU T ONL Y I FMATCHIN GCOLO R^^^ ^ 4'ldf^ ^ Paint matching form : ^ /

—7 Propert y address : l^O
- /» • J^5V v I UNDERSTAN D SHERWI N WILLIAM S WIL LMATCH MY CURREN T COLORS . Homeowne r

signatuTST ^



# IfAu e M 6idiifj ^ Mon B psf i H/ci/Ji/ei

Pag e 1

## PRE-STABILIZATION PROPERTY SAFET Y ASSESSMEN T FOR M PROPERTYADDRESS : I'^I'S ^ tf ' ^ V ^ BVID/SAI D 

# ' 

# ^^1> ^ PRUDEN T REPRESENTATIVE DOIN GASSESSMENT : 

# f^ H ****IFSAFET Y RIS K PROPERT Y MUS T B E TURNE D OVE R T O KATH Y ROTHE RBEFOR E I T CA N B E ASSIGNE D T O A CREW/SUB . REPRESENTATIVE REMARKS/FINDING S (POWER-LIN E PROXIMIT Y TO HOUSE , SCAFFOLDING/LADDERS/LIF T NEEDED , UNSAF E AREAS , UNSAF E NEIGHBORHOOD...ETC.) : 

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REQUIRE S K.ROTHE RAPPROVA LYES/NO SUBMITTE D TO K.ROTHE RON :TECHNOLOGIES , IN C 

## Checklis t fo r th e Worksit e Hazar dAnalysi s Address : 

# i^\i ^ Crew : Ite m Overhea dLine s In-transi t Vehicl e Clearanc e Level s aroun dhig h wire s Vehicl e Clearanc e around hig hwire s whe n workin 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 Hig hTraffi c Are a Garag e Structure s Drivewa y Sidewalk Foundatio n Retainin g Wall s Fence s Tree s Foliag e Genera l Conditio n ofyar d Damage dAreas : sin k holes/rotte dwoo d Sprinkle r System Pet s Insect s Weathe r Condition s Unsaf e drivin g condition s Unsaf e neighborhoo d OK ? 

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Sit e Safet y Office r Hazar d-y^SZ ^ \<\fe A <VT O rcrA \< Cc*v^,O K «4 ~

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808 0 War d Parkw^JSuit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 IMedica l Drive , Suit e 425 0 Kansa s City , MO.OT11 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 7S f



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# Curren t Sampl e Pre-Renovatio n For m Effectiv s unti l Apri l 2010 . Confinnatio n of Receip t of Lea d Pamphle t d |I hav e teceive d a cop y of th e pemphiet , Renovat e Right : Importan t Lea d Hazar d ^

InfonnaOo n for Rur^es,Chk l Car e Provkier s an d Schoote^p^xrt ^ rn e c^ th e potentia l riskof th e lea d hazar d eoqx)8ur e (re m tQn]^ffittk] n acth % to t>e performe d in mydwellin g unit . I received thi s pamphle t befor e th e worl < began . 

# /?'^'<f f recipient „//—r^ - Dat e 

# Z ^ Signatu i 8etr>Ger1ffieatk m 6|jfio n (fo rtenant-oocuple d dwetllng e only ) — if th e lea d pampMe 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 . •Refusa l to sign— I oeriif ytha t I hav e mad e a goo d fait h eflo t to delive rth e petmphlet./tenovala/%^t : Irnportan f Lea d Hazart f Mvmaflb n fer fii^ CVilc f ca m ftovlblare an d Sctoofe , to th e rental dwellh g uii t Hste d belo w at ^ dat e an d tim e indteate d an d tha t th e occupan t refuse d to sig n th e conflnnatio n of race^ . I Eithe rcertH ytha t I hav e lef t a oop y of th e pamphle t at th e uni t wit h theoooupant . Q Unavailabl e fb rsignature— I oertif ytha t I hav e mad e a goo d felth effort to deTiva rth s pamphlet , Aiarwvat o nSof/it* Importan t Laa d Hazar d Informatio n for fbrnAas ; Chfic f Car e preWdsr a an d SChooils , to th e rsrttaJ dweilin g un ^ belo wan d tha t th e occupan t wa s unavailabl e to sig n th e confirmatio n of receipt , i ftrthercertif ytha t I hav e lef t a oop y of th e pamphle t at th e uni t byslidin g it 

# WM M/AJ/ ^ Iram Attempte d delivery Rrtnte d nam e e of perso n osrtifyin g dat a an d tim e lea d pamphie t delivery I certifyin g lea d panphie t deliver y

UhltAdcbas s Not o Regardin g Mailin g Option—A s an altemativ e to deliveryh person , yo u ma yma B th e lea d pamphle t to th e owne rand/ a tenant . Pamphle t mus t be maile d at leas t 7 da ^ beltora re^G^«tlo n (Pocumen t wit h a certificat e of mailin g lio m th e postoffloe) . ^Dougla s Count y Account Infomiatio n http://douglasne.niaiming-online.com/DouglasCoNe/static/accountinfo. , i.m^mi i Dougla s County , Nebrask a Propert yRecor d - R164210000 0 Prin t Repor t NE

W Featur e - Parce l Dimension s availabl e @ scal e 0-50 f t wes t o

f 52n d S t - VJe W O n Ma p Informatio n i s vali d a s o f 2009-6- 3 Treasurer' s TaxRepor t Ne wFeature -•-•- > Aut o Sale s Searc h Owne r IVIEYE R RODGE R 

# nr-fO C 364 8 U^FAYETT E AV E N E ^T\\I J /^7^ 0 ^ ^ ; OIVIAHAN E 68131-000 0 " V • ", ^

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Propert yInformatio n Ke yNumber : 421 0 OOO O 1 6 Accoun t Type : Residentia l Parce l Number : ' 164210000 0 Parce l Address : 141 2 N 3 4 S T j OINAH A N E 68131-000 0 ; Lega l Description : LOWE S AD D LO T 2 BLOC KU N 34. 5 F T LO T 1 & E 2 0 N 34. 5 F T 34. 5 X 8 0 Valu e Informatio n 200 9 [200 8

200 7 200 6 2005 200 4 Lan d

;
! $1,700.0 0 $1,700.0 0 $1,700.0 0 $1,700.0 0 $1,700.0 0 $1,700.0 0 Improvemen t $43,200.0 0 $43,200.0 0 $43,200.0 0 $43,200.0 0 $43,200.0 0 $16,900.0 0 Tota l $44,900.0 0 $44,900.0 0 $44,900.0 0 $44,900.0 0 $44,900.0 0 $18,600.0 0 i \ ' 1 Sale s Informatio n Sale s Date : 2006-09-1 1
' Dee d Type : Price : W D j $34,500.0 0 SooAr : 200 6 Page ; ' 11026 2 Grantor : i CENTE X HOM E EQUITY COMPAI ^ LL C j Grantee : I^EYE R RODGE R ETA L Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 2005-12-0 7 Dee d Type ; ; TR D Booir : ; 200 5 Page : 15539 2 i Price : [ $52,850.0 0 Grantor : Eri cH Lindquis t Grantee : Cente xHom e EquityCompan y 1 Valid/Invalid : \ invali d
lo f 2 6/8/200 9 12:2 8 P Mi (ougla s Count y Account Informatio n ht^://douglasne.iTiaa|^ng-online.com/Doug ] asCoNe/static/accounti nfo. . i.m^ljur Exclusio n Reason : Sal e t o Mortgag e - Banl < Lan d Informatio n Acre s 0.0 6 S F 2800. 0 Unit s 1. 0 Dept h 80. 0 Widt h 35. 0 Vacan t N o Improvemen t Buildin g 1 Informatio n

Squar e Footage : 1117. 0 Perimete r 0. 0 Uni t Type :

Buil t As : 1 1/ 2 StoryFi n HVAC : Centra l Ai rt o 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 Yea rBuil t Yea r Remodele d Percen t Remodele d 191 0 0 % Deta/7 Typ e Deta/7 Descriptio n Applianc e Allowanc e Basemen t Bsmn t Bloc k 8 f t Fixtur e Bas e Fixture s Fixtur e Bat h Ful l Porc h Enc I Scree n Use r NE W ROO F CLIC KT O ENLARG E IMAG E 'Z ] Percen t Complete : 10 0 0 % Quality : Averag e Condition : Averag e Cond o Squar e Footage : 0. 0 Rooms : 6. 0

Units : 1. 0 Baths : 1. 0 Bedrooms : 3. 0 Stories : 1. 5 Foundation : Blocl ( Sprinkle rSquar e Footage : 0. 0 Adjuste d Yea r Physica l Ag e Buil t 191 0 9 4 Unit s 1. 0 665. 0 1. 0 1. 0 154. 0 1. 0 2 o f 2 6/8/200 9 12:2 8 P M% TECHNOLOGIES , INC . 

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

### ;:?<rtr<2^. C Propert yAddress : _ 

# im9 . -Kl . e^-^ ^ 51
­ Owner' s Name : l^Qo J 

# fll JC ^

LLlSd j S.N 0 Performanc e Standards/close-Ou t Criteri a Ye s NO 1 Wa s th e entir e structure(s ) painte d wit h th e exceptio n of th e stated , exclude d areas ? Thi s woul d includ e paintin g of othe rassociate d feature s includin g fascia , eaves , siding , al l trim , porches , bo x 

# A beams , columns , rails , an d exterio rsurface s of garages . 2 Wa s al l scrapin g an d othe rpreparatio n wor k complete d satisfactorily ? 

# X 3 Were al l require d area s of th e structure(s ) prime d as neede d an d painte d wit h tw o to p coats ? 

# i< . 4 Ar e al l ofth 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 on th e entir e property , roadways , alleyways , publi cacces s area s an d als o remov e an yothe rgenerate d debris ? 

# .X 6 Is th e gras s are a tha t surround s th e structure(s ) in reasonabl ygoo d condition ? ^ 7 Wa s th e pain t product s utilize d equivalen t to a 30 yea r product/quality ? 8 Ar e al l item s suc h as polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e et cproperi yremoved ? 

# X 9 Is ther e an yevidenc e of propert ydamag e tha t wa s don ebyth e contractor ? An ypropert ydamag e need s tobe complete d prio r to th e EP AClose-Out . 

# K 10 Ar e ther e an ypropert yitem s tha t wer e temporaril yre-locate d byth e contracto rtha t nee d tobe move d back ? 

# Y 11 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 ? 

# X 12 Othe rConsiderations ? Propert yOwne rDiscussions ? Additiona l Wor k tha t is Require d \ Pruden t e Signatur e Representativ e Signature : 

## ^J/^AJ ^ ^^•>MJ \ Date : Propert yOwne rSignature : 

## Date : y-Z^-O f 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 , Nebraslt a 6811 0 Sa n Antonio , TX 7822 9 Plione : (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