## TRANSMITTA Lof OMAHA LEAD SIT E PAIN T STABILIZATIO NFIL EFOLDE R SAID : 518 9 Date : 12/26/200 8 Address : 81 5 TURNE RBLV D Stabilizatio nContractor : Pruden t Technologie s Year : 200 8



## \ 7 u D 

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### PAIN T STABILIZATIO N

PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f property (DVD ) Executiv e Summary Signe dAcces s Agreemen t for subjec t property Paintin g Agreemen t Settlemen t

document s (i.e. , for

damag e o r

t o replac e plants , etc. ) Photograph s Satisfactory restoratio nsigne db y Property Owne r Property close-ou t

chec k lis t signe db y EP A Property informatio nfro mDougla s County Assessor' s Offic e

Signatui ^ oz/oejo j 

### )ate 4030799 1 

# iiii n Superfun dPROPERT Y SUMMAR Y

Date : 12/29/0 8 LB PSTABILIZATIO NEP A CONTRA T EP-R7-08-0 7 Mont hof : Decembe r Propert y Address : 81 5 TURNE RBLV D SAID ; 518 9 A . EXECUTIV ESUMMAR Y A. 1 Issue s Encountered : NONE . A. 2 Issue s Resolved : NONE . A. 3 Uniqu e Findings : NONE . A. 4 Othe r

Relevan t

Information : Acces s Date : 10/21/0 8 Wor k Began : 10/28/0 8 Closeou t Date : 10/30/0 8 Enclosures : 1 . Pre-Vide o 2 . Post-Vide o 3 . Propert y Statu s For m 4 . Signe dAcces s Agreemen t 5 . Pre-Renovatio nFor m 6 . Pain t Matc hFor m 7 . Trackin g For m 8 . Dougla s Count y Assesso r Propert y Informatio nPag e 9 . EP A Propert y Closeou t for m 10 . Propert y Completio nAgreemen t

TECHNOLOCIES , INC .

### TECBNOLOGIES,WC . 

# K INVIRONMENTAL « OONSTRUCnO N 

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## Propeit y Owne r Signature ! ^^-.g^ ^ 

## Pruden t Employe e Signatuic;y5^'^-- ^ ^

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Fiuden t Tedmologies , Inc . (Prudent ) i s unde r contrac t (Contrac t #EP-R7-08-07 ) witl i th e U . S . Binnxonmeota

l Protectio n/^enc y (EPA ) t o stabiliz e Lea dBas^dLPaint .(L£P ) a t anumbeLo f

propertie s locate di nOmalia , Nebraska , includin g th e propert y locate da t pf D ^>^av\ g { ^CivqU " Th e EP Arequest s yoti r

pennissio nt o allo w Pruden t t o performLB PStabilizatio na t thi s property . B y tigning tins form , tiie propert y owne r grant s permissio nt o Pruden t t o perfor mactivitie s relate dt o LB P Stainlizatio nincludin g scrapin g pain t an dpaintm g o f

th e reference dproperty . Further , tiie owner/tenan t verifie s tiiat

tiiey hav e receive dtiie LB Ppamphle t **Renovat e Right " I f yo u hav e an y question s abou t th e LB PstabiUzatio nplanne dfo r you r property , pleas e contac t

Prudent^ s /iit|pinfg»nifiv e Cler k

for tiie Lea dBase dPain t

Stabilization , Mrs . Debora hAkerdMnhMnti i a t (402 ) 504-1004 . Genera l question s abou t tiie Omah aLea dSit e cleanu p ca nb e directe dt o tiie ^ A Publi c Infonnatio nCenter s a t (402 ) 731-304 5 (Souti i Omah aofitce ) o r (402 ) 991-9S8 3 (NorthOmah a °^^^
- A y - ^ rl>HIBllyAtBeilOlMlBdBy ! (Pleas e Print Name) 

### <:*<55 ^ ^ yy yy/tTL. . Prapeiiy Omc r

Signatora : 

# ^^A 4 y ^ //F^Fo y (SiSMtute ) C y (Date )

PROPERT Y INFORMATION (T o b e coaplcte db x itiidcn t ndAn r pnpcit r owBc r > pIcM e prist ) RESIDENTNAME : '^ ^ >fe>V»/<^< / Owne r ^ ^ 

# fe f7 K'T^y^^ rSr^^^Aa^y y RE8I0EN TADDRESS : I PRENTAL , PROPERT Y OWNE D 

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OWNERrSTELEPHONENUMBER.HOME : i¥e?y7^/^!>Z73 S WORK ; ( \ NUMBE R O P OCCUPANT S UNDE R 7 YEAR S OLD : .JL . NUMBE R O P OCCUPANT S 7 YEAR S OL D AN D OLDER : .J ^ NUMBE R OPCHILDRE N UNDER TYEAR S OL D WH O PLAYI N TH E YAR D FO R 8 HOUR S O R MOR E PE R WEEK : / COHMENTSORSPECIALINSTRUCnONS : (L E DOOS . ENTRYQATES . ETC. )

AUniOnr r

FO REtwaU>NMBKrA LKESPONS B ACTIONS ; Tlw wthrWet t o b e UnptemeaMl y ^ of CBRCU . 4 3 UA C 9604 . BPA' i right o f aoee nto flw preperty bproWde dIbr taSectio n104(e ) o f

CERCIJ^ . 4 2 Ar'^deleniMB i th e nee d(b r

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eboeeiii g ortricb v n y tctpen w 1 ^

# Curren t Sampl e Pre-Renovatio n Fon n eriMiMunt n Apri l 2010 . ConflmHUQ n o fReceip t o fLoa d Pamphlo t 1Sif\hBNet9e(t>iedaco(rfdlthef)ernriieil , Renovat e fVghtlnyjo ^ haixrnibn1drFmBes,ChBdCaeProvkJer8andSchool8MarrrlDqme ^ th s potant U tta k

o ( th e lee d hazar d eMpoot n (ifor n renos«aon activit yt o t) e pettarw d I n rt ydwellin g wItMieoeKw d thi s paniphle t befty e Ih e wor k begari . Printe d nam e o frecipient ^ Dot e Signatur e o frecipient F J SeifOertWcado n Opttoi t (fo rtenant-occupie d dwoHlng e only ) — I fth e lea d parnphle t wa s delivere d bu ta tenan talgretur e wa s no t obtainable , yo u me ychec k

th e eppropriat e bo xbelow . Q Refusa l t o sign— I certif ytha tI hav e mad e a goo d MhelRx t t o delive rth e pemphlet , nenoval e /%M : Inportan t Les d Hezer d brfomwtio n forf^liee , CMk fCare Aodbler s an d SCfiooyis , t o th e renta l dwellin g uni t 1 ^ dat e en d tim e indcate d an d tha t th e oocupan t refuse d t o 8lg n th e confimiatio n o freoeipLI llvthe roertu ytha tI hav e iel l a cop yo fth e pemphle t a t th e uni t wit h ttieoooupant Q Unavailabl e Ib rsignattva-- 1 certif ytha t I hav e mad e a goo d fait h eflbrt t o dallv wth s pamphlet./?arx}v«l d nig/it : ArrportEn ftestf/'^ ^ /^•98 ^ C WCSar e protdblara an d Sc/x)ofe , t o th e rental dwein ^ belo wan d tha t th e occupan twa s unavailabl e t o aig n th e confitrnatio n o freceipt. llUlhe rcertitytha tI hav e left a cop yo fth e pamphle t a t th e uni t b yslidin g i t underthedoor . (^^cyrA ^

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y\'U-o g /^» & Printe d nam e c fperBo n oeitiiyin g Attempte d deHvo y dateandtim e I yI I A* ^

/ lea d pamphle t deliver y Sfgna&jre o fpereo n certilyin g lea d pamphle tddnver y 

## S) 6 -J.y~^<z,t : <fi.\^J l r ^ ys v Fi^o ^ F^c . 1^3l o 4 IMtAddee s Not e Ragardin s Maliin g Option- > A s a n alternativ e t o deBver yi n person , yo u ma yma l th e lea d pamphle tt o th e owne rand/o rtenant . Pamphle t mus t b e maile d a t leas t 7 days before renovatio n (Documen t wit h a certificat e o fmailin g fjfo m th e postoffice) .

# M o O.^- - • w^e(T ) pain t matc hrferm : Pain t matchin g form : _

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### Pag e 1 o f 3 Doujia s county , Nebrask aPropert y Recor d- Rl72265000 0 Informatio n i s vali d a s o f 2008-9- 4 Prin t Repojr t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t of SOt h St - Vig W pn.Ma p Trea_surer' s Ta xRepor t Ne wFeatur e - » ^

- V Aut o Sale s Searc h 

### Owne r GOET Z MAR K ETA L 563 4 PARKE R S T OMAH AN E 68104-000 0 Propert yInformatio n Ke yNumber : 226 5 OOO O 1 7 Accoun t Type : Residentia l Parce l Number : 172265000 0 Parce l Addres s 81 5 TURNE R B D

OMAH AN E 68105-000 0 Lega l Description : MAYN E PLAC E LO T2 5 BLOC K1 S 3 6 F T 3 6 X 12 5 Valu e Informatio n

Lan d 200 8 200 7 200 6 200 5 200 4 200 3 $5,400.0 0 $5,400.0 0 $5,400.0 0 $5,400.0 0 $5,400.0 0 $5,400.0 0 Improvemen t $6 1 

### Tota l $6 1 $7 2 $7 2 $7 2 $7 2 200,0 0 200.0 0 200.0 0 200.0 0 200.0 0 200.0 0 $66,600.0 0 $66,600.0 0 $77,600.0 0 $77,600.0 0 $77,600.0 0 $77,600.0 0 Sale s Informatio n

Sale s Date : 2007-03-0 6 Dee d Type : W D j Price : $44,900.0 0 Grantor : Wester n Financia l Grantee : Qoet z Mar k eta l Valid/Invalid : Vali d Exclusio n Reason : Book : 200 7 Page : \02540 8

Sale s Date : 2006-05-0 3 Dee d Type : W D j Price : $50,000.0 0 Grantor : DAVI D ATHOMPSO N ETA L Book : I 200 6 

### 1 Page : \05046 3



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17.. . 10/1/200 8J-V/AlllCtllWl l 

### Pag e 2 o f 3

oramee : WESTER N FINANCIA L LL C Valld/lnvalld : Vali d Exclusio n Reason : \ 

### Lan d Informatio n Acre s 0. 1 S F Unit s

4500. 0 1. 0 Dept h 125. 0 I VV/dtf

i Vacan t 36. 0 N o Improvemen t Informatio n Buildin g 1 iiS*'"!^ ' f' . -(-.^^Ai* * iSeconcFloc r 66 4 G& qt

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CLIC KJ O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : Perimete r Uni t Type : Buil t As : HVAC : Exterior : interior : Roo f Cover : Roo f Type : Floorcover : 1373. 0

0. 0 2 1/ 2 Stor yUnfi n Force d Ai r Fram e Sidin g Plaste r Compositio n Shingl e Gabl e Aliowanc e Percen t Complete ; 100.0 % Quality : Averag e Condition : Goo d Cond o Squar e Footage :

Rooms : Units : Baths : Bedrooms : Stories : Foundation : Sprinkle rSquar e Footage : 0. 0 6. 0 1. 0 1. 0 3. 0 2. 5 Block 0. 0 YearBuil t 190 0 Yea r

Remodele d Percen t

Remodele d 0 % Adjuste d Yea r

Buil t 190 0 Physica l Ag e 10 7 Detai l Typ e Ad d O n Applianc e Basemen t Fixture Detai l Descriptio n Unfinishe d Atti cW/floo r Allowanc e Bsmn t Bloc k

8 f t Bas e Fixture s Unit s 266. 0 1. 0 664. 0 1. 0 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.isp?accountno=R17.. . 10/1/200 8

### Pag e 3 o f 3

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### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17.. . 10/1/200 8

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

SAID : yt ^

^ Propert yAddress : % ' I S '"1". ^ v - fN-F. v^\y J Owner' s Name : r^c-cV: . G ^ g Ag — 

### Performanc e Standards/close-Ou t Criteri a YES N O 1 . Wa s th e entire 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 , ai l trim , porches , bo x beams , columns , rails , an d exterio rsurface s o f garages . 

# y 2 . Wa s al l scrapin g an d othe rpreparattio n wor k complete d satisfactorily ? 3 . Wer e 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 ? ^ 

### A F 4 . Wa s th e pain t product s utilize d equivalen t t o a 3 0 yea rproduct/quality ? ^ _ 5 . Ar e al l o f th e area

s where contaminate d material s hav e bee n spille d thoroughl yvacuumed/

cleaned ? ^ ^ 

# V 6 . Di d th e contracto rcollect/vacuu m al l fallin g an d scrape d pain t chips o n th e entir e property , roadways , alleyways , publi cacces s area s an d also remov

e anyothe rgenerate d debris ? 

# > 7 I s th e gras

s area tha t surround s th e structure(s ) i n reasonabl ygoo d condition ? 

### 3 ^ ' 8 . Ar e al l item s such a

s polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e etc . properl yremoved ? ^ 

# > C . 9 . I s ther e anyevidence o f propert ydamag e tha t wa s don e b yth e contractor ? An ypropert ydamag e need s t o be complete d prio rt o th e EP AClose-Out . 

# X 10 . Ar e ther e anypropertyItem s tha t were temporatii yre-locate d b yth e contracto r tha t need t o be move d back ? 

# x r 11 . Ar e ther e any(known ) lingerin g issue s wit h th e propertyowner{s ) tha t hav e bee n lef t unresolved ? Othe rConsiderations?propert yOwne rDiscussions?Additiona l Wor k tha t i s Require d 

### Pruden t Representativ e Signatur e 'ayZ.^f^y~t.A^-» y 

### Dat e i ^ , 

# ' / 3o l o y Propert yOwne rSignature : ;^yF^ / 7 ^


## • a I^JZoJol i Dat e 

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