## TRANSMITTA LO FOMAHA LEAD SIT E PAIN T STABILIZATIO NFIL EFOLDE R SAID# : _3L3_S3_

_



### Date ; n'bj/iS.joacP , Address : ^l^O,J ^ \/At4 ^ ^ 7 LB PStabilizatio nContractor : PRUDEN T TECHNOLOGIES , INC . Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S y Vide o of propert y (DVD) : Pre-Stabilizatio nA rust-3taUllLi.atiu u Vidtu a y Executiv e Summary y Signe dAcces s Agreement Form y Advanc e Notic e Form ^ Pre-Stabilizatio nVide o Agreement Form y Acces s Trackin g Form y Propert y Acces s Assessmen t Form y Neighbo r Acces s Agreement Form y Pain t Matc hForm y Pre-Stabilizatio nPropert y Safet y Assessment Form y Work-Sit e Hazard s Analysi s Checklis t y Photographs : Pre-Stabilizatio nPropert v Hazar dAssessment Photograph s y Dougla s County Assessor Propert y informatio n y Propert y Completio nAgreement FormSignedby Propert y Owne r D Propert y Close-Out Chec k Lis t SignedB y EPA Pruden t Technologies , Inc . Signatur e Dat e 44iU > 

# "f/^y/f t 

# 'lo . A Signatur e / Dat e 3005542 6 

# iuni Superfun dTECHNOLOGIES , IN C 

# Propert y Summar y Date : 8/03/200 9 | LB PSTABILIZATIO NEP A CONTRAC T EP-R7-08-0 7 | Mont hof : Au g Propert y Address ; 243 2 Van e S t SAI D # : 4135 3
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 : 7/10/200 9 ii . Wor k Began : 7/17/200 9 iii . Close-Ou t Date : 7/19/200 9 B . Enclosures ; 1 . Pre-Stabilizatio nVide o 2 . Post-Stabilizatio nVide o 3 . Signe dAcces s Agreemen t For m 4 . Advance-Notic e For m 5 . Pre-Stabilizatio nVide o Agreemen t For m 6 . Acces s Trackin g For m 7 . Propert y Acces s Assessmen t For m 8 . Neighbo r Acces s Agreemen t For m 9 . Propert y Pain t Matc hFor m 10 . Pre-Stabilizatio nPropert y Safety Assessmen t For m 11 . Work-Sit e Hazard s Analysi s Checklis t 12 . Pre
- Stabilizatio nPropert y Hazar dAssessmen t Photograph s 13 . Dougla s Count y Assesso r Propert y Informatio n 14 . Signe dPropert y Completio nAgreemen t For m 15 . Propert y Close-Ou t Chec k Lis t Signe dB y EP Ar.::;-^,:r7--'^t,-,:rj,r:r;v ' r;:-^^-^.^r-^-.-..'-•-••-.•v'^, . -.^r.-y-v.'.v*•••.-.:-r'-T^*:.':^.""^V".* V ?'P3:sKrTM;7.B'i".scr3:32Jc;=t."iT i -r r 

# *R TECHNOLCXFIBS . INC .

Pruden t Technologies , Inc . (Prudent ) i s unde r contract (Contract #EP-R7-08-07 ) wit hthe U . S . Environmenta l Protection Agenc y (EPA) to stabiliz e Lea dBase dPain t (LBP) a t anumbe r ofpropertie s locatedi nOmaha, Nebraska , including the propert y locateda t l.f3ZV'*'^* ' 5-^ ^ Th e EP A requests you r permissionto allow Pruden t to perfom i LB PStabili2:atio na t thi s property . By signing thi s form , th e propert y owne r grant s permissionto Pruden t to perfor mactivitie s relatedto LB PStabilizationincluding scraping pain t an d painting ofth e referencedproperty . Further, th e owner/tenan t verifie s tha t the y have receivedth e LB Ppamphle t "Renovat e Right. " B

y signing thi s documen t Iagree to allow a nEP A contracto r to conduc t asoi l cleanu p a t m y propert y followin g completionof lead-basedpain t stabilization , ifth e soil cleanu p has not alread y bee nperformed . I understandtha t the stabilizationcontracto r canno t provid e assurance s of whic hcontracto r wil l be boun dto the soi l cleanup . I furthe r understan dtha t the soil cleanu p contracto r wil l mak e al l reasonable effort s to addres s concems tha t I , as the propert y owner, ma y have regarding soi l cleanu p a t m y property . [l^fYes , Lhave rea dandunderstan dthe paragrap habove . Signatur e of Propert y Owne r Dat e Ifyou have an y question s abou t the LB Pstabilizationplannedfo r you r property , pleas e contact Pmdent' s Custome r Relations/Office Manage r fo r the Lea dBase dPain t Stabilization , Mrs . Shanno nHolt , 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 nbe directedt o th e EP A Public Informatio nCenters a t (402 ) 731
­ 304 5 (Sout hOmah aoffice ) o r (402 ) 991-958 3 (Nort hOmah aoffice) . Propert y Acces s GrantedBy : 

### 5^UtAKr»^ e 5c^»o(?ar?/o ^ Pleas e Brin t Name) Propert y Owne r Signature : (Signature) 

## 7 /io/o f (Date )

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 , M O 6411 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 7• m

m TECHNOIOGIES . INC . PROPERT YINFORMATIO N (T o b e complete d b yresiden t and/o rpropert yowne r—pleas e print ) RESIDEN TNAME : Rente r RESIDEN TADDRESS : 

# jyfS^^i^ ^ ^ . I F RENTAL , PROPERT YOWNE D BY :
OWNER' S MAILIN G ADDRESS ;
OWNER' S TELEPHON E NUMBER - HOME : ( ( "< - W ^ ' ' WORK : 

# lioL'AiyrHi^oRK :

- l^ ^ ' CtrUC- \ 

# t^dLii'^^'^^'- i NUMBER O F OCCUPANT S UNDE R 7 YEAR S OLD : / NUMBER O F OCCUPANT S 7 YEAR S OL D AN D OLDER : 

# 2 ^ NUMBER O F CHILDRE N UNDE R 7 YEAR S OL D WHO M PLA YI N TH E YAR D FO R 5 HOUR S O R MOR E PE R WEEK : 

# i COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES „ ETC. ) /

AUTHORIT Y FO RENVIRONMENTA LRESPONSEACTIONS : Th e activitie s to be implemente db y EP A unde r thi s agreemen t ar

e pursuan t t

o Sectio n10 4 ofCERCLA , 42 U.S.C . 9604 . EPA' s righ t of

acces s to the propert y i s providedfo r i

nSectio n104(e ) ofCERCLA , 42 U.S . C 9605(e) , whic hprovide s entr y fo r "detennining the nee dfo r response , o r choosin g o r taking an y respons e actio nunde r thi s title , o r otherwis e enforcin g the provision s ofth e title. "

808 0 War d Parkway , Suit e 40 5 260 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 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 7TECHNOLOGIES. ] 

# Advance dnotic e needed . After signin g th e acces s yo u allo w Pruden t t o begi nLea dBase d Pain t Stabilization . Al l Plants , weed s an dan y vehicle s o r item s o n ope nporc 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 ou t ofyar ddurin g stabilization . Ho w muc hnotic e d o yo u nee dt o hav e abov e mentione dtask s completed ? Ifyo u ar e alandlor dyo u wil l nee dt o contac t th e tenan t a s Pruden t Technologie s wil l onl y informyou . D o yo u hav e an y pet s tha t resid e i n yard ? i^< ^ C /'^^^' ^ ^ c?^ ^ Notic e needed : 

# / i ^ 

# Numbe r t o cal l t o giv e notice : Who mw e ar e givin g notic e to : ^ Hom e Owner' s Signatur e C ^

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 , M O 6411 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 7TECHNOLOGIES . ] ^

K S ^ 

## PRE-STABILIZATIO NVIDE O FOR M I UNDERSTAND THA T PRUDEN T TECHNOLOGIE S WIL LB ECOMIN G OU T T O SHOO T A PRE-STABILIZATIO NVIDE O A T M Y PROPERTY . TH EVIDE O I S JUS T A TOO LUSED T O DOCUMEN T TH ECURREN T PROPERT Y STATUS/CONDITION . A POS T VIDE O WIL LALS O B E SHO T PRIO RT O COMPLETIO NO FSTABILIZATION . OWNER S NAME [piCc / Q.*^JUL<if^M , J cM/>r^h i errv-e* ' 

## PROPERT Y ADDRES S 

# ' 2/^J Z\A/vJ e 5" / 0^ ^ BVID/SAID : ^^'^6' X HOMEOWNER S SIGNATURE 

# •izm . PRUDEN T REPRESENTATIV ESIGNATURE : AN Y CONDITION S NEED T O B EAWAREO FBEFOR ESHOOTIN G VIDEO : (I.E . PETS , NOTIC ENEEDED) : / ­

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 , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 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 7

# m TECHNOLOGIES, ] 

# ACCES S INFORMATIO NTRACKIN GSHEE T BVID : A\^5 3 PROPERTYADDRESS : 2^'b ^ Van e st . IX^C- M __5_^V26nb_e_t_oe_r _ 

## Propert y Owne dBy : (I f new propert y owner )

Owner s Phon e No's : Home : Work : Cel l : —^y . Fax : 

## Acces s Contractor : AS WPD A ME S P EOthe r (Prudent ) DATE TIM E ACCESSO R CONRAC T DETAI L ^\\0^o q 

## \aprv\ ^<xr\\-eje-\ . ^. Q coS ^ c^vaOiV ^ -NKe


## oe.\^^\^-^>oc> . \



## Comments :

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 , M O 6411 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 7TECHNOLOGIES. ] 

# Acces s Assessmen t Form : (Mus t b e complete dfo r every property . Informatio nmus t b e obtaine dfro mapropert y wal k thru , no t given b y owner ) I s th e propert y stucc o o r asbestos ? Ifyes , i s an y ofth e stucc o o r asbesto s damage do r cracked ? M o 

## Ifyes , sto p a s w e can' t stabiliz e thi s property . I t require s special preparatio n techniques . I t wil l b e returne dt o EP A an dthe y wil l assig n a t alate r date . fvi O 

## Doe s thi s propert y requir e lot s of scrapping ? Doe s thi s propert y requir e alif t o r scafiToldin g t o reac huppe r levels ? Doe s thi s propert y hav e lot s of plant s o r item s in area s wher e paintin g i s required ? Doe s thi s propert y hav e an y significant structura l damage ? ^4 0 

## Ifyes , EXPLAIN ? tA O

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 , M O 6411 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 7TECHNOLOGIES . ] 

## Doe s thi s propert y hav e agarage ? Ifyes , describ e locatio no f garage . 

## ^;^^^ Q JUa A.^.<^^-^M . 1 ^ ^ ^ Doe s thi s propert y hav e aluminu msiding ? \ J ^-J ^ r \VTL. ^ Ifyes , i s i t origina l factor y finis ho r ha s i t bee npainte dover ? Doe s thi s propert y hav e an y othe r typ e o f structura l components ? (I.e . roo f shingle s a s siding) ? i\3 0 

## Ifyes , EXPLAIN ? M O i'> ) "b<=V<L\S 

## I s thi s propert y vacan t o r occupied ? J A Ar e ther e an y pet s a t thi s property ? r^ i 

## Ar e ther e an y lo w hangin g powe r lines ?

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 , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 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 7TECHNOLOGIES , IN C 

## NEIGHBORHOO D PROPERT Y ACCES S FOR M I S THER EA NEIGHBORIN GPROPERT Y THA T NEED S T O B EACCESSED ALON G WIT H ASSIGNED PROPERT Y T O COMPLET ESTABILIZATIO NPROCESS ? VJO I FI T IS , GE T ACCES S FRO M ALLREQUIRE D NEIGHBORHOO D PROPERTIES . 

## N O

808 0 War d Parkway , Suit e 40 5 2S0 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 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 7TECHNOLOGIES , IN C 

# PAIN T MATCHIN GFORM : T O B EFILLE D OUT ONLY I FMATCHIN GCOLO R PROPERTYADDRESS : 2^"b: X Vao ^ ^ V BVID : Ml^G? ) I UNDERSTAN D SHERWINWILLIAM S WIL LMATC H MY CURREN T COLORS . Homeowner signature :

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Streat , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 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 7^"^' ^ TECHNOLOGIES. ] 

## PRE-STABILIZATIO NPROPERT Y SAFET Y ASSESSMENT FOR M PROPERTYADDRESS : :x^'h ^ Vane . S ^ BVID/SAID : 

## A1-^5 3 PRUDENT ASSESSMENT REPERSENTATIVE :



## ******IFSAFET Y RIS K PROPERT Y MUS T B ETURNED OVE RT O KATH Y ROTHE RBEFOR EI T CA N B EASSIGNED T O A CREW/SUB . REPERSENTATIV EREMARKS/FINDINGS : (POWER-LIN EPROXIMIT Y T O PROPERTY , SCAFFOLDING / LADDERS / LIFT S NEEDED , UNSAF EAREAS , UNSAF ENEIGHBORHOOD...ETC. )

REQUIRE S K.ROTHE RAPPROVAL YES/N O SUBMITTED T O K.ROTHE RON :

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 , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 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 7• • TECHNOLOGIES , ] 

# Checklis t fo r th e Worksit e Hazar dAnalysi s Address : CxC . f^^(^7~' ^ Crew : Date : Ite m OK ? Hazar d Correctiv e Actio n 

# f Overhea dLine s In-transi t Vehicl e Clearanc e Level s aroun dhig hwire s 

# y Vehicl e Clearanc e aroun d 

# y hig hwire s whe nworkin g Phon e line s 

# M Cabl e line s 

### .A _ Ga s Lin e Wate r Lin e Sewe r Lin e Septi c Tan k Propane/Butan e Acces s to/o nPropert y Lut i ^jiM. ' 

### vkjuiy Neighbo r Acces s Require d >fc ^ Hig hTraffi c Are a Garag e Structure s Drivewa y Sidewal k c<?f7ry-e-fKi;.^i: > 

# s^-^U/rt^ ^ y < Foundatio n ^Lt - Retainin g Wall s Fence s ^hu^^ l S^Tnr^'ft^'--ry—^lJ±^L'^a^urv^v^p ^ Tree s Foliag e Genera l Conditio nofyar d Daniage dAreas : sin k holes/rotte dwoo d Sprinkle r Syste m Pet s Insect s 

### J-v^g ^ fy*> ^ j ^ i-u^J^^^ ^ Weathe r Condition s Unsaf e drivin g condition s Unsaf e neighborhoo d 

# ^

CAWJW - 

# h4 ^ i ^ oJU L frv<^ 6u^W=^^ CrewJForeman / Sub-Contractoc j Office r 

# ^/JLK:: ^ 808 0 War d Parkw l 40 5 250 5 N . 24' " Street , Suit e 30 8 24 2 Medica l Drive , Saite.425 0 Kansa s City , M O Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 3 Phone:(816)363-37 0 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

# Curren t Sampl e Pre-Renovatio n For m Effectiv e unti l Apri l 2010 . Confirmatio n o f Receip t o f Lea d Pamphle t ^rVnav e receive d a cop yof th e pamphlet , Renovat e Right : Importan t Lea d Hazar d Informatio n fo rFamiiies , Chil d Car e Provider s an d School s informin 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 performe d i n m ydwellin g unit . I receive d thi s pamphle t befor e th e wor k began . 

### Ji^T^z/n t J<^M£t^(:&rxc ^ 

# 7//^A ? Printe d nam e of'fep^ien t Dat e Signatur e o f recipien t Self-Certificatio 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 maychec k th e appropriat e bo xbelow . •Refusa l t o sig n —I certifytha t I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , Renovat e Right : Importan t Lea d Hazar d Informatio n fo rFamiiies , Chil d Car e Provider s 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 confirmatio n o f receipt . I furthe rcertifytha t I hav e lef t a cop yo f th e pamphle t at th e uni t wit h th e occupant . •Unavailabl e fo rsignatur e — I certifytha t I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , Renovat e Right : Importan t Lea d Hazar d Informatio n fo r Families , Chil d Car e provider s an d Schools , 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 confirmatio n o f receipt . I furthe rcertifytha t I hav e lef t a cop yo f th e pamphle t at th e uni t b yslidin g i t unde rth e door . Printe d nam e o f perso n certifyin g Attempte d deliver y dat e an d tim e lea d pamphle t deliver y Signatur e o f perso n certifyin g lea d pamphle t deliver y

Uni t Addres s Not e Regardin g Mailin g Optio n —A s a n alternativ e t o deliver yi n person , yo u maymai 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 of mailin g fro m th e pos t office) .ENVIRONMENTA L& CONSTRUCTIO N TECHNOLOGIES , INC . SERVICE S 

# RcD C

_ ^^^^t.oc To : Trac ySchonberne r From : Mr . Chandr a Sheka r Fax : 402-451-284 7 Pages : 1 + Phone : 402-451-284 7 Date : 7/8/0 9 Re : 243 2 Van e St , Omaha , N E Tracy : Pruden t Technologie s (Prudent ) i s EP Acontracto rfo rpaintin g exterio ro f th e house s i n Omaha . You rpropert ylocate d at : •243 2 Van e St , Omaha , NE . i s assigne d t o Pruden t b yEPA . W e hav e t o ge t you rsignatur e fo raccessin g you r property . Therefore , pleas e cal l ou roffic e a t 402-504-100 4 t o se t u p a meeting . A Pruden t representativ e will : •com e an d visi t wit h you a t th e propert y(243 2 Van e St ) •explai n th e scop e o f wor k an d •wil l answe ran yquestion s yo u hav e Pleas e not e tha t EP Apay s fo rpaintin g you rhouse . Tha t mean s i t i s fre e fo ryou . Sincerely , Q O



# c 3^
- - \ i Mr . Chandr a Shekar , P.E . ^< ^ 

### Projec t Manager ^ - 

### P.S. : 1 . I f yo u hav e an yquestion s regardin g 'EPA' s Omah a Lea d Base d Pain t Stabilizatio n Program ' pleas e fee l fre e t o call :

• EP APubli cInformatio n Cente ra t 402-991-9583 . Yo u ca n reac h Pruden t representativ e Ranj i o n hi s cel l phone : 402-212-692 1 a t anytime . 808 0 War d Parkway , Suit e 40 5 250 5 N . 24* ^ Street , Suit e 21 8 424 2 Medica l Drive , Suit e 725 0 Kansa s City , M O 6411 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 7

### Dougla s Count y Accoun t Inforn^io n Page 1 of 2 rn^ c Dougla s County , Nebrask a Propert yRecor d - R174820000 0 Prin t Repor t ME

W Foatur e - Parce l Dimension s availabi e @ scal e 0-5 0 f t wes t of 52n d S t - Vle W Ot l Ma p Informatio n i s vali d a s o f 2009-6-1 6 Treasurer' s Ta xRepor t Ne wFeatur e - ^ -• - > Aut o Sale s Searc h Owne r 

# ^r/\A > SCHONBERNE R TRAC YD ETA L ^^ ^ 

# i^ A \>tAs 3 243 2 VAN E S TmJ W 

# Ph : OMAH AN E 68112-000 0 ' Propert yInformatio n Ke yNumbe r Accoun t Type : Parce l Numbe r Parce l Address : Lega l Description : Valu e Informatio n

' Lan d 200 9 ' 200 8 ; 200 7 200 6 200 5 ' 200 4 Sale s Informatio n Saie s Date : Dee d Type : Price : Grantor : Grantee : Valid/Invalid : Exclusio n Reason : Lan d Informatio n Acre s S F 0.1 8 : 482 0 OOO O 1 7 <(' ' < Residentia l

, 174820000 0 243 2 VAN E S T OMAH AN E 68112-000 0
' MINN E LUS ALO T6 BLOC K1 W 1/ 2 LT5 & AL L & AL L VA C REA D S TAD J O N W
$5,800.0 0 $5,800.0 0 $5,800.0 0 $5,800.0 0 $5,800.0 0 $5,800.0 0 Improvemen t Tota l $119,600.0 0 $125,400.0 0 $119,600.0 0 $125,400.0 0 $100,300.0 0 $106,100.0 0 $100,300.0 0 $106,100.0 0 $100,300.0 0 $106,100.0 0 $84,300.0 0 $90,100.0 0 1999-11-0 1 D Book : 213 7 Page : 42 6 $24,750.0 0

invali d Sal e b yGovt Agency Unit s ' Dept h Widt h Vacan t 8170. 0 1. 0 86. 0 95. 0 N o Improvemen t Informatio n 

### http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R174.. . 7/7/2009-;ti.;T;,:t „ • ;,:r: . ^M^t»ii./'J#^imi.^'.-..^^;S!(:'.if;f-. . 

### Dougla s County Accoun t Infonj^|io n Pag e 2 of 2 n|^|i c Buildin g 1
2*^ 2 van e SJ t Ranc h

.rS!!!"J'» ,

Tfrf * r;* * "Cf : : ^ f I CjLIC KT O ENLARG E IMAG E Squar e Footage : 1728. 0 Percen t Complete : 100.0 % Perimete r; 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : Ranc h Cond o Squar e Footage : 0. 0

HVAC : ^ Centra l Ai rt o Ai r Rooms : 6. 0 Exterior : Frann e Sidin g Units : 1. 0 Interior : Drywal l Baths : 3. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 2. 0

Roo f Type : Gabl e Stories : 1. 0 ...j.. . Floorcover : Allowanc e Foundation : | Bloc k Sprinkle rSquar e Footage : i 0. 0 Yea r Percen t Adjuste d Yea r YearBuii t Physica l Ag e Remodele d Remodele d Buil t 192 0 0 0 % 192 0 8 8 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1.0 Applianc e Fireplac e Masonr y 2. 0 Basemen t Bsmn t Bloc k 8 f t 1728. 0 Basemen t Finishe d 1000. 0 Fixtur e Additiona l Fixture s 1.0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l „ 3. 0 Garag e Attache d 200. 0 Porc h Ope n Sla b 322. 0 Porc h Sla b Roo f Cei l 80. 0



### http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R174. . . 7/7/200 9• • TECHNOLOGIES , INC . 

## Pruden t Propert yClose-Ou t For m (Lead-Base d Pain t Stabilization ) SAID : ^/2>5 Z Propert yAddress : ^H'i' l \/^XALC ^ 

### ^JT ' Owner' s Name : / n/ua, J Sa^A/Z^svgflei r S.N O Performanc e 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 ofth 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 . 

# A

1 2 Wa s al l scrapin g an d othe rpreparatio n wor k complete d satisfactorily ? / 3 Were 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 ? 

# J 4 Ar e al l o f th 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 o n th e entir e property , roadways , alleyways , publi cacces s area s an d als o remov e an yothe rgenerate d debris ? 

# y 6 I s th e gras s are a tha t surround s th e structure(s ) i n reasonabl ygoo d 7 condition ? Wa s th e pain t product s utilize d equivalen t t o a 30 yea r / product/quality ? i / 8 Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e et cproperl yremoved ? 

### 1 / 9 I s ther e an yevidenc e 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 . / 1 0 Ar e ther e an ypropert yitem s tha t wer e temporaril yre-locate d b yth e contracto rtha t nee d t o b e move d back ? 

# y 1 1 1 2 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 ? Othe rConsiderations ? Propert yOwne rDiscussions ? Additiona l Wor k tha t i s Require d 

# y 

# A Pruden t Representativ e Signatur e 

# •Ay Dat e Propert yOwne rSignature:-<rjJ^;^t<n<j6^>t.4/^>'' ^ Dat e 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 , WI O 6411 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 7