## TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO NFIL EFOLDE R SAID : 3942 4 Date : 12/26/200 8 Address : 632 1 N3 2 S T StabilizationContractor : Pruden t Technologie s Year : 200 8 PAINT STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S a^ Video of propert y (DVD ) H Executive Summar y WSignedAcces s Agreemen t fo r

subject propert y mPainting Agreemen t D Settlemen t documents (i.e. , fo r

damag e o r

to replac e plants , etc. ) D Photograph s 4 Satisfactor y restoratio nsignedby Propert y Owne r D Propert y close-out chec k

lis t signedby EP A sf

' Propert y informationfromDougla s Coimt y Assessor' s Offic e D D D 

## ^ignatur ^ Dat e

4031044 5 IIII I IIII I ni l I 

### Superfun d

### PROPERT 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 : 632 1 N3 2 S T SAID : 3942 4 

### A . EXECUTIV ESUMMAR Y A. 1 Issue s Encountered : NONE . A. 2 Issue s Resolved : NONE . A. 3 Uniqu e Findings : NONE . A. 4Othe r Relevan t Information : Acces s Date : 11/05/0 8 Work Began : 11/10/0 8 Closeout Date : 11/13/0 8 Enclosures ; 1 . Pre-Vide o 2 . Post-Vide o 3 . Propert y Statu s Form 4 . Signe dAcces s Agreement 5 . Pre-Renovatio nForm 6 . Pain t Matc hForm 7 . Trackin g Form 8 . Dougla s County Assessor Propert y Informatio nPag e 9 . EPA Propert y Closeout for m 10 . Propert y Completio nAgreemen t

TECHNOLOCIES , INC .

### KNVIRONMDnAL A OONSTRUCnO N 

## TECHNOLOGnSS,INC . SERViCB S 

# Propert y Statu s For m Address:C^'b^ IlA . 3p^*^ . Date : y^-t^-c^ t Phone : ^5^4^^-^,.^^;.^,^^^^^^^^^ ^ Plan t & Pemianen t Landacapin p T o Rcmii^ ^ ^ p f^^ ^ Item# Descriptio nan dLocado n OnMq ) 

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Ptt»Eri8tm y Ccm&tio no f StmchiM a Doe s you r Basemen t hav e ahistor y o f leaking ? Ye s - ~ 

# No X Itan # Descnptio n& Locatio n OnMa p

Propeit y Owne r Pniden t Boq)loye e Sigoatme: . 

# I2^u ^ Signature : ji<-X /^ 

# m^M '

Prodeo t Technologies , Inc . (Prudent ) i s unde r contrac t (Contrac t #EP-R7-08-07 ) yritf ath e U . S . Environmenta l Protectio n/^enc y (EPA ) t o stabiliz e Lea dBaso dPa ^ (LBF ) a t anumbe r o f propertie s locate di nOmaha , Nebraska , includin g th e propert y locate da t U?-^!! ! M . .^ ^ ^ . Th e EP Arequest s you r permissio nt o allo w Pruden t t o performLB PStabilizatio na t thi s propeity . B y signin g thi s form , th e proper ^ owne r grant s pennissio nt o Pruden t t o perfon nactivitie s relate dt o LB P Stabilizatio nincludin g scrapin g pain t an dpaintin g o f th e reference dproperty . Further , di e owner/tenan t verifie s ttat the y hav e receive dtiie LB Ppamphle t '^Renovate Right.* * I f

yo nhav e an y question s abou t th e LB Pstabilizatio nplanne dfo r you r property , pleas e contac t Prudent' s /^itm|i^idrnfa e Cler k for tiie Lea dBase dPahi t Stabilization , Mrs , Debora hAkcreie^lnli««Mi , a t

(402 ) S(M»1004 . Genera l question s abou t th e Omah aLea dSit e cleanu p ca nb e directe dt o th e EP A Publi c Infomiatio nCenter s a t (402 ) 731-304 5 (Sout hOmah aoffice ) o r (402 ) 991-958 3 (NorthOmah a ofBce) .

' (Pleas e Print Name ) PimiMvOiHigSteiilnm : /hu/ l Y /V/o ^ :>QO Q (Signirtim ) CDtte ) PROPERT Y INFORMATIO N (T o b e coaplete dIq r rciidei t nd/o r propert y oirnc r - plcai e prIa O Rtnlt r



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^ 00IIMEKT80R8PECIALIN8TRUCT1ON8 : (L E DOOS , ENTR YQATES , ETC. )

AOTHORnYFORBNVIROMMBNTA LRESPONS B ACTIOra ; Th e •ethrtte t tob e Implementedb y EP A 0 ^ cTCERCLA . 4 2 UJ. C 9604 . BPA' i ris M ofaooe u t o th e propeity bpnvide dte b Seetlo n104(0 ) o f CBRCLA . 4 2 Uj ^ to<ldetenBtatafflie nee dfbr feipoia^<vcliooitagortddt««iyntpQnieiotfo nande r (h

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# Curren t Sampl e Pre-Renovatio n Fon n eifeoawunl R Apri l soi a CoiMnMlioit.o fPtctlp t of Lsa d Pamphlv t W^)w6noMiiacopf<*^penv*isx.BBnovai B Right : impona m Laa d H ^ Myrnatftx t Ib rf^rnflto . C/dt fOare/^ovlbi m ant fSc ^ th 9 patanaa l tta K orth e lea d han d eMp08ut B frorn f«novado n aclMt y to te perfcime d In rii ydwelln g tjn R J rBoe^« d thi s parnphle t betot B tt a Rfniednemed rrecipien t Oat e Signatur e ofledpier t SaN^OertHleallo n Optio n (fo rtenaniKxxwpla d dweHbig s only ) — tf th e lea d peniphle t wa s delveie d btj t a tenan t Signatur e wo e no t oiJtalnable . yo u ma ychec k th e appnpriat e bo xbelow . Q ReAM l to eign— I certn ytha t I hav e inad e a goo d 1 ^ effCr t to delive rth e perrv3h H Berxivai s f%ht : irnports m Lea d NSEeart fMb^ CMt fcar e AoiMar e an d Schoob , to th e rerital dweOri g uti t lis M dat e aii d lln M lndk»te d arx l tha t th e occuparr t refused to sig n th e coi^ftrnatlo ^ ofreoeipl I ftrtieroertif/tha t I hev e lef t a cop y of th e peirphle t at th e um t wit h thaoocMxn t Q UnavailaU e ft reignatur a - 1 certif ytha t I hav e trad e a goo d fafl h etibrt to deOve rth e panqjhiet , f^dnoi«t e Rfgfit * frrqxrtarn Laa d HB ^ 

### Pmtn,CWCmpmvltkt9mdS(:lwol8.^VKmi(Ma ^ belo wan d tha t th e occi^sar n wa s iravaHabl e to sigr ) th e (xxifirmatio n ofrecel ^ i titheroQrtli ytha t I hav e lef t a cop y of th e pamphle t at th e t ^byslidin g it underthedoor . 

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## DA^X ^ 

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### lyuugio dv^uiuii; ' /\i;i;uuii i xiuuiiiiiiuui i rag e i oiJ Dougla s County , Nebrask a Propert yRecor d - R060450000 2 Prin t Repor t NE W Featur e - Parce l Dimension s availabi e @ scal e 0-5 0 ft wes t o f SOt h S t - Vle W O n Ma p Informatio n i s vali d a s o f 2008-9- 4 Treasurer' s Ta xRepor t Ne wFeatur e -•-+- * Aut o Sale s Searc h Owne r WES TJ R RAND YS ETA L 632 1 N 3 2 S T OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : 1045 0 000 2 0 6 Accoun t Type : Residentia l Parce l Number : 060450000 2 Parce l Address : 632 1 N 3 2 S T OMAH AN E 68111-000 0 Lega l Description : ; BELVEDER E AD D LO T1 7 BLOC K2 N 97.7 5 F TLT1 7 97.7 5 X 12 2 Valu e Informatio n 200 8 200 7 200 6 200 5 200 4 200 3 Lan d $7^000.0 0 $7,000^0 0 

### $7io6oTo o $7,000.0 0 $7,000.0 0 $7,000.0 0 j Improvemen t I $69,600.0 0 I _$71,060.0 0 

### j $71,066.0 6 $71,000.0 0 

### $52,900.0 0 $52,900.0 0 Tota l $76,600.0 0 

### $78,660.0 0 $78,000.0 0 $78,000.0 0 $59,900.0 0 $59,900.0 0 Sale s Informatio n Sale s Date : ; 2008-05-2 8 Dee d Type : Price : \ W D \ $74,000.0 0 Book : j 200 8 Page : 05265 4 Grantor : TIM M MATTHE W D ETA L Grantee : WES TRAND YS ETA L Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : i 2002-01-1 7 

# X " T Dee d Type : l W D Book : ' 220 4 Page : j 71 8 Price : I $64,500.0 0 Grantor : 

## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accoiintno=R06.. . 10/1/200 8

### L»ougias uount y Accountiniormatio n rag e z oiJ Grantee : Vaiid/invaiid : ; invali d Exclusio n Reason : ; Financin g Sellor/Specia l Sale s Date : i 1999-03-2 6 Dee d Type : \ D \ Price : ; $53,000.0 0 Grantor : \ Grantee : Valid/invalid : ' Vali d Exclusio n Reason : j Lan d Informatio n Acre s S F Unit s 0.2 7 11956. 0 1. 0 Improvemen t Informatio n Buildin g 1

CLIC KTO ENLARG E IMAG E L.. - Squar e Footage : 1500. 0 Perimete r 0. 0 Uni t Type :

Buil t As : 1 1/ 2 Stor yFi n HVAC : Centra l Ai rt o Ai r Exterior : Fram e Viny l interior : ; Drywal l Roo f Cover : j Compositio n Siiingl e

Roo f Type : ! Gabl e Floorcover : Allowanc e Book : ; 211 8 Page : ; 30 1

; Dept h Widt h Vacan t 

### 122. 6 98. 0 N o

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CLIC KT O ENLARG E IMAG E 

## ZZZ J Percen t Complete . ; 100^ % Quality : j Averag e Condition : i Averag e Cond o Squar e Footage : : 0. 0 Rooms : ; 5. 0

Units : M. O Baths: ! 1. 0 Bedrooms : i 3. 0 Stories : ! 1. 5 Foundation : i Bloc k 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R06. . . 10/1/200 8L.•.wvwuj.ii . xijj.\^iiixaiiux i 

### Fage i o f 3

YearBuil t 192 5 Detai l Typ e Applianc e Applianc e Basemen t Basemen t Fixtur e Fixtur e Garag e Use r i 1 Sprinide rSquar e Footage : "­ . 0. 0 Yea r Remodele d Percen * Remodele d Adjuste d Yea r Buil t Bh.„.v.« , A„ ^ Physica l Ag e 0 1 0 % 192 5 1 8 4 i_ . —— i

1 Detai l Descriptio n ; Unit s ' Allowanc e \ 1. 0 Fireplac e Masonr y 1. 0 Bsmn t Bloc k 8 f t 

### ' '"'" " "~'" i ~"l'624. 0 i Walkou t 

## l '^. o 1 Bas e Fixture s i 1. 0

Bat h Ful l

_j __ _i.o _ Basemen t Singl e Finishe d Atti c '" " i '"" " 476^0 '



## http://dougIasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R06.. . 10/1/200 8

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

# :?wj / 'I?/^ ^ ^ PropertyAddra« ; fio2iO \ hi . '^'^ * ­ Owner' s Name : /"i^^ > > ^ Qd^iJ ^ <^SU ^ 

## Performanc e Standards/ciose-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 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 , al l trim , porches , box beams , columns , rails , an d exterio rsurface s o f garages . 

# A 2 .Wa s al l scrapin g an d othe rpreparattio n wori ccomplete d satisfactorily ? 

# X 3 .

Wer e al l require d areas o f th e structure(s ) prime d a s neede d an d painte d wit h tw o to p coats ? 

# X 4 .Wa s th e pain t product s utilize d equivalen t t o a 3 0 yea rproduct/quality ? 5 .

Are al l o f th e area s wher e contaminate d material s hav e bee n spiile d thoroughl yvacuumed/cleaned ? 

# X 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 areas an d als o remov e an yothe rgenerate d debris ? 

# X 7 .

I s th e gras s are a tha t surround s th e structure(s ) i n reasonabl ygoo d condition ? 8 .

Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e etc . properl yremoved ? 

# 1 9 .

I s ther e anyevidence o f propert ydamag e tha t wa s don e byth e contractor ? An ypropert ydamag e need s t o b e complete d prio rt o th e EP AClose-Ou t ^ 10 .Ar e ther e an ypropert yitem s tha t wer e temporatil yre-locate d b yth e contracto r tha t need t o b e move d back? 

# X 11 .Are ther e any(known ) lingerin g issues wit h th e propert yowner(s ) tha t hav e bee n lef t unresolved ? 

# Y . Othe rConsiderations?propert yOwne rDiscussions?Additiona l Wor k tha t i s Require d 

# / f c % 9 ////7/c e PrucTent Re^fesentatlv e