## TRANSMITTA LO FOMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R SAID# : _2£,Ci£i_3

_Date : g/li)^n^« ^ Address : S>Ar>t ^ r^(Y\r^fi . tY \/y LB P Stabilizatio n Contractor : PRUDEN T TECHNOLOGIES , INC . Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S Videoo f propert y (DVD) : Pre-Stabilizatio n & Post-Stabilizatio n Video s Executiv e Summar y SignedAcces s Agreement For m V Advanc e Notic e Form Pre-Stabilizatio n Vide o Agreement Form Acces s Tracidn g Form 1

/ Propert y Acces s Assessmen t Form Neighbo r Acces s Agreement Form i

/ Pain t Matc hForm 0 Pre-Stabilizatio n Propert y Safet y Assessmen t Form <

/ 

### Worl<-Sit e Hazard s Analysi s Checklis t ^ 

### Photographs : Pre-Stabilizatio n Propert v Hazar dAssessmen t Photograph s I v Dougla s Count y Assesso r Propert y informatio n i A Propert y Completio n Agreemen t For mSigne dh y Propert y Owne r D Propert y Close-Ou t Chec k Lis t Signe dB y EP A 

### Pruden t Technologies , Inc . Signatur e Dat e EPASignatur e Dat T

3005468 8 

# IIIIIH I Superfun dlECHNOLOGIBS , IN C 

# Propert y Summar y Date : 8/Ai/200 9 LB P STABILIZATIO N EPA CONTRAC T EP-R7-08-0 7 Mont hof ; Aug . Propert y Address : 260 4 Camde n Av . SAID # : 3640 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 : 7/21/2009 ii . Wor k Began ; 7/30/200 9 iu . Close-Ou t Date ; 7/31/200 9 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 hForm 10 . Pre-Stabilizatio n Propert y Safet y Assessment Form 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 EP A

# 3i^^o ^

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 of orooertie s locatedi n Omaha, Nebraska , including the propert y locateda t ^LPU' 7 (^777/177£/ l TTl/ P Th e EP A request s you r permission t o allow Pruden t to perfor mLB P Stabilization a t thi s property . By signing thi s form, the propert y owne r grant s permission t o Pruden t t

o perfor mactivitie s relatedto LB P Stabilization including 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 contracto r to conduc t a soil cleanu p a t m y propert y following completion o f lead-basedpain t stabilization . I understandtha t the stabilization contractor cannot provid e assurance s tha t the soi l cleanu p contractor will b e boun dto . I furthe r understan dtha t the 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 soil cleanu p a t m y property . I f yo u 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/Office 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 b e directe dto the EP A Public Informatio n Centers a t (402 ) 731-304 5 (Sout hOmah aoffice) o r (402 ) 991-958 3 (Nort hOmahaoffice) . 02)731- 3 Propert yAcces s Grante d By: . L C U 

# 7]y^ . 

# y -7-3/-tD ? Property Owne r Signature : (Signature ) (Date ) PROPERT Y INFORMATIO N (T o be complete d b yresiden t and/o rpropert yowne r- pleas e print ) 

# l^loi . & 

# ^ i 44.-U - RESIDEN T NAME : Owne r RESIDEN T ADDRESS: . 

# 3U> H ^^mJp n A\l f I F RENTAL , PROPERT Y OWNE D BY : 

## V\^c_4o e '^ooii'f.l ^ OWNER' S MAILIN G ADDRESS ; OWNER' S TELEPHON E NUMBE R 

# -^StPd^i^^iiis^ . ORK : J L NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : 0 NUMBER O F OCCUPANT S 7 YEAR S OL D AN D OLDER : D NUMBER O F CHILDRE N UNDE R 7 YEAR S OL D WHO M PLA Y 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. ) 

## \

iJ c ^ 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 o f CERCLA , 42 U.S.C . 9604 . EPA' s right o f acces s t o th e propert yi s provide d fo ri n Sectio n 104(e) o f CERCLA . 42 U.S . C 9605(e) , whic h provide s entr y fo r"determinin g th e nee d fo rresponse , o rchoosin g o rtakin g anyrespons e actio n unde rthi s title , o rotherwis e enforcin g th e provision s ofth e title. "

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 - (R16)36.1-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7

# 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 andany 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 o f yarddurin g stabilization . Ho w muc hnotic e do yo u nee dt o hav e abov e mentione dtask s completed ? I f yo u ar e 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 ? Notic e needed : Number t o cal l t o giv e notice : Whomw e ar e givin g notic e to : Home Owner' s Signature . , 

# 7l.^.y\J±yt.^Q<^s.hM

## PRE-STABILIZATIO N VIDE O FOR M I UNDERSTAN D THAT PRUDEN T TECHNOLOGIE S WIL L B E COMIN G OU T TO SHOO T APRE-STABILIZATIO N VIDE O AT M Y PROPERTY . TH E VIDE O I S JUS T ATOO L USE D T O DOCUMEN TTH E CURREN T PROPERT Y STATUS/CONDITION . APOS T VIDE O WIL L ALS O B E SHOT PRIO R T O COMPLETIO N O F STABILIZATION . 

## OWNERSNAME : f^a^c^'c L KJ.-UueU r/(IcLtt-^CL^^^ ^ PROPERT Y ADDRESS : BVID/SAID : 3,^1/0^ . HOMEOWNER S SIGNATURE : 

# TidA^y^iUl r PRUDEN T REPRESENTATIV E SIGNATURE : Qr/i ^ ^-<y7y AN Y CONDITION S NEE D T O B E AWAR E O F BEFOR E SHOOTIN G VIDEO : (I.E . PETS , NOTIC E NEEDED) :

# ACCES S INFORMATIO N TRACKIN G SHEE T

PROPERT Y BVID : 

# '^fi<^03 > ADDRESS : 

# J^f^o ^ Qayrri/lc M /Qy^ . Propert y Owne dBy : (ltMmptCD»itiicmtn )

Owner s Phon e No's : Home : Work : Cell : Fax : Acces s Contracto rAS W FD AME S P E 

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rn.- ( /ii - ht ' (CictoOMt ; DAT E TIM E Nossssx x COrfTAC rDETAI L 

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## Acces s Assessmen t Form : (Mus t b e complete dfor every property . Informatio n mus t b e obtaine dfrom apropert y wal k thru , no t give n b y owner ) I s th e propert y stucc o o r asbestos ? 

# '^\/\o S s\(M ^ . : ( 

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

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## I f

yes , sto p a s w e can' t stabiliz e thi s property . I t require s specia l preparatio n techniques . I t wil l b e retume dt o EP A an dthe y wil l assig n at alate r date . Doe s thi s propert y requir e lot s o f scrapping ? Doe s thi s propert y requir e alif t o r scaffoldin g t o reac huppe r levels ? ;^^-y O 

## Doe s thi s propert y hav e lot s o f plant s o r item s i n area s wher e paintin g i s required ? Doe s thi s propert y hav e an y significan t structura l damage ? 

## ^'^J^ipovciN , )rn ^

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yes , EXPLAIN ? 

## V L ^ 

# 7 Doe s thi s propert y hav e agarage ? 

## / ^ h e t^/^A'"^' ' ^ I f

yes , describ e locatio n o f garage .

## Doe s thi s property hav e aluminu msiding*^

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## I f

yes , i s i t origina l factory finis ho r ha s i t bee n painte dover ? fy j 0 

## 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) ? /v- O 

## I f

yes , EXPLAIN ? 

# y

^ r~ I s thi s propert y vacan t o r occupied ? ^ ^ ^ 

## QCCU) ^ 

# y ^y-^^ y /4 , Ar e ther e an y pet s at thi s property ? /-—ex t 

# y^A , UK ^ M 

# ^ 

# ^ v 

# ^t^ y < ^ ^l ^ Ar e ther e an y lo w hangin g powe r lines ? 

# /y d

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

# A7 ) 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 Paint matching form : . Propert y address : SlGO ^ G2oi^ 4 (U y |/Jv^^^ — BVID : 3GM0 ^ I UNDERSTAN D SHERWI N WILLIAM S WIL LMATCH M Y CURREN T COLORS .

Pag e 1

# PRE-STABILIZATIO N PROPERTY SAFET Y ASSESSMEN T FOR M PROPERTYADDRESS : 2G^ H C^f^^^^" ^ N—e ^ BVID/SAID : > e ? t j > PRUDEN T REPRESENTATIVE DOINGASSESSMENT : ^ ^ 

# ****I FSAFET Y RISK PROPERT Y MUS T B E TURNED 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 PROXIMITY TO HOUSE , SCAFFOLDING/LADDERS/LIF T NEEDED , UNSAF E AREAS , UNSAF E NEIGHBORHOOD...ETC.) :

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## }

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# REQUIRE S K.ROTHE RAPPROVA LYES/NO SUBMITTE D T O K.ROTHE RON : 

# if# TECHNOLOGIBS, ] 

## Checklis t fo r th e Worksit e Hazar dAnalysi s Addres s Crew : Ite m Overhea dLine s In-transi t Vehicl e Clearanc e Level s aroun dhig hwire s Vehicl e Clearanc e aroun d 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 Sidewal k Foundatio n Retainin g Wall s Fence s Tree s Foliag e Genera l Conditio n o f yar d Damage dAreas : sin k holes/rotte dwoo d Sprinkle r Syste m Pet s Insect s Weathe r Condition s Unsaf e drivin g condition s Unsaf e neighborhoo d 

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250 5 N . 24' " Street , Suit e 30 8 Omaha , Nebrask a 6811 0 Phone : (402)504-100 4

Fax : (402)504-100 5 Correctiv e Actio n

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## >--b^fui ^ fffva L 

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fet y Office r /ledica l Drive , SuTtfr425 0

Sa n Antonio , TX 7822 9 Phone : (210)822-958 8 Fax : (210 ) 579-657 7

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# 'M\ Curren t Sampl e Pr^Renovatio n For m effeofiveunH I Apri l 2010 . Contlnnatio n o f Receip t o f Laa d Pamphle t Q/ \ hav e (eceive d a cop yo fth e pampNet , Renovat e njgfir ; Importan t Lea d Hazar d Infonretto n torftunSes , Chil d Car e Provider s an d School s Connin g m e o f th e potent yris k o fth e lea d hazar d exposijr e fro m renovatio n actMt yt o b e perfomte d I n m ydwellin g unit . I receive d thi a pamphle t betoi e th e wor k began . Printe d nam e o fredplait . r, , Dat e Signatur e onedpien t SeK-Certifieatio n Optio n (To rtenant'occupie d dweiling e only ) — I fth e lea d pamphle 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 xt)elow . Q Refusa l t o sig n — I certif ytha t i hav e mad e a goo d M h effor t t o delive rth e parr^ihlet , Renovat e RI!EI^ ' importan t Lea d Hazar d Infonnatio n fyrf^anSes , C t M Car a Provider s an d &:hod3 , t o th e renta l dwellin g uni t liste d belo wa t th e dat e an d tim e mdcate d an d tha t th e occupan t refuse d t o sIS n th e confirmatio n o frece ^

I furthe rcertif ytha t I hav e lef t a cop yo fth e pamphle t a t th e urf t wit h theoocupan L Q^navaliabl e fn * signatine— I certif ytha t t hav e mad e a goo d feith effor t t o deDve rth e pamphlet , Renovat e Righ t Importan t Laa d Hazsst i Informatia i tor FamBoa , ChH d Car a provider a an d Schoda , t o th e renta l dwellin g uni t liste d belo wan d Iha t th e occupan t wa s unavailabl e t o tig n th e confinnaQo n o freceipt , I furthe rcertif ytha t I hav e lef t a cop yo f th e pamphle t a t th e uni t b yslidin g i t un c



# 1^'MI ^



# A^Uk- ^ 7-Z-r-o ^ q P ^ Attempte d dellvei y dat e an d tim e lea d pamphle t deRvet y SIgnetui e o fperso n oertityb ^ lea d pamphle t deliver y

UmtAdttes s Not e RsgsRfln g MaWn g Option—A s a n alternativ e t o deliveryi n person , yo u ma yma o th e lea d pamphle t t o th e owno rand/o rtenant . PamphI Amus t b e maile d a t leas t 7 dey B befor e renova ^ {Documen t wit h a certificat e o frnailin g (ifo m th eDougla s Count y Accoun t Infomiatio n http://douglasne.nia|^^-online.com/DouglasCoNe/static/accountinfo. . 

### ajg^ - Dougla s County , Nebrask a Propert yRecor d - R130195000 0 1 Prin t Repor t NE

W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t o

f 52n d S t - Vle W O n ll/la p Informatio n i s vali d as of 2009-5-1 2 Treasurer' s TaxRepor t Ne w Featur e -*-¥- ¥Aut o Sale s Searc h Owne r OA S OBE D 

## ^^ iu i 

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O l 1 ir\ n P 0 BO X 5 3 i BELLEVU E N E 68005-000 0 1 

### 1 Propert yInformatio n Ke yNumbe r019 5 000 0 1 3 1 Accoun t Type : Residentia l t Parce l Numbe r\ 130195000 0 Parce l Address : 260 4 CAIVIDE N A V Oi^AHAN E 68111-000 0 Lega l Description : HASTING S & HEYDEN S AD D LO T 1 8 BLOC K1 5 0 X 12 0 Valu e Informatio n "•' " " 1 1 l^n d • Improvemen t \ Tota l 200 9 $2,500.0 0 $19,600.0 0 \ $ 22,100.0 0 200 8 $2,500.0 0 $19,600.0 0 $ 22,100.0 0 200 7 $2,500.0 0 $19,600.0 0 $ 22,100.0 0 200 6 $ 2,500.0 0 . $19,600.0 0 $ 22,100.0 0 L^ 2005 $ 2,500.0 0 $12,800.0 0 $ 15,300.0 0 200 4 i $2,500.0 0 $11,600.0 0 $ 14,100.0 0 ! Sale s Informatio n 1 Sale s Date : 2001-01-2 6 Dee d Type : D Book : j 217 3 i Page : 40 3 Price : • $23,000.0 0 1 Granto r •' Grantee : Valid/Invalid : Vali d 1 Exclusio n Reason : - ' Lan d Informatio n

Acre s \ S F Unit s Dept h Widt h Vacan t 0.1 3 6000. 0 1. 0 1 120. 0 5 0. 0 N o : Improvem e n t Informatio n

Buildin g 1

lo f 2 6/8/200 9 10:1 4 A Mpougla s Count y Accoun t Informatio n http://doug1asne.niai^fcg-online.com/DouglasCoNe/static/accountinfo. .

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1 I C STORY FI N nMJs i g ^ E S I Squar e Footage :

' " I 1322. 0 ' CLIC KT O ENLARG E IMAG E Percen t Complete : I 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Poo r

Buil t As : 1 1/ 2 StoryFi n Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 5. 0 Exterior : Fram e Viny l Units : 1. 0 interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shiingl e Bedrooms : 2. 0

Roo f Type : Hip/Gabi e Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 190 6 0 % 190 6 10 3 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fenc e Chai n Lin k 1. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 890. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h Cvrd Woo d Dec k 120. 0 Porc h Cvrd Woo d Dec k 176. 0 Porc h En d Soli d Wal l 72. 0 Use r SOURC E 2 1. 0

2 o f 2 6/8/200 9 10:1 4 A MTBOINOLOGIBS , IN C 

## Pruden t Propert yClose-Ou t For m (Lead-Base d Pain t Stabilization ) SAID : 36^0 ' ^ 

## 3 y Propert yAddress : 

# t: 2^7:)^d///^^7Ulr ^ ( ^^^ ^ Q^o/e ^ Av^ Owner' s Name :

S.N O 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 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 3 4 5 satisfactorily ? Were ai i 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 ? Ar e al l ofth e area s wher e contaminate d material s hav e bee n spille d thoroughl yvacuumed / cleaned ? Di d th e contracto rcollect/vacuu m ai l fallin g an d scrape d pain t chip s % 

# 7 7

1 on th e entir e property , roadways , alleyways , publi cacces s area s an d als o remov e an yothe rgenerate d debris? 6 is th e gras s are a tha t surround s th e structure(s ) in reasonabl ygoo d / condition ? 

# y 7 Wa s th e pain t product s utilize d equivalen t to a 30 yea r • T\ product/quality ? 8 Ar e al l item s suc h as polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e et cproperl 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 to be complete d prio r to th e EP AClose-Out . 

# A 10 Ar e ther e an ypropert yitem s tha t wer e temporaril yre-locate d byth e contracto rtha t nee d to be move d back ? \ 11 Ar e ther e an y(known ) lingerin g issue s wit h th e propert yowner(s ) tha t have bee n lef t unresolved ? 12 Othe rConsiderations ? Propert yOwne rDiscussions ? Additiona l 

# t 7} Wor k tha t is Require d 

# h Pruden t Representativ e Signatur e 

## Date: 9 ' 3 <-^' ^

' , Propert yOwne rSignature : / l(7/Lsi:J*7L y/ l - Date : 

# 7•5^^^ f 808 0 War d Parkway , Suit e 40 5 Kansa s City , MO 6411 4 Phone : (816 ) 363-370 3 Fax : (816 ) 363-370 7 250 5 N. 24' " Street , Suit e 30 8 Omaha , Nebrask a 6811 0 Phone : (402)504-100 4

Fax : (402)504-100 5 424 2 Medica l Drive , Suit e 425 0 Sa n Antonio , TX 7822 9 Phone : (210)822-958 8 Fax : (210 ) 579-657 7