## TRANSMITTALO FOMAHA LEAD SIT E PAINT STABILIZATIO NFIL EFOLDE R SAI D # : Tt^^-.^ l Date : a//l)^nQ« ? Address : 5'^ 1 ah | S~l ,S T LB PStabilizatio n Contractor : PRUDEN T TECHNOLOGIES , INC . Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S / 

### \ X i £ U Q

^ 0 ^ ^ i X y 0 i

/ {X i X t K Video of property (DVD) : Pre-Stabilizatio n& Post-Stabilizatio nVideo s Executiv e Summary SignedAcces s Agreement For m Advanc e Notic e Form

Pre-Stabilizatio n Video Agreement Form Acces s Trackin g Form Propert y Acces s Assessmen t For m Neighbo r Acces s Agreement For m Pain t Matc hFor m Pre-Stabilizatio n Propert y Safet y Assessmen t Form Work-Site Hazard s Analysi s Checklis t

Photographs : Pre-Stabilizatio nPropert y Hazar dAssessmen t Photograph s Dougla s Count y Assessor Propert y informatio n Property Completio n Agreement FormSignedb y Propert y Owne r Propert y Close-Out Chec k Lis t SignedB y EP A Pruden t Technologies , Inc . Signatur e Dat e
EP A Signatur e '^ Dat e 3005475 1



# ..

J Superfun dTRCHNOLOGIBS , IN C 

# Propert y Summar y Date : 8//V200 9 | LB PSTABILIZATIO NEP A CONTRAC T EP-R7-08-0 7 | Mont hof ; Aug . Propert y Address ; 521 2 N2 7 St . SAI D # ; 3643 7
A . Executiv e Summary ; 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 ; 7/22/200 9 ii . Wor k Began ; 7/27/200 9 iii . Close-Ou t Date ; 7/28/200 9 B . Enclosures ; 1 . Pre-Stabilizatio n Vide o 2 . Post-Stabilizatio n Vide o 3 . Signe dAcces s Agreemen t For m 4 . Advance-Notic e For m 5 . Pre-Stabilizatio n Vide 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 n Propert 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 AiSCHNOIOCIBS . 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 dPainULBE)ja. anunibe r of propertie s locatedi n Omaha, Nebraska , including the propert y locateda t ^^f ^ ^ • ot l ^ Th e EP A requests you r permission to allow Pruden t to perfor mLB PStabilization a tthi s property . B y signing thi s form, the propert y owne r grant s permission to Pruden t to perfor mactivitie s relatedt o LB PStabilization including scraping pain t an d painting ofth e referencedproperty . Further , the owner/tenan t verifie s tha t the y have receivedthe LB Ppamphle t "Renovat e Right. " B y signing thi s documen t I agree t o allow a n EP A contracto r to conduct asoil cleanu p a t m y propert y followin g completionof lead-basedpain t stabilization , if the soil cleanu p ha s not ah^ad y bee nperformed . I understanddia 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 understandtha t the soil cleanu p contracto r wil l mak e all reasonable efforts to addres s concern s tha t I , as the propert y owner, ma y have regarding soi l cleanu p a t m y property . ^^Yes , IJi&v e rea dan dundgr^tandjfth e paragraphabov e Signatur e of Propert y Owne r Dat e I f yo u have an y question s abou t the LB Pstabilizationplannedfo 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 f402)812-0223 . Genera l question s abou t the Omah aLea dSit e cleanu p ca nb e directedt o the EP A Public Informatio n Centers a t (402 ) 731
­ 304 5 (Sout hOmah aoffice ) or (402 ) 991-958 3 (Nort hOmah aoffice) . Propert y Acces s Granted 

# ^'X^G/i/^R O f^y^AKG/XS/ i (Pleas e Prin t Name) Propert y Owne r Signature : (Signature) 

# 7
- 

# n-o" ^ (Date)

jSOS O 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 iKansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 jiPhone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 iFax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7TBCHNOLOCIBS . INC7 ~ PROPERT YINFORMATIO N (T o be complete d b yresiden t and/o rpropert yowne r—plepcLprint ) 

## RESIDEN TNAME : (S^/^Mc i 1 \ mS^J j 5 ^ Owne r/ Rente r RESIDEN TADDRESS : I F RENTAL , PROPERT YOWNE D BY : OWNER' S MAILIN G ADDRESS ; 

# <ihli!\P %H/^(fJiQ ) OWNER' S TELEPHON E NUMBE R - HOME : { \ ^dH'^-JP^p } WORK : _( \ 1 0 I f 60^( 0 CSl l 

# (T s 1^31-3 1 H I U/Ul i l& H

NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : ^ NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDER : 

# 2 NUMBE R O F CHILDRE NUNDE R 7 YEAR S OL D WHO M PLA Y I NTH 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 YGATES , ETC. ) 

# m£ .

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

e pursuan t t

o Sectio n 10 4 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s righ t ofacces 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 "determining the nee dfo r response , o r choosin g o r taking an y respons e action unde r thi s title , o r otherwis e enforcin g the provision s ofth e title. "

8080 Ward Parkway , Suit e 40 5 2505 N . 24' " Street , Suit e 308 4242 Medica l Drive , Suit e 425 0 Kansa s City , MO 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-3703 Fax : (816) 363-3707 Phone : (402)504-100 4 Fax : (402)504-100 5 Phone : (210)822-958 8 Fax : (210 ) 579-6577

# m TECHNOLOGIES . INC . 

# Advance dnotic e needed . After signin g th e acces s you 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 on ope n porc h(enclose dporche s wil l NO T b e stabilized ) mus t b e remove dprio r t o stabilization . All Pet s mus t b e ou t of yar ddurin g stabilization . Ho w muc hnotic e d o you nee dt o hav e abov e mentione dtask s completed ? I f yo 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 nyard ? Notic e needed : 

# ^06 1 ft C-kl l Numbe r t o cal l t o giv e notice : > , A 

# 5/iH-H^i/ , Xam . Who mw e ar e givmg notic e to : v Hom e Owner' s Signatur e

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Sui'Le 30 8 4Z4 2 IVIedica l Drive , Suit e 425 0 Kansa s City , l\1 0 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone ; (816 ) 363-370 3 Phone : (402 ) 504-1C0 4 Phone : (210)822-958 8 Fax : (816)363-370 7 Fax : (402)504-100 5 Fax : (210)579-657 7/^"^'•" ^ TECHNOLOGIBS , INC . 

## PRE-STABILIZATIO N VIDE O FOR M I UNDERSTAND THA T PRUDENT TECHNOLOGIE S WIL LB ECOMIN G OU T T O SHOO T A PRE-STABILIZATIO N VIDE O A T M Y PROPERTY . TH EVIDE O I S JUS T A TOO LUSED T O DOCUMENT TH ECURREN T PROPERT Y STATUS/CONDITION . A POS T VIDE O WIL LALS O B E SHO T PRIO RT O COMPLETIO N O FSTABILIZATION . OWNER S NAME 

# '-^M G/^( ^ PROPERT Y ADDRESS : 

# ^^/ ^ // . 

# 3-1 ^ s7 7 BVID/SAID : 

# 3^ m HOMEOWNER S SIGNATURE : PRUDENT REPRESENTATIV ESIGNA T AN Y CONDITION S NEED T O B EAWAREO FBEFOR ESHOOTIN G VIDEO : (LE . PETS , NOTIC ENEEDED) : ^ 

# /{jM 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 , 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 

# ACCES S INFORMATIO N TRACKIN GSHEE T

in . 

# BVID : 5^//J 7 Propert y Owne dBy : (I f new propert y owner )

Owner s Phon e No's : 

# I Acces s Contractor : AS W DATE •7-t^ti-d^ TIM E ^'-36pf A PROPERT Y ADDRESS : ^/P ^ Z^
- ^"/ ^ S? ^

Home : -f^l-ii^ , „ Work : ~^lJ=-22iti


# ce„: JM::SSkl^L. . PD A ME S P EOthe r (Prudent ) M:CESSO R CONRAC T DETAI L ^ 

# r^fiMm J 

# 1

Comments : 

# ^Md-JL-jUM i

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

### 1 —...-MBP ^ IfeCHNULUGIES i INC . 

# Acces s Assessmen t Form : (Mus t b e complete dfo r every property . Informatio n mus t b e obtaine dfro mapropert y wal k thru , no t give n 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 ? Ifyes , 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 returne dt o EP A an dthe y wil l assig na t 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 ? Doe s thi s propert y hav e lot s o f plant s o r item s i narea s wher e paintin g i s required ? Doe s thi s propert y hav e an y significan t structura l damage ? I f

yes , EXPLAIN ?

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 . IN C 

## Doe s thi s propert y hav e a 

# ^''""' ' d/^t M i ) /) M ^iJ^ide
Ifyes , describ e locatio no f garage . Doe s thi s propert y hav e aluminu msiding ? Ifyes , i s i t origina l factor y finisho 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) ? Ifyes , EXPLAIN ? I s thi s propert y vacan t orydccupied ? Ar e ther e an y pet s a t thi s property ? 

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

# ////» M 

# 4

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 7IICHNOLOGIES , INC . 

## 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 N PROCESS ? 

# f^ b I FI T IS , GE T ACCES S FRO M ALLREQUIRE D NEIGHBORHOO D PROPERTIES .

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 , IN C 

# PAIN T MATCHIN GFORM : T O B EFILLE D OU T ONL Y I FMATCHIN GCOLO R PROPERT Y ADDRESS : ^^y ^ /(/ . ^f ^ 5 Y BVID : J^yj y I UNDERSTAN D SHERWIN WILLIAM S WIL LMATC H MY CURRENT COLORS . Homeowner signature : 

# JJM M 

# (fyr^' t Gx/ik^srO^^^^ip^^" ^ f ^ H^fotjj^^ ^

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 7sp^^**' ^ \\< ^ TECHNOLOGIES , INC . 

### PRE-STABILIZATIO N PROPERT Y SAFET Y ASSESSMEN T FOR M PROPERT Y ADDRESS : ^^ ^ / / 2 V 5 / BVID/SAID : ^ , ^ PRUDENT ASSESSMENT REPERSENTATIVE :

******I FSAFET Y RIS K PROPERT Y MUS T B ETURNE D OVE RT O KATH Y ROTHE RBEFOR EI T CA N B EASSIGNE D 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 YES7N 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

# ^/XX - V/d £ 

# OTECHNOLOGIES . IN C 

# Checklis t fo r th e Worksit e Hazar dAnalysi s Address : S;1I1 1 kl IXT ^ S t Crew : 

### Date : Ite m Hazar d Correctiv e Actio n Overhea dLine s 

## /Kb^ " ijXf ^ In-transi t Vehicl e Clearanc e Level s aroun dhig hwire s Vehicl e Clearanc e aroun d hig hwire s whe nworkin 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 nPropert y 

### J^W ^ Neighbo r Acces s Require d Hig hTraffi c Are a 

# i^

- JZ^/^C-l f 

## t-(jUr v Garag e Structure s ijQOGfii
- 

# ^Lpflfg AlA^o^Uv y Drivewa y 

## MfX>H>/ L Sidewal k LiLjKiLv>e.^ — CA.teC^e ^ Foundatio n Retainin g Wall s 

# :^t?^ : Fence s Tree s Foliag e Genera l Conditio nof yar d 

# SySfc^^^^^ ^ vO^tj^dUj o A>vg^^fl» ^ Damage dAreas : sin k holes/rotte dwoo d 

# '^^^Ij^f ^ Sprinkle r Syste m Pet s Insect s Weathe r Condition s Unsaf e drivin g condition s Unsaf e neighborhoo d 

## Sit e Safet y Office r

808ir«Var d Parkwj 250 5 N. 24' " Street , Suit e 30 8 Medica ll Drive , Suit e 425 0 4242Medica Kansa s City , Mi Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 )3i 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 

# J

^ I hav e receive d a cop yof th e pamphlet , Renovat e Right : Importan t Lea d Hazar d Informatio n fo rFamilies , Chil d Car e Provider s an d School s informin g m e of 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 . 

# ^ 7-^^-P f 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 rFamilies , 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 ude rth e door . 

# fx)IA f 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 persro/ certifyin g lea d pamphle t deliver y 

# f^f ^ N ' ^Y ^ <s ^ 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 o f mailin g fro m th e pos t office) .

### Dougla s County Accoun t UDimatio n Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R253829000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t ot 52n d S t - Vie W O H 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 KIMSE YGERAL D A ETA L 521 2 N 2 7 S T OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : 382 9 000 0 2 5 Accoun t Type : Residentia l Parce l Number : 253829000 0 Parce l Address : 521 2 N 2 7 S T OMAH AN E 68111-000 0 Lega l Description : WILLI S PAR KPLAC E LO T1 0 BLOC K3 N 48. 5 F TLT1 0 48. 5 X 4 7 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $1,500.0 0 $48,500.0 0 $50,000.0 0 200 8 $1,500.0 0 $48,500.0 0 $50,000.0 0 200 7 $1,500.0 0 $48,500.0 0 $50,000.0 0 200 6 $1,500.0 0 $48,500.0 0 $50,000.0 0 200 5 $1,500.0 0 $15,200.0 0 $16,700.0 0 200 4 $1,500.0 0 $13,800.0 0 $15,300.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 5 2303. 0 

### 1. 0 47. 0 49. 0 N o Impro t vemen Informatio n Buildin g 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R253. . . 7/7/200 9^'^M^'^-"'i'^'!v*'C*'^'*7'^''j-''*,'':'""•'••-''".'J^^' - •f.'Wi/,p/'-V:-i.t-A:( i '-•*;•'; , •>••"'•,. ' ••, . '•• • r--'—^ , -.-'t^^-y , ', ..•.Jifi-^jt_-y.y;f - i .•^;j*rt:. i •••.•'J , V'^ii.* . vnll-'- . ;1|.. . yiflf'JftJ.'i.::"','''""','^';.^^*;'^';-.'' ^ '•'•*;'1i*lli'l.',:!?''"'Jt*.5'lJ?.'>t'.?. ' 

### Dougla s County Accoun t Igfcrmatio n

Squar e Footage : 1362. 0 Perimete r 0. 0 Uni t Type :

Buil t As : 2 1/ 2 Stor yFi n HVAC : Centra l Ai rt o Ai r Exterior : Fram e Sidin g Interior : Plaste r Roo f Cover : Compositio n Shingl e

Roo f Type : Hi p Floorcover : Allowanc e Yea rBuil t Yea r Remodele d Percen t Remodele d 191 0 0 % Detai l Typ e Detai l Descriptio n Ad d O n Unfinishe d Atti cW/floo r Applianc e Allowanc e Basemen t Bsmn t Bloc k 8 ft Fixtur e Bas e Fixture s Fixtur e Bat h Ful l Garag e Attache d Porc h Cvrd Woo d Dec k Use r SOURC E 3 

### Pag e 2 o f 2

2 V2STOR Y M l : N 2 7 S

T

C"rs l f IM f SACMli d FIC4 /

7 US '

29 6 Q ' ! Bi t

CUC KTO ENLARG E IMAG E Percen t Complete : 100.0 % Quality : Fai r Condition : Fai r Cond o Squar e Footage : 0. 0 Rooms : 7. 0

Units : 1. 0 Baths : 1. 0 Bedrooms : 3. 0 Stories : 2. 5 Foundation : Blocl < Sprinkle rSquar e Footage : 0. 0 Adjuste d Yea r Physica l Ag e Buil t 191 0 9 9 Unit s 672. 0 1. 0 689. 0 1. 0 1. 0 296. 0 142. 0 1.0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R253. . . 7/7/200 9TECHNOLOGIES . INC . 

## Pruden t Propert yClose-Ou t For m (Lead-Base d Pain t Stabilization ) SAID : ?/, ^ S 7 Propert yAddress : ?^l ^

Nf - ^ 7 SQUULPJL ) 

### Owner' s Name : GsrTz P A*fOuYUiRX ^

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 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 , bo x 

# y beams , columns , rails , an d exterio rsurface s o f garages . 2 Wa s al l scrapin g an d othe rpreparatio n wori ccomplete d 

# \y ^ satisfactorily ? 3 Were al l require d area s o f th e structure(s ) prime d a s neede d an d 

### 1 ^ painte d wit h tw o to p coats ? 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 ? 

# y 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 

# y ^ an d als o remov e an yothe rgenerate d debris? 6 I s th e gras s are a tha t surround s th e structure(s ) i n reasonabl ygoo d 

### u ^ condition ? 7 Wa s th e pain t product s utilize d equivalen t t o a 3 0 yea r 

## t / product/quality ? 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 p 

# y 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 ^ 

### 1 ^ contracto rtha t nee d t o b e move d back ? 1 1 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 ? ^ 1 2 Othe rConsiderations ? Propert yOwne rDiscussions ? Additiona l Wor k tha t i s Require d 

# \ y Pruden t Representativ e Signature : Date:n/ar|^GO- | 

# ^yjCK ^ i^^^fiM ^ Propert yOwne rSignature : 

# Date : 7/^9/'^ 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 , 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 : (815)363-370 7 Fax : (402)504-100 5 Fax:(210)579-657 711CHNQLOGIBS , IN C 

## EP AClose-Ou t For m (Lead-Base d Pain t Stabilization ) BVID : g/C^" ^ 7 

# K Propert yAddress : ^^\2 - N '2X 1 *> r Owner' s Name : ^^f^^ d r^iV } 5<P y

S.N O Performanc e Standards/close-Ou t Criteri a Ye s 

### N O 1 Was 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 , bo x 

# y beams , columns , rails , an d exterio rsurface s o f garages . 2 Was al l scrapin g an d othe rpreparatio n wor k complete d satisfactorily ? if ^ 3 Wer e al l require d area s o f th e structure(s ) prime d a s neede d an d 

## y painte d wit h tw o to p coats ? 4 Ar e al l ofth e area s wher e contaminate d material s hav e bee n spille d thoroughl yvacuumed / cleaned ? 

## y 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 u y an d als o remov e an yothe rgenerate d debris ? 6 I s th e gras s are a tha t surround s th e structure(s ) i n reasonabl ygoo d condition ? ^/ ^ 7 Was th e pain t product s utilize d equivalen t t o a 30 yea r product/quality ? 

## y 8 Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , 

## y cones , barrie rtap e et cproperl yremoved ? 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 

## y 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 y contracto rtha t nee d t o b e move d back ? 1 1 Ar e ther e an y(known ) lingerin g issue s wit h th e propert yowner(s ) 

## ^ y tha t have bee n lef t unresolved ? 1 2 Othe rConsiderations ? PropertyOwne rDiscussions ? Additiona l 

### y Wor k tha t i s Require d



### EP ACOR/ Representativ e Signature;....-^i^g^^^2i^^j;^ ^ Dat e ^ 

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