## TRANSMITTA LO FOMAH A LEA D SIT E PAIN T STABILIZATIO NFIL EFOLDE R
SAID# : ^.^^9.<: > Date : R/|||.afle ^ Address : <v)Q>Rg ^ ^ l ^ nA v LB PStabilizatio nContractor : PRUDEN T TECHNOLOGIES , INC . Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S M Videoo f propert y (DVD) : Pre-Stahilizatio n& Post-Stabilizatio nVideo s { /

Executiv e Summar y IMSigne dAcces s Agreemen t For m M Advanc e Notic e For m M Pre-Stabilizatio nVide o Agreemen t For m I v Acces s Trackin g For m EPropert y Acces s Assessmen t For m s l Neighbo r Acces s Agreemen t For m S Pain t Matc hFor m A Pre-Stabilizatio nPropert y Safety Assessmen t For m M Work-Sit e Hazard s Analysi s Checklis t s

/ Photographs : Pre-Stabilizatio nPropert v Hazar dAssessmen t Photograph s A Dougla s Count y Assesso r Propert y informatio n Propert y Completio nAgreemen t For mSigne db y Propert y Owne r Propert y Close-Ou t Chec k Lis t Signe dB y EP A
Pruden t Technologies , Inc . Signatur e Dat e 

# y^fqu^ ^ _^/^iIO _ ^ ' EPA^Snatur e r ^ Dat e 3005468 5 

# • 0 1 Superfun dTECHNOLOGIBS , IN C 

# Propert y Summar y Date ; 8/y//2009 | LB PSTABILIZATIO NEPA CONTRAC T EP-R7-08-0 7 | Mont hof ; Aug . Propert y Address ; 248 9 N4 7 A v SAID # : 6358 6 A . Executiv e Summary ; a . Issue s Encountered : NONE b . Issue s Resolved ; NON E c . Uniqu e Findings ; NON E d . Othe r Relevan t Information ; i . Acces s Date ; 7/14/2009 ii . Work Began ; 7/17/2009 iii . Close-Ou t Date ; 7/19/2009 B . Enclosures ; 1 . Pre-Stabilizatio nVide o 2 . Post-Stabilizatio nVide o 3 . Signe dAcces s Agreemen t Form 4 . Advance-Notic e Form 5 . Pre-Stabilizatio nVide 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 nPropert y Safet y Assessment Form 11 . Work-Sit e Hazard s Analysi s Checklis t 12 . Pre
- Stabilizatio nPropert y Hazar dAssessment Photograph s 13 . Dougla s County Assessor Propert y Informatio n 14 . Signe dPropert y Completio nAgreement Form 15 . Propert y Close-Ou t Chec k Lis t Signe dB y EP AT.r- ' Hii'J,j.t-.'3r^-''='-w:7.-s " " »^-:.r^^..f-p.-^ .

TBCHNOLOCIBS . INC T 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 anunibe r of propertie s locatedi nOmaha, Nebraska , including the propert y locateda t .2.^8 3 Nl Lf: j A v Th e EP A requests you r permissionto allow Pruden t to perfor mLB PStabilizationa t thi s property . By signing thi s form, th e propert y owne r grants permissionto Pruden t to perfor mactivitie s relatedto LB PStabilizationincluding 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 to allow a nEP A contracto r to conduct asoi l cleanu p a t m y propert y followin g completiono f lead-basedpain t stabilization , i f the soil cleanu p has no t alread y bee nperformed . I understan ddia t the stabilizationcontracto r canno t provid e assurance s of whic hcontracto r wil l be boun dto th e soi l cleanup . I fiirthe r understan dtha t the soi l cleanu p contracto r wil l mak e al l reasonable effort s to addres s concems tha t I , as th e propert y owner, ma y have regarding soi l cleanu p a t m y property . [ i/fVes , I have rea dan dunderstan dthe paragrap habove . llt/^_cM ^ f£^aJA..y ^ Signatur e o f Propert y Owne r 

# 7/V-^^^ 1 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 th e 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 directedto the 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 : (Pleas e Prin t Name) Propert y Owne r Signature : 'CAyjA_a_ U /4Lj43-A»-.g . (Signature) 

## ^-/ y^^^ ^ (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 , 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«n?::5ftTi-:4iii;i;-ii^;^-.i?v^;*^rr."jra'A
- w- r ""•". • '-^T-'.-^trr^.' ^ r.w-TP'-""V*^.;:- . "T^.^^TTTT^HitiW^'i"'^?. ^

TECHNOLOGIBS , INC . PROPERT YINFORMATIO N (T o b e complete d b yresiden t and/o rpropert yowne r— pleas e print ) RESIDEN TNAME : Kache. \ \<Xpe<' Q /Owne rJ Rente r RESIDEN TADDRESS : 

## 3^g. 6 1 ^ M l five I F RENTAL , PROPERT YOWNE D BY : OWNER' S MAILIN G ADDRESS ; OWNER' S TELEPHON E NUMBE R - HOME : 1^07 ) SC d '^/V 7 WORK : _ i ) AJAT J NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : Z > NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDER : NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WHO M PLA YI N TH E YAR D FO R 5 HOURS O R MOR E PE R WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s t o b e implemente db y EP A unde r thi s agreemen t ar e pursuan t t o Sectio n104 o f CERCLA, 4 2 U.S.C . 9604 . EPA' s righ t o f

acces s t o th e property i s provide dfor in Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry for "determinin g th e nee dfor response , o r choosin g o r takin g an y respons e actio n unde r thi s title , o r otherwis 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 , 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 you allo w Pruden tto begi nLea dBase d Pain t Stabilization . Al l Plants , weed s an dan y vehicle s or item son ope nporc h(enclose dporche s wil l NO Tbe stabilized ) mus tbe remove dprio r to stabilization . Al l Pet s mus t be ou t of yar ddurin g stabilization . Ho w muc hnotic edo you nee dto hav e abov e mentione dtask s completed ?If yo u ar e alandlor dyo u wil l nee dto contac t th e tenan t as Pruden t Technologie s wil l onl y informyou . Do you hav e an y pet s tha t resid einyard ? Notic ice e needed : 2, 07^\J ^ Numbe r to cal l to giv e notice : ^7^2^
- T J ^ _^ /w ^ Who m we ar e givin g notic e to : Hom e Owner' s Signatur e 

# !^±±7^..!7i^Ai.^ .

808 0 War d Parkway , Suit e 40 5 250 5N. 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , MO 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 7Svt! > ST . " ^ TECHNOLOGIES , IN C 

## PRE-STABILIZATIO NVIDE O FOR M I UNDERSTAN D 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 LUSE D 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 . OWNERSNAME : (?ac\^e \?<:\p«va k PROPERT Y ADDRESS : ^M^o j rs i ^ 1 PVM C BVID/SAID : g^^^g . (^ HOMEOWNER S SIGNATURE : TCC^LMA J 

## PRUDEN T REPRESENTATIV ESIGNATURE : 

# cr^R^.^ ^ AN Y CONDITION S NEE D T O B EAWAR EO FBEFOR ESHOOTIN G VIDEO : (I.E . PETS , NOTIC ENEEDED) :

dfM^i ^ 7 \ t^ S /^.£ >

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

# (g ) TECHNOLOGIES. ] 

## ACCES S INFORMATIO NTRACKIN GSHEE T BVID : 6'2>SS» &PROPERTYADDRESS : aMS* 3 M ^ 1 A V €.
- Propert y Owne dBy : .R<^cbel„.2^.e?£?„,„ „ (If ne w propert y owner )

Owner s Phone No's : Home : Work : Cell : 

## Fax : Acces s Contractor : AS WPD A ME S PEOthe r (Prudent) DATE TIM E ACCESSO R CONRAC T DETAI L 

# -^i n \V3> 0 Ko^i^i^^ V 

# q\af^^- J > \ 1



## 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 ? I f

yes , i s an y ofth e stucc o o r asbesto s damage do r cracked ? 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 returne dt o EP A an dthe y wil l assig na t alate r date . 

# r\y ) Doe s thi s propert y requir e lot s o f scrapping ? 

# 7ne > J (>hj3yt ^ 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 ? I^. ^ K ^ J JU i - ^ " ^ ^ 7 ^ 

# ' ^ ^ ^ V / ) Doe s thi s propert y hav e an y significan t structura l damage ? y fj< ? 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 , 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 7HBCHNOLOGIES , IN C 

## Doe s thi s propert y hav e agarage ? I f

yes , describ e locatio no f garage . 

## <^^\yyl . Doe s thi s propert y hav e aluminu msiding ? I f

yes , 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) ? 

# 0 t^^^ ^ 

# ^ (^^^ e I f

yes , EXPLAIN ? V o \>Ays\yQy ^ 

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

## 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 ? 

# f\| 0 I FI T IS , GE T ACCES S FRO M ALLREQUIRE D NEIGHBORHOO D PROPERTIES . 

# m

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 

# PAIN T MATCHIN GFORM : T O B EFILLE D OUT ONLY I FMATCHIN GCOLO R PROPERTYADDRESS ; :iM&*2 > » ^ ^- [ ^^ ^ BVID ; G'hS9>Q > I UNDERSTAN D SHERWINWILLIAM S WIL LMATC H MY CURRENT COLORS . Homeowner signature ; Tt/kZyku y A!iL-jfay.A^a ^

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 7SteD9r <' ^ TECHNOLOGIBS , IN C 

### PRE-STABILIZATIO NPROPERT Y SAFET Y ASSESSMEN T FOR M PROPERTYADDRESS : ^M^ ^ ' ^ '^~ ^ ^VV C BVID/SAID ; G? > S & G 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 NB 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 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 , 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«}OLOGIBS.IN C 

## Checklis t fo r th e Worksit e Hazar dAnalysi s 

# Addr.«: TLi^ l KI . ^ ^ A ^ Crew : Date ; Ite m OK ? Hazar d Correctiv e Actio n Overhea dLine s tx^ - 

## \a/iyM7 7 AM > L7:iA 7 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 "0^= ^ 

### Phon e line s Cabl e line s Gas Lin e Wate r Lin e Sewe r Lin e Septi c Tan k Propane/Butan e Acces s to/o nPropert y QOXkA L 

## cu> Neighbo r Acces s Require d y Q-y Sytyt.. ^ A'-jOyiiy i S ^ <2.£>y^>^>.>^ _ 

### Hig hTraffi c Are a Garag e ty)IAxA ^ Q^-Tnr-^yyr y J^^— . OiVi^^ LNA- » yf>^y ? Structure s Drivewa y I^A ^ Sidewalk 

## ~S ^ s -Cnidiy ^ 

# ^.^r- tl ^ dUUAJ-iyt ^ ^ 

### Foundatio n V^^LJIOJ^^ ^ 

# - Retainin g Wall s Fence s 

# ^s^ ^ Tree s Foliag e /^y\ A ^ 

### Genera l Conditio nof yar d AJIa^yf^s L^pAyt-ct. . Damage dAreas : sink ^yO^gfcx? ^ jlytU^^ ^ holes/rotte dwoo d Sprinkle r System Pet s Insect s 

## ^a^./f\j^l7 X Weathe r Condition s Unsaf e drivin g condition s Unsaf e neighborhoo d Cre w Foreman / Office r

1080 V\t?r d Parkwayy^ui i 250 5 N . 24* " Str«et , Suit e 30 8 24 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6f f 1 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 >hone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 =ax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax:(210)579-657 7

# 1 —"^V^^ ^

HMWiP^w ? 

# } •••V^IPI I I' ^""'^^''Sfea AA . yyif^ ^ l^^^^t^,,,.... ; . t ^... . '-T+L i 

# •#i S

# 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 a n hav e receive d a cop yo f 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 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 . f^/^/Lff^- ^ 7^7 ^

Pi^/Ly i 

### ni H 'AA^ ^ Printe d nam e o f recipien t Dat e 

## T^Uf^I ^ /^^i^^fl^M.^ ^ 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 unde rth e door . 

### gan^e^ V ficAV^^ VJtxv' ^ 

# n-^H-o ^ 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 at 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) .

### Douglas Count y Accoun t In£flkatio n Page 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R081234000 0 Prin t Repor t

. . , . • ,,„I: J ^finn o e ^ e NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 tt wes t of 52n d S t - ViO 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 

# .^ y PAPER ARACHE L L />-v\\- X ' ^ 248 9 N 4 7 AV E <W ) ^ OMAH AN E 68104-000 0 Y J ^ Propert yInformatio n Ke yNumber : 123 4 000 0 0 8 Accoun t Type : Residentia l Parce l Numbe r 081234000 0 Parce l Address : 248 9 N 4 7 A V OMAH AN E 68104-000 0 Lega l Description : CLAIRMON TLO T2 5 BLOC K6 W 3 FTL T4 & AL L L T2 4 & S 1 FT5 0 X 12 8 1 X 12 5 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $6,400.0 0 $66,200.0 0 $72,600.0 0 200 8 $6,400.0 0 $66,200.0 0 $72,600.0 0 200 7 $6,400.0 0 $66,200.0 0 $72,600.0 0 200 6 $6,400.0 0 $66,200.0 0 $72,600.0 0 200 5 $6,400.0 0 $67,800.0 0 $74,200.0 0 200 4 $6,400.0 0 $61,600.0 0 $68,000.0 0 Sale s Informatio n Sale s Date : 1995-06-1 5 Dee d Type : D Book : 200 6 Page : 60 6 Price : $ 57,999.0 0 Granto r Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 4 B400. 0 1. 0 128. 0 50. 0 N o Improvemen t Informatio n 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=R081.. . 7/7/2009*»'Wu.v.4 ' -.ihf•; , t.w."-*ti>-^i^-pX'- V 

### Dougla s County Accoun t Initiatio n Pag e 2 of 2
Buildin g 1

2M?N4.>* V
• '. • ^ r. -

1 - y ' Secon d FJDS T 66 $ 0 M I I - . „ ,. ,

»=if M Floo r 65 1 0 aq . t 1 2 STOR ^ Bimn t Boc k B s s o 1 4 t' •J" ' tMOs a n

CLIC KT O ENLARG E IMAG E Squar e Footage : 1317. 0 Percen t Complete : 100.0 % Perimete r| 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 2 Stor y Cond o Squar e Footage : 0. 0

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

Roo f Type : Gabl e Stories : 2. 0 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 192 1 0 0 % 192 1 8 8 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fenc e Chai n Lin k 1. 0 Ad d O n Fenc e Woo d 1. 0 Ad d O n Lea n T o 216. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 651. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 216. 0 Porc h En d Scree n 152. 0 Porc h Sla b Roo f Cei l 15. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R081. . . 7/7/200 9TECHNOLOGIES . 1 

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

# Jf^^" ^ U q-t" ^ Av/^ ­ Owner' s Name : .QOKA

### Vc^^pi ^

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 . ) ( / 2 Wa s al l scrapin g an d othe rpreparatio n wor k complete d satisfactorily ? 

# t p 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 ? 

# y 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 ? 6 I s th e gras s are a tha t surround s th e structure(s ) i n reasonabl ygoo d 

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

# f 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 ? 

# t 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 ? 

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

# f Pruden t Representativ e Signature : Date : c y Propert yOvi^n^ rSignature : 

### Date : 803 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 Fa:< : (815)363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7