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OMAHA LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R SAID : 2739 2 Date : 01/15/200 9 Address : 261 5 PATRIC K Stabilizatio nContractor : Pruden t Technologie s Year : 200 8 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 2 f Vide o o f propert y (DVD ) .' B f

Executiv e Summar y S

f Signe dAcces s Agreemen t fo r subjec t propert y o

f Paintin g Agreemen t D Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) D Photograph s H Satisfactor y restoratio nsigne db y Propert y Owne r D Propert y close-ou t chec k lis t signe db y EP A ( ZPropert y infonnatio nfromDougla s Count y Assessor' s Offic e D D D 

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### PROPERT Y SUMMAR Y Date : 01/15/2009 LB P STABILIZATIO N EP A CONTRAT EP-R7-08-0 7 Mont hof : JANUARY + Propert y Address : 261 5 PATRIC K SAID : 2739 2 A . EXECUTIVE SUMMAR Y A. 1 Issue s Encountered ; A. 2 Issue s Resolved : A. 3 Uniqu e Findings : NONE . A. 4Othe r Relevant Information : Acces s Date ; 10/18/0 8 Wor k Began : 11/04/0 8 Closeout Date : 11/21/0 8 Enclosures ; 1 . Pre-Vide o 2 . Post-Vide o 3 . Propert y Statu s Form 4 . SignedAcces s Agreemen t 5 . Pre-Renovatio n Form 6 . Pain t Matc hForm 7 . Trackin g Form 8 . Dougla s Count y Assesso r Propert y Informatio n Pag e 9 . EPA Propert y Closeou t for m 10 . Propert y Completio n Agreemen t

TECHNOLOGIES , INC .-/ / 

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EI4VIR0NMENTAL & 

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### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : ^^yf ^ l^oiOL v cVC . IVu e ^'^' ' W^l^i-O ^ Phone : ^/" 7 'OCiCiL O BVID : Q"!^ ^ ^ Plant & Pennanent Landscaping T o Remai n In Plac e Item# Descriptio n an dLocatio n O

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Pre-Existin g Conditio n o f Structure s Doe s your Basement hav e ahistor y o f leaking ? Ye s — N o Item# Descriptio n & Locatio n OnMa p 

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## Propert y Owner/'xj / Pruden t Empl o Signature : Signature : 808 0 Vtar d Pailnray , Suit e 40 S 250 6 N . 24* * Streat , Sult a 30 8 U Medica l Drive , Sult a 426 0 Kansa s City , M O 6411 4 Omaha , Nabraska 8811 0 Sa n Antonio , T X 7822 9 Phona : (818 ) 383^70 3

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Pruden t Technologies , Inc . (Prudent) i s under contrac t (Contract #EP-R7-08-07 ) wifl i tiie U . S . Environmenta l Protectio n Agenc y (EPA ) t o stabiliz e Lea dBasedPaint (LBl^a t anumbe r

o f propertie s locatedin Omaha, Nebraska , includin g th e propert y locateda t ^LQJ ^ V-^3cic( U cJi/ ^ \-tJQ . The EP A request s you r

permissio n t o allo w Pruden t to perfor mLB P Stabilizatio n a t thi s property . B y signing M s form, titie propert y owner grant s permissio n to Pruden t t o perfor mactivitie s relatedt o LB P Stabilization including scrapin g paint andpaintin g ofth e referencedproperty . Further , th e owner/tenan t verifie s tha t they hav e receive dtiie LB P pamphlet "Renovat e Right. " I f

you hav e an y question s abou t th e LB P stabilizatio n plannedfo r

your property , pleas e contact Prudent' s Administrative Cler k

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th e LeadBasedPaint Stabilization , Mrs . DeborahAkerele-Johnson ^ a

t (402 ) 504-1004 . Genera l question s about the OmahaLea dSit e cleanu p can b e directe dt o tiie EP A Publi c Information Center s a t (402 ) 731-304 5 (Soutii Omahaoffice) or (402 ) 991-958 3 (Nort hOmaha office) . FlopetQ r Aooe u OrmtedBy : 

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PROPERT Y INFORMATIO N CF

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w coBpIct^bjrre i Mea t and/orjanpcr^LeiiiBc r ­ pleas e print ) RESIDEN TNAME: . Rante r RESIDEN TADDRESS : 

# Jki^/' S 'T^^h^^^ ^ I F RENTAL , PROPERT YOWNE D BY : OVmERTSMAIUN G ADDRESS ; OWNER' S TELEPHON E NUMBE R • HOM E NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OL D / 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 WH O PLA YI 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 DOOS . ENTR YGATES , ETC. ) / ^^f^-^^ ^

AUTHORTf Y FO RENVIRONMENTA LRESPONS E ACTIONS : The actNide s t o b e iinpleincntedb y EP A underlie s agreemen t ar

e purtnan t t o Sectio D 10 4 o f

CEROA . 4 2 U.S. C 9604 . EPA' s right o f

acces s t o the propett y i s providedfb r io Section 104(c ) o f CERCLA . 4 2 U.S . C 9605(e X whic hprovide s enti y for "detennining O e nee d forresponse, o r ctaoosin g ortaldn g an y response actio n imde r thi s title , o r otherwis e enforcing < ^

i08 0 War dPariomy , Suit e 40 5 250 5 N . 24* ^ Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 '.ansa e city , M O 6411 4 Omaha , Nebrask a6811 0 Sa n Antonio , T X 7822 9 • hone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-988 8 • » • /o<f« « «« « vi m

# Curren t Sampl e Pre-fienovatio n For m EffacSv e unti l Apri l 2010 . Confinnatio n of Receip t of Lea d Pamphle t I hav e received a cop y ofth e pamphlet . Renovat e Righ V Importan t Lea d Hazan j 

### ^ Infomrntio n fo rFamSes , Chil d Car e Pro\Mer s an d School s informin g me of th e potentia l ri * ofth e lea d hazar d exposur e fro m renovation activit y to be performe d in mydwellin g uni U receive d thi s pamphle t befor e th e wor k began .

Self-Certiflcati6 n Optio n (fo rtenant-occupie d dwelling s only ) — Ifth e lea d pampMe t wa s delivere d bu t a tenan t signatur e wa s no t obtainable , yo u ma ycheci < th e appropriat e bo xbelow . •Refusa l to sig n — I certil ytha t I hav e mad e a goo d fait h effor t to delive rth e pamphlet , Renovat e Right : Importan t Lea d Hazar d Infonnatio n fo rFamSes , Chik i Car e Provider s an d Schools , to th e renta l dwellin g uni t liste d belo w at th e dat e an d tim e indicate d an d tha t th e occupan t refuse d to sig n th e confirmatio n ofreceipt . I furthe rcertif ytha t I hav e lef t a cop y ofth e pamphle t at th e uni t wit h th e occupant . Q Unavailabl e fb rsignatur e —I certif ytha t I hav e mad e a goo d fait h effor t to delive rth e pamphlet , Ftenovat e Righ t Importan t Laa d Hazar d Infonnatio n fo r FemSes , ChS d Car e provider s an d Schools , to th e renta l dwellin g uni t liste d belo wan d tha t th e occupan t wa s unavailabl e to sig n th e confirmatio n ofreceipt . I furthe rce|$f ytha t I hav e lef t a cop y of th e pamphle t at th e uni t byslidin g it unde r1 ^B f Printe d nam e o o f perso perso n n certiiyin

certiiyin g g Attempte d deliver y dat e an d tim e lea d pamphle t delivery Signatur e of iiyin g lea d pamphle t deliver y 

# a^/ < Pfi^f^ic H /^ . Uni t Addres s . Not e Regardin g Mailin g Optio n — As an aitemat'rv e to deliver yIn person , yo u ma ymai l th e lea d pamphle t to th e owne rand/o rtenant . Pamphle t mus t be maile d at leas t 7 day s belbr e renovatio n (Documen t wit h a certificat e of ma'lin g fro m th e |308 t office) .

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### • MOBBane aPag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R200085000 0 i I Prin t Repor t I NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f 90t h St - ViC W O n Ma p Informatio n i s vali d a s o f 2008-9- 4 Treasurer' s TaxBe^or t Ne wFeatur e -»-»- * Auto^Saie s Searc h Owne r SCOT T NANCYL 261 5 PATRIC KAV E OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : 008 5 000 0 2 0 Accoun t Type : Residentia l Parce l Number : 200085000 0 Parce l Address : 261 5 PATRIC KA V OMAH AN E 68111-000 0 Lega l Description : PATRICK S AD D LO T 4 BLOC K4 W 4 0 F T Valu e Informatio n Lan d Improvemen t Tota l 200 8 $1,100.0 0 $31,700.0 0 $32,800.0 0 200 7 $1,100.0 0 $31,700.0 0 $32,800.0 0 200 6 £1,100,0 0 $31,700.0 0 $32,800.0 0 200 5 $1,100.0 0 $31,700"00 " _$32,800.0 0 200 4 200 3 $1,100.0 0 $1,100.0 0 -) . $10,200.0 0 $10,200.0 0 $11,300.0 0 $11,300.0 0 Sale s Informatio n Sale s Date : 2006-08-0 4 Dee d Type : W D j Price : \ $37,900.0 0 Grantor : Rjc h Tamar a M Grantee : Scott H NancyL Valid/Invalid : Vali d Exclusio n Reason : Book : 200 6 Page : 09209 4

Lan d Informatio n Acre s S F 0,1 2 "" " 5280, 0 Unit s 1, 0 Dept h 132, 0 

### WId m 40, 0 Vacan t N o Improvemen t Informatio n 

### http://douglasne.mapping-online.comi/DougIasCoNe/static/accountinfo.jsp?accountno=R20, , . 10/1/200 8

### Pag e 2 o f 2 Buildin g 1

Squar e Footage ; Perimete r Uni t Type :

Buil t As :

HVAC : Exterior : Interior : Roo f Cover :

Roo f Type : 1081. 0 

### o.o"" " 1 1/ 2 Stor yFi n Centra l Ai rt o Ai r Fram e Sidin g Drywal l Compositio n Shingl e Gabl e Floorcover : I Allowanc e Yea r Percen t Yea rBuil t Remodele d Remodele d 191 3 Detai l Typ e Ad d O n Applianc e Applianc e Basemen t Fixtur e Fixtur e Porc h Porc h Use r 0 % Detai l Descriptio n Ston e Tri m Allowanc e Securit ySyste m Bsmn t Bloc k 8 ft Bas e Fixture s Bat h Ful l \ En d Scree n I En d Scree n

Atti cFul l Finis h 261 5 Patric k A v

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...— « J 1 11^ 2 Srcf vFi n CLIC KT O JNyaLRG E IMAG E Percen t Complete ; 100.0 % Quality : ; Averag e Condition : Fai r Cond o Squar e Footage : ^ 0. 0 Rooms : 6. 0

Units : 1. 0 Baths : i 1. 0 Bedrooms : 

## 2£_ _ Stories : 

# { I Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Adjuste d Yea r Physica l Ag e Buil t 191 3 9 5 Unit s 150. 0



### 1. 0 1. 0 624. 0 1. 0 1. 0 63, 0 168, 0 408. 0



### http://dougIasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R20. . . 10/1/200 8

## Pruden t Propeit yClose-Ou t For m (Lead-Base d Pain t Stabilization ) SAID: J2'73l ^ . p PropertyAddress : X'(^/5 " /ar/y^/^jt " >^<2 . Owner' s Name : /U^U^rc ^ Sra-/ ^ 

## Performanc e Standards/close-Ou t Criteri a YE S N C 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 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 rpreparattio n wor k complete d satisfaaorily ? 3 .Wer e 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 .Wa s th e pain t product s utilize d equivalen t t o a 30 yea rproduct/quality ? 

# z 5 .Ar e al l o f th e area s where contaminate d material s hav e bee n spille d thoroughl yvacuumed/ cleaned ? 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 area s an d also remov e anyothe rgenerate d debris ? 

# z l 7 .

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

Ar e al l item s such a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e etc . properl yremoved ? 9 .

I s ther e anyevidenc e o f propertydamag e tha t wa s don e b yth e contractor ? An ypropertydamag e / need s t o be complete d prio rt o th e EP AClose-Out . 

# V 10 .Ar e ther e anypropertyitem s tha t were temporatil yre-locate d b yth e contracto r 1 ^ 

# V tha t nee d t o b e move d back ?


# - y 11 .Ar e ther e any(known ) lingerin g issue s wit h th e propertyowner{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 

# ~1 Pruden t Representativ e Signature : /r/K ^ 

# Dat e (I'S-O^ ^ Propert yOwne rSignature: / Date :