## TRANSMITTA LO FOMAH A LEA D SIT E PAIN T STABILIZATIO NFIL EFOLDE R SAID# : U0\^' O Date : Address : Ll^ h HI^^\Q ^ IU^ ^ 

### ^ ^ LB PStabilizatio nContractor : PRUDEN T TECHNOLOGIES , INC . Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S

« Vide o ofpropert y (DVD) : Pre-Stabilizatio n& Post-Stabilizatio nVideo s y Executiv e Summar y K

Signe dAcces s Agreemen t For m H Advanc e Notic e For m M Pre-Stabilizatio nVide o Agreemen t For m ^ Acces s Trackin g For m I ZPropert y Acces s Assessmen t For m i £Neighbo r Acces s Agreemen t For m ^ Pain t Matc hFor m V Pre-Stabilizatio nPropert y Safety Assessmen t For m M Work-Sit e Hazard s Analysi s Checklis t K

Photographs : Pre-Stabilizatio nPropert v Hazar dAssessmen t Photograph s 'i & Dougla s Count y Assesso r Propert y informatio n 0 Propert y Completio nAgreemen t For mSigne db y Propert y Owne r D Propert y Close-Ou t Chec k Lis t Signe dB y EP A 

## y-jP ' y^r^y^^^>^}^fc y _^ Pruden t Technologies , Inc . Signatur e ~ Dat e

EP A Signatur e 

# ^//s//o ' Dat e 3005511 2 

# n w Superfun dTECHNOLOGIBS k IN C 

# Propert y Summar y Date : 11/~/200 9 LB PSTABILIZATIO NEPA CONTRAC T EF-R7-08-0 7 Mont hof : Nov Propert y Address : 670 3 Minn e Lus aBd . SAID # : 4014 5
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 : 9/29/2009 ii . Work Began : 10/08/2009 iii . Close-Ou t Date : 10/09/2009 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 nAgreemen t Form 15 . Propert y Close-Ou t Chec k Lis t Signe dB y EPATECHNOLOGIB S INC ' Prudent Technologies , Inc . (Prudent ) i s under contrac t (Contrac t #EP-R7-08-07 ) wit hth e U . S . Environmental Protectio n Agenc y (EPA ) t o stabiliz e LeadBase dPaint (LBP ) at anumbe r o f propertie s locate dinOmaha , Nebraska , includin g th e 

### properl y locate da t 4?7Q 3 

### fY) ) f)/^^ . j^U^O . B ll/ ^ Th e EP A request s you r permissio nt o allo w Pruden t t o perfon mLB PStabilizatio nat thi s property . B y signin g thi s form , th e propert y owner grant s permissio nt o Pruden t t o perfor mactivitie s relate dt o LB PStabilizatio nincludin g scrapin g pain t an d paintin g ofth e reference dproperty . Further , th e owner/tenan t verifie s that the y hav e receive dth e LB Ppamphle t "Renovat e Right. " B y signin g thi s documen t I agree t o allo w a nEP A contracto r t o conduc t asoi l cleanu p at m y property followin g completio no f lead-base dpain t stabilization , if th e soi l cleanu p ha s no t alread y bee nperformed . I understan dthat th e stabilizatio ncontracto r canno t provid e assurance s o f whic hcontracto r wil l b e boun dt o th e soi l cleanup . I further understan dthat th e soi l cleanu p contracto r wil l make al l reasonabl e effort s t o addres s concern s tha t I , a s th e property owner , ma y hav e regardin g soi l cleanu p at ^ m y property . v e readan dunderstan dth e paragrap habove . Signature o f Proper ^ Owne r
Dat e Ifyo u hav e an y question s abou t th e LB Pstabilizatio nplarme dfor you r property , pleas e contac t Prudent' s Custome r Relations/Offic e Manager fo r th e LeadBase dPaint Stabilization , Mrs . Shanno nHolt , at (402 ) 504-100 4 o r (402)812-0223 . General question s abou t th e Omah aLeadSite cleanu p ca nb e directe dt o th e EP A Publi c Informatio nCenter s at (402 ) 731
­ 304 5 (Sout hOmah aoffice ) o r (402 ) 99 1 -958 3 (Nort hOmah aoffice) . Propert y Acces s Grante dB 

# Hrncia ^ I,CLf>4 ^

ML . (Pleas e Print Name ) Propert y Owne r Signature : (Signature ) 

# '^l^'l/o' } (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 7TECHNOIOCIBS . IN C PROPERTYINFORMATIO N (T o be complete d byresiden t and/o rpropert yowne r — please print ) RESIDEN TNAME : Rente r RESIDEN TADDRESS :
I F RENTAL , PROPERTYOWNE D BY :
OWNER' S MAILIN G ADDRESS ; 

### OWNER' S TELEPHON E NUMBE R - HOME : (^/O ^ ^Sy-Qh^ l WORK : ( V^^ ) ^ j C ''O^O S :-^ l NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDER : NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : /g 9

NUMBE R O F CHILDRENUNDE 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 : lUMB I
COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. )

/ 

# nystuJJ i (JG a - iTUy o A^- ^ iKuyuMuy ^

Volify^y^^sh(ypLf>JUy d

A

U rHORir V FORENVIRONMENTA LRESPONS EAC ! IONS : Th e activitie s to b e implemente dby EP A unde r thi s agreemen t are pursuant to Sectio n10 4 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s rigjit o f acces s t o th e property i s provide dfo r i

nSectio n104{e) ofCERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry fo r "determinin g th e nee dfo r response , o r choosin g o r takin g any respons e actio nunder thi s title , o r otherwis e enforcin g th e provision s ofth e title. "

808 0 War d Parkway , Suit e 405 250 5 N . 24' " Street , Suit e 30 8 4242 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 Fax ; (816 ) 363-370 7 Phone : (402)504-100 4 Fax : (402)504-100 5 Phone : (210)822-958 8 Fax : (210 ) 579-657 7TECHNOLOGIES^ ] 

# Advance dnotic e needed . Afte r

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 iteni s on openporc h(enclose dporche s wil l NO T b e stabilized ) mus t b e reniove dprio r t o stabilization . Al l Pet s mus t b e ou t o f

yar ddurin g stabilization . How muc hnotic e d o you nee dt o hav e abov e mentione dtask s completed ? If you ar e alandlor dyo u wil l nee dt o contac t th e tenan t a s Pruden t Technologie s wil l only infor myou . D o you hav e an y pet s tha t resid e inyard ? y / 

# M o Notic e needed : 

# ^</^ s Numbe r t o cal l t o giv e notice : Whomwe ar e givin g notic e t o Hom e Owner' s Signatur e

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 7TBCHNOLOGIES t ] 

## PRE-STABILIZATIO NVIDE O FORM I UNDERSTAN D THA T PRUDENT TECHNOLOGIE S WIL LB ECOMIN G OUT T O SHOO T A PRE-STABILIZATIO NVIDE O A T MY PROPERTY . TH EVIDE O I S JUS T A TOO LUSE D 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 NO FSTABILIZATION . ?a\:>rNC aC^SV^ ^ OWNER S NAM E 

# ftd G- 7 0? > ^A^r^^e . Uv^^ ^ 

## PROPERT Y ADDRES S , 

## BVID/SAID : Uo\^ S HOMEOWNER S SIGNATURE : <^-- \ PRUDEN T REPRESENTATIV ESIGNATUREV_^^|^^^^ ^ J^^CUlZ ^ AN Y CONDITION S NEED T O B EAWAR EO FBEFORESHOOTIN G VIDEO : (LE . PETS , NOTIC ENEEDED) : 

# {/^y J tuid U

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 S811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phona : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7

### TBCHNOLOGIBS^ ] 

## ACCES S INFORMATIO NTRACKIN GSHEE T ^^^^ ^ ^ \\3S.CAQC J 

## BVID : h6]L{ ^PROPERT Y ADDRESS : GlO' b Propert y Owne dBy : (I f new propert y owner )

Owner s Phon e No's : Home : Work : Cell : ~ Fax : - Acces s Contractor : AS WPDA ME S P E Othe r (Prudent ) DAT E TIM E ACCESSO R CONRAC T DETAI L 

# ^l-v^l^^ £"'2» o ^an^e V «5ireir>-V-«- J f o 

## O

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 7TECHNOLOGIBS; ] 

# Acces s Assessment Form : (Mus t b e complete dfor every property . Informatio nmus t b e obtaine dfro mapropert y wal k thru , no t given by owner )
I s th e propert y stucc o o r asbestos ?
I f

yes , i s an y o f the^tucc^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 . Doe s thi s propert y requir e lot s o f scrapping ? 

# NX ) Doe s thi s propert y requir e alif t o r scaffoldin g t o reac huppe r levels ? 

# N O 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 ? 

# tJ O 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 7TBCHNOLOGIBS* ] 

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

yes , describ e locatio no f garage . 

# VxxcV : iU<S ^ Doe s thi s propert y hav e aluminu msiding ? / v O I f

yes , i s i t origina l factor y finis ho r ha s i t bee npainte dover ? y>J{ ) 

## Doe s thi s propert y hav e an y othe r typ e o f structura l components ? (l.e . roo f shingle s a s siding) ?
I f

yes , EXPLAIN ?
I s thi s propert y vacan t o r 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 7

### OOLOGIES . IN C 

## 2 . T O B EFILLE D OUT ONLY I FCHANGIN GCOLO R PROPERT Y ADDRESS : 

## BVID : MONMC , iGlO' ^ ^^\Y^^vg

_V>>J S O V B G I


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## I AGRE ET O TH E COLOR S INDICATE D ABOVE . I UNDERSTAN T THA T I CANNO T CHANG ETH E SELECTE D COLOR S LATE RO N A S PRUDEN T WOUL D HAV EPURCHASE D TH E PAIN T SPECIFICALL Y FO RTH E REFERENCE D PROPERTY . ALS O I UNDERSTAN D THA T COLOR S SELECTE D MA Y NO T LOO K

EXACTL Y A S I T IS^HOW NO N SWATCHE S AFTE R PAINTIN GO NM Y PROPERTY! ) Homeowner signat u 

# ^kAAJLjIput ^ 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 , 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 ) 579-6S7 7TECHNOLOGIBS ; ] 

## NEIGHBORHOO D PROPERT Y ACCES S FOR M I S THEREA NEIGHBORIN GPROPERT Y THA T NEED S T O B EACCESSED ALONG WIT H ASSIGNE D PROPERT Y T O COMPLET ESTABILIZATIO NPROCESS ?

I FI T IS , GE T ACCES S FRO M AL LREQUIRE 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 , 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 ) 579-857 7TECHNOLOGIES . 1 

## PRE-STABILIZATIO NPROPERT Y SAFET Y ASSESSMENT FORM ^IC b lnn%no e LoS^ o tjx j PROPERT Y ADDRES S BVID/SAID : ^O^M S PRUDEN T ASSESSMEN T REPERSENTATIVE : 

## -Son , .a - Aal^l^ " REPERSENTATIV EREMARKS/FINDINGS : (POWER-LINEPROXIMIT Y T O PROPERTY , SCAFFOLDING / LADDERS / LIFT S NEEDED , UNSAF EAREAS , UNSAF ENEIGHBORHOOD...ETC. )

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

### TECHNOLOGIBS. ] 

# Checklis t fo r th e Worksit e Hazar dAnalysi s \^^.- .
Crew : 

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

### /as/Jj ^ 

# JMl
­ In-transi t Yehicl 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 

## M ^ Neighbo r Acces s Require d 

### - 4 ^ Hig hTraffi c Are a 

## y)u ^ Garag e ^ ^ 

# ^"i-uuiyc ^ Structure s |n ^ r^cKg ^ ^ 

# ^AiC^x: ^ LdncM Drivewa y 

# oi y Sidewal k Foundatio n 

# £ jT i c/ — 

### Retainin g Wall s 

# n ^ Fence s Tree s 

## -6^^= ^ Foliag e OuTOi . 

# atJl^Ki^T ^ Genera l Conditio no f yar d 

# M _ h^^^ft^^ ^ i^iy^J^c d Damage dAreas : sin k holes/rotte dwoo d Sprinkle r Syste m Pet s 

# 3 n ^ Insect s Weathe r Condition s Unsaf e drivin g condition s Unsaf e neighttorhoo d Cre w Suli-Contracto r Saf i

808 0 WardBeltway , Suit e 40 5 250 5 N . 24* " Street , Suit e 30 8 edica l l^rive , Suit e 425 0 Kansa s CitVvM O 6411 4 Omaha , Nebrask a6811 0 Sa nMitonio , T X 7822 9 Phone:(816)363-370 3 Phone : (402)504-100 4 Phon4 : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 F|IX : (210 ) 579-657 7

## Glo 3 (A*:«v^vuU ^ Sp .

# 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 5/Khav e receive d a copyo f th e pamphlet , Renovate Right : Importan t Lea d Hazar d Infonmatio n fo rFamilies , Chil d Car e Provider s an d School s infoimin g m e of th e potentia l ris k of 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 pamphlet befor e th e wor k began . 

# ^M^/o ? o

f recipien t / 7 Date 

# \jlj.0y./ L 

# . yTeexiJlju J Signatur e of recipien t Self-Certificatio n Optio n (fo rtenant-occupie d dwelling s only ) — I f th e lead pamphlet was delivere d bu t a tenan t signatur e was not obtainable , yo u ma ychec k th e appropriat e bo xbelow . •Refusa l t o sig n —I certif ythat I hav e mad e a goo d fait h etfoi l t o delive rth e pamphlet , Renovate Right : Importan t Lea d Hazar d Informatto n fo rFamilies , Chil d Car e Provider s an d Schools , t o th e renta l dwellin g uni t liste d belowa t th e dat e an d tim e indicate d an d that th e occupan t refuse d t o sig n th e confirmatio n o

f receipt . I furthe rcertif ythat I hav e lef t a copyof th e pamphlet a t th e uni t wit h th e occupant . ^Unavailabl e fo rsignatur e —I certif ythat I hav e mad e a goo d fait h effor t t o delive rth e pamphlet . Renovate 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 belowan d that th e occupan t wa s unavailabl e t o sig n th e confirmatio n o f receipt . I furthe rcertif ythat I hav e lef t a copyo f th e pamphlet a t th e uni t byslidin g i t unde rth e door . Printe d nam e of perso n certifyin g Attempte d deliver y dat e an d tim e lead pamphlet deliver y 

# C^M" ^ Signatur e o f perso n certifyin g lead pamphlet deliver y

Uni t Addres s Not e Regaidin g Mailin g Optio n — /V s a n alternative t o deliver yi n person , yo u ma ymai l th e lead pamphlet t o th e owne rand/o rtenant . Pamphlet must 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 post office) .Douglas Coimt y Accoun t Infomiatio Page 1 of 2 laion Dougla s County , Nebrask a Propert yRecor d - R175054000 2 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0ft wes t of 52n d St - VJO W O n Ma p Informatio n is vali d as of 2009-9-1 5 Treasurer' s Ta xRepor t Ne wFeatur e " • r* • • Aut o Sale s Searc h 

### Owne r EASTE R PATRICI AL 

## ^^vj i ^ Ifoi ^ 670 3 MINN E LUS ABLV D OMAH A NE 68112-000 0 Propert yInformatio n Ke yNumbe r 505 4 000 217 Accoun t Type : Residentia l Parce l Number : 175054000 2 Parce l Address : 670 3 MINN E LUS A BD OMAH A NE 68112-000 0 Lega l Description : MINN E LUS ALO T 14 BLOC K 11 LOT S 13 & 14 MINNI E LUS AAD D BL K 11 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $8,900.0 0 $83,100.0 0 $92,000.0 0 200 8 $8,900.0 0 $83,100.0 0 $92,000.0 0 200 7 $8,900.0 0 $83,900.0 0 $92,800.0 0 200 6 $8,900.0 0 $83,900.0 0 $92,800.0 0 200 5 $8,900.0 0 $83,900.0 0 $92,800.0 0 200 4 $8,900.0 0 $67,800.0 0 $76,700.0 0 Sale s Informatio n Sale s Date : 2004-07-2 4 Dee d Type : WD Book : 200 4 Page : 12904 0 Price : $100,000.0 0 Grantor : Mart o T Whit e eta l Grantee : Patrici a L Easte r Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s SF Unit s Dept h Widt h Vacan t 0. 0 0. 0 1. 0 120. 0 106. 0 No Improvement Informatio n
http://douglasne.niapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R1750540002 9/24/2009Dougla s Count y Accoun t Informado n Pag e 2 of 2 latio n Buildin g 1 5.£;,o:, . 

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1 CLIC KT O ENLARG E IMAG E 1 Squar e Footage : 1711. 0 Perimete r 0. 0 Uni t Type :

BuiitAs : 2 Stor y HVAC : Centra l Ai rt o Ai r Exterior : Masonr yCommo n Bric k Interior : Drywal l Roo f Cover : Compositio n Shingl e

Roo f Type : Gabl e Floorcove r Allowanc e Yea r Percen t Yea rBuil t Remodele d Remodele d 192 5 0 % Detai l Typ e Detai l Descriptio n Applianc e Allowanc e Applianc e Fireplac e Masonr y Basemen t Bsmn t Bloc k 8 ft Fixtur e Additiona l Fixture s Fixtur e Bas e Fixture s Fixtur e Bat h Ful l Garag e Detache d Porc h Sla b Roo f Cei l Eii L • avjin ^ M« <

• rgVT ' KM H n

CLIC KT O ENLARG E IMAG E Percen t Complete : 100.0 % Quality : Averag e Condition : Averag e Cond o Squar e Footage : 0. 0 Rooms : 6. 0

Units : 1. 0 Baths : 1. 0 Bedrooms : 3. 0 Stories : 2. 0 Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Adjuste d Yea r Physica l Ag e Buil t 192 5 8 4 Unit s 1. 0 1. 0 768. 0 1. 0 1. 0 1. 0 361. 0

70. 0

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R l 75054000 2 9/24/200 9IES»INC . 

## Pruden t Propert yClose-Ou t For m (Lead-Base d Pain t Stabilization ) SAID : if0t^9 '



# . . Propert yAddress : 

# 470 S f^'UA^lVS.^ , ^1 ^ Owner' s Name : 

# Patr^Oioo ba^fv r i S.N O ' 1
\ 2 : 3

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### ;i o i 1 1 ! 1 2 Performanc e Standards/close-Ou t Criteri a Wa s th e entir e 8tructure(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 beams , columns , rails , an d exterio rsurface s o f garages . Wa s al l scrapin g an d othe rpreparatio n wor k complete d satisfactorily ? 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 ? Ar e ai l o f th 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 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 ? I s th e gras s are a tha t surround s th e structure(s ) i n reasonabl ygoo d condition ? Wa s th e pain t product s utilize d equivalen t t o a 3 0 yea r product/quality ? Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e et cproperi yremoved ? 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 . 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 ? 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 ? Othe rConsiderations ? Propert yOwne rDiscussions ? Additiona l Wor k tha t i s Require d 

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250 6 N . 24 " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0

Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (402)504-100 4 Phone : (210)822-958 8

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