## TRANSMITTA Lo f

OMAHA LEA D SIT E PAIN T STABILIZATIO N FIL EFOLDE R SAID# : 2674 5 Date : Octobe r

2 8 Address : 2620 Decatu r

St . Remediation Contractor : Pruden t Technologie s Year : 200 8 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S e

f

Vide o o f

propert y (DVD ) 0 Executive Stimmar y H SignedAcces s Agreemen t fo r

subject propert y aPainting Agreemen t D Settlemen t document s (i.e. , fo r

damag e o r

to replac e plants , etc. ) D Photograph s y Satisfactor y restoratio n signedby Propert y Owne r D Propert y close-out chec k

lis t signedb y EP A y Propert y information fromDougla s Count y Assessor' s Office D D D 

## Signatur e > • ^ Dat e

4031036 0 

# ilH I Superfun d

### PROPERT Y SUMMAR Y Date : 10/22/0 8 LB PSTABILIZATIO N EP A CONTRA T EP-R7-08-0 7 Montl i of : Septembe r

. « h• J rr - .. . , - t - t . .^%v-- - 

### Propert y Address : 262 0 Decatu r St . SAID : 2674 5 A . EXECUTIV ESUMMAR Y A. 1 Issue s Encountered : Non e

A. 2 Issue s Resolved : Non e

A. 3 Uniqu e Findings : Non e

122A. 4 Othe r Relevan t Informatio n Acces s Date : 9/08/0 8 Wor k Bega n Date : 9/17/0 8 Closeou t Date : 9/30/0 8

Enclosures : 1 . Pre-Vide o 2 . Post-Vide o 3 . Propert y Statu s For m 4 . Signe dAcces s Agreemen t 5 . Pre-Renovatio n For m 6 . Pain t Matc hFor m 7 . Trackin g For m 8 . Dougla s Count y Assesso r Propert y Informatio n Pag e 9 . EP A Propert y Closeou t for m 10 . Propert y Completio n Agreemen t

TECHNOLOCIES . INC .ENVIRONMENTA L& CONSTRUCTIO N 

## TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : ^^^ O /JtC-iti-yf ^ Date : ^/^/O ^ Phone : ^fo U - :^H H " ^^S'S ' BVID : "^^7 y^ " Plant «f

e Permanen t Landscaping T o Remain I n Plac e Item # Descriptio n an dLocatio n On Ma p /^d> y /idf^^Se . i*#^^ -



## Item # On Ma p Pre-Existin g Conditio n of Structure s 

# y Doe s you r

Basemen t hav e ahistor y o f leaking ? Ye s —N o — Descaiption& , Locatio n x



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## tea^i. p Sc/^eeti F Propert y Owne r Pruden t Employee Signature ; Signature : /: . 8080 Ward Parkway , Suit e 40 5 2505 N . 24 ^ Street , Suite 30 8 424 2 tfledica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebraska 6811 0 Sa n Antonio , T X 7822 0 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 ) 579-6577

# ^^1^ 5 Pruden t Technologies , Inc . (Prudent) is under contrac t (Contract #EP-R7-08-07 ) wit hth eU. S. Enviromnenta l Protectio n Agenc y (EPA) to stabiliz e Lea dBase dPaint (LBP ) at anumbe r

ofpropertie s located in Omaha , Nebraska , includin g th e propert y locate d at ''.Z.6?2' > T^-^^dlia-{f-> P-^" ^ Th e EP A request s you r

permissio nto allo w Pruden t to perfor mLB PStabilizatio n at thi s pioperty . By signing thi s form, th e propert y owne r

grant s permissio nto Pruden t to perfor mactivitie s relate d to LB P Stabilization including scrapin g paint andpaintin gof th e referencedproperty . Further , th e owner/tenan t verifie s tha t they hav e receive dli e LB Ppamphlet "Renovat e Right. " If

you hav e an y question s about th e LB Pstabilizatio n plaimedfo r

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

fo r

th e Lea dBase dPaint Stabilization , Mrs . Debora hAkereifrJohnsoii , at

(402 ) 504-1004 : Genera l question s about th e Omah aLea dSit e cleanup ca nbe directe d to th e EP A Publi c Infonnatio n Center s at (402 ) 731-304 5 (Sout hOmahaoffice) or (402 ) 991-958 3 (Nortii Omah a office) . -. / ^ .- Propert y Access Grante dBy : A - O r /

/

/<5. - /__^^' ^ JL
,_ V ~ T (Pleas e Prin t Name ) Propert y Owne r Signature : ^ .( y yU/LA ^ (/ ^ (Signature ) (Date ) PROPERT YINFORMATIO N

. ^ (T o b^f^npletedtt y residen t and/o r propert y owner-pleas e print ) L i K - ( ll(~ e I U ~e . Z^^g - 3 ^ - f^ ( Owne r^^ Rente r RESIDEN T NAME : /^ ^ r~ - TS RESIDENTADDRESS : ^ IF RENTAL , PROPERT YOWNE D BY : OWNER' S MAILIN G ADDRESS ; "^^f H € ^ OWNER' S TELEPHON E NUMBER-HOME : (V^ ^

o'r- t ^ / ^ 5 WORK : ( \ NUMBE R OF OCCUPANT S UNDE R 7 YEAR S OLD : U NUMBE R OF OCCUPANT S 7 YEAR S OL D AN D OLDER : _ L NUMBE R OF CHILDRE N UNDE R 7 YEAR S OL D WH O PLA Y

IN TH E YAR D FO R 5 HOUR S OR MOR E PE R WEEK : COMMENT S

OR SPECIA L INSTRUCTIONS : (LE . DOGS , ENTR YGATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activities to

be implemente d

by EP A unde r tid s agreemen t ar

e pursuan t to Sectio n 10 4 of CERCLA . 42 U.S.C . 9604 . EPA' s righ t of access to th e propert y

is provide dfo rii Sectio n 104(e ) of CERCLA . 42 U.S . C 9605(e) . whic hprovide s entr y for "determinin g th e nee d forresponse, or choosin g ortaldn g an y respons e actio n unde r this title , or otherwis e enforcin g «K provisicn s of th e title. "

. _ ^ »,»...« « 9<;o ^

N 24 * Stree t Suit e 308 4242 Medica l Drive , Suit e 425 0 08 0 War d Pariway , Suit e 40 5 y^yy^^^^^y rSa n Antonio , TX 7822 9 ansa s City . MO 6411 4 Omaha . N^brast e e^^i^ ^

^^^^^ ^ hone : (816 ) 363-3703 Si S 504-1005 Fax:(210)579.857 7 ax : (816 ) 363-3707 Fax . (40Z ) su a nou s

# 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 Q M hav e received a cop yo f tli e pamphlet , Renovat e Righ t Importan t Lea d Hazar d Infbnnatio n torFamilies , Chil d Ca m F'rovider s an d Sc/joo/ s informin g m e o f th e potentia l risl< o f th e lead hazar d exposur e fro m renovation activit yt o b e perfomie d i n m ydwellin g unit . I received thi s pamphlet befor e th e worl < began . Print^nam e o f recipient./? , Dat e 7 

# 7C?\>z. - n^ ^ Signatur e o f recipient Self-Certificatio n Optio n (fo rtenant-occupie d dwelling s only) — i f th e lead pamphle t wa s delivere d bu t a tenan t signatur e wa s not obtainable , yo u ma ycheci < th e appropriate bo xbelow . Q Refusa l t o sig n —I certif ythat I hav e mad e a goo d M h effor t t o delive rth e pamphlet , Renovat e FS^ t Importan t Lea d Hazar d Infbrmatio n fb rFamSies , Chil d Ca m Pmvider s an d Schools , t o th e rental dwellin g uni t liste d beio wa 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 copyo f th e pamphle t a t th e uni t wit h th e occupant . Q 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 , Renovat e Rgh t Importan t Lea d Hazar d Intonnatio n fo r FamlSes , Chil d Ca m pmvider s an d Schools , t o th e rental dwellin g uni t liste d belo wan d tfia t th e occupan t was unavailabl e t o sig n th e confimnatio n o f receipt, t furthe rcertif ytha t I hav e lef t a copyo f th e pamphlet a t th e uni t b yslidin g i t unde rth e dpO ^

^^ ^ /

# >&/ " en s 

# '^i<f ^ P ^ Printe d nam e o f peijp n certifyin g Attempte d deliver y dat e an d tim e lea d pamphlet deliver y Signatur e o f perso n s^rtifyin g ieadpamphle t deliver y (^/VVcc^qt . /O ^ Uni t Address Not e Regatdin g Mailin g Optio n —A s a n alternativ e t o deliver yi n person , yo u ma ymai 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 (Document wit h a certificate o f mailin g fro m th e pos t office) .

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# pain t matc h for m Pain t matchin g form : /p , ' / } Propert yaddress : ^^a^^ //e^u-f-^ A ^\W.H^-_ L 

# BVID : 

# ^(^7^ f Area : ^^^Z.-? ^ Color : 

# uyh*4 f Explanat i on : Area : Color : Explanation : Area ; color : Explanation : Area : colo r 

# Explanation : Area : Color : Explanation : 

# Xz c Pag e 1

### Dougla s Cotint y Accoun t InfMmatio n Pag e 1 ot l mm a Dougla s County , Nebrask a Propert yRecor d - R194604000 0 ; HI".'. ' Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-S O f t wes t o f SOt h S t - Vljewpri._Ma p Informatio n i s vali d a s o f 2008-7-1 4 Treasurer' s fa xRepor t Ne wFeatur e ->">- » Aut o Sale s Searc h 

### Owne r BEC KLILLI E G 

# fi<¥ > 262 0 DECATU R S T OiWAHAN E 68111-000 0 

# 'S ^ Propert yInformatio n Ke yNumber : 460 4 000 0 1 9 Accoun t Type : Residentia l Parce l Number : 194604000 0 Parce l Address : 262 0 DECATU R S T OIWAHAN E 68111-000 0 Lega l Description : PARKER S AD D LO T1 1 BLOC K9 W 1/ 2 3 0 X 12 6 Valu e Informatio n Lan d improvemen t Tota l 200 8 $900.0 0 $49,100.0 0 $50,000.0 0 200 7 $900.0 0 $49,100.0 0 $50,000.0 0 200 6 $900.0 0 $49,100.0 0 $50,000.0 0 200 5 $900.0 0 $49,100.0 0 $50,000.0 0 200 4 

### $900.0 0 $10,100.0 0 $11,000.0 0 200 3 

### $900.0 0 $10,100.0 0 $11,000.0 0 Lan d Informatio n Acre s S F Unit e Dept h Widti i Vacan t 0.0 8 3780. 0 1. 0 126. 0 30. 0 

### N o Improvement Informatio n Buildin g 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19. . . 8/26/200 81 

## Dougla s Count y Accoun t Infijnnation ifojpi s Page 2 of 2

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# slftiSi B 

# •

CLIC KT O ENLARG E IMAG E n a 1 1 Squar e Footage : Perimete r Uni t Type :

Buii t As :

HVAC : Exterior : Interior : Roo f Cover :

Roo f Type : Floorcover : 1017. 0 0. 0 1 1/ 2 Stor yUnfi n Force d Ai r Fram e Sidin g Drywal l Compositio n Shingl e Gabl e Allowanc e Yea rBuil t 190 0 Detai l Typ e Ad d O n Applianc e Basemen t Fixture . Fixtur e Porc h Porc h yea r Percen t Remodele d ' Remodele d 0 0 % Detai i Descriptio n Unfinishe d Atti cW/floo r Allowanc e Bsmn t Bloc k 8 f t Bas e Fixture s Bat h Ful l Sla b Roo f Cei l Woo d Dec k J620DECATUR.S I 1,1 V ::.-z . . : p- a wa rc&a t ea i

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# - .X...- i STOR YtWFI N CLICKJ O ENLARG E IMAG E | Percen t Complete : 100.0 % Quality : Fai r Condition : Averag e Cond o Squar e Footage : 0. 0 Rooms : 5. 0

Units : 

### 1. 0 Baths : 1. 0 Bedrooms : 2. 0 Stories : 1. 5 Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Adjuste d Yea r Physica l Ag e Buii t 190 0 10 8 Unit e 880. 0 1. 0 960. 0 1. 0 1. 0 30. 0



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19.. . 8/26/200 8 1

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## Pruden t Propert yClose-Ou t For m (Lead-Base d Pain t Stabilization ) SAID: 2 L l ^ T PropertyAildress ; . ^ L XC'; - X" ^ gy^^v>tU A OwTfif'sName i ^'i/// b . ISXdki . 

## Performanc e Standards/close-Ou t Criteri a YE S IN O 1 .

Wa s th e entir e structure(s ) painte d wit h th e exceptio n o fth e stated , exclude d areas ? Thi s woui d I hclud e paintin g o f othe rassociate d feature s includin g fascia , eaves , siding , al i trim , porches , bo x beams , columns , rails , an d exterio rsurface s o fgarages . 2 .Wa s al l scrapin g an d othe rpreparattio n wor k complete d satisfactorily ? 3 .Wer e al l require d area s o fth e structure(s ) prime d a s neede d an d painte d wit h tw o to p coats ? 

# A 4 .

Wa s th e pain t product s utilize d equivalen t t o a 3 0 yea rproduct/quality ? 

# )L. [ Ar e al l o fth e area s wher e contaminate d material s hav e bee n spille d t-ioroughl yvacuumed / cleaned ? 

# y 6 .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 , noadways , alleyways , publi cacces s area s an d als o remov e an yothe rgenerate d debris ? 

# K 7 .

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

# L 8 .fr e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e etc . properl yremoved? ^ 

# t 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 reed s t o b e complete d prio rt o th e EP AClose-Out . 

# X 10 .Ar e ther e an ypropert yItem s tha t wer e temporatii yre-locate d b yth e contracto r t.ia t nee d t o b e move d back ? 

# X 11 . Ar t 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 rConslderations?propert yOwne rDlscusslons?Additiona l Wor k tha t i s Require d 

### > 

# R Pruden t Reiptesentativ e ff{ 

# CoA/pWny^ ^ 'e^Q' ^ 

## Dat e 9 ^ 7 0 --<^ V