## TRANSMITTA Lo f

OMAHA LEA D SIT E PAIN T STABILIZATIO N FIL EFOLDE R SAID ; 2017 1 Date : 12/27/200 8 Address : 132 9 S 2 6 S T Remediatio n Contractor : Pruden t Technologie s Year : 200 8 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S ETVide o o f propert y (DVD ) B ^ Executiv e Summar y 

### [ j Signe dAcces s Agreemen t for subjec t property B ^ Paintin g Agreemen t

• Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. )

• Photograph s w Satisfactory restoratio n signe db y Property Owne r • Property close-ou t chec k lis t signe db y EP A WProperty informatio n fromDougla s County Assessor' s OfRc e D D D „£L^i& ^ Qik3lo i 

### Signature * Dat e 4030795 6 

# HiJlIt t Superfun dPROPERT Y SUMMAR Y Date : 12/27/0 8 LB P STABILIZATIO N EPA CONTRAT EP-R7-08-0 7 Monthof : Decembe r Propert y Address : 1329 S 2 6 S T SAID . 2017 1 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 A. 4 Othe r Relevan t Information : Non e Acces s Date : 10/30/200 8 Wor k Began : 11/8/200 8 CloseoutDate : 12/11/200 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

TECHNOLOGIES . INC .ENVIRONMENTA LA CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : \'^-^( ^ S ^U ? S ^ Date : l0/2^Jo ^ Phone : •SM' ^ '7CJ/G - 

## BVID : DO' S \ 4 Plan t & Permanent Landscapin g T o Remai nInPlac e Itein # Descriptio nan dLocatio n O nMa p 

# fcu^L . y^^/c^ Ai^ ^ c^'^ ^ ^ ^

Pre-Rxistin p Conditio no f Structure s Doe s you r Basemen t hav e ahistory o f leaking ? Ye s —N o — Item # Description ^ Locatio n O nMa p 

# o f h^>Me .

Property Pruden t EmpL^ ^ Signature^ : 

# kijV\' . ^(^i r Signature : Ka/jl h 808 0 Wu d PaitaMy , Suit * 40 8 260 8 N . 24 * Street , Suit e 30 8 424 2 MedlM l Drive . Suit e 426 0

### • ^CbSlNM f Pruden t Technologies , Inc . (Prudent ) i s unde r contrac t (Contrac t #EP-R7-08-07 ) mH ath e U . S . Environmental Protectio n Agenc y (EPA ) t o stabiliz e Lea dBase dPain t (LBP ) a t anumbe r o f propertie s locate di n Omaha , Nebraska , includin g th e property locate dat/ ?)";^ ^ S ^- ^ \i ? S: J . Th e EP A request s you r permissio n t o allo w Pruden t t o perfor mLB PStabilizatio n at thi s property . B y signin g thi s form , tiie propert y owne r grant s permissio n t o Pruden t t o perfor mactivitie s relate dt o LB P Stabilizatio n includin g scnq)in g pam t an dpaintm g o f th e reference dproperty . Further , th e owner/tenan t verifie s that tiiey hav e receive dth e LB Ppamphle t "Renovat e Right. " I f

yo u hav e any question s abou t th e LB Pstabilizatio n planne dfo r you r property , pleas e contac t Prudent' s /krlpiinistrativ e Clerk fo r th e Lea dBase dPain t Stabilization , Mrs . Debora hAkerele-Johnson . a t

(402 ) 504-1004 . Genera l question s abou t th e Omah aLea dSit e cleanu p ca n b e directe dt o th e EP A Publi c Informatio n Center s a t (402 ) 731-304 5 (SouthOmah aoffice ) o r (402 ) 991-958 3 (Nort hOmah a office) . . PrepnQ r AcocuOfnlc dBy: ; 

# X 1 ) -klT^Aiiy..e^^ ^ ^ _(Pleas e Printllaine ) 

# V 

# . y0 ^ -W.W(L ^ /-•^<;o ^ Piopeil y Owner Sigmtuie ; (SidatM ) (Date ) PROPERT YINFORMATIO N (T o b e cenplcte dbj r rctlden t ud/o r propert y owne r - picu e prist ) RE8IDEMTNAIIE ! 17 . Kt'^Z^fi^'^l\€ C (Jvner ) Rente r 

# / 3 5 9 ^ . 

# Ti O 

# U . RE8IDEH TADDRESS : F RENTAL , PROPERT YGWNE C >BY: . 

# S^ , Yi^- e GWNER WHAUN O ADDRESS ; OWHEir S TELEPHON E NUMBER . HOME : 

# , jMlJlLie^WORK : ^ " ^^'^VIORK i J I t7i^'^ \ NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : ^ NUMBE R O P 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 6 HOUR S O R MOR E PE R WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOOS , ENTR YGATES , ETC. ) 

# ^ c < , ^ ^«^/- > . /msicl ^ AUffiORTr YFORBNVIRONMBNTALRESPONS EACTIONS ; Th e ictlvftie t t o b e Implemente db y EP Aunde r tU s agreemen t ar e purmin t t o Secta m104 o f

CERCLA . 4 2 UA C 9604 . EPA' i righ t o f

aooet t t o th e propert y bprovide d fork i Sectio n104(e ) o f CERCLA , 4 2 U.S . C 960S(e) , whic hprovide s e iti y Ibr''detennhihi g (he nee d(b r response , o r clwoeui g ortakta g an y respons e acdo nunder thi s title , o r olwiwl w enfi>rebi g ti e provUt ^

4 * «8 0 Wil d PailNMy , Suit e 40 8 280 8 N . 24 * Street , Suit e 30 8 424 2 Medica l Drive , Suit e 4280

, «M4. - •B««««4l4 « ^.. . _•. . »a.a .

# ACCES S if^FOt^HficrioNTR^OmiOStmE T Wi3£^l9_^ ^ 73;? ? i . -^^ . BflfMlyOniMBy :

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# Curren t Sampl e Pre-Renovatio n Fom n Effectiv e imtl l Apri l 2010 . ConflrmaUo n of Receip t of Lea d Pamphle t Q I hav e received a cop y ofth e pamphlet,/?9novafefliiig/7^'J!rnp(vi ^ Infonnatio n fo rFamBles , CNI d Car e Prwkier a an d School s informin g me of th e potentia l risk ofth e lea d hazar d exposur e fro m reriovatlo n activit y to be perfomie d in mydwellin g unit . I receive d thi s pamphle t befor e th e wor k tsegan .

• • • • Dat e Signatur e ofrecipient Self-Certiflcatla n Optio n (fo rtenant-occupie d dwelling s only ) — Ifth e lea d pamphle t wa s delivere d bu t a tenan t signatur e wa s no t obtainable , yo u ma ydiec k th e appropriat e bo xbelow . Q Refusa l to sig n — I certif 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 InfonnOki n fb rFamHes , Ct M Car a Provider s en d S(^KX3b , to th e renta l dwellin g uni t liste d beio w at th e dat e an d tim e indicate d an d tha t th e occupan t refused to sig n th e confirmatio n ofreceipt . I furthe rcertif ytha t I hav e lef t a cop y of th e pamphle t at th e uni t wit h th e occupant . Q Unavailabl e forslgnatur e —i certif ytha t I hav e mad e a goo d feltheffott to delive rth e pamphlet , Renovat e Rls^t : Importan t Lea d Hazsr d Informatio n fo r Fait^Bes , (M i Car a 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 rcertif ytha t I hav e lef t a cop y of th e pamphle t at th e uni t byslidin g it unde rth e dOQi<; < Printe d nam e of perso n certifyin certifyin g g Attempte d delivery dat e an d tim e lea d pamphle t delivery Signatur e ofperso n ceoHyfn g lea d pamphle t deliver y. 

## Ofi/jclhc L , /V ^ UnttAddres s Not e Regardin g Mailin g Optio n — As an alternativ e to deliveryin.per5on , 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 befor e renovatio n (Documen t wit h a certificat e of mailin g fro m th e pos t office) .

# pain t matc hrfor m pain t matchin g form : ^r property address : BVID : 70' ^ f i 

# Area : Explanation : Area : Explanation : Area : Explanation : Area : Explanation : Area : Explanation : n^ r ^ Color : 

# 1 0 ftl/oi^s :

color :

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# color :

color :

Pag e 1

### Dougla s Count y Accoun t InfoM^tio n Pag e 1 o f 2 

### cm^ t Dougla s County , Nebrask a Propert yRecor d - R221890000 0 Prin t Repor t NE W Featur e - Parce l Dimenston s availabl e @ scal e 0-5 0 f t wes t of 90t h S t - VJeW . Q D Ma p Informatio n i s vali d a s o f 2008-9- 4 Treasurer' s Ta xRepar t Ne wFeatur e -*-*- * Aut o Sale s Searc h Owne r CAMPSE YFRANCE S ETA L 132 5 3 2 6 S T OIVIAHAN E 68105-000 0 Propert yInformatio n Ke yNumber : 189 0 000 0 2 2 Accoun t Type : Residentia l Parce l Number : 221890000 0 Parce l Address : 132 5 S 2 6 S T OMAH AN E 68105-000 0 Lega l Description : SHULL S 2N D AD D LOT1 6 BLOC K1 0 5 0 X 12 7 Valu e Informatio n Lan d Improvemen t Tota l 200 8 200 7 j i $4,900.0 0 $4,900,0 0 f ­ $75,000.0 0 $75,000.0 0 $79,900.0 0 $79,900.0 0 200 6 ^ $4,900.0 0 $63,600.0 0 368,500.0 0 200 5 $4,900.0 0 $63,600.0 0 $68,500.0 0 2004 $4,900,0 0 $63,600,0 0 $68,500.0 0 200 3 $4,900.0 0 $63,600.0 0 $68,500.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 4 6350. 0 1. 0 127. 0 50. 0 N o Improvemen t Informatio n Buildin g 1

v.ttr>-//rir>iirrincn p mnnnina.nnlinp : r.nm/nnnp]asCoNe/static/accountinfo.isD?accountno=R22.. . 10/1/200 8

### Dougla s Count y Accoun t Informatio n Pag e 2 o f 2 Mjm a

CLIC KTO ENLARG E IMAG E Squar e Footage : 1432. 0 Perimete r 0. 0 Uni t Type :

Buil t As : 2 Stor y HVAC : Force d Ai r Exterior : Fram e Shingl e Interior : Plaste r Roo fCover : Compositio n Shingl e

Roo f Type : Hi p Fioorcover : Allowanc e Yea rBuil t Yea r Remodele d Percen t Remodele d 188 8 0 % Detai l Typ e Detai l Descriptio n Ad d O n Fenc e Chai n Lin k Applianc e Allowanc e 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 Porc h Sla b Roo f Cei l TW O STOR Y

CLIC KTO ENLARG E IMAG E Percen t Complete . 100.0 % Quality : Averag e Condition : Fai r Cond o Squar e Footage : 0. 0 Rooms : 8. 0

Units : 1. 0 Baths : 2. 0 Bedrooms : 5. 0 Stories : 2. 0 Foundation : Sprinkle rSquar e Footage : 0. 0 Adjuste d Yea r Buil t 188 8 Physica l Ag e 

### 12

0 Unit s 

### 1.

0 1. 0 976. 0



### "T. O

z o 160. 0

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## Pmds mjPropertv Ci®^e-Oyt ¥o^m{isad-Bsss dPm mStato!iteato©ii |

jYa S IN C WEsthe entire structure(3)ipaint6 dwit hth e sxcacstlo n o f th e stated. , exciuds dsreas ? Tni s wouid Includ e psinting o f ethe r aspcciate dfeature s inciudin g fssde , eaves , siding, , al l trim , porches , box 

# A bsstns , columns , raiSs , an dfxteno r siirfees s o f garages . 

# I 12.Wa s el i scraping andothe r fyeparattic- n wor k

complete dsaftisfactoriiy ? 

## • nTt ­ l3 .Wer e el l require darea s o f t'n e structurefs ) prin-ie da s neede dandpainte dwit htrw o to p costs ? 14

.Wa s th e pain t product s utjti^e dequrvsient t o = 3 0 yea r product/quaiity ? ii . .Ar e ai s ofth e area s \«here cdntaminate dmaterial s have bee n spiiis d i thoroughl y vacuumed/dearj^d ? iS . Di dt^i e contractor coliect/vacuuma! " fsllsn g andscrape dpain t chip s en th e entir e property , 

# V \ roadways , aKeyways , publi c scces s area s andsls c remov e any othe r generate ddebr-s ? p t7 . i s th e gras s are atha t surrou.np s th e structurefs ) ir; reasonably goodconditiori ? |S . 

## sth 4 Ar e al l Items suc ha s polyethijiene sheeting , ladders , paint brushes , cones , barrier tap e etc . = \ I propsri y removed ? j l -iS . I s ther e an y evidenc e o f property damag e tha t wa s don e b y th e contractor ? .An y prcperty damag e ; need s t o b e eompiets dprio r fe th e SP A dose-Out . ilC . A. TM ther e an y propert y item s |r.3 t were tempcratily re-iocate db v th e contracto r 1 tha t needt o b e movedback?- 1 

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# ~~— : 111 ..iir e ther e an y (k.f:Own ) fsngsrin g Issue s wit htn e sropert* ; ow.-isn,S } triat nav e £ee.r- i :ef t unresoh/ed ? ethe r Con5'tder3tigns?prope!ty|ov.?ne r DiscussionsT.Adaitlona i Wor k

tha t i s Required 

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