TRANSMITTA Lo f OMAH A LEA D SIT E PAIN T STABILIZATIO NFIL EFOLDE R SAID# : ^t^.)A | Date : ^j^'^ } ^' ^ Address : ^q-t n CAtl-frRN mSl , Stabilizatio nContractor : Pruden t Technologies , Inc . Year : 2010 _ PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S y Vide o o f propert y (DVD ) pr ^ ^/i j pi^< r 0 ' Executiv e Summary \ y Signe dAcces s Agreemen t fo r subjec t propert y Q

ZPre-Renovatio nFor msigne db y Propert y Owne r D Pre-Renovatio nFor mfo r Occupant/Tenant , i f applicabl e y Paintin g Agreemen t D Settlemen t document s (i.e. , for-damag e o r t o replac e plants , etc. ) S K Renovatio nRecordkeepin g Checklis t signe db y Certifie dRenovato r y Photograph s s f

Satisfactor y close-ou t chec k lis t signe db y Propert y Owne r o f

Propert y close-ou t chec k lis t signe db y EP A y Propert y informatio nfro mDougla s Count y Assessor' s Offic e ^ Hazar danalysis , i f prepare d D Safet y Audi t 3026016 1 D Othe r (describe) : IIIIIIlll lllll lIII III Illll lllll lI Superfun d

Pruden f Technology , Inc . Signattire MJate ' 'Oat /TECHNOLOGIES . ] 

## Propert y Suinmary Date : 6/24/201 0 LB PSTABILIZATIO NEP A CONTRAC T EP-R7-08-0 7 Mont hof : Jun e Propert y Address : 341 0 Californi aSt . SAI D # : 2416 1
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 : 0i3/30/201 0 U. Wor k Began : 04/18/201 0 iii . Close-Ou t Date : 04/20/201 0 B . Enclosures : 1 . Pre-Stabilizatio n Vide o 2 . Post-Stabilizatio n Vide o 3 . Signe dAcces s Agreemen t For m 4 . Advance-Notic e For m 5 . Pre-Stabilizatio n Vide o Agreemen t For m 6 . Acces s Trackin g For m 7 . Propert y Acces s Assessmen t For m 8 . Neighbo r Acces s Agreemen t For m 9 . Propert y Pain t Matc hFor m 10 . Pre-Stabilizatio n Propert y Safety Assessmen t For m 11 . Work-Sit e Hazard s Analysi s Checklis t 12 . Pre
- Stabilizatio n Propert y Hazar dAssessmen t Photograph s 13 . Dougla s Count y Assesso r Propert y Informatio n 14 . Signe dPropert y Completio nAgreemen t For m 15 . Propert y Close-Ou t Chec k Lis t Signe dB y EP A

# s STsPs w % .& TECHI40L0GIBS . IN C Pruden t Technologies , Inc . (Prudent ) i s unde r contrac t (Contrac t #EP-R7-08-07 ) vsdt hth e U . S . Environmenta l Protectio n Agenc y (EPA ) t o stabiliz e LeadBase dPain t (LBP ) a t anumbe r ofpropertie s locate din Omaha , Nebraska , includin g th e property locate dat : Th e EP A request s you r permissio n t o allo w Pruden t t o perfon nLB PStabilizatio na t thi s property . B y signin g thi s form , th e property owne r grant s permissio nt o Pruden t t o perfor mactivitie s relate dt o LB P Stabilizatio n includin g scrapin g pain t an dpaintin 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 agre e t o allo w anEP A contracto r t o conduc t asoi l cleanu p at my property followin g completio no f lead-base dpain t stabilization , i f fh e soi l cleanu p ha s not already bee n performed . I imderstan dthat th e stabilizatio ncontracto r canno t provid e assurance s o f whic h contracto r wil l b e boun dt o th e soi l cleanup . I further imderstan dthat th e soi l cleanu p contracto r wil l mak e al l reasonabl e effort s t o addres s concem s tha t I , a s th e property owner , ma y hav e regardin g soi l cleanu p at my property . [X. ] Yes , I hav e rea dan dunderstan dth e paragrap habove . 

## S^-<rly£^ft^7>^ia.''<r'^'^t , <^^^<=g^t^A ^ ^^-^CZ Q Property Owner' s Signatur e Dat e I f

yo u hav e an y question s abou t th e LB Pstabilizatio nplaime dfo r you r property , pleas e contac t Prudent' s Custome r Relations/Offic e Manage r for th e LeadBase dPain t Stabilization , Mr . Chandr a Sheka r at 402
- 504-100 4 o r 402-889-3821 . Genera l question s abou t th e Omah aLeadSite cleanu p can b e directe dt o th e EP A Publi c hiformatio n Center s at (402 ) 731-304 5 (SouthOmah aoffice ) o r (402 ) 991-958 3 (NorthOmah aoffice) . Propert v Acces s Grante dBv :

^ 

# QM'Cl^^ZViyO.^ttt , hn^ZAytl u ^(^'J<0Z O Property Owner' s Signatur e Dat e

Pleas e Prin t Nam 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 7% 

# s

TECHNCnOCIBS , INC . PROPERT Y INFORMATIO N (T o b e complete db y residen t and/o r propert y owne r ~ pleas e print ) RESIDEN T NAME : ^^CtZL/yj^ C ofU . cL^iUaxS^ ^ /^Owne ) Tenan t RESIDEN T ADDRESS : \^cxtXc x O^o^'^Ifa ^

I FRENTAL , PROPERT Y OWNE D BY : ^^H^^JAyO-i Loly€i4y^^^i^az^'<:^ ^ OWNER' S MAILIN GADDRESS : 'JiUs O (^Ql.A>rpC ^
OWNER' S TELEPHON ENUMBER : Home : 3^1-^52- 7 Work : _ Cell : NUMBE RO FOCCUPANT S UNDE R7 YEAR S OLD : 

### O TOTA LNUMBE RO FOCCUPANTS : NUMBE RO FCHILDRE N UNDE R7 YEAR S OL D WH O PLA Y INTH EYAR D FO R5 HOUR S O RMOREPE RWEEK : CD . COMMENT S O RSPECIA LINSTRUCTION S (suc ha s dogs , entr v gates , etc.) :

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s t o b e implemente d b y EP A unde r thi s agreemen t are pursuan t t o Sectio n10 4 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f

acces s t o th e property i s provide dfor i n Sectio n104(e ) ofCERCLA , 4 2 U.S . C 9605(e) , whic h provide s entry for "determinin g th e nee dfor response , o r choosin g o r takin g an y respons e actio nunde r thi s title , o r otherwis e enforcin g th e provision s ofth e title. " Property Owne r Signature : V T Lyd-eyy^^ZU^'^x^t^Cei ^ %i.y)LZ^^A . " ^ O- O cu t o (Signature ) 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 ) 579-657 7% 

### PR E & POS TPAIN TSTABILIZATIO N VIDE O AN D PICTURE S I understan d tha t pruden t Technologie s (Prudent ) wil l b e comin g ou t t o shoo t a Pre Stabiiizatio n vide o an d t o tak e picture s o f m yproperty . Pruden t wil l us e th e video s an d picture s t o documen t th e curren t propert ystatus/condition . Also , Pruden t wil l shoo t a vide o sho t followin g th e completio n o f th e pain t stabilization . I giv e permissio n t o video s an d picture s o f m yproperty . Pleas e lis t an yspecia l condition s tha t Pruden t employee s nee d t o b e awar e o f befor e shootin g a vide o (suc h a s pets , prio rnotice , etc.) . 

# 3 ^ 1 ^ C<y\'€^ c Oiot 

# St - Propert yAddres s T^aCCn t l^gck-oAc i Owner' s Nam e X Signatur e 

# ^f^^// ^ Dat e 

### ADVANC E NOTIC E REQUIREMEN T Afte rsignin g th e acces s yo u allo wPruden t t o begi n Lea d Base d Pain t Stabilization . Al l Plants , weed s an d an yvehicle s o ritem s o n ope n porc h (enclose d porche s wil l NO Tb e stabilized ) mus t b e remove d prio rt o stabilization . Al l Pet s mus t b e ou t o f yar d durin g stabilization . Pleas e indicat e belo who wmuc h advanc e notic e you nee d t o hav e th e above mentione d task s completed . I f you ar e a landlor d you wil l nee d t o contac t th e tenan t a s Pruden t wil l onl yinfor m th e propert yowners . D o you hav e an ypet s tha t resid e i n yard : "Vv- ^ Notic e needed : r > H *^ ^ ^ Phon e numbe rt o cal l t o giv e notice : 

## ^L/ y^5^ 7 Who m w e ar e givin g notic e to : pHe^ r>'* ? 

# f ry.r i OS .

608 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

# 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
" 9 I hav e receive d a copyo f th e pamphlet , Renovate 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 of th e lead 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 . Printe d nam e o f recipien t Dat e 

## ^j^^^<Uz€yt\..a^cL:t ^ Signatur e of recipien t Self-Certificatio n Optio n (fo rtenant-occupie d dwelling s only ) — If th e lead pamphlet was delivere d bu t a tenan t signatur e was no t obtainable , yo u ma ychec k th e appropriat e boxbelow . Q Refusa l t o sig n —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 Infonnatio 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 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 pamphlet 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 . Renovate Right : Importan t Lead-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 cop yo f th e pamphlet a t th e uni t b yslidin g i t unde rth e door . Printe d nam e o f perso n certifyin g Attempte d deliver y dat e an d tim e lead pamphlet deliver y Signatur e o f perso n certifyin g lead pamphlet deliver y

Uni t Addres s Not e Regardin g Mailin g Optio n —A 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 . Pamphle t 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) .

# SRm INC . % 

### PAIN T MATCHIN GFORM : 1 . T O B EFILLE D OUT ONL Y I FMATCHIN GCOLO R PROPERT Y ADDRESS : "^Z ) )d ? (^^\ x Co ? ^ BVID : Th e following note s ar e for th e benefit o f

pain t crew only . Locatio n Sidin g Soffit Fascia Come r Tri m Windo w Trim s Doo r Trim s Fron t Porc hCeilin g Fron t Porc hCeilin g Beam s Fron t Porc hFloo r Fron t Porc hRailing s Fron t Porc hStep s Sidin g Baseboard s Foundatio n (T\CC<^< ^ P v- y > ( J Pain t Descriptio n 

## Asit^^^^ ^

-



### « J D H r i VAJ^?^^C ^ *r,*cU'i ^ 

# y ^ o k 

# S 4

Pain t Ye s Pain t N o 

# y y 

# y y y 

# y 

# y y y y y



# y / 

# y

• I UNDERSTAN D SHER ^ VI N WILLL\M S WIL LMATC H M Y C URREN T CO ] LORS . 

### Homeowner signature : > C tt^'^^.-cOC^JC^^^^u.^Ci LDzte:}iUZAyL6(. . 3 ^ -'^t^ P£O 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% TECHNOLOGIES , IN C 

### ACCES S ASSESSMEN T FORM : ^ l j \ ^ ^/ ^ L ' « ^ (- ^ Z \ 

### ' I s th e propert ystucc o o rasbestos ? 

# ftsl:><2^<.-f^^ I f yes , i s an yo f th e stucc o o rasbesto s damage d o r cracked ? 

## y ^ o 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 d t o EP Aan d the ywil l assig n a t a late rdate . Doe s thi s propert yrequir e lot s o f scrapping ? 

## r J ^ Doe s thi s propert yrequir e a lift o rscaffoldin g t o reac h 

### K/C J uppe rlevels ? Doe s thi s propert yhav e lot s o f plant s o ritem s i n area s wher e paintin g i s required ? 

## S^v^^^ — Doe s thi s propert yhav e an ysignifican t structura l damage ? I f yes , EXPLAIN ? 

## > i e Doe s thi s propert yhav e a garage ? 

## yey ; - yy^\^c\^t y I f yes , describ e locatio n o f garage . Doe s thi s propert yhav e aluminu m siding ? Ifyes , i s i t origina l factoryfinis h o rha s i t bee n painte d over ? 

## -r( o Doe s thi s propert yhav e an yothe rtyp e o f structura l components ? (I.e . roo f shingle s a s siding) ? 

## > 1 0 Ifyes , EXPLAIN ? I s thi s propert yvacan t o roccupied ? 

# o Ar e ther e an ypet s a t thi s property ? 

## W< 9 Ar e ther e an ylo whangin g powe rlines ? 

# yc< r D o w e nee d neighbor' s access ? I f ye s pleas e explai n an d ge t neighbor' s propert yaddres s an d owne r information . I f possible , ge t signatur e fro m th e neighbor .

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% 

# 4» . TEOiNOLOGIBS , IN C %. . R0*5 » 

### ACCES S INFORMATIO N TRACKIN GSHEE T BVID : PROPERT Y ADDRESS : I^y/ O y/^ZL/yzPZ^zyzy ^ j-y . Propert y Owne dBy : (If ne w propert y owner )

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

## ^o^V^ " 

# HA ^ ^ \\ 

# y

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 7(effectiv e Apri l 2010 ) RENOVATIO N RECORDKEEPIN GCHECKLIS T Nam eof Firm : 

# /j^fiL/i y60 . Dat e an dLocatio n of Renovation : j]?- ^ ^U ^ ^^l O n^-llUf/Jj i g ^ Brie f Descriptio nof Renovation : ^C^Ap C j Pfjm ^ /fhl/iJ V - j dkf)^
- ^ Nam eof Assigne dRenovator : Pfiy f flffy/)lfjp . Name(s ) of Traine dWorkers : ^ (j o lrf > j/ l /^tM'2- ^ Nam eof Dus t Samplin g Technician , Inspector use d jcter , , and/o

and/o r r Ris Ris k k

Assessor Assessor , , i

i f f used : 

# kmCm\fzc /

(^fiM y Um/yy ?

^ Copie s ofrenovato r an ddus t samplin g technicia nqualification s (trainin g certificates , certifications ) on file. y Certifie drenovato r provide dtrainin g to worker s on (chec k al l tha t apply) : ]/Postin g wamin g sign s B^ettin g up plasti c containmen t barrier s ^Maintainin g containmen t ^Avoidin g sprea d of dus t to adjacent area s ^^Wast e handlin g / • Post-renovatio ncleanin g D Tes t kit s use d by certifie drenovato r to determin e whethe r lea dwa s presen t on component s affecte d by renovatio n (identity kit s use dan ddescrib e samplin g location s an dresults : i 

### JZW J Warnin g sign s poste d at entranc e to wor k

area . ^0^Wor k are acontaine dto preven t spreadof dus t an ddebris . /•"Window s in an dwithi n20 feet ofth e wor k

are aare close d ytiooT S in an dwithi n20 feet ofth e wor k

area s ar e close dan dseale d D Door s that mus t be use d in th e wor k

are aar e covere d to allo w passag e but preven t sprea d of dust . ^0^oun dcovere d by plasti c sheetin g extendin g 10 feet firom wor k

are a- plasti c anchore d to th e buildin g an dweighte ddow n by heav y objects . DIf necessary , vertica l containmen t installe d to preven t migratio nof dus t an ddebri s to adjacent property . 

# y Wast e containe don-sit e an dwhil e bein g transporte doff-site .

Renovatio n Recordlceepin g Checklis t Omah a Lea d Sit e(effectiv e Apri l 2010 )

Work sit e properl y cleane dafter renovation . jZf'^Al l chip s an ddebri s picke dup , protectiv e sheetin g misted , folde ddirty sid e inward , an dtape dfor removal . ]^Wor k are aHEPA vacuume dt o ge t pain t chip s fromgroun dsurface , i f necessary . D Certifie drenovato r performe dpost-renovatio ncleanin g verificatio n(describ e results) : 

# y I certif y unde r penalt y of la

w tha t the above infonnationi s tru e an dcomplete .

Nam e an dTitle Dat e

Renovatio n Recordkeepin g Checlciis t Omah a Lea d Sit e% 

# mm m Ru y TECHNODiCXSIiS , IVi C 

## Checklis t fo r th e Worksit e Hazar dAnalysi s Address : ^^V/( 0 LiJUh\/iLU J J ^ ' Crew : 

### Date : ^'U ' / 6 Ite m OK ? Hazar d Correctiv e Actio n Overhea dLine s y In-transi t Vehicl e Clearanc e Level s aroun dhig hwire s 

### y 

# I^^^Uiy^jM^ f Vehicl e Clearanc e aroun d y hig hwire s whe n workin g 

## jUyy ^ czy£ \^ Phon e line s y Cabl e line s 

### y Ga s Lin e . y Wate r Lin e •,y Sewe r Lin e 

## y Septi c Tan k

. ^ Propane/Butan e y Acces s to/o n Propert y 

## y Neighbo r Acces s Require d ^ Hig hTraffi c Are a • . ^ Garag e y Structure s 

### y Drivewa y y Sidewal k

. y Foundatio n . y Retainin g Wall s y Fence s -, ^ Tree s i ^ Foliag e Genera l Conditio n o f yar d i ^ Damage dAreas : sin k holes/rotte dwoo d i - ^ Sprinkle r Syste m t y Pet s . y Insect s . y Weathe r Condition s 

### y Unsaf e drivin g condition s 

### y Unsaf e neighborhoo d 

# y

808 0 War d Parkwdy , Suit e 40 5 250 5 N . 24" " Street , Suit e 30 8 424 2 Medicd 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% ENVIRONMENTA L& CONSTRUCTIO N TECHNOLOGIES , INC . SERVICE S 

### OMAHA LEAD BASE D PAINT REMEDIATIO N 201 0 (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-07 ) 

### Propert y Owne r Close-Ou t Form SAID : 

## o?m6 i Propert y Address : rT^^C f <<>?Z . Zy=tZy^y\Zyy 9 .^y Owner'sName : Z^/Jye// ^ 7>/Z'^: ^ 7^/9'Z>y P Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) painte dwithth e exceptio nofth e stated , exclude dareas ? Thi s woul dinclud e paintin g o f othe r associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an dexterio r surface s o f garages . 2 . Wa s al l scrapin g an dothe r preparatio n wor k

complete dsatisfactorily ? 3 . Were al l require darea s ofth e structure(s ) prime da s neede dan dpainte dwithtw o to p coats ? 4 . Wa s th e pain t product s utilize dequivalen t t o a2 5 year product/quality ? 5 . Are al l ofth e area s wher e contaminate dmaterial s hav e bee nspille dthoroughl y vacuumed / 

# y cleaned ? 6 . Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s o nth e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y othe r generate ddebris ? 1 . I s th e gras s are athat surround s th e structure(s ) inreasonabl y goo dcondition ? 

# i 8 . Are al l item s suc ha s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . properl y removed ? 

# { 9 . I s ther e any evidenc e ofpropert y damag e that was don e b y th e contractor ? An y property 

# 7 damag e need s t o b e complete dprio r t o th e EPA Close-Out . 10 . Are yo u satisfie dwithth e wor k

performed ? 

# T 11 . Are ther e an y property item s that were temporaril y re-locate db y th e contracto r that nee d 

# 7 t o b e move dback ? 12 . Are ther e any (known ) lingerin g issue s withth e property owner(s ) that hav e bee nlef t 

# t unresolved ? Other Considerations/Property Owne r Discussions/Additiona l Wor k

that i s Required :

PropeftyOwnei v Signatur e Date Prudent Techno/ogies , Inc . Signatur e Date

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 21 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 San Antonio , T X 7822 9 Phorie : (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

# • RIJDE N ENVIRONMENTA L & CONSTRUCTIO N TECHNOLOGIES , INC . SERVICE S



### OMAH A LEA D BASE D PAIN T REMEDIATIO N EP A Close-Ou t For m 201 0 (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-07 ) SAID : 

# p//;6 / Property Address : 

## 3^| Q <^fc'iC.e^c- Q S f Owner' s Name : Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) painte dwithth e exceptio nofth e stated , exclude d areas ? Thi s woul dinclud e paintin g o f othe r associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an dexterio r surface s o f y garages . 2 . Wa s al l scrapin g an dothe r preparatio n wor k

complete dsatisfactorily ? y 3 . Were al l require darea s ofth e structure(s ) prime da s neede dan dpainte dwith tw o to p coats ? t y 4 . Wa s th e pain t product s utilize dequivalen t t o a2 5 year product/quality ? K ^ 5 . Are al l ofth e area s wher e contaminate dmaterial s hav e bee nspille dthoroughl y vacuumed / cleaned ? y 6 . Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s o nth e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e any t ^ othe r generate ddebris ? 7 . I s th e grass are athat surround s th e structure(s ) i n reasonabl y goo dcondition ? y 8 . Ar e al l item s suc ha s polyethylen e sheeting , ladders , pain t brushes , cones , y barrie r tape , etc . properl y removed ? 9 . I s ther e an y evidenc e ofpropert y damag e that was don e b y th e contractor ? An y y property damag e need s t o b e complete dprio r t o th e EP A Close-Out . 10 . Ha s th e Property Ovraer signe dth e completio nform ? 11 . Are ther e an y property item s that were temporaril y re-locate db y th e contracto r y that nee dt o b e move dback ? 12 . Ar e ther e an y (known ) lingerin g issue s v^thth e property owner(s ) that hav e y bee n lef t unresolved ? Othe r Considerations/Property Owne r Discussions/Additiona l Wor k

that i s Required :



## yaliAjrfL..y£ayLc^J^y^t^ EP A CO RSignatur e

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 21 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 7Dougla s Count y Accoun t Inforij^io n Pag e 1 of 3 rn^io n % Dougla s County , Nebrask a Propert yRecor d - R126420000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e & . scal e 0-5 0 f t wes t o f 52n d St - ViewO H IVia O Informatio n i s vali d a s o f 2010-3-1 6 Treasurer' s Ta xRepor t Ne wFeatur e - • - > ^ Aut o Sale s Searc h Owne r DEESTRAD AMARI AE 

### ^ ^ ' pvwo : 24-1-M-5S T 341 0 CALIFORNI AST~ OMAH AN E 68131-000 0 Propert yInformatio n Ke yNumbe r 642 0 000 0 1 2 Accoun t Type : Residentia l Parce l Numbe r 126420000 0 Parce l Address : 341 0 CALIFORNI AS T OMAH AN E 68131-000 0 Lega l Description : HART S SU B DI V LO T8 BLOC K0 W 4 0 F TLT S 6- 7 & 4 0 X 12 0 Valu e Informatio n Lan d Improvemen t Tota l 200 9 200 8 200 7 200 6 200 5 200 4 $6,000.0 0 $6,000.0 0 $6,000.0 0 $6,000.0 0 $5,600.0 0 $5,600.0 0 $56,300.0 0 $56,300.0 0 $46,300.0 0 $49,000.0 0 $54,100.0 0 $31,000.0 0 $62,300.0 0 $62,300.0 0 $52,300.0 0 $55,000.0 0 $59,700.0 0 $36,600.0 0 Sale s Informatio n Sale s Date : Dee d Type : Price : Granto r 2001-10-2 6 W D $63,000.0 0 Book : 219 5 Page : 53 4

Grantee : Valid/Invalid : Exclusio n Reason : Vali d Sale s Date : Dee d Type : Price : Granto r 1994-10-3 1 D $34,000.0 0 Book : 199 1 Page : 44 9

http://douglasne.niapping-online.com/DouglasCoNe/static/accountinfo.jsp7accou n tno=R126420000 0 3/22/201 0Dougla s Count y Accoun t Inforn^io n Pag e 2 o f 3 rn^^o n % 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 1 4800. 0 1. 0 120. 0 40. 0 N o Improvemen t Informatio n Buildin g 1 11/ 2 Stor yFi n 341 0 Californi a S t

D«t<>«fB0 « 40 0 iq t LI 7 • 0 ss?t?f r

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Si r H t >U«4 t SBinakxliB n eTZDSq R CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1200. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : 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 : 1. 5 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 191 4 0 % 191 4 9 6 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Covere d Pati o 24. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 672. 0 1. 0 Fixtur e Additiona l Fixture s http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno= R126420000 0 3/22/201 0Dougla s County Accoun t InfornM^o n Pag e 3 of 3 rnu^o n % Fixtur e Fixtur e Garag e Porc h Use r Use r Bas e Fixture s Bat h Ful l Detache d Sla b Roo f Ceilin g Fram e Asbesto s SE E NOTE S 1. 0 1. 0 400. 0 192. 0 1. 0 1. 0

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R126420000 0 3/22/201 0