## TRANSMITTALO FOMAHA LEAD SIT E PAINT STABILIZATIO NFIL EFOLDE R SAID# : «g.^ y ^ ? ^ , Date : Address : S^:? ^ ^V^>9>^^/^ r .< " ^ • LB PStabilizatio nContractor : PRUDEN T TECHNOLOGIES , INC . Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 0 ^ m 0 M 15

^ M u

y H D ^ / / 

### Vide o o f property (DVD) : Pre-Stabilizatio n& Post-Stabilizatio nVideo s Executiv e Summar y SignedAcces s Agreement Form Advanc e Notic e For m Pre-Stabilizatio nVideo Agreement For m Acces s Trackin g Form Propert y Acces s Assessmen t Form Neighbo r Acces s Agreement For m Pain t Matc hForm Pre-Stabilizatio nPropert y Safet y Assessmen t Form Work-Site Hazard s Analysi s Checklis t Photographs : Pre-Stabilizatio nPropert v Hazar dAssessmen t Photograph s Dougla s Count y Assessor Property informatio n Propert y Completio nAgreement For mSignedb y Propert y Owne r Property Close-Out Chec k Lis t SignedB y EP A PrudSn t TeciinoTogies , Inc . Sig n atur e Dat e
EP A Signatur e ^ ' Dat e
3005495 3 

# nn i i Superfun dTECHNOLOGIBS , IN C 

# Propert y Summar y Date : 11/~/200 9 LB PSTABILIZATIO NEP A CONTRAC T EP-R7-08-0 7 Mont hof: Nov . Propert y Address : 332 5 Charle s St . SAI D # : 2557 3
A . Executiv e Summarv : 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 : 9/21/200 9 ii . Wor k Began : 9/24/200 9 iii . Close-Ou t Date : 9/25/200 9 B . Enclosures : 1 . Pre-Stabilizatio nVide o 2 . Post-Stabilizatio nVide o 3 . Signe dAcces s Agreemen t For m 4 . Advance-Notic e For m 5 . Pre-Stabilizatio nVide 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 nPropert y Safety Assessmen t For m 11 . Work-Sit e Hazard s Analysi s Checklis t 12 . Pre
- Stabilizatio nPropert 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_ ^ TBGHNOLOCIBS . INCT " 

## ^—-^^^^MJP^'^^^^^^^^ ^ Prudent Technologies , Inc . (Prudent ) i s unde r contrac t (Contrac t #EP-R7-08-07 ) wit hth e U . S . Environmental Protectio n Agenc y (EPA ) t o stabiUj ^ Lead£ase dPain t (LER ) a t anumbe r o f propertie s locate dinOmaha , Nebraska , includin g th e propeti , locate d^x3%^flXU C^ . ^ ^ T Th e EP A request s you r permissio nt o allo w Pruden t t o perfor mLB PStabilizatio nat thi s property . B y signin g thi s form , th e property owne r grant s permissio nt o Pruden t t o performactivities 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 1 agree t o allo w a nEP A contracto r t o conduc t asoi l cleanu p a t m y property followin g completio no f lead-base dpain t stabilization , ifth e soi l cleanu p ha s no t already 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 imderstan dthat th e soi l cleanu p contracto r wil l make al l reasonabl e effort s t o addres s concem s that I , a s th e property owner , ma y hav e regardin g soi l cleanu p at m y property . [v'j^es , I hav e readan dunderstan dth e paragrap habove .

Signat i

Date Ifyo u hav e any question s abou t th e LB Pstabilizatio nplanne 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 , 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 EPA Publi c Informatio nCenter s at (402 ) 73 1 ­ 304 5 (Sout hOmah aoffice ) o r (402 ) 991-958 3 (Nort hOmah aoffice) . Propert y Acces s Grante dBy : 

# ^;f yti l ^ (Pleas e Prin t Name ) Propert y Owne r Signature :

(Date )

808 0 War dParkway , Suit e 405 2505 N. 24' " Street , Suite 30 8 4242 Medica l Drive , Suite 425 0 Kansa s City , AA O 6411 4 Omaha , Nebraska6811 0 Sa nAntonio , T X 7822 9 Phone : (816 ) 363-3703 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-6577iiafLOCIBS , INC . PROPERT YINFORMATIO N (T o b e complete d b yresiden t and/o rpropert yowne r— pteas e print ) RESIDEN TNAME : Owner / Rente r fOv/ne a RESIDEN TADDRESS :

I F RENTAL , PROPERTYOWNE D BY :
OWNER' S MAILIN G ADDRESS ;
OWNER' S TELEPHON E NUMBER - HOME : Vjf Q ) . *£ ^

jf ^ ^^ORK : (M^ l y^o O &^/ 7 NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : f j NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDER : UM 1

NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WHO M 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 . DOGS , ENTR YGATES , ETC. )

AUI'HORIT V FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s t o b e implemente dby EPA unde r thi s agreemen t ar e pursuan i t o Seclio n10 4 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s righ t ofacces s t o th e property i s provide dfo r i

nSeclio 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 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 7TECHNOLOGIES , INC . 

# 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 item s on openporc h(enclose dporche s wil l NO T b e stabilized ) mus t b e remove dprio r t o stabilization . A U 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 dyou 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 ? Notic e needed : 3 L ^ kA } Numbe r t o cal l t o giv e notice : S' ^ ^ 

# 8& 0 Whomw e ar e givin g notic e to : Hom e Owner' s Signatur e 

# (Es^ .

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " street . Suit e 30 8 424 2 Medical Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a6811 0 Sa nAntonio , 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 7TKCHNQLOCIBS, ] 

## PRE-STABILIZATIO NVIDE O FORM I UNDERSTAN D THA T PRUDENT TECHNOLOGIE S WIL L BECOMIN G OUT TO SHOO T A PRE-STABILIZATIO NVIDE OAT MY PROPERTY . TH EVIDE O IS JUS T A TOO LUSE D TO DOCUMENT TH ECURRENT PROPERT Y STATUS/CONDITION . A POS T VIDE O WIL LALS O BE SHO T PRIO R TO COMPLETIO NOFSTABILIZATION . 

# ?>3:>. 5 cVyc^^e ^ sV OWNER S NAME : PROPERT Y ADDRESS : 

# 26S7 3
BVID/SAID : "X S S 7 ^ HOMEOWNER S SIGNATURE : IV E ES^ I PRUDEN T REPRESENTATIV SWiNATURE : AN Y CONDITION S NEED TO BEAWAR E OFBEFORESHOOTIN G VIDEO : (LE . PETS , NOTIC ENEEDED) : Cl A/Jy^'t^^'^tij ^

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 , MO 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 7TECHNOLOGIES, ] 

# ACCES S INFORMATIO NTRACKIN GSHEE T BVID : 7''5^7 ^ PROPERT Y ADDRESS : 1??> ^ ^ C/>ff ^ Propert y Owne dBy : (I f ne w propert y owner )

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

# ^\>\] ^ 

# 1 0 t o 

# d^.^ ^ /f^AyX^^y-Z^J • M l 1 

# A i l \ /



## 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 7TEQiNOILOGIBS ^ IN C 

# Acces s Assessment Form : (Mus t b e complete dfo r ever y property . Informatio nmus t b e obtaine dfro mapropert y wal k thru , no t given by owner ) 

# ry } I s th e propertj l stucco/O r asbestos ? >^U - 

### /V 

## I f

yes , i s an y o f th e stucc o o r asbesto s damage do r cracked ? / ^ ^ O Ifyes , 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 ?
Doe s thi s propert y requir e alif t o r scaffoldin g t o reac huppe r levels ?
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 

# 1 required ?
Doe s thi s propert y hav e an y significan t structura l damage ? Ifyes , 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 , 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-«57 7TECHNOUXilSS. ] 

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

yes , describ e locatio no f garage . Doe s thi s propert y hav e aluminu msiding ? Ifyes , i s i t origina l factor y finis ho r ha s i t bee npainte dover ?
Doe s thi s propert y hav e an y othe r typ e o f structura l components ? (I.e . roo f shingle s a s siding) ? Ifyes , EXPLAIN ?
I s thi s propert y vacan t o r occupied ?
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 , 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-«57 7TSGHNOIXX;iBS.INC . 

## 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 , GET ACCES S FRO M ALLREQUIRE 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 ) 579-657 7

### ^OLOGIBS , INC . 

### PAIN T MATCHIN GFORM : 1 . T O B EFILLE D OU T ONL Y I FMATCHIN GCOLO R 3 L-UL.U K 

## PROPERT Y ADDRESS : 33/^_ C ( ^ BVID : 2S<:7'a . Th e followin g note s ar e fo r th e benefi t o f pain t cre w only . Pain t Ye s Pain t No Locatio n Pain t Descriptio n Sidin g ilvct* ) ^ \ / Soffi t P[\mMi\\uv A (^iJUVt \ ^ ^ 

### Fascia ik.id» J (^^>^^^ | 

# v ^ Come r Tri m Windo w Trim s C^JO<H J t'^V<' ^ \iit6 ^ tu^Uir* ^ Doo r Trims Fron t Porc hCeiling 

### uooo*^ C««^'^k \ Fron t Porc hCeiling Beams Fron t Porc hFloo r Fron t Porc hRailing s 

### »^e•fel J ( , Q l acV ^ ^ v ^ 

# U ^ Fron t Porc hStep s \>SAO^{^^^" ^ 

### \ ^ Sidin g Baseboards Foundatio n U«***K ^ <Jooans,^a^ S 

## • htWl'^U-k ) y ^)0* ^ C**^^ ^ i'lM'eHlM ^ OtK>t* * 

# A l l 

# 1^15^5= ^ Ttc b 

# r 3 y

v f ^ I UNDERSTAN D SHERWI NWILLIAM S WIL LMATC H M Y CURREN T COLORS . Homeowne r signature : ITXAJISJ ^ 

### T\.l^^LA ^ Date :

808 0 WardParkway , Suit e 40 5 250 5 N . 24* " Street , Suit e 30 8 424 2 Medical Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa nAntonio , 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 ^TECHNaUOGIB& ] 

## PRE-STABILIZATIO NPROPERT Y SAFETY ASSESSMENT FORM PROPERT Y ADDRESS : BVID/SAID : PRUDEN T ASSESSMENT REPERSENTATIVE : 

# (2^. ^ 

# U^^ ^ 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 , 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-€57 7

# Curren t Sampl e Pre-Renovatio n For m Effectiv e unti l Apri l 2010 . Confijxnatio n o f Receip t o f Lea d Pamphle t !3 n 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 o

f 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 nan^ e o f recipien t w / rriiiitJ U I 

### Date Signatur e o f recipient ^ Self-Certlflcatlo 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 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 effor t t o delive rth e pamphlet , Renovate Right : Importan t Lea d Hazar d Informatio 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 . \JAJT^ \ 

### navallabl 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 belo wan 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 copyof 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 cei/tifyin g lead pamphlet deliver y

Unit 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 . 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) .TECMNOUX;iBS .

Address : 

## Checklis t fo r th e VS^prksit e Hazar dAnalysi s / Crew : 

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

# l>-& ^ < ^ ^ v Jyt<
­ In-transi t Vehicl 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 

# cMA ^ 

# a i Neighbo r Acces s Require d („:g^^ ^ Hig hTraffic Are a Garag e {jJOdf ^ 

## i2 £ 

# '6 .srz^g^p v^^x^^ . Structure s 

## v54uc<>e ^ Driveway Sidewal k Foundatio n Retainin g Wall s . QJCWC^ i Fence s Tree s 

## JJ X 

## hi>-ci' ^ Foliag e (XAj.xuuy ^ Genera l Conditio no f yar dC 

## \XAJX ^ IA/ \ Damage dAreas : sin k .fifeW-t ^ 

## ctcO\> a holes/rotte dwoo d(jj i jy/vs . 

# i ^ Sprinkle r Syste m Pet s ^ 

# i^^- ^ Insect s 

## .j^oS'i.uyt s Weathe r Condition s Unsaf e drivin g condition s Unsaf e neighborhoo d^



### re

w Foreman / Sub-Contracto r

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medical Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a6811 0 Sa nAntonio , 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 7j m nDougla s County Accoun t Informatio n Pag e 1 of 2 Dougla s County , Nebrasic a Propert yRecor d - R164205000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e ffl scal e 0-5 0 f t wes t of 52n d S t - VlO W O n Ma P Informatio n i s vali d a s o f 2009-9-1 5 Treasurer' s Ta xRepor t Ne wFeatur e •* -•- * Aut o Sale s Searc h Owne r KIN G RILE Y ETA L 332 5 CHARLE S S T OMAH AN E 68131-000 0 Propert yInformatio n Ke yNumbe r 4205 000 0 1 6 Accoun t Type : Residentia l Parce l Number : 164205000 0 Parce l Address : Lega l Description : 332 5 CHARLE S S T OMAH AN E 68131-000 0 LOWE S AD D LO T5 BLOC KTN1/2E40FT 40 X 7 8. 5 Valu e Informatio n 200 9 200 8 200 7 200 6 200 5 200 4 Lan d $1,800.0 0 $1,800.0 0 $1,800.0 0 $1,800.0 0 $1,800.0 0 $1,800.0 0 Improv emen t $64,500.0 0 $64,500.0 0 $64,500.0 0 $64,500.0 0 $64,500.0 0 $28,000.0 0 Tota l $66,300.0 0 $66,300.0 0 $66,300.0 0 $66,300.0 0 $66,300.0 0 $29,800.0 0 Lan d Informatio n Acre s 0.0 7 S F 3120. 0 Unit s 1. 0 Dept h 78. 0 Widt h 40. 0 Vacan t N o Improvement Informatio n Buildin g 1

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.J3p?accountno=R164205000 0 9/16/200 9Dougla s Count y Accoun t Informatio n Pag e 2 of 2

»KCHWi£Ss r

11«8T0IIYWmMr< r•«<. •

CLIC KT O ENLARG E IMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : i 1664. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Fai r

Buil t As : 2 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 8. 0 Exterior : Fram e Stucc o Units : 1. 0 interio r Drywal l Baths : 1. 5 Roo f Cover : Compositio n Shingl e Bedrooms : 4. 0

Roo f Type : Hi p Stories : 2. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 191 0 0 % 191 0 10 0 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 832. 0 Basemen t Finishe d 400. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Fixtur e Bat h Hal f 1. 0 Garag e Detache d 264. 0 Porc h Sla b Roo f Cei l 154. 0

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno= R164205000 0 9/16/200 9TBCHNOLOGIBS ; INC . 

## Pruden t Propert yClose-Ou t For m (Lead-Base d Pain t Stabilization ) SAID : y^^7 ^ Propert yAddress : 

# $52 3 C^a^^ ^ . ^ Owner' s Name :

S.N O Performanc e Standards/close-Ou t Criteri a Ye s 1 Was th e entir e 8tructure(s ) painte d wit h th e exceptio n ofth 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 Was al l scrapin g an d othe rpreparatio n wor k complete d satisfactorily ? 1 ^ 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 ? 

# y 4 Ar e al l o f th e area s wher e contaminate d material s hav e bee n spille d thoroughl yvacuumed / cleaned ? 

# y 5 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 

# y an d als o remov e an yothe rgenerate d debris? 6 I s th e gras s are a tha t surround s th e structure(s ) i n reasonabl ygoo d condition ? 

# y 7 Wa s th e pain t product s utilize d equivalen t t o a 3 0 yea r product/quality ? 

# y 8 Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e et cproperi yremoved ? 

# y 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 need s t o b e complete d prio rt o th e EP AClose-Out . 1 0 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 ? 1 1 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 ? 1 2 Othe rConsiderations ? Propert yOwne rDiscussions ? Additiona l Wori ctha t i s Require d 

### Pruden t Representativ e Signatur e 

# 'O f Propert yOwne rSignature : Date : N O



# y i ^ ^ ' 1 ^ ­

808 0 War d Parkway , Suit e 250 6 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 ) 579-857 7