### TRANSMITTA L o f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R SAID# : c?5}6 ^ , Date : /^J^jl O Address : ^l U / ft-fi^vff^tTF i ^ . Stabilizatio n Contractor : Pruden t Technologies , Inc . Year : 201 0 PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S S / Vide o of propert y (DVD ) ^ Executiv e Summar y B ^ SignedAcces s Agreemen t fo r

subject propert y B ^ Pre-Renovatio n For msignedby Propert y Owne r D Pre-Renovatio n For mfo r

Occupant/Tenant , i f applicabl e H Paintin g Agreemen t D Settlemen t document s (i.e. , fo r

damag e o r

t o replac e plants , etc. ) 0 ^ Renovatio n Recordkeeping Checklis t signedb y CertifiedRenovato r ^ Photograph s Q

^ Satisfactor y close-out check lis t signedby Propert y Owne r D Propert y close-out check lis t signedb y EP A y Propert y information fro mDougla s Coimt y Assessor' s Offic e y Hazar danalysis , i f prepare d D Safet y Audit 3026002 8 D Othe r

(describe) : 

# , .J l Superfun d



### en t Technorogy , hic . Signatur e /Date r T5at e (afte r file folde r review )TECHNOLOGIES . 

## Propert y Summar y Date : 6/29/201 0 LB P STABILIZATIO N EP A CONTRAC T EP-R7-08-0 ' '' Mont h of : Jun e Propert y Addres s : 311 1 Lafayett e Av . SAI D # : 2516 9
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 : 04/23/201 0 ii . Wor k Began : 05/03/201 0 iii . Close-Ou t Date : 05/04/201 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 h For m 10 . Pre-Stabilizatio n Propert y Safet y 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 n Agreemen t For m 15 . Propert y Close-Ou t Chec k Lis t Signe dB y EP A- TECHNOLCXSIBS , INC. ~ 

### Pruden t Technologies , Inc . (Prudent ) i s unde r

contrac t (Contract #EP-R7-08-07 ) wit h th e U . S . Environmenta l Protectio n Agency (EPA) t o stabiliz e Lea dBasedPain t (LBP) a t anumbe r

ofpropcrtie s locatedin Omaha , Nebraska , including tii e propert y locatedat : " ^ \\\(^HJ / g«_» ^ f <?lKy ^ -A^
- x ^ Th e EP A request s you r

permissio n t o allo w Pruden t to perfor mLB P Stabilizatio n a t thi s property . By signing thi s form , di e propert y owne r

grant s permissio n to Pruden t to perfor mactivitie s relate dto LB P Stabilizatio n including scraping paint an dpaintin g ofth e referenced property . Further , th e owner/tenan t verifie s tha t they hav e receive dthe LB P pamphle t "Renovat e Right. " B y signing thi s documen t I agre e to allo w a n EP A contractor t o conduct asoi l cleanu p a t m y propert y following completio n o f lead-base dpaint stabilization , ifth e soi l cleanu p ha s no t alread y been performed . I understandtha t th e stabilizatio n contractor cannot provide assurance s o f which contractor wil l b e botm dt o th e soi l cleanup . I furthe r

understandtha t th e soi l cleanu p contractor will mak e all reasonabl e efforts to addres s concem s tha t I , a s th e propert y owner , ma y have regarding soi l cleanu p a t m y property . [i ^ Yes , I hav e rea dandunderstandthe paragraph above . 

### J=A . frt

y Owner' s Signatur e Dat e Ifyo u hav e an y question s abou t th e LB P stabilizatio n plannedfo r

you r

property , pleas e contact Prudent' s Custome r

Relations/Offic e Manage r

fo r

the Lea dBasedPain t Stabilization , Mr . Chandr a Sheka r a

t 402
- 504-100 4 o r 402-889-3821 . Genera l question s abou t th e OmahaLea dSit e cleanu p ca n be directe dto th e EP A Publi c hiformation Center s a t (402 ) 731-304 5 (Sout h Omahaoffice ) or (402 ) 991-958 3 (Nort h Omahaoffice) . Propert v Acces s Grante dBy : 

## Uij}M^Z^^^.y>zT)^^J/^ J ! Propert y Owner' s Signatur e Dat e



### Pleas e Print Nam e

808 0 War d Parkway , Suit e 40 S 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 

### I

### 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 : A\.Ve_ A V-gg . . , L Owner y Tenan t RESIDEN T ADDRESS : ^\\\ 

## G^^-«^gQ d 1 ^ i^^-< .


### I F RENTAL , PROPERT Y OWNE D BY : _ OWNER' S MAILIN G ADDRESS : ^ OWNER' S TELEPHON E NUMBER : Home : <^2-.^M^y-IOiC , Work : _ Cell : NUMBE RO F OCCUPANTS UNDE R7 YEAR S OLD : TOTA L NUMBE RO F OCCUPANTS : 2 . NUMBE RO F CHILDRE N UNDE R7 YEAR S OL D WH O PLA Y I N TH E YAR D FO R5 HOUR S O

RMOR E PE RWEEK : COMMENT S O RSPECIA L INSTRUCTION S (suc h a s dogs , entr y gates , etc.) :



## <^^c^A . k U r. —^Qj t ^ ^ K-- r

AUTHORIT Y FO RENVIRONMENTA L RESPONS E ACTIONS : Th e activitie s to b e implemented b

y EP A unde r

thi s agreemen t ar e pursuan t to Section 10 4 of CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t ofacces s t o the propert y i s provide dfo r

in Section 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic h provide s entr y fo r

"determinin g th e needfo r

response , or choosing or takin g an y respons e actio n unde r thi s title , or otherwis e enforcing the provision s ofth e title." Propert y Owne r

Signatur e 

## : C0yCe^.^A ^ ^gyyJzL j (Signature ) Dat 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 , 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'TBCHNClJOClBS,INC r 

### PR E & POS T PAIN T STABILIZATIO N VIDE O AN D PICTURE S I understan d tha t pruden t Technologie s (Prudent ) wil l b e connin g ou t t o shoot a Pre Stabilizatio n vide o an d t o tak e picture s of my property . Pruden t wil l us e th e video s an d picture s t o docunnen t th e curren t propert y status/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 my property . Pleas e lis t an y specia l condition s tha t Pruden t employee s nee d t o b e awar e of befor e shootin g a vide o (suc h a s pets , prio rnotice , etc.) .



### 3H l LtLLo^r^^l M 

## (^^,^oJU ^ M e ^^t ^ I Propert y Ad d res ' ^ 

### Owner' s Nam e Signature Dat e 

### ADVANC E NOTIC E REQUIREMEN T Afte rsignin g th e acces s yo u allo w Pruden t t o begi n Lead Base d Pain t Stabilization . Al l Plants , weed s an d an y vehicle s o ritem s o n ope n porc h (enclose d porche s wil l NO T b e stabilized ) must b e remove d prio rt o stabilization . Al l Pets mus t b e ou t o f yar d durin g stabilization . Pleas e indicat e below ho w muc h advance notic e yo u nee d t o hav e th e above mentione d tasks completed . I f yo u are a landlor d yo u wil l nee d t o contac t th e tenan t a s Pruden t wil l onl y infor m th e propert y owners . D o yo u have an y pet s tha t resid e i n yard : y^u ^ Notice needed : Phon e numbe rt o cal l t o giv e notice : Who m w e ar e givin g notic e to :

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

# Curren t Sampl e Pre-Renovatio n For m Effectiv e unti l Apri l 2010 . Confirmatio n of Receip t of Lea d Pamphle t •I hav e receive d a cop y of th e pamphlet . Renovate Right : Importan t Lea d Hazar d Informatio n fo r Families , Chil d Car e Provider s an d School s informin g me of th e potentia l ris k of th e lead hazar d exposur e fro m renovatio n activit yto be performe din my dwellin g unit . I receive d thi s pamphlet befor e th e wor k began . I f Printe d nam e of recipien t / Sianatur Signatur e

of recipien t recioien Self-Certificatio n Optio n (fo rtenant-occupie d dwelling s only ) — If th e lead pamphlet wa s delivere d bu t a tenan t signatur e wa s not obtainable , yo u ma y chec k th e appropriat e bo x below . Q Refusa l to sig n —I certif y tha t I hav e mad e a goo d fait h effor tto 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 , to th e renta l dwellin g uni t liste d below at th e dat e an d tim e indicate d an d tha t th e occupan t refuse d to sig n th e confirmatio n of receipt . I furthe rcertif y tha t I hav e lef t a cop y of th e pamphlet at th e uni t wit h th e occupant . •Unavailabl e fo rsignatur e —I certif y that I hav e mad e a goo d fait h effor t to delive rth e pamphlet . Renovate Right : Importan t Lea d Hazar d Infomnatio n fo r Families , Chil d Car e provider s an d Schools , to th e renta l dwellin g uni t liste d below an d tha t th e occupan t wa s unavailabl e to sig n th e confirmatio n of receipt . I furthe rcertif y tha t I hav e lef t a cop y of th e pamphlet at th e uni t by slidin g it unde rth e door . Printe d nam e of perso n certifyin g Signatur eof perso n certifyin g lead pamphlet deliver y

Uni t Addres s Attempte d deliver y dat e an d tim e lead pamphlet deliver y

Not e Regardin g Mailin g Optio n — As an alternative to deliver y

in person , yo u ma y mai l th e lea d pamphle t to th e owne rand/o rtenant . Pamphle t must 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) .

# WS l TECHN G i,IN C 

### PAIN T MATCHIN G FORM : 1 . T O B E FILLE D OU T ONL Y I F MATCHIN G COLO R PROPERT Y ADDRESS : 

### ^\ \

I Lcxjju ^ e^^-g - BVID : Th e followin g note s ar e fo r th e benefi t o f pain t cre w only . Locatio n Siding Soffi t Fasci a Come r Tri m Windo w Trim s Doo rTrim s Fron t Porc h Ceiling Fron t Porc h Ceiling Beams Fron t Porc h Floo r Fron t Porc h Railing s Fron t Porc h Step s Siding Baseboard s Foundatio n 

### NJ o 

### c u ^^^< _ Pain t Descriptio n ^

< " C C o INSCO X 

### V^oo d N/A VOO D c i Wood } Wtrzjd l 

### lO00( ^ 

### y^o o d WJo dc d Cor\Cv^-gi^--€-- .



### r^/ A C_O^Cav-«3-e_ . 

# -7 A^^t Pain t Yes Pain t N o L ^

• I UNDERSTAN D SHERWI N WILLIAM S WIL L MATC H M Y CURREN T COLOR S

X ^ Homeowne r signature : UJ/iyZ^J^/^^.Ult ^ 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

### ACCES S ASSESSMEN T FORM : I s th e property/§tuccaJ) rasbestos ? I f yes , i s an y o f th e stucc o o rasbesto s damage d o 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 d t o EP A an d the y wil l assig n a t a late rdate . Doe s thi s propert y requir e lot s o f scrapping ? Doe s thi s propert y requir e a lif t o rscaffoldin g t o reac h uppe rlevels ? Doe s thi s propert y hav e lot s o f plant s o ritem s i n area s wher e paintin g i s required ? Doe s thi s propert y hav e an y significan t structura l damage ? I f yes , EXPLAIN ? Doe s thi s propert y hav e a garage ? I f yes , describ e locatio n o f garage . Doe s thi s propert y hav e aluminu m siding ? I f yes , i s i t origina l factor y finis h o rha s i t bee n painte d over ? Doe s thi s propert y hav e an y othe rtyp e o f structura l components ? (I.e . roo f shingle s a s siding) ? I f yes . EXPLAIN ? I s thi s propert y vacan t o roccupied ? Ar e ther e an y pet s a t thi s property ? Ar e ther e an y lo w hangin g powe rlines ? D o w e nee d neighbor' s access ? I f ye s pleas e explai n an d ge t neighbor' s propert y addres s an d owne r information . I f possible , ge t signatur e fro m th e neighbor . 

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## M" ^ /^Z ) 

## l U o k J O 

## j J o / O 0 C?Cc.O(«?^ ^ , 

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# y^^ \fJ 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 7TECHNOLOGIES , IN C 

## ACCES S INFORMATIO N TRACKIN G SHEE T BVID : 

### PROPERT Y ADDRESS : Propert y Owne dBy : 

## Kci^V< ^ A L <::&£fe:J-J& . 

### (I f ne w propert y owner )

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

## M)? 3 i:p ^ %j \ .v ^ V ^ 

### dUc d i^o^ - 0»vci ^ <J* ^ Cp^'Jr^lASr 

## v^to ^ 

## S7 f

_ H > Lo)4-r4 - g 11<

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 San 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 7402-505-860 6 p. 2 RENOVATIO N RECORDKEEPIN G CHECKLIS T Nam e o f Firm: fh £ ^UZ/tdPtniXU ^ n"'« e an dLocatio n o f Renovation : \^J l I f . fl^hUirrt if^lZ/ . y , .^ . . f Descriptio n o f Renovation : ^^J-Pld L ^^JP L kM^ f I/^/^\ n / ) Nam e of Assigne dRenovator : Name(s ) o f Traine dWorkers , i f use d 

# ed:n./ /

(/zu £ Ip/jrnry J Nam e of Dus t SampHn g Technician , Inspector, o r Ris k

Assessor, i f used : 

# ifz> i "TTrXnokaz s

• ^opie s o f renovato r an

ddus t sampling technicia n qualification s (training certifications , certification s o n fite . Certifie d renovator provide dtrainin g to workers o n (chec k

all tha t appiy ) • ^-l^atin g wamin g sign s vSettin g u p plastic containmen t barrier s Hwiintainin g containmen t v ^Avoiding sprea dofdus t t

o adjacen t area s vwast e handlin g _i^P6st-renovatio n cleaning Tes t kits use db y certifiedrenovato r to determin e whethe r lea dwa s presen t o

n components affecte d b

y renovatio n (identif y kit s use dan ddescrib e samplin g location s an dresults) : _:^Wamin g sign s poste da t entranc e t o wor k

area . \/Wor k are acontainedt o preven t sprea dc f dus t an ddebri s ^Al

l objects i n the wor k

are aremoved or covere d(interior ) HVA C duct s i n the wor k

are aclose dan dcovere d(interior ) ^Window s i

n th e wori c are aclose d(interior ) v^indow s i n an dwithi n 2 0 fee t ofth e wor k

are aclose d(exterior ) Door s i

n the wor k

are aclose dan dsealed(interior ) jj^^poat i i n an dwithi n 2 0 fee t ofth e wor k

are aclosedan dsealed(exterior ) ySoor s tha t must b e use di n the wor k

are acovere dto allow passag e bu t preven t sprea dofdus t ^Floor s i

n the wor k

are acovere dwit h taped-dow n plasti c (interior ) y/droun dcovere db y plasti c extending 1 0 fee t fro mwor k

are a(exterior ) v^lasti c anchore dt o building an dweighe ddow n b y heav y objects (exterior ) j^ f necessaiy , vertica l containmen t installedt o preven t migratio n ofdus t an ddebri s (exterior ) • ^Wast e containe don-sit e an dwhile bein g transportedofF-sit e .•Wor k sit e properl y cleanedafte r renovation ^^Al l chi p an ddebri s picke dup , protective sheeting misted , folde ddirt y sid e in , A tape dfo r remova l Wor k

are asurface s an dobjects cleane dusing HEP A vacuu mand/or we t cloth s o r mop s (interior )

. Certifie d renovator performe dpost-renovation cleaning verificatio n (describ e results , including the numbe r o

f we t an d dr

y cloth s used) :

y I f dus t clearanc e testing wa s performe dinstead , attac h acop y o f report, y^ \certif y unde r penalty;»flla w tha t th e above informatio n i s true an dcomplete . 

# ^ f 

# - 4 ^ 

# M Nam e an dTitle / / j f Dat e# TECHNOLOGIBS , IN C 

## Checklis t fo r th e Worksit e Hazar dAnalysi s Address : 

### ^11 ) ^OLOJI^ ^ 

## /^ y/^y^<v/rry. ry^y. ) Crew : Date : 

# "^-Al
- ib Ite m Hazar d Correctiv e Actio n OK ? 

# fcS^ Overhea dLine s L</Y\ . In-transi t Vehicl e Clearanc e Level s aroun dhig h wire s Vehicl e Clearanc e aroun d hig h wire s whe n workin g Phon e line s lj(yv^±cp p ~0ci IAJ t t^-^irJ - CD h i U^ J ^ .^f^Xr€cAj ^ Cabl e line s Gas Lin e Wate r Lin e Sewer Lin e Septi c Tan k Propane/Butan e Acces s to/o n Propert y Neighbo r Acces s Require d:bh^^)-^i-^- ' I\ A Hig h Traffi c Are a /U Garag e 

### AA . structure s Drivewa y ^hlhJLk ^ JZ ^

lUfLul ) ^ liyy^n^r^JL J 'ciZ^.^ ]jiock ^ ^v ^

*4»^^feaf: ^ . !4idew9i k oTyyvyT i ' r ^ ^c..* ^ Foundatio n j y ^ ^aJluA^^ ^ Ci»»,y ^

O^^^^t: ^ 17^-4.^*4^^1^f^JC^tl^M^ ' Retainin g Wall s CXYl y (j}6 t UHSC^AJL ^ Fence s Tree s ; ^ ^ Foliag e Genera l Conditio n of yar d< 'yt/.6A ^ Damage dAreas : sin k boles/rotte dwoo d 

### ^fj?Q.^c.^a^L^^Z^^«^

_A^^n ^ Sprinkle r System Pet s (fULX^Yt^i^Jti ^ ~3BS ^ Insect s . ^ ^ trU^AAAiA,y ^ rZ ^ y . va*.ot S Weathe r Condition s Unsaf e drivin g condition s Unsaf e neighborhoo d I ^ 

# 7W^ - dy^jOu ^ f^^^<UjiM^^> ^ 

### Cre w Forema n At 

# i A >A. x 808 0 War d P3rkway>5u H arkwayrSuit e 40 1 5 5 ^ 1 250 5 N. 24' " Street , Suit e 308 aica l Drive , Suit e 425 0 Kansa s City , MO 6411 4 i/\Ai k 3//6Pmaha, N Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 (402 ) 504-1004 Phone : (210)822-958 8 [fyiir l <y \ Phone : ( Fax : (816 ) 363-370 7 (402)504-100 5 Fax:(210)579-657 7 Fax : (4^ ^

f

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/^^^^^^^^^^^^^^^^^^^^K : "" ' •-. ^

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# ^^m L H ^ Jk :• ENVIRONME N TA L & CONS' I RU C I lO. N TECHNOLOGIES , INC . SERVICK. S 

### OMAH A LEA D BASE D PAIN T REMEDIATIO N Propert y Owne r Close-Ou t For m 201 0 (Lead-BasedPain t Stabilizatio n EP A Contract EP-R7-08-07 ) SAID : 

### J^S-{6 ^ Propert y Address : 

### 3if t mj.a^jp^ Q 

## M L Owner' s Name : / \ '/v- i ce4^J^J^ ^ iQ/jy ^ 

### Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Was the entir e structure(s ) painte dwit h th e exceptio n ofth e stated , excludedareas ? Thi s woul dinclud e paintin g o f othe r

associate dfeature s including fascia , eaves , siding , all trim , 1—'' ' 

### porches , box beams , columns , rails , an dexterior surface s o f

garages . 2 . Was all scraping an dothe r

preparatio n wor k

completedsatisfactorily ? 

### y 3 . Wer e al l require darea s ofth e structure(s ) primeda s neededan dpaintedwit h tw o top coats ? y ^ 

### 4 . Was th e pain t product s utilize dequivalen t t o a2 5 yea r

product/quality ? 

# y 5 . Ar e all ofth e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y vacuumed / 1 / 

### cleaned ? 6 . Didth e contractor collect/vacuumal l falling an dscrapedpaint chip s on the entir e property , roadways , alleyways , publi c acces s area s an dals o remove an y othe r

generateddebris ? \ ^ w < 

### 7 . I s the gras s are atha t surround s th e structure(s ) i n reasonabl y goodcondition ? 8 . Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r

tape , etc . properl y removed ? K y 

### 9 . I s ther e an y evidenc e ofpropert y damag e tha t wa s don e b y th e contractor ? An y propert y -^ 

### damage need s to b e complete dprior t

o th e EP A Close-Out . v / 

### 10 . Ar e you satisfiedwit h th e wor k

performed ? 11 . Ar e ther e an y propert y item s tha t wer e temporarily re-locate dby th e contractor tha t nee d

. y 

### t o b e move dback ? 12 . Ar e ther e an y (known) lingerin g issue s wit h the propert y owner(s ) tha t hav e been lef t f 

### unresolved ? Othe r

Considerations/Propert y Owne r

Discussions/Additiona l Wor k

tha t i s Required :

Propert y Owne r

Signature ^ ^ ^ 

### Pruden t Inc . Signatur e
808 0 Ward Parkway , Suit e 40 5 250 6 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 ) 363-3703 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax:(816)363-370 7 Fax : (402)504-100 5 Fax:(210)579-657 7Douglas Count y Accoun t Informatio n Page 1 of 2 Dougla s County , Nebrask a Propert y Recor d - R180266000 0 Prin t Reoor t NE W Futur e - Parce l Dimension s availabi e O scal e 0-5 0 f t wes t o f 52n d S t - Vie w O H Ma p Informatio n i s vali d a s o f 2010-4- 5 Treasurer' s Ta x Reoor t Ne w Featur e ->-•• • Aut o Sale s Searc h Owne r LEWI S MARCE L L ETA L 311 1 LAFAYfcTT E AV E OMAH A N E 68131-000 0 Propert y Informatio n Ke y Numbe r 026 6 000 0 1 8 Accoun t Type : Residentia l Parce l Numbe r 180266000 0 Parce l Address : 311 1 LAFAYETT E A V OMAH A N E 68131-000 0 Lega l Description : MONTCLAI R AD D LO T 6 1 BLOC K0 4 5 X 115. 7 Vaiu e Infor n matio 200 9 200 8 200 7 200 6 200 5 200 4 Lan d $2,400.0 0 $2,400.0 0 $2,400.0 0 $2,400.0 0 $2,400.0 0 $2,400.0 0 I mprovemen t $48,800.0 0 $48,800.0 0 $48,800.0 0 $48,800.0 0 $48,800.0 0 $21,400.0 0 Tota l $51,200.0 0 $51,200.0 0 $51,200.0 0 $51,200.0 0 $51,200.0 0 $23,800.0 0 Lan d Informatio n Acre s . 0.1 1 S F 5175. 0 Unit s 1. 0 Dept h 115. 0 Widt h 45. 0 Vacan t N o Improvemen t Info n rmatio Buildin g 1

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CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1540. 0 Perimete r 0. 0 Uni t Type :

Buil t As : 1 1/ 2 Stor y Fi n HVAC : Centra l Ai rt o Ai r Exterior : Fram e Stucc o Interior : Drywal l Roo f Cover : Compositio n Shingl e

Roo f Type : Gabl e Floorcover : Allowanc e Yea rBuil t Yea r Remodele d Percen t Remodele d Percen t Complete : 100.0 % Quality : Averag e Condition : Averag e Cond o Squar e Footage : 0. 0 Rooms : 7. 0

Units : 1. 0 Baths : 1. 0 Bedrooms : 3, 0 Stories : 1. 5 Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Adjuste d Yea r Buil t Physica l Ag e 191 9 0 % 191 9 9 1 Detai l Typ e Applianc e Basemen t Detai l Descriptio n Allowanc e Bsmn t Bloc k 8 f t Unit s 1. 0 928. 0 Fixtur e Fixtur e Additiona l Fixture s Bas e Fixture s 1. 0 1. 0 Fixtur e Porc h Use r Bat h Ful l Cvr d Woo d Dec k Se e Note s 1. 0 116. 0 1. 0

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