### PROPERT Y SUMMAR Y Date : 11/26/200 7 Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 Mont h of : Novembe r Propert y Address : 421 5 Davenpor t S t A . EXECUTIV E SUMMAR Y A. I Issue s Encountered : Non e A. 2 Issue s Resolved : Re-See dwil l occu r i n Novembe r o n an y dea dspot s t o encourag e sprin g growth . A. 3 Uniqu e Findings : A. 4 Othe r Relevan t Information : Bushe s i n F l denie dacces s - 49 6 @ scrap e CONFIRMATIO N SAMPLIN G DATA/RESULTS : F l - 7 8 @ 8 " 

### E l - 2 9 @ scrap e B 2 - 6 1 @ 6 " 

### ATTACHMENT S 1 ) Propert y sketc h provide db y EP A pursuan t t o contrac t specification s 2 ) Signe dAcces s Agreemen t includin g acces s agreement s require dfo r crossin g othe r propertie s 3 ) Pre-Excavatio n digita l vide o clip/photograph s 4 ) Post-Excavatio n digita l vide o clip/photograph s 5 ) Documentatio n - Complete dClose-ou t Checklis t 6 ) As-Buil t sketc h ­ i ) Shal l includ e fina l lea dlevel s v ) Legen d ii ) Contaminatio n lef t behin darea s vi ) Contracto r identificatio n iii ) Property addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e include di n th e individua l propert y file , i f available , o r obtaine dinclude : i ) Pre-excavatio n agreemen t detail s (i f an y ar e mad e wit h th e propert y owner ) ii ) Excavatio n digita l vide o i n MPEG , WM V (Window s Medi aVideo ) o r SW F(Flas h Player ) forma t and/o r photograph s iii ) Signe dfor mverifyin g satisfactor y restoratio n iv ) Descriptio n o f area s no t meetin g Interi mRO D cleanu p criteria .

4028582 2 

### HNOLOCIES , INC . 

# Illlllll l Superfun do ? 

## 2318 2

Omah aLeadSit e 4613 0

# 2318 2 Omah a Lea a sit e Exterio rPain t Owne rName : GREGOR Y L SCHANEMA N Goo d 

### Sit e Sketc h Address : 421 5 DAVENPOR T S T Poo r o t Pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r Concentratio n Collecte d Firm : A £ t RYASCPXA-2318 2 Date : I O I \ I RYBSCPXA-2318 2 RYCSCPXA-2318 2 Sample s Analyze d RYDSCPXA-2318 2 RDZSCPXA-2318 2 XR F Unit : & ^' 2

- Book : 

### , 1 if f RPZSCPXA.2318 ? Numbe ro f Sample s = 

# NTERE5 D OC Tn 5 200 4

Omah aLea dSit e 4613 0

## vvr - « „ Agreemfl^tt o aHo w acces s t o (T

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## 3. ' dOf e v th e properl y i n orde r t o conduc t Sit e Remedia l £ \^B?/ f 

## * environmenta l samplin g an d t o Actio n vdiwtfrtfr- ^

remove lead-contaminate d soi l Prudent Technologies , Inc . (Prodenf ) i s under contrac t wit the U . S . Environmenta l Protectio n Agenc y (EPA) to dea n up lead-contaminate dsoil s a t anumbe r o f propertie s locate di n Omaha , Nebraska , includin g me propert y locate da t <r~?/- 5 bAV/mfaf r

S ~ T Th e EP A request s your permission t o allow Prudent t

o performasoi l cleanu p a t thi s propert y t o remov e lead-contaminate dsoil B y signing mi s form , me propert y owner granb permissio n to Prudent to perfor mactivitie s relate dto me cleanu p includin g soi l sampling , remova l o f lead-contaminate dsoil , an drestoratio n o f me reference d property . Afte r obtainin g th e owner' s signature o n ftu s form , Pnident Technologies , Inc . will contac t th e propert y owner (an dresident! ) withi n me nex t fe w week s to coordinat e performanc e me wor k I f

yo u hav e any question s abou t th e soi l cleanup planne dfo r your property , pleas e contact Piudenf s Administrativ e Cler k

for m e Omah aLea dSit e cleanup , Ms . Cyndi e Hind s a t (402) 504-1004 : Genera l question s about me Omah aLea dSit e cleanu p ca n b e directe dto th e EPA Publi c Informatio n Center s a t (402) 731-304 5 (sout h Omah aoffice ) o r (402 ) 991-9583 (nort h Omah aoffice) . Propert y Acces s Grante dBy : V Q /" * a*S>£jlr \a/ i e T \Q x\ ^ <?!»•» MntNom* )

. I / I / 

### Propert y Owne r Signature : (Date ) 

### PROPERT Y INFORMATIO N 

### (T o b e completedb y readeot and/o r properl y owne r - pleas e prin ) RESDEHTNAME : • QJwne rQente r RESDEN T ADDRESS : - _ f RENTAL.PROPERT Y OWNE D BY : OWN E R- S MALH G ADDRESS ; OWNER' S TELEPHON E NUMBER-HOME : jt__J WORK : _ ( AG E OFHOME rO—> YEARS . HO W LON G HAV E YO U LIVE D HERE ? 7 HA S TH E EXTERIO RBEE N PANTE D O RCOVERE D WITH SDM G SMC E 1978 ? NUMBE RO FOCCUPANT S UNDER 7 YEAR S OLD : NUMBE RO FOCCUPANT S 7 YEAR S OL D AN D OLDER . NUMBE RO FCHILDRE N UNDE R7 Y E AR S OL D WH O PLA Y M TH E YAR D FO RS HOUR S O RMOR E P E RWEEK : _ COMMENT S O RSPECIA L MSTRUCTIONS : (1£ . DOGS.ENTR Y GATES . 

### AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS ; Th e activitie s to b e implemente db y EPA under thi s agreemen t ar e pursuant t

o Sedtic n 10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f acces 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 "determining the needfo r response , or choosin g or takin g an y respons e actio n under thi s title , or otherwis e enforcin g the provision s o f the title. "

# vvEPA EP A Propert y Clos e Ou t Propert y # : Propert y Address : Date/Time : Owner' s Name : ,/,/r/ r ffef f ^

^ ^ '' " Quad s Excavated : Contracto r Grou p Pruden t Technologie s Excavatio n Genera l Ye s 1 .I f necessary , were th e correc t quadrant(s ) excavate dan drestored ? / 2 .I f necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? 

### / Gradin g So dan dVegetatio n Ye s 

## 1 . Doe s th e gradin g aroun dth e perimete r o f

th e hous e i n excavate darea s generall y slop e awa y fro mth e house ? •­ 2 . Ha s so dbee n lai di n al l area s tha t wer e excavated ? ^ 3 . Doe s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period ) 

### ^ 4 . Ar e sodde darea s generall y fir man devenl y graded ? 

### S 5 . Ar e th e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period ) IS * 6 . Wa s th e propert y grade dsuc h tha t wate r wil l no t poo l o n th e property ? 

### S 7 . Wa s damag e t o landscapin g o r plan t material s avoided ? 

### ^ Gates , Fence s an dRetainin g Wall s Ye s 1 .D o gate s ope n an dclos e freely ? (I f applicable ) 

### i / 2 .

Wer e al l gate s o r fence s take n dow n durin g restoratio n activitie s reinstalled ? (I f applicable ) 

### , / 3 .

Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) 

### S 4 .Wa s damag e t o retainin g wall s avoided ? (I f applicable ) 

### S Foundation , Sidin g an dGutter s Ye s 1 .Wa s damag e t o th e sidin g o r tri mavoided ? / 2 .

Wa s damag e t o th e foundatio n avoided ? 

### ( / 3 .

Wa s damag e t o window s avoided ? 

### / 4 .Wa s damag e t o window s o r doo r screen s avoided ? 

# y 5 . Wa s damag e t o downspout s o r downspou t extension s avoided ? 

# / Sidewalk s an dDriveway s (Concrete ) Ye s 1 .Wa s damag e t o drivewa y surface s avoided ? 

### S 2 .

Wa s damag e t o walkwa y surface s avoided ? 

### \ S N o

N o

N o

N o

N o

### Owner s comments :

Inspectio n notes :



### Remova l an drestoratio n activate s complet e includin g th e 30-da y so dwarranty : EP A Representativ e ^jG L _ Date :

## 1318 2 Exterio rPain t 

### Omah a Lead Site Owne rName : GREGOR Y L SCHANEMA N Goo d 

### Sit e Sketc h Address : 421 5 DAVENPORT S T Poo r Phone : J * w = o t pain t Lead Sampl e Sample s Collecte d Sampl e Numbe r Concentratio n Collecte d Firm : / £ M / RYASCPXA-2318 2 Date : I P l \ RYBSCPXA-2318 2 Time : 1 O - O O RYCSCPXA-2318 2 Sample s Analyze d RYDSCPXA-2318 2 RDZSCPXA-2318 2 XR F Unit : I" 2

- Book : Date : Time : Staff : Numbe ro f Sample s = 

## OC Tn 5 200 4

Omah aLea dSite f i £CAJ>J)A ­ ** - /

## Propert y Completio n Agreemen t Thi s agreemen t document s th e completio n o f remova l activitie s performe do n th e belo w liste dproperty . Th e propert y owner' s signatur e indicate s tha t th e propert y owne r i s satisfie dwit h th e restoratio n o f th e subjec t property , an dtha t n o item s ar e i n question , now , o r a t an y tim e i n th e future , excludin g an y remainin g warrant y (9 0 day s overall , 3 0 day s o n so dgrowt h guarantee ) excep t thos e item s liste dbelow , 

### i f



### any . Propert y ID : ^3/^J J Propert y Address : £ . 

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# >$-it/a 3 Restoratio n Item s i n Question :

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### I I d o no t agre e restoratio n i s complete d

Owner' s Signatur e Dat e 

### IName : 

### Date : ///O 

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# * £Fin d Record Clea n U p Quer y Lea d Remainin g Quer y 

### Sampl e Area : 2318 2 - 421 5 DAVENPOR T S T Owner : J Owne rOccupie d Owne rName : SCHANEMA N GREGOR Y L Owne rAddressl : Owne rAddress2 : 505N41AVE# 2 Resident : 1 : 1 j \ Residen t Name : ! j ' TENANT S Property Address : 421 5 DAVENPOR T S T Zi p Code : | 6813 1 Residen t Phon e City : State : Zi p Code : OMAH A |N E (6813 1 Owne rPhone : Alternat e Phone : j 

### \(AQ2 ) 850-035 0



## 3 PropertyDamag e Quer y Clos e

Contract : ! Contractor : PRUDENT200 7 Group : Assessment : Qualifyin g Grou p 80 0 Assessmen t XR F Date : Assessmen t Ma xXR F Value : 915.1 3 

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# • * Dougla s County-Omaha , N E

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2 VA C ALLE Y & E 1/ 2 L T 2 0 & E 2 5 N 3 1 . 2 FT LT 1 9 & W 3 3 E 5 8 N 1 0 FTLT1 9 http://douglasne.mapping online.com/DouglasCoNe/static/accountinfo.jsp ? accountno=R 1 4453 1 000 0 Disclaimer: Ma p an d parce l dat a are believe d t o b e accurate , bu t accuracy i s no t Ma p Scal e guaranteed . Thi s i s no t a lega l documen t an d shoul d no t b e substitute d fo ra titl e search , 1 inc h = 2 7 fee t appraisal , survey , o rfo rzonin g verification . 

### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 7/16/200 7