### PROPERT Y SUMMAR Y IDate : 11/28/200 7 \Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 | Mont hof : Novembe r fPropert y Address ; 432 6 N 3 9 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 : Ma p Erro r o n fenc e line . Marke do n a s buil t CONFIRMATIO N SAMPLIN GDATA/RESULTS : 

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### ATTACHMENT S 1 ) Propert y sketc hprovide 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 ndigita 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 nleft behin darea s vi ) Contracto r identificatio n iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e include di nth 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 hth e propert y owner ) ii ) Excavatio n digita l vide o i nMPEG , WM V (Window s Medi aVideo ) o r SW F(Flas hPlayer ) 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 .

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### dS it e Owne rName : WILLI E HOLME S
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## Omah a Lea d / ,$£ & V th e prope.i yi n orde rt o conduct Sit e Remedia l | \jvP v? environmenta l samplin g an d t o Actio n \*fo**mr-_ > remov e lead-contaminate d soi l Pruden t Technologies , Inc . (Prudent) i s unde r contrac t wit h di e 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 fe e properl y locate da t H^ZA , S > 3 * T ^ Th e EPA request s your permissio n to allo w Pruden t to perfor ma:;oi l cleanup a t thi s properl y to remov e lead
- contaminate dsoi l B y signing mi s form , me property owne r grant s permissio n to Prudent to perfor mactivitie s relate dto me cleanup includin g soil sampling , removal o f lead-contaminate dsoil , an drestoratio n o f me reference d property . Afte r obtainin g me owner' s signatur e o n mi s form , Prudent Technologies , Inc . will contac t me properl y owne r (an dresidents ) withi n m e nex t fe w week s t o coordinate performanc e m e work . I f

yo u hav e an y question s abou t th e soil cleanu p planne dfo r you r property , pleas e contac t Prudent ' s Administrativ e Cler k

fo r me Omah aLea dSit e cleanup , Ms . Cyndi e Hind s a t (402) 504-1004 . General question s abou t me Omah aLeadSit e cleanup can b e directe dto me EPA Publi c Informatio n Center s a t (402) 731-3045 (sout h Omah aoffice ) or ('102 ) 991-958 3 (nort h Omah aoffice) . Property Acces s Grante dBy : O A ^- " Property Owne r Signature: ' (Signature ) (Date ) PROPERT Y INFORMATIO N (T o b e complete db y residen t and/v property owne r - pleas e print } RESBEMTHAME : Ovg- O \\o\rvN4' ^ rj^wne rQente r RESDEHTADDRESS : A2 > 3.f e M _,c f ^ 6 t ^

7*Ln . ^ 9 ( \ f RENTAL.PROPERT YOWNE D BY : " ~ OWNER' S MAILM G ADDRESS ; M ? > 2-. k K J '3 > ^ ^ ^

QjTA.^Xf rK KC < £ \ \ OWNER' S TEL E PHON E NUMBER-HOME : L^& l ^ ' S 3 ~ \ 4 H " f WORK : _ i ^G^ l 33 3 - c i c i^' i AG E O F HOME?:'^22_

_YEARS . HO W LON G HAV E YO U LWE D HERE ? 1 { 5 YEARS . HA S TH E EXTERIO R BEE N PANTE D O R COV E RE D WITH SDMGSMC E 1978 ? _J^YE S N O NUMBE R O F OCCUPANT S UNDER ? YEAR S OLD : D NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDE R _ NUMBE R O F CHILDRE N UNDE R 7 Y E AR S OL D W H 0 PLAY M TH E YAR D FO R S HOUR S O R MOR E P E R WEEK : _ COMMENT S O R SPECIALMSTRUCTiONS : (I f .DGGS.ENTR Y GATES.ETC. ) K 3 ° AUTHORIT Y FO RENVIRONMENTA LRESPONSEACTIONS : Th e activitie s to b e implemente db y EPA under thi s agreemen t ar e pursuant t

o Sectio n 104 o f CERCLA , 4 2 U.S.C . 9604 . HlA' s righ t o f acces s t o the properly i s provide dfor in Section 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entr y fe r "detemiinin g the needfor response , or choosin g or takin g any respons e actio n tinder thi s title , or otherwis e enforcin g the provision s o f the title "

# &EP A EP A Propert y Clos e Ou t / V Date/Time : Owner' s Name : £./£< , Quad s Excavated : f 2
- Contracto r Grou p Pruden t Technologie s Propert y # : Propert y Address :

Excavatio n Genera l Ye s 1 .I f necessary , wer e th e correc t quadrants ) excavate dan drestored ? S 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 dappear 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 firman 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 

# s tim e period ) 6 . Wa s th e propert y grade dsuc htha 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 ) 

# s 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 ? 

### S 2 .Wa s damag e t o th e foundatio n avoided ? 

# s 3 .Wa s damag e t o window s avoided ? 

# J 4 .

Wa s damag e t o window s o r doo r screen s avoided ? 

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

# s Sidewalk s an dDriveway s (Concrete ) Ye s 1 .Wa s damag e t o drivewa y surface s avoided ? / 2 . Wa s damag e t o walkwa y surface s avoided ? 

### SN o

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### Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complet e includin g th e 30-day so dwarranty : EPA Representativ e ^ , & ~ Date: _

## AGREEMEN T AN D RELEAS E FO R RESTORATIO NO F REAL PROPERT Y Thi s Agreement an dReleas e (hereinafte r Agreement ) i s entere dinto b y an dbetween , Cle o Holme s (hereinafte r Propert y Owner ) an dth e Unite dState s Environmenta l Protectio n Agenc y (hereinafte r EPA) . WHEREAS , th e property locate dat 432 6 N 3 9 Stree t (hereinafte r th e Property) , mor e specificall y describe dbelow , i s owne db y Cle o Holmes ; WHEREAS , EP A throug hsamplin g an danalysi s ha s discovere dth e Propert y wa s contaminate dwit hlead ; WHEREAS , th e EP A performe daremova l actio n an dremove dth e contaminate dsoil s fro mth e property an dbackfille dth e formerl y contaminate darea s wit hclean fil l the n sodde d and/o r seededth e described , effecte dproperty ;

WHEREAS , th e Property currentl y require s alimite damoun t o f restoratio n wor k t o return th e Propert y t o it s original conditio n prio r t o initiatio n o f EPA' s respons e activities , o r a s nearl y a s possibl e t o it s origina l condition ; NO WTHEREFORE , i n consideratio n o f th e mutua l covenants , promise s an dcondition s an dterm s t o b e kep t an dperforme da s recite dherein , th e partie s heret o agre e a s follows : 1 . Th e real property whic hi s th e subjec t o f thi s agreemen t i s owne db y Cle o Holme s an d i s more specificall y describe da s follows : LOOMI S 2N D SU B DI V LO T 6 BLOC K2 4 0 X 13 3 

### 2 . Th e EP A wil l complet e th e followin g restoratio n items : Pay $22 0 i n lie u o f purchasin g an dreplantin g plant s an dreimbursemen t o f water . 3 . Th e Propert y Owne r acknowledge s tha t EP A shal l hav e n o responsibilit y fo r furthe r restoratio n work a t th e Property . 4 . Th e Property Owne r release s th e Unite dState s an dth e EP A fro man y an dal l claim s arisin g ou t o f o r connecte dwith , directl y o r indirectly , thei r abilit y t o inhabit , occupy , use , transfer , o r

sel l th e real o r persona l property at 432 6 N 3 9 Stree t an dth e reimbursements , compensation , payments , costs , expenses , an dany inconvenience s o r damage s relatin g to th e foregoin g an dth e cleanup , decontamination , disposa l an drestoratio n o f th e Property , includin g an y claim s unde r th e

### Unifor mRelocatio n Assistanc e an dReal Propert y Acquisitio n Policie s Act , 4 2 U.S.C. , Sectio n 460 1 et . 

### seq . 5 . Th e Property Owner affirm s tha t he/sh e i s th e lega l owne r o f th e propert y at 432 6 N 3 9 Street . Thi s agreement i s entere dint o an dmad e effectiv e th e /9 day o f flfaau»L+ L2007 . FO RTH E PROPERT Y OWNE R

Dat e FO RTH E UNITE D STATE S ENVIRONMENTA LPROTECTIO N AGENC Y

Date U.S . EP A Regio n VI I

naye2o<j > 2

## 1713 2 PRUDEN T TECHNOLOGIES , FIRS T NATIONA L BAWTO F OLATH E 83-172/101 0 808 0 WAR D PARKWAY , SUIT E 40 5 KANSA S CITY . M O 6411 4 (816 ) 363-370 3



# i:iOiODi?soi :
PRUDEN T TECHNOLOGIES , INC . 

## 1713 2

PRUDEN T TECHNOLOGIES , INC . 1713 2

# oEP A PropertyCompletio 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 property owner' s signatur e indicates ; tha t th e propert y owne r i s satisfie dwit hth 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 dgrowthguarantee ) excep t thos e item s liste dbelow , 

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Item : Item : Item : Item : Item : Item : Require d correction s t o complet e th e property :



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

Owner' s Signatur e Dat eFin d Record j dea n U p Quer yLead Remainin g Quer y{ Propert yDamag e Quer yClos e j 

### ampl e Area : 3407 3 - 432 6 N 3 9 S T Owner : Resident : Contract : n Owne rOccupie d Owne rName : HOLME S WILLI E Owne rAddressl : Owne rAddress2 : 432 6 N 3 9 S T City : OMAH A Owne rPhone : |(402 ) 453-164 9 State : Zi p Code : |N E |6811 1 Alternat e Phone :

|(402 ) 829-452 4 

### Residen t Name : 

## [HOLME S WILLI E Propert yAddress : J432 6 N 3 9 S T Zi p Code : J6811 1 Residen t Phon e 1 I ; '•

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## ; 1 Contractor : PRUDENT200 7 Group :

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## SO D Assessmen t XR F Date :

Assessmen t Ma xXR F Value: 890.9 4ENVIRONMENTA L & CONSTRUCTIO N TECHNOLOGIES , INC SERVICE S 

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## Signature o f th e Reportin g Staf f Membe r 80B O War d Parkway , Suite 40 5 250 5 N . 24 * Streot , Suite 30 8 424 2 Medica l Drive . Suite 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 ) 504-1004 Phone : (210)822-958 8 Co. - (Ai d Fax : (402)504-100 5 Fax : (210 ) 579-6677

# 1 ENTERED 3407 3 Exterio rPain t Nort h Arro w 

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## Dougla s County-Omaha , N E

Parce l I D Owne r Nam e Propert y Addres s Cit y Zi p Owne r Addres s Owne r Addres s 2 Owne rCit y Owne r Stat e Owne rZi p 163669000 0 HOLME S WILLI E 432 6 N 3 9 S T OMAH A 6811 1

432 6 N 3 9 S T OMAH A N E 6811 1 Sec-Twn-Rn g Owne r Addres s Additio n Block Lot Lega l 1 Lega l 2 Lega l 3 Lega l 4 Assesso r Website Lin k 05-15-1 3
LOOMI S 2N D SU B DI V 2 6 40X13 3

http://douglasne.mapping online.com/DouglasCoNe/static/accountinfo.jsp ? accountno=R 1 63669000 0 Disclaimer. Ma p an d parce l dat a are believe d t o b e accurate , bu t accurac yi s not 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

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