### PROPERT Y SUMMAR Y | Date ; 06/21/200 7 | Omah aLea dSite Remedia l Actio nContrac t #EP-R7-07-0 6 | Mont hof : Jun e | Propert y Address ; 206 6 N 1 8 S t A . EXECUTIV E SUMMARY A. I Issue s Encountered : Non e A. 2 Issue s Resolved : A. 3 Uniqu e Findings : A. 4 Othe r Relevan t Information : CONFIRMATIO N SAMPLIN GDATA/RESULTS : Fl-133@7 " F2-96@7 " Bl-372@7 " B2-124@7 " ATTACHMENT S 1 ) Property 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 nlef 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 nth e individua l propert y file , i f available , o r obtaine dinclude : i ) Pre-excavatio nagreemen t detail s (i f an y ar e mad e wit hth e propert y owner ) ii ) Excavatio ndigita 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 .

TECHNOLOGIES , INC .

# 6/O 7

• I

7/26/200 7 7/26/200 7Tota l Qua^H Squar e Footag e t o b e Excavate d = 928 5 Tota l OTPZon e Linea rFootapo t o b e Excavate d = 0

Legen d Nort h Arro w 

### Omah a Lead Site Concret e Omaha , Nebrask a 

# z a Excavate d Are a Propert yNumbe r ExlbUn g Stnjctur e Scal e OLS-5003 6

* * ;:'X'X * Fenc e Permanen t Landscapin g 20feetor 1 grld°Sx5t t Propert yAddress 2066N18S T

•TM ^ ~ —^^ —

QuBdjdri t Boundar y Stree t Boundar y 

# HG L F1 . F2 Pos t Excavatio n Concentration s (ppm ) B 2 PtayAre a D

Z Easement \>Tree/Shru b B 1 Garde n Othe r Descriptor ) o* postmcavaflo n area s R . ftontyardWHian d qiadrart ; F2 , ftont yar t rtgm-tan d quadrant ; B1 . tedcyar i totMandquadiant;B2,bacl!yanlrtgh»-hand<)iadnint DZ , dfl p zon e (1- 3 too t are a o Tsoi l aroun d ft * TounJatto n o f th e hou» X

# 50CX3 U Owne rName : Address : u[\f t 

### Omah aLead Site Sketc h Nort hArro w Phone : H : W : Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Firm : Sample s Collecte d RYASCPXA ­ F 1 pp m D Date : RYBSCPXA ­ F 2 pp m F T D 

### Time : ?•'/ ? RYCSCPXA ­ B 1 RYDSCPXA ­ B 2 pp m Sample s Analyze d RO^SC^PX AD Z pp m 

### D XR F Unit : ^ | Q Book : r ? f * ~ 7 p f * P vA

_ T\V^i—N—'W I ^" " f* . 7 ­ VJiZ ^ 

# n jo> . 

### -PZ ­ pp m D 

# n Time : "3'.2 O iv- v o f Sample s = !

Omah aLea dSit e 4613 0

## Agreemen t t o allo wacces s t o Omah a Lea d / $£* * \ th e propert yi n crcSe rt o conduc t Sit e Remedia l A c 

## tj o n 

## \ ^ V$KW' / •; • ' /ff 

## ^

f 

## ' ff f 

## v ­ environmenta l samplin g an d t o remov e lead-contaminate d soi l

'' V ..Y-."' - 

### Pruden t Technologies , Inc . (Prudent ) i s unde r contrac t withth e U . S/jEnvironniental Protectio n Agenc y (EPA ) t o clea n u p lead-contarninatecj^oil s a t anumber.o f propedj^locate di n Omaha , Nebraska , includin g th e propert y locate dat r~ ^ < & 6 2 6 ? / J , I rY *$ 4 • Tlle 

### EP A reques t you r permissio n t o allo w Pruden t t o perfor masoil cleanup at thi s propert y t o remov e lead-camsmirtatet i soil . B y signin g thi s form , th e propert y owne r grant s permissio n t o Pruden t t o perfor mactivitie s * elate dt o th t cleanu p includin g soi l sampling , remova l o f lead-contaminate dsoil , an drestoratio n o f th e reference d property . Aftfc f obtaining , th e owner' s signature o n thi s form . Pruden t Technologies . Lie . wil l contac t tlc.. e proper^ ' owne r (an dresidents ) withi n th e nex t fe w week s t o coordinat e performanc e th e v-ork . I f

yo u hav e an y QTiestion s abou t th e soi l cleanu p planne dfo r you r property , pleas e contac t Pmdeni' s Aamtnisiranv e Cler k fo r m e Omah aLea dSir e cleanup , Ms . Cynai e Hind s a t (402 ) 50s-iOC ^ Gene : era l question s abou t th e Omah aLea dSit e cleanu p can b e directe dt o th e EP A Publi c Information . Center s at 'T^

I - t

-t/\j i r t

t \/~ i 4 iv * \/ ji/v ^ • » i*\r\i H r \£rv~ > / j i -~ \« rv » i 

### /J1--1U4 J vsoimi uman e ornce ; o r IMVZ ; yyi-yjo j (nor mUmah aoffice; . Property Acces s Grante dBy . 

# A . Propetty Owne r Signature : 

## PROPERT Y INFORMATIO N (T o b e complete db y residen t and/o r propsrij 1 

### owne r - - pleas e pritif) RESIDEN T NAME : RESIDEN TADDRESS : I P RENTAL . PROPERT YOWNE D BY : OWNER' S MAILIN G ADDRESS ; OWNER' S TELEPHON E NUMBE R -HOME : ( ) WORK : J _ AG E O F HOME? : YEARS . HO W LON G HAV E YO U LIVE D HERE ? 

### HA S TH EEXTERIO RBEE NPAINTE D O RCOVERE D WIT HS!3l?i C S'.UC E1573 ? YE S NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDE R NUHBE R O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLA Yi) J 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 . DOCS . FNTF. YGATF.S , FTC. ; 

### AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS , Th ; activitie s ^ o b ? impis-ne ^ b y EP A - ^ ±i . agrssna u are puraiari t t o Sectio n 10 4 o f CSRCLA , 4 2 U . S . C P604 . EPA ' Ensh r o f acc« s t o tli e properp.' ; i preside dfa " i nStcticn ^ lC4(e ) o f CEECLA , 42U.S . C 9t05:5) , v;-hichprc^id^ i s-;ti y for"d^ts^:--.:: ^ 'J-. ? .-.;•; : f : 'isa, or dvoosiri g a - taldn s ar^ ' respons e acliori unds r ti\. i litis . or ott.err.'ii e •iri.forci:' ^ f



### J « ^roviiia:' ^ .; : ii. r

# EP A Propert y Clos e Ou t For m Propert y # : _ Propert y Address : 

### lae c / v Date/Time : J un , y/ i Owner' s Name : OmnH * Quad s Excavated : P L Contracto r Grou p Excavatio n Genera l Ye s N o 1 .I f necessary , wer e th e correc t quadrant(s ) 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 ? 

# y Gradin g So dan dVegetatio n 

### Ye s N o 

## 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 

### S fro mth e house ? 2 . Ha s so dbee n lai di n al l area s tha t wer e excavated ? 

### S 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 ? 

### t / 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 ) 

### / 6 . Wa s th e property grade dsuc htha t wate r wil l no t poo l o n th e property ? 

### « / 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 N o I.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 ) 

# y 3 .Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) 

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

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

### ,/ 

### 2.Was damag e to the foundatio navoided ? i/ 3 .Wa s damag e t o window s avoided ? 

### « / 4 .Wa s damag e t o window s o r door screen s avoided ? c / 5 .Wa s damag e t o downspout s o r downspou t extension s avoided ? 

# ( / Sidewalk s an dDriveway s (Concrete ) Ye s N o 

### 1 .Wa s damag e t o drivewa y surface s avoided ? 

# i / 2 .Wa s damag e t o walkwa y surface s avoided ? 

# (/

### Owner s comments :

Inspectio nnotes :

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

## LC.V- - Tota l Qua^ B Squar e Footag e t o b e Excavate d = 928 5 TQtajWzon e Linea rFoota fl e t o b e Excavate d = 0 PropertyClassification : 80 0



## u x - X : i 

### v) J

Legen d Nort h Arro w Concret e Excavate d Are a Existin g Structur e 

# iza Scal e Fenc e 1 Inc h = 2 0 fee t o r1 gri d = 5 x5 f t Permanen t Landscapin g

——— Quadran t Boundar y Stree t Boundar y 

# i • Tree/Shru b 

### Omah a Lea d Sit e Omaha , Nebrask a Propert yNumbe r OLS-5003 6 Propert yAddres s 2066N18S T Post Excavatio n Cor^pentration s (ppm ) F 1 ±Z2.^ p 1 " B 2 iZ^ffi l PlayAre a F2 ^L ( S 1 vD Z Easemen t B 1 "V ? •> ( a 7 " Garde n Othe r Descriptio n of pos t excavatio n areas : F1 , fron t yar d left-ran d quadrant F2 , fron t yar d right-han d quad n DZ , dn p zon e (1- 3 foo t are a o f soi l aroun d th e foundatio n o f th e house) .uar e Footag e t o b e Excavate d = 928 5 Linea rFootag e t o b e Excavate d = 0



## u o i P C 

# J o

en d Concrete Excavate d Are a IMBI Existin g Structur e • * • Fenc e J5& J Rermanen t Landscapin g

——— Quadran t Boundar y Street Boundar y \j ) Tree/Shru b Nort h Arro w

Scal e 1 Inch = 2 0 fee t o r1 gri d = 5 x5 n F1 . F 2 B 1 

### f 

# vHJ5 L Omah a Lea d Sit e Omaha , Nebraska PropertyNumbe r

OLS-5003 6 Propert yAddres s 2066N18S T Post Excavatio n Concentration s (ppm ) B 2 Pla yAre a DZ Easemen t Garde n Othe r Descriptio n o f pos t excavatio n areas : F1 , fron t yar d left-han d quadrant ; F2 , fron t yar d right-han d quadrant ; B1 , backyar d left-han d quadrant ; B2 , backyar d right-han d quadran t DZ , dri p zon e (1-3 foo t are a o f soi l aroun d th e foundatio n o f th e house) .

# SEP A Propert yCompletio n Agreemen t Thi s agreement document s th e completio n o f removal activitie s performe do n th e belo w liste dproperty . Th e property owner' s signatur e indicate s tha t th e property owne r i s satisfie dwit hth e restoration 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 so dwarranty (9 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y ED : Propert y Address : £ n( 

### ( Owner : f \\< g Phone : ' Q^O ^ ­ H M H ­ ^ > \% 0 Restoratio n Item s i n Question :



### Item : Item : Item : Item : Item : 

### Item : Require d correction s t o complete th e property :

i agre e restoratio n i s completed , except a s note d above . L

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



# ^ PL , ^ Owner' s Signatur e f l / / DateFind Recor d Clea n U p Quer y Lead Remainin g Quer yPropert yDamag e Quer y 

### Sampl e Area : 5003 6 - 206 6 N 1 8 S T Owner : Resident : Contract : C H Owne rOccupie d Owne rName : 

## ICIT YO F OMAH A Owne rAddres s 1 : |C/

O JAME S THEL E CIT Y PLANNIN G Owne rAddress2 : |1819FARNAMST#111 1 City : State : Zi p Code : OMAH A|N E |6818 3 Owne rPhone : Alternat e Phone : |(402 ) 441-515 0 | Residen t Name : VACAN TLOT Propert yAddress : 206 6 N 1 8 ST Zi p Code : Residen t Phon e Contractor : PRUDENT200 7 Group : Assessment : Qualifyin g Grou p |80 0 Assessmen t XR F Date : Assessmen t MaxXR F Value : 944.7 8