### PROPERT Y SUMMAR Y Date : 11/14/200 7 Omah aLea dSit e Remedia l Actio nContrac t #EP-R7-07-0 6 Mont hof : Novembe r Propert y Address : 42 0 N 4 0 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 : CONFIRMATIO N SAMPLIN GDATA/RESULTS : B 2 - 14 0 @ 8 " 

### 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 ndigita 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 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 .

# In 

# /0* 7

# f/• !*»-*•?-.. .

### Agreemen t t o allo w acces s t o 

## Ornah a Lea d th e propert yi n orde rt o conduct 

## Sit e Remedia l environmenta l samplin g an d t o remov e leacJ-contaminate d soi l 

# ^ A ctio n 

# A '"" " // ) Prudent Technologies , Inc . (Prudent ) i s under contrac t wit hth e U . S . Emironmenta l Protectio n Agenc y (EPA) t o clean u p lead-contaminate dsoil s at anumbe r o f propertie s locate di n Omaha , Nebraska , including th e property locate da t *i/J2f ) A / *~/f l «S Z ~ T . Th e EPA request s you r permissio n to allo w Prudent to performasoi l deaoup a t thi s propert y to remov e Icad-coctuQiicate dsoil B y signin g thi s form , th e propert y owner grant s permissio n t o Prudent t o perfor mactivitie s relate dt o th e cleanup includin g soi l sampling , remova l o f lead-contaminate dsoil , an drestoratio n o f th e reference d property . Afte r obtainin g th e owner' s .signatur e o n thi s form , Prudent Technologies , In c mi l contac t (h e yr . jperty owner (au dresidents ) withi n th e next fe w week s t o coordinat e performanc e th e wor k *' . 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 Prudent7 s ,-uiministrativ e Cler k

for th e Omah aLeadSit e cleanup , Ms . Cyndi e Bind s a t (402 ) 504-1004 . Genera l ijtiesnon s abou t th e 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 ) or (402) 991-958 3 (nort h Omah aoffice) . Propert y Acces s Grante dBy : _ Propert y Owne r Signature : (jSignaturiJ f / (Date ) PROPERT Y INFORMATIO N (T o b e completedb y residen t and'o r property owne r - pleaseprrat) RESIDEN T KAttE : 

## A RESIDEN T A D DRESS : 

# 3 n 

# A/_

— M U 

# _______ I F RENTAL . PROPERTYOWNE D B Y OWNER' S UAILW G ADDRESS ; /i j rf( ' OWNER' S TELEPHON E NUMBE R -HOME : $ V / < < AG E O F HOME? : / / YEARS . HO W LON G HAV E YO U LIVE D HERE ? ^ YEARS . HA S TH E EXTERIO R BEE N PAIHTE D O R COVERE D WIT H SDIN G SINC E 1378 ? ^ YE S _N O NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : /*j t _ MUM0E R O f OCCUPAHTS 7 YEAR S OL D AN D OLDE R NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLA YM TH t YAR D f Of t 5 HOW S O H UOK E PC H WEEK . COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS . ENTR YGATES . ETC. ) AUTHOR! T V FO RENVIRONMENTA LRESPONS EACTIONS ^ Th e activitie s t o b e implemente db y EP A unde r t^u s V- ' agreer^entarepunuflnttoSedicst i 104o f CSRCLA,42U.S.C . 9604 . EPA' s right o f acces s t o th e property h\ f ' proviaec t rc r i n secuo n 104<e > o r CERCLA , 42U.S . c 9003(e) , wnic hprovide s entr y fo r -determinin g d*ne« df c r respons e o r djoosin g o r takin g any respons ? atlioniiridertliistitli; , o r otherwis e eriforcingtri aprovision s o f thi e title. " 

# AUTHORITY :

# EP A Propert y Clos e Ou t Property* : Propert y Address : V3 o / V ViV A X/te*/ - Date/Time : "/ U Owner' s Name : 6f)fib>* » frtto c Quad s Excavated : Contracto r Grou p Pruden t Technologie s Excavatio n Genera l Ye s N o 1 .I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? v/ 2 .

I f necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? 

# s 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 nexcavate 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 ? 

# 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 ? 

### j 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 ) 

### s 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 ? 

## y Gates , Fence s an dRetainin g Wall s Ye s N o 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 ) 

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

# s 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 ? 

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

### S 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 ?



### . / 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 ? 

### L /

### 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 _A^ , Jj . _Date : ff

## 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 propert y owner' s signatur e indicate s that th e propert y owner 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 (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y ED : Property Address : (j ^ ^c D J ^ L I O^*^ ~ Owner : T 5 A- Q \^jA^ ^ ^\"V^C _ Phone : "$<-\\

- 5~5 ~ 3 < 

# - r / ?>°5 - -*W2- & Restoratio n Kern s i n Question :

Hem : ttem: Item : Item : Item : Item : Required correction s to complete th e property :



### LJ I agre e restoratio n i s completed , excep t a s note d above . L

J I d o not agre e restoratio n i s complete d

Owner' s Signatur e Dat e

# * hENTERED dM» » *fs/° *

### Prin t Previe w Pag e 1 o f 1 

# * •

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 224632000 0 RUCKE R ENTERPRIS E TRUS T 412N39S T OMAH A 6813 1

82 1 N 6 9 S T OMAH A N E 6813 2 Sec-Twn-Rn g Owne r Addres s Additio n Bloc k Lot Legal 1 Lega l 2 Lega l 3 Lega l 4 Assesso r Website Lin k 17-15-1 3

STEWAR T PLAC E 0 2 9 49X13 0

http://douglasne.mapping online.com/DouglasCoNe/static/accountinfo.jsp ? accountno=R224632000 0 Disclaime rMa p an d parce l dat a are believe d t o b e accurate , bu t accuracyi 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 6 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