### PROPERT Y SUMMAR Y Date : 09/25/200 7 | Omah aLea dSit e Remedia l Actio nContrac t #EP-R7-07-0 6 | Mont hof : Septembe r Propert y Address : 257 6 Manderso nS t A . EXECUTIV ESUMMAR Y A. I Issue s Encountered : Non e A. 2 Issue s Resolved : Re-See dwil l occu r i nOctobe r o nan 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 : Bl-192@6 " B2-180@6 " Easemen t 3 0 @ Scrap e ATTACHMENT S 1 ) Propert y sketc hprovide db y EP Apursuan 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 nlef t 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 no f area s no t meetin g Interi mRO D cleanu p criteria .
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### CHNOLOCIES , INC .

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## 3 Name : Omah a Lead Site 

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## ? * environmenta l samplin g an d t o Actio n \^v>//Avtfv.^ , remov e lead-contaminate d soi l Pruden t Technologies , Inc . (Prudent ) i s unde r contrac t withfh e U . S . Environmental 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 , includin g th e property locate dat ^) S 7£ > /D^>y-/^>-j^. ^ . Th e EP A request s you r permissio n t o allo w Pruden t t o perfor masoi l cleanu p at thi s property t o remov e lead-contaminate dsoi l 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 relate dt o fh e cleanu p includin g soi l sampling , remova l o f lead-contaminate dsoil , an drestoratio n o f fh e reference d property . Afte r obtainin g th e owner' s signatur e o n thi s form , Pruden t Technologies . Inc . will contac t fh e propert y owns ' (an dresidents ) withi n th e nex t fe w week s t o coordinat e performanc e fh e work . I f

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

fo r th e Omah aLea dSit e cleanup , Ms . Cyndi e Hind s at (402 ) 504-1004 . Genera ! question s abou t th e Omah aLea dSit e cleanup can b e directe dt o fh e EP A Publi c Informatio n Center s at (402) 731-304 5 (souf hOmah aofjic^o r (402 ) 991-958 3 (nort hOmah aoffice) . Property Acces s Grante dBy : (Pit i aPriniNnm» j

'' / // ­ ! - , / » S * / / / Propert y Owner Signatures , ^ (JSignatui* ) / ? (Date ) 

### PROPERT YINFORMATIO N (T o b e complete db y resident and/o r propert y owner - pleas e print ) RESDENTNAME : ^? j /•$ - QJwne rQente r RESIDEN TADDRESS : I F RENTAL.PROPERT YOWNE D BY : OWN E R' S HALIN G ADDRESS ; OWNER- S TELEPHON E NUMBE R - HOME : L\ V ^ _ \ WORK : J _ AG E O F HOttET : YEAR \ \OWJjM G HAV E YWtfVE D HERE ? YEARS . 

# \ HA S TH E EXTERIO R BEE N PAWTE D O R COVERED WFT H SB3IN G SWC E 1378 ? YE S N O 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 OLD E R NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLAYM TH E YAR D FO R 5 HOUR S O R MOR E P E R WEEK : _ COMMENT S O R SPECIA L INSTRUCTIONS : (LE . DOGS.ENTR YGATES.ETC 4 

### AUTHORIT YFO RENVIRONMENTA LRESPONS EACTIONS ; Th e activitie s t o b e implemente db y EP Aunde r thi s agreemen t ar e pursuant to Sectio n104 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f acces s to the propert y i s provide dfor i nSectio n104(e ) o f CERCLA , 4 2 U.S . C y605(e) , whic hprovide s entr y tor "determinin g the needfor response , or choosin g or takin g any respons e actio nunde r thi s title , or otherwis e enforcin g the provision s o f the titlo. "

# EP A Propert y Clos e Ou t Propert y # : 3 3 se n Propert y Address : 257 C Date/Time : spfit'jf . Owner' s Name : Job * Vos<. y Quad s Excavated : QJ _ Contracto r Grou p Pruden t Technologie s Excavatio nGenera l 

### Ye s 

### N o 1 .I f necessary, wer e th e correc t quadrants ) excavate dan drestored ? 

### i / 2.If necessary , wer e the correc t area s of dri p zon e excavate dandrestored ? 

### 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 

### S fro mth e house ? 

### 2 . Ha s so dbee nlai di nal l area s tha t wer e excavated ? 

# y 3 . Doe s th e so dappear t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte dat 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 nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte dat a3 0 day tim e period ) 

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

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

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

# s 2 .Wer e al l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (I f applicable ) 

# s 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 ) 

# / Foundation , Sidin g an dGutter s 

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### N o 1 .Wa s damag e t o th e sidin g o r tri mavoided ? 

# y 2 .

Wa s damag e t o th e foundatio navoided ? 

# c/ 3 .

Wa s damag e t o window s avoided ? 

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

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

# ( / Sidewalks an dDriveway s (Concrete ) Ye s N o 1 .Wa s damag e t o driveway surface s avoided ? 

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

### ( /

### 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 £L*yfiL + Date : 9//?// £7 • 

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# IvEP A PropertyCompletio n Agreemen t Thi s agreemen t document s th e completio no f remova l activitie s performe do nth e belo w liste dproperty . Th e propert y owner' s signatur e indicate s tha t th e properl y owne r i s satisfie dwit hth e restoratio no f th e subjec t property , an dtha t n o item s ar e i nquestion , now , o r a t an y tim e i nth 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 0) : Propert y Address : £<r—T / Owner : Phone : Restoratio n Item s i n Question :

Item : Item : Item : 

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



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j I agre e restoratio n i s completed , excep t a s note d above , d o no t agre e restoratio n i s complete d

Dat e

### Prin t Previe w Pag e i 0 1 i 

## 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 171509000 0 MOSLE YJOH N A 257 6 MANDERSO N S T OMAH A 6811 1
730 1 N 3 3 S T OMAH A N E 6811 2 Sec-Twn-Rn g Owne r Addres s Additio n Bloc k Lo t Lega l 1 Lega l 2 Lega l 3 Lega l 4 Assesso r Website Lin k 04-15-1 3

MARYSVILL E AD D 2 1 8 50X12 8

http://douglasne.mapping online.com/DouglasCoNe/static/accountinfo.jsp ? accountno = R 1 7 1 509000 0 Disclaime rMa p an d parce l dat a ar e 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 = 3 9 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 7Fin d Recor d 1 Clea n U p Quer yLea d Remainin g Quer y1 Propert yDamag e Que r YClos e 

### ampl e Area : 3273 0 - 257 6 MANDERSO N S T Owner : Resident : Contract :

._ | Owne rOccupie d Owne rName : 

### IMOSLEYJOHN A Owne rAddressl :
> ' Owne rAddress2 : J730 1 N 3 3 S T. V_City:^^-^ ^ JOMAH A Owne rPhone : |(402 ) 457-425 7

*+0 rI I 

# fjf a ­

State : Zi p Code : JN E [6811 2 Alternat e Phone :

j(402 ) 680-905 7 Residen t Name : VACAN TLOT Propert yAddress : 257 6 MANDERSO N S T Zi p Code : 6811 1 Residen t Phon e 1 ; : Contractor : PRUDENT200 7 Group : Assessment : Qualifyin g Grou p

j 80 0 Assessmen t XR F Date : Assessmen t Ma xXR F Value : 889.0 3 

# 0

### Pag e 1 o f 1

Creat e Anothe rTicke t Bac k t o Irt h Interne t Sen d Emai l 

### YOU RTICKE T NUMBE RI S 1846661 . Origina l Cal l Date : 7/20/0 7 Time : 1:5 2 p m Op : CYNDIE1896 7 Wor k t o Begi n Date : 7/24/0 7 Time : 2:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 257 6 Street : MANDERSO NS T Twp : 15 NRng : 13 E Sect-Qtr : 04-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : Soi l Excavatio n - Lea d Locatio n o f Work : LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)504-100 5 Compan y: PRUDEN T TECHNOLOGIE S Contac t Name : CYNDI E Phone : (402)504-100 4 Wor k Bein g Don e For : EP A Dept h o f Excavation : 13 " Ma x Corne r Lot : N Front : NRear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MUD0 1 OMAHACO F OPPDGPR 5 QLNNE1 C

Servic e Are a Contac t Phon e Numbe r Utilit y Typ e 

### Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C 

### HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUD0 1 METROPOLITA NUTILITIE S DISTRIC T EDWIN AAlt : 

### Emerg : 402504794 6 Day : 402444719 7 OMAHACO FCITYOFOMAHA-TRAFFIC,SEWE RRO NAlt : 402444516 1 

### Emerg : 402444516 0 Day : 406728934 3 OPPDGPR 5 OMAH APUBLI C POWE RDISTRIC T N A 

### Alt : 

### Emerg : 888728934 3 Day : 406728934 3 QLNNE1 C QWES T LOCA LNETWOR K N A 

### Alt : 

### Emerg : 888728934 3 http://www.dhon.org/irthinternet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS .. . 7/20/200 7