### PROPERT Y SUMMAR Y Date : 09/24/200 7 Omah aLea dSite Remedia l Actio n Contrac t #EP-R7-07-0 6 | Mont hof : Septembe r Propert y Address : 256 9 Evan s 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 : E l - 2 6 @ scrap e D l - 13 2 @ 13 " 

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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 . Superfun d 

### TECHNOLOGIES , INC .Name : Omah a Lea d Sit e Date : Nort h Arro w Address : Site Sketc h Time : Phone : Tea m ) BV1D # XR F Cod e Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e 

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## * environmenta l samplin g an d to Actio n \*m$i»r-j > remov e lead-contaminate d soi l Prudent Technologies , Inc . (Pruden $ is under contrac t wif e

me U. S. Environmenta l Protectio n Agenc y (EPA) to clea n

up lead-contaminate dsoil s at anumbe r of propertie s locate d in Omaha , Nebraska , includin g me properl y locate d at t?^SC=> c l £\>-<^vvJ L&*~ ~ Th e EP A request s your permissio n to allo w Pruden t to performasoi l cleanupat thi s propert yto remov e lead-contaminate dsoi l By signin g mi s form , me property owne r grant s permissio n to Prudent to perfor mactivitie s relate d to me cleanup includin g soi l sampling , removal of lead-contaminate dsoil , an d restoratio n of di e reference d property . Afte r obtainin gme owner' s signatur e

on mi s form , Pruden t Technologies , Inc . will contac t me property owne r (an dresidents ) withi n th e nex t fe w week s to coordinat e performanc eme work . If

yo u hav e any question s abou t me soi l cleanup planne dfo r you r property , pleas e contac t Prudent' s Administrativ e Cler k

for me Omah a LeadSit e cleanup , Ms . Cyndi e Hind s at (402) 504-1004 . General question s abou t me Omah aLeadSit e cleanu p ca n

be directed to me EPA Publi c Informatio n Center s at (402)731-304 5 (sout h Omah aoffice ) or (402 ) 991-958 3 (nort h Omah aoffice) . Propert y Acces s Grante dBy : CPUa»PrintNBm. ) Property Owne r Signature : 

# *1 S (Data) \ " PROPERT Y INFORMATIO N 

### (T o be complete d by residen t and/o r property owne r - pleas e prirt ) "F e>run> >run> ^ ^

> ^ RESDENTNAME : 'uViv i ^ A QMfne rQente r i i p -^ 1 RESPEM T ADDRESS : rCl^/C ^ g \ J ^Y\ A

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\ f RENTAL . PROPERT Y OWNE D BY : 

### OWNER-SHALM G ADDRESS : rQS£>< 3 C^if^yv ^ R\ - Qtnr>ALo ^ t^>g - (3 '$ \\ \ OWNER' S TELEPHON E NUMBE R -HOME : I^°^ l M S! ^ " Q I 5 ^ WORK : I I _ AG E OF HOME? : _£;f

_YEARS . HO W LON G HAV E YO U LB/E D HERE ? . YEARS . HA S TH E EXTERIO R BEE N PAMTE D OR COVERE D WITH SDM6SMC E 1978 ? _J^^E S _ NO NUMBE R OF OCCUPANTS UND E R 7 YEAR S OLD : 4$ D NUMBE R OF OCCUPANT S 7 YE AR S OL D AN D OLD E R I NUMBE R OF CHILDRE N UNDE R 7 YEAR S OL D WH O PLA Y M TH E YAR D FO R S HOUR SOR MOR E PE R WEEK : QCOMM E NT S OR SPECIA L WSTRUCTIONS : (LE . DOGS . ENTR Y GATES . ETC. ) V\ 0 WC 

### AUTHORIT Y FO R ENVIRONMENTA LRESPONS EACTIONS : Th e activitie s tobe inqriemente d by EPA under thi s agreemen t ar e pursuant to Sectio n 104ofCERCLA,42U.S.C . 9604 . EPA'srigh t of acces sto the propert y

is provide dfor inSection 104{e )of CERCLA , 42 U.S . C 960S(e) , whic hprovide s entr y fi r "determining the needfor response , or choosin g

or takin g an y respons e action unde r thi s title , or otherwis e enforcin g the provision sof the title "

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# EP A Propert y Clos e Ou t For m Propert y # : nsz t Date/Time : .£,„ / Quad s Excavated : Q L . 20 0 7 f 03 - rG Propert y Address : Owner' s Name : Contracto rGrou p Excavatio n Genera l Ye s N o 1 . 2 . Gradin g 

### 1 . 2 . 3 . 

### 4 . 5 . 6 . 7 . I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 

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

### ^ So dan dVegetatio n 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 ? Ye s 

### < /

N o Ha s so dbee n lai di n al l area s tha t wer e excavated ? Doe s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte dat a3 0 day tim e period ) 

### ^ t ^ Ar e sodde darea s generall y firman devenl y graded ? 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 ) 

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

### ^ Wa s damag e t o landscapin g o r plan t material s avoided ? c / 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 ) « / 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 ) i/ 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 . Wa s damag e t o th e foundatio n avoided ? L / 3 . Wa s damag e t o window s avoided ? I / 4 . Wa s damag e t o window s o r doo r screen s avoided ? i / 5 . Wa s damag e to 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 n notes :

Remova l an drestoratio n activate s complet e includin g th e 30-day so dwarranty : EP A Representativ e Qc~ , &«, , Date :Address : Phone : 

### 6UfionJ l S BVID # Sampl e Numbe r



### Omah aLead ! 4613 0S o

Omah aLea dSit e 4613 0DLOGIES , INC . 

# SEP A Propert yCompletio 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 indicate s 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 so dwarrant y (9 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y ID : Propert y Address : Owner : 

## b \ 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 :

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

Owner's^ignatur e Dat e 

# TFin d Recor d Clea n U p Quer yLea d Remainin g Quer yPropertyDamag e Quer y Clos e 

### ampl e Area : 31954 - 256 9 EVAN S S T Owner : Resident : Contract : 1 n Owne rOccupie d Residen t Name : Contractor : Owne rName : FERNANDE Z RUB YM |PRUDENT200 7 FERNANDE Z RUB Y Propert yAddress : | Group : Owne rAddressl : 256 9 EVAN S S T i Owne rAddress2 : Zi p Code : 6811 1 l Assessment : 256 9 EVAN S S T Residen t Phon e Qualifyin g Grou p

, City : State : Zi p Code : j 80 0

, OMAH AJN E 6811 1 Assessmen t XR F Date : i Owne rPhone : Alternat e Phone : I i Assessmen t Ma xXR F Value : 916.4 7

### Prin t Previe w rag e i 

## Dougla s County-Omaha , N E

Parce l I D Owne r Nam e Properly 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 210068000 0 FERNANDE Z RUB Y 256 9 EVAN S S T OMAH A 6811 1 256 9 EVAN S ST OMAH A N E 6811 1 Sec-Twn-Rn g Owne r Addres s Additio n Block Lo t Lega l 1 Lega l 2 Lega l 3 Lega l 4 Assesso r Website Lin k 09-15-1 3 REDICKS-CLARK-AD D 3 5 46.23X12 0

http://douglasne.mapping online.com/DouglasCoNe/static/accountinfo.jsp ? accountno=R2 1 0068000 0 Disclaime rMa p an d parce l dat a ar e 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 = 3 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