TEeRRsrsETEsrnJc r 

## PROPERT Y SUMMAR Y SHEE T dihah aLea dSit e Remedia r Actio nContract s EP-S7-10-0 5 Said : 2914 0 

## Executiv e Suinmary : .•i - Issiie s Encpiihtered : None . •. ; issue s Resdived : None. . . • Uhiqu e Findings : • Othe rRelevan t Information :

• CONFIRMATIO N SAMPLIN G DATA/RESULTS : B1 EASEMENT . Attacliments : Document s Include d i n th e Propert yFile : 

### .PropertyAddress;271 1 N2 6 S T

3026138 4 

# iliu m Superfun d

= 42 2 PP M @13" ; B2 = 20 6 PP M @13" ; N O
Propert ysketc h provide d b yEP Apursuan t t o contrac t specification s Signe d Acces s Agreement ; includin g acces s agreement s obtaine d (i f required ) fo rcrossin g ont o adjacen t propertie s . Pre-excavatio n agreemen t detail s (i f an yar e mad e wit h th e Propert yowner ) Pre-iExcavation.digita l vide o di p Samplin g dat a sheet. . Post-Excavatio n digita l vide o cli p Documentatio n - Complete d EP Aclose-ou t checklis t As-Buil t sketc h

, Omah a Lea d Sit e Databas e sampl e informatio n documerit . .

Signe d for m verifyin g satisfactor yrestoratio n Othe rDpcunients : 3 0 da ySO D warrant ypicture s Utilit yclearance s doicumen t Propert yinformatior i fro m Dougla s Count yAssessor' s office . Settlemen t document s (i.e . fo ran ydamages , replacemen t o f plants , etc: ) Sit e safet yhazar d analysi s documen t wit h pictures . Legend : Ye s - : Include d I n th e File ; N o - No t include d i n th e File ; N/A- ' Doe s no t Apply . Pruden t Representative : ^o V EP AAcceptance : 

### >\\ Date : Date : 

# y ^ Ye s N o N/A V V V 

### .-v.. . 

## v : V V . V V V V V V V V - ' -



### Pruden t Technologies , Inc . j 250 5 N . 24T H Street , Suit e 30 8 jOmaha , N E6811 0 US A | Tel . 402.504.100 4 j Fax : 402.504.100 5 Environmenta l Engineerin g & Service s | Remediatio n j Constructio n

# • i i i II I III I II I 2914 0 Exterio rPain t North Arrt w 

### Owne rName : MARL AM WYNN Omah a Lea d Sit e 

### • Goo d Address : 271 1 N 2 6 S TSit e Sketc h 

### • Poo r Phone : H : W : •• * [yNo t pain t 

### Sampl e Numbe r Lea d Sampl e LA B 

### Samples Collected Concentratio n Collecte d 

### Firm : A5\ M £ M kA ^ RYASCPXA-2914 0 F l 

# u a pp m 

## D 

# i Date : ^-3L\-OV. ^ RYBSCPXA-2914 0 F2 

## 2:\- l pp m 

# a Time : ^-'^f i 

# fei . RYCSCPXA-2914 0 B l 

## H3, l pp m 

## D Samples Analyze d RYDSCPXA-2914 0 B 2 

## 5U O pp m 

# n RDZOCrXA-2014 0 BZ ­ pp m 

## D XR F Uni t 700 1 Book: J{ft3 L 

## D ROZOCPX A2014 0 S i pp m 

# n Date : 8ZZ'OCr > . 

## D nrzocpx A20140—pz - pp m 

### Time : /Vrv i 

## D Staff : fAgs ^ ; Numbe ro f Samples = [ ^ Legend : F l = Front Left , F 2 = Fron t Right , B l = Bac k

Left , B 2 = Bac k

Right D Z = Dri p Zone , GZ = Garden , P Z = Pla y Al l quadrant s ar e a s viewed fro m th e street , facin g propert y 

# 6 1 mr . 

# ENTERED AU G 2 1200 6 

# 3^-71 1 \ n-zy s r 5(p O 

# 43 1

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# S r Re v4 046141.0)2 3

# PROPERT Y ACCES S FOR M Pruden t Technologies , Inc . (Prudent ) is unde r contrac t wit hth e U. S. Environmenta l Protectio nAgenc y (EPA ) to clean up lead-contaminate dsoil s at anumbe r ofpropertie s locate d in Omaha , Nebraska , includin g th e property locate d at

^ ^4- 1 I K^i f OJ.CQ^'T^ . Th e EP A request s you r permissio nto allo w Pruden t to performasoi l cleanu pat thi s property tp remov e lead-contaminate dsoil . By signin g thi s form , th e property owne r grant s permissio n to Pruden tto perfor mactivitie s relate d to th e cleanu p includin g soi l sampling , removal of lead contaminate dsoil , an drestoratio nofth e reference dproperty . Ifyo u hav e an y question s abou t th e soi l cleanu p planne dfor you r property , pleas e contac t th e Pruden t Offic e fo r th e Omah aLea dSit e cleanu p at (402 ) 733-1188 . General question s abou t th e Omah aLeadSit e cleanu p canbe directe d to th e EP A Publi c Informatio nCenter s at (402 ) 731-304 5 (SouthOmah aoffice ) or (402 ) 991-958 3 (NorthOmah aofTice) . Ifyou r property ha s agrave l or dirt driveway s or parkin g area s the nth e remova l an dreplacemen t ofth e soi l and/o r grave l durin g th e remediatio nproces s doeino t mak e you r illegal gravel/dirt driveway s or parkin g area s legal . Propert y Acces s Grante dBy : ' < '7/yVlil7K y 7s\.y2iPyhi'*y > *• (Pleas^rin t Name ) 

# ^ha i Propert y Owne r Signature : (Signature) ^ (Date) (Pruden t Employe e Name ) Property Accesse d 

## '' • _....G^\.£ r edjQ_

_ J^kDii2:£ia . PROPERT YINFORMATIO N (T o be complete d byresiden t and/o rpropert yowne r~ pleas e print ) \> i RESIDENTNAME : ( S«^rt e <^ ^ £LDcN&- ) /^Owner ] Rente r 2.V : IF RENTAL , PROPERT YOWNE D BY : /V)/A 3.410WNER' S MAILIN G ADDRESS ; ^^'j ^

Kyjpj d U T 4. J<OWNER' S TELEPHON E NUMBE R - HOME : (V^ ^

^ll^^ L WORK : J _ 5. TENANT' S TELEPHON E NUMBE R - HOME : ( ) WORK : _ L 

### _L 6. yAG E OF HOME? : N// V YEARS . HO W LON G HAV E YO U LIVE D HERE ? 

### YEARS . 7i< ; HA S TH E EXTERIO R BEE N PAINTE D OR COVERE D WIT H SIDIN G SINC E 1978 7 

### _YE S V NO Z ^ # OF OCCUPANT S UNDE R AG E OF 7: (\) D 

### # OF OCCUPANT S AT OR OVE R 7 YEAR S OL D ^ 94^ # OF CHILDRE N UNDE R AG E OF 7 WH O PLA YIN TH E YAR D FO R 5 HOUR S OR MOR E PE R WEEK : 1 ^ COMMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , NEIGHBORIN G PROPERT Y

ETC. ) ORW e F NVIR0NMEN 1 AUTHORIT YPOR f NVIRONMENTA L RESPONS E ACTIONS i Th e activitie s tobe implemente dbyEP Aunde rthi s agreemen t ar e pursuan t to Sectio n 104 ofCERCLA , 42 U.S.C . 9604 . EPA' s righ t of acces s to th e propert y Is provide d fb r In Sectio n 104(e ) ofCERCLA , 42 U.S . C 9605(e) , whic h provide s entryfo r"determinin g th e nee d fo r response , orchoosin g ortakin g an yrespons e actio n unde rthi s title , orotherwis e enforcin g th e provision s of th e title. " 

## Pruden t Technologie s Inc . 5600 S. IO** * St . Omaha , NE68107 , 402.733.118 8 (Office) 402.733.188 3 (Fax )ENVIRONMENTA L& CONSTRUCTIO N SERVICE S 

## Propert y Statu s Form Address : 9.'^lV(sJL - 'St< o IT T Date:Cl-3.q^l ( Phone.'i 

# ''•[7\<^y \ NOTIC E T O BE GIVE N TO : /OWNE R I TENAN TBOT H , ^ HO W MUC H NOTIC E I S NEEDED : 2 4 HOUR S /4 8 HOUR S ^ HOUR S < OTHE R NOTIC E NEEDE D (PLEAS E SPECIFY) : PHON E # AN D NAM E T O WHO M NOTIC E NEED S T O B E GIVEN : 

# lto.r\aZ\M^(\r \- 4ox ^ S7A ^67 ^ WILL NEIGHBORIN G PROPERT Y NEE D T O B E USE D FO R ACCESS ? YE S N O jl

F NEIGHBORIN G PROPERT Y WIL L NEE D T O B E ACCESSE D WHA T I S TH E ADDRESS : WA S A NACCES S FOR M OBTAINE D FRO M TH E NEIGHBOR ? YE S N O 

### tw i IL L AFENC E NEE D T O B E TAKE N DOW N T O OBTAI N ACCESS ? YE S N O I F ANSWERE D YE S T O NUMBE R 1 2 PLEAS E PROVID E LOCATIO N O F FENCE : li s THER E PRE-EXISTIN G FACIA L DAMAG E T O TH E PROPERT YAN D I F S O PLEAS E PROVIDE D LOCATIO N AN D DESCRIPTIO N

)FSUCH : YE S N O SPECIFY : I S THER E PRE-EXISTIN G CONCRET E DAMAG E T O TH E PROPERT YAN D I F S O PLEAS E PROVIDE D LOCATIO N AN D DESCRIPTIO N O F SUCH : YE S N O SPECIFY :



### Propert y Owne r Pruden t Employe e signature; . Signature ; CjjJj^J\li€>y^^cMj2< ^ 

# J ^DATE : ^7J^^/JPC>/ , Pruden t Technologie s Inc . 560 0 S . lO" " St . Omaha , N E68107 , 402.733.118 8 (Office ) 402.733.188 3 (Fax )ENVIRONMENTA L& CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

## Propert y Inspectio nForm Address : ol" ^ I ( M - ^l ^ ^ ^ Date : C^--Q.«- { - 1 ( Phone : (M,Q ^ 

## BVID: oi qi qb 

# Pre-Existin g Damage : Pleas e writ e i ndetai l an dinclude dlocatio n an ddescriptio n o f

damage ; Concret e Damage ;

Facia l Damag e Includin g Siding :

Doe s Basemen t hav e histor y o f leakin g o r flooding ? YE S N O 

## J C 

# hfl K

Doe s Homeowne r wan t so dreplace di nal l areas?(YE S J N O I f N O pleas e provid e wha t ^ 

### area s ar e no t t o b e sodde dan dwha t need s t o b e replace dinstea do f so d(i.e . mulch , rock , leav e bare ) i f mulc ho r roc k pleas e specif y wha t typ e an dcolor ;

AN Y OTHE RDAMAG EO RREQUESTS ; 

# A 

# /V/A Propert y Owne r

, Pruden t Employe e Signature : H* ^i^'J^SL^tJ^fX^ ; Signature : Cy-Lx-J^J ^ ^Q-^&idU^h i I DATE : ^ '^/^^i?QI / DATE ; ^ - 0^^.-< |ENVIRONMENTAI . & CONSTRUCTION 

### TECHNOLOGIES , INC . SERVICE S 

# • t m XR F CLEARANC E SHEE T PROPERTYADDRESS : 7^!.[( ' I/.,^^t^* ^ ^ --. 2 PROPERT Y ID: . .^ : [• ^ 5 • ' iVlA PHA S BEE N REVIEWE D AN D N O MISSED AREA S EXIST : N O WA S CONTAMINATIO N LEF T BEHIND ? I FYE S WHFiR EAN D DIMENSIONS : GREW : XR FTEC H DAT E DEPT H QUADRAN T F l .^F2; . .,• ; READIN G

. • ' ' . '•• • 

# READING S DOCUMENTE D IN LOGBOOK?/ ^ N O 

# m f/i^ f

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# jis^irr^Rfcrr ^•\yy£dJlM ^ -raCHNOLOGIBS , INC . 

### Propert y # : 2.^1^ 6 Date/Time : Quad s Excavated : ^( , ig ^ 

# EP A Propert y Clos e Ou t Propert y Address:-^7/ / A J '2.< i ^ f ^ Owner' s Name:/A^y.\ ^ {jiii>^-.-\Y \ Contracto r Group : Pruden t Technologies , Inc , Excavatio nGenera l Ye s No 1 . I f necessary , wer e th e correct quadrant(s ) excavatedan drestored ? 

# v 2 . I f necessary , wer e th e correct area s o f drip zon e excavatedandrestored ? 

# y Gradin g So dan dVegetatio n Ye s N o 1 . Doe s th e grading aroundth e perimete r o

f th e hous e ir i excavatedarea s generall y slop e awa y / fro mth e house ? 2 . Has sodbee nlai din all area s tha t wer e excavated ? / 3 . Doe s th e so dappea r to b e generall y health y andgrowing ? (Onl y evaluate if inspectedat a3 0 / da

y time period) . • 4 ; . Ar e soddedarea s generall y fir maii devenl y graded ? / 5 . Ar e the joint s between th e so dstrip s generall y tight ? (Onl y evaluate i f inspecleda t a3 0 da y / timeperiod ) 6 . Was th e propert y gradedsuc htha t wate r will not pool o n the property ? / 7 . Wa s dainag e t o landscaping o r plan t material s avoided ? / Gates , Fence s an dRetainin g Wall s Ye s N o 1 . D o gate s ope.nandclose.freely ? (Ifapplicable ) / 2. . Wer e al l gate s o r fence s taken dow n during restoratio n activitie s reinistalled ? (I f applicable ) 

# y 3 . ^yasdaJ^^age.(. o gate s o r fence s avoided ? (Ifapplicable ) . ' 

# y

. 4 . Was dainag e t b retainin g wall s avoided ? (Ifapplicable ) . 

# y Foundation , Sidiii g an dGutteri s Ye s .No . ] . Was dajnag e to th e siding o r trimavoided ? 

# y 2 . Was damag e t o th e foundation avoided ? 

# y



# - 7 Was daraag e t o window s avoided ? 4 . Was dantag e t o wiiidow s o r doo r screen s avoided ? 

# y 

# 7 5 . Was damag e to downspouts or downspou t extension s avoided ? Sidewalk s an dDriveway s (Goiicretc ) Ye » N o 1 . Was da.niage t o diivewa y surface s avoided ? 

# f 7 2 . Was damag e t o walkwa y surface s avoided ?

## Ownes' s comments :

Inspectio nnotes :

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

### AS - BUILT DRAWIN G Sampl e Area ; 291+ 0 - 271 1 N2 6 S* . Dat e Excavated ; 10/14/201 1 

### OMAH A LEA D SUPERFUND SIT E Sample dBy: ; Isaa c 

### CONTRAC T # : EP-S7-10-0 S 2914 0 FxlRrio rPain i Omah a Lea d Sit e Owne rName : MARL AM WYN N Sit e Sketc h • Goo d Address : 271 1 N2GST • Poo r

Phone : H w Q ' Not pai>i t Sampl e Numbe r Lead Sampl e Sample s CoUecte d LA 8 Concentratio n Collecte d Firm ; isy.i i xj.i . y.-y - RYASCPXA-2914 0 F l

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# y RYBSCPXA-2914 0 F 2 

# z n

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### D 0 " Sample s Analyze d RYDSCPXA-291.4 0 B2 5 in O pp m 

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### D Time : 

# n Staff : K^v ^ Numbe rof Sample s = Legen d F » = Fron t Lef t F 2 = Fron t Riglit , 8 1 = Bac k Left , B 2 = Bac k Righ t DZ = Dri p Zone . G Z = Garden , P Z = Pla y A H ouadrant s ar e a s viewe d tro m lh e street, , facin g pfopert y • • '' t I 

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• YOU R TICKE T NUMBE R I S 2873885 . Origina l Cal l Date : 10/11/1 1 Wor k t o Begi n Date : 10/13/1 1 Time : 12:5 9 p m Time : 1:1 5 p m Op : ASHLEIGH1 8 96 7 State : N E Address : 271 1 County: DOUGLA S Street : N26T H S T Place : OMAH A Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 09-S E Sect-Qtr : • : Typ e o f Work : LEA D SOI L REMEDIATIO NPROJEC T Locatio n o f Work : ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)733-188 3 : UNSUR E CORNER S Compan y Contac t Nam e Alt . Contac t PRUDEN T TECHNOLOGIE S ASHLEIG H ANIKPUT A NON E Phone : (402)733-118 8 

### m Wor k Bein a Don e For : EP A y »

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