### PROPERT Y SUMMAR Y Date : 10/22/200 7 Omah aLea dSite Remedia l Actio n Contrac t #EP-R7-07-0 6 Mont h of : Octobe r Propert y Address : 181 1 Ohi o 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 Informatio n : CONFIRMATIO N SAMPLIN G DATA/RESULTS : 

### F2 - 17 0 @ 8 " Bl-185@8 " B2-146@8 " E l - 20 3 @ Scrap e ATTACHMENT S 1 ) Property sketc h provide 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 n digita 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 n lef 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 n th 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 h th e propert y owner ) ii ) Excavatio n digita l vide o i n MPEG , WM V (Window s Medi aVideo ) o r SW F(Flas h Player ) 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 . 4028437 1 Superfun d 

### TECHNOLOGIES , INC ,Name : Pau/ g Address : ffll l <DA«t > S + • Phone : Omah a Lea d Sit e Sit e Sketc h Date : Time : 6' - /fr ­ / £ Nort h Arro w

Tea m BVID # : LA XR F Cod e 103 7 T"»ie:p/ H : \2-° ( Sampl e Numbe r Lead Concentratio n Confirmatio n Sampl e



## - 

## 2 * D 6 0 K1C.ZC.fX.A ­ pp m ^5/Ye s N O N o N O pp m N o pp m pp m N o 

## N U a pp m D 

### N o D



## A U 

# M l m ___,»-,_—• - 

# _

— 

# T ! T \V L ^

6 e« ^ U5) ^ 

## J 

# t r

•

52 1

Omah aLea dSite 4613 0

# OK . oName : Pavla . Larso n Omah a Lea d Sit e Address : /8 H 0Ait > S + > Site Sketc h Phone : Tea m f~6 # M3 " j l?u ) BVID # £. c >/>A/ 3 Sampl e Numbe r Lea d Concentratio n I f£ i & <SCf > x A ­ 2f ( 0 t> 0 L\~\ £ Kr " " t A RiC-ZC.PX- A ~ 2.306 O p-yiDS'CPxA - 2/?04> O ^_ ° J / ^ 6 ej ^ ' 3prn

Pp m pp m 5 pp m 7 

### co m 

# Vt 

# wlkf L !

.... . . 

# 1 i 1 i 

# Q ! 1 t ~ 7 ° 

# ) ! 

# f j
i ^ 

# I 1 ^ 6 I j ( 

## | 6

## ^ 

## i i j . l_ . 

## I I I ! '

_ 

## ... . «..^... . i j, . 

## , , \ 

## 1 I 

# <* r 1 4J75 

## ^ P J 

# \4 7/^ T $ \ 

### WAi U !

• 

# 2-1 0 b O Date : 

### 6' - Jfr-5 - Nort h Arro w Time : /(7 •' V5 "

XRFCod e 103 7 gwH : 12. 1 Confirmatio n Sampl e P i Ye s d N o ^ ^

2 Ye s C D N o E f ^?

/ Yes C D N O 1 3 -SZYe s C D M O C Z YP U g N o Q Yes C D N u C D Ye b C D N o D

7IT J 

# EI H 

# a **-? ? ij r2: a 

## A U 

# i 7 2 

# r

— ~ B U 

# » U>lw< 2 

# 4

- ^

Omah aLeadSite 4613 0

### tt o a Ho w acces s t o th e prorSBrt y i n orde rt o conduc t environmenta l samplin g an d to remov e lead-contaminate d soi l Pruden t Technologies , lac . (Prudent) i s unde r contrac t wit h fil e U . S . Environmenta l Protectio n Agenc y (EPA) t o clea n u p lead
- contaminate dsoil s ata-numbeprifDfopertie s locate di n Omaha , Nebraska , includin g fil e property locate dat _ /<%* / Cs^^^jrj O

_ . Th e EP A request s your permissio n to allo w Pruden t to perfor masoil cleanup a t mi s propert y to remov e lead
- contaminate dsoil . B y signin g thi s form , me property owner grant s permissio n to Prudent to perfor mactivitie s relate dto me cleanup includin g soil sampling , remova l o f lead-contaminate dsoil , an drestoratio n o f me reference d property . Afte r obtainin g m e owner' s signatur e o n mi s form , Pruden t Technologies , Inc . will contac t th e property owne r (sa dresidents ) withi n th e nex t fe w week s t o coordinate performanc e th e wor k I f

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

fo r me Omah aLea dSit e cleanup , Ms . Cyudi e Hind s a t (402 ) 504-1004 . General question s abou t me Omah aLeadSit e cleanup ca n b e directe dto me EPA Publi c laforauatio n Center s a t (402 ) 731-304 5 (sout h Omah aoffice ) o r (402 ) 991-958 3 (nort h Omah aoffice) . Property Acces s Grante dBy : L-ty f £ > - p / / (Pl»a » PrintNsm» ) 

### Property Owne r Signature : S U ri^L * (Sigrntura) . J (Date ) 

### PROPERT Y INFORMATIO N (T o b e complete db y readeo t and/o r property owne r - pleas e print ) RESIDEN T NAI3E : !&, ) La . Qente r RESIDEN T ADDRESS : 

## T ff = RENTAL.PROPERT Y OWNE D BY : OWNER-SBAELM G ADDRESS ; OWNER S TELEPHON E NUMBE R -HOHE : j%2 i
- 3 WORK : I AG E OFHOHE7 : YEARS . HOWUM G HAV E YO U LWE D H E HAS TH E EXTERIO R BEE N PAWTEDXJRCOV E RE D WITH SIDWS'SWC E 1378 ? NUMBE R O F OCCUPANT S UNDER ? YEAR S OLD : NUMBE R O F OCCUPANT S 7 Y OL D AN D OLDE R NUQBE R O F CHILDRE N UNDER ? Y E ARS^ D WH O PLA Y M TH E YAR D FO R 5 HJttJR S O R MOR E PE R WEEK : COMfilEHT S O R SPECIA L BiSTRUCTtOHS : (LE . DOGS.ENTR Y GATES.ETC } (^ru^fZf c ^j^^ ^ 

# JLJ , AUTHORIT Y FO RENVIRONMENTA LRESPONS E ACTIONS ; Th e activitie s to b e implemente db y EPA under thi s agreemen t ar e pursuant t

o Section 104 ofCERCLA , 4 2 U.S.C . 9604 . EPA'srigh t o f acces s t o the propert y i s provide dfor i n Sectio n 104(e ) ofCERCLA , 4 2 U.S . C y605(e) , whic h provide s entr y tor "determinin g th e needfor response , or choosin g or takin g any respons e actio n under thi s title , or otherwis e enforcin g the provision s o f the title ". i&'ftwv* . •

sn' J vj». ' itiiJi; 1 * ! t ai&akii O W 5 LsibJo i t d v »i*«llUUi i aJS J iic84ips i i AT I stS T . 

### 'i s 

### .'ID ? 

### r^T.Es h .'io ? e •.o

### so^ " _ c3£jjlVI$3 G JHXMfisStg U J JiSi.ijil' 1 i U j liOi2eiiffir£3C [ ejffiS'S ^ 'JSffiW O vSl35BO"i^)SJi S -iffiTSO i aM> 5 £SMt35 2

iu l ySliiitSJS Q tJlil!I^9L ) fifiO c tfii!0.141 1 Ob i ifciOJtifcSiifi 1 V5I 3 SVSii l SJOV " .-l/i c ^'jiioi:L ' tji S Lis;..JaiiBMi O si S iu l J^i^ > a^ i 

### ; s o

• - "fii.IW(i ir-l'^S^OM j tOVDil B iiTiuSS l 'f u teKitjICO ) 9i j *j'l )



## /.i&j o o^AUJC 1 

## gfltt3t f varnnsuju o -JOD-iiaau ajj o %A^ V \«iciti u

# EP A Propert y Clos e Ou t Propert y # : 2<j6 6 Q Propert y Address : /?// Oh m Date/Time : 10/32/0- 7 Owner' s Name : Pouin . Ltwsa * 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 quadrants ) excavate dan drestored ? 

### i / 2 . I f necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? 

### , / Gradin g So dan dVegetatio n 

### Ye s 

### N o 

# 1 . Doe s th e gradin g aroun dth e perimeter o f th e hous e i n excavate darea s generall y slop e away fro mthe house ? 

# t / 2 . Ha s so dbee n lai di n al l area s that were excavated ? 

# y 3 . Doe s th e so dappea r to b e generall y health y an dgrowing ? (Only evaluat e i f inspecte da t a3 0 day tim e period ) 

# • / 4 . Are sodde darea s generall y fir man devenl y graded ? 

# s 5 . Ar e the joint s betwee n the so dstrip s generall y tight ? (Onl y evaluat e i f inspecteda t a3 0 da y tim e period ) 

# / 6 . Wa s th e property grade dsuc h that water wil l no t poo l o n th e property ? u / 

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

# i / 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 .

Were 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 to 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 ) 

# I / 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 foundation avoided ? 

### S 3 .

Wa s damag e to window s avoided ? 

### </ 4 .Wa s damag e to window s or door screen s avoided ? 

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

### i/ 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 to walkwa y surface s avoided ? 

### i /

### Owner s comments :

Inspectio n notes :

Removal an drestoratio n activate s complete includin g th e 30-da y so dwarranty : 

## EPA Representativ e &*,$* *

_ Date :



## — t

# dji^ ^ ?// r

Omah aLea dSite 4613 0

## Propert y Completio n Agreemen t Thi s agreemen t document s th e completio n o f removal activitie s perf c me do n th e belo w liste dproperty . Th e propert y owner' s signature indicate s that th e propert y owne r i s ia-isfie dwit h th e restoratio n o f th e subjec t property , an dthat n o item s ar e i n question , now , o r at ai ' i»a e in'th e iuture , excludin g an y remainin g warranty (3 0 day s total ) except thos e item s liste dbelow , i • a r / . PropertyD) : Propert y Address : 

### Owner : Phone : 

### , ^ 3 Restoratio n Kern s i n Question :

Kern : Item : item : Item : 

### Item : Item : Required correction s to complete th e property :



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



# - 8~<=> 7

Owner' s Signatur e Date 

### I

## rnn i rrevie w Pag e 1 o f 1 

## Dougla s County-Omaha , N E

Parce l I D Owne r Name Propert y Addres s Cit y 

### Zi p Owne r Address Owne r Addres s 2 Owne rCit y Owne r Stat e Owne rZi p 1600500000 LARSO N PAUL A M 181 1 OHI O S T OMAH A 6811 0 258 JUNIPE R R D NIOBRAR A N E 6876 0 SeoTwn-Rn g Owne r Addres s Additio n Bloc k Lo t Legal 1 Legal 2 Legal 3 Legal 4 Assesso r Websit e Lin k 10-15-1 3

LAK E AD D i 

### 1

1 W 48.33 48.33X6 1

h i

tp://douglasne.mapping Ol iline.com/DouglasCoNe/static/accountinfo.jsp ? a :countno=R 1 60050000 0 Disclaime rMa p an d parce l data ar e believ i ; d to b e accurate , bu t accurac y i s no t M o-_i . guaranteed . Thi s i s no t a lega l document an d s ttoul d not b e substitute d fo ra titl e search , , . : nc jT - A Q toot appraisal , survey , o rfor ; conin g verification . ~ 

### http^/www.dog^.oi^dogis_aUas/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 7/16/200 7Name : fet v/a . L«r«o A Omah a Lea d Site Date : 8 ' i<s~ S Nort h Arro w Address : / f t 1 1 

# ^A« o s+ - Site Sketc h Time : /O'^ S Phone : Tea m Fbf t Mf#14 ) BV1D # : t- A XRFCod e 

### . 8-2,H'°S ' Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e



### - 2.106 0 

## 14 7 £ °l\l a pp m pp m pp m pp m pp m pp m pp m . . 1C O D ^

2 Ye s a 

## "Ye s 

## a a -Q Ye

s 1= 1 

## Yb b 

## a N o 

## N O N o N o N o 

# N U N o E T 

## ca ' CZ t2T P 

# a D



### Omah aLeadSite 4613 0Fin d Recor d dea n U p Quer y j Lea d Remainin g Quer y 1 Propert y Damag e Quer y / \ 

### Sampl e Area : 2906 0 - ] 181 1 OHI O ST gwner: ^ Resident : O Owne rOccupie d N . A Residen t Name : Owne rName : \ \\ J ^ * / 

### t~ ^ 

### - ^ / 

## JLARSO N PAUL AM ) J f , ^ —^ / Propert y Address[jr \ vOwne rAddressl : Nj'J p V flSHOHIOS T V A ix . ^ s s \Zi p Code : J •- — ^^ ^ Owne rAddress2 : i J68TI D ^ J25 8 JUNIPE R R D . / /" ' ^ \ Residen t Phon e /

/ /

X City : ^^ ^

State : Zi p Code : \ 

### ] 

## INIOBRARA ' , ]N E ]6876 0 \ Owne rPhone : Alternat e Phone : /

' ^ \ A KL^J ^

*V*cx^O" ' f^ ~ \\JC r T 

# 7//7/0 7 ] Clos e I

Contract : Contractor : JPRUDENT200 7 Group : 

# , , Assessment : Qualifyin g Grou p J80 0 Assessmen t XR F Date : 

### ] Assessmen t Max . XK F Value : | 915.7 1 

### i