### PROPERT Y SUMMAR Y SHEET Oniah aLea dSit e Remedia l Actio nContrac t #EP-S7-10-0 5 Said : 3150 9 Propert y Address : 352 4 N4 3 S T 

### Executiv e Summary : Issue s Encountered : Non e 3026112 0 Issue s Resolved : Non e Uniqu e Findings : Superfun d Othe rRelevan t Information : CONFIRMATIO N SAMPLIN G DATA/RESULTS : B2=27 4 PP M @ 4" ; F2 = 7 3 PP M @ 4" ; DZ= 6 4 PP M @10' ; EA = 7 4 PP M (SScrape . Attachments : Document s Include d i n th e Propert yFile : Yes N o N/A Propert ysketc h provide d b yEP Apursuan t t o contrac t specification s V Signe d Acces s Agreement ; includin g acces s agreement s obtaine d (i frequired ) fo rcrossin g V 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 ) V Pre-Excavatio n digita l vide o cli p V Samplin g dat a shee t V Post-Excavatio n digita l vide o cli p V . Documentatio n - Complete d EP Aclose-ou t checklis t V As-Buil t sketc h V Omah a Lead Sit e Databas e sampl e informatio n document . V Signe d for m verifyin g satisfactor yrestoratio n V Othe rDocument s : 3 0 daySO D warrant ypicture s V Utilit yclearance s documen t V Propert yinformatio n fro m Dougla s Count yAssessor' s office . V Settlemen t document s (i.e . fo ran ydamages , replacemen t o fplants , etc. ) V Sit e safet yhazar d analysi s documen t wit h pictures . V 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 Representativ e EP AAcceptance : Date : Date : ^

PrudentTechnologies , Inc . j 250 5 N . 24T H Street , Suit e 30 8 (Omaha , N E6811 0 USAj Tel . 402.504.100 4 | Fax : 402.504.100 5 Environmenta l Engineerin g & Service s | Remediatio nj Constructio n

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# PROPERT Y ACCES S FOR M Prodflii t TKhRol«gia , lae . (Pnideirt ) i s unde r eontrac t wit hftc U . S . Bovironnwrta l ProtDCtionAgenc y (EPA ) t o clea nu p tead-comatninate dsoil s a t anumbe r p f

propertie s locate dmOmshA . Nebraska , includin g th e pnpax y locate da t - ^ ^>>'2- M J^ ) Vf7 > -Ce i ^Th e EP Arequest s you r pemrisao nt o allo w Pnide mt o pefftri B asoi l cleamq ) a t tihis^open y t o ranovc leadTcooiaaiiiiale dsoil . S y signin g thi s fomi, th e propert y ovne r giant s pennissio nt o Praden i t o perfom i activitie s reiate dt o th e clesmi p includiii g soi l sampling , remova l o f lead ­ contaminate dsoil , an drestoratio nofth e reference dpropeny . I f

yo v hav e an y questioa' ? abou t th e soi l cleana p planne dfo r you r property , pleas e contac t th e Proden t OfTic e fo r th e Oniah aLea dSit e cieann p a« <402 ) 735-1188 . Genera l question s abou t th e Omah aLea dS'lt e cleanu p ea nb e directe dt o th e EP APubli c InformaHo nCenter e at (A02 ) 731-3M 5 (Sout hOmah aofRce ) o r (402 ) 99 1 -958 3 (NorthOmah aofTice V I f

you r propert y ha s agrave ) ordirtdrivcwBysarparfcingareasth.c nth e remova l an drcpltcemen Tofth e soi l and/o r grave l during : th e remediatio nproces s doc s no t mak e you r illega l gravel/dir t drive^^ay s o r parkin g area s legal Pnipwiy Acces s OtantedBy : . £^££V ^ >4 > (PtsBs cPrifl i Name ) (Signaiure ) (D&te) Propert yAc««»cd by . ^^^JWycLcOJ^^^^^- ^ ^'^''* " ^"^ ^ "*"' ' PROPERT YINFORMATIO N (T o b e compute d b yresiden t and/o rptroperl yowne r• • pleas e print ) 1 .

RESIDEN TNAME : iS^-y > Cfi^Rrep , ' Owne rA^^& ) 2 .

I F RENTAL , PROPERT YOWNE D BY : ^gSl ? ^A- S 3 .OWNER' S MAIUN G ADDRESS ; Bi(t > 10 , : e j i i*- S g i L,< ^ S . l)g . Sfe--w6.>./Lt, g A- C fc® « 3 . 3 d .OWNER' S TELEPHON E NUMBE R - HOME : t-lo> H ^/- ^ o d U WORK : ( 1 5 .TENANr s TELEPHON E NUMBE R - HOME : fWo X \^'^\ll&>\< ^ WORK : [ ) 6 .AG E O F HOME? : ^ 0 - h YEARS . HO WLON G HAV E YO U LIVE D HERE ? " - ^ YEARS . 7 .

HA S TM E EXTERIO R BEE N PAINTE D O R COVERE D WIT M SIDIN G SINC E 1978 7 /^fesJ N O 8 .« O F OCCUPANT S UNDE R AG E O F 7: , # O F OCCUPANT S A TO R OVE R 7 YEAR S OL D 9 .P O F CHILDRE N UNDE R AG E O F 7 WH O PLA YI N TH E YAR D FO R S HOUR S O R MOR E PE R WEEK : 10 .COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , NEIGHBORIN G PROPERT Y ETC. ) AUT>iORrrYFO R ENVIRONMENTA L RESPONS E ACTIONS : Tl wactivitie s K > b s ImptamontB d b yEP Aunde rfills asreamen l ar e itufsvmtt o Sectio n 10 4 c fCERCLA , 4 2 aS.C . 8804 . EPA' s riglit o facces s l o th a pt«pett yI s prwiae d tarI n Sectio n 104(e ) o TCERQ A4 2 U.S . C 8S05(B) , wfilef i provide s enb yfo r"detatmhrin s th e nee d fo r rrapmse . o rehoostn g o rtakin g an yrespons e actio n unde rliii s tide , o rotherwis e entorcin g th e piovtsion s o fth e titn . 

## Pruden t Technologie s Inc . S60 0 S . 10* ^ St . Omaha , N £68107 , 402.733.118 8 (Office ) 402.733.188 3 (Fax )

### R XDate/Tim e 05/10/m i 09:0 5 A_ P.00 2 uuutu/ui i \)o.9 a H p f ^ ^ ' ENVJRCWMENTAL & CONSTRUCTIO N SERVICE S 

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NOTIC E T O B E GIVE N TO : OWNE R (^ENAJj ) BOT H HO W MUC H NOTIC E I S NEEDEDy^ M HOUR ^ 4 8 HOUR S 7 2 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 BE GIVEN : ^fiujt ? <1AK'7^ ^ 5"?I/0«^« » WVIL L NEIGHBORIN G PROPERTYNEE D T O B E USE D FO R ACCESS ? YE S ^<^ ) I F NEIGHBORIN G PROPERTYWIL L NEE D T O B E ACCESSE D WHA TI S TH E ADDRESS : WA S A N ACCES S FOR M OBTAINE D FRO M TH E NEIGHBOR ? YE S X N O WIL L AFENC E NEE D T O B E TAKE N DOW N T O OBTAI N ACCESS ? YE S VN O I F ANSWERE D YE S T O NUMBE R 1 2 PLEAS E PROVID E LOCATIO N O F FENCE : I S THER E PRE-EXISp^ G FACIA L DAMAG E T O TM E PROPERT YAN D I F S O PLEAS E PROVIDE D IXKIATIO N AN D DESCRIPTIO N O F SUCH : YE S /^o ) SPECIFY : I S THER E PRE.EXISnN 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 ^f ^

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## Propert y Owne r Pmden t Employee /' ^ Y ) Sisnatnre c c.^*^BSf-^ ••*;? . Signatnre ; v(..jg<llvvu U . <CsY ^ ^^UAA DATE : r-t-/ / Pmden t Tecbnologie s Inc . 560 0 S . 10 ^ S t Oinaha , NE«S107 , 402.733.118 8 (Office ) 402.733.188 3 (Fax )Em'lRON M ENTA L& CONSTRUCnO N SERVICE S 

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Doe s HomeoTvnerwan t so dreplace di nal i areas ? ^^E ^ 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 dof so d(i & mnlch , mck , leav e bare ) i f mnlc ho r roc k pleas e speci f wha t typ e an dcolor ;

AN Y OTHE RDAMAG EO RREQUESTS :

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# J^Kv^^/ui?^ DATE : ^'9.-1 1 DATE : W u 

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# y tim e period ) 6 .Wa s th e property grade dsuc htha t wate r wil l no l poo l o nth e property ? / 7 .

Wa s damag e t o landscapin g or plan t material s avoided ? / 

### Gales , Fence s an dRetainin g Wall s Ye s N o I .D o gate s ope nan dclos e freel)' ? (If applicable ) 

# y 2 .Wer e al l gate s or fence s take ndow ndurin g restoratio nactiviiie s reinstalled ? (If applicable ) / 3 .

Wa s dajiiag e to gate s orfence s avoided ? (I f applicable ) / 4 . Wa s dajnag e to retainin g wall s avoided ? (Ifapplicable ) 

# y Foundation , Sidm g an dGutter s Yes ^ N o 1 . Wa s dajiiag e to th e sidin g or tri mavoided ? 

# y 2 . Wa s damag e to th e foimdatio navoided ? / 3 .

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# y 4 .Wa s damag e to window s or doo r screen s avoided ? 

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• YOU R TICKE TNUMBE R I S 2838762 . Origina l Cal l Date : Wor k t o Begi n Date : 9/02/1 1 9/07/1 1 Time : 9:4 8 a m Time : 10:0 0 a m Op : ASHLEIGH1896 7 State : N E Address' : 352 4 County : DOUGLA S Street : N43R D S T Place : OMAH A Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 08-NW 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 : EMAI L AL L CLEAR S TO : AANIKPUTA@PRUDENTWEB.CO M : 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 Wor k Bein g Don e For : EP A Dept h o f Excavation : 6 F T Corne r Lot : NFront : Y Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Rear :



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