### PROPERT Y SUMMARY Date : 11/7/200 7 Omah aLeadSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 Mont hof : Novembe r Property Address ; 181 4 Manderso n S t A . EXECUTIV E SUMMARY 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 deadspot 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 : Fl
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### E l - 111 @ Scrap e 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 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 leadlevel s v ) Legen d ii ) Contaminatio n lef t behin darea s vi ) Contracto r identificatio n iii ) Propert y addres s vii ) Date 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 hth 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 hPlayer ) forma t and/o r photograph s iii ) Signe dfor mverifyin g satisfactory restoratio n iv ) Descriptio n o f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOGIES , INC .__ _ 

# 3284 6 Nort h Arro w Oma hi a Lea d Sit e Exterio rPaint Owne rName : WILLI E L MOIS E 

### Si i » Sketc h D G 00* 1 Address : 18t 4 MANDERSO N ST 

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## t o allo wa cces s t o Omah a Le a th e propertyi n orde rt o conduct Sit e Remed i environmenta l samplin g an d t o remove Icad-contaminatsc ! soi ! Prudent Technologies , Inc . (ftudent ) i s unde r contrac t witi i me U . S . Environmenta l Rotectio n Agenc y (EPA) to dea n up lead-contaminate dsoijs , a t anumba^o f propertie s locate di n Omaha , Nebraska , includin g m e property locate dat /<7f</ .^//^^^^^.^n ) • Th * EP A request s you r permissio n to allo w Prudent to perfor masoi l cr^ani^Tat'tnl^prop^y't D remov e lead-contaminate dsoi l B y signin g thi s form , m e propert y owne r grant s permissio n t o Pruden t t o perfor mactivitie s relate dt o th e 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 th e owner' s signatur e o n thi s form , Pruden t Technologies , Inc . will contac t th e properl y owne r (an dresidents ) withi n th e nex t fe w week s t o coordinate performanc e m e wor k I f

yo u hav e an y question s abou t th e soil cleanup planne dfo r you r property , pleas e contac t Indent' 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 can b e directe dto th e EPA Publi c Informatio n Center s a t (402)731-304 5 (souf e Omah aoffice ) or (402 ) 991-958 3 (nor mOmah aoffice) . Property Acces s Grante dBy : Property Owne r Signature : PROPERT Y INFORMATIO N 

# 1

! o b e complete db y reades t and/o r property owne r - pleas e print ) RESIDEN T NAME : QDwne r[Cente r R E SID E N T ADDRESS : I F RENTAL . PROPERT Y OWNE D BY : OWNER' S HAIUNGADDRESS ; OWNER' S TELEPHON E NUttBE R -HOC3E : 

## WORK : i AG E O F HOME? : YEARS . HO W LON G HAV E YO U LIVE D H E R E 7 YEARS . HA S TH E EXTERK X D O R COV E R E D WIT H SIDIN G SINC E 1378 ? YE S NUMBE R O F OCCUPANTS UND E E R O F OCCUPANTS 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 PLAY I N THETA& D FO R 5 HOUR S O R MOR E P E R WEEK : COHH E NT S O R SPECIA L INSTRUCTIONS : (IE . DOGS . E NTR Y GATES.ETC. ) 

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

o Sectio n 104 o f CERCLA , 42U.S.C . 9604 . EPA'srigh t o f acces s t o the propert y i s provide dfor in Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 96X)5(e) , whic hprovide s entr y fdr a 

### detenninin g the needfor response , or choosing or takin g any respons e actio n unde r thi s title , or otherwis e enforcin g the provision s o f the title "»>•• •

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## propertyi n orde rt o conduc t Remedia l * \:$jf $ « * environmenta l samplin g an d t o J remov e lead-contaminate d soi l TedcEsologies , Lie . (TcfoHSeaxii ) i s iraada rcosafract wafH h fe e U . S . Esvizooaieata i Protedio a Ageecy (EPA ) to cleata u p iead-coatemmatet S soiS s a t a mmba rof prope l es^Dcates I i m OsKsfes , Meb?Bskfi , kcliM&ffl g ik e propert ylocaiec J a t \%V* \ Vf \ f > r i A QJ 3 ,<Vvfr 1 Sr . Ut a EP A srecpests you r pemassio a to allow Prndea t to pedbsra i a soi i cleaasij p a t tM s propert y to remove lead-coMafflaafflate d soil . Bysigsma g {Jas fcsssa , 4k e pa'opesi yowae rgrasS s pemjjssios i to Pmdeia t to pearfoss a activitie s relate d to tJi a cleanu p iadudm g soi l sasupliag , ?emova l o f lead-costasraiaated l soil , sad ires4ora{ioff l of& e reference d pt'oaai-ty . Aftei rouiaisjiia g {Ji e owaes - 's sigiaaiija a o a iisis fozua , PffiSiiW i Teclnaoiogies , lac . wil l cotitac t th e propest yowne r(an d residcots ) mti m & e nes t few week s to ccoir$£i3t c pairfoirmszic a & e wo? k I F yo u hav e sa ytjuesiioa s abou t th e soi ! claaaii p plasssie d fo ryou ? property , pleas e coaiac i Psradasst' s AdsHmisfe-Biiv e Clesfe fos rSSi a Omah s Lea d Sit " daesmp , Bfis . Cya& e ffiffldl s a t (^402) 504-1004 . Geaesrs S tpasiioia s sbou t i& s OmaSia Lea d Sit s cleanu p csa b e (2kecte d t o sk a EP A Pinbii c SafcsT-ma'ao- a Ceats2 3 a i (402) 731-304 5 (souli i Omsh s ofSce ) o f (402 ) 991-958 3 (aortS i Osnah s oiffice) . Psrope^t yAcces s Gs'siiie d By : 

# L (Ploai=oPrinlNEin«. ) Propert yOwne rSigsatee : ^ Jw " V^ltt^^ ^ ^igaaturo) PROPERT Y (T o b e tosaplsiei l & y reafiEs i aafi/o r proper^

RESJDEH T ADDRESS : : \ | f^Lf t tvA~~V-.o V I F RENTAL . PROPERT Y OWME D BY : OWCJER' S aaiLMi B ADDRESS ; OWMER'STELEPHOMEHUiniSER-MOClE : ( } ( V AG E O F HOQE7 : YEARS . HO W LOH G NAV E YO U LIVE D HERE ? Vs

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WORK : J VGAflE .

YE S M O [ X HUOBE R O F OCCUPANT S UWBE H 7 YEAR S OLD : MUtTlBE R 9 F ©COJPACTS ? YEAR S OL D AM D OLDE R . MUCOSE R O F CHIL3RE M UUDE R 7 YEAR S OL D WH O PLA Y ft ! TH E YAR D FO R 5 HOUfl S O R KOR E PE R WEEK : _ COdClEMT S O R SPECJA L inSTRUCTIOKS : (I.E . DOGS . EWTR Y SATES , ETC. ) AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s t o b e iraplsnente db y EP A unds
- thi s agreement are pursuan t to Sectio n 10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f acces s to th e propert y i s provide dfc r i n Sectio n 1 W(s ) o f CHR.CLA , 4 2 U.S . C 9C02(s) , whic h provide s entr y SET "determinin g th e nee dfc r response , o r chcasizi g o r taldn g any respcas e actio n unde r thi s title , o r otherwis e enfordn g th e provisicsn s o f th e title. "

# SEP A EP A Propert y Clos e Ou t Propert y # : 328V f Propert y Address : If Wft«»oe*.to< t Date/Time : // / Owner' s Name : ^jn-u t flo* * 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 quadrant(s ) excavate dan drestored ? 

### • 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 perimete r o f th e hous e i n excavate darea s generall y slop e awa y fro mth e house ? 

### / 2 . Ha s so dbee n lai di n al l area s tha t wer e excavated ? 

### , / 3 . Doe s th e so dappear t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period ) 

### ^ 4 . Ar e sodde darea s generall y fir man devenl y graded ? 

### / 5 . 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 ) S 

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

### 7 . Wa s damag e t o landscapin g 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 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 ) 

### , / 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 ? 

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

### t /

### Owner s comments :

Inspectio n notes :

Removal an drestoratio n activate s complet e includin g th e 30-da y so dwarranty : EPA Representativ e ^L . £L * Date : 

# ^~

## 3284 6 Exterio rPain t Nort h Arro w rnah a Lea d Sit e Owne rName : WILLI E LI\M| n ENTEHE 1 U Goo d Site Sketc h Address : 181 4 MANDER§t A S T f j Poo r Phone : H : 402-457-551 2 W : 

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## PropertyCompletio 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 propert y 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 warrant y (9 0 day s overall , 3 0 day s o n so dgrowthguarantee ) excep t thos e item s liste dbelow , 

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### any . Propert y ID : Propert y Address : V^.C' f 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 :



### I d o no t agre e restoratio n i s complete d

Owner' s Signatur e Dat e

### Prin t Previe w Pag e 1 o f 1 

## 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 151239000 0 MOIS E WILLI E L 181 4 MANDERSO N S T OMAH A 6811 0

P O BO X 3474 6 OMAH A N E 6813 4 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 Websit e Lin k 

### 03-15-1 3
KIRKWOO D AD D 3 7 

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http://douglasne . mapping online . com/DouglasCoNe/static/accountinfo.jsp ? accountno=R 1 5 1 239000 0 Disclaimer: Ma p an d parce l dat a are believe d t o b e accurate , bu t accurac yi s no t 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 = 1 9 fee t appraisal , survey , o rfo rzonin g verification . 

### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 8/6/200 7Find Recor d Clea n U p Quer y Lead Remainin g Quer y Propert yDamag e Quer y

Owne rOccupie d Residen t Name : Owne rName : 

## JVACAN TLOT JPRUDENT200 7 (MOIS E WILLI E L Propert yAddress : Group : Owne rAddressl : 181 4 MANDERSO N S T i i Zi p Code : Owne rAddress ! 6811 0 |P O BOX 3474 6 Residen t Phon e Qualifyin g Grou p City : State : Zi p Cod e 80 0 JOMAH A N E 116813 4 Assessmen t XR F Date : Owne rPhone : Alternat e Phone : 

### | (402 ) 457-551 2 Assessmen t MaxXR F Valu eFin d Recor d ._..- - ...Clea n U p Quer y Lead Remainin g Quer yj Propert yDamage ; Quer y 

# •• / " 

# / / Sampl e Area : 32846-181 4 MANDERSO N S T Owner : 

## \ ' ' JI U - OwneflOccupie d /Owne rName :



## [MOIS E WILLI E L / ]\Qwne rAddressl: ' 

# J 

# L-p-r- < Owne rAddress2 : JPO-BOX 34746 , ^-Gity : > r ^ \ State : Zi p Code : JOMAH A / x 

## INE " 6813 4 Owne ? Phone : Phone:---" ' [(402 ) 457-5512^ r-^V^ 1 

## L S A - Resident : Residen t Name : (VACAN TLOT Propert yAddress : 1181 4 MANDERSO N S T Zi p Code : 6811 0 Residen t Phon e Contract : Contractor : PRUDENT2007 Group : Assessment : Qualifyin g Grou p J80 0 ' """" " Assessmen t XK F Date : Assessmen t Ma xXR F Value : 908.6 3



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