### PROPERT Y SUMMAR Y Date : 10/5/200 7 Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 Mont hof : Octobe r Propert y Address ; 633 2 N 3 3 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 deadspot 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 : Bl-188@6 " 

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- 28 5 @ 13 " E l - 7 3 @ 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 ndigita 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 ) Property addres s vii ) Dat e iv ) BVJ 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 nagreemen t detail s (i f an y ar e mad e wit hth e property owner ) ii ) Excavatio ndigita 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 no f area s no t meetin g Interi mRO D cleanu p criteria .

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To Conduct Easemen t Sit e Remedia l * '?%$? 2 Samplin g an d Cleanu p Actio n ^2 " y Under Contrac t EP-R7-07-06 , th eU. S. Environmenta l Protectio n Agenc y (EPA) ha s Contacte dPrudent Technologies , Inc . (Prudent) , to cleanup lea dcontaminatio n on variou s residentia l propertie s includin g your property . Yo u ca n hel p wit h thi s activit yby givin g permissio n to conduc t easement samplin g an d conduc t cleanu pon your property . If yo u sig n thi s form , Prudent will return in afe w week s an dperform th e work . We will coordinate samplin g an dcleanu p wit hyo u prio r to commencement . If

yo u hav e an y question s abou t th e propose dwork , pleas e contac t Dan Garvey , EPA' s Projec t Office r fo r our Omah aLea dSit e Contrac t Mr . Garvey ca n

be reache d at (402) 731-0788 . Property Acces s Grante dBy : Propert y Owner Signature ; (Signature ) \) (Dat« )


### PROPERT Y INFORMATIO N (T obe completed by residen t and/o r property owner - pleas e print) RESIDEN T NAME : : } Q Q

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### RESIDEN TADDRESS : IF RENTAL . PROPERTYOWNE D BY! " OWNER' S MAILIN G ADDRESS ; £- > ^ 3 -} fy ) ^^ <^ - QWxig ) L^O i }O l (^ § \ \( OWNER' S TELEPHON E NUMBE R -HOME : t 4*0* . __ M S >' £>3~1. 3 WORK : J ) AG E OF HOME? : d-jgV V \ btlEARS . HO W LON G HAV E YO LIVE D HERE ? * ' YEARS . O I• < ^

i HA S TH E EXTERIO R BEE N PAINTE D OR COVERDE D WITH SIDM G SWCE1978 ? YES""" ^

~N O <^ HA S TH E INTERIO R BEE N PAINTE D OR COVERE D SINC E 1378? ^ YE S NO NUUBE R OF OCCUPANT S UNDE R C YEAR S OLD : _J NUMBE R OF OCCUPANTS 6 YEAR S OL D AN D OLDE R ^c.. ^ '

—) /tL r<^ - NUMBE R OF CHILDREN T UNDE R 6 YEAR S OL D WH O PLA Y

IN TH E YAR D FO R 5 HOUR S OR BOR E PE R WEEK : ^ COMMENT SOR SPECIA L INSTRUCTIONS : (IE . DOGS . ENTR Y GATES . ETC. )



### , RESPONS E ACTION S Th e activitie s tobe implement s by EPA unde r thi s agreement are pursuan t to Sectio n ] 04of CERCLE , 42U. S.C . 9604 . EPA'srighto f accesstotheprcpert y isprtwidedfcrinSectic n 104(e ) of CERCLE,42U.S . C 9605(e) , whic h provide s entr y fo r "detOTninin g th e nee dfo r response , or choosingor takin g any respons e actio n unde r thi s title , or otherwis e enforcin g the provision s of the title. "

# EP A Propert y Clos e Ou t For m Propert y # : _ Propert y Address : €33 2 Date/Time : $< p Owner' s Name : DOA U Quad s Excavated : 

### 0 1 Contracto r Grou p P^ u 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 away fro mth e house ? 

### u / 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 day tim e period ) 

### / 4 .Ar e sodde darea s generall y firman devenl y graded ? 

# y 5 .

Ar e th e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte dat a3 0 da y tim e period ) 

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

# . / 1 .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 ) 

### S 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 ) iX 3 . Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) v/ ' 4 . Wa s damag e t o retainin g wall s avoided ? (I f applicable ) 

## I / Foundation , Sidin g an dGutter s 

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### N o 1 .Wa s damag e t o th e sidin g o r tri mavoided ? 

### i / 2 .Wa s damag e t o th e foundatio n avoided ? 

### S 3 .

Wa s damag e t o window s avoided ? 

### ,/ 4 .Wa s damag e t o window s o r doo r screen s avoided ? 

### / 5 .Wa s damag e t o 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 driveway surface s avoided ? 

### • / 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-da y so dwarranty : EPA Representativ e .Qc^jtiLu . Date :Name : Omah a Lea d Sit e Date : Nort h Arro w Address : 

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## PropertyCompletio n Agreemen t Thi s agreemen t document s th e completio no f remova l activitie s performe do nth e belo w liste dproperty . Th e property owner' s signatur e indicate s tha t th e property 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 nquestion , now , o r a t an y tim e i nth e future , excludin g an y remainin g warrant y (3 0 day s total) excep t thos e item s liste dbelow , i f any . Propert y ID : £ 9 Y53 " Propert y Address : / J 

### Owner : Phone : 

# -z/- Restoratio n Item s i n Question :

Kern : Item : Item : Kern : Kern : Hem : 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 . L

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Owner' s Signatur e Dat e

## Omah aLeadApplicatio n Pag e 1 o f 2

Ne w Searc h Logou t 

## Omah a Lea d Applicatio n Chang e P ;

Summar yj Propert yjnf p Assessmen t CJeanJJ p Place o n Hol d Overview Remov e Hol d J Cal l Trackin g Propert y Google . Maps Dougla s Count yInteractiv e EPA Ma p Image s Sampl e Are a I D Propert yAddres s Sampl e Addres s Zi p Owne rNam e 3945 5 533 2 N 3 3 S T 333 2 N 3 3 S T 5811 1 WASHINGTO N DORI S J Propert yInf o View/Edi t Existin g Propert y Dougla s C O Parce l ID : Owne rName : Owne rOccupied : Address : Address2 : City : State : Zip : Owne rHom e Phone : Owne rAl t Phone : Owne rNotes : PropertyType : Residen t Name : Residen t Phone : Propert yAddress : Addres s Notes :

Unit : OccupancyLengt h Years : Exterio rPain t Sinc e 1978 : Interio rPain t Sinc e 1978 : Tota l Occupants : Tota l Childre n Unde r7 : 060632000 0 WASHINGTO N DORI S J



# r EB L 633 2 N 3 3 S T Chil d Care OMAH A N E 6811 1 {(402)933-633 2 ((402)552-338 1

! RESIDENC E CountyPropertyType : RES l (WASHINGTO N DORI S J 

# r 633 2 N 3 3 S T 

## ;GRANDKID S UNDE R6 Y/ O i

Addres s Info Provider : B& V Info Date : 09/06/200 3


## http:// r 7arcims.r7comp.epa.gov/ols / Access_Info.cfi n 5/20/200 7

### Omah aLea dApplicatio n ^ ^ ^ ^ Pag e 2 o f 2

Younges t Chil d DOB : j Chil d Info Date : Younges t Chil d i n Months : Addres s Inf o Provider : B&V Chil d Info Provider : Updat e I



### http://r7arcims.r7comp.epa.gov/ols/Access_Info.cf m5/20/200 7

### Dougla s County

Clic k t o Enlarg e Imag e Square Footage : Perimete r Uni t Type :

Buil t As :

HVAC : Exterior : Interior : Roo f Cover :

Roo f Type : Floorcover :
192 1 Detai l Typ e Applianc e Basemen t Basemen t Fixtur e Fixtur e Garag e Porch Use r 1008. 0 0. 0
1 1/ 2 Stor yFi n Force d Ai r Fram e Aluminu m Drywal l Compositio n Shingl e Gabl e Allowanc e
0 % Detai l Descriptio n Allowanc e Bsmn t Bloc k 8 f t Fai rFinis h Bas e Fixture s Bat h Ful l Detache d Enc l Soli d Wal l Atti cFul l Finis h 1 1/ 2 STOR Y



### •

Clic k t o Enlarg e Imag e Percen t Complete : Quality : Condition : Cond o Square Footage : Rooms :

Units : Baths : Bedrooms : Stories : Foundation : Sprinkle rSquar e Footage : 

### 192 1 

### Pag e 2 o f 2

100.0 % Fai r Averag e 0. 0 6. 0 

### 1. 0 1. 0 3. 0 

### 1. 5 Bloc k 0. 0
8 3 

### Unit s 1. 0 

### 816. 0 300. 0 

### 1. 0 216. 0 140. 0 192. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R06 .. . 6/21/200 7 1. 0

## Dougla s Count y Pag e 1 o f 2 Dougla s County , Nebraska PropertyRecor d ­ R060620000 0 Informatio n i s vali d a s o f 2007-5- 9 Value s no t finali/ec l unti l afte rBoar d o fEqur-ih/atio r Prin t Repor t Vie wo n Ma p 

### Owne r KANN E KOR P L P 62 4 N CRAWFOR D S T P O BO X 72 9 CARROL L I A51401-000 0 

### Propert yInformatio n Ke yNumber : 062 0 000 0 0 6 Accoun t Type : Residentia l Parce l Number : 060620000 0 Parce l Address : 633 3 N 3 3 S T OMAH AN E 68111-000 0 Lega l Description : BELVEDER E HEIGHT S LO T2 3 BLOC K0 4 1 X 120.2 5 Valu e Informatio n 200 7 200 6 200 5 200 4 200 3 200 2 Lan d $4,300.0 0 $4,300.0 0 $4,300.0 0 $4.300.0 0 $4.300.0 0 $0.0 0 Improvement $36,400.0 0 $36.400.0 0 $36.400.0 0 $35,500.0 0 $35,500.0 0 $0.0 0 Tota l $40,700.0 0 $40,700.0 0 $40,700.0 0 $39,800.0 0 $39,800.0 0 $0.0 0 

### Sale s Informatio n Dat e 1997-10-3 0 Typ e Boo k 207 4 Pag e 72 9 Pric e $28.700.0 0 

### Lan d Informatio n Acre s 0.1 1

S F 4920. 0 F F 41. 0 Unit s 1. 0 Dept h

120. 0 Widt h 41. 0 Vacan t N o Lan d Attribute s Attribute Attribute Descriptio n 

### Improvemen t Informatio n Buildin g 1



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R06 .. . 6/21/200 7