### PROPERT Y SUMMAR Y Date ; 08/28/200 7 Omah aLea dSite Remedia l Actio nContrac t #EP-R7-07-0 6 | Mont hof : Augus t Propert y Address ; 1609 Grac e 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 October/Novembe r o n an y dea dspot s t o encourag e sprin g growt h A. 3 Uniqu e Findings : A. 4 Othe r Relevan t Informatio n CONFIRMATIO N SAMPLIN GDATA/RESULTS : Fl-299@8 " F2
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### B l - 24 3 @ 8 " Easemen t 25 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 n left behin darea s vi ) Contracto r identificatio n iii ) Propert y addres s vii ) Dat e iv ) BVI 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 propert y 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 .

CHNOLOCIES , INC .

## 2712 4 1 3 Lea d Sit e Exterio rPain t Nort h Arro w— • Owne rName : CIT YpF^OMAH A O l ^ e Sketc h Q Goo d Address : 160 9 GRACJEJ J * " ' D Poo r^ Phone : H : w . QJ^No t pain t Lead Sampl e . . „ Sample s Collecte d Sampl e Numbe r Concentratio n Collecte d Firm : P f &> /

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## Omah a Lea d / ,$%, \ Propert yT o Conduc t Easemen t Sit e Remedia l * v?!? y j * Samplin g an d Cleanu p Actio n \ ri ^ Under Contrac t EP-R7-07-06 , th e U . S . Environmenta l Protectio n Agenc y (EPA) ha s Contracte dPrudent Technologies , lac . (Prudent) , to cleanup lea dcontaminatio n o n variou s residential propertie s includin g you r property . Yo u can hel p wit hthi s activity b y givin g permissio n to conduc t easemen t samplin g an d conduc t cleanup o n your property . I f yo u sign tin s form , Prudent will return i n afe w week s an dperform th e work . W e will coordinate samplin g an dcleanu p withyo u prio r to commencemen t I f

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 aLeadSit e Contrac t Mr . Garvey ca n b e reache da t (402) 731-078 8 It ? 

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### PROPERT Y INFORMATIO N (T o b e completedb y resident and/o r propert y owne r - pleas e prat ) RESIDENTNAHE : V M . C_-£l>—J | | p (r ~ QDwne rQente r RESIDEN T ADDRESS : I FRENTAL . PROPERT Y OWNE D BY . OWNER' S HAILIN G ADDRESS ; OWNER'STELEPHON E NUMBER-HOME : ( ) WORK : J ) AG E O F HOHE7 . YEARS . HO W LON G HAV E Y O LIVE D HERE ? YEARS . HA S TH EEXTERIO RBEE NPAINTE D O RCOVERDE D WITH SIDM GSMCE1978 ? ^YE S N O HA S TH E INTERIO R BEE N PAINTE D O R COVERE D SINC E 1978 7 YE S N O NUMBE R O F OCCUPANT S UNDE R C YEAR S OLD : NUMBE R O F OCCUPANT S 6 YEAR S OL D AN D OLDE R NUMBE R O F CHILDREN T UNDE R 6 YEAR S OL D WH O PLAYI N TH E YAR D FO R 5 HOUR S O R MOR E PE R WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (IE . DOGS . ENTR YGATES . ETC. ) AUTHORITY FO RENVIQRHMEMTA LRESPONS EACTION S Th e activitie s to b e implement s b y EPA unde r thi s agreement are pursuan t to Sectio n 10 4 o f CERCLE . 4 2 U . S.C . 9604 . EPA ' arief r o f acces s to the propat y i s provide dfor i n Sectio n 104<e ) o f CERCLE , 4 2 U.S . C 9605(e) , whic h provide s entr y for "determinin g th e nee dfor response , or choosin g or takin g any respons e actio n unde r thi s title , or otherwis e enforcin g th e provision s o f th e title. "

# £EP A EP A Propert y Clos e Ou t Propert y # : ^ Propert y Address : /£o ? Date/Time : Owner' s Name : £ , AO FO/w/»A,- » Quad s Excavated : Contracto r Grou p Pruden t Technologie s Excavatio nGenera l Ye s N o 1 .I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 

### t / 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 nexcavate darea s generall y slop e awa y fro mth e house ? 

### i / 2 .

Ha s so dbeen lai di n al l area s that were excavated ? 

### i / 3 .

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

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

### S 5 .

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

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

# y 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 nan dclos e freely ? (I f applicable ) 

### / 2 .Wer e al l gate s o r fence s take ndow n durin g restoratio nactivitie s reinstalled ? (I f applicable ) 

### i / 3 .Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) 

### • S 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 .Was damag e to the sidin g or tri mavoided ? 

## V 2 .Wa s damag e t o th e foundatio navoided ? I/ 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 ? / 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 ? 

### I /

### Owner s comments :

Inspectio n notes :

Remova l an drestoratio nactivate s complet e includin g th e 30-da y so dwarranty : EPA Representativ e -,J ~ _Date : IT

## 27124 Owne rName : CjTV^J^OMAH A Address : 160 9 GRAC E S J Phone : H : Sampl e Numbe r RYASCPXA-2712 4 RYBSCPXA-2712 4 RYCSCPXA-2712 4 RYDSCPXA-2712 4 RDZGCPXA'^7 1 2 4 ROZOOPXA-g7ie 4 HPZ3CPXA-27I2 4 F t F2 B 1 B 2 D Z • Q g — P 2 — 

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# SEB V Property Completio n Agreemen t Thi s agreement document s the completion o f remova l activitie s performe do n the belo w listedproperty . Th e propert y owner' s signature indicate s that th e propert y owner i s satisfie dwit hth e restoratio n o f th e subjec t property , an dthat n o item s are i n question , now , o r at an y tim e i n th e future , excludin g an y remainin g warranty (3 0 day s total ) except thos e hem s listedbelow , if any . Propert y ID : Propert y Addres s Owner : M Phone : Restoratio n Item s i n Question :



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O CIT Y FINANC E 1819FARNA M S T OMAH A N E 6818 3 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 15-15-1 3 C/

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http://douglasne.mapping online.com/DouglasCoNe/static/accountinfo.jsp ? accountno=R222892000 0 Disclaimer. Ma p an d parce l dat a ar e believe d t o b e accurate , bu t accurac yi s not 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 = 2 0 fee t appraisal , survey , o rfo rzonin g verification . 

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### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 7/20/200 7

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

## Dougla s County-Omaha , N E

Disclaime rMa p an d parce l dat a ar e believed to b e accurate , bu t accurac yi s not Ma p Scal e guaranteed . Thi s i s not a lega l documen t an d shoul d not b e substitute d fo ra titl e search , 1 inc h = 1 2 fee t appraisal , survey , o rfo rzonin g verification . 

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### Pag e 1 o t 1

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## ^m^mmm . 222893000 0 CIT YO F OMAH A 1845N17S T OMAH A 6811 0 C/

O CIT Y FINANC E 18 1 9 FA R NA M S T OMAH A N E 6818 3



### http://wvAv.dogis.org/dogis_aIias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 7/20/200 7

### Pag e 1 o i

Creat e Anothe rTicke t Bac k t o Irt h Interne t Sen d Emai l 

### YOU RTICKE T NUMBE RI S 1845968 . Origina l Cal l Date : 7/19/0 7 Time : 5:5 7 p m Op : CYNDIE1096 7 Wor k t o Begi n Date : 7/23/0 7 Time : 6:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 160 9 Street : GRAC E S T Twp : 15 NRng : 13 E Sect-Qtr : 15-NE-N W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : Soi l Excavatio n Locatio n o f Work : LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)504-100 5 Compan y: PRUDEN T Contac t Name : CYNDI E TECHNOLOGIE S Phone : (402)504­ 100 4 Wor k Bein g Don e For : EP A Dept h o f Excavation : 13 " Corne r Lot : Involve s Tunnelin g o r Horizonta l Borin g : CXCATV LEVEL S MAGELLANMC I QLNNE1 C N N MU D0 1 Explo Front : N N OMAHACO F sives : Rear : OPPDGPR b

Utility Servic e Are a Contac t Phon e Numbe r Typ e 

### Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I 

### Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 LEVEL 3 LEVEL 3 COMMUNICATIONS , LL C N A 

## Alt : Emerg : 877366834 4 Day : 918574709 8 MAGELLA NMIDSTREA M MAGELLA N TONY A 

### Alt : PARTNER S L P 

### Emerg : 918574709 8 Day : 800289342 7 N O CAL LPE R MC I MC I 

### Alt : MEM O 

### Emerg : 800289342 7 http://www.dhon.org/irtm'ntemet/DHONNoticeCreationyMessageTexl.asp?ret=<RESULTS .. . 7/19/200 7Fin d Recor d 

### Sampl e Area : 2712 4 - 160 9 GRAC E S T Owner : dj Owne rOccupie d Owne rName : j CIT YO F OMAH A Owne rAddressl : 1 |C/ 0 CIT YFINANC E Owne rAddress2 : |1819FARNAMS T City : State : Zi p Code : JOMAH A|N E J6818 3 Owne rPhone : Alternat e Phone : |(402 ) 441-515 0 j(402 ) 444-520 6 Clea n U p Quer y Lea d Remainin g Quer y

Resident : Residen t Name : 

## (VACAN TLOT PropertyAddress : 1609 GRAC E ST Zi p Code : J6811 0 Residen t Phon e 

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## ! Assessmen t Ma xXR F Value : | 87 7

### Pag e 2 of2

METROPOLITA NUTILITIE S MUDO I EDWIN A DISTRIC T

OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE RRO N

OPPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T N A
QLNNE1 C QWES T LOCA LNETWOR K N A 

### Day : 402504782 3 

## Alt : Emerg : 402504794 6 Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 

## Alt : Emerg : 888728934 3 Day : 406728934 3 

### Alt : Emerg : 888728934 3

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