### TRANSMITTA L o f OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAE)# : 2^62- ^ Date : [ ? [iS|Q i Address : \vt> ^ 73^P^/I ^ 

### 9 ^ Remediatio n Contiactor : PTO ^ A , ^ ^sA . -S>nc^ Year : ^ 0 T SOI L REMEDIATION PROPERTY FIL E FOLDE RDOCUMENT S e

f

Vide o o f propert y (DVD ) E Executiv e Summar y E

f

EPA-provide dpropert y sketch 0 Signe dAcces s Agreemen t fo r

subjec t propert y D Signe dAcces s Agreement(s ) fo r

adjacen t propert y 0 Restoratio n Agreemen t D Settlement document s (i.e. , fo r

dam^^ e o r t o replac e plants , etc. ) aConfirmatio n dat a 0 Photograph s n

f

As-built sketc h Satisfector y restoratio n signe db y Propert y Owner Propert y close-otr t check lis t signe db y EP A D Descriptio n o f area s no t meetin g RO D cleanup criteri a 

# d Utilit y clearance s 

# d Propert y informatio n fromDougla s Count y Assessor' s Of&c e D D D 

### z/gji o Signatur e y ^ DSi " 3005412 9 

# ni l Superfun dRn d Record Remediatio n QueryI Lea d Remainin g Quer yI Propert yDamag e Query Backfill :

Sampl e Area : 2652 4 - 300 9 DECATU R S T Owner : n Owne rOccupie d Owne rName : JHATHEL D RAYMON D B Owne rAddressl : 

# r Owne rAddressZ : 

# I 300 9 DECATU R ST State : Zi p Code : City : [ N E |6811 1 jOMAH A Owne rPhone : Aitemat e Phone : |(402 ) 933-548 8 |(402 ) 733-840 1 Resident : Residen t Name : |HATI=IEL D RAYMON D B Propert yAddress : [300 9 DECATU R ST Zi p Code : |6811 1 Residen t Phon e 

# I Contract : Contractor : |PRUDENT2009_S Contrac t Optio n OFnON 2 Assessment : Qualifyin g Grou p 40 0 Assessmen t Ma xXR F Value : I 456 '

# 0 iHHUbinipWfliivy *M i wimii»iiB y Date : 12/15/200 9 Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l Mont h of : November Propert y Address : 300 9 DECATURS T A . EXECUTIV E SUMMAR Y A. 1 Issue s Encountered : NON E A. 2Issue s Resolved : NON E A. 3Uniqu e Findings : NON E A. 4 Othe r Relevan t Information : ARE A NOT EXCAVATE D B Y PO' S REQUES T DZ/LS l'X3 ' 367 PP M @ SCRAP E CONFIRMATIO N SAMPLIN G DATA/RESULTS : B 2 = 25 7 PP M @ 8" ; F l = 12 8 PP M @ 6" ; D Z = 14 8 PP M @ 12" ; EA = 13 1 PP M @ SCRAPE (~1 ) ATTACHMENT S 1 ) Propert y sketch providedby EP A pursuan t to contract specification s 2 ) SignedAcces s Agreemen t including acces s agreement s require dfo r crossing othe r propertie s 3 ) Pre-Excavation digita l vide o clip/photograph s 4 ) Post-Excavatio n digita l vide o clip/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Buih sketch
i ) Shall includ e final lea dlevel s v ) Legen d ii ) Contamination lef t behindarea s vi ) Contractor identification iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e includedi n th e individua l propert y file, if available , o r obtainedinclude : i ) Pre-excavation agreemen t detail s (i f an y ar e mad e wit h th e propert y owner ) ii ) Propert y Statu s For msignedb y propert y owne r iii ) Excavation digita l vide o i n MPEG , WM V (Window s Medi aVideo ) or SW F(Flash Player ) forma t and/or photograph s iv ) Signedfor mverifying satisfactor y restoratio n v ) Descriptio n o f area s no t meeting hiteri mROD cleanu p criteria .

7miHNDiaKieE$,IH< LTECHNOLOGIES , INC . Propert y # : 9-4S2- ^ Date/Time : Quad s Excavated : F ) i fil.^ p ^ 

## EP A Propert y Clos e Ou t Propert y Address L "ICC^ J^oyJu/ ^ ^ Owner' s Name : (/^( ^ l4«i'^vd4 . Contracto r Group : Pruden t Technologies , Inc , Excavatio n Genera l Ye s N o 1 .

I f necessary , wer e th e correct qiiadranl(s ) excavatedandrestored ? / 2 .

I f necessary , wer e th e correct area s o f drip zone excavatedandrestored ? / Gradin g So dan dVegetatio n Ye s N o 1 .

Doe s the grading aroundthe perimete r o

f the hous e in excavatedarea s generall y slop e awa y fro mthe house ? 

## y 2 .

Has sodbeen lai di n all area s tha t wer e excavated ? 

## y 3 .

Doe s the sodappea r to b e generall y health y andgrowing ? (Onl y evaluat e i

f inspecteda t a3 0 da

y tim e period) / 4 .

Ar e sodde darea s generall y fir mandevenl y graded ? / 5 .Ar e the joint s betwee n the sodstrip s generall y tight ? (Onl y evaluat e if inspecteda t a3 0 da y / tim e period) 6 .

Wa s the propert y gradedsuc h tha t wate r will not pool on the property ? / 7 .

Wa s damage to landscaping o r plan t material s avoided ? / Gates , Fence s an dRetainin g Wail sYe s N o 1 .

Do gate s ope n andclos e freely ? (I f apphcable ) / 2 .

Wer e all gate s o r fence s taken dow n during restoratio n activitie s reinstalled ? (I f applicable ) / 3 .

Wa s damage t o gate s o r fence s avoided ? (I f applicable ) / 4 .

Was damage to retaining wall s avoided ? (I f applicable ) / Foundation , Sidin g an dGutter s Ye s N o I .Wa s damage t o the siding o r trimavoided ? / 2 .

Wa s damage t o the foundation avoided ? 

# J 3 .

Wa s damage t o window s avoided ? y 4 .

Wa s damage t o window s o r doo r screen s avoided ? 

# y 5 .

Was damage t o downspouts o r downspou t extension s avoided ? 

## y Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 .

Wa s damage to drivewa y surface s avoided ? 

# y ^ 2 .

Wa s damage t o walkwa y surface s avoided ?

### Owner s comments :

Inspectio n notes :



## I Remova l andrestoratio n activate s complet e includin g th e 30-da y so dwajrranty : i EP A Representativ e Bon^M j ^Date: uki/o f

# «EF W
! Propert yCompletio n Agreemen t Thi s agreement document s th e completion 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 h th e restoratio n ofth 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 (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y Addm. : ^^f l O q ^^ f r-^U. ^ S ^

_

Owner ; 

# [3 6 2 ^ K>^J?- ^ 

# Id . Phone : L Restoratio n Item s i n Question :

Require dcorrection s t o complet e th e property :

H^ l agre e restoratio n i s completed , excep t a s note d above . L J I d o no t agre e restoratio n i s complete d

Cwvne i ignat u 

### •' K y ner' s Signature ' DatePruden t Technologies , Inc . (Prudent ) is unde r contrac t wit h th e U. S. Environmenta l Protectio n Agenc y (EPA ) to clea n up lead
contaminate dsoil s at anumbe r ofpropertie s locate din Omaha , Nebraska , includin g th e propert y locate d at

. Th e EP A request s you r permissio n to allo w Pruden t to perfor masoi l cleamq } at thi s property to remov e lead-contaminate dsoil . By signin g thi s form , th e property owne r grant s pennissio n to Pruden t to perfon n activitie s relate d to th e cleanu p includin g soi l sampling , remova l of lead-contaminate dsoil , an drestoratia n of th e reference dproperty . If

yo u hav e an y question s abou t th e soi l cleanu p planne dfor you r property , pleas e contac t Prudent' s Administrativ e Cler k fo r th e Oinah aLea dSit e cleamy . Ms . Siv a S. Jampana-a t (402 ) 733-1188 . Genera l question s abou t th e Omah aLea dSit e cleaniq> ca n be directe d to th e EP A Publi c Infonnatio n Center s at (402 ) 73 1 -304 5 (South Omah aoffice ) or (402 ) 991-958 3 (Nort h Omah aofBce) . Propert yAcces s Grante d By : \{f\^\n\OP D "^ ff\Pl{lS.Hf i \\f)TFl E "JlegaePrin t Name ) L1 > Propert y Owne r Signature :

RESIOEN T NAIME : (Date ) YAa/loV\ aCS \i4(3cdltaJ ) fl 9 " CX J ' Q Q (SignatJre ) PROPERT Y INFORMATIO N (T o be compkte d byretiden t and/o rpropert yowne r— pkat e print ) ±ie.J C .-^ H . R . H oJrp^f^^^n.r.. . AODRESS : RESIOEN T T AODRESS:- ^ _, < i « / \ fv- . , r ^
IF RENTAL , PROPERT Y OWNE D BY :
OWNER S MAILIN G ADDRESS ;
OWNER' S TELEPHON E NUMBE R - HOME : _LMUJ - QlZyWORK :
AG E OF HOME ? : ^ 0 YEARS . HO W LON O HAV E YO U LIVE D HERE ? J ^ YEARS .

J)«8 - ^ O ^ ^ HA S TH E EXTERIO R BEE N PAINTE D OR COVERE D WTT H SIDIN G SINC E 1978 7 . NUMBE R OF OCCUPANT S UNDE R 7 YEAR S OLD : O NUMBE R OF OCCUPANT S 7 YEAR S OL D AN D OLDE R > NUMBER OF CHILDRE N UNDE R 7 YEAR S OL D WH O PLA YIN TH E YAR D FO R 5 HOUR S OR MOR E PE R WEEK : COMMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA L RESPONS E ACTIONS : Tb e activitie s to be implemente d by EP A unde r this agreemen t ar e pursuan tto Sectio n 10 4 ofCERCLA , 42 U.S.C . 9604 . EPA' s righ t of

acces s to th e property is provide dfor in Sectio n 104(e ) of CERCLA , 42 U.S . C 9605(e) , whic h provide s entry for "determinin g th e nee dfo r response , or choosin g or takin g an y respons e actio n unde r thi s title , or otherwis e enforcin g th e provision s ofth e title. "

808 0 War d Parkway , Suit e 40 5 250 5 N. 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 KansasCity , MO6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7ENVIROMVIENTA L & CONSTRUCTIO N 

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### Prin t Preview Page 1 of 2 Dougla s County-Omaha , N E

Pame l I D Owne r Nam e Propert y Addres s City Zi p Owne r Addms s Owne r Addres s Owne r City Owne r Stat e Owne r 211169000 0 HATFIEL D RAYMON D B 300 9 DECATU R S T OMAH A 6811 1 300 9 DECATU R S T OMAH A N E 6811 1 Additio n Bloc k Lo t Lega l 1 Lega l 2 Lega l 3 Legal 4 Acre s Tmasum r Websit e Lin k Assesso r Websit e Un k REED S 3R D AD D 4 2 50X127. 5

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### Pag e 1 o f 2

" > } Creat e Anothe rTicke t j | Bac k t o Irt h Interne t ] Sen d Emai l



### • YOU RTICKE T NUMBE RI S 2361702 . Origina l Cal l Date : Wor k t o Begi n Date : 9/11/0 9 9/15/0 9 Time : Time : 8:3 6 a m 9:0 0 a m Op : SIVA1896 7 State : N E Address : 300 9 County : Street : DOUGLA S DECATU R S T Place : OMAH A Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 16-NE-N W Sect-Qtr : Typ e o f Work : SOI L LEA D REMEDIATIO NPROJEC T Locatio n o f Work : LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)733-188 3 : FA X AL L CLEAR S T O (402 ) 73 3 188 3 : UNSUR E CORNER S Compan y: PRUDEN T TECHNOLOGIE S Contac t Name : SIV AJAMPAM A Piione : (402)733-118 8 Wor k Bein g Don e For : EP A Dept h o f Excavation : 6 F T Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL 3 MUDO l OMAHACO F 0PPDGPR 5 QLNNEIC Servic e Are a Contac t Phon e Nunibe r Utilit y Typ e Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 LEVEL S LEVEL S COMMUNICATIONS , LL C N A Alt : 

### Emerg : 877366834 4 Day : 402504782 3 MUDO l METROPOLITA N UTILITIE S DISTRIC T SAND Y Alt : 

### Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO N Alt : 402444516 1 Emerg : 402444516 0 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/11/200 9

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0PPDGPR 5 OMAH A PUBLI C POWERDISTRIC T N A Day : Alt : 406728934 3 406207149 4 Emerg : 888728934 3 QLNNEI C QWES T LOCA L NETWOR K N A Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3



### http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 9/11/2009ENVIRONMENTA L & CONSTRUCTIO N 

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