### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 1765 8 DATE : 12/15/201 0 ADDRESS : 232 1 S 2 1 ST REMEDIATIO N CONTRACTOR : PRUDEN TTECHNOLOGIES . INC . YEAR : 201 0 

### SOI L REMEDIATIO N PROPERT

YFIL E FOLDE R DOCUMENT S d PR E AN D POSTVIDE O O F PORPERT Y(DVD ) [ ^ EXECUTIV E SUMMAR Y Q l EPA-PROVIDE D PROPERT YSKETC H 0 SIGNE D ACCES S AGREEMEN TFO R SUBJECTPROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FO R ADJACEN TPROPERT Y 0 RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENT S (I.E. , FO R DAMAG E O R T O REPLAC E PLANTS , ETC. ) m CONFIRMATIO N DAT A 0 / PHOTOGRAPH S c a AS-BUIL TSKETC H d SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT

YOWNE R a PROPERT

YCLOSE-OU TCHEC KLISTSIGNE D B YEP A D DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A d UTILITYCLEARANCE S d PROPERT

YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR' S OFFIC E 

### D D f ^ V w *'^' ' SIGNATUR E DAT E 

### 3026081 3 Superfun dFin d Record Remediatio n Quer yLea d Remainin g Quer y' Propert yDamag e Quer y 

### Backfill : Sampl e Area : 1765 8 - 232 1 S 2 1 S T Owner : D Owne rOccupie d Owne rName : JMANDOLF

O KIMBERL

YJ Owne rAddressl : Owne rAddress2 : |100 6 SKYLIN E D R City : JELKHOR N Owne rPhon e State : Zi p Code : :|N E |68022 - Alternate Phone : 

### ' ^ Contract : Contractor : |PRUDENT2010_ S Contrac t Optio n OPTIO N 1 Use rProvide d Owne rInformatio n Owne rName : Owne rAddress :
City : Owne rPhone : State : Zi p Code :



# '1— ! Alternate Phone :

Assessment : Qualifyin g Grou p l|40 0 Assessmen t Ma

xXR F Valu e i

j 513.5 8 Resident : Residen t Name : Propert yAddress : |232 1 S 2 1 S

T Zi p Code : [68108 - Residen t Phon e 

# J —

### PROPERT Y SUMMAR Y

Date : 12/15/201 0 Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Montl i of : Decembe r Propert y Address ; 232 1 S 2 1 S T A . EXECUTIV ESUMMAR Y A. 1 Issue s Encountered : NON E A. 2 Issue s Resolved : NON E A. 3 Uniqu e Findings : NON E A. 4 Otlie r

Relevan t

Information : NON E CONFIRMATIO NSAMPLIN GDATA/RESULTS : F 2 = 20 5 PP M @ 6" ; B l = 16 0 PP M @ 6" ; B 2 = 16 3 PP M @ 6" ; E A = 12 3 PP M @ 2 " ATTACHMENT S 1 ) Property sketc hprovide db y EPA pursuan t t o contrac t

specification s 2 ) Signe dAcces s Agreemen t includin g acces s agreement s require dfor crossin g othe r

propertie s 3 ) Pre-Excavatio ndigita l vide o clip/photograph s 4 ) Post-Excavatio n digital 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 fma

l leadlevel s v ) Legen d ii ) Contaminatio n lef

t behin darea s vi ) Contracto r identificatio n iii ) Property addres s vii ) Date iv ) BVI D numbe r 7 ) Othe r item s t o b e include di

n th e individual property 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 property owner ) ii ) Property Statu s For

msigne db y property owne r iii ) Excavatio ndigital vide o i n MPEG , WMV (Window s Medi aVideo ) o r SWF(Flas hPlayer ) forma t and/o r photograph s iv ) Signe dfor

mverifyin g satisfactory restoratio n v ) Descriptio n o f

area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOCIES , INC .TECHNOLOGIES , INC .



### Property # : nC?*?* ^ Date/Time : Quad s ExcaviUed : f

Z , ^ < ,^ * 

# EP A Propert y Clos e Ou t Propert y Address : 2 ^2. 1 >-2 i ^T Owner' s Name : \C<rrxWl(j ^ M,a^c/oi(c ' Contracto r

Group : Pruden t

Technologies , Inc. . Excavatio nGenera l Ye s N o I . i f necessan' . wer

e tli e correci quadrant(s ) excavatedandrestored ? / 

### 2 . I f necessarv' . wer

e th e correct

area s o f drip zone e.xcavate

dan drestored ? / 

### Gradin g Sodan dVegetatio n 1 . Doe s tli e grading aroundtlie perimete r o f th e hous e i

n excavatedarea s generall

y slop e awa

y fro mthe house ? 2 . Ha s so dbee nlaidi nall area s tha

t wer e excavated ? Tl . Doe s the sodappea

r to be generall

y health y andgrowing ? (Onl

y evalual e i

f inspecteda

t a30 da y lim e period) 4 . Ar e sodde darea s generally fim

i an devenl y graded ? 5 . Ar e llie joint s betwee

ntlie sodstrip s generall

y light ? (Onl

y evaluat e i f inspecteda

t a3 0 da y tim e period) 6 . Wa s the propert

y gradedsuc

hllia t wate r wil l not pool o n tlie property' ? 7 . Wa s danuig e l o landscaping o

r plan t material s avoided ? Ye s / / / / 

## y y y N o

Gates , Fence s an dRetainin g Walt s Ve s N o 1 . Do gate s ope

n an dclos e freely ' (I

f applicable ) 2 . Wer e al l gale s o r fence s take

n dow n during restoratio n activitie s reinstalled ? (I f applicable ) 3 . Wa s dainag e t o gate s or fence s avoided ? (I

f applicable ) 4 . Wa s damag e 1

0 retaining wall s avoided ? (I f applicable ) / / / / Foundation , Sidin g an dGutter s 1 . Wa s damage t o the siding o

r tri mavoided ? 2 . Wa s damage lo th e foundaiion avoided ? 3 . Wa s damag e t o window s avoided ? 4 . Wa s daniag e t o window s o

r doo r screen s avoided ? 5 . Was damag e t

o downspout s o

r downspou t extension s avoided ? Ye s / ^ / / 

# y y N o

Sidewalk s an dDriveway s (Concrete ) Wa s damag e t o drivcwfi v surface s avoided ? Ye. s N o 

# ~7 ^ 2 . Wa s damage t o walkwa y surface s avoided'! "

## Owner s connments :

Inspectio n notes :

Remova l an drestoratio n activate s complete includin g th e 30-da y sodwarranty : EP A Representativ e S< ^ ^^ ^ ^Date: ///iy/.- ^tCHNOLOGIES . INC .

OL S #1765 8 Dat e Excavated : 09/22/201 0 I SEP.ASigned-Of

TDate : 

## AS - BUILT DRAWIN G

OMAH A LEAD SUPERFUND SIT E 1765 8 Owne rName : JOH

N COMSTOC KOmah a Lea d Sit e Address:232iS2iS T_Sit e Sketc h Phone : » •402-933-677 9 W 402-250-230 0 Exterio rPain t • Goo d n Poo r 1 3 Not pain t North Arro w Sarr.pl e Numbe r RYASCPXA-1765 8 F l RYBSCPX/^-1765 8 F2 RYCSCPXA-1765 8 B l RYDSCPXA-1765 8 B2 -Re-zseP)tA-w66e—9 Z nCZSCPX A17668 G 2 RPgOCrXA-1705 Q FC Lea d Concentratio n 2 TZ , w?- ^ HO(j Ho q
— — pp m pp m pp m pp m pp m pp m pp m Sampl e Collecte d 

### D D D 

# a D D 

# n D D D Numbe ro

f Sample s = M Firm : Oate : Time : Sample s Collecte d J^Ct^ . f ^ r c / o • ^-ci c Sample s Analyze d XR F Uni t tao l Bock : J7- ^ Date - /C>-/ 9 -jg g Time : P m Staff : Al<i>, / Legend : F l = Fron t Lef t F 2 = Fron t Right , B l = Bac k Left , B 2 = Bac k

Righ t DZ = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a s viewe d fro m th e street , facin g propert y

i.<y.b .
B l = 16 0 PP M (2 ! 6 

# y r

• / > ^-<i (


### r\ • • • fr 

### OC T 

# <m .; . cii'iS^ ^

8 2 = 16 3 PPM ®

6 " 

### •isZ'/sy i 5

c

\ 1 / 

## '-izy. F

2 = 20 5 PP M @ 6 "

i 

## F

2 .i&ZQli*w... ' 5^ 1 S h E A = 123PPM(2>2 - 1 ^ '

CONTRAC

T# : EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC .

## Propert} / ComplBtm n Agr®em©ot Ti!i 5 S.gfCefhcjTt

doCiiiiicrit S il'i c COliipietiOi i o t i'ciiiova l acuviiic s pcrioiTric dOi J t.hf c btJiO' w jiStc dpi'OpcjT/ . 

### Th e p.ropei-t> ' owner' s signatur e indicate s tha t the - propert y ov\'ne

r i s sarisfie dvvit

hth e restoratio nofth e .subject ; properijy- . an dthat n o item s ar e i

n question , now. , o r

a l any tim e i

n th e future , excludin g any remainin g warrants ' (3 0 day s tota) ) excep t thos e item s li.stedbeiow , i f any . j Propert y Propert y Ownsr; : Ptione ; ID ;

,4ddrass ; 

## \/C / 'M . ' 

## fOX 

## i 

## ^23yyi i ^GT/lii f 

## IbS l

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## ry / Sr - ^/l/yj c Lf^ 6 

## ^6?- ^ ? 9 9'i^ ' 1 • 1 Restcraiiiiiorn i litem s 5

^ QtiestLJort



### Reqwiired i correctooni s to complet e th ® propeBty: .

j/v ' i agre e restoratio n I s compieied , excep t a s note d above .

. 1 ^ - i a o no t agre e restoratio n i s complgte d

^ ' /AC - I 

# /7'//V ^ .Daii e!f\:l!^;:5 > l\] .

Pruden l -rcchnologies , Inc . (Prudent ) i s unde r contrac t withth e U . S . Environmema l Protectio n Agenc y (£PA ) t o clean u p lead contaminate dsoil s a l anushe r ol " Djflpertie s locate di

n Omaha , Nebraska , includin g th e property locaie da t Th e EPA request s you r

permissio n to allo w Pruden t t o perfor masoi l cleanu p a

t Ihi s profWns''t5>eVnove1ead-coWtaminated'soi l B y signin g thi s form , th e property owne r grant s permissio n l o Paiden l t o pcrforni activilie s relate dt o th e cleanu p includin g soi l samplmg , remova l o f lead-contaminate dsoil , an drestoratio n o f .he reference dproperty . Ifyo u hav e an y question s abou t th e soi l cleanu p planne dfor you r property , pleas e contac t

Pruden t . • '•.!•-, --.-. : )i.-:. - fo r the Omah a LeadSit e cleanup , a

t (402 ) 733- 1 188 ; 733-1455 . Genera l question s abou t th e Omah aLeadSil e cleanu p can b ; directe dt o the EP A Publi c Informatio nCenter s a t (402 ) 731-304 5 (Sout

hOmaii aoffice) . Propert yAcces s Grante d By Property Owne r

Signature : 

# ^ < f m^tjJ o Lf o

(Pleas e Prin t

Name ) 

# f' ^ (Dale ) PROPERT YINFORMATIO N (T o b e complete d b yresiden t and/o rpropert yowne r- ple.is e print ) RESIDEN T NAM E RESIDEN T ADDRES S Rente r ^unESS : . _ ^ ^

_„ g CENTAL , PROPERT YOWNE D BY : ^ OWNER' S MAILIN G ADDRESS ; 

# /an ^ S/ri//-/ju €

•7)/e - ei/cyihicjo , Ale , c%o7' ^ OWNER' S TELEPHON E NUMBE R - HOME : ^Or2 \ Bl^^-^/i O /

/ WORK : AG E O F HOME? : T ^ YEARS . HO W LON G HAV E YO U LIVE D HERE ? 

## O YEARS . HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978 ? YE S N O f ^ ^ ; NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : ^ NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLA YI N TH E YAR D FO R 5 HOUR S O R MOR E PE R WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. )

AUTHORIT Y 1-O

RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s to b e implemenle db y EP A .uider thi s agreemen t ar e pursuan t

t o Sectio n10

4 ofCERCLA , 4 2 U.S. C 9604 . EPA' s righ t o f acces s t o th e property i s provide dfo " i n Sectio n I04le ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry for "determinin g th e nee dfor response , o r

choosin g or

takin g any respons e actio n unde r thi s tale , o r

otherwis e enforcin g th e provision s ofth e title. "

30S0V-VO:L - P-:y,- ; Asnsa s C.i > V. C

# iRUDRN I TECHNOLOGIES , INC . E^VlRO^ME^TALX • CONSTRUCTIO N SERVICE. S 

# Propert y Statu s For m, Address : ^ 3 j2. ( < £J 2 ) S ^ ^T ^ ^^*^ - 7 /^/^ ^ / ^ Phone : BVID : 

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# P opert y Owne r ignatur e Pruden t Emp^ye e Signature :

Mnptoye e ^ 808 0 War d Parkvi/ay . Suit e 4 Kansa s City , M O 6411 4 Phone : (316 ) 353-370 3 560 0 S 1 0 S I Omaha , Nebrask a 6810 7 Phone : (402 ) 733-118 S 424 2 Medica l Drive . Suit e 425 0 Sa n Antonio , TX7822 S Phone : (210 ) 822-95S 8

### 1765 8

Owne rName:JUMN<;ows-oc K Ad*«»:aaiiS2ia r Phone : " 4Di93a.C7T 9 tv>iQ2.2»,3.-)n o Omah a Lea d Sit e Sit e $kotc h Eite-k p Pain l

• f'fiOf •_h«t^>'' : Sarrpl B Numbe r L«a d Concenlralio n Sampi e

Colecie d RYASCPXA-17e5 8 RVBSCPXA-1T65 8 RYCSCPXA-176S a RYDSCPXA-1765 8 -R«2'S6PXA^?e6 a <M I -ftpzaeP K n F 2 0 1 0 2 pp m

np- n nfprr i oprr . sp m pp m r<uin(ie f o l Saitipvs s • 2 T i . <^? ^ HOi P 4 c q

_ — D

D 

# a LA B 

## a a D D Q 

# n a SanipV: ! CcllSCt M

Firm , t" ^

F}? > T. c Dale , /i- i </-C( , T4X\6 . ^/-y p ?•" }
XR F Unn . JO0 7 DOCU L j 7 ^ Dat e J O - /< i -Dt ) Tim e Prt- j Staff-asi/: ^ leiiend : F t >

• FroMlell . F

2 - Fri>;il.«?iijhl , B ; = Bac k Left , Q 3 ^ &ir> ; fiigtitO? = ni( p iono . G i = Gsrdon , P i - Pl3 y A l t;M(ii»il > » va

s *K*e d i'v n iji t atvcl , ra:4i g pro;«ft f 

## SNT.I5.EED

# A 232 1 S2 1 ST : 47X55. 7 Printed : De c 03 . 201 0 www . dcgis . org/dogi s" > 

### Pag e 1 of 2

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

### YOU RTICKE T NUMBE RI S 2590959 . Origina l Cal l Date : 9/13/1 0 Time : 4:1 8 pm Wor k t o Begi n Date : 9/15/1 0 Time : 4:4 5 p m State : N E Address : 232 1 County : DOUGLA S Street : S 21S T S T Op : SIVA1896 7 Place : OMAH A Twp : 15 NRng : 13 E Sect-Qtr : 27-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d soi l remediatio n projec t Locatio n o f Work : LOCAT E ENTIR E PROPERT Y Remarks : FA

X AL L CLEAR S TO : (402)733-188 3 : UNSUR E CORNER S Compan y: PRUDEN T TECHNOLOGIE S Contac t Name : SIV AJAMPAMA 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 Rear : Y Involve s Tunnelin g o r Horizonta l Borin g . : NExplosives : N ALT87 2 ATTNEBR l CXCAT V LEVEL 3 MUD0 2 OMAHACO F 0PPDGPR 6 PAETE C QLNNEI F Servic e Are a ALT87 2 WINDSTREA M

COMMUNICATIO N
ATTNEBR l ATT/T Contac t EL M LOCATIN G

CXCAT V

LEVEL S CO X COMMUNICATIONS ,

IN C
LEVEL S COMMUNICATIONS , LLC HEID I

N A Phon e Numbe r 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 8002413624 9 /yt : Emerg : 8002413624 9 Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 Alt : 

### Emerg : 877366834 4 Utility Typ e



### http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 9/13/201 0Pag e 2 o f 2

MUD0 2

OMAHACO F

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DISTRIC T CIT Y O FOMAHA TRAFFICSEWE R OMAH A PUBLI C POWE R DISTRIC T SAND Y

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PAETE C PAETE C COMMUNICATION S EL M LOCATIN G
N O NEE D T O CALLOU T EMERGENC Y QLNNEI FQWES T LOCA LNETWOR K ELM LOCATIN G Day : 402504782 3 Alt : Emerg : 402504797 0 Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 800289190 1 Alt : Emerg : 800289190 1 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

http://www.dhon.orR/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 9/13/201 0

## TEeHNimasss , mc . ENVIRONMENTAL ENGINEERIN GAN

D CONSTRUCTIO N SOLUTION S 

## SIT ESAFET Y HAZAR D ANALYSI S Address : Crew : Excavatio n Date : Backfil l Date : 

# • V^/// o

Ite m Overhea dLine s Ga s Lin e Wate r Lin e Sewe r Lin e Septic/Leec h Fiel d Propane^ntan e Sidewal k Foundatio n Retainin g Wall s Fence s Tree s Structure s Drivewa y Sprinkle r Syste m Othe r Conditio n \tljiljj'^"Sf* ^ ^ryt^-^ ^ .y^^i i %\j<-\ji. d 

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## rv / laAJ l n Hazard s TNJTT P 

## Correctiv e Actio n

Cre w Forema n Sit e Safet y Offic e Date :

808 0 Wait f Paftaray . Sut e 40 5 Kansa s Gily , ••0«411 4 PfMne : ^6 ) 363'370 3 Fa c(8ffi ) 363-370 7 560 0 SI O S t Omaha , NdMask a 6810 7 Phone : (402)733-11S 8 Fax : (402)733^188 3 424 2 Medica l Drive , Suit e 725 0 Sa nAntonio , T

X 7822 9 Phone : (2t0 ) 822.-.S58 8 Fax : (210 ) 579-657 7

# \/l8/^o/ o