## TRANSMTTTA L o f OMAH A LEA D SH E SOI L REMEDLVTIO N FIL E FOLDE R SAI D # : 60 ) Date : loll<^n ^ Address : 9-1C7) / S I ^ Xh Remediatio n Contractor : /^3^ . ^ 0^, / > T^c , Year : -2^0 ^ SOI L REMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S
^ Vide o o f propert y (DVD ) ____^__ iz

f Executiv e Svunixiar y E

f EPA-provide dpropert y sketc h 0 Signe dAcces s Agreemen t fo r subjec t propert y D Signe dAcces s .^reement(s ) for adjacen t propert y E

f Restoratio n Agreemen t E

f Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) 0 Confirmatio n dat a e

f Photograph s e

T As-b\jil t sketc h S

l Satisfectory restoratio n signe db y Propert y Owne r ^ Propert y close-on t chec k lis t signe db y EP A D Descriptio n o f area s no t meetin g RO D cleanu p criteri a aUtilit y clearance s 

### E Propert y informatio n fromDougla s Count y Assessor' s Offic e D D D Signatur e Dat e 3005427 8 

# inimii i Superfun dRn d Recor d Backfill :

Sampl e Area : 60 1 - 2501 S 1 2 S T Owner : D Owne rOcaipie d Owne rName : [SMIT H 3AS0 N A Owne rAddressl : Owne rAddress2 : |250 1 S 1 2 S T City : State : Zi p Code : (OMAH A |N E |6810 8 Owne rPhone : Alternat e Phone : 

# 1 1 Remediatio n Query I Lea d Remainin g Query I

Resident : Residen t Name : 

# r Propert y Address : )250 1 S 1 2 S T Zi

p Code : |6810 8 Residen t Phon e 

# I Propert y Damag e Query I

Contract : Contractor : |PRUDEI^r2009_ S contrac t Optio n [OPTIO N 1 Assessment : Qualifyin g Grou p 400/CHIL D Assessmen t Ma xXR F Value : I 549. 2

## mmaxmswmBUBiiMs ^ Date : 10/15/200 9 | Omah aLea dSite Remedial Actioi i Contrac t #EP-R7-07-0 6 TO# l | Month of : Septembe r Propert y Address : 250 1 S 1 2 S T A . EXECUTIV E SUMMAR Y A. 1 Issue s Encountered : NON E A. 2 Issue s Resolved : NON E A 3 Uniqu e Findings : NON E A. 4 Othe r Relevan t Information : NON E CONFIRMATIO N SAMPLIN G DATA/RESULTS : F l = 74 PP M @ 10" ; D Z = 69 5 PP M @ 13" ; E A = 13 2 PP M @ SCRAPE (~1" ) ATTACHMENT S 1 ) Propert y sketch providedb y EP A pursuan t t o contrac t specification s 2 ) SignedAcces s Agreemen t including acces s agreement s requiredfo r crossing othe r propertie s 3 ) Pre-Excavation digita l vide o clip/photograph s 4 ) Post-Excavation digita l vide o clip/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Buih sketch
i ) Shall includ e fina l 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-excavatio n 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 msignedby propert y owne r iii ) Excavation digita l vide o i n MPEG , WM V (Window s Medi aVideo ) or SW F(Flas h Player ) forma t and/or photograph s iv ) Signedfor mverifying satisfactor y restoratio n v ) Descriptio n o f area s not meeting InterimRO D cleanu p criteria .

THEHNOIQCKS.IINC .TECHNOLCX;iES.INC . 

# SEP A EP A Propert y Clos e Ou t Propert y # : 6 o ^ Propert y Address : 2S 0 | S )2 . firf Date/Time:^
- Z^~^ ^ Owner' s Name : "^e^-^ov ^ ^n^^^ ^ Quad s Excavated : ypfVZ
- Contracto r Grou p Pruden t Technologie s Excavatio n Genera l Ye s N o 1 .

If necessary , wer e th e correct quadrant(s ) excavatedan drestored ? ^ 2 .I f necessary , wer e th e correct area s ofdri p zone excavatedan drestored ? ^ / Gradin g Sodan dVegetatio n Ye s N o 1 .

Doe s th e grading aroun dth e perimete r ofth e hous e i n excavatedarea s generall y slop e awa y fromth e house ? 

# y 2 .Ha s sodbee n laidi n all area s tha t wer e excavated ? ^ 3 .

Doe s the sodappea r to b e generall y health y an dgrowing ? (Onl y evaluat e if inspecte da t a3 0 da

y tim e period) / 4 .

Ar e sodde darea s generall y firman devenl y graded ? v / 5 .Ar e th e joint s betwee n the sodstrip s generall y tight ? (Onl y evaluat e i

f inspecte da t a3 0 da y / time period) 6 .Wa s th e propert y gradedsuc h tha t wate r wil l not poo l o n th e property ? / 7 .

Was damage t o landscaping or 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? (If applicable ) » / 2 .

Wer e all gate s or fence s take n dow n durin g restoratio n activitie s reinstalled ? (If applicable ) / 3 .

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

Was damage t o retaining wall s avoided ? (I f applicable ) / Foundation , Sidin g an dGutter s Ye s N o 1 .

Was damag e t o th e siding o r trimavoided ? 

## V 2 .Wa s damag e t o th e foundation avoided ? / ^ 3 .

Was damage t o wandow s avoided ? 4 .

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

## y 5 .Wa s damage to downspouts or downspou t extension s avoided ? 

# J Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Wa s damag e t o drivewa y surface s avoided ? / 2 . Was damage to walkwa y surface s avoided ? ^

### Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complet e includin g th e 30-da y so dwarranty : EP A Representativ e B ^ ^ Date : ^h*t/o ^^•^^^^^• ^ ''14 . • 

## Propert y Completio n Agreemen t Thi s agreemen t documents 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 owner i s satisfie dwith th e restoratio n o f th e subjec t property , an dtha t n o item s ar c i n question , now , o r a t an y tim e i n th e future , excludin g any remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y ID : Propert y Address : ol^C^ J 5 " 

# / A >/-
- Owner : )j^^ ^ <JM7TH- ' 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 :

agre e restoratio n i s completed . I I d o no t agre e restoratio n i s complete d a t (note d deficiencie s above ) 

# 1 - /V- ^ Date IPruden t Technologies , Inc . (Prudent ) i s unde r coatrac t with th e U . S . Envirwinienta l Protectio n Agenc y (EPA ) t o clea n u p lead
contaminate dsoil s a t anumbe r ofpropertie s locate di n Omaha , Nebraska , includin g th e propert y locate da t

. Th e EP A request s you r permissia n t o allo w Pruden t t o perfor masoi l cleanu p a t thi s propert y t o remov e lead-cantaminate dsoil . B y signin g thi s form , th e property owne r grant s permissio n t o Pruden t t o perform activitie s relate dt o th e cleanu p includin g soi l sampling , remova l o f lead-cantaminate dsoil , an drestoratio n ofth e reference dproperty . I f

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 Prudenf s AJinnii^ h mi , c I.JL I ^.

_fo r th e Omah aLea dSit e cleanup , JVls^'i i u > J>...'."IiJl2i!Ui ! -a t (402 ) 711_:1 1 sx . Genera l question s abou t th e Omah aLea dSit e cleanu p ca n b e directe dt o th e EP A Pubh c Informatio n Center s a t (4Q2 ) 731-304 5 (South Omah aoffice ) o r (402 ) 991-958 3 (North Omah aoffice) . Propert y Acces s Grante dBy : 

# W<^^I^ii ^ Propert y Owne r Signature ; 

# -f'-il' ^ (Signature ) (Date ) PROPERT Y INFORMATIO N ' (T o b e complete db y residen t and/o r propert y owne r — pleas e print ) RESIDEN T NAME : /OflL^Py N Ss7'^/>> ^ ^ C Owne r^ Rente r RESIDEN T ADDRESS :
I F RENTAL , PROPERT Y OWNE D BY :
OWNER' S MAILIN G ADDRESS ; ^33 - OWNER' S TELEPHON E NUMBE R - HOME : J L WORK : . ' \ • ^ 

# s AO E O F HOME? : ( /f p YEARS . HO W LON O HAV E YO U LIVE D HERE ? ^ YEARS . HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978 ? \^.i(t S N O 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 

# _s NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLA Y I N TH E YAR D FO R S HOUR S O R MOR E PE R WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA L RESPONS E ACTIONS : Th e activitie s t o b e implemente db y EP A unde r this agreemen t ar e pursuan t t o Sectio n 104 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f

acces s t o th e propert y i s provide dfo r i n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic h provide s entry fo r "determinin g th e nee dfor response , o r choosin g o r takin g an y respons e actio n unde r thi s title , o r 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 , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Ptione : (816 ) 363-370 3 Phone : (402 ) 504-100 4 Phone : (210)822-958 8 Fax : f816 1 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7ENVTROlVfMENTA L & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Date : ^/3 I t<*« t Phone ; Q(" ? - 5 H H BVID : Ite mN O Plant s & Permanen t Landscapin g T o Remai n I n Plac e O n Ma p Descriptio n & Locatio n 

# ?

z SVe^i'^^^ ^ ^ SvvAoJli l -Uetf . KX^ee ^ k > bu L ^oju.eJ [ 

# p 3 Pre-Existin g Conditio n o f

Structure s DoesyourBasemen t hav e ahistory o f

leaking ? Ye s N o Ite mN O Descriptio n & Locatio n O n Map

Propert y Owne ; Pruden t Employe e ^'•"''' ^ ~~ ^ Signature : Signature : 

# Xs0c^-- ^

808 0 War d ParkwMr . Siiit p 40 S '><;n< ; M Oii' ^ <itr<»o » c..ifr « tn o .• T Jr t H J I 1; .

### 60 1 FCTTKnrnniF.s . i\ c 

### A S - BUBL T DRAWIN G Or,S#:60 1 Dat e F.via>utwl : (lS/21/2UIJ9 

### OMAHA LEAD SUPERFUND SIT E I SKP. \SIsncd-Of f Date :

Exteno rPain t Nort h Arro w Omah a Lea d Sit e Owne rName : • Good Sit e Sketc h Address : 250 1 S1 2 S T 

## A • Poo r Phone : H : W : • No t pain t Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Firm : _ Sample s Collecte d Sverdru p RYASCPXA-60 1 Y A 356. 6 pp m D Date : _ RYBSCPXA-60 1 Y B 33 4 pp m 

## n Time; . RYCSCPXA-60 1 RYDSCPXA-60 1 Y C Y D 337. 2 549. 2 pp m .pp m 

### 1 ^ 12

1 

## n a Sample s Analyze d RDZSCPXA-60 1 D Z 3507. 2 pp m 

## a XR F Un i l : Boo k RGZSCPXA-60 1 G Z 224. 8 .pp m B D Date: . 10/10/199 9 RPZSCPXA-60 1 P Z 38 2 6 .pp m Numbe ro f Sample s = 7 

## a Time: . Staff : 10:4 4 Legend : Y A = Yar d (NE) , Y B = Yar d (SE) , Y C = Yar d (SW) , Y D = Yar d (NW) , D Z = Dri p Zone , G Z = Garden . P Z = Pla y

E

A = 13 2 PP M a Sf.RAPF . (~1" )

Pi^V&WAf 

### LOCATIOKS HC n NCTE P

CONTRA a # : E P - R7-07-0 6 T0# 1 PRUDEN T TECHNOLOGIES , INC .• • 

## 60 1 Exterio rPain t Nort h Arro w Omah a Lea d Sit e Owne rName : • Goo d 

### Sit e Sketc h Address : 250 1 s 1 2 S T W : 

### D P°°' ^ Phone : H : 

# [ • No t pain t 

# t Sampl e Numbe r RYASCPXA-60 1 Y A Lea d Concentratio n

356. 8 pp m Sampl e Collecte d 

## E l LA B 

# a Firm : Date : Sample s Coliecte d Sverdru p RYBSCPXA-60 1 Y B 334 pp m 

# a Time : RYCSCPXA-60 1 RYDSCPXA60 1 Y C Y D 337. 2 549. 2 po m pp m 

# a a Sample s Analyze d RD2SCPXA-60 1 D Z 3507. 2 pp m 

# a XR F Uni t Book : RGZSCPXA-60 1 G Z 224. 8 pp m 

## D Date : 10/10/199 9 RPZSCPXA60 1 P Z 392. 6 pp m 

## 0 D Time : 10:4 4 Staff : Numbe ro f Sample s = I 7 Legend : Y A = Yar d (NE) , Y B = Yar d (SE) . Y C = Yar d (SW) , Y D = Yar d (NW) , D Z = Dri p Zone . G Z = Garden , P Z = Pla y



## PZ = 550X2 . Pi^jv^WA Y 

## LOCATION S HO T HOTB Q [tav 4 046141.0IZ 3• • • •• • • • 

### Prin t Preview Pag e 1 of 2 Dougla s County-Omaha ,

Parce l I D Owne r Nam e 070423000 0 SMIT H JASO N A Additio n : l : „ , . ^'°' ^ BOWER Y HIL L

„ ^

\ Propert y Addres s 250 1 S1 2 S T Lo t 7 Cit y Zi p OMAH A 6810 8 Legal l Lega l 2 LT S 6 & 7 132X13 8 Owne r Addres s • Lega l 3 Owne r Addres s 2 ocn n o n n ^=" 1 ^ ^^ ^ ' Legal 4 jcX'^' ^ i OMAH A Acre s 0.4 1 Owne r \ Stat e ^. p , w^^i^' ^ iS k http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp ? i Parc=070423000 0 1

^ uwne r ^ gg.,Q g

Assesso r Websit e iLin k http://douglasne.mapping online.com/DouglasGoNe/static/accountinfo.jsp ? accountno-R070423000 0 Sec-Twn - Rn g 27.15.1 3 ^^liJi- i ." > Creat e Anothe rTicke t Bad ( t o Irt h Inteme t Sen d Emai l 

### YOU RTICKE T NUMBERI S 2342576 . Origina l Cal l Date : 8/17/0 9 Time : 12:0 8 p m Op : SIVA1896 7 Wor k t o Begi n Date : 8/19/0 9 Time : 12:4 5 pm State : N E County : DOUGLA S Place : OMAH A Address ; 250 1 Street : S 12TH S T Twp : 15 NRng : 13 E Sect-Qtr : 27-SE,34-NE Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : SOI L LEA D REMEDIATIONPROJEC T Locatio n o f Work : LOCAT E ENTIR E PROPERTY 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 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 : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N ATTNEBR l CXCAT V

LEVEL 3 MCINE B MUD0 2 OMAHACO F 0PPDGPR 6 PAETE C QLNNEI F
Servic e Are a Contac t Phon e Numbe r Utilit y Typ e ATTNEBR l ATT/ T 

### Day : Alt : Emer g 8002413624 9 8002413624 9 CXCAT V CO X COMMUNICATIONS . IN C HEID I 

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

### Day : Alt : Emerg : 877366834 4 877366834 4 MCINE B MC I N O CAL L PE RMEMO 

### Day : Alt : 8002893427

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessaeeText.a.sti?ret=<RF.S T n T S 8/17/9nn oM-e ^ ^ v x^

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N A Emerg : 800289342 7 

### 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

httn:// www.dhon.orc/irthintemet/DTTONNoticeCreation/MessageTex t a<5n7re1=<RF,S T T T ,T S 8/17/700 9

### AGREEMEN T AN D RELEAS E FO RRESTORATIO N O FREA L PROPERT Y Thi s Agreemen t andReleas e (hereinafte r

Agreement ) i s entere dinto by andbetween , Jaso n Smit h (hereinafte r

Propert y Owner ) andth e Unite dState s Environmenta l Protectio n Agency (hereinafte r

EPA) . WHEREAS , th e propert y locate dat250 1 S 12 * Street (hereinafte r

th e Property) , mor e specificall y describe dbelow , i s ownedby Jaso n Smit h WHEREAS , EP A throug h samplin g an danalysi s ha s discovere dth e Propert y wa s contaminate dwit h lead ; WHEREAS , th e EP A performedaremedia l actio n andremove dth e contaminate dsoil s fromth e propert y andbackfille dth e formerl y contaminate darea s wit h clea n fill then sodded and/or seede dth e described , effecte dproperty ; WHEREAS , th e Propert y currently require s alimite damoun t o f restoratio n wor k

t o retur n th e Propert y t o it s origina l conditio n prio r t o initiatio n o f EPA' s remedia l activities , or a s nearly a s possibl e t o it s origina l condition ; NO W THEREFORE , in consideratio n ofth e mutua l covenants , promise s andcondition s andterm s t o b e kep t andperformeda s recite dherein , th e partie s hereto agre e a s follows : 1 . The rea l Propert y which i s th e subject o f thi s agreemen t i s ownedby Jaso n Smit h an di s mor e specifically describe da s follows : BOWER Y HIL L LO T 7 BLOC K8 LT S 6 & 7 13 2 X 13 8 

### 2 . The EP A wil l complet e th e following restoratio n items : A small sectio n ofth e bac k

yar d(angle dportion ) tha t th e propert y owne r

previously di dno t wan t sodded , now , wil l b e sodded . 3 . The Propert y Owne r

acknowledge s tha t EP A shall hav e n o responsibilit y fo r

fiuther restoratio n wori c a t th e Propert y beyondth e 9 0 da y warrant y period . 4 . The Propert y Owne r

release s th e Unite dState s andth e EP A fix>man y andal l claim s arisin g out o f o r connecte dwith , directly o r indirectly , their abilit y t o inhabit , occupy , use , transfer , o r sel l th e rea l o r persona l propert y a t 250 1 Sout h 12 * Street andth e reimbursements , compensation , payments , costs , expenses , andan y inconvenience s o r damage s relatin g t o th e foregoing andth e

### cleanup , decontamination , disposa l andrestoratio n ofth e Property , includin g an y claim s unde r

th e Unifor mRelocatio n Assistanc e andRea l Propert y Acquisitio n Policie s Act , 4 2 U.S.C , Sectio n 460 1 et . seq . 5 . The Propert y Owne r

affirms tha t she i s th e lega l owne r

ofth e Propert y at250 1 Sout h 12 * Stree t Thi s agreemen t i s entere dinto andmade effective th e i 8 da y o f Stpjcmbc a2009 . FORTHEBROPERT Y 

# 7
- (^ ^ d f Dat e

' F0 RTHE UNITE D STATE S ENVIRONMENTA L PROTECTIO N AGENC Y 9h/o' i 

### cfcunAt 2 Dat e U.S . EPA , Regio n V H

nay 8 2o«t » 2•-?**' ' • 1