### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 2350 6 DATE : 1/1 5 ADDRESS : 30 9 N 3 5 S T REMEDIATIO N CONTRACTOR : PRUDEN TTECHNOLOGIES . INC . YEAR : 201 ^ 

### SOI L REMEDIATIO N PROPERT Y FIL E FOLDE R DOCUMENT S a PRE AN D POS T VIDE O O F PORPERT Y (DVD ) E f EXECUTIV E SUMMAR Y m EPA-PROVIDE D PROPERT Y SKETC H 0 SIGNE D ACCES S AGREEMEN T FOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN TPROPERT Y a RESTORATIO N AGREEMEN T D SETTLEMEN T DOCUMENTS (I.E. , FOR DAMAG E O R TO REPLAC E PLANTS , ETC. ) C

/ CONFIRMATIO N DAT A Z

/ PHOTOGRAPH S Q AS-BUIL T SKETCH B SATISFACTOR Y RESTORATIO N SIGNE D B Y PROPERT Y OWNE R 0 PROPERT YCLOSE-OU T CHECKLIS T SIGNE D B YEP A a DESCRIPTIO N O F AREA S NO T MEETIN G RO D CLEANU P CRITERI A e f UTILIT Y CLEARANCE S PROPERT Y INFORMATIO N FRO M DOUGLA S COUNT Y ASSESSOR'S OFFIC E 

### D D 

## a

SIGNATUR E DAT E 3021761 4 

# il l Superfun dPROPERT Y SUMMAR Y Date : /15/201 0 Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Propert y Address : 30 9 N 3 5 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 GDATA/RESULTS : B 2 = 17 1 PP M @ 9" ; D Z = 42 6 PP M @ 13" ; E A = 4 2 PP M @ SCRAP E(~1" ) 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 n digita l vide o clip/photograph s 4 ) Post-Excavatio n digita 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 final leadlevel s v ) Legen d ii ) Contaminatio n lef t behin darea s vi ) Contracto r identificatio n iii ) Property addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e include di n th e individua l property file , i f available , o r obtaine dinclude : i ) Pre-excavatio n agreement detail s (i f any ar e mad e wit hth e property owner ) ii ) Property Statu s For msigne db y property owne r iii ) Excavatio n digita l vide o i n MPEG , WM V (Window s Medi aVideo ) o r SW F(Flas hPlayer ) format and/or 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 .Fin d Record Backfill :

Sampi e Area : 2350 6 - 30 9 N 3 5 S T Owner : n Owne rOccupie d Owne rName : jSTEPHEN S WILLIA M 0 Owne rAddressl : 

# 1 Owne rAddressZ : |351 5 LAFAYETT E AV E City : State : Zi p Code : lOMAH A |N E |68131 - Owne rPhon e Alternat e Phone : 1(402 ) 280-263 2 |(402 ) 981-139 8

Contract : contractor : )PRUDErn"_2010_S Contrac t Optio n [BAS E Remediatio n QueryI Lea d Remainin g Quer yI Propert yDamag e Quer y

Use rProvide d Owne rInformatio n Owne rName : Owne rAddress :
City : state : 

# 'I— I Zi p Code : Owne rPhone : 

# r Alternat e Phone :

Assessment : Qualifyin g Grou p |40 0 Assessmen t Ma xXR F Valu e j 49 2 Resident : Residen t Name : |Zac h Fitzgeral d Propert yAddress : |30 9 N 3 5 S T Zi p code : )68131 - Residen t Phon e 1(402 ) 681-645 8• ; '•• • t i -TV : 

# i-iMiiliiii O TECHNOLOGIES , INC . 

## EP A Propert y Clos e Ou t Propert y # : 2" ^ ^<^ ^ Propert y Address : 3>< ^ ^ ^' ^ ^^ ' Date/Time : Owner' s Name : c£)".lf(>w ^ 9^<^(3l^€Vv. > Quad s Excavated : D^ . 'g>'Z_ _ Contracto r Group : Pruden t Technologies , Inc. . Excavatio n Genera l Ye s N o 1 I f necessary . wer e th e correc l quadrant{s ) excavatedandrestored ? 

## J 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 gradin g aromidth e perimete r o

f th e hous e i n excavatedarea s generall y slop e awa y fro mlhe house ? 

# y 2 .

Has sodbeen laidni al l area s tha t wer e excavated ? 

# y 3 .

Doe s the sodappea r t

o b e generall y health y andgrowing ? (OiU y evaluate i f inspecteda t a3 0 da

y lim e period) 

# y 4 .

Ar e soddedarea s generally fir man devenl y graded ? 

# y 5 .Ar c lit e joint s betwee n the sodstrip s generall y tight ? (Onl y evaluat e i

f inspecte da t a3 0 da y lim e penod ) 

# y 6 .

Wa s the propert y grade dsuchtlia t wate r will no t pool on tlie property ? 

# y 7 .

Wa s diiinage l o landscaping o r plan t inaterial s avoided ? 

# y Gates , Fence s an dRetainin g Wall s Ye s N o 1 .

D o gate s ope n andclos e freely ? (I f applicable ) 

# y 2 .

Wer e al l gate s o r fence s taken dow n during restoratio n activitie s reinstalled ? (I f applicable ) 

# y 3 .

Wa s damag e lo gate s o r fence s avoided ? (I f applicable ) 

# y 4 .

Wa s damag e to retainin g wall s avoided ? (I f applicable ) 

# y Foundation , Sidin g an dGutter s Ye s N o 1 Wa s damag e t o the siding o r trimavoided ? 

# y 2 . Wa s damag e lo the foundation avoided ? 

# y 3 . Wa s damag e ( o window s avoided ? 

# y 4 . Wa s damag e t o window s or doo r screen s avoided ? 

# y 5 . Wa s damag e lo downspout s o r downspou t extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Ye s N o ! Wa s damag e t o driveway surface s avoided ? 

## y A ^ Wa s damag e l o walkwa y surface s avoided ?

### Owner s comments :

Inspectio n not^ :

Remova l andrestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e Bc^'A ^ Date : izlioh oHNOLUGIES , INC . 

### A S - BUIL T DRAWIN G OL S t t 2350 6 Dat e Excavated : 08/30/201 0 USEP A Signed-Of r Date : 

### OMAHA LEAD SUPERFUND SIT E

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

# i l Propert yCompletio n Agreemen t Thi s agreemen t documents the completion of remova l activitie s performe do n the below listedproperty . Th e propert y owner' s signatur e indicate s tha t the propert y owne r i s satisfiedwit hthe restoration of the subject property , an dtha t no items ar e i n question , now , o r a

t an y tim e i n the fiiture , excluding an y remaining warrant y (3 0 day s total ) except thos e items listedbelow , i f any . Propert y ID : PropertyAddress;3(r)<^^3l l |^ ^ 3 ^ A ^-^V^ ^ O/vUAiv^NC B 4> ^ i ^ T Owner ; Qam^-flUy ^ S^-f^Ke>l S Phone : ( I^Q2. 1 

### :?W-3'i&3 ^ Restoratio n Item s i n Question :



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agre e restoratio n i s complete d a t (note d deficiencie s above )



# 2 . l^ecen^L^. ^ 2X)1 0 Owner' s Signatur e H Dat e"L-JtVnE^X'JF^tV ; Pruden t Technologies , Inc . (Prudent ) i s unde r contrac t withth e U . S . Environmenta l Protectio n Agenc y (EPA ) t o clean up lead 4 A 4V l <l^5JpP''t^'"'"*'^< ' ^°'' ^ * ' ^ numbe r o f

propertie s locate di n Omaha , Nebraska , includin g th e property locate dat 3 ^ T TM ** ^ ^yy3iCI GL^W#*fgffpg - JW^ « Th e EP A request s yqu r permissio n t o allo w Pruden t t o performasoi l cleanu p a t thi s propert y t o remov e lead-contaminate dsoil . B y signin g thi s form , th e property owne r grant s permissio n t o Pruden t t o perfor m activitie s relate dt o th e cleanu p includin g soi l sampling , remova l o f lead-contaminate dsoil , an drestoratio n o f th e reference dproperty . I f yo u hav e any question s abou t th e soi l cleanu p planne dfor you r property , pleas e contac t Pruden t fo r th e Omah a Lea dSit e cleanup , a t (402 ) 733-1188 ; 733-1455 . Genera l question s aiiou t tli e Omah aLeadSit e cleanu p can b e directe dt o th e EPA Publi c Informatio n Center s a l (402 ) 731-304 5 (SouthOmah aoffice) . Propert y Acces s Grante dBy : (Pleas e Prjn\Name ) Property Owne r Signamre : (Sigijature ) (Date ) PROPERT YINFORMATIO N (T o b e complete d b yresiden t and/o rpropert yowne r~ pleas e print ) RESIDEN TNAME : \ e.^riv\\- ^ Owne r RESIDEN T ADDRESS : 

## f O -^^ ^

21 - rorv^T^Lo . UE : ^" ^ i ^ I I F RENTAL , PROPERT Y OWNE D BY : / ^ . OWNER' S MAILIN G ADDRESS ;



## 3 S^ 5 LCU^CIJUP , 

# A v ^ Om>>ivc LiO Fc^\ ^ 

# + ^ OWNER' S TELEPHON E NUMBE R - HOME : J L WORK : OWVAeJ L AG E O F HOME? : YEARS . HO W LON G HAV E YO U HsIVE S HERE ? YEARS . 

# v ^ 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 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 : M.E . DOGS , ENTR Y GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS E ACTIONS ; Th e activitie s t o b e implemente db y EP A unde r thi s agreemen t ar e pursuan t t o Sectio n 10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f

acces s t o th e property i s provide dfor i

n Sectio n 104(c ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry for "determinin g th e nee dfo r response , o r choosin g o r takin g any respons e actio n unde r this title , o r otherwis e enforcin g th e provision s o f th e title. "ENVIRONMENTA L& CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

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Parce l I D Owne r Nam e Propert y Addres s Cit y \Zi p Owne r Addres s Owne r Addres s 2 Owne r Cit y Owne r Stat e Owne r Zi p Sec-Twn Rn g 130446000 0 STEPHEN S WILLIA M 0 30 9 N 3 5 S T OMAH A 6813 1 351 5 LAFAYETT E AV E OMAH A N E 6813 1 16-15-1 3 Additio n ' , "'°^' ^ Lo t Lega l 1 Lega l 2 Lega l 3 Legal 4 Acre s Treasure r Websit e Un k Assesso r Websit e Un k HAWTHORN E AD D 3 1 7 50X13 6

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### httt)://www.doeis.orB/do2i s alias/doeis/nrintPreview.a.sr)x?PrintODtData=Douela s Countv-.. . 8/19/201 08/17/201 0 ittp://www.dhon.org/irthinternet/DHO. . . Creat e Anothe rTicke t Bac k t o Irt h Intemet Sen d Emai l 

### YOURTICKE T NUMBE RI S  2569692 . Origina l Cal l Date : Wor k t o Begi n Date : 8/17/1 0 8/19/1 0 Time : 10:2 2 a m Time : 10:4 5 am Op : SIVA1896 7 State : N E Address : 30 9 County : Street : DOUGLA S N35T H S T Place : OMAHA Twp : 15 NRng : 13 E Sect-Qtr : 16-SW,21-N 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 REA R O F PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)733-188 3 : UNSUR E CORNER S Company: 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 Involve s Tunnelin g o r Horizonta l Borin g : N Front : Y Explosives : N Rear ; CXCATV LEVEL 3 MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C 

### Servic e Are a Contac t Phon e Nunibe r Utilit y Typ e CXCATV CO X COMMUNICATIONS , IN C HEID I Day : Alt : 402934046 9 402934046 9 Emerg : 402932975 7 LEVEL 3 LEVEL S COMMUNICATIONS , LL C 

## N A Day : 877366834 4 Alt : Emerg : 877366834 4 MUDOl METROPOLITA N UTILITIE S DISTRIC T 

## SAND Y Day : 402504782 3 Alt : Emerg : 402504797 0 Day : 402444719 7 CITYOFOMAHA - OMAHACO F RICH/TRAFFI C AH: 402444516 1 TRAFFIC,SEWER Emerg : 402444516 0 dhon.org/irthinternet/.../MessageText.as. . 1/ 28/17/201 0 ^yittp://www.dhon.org/irthinternet/DHO.. . 

### OPPDGPR 5 OMAHA PUBLIC POWE REL M ^Day : 406728934 3 406207149 4 OPPDOPR 5 DisT^c T LOCATIN G^ ­ ^06207149 4 Emerg : 888728934 3 QLNNEI C QWES T LOCALNETWOR K FTM LOCATIN G Day : ^ " 406728934 3 ^06207149 4 Emerg : 888728934 3

dhon.org/irthinternet/.../MessageText.as.. . 2/ 2ENVIRONMENTA L & CONSTRUaiO N TECHNOLOGIES , INC . SOLUTION S 

# Sit e Safet yHazar d Analysi s Address : 30" ^ Mo . S S S- h Ex. . Crew : ](.ey\r\K j DWCfglM Bf . Date : ^^JSO / f O 

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