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### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 50038 DATE : 1/1 5 ADDRESS : 361 3 SEWAR D S T REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES . INC . YEAR : 20l( ) 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S [ ^

PRE AN D POS T VIDE O O F PORPERT Y(DVD ) 3023754 4 H EXECUTIV E SUMMAR Y

/ Superfun d G l EPA-PROVIDE D PROPERT YSKETC H H SIGNE D ACCES S AGREEMEN TFOR SUBJEC T PROPERT Y D SIGNE D ACCES S AGREEMENT{S ) FOR ADJACEN TPROPERT Y RESTORATIO N AGREEMEN T D SETTLEMEN T DOCUMENTS (I.E. , FOR DAMAG E O R TO REPLAC E PLANTS , ETC. ) fli CONFIRMATIO N DAT A

• PHOTOGRAPH S o f AS-BUIL TSKETC H m SATISFACTOR YRESTORATIO N SIGNE D B Y PROPERT Y OWNE R APROPERT YCLOSE-OU T CHECKLIS T SIGNE D B YEP A D DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A AUTILIT YCLEARANCE S d PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E D D D 

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# f A SIGNATUR E DAT E

### PROPERT Y SUMMAR Y Date : /15/201 0 Omah aLea dSit e Remedia l Actio n Contrac t U EP-R7-07-0 6 TO# l Mont hof : Propert y Address : 361 3 SEWAR D 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 Othe r Relevan t Infonnation : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : F 2 = 13 7 PP M ( @ 3" ; E A = 10 4 PP M @ SCRAP E(~1" ) ATTACHMENT S 1 ) Property 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 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 fina l lea dlevel s v ) Legen d ii ) Contaminatio n lef t 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 n th e individua l property file, i f available , o r obtainedinclude : i ) Pre-excavatio n agreemen t detail s (ifan y ar e mad e withth e property owner ) ii ) Property Statu s Formsigne 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/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 .Fin d Record Remediatio n QueryI Lea d Remainin g QueryI Propert yDamag e Query 

### Backfill :

Sampl e Area : 5003 8 - 361 3 SEWAR D S T Owner : Use rProvide d Owne rInformatio n 1 n Owne rOccupie d Owne rName : Owne rName : ICTT YO F OMAH A 

# 1 Owne rAddressl : Owne rAddress : |C/ 0 OT YnNANC E 

# 1 Owne rAddress2 : |181 9 FARNAM ST City : State : ZipCode : City : State : Zi p Code : lOMAH A | N E |68183 - 

# 1 1 1 Owne rPhon e Alternat e Phone : Owne rPhone : Alternat e Phone : 1(402 ) 441-515 0 |(402 ) 444-518 0 

# 1 1 Resident : Residen t Name : 

# I Propert yAddress : |361 3 SEWAR D S T Zi p Code : |68111 - Residen t Phon e

Contract : Assessment : Contractor : |PRUDENT2010_S Qualifyin g Grou p |46 6 Contrac t Optio n lOPTIO N 2 Assessmen t Ma xXR F Valu e j " 470.9 8TECHNOLOGIES , INC . 

### Propert y # : yOOlA b Date/Time : ^ Quad s Excavated : p n 

# EP A Propert y Clos e Ou t Propert y Address : ~^Q[' b ^ujofA . Owner' s Name : Cy ^ o ^ Qirr^ad/KC K Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s N o I . I f necessary , wer e th e correct quadrant(s ) excavate dandrestored ? • r I f necessary , wer e th e correct area s o f drip zone excavate dandrestored ? 

# y Gradin g Sodan dVegetatio n Ye s N o 1 . Doe s the gradin g aroim dthe perimete r o

f the hous e i n excavatedarea s generally slop e awa y / fro mthe house ? 2 . Has sodbee n laidin all area s tha t wer e excavated ? 

# J ?i

. Doe s tlie so dappea r to b e generall y health y andgrowing ? (Onl y evaluat e i f inspecte da t a3 0 / da

y lim e period) 4 Ar e soddedarea s generally fin n andevenl y graded ? 

# y 5 . Ar e Ih e joint s between die sodstrip s generally tight ? (Onl y evaluat e i

f inspecte da t a3 0 da y 

# y (im e period) 6 . Wa s the propert y grade dsuc htlia t wate r wil l not pool o n tli e property ? 

# y 7 . Wa s damag e t o landscapmg o r plan t material s avoided ? 

# y Gates , Fence s an dRetainin g Wall s Ye s N o 1 . Do gate s ope n an dclos e freely ? (I f applicable ) / 2 . Wer e all gale s o r fence s take n dow n during restoratio n activitie s reinstalled ? (I f applicable ) 

# y 3 . Wa s damag e t o gate s or fence s avoided ? (I f applicable ) 

# y 4 . Was damag e t o retainin g wall s avoided ? (I f applicable ) 

# y Foundation , Sidin g an dGutter s Ye s N o 1 Was damag e t o the siding o r trimavoided ? / 2 . Was damag e l o the foundation avoided ? 

# y 3 . Was damag e t o window s avoided ? 4 . Wa s damag e t o window s or doo r screen s avoided ? 

# y -"i

. Wa s damag e t o downspout s o r downspou t extension s avoided ? 

# r Sidewalk s an dDriveway s (Concrete ) Yes . N o ye » 

### Wa s damag e t o diivewa y surface s avoided'^ 

# y Wa s damag e t o walkwa y surface s avoided ? I

## Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e ^^ ^ Date : iz)^}' ^rFTNDDCSClE.S , IN C 

### A S - BUIL T DRAWIN G OL. S #.MM)3 8 Dat e Excavated : 11/04/201 0 

### OMAH A LEA D SUPERFUN D SIT E ISEP A .Signed-Of r Date : 

# ^ 0 0 2> ? Omah a Lea d Sit e CXMTte i Hame : y,l^^ i Qi^-i^'iy-* ^ Sit e Sketc h Address : "iyi l •^^-.y l

Phone : H W Lea d Sampl e , . „ Sampl e Numbe r Concentrstio n Collecte d RYASCPXA - F 1 i^( ^ pp m B' ' n RYBSCPXA - F 2 ^ 7 / pp m 0 " [- ] RYCSCPXA - B l ^ ^ ^ pp" i Ei : D RYDSCPXA - B 2 

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# I Sample s Cotlecte d Firm : MB.' ) Date : ^5 ^ 3'- / Time : i'.'/i
Sample s Analyze d XR F Unit : ^( D Book : ..^3 _ Oat e 

### ^g/zV^. V Tim e 

# r/ ^ Staff : 

### FA J

Otnah a Lea d Sit e 46I M

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

# OfcHrV Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n o f remova l activitie s perfomie d o n th e belo wliste d property . Th e propert yowner' s signatur e indicate s tha t th e propert yowne ri s satisfie d wit h th e restoratio n o f th e subject property , an d tha t n o item s are i n question , now , o ra t an ytim e i n th e future , excludin g an y remainin g warrant y(3 0 days total ) excep t thos e item s liste d below , ifany .

Properl yID : 

### Sfi<?Sg ' Properl yAddress : . 1 ' • Owner : < I ••U- . • A M Phone : 

### y - yy/'ftj " Restoratio n Item s i n Question :

Item : item : Item : Item : item : item :

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



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# y• Date Owner' s Signatur e , ,Pruden t Technologies , Inc . (Prudenl ) i s unde rcontrac l vvith th e U . S . Enviionmcnta l Proteclio n Agenc y(KPA) t o clea n u p lead contaminated soil s a t a numbe rofpropertie s located i n Omaha , Nebraska , includin g th e propert ylocated a l 3c-/ vS.^'V« ' S-yry r. Th e EP Arequest s )-ou rpermissio n l o allowPrudent l o perfor m a soi l cleanu p a t Ihi s propert) ' l u remov e lead-contaminale d soil . B ysignin g thi s form , tii e propert) owne rgrant s permissio n l o Prudent t o perform activitie s relate d l o th e cleanu p includin g soi l sampling , remova l o f lead-contaminated soil , an d rcsloratiu n ofth e referenced property . I f yo u hav e an yquestion s about th e soi l cleanu p planne d fo r)'uu rpropert)' . pleas e contac t Pruden t sout h onic e .fo rth e Omah a Ua d Site cleanup-a t (402 ) 733-1188 . Genera l question s abou t Ih e Omaha Lea d Site cleanu p con b e directe d l o Ih e EP APubli cInformalio n Center s a

t (402 ) 731-304 S (Sout h Omaha olTice ) o r(402 ) 99 1 -9583 (Nort h Omaha ofl'ice) . Properl yAcces s Granted By : //.//,,'/•' t / .-^-. n v . }r

\ (Pleas e Prin t Name ) Properl yOvme rSignature : /V^V " 

### y/yy > 2 I yy.^A i u^j-Cif-.^o/ o (Signature ) (Date ) PROPERT Y INFORMATIO N (T o b e complete d b yresiden t and/o rproperl yowne r- pleas e print ) RESIDEN TNAME : Ovme r Rente r RESIDEN TADDRESS : ^ 

## (ymSi^Wj K Mg " Q g l l ( o I F RENTAL , PROPERT YOWNE D BY : 

# ^ /!-'• / (bvx ^ e (T I• 

# f OWNER' S MAILIN G ADDRESS ; OWNER' S TELEPHON E NUMBE R - HOME : J L WORK : 

### J 1 AG E O F HOME? : YEARS . HOW LON G 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 ? 

### 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 NUNDE R 7 YEAR S OL D WH O PLA Y I NTH E YAR D FO R 6 HOUR S O R MOR E PE R WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. )

AUTHOR I T Yl-O R ENVIRONMENTA L RESPONS E ACTIONS : Th e activitie s t o b e implemented b yEP Aunde rthi s agreemen t ar

e pursuant t o Sectio n 10 4 ofCERCLA . 42 U.S.C . 9604 . EPA' s righ t o f acces s t o Ih cproperl yi s provide d fo ri n Sectio n 104(e ) o f CERCLA . 4 2 U S . C 960S(e) . whici i provides entr) ' fo r"detenninin g th e nee d fo rresponse , o rchoosin g o rtakin g an yrespons e actio n unde rIhi s litle . o rotherwise enforcin g Ih cprovision s ofth e tille. " 808 0 War d Parkway , Suit e 40 5 560 0 S lost 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6810 7 Sa n Antonio , T X 7622 9 Phone : (816 ) 363-370 3 Phone : (402)733-118 8 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)733-188 3 Fax : (210 ) 679-667 7E N VlROP^fVlEri'TAL.i t Ct>f^STRUrTIO> i 

### TECHNOLOGIES , IINC . 

# Propert y Statu s For m Address : 3 e.l' b Sp,.^nrd t ^ Date:V0(2_ ^ f ^ Phone : BVID : 

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308 0 Weird ParHway . Suit p 40, S 5GC( ) y-flJ Sl . •;^.:;? . Merncs ! Otivo . Oimo425 0 fvansa s City , iVl O B-tH-' J Oriwrii") , I'Jebrasti. a i'l' B lO " Gwi i Anioriic , T X '/'JS:;! ! Pt\one : (S'ie ) 365-i70.- ? f^hone : <i:iO ) rJZii-MSOf l /.*vi'^ ^ 7^'- r•.;<SO* J JV - *'J-»rt \ CT Q tcT- r

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## • YOURTICKE T NUMBERI S 2629435 . Origina l Cal l Date : 10/29/1 0 Time : 8:5 8 a m Op : SIVA1896 7 Wor k t o Begi n Date : 11/02/1 0 Time : 9:3 0 a m State : N E County : DOUGLA S Place : OMAH A Address : 361 3 Street : SEWAR D S T Twp : 15 NRng : 13 E Sect-Qtr : 16-NW,17-N E 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 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 : Y 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 QLNNEI C

Servic e Are a Contac t Phon e Numbe r Utilit y Typ e 

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

## Alt : 402934046 9 Emerg : 402932975 7 Day : 8773668344 LEVEL 3 LEVEL S COMMUNICATIONS , LL C N A 

## Alt : Emerg : 8773668344 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 RRICH/TRAFFI C 

### Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 

## http://vmw.dhon.org/irthimemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.. . 10/29/201 0

### Pag e 2 of 2
OPPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T Alt : 406207149 4

EL M LOCATIN G Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K Day : 406728934 3

EL M LOCATIN GAlt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthimemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 10/29/201 0TECHNQLOSSS , INC . 

### ENVIRONMENTAL ENGINEERIN GAN D CONSTRUCTIO N SOLUTION S 

## SIT ESAITfcT Y HAZAR D ANALYSI S Address : 

# : 2L£i:L.-5£i^i:i-_^ i Excavatio n Date : J-tAlZJ ^ Crew : —-Jfcl^iS^- ^ 

## Backfil l Date : —iL-tl^y^L- ^

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# ^ V y t«A Cre w Forema n Sit e Safet y Offic e Date :

808 0 WanllSartaany , Sut e 40 S SSOOSIOS t 424 2 Medica l Drive , Suit e 725 0 Kansa s GMy , MO 0411 4 ebnsi a 6810 7 Sa n Antonio , T X 7822 9 Phone : 1810) 363^70 3 Phone : (402)733-118 8 Phone : (210)822^958 8 Fax : (816 ) 363-370 7 Fax : (402)733^188 3 Fax : (210)679-657 7.. . „ . . iMIi m •WHWW I M l -——,i,.,iiir,.i,a.<H*»»W.tl M 

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