### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL E FOLDE R SAID# : rMc o Date : I ^^13.'^-/Zeo l Address : io n r\ f

(^^ c H Remediation Contractor : YyX^,.J
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^ Vide o o f i)ropert y (DVD ) I FExecutiv e Summary ^ EPA-proyidedpropert y sketc h y Signe dAcces s Agreemen t fo r subjec t propert y I s Signe dAcces s Agreement(s ) for.adjacent propert y aRestoratio nAgreemen t D Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) y Confirmatio ndat a y Photograph s ^ As-b\]i hsketc h ^ Satisfiactor y restoratio nsigne db y Propert y Ovme r M Property close-ou t chec k lis t signe db y EP A D Descriptip no f area s no t meetin g RO D cleanu p criteri a w Utility clearance s mProperty infonnatio nfromDougla s County Assessor' s Offic e D 4030959 9 D 

# imiynMHi i n Superfun d 

### iMgnah ^ Dat e

### PROPERT Y SUMMAR Y Date : 12/20/200 8 Omah aLeadSite Remedial Actio nContrac t #EP-R7-07-06/0004 Montti of : Nov/De c Propert y Address : 80 8 N4 9 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 Ottie r Relevan t Information : NON E CONFIRMATIO NSAMPLIN GDATA/RESULTS : G Z= 23 3 PP M @ 17" ; P Z= 11 3 PP M @ 6" ; N O EASEMENT ATTACHMENT S 1 ) Propert y sketc hprovidedby EP A pursuan t t o contract specification s 2 ) SignedAcces s Agreemen t including acces s agreement s requiredfo r crossing odie r propertie s 3 ) Pre-Excavationdigita l vide o cUp/photogr^h s 4 ) Post-Excavationdigita l vide o clip/photograph s 5 ) Documentation- CompletedClose-ou t Checklis t 6 ) As-Buil t sketch­ i ) Shall include final lea dlevel s v ) Legend ii ) Contaminationlef t behindarea s vi ) Contracto r identification iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e includedinth e individua l propert y file, i f available , or obtainedinclude : i ) Pre-excavationagreemen t detail s (i f an y ar e mad e wit hthe propert y owner ) ii ) Propert y Statu s For msignedb y propert y owne r iii ) Excavationdigita l vide o inMPEG , WM V (Window s Medi aVideo ) or SW F(Flas hPlayer) forma t and/o r photogr£q)hs iv ) Signedfor mverifyin g satisfactoiy restoratio n v ) Descriptiono f areas no t meeting InterimRO D cleanu p criteria .

TECHNOLOCIES , INC ,Rn d Recor d 

### Backnil :

Sampl e Area : 5190 0 - 80 8 N 4 9 S T Owner : D Owne rOGcupie d Owne rName : |PUSC H JA N ERI C

—— Owne rAddressl : Owne rAddressZ : |P 0 BO X 54043 2 City : State : Zi p Code : jOMAH A |N E |6815 4 Owne rPhone : Alternat e Phone : j(402 ) 330-578 1 : |
..... . . Qea n U p Query Lea d Remainin g QueryI Propert yDamag e Query

Resident : Residen t Name : I RAND Y& MICHELL E TODALE N Propert yAddress : |80 8 N 4 9 S T 

### Zi p code : 6813 2 Residen t Phon e Contract : Contractor : |PRUDENT2008^S Group : 

# 1 Assessment : Qualifyin g Grou p |80 0 Assessmen t XR F Date : /Assessmen t MaxXR F Value : I 118 6

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completiono 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 property owne r i s satisfie dwithth e restoratio n o f th e subjec t property , an dtha t n o item s ar e i n question , now , o r at an y tim e i n th e future , excludin g an y remainin g warranty (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y ID : Property Address : (?0 ^ Owner : Phone : 

# ?
Restoratio n Item s I n Question :

Item : Item : item : Item : item : item : Require d conection s t o complet e th e property :

E H I 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

Owner' s Signatur e ' Dat e 'Pruden t Technologies , Inc . (Prudent ) is unde r contrac t withth e U. S. Environmenta l Piotectio nAgenc y (EPA ) to clea nvp lead
conteminate dsoil s at anumbe r ofpropertie s locate d inOmaha , Nebraska , includin g Ih e propert y locate d at A Oi i l\itSrH t </0 ^ If . Th e EP A request s you r pennissb n to allo w Pruden t to perfon n asoi l cleanu p at thi s propert y to remo w lead-contaminate dsoil . By signin g dii s form , th e propert y owne r grant s permisao n to Pniden t to perfor m activitie s relate d to th e cleanu p includin g soi l sampling , remova l of lead-contaminate dsoil , an drestoratio nofth e refiaence dproperty . If

yo u hav e any question s abou t di e soi l cleanu p planne dfor you r property , pleas e contac t Pruden t Administrativ e Cleri c for di e Omah aLea dSit e cleanup . Ms . DeborahJohnso n-a t (402 ) 733-1188 . Gouia l question s abou t th e Omah aLea dSit e cleaiu p ca n be directe d to th e EP A Publi c Infonnatio n Center s a t (402 ) 731-304 731-304 5 (SouthOmah aofSce ) InfonngiM i o r (402199 1 (4021991-958 3 (NorthOmah aofBce) . Property Acces s Grante d 

# Bv : T3^V V ^>f^\77 ^ P u S ^

y ^ (Pleas e Print-Name ) Property Owne r Signature : 

# KJI U (Signature ) (DtJle ) PROPERT Y INFORMATIO N (T o be complete d by reilden t and/o r propert y mrne r - pleas e print ) RESIDEN T NAME : 

# i^Ai^fJ^ j T Jfk.itys s Rente r Owne r RESIDEN T ADDRESS : 

## rW / 

# 9>o % Aj . yr ^ -S/. (),^,L , Ki x 68/31 ^
•fIF RENTAL , PROPERT Y OWNE D BY ; 

# J/H V fUScM OWNER' S MAILIN G ADDRESS ; 

# isp s: > /?a/^o x ^-^oyj p /9/n/j^7i,i/ ^ ssjs- ^
OWNER' S TELEPHON E NUMBER-HOME : t9C^ \ ^^S-SSf l WORK :
AG E OF HOME? : YEARS
. HO W LON G HAV E YO U LIVE D HERE ? 

# -8 .YEARS
. HA S TH E EXTERIO R BEE N PAINTE D OR COVERE D WIT H SIDIN G SINC E 1978 ? ^YE S V ^ NO NUMBE R OF OCCUPANT S UNDE R 7 YEAR S OLD : \ ) NUMBE R OF OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R OF CHILDRE N UNDE R 7 YEAR S OL D WH O PLA Y

IN TH E YAR D FO R 6 HOURS OR MOR E PE R WEEK : COMMENT S

OR SPECIA L INSTRUCTIONS : (I.E
. DOGS , ENTR Y GATES , ETC. )

AUTHORIF Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s to be implemente dby EP A unde r thi s agreemen t ar e pursuan t to Sectio n10 4 of CERCLA , 42 U.S.C . 9604 . EPA' s righ tof acces s to th e propert y is providedfo r in Sectio n 104(e ) of CERCLA , 42 U.S . C 960S(e) , whic hprovide s entry for "deteiminingth e nee dfor response , or choosin g or takin g an y respons e actio n unde r thi s tide , or otherwis e enforcin g theprovision s of di e tide. "

8080 Ward Parkway , Suit e 40 5 250 5 N. 24* ^ Street . Suit e 30 8 4242 Medica l Drive , Suit e 425 0 Kansa s City , MO 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816) 363-3703 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7

### V AS'vBlJDi. T DRAWIN G- >:/ ^ OlMg^^iH A LEA D SUIfEREUN D SUE , OLSW : 5190 0 Dat e Excavated : 12/01/200 8 USEP A SigMd-OfTDate : *"% , 

### ^ 5190 0 Omah a Lea d Sit s f Nort h Am w Extario rPsin t Sit e Sketc h Q Good • Poo r 1 Samplin Q AddrMs : 808 N 4 9 S T 1 0'Nolpair t Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B 

### Finn : Sampla s Collecte d 

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# l o Staff : /^I J Legend : F l > Fron t Left , F2 > Fron t Right
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s visMml Iroi n t wilree t tadrg praoe't y 

### SE P0 3 u :

CONTRAC T# : E P - R7-07-0 6 / 000 4 PRUDEN TTECHNOLOGIES , INC
.ENVIRONMENTA L& CONSTRUCTIO N 

## nECHNOLOGIES , MC . SERVICE S 

# Propert y Statu s F®r m Address : ^(9 ^ h\Q< ^ "4^ ^ % Dat e Phone ; i^O'X ) OST^-^^S l f^r
- lVo^)7^^-^^J ^ BVID : ^ / ^O O Ite m NO Plant s & Permanen t Landgcapin g To Remai n InPlac e On Ma p Descriptio n & Locatio n

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# Als o Descriptio n& Locatio n

Propert y Owne r D K rruae mn^mpioye y^y^; ^ Pnidn t Employe e l-f^rtOAt db-Tjl ^ i ^' ^ Signature : (Ao/ n & ^ jOw l ^gnature : v;^ ^ ^

808 0 War dParkway , Suit e 40 5 250 5 N. 24* ^ Street , Suit s 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , MO 6411 4 Omaha , Nebrask a6811 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 7

# 51900R07541700000001.jp g (JPE GImage , 640x48 0 pixels ) ht:^)://douglasne.mapping-online.com/assessdoc/Photos/39/R0754l7.. .



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## Dougla s County-Omaha , N E

Parce l I D 075417000 0 Sec-Twn-Rn g 18-15-1 3 Owne r Nam e PUSC H JA N ERI C Additio n CARTHAG E AD D Propert y Addres s 80 8 N 4 9 S T Bloc k 2 3 Cit y OMAH A Lo t 1 1 Zi p 6813 2 Lega l 1 E60F T Owne r Addres s Lega l 2 47X6 0 Owne r Addres s 2 POBO X 54043 2 Lega l 3 Owne rCit y OMAH A Lega l 4 Owne r Stat e N E Treasure r Websit e Lin k http://webapps.dotcomm.org:8080/TreasTax/faces/page s /taxinfo.jsp?parc=075417000 0 Owne rZi p 6815 4 Assesso r Websit e Lin k http://douglasne.mapping-online.com/DouglasCoNe/stati c /accountinfo.jsp?accountno=R075417000 0 Disclaimer : Ma p an d parce l dat a ar e believe d t o b e accurate , bu t accurac yi s no t Ma p Scal e guaranteed
. Thi s i s not a lega l documen t an d shoul d not b e substitute d fo ra titl e search , 1 inc h = 1 7 fee t appraisal , survey , o rfo rzonin g verification
.

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# ^7^^"^: ' \d:<'s^ d

## Page 1 of 2

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

## YOURTICKE T NUMBE RI S 2181209 . Origina l Cal l Date : 11/24/0 8 Time : 2:1 3 p m Op : MADHURIMA1896 7 Wor k t o Begi n Date : 11/26/0 8 Time : 2:4 5 p m State : NE County : DOUGLAS Place : OMAH A Address : 80 8 Street : N4 9T H S T Twp : 15 NRng : 13 E Sect-Qtr : 18-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lead remediatio n wor k fo r soi l Locatio n o f Work : LOCAT E ENTIR E PROPERTY 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 : MADHURIM A Phone : (402)733-118 8 Alt . Contact : Phone : (618)401-222 3 Wor k Being Don e For : ep a Dept h o f Excavation : 6 f t Corne r Lot : NFront : Y Rear : Involve s Tunneling o r Horizonta l Boring : NExplosives : N CXCAT V

MCLEODNE MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are aContac t Phon e Numbe r Utilit y Typ e n^nAT M CXCAT V CO X COMMUNICATIONS , „!/- . IN C „„„ i HEID I 

## Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
MCLEODN E MCLEODUS A N O NEE D T O CAL L OU T EMERGENC Y 

### Day : 800289190 1 Alt : 

## Emerg : 800289190 1
MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y 

## Day : 402504782 3 Alt : Emerg : 402504797 0
OMAHACO F CIT Y O FOMAHA
TRAFF1C,SEWE R RO N 

## Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.. . 11/24/200 8

## Pag e 2 of 2

OPPDGPR 5 OMAH A PUBLI C POWE R DISTRIC T N A 

## Day : 406728934 3 Alt : 888728934 3 Emerg : 406728934 3 QLNNEIC QWES T LOCA LNETWOR K

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## Day : 406728934 3 Alt : Emerg : 888728934 3

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