## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL EFOLDE R 

# SAID# : c^VV ?Date : 1 1 ^ I 5 "" I 0 Address : ^S^J H . ]mt ^ 9 ^ Remediatio n Contractor : Pb^->ngarM ^ T^/^- H N<V.00 | 

### i"^<^ ^ /rsir o Year : LX ) 

### I (, J SOI LREMEDL^TIO N PROPERT Y FIL EFOLDE RDOCUMENT S [ / 

### Vide o o f propert y (DVD ) Executiv e Summar y EPA-providedpropert y sketch / 

### SignedAcces s Agreemen t fo r

subject propert y D SignedAcces s Agreement(s ) fo r

adjaipen t propert y 

# y Restoratio n Agreemen t D Settlemen t document s (i.e. , fo r

damag e or to replac e plants , etc. ) 

# y Confirmation data Q/ ' 

### Photograph s 

# a

" As-built sketch Satisfector y restoratio n signedb y Propert y Owne r Propert y close-out chec k

Us t signedby EP A D 

### Descriptio n of area s no t meeting RO D cleanu p criteri a [

/ 

### Utilit y clearance s Propert y information firomDougla s Count y Assessor' s Office D D D



## ^ M ^ AV^ V Signatur e Dat e 3021887 6 Superfun d# PROPERT Y SUMMAR Y Date : 11/15/201 0 Oinah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Novembe r Propert y Address ; 257 0 JONE S 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 : B 2 = 7 3 PP M @ 6" ; N O EASEMEN T 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-Built 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 ) Property addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e include din th e individual property file , ifavailable , o r obtaine dinclude : i ) Pre-excavatio n agreement detail s (i f an y ar e mad e withth e property owner ) ii ) Property Statu s For msigne db y property owne r iii ) Excavatio n digita l vide o in MPEG , WM V (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 .

TECHNOLOGIES , INC .Fin d Record Backfill :

Sampl e Area : 2244 8 - 257 0 JONE S S T Owner :

• Owne rOccupie d Owne rName : I HERMAN BRO S IN C Owne rAddressl : 

# I Owne rAddressZ : )256 5 STMARY S AV E City : State : ZipCode : [OMAH A " " [N E |68105 - Owne rPhon e Alternat e Phone : 

# I I

Contract : contractor : |PRUDEr^n010_ S Contrac t Optio n (OPTIO N 1 Remediatio n Quer yI Lea d Remainin g Quer yI Propert yDamag e Query

Use rProvide d Owne rInformatio n Owne rName : Owne rAddress : City : State : Zi p Code : 

# 1— r Owne rPhone : Alternat e Phone :

Assessment : Qualifyin g Grou p pO O Assessmen t Ma xXR F Valu e | 526.7 7 Resident : Residen t Name : 

# I Propert yAddress : |257 0 JONE S ST Zi p Code : )68105 - Residen t Phon eTECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y # : ;2-2-H*\ S Propert y Address : 2^S7 0 IJOY^C ^ 5iV Date/Time : ( o (l ^ Owner'sName : H<r»v\-C»-* \"^foi/ln c Quad s Excavated : Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s N o 1 . if necessary , wer e th e correct quadrant(s ) excavate dandrestored ? / 2 , I f necessary , wer e th e correc t area s o f drip zone excavate dandrestored ? / Gradin g So dan dVegetatio n Ye s N o 1 .

Doe s th e grading aroundth e perimete r o

f th e hous e in excavate darea s generall y slop e awa y / fro mth e house' ? 2 .Ha s sodbeen laidi n al l area s tha t wer e excavated ? / 3 .

Doe s the sodappea r to be generally health y andgrowing ? (Onl y evaluat e i f inspecteda t a3 0 da

y tim e period) / 4 .

Ar e soddedarea s generally firmandevenl y graded ? / 5 .Ar c tli e joini s between th e sodstrip s generall y tight ? (Onl y evaluat e i

f inspecte da t a3 0 da y tim e period) 

# y 6 .

Wa s the propert y grade dsuc htlia t wate r wil l not pool o n the property ? 

# y 7 .

Was damag e t o landscaping o r plan t material 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 ? (Ifapplicable ) / 2 .Wer e all gate s o r fence s taice 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 ? (Ifapplicable ) 

# y 4 .

Was damag e t o retainin g wall s avoided ? (Ifapplicable ) 

# y Foundation , Sidin g an dGutter s Ye s N o 1 .

Was damag e t o the siding o r trimavoided ? / Wa s damag e t o the foundaiion avoided ? / Wa s damag e l o window s avoided ? 

# y 4 .

Wa s daniag e t o window s o r door screen s avoided ? 

# A Wa s damag e l o downspout s o r downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ye s N o Wa s damag e t o drivewa v surface s avoided ? 

# y 2 .Wa s damag e t o walkwa y surface s avoided ? 1

### Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e ^« M - ^ ^Date: wjuffi o^CHNOLOOIES . INC . 

### A S - BUIL T DRAWIN G OL S #2244 8 Dat e Excavated : 9/30/201 0 

### EA D SUPERFUND SIT E rSEP A Signed-Of T Date : 2244 8 Exterio rPain t Omah a Lea d Sit e Owne rName : HERMA N BRO S IN C • Goo d Sit e Sketc h Address : 257 0 JONE S S T • Poo r W : Q^No l pain t Phone : ^ - Sampi e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Firm : Asto l Ra. 1 »i r RYASCPXA-2244 8 F 1 pp m 

### D Date : to-to-06 . RYBSCPXA-2244 8 F 2 

### [ T D Time : M-.;^ t ^^ ^ 

## _a

_ pp m RYCSCPXA-2244 8 B 1 

### Ifi H pp m 

### \ ^ D Sample s Analyze d RYDSCPXA-2244 8 B2 pp m 

### 0' ^z- ? 

## n RDZaePXA-gg44 0 B 2 pp m 

### D XR F Uni t too ? Book : 1 1 " ^ WOgOOPXA-gg440 6 2 pp m 

### D D Date : /<?-/? - Qj e npnoorx A22440—P S pp m 

### D D Time : A m 

### D Staff : JISW : Numbe ro f Sample s = Legend : F l = Fron t Left , F2 = Fron t Right , 8 1 = Bacl < Left , B 2 = Bac k Righ t D Z = 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

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

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

t an y tim e in the future , excluding an y remaining warrant y (3 0 day s total ) except thos e items listedbelow , i f any . Propert y ID : Propert y Address : QP^'/ Q 

### ^,Wi\il^ Owne r 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 :



### Q l ag n agre e restoratio n i s completed . 1 I d o no t agre e restoratio n i s complete d a t (note d deficiencie s above ) 

# z ^ <ZZ/ ^ Owner^sSignatur e Dat e I-10-1 0 14:0 0 FROM-TransWood-^,N E T-03 1 P00l/0g 4 F-II O 

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# TransWoo d Inc , 2665 S i Mary' s Ave . P.0 , Bo x18 9 Omaha , N E G810 5 fkoM#40Z>^46>809 2 Kn #4t^341'211 2 FROM : flJcTfA/^^.. 

# f - DATE : 

## f//?/ / 7 o ^fmnbe ro f Pages :_, iaehidiq g care rsbee t TO :



### Notos :

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# li^ noLozrat/6 009-10-1 0 14:0 8 FROM-TransWoo d T-03 9 P.003/00 4 F- GNVtRONMeNTAL ^ COrfSTHUCTJO N 

### TECHN0L06XES , INC . SERVICE S 

# Propert y Statu s For m Addles : Date : Phone : BVID : 

# \Jxu^ yL^i :

Propeit y Owne r 9/7er//( y 8B80 Ward Pailnvay ; Suit e 40f i 660 0 SI O S I Kansa s Ctty , M O 6411 4 Omaha , Mabraalt a6810 7 San'flnlonlD , 7 7 76228 Phone : («16 ) 383-370 3 Phone : (403)7^^^16 0 Phona : (Slfl) 827.^8 6 Cum ' nifl i «Ta.^c7 T 

### »00/£0(r d 00f: 0 LZV LOLOZ/OL/6 0• • 09-10-1 0 ^ 14:0 9 FROI*-TransWood-^a,N E T-039 P.004/004 FExiefio rPai m NorihAna w Omah a Lea d 6it d Owne rName : H6RMA » BRO S IN C 

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### Pag e 1 of 2 " > Creat e Anothe rTicke t Bgc k J p Ji;t|:i^l.ijjte.r,n.e t •Sen d Emai l „ . 

### YOURTICKE T NUMBERI S 2594330 . Origina l Cal l Date : 9/16/1 0 Time : 3:1 7 p m Op : SIVA1896 7 Wor k t o Begi n Date : 9/20/1 0 Time : 3:4 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 257 0 Street : JONE S S T Twp : 15 NRng : 13 E Sect-Qtr : 21-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : SOI L LEA D REMEDIATIO NPROJEC 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 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 : NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V LEVEL 3 MUDO l OMAHACO F 0PPDGPR 5 PAETE C QLNNEI C utilit y Servic e Are a Contac t Phon e Nunibe r Typ e 

### Day : 402934046 9 r^vr-A'^^ / CO X COMMUNICATIONS , TM„ , 

### Alt : 402934046 9 CXCAT V „, „ HEID I IN C 

### Emerg : 402932975 7 Day : 877366834 4 LEVEL S LEVEL S COMMUNICATIONS , ^ ^ 

### Alt : 

### Emerg : 877366834 4 Day : 402504782 3 METROPOLITA N UTILITIE S MUDO l SAND Y 

### Alt : DISTRIC T 

### Emerg : 402504797 0 Day : 402444719 7 CIT Y O FOMAHA - OMAHACO F RICH/TRAFFI C 

### Alt : 402444516 1 TRAFFICSEWE R 

### Emerg : 402444516 0 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 9/16/201 0

### Pag e 2 of 2

OMAH A PUBLI C POWE R OPPDGPR 5 EL M LOCATIN G DISTRIC T
N O NEE D T O CAL LOU T PAETE C PAETE C COMMUNICATION S EMERGENC Y QLNNEI C QWES T LOCALNETWOR K EL M LOCATIN G 

### 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.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 9/16/201 0

### ENVIRONMENTA L ENGINEERIN GAN D CONSTRUCTIO N TEOHNoiAnEs , mc . 

### SOLUTION S 

## SIT ESAlfifcT Y HAZAR D ANALYSI S Address : —^• ^ ^ ^ Crew :

Ite m Overhea dLine s Ga s Lin e Wate r Lin e Sewe r Lin e Septic/Leec h Fiel d Propane/Butan e Sidewal k Foundatio n Retainin g Wall s Fence s Tree s Structure s Driveway Sprinkle r Syste m Othe r Cre w Forema n ^^t? S Excavatio n Date : Backfil l Date : —

Conditio n Hazard s Correctiv e Actio n

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## Sit e Safety Offic e Date :

80601MMF«ariany . 5uito4I K Kannsei^,liOe411 4 SSOOSIOS t Omaha , Mebraifc a eotO T 424 2 Bdedica l Drive , Suit e 726 0 Sa n Antonio , T X 78229 Phone : (QI Q 36^370 3 ftc(8ie ) 363^70 7 Itwm : (400 ) 733-118 8 Fao c(402)733488 3 Phone : (2t0 ) 822-«588 Fax : (210) 679-8S7 7

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