SAID# : 2157 3 

### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R DATE ; 1/1 5 ADDRESS : 81 5 PACIFI C S T REMEDIATIO N CONTRAaOR : PRUDEN TTECHNOLOGIES . INC . YEAR : 201 ^ 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S 1 3 PR E AN D POS T VIDE O O F PORPERT Y (DVD ) m EXECUTIV E SUMMAR Y 

# I EPA-PROVIDE D PROPERT YSKETCH 

# J SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN TPROPERT Y H RESTORATIO N AGREEMEN T D SETTLEMEN T DOCUMENTS (I.E. , FOR DAMAG E O R T O REPLAC E PLANTS , ETC. ) d CONFIRMATIO N DAT A a PHOTOGRAPH S m AS-BUIL T SKETCH E l SATISFACTOR YRESTORATIO N SIGNE D B Y PROPERT Y OWNE R d PROPERT YCLOSE-OU T CHECKLIS T SIGNE D B Y EP A D DESCRIPTIO N O F AREA S NO T MEETIN G RO D CLEANU P CRITERI A II I UTILIT YCLEARANCE S d PROPERT YINFORMATIO N FRO M DOUGLA S COUNT Y ASSESSOR'S OFFIC E 

## D n n
< ^ ^s ^ t\^\^ ^ SIGNATUR E DAT E 302374 

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### PROPERT Y SUMMAR Y Date : /15/201 0 Omah aLeadSit e Remedial Actio n Contrac t § EP-R7-07-0 6 TO# l Monthof : Propert y Address : 81 5 PACIFI C 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 Information : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : F2 = 13 9 PP M @ 4" ; B l = 38 0 PP M @ 4" ; N O EASEMENT ATTACHMENT S 1 ) Propert y sketc hprovidedb y EP A pursuan t to contract specification s 2 ) Signe dAcces 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 video clip/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Buihsketc h­ i ) Shal l includ e final lea dlevel s v ) Legen d ii ) Contamination lef t behin darea s vi ) Contractor identification iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r items to b e includedi n the individua l propert y file, if available , o r obtainedinclude : i ) Pre-excavation agreemen t detail s (if an y ar e mad e wit hthe propert y owner ) ii ) Propert y Statu s For msignedb y propert y owne r iii ) Excavation digita l vide o i n MPEG , WM V (Window s Medi aVideo ) o r SW F(FlashPlayer ) forma t and/or photograph s iv ) Signedfor mverifying satisfactor y restoration v ) Description of area s not meeting Interi mRO D cleanu p criteria .

TECHNOLOGIES , INC .Fin d Record 

### Backfill :

Sampl e Area : 2157 3 - 81 5 PACIFI C S T Owner : n Owne rOccupie d Owne rName : jCANIGLI ALrrn i ITAL Y LLC^ Owne rAddressi : jc/ 0 BLUESTONE^EVELOPTIEN T Owne rAddress2 : 

### 1 S 1 5 S T #10 0 City : State : Zi p Code : lOMAH A IN E |68102 - Owne rPhon e Alternate Phone : 

# r

Contract : Contractor : JPRUDENT2010_ S Contrac t Optio n jOPTIO N 2 Remediatio n Quer y Lea d Remainin g Quer y- Propert yDamag e Quer y

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

## ] •"•• • rr Owne rPhone : Alternat e Phone : 

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Assessment : Qualifyin g Grou p |40 0 Assessmen t Ma xXR F Valu e j " 484.7 5 Resident : Residen t Nanrie : 

# i • Propert yAddress : |81 5 PAQR C S T Zi p Code : 968108 - Residen t Phon e 

# 1TECHNOLOGIES , INC . Propert v #: ' 'Z l 5 7 3 > Propert y Address ; ^l* ^ P^C^-Cv c ^•^
- Date/Time : Owiiier''§Kame : ([^( ^ K \t^^ l i'' V LLC _ Quad s Exca>'ated : ^\p '2_ _ Contracto r Croup : FnMk'int Teelhumologics , .Inc. , Excavatio n Genera l Ye s 1 I f necessarv . wer e tli e correc l quadji"ant(s ) excavate dan drestored ? / 2 If nccessiiiy , wer e th e correc t area s o f dri p zon e excavate dan drestored' ^ / Gradin g So dan dVegetatio n Ye s J Doe s tJi e gradin g aroim dtli e penmete r o f th e hous e i n excavate darea s generall y slop e awa y fromth e liouse' ^ / 2Ha s so dbee n laj dmal l area s that wer e excavated ? / 3 Doe s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 day dm e period ) / 4 .Are sodde darea s generall y firman devenl y graded ? / 5 .Ar c iJie joint s betwee n th e so dstnp s generall y tight ? (Onl y evaluat e i f inspecte da l a3 0 day lim e penod ) 

# y b .

Wa s tii e ])ropert y grade dsuc htliat wate r wil l no t poo l o n tli e property' ^ / 7 Wa s daiu;sg e l o landscapin g or plan t material s avoided ? / Gates , Fence s an dRelainin g Wali s Ye s ! D o gate s ope n an dclos e freely ? (I f apphcable ) i / 2Were al l gale s o r fence s take n dow n durin g restoratio n activitie s reinstalled ? (I f applicable ) / 3 Wa s danijig e 10 gate s o r fence s avoided ? (I f applicable ) / 4 Wa s damag e t o retainin g wall s avoided ? (I f applicable ) / Foundation , Siding , an dGutter s Ye s 1 Wa s damag e t o th e sidin g o r tri mavoided ? / 2Wa s damag e l o th e foundatio n avoided ? / 3Wa s damag e t o window s avoided ? / 4Wa s damag e t o window s o r doo r screen s avoided ? / 5 Wa s damag e t o downspout s o r downspou t extension s avoided ? / Sifllewalkf t an dPrivcwrty s (Concrete ) Ve s 1 Wa s damag e t o diivewa v surface s avoided' ? / Wa s damag e t o walkwa y surface s avoided ? N o

N o

N o

N o

W o

## 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 fj,. ^ y ^ Date : ///s// /

### 2157 3 

# ra CHNOLOGIES . INC . 

### AS - BUIL T DRAWIN G OL S #2157 3 Dal e Excavated : 12/03/201 0 IISEP A Signed-OfTDate : 

### OMAH A LEA D SUPERFUN D SIT E

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Omah aLea dSit e 4613 0 NO EASEMEN T

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

# oER \ Propert yCompletio n Agreemen t Thi s agreement document s 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 owne r i s satisfie dwithth e restoratio n ofth 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 warrant y (3 0 day s total ) excep t thos e item s liste dbelow , ifany . Propert y ID : Propert y Addres s Owner : 

# *H ^ jt'^^H ^ Phone : Restoratio n Item s i n Questio n

Item : Item : Item : Item : Item : Kem : Require d correction s t o complet e th e property :

CB4.agre e restoratio n i s completed . L J I d o no t agre e restoratio n i s complete d a t (note d deficiencie s above ) 

# /I'ir'Tot o ^Signatur e Dat ePrudent Technologies , Inc . (Pmdenl ) i s under contrac i wil hth e U . S . Environmental Proleclio n Agenc y (EPA ) l o dea n u p lead
conlaniinated^ai b at^umbe r o f

propertie s locate di n Omaha , Nebraska , includin g Ihe propert y locale da l ^815 Pacifi c Siree l ^ j /TA-ti^iy* , Th e EP A rcques U >'ou r pennissio n l o allo w Pniden t l o perfonn o soi l cleanu p a t this property l o removelc&d-contMninaialsoil . B y signin g Ihi s form , th e propert y owner grant s pennissio n t o Prudenl t o perfon n activitie s relate d l o Ihe cleanup includmg soi l sampling , remova l o f lead-contaminate dsoil , an drestoratio n o f Ihe relercncc dproperty . I f

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u hav e any question s abou t Ihe soi l cteanup planne dfo r }t)u r property , pleas e coniac t Prudent sout hofTic c .for Ihe Omah aLea d Sit e cleanup-o l (402 ) 733-1188 . General question s about th e Omah aLeadSit e cleanu p can b e directe dt o di e EP A Publi c Informatio n Center s a t (<t02 ) 73 1 -304 5 (Sout hOmah aoffice ) o r (402 ) 99 1 -958 3 (Nort hOmah aoffice) . Propert y Acces s Grante dBy : .Christia n Christendsen_ (Pleas e Print Name ) Propert y Oivne r Signature : 

# /f'/?'tfH C (Date ) PROPERT Y INFORMATIO N (T o b e complete d b yresiden t and/o rproperl yowne r~ please print ) RESIDEN T NAME : _N/ Aempt ylot Owne r Rente r RESIDEN TADDRESS : 81 6 Pacifi c stree t Omah a N E I F RENTAL , PROPERT Y OWNE D BY : N/

A OWNER' S MAILIN G ADDRESS ; _72 0 Nort h 13 " Strse t Omah a N e 6810 2 OWNER' S TELEPHON E NUMBE R - HOME : JL402-346-240 8 L WORK : 

### J 1 AG E O F HOME? : N/ AYEARS . HO W LON G HAV E YO U LIVE D HERE ? N/ A YEARS . HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978 7 _YE 8 

### 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 O 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. )

AUTHORIT Y FORENVIRONMENTALRESPONS EACTIONS : Th e activitie s t o b e implemente db y EP A under Ihi s agreemen t ar e pursuan l t o Sectio n 10 4 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s right o f

acces s l o Ih e propert y i s provide dfo r i

n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , wliic hprovide s cnli y fo r "detenninin g Ihe nee dfo r response, o r choosin g o r takin g an y response actio n under this title , o r otherwis e enforoin g th e provision s ofth e title. " 808 0 War dParkway , Suit e 40 5 seoosios t 424 2 Medica l Drive , Suit e 426 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6810 7 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)733-118 8 Phona : (210)822-998 8 Fax:(816)363-370 7 Fax : (402)733-188 3 Fax : (210 ) 679-667 7ENVIRONMENTA L& CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m

808 0 War d Parkvray , Suit e 40 5 

### seoosios t 424 2 Medica l Drfre , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 68107 - Sa n Antbnio , TX 7822 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 ) $79-657 7

## 2157 3 

# III I Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e Owne rName : EMILI ALL C • Goo d 

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### YOU RTICKE T NUMBE RI S 2644078 . Origina l Cal l Date : 11/17/1 0 Time : 5:1 0 p m Op : SIVA1896 7 Wor k t o Begi n Date : 11/19/1 0 Time : 5:4 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 81 5 Street : PACIFI C S T Twp : 15 NRng : 13 E Sect-Qtr : 22-SE,23-SW,26-NW,27-N 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 : N Front : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL 3 MUDO l MUD0 2 OMAHACO F 0PPDGPR 5 0PPDGPR 6 QLNNEI C QLNNEI F QWESTN E SPRINTN E

Servic e Are a Contac t Phon e Numbe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEID I 

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### Day : 877366834 4 Alt : Emerg : 877366834 4 MUDO l METROPOLITA N UTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0 MUD0 2 METROPOLITA N UTILITIE S DISTRIC T SAND Y 

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### seoosios t 424 2 Medica l Drive , Suit e 72S 0 • naMCi|^.aH>«411 4 Ontidm , Ncbnrtk a 0810 7 Sa n Antonio , T X 7822 9 Mine : (St6 ) 363*370 3 Plione : (402)733-118 8 Phone : (210)822468 8 KifSIS ) 383.^370 7 Fax : (402)733^188 3 Fax : (210 ) 679-657 7