## TRANSMITTA L o f OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAn)# : \IQ\17^
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## Date : {}l]\^h ^ Address : 7?| q ^ . ^^ M C 4 RemediatioiiContiactor : ^Hdlfl-l r ^H\\0 L Year : AOlQ
- SOI L REMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S Vide o o f property (DVD ) 

# i Executiv e Summar y I ^ E P A-provide dproperty sketc h ffl Signe dAcces s Agreemen t for subjec t property D Signe dAcces s Agreement(s ) for adja^«nt propert y B Restoratio n Agreement 0 Setdemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) Confirmatio n dat a Photograph s As-buil t sketc h SatisfiKtor y restoratio n signe db y Property Owne r 

# A Property close-ou t chec k lis t signe db y EP A D Descriptio n o f area s no t meetin g RO D cleanu p criteri a Q Utilit y dearaace s 

## l aProperty informatio n fromDougla s County Assessor' s Offic e D D D 

## r\^' ' Signatur e Dat e 3005418 5 

# in i Superfun dRn d Recor d Backfill :

Sampl e Area : 1617 2 - 251 8 S 3 4 S T Owner : D Owne rOccupie d Owne rName : |Hn T ELIZABET H A Owne rAddressl : Owne rAddressZ : |251 8 S 3 4 ST Qty : State : Zi p Code : |OMAH A |N E |68105 Owne rPhone : Alternat e Phone : 

# 1 1 Remediatio n Query I Lea d Remainin g Query I

Resident : Residen t Name : HARRI S JRIUCHAR D A Propert yAddress : |2518S34S T Zi p Code : |6810 5 Residen t Phon e 

# I Propert yDamag e Quer y

Contract : Contractor : |PRUDEI^T2009_S Contrac t Optio n )OPnO N 3 " Assessment : Qualifyin g Grou p |400/CHIL D Assessmen t MaxXR F Value : 474.2 5

### PROPERT Y SUMMAR Y Date:ft)/15/201 0 | Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l | Mont h of : d C T Propert y Address : 251 8 S 3 4 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 : ARE A NO T EXCAVATE D PE RP.O . REQUEST ; F2/L S (5X10' ) = 20 5 PP M @ SCRAP E CONFIRMATIO N SAMPLIN G DATA/RESULTS : F 2 = 9 2 PPM @ 6" ; E A = 5 1 PPM @ SCRAPE (-1" ) ATTACHMENT S 1 ) Propert y sketc h providedb y EP A pursuan t to contrac t specification s 2 ) SignedAcces 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 vide o clip/photograph s 5 ) Documentation - CompletedClose-ou t CheckUs t 6 ) As-Buil t sketc h ­ i ) Shal l include fina l lea dlevel s v ) Legen d ii ) Contamination lef 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 includedi n th e individua l propert y file , i f available , or obtainedinclude : i ) Pre-excavation agreemen t detail s (if an y ar e mad e wit h the propert y owner ) ii ) Propert y Statu s For msignedby propert y owne r iii ) Excavation digita l vide o i n MPEG , WM V (Window s Medi aVideo ) o r SW F(Flash Player ) forma t and/o r photograph s iv) Signe dfor mverifying satisfactor y restoratio n v ) Description o f area s no t meeting InterimRO D cleanu p criteria .

TECHNOLOGIES . INC .TBCHNOLOGDBS , INC . 

# EP A Propert y Clos e Ou t Propert y # : lUll ^ Propert y Address : £^l ^ ^ . ^l ^ Sh Date/Time : IJ^j j fc ^ Owner' s Name : ^,o^^ A ^cixf^g : Quad s Excavated : Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s N o 1 . I f necessary , wer e the correct quadrant(s ) excavatedandrestored ? / 2 . I f necessary , wer e th e correc t area s o f drip zon e excavatedandrestored ? / Gradin g Sodan dVegetatio n Ye s N o 1 . Doe s th e gradin g arouiT dth e perimete r of th e hous e i n excavate darea s generall y slop e awa y fro mth e house ? / 2 . Has so dbeen lai di n al l area s tha t wer e excavated ? / 3 , Doe s tli e sodappea r to b e generall y health y andgrowing ? (OiJy evaluate i f inspeae da t a3 0 da

y tim e period) / 4 . Ar e soddedarea s generall y firmandevenl y graded ? v " 5 . Ar e tlie joint s between the sodstrip s generall y tight ? (Onl y evaluat e if inspecte da t a3 0 da y lim e period) / 6 . Wa s the propert y gradedsuc h tlia t wate r wil l not pool on the property ? / 7 . Wa s damag e t o landscapin g 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 andclos e freely ? (I f applicable ) 

### y 2 . Wer e all gate s o r fence s taken dow n during restoratio n activitie s reinstalled ? (I f apphcable ) 

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

## y 4 . Wa s damag e t o 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 t o the foundation avoided ? 

# y .1 . Was damag e t o window s avoided ? / 4 . Wa s damag e t o window s o r doo r screen s avoided ? 

## y 5 . Wa s damag e l o downspout s or downspou t extension s avoided ? ^ 

# y Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Was damag e l o drivewa y surface s avoided ? 

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

### Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complet e includin g th e 30-da y so dwarranty : EP A Representativ e BCU^JBL ^ 

### _Date : /g/a/o ?

## Propert yCompletio n Agreemen t Thi s agreemen t documents th e completio n o f removal activitie s performe do n th e belo w liste dproperty . Th e property owner' s signatur e indicate s tha t th e propert y owne r i s satisfie dwith th 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 a t an y tim e i n th e future , excludin g any remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y ID : Propert y Address : 

# ^5 7 S " 

# ^•3t * 

# ^T T Owner : Phone : Restoratio n Item s i n Question :

Item : Item : Hem : Item : Item : Item : Require d connection s t o complet e th e property :

UL I I agre e restoratio n i s completed . I I d o no t agre e restoratio n i s complete d a t (note d defidencie s above )

Dat e IPruden t Technologies , Inc . (Prudent ) i s unde r contrac t with th e U . S . Environmenta l Protectio n Agenc y (EPA ) t o clean up lead
contaminate dsoil s a t anumbe r o f

propertie s locate di n Omaha , Nebraska , includin g th e property locate da t

. Th e EP A request s you r permissio n t o allo w Pruden t t o perfor masoi l cleanu p a t thi s property t o remov e lead-contaminate dsoil . B y signin g this form , tli 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 dfo r you r property , pleas e contac t Pruden t Administrativ e Cler k for th e Omah aLeadSit e cleanup . Ms . Deborah Johnso n -a t (402 ) 733-1188 . General question s abou t th e Omah aLea dSit e cleanu p ca n b e directe dt o th e EP A Publi c Infomwlio ^ ( f enter s a t (402 ) 731-304 5 (Sout h Omah aoff^ie ) o r (402 ) 991-958 3 (Nort h Omah aoffice) . Property Acces s Grante dB ; Property Owne r Sig n 

# IMSip n (Date ) PROPERT Y INFORMATIO N (T o be complete d b yresiden t and/o rpropert yowne r—pleas e print ) RESIDEN T NAME : 

# ^.Uy.k^^iJ ^ IjLLi L Owne r Rente r RESIDEN T ADDRESS : 

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# JCd e G-^l o - ^ I F RENTAL , PROPERT Y OWNE D BY :
OWNER' S MAILIN G ADDRESS ;
OWNER' S TELEPHON E NUMBE R - HOME : J _ WORK :
AG E O F HOME? : YEARS . HO W LON G HAV E YO U LIVE D HERE ? YEARS . 

# 31 . 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 CHILDRENUNDE R 7 YEAR S OL D WH O PLA Y I NTH E YAR D FO R 5 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 FO RENVIRONMENTA L RESPONS E ACTIONS : Th e activitie s t o b e implemente db y EP A unde r this agreemen t are pursuan t t o Sectio n 104 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(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic h provide s entry fo r "determinin g th e nee dfor response , o r choosin g o r takin g an y respons e actio n unde r thi s title , o r otherwis e enforcin g th e provision s o f th e title. "

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 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 7ENVIRONMENTA L & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S



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# r Propert y Statu s For m ^15) ^ S ^ M ^-* ^ Date : 

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### ProperW|6wne i Pruden t Employe e Signature : Signature :FrHNOT.OGIF.S . INC . 

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### OMAHA LEAD SUPERFUND SIT E 617 2

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### A S - BUIL T DRAWIN G DiK f l'ACii\aU(i : 10/.5(l.20ns > t M;!'\SijiiH- dOffline : 

### OMAH A LEA D SUPERFUN D SIT E 617 2 Omah a Lea d Sit e Exterio rPain t Nort h Arro w Owne rName : RiCHAR D A HARRI S J R Sit e Sketc h Address : 251 8 S 34 S T • Poo r Phone : H : (402)707-294 4 W^ ^ [402 } 707-294 4 Q No t pain t Sampl e Numbe r RYASCPXA-1617 2 RYBSCPXA-1617 2 RYCSCPXA-1617 2 RYDSCPXA-1617 2 RDZSCPXA-1617 2 F 1 F2 B l B2 D Z Lea d Concentratio n

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### Print Preview Pag e 1 of 2 Dougla s County-Omaha , N E

Parce l I D Owne r Nam e Pnsperty Addres s Cit y Zi p Owne r Addres s Owne r Addres s Owne r Cit y Owne r Stat e Owne r Zi p 100234000 0 HIT T ELIZABET H A 2518S3 4 S T OMAH A 6810 5
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0.1 6 http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp ? parc=100234000 0 http://douglasne.mapping online.com/DouglasCoNe/static/accountinfo.jsp ? accountno=R100234000 0 

### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 9/17/200 9

2Pag e 1 of 2

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YOU RTICKE T NUMBE RI S 2388971 . Origina l Cal l Date : 10/19/0 9 Wor k t o Begi n Date : 10/21/0 9 Time : Time : 10:4 3 a m 11:1 5 a m Op : SIVA1896 7 State : N E Address : 251 8 UGLA S Place : OMAH A Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 28-SW,33-N W Sect-Qtr : 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 : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V LEVEL 3 MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F
Servic e Are a Contac t Phon e Numbe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEIDI Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
LEVEL3 LEVEL S COMMUNICATIONS , LL C N A Day : 877366834 4 Alt : Emerg : 877366834 4
MUD0 2 METROPOLITA N UTILITIE S DISTRICT SAND Y Day : 402504782 3 Alt : Emerg : 402504797 0
OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRICH/TRAFFI C Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0

### Pag e 2 of 2

0PPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T N A Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNNEI FQWES T LOCA L NETWOR K 

### NA Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

## Address : rQS/ ^ Crew : Date : /C:!>-^3'0' T


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### TECHNOLOGIES , INC . SOLUTION S 

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