### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 4771 6 DATE : 12/15/201 0 ADDRESS : 361 5 R ST REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES . INC . YEAR : 201 0 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S a i PR E AN D POS TVIDE O O F PORPERT Y(DVD ) 

# d EXECUTIVESUMMAR V

m EPA-PROVIDE D PROPERT YSKETC H [ ^

SIGNE D ACCES S AGREEMEN TFO R SUBJECTPROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FO R ADJACEN TPROPERT Y [ ^

RESTORATIO N AGREEMEN T 3023753 5 

# 111111111111111 1 Superfun d

• SETTLEMEN TDOCUMENT S (I.E. , FO R DAMAG E O R T O REPLAC E PLANTS , ETC. ) B l CONFIRMATIO N DAT A a PHOTOGRAPH S Q AS-BUIL TSKETC H ffl SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R m PROPERT YCLOSE-OU TCHEC KLISTSIGNE D B YEP A

• DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A ofUTILIT YCLEARANCE S I Z PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR' S OFFIC E 

# • • •

SIGNATUR E DAT EFin d Record Remediatio n Quer yi Lea d Remainin g Quer ya Propert yDamag e Quer y Backfill :

Sampl e Area : 4771 6 ­ 361 5 R S T Owner : Use rProvide d Owne rInformatio n Resident : n Owne rOccupie d Owne rName : Owne rName : Residen t Name : JGARO AALFREDO 0 

### \ 

# I Owne rAddressl : Owne rAddress : Propert yAddress : 

### ! 361 5 R S T Owne rAddressZ : Zi p Code : J360 9 R S T |68107 - City : State : ZipCode : City : state : Zi p aide : Residen t Phon e jOMAH A JN E J68107 ­ 

# [ 

# 1 1 Owne rPhon e Alternat e Phone : Owne rPhone : Alternat e Phone : 

# r

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Contract : Assessment : Contractor : |PRUDENT2010_S Qualifyin g Grou p [40 0 Contrac t Optio n lOFTlO N 2 Assessmen t Ma xXR F Valu e 

### ! 499.7 7

### PROPERT Y SUMMAR Y Date : 12/15/201 0 Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Monti i of : Decembe r Propert y Address : 361 5 RS 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 Otiie r Relevan t Information : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : B l = 7 6 PP M @ 2" ; E A = 5 1 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 final 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 individua l property file, i f available , o r obtaine dinclude : 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 ) 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 .•HECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Property # : U'^' ^ Propert y Address : 3t . \'= • " ^ ^ ^ . Date/Time : )(/ n Owner' s Name : A\^-«^* ^ Ciarcac v Quad s Excavated : ^ ( Contracto r Group : Pruden t TeSahnologies , Inc. , Excavatio n Genera l Ye s N o 1 , I f necessar>' , wer e th e correct quadrant(s ) excavatedan drestored ? / 2 , I f necessary- , wer e th e correct area s o f drip zon e excavatedandrestored ? / Gradin g So dan dVegetatio n Ye s N o 1 , Doe s th e grading aroim dthe perimete r o

f th e hous e i n excavatedare.a s generall y slope awa y / fro mthe house ? 2 , Has sodbee n lai din all area s tlia t wer e excavated ? 

## y 3 , Doe s the so dappea r t

o be generall y health y andgrowing ? (Onl y evaluat e i f inspecteda t a3 0 da

y time period) 

## y 4 , Ar e sodde darea s generall y fir man devenl y graded ? 

# y 5 , Ar e the joint s betwee n the sodstrip s generall y tight ? (Onl y evaluat e i

f inspecteda t a3 0 da y 

## y tim e period) 6 , Wa s the propert y gradedsuc htlia l wate r wil l no l pool o n the property ? 

### y 7 , Wa s damage t o landscaping o r plan t material s avoided ? 

# y Gates , Fence s an dRetainin g Wall s Ye s N o ] , Do gate s ope n andclos e freely ? (I f applicable) 2 , Wer e al l gate s o r fence s take n do\v n during restoration activitie s reinstalled ? (I f applicable) 3 . Was damage t o gate s o r fence s avoided ? (I f applicable) 

# y 4 . Wa s dainag e t o retainin g wall s avoided ? (I f applicable) 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 dainag e t o the foundation avoided ? 

# y 3 , Was damag e t o window s avoided ? 

# ~y 4 Wa s damag e t o window s o r doo r screen s avoided ? 

# 7 ' 5 , Was damag e to downspouts o r downspou t extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Wa s dainag e t o drivewa y surface s avoided ? 

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

## Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complete includin g th e 30-da y so dw^arranty : EP A Representativ e Q ^ ^^ ^ ^Date:_

_ulizh bX'llNOIOdlRS . INC . 

### A S - BUIL T DRAWIN G OL S #4771 6 Dat e Excavated : 10/14/201 0 

### OMAH A LEA D SUPERFUN D SIT E I SEP. \Signed-Of T Date : 

# y77/ g Exterio rPain i Noit h AFFDW Owne rName : AJfTed o G&tXUS - Onnah a Lea d Sit e • Goo d Addre»:_3G/ 5 /? ^

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A = 5 I PP M aSCRAPK I 1" ) CONTRAC T # : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC .

# p RIDE N

Thi s agteeirici-ii doc-uiiievii s tli e uoijiplctio n o t remova l aciiviiic s pertoiHie u o n tii e beio w jisic dpcopeiT y Th e DTopei-r y o->viie r s .signature tndicate s tha t th e propeit y owtie r i s satisfie dwiti i 'th e restoia'fio n o f th e subjec t property' , an dtha t n o ite:fn' i ar e in question, , no-w , o r a

t anj ' tim e in th e future , excludin g any remainin g -W'arrant^
- (3 0 day s totai ) excep t thos e item s liste dbelow. , ifany . Propert y HD' . Property .'^ddrsss ; " P 

# zyyyy^. ^ 2 ^ Phone ; 

# ygy^yy^iv? ^ Restoraltoos-i i litem s LT D Quiestioini :

, 1 RequjiDFe d co-STecltooFD S t o compielt e ih ® propestj/ :

,[/N - I ?,gfe e resTora'iio n i s completed , excep t a s note d abov e
I — I 

### I ' • \ a o ,no t agre e restoratio n i s complete d 

# \ypy ± Dav e 3igii..aifur e

## \o/n *

Piiideii t Technologies , Inc . (Prudent ) is unde r contrac t withth e U. S, Environmenla l Protectio n Agenc y fEPA ) to clean up leacl
gjntaminate dsi^ s at. a. numbe r of

propertie s locate d in Omaha , Nebraska , includm g th e property locate dat Q V? / ^ J K t)^ ? '^^ ^ KP A request s you r permissio n to allo w Pruden t to performasoi l cleanu pat thi s property to remov e lead-contammate dsoil . By signin g thi s form , th e property owne r grant s permissio n to Pruden l to perforn i activitie s relate d to tli e cleanu p includin g soi ] sampling , remova lof lead-contaminate dsoil , an drestoratio n ofth e reference dproperty . If

yo u hav e an y question s abou t th e soi l cleanu p planne dfor you r property , pleas e contac t Pmden t souti i offic e for th e Omah aLead Site cleanup-a t (402 ) 733-1188 , Genera l question s abou t tlt e Omah aLea dSit e cleanu p ca nbe directe d to th e EP A Publi c Informatio n Center s at (402 ) 731-304 5 (SouthOmah aoffice ) or (402 ) 99 1 -9583 (NorthOmah aofl'ice) . Property Acces s (jranio d Dy (PleasePrin l Name ) Property Owne r Signature : 

# ^<^^.^ ^ AAHiAAyy A (Signature ) (Date l PROPERT Y INFORMATIO N (T o be complete dby residen t and/o T properl y owne r -- pleas e prin t> RESIDEN TNAME: . ^ iCy^t O Owne r Rente r RESIDEN TADDRESS : 

# 3(A'^' A .^ s l IF RENTAL . PROPERT YOWNE D BY : 

# UZ . OWNER' S P/IAILIN G ADDRESS ;
OWNER' S TELEPHON TELEPHON E NUMBE R - HOME : J L WORK ; 

# Ceu , yti22yMJ^lJko ± AG E OF HOME? : YEARS . HO W LON G HAV E YO U UVE D HERE ? YEARS . HA S TH E EXTERIO R BEE N PAINTE D OR COVERE D WIT H SIDIN G SINC E 1978? YE S 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 NUNDE R 7 YEAR S OL D WH O PLA Y INTH E YAR D FOR 5 HOUR S OR MOR E PE R WEEK - COMMENT S OF^^ECIAL INSTRUCTIONS : (I.E . DOGS , ENTRY GATES , ETC. ) A 

## M>vT^DG ^

CA ACA!^P^ k ^d TK^^r-jx ^ ^ ^f/A rruud y ,.\LlTHORIT Y l-O RENVIRONMENTA LRESPONS EACTIONS ; Th e activitie s to be implemente d by EPA unde r this agreemen t ar

e pui-suanri o Sectio n 104 ofCERCLA , 42 U.S.C . 9604 , EPA' s righ t of

acces s to th e propert yis provide dforin Sectio n 104(e ) of CERCLA , 42 O.. S C 9603(e) , whic hprovide s entry for "detenninin g th e nee dfor response , or choosin g or takin g an y respons e actio n under tlii s title , or otherwis e enforcin g th e provision s of tli e title. "

• ifilii l : . ::< ; 808 0 vVare i PdikVva'v , Sairi ^ • •:Vi7 . fvle/iir.a l Drivft , ;jijitf t 42S O C-'ru::\\i. . :\iftij^ii;;: ^ Kansa s Ciry.M O (T-i i i * Pnone ; 1816 ^ 36-.tj70 S I- ;.,, • .!io:; • •::.•:• . ^ax : '816' ; ses-.-i'-jr' ­i;,NVl.KOiN!VH?:.i'vr,.'Xi , .*i : C(•>NSTRt,lCTfO ^ SE,RVlCF,r ) 

### TECHNOLOGIES , INC . 

# Propert y Statu s For m Address : 3 6 / 6 % ^ ^ x^y f /Jl)C < Date : Phon e 

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# Ayyiy ^ 30B a War d Par*;w3-v' . -TI . 'p . 40 H 5(>(;> i o If ; o t V<,7. ivieriica l Dfivt v Suit e 4-iS O riansa s City , M O (5411. 1 iiai i Anioniu . T X 7«i2 8 Phone ; (816 ) n63-:i70.- ? fhoMs : (210)822.»68 R

# ^771 G Omah a Lea d Sit e Exterio rPaint ttorthAm w Owne rNam e Q Goo d Address : 3C n 

## z^y<3Qant U^' ^

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# i Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Firm : Sample s Collecte d V^t % KM , &ly A nVAOCPXA ­ -f^- 

## D Date : lg|'2-t/6( o nYDOOPX A 

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# n Date : _ 

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# AM . Numbe rof Sample s Staff : 

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### Printed : Oc t 12.201 0 wwwdcgis.org/dogi s

## Pag e 1 of 2

" > Creat e Anothe rTicke t Bac k t o Irt h Interne t .Send.Email . 

## YOURTICKE T NUMBERI S 2614392 . Origina l Cal l Date : 10/11/1 0 Time : 4:2 9 p m Op : SIVA1896 7 Wor k t o Begi n Date : 10/14/1 0 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 361 5 Street : R S T Twp : 14 NRng : 13 E Sect-Qtr : 08-NE,09-N W 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 : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V METR O 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 HEID I 

## Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
METR O METR O COMM . COLLEG E CHRI S 

## Day : 4024572307 Alt : 402672703 3 Emerg : 402457231 3
MUD0 2 METROPOLITA N UTILITIE S DISTRIC T 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 Day : 406728934 3 

## http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.. . 10/11/201 0

## Pag e 2 of 2

OPPDGPR 6 OMAH A PUBLI C POWE RDISTRICT EL M LOCATIN G 

## Alt : 406207149 4 Emerg : 888728934 3 QLNNEI FQWES T LOCA LNETWOR K

EL M LOCATIN G 

## Day : 406728934 3

Alt : 406207149 4 

## Emerg : 888728934 3

http://www.dhon.org/irthintemefDHONNoticeCreation/MessageText.asp?ret=<RESULT.. . 10/11/201 0l!;iNl^iISl<;ERIN GAN D 

### CONSTRUCTKH ^ SOLUTION S 

## SIT ESAFTfcT Y HAZAR D ANALYSI S 1(QA ^ 

## 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 (L
- 

## Excavatio n Date : BackfiU Date : —

Conditio n Hazard s Correctiv e Actio n 

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## Sit e Safety Offic e Date :

SGWSIOS t 424 2 Mtadical Drive , Suit o 725 0 Kai»a»Cliy;lia«411 4 San^Antenio , T X 7822 9 Phone : (>W ) SOjn W (402)733-118 8 Phone : (2t0 ) 822^958 8 ^x : fStt ) 383^^370 7 Fax : (402)73»'188 3 Fax : (210 ) 879-657 7

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