### TRANSMITTA L o f OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : I7^U> 7 Date : /2/W^^ ^ Address : ^ f/d/ . £^ 9 h Remediatio n Contractor : r^'^Jr 'Titi^i^yt>^t^^%it , Year : 2.oo ^ SOI L REMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S D Vide o o f propert y (DVD ) D Executiv e Summar y D EPA-providedpropert y sketch D SignedAcces s Agreemen t fo r

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

adjai^en t propert y D Restoration Agreemen t D Settlemen t document s (i.e. , fo r

damag e o r

t o replac e plants , etc. ) D Confirmation data D Photograph s D As-built sketch D Satisfiactor y restoratio n signedby Propert y Owne r D Propert y close-out chec k

lis t signedby EP A D Descriptio n o f area s no t meeting RO D cleanu p criteri a n Utilit y clearance s D Propert y information firomDougla s Coimt y Assessor' s Office D n 4030958 4 

# 0 _illHllDII I '- ' : Superfun d Signatur e Dat e

### PROPERT Y SUMMAR Y Date : 12/20/200 8 Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-06/0004 Month of : Nov/Dec . Propert y Address : 391 4 S 9 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 Odie r Relevan t Infonnation : NON E CONFIRMATIO N SAMPLIN G DATA/RESULTS : B l = 22 0 PP M @ 6" ; P Z = 22 7 PP M ( @ 6" ; D Z = ZER O @ 2" ; N O EASEMEN T ATTACHMENT S 1 ) Propert y sketch provide db y EP A pursuan t to contract specification s 2 ) SignedAcces s Agreemen t including acces s agreement s requiredfo r crossing 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 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Buil t sketch ­ i ) Shall include final leadlevel s v ) Legend h ) 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 incltidedin th e individua l propert y file, i f available , or obtainedinclude : i ) Pre-excavatio n agreemen t detail s (i f an y ar e mad e wit h th e propert y owner ) ii ) Propert y Statu s For msignedby propert y owne r iii ) Excavation digita l vide o i n MPEG , AVM V (Window s Medi aVideo ) or SW F(Flas h Player) fonna t and/o r photograph s iv ) Signedfor mverifying satisfactoiy restoratio n v ) Description o f area s no t meeting InterimROD cleanu p criteri a

ECHNOLOGIES , INC .Rn d Recor d Backfill :

Sampl e Area : 1266 7 Owner : D Owne rOccupied Owne rName : SCHIPANSK Y RENE E Owne rAddressl : Owne rAddressZ : 391 6 S 9 S T City : OMAH A Owne rPhone : Qea n U p Quer y Lea d Remainin g Quer yI

­ 391 4 S 9 S T Resident : Residen t Name : |HAIZLJ P JO N R Propert yAddress : [391 4 S 9 S T Zi p Code : [6810 7 Residen t Phon e State : Zi p Code : 

# I |rJ E [6910 7 Alternat e Phone : Propert yDamage Quer y

Contract : Contractor : PRUDENT2008_ S GiX)up : Assessment : Qualifyin g Grou p jPLA Y ZON E Assessmen t XR F Date : 

# I Assessmen t Ma xXR F Value : I 493.4 7HCHNQIJOGIBS I IN C 

# &EP A EP A Propert y Clos e Ou t Propert y # : l^^^ ? Propert y Address : 1^/ U S^-Sr Date/Time : Owner' s Name : Quad s Excavated : P^^P^ ; B> ) Contracto r Grou p Praden t Technologie s Excavatio n General 1 .

I f necessary , wer e the correct quadrant(s ) excavatedan drestored ? 2 .I f necessary , wer e the correct area s of dri p zone excavatedan drestored ? Gradin g Sodan dVegetatio n 1 .

Doe s the grading aroun dth e perimete r ofth e hous e i n excavatedarea s generall y slop e awa y fromthe house ? 2 .

Ha s sodliee n lai di n all area s tha t wer e excavated ? 3 .

Doe s th e sodappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e if inspecteda t a3 0 da

y time period) 4 .Ar e sodde darea s generall y fir man devenl y graded ? 5 .

Ar e th e joint s betwee n th e sodstrip s generall y tight? (Onl y evaluat e i f inspecteda t a3 0 da y time period) 6 .Was th e propert y gradedsuc h tha t wate r wil l not pool on th e property ? 7 .

Wa s damag e t o landscapin g or plan t material s avoided ? Gates , Fence s an dRetainin g Wall s 1 .

D o gate s ope n an dclos e freely ? (If applicable) 2 .Wer e all gate s or fence s taken dow n during restoration activitie s reinstalled ? (If applicable ) 3 .

Was damage t o gate s or fences avoided ? (IfappUcable) 4 .Wa s damage t o retaining wall s avoided ? (IfappUcable) Foundation , Sidin g an dGutter s 1 .

Wa s damag e t o th e siding or trimavoided ? 2 .Was damag e t o th e foundatio n avoided ? 3 .

Was damag e t o window s avoided ? 4 .Wa s damage t o window s o r doo r screen s avoided ? 5 .

Was damage t o downspouts or downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) 1 .

Was damage t o drivewa y surface s avoided ? 2 .Wa s damage t o walkwa y surface s avoided ? Ye s No / 

## X Ye s No

/ / 

## X X 

# X X 

# y Ye s N o / 

## X X 

# y Ye s N o 

# y y y y X Ye s N o



## X u

### Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complet e including th e 30-da y sodwarranty : EP A Representativ e Ba mdSLa j Date : /ajf/o s

## Propert yCompletio n Agreemen t Thi s agreemen t documents th e completion of remova l activitie s performedo n th e below listedproperty . Th e propert y owner' s signatur e indicate s tha t th e propert y owne r i s satisfiedwit h th e restoratio n ofth e subject property , an dtha t n o item s ar e i n question , now , o r a

t an y time in th e future , excludin g an y remaining warrant y (3 0 day s total ) except thos e item s listedbelow , if any . Propert y ID : Propert y Address : '- ^ A i u 

### ^H v 

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# "^ h Owner : Phone : Restoratio n Item s i n Question :

Kem : Item : Hem : Hem : item : Hem : Require d correction s t o complet e th e property : U'-NVccba-ti ?

1

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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



# U {-i^o i DatePniden t Technologies , Inc . (Prudent ) is unde r contrac t wit hth e U. S. Environmenta l Protectio nAgenc y (EPA ) to clea n up lead
contaminate dsoil s at anumbe r of propertie s locate dinOmaha , Nebraska , includin g th e propert y locate d at

. Th e EP A request s you r permissb n to allo w Pruden t to perfor masoi l cleanu p at thi s propert y to remo w lead-contaminate dsoil . By signin g thi s form, th e propert y owne r grant s pennissio n to Pruden 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 refoence dproperty . If

yo u hav e an y 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 forth e Omah aLea dSit e cleanup . Ms . Debora hJohnso n-a t (402 ) 733-1188 . Genera l question s abou t th e Omah aLea dSit e cleam p ca n be directe d to th e EP A PuUiCliilSrmatio nCenter s at (402 ) 731-304 5 (Sout hOmah aofBce ) or (402 ) 991-958 3 (Notfl i Omah aofBce) . Propert y Acces s Grante d iT ' \(Pleas e Pri n PrintName ) Propert y Owne r Sig i (Date ) PROPERT Y INfOpMATIO N • V (T o be complet e b yresiden residen t and/o rpropert propert y o

wne r—pleai e print ) RESIDEN T NAME : Owne r Rente r RESS : RESIDEN T ADDRES S 

### Q>s \ IF RENTAL , PROPERT Y OWNED BY : OWNER' S MAILIN G ADDRESS ;
OWNER' S TELEPHON E NIJIIIBE R - HOME : WORK : AG E OF HOME ? : l o > 3 YEARS . HO W LON G HAV E YO U LIVE D HERE ? Cd l ^EARS . HA S TH E EXTERIO R BEE N PAINTE D OR COVERE D WIT H SIDIN G SINC E 1978 7 Vy n YE S NO 

# jar , 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 CHILDREN UNDE R 7 YEAR S OL D WH O PLA Y IN TH E YAR D FO R 6 HOUR S 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 d by 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 t of acces s to th e propert y is providedfo rinSectio n104(e ) of CERCLA . 42 U.S . C 9605(e) , whic hprovide s entr y for "determiningth e nee dfor response , or choosin g or tikin g an y respons e actio n unde r thi s title , or otherwis e enforcin g theprovision s ofth e title. "

808 0 War d Partnvay , 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 , MO 6411 4 Omaha , Nebrask a 6811 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

# # A S - BtIL T DRAWIN G . : OMAHA LEAD SUPERFUND SIT E ! OLS# : 1266 7 Date Excavated : 11/01/200 8 USEP A Slpied-OffDate : 1266 7 Exterio rPain t Non h Anew Omah a Lea d Sit e Owira rN«ine : JO N R HAtZLIP . Sit e Sketc h • Goo d Addf«»»:M14SSLST. . D^oo r

Phon«:.H : 402-614-487 6 W : 402-293-170 0 • Nrtpatr t Sampi o Numbe r Lead Sampl e Samf^e s CoHecte d LA B Concentratio n Coiiecte d Firm : P c ^C T ^ 6g_ RYASCPXA-1266 7 F l /^"Z . pp m 

## ca - D RYBSCPXA-1266 7 F 2 / 6 7 Do m E T Time ; /0- ' ^ C

> A M RyCSCPXA-1266 7 B 1 g 6 3 ao m D Sample s Analyze d nYD6CPXA-1266 7 - B 2 D D RDZSCPXA-1266 7 D Z 12<P 3 oo m 0 " 

## a XR F Unit : lOJ l Book : /? g ROZSOPX A1286 7 -6 2 " DDf n 

## • Date : \2.-l4'OS ' RPZSCPXA-126S 7 PZ ^'f a ao m 

## a Time ; 

### P m Lab RYCSCPl.A-12667 : Staff ; Numbe ro f Sample s = j i f \ ; / ; LA .

. Re»« * .42 9 pp m _ Fron t Right , B 1 = Bac k Left , B 2 ^ Bad e Righ t D Z ^ Dri p Zone , G Z « Garden , P Z >= Pla y A V qutdtMi t ar e a

a viawad fro m th e t(i««t , facin g prapart y

CONTRA a » : E P - R7-07-0 6 / 000 4 PRUDEN TTECHNOLOGIES , INC .ENVIRONMENTA L & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address:- ^ ^\\ ^ Q ^ <^V k

"2 V- Date : Phone : ^02- ^ ^fi
- IV M H BVID : Ite mN O Plant s & Permanen t Landscapin g T o Remai n I n Plac e O n Ma p Descriptio n & Locatio n 

# ^v^cJ L a^- drv' p p Ce.. L e ^



### Pre-Existin g Conditio n of Structure s DoesyourBasementhaveahistor y o f

leaking ? Ye s N o Ite mN O Descriptio n & Locatio n O n Ma p

Propert y Owne r Pruden t Emplo ;

' ^ Si&natuperY \ Signature :

808 0 War d Parkway , Suit e 40 5 2505 N . 24' " Street , Suit e 30 8 4242 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 Fax : (816 ) 363-370 7 Phone : (402)504-100 4 Fax : (402)504-100 5 Phone : (210)822-958 8 Fax:(210)579-657 7,..i

—,».,n.iL , ,.|iM i ^f.Mvt9t,<-if . <i*m*i.J'*ti^*i»inAr«K*<VW^***ifi*^fit.Jli*ii-.'viTeiVifi»-£^i-^^JXX)i . MM4jg^V t 

## 1266 7 ExteriorPain t Noitt i Arro w 

### Omah aLea dSit e Owna rName : JO N R HAIZLI P • Gio d 

### Sit e Sketc h A l dress : 391 4 S 9 ST ^::- ^ EJ-Pio r >|lone : H : 402-614-497 5 W: 402-293-1 7 » • N<*p*n t Sqmpt e Numbe r 

### Lea d Sampl e LA B Sample s Collected 

### ConcentFatio r Collecte d Fimt : ^ /^ ^ \ 6t . RYA|SCPXA-1266 7 F 1 pp m 

## D Data : \\- 0 ^ C ^ RYBBCPXA-1266 7 F 2 pp m 

## 14 7 Time ; 

### 10
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## D 

# M ^ ;CPX A1266 7 K 

### Sample s Analyze d pp m 

## D D ROZlSCPXA-1266 7 D Z 

### 12^ 3 loo m 

## D XRFUni t 

### I£12 L Book : _I1 £ nOZDCPX A1266 7 6 2 pp m 

# a Date : 

## \Z't*i-o ^ RPZ$CPXA-1266 7 P Z 

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## D Twne : 

## P m ' i la b RYCSCPLA-126e7^ Staf h 

## AA , Numbe r

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### Fron t Right . B 1 = B 2 - Bac k Righ t D Z « Dri p Zoije . G Z - Garden , P Z = Pla y ASquadFanlsaijia s fram ttie atiM t Caein g prapat ^

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# r ^ ^ S I t«v4 . 046141.013 )PRUDEN T TECHNOLj^ES , INC . FIRS T N/l^BlA L BAN KO F OLATH E 808 0 WAR D PARKWAV^iT E 40 5 -172/101 0 

## 199 : KANSA S CITY , M O 6411 4 (816)363-370 3

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### Yahoo ! Mail - jdenne@prud|||toveb.co m Pag e 1 of 2 VUESOO i SMAL L BUSINESS Prin t - Clos e Windo w CLASSI C Date : Wed , 5 Nov-200 8 07:01:3 0 -080 0 (PST ) From : "Ramlt a Shrestha " <rshrestha@prudentweb.com > Subject : Fwd : Re : flower s To : "Joh n Denne " <jdenne@prudentweb.com > Note : forwarde d messag e attached .

Forwarde d Messag e ^'s^s r Date : Mon , 3 No v200 8 04:34:5 1 -080 0 (PST ) From : "Rene e Schipansky " <thedreamcatcherl954@yahoo.com > Subject : Re : flower s To : "Ramit a Shrestha " <rshrestha@prudentweb.com > HTM L Attachmen t Ther e wa s on e eac h fo ra tota l of 19.94 . Rene e

— O n Sun , 11/2/08 , Ramit a Shresth a <rshrestha@prudentweb.com > v/roie .
V From : Ramita Shresth a <rshrestha(gprudentweb.com > r%&kuv* \ Kcr\Trt«.«l ^ Subject : Re : flower s To : thedreamcatcher l 954(@yahoo.co m



## - ^ CU u l'fl'<: 5 Date : Sunday , Novembe r2 , 2008 , 9:0 2 PIV I Renee , Thanlc s fo ryou rcorrespondence . I wil l brin g a chec k fo ryou . ho w manyda ylilie s w e have t o reimbursemnet Pleas e le t m e kno w an d quantit y Ramit a 452-980 6 Rene e Schipansky<thedreamcatcher1954@yahoo.com > wrote :

Ramita , 1 forgo t t o get thi s informatio n t o yo u befor e the ystarte d th e wor k o n m yyard . Th e plants that I wil l nee d replace d ar e on e sedu m herbfreud e price d a t 9.9 9 an d th e da ylillie s were 9.9 5 a piece . Bu t I have som e concern s that I woul d lik e t o address . The ydi d not di g where yo u sai d they were goin g to , theystoppe d right a t th e plants . Als o theytore u p m yyar d goin g u p an d dow n th e hill . Th e carpor t was to lo w fo rthe m t o brin g th e equipmen t u p th e bac k way . Ca n someon e pleas e cal l m e t o addres s thes e concerns . Rene e Schipansk y 391 4 S 9t h Street 612-250-118 7 

### http://b l l.mail.yahoo.com/ym/prudentweb.com/ShowLetter?box=Inbox&MsgId=1066_27.. . 11/5/200 8

### Pag e 1 of 1



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### YOURTICKE T NUMBE RI S 2152978 . Origina l Cal l Date : 10/10/0 8 Time : 3:3 8 p m Op : RAMITA1896 7 Wor k t o Begi n Date : 10/15/0 8 Time : 4:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 391 4 Street : S 9T H S T Twp : 15 NRng : 13 E Sect-Qtr : 34-SE,35-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n wor k fo r soi l 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 Nam e RAMIT A Phone : (402)733-145 5 Alt . Contac t 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 MCLEODN E MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F QWEST 2 Utilit y

Servic e Are a Contac t Phon e Numbe r Typ e 

### Day : 402934046 9 nvr A T M CO X COMMUNICATIONS , HEID I 

### Alt : 402934046 9 t.AC A 1 v j^ ^ 

### Emerg : 402932975 7 Day : 877366834 4 LEVEL 3 COMMUNICATIONS , LEVEL 3 N A 

### Alt : LL C 

### Emerg : 877366834 4 Day : 800289190 1 N O NEE D T O CAL L OU T MCLEODN E MCLEODUS A 

### Alt : EMERGENC Y 

### Emerg : 800289190 1 METROPOLITA N UTILITIE S 

### Day : 402504782 3 MUD0 2 SAND Y DISTRIC T 

### Alt : http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.. . 10/10/200 8

### Pag e 2 of 2

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- OMAHACO F RO N TRAFFICSEWE R OMAH A PUBLI C POWE R 0PPDGPR 6 N A DISTRIC T QLNNEI FQWES T LOCA L NETWOR K

N A QWEST 2 QWES T LON G DISTANC E SAR A 

### Emerg : 402504794 6 Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 Alt : 888728934 3 Emerg : 406728934 3 Day : 406728934 3 Alt : Emerg : 888728934 3 Day : 800283423 7 Alt : 303992192 6 Emerg : 800283423 7



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