## TRANSMITTA Lo f OMAHA LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 3-^^S\Date : lO/(B/2>ot o Address^ i^l2> & grs.ig-to€ ^ ^ ^ Remediatio n Contractor : fecopPrM'J /g•/^4^N<;)g.<:bC|l^q.^/(^/g,' ? Year : '^-OiO . SOILREMEDLATIO N PROPERT Y FIL E FOLDE RDOCUMENT S s f

Vide o ofpropert y (DVD ) H Executiv e Summar y EPA-provide dpropert y sketch SignedAcces s Agreemen t fo r

subject propert y D Signe dAcces s Agreement(s ) fo r

adja<?en t propert y 

# d' Restoratio n Agreemen t D Settlemen t documents (i.e. , fo r

damag e o r

to replac e plants , etc. ) aConfinnatio n data 

# i Photograph s As-built sketch Satisfector y restoratio n signedby Propert y Owne r 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 Utilit y clearance s 

# d Propert y information fro mDougla s Count y Assessor' s Office D D D 

### Signatur e I5at e 3021793 7 

# l i Superfun d

### PROPERT Y SUMMAR Y Date : 10/15/201 0 Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l Monthof : Octobe r Propert y Address ; 473 5 ERSKINE S T A . EXECUTIVE 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 : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : F l = 5 6 PP M @ 9" ; F 2 = 13 4 PP M @ 9" ; E A = 23 8 PP M @ SCRAP E (~1" ) 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 agreements 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-Buihsketch
i ) Shal l includ e final lea dlevel s v ) Legen d ii ) Contamination lef t behin darea s vi ) Contracto r identification iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r items to b e includedi n th e individua l propert y file, i f available , o r obtainedinclude : i ) Pre-excavationagreementdetails(i f an y ar e mad e wit hth e 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/o r photograph s iv ) Signedfor mverifying satisfactor y restoration v ) Description of area s no t meeting Interi mRO D cleanu p criteria .

TECHNOLOCIES . INC .Fin d Record Remediatio n Quer yI Lea d Remainin g Quer yI Propert yDamag e Query Backfill :

Sampl e Area : 5795 1 - 473 5 ERSKIN E S T Owner : n Owne rOccupie d Owne rName : IFITZLE R LARR Y L Owne rAddressl : 

# 1 Owne rAddressZ : |473 5 ERSKIN E ST City : State : Zi p Code : jOMAH A )N E |68104 - Owne rPhon e Alternat e Phone : 1(402 ) 556-908 6 

# 1

Contract : Contractor : |PRUDEMT_2010 . . S contrac t Optio n |BAS E Use rProvide d Owne rInformatio n Owne rName : 

# 1 Owne rAddress : 

# 1 City : 

# 1 State : 

# 1 Zi p Code : 

# 1 Owne rPhone : 

# 1 ' Alternat e Phone : 

# 1

Assessment : Qualifyin g Grou p jp^O O Assessmen t Ma xXR F Valu e [ " 434 Resident : Residen t Name : 

# I Propert yAddress : |473 5 ERSKIN E ST Zi p Code : |68104 - Residen t Phon e 

# ITECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y # : ^1^^ ^ Propert y Address : 4 7 5 ^ 2rrsV:^'^ e *?+ . Date/Time : Owner' s Name : | 4rr(A- f ?H-z<?* ' Quad s Excavated : F) , P 2
- Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s 1 . I f necessary , wer e th e correct quadrant(s ) excavatedandrestored ? / 2 . I f necessary , wer e th e correct area s o f drip zone excavatedandrestored ? / Gradin g So dan dVegetatio n Ye s 1 .

Doe s the gradin g aroundthe perimete r o

f th e hous e i n excavatedarea s generally slop e awa y / fro mUi e house ? 2 .

Has sodbeen lai din all area s tha t wer e excavated ? / 3 .

Doe s th e so dappea r t

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

y time period) / 4 .Ar e soddedarea s generally firmandevenl y graded ? / 5 .Ar e the joint s between the sodstrip s generall y tight ? (Onl y evaluat e if inspecteda t a3 0 da y tim e period) ; 6 .

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

# y 7 .

Wa s damag e t o landscaping o r plan t material s avoided ? 

# y Gates , Fence s an dRetainin g Wall s Ye s 1 .

Do gate s open an dclos e freely ? (I f appUcable ) 

# y 2 .

Wer e all gate s o r fence s taken dow n during restoratio n activitie s reinstalled ? (Ifappiicable ) 

# y 3 .

Was daniag e t o gate s or fence s avoided ? (Ifappiicable ) 

# J 4 .

Was damag e t o retainin g wall s avoided ? (I f applicable ) / Foundation , Sidin g an dGutter s Ye s 1 .

Wa s damag e t o th e siding o r trimavoided ? / 2 .

Wa s damag e t o tli e foundation avoided ? / 3 .

Was damag e t o window s avoided ? / 4 .Wa 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 ? / Sidewalk s an dDriveway s (Concrete ) Ye s 1 . Was damag e t o drivewa y surface s avoided ? 

# f 2 . Was damag e to walkwa y surface s avoided ? 

# -t N o

N

o

N

o

N

o

N o

### 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 ^' ^ ^ Date : ^\^^ ^

# m CHNOLOGIES . INC . 

### A S - BUIL T DRAWIN G OL S #5795 1 Dat e Excavated : 08/10/201 0 

### OMAH A LEA D SUPERFUN D SIT E USEP A Signed-Of f Date : 

### 5795 1 Exterio rPain t Omah a Lea d Sit e • Goo d Sit e Sketc h Q^Poo r Samplin g Address : 473 5 ERSKIN E S T • Not pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : ? E IM C D&T A RYASCPXA-5795 1 F l pp m 

## n Date : folT/o l RYBSCPXA-5795 1 F 2 pp m 

## n Time : . ) 3 0 Pr> A RYCSCPXA-5795 1 B l pp m 

## n Sample s Analyze d RYDSCPXA-5795 1 8 2 IIZ - pp m D RDZSCPXA-5795 1 D Z 

### 11 1 . pp m D XR F Unit : \b9ia L Book : 2 S t nCZCCPX A6706 1 -€ Z pp m D 

## n Dat e -lo \ O ^ nrZ0OPXA-G79G 1 -PZ - .pp m D 

## n Tim e Staff : Numbe ro f Sample s = 

## (ns W Legend ; F l = Fron t Left , F 2 = Fron t Rigtit . B 1 = Bac k Left , 8 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla ; Al l quadrant s ar e a s vrewed fro m tti e street , facin g propert y

EES.I<<M £'Sn- . E.\ = 23 8 PP M % SCR.\P E (~ r

r'r\^v^r \A 0" ^ JJ. . rw \<•• » <« r \i\ r

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n o f removal activitie s performe do n th e belo w hste dproperty . Th e propert y owner' s signatur e indicate s tha t th e propert y owner i s satisfie dwit hth 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 fiiture, excludin g an y remainin g warrant y (3 0 day s total ) excep t thos e item s Uste dbelow , i f any . Propert y ID : Propert y Address : 

## ^ll S ^>^< ^ 

# At . Owner : \ ^ 

# '^^^~II ^ ^-^ \ Phone : Restoratio n Item s i n Question :

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



# SJ i W 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 ) 

# Sr-'/r-/ ^ Owner' s Signatui Date

# m&.m : Pruden t Technologies , Inc . (Prudent ) i s unde r contrac t withth e U : S . Environmenta l Protectio n Agenc y (EPA ) t o clean u p lead
contaminate dsoil s at anumbe r ofpropertie s locate di n Omaha , Nebraska , includin g th e property locate da t Li'J^ ^ ^A>Sfc 4 N ?
- . Th e EPA request s you r permissio n t o allo w Pruden t t o perfor masoi l cleanu p a t this propert y t o remov e lead-contaminate dsoil . B y signin g this form , th 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 , removal o f lead-contaminate dsoil , an drestoratio n ofth e reference dproperty . Ifyo u hav e an y question s abou t th e soi l cleanu p plarme dfor you r property , pleas e contac t Pruden t Sout hOmah aOffic e for th e Omah a Lea dSit e cleanup,_a t (402 ) 733-1188 ; 733-1455 . Genera l question s abou t th e Omah aLeadSit e cleanu p ca n b e directe dt o th e EPA Publi c Informatio n Center s a t (402 ) 731-304 5 (Sout hOmah aoffice) . Property Acces s Grante dBy : 

# a ^ ^ (Pleas e Prin t Naine ) ^ Property Owne r Signature : PROPERT Y INFORMATIO N (T o b e complete d by_resident,and/o rpropert yowne r- pleas e print ) RESIDEN T NAM E /Ownei x Rente r RESIDEN T ADDRES S
I F RENTAL , PROPERT Y OWNE D BY :
OWNER' S MAILIN G ADDRES S 

# • ^1^ ^

yr<;tj^ ^ OWNER' S TELEPHON E NUMBE R - HOM E 

### : iadl \ ^^6 - '^ 0 ^£ > WORK : 

## J 1 AG E O F HOME? : ^ ^<j^EARS . HO W LON G HAV E YO U LIVE D HERE ? _Zs2__^YEARS . HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978?-t

_ ^YE S _ N O NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : C / NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLA Y I N TH E YAR D FO R 5 HOUR S O R MOR E PE R WEEK : 

# s COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS E ACTIONS : Th e activitie s t o b e implemente db y EPA unde r this agreemen t ar e 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 hprovide s entry for "determinin g th e nee dfo r 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 ofth e title. "

808 0 War d Parkway , Suit e 40 5 560 0 S . 10' " stree t 424 2 IVIedica l Drive , Suit e 425 0 KansasCity , MO6411 4 Omaha , Nebrask a 6810 7 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)733-145 5 Phone : (210)822-958 8 Fax : (818 > 363-370 7 Fax : (402 ) 733-188 3 Fax : (210 ) 579-657 7ENVIRONMENTA L& CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : Li-y^ ^ lAje _ 

# Date: 7 j l^jTol O Phone : f^ l - ?Z > 3 t BVID : 

# Im^j^^ r na= y n o Li<.Lr y oi ~ 7^ - N o fOa^ k ori s jy i P / o r

O Q

,^ , UcA/tfS hij^l/ \/ n 

# £ Z Qe^mo^ ^ /Os J 

# CjayJC ^ cp ^ S/'c U (Aj^rJ t uye^-f5'rJ< z ^l^cny^5i<J Q

Propert y Owne r Pruden t Employe e Signatur e Signature :

«>fm r* i n^t h r«A_-_Ar^..:*. . ^n. n mns n iia«.j:.- i n.: —r*..n, ^ jAr- n

## 5795 1 Exteno rPain t Nort h An-o w 

### Omah a Lea d Sit e • Goo d 

### Sit e Sketc h Q^Poo r Samolin a Address : 473 5 ERSKIN E S T [ ] Notpain t \ Sampl e Numbe r Lea d Concentratio n Sample s Collecte d Firm : ? £ IN 6 X>^T \ RYASCPXA-5795 1 F l 

### Date : iJ^lh' ) RYBSCPXA-5795 1 F2 Time : .l-30prA__ _ RYCSCPXA-5795 1 B l RYDSCPXA-5795 1 B2 Sample s Analyze d RDZSCPXA-5795 1 D Z XR F Unit : |Qft(o7 . Book : 2M \ nCZCCPX A570S 1 G Z Date : 1 O l O ^ 

### nrzocrxA-57osi—P E Time : Pn n Numbe ro f Sample s = Staff : MSU ) Legend : F l = Fron t Left , F 2 = Fron t Right , B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla ; Al l quadrant s ar e a s viewe d fro m th e street , facin g propert y 

# ENTERE D

E?.&v<m £ ST .

### Paa e 1 o f 1



## LflZ S Lr^^ir ^ S r

http://douglasne.mapping-online.comyassessdoc/Photos/10/R0.5323800000001.jp g 6/15/201 0

### Prin t Previe w Pag e 1 of 2 ISpunty-Omaha , N E 

# USB *

Parce l I D Owne r Nam e Propert y Addres s Cit y Zi p Owne r Addres s Owne r Addres s 2 Owne r Cit y Owne r Stat e Owne r Zi p Sec-Twn Rn g 053238000 0 FITZLE R LARR Y L 473 5 ERSKIN E S T OMAH A 6810 4
473 5 ERSKIN E S T OMAH A N E 6810 4 Additio n Bloc k Lo t Lega l 1 Lega l 2 Lega l 3 Lega l 4 Acre s Treasure r Websit e Lin k Assesso r Websit e Lin k BAKE R PLAC E 2 1 0 50X12 8

0.1 5 http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp ? parc=053238000 0 http://douglasne.mapping online.com/DouglasCoNe/static/accountinfo.jsp ? accountno=R053238000 0


### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 6/15/201 0

### Creat e Anothe rTicket Back t o V rinteme t Sen d Emai l 

### YOURTICKE T NUMBE RI S  2563735 . Origina l Cal l Date : 8/09/1 0 Time : 2:5 5 p m Op : SIVA1896 7 Wor k t o Begi n Date : 8/11/1 0 Time : 3:3 0 p m State : N E Address : 473 5 County : Street : DOUGLA S ERSKIN E S T Twp : 15 NRng ; Twp : Rng ; Lega l Given : C 13 E Sect-Qtr : Sect-Qtr : 07-SE ,OB-S W
Typ e o f Work : Lea d Soi l Remediatio n Projec t Locatio n o f Work : LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)733-188 3 Company: PRUDEN T TECHNOLOGIE S Contac t Name : SIV AJAMPAM A Wor k Bein g Don e For : EP A Dept h o f Excavation : 6 F T Corne r Lot : N Involve s Tunnelin g o r Horizonta l Borin g : N CXCAT V MUDO l OMAHACO F 0PPDGPR 5 

### Servic e Are a CXCATV CO X COMMUNICATIONS , IN C
METROPOUTA N UTILITIE S MUDOl DISTRIC T CIT Y OFOMAHA
- OMAHACO F TRAFFICSEWE R Place : OMAHA

Phone : (402)733-118 8 Front : Y Rear ; Explosives : N QLNNEI C 

### Utilit y Contac t Phon e Numbe r Typ e Day : 402934046 9 HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 

## SAND Y Alt : Emerg : 402504797 0 Day : 402444719 7 RICH/TRAFFI C Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 OMAHA PUBLI C POWE R EL M OPPDGPR 5 Alt : 406207149 4 DISTRIC T LOCATIN G Emerg : 888728934 3 dhon.org/irthinternet/.../MessageText.as. . 1/ 2u / ^ / ^v^\ y 

### FT M ^ay : 406728934 3 

### QLNNEI C QWES T LOCALNETWOR K TTC/AT>TXT ^ 

### ^Alt : 406207149 4 LOCAllNC j Emerg : 888728934 3

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### ENVIRONMENTAL ENGINEERIN GAN D CONSTRUCTIO N TECHNOUKSffiS , INC . 

### SOLUTION S 

## SIT E SAFET Y HAZARD ANALYSI S 

# .jm £ j ^ ^ 

# . 9yoy- ^ Address : Excavatio n Date : 

# ^yW vP/lfL^ ^ Cre w Backfil l Date :

Ite m Conditio n Hazard s Correctiv e Actio n Overhea dLine s 

## {^^ y Ga s Lin e ^^'poc L Wate r Lin e Sewe r Lin e Septic/Leec h Fiel d Propane/Butan e Sidewal k 

## P/Y<^< ^ Foundatio n 

## Retainin g Wall s 

# ///A Fence s Tree s Structure s Driveway 

# c^ck^ . p/ ^ U.^^ ^ Sprinkle r System /y/zj 

## othe r Cre w Forema n Site Safet y Offic e Date : - ^ 

# :.^...^.:^ ' / 6

808 0 Wan t Pariony . Sut e 40 5 . 560 0 SI O S t 424 2 Medica l Drive , Suit e 725 0 KanasGHy . M O 6411 4 Omatia . Mabiatir a 6810 7 Sai l Antonio , T X 7822 9 PfMfie : (816 ) 363^370 3 PtXMie : (402 ) 733-118 8 Phone : (210 ) 822T958 8 Fax : (816 ) 363-370 7 Fax : (402)733-188 3 Fax:(210)579-657 7