## TRANSMTTTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL E FOLDE R

s m# : 17^92
- Date : 1'LJl<:fn' ^ Address : p__Zl o ^ 2 ^ ^ Remediatio n Contractor : nwj,^ > 'lltA . Lvrc ^ Year : 2^r)'= j SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOOJMENT S 1 2 Vide o o f propert y (DVD ) EExecutiv e Smnmar y
D 

# A EPA-provide dpropert y sketch SignedAcces s Agreemen t fo r

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

adjacen t propert y Restoratio n Agreemen t D I D

Settlement docum«its(i.e. , fo r

damag e o r t o replac e plants , etc. ) Confixmation dat a Photograph s As-built sketch

D D 

# i D 

## Satisfector y restoratio n signedb y Propert y Owne r Propert y close-out chec k

lis t signedb y EPA Descriptio n o f area s no t meeting RO D cleanup criteri a Utilit y clearance s 

## Propert y information fromDougla s Count y Assessor' s Offic e D D 

## Signatur e "~~ " iJat e 3021825 2 

# m i Superfun dFin d Record Remediatio n QueryI Lea d Remainin g QueryI Propert yDamag e Query 

### Backfill :

Sampl e Area : 1735 2 ­ 231 0 S 3 5 S T Owner : Resident : Contract : n Owne rOccupie d Residen t Name : Contractor : Owne rName : |GUZMA N MAURILLI O B |PRUDENT2009_S |TRUSCOT TCHRISTOPHE R C Propert yAddress : Contrac t Optio n Owne rAddressl : |231 0 S 3 5 s r |OmO N 3 

# I Zi p Code : Owne rAddress2 : 6810 5 

### Ass^ment : |231 0 S 3 5 ST Residen t Phon e City : State : Zi p Code : Qualifyin g Grou p |OMAH A |N E |6810 5 400/CHIL D Owne rPhone : 

# I Altemat e Phone : Assessmen t MaxXR F Value : I 442.1 5

# imBmBBmfmmBmis x Date : 12/15/2009 Omah aLea dSite Remedial Actio nContrac t #EP-R7-07-0 6 TO# l Montl i of : November Propert y Address : 231 0 S 3 5 S T A . EXECUTIV ESUMMAR Y A. 1 Issue s Encountered : NON E A. 2Issue s Resolved : NON E A 3Uniqu e Findings : NON E A. 4Othe r Relevan t Information : ARE A NOT EXCAVATE D B Y PO' S REQUES T F2/L S 2'X4 ' 240 PP M @ SCRAP E CONFIRMATIO N SAMPLIN GDATA/RESULTS : F 2 = 16 6 PP M @ 6" ; E A = 7 7 PP M @ SCRAPE(~1 ) ATTACHMENT S 1 ) Propert y sketchprovidedb y EP A pursuan t t o contract specification s 2 ) SignedAcces 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-Excavationdigita l vide o clip/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Built sketch
i ) Shall includ e final lea dlevel s v ) Legend ii ) Contamination lef t behindarea s vi ) Contractor 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, if available , o r obtainedinclude : i ) Pre-excavationagreemen t detail s (i f an y ar e mad e wit hthe propert y owner ) ii ) Propert y Statu s For msignedby propert y owne r iii ) Excavation digita l vide o inMPEG , WM V (Window s Medi aVideo ) or SW F(FlashPlayer ) forma t and/o r photograph s iv ) Signedfor mverifying satisfactor y restoration v ) Description of area s no t meeting InterimRO D cleanu p criteria .

TKSMNimmES.KNi: .TECHNOLOGIES . INC . 

# EP A Propert y Clos e Ou t Property* : H'^SX
- Propert y Address : 2.11 0 - 5 3 5 2 t Date/Time : Owner' s Name : AA.i!tttr^ll<< ? Cbc«..Z,»v\<tv^ Quad s Excavated : f-2 ^ Contracto r Grou p Pruden t Technologie s Excavatio n Genera l Ve s 1 .

I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? / 2 .If necessary , wer e th e correc t area s ofdri p zon e excavate dan drestored ? / Gradin g So dan dVegetatio n Ye s 1 Doe s th e gradin g aroun dth e perimete r ofth e hous e in excavate darea s generall y slop e awa y fro mth e house ? 

## J 2Ha s so dbee n lai dinal l area s tha t wer e excavated ? 

## J 3 .

Doe s th e so dappeaj
- t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte dat a3 0 da

y tim e period ) / 4 .

Are sodde daiea s generall y fir man devenl y graded ? 

## J 5 .

Ar e th e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte dat a3 0 day tim e period ) 

## • 6 .Wa s th e property grade dsuc htha t wate r wil l no t poo l o n th e property ? / 7 . Wa s damag e t o landscapin g o r plan t material s avoided ? 

## J Gates , Fence s an dRetainin g Wall s Ye s 1 D o gate s ope n an dclos e fi-eely? (Ifapplicable ) / 2 . Were al l gate s o r fence s take n dow n durin g restoratio nactivitie s reinstalled ? (Ifapplicable ) / 3 Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) 

## J 4 Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) / Foundation , Sidin g an dGutter s Ye s 1 Wa s damag e t o th e sidin g o r tri mavoided ? 

# J 2 . Wa s damag e t o th e foundatio n avoided ? / 3 , Wa s damag e t o window s avoided' ? 

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

# J 5 .Wa s damag e t o downspout s o r downspou t extension s avoided ? 

## J Sidewalk s an dDriveway s (Concrete ) Ye s 1 . Wa s damag e t o drivewa y siirfare s avoided' ' 2 Wa s damag e t o walkway surface s avoided ? L_

_ JN o

N o

N o

N o

N o

## Owner s comments :

Inspectio n notes :



## I Remova l andrestoratio n activate s complet e includin g th e 30-da y so dwarranty :
I 

## EP A Representativ e Q ^ £•£2 . 

## J< ^ Date : //frfc y

## Propert yCompletio n Agreemen t Thi s agreement document s 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 property owner i s satisfie dwithth e restoratio n o f th e subjec t property , an dtha t n o item s ar e in question , now , o r a t an y tim e in th e fiiture , excludin g an y remainin g warrant y (3 0 day s total ) excep t thos e item s hste dbelow , ifany . Propert y ID : Propert y Address : 

## 9^1 0 $ . 

## 16 ^ 

# 5 r Owner : Phone : Restoratio n Item s i n Question :

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

^^ 1 agre e restoratio n i s completed . 1 I d o no t agre e restoratio n i s complete d a t (note d deficiencie s above )


# 13/lb>/^ ? Owner' s Signatur e Date IPruden 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
­ (jDi^aminatedsoil s || 1 anumbe r of

propertie s locate din Omaha , Nebraska , includin g th e propert y locate d at ^^( O ^ . Jo A ^ r • . Th e EP A request s you r permissio n to allo w Pruden t to performasoi l cleam^ ) at thi s property to remov e lead-cantaminate dsoil . By signin g thi s fonn , th e property owne r grant s permissio n to Pruden t to perform activitie s relate d to th e cleanu p includin g soi l sampling , remova l of lead-contaminate dsoil , an drestoratio n ofth e reference dpropeity . 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 Prudent' s Administrativ e Cler k for th e Omah aLea dSit e cleamqj . Ms . Siv a S. Jampana-a t (402 ) 733-1188 . Genera l question s abou t th e Omah aLea dSit e cleanu p ca n be directe d to th e EP A Publi c Informatio nCenter s at (402 ) 73 1 -304 5 (SouthOmah aoffice ) or (402 ) 991-9583 (NorthOmah aoffice) . Property Acces s Grante dBy : X O' T \ T \'^' ^ '- g ^ ^ '^' J Cc y t V ^^^

5 rPlRiia t Nmne l (Pleas e e Prin

Prin t Name ) 

# y#^>^/^ ^ [lOckO n Propeity Owne r Signature : (Signature ) (Date ) PROPERT Y INFORMATIO N (T o be complete d by retidcn t and/o r propert y owne r —pkas c print ) RESIDEN TNAME : 

# Bnl^t yTfu^coit ' Rente r RESIDEN TADDRESS : 

# ^••?y/ 9 .^ r 35
- 9 r ' IF RENTAL , PROPERT YOWNE D BY : OWNER' S MAILIN G ADDRESS ; 

### SctvJA^ ^ 

# : m,m'3^5^ ^ OWNER' S TELEPHON E NUMBE R - HOME : t"^^ \ WORK : 

### J \ AG E OF HOME ? 

# : fO ? YEARS . HO W LON G HAV E YO U LIVE D HERE ? HA S TH E EXTERIO R BEE N PAINTE D OR COVERE D WIT H SIDIN G SINC E 1978 7 NUMBE R OF OCCUPANT S UNDE R 7 YEAR S OLO : ^ NUMBE R OF OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R OF CHILDRE N UNDE R 7 YEAR S OL D WH O PLA Y IN TH E YAR D FO R S HOUR S OR MOR E PE R WEEK :



## O COMMENT S OR SPECIA DOGS , ENTR YGATES . ETC. ) >ECIAL INSTRUCTIONS INSTRUCTIONS ^ (I.E .

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s to be in^ilemente dby EP A unde r thi s agreemen t ar c pursuan tto Sectio n 10 4 of CERCLA , 42 U.S.C . 9604 . EPA' s righ t of

acces s to th e property is provide dfor inSectio n 104(e ) of CERCLA , 42 U.S . C 9605(e) , whic hprovide s entry for "determinin g th e nee dfor response , or choosin g or takin g an y respons e actio n unde r this title , or otherwis e enforcin g th e provision s ofth 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 KansasCity , MO6411 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 7ENVIROJNMEMAI.C ^ CON-STRUCTlOi N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : ^3/t > S> ^ 3^^
- 

## Date : /0-/7'd> f Phone : H^ ^ ' ^fS ' ' ^^^ ? BVID : / 735' ^ ItemN O Plant s & Permanen t Landscapin g T o Remai n I n Plac e On Map Descriptio n & Locatio n



# A<^ : ^ ^ care-r^ / uj^i-l ^ /le,^hof^. r ,y/an^ ^ 9-i^it ^ / I 

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Structure s Doe s you r Basemen t hav e ahistory o f

leaking ? Ye s N o ^ ^ 

## ItemN O Descriptio n & Locatio n On Map

Propert y Owne r Pruden t Employe e Signature : 

## Signature : j^JJ/U0yie^^^sf- ~ 808 0 War d Parkway , Suit e 40 5 560 0 S 1 0 S t 424 2 Medica l Drive , Suit e 425 0 KansasCity , M O 6411 4 Omaha . Nebrask a 6810 7 San Antonio . T X 7822 9

, tOAC\OC O OTA OFCtlKiMXxHFS , r\- C 

### A S - BUIL T DRAWIN G ()r,S#:17J5 2 I)rtt e Evcavatfrf : 10/2S/200 9 t SEI' V Signe dOf f Date : 

### OMAH A LEA D SUPERFUN D SIT E 1735 2 Exterio rPain t Omah a Lea d Sit e Owne rName : MAURILLI O B GUZMA N • Goo d Sit e Sketc h Address : .231 0 S 3 5 ST _ • Poo r - ^ Phone : H ; W : 1 3 No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r 

# I LA B Concentratio n Collecte d Firm : FO AQc/ M RYASCPXA-1735 2 F l 

### g H 3 pp m D Dat e 

### f/o-o H RYBSCPXA-1735 2 F 2 M ^ o< . pp m 

### D Tim e \5-H o RYCSCPXA-1735 2 B l \ ^ _^ pp m 

### D Sample s Analyze d RYDSCPXA-1735 2 8 2 -2J^2

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# n RDZSCPXA-1735 2 D Z 

### S^PPn n XR F Unit : ' ^ ^ ^ Book:^M _ 

### D -RQZSCPXA^17351 ? S2 - pp m 

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## Date : Q \• stn : 0 . 4 ^ RPZ3CPXA-1736 2 PZ — pp m 

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### 5 35** ' EA-77P!'\ i aS('KAFK(-r- i Omah aLeadSit e 4613 0 CONTRAC T# : E P - R7-07-0 6 T0# 1 PRUDEN TTECHNOLOGIES , INC .

## 1735 2 Exterio rPain t Nort h Arro w Omah a Lea d Sit e Owne rName : MAURILLI O B GUZMAN • Good Sit e Sketc h Address : 231 0 3 3 5 S T 

# f 

# 1 n^oo r • ^ Phone : H : w : 0 No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : FQ AQ d lOf i RYASCPXA-1735 2 F 1 S H J ^ Do m 

# D Date : f/Po H RYBSCPXA-1735 2 F 2 

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# D Time : 1.^ : V O RYCSCPXA-1735 2 B 1 \ ^ ^ pp m 

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# n RDZSCPXA-1735 2 D Z ^AiLPP m 

# D XR F Unit : ^ t \ Book:C\^ ^ • RQZ3CPXA--1730 2S2 - pp m 

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## ^ss- ^ Omah aLea dSite 4613 0

## 231 0 S ? 5 S T arc h 200 7 DOUGLA S COUNT YASSESS O ''ii! % aSiifl'iS H

## Prin t Preview Page 1 of 2 Dougla s County-Omaha , N E

Parce l I D Owne r Nam e Propert y Addres s City Zi p Owne r Addres s Owne r Addres s Owne r City Owne r Stat e Owne r 

### Zi p 090542000 0 TRUSCOTT CHRISTOPHE R C 231 0 S 3 5 S T OMAH A 6810 5

231 0 S 3 5 S T OMAH A N E 6810 5 Additio n Bloc k Lo t Lega l 1 Legal 2 Lega l 3 Lega l 4 Acre s Treasure r Websit e Lin k Assesso r Websit e Lin k CREIGHTON S 1S TAD D 1 0 3 50X13 3

0.1 4 http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp ? parc=090542000 0 http://douglasne.mapping online.com/DougiasCoNe/static/accountinfo.jsp ? accountno=R090542000 0 

## http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 9/17/2009

2Pag e 1 of 2

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• YOU RTICKE T NUMBE RI S 2389391 . Origina l Cal l Date : 10/19/0 9 Wor k t o Begi n Date : 10/21/0 9 Time : Time : 2:2 8 p m 3:0 0 p m Op : SIVA1896 7 State : N E Address : 231 0 County : DOUGLA S Street : S 35T H S T Place : OMAH A Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 28-S 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 : SIVAJAMPAM 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 OPPDGPR 6 QLNNEI F Servic e Are a Contac t CXCAT V CO X COMMUNICATIONS , IN C HEIDI

LEVEL S LEVEL3 COMMUNICATIONS , LL C N A

MUD0 2 METROPOLITA N UTILITIE S DISTRIC T SAND Y

OMAHACO FCITYOFOMAHA-TRAFFICSEWERRICH/TRAFFI C Phon e Numbe r Utilit y Typ e Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 Alt : Emerg : 877366834 4 Day : 402504782 3 Alt : Emerg : 402504797 0 Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0ENVIRONMENTA L & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SOLUTION S 

# (L Sit e Safet yHazar d Analysi s
s t Address : AS^ ^ S
- 3 S — Ex . Crew : Bf . Date : ^^•^jo' ? Correctiv e Ite m Conditio n Hazard s Actio n Overhea dLine s \t>«tS > h^ufh^f ^ 

## Ga s Lin e ^'^>-igt / lv<ny J ^^^/ ^ 

## Wate r Lin e 

# -f -f Sewe r Lin e C'Or t ec / kyl^. J //g-g.^? ^ 

## Septi c / Leec h fiel d / L ^ 

## Propane/Butan e /Vv & 

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## Foundatio n ^ 

## Retainin g Wall s ^t. ^ 

## Fence s • T^^ ^ 

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## Structure s /uj ^ 

## Drivewa y ^ L-^a . jt^lj^-f^ t 

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• 3

308 0 War d Parkway . Suit e 'lOf i 250 6 \'\ . Z A Street . Suit e oO S •1-.'J:4i ' i'viedica ! Drive . Suit e "25 0 KansasCity . M O 6411 4 Omaha , Webiask a B811 0 Sai l Antonio . T X 7322 S Phone:(816)383-370 3 Phone : (402 ) 504-100 4 Phone ; (210) 322-S68 8 Fax : (81Si3«-;T0 7 Fax ; (4fl:r ) fi04-1nor^

# • 4 " ^^'-^-^ ^