### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 3139 4 DATE : 12/15/201 0 ADDRESS : 146 7 E M M E T S T REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES . INC . YEAR : 201 0 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S [ / PR E AN D POS TVIDE O O F PORPERT Y(DVD ) d EXECUTIVE SUMMARY iz f EPA-PROVIDE D PROPERT YSKETCH a SIGNE D ACCES S AGREEMEN T FOR SUBJEC TPROPERT Y n SIGNE D ACCES S AGREEMENT(S ) FO R ADJACEN TPROPERT Y a RESTORATIO N AGREEMEN T D SETTLEMEN T DOCUMENTS (I.E. , FO R DAMAG E OR T O REPLAC E PLANTS , ETC. ) d CONFIRMATIO N DAT A 0 PHOTOGRAPH S [ J AS-BUIL T SKETCH Q SATISFAaOR YRESTORATIO N SIGNE D B Y PROPERT Y OWNE R 0 PROPERT YCLOSE-OU T CHEC KLIS T SIGNE D B Y EP A D DESCRIPTIO N O F AREA S NO T MEETIN G RO D CLEANU P CRITERI A 0 UTILIT YCLEARANCE S U PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E 

### D D D ^ ^ V <

A V SIGNATUR E DAT E 3026082 3 

# I I Superfun dFin d Record Remediatio n Quer yLea d Remainin g Quer y Propert yDamag e Quer y 

### Backfill :

Sampl e Area : 3139 4 -146 7 EMME TS T Owner : n Owne rOccupie d Owne rName : IHABITA T FO R HUMANIT YOMAH A Owne rAddressl : 

# 1 Owne rAddressZ : J220 4 AME S AV E City : )OMAH A State : |N E Zi p Code : J68110 - Owne rPhon e 

# 1 " 1 Alternat e Phone :

Contract : Contractor : JPRUDENT2010_ S Contrac t Optio n lOPTIO N 2 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 40 0 Assessmen t Ma xXR F Valu e | 477.5 6 Resident : Residen t Name : 

# I Propert yAddress : )146 7 EMME T ST Zi p Code : 68110 - Residen t Phon e

### PROPERT Y SUMMAR Y Date : 12/15/201 0 Omah aLea dSit e Remedia l Acdo n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Decembe r Propert y Address : 146 7 EMME T S 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 Othe r Relevan t Information : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : B 2 = 38 5 PP M @ 2" ; E A = 20 7 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 digital vide o clip/photograph s 4 ) Post-Excavatio n digital vide o clip/photograph s 5 ) Documentatio n - Complete dClose-ou t Checklis t 6 ) As-Built sketc h­ i ) Shal l includ e fina l leadlevel 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 individual property file , i f available , o r obtaine dinclude : i ) Pre-excavatio n agreemen t detail s (i f an y ar e mad e wit hth e property owner ) ii ) Property Statu s For msigne db y property owne r iii ) Excavatio n digital vide o in 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 .

TECHNOLOCIES , INC .' TECHNOLCXJIES , EMC . 

### Propert y # : "^C?* ^ M " Date/Time : Quad s Excavated : f??" ? 

# EP A Propert y Clos e Ou t Propert y Address : \^0 7 t vnnveV >* ­ Owner' s Name : rV^+^j^^-.^ . tWwimHi ) Contracto r Group : Pruden t Technologies , Inc , Excavatio n Genera l Ye s N o 1 .

I f necessary , wer e Lli e correct quadrant(s ) excavatedandrestored ? s/ 2 .

I f necessary , wer e th e correct area s o f drip zone excavatedan drestored ? / Gradin g Sodan dVegetatio n . Ye s N o ] . Doe s tlie gradin g aroundth e perimete r o

f th e hous e i n excavatedarea s generally slop e awa y / fro

mthe house ? 2 .Has so dbee n lai di n all area s tlia t wer e excavated ? / 3 .

Doe s Oi e so dappea r to b e generaJl y health y an dgrowing ? (Onl y evaluate i f inspecte dat a3 0 da

y lirae period) 

## y 4 .

Ar e soddedarea s generally fim i andevenl y graded ? 

# y 5 .Ar c Ui e joint s betwee n the sodstrip s generall y tiglit ? (Onl y evaluat e i f inspecte da t a3 0 da y 

# y tim e period) 6 . Wa s the propert y grade dsuc htlia t wate r wil l not pool o n the property ? / 7 . Wa s damag e ( o landscaping o r plan t material s avoided ? / Gates , Fence s an dRetainin g WalJ sYe s N o 1 . Do gate s ope n an dclos e freely ? (I f applicable ) 

# y •?

. Wer e al l gale s o r fence s taken dow n diuin g restoratio n activitie s reinstalled ? (I f applicable ) 

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

# y 4 . Was damag e to relaining wall s avoided ? (I f applicable ) 

# y Foundation , Sidin g an dGutter sYe s N o 1 . Wa s damag e t o tlie siding o r trimavoided ? 

# y 2 . Wa s damag 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 door screen s avoided ? 

# y .i . Wa s damag e l o downspout s o r downspou t extension s avoided ? 

### y Sidewalk s an dDriveway s (Concrete )Ye s N o 1 .

Wa s dajiiage t o drivewa y surface s avoided ? 

## y 2 .

Wa s damag e t o walkwa y surface s avoided ?

## Owner s coiinments :

Inspectio n notes :

Remova l andrestoratio n activate s complet e includin g th e 30-da y so dwarranty : EP A Representativ e Q'^JU . Date : nhili oECHNDEDGIES . tNC . 

### A S ­ BUIL T DRAWIN G OL S #3139 4 Dat e Excavated : 10/21/201 0 USEP ASigncd-Or rDate : 

### OMAH A LEA D SUPERFUN D SIT E 3139 4 Exterio rPain t NonhAmM i Omah a Lea d Sit e Owne rMame : ALEXANDE R EASTER _ • Goo d Address : 146 7 EMME T S T

Phone : Jl ; 402-345-917 1 Sit e Sketc ^ w : h D Q Pot *

Notpain t 

# i Sampt e Numbe r Lea d Concentratio n Sampl e Collecte d lA B Firm : Sample s CoDected r^ A MT/.^«A 1 RYASCPXA-3139 4 F l 2{?2.pp m 

### 0 D Date ; B-I1- S RYBSCPXA-3139 4 F 2 Z?-* ? .pp m 

### E J D Time ; <?' - ^ C RYCSCPXA-3139 4 RYDSCPXA.3139 4 B l B2 S'J Z Do m H7 a -PPr " 

### 0 0 D D Sample s Analyze d n 7 pp m 

### D D XR F UnH : 10^ 7 Book : '2 9 RGZSCPXA-3139 4 G Z n & .pp m 

### \H D Date : f.-/-" ^ po m 

# a D Time : Z*** ! Numbe ro f Sample s staff ; Z. A 1 • Legend : F l = Fro m Left , F 2 = Fro m Right , B l = Bac k Left , 8 2 = Bac k Rigti t D Z = Dri p Zone , G Z = Garden , P Z = Pla y A D quadrant s ar e a

s viewe d fro m th e street , facin g propert y AuLe V T"Tr7>"^ ^ "i~ ^ tTt" : ~^ ' s m• 0 iir S

B 2 = 38 5 PP M fS J 2 ' 

## 34 2 

## I ¥7 8 3 2 • | - _ •• : 

# t d ^76 ! iGi^ . L J'^.l.TfviHrr.s r 

### Z.S2 . I 

# iz r F Z 

# a

WAL K 

### .£»'l.MET> r Ilcv4 ' E A = 20 7 PP M @ SCRAP E (-1" ) CONTRAC T# : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC .

# SEPA Propert yCompletio n Agreemen t Thi s agreement document s th e completio n o f remova l activitie s performe do n th e belo w liste dproperty . Th e propert y owner's signature indicate s tha t th e propert y owne r i s satisfie dwithth e restoratio n ofth e subjec t property , andtha t n o item s are i n question , now , or at any tim e in 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 : i4l; 7 glQi/Vtr^-i - Sf . Owner : |^^4^.} - 4. . Hutvt^,,v; ^ .f/W^k i 

### Phone : ^bl-^q ^ Q^Cy- J Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item :

J^ l agre e restoratio n i s completed .

L J I d o not agre e restoratio n i s complete d a t (note d deficiencie s above )



### i l i U 2^1. 0 ^yLy-^yny^^y^^^-^y-''*^'' ^ Dat e

### P.00 3 R

X Date/Tim e 10/08/2 J 

### 12:3 0 40 2 45 7 401 2

Oct . 8 . 20 1 I2:28P M H a 

# l l fo r Huma n i ty 

## No . 141 4 P . 3

Pmdertt Teebnologies , Inc . (Pnidoii ) i s unde r contrac t withtli e U . S . Environmenla l Protectio nAgmc y (EPA ) t o dea no p lead contaminate dsoil s a t tJiurabe r o f

propenie s locate di nOmahf ^ Nebraska , includin g th e propeit y locate da t |4lp 1 &tMliVltarSr . . Th e EP Areques u you r pwraissio nt o allo w Piuden t t o perfon naso Ucleanu p a t thi s piopecty t o (cmov e lead-coiuaniinaie dsoil . B y signin g thi s form , th e propert y ovmer giant s pennissio nt o Pniden t t o pcifoi m activitie s relate dt o th e cleanu p includin g soi l samplin g remova l o f lead-contaminate dsoil , an drestoratio nofth e reftrenee dproperty . Ifyo u hav e any question s abou t (he soi l cleanu p planne dfbr you r property , pleas e contac t Pruden l sout hoHic c .fo r fhe Omah aLea d Sit e cleanup-a t (402 ) 733-1183 . Qeneia l question s abou t th e Om ^ Lea dSit e cleanu p ca nb e directe dt o th e EP APubli c Informatio n Cente na t (402 ) 731-304 5 (Sout hOmah aotTice ) o r (402 ) 991-9SS 3 (NorthOmah aoilice) . Property Access Grante d ^ /\(Pleas e Priqit Name ) Propeit y Owne r Signature : 

## fd/e/2^i d (Date ) PROPERi y INFORMATIO N (T o b e complete db y residen t and/o r propert y owne r - pleas e print ) RESIDEN TNAME : Owner J Rente r RESIDEN T ADDRES S 

## lifb n (-^-ryj - J ^ I f RU N I AL , PROPERT Y OWNE D BY , 

### |47tfafk4--fe<- [JtlM^Vilix j (OrviA.^g ^ OWNER' S MAILIN G ADDRESS ;



## 22 M ViA^Ai/g . Qi^/iU ^ Kft ? UM b OWNER' S TELEPHON E NUMBER . HOME : (462 . t 4tr7-f7Ti*f 7 WORK : 

### J 1 ., AG E O F HOME? : n/f l YEARS . HO W LON G HAV E YO U LIVE D HERE ? YEARS . HAS TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 197B 7 _YE S N O NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : NUMBE R O F OCCUPANTS 7 YEAR S 011 0 AN O 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 6 HOUR S O R MOR E PE R WEEK : COMMENTS O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. )

AinHORIT Y PO RENVIRONMENTA LRESPONS EACTIONS ; Th e activilie s t o b e implemenle db y EP Aunde r thi s agreemen t are pursuan i t o Sectio n104 ofCERCLA , 4 2 tJ.S. C 9604 . EPA' s righ t o f

acces s t o th e properl y i s provide dfor i nSectio n104(e ) o f CBRCLA , 4 2 tJ.S . C 9£0S(e) , whiel i provide s eniry for "determinin g th e nee dfor response , o r choosin g or takin g an y respons e actio n unde r Sii s title , o i otherwis e enforcin g th e provision s ofth e title. " 808 0 War d Parkway , Suit e 40 5 560 0 SI O S t 424 2 Medica l Drive , Suit e 426 0 Kansa s City , M O 6411 4 Omaha , Nebrask a6810 7 Sa n Antonio , TX 7622 8 Phone:(816)363.370 3 Phono : (402)733-116 8 Phone : (210)822-958 8 Pax : (816 ) 363-370 7 Fax : (402)733-188 3 Fax : (210 ) S7S-6S7 7ENVIRONMENTA L& CONSTRUCTIO N SERVICE S 

# Propert y Statu s Form 

# ofV f Address : JLfL' l Phone : BVID : 

# \M'J ^ 

# luvf c c l IA J c r \ c (X^vouv V ( ^ ^ ^ l-^'^ ^ ^^iJ-^J .

^ = ^ 

# ^ ^ c H

•j yii : 

## 0 tC - Propert y Owne r Pruden t Employe e Signature : Signature : 808 0 War d Parlway , Suit e 40 5 560 0 S 1 0 S t 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6810 7 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)733-118 8 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)733-188 3 Fax : (210 ) 579-657 7

## 3139 4 Exterio rPain t Nort hArro w Omah a Lea d Sit e Ovme rName : ALEXANDE R EASTE R 

### • Goo d Sit e Sketc h Address : 146 7 EMME T

ST • Poo r Phone : H 402-345-917 1 Vll : 

# i Q Notpain t Sampl e Numbe r Lea d Sampl e Sample s Ck5llected LA B Concentratio n Collecte d Firm : ri\ A U.T//ZU U RYASCPXA-3139 4 Fl 

## ZS Z pp m 

## Ef 

# n Date : &-i' l -- 5 RYBSCPXA-3139 4 F2 

## IZ± . pp m 

## 0 Time : ^--S< ? 

## D RYCSCPXA-3139 4 B1 pp m 

## IZ f 

# n Sample s Analyze d RYDSCPXA-3139 4 B2 

## H7 S pp m 

## 0 

# n RDZSCPXA3130 1 92 

## D 103 7 I Z 9 pp m 

# n XR F Uni t 

### Book : 

### : RGZSCPXA-3139 4 GZ 

# 113 - pp m 

# m D Date : _ 

## ±L L RP7SCPXA^130 1 Pf - pp m 

## D Time : _ /»/» > Staff : Numbe r of Sample s = j -5 " 

## _4A Legend : Fl = Fron t Left ,F2 Fron t Right . Bl = Bac k Left . B2 = Bac k Righ t DZ = Dri p Zone , GZ = Garden ,PZ = Pla y Al l quadrant s ar e as viewed fro m tt « street , facin g propert y 

## AuLe Y AU G 1 s 2m 3H Z V7 8 3Z 

# 0 Ul S I 

# A i 

# i f ! j^.iti.rviHer. ^ ZS2 . iZ f 

# fl 

# B

U) I- > 

## WAL K Re v4' 

### £MKB T in 0J6I4I.0I2 J

# m t

N 

# 5 0 X 124 

# A Printed : No v 16,201 0 CI S www . dcgis . org/dogi s

### cuwsiKliCriO N SOLUTION S 

## SIT E SAFfcT Y HAZAR D ANALYSI S Address : . /44 7 ^yyiyy^ yf f 

## Excavatio n Date : ^^./^/^'l . Crew : Backfi U Date : —f'/^-lJui v

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 Drivewa y Sprinkle r Syste m Otlie r Cre w Forema n Conditio n CP^ ^ 

# e ^ 

# h^ ' \ j 

## ofi^ dy* ­ m ^C£ ^ CE« ^ l?< ­ 

# o*-

— Hazard s Correctiv e Actio n /.jcy^ i AM^-Mbr. ^ O C ( » / P ire- O



## Sit e Safet y Offic e Date :

808 0 WanfBaftany . Sut e 40 5 560 0 SI O S t 424 2 Medica l Drive , Suit e 725 0 Kansa s G«y ; 1106411 4 OotidB , Netaasfc a 6810 7 Sa n Antonio , T X 7822 9 Phone : (S16 ) 36S'370 3 nwne : (4a2)73»-11S 8 Phone : (2t0)822-«58 8 |^9 C (816 ) 363.470 7 Fa c(402 ) TS^-ISS S Fax : {210)«T»<57 7

# '/% 7 '^me . r

^siRwry;- " 

# 2 IZo i o

• ­ ­ ­ ­ •ii-^->^ p ­ •••- J r-|^ ' '*\imw^K \ •••' —-inr * 

# m J 

# ^ m H i ^ 

# 4

l^^^^^l 

# 1

• 

# iii i » 

# ^^:w j