### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 2655 2 DATE : 1/1 5 ADDRESS : 2815 DECATU R S T REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES . INC . YEAR : 2011 ^ 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S d PRE AN D POS T VIDE O O F PORPERT Y(DVD ) d EXECUTIV E SUMMAR Y E l EPA-PROVIDE D PROPERT YSKETC H 0 SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y n SIGNE D ACCES S AGREEMENT{S ) FOR ADJACEN TPROPERT Y 0 RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R TO REPLAC E PLANTS , ETC. ) I3''^C0NFIRMATI0 N DAT A 0 F PHOTOGRAPH S 

# dI AS-BUIL TSKETC H d SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R M PROPERT YCLOSE-OU TCHECKLIS T SIGNE D B YEP A D DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A \yUTILIT YCLEARANCE S d PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E D D D

SIGNATUR E DAT E 

### 3021842 9 

# llilli l Superfun d

### PROPERT Y SUMMAR Y Date : /15/201 0 Oinah aLea dSit e Remedia l Actio n Contrac t § EP-R7-07-0 6 TO# l Mont hof : Propert y Address : 281 5 DECATU 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 Othe r Relevan t Information : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS :

B l = 27 7 PP M @ 2" ; E A = 11 9 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 digita l vide o clip/photograph s 5 ) Documentatio n - Complete dClose-ou t Checklis t 6 ) As-Built sketch
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 di n th e individua l property file, i f available , o r obtaine dinclude : i ) Pre-excavatio n agreemen t detail s (i f any 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 SWF(Flas hPlayer ) forma t and/o r photograph s iv ) Signe dfor mverifyin g satisfactory restoratio n v ) Descriptio n ofarea s no t meetin g Interi mRO D cleanu p criteria .

TEGHNOLOCIES . INC .Fin d Recor d Remediatio n Quer yI Lea d Remainin g Quer yI Propert yDamag e Quer y 

### Backfill :

Sampl e Area : 2655 2 ­ 281 5 DECATU R S T Owner : Use rProvide d Owne rInformatio n Resident : n Owne rOrnipie d Owne rName : Owne rName : Residen t Name : JBUND YCAROL E A Owne rAddressl : 

# 1 Owne rAddress2 : |172 2 N 2 8 ST City : lOMAH A Owne rPhon e 1(402 ) 342-660 4 State : Zi p Code : JN E |68111 - Alternat e Phone : |(402 ) 455-231 1 

# 1 Owne rAddress : 

# 1 City : 

# 1 Owne rPhone : 

# 1 State : Zi p Code : 

# 1 1 Alternat e Phone : 

# 1 Propert yAddress : |281 5 DECATU R ST Zi p Code : |68111 - Residen t Phon e 

# I

Contract : Assessment : Contractor : |PRUDENT2010_S Qualifyin g Grou p |40 0 Contrac t Optio n {OPTIO N 2 Assessmen t Ma xXR F Valu e | 474.8 8TECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y # : '2~'! o 5^2_ Propert y Address : ^l" ? Pe^^rVoj,
- <?-V . Date/Time : Owner' s Name : Oj,,r o I BiJc<«a^A^ Quad s Excavated : ^ f Contracto r Group : Pruden t Technologies , Inc . Excavatio n Genera l Ye s No 1 . If necessary , wer e tli e correc t quadjrant(s ) excavate dan drestored ? / 2 . If necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? 

# y Gradin g So dan dVegetatio nYe s N o 1 .Doe s th e gradin g aroun dth e perimete r ofth e hous e i n excavate darea s generall y slop e awa y / fromth e house ? 2 . Ha s so dbee n lai di n al l area s that wer e excavated ? / 3 .Doe s th e so dappear t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 / day tim e period ) 4 . Are sodde darea s generall y fir man devenl y graded ? / 1 5 .Ar e th e joint s betwee n th e so dstrip s generall y tiglit ? (Onl y evaluat e if inspecte dat a3 0 day / tim e period ) 6 . Wa s th e property grade dsuci i tliat wate r wil l no t poo l o n th e property' ^ / 7 . Wa s dainag e t o landscapin g o r plan t material s avoided ? / 1 Gates , Fence s an dRetainin g WalS sYe s N o 1 . D o gate s ope n an dclos e freely ? (I f applicable ) / 2 . Wer e al l gate s o r fence s take n dow n durin g restoratio n activitie s reinstalled ? (I f applicable ) / 3 . Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) / 4 . Wa s damag e t o retainin g wall s avoided ? (I f applicable ) / Foundation , Sidin g an dGutter s Ye s No 1 . Wa s damag e t o th e sidm g or tri mavoided ? / 2 . Wa s damag e t o tli e foundalio n avoided ? 

# y 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 ? 

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

# y Sidewalk s an dDriveway s (Concrete ) Ve s N o 1 Wa s damaj^e to diivewa v surface s avoided' ? / 2 Wa s damag e t o walkwa y surface s avoided ? /

## Owner s comments :

Inspectio n notes :



# . y. y 

# y * , y 1



## Remova l andrestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e Q< ^ y* ^ Date : i/i?///

## >RUPEN 1 THNOLOGIES . IN C 

### A S - BUIL T DRAWIN G OL S U 2655 2 Dat e Excavated : 11/11/201 0 

### OMAH A LEA D SUPERFUN D SIT E I'SEP ASigned-OfTDate : 

### 2655 2 Owne rName : CAROL E ABUND Y Address : 281 5 DECATU R S T

Phone : H : Sampl e Numbe r RYASCPXA-2655 2 F 1 RYBSCPXA-2655 2 F 2 RYCSCPXA-2655 2 B l RYDSCPXA-2655 2 B 2 RaZ€€PXA=2t555 2 B Z RGZSCPXA-2055 2 G Z RP2SCP77rZ555 2 P Z 

## y:^-yyyi-yy-' - Omah a Lea d Sit e Sit e Sketc h W : Lea d Concentratio n Sampl e Collecte d LA B 1 n p^—•pp m 

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# dERA Propert yCompletio n Agreemen t Thi s agreemen t documents the completion of remova l activitie s performe do n the below listedproperty . Th e propert y owner' s signatur e indicate s tha t the propert y owne r i s satisfiedwit hthe restoratio n of the subject property , an dtha t no item s ar e i n question , now , o r a

t an y tim e i n the future , excluding an y remaining warrant y (3 0 day s total ) except thos e items listedbelow , if any . Propert yID : Propert yAddress ; ^S\ S 'I ^

(g^dpJKjLX ­ ^^ V 

### Q""^'- ^ O a/ ^ A Phone : MfeSL ­ ^MT^ ' S A6^ ^ Restoratio n Item s i n Question :

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



# ^""•~""" TM d o no t agre e restoratio n i s complete d a t (note d deficiencie s above ) 

# /^-^1-^^^ " Owner' s Signatur e ^ / Dat ePruden t lechnologies , inc . (Prudent ) is under contrac t withth e U. S. Environmenta l Protectio n Agenc y (EPA ) to clea n up Icad
conlaminate ^ soij s at anumbe r ot" propertie s locate d in Omaha , Nebraska , includin g tb e property locate d at ^ 8 t o Dg0^tn^./y ~ ^T ~ Th e EPA request s you r permissio nto allo w Pruden t to pertbrmasoi l cleanu p at

Ihi s properl y to remov e lead-contaminate dsoil . By signin g this form , th e property owne r grant s permissio nto Pru-1en l to pertbr m activitie s relate d to th e cleanu p includin g soi l sampling , removalof lead-contaminate dsoil , an drestoratio n of

:he leference dpioperty . 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 Pruden t . , • .-.•:- . M. ., Ib r the Omah a Lea dSit e cleaxiup , al (402 ) 733-1188 ; 733-1455 . Genera l question s abou t th e Omah aLeadSit e cleanu p ca n b; directe d to ihe EP A Publi c Informatio n Center s af

(402 ) 731-304 5 (SouthOmah aoffice) . Propert yAccess Grante d By 

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# A^yr A.^y^JyiJy A RESIDErrLADDRESS : : jIDErTLADDRESS , ^ r- / I r> , ^ ^ . ^ I
IF RENTAL , PROPERT YOWNE D BY : OWNER' S IVIAILIN G ADDRESS ;
OWNER' S TELEPHON E NUIWBE R - HOWIE : ( ) WORK :
AG E OF HOME? : ^^ Q VEARS . HO W LON G HAV E YO U LIVE D HERE ? "•^' ^ YEARS . HA S TH E EXTERIO R BEE N PAINTE D OR COVERE D WIT H SIDIN G SINC E 1978 ? 

## M\^\tL ' ^ / U - YE SNO NUMBE R OF OCCUPANT S UNDE R 7 YEAR S OLD : V/f V NUMBE R OF OCCUPANT S 7 YEAR S OL D AN D OLDE R



## X ^ NUMBE R OF CHILDRE N UNDE R 7 YEAR S OL D WH O PLA Y IN TH E YAR D FO R 5 HOUR S OR MOR E PE R WEEK : COMMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS E ACTIONS . Th e activitie s tobe implemente d by EP A .indei thi s agreemer t are pursuan t to Sectio n 10 4 ofCERCLA , 42 U S C. 9604 . EPA' s righ t ofacces s to th e propertyis piovide dfo
- in Sectio n 104(e) of CERCLA , 42 U.S . C 9605(e) , whic hprovide s entry for "determinin g th e nee dfo r response , or choosin gor takin g an y respons e actio n unde r thi s title , or otherwis e enforcin g th e provision s of th e title. "

308 0 -.Va.-c,-.?.'" < Ai.d-, , .Hiansas Ciry , •'W C ^^--i " s'lo.'VB . •.^••j^) " .7 f 3•-•.•"" 'ENVfROiNMENTAL A CONSTRLCTiO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : ^<SI S D^CfM^rs V Date : t ( - o^-l7 ^ Phone ; 

## i(Ac^ ^ 3H0.-(d(DCL i BVID : 

## ^jPyyiiUy-t ^ Airc ^ f M

Propert y Owne r Pruden t Empl^^ye e Signature ; y 

# ^^[^d^iilisj^- ^ 808 0 Wat d Parkway . 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 c-­ - /o-«e \ t o ty m c.. . t4rto \yy. y ^OQ- > l-H M ET0.*e7 7

# 2655 2 Omah a Lea d Sit e Exterio rPain t Nort hArro w 

### Owne rName : CAROL E ABUND Y 

### Sit e SIcetcl i • Goo d Address: 281 5 DECATU R S T • Poor Phone : H : 

## w . • No t paint Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d 

## Finn : rPft / ^ 1 ^ RYASCPXA-26552 F 1 

## D Date : ^//Q/Cf / RYBSCPXA-26552 F 2 

### A M 

## 4 pp" ^ D Time : 19 ' ^ § RYCSCPXA-26552 B 1 

# vns > pp m D Samples Analyze d RYDSCPXA-26552 B 2 

### V \ q oo m 

## E f D RDZDOPX A2BSS J B Z pp m 

# n D XR F Unit : 

# .^1 1 Book : 

# M . RGZQCPXA-iOa52 GZ pp m 

# n D Date : _ 

# 1\^^ 4 RPZSCPX7r2B5S 2 PZ pp m 

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# A Printed : No v 05 , 201 0 vw.dcgis.org/dogi s

### Pag e 1 of 2

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### • YOU RTICKE T NUMBE RI S 2635567 . Origina l Cal l Date : 11/05/1 0 Time : 9:5 9 a m Op : SIVA1896 7 Wor k t o Begi n Date : 11/09/1 0 Time : 10:3 0 a m State : N E County : DOUGLA S Place : OMAH A Address : 281 5 Street : DECATU R S T Twp : 15 NRng : 13 E Sect-Qtr : 16-N E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : soi l lea d remediatio n propjec t Locatio n o f Work : LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)733-188 3 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 : 6F T Corne r Lot : Y Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V LEVEL 3 MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Servic e Are a Contac t Phon e Nunibe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEID I 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
LEVEL S LEVEL 3 COMMUNICATIONS , LL C N A 

### Day : 877366834 4 Alt : Emerg : 877366834 4 MUDO l METROPOLITA N UTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R 

### RICH/TRAFFI C Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 1 1 /5/201 0

## Pag e 2 of 2

OPPDGPR 5 OMAH A PUBLI C POWE RDISTRICT EL M LOCATIN G 

## Alt : 406207149 4 Emerg : 888728934 3 QLNNEIC QWES T LOCA LNETWOR K

EL M LOCATIN G 

## Day : 406728934 3

Alt : 406207149 4 

## Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 11/5/201 0

### ENVIRONME^r^A L ENGINEERIN GAN D tBBHNOUWIBB , mc . 

### CONSTRUCTIO N SOLUTION S 

## SIT ESAltT Y HAZAR D ANALYSI S 

# g)^-/u rsf 

# i/-y^ o Excavatio n Date : Backfi U Date : —

Ite m Conditioi i Hazard s Correctiv e Actio n Overhea dLine s 

# Q A Gra s Lin e O Wate r Lin e 

# n Sewer Lin e Septic/Leec h Fiel d 

# nj ± Propane^utan e 

# n o Sidewal k A ^ Foundatio n 

# M . Retainin g Wall s 

# ni x Fence s 

# ao . Tree s 

# ^k i structure s 

# m . Driveway 

# a Sprinkle r Syste m ^ 

# D Othe r 

# n ^ Cre w Forema n Sit e Safet y Offic e Date :

.Suito4( B 424 2 Medica l Drive , Suit e 725 0 

### iseoosios t lG«y,llO«411 4 Sa n Antonto , T X 7822 9 NilwMkaS810 7 Phone : (SIS ) 363470 3 Phone : (2t0 ) 822458 8 (402)733-118 8 Fax : (81S ) 383470 7 Fax : (210 ) 6T9-«57 7 Tax : (402)73»'188 3