### TRANSMITTA L o f OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : t^^/Q ^ Date : __iL/a|2aa S Address : 16/ g ^ / s^ ^ s j Remediatio n Contractor : PgpQfiNTTftr'ftNgfnry/RS , /MC. y Year : ^p ^ SOI L REMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S ^ Vide o o f propert y (DVD ) H Executiv e Summar y EPA-provide dpropert y sketch 

# y SignedAcces s Agreemen t fo r

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

adjacen t propert y aRestoratio n Agreemen t D Settlemen t doctmient s (i.e. , fo r

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t o replac e plants , etc. ) B TConfirmation data ^ Photograph s \ £As-built sketch \ £Satisfactor y restoratio n signedby Propert y Owne r S

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Propert y close-out check lis t signe dby EP A D Descriptio n o f area s no t meeting RO D cleanu p criteri a H Utilit y clearance s Q ^ Propert y infonnatio n fromDougla s Coimt y Assessor' s Office D D ' 4031356 6 D



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### PROPERT Y SUMMAR Y Date : 11/19/200 8 Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-06/0004 Month of : Oct/Nov , Propert y Address ; 161 8 N 3 5 S T A . EXECUTIV E SUMMAR Y A. 1 Issue s Encountered : NOI>^ A. 2 Issue s Resolved : NON E A. 3 Uniqu e Findings : NON E A. 4 Othe r Relevan t Information : ARE A NOT EXCAVATED , B 1 BUSHES , 2'X2 ' @ 36 2 PP M CONFIRMATIO N SAMPLIN G DATA/RESULTS : B l = 21 3 PP M @ 12" ; B 2 = 39 1 PP M @ 6" ; D Z = 20 8 PP M @ 12" ; EA = 16 8 PP M @ SCRAPE ATTACHMENT S 1 ) Propert y sketc h provide dby EP A pursuan t t o contrac t specification s 2 ) SignedAcces s Agreemen t including acces s agreement s require dfo 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 ) Documentatio n - CompletedClose-ou t Checklis t 6 ) As-Built sketch ­ i ) Shall include fma l 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 obtaine dinclude : i ) Pre-excavatio n agreemen t detail s (if 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 ) Excavatio n digita l vide o i n MPEG , WM V (Window s Medi aVideo ) or SW F(Flas h Player) forma t and/o r photograph s iv ) Signedfor mverifying satisfactor y restoratio n v ) Descriptio n o f area s no t meeting InterimROD cleanu p criteria .

TECHNOLOGIES , INC .Fin d Record Clea n U p Query Lea d Remainin g Quer y j Propert yDamag e Quer y Backfill :

Sampl e Area : 2610 2 ­ 161 8 N 3 5 S T Owner : Resident : Contract : n Owne rOccupie d Residen t Name : 1 Contractor : Owne rName : 

# 1 j HAYNE S EARNESTEE N Propert yAddress : 1 Group : Owne rAddressl : Owne rAddressZ : |161 8 N 3 5 S T ZipCode : [6811 1 

# | l Assessment : [l61 8 N 3 5 S T Residen t Phon e Qualifyin g Grou p City : State : Zi p Code : |80 0 [OIVIAHA |N E |6811 1 /\ssessmen t XR F Date ; Owne rPhone : |(402 ) 558-699 1 Alternat e Phone : 

# 1 | 

# 1 Assessmen t l^a xXR F Value : 1 921.7 6TECHNOLOGIES * IN C 

# oEB V EP A Propert y Clos e Ou t Property# : lt,\bl . Propert y Address : /t/8 r -^4 5 St " Date/Time : Owner' s Name : Quad s Excavated : F',&i- , P ^ Contracto r Grou p Pruden t Technologie s Excavatio n Genera l 1 .If necessary , wer e th e correc t quadrant(s ) excavatedan drestored ? 2 .I f necessary , wer e the correc t area s o f dri p zon e excavatedandrestored ? Gradin g So dan dVegetatio n 1 .

Doe s the grading aroundth e perimete r of the hous e in excavatedarea s generall y slop e awa y fromthe house ? 2 .Ha s so dbeen lai di n al l area s tha t wer e excavated ? 3 .

Doe s the sodappea r t o b e generall y health y andgrowing ? (Onl y evaluat e i f inspecteda t a3 0 da

y tim e period ) 4 .

Ar e soddedarea s generall y firman devenl y graded ? 5 .Ar e th e joint s betwee n the so dstrip s generall y tight ? (Onl y evaluat e if inspecteda t a3 0 da y tim e period) 6 .Wa s the propert y gradedsuc h tha t wate r will no t poo l o n the property ? 7 .

Was damage t o landscaping o r 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 al l gate s o r fence s taken dow n durin g restoratio n activitie s reinstalled ? (I f applicable ) 3 .

Was damag e to gate s o r fence s avoided ? (If applicable ) 4 .

Was damage to retainin g wall s avoided ? (I f applicable ) Foundation , Sidin g an dGutter s 1 .Was damage t o the siding or trimavoided ? 2 .Was damage to th 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 damage t o downspouts or downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) 1 .Was damage to drivewa y surface s avoided ? 2 .Was damage t o walkwa y surface s avoided ? Ye s N o / 

# y Ye s N o

/ / / / / / / Ye s N o / / / / Ye s N o / i / / / / Ye s N o / 

### \ y

### Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complet e including th e 30-da y so dwarranty : EP A Representativ e Ba „ ^jj ^ Date : n/t/0 7

# ^EP A Propert yCompletio n Agreemen t Thi s agreemen t documents th e completio n o f remova l activitie s performedon th e helo w liste dproperty . The 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 in question , now , or 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 liste dbelow , i f any . Propert y ID : Propert y Address : ^^/ ^ ^ ^ :?5'> ^ Owner : fc^^r^e.54e, e n -H<^.v/.ner 5 Restoratio n Kem s I n Question :

Item : Item : Item : Item : 

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

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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 

# \c^l^J d Dat ePruden t Technologies , Inc . (Prudent ) i s unde r contrac t wit h th e U . S . Environmental Protectio n Agenc y (EPA ) t o clean u p lead
contamin^ dsoil s aL ? number c f

propertie s locate di n Omaha , Nebraska , includin g th e property locate dat IK/ aA / WA J •^T ' . Th e EPA request s you r permissio n t o allo w ftudent t o perfor masoi l cleanu p a t thi s property t o remov e lead-contaminate dsoil . B y signin g thi s form, th e propert y owner grant s permissio n t o Pruden t t o perfon n activitie s relate dt o th e cleanup includin g soi l sampling , removal o f lead-contaminate dsoil , an drestoratio n ofth e reference dproperty . I f

yo u hav e any question s abou t th e soi l cleanu p plaime dfor your property , pleas e contac t Prudent' s Administrativ e Cler k forth e Omah aLeadSite cleanup . Ms . Madhurim aDun i -a t (402 ) 733-1188 , 733-1455 . General question s abou t th e Omah aLeadSite 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 h Omah aoffice ) o r (402 ) 991-958 3 (Nort h Omah aoffice) . Property Acces s Grante dBy : Property Owner Signature : ^v . 

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# ^M^^\w ^ (Date ) PROPERT Y INFORMATIO N (T o b e complete db y residen t and/o r propert y owne r — pleas e print ) RESIDEN T NAME : Rente r RESIDEN T ADDRESS : 

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### J 1 

# Id - AG E O F HOME? : YEARS . HO W LON G HAV E YO U LIVE D HERE ? * ( T YEARS . HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978 ? V YE S N O NURWE R O F OCCUPANT S UNDE R 7 YEAR S OLD : O 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 : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA L RESPONS E ACTIONS : Th e activitie s t o b e implemente db y EPA unde r thi s agreemen t ar e pursuan t t o Sectio n 10 4 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 in Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic h provide s entry fo r "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 5 250 5 N . 24* ^ Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omalia , Nebrask a 6811 0 Sa n Antonio , T X 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 - BUILT DRAWIN G ~ S OMAHA LEAD SUPERFUND SIT E OLS# : 2610 2 Dat e Excavated : 8/28/200 8 Dat e USEP A Signed-OfT : 

### 2610 2 Exterio rPain t Nort h Arrow Omah a Lea d Sit e Owne rUame : EARNESTEE N HAYNE S Q^Goo d Sit e Sketc h Address : 161 8 N^3 5 S T 2 . y • Poo r Phone : H : W ; n No l pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : FH> a ^ ft&> T o RYASCPXA-2610 2 F l pp m D Date : Q7 - aft-O M RYBSCPXA-2610 2 F 2 

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808 0 War dParkway , Suit e 40 S 260 5 N . 24 ^ Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebraska 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)804-100 4 Phone : (210)822-956 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7

## 2610 2 Nort h Arro w Omah a Lea d Sit e Extepo rPain t Owne rName ; EARNESTEE N HAYNE S Sit e Sketc h [3^Goo d 

# r Address : 161 8 N 3 5 S T C^^ll f 

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### YOURTICKE T NUMBERI S 2116252 . Origina l Cal l Date : 8/26/0 8 Time : 8:1 2 a m Op : RAMITA1896 7 Wor k t o Begi n Date : 8/28/0 8 Time : 8:4 5 a m State : NE County : DOUGLA S Place : OMAH A Address : 161 8 Street : N35T H S T Twp : 15 NRng : 13 E Sect-Qtr : 16-N W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n projec t fo r soi l Locatio n o f Work : LOCAT E ENTIR E PROPERTY LOCAT E ENTIR E PROPERTY 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 : RAMIT A Phone : (402)733-145 5 Alt . Contact : Phone : (402)733-118 8 Wor k Being'Don e For : EPA Dept h o f Excavation : 6 FT Corne r Lot : NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Boring : NExplosives : N CXCAT V

LEVEL 3 MCLEODNE MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Utilit y Servic e Are aContac t Phon e Numbe r Typ e 

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### Emerg : 8773668344 Day : 800289190 1 N O NEE D T O CAL L OU T MCLEODN E MCLEODUS A 

### Alt : EMERGENC Y 

### Emerg : 800289190 1 Day : 402504782 3 METROPOLITA N UTILITIE S MUDO l SAND Y 

### Alt : DISTRIC T 

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