## TRANSMITTA L o f OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : y)^^ ^ Date : 11-15^1 0 Address : 3^B 1 Oc.fb u S f Remediatio n Contractor : Ppfirypr^-f 7»^-H'^o<^C|<g'V/^'^ 7 Year : SOI LREMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S [?

( Vide o of propert y (DVD ) ffl Executiv e Summar y aEPA-providedpropert y sketch H SignedAcces s Agreemen t fo r

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

adjacen 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. ) S

l Confirmation data 

# d Photograph s 

# d As-built sketch 

# i Satisfector y restoratio n signedb y Propert y Owne r 

# d Propert y close-out check lis t signe dby EP A D Descriptio n o f

area s not meeting RO D cleanu p criteri a 

# i Utilit y clearance s Propert y information firomDougla s Count y Assessor' s Of&c e D D D 

# ^ . ^v v '^ W Sipature ^ Dat e 3021892 8 

# innini n Superfun d

### PROPERT Y SUMMAR Y Date : 11/15/201 0 Omah aLea dSit e Remedia l Actio n Contrac t § EP-R7-07-0 6 TO^ l Mont hof : Novembe r Propert y Address : 285 7 CORB Y S T A . EXECUTIV E SUMMAR Y A. 1 Issue s Encountered : NON E A. 2 Issue s Resolved : NON E AJ Uniqu e Findings : NON E A. 4 Othe r Relevan t Information : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : B 2 = 33 6 PP M @ 8" ; E A = 5 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 digita l 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-Buil t sketc h­ i ) Shal l includ e fma l lea dlevel s v ) Legen d ii ) Contaminatio n lef t behin darea s vi ) Contracto r identificatio n iii ) Propert y 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, ifavailable , o r obtaine dinclude : i ) Pre-excavatio n agreemen t detail s (i f an y 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 o f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOGiES . INC .Fin d Record 

### Backfill :

Sampl e Area : 2934 2 - 285 7 CORB Y S T Owner : D Owne rOccupie d Owne rName : IPOLSLE Y GREGOR YS Owne rAddressl : Owne rAddressZ : |699 6 COUNT Y ROA D #3 2 City : State : Zi p Code : I F=OR T CALHOU N |N E |68023 - Owne rPhon e Alternat e Phone : |f402 ) 468-511 9 |f402 ) 658-238 0

Contract : Contractor : |PRUDENT2010_S Contrac t Optio n |OPTIO N 1 Remediatio n QueryI Lea d Remainin g Quer yI Propert yDamag e Query

Use rProvide d Owne rInformatio n Owne rName : Owne rAddress :
City : State : Zi p Code : 

# I — r Owne rPhone : Alternat e Phone :

Assessment : Qualifyin g Grou p J40 6 Assessmen t Ma xXR F Valu e | 518.5 7 Resident : Residen t Name : IBRUMFIEL D HATTI E Propert yAddress : |285 7 CORB Y ST Zi p Code : |68111 - Residen t Phon e 

# IINOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y # ; 2.13^12 - Propert y Address : 2-SS T CcRB M ^ T Date/Time : t o f\ \ Owner' s Name : MR£" 6 

### PoS6.t W Quad s Excavated : rt^o__ Contracto r Group : Prmlen t Technologies , Inc , Excavatio n Genera l Ye s N o 1 .

I f necessar>' , wer e tli e correct quadrant(s ) excavatedan drestored ? / 2 .

I f necessar>' , wer e th e correct area s o f drip zon e excavatedan drestored ? / Gradin g So dan dVegetatio n Ye s N o 1 , Doe s th e grading aroundthe perimete r o

f the hous e i n excavatedarea s generall y slope awa y ^ fro mth e house ? 2 .

Has sodbee n laidi n all area s tha t wer e excavated ? / 3 .

Doe s th e sodappea r t

o b e generall y health y an dgrowing ? (Onl y evaluat e i

f inspecteda t a3 0 

# y da

y time period) 4 .

Ar e soddedarea s generall y fir mandevenl y graded ? 

# y 5 .Ar e tlie joint s betwee n the so dstrip s generall y tight ? (Onl y evaluat e i

f inspecteda t a3 0 da y time period) 

# y 6 .

Was the propert y gradedsuc htlia l wate r wil l not pool o n the property ? 

# y 7 .

Was damag e to landscaping o r plan t material s avoided ? 

# y Gates , Fence s an dRetainin g Wall sYe s N o I .

D o gate s ope n andclos e fireely ? (I f applicable ) / 2 .

Wer e all gate s o r fence s take n dow n during restoration activitie s reinstalled ? (I f applicable) 

# y

• 

### 3 .

Was damag e t o gate s o r fence s avoided ? (I f applicable) / 4 .

Was damag e t o retainin g wall s avoided ? (Ifapplicable ) 

# y Foundation , Sidin g an dGutter sYe s N o 1 .

Was damag e t o the siding o r trimavoided ? 

# y 2 .Was damag e t o the foundation avoided ? 

# y 3 .

Was damag e to window s avoided ? 

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

# y 5 . Was damag e t o downspouts o r downspou t extension s avoided ? 

# y y 

### Sidewalk s an dDriveway s (Concrete ) Ye s N o Was damag e to drivewa y surface s avoided ? 

# y 2 .Was damag e to walkwa y surface s avoided ? ^ 1

## Owner s co mmeats :

Inspectio n notes :

Remova l andrestoratio n activate s complet e includin g th e 30-da y so dwajranty : i 

## EP A Representativ e ^ /Q^ ^ y ^ ^Date; lolnli a

# m i :CHNUL(XiIES , INC . 

### A S - BUIL T DRAWIN G OL S #2934 2 Dat e Excavated : 09/22/201 0 ISEP A Signed-OrrDate : 

### OMAH A LEA D SUPERFUN D SIT E 

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OmahaLea dSit e E A = 57PP M aSCRAP E 4613 0 CONTRAC T # : EP-S7-10-0 5 PRUDENTTECHNOLOGIES , INC .

### I Thi s agreement document s th e completio n o f removal activitie s performe do n th e belo w liste dproperr y Th e property owner' s signatur e indicate s tha t th e property owne r i s satisfie dv/it 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 future , excludin g any remainin g warrant y (3 0 day s totai ) excep t thos e item s liste dbelow , i f any .

Restoratso m litem s ii n Questiomi :

1 1 agre e restoratio n i s completed , excep t a s note d abov e L J i d o no t agre e restoratio n i s complete d



## L^z^^yA . s SigjMtur e ^\ ^ i . :• • > ' I • - I y • / Pruden t Technologies , Inc . (Prudent ) is unde r contrac t withth eU. S. Environmenta l Protectio n Agenc y (EPA ) to clea n up lead soil ^ f propertie s locate d in Omaha , Nebraska , includin g th e property locate d at contaminate dsoilsji f anumbe r o

l Tli e EP A request s you r permissio n to allo w Pruden t to performasoi l cleanu p at thi s ninate dsoil . By signin g thi s form , th e property owne r grant s permissio n to Pruden tto perform property to remov e lead-contim u 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 dproperty . Ifyo 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 southoffic e .fo r th e Omah aLea d Site cleanup-a t (402 ) 733-1188 . Genera l question s abou t th e Omah aLea dSit e cleanu p ca nbe directe d to th e EP A Publi c Informatio n Center s al (402 ) 731-304 5 (SouthOmali aoffice ) or (402 ) 991-958 3 (NorthOmah aoffice) . Property Acces s Granted By / ^ f^^/j^f ^ "^/ 2 iblM^ r ^L A (Pleas e Prin t Name ) Property Owne r Signature : rj^j(j^|gf ^ ^ ^/iJ-^O l ^ "—(Signature ) (Date ) PROPERT Y INFORMATIO N (T o be complete d by residen t and/o r propert y owne r —pleas e print ) RESIDEN TNAME : ^Pttti'^Z ^ X> ^^- ^ ^

I^TQ^IC L Owne r^ntej ) RESIDEN TADDRESS : IF RENTAL , PROPERT Y OWNE D BY : 

# (^r^ ^ ^(s\fh\^c^^^o^-^'r^-ii^' ) OWNER' S MAILIN G ADDRES S 

### (IP^O'IVATO / ^ ^ OWNER' S TELEPHON E NUMBE R - HOME : t/o-0J S ^'/^f-f l 3^ C / WORK : AG E OF HOME? : ICf O - KYEARS . 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 ? ^ YE S NO NUMBE R OF OCCUPANT S UNDE R 7 YEAR S OLD : U 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 5 HOUR S OR MOR E PE R WEEK : COMMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES . ETC. )

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

acces s to th e propert y is provide dfo r in Sectio 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 thi s title , or otherwis e enforcin g th e provision s ofth e title. " 808 0 War d Parkway , Suit e 40 & 560 0 S 10 St 424 2 Medica l Drive , Suit e 426 0 Kansa s City . MO 6411 4 Onnaha . Nebrask a 6810 7 Sa n Antonio . TX 7822 9 Phone:(816)363-370 3 Phone:(402)733-118 8 Phone:(210)822-968 8 Fan : (816 ) 363-370 7 Fa* . (402W33-188 3 Fax:(210)679-867 7E^VrRO^\MENTAL & CONSTRLCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : ^S*^' ^ CX>^^ Y 

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

### Pag e 1 o f 1

" > Creat e Anothe rTicke t Bac k t o Irt h Interne t Sen d Emai l 

### YOU RTICKE T NUMBE RI S 2592061 . Origina l Cal l Date : 9/14/1 0 Time : 5:1 2 p m Op : SIVA1896 7 Wor k t o Begi n Date : 9/16/1 0 Time : 5:4 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 285 7 Street: - CORB Y S T Twp : 15 NRng : 13 E Sect-Qtr : 09-SE-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : soi l lea d 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 : UNSUR E CORNER S Compan y: PRUDENT 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 : 6 F T Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V

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 , INC HEID I 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUDO l METROPOLITA N UTILITIE S DISTRIC T SANDY 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACOFCITY OFOMAHA-TRAFFIC,SEWE R RICH/TRAFFIC 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 OPPDGPR5 OMAH A PUBLIC POWE RDISTRIC T EL M LOCATING Day : 406728934 3 Alt : 406207149 4 

### Emerg : 888728934 3 QLNN E 1 C QWES T LOCA LNETWORK EL M LOCATING Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 

### http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/14/201 0

### ENVIRONMENTA L ENGINEERIN GAN D CONSTRUCTIO N SOLUTION S TEOHNOUkmBi , Ht C 

## SIT E SAF&TY HAZAR D ANALYSI S Address : - ^.f.f ? Crew :

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 WaU s Fence s Tree s Structure s Driveway Sprinkle r Syste m Othe r Cre w Forema n CgtfJiy . Excavatio n Date : Backfil l Date : —

Conditio n Hazard s Correctiv e Actio n CP ^ 

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## Sit e Safety Offic e Date :

aOMUMmflRaftany . SiMtMI S iSSOOSIOS t 424 2 Medica l Drive , Suit e 726 0 Kansa s Oly; , IIO«411 4 OmAta , NdMaMi a tttOT Sa n Afltento , T X 78229 PtMne : |»1<)36M70 3 Ptane : (402)733-1ia 8 Tte : (402)733'<1«8 3 Phone : (2t0 ) 822-4S8 8 Fax : (210)679-657 7