SAIDtt : 3205 0 

### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R DATE : 1/1 5 ADDRESS : 360 7 N 2 9 S T REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES
. INC
. YEAR : 201 ^ 

### SOI L REMEDIATIO N PROPERT Y FIL E FOLDE R DOCUMENT S d PRE AN D POS T VIDE O O F PORPERT Y (DVD ) d EXECUTIV E SUMMAR Y [ i EPA-PROVIDE D PROPERT Y SKETC H d SIGNE D ACCES S AGREEMEN T FOR SUBJEC T PROPERT Y n SIGNE D ACCES S AGREEMENT{S ) FOR ADJACEN T PROPERT Y E l RESTORATIO N AGREEMEN T n SETTLEMEN T DOCUMENTS (I.E. , FOR DAMAG E O R TO REPLACE PLANTS , ETC. ) m CONFIRMATIO N DAT A Q PHOTOGRAPH S d AS-BUIL T SKETCH 0 SATISFACTOR Y RESTORATIO N SIGNE D B Y PROPERT Y OWNE R D

/ PROPERT Y CLOSE-OU T CHECKLIS T SIGNE D B Y EP A D DESCRIPTIO N O F AREA S NO T MEETIN G RO D CLEANU P CRITERI A [ ^

UTILIT Y CLEARANCE S d PROPERT Y INFORMATIO N FRO M DOUGLA S COUNT Y ASSESSOR'S OFFIC E D D D

SIGNATUR E DAT E 3021887 1 

# il i Superfun dPROPERT Y SUMMAR Y Date : /15/201 0 Omah aLea dSit e Reinedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof: Propert y Address ; 360 7 N 2 9 S T A . EXECUTIV E SUMMAR 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 = 24 3 PP M @ 8" ; E A = 18 3 PP M @ SCRAP E (~1" ) ATTACHMENT S 1 ) Propert y 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 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 ) 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 obtainedinclude : i ) Pre-excavatio n agreemen t detail s (i f an y ar e mad e withth e property owner ) ii ) Propert y Statu s Formsigne db y property ovme r iii ) Excavatio n digita l vide o i n 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 .

TECHNOLOGIES
. INC
.Rn d Recor d Backfill : Remediatio n Quer yj Lea d Remainin g Quer yI Propert yDamag e Quer y Sampl e Area : 3205 0 Owner : ­ 360 7 N 2 9 S T Use rProvide d Owne rInformatio n Resident :
n Owne rOccupie d Owne rName : iJACKSON CARO L Owne rAddressl : Owne rAddressZ : J352 1 N 2 9 S T City : JOMAH A^ Owne rPhon e j(402 ) 455-272 9 State : Zi p Code : ^

JNE J68111 - Alternat e Phone : Owne rName : Owne rAddress :
Cjty : Owne rPhone : 

# r State : Zi p Code : Alternat e Phone : Residen t Name : Propert yAddress : I3607N29S T Zi p Code : 168111 - Residen t Phon e 

# I

Contract : Assessment : Contractor : JPRUDEMT2010_ S Qualifyin g Grou p ^40 0 Contrac t Optio n jOFTIO N 1 Assessment Ma xXR F Valu e | 520.85' TECHNOLOGIES , INC . 

# EP A Propert y CJlos e Ou t Propert y # ; 3 2J b ^ C) Propert y Address ; ^(QC^ T ^ - ^"^^" T Date/Time : Owner' s Name : Ci^o*^'^<2cW o t A Quad s Excavated ; \= > Z _ Contracto r Group ; Frudeiir t TechinioSogies , Sue , Excavatio n Genera l Yc 3 N o 1 .

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

I f necessary , wer e th e coirec t area s ofdri p zon e excavatedandrestored ? / Gradin g Sodan dVegetatio n Ye s N o 1 .

Doe s tli e gradin g aroundthe perimete r o

f the hous e in excavatedarea s generally slop e awa y fro

mthe house': ' / 2 .Has sodbeen lai din al l area s tha t wer e excavated ? / 3 .

Doe s the so dappea r to b e generally health y an dgrowing ? (Onl y evaluate i f inspecteda t a3 0 da

y lime period) / 4 .Ar e soddedarea s general!) ' fimi an devenl y graded ? / 5 .Ar c the joint s belween tlie sodstrip s generall y tight ? (Onl y evaluat e i

f inspecte da t a3 0 da y / tim e penod ) 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 lo landscapin g or plan t material s avoided ? / Gates , Fence s an dRetainin g WalS s Ye s N o ! . Do gate s ope n an dclos e freely ? (I f applicable ) / 2 .

Wer e al l gate s o r fence s taken dow n during restoratio n activitie s reinstalled ? (I f applicable ) 

# y 3Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) / 4 . Was daniag e l o retainin g wall s avoided ? (Ifapplicable ) 

# y Foundation , Sidiin g an dGutter s Ye s N o 1 .

Was damag e t o th e sidin g o r trimavoided ? / Wa s damag e t o th e foundation avoided ? 

# y Wa s damag e l o window s avoided ? Wa s damag e t o window s o r door screen s avoided ? 

# y 5 .Was damag e l o downspout s o r downspou t extension s avoided ? Sidewalk s an dDriveway s (Cono'ete ) Ve s N o 1 Wa s damag e t o drivewa y surface s avoided ? 

# r Was damag e t o walkwa y surface s avoided ?

### Owner s coniments :

Inspectio n notes :

M i * 

# ^ . W W ^^ ' 

# ' <K >

Remova l an drestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e 6CM . ^ ^Date: i/<?// /

# m m rnNDCDGiEs . m c 

### A S - BUIL T DRAWIN G OL S # 3205 0 Dat e Excavated : 11/02/201 0 

### OMAH A LEA D SUPERFUN D SIT E I'SEP A Signed-Of T Date : 

### 3205 0 Exterio rPain t Omah a Lea d Sit e Owne rName : CARO L JACKSO N • Good Sit e Sketc h Address : 360 7 N 2 9 S T • Poo r

Phone : " : W r Q-'fTo t pain t Sannpl e Numbe r Lea d Concentratio n Sampl e Coltecte d ^ LA B Firm : Sample s Collected , RYASCPXA-3205 0 F 1 pp m D Date : RYBSCPXA-3205 0 F2 pp m D Time : RYCSCPXA3205 0 RYDSCPXA3205 0B 1 B2 pp m pp m D D Sample s Analyze d RDZ0CPXAO200 0 RCZ6CPX A3205 0 RP2SCPXA-3205 0 B? - Gi ­ PZ 

## \i^
. pp m pp m pp m - B 

## a Q ­ -B - 

## n XR F Unit : " Date :

Time : 

# A I ^ Boo l 

# i Numbe ro f Sample s = y> . ^ 

# o Staff :

Omah aLeadSite E A = 18 3 PP M aS C RAP E (~l" )
CONTRAC T # : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC
. 4613 0

# %S> A Propert yCompletio n Agreemen t Thi s agreemen t documents the completion of remova l activitie s performedo n th e below listedproperty . Th e propert y owner' s signatur e indicate s tha t th e propert y owne r i s satisfiedwit hth e restoratio n of th e subject property , an dtha t no items ar e i n question , now , o r a

t an y tim e i n th e future , excluding an y remaining warrant y (3 0 day s total ) except thos e item s listedbelow , if any . Propert y ID : Propert y Address ; 3 ( ^ <3^' ^ (y j '2J^ ^ ^ 

## Owner : Q_o^p^-) ( O ^ rA<^> ^ Phone: ^/ ^ ^ ^^-y^)} ^ r P J j 6^'Cf03C , 

# w Restoratio n Item s I n Question :



### Item : n- ^ item : item : item : item : item : Require d correction s t o complet e tli e property :

L J I agre e restoratio n i s completed . ^L I d o no t agre e restoratio n i s complete d a t note d deficiencie s abov e 

# /<^-y-// ) Owner' s Signatur e / / / / Dat eENVIRONMENTA L& CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m. -,/_/y , Address : 3/ ^ D 7 j U 3^^ ^ Date : /^"<=^ ^ '^ ^ 

## Phone : ^D^ ' d^ld^SOS O ^QS^-QO' ^ BVID :



## Propert y Own e Signatur e 808 0 War d Parkway , Suit s 40 5 560 0 S 1 0 S t 424 2 Medica i Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omalia , Nebrasic 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 

# i

# 3205 0 Exterio rPain t NorthArro w Omah a Lea d Sit e Owne rName : CARO L JACKSO N Sit e Slwtc h 

### • Goo d Address : 360 7 N 2 9 S T • Po^ r 

# x : Phone : H : W : Q*^ ! pain t Lea d imple s Collecte d Sampl e Numbe r Concentratio n RYASCPXA-3205 0 F 1 

### iP^ App m RYBSCPXA-3205 0 F2 RYCSCPXA-3205 0 B l 

# m z Sample s Analyze d RYDSCPXA-3205 0 B 2 RD20CPXA-3200 0 BZ nOZSCPX A3206 0 6Z ­ 

# %1L ^ ^ RPZSCPXA-3205 0 P Z I I J ppm % Numbe ro f Sample s = j,. ^ ^ X ;> ; 

# ?.^ : 11 2 CS I 

## a . U X 

# Sa l C O
A

O 

# s3t^o" l 

# a ^ 5 r

/^? ^ ) ^ ^ 

# \M u 3H \

U^VVf^. <

o 

# ol° l a t Omah aLea dSit e 4613 0

# iSfi n

H 

# 360 7 N 2 9 S T 

# A ^Zui^ F Printed : De c 02.201 0 www.dcgis.org/dogi sPag 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 2628097 . Origina l Cal l Date : 10/27/1 0 Time : 4:4 7 p m Op : SIVA1896 7 Wor k t o Begi n Date : 10/29/1 0 Time : 5:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 360 7 Street : N29T H S T Twp : 15 NRng : 13 E Sect-Qtr : 04-SE,09-N E Twp : Rng : Sect-Qtr : Lega l Given : C 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 : 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 yTyp e CXCAT V CO X COMMUNICATIONS , IN C HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
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 RICHA-RAFFI C Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0
OPPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T EL M LOCATIN G Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNN E 1 C 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=<RESULT. . . 10/27/201 0

### ENGINEERIN G AN D CONSTRUCTIO N SOLUTION S 

## SIT E SAFET Y HAZAR D ANALYSI S 

# ,g&o^/t^ - ;z ^ Address : 

# : Excavatio n Date : Crew ; Backfi U Date : —

Ite m Overhea dLine s Gas 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 Conditio n Hazard s Correctiv e Actio n ^l^ L A uri-e


# P^ '

f-c-/ ^ Q/l ^ 

### ofc ^

—. • ^.ei— — 

## Sit e Safety Offic e Date : ^ ^

868 0 Waitf^eaitany . Suito4i e SSOOSIOS t 424 2 Medica l Drive , Suit s 726 0 KanawC«lr/IK>«411 4 Onrtta , NcbnM a 8810 7 Sa n Antonio , T X 7822 9 Phon K(818 ) 30^310 3 Plaaiw : (402)733-118 8 Phone : (2t0 ) 82Z-«58 8 Fax : 018 ) 363ni7D 7 Fia c(402 ) 73»*188 3 Fax : (210 ) «7»457 7

# l l ZOI O