SAID# : 2809 6 

### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R DATE : 1/1 5 ADDRESS : 286 4 GRAN TS T REMEDIATIO N CONTRACTOR : PRUDEN TTECHNOLOGIES . INC . YEAR : 20l 4 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S d PR E AN D POS TVIDE O O F PORPERT Y(DVD ) 0 EXECUTIV E SUMMAR Y m EPA-PROVIDE D PROPERT YSKETC H Q SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y n SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN TPROPERT Y E l RESTORATIO N AGREEMEN T E l SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R TO REPLAC E PLANTS , ETC. ) 0 CONFIRMATIO N DAT A \ i PHOTOGRAPH S Q AS-BUIL TSKETC H d SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R m PROPERT YCLOSE-OU TCHECKLIS TSIGNE D B YEP A D DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A m UTILIT YCLEARANCE S 0 1 PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E 

# n ^ ^ D D

SIGNATUR E DAT E 

### 3021761 0 

# IHIH I Superfun d

### PROPERT Y SUMMAR Y Date : /15/201 0 Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Propert y Address : 286 4 GRAN 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 l = 7 5 PP M @ 6" ; B 2 = 10 9 PP M @ 6" ; N O EASEMEN T ATTACHMENT S 1 ) Property sketc hprovide db y EPA 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 digital 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 fina l 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 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 withth e property owner ) ii ) Property Statu s For msigne db y property owne r iii ) Excavatio n digita l 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 .Fin d Record 

### Backfill :

Sampl e Area : 2809 6 - 286 4 GRAN TS T Owner : D CXvne rOccupie d Owne rName : 1 MORELL O BERNARD : 

### 1 Owne rAddressl : 

# 1 Owne rAddress2 : 11141 3 HICKOR YR D City : jOMAH A State : |N E Zi p Code : |68144 - Owne rPhon e 1(402 ) 342-282 0 

# 1 Alternat e Phone :

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

Use rProvide d Owne rInformatio n Owne rName : 

# 1 Owne rAddress : 

# 1 City : 

# 1 State : 

# 1 Zi p Code : 

# 1 Owne rPhone : 

# 1 Altemat e Phone : 

# 1

Assessment : Qualifyin g Grou p |46 6 Assessmen t Ma xXR F Valu e | " 514.6 1 Resident : Residen t Name : 

# r Propert yAddress : 286 4 GRAN TST Zi p Code : |68111 - Residen t Phon e•-•- • ir^: ^ i* . TECHNOIXXJIES , INC . 

# EP A Propert y Clos e Ou t Propert y #:'7^^^ ^ Propert y Address ; ZS*^* ^ <5)(nt>^*.'+ ' ^t
Date/Time : Owner' s Name : ^er^A>^ ^ flAd>ret/ d Quad s Excavated : (2, f ^ 6. Z Contracto r Group : Pruden t Technologie.* , Inc. , Excavatio n Genera l Ye s N o 1 , I f necessarv . wer e th e correct quadrant(s ) excavatedan drestored ? / 2 , I f necessary , wer e the correct area s o f drip zon e excavatedandrestored ? v / Gradin g So dan dVegetatio n Ye s N o 1 , Doe s the grading aroim dthe perimete r o

f the hous e in excavatedarea s generall y slop e awa y / fro mthe house ? 2 , Has so dbee n laidi n all area s tha t wer e excavated ? / 3 , Doe s the sodappea r t

o be generall y health y andgrowing ? (Onl y evaluat e i f inspecteda t a3 0 da

y lim e period) / 4 . Ar e soddedarea s generall y finn andevenl y graded ? 

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

f inspecteda t a3 0 da y 

## y tim e period) 6 , Wa s the propert y gradedsuc htlia t wate r wil l not pool o n tli e property ? / 7 . Wa s damage t o landscaping o r plan t material s avoided ? 

# y Gates , Fence s an dRetainin g Wall s Ye s N o 1 , D o gate s ope n andclos e freely ? (I f applicable ) / 2 , Wer e all gate s o r fence s taken dow n during restoratio n activitie s reinstalled ? (I f apphcable ) 

# y 3 , Wa s damage t o gate s o r fence s avoided ? (I f applicable ) 

# y 4 , Wa s damage t o retaining wall s avoided ? (I f applicable ) 

# y Foundation , Sidin g an dGutter s Ye s N o 1 , Wa s damage t o tlie sidui g o r trimavoided ? 

# X 2 , Wa s damage t o tlie fomidatio n avoided ? 

## y 3 . Wa s damage t o window s avoided ? 

# y 4 .

Wa s damag e t o window s o r doo r screen s avoided ? / / 5 . Wa s damage t o downspout s or downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ye s N o Wa s damage ( o diivewa v surface s avoided ? 

# n 2 . Was damage t o walkwa y surface s avoided ? I

## Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complete includin g th e 30-da y so dwarranty . EP A Representativ e 9^ ^ ^Date: 'Z^'^^^ "

# m m R'HNOLOUIES , INC , 

### A S - BUIL T DRAWIN G OL S #2809 6 Dat e Excavated : 10/04/201 0 USEPASigned-Of f Date : 

### OMAH A LEA D SUPERFUN D SIT E 2809 6 Exterio rPain t No* , h Arro w Omah a Lea d Sit e Owne rName : BERNAR D J MORELL O Sit e Sketc h • Goo d Address : 286 4 GRAN TS T • Poo f Phone : H 402-342-282 0 V t 

# 1 [3''^Not paint Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Firm : Ctof t '.ftsVCx i RYASCPXA-2809 6 F 1 pp m 

### iz r D Date : y^s - 2H-oi . RYBSCPXA-2809 6 F 2 pp m 

### 0' D Time : I O : t S ^ r ^ RYCSCPXA-2809 6 B 1 pp m 

### 0 " D Sample s Analyze d RYDSCPXA-2809 6 B2 ppm K 

### 0 ' D RDZ8CPX A28P9 6 Bi r pp m 

### D D XR F Unit : qO Z Book : lOC f pp m 

### D D Date : 

## ic-O^-ci ^ pp m 

### D D Tim e 

### f M Staff : <1>5 U Numbe ro f Sample s = J ^ Legend : F 1 = Fron t Left . F 2 = Fron t Right , B 1 = Bac k Left , 8 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a s viewe d fro m th « street , facin g propert y 

# ENTERE D 'iMArprti . .\.y/ s B 2 = 10 9 PP M (o : 6 ' B l = 7 5 PP M ffl ) 6 ' 

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C/^rar^ * • '3.' - N O EASEMEN T CONTRAC T# : EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC .

# &ERI V Propert yCompletio n Agreemen t Thi s agreemen t documents the completion of remova l activitie s performedo 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 restoration of the subject property , an dtha t no items 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 . Property ID : Propert y Address : ^ g £ , M 

## Q(t-«^ ^ Si - Owner : Phone : Restoratio n Item s i n Question :

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

Li J I agre e restoratio n i s completed . L J I d o no t agre e restoratio n i s complete d a t (note d deficiencie s above )



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L ner' s Signatur e Dat e• ; t Pruden t Technologies , Inc . (Prudent ) is unde r contrac t withth eU. S. Environmenta l Protectio n Agenc y (EPA ) to clean up lead- . cqnlim^njrfe dspil s a laer^f^propertie s locate d in Omaha , Nebraska , includin g th e propert y locate d at i t anumbe r ofp i soil s a' Th e EP A request s you r permissio n to allo w Pruden t to performasoi l cleanu pat thi s m/f e 1 propert y to remej e lead-contaminate dsoil . By signin g thi s form , th e propert y owne r grant s pemjissio n to Pruden t to perfon n activitie s relate d to th e cleanu p includin g soi l sampling , remova l of lead-contaminate dsoil , an drestoratio n of th 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 sout hoffic e for th e Omah aLea d Sil e cleanup-a t (402 ) 733-1188 , Genera l question s abou t th e Omah aLea dSit e cleanu p ca n be 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) . 

# i)Bfi^yi/i P /h6/e^^^ Q Property Acces s Grante dBy : (Pleas e Prin t Name ) 

# f/2.4/ ^ 

# iJ h Property Owne r Signature : /^^ ^ J^.J\J^ ^ (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 T NAME : </ ^C.A[^ T [^ Q ' f ' Owne r Rente r RESIDEN T ADDRES S 

### ^g^ M <^rc<Lo^ W S ^ DrAOLk AN^E - C1S > VI o IF RENTAL , PROPERT Y OWME D BY : . . 

### 'BiOjrruiJl J KM. 0 rgAlj P OWNER' S MAILIN G ADDRESS ; 

### ^ -^^C ^ ^VV^AJv-fl . jNL b f6^\^K ^ OWNER' S TELEPHON E NUMBE R - HOME : fj^ ^

3 yZ ' ^ ^

AG E OF HOME? : 

### ^ YEARS . HO W LON G HAV E YO U LIVE D HERE ? HA S TH E EXTERIO R BEE N PAINTE D OR COVERE D WIT H SIDIN G SINC E 1978 ? WORK : 

# M/A
- YEARS .

_ YE S NO NUMBE R OF OCCUPANT S UNDE R 7 YEAR S OLD : 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 : A ^ I ^ COMMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. ) A ^ /

^

AUTHORIT Y FO RENVIRONMENTA LRESPONS E ACTIONS ; 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 of CERCLA , 42 U.S.C . 9604 . EPA' s right of

acces s to th e propert yis provide dfor in Sectio n 104(e ) of CERCLA , 42 U.S . C 9605(e) , whic hprovide s entry for "detenninin 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 of th e title. " 808 0 War d Parkway , Suit e 40 5 560 0 S 10 St 424 2 Medica l Drive , Suit e 425 0 Kansa s City,'M O 6411 4 Omaha . Nebrask a 6810 7 Sa n Antonio , TX 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 ) 579-667 7ENVfRONMENT.AL A CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE. S 

# Propert y Statu s For m Address : J ? $ 4 L ( (^ran|
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## Phone : BVID : 4^0^ ^ 3M2-
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Propert y Owne r Pruden t Employe e Signature : Signature : 808 0 War d Parkway , Su f 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 , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)733-118 8 Phone : (210)822-958 8

## 2809 6 Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e Owne rName : BERNAR D J MORELL O • Good 

### Sit e SIcetc h Address : 286 4 GRAf^n " S T • Poo r Phone : H : 402-342-282 0 W^ 

# 1 Q'^No t pain t Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Sample s Collecte d Firm : f:^ ^

\ft&^g M RYASCPXA-2809 6 F 1 pp m 

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## D Date : e^K ^ .2'^^of c RYBSCPXA-2809 6 F2 pp m 

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## D Time : to ; 1 ^

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## S/ S pp m ppm M 

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## D D Sample s Analyze d RD2SCPX A2600 6 92 ­ pp m 

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## D XR F Unit : 90 Z Book : A ^ ROgGCrXA-2000 G r^rZSCPXA-2000 6 GiS- * PZ pp m pp m 

## D D 

## D D Dat e Tim e 

## (£> - O^'C ^ £± L Numbe rof Sample s = : 4 . Staff : 

# n'iu / Legend : F 1 = Fron t Left , F2 = Fron t Right , B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y A H quadrant s ar e a s viewe d fro m th e street , feeing propert y 

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# A Printed : No v 30 , 201 0 www.dcgis.org/dogi shttp://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=%3CRESU. . 

### Creat e Anothe rTicke t Bac k t o Irt h Internet Sen d Emai l 

## YOU RTICKE T NUMBE RI S  2605473 . Origina l Cal l Date : 9/30/1 0 Time : 12:3 3 p m Op : SIVA1 8 96 7 Wor k t o Begi n Date : 10/04/1 0 Time : 1:0 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 286 4 Street : GRAN T S T Twp : 15 NRng : 13 E Sect-Qtr : 09-S E 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: PRUDEN T TECHNOLOGIE S Contac t Name : SIV AJAMPAMA 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 : NFront : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCATV MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C 

## Servic e Are a Contac t Phon e Numbe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUDO l METROPOLITA N UTILITIES DISTRICT SAND Y Day : 402504782 3 Alt : 

## Emerg : 402504797 0

lof 2 9/30/201 0 12:3 3 PM

### http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=%3CRESU. .


## OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R RICH/TRAFFI C Day : 402444719 7



## Alt : 402444516 1 Emerg : 402444516 0 0PPDGPR 5 OMAH A PUBLI C POWE RDISTRICT EL M LOCATIN G Day : 406728934 3



## 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

2 of 2 9/30/201 0 12:3 3 P MilNC . 

### CONSTHUCnO N SOLUTION S 

## SIT E SAFET Y HAZAR D ANALYSI S Address : --2L^.$^-^v:,^,£ir . Excavatio n Date : Crew : Backfi U Date : —

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