### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 2069 3 DATE : 1/1 5 ADDRESS : 123 5 S1 4 S T REMEDIATIO N CONTRAaOR : PRUDEN TTECHNOLOGIES . INC . YEAR : 201< ) 

### SOI L REMEDIATIO N PROPERT Y FIL E FOLDE R DOCUMENT S H PR E AN D POS T VIDE O O F PORPERT Y (DVD ) & EXECUTIV E SUMMAR Y B^EPA-PROVIDE D PROPERT YSKETC H DESIGNE D ACCES S AGREEMEN T FOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN TPROPERT Y 'D^RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R TO REPLAC E PLANTS , ETC. ) D^CONFIRMATIO N DAT A B^PHOTOGRAPH S "^-AA^ ^ <n X &^-BUIL T SKETC H KP^SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT Y OWNE R ^P^PROPERT YCLOSE-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 taMJTILIT YCLEARANCE S O^PROPERTY INFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E D D

' SIGNATUR E \j\ j \ 'DAT E 

### 3026241 2 Superfun d

### PROPERT V SUMMAR Y Date : II/IS/20I 0 Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l Monthof : NjDvembe r Propert y Addregs : 123SS14St . A . EXECUTIV E SUMMARY

A.I ; imlie s Encountered : NON E A. 2 Issue s Resolved : NON E A J Uniqu e Findings : NON E A. 4 Othe r Relevan t Information : None CONFIRMATIO N SAMPLIN GDATA/RESULTS : F I = 14 6 PP M @ 13" ; EA = 21 3 PP M @ SCRAPE (~1" ) ATTACHMENT S 1 ) Propert y sketchprovidedtr y EP A pursuan t to contrac t specification s 2 ) SignedAcces s Agreemen t includin g acces s agreement s requiredfo r crossing othe r propertie s 3 ) Pre-Excavatior i digita l vide o clip/photograph s . . . 4 ) Post-Excavation digita l vide o clip/photograph s 5 ) Documentation - CompletedClose-out Checklist ' 6 ) As-Built sketch i ) Shall include final-lea dlevel s v ) Legen d 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 , or obtainedinclude : i )Pre-excavation agreemen t detail s (i f an y are mad e wit hth e propert y owner ) ii ) Propert y Statu s For msignedb y propert y owne r iii ) Excavatio n digita l vide o i n MPEG , WM V (Window s Medi aVideo ) or SW F(Flas hPlayer ) forma t and/or photograph s iv ) Signedfor mverifying satisfactor y restoration v ) Inscriptio n o f area s not meeting Interi mRO D cleanu p criteria .

TECHNOLOGIES . INC .Fin d Record Remediatio n Quer yj Lea d Remainin g Quer y Propert yDamag e Query 

### Backfill :

Sampl e Area : 2069 3 -123 5 S 1 4 S T Owner : Use rProvide d Owne rInformatio n Resident :

• Owne rOccupie d Owne rName : Owne rName : Residen t Name : JSAMUE L C MARTINE Z LI V TRUST 

# 1 I Owne rAddressl : Owne rAddress : Propert yAddress : 

# 1 11235 S 1 4 S T Owne rAddress2 : Zi p Code : |l32 1 JONE S ST 168108 - City : State : Zi p Code : 

### aty : State : Zi p Code : Residen t Phon e jOMAH A N E 68102 - 

# 1 1 1 I Owne rPhon e Alternat e Phone : Owne rPhone : Alternat e Phone : 

# 1 1
Contract : Assessment : Contractor : |PRUDENT2010_ S Qualifyin g Grou p |40 0 Contrac t Optio n jOPTIO N 1 Assessmen t Ma xXR F Valu e | 

### 50 7

# QRIJOF M TBCHNCHJOGIBS i IN C 

# I? ' 

# IEPA Propert y Clos e Ou t Propert y #:706^3 » Propert y Address : V Z^* ? 9.f'*'>^ - Date/Time : Owner' s Name : Ui V k \Wt k

\ i ct» \ Quad s Excavated : f ^ | Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera ) Ye s No I . I f necessaiy . wer e th e correc t quadrant(s ) excavate dan drestored ? / 

### 2 . I f necessary , wer e th e coirec t area s o f drip zone excavate dandrestored ? / 

### Gradin g Sodan dVegetatio n Ye s N o 1 . - Doe s th e gradin g aroun dth e perimete r o

f th e hous e i n excavate darea s generally slop e awa y / 

### fro mth e house ? 2 . Ha s so dbeen lai di n al l area s tha t wer e excavated ? / 

### 3 . Doe s th e so dappea r t o b e generally health v an dgrowing ? (Onl y evaluate if inspectedat a3 0 / 

### da

y lime period ) 4 . Ar e soddedarea s generally firmandevenl y graded ? / 

### 5. , Ar c tli e joint s between the so dstrip s generally tiglit ? (Onl y evaluat e i f inspecte da l a3 0 da y time period) / 

### 6 . Wa s th e propert y grade dsuch.dwt wate r will not pool o n di e propeity ? 

# y 7 . Was damag e t o landscapin g o r plan t niaterial s avoided ? / 

### Gates , Fence s an dRetainin g Wall s Ye ) N o 1 . D o gate s ope n an dclos e freely ? (I f apphcabie ) 

# y 2 . Wer e al l gale s or fence s taken down diuin g restoratio n activitie s reinstalled ? (I f jqjplicable) / 

### 3 . Wa s damag e to gate s or fence s avoided ? (Ifapplicable ) 

# y 4 . Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) / 

### Foundation , Sidin g an dGutter s Ye s N o 1 . Was damag e t o the sidin g or trimavoided ? / 

### 2 . Wa s damag e t o th e foundatio n avoided ? / 

### 3 . Was damag e t o window s avoided ? / 

### 4 . Wa s damag e to window s or door screen s avoided ? / 

### 5 . Was damag e to downspout s or downspou t extension s avoided ? / 

### Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Was damag e l o diivewa y surface s avoided ? / 

### 2 . Wa s damag e t o walkwa y surface s avoided ? /

## OwBc ncomments :

Inspectio nnotes :

/ . 

# A ' J Removal an drestoratio nactivate s complet e includin g th e 30-day so dwarranty : EPA Representativ e ff ^ >a LDate ; fh/ n3IES , INC . 

## A S - BUIL T DRAVWf G OL S #2069 3 Dat e Excavated : 12/7/201 0 

## LEAD 811P£RFUND SIT E USEP A Signed-Of r Date : 

# 1 lllililililiililll l 2069^ Exterio rPaint Nort h Arro w Omah a Lea d Sit e • Goo d Sit e Sketc h • Poo r Samolin a Address : 123 5 8 1 4 S T g^o t paint Lea d Sampl e |. „ Sample s Collecte d Concentratio n Collecte d Sampl e Numbe r Firm : FD ADR/j^ ^ RYASCPXA-2069 3 F l .5<> 7 pp m Q ^

D Date : U//q//5<= ? ' RYBSCPXA-2069 3 F2 

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### - oo m n n Date : ~ l •o S •Ofi \ nPZSGPX A3060 3 4« ­ -pp m n n Time : ft-»>i Staff : KSW * Numbe rof Sample s =1 - ^ Legend : F 1 = Fron t Left , F 2 = Fron t Right , B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Play Al l quadrant s ar e a

s viewe d fro m the street , facing propert y 

## ; ENT E IRE D 1 

## iUN 2 9 2009 ! \

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## I ?V f VlAL k ^•/VsH ­ 04470 1 m.l i E A = 213PPIV1@SCARP E CONTRAC T # : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC .

## (^dA- ^ N--»r 

## Propert yCompletio n Agreemen t Thi s agreenieiri document s th e compietio n o f remova l activitie s perfonne dou th e belo w liste dpiopeiTy . Th e propert y owtier' s signatur e indicate s tha t th e propert y owne r i s satisfie dwith'the restoratio n ofth 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 dbeiow , ifany . Propert y DD : • Pi-openy^llia ^ \'2

_1 ^ S 1 4 K . <S V 

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agre e restoratio n i s completed , a>;ccpl : aa , note d dbnve . I I I d o no t agre e restoratio n i s complete dt: - 

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_^ ^ Pruden t Technologies , Inc . (Prudent ) i s unde r contrac t withth e U . S . Environmenta ] Protectio n Agenc y (EPA ) t o clea n u p lead I * ' , ccptaminale dsoil s a t anumb ^ p f propertie s locate di n Omaha , Nebraska , includin g th e propert y locate da t h^

f C f n \ i \^KS^^ ^ \\S r ' Tli e EP A request s you r permis.slo n t o allo w Pruden t t o performasoi l cleanu p at thi s '• . 7 ' property t o remov e lead-contaminate dsoil . B y signingthi s form , thepropert y owne r grant s permissio n t o Pruden t t o perfor m lu ^ jL ' activitie s relate dt o th e cleanu p incliidin g soi l sampling , remova l o f 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 sout hoffic e .fo r th e Omah aLea d Site cleanup-a t (402 ) 733-1188 . Genera l question s aboAnh e Omali aLea dSit e cleanu p ca n b e directe dt o th e EP A Publi c Infomiatio n Center s a t (402 ) 73 1 -304 5 (SouthOmali aofBce ) or>lflJ)99T=9J8 3 (Nort hOmah aoffice) . Propert y Acces s Grante dB ; Propert y Owne r Signature : "7^ - ^ ^ ' (Signature ) ^ ^ / (Dkte ) PROPERT Y INFORMATIO N (T o b e complete db y residen t and/o r propert y owne r —pleas e print ) RESIDEN TNAME : Owne rRente r RESIDEN TADDRESS:)?-^ ^ i S | U ^ t r 

### -A-N-s«aJ> > iXfiV . 

# ro-g r£3 8 jo g I F RENTAL , PROPERT YOWNE D BY : ^ OWNER' S MAILIN G ADDRESS ; 

# K>^aJl ^

M c(^<2 iD- r OWNER' S TELEPHON E NUMBE R - HOME : _ L WORK : AG E O F HOME? : i Q YEARS . HO W LON G HAV E YO U tHVE»HERE ? HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978 ? N O NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : cJ I 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 S HOUR S O R MOR E PE R WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. ]

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS ; Th e activitie s t o b e implemente db y EP A 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 rigjit ofacces s t o th e propert y i s provide dfo r i n Sectio n 104(e)o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entr y fo r "determinin g th e nee dfor response , o r choosin g o r takin g an y respons e aclio n unde r tlii s title , o r otherwis e enforcin g th e provision s ofth e title. " 808 0 War d Parkway , Suit e 40 5 S8G 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 68107 ' Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402 ) 733-118 8 Phone : (210)822-968 8 Fax : (816 ) 363-370 7 Fax : (402 ) 733-188 3 Fax : (210 ) 579-667 7ENVIRONMENTA L« CONSTRUCTIO N 

## TECHNOLOGIES , S£RVICE. S 

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# o\ h ^:g^l^ ^ pgMf, ^ vtP^ V f^FKlrrMa i -TA I \/AlIi./^ Pruden t Employi Signature : v^ 8080 War d Parkway , Suit e 40S Kansa s CHy , M O «411 4 Phone : (816 ) 363-370 3 560 0 S 1 0 S t Omaha , Nebraska 6810 7 Phone : (402 ) 733-118 8 Ilea l Drive , SuK a 425 0 Sa n Antonio , T X 7822 0 Phone : (210)822-958 8

# '""1 1 2069: 3 Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e Q Good 

### Sit e Sketc h • Poo r Samplin g Address : 123 5 S 1 4 S T g^o t pain t Sampl e Numbe r RYASCPXA-2069 3 F l Lea d Concentratio n pp m Sampl e Collecte d LA B 

## D Sample s Collecte d 

### Firm ; FPf ^ D^//^ ^ Date: (^//^//) ^ RYBSCPXA-2069 3 F2 

## .liL L pp m 

## D Time ; (/. ' i^ S ^ h o RYGGCnX A2060 3 &4 ~ 

### nYDScnx; ^ 20603—&9 ­ _Z 

### J I PPn ^ 

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## D D D D Sample s Analyze d 

### nDZSCP)(A'20003 B2 - J Z pp m 

## D D XR F Unit ; /Qga>2 ­ Book : L^j p 

### ^GZ£G^X; ^ 20603—s ^ nnzsopx A20603—P2 - H Z pp m

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## D D D D Dat e Tim e "?'Og-Q ^ 

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# ^ o Staf f 

### MSVx T Legend ; F l = Fron t Left , F 2 = Fron t Right , B l = 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 e street , facin g propert y 

# ENTERE D iU N 2 9 200 9

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## Pag e 1 of 2

" > Creat e Anothe rTicke t Bac k t o irt h Internet Sen d Emai l 

## YOURTICKE T NUMBERI S 2651917 . Origina l Cal l Date : 12/03/1 0 Wor k t o Begi n Date : 12/07/1 0 Time : 10:4 0 a m Time : 11:1 5 a m Op : SIVA1896 7 State : N E Address : 123 5 County : DOUGLA S Street : S 14T H S T Place : OMAH A Twp : Twp : 15 NRng : 13 E Rng : Sect-Qtr : 27-N E 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 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 : NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N ATTNEBR l CXCAT V LEVEL 3 MCINE B MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F QWESTN E

Servic e Are a Contac t Phon e Nunibe r Utilit y Typ e ATTNEBR l ATT/ T 

### Day : 8002413624 9 Alt : Emerg : 8002413624 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I 

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

### Day : 877366834 4 Alt : 

## Emerg : 877366834 4 MCINE B MC I N O CAL LPE R MEMO 

### Day : Alt : 800289342 7 

## Emerg : 8002893427 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 12/3/201 0

## Pag e 2 of 2

MUD0 2

OMAHACO F

OPPDGPR 6 QLNN E1 F QWESTN E METROPOLITA N UTILITIE S DISTRIC T CIT Y O FOMAHA TRAFFIC.SEWE R OMAH A PUBLI C POWE R DISTRIC T QWES T LOCALNETWOR K QWES T LON GDISTANC E SAND Y

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### Day : 402504782 3 Alt : Emerg : 402504797 0 Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 800283423 7 Alt : 

## Emerg : 800283423 7

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 12/3/201 0

### CONSTRUCTIO N 

## soLirncKif s SIT E SA^T Y HAZAR D ANALYSI S Address : /^? ^ ^ i f ^ Excavatio n Date : Crew : Backfi U Date : —
Ite m Overhea dLine s Ga s Lin e Wate r Lin e Sewe r Lin e Septic/Leec h Fiel d Propane/Bntan e Sidewal k Foundatio n Retainin g Wail s Fence s Tree s Structure s Driveway Sprinkle r Syste m Othe r Cre w Foreman Conditio n c ^ ^ 

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## Site Safet y Office Date :

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BtM * 7250 Sm^MeBlo.'TXTI2 » 

### —irsi.Mmtti i fiOQTIMI M Phone : (210^a2MB n (4«2}7n¥M n Tte : (2ie)«7»4S7 7