## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R 

# SAI D #: cy}ip3S ^ Date: 1 1 ' I O "" ' U Address : /So? 9 -T/or^.nC O P) 0 Remediatio nContractor : Ppf- , rypry f %-r-\ ^ fa/^o qi^<i . )r\ic.i j Year : <^ U I ( j SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S
^ Vide o o f propert y (DVD ) ^ [/

Executiv e Summary aEPA-provide dproperty sketc h aSigne dAcces s Agreemen t for subjec t property D Signe dAcces s Agreement(s ) for adjacent property ^ 

### Restoratio nAgreemen t D Settlement document s (i.e. , for damag e o r t o replac e plants , etc. ) o

f Confirmatio ndat a aPhotograph s 

# i As-buil t sketc h Satisfactory restoratio nsigne db y Property OAvne r Property close-ou t chec k lis t signe db y EP A D Descriptio no f area s no t meetin g RO D cleanu p criteri a ffl Utility clearance s B Propert y informatio nfromDougla s Coimt y Assessor' s Offic e D D D 

### Signatur e Date 3026074 9 

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### PROPERT Y SUMMAR Y Date : 11/15/201 0 Omah aLea dSit e Remedia l Actioi i Contrac t #EP-R7-07-0 6 TO# l Mont hof : Novembe r Propert y Address ; 152 9 FLORENC EBLV D 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 NSAMPLIN GDATA/RESULTS : B l = 6 4 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 ndigital 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 sketch
i ) Shal l includ e final leadlevel s v ) Legen d ii ) Contaminatio nlef 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 nagreemen t detail s (ifan y ar e mad e wit hth e property owner ) ii ) Property Statu s For msigne db y property owne r iii ) Excavatio ndigital vide o inMPEG , 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 .

TEGHNOLOCIES , INC
.Fin d Record Remediatio n Quer y Lea d Remainin g Quer yPropert yDamag e Quer y 

### Backfill :

Sampl e Area : 2625 9 - 152 9 FLORENC E B D Owner : D Owne rOccupie d Owne rName : ICri YO F OMAH A Owne rAddressi : )C/ 0 PLANNIN G DEP T Ownel - AddressZ : )1819FARNAMST#111 1 City : State : Zi p Code : loMAH A |N E 368183 - Owne rPhon e Alternat e Phone : 

# r

Contract : Contractor : JPRUDENT2010_ S Conti-ac ±Optio n JOPTIO N 1 Use rProvide d Owne rInformatio n Resident : Owne rName : 

## I Owne rAddress : 

# 1 City : 

# 1 Owne rPhone : 

# 1 State : ZipCode : 

# " 1 1

Alternat e Phone : 

# r Residen t Name : 

## j Propert yAddress : !|152 9 FLORENC E B D Zi p Code : 168110 - Residep t Phon e

Assessment : Qualifyin g Grou p MO O Assessmen t Ma xXR F Valu e f 

### 50 3TECHNOIOGIES , INC . 

# aEP A EP A Propert y Clos e Ou t Propert y #:'Z.<^2.^' ^ Propert y Address : ( ^ ^ ^ F'c^^-^^^.ci , Date/Time : Owner' s Name : C ''i-c j «S-OivuaW ^ Quad s Excavated : \^ ( Contracto r Group : Pruden t Technologies , Inc. , Excavatio nGenera l Ye s No 1.

If necessary , vver e th e correc t quadrant(s ) e\cavale dan drestored ? 2.

If necessary , wer e lh e correc t area sof dri p zon e e.xcavate dan drestored ? 

## y Gradin g So dan dVegetatio n Ye s No 1.

Doe s th e gradin g aroun dth e perimete r ofth e hous ein excavate darea s generall y slop e away fro mth e house ? / 2.Ha s so dbee nlai d inal l area s tha t were excavated ? / 3.

Doe s tli e so dappear to be generall y health y an dgrowing ? (Onl y evaluat eif inspecte d at a

30 / da

y tim e period ) / 4.

Are sodde darea s generall y fimi an devenl y graded ? 5.Are di e joint s betwee ntli e so dstrip s generall y tight ? (Onl y evaluat e if

inspecte d at a

30 da y / tim e period ) 6. Wa s th e property grade dsuc htliat wate r wil l no t poo lonth e property ? / 7. Wa s damag e to landscapin g or plan t material s avoided ? / Gates , Fence s an dRetainin g Wall s sNo Ye Ye ^ 1.

Do gate s ope n aii dclos e freely ? (I f apphcable ) 2.Were ai l gale s or fence s take n dow n durin g restoratio nactivitie s reinstalled ? (If applicable ) / Wa s damag eto gate s or fence s avoided ? (Ifapplicable ) / 4.

Wa s dajnag e to retainin g wall s avoided ? (Ifapplicable ) / Foundation , Sidin g an dGutter s Ye s No / 1.Wa s damag e to th e sidin g or tri mavoided ? 2.Wa s damag e to Lh e foundatio navoided ? / ' 3.

Wa s damag e to window s avoided ? / 4. Wa s damag e to windows or doo r screen s avoided ? 

### y .T

. Wa s damag eto downspout s or downispou t extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Ye s No I. Wa s damag e to driveway surface s avoided ? / 2. Wa s damag e to walkway surface s avoided ? 

## y

## Owffier s comments :

Inspectio nnotes :

Remova l andrestoratio nactivate s complet e includin g th e 30-da y so dwajranty : EP A Representativ e _Date : iof.6Ji o - ^ ^BCHNOLUUIES , INC . 

## A S - BUBL T DRAWIN G OL S U 2625 9 Dat e Excavated : 9/22/201 0 

## OMAH A LEAD SUPERFUND SIT E USEP A Signed-Of f Date : 

## 2625 9 Exterio rPain t Nort h Arro w Omah a Lea d Sit e Samplin g Address : 152 9 FLORENC E BD Sit e Sketc h Q Goo d Q Poo r Phone : H : (913)829-992 9 ALT : [^'No t paint Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Firm : Sample s Collecte d A5wV^A < RYASCPXA-2625 9 F 1 pp m 

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### D Date : OT~T> - ^c^" ^ nTDSCPXA-£0£G 9 H=2 ­ pp m 

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# n D Sample s Analyze d f^DgOCPXA-g025 9 pp m 

# n D XR F Unit : &5f Z Book : /6 V •~RI32SCPX?P2e2S 9

nPZCCPX/ V 2625 0 62
- P 2 pp m pp m Numbe ro f Sample s = 

### D D 1 

# n D Date : ^jHfO I Time : Staff : 

## A n f^^ W 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 = Pla y A H quadrant s ar e a s viewe d fro m tii e street , facin g propert y 

# ENTERE D JU L 3 1 200 7

Rev ! Creaie dmj/ZOO ? 08.314 1 miuTRArrit-FP-«7-in-n« ; PRiinFMTTFrHNninfiiF Q iw r

# oERf V Propert yCompletio n Agreemen t Thi s agreement document s th e compietio n o f remova i activitie s performedo n th e belo w liste dproperty . Th e propert y owner' s signature indicate s that th e propert y owne r i s satisfie dwit hth e restoratio n ofth e subjec t property , an dtha t n o item s ar e i nquestion , now , or a

t any time i n th e ftiture, excludin g an y remainin g wanant y (3 0 day s total ) excep t thos e item s liste dbelow , ifany . Property ID : 7i?25 ^ 

### Propert yAddress ; / ^ 2^ ^ f^^^l^^y^ ^ 5 ^ ?Z!Z:ZZ L 

### C^T Yt. F OAA^i A Phone : 

# /y^ ) myzi/ i Restoratio n Item s i n Question :



### Item : / Item : item : Item : Item : Kem : Require d correction s t o complet e th e property :

K l 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 )

J^ner' s Sigliatur e Dat e 'Pruden t Technologies , Inc . (Prudent ) is unde r contrac t withth eU. S. Environmenta l Proiectio nAgenc y (EPA ) to clean up lead
contaminate dsoil s at anumbe r of

propertie s locaie d inOmaha , Nebraska , includin g th e property locaie dat /V' ^ J-IO'-cylC C .. • Tlte EP A request s you r permissio n to allo w Pruden t to performasoi l cleanu pat thi s propen y to remov e lead-conlaminate dsoil . By signin g Ihi s form , th e property owne r grant s permissio n lo Pruden tto perform activitie s relate d to th e cleanu p includin g soi l sampling , remova lof lead-conlaminate dsoil , an drestoratio nofth e reference dproperty . Lf

yo u hav e an y question s abou t th e soi l cleanu p plamie dfor you r propeity , pleas e conta aPruden i southoffic 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 dSil e cleanu p can be direae d lo th e EP A Publi c Informatio n Center s at (402 ) 731-304 5 (Sout hOmah aoffice ) or (402 ) 991-958 3 (NorthOmah aoffice) . Property Acces s Grante dBy : /^l///r^yy i /^i^ly/tiir i leas e Prin t Name ) 

# yyfZyZy. A s-y-^o y Property Owne r Signature : (Date ) y / y \(Signature) '' PROPERT Y INFORMATIO N (T o be coinplete d by residen t and/o r propert y owne r —pleas e print ) RESIDEN TNAME : 

## yZi U U- O/YT^hyi
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# H RESIDEN TADDRESS : , 

## ergjtvc ^ IF RENTAL , PROPERT YOWNE D BY :
OWNER' S MAILIN G ADDRESS ;
OWNER' S TELEPHON E NUMBE R - HOME : J L WORK :
AG E OF HOME? : YEARS
. 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 : NUMBE R OF OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R OF CHILDRE NUNDE 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 , ENTRY GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS ; Th e activitie s to be implemente d by EP A unde r thi s agreemen t are pursuan t to Sectio n10 4 ofCERCLA , 42 U.S.C . 9604 . EPA'srigh t of

acces s to th e properl yis provide dfori nSectio 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 gor takin g an y respons e actio n unde r thi s title , or otherwis e enforcin g th e provision s ofth e litle. " 808 0 War d Parkway
. Suit e 40 6 560 0 S 10 Si 424 2 Medica l Drive , Suit e 425 0 Kansa s City,'M O 6411 4 Omaha
. Nebrask a 6S10 7 Sa n Anionic
. t X 7822 9 Phone : (81S ) 363-370 3 Phone : (402 ) 733-118 8 Phone : (210 ) 822-958 8 Fax : (816)363-370 7 Fax : (402 ) 733-138 3 Fax : (210)579-657 7ENV{ROi>f!VIELVTAL< S CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE. S 

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### Propert y Owne r Pruden t Employe e / Signature : Signature : / 808 D War d Parkway , Suit e 40 5 560 0 S 1 0 S t nedica l Drive , Suit e 425 0 KansasCity , M O 6411 4 Onnaha , Nebrask a 6310 7 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 c^« . 'o^c » ne n OTA ? PhorJe : (402)733-118 8 r:..v . /4f%--i \ 7-^ n 4oo n Phone : (210)822-958 8

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## YOURTICKE T NUMBE RI S 2592086 . Origina l Cal l Date : Wor k t o Begi n Date. : 9/14/1 0 9/16/1 0 Time : Time : 5:2 7 6:0 0 pm pm Op : SIVA1896 7 State : N E Adciress : 152 9 County : Street : DOUGLA S FLORENC E BLV D Place : OMAH A Twp : 15 NRng- : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 15-NW Sect-Qtr : 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 : N Involve s Tunnelin g o r Horizonta l Borin g : N Front : Y Explosives : N Rear : CXCAT V LEVEL 3 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
LEVEL S LEVEL S COMMUNICATIONS , LL C N A Day : 877366834 4 Alt : Emerg : 877366834 4
IVfUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y Day : 402504782 3 Alt : Emerg : 402504797 0
OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R RICH/TRAFFI C Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day ; 406728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/14/201 0

### Pag e 2 of 2

0PPDGPR5 OMAH A PUBLI C POWE RDISTRIC T EL M LOCATIN G Alt : 406207149 4 Emerg : 888728934 3 QLNNEIC QWES T LOCA LNETWOR K

EL M LOCATIN G Day :

Alt : 406728934 3 406207149 4 Emerg : 888728934 3

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

### ENVIRONMENTA L ENGINEERIN GAN D CONSTRUCTIO N SOLUTION S TEPHHOUMWES , mc . 

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Sit e Safety Offic e Date :

888 0 «IEatf«aitany,Sut B 40 5 SGfMSIOS t 424 2 Medica rDrive , StiSt e 725 0 Kaisa5Glly.eiO:«411 4 dHasfcafiStO T Sa n Antonio , T X 7822 9 PtMiie : (8tfi)36S470 3 Ptane : (402)733-118 8 Phone : (2t0 ) 822-i958 8 Fax : {816 ) 363-370 7 Fax : (4(02)733^188 3 Fax : (210 ) 579-657 7

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