## TRANSMITTA Lof OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R /* ^ 

## sAn)# : l^l^'5 D Date : ^ ^ 

# ^ f / r Address : ?>^S ^ ^A/)^^/ ! ^ ^ Remediatioii Contractor : Hu;ia^ f lee M - ^TH t • . Year : 2X30 ^ SOBLREMEDL^TIO N PROPERT Y FIL E FOLDE RDOCUMENT S Vide o of propert y (DVD ) 

# y Executiv e Siimmar y EPA-providedpropert y sketch SignedAcces s Agreemen t fo r

subject propert y D 

## SignedAcces s Agreement(s ) fo r

adjacen t propert y 

# y Restoratio n Agreemen t D 

## Settlemen t documents (i.e. , fo r

damag e or t o replac e plants , etc. ) Confirmation data Photograph s 

# y As-built sketch Satisfector y restoratio n signedb y Propert y Owne r 

# y Propert y close-out chec k

lis t signedby EP A D 

## Descriptio n o f area s no t meeting RO D cleanu p criteri a Utilit y clearance s 

# y Propert y infonnatio n fi-omDougla s Count y Assessor' s Of&c e D D D ISignatUTO^ " • ^ ^ 

### 3005421 4 

# • m Superfun dRn d Record Remedlatjo n Quer yj Lea d Remainin g QueryI Propeit yDamag e Query 

### Backfill :

Sampl e Area : 1345 0 - 363 9 HASCAL L ST Owner : D Owne rOccupie d Owne rNanie : |MORRTS.SE Y BARNEY A Owne rAddressl : Owne rAddressZ : |363 9 HASCAL L ST City : State : Zi p Code : [OMAH A |N E |6810 5 Owne rPhone : Altemat e Phone : j(402 ) 553-458 1 | Resident : Residen t Name : 

# 1 Propert yAddress : [363 9 HASCAL L s r Zi p Code : |6810 5 Residen t Phon e 

# 1 Contract : Contractor : |PRUDENT2009_S Contrac t Optio n [BAS E Assessment : Qualifyin g Grou p (PRIORTT Y Assessmen t Ma xXR F Value : 

### 1 64 1

### mOPEKT Y SUMNIAR Y Date : 9/15/200 9 Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l Month of : Augus t Propert y Address : 363 9 HASCALLS 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 G DATA/RESULTS : F l = 9 9 PP M @ , 10" ; B 2 = 38 9 PP M @ , 6" ; P A = 23 2 PP M @ 6 " ; D Z = 1042 PP M @ 13" ; E A = 147 PP M @ SCRAPE (~1 ) ATTACHMENT S 1 ) Propert y sketc h providedb y EP A pursuan t to contract specification s 2 ) SignedAcces s Agreemen t including acces s agreement s requiredfo r crossing othe r propertie s 3 ) Pre-Excavation digita l vide o clip/photograph s 4 ) Post-Excavation digita l vide o clip/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Built sketch ­ i ) Shal l includ e fina l 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 nth e individiia l propert y file , if available , or obtainedinclude : i ) Pre-excavation agreemen t detail s (i f an y ar e mad e wit h th e propert y owner ) ii ) Propert y Statu s For msignedby propert y owne r iii ) Excavation digita l vide o i n MPEG , WM V (Window s Medi aVideo ) or SW F(Flas h Player ) forma t and/or photograph s iv ) Signedfor mverifying satisfactor y restoratio n v ) Description of area s not meeting InterimRO D cleanu p criteria .

TECHNOLOGIES , INC .

### TIBCHNOLOGIES.INC . 

# EPA EP A Propert y Clos e Ou t Propert y # : \'^^S O Propert y Address : 3 fc?^ M«-S<ra U "^> . Date/Time : S-i'-oC f Owner' s Name : ^CVITCV A 

### KorrCStf'c ^ Quad s Excavated : F / , C?Z ; PZ , B ' 2
- Contracto r Grou p Pniden t Technologie s Excavatio n Genera l Ye s N o 1 .

If necessary , wer e th e correct quadrant(s ) excavatedan drestored ? / 

### 2 .

If necessary , wer e th e correct area s o f dri p zone excavatedan drestored ? ^ 

### Gradin g Sodan dVegetatio n Ye s No 1 .

Doe s the gradin g aroundth e perimete r ofth e hous e in excavatedarea s generally slop e awa y fromthe house ? / 

### 2 .

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

### 3 ! Doe s the sodappea r t o b e generally health y an dgrowing ? (Qnl y evaluat e if inspecte da t a3 0 da

y tim e period) i / 

### 4 .

Ar e sodde darea s generally fir man devenl y graded ? / 

### 5 .Ar e th e joint s betwee n th e sodstrip s generall y tight ? (Onl y evaluat e if inspecte da t a3 0 da y tim e period) / 

### 6 . • Was the propert y graded-suc h tha t wate r wil l not pool o n th e property ? ' / 

### 7 .

Was damag e t o landscaping or plan t material s avoided ? c / 

### Gates , Fence s an dRetainin g WaO s Ye s N o 1 .

D o gate s ope n an dclos e freely? (If applicable ) / 

### 2 .

Wer e all gate s o r fence s taken down during restoratio n activitie s reinstalled ? (If applicable ) / 

### 3 . Was damage to gate s or fence s avoided ? (If applicable ) 

# y 4 . Was damag e t o retaining wall s avoided ? (If applicable ) 

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

Was damag e t o th e siding o r trimavoided ? / 

### 2 .

Was damag e t o the foundation avoided ? / 

### 3 .

Was damag e t o window s avoided ? / 

### 4 .

Was damag e to window s o r doo r 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 t o drivewa y surface s avoided ? / 

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

# 0^3 ^ fecali ^t - Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complet e includin g th e 30-da y so dwarranty : EP A Representativ e f^yd y Date : S/n/o j ^

# E P A Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n o f removal activitie s performe do n th e belo w liste dproperty . Th e property owner' s signatur e indicate s tha t th e property owner i s satisfie dwithth 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 an y remainin g warrant y (3 0 day s total ) excep t thos e item s Uste dbelow , i f any . Propert y ID : Propert y Address : 3^3 ^ \-U/ ^ r « i f 'S ; Owner : Phone : O j <-jo2 _ 

## • ^ M'''/.'^ - 

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- 

# ^^^ 3 Restoratio n Item s i n Question :

Item : Item : Item : Item : Hem : Hem : Require d correction s t o complet e th e property :

^

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 )



## ^/3( 0 

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### "^'^-^^y p Owner^sSi^wur e DatePniden t Technologies , Inc . (Prudent ) i s unde r contrac t wit h th e U . S . Environmenta l Protectio n Agenc y (EPA ) t o clea n u p lead
contaminate dsoil s a t anumbe r ofpropertie s locate di n Omaha , Nebraska , includin g th e propert y locate da t

. Th e EP A request s you r pennissio n t o allo w Pruden t t o performasoi l cleanu p a t thi s property t o remov e lead-contaminate dsoil . B y signin g thi s form , tiie propeit y owne r giant s pennissio n t o Pruden t t o perform activitie s relate dt o th e cleanu p includin g soi l sampling , remova l o f lead-contaminate dsoil , an drestoratio n ofth e reference dproperty . I f

yo u hav e an y question s abou t th e soi l cleanu p planne dfor you r property , pleas e contac t Prudent' s Administrativ e Cler k fo r th e Omah aLea dSit e cleanup . Ms . Siv aS . .lampana-a t (402 ) 733-1188 . Genera l question s abou t th e Omah aLea dSit e cleanu p ca n b e directe dt o th e EP A Publi c Informatio n Center s a t (402 ) 731-304 5 (South Omah aoffice ) o r (402 ) 991-958 3 (Nort h Omah aoffice) . Property Acces s Grante dB y (Pleas e Prin t Njille ) Property Owne r Signature : 

## ^ is^b ^ 

## J y (Date ) PROPERT Y INFORMATIO N (T o b e complete db y residtm t and/o r propert y owne r —p i RESIDEN T NAME : Rente r RESIDEN T ADDRESS : 

## ^ v ^ ^ g 1 6 ^ I F RENTAL , PROPERT Y OWNE D BY :
OWNER' S MAILIN G ADDRESS ;
OWNER' S TELEPHON E NUMBE R - HOME : _L WORK :
AO E O F HOME? : ^ ^ YEARS . HO W LON G HAV E YO U LIVE D HERE ? 1 YEARS . HA S TH E EXTERIO R BEE NPAINTE D O R COVERE D WTT H SIDIN O SINCE 1978 ? . 

### _-^«e - -N& > ^ ^ 

## (L a NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : L x 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 . DOOS , ENTR Y OATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA L RESPONS E ACTIONS : 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 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s rigli t ofacces s t o th e propert y i s provide dfor i n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(6) , \^ch provide s entry fo r "determinin g th e nee dfor response , o r choosin g o r takin g an y respons e actio n unde r this title , o r otherwis e enforcin g th e provision s ofth e title. "

8080 Ward Parkway , Suit e 405 250 5 N . 24* " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 KansasCity , MO6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816) 363-370 7 Fax : (402)504-100 5 Fa v f9in \R7QJiR7 7ENVERON.MEMA L CONSTRUCn O 

### TECHNOLOGIES , mc . SERVi a 

# Propert y Statu s For m Address : '3>Q>'2> ^ Uot/ac^Jl L *i ^ Date : Phone : VAOJ L

### ^ 1> M 

### S - 'SC''' 3 BVID : Plant s & Permanen t Landscapin g T o Remai n I n Plac e Descriptio n & Locatio n ]^,^^^ ^ rseea ^ ^ ^ ^^ o . ^ . 

## A\ l ^os e

Pre-Existin g Conditio n o f Structure s Doe s you r Basemen t hav e ahistor y o f leaking ? Ye s N o V ^ Ite mN O O n Ma p Descriptio n & Locatio n 

## Qjr^uJk ^ -3 ^

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Propert y Owne r Pruden t Emp l ignature : Signature : 

# y ^ .

808 0 War d Parkway , Suit s 40 5 250 5 N . 24* " Street . Suit e 30 8 424 2 Medica l Drive , Suit s 425C Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX7822 S Phnnn - fA02 ) 504.100 4 Phona : (210)822-9S8 S3IES , INC . OLS#:134S 0 Dat e Excavated : 07/22/200 9 USEP A Signed-OfTDate : 

## 1345 0 Exterio rPain t Nort h Arrow Omah a Lea d Sit e • Goo d Sit e Sketc h Q^Poo r aWHl^nri'O ' AddWas : 383 9 M/tSCAL L S T Q ' No t pain t Sampl e Numtie r Les d Sampl e LA B Sample s Collecte d Concentratio n Collecte d Fir m RYASCPXA-1345 0 F l pp m 

### D Dat e lO-M-d g RYBSCPXA-1345 0 F 2 

## 3g g pp m Tim e Qi'.to i <ki»«. . RYCSCPXA-1345 0 B l pp m Sample s Analyze d RYDSCPXA-134S a B 2 pp m 

### D ROZSCPXA-1345 0 D Z pp m 

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# i n XR F Unit : tfSH n Book : 22. 0 • RC26CPX A1348 0 6Z - pp m 

### D Date : IIPIO Q

BZ6CPX A m w RZ - 

# Too ' pp m 

### D Time : Qt a • / ^ 

### D staff ; cast i Numbe ro f Sample s " [ ( j • [ [ ( ^ [ Legend : F l = Fren t Left , F 2 = Fron t Right , B l - Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , O Z = Garden , P Z = Pla ; A H quaayi s ar o t » vlww d Trat i Bie tlreat , taeh g propert yAllg V

Revs TM Crood . lA-SepJ H E A = 14 7 PP M @ SCRAP E (~1" )
CONTRAC T # : E P - R7-07-0 6 T0# 1 PRUDENTTECHNOLOGIES , INC .

## 1345 0 fcrtorisrPan t 'irrt ' An w 

### Omah a Lea d Sit » • Ooor J ^ 5 5 • H S S I 

### Sit s Skatc h Ssmplin o Addrgss : >3:-i 9 HASCA^ L & T Q N= t P*.T t 

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# I U 8 Cc-ncpnlralto i Contacte d Fim i RYASCPXA-1345 0 F l V^ V POT . 

## D Date 

### 10-a « -0 * RYBSCPXA-f34 M r 2 

## D Tim e ^xWtfi ^.-t^ . RYCSCPXA-134S D 8 1 

## D Ssinpie s Analyze d RYDSCPXA-1345 0 B 2 

## D ROZSC^X;i-»345 0 OZ ^ <9<i ? nty p 

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### Staif : nSL ^ Nu n so ro t S a mpiG s = I fcLo J Legeni l F l -^ F/oii l Left r 2 - Fiw l Righ t B l " Cac\ Lefl . B P - Qdc k R'^ t D Z = On p Zone , C Z = Garden , ^ Z = Pla * M ^.aHmt i jr n m >««<« ! lio n in * iS\4af. *Aa m t*f^M^ t A l i r ? ^ ^-——V-'"—,• • • y1 * V • • ~-"^ T • 6«-'ne ^ AMo*.n«« ^ 

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## Dougla s County-Omaha , N E

Parce l I D Owne r Nam e Propert y Addres s Cit y Zi p Owne r Addres s Owne r Addres s 2 Owne rCit y Owne r Stat e Owne rZi p 173897000 0 MORRISSE Y BARNE Y A 363 9 HASCAL L S T OMAH A 6810 5
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http://webapps.dotcomm.org:8080/TreasTax/faces/page s /tax i nfo.jsp?parc=173897000 0 http://douglasne.mapping-online.com/DouglasCoNe/stati c /accountinfo.jsp?accountno=R173897000 0 Disclaimer : Ma p an d parce l dat a ar e believe d t o b e accurate , bu t accurac yi s no t Ma p Scal e guaranteed . Thi s i s not a lega l documen t an d shoul d not b e substitute d fo ra titl e search , 1 inc h = 4 0 fee t

## Page l of l

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YOU RTICKE T NUMBE RI S 2318809 . Origina l Cal l Date : 7/15/0 9 Time : 6:1 0 p m Op : SIVA1896 7 Wor k t o Begi n Date : 7/20/0 9 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 363 9 Street : HASCAL L S T Twp : 15 NRng : 13 E Sect-Qtr : 32-NE,33-N W 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 PROPERTY Remarks : FA X AL L CLEAR S TO : (402)733-188 3 : FA X AL L CLEAR S T O (402 ) 73 3 188 3 : UNSUR E CORNER S Coitipan y: PRUDEN T TECHNOLOGIE S Contac t Name : SIV AJTiMPAM A Phone : (402)733-118 8 Wor k Being Don e For : EP A Dept h o f Excavation : 6 FT Corne r Lot : NFront : Y Rear : Involve s Tunnelin g o r Horizonta l Boring : NExplosives : N CXCAT V

MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F Servic e Are a Contac t Phon e Numbe r Utilit y Typ e Day : 402934046 9 CXCAT V CO X COMMUNICATIONS . IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUD02 METROPOLITA N UTILITIE S DISTRICT SAND Y Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO N Alt : 402444516 1 Emeig : 402444516 0 Day : 406728934 3 0PPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T N A Alt : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 QLNNEI FQWES T LOCA L NETWOR K N A Alt : 406207149 4 Emerg : 888728934 3

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### TECHNOLOdlES , INC . SOLUTION S 

# Sit e Safet yHazar d Analysi s 

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808 0 War d PaMAvay , Suit e 40 5 250 5 N . 24 " Street . Suit e 3G S 424 2 i\;edlca i Drive . Suit e 725G KansasCity . M O 6411--t Omaha , Nebrask a 6811 0 Sa n Anionio . T. X 7822 9 Phone : (816 ) 363-370 3 Phone : (402 ) 504-100 4 Phone : (210 ) 822-958 8 Fax : MQ2 ) 5D4-100 5 Fax ; (210)579-557 7-'* • -r. ,



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