### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAIDft : 2069 5 DATE : 1/1 5 ADDRESS : 123 5 1/ 2 S 1 4 S T REMEDIATIO N CONTRACTOR : PRUDEN TTECHNOLOGIES . INC . YEAR : 20l( ) 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S m PR E AN D POS TVIDE O O F PORPERT Y(DVD ) fVl)J[-i ' ^ ^ C^ fe€'\»Ofro . Il l EXECUTIV E SUMMAR Y

• EPA-PROVIDE D PROPERT YSKETC H I D SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT{S ) FOR ADJACEN TPROPERT Y I D RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R T O REPLACE PLANTS , ETC. )

• CONFIRMATIO N DAT A m PHOTOGRAPH S

• AS-BUIL TSKETC H C D SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R m PROPERT YCLOSE-OU TCHEC KLIS 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

• PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR' S OFFIC E D D D ,\,<^^ 

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SIGNATUR E DAT E 1858 6 

# n i lli i erfun d Su p

### PROPERT Y SUMMAR Y Date : /15/201 0 Omah aLea dSit e Remedia l Actio nContrac t #EP-R7-07-0 6 TO# l Montl i of : Propert y Address : 123 5 V i S 1 4 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 NSAMPLIN GDATA/RESULTS : F 2 = 32 1 PP M @ 6" ; E A = 20 1 PP M @ SCRAP E(~1" ) ATTACHMENT S 1 ) Property sketc hprovide db y EP A pursuan t t o contrac t speciflcation s 2 ) Signe dAcces s Agreemen t includin g acces s agreement s require dfor crossin g othe r propertie s 3 ) Pre-Excavatio ndigita 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-Built sketc h­ i ) Shal l includ e final lea dlevel 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 dinth e individual property file , i f available , o r obtaine dinclude : i ) Pre-excavatio nagreemen t detail s (i f an y ar e mad e withth e property owner ) ii ) Property Statu s Formsigne db y property owne r iii ) Excavatio ndigita l vide o i nMPEG , 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 .Fin d Record Remediatio n Queryj Lea d Remainin g QueryI Propert yDamag e Quer y 

### Backfill :

Sampl e Area : 2069 5 ­ 123 5 1/ 2 S 1 4 S T Owner : Use rProvide d Owne rInformatio n Resident : n CXvnerOrniple d Owne rName : IHRDLICK AMITCHEL L Owne rAddressl : 

# 1 Owne rAddress2 : 112564 WIR TQ R City : lOMAH A Owne rPhon e )(402 ) 346-352 2 State : Zi p Code : |N E J68164 - Alternat e Phone : 1(402 ) 431-907 4 Owne rName : 

# 1 Owne rAddress : 

# 1 City : 

# 1 Owne rPhone : 

# 1 " State : Zi p Code : 

# 1 1 Alternat e Phone : 

# 1 Residen t Name : 

# I Propert yAddress : 11235 1/ 2 S 1 4 S T Zi p Code : J68108 - Residen t Phon e

Contract : Assessment : Contractor : |PRUDENT2010_S Qualifyin g Grou p |40 0 Contrac t Optio n joPTTO N 1 Assessmen t Ma xXR F Valu e j 

### 51 5TECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y # : 7- 6 6?*^ ^ Propert y Address : (23 5 ^ ^ 5 . '^Sf : Date/Time : Owner' s Name : ^A,r«-£W v Hr-Al(~ct<\ Quad s Excavated : pT - Contracto r Group : Pruden t Tedhnologics , Inc. . Excavatio nGenera ) Ye s N o 1 .If necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 

# y 2 .If necessiuy , wer e th e correc t area s o f dri p zon e excavate dan drestored ? / Gradin g So dan dVegetatio nYe s N o 1 .Doe s th e gradin g aroun dth e perimete r of th e hous e i nexcavate darea s generall y slop e awa y / fro mth e liouse' / 2 .Ha s so dbee n lai din al l area s tha t wer e excavated ? / 3 .

Doe s (he so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da l a3 0 da

y lim e period ) / 4Ar e sodde darea s generall y fm nan devenl y graded ? / 5 .Ar c th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e if inspecte da l a3 0 da y (un e penod ) / 0 .Wa s th e property grade dsuc htliat wate r wil l no t poo l o ntli e property' ? / 7 .

Wa s damag e t o landscapin g o r plan t material s avoided ? / Gates , Fence s an dRetainin g Wall s Ye s N o 1 . D o gate s ope nan dclos e freely ? (Ifapplicable ) i / 2 .Wer e al l gate s o r fence s take ndow ndurin g restoratio nactivitie s remstalled ? (I f applicable ) / 3 Wa s damag e t o gate s o r fence s avoided ? (If applicable ) 

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

# y Foundation , Sidin g an dGutter sYe s N o 1 . Wa s damag e t o th e sidin g o r tri mavoided ? / 2 .Wa s damag e t o th e foundatio navoided ? 

# y / 3 . Wa s damag e t o window s avoided ? 4 Wa s damag e t o window s o r doo r screen s avoided ? / 5 .

Wa s damag e t o downspout s o r downspou t extension s avoided ? / Sidewalk s an dPriveway s (Concrete ) Yes , No t W;i s daiiias e l o diivcwa v surface s avoided' ? 

# -7 Wa s damag e l o walkwa y surface s avoided ?

## Owner s comments :

Inspectio nnotes : 

# y y '

Remova l an drestoratio nactivate s complete includin g th e 30-da y so dwarranty : EP A Representativ e iX ^ y ^ ^Date: ]\\i\H

### 2069 5 KOTNOI.OCMKS . INC . 

### A S - BUIL T DRAWIN G OL S t f 2069 S Dat e Lxcavared : 11/10/201 0 

### OMAH A LEA D SUPERFUN D SIT E rSEP A Signed-OffDate :

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## n XR F Unit : (oSH Q Bool e XD2 nogccpx/ i Doeo s - S 2 pp m D 

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## n Tim e 

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CONTRAC T# : EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC . 

# c

# »EF A Propert yCompletio n Agreemen t Thi s agreemen t documents th e completio n o f removal activitie s performe do nth e belo w liste dproperty . Th e property owner' s signatur e indicate s tha t th e property owne r i s satisfie dwithth e restoratio no f th e subjec t property , an dtha t n o item s ar e in question , now , o r at an y tim e inth e future , excludin g an y remainin g warranty (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y ID : 

### Propert y Address : I . 7 ' 3 " 

# •i f,.- . 1 4 ^ S V Owner : UlVcX v 

# kVr'X^''-^^ - Phone : 

### Restoratio n Item s i n Question :

item : Item : Item : Item : item : Item :

^1 1 agre e restoratio n i s completed . L H I d o no t agre e restoratio n i s complete d a t (note d deficiencie s above )

Owner' s Signatur e Dat ePruden t Technologies , Inc . (Prudent )is unde r contrac t wit hth eU. S. Environmenta l Protectio nAgenc y (EPA ) to clean up lead contaminate dsoil s at anumbero f propertie s locate d in Omaha , Nebraska , includin g th e property locate dat l/-? ^ Vz - .S I ^ - ^ l . Th e EPA request s you r permissio n to allo w Pruden tto perfor masoi l cleanu p at thi s propertyto remov e lead-contaminate dsoil . By signin g thi s form , th e property owne r grant s permissio n to Pruden t to perfor m activitie s relate d to th e cleanu p includin g soi l sampling , removal of lead-contaminate dsoil , an drestoratio nofth e reference dproperty . If

yo u hav e any question s abou t th e soi l cleanu p plaime dfo r you r property , pleas e contac t Pruden t southoffic e .fo r th e Omah aLead Sit e cleanup-a t (402 ) 733-1188 . General question s abou t th e Omah aLea dSit e cleanu p ca n be directe dto 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 d 

# BV . Mi4<LUUfcAl;cti q (Pleas e Prin t Name ) Property Owne r Signature : 

### >//^^^' ' (Date ) PROPERTYINFORMATIO N (T o be complete d byresiden t and/o rpropert yowne r- pleas e print ) RESIDEN TNAME : Owne r Rente r 

# I ESIDEN TADDRESS : IF RENTi^ , PROPERTYOWNE D BY ; ;tN i AL , KKUKSK ryuwNb u BY : J OWNER' S MAILIN I G GADDRESS

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# W.HZb9D> { OWNER' S TELEPHON E NUMBE R - HOME : J . WORK : 

### J 1 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 CHILDREN 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 : COMMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s to be implemente d by EPA unde r thi s agreemen t ar e pursuan tto Sectio n10 4 of CERCLA , 42 U.S.C . 9604 . EPA' s rightof acces s to th e propertyis provide dfor inSectio n104(e ) of CERCLA , 42 U.S . C 9605(e) , whic hprovide s entry for "determinin g th e nee dfo r 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 of th e title. " 808 0 Wan l Parkway , Suit e 40 5 560 0 S 10 St 424 2 Medica l Drive , Suit e 425 0 Kansa s City , MO 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 ) 579-657 7ENVrRONMENTA L& CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m. Address : 12- 3 3 Vz . S 04-S hDate : i///>/'^' ^ Phone : BVID : 

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### Piniden t Employe e 808 0 War d Parkway , Suit e 40 5 560 0 S 1 0 S t 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)822-968 8 C-.U . lttAC \ '>C » 'STA T C v lOII We7«JS<!7 7

## 2069 5 Exterio rPain t Nort h Arrow 

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### ENVIRONMENTAL ENGINEERIN GAN D CONSTRUCTIO N SOLUTION S 

## SIT ESAFfcT Y HAZAR D ANALYSI S Address : 

# .A^SLS ^ Excavatio n DaterA-*— ' Crew : .-^-^^i:^::: ! Backfil l Date : -/--^—^ ~ ^

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560 0 8108 1 424 2 Medica l Drive , Suit e 725 0 Kansa s GMy . M O 6411 4 Omaba , Mefaraafca 6810 7 Sa n Antonio , T X 7822 9 Phone : («t6 ) 363*370 3 Ptione : (402)733-116 8 Phone : (210)822^^958 8 Fax : ^t« ) 363^0 7 Fax : (402)733'1«8 3 Fax : (210 ) 5T9-657 7 SOSOWfanfBartonqr . Suit e 40 5^