SAID# : 2770 5 

### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R DATE : 1/1 5 ADDRESS : 261 9 BURDETTE S T REMEDIATIO N CONTRAaOR : PRUDEN TTECHNOLOGIES . INC . YEAR : 201(| ) 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S PR E AN D POS TVIDE O O F PORPERT Y(DVD ) W\g3L S IMC , 4W-^o ^

ffe-^^'/j-2. . 

# 6 EXECUTIV E SUMMAR Y EPA-PROVIDE D PROPERT YSKETC H 

# i SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y 

# n SIGNE D ACCES S AGREEMENT{S ) FOR ADJACEN TPROPERT Y RESTORATIO N AGREEMEN T SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R TO REPLAC E PLANTS , ETC. ) CONFIRMATIO N DAT A PHOTOGRAPH S 

# L AS-BUIL TSKETCH SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R 

# b 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 

# h UTILIT YCLEARANCE S 

# L PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E 

### D D D ^\xt\ ^ 

# yv y SIGNATUR E DAT E 

### 3021857 9 

# IIIIIII I Superfun d

### PROPERT Y SUMMAR Y Date : /15/201 0 Omah aLea dSit e Remedia l Actio nContrac t #EP-R7-07-0 6 TO# l Mont hof : Propert y Address : 261 9 BURDETT ES 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 :

B I = 30 8 PP M @ 10" ; E A = 12 0 PP M @ SCRAP E(~1" ) ATTACHMENT S 1 ) Property sketc hprovide db y EP A 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 ndigita l vide o clip/photograph s 4 ) Post-Excavatio ndigita l vide o clip/photograph s 5 ) Documentatio n- Complete dClose-ou t Checklis t 6 ) As-Built sketch
i ) Shal l includ e fina l 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 din th e individua l 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 Formsigne 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 .

TECHNOLOCIES . INC .Fin d Record 

### Backfill :

Sampl e Area : 2770 5 Owner : Remediatio n Quer y Lea d Remainin g Quer yPropert yDamag e Quer y



### ­ 261 9 BURDETT E S T Use rProvide d Owne rInformatio n Resident : n Owne rOccupie d Owne rName : JMOBEC O INDUSTRIE S Owne rAddressl : Owne rAddress2 : 11141 3 HICKOR YRD City : I OMAH A Owne rPhon e 1(402 ) 342-282 0 State : Zi p Code : |N E 168144 - Aiternat e Phone : Owne rName : Owne rAddress :
City : Owne rPhone : State : Zi p Code : Alternat e Phone : Residen t Name : Propert yAddress : 1261 9 BURDETT E S T Zi p Code : 168111 - Residen t Phon e

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 

### 539.3 6TECHNOLOGliS , iNC . 

# EP A Propert y Clos e Ou t Propert y #:'2^770 ^ Propert y Address : 2<^l ^ Bc^y-flAe+i-f " ?f ' Date/Time : Owner' s Name : M^'fc-ac o 31^3^ ' Quad s Excavated : ( h^ Contracto r Group ; Pruden t Technologies , Inc , Excavatio n(Genera l Ye s N o 1 .I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? / 2 .If necessary , 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 fromth e house ? / 2 .Ha s so dbee nlai di nal l area s that wer e excavated ? / ?i. Doe s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e if inspecte da t a3 0 / day tim e period ) 4 .Ar e sodde darea s generall y fir man devenl y graded ? / 5 .Ar c th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte dat a3 0 day tim e period ) / 6 .Wa s th e property grade dsuc htliat wate r wil l no t poo l o nth e property ? / 7 .

Wa s damag e l o landscapin g o r plan t material s avoided ? / Gates , Fence s an dRetainin g Wall sVe s No 1 .

D o gate s ope nan dclos e freely ? (If apphcable ) / 2 .Wer e al l gale s or fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (I f applicable ) / 3 .

Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) 

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

## y Foundation , Sidin g an dGutter s Ye s N o 1 .Wa s damag e t o tli e sidm g o r tri mavoided ? 

## y 2 .Wa s damag e t o th e foimdatio n avoided ? 

## y / 3 .

Wa s damag e l o window s avoided ? 4 .Wa s damag e t o window s o r doo r screen s avoided ? 

# y 5 .

Wa s damag e l o downspout s o r downspou t extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 .

Wa s damag e t o drivewa y surface s avoided' ? 

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

### y

## Owner s comments :

Inspectio nnotes : 

# yy y ^ 

# y y

Remova l andrestoratio nactivate s complete includin g th e 30-da y so dwarranty . EP A Representativ e fl,^3de ^ Date : //yj// /^HNOLOUIES , INC . 

### A S - BUIL T DRAWIN G OL S #2770 5 Dat e Excavated : 10/05/201 0 

### OMAH A LEA D SUPERFUN D SIT E USEP ASigned-Of f Date : 

### 2770 5 Exterio rPain t Noitti Arro w Owne rName : MOBEC O iNDUSfRiE S Omah a Lea d Sit e • Goo d Addres8:26i9BURpETTES TSit e Sketc h • Poo f Phone : » : 402:342:282 0 \W ; 

### f 0 No t paint Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : F m Tf e D B RYASCPXA-2770 5 F l .pp m 

### D Date: ^)Z ^ J^ , RYBSCPXA-2770 5 F 2 pp m 

## I S i D Time : i^iO D fi ^ RYCSCPXA-2770 5 8 1 5AS L pp m 

### D Sample s Analyze d RYDSCPXA-2770 5 B 2 Z(^ '
. pp m 

### D RBiSGPXA-SWO e OZ ­ . pp m 

### D D XR F Unit : ^0 1 Book : JOU> RCiZSGPXV27-76 6 G Z , pp m 

### D D Date : 

### "^-yt'O U pp m 

### D D Time : 

# An . Staff : t^S W Numtje ro f Sample s = [ 4 Legend : F 1 = Fron t Lett , F 2 = Fron t Right , 8 1 = Bac k Left , B2 = Bac k Righ t DZ = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a

s viewe d fro m tn e street , facing propert y •'" : iftVififip^ f : "

• f 

# SHTERB D nmi^'m' ^ 53°l \ZU X B l =30 8 PPM ® 10 " g i 

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# n : I

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A = 12 0 PP M & • SCRAP E(~1" ) CONTRAC T# : EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC .

# ilEP A Propert yCompletio n Agreemen t Thi s agreement document s th e completiono f remova l activitie s performe do n th e belo w liste dproperty . Th e propert y owner' s signatur e indicate s tha t th e propert y owne r i s satisfie dwithth e restoratio n o 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 in th 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 . Property ID : ProptH y Address : at,l<= l 3 , ,rf < PW ^ S(
- Owner ; ^



### Phone : 

# E Restoratio n Item s i n Question :

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

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


# K 

# /xs k Owner' s Signatiire / ^ Dat e I/

Pruden t Tectmologies , Inc . (Prudent ) i s unde r contrac t withth e U . S . Environmenta l Protectio n Agenc y (EPA ) t o clea n u p lead
contaminale dsoil s at anumbe r ofpropertie s locate din Omaha , Nebraska , includin g th e propert y locate dat ^•fo I " RcX r C x e^lA^ C - ^ I Th e EP A request s you r permissio nt 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 , th e property owne r grant s permissio n t o Pruden t t o perfor m 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 yovi r property , pleas e contac t Pruden t sout hoffic e ,fo r th e Omah aLea d Sit e cleanup-a t (402 ) 733-1188 . Genera l question s abou t th e Omah aLea dSit e cleanu p can b e directe dt o th e EP A Publi c Informatio n Center s a t (402 ) 731-304 5 (SouthOmah aofBce ) o r (402 ) 991-958 3 (NorthOmah aoffice) . Property Acces s Grante dBv : B^T ^ AfU > . ^^^^^^/X ^ J ^/^O ^ (Pleas e Prin t Name ) . ^ ^ ^ Q "^^e ^ ii**** — ^ Property Owne r Signatu ^Date ) 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 : Rente r 

# \/(XcAn4
- t o K RESIDEN TADDRESS : 

## ^(h\° { ^orrJpfcg p iS V IFRENTAL , PROPERT YOWtNE D BY : ^ ^ - OWNER' S MAILIN G ADDRESS ; 

## fi^h O^^^UJL ^ »ot : 

# k,t\ ^ OWNER' S 

### TELEPHON E NUMBE R - HOME : [fd ^ , ? j'Z^' ^ ^k^D-/ ^ WORK : J L

L_ 

# ,. . 

# t^j k AG E O F HOME ? YEARS . HO W LON G HAV E YO U LIVE D HERE ? YEARS . HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978 ? _ YE S N O 

# // A NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : 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 YI N TH E YAR D FO R 5 HOUR S O R MOR E PE R WEE K COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. ) 

# Ai/ ^

ALUHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS i 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 n10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s right o f

acces 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(e) , whic hprovide s entry for "detenninin g th e nee dfor response , or choosin g o r takin g an y respons e actio n unde r thi s title , o r otherwis e enforcin g th e provision s ofth e title. " . 808 0 War d Parkway , Suit e 40 5 560 0 S 1 0 S t 424 2 Medica l Drive , Suit e 426 0 Kansa s City,'M O 6411 4 Omaha . Nebrask a 6810 7 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 ^Wione : (402 ) 733-118 8 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)733-188 3 Fax:(210)579-657 7ENV[ROiVMEr<fT.AL & CONSTRLCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : ^^\ ^ ^^^r< { eH e S ^ ^^*^ ' ^l2 ^ / I ' O Phone : Ho2-347^^_^^2 ^ °^^
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Propert y Owne r Pruden t Employ e Signature : Signature : 808 0 War d Parkway , Sui i 560 0 S 1 0 S t 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Phone : (816 ) 363-370 3 

# ^ 9 I ^ f2 ^ Onnaha , Nebrask a 6810 7 Phone : (402)733-118 8 Sa n Antonio , TX 7822 9 Phone : (210)822-958 8 C^v ­ l4A'i \ Tl- ^ .fOO ^I , Owne rName : MOBEC O INDUSTRIE S Omah a Lea d Sit e Address : 261 9 BURDETTE S TSit e Sketc h Phone : »• 402-342-282 0 W: 

### Sampl e Numbe r RYASCPXA-2770 5 RYBSCPXA-2770 5 RYCSCPXA-2770 5 RYDSCPXA-2770 5 RDZCCPX A2770 6 RGZSCPX A2770 6 Lea d Sampl e LA B Concentratio n Collecte d F l pp m 

# D F 2 

# i^ X pp m 

# D B 1 

# .^AB . pp m 

# D 8 2 Zlt.' L pp m 

# D OZ- pp m 

# O D 6 Z pp m 

# O D pp m 

# D D ; Numbe ro fSample s = j M ^ Exterio rPain t 

### • Goo d • Poo r ^

No t pain t 

## 2770 5 Nort h Ano w \ 

### Firm : Sample s Collecte d Fff l P B Of t Date : Time : S)2iUsL z 9<g p fr ^ Sample s Analyze d XR F Unit : <iC> 1 Book : 7oG >

Date : ^ -3t-C> G Time : A/* 1 Staff : A15 W Legend : F 1 = Fron t Lef t 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 Al l quadrant s ar a a s viewe d Anom th e street , facin g propert y 

# ENTERE D Sl'^ i



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# 2619BurdetteS t 30x12 6 

# A Printed : Nov 30 , 201 0 www.dcgis.org/dogi s

### http://www.dhon.org/irthmtemet/DHONNoticeCreation/MessageText.asp?ret=%3CRESU.. . Creat e Anothe rTicke t Bac k t o Irt h Interne t Sen d Emai l



## • YOURTICKE T NUMBERI S  2605472 . Origina l Cal l Date : 9/30/1 0 Time : 12:3 2 p m Op : SIVA1896 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 : OMAHA Address : 261 9 Street : BURDETT E 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 Company: 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 HEIDI Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUDO l METROPOLITA NUTILITIES DISTRICT SAND Y Day : 402504782 3 Alt : 

## Emerg : 402504797 0

lo f 2 9/30/201 0 12:3 2 P M

### http://www.dhon.org/irthmtemet/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 : 4062071494 Emerg : 888728934 3 QLNN E1 C 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 2 P M

### CONSTBUCnO N TEOmf l 

### SOLUTION S



## SIT ESATfcT Y EDVZAR D ANALYSI S



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## Sit e Safet y Offic e Date :

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### seoosios t 424 2 Medica l Drive , Sutt e 726 0 :sMa8Qllr<*K>«*'<1 4 OnUta , NoiMBBk a08107 Sa n V^fltonio . T X 7822 9 lione : (S18 ) ses-afO S PHons : {402)733-11S 8 Phone : (2t0 ) 822458 8 « c(SIC ) 363.^370 7 Fax : f««2 ) 733^08 3 Fax : |210)«7»-«57 7

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