## TRANSMrrtA L o f OMAH A LEA D SIT E son . REMEDUTIO N FIL E FOLDE R 

## SAID# : lA^I' ; I^ ^ l^jl'^o l Address ; __2Si2^_i_l S S L

, ^ g ^ 4^^ , A T^. . Yc« : ^£1 ^ Remediatio n Contractor : SOI L REMEDIATION PROPERTY FIL E EOLBERDOCUMENT S 2

f

Video o f

propert y (DVD ) ^ B

^ Executiv e Summar y 13

^ EPA-provide dpropert y sketc h IET ' Signe dAcces s Agreemen t fo r subjec t propert y D Signe dAcces s Agreement(s ) fo r adja^^n t propert y Qf

^ Restoratio nAgreemen t D Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) a ^ Confiimatio ndat a E

T Photograph s _ . B As-buil t sketc h 0 Satisfector y restoratio nsigne db y Propert y Owne r 0 Propert y close-otr 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 S

l Utilit y dearaxxce s 

## B

^ Propert y informatio n fromDougla s Count y Assessor' s Offic e Q D D 

## Signatur e ^ ^ 3021798 1 

# il l Superfun dFin d Record Remediatio n Query I Lea d Remainin g Query I Propert yDamag e Quer y Backfill :

Sampl e Area : 1641 5 - 251 2 S 2 5 S T Owner : Resident : Contract : D Owme rOccupie d Residen t Name : Contractor : Owne rName : [ANDERSO N PAU L F PRUDENT200 9 S JANDERSO N PAU L F Propert yAddress : Contrac t Optio n Owne rAddressl : J2512S25S T |OPnO N 3 

# I Zi p Code : |6810 5 Owne rAddressZ : Assessment : |251 2 S 2 5 ST Residen t Phon e Qty : State : Zi p Code : Qualifyin g Grou p 

# I jOMAH A [ N E [6810 5 

## po o Owne rPhone : Altemat e Phone : Assessmen t MaxXR F Value : |(402 ) 99 1 613 2 j(402 ) 829-128 7 425.8 1 

# rmWfllHHIMIWSHITillWmMlK y 

### Date : 12/15/200 9 Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l Month of : November Propert y Address : 251 2 S 2 5 S 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 : B l =21 0 PP M @ 8" ; D Z = 37 6 PP M @ 13" ; EA = 11 4 PP M @ SCRAPE (~1 ) ATTACHMENT S 1 ) Propert y sketch provide db y EP A pursuan t t o contrac t specification s 2 ) SignedAcces s Agreemen t including acces s agreement s require dfo 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 ) Shall includ e 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, i f available , o r 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(Flash Player) forma t and/or photograph s iv ) Signedfor mverifying satisfactor y restoratio n v ) Descriptio n o f area s not meeting InterimRO D cleanu p criteria .

INOmCEESjINC .« 'raCHNOLOGIES.INC 

# »EP A EP A Propert y Clos e Ou t Zfii - Propert y# : l(,i^\ S Propert y Address : ;L£/ ^ ^ Date/Time : Owner'sName : g^U- l A^^^^^^' ^ Quad s Excavated : fLl^VZ
- Contracto r Grou p P i iiden t Technologie s Excavatio n General Ye s N o 1 .

I f necessary , wer e th e correct quadrant(s ) excavatedan drestored ? / 2 .

If necessary , wer e th e correct area s of dri p zone excavatedan drestored ? 

### 7 Gradin g Sodan dVegetatio n Ye s N o 1 .

Doe s th e grading aroundth e perimete r ofth e hous e i n excavatedarea s gener^l y slop e awa y fromth e house ? / 2 .Ha s sodbee n laidi n all area s tha t wer e excavated ? 3 .

Doe s th e sodappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f ipspecteda t a3 0 da

y tim e period) / 4 .

Ar e sodde darea s generall y firman devenl y graded ? 5 .Ar e th e joint s betwee n th e sodstrip s generall y tight ? (Onl y evaluat e if inspecjte da t a3 0 da y tim e period) 6 .

Was th e propert y gradedsuc h tha t wate r wil l not pool o n th e property ? 

### y 7 .

Wa s damag e t o landscaping or plan t material s avoided ? 

## 7 Gates , Fence s an dRetainin g Wall s Ye s N o I .

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

# 7 2 .Wer e al l gate s o r fence s taken dow n durin g restoratio n activitie s reinstalled ? (I f applicable ) 

# 7 3 .

Was damage t o gate s or fence s avoided ? (If applicable ) 

# 7 4 .

Was damage t o retaining wall s avoided ? (If applicable ) 

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

Was damage t o th e sidin g or tri mavoided ? 

# 7 2 .

Wa s damag e t o th e foundatio n avoided ? 

### y 3 .

Was damage t o window s avoided ? 

# y 4 .

Was damage to window s o r doo r screen s avoided ? 

# y 5 . Was damag e t o downspout s or downspou t extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Ye s No 1 .

Was damag e t o drivewa y surface s avoided ? 

# y 2 . Was damage t o walkwa y surface s avoided ? 

### y

## Owner s comments :

Inspectio n notes :

vcur H sio c Ol ' rk . R f ^ 

## <x >



# . 0 

# ^rA^\^' ^

Removal an drestoratio n activate s complete includin g th e 30-da y so dwarranty : EPA Representativ e :Qc^A mDate : ^W ^

## Propert y Completio n Agreemen t Thi s agreemen t document s th e completio n o f removal activitie s performe don 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 dwit h th e restoratio n o f th e subjec t property , cui dtha t n o item s ar c i n question , now , o r a t an y tim e in th e fliturc , excludin g an y remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y IB : Propert y Address : ' ^ 5 V 3 ^ r •^5 " f ^ Owner : /^ ^ / >^^^/-^^ ^ Phone : f^Q ^ ^ ^^Cf ) - {p j 33 i Restoratio n item s i n Question :

Item : 

### riAi5fl l S^or J }\eUii\ 4 ^G^dtr^^c^ ^ Item : 

# / ^ <i^dik7'^i > hiBcy< 7 %r > y^yir ^ Le^s>^' ) Item : Item : Item : Item : Require dcorrection s t o complet e th e property :

k S I agre e restoratio n i s completed . 

### I 1 do not agre e restoratio n i s completeda t (noteddeficiencie s above ) 

# y.^7c^^ ^ /^ A 7/. ^ Owner ^ Signatur e Date 

### IPruden t Technologies , Inc . (Pnident ) is unde r contract wit h the U.

S. Environmenta l Protection Agenc y (EPA ) to clea n

up lead
cgntamingtf dsoi] ^ at

anumljp r of propertie s locate d in Omaha, Nebraska , includin g th e propert y locate d at e r a/ fi . .y I ^ D ii r * . Th e EP A requests you r permissio nto allow Pruden t to perfon n asoil cleantq >

at

thi s propert y

to remov e lead-contaminate dsoil . By signin g thi s form, the propert y owne r grant s permission to Pruden t to perfor m activitie s related to th e cleanu p includin g soi l sampling , remova l of

lead-contaminate dsoil , an drestoration ofth e reference dproperty . If

yo

u have an y question s abou t the soi l cleanu p plannedfo r you r property , pleas e contac t Prudent' s Administrative Cler k

fo

r th e Omah aLea dSit e cleanup . Ms . Siv a S. Jampana-a t (402) 733-1188 . Genera l question s abou t the Omah aLea dSit e cleaniq ) ca n be directe d to th e EP A Publi c hiformatio n Centers at (402) 731-304 5 (Sout h Omah aoffice ) or (402 ) 991-958 3 (Nort h Omah aoffice) . 

### RUA I 

## ' f i^darsoir ^ Propert y Acces s Grante dBy : (Pleas e Prin t Name ) Propert y Owne r Signature : X f C^^y [ 4 " (D—^.-y" ^ I / Z L j t> l (Signature) (Date) PROPERT Y INFORMATIO N b complete 1^ residen t and/o r property owner — pleas e print ) (To h e compiete d by reside i RESIOEN T NAME : *7^y?l/ l /"OwneTyRente r RESIDEN T ADDRESS : 

# 35-12 . ?. 25 ^ 5d . IF RENTAL , PROPERT Y OWNE D BY :
OWNER' S MAILIN G ADDRESS ; 

# Sa/h e OWNER' S TELEPHON E NUMBE R 

## -HOME : 1^? , ff/'i'/^ ^

,„„K : /^^ y- <?P'7' - /^^ Z J 1 

# ,: 90 ^ YEARS . HO W LON G HAV E YO U LIVE D HERE ? 

# ^0 AG E OF HOME? : / r/- ^ YEARS . HA S TH E EXTERIO R BEE N PAINTE D OR COVERE D WFT H SIDIN G SINC E 1978 ? V 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 / NUMBER OF CHILDRE N 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. ) 

## 0O O " iTl^ld y
AUTHORIT Y FO RENVIRONMENTA L RESPONSE ACTIONS i Th e activitie s to be implemente d by EP A unde r thi s agreemen t ar

e pursuan t to Sectio n 10 4 of

CERCLA ,42 U.S.C . 9604 . EPA' s righ t ofacces sto th e propert y

is provide dfo r in Sectio n 104(e ) of CERCLA, 42 U.S . C 9605(e) , whic h provide s entr y fo r "determinin g th e needfo r response , or choosin g or

takin g an y respons e action unde r thi s title , or

otherwis e enforcin g the provision s ofth e title. "

808 0 War d Parkway , Suit e 40 5 250 S 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 , TX 7822 S 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 Fax : (210 ) 579-657 7

# tUDEN T ^TECHNOLOGIES , INC . 

# Propert y Statu s For m Address : 96^' ^ ^ - 9^ ^ S h Date : f
- ^^" ^ f Phone : ^0^ " fV'6/3? . BVID : /^^/vT ' Plant s & Permanen t Landscapin g Item# O

n Ma p Descriptio n an dLocatio n 

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Propert y Owne r Pruden t Employe e Signature : yarx^^^^y y CA^—*- — Signature : 808 0 War d Parkway , Suit e 40 5 2S0 5 N . 24" ' Street , Suit e 30 8 424 2 Medica l Drive , Suit e 426 0 Kansa s Cfty , M O 6411 4 Omaha , Nebrask a 6811 0 San Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 1 Phone : (210)822-958 8 iQAe: \ fi^ ^ -ITrt- T^UilNOi.OtilES . INC . A S - BUIL T DRAWIN G <)l.S#:1641 5 Dat e KNcavattd : l(»/13/2tHH ) OMAH A LEA D SUPERFUN D SIT E I SF.P. \,Sign«l-Of r Date :

Name : _ Omah a Lea d Sit e Date : yy2.7.yoi > Nort h Arro w Address : z<r/t . i . ?irt > y . Sit e Sketc h Time ; Phone : 7 / 6 y/- y XR F Cod e 

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### http://vvww.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 9/17/200 9

### Page 1 of 2

" > [ Creat e Anothe rTicke t ] [ Bac k t o Irt h Interne t ] Sen d Emai l



### • YOURTICKE T NUMBERI S 2375354 . Origina l Cal l Date : 9/29/0 9 Time : 2:3 1 p m Op : SIVA1896 7 Wor k t o Begi n Date : 10/01/0 9 Time : 3:0 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 251 2 Street : S 25T H S T Twp : 15 NRng : 13 E Sect-Qtr : 28-SE,33-N E 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 PROPERT Y 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 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 MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F QWESTN E

Servic e Are a Contac t Phon e Numbe r Utilit yTyp e Day : 8002413624 9 ATTNEBR l ATT/ T Alt : Emerg : 8002413624 9 Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 LEVEL S LEVEL S COMMUNICATIONS , LL C N AAlt : Emerg : 877366834 4 

### Day : 402504782 3 MUD0 2 METROPOLITA N UTILITIE S DISTRIC T SAND Y Alt : 

### Emerg : 402504797 0 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 9/29/200 9

### Pag e 2 of 2

OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO N 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 0PPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T N A 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNN E I FQWES T LOCA L NETWOR K N A 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QWESTN E QWES T LON G DISTANC E 

### Day : 800283423 7 Alt : 

### Emerg : 800283423 7

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 9/29/200 9CON.STRUCTiOi V TECHNOLOGIES , IIMC . SOUJTiO^i S 

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808 0 War d ."arkway . Siiit s ^G S ?50 5 'vl. 24' " Sti-eet , Gtii": e 30 g 3:--cs ; Orivs . 3:j!t £"25 0 Kansa s Citv . M C 6411-' 1 Omahr; , Nebrask a 6811 0 £:?, n Antonio , T X 757:2 9

. Phor.e : (SIC ) 363-370 3 Pi-;c:-:e : (402 ) SQ'MOC ^ ?;-oni: : ;::;'iu } 523-9s8 3 ??.-. : i-'rl>:^, ) c04-'i00 5 T:';: ; ;21C ) 579-357 7^•,W* ' " ­ 3» - •— .