### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# ; 2852 2 DATE ; 1/1 5 ADDRESS : 241 2 N 1 7 S T REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES . INC . YEAR : 20l t 

### SOI L REMEDIATIO N PROPERT Y FIL E FOLDE R DOCUMENT S [ ^

PR E AN D POS T VIDE O O F PORPERT Y(DVD ) N^lSAiiv ^

Rlfxffit o ^\iJl ^ IZ ( EXECUTIV E SUMMAR Y •

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EPA-PROVIDE D PROPERT YSKETC H

• SIGNE D ACCES S AGREEMEN T FOR SUBJEC T PROPERT Y n SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN TPROPERT Y 0 RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R T O REPLACE PLANTS , ETC. ) \ i CONFIRMATIO N DAT A ^

PHOTOGRAPHS . Q AS-BUIL T SKETC H

• SATISFACTOR YRESTORATIO N SIGNE D B Y PROPERT YOWNE R 0 PROPERT YCLOSE-OU T CHECKLIS T SIGNE D B Y EP A n DESCRIPTIO N O F AREA S NO T MEETIN G RO D CLEANU P CRITERI A m UTILIT YCLEARANCE S m PROPERT YINFORMATIO N FRO M DOUGLA S COUNT Y ASSESSOR'S OFFIC E D D D

SIGNATUR E DAT E 3021837 5 

# llilli l Superfun dPROPERT Y SUMMAR Y Date : /15/201 0 Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Propert y Address ; 241 2 N 1 7 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 GDATA/RESULTS : F l = 9 5 PP M @ 13" ; B l = 27 7 PP M @ 13" ; E A = 6 8 PP M @ 2 " 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 dfo r crossin g othe r propertie s 3 ) Pre-Excavatio n digita l 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 n lef 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 individua l property file, i f available , o r obtaine dinclude : i ) Pre-excavatio n agreement detail s (i f an y ar e mad e wit hth e property owner ) ii ) Property Statu s For msigne db y property owne r iii ) Excavatio n digital vide o in MPEG , WM V (Window s Medi aVideo ) o r SW F(Flas hPlayer ) forma t and/o r photograph s iv ) Signe dfor mveriiyin g satisfactory restoratio n v ) Descriptio n ofarea s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOCIES , INC .3 

# li-y RiiiiiiOi j TECHNOLOGIES , INC . 

# EP A Propert y CSose Ou t Propert y # : 2^5 " Z'Z
- Propert y Address : 24'2 . /O
- I ? $f . Date/Time : Owner' s Name : V\bi>jk Pa^vl^i^ ) Quad s Excavated : Ff ^ ^ / Contracto r Group : Pruden t Teclmologies , Inc. , Excavatio n Genera J Ye s N o I .I f necessary , wer e th e correc l quadrant(s ) excavatedandrestored ? / 2 .

I f necessary , wer e th e correct area s o f drip zone excavatedandrestored ? / Gradin g Sodan dVegetatio n Ye s N o 1 .

Doe s the gradin g aroundth e perimete r o

f th e hous e in excavatedarea s generall y slop e awa y / fro mthe house ? 2 .Has sodbee n lai du i all area s tha t wer e excavated ? / Doe s the sodappea r to b e generall y health y andgrowing ? (Onl y evaluat e i f inspecte dat a3 0 / da

y tim e period) 4 .

Ar e soddedarea s generaU y finn andevenl y graded ? / 5 .

Ar c th e joint s between the so dstrip s generall y tight ? (Onl y evaluat e i

f inspecte da t a3 0 da y / tim e penod ) 6 . Wa s th e propert y grade dsuc htlia t wate r will not pool o n the property ? 

## y 7 . Was damag e l o landscapin g o r plan t material s avoided ? 

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

D o gate s ope n andclos e freely ? (I f applicable ) / 2 .

Wer e all gate s o r fence s taken dow n during restoratio n activitie s reinstalled ? (I f applicable ) 

# y Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) / 4 .

Was dainag e to 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 the siding o r trimavoided ? / 2 . Wa s damag e t o the foundation avoided ? / 3 . Wa s damag e l o window s avoided ? 

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

### y .^

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

## y Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Wa s damag e t o diivewa v surface s avoided' ? 

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

# y

### Owner s cominents :

Inspectio n notes :

Remova l andrestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e jdo ^ 3 ^ Date : i^fijr ^CHNOLOOIES . INC 

### A S - BUIL T DRAWIN G OL S #2852 2 Dat e Excavated : 10/07/201 0 

### OMAH A LEA D SUPERFUN D SIT J USEP A Signed-OffDate : 

### 2-ii5Z Z Name : _/><»/iS«/ / /'^«K«f Address ; Z^IZ . N . 11+bS h Phone : V53-S5- 7 3 Omah a Lea d Sit e Sit e Sketc h Date : f ­ i.^'S ' Time : //.S j Nort h Arro w

Tea mF{>A MT/r^/<U/ ' BVI D #''^^t,l<i XR FCod e /g3 7 /iooK'-iz.' h Sampl e Numbe r Lea d Concentratio n 50 3 ? 3 9 ^g g 32 ? pp m pp m pp m pp m pp m pp m pp m Confimiatio n Sampl e p i Ye s 1 ^ F 2 Ye s C D 8 i Ye s • **2.Yes •= • V6 S P T-(J! . • Ttf e D N o El , N o Q N o c a N o ^ N O P W

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CONTRACT tt : EP-S7-10-0 5 PRUDENTTECHNOLOGIES , INC .

# dERf V Propert yCompletio n Agreemen t Thi s agreemen t documents the completion of remova l activitie s performe do n the below listedproperty . Th e propert y owner' s signatur e indicate s tha t the propert y owne r i s satisfiedwit hthe restoratio n of the subject property , an dtha t no item s ar e i n question , now , o r a

t an y tim e i n th e future , excluding an y remaining warrant y (3 0 day s total ) except thos e item s listedbelow , if any . Propert y ID : Propert y Address : ^^/ ^ f V )" ) ^/ ^ Owner : Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item : 

# I Require d correction s t o complet e th e property :

13^ 1 agre e restoratio n i s completed . LJ I d o no t agre e restoratio n I s complete d a t (note d deficiencie s above ) 

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Pruden t Technologies , Inc . (Prudent ) is unde r contrac t withth e U. S. Environmenta l Protectio n Agenc y (EPA ) to clean up lead
cofltaminate dsoil s at, anumbetvg f projj f rtie s locate d in Omaha , Nebraska , includin g th e propert y locate dat g^^/i ? / v / Y " ^ O'T'^i e EP A request. ^ you r permissio n to allo w Pruden t to performasoi l cleanu pat tlii s propert y to remove lead-contaminate dsoil . By signin g thi s form , th e propert y owne r grant s permissio n to Pruden t to perform activitie s relate d to th e cleanu p includin g soi l sampling , remova l of lead-contaminate dsoil , an drestoratio n ofth e reference dproperty . Ifyo u hav e an y question s abou t th e soi l cleanu p planne dfor you r property , pleas e contac t Pruden l southoffic e for th e Omah aLea d Site cleanup-a t (402 ) 733-1188 . Genera l question s abou t tli e Omah aLea dSit e cleanu p ca nbe directe d to th e EP A Publi c Informatio n Center s at (402 ) 731-304 5 (SouthOmah aoffice or (402 991.-958 3 (NorthOmah aoft'ice) . Umah aoffice ) ) or(4U7 ) ) 991-958 3 (N i / Propert y Acces s Grante dBy : eas e Prin t Name ) Property Owne r Signature : 

# q-^^ 0 (Date ) PROPERT Y INFORMATIO N (T o be complete d by residen t and/o r propert y owne r — pleas e print )

Owner Rente r RESIDEN TNAME : |//\C/^A/ T L o RESIDEN T ADDRESS : 

# .ey/ ^ /O n^ sr IF RENTAL , PROPERT Y OWNE D BY : 

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OWNER' S MAILIN G ADDRES S 

# • m^ (t^^iAs t OWNER' S TELEPHON E NUMBE R - HOME : 

# ..'^-4^\' ^ WORK :



### i^l,x ^ :IJOX-1?^^ ^ AG E OF HOME ? 

# -W 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 ? NO NUMBE R OF OCCUPANT S UNDE R 7 YEAR S OLD : v\ P NUMBE R OF OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R 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 : iOMMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS E ACTIONS : Th e activitie s to be implemente d by EPA unde rthi.< ; agreemen t ar e pursuan t to Sectio n 10 4 ofCERCLA , 42 U.S.C . 9604 . EPA' s righ t ofacces s to th e propert y is provide dfo r in Sectio 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 title. " 808 0 War d Parkway . Suit e 40 6 560 0 s -.es t ''i24 2 Medica l Drive , Suit n 42S 0 Kansa s City.'M O 6411 4 Omsna . Weic-ij;.=;ji B 631'j 7 HmAntonio . TX 7822 9 Phone ; (816 ) 363-370 3 Phonft ; (210 ) 822.B88 8 Fax:(816)363-370 7 FMX : (210 ) 579-^}67 7EiNVfRONMENTAL A CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE. S 

# Propert y Statu s For m Address : ^ V/ 2 / J H' ^ % r Date : ^/^ZL^XOI O



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808 0 War d Parkway , Suit e S60 0 S 1 0 S t 424 2 Medica l Dnve , 9nit e 425 0 Kansa s City , M O 6411 4 Onnaha , Nebrask a 6810 7 Sart Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone ; (402)733-118 8 Phone : (210)823-968 8 e..!. . rt>He* *i6' % '•TA T c:.«v ­ iAc\n \ .fi t iOo- ^ Civ/tin t ETOJSIIT T- •uaav.-ja^tai'.jyt^-.v.'^ateii.-; ^ v - 

# BfE a Name : /^ronz.e.1 1 Fa.nl/Le.' ^ Omah aLea dStt e 

### Date ; f-ig- S MDCtt i /\MCM V — c Address : Zmz . N . l7-^Sh Sit e Sketc h Time : .U• 3c > Phone : ^^53-85^7 3 TeamF^ 4 UX/r\J tl)K ( BVI D #^1^ 5 ^Z XR FCod e /g3 7 /?oc*::ta< » Sampl e Numbe r Lea dConcentratio n Carrf-irmatio n Sanrtple 

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### YOURTICKE T NUMBERI S  2605485 . Origina l Cal l Date : 9/30/1 0 Time : 12:3 6 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 : OMAH A Address : 241 2 Street : N17T H S T Twp : 15 NRng : 13 E Sect-Qtr : 10-S W 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 Compan y: 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 N UTILITIES DISTRICT SAND Y Day : 402504782 3 Alt : 

### Emerg : 402504797 0

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### OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R RICHATRAFFI C Day : 402444719 7



### Alt : 402444516 1 Emerg : 4024445160 0PPDGPR 5 OMAH A PUBLI C POWE RDISTRICT EL M LOCATIN G Day : 406728934 3



### Alt : 4062071494 Emerg : 888728934 3 QLNNEIC 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 6 P MVivci ; 

### ENVIRONMENTAL NGINEERIN GAN D CONSTRUCTIO N SOLUTION! ^ 

## SIT E SAFET Y HAZARD ANALYSI S Address : ^M' X Cre w

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M M Wan f BMtany , Sut e 40 5 seoosios t 424 2 Bledica l Drive , Stiit e 725 0 KaisasGity;iK>««11 4 Omaha , Nebrask a 6810 7 Sa n Antonio , T X 7822 9 Phone : (8t< ) 363470 3 Phone : (402)733-118 8 Phone : (210 ) 822-«58 8 Fax : (SIS ) 363^0 7 Fax : (402)733^188 3 Fax:(210)«7M57 7

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