0 

### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 

### 2796 6 DATE : fl/1 5 ADDRESS : 211 3 Gran t St REMEDIATIO N CONTRACTOR : PRUDEN TTECHNOLOGIES . INC . YEAR : 

### 201 O 

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

PR E AN D POS TVIDE O O F PORPERT Y(DVD ) fV\\ssir>C j B^-vMP€^ o

• EXECUTIV E SUMMAR Y

• EPA-PROVIDE D PROPERT YSKETC H E i SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT 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. ) iz f CONFIRMATIO N DAT A Q PHOTOGRAPH S

AS-BUIL TSKETC H [ ^

SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R m 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 d UTILIT YCLEARANCE S ^

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

## D D

. ^ ^ 

### ^iJl i GNA l SIGNATUR E DAT E 3021858 5 

### Superfun d^ 

### PROPERT Y SUMMAR Y Date : 12/15/201 0 Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO^ l Mont hof : Decembe r Propert y Address : 211 3 GRAN T 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 N SAMPLIN GDATA/RESULTS : B l = 101 6 PP M @ 13" ; E A = 7 3 PP M @ SCRAP E(~1" ) 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 digita l vide o clip/photograph s 5 ) Documentatio n - Complete dClose-ou t Checklis t 6 ) As-Buil t sketc h­ i ) Shal l includ e final lea dlevel 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 individual property file, i f available , o r obtaine dinclude : i ) Pre-excavatio n agreement detail s (i f an y ar e mad e withth e property owner ) ii ) Property Statu s For msigne db y property owne r iii ) Excavatio n digita l vide o i n MPEG , 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 .

TECHNOLOGIES . INC .TECHNOIOGHES . INC . 

# EP A Propert y Clos e Ou t Propert y # : X7ACcG ? Propert y Address : "ZJ- ' 3 tiraw*
- % • Date/Time : Owner' s Name ; (ZtfYv^t e 3<tv* v e'5 . Quad s Excavated : ^ [ Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s N o I . I f necessary , wer e th e correc i quadrant(s ) excavate dan drestored ? 

## y 2 . I f necessary , wer e th e correct aiea s o f drip zone excavatedandrestored ? 

# y Gradin g Sodan dVegetatio n Ye s N o 1 . Doe s the gradin g aroun dtli e perimete r o

f the hous e in excavate darea s generall y slop e awa y / fro mthe house ? 2 . Has sodbee n laidi n all area s tha t wer e excavated ? / 3 . Doe s th e sodappea r to be generall y health y andgrowing ? (Onl y evaluate i f inspecte da t a3 0 / da

y tim e period) 4 . Ar e sodde darea s generally finn andevenl y graded ? / 5 . Ar e the joint s between the sodstrip s generall y tight ? (Onl y evaluat e i

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

# y 7 . Wa s dainag 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 . Do gate s ope n an dclos e freely ? (Ifapplicable ) 

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

# y 3 . Wa s damag e t o gate s or fence s avoided ? (I f applicable ) 

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

# y Foundation , Sidingan dGutter s Ye s N o 1 . Wa s damag e t o the siding o r trimavoided ? 

## y 2 . Wa s damag e t o the foundation avoided ? 

# y 3 . Wa s damag e t o window s avoided ? 

# y 4 . Wa s damag e t o window s or doo r screen s avoided ? / 5 . Was damag e l 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 drivewa y surface s avoided ? ^ 2 Wa s damag e t o walkwa y surface s avoided ? /

## Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complete includin g th e 30-da y so dwarranty . EP A Representativ e 7d<i^ ;5 UDate : fijiifioC'HNOLOGIES . INC . 

### A S - BUIL T DRAWIN G OL S # 2796 6 Dat e Excavaled : 10/25/201 0 IISEP ASigned-Of TDate : 

### OMAH A LEA D SUPERFUN D SIT E 2796 6 Exterio rPaint Omah a Lea d Sit e Owne rName : JAME S RONNI E G ^ • Goo d Sit e Sketc h Address : 211 3 GRANTS T • Poo r Phone : H : W : ^ No t pain t 

# i
Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Sample s Collecte d Firm : 45w­ fe?. ^ S RYASCPXA-2796 6 F l / J^ O pp m Q 

### D Date : <\l'Z<fJb i RYBSCPXA-2796 6 F2 Z5Tpp m 

### D Time : 10-1 0 RYCSCPXA-2796 6 RYDSCPXA-2796 6B l B 2 H " 1 i P.i q pp m pp m \ 2 S

\ 

### D D Sample s Analyze d fiDgocrxA-gyooo B2 ­ pp m 

# a D XR F Unit : /QO V Book : /7 3 nGZ0CrXA-2790 C 62 - pp m 

# a D Date : y o . / 9 ­ 0( „ RPZOCrXA-2790 0 P2 - pp m 

# n n Time : ^ Numbe rof Sample s = H Staff : rlsi ^ Legend : F l = Fron t Left , F 2 = Fron t Right , B l = Bac k Left , 8 2 = Bac k Righ t DZ = Dri p Zone , G Z = Garden , P Z = Pla y Al l qu^rant s ar e 4 S viewft d fro m th e street , facin g propeit y t ' 1 r 

# M ENTERE D B l = 101 6 PP M « 13 " L 

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• v^v r &^^^ \i V '• ' '• E A= 7 3 PP M a S ( RAP E CONTRAC T# : EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC . 04614 1

# ^ R ^ Propert yCompletio n Agreemen t Thi s agreement documents th e completio n o f remova l 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 owne r i s satisfie dwithth e restoratio n o f th e subjec t proj)erty , an dtha t n o item s ar e i n question , now , o r at an y tim e i n th e future , excludin g any remainin g warranty (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Property ID : Propert y Address : O * r ^ 

# O ra.J h ^Si ^ Owner : .(xtMLS^^K.^. ^ 'VjJL'^-Ovj L 

### Pbone : 

# t Restoratio n Item s i n Questio n

Ite m

[p ] 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 )



# -U . P ^ ( I 0 DatePniden t Technologies , Inc . (Prudent ) i s unde r contrac t wit hth e U . S . Environmenta l Protectio n Agenc y (EPA ) t o clea n u p lead
contaminate dsoil s a t anumbe r o f

propertie s locate di n Omaha , Nebraska , includin g th e propert y locate dat Th e EP A request s you r permis.sio 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 , 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 you r property , pleas e contac t Pruden t southoffic e for 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 Infonnatio n Center s a t (402 ) 731-304 5 (SouthOmali aoffice ) o r (402 ) 991-958 3 (Nort hOmah aoffice) . \ Property Acces s Grante dBy : \\7 ) Ov ^ Y \\ l 7/L^w^sLy^ : ^ 

# 3 (Pleas e Prin t Name ) Property Owne r iligruiture : 

# ytSfihw u JW) ^ /g/V^^ ^

e ) ^ ' (Signature ) ' (Dat e PROPERT Y INFORMATIO N o b e complete db y residen t and/o r propert y owne r —pleas e print ) RESIDEN TNAME : Owne r Rente r 

# £^4 - RESIDEN TADDRESS : 

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# to e Q.^\\ \ IFB^ENTAL , PROPERT YOWNEMY : II - KCf M I AL , KKUfC KI
OWNER' S MAILIN G ADDRESS ; 

## 70\<sL { ^O^ICJU^ ^ X) r j y tA-/^-»—^1-^^- ^ ] ^ ^S(( f OWNER' S TELEPHON E NUMBE R - HOME : I WORK : X 

### _L 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 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 WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. ]

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s t o b e implemente db y EP A unde r thi s agreemen t are pursuan t l o Seaio n 10 4 o f CERCLA , 4 2 US.C . 9604 . EPA' s ligh t o f

acces s t o th e property 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 or 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 42S 0 Kansa s City.'M O 6411 4 O.maha , Nebrask a 6S l 0 7 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 PhOfie : (4.02 ) 733-i1S 8 Phone : (210)822-958 8 Fax ; (816 ) 363-370 7 fs r(402)733-188 3 Fax : (210)579-657 7ENVIRONMENTA L & CONSTRUCTIO N SERVICE S 

# Propert y Statu s For m Address : g ^ \\^ C \T C^t^^J ^ H Date : Phone : BVID :

Pruden t Employe e
808 0 War d Parkway , SuK e 40 5 560 0 SI O S t 424 2 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)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)733-188 3 Fax : (210 ) 579-657 7- 

## 2796 6 Exterio rPaint Nort h Arro w 

### Omah a Lea d Sit e Owne rName : JAME S RONNI E G • Goo d 

### Sit e Sketc h Addre8s:211 3 GRAN TS T • Poo r Phone : « W: 

# 1 g . No t paint ^ 

### 1 Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Sample s Collecte d Firm ; /45w­ fe?, ^ S RYASCPXA-2796 6 F 1 

## /3 0 pp m 

## Q D Date ; ^f'Z'kl U RYBSCPXA-2796 6 F2 pp m 

## E l D Time ; 10-'I Q RYCSCPXA-2796 6 RYDSCPXA-2796 6 B 1 8 2 

## H1 i ^1< ^ pp m pp m 

## E H 

## D D Sample s Analyze d fiDZOGPXA-2790G RGZ0CPKA-279G 0 RPZGCPXA-279G G B2 ­ G2 ­ P2 ­ pp m pp m pp m 

## D D D 

# n D D XR F Unit ; /OQ- ? Book ; Date ; / O ^ / 9 ­ 06 , Time ; / ^ rz i
Numbe ro f Sample s = ^ Staff ; j^isi ^ Legend ; F 1 = Fron t Left , F2 = Fron t Right , B 1 = Bac k Left , 8 2 - Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e 4 S viewe d fro m th e street , facin g property \ 1 ; 1 ; 

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" > Creat e Anothe rTicke t Bac k t o Irt h Interne t Send..EmaiL . 

### YOURTICKE T NUMBERI S 2622431 . Origina l Cal l Date : 10/20/1 0 Time : 5:2 7 pm Op : SIVA1896 7 Wor k t o Begi n Date : 10/22/1 0 Time : 6:0 0 pm State : N E County : DOUGLA S Place : OMAH A Address : 211 3 Street : GRANT 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 AJAMPAM A Phone : (402)733-118 8 Wor k Bein g Don e For : EPA Dept h o f Excavation : 6 F T Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Servic e Are a Contac t Phon e Numbe r Utility Typ e CXCAT V CO X COMMUNICATIONS , INC HEIDI 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUDO l METROPOLITA N UTILITIE S DISTRIC T SANDY 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCITY OFOMAHA-TRAFFIC,SEWE R RICHAFRAFFI C 

### Day : 402444719 7

Alt : 402444516 1 

### Emerg : 402444516 0 OPPDGPR 5 OMAH A PUBLIC POWE RDISTRIC T EL M LOCATING 

### Day : 406728934 3 Alt : 406207149 4 

### Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K EL M LOCATING 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 

### http://www.dhoii.org/irthinteniet/DHONNoticeCreatioii/MessageText.asp?ret=<RESULT. . . 10/20/201 0ENVIRONMENTA L & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SOLUTION S 

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