### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL EFOLDE R SAID# : ^2>^ g Date : )njl}J2jDo E Address : Q7fb° i PoopLlvr , AJ Remediatio nContractor : P>^j^iu ^ 'Xeiu^Jopo , _. -i^c-j Year : 2-P O ^ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S
^ Vide o ofpropert y (DVD ) 0 Executiv e Summary B EPA-provide dproperty sketc h ffl Signe dAcces s Agreemen t fo r subjec t propert y D Signe dAcces s Agreement(s ) fo r adjacen t propert y l 7 Restoratio n Agreemen t D Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) H Confirmatio n dat a 

### ffl Photograph s aAs-buil t sketc h 0

^ Satisfactory restoratio nsigne db y Property Owne r y Property close-ou t chec k lis t signe db y EP A D Descriptio n o f area s not meetin g RO D cleanu p criteri a IZf

Utility clearance s ^ Property informatio n fromDougla s County Assessor' s Offic e D D D 3/2y/o f 

### Signatur ^ Dat e 4031135 3 Superfun d

### PROPERT Y SUMMAR Y Date : 10/17/200 8 Oinah aLea dSit e Remedia l Actio nContrac t #EP-R7-07-06/000 4 Mont hof : Sept/Oc t Propert y Address : 296 9 PAPPLETO NAV E A . EXECUTIV ESUMMAR Y A. l 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 : ARE A NO T EXCAVATE D F 2 L S 10X1 7 F T @ 26 7 PP M CONFIRMATIO NSAMPLIN GDATA/RESULTS : F2=6 1 PP M @ 8" ; EA=7 7 PP M @ SCRAP E 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 dfor crossin g othe r propertie s 3 ) Pre-Excavatio ndigital 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 sketc h­ i ) Shal l includ e final leadlevel 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 di nth e individual property file, i f available , o r obtaine dinclude : i ) Pre-excavatio n agreement detail s (i f any ar e mad e wit hth e property owner ) ii ) Property Statu s For msigne dby property ovmer iii ) Excavatio n digita l vide o in MPEG , WM V (Window s Medi aVideo ) o r SWF(Flas hPlayer ) format and/o r photograph s iv ) Signe dfor mverifyin g satisfactor y restoratio n v ) Descriptio n o f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOCIES , INC .Fin d Recor d 

### Backfill :

Sampl e Area : 2039 8 Owner : n Owne rOccupie d Owne rName : |SANCHE Z ADALBERT O Owne rAddressl : Owne rAddressZ : 296 2 POPPLETO N AV E City : JOMAH A Oea n U p Quer y Lea d Remainin g Quer yi



### - 296 9 POPPLETO N A V Resident : Residen t Name : Propert yAddress :
" - , -v ^ 1 ­ 1296 9 POPPLETO N A V Zi p Code : 6810 5 Residen t Phon e State : Zi p Code : |N E |6810 5 Owne rPhone : A Iternat e Phone : Propert yDamag e Quer y 

### dos e

Contract :

Assessment : Qualifyin g Grou p I PRIORIT Y^ Assessmen t XR F Date: 

# I /^sessmen t Ma xXR F Value : 615.1 8

# EP A Propert y Clos e Ou t For m Propert y # : 2^5^^ ^ Propert y Address : '^^7_'^fe' ^ Pepp(e+c» ^ A^> ^ Date/Time : Owner' s Name : /4^g<H^rV o Ct^^cU-^T ^ Quad s Excavated : p-Z
- Contracto r Grou p Excavatio n Genera l Ye s No 1 .Ifnecessary , were th e correc t quadrant(s ) excavate dan drestored? 

### 7 2 .Ifnecessary , wer e th e correc t area s ofdri p zon e excavate dan drestored ? 

### y Gradin g So dan dVegetatio n Ye s No 1 .Doe s th e gradin g aroun dth e perimete r ofth e hous e mexcavate darea s generall y slop e away fi-omth e house? 

### y 2 .Ha s so dbee n lai di n al l area s that wer e excavated ? y 3 .Doe s th e so dappear t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 da

y tim e period ) 

### y 4 .

Ar e sodde darea s generall y fir man devenl y graded ? 

### y 5 .Ar e th e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e if inspecte da t a3 0 da y 

### y tim e period ) 6 .Wa s th e property grade dsuc hthat wate r will no t poo l on th e property ? y 7 .

Wa s damag e t o landscapin g or plant material s avoided ? 

## y Gates , Fence s an dRetainin g Wall s Ye s No 1 .D o gate s ope n an dclos e freely ? (I f applicable ) 

## y 2 .Were al l gate s o r fence s take n dow n durin g restoratio nactivities reinstalled ? (I f applicable ) 

## y 3 .

Wa s damag e t o gate s o r fence s avoided ? (IfappUcable ) 

### 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 th e sidin g or tri mavoided ? 

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

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

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

## y 5 .Wa s damag e t 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 driveway surface s avoided ? 

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

### Inspectio nnotes :

f^C£ o i apcofi C /tS-lutt. r S/<erct t /^ffO fieF/ee f feff O UotL ^ /A / T/) c Oi O ^£xc/>0/,rB O 

### 9767o f 0 ^ 

# 4 ^ ^

Remova l an drestoratio n activate s complet e includin g th e 30-day so dwarranty : EP A Representativ e /L^?5L ^ 9l3ojo7 ) ?^** 7 

### Date :

# SEPA Propert yCompletio n Agreemen t Thi s agreemen t document s 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 that th e property owne r i s satisfie dwit hth e restoratio nofth e subjec t property , an dtha t n o item s ar e in question , now , o r at an y tim e i n th e future , excludin g an y remainin g warranty (3 0 day s total ) excep t thos e item s liste dbelow , if any . Propert y ID : 2 ^ ^ ^ ^ Propert y Address : Owner : ^C ^ ^ c: \ 

# ' -^opple.^v v Ao/^- ^ Phone : 

### Restoratio n Item s i n Question :

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

L J I agre e restoratio n i s completed , excep t a s note d above . L J I d o no t agre e restoratio n i s complete d



# C

\ 

# 0 % 

# 2J5 i Qg Owner' s Signature Dat e 

# [.da^G^Y\-^Qr ^

## . y.V.-.', , X

Fiudsnt T ochadogjftK , Ins . (Pm<i»n $ i

^ uad»r contract rri^ i fe9 IJ . S . Enriiomnonta l ProUrtion Ageic y (^PA ) t o CUE Q ^ coiity.iiHta d«)il s a t anumb w o f p:op»iti»slDcat»diBOmaha,N»braidca, iiicludingth « piopert y locateda t

. ThsEPAnqussltyourpHsnisaoat o allo w Pludtsfl.topfrrfomssoilcUam^iEtlhi B ptop«it y t o nmo'f t Uad-ctrntmninifle dsoil . B y Qgmn g thi Efonn , th» piopnt y ownti grants pnraisao n t o PiudAa t to ptifon a sctivitisEi«lat» dt o the clssn^ j iacliziSsH g soil sjaaplizg . lomovr i o

f load-contarainal» dsoil , andr«Etoratio u ofthe lefeiencedproperty . I f you hs.r o sny queSioa s abou t the soi l cleans ^ plaaao dfoi yo mproperty , pleas e contact Pnident' s Adoiiiitiisliv e Clei k

foi the O

mah aLea dSit e cleanup . Ms . Shannon Holt-a t (402^504-1004 . Genen dquestion s abou t fiu OmahaLeadSit e cleanu p canb e directedto & 4 EP APubhc InfonnationCentei s BI(40 ^ 731-3045 (ISouShOmah aoffice ) oi(402 ) 991-958 3 (J ^ oit hOinahaoffice) . PiopertyAccess Gnaile d By : //z?Zi- f .Oy-r/y O 3>% . J^-^ " t ? (Pleas e Pnn t T>

3 ase ) PiopertyOsmeiSignature : fJo^Cr^fr O 'Q\iluk y 7)7h/&{ l (Signatffo ) 7 / (Pato ) PROPERT YIMFORMATIO M fT

o b e ceioplstB db y nrndentflni/orpiopert y owner - pless e print ) RESIDEN TMAKE : 

### ^ 

# iWi . Owne r Rents r RESIDEN TADDRESS : 

## .^l^^__JabJ^€_'b.c,__a:v^bfi = OP^-S ^



## M2=__^^\C 3 ^ I F RENTAL . PROPERT YOWNE D BY : /KS-I-A ^ y
OWNER' S HAILINGADDRESS ; 

## jo^i . 

# P\^ ^ C^'^iX ^ KS PCS ( 0 J ' OWNER'STELEPHON E NUfSBE R - HOfJE : ( 702 ) ^ 3' ^ ' - ^ ^ & ^VQRK : 

# J 1 AG E O F HOME? : 

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

# B . YEARS . 

### ^ ^ HA S TH E EXTERIO R BEE N PAIMTE D O R COVERE D Wn H SIDIN G SINC E 1378 7 YES - —» 0 

### " ^ NUt/IBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : | U NUMBE R O F OCCUPANT S 7 YEAR S OL D AtJ D OLDE R NUHBE R O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLA YI H TH E YAR D FO R 5 HOUR S O R E30f KPE R WEEK : corancwT S O R SPECIA L IHSTOUCTIOMS : (i.e . DOGS , CMTI\ YGATCE , CTC. J

AUTHORi f Y FOREHVIROwwIIHTA LRESPONS EACTIOHS i "th e activitie s to b e imploiaontedbyiLP A unde r thi s ayeeiHen t Bi

e puraian l t o Section 10 4 o f CERCLA, 42 U SXI . 9604 . EPA' s li ^ o f acces s t o the piopert y i s promdedfoi i nSectio n1 M(fi ) o

f CERCLA, 4 2 US. C 9605(e) , whic hpioTTide s entr y fo i "detei&iiningtheBeedfoiiesponse , 0 1 choosing o r takin g in y reipons e action unde i thi s title , o i otheiwis e enfoicingtli e pio^son s ofthe title. "

808 0 wsr d Pamviw/ . Suit e 40 5 250 5 N . 24* ^ Street , Suit e 30 8 424 2 essdlcs l Drive . Suit e 425 0 Ksf8scii}|r , Baaedii a Omatia , NeDrsekaesil O ss n Antonio . TX 7922 ? Phone : (SIC ) 3C3-370 3 Fm : (916)969470 7 Phone : <402 ) 504-100 4 Fa K(4(>£ ) e04-100 S Phone : (ZIO ) 822-358 8 Pai c(810)678-657 7

## ^-M^MiLii r IMMIIMS:® ^ OLS# : 2039 8 Dat e Excavated : 7/14/200 8 Dat e USEP A Signed-OfT :

Owne rName : ADALBERT O SANCHE Z Omah a Lea d Sit e Address : 296 9 POPPLETO N A V ^'* ® Sketc h Phone : H : W : Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B R'i'A3CPXA^2039 0 RYBSCPXA-2039 8 F V F 2 ^/JS ­ . pp m .pp m 

# n D D RYCSCPXA-2039 8 RYDSCPXA-2039 8 B 1 B 2 3.^' / ppm 'Ay'^S^ ^ pp m 0 ' D D RDZSCPXA-2039 8 RQZ9CPXA-2039 a D Z

62 - 7-13 ^ pp m pp m 

## x y 

## \y D 

# n RPZ3CrXA-g009 0 P^ - PPn > 

# u n Numbe ro f Samples : 

# ENTEREI ) SE P a 7 200 4 

## ^ L 

# 5^ ^ I Z3 5
o : C£c < 

# n : a .

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ARE A NO T EXCAVATE D IF 2 LANDSCAPE , 10'X17 ' @ 26 7 PP M [P O REQUEST ] y/H- K Otnah aLea dSic e 2039 8 Exterio rPajn t NorthArrow Q'Goo d • Poo r • No t pain t Sample s Collecte d Fir

m4^ ^ 1^.7^^ ^ Date . '7/.i/£'- ' Time ' !.:> • -i' C Sample s Analyze d XR F Unit- ^ / ^ - Boo k ^" ^ Dale . <y-/ 3 '£^* y Time : /9>^' ^ Staffzy^j:^' ^

F 2 = 61PPM(ajS "

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A = 7 7 PP M @ SCRAP E 4f t 13

0
CONTRAC T# : E P - R7-07-0 6 / 000 4 PRUDEN TTECHNOLOGIES , INC .

# >RUDEN ' ^TECHNOLOGIES , INC . 

# Propert y Statu s For m Address : p.<=<t' ^ '^c>5>p\e.\,'T5Y~ N ^v- ^ Date : ^ ^yi ^ 3ero ' 

### Phone : BVID : po ^ ^ « Woa
- 013?>
- §4,92
- Plant s & Permanen t Landscapin g Item # O n Map Descriptio n an dLocatio n

Pre-Existin g Conditio nof Structure s Doe s you r Basemen t hav e ahistory o f leaking ? Ye s — N o — Item # Descriptio n & Locatio n O n Ma p C.<"C\C,V:G< ^ 

### ^td e (socxJiX dlo^ ^ "j^cJl e V8- Z CfcxcVc^ A SU e ^"^ ^ ^^^" ^ ^^^' ^ 1 5 ?*^?^b ®*^^ "

Property Owne r Pruden t EmployeejjC ^ j Signature : fiP^<!y?'t^'^ 0 "^Nst'':^' ^ Signature : , /&y ^ ( ^
808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 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

# 2039 8 Nort h Arro w 

### Omah a Lea d Sit e Exterio rPain t Owne rName : ADALBERT O SANCHE Z H'Goo d 

### Sit e Sketc h Address : 296 9 POPPLETO N AV 

### • Poo r Phone : H: w. [|| ] No t pain t 

# I Sampl e Numbe r R'i'A3CPXA-2039 8 RYBSCPXA-2039 8 RYCSCPXA-2039 8 RYDSCPXA-2039 8 RDZSCPXA-2039 8 • RGZ3CPXA-2039 6 RPZOCP)(A-2009 0

( Ph F2 B1 B2 DZ 6 ^ P2 - Lea d Concentratio n



## y?7 ^ pp m pp m Sampl e Collecte d LA B 

# D 

# n Firm : Date : Time : Sample s Collecte d /f^' ^ cs/f C ^/i/^y 

### fSi-S O 

## Z3 ^ pp m pp m pp m pp m 

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# n RGZSCPXA-2Q39 8 ©2 ­ pp m 

# u n RPZ3CPXA-2009 0 P£ ­ pp m 

## D Numbe ro f Sample s = : V 

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# ol^6 ^ PoppLETor ^ A V

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## Prin t Preview Page 1 of2 Dougla s County-Omaha , N E

Parce l I D Owne r Nam e Propert y Addres s Cit y Zi p Owne r Addres s Owne r Addres s 2 Owne r City Owne r Stat e Owne r Zi p 123796000 0 SANCHF 7 ADALBERT O 296 9 POPPLETO N A V OMAH A 6810 5
296 2 POPPLETO N AV E OMAH A N E 6810 5 Sec-Twn Rn g Additio n Bloc k Lo t Lega l 1 Lega l 2 Legal 3 Legal 4 Treasure r Websit e Lin k Assesso r Websit e Lin k 28-15-1 3 HANSCO M PLAC E 1 1 2 2 W 3 5 1/ 2 FTLT S 2 1 & 35.5X10 0

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## http://wvvw.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas%20Coiinty-Omah.. . 6/12/200 8.r-^^ryyj^iry'^^ ' iT^f^V.T^-'^' - Print Previe w http://www.dogis.org/dogi s alias/dogis/printPreview.aspx?PrintOpt. . Dougla s County-Omaha , N E

Parce l I D Owne r Nam e Propert y AdOies s Cit y Zi p Owne r Addres s Owne r Addres s 2 Owne r Cit y Owne r Stat e Owne r Zi p 123796000 0 Sec-Twn-Rn g SANCHE Z Additio n ADALBERT O 296 9 POPPLETO N Bloc k A V OMAH A Lo t 6810 5 Legal l Lega l 2 296 2 POPPLETO N Lega l 3 AV E OMAH A Lega M Treasure r N E Websit e Unl < Assesso r 6810 5 Websit e Un k 28-15-1 3 HANSCO M PLAC E 1 1 2 2 W 3 5 1/ 2 F TLT S 2 1 & 35.5X10 0

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1 of l 6/6/200 8 2:2 1 P M- S i 

# rfile:///C:/Users/lord^0is%20my%20shepherd/Desktop/STREETS/ 2

, Creat e Anothe rTicke t | Bac k t o Irt h Inteme t Sen d Emai l 

### YOU RTICKE T NUMBE RI S  2077055 . Origina l Cal l Date : 7/08/0 8 Time : 10:0 5 p m Op : RAMITA1896 7 Wor k t o Begi n Date : 7/11/0 8 Time : 7:1 5 am State : N E County : DOUGLA S Place : 0^4AH A Address : 296 9 Street : POPPLETO NAV E Twp : 15 NRng : 13 E Sect-Qtr : 28-NE-NW Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remidatio n Locatio n o f Work : ENTIR E PROPERT Y LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : ( 4 02)504-100 5 : UNSUR E CORNE R Compan y PRUDEN T TECHNOLOGIE S Contac t Nam e RAMIT A Phone : (402)504-100 4 Alt . Contac t Phone : ( 4 02) 4 52-980 6 Wor k Bein g Don e For : EP A Dept h o f E.xcavation : 6f t Corne r Lot : NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : NE;<plosives : N CXCAT V LEVEL 3 MCLEODN E MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F QWEST 2



### Servic e Are a Contac t Phon e Numbe r Utilit y Typ e CXCATV CO X COMMUNICATIONS . IN C HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 LEVEL 3 LEVEL 3 COMMUNICATIONS , LL C N A Day : 877366834 4 Alt : Emerg : 877366834 4 MCLEODN EMCLEODUS A N O NEE D T O CALL OU T EMERGENC Y Day : 800289190 1 Alt : 

### Emerg : 800289190 1 MUD0 2 METROPOLITAN UTILITIE S DISTRIC T EDWIN A Day : 402504782 3 Alt : Emerg : 402504794 6

I o f 2 7/9/200 8 1 • 1 7 P Mflle.///C./Users/lord^0is%20my%20shepherd/Desktop/STREETS/ 2 r^^ i


### CITY O FOMAHA
- OMAHACO F RO N TRAFFICSEWE R nopr^rpP A OMAHA PUBLI C POWE R.. . OPPDGPR 6 NA QWES T LOCAL QLNNEI F N A NETWOR K QWEST 2 QWES T LON GDIST/WC ESAR A Day : 402444719 7 Alt: ' 402444516 1 Emerg : 402444516 0 Day : 406728934 3 Alt : 888728934 3 Emerg : 406728934 3 Day : 406728934 3 Alt : Emerg : 888728934 3 Day : 800283423 7 Alt : 303992192 6 Emerg : 800283423 7

2 o f 2 7/9/200 8 1:1 7 P M