## TRANSMITTA L o f OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : hlf^l b Date : gj}^/n ^ Address : ol9/ 4 fnJLy^iU U U Remediatio n Contractor : ryv^d^' h Te,J \. i-vic ^ Year : 2-^n< 9 SOI L REMEDIATIO N PROPERT Y FILE FOLDE RDOCUMENT S IE T Vide o of proDcrt v (DVD ) 

# e T Executiv e Summar y 

# \

y EPA-provide dpropert y sketch 

# \ y Signe dAcces s Agreemen t fo r

subject propert y D Signe dAcces s Agreement(s ) fo r

adjacen t propert y ^ 

## Restoratio n Agreemen t D Setdement document s (i.e. , fo r

damag e or t o replac e plants , etc. ) 

# y Confiimatio n data 

# y Photograph s 

# y As-bmlt sketch 

# y SaHsfiactor y restoratio n signe db y Propert y Owne r [ y Propert y close-out check lis t signe db y EP A D Descriptio n o f area s no t meetin g RO D cleanit p criteri a ^ 

## Utilit y clearance s 

# y Propert y infonnatio n firomDougla s Count y Assessor' s Offic e 

# u D D S<^- ^ Ziiili o 

## Signatiu * Dat e 3005421 2 

# nimi i Superfun d

### PROPERT Y SUMMAR Y Date ; 08/13/200 9 I Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l | Monthof : June/July , Propert y Address ; 291 2 FONTENELLE BLVD A . EXECUTIV E SUMMAR Y A. 1 Issue s Encountered : NON E A. 2Issue s Resolved : NON E A. 3Uniqu e Findings : NON E A. 4Othe r Relevan t Information : AREA NO T EXCATED PE RP.O . REQUES T A T Bl/L S (12'X5 % 8'X5' , AN D 25'X5' ) = 20 3 PP M @ SCRAPE CONFIRMATIO N SAMPLIN GDATA/RESULTS : B l = 16 4 PP M @ 13" ; EA=17 3 PP M @ SCRAPE O ^ " ) ATTACHMENT S 1 ) Propert y sketc hprovidedb y EP A pursuan t t o contract specification s 2 ) SignedAcces s Agreemen t including acces s agreement s requiredfo r crossing othe r propertie s 3 ) Pre-Excavation digita l vide o clip/photogr^h s 4 ) Post-Excavation digita l vide o cUp/photogr^h s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-BuU t sketc h­ i ) Shal l include final lea dlevel s v ) Legen d ii ) Contamination lef t behindarea svi ) Contracto r identification iii ) Propert y addres svii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s to b e includedin th e individua l propert y file, i f available , or obtainedinclude : i ) Pre-excavation agreemen t detail s (i f an y ar e mad e wit hth e propert y owner ) ii ) Propert y Statu s For msignedby propert y owne r iii ) Excavation digita l vide o in MPEG , WM V (Window s Medi aVideo ) or SW F(FlashPlayer ) fonna t and/or photograph s iv ) Signedfor mverifyin g satisfactor y restoratio n v ) Description o f area s no t meeting InterimRO D cleanu p criteri a

TECHNOLOGIES , INC .Rn d Record Remediatio n Quer yLea d Remainin g Quer yPropert yDamag e Quer y 

### Backfill :

Sampl e Area : 8471 6 - 291 2 FONTENELL E B D Owner : Resident : Contract : D Owne rOccupie d Residen t Name : Contractor : Owne rName : PRUDENT2009_S QUIN N KEVI N R Propert yAddress : Contrac t Optio n Owne rAddressl : 291 2 FONTENELL E B D BAS E

. . . . . Zi p Code : Owne rAddressZ : 6810 4 Assessment : 291 2 FONTENELL E BLV D Residen t Phon e City : State : Zi p Code : Qualifyin g Grou p OMAH A 

### N E 6810 4 800/CHIL D Owne rPhon e Alternat e Phone : Assessmen t MaxXR F Valu e (402 ) 933-833 7 (402 ) 995-241 9 91 9TBCHNOLOGIBS , IN C 

# »EPA EP A Propert y Clos e Ou t Propert y # : 5*7/ 6 Propert y Address : 29/ Z fonieaieu c BlJi . DateATime : 0 7/3olo> i Owner' s Name : Ki^! » a*n o Quad s Excavated : QJ_ Contracto r Grou p Pruden t Technologie s Excavatio n General Ye s N o 1 .

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

If necessary , wer e th e correr t area s o f dri p zone excavatedan drestored ? / Gradin g Sodan dVegetatio n Ye s No 1 .

Doe s th e grading aroun dthe perimete r ofth e hous e i n excavatedarea s generall y slop e awa y 

## y fromthe house ? 2 . Has sodbee n laidi n all area s tha t wer e excavated ? 

# y 3 ! Doe s the sodappea r t o b e generall y health y an dgroAving? (Onl y evaliiat e if insperte da t a3 0 / da

y tim e period) 4 .Ar e sodde darea s generall y fir man devenl y graded ? 

## y 5 .

Ar e the joint s betwee n the sodstrip s generall y tight ? (Onl y evaluat e if insperte da t a3 0 da y tim e period) 

## y 6 . • Was the propert y gradedsuc htha t wate r wil l not pool o n the property ? " 

# y 7 .

Was damage t o landscaping or 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 an dclos e freely? (If applicable) / 2 .

Wer e all gate s or fence s take n dow n during restoration artivitie s reinstalled ? (If applicable ) 

# y 3 .

Was damage t o gate s or fence s avoided ? (If applicable) / 4 . Was damage t o retaining wall s avoided ? (If applicable) 

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

Was damage t o th e sidin g o r trimavoided ? 

# y 2 .

Was damage t o the foundatio n avoided ? / 3 .

Was damage t o window s avoided ? 

# y 4 .Was damage t o window s or doo r screen s avoided ? 

# y 5 .Was damage t o downspouts or downspou t extension s avoided ? 

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

Was damage t o drivewa y surface s avoided ? / 2 .

Was damage t o walkwa y surface s avoided ? / 

# i

## ^V;L^IttyeJd ^ Blvt / Owner s comments :

Iiiisipec'tid n notes' :

Remova l an drestoratio n activate s complet e includin g th e 30-day so dwarranty : EP A Representativ e ^9ct^jA^ Date : 7/30/o fJul . 23 . 200 9 3:47P M Jo , 035 8 P . 2 

# &EP ^ Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n o f remova l activitie s performe do n th e belo w liste dproperty . Th e propert y owner' s signatur e tndioate s tha t th e property owne r i s satisfie dwit hth e restoratio n ofth e subjec t property , 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 warrant y (3 0 day s total ) excep t dios e item s liste dbelow , i f any . 1 Propert y ID : Propert y Address : 2.^\^ ^ T e>r^ > «. n « . Li e 

### S O Owner : ^^ ^ ^ ^ CC^s A r. ^ 1 

### [Phone : ^^ T . *i | *^« ; , 9'^^ . i . RMtoratlo n Item s I n Question : Item : Item ; 1 Kem : Item : Item : ' 

### Item : 1 Require d correction s t o complet e th e property :

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

Dat e ^

### Jun . 19 . 200 9 12;33P M No . 034 3 P. 

# 6>V" ^

Pnulen i TadMologi«t . Inc . (Pnidoti ) ii undt f eonuue t wit hth e V. S. Eovlnnmenta l Prawciio n AsooB y (EPA ) lg clean up luad ' e(inUimiiwl« d<oil « mo itumbe rcf properiia * locate d tn Omalu . Nebnika , Includui g th e property leeato d al

. 'fh e EP A requni s your pantiiaio nto allo w Pru(ini t u> perTon n aioi l clsuiu p ax ihi s prtpol yto KRWv o lusd-conlaminBlGd«e>l . By stgnin s thi s fonn , ifa e prapett y owia r Giant s pemioie n to Prud«n i lo pcrfoin i ealivi(i« i nilDied to th u cleanu p includin g loi t tampling , remova l orieud-contaminttte dMil , an dnnomtio aot'lh e rafiircnoedpropeity Ifyo u hav e an y question * aboi u th e Mi l etoanu p planne dib r yot v property , ptw w eoniac i Prudent' ) Adj2iH]ijt]iuu%iLCli!Ck.fe r th e Oinali aLea dSit u cleanup . .Vis . siv; i s Jmn|iuiq-n i (402 ) ".V^-l IXx . Gewra l ijaealioff i abou t th e Omah aLen dSil o cleanu p ca n be diroeiw l to th o EPA Publi e IntbrmBtie^eenter * (402 ) 731-304 (Sout hOmBhaofliee er (402 ) 99 ) -95S 3 (NorthOmah aoniee) . MiopCenter*a t (402)731-304 S (SouthOmBhaofliee } er(402)99)-9 J l^ropony Aiceea aOranto dBy ; (Pteaa c Print Name ) I'roperi y Ovrnt r Signuiure ; 

# (• Vf -1^ ? ( ^ ^ Mil l PROkGfilXlMreRMATIO N (T o be eoiDptais d b / iMidoB t and/o r propel ^ owiu r - plew e print ) RESIDEN T NAME : 

### \C^U < *\ <L ^.jJ.s ^ /Owne M Rante r RESIDEN T ADDRESS : 

## t^^:sV.. . K.V ^

^^1 0 H IP RENTAL , PROPERT V OWNE D BY : OWNER' S MAILIN G ADDRESS ;



# z.qi- ^ v^a^^^^^tli ^ Qj ^ r,m^ U la ^ <b*?io w OWNER' S TELEPHON E NUMBER-HOME : t "ja a ^33 ' ^33 1 WORK : AO E OF HOME? ! 

# ,85 - YEARS . HO W LON O HAV E YO U LIVE D HERE ? 

# ?:/ - YEARS . HA S TH E EXTERIO R BEE N PAINTE DOR COVERE D WTTH SIDIN O SINC E 1976? 

# JL . .YE S .N O 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 NUMBE R OF CHILDREN UNDE R 7 YEAR S OL D WH O PLA Y

INTH E YAR D FO R 6 HOUR S OR MOR E PE R WEEK : 

# o COMMENT SOR SPECIA L INSTRUCTIONS : (l£ . DOCS , ENTR Y OATES , ETC J 

## T)66 r \^ U^^^\^^ . \ AU'rj-IOKlT Y I'X> RUNVUIONMHNTA LKliSI'ONS U AC'I'IONS ; 'I'l u acliviiii! ) (o be implemente d by [-P A tmdii r ihi i agreemen i an : punuan i lo Sectio n 10 4 ot'CRRCLA , 42 U.S.C . 9^ . SPA' < righ t oraceei ito th e proparty U provide dfb rin Sectio n 104(a) oT CERCLA , ^3 U.S . C 960J(G) , whic hprovide * cnti y ror"det«ntiii\irt g th e nee dfo r rceponae , or vhootin s or

Uikin s uny reipDnB e actio n und v Ihi atitle ,or othenvit e onforun g th e proviiion x ofth e title. " SOS O War d Parltway , Suit e 40 5 260 S N. 24' " StrsBt , Suit e 30 6 424 2 Mrdicn i Drive , Suit e 426 0 Kansa s City , MO 8411 4 Omaha , Nttbrdsk a 6811 0 Ss n Antonio . TX 7822 6 Phon* : (816 ) 363-370 3 Phone : (402 ) $04-100 4 Phona : (210)622-856 6 Fax : (616 ) 3S3-370 7 Fax : (402)504-100 9 Fax : (210 ) 479467 7 »nnn/cnonB i YVil 0S:8 T fi00Z/8T/90

### Jun . 19 . .200 9 12:33P M Jo , 034 3 P . 2 EWTRONMENTA L CONSTRUCT K 

### TECHNOLOGIES , INC . SER>1 C 

# Propert y Statu s For m Address : 2.c{\*i ^ T=orNVeyNeU e Q > D Date : Phone : Mo2. - c\^ s - '^Ht q BVID : Plant s & Permanen t Landscapin g T o Remai n I n Plac e Descriptio n & Locatio n

Pre-Existin g Conditio n o f Structure s Doe s you r Basemen t hav e ahistor y of lealdng ? Ye s _j\N o Iter aN O Descnptio n & Locatio n O n Ma p

ruden t Employe e Signature :

806 0 War d Parkway , Suit s 40 S 250 5 N . 24 " Streec , Suit e 30 6 424 2 Medica l Drive , Sult a 42 ! Kansa s City , M O S411 4 Omaha , Nebrask a esil 0 Sa n Antonio , TX 782 : Ph(\n» t IM7 \ fiM-AaO i Phone : (210)622-95 1 yv a nc:A T nnnx/fn/a n

# m HNULlXilES , INC . OLS<>:8471 6 Dat e Excavated : 07/09/200 9 

## OJMUiHi i I^kt o $^^ ^ SIT E USEP A Slgned-OfTDate : 

## M71 6 Exterio rPain t ' NoffiAiraw Omah a Lea d Sit e n Soo d Sit e Sketc h (g^Poo r Samplin g Addraas : 291 2 FONTENELt f B D • Not pain t Sampl e Numbe r lea d Sampl e Sample s Collecte d Concentratio n Collecte d Firm : Pg . CC . c-K - RYASC»>XA^71 6 F l 3.H S co m D Date : lo->4-oa r RYBSCPXA-847i e F 2 2.1 $ PPn o D Time : I2.'.^g - p.n^ . RYCSCPXA-6471 6 B l 

### .ai.9_pp m D Sample s Analyze d RYDSCPXA-8471 6 B 2 D RDZSCPXA4471 6 D Z -JS£2_PP m D XR F Unit : &6H O Boo t 7.7.l i ncaccpx A g«7i8—oe - .pp m D D Date : / g -.Z g -O B RPZ3CPXA-e47i e P Z 

# ISS . .PP" " D Time : flrO Staff : ms\ ^ Numbe ro f Sample s = | ( g \ | | Legend : F 1 ° Fron t LeR , F2 >: Fron t Rlgm , B l » Bsd^^n . B 2 a Bac k Righ t D Z > Dri p Zone . G Z ° Garden , P Z » Pis ; AJ l quadrerl s ar e a

s Mtow d lio n n n Easal , faoki g propeit y J l I f UC(I5'X4' ) = 2) I PP M ARE A NO T EXCAVATED ; ' aSCRAP E(-l" ) h, Bl/L S (2.'^'X5' , 8'X5' , 12'X5' ) ^ • , „, , . 1 ^ • = 20 3 PP M a , SCRAP E (~ n 

## OC T2 b 268 a < W B I = 164 PP M a13 "

WIM K lwrf4«.iJ*il« . ttO KovlOO l Onan t OMq»( « EA = 17 3 PP M aSCRAP E (-1" )

CONTRAC T # : E P - R7-07-0 6 T0# 1 PRUDENTTECHNOLOGIES , INC .

### Jo , 034 3 P . 3 Jun . 19 , 200 9 12;33P M



## 8471 6 Omah a l.qa d Sit e &t*;ic * P*r» t .'*<in.firo< v Sit e Skotc h samplin g Addmaa : 2 i 1 3 FO^TeMfl.Ll ; 6 0 O ='lgtpB,-t i P.YASCPXA.a47lf i F l Cwia'niratrc n S£n)pl e ColioctQ d LA 6 

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# n a •Sampl96 AnAlyzo d R02SCfXA-a47li 5 0 2 

# o XJtFUfiit : ^H O Baok : 21 6 RPZSC.PXa-8471 6 P Z 3 5* ^ ppr n 

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# 29 1 

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httD://douslasne.maDDine-online.com/assessdoc/Photos/04/R24020800000001.iD e 6/12/200 9

### Prin t Previe w http : //www . dogis . org/dogisalias/dogis/printPrevie w .aspx?PrititOpt. . 

## Dougla s County-Omalia , N E

J9II 5 KJNTENELLE'S D

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 rCit y Owne r Stat e Owne rZi p 240208000 0 QUIN N KEVI N R 291 2 FONTENELL E B D OMAH A 6810 4

• 291 2 FONTENELL E BLV D OMAH A N E 6810 4 Sec-Twn-Rn g Additio n Bloc k Lo t Lega l 1 Lega l 2 Lega l 3 Lega l 4 Treasure r Websit e Un k Assesso r Websit e Lin k 08-15-1 3 VINELAN D 1 "' ^ 1 3 40X12 5

http://webapps.clotcoinm.org:8080/TreasTax/faces/page s /taxinfo.jsp?parc=240208000 0 http://clouglasne.mapping-online.com/DouglasCoNe/stati c /accountinfo.jsp?accountno=R240208000 0 Disclaimer : Ma p an d parce l dat a ar e believe d t o b e accurate , bu t accurac yi s not Ma p Scal e

## Pag e 1 o f

1

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### • YOU RTICKE T NUMBE RI S 2303584 . Origina l Cal l Date : 6/25/0 9 Time : 2:0 7 p m Op : SIVA1896 7 Wor k t o Begi n Date : 6/29/0 9 Time : 2:4 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 291 2 Street : FONTENELL E BLV D Twp : 15 NRng : 13 E Sect-Qtr : 08-NW-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : SOI L LEA D REMEDIATIONPROJEC 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)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 : EP A Dept h o f Excavation : 6 F T Corne r Lot : N Front : Y Rear : Y 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 , IN C HEID I Day : 402934046 9 Alt : 402934046 9 Emeig : 402932975 7 MUDO l METROPOLITA N UTILITIE S DISTRICT SANDY 

### Day : 402504782 3 Alt : 

### Emerg : 402504797 0 OMAHACO FCITY OFOMAHA-TRAFnC,SEWERRO N Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 0PPDGPR 5 OMAH A PUBLIC POWE RDISTRICT N A Day : 406728934 3 Alt : 406207149 4 Emeig : 888728934 3 QLNNE l C QWES T LOCA LNETWOR K N A Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

## L^ S E.NVIRONMEIMTA L & CGIMSTRUCTIO N 

### TECHNOLOGIES , INC . SOLUTION S 

# C D 

# Sit e Safet yHazar d Analysi s Address : Ji'i/' Z V^/^^^// ^ Date : ^-JlS - <y q



## Ite m Overhea dLine s 1 Gas Lin e Wate r Lin e Sewer Lin e Septi c / Leec h field Propane/Butan e Sidewalk Foundatio n Retainin g Wall s Fence s Tree s Structure s Drivewa y Sprinkle r System Othe r Cre w Forema n 

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## I ( K.t^ y /«,>'^« -



## Sit e Safet y Office r 

# .J k llLLLLl . 

# fi^^g /C ^ Co'^jz) ^ 808 0 War d Parkway , Suit e 40 5 KansasCity , M O 6411 4 Phone : (816 ) 363-370 3 250 5 N . 24" ' Street . Suit e 30 8 Omaha , Nebrask a 6811 0 Phone : (402 ) 504-100 4 424 2 Medica l Drive , Suft e 725 0 San Antonio , T X 7822 9 Phone : (210 ) 822-958 8 Pa y/mft \ r^K.-s-iTn ? Fax : (402)504-100 5 Fax : (210)579-657 7

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