SAID# : 3275 6 

### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R DATE : 1/1 5 ADDRESS : 244 8 MA N PERSO N S T REIVIEDIATIO N CONTRAaOR : PRUDEN TTECHNOLOGIES . INC . YEAR : 201 ^ 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S C l PR E AN D POS TVIDE O O F PORPERT Y(DVD ) 1 3 EXECUTIV E SUMMAR Y m EPA-PROVIDE D PROPERT YSKETC H

• SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN TPROPERT Y \ ^

RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R T O REPLAC E PLANTS , ETC. ) 0 CONFIRMATIO N DAT A m PHOTOGRAPH S m AS-BUIL TSKETC H d SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R rf PROPERT YCLOSE-OU TCHECKLIS TSIGNE D B YEP A n DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A i UTILIT YCLEARANCE S d PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E D D D 

## Qc^-^ y il^l n SIGNATUR E ­ DAT E 

### 3021758 7 Superfun d

### PROPERT 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 ; 244 8 MANDERSO NS 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 NSAMPLIN GDATA/RESULTS : B 2 = 17 5 PP M @ 4" ; E A =7 7 PP M @ SCRAP E(~1" ) ATTACHMENT S 1 ) Property sketc hprovide dby EP A 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 n digita l vide o clip/photograph s 4 ) Post-Excavatio ndigita l vide o clip/photograph s 5 ) Documentatio n- Complete dClose-ou t Checldis t 6 ) As-Built sketc h­ i ) Shal l includ e fma l lea dlevel s v ) Legen d ii ) Contaminatio nlef t behin darea s vi ) Contracto r identificatio n iii ) Property addres s vii ) Date iv ) BVI D numbe r 7 ) Othe r item s t o b e include di nth e individual property file , ifavailable , o r obtaine dinclude : i ) Pre-excavatio n agreemen t detail s (ifan y ar e mad e wit hth e property owner ) ii ) Property Statu s Formsigne db y property owne r 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 satisfactory restoratio n v ) Descriptio n ofarea s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOGIES , INC .Fin d Record Remediatio n Quer yI Lea d Remainin g Quer yI Propert yDamag e Quer y 

### Backfill :

Sampl e Area : 3275 6 ­ 244 8 MANDERSO N S T Owner : Use rProvide d Owne rInformatio n Resident : n Owne rOccupie d Owne rName : INEIGHBORHOO D AC T& FAC TCO M I N Owne rAddressi : |C/ 0 JOH N ABUTLE R Owne rAddress2 : |257 6 EVAN S ST City : JOMAHA Owne rPhon e 

# 1 State : Zi p Code : |N E |68111 - Alternat e Phone : 

# 1 Owne rName : 

# 1 Owne rAddress : 

# 1 City : 

# 1 Owne rPhone : 

# 1 " State : Zi p Code : 

# 1 1 Alternat e Phone : 

# 1 Residen t Name : 

# I Propert yAddress : |244 8 MANDERSO N S T Zi p Code : |68111 - Residen t Phon e 

# I

Contract : Assessment : Contractor : JPRUDENT2010_ S Qualifyin g Gi^u p |46 o Contrac t Optio n JOPTIO N 2 Assessmen t Ma xXR F Valu e | ~ 484.5 9;• :|. : ...' , .CAi.:..^vcJi..y:^.X r i/r.^-;;^, . TECHNOLOGIES . INC . vlnui-. U 

# EP A Propert y Clos e Ou l Propert y # : ^'Z7f ^ Propert y Address : ^^^^T ^ AW.'l^r^ ^ Date/Time : Owner' s Name : ^\ WiAiA\ K

3

> Quad s Excavated : <^- ^ Contracto r Group : Pnnden t Technologies , Unc , Excavatio nGenera l Ye s N o I .

i f necessarv . wer e th e correc l quadrant(s ) excavate dan drestored ? 

# A 2 .I f necessars' . wer e th e correc t area s o f dri p zon e excavate dan drestored ? / Gradin g So dan dVegetatio n Ye s N o 1 .Doe s th e gradin g aroun dtli e perimete r o f th e house i nexcavate darea s generall y slop e awa y / fro mth e liouse ? 2. " Ha s so dbee n lai di n al l area s tha t wer e excavated ? / 3 .

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

# y day (ime period ) 4 .Ar e sodde darea s generall y fir man de\'enl y graded ? 

# y 5 .

Are Ui e joint s betwee ndi e so dsuip s generall y tight ? (Onl y evaluat e i f inspecte dat a3 0 day tim e period ) / 6 .Wa s th e property ' grade dsuc htlia t wate r wil l no t poo l o nth e property ? 

# X 7 .

Wa s damag e t o landscapm g o r plan t material s avoided' ' / Gates , Fence s an dRetainin g Wall sYe s N o 1 .D o gate s ope n ^m dclos e freely ? (Ifapplicable ) 

# y 2 .Were al l gale s o r fence s take ndow ndiuin g restoratio nactivitie s reinstalled ? (I f apphcable ) ^ 3 . Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) 

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

# y Foundation , Sidin g an dGutter sYe s N o 1 .Wa s damag e t o th e sidin g o r tri mavoided ? 

# y 2 .Wa s damag e t o th e fomidatio navoided ? 

# y y ^ • ^ 3 .Wa s damag e t o window s avoided ? ^ 4 .Wa s damag e t o window s 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 W;i s cifiniage l o drivewa v surfece s avoided ? 

# ~ y Wa s damag e t o walkwa y surface s avoided' ? 

# -y r

## Owner s comments :

Inspectio nnotes :

Remova l andrestoratio nactivate s complete includin g th e 30-da y so dwarranty : EP A Representativ e "'^^* 7 Date : n\\H\i c

# M CHNOLOUIES , INC . 

### A S - BUIL T DRAWIN G OL S #3275 6 Dat e Excavated : 10/27/201 0 

### OMAH A LEA D SUPERFUN D SIT E USEP A Signed-Of f Date : 

### 3275 6 Exterio rPain l Omah a Lea d Sit e Owne rName : NEIGHBORHOO D ACTIO N & Sit e Sketc h • Goo d Address : 244 8 MANDERSO N S, T • Poo r Phone : »f57
- ^<? f I W- ^ [ 3 Not pain t Lea d Sampt e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : _£M__^ ^ /

'^ ^ - h RYASCPXA-3275 6 F l 

### 23 2 pp m 

### D Date : »?-/" j RYBSCPXA-3275 6 F 2 J2 ^ pp m 

### D Time : _AC>~^ _ RYCSCPXA-3275 6 B 1 pp m 

# n 3A L Sample s Analyze d RYDSCPXA-3275 6 B 2 

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# n XR F Unit : /03 7 Book ; 

## iZ ± nogscPX A aa?66—6£ - pp m D 

### D Date : .RPgSCPX A 3276 6 P ^ pp m D 

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## J.A .

Oniat u Lea dSite E A = 7 7 PP M @ SCRAP E (-1" ) 461J 0 CONTRA a # : EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC .

# SEF W Propert yCompietio n Agreemen t Thi s agreement document s th e completion 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 nofth e subjec t property , an dtha t n o item s ar e in question , now , o r at any tim e in th e fiiture, excludin g an y remainin g warranty (3 0 day s total ) excep t thos e item s liste dbelow , ifany . Property ID : Propert y Address : ^HC/ ^ HO^V K



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A^cJ^^P^ ^ Restoratio n Item s i n Question :

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

I agre e restoratio n i s completed. : I d o no t agre e restoratio n i s complete d a t note d deficiencie s abov e



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Pniden t Technologies , Inc . (Prudent ) i s under contrac t wit hth e U . S . Environmental Protectio nAgenc y (EPA ) t o clean up lead
contaminate dsoil s at anumbe r o f

propertie s locate dinOmaha , Nebraska , includin g th e property locate dat • Th e EP A request s you r permissio n t o allo w Pruden t t o perfor masoi l cleanu p a t this property t o remove lead-contaminate dsoil . B y signin g thi s form , th e property owne r grant s permissio nt 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 nofth e reference dproperty . tf

yo u hav e any question s abou t th e soi l cleanu p planne dfo r you r property , pleas e contac t Pruden t Sout hOmah aOffic e fo r th e Omah a Lea dSit e cleanup,_a t (402 ) 733-1188 ; 733-1455 . General question s abou t th e Omah aLea dSit e cleanu p ca nb e directe dt o th e EP A Publi c hiformatio nCenter s a t (402 ) 731-304 5 (Sout hOmah aoffice) . Property Acces s Grante dBy : ^ ^Af i l^ j UjyAA y (Pleas e Prin t Name ) Property Owne r Signature : SpQ.^^ ^ /• / ^^c/'<^-^< ^ f A<S—^B— / ^ I (Signature ) / G (Date ) PROPERT YINFORMATIO N / \

(T o be complete d b yresidep t and/o rpropert yowne r~ pleas e print ) RESIDEN TNAME : Rente r RESIDEN TADDRES S 

# \J\s ^ 

# 6 ? I I I F RENTAL , PROPERT YOWNEDIBY : i i . \
OWNER' S MAILIN G ADDRESS ; . 

# a . OWNER' S TELEPHON E NUMBER - HOME : J L WORK :



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- /O l 1 , 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 NO 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 ar e pursuan t t o Sectio n 10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f

acces s t o th e property i s provide dfor i

nSectio n104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry for "detenninin g th e nee dfo r response , o r choosin g o r 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 Ward^Parkway , Suit e 40 5 560 0 S . 10* ^ Stree t 424 2 Medica l Drive , Suit e 425 0 KansasCity , MO6411 4 Omaha , Nebrask a 6810 7 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)733-145 5 Phone : (210)822-958 8ENVIRONMENTA L& CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : ^HH ^ (J^JK^^Jf^U^- ^ '^**'
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Propert y Owne r Signature : /^^Ul ^ 808 0 War d Parkway , Suit e 40 5 KansasCity , M O 6411 4 Phone : (816 ) 363-370 3 Fax : (816 ) 363-370 7 

## Aid ) 560 0 S 1 0 S t Omaha , Nebrask a 6810 7 Phone : (402)733-118 8

Fax : (402)733-188 3 Medica l Drtve , Suit e 425 0 Sa n Antonio , TX 7822 9 Phone : (210)822-958 8 Fax : (210 ) 579-657 7

## 3275 6 Exterio rPaint Nort h Arro w 

### Omah a Lea d Sit e rOwne rName : NEIGHBORHOO D ACTIO N 

### & Sit e Sketci i • Goo d Address : 244 8 MANDERSO N ST 

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YOU RTICKE T NUMBE RI S 2624623 . Origina l Cal l Date : 10/23/1 0 Time : 11:3 6 a m Op : SIVA1896 7 Wor k t o Begi n Date : 10/27/1 0 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 244 8 Street : MANDERSO NS T Twp : 15 NRng : 13 E Sect-Qtr : 03-SW,04-S 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 : 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 : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N ALT87 2 CXCAT V MUDO l OMAHACO F OPPDGPR S QLNNEI C

Servic e Are a Contac t Phon e Numbe r Utilit y Typ e Day : 406728934 3 ALT87 2 WINDSTREA M COMMUNICATIO N EL M LOCATIN G Alt : 406207149 4 Emerg : 888728934 3 Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEIDI Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUDO l METROPOLITA N UTILITIES DISTRICT SAND Y Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y OFOMAHA-TRAFFIC.SEWE RRICH/TRAFFI C Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 10/23/201 0

### Pag e 2 of 2
OPPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T Alt : 406207149 4

EL M LOCATIN G Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K Day :

EL M LOCATIN GAlt : 406728934 3 406207149 4 Emerg : 888728934 3

http://www.dlion.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 10/23/201 0ENVIRONMENTA L & CONSTRUCTIO N TECHNOLOGIES , INC . SOLUTION S 

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