### TRANSMITTA L o f OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 22-3>7 7 Date : i Jn^J^ol ^ Address : li f 5 2. ^ /Ix y Remediatio n Contractor : nr^e.y r Ttu7..^y L fi^.^7^1nt . Year : p/^oT I SOI L REMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S 0 ' Vide o ofpropert y (DVD ) y Executiv e Summar y y EPA-providedpropert y sketch y SignedAcces s Agreemen t fo r

subject propert y D SignedAcces s Agreement(s ) fo r

adjacen t propert y y Restoratio n Agreemen t y Settlemen t documents (i.e. , fo r

damag e o r

t o replac e plants , etc. ) WConfiimation data y Photograph s y As-built sketch y Satisfector y restoratio n signedb y Propert y Ovvne r y Propert y close-out chec k

lis t signedby EP A D Descriptio n o f area s no t meeting RO D cleanu p criteri a 0 ' Utilit y clearance s y Propert y information fromDougla s Count y Assessor' s Office D D D 

### J^^^t ^ 3/ltl£r' i Signatmy*
­ ' Date 4031130 4 

# liiinniiini Superfun d

### I PROPERT Y SUMMAR Y 1 Date : 01/23/200 9 | Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-06/0004 Mond i of : Dec/Ja n | 1 Propert y Address : 721S25A V 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 Oflier Relevan t Information : ARE A NO T EXCAVATE D BRICK S 6'X2' , 6'X2 ' @ 31 7 PP M CONFIRMATIO N SAMPLIN G DATA/RESULTS : F l = 23 7 PP M @ 6" ; F 2 = 21 9 PP M @ 6" ; D Z = 46 0 PP M @ 13" ; B 2 = 13 7 PP M @ 6" ; B l = 28 7 PP M ( @ 6" ; E A = 224 PP M @ SCRAPE ATTACHMENT S 1 ) Propert y sketch providedby EP A pursuan t to contract specification s 2 ) SignedAcces s Agreemen t including acces s agreement s require dfo r crossing othe x propertie s 3 ) Pre-Excavation digita l vide o clip/photograph s 4 ) Post-Excavation digita l vide o clip/photograph s 5 ) Documentation - Comfdete dClose-ou t Checklis t 6 ) As-Built sketch ­ i ) Shall include final lea dlevel s v ) Legend ii ) Contamination lef t behindarea s vi ) Contracto r identification iii ) Propert y addres s vii ) 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 h th e propert y owner ) ii ) Propert y Statu s For msignedb y propert y owne r iii ) Excavation digita l vide o i n MPEG , WM V (Window s Medi aVideo ) o r SW F(Flas h Player) forma t and/or photograph s iv ) Signedfor mverifyin g satisfactor y restoratio n v ) Descriptio n o f area s no t meeting InterimRO D cleanu p criteria .

TECHNOLOCIES , INC .Fin d Record 

### Backnil :

Sampl e Area : 2237 7 - 72 1 S 2 5 A V Owner :
n Owne rOccupie d Owne rName : JGODBERSO N MARTI N Owne rAddressl : 

# r Owne rAddress2 : (810 6 CEDA R ISLAN D ROA D 

### City : State : Zi p Code : [OMAH A [N E [6814 7 Owne rPhone : Alternat e Phone : 

# r r Qea n U p Query lea d Remainin g QueryI Prapert yDamag e Quer y

Resident : Residen t Name : [ALLE N BENNET T Propert yAddress : j72 1 S 2 5 A V Zi p Code : [6810 5 Residen t Phon e 

# I " Contract : Contractor : PRUDEI^T2008_S Group : Assessment : Qualifyin g Grou p 

## Iso o /Assessmen t XR F Date : /Assessmen t MaxXR F Value : 103 2

# SEm w EP A Propert y Clos e Ou t For m Propert y # : 

## ^^31 1 Propert y Address : ~lo? ) - ^ o?5«Q' V Date/Time : Owner' s Name : ^ /; ' Quad s Excavated : Contracto r Grou p 'j^iPgr^- f T<"(i|-l»Nififf t <:j>i-S? Excavatio n Genera l Ye s N o 1 .

Ifnecessary , wer e the correct quadraQt(s ) excavatedan drestored ? 2 .

Ifnecessary , wer e tiie correc t area s ofdri p zane excavatedan drestored ? Gradin g Sodan dVegetatio n Ye s No 1 .Doe s the grading aroundthe perimete r of the hous e i n excavatedarea s generall y slop e awa y 

# y fit)mthe house ? 2 .

Has so dbeen lai di n al l area s tha t wer e excavated ? 

# y 3 .

Doe s the so dappea r to b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecteda t a3 0 

# 7 ^ da

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

# y 5 .Ar e th e joint s betwee n the so dstrip s generall y ti^t ? (Onl y evaluat e if inspecte da t a3 0 da y tim e period ) 

# y 6 .

Was th e propert y gradedsuch tha t wate r wil l no t poo l on fee property ? ^	 ' 

### 7 .

Was damag e t o landscapm g o r plan t material s avoided ? Gates , Fence s an dRetainin g Wal b Ye s No 1 .D o gate s ope n an dclos e fieely? 0 f applicable ) 2 .Wer e al l gate s o r fence s taken dow n during restoration activitie s reinstalled ? (If applicable ) 

# 7 ^ 7 z L 3 .

Was damag e t o gate s o r fence s avoided ? (I f applicable ) 

# 1 4 .Was damag e t o retainin g wall s avoided ? (IfappUcable ) Foundation , Sidin g an dGutter s Ye s No 1 . Was damage t o the isidin g o r trimavoided ? 

## y ' 2 . Was damag e t o tfa e foundation avoided ? 

# 7 ^ 3 . Was damag e t o window s avoided ? I/ ' 4 . Was damag e t o window s o r doo r screen s avoided ? 

# 7 ^ 5 . Was damag e t o downspouts or downspou t extension s avoided ? 

# 7 ' Sidewalk s an dDriveway s (Concrete ) Ye s ^No 1 . Was damag e t o drivewa y surfece s avoided ? 

# y y 2 . Was damag e t o walkwa y surfece s avoided ? 

# \ y

### Owner s comments :

Inspectio n notes :

Remova l andrestoratioiLactivate s complat e includin g th e 30-da y sodwarranty : EP A Representativ e N>X ^ Z^<^CA ^ 

### Date : /j J f f

'^^'(^ ^

# i . 9 » Propert yCompletio n Agreemen t Thi s agreemen t documents th e completion of remova l activitie s performedon th e below liste dproperty . Th e propert y owner' s signatur e indicate s tha t th e propert y owne r i s satisfiedwit h the restoratio n ofth e subject property , an dtha t no item s ar e i n question , now , o r a

t an y time i n th e future , excluding an y remaining warrant y (3 0 day s total ) except thos e item s listedbelow , i f any . Propert y ID : Propert y Address : / ^ ^ ( • 

# ^ p<;h V Sl
- L y iT ^ Owner : Phone : I 

### Restoratio n Item s i n Question :

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

10 ] 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 

# /j^7-^ y Dat ePruden t Technologies , In c (Prudent ) i s unde r contrac t wit hthe U S Environmental Protectio n Agenc y (EPA ) t o clean u p lead
contammate dsoil s at anumbe r ofpropertie s locate di n Omaha , Nebraska , includin g the property locate da t

. Th e EPA request s you r permissio n t o allo w Pruden t t o perfor masoi l cleanu p a t thi s property t o remov e lead-contammate dsoi l B y signin g thi s form, the property ovmer grant s permissio n t o Pruden t t o perfor m activitie s relate dt o the cleanu p mcludin g soi l samplmg , removal oflead-contaminate dsoil , an drestoratio n ofth e reference dpropert y If

yo u hav e any question s abou t the soi l cleanu p planne dfo r your property , pleas e contac t Pruden t Administrativ e Cler k fo

r the Omah aLeadSite cleanup . Ms . Deboral i Johnso n -a t (402 ) 733-118 8 General question s abou t the Omah aLeadSit e cleanu p can b e directe dt o the EP A Publi c Informatio n Center s at (402 ) 73 1 -3jHiiSout hOmaha^ffice^o r (402 ) 99, 1 -958 3 (Nort hOmah aoffice ) Property Acces s Grante dBy . [/ I P J ^ K f^r&'^ . rt^ytjl l fC ^ -'[^Pleas e Prin t Name ) Property Owne r Signatur e PROPERT Y INFORMATIO N I / (T o b e completedj w residen t and/o r propert y owne r ~ pleas e print ) 

# i^U. ^ ^7Z 7 7e,J L RESIDEN T NAME : Rente r RESIDEN T ADDRESS : « 

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- l \ vsL . I F RENTAL , PROPERT Y OWNE D BY : 

## >pd.AiUiL^ . OWNER' S MAILIN G ADDRESS ; 

### [ U 

## ^tA^jJL ^ fo ^ Cg ? ( o -^ OWNER' S TELEPHON E NUMBER - HOME : ( ^fl ) 1 Hi,-CiO l WORK : 

### J 1 AG E O F HOME? : 

### : /:? 3 YEARS . HO W LON G HAV E YO U LIVE D HERE ? 

## ? o , 6 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 CHILDRENUNDE R 7 YEAR S OL D WH O PLA Y I NTH 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 Y GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS E ACTIONS . Th e activitie s t o b e implemente db y EP A unde r thi s agreemen t are pursuan t t o Sectio n 10 4 o f CERCLA , 4 2 U S C . 960 4 EPA' s righ t o f

acces s t o the property i s provide dfo r i n Sectio n 104(e ) o f CERCLA , 4 2 U S C 9605(e) , whic hprovide s entry fo r "determinin g the 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 titl e "

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 , T X 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

# pllp^i* ^

OLS# : 2237 7 Dat e Eicavated : 11/25/200 8 USEP A SIpwd-OfTDate : 2237 7 Omah a Laa d Sit e Exterio rPain t Noit h Arro w Sit e Sketc h • Goo d B'Poo r Samplin g AddraM : 721S2SA V Q Notpaln t Sampl e Numbe r Lea d Concentratto n Sampl e Collecte d ^^ . ^ ^ Fimi : Sample s Collecte d fatw, p B 11 ) RYASCPXA-2237 7 RYBSCPXA-2237 7F l F 2 <i3 1 Ci H pp m pp m EJ '

Q ^ D n Date : £l£ic/£if L 

### Time : .aifidMi . RYCSCPX/^2237 7 RYDSCPXAr2237 7 B l B 2 __fi2i/L.PP m _Lfl32^pp m o r sy D D Sample s Analyze d RD2SCPXA-2237 7 D Z 382 a ppn o E T D XR F Unit : CBH O Book : 2( ? ROZSOPXA-ifflOT ? 6 Z pp m D D Date : fi-Zgr-CS nPgOOP}(A-Bg07 7 P Z pp m n D Time : _ftca _ Numbe ro f Sample s = [^5 ! | ^ [ Staff : rn5u; > Legend : F 1 = Fron t Left , F 2 « Fron t Right , 8 1 = Bac k Left , B 2 - Bac k Righ t OZ = Dri p Zone , G Z = Garden . P Z = Play M l quadrint i ar e a t rfawad fro m ttw sirsst , Mn g pnipot y .-JJl l 8 1 = 28 7 PPM ® 6 " W RDL K : ,o n U S i; 2 :B. \ 

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# i z fiiMLA&E 

### D2 » 3«i a D Z = 460PPM@13' <

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

### INC . 

# Propert y Statu s For m Add«ss : 7^ f S . Z5^ ^ ^^ ^ 0M7^H( ^ \] £a/O S ^^^^ , Phone : BVID : ILN V IRONMENTA L &

CONSTRUCTIO N SERVICE S 

# f/^/^-o r
Ite mN O Plant s & Pennanen t Landscapin g T o Remai n I n Plac e OnNfa p Descriptio n & Locatio n 

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leaking ? Ye s No Ite mN O Descriptio n & Locatio n O n Map

Propert y Owne r Pruden t Employ e

' Signature : V 

# ^'— M \ j 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 . T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210 ) 822-956 8 Fax:(816)363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7

## 2237 7 Omah a Lea d Sit e Exterio rPain t Nort h Anrow 

### Sit e Sketc h q|Goo d OlPoo r Samplin g Addres ! c 72 1 S 2 5 A V •igNo t pain t Lea d Sampl e Sampl e Numqe r bk B Concentratio n Collecte d RYASCPXA-22i7 7 F 1 pp m 

# m RYBSCPXA-22;;7 7 F 2 

### jSt2 J pp m 

## [ ] RYCSCPXA-22a7 7 B 1 

## Ji2j L pp m 

## [ ] RYDSCPXA-22;(7 7 B 2 

## [ ] RDZSCPXA-22;i7 7 D Z 

# ^sai a pp m 

# % y [ ] RO200PXA-22|)7 7 G Z pp m 

## U [ ] RrzocpxA-22:ffy—P E pp m 

## D [ ] Numbe rc f Sample s = | g " | ( \ Legend : F 1 = Fron^ Left , F 2 = Fron t Right , B l = Bac k Left , B 2 = Bac k Al l quadrant i ar e a s viewe d fro m th e street , i | Sample s Collecte d i | . oaiiipi e 

## FirmlfB: ^ Daty^i^Lj M 

## Timyi:(X)Ay \ 1 5 1 ^

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## Dougla s County-Omaha , N E

Parce l I D 142689000 0 Sec-Twn-Rn g Owne r Nam e PERALTA VICTO R P Additio n Propert y Addres s 72 1 S 2 5 A V Bloc k \cit y OMAH A Lo t Zi p 6810 5 Lega l 1 Owne r \ Addres s Lega l 2 Owne r \ Addres s 2 7 1 S 2 5 AV E Lega l 3 1 Owne rCit y OMAH A Lega l 4 Owne r \stat e N E Treasure r Websit e Lin k Owne rZi p 6810 5 Assesso r Websit e Lin k 21-15-1 3 1 JOHNSO N AD D REPLAT 0 9 8 5 F T SU B LT 2 & AL L SU B LT 3 O F 33.13X13 2 http://webapps.dotcomm.org:8080/TreasTax/faces/page s /taxinfo . jsp?parc = 142689000 0 http://douglasne.mapping-online.com/DouglasCoNe/stati c /accountinfo.jsp?accountno=R142689000 0 Disclaime rMap an d parce l dat a are believe d t o b e accurate , bu t accurac yi s no t guaranteed . Thi s i s no t a lega l documen t an d shoul d no t be substitute d fo ra titl e search ,
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### " > Create Anothe rTicke t Bac k t o Irt h Internet Sen d Emai l 

### YOURTICKE T NUMBERI S 2179296 . Origina l Cal l Date : 11/20/0 8 Time : 10:5 0 a m Op : MADHURIMA1896 7 Wor k t o Begi n Date : 11/24/0 8 Time : 11:1 5 a m State : N E County : DOUGLA S Place : OMAH A Adciress : 72 1 Street : S 25T H AV E Twp : 15 NRng : 13 E Sect-Qtr : 21-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n wor k fo r soi l 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 : MADHURIM A Phone : (402)733-118 8 Alt . Contact : Phone : (618)401-222 3 Wor k Bein g Don e For : ep a Dept h o f Excavation : 6 f t Corne r Lot : NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V LEVEL 3 MCLEODN E MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Utilit y Servic e Are aContac t Plion e Numbe r Typ e 

### Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , ^^^^ ^ 

### Alt : 402934046 9 IN C 

### Emerg : 402932975 7 Day : 877366834 4 LEVEL S LEVEL S COMMUNICATIONS , ^ ^ 

### Alt : 

### Emerg : 8773668344 Day : 800289190 1 N O NEE D T O CAL L OU T MCLEODN E MCLEODUS A 

### Alt : EMERGENC Y 

### Emerg : 800289190 1 Day : 402504782 3 METROPOLITA N UTILITIE S MUDO l SAND Y 

### Alt : DISTRIC T 

### Emerg : 402504797 0 http://www.dhon.org/irthinternet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.. . 11/20/200 8

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### Emerg : 888728934 3

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