## TRANSMITTA L o f OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAm# : jCU l Date : Address : ^^CfLC f

H'^^C ^ ^iu A Remediatio n Contractor : fy^2,^4

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### Vide o o f propert y (DVD ) Executiv e Summar y EPA-providedpropert y sketch SignedAcces s Agreemen t fo r

subject propert y SignedAcces s Agreement(s ) fo r

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

damag e o r

t o replac e plants , etc. ) Confirmation data

Photograph s As-built sketch Satisfector y restoratio n signedby Propert y Owne r Propert y close-ou t chec k

lis t signedby EP A Descriptio n o f area s not meeting RO D cleanu p criteri a Utilit y clearance s 

### Propert y information fromDougla s Count y Assessor' s Office

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### Signature^I ? " bat e 4031070 7 

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### PROPERT Y SUMMAR Y Dat« : 01/23/200 9 Oinah aLea dSite Remedial Actio n Contrac t #EP-R7-07-06/0004 Mont h of Dec/Ja n Propert y Address ; 2404 HANSCO M BLV D A EXECUTIV E SUMMAR Y A. 1 Issue s Encountere dNON E A. 2 Issue s Resolved
. NON E A. 3 Uniqu e Findings : NON E A. 4 Othe r Relevan t Infomiation
. NON E CONFIRMATIO N SAMPLIN G DATA/RESULT S B l = 3 0 PP M @ 6" ; B 2 = 37 3 PP M @ 6" ; D Z = 14 6 PP M @ 13" ; F l = 14 3 PP M @ 6" ; EA = 20 2 PP M ©SCRAP E ATTACHMENT S 1 ) Propert y sketch provide db y EP A pursuan t to contract specification s 2 ) SignedAcces s Agreemen t including acces s agreement s require dfo r crossing othe r propertie s 3 ) Pre-Excavatio n digita l vide o chp/photograph s 4 ) Post-Excavatio n digita l vide o chp/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Built sketch ­ i ) Shal l include final lea dlevel s v ) Legend ll ) Contamination lef t behm darea s vi ) Contracto r identificatio n m ) Propert y addres s vn ) Dat e iv ) BVI D numbe r 7 ) Othe r item s to b e mcludedmth e mdividua l propert y file, i f available , o r obtamedmclud e i ) Pre-excavatio n agreemen t detail s (i f an y ar e made wit h th e propert y owner ) il ) Propert y Statu s For msignedby propert y owne r Ul ) Excavation digita l vide o in MPEG , WM V (Window s Medi aVideo ) or SW F(Flash Player) forma t and/o r photograph s iv ) Signedfor mvenfym g satisfactor y restoratio n v ) Descriptio n o f area s no t meeting InterimROD cleanu p cntena .

TECHNOLOCIES , INC
.Fin d Record Clea n U p Query Lea d Remainin g QueryI Propert yDamag e Quer y Backfill :

Sanipl e Area : 1686 7 - 240 4 HANSCO M B D Owner :
n Owne rOccupie d Owne rName : |JONE S A W Owne rAddressl : 

# r Owne rAddressZ : 1240 4 HANSCO M BLV D City : State : Zi p Code : [OMAH A INE " 6810 5 Owne rPhone : Alternat e Phone : |(402 ) 344-268 5 | " Resident : Residen t Name : JONE S A WALLAC E Propert yAddress : |240 4 HANSCO M B D Zi p Code : |6810 5 Residen t Phon e 

# I Contract : Contractor : jPRUDErn2008_ S Group :
Assessment : Qualifyin g Grou p |800/CHIL D Assessmen t XR F Date : 

# I Assessmen t MaxXR F Value : 

### I 8i STECHNOLOGIES , IN C 

# EP A Propert y Clos e Ou t Propert y # : 166^ 1 Propert y Address : cfiUo^ f / i WK M <r o msn;- D Date/Time : Owner' s Name : Liate/iime : f , ^ ^ Contracto r Grou p Pruden t Technologie s Quad s Excavated : Bl / B2
- y X > Z . ,^ f" ' ^ ^ « Excavatio n Genera l Ye s N o 1 If necessary , wer e th e correct quadrant(s ) excavatedan drestored* ? / 2 If necessary , wer e th e correc t area s o f dn p zon e excavatedan drestored* ? 

# y Gradin g Sodan dVegetatio n Ye s N o 1 Doe s the gradm g aroun dth e perimete r ofth e hous e i n excavatedarea s generall y slop e awa y fromthe house* ? / 2 Has sodbee n lai dmal l area s tha t wer e excavated* ? / 3 Doe s th e sodappea r to b e generall y health y an dgrowmg* ? (Onl y evaluat e i

f mspecteda t a3 0 da

y tim e period) / 4 Ar e sodde darea s generall y fir man devenl y graded* ? / 5 Ar e th e jomt s betwee n the so dstrip s generall y tight* ? (Onl y evaluat e i f mspecteda t a3 0 da y tim e period) / 6 Was th e propert y gradedsuc h tha t wate r will no t poo l o n th e property* ? / 7 Was damage to landscapm g o r plan t material s avoided* ? / 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 Wer e al l gate s o r fence s taken dow n dunn g restoration activitie s remstalled* ? (If applicable ) 

# y 3 Wa s damage t o gate s o r fence s avoided* ? (I f applicable ) 

# y 4 Wa s damage t o retamm g wall s avoided* ? (I f apphcable ) 

# y Foundation , Sidin g an dGutter s Ye s No 1 Wa s damag e to th e sidm g o r trun avoided* ? 

# y 2 Wa s damage t o the foundatio n avoided* ? 

# y 3 Wa s damage to window s avoided* ? 

# y 4 Wa s damage to wmdow s o r doo r screen s avoided* ? 

# y 5 Wa s damage t o downspouts o r downspou t extension s avoided* ? / Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 Wa s damage to drivewa y surface s avoided* ? / 2 . Wa s damage t o walkwa y surface s avoided* ? 

# y

### Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complet e including the 30-da y so dwarranty : EP A Representativ e 9c ^ iSL y Date : //g//^ji >

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n o f remova l activitie s perfonne don th e belo w liste dpropert y The propert y owner' s signatur e indicate s tha t th e propert y owne r i s satisfiedwit h th e restoratio n o f th e subject property , an dtha t n o item s ar e i n question , now , or a

t an y time in th e fiiture, excludm g an y remaming warrant y (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y ID : Propert y Address : ZHQ ^ UAA^6OO ^ 

### pi^iyi y Owner : 

### /^qy^/Zi ^ ^^.e^o^Jj^s ^ J ( 1 Phone : 

## 4/^- ^ ^^4^^^^^ ^ Restoratio n Item s i n Question :

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

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

# y^Aa<^/^P ^

Owner' s Signat i Dat ePruden t Technologies , In c (Prudent ) i s unde r contrac t with th e U S Environmental Protectio n Agenc y (EPA ) t o clean u p lead

contaminate dsoil s a t anumbe r o

f propertie s locate di n Omaha , Nebraska , includin g th e property locate da t 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 thi s property t o remove lead-contaminate dsoi l B y signin g this 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 , removal oflead-contaminate dsoil , an drestoratio n ofth e reference dproperty I f 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 Administraliv c Clci k for th e Omah aLeadSit e cleanup
. M s Deboral i Johnso n -a t (402 ) 733-118 8 General question s abou t th e Omah aLeadSit e cleanu p can b e directe dt o th e EPA Publi c Informatio n Center s a t (402 ) 73 1 -304 5 (Sout h Omah aofTice) o r (402 ) 99 1 -958 3 (Nort h Omah aoffice ) Property Acces s Grante d 

## BvRoW\Y \ vJ^Mg ^ (Pleas e Prin t Name ) Property Owne r Signatur e (Date ) 3PERTY INFORMATIO N (T o be complete d b yresiden t and/o rpropert yowne r—pleasepnnt ) RESIDEN T NAM E Owne r Rente r fi-^ RESIDEN T ADDRES S

I F RENTAL , PROPERT Y OWNE D B Y

OWNER' S MAILIN G ADDRESS ,
OWNER' S TELEPHON E NUMBER - HOM E _ L WOR K

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### ((To ^ AG E O F HOME' ' YEAR S HO W LON G HAV E YO U LIVE D HERE ' O YEAR S HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978 ? \y_yE S N O NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OL D NUMBER O F OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBER O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLA Y I N TH E YAR D FO R 5 HOUR S O R MOR E PE R WEE K COMMENT S O R SPECIA L INSTRUCTION S ( I E DOGS , ENTR Y GATES , ET C )

AUTHORIT Y FO RENVIRONMENTA L RESPONS E ACTIONS . Th e activitie s t o b e implemente db y EP A unde r this agreemen t ar e pursuan t t o Sectio n 10 4 of CERCLA , 4 2 U S C 960 4 EPA s righ t o f

acces s t o th e property i s provide dfo r i

n Sectio n 104(e ) o f CERCLA , 4 2 U S C 9605(e) , whic h provide s entry fo r "determinin 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 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 Phon e (816)363-370 3 Phon e (402)504-100 4 Phon e (210)822-958 8 Fa x(816)363-370 7 Fa x(402)504-100 5 Fa x(210)579-657 7

### AS-BUIL T DRAWIN G OMAH A LEA D SUPERFUN D SIT E OLS# : 168( 7 Dat e ExcJivated : 12«»/I»0 S USEP A Sigped-OfTDate :



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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 Cit y Owne r Stat e Owne r Zi p 090438000 0 JONE S A W 240 4 HANSCO M B D OMAH A 6810 5
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[ Creat e Anothe rTicke t ] [ Bac k t o lf| h Internet ^

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## YOU RTICKE T NUMBE RI S 2180219 . Origina l Cal l Dat e 11/21/0 8 Time : 2:3 1 p m Op : MADHUR I Wor k t o Begi n Dat e 11/25/0 8 Time : 3:0 0 p m State : N E County : DOUGLA S Plac e Address : 240 4 Street : HANSCO M BLV D Twp : 15 NRng : 13 E Sect-Qtr : 28-S W 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) 7 Alt . Contact : Phone : (618) 4 Wor k Bein g Don e For : ep a Dept h o f Excavation : 6 f t Corne r Lot : NFront : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : CXCAT V LEVEL 3 MUD0 2 OMAHACO F 0PPDGPR 6 QLNN E

Servic e Are a Contac t Phon e Nuinber utilit y Typ e 

## Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C 

## HEID I Alt : 402934046 9 

## Emerg : 402932975 7 Day : 877366834 4
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LEVEL S LEVEL S COMMUNICATIONS , LL C N A 

## Alt : Emerg : 877366834 4

MUD0 2 METROPOLITA N UTILITIES DISTRICT SAND Y 

## Day :

Alt : 

## 402504782 3 Emerg : 402504797 0
OMAHACO FCIT Y O FOMAHA-TRAFFIC.SEWE RRO N 

## Day : Alt : 

## 402444719 7 402444516 1 

## Emerg : 402444516 0
0PPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T N A 

## Day : 406728934 3

Alt : 888728934 3 

## Emerg : 406728934 3
QLNN E 1 FQWES T LOCA L NETWOR K 

## N A Day : 406728934 3

Alt : Emerg : 888728934 3
QWEST 2 QWES T LON G DISTANC E 

## SAR A Day : 800283423 7

Alt : 303992192 6 Emerg : 800283423 7

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. . 11/21/200 8