'/ / • . 

### TRANSMITTA L o f OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 30siir ^ Date : ,1-10- 1 f^Jl Q S ^ ]^S>A\^ ^ 

### Address : :^7r> 7 K j [ ^ S'f
Remediatio n Contractor : J^-^T^Krfm'-Ut^nqifK. . \N C . J Year : ^^8-i>>» ? SOI L REMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S 0 ^ Vide o of propert y (DVD ) . — ^ Bxecuaves TM ,^J|| a ^ EPA-provide dpropert y skrtc h """flfpS ' B ^ Signe dAcces s Agreemen t fo r

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

adjacen t propert y 0^ Restoratio n Agreemen t B Settlemen t document s (i.e. , fo r

damag e or t o replac e plants , etc. ) 0 ^ Confinnatio n data H ' Photograph s B ^ As-built sketch 0 ^ Satisfector y restoratio n signedby Propert y Owne r 0 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 13

^ Propert y infonnatio n fromDougla s Count y Assessor' s Office D D D



### ., . Pi•^ ^ M^ ^ ^2£^ ^ Signature/ * Dat eTECHNOLOGIES b IN C 

# EP A Propert y Clos e Ou t Propert y # : 3ao1' 0 Propert y Address : 370* 7 A j I'^sr
Date/Time : Owner' s Name : Quad s Excavated : Bo. ; D"2- > Fo . y Gf i Contracto r Grou p Pruden t Technologie s Excavatio n Genera l 

### Ye s Ji o 1 .If necessary , wer e th e correc t quadrant(s ) excavatedan drestored ? 2 .I f necessary , wer e th e correc t area s o f dri p zone excavatedan drestored ? Gradin g Sodan dVegetatio n Ye s No 1 .Doe s th e grading aroundth e perimete r ofth e hous e i n excavatedarea s generall y slop e awa y 1 ^ fro mth e house ? 2 .

Ha s so dbee n lai di n al l area s tha t wer e excavated ? 7 ^ 3 .

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

y tim e period ) 

# \ y 4 .Ar e soddedarea s generall y fir man devenl y graded ? 5 .Ar e th e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e if inspecteda t a3 0 da y tim e period) 6 .

Was th e propert y grade dsuc h tha t wate r will not poo l o n th e property ? 

# V' ­ 7 .

Was damage t o landscaping o r plan t material s avoided ? 

# V Gates , Fence s an dRetainin g Wall s Ye s yN b 1 .

D o gate s ope n an dclos e fi-eely? (I f applicable ) 

## i / 2 .

Wer e al l gate s or fence s taken dow n during restoratio n activitie s reinstalled ? (I f applicable ) 3 .

Wa s damage t o gate s o r fence s avoided ? (If applicable ) 4 .Wa s damage to retainin g wall s avoided ? (If applicable ) 

### i / Foundation , Sidin g an dGutter s Ye s ^N o 1 .Wa s damage t o th e siding o r trimavoided ? 2 .

Was damage to th e foimdatio n avoided ? 

# V / ­ 3 .

Was damage t o window s avoided ? 

# }^ Z 4 .

Was damag e t o window s o r doo r screen s avoided ? 

# ^ Z 5 . Was damage to downspouts o r downspou t extension s avoided ? 

# 1 7 Sidewalk s an dDriveway s (Concrete ) Yes/^ o 1 .

Wa s damage to drivewa y surface s avoided ? 

## • y 2 .

Wa s damage t o walkwa y surface s avoided ?

### Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complet e including the 30-da y so dyarra^ty : l u u o^uvai& aV/UIIIUICIIE ; uiciuuiii ^ ui c ju-ua y au u waiiaiiiy . 

### EP A Representativ e

### PROPERT Y SUMMAR Y DiM» ; miMOS mQmah aLea A Sit e Remedial Actio n Contrac t '#EP-R7-Q7-06/Q(M) 4 Month.of: I>ec/Ian . Propert y Address : 370 7 N 1 9 S T 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 Othe r Relevan t Infonnation : NON E CONFIRMATIO N SAMPLIN G DATA/RESUETS : D Z = 107 PP M @ 13" ; B 2 = 22 0 PP M @ 6" ; F 2 = 129 PP M @ T' ; E A = 14 6 PP M @ SCRAPE ATTACHMENT S 1 ) Propeit y sketch provide dby EP A pursuan t t o 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 clip/photograph s 4 ) Post-Excavation digita l vide o clip/photogr^h s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Buil t sketch
i) . Shall , includ e final lead-levd s v) . Leg&ad. ii ) Contamination lef t behindarea s vi ) Contracto r identification iii ) Properly addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s to b e include din th e individua l propert y file, i f available , or obtaine dinclude : i ) Pre-excavatio n agreemen t detail s (i f an y ar e mad e wit h the propert y owner ) ii ) Propert y Statu s For msignedb y propert y owne r iii ) Excavation digita l vide o in MPEG , WM V (Window s Medi aVideo ) or SW F(Flas h Player ) forma t and/o r photogr^h s iv ) Signedfor mverifying satisfactor y restoratio n v ) Descriptio n o f area s no t meetin g InterimROD cleanu p criteria .

TECHNOLOGIES , INC .Fin d Recor d I Qea n U p Quer y Lea d Remainin g Quer yI Backfill : .r;-..«*«%j-^.^-'^r?;-"^'^'':-'--,-- -

Sampl e Area : 3254 0 - 370 7 N 1 9 S T Owner : 

### Resident : D Owne rOccupied Residen t Name : Owne rName : |NER O DORTH Y JCOLEMANGIZ A Propert yAddress : Owne rAddressl : )3707 N 19S T Zi p Code : ^••n-T-vr- ; :::•;•;•:,-•; . v;-^--.-^/ ' Owne rAddress2 : 16811 0 |370 7 N 1 9 S T Residen t Phon e City : State : Zi p Code : 

# I JOMAH A |N E {6811 0 Owne rPhone : Alternat e Phone : | j(402 ) 933-276 6 |(314 ) 517-860 8 Propert yDamage Quer y

Contract : Contractor : PRUDENT2008_ S Group : Assessment : Qualifyin g Grou p NORT H Assessmen t XR F Date : 

# I Assessmen t MaxXR F Value : 747.4 2

## Propeil yComptetio n Agreemen t Thi s agreement 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 indicate s that th e propert y owne r i s satisfie dwith th e restoratio n ofth e subjec t property , an dthat n o item s are in question , now , o r at any tim e i n th e future , excludin g any remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y ID : Propert y Address : ^ - 7 p- ] / ^ j / ^ " ^ S' ^ 

## 0^"'^ = ni±jQ rCLUv^Aifr^ Phone : 

# ^^o; r - i50'J ~ ~ ^^H 5 Restoratio n Item s i n Question : 

### SOXL/ ^ aa-h ^ mc;S/i) U IT P Vay\Oiir \ < K 1 < i - ^ Item : ^ ^ , t i n hactd^Dtdr d Item : ' 

# 7 Item : Item : Item : 

### Require dcorrection s t o complet e th e property : 

## ^ I r e^u ^ ^(i. e ^^K'-t i O p ^ 

## iCcd^ K s ^ 

## Op^LJ?
- ^ 5o 4 * i-ovce . 

# T I3a c K^f l \ire i Gaf-e . 

## prof^ ^ W x »^8»^ 3 Q ^

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 com|:^ete d 

# /a/^^//) ^ Dat ePruden t Technologies , Ine . (Prudent ) is unde r contrac t wit h th e U. S. Environmental Protectio n Agenc y (EPA ) to clean up lead
contaminate dsoil s at anumbe r of

propertie s locate d in Omaha , Nebraska , includin g th e property locate dat

. Th e EPA request s you r permissio n to allo w Pruden tto perfor masoi l cleanu p at thi s property to remov e lead-contaminate dsoil . By signin g this form , th e property owne r grant s permissio n to Pruden t to perfor m activitie s relate d to th e cleanu p includin g soi l sampling , removal of lead-contaminate dsoil , an drestoratio n ofth e reference dproperty . If

yo u hav e an y question s abou t th e soi l cleanu p planne dfor you r property , pleas e contac t Pruden t Administrativ e Cler k fo

r th e Omah aLeadSit e cleanup . Ms . Dcboral\Johnso n -a t (402 ) 733-1188 . General question s abou t th e Omah aLeadSit e cleanu p ca n be directe d to th e EPA Publi c Informatio n Center s at (402 ) 731-3D45/Sout .Jl-3D45<;South Omah a of ffice ) or (402 ) 991-9583 (Nort h Omah aoffice) . ,..- , Property Acces s Grante d 

# By Y^Qi:F. aC .handle ^ I \i . ff r \ft (Pleas e Prin t Nagie ) Property Ovme r Signatu i (Datfe ) PROPERT Y INFORMATIO N (T o be complete d byresiden t and/o rpropert yowne r~ pleas e print ) RESIDEN T NAME : Owne r Rente r RESIDEN T ADDRESS : 

# R^ Ov^.v.vJ ^ ^U

_ Q, tlVt ) 37<?' 7 lO LA 4v IF RENTAL , PROPERT Y OWNE D BY : ^ OWNER' S MAILIN G ADDRESS ;
OWNER' S TELEPHON E NUMBER - HOME : WORK :
AG E OF HOME? : YEARS . HO W LON G HAV E YO U LIVE D HERE ? YEARS . HA S TH E EXTERIO R BEE N PAINTE D OR COVERE D WIT H SIDIN G SINC E 1978 ? YE S NO 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 NUMBER OF CHILDRE N UNDE R 7 YEAR S OL D WH O PLAYIN TH E YAR D FO R 5 HOUR S OR MOR E PE R WEEK : COMMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. ]

AUTHORIT Y FO RENVIRONMENTA L RESPONS E ACTIONS : Th e activitie s to be implemente d by EPA unde r this agreemen t ar e pursuan tto Sectio n 10 4 of CERCLA , 42 U.S.C . 9604 . EPA' s righ t of

acces s to th e propert y is provide dfo r in Sectio n 104(e ) of CERCLA , 42 U.S . C 9605(e) , whic h provide s entry fo r "determinin g th e nee dfo r response , or choosin g or takin g an y respons e actio n unde r thi s title , or otherwis e enforcin g th e provision s of th e title. "

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 KansasCity , MO 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

### AS-BUIL T DRAWIN G ^ OMAHA LEA D SUPERFUND SITE . OLS« : 32S4 0 Dat e Excavated : 12/09/200 8 USEP A Signed-OfTDate : 

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CONTRA a # : E P - R7-07-0 6 / 000 4 PRUDEN T TECHNOLOGIES , INC .EINVIRONMENTA L & CONSTRUCTIO N 

### ,CHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : ^^o l ^ V.'^ ^ ^ ^ Date : Phone : BVID : Ite mN O Plant s & Permanen t Landscapin g T o Remai n I n Plac e O n Ma p Descriptio n & Locatio n t F / n

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leaking ? Ye s N o / 

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Propert y Owne i / ] f j y^den t Employ ! Signature :

8080 Ward Partway , Suit e 40 5 250 5 N . 24* ^ street , Suit s 30 8 4242 Medica l Drive , Suit e 425 0 Kansa s City , MO 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , 1X7822 9 Phone : (816) 363-3703 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-3707 Fax : (402)504-100 5 Fax : (210 ) 579-6577

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### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s Count.. . 11/19/200 8

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### • YOU RTICKE T NUMBE RI S 2178792 . Origina l Cal l Date : 11/19/0 8 Wor k t o Begi n Date : 11/21/0 8 Time : Time : 4:5 1 p m 5:1 5 p m Op : MADHURIMA1 8 96 7 State : N E Address : 370 7 County : DOUGLA S Street : N19T H S T Place : OMAH A Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 03-SW,10-N W Sect-Qtr : Typ e o f Work : lea d remediatio n projec t 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 Alt . Contact : Phone : Phone : (402)733-118 8 (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 : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V * MAGELLANMUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Servic e Are a Contac t Phon e Numbe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C 

### HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MAGELLA N MAGELLA N MIDSTREA M PARTNER S L P TONY A 

### Day : 918574709 8 Alt : 

### Emerg : 918574709 8 MUDO l METROPOLITA N UTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : 

### Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R 

### RO N Day: > 402444719 7

Alt : 402444516 1 Emerg : 402444516 0 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 11/19/200 8

### Pag e 2 of 2 Day : 406728934 3 OPPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T NA 

### Alt : 888728934 3 Emerg ::406728934 3 Day : 406728934 3 QLNNEI C QWES T LOCA L NETWOR K N A 

### Alt : Emerg : ; 888728934 3



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