## TRANSMITTA L of OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : ^I^ Q Date : n \j ^.-jjr^t^ ^ Address : 

## ,^-70 8 H 4-p-«4Yf? . Remediatio n Contractor : fh^DC•r^l / f^rUt^ir^ f

^qf^.^ . INC. , 

### Year : A,3V^« - /4K^ ^ 

### SOI L REMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S Vide o o f propert y (DVD ) Executiv e Summar y / 

### EPA-providedpropert y sketch SignedAcces s Agreemen t fo r

subject propert y D 

### SignedAcces s Agreement(s ) fo r

adjacen t propert y Restoratio n Agreemen t E T 

### Setdemen t document s (i.e. , fo r

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

### Confirmation data Photograph s As-built sketch Satisfiactor y restoratio n signedby Propert y Owne r 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 Utilit y clearance s Propert y infomaation fromDougla s Count y Assessor' s Office D D D 

### Signatu^ ^ 

# •^^^^'fe 4031126 1 

# iinuiHiii i Superfun d

### PROPERT Y SUMMAR Y Datg ; na^ai ml Omali aLea dSite RemcAU l AcitiQiiLCQiitcactt f EP-R7-O7-0.6/0.Q.q4 . I MQftt h Q t Vt^i m Propert y Address ; 270 8 N 4 5 AV 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 Odie r Relevan t Information : NON E CONFIRMATIO N SAMPLIN G DATA/RESULTS : D Z = 10 4 PP M @ 13" ; F l = 9 4 PP M @ 6" ; F 2 = 9 0 PP M @ 6" ; E A = 11 5 PP M @ SCRAPE ATTACHMENT S 1 ) Propert 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-Excavation digita l vide o clip/photogr^h s 4 ) Post-Excavation digita l vide o clip/photograph s 5 ) Documentation - CompletedClose-ou t Cheddis t 6 ) As-Buil t sketch ­ i ) Shall includ e final leadlevels . v ) Legen d ii ) Contamination lefi : behindarea s vi ) Contracto r identification iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e includedin th e individua l property , file, i f available , o r obtainedinclude : i ) Pre-excavation 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 i n MPEG , WM V (Window s Medi aVideo ) or SW F(Flas h Player ) forma t and/o r photograph s iv ) Signedfor mverifying satisfactoiy restoratio n v ) Description o f area s no t meeting hiteri mROD cleanu p criteria .

TECHNOLOGIES , INC .- - Fin d Recor d Backfill :

Sampl e Area : 212 8 - 270 8 N 4 5 A V Owner : D Owne rOccupie d Owne rName : JALLISO N SCOT T D Owne rAddressl : Owne rAddress2 : [270 8 N 4 5 AV E aty : State : Zi p Code : |OMAH A |N E J |6810 4 Owne rPhone : Alternat e Phone : 1(402)880-422 1 

## 1 • Clea n U p Query Lea d Remainin g QueryI

Resident : Residen t Name : |RESIDEN T Propert yAddress : |2708N45A V Zi

p Code : |6810 4 Residen t Phon e 

# I Propert yDamag e Quer y

Contract : Contractor : (PRUDEIVT2008_ S Group : 

# I- - Assessment : Qualifyin g Grou p |800/CHILD _ Assessmen t XR F Date : 

# I -

__ _ Assessmen t MaxXR F Value : I 110 8TECHNOLOGIES , IN C 

# &BV K EP A Propert y Clos e Ou t Propert y # : SlSf % Propert y Address : o?7o 8 Nl^SA' ^ Date/Time : Owner' s Name : Quad s Excavated : XJ-z. y f^ O F5- y ^f t Contracto r Grou p Pruden t Technologie s Excavatio n Genera l Ye s m 1 .Ifnecessary , wer e th e correct quadrant(s ) excavatedan drestored ? 

# t r 2 .

If necessary , wer e th e correct area s of dri p zone excavatedan drestored ? Gradin g Sodan dVegetatio n Ye s T» o 1 .Doe s the grading aroun dthe perimete r ofth e hous e i n excavatedarea s generall y slop e awa y fromthe house ? 2 .

Has so dbee n laidmall area s tha t wer e excavated ? 3 .

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

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

## i y ' 5 .

Ar e the joint s betwee n the sodstrip s generall y tight? (Onl y evaluat e if inspecteda t a3 0 da y tim e period) 6 .Wa s the propert y gradedsuc h tha t wate r will no t poo l o n the property ? ^ ' J ­ 7 .

Wa s damage to landscaping o r plan t material s avoided ? ^ ^ Gates , Fence s an dRetainin g Wall s Ye s J4 o 1 .D o gate s ope n an dclos e freely? (IfappUcable) 

## y 2 .

Wer e all gate s o r fence s taken dow n durin g restoratio n activitie s reinstalled ? (If applicable) ^ 3 . Wa s damage t o gate s o r fence s avoided ? 0 f applicable ) 

# ^1 7 / . 4 .

Wa s damage to retaining wall s avoided ? (If applicable ) Foundation , Sidin g an dGutter s Ye s No 1 .

Wa s damage to the siding o r trimavoided ? ^' ­ 2 .

Wa s damage to the foundation avoided ? 3 .

Wa s damage to window s avoided ? t / 4 .Wa s damage t o window s o r doo r screen s avoided ? 

# 1?^ . 5 .Was damage t o downspouts o r downspou t extension s avoided ? 

# ly ' / L Sidewalk s an dDriveway s (Concrete ) Ye s ^ 0 1 . Wa s damage t o drivewa y surface s avoided ? 

# y\ / 2 . Wa s damage to walkwa y surface s avoided ? 

### L y

### Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s cpmplp^ e iiicluding th e 30-da y so dwarranty : EP A Representativ e l\Jyh ./J^l^i-T^^^-t.^^ " Date : ( / ^ / ^ (12-19-'0 8 16:5 4 FROM-Avanta s 402-717-777 9 T-28 9 P001/00 2 F-29 0 

# SEP A Propert y Completio n Agreemen t TThi s agreement documcat s di e completio n o f roinova l ootivide s peifbnne do n th e belo w Ustedpiopeity . Th e propert y o'«haer' 8 signatui e in^ctte s tha t th e propert y owne r i s satisfie dwid i th e restotaTio n o f ^ subjec t property , an dtha t n o item s ar e i n question , now , o r a t an y tim e i n th e Aiture , eocdudlng an y remainin g wonrant y (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y uy . tK^f^KtjAMtmu : :?'7o ^ ^ 0 MS>* ^ A-oc ^ Owner : 

### Utfc a /iV.t\cr^ / Scof f A\U<^r . Phone : 

### ^oa > g9 o . - M22. I Raatoratto n Itonu i i n caiestion :

Rem : Ham : Item : Item : RaquiradconactfonntDoompfaC a th a proparty : .

I agre e restoration i s compietttd , excep t a s note d above . L J I d o no t agre e restoratio n i s oomplete d

nr i SifBalar e

eOO/ZOO d«idgi;p o gOO ; L l 93 Q -.m- iPruden t Technologies , Inc . (Prudent ) i s unde r contrac t witi i tli e U . S . Environmenta l Protectio n Agenc y (EPA ) t o clean up lead contaminate dsoil s a t anumbe r ofpropertie s locate di n Omaha , Nebraska , includin g th e property locate da t

. Th e EPA request s you r permissio n t o allo w Pruden t t o perfon n asoi l cleanu p a t thi s property t o remov e lead-contaminate dsoil . B y signin g this form , tli e property ovmer 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 dpropeity . I f 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 for th e Omah aLea dSite cleanup , Ms . Deboral i Johnso n -a t (402 ) 733-1188 . 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 ) 731-304 5 (Sout h Omah aoffice ) o r (402 ) 991-9583 (Nort h Omah aoffice) . Property Acces s Grante dB ; ( ^ (Pleas e P Prin t Name ) Property Owne r Signature : I d J (Siinamre ) A ' < PROPERT Y INFORMATIO N (T o b e complete d b yresiden t and/o rpropert yowne r~ pleas e print ) RESIDEN T NAME : Owne r Rente r RESIDEN T ADDRESS : 

# M^> < A^ ^ /^v-^^pot ^ KJ^.QB i 0 y IFRENTAL , PROPERT Y OWNE D BY:/ N . / ^ 

# T - OWNER' S MAILIN G ADDRESS ; OWNER' S TELEPHON E NUMBE R - HOME : _L WORK :



# i^( ^ ^Yh " ^^-^ f AG E O F HOME? : 

## {(/ V 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 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 FORENVIRONMENTA L RESPONS E ACTIONS : Th e activitie s t o b e implemente db y EPA 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 dfo r i

n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic h provide s entry for "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 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 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 7212 8 

### ^ - :.//.AS i BlIlM^ORiCVVINa . ^v;M '^fK- \ •••.•',-'r.- » ' .'y.!.-^,'-' - '-;.''"'}»'''•''• ' '•••• • ••."'•"'• • *"'^f ( 

## ^^'^diVt^EtAiJEAkfeEifelSl ^ OLS# : 212 8 Dat e Excavated : 11/26000 8 USEP A Signed-OffDate :

DJifio rPain t MarthAa w Onnt M LM d stt e SfteSlnte h • Qoo d B'Poo r 8«npaMlAllllre«»;270eW45A V • HctpaB t Sanfil e Sampia s CoBeo M Simpl e Numbe r LA B Conoontnlifl n Cdtocte d Wnw-PCTir, , PPT l RYA8CPX>M12 8 F l 

### D Me:.lf2illa L RYB$CPW^«2 8 F 2 _iXOfl__Pp m 

## o r nme : ^.'0 ^ P M 

### D RYC8CPX^2t2l B B l Sompl«sAiiai| ^ RVD6CPXA-212 8 B 2 2^Z 7 w m 

## a R0ZSCPXA^2 S D Z 

### D xwFUili t fi,Sa&_Boefc22ft . RG2SCPXAn212 B O Z _3Sa_pp m 

### D Dat e / a >Q A -^g g 

### nreacpx^2t2 B P Z —LadL-PP m 

## a Thna : fl«o 8t«lt_J!3SL i Nuwbwo(Swip>as=i ( 7 I ( Q \ 

### D Legml : Fl ' Fnm t Lett . F 2 =.Fron t regM. B l •• Bx k Laft . B 2 » Bac k Rigli t O Z » Oi « Zdne . G Z - Gantai . P Z > Pta ; M ^Mi4aM d tan VwftoMt . taiiQ nnni % rf—J C Jt—*FT~ *

• E A = 11 5 PP M @ SCRAP E

CONTRAC T # : E P - R7-07-0 6 / 000 4 PRUDEN T TECHNOLOGIES , IN C• SNVIRONMENTA L & 

# »RUDEN ' CONSTRUCTIO N 

### TECHNOLOGIES, ] SERVICE S 

# Propert y Statu s For m Address : 5"lo g l O M 5 ^ A^^-e . Date : Phone : BVID : Ite mN O Plant s & Permanen t Landscapin g T o Remai n I n Plac e O n Map Descriptio n & Locatio n 

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Propert y Owne r Pruden t Emplo ; Signature s Signature: ^ 

## /{^^'^AI— ^

808 0 War dParkway , Suit e 40 5 2S0 S 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 AntonicT 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

## 212 8 Exterio rPain t Nott h Ane w 

### Omah a Lea d Sit e • Goo d 

### Sit e Sketc h CfPoo r Samplin g Address : 270 6 N 4 5 A V Q Notpeint Sample . Numbe r Lead Sampl e . Sample s Collecle d LA B Concentratio n Collecte d 

### Fimi : p c IH C PPT \ RYASCPXA-212 8 F l pp m 

## D Date : jJaHlO g RYBSCPXA-212 8 F 2 pp m 

## D Time : ^••Q ^ P H RYCSCPXAr212 8 B l pp m 

## D Sample s Analyze d RYDSCPXAr212 8 B 2 pp m 

# n RDZSCPXA-212 8 O Z pp m 

## D XR F Unit : /n^^f l Bool e 77<r > RGZSCPXA-212 8 G Z pp m 

# n Date : / O -Q ^

-Q g RPZSCPXA-212 8 PZ . 

# o r pp m Time : fl<o Staff : <nst ^ Ni«nl»e ro f Samples=jj2_ j . } Q j Legend : F 1 = Fron t Left , F 2 = Fron t Right , B l - Bac KLeft , B 2 - Bac k Rigli t O Z - Dri p Zone , G Z = Garden ; PZ - Pla ; A

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## 2040i i KANSA S CITY . M O 641 1 1 1 ^ (816)363-370 3 f i

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Parce l I D Owne r Nam e Property Addres s at y Zi p Owne r Addres s Owne r Addres s 2 Owne r Cit y Owne r Stat e Owne r Zi p 081166000 0 ALUSO N SCOT T D 270 8 N 4 5 AV OMAH A 6810 4 270 8 N 4 5 AV E OMAH A N E 6810 4 Sec-Twn Rn g Additio n Bloc k Lo t Legal l 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 CLAIRMON T 4 1 2 N45F T 45X12 5

http:/Awebapps.dotcomm.org:8080/rreasTax/faces/pages/taxinfo.jsp ? parc=081166000 0 http://douglasne.mapping online.com/DougIasCoNe/static/accountinfo.jsp ? accountno=R081166000 0 Disclaimer : Ma p an d parce l dat a are believe d t o b e accurate , bu t accurac yi s not Ma p Scal e guaranteed . Thi s i s not a lega l documen t an d shoul d no t b e substitute d fo ra titl e search , 1 inc h = 2 6 fee t appraisal , survey , o rfo rzonin g verification . 

### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s Count.. . 11/20/200 8

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### . YOURTICKE T NUMBE RI S 2179298 . Origina l Cal l Date : 11/20/0 8 Time : 10:5 2 a m Op : MADHURIMA1 8 96 7 Wor k t o Begi n Date : 11/24/0 8 Time : 11:1 5 a m State : NE County : DOUGLAS Place : OMAH A Address : 270 8 Street : N45T H AVE Twp : 15 NRng : 13 E Sect-Qtr : 08-NW-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lead 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 . Contac t Phone : (618)401-222 3 Wor k Being Don e For : ep a Dept h o f Excavation : 6 f t Corne r Lot : NFront : Y Rear : Involve s Tunneling o r Horizonta l Boring : NExplosives : N CXCAT V

MCLEODNE MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Servic e Are a Contac t Plion e Numbe r Utilit y Typ e n^rn A T^ / CXCAT V CO X COMMUNICATIONS , ^ ^ HEID I 

### Day : Alt : 402934046 9 402934046 9 Emerg : 402932975 7 MCLEODN E MCLEODUS A N O NEE D T O CAL L OU T EMERGENC Y 

### Day : 800289190 1 Alt : Emerg : 800289190 1 MUDO l METROPOLITA N UTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO F CIT Y O FOMAHA TRAFFIC,SEWE R RON 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.. . 1 1 /20/200 8

### Pag e 2 of 2 Day : 406728934 3 noor./ - D D ^ OMAH A PUBLI C POWE R 

### Alt : 888728934 3 Emerg : 406728934 3 0PPDGPR5 DISTRICT ^ ^ 

### •Day : 406728934 3 QLNNEIC QWES T LOCA L NETWOR K

N A 

### Alt : 

### Emerg : 888728934 3

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