SAiD# : 3380 1 

### Ti^NSIVIITTA L O F OIVIAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R DATE : 1/1 5 ADDRESS : 161 8 SPRAGU E S T REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES . INC . YEAR : 20l t 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S d PR E AN D POS TVIDE O O F PORPERT Y(DVD ) E J EXECUTIV E SUMMAR Y d EPA-PROVIDE D PROPERT YSKETCH d SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN TPROPERT Y d RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R TO REPLAC E PLANTS , ETC. ) d CONFIRMATIO N DAT A PHOTOGRAPH S 0 AS-BUIL TSKETCH SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R ^ PROPERT YCLOSE-OU TCHECKLIS TSIGNE D B YEP A D DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A

• UTILIT YCLEARANCE S I D PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E D D D

SIGNATUR E DAT E 3021838 8 

# lIH I Superfun d

### PROPERT Y SUMMAR Y Date : /15/201 0 Oinah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Propert y Address : 161 8 SPRAGU ES 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 Infomiation : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS :

B l = 24 7 PP M @ 2" ; E A = 28 2 PP M @ SCRAP E(~1" ) ATTACHMENT S 1 ) Property sketc hprovide db y 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 n digita l vide o clip/photograph s 5 ) Documentatio n - Complete dClose-ou t Checklis t 6 ) As-Bui hsketch i ) Shal l includ e final lea dlevel s v ) Legen d ii ) Contaminatio n lef t behin darea s vi ) Contracto r identificatio n iii ) Property addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e include di n th e individual property file, i f available , o r obtainedinclude : i ) Pre-excavatio n agreement detail s (i f an y ar e mad e withth 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 o f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOCIES , INC .Fin d Record Remediatio n Quer y Lea d Remainin g Quer yPropett yDamag e Quer y 

### Backfill :

Sampl e Area : 3380 1 -161 8 SPRAGU E S T Owner : Use rProvide d Owne rInformatio n

• Owne rOccupie d Owne rName : Owne rName : JANDERSO N J R GEORG E C Owne rAddressl : 

# r Owne rAddress : Owne rAddress2 : J160 4 SPRAGU E ST City : (OMAH A State : 

## IN T Zi p Code : {6811 0 

### City : State : Zi p Code : 

# 1 Owne rPhon e 1(402 ) 453-186 8 

# I Alternat e Phone : Owne rPhone : Alternat e Phone :

Contract : Assessment : Contractor : PRUDENT201 0 S Qualifyin g Grou p |40 0 Contrac t Optio n JOPTIO N 2 Assessmen t Ma xXR F Valu e 

### 495.4 1 Resident : Residen t Name : 

# r—TM " Propert yAddress : J161 8 SPRAGU E S T Zi p Code : J68110 - Reslden t Phon e

# y^^,Xy\Q/0^ TECHNOIXDGIES , INC . 

# EPA Property Clos e Ou t Propert y # : "^ ^ ^ ^ ^ Propert y Address : )^1^%^2>'^' ^ Date/Time : Owner' s Name : ^^^Of^e^A^^d^Tf- o ^ Quad s Excavated : B V Contracto r Group : Pruden t Techiniologics , Unc , Excavatio n Genera l Ye s N o 1 .I f necessan' . wer e th e correc t quadrant(s ) excavate dan drestored ? / 2 . I f necesscirv' . wer e th e correc t area s of dri p zon e excavate dan drestored ? 

# y Gradin g So dan dVegetatio nYe s N o 1 .Doe s th e gradin g aroun dtli e perimete r of th e hous e i n excavate darea s generall y slop e away 

# y fromth e liouse ? 2 .Ha s so dbee n lai di n al l area s tha t wer e excavated ? 

# y o .Doe s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e if inspecte da t a3 0 day lim e period ) / 4 .Are sodde darea s generall y firman devenl y graded ? 

# y 5 .

Are di e joint s betwee n tli e so dsuip s generall y tight ? (Onl y evaluat e if inspecte dat a3 0 da y tim e period ) 

# y 0 .Wa s th e propertA ' grade dsuc htlia t wate r wil l no t poo l o n tli e property ? 

# y 7 . Wa s damag e t o Lindscapm g o r plan t material s avoided ? 

# y Gates , Fence s an dRetainin g WalS s Ye s N o ! . 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 take n dow n diuin g restoratio n activitie s reinstalled ? (I f applicable ) 

# y 3 . Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) 

# y 4 . Wa s dainag e t o retainin g wall s avoided ? (I f applicable ) 

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

# y 2 . Wa s damag e to th e foundatio 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 dainag e to downspout s o r downspou t extension s avoided ? 

### y < • Sidewalk s an dDriveway s (Concrete ) Ye s N o I Wa s damag e l o drivewa y surface s avoided " Wa s damag e t o walkwa y surface s avoided ? ^

## Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complete includin g th e 30-da y so dwarranty . EP A Representativ e "'^T ^ ^Date: \^\'" ^ '^^

# m t'HNOLOGlES . INC . OL S #338(1 1 Dat e Excavated : 11/02/201 0 IISEP ASigned-OffDate : 

### A S - BUIL T DRAWIN G OMAH A LEA D SUPERFUN D SIT E 3380 1 Exterio rPain l Nort h Arro w Omah a Lea d Sit e Owne rName : GEORG E C ANDERSO N J R • Goo d Sit e Sketc h Address : 161 8 SPRAGU E S T • Poo r

Phone : H : V53 - /<?* & W : • No t pain t 

# i

Lea C Sampl e Sample s Collecte d Sampl e Numbe r Concentratio n Collecte d LA B Fir m 

### f D AfiTf rA f RYASCPXA~3380 1 F l pp m 

### \ y D Dat e RYBSCPXA-3380 1 F 2 pp m 

# \ y D Tim e RYCSCPXA-33aQ 1 B 1 _!i251pp m 

### D Sample s Analyze d RYDSCPXA-3380 1 B 2 I l" 7 pp m 

### % D nD2CCrxA-300Q 1 - 0 2 ~ pp m 

# n D XR F Unit : Id-Z l Book ; /2 ? nOZGCPXA-OJOO l S € J^ ^ pp m 

### D D Date : 

## e-/i>-os - nPZSGPXA'3300 1 P £

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# n D Time : f/I O Staff : Numbe ro f Sample s = ^ 

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# W ^? 5 11 7 B2 . B l = 24 7 PP M (w , 2 " 

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A =28 2 PP M (qj . S C RAP E(~1" ) CONTRAC T# : EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC .

# 6ERI V Propert yCompletio n Agreemen t Thi s agreemen t documents the completionof remova l activitie s performe do nthe belo w listedproperty . Th e propert y owner' s signatur e indicate s tha t the propert y owne r i s satisfiedwit hthe restoratio nof the subject property , an dtha t no items ar e i nquestion , now , o r a

t an y tim e i nthe fiiture , excluding an y remaining warrant y (3 0 day s total ) except thos e item s liste dbelow , if any . Propert y ID : Propert y Address : //y f 2 

## J^J^fU - Owner : f^^^,.^ ^ d^tsJS-OA j 

### Phone : yojL . jTg ^

^Sf^t > Restoratio n Item s in,Question :

Item : 

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

B I agre e restoratio n i s completed . LJ I d o no t agre e restoratio n i s complete d a t (note d deficiencie s above )



## yu<^c^yd^^*^- ^ 

# M ^ . / ^ Owner's^ignature Dat e

### T?rnvcilC>i:;3F> , !V: ; S'rudenl Technologies , Inc . ^V'vudent ) i s unde r contrac t withth e U . S . Environmenta l Protectio n Ageiic y (EPA ) to clean u p load contaminalg p so ^ a t anumbe r ofpropertie s locate di n Omaha , Nebraska , includin g th e property locate da t jlOj/ i D^^^QtLA't ' Th e EP A request s you r permissio n ( o allo w Pruden t t o pertbm i asoi l cleanu p a t thi s prop'eriy't o remov e lead-contaminate dsoil . B y signin g thi s form , th e property owne r grant s permissio n t o Pruden l to pertbrm activitie s relate dt o th e cleanu p includin g soi l sampling , remova l o f lead-contaminate dsoil , an drestoratio n o f h e reference dpropert y Ifyo 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 l • .; : '• • Ib r th e Omah a Lea dSit e cleanup , a t (402 ) 733- 1 188; 733-1455 . Genera l question s abou t th e Omah aLeadSit e cleanu p can b ; directe dl o th e EPA Publi c Informatio nCenter s a t (402 ) 731-304 5 (SouthOmah aoffice) . Property Acces s Grante dB y 

## ^^—^A<^*^ - y j >^ ^ ^ -^/t^g/L ^ ^ (Pleas e Prin t Name ) Property Owne r Signature ­ 

# yLy^^^ ij^l- ^ (Signature ) (Date ) PROPERT Y INFORMATIO N (T o b e complete db y residen t and/o r propert y owne r - pleas e print ) RESIDEN TNAME : Ovi/ne r P.ente r 

# Up - RESIDEN TADDRES S 

# y^rt2:± ^ I F RENTAL , PROPERT YOWNE D BY : OWNER' S MAILIN G ADDRESS ; 

## /iffof ^ 'y^^^-'^^^yy(y— 

# ffeP r

^f: ^ 0^ 0 OWNER' S TELEPHON E NUMBE R - HOME : WORK : 

### J

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# ,..yy . AG E O F HOME ? EARS . HO W LON G HAV E YO U LIVE D HERE ? EARS . 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/^^Q_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 EPA .mde v thi s iigreemeni ar e pursuan t t o Sectio n10 4 ofCERCLA , 4 2 U S.C . 9604 . EPA' s righ t ofacces s to th e property i s provide dtb " i n Sectio n 104(c ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry fo r "determinin g th e nee dfor response , o r choosin g o r takin g any respons e actio n unde r thi s title , o r otherwis e enforcin g th e provision s ofth e title. "

SOS O War M P.-.i:Kvv,--,y . Kansa s Cit y.Vi C P;.J 'ENVrRONMENTA L \ CONSTRLfCTlO N 

### TECHNOLOGIES , INC . SKRVI(i: S 

# Propert y Statu s For m Address : /^/ /

"GfK/^G^ ^ Date:/^^/ ^ 7/^ 0 Phone : ^^^ . ^^^ Q BVID : ggJ^Q /

' O y::X/n^y>/A ^ yA/2-e/ i ^ ^ 

# fe-/ £" . x^. ^ \// ? r £ 

# C 2^ 5 o ^ o

Prudent Employe e Signature : 808 0 War d Parkway , syit e 40 S 560 0 S 1 0 S t 424 2 Medica l Drive . Suit e 425 0 Kansa s City , M O 64 1 Omaha , Nebrask a 6810 7 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402 ) 733-118 8 Phone : (210)822-958 8

# 3380 1 Exterio rPain t Nort h Arro w 

### Omah a Lea d SK e Owne rName : GEORG E C ANDERSO N J R • Goo d 

### Sit e Sketc h Address : 161 8 SPRAGU E S T • Poo r 

### Pho^B^^S^^J A Q Not pain t 

# i Sampl e Numbe r RYASCPXA-3380 1 RYBSCPXA-3380 1 RYCSCPXA-3380 1 RYDSCPXA-3380 1 nDZCCP)( A3300 1 ROZOCPXA-3300 1 RPZSCPX A3300 1 F l F 2 B l B 2 -P Z Lea d Sampl e Sample s Coifecte d LA B Concentratio n Collecte d 

### Firm : ffiA ftTff C:\y ^ pp m 

# \y n Date : OpJ!0[d 5 pp m 

# n Time : ^'.J 5 

# i n pp m % 

# D Sample s Analyze d pp m 

# n pp m XR F Unit : 

### ICi l Book : /Z ? 

# D pp m 

# n Date : 

# D 

# n pp m 

# D Time : Staff : 

## L A Numbe ro f Sample s = . ^



### pt^AGiU g Omah aLea dSit e 4613 0

## N 

# 161 8 SPRAGUEST : 50.3 3 X 9 0 

# A &U I 

### Printed : De c 10.201 0 www.dcgis.org/dogi s i

### i'ag e 1 ot 1

Creat e Anothe rTicke t Bac k to Irt h Interne t Sen d Emai l 

### YOURTICKE T NUMBER IS 2628305 . Origina l Cal l Date : 10/28/1 0 Time : 8:3 0 am Op : SIVA1896 7 Wor k to Begi n Date : 11/01/1 0 Time : 9:0 0 am State : NE County : DOUGLA S Place : OMAH A Address : 161 8 Street : SPRAGU E ST Twp : 15 NRng : 13 E Sect-Qtr : 03-SE-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e of Work : omah a soi l rememediatio n projec t Locatio n of Work : LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)733-188 3 Compan y: PRUDENT TECHNOLOGIE S Contac t Name : SIV AJAMPAM A Phone : (402)733-118 8 Wor k Bein g Don e For : EPA Dept h of Excavation : 6F T Corne r Lot : Y Front : Y Rear : Y Involve s Tunnelin g or Horizonta l Borin g : N Explosives : N CXCAT V

MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Servic e Are a Contact Phon e Numbe r Utility Typ e 

### Day : 402934046 9 CXCAT V COX COMMUNICATIONS , INC 

### lElD l Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUDOl METROPOLITA N UTILITIE S DISTRIC T Y SAND Alt : 

### Emerg : 402504797 0 Day : 402444719 7 OMAHACOFCITY OFOMAHA-TRAFFIC.SEWE R RICH/TRAFFI C Alt : 402444516 1 

### Emerg : 402444516 0 Day : 406728934 3 0PPDGPR 5 OMAH A PUBLIC POWE RDISTRIC T EL M LOCATINGAlt : 406207149 4 

### Emerg : 888728934 3 Day : 406728934 3 QLNN E

1C QWES T LOCA LNETWORK 

### EL M LOCATIN GAlt : 406207149 4 Emerg : 888728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 10/28/201 0l,IN C 

### CONSTHUCTIO N TEOHN l 

### lOLoams , SOLUTION S



## SIT ESAFET Y HAZAR D ANALYSI S Address : --../^L-^-v:«L-^>.lt l Excavatio n Date : Crew : Backfil l Date :

Ite m Conditio n Hazard s Correctiv e Actio n Overhea dLine s CP(< - 

## Ga s Lin e 

# e ^ Wate r Lin e 

# (h^ ' Sewe r Lin e y j 

## Septic/Leec h Fiel d Propane/Butan e - — 

## Sidewal k ore - Foundatio n a/' ^ Retainin g Wall s

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## Fence s pcc ^ Tree s CP« ^ 

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### seoosios t 424 2 Medica l Drive , Suit * 725 0 lama * Gtty ; M04411 4 Ontite k NelifaAk a «8t0 7 Sa n Antonio , T X 7822 9 iKMia ; (81< ) 363i^37B 3 Phono : {402)733-113 8 Phone : (2t0 ) 82Z-«58 8 ax : (Vn ) 363-4T0 7 i=te : 4402)733^108 3 Fax : (210 ) «T«-65 n

# IU)l O e^PRAau e S r 

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