## TRANSMTTTA Lo f OMAH A LEA D STT E SOI LREMEDLATIO NFIL EFOLDE R SAID# : 2M^4 ^ Date : /jf T Address : ^Ci?> N . ^ ^ R- f Remediatio nContractor : yvU^YV V fi.^^ ! \ ^ Year : cSc l D SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Q' Vide o o f propert y (DVD ) 0

^ Executiv e Summar y aEPA-provide dpropert y sketch 3 Signe dAcces s Agreemen t fot subjec t propert y D Signe dAcces s Agreement(s ) fo r

adja^«n t propert y 3 Restoratio nAgreemen t

• Settlement document s (i.e. , fo r

damag e or t o replac e plants , etc. ) aConfirmationdata Photograph s / 

## As-built sketch Satisfactor y restoratio nsigne db y Propert y Owner s f

Propert y close-out check lis t signe db y EPA D Descriptio no f area s no t meetin g RO D cleanup criteri a / Utilit y clearance s

I 

# i Propert y informationfromDougla s Count y Assessor' s OfBc e D D D 

## JSignattrr e Date 3026073 4 

# iiiliilii i Superfunc iFin d Record Remediatio n Quer yi Lea d Remainin g Quer yI Propert yDamag e Quer y 

### Backfill :

Sampl e Area : 2454 3 ­ 80 3 N 3 5 S T Owner : Resident : 

### Contract :

• Owne rOccupie d Residen t Name : Contractor : Owne rName : jZARDETTO-SMU H ANDRE AM |PRUDENT2009_S )ZARDETTO-SMIT H ANDRE AM Propert yAddress : Contrac t Optio n Owne rAddressi : |80 3 N 3 5 S T [OPTIO N 1 Zi p Code : Owne rAddress2 : [6813 1 Assessment : |80 3 N 3 5 ST Residen t Phon e City : State : Zi p Code : 

# I Qualifyin g Grou p [OMAH A |N E |6813 1 [40 0 Owne rPhone : Alternat e Phone : Assessmen t Ma xXR F Value : j(402 ) 614-576 5 )(402 ) 280-259 6 I 531. 6• • • •



### PROPERT Y SUMMAR Y Date : /15/201 0 [ Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 T0# 1 | Mont hof : C /^ P Propert y Address : 80 3 N3 5 S T A EXECUTIV ESUMMAR Y A. l 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 Information : NON E CONFIRMATIO NSAMPLIN GDATA/RESULTS : B l = 17 1 PP M ( g 13" ; D Z= 52 8 PP M % 13" ; E A = 15 7 PP M ( g SCRAP E(~1" ) ATTACHMENT S 1 ) Property sketc hprovide db y EPA pursuan t t o contrac t specification s 2 ) Signe dAcces s Agreemen t includin g acces s agreement s require dfor crossin g other propertie s 3 ) Pre-Excavatio ndigital vide o clip/photograph s 4 ) Post-Excavatio ndigital vide o clip/photograph s 5 ) Documentatio n- Complete dClose-ou t Checklis t 6 ) As-Buil t sketc h­ i ) Shal l includ e final lea dlevel s v ) Legen d ii ) Contaminatio nlef t behin darea s vi ) Contracto r identificatio n iii ) Property addres s vii ) Dat e iv ) BVI D numbe r 7 ) Other item s t o b e include dinth e individua l property file, i f available , o r obtaine dinclude : i ) Pre-excavatio n agreement detail s (ifan y ar e mad e withth e property owner ) ii ) Propertv
- Statu s Formsigne db y property owne r iii ) Excavatio n digita l vide o i n MPEG , WM V (Window s Medi aVideo ) o r SW F(Flas hPlayer ) format and/o r photograph s iv ) Signe dfor mverifyin g satisfactory restoratio n v ) Descriptio n ofarea s no t meetin g Interi mRO D cleanu p criteria .

T.EGHNOLOCIES , INC .'yy^^^y^'''' ' TECHNOLOGIIES , EvTC . Property* : /-•M''^? ' Date/Time : Quad. s Excavated : (6 > I , PZ _ 

# EP A Propert y Cflos e Om t Propert y Address ; ^' 0 3 /" V '5 b $ ^ OwTicr' s Name : ^iN^lr^i^. . '>"r n' Vx , ConlD-acfor Groiup : Pnu'lcn l T?clinologi(CS , Int. , Excavatio nGenera l Ye s No L

.I f neccssar\ . wer e lh e correc t qus,drant(s ) excavate dan drestored ? / 2 .If necessarv . wer e lh e correc t area s ofdri p zon e excavate dan drestored ? 

## y Gradin g So dan dVegetatio m Ye s No 1 Doe s Lli e gradin g aroun dth e perimete r o f th e house i nexcavate darea s generall y slop e awa y / fro mIh e house ? 2 .Ha s so dbee n lai din al l area s tlia t wer e excavated ? 

## y 3 .Doe s lh e so dappea r t o b e generall y healtli y an dgrowing ? (Onl y evaluat e if inspecte dat a3 0 da

y lim e period ) / 4Are sodde darea s generallj ' fir mfn devenl y graded ? 

## y 3 .Ar e lh e joinl s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e if inspecte da l a.3 0 day
lim e period ) 

# J 6 .Wa s lh e properl y grade dsuc htliat wate r wil l no t poo l o nth e property ? 

## y 7 .

Wa s damag e l o landscapin g o r pUm t material s avoided ? 

## 7 Gates , Fence* ; an dRetaimiin g Wall s Ye s No 1 D o gale s ope nim dclos e freely ? (If apphcable ) 1 / 2Wer e al l gate s o r fence s take ndovv n durin g restoratio nactivitie s reinstalled ? (I f applicable ) / .3 . Wa s damag e l o gale s o r fence s avoided ? (Ifapplicable ) / 4 .Wa s damag e l o retainin g wall s avoided ? (Ifapplicable ) / Foundation , Sidin g atid i Gutter s Ye s No \ . Wa s damag e l o th e sidin g o r tri mavoided ? / 2 .Wa s damag e l o lh e foundatio n avoided ? / 3 .

Wa s dnm;ig c (o window s avoided'? " 

## 7 4 .Wa s damag e l o window s o r doo r screen s avoided ? 

## 7 5 . Wa s damag e l o downspout s o r downspou t e.xtension s avoided ? 

## 7 Sidewaiki ; anr i Ri'ivt'way s (Coincrgtc ) I . W;i s diiiiiag c i o drivcwH y siirfHce s avoided'. ' • • • Ye. s / No 2 Wa s damag e l o walkwa y surface s avoided ? \ j

# 0,6 ^ N3 6 Sl -

Owner s comments :

Inspectio nnotes :

Remova l andrestoratio nactivate s complet e includin g th e 30-da y so dwarranty : EP A Representativ e •^c.^J ^ Date : 12/17/0^s;:^3s?i . 

# DRU D 15 . 

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n o f removal activitie s performe do nth e belo w liste dproperty . Th e property owner' s signatur e indicate s tha t th e property owner i s satisfie dwit hth e restoratio n o f th e subjec t property , an dtha t n o item s ar e in question , now , o r at an y tim e in th e fiiture , excludin g any remainin g warranty (3 0 day s total ) excep t thos e item s liste dbelow , ifany . Propert y ID : Propert y Address : o ^ <- ^ 

## K ) ?> ^ 

# ^ K 0^°^'- = (\^Ar^ n cao^ A V-'L Phone : Restoratio n Item s i n Question :

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

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

Date 

# 1 f yH IPruden t Technologies , Inc . (Prudent ) is unde r contrac t wit hth e U. S. Enviromnenta l Protectio n Agenc y (EPA ) to clea nup lead
cpntargjnate dspilsatajjurabe r of propertie s locate d in Omaha , Nebraska , includin g th e property locate dat flO J / v J O .^j T ' . Th e EP A request s you r permissio n to allo w ftiident to perfon n asoi l cleanu pat this 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 perfon n activitie s relate dto th e cleanu p includin g soi l sampling , remova lof lead-contaminate dsoil , an drestoratio n of

th e reference dproperty . If

yo u hav e an y question s abou t th e soi l cleanu p planne dfo r you r property , pleas e contac t Prudent' s Adminislniiiv e Clei k fo

r th e Otnah aLea dSit e cleanup . Ms . Si\ a S. .l^imiianii-a t (402 ) 733- 1 ISS . General question s abou t th e Oinah aLea dSit e cleanu p ca nbe directe dto th e EPA Publi c Infonnatio n Center s at (402 ) 731-304 5 (SouthOmah aoffice ) or (402 ) 991-9583 (NorthOmah aoffice) . Property Acces s Grante dBy : 

## X //ndn/ y TjQurlp-ri? ^ -S/vw^j-Jx (Pleas e e Prin

Prin t t Name ) Propert y Owne r Signature : leas 

# k 1//V^ y (Date ) PROPERT Y INFORMATIO N (T o be complete dby residen t and/o r propert y oinie r —pleas e print ) RESIDENT NAME : /l/^clr€ ^ ^/^J/"^ 0 SfV\l-f'l l ^OwneT ) Rente r RESIDENT ADDRES S 

# f o J 

# li/, 3 f Si
IF RENTAL , PROPERT YOWNE D BY :
OWNER' S MAILIN G ADDRESS ; 

## Sa/TTd y 

# Ho^S^\-iV5 3 cee// ) OWNER' S TELEPHON E NUMBER - HOME : WORK : 

### J 1 AG E OF HOME? : 

# IO O YEARS . HO W LON G HAV E YO U LIVE D HERE ? 

# IO YEARS . HA S TH E EXTERIO R BEE N PAINTE D OR COVERE D WIT H SIDIN G SINC E 1978 7 yYE S NO NUMBEROF OCCUPANT S UNDE R 7 YEAR S OLD : 

### 3: O NUMBEROF OCCUPANT S 7 YEAR S OL D AN D OLDE R 

# a NUMBE R OF CHILDRE N UNDE R 7 YEAR S OL D WH O PLA Y IN TH E YAR D FO R 5 HOUR S OR MOR E PE R WEEK : COMMENT S ORSPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s to be implemente dby EP A unde r this agreemen t ar e pursuan tto Sectio n 10 4 ofCERCLA , 42 U.S.C . 9604 . EPA' s righ t of

acces s to th e property is provide dfor in Sectio n 104(e ) of CERCL A42 U.S . C 9605(e) , whic hpro\ide s entr> ' fo r "determinin g th e nee dfo r response , or choosin g or takin g an y respons e actio n under this title , or 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 KansasCity , MO 6411 4 Omatia , 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(«(>iNmi«li;CjT?IO N 

### TECHNOLOGIES , INC . 

# Propert y Statu s Form Address : ^"^ 3 /. ^ J^ ' $</

- 

# D..e : 9'li-£> 9 Ph„e : '£>i-m'l'/^ 3 BVID : Sy^rV ? ^=^^^^^—^^^~—;^^^^—^^^^—»—^—^^—-—^ — —.. . . 

### Ite mN O Plant s & Permanen t Landscapin g T o Remai nI nPlac e O nMa p Descriptio n & Locatio n


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## ^^^'^ ' Pre-Existin g Conditio no f Structure s Does you r Basemen t hav e ahistor y o f leaking ? Yes N o y Ite mN O Descriptio n& Locatio n O nMa p 

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;aaSO-.»fertf Parkwa y,5Siate:'4Q 5 ;25Q5-N.'24*;StTBet,=SiittE;30 8 I KansasTCit y.i^WtO;S4t1' 4 'Ornaha,'Nebraska'68i;i O f Ptione : (816):363^;n0 3 fPhone : (f402)-:5(J4^-t004 .T=ax : (S16):363;J7D 7 r'Fax ; ;f402)f504-100 5• • 

# IM I UHTsTTCnniES , INC . 

### A S - BUIL T DRAWIN G OI.S#:2454 3 Dat * K.\ia\;iti<l : 09/22/200 9 

### OMAH A LEA D SUPERFUN D SIT E l>iJ':P. \ Signcd-OtTlXite :

Name : ^Ai/>fi£/ h i/^/ifiz/ h smcr* ^ Oniah a Lea d Sit s Date ; '?/^'//^ 3 Nort h Arro w AddressT ~ I?/? 3 ^ > ^-ir^* - Sit e Sketc h Time : Phone : (Vq? ) A/<^~<-H,S Tea m Mry.fiA£&/t}iiiS^y^<.. f BVID # ^^•f'^' b XRFCode ^ V'^ ^ M Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e ^ Ye s n 

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Omah aLea dSit e 46130 CONTRAC T# : E P - R7-07-0 6 T0# 1 PRUDENTTECHNOLOGIES , INC .• • Name : PAi/>/l£/ h ^Ano^Tt e styicrf ^ AddressT~j?<? 3 A , •^^•^' ^ Phone : (vto ; A/'^~<-?/. ^ Omah a Lea d Sit e Sit e Sketc h Date : Time : •^/?'//a 3 Nort h Arro w —i

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Parce l I D Owne r Nam e Propert y Addres s City \Zi p Owne r Addres s Owne r Addres s Owne r City Owne r Stat e Owne r 164274000 0 ZARDETTO SMIT H ANDRE AM 80 3 N 3 5 S T OMAH A 6813 1

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## http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 9/15/2009

2• • • • 

### Pag e 1 of 2

" > [ Creat e Anothe rTicke t ] | [ Bac k t o Irt h Interne t Sen d Emai l 

### YOU RTICKE T NUMBE RI S 2364471 . Origina l Cal l Date ; 9/15/0 9 Time : 11:4 1 am Op : SIVA1896 7 Wor k t o Begi n Date ; 9/17/0 9 Time : 12:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 80 3 Street : N35T H S T Twp : 15 NRng : 13 E Sect-Qtr : 16-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : SOI L LEA D REMEDIATIO NPROJEC T Locatio n o f Work : LOCAT E ENTIR E PROPERT Y .Remarks : FA X AL L CLEAR S TO : (402)733-188 3 : F/\ X AL L CLEAR S T O (402 ) 73 3 188 3 : UNSUR E CORNER S Compan y: PRUDEN T TECHNOLOGIE S Contac t Name : SIV AJAMPAMA Phone : (402)733-118 8 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 ALT8 7 2 ATTNEBR l CXCAT V LEVEL 3 MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac t Phon e Numbe r Utilit y Typ e 

### Day : 406728934 3 ALT87 2 WrNDSTREA M COMMUNICATIO N 

### N AAlt : 406207149 4 Emerg : 888728934 3 Day : 8002413624 9 ATTNEBR l ATT/T 

### Alt : 

### Emerg : 8002413624 9 Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , INC 

### HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 LEVEL 3 LEVEL 3 COMMUNICATIONS , LLC 

### N AAlt : Emerg : 877366834 4 

### http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/15/200 9• • • • 

### Pag e 2 of 2 Day : 402504782 3 MUDOl METROPOLITA N UTILITIE S DISTRIC T SAND Y Alt : 

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

### RO N Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 0PPDGPR 5 OMAH A PUBLI C POWERDISTRIC T 

### N A Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNNEI C QWES T LOCALNETWOR K 

### N A Day : 406728934 3

Alt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/15/200 9• • ENVIRONMENTA L & CONSTRUCTION TECHMOLOGIES , INC , SOLUTIONS 

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808 0 War d Parkway , Suit e 40 5 350 5 W . 24" ' Street . Suit e 30 S :4 2 Medica l Dnve , Suit e 725 0 Kansa s City . M O 641 K Omaha , Nebrask a 5311 0 Sa n .Antonio , T X 7822 S Phone : (816 ) 363-370 3 Phone : (402 ) 504-100 4 Phone : 1210 ) 822-958 8 Fax : (816 \ 363-370 7 Fax : Mn? \ ^r,/i.M^n ~^ ' fi ' ^' ^ #• ' ' t'"*^****''— ,