## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL EFOLDE R SAID# : l41g^ Q Date : ^ | ^^ T Address : ^6 7 <^^ ^ ' ? 7 ^ Y Reinediatio n Contractor . ?iriAAjU\ i Xlli W\X\ LYear : ^ ^ ^ ^ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 2

l Vide o ofproperty (DVD ) EExecutiv e Stammar y EPA-provide dpropert y sketc h Signe dAcces s Agreemen t fo r subjec t propert y D Signe dAcces s Agreeinent(s ) fo r adjacen t propert y ffl Restoratio nA^eemen t D Settlemen t documetit s (i.e. , fo r damag e o r t o replac e plants , etc. ) ffl Confirmatio ndi^t? i li

l Photograph s dAs-buil t sketc h QDSatisfector y restoratio nsigne db y Propert y Owne r IEPropert y close-ou t chec k lis t signe db y EP A D Descriptio no f area s no t meetin g RO D cleanti p criteri a Utilit y clearance s 

## Propert y informatio nfiromDougla s Count y Assessor' s Offic e D D D \oA't­ ^ > ^ Signattg e Dat e 3026096 2 Superfunc iFin d Recor d Remediatio n QueryI Lea d Remainin g Quer yI Propert yDamag e Query 

### Backfill :

Sampi e Area : 1464 9 - 302 5 S 3 2 S T Owner : Resident : Contract : n Owne rOccupie d Residen t Name : Contractor : 

# t Owne rName : [GLEN N DOROTH YJ [PRUDENT2009_S JBOSHAR TMATTHE W J Propert yAddress : Contrac t Optio n Owne rAddressi : [302 5 S 3 2 S T OPTIO N 3 Zi p Code : Owne rAddress2 : [6810 5 Assessnient : [302 5 S 3 2 S T Residen t Phon e City : State : ZipCode : Qualifyin g Grou p 

# I jOMAH A JN E [6810 5 40 0 • y'-^- i Owne rPhone : Aitemat e Phone : Assessmen t Ma xXR F Vaiue : 

# 1 I 782.5 7

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### ^

PROPERT Y SUMMAR Y Date:g^/15/201 0 | Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 T0# 1 | Mont hof : hf a{ J Propert y Address : 302 5 S 3 2 S T A EXECUTIV ESUMMAR Y A. lIssue s Encountered : NON E A. 2Issue s Resolved : NON E A. 3Uniqu e Findings : NON E A. 4 Othe r Relevan t Information : ARE A NO T EXCAVATE D PE RP.O . REQUEST ; Bl/L S (10'X20 0 = 6 0 PP M @ SCRAP E CONFIRMATIO NSAMPLIN GDATA/RESULTS : F l = 8 0 PP M @ 6" ; B l = 8 2 PP M @ 6" ; E A = 10 3 PP M @ 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 othe r propertie s 3 ) Pre-Excavatio n digita l vide o clip/photograph s 4 ) Post-Excavatio n digital 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 fma l lea dlevel s v ) Legen d ii ) Contaminatio nlef t behin darea s vi ) Contracto r identificatio n iii ) Property addres s vii ) Date iv ) BVI D numbe r 7 ) Othe r item s t o b e include din th e individua l property file, i f available , o r obtaine dinclude : i ) Pre-excavatio nagreemen t detail s (ifan y ar e mad e withth e property ovvner ) ii ) Property Statu s For msigne db y property owne r iii ) Excavatio n digita l vide o inMPEG , WM V (Window s Medi aVideo ) o r SW F(Flas hPlayer ) forma t and/o r photograph s iv ) Signe dfor mverifyin g satisfactory - restoratio n v ) Descriptio no f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOCIES , INC .TECHNOLOGIES , INC . 

### Property # : }4iD^' 7 Date/Time : Quad s Excavated : ^ \/ f

- \ 

### £ \ . *mmW . F ^ 

# EP A Propert y Clos e Ou t Propert y Address : ^ChlS " ^ •^' ^ -^ ' Owner'sName : AAa."\ V So'^fV Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s N o I . I f necessary , wer e th e correc t quadrant(s ) e.xcavate dan dreslored ? / 2 , I f necessar y wer e th e correc t area s ofdri p zon e excavate dan drestored ? 

### • Gradin g So dan dVegetatio n Ye s N o 1 .

Doe s th e gradin g aroun dth e perimete r of th e house i nexcavate darea s generall y slop e away fromth e house ? / 2 ,Ha s so dbee n lai di nal l area s Vlia i wer e excavated ? ^ 3 .

Doe s tli e so dappear t o b e generall y healtli y an dgrowing ? (Onl y evalual e if inspecie dat a3 0 da

y lim e period ) • 4 .Are sodde darea s generall y finn an devenl y graded ? • 5 .

Are lli e joint s betwee n tli e so dstrip s generall y light ? (Onl y evalual e if inspecie dat a3 0 da y lim e period ) Z ' 6 .Wa s th e propert} ' grade dsuc hthat wate r wil l no l poo l o n th e property ? i / 7 .

Wa s daniag e l o landscapin g or plan t material s avoided ? 

## • Gates , Fence s an dRetainin g Wall s Ve s No 1 .

D o gate s ope n an dclos e freely ? (I f applicable ) t ^ 2 .Were al l gate s or fence s take n dow n durin g restoratio nactivitie s reinstalled ? (I f applicable ) / 3 .

Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) 

### • 4 .Wa s damag e t o relainin g wall s avoided ? (Ifapplicable ) y 

### Foundation , Sidin g an dGutter s Ye s N o 1 .Wa s damag e t o th e sidin g or ui mavoided ? y 2 .Wa s damag e to th e foundalio navoided ? / ^ 3 .

Wa s damag e t o windows avoided ? /" 4 .Wa s damag e t o window s o r doo r screen s avoided ? y 5 . Wa s damag e l o downspout s o r downspou t extension s avoided ? 

# y Sidewallv s an dDriveway s (Concrete ) Ye s No 1 . W;i s damag e l o driveway surface s avoided ? 

# y 2 . Wa s damag e l o walkway surface s avoided ? y

# ,3o^ 5 5 3- ^ £ t

Owner s comments :

Inspectio n notes : ^ttiLe o Snou t CcnIilTIOV i f^f ' 

## DuM. p ik t ePBckse-oniRemova l an drestoratio n activate s complet e including th e 30-da y sodwarranty : EP A Representativ e "' ^ ^ Date : //^»/< b

### ^



## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n o f removal activitie s performe donth 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 nofth e subjec t property , an dtha t n o item s ar e in question , now , o r at an y tim e i n th e fiiture, excludin g any remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , ifany . Propert y ID : Property Address : 

# < 

# Jj^ ^ Owner : ^/ ^ (bX^bM t 

# m , Phone : '39~XS07 3 f^C.hA4^ ( (Jj-^ ) 2p-/>ff^ ^ Restoratio n Item s i n Question :

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

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^m ^ ujolut-fliAJC s fr/iuliM l ^i^ k

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

# ':^t l ' - f7-0 7 Owner' s Signatur e Date I• • 

### TECHNOLOGIES , INC . Pruden t Technologies , Inc . (Prudent ) is unde r contrac t wit hth e U.S. Environmenta l Protectio nAgenc y (EPA ) to clea n up Icad ajnlaminajt d.soil s at aniimb M ofpropertie s locaie d in Omaha , Nebraska , includin g th e property locate dal ti^Sif f

^ I O ^ S' ' ^ ^ ^f^ request s you r pemiissio n to allo w Pruden t to performasoi l cleanu p al this propertyto remov e lead-contaminate dsoil . By signin g this form , th e property owne r grant s permissio n to Pruden ito perfon n activitie s relate d lo th e cleanu p includin g soi l sampling , remova l of

lead-contaminale dsoil , an drestoratio n ofth e reference dproperty . Ifyouhavean y question s abou t lh e soi l cleanu p planne dfo r you r property , pleas e contac t Prudent' s ',.ir.!.i!'.'..-i'..ii-.\ . ;. :.-,! . forth e Omah aLea dSit e cleanup , .'.i^ ^.•\ J > .•.:,i:;\:j.i: : at (402 ) '^-ll^^s . Genera l question s abou l th e Omah aLeadSite cleanu p can be directe dlo th e EP A Publi c Informatio nCenter s at (402 ) 731-304 5 (SouthOmah aotBce ) or (402 ) 991-9583 (NorthOmah aoffice) . Property Acces s Granie d By (Pleas e Prin t Name ) Property Owne r Signature : (Signature ) Pate ) PROPERT Y INFORIVIATION (T propert y owne r — pleas e print ) jT o

o b

b c

c complete

complete d db

b y

y residen

residen t t and/o and/o r r [ RESIDEN TNAME : Owne r Rente r RESIDEN TADDRES S 

# ^o^ b 

# 6, 3 Z S^ - IF RENTAL , PROPERT YOWNE D BY : OWNER' S MAILIN G ADDRESS ; 

# ^a/H d OWNER' S TELEPHON E NUMBE R - HOME : l^^^ ) 7. ^^OC ^ WOR K 

## y AG E OF HOME ? 

# .31 _ 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 

# : 0 NUMBE R OF OCCUPANT S UNDE R 7 YEAR S OL D NUMBE R OF OCCUPANT S 7 YEAR S OL D AN D OLDE R UM I 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 OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. )

AUTHOkl' f Y I'O RENVERONMBN'l'ALRliSPONS EACTIONS : Th e activitie s to be implemente d by EPA unde r thi s agreemen t ar e pursuan t to Sectio n10 4 ofCERCLA . 42 U.S.C . 9604 . EPA' s right ofacces sto th e propertyis provide dfo r in Sectio n 104(c ) of CERCLA , 42 U.S . C 9605(e) , whic hprovide s entry fo r "determinin g th e nee dfo r response , or choosin gor takin g any respons e actio n under this title , or otiierwis e enforcin g th e provision s ofth e title. " 808 0 War d Parkway . Suit e 40 6 560 0 S i[)' " Stree l 424 2 Wledic.T l Drive , Suit e 425 0 Kansa s City . MO 6411 4 0~aha . 'Mobrask a 5810 7 S.^ n Antonio . TX 7822 9 Phone ; (816)363-370 3 Phono : ••402173 3 -i^S S Phone : (210 ) 822-958 8 ra.v : (816 ) 363-.'?70 7 (-".IX (402' i ~3 3 -'.an.-' . Fax : (210 ) 579-657 7• •

• •-,!" , 

### TECHNOLOGIES , SNC . 

# Propert y Statu s For m Address : 3^36 ' £ , Zd ^ ^/ - Date : /^/PL^/^ 9 

## Phone : ^^^ ^ ^97 " Q<Po>6 > BVID : /J/^^ 9 Plant s & Permanen t Landscapin g Ite m# O n Map Descriptio n an dLocatio n 

# Z^, ^ reiMioiy/se.J^^^^ '

Pre-Existin g Conditio n o f Structure s Does yeu r Basemen t hav e ahistory o f leaking ? Ye s —N o Item # O n Map Descriptio n & Locatio n 

# ff?. ­ Urcick s //i ^ dtii^uOctj y Cs£>iyM )

Property Ovvne r Pruden t Emploj^e e Signature : X^ J IL . f f Signature : trt^/^/l26^^'0/V. ^

### #

rUHMilXKHES . INC , 

### A S - BUIL T DRAWIN G ()1,.S# : 1464 9 Dat e KMiivuUd : M/(J3/2(Mt 9 l8EI>.\Siam(l-01TI)atc i 

### OMAH A LEA D SUPERFUN D SIT E 1464 9 Exterio rPain t Nortt i Arro w Omah a Lea d Sit e Owne rName : DOf=tOTH YJ GLEN N • Goo d Address : 302 5 8 3 2 S T Sit e Sketc h ^ • Poo r Phone : H : 402-341-201 1 W ; [3^0 1 pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : a J Jt ^ - Ty^' i RYASCPXA-1464 9 F 1 

## •7^ 3 pp m 

### D Date: 4 / S-'^' H RYBSCPXA-1464 9 F 2 pp m 

# a Time : Of^l - RYCSCPXA-1464 9 8 1 

### j-^ - pp m 

# n Sample s Analyze d RYDSCPXA-1464 9 8 2 pp m 

# n RDZSCPXA-U64 9 D Z 

## 3 7 ^ pp m 

### D XR F Unit : ^''^- ' Book : ^"^ ^ Ra2SGPXA=t462ra - pp m 

### D Date : 7/^-^^ ^ 

### D RP2SePXA^T2re? S •PT ^ pp m 

### D D Time : 

## 4 ^ Staff : ^PsT'yy p Numbe ro f Sample s = S ~ O

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# ENTERE D JU N I 6 p i ii i - S 2 I'l' M a 6 " L-a.i^ ;

Omah aI.,ea dSite 4513 0 CONTRAC T# : E P - R7-07-0 6 T0# 1 PRUDENTTECHNOLOGIES , INC .

# 14649

Omah aLea dSite 4613 0

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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 2 Owne r City Owne r Stat e Owne r Zi p Sec-Twn Rn g 141008000 0 BOSHAR T MA I IHEW J 302 5 S 3 2 S T OMAH A 6810 5

302 5 S 3 2 S T OMAH A N E 6810 5 33-15-1 3 Additio n Bloc k Lo t Legal 1 Lega l 2 Legal 3 Legal 4 Acre s Treasure r Websit e Lin k Assesso r Websit e Lin k ILE R AD D 8 6 S 42. 3 F T 42.3X115. 4

0. 1 http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp ? parc=141008000 0 http://douglasne.nnapping online.com/DouglasCoNe/static/accountinfo.jsp ? accountno=R141008000 0


### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 9/17/200 9• • 

### Pag e 1 o f 2

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# E 

# a e

. YOU RTICKE T NUMBE RI S 2394405 . Origina l Cal l Date : 10/27/0 9 Time : 9:1 9 a m Op : SIVA1896 7 Wor k t o Begi n Date : 10/29/0 9 Time : 9:4 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 302 5 Street : S 32N D S T Twp : 15 NRng : 13 E Sect-Qtr : 33-NW 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 : UNSUR E CORNER S Compan y: PRUDEN T TECHNOLOGIE S Contac t Name : SIV AJAMPAM A 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 : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F Servic e Are a Contac t Phon e Number Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEIDI Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUD0 2 METROPOLITA N UTILITIES DISTRIC T SAND Y Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCITYOFOMAHA-TRAFFICSEWE RRICH/TRAFFI C Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0 0PPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T 

### N A Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3• • 

## Pag e 2 o f

2 Day : 406728934 3 QLNNE1 FQWES T LOCALNETWOR K 

### N A Alt : 406207149 4 Emerg : 888728934 3

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