### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 2361 6 DATE : 12/15/201 0 ADDRESS : 440 2 CHICAG O S T REMEDIATIO N CONTRAaOR : PRUDENT TECHNOLOGIES . INC . YEAR : 201 0 

### SOI L REMEDIATIO N PROPERT Y FIL E FOLDE R DOCUMENT S

• PR E AN D POS T VIDE O O F PORPERT Y (DVD ) o i EXECUTIV E SUMMARY m EPA-PROVIDE D PROPERT YSKETCH I D SIGNE D ACCES S AGREEMEN T FOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN T PROPERT Y [ J RESTORATIO N AGREEMEN T D SETTLEMEN T DOCUMENTS (I.E. , FOR DAMAG E O R TO REPLACE PLANTS , ETC. ) ACONFIRMATIO N DAT A t l PHOTOGRAPH S i l AS-BUIL T SKETCH D SATISFACTOR Y RESTORATIO N SIGNE D B Y PROPERT Y OWNE R m PROPERT Y CLOSE-OUT CHEC KLIS T SIGNE D B Y EP A D DESCRIPTIO N O F AREA S NO T MEETIN G RO D CLEANU P CRITERI A m UTILIT Y CLEARANCE S m PROPERT YINFORMATIO N FRO M DOUGLA S COUNT Y ASSESSOR'S OFFIC E 

## D D gy>^ ^

^\v\\ft SIGNATUR E DAT E 3021862 2 Superfun dFin d Record Remediatio n Quer y Lea d Remainin g Query Propert yDamag e Quer y 

### Backfill :

Sampl e Area : 2361 6 - 440 2 CHICAG O S T Owner : Use rProvide d Owne rInformatio n 

# i n n Owne rOccupie d Owne rName : i Owne rName : fSWANSO N ELAIN E E Owne rAddressl : Owne rAddress : Owne rAddress2 : |440 2 CHICAG O S T aty : JOMAHA~ 

### State : |N E 

### Zi p Code : ^ ^68131 ­ I City : State : 

# 'I— ! Zi p Code : Owne rPhon e Alternat e Phone : Owne rPhone : Alternat e Phone : 

### 1(402)^^4 0 ~
Contract : Assessment : Contractor : JPRUDENT2010_ S Qualifyin g Grou p |40 0 Contrac t Optio n JOPTTONT Assessmen t Ma xXR F Valu e j 421. 6 Resident : Residen t Name : JSWANSO N ELAIN E E Propert yAddress : J440 2 CHICAG O ST Zi p Code : |68131 - Residen t Phon e 

# I

### PROPERT Y SUMMAR Y Date : 12/15/201 0 Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Decembe r Propert y Address ; 440 2 CHICAG O 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 Information : B 1 LA B SAMPL EUTILIZE D CONFIRMATIO N SAMPLIN GDATA/RESULTS : B 2 = 8 6 PP M @ 6" ; D Z = 6 8 PP M @ 13" ; E A = 12 4 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 dfo r 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-Built sketc h­ 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 din th e individua l property file , i f available , o r obtaine dinclude : 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 SW F(Flas hPlayer ) forma t 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 .

### 4 

# ^i y TECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y # : 2-3 » fc t t . Propert y Address : i^ O X Cht'c^J^ O S^t " Date/Time : IO/'2,-^/fj o | o Owner' s Name : g,\a{nt .5M3C»JOSoy ^ Quad s Excavated : Contracto r Group : Pruden t Technologie-s , Inc. , Excavatio n Genera l Ye s N o 1 .

I f necessary , wer e th e correct quadrant(s ) excavatedandrestored ? / 

### 2 , I f necessary , wer e th e correct area s o f drip zon e excavatedandrestored ? / 

### Gradin g Sodan dVegetatio n Ye s N o 1 .

Doe s the gradin g aroundthe perimete r o

f th e hous e i n excavatedarea s generally slop e awa y / fro mthe house ? 2 .

Has sodbeen laidin all area s tha t wer e excavated ? / 3 .

Doe s tli e sodappea r to b e generall y health y an dgrowing ? (Onl y evaluat e i

f inspecte da t a3 0 / da

y tim e period) 4 .

Ar e soddedarea s generally firn i an devenl y graded ? 

# y 5 .Ar e the joint s betwee n the so dstrip s generall y tight ? (Onl y evaluat e if inspecteda t a3 0 da y 

# y tim e period ) 6 . Wa s th e propert y grade dsuc htha t wate r wil l not pool o n tli e property ? 

# y 7 . Wa s damag e to landscaping o r plan t material s avoided ? 

# y Gates , Fence s an dRetainin g Wall s Ye s N o 1 .

Do gate s ope n mi dclos e freely ? (I f applicable ) 2 .

Wer e all gate s o r fence s taken dow n during restoratio n activitie s reinstalled ? (I f applicable ) 3 .

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

# y Wa s damag e t o retainin g wall s avoided ? (I f applicable ) Foundation , Sidin g an dGutter s Ye s N o 1 .

Was daJiiage t o th e siding o r trimavoided ? 

# y 2 .

Wa s damag e t o tli e foundation avoided ? 

# y 3 .

Wa s damag e t o window s avoided ? 

# y 4 ,Wa s damag e t o window s or doo r screen s avoided ? 

# y 3 ,Wa s damag e t o downspout s o r downspou t extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 .

Was damag e t o drivewa y surface s avoided ? 2 .

Wa s damag e t o walkwa y surface s avoided ? 

# y

## Owner s cominents :

Inspectio n notes :

Remova l andrestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e Qr ^ ^. ^ Date : /o/3.gy/ o

# m iCHNOLOGIES , INC . 

## AS - BUILT DRAWIN G OL S #2361 6 Dat e Excavated : 10/12/201 0 

## OMAHA LEAD SUPERFUND SIT E USEP A Signed-Of T Date : 

# —(>/y p Name : S'L^A'JS-QJ J Omah a Lea d Sit e Date : •<yA/'ll 7 Noitt i Arro w Sit e Slcetc h Time : MiHS^
- Phone : IVC3 ) ir^/~'^/^/d > 

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### No a pp m Ye s U RYCSCPLA-2361 6 No • La b 237pp m

Omah aLea dSit e E.4 = 12 4 PP M ® SCRAP E 4613 0 CONTRA a #: EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC .

# Propert y Completio n Agreemerit Thi s agreement document s th e completion o f remova l activitie s performe do n tli e belo w liste dpropert y Th e property owner' s signatur e indicate s tha t th e propertj
- owne r i s satisfie dwithth e restoratio n ofth e 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 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 Propert y Address : V^Q^ , (i/UCCka Q S/>^~] ^ Owner Phone : Restoratio n litem s i n Questioini :



### 1 agre e restoratio n i s completed , except a s note d abov e L J I d o no t agre e restoratio n i s complete d 

# .l±.i,ty(L- ­ Ownier' s Sigoatur e DatePniden t Technologies , Inc . (Prudent ) i s unde r contrac t wit hth e U . S , Environmenta l .Protectio n Agenc v (EFA ) l o dea n u p leacl
contaminate dsoil s a t anumbei ' ofpropertie s locate di n Omaha . Nebraska , includin g th e property locate da t ^^O ^ Cl4lCA<^€ > Sy ^ The EPA requests ; your permissio n t o allo w Pniden t t o performasoi l cleanu p a t tJii. s propert y t o remov e lead-contarainate dsoi l B y signin g thi s tbrm , th e propert y owne r grant s permissio n t o Pruden t t o perforn i cictivitie s relate dt o th e cleanu p includin g soi l sampling , remova l o f lead-contarainate dsoil , an dres i oratio n ofth e reference dproperty D'yoi i hav e ar. y question s abou t th e soi l cleanu p planne dfo r you r property , pleas e contac t Pruden t southoffic e fo r th e Omah aLea d Site cleanup-a t (402 ) 733-1188 . Genera l question s abou t th e Omah aLeadSit e cleanu p ca n b e directe dt o th e EP A Publi c Informatio n Center s a t (402 ) 7,3 1 -304 5 (Sout hOmah aoffice ) o r (402 ) 991-958 3 (NorthOr.nahaofllce ) Propeil y .Acces s (jiante dB y ' y^/^^/'y^J ^

^yy^yi^^^A / (P)eas e Print Name ) Property Owne r Signature ; (Signature ) 

# ^/iyy ^ (Date ) PROPERT Y INFORMATIO N (T ch e tomplete d byresidc-ii t and/o rpropert yowne r- - pleas e piint ^ RESIDEN T MAME: . ^/-^/9y/y ^ ..'^(y^ /fyS<!>A / /jwnerj ) Rente r RESIDEN T ADDRE^JS ;
I F REIMTAL , PROPERT Y OV\/NE D BY :
OWWER' S MAILIM G ADDRESS ;
OWNER' S TELEPHON E NUMBE R - HOME : l.^^ ^ 4T/ ^ ^/i' ^ V\tORK : 

### J J AG E O F HOME? : fj ^ YEARS . HO W LOW G HAV E YO U LIVE D HERE ? ^ S VEARS . HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978 ? > < YE S f^ O NUMBE R O F OCCUPANT S UWDE R 7 YEAR S OLD : g > NUMBE R O F OCCUPANT S 7 YEAR S OL D AM D OLDE R NUMBER O F CHILDRE N UNDE R ? YEAR S OL D WH O PLA Y I N TH E YAR D FO R S HOUR S O R MOR E PE R WEEK COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS . ENTR Y GATES , ETC. )

.A.IITI-IORIT Y FO RENVIRONMENTA LRESPONS E ACTIONS , Th e activitie s t o b e implemente dhy f.P A unde r thi s agreemen t ar

c pui-siianri o Sectio n J 0 4 o f CERCLA , 4 2 U S.C . 9604 . EP.A' s righ t o f

acces s t o th e propert y i s provide dfor mSectio n 104(e ) o f CERCLA . 4 2 U. S C 960:)(e) , which , provide s entr y fo r ''detenTiinrngth e nee dfo r response , o r choosin g or takin g an y respons e actio n under tlus title , or otherwis e enforcin g th e provision s ofth e title. " 808 0 vVare t PdrrRvjay . Sifir s 4y; r5r;0. > i -f ; .'.'i r.r:>A7 . S/ieu(ca l Drivfi , Sijii w42^ 0 Kansa s Citv , M G fi-^l 5 4 C(u2;J!ft , :'!fii:.irt:,;c; * iviiii r'U wArit(;ni<) . 'i') J /y2i S Phone ; (816 ) 363-370 3 Pttcne : :4Q; ; r:^>--f;s? rPftoiui : (210 ) C!22.0ftf; 3 ra;; : (815 ; 363.:;T0 7 i^A f .^ifi; - ^•-v:;-t3Si: : '-Wi. : \%^(^' \ K l <^-mi lENVliU>r'JME;NTAL> t CONsTRUCnO?- : SEKV!CK 5 

### HNOLOGIES , INC . 

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### Create Anothe rTicke t Bac k t o Irtl i Internet Sen d Emai l YOU RTICKE T NUMBE RI S 2610742 . Origina l Cal l Date : 10/06/1 0 Time : 5:2 2 p m Op : SIVA1896 7 Wor k t o Begi n Date : 10/08/1 0 Time : 5:4 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 440 2 Street : CHICAG O S T Twp : 15 NRng : 13 E Sect-Qtr : 17-SW,20-N 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 : UNSUR E CORNER S Compan y: PRUDEN T TECHNOLOGIE S Contac t Name : SPV 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 : N Front : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N BSHPCLK S CXCAT V MUDO l OMAHACO F 0PPDGPR 5 PAETE C QLNNEI C 

### Servic e Are a Contac t 

### Phon e Number Utilit y Typ e BSHPCLK S NEBRASK A HEALT H SYSTE M N A Day : 402552346 0 Alt : 402552334 7 Emerg : 402559511 1 CXCAT V CO X COMMUNICATIONS , IN L ^^^ ^ 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUDO l METROPOLITA N UTILITIES DISTRICT SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO F CIT Y O FOMAHA
TRAFFIC.SEWE R RICH/TRAFFI C Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0
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OMAH A PUBLI C POWE R OPPDGPR 5 EL M LOCATIN G DISTRIC T
N O NEE D T O CAL LOU T PAETE C PAETE C COMMUNICATION S EMERGENC Y QLNNEI C QWES T LOCA LNETWOR K EL M LOCATIN G 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 800289190 1 Alt : 

## Emerg : 800289190 1 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

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### ENVIRONMENTAL ENGINEERIN GAN D CONSTRUCTIO N TESHNOuianB , mc . 

### SOLUTION S



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## Crew :



## Ite m Overhea dLine s Gas Lin e Wate r Lin e Sewer Lin e Septic/Leec h Fiel d Propane/Butan e Sidewal k Foundatio n Retainin g Wall s Fence s Tree s Stmcture s Driveway Sprinkle r Syste m Othe r Cre w Forema n SIT E SAI^T Y HAZAR D ANALYSI S ^^^^^ ^ Excavatio n Date : ^" ^ ^"^ ^ Backfi U Date :

Conditio n Hazard s Correctiv e Actio n O K O K (^i C 

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SGMSIOS t 424 2 Medica l Drive , Suit e 7260 tC>|ly;ilO«411 4 Omilia , Nataraak a 4810 7 Sa n Antm^CT X 7822 9 PfMn Kg1t)368'aT0 3 flWiw : (40Z)733-1ia 8 Phone : (2t0y822^858 8 Fa c|8tt ) 363-370 7 Fax : (402)73»'1«8 3 Fax : (210)679-667 7