### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL EFOLDE R 

# SAID#:^3i23

_Date : H ' I 5 "^ I 0 Address : c^H^c ^ ft/JLLfmn A V Remediation Contractor : f)? n nrPr^' f 7»/^>f 4 NO<LOC ) I?<J. ^ IN<I.< J 

### Year : ^(J I ( j SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S [ ^ Vide o o f propert y (DVD ) „ , J?237560 , \ S Executiv e Summar y Superfun d 

### w EPA-providedpropert y sketch [ « Signe dAcces s Agreemen t fo r subjec t property D Signe dAcces s Agreement(s ) fo r adjacen t property aRestoratio nAgreemen t H Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) 0 Confirmatio ndat a WPhotograph s ' aAs-buil t sketc h w Satisfactory restoratio nsigne db y Property Owne r 0 Propert 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 cleanu p criteri a 0 Utilit y clearance s aProperty informatio nfromDougla s County Assessor' s Offic e D D D Signatur e ' Dat e

### PROPERT Y SUMMAR Y Date : 11/15/201 0 Omah aLea dSit e Remedia l Actio nContrac t #EP-R7-07-0 6 TO# l Mont ho f Novembe r Propert y Address ; 244 2 BAUMA NA V A . EXECUTIV ESUMMAR Y A. 1 Issue s Encountere dNON E A. 2 Issue s Resolve dNON E A. 3 Uniqu e Findings : NON E A. 4 Othe r Relevan t Information : NON E CONFIRMATIO NSAMPLIN GDATA/RESULT S B l = 20 5 PP M @ 8" ; D Z= 6 3 PP M @ 12" ; E A= 7 2 PP M @ SCRAP E(~1" ) ATTACHMENT S 1 ) Property sketc hprovide db y EPApursuan 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 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 fina l leadlevel s v ) Legen d ii ) Contaminatio nlef t behin darea s vi ) Contracto r identificatio n 111

) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e include di nth e individual property file , if available , o r obtaine dinclud e i ) Pre-excavatio nagreement detail s (i f any ar e mad e wit hth e property owner ) ii ) Property Statu s For msigne db y property owne r 111

) Excavatio ndigita l vide o i nMPEG , WM V (Window s Medi aVideo ) o r SWF(Flas hPlayer ) format and/o r photograph s iv ) Signe dfor mveniyin g satisfactory restoratio n v ) Descriptio no f area s no t meetin g Interi mRO D cleanu p criteri a

TECHNOLOGIES , INC .Fin d Record 

### Backfill : Remediatio n Quer yLea d Remainin g Quer yPropert yDamag e Quer y 

### Sampl e Area : 3997 9 Owner : ­ 244 2 BAUMA N A V Use rProvide d Owne rInformatio n Resident : n Owne rOccupie d Owne rName : JFRAZIE R ETHE L Owne rAddressl : 

# 1 Owne rAddress2 : 244 2 BAUMAN AV E City : JOMAH A Owne rPhon e |C402 ) 453-655 6 State : Zi p Code : |N E 168112 - Alternat e Phone : 

# 1 Owne rName : Owne rAddress :
City : Owne rPhone : State : Zi p Code : Alternat e Phone : Residen t Name : 

# I Propert yAddress : 1244 2 BAUMAN A V Zi p Code : Residen t Phon e

Contract : Assessment : Contractor : PRUDENT_2010 . . S Qualifyin g Grou p J40 0 Contrac t Optio n IBAS E Assessmen t Ma xXR F Valu e 44 4

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# EPAPropert y Clos e Ou t Propert y # : ^^^T ^ Propert y Address : 7-^:4^2 - 8i!iAK,w\awc A*^ ^ 

### Date/Time : Owner' s Name : £r4fve j Fr^C^i'^l P 

### Quad s Excavated : t?2.1 0 1 Contracto r Group : Pruden t Technologies , Inc , Excavatio nGenera l 

### Ye s No 1 . If necessary , wer e tli e correc t quadraiit(s ) excavate dan drestored ? / 2 . I f necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? 

# y Gradin g So dan dVegetatio n Ye s N o 1 . Doe s th e gradin g aroun dth e perimete r o f th e hous e i n excavate darea s generall y slop e awa y 

### y fromth e house ? 2 . Ha s sodbee nlai di n ai l area s tha t wer e excavated ? 

# y 3 . Doe s th e sodappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 

### / da y tittl e period ) 

# 71 4 . Ar e sodde darea s generall y firman devenl y graded ? 5 . Ar e th e joint s betwee nth e sodstrip s generall y tiglit ? (Onl y evaluat e i f inspecte da t a3 0 day 

# 7 tim e period ) 6 . Wa s th e propert y grade dsucl i tha t wate r wil l no t poo l o n th e propeity ? 7 . Wa s damag e t o landscapin g o r plan t material s avoided ? 

# "7 Gates , Fence s an dRetainin g Wall s Ye s N o 1 . D o gate s ope nan dclos e freely ? (I f applicable ) / 2 . Wer e al l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (I f applicable ) 

# 7 3 . Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) / 4 . Wa s damag e t o retainin g wall s avoided ? (I f applicable ) / Foundation , Sidin g an dGutter s Ye s N o 

### l y 1 . Wa s damag e t o th e sidin g o r tri mavoided ? 2 . Wa s damag e t o th e foundatio navoided ? / 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 ? / 5 . Wa s damag e t o downspout s o r downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ye s y N o 1 . Wa s damag e t o drivewa y surface s avoided ? 2 . Wa s damag e t o walkwa y surface s avoided ? 

### y

## Owner s comments :

Inspectio nnotes :

Remova l andrestoratio nactivate s complet e includin g th e 30-da y so dwarranty : EPARepresentativ e JQJ^J ^ 

## ; Date : lojffff o}IES . INC . 

## A S - BUIL T DRAWIN G OLS#3997 9 Dit e Excavated : 09/03/201 0 

## OMAHALEA D SUPERFUND SIT E USEPASIgned-OirDatc : 

## 3997 9 ExtariorPan t NofttiAfra w Sit e Sketc h nooo d Q Poor Omah a Lea d Sit e Samplin g Address : 2442BAUMANA V • Notpsin t Sampl e Numbe r RYA9CPXA-3M7 0 F 1 Concentratio n ?22

_Bom Sampl e Collecte d LA B 

### D Fimn : Date : Sample s Collecte d ftfit I3g-Ai r t-15-0 1 RYBSCPXA-aSOT O F 2 2 3 O pp m 

### D Time : I P it O 0* 1 RYCSCPXAr3e979 n¥DOOPXA-09Q79 B l -Ba 

### D D Sample s Analyze d RDZSCPXA^OSr O D Z _lL2JL.PP m 

### D XR F Unit : JQ^^ ^

Book : 235 - WOZOOPX AaOBT Q -e z ~ ppm 

# a D Drte : H-iO-a ^ nPZOOPXA-38870 -PZ - 

# n •nme:_JBaa Numbe ro fSamples- I t f | | o | strtr:__caSL. i Legend : F 1 > Fron t Left . F 2 = Fron t Right . B l => Bac k Len . B 2 » Bac k R^ M D Z < Ori p zone , G Z - Garden . P Z » Pla ; AlflUKlrart i M 9 M viMw d ftmi ttM t0tt/t , ttfi ^ 

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## cm o w^ ^ ^* ipi»,.Ae . Il<r3 » Cnatt : OHw A

EA = 7 2 PP M ( 9 Scrap e CONTRA a « : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC .

## Propert yCompletio n Agreemen t Thi s agreemen t document s the completio no f remova l activitie s performedo nth e belo w listedproperty . The propert y ovmw' s signatur e indicate s tha t th e propert y owner i s satisfiedwit hth e restoratio no f th e subject property , andtha t n o item s ar e inquestion , now , or a

t an y time inth e future , excludin g an y remaining warrant y (3 0 day s total ) excep t thos e item s liste dbelow , if any . Propert y ID : Propert y Addre«» ; ^ M M Z , ^ r . t J tv\Ciir > 

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# := Piia. ^ Fr<^^:irr Phone : Restoratio nItem s i nQuestion : Hem : Item : Item : 

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

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# ; ? I agre e restoratio n I s completed , excep t a s note d above . L J I d o no t agre e restoratio n i s complete d 

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### Owner' s Signatur e Dat e

## TWHf«)!j(»ll&rN C Pniden t Technologies , Inc . (Prudent ) is unde r contrac t wit hth e U. S. Environmenta l Protectio nAgenc y (EPA ) to clea n up lead ­ cmtaminate dsoilsa t anumbe rof propertie s locate d inOmaha , Nebraska , includin g th e propert y locate d at 2-L|L 4 T ^ faPrtJlVVA ^ AVTh e EP Arequest s you r permissio n to allo w Pruden tto performasoi l cleanu p at thi s propert y to remov e lead-contaminate dsoil . By signin g thi s form , th e propert y owne r grant s permissio n to Proden t to perform activitie s relate d to th e cleanu p includin g soi l sampling , remova l of lead-contaminate dsoil , an drestoratio n of th e referencedproperty . If

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 SouthOmah aOfRc e for th e Omah a Lea dSit e cleanup,^at (402 ) 733-1188 ; 733-14SS . Genera l question s abou t th e Omah aLea dSit e cleanu p can be directe d to th e EP A Publi c Informatio nCenter s at (402 ) 731-304 5 (SouthOmah aoffice) . . Propert y Acces s Grante d1 

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# -f J "^ \ r ^ (Pleas e Prin t Name ) Propert y Owne r Signature : _^2BZL ^ v ^ ^'O-^^jUL ^ (Signature ) > 4 (Date ) PROPERT YINFORMATIO N iff^ob e coiiii|>lete(LI> y residen t i pleas e print ) and/o r propert y owne r — RESIDEN TNAME ; Otme r J Rente r RESIDEN TADDRESS : 

# 3.^7o lr^acj,no^Ay ^

IF RENTAL , PROPERT YOWNE D BY : OWNER' S MAILIN G ADDRES S 

# -;3^4^ ^ fLu^ . M/ ^ OWNER' S TELEPHON E NUMBE R 

### HOME : (/^ > ^^><^« S WORK : 

### J I AG E OF HOME? : : ^ J > YEARS . HO WLON G HAV E YO U LIVE D HERE ? G? ^ YEARS . HAS TH E EXTERIO R BEE N PAINTE D OR COVERE D WIT H SIDIN G SINC E 1978 7 

### YE S NO NUMBE R OF OCCUPANT S UNDE R 7 YEAR S OLD : ^ / NUMBE R OF OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R OF CHILDRE N UNDE R 7 YEAR S OL D WH O PLA Y INTH E YAR D FO R 5 HOUR S OR MOR E PE R WEEK : COMMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LR£SPONS EACTIONS : Th e activitie s to be implemente dby EP Aunde r thi s agreemen t ar e pursuan t to Sectio n10 4 of CERCLA , 42 U.S.C . 9604 . EPA' s righ t of acces s to th e propert y is provide dfor inSectio n104(e ) of CERCLA , 42 U.S . C 960S(e) , whic hprovide s entr y fo r "determinin g th e nee dfor response, or choosin g or takin g an y respons e actio n unde r thi s title , or otherwis e enforcin g th e provision s of ttie title. "

808 0 War d Parkway , Suit e 40 5 Kansa s City , MO 6411 4 560 0 S. 10' " Stree t Omaha , Nebraska 68107 4242 Medica l Drive , Suit e 4250 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)733-145 5 Phone : (210)822-958 8 Fax : rSIS I 3S3-3707 Fax : (402)733-188 3 Fax : (210 ) 579-657 7ENVIRONMENTA L& 

# TDMJD E CONSTRUCTION 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : ^ ^ y^ 3 [3c»^/H^/ 1 At/ ^ ^^^ ' "^'f^^/ O Phone : ^l'^^^ Q BVID : J'^'77 ^ 

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Propert y Owne r Prudent Employ e Signature;^^^;^:^^ ^ ^J ./^ gL>yUL a Signature :

808 0 Wm d Pailcwav . Sulf a M S 250 5 N . 7A^ Straat . Siiil a 30 8 424 2 Madlca l Drive . Suit e 426 0

## 3997 9 Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e • Goo d 

### Sit e Sketc h G d Poor Samplin g Address : 244 2 BAUMA N A V Q No t paint Sampl e Numbe r Lead Sampl e Sample s Collecte d 

# i LA B Concentratio n Collecte d 

### Flmi : fPfirtSA T RYASCPXA-3997 9 F 1 pp m 

# n Date : H'l5-& ^ RYBSCPXA-3997 9 F 2 

## 2 3 O pp m 

## D Time : t a ••&) a* » RYCSCPXA-3997 9 B 1 pp m 

# n Sample s Analyze d R¥DOOPXA"39979 D2

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# n RDZSCPXA-3997 9 D Z 

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# s- XR F Unit : /aHAA . Book : ITKf k 

# n ROgOCPXA-30070 O Z " * pp m Date : H -^ O -O ^ 

# n a RPZOCPXA'3997 9 PZ - — pp m D Time : Bo a 

# n Staff : COSL i Numbe ro fSample s = { 4 " I | Q | Legend : F 1 = Fron t Left , F 2 = Fron t Right , B l = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla ; Ajlguadrentaar e a s vimw d fre m th e siratt , (adn g propert y 

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### • YOURTICKE T NUMBE RI S  2563504 . Origina l Cal l Date : 8/09/1 0 Time : 1:1 2 p m Op : SIVA1896 7 Wor k t o Begi n Date : 8/11/1 0 Time : 1:4 5 p m State : N E County : DOUGLA S Place : OMAHA Address : 244 2 Street : BAUMA NAV E Twp : 16 NRng : 13 E Sect-Qtr : 33-NE,34-NW Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : Lea d Soi l Remediatio n Projec t Locatio n o f Work : LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)733-188 3 Company: PRUDENT 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 METR O MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Servic e Are a Contac t Phon e Numbe r UtiUt y Typ e CXCATV CO X COMMUNICATIONS , IN C HEID I Day : Alt : 402934046 9 402934046 9 Emerg : 402932975 7 METRO METRO COMM . COLLEG E 

## CHRI S Day : Alt : 402457230 7 402672703 3 Emerg : 402457231 3 MUDO l METROPOLITAN UTILITIE S DISTRIC T 

## SAND Y Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO F CITYOFOMAHA TRAFFIC,SEWER RICH/TRAFFI C Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 dhon.org/irthinternet/.../MessageTextas.. . 

### 1/ 28/9/201 0 ^nttp://www.dhon.org/irthinternet/DHO.. . ^ 

## W^ay : 406728934 3 r»DDT^r-TJD ^ OMAHAPUBLI C POWE REL M , ^ .n^^n^,.,^ . 0PPDGPR 5 j^j^^^ ^ LOCATIN G^^- ^ ^06207149 4 Emerg : 888728934 3 FTM Day : 406728934 3 QLNNEI C QWES T LOCALNETWOR K TMA^T ^ Alt : 406207149 4 LULAllN G 

## Emerg : 888728934 3

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### ENVIRONMENTA L ENGINEERIN GAN D TEBHNOUMWS , mC . 

### CONSTRUCTIO N SOLUTION S 

## SIT ESAFfeTY HAZARD ANALYSI S Address : --^^'^--^^Ji^^tifc--u^. , Excavatio nDate : Crew :



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SMOWmFBukMay . SutB40 5 i9600S10S t 424 2 Medica l Drive.Suit e 725 0 Kano s G«y i IK>«411 4 Omaha , Nebnik a 6810 7 Sa n Afltonio , T X 7822 9 Phone : 1816)36^370 3 Phone : (402)733-116 8 Phone : (2t0)822!«58 8 Fs c(816 ) 363370 7 Fax : (402)733^168 3 Fax : (210 ) 579-«57 7• /^f...;A.t,<.. ;