## TRANSMITTA L o f OMAH A LEA D SIT E SOI LMIMEDIATIO N FIL E FOLDE R SAID# : lU^r ^ Date : g / 16 ^ Address : ^o^? l C - z 7 .^h RfimediadonConttactor : f>fnAe>r & '^tch Qr^ C Year : ^O l n SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S B Vide o o f property (DVD ) 3 Executiv e Sunomar y 

# J EPA-provide dproperty sketc h 

# d Signe dAcces s Agreemen t for subjec t property D Signe dAcces s Agreenient(s ) for adjacent propert y dRestoration Agreement D Settlemen t document s Q.e. , fo r damag e o r t o replac e plants , etc. ) 0 Confiimatio n dat a 

# d Photogr^jh s As-bidl t sjcetc h Satisfiactor y restoratio n signe db y Property Owne r 

# d Property close-ou t chec k lis t agne db y EP A D Descriptio n o f area s no t meetin g RO D cleamq > criteri a Utilil y clearance s 

# d Property infonnatio n fiomDougla s County Assessor' s Offic e D Q D 

## Signatur e DS " 3021797 4 

# HH I

Superfun d•

« Fin d Recor d I 

### Badcflil :

Sampl e Araa : 1465 9 - 302 2 S 3 3 S T Owner : D Owne rOccupie d 

### Owne rName : JHEMSLE Y DONAL D L Owne rAddressl : 

# 1 Owne rAddressZ : |3022S33S T aty : State : Zi p Code : |OMAH A |N E [6810 5 Owne rPhone : Altemat e Phone : |(402 ) 341-951 5 

# 1 Remediatio n QueryI Lea d Remainin g QueryI



### Resident : Residen t Name : JHEMSLE Y DONAL D L Propert yAddress : |3022S33S T Zi p Code : |6810 5 Residen t Phon e 

# 1 Propert yDamag e Query


### Contract : Contractor : |PRUDEWT2009_ S Contrac t Optio n lOPnO N 1 Assessment : Qualifyin g Grou p |400/CHIL D Assessment Ma xXRF Value : 1 648. 8

### PROPERT Y SUMMAR Y Date;.S./15/201 0 | Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l | Mont hof : fl (^ / / ^ Propert y Address : 302 2 S 3 3 S T A . EXECUTIV E SUMMAR Y A. 1Issue s Encountered : NON E A. 2Issue s Resolved : NON E A. 3Uniqu e Findings : NON E A. 4Othe r Relevan t Information : ARE A NO T EXCAVATE D PE RP.O . REQUEST ; Bl/L S (20'X10' ) = 10 7 PP M @ SCRAP E CONFIRMATIO N SAMPLIN GDATA/RESULTS : B l = 15 5 PP M @ 6" ; D Z = 29 0 PP M @ 13" ; E A = 15 8 PPM @ SCRAPE (~1" ) ATTACHMENT S 1 ) Propert y sketc hprovidedb y EP A pursuan t t o contract specification s 2 ) Signe dAcces s Agreemen t including acces s agreements requiredfo r crossing othe r propertie s 3 ) Pre-Excavation digita l vide o clip/photograph s 4 ) Post-Excavation digita l vide o clip/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Buil t sketc h­ i) Shal l include final lea dlevel s v ) Legen d ii ) Contamination lef t behindarea s vi ) Contracto r identification iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r items t o b e includedi n th e individua l propert y file, i f available , or obtainedinclude : i) Pre-excavation agreemen t detail s (if an y ar e mad e wit hth e propert y owner ) ii ) Propert y Statu s For msignedb y propert y owne r iii ) Excavation digita l vide o i n MPEG , WM V (Window s Medi aVideo ) or SW F(FlashPlayer ) forma t and/or photograph s iv ) Signe dfor mverifying satisfactor y restoration v ) Description ofarea s no t meeting InterimRO D cleanu p criteria .

i.y\0Jj7.'^ . \L .TECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Property # : f^^^ ^ Propert y Address : SD^-- ^ 

### ^ f ^ ^* ~ Date/Time : Owner' s Name : fArcl^U<€ , \K^y^^K ^ Quad s Excavated : 6 LP 2 - Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s N o I . If necessary , wer e Ih e correc t quadrant(s ) excavate dan drestored ? / 2 . If necessary , wer e th e correc t area s o f dri p zon e e.xcavate dan drestored ? / Gradin g So dan dVegetatio n I . Doe s th e gradin g aroun dtli e perimete r o f th e house i n excavate darea s generall y slop e awa y fromth e house? Ye s 

## 7 N o 2 . Ha s so dbee n lai di n al l area s tliat wer e excavated ? 3 . Doe s di e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 day tim e period ) 4 . Are sodde darea s generall y fim i an devenl y graded ? 5 . Ar e di e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte dat a3 0 da y tim e period ) 6 . Wa s tli e property grade dsuc hdiat wate r wil l no t poo l o n th e property ? 

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

# y Gates , Fence s an dRetainin g Wall s 1 . D o gate s ope n an dclos e freely ? (I f appUcable ) Ye s 

## 7 N o 2 , Wer e al l gate s o r fence s take n dow n durin g 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 ) 4 . Wa s dmnag e t o retainin g wall s avoided ? (I f applicable ) 

# y 7 7 Foundation , Sidin g an dGutter s 1 . Wa s damag e t o tli e sidin g or tri mavoided ? Ye s 

# 7 N o 2 . Wa s damag e t o tli e foundatio n avoided ? 

# 7 3 . Wa s damag e t o window s avoided ? 

# 7 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 ? 

# 7 7 Sidewalk s an dDriveway s (Concrete ) 1 . Wa s damag e l o driveway surface s avoided ? Ye s 

## 7 N o 2 . Wa s damag e t o walkwa y surface s avoided ? 

## 7

# 3^17 ^ S 

# 3 3 S\ r Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complet e includin g th e 30-da y so dwa^anty : EP A Representativ e A m)SL y Date : t/s//fayifss^ssi gi p 

## Propert yCompletio n Agreemen t Thi s agreement document s th e completio n o f remova l activitie s performe do n th e belo w liste dproperty . Th e property owner' s signatur e indicate s tha t th e propert y 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 at an y tim e i n th e future , excludin g an y remaining warrant y (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y ID : 

# l/^ti ^ Propert y Address : 

# 2«2_'2 - S I^SrT - Owner : Phone : Restoratio n Item s i n Question :

Item : Item : 

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^s„ ^ L . £ ^ Item : Item : Item : Require dcorrection s t o complet e th e property :

L J 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• • 

# t *

ENVIRONMENTA L & CONSTRUCTION TECHNGLGGEB S SERVICE S 

## PROPERT Y CONTAC T ATTEMPT S Propert y ID : /^6^ ^ Propert y Address : 102.2^ ^3 3 Q ^ Owne r Name ; ^/&vi . lAJL t t>^^Jl J 7 . Owne r Phone : Belo w pleas e findalistin g o f unsuccessfu l attempt s t o reac h th e abov e propert y owner . Dat e Tim e Initial s Resul t 

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# t^/ly/^ ^ Signatur e Dat e Pruden t Technologies , Inc. ,



# B^^f^e m /«/4f/> y 

## Acknowledgmen t signatur e Dat e EP A 808 0 War d Parkway , Suit e 40 5 250 5 N . 24* ^

street . Suit s 30 8 424 2 IWedica l Drive , Suit e 7250 Kansa s City , M O 6411 4 Omaha ; Nebraska 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8

### TECHNOLOGIES , INC . Pruden t Technologies , Inc . (Pmdent ) i s unde r caabac t 'wit h th e U . S . Environmenta l Protection Agenc y (EPA ) t o clea n up lead cqpteminate^oil g a t anumtei;^ f propertie s locate din Omaha, Nel)raska, includin g th e propert y locateda t '^ 0 9"l~ . ^ ZT Q ST T Th e EP A requests you r permission to allow Pruden t t o perfor masoil cleaniq ) a

t thi s propert y to remov e lead-contaminate dsoil . B y signin g thi s form, di e propert y owne r grant s permission t o Pruden t t o perfor m activitie s relatedto the cleanu p includin g soi l sampling , remova l o

f lead-contaminate dsoil , an drestoration ofth e reference dproperty . I f yo

u have an y question s abou t the soil cleanu p plannedfo r you r property , pleas e contac t Prudent' s Administrative Cler k

fo

r th e Omah aLea dSit e cleanup . N4s . Siv aS . Jampana-a t (402) 733-1188 . Genera l question s abou t the Omah aLea dSit e cleanu p ca n be directedto the EP A Public Informatio n Centers a t (402) 731-3045 (Sout h Omah aoffice ) o

r (402) 991-958 3 (Nort h Omah aoffice) . Propert y Acces s Grante dBy : /V l ,(» A fif-C ^ ^4 ^ <W<.Cl. ^ (Pleas e Prin t Name ) T ^ Propert y Owne r Signature : 

# y[i,<iM , tvAk- y <i.- n 0° ) (SigifctSre ) T y ' (Date) PROPERTTINFORIMATIO N (To b e complete db y rctiden t and/o r property owne r —pleas e print ) RESIDE! ^ NAME : • _ Rente r RESIDEN T ADDRESS ; 

# 3^^ a^ . ^ ^ si- ' I F RENTAL , PROPERT Y OWNE D BY : OWNER' S MAILIN G ADDRESS ; 

# Sr/y\e r : ,^ ^ 3^/ - 'is'/ r OWNER' S TELEPHON E NUMBE R • HOME : WORK : 

### J 1 AO E O F HOME? : YEARS . HO W LON G HAV E YO U LIVE D HERE ? YEARS . 

# W J k HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978 ? S C YE S N O NUMBER O F OCCUPANT S UNDE R 7 YEAR S OLD : ' 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 Y I 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 Y GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONSE ACTIONS ; Th e activitie s to b e implemente dby EP A unde r thi s agreemen t ar

e pursuan t to Sectio n 10 4 o f CERCLA, 4 2 U.S.C . 9604 . EPA' s righto f acces s t o the propert y i s provide dfo r in Sectio n 104(e ) o

f CERCLA, 42 U.S . C 9605(e) , whic hprovide s entr y fo r "determining th e needfo r response , o r choosing o r taking an y respons e action unde r thi s title , o r otherwis e enforcin g the provision s ofth e title. " 808 0 War d Parkway , Suit e 40 5 560 0 S 10* ^ Stree t 424 2 Medica l Drive , Suit e 425 0 KansasCity , MO6411 4 Omaha , Nebrask a 6810 7 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)733-118 8 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)733-188 3 Fax : (210 ) 579-657 7ENVIRONMENTA L& CONSTRUCTION TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : 'do'^'^f . Cj ^ ^ ' 

## Date : 7-/T'O f Phone : 7^^ - 3>^>' ' 9^/ ^ BVID : /V^r ? Ite mN O Plant s & Permanen t Landscapin g T o Remai n I n Plac e O n Map Descriptio n & Locatio n 

# f^ - Boe,f^c€ ^

Tre e ^roJ e u/)^e/r>« « 

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Pre-Existin g Conditio n of Structure s 

# y Doesyou r Basemen t hav e ahistory of leaking ? Ye s No Ite mN O Descriptio n & Locatio n O n Map I l A 

## p7^|aA cyJcti ^ r



## Propert y Owne r Pruden t Employe e Signature : Signature :

808 0 War d Parkway , Suit e 40 5 560 0 S 10* ^ stree t 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 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 Fax : (816 ) 363-370 7 Fax : (402)733-188 3 Fax : (210 ) S79-657 7KHKOrOGfES , INC . 

## A S - BUILT DRAWIN G 0!.SB : 1465 9 Dat e K\cavattd : 08/17/2tW 9 t:SF,P,\Siencd-OiTnatc : 

## OMAHA LEAD SUPERFUN D SIT E

Name : ,rit(i...'-< . /^tj/,*../­ ' Omah a Lea d Sit e Date : / J A.'<-•• > Nort h Arro w Address : To^- ? s 33^' " Sit a Sketc h Time : Phone: ' ^cs * jv/ ­ •jj-^'i "

CONTRAC T # : E P - R7-07-0 6 T0# 1 PRUDEN T TECHNOLOGIES , INC .Name : ,tii:i-.u / ^'.f.tij>.. j - / AddresB . lco > s Si.- /

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302 2 S 3 3 S T Marc h 200 7 DOUGLA S COUNT Y ASSESS O

# V Prin t Preview Pag e 1 of 2 Dougla s County-Omaha , N E • w

Parce l I D 194252000 0 Additio n PARKVAL E Owne r HEMSLE Y n ­ . L Nam e DONAL D L ^'° ^

! * Propert y Addres s 302 2 S 3 3 S T Lo t 6 Cit yOMAH ALega l 1 40X13 0 Zi p 16810 5 Lega l 2 °^"®' ' Addres s 'Leaal 3

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## Pag e 1 of 1

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YOU RTICKE T NUMBE RI S 2336440 . Origina l Cal l Date : Wor k t o Begi n Date : State : N E Address : 302 2 8/07/0 9 Time : 3:2 9 p m Op : SIVA1896 7 8/11/0 9 Time : 4:0 0 p m County : DOUGLA S Place : OMAH A Street : S 33RD S T Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 33-N W Sect-Qtr : Typ e o f Work : SOI L LEA D REMEDIATIONPROJEC T Locatio n o f Work : LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)733-188 3 : FA 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 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 CXCAT V CO X COMMUNICAHONS , IN C HEID I

MUD0 2 METROPOLITA N UTILITIE S DISTRICT SANDY

OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO N

OPPDGPR 6 OMAH A PUBLI C POWE RDISTRICT N A QLNNEIFQWES T LOCA LNETWOR K

N A Phon e Numbe r Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 Alt :

Emeig : 402504797 0 Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Utility Typ e

FA» : miR136S-370 7 r-none ; (iiio ) BZVJ-saaU " Fax : (402 ) 604-100 5 Fax : (2101579.€57 7 

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