### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 2618 2 DATE : 1/1 5 ADDRESS : 151 5 N 1 8 S T REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES . IN C YEAR : 201( ^ 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S \ 6 PR E AN D POS TVIDE O O F PORPERT Y(DVD ) m EXECUTIV E SUMMAR Y d EPA-PROVIDE D PROPERT YSKETC H d SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN TPROPERT Y ffl RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R TO REPLAC E PLANTS , ETC. ) I D CONFIRMATIO N DAT A d i PHOTOGRAPH S d AS-BUIL TSKETC H D

) SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R m PROPERT YCLOSE-OU TCHECKLIS TSIGNE D B YEP A D DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A d UTILIT YCLEARANCE S m PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E D D D 

# 'y^ ^

^^'^' ' SIGNATUR E DAT E 3021838 6 

# • 1 Superfun d

### PROPERT Y SUMMAR Y Date : /15/201 0 Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Propert y Address : 151 5 N 1 8 S T A . EXECUTIV ESUMMAR 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 Infomiation : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : B 2 = 28 1 PP M @ 2" ; N O EASEMEN T 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 dfor 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 sketch
i ) Shal l includ e fina l 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 di n th e individua l property file , i f available , o r obtainedinclude : i ) Pre-excavatio n agreement detail s (i f an y ar e mad e withth e property owner ) ii ) Property Statu s For msigne 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 ) format and/o r photograph s iv ) Signe dfor mveriiyin g satisfactory restoratio n v ) Descriptio n ofarea s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOCIES , INC .Fin d Record Remediatio n Quer y Lea d Remainin g Quer yPropert yDamag e Quer y 

### Backfill :

Sampl e Area : 2618 2 -151 5 N 1 8 S T Owner : Use rProvide d Owne rInformatio n Resident : D Owne rOccupie d Owne rName : Owne rName : Residen t Name : JCARADOR I TO M 

# 1 ~ ~ Owne rAddressl : Owne rAddress : Propert yAddress : 

# 1 ^ ' J1515N18S T Owne rAddress2 : Zi p Code : 1337 5 S 1 7 S T J6811 0 City : State : Zi p Code : City : state : Zi p Code : Residen t Phon e JOMAH A JN E ]67108 ­ 

# 1 Owne rPhon e Altemat e Phone : Owne rPhone : Alternat e Phone : ] ^ " • " " 

# 1 "

Contract : Assessment : Contractor : jPRUDENT2010l s Qualifyin g Grou p |40 0 Contrac t Optio n foPrfo N 1 Assessmen t Ma xXR F Valu e 514. 4

# ^MiilEM l TECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Property# : "Z^l^T
- Propert y Address : l^/ ^ ^ - ^^ ^ Date/Time ; Owner' s Name:'Tom . Co-tad-^v ^ Quad s Exca>'ated : ^1 — Contracto r Group : Pruden t Technologies , Inc. , 

### Excavatio n Genera l Ye s N o I . I f necessarv . wer e the correct quadraiit(s ) excavatedandrestored ? / 2 . I f necessary , wer e th e correct area s o f drip zone excavatedandrestored ? / Gradin g Sodan dVegetatio n Ye s N o 1 , Doe s the grading aroundthe perimete r o

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

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

Doe s di e sodappea r to be generall y health y andgrowing ? (Onl y evaluat e i f inspecteda t a3 0 da

y lim e period) / 4 .

Ar e sodde darea s generalh ' fir mandevenl y graded ? / 5 , Ar e tlie joint s between tlie sodstrip s generall y tight ? (Onl y evaluat e i

f inspecteda t a3 0 da y (im e penod ) 

# y 6 .

Wa s th e propert y grade dsuc htlia t wate r wil l not pool on the property ? / 7 .Wa s damag e l o landscaping o r plan t material s avoided ? 

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

D o gate s ope n andclos e freely' ^ (I f applicable ) 

# y 2 .

Wer e all gale s o r fence s take n dow n during restoratio n artivitie s reinstalled ? (I f applicable ) 

# y 3 .

Was damag e t o gate s or fence s avoided ? (I f applicable ) / 4 ."Wa s damag e l o retainin g wall s avoided ? (I f applicable ) 

# J Foundation , Sidin g an dGutter s Ye s N o 1 Was damag e t o the siding o r trimavoided ? 

# y 2 .Was damag e l o the foundation avoided ? / 3 .

Was damag e lo window s avoided ? 

## y l 4 .

Wa s damag e t o window s or doo r screen s avoided ? / ."5

. Was damag e l o downspout s o r downspou t extension s avoided ? 

# • Sidewalk s an dDriveway s (Concrete ) Ye s 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 ? /

## Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complete includin g th e 30-da y so dwarranty . EP A Representativ e Qc-^^ y Date ; /g/,/, , U£L .CHNOLOGIES . IN C 

### A S - BUIL T DRAWIN G OL S #2618 2 Dat e Excavated : 11/04/201 0 

### OMAH A LEA D SUPERFUN D SIT E rSKPA Signed-OffDate :

Name : ,'/'«.*» . 6:»*ctr / Oinah a Lea d Sit e Date : f-2^-<^ f Nort h Arro wV Address : i^li T A J {ff ^ Sit e Sketc h Time : ll-Z C Phone : Tea m 

# 'pwr y 'Jtltrlfitf-^'-ZWllrtm^ BVID #ZCol^ ^ XR F Cod e 

## 5SD / Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampi e 

### 3 vy^^.spy^ - yii:\% y .3'$'5 - *3 } pp m pp m pZYe s *(Ye s STYe s t^Ye s a a • _ E T N o ^ N o S ^ N o a N o C ] pp m Ye s a N o C D pp m Ye s a N o C D _La b RD2SCPLA-2618 2 pp m Ye s • N o D Resul t 23 4 pp m N o f 1 

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Omah aLea dSit e 4613 0 CONTRAC T # : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC .

# SER ^ Propert yCompletio n Agreemen t Thi s agreemen t document s th e completion 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 property owne r i s satisfie dwithth e restoratio n o f th e subjec t property , an dtha t n o item s ar e i n question , now , o r at any tim e i n th e future , excludin g any remainin g warranty (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y ID : 

# QMH'i
- Propert y Address : \ S \S / J J ^ S ^ I Owner : ^ 

# y /a ^



### L ^ fi-n>-^o'f'J I Phone : < 

# </^y^-^-y ^ -t^s^^ y Restoratio n Item s i n Question :

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

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

# //-;??y ^ Owner' s Signatur e DatePniden t Techuologiis . Inc . (Prudent ) is unde r contrac t wit hth eU.S. Environmenta l Protectio n Agenc v CEPA ) to Clea n up le.acl
conta.mii)atecl,Siw4f ; at n nivdiber of

orap^ftie s locate dinOiriaha , Nebraska , includin g tti e property locate d at I request s you r permissio n to allo w Pruden llo pertor masoi l cleanu pat liii s pr(fpert y to remov e lead-contaiiimate dsoT T "B y signin g thi s form , th e property owne r grant s permissio n to Pmden t to perfortJ i activitie s relate dto th e cleanu p includin g soil sampling , remova l of

Iead-contaminale dsoil , aii drestoratio n ofth e reference dproperty Ifyo u hav e an y cjuestion 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 (^02 ) 733-1188 . Genera l question s abou t th e Omah aLeadSit e cleanu p ca nbe directe d to th e EPA Publi c Informatio n Center s at (402 ) 73 1 -304 5 (SouthOmahao£Gce 3 (Nort hOmah^fTice) . nahao£Gce ) o

r (402 ) 991-958 991-958 ; Property .Acces s (jranle df.i y Property Own^ r Signature ; 

# yuyy ^ (Signature ) (Date ) PROPERT YIWFORIVIATIOI M (T o be complete d byresiden t aiid/o rproperl yowne r- pleas e print ) RESIDEN TMAME : 

# y ^r ^ Owne r Rente r RESIDEN TADDR E 

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IF RENTAL . PROPERT V OWNE D BY : 

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AyZ^^i:.^^^ ^ OWNER' S MAILIN G ADDRES S 

# • ^^- j GA..., ^ y^ : c.y . T ^ ^^^ ^ ^
IWNER' S TELEPHON E NUMBE R - HOME: ^ ^

! "WORK : 

# : m jy^-yT99oyr^' ~ AG E OF HOWIE? : VX/VEARS . HO WLON G HAV E YO U LIVE D HERE ? HA S TH E EXTERIO R BEE N PAINTE D OR COVERE D WIT H SIDIN G SINC E 1978 ? NUMBE R OF OCCUPANT S UNDE R 7 YEAR S OLD : f ^ MUMBE R OF OCCUPANT S 7 YEAR S OL D AN D OLDE R NUIVIBE R OF CHILDRE W UNDE R 7 YEAR S OL D WH O PLA YIN TH E YAR D FO R 6 HOUR S OR MOR E PE R WEEK COWIMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. >

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS , Th e activitie s to be implemente d by EPA utide r thi s agreemen t ar

e pursuan t lo Sectio n J 04 ofCERCLA . 42 U.S.C . 9604 . EPA' s righ t of

acces s to th e propert yis provide dfo r in Sectio n 104(e ) of CERCLA , 42 U.. S C 9605(e) , whicl i provide s entr y for "detenninin g th e nee dfo r response , or choosin gor takin g an y i espous e actio n under tlu s title , or otherwis e enforcin g th e provision s ofth e titl e " e08 0 vVare t PaiKV/ay . Surff i • .?4? . fVi'.'iJir.n t Drivr^ . Giiitr i fl'/iiO Kansa s City . MO fi41 M n:;r \ r.iwiwo . T; : /.';:>,c: « Phone ; i816 i 363-i70 S ffi'ot'ii: "Jili: ; V': ; Pa'.M:>.\ Ci 1(1)0t2-o:ir;i ; f^3.x : fsiG i aSo-.^'o ? ;«(!: : »-i:y : !:-iio)(;/^i.i>S/' yKNVl.KO{^iMKiNV4L. * CON»TRUCTIO^ : 

### TECHNOLOGIES , mC . SEKVJCKf j



# , Propert y Statu s For m Address : 

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## /yf.'^^t y SnSf l War d Pari<wBy , Suit f 40. S SGOf l a -11 1 St . Kansa. ? City , iW O 6411 4 Phone : (S'lfi ) 365-'l70: > l'0^^ i •^c^- ^ '>'*i^ T Ortiariii , i'^ebrastt- s o810' i "^^horie ; i'40Z i 7;i;;-M3' o M^'t'l X t*i- i iiSO' ^ Sa n Anionic , T X /a22 9 Phone : |i:iO ) «2a-J>60f l C-jv ­ *^nn \ c-; a t:oi'' rName : /At ^

CcMr^dir i Address : /gV rA ) ff ^ Phon e Omah a Lea d Sit e Sit e Sketc h Date : Time : f'^-'^' ? H'-Z^Cf i

•^^—^ . 1 i»—— Tea m ^&fr(f^tf^'^/bi/,Ifrot* ^ BVI D # 

# 26/ ^ XR F Cod e 5S D 1 Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e pp m PZYe s O N o ^ pp m ftfYes a N o E ^ 

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### Pag e 1 of 2

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### Creat e Anothe rTicke t Bac k t o Irt h Internet Sen d Emai l



### • YOU RTICKE T NUMBE RI S 2631586 . Origina l Cal l Date : 11/01/1 0 Time : 4:4 0 p m Op : SIVA1896 7 Wor k t o Begi n Date : 11/03/1 0 Time : 5:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 151 5 Street : N18T H S T Twp : 15 NRng : 13 E Sect-Qtr : 15-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 LEVEL S MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Servic e Are a Contac t 

### Phon e Numbe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEID I 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 LEVEL S LEVEL S COMMUNICATIONS , LL C N A 

### Day : 877366834 4 Alt : Emerg : 877366834 4 MUDO l METROPOLITA N UTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R 

### RICH/TRAFFI C Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 11/1/201 0

## Pag e 2 of 2

OPPDGPR 5 OMAH A PUBLI C POWE RDISTRICT EL M LOCATIN G 

## Alt : 406207149 4 Emerg : 888728934 3 QLNNEIC QWES T LOCA LNETWOR K

EL M LOCATIN G 

## Day : 406728934 3

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## Emerg : 888728934 3

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### CONSTRUCTIO N SOLUTION S 

## SIT ESAFfeT Y HAZAR D ANALYSI S 

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# N ir/ r Address : Excavatio n Date : Crew : Backfi U Date :

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M O Wutf«arteway , Sut e 4« s 424 2 Medica l Drivo , Stdt e 726 0 

### seoosios t ;a»a«GiDr;lM>«411 4 Sa n Antonio , T X 7822 9 fMMadkaCS10 7 tKMis : fSfC ) 3^^370 3 Phone : (2t0 > 822-i9S8 8 t402)733-1ia S «x : fSIC ) 363>37II 7 Fax : (210 ) «79-<57 7 F s c(402 ) 733<1S8 3K0