### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 2745 2 DATE : 12/15/201 0 ADDRESS : 422 4 BURDETTE S T REMEDIATIO N CONTRACTOR : PRUDENT TECHNOLOGIES
. IN C YEAR : 201 0 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S d PR E AN D POS T VIDE O O F PORPERT Y (DVD ) d EXECUTIV E SUMMAR Y a EPA-PROVIDE D PROPERT Y SKETCH d SIGNE D ACCES S AGREEMEN T FOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT(S) FOR ADJACEN T PROPERT Y d RESTORATIO N AGREEMEN T D SETTLEMEN T DOCUMENTS (I.E. , FOR DAMAG E O R T O REPLACE PLANTS , ETC. ) Q CONFIRMATIO N DAT A d PHOTOGRAPH S d AS-BUIL T SKETCH d SATISFACTOR Y RESTORATIO N SIGNE D B Y PROPERT Y OWNE R H PROPERT Y CLOSE-OU T CHECKLIS TSIGNE D B Y EP A D DESCRIPTIO N O F AREA S NO T MEETIN G RO D CLEANU P CRITERI A a UTILIT Y CLEARANCE S d PROPERT Y INFORMATIO N FRO M DOUGLA S COUNT Y ASSESSOR'S OFFIC E 

## D D D

SIGNATUR E " ~~ DAT E 3023747 0 

# miiii i Superfun dFin d Record 

### Backfill :

Sampl e Area : 2745 2 Owner :
n Owne rOccupie d Owne rName : |MAL YJAME S R Owne rAddressi : 

# 1 Owne rAddress2 : J14505N156S T City : JBENNINGTO N Owne rPhon e j(402 ) 238-206 5


### Contract : Remediatio n Quer yj Lea d Remainin g Quer yi Propert yOamag e Quer y



### - 422 4 BURDETT E S T

State : Zi p Code : JN E J68007 - Aiternat e Phone : 1(402 ) 708-330 9

Contractor : JPRUDENT2010_ S Contrac t Optio n |0PTI0 N 1 Use rProvide d Owne rInformatio n Owne rName : Owne rAddress :

City : State : Zi p Code : Owne rPhone : Alternat e Phone :

Assessment : Qualifyin g Grou p 140 0 Assessmen t Ma xXR F Valu e f 

### 504.5 1 Resident : Residen t Name : Propert yAddress : 422 4 BURDETT E ST Zi p Code : J68111 - Residen t Phon e

### 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 : 422 4 BURDETT E 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 : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : P Z = 18 0 PP M @ 4" ; 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-Buil t 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 ) Propert y 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 agreemen t detail s (ifan 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 i n 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 TECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y #: 2. 7 ^52
- Propert y Address:'-^^^' ^ ^i>^^ ^ "^ ' Date/Time : 

### Owner' s Name : ''13a<^^ ^ KftUe ^ Quad s Excavated : ^ 2 ^ Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s No I.

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

### 2.

If necessary , wer e th e correct area s ofdri p zone excavatedan drestored ? / 

### Gradin g Sodan dVegetatio n Ye s No 1.Doe s the gradin g aroundthe perimete r of th e hous e in excavatedarea s generally slop e awa y / fro mthe house ? 2.

Has sodbeen lai d in al l area s tha t wer e excavated ? / 3.Doe s di e sodappea r to be generall y health y andgrowing ? (Onl y evaluate if

inspected at a

30 da

y time period) / Ar e soddedarea s generally fir mandevenl y graded ? / 5.

Ar c tlie joint s between the sodstrip s generall y tight ? (Onl y evaluat e

if

inspecte d at a

30 da y / tim e period) 6.Wa s the propert y grade dsuc hdia t wate r wil l not pool on the property ? 

## y 7.Wa s damag e to landscapin g or plan t material s avoided ? / Gates , Fence s an dRetainin g Wall s 1. Do gate s ope n an dclos e freely ? (I f applicable ) Ye s 

## X No 2. Wer e all gate sor fence s taken dow n during restoratio n activitie s reinstalled ? (I f applicable ) 3. Was damag e to gate s or fence s avoided ? (I f applicable ) 4 Wa s damag e to retainin g wall s avoided ? (I f applicable ) 

# y y y Foundation , Sidin g an dGutter s 1. Wa s damag e to the siding or trimavoided ? s Ye Ye ^ No 2 Wa s damag e to tli e foundation avoided ? / 

### Was damag e to window s avoided ? 4. Was damag e to window sor doo r screen s avoided ? 

## y 5 Was damag e to downspout s or downspou t extension s avoided ? 

## y Sidewalk s an dDriveway s (Concrete ) 1 Was damag e lo drivewa y surface s avoided ? 2. Wa s damag eto walkwa y surface s avoided ? Ye s 

# y^ y No

## Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complete includin g th e 30-da y sodwarranty : EP A Representativ e P*^") ^ Date : uMo j 'o[•ClINOliXllES . INC . 

### A S - BUIL T DRAWIN G OL S n 2745 2 Dal e Excavated : 09/30/201 0 

### OMAH A LEA D SUPERFUN D SIT E I SEP ASigned-Of f Date : 

## ^rVJ?r'
. Exierio rPain t Nort h Arro w Omah a Lea d Sit e Owne rName : ijame ^ f ^ A/la/ y • Goo d Sit e Sketc h Address : 'iS£j ^ BurHfif^ P if f Q Poo r Phone : H W Q No t pain t 

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L^iJi . yd , .itii yV K N O EASKME M
PRUDEN TTECHNOLOGIES , INC
. CONTRA a # : EP-S7-10-0 5

# «E m Propert yCompletio n Agreemen t Thi s agreemen t documents the completion o f remova l activitie s performedo n the below liste dproperty . Th e propert y owner' s signatur e indicate s tha t the propert y owne r i s satisfiedwit hthe restoratio n ofth e subject property , an dtha t no items ar e i n question , now , o r a

t an y tim e i n the future , excludin g an y remaining warrant y (3 0 day s total ) except thos e items listedbelow , i f any . Propert y ID : Propert yAddress : M ^ gjl j torfiPttj 

### Owner : 

# H\^£ \ moi } ui k Phone : Restoratio n Item s i n Question :

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

yQ ^ agre e restoratio n I s completed
. LJ I d o no t agre e restoratio n i s complete d at (note d deficiencie s above ) 

# uh l 

# 1 0 Owncr ^ Signatur e Dat e

# • 

# > 1

Prudeti t Technologies , Inc . (Prudent ) i s unde r contrac t withth e U . S , Environmenta l Protectio n Agenc y (EPA ) t o clean u p lead
contaminate dsoil s a t anumbo^ f propertie s locate di n Omaha , Nebraska , includin g th e propert y locate da t H2-^M OVJL.'TCACAVI C •n v Th e EP A request s you r permissio n t o allo w Pruden t t o performasoi l cleanu p a t thi s propert y t o remov e lead-contamirtate dsoil . B y sigmn g thi s form , th e propert y owne r grant s permissio n t o Pruden t t o perfor m activitie s relate dt o th e cleanu p includin g soi l sampling , remova l o f lead-contaminate dsoil , an drestoratio n ofth e reference dproperty . Ifyo 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 southoffic e for th e Omah aLea d Site cleanup-a t (402 ) 733-1188 . Genera l question s abou t th e Omah aLea dSit e cleanu p can b e directe dt o th e EP A Publi c Infonnatio n Center s at (402 ) 731-304 5 (SouthOmali aoffice ) o r (402 ) 991-958 3 (Nort hOmah aoffice) . Property Acces s Grante dB y ^•J-1^QT,f O Property Owne r Signature : (Signature ) (Date ) PROPERT Y INFORMATIO N (TcKb i l e complete db y residen t and/o r propert y owne r —pleas e print ) RESIDEN TNAME : 

### 6^^ ^ /* / Owne r Rente r RESIDEN TADDRESS :
I F RENTAL , PROPERT Y OWNE D BY : 

# vM^o s K J is^" ^ 1 ^ (^nr^;^..^ ^ f o g 6 ^ ^

<^ 7
OWNER' S MAILIN G ADDRESS ;
OWNER' S TELEPHON E NUMBE R - HOME : J L WORK :
AG E O F HOME? : YEARS
. HO W LON G HAV E YO U LIVE D HERE ? YEARS
. HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978 ? 

### YE S NO NUMBE R 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 NUNDE R 7 YEAR S OL D WH O PLA Y I NTH 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 , ENTRY GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS ; Th e activitie s t o b e implemente db y EP A unde r thi s agreemen t ar e pursuan t t o Sectio n 10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA'sngh t o f

acces s t o th e propert y i s provide dfor i n Sectio n 104(e)o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry for '"determinm g th e nee dfor response , o r choosin g o r takin g an y respons e actio n unde r thi s title , o r otherwis e enforcin g th e provision s ofth e title. " 808 0 War d Parkway , Suit e 40 5 560 0 S 1 0 S 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
. 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 7ENV£RO^ME^fTAL & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : L^2X ^ h^f<i^ ^ S< ^ '^^*' ' Phone : BVID :
J^ery^P^..^ ^ At^n ^

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Propert y Owne ^ Pruden t Employ e Signature : Signature : 808 0 War d Parkway , Suit e 40 5 560 0 S 1 0 S t n Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 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 Co»
. lO^tt t R7«J!«T 7

### Owne rName : tjsmfi.* i R M^f u 

## Address ; ygg ^ Burcfe/f e iSf
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## D XR F Unit : lOcT T Book : /7 7 

## D Date 

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## D Tim e 

# Jim . Staff : j22sjaZ
. Legend : F l = Fron t Left , F 2 = Fron t Right , B 1 = Back Left , B 2 = Back Righ t D Z = Dri p Zone , GZ = Garden , P Z = Pla y A

H quadrant s ar e a t viewe dfrontth e street , facing proper ^ /l y c 

# ENTERE D DEC 0 6 260 6 

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# 422 4 BURDETTE ST : 5 0 X 12 0 

# A Printed : De c 06.201 0 www.dcsis.orc/doui. sPag e 1 o f 1

" > Creat e Anothe rTicke t Bac k t o Irt h Interne t Sen d Email s
YOU RTICKE T NUMBE RI S 2600849 . Origina l Cal l Date : 9/24/1 0 Time : 4:4 6 p mOp : SIVA1896 7 Wor k t o Begi n Date : 9/28/1 0 Time : 5:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 422 4 Street : BURDETT E S T Twp : 15 NRng : 13 E Sect-Qtr : 08-SE-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : soi l lea d 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 : UNSUR E CORNER S Compan y: 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 : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Service Are a Contact Phon e Nunlbe r utilit y Type CXCAT V CO X COMMUNICATIONS , IN C HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
MUDO l METROPOLITA N UTILITIE S DISTRIC T SANDY Day : 402504782 3 Alt : Emerg : 402504797 0
OMAHACOFCIT V OFOMAHA-TRAFFIC,SEWE R RICHH-RAFFI C Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0
0PPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T EL M LOCATIN G Day : 406728934 3

Alt : 406207149 4

Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K EL M LOCATIN G Day : 406728934 3

Alt : 406207149 4

Emerg : 888728934 3
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/24/201 0

# m m ENVIRONMENTAL ENGINEERIN GAN D CONSTRUCTIO N TECHNOUk^Bs , mc . 

### SOLUTION S 

## SIT E SAFT^T Y HAZARD ANALYSI S



# , ^^ ^ f)^J.i- ^ 

# , q-3Jit l Addres s Excavatio n Dat e Cre w 

# :Jc4 k Backfil l Date :

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 Conditio n HajArd s 

## Correctiv e Actio n 

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## A d tl\ 0 1 . 

## Pl O Sit e Safet y Offic e Date :

MS O Wanf^Bartany , Sute4< B 

### seoosios t 424 2 Medica l Drive , Suit e 7260 Kansa s C«ly;MO«411 4 Omalia , NstMasIc a 6610 7 Sa n Antonio , T X 7822 9 Plione : ^16 ) 363^3703 Phone : (402)733-118 8 Phone : (21t»822:«58 8 Fax:(816)363.370 7 F^x : (402)733^188 3 Fax : (210)579-657 7

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