### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID* : 27749 DATE : 1/1 5 ADDRESS : 151 1 BURDETTE S T REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES . IN C YEAR : 201( t 

### SOI L REMEDIATIO N PROPERT Y FIL E FOLDE R DOCUMENT S D l PR E AN D POS T VIDE O O F PORPERT Y (DVD ) E EXECUTIV E SUMMAR Y D i EPA-PROVIDE D PROPERT YSKETC H Q SIGNE D ACCES S AGREEMEN T FOR SUBJEC TPROPERT / D SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN TPROPERT Y I D RESTORATIO N AGREEMEN T

• SETTLEMEN T DOCUMENTS (I.E. , FOR DAMAG E O R TO REPLAC E PLANTS , ETC. ) d CONFIRMATIO N DAT A

• PHOTOGRAPH S

• AS-BUIL T SKETC H

• SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT Y OWNE R I D PROPERT YCLOSE-OU TCHECKLIS 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 YCLEARANCE S

• PROPERT YINFORMATIO N FRO M DOUGLA S COUNT / ASSESSOR'S OFFIC E D D

SIGNATUR E DAT E

### 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 Montl i of : Propert y Address : 151 1 BURDETT ES 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 Information : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : F 2 = 22 2 PP M @ 2" ; B l = 37 5 PP M @ 2" ; B 2 = 38 7 PP M @ 2" ; N O EASEMEN T ATTACHMENT S 1 ) Property sketc hprovide dby EP A pursuan t t o contrac t specification s 2 ) Signe dAcces s Agreemen t includiti 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 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 obtainedinclude : i ) Pre-excavatio n agreement detail s (ifan 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 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 ofarea s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOGIES . INC .Fin d Record Remediatio n Quer y Lea d Remainin g Query Propert yDamag e Quer y BadcTill :



### Sampl e Area : 2774 9 - 151 1 BURDETT E S T Owner : D Owne rOccupie d Owne rName : jSIXTEEN m STREE TLT D PTF T Owne rAddressl : 

# 1 Owne rAddressZ : 1222 1 N 2 4 S T City : State : Zi p Code : JOMAHA JN E 168110 - Owne rPhon e Alternat e Phone : 

# r

Contract : Contractor : )PRUDENT2010_ S 

### Contrac t Optio nJOPTIO N2 Use rProvide d Owne rInformatio n Resident : Owne rName : Residen t Name : Owne rAddress : Propert yAddress : ]151 1 BURDETT E ST Zi p Code : )68110 - City : State : Zi p Code : Residen t Phon e ^__

_^ Owne rPhone : Alternat e Phone : 

# 1 j

Assessment : Qualifyin g Grou p 40 0 Assessmen t Ma xXR F Valu e 499.6 5TECHNOLCX5IIES . INC . Propert y # : '27'^ ^ Date/Time : Quad s Excavated : F2 , 6 ^ 9>2 ­ 

# ^i^-jhiaS' . / •;' ; V 

# EP A Propert y Clos e Ou t Propert y Address : [''^l l ^urrd^-^'^'^ ' Owner' s Name : 'C^rciv<£e l ^^(A.(Z_ - Contracto r Group ; Pruden t Techiraologics , line , 

### Excavatio n Genera l Ye s N o I . I f necessary , wer e th e correc i quadrant(s ) excavatedandrestored ? / 2 . I f necessary , wer e the correct area s o f drip zon e excavatedandrestored ? / Gradin g Sodan dVegetatio n Yes , N o ) . Doe s the gradin g aroundtli e perimete r o

f the hous e in excavatedarea s generall y slop e awa y / fro mthe house ? 2 .Ha s sodbeen laidmal l area s tha t wer e excavated ? / 3 .

Doe s the sodappea r t

o be generall y health y andgrowing ? (Onl y evaluat e i f inspecte dat a3 0 / da

y lim e period) 4 .Ar e soddedarea s generall y fir man devenl y graded ? 

# y 5 .Ar c Ui e joint s betwee n tli e sodstrip s generall y tight ? (Onl y evaluat e i

f inspecte da t a3 0 da y tim e period) 

# y (i >Wa s the property ' gradedsuc htlia t wate r wil l not pool o n the property ? 

# y 7 .

Wa s damag e t o landscapm g o r plan t material s avoided ? / Gates , Fence s an dRetainin g Wall s Yc 3 N o 1 .D o gate s ope n iui dclos e freely ? (I f appUcable ) 

# y 2 .Wer e al l gale s o r fence s talcen dow n durin g restoratio n activitie s reinstalled ? (Ifapplicable ) 

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

# y 4 . Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) 

# y Foundation , Sidin g an dGutter s Ye s ,No I Wa s damag e t o the siding o r trimavoided ? 

# . y 2 . Wa s damag e t o tli e foiuidalion avoided ? 

# y 3 Wa s damag e l o window s avoided ? 

# y 4 .

Wa s damag e t o window s o r doo r screen s avoided ? 

# ' J 5 . Wa s damag e t o downspout s o r downspou t extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) YeS / No W;i s damag e l o drivewa v surface s avoided ? Wa s damag e t o walkwa y surface s avoided ? • ^

## Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e 9^' ^ j^^^^ . tt/f3// ot'HNOLOtMES . INC . 

## A S - BUIL T DRAWIN G OL S # 2774 9 Dat e Excavated : 10/20/201 0 

## OMAHA LEAD SUPERFUND SIT E USEP ASigned-Of rDate : 

# tJ7H- 3 Exterio rPaint Nort h Arro w Owne rName : .=5/>^£-gT/ ycS^fE T Cf b Oma^ a Lea d Sit e • Goo d Address : / ^/ / £Kei>£Tr £ ^Tl''^^^^! f Sketc h • Poo r Phone : H : w : 0 No t pai m Satmpl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Fir m RYASCPXA-.?77y' 9 F l 

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# a Dat e RYBSCPXA- J 774^ ? F 2 H 6 1 pp m H 

### D Tim e RYCSCPXA-J7 7 V f B l ^ i I ppm \ i 

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### D RDZ8ePXA-^7>^^~© 2 ppm D 

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m n Time : ^r ^ Staf^^f, ^ Numbe rof Sample s 

# n ^ D Legend : F 1 = Fron t Left . F2 = Fron t Right , B l = Bac k Left , 8 2 = Bac k Righ t DZ = Dri p Zone , G Z = Garden . PZ = Pla y Al l quaorant s ar e a s viewe d fro m tti e street , facin g propert y •o'?^ a

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N O I.AS F MK M CONTRAC T# : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC .

# %EP A Propert yCompletio n Agreemen t Thi s agreemen t documents the completion of remova l activitie s performedo n the below listedproperty . The propert y owner' s signatur e indicate s tha t the propert y owne r i s satisfiedwit hthe restoration ofth e subject property , an dtha t no item s ar e i n question , now , o r a

t an y tim e i n the future , excluding an y remaining warrant y (3 0 day s total ) except thos e items listedbelow , ifany . Propert y ID : Propert y Address : 

## trS W 

# IfSurA^i^ ^ ^] - Owner : Phone : . —. - Restoratio n Item s i n Questio n

Ite m

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

I 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 abov e

Dat ePmden 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 anumbe r o f

propertie s locate di n Omaha , Nebraska , includin g th e propert y locate dat 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 property t o remov e lead-contaminate dsoil . B y signin g thi s form , th e property 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 . I f

yo u hav e an y question s abou t th e soi l cleanu p plamie 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 ca n b e directedt o th e EP A Publi c Informatio n Center s a l (402 ) 731-304 5 (SouthOmali aoffice ) o r (402 ) 991-958 3 (NorthOgash aoffice) . 

# {V\. i tSjcot ^ V^^cXAxCtl > Property Acces s Grante dBy : (Pleas e Prin t Name ) 

# J o /^'/2 > Property Owne r Signature : 

# m Ignature ) (Date ) PROPERT Y INFORMATIO N (T o b^cdmplete db y residen t and/o r propert y owne r —pleas e print ) RESIDEN T NAME : 

## r^TouLJl r\dy Owne r Rente r SIDEN TADDRESS ; , ^ ^ / > I F RENTAL , PROPERT Y OWNE D BY : OWNER' S MAly^ G ADDRES S 

# ;;^^g. i ^ ^ ^^ ^ g f

X\t..S u K3 t

t^k D OWNER' S TELEPHON E NUMBE R - HOME : J L WORK : 

# J 1 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 N O 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 N UNDE R 7 YEAR S OL D WH O PLA YI 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. )

AllTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS ; Th e activitie s t o b e implemente db y EP A unde r this agreemen t ar e pursuan t t o Sectio n 10 4 o f CERCLA , 4 2 U S.C . 9604 . EPA' s right 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 '"detenninin g th e nee dfor response , or choosin g o r takin g an y respons e actio n unde r tlii s title , o r otherwis e enforcin g th e provision s ofth e title. " 808 0 War d Parkway . Suit e 40 5 580 0 S 1 0 S t 424 2 Medica l Drive . Suit e 425 0 Kansa s City.'M O 6411 4 Omaha , Niebrask a6810 7 Sa n Antonio . TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402 ) 733-118 8 Phone : (210)822-968 8 Fax:(816)363-370 7 Fav : <402 i 733-188 3 Fax : (210 ) 579-667 7ENVIRONMENTA L& CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : \S\ \ %j^f^^€ L \ Date : 

### Phon e

Propert y Owne r Pruden t Employe e Signature : Signature : 8080 Ward Parkway , Suit e 40 5 5600 SI O S t 4242 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 68107 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Fax : (816 ) 363-370 7 Phone : (402)733-118 8 Fax : (402)733-188 3 Phone : (210)822-958 8 Fax : (210 ) 579-6577

# a i rH- 3 Exterio rPain t Nort h Arro w 

### Owne rH9XM'.^/KTE^Tf^.sniee rLT h Omah a Lea d Sit e n Goo d 

### Address : / ^/ / Sn^l^eTT E ST^'^^lf Sketc h • Poo r Phone : * ^ W : 

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# [ Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Firm : fQf i t^ . C C RYASCPXA-^??^ ^

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# n Date : lO-tJ^O U RYBSCPXA- J 774^ ^

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## D D Time : 221 . ^ Staff : j/i^^J - Numbe ro f Samples = Legend : F 1 = Fron t Left , F 2 = Front Right , B l = Back Left , B 2 = Bac k

Right D Z = Dri p Zone , G Z = Garden , 9 Z - Pla y Al l quadrant s ar e a s viewe d fro m th e street , facin g propert y



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## Pag e 1 of 2

" > Creat e Anothe rTicke t Bac k tojrthjnterne t Sen d Emal L 

## YOURTICKE T NUMBERI S 2616909 . Origina l Cal l Date : 10/14/1 0 

### Time : 8:1 7 a m Op : SIVA1896 7 Wor k t o Begi n Date : 10/18/1 0 

### Time : 8:4 5 a m State : N E 

### UGLA S Place : OMAH A Address : 151 1 Street : BURDETT E S T Twp : 15 NRng : 13 E Sect-Qtr : 10-SE-S 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 : 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 MCINE B 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 MCINE B MC I N O CAL LPER MEMO 

## Day : 8002893427 Alt : Emerg : 800289342 7 MUDO l METROPOLITA N UTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE RRICH/TRAFFI C 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 

## http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.. . 10/14/201 0

## Pag e 2 of 2

0PPDGPR5 OMAH A PUBLI C POWE RDISTRICT EL M LOCATIN G 

## Day : Alt : 406728934 3 406207149 4 Emerg : 888728934 3 QLNN E1 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=<RESULT.. . 10/14/201 0IBOHNOUkMB , I , INC . 

### CONSTBUCTIO N SOLUTION S 

## SIT E SAFtT Y HAZAR D ANALYSI S Address : Excavatioi i Date : Crew : 

## BackfiU Date :

Ite m Overhea dLine s Ga s Lin e Wate r Lin e Sewe r Lin e Septic/Leec h Fiel d Propane/Butan e Sidewal k Foundatio n Retainin g Wall s Fence s Tree s Structure s Drivewa y Sprinkle r Syste m Otlie r Cre w Forema n Conditio n c ^ ^ 

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## a^ — Hazard s Correctiv e Actio n

Sit e Safet y Offic e Date :

OMI¥faitf«ariamy , S(rito40 5 560 0 SI O S t 424 2 Modica l Drive , Sutt » 726 0 ;aisa8C«yiMO«411 4 rfmiMaesior Sa n Antonio , T X 7822 9 hone : ISW ) 363t-3rQ S PttOR K{402)733-118 8 Phone : (2t0 ) 82Z-068 8 ax : |S ^

363>3T0 7 Fax : (402)733<1M 3 Fax : (210 ) «r»-657 7

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