SAID# : 2937 4 

## TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R DATE : 12/15/201 0 ADDRESS : 200 6 MIAM I S T REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES . INC . YEAR : 201 0 

## SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S B

J PR E AN D POS TVIDE O O F PORPERTY(DVD ) d EXECUTIV E SUMMAR Y lf i EPA-PROVIDE D PROPERT YSKETC H 1 3 SIGNE D ACCES S AGREEMEN TFO R SUBJECTPROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FO R ADJACEN TPROPERT Y H RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENT S (I.E. , FO R DAMAG E O R T O REPLAC E PLANTS , ETC. ) H CONFIRMATIO N DAT A \ £ PHOTOGRAPH S II I AS-BUIL TSKETC H m SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R [? fPROPERT YCLOSE-OU TCHEC KLISTSIGNE D B YEP A D DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A d UTILITYCLEARANCE S d PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR' S OFFIC E 

## D D D 

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# .^v ^ SIGNATUR E DAT E 3026078 8 Superfun dFin d Record Remediatio n Quer y Lead Remainin g Quer y: Propert yDamag e Quer y 

### Backfill :

Sampl e Area : 2937 4 - 200 6 MIAM I S T Owner : n Owne rOccupie d 

### Owne rName : ]CA M RAN H BA YINVESTMENT S Owne rAddressi : Owne rAddressZ : J371 1 N1 9 S T City : State : Zi p Code : lOMAH A 

## ]N Ejesiio - Owne rPhon e Alternat e Phone :

Contract : Contractor : PRUDENT201 0 S Contract Optio n ^OPTIO 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 MO O Assessmen t Ma xXR F Valu e f " 524.2 7 Resident : Residen t Name : 

# I Propert yAddress : |200 6 MIAM I ST Zi p Code : J68110 - Residen t Phon e

### PROPERT Y SUMMAR Y Date : 12/15/201 0 Omah aLea dSit e Remedia l Actio nContrac t #EP-R7-07-0 6 TO# l Mont hof : Decembe r Propert y Address : 200 6 MIAM I S T A . EXECUTIV ESUMMAR Y A. l 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 NSAMPLIN GDATA/RESULTS : B l = 39 0 PP M @ 6" ; B 2 = 23 2 PP M @ 6" ; E A= 35 7 PP M @ SCRAP E(~1" ) ATTACHMENT S 1 ) Property sketc hprovide dby EP Apursuan t t o contrac t specification s 2 ) Signe dAcces s Agreemen t includin g acces s agreement s require dfo r crossin g othe r propertie s 3 ) Pre-Excavatio ndigital vide o clip/photograph s 4 ) Post-E.xcavatio ndigital 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 nlef t behin darea s vi ) Contracto r identificatio n iii ) Property addres s vii ) Date 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 dinclude : i ) Pre-excavatio nagreemen t detail s (ifan y ar e mad e wit hth e property owner ) ii ) Property Statu s For msigne dby property owne r iii ) Excavatio ndigital vide o i nMPEG , WM V (Window s Medi aVideo ) o r SWF(Flas hPlayer ) forma t and/o r photograph s iv ) Signe dfor mverifyin g satisfactory restoratio n v ) Descriptio nofarea s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOCIES , INC .TECHNOLOGIES , INC . 

# EPAProperty Clos e Ou t ^dOci
- M \^«i>v. . Propert y # : 

# d^iy^ A Propert y Address : DiUc/Tinie : Owner'sName : ('4^rcitd(l

_G>a!y.c ^'> Quad s ExcaA'ated: ' 6l , ' S 2. ^ Contracto r Gn'oup : Pn.mk'.n t Technologic.'i , Inc. . Excavatio nGenera l Ye s N o 1 I f !iecessp.r> . wer e th e correc l quadiant(s ) excavate dan drestored' ' / 2 . If necessiiry . wer e th e correc t area s of dn p zon e excavate dan drestored ? / Gradin g So dan dVegetatio n Ye s N o 1 . Doe s th e gradin g arouiTdtli e penmete r o f th e house i nexcavate darea s generall y slop e away 

# y fromth e house' ? 2 Ha s so dbee nlai dinal l area s llia t vver e excavated ? 

# y 3 Doe s th e so dappea r t o b e generaUy health y an dgrowing ? (Onl y evaluat e if inspecte da t a3 0 da

y lun e period ) 

# y 4 Ar e sodde darea s generall y fir man devenl y graded' ? 

# y 5 . Ar c th e joint s betwee nth e so dstnp s generall y light ? (Onl y evaluat e i f inspecte da l a3 0 da y 

### / tim e penod ) y 

### 6 Wa s th e property grade dsuc htliat wale r wil l no t poo l o ntli e property' ^ 

# d 7 Wa s damag e l o landscapin g or plan t material s avoided ? 

# A 1 

### Gates , Fence s an dRetainin g W.-jlL s Ye s IM o ) D o gale s ope nan dclos e freely'' ' (Ifapplicable ) 2 Wer e al l gate s or fence s take ndow ndunn g restoratio nactivitie s reinstalled ? (Ifapplicable ) 

# r 3 Wa s damag e l o gale s o r lence s avoided ? (Ifapplicable ) 

# y 4 Wa s damag e to retamin g wall s avoided ? (Ifapplicable ) 

# y Fonindation , Sitlin g inn dGutter s Ye s No 1 Wa s damag e l o th e sidin g o r tru navoided ? 

# A Wa s damag e l o th e foundalio navoided ? 

# A Wa s damag e t o window s avoided ? 

# -y ^ 

# A 4 , Wa s damag e l o window s o r doo r screen s avoided ? 5 Wa s damag e t o downspout s or downspou t extension s avoided ? 

# A Siclewallk s am i Drivc^vay s (Concrete ) Ye. s . W 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 :

Inspectao nnotes :

Remova l aii drestoratior i activate s complet e includin g th e 30-da y so dwarranty . EP ARepresentativ e Qt v ^6 ^ ^Date ; ii/'7|| g

# m CHNOLOGIES . INC 

## A S - BUIL T DRAWIN G OL. S #2937 4 Dat e Kxcavated : 10/07/201 0 

## OMAH ALEA D SUPERFUN D SIT E USEP ASigncd-Of fDate : 

## 2937 4 Exterio rPain t Omah a Lea d Sit e Owne rName : CA M RAN H BA YINVESTME N • Goo d Sit e Sketc h Address : 200 6 MIAM I S t • Poo r 

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## .Ai/^0_Aj/17yiyriAL . 

# '^yyy:/Asffrs^.AA..._AAys^^^. P«Km. : S^J^OQi^ l f ls;esitoraS:5oiSi i liilem s itir a Qiaesitiiofb :

• i ReQinr^d i cc-rreei^5o'[ri s tto compieu e iiiTi^ s p^^p^S-s' .

• J 3gre e restoratio n i s completed , excep t a s note d abov s I — I 

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## ••myPiiideii t Techiinlo^jes . Inc . (Prudent ) is unde r conirac i wii hlh e U. S. Environmenia l Proieciio n.'\genc y (tPA ) to clea n up lead
eonlaminato dsoil s ax

;i numbe r of propertie s l.^cate d in Omaha , Nebraska , includin g th e propert y locate d al -yOO\iiA > A^/y \/* 7 /

Th e F.PArequest s you r permissio n to allo w Pniden t lo perlor m .n soi l clciinu p ,it tlii. s propert y lo remov e lead-contaminale dsoil . By signin g thi s form , th e propert y owne r grant s permissio n to Pruden t lo perfor m activitie s relate d lo lh e cleanu p includin g soi l sampling , remova l of lead-eontaminate dsoil , an drestoratio not'th e reference dproperty . Ifyo u hav e an y question s abou t th e soi l cleanu p planne dfo r you r property , pleas e conlac t Pruden t soui holTie e fo r th e Omah aLea d Sil e cleanup-a t (-102 ) 73.V11S8 . Genera l question s abou l tli e Oniah aLea dSil e cleanu p ca n be directe d to lh e EP A Publi c Int'ormatio n Center sal (402 ) ''1 1 -.•;n4 5 (Sout hOmaliMiffice ) or (402 ) 991-958 3 (Norti i Omah aoftice.i . Propert v .Acces s Cjianle dBy : I (Pl&s e Prin t Name ) Propert y (.)wne r Signatur e (Date ) ROPERT YINFORMAT^ N te d byresiden t aiid/o rpropert yoivne r—pleas e print ) RESIDENT NAME : Rente r RESIDENT ADDRES S 

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## p y OWNER' S MAILIN G ADDRESS ;

OWNER' S TELEPHON E NUMBE R - HOME : ('VO^'V S -!? — (c > olf-S ' WORK : ( ) . AG E OF HOME ? YEARS . HO W LON G HAV E YO U LIVE D HERE ? NO HA S TH E EXTERIO R BEE N PAINTE D OR COVERE DD WIT WIT HH SIDIN G SINC E 1978 ? NUMBE R OF OCCUPANT S UNDE R 7 YEAR S OLD : /yfANUMBE R OF OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBER OF CHILDRE N UNDE R 7 YEAR S OL D WH O PLA YIN TH E YAR D FO R 5 HOUR S OR MOR E PE R WEEK : 

# -M
- COMMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. ) / / ..V

I ITl-IORIT Y FO RENVIRONMENT,A LRESPONS EACTIONS : Th e activitie s to be implemente d by EP A unde r thi s .agreemen t ar e pursuan t lo Sectio n10 4 ofCERCLA . 42 U.S.C . 9604 . EPA' s righ t ofacces s to th e propert y is provide dfo rin Sectio n104(e ) of CERCL.A, , 42 U.S . C 9603(e) . whic hprovide s entr y fo r "delcniiiiiin g tli e nee dfo r respi.^nse , oj choosin g or takin g an y respons e aclio n unde r till s lille , or otherwis e eni^orcingth e provision s of th e title.' ' 808 0 War d Parkv/ay , Suit e 40 5 560 0 S 10 3t 424 2 Medica l Drive , Suit e 425 0 Kansa s City.'M O 6411 4 Omaha . Tilebrask a 6210 7 Sa n Antonio . TX 7S22 9 Phone : (816 ) 363-370 3 Phcjne : (402 ; 733..11S 8 Phone : (210)822-968 8 Fax : (316 ) 363-370 7 F<1>: : (402 ) 7?.3-18Sr i Fax : (210)679-667 7ENVlROiNMEiVTALJ i 

# mm m CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

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# 2937 4 Omah a Lea d Sit e Owne rName : _CAN/LRAN H BA YINVESTME N 

### Sit e Sketc h Address : 200 6 MIAM I S T Phone : H : W : Sampl e Numbe r Lea d Concentratio n Sampl e Coltecte d LA B RYASCPXA-2937 4 F l 3> 2 Ca » pp m 

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## PJS L Staff : 

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### Omah aLeadSit e 46139^

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# 200 6 Miam i 

# A Printed : No v 16,201 0 www.dcgis.org/dogi sPag e 1 o f 1

" > Creat e Anothe rTicke t Bac k t o Irt h Interne t Sen d Emai l

• YOU RTICKE T NUMBE RI S 2609449 . Origina l Cal l Date : Wor k t o Begi n Date : 10/05/1 0 10/07/1 0 Time : Time : 4:2 7 5:0 0 p m p m Op : SIVA1896 7 State : N E Address : 200 6 County : Street : DOUGLA S MIAM I S T Place : OMAH A Twp : 15 NRng : 13 E Sect-Qtr : 10-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 : SIVAJAMPAM A Phone : (402)733-11 ! 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 MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Servic e Are a Contac t Phon e Nunibe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUDO l METROPOLITA N UTILITIE S DISTRICT SANDY Day : 402504782 3 Alt : Emerg : 402504797 0
OMAHACOFCITYOFOMAHA-TRAFFICSEWE RRICH/TRAFFIC Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0
OPPDGPR5 OMAH A PUBLIC POWE RDISTRICT 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. . . 10/5/201 0TECHNOUmiES , INC . 

### ENVIRONMENTA L ENGINEERIN GAN D CONSTRUCTIO N SOLUTION S 

# SIT ESAFET Y HAZARD ANALYSI S Address : Excavatio n Date : -dJ7s3sdfd ^ Crew : — 

# 3. Backfil l Date :

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# Correctiv e Actio n

Cre w Forema n Site Safet y Offic e Date : ^fy - /<^ - 

### 1 • y ^

808 0 Wan t Parioiiay , Suit e 40 5 560 0 S 1 0 S t 424 2 Medica l Drive , Suit e 725 0 Kansa s Gity . M O 6411 4 Oinaha , Nebiask a6810 7 Sa nAntonio , T X 7822 9 Phone : (816 ) 362^370 3 Phone : (402)733-118 8 Phone : (210 ) 822-958 8 Pax : (816 ) 363^370 7 Fax : (402)733-188 3 Fax : (210 ) 579-657 7

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