### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 2830 8 DATE : 1/1 5 ADDRESS : 291 0 ERSKIN E S T REMEDIATIO N CONTRACTOR : PRUDEN T TECHNOLOGIES . INC . YEAR : 20lf e 

### SOI L REMEDIATIO N PROPERT Y FIL E FOLDE R DOCUMENT S I ^

PR E AN D POS T VIDE O O F PORPERT Y (DVD ) I ^

EXECUTIV E SUMMAR Y d EPA-PROVIDE D PROPERT Y SKETC H d SIGNE D ACCES S AGREEMEN T FOR SUBJEC T PROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN T PROPERT Y H RESTORATIO N AGREEMEN T D SETTLEMEN T DOCUMENTS (I.E. , FOR DAMAG E O R T O REPLACE PLANTS , ETC. ) E

J CONFIRMATIO N DAT A d PHOTOGRAPH S Ca

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AS-BUIL T SKETC H d SATISFACTOR Y RESTORATIO N SIGNE D B Y PROPERT Y OWNE R d PROPERT Y CLOSE-OU T CHECKLIS T SIGNE D B Y EP A O DESCRIPTIO N O F AREA S NO T MEETIN G RO D CLEANU P CRITERI A a UTILIT Y CLEARANCE S D J PROPERT Y INFORMATIO N FRO M DOUGLA S COUNT Y ASSESSOR'S OFFIC E D D 

## fLr,4u ^ _illl u SIGNATUR E DAT E 

### 3021760 6 

# il H Superfun d

### PROPERT Y SUMMAR Y Date : /15/201 0 Omah aLea dSit e Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l Mont h of : Propert y Address ; 291 0 ERSKINE 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 :

F 2 = 34 3 PP M @ 6" ; E A = 26 1 PP M @ SCRAP E (~1" ) ATTACHMENT S 1 ) Propert y sketch providedb y EP A pursuan t to 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 video clip/photograph s 4 ) Post-Excavation digita l video clip/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Buil t sketch i ) Shal l includ e fina l lea dlevel s v ) Legen d ii ) Contamination lef t behin darea s vi ) Contracto r identification iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r items to b e includedi n the individua l propert y file, i f available , o r obtainedinclude : i ) Pre-excavation agreemen t detail s (if an y ar e mad e wit h the propert y owner ) ii ) Propert y Statu s For msignedb y propert y owne r iii ) Excavation digita l video i n MPEG , WM V (Window s Medi aVideo ) o r SW F(Flash Player ) forma t and/o r photograph s iv) Signe dfor mverifying satisfactor y restoration v ) Description of area s no t meeting InterimRO D cleanu p criteria .

TECHNOLOCIES , INC .Rn d Record Remediatio n Quer y Lea d Remainin g Query: Propert yDamag e Quer yi 

### Backnil :

Sampl e Area : 2830 8 - 291 0 ERSKIN E S T Owner : Use rProvide d Owne rInformatio n n Owne rOccupie d Owne rName : Owne rName : IWATKIN S JEA N Owne rAddressl : Owne rAddress : 

# r Owne rAddcessZ : 12905 LAKE ST City : iOMAH A State : NE " Zi p Code : 16811 1 City :

.. . State : ^ , Zi p Code : ^ , Owne rPhon e Altemat e Phone : Owne rPhone : Alternat e Phone : 

# r

Contract : Assessment : contractor : |PRUDEI\rT2010_ S Qualifyin g Grou p }40 0 Contrac t Optio n |OPTIO N 2 Assessmen t Ma xXR F Valu e f 474.8 7 Resident : Residen t Name : 

# I Propert yAddress : J291 G ERSKIN E S T Zi p Code : J68111 - Residen t Phon e 

## ]TECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y # : '^"^3^ ^ Propert y Address : "^A1 0 Br<i^ < -^ - ^ Date/Time : Owner' s Name : "^.^o.. ^ 10AV^\ ^ Quad s Excavated : ^ 'Z - Contracto r Group : Prurien t Technologies , Inc. , 

### Excavatio n Genera l Ye s N o I . I f necessary , wer e lh e correct quadrant(s ) excavatedandrestored ? 

## ^i f 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 th e hous e i n excavatedarea s generall y slop e awa y 

## J fro mthe house ? 2 . Has sodbee n laidi n aJ l area s tha i wer e excavated ? / 3 . Doe s the sodappea r t

o b e generall y health y andgrowing ? (Onl y evaluat e i f inspecteda t a3 0 / da

y lim e period) 4 . Ar e soddedarea s generally fir mandevenl y graded ? / 5 , Ar c the jomt s between the sodstrip s generally tight ? (Onl y evaluat e i

f inspecte da t a3 0 da y tim e penod ) / 6 . Wa s the propert y grade dsuc htlia t wate r wil l not pool o n the property ? / 7 . Wa s damag e to landscapin g o r plan t material s avoided ? / Gates , Fence s an dRetainin g Wall s Ye s N o 1 . D o gate s ope n andclos e freely ? (I f apphcable ) / 2 . Wer e all gate s o r fence s taken dow n during restoratio n activitie s reinstalled ? (I f apphcable ) / / 3 . Wa s damag e to gate s or fence s avoided ? (I f applicable ) 4 . Wasdamagetoretainin g wall s avoided ? (I f applicable ) / Foundation , Sidin g an dGutter s Ye s N o 1 . Wa s damag e t o the sidin g o r trimavoided ? 

# y 2 . Was damag e l o lh e foundation avoided ? 

# y 3 . Was damag e l o window s avoided ? / 4 . Wa s damag e t o window s or doo r screen s avoided ? / 5 . Was damag e t o downspout s or downspou t extension s avoided ? / Sideyyalk s an dPrivcvyay s (Concrete ) Ye s N o Wa s daiiia" e l o drivewa v surface s avoided ? Wa s damag e l o walkwa y surface s avoided ? 

# - y 1

## Owner s comments :

Inspectio n notes :



# ^ y

Remova l an drestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e ^'^^ . ^ Date : 4i ^'CIINOI.CKIinS . INC . 

### A S - BUIL T DRAWIN G OL S #283() S Dat e Excavated : 10/11/201 0 

### OMAH A LEA D SUPERFUN D SIT E ISEP A Signed-OI T Date : 

## < f d 30< ^ Nam e _ Omah a Lea d Sit e Dat e ^ C 6 ^> - Nort h Arro w Addres s Sit e Sketc h Time : Phone : Tea m/f/'^ ^ X T ^ .-^- » ' BVID) » '^^ ^ XR F Cod e /» 3 7 Sa.oH-13- i Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e 

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CONTRAC T # : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC .

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/•.:• . / . ' " • ' • ^ ^ • A ^v - • .- y Pruden t Technologies , Inc . (Prudent ) is unde r contrac t with th eU. S. Environmenta l Protectio n Agenc y (EPA ) to clean up lead conlaminale dsojj s at anumbe rof propertie s locate d in Omaha , Nebraska , includin g th e propert y locate dat f(L t w>.<

_ Vr ~ Tli e EPArequest s you r permissio n to allo w Pruden t to performasoi l cleanu p at

thi s properl y to remov e lead-contaminate dsoil . By signin g thi s form , th e propert y owne r grant s permissio n to Pruden t to perfor m activitie s relate d to th e cleanu p includin g soi l sampling , remova l of lead-contaminate dsoil , an drestoratio nof th e reference dproperty . If

yo 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 sout h offic e .fo r 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 canbe directe d to th e EP A Publi c Informatio n Center s at (402 ) 731-304 5 (SouthOmali aofBce ) or (402 ) 991-958 3 (North Omah aoffice) . Property Acces s Grante d By Property Owne r Signature : 

# ^cyM%: ^ /^-^-/ ^ (Signature ) PROPERT Y INFORMATIO N /(To* i e complete d by residen t and/o r propert y owne r —pleas e print ) RESIDEN T NAM E 

## C^Cojf\ \ [^\ r Owne r Rente r (ESIDEN T ADDRESS L x ^ IF J^NTAL , PROPERTYiOWNE D BY : OWNER' S MAILIN G ADDRESS ; /? , _. . A* - /^ r- ^ OWNER' ij S TELEPHON E NUMBE R TELEPH I - HOME : J\_ WORK : AG E OF HOME? : YEARS . HO W LON G HAV E YO U LIVE D HERE ? YEARS . HA S TH E EXTERIO R BEE N PAINTE D OR COVERE D WIT H SIDIN G SINC E 1978 ? YE S NO NUMBE R OF OCCUPANT S UNDE R 7 YEAR S OLD : NUMBE R OF OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R OF CHILDRE NUNDE R 7 YEAR S OL D WH O PLA Y IN TH E YAR D FO R 5 HOUR S OR MOR E PE R WEEK : COMMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTRY GATES , ETC. )

ALrrHORFT Y FO RENVIRONMENTA LRESPONS E ACTIONS : Th e activitie s to be implemente dby EP A unde r thi s agreemen t are pursuan t to Sectio n 10 4 of CERCLA , 42 U.S.C . 9604 . EPA' s righ t of

acces s to th e propert yis provide dfor in Sectio n 104(e ) of CERCLA , 42 U.S . C 9605(e) , whic h provide s entry for "determinin g th e nee dfor response , or choosin g or takin g an y respons e actio n unde r thi s title , or otherwis e enforcin g th e provision s of th e title. " 808 0 War d Parkway . Suit e 40 5 560 0 S10 St 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 7ENVIRONMENTA L& CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : ^ g| l O Q , j . ,^ ; ^ e ^j( _ 

# Date : /J ^ ^ ~ / ^ BVID : 

# Phone : ^-/ - (y^SZS'S "

808 0 War d 560 0 S 1 0 S t 424 2 Medica l Drive , Suit e 425 0 Kansa s CIM^M O 6411 4 Omaha , Nebrask a 6810 7 Sa n Antonio , T X 7822 9 Phone : (81« ) 363-3703 Fax : (816 ) 363-370 7 Phone : (402)733-118 8 Fax : (402)733-188 3 Phone : (210)822-958 8 Fax : (210 ) 579-657 7I < V &';-' * » V ' f ^iri-nii ; Name : _ Omah a Lea d Sit e Date : / O '6~fi ^ Nort h Arro w Address : Sit e Sketc h 

### Time : / , i o Phone : \ Tea mASi ^ / Ti^- X4- ^ BVID # 

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# A \ium f Printed : Oc t 07 , 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 YOURTICKE T NUMBE RI S 2611136 . Origina l Cal l Date : 10/07/1 0 Time : 9:2 8 a m Op : SIVA1896 7 Wor k t o Begi n Date : 10/12/1 0 Time : 10:0 0 a m State : N E County : DOUGLA S Place : OMAH A Address : 291 0 Street : ERSKIN E S T Twp : 15 NRng : 13 E Sect-Qtr : 09-SE-S W Twp : Rng : Sect-Qtr : Lega l Given : C 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 : 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

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 HEIDI 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 Y OFOMAHA-TRAFFICSEWERRICH/TRAFFIC Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 OPPDGPR5 OMAH A PUBLIC POWE RDISTRIC T EL M LOCATIN G Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNN E 1 C QWES T LOCA L NETWOR K EL M LOCATING Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 10/7/201 0

### ENVIRONMENTAL ENGINEERBV GAN D TEOHNOUieflES , INC . 

### CONSTRUCTIO N SOLUTION S 

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