0 

### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAIDff : 

### 2918 5 DATE : 1/1 5 ADDRESS : 281 2 MIAM I S T REMEDIATIO N CONTRACTOR : PRUDEN TTECHNOLOGIES . INC . YEAR : 

### 20l( ) 

### SOI L REMEDIATIO N PROPERT Y FIL E FOLDE R DOCUMENT S d PR E AN D POS T VIDE O O F PORPERT Y (DVD ) d EXECUTIV E SUMMAR Y

EPA-PROVIDE D PROPERT Y SKETC H d SIGNE D ACCES S AGREEMEN T FOR SUBJEC T PROPERT Y

• SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN T PROPERT Y E f RESTORATIO N AGREEMEN T

• SETTLEMEN T DOCUMENTS (I.E. , FOR DAMAG E O R TO REPLACE PLANTS , ETC. ) d CONFIRMATIO N DAT A a PHOTOGRAPH S d AS-BUIL T SKETC H [

/ 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 •DESCRIPTIO N OFAREAS NO T MEETIN G RO D CLEANU P CRITERI A d

UTILIT Y CLEARANCE S PROPERT Y INFORMATIO N FRO M DOUGLA S COUNT Y ASSESSOR'S OFFIC E 

# • a i/i/ n SIGNATUR E DAT E 

### 3021760 4 

# Hii n 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 ; 281 2 MIAM I 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 :

B l = 22 0 PP M @ 8" ; B 2 = 34 2 PP M @ 8" ; E A = 13 2 PP M @ SCRAP E (~1" ) 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 ) Docimientatio 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 di n th e individua l property file , i f available , o r obtaine dinclude : i ) Pre-excavationagreementdetails(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 o f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOCIES , INC ,Fin d Record Backnil :

Sampl e Area : 2918 5 - 281 2 MIAM I S T Owner : D Owne rOccupie d Owne rName : JBALLAR D ELAIN E A Owne rAddressl : 

# 1 Owne rAddress2 : |348 3 SPRAGU E ST City : State : Zi p Code : lOMAH A |N E |68111 - Owne rPhon e Alternat e Phone : |(402 ) 451-612 9 

# 1

Contract : Contractor : |PRUDENT2010_S Contrac t Optio n JOPTIO N 1 Remediatio n QueryI Lea d Remainin g QueryI Propert yDamag e Quer y

Use rProvide d Owne rInformatio n Owne rName : 

# 1 Owne rAddress : 

# 1 City : 

# 1 State : Zi p Code : 

# 1 1 Owne rPhone : Alternat e Phone : 

# 1 ' 1

Assessment : Qualifyin g Grou p [40 0 Assessmen t Ma xXR F Valu e | 505.4 9 Resident : Residen t Name : 

# I Propert yAddress : |281 2 MIAM I ST Zi p Code : |68111 - Residen t Phon e 

# ITECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y # : 7 ^l'^^ ' Propert y Address : ^S' l 2 . KTarA t M ^ » Date/Time : Owner' s Name : \I-^<\\D W9xt%C ^ Contracto r Group : Pruden t Technologies , Inc , Quad s Excavated : '(^\^^ ^ Excavatio n Genera l Ye s N o 1 .

I f necessary , wer e th e correct quadrant(s ) excavatedan drestored ? / 2 .

I f necessary , wer e th e correct area s o f drip zone excavatedandrestored ? / Gradin g So dan dVegetatio n Ye s N o 1 .

Doe s the gradin g aroxui dthe perimete r o

f th e hous e in excavatedarea s generall y slop e awa y 

# y fro mthe house ? 2 .Has sodbee n lai di n all area s tha t wer e excavated ? 

# - y 1 .

Doe s tlie sodappea r to b e generall y health y andgrowing ? (Onl y evaluat e i f inspecteda ta3 0 da

y lim e period) ' 

# y 4Ar e soddedarea s generall y firman devenl y graded ? 

# y 5 .Ar c Ih e joint s belAvee n the sodstrip s generall y tight ? (Onl y evaluat e i

f inspecte da t a3 0 da y tim e period) 6 .Wa s tli e propert y grade dsuc htlia t wate r wil l not pool o n the property ? 

# r 7 .Wa s damag e t o landscapin g o r plan t material s avoided ? 

# r Gates , Fence s an dRetainin g Wall s Ye s N o 1 . Do gate s ope n andclos e freely ? (I f applicable ) / 2 . Wer e all gate s o r fence s taken dow n during restoratio n activitie s reinstalled ? (I f applicable ) 

# y 3 . Wa s damag e t o gate s or fence s avoided ? (I f applicable ) 

# y 4 . Was daniag e t o retainin g wall s avoided ? (I f applicable ) 

# y Foundation , Sidin g an dGutter s Ye s N o 1 .

Wa s damag e t o tlie siding o r trimavoided ? / 2 .

Wa s damag e t o the foundation avoided ? / 3 . Wa s damag e l o window s avoided ? / 4 . Wa s damag e t o window s or doo r screen s avoided ? / 5 Wa s damag e l o downspout s or downspou t extension s avoided ? / Sidewalk s an dDriveway s (Concrete ) Ye s N o Wa s damag e lo diivewa y surface s avoided ? 

# Y 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°- ^ A ^ ^Date: uKI' Q[•CHNOLOOIES . INC . 

### A S - BUIL T DRAWIN G OI,S#2yi8 5 Dat e Kxcavated : 11/17/201 0 

### OMAH A LEA D SUPERFUN D SIT E ISKPASigned-OlTDate : 

## y i ^ } & S Name ; f/«i/i e BI/(A»W Omah a Lea d Sit e Date : Cf i >t 5 OS ' Nort h Arro w Addres s 2.^12 . MxW^ \ Si - Sit e Sketc h Time : ff . M^-A ^ 

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## L . J \ \ 1 i 1 '^l^'^^^^ r1 i T i 1 1 1 1 K\=132I>P M u S(RAI'K ( 1" ) OmahaLea dSit e 4613 0 CONTRAC T # : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC .

### I 

# 6ERI \ Propert yCompletio n Agreemen t Thi s agreemen t docimients th e completion of remova l activitie s performe do n th e below listedproperty . Th e propert y owner' s signatur e indicate s tha t the propert y owne r i s satisfiedwit hth e restoratio n of the subject property , andtha t n o item s ar e i n question , now , or a

t an y tim e i n th e future , excluding an y remaining warrant y (3 0 day s total ) except thos e item s liste dbelow , if any . Propert y ID : Propert y Address: ^ g , 2, ^ > M » ^ - ­ ^ ^ 

### Phon e Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item :

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

# /^-/-y ^ 

# ^.- ^ }^.d y Owner' s Signatur e Dat ePruden t Technologies , Inc . (Pnident ) i s unde r contrac t wit hIh e U . S . Environmenta l Protectio n Agenc y (EPA ) t o clean u p lead contanjinpte ^ |p|l ^ anumbC T o f prop^e s locate di n Omaha , Nebraska , includin g th e property locate da t f~a^ r'O/ , -j ^ j/y^/^./Tt / • Th e EP A request s you r pennissio n t o allo w Pruden t t o perfon n asoi l cleanu p at thi s propert y t o remov e lead-contaminate dsoil . B y signin g thi s form , tli 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 inchidin g soi l sampling , removal o f lead-contaminate dsoil , an drestoratio n o f th e reference dproperty . I f

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 hOmah aOffic e fo r th e Omah a Lea dSit e cteanup.a l (402 ) 733-1188 ; 733-1455 . General question s abou t th e Omah aLea dSit e cleanu p can b e directe dt o th e EP A Publi c Informatio n Center s a t (402 ) 731-304 5 (Sout hOmah aofBce) . Property Acces s Grante d 

# Bv: X Y/^/^KfOA i / . A^/fA^ A (Pleas e Prin t Name ) 

# ^\4o...^ l i&d/. l _y^^zy^^p Property Owne r Signature ^ (Signature ) (Date ) > fSiotifliiire^ ( PROPERTY INFORMATIO N ff o be complete d b yresiden t and/o rpropert yowne r- please print ) RESIDEN T NAME : i^-^ / Owne rRente r RESIDEN T ADDRESS :

I F RENTAL , PROPERTY OWNE D BY ; 

# ^^,y)^^.y^ M '^j'^ y OWNER' S TELEPHON E NUMBE R - HOME K{'/02 X ^^^f~ ~ / ^ Q .^JWORK : ( 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 Y I N TH E YAR D FO R 5 HOUR S O R MOR E PE R WEEK :

>MMENT S O R SPECIA L JNSTgWDONS : (I.E . DOGS , ENTR Y GATES , ETC-L , j l

AUTHORIT Y FO RENVIRONMENTA LRESPONS E ACTIONS : Th e activitie s t o b e implemente db y EP A unde r fliis agreemen t are pursuan t t o Sectio n 104 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 mSectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry for "determinm g th e nee dfo r 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 & e provision s o f th e title. "

808 0 War d Parkway , Suit e 40 5 560 0 S . 10* ^ Stree 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)733-145 5 Phone : (210 ) 822-958 8 Fax : (816 ) 363-370 7 Fax : (402 ) 733-188 3 Fax : (210 ) 579-657 7

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### Pag 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 2632339 . Origina l Cal l Date : 11/02/1 0 Time : 11:4 5 a m Op : SIVA1896 7 Worl c t o Begi n Date : 11/04/1 0 Time : 12:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 281 2 Street : MIAM I S T Twp : 15 NRng : 13 E Sect-Qtr : 09-S E 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)733-118 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 Service Are a Contac t Phon e Numbe r utilit y Typ e 

### Day : 402934046 9 CXCAT V C O X COMMUNICATIONS , IN C HEIDI 

### Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUDO l METROPOLITA N UTILITIE S DISTRIC T SANDY 

### Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACOFCITY O FOMAHA-TRAFFIC,SEWE RRICH/TRAFFIC Alt : 402444516 1 

### Emerg : 402444516 0 Day : 406728934 3 0PPDGPR 5 OMAH A PUBLIC POWE RDISTRIC T ELMLOCATFNG Alt : 406207149 4 

### Emerg : 888728934 3 Day : 406728934 3 QLNN E 1 C QWES T LOCA L NETWOR K 

### EL M LOCATIN GAlt : 406207149 4 Emerg : 888728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 11/2/201 0I f INC . 

### CONSTBUCnO N SOLUTION S 

## SIT E SAFi:T Y HAZARD ANALYSI S .^X^..£^^£i2-U^ . Addres s : Excavatio n Date : Crew : Backfi U Date :

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0 IdtetfBartaMy . Suil»4I B SSOOSIOS t 424 2 Madica l Drive , Suit e 725 0 imnaiy/llO«411 4 Ontfta , Nataaik a 0810 7 Sa n Antonio , T X 7822 9 tone : CaW ) 36Sg7l> 3 Pliena : (402)733-118 8 Phone : (210)822458 8 P C 19^383^3711 7 Fax : (4Q2)73»<1«8 3 Fax : (210)579-657 7• ^fe. ^

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