### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 2514 7 DATE : 1/1 5 ADDRESS : 292 6 MYRTL E S T REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES . INC . YEAR : 201( ^ 

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

TPR E AN D POS TVIDE O O F PORPERT Y(DVD ) [2 ^

EXECUTIV E SUMMAR Y Q^EPA-PROVIDE D PROPERT YSKETC H [ F SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN TPROPERT Y Q^RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R T O REPLAC E PLANTS , ETC. ) d CONFIRMATIO N DAT A \ 3 PHOTOGRAPH S 0 AS-BUIL TSKETCH C /

SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R 0 PROPERT YCLOSE-OU TCHECKLIS TSIGNE D B YEP A D DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A G rUTILIT YCLEARANCE S H PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E D D

SIGNATUR E DAT E 

### 3021842 5 

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### PROPERT Y SUMMAR Y Date : /15/201 0 Oinah aLeadSite Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l Montl i of : ' 

### Propert y Address : 292 6 MYRTLEA V A . EXECUTIVESUMMAR 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 Relevant Infomiation : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : B l = 320 PP M @ 2" ; E A = 21 5 PP M @ 2 " ATTACHMENT S 1 ) Propert y sketchprovidedb 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 vide o clip/photograph s 4 ) Post-Excavation digita l video clip/photograph s 5 ) Documentation - CompletedClose-ou t Checklist 6 ) As-Buil t sketch
i ) Shall includ e fina l lea dlevel s v ) Legen d ii ) Contamination lef t behindarea s vi ) Contracto r identification iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r items to be includedi n the individua l propert y file, if available , o r obtainedinclude : i ) Pre-excavation agreemen t detail s (i f an y ar e mad e wit hthe 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(FlashPlayer ) forma t and/o r photograph s iv ) Signedfor mverifying satisfactor y restoration v ) Description ofarea s not meeting Interi mRO D cleanu p criteria .

TECHNOLOCIES . INC .Fin d Record Remediatio n Quer y| Lea d Remainin g Quer/ I Propert yDamag e Quer y Backfill :

Sampl e Area : 2514 7 - 292 6 MYRTL E A V Owner : D Owne rOccupie d Owne rName : lOT Y O F OMAHA " Owne rAddressl : |C/ 0 nNANC E DEPARTMEN T Owne rAddress2 : 1181 9 FARNAM S T City : State : Zi p Code : lOMAH A |N E 168183 - Owne rPhon e Alternat e Phone : 

# I

Contract : Contractor : |PRUDENT2010_S Contrac t Optio n |OPTIO N 1 Use rProvide d Owne rInformatio n Owne rName : 

# 1 Owne rAddress : 

# 1 City : 

# 1 State : Zi p Code : 

# 1 1 Owne rPhone : 

# 1 " Alternat e Phone : 

# 1

Assessment : Qualifyin g Grou p J40 0 Assessmen t Ma xXR F Valu e f 

### 18 5 Resident : Residen t Name : [UNOCCUPIE D Propert yAddress : |292 6 MYRTL E A V Zi p Code : |68131 - Residen t Phon e 

# rTECHNOLCX:-T.ES , INC . 

# EF A ;rt v Clos e Oof . Satc/TJme ; QiiadsExcavatci-t' B \ Propert y Address ; "ZAT-^ e (^.(^(rf^ ^ Owner' s Name : ^ rS & o ^ ^'>^avuj< ^ Cositiracto r Growp : lPriiuk>,n t Tecllmo!ogic.s , FliniK. E:5c:iivatioii Genera ) Ye s N o I 1 1 necessary , wer e th e correc l quadiaiU(s ) excavate dan drestored ? / 2 . i r necessary , wer e th e conec t area s o f dri p zon e excava(e dan drestored ? / Gradin g So dan dVcgeilatioR i ¥e s No 1 Doe s th e gradin g aroun dth e perijiiete r o

f th e hous e i n excavate darea s generall y slop e away fro mth e liouse ? / 2 Ha s so dbee n lai dmal i area s tliat wer e excavated ? /

• - 1

. 1 . Doe s (h e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da l a3 0 / day iini e period ) 4 . Are sodde darea s generally ' fir man devenl y graded ? / 5 Ar c tli e joint s betwee n th e so dstrip s generaJl y tight ? (Onl y evaluat e i f inspecte da l a3 0 dai> ' tun e penod ) / 0 . Wa s th e property grade dsuc htha t wate r wil l no t poo l o n tli e property ? / 7 . W;i s damag e ( o landscapin g or plan t material s a\'oided ? / 0;i!teS ; Fence s an dRKlaiaim g Wati s Yes . N o ujL^O y ! D o gate s ope n an dclos e freely ? (I f applicable ) Wer e al l gate s o r fence s taice n dow n dunn g restoratio n activitie s reinstalled ? (I f applicable ) 

# 7 7 Wa s damag e t o gate s o r fence s avoided ? (If applicable ) 4Wa s damag e t o retainin g wall s avoided' ' (I f applicable ) / FoMKidation , Stains , an dGulrtej' s ''i<t % IM Wa s damag e t o th e suiin g o r tri mavoided ? / Wa s damag e to th e foundatio n avoided ? 

### / W;i s damag e i o window s a\'0Kied ? 

# 7 / 4 .Wa s dania"; e t o ^vindow s o r doo r screen s avoided': * Wa s damag e t o downspout s o r downspou t extension s avoided ? 

# 7 Sidewalk s %n. A pitivgway s (Coni'c'e.ite ) Y« aN o ! , Wa s da.iiiaj; e t o d]"ive\va \sisrfac;e s avoided ? 2 .Wa s damag e t o walkwa y surface s avoided ? 

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## Owner s confiimeiits :

Inspectio n notes : 

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Remova l andrestoratio n activate s complete includin g th e 30-da y so dwarranty . EP A Representativ e Q ^ J H Date : i\»''WhTHNDrDGIES . INC . 

## A S - BUIL T DRAWIN G OLS#2514 7 Dat e Excavated : 10/06/201 0 t'SEP A Signed-Of f Date : 

## OMAHA LEAD SUPERFUND SIT E 

# ZSIU T Exterio rPain t Nortt i Ano w Omah a Lea d Sit e • Good Sit e Sketc h • Poo r Samplin g Address : z'?2f e KWRTl- g A V Q'^No t pain t Sampl e Numtje r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Firm : fijjsj. P S M f^YASCPXA-ZSW TF l 

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

# SEF W Propert yCompletio n Agreemen t Thi s agreeinen t document s th e completio n o f remova l activitie s performe do n th e belo w liste dproperty . Th e propert y owner' s signatur e indicate s tha t th e propert y owne r i s satisfie dwit hth e restoratio n o f th e subjec t property , an dtha t n o item s ar e in question , now , o r at an y tim e in th e future , excludin g an y remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y tP ; ^ ^ ^ : ^ Propert y Address ; ^9p( ^ ^^ ^ 

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H0^ ~ ^^H-^JtUk ' Restoratio n item s i n Question :

Item : item : Item : item : item : item :

1^ 1 agre e restoratio n i s completed . [ U I d o no t agre e restoratio n i s complete d a t (note d deficiencie s above ) 

# ^^yyyyy y 'f-ji^.^y^A<y-;po/C i Owner' s Signatur e ^ Dat e

### (FAX ) P.002/00 3 09/10/201 0 16:0 1

Pradea t Technologies , Ine . (Pnuient ) I s unde r eontrec t witb th e U , S . Bnvironmeote ) Protectio o Agene y (EPA ) t o cleanu p lead
­ contamintTw i loll i a t awamib aofpropertie s locate dI nOmaha , Nebnika , faiclnding th e propetty locate da t J<^J< . /r\-y4 Wwc ^ __ . Th e EP Arequet u you r peimisiio at o allo w I^ant t aperfbn naaoi l cleanu p a t thi s propen y t o leiAbv e lead-contaminate daoil . B y f Ignin g thi atbnn , dt e property owne r gtant i permiMio nt o Pniden t t o perfon n activltie i relate dt o th e clunu p Inoludin g soi l Mmpliog , removi l o f lead-conlaminate dsoil , an drcstoran'o nofth e leArence dpropeny . Ifyo u hav e an y question s abou t th e aolt cleanu p ptanse dfb r you r propeny , pleai e contao t Pruden t SomhQmnliii nme e fer th e Oroafa a LeadSit e cleanu p ji t

(402 ) 733-lUS ; 733-145S . Oeneia l queition s abou t th e Omah aLea dSit e cleanu p canb e directe dt o th e EP A Publi c Infbrmatlo nCente nat (402 ) 73I-304 S (SouthOmah aoflFice) . Property Acces s Grante dBy : LjilliAi ^ Li^UAj^ h (Pleas e Prin t Name ) Property Owne r Signamn 

# ure : ^jC ^ y^yAA A /^'VA^/ Q ^:^igmture ) (Date ) PROPERT Y INFORIMATION (T o b e complete db y residen t and/o r propen y owne r - plea M print ) RESIDEN TNAME : 

## < w / qy Ot^nj^l ^ Rante r RESIDEN TADDRESS : 

## S^'=fi(o m^r-^U . Ay^ ^ ^ I F RENTAL , PROPERT YOWNE D BY :
OWNER' S MAILIN G AODRBSS ; 

# i^[ \ykrAi^r A^^.^y y n u o^i ^ 6Mh OWNER' S TELEPHON E NUMBE R - HOME : J L WORK :



## i'/(} M vy^-v^c/ ^ AOEOFHOME? ! YEARS . HO W LON G HAV E YO U LIVE D HERB ? .YEARS . HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN O SINC E 1978 7 _YE 8 .N O NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD: . . NUMBE R O F OCCUPANT S 7 YEAR S OL O AN D OLDE R NUMBER O F CHILDRE N UNDE R 7 YEAR S OL D WH O PUYI N TH E YAR D FO R 6 HOUR S O R MOR E PE R WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOOS , ENTR YGATES , ETC, )

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s n > b e implemente db y EP Aunde r thi s agreemen t ar e pursuan t to Sectio n104 ofCERCLA , 4 2 U.S. C 9604 . EPA' s right ofacces s t o th e property i s provide dib r i

nSectio n104(e ) o f CERCLA , 4 2 U.S . C 9603(e) , whid ) provide s entry Jb r "determmin g th e nee dib r response , o r ehoosin g orukin g an y rcapons e actio n unde r Ai s title , o r otiierwjs aenfbrcin g th e provision s ofth e title. "

806 0 War d Parkway , Suit e 40 5 560 0 S.10" > Stree t 424 2 Medica l Drive , Suit s 425 0 Kansa s City , M O Q411 4 OmahB , Nabraek a 6610 7 Sa nAntonio , TX7B22 S Pfione : (816 ) 363-370 3 Fax : (B16 ) 393-370 7 Phone ; (402)733-146 6 Fax : (403)733-166 3 Phone : (210)822-968 6 Fax : (210 ) 679-6S7 7ENVrRONMENTA L & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : Oada ^ U\
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Propert y Owne r Pruden t Employe e Signature : Signature : (jL^ _ 808 0 War d Parkway , Suit e 40 5 560 0 S 1 0 S t ledica 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 Civ . /4AO I 7^ ^ •lOO ^ C o vIII M C70J«7 7*vi--,-^«-Vs»"i^ - ri-i-vt-iii-rir ; V

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### Create Anothe r Ticke t Bac k t o Irt h Inteme t Sen d Emai l 

### YOU RTICKE T NUMBE RI S 2592069 . Origina l Cal l Date : 9/14/1 0 Time : 5:1 8 p m Op : SIVA1896 7 Wor k t o Begi n Date : 9/16/1 0 Time : 5:4 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 292 6 Street : MYRTL E AV E Twp : 15 NRng : 13 E Sect-Qtr : 16-NE-NW-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: 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 LEVEL 3 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 LEVEL S LEVEL 3 COMMUNICATIONS , LL C N A 

### Day : 877366834 4 Alt : Emerg : 877366834 4 MUDO l METROPOLITA N UTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFIC.SEWE R 

### RICH/TRAFFI C Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/14/201 0

### Pag e 2 of 2
OPPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T Alt : 406207149 4

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

EL M LOCATIN GAlt : 406728934 3 406207149 4 Emerg : 888728934 3

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## SIT ESAFET Y HAZAR D ANALYSI S 

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## BackfiU Date :

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W n WwfVoriony . SiMe4( W S600S10a t 424 2 Medica l Drive , Suit e 726 0 Ciu M C^ , Ma«411 4 Omliia , NctaaM a 4810 7 Sa n Antonio , T X 7822 8 ihone : {SIS ) sas-aTO S VlMatmr . (402 ) 733- 1 IS S Phone : {21t> ) 822-i968 8 Fa c(402)733^1S8 3 Fax : (210 ) S70-657 7

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