## TRANSMITTA L O F OMAH ALEAD SITE SOI L REMEDIATIO N FILE FOLDE R SAID# : 3123 4 DATE : 1/1 5 ADDRESS : 320 6 EMME T S T REMEDIATIO N CONTRACTOR : PRUDEN TTECHNOLOGIES . INC . YEAR : 20lt ) 

## SOI L REMEDIATIO N PROPERT Y FIL E FOLDE R DOCUMENTS d PR E AN D POS T VIDE O O F PORPERT Y (DVD ) m EXECUTIV E SUMMAR Y 0 EPA-PROVIDE D PROPERT V SKETC H m SIGNE D ACCES S AGREEMEN T FOR SUBJEC TPROPERT V D SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN T PROPERT Y d RESTORATIO N AGREEMEN T D SETTLEMEN T DOCUMENTS (I.E. , FOR DAMAG E O R TO REPLAC E PLANTS , ETC. ) M CONFIRMATIO N DAT A [ Z PHOTOGRAPH S 0 AS-BUIL T SKETC H 0 SATISFACTOR Y RESTORATIO N SIGNE D B Y PROPERT Y OWNE R E T PROPERT YCLOSE-OU T CHECKLIS T SIGNE D B Y EP A n DESCRIPTIO N O F AREA S NO T MEETIN G RO D CLEANU P CRITERI A E l UTILIT Y CLEARANCE S Q PROPERT Y INFORMATIO N FRO M DOUGLA S COUNT V ASSESSOR'S OFFIC E D D D



## ^ 4 n ztil n SIGNAfUR E ~ " ~ ~ DAT E 

### 3021763 2 

# •

1 1 Superfun d

### PROPERT Y SUMMAR Y Date : /15/201 0 Omah aLeadSite Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l Monthof : Propert y Address ; 320 6 EMME T 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 = 16 6 PP M @ 6" ; E A = 30 0 PP M @ SCRAP E (~1" ) 

### ATTACHMENT S 1 ) Propert y sketc hprovidedb y EP A pursuan t to contract specification s 2 ) Signe dAcces s Agreemen t including acces s agreement s requiredfo r crossing othe r propertie s 3 ) Pre-Excavation digita l vide o clip/photograph s | 4 ) Post-Excavation digita l vide o clip/photograph s ! 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Buihsketc h- \ i ) Shal l includ e fina l lea dlevel s v ) Legen d ii ) Contamination lef t behin darea s vi ) Contractor 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 (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 vide o i n MPEG , WM V (Window s Medi aVideo ) or SW F(FlashPlayer ) forma t and/o r photograph s I iv ) Signedfor mverifying satisfactor y restoration v ) Description of area s no t meeting Interi mRO D cleanu p criteria .

TECHNOLOCIES . INC .Fin d Record 

### Backfill :

Sampl e Area : 3123 4 - 320 6 EMME TS T Owner : D Owne rOccupie d Owne rName : I DAVIS-MOS S PATRICI AG Owne rAddressl : Owne rAddress2 : |340 4 JOH N CRHGHTO N BLV D City : State : Zi p Code : lOMAH A |N E {68111 - Owne rPhon e Alternat e Phone :

Contract : Contractor : JPRUDENT2010_ S Contrac t Optio n |OPTIO N 2 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 : 

# 1 Alternat e Phone : 

# 1

Assessment : Qualifyin g Grou p |40 0 Assessmen t Ma xXR F Valu e [ ~ 477.6 1 Resident : Residen t Name : Propert yAddress : 320 6 EMME T ST Zi p Code : |68111 - Residen t Phon eTECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y # : Propert y Address : SZXX p ^""^'^ ^ ^ Date/Time : Owner' s Name : Quad s Excavated : Contracto r Group : Pniden t Technologies , Inc. , Excavatio n Genera l Ye s No 1 . If necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? / 2 . If necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? / 

### Gradin g So dan dVegetatio n Ye s N o 1 . Doe s the gradin g aroundthe perimete r o

f th e hous e i n excavatedarea s generall y slop e awa y / fro mthe house ? 2 . Ha s sodbee n lai di n all area s tha t wer e excavated ? 

## y 3 . Doe s the sodappea r to b e generall y health y andgrowing ? (Onl y evaluate i f inspectedal a3 0 

# y da

y tim e period) 4 . Ar e soddedarea s generally fin n an devenl y graded ? 

# y 5 , Ar e tlie joint s betwee n the so dstrip s generally tight ? (Onl y evaluat e i

f inspecieda t a3 0 da y 

# y lim e penod ) 6 . Wa s the propert y grade dsuc htlia t wate r wil l not pool o n th e property ? 

# y 7 . Wa s damag e t o landscaping o r plan t material s avoided ? / Gates , Fence s an dRetainin g Wall s Ye s N o I . D o gate s ope n an dclos e freely ? (I f apphcable ) 

# ~y 2 . Wer e al l gale s o r fence s take n dow n durin g restoratio n activitie s remstalled ? (I f applicable ) / 3 . 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 ? (I f applicable ) 

# y Foundation , Sidin g an dGutter s Ye s No 

### 1 . Wa s daniag e t o the siding o r tri mavoided ? / 2 . Wa s damag e t o the foundation avoided ? 

# y 3 . Wa s damag e t o window s avoided ? 

# y 4 . Wa s damag e t o window s o r doo r screen s avoided ? 

# y 5 . Wa s damag e t o downspout s o r downspou t extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Ye s No 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 :

Inspectio n notes :

V 

### .x*
- 

# y ^
/ 

# ^* / yy

Remova l andrestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e A*-^* ^ ^Date: izlisftortCHNUl.UUIKS . INC . 

## A S - BUIL T DRAWIN G OL S #3123 4 Dat e Excavated : 10/19/201 0 I SEP A Signed-Of f Date : 

## OMAHA LEAD SUPERFUND SIT E 

# 3fa3 ¥ Omah a Lea d Sit e Exterio rPain t rtontiAm w Owne rName : . .p ^ YH i l»> » Oftio t •yftof. i D Good Sit e Sketc h Address : 3^0( ^ . g»?*>»r f . • Poo r Phone : H : VJJ - f^f H w • No t pain t Sampl e Numt>e r Lea d Concentratio n Sampl e Collecte d LA B Firm : Sample s Collecte d Q> 0 ­ f g JOr ^ RYASCPXA-2>va.3> 4 F l 30- 1 pp m 

### D Date : Sj)7JOt / RYBSCPXA-3\a3,\ ^ RYCSCPXA-2)v2^3 4 RYDSCPXA-J^\:i3t i F 2 B l 8 2 ^O" ? pp m '-j l 9^ pp m P I ­ pp m 

### D D D Time : 

### J&l^ ^ Sampie s Analyze d BSZOCPXA ­ 

## ® r B2 ^ pp m pp m pp m Numbe ro f Sampie s = 

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### Date: q^;;iar)4 . Time : _ Staff : 

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# t ENTERE D AU G ?i a 2005 :


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# y A ^ ' 

# ? ^ ?,07 , tj-n a Omah aLeadSite 46l3f > EA = 30 0 PP. M @ SCRAP E (-1" ) CONTRAC T # : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC .

### I 

# «ER(V Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n o f remova l activitie s performe do n th e belo w liste dproperty . Th e property owner' s signatur e indicate s tha t th e property 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 any tim e i n th e future , excludin g any remaining warrant y (3 0 day s total ) excep t thos e item s liste dbelow , i f any . PropertylD : ^ ; 2-Im
properl y Address : y^ ^ f'g^yy.tJ
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### Restoratio n Hents i n Question :

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### (ii(i^h Q Owner' s Signatur e Dat eENVIRONMENTA L& CONSTRUCTIO N 

### TECHNOLOGIE S SERVICE S 

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## Owne r Name : VC A W ^ 

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## Owne r Phone : 4 6 5 - Ll-S^^C^ ^ \ 

## Belo w pleas e find alistin g o f unsuccessfu l attempt s t o reac hth e abov e propert y owner . Dat e Tim e Initial s \ \ O T 

## ^'':^ n I^OLWVIV A 

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## Signatur e Pruden t Technologies , Inc. , 

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## Acknowledgmen t signatur e EP A 8080 War d Paricway . Suit e 40 6 Kansa s City , M O 6411 4 Phnna - ffllAI 363-370 3 

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424 2 Medica l Drive , Suit e 7250 Sa n Antonio , T X 78229 Phone : (210)822-958 8 250 5 N . 24* ^

Street . Suit s 30 8 Omaha . Nabiask a 6811 0 Phone : (402)504-100 4^•^•y- - y^ ' Pruden 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 dsoils,^ t anumbe r ofpropertie s locate di n Omaha , Nebraska , includin g th e propert y locate dat a^-Ob g|'tt^^6• T S T Tli e EP A request s you r permissio n t o allo w Prudent.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 propert y owne r grant s permissio n t o Pruden t t o perform 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 . Ifyo 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 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 can b e directe dt o th e EP A Publi c Informatio n Center s at (402 ) 731-304 5 (Sout hOmah aoffice ) o r (402 ) 991-958 3 (NorthOmah aoffice) . Property Acces s Grante dBy . 7 (Pleas e Prin t Name ) 

# ?[<]')o\{ } Property Owne r Signature ' 

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# W_^0_t ' (Signature ) PROPERT Y INFORMATIO N o b i complete db y residen t and/o r propert y ovme r —pleas e print ) RESIDEN T NAME : Owne r Rente r 

# c^rA.A^ ^ fco ^ RESIDEN T ADDRESS :
IFRE I fS(;tA L PROPERT Y OWNE D BY : W . 

### 0 ^^c S OWNER ' • S MAILIN G ADDRESS ; ^- ^ - f ^ r ^ / I "V\>C^r^<?v )
WNER' S TELEPHON E NUMBE R - HOME : { > WORK : 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 NUNDE R 7 YEAR S OL D WH O PLA Y I NTH 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 , ENTRY GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS E ACTIONS ^ Th e activitie s t o b e implemente db y EP A unde r thi s agreemen t ar e pursuan t t o Sectio n 10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t ofacces 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 '"determinin g th e nee dfor response , OT choosin g o r takin g an y respons e actio n unde r thi s title , o r otherwis e enforcin g th e provision s ofth e title. " 808 0 War d Parkway , Suit e 40 5 560 0 S 1 0 S 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 ) 733-118 8 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402 ) 733-188 3 Fax : (210 ) 679-667 7ENVfROMMEOT.'V L & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE. S 

# Propert y Statu s For m Address : 3^ 0 ^ &^^.,. ^ <- ^ "^^^' ^ lo/^lo(( ) Phone : BVID :



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Hy ^ Pruden t Employe e Signature : Signature : 808 0 War d Parkway , Suit e 40 5 560 0 S 1 0 S 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)733-118 8 Phone : (210)822-958 8 IOHC \ t o ^TA T /4AO I T-^ 1 -leo ^

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# A Printed : Oc t 08 , 201 0 www.dcgis.org/dogi s

### Pag e 1 o f 1

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### • YOURTICKE T NUMBERI S 2609834 . Origina l Cal l Date : 10/06/1 0 Time : 9:0 2 a m Op : SIVA1896 7 Wor k t o Begi n Date : 10/08/1 0 Time : 9:3 0 a m State : N E County : DOUGLA S Place : OMAH A Address : 320 6 Street : EMME T S T Twp : 15 NRng : 13 E Sect-Qtr : 09-N 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: PRUDENT 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 Nunibe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , INC 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 OMAHACOFCITY OFOMAHA-TRAFFICSEWERRICH/TRAFFIC 

### Day : 402444719 7 Alt : 402444516 1 

### Emerg : 402444516 0 OPPDGPR5 OMAH A PUBLIC POWE RDISTRIC T EL M LOCATING 

### Day : 406728934 3 Alt : 406207149 4 

### Emerg : 888728934 3 QLNN E 1 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. . . 10/6/201 0TCOHN t IOUMS|| L 

### CONSTRUCTIO N 

## mc . SOLUTION S 

## SIT E SAFET Y HAZARD ANALYSI S Address : •'^2 ^ ^ gono-ttoA " / / 

## Excavatio n 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 Sidewalk Foundatio n Retainin g Wall s Fence s Tree s Structure s Driveway Sprinkle r Syste m Othe r Cre w Forema n Conditio n c^< ­ 

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## Sit e Safet y Offic e Date :

IOWafdVaftainy.8uMe40 S SSOOSIOS t 424 2 Medica l Drtvo , Suit e 7ZS 0 iisasC«y;ilO«411 4 OmMut f Mtbit M Sa n Antonio , T X 7822 9 ana : (8K ) 36S«370 3 1>lwm : (402)733-118 8 Phone : (2t0 ) 822^«58 8 cISIS ) 363.370 7 fax : (402)73><18S 3 1=W . (210)679-657 7

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