## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL E FOLDE R SAID# : Zlf-l^" ) Date : / O JJ9 J ^n 8 Address : 3x/j ? HaJt^Z-T^yJ^ 9fRemediation Contractor : i^y^uJ r lotUiAyL . jlc, . Year : 2-Dog SOI LREMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S Video ofpropert y (DVD ) Executive Summar y 

## B

f EPA-providedpropert y sketch SignedAcces s Agreemen t fo r

subject propert y D 

## SignedAcces s Agreement(s ) fo r

adjacen t propert y Restoratio n Agreemen t Settlemen t dociunent s (i.e. , fo r

damag e or to replac e plants , etc. ) Confirmation data 

# y Photograph s As-built sketch 

# y Satisfactor y restoratio n signedby Propert y Owne r 

# y Propert y close-out chec k

lis t signedby EP A D 

## Descriptio n ofarea s not meeting RO D cleanu p criteri a 

# y Utilit y clearance s 

# y Propert y infonnatio n fromDougla s Count y Assessor' s Office 

# u D D 

### jk'jlo± _ 

## SgnSt e Dat e 4031142 3

# • Superfun d V ­

### PROPERT Y SUMMAR Y Date : 10/17/200 8 Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-06/0004 Monthof : Aug/Sep t Propert y Address : 321 8 CALIFORNI A S T A . EXECUTIV E SUMMAR Y A. 1 Issue s Encountered : NOM E

I * ' y 

### A. 2 Issue s Resolved : NON E A. 3 Uniqu e Findings : NON E A. 4 Othe r Relevan t Infomiation : CONTAMINATIO N LEF T BEHIN D F l BUSHES 2X 3 F T @ 82 5 PP M CONFIRMATIO N SAMPLIN GDATA/RESULTS: ' Bl=10 4 PP M @ 13" ; Fl=34 0 PP M @ 6" ; N O EASEMENT 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 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-Built sketc 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 be incliidedi n th e individua l propert y file , i f available , o r obtainedinclude :

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### i ) Pre-excavationagreementdetails(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 ) o r SW F(FlashPlayer) forma t and/or photograph s ^ iv ) Signe dfor mverifying satis'factor y restoration v ) Descriptiono f area s not meeting Interi mRO D cleanu p criteria .

TECHNOLOCIES , INC .Fin d Recor d Qea n U p Query Lea d Remainin g QueryI Propert yDamag e Query Clos e Biadcnil :

Sampl e Area : 2419 9 ­ 321 8 CALIFORNI A S T Owner : Resident : n Owne rOccupie d Owne rName : |JAMERSO N TYRON E Owne rAddressl : ---—-­ — ­ ­ ­ — J Residen t Name : |THNANT S " Propert yAddress : 321 8 CALIFORNI AS T Owne rAddress2 : |321 8 CALIFORNI AS T City : [OMAH A OwnerPhone : 1(402)344-238 7 State : Zi p Code : ;|N E 116813 1 Alternat e Phone : 1(402)2907215 3 Zi p Code : 6813 1 Residen t Phon e t Contract :

Assessment : Qualifyin g Grou p |120 0 Assessmen t XR F Date : Assessmen t Ma xXR F Value : 1629.9f .

# SER/ V EP A Propert y Clos e Ou t For m Propert y # : L-^:i ^ Propert y Address : 'g ^ 'J^'T-Xo C ^ li-^r n )a i Date/Time : Owner' s Name : ~'inlr^if\/' . '^M0r^r\ Quad s Excavated : \^ ) ^ F | Contracto r Grou p j^t t ole.i-^-'fiQ4/i«c\Q^'iO;< , Excavatio n Genera l 1 .I f 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 1 .Doe s th e gradin g aroun dth e perimete r ofth e hous e i n excavate darea s generall y slop e away fromth e house? 2 .Ha s so dbee n lai di n al l area s tha t wer e excavated ? 3 .Doe s th e so dappear t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte dat a3 0 day tim e period ) 4 .

Ar e sodde darea s generall y fir man devenl y graded ? 5 .

Ar e th e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 day tim e period ) 6 .Wa s th e property grade dsuc htha t wate r wil l no t poo l o n th e property ? 7 .Wa s damag e t o landscapin g o r plan t material s avoided ? Gates , Fence s an dRetainin g Wall s 1 .D o gate s ope n an dclos e freely? (IfappUcable ) 2 .Wer e al l gate s o r fence s take n dow n durin g restoratio n activitie s reinstalled ? (I f applicable ) 3 .

Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) 4 .

Wa s damag e t o retainin g wall s avoided ? (IfappUcable ) Foundation , Sidin g an dGutter s 1 .Wa s daniag e t o th e sidin g o r tri mavoided ? 2 .Wa s damag e t o th e foundatio n avoided ? 3 .Wa s damag e t o windows avoided ? 4 .

Wa s damag e t o window s o r doo r screen s avoided ? 5 .Wa s damag e t o downspout s o r downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) 1 .Wa s damag e t o drivewa y surface s avoided ? 2 .Wa s damag e t o walkwa y surface s avoided ? Ye s N o / / Ye s N o

/ / 

# y y y y y Ye s N o



### y 

## y y y Ye s N o



## y y • 

## y 

# y y Ye s N o 

# y i ?

## Owner s comments : f

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## Inspectio n notes : \ >

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## Remova l andrestoratio n activate s complet e includin g th e 30-da y sodwarranty : EP A Representativ e Date : 9/»/o »

# %B> A Propert yCompletio n Agreemen t Thi s agreemen t document s th e completion 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 dwithth e restoratio n ofth e subjec t property , an dtha t no-item s ar e i n question , now , o r at an y tim e i n 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 ID : ^.i^ l ^ ^ Propert y Address : .;^ ^ , g ^ r^^^ l ir^r^.T ^ 

# S\ ­ 1 Owner : 1 ) Phone : Restoratio n Item s i n Question :

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

L J I agre e restoratio n i s completed , excep t a s note d above . L J I d o no t agre e restoratio n i s complete d 

# ^72^/^ f Dat eM ' ••• » * t i' l .VV . rt '• * tV^w y ^ • ;;- . .-s^WK- y v )

FtudtB t T ftcfando^*^ Inc . (Pludto Q i s imd « coBlnet wifl i tfa * IJ . S . EnviioiiBtiii ^ «l*iiiu p atftn E Pmdtn t to p«f« B wli«iti»snlBt»<ltoth * dtas^incluiiii^Eai l Bmplii^iHBOva l o

f Iwd-coBtiniiTiiift dBofl , mdwdonlio n o f th t nfmnw dpwpwty . If

yxmhanr v aay qiudion s abou t tl u soi l dfta^plannw l fb r you t prop wly , pltai t coHtMtPnidwit'' « Adminianliv t Clw k far th t OaihaLtwlSit t dtanuB . Ms.ShamoinHolt-ai''W a304-1004 . Gtnw dqutsfion s abou t tiu OmahaLta dSite dtanq ^ cnb t diitctt dt o flu EP APubli c LafbnaationCwdMS at<40 ^ 731-304 i (^wthOmah aoffict ) o((;402) 991-938 3 l^oithOaiafa aoffict) . Ptoowt^Acct^GxanttdBv : YV^^^ST/^ ^ t^f^^^^^^ ^ (Pitas t Pnnt H amt) Ptoptit y OvnwSi^iaiBit : 

# / 7 ^ (PaU ) PROPERI Y MFORMATIO N (T t Wnrnfltto d¥y znlon t Ksl/irpn f nt f awnB r - ploutpiint ) RESIDEN T NABE : Tv * Cvif\ 0 3~0c»v>gX-Sc^f \ (^wneT ) Rente r RESIDEN T ADDRESS : I F RENTAL . PROPERT Y OWNE D BY : OWNER' S HAILM G ADDRESS : 

### ^:i7\9 . CaH^onrN; ^ 'S^ r HYVS^^ U 

### h ^ C.*^\- \( OWNER'STELEPHON E NUMBE R - HOME : { \ WORK : AG E O F HOME? : YEARS . HO W LON G HAV E YO U LIVE D HERE ? YEARS . ^o 

# s\l x v HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SDIN G SINC E 1978 7 YE S N O ^ NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : 

# • 5 ^

NUMBE R O F OCCUPANTS ? YEAR S OL D AH D OLDE R NUMBE R O F CHILDRE N UHDE R 7 YEAR S OL D WW D PLA Y H TH E YAR D FO R 5 HOUR S O R HOR E PE R WEEK : COMMENT S O R SPBCIA L INSTRUCTIONS : (IE . OOGS . ENTR Y GATES . ETC J

AUTHORITr FORENTIRiaNMENTA L RESPONSE ACTIONS ; Tht octintitEtohtimpltmwitdbyEFAuuiHtfaisaffttmtn t ]ni!3m"i4tt4^;S4<)ftlA 1 gfCEJtCLA,43USjC.9!S04 . EPA' s jigb t o

f KC« B t o th t propwi x i s Kpvidtdfiiri n Stctio n 104(t) o f CERCLA . 4 2 Ua . C 96Qj(t) , ymchpnmdt s tnli j lu i dttwrninuaBth t nttdro r rtyonstTo r thooHn g oftaan B gyrtyons t fctiflp undtr tU s titlt , o r othmris t tsfoicii Q tfa t pnniBon s o f th t tidt.' ' 808 0 Wan l Parkwy - Sulf a 40 5 2505 N . 24 * Sfreet . Sulf a 308 4242 Medlc M Drtve , Sulf a 42S 0 KonflBCl^ . M O 6411 4 Omitta . Nebraska 6811 0 Sa n Anfonio . T X 7822 a Phon K^16 ) 363-370 3 Phone i ^Q2)9!4-1QS 4 PiiSRS : ^1S}SZZ-9K S ra c^tS ) 3S3-37G 7 Fa c(402)504-100 5 Fax : ^10 ) 579-657 7.\ - rV-V , A ll - r-iWflfr y..:• }

Piudti * T tchndo^ti ^ Inc . (Ptudt ^ i s nnd w coiriiBc t wifl i th « U . S . Exmianmtnt dPtcttctia n Agtnc y 1^ ^ t o d* ^ contamimu dsoft s a

t anumb w o f pnpwtitsloc8t»dmOmalu, N tbiadca , iadudii g tfa t prapw^locatt da t "7.'! ^ t ^ T^ n $ iLT'rvL^ A ^j^^^'^^itqiMdByourpwmisBoat o dlowPtudtnttopafoi masoi l dtanq p atflii s fu^mftaxnmmiiiifrnmSmiaiaS . BysiBmaBflBsftim.thtp»pwtyownwgnntspMaiisBoatoPnid«ttti>pMfbi m •cdvilitExdaltdl D th t cwanip inchiiit ^ soi l "T*" ^ i«mo« do f Itad-contaaiaitt dsoil , anditOontia n o f ih t Itfwalc•dpIOlp«tty • Ifyouhnr » ao y qntsfioosaboutth t scil dtam f plaau dfa t yampiopwly , pitast«ontat t Pnidaat' s A<hunitfialiT t Cltdc f mth t OmduLtadSi u dtanua . Ms . Sh«BflBHolt-«ti;402 ) 304-1004 . Gwui dquesiioasiibout flu Omd aLta dSiU dtaup caub t dtitcUdto^EPAPiMc&ifbnaaiioaCtiAa s at (40^731-304 3 (^oui h Omahaoffict ) €((402)991-938 3 9 1 oithOmd aoffict ^ PtoBwtvAccssGiaHUdBv : T^EOf<y t ' 7f/i'/U)C^<yT ^ Ptopict y OwBtt c Siyirtuto :

RESIOENTNAME : Tv U O f V g / / (^gnaluw ) PROPERT Y MFORMATIO N (T t ¥ • coafkto t h yiwleataalAir f n f «ctf •wa w- plMKByiiat ) RESIDEN T ADDRESS : ! I F REHIAL . PROPERT Y OWHE D BY : 

## OTV^y ^ ,...;*'•• * 

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OWNER' S MAILM G ADDRESS ; OWNER'STELEPHONE NUMBER-HOME : j \ Y WORK : AG E O F HOME? : YEARS . HO W LOH G HAV E YO U LIVE D HERE ? YEARS . HA S TH E EXTERIO R BEE H PAINTE D O R COVERE D WIU I SBIIN G SINC E 1978 7 YE S N O 

## sy^ x • ^ NUMBE R O F OCCUPANT S UHDE R 7 YEAR S OLD : '* 3 NUMBE R D F OCCUPANTS 7 YEAR S OL D AH D OLDE R NUHBE R O F CHILDRE N UNDE R 7 YEAR S OL O WH O PLA Y H TH E YAR D FO R 5 HOURS O R QOR E PE R WEEK : COUMENTS O R SPECIA L INSTRUCTIOliS : (I.E . OOGS . ENTR Y GATES . ETC. !

AUTHORIT Y F0REN7IR0KMENTALRESPONSE ACTION S Th t acti^1i«stobtimpItm«BtodhyEPAundiithisa9«tm«B t UnfffiPIB^it^^.S'lMl^lQ,' ) {fCU!CLA,^ 2 U5C.9|{04 . EPA' s jid ^ o f accts s t o th t pcop«itvisp^dtdftvisStctiaal04C» ) o f undwfUstitl* , otothwwis t wnfonJmth t pnmaon t o

f th t titlt. " 

## • V V

808 0 Ward Parkwar . Sulf a t 290 5 N . 24 * Sfreet , SuH e 30 6 424 2 HadlG H OrtVB L Suit * 425 0 RanBaiCi^.H064il 4 omahfl i Nebraska 6811 0 SanADtonlo.TX78£{ 9 Phon e (816 ) 3G3-V0 3 PnORfl C ^0Z)SQ4-190 4 . « ! hflntf * Ai m 1199JI'WI I ,1SWUW - f k SW I WiU * www v Kimr - «M m•^ O ' FSSC : (402)504-180 5 '• yfa c^10)573-657 7 n^'y/ y• .•,-;.,.-;'r;v . 

## .:7-n^ 4 •' ­

# ii i Bii!5iiM:MwSii^ ^ OLS# : 2419 9 Dat e Excavated : 8/13/200 8 Dat e USEPA.Signed-OfT : 2419 9 Owne rName : OTMCO.nQDItjjg. .Ti:ftssm..k!*d«<w»*'"|?.!|' * ^^^ ^ ®'* * Address : 321 8 CALIFORNIAS T. Sit e Sketc h Phone : H^OL-C^yloi i « • Sampl e Numbe r Lea d Concentratio n •Sampl e Collectei l LA B RYASCPXA-2419 9 F 1 \P^ \ pp m D •Bvescpx AaiiQO—E2— pp m D RYCSCPXA-2419f l B l , RYDOCPX A2410 0 B3 . ROSSCPJOrarre B 0 2 RdZBCPXAanaa—G Z

. RPZ6ePXA-244« 0 BZ . , lU'^.Qpo m pp m Pf>

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## Jim : _m^.MlAl L

Date - lOjlljO- i Time : •^\'b' K Sample s Analyze d XR F Unit : " ^ \ \ Book : \\j'iX . Date: . Time: . ^ = Staff . ^



## ENTERE D i • m 7 9Z88 4 :

CONTAMINATIO N LEFI ' BEHIN D |F- I BUSHE S 2X 3 F T @ 82 5 PPM |

N O EASEMEN T 'tftl.'l G CONTRAC T # : E P - R7-07-0 6 / 000 4 PRUDEN T TECHNOLOGIES , INC .

# >RUDE ] rECHNOLOGIES , INC . 

# Propert y Statu s For m Address : 'az\ 8 CoiUa-orM^ aSl- - Date : T u ne . U W^ 2cro g Phone : BVID : 5 i q^ ^ <^ 

## C'\-^ ' -104 3 Plant s & Permanen t Landscapin g Item # O

n Ma p Descriptio n an dLocatio n 

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Structure s DoesyourBasementhaveahistor y of leaking ? Ye s -v - N o ~ Item# Description & Location O

n Ma p t OA\S\eAe - 

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## Propert y Owne r Pruden t Employee SignatureOy^t.^''^<_J^^«^rv-#ct - Signature : 808 0 War d Parkway , Suit e 40 5 250 5 N . 24* ^ Street , Suit e 30 8 424 2 iMedica i Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 

### / Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7

# 2419 9 Owne rHame:m^OngD»^JXjej^_^t^ts^^"*^^^^^ f Sit e Addr«8»;^1 8 CALIFORNIA , S T* TM SkfttC h

Omah a Lea d Sit e 4613 0

# 2419 9 

# C J Owne rName:.?«yiifr«©B« ^ Jt_^ge*. . ^ Address;^! ? CALfFORNLA . ST ^" ® &K©tc n



# (1 . OmahaLeadSit e 4613 0

## Print Previe w Pag e 1 o f 1 Dougla s CouDty-Omaha , N E

Parce l I D Owne r Nam e Pmpert y Addms s Cit y Zi p Owne r Addres s Owne r Addres s 2 Owne r Cit y Owne r Stat e Owne r Zi p 193992000 0 JAMERSO N TYRON E 321 8 CALIFORNI A S T OMAH A 6813 1 321 8 CALIFORNI A S T OMAH A 

### N E 6813 1 j l Sec-Twn Rn g Additio n Bloc k Lo t Lega l 1 Lega l 2 Lega l 3 Lega l 4 Tmasum r Websit e Un k Assesso r Websit e Un k 17-15-1 3 PAR KPLAC E 2 3 0 W27.5E55S174.25F T 27.5X174.2 5

http7/webapps.dotcomm.org:8080/TreasTax/bces/pages/taxinfb.jsp ? parc=193992000 0 http://dougiasne.mapping online.com/DouglasCoNe/static/accountinfo.jsp ? accountno=R193992000 0 Disdainke rMa p an d parce l dat a are believe d t o b e accurate , bu t accurac yi s not Ma p Scal e guaranteed ^

Thi s i s no t a lega l documen t an d shoul d not b e substitute d fb ra titl e search , 1 inc h = 5 7 fee t appraisal , survey , o rfo rzonin g verification .

### R l 939920000000 Ljp g (JPEGImage , 640x48 0 pixels ) http://douglasne.mapping-online.com/assessdoc/Photos/11/R193992. ,

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to.lrl h Internet - > ^ i v;;Sen d Email YOU RTICKE T NUMBE RI S 2099317 . Origina l Cal l Date : 8/05/0 8 Wor k t o Begi n Date : 8/07/0 8 Time : Time : 1:2 0 pm 1:4 5 p m Op : RAMITA1 8 96 7 State : N E County : DOUGLA S Place : OMAH A Address : 321 8 Street : CALIFORNI AS T Twp : 15 NRng : 13 E Sect-Qtr : 16-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATIO NWOR K Locatio n o f Work : LOCATE"ENTIR E PROPERTY 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 : RAMIT A Phone : (402)733-145 5 Alt . Contact : Pnone : (402)733-118 8 Wor k Being Don e For : EPA Dept h o f Excavation : 6 F T Corne r Lot : N Front : Y Rear : Involve s Tunneling o r Horizonta l Boring : N Explosives : N CRGHTO NCXCAT V

LEVEL 3 MCLEODNE MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Utilit y Servic e Are a Contac t Phon e Numbe r Typ e Day : 402280278 0 CRGHTO N CREIGHTO N UNIVERSIT Y DAV E MCATE E Alt : 402510199 5 Emerg : 712545461 6 Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , ^p,^^ , Ah : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 LEVEL 3 LEVEL 3 COMMUNICATIONS , ^ ^ Ah : Emerg : 877366834 4 Day : 800289190 1 NO NEE D T O CAL LOU T MCLEODN E MCLEODUSA EMERGENC Y Alt : http://www.dhon.org/irthintemet/DHON>]oticeCreation/MessageText.asp?ret=<RESULTS. . . 8/5/200 8f N S f 

## Pag e 2 of 2

MUDO l

OMAHACO F

OPPDGPR 5 QLNNEI C METROPOLITA N UTILITIE S DISTRIC T CIT Y O FOMAHA TRAFFICSEWE R OMAH A PUBLI C POWE R DISTRIC T QWES T LOCA LNETWOR K EDWIN A

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N A

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### Emerg : 800289190 1 Day : 402504782 3 Alt : Emerg : 402504794 6 Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 Ah : 888728934 3 Emerg : 406728934 3 Day : 406728934 3 Alt : 

## Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . .8/5/200 8