## TRANSMITTA L o f OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R 

# SAID# : lD3ti y Date : 1 WI 5 "^ I 0 Address : ^^Si p ^ . ^ 3 S f Remediatio n Contractor : PPr- , nPrM j T^r ^ N^o q i^<^ ^ irjc^. i Year : ^ U 1 ( J SOI L REMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S 

# ef Vide o o f propert y (DVD ) 

# af Execxitiv e Summar y 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 D 

### Settlemen t document s (i.e. , fo r

damag e or t o replac e plants , etc. ) 

# i / 

### Confirmation data 

# d PhotoRTdph s ^ 

### As-built sketch 

# ef Satisfiactor y restoratio n signedb y Propert y Owne r / 

### Propert y close-out check lis t signedby EP A D Descriptio n ofarea s not meeting RO D cleanu p criteri a 

# i Utilit y clearance s Propert y information firomDougla s Count y Assessor' s Office D D D ^ W Signatur e2\*' "

Dat e 30218335 

# •IIHIiH I Superfun d

### PROPERT Y SUMMAR Y Date : 11/15/201 0 Omah aLea dSit e Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l Mont h of : November Propert y Address ; 452 6 S 3 2 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 G DATA/RESULTS : F l = 6 5 PP M @ 13" ; B 2 = 28 0 PP M @ 18" ; D Z = 6 6 PP M @ 13" ; E A = 11 7 PP M @ 2 " ATTACHMENT S 1 ) Propert y sketc h providedb y EP A pursuan t to contract specification s 2 ) SignedAcces 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 be includedi n th e 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 h the 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(Flash Player ) forma t and/o r photograph s iv ) Signe dfor mverifying satisfactor y restoration v ) Description of area s not meeting Interi mRO D cleanu p criteria .

TECHNOLOCIES , INC .Fin d Recor d Backfill :

Sampl e Area : 1020 5 - 452 6 S 3 2 S T Owner : D Owne rOcx:uple d Owne rName : I RAMOS-MOR A ADA N Owne rAddressl : 

# 1 Owne rAddressZ : |251 6 G S T City : State : Zi p Code : lOMAH A |N E |6810Z Owne rPhon e Alternat e Phone : 1(402 ) 731-399 8 

# 1

Contract : Contractor : |PRUDEI^nZ010_S Contrac t Optio n JORIO N 1 Remediatio n Quer yj Lea d Remainin g QueryI Propert yDamag e Query

Use rProvide d Owne rInformatio n Owne rName : Owne rAddress :
City : State : Zi p Cdde : Owne rPhone : Alternat e Phone :

Assessment : Qualifyin g Grou p |40 0 Assessmen t Ma xXR F Valu e [ " 506.6 3 Resident : Residen t Name : IZAVAL A EZEOUIE L & AMBE R Propert yAddress : 452 6 S 3 2 ST Zi p Code : |68107 - Residen t Phon e 

# I

# m m £y ^ TECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y # : 1 0 2-O S Propert y Address : A52 ^ S 3 2-S f Date/Time:/O/(> _ Owner' s Name : Sv ) &A J tA A I H hL. \ Quad s Excavated : p | 9-2.,62 - Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s N o 1 .

I f necessary , wer e th e correct quadraiit(s ) excavatedan drestored ? 

### y 2 .

I f necessary , wer e th e correct area s o f drip zon e excavatedandrestored ? 

# y Gradin g So dan dVegetatio n Ye s N o 1 .

Doe s th e grading aroundthe perimete r o

f the hous e i n excavatedarea s generall y slop e awa y / fro mthe house ? 2 .

Has sodbee n laidi n all area s tlia t wer e excavated ? 

# y 3 .

Doe s th e sodappea r to b e generall y health y andgrowing ? (Onl y evaluat e if inspecteda t a3 0 y ^ da

y time period) 4 .

Ar e soddedarea s generall y fir man devenl y graded ? 

# y 5 .Ar e the ; joint s betwee n the so dstrip s generall y tight ? (Onl y evaluat e i

f inspecte da t a3 0 da y tim e period) 

# y 6 .Was the propert y gradedsuc h tha t wate r wil l not pool o n the property ? 

### y 7 .

Wa s damag e to landscaping o r plan t material s avoided ? 

# y Gates , Fence s an dRetainin g Wall s Ye s N o 1 . D o gate s ope n andclos e freely ? (I f applicable ) 

# y 2 .

Wer e all gate s o r fence s take n dow n during restoration activitie s reinstalled ? (I f applicable ) 

# y 3 .

Was damag e t o gate s o r fence s avoided ? (I f applicable) 

# y 4 .

Was damag e to retainin g wall s avoided ? (I f applicable) / Foundation , Sidin g an dGutter s Ye s N o 1 . Was damag e t o the siding o r trimavoided ? / 2 .

Was dainag e t o the foundation avoided ? 

# y 3 .

Was damag e t o window s avoided ? / 4 , Wa s damag e t o window s o r doo r screen s avoided ? 

# y 5 .Was damag e t o downspouts or downspou t extension s avoided ? / Sidewalk s an dDriveway s (Concrete ) Yes.N o 

# ~y\ ~ 1 .

Was damag e to drivewa y surface s avoided ? Was damag e t o walkwa y surface s avoided ? 

# y

### Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complet e includin g th e 30-da y so dwajranty : I 

### EP A Representativ e Bo^'Q ^ _Date : Jplisli at'HNULOGIES , INC . 

### A S - BUIL T DRAWIN G OL S #1020 5 Dat e Excavated : 09/28/201 0 

### OMAH A LEA D SUPERFUN D SIT E LSEP A Signed-Of T Date : 

### 1020 5 Omah a Lea d Sit e Owne r Name : ADA N RAMOS-MOR A Address : 452 6 S 3 2 S T

Phone : H : Sampl e Numbe r RYASCPXA-1020 5 F 1 RYBSCPXA-1020 5 F 2 RYCSCPXA-1020 5 B l RYDSCPXA-1020 5 B 2 RDZSCPXA-1020 5 D Z La b RDZSCPLA-1020 5 Resul t 113 0 pp m Sit e Sketc h W : Lea d Concentratio n y ^ \pp m

Numbe r o

f Sample s = \H Exterio rPain t • Gop d Q^oo r [~ 1 No t pain t Sample s Collecte d Firm : .•/?^f-: > ^/-j//Ai 4 Date : [ Z /•z/Jo ^ Time : l ] V2 - Sample s Analyze d XRF Unit : '%\ % Book : W M Date : 1- I \ . n ^ Time : p\ ; M Staff : 

# Ca n

Omah aLea dSit e 4613 0

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

## 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 dpTopert>' , Th e properi y owner' s signatur e indicate s that th e property owne r i s satisfie dwit h th 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 i n th e future , ex.cludin g an y remaining warrant y (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y BD : Propert y Address : L^^^ £g ?)1.n A 

# £t l Owner : 

## Su<ft,i ^ KAA^ftil < Phone : 

### ^\hD ^ \r^3. o - -11 8 8 ^ Restoratio n litem s in Question :

Require dcorrectioirt s t o complet e th e property :



### agre e restoratio n i s connpleted , 

# i s L J I d o no t agre e restoratio n I s complete d 

# JbhdiJ X Bat e '. \

Pruden t Technologies , Inc . (Prudent ) i s unde r contrac t with th e U . S . Environmenta l Protectio n Agenc y (EPA ) t o clean u p lead contaminate dsoil s a t anumbe r o f

propertie s locate di n Omaha , Nebraska , includin g th e propert y locate da t cJ{h2- C ^ ' S.2 - 5 T cJ>Vte^w< ^ . Tli e EP A request s you r pennissio n t o allo w Pruden t t o perfor masoi 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 perfor m activitie s relate dt o th e cleanu p includin g soi l sampling , remova l o f lead-contaminate dsoil , an drestoratio n o f th e reference dproperty . Ifyo u hav e an y question s abou t th e soi l cleanu p plamie dfor you r property , pleas e contac t Pruden t south 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 can b e directe dt o th e EP A Publi c Informatio n Center s a t (402 ) 731-304 5 (South Omali aoffice ) o r (402 ) 991-958 3 (North Omah aoffice) . Property Acces s Grante dBy : 

### Sur A rAaina k Property Owne r Signature : (Signature ) (Date ) PROPERT Y INFORMATIO N (T o b e complete db y residen t and/o r propert y owne r —pleas e print ) RESIDEN T NAME : <^y ^ 

### r^yiv\^ U Owner 

### (^^^^R^^ y RESIDEN T ADDRESS : y\ y 

# uy M ^ 

# ^^" ^ ii- . a^^l y ^/ g ^m r I F RENTAL , PROPERT Y OWNE D BY : 

### AMy \t£xi^d3 > iy\<yyc ^ OWNER' S MAILIN G ADDRESS ; OWNER' S TELEPHON E NUMBE R - HOME : {(yCp j '2,2- 0 -?- / ^

JfltfWt l - 

### J \ . AG E O F HOME? : ^ YEARS . HO W LON G HAV E YO U LIVE D HERE ? 

# 1 YEARS . HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978 ? (X . YE S N O NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : C ^ 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. )

ALfTHORITY FO RENVIRONMENTA L RESPONS E ACTIONS : Th e activitie s t o b e implemente db y EP A unde r this agreemen t are pursuan t t o Sectio n 10 4 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f

acces s t o th e propert y i s provide dfo r i n Sectio n 104(e)o f CERCLA , 4 2 U.S . C 9605(e) , whic h provide s entry fo r "determinin g th e nee dfo r response , or 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 o f th 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 Onnaha . Nebrask a 6310 7 Sa n Antonio . T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402; . 733-118 E Phone : (210)822-958 8 Fax ; (816 ) 363-370 7 Fax : (402 i 733-188 3 Fax : <210 ) 579-667 7ENVfRO.MWENTAL A CONSTRUCTIO N SERVICE S 

### TECHNOLOGIES , INC . 

# Propert y Statu s For m Address : ^^^ C ^ . ^^^ ^ y f O^^^^^ ^ ^ ^ ^^/6 ^ ^''^'''•O'^ll^l/ d Phon e BVID : 

## Ai^v ^ ^%^ \

-^ - 

## i S ^

Propert y Own ; Pruden t Employe e Signatur e Signature : 808 0 War d Parfcw a 560 0 S 1 0 S t 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Oniaha , Nebrask a 6810 7 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)733-118 8 Phone : (210)822-958 8

## \y Omah a Lea d Sit e \ } Owne rName : ADA N RAMOS-MOR A 

### Sit e Sketc h Address : 452 6 S 3 2 S T 

### 1 Phone : H : W ;
• ' Lea d •Sampl e Sampl e Numbe r LA B Concentratio n Collecte d RYASCPXA-1020 5 F l \ pp m 

# • D RYBSCPXA-1020 5 F 2 pp m 

## D 

# n RYCSCPXA-1020 5 B l 

## n 4 L PPi^ T 

## Q 

# n ^ ^ RYDSCPXA-1020 5 B 2 pp m 

## D D. , RDZSCPXA~1020 5 D Z pp m D r 

# 0 pp m 

## D 

# n La b RDZSCPLA-1020 5 pp m Resul t 113 0 pp m 

## D D Numbe rof Sample s 

## H \ 

# i r - ^ .•--. . t. . i 

# I ; f I y i- 4 t . • : ^ ' i • i -.:.•,-. I ••• V U-v . I • •

- • * - ' - ' - ^ - ^ - • - \ 

# l l ': ^ 

# f 

# ^2-^H O

X A 

# 1

/ y , ^ 

# y r / • iv . 

### „ y^i^ ^ i. . 

## ^ y <y -rt ^ 

## 1020 5 ^ Non h Arro w Exterio rPain l n Goo d 15 > 

### • "Poo r Q No t pain l Sample s Collecte d Fir m .y-l: z . . ,z/ i ry^ i Dat e Tim e Sample s Analyze d i/Tl XR FUnit ; i . Y'L . Book : A _ Date : i - i • • r^^ ^ Tim e 

# th y Staf f 

## yy y h= ^

..-- 1 - K-* . -' . • .-"v. - .ffk.i» £ti w V JBI ^ 1 > V ' " 7 i-w^-'^C "

• i(>I,^ >

### Pag e 1 o f 1 

# ly5^ C £3 ^ s/­ ,*>



### http://douglasne.mapping-online.com/assessdoc/Photos/35/R04306100000001.jp g 9/15/201 0

# 452 6 S 3 2 S t 

# A Printed : No v 16,201 0 www.dcgis.org/dogi s

### Pag e 1 of 2

" > Creat e Anothe rTicke t Back^a Ijj h Int^rnet ^ Sen d .Emai l 

### YOURTICKE T NUMBE RI S 2594281 . Origina l Cal l Date : 9/16/1 0 Time : 2:5 3 p m Op : SIVA1896 7 Wor k t o Begi n Date : 9/20/1 0 Time : 3:3 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 452 6 Street : S 32N D S T Twp : 14 NRng : 13 E Sect-Qtr : 04-NW 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 : 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 : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V METR O ' MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F 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 METR O METR O COMM . COLLEG E CHRI S 

### Day : 402457230 7 Alt : 402672703 3 Emerg : 402457231 3 MUD0 2 METROPOLITA N UTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRICH/TRAFFI C 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 

### http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 9/16/201 0

### Pag e 2 of 2

OPPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T EL M LOCATIN G 

### Alt : 406207149 4 Emerg : 888728934 3 QLNNEI FQWES T LOCA L NETWOR K Day :

EL M LOCATIN G Alt : 406728934 3 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/16/201 0TEBHNOUMRBi , mc . 

### ENVIRONMENTA L ENGINEERIN G AN D CONSTRUCnCHV SOLUTION S 

## SIT E SAFT6:T Y HAZAR D ANALYSI S 

## ^£7,(» ^ S < '3>'Z . 

## Address : Excavatio n Date : Crew : 

## Backfil l Date :

Ite m Conditio n Hazard s Correctiv e Actio n Overhea dLine s 

# f^y ^ Ga s Lin e 

# ^ Wate r Lin e 

# 7 ^L Sewe r Lin e ^ 

## Septic/Leec h Fiel d Propane/Bntan e Sidewal k C.^<TS - 

# J^^^^.^^ ^ Foundatio n a y ^ 

## Retainin g Wall s Fence s Tree s Structure s Driveway ^ ^ U^g

_a:3!^/8>T&e. ^ 

## Sprinkle r Syste m Othe r Cre w Forema n Sit e Safet y Offic e Date :

r.Suto40 S seaosios t 424 2 Medica l Drive , Suit e 725 0 i(a|ly;MO«t11 4 Omata , NeboMi aCft107 Sa n Antonio , T X T822 9 Phon K(SW ) 30^^70 3 Pbom : (402)733-118 8 Phone : (210 ) 822-«58 8 Fax : {8^)363-370 7 Fai c (402)733*188 3 Fax : (210 ) 578-657 74 - a '••'. ' .^-^ ^

^^^2w*' ' ..^^ 

# ' • HH I 

# "IBVI^ B



# m yl i 

# l i ^HHak^^^B I <^^^^^^^^^^^ H ••.:-.^i,.j..-. - " ^

# ^ 1 BBBBB^3B^S5^^ M 

# |||^H | '^^^B^^^^^B ^ 

# 1- i '