## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAT O # : KO^TL ^ Date : J^jr ^ Address : ZU ^ M • U<^ . ^
- Remediatio nContractor : ^i/l/:rt V 'T^ll ) IW^ ^ Year : f^ D f f ) SOI LREMEDIATION PROPERTY FIL EFOLDE RDOCUMENT S B

l Vide o o f

propert y (DVD ) ^ Q

l Executiv e Summar y aEPA-provide dpropert y sketc h Q Signe dAcces s Agreemen t fo r

subjec t propert y D Signe dAcces s Agreement(s) fo r

adjacen t propert y 11

1 Restoratio nAgreemen t nSettlemen t document s (i.e. , fo r

damag e o r

t

o replac e plants , etc. ) [i Confirmatio n dat a Photographs As-buil t sketc h Satisfector y restoratio nsigne db y Propert y Owne r Propert y close-ou t chec k

lis t signe db y EP A Descriptio no f

area s no t meetin g RO D cleanu p criteri a Utilit y clearance s 

## Propert y mformatio n fromDougla s Count y Assessor' s Offic e

Signatur e ' Dat e 3026073 0 

# lilli l Superfun dFin d Record Remediatio n Quer yI Lea d Remainin g QueryI Propert yDamag e Quer y Backfill :

Sampl e Area : 6922 0 ­ 220 4 N 4 8 S T Owner : Resident : Contract : n Owne rOccupie d Owne rName : jWHUE D CHRISTOPHE R K Owne rAddressi : Residen t Name : 

# I Propert yAddress : [220 4 N 4 8 ST Contractor : (PRUDEm7009_ S Contrac t Optio n [BAS E Owne rAddress2 : |220 4 N 4 8 S T City : [OMAH A State : [N E Zi p Code : [6810 4 Zi p Code : (6810 4 Residen t Phon e 

# I Assessment : Qualifyin g Grou p [1200/CHIL D Owne rPhone : ((402 ) 708-337 6 Alternat e Phone : |(402 ) 612-720 4 Assessmen t Ma xXR F Value : I 156 2

### PROPERT Y SUMMAR Y Date : ^15/201 0 | Omah aLea dSit e Remedia j Actio nContrac t #EP-R7-67-0 6 T0# 1 I Mont hof : Q u f 

# S : Propert y Address : 220 4 N4 8 S T A EXECUTIV ESUMMAR 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 : ARE A NO T EXCAVATE D PE RP.O . REQUES T

- F2/L S (4'X4' ) = 35 4 PPM @ SCRAPE ;

- UC (25'X2' ) = 28 5 PP M @ SCRAP E CONFIRMATIO NSAMPLIN GDATA/RESULTS : F 2 = 38 6 PP M @ 6" ; D Z= 23 8 PP M @ 6" ; E A = 14 9 PP M @ SCRAP E(~1" ) ATTACHMENT S 1 ) Property sketc hprovide db y EPA pursuan t t o contrac t specification s 2 ) Signe dAcces s Agreemen t includin g acces s agreement s require dfor crossin g other propertie s 3 ) Pre-Excavatio ndigita l vide o clip/photograph s 4 ) Post-Excavatio ndigita l vide o clip/photograph s 5 ) Documentatio n- Complete dClose-ou t Checklis t 6 ) As-Built sketch
i ) Shal l includ e final leadlevel s v ) Legen d ii ) Contaminatio nlef 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 nth e individua l property - file, i f available , o r obtaine dinclude : i ) Pre-excavatio nagreemen t detail s (ifan y ar e mad e withth e property owner ) ii ) Property Statu s For msigne db y property owne r iii ) Excavatio ndigita l vide o inMPEG , WM V (Window s Medi aVideo ) o r SWF(Flas hPlayer ) forma t and/o r photograph s iv ) Signe dfor mverifyin g satisfactory restoratio n v ) Descriptiono f area s no t meetin g Interi mRO D cleanu p criteria .

TEGHNOLGGIES , iNC .

# ••[©RUOEM ^ TECHNOLOGIES , INC . 

### Property # : [ol^3. 0 Date/Time : l^^^f i fQC f Quad s Excavated : 'r?=*hi S 

# EP A Propert y Clos e Ou t Propert y Address:ciijot / AJ . QSSri ~ Owner'sName : dk^^c^^cf>^^
- i<J" . v-e<^ Contracto r Group : Pruden t Technologies , Inc. , Excavatio nGenera l Ye s No 1 .If necessary , wer e lli e correc l quadrant(s ) e.xcavate dan drestored? / 2 . If necessar)- , wer e th e correc t area s o f dri p zon e excavate dan drestored ? 

# y Gradin g So dan dVegetatio nYe s N o 1 .Doe s tli e gradin g aroun dth e perimete r o f th e house i nexcavate darea s generall y slop e awa y 

### y fromth e house? 2 .Ha s so dbee nlai dinal l area s thai wer e excavated ? 

## y 3 .

Doe s tli e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e if inspecte dat a3 0 da

y tim e period ) 

# y 4 .Are sodde darea s generall y fir man devenl y graded ? 

## y 5 .Are tli e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte dat a3 0 da y tim e period ) / 6 .Wa s th e propen y grade dsue htliat wate r willno l poo l o nth e property ? / 7 .

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

# y Gates , Fence s an dRetainin g Wall sYe s No 1 . D o gate s ope nan dclos e freely ? (If apphcable ) 

## y 2 . Were al l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (Ifapplicable ) 

# y 3 . Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) 

# y 4 , Wa s damag e t o relainin g wall s avoided ? (Ifapplicable ) 

# y Foundation , Sidin g an dGutter sYe s No 1 .Wa s damag e l o th e sidin g o r tri mavoided ? 

## y 2 .Wa s damag e to tli e foundatio navoided ? 

# y 3 .

Wa s damag e l o window s avoided ? 

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

### y -"i

. Wa s damag e l 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 l o driveway surface s avoided ? 

## y 2 . Wa s damag e t o walkwa y surface s avoided ? t y

## Owner s comments :

Inspectio nnotes :
,.W ^ '''' ^ 

# -n'^ ...cJ l

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## Remova l andrestoratio nactivate s complet e including th e 30-da y so dwarranty : EP A Representativ e 9o ^ ^ Date : 4|n|i o] • / I' l '^ V 

## " ^ y Z" Jhy s 0 0 ..y . 

## Propert yCompletio n Agree!nen t Thi s agreemen t document s th e completio no f removal activitie s perfqrme do nth e belo w liste dproperty Th e propert y owner' s signatur e indicate s tha t th e propert y owner i s latisfiedwithth e restoratio no f th e subjec t property , an dtha t n o item s ar e inquestion , now , o r at any tim e mth e future , excludm g an y remainin : : warrant y (3 0 day s total ) excep t thos e item s liste dbelow , i f ai y Propert y ID : Propert y Address : oi^^ ^ 

# ^ Owner : 

# 23S^^ ^ 

# \3^ ^ y ^ Phone : 

# Ud % 

# -70^ 3 2y b Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item : Require d correction s t o complet e th e propert y 

# dujne ryt? ^c^ ^

J/si/j^ ^ CP//"- ^ 

# 4/?/ ^ r-eAAaueJ ,

, agrfe e restoratio n i s completed . 

## D I do no t agre e restoratio n i s complete d a t (note d deficiencie s abjove ) 

# \l/>^/ ^ Owner ' Signiature DatePruden t Technologies , Inc . (Prudent ) i s imder contrac t withth e U . S . Enviromnenta l Protectio nAgenc y (EPA ) t o clea nu p lead
contaminate dsoil s at armmber o f

propertie s locate di nOmaha , Nebraska , includin g th e property locate da t

. Th e EP A request s you r permissio nt o allo w iWlen t t o performasoi l cleanu p at this property t o remov e lead-contaminate dsoil . B y signin g thi s form , th e property owne r grant s permissio nt 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 nofth e reference dproperty . Ifyo u hav e an y question s abou t th e soi l cleanu p planne dfo r you r property , pleas e contac t Prtident' s Administmtiv e Clei k Fo

r th e Omah aLea dSit e cleanup . Ms . Siv aS . Jampana-a t (402 ) 733-1188 . Oenera l question s abou t th e Omah aLea dSit e cleanu p canb e directe dt o th e EP A Publi c Infoimatio nCenter s a t (402 ) 731-304 5 (Sout hOmah aoffice ) o r (402 ) 991-9583 (NorthOmah aoffice) . Property Acces s Grante dBy : (Pleas e Prin t Name ) Property Owne r Signature ; 

# /Zi:^LM ^ 0>///7^ (Date ) / ^ (Signature ) PROPERT Y INFORMATIO N (T o b e complete db y residen t and/o r propert y owne r — pleas e print ) RESIDEN TNAME ; Rente r RESIDEN TADDRESS :
I F RENTAL , PROPERT YOWNE D BY :
OWNER' S MAILIN G ADDRESS ;
OWNER' S TELEPHON E NUMBE R - HOME : ( 1 Cl^ - " ^ TZ. ^ ^ WORK : 

### -Tt)« - 33-7f e AG E O F HOME? : 1^^- * YEARS . HO W LON G HAV E YO U LWE D HERE ? I 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 CHILDRENUNDE R 7 YEAR S OL D WH O PLA Y I NTH E YAR D FOR 5 HOUR S O R MOR E PE R WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. ) /

AtJTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s t o b e implemente dby EP A unde r this agreemen t ar e pursuan t t o Sectio n10 4 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f

acces s t o th e property i s provide dfo r inSectio n104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry fo r "determinin g th e nee dfo r response , o r choosin g o r takin g aii 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 5 250 5 N . 24* ^ Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 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 7ENVKONMENTA L& co^•STRUC^o ^ 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : Z2.@g L[\ 1 ^ S ^* ^ S\
- Date : (2,[ 1 1 \G'= < Phone : ^o 2 - loS
- '2>?)nf = BVID : Ite mN O Plant s & Permanen t Landscapin g T o Remai nI n Plac e O niMa p Descriptio n& Locatio n /4 0 Ay\o«.al s "'J J 7-
- *i ^ rv/-./ ^ 

### t^r nku< ^ [^cf ^ 

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# t Ite mN O Descriptio n& Locatio n O nMa p 

# 1

Propert y Owne r Pruden t Employ e Signatu r 

# zy-r ^ Signature :

808 0 War d Parkway , Suit e 40 5 250 5 N . 24* ^ Street , Suit e 30 8 424 2 Medica l Drive . Suit e 425 0 KansasCity , 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 : fa i 61363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7IES. NC OL,S#:6922D Uate Excavated: 07/07/2009 USEPA Signtd-OfPhte:
Omaha Lead Site Exlerior Paint North Arrw Site Sketch Sampling Address: 2204 N 48 ST 

## I # N& mnt 

## / ,Y ' I Sample Number Lead Sample Samples Collected Concentration Collected LAB Firm: 

## TQk 

# w&- RYASCPXA-69220 F1 

### -3 (Q 

### 4 PPm 

# d Date: \ \-,j-,-og RYBSCPXA-69220 F2 

### 15 (o 

## 2 ppm 

# a Time: 1:s RYCSCPXA~Q~O BI 

### 29 

## 9 ppm 

### 13 CI 

### . 

# - PPm 

### 0 

### 0 Samples Analyzed RDZSCPXA49220 DZ 

# 1 PW 

### Gi' 0 XRF unit: 

### &qb BOO^:^ 

# - - PPm Date: 12./2-0& 

# - - PPm Time: 

## Rlr, ~umbr of samples = 

### m5 Legend: Fl = Front Lefl, F2 = Front Right, 01 = Back Lefl, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = PI6

.. ................. .................................. A" quad- are 

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## itky.,

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# 1 KOT EXCAVATED; FZIIS 

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# / (CX4') = 3% PPM 

### (9 SCRAPE (-1") 

# I

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## .- . EA 

# - 119 PPM 12' SCRAPE (-1")


### CONTRACT #: 

### EP 

# - R7-07-06 TO#1 PRUDENT TECHNOLOGIES, INC.

## 6922 0 %

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### Orna:h a Lea d Sit e • C-oc d Sit e Sketc h QP-,o i .^b . Sam p lin g Adtdr^ss : ?iWJi£Hj[2

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## .:^i^ q pp m 

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## 0 D Time ; RYC3'C-PXA-6J322 0 R¥DaC.PKA-:rJ2J 0 8 1 9* ­ — ppj n fipHf l 

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# a Time ; i^f> o „, ^ Nui!'i»e rO f SaiViplfea = r l 

# m L^ger^a : F 1 = fra m Lett , r Z = fron t fcghl, 9 1 = Bsc KLP1I . a 2 = Ba^c k Righ l O Z = Dn p Zono . G Z = GarcJL-n . P Z = Pis ; itl l (ii»!l::irl i -ir e i s •.•Jr.ve d Irc m ^. cstiMt , iscTi u prcpwt yAl'tv

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## Dougla s County-Omaha , N E

Parce l I D Owne r Nam e Propert y Addres s Cit y Zi p Owne r Addres s Owne r Addres s 2 Owne rCit y Owne r Stat e Owne rZi p 120500000 0 WHITE D CHRISTOPHE R K 220 4 N 4 8 S T OMAH A 6810 4
220 4 N 4 8 S T OMAH A N E 6810 4 Sec-Twn-Rn g Additio n Bloc k Lo t Lega l 1 Lega i 2 Lega l 3 Lega l 4 Treasure r Websit e Lin k Assesso r Websit e Lin k 07-15-1 3 GRAMMERC YPAR K z • - 1 5 50X132. 9

lTttp://webapps.(Jotcofnm.org:8080/TreasTax/faces/page s /tax i nfo.jsp?parc=120500000 0 http://clouglasne.nnapping-online.com/DouglasCoNe/stati c /accountinfo.jsp?accountno=R120500000 0 Disclaimer : Ma p an d parce l dat a ar e believe d t o b e accurate , bu t accurac yi s no t 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 fo ra titl e search , 1 inc h = 2 7 fee t• 

### Page l of 2

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# E i E

• YOU RTICKE T NUMBE RI S 2294794 . Origina l Cal l Date : 6/15/0 9 Time : 2:5 0 p m Op : SIVA1896 7 Wor k t o Begi n Date : 6/17/0 9 Time : 3:3 0 p m State : N E County : DOUGLA S Place: . OMAH A Address : 220 4 Street : N48T H S T Twp : 15 NRng : 13 E Sect-Qtr : 07-SE,08-S W Twp : Rng : Sect-Qtr : Lega l Given : C Type , 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 : FA X AL L CLEAR S T O (402)733-188 3 : :UNSUR E CORNER S Compan y: PRUDEN T TECHNOLOGIE S Contac t Name : SIV AJAMPAM A Phone : (301)919-674 5 Alt . Contact : 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 , IN C 

### HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : 

### Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAEFIC,SEWE R 

### RO N Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 0PPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T 

### N A Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

### % Pag e 2 o f 2 QLNNEIC QWEST LOCA LNETWOR K

N A Day : 406728934 3

Alt : 406207149 4 Emerg : 888728934 3ENVIRONMENTA L & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SOLUTION S



## Address : ,22G*- { 

## Crew : 

## Date : ^ ' iSo' n
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