### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 3146 3 DATE : 12/15/201 0 ADDRESS : 291 1 PINKNE YST REMEDIATIO N CONTRACTOR : PRUDEN TTECHNOLOGIES
. INC
. YEAR : 201 0 

### SOI L REMEDIATIO N PROPERT Y FIL E FOLDE R DOCUMENT S

• PR E AN D POS TVIDE O O F PORPERT Y(DVD ) ^

EXECUTIV E SUMMAR Y 0 EPA-PROVIDE D PROPERT YSKETC H i d SIGNE D ACCES S AGREEMEN TFO R SUBJECTPROPERT Y SIGNE D ACCES S AGREEMENT{S ) FO R ADJACEN TPROPERT Y a RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENT S (I.E. , FO R DAMAG E O R T O REPLAC E PLANTS , ETC. ) I D CONFIRMATIO N DAT A I D PHOTOGRAPH S D AS-BUIL TSKETC H

• SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R I D PROPERT YCLOSE-OU TCHEC KLISTSIGNE D B YEPA D DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A D UTILITYCLEARANCE S m PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR' S OFFIC E D ^_ ^ D D

SIGNATUR E - DAT EFin d Record Remediatio n Quer yLea d Remainin g Quer yPropert yDamag e Quer y 

### Backfill :

Sampl e Area : 3146 3 - 291 1 PINKNE Y S T Owner : Use rProvide d Owne rInformatio n Resident :
I i I i I— , U Owne rOccupie d Owne rName : JVAUGHA N CLYD E L Owne rAddressl : ! ' Owne rAddress2 : I3330N37S T City : loMAH A Owne rPhon e 

# I '

State : Zi p Code : |N E J68111 - Alternat e Phone : ! i Owne rName : Owne rAddress :
City : Owne rPhone : State : Zi p Code : 

# r^ i Alternat e Phone : 

# r Residen t Name : Propert yAddress : 1291 1 PINKNE Y S T Zi p Code : 

## lesiii
Residen t Phon e

Contract : Assessment : Contractor : |PRUDENT2010_ S Qualifyin g Grou p J40 0 Contrac t Optio n jOPTlO N 2 Assessmen t Ma xXR F Valu e f 502.5 8

### PROPERT Y SUMMAR Y Date : 12/15/201 0 Omali aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Montl i of : Decembe r Propert y Address ; 291 1 PINKNE Y S T A . EXECUTIV E SUMMAR Y A. 1 Issue s Encountered : NON E A. 2 Issue s Resolved : NON E A J Uniqu e Findings : NON E A. 4 Othe r Relevan t Infonnation : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : B l = 13 4 PP M @ 2" ; B 2 = 29 9 PP M @ 2" ; E A = 12 2 PP M @ SCRAP E (~1" ) ATTACHMENT S 1 ) Propert y sketc hprovide db y EP A pursuan t t o contrac t specification s 2 ) Signe dAcces s Agreemen t includin g acces s agreement s require dfor crossin g othe r propertie s 3 ) Pre-Excavatio n digita l vide o clip/photograph s 4 ) Post-Excavatio n digita l vide o clip/photograph s 5 ) Documentatio n - Complete dClose-ou t Checklis t 6 ) As-Built sketc h­ i ) Shal l includ e fina l lea dlevel s v ) Legen d ii ) Contaminatio n lef t behin darea s vi ) Contracto r identificatio n iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e include di n th e individua l property file , i f available , o r obtaine dinclude : i ) Pre-excavatio n agreement detail s (i f an y ar e mad e withth e property owner ) ii ) Property Statu s Formsigne db y property owne r iii ) Excavatio n digita l vide o i n MPEG , WM V (Window s Medi aVideo ) o r SW F(Flas hPlayer ) forma t and/o r photograph s iv ) Signe dfor mverifyin g satisfactory restoratio n v ) Descriptio n o f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOGIES , INC
.TECHNOLOGiis , INC . 

# EP A Propert y Clos e Ou t Propert y #: 2>''^^ ^ Propert y Address : 2^\ { Pi'r\ ^ n€-^S>} • Date/Time : 10/2 ^ Owner' s Name : Cl» ^ di €. VOLUJRUCI> A 

### Quad s Excavated : Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s No 1 If necessary , wer e th e correct quadjtant(s ) excavate dandrestored ? 

## y 2. If necessary , wer e th e correct area s of drip zone excavatedandrestored ? ^ Gradin g So dan dVegetatio n Ye s No 1.Doe s the gradin g aroundth e perimete r of th e hous e in excavatedarea s generally slop e awa y ^ fro mthe house ? 2.Has sodbeen lai d in al l area s tha t wer e excavated ? 

## y ?i

.Doe s th e sodappea r to be generall y health y andgrowing ? (Onl y evaluate if

inspecte d at a

30 da

y time period) / 4.

Ar e soddedarea s generally fir mandevenl y graded ? 

# y 5.

Ar e tlie joint s between the sodstrip s generall y liglit ? (Onl y evaluat e if

inspecte d at a

30 da y 

## y tim e period) ^ 6.Wa s th e propert y grade dsuc htlia t wate r wil l not pool on the property ? 7.Wa s damag e to landscapin g or plan t material s avoided ? 

## y Gates , Fence s an dRetainin g Wall s Ye s No 1.

Do gate s ope n andclos e freely ? (I f apphcable ) / • 

### Wer e all gate sor fence s taken dow n during restoratio n activitie s reinstalled ? (I f applicable ) 

# y Wa s damag e to gate s or fence s avoided ? (I f applicable ) 

## y X " 

### Was damag e to retainin g wall s avoided ? (I f applicable ) Foundation , Sidin g an dGutter s Ye s No Was damag e to th e siding or trimavoided ? 2.Was damag e to the foundation avoided ? 

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

# y 5, Wa s damag e lo downspout s or downspou t extension s avoided ? 

### y Sidewalk s an dDriveway s (Concrete ) Ye s S 

### JV

JV C 

### o Wa s damag e to drivewa y surface s avoided ? Was damag e to walkwa y surface s avoided ? 1

## Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e ^ ^ Date : \b\2filie ^fHNOLOOlES . INC . 

### A S - BUIL T DRAWIN G OL S #3146 3 Dat e Excavated : 10/14/201 0 

### OMAH A LEA D SUPERFUN D SIT E I'SEP A Signed-Oi r Date : 

### 3146 3 Exterio rPain t Omah a Lea d Sit e Owne rName : CLYD E L VAUGHA N • Goo d Sit e Sketc h Address : 291 1 PINKNE Y S T • Poo r

Phone : H : W ; Q^o t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : ffif i ?)C\J G RYASCPXA-3146 3 F 1 

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# a pp m D Date : ^j/t.JQ' ^ 

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CONTRAC T # : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC
. 4613 0

# %B> A Propert yCompletio n Agreemen t Thi s agreemen t documents th e completion of remova l activitie s performe do n the below listedproperty . Th e propert y owner' s signatur e indicate s tha t the propert y owne r i s satisfiedwit hthe restoratio n o f the subject property , an dtha t no items ar e i n question , now , o r a

t an y tim e i n the future , excluding an y remaining warrant y (3 0 day s total ) except thos e items listedbelow , i f any . Propert y ID : Propert y Addres s 

# 2 ^ tl^-'vt i uxp ^ Owner : Phone : Restoratio n Item s i n Question :

Item : Item : Item : Kem : Kem : item : Require d correction s t o complet e tli e property :

M I agre e restoratio n i s completed . L J I d o no t agre e restoratio n i s complete d a t (note d deficiencie s above )



# ^^"4^'^ . "Z^tw^t^-v ^ } o /%y ^ / h Wner's'Signatur e 7 ©at e / "Pniden t Technologies , Inc . (Prudent ) is unde r contrac t wit hth e U. S. Environmenta l Protertio n Agenc y (EPA ) to clea n up lead
contaminale dspjJ s at anumbe r of

nf^pertie s locate d in Omaha , Nebraska , includin g th e propert y locate dat ^7M On ^ /<A>^.»~-«V ^ Th e EP A request s you r permissio n to allo w Pruden t to performasoi l cleanu pat thi s propert y to remov e lead-contan4nate dsoil . By signin g thi s form , th e propert y owne r grant s permissio n to Pruden t to perfor m activitie s relate d to th e cleanuifincludin g soi l sampling , remova l of lead-contaminate dsoil , an drestoratio n of th e reference dproperty . If

yo 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 sout hoffic 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 canbe directe d to th e EP A Publi c Informatio n Center s at (402 ) 731-304 5 (SouthOmali aoffice ) or (402 ) 991-958 3 (NorthOmah aoffice) . Property Acces s Grante d By /' ^ (Pleas e Pr i Property Owne r Signature : y° ^ . (Signature ) >^ ^ (Date ) PROPERT Y INFORMATIO N o e and/o r propert y owne r —pleas e print ) y \ (T (T o b b e complete complete d db

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y residen

residen t t and / RESIDEN T NAM E 

## •• \/d i Cr«.c ^ 3- ln ^ Owne r Rente r RESIDEN T ADDRE S K^<?' a 

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# cr IF RENT fL, PROPERT Y OWN f D BY : A ^ . OWNER' S MAILIN G ADDRESS ; 

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# 0.-lt ^ U ^^^JU aK3 ^
OWNER' S TELEPHON E NUMBE R - HOME : J _ WORK :
AG E OF HOME? : YEARS
. HO W LON G HAV E YO U LIVE D HERE ? YEARS
. HA S TH E EXTERIO R BEE N PAINTE D OR COVERE D WIT H SIDIN G SINC E 1978 ? YE S NO NUMBE R OF OCCUPANT S UNDE R 7 YEAR S OLD : NUMBE R OF OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R OF CHILDRE NUNDE R 7 YEAR S OL D WH O PLA Y IN TH E YAR D FO R 6 HOUR S OR MOR E PE R WEEK : COMMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTRY GATES , ETC. )

AT.1THORIT Y FO RENVIRONMENTA LRESPONS E ACTIONS : Th e activitie s to be implemente d by EP A unde r this agreemen t ar e pursuan t to Sectio n 10 4of CERCLA , 42 U S.C . 9604 . EPA' s right ofacces s to th e propert y is provide dfor mSectio n 104(e ) of CERCLA , 42 U.S . C 9605(e) , whic hprovide s entry for ''determinin g th e nee dfor response , or choosin g or takin g an y respons e actio n unde r thi s title , or otherwis e enforcin g th e provision sof th e title. " 808 0 War d Parkway , Suit e 40 5 560 0 S10 St 424 2 Medica l Drive , Suit e 426 0 Kansa s City , MO 6411 4 Omaha
. Nebrask a S810 7 Sa n Antonio , TX 7822 9 Photte ; (816 ) 363-370 3 Phone : (402 ) 733-118 8 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 f?: c(402 i 733-188 3 Fax:(210)579-667 7ENVIRONMENTA L & CONSTRUCTIO N SERVICE S 

# ^Propert y Statu s For m, . Address; ^ ^ 1 1 Date : 

# f D Phone : ^Q'^ ^ ^^o ^ ^ ^ BVID :

808 0 War d Parkway , Suit e 40 5 560 0 S 1 0 S t '424 2 Medica l Drive , sbit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebraska 6810 7 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-3703 Fax : (816 ) 363-370 7 Phone : (402)733-118 8 Fax : (402 ) 733-188 3 Phone : (210)822-958 8 Fax : (210 ) 579-6577

### 3146 3 Omah a Lea d Sit e Exterio rPain t Nort h Arro w Owne rName : CLYD E L VAUGHA N 

### Sit e Sketc h • Goo d Address : 291 1 PINKNEY S T • Poo r Phone : H : W : 

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### • YOURTICKE T NUMBERI S 2614799 . Origina l Cal l Date : 10/12/1 0 Time : 9:0 6 a m Op : SIVA1896 7 Wor k t o Begi n Date : 10/14/1 0 Time : 9:3 0 a m State : N E Count.y : DOUGLA S Place : OMAH A Address : 291 1 Street : PINIOIE Y S T Twp : 15 NRng : 13 E Sect-Qtr : 09-NE-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: 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

MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Servic e Are a Contac t Phon e Numbe r Utilit y Typ e CXCAT V COX 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
OMAHACOFCIT Y OFOMAHA-TRAFFIC,SEWE R 

### RicnmiAFFi C Day : 402444719 7 

### Alt : 402444516 1 Emerg : 402444516 0
OPPDGPR5 OMAH A PUBLIC POWE RDISTRIC T 

### EL M LOCATIN G 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=<RESULT. . . 10/12/201 0TEOHtmLOOn^ l 

### CONSTRUCTIO N 

## mc . SOLUTION S 

## SIT E SAFfeT Y HAZAR D ANALYSI S
Address : 

# ..43iL_ftnk^ t Excavatio n Date : M4^ ^ Crew : — Backfl U Date : —tP-/u]l2. .

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 Sidewal k Foundatio n Retainin g Wall s Fence s Tree s Structure s Drivewa y Sprinkle r Syste m Othe r Cre w Forema n Conditio n Hazard s Correctiv e Actio n c^<
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## Sit e Safety Offic e Date :

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. 5uito4< K 5«0 0 81 0 8 t 424 2 Medica l Drive , Stdt e 726 0 Sa n Antonio , T X 7822 9 V^anr . (402)733-118 8 Phone : (2t0 ) 822-«S8 8 4a

c(SIS ) SBS-^sra r Fax : (402)7334188 3 Fax : (210 ) «7».«57 7VfCl^tl/ T Io n

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