## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL EFOLDE R SAI D # : 5^( 6 Date : // ^ / ^ -loo ^ Address : &/ ^ 5 ^ ^ < F Remediation Contractor : Vf2upF^j r T&CfPfyn/~o(niaiH C Year : phoj f SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S ^ Video o f

propert y (DVD ) l?

r

Executive Summar y ffl' EPA-providedpropert y sketch z

f

SignedAcces s Agreemen t fo r

subject propert y D SignedAcces s Agreement(s ) fo r

adjacen t propert y y Restoratio n Agreemen t 0 Settlemen t documents (i.e. , fo r

damage o r

t

o replac e plants , etc. ) B Confirmation data B Photograph s a

r

As-built sketch B Satisfactor y restoratio n signedby Propert y Owne r ^ Propert y close-out check lis t signedby EP A D Descriptio n o f

area s not meeting RO D cleanu p criteri a B Utilit y clearance s 

## B ) Propert y information firomDougla s Count y Assessor' s Office D D 4031355 5 

### D Superfun d 

## Bm . ^ 

## Signature/ * 'Dat e

### PROPERT Y SUMMAR Y Date : 11/19/200 8 Oinah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-06/000 4 Mont hof : Oct/Nov . Propert y Address : 81 4 S 3 3 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 Infomiation ; NON E CONFIRMATIO NSAMPLIN GDATA/RESULTS : B 2 = 17 0 PP M @ 8" ; D Z= 20 2 PP M @ 8" ; F l = 20 6 PP M @ 10" ; F 2 = 32 4 PP M @ 4" ; E A = 24 2 PP M @ SCRAPE . ATTACHMENT S 1 ) Property 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-Bui hsketch
i ) Shal l includ e final lea dlevel s v ) Legen d ii ) Contaminatio n lef 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 dinth e individua l property file, i f available , o r obtaine dinclude : i ) Pre-excavatio n agreemen t 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 in MPEG , WM V (Window s Medi aVideo ) o r SWF(Flas hPlayer ) format and/o r photograph s iv ) Signe dfor mverifyin g satisfactory restoratio n v ) Descriptio n ofarea s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOCIES , INC .Fin d Recor d Qea n U p Quer y Lea d Rennainin g Quer yI Propert yDamag e Quer y 

### Backfill :

Sampl e Area : 561 0 ­ 81 4 S 3 3 S T Owner : Resident : Contract : n Owne rOccupie d Residen t Name : Contractor : Owne rName : 

# 1 |PRUDENT2008_S JTHOMA S CHESTE R H Propert yAddress : 

### 1 Group : Owne rAddressl : Owne rAddress2 : [81 4 S 3 3 S T Zi p Code : [6810 5 

# | l Assessment : |814S33S T Residen t Phon e | Qualifyin g Grou p City : State : Zi p Code : 

# 1 [80 0 [OMAH A|N E [6810 5 Assessmen t XR F Date : Owne rPhone : Alternate Phone : 

# 1 [(402 ) 341-204 3 | Assessmen t Ma xXR F Value : 

### 1 960. 8TECHNOLOGIES , INC . 

# &EP A EP A Propert y Clos e Ou t Propert y # : 5f e ( Q Propert y Address : 8 m-^2,3. ^ T Date/Time : Owner' s Name : Ctte.STTE« ? t+«)MtCfcS Quad s Excavated : ^h^^ ^ f^ ^ D2.y^f= > Contracto r Group : Pruden t Technologies , Inc. , Excavatio nGenera l Ye s I .Ifnecessary , were th e correc t quadrant(s ) excavate dan drestored ? / 2 .Ifnecessary , wer e th e correc t area s ofdri p zon e excavate dan drestored? 

## y Gradin g So dan dVegetatio n Ye s 1 .Doe s th e gradin g aroun dth e perimete r ofth e hous e inexcavate darea s generall y slop e away fromth e house? 

## y 2 .Ha s so dbee nlai dinal l area s that were excavated ? 

# y 3 .Doe s th e so dappear t o b e generall y health y an dgrowing ? (Onl y evaluat e i f mspecte dat a3 0 da

y tim e period ) 

# y 4 .

Are sodde darea s generall y firman devenl y graded ? / 5 .Are th e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e if inspecte dat a3 0 da y / tim e period ) 6 .Wa s th e property grade dsuc hthat wate r wil l no t 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 s Ye s 1 . D o gate s ope nan dclos e freely ? (Ifapplicable ) 

# y 2 .Were al l gate s or fence s take n dow n durin 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 retainin g wall s avoided ? (I f applicable ) 

# y Foundation , Sidin g an dGutter s Ye s 1 .Wa s damag e t o th e sidin g o r tri mavoided ? 

# y 2 .Wa s damag e t o th e foundatio navoided ? 

# 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 1 .Wa s damag e t o driveway surface s avoided ? 

# y 

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

No

N o

N o

N o

### Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complet e includin g th e 30-day so dwarranty : EP A Representativ e ^ dyf . 

### .Ati ^ 

### Date : / /

### 'J/2J 0 ?

# «EFy v Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio nof remova l activitie s performe don th e belo w liste dproperty . Th e property owner' s signatur e indicate s tha t th e property owne r is satisfie dwithth e restoratio n ofth e subjec t property , an dtha tno item s ar ein question , now , or at an y tim e in th e future , excludin g an y remaining warranty (3 0 day s total ) excep t thos e item s liste dbelow , if any . Property ID : Property Address : y^ \^\ci , '^'A) ^ c\ 

## SI Owner : - ^ ^ (^^ ^ ^^^ ^ y { _^ Phone : Restoratio n Item s in Question : Item : Item : 

### Item : Kem : Item : Item : Require dcorrection s to complet e th e property :



### L J I agre e restoratio nis completed , excep t as note d above . L J I do no t agre e restoratio nis complete d 

# "lA m Owner' s Signature "" Dat ePruden t Technologies , Inc . (Prudent ) i s unde r contrac t wit hth e U . S . Environmental Protectio nAgenc y (EPA ) t o cleanup lead
contaminate dsoil s a t anumbe r ofpropertie s locate di n Omaha , Nebraska , includin g th e property locate da t Th e EP A request s you r permissio nt o allo w Pruden t t o perfor masoi l cleanu p a t this property t o remov e lead-contaminate dsoil . B y signin g thi s form , th e property ownafgrant 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 , removal o f lead-contaminate dsoil , an drestoratio nofth e reference dproperty . If

yo u hav e any question s abou t th e soi l cleanu p planne dfor you r property , pleas e contac t Prudent' s Administrativ e Cler k for th e Omah aLeadSite cleanup . M s Madhurim aDur u -a t (402 ) 733-1188 , 733-1455 . General question s abou t th e Omah aLeadSit e cleanu p ca nb e directe dt o th e EPA Publi c Informatio n Center s a t (402 ) 731-304 5 (Sout hOmah aoffice ) or (402 ) 991-958 3 (Nort h Omah aoffice) . Property Acces s Grante dBy : (Pleas e Prin t Name^ I Property Owne r Signature : _ 

# w m gnature ) (Date ) PROPERT YINFORMATIO N (T o be complete d byresi^entayd/o rpropert yowne r~ ple i si^entM d RESIDEN TNAME : C W^J'^V^^^V , O t«-^o>_/ ^ Rente r RESIDEN TADDRESS : 

## c^vw.A ^ ^ ^

^'T i Q 5 I F RENTAL , PROPERT YOWNED BY : OWNER' S MAILIN G ADDRESS ; 

## ^ i - (N^W^xl. ^ \^K , GSV«> ^ OWNER' S TELEPHON E NUMBE R - HOME : J L WORK :



### ( ^ I ^H\ - .^C3M 3 AG E O F HOME? : ( 6 ^ 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 NUMBER O F OCCUPANT S UNDE R 7 YEAR S OLD : L F NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBER O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLAYI N TH 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 , ENTR YGATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s t o b e implemente db y EP A unde r this agreemen t ar e pursuan t t o Sectio n10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s right o f

acces s t o th e property 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 , o r choosin g o r takin g any respons e actio n unde r this 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 7

## A S - BUIL T DRAWIN G^ P OMAHA LEAD SUPERFUND SIT E OLS# : 561 0 Dat e Excavated : 9/24/200 8 USEP A Signed-Of f Date : Tela l Quadran t Squa m Footag s t o b e Excavate d = 18S S Aope ^ Clatafcation : 80 0 Tota l Dil p Zon e IJn«a rFoolaa e ^ * » Exca»^e d -11 8

Pos t Excavatio n Concentration s (ppm ) P I B 2 PEay/Ue a 

# i3t| THG L F 2 D Z Eaaeowii t Tree/Slni b 

# o B l Garde n Ofl w

E A = 24 2 PP M aSCRAP E 5'*^'*' ^ CONTRA a # : E P - R7-07-0 6 / 000 4 PRUDEN TTECHNOLOGIES , IN C

# mjDM (TECHNOLOGIES , INC . 

# Propert y Statu s For m Address : Sl M SSSr ^ <?,< ^ Date : Phone : 

## HoX - '^ ^ V - ^^H2 > BVID : Plant s & Permanen t Landscapin g Item # O n Map Descriptio nan dLocatio n <>^ ' 

# )\ep ^ 

# 5w'^^ . S o p(e-.!>- X CJL L 

# v^- i . q
Pre-Existin g Conditio no f Structure s Doe s you r Basemen t hav e ahistory o f leaking ? Ye s —N o y* ^ Item # Descriptio n & Locatio n O n Map 

## ^ o C l ycK^Qji^ ^

Property Pruden t Employe ^ Signature Signature : 

# 1^- ^ 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 7Tota l QuadrJI^tuar e Footag e t o b e Excavate d = 185 8 Propert yClassifk:ation : 80 0 Tota l Dri p Zon e Linea rFootag e t o b e Excavate d = 11 8



### ,SQUttL33LStEee t Legen d Nort h Arro w 

### Omah a Lea d Sit e Oniaha , Nebrask a 1 ^ Concret e y/ \ Excavate d Are a Propert yNumbe r OLS-561 0 l U Existin g Structur e Scal e •—•— • Fenc e Propert yAddres s 1 Inc h = 2 0 fee f o r1 gri d = 5 x5 ft PO Q Permanen t Landscapin g 81 4 S 3 3 S T

———Quadran t Boundar y oo""^'. . Pos t Excavatio n Concentration s (ppm ) Stree t Boundar y F l B 2 PlayAre a 

# ^.\ yHGI L F 2 D Z Easemen t (yTree/Shru b *>|< F f T rHyclruGeo!.c:gic . in c B l Garde n Othe r DescripUo n o

fpo « excavation anus : F1 , front yar d left+an d quadrant F2 . fron t yar d right-han d quadrant ' Bl , badtyar H left-han d quadrant B2 , backyar d lioht-han d quadrant DZ, dri p zon a (1-3 fbo t are a o

f soi l araund th e foundatio n o ftn e house) . ^^J^*;ZOH 3PRUDEN TTECHNOLOGIES , IN C FIRS TNATIONA L BAN KO F OLATH E 808 0 WAR D PARKWAY , SUIT E 40 5 83-172/101 0 

## 1976 4 KANSA S CITY , M O 6411 4 (816)363-370 3 

# w AFiyi t 5 i PA YT O TH E ORDE R O F _ 

# C/UJI ^ TI, . T-^nn^z-A ^ 

## CAyyvi'ArJ^ii>.iakr J ^y ^

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A<y) C f ^ DOLLAR S Q g

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### ii' O n7E,i,ii " .« : 1 0 10 0 1 7 20i : "'Oil * S^ 5 »*« • /

PRUDEN TTECHNOLOGIES , INC . 

## 1976 4 

# g/i ^ ^ ? 2 <iF

PRUDEN TTECHNOLOGIES , INC . 

## 1976 4

n

## Pag e 1 of 1



# Sih s 3 3 s r

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## Prin t Preview Page 1 of 1 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 r Cit y Owne r Stat e Owne r Zi p 172247000 0 THOMA S CHESTE R H 81 4 S 3 3 S T OMAH A 6810 5

81 4 S 3 3 S T OMAH A N E 6810 5 Sec-Twn Rn g Additio n Bloc k Lo t Lega l 1 Lega l 2 Lega l 3 Lega l 4 Treasure r Websit e Lin k Assesso r Websit e Lin k 21-15-1 3 MAYN E PLAC E 1 8 50X12 5

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## http://vvww.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 9/16/200 8

### y 

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Nurser y 3 0 3 Nort hSad^ e Cree k R d Omaha , N E6813 1 Phone : 402-558-590 0 Fax : 402-932-346 0 

### Client : ^<^ ^ 

### Cheste rThoma s '-^ At"V ^ 81 4 Sout h 33r d Stree t Omaha , N E Phon e 341-204 3 Cos t o f a ne warrangemen t o f plan t materia l Descriptio n Qt y Siz e Peon y 1 0 # 2 Va n Houtt e Spire a 0 # 2 Dayiil y 6 # 1 Purpl e Coneflowe r 5 # 1 Butterfl yBus h 1 # 1 Kar i foreste rGras s 3 # 1 Blu e Chi p junipe r 0 # 2 Hall' s Honeysuckl e 7 Q t Rhododendro n PJ M t # 2 Emeral d n GoRTEuonymiiis : # 2 Magi cCarpe t Spicsa - # 2 Genma n Bearde d Iri s # 1
Tota l Materia l Instal l ^. \ 

### Sale s Ta x Tota l ^ 

# Sr , 0 t o

Date : Octobe r2 . 200 7 Revised : Jun e 20 , 200 8 Revised : Septembe r9 . 200 8

Pric e 19.9 9 34.9 9 12.9 9 10.9 9 19.9 9 14.9 9 

# '^M .

1^79 9 

### Total , 199.9 0 0.0 0 77.9 4 54.9 5 19.9 9 44.9 7

0.0 0 41.9 3 44.9 9 34.9 9 104.9 7

65.9 4

0.0 0 0.0 0 $ $ $ $y /

/

Mr . Cheste rThomas , Thi s lette rserve s t o confir m tha t Pruden t Technologie s \N\\ \ provid e a chec k i n th e amoun t o f $ 1,256.1 5 (on e thousan d tw/o hundre d fift ysi xdollar s an d fiftee n cents ) t o yo u fo rreplacemen t an d installatio n o f horticultura l item s as agree d t o o n th e attache d sheet . N o additiona l item s o rlabo rwil l b e reimburse d unde rthi s agreement . Thi s reimbursemen t i s fo rth e propert ylocate d a t 81 4 S . 33" * St . Omah a Ne . unde rcontrac t EP-S7-07-O 6 Omah a Lea d Soi l Remediation .

Cheste rThomas , Propert yOwne r Dann ySnow , Pruden t Technologie s Dat e Dat eMr . Cheste rThomas , Thi s lette rserve s t o confir m tha t Pruden t Technologie s wil l provid e a chec k i n th e amoun t o f $ 1,256.1 5 {on e thousan d tw o hundre d fift ysi xdollar s an d fiftee n cents ) t o yo u fo rreplacemen t an d installatio n o f horticultura l item s as agree d t o o n th e attache d sheet . N o additiona l item s o rlabo rwil l b e reimburse d unde rthi s agreement . Thi s reimbursemen t i s fo rth e propert ylocate d a t 81 4 S . 33"^ ^

St . Omah a Ne . unde rcontrac t EP-S7-07-0 6 Omah a Lea d Soi l Remediation . 

# o y ^ Cheste rTI)omas , Propert yOwne r Dann ySnow , Pruden t Technologie s Dat e

# 0 ^•V i 

# " j Sk o .O India nCiee k

NuTsei y 30 3 Nort h Saddl e Cree k B Omaha , NE 6813 1 Ld Phone : 402-558-590 0 Fax : 402-932-346 0 

### Date : Octobe r 2. 200 7 "


### Revised : Jun e 20 , 200 8 Client : /y ^

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### Cheste rThoma s

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# \y^F \ y^A \ 

# F^ Revised : Septembe r9. 200 8 81 4 Sout h 33r d Stree t 

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# Fy­

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### Phon e 341-204 3

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### Cos t of a ne warrangemen t of plan t materia l /Descriptio n Qt y Siz e 

## Pric e Total , Peon y 10 #2 19.9 9 199.9 0 Va n Houtt e Spire a 0 #2 34.9 9 0.0 0 /Dayiil y 6 #1 12.9 9 77.9 4

. Purpl e Coneflowe r 5 #1 10.9 9 54.9 5

Butterfl yBus h 1 #1 19.9 9 19.9 9 Kar i foreste rGras s 3 #1 14.9 9 44.9 7 Blu e Chi p junipe r 0 #2 

## 34^9 - 0.0 0 Z'" " 

### Hall' s Honeysuckl e 7 Qt 5.9 9 41.9 3 Rhododendro n PJ M 1 #2 44.9 9 44.9 9 ~ - 

### Emeral d n GolcT&Jony i TlUSts : 

### #2 

## iM.y y 34.9 9 Magi cCarpe t Sgi^g^. ' #2 104.9 7 ( ^ 

# .its,i ) Genma n Bearde d Iri V #1 

## fo:9 9 65.9 4 0.0 0

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### 0.0 0 r\

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### Tota l Materia l $ 

## rv . ^05 7 

# ~I > Installatirj n 1 aho r^ , 

# 4 ^ ^ $ 

# r \ ' "\i i Sale s Ta x '* > $ 

### 82.1 8 - A 

### Tota l $ 

### 1.256.1 5Pag e 1 of 2

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### • YOU RTICKE T NUMBE RI S 2129830 . Origina l Cal l Date : 9/12/0 8 Time : 9:2 6 am Op : RAMITA1896 7 Wor k t o Begi n Date : 9/16/0 8 Time : 10:0 0 am State : N E County : DOUGLA S Place : OMAH A Address : 81 4 Street : S 33R D S T Twp : 15 NRng : 13 E Sect-Qtr : 21-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n wor k Locatio n o f Work : LOCAT E ENTIR E PROPERT Y 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 Nam e RAMIT A Phone : (402)733-145 5 Alt . Contac t Phone : (402)733-118 8 Wor k Bein g Don e For : ep a Dept h o f Excavation : 6f t Corne r Lot : NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V LEVEL 3 MCLEODN E MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Servic e Are a Contact Phon e Numbe r Utilit y Typ e CXCAT V c o x COMMUNICATIONS , IN

C HEID I Day : 402934046 9 Ah : 402934046 9 Emerg : 402932975 7 LEVEL 3 LEVEL 3 COMMUNICATIONS , LL C N A Day : 877366834 4 Alt : Emerg : 877366834 4 MCLEODN E MCLEODUSA NO NEE D T O CAL LOU T EMERGENC Y Day : 800289190 1 Ah : Emerg : 800289190 1 MUDO l METROPOLITA N UTILITIES DISTRIC T SAND Y Day : 402504782 3 Ah : Emerg : 402504794 6 http://www.dhon.org/irthinternet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/12/200 8

### Pag e 2 of 2

OMAHACO F

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### QLNNEI C CIT Y O FOMAHA
TRAFFICSEWE R
OMAH A PUBLI C POWER DISTRIC T 

### QWES T LOCAL NETWOR K RON

N

A

N A Day : 402444719 7 Ah : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 Ah : 888728934 3 Emerg : 406728934 3 Day : 406728934 3 Ait : 

### Emerg : 888728934 3

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