## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R 

# SAID# : 133 3 1 Date : l i ^ I 5 " 1 0 Address : /p ? / 0 f)\yA.LAJL ^ ^f " Remediatio nContractor : PPf-yn^T^- f 7»/"4iN<X0C|i?-<?.^/fNi("-' ^ Year : AU i i j SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S g

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### ffl EPA-provide dpropert y sketc h [ A Signe dAcces s Agreemen t fo r subjec t propert y D Signe dAcces s Agreement(s ) fo r adja<?en t propert y aRestoratio nAgreemen t D Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. )
• Confirmatio ndat a 3 Photograph s H As-buil t sketc h [

/ Satisfactor y restoratio nsigne db y Propert y Owne r 0 Propert y close-ou t chec k Us t signe db y EP A D Descriptio no f area s no t meetin g RO D cleanu p criteri a 

## \ j Utilit y clearance s [ J Propert y informationfromDougla s Count y Assessor' s Office D D 

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### PROPERT Y SUMMAR Y Date : 11/15/201 0 Omah aLea dSit e Remedia l Actio nContrac t #EP-R7-07-0 6 TO# l Mont hof : Novembe r Propert y Address : 121 0 BLAIN ES 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 : NON E CONFIRMATIO NSAMPLIN GDATA/RESULTS : F 2 = 36 6 PP M @ 9" ; D Z= 14 9 PP M @ 13" ; E A = 11 3 PP M @ SCRAP E(~1" ) ATTACHMENT S 1 ) Property sketc hprovide dby 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 ndigital vide o clip/photograph s 4 ) Post-E.\cavatio ndigital vide o clip/photograph s 5 ) Documentatio n- Complete dClose-ou t Checklis t 6 ) As-Buil t sketc h­ i ) Shal l includ e fina l lea dlevel s v ) Legen d ii ) Contaminatio nlef t behin darea s vi ) Contracto r identificatio n iii ) Property addres s vii ) Date iv ) BVI D numbe r 7 ) Othe r item s t o b e include di nth e individual property file , if available , o r obtaine dinclude : i ) Pre-excavatio nagreemen t detail s (ifan y ar e mad e wit hth e property owner ) ii ) Property Statu s For msigne dby property owne r iii ) Excavatio ndigital vide o i nMPEG , 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 ) Descriptio no f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOGIES , INC .Fin d Record Remediatio n Quer y Lea d Remainin g Quer y Propert yDamag e Quer y 

### Backfill :

Sampl e Area : 1232 7 - 121 0 BLAIN E S T Owner : n Owne rOccupie d Owne rName : JVALENTIN-CALDCT O MARI AI Owne rAddressl : 

# f " Owne rAddress2 : I12I O BLAIN E S T City : State : Zi p Code : JOMAHA 

### JN E 68107 - Owne rPhon e Alternat e Phone : 

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Contract : Contractor : ]PRUDENT2010_S Contrac t Optio n JOPTIO N 1 Use rProvide d Owne rInformatio n Owne rName : Owne rAddress : City : State : Zi p Code : 

# p — 

# r Owne rPhone : Alternat e Phone :

Assessment : Qualifyin g Grou p 400/CHIL D Assessmen t Ma xXR F Valu e | 456. 8 Resident : Residen t Name : JALVARADO ANTONI O Propert yAddress : J121 0 BLAIN E S T Zi p Code : 168107 - Residen t Phon e 

# r~— "6F % r=^ " TECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y # : 12-32- 7 Propert y Address : \5_lt 5 T3>l-'^"^E ^ "^ f Date/Time : /o/| / Owner' s Name:apsftP>€- ^ l/ALeiNTlH£ - Quad s Evcavated : ri O "T ) "^ ^ Contracto r Group : Pruden t Technologies , Inc. , Excavatio nGenera l Ye s No ) I f necessar) . wer e lli e correc t quadrant(s ) e.xcavate dan drestored ? 

## y 2 If necessar)' . v\'er e ili e correc t area s of dri p zon e excavate dan drestored ? / Gradin g So dan dVegetatio n Ye s No 1 .Doe s th e gradin g aroun dtli e perimete r of th e hous e inexcavate darea s generall y slop e away fro mth e house' ' / 2Ha s so dbee nlai dinal l area s tlia l were excavated ? / 3Doe s tli e so dappear t o b e generall y healtli y an dgrowing ? (Oni ) e\-aluate if inspecte da t a3 0 / day tim e period ) 4 .^r e sodde darea s generall y fir man devenl y graded' ? 

## J .S Are Lli e joint s betwee ntli e so dstrip s generall y tight' ? (Onl y evaluat e if inspecte da t a3( ^ da y lim e period ) / 6 .Wa s th e property grade dsuc htlia t wate r wil l noi poo l onth e propeny' ? / 7 Wa s damag e t o landscapin g or plan t material s avoided' ? 

# y Gates , Fence s an dRetainin g Wall s Ye s No 1 .D o gale s ope n midclos e freely* ? (If applicable )
. / 2 ,Were al l gale s or fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (If applicable ) / 3 Wa s d;unag e to gate s o r fence s avoided' ? (If applicable ) / 4 Wa s damag e t o reUnmn g wall s a\oided ? (If applicable ) / Foundation , Sidin g an dGutter s Ye s N o 1 Wa s damag e l o ih e sidm g or tri mavoided'. ? / 2Wa s dajnag e t o di e foundaUo navoided ? / 3 .Wa s damag e t o ^vlndow s a^•oided ? / 4 Wa s damag e i o window s o r doo r screen s avoided' ? / : ^ Wa s damag e l o do w nspout s o r downspou t extension s avoided' ' / Sidewalk s an dDiivewa y s (Concrete ) Ye s No Wa s damag e t o drivi.-wa \surfa(.:e s avoided' ? Wa s dainas e l o waIk^^'a ) surface s avoided ? 

# r

### Owner s comments :

Inspectio nnotes :

Remova l an drestoratio nactivate s complet e includin g th e 30-day so dvvajranty : EP A Representativ e .^r, ^ >^ ^ Date : ____jf(2yt5j/^^

# il l CHNOLOCIIES , INC . 

## A S - BUILT DRAWIN G OLS #1232 7 Dat e Excavated : 09/22/201 0 

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### ENVIRONMENTA L ENGINEERIN GAN D CONSTRUCTIO N TECHNOLOGIES , INC . 

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### • YOU RTICKE T NUMBE RI S 2590956 . Origina l Cal l Date : 9/13/1 0 Time : 4:1 6 pm Op : SIVA1896 7 Wor k t o Begi n Date : 9/1.5/1 0 Time : 4:4 5 pm State : N E County : DOUGLA S Place : 0^4AH A Address : 121 0 Street : BLAIN E S T Twp : 14 NRng : 13 E Sect-Qtr : 03-N E Twp : 15 H Rng : 13 E Sect-Qtr : 34-S E Lega l Given : C Typ e o f Work : lea d soi l remediatio n projec t Locatio n o f Work : LOCAT E ENTIR E PROPERT Y Remarks : FA; K AL L CLEAR S TO : (402)733-1 8 8 3 : UNSUR E CORNER S Compan y: PRUDEN T TECHNOLOiSIE S Contac t Name : SIV AJAMPAMA Phone : (402)733-11 8 8 Wor k Bein g Don e For : EP A Dept h o f Excavation : 6 F T Corne r Lot: NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : NE.xplos i ves : N ATTNEBR l C;<CAT V

LEVEL 3 MCINE B MUD0 2 OMAHACO F 0PPDGPR 6 PAETE C QLNNEI F Servic e Are a Contac t Phon e Numbe r Utilit y Typ e ATTNEBR l ATT T 

### Day : Alt : 8002413624 9 Emerg : 8002413624 9 CXCAT V CO X COMMUNICATIONS , INC HEID I 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 LEVEL S LEVEL 3 COMMUNICATIONS , LL C N A 

### Day : 877366834 4 Ah : Emerg : 877366834 4 MCINE B MC I N O CAL L PE R MEM O 

### Day : 800289342 7 Ah : 

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