## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL E FOLDE R SAID# : Hbl^ l Date : lO/jt/z^t O Address : I ^Cs ^ 7 <^ t Remediatio n Contractor : Ppt- , rypr>r f l^r.\k N^icp g '<^* V /Ai<r. y Year : '3-010 ^ SOI LREMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S 

## CQ / Vide o o f

propert y (DVD ) IjVe , / fios.^ s

/ JExecutiv e Summar y EPA-provide dpropert y sketc h ESy Signe dAcces s Agreemen t fo r

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

adjacen t propert y S / Restoratio n Agreemen t D Settlemen t document s (i.e. , fo r

damag e o r

t

o replace plants , etc. ) • 'B ^ ConjBrmatio n dat a IS / Photographs 3o-4^ ^ *=^^ ^ 5/ ^ As-buil t sketc h IS/ ^ Satisfector y restoratio n signe db y Propert y Owne r Sl / Propert y close-ou t chec k

list signe db y EP A D Descriptio n o f

area s no t meetin g RO D cleanu p criteri a "SK Utilit y clearance s 5 /

Propert y infonnatio n fromDougla s County Assessor' s Offic e D ^ D

3026240 8 

# iiHnniii i Superfun d

### PROPERT Y SUMMAR Y Date : 10/15/201 0 Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l Monthof : Octobe r Propert y Address ; 150 9 Z 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 GDATA/RESULTS : F 2 = 34 7 PP M @ 9" ; D Z = 7 7 PP M @ 13" ; B l = 25 5 PP M @ 9" ; B 2 = 31 0 PP M @ 9" ; E A = 18 3 PP M @ SCRAPE (~1" ) ATTACHMENT S 1 ) Propert y sketchprovidedb y EP A pursuan t to contrac t specification s 2 ) SignedAcces s Agreenien t including acces s agreement s requiredfo r crossin g othe r propertie s 3 ) Pre-Excayation digita l vide o clip/photograph s 4 ) Post-Excavation digita l vide o clip/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Built sketch i ) Shall includ e fina l lea dlevel s v ) Legen d ii ) Contamination lef t behin darea s vi ) Contractor identification iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r items to b e includedi n th e individua l propert y file , i f available , or obtainedinclude : i ) Pre-excavatio n agreemen t detail s (i f an y ar e mad e wit hth e 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(Flas hPlayer ) forma t and/o r photograph s iv ) Signedfor mverifying satisfactor y restoration v ) Descriptio n of area s not meeting hiterimRO D cleanu p criteria .

TECHNOLOGIES . INC .Fin d Record Backfill :

Sampl e Area : 4613 4 -150 9 Z S T Owner : d Owne rOccupie d Owne rName : JRODRIGUE Z ERIK AC Owne rAddressl : 

# r Owne rAddress2 : 1150 9 Z S T City : State : Zi p Code : lOMAH A " [N E 168107 - Owne rPhon e Aiternat e Phone : 

# r

Contract : Contractor : |PRUDENT_2010 . . S Contrac t Optio n iBAS E Remediatio n Quer yJ Lea d Remainin g Quer yJ Propert yDamag e Quer y

Use rProvide d Owne rInformatio n Owne rName : 

# 1 Owne rAddress : 

# 1 City : 

# 1 State : 

# 1 Zi p Code : 

# 1 Owne rPhone : Alternat e Phone : 

# 1 " 1

Assessment : Qualifyin g Grou p 1400/CHIL D Assessmen t Ma xXR F Valu e j 65 0 Resident : Residen t Name : JMEYE R ROLAN D P Propert yAddress : |1509ZS T Zi p Code : 168107 - Residen t Phon e

# ! R TBCHNOLCXilBS , IN C 

# S^drf A EP A Propert y Clos e Ou t Propert y # : ^6> i 5 f Propert y Address : ^'^^ ^ " ^ ^ " Date/Time : Owner' s Name : ^yr \I'cu . Y- o d\i Oi.^ ZQuad s Excavated : p 2 i O'Z. , €.1 , ft2- Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s N o 1 .

I f necessary , wer e th e correct quadrant(s ) excavatedandrestored ? / 2 .

If necessary , wer e th e correc t area s o f drip zone excavatedandrestored ? / Gradin g Sodan dVegetatio nYe s N o I .

Doe s th e gradin g aroundthe perimete r o

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

Has sodbeen lai di n al l area s tha t wer e excavated ? / 3 .

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

y tim e period) / 4 .Ar e soddedarea s generall y firmandevenl y grad.ed ? / 5 .

Ar e the joint s between the sodstrip s generall y tight ? (Onl y evaluat e if inspecteda t a3 0 da y time period) 

## • 6 .Was the propert y grade dsuc hdia t wate r wil l not pool on th e property ? / 7 .

Was damag e to landscapin g o r plan t material s avoided ? / Gates , Fence s an dRetainin g Wail s Ye s N o 1 .

D o gate s ope n andclos e fireely ? (Ifapplicable ) / 2 .

Wer e all gate s o r fence s taken dow n durin g restoratio n activitie s reinstalled ? (I f applicable ) 

# J 3 .

Wa s damag e to gate s or fence s avoided ? (Ifapplicable ) 

## 7 4 .

Was damag e t o retainin g wall s avoided ? (Ifapplicable ) / Foundation , Sidin g an dGutter s Ye s N o 1 .

Was damag e t o the sidin g o r trimavoided ? / 2 .Wa s damag e t o the foundation avoided ? / 3 .

Was damag e to window s avoided ? / 4 .Wa s damag e t o window s or door screen s avoided ? 

# y 5 .

Was damag e to downspout s o r downspou t extension s avoided ? / Sidewalk s an dDriveway s (Concrete ) Ye s , N o 1 .

Was damag e t o drivewa y surface s avoided ? / 2 .

Was damag e to walkwa y surface s avoided ? 

# y

### Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complet e includin g th e 30-da y so dwaTanty : EP A Representativ e B"^-fi ^ ^Date: 5 ^ 

# i l

[ nii 6

# m. CHNOLCXJIES , IN C 

### A S - BUIL T DRAWIN G OL S #4613 4 Dat e Excavated : 08/28/201 0 USEP A Signed-Of r Date : 

### OMAH A LEA D SUPERFUN D SIT E

Name : fc . 1 f . h : ^ Oinah a Lea d Sit e Address ; •SF 7 Sit e Sketc h Phone : Tea m /i ) /ii/'/i. ' ( C^i. ) BVID * ^//-./i y Sampl e Numtie r Lea d Concentratio n pp m 

# 1 S o pp m ^ ^ 1 ^ 3 ^ pp m pp m 

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### " Z s e Omah aLea dSite 4613 0 FA = 183PPMfa'SCR.AP K CONTRAC T # : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC .

## Propert yCompletio n Agreemen t Thi s agreemen t document s the completion of remova l activitie s performedo n th e belo w listedproperty . Th e propert y owner' s signatur e indicate s tha t th e propert y owne r i s satisfiedwit hth e restoratio n of th e subject property , andtha t n o item s ar e i n question , now , o r a

t an y time i n th e future , excludin g an y remaining warrant y (3 0 day s total ) excep t thos e item s liste dbelow , ifany . Propert y ID : Propert y Address : ( ^ & < ) - ^ S^ — Owner : ^^ « ^ ^ ^^fH^^ i ^ V - 

### Phone : " 0 Restoratio n Item s i n Question :

Item : Item : Hem : Item : Item : Item : Require d correction s t o complet e th e property :

^ ^ ^ /t u I agre e restoratio n i s completed , excep t a s note d above .

L J I d o no t agre e restoratio n is . complete d



### Dat ePruden 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 contaminateiLspil s a t anumbe r o f

propertie s locate di n Omaha , Nebraska , includin g th e property locate dat |9P ^ ^ ^ K ' . Th e EP A request s yqu r permissio n t o allo w Pruden t t o perfor masoi l cleanu p at thi s propert y t o remove lead-contaminate dsoil . B y signin g thi s form, th e property owne r grant s permissio n t o Pruden t to perfor m activitie s related to th e cleanu p includin g soi l sampling , removal o f lead-contaminate dsoil , an drestoratio n ofth e reference dproperty . Ifyo 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 h Omah aOfl'ic e for th e Omah a Lea dSit e cleanup,.a t (402 ) 733-1188 ; 733-14SS . Genera l question s abou t th e Omah aLea dSit e cleanu p can b e directe dto th e EP A Publi c Informatio n Center s a t (402 ) 731-304 S (Sout h0mp|; aoflice) . Propeit y Acces s Grante d Property Owne r Signature : 

# p k /if ) "(Date ) ^MATIO N (T o be complete d b yresiden t and/o rpropert yowne r- pleas e print ) \ RESIDEN T NAME : ^"^ W t_ ^ Owne r Rente r RESIDEN T ADDRESS :

\Se> q 7 ? Q » 

## Ovs.^..JL . v^ ^ C^-\c^ n I F RENTAL , PROPERT Y OWNE D BY : OWNER' S MAILIN G ADDRESS ; JWNER' S TELEPHON E NUMBE R - HOME : J L WORK : AG E O F HOME? : ^O ^ 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 NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : . NUMBER O F OCCUPANT S 7 YEAR S OL D AN D OLDE R 

# _3 _ NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLA Y I N TH E YAR D F0R. 5 HOUR S O R MOR E PE R WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS E ACTIONS ; Th e activitie s to b e implemente db y EP A unde r thi s agreemen t ar e pursuan t to Sectio n 104 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f

acces s to th e property i s provide dfor i

n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 960S(e) , whic hprovide s entry for "determinin g th e nee dfor response, o r 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 ofth e title. "

808 0 War d Parkway , Suit e 40 5 560 0 8.10' " Stree t 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6810 7 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)733-145 5 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)733-188 3 Fax : (210 ) 579-657 7ENVIRONMENTA L & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m. . Address : 1* 5 <^ ^ <S>i hDate : ^M | | 0 Phone : qp^­ - ^ H ~ S3» ^ BVID :



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## Prudent Employe e Signature : 808 0 War d Parkway , Suit e 40 5 2505 N . 24" * Street , Suit e 30 8 4242 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebraska 6811 0 Sa n Antonio . T X 7822 9Name : P.- . . I AK Omah a Lea d Sit e Date : //-'V-f o Nort h Arro w 

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### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 6/15/201 0,ttp://www.dhon.org/irthinternet/DHO. . . 8/9/201 0 Creat e Anothe rTicke t Bac k t o Irt h Inteme t



### • YOURTICKE T NUMBE RI S « 2563770 . Origina l C al l Date : 8/09/1 0 Time : 3:0 6 Wor k t o B e gi n Date : 8/11/1 0 Time : 3:3 0 State : N E County : DOUGLA S Address : 150 9 Street : Z S T Twp : 14 N Rng : 13 E Sect-Qtr : 10-S E Twp : Rng : Sect-Qtr : 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 X AL L CLEAR S TO : (402)733-188 3 Company: PRUDENT TECHNOLOGIE S Contac t Name : SIV AJAMPAM A Wor k Bein g Don e For : EP A Dept h o f Excavation : 6 F T Corne r Lot : Involve s Tunnelin g o r Horizonta l Borin g : CXCAT V LEVEL 3 MUD0 2 OMAHACO F 

### Servic e Are a CXCATV CO X COMMUNICATIONS , IN C LEVEL S COMMUNICATIONS , LEVELS LLC METROPOLITAN UTILITLE S MUD0 2 DISTRIC T :^en d Email, ,

p m Op : SIVA1896 7 p m Place : OMAHA

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### Utilit y Contac t Phon e Numbe r Typ e Day : 4029S4046 9 HEID I Alt : 4029S4046 9 Emerg : 4029S2975 7 Day : 877S668S4 4 N A Alt : Emerg : 877S668S4 4 Day : 402504782 S 

### SAND Y Ak : 

### Emerg : 402504797 0 Day : 402444719 7 

### CIT Y OFOMAHA - OMAHACO F RICH/TRAFFI C Alt : 402444516 1 TRAFFICSEWE R Emerg : 402444516 0 dhon.org/irthinternet/. ../MessageTextas.. . 1/ 2ttp:// www.dhon.org/irthinternet/DHO. . 8/9/201 0 

## OMAH A PUBLI C POWE R 0PPDGPR 6 DISTRIC T QLNNEIFQWES T LOCA L NETWOR K EL M LOCATIN G EL M LOCATIN G Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 Ak : 406207149 4 Emerg : 888728934 3

dhon.org/irthinternet/.../MessageText.as.. . 2/ 2ENVIRONMENTA L ENGINEERIN G AN D CONSTRUCTIO N SOLUTION S 

## SIT E SAFfcTY HAZAR D ANALYSI S 

# s 4 Address : l^u^^^J ^ ._^JLJ^1 ^ Excavatio n Date : Crew : fcLiW^-. Backfil l Date :

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OSOOSIOS t 424 2 Madica l Drna . Suit e 72S 0 iCMy;MO«411 4 ibMlMWia ? SanAntonio,T X 7822 9 : (816 ) 30^370 3 Phofi K(402)733-i m Phone : (2t0).822!«58 8 toe (MS ) 36347V 7 ftc fMQTSS^Itt S Fax : (210)679-657 7

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