SAID# ; 2690 2 

### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R DATE : 12/15/201 0 ADDRESS : 241 9 PARKE R S T REMEDIATIO N CONTRAaOR : PRUDENTTECHNOLOGIES
. INC
. YEAR : 201 0 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S [ 6 PR E AN D POS TVIDE O O F PORPERT Y(DVD ) E EXECUTIV E SUMMARY • rEPA-PROVIDE D PROPERT YSKETCH a SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT(S) FO R ADJACEN TPROPERT Y Q RESTORATIO N AGREEMEN T D SETTLEMENTDOCUMENTS (I.E. , FOR DAMAG E O R T O REPLACE PLANTS , ETC. ) d CONFIRMATIO N DAT A m PHOTOGRAPH S B AS-BUIL TSKETCH Q SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R d PROPERT YCLOSE-OUTCHECKLIS TSIGNE D B YEP A D DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A d UTILIT YCLEARANCE S

• PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E 

## D D
<a^4 ^ 4\*'l u SIGNATUR E DATE 3021861 4 

# H i

Superfun dFin d Record Remediatio n Quer y] Lea d Remainin g Quer yI Propert yDamag e Query 

### Backfill :

Sampl e Area : 2690 2 ­ 241 9 PARKE R S T Owner : Use rProvide d Owne rInformatio n Resident :
n Owne rOccupie d 

### Owne rName : Owne rName : Residen t Name : ICTT YOF OMAH A 

### j 

# f TM ~ Owne rAddressl : Owne rAddress : Propert yAddress : IC/ O RNANC E DEP T 

# r i241 9 PARKE R S T Owne rAddressZ : Zi p Code : |181 9 FARNA M S T 168111 - City : state : ZipCode : Qty : state : Zi p Code : Residen t Phon e lOMAHA JN E J68183­ 

# r 1 1 • 

# 1 Owne rPhon e Alternat e Phone : 

# r Owne rPhone : 

# r 

# ' Alternat e Phone : 

# r

Contract : Assessment : Contractor : (pRUDEN^lo T 40 0 Contrac t Optio n JOPTION 2 472.8 3

### PROPERT Y SUMMAR Y Date : 12/15/201 0 Omah aLea dSit e Reinedia l Actio n Contrac t t

t EP-R7-07-0 6 TO# l Montl i of : Decembe r Propert y Address : 241 9 PARKE RS 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 N SAMPLIN GDATA/RESULTS : B l = 31 9 PP M @ 6" ; F 2 = 27 8 PP M @ 6" ; N O EASEMEN T 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 digital 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-Buil t sketch
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 ) BVK ) numbe r 7 ) Othe r item s t o b e include din 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 For msigne 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 ) 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 .

TECHNOLOCIES , INC
.

# -yULi y TECHNOLOGIES , INC . 

### Propert y # : ZCO^GT - 

### Date/Time : Quad s Excavated : i^^f^ { 

# EP A Propert y Clos e Ou t Propert y Addres>:/2-^' ^ P/i.rVL&
- *ii^ . Owner' s Name : C-?>tt> ^ »Y-^'"vv^U*. ^ Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l I If necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 2 If necessar> , wer e th e correr t area s o f dri p zon e excavate dan drestored' ? Gradin g So dan dVegetatio n 1 Doe s th e gradin g aroun dth e penmete r o f th e hous e mexcavate darea s generall y slop e awa y fro mth e house' ? 2 Ha s so dbee n lai di n al l area s that wer e excavated ? 3 Doe s di e so dappea r t o b e generall y health y an dgrowing' ? (Onl y evaluat e if mspecte da t a3 0 da

y tim e penod ) 4 Ar e sodde darea s generall y fim i an devenl y graded" ? 5 Are th e joint s betwee n th e so dstnp s generall y tight ? (Onl y evaluat e if inspecte dat a3 0 day tim e penod ) 6 Wa s lh e propert y grade dsuc htliat wate r wil l no t poo l o n th e property' ? 7 Wa s damag e t o landscapin g o r plan t material s avoided" ? Gates , Fence s an dRetainin g Wall s 1 D o gate s ope n mi dclos e freely' ? (I f apphcable ) 2 Were al l gate s o r fence s take n dow n dunn g restoratio n activitie s reinstalled' ? (I f applicable ) 3 Wa s damag e l o gate s o r fence s avoided" ? (Ifapplicable ) 4 Wa s damag e t o retainm g wall s avoided" ? (Ifapplicable ) Foundation , Sidin g an dGutter s 1 Wa s damag e t o tli e sidin g o r U-i mavoided" ? 2 Wa s dainag e t o tli e foundauo n avoided" ? 3 Wa s damag e t o window s avoided ? 4 Wa s damag e t o window s o r doo r screen s avoided ? 5 . Wa s damag e t o downspout s o r downspou t extension s avoided" ^ Sidewalk s an dDriveway s (Concrete ) 1 Wa s damag e l o dnvewa y surface s avoided ? 2 Wa s damag e t o walkwa y surface s avoided" ? Ye s N o 

## y y Ye s N o 

# y / " 

# y y 

# y y y Ye s N o



## y 

# y y y Ye s N o



# y / 

# y y / Ye s N o



## y / ^

## Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complete includin g th e 30-da y so dwarrant y EP A Representativ e 9*^:^ ^ Date " io\i.7li o

# m CHNOLOUIES , INC . 

## A S - BUILT DRAWIN G OL S #2690 2 Dat e Excavated : 10/08/201 0 

## OMAHA LEAD SUPERFUND SIT E IISEP A Signed-OffDate : 

## 26902 Exterio rPain t Owne rName : FRAN KD GLEBAVICIU S Omah a Lea d Sit e • Goo d Sit e Sketc h Address : 241 9 PARKER^S J • ^Poo r

Phone : H : 907-490-668 8 W ; 907-377-212 9 Q No t pain t Lea d Sampl e Sample s Collecte d Concentratio n Collecte d Sampl e Numbe r LA B Flm, : _£jM_ai_i ^ RYASCPXA-2690 2 F l pp m 

### D Date : jO'l 3 6 U RYBSCPXA-2690 2 F 2 pp m 

### D Time : )^'.l R ^,V^ RYCSCPXA-2690 2 B l pp m 

### D Sample s Analyze d RYDSCPXA-2690 2 8 2 pp m 

### D RDZSCP.Y A3600 2 -B 2 pp m 

### D D XR F Unit : /Q/J J Book ; /7 3 RGgSCPX A2600 2 -6 » pp m 

### D D Dat e / o •/ ? -^l " nr£0CPXA-2G90 2 -P2 - pp m 

### D D Tim e Staff : ^i> y Numbe ro f Sample s = : *- ( Legend : F l = Fron t Left , F 2 = Fron t Rigtit , 8 1 = Bac k Left , 8 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a

s viewe d fro m th e street , facin g propert y 1 

# ENTERE D .473 .355 . B l =31 9 PP M a 6 " 

# .e> i
I
• % ^ • T F2 = 27 8 PP M f a6 " 

## .Z5 3

l- l

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WAl K 

### P/^.ig/^e? . ^•.._ N O EASEMEN T CONTRAC T# : EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC
.

# EP A Propert yCompletio n Agreemen t Thi s agreement document s th e completio n o f remova l activitie s perfonne do n th e belo w liste dproperty . Th e propert y owner' s signature indicate s tha t th e propert y owner i s satisfie dwit hth e restoratio n o f th e subjec t property , andtha t n o item s are i n question , now , or a

t any time i n th e future , excludin g any remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , if any . 

## r Propert y ID : Propert y Address ; ^^/y ^ P^,U^ r \-\r.^ J Owner : 

# c L W O.^iy ^ Phone : ^^^ - ^^^ ^ Restoratio n Item s i n Question :

item : Item : 

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

l^v l agre e restoratio n i s completed
. n I d o no t agre e restoratio n i s complete d a t (note d deficiencie s above )



### (^f-Qckkx / -J^I O Dat ePruden t Technologies , In c(Prudent ) is unde rconlmc l wil h Ih e U S Environmenia l Proleciio n Agenc y(EPA ) lo clea n up lead comaminalc d soil s al a numbe rofpropertie s located in Omalia
. Nebraska , includin g Ih cpropert ylocated al cfHi' i ft^Ut. rSJA^/ - , Th e EP Arequest s you rpermissio n lo allowPruden t lo perfor m a soi l cleanu p al thi s propen y lo remov e lead-conlaminated soil
. Dysignin g thi s form , lh e propert yowne rgrant s permissio n lo Pruden i lo perfor m ociivilie s relatedto lh e cleanu p includin g soi l sampling , remova l of Icad-conlaminaled soil , and restoratio n ofth e referenced propen y Ifyo u hav e an yqueslion s abou t th e soi l cleanu p planne d fo ryou rpropert)' , pleas e contac t Pruden i south offic e .fo rIh e Omah a Lea d Site cleanup-a t (<t02 ) 733-118 8 Genera l queslion s abou t th e Omah a Lea d Sue cleanu p ca n be directe d lo th e EP APubli cInformalio n Center s at (402 ) 73I-304 S (South Omaha office ) or(402 ) 991-958 3 (Non h Omaha office)
. Propert yAcces s GrantedByMiltAt ^ LuU'/^d h (Pleas e Prin t Name ) S-O^ i "t/O/ U Propert yOwne rSignature­ y(S l (Date ) (Signalure ) PROPERT YINFORMATIO N (T o bccomplete dbyresiden t and/o rpropertyowne r~ pleas e print ) RESIDEN TNAME : " ^ Owne r Rente r RESIDEN ADDRES S / ) I T TADDRESS : 

# r^^^ n M/ju y yy IF RENTAL , PROPERT YOWNE D BY :
OWNER' S MAILIN G ADDRESS ; 

### .-^^^m^h-^rdcq-^^t^cd-
. Ih ^ Jy^/ia ^ SASi'ikllf l Ofw L ^/\// ^

&Sill ^ OWNER' S TELEPHON E NUMBER-HOME : J L WORK :
AG E OF HOME? : YEARS
. HOW 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 ROF OCCUPANT S UNDE R 7 YEAR S OLD:
. NUMBE ROF OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE ROF CHILDRE N UNDE R 7 YEAR S OL O WH O PLAYIN TH E YAR D FO R 5 HOUR S OR MOR E PE R WEEK : COMMENT S OR SPECIA L INSTRUCTIONS : (I.E
. DOGS , ENTR YGATES , ETC. )

AUTHORIT YIO R ENVIRONMENTA L RESPONS E ACTIONS ; Tli e activitie sto be implementedbyEP Aunde rthi s agreemen l ar

cpursuant to Sectio n 10 4 ofCERCLA , 42 U S. C 960 4 EPA' s righ i of acces s lo th e propert y is provide d fo r in Sectio n 104(e ) of CERCLA
. 42 U S. C 9605(e) , whic h provides entr yfo r'detenninin g th e nee d fo rresponse , orchoosin g ortakin g an yrespons e actio n unde rthi s title , orotherwise enforcin g Ih e provision s ol lh e titl e " 808 0 War d Parkway , Suit e 40 5 560 0 SI O St 424 2 Medica l Drive , Suit e 425 0 Kansa s City , MO 6411 4 Omaha , Nebrask a 6810 7 Sa n Antonio , TX 7822 9 Phone:(816)363-370 3 Phone : (402 ) 733-118 8 Phone : (210)822-958 8 Fax:(816)363-370 7 Fax : (402)733-188 3 Fax : (210 ) 579-657 7

## 2690 2 Exterio rPain t MonhArro w 

### Omah a Lea d Sit e Owne rName : FRAN KD GLEBAVICIU S n Goo d 

### Sit e Sketc h Address : 241 9 PARKER^ST n Poo r

Phone : H : 907-490^68 8 W ; 907-377-212 9 [ ^

No t pain t Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Fir m Sampie s Coliecte d RYASCPXA-2690 2 F l pp m 

## D Dat e 

## 10 ' ; 3 c^ . RYBSCPXA-2690 2 RYCSCPXA-2690 2 RYDSCPXA-2690 2 F 2 B 1 B 2 

### •4 3 

### H ­ pp m pp m pp m 

## D D 

# • Tim e 

## )iyi^ m Sample s Analyze d RDZSCPX A2560 2 E ^ pp m 

## D D XR F Uni t 

### Book: J 7 3 nCZCCPXu A2600 2 n!PZOCrXA-2C90 2 G * P2 ­ pp m pp m 

## D D D D Dat e Tim e 

## /Oi l 

## Pr p Ot p Numbe ro f Sample s = j ^ Staf f Legend : F 1 = Fron t Left , F 2 = Fron t Riglnt , B 1 = Bac k Left , 8 2 = Bac k Righ t D Z = Dn p Zone , G Z = Garden , P Z = Pla y Al l quadrant s are a s vii^ie d fro m th e street , facin g property 

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# A Printed : Oc t 25 , 201 0 www.dcgis.org/dogi s

### Pag e 1 of 2
" > Creat e Anothe rTicke t Bac k t o Irt h Inteme t Sen d Emai l


### YOU RTICKE T NUMBE RI S 2609464 . Origina l Cal l Date : 10/05/1 0 Time : 4:3 4 p m Op : SIVA1896 7 Wor k t o Begi n Date : 10/07/1 0 Time : 5:0 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 241 9 Street : PARKE R S T Twp : 15 NRng : 13 E Sect-Qtr : 15-NW,16-N E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e 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 : 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 LEVEL 3 MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C 

### Servic e Are a Contac t 

### Phon e Nuniber Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEIDI Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
LEVEL3 LEVEL S COMMUNICATIONS , LL C N A Day : 877366834 4 Alt : Emerg : 877366834 4 MUDO l METROPOLITA N UTILITIES DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R RICH/TRAFFI C 

### Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0 

### Day : 406728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 10/5/201 0

## Pag e 2 of2

OPPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T EL M LOCATIN G 

## Alt : 406207149 4 Emerg : 888728934 3 QLNNEIC 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=<RESULTS.. . 10/5/201 0TEPMWOtOOTO , JM C 

### ENVIRONMENTAL ENGINEERIN GAN D CONSTRUCTIO N SOLUTION S 

## SIT ESAFi^TY HAZAR D ANALYSI S



# . 

# 7^^' > ^c^h f ^} r Excavatio n Date : l^SEJL Address : Crew : ^ Backfil l Date :

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 Stmcture s Driveway Sprinkle r Syste m Othe r Cre w Forema n Conditio n 

# (9 L O K O K C\i< . 

# A H /O^A . 

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## Jj&^i OC 

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# /l^^ ^ Hazard s Correctiv e Actio n

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## Sit e Safet y Offic e Date :

80 » WaR^Baitany
. Suit e 40 5 

### seoosios t 424 2 Medica l Drive , Suit e 725 0 Kaisa s Cify
. MO««11 4 Omaha , Nttaa^k a 0810 7 Sa n Antonio , T X 7822 9 Pfione : (81S ) SGMTOS fhone : (402 ) 733-110 8 Phone : (210 ) 82Z-«588 f^ac^lS ) 363-^370 7 Fax : (402)733'188 3 Fax : (210)579-657 7 V^.
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