### TRANSMITTA L o f OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 9*^ L2. I Date : 1)2.1/200 ^ Address : ZS/ 1 / / 2- S A ' Remediatio n Contractor : K^^^^ ^ 'Tt'Ui^/Ly l ^ Svi, . Year : 2a>ei2 SOI L REMEDIATIO N PROPERTi ^ FIL E FOLDE RDOCUMENT S \y

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Vide o ofpropert y (DVD ) B ^ Executiv e Summar y ffl^ EPA-providedpropert y sketch 0'' ^ SignedAcces s Agreemen t fo r

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

adjacen t propert y Ef

' Restoratio n Agreemen t D Settlemen t document s (i.e. , fo r

damag e o r

t o replac e plants , etc. ) y Confirmation data y Photograph s 0 ^ As-built sketch 0 ^ Satisfector y restoratio n signedb y Propert y Owne r aPropert y close-out chec k

lis t signedby EP A D Descriptio n o f area s no t meetii ^ RO D cleanu p criteri a y Utilit y clearance s 0 ^ Propert y infonnatio n firomDougla s Count y Assessor' s Office D D D 

### SigaSiSe ^ Dat e 4031126 6 

# iinuiiiui i Superfun dFin d Recor d I Backfill :

Sampl e Area : 2962 7 - 281 3 N 2 8 A V Owner :
n Owne rOccupie d Owne rName : |MCCREAR Y JOYC E

—- Owne rAddressl :

- Owne rAddress2 : |6729N106S T City : State : Zi p Code : |OMAH A |N E |6812 2 Owne rPhone : Alternat e Phone : 1(402)491^037 1 

# ^ l - Qea n U p Query Lea d Remainin g QueryI

Resident : Residen t Name : 

# r Propert yAddress : |281 3 N 2 8 A V Zi

p Code : |6811 1 Residen t Phon e 

# I Propert yDamag e Query

Contract : Contractor : |PRUDEm7008_ S Group : Assessment : Qualifyin g Grou p 

### |i2q o "" " Assessment XR F Date : 

# f —— . Assessment Ma xXRF Value : I 1619 'TECHN0L0GI15,IN C 

# SERI V EP A Propert y Clos e Ou t Propert y # : 2^1,2- 1 Propert y Address : 2S^I ^ ^^2- 8 A / Date/Time : Owner' s Name : Quad s Excavated : /^ ) Contracto r Grou p Pruden t Technologie s Excavatio n Genera l 

# i(UiaJ ( 'o"l " Ye s N o 1 .Ifnecessary , wer e the correct quadrant(s ) excavatedan drestored ? l / 2 .If necessary , wer e th e correct area s of drip zone excavatedan drestored ? 

# ii V Gradin g Sodan dVegetatio n Ye s N o 1 .Doe s the grading aroun dthe perimete r ofth e hous e i n excavatedarea s generall y slop e awa y ^ fromth e house ? ^ 2 .

Has sodbee n laidi n all area s tha t wer e excavated ? 3 .

Doe s the sodappea r to b e generall y health y an dgrowing ? (Onl y evaluat e if inspecteda t a3 0 

### y da

y tim e period) 4 .Ar e sodde darea s generall y firman devenl y graded ? ^ 5 .

Ar e the joint s betwee n the sodstrip s generall y tight ? (Onl y evaluat e i f inspecteda t a3 0 da y tim e period) IX ' 6 .Wa s the propert y gradedsuc h tha t wate r will no t poo l on th e property ? y ^ 7 .

Was damage to landscapm g o r plan t material s avoided ? 

### y " Gates , Fence s an dRetainin g Wall s Ye s N o \ . D o gate s ope n an dclos e freely? (If applicable ) 2 .

Wer e all gate s or fence s taken dow n durin g restoration activitie s reinstalled ? (If applicable ) 3 .

Wa s damage t o gate s o r fence s avoided ? (I f applicable ) # 4 .

Wa s damage t o retaining wall s avoided ? (I f applicable) Foundation , Sidin g an dGutter s Ye s N o 1 .

Wa s damage t o the siding o r trimavoided ? 2 .

Was damage t o the foundation avoided ? 

# r ^ \[fiC/i ^ 3 .

Wa s damage to window s avoided ? 

# k 4 .

Wa s damage t o window s o r doo r screen s avoided ? 5 .

Wa s damage t o downspouts o r downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ye s No 1 . Wa s damage t o drivewa y surfece s avoided ? . y 2 . Was damage to walkwa y surface s avoided ? 

### y

### Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complet e including th e 30-da y sodwarranty : EP A Representative^;^^I<iC^gl.<;j:^^g^^UL; ^ Date : /^/y/d ?

## Propert yCompletio n Agreemen t Thi s agreemen t documents th e completion of remova l activitie s performedo n th e below liste dproperty . The propert y owner' s signatur e indicate s tha t th e propert y owne r i s satisfiedwit h th e restoratio n ofth e subject property , an dtha t n o item s ar e i n question , now , or a

t an y tim e i n th e future , excluding an y remaining warrant y (3 0 day s total ) except thos e item s listedbelow , if any . Propert y ID : Propert y Address : 2 S.!" ^ K J ^8H ^ 

# & 

# A^^^ Owner : Phone : Restoratio n Item s I n Question :

Item : 

### Item : Item : Item : 

### Item : Item :

L J I agre e restoratio n i s completed , excep t a s note d above . JZ I I d o no t agre e restoratio n i s complete d /Z^^txL-* —-^LilA j . ^ J 

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- 3-^. P )wner' s Signatur e j Dat ePruden t Technologies , Inc . (Prudent ) i s unde r contrac t wit hth e U . S . Environmenta l Protectio nAgenc y (EPA ) t o clea nu p lead

contaminate dsoil s a t anuinbe c o f pronertie s locate di nOmaha , Nebraska , includin g th e propert y locate da t ,P^\ 3 ^ *2-S'* ^ Sr T Th e EP A request s you r permissio n t o allo w Pniden t t o perfoi masoi l cleanu p a t thi s propert y t o remov e lead-contaminate dsoil . B y signin g thi s ftwm, th e propert y owne r grant s pennissio nt o Pruden t t o perfor m activitie s relate dt o th e cleanu p includin g soi l sampling , remova l oflead-contaminate dsoil , an drestoratio nofth e reference dproperty . I f

yo u hav e an y question s abou t th e soi l cleanu p planne dfo r you r property , pleas e contac t Prudent' s Administrativ e Cler k forth e Omah aLea dSit e cleanup . Ms . Madhurim aPu m-a t (402 ) 733-1188 , 733-1455 . Genera l question s abou t th e Omah aLea dSit e cleanu p ca nb e directe dt o th e EP A Publi c Informatio nCenter s a t (402 ) 731-304 5 (SouthOmah aoffice ) o r (402 ) 991-958 3 O^ort h Omah aoffice) . Propert y Acces s Grante d I * / ' (Pleas e Prin t Name ) y Propert y Owne r Signature : / / / (Signature ) X (Date ) PROPERT Y INFORMATIO N (T o b e complete d b yresiden t and/o rpropert yowne r~ pleas e print ) RESIDEN T NAIME : VcXf^. U \r^\ ^ Owne r Rente r RESIDEN T ADDRESS : • Q •g» ^ A w C3>u>-JL. ^ 

## U g C a \ \ o I F RENTAL , PROPERT Y OWNED BY :

OWNER' S MAILIN G ADDRESS ;

OWNER' S TELEPHON E NUMBE R - HOME : J \_ WORK :



### i>\t^ i Mq i -(<^9n i AG E O F HOME? : 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 7 YE S N O NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : NUMBE R O F OCCUPANT S 7 YEAR S OL O AN O OLDE R NUMBE R O F CHILDRENUNDE R 7 YEAR S OL D WH O PLA Y I NTH 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 Y GATES , ETC. )

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

acces s t o th e propert y i s provide dfor i nSectio n104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entr y fo r "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 5 250 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 , T X 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

### I- OMAH A LEADiSJJPEREUN D SIT K t t OLSH : 2962 7 Dat e Excavated : 9/25/200 8 Dat e USEP A SigDed-Off : 

### 2962' / Omah a Lea d Sit e Exterio rPain t Nort h Arrm v Sit e Sk«tc h • Goo d D Poo r Swiplln g Addrass : 2813N2BAV Q'No t paint Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm:?EX/> ^ OftT k RYASCPXA-2962 7 F 1 

### (7 8 pp m 

### D Date : Ul-inio A RYBSCPXA-2962 7 F 2 

### I S 3 pp m 

### D Time : 2'MSn ^ RYCSCPXA-2982 7 B 1 

### Ifel* ^ pp m 

### D Sample s Analyze d RYDSCPXA-2962 7 B 2 

### 20 ^ pp m 

## n nDgoopjw-aoea?—ee - pp m 

## o XR F Unit : (iSH O Book : 2o a noZ0OrKA-iM02 7 62 - pp m 

## a D Date: _ 

### "i-f4>-o a fyzsopx A aoaa?—PZ - .pp m 

### D Time : 

### D 

## .M . Staff : Numbe ro f Sample s = | L { | | Q | 

### nsu / Legend : F 1 = Fron t Left , F2 = Fron t Right , B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Ori p Zone , G Z = Garden , P Z = Play Al l quadranl s ar e a

s vletM d ftom tfie street , fadn g propert y B 1 = 133PPM@6 " y ^ 

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# n-z^.^v....: . iUv2a(«. N Cmed'Zti-l-cfc-O S 04470 1 0U. 1 N O EASEMEN T CONTRAC T # : E P - R7-07-0 6 / 000 4 PRUDEN T TECHNOLOGIES , IN C

### ECHNOLOGIES , INC . — 

# Propert y Statu s For m Address : jis\ 3 K) 2^%V W^i ^ ^^^^ = Phone : BVID : Plant s & Permanen t Landscapin g Item # QnMap Description an dLocatio n

Pre-Existin g Conditio n of Structure s DoesyourBasementhaveahistor y of leaking ? Ye s — No Iteni # Description & Locatio n QnMap

vne r r

\ Signatur e Signature : ropert y Owne Pruden t Employee 

# Yy ^ ^-^^^L ^ 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 , MO 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 7ENVIRONMENTA L & CONSTRLCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

### Ms . Joyc e Mccreary 09/10/200 8 281 3 N 28 * A v QmahaN E 6811 0 Regardin g th e Property a t 281 3 N 28** ^ Av , w e ar e requestin g you r signatur e o n th e Enclose dacces s agreemen t for remediatio n actio n for lea dcontaminatio n i n th e soil . Thi s woul dallo w Pruden t Technologie s t o remov e th e contaminate dsoi l the n replac e i t with clea n teste dsoi l an dne w sod . Th e proces s wil l b e complete dat n o charg e t o th e propert y owner . Th e so dwil l b e watere dfor thirt y day s the n responsibility fall s t o th e owner . Al l quadrant s o f thi s propert y teste dhig h for lea dlevels .

Sincere : Ram
402

ENCLOSUR E 1 . Acces s Agreemen t 2 . Property Statu s Form

808 0 War dParkway , 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 , T X 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

# 1962 1 Omah a Lea d Sit e 

## Sit e Sketc h Samplin g Address : 2813N28AV Sampl e Numbe r RYASCPXA-2962 7 RYBSCPXA-2962 7 RYCSCPXA-2962 7 RYDSCPXA-2962 7 RDZOOPX A 2062 7 RQZOCPXA-2062 7 RPZOOPX A 2062 7 Lea d Sampl e LA B Concentratio n Collecte d F 1 

## D 1 7 9 Do m F2 

## D B 1 

## D pp m 8 2 

# n BZ - 

## D D GZ - 

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## n D Numbe ro f Sample s = | l \ j { Q ] Exterio rPain t NorthArro w 

## • Goo d • Poor Q'No t pain t Sample s Collecte d 

### Date : lfl2RlQr i Time : 2. ^

M S P M Sample s Analyze d XR F Unit : (nS^ O Book : Z0 &

Date : _ Time : 

## JEd L Staff : 

# n s w Legend : F l = Fron t Left , F 2 = Fron t Right , B 1 = Bac k Left , B 2 s Bac k Righ t D Z = Dri p Zone . G Z = Garden , P Z = Pla y Al l quadrant s ar e as viewe d from th e street , fedng piopert y 

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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 075507000 0 IVICCREAR Y JOYC E 281 3 N2 8 A V OMAH A 6811 1

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http://webapps.dotcx>mm.org:8080/TreasTax/faces/pages/taxinfo.jsp ? parc=075507000 0 http.7/douglasne.mapplng online.com/DouglasCoNe/static/accountinfo.jsp ? accountno=R075507000 0 Disclaime rMa p an d parce l dat a are believe d t o b e accurate , bu t accurac yI s no t Ma p Scal e guaranteed . Thi s i s not a lega l documen t an d shoul d no t b e substitute d fo ra titl e search , 1 inc h = 7 4 fee t appraisal , survey , o rfo rzonin g verification . 

### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s Coimty-.. . 9/9/200 8