### TRANSMITTA Lo f OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : I t 2-2 ^ 3 Date : l2^}X'i^)->>o g Address : 4-r/ 7 S, Z( f

I ^ Remediatio n Contractor : rv,.,^^ ^ TL/t^tf/ayl . ,.^C v Year : 2J>O ? 

# T SOI L REMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S [ /

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r EPA-provide dpropert y sketc h 0 Signe dAcces s Agreemen t fo r subjec t propert y D Signe dAcces s Agreement(s ) for . adjacen t propert y 0 ; Restoratio n Agreemen t D Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) 

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As-built sketch 0 Satisfactor y restoratio n signedby Propert y Owne r [ 3 Propert y close-out chec k

lis t signedby EP A D Descriptio n of area s not meeting ROD cleanu p criteri a % Utilit y clearance s 0 Propert y infoimatio n firomDougla s Count y Assessor' s Office 

## a 4030955 6 

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### PROPERT Y SUMMAR Y Date : 12/20/200 8 Omah aLea dSite Remedia l Actio n Contrac t #EP-R7-07-06/0004 Monti i of : Nov/De c Propert y Address : 451 7 S 3 4 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 Ofte r Relevan t Information : ARE A NO T EXCAVATE D G Z BRICK S 5'X5 ' @ 30 3 PP M CONFIRMATIO N SAMPLIN G DATA/RESULTS : G Z = 2 7 PP M @ 12" ; E A = 15 0 PP M @ SCRAPE ATTACHMENT S 1 ) Propert y sketchprovide dby EP A pursuan t t o contract specification s 2 ) SignedAcces s Agreemen t including acces s agreement s requiredfo r crossing othe r propertie s 3 ) Pre-Excavatio adigita 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 include final lea dlevel s v ) Legend ii ) Contamination lef t behindarea s vi ) Contracto r identification iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s to b e include din th e individua l propert y file, i f available , or obtaine dinclude : i ) Pre-excavatio n agreemen t detail s (i f an y ar e made wit h th 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 ) o r SW F(Flas h Player ) forma t and/or photograph s iv ) Signedfor mverifying satisfactor y restoratio n v ) Descriptio n o f area s no t meeting InterimROD cleanu p criteria .

TECHNOLOGIES , INC .Fin d Record I Bacicfill :

Sampl e Area : 1022 3 - 451 7 S 3 4 S T Owner : n Owne rOccupie d Owne rName : I PINT O EFRAI N L Owne rAddressl : 

# r Owne rAddress2 : |451 7 S 3 4 S T City : State : Zi p Code : |OMAH A [N E [6810 7 Owne rPhone : Alternat e Phone : [(402 ) 733-827 6 

# I ' 

# '. " Clea n U p Query Lea d Remainin g QueryI

Resident : Residen t Name : PINT O EFRAI N L Propert yAddress : [451 7 5 3 4 S T Zi p Code : [6810 7 Residen t Phon e Propert yDamag e Quer/

Contract : Contractor : PRUDENT2008_ S Group : Assessment : Qualifyin g Grou p I PLA Y ZON E Assessment XRF Date : 

# I Assessment Ma xXRF Value : I 619.1 8TECHNOLOGIES . INC . 

# ^BV < EP A Propert y Clos e Ou t Property* : jDliT , Propert y Address : ^-^V 1 S ')> U S, ^ Date/Time : Owner' s Name : Quad s Excavated : (yi ^ Contracto r Grou p Pruden t Technologie s Excavatio n Genera l Ye s N o 1 .I f necessary , wer e th e correct quadrant(s ) excavatedan drestored ? / 2 .Ifnecessary , wer e the correct area s ofdri p zone excavatedan drestored ? 

# y Gradin g Sodan dVegetatio n Ye s No 1 .Doe s th e grading aroun dth e perimete r of the hous e i n excavatedarea s generall y slop e awa y fromth e house ? 

# y 2 .

Ha s so dbee n laidi n all area s tha t wer e excavated ? 

# y 3 .

Doe s th e sodappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i

f inspecteda t a3 0 

# y da

y tim e period) 4 .Ar e soddedarea s generall y fir man devenl y graded ? 

# y 5 .Ar e th e joint s betwee n th e sodstrip s generall y tight ? (Onl y evaluat e if inspecteda t a3 0 da y tim e period) 

# y 6 .

Was th e propert y gradedsuc htha t wate r wil l not pool o n the property ? / 7 .

Wa s damag e t o landscaping or plan t material s avoided ? 

# y Gates , Fence s an dRetainin g Wal b Ye s No 1 .

D o gate s ope n an dclos e freely? (IfappUcable) 

# y 2 .Wer e all gate s o r fence s taken dow n during restoration activitie s reinstalled ? (If applicable ) 

# y 3 .

Wa s damage t o gate s or fence s avoided ? (IfappUcable) 

# y 4 .Wa s damage t o retaining wall s avoided ? (IfappUcable) / Foundation , Sidin g an dGutter s Ye s No 1 . Wa s damage t o the siding o r trimavoided ? 

# y 2 . Wa s damag e t o th e foundation avoided ? 

# y 3 . Was damage t o window s avoided ? 

# y 4 . Was damag e t o window s or doo r screen s avoided ? 

# y S . Wa s damag e t o downspouts or downspou t extension s avoided ? 

# y Sidewaiii s an dDriveway s (Concrete ) Ye s No 1 . Wa s damage t o drivewa y surface s avoided ? 

# y 2 . Was damage t o 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 so dwarranty : EP A Representativ e ><?r. ^ y^ ^ Date : /W//^ ^

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completion o f remova l activitie s performe do n th e belo w liste dproperty . Th e property owner' s signatur e indicate s tha t th e property owne r i s satisfie dwithth e restoratio n ofth e subjec t property , an dtha t n o item s ar e i n question , now , o r a t an y tim e 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 , i f any . Propert y ID : Propert y Address : 

# K 5 0 ^ 

# -^ M S U Owner : Phone : Restoratio n Item s i n Question :

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

LJ 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 i s complete d 

# //^/^i ^ DatePruden t Technologies , Inc . (Prudent ) i s unde r contrac t wit h th e U . S . Environmental Protectio n Agenc y (EPA ) t o clean up lead
contaminate dsoil s a t anumbe r o f

propertie s locate di n Omaha , Nebraska , includin g th e property locate da t

. Th e EPA request s you r pennissio 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 pennissio 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 n ofth e reference dproperty . I f

yo 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 Administrativ e Cler k for th e Omah aLeadSite cleanup . Ms . Dcboralt Johnso n -a t (402 ) 733-1188 . General question s abou t th e Omah aLeadSit e cleanu p can b e directe dt o th e EP A Publi c Inforrnatiop.^enter s a t (402 ) 731-304 5 (Soutl j Omah aoffice ) o r (402 ) 991-9583 (Nort h Omah aoffice) . Property Acces s Grante dBy . ^ Property Owne r Signature : (Date ) PROPERT Y INFORMATIO N (T o be complete d byresiden t and/o rpropert yowne r~ pleas e print ) RESIDEN T NAME : Owne r Rente r RESIDEN T ADDRESS :

I F RENTAL , PROPERT Y OWHE p BY :
OWNER' S MAILIN G ADDRESS ; A
OWNER' S TELEPHON E NUMBE R - HOME : J . _L WORK :
AG E O F HOME? : ICA Q ^4 ^ 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 ? YE6 — N O =* fiSt c D • ^ NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : ( I NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLA Y I 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 Y GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA L RESPONS E ACTIONS : Th e activitie s t o b e implemente db y EPA unde r this agreemen t ar e pursuan t t o Sectio n 10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t 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 960S(e) , whic hprovide s entry for "determinin g th e nee dfo r response , o r choosin g o r takin g an y 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 , 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

### AS - BUIL T DRAWIN G ^ OLS# : 1022 3 Dat e Excavated : 10/10/200 8 USEP A Signed-Of f Date : 

### OMAHA LEAD SUPERFUN D SITE 

## 102.2 3
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CONTRA a #: EP - R7-07-0 6 / 000 4 PRUDEN T TECHNOLOGIES , INC .ENVIRONMENTA L & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# r Propert y Statu s For m Address : MS\ T 5 ^ ^ s\ ^ Date : Phone : BVID : 

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Propert y Owne r Pruden t Employee Signature : Signature : 808 0 War d Parkway , Suit e 40 5 2505 N . 24' " Street , Suit e 30 8 I 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 Fax : (816 ) 363-370 7 Phone : (402)504-100 4 Fax : (402)504-100 5 'Phone : (210)822-958 8 Fax:(210)579-657 7

## 102LZ 3 Samplin g Address : 4SI" 7 S SM * .S- f Omah a Lea d Sit e Sit e Sketc h Exterio rPain t [3

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## D Time : 2.13M - p m RYCSCPXA-JOZZ 3 B l 4 S pp m 

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## D Time : 811 5 d m Staff : PA J Numbe rQ f Samples = 7 Legend : F 1 = Fron t Left , F 2 = Fron t Right , B l = Bac k Left , B 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 vywe d fjo m th e street , facing propert yi • t g - y

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### • YOU RTICKE T NUMBE RI S 2147123 . Origina l Cal l Date : 10/03/0 8 Wor k t o Begi n Date : 10/07/0 8 Time : 10:2 6 a m Time : 11:0 0 a m Op : RAMITA1896 7 State : N E Address : 451 7 County : DOUGLA S Street : S 34T H S T Place : OMAH A Twp : 14 NRng : 13 E Sect-Qtr : 04-NW Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n projec t fo r soi l 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 : RAMIT A Phone : (402)733-145 5 Alt . Contact : 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 : Y Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V METR O MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F QWEST 2 Servic e Are aContac t Phon e Numbe r utilit y Typ e 

### Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I AU : 402934046 9 

### Emerg : 402932975 7 Day : 4024572307 METR O METR O COMM . COLLEG E CHRI S Alt : 402672703 3 

### Emerg : 402457231 3 Day : 402504782 3 MUD0 2 METROPOLITA N UTILITIE S DISTRIC T SAND Y Alt : 

### Emerg : 402504794 6 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R 

### RO N Ah : 402444516 1 Emerg : 402444516 0 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 10/3/200 8

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OPPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T N A 

### Day : Alt : 406728934 3 888728934 3 Emerg : 406728934 3 QLNN E I FQWES T LOCA LNETWOR K N A 

### Day : 406728934 3 Ah : 

### Emerg : 888728934 3 QWEST 2 QWES T LON GDISTANC E 

### SAR A Day : 800283423 7

Ah : 303992192 6 Emerg : 800283423 7

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