SAID# : 2905 2 

### TRANSMITTA L OF OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R DATE : 1/1 5 ADDRESS : 253 0 N 14 ST REMEDIATIO N CONTRACTOR : PRUDEN TTECHNOLOGIES . INC . YEAR : 201 ^ 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S [ /

PR E AN D POS T VIDE O OF PORPERT Y(DVD ) ( /

EXECUTIV E SUMMAR Y 0 ^ EPA-PROVIDE D PROPERT YSKETC H 13 SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN TPROPERT Y iz f RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E OR TO REPLAC E PLANTS , ETC. ) Cl CONFIRMATIO N DAT A Ef PHOTOGRAPH S Q AS-BUIL TSKETCH Q SATISFACTOR YRESTORATIO N SIGNE D BYPROPERT YOWNE R EJ PROPERT YCLOSE-OU TCHECKLIS TSIGNE D BYEP A n DESCRIPTIO NOF AREA S NO TMEETIN G RO D CLEANU P CRITERI A [^

UTILIT YCLEARANCE S [ /

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

## y Al^Al. . ihilj L ,p3R SIGNAIIdR E DAT E 3021758 1 

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### PROPERT Y SUMMAR Y Date : /15/201 0 Omah aLeadSite Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l Monthof : Propert y Address ; 253 0 N 1 4 S T A . EXECUTIVESUMMAR 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 = 6 4 PP M @ 13" ; N O EASEMENT ATTACHMENT S 1 ) Propert y sketchprovidedb y EP A pursuan t to contract specification s 2 ) SignedAcces s Agreemen t including acces s agreements requiredfo r crossing othe r propertie s 3 ) Pre-Excavation digita l vide o clip/photograph s 4 ) Post-Excavation digita l video clip/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Buil t sketch
i ) Shal l includ e fina l lea dlevel s v ) Legen d ii ) Contamination lef l behindarea s vi ) Contracto r identification iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r items to b e includedi n the individua l propert y file , ifavailable , o r obtainedinclude : i ) Pre-excavation agreemen t detail s (ifan y ar e mad e wit hthe 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(FlashPlayer ) forma t and/o r photograph s iv) Signedfor mverifyin g satisfactor y restoration v ) Description ofarea s not meeting InterimRO D cleanu p criteria .

TECHNOLOGIES . INC .Fin d Recor d 'i Baclcfill :



### Sampl e Area : 2905 2 - 253 0 N 1 4 S T Owner : D Owne rOccupie d Owne rName : JPSCHENIC AFRAN Z Owne rAddressi : Owne rAddress2 : 1140 7 SHERWOO D AV E City : State : Zi p Code : JOMAHA jiyi E J68110 - Owne rPhon e Alternat e Phone : 

# r j(402 ) 203^588 0

Contract : contractor : PRUDENT201 0 S Contrac t Optio n OPTIO N 2 Remediatio n Query Lea d Remainin g Query Propert yDamag e Query

Use rProvide d Owne rInformatio n Owne rName : JFRANZ PSCHENIC A Owne rAddress : il40 7 SHERWOO D AV E Cjty : state : Zi p Code : loMAIH A ^ JN E (68110 - Owne rPhone : Altemat e Phone : 

# r 1

Assessment : Qualifyin g Grou p ^40 0 Assessmen t Ma xXR F Valu e 

### 47 7 Resident : Residen t Name : Propert yAddress : 3253 0 N 1 4 S T Zi p Code : J68110 - Residen t Phon eTECHNOLOGIES , liNC : 

# EP A Propert y Clos e Ou t Property# : TAO<oA ^ Propert y Address : 'TA ) 3* 6 /\ ) I ^^ . Date/Time ; Owner' s Name : FTOLAV
- 9SCVQUV;.QC\ Quad s Excavated : ^ ^ Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s N o 1 .I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? / 2 .If necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? Gradin g So dan dVegetatio nYe s No I .Doe s th e gradin g aroun dth e perimete r o f th e hous e i n excavaie darea s generall y slop e awa y fro mth e liouse ? / 2 .Ha s so dbee n lai di n al l area s tha t wer e excavated ? / 3 .Doe s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 day tim e period ) / 4 .Ar e sodde darea s generall y fimi an devenl y graded ? / 5 .Arc th e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e if inspecte da t a3 0 day tim e penod ) 

# y 6 .Wa s th e property grade dsuc htliat wate r will no t poo l o n tli e property ? / 7 .

Wii s damag e t o landscapin g or plan t material s avoided ? / Gates , Fence s an dRetainin g Wall sYe s N o 1 .D o gale s ope n an dclos e freely ? (I f applicable ) 

# y 2 .Were al l gate s or fence s take n dow n diuin g restoratio n activitie s reinstalled ? (I f applicable ) 

# y 3 .

Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) 

# y 4 .Wa s damag e t o retainin g wall s avoided ? (I f applicable ) / Foundation , Sidin g an dGutter sYe s N o 1 . Wa s damag e t o tli e sidin g o r tri mavoided ? / 2 .Wa s damag e t o th e foundatio n avoided ? 

# y 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 ? 

# y 5 . Wa s damag e t o downspout s o r downspou t extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Ye s N o I Wa s damag e t o diivewa v surface s avoided ? 

### / 2 . Wa s damag e t o walkwa y surface s avoided ? 

# 7 ^

## Owner s comments :

Inspectio n motes :

Remova l andrestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e S ^ ^^ ^ ^Date: ^lbl't >

# ra C'HNOLOUIES . INC . 

### A S - BUIL T DRAWIN G OL S #2905 2 Dat e Excavated : 10/21/201 0 

### OMAH A LEA D SUPERFUN D SIT E liSEPASigned-OffDate : 

### 2905 2 Omah a Lea d Sit e Exterio rPain t Sit e Sketc h • Goo d • Poo r Samplin g Address : 253 0 N 1 4 S T U^ " No t paint Lea d Sampl e Sample s Collected Sampl e Numbe r LA B Concentratio n Collected 

### Firm : -VBTN C 0X'*^ W RYASCPXA-2905 2 F 1 ^Q- ^ pp m D Date : 5-/^-Z0/ 0 RYBSCPXA-2905 2 F2 -i I ^ pp m D Time : IZ'Zol'.yi - RYCSCPXA-2905 2 B 1 Mi l pp m E T D Sample s Analyze d RYDSCPXA-2905 2 B 2 _333_pp m D nDZSCPX A2005 2 B S

- pp m D D XR F Unil : [QBCoL i Book : 2AD£i . nogGcrxA-20002—sa ­ ~ pp m D D Date : 

### ro-oH-i o nPZeCPX A2005 2 PS - D ~ pp m D Time : 

## M L Staff : M9 W Numbe rof Sample s = [ ^ | | Q [ Legend : F 1 = Fron t Left , F 2 • Fron t Right , B 1 = Bac k Left , B2 = Bac k Righ t DZ = Dri p Zone , G Z = Garden , PZ = Play Al l quadrant s ar e a s viewe d fro m th e street , facin g propert y 

## EKTTEnE D MAY l 9 2010 :

B l =6 4 PPM ® 13 " 

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# i 4 ;S T Re v :iKI S Crealfd : U,'-M.ny-0 8 N O EASEMEN T CONTRAC T # : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC .

### I 

## Propert yCompietio n Agreemen t Thi s agreemen t document s th e completio n 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 dvv-it hth 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 any remaining warrant y (3 0 day s total ) excep t thos e item s liste dbelow , ifany . 1 Propert y ID :

Property Address : <* * '<: ^ ' ^ Q 

## l O V H ^ 

## Pc^. ^ Owner : ^^^^^ ^ Phone : ^, ^ _^^, ^ Restoratio o Item s in Question :



### 1 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

DatePniden t Technologies , Inc . (Prudent ) i s unde r contrac t withth e U . S . Environmenta l Protectio n Agenc y (EPA ) t o clean u p lead
contaminate dsoil s a t anuirJje r o f

propertie s locate di n Omaha , Nebraska , includin g th e propert y locate dat f ^ y ? p Mf f ft l y y Th e EP A request s you r permissio n t o allo w Pruden t t o performasoi l cleanu p a t thi s property t o remo ^ lea'd-cohtamiiute dsoil . B y signin g thi s form , th e property owne r grant s permissio n t o Pruden t t o perform activitie s relate dt o th e cleanu p includin g soi l samphng , remova l 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 dfo r you r property , pleas e contac t Pruden t southoffic e for th e Omah aLea d Site cleanup-a t (402 ) 733-1188 . Genera l question s abou t th e Omah aLea dSit e cleanu p ca n b e directe dt o th e EP A Publi c Informatio n Center s a l (402 ) 731-304 5 (Sout hOmah aoffice ) o r (402 ) 991-958 3 (NorthOmah aoffice) . Property Acces s Grante dB y Property Owne r Signaturl 

## fi>'l9'/t > (Signature ) (Date ) PROPERT Y INFORMATIO N (TA , e complete db y residen t and/o r propert y owne r — pleas e print ) RESIDEN TNAIVIE : 

# \ 4 CjLCjgu^i-i r Q ^ Rente r RESIDEN TADDRESS : 

# M l^ii^ v ^1 ^ <^^A7^l a\A\ G6 ? ( ( 0 I F RENTAL , PROPERT YOWNEDB Y

^CCKA~ ^ g^AA. , i C-CK _ OWNER' S MAILIN G ADDRESS ; OWNER' S TELEPHON E NUMBE R - HOME : J_ WORK : 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 ? 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 D AN D OLDE R NUMBE R O F CHILDRE NUNDER 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 , ENTRY GATES . ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s t o b e implemente db y EP A unde r this agreemen t are pursuantt o Sectio n 10 4 o f CERCLA , 4 2 U S.C ; 9604 . EPA'srigh t o f

acces s t o th e propert y i s provide dfor i n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry for 'determinin g th e nee dfor response , or choosin g or takin g an y respons e actio n under tlii 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 S 1 0 S t 424 2 Medica l Drive . Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a S610 7 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402 ) 733-118 8 Phone : (210)822-958 8 Fax : (816)363-370 7 Fai : (402 ) 733-188 3 Fax:(210)679-667 7ENVIRONMENTA L& CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : Phone :

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808 0 War d Paflcway , Su H 560 0 3 1 0 S 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 , 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

# 2905 2 Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e • Goo d 

### Sit e Sketc h • Poo r Samolin a Address : 2530 N 1 4 S T 0 * No t pain t Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Ck>ncentratio n Collecte d 

### Firm : TBTN C DX^-^ ^ RYASCPXA-2905 2 F 1 

### 3Q ^

pp m 

## E f 

## D Date : B'tS-ZDl Q RYBSCPXA-2905 2 F 2 

## —3_L3_pp m E f 

## D Time : /2'2o'^-H - RYCSCPXA-2905 2 B 1 

## _H2n__pp" i E T 

## D Sample s Analyze d RYDSCPXA-2a)5 2 8 2 

## _333_pp" i E T 

## D nOZCCPX A2005 2 B2 > - pp m 

# n D XR F Unit : \Of^o/ cBook : 2/flf t RGEOCPX A2000 2 6 * pp m 

## D D Date : A o - O H - I O nPZCCPX A2005 2 PiS- pp m 

# n D Time : A M 

### Staff : M8Vi / Numbe ro f Sample s = [ ^

| | Q { Legend : F l = 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 viewe d fro m th e street , facin g propert y 

## MAY l 9 2010 :

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# m H 1 4 ST Re v J00 8 Created : O.l-Mny-Oi l 04470 1 ,01.2. ^

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# 'W m Printed : De c 08 . 201 0 www.dcgis.org/dogi s 

# APag e 1 of 2 " > Creat e Anothe rTicke t Bac k t o Irt h Interne t Sen d Emai l
YOU RTICKE T NUMBERI S 2620496 . Origina l Cal l Date : 10/19/1 0 Time : 9:0 7 a m Op : SIVA1896 7 Wor k t o Begi n Date : 10/21/1 0 Time : 9:3 0 a m State : N E County : DOUGLA S Place : OMAH A Address : 253 0 Street : N14T H S T Twp : 15 NRng : 13 E Sect-Qtr : 10-SE-S W 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 : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MCINE B MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac t Phon e Nunibe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEIDI Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MCINE B MC I NO CAL L PE R MEM O Day : 800289342 7 Alt : Emerg : 8002893427 MUDO l METROPOLITA N UTILITIES DISTRICT SAND Y Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRICH/TRAFFI C Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0

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## Pag e 2 of 2

0PPDGPR5 OMAH A PUBLI C POWE RDISTRICT EL M LOCATIN G 

## Day : 406728934 3

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=<RESULT.. . 10/19/201 0

### SOLUTION S 

## ITT E SAFfeT Y HAZAR D ANALYSI S 

# A ) 1 ^ <S ^ Addres s 

# ; 262> D Excavatio n Date : 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 Structure s Drivewa y Sprinkle r Syste m Othe r Cre w Forema n Conditio n Hazard s Correctiv e Actio n ^ ^ 

### f ^ ^ ^ ' 

# { p

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# oi ^ a/ ^

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## ^ca ^ &^< ^ A T ^ 

## a^ —

Sit e Safety Offic e Date :

5G0 0 8108t 424 2 Medica l Drive , Stdt o 726 0 nflwCVr/MO^II ^ OiiUUM f WehfjitlM 68 m Ptwiw : {402)733-118 8 Sa n Afltenio.T X 7822 9 Phone : (2tO ) 82Z-«688 Fax : (4a2)73»d88 3 Fax : f21« ) 6T9-667 7

# B l Z' ^ ZOI O