### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL E FOLDE R SAI D # : ^nn^ ^ Date : /0/ft/2^t o Address : (^^OS , J l SJ " • Remediatio n Contractor ; Rl?f,rypn' J T^r ^ NOCOC, 

### t^ q. ^ /r ^ y Year : '^lO ^ SOI LREMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S B ^ Vide o o f propert y (DVD ) ^ ^ i Pc > 'g,V
B ' Executiv e Svimmar y "S / EPA-provide dpropert y sketch C / Signe dAcces s Agreemen t fo r

subject propert y D Signe dAcces s Agreement(s ) fo r

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

damag e o r

t o replac e plants , etc. ) S

r

Confinnatio n data ^ Photograph s •B ^ As-built sketc h l y Satisfector y restoratio n signedby Propert y Owne r B ^ Propert y close-out check lis t signedby EP A S / Descriptio n o f area s no t meeting ROD cleanu p criteri a w Utilit y clearance s M Propert y mformation firomDougla s Count y Assessor' s Office D D 

# 4 4 :i itur e VH\\Oat e 3026241 3 

# • lUmiMM I Superfun d

### - ' PROPERT Y SUMMAR Y ' <^^f>o/>g ^ Date ; If t 7i^f[ ^ I Omah aLead-Site Remedial Actio n Contrac t #EP-R7-10-0 S | Monthof : SfepliBwiier . Propert y Address ; 1340 S 2 7 ST . A . EXECUTIV E SUMMAR Y A. 1 Issue s Encountered : NON E \ 

### A J Issue s Resolved: . NON E A 3Uniqu e Findings : NON E A. 4Othe r Relevan t Information : CONTAMINATIO N LEF T BEHIN D B Y PO' S REQUES T 3 ' x 3 ' DZ/L S 57 0 PP M @ SCRAPE . CONFIRMATIO N SAMPLIN GDATA/RESULTS : B l = 19 8 PP M @ 9" , B 2 = 21 7 PP M @ 9" , D Z = 8 0 PP M @ 9" , F 2 = 28 1 PP M @ 9" , EA = 19 8 PP M @ SCRAPE , ATTACHMENT S 1 ) Propert y sketchprovidedb y EP A pursuan t t o contrac t specification s 2 ) SignedAcces s Agreenien t including acces s agreement s requiredfo r crossin g othe r propertie s 3 ) Pre-Excavation 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 include fina l lea dlevel s v ) Legen d ii ) Contamination lef t behindarea s yi ) Contractor identification iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e includedi n th e individua l propert y file , if available , o r obtainedinclude : i ) Pre-excavation 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 ) o r SW F(FlashPlayer) forma t and/or photograph s iv ) Signedfor mverifying satisfactor y restoratio n v ) Descriptio n o f area s not meeting InterimROD cleanu p criteria .



### MH6i6t\tS i iHC .Rn d Record Remediatio n Quer yI Lea d Remainin g QueryI Properl yDamag e Query Bacicflii :

Sampl e Area : 2003 4 -134 0 S 2 7 S T Owner : Use rProvide d Owne rInfomiatio n Resident : n Owne rOccupie d Owne rName : Owne rName : Residen t Name : [JANSAHEID I D 

# 1 |JANSAHEID I D Owne rAddressl : Owne rAddress : 

# 1 Propert yAddress : |1340S27S T Owne rAddress2 : 1134 0 S 2 7 ST Zi p Code : |68105 ­ 

# m aty : |Oi^AH A State : |N E Zi p Code : |68105 ­ 

### aty : 

# 1 State : Zi p Code : 

# 1 1 Residen t Phon e 

# 1 Owne rPhone : Alternat e Phone : Owne rPhone : Alternat e Phone : |(402 ) 559-402 4 

# 1 1

Contract : Assessment : Contractor : jPRUDE|y|T_2010_ S Qualifyin g Grou p [40 0 Contrac t Optio n |BAS E Assessmen t l«la xXR F Value : | 463.1 1if \ 

# EP A [QLOGnSiINC . 

# EP A Propert y Clos e Ou t Propert y # : 7.00?' ^ Propert y Address : V 3 ^ ^ . Z 7 9*" ^

. . Date/Time : Owner' s Name : f- ) eTA * 1<>2 ^ > Quad s Excavated : p Z , P21 S • i ^ Z , Contractor Group ; Prudent Technologies , Inc. , Excavatio n Genera l Ye s N o 1 . Ifnecessary , wer e th e correc t quadrant(s ) excavate dandrestored ? 

# y 2 . If necessary , wer e th e correc t area s of dri p zone excavate dandrestored ? 

# y Gradin g Sodan dVegetatio n Ye s N o 1 . Doe s th e gradin g aroun dth e perimete r of th e hous e i n excavate darea s generally slop e awa y 

# y fro mth e house ? 2 . Ha s so dbeen lai di n al l area s tha t wer e excavated ? 

## y 3 . Doe s th e so dappea r t o b e generally health y an dgrowing ? (Onl y evaluate if inspecie da t a3 0 

# y da

y time period) 4 . Ar e soddedarea s generally firman devenl y graded ? 

# y 5 . Ar e th e joint s between th e sodstrip s generally tight ? (Onl y evaluate i f inspecte da t a3 0 da y / time period) 6 . Was th e propert y grade dsuchtha t wate r will no t poo l o n th e propeity ? 

# y 7 . Wa s damag e t o landscapin g o r plant material s avoided ? / Gates , Fence s an dRetainin g Wall s Ye s N o I . D o gate s open , an dclos e freely ? (Ifapplicable ) / 2 . Wer e all gate s or fences take n down durin g restoradon activitie s reinstalled ? (If applicable ) 

## y 3 . Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) 

# y 4 . Wa s damag e to retainin g wall s avoided ? (Ifapplicable ) 

# y Foundation , Sidin g an dGutter s > Ye s N o 1 . Was damag e to th e sidin g o r trimavoided ? / 2 . Wa s damag e t o th e foundatio n avoided ? / 3 . Wa s damag e t o window s avoided ? / ; 4 . Was damag e t o window s o r door screen s avoided ? / S . Wa s damag e to downspout s or 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 ? 

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

### Owne n comments :

-

I
- 

### Inspectio n notes :

' " .-^ ^

J \ /

1 / 

### Remova l an drestoratio n activate s complete includin g th e 30-da y so d-warranty : EPA Representativ e Date : aa n ^

# i m OTOUCDGIES , INC . 

### A S - BUIL T DRAININ G OL S #2003 4 Dat e Excavated : 08/10/201 0 

### OMAII A LEA D SUPERFUND SIT E USEP A Signed-Of r Date :
Name . AvigiW / fi, '\^i^y^a ^

Oinah a Lead Sit e Date : l/Z/fAc' } Nort h Arro w —i Address l fS*yo ^ Zy" * S T Sit e Sketc h Time : _£2 £ Phone : fetoZ:) Sg< ? -yg>2 ^ Team A^< . .X^^^^T/ p <f c ^

BVI D # ZLO^^ ^ XR F Code 5^^ ^ Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e A?Ye s ° N o n j ^ / j 4 %i , PP^ y^ZYe s n N o ^ /?/Ye s • N o H y/^Ye s n N o ^ 

# mills : ^ 2 . Ye s a N o C S Ye

s • No • Ye

s • N o •



## 117^ : r i OmahaLeadSit e 4613 0 EA = 19 8 PP M @ SCRAP E (-1" ) CONTRAC T # : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC .

# El ^ Propert yCompletio 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 propert y owner' s signatur e indicate s tha t th e propert y owner , i s satisfie dwiththi e restoratio n ofth e subjec t property , an dtha t n o item s ar e in.questioii j now , o r a t an y tim e i n th e future , excludin g an y remainiqg warrant y (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y ID : Propert y Address ; j 3 ^ g S ^ T ^ ^> — Owner : 

# i i sU L 

# E A - Phone : Restoratio n Hem s i n Question :

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

uyI agre e restoratio n i s completed . L J I d o no t agre e restoratio n i s complete d a t (note d deficiencie s above ) 

## ^ ^Q/^; ^ 

# 3 ^

^"H i T ^

hiii J Qiy^< ^ 

# Tn-/ o iwner' s Signatur e Dat ePnuUn t Tecfanologiei , lac . (Prudent ) i t unde r cootnc t wit h th e U . S . Envinmmenla l Protectio n Agenc y (EPA ) t o clea n u p lead
contuninBte dloil * a t anumbe r ofnopatie t locate di n Omaha , Nefanika , Indudin g th e propert y locate da t I'^^ O ^ S_" 7 ^r * Th e EP A request ayou r permiuio n t o allo w Pruden t t o perfor masoi l cleanu p a l thi s propert y t o remov e lead-oontaminate dtoil . B y ligiitngthi B firm, th e propert y owne r graitf a'pennisaio n t o Pruden t t o perfor m activitie B relate dt o th e cleanu p includin g soi l sampling , remova l o f lcad<ontaminate dsoil , an dreatcratio n ofth e refereace dproperty . Ifyo u hav e an y ciuestion s abou t th e soi l c\taaa p planne dfo r you r property , pleaa e coitac t Pruden t sout h offic e /o r th e Omah aLea d Sh e cleanup-a t (402 ) 733-1188 . Genera l queatioo aabou t th e Omah aLea dSit e cleanu p ca n b e directe dt o th e EP A Publi c Infonnalio n Centers.a t (402 ) 731-304 5 (Sout h Omah aofBce ) o r (402 ) 991-938 3 (Nort h Onuh aotRce) . Propert y Accea aGrante d J (Pleas e Prin t Name ) Propert y Owne r Signatura : (Signroe ) (Date ) PROPERT Y INFORMATIO N (T o b e completed bynMtp t and/o rIMIHICIIJ I oimc r~ pleaa e leawj^tf ) RESIDEN T NAME : _J^i:£.AAj L 

### %» • ^Owne r1 Rente r RESIDEN T ADDRESS : 

# <2n ^ ^r c:^t^^^X< K ^)- p (^%\ o 5 ; I F RENTAL , PROPERT Y OWNE D BY :
OWNER'SJ^MUN G ADDRESS ; i?0< ^ f OVmiER' S TELEPHON E NUMBE R - HOME : J L WORK :
AG E O F HOME? : \0- % YEARS . HO W LON O HAV E YO U LIVE D HERE 7 (L . HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WTT H SIDIN G SINC E 1978 ? 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 

# J _ , 9— 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 S HOUR S O R MOR E PE R WEEK : COMMENTS O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. )

AUTHORrr y FO RENVIRONMENTA LRESPONS EACTIONS : Ti e activitie s t o b e implemente db y EP A unde r thi s agreemeo 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

acce u t o th e propert y i s provide dfo r i n Sectio n 104(e)o f CERCLA , 4 2 U.S . C 9603(0 % whic h provide s entr y fo r "determinin g th e nee dfo r response , o r choosin g o r takin g an y respons e aclio n unde r thi atitle , o r otherwia e enforcin g th e provisico s o f th e title. " 8080 Ward Parkway , Suit e 40 5 560 0 S 1 0 S t 424 2 Medica l Drive , Suit e 426 0 Kansa s City , M O 6411 4 Omaha , Nebraska 6810 7 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)733-118 8 Phone : (210)822-958 8 Fax : 1816)363-370 7 Fax : (402)733-188 3 Fax : (210 ) 97»-«e77ENVmONMENTAL A CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : j^tf O 5 3 7/t ^

^S V ®*'* = ^/^£»/^ O f D BVID : Phone : MOX-2-^t) - ^'^^p* ? 'patrvtnvJn Q JQQU , 

# i i PZ 

# p^o ^ A^'j ^ 

# p'C b .-^f U Q g />£>tvJULL> ^ 

### j l ^ .g^-^ ^ >^ ^ 

# A . 

# P - o • L^f _ 

### C ^ 

# f O^l^l
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< ^ G-yU7f l fXy O J^TT m Q ^ 

# C ^ ' b^^^fl^ ^ 

# 2£i L ^ 

### Propert y Owne r Pruden t Employe e Signature : Signature : 8080 Ward Parkway , Suit e 40 6 560 0 S 1 0 S t rive, Suit e 425 0 Kansa s CKy , M O 6411 4 Omaha , Nebraska 6810 7 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)733-118 8 Phone : (210)822-968 8 f--.. . iJAA l V« « .4AA 4Name : rf^a J Omah a Lea d Sit e Date : 7/7^/^^ ^ Nort h Arro w— i Address l I'S'^ Q - S ^>><•^' ' ^ Sit e Sketc h Time : '^iP ^ 

# 5 T Phone : iVd^Z ; S?< ? -^c^^^ / Tea m '7^/i7>i . y^c^c* , y ? ^H ; BVID # ^O Q 'l ^ XR F Cod e ^^^^ ^ Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e 

# ^4 qf aI /7Ye s n N o ^ pp m 

### /^^Ye s n N o ^ 

# S pp m ^ / Ye s n No S y^ZYe s n No ^ ^XYe s n 

### No l a pp m Ye s • 

### No a pp m Ye s • 

### N o 

### n



# s . ^ 7 y / / .

### Pag e I of 1



# /3M Q s . a-T^S '

http://douglasne.mapping-online.coni/assessdoc/Photos/19/R12385200000001.jp g 6/11/201 0

### Prin t Preview Page 1 of 2 Dougla s County-Omaha , N E

Parce l I D Owne r Nam e Propert y Addres s City Zi p Owne r Addres s Owne r Addres s Owne r City Owne r Stat e Owne r Zi p Sec-Twn Rn g 123852000 0 JANS A HEID I D 134 0 8 2 7 S T OMAH A 6810 5
1340S2 7 S T OMAH A N E 6810 5 28-15-1 3 Additio n Bloc k Lo t Lega l 1 Lega l 2 Lega l 3 Lega l 4 Acre s Treasure r Websit e Lin k Assesso r Websit e Lin k HANSCO M PLAC E 1 4 1 0 N35F T 35X151. 7

0.1 2 http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp ? parc=123852000 0 http://dougiasne.mapping online.com/DouglasCoNe/static/accountinfo.jsp ? accountno=R123852000 0


### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 6/10/201 0

2

### Ticket Tex t andMa p displa y fo r

'"'-.ket : #255945 0 Pag e 1 of 2 

### Origina l Cal l Date ; 8/03/1 0 Time : 3:4 0 pm Op : SIVA1896 7 Wor k t o Begi n Date ; 8/05/1 0 Time : 4:1 5 pm State : N E County : DOUGLA S Place : OMAH A Address : 134 0 Street : S 27TH S T Twp : 15 NRng : 13 E Sect-Qtr : 28-NE 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 PROPERTY 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 Being Don e For : EPA Dept h o f Excavation : 6 FT Corne r Lot : NFront : Y ' Rear ; Involve s Tunnelin g o r Horizonta l Boring : NExplosives : N CXCAT V

LEVEL 3 MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F utilit y Servic e Are aContac t Phon e Nunibe r Typ e 

### Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEIDI 

### Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 LEVEL S LEVEL S COMMUNICATIONS , LL C N A 

### Alt : Emerg : 877366834 4 Day : 402504782 3 METROPOLITA N UTILITIES MUD0 2 SAND Y 

### Alt : DISTRICT 

### Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y OFOMAHA-TRAFFIC,SEWE RRICH/TRAFFI C Alt : 402444516 1 

## Emerg : 402444516 0 EL M 

### Day : 406728934 3 0PPDGPR 6 OMAH A PUBLI C POWE RDISTRICT LOCATIN G 

### Alt : 406207149 4 http://www.dhon.org/irthintemet/MessageText/MessageTextAndMap.asp?NoticeID=DH.. . 10/19/201 0

### Ticke t Tex t an dMa p displa y for Ticket : #255945 0 Pag e 2 of 2 

## Emerg : 888728934 3 QLNNEI FQWES T LOCA LNETWOR K EL M LOCATIN G 

## Day : 406728934 3 Alt : . 406207149 4 Emerg : 888728934 3

Vie wMa p Clos e Ma p



### http://www.dhon.org/irthintemet/MessageText/MessageTextAndMap.asp?NoticeID=DH. . . 10/19/201 0

### ENVIRONMENTAL ENGINEERIN GAN D CONSTRUCTIO N SOLUTION S 

## SITE SAFET Y HAZAR D ANALYSIS 

# Addr.»:-l2H0_S2af l Crew :

Ite m Overhea dLine s Ga s Lin e Wate r Lin e Sewe r Lin e Septic/Leec h Fiel d Propane/Bntan e Sidewal k Foundatio n Retainin e Wall s Fence s Tree s Structure s Driveway Sprinkle r Syste m Othe r Cre w Forema n 

# Xx . Conditio n ^(IWDJ ) ^ ^ 

## li^Kt\7 L AjarJ L



# > 6 ^ a-A/to.tK *'^ ) 

# \J ^ ^ iS^ r c ^ P o ^



# (y»J ( iiro,^\^ ^ /Mv€ . Excavatio n Date : -£i^»^
- Backfil l Date : ^"f^~/ ^

Hazard s Correctiv e Actio n

• *. ,

- 

## Sit e Safet y Offic e Date : ^
- 70r A

81 0 a t 424 2 MWdlca l Drive , Suit e 725 0 i€l|y.'W>M11 4 Sa n Antonicil X 7822 9 :(SH)1SS^PD3 ­ 'Ra cfSIt ) SSS4?B 7 >:(4a2):73S-11S 8 Fac:(4e2)733^1S U 'Phon«:!(210):82Z«58 8 Fax : (210)-67ft«57 71 JA * 

### fc~i ' ''•• ' , ^ 

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