### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 2145 3 DATE : 1/1 5 ADDRESS : 261 0 REE S S T REMEDIATIO N CONTRACTOR : PRUDEN TTECHNOLOGIES . INC . YEAR : 201( b 

### SOI L REMEDIATIO N PROPERT Y FIL E FOLDE R DOCUMENT S 0 PR E AN D POS T VIDE O O F PORPERT Y (DVD ) m EXECUTIV E SUMMAR Y 0 EPA-PROVIDE D PROPERT Y SKETC H H

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SIGNE D ACCES S AGREEMEN T FO R SUBJEC T PROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN T PROPERT Y 1

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RESTORATIO N AGREEMEN T D SETTLEMEN T DOCUMENTS (I.E. , FOR DAMAG E O R T O REPLACE PLANTS , ETC. ) 0 CONFIRMATIO N DAT A m PHOTOGRAPH S M AS-BUIL T SKETC H la ^ SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT Y OWNE R m PROPERT Y CLOSE-OU T CHECKLIS T SIGNE D B Y EP A D DESCRIPTIO N O F AREA S NO T MEETIN G RO D CLEANU P CRITERI A E I UTILIT Y CLEARANCE S

• PROPERT Y INFORMATIO N FRO M DOUGLA S COUNT Y ASSESSOR'S OFFIC E 

## D D

SIGN^ffUR E DAT E 3021758 8 

# NMil i Superfun d

### PROPERT Y SUMMAR Y Date : /15/201 0 Omah aLeadSit e Remedial Actio n Contrac t I

f EP-R7-07-0 6 TO# l Mont hof : Propert y Address ; 261 0 REE S S T A . EXECUTIVE 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 Othe r Relevant Information : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS :

B 2 = 33 2 PP M @ 8" ; N O EASEMENT ATTACHMENT S 1 ) Propert y sketc hprovidedb y EP A pursuan t to contract specification s 2 ) Signe dAcces s Agreemen t including acces s agreements requiredfo r crossing othe r propertie s 3 ) Pre-Excavation digita l video 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 t behin darea 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 ) Signe dfor mverifying satisfactor y restoration v ) Description of area s not meeting InterimRO D cleanu p criteria .

TECHNOLOGIES . INC .Fin d Record 

### Backfiii :

Sampi e Area : 2145 3 - 261 0 REE S ST Owner :

• Owne rOccupie d Owne rName : JOUADAKRA M Owne rAddressi : 

# r—^— ^ Owne rAddress2 : ] 1701 4 M ST State : Zi p Code : City : JOMAHA JN E J68135 - Owne rPhon e Alternat e Phone : fC402 ) 934-838 3 1(402)934^535 4

Contract :
contractor : jPRUDEKrr2010_S contrac t Optio n JOPTIO N 2 Remediatio n Query Lea d Remainin g Query\ Propert yDamag e Query

Use rProvide d Owne rInformatio n Owne rName : Owne rAddress : i City : State : Zi p Code : 

### j 

# r Alternat e Phone : Owne rPhone : j
Assessment : Qualifyin g Grou p J40 0 Assessmen t Ma xXR F Valu e 

### 47 0 Resident : Residen t Name : 

# I "" Propert yAddress : J261 0 REE S ST Zi p Code : 

### J68165 - Residen t Phon e 

# 1'tECHNCHX)GI18S , INC . 

# EP A Propert y Clos e Ou t Propert y # : 2,(4 5 3 Propert y Address ; 2-.<S I O f^ee i ^ ^ Date/Time : Owner' s Name : JM.^.^^J/Y\ ^ 

### Ory^i ^ Quad s Excavated : ^ - p Contracto r Group : Pruden t Technologies , Inc . Excavatio n Genera l Ye s N o 1 .

I f necessary , wer e th e correct quadrant(s ) excavatedandrestored ? 

# y 2 .I f necessary , wer e th e correct area s o f drip zon e excavatedandrestored ? / Gradin g Sodan dVegetatio n Ye s N o 1 Doe s the gradin g aroundthe perimete r o

f the hous e in excavatedarea s generall y slop e awa y fro m(h e house ? 

## A 2 .

Has sodbeen laidi n al l area s tha t wer e excavated ? 

## J 3 .

Doe s tli e so dappea r to be generally health y andgrowing ? (Onl y evaluat e i f inspecteda t a3 0 da

y lim e period) / 4 .Ar e soddedarea s generall y finn andevenl y graded ? / 5 .Ar c th e joint s betwee n tlie sodstrip s generall y tight ? (Onl y evaluat e i f inspecteda t a3 0 da y tim e penod ) / 6 .

Wa s the propert y grade dsuc htlia t wate r wil l not pool o n the property ? / 7 .

Wa s damag e t o landscapin g o r plan t material s avoided ? / Gates , Fence s an dRetainin g WalJ s Ye s N o 1 .

D o gate s ope n an dclos e freely ? (I f applicable ) / 2 .

Wer e al l gate s o r fence s taice n dow n during restoratio n activitie s reinstalled ? (I f applicable ) / 3 , Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) / 4 .Wa s damag e to retainin g wall s avoided ? (Ifapplicable ) / Foundation , Sidins ; an dGutter s Ye s N o 1 Was damag e to the siding o r trimavoided ? / 2 Wa s damag e t o th e foundation avoided ? / 3 .

Wa s damag e t o window s avoided ? / 4 .

Wa s damag e l o window s o r doo r screen s avoided ? / ."i

. Wa s damag e t o downspout s or downspou t extension s avoided ? / Sidewalk s an dDriveway s (Concrete ) Ve s N o I .W;i s d;iniaec t o drivewa v surface s avoided ? 

# 7 Wa s damag e l o walkwa y surface s avoided ? /

## Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complete includin g th e 30-da y so dwarranty . EP A Representativ e 9cy » y£L» , Date : ///^/ gCHNOLOGIES . INC . 

# V A S - BUIL T DRAWIN G OL S #2145 3 Dat e Excavated : 11/01/201 0 

### OMAH A LEA D SUPERFUN D SIT E USEP A Signed-Of f Date : 2145 3 Omah a Lea d Sit e Exterio rPain t Sit e Sketc h • Goo d Q Poo r Samplin g Address : 261 0 REE S S T [ 3 Not pain t Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Firm ; Sample s Collecte d RYASCPXA-2145 3 F l ff l 2 pp m Date : 

## fl l iff l RYBSCPXA-2145 3 RYCSCPXA-2145 3 RYDSCPXA-2145 3 F 2 B l B 2 2.g ^ 3 0 5 " ^1 0 pp m

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CONTRAC T# : EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC .

# SEPf ^ Propert yCompietio n Agreemen t Thi s agreemen t documents the completion of remova l activitie s performedo n the below listedproperty . Th e propert y owner' s signatur e indicate s tha t the propert y owne r i s satisfiedwit hthe restoratio n of the subject property , an dtha t no item s ar e i n question , now , o r a

t an y tim e i n the future , excluding an y remaining warrant y (3 0 day s total ) except thos e items listedbelow , ifany . Propert yID : Propert yAddress : ^ h ^ '^ 

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### Restoratio n item s i n Question :

Item : item : item : Item : Item : item : Require d correction s t o complet e tii e property : 

# R agre e restoratio n i s completed . LJ I d o no t agre e restoratio n i s complete d a t (note d deficiencie s above ) 

# /2 ' 8^-^- ^ Owner' s Sign^tdf e Dat e

### TpO«s:0li>i;;SF^ , !\: : Pruden t Technologies , Inc . (Pi-udent) i s unde r contrac t withth e U . S . Environmenta l Protectio n Agenc y (EPA ) to clea n u p Icitd
contanTjpate dsoil s aty i numbe r ofpropertie s locate di n Omaha , Nebraska , mcludin g th e property locate da t ^ ( g /( A /CX-g^ S Th e EPA request s you r permissio n t o allo w Pruden t t o perfom i aS(M I cleanu p a t (hi s propert y t o remov e load-contaminate dsoil . B y signin g thi s form , th e property owne r grant s permissio n t o Pruden t l o perfor m activitie s relate dt o th e cleanu p includin g soi l sampling , remova l o f lead-contaminate dsoil , an drestoratio n o f .h

e reference dpropert y 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 . . ''i.-. . fo r lhe Omah a LeadSit e cleanup , a t (402 ) 733-1188 ; 733-1455 . Genera l question s abou t th e Omah aLea dSit e cleanu p ca n b : directe dlo the FPA Publi c informaiio n Center s at (402 ) 731-304 5 (SouthOmah aofn c Propert yAccess Grante d R y 

# M A Propert y Owne r Signature : (Date ) PROPERT YINFORMATIO N (T o b e complete d byresiden t and/o rpropert yowne r- pleas e print ) RESIDEN T NAM E Owne r Rente r RESIDEN T ADDRES S
I F RENTAL , PROPERT YOWNE D BY :
OWNER' S MAILIN G ADDRESS ;
OWNER' S TELEPHON E NUMBE R - HOME : (7<^^ > J J ^ ^ 7 WORK : 

## t^tj u q3<A-S3r ^ 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 N UNDE R 7 YEAR S OL D WH O PLA YI 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 PO RENVIRONMENTA LRESPONS EACTIONS ; Th e activitie s t o b e implemente db y EPA .mdc v thi s 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 dt'o ' i n Sectio n 104(c ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry fo r "determinin g th e nee dfo r response , o r choosin g or takin g any lespons e actio n unde r thi s title , o r otherwis e enforcin g th e provision s ofth e title. "

808 0 War o P.^rKvi/ay . . - Kansa s City . WI C 6-4 "ENVfRO\MENTALi! 4 CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERV K K

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# yp-^A^yy ) 808 0 War d Parkw a 560 0 S 1 0 S t 424 2 Medica l Drive . Suit e 425 0 KansasCity , M O 6411 4 Omaha , Nebrask a 6810 7 San Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402 ) 733-118 8 Phone : (210)822-958 8

# ;145 3 Exterio rPain t Nort h An'o w Omali a Lea d Sit e 

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### Pag e 1 of 2

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### • YOU RTICKE T NUMBE RI S 2629132 . Origina l Cal l Date : 10/28/1 0 Wor k t o Begi n Date : 11/01/1 0 Time : Time : 4:0 9 p m 4:4 5 p m Op : SIVA1896 7 State : N E Address : 261 0 County : DOUGLA S Street : REE S S T Place : OMAH A Twp : 15 NRng : 13 E Sect-Qtr : 21-SE,28-N E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : soi l lea d remediatio n projec t Locatio n o f Work : LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)733-188 3 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 : 6F T Corne r Lot : Y Front : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V LEVEL 3 MUDO l MUD0 2 OMAHACO F OPPDGPR S 0PPDGPR 6 QLNNEI C QLNNEI F

Servic e Are a Contac t Phon e Nunibe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEID I 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
LEVEL S LEVEL 3 COMMUNICATIONS , LL C N A 

### Day : 877366834 4 Alt : Emerg : 877366834 4
MUDO l METROPOLITA N UTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0 MUD0 2 METROPOLITA N UTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0 Day : 402444719 7 http://www.(ihon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 10/28/201 0

### Pag e 2 of 2

OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRICH/TRAFFI C 

### Alt : 402444516 1 Emerg : 402444516 0 0PPDGPR5 OMAH A PUBLI C POWE RDISTRICT EL M LOCATIN G Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 OPPDGPR 6 OMAH A PUBLI C POWE RDISTRICT EL M LOCATIN G Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNN E 1 C QWES T LOCA LNETWOR K 

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### Alt : 406207149 4

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### ENVIRONMENTAL ENGINEERIN GAN D CONSTRUCTIO N itccHNOijamEs , IMC . 

### SOLUTION S 

## SIT E SAFfeT Y HAZAR D ANALYSI S Address:^iiA5-i^.- i Excavatio n Date : ilulJJ —

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808 0 WaitfBaftaBay , Suit a 4( B 560 0 S los t 424 2 Medica l Drive , Suit e 725 0 Kansa s (>«y<lia6411 4 Omaha , Nebtadlc a 6810 7 Sa n Antonio , T X 7822 9 Phone : («16 ) 36X070 3 Phone : (402)733-118 8 Phone : t2t0 ) B22r>958 8 Fa«:(a« ) 383-370 7 Paae . (402)733^188 3 Fax : (210 ) 579-657 7"'•'- y 

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