## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL EFOLDE R SAID# : ^n^O'- f Date : l(|HJ^m ^ Address : A^ot^n 4lnp<^f^C< ^ fe^yn Remediation Contractor : Pfjj- , n> p t^y j / ^ hNO(o(yi<^< ; . f/^C y Year : c^Co S SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S [ 2 Vide o o f propert y (DVD ) 2

I Executive Smnmar y 0 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 1 2 Restoration Agreemen t D Settlemen t documents (i.e. , fo r

damage o r

to replac e plants , etc. ) Il

l Confirmation data B Photograph s I K

As-built sketch i f

Satisfactor y restoratio n signedby Propert y Owne r o

f

Propert y close-ou t chec k

lis t signedb y EP A D Descriptio n of area s no t meeting RO D cleanu p criteri a i j Utilit y clearance s aPropert y information fromDougla s Count y Assessor' s Offic e D D 

## Signaturev ' jJat e 4031291 5 

# Mlliiil Superfun d

### PROPERT Y SUMMAR Y Date : 11/19/200 8 Omali aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-06/000 4 Mont hof : Oct/Nov . Propert y Address : 204 0 FLORENC EB V A . EXECUTIV ESUMMAR 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 : NONE . CONFIRMATIO N SAMPLIN GDATA/RESULTS : B l = 27 4 PP M @ 8" ; B 2 = 24 5 PP M @ 8" ; N O EASEMENT . ATTACHMENT S 1 ) Property sketc hprovide db y EP A pursuan t t o contrac t specification s 2 ) Signe dAcces s Agreemen t includin g acces s agreement s require dfor crossin g othe r propertie s 3 ) Pre-Excavatio n digital vide o clip/photograph s 4 ) Post-Excavatio n digita l vide o clip/photograph s 5 ) Documentatio n - Complete dClose-ou t Checklis t 6 ) As-Built sketch i ) Shal l includ e fina l lea dlevel s v ) Legen d ii ) Contaminatio n lef t behin darea s vi ) Contracto r identificatio n iii ) Property addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e include din th e individua l property file , i f available , o r obtaine dinclude : i ) Pre-excavatio n agreemen t detail s (i f any ar e mad e wit hth e property owner ) ii ) Property Statu s For msigne db y property owne r iii ) Excavatio n digita l vide o in MPEG , WM V (Window s Medi aVideo ) o r SW F(Flas hPlayer ) forma t and/o r photograph s iv ) Signe dfor mverifyin g satisfactory restoratio n v ) Descriptio n o f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOCIES , INC .Fin d Record 

### Backfill :

Sampl e Area : 9090 7 Owner : D Owne rOccupie d Owne rName : |MORELL O BERNAR D J Owne rAddressl : Owne rAddress2 : 11141 3 HICKOR YR D City : |OMAH A Owne rPhone : |(402 ) 342-282 0 Clea n U p Quer y Lea d Remainin g Quer y1



### - 204 0 FLORENC E B D Resident : Residen t Name : Propert yAddress : 204 0 FLORENC E B D Zi p Code : 

# I Residen t Ption e State : Zi p Code : |N E |6814 4 Alternate Phone : 

# 1 Propert yDamag e Quer y

Contract : Contractor : Group : Assessment : Qualifyin g Grou p 

### 11200 Assessmen t XR F Date: Assessmen t Ma xXR F Value : 

### 147 6

### TECHNOLOGIES , IN C 

# SEB V EP A Propert y Clos e Ou t Propert y # : To 'Jo 7 Propert y Address : 2.04. 0 f^iirt*^ ^ & v Date/Time : Owner' s Name : Quad s Excavated : g/ g 3 . Contracto r Grou p Pruden t Technologie s Excavatio n General I .

I f necessary , wer e the correct quadrant(s ) excavatedan drestored ? 2 .I f necessary , wer e the correct areas o f dri p zon e excavatedan drestored ? Gradin g So dan dVegetatio n 1 .

Doe s the grading aroun dthe perimete r o

f th

e hous e i n excavatedareas generall y slope awa y fromth e house ? 2 .Ha s sodbee n laidi n all area s tha t wer e excavated ? 3 .

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

y tim e period) 4 .Ar e sodde dareas generall y fir man 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) 6 .Wa s the propert y gradedsuc htha t wate r wil l not pool o nthe property ? 7 .

Wa s damage to landscaping o r plan t material s avoided ? Gates , Fence s an dRetainin g Wall s 1 .

Do gate s ope n an dclos e freely? (Ifapplicable ) 2 .Wer e all gate s o r fence s taken dow n durin g restorationactivitie s reinstalled ? (Ifapplicable ) 3 .

Wa s damage to gate s o r fences avoided ? (Ifapplicable ) 4 .

Wa s damage t o retaining wall s avoided ? (Ifapplicable ) Foundation , Siding an dGutter s 1 .

Wa s damage to the siding o r trun avoided ? 2 .Wa s damage to the foundatio n avoided ? 3 .

Wa s damage t o window s avoided ? 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 ) I .

Wa s damage to drivewa y surface s avoided ? 2 .Wa s damage to walkwa y surface s avoided ? Ye s N o / i / 

### Ye s N o / 

# y y y 

# y / i / 

### Ye s N o 

## y / 

### y y Ye s N o 

# y y y / / Ye s N o 

## y t /

## Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complet e including the 30-da y sodwarranty : EP A Representative i ^ y^u ^ Date : io)si/o ^

# ^EP A Propert yCompletio n Agreemen t Thi s agreement document s th e completio n of remova l activitie s performe d on th e belo w liste dproperty . Th e property owner' s signatur e indicate s tha t th e property owne r is satisfie dwithth e restoratio nof th e subjec t property , an dtha t no item s ar e inquestion , now , or at an y tim e in th e fiiture , excludin g an y remainin g warranty (3 0 day s total ) excep t thos e item s liste dbelow , if any . Propert yID : 

# Ao^e Q Property Address : ^ ^ ^ o ^\ore,t/vC e B p Q^°^'- = Vye^^..y.^ ^ Korpll ^ Phone : Mo 7 - ^ U O - 9,9^'XC ? Restoratio n Item s in Question :



### Item : Item : Item : Item : Item : Item : 

### Require d correction s to complet e th e property :

I agre e restoratio n is completed , excep tas note d above . I 1 do no t agre e restoratio n is complete d

iiV:; ; ignatur Dat e ner' s Signatur e e 

### I•••--*;.••; • ••WiyJ'- V

# • • • fl 1 • X / , . V, ' . / V v.' , Vf,V.;V f .ft V'v . •' / Pmdtn t TtcfanfllDgtE , Inc . ([Piudtn ^ isundt i contiac t wid i th « U . S . Eaniionaitnta l ProUctio n Agooc y (EPA ) t o cltaniq ) Itad - * . contnTHiTiitt dsoil s a t anumbt r o f

proptrtitilociittdinQiaaha.' H tbradca , indiiiiingth * propart y locate dat ^ ^_ . Th9EPArsqu«stsyourp»nnisaontoaIlo(rPiud«nttop«ifoimasoilcUasupattt s pioptit y t o i«moTr « l»adrccDtaBiinA» dsoil . B y sigoingftnsfonn , tfa * piopsi ^ own n grantsp»niusBo n t o Piud«n t t o ptifon a actiTnti« s i»lat« dt o tl w cltsn ^ iucluclin g soi l sampling , nmova l o f UiuJ-contaminaU dsoil , an dt»stoialio n o f tfa

t i»f«T»nc» dpioptity . IfyouhaT « an y question s abou t th s Eoi}'cl*ati9plann«dfoiyourpiop»ity,pl«as « contac t Pnidtnt'sAdmigiaraliv * Clti k forth * OmahaLtadSit i cUanm . Ms.ShaHnonHolt-atf402^3Q4-1004 . G»n«ral qutsdonsabout&«OiaahaL»adSit e cltaa ^ canb « diT*ct«dt o & » EPA Publi c InfomiatiDnCtnUr s at(;40: ^ 731-304 3 (|5outhOmah ao£Bc«) oi(402 ) 991-938 3 l^oithOmah aoffict) . Proptrt7AcctssGiant»dBTry - ,^<^^' ^ ^ ^ (T - fYlQ^ELJ- ^ . .. , n ^_„_ ^ / N ^ (Pitas * PnatWarn* ) 

# (^J2^/& ? Proptit y 0wn* i Sigaatur* : IpaU ) PROPERT YINFORMATIO N ( t * \ t cta^leto d \ j reaiien t ftal/*rf rt f eit ^ •vae r- f kasB f riat) RESIDEN T NAME : \f r \ rnv.! - \_it \ \ rOwne r Rente r RESIDEN TADDRESS : I F RENTAL . PROPERT YOWNE D BY ; 

# 'Bei^»^a^(^—X V\C)rpU o OWNER' S MAILM G ADDRESS ; 

## r< J QI^AIM X 

## y\ t 6- . glU ? * OWNER-STELEPHON E NUMBER-HOME ; X WORK :



## (^g | 9Mg'-.7<^A4 > 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 Wft m SDIN 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 YH 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 YGATES . ETC. )

AtJIHORIT Y TORENVIRONMINTALRESPONS EACTIONS ^ Ih » Bcti7iti«stob»impl»m»it»dbyEPAunii»rthisBgr»««»n t a n Dunaun t to S»ctjo n ID / o f

CEKCLA , 4 2 U £.C . 9604 . EPA' s xi ^ o f acc»s s t o th « propMt y i s prorndt dfo r i n Sectio n 104(« ) o f CERCLA , 4. ^ U S . C 96 0 j(«) , vfaic hpro^d* s «nti y fo i '^d«t«nmiin g th » n«« dfor n^onst , o i chooan g o r takin g an y n^ons * actio n und«ithistitl» , o i oth*nris « »nforcingth » proMision s o f th t titl». "

808 0 War d Parkw^ . Sult a 40 5 250 5 N . 24* * Stree t Sult a 30 8 424 2 Medica l Drive . Suit e 425 0 Kansa s city . M O 6411 4 Omaha , Nebraskaesil O San Antonio . T X 7822 3 Phons : (SIC ) 363-370 3 Fa x(S1€ ) 353-370 7 Phone : (402)504-100 4 Fax : (482)504-100 5 Pfions : piQ ) 822-358 8 Fax : 510)579-657 7/ . ' ... . ' \ 

# Wd M

Pmdwt t T»chB(il(>{i*i;lnc . (Prud«n$iiund M contrac t wi4 i tfa « U . S . EnoiionmMiitalProtwtitmAgoac y (EPA)t o dtaniqtUad ­ coBtaminatc dsoil s A anmabt i o f pn^«iti*Elocat»di nOmaha , K«biasica , includingth » propMt y locate da t

. Th»EPAT>qu*EtEyompfrniiisaontoaUoirPtud«attop«tfoi masoi l cUam ^ atdn s piop»rt f tc- iMnov t l«adrccDtimin9t« dsoil . B y sigmn g du s fozm, th » proped y own w ^ant s pumisso at o Pmd«n t t o p»ifonB activiSi«:i:4lat*dloth « cl*iuu p includin g soi l sampling , itmova l of l«ad-contamin^ dsoil , a&dTeaDiatiogaafth*tefei»tic*dprop«ity . Ifyouhav t an y question s abou t th * soil deam p planne dfo i you r pioptity , pleas e contad.Pnident'sAdmijaitliatl'y e Cleric foi th e Omah aLea dSit e deana> , Ms . Shanno nHolt-a t (402 ^ 504-1004 . Gen«ia l quedion s abou t ftteOnahaLeadSite decw p ca nb e directe dt o th e EP APubli c Infoiaitio nC eater s tf.(402) 73 1 -304 3 (Sonlf aOmah aoffice) c»(402 ) 991-93S31 ^ oit hOmah aoffice) . Property AccessGiante dBy : \ Ay ^ ' '^ ^ ^

^ '' ^ '" " ' ^ J ' • i.e . l O / ^ .-T~ , v-"""^— \(ReasePnntName ) PropertyOwnerSignature : V.r;:O^A^.-- ^ ,/^MX^ A ( & I2^ ^ f ^ ? 'f^

— (Signature ) (Date ) PROPERT Y INFORMATIO N (T * k * nsfleto d¥ y iMoinrn t Aai/txfnftxt f vwan r - fitMmfximi } RESIDEN T NAME ; V/ArC... I 

# -U-i . Owne r Rente r RESIDEN T ADDRESS : S-&M 4 ^ Ofe>- > C-.g , 

# Six V-A ­ r* - I F RENTAL . PROPERT YOWNE D BY ; TSr^>>.f i f,. \ 4——VACIVP K 

# o OWNER' S MAILM GADDRESS ; 

## J OWNER' S TELEPHON E NUMBER-HOME : J \_ ¥VORK : J ; • • t ] AG E O F HOME? : YEARS . HO W LON G HAV E YO U LIVE D HE»E 7 % . *• ' YEARS . HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WTTlil^illi G SINC E 1978 ? ,-\i:YE S M O NUMBE R O f OCCUPANT S UNO ^ V fEAR S OLD ; NUMBE R OF OCCUPANT S 7 YEAR S OL D AN D OLDE R

\.. ^ MTHEYAttO r NUMBE R OF CHILDRE N UNDE R 7 YEAR S OL D WH O PLA YM l TH E YARD , FO R S HlOUR S O R MORE PE R WEE K COMMENT S O R SPECIA L INSTRUCTIONS : (I.E.^06^!ENTR YGATES . ETC. )

AUTHOIUT r FOR . ENVIRONMENTA LRESPONS EACTIONS : The activitie s t o b e implemeiledt ^ EPAunder thi s agreusen t ar

e BjanaMBt t o Sectio n10 4 o f CERCLA , AiU^'C . 9604 . EPA' s li ^ o f acces s t o th e propeH ^ i s provide dfor inSectio n104(e ) of CERCLA , 4 2 U 5 . C 9603(e) , whic hprovide s entr y for "detezmiain g th e nee dfor responsti , o r efaoosn g or takin g m j rt^ons e actio n unde r thistitle , o r otherwis e enforcin g th e prtmaon s of th e title. " 888 0 Wan t Pamw^ . Suit e 40 5 2505 N . 24* ^ Stree t Suit e 30 8 4242 Medica l Drive . Suit e 425 0 KflneaBCitf . M O 6411 4 Omaha . Nehraska 6811 0 Sa n Antonio . T X 7822 9 PtlOlfs : (816 ) 363-370 3 rsx . ^IS ) 3S3478 7 Phone : ft02 ) 504-1004 Fax : (402)504-180 5 PUona : pie)822-SK 8 Fax : <218 ) 579-657 7

### AS ­ BUIL T DRAWIN G^ OMAH A LEA D SUPERFUN D SIT E OLS# : 9090 7 I B Dat e Excavated : 7/10/200 8 Dat e USEP A Signed-OfT : 

### 9090 7 Exterio rPain t Omah a Lea d Sit e • Goo d Sit e Sketc h npoo t Samplin g Address : 204 0 FLORENC E BV [ 2 No t pain t Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Cortcerttatio n Collecle d Fir m RYASCPXA-9090 7 F1 2.^ 1 pp m 

### D Date : 11 / I /D 7 RYBSCPXA-9090 7 F2 

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### D Tim e 1 2 •• 2- 7 ff ^ RYCSCPXA-9090 7 Bl .pp m 

### D Sample s Analyze d RYDSCPXA-9080 7 B2 6>5 3 .PP" i 

### D ROZSCPX AOOOO r B i pp m 

### D D XR F unit : C>S'H2 . Book : l<^ i ROZoopxA-oaao?—s z pp m 

### D Date : 

## a n-oT-a i nrzocrxA-90907—P Z .pp m 

### D Time : 

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# £] Staff : AlSu / Numbe r of Sample s = Legend ; Fl = Fron t Left , F2 = Fron t Right . 81 = Bac k Left . B2 = Jac k Rjgh t DZ = Dri p Zone , GZ = Garten , PZ = Pla y Al l quadrants are as viewe d rranithfsrrat . racin g propert y @ 

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# m m rECHNOLOGIES , INC . 

# Propert y Statu s For m Address : cPe'^ O 'h\ry'T^^<e^L ^ ^X ^ Date : ^Jur^Jt . \<l;ieti ^ Phone : ^o^ - 3 M ;i . - -^S- 8 Sl o BVID : q^ i q o 1 Plant s & Permanen t Landscapin g Item # O n Map Descriptio n an dLocatio n



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Property Owner Pruden t Employ ! / 

### Signature : Ignature \ 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 , 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 7

## 9090 7 Exterio rPain t Noft h Arro w 

### Omah a Lea d Sit e • Goo d 

### Sit e Sketc h nfoo r Samolin q Address : 2040 FLORENC E B V [ 2 No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : RYASCPXA-9090 7 F l 7 H I Do m 

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### YOU RTICKE T NUMBE RI S  2077053 . Origina l Cal l Date : 7/08/0 8 Time : 9:5 5 p m Op : RAMITA1896 7 Wor k t o Begi n Date : 7/11/0 8 Time : 7:1 5 am State : N E County : DOUGLA S Place : OMAH A Address : 204 0 Street : FLORENC E BLV D Twp : 15 NRng : 13 E Sect-Qtr : 10-SW,15-N W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remidatio n Locatio n o f Work : ENTIR E PROPERT Y LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)504-100 5 : UNSUR E CORNE R Compan y: PRUDEN T TECHNOLOGIE S Contac t Name : RAMIT A Phone : (402)504-100 4 Alt . Contact : Phone : (402)452-980 6 Wor k Bein g Don e For : EP A Dept h o f Excavation : 6f t Corne r Lot : NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V LEVEL 3 MAGELLANMUDO l OMAHACO F 0PPDGPR 5 QLNNEI C 

### Utilit y Servic e Are a Contac t Phon e Numbe r Typ e Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 

### LEVEL 3 LEVEL 3 COMMUNICATIONS , LL C N A Alt : 

### Emerg : 877366834 4 Day : 918574709 8 MAGELLA N MIDSTREAM MAGELLA N TONYAAlt : PARTTMER S LP Emerg : 918574709 8 Day : 402504782 3 METROPOLITA N UTILITIE S MUDOl EDWIN AAlt : DISTRIC T Emerg : 402504794 6 Day : 402444719 7 

### OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO N

lof 2 7/9/200 8 1:1 6 P Mfile:///C:/Users/lord»^^s%20my%20shepherd/Desktop/STREETS/2.. . 

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OMAHA PUBLI C POWE R 0PPDGPR 5 DISTRIC T QLNNE1 C QWES T LOCA LNETWOR K Alt : 402444516 1 Emerg : 402444516 0 NA Day : 406728934 3 Alt : 888728934 3 Emerg : 406728934 3 N A Day : 406728934 3 Alt : Emerg : 888728934 3

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