### TRANSMITTA L o f OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAE)# : 

# 397/ 4 Date : 

## H //^/D 9 Address : 2-7^; P /^'f A A / Remediatio n Contractor : fW^.. ^ "7^^/ . IZT7C; . 

### Year : ^SLOO ? SOI L SEMEDIATID N PROPERT Y FIL E FOLDE RDOCUMENT S ^ 

### Vide o of propert y (DVD ) Executiv e Suimnar y / 

### EPA-provide dpropert y sketch SignedAcces s Agreemen t fo r

subject propert y Signe dAcces s .^reement(s ) fo r

adjacen t propert y Restoratio n ^jeemen t D 

### Settlemen t document s (i.e. , fo r

damag e or t o replac e plants , etc. ) [ / 

### Confirmation dat a 

# V Photograph s As-built sketch Satisfector y restorado n signe db y Propert y Owne r Propert y close-out check Us t signe dby EP A D 

### Descriptio n o f area s no t meeting RO D cleanu p criteri a Utilit y dearance s 

### Propert y mformation fromDougla s Count y Assessor' s Offic e D D D 

### Signaturef 

# —<rt i TSte " 3005415 2 

# il l Superfun dFin d Recor d Remediatio n Queryj Lea d Remainin g QueryI Propert yDamag e Query Backfill :

Sampl e Area : 3971 4 Owner : D Owne rOccupie d Owne rName : JFLANNERYROGERA Owne rAddressl : 

# r Owne rAddress2 : |274 8 REDIC KAV E City : jOMAH A Owne rPhone : j(402 ) 45 5 745 9 - 274 8 REDIC KA V

State : Zi p Code : |N E )6811 2 Alternat e Phon e

|(402 ) 455-745 9 Resident : Residen t Name : |FLANNERYROGER A Propert yAddress : |274 8 REDIC KA V Zi p Code : |6811 2 Residen t Phon e 

# I ~ Contract : Contractor : )PRUDENT2009_ S contrac t Optio n OPnO N 2 Assessment : Qualifyin g Grou p 

## po o 

## ; Assessmen t l^a xXR F Value : 

# r 444

### Date ; 1^/15/2009 I Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l | Month of : Octobe r Propert y Address : 274 8 REDIC K A V 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 Othe r Relevan t Information : NON E CONFIRMATIO N SAMPLIN G DATA/RESULTS : B l = 12 8 PP M @ 6" ; N O EASEMENT ATTACHMENT S 1 ) Propert y sketc h providedb y EP A pursuan t t o contrac t specification s 2 ) SignedAcces s Agreemen t including acces s agreement s require dfo r crossing 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 includ e fina l lea dlevel s v ) Legen d ii ) Contamination lef t behindarea s vi ) 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 mdividua l propert y file , if available , o r obtainedinclude : i ) Pre-excavatio n agreemen t detail s (i f an y ar e mad e 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 ) or SW F(Flas h Player ) forma t and/o r photograph s iv ) Signedfor mverifying satisfactor y restoratio n v ) Descriptio n o f area s not meeting InterimRO D cleanu p criteria .

IHCHNOeaieESjIIC .TECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y # : %'^'7ll f Propert y Address; ^ 2'?4' ? ^' ' Date/Time : Owner' s Name : Y-^AJJ ' F^OA^f^^'* ^ Quad s Excavated : 9> \ Contracto r Grou p Pniden t Technologie s Excavatio n General Ye s N o 1 . I f necessary , wer e the correct quadrant(s ) excavatedan drestored ? / 2 . I f necessary , wer e the correct area s of dri p zone excavatedan drestored ? 

## y Gradin g Sodan dVegetatio n Ye s N o 1 .

Doe s the gradin g aroundthe perimete r ofth e hous e i n excavatedarea s generally slop e awa y fi-omthe house ? ^ 2 .

Ha s sodbee n lai di n al l area s tha t wer e excavated ? 

## y 3 .

Doe s the sodappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 da

y tim e period) 

## y 4 .Ar e sodde darea s generall y firman devenl y graded ? 

# y 5 .

Ar e the joint s betwee n the so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period) 

## y 6 .

Was the propert y gradedsuc h tha t wate r wal l not pool o n the property ? 

## y 7 .

Wa s damag e t o landscaping or plan t material s avoided ? / Gates , Fence s an dRetainin g Wall s Ye s N o 1 . D o gate s ope n an dclos e freely ? (If applicable ) / 2 . Wer e al l gate s o r fence s taken dow n durin g restoratio n activitie s reinstalled ? (If applicable ) / 3 . Was damag e to gate s or fence s avoided ? (I f applicable ) / 4 . Wa s damage to retainin g wall s avoided ? (If applicable ) / Foundation , Sidin g an dGutter s Ye s N o 1 .

Wa s damag e t o the siding o r trimavoided ? / 2 .Wa s damage to the foundatio n avoided ? / 3 .

Was damage to window s avoided ? / 4 .Was damage t o window s o r doo r screen s avoided ? / 5 .Was damage t o downspout s or downspou t extension s avoided ? / Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Wa s damag e t o drivewa y surface s avoided ? / 2 . Wa s damag e 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 £L.) ^ ^Date: lolu/o ^

## Propert yCompletio n Agreemen t Thi s agreemen t documents 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 owne r i s satisfie dwith th e restoratio n o f th 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 remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y ID : Properl y AddreM : ^ 7 M g j^eX i c S T r\. ^ Phone : ^ 

# t Restoratio n Item s i n Question :

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

Ll J I agre e restoratio n i s completed . L l I d o no t agre e restoratio n i s complete d a t (note d defidencie s above )Pruden t Technologies , Inc . (Prudent ) is unde r contrac t with th eU. S, Environmenta l Protectio n Agenc y (EPA ) to clea n up lead
coi^yniti^ed^il s at anumbe aofpropertie s locate d in Omaha , Nebraska , includin g th e property locate dat 9tf' 0 /iS^ffUk . m/c . Th e EP A request s you r permissio n to allo w ftudent to perfon n asoi l cleanu p at thi s property to remove lead-contaminate dsoil . By signin g thi s form , th e property owne r grant s permissio n to Pruden tto perfor m activitie s relate d to th e cleanu p includin g soi l sampling , remova lof lead-contaminate dsoil , an drestoratio n ofth e reference dproperty . If

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 th e Pruden t Offic e fo r th e Omah aLea dSit e cleanu p at (402 ) 733-1188 . Genera l question s abou t th e Omah aLea dSit e cleanu p can be directe d to th e EP A PubUc Informatio n Center s at (402 ) 731-304 5 (South Omah aoffice ) or (402 ) 991-958 3 (North Omah aoffice) . Property Acces s Grante dBy : / ^ ^\ ^ Q ^ t^ 

## y ^ y^y^* i ^ e/- y (Pleas e Print Name ) / Property Owne r Signature : (Signature ) (Date ) PROPERT Y INFORMATIO N (T^ ^ complete d by residen t and/o r propert y owne r . .. . —pleas e print )

. . . , RESIDEN T NAME : Rente r RESIDEN T ADDRESS : A ^ RESS ' ""
IF RENTAL , PROPERT Y OWNE D BY :
OWNER'

WNC K S S MAILIN

MAILIN G G AUUKCS S

ADDRESS ; • / ) i . , .«-t^>y ­ 

# 23^5 ^ yi ^ y^ ^ S^ , (P/»ic^k>^/0 ^ ^S/(> V OWNER' S TELEPHON E NUMBE R - HOME : _ i 

# 3^;i^ar7 7 WORK : 

# , M ( \ 

# fy if f AG E OF HOME? : YEARS . HO W LON G HAV E YO U LIVE D HERE ? YEARS . HA S TH E EXTERIO R BEE N PAINTE D OR COVERE D WIT H SIDIN G SINC E 1978? 

### V^T E NO YE S NUMBE R OF OCCUPANT S UNDE R 7 YEAR S OLD : NUMBE R OF OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R OF CHILDRE NUNDE R 7 YEAR S OL D WH O PLA Y IN TH E YAR D FO R 5 HOUR S OR MOR E PE R WEEK : COMMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA L RESPONS E ACTIONS : Th e activitie s to be implemente d by EP A unde r thi s agreemen t ar e pursuan t to Sectio n 104 ofCERCLA , 42 U.S.C . 9604 . EPA' s righ t of

acces s to th e propertyis provide dfor in Sectio n 104(e ) of CERCLA , 42 U.S . C 9605(e) , whic h provide s entry for "determinin g th e nee dfo r response , or choosin g or takin g an y respons e actio n unde r thi s title , or otherwis e enforcin g th e provision s ofth e title. "

J t A . •: ... I II'VMKOSMI'A ; > , .

V (ONSTI U .;•• : 10 ' S l P' C v. : 

# Propert y Statu s For m Addre,, : ^T/ g /tcd,C ^ ^^ ^ Date : 

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## BVID: 39^ 7 f i Ite mN O Plant s & Permanen t Landscapin g T o Remai n I n Plac e O n Map Descriptio n & Locatio n



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Pre-Existin g Conditio n of Structure s Doe s you r Basemen t hav e ahistory o f

leaking ? Ye s No y Ite mNO Descriptio n & Locatio n O n Map 

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Propert y Owner/'^ / yi^/ J Pruden t Employe e Signature : Y*
- Signature : 

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S08 0 War d Parkway , Suit e 40 5 250 5 N . 24 " Stree t Suit e 30 8 Kansa s City , U O S411 4 Omaha , Nebrask a 6811 0 Phone : (816 ) 3£3-37a 3 Phone : (402 ) 504-100 4 Pax : (816 ) 363-370 7 Fax : (402 ) 504-100 5

### A S - BUILT DRAWIN G OMAHA LEAD SUPERFUND SIT E

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### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 9/2/2009

### Pag e 1 of 2

" > [ Creat e Anothe rTicke t ] [ Bac k t o Irt h Inteme t ] Sen d Emai l 

### YOU RTICKE T NUMBE RI S 2366607 . Origina l Cal l Date : 9/17/0 9 Time : 12:3 1 p m Op : SIVA1896 7 Wor k t o Begi n Date : 9/21/0 9 Time : 1:0 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 274 8 Street : REDIC K AV E Twp : 16 NRng : 13 E Sect-Qtr : 33-N E 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 : FAX AL L CLEAR S TO : (402)733-188 3 : FA X AL L CLEAR S T O (402 ) 73 3 188 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 : 1 Front : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : I Explosives : N CXCAT V MAGELLA NMETR O MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C 

### Servic e Area Contact Phon e Numbe r Utilit y Typ e Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 918574709 8 MAGELLA N MAGELLA N MIDSTREA M PARTNER S L P DEBORA H Alt : Emerg : 918574709 8 Day : 402457230 7 METR O METR O COMM . COLLEG E CHRI S Alt : 402672703 3 Emerg : 402457231 3 Day : 402504782 3 MUDO l METROPOLITA N UTILITIE S DISTRIC T SAND Y Alt : Emerg : 402504797 0 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/17/200 9

### Pag e 2 of 2

OMAHACO FCITYOFOMAHA-TRAFFICSEWE RRO N 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 OPPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T N A 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNN E 1 C QWES T LOCAL NETWOR K N A 

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

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/17/200 9

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