## TRANSMITTA L o f

OMAHA LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 20^ 1 Date : l-jJi-^A t Address : /// O 5 3 1 ^ ^ Remediatioii Contractor : r^u^t ^ 7^1"^^^ ^ Xvif > Year : SOI L REMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S B ^ Vide o o f propert y (DVD ) y Executive Summar y y EPA-proyide dpropert y sketcli y SignedAcces s Agreemen t fo r

subject propert y aSignedAcces s Ag;reement(s ) for.adjacen t propert y y Restoratio n Agreemen t D Settlemen t document s (i.e. , fo r

damag e or to replac e plants , etc. ) y Confirmation data 0 Photograph s y As-built sketch y Satisfactor y restoratio n signedb y Propert y Owne r s X Propert y close-out check lis t signedby EP A D Descriptio n o f area s no t meeting RO D cleanu p criteri a B Utilit yclearance s 

### \ y Propert y information firomDougla s Count y Assessor' s Office D 4030958 0 

### D 

# MIPIHP i r- j Superfun d 

# s-fe^ z • —W ^

### PROPERT Y SUMMAR Y Date : 12/20/200 8 Omah aLea dSite Remedial Actio n Contrac ti t EP-R7-07-06/0004 Mont h of : Nov/De c 1 Propert y Address : 111 0 S 3 3 S T A . EXECUTIV E SUMMAR Y A. 1Issue s Encountered : NON E A. 2 Issue s Resolved : NON E A. 3Uniqu e Findings : NON E A. 4Othe r Relevan t Information : ARE A NO T EXCAVATE D F l PLANT S 3'X30 ' @ 39 7 PPM ; ARE A NO T EXCAVATE D FIPLANT S 3'X3 ' @ 36 8 PP M CONFIRMATIO N SAMPLIN G DATA/RESULTS : B l = 33 8 PP M @ 6" ; D Z = 204 PP M @ 10" ; F l = 21 5 PP M @ 6" ; F 2 = 19 0 PP M @ 6" ; EA = 18 5 PP M @ SCRAPE . ATTACHMENT S 1 ) Propert y sketch provide db y EP A pursuan t t o contract specification s 2 ) SignedAcces s Agreemen t includm g acces s agreement s require dfo r crossing other propertie s 3 ) Pre-Excavatio n digita l vide o cUp/photogr{q)h 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 final lea dlevel s v ) Legend ii ) Contamination lef t behindarea svi ) Contracto r identificatio n iii ) Propert y addres svii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e include din th e individua l properly file, i f 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) fonna t and/o r photograph s iv ) Signedfor mverifying satisfactor y restoratio n v ) Descriptio n o f area s no t meeting InterimROD cleanu p criteria .

TECHNOLOGIES , INC
.Fin d Record I Clea n U p Query Lea d Remainin g QueryI Propert yDamag e Quer y Backfill :

Sampl e Area : 2089 7 ­ 111 0 S 3 3 S T Owner : Resident : Contract : n Owne rOmjpie d Residen t Name : Contractor : Owne rName : [PRESCOTT-VIVENa O JANE T L 

### |PRUDErn2qo8_ s jPRESCOT T JANET L

- — Propert yAddress : Group : Owne rAddressl : 

### |1110S33S T ' " Owne rAddressZ : - Zi p Code : 6810 5 Assessment : |1110S33S T Residen t Phon e Qualifyin g Grou p City : State : Zi p Code : |PLA Y ZON E JOMAH A |N E |68iq 5 Assessment XRF Date : Owne rPhone : Alternat e Phone : 

# I 1(402)341-086 3 1(402)341-086 3 Assessment Ma xXRF Value : I 753.7 3TBCHNOLOGIBS i INC T Propert y # : 2.°%^ 1 Date/Time : Quad s Excavated : F» , /^*
- /

& ' / £> ^ 

# &EP k EP A Propert y Clos e Ou t Propert y Address : )\l o S 3 % S t Owner' s Name : Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l 1 .Ifnecessary , wer e the correct quadrant(s ) excavatedan drestored ? 2 .

If necessary , wer e fh e correct area s of dri p zone excavatedandrestored ? Gradin g So dan dVegetatio n 1 .Doe s th e grading aroundthe perimete r of the hous e in excavatedarea s generall y slop e awa y fromth e house ? 2 .Ha s so dbeen laidin al l area s tha t wer e excavated ? 3 .

Doe s the so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e if inspecteda t a3 0 da

y tim e period) 4 .Ar e soddedarea s generall y fir man devenl y graded ? S .Ar e th e joint s betwee n the so dstrip s generall y tight? (Onl y evaluat e if inspecteda t a3 0 da y tim e period ) 6 .Was the propert y gradedsuc h tha t wate r will no t poo l o n the property ? 7 .

Was damage to landscaping o r plan t material s avoided ? Gates , Fence s an dRetainin g Wall s 1 .D o gate s ope n andclos e freely? (IfappUcable ) 2 .Wer e al l gate s o r fence s taken dow n during restoration activitie s reinstalled ? (If applicable ) 3 .

Wa s damage t o gate s or fence s avoided ? (IfappUcable ) 4 .

Was damage t o retaining waU s avoided ? (IfappUcable ) Foundation , Sidin g an dGutter s 1 .Was damage to the siding or trimavoided ? 2 .Was damage t o th e foundatio n avoided ? 3 .

Was damage t o window s avoided ? 4 .

Was damage to wmdow s or doo r screen s avoided ? S .Wa s damage t o downspouts o r downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) 1 .Wa s damage t o drivewa y surface s avoided ? 2 .Wa s damage to walkwa y surface s avoided ? Ye s No / / Ye s No / 

## X 

# y / / 

## X 

# y Ye s No / / 

## 7 X Ye s N o / 

## X X 

# y y Ye s No



## X X

### 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 A.
- ^. . Date : ii/aofr,- ^ 

# y

## Propert yCompletio n Agreemen t Thi s agreement documents th e completion 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 dwit h th 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 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 : Propert y Address : \1| ( 1 Q 

# G T^3n ^ ^ Owner : Phone : Restoratio n Item s i n Question :

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

# v; p

L J 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



## X 7 X/ , yn ^ Dat ePruden t Technologies , Inc . (Prudent ) i s unde r contrac t with th e U . S . Environmenta l Protectio n Agenc y (EPA ) t o clean u p lead
contaminate dsoil s a t anumbe r o f

propertie s locate di n Omaha , Nebraska , includin g th e propert y locate da t

. Th e EP A request s you r pennissio n t o allo w Pruden t t o perfor masoi l cleanu p a t thi s propert y t o remove lead-contaminate dsoil . B y signin g this^form , di 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 sampling , 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 dfor you r property , pleas e contac t Prudent' s Administrativ e Cler k for th e Omah aLea dSit e cleanup . Ms . Madhurim aDur u -a t (402 ) 733-1188 , 733-1455 . General question s abou t th e Omah aLea dSit e cleanu p can b e directe dt o th e EP A Publi c Informatio n Center s a t (402 ) 731-304 5 (Sout h Omah aoffice ) o r (402 ) 991-958 3 (North Omah aoffice) . Propert y Acces s Grante dBy : 

# A (Pleas e Prin t Name ) W Ut^A ^ A i Property Owne r Signature : v , /^^"^" ^ 

# %/o y (Signature ) (Date ) PROPERT Y INFORMATIO N (T o b e complete db y residen t and/o r propert y owne r —pleas e print ) RESIDEN T NAME : v Owne r Rente r 

## J g W^ , RESIDEN T ADDRES S RESli :

I F RENTAL , PROPERT Y OWNED BY :
OWNER' S MAILIN G ADDRESS ; ^ . _ r , \ Ko ^ y ­ 

# \\\ D R -^sfc ^ ^ f r)l..^J U v^> c c^(o ^ OWNER' S TELEPHON E NUMBER-HOME : J L WORK :



## H02 ) ?>M \ 

## - n \ A ^ ^ AG E O F HOME? : 

# :-touV > YEARS
. HO W LON G HAV E YO U LIVE D HERE ? 

# ^ n YEARS
. HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978 7 _ TES " ri«o ~ ^<A A ' ^ NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : O 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 PLAY I 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 FO RENVIRONMENTA L RESPONS E ACTIONS ; Th e activitie s t o b e implemente db y EP A unde r thi s agreemen t at e pursuan t t o Sectio n 104 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s right o f

acces s t o th e property i s provide dfo r i n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic h provide s entry for "determinin g th e nee dfor response , o r choosin g o r takin g an y respons e actio n unde r this title , o r otherwis e enforcin g th e provision s ofth e title. "
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 , T X 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

## A S - BUIL T DRAWING ; 

## OMAB A LEA D SUPERFUN D SIT E OLSV : 2089 7 Dat e Excavated : 10/16/200 8 USEP A Slfficd-OffDate : 

## 2089 7 Exterio rPain l Nofl h Arrow Omah a Laa d Sit » Owne rName : JANE T L (PRESCOTT ) VIVE N Sit e SIcetc h • Goo d Address : 111 0 S 3 3 S T • Poo r ^ Phone : H : 4(g-34i.qe6 3 Wf t 402-*41-pB6 3 [] ) Notpain t

Lea d Sampl e Sample s Collect ^ Sampl e Numbe r LA B Concentratio n Collecte d Fimi: ASi ^ 6<.fC S RYASCPXA-2080 7 F l _J£i2_pp m D Date:
. f/^/Q M RY8SCPXA-2060 7 F 2 W 0 3 pp m Q D Time : 

### < ? - i s RYCSCPXA-2089 7 B l _!£*£

_pp m B D Sample s Analyze d RYDSCPXA-2088 7 B 2 

## dJL ( X pp m D RDZSCPXA.2089 7 D Z pp m B D XRFUnit : il O Book : S 3 

### 31S L RG2SCPXA-2080 7 G Z 

## M . pp m B Dat« : 6//<./c V 

## a RPZSCPXA-20B9 7 P Z ^T U pp m 

## 0 Time : firm D Staff : L- A
. Numbe ro f Sample s = 7 

## ENTERE T ( . V n <. 

## m\8 ms 5lI3*—8 $ 

## l££Krg7( ^ _R.:^ : u.^r

ARE ANO T EXCAVATE D (F

l PLANTS , 3's30 ' @ 39 7 PPM ]

ARE A NO T EXCAVATE D [F l PLANTS ; 3'x3 ' @ 36 8 PP M ] Omiht t Lea dSite 4(SI3 0 E A = 18 5 PP M ® SCRAP E

CONTRAC T # : E P - R7-07-0 6 / 000 4 PRUDEN T TECHNOLOGIES , IN C

# mj M [ECHNOLOGIES , INC . 

# Propert y Statu s For m Address : Date : Phone : BVID : Plant s & Permanen t Landscapin g Item # On Ma p Descriptio n andLocatio n 

# s*-* ' b^vC ^ \tJ ^ ^ 

# a-^c i C:xcU.^.. ^ h'z..dd- ^ l ^

Pre-Existin g Conditio n o^tructuAt s ( ) '^y ^ Doe s you r

Basemen t hav e ahistor y of leaking ? Yes,

—N o —| , Item# • e IA-NJUXSQV X 

# S c Descriptio n & Location cJlftv^^o^^'Vf ^ gov.JH/^.%\«kg , ^o\a
­ UOJL. . 

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Propert y Owne r Pruden t Emplo ; 

# M >^ignaturey<-v. U W->toL * Signature :
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 , T X 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-•e_ev-^ o tA- ^ fdj l ^



# &^ ^ «Wt.L ^ ^ ^ ^^ ' ^'^- ^ oJ^-^^^'^-^ ^

## 2089 7 Omah a Lea d Sit e Exterio rPain t Nort h Arro w Owne rName : JAN E rL (PRESCOTT ) VlVE N 

### Sit e Sketc h Q Goo d Address : 111 0 >33S T • Poo r - > Phone : H : 4C 2-341-086 3 W: 402-341-O t 6 3 Q Notpain t Sampl e Numbej r Lea d Concentratio h Sampl e Collecte d LAIi Colect ^ Sample s (
. RYASCPXAr208d 7 RYBSCPXA-208i 7F 1 F 2 

## Mi 2 Mo 3 pp m pp m 

### Date : Time : i ^ / ^ 3

­ 55 1 

# C ± RYCSCPXA-208U 7 RYDSCPXA-208!) 7 B l 8 2 

# J £ JJ L ^ pp m pp m 

## Q Sample s Analyze d RDZSCPXA-208)> 7 RGZSCPXA-208!) 7 OZ G Z 

## SU L 

# M . pp m pp m XR F Unit : Date : 31 0 Book : S 3 B/JJPXO H RPZSCPXA-2080 7 P Z 

# -si u pp m 

# 0 Time : 

### t^ m Numbe r ofS ; ample s = . 7 Staff : 

### L- A 

# IJNTERE P {>y \ C 

## JUN 1 8 i m I^l*-Si J IEHr^7( ^ ;R></> : T.,^:, c

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Parce l I D Owne r Nam e Property Addres s Cit y Zi p Owne r Addres s Owne r Addres s 2 Owne r Cit y Owne r Stat e Owne r Zi p 190314000 0 PRESCOT T JANE T L 111 0 S 3 3 S T OMAH A 6810 5
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. 

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### Pag e 1 of 2

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

### YOURTICKE T NUMBE RI S 2144995 . Origina l Cal l Date : 10/01/0 8 Time : 9:5 7 a m Op : RAMITA1896 7 Wor k t o Begi n Date : 10/03/0 8 Time : 10:3 0 a m State : N E County : DOUGLA S Place : OMAH A Address : 111 0 Street : S 33R D S T Twp : 15 NRng : 13 E Sect-Qtr : 21-SW,28-N W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n projec t fo r soi l 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 Nam e RAMIT A Phone : (402)733-145 5 Alt . Contac t Phone : (402)733-118 8 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 MCLEODN E MUDO l MUD0 2 OMAHACO F 0PPDGPR 5 0PPDGPR 6 QLNNEI C QLNNEI F
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### Day : 402934046 9 nM r AT M CO X COMMUNICATIONS , „„,r. , 

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### Emerg : 402932975 7 Day : 877366834 4 LEVEL S LEVEL 3 COMMUNICATIONS , ^ ^ 

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### Emerg : 877366834 4 Day : 800289190 1 N O NEE D T O CAL L OU T MCLEODN E MCLEODUS A 

### Alt : EMERGENC Y 

### Emerg : 800289190 1 METROPOLITA N UTILITIE S MUDO I SAND Y 

### Day : 402504782 3 DISTRIC T 

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