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### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 2756 2 DATE : 1/1 5 ADDRESS : 262 0 PATRIC KA V REMEDIATIO N CONTRACTOR : PRUDEN T TECHNOLOGIES . INC . YEAR : 201( ^ 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S yJ ^ 1/5-7 ^ PR E AN D POS T VIDE O O F PORPERT Y (DVD ) '«'^>'V< i m EXECUTIV E SUMMAR Y

• EPA-PROVIDE D PROPERT YSKETC H Q SIGNE D ACCES S AGREEMEN T FOR SUBJEC T PROPERT Y d SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN TPROPERT Y d RESTORATIO N AGREEMEN T D SETTLEMEN T DOCUMENTS (I.E. , FOR DAMAG E O R TO REPLAC E PLANTS , ETC. ) Q CONFIRMATIO N DAT A a PHOTOGRAPH S •AS-BUIL TSKETCH SATISFACTOR YRESTORATIO N SIGNE D B Y PROPERT Y OWNE R PROPERT YCLOSE-OU T CHECKLIS T SIGNE D B Y EP A O

DESCRIPTIO N O F AREA S NOT MEETIN G RO D CLEANU P CRITERI A

• UTILIT YCLEARANCE S p l PROPERT YINFORMATIO N FRO M DOUGLA S COUNT Y ASSESSOR'S OFFIC E D D D s\] ^ ^ ' ^ SIGNATUR E DAT E 

### 3021857 8 Superfun d

### PROPERT Y SUMMAR Y Date : /15/201 0 Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Propert y Address ; 262 0 PATRIC K A V A . EXECUTIV ESUMMAR Y A. l 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 GDATA/RESUj&'S : B 2 = 23 6 PP M @ 8" ; N O EASEMEN T ^ V ATTACHMENT S * s ^ 1 ) Property sketc hprovide db y EPA 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 digita l 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 final 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 di n th e individua l property file, i f available , o r obtaine dinclude : i ) Pre-excavatio n agreement detail s (i f an y ar e mad e withth e property owner ) ii ) Property Statu s For msigne db y property owne r iii ) Excavatio n digital vide o i n 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 .

TECHNOLOGIES , INC .Fin d Recor d Remediatio n Query Lea d Remainin g Query; Propert yDamag e Quer y 

### Backfill :

Sampl e Area : 2756 2 - 262 0 PATRIC KA V Owner :

• Owne rOccupie d Owne rName : MOBEC O INDUSTRIE S Owne rAddressl : Owne rAddress2 : 11141 3 HICKOR YR D City : State : Zi p Code : JOMAHA N E 168144 - Owne rPhon e Aiternat e Phone : 174027342-282 0 f

Contract : Contractor : JPRUDENT2010_ S Contrac t Optio n [oPTIO N 2 Use rProvide d Owne rInformatio n Owne rName : 

# i Owne rAddress :
City : State : Zi p Code : Owne rPhone : Alternat e Phone : 

# i

Assessment : Qualifyin g Grou p J40 0 Assessmen t Ma xXR F Valu e Resident : Residen t Name : ] RESIDEN T Propert yAddress : ]262 0 PATRIC KA V Zi p Code : 168111 - Residen t Phon eTECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y # : Z 7 %2 - Propert y Address : 2^Z( ^ PaV^^V . <4l^«- . Date/Time : Owner' s Name : /X<3bec< 3 Xi^ M ­ Quad. s Excavated : (^" 2 Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s N o 1 . I f necessary , wer e th e correci quadrant(s ) excavatedandrestored ? 2 , I f necessary , wer e th e correct area s o f drip zone e.xcavate dandrestored ? / 

### Gradin g Sodan dVegetatio n Ye s N o 1 Doe s the gradin g aroundth e perimete r o

f th e hous e in excavatedarea s generall y slop e awa y 

## y fro mth e house ? 2 .

Has sodbee n lai di n all area s tha t wer e excavated ?

. ^ 3 .

Doe s the sodappea r to b e generally health y andgrowing ? (Onl y evaluat e i f inspectedat a3 0 da

y lim e period) 

# y 4 .Ar e soddedarea s generally fm n andevenl y graded ? 

# A 5 ,

Ar e tlie joint s betwee n tlie sodstrip s generall y tiglit ? (Onl y evaluat e i f inspecte da t a3 0 da y lim e period) 

# X 6 .

Wa s tli e propert y gradedsuc htlia t wate r wil l not pool o n the property ? y 7 .

Wa s dainag e t o landscaping o r plan t material s avoided ? 

## y Gates , Fence s an dRetainin g Wall s Ye s N o 

### y 1 .

Do gate s ope n andclos e freely ? (I f applicable ) 1 .Wer e all gate s o r fence s taken dow n during restoratio n activitie s reinstalled ? (I f applicable ) 

# y 3 .

Was dainag e t o gate s or fence s avoided ? (I f applicable ) 

# y Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) 

## y Foundation , Sidin g an dGutter s Ye s N o 1 .

Wa s damag e t o the siding o r trimavoided ? 

# y 2 .

Was damag e t o th e foundation avoided ? 

# y 3 .

Wa s damag e l o windo w s avoided ? 

## . y 4 . Wa s damag e t o window s o r doo r screen s avoided ? ^ 5 . Wa s damag e l o downspout s o r downspou t extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Ye s N o Wa s damag e t o drivewa v surface s avoided ? 2 .

Was damag e to walkwa y surface s avoided ? I

## Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e ^^^s^L - Date : njtji bnTTiNoixXiir-is , INC . 

### vS - BUIL T DRAWIN G OL S n 2756 2 Dat e ^:\ca^aU'd : 10/20/201 0 

### [ A LEA D SUPERFUN D SIT E ISEP A Signed-OffDate : 

### 2756 2 Exterio rPain t Nort h Arro w Omah a Lea d Sit e Samplin g Address : 262 0 PATRIC KAV Sit e Sketc h • Goo d 

# i

• Poo r Phone : H (402)342-282 0 ALT : [ ^ No l pain l Sampl e Numbe r Lea d Sampl e LA B Sample s Collected Concentratio n Collecte d Fir mFP/ I P9-(:< : RYASCPXA-2756 2 F l pp m 

### D Dat e ? - 17 - -Jll . RYBSCPXA-2756 2 F 2 pp m Tjm e U • |ga m 

# n RYCSCPXA-2756 2 B l pp m 

### D Sample s Analyze d RYDSCPXA-2756 2 B2 pp m 

# I D nOZCOPX A2750 2 B2 ­ pp m 

### D D XR F Unit : (o5H2 . Book . //? y nozocrxA-27002—e ? pp m 

### D D Dat e RJRfCr i RPg3CPXA-2750 2 P2 - pp m Tim e ? h ' 

# a a Staf f M9> U Numbe rof Sample s = U Legend : F l = Fron t Left , F2 = Fron t Right . 8 1 = Bac k Left , 8 2 = Bac k Righ t DZ = Dri p Zone , G Z = Garden , P Z = Pla y Al l Quadrant s ar e a s ubEUMedfrorn th e street , facin g propert y 

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

# hlS> A Propert yCompletio n Agreemen t Thi s agreement document s 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 dwithth 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 at an y tim e i n th e future , excludin g any remainin g warranty (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y ID : Propert y Address : 

## Q^CSi o pr>^nri : /r^> ^ Owner : Phone : Restoratio n Item s i n Question :

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

lid n 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 )

Owner' s Signaturev ^ DatePniden t Tectaologies , Inc . (Prudent ) i s unde r contrac t withth e U . S . Enviromnenta l Proteaio n Agenc y (EPA ) t o clea n u p lead cogLarninate dsoils/r t anumbe r o f

propertie s locate di n Omaha , Nebraska , includin g th e propert y locate dat (7^ ^ WL P fOrt'C* - " V ^^" ^ ^^' ^ request s you r permis.sio n t o allo w Pruden t t o performasoi l cleanu p a t thi s propert y t o remov e lead-contaminate dsoil . B y signin g thi s form , th e property owne r grant s permissio n t o Pruden t t 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 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 Pruden i southoffic e for th e Omah aLea d Site cleanup-a t (402 ) 733-1188 . Genera l question s abou t th e Omah aLea dSit e cleanu p ca n b e directe dt o th e EP A Publi c Informatio n Center s at (402 ) 731-304 5 (Sout hOmah aoffice ) o r (402 ) 991-958 3 (NorthOmah aoffice) . Property Acces s Grante dBy : 3^f^Afi-l > ^( 3 fZiaLlj O F ^ ^ /^0^£C Q jT ^ ^ •^'^ C (Pleas e Prin t Name ) Property Owne r Signature :

## ^^PdhMc^J. . (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 TNAME : (/AKL/A/T " Ct > T Rente r RESIDEN TADDRESS : 

## e^^l afATl^lCJ C At/ ^ I F RENTAL , PROPERT Y OWNE D BY : 

# fOlk OWNER' S MAILIN G ADDRESS ; 

## /I' f 1 3 /^/cKoit U 1^ ^ omAHj ^ OWNER' S TELEPHON E NUMBE R - HOME : (4^2 ^ 1> 1 2 ' Z- % "2^ WORK : ( ) 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 : A'/A COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES . ETC. ) W / ^

ALTHORIT Y FO RENVIRONMENTA LRESPONS E ACTIONS : Th e activitie s t o b e implemente db y EP A unde r 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 right o f

acces s t o th e propert y i s provide dfor mSectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry for "determinin g th e nee dfor response , o r choosin g or takin g an y respons e actio n unde r thi s title , o r otherwis e enforcin g th e provision s ofth e title. " 808 0 War dParkway , Suit e 40 5 560 0 S 1 0 S t 424 2 Medica l Drive , Suit e 425 0 Kansa s City.'M O 6411 4 Omaha , Nebrask a6810 7 Sa n Antonio , T X 7822 9 Phone ; (816 ) 36^-370 3 Phone : (402 ) 733-118 8 Phone ; (210)822-958 8 Fax : (816 ) 363-370 7 Fait : (402 ) 733-188 3 Fax ; (210)679-667 7

### Pag e 1 of 2

" > Creat e Anothe rTicke t Bac k t o Irt h Intemet Sen d Emai l YOU RTICKE T NUMBE RI S 2618625 . Origina l Cal l Date : 10/15/1 0 Time : 4:0 1 p m Op : SIVA1896 7 Wor k t o Begi n Date : 10/19/1 0 Time : 4:3 0 p m State : NE County : DOUGLAS Place : OMAH A Address : 262 0 Street : PATRICK AVE Twp : 15 NRng : 13 E Sect-Qtr : 09-SE,16-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 : 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 Bein g Don e For : EP A Dept h o f Excavation : 6 F T Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL S MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C



### Servic e Are a Contac t Phon e Number 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 UTILITIES DISTRICT SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R RICHATIAFFI C 

### Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0 

### Day : 406728934 3 http://www.dhoii.org/irthmternet/DHONNoticeCreatioii/MessageText.asp?ret=<RESULT. . . 10/15/201 0

### Pag e 2 of 2 0PPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T Alt : 406207149 4

EL M LOCATIN G Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K Day :

EL M LOCATIN GAlt : 406728934 3 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 10/15/201 0TBBHMOLO^^ , WC . 

### CONSTBUCnO N SOLUTION S 

## SIT E SAIi^T Y HAZAR D ANALYSI S Address ; -^iA:f>- . 

# fcJ^^cl ^ /> y Excavatio n Date : Crew : 

## Backfil l Date :

Ite m Overhea dLine s Ga s Lin e Wate r Lin e Sewe r Lin e Septic/Leecl i Fiel d Propane/Butan e Sidewal k Foundatio n Retainin g Wall s Fence s Tree s Structure s Drivewa y Sprinkle r Syste m Othe r Cre w Forema n Conditio n Hazard s Correctiv e Actio n c^ ^ A=^. ) i-t^ . >-r- 5 -s 

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## Sit e Safet y Ofiic e Date :

seoosios t 424 2 Medica l Drive , Suit e 726 0 nsM;a)lyillO«411 4 OmAtai , NalM<B6k 8 4810 7 Sa n Antonio , T X 7822 9 tone : fSM ) SSS-STOS Phon K(402)733-11S S Phone : (2t0 ) 82Z-«68 8 x : ^n ) 383«370 7 Fax : (4aZ)73»»-MS 3 F« : {210 ) «r»-«57 7

# 2756 2 Exterio rPain t Nort h Arro w 

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