SAID# : 2830 0 

### TRANSMITTA L O F OIVIAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R DATE : 1/1 5 ADDRESS : 291 6 ERSKIN E S T REMEDIATIO N CONTRAaOR : PRUDENTTECHNOLOGIES . IN C YEAR : 201 0 

### SOI L REMEDIATIO N PROPERT Y FIL E FOLDE R DOCUMENT S d PR E AN D POSTVIDE O O F PORPERT Y (DVD ) I Z EXECUTIV E SUMMAR Y m EPA-PROVIDE D PROPERT Y SKETC H 0 SIGNE D ACCES S AGREEMEN T FOR SUBJEC T PROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN T PROPERT Y 0 RESTORATIO N AGREEMEN T D SETTLEMEN T DOCUMENTS (I.E. , FOR DAMAG E O R TO REPLAC E PLANTS , ETC. ) d CONFIRMATIO N DAT A

• PHOTOGRAPH S [ Z AS-BUIL T SKETC H d SATISFACTOR Y RESTORATIO N SIGNE D B Y PROPERT Y OWNE R yPROPERT Y CLOSE-OU T CHECKLIS T SIGNE D B Y EP A n DESCRIPTIO N O F AREA S NO T MEETIN G RO D CLEANU P CRITERI A [ F UTILIT Y CLEARANCE S 0 PROPERT Y INFORMATIO N FRO M DOUGLA S COUNT Y ASSESSOR'S OFFIC E D 

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^<y ^ \\^t>\\\ . SIGNATUR E DAT E 

### 3021842 6 

# lliliill i Superfun c

### PROPERT Y SUMMAR Y Date : /15/201 0 Omah aLeadSit e Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Propert y Address : 291 6 ERSKINE 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 = 29 0 PP M @ 4" ; N O EASEMENT ATTACHMENT S 1 ) Propert y sketchprovidedb 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 vide o clip/photograph s 4 ) Post-Excavation digita l video clip/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Buil t sketc h­ i ) Shal l includ e fina l lea dlevel s v ) Legen d ii ) Contamination lef t behindarea s vi ) Contracto r identification iii ) Propert y addres s vii ) Dat e iv) BVI D numbe r 7 ) Othe r items to be includedi n the individua l propert y file , i f available , o r obtainedinclude : i ) Pre-excavation agreemen t detail s (if an 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 video i n MPEG , WM V (Window s Medi aVideo ) o r SW F(FlashPlayer ) forma t and/o r photograph s iv ) Signedfor mverifying satisfactor y restoration v ) Description ofarea s no t meeting Interi mRO D cleanu p criteria .

TECHNOLOCIES . INC .

### 3 TECHNOLOGIES , INC . 

### Propert y #: Z ^ 3 <; ^ Date/Time : Quad s Excavated : ^'2_
­ 

# .A'.-yryA \ ••^•: . y^y=^\ i yy . 

# EF A Propert y Clos e Ou t Propert y Address : 2^i ^ ^rfKl-^ e S^
­ Owner' s Nannie : ^Tr-Hj , c^^''*^*-'^' H Contracto r Group : Pruden t Techuologics , Hwc , Excavatio n Genera l Ye s N o I I f necessary , wer e the correct quadraitt(s ) excavatedaiT drestored ? / 2 . I f necessim- , wer e tii e correct area s o f drip zone excavatedan drestored ? / Gradin g So dan dVegetatio n Ye s N o 1 .

Doe s the gradin g aroundtli e perimete r o

f th e hous e in excavatedarea s generally slop e awa y / fro mthe house ? 2 .Ha s so dbeen laidi n all area s tha t wer e excavated ? / Doe s the sodappea r to b e generall y health y andgrowing ? (Onl y evaluate i f inspecteda t a3 0 da

y lim e period) 

# y 4 .Ar e sodde darea s generally fir mandevenl y graded ? 

## y 5 .Ar c tlie joint s between the sodstnp s generall y light ? (Onl y evaluat e i f inspecte da t a3 0 da y


### —.. . tim e penod ) 

### / 6 ,Wa s the propert> ' gradedsuc htlia t wate r wil l no t pool o n di e property ? 

# y 7 . Wa s daniag e t o landscaping o r plan t material s avoided ? 

## y Gates , Fence s an dRetainin g Wali s Ye s N o 1 .

D o gate s ope n andclos e freely ? (I f apphcable ) / 2 . Wer e al l gate s o r fence s talce n dow n during restoratio n activitie s reinstalled ? (I f applicable ) 

# y 3 . Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) 

# y 4 . Wasdamag e t o retaining wall s avoided ? (I f applicable ) 

## y Foundation , Sidin g an dGutter s Ye s N o 1 Wci s damag e t o the siding o r tri mavoided ? 

# y 2 . Wa s damage lo th e foundalion avoided ? 

## y 3 . Wa s damag e l o window s avoided ? 

# y 4 . Wa s damag e t o window s or doo r screen s avoided ? 

# y 5 . Wa s damag e t o downspout s o r downspou t extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Ye s N o W;is damag e lo diivewa v surface s avoided ? / 

### Wa s damag e t o walkwa y surface s avoided ? 

# y

## Owner s comments :



# y Inspectio n notes : o f 

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## Remova l an drestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e J9e ^ ^. ^ Date : i/iifil

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### A S - BUIL T DRAWIN G 

# f OLS#28J« 0 Dat e Excavated : 11/23/201 0 I'SEP ASigned-Of T Date : 

### OMAH A LEA D SUPERFUN D SIT E

Name : C ir> ) c- f 6;»t^./.v , Omah a Lea d Sit e /\cldress~~T'i7( - C,<iKini > 5 h Sit e SIcetc h Phone ; Tea m 

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•-'• y y Time : XR FCod e Q/SHJ ) Confirmatio n Sampl e r < Ye s a No S2 ^ T

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Oniah aLea dSite 4613 0 CONTRAC T # : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC .

# SEPA Propert yCompietio n Agreemen t Thi s agreemen t document s 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 dwit hth 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 : PropertyAddress ; ^c^i^ ^ fj^s^/r ^ Sdj^y Owner : Phone : 0 /J/- . , / j/j/^i ^ 

## Hoj - ^/(-/H - ^/p^ r Restoratio n Item s i n Question :

Item : iv^''0^<X - prppM;/by-t.v^<. . <<S>WccX 5t'< S mAi 9 Item : Item : item : Item : Item : Require d correction s t o complet e th e property :

E H I agre e restoratio n i s completed . 

# "^a^ t d o no t agre e restoratio n I s complete d a t (note d deficiencie s above )



### y i 

### " /

^^u..^i,y y-yoc d DatePruden t Technologies , Inc . (Prudent ) i s unde r contrac t withth e U . S . Enviromnenta l Protectio n Agenc y (EPA ) t o clea n u p lead
contaminatedsoil s at anumbe r ofpropertie s locate di n Omaha , Nebraska , includin g th e propert y locate da t i^Tl( i r^fS.Lcf/'i ^ • Tli e EP A request s you r permissio 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 propert y 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-contamitiate dsoil , an drestoratio n ofth e reference dproperty . Ifyo 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 sout hoffic e _fo r th e Omah aLea d Sit e cleanup-a t (402 ) 733-1188 . Genera l 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 at (402 ) 731-304 5 (SouthOmah aoffice ) o r (402 ) 991-958 3 (NorthOmah aoffice) . Property Acces s Grante dBy : 

## //////>o^v ) yui^ h (Pleas e Prin t Name ) Propert y Owne r Signature : '^/l y ^7^y/i y { ly^yyOl Q J 7 ^ (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 : A/ITflff ^ -^L^U/j^y ] yiLo4<yA1hh { (Owner ) Rente r ^ RESIDEN T ADDRESS : 

# <Q^\ L ^x^vy^ ^ iii . I F RENTAL , PROPERT Y OWNE D BY :
OWNER' S MAILIN G ADDRESS ; ^ ^ - , 

## /// ^ ^AA ^ C)- . S^ y ni l . Qyyyha ^ U rtr/& ^ OWNER' S TELEPHON E NUMBE R - HOME : ( \ WORK : 

## (Va > ^ y y?^} " 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 Y 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 LRESPONS E ACTIONS ; Th e activitie s f o b e implemente db y EP A unde r thi s agreemen t ar e pursuan t t o Sectio n 10 4 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s righ t ofacces s t o th e propert y i s provide dfor i n Sectio 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 o r 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 d Parkway , 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 . NetKask a 6810 7 Sa n Antonio , TX 7822 9 Phone:(816)363-370 3 Phone : (402)733-118 8 Phone : (210)822-968 8 Fax:(816)363-370 7 Fax : (402 t 733-188 3 Fax ; (210 ) 579-667 7

# 1 ENV[RO.NME^TAL & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SJERVICE. S 

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Propert y Owne r Pruden t Employe e Signature : Signature : 808 0 War d Parkway , Suit e 40 5 560 0 S 1 0 S t edica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Onnaha , Nebrask a 6810 7 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)733-118 8 Phone : (210)822-958 8

### Name : C < f y <: < OtAc^Lu \ Omah aLea dSit e 

# Date : Ml^hfL . NtorthAiro w — i 

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# 291 6 Erskin e 

# A Printed : De c 08 . 201 0 www.dcgis.org/dogi s

## Pag e 1 o f

1

Creat e Anothe rTicke t Bac k t o Irt h Inteme t Sen d Emai l
YOU RTICKE T NUMBE RI S 2592088 . Origina l Cal l Date : Wor k t o Begi n Date : 9/14/1 0 9/16/1 0 Time : 5 Time : 6 2 8 p m 0 0 p m Op : SIVA1896 7 State : N E Address : 291 6 County : Street : DOUGLA S ERSKIN E S T Place : OMAH A Twp : 15 NRng : 13 E Sect-Qtr : 09-SE-S W 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 : UNSUR E CORNER S Compan y: PRUDEN T TECHNOLOGIE S Contac t Name : SIVAJAMPAM 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 : NFront : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Service Are a Contac t Phon e Numbe r Utilit y Typ e Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEIDI Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUDO l METROPOLITA N UTILITIE S DISTRIC T SAND Y Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACOFCITY O FOMAHA-TRAFFIC.SEWE RRICHnTRAFFI C Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 OPPDGPR5 OMAH A PUBLI C POWE RDISTRIC T EL M LOCATIN G Alt : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 QLNNEI C QWES T LOCA L NETWOR K EL M LOCATIN G Alt : 406207149 4 Emerg : 888728934 3
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/14/201 0

### ENVIRONMENTA L ENGINEERIN GAN D CONSTRUCTIO N TDDHMflLOOaSB , m c 

### SOLUTION S 

## SIT E SAFfeTY HAZAR D ANALYSI S Address : 

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## Overliea dLine s Gas Lin e Wate r Lin e Sewer Lin e Septic/Leec h Fiel d Propane/Bntan e Sidewal k Foundatio n Retainin g Wall s Fence s Tree s Stmcture s Driveway Sprinkle r Syste m Othe r Cre w Forema n 

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## Sit e Safet y OfBc e Date :

424 2 Medica l Drive , Suit e 725 0 Sa n Afltenio , 7X7822 9 Phone : (210 ) 822.«58 8 Fax : (240)679-657 7

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