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### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 2925 3 DATE : 1/1 5 ADDRESS : 250 9 CORB YS T REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES . INC . YEAR : 20l t 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S D

TPR E AN D POSTVIDE O O F PORPERT Y(DVD ) Q^EXECUTIV E SUMMAR Y \ Z EPA-PROVIDE D PROPERT YSKETCH SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN TPROPERT Y H'^RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R TO REPLAC E PLANTS , ETC. ) H^CONFIRMATIO N DAT A B^PHOTOGRAPH S Q^AS-BUIL TSKETCH 0

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SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R O^PROPERT YCLOSE-OU TCHECKLIS TSIGNE D B YEP A D DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A Ca^UTILIT YCLEARANCE S

•^PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E D D D 

### A ^

Wfr.»i 3////// SIGN/^UR E DAT E 

### 3021842 0 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 : 250 9 CORB Y S T 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 : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS :

B l = 32 7 PP M @ 2" ; N O EASEMEN T ATTACHMENT 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-Buil t sketc h­ 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 din 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 Formsigne db y property owne r iii ) Excavatio n digita l vide o in MPEG , WM V (Window s Medi aVideo ) o r SWF(Flas hPlayer ) format 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 : 2925 3 - 250 9 CORB YS T Owner : D Owne rOccupie d Owne rName : lOMAH AHOUSIN G AUTHORIT Y Owne rAddressl : 

# I Owne rAddressZ : |54 0 S 2 7 S T City : State : Zi p Code : JOMAHA 

## [N T {6810 5 Owne rPhon e Alternat e Phone :

Contract : Contractor : |PRUDENT2010_S Contrac t Optio n (OPnO N 2 Remediatio n Queryj Lea d Remainin g Queryj Propert yDamag e Query

Use rProvide d Owne rInformatio n Owne rName : 

# 1 Owne rAddress : 

# 1 aty : 

# 1 State : 

# 1 Zi p Code : 

# 1 Owne rPhone : 

# 1 Alternat e Phone :



# - 1

Assessment : Qualifyin g Grou p (40 0 Assessmen t Ma xXR F Valu e ( 

### 484 Resident : Residen t Name : Propert yAddress : |250 9 CORB YST Zi p Code : |68111 - Residen t Phon eTECHNOLOGlfe , INC . 

# EP A Propert y Clos e Ou t Propert y # : Z^"?.63 - Propert y Address : Z^<^ ^ Ca-rhc y VT . Date/Time : Owner' s Name : ^%-«» V {4ow.'>i" ^ /4«c^*"^'^<^ Quad s Excavated : V3 > \ Contracto r Group : Pruden t Technologies , Unc. , Excavatio n Genera l Ye s N o 1 . I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? / 2 . If necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? , / 

### Gradin g So dan dVegetatio n Ye s N o 1 . Doe s the grading aroundth e perimete r o

f th e hous e in excavatedarea s generall y slop e awa y / fro mthe house ? 2 . Ha s sodbeen laidin all area s tha t wer e excavated ? / :i . Doe s th e sodappea r to b e generall y health y andgrowing ? (Onl y evaluate i f inspecte da t a3 0 / da

y time period) 4 . Ar e soddedarea s generally fir man devenl y graded ? 

# y 5 . Ar c tlie joint s between tlie so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 da y / tim e period) 6 . Wa s the propert y grade dsuc hdia t wate r wil l not pool o n the property ? 

# y 7 . Wa s dainag e t o landscaping o r plan t matenal s avoided ? 

# y Gates , Fence s an dRetainin g Wall s Ye s No 1 . D o gate s ope n an dclos e freely ? (I f applicable ) 

# y 2 . Were al l gate s o r fence s take n dow n durin g restoratio n activitie s reinstalled ? (I f apphcable ) Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) 

# y 4 . Wa s damag e t o retainin g wall s avoided ? (I f applicable ) 

# 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 . Wa s damag e t o the foundalion avoided ? 

# y 3 . Was dainag e t o window s avoided ? 

# y 4 . Wa s damag e t o window s o r 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 y N o Wa s damag e t o drivewa y surface s avoided' ? Wa s damag e t o walkwa y surface s avoided ? 

# y I

## Owner s comments :

Inspectio n notes :

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# y\ ^^

Remova l an drestoratio n activate s complete includin g th e 30-da y so dwarranty . EP A Representativ e ^< ^ M^ Date : t-i^-' i2925 3 CHNOLOGIES . INC . 

### A S - BUIL T DRAWIN G OL S #292,S 3 Dat e Excavated : 11/04/201 0 

### OMAH A LEA D SUPERFUN D SIT E USEP A Signcd-Of f Date :

Exterio rPain t Nor m Arro w < ' Omah a Lea d • Sit e • Goo d Sit e Sket ( : h • Poo r Samplin g Address : 250 9 CORB YS T 

# I 1 rt* No t pain t Sampl e Numbe rLea d Sampl e Sample s Collecte d Concentratio n Collecte d ^ F irm : fnl ^ P Ar.f . RYASCPXA-2925 3 F l J ^ <

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

# SERA

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## Propert yCompietio n Agreemen t Thi s agreement document s th e completio n o f removal activitie s performe do n th e belo w liste dproperty . Th e property owner' s signature indicate s that th e property owner i s satisfie dwithth e restoratio n o f th e subjec t property , an dthat n o item s ar e i n question , now , o r at an y tim e i n th e fiiture, excludin g any remainin g warranty (3 0 day s total ) excep t thos e item s liste dbelow , i f any , Property ID : Property Address : 250 9 Corb y S t Owner : Omah a Housin g Authorit y 

### Phone : 402-444-6900x25 1 Restoratio n Item s i n Question :

Item : Th e sit e i s sno wcovere d a t thi s tim e an d th e so d i s dormant . Bein g unabl e t o Kem : inspec t th e sod ; OH Acanno t b e certaj n o f satisfaction . Pmden t agree s tha t Item : warrant yo f wor k i s extende d durin g winte rmonth s throug h spring , i f so d doe s no t Hem : tai< e roo t an d becom e health yb yth e en d o f spring , Pruden t t o b e responsibl e fo r Item : replacin g so d a t tha t time . Kem : Require d correction s t o complet e th e property :

I I I agre e restoratio n i s completed . X I d o no t agre e restoratio n i s complete d a t (note d defldencie s above )



## ' yZ^4LyyyyAy^u.ti ^^ y ^ 

# '^/yA// i 7 0 Owner' s Signature Dat ePruden t Technologies . Inc . (Prudent ) i s under contrac t wit hth e U . S . Envntrnmenta l Protectio n Agency (EPA ) t o clea n u p lead contaminate dsoil s a t anumber ofpropertie s locate di n Omaha . Nebraska , includin g Ihe propert y locate dat 230 9 Corb y Stree L Omaha , NE . Th e EP A request s your permissio n t o allo w Prudent t o perfor masoi 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 owner grant s pennissio n (o Pruden t t o perfor mactivitie s relate dt o th e cleanu p includin g soi l sampling , remova l o f lead-contaminate dsoil , andrestoratio n ofth e reference dproperty . I f you hav e an y question s abou t th e soi l cleanu p planne dfo r your propetty , pleas e contac t Pruden t soulhofTic e .for th e Omah aLea d Sit e cleanup-at (402 ) 733-1188 . Genera l question s abou t th e Omah aLea dSit e cleanup ca n b e directe dt o th e EP A Publi c Infonnatio n Center s a t (402 ) 73 1 -304 5 (Sout hOmah aoffice ) o r (402 ) 99 1 -958 3 (Nort hOmah aoffice) . Propert y Acces s Grante dBy : Stanle y Timm , Executiv e Directo r fo r Oinah aHousin g Authorit y Pleas e Prin t Name ) Propeft y Owner Signature : 

# id^ r (Date ) 

# / o PROPERT Y INFORMATIO N (T o b e complete dby residen t and/o r propert y owne r —

pleas e print ) RESIDEN T NAME : Vacan t Lo t Owne r Rente r RESIDEN T ADDRESS : 250 9 Cofb yStreet , Omaha , NE . I F RENTAL , PROPERT Y OWNE D BY : Th e Omah a Housin g Authorit y OWNER' S MAIUN G ADDRESS ; 54 0 S . 2?" * Street , Omaha , NE , 6810 5 OWNER' S TELEPHON E NUMBE R - WORK : ( 40 2 ) 444-690 0 X25 1 AG E O F HOME? : N/ A YEARS . HO W LON G HAVE YO U LIVE D HERE ? N/ A YEARS . HA

S TH E EXTERIO R BEE N PAINTE D OR COVERE D WIT H SIDIN G SINC E 1978 ? YE S N O N/A NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : _N/ ANUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDE R

N/A NUMBE R O F CHILDRE NUNDE R 7 YEAR S OL D WH O PLA Y I NTH E YAR D FO R 5 HOUR S O R MOR E PE R WEEK : N/ A COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. )

AUTHORITY FO RENVIRONMENTA LRESPONS EACTIONS ; Th e activitie s t o b e implemente db y EP A under thi s agreement are pursuant t o Sectio n 10 4 ofCERCLA . 4 2 U.S.C . 9604 . EPA s right ofacces s t o th e propert y i s provide dfo r i n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) . whic hprovide s entr y fo r "determinin g th e needfo r response , o r choosin g o r takin g an y respons e actio n unde r thi s title , or otheruis 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 , 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 Fax : (816 ) 363-370 7 Fax : (402)733-188 3 Fax : (210 ) 579-657 7riOfWTRfJCfVO!' ! 

### TECHNOLOGRIES . INC . 

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# 2925 3 

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### Pag e 1 o f 1

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### • YOURTICKE T NUMBERI S 2632793 . Origina l Cal l Date : 11/02/1 0 Time : 4:2 1 pm Op : SIVA1896 7 Wor k t o Begi n Date : 11/04/1 0 Time : 4:4 5 pm State : N E County : DOUGLA S Place : OMAH A Address : 250 9 Street : CORB Y S T Twp : 15 NRng : 13 E Sect-Qtr : 09-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : SOI L LEA D REMEDIATIONPROJEC 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 MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Servic e Are a Contac t Plion e Nunibe r Utility Typ e CXCAT V CO X COMMUNICATIONS , INC HEID I 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUDO l METROPOLITA N UTILITIE S DISTRIC T SANDY 

### Day : 402504782 3 Alt : 

### Emerg : 402504797 0 OMAHACOFCIT Y O FOMAHA-TRAFFIC,SEWE R 

### RICHA-RAFFI C Day : 402444719 7



### Alt : 402444516 1 Emerg : 402444516 0 OPPDGPR5 OMAH A PUBLIC POWE RDISTRIC T EL M LOCATING 

### Day : 406728934 3 Alt : 406207149 4 

### Emerg : 888728934 3 QLNN E1 C QWES T LOCA LNETWOR K 

### EL M LOCATIN G Day : 406728934 3

Alt : 406207149 4

Emerg : 888728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 11/2/201 0

### ENVIRONMENTAL ENGINEERm GAN D CONSTRUCTIO N TECMNOLOGIES , mc . 

### SOLUTION S 

## SIT ESAFET Y HAZAR D ANALYSI S Address : 2£o5_Qo/.L^_<i i Excavatio n Date : IhJl^jiQl O Crew : j2iH^JoylsuJ.lo.£,j L Backfil l Date :

Ite m Conditioi i Hazard s Correctiv e Actio n Overhea dLine s Ga s Lin e Wate r Lin e ^j_6 _ 

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## Fence s 

# ao - Tree s IU . 

## Structure s ^Ij ^ 

## Driveway 

# n ^ Sprinkle r Syste m K ^ Othe r Cre w Forema n Site Safet y Offic e Date : ^

808 0 Wan f Cailany , Suit e Att S 424 2 Medica l Drive , Suit e 725 0 

## iseoosios t Kansa s GJfy . M O 6411 4 Sa n Antonio , T X 7822 9 PlMtie:(816)36»^70 3 Omaha , NebRask a6810 7 Phone : (21D) 822-958 8 Fax : (8t6 ) 363-370 7 Phone : (402)733-118 8 Fax : (210)579-657 7 1=ax: (402)733-188 3i< i 

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