0 

### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 2882 0 DATE : 1/1 5 ADDRESS : 201 1 OHI O S T REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES . INC . YEAR : lOl t 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S PRE AN D POSTVIDE O O F PORPERT Y(DVD ) 1 3 EXECUTIV E SUMMARY IZ I EPA-PROVIDE D PROPERT YSKETCH 0

^

SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y n SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN TPROPERT Y B ^ RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R T O REPLACE PLANTS , ETC. ) 1

^

CONFIRMATIO N DAT A ^PHOTOGRAPH S C rAS-BUIL TSKETCH Q^SATISFACTORYRESTORATIO N SIGNE D B YPROPERT YOWNE R Q^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 Q

^

UT I LIT YCLEARANCE S a PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E
D D

SIGNATUR E DAT E 

### 3021836 2 

# Hil l Superfun d

### PROPERT Y SUMMAR Y Date : /15/201 0 Oinah aLea dSit e Remedia l Actio nContrac t #EP-R7-07-0 6 TO# l Mont hof : Propert y Address : 201 1 OHI O 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 Infomiation : NON E CONFIRMATIO NSAMPLIN GDATA/RESULTS :

B l = 24 4 PP M @ 6" ; E A= 13 5 PP M @ SCRAP E(-1" ) ATTACHMENT S 1 ) Property sketc hprovide db y EPApursuan 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 ndigita l vide o clip/photograph s 4 ) Post-Excavatio ndigita 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 nlef 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 nth e individual property file, i f available , o r obtainedinclude : i ) Pre-excavatio nagreement detail s (i f any ar e mad e withth e property owner ) ii ) Property Statu s Formsigne db y property owne r iii ) Excavatio ndigita l vide o inMPEG , 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 nofarea s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOCIES , INC .Fin d Record 

### Backfill :

Sampl e Area : 2882 0 - 201 1 OHI O S T Owner : D Owne rOccupie d Owne rName : lOT YO F OMAH A Owne rAddressl : |C/ 0 PLANNIN G DEPARTMENT Owne rAddressZ : |181 9 FARNAM ST City : State : Zi p Code : lOMAH A JN E |68183 - Owne rPhon e Alternat e Phone : 

# 1 i

Contract : Contractor : |PRUDENT2010_S Contrac t Optio n ]BAS E Remediatio n Query| Lea d Remainin g Quer yI Propert yDamag e Quer y

Use rProvide d Owne rInformatio n Owne rName : 

# 1 Owne rAddress : 

# r City : 

# r state : 

# 1 Zi p Code : 

# 1 Owne rPhone : 

# r Alternat e Phone : 

### ' Assessment : Qualifyin g Grou p |40 0 Assessmen t Ma xXR F Valu e 

### 41 4 Resident : Residen t Name : TENAI^TS Propert yAddress : |201 1 OHI O S T Zi p Code : |68110 - Residen t Phon e 

# ITECHNOLOGIES ; INC . 

# EP APropert y Clos e Ou t Propert y # : £.8-8^2 ^ Propert y Address : 2.0J \O^i^ a'?^ , Date/Time : Owner' s Name:<i'5.|. ^ a^< 3 n^A^t L Quad s Excavated:( ^ 1 Contracto r Group : Pniden t Technologies , Inc. , Excavatio nGenera l Ye s 1 . I f necessary . wer e tli e correc l 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 1 . Doe s th e gradin g aroiui dth e perimete r o f tli e hous e i nexcavate darea s generall y slop e awa y / fromth e house ? 2 . Ha s so dbee nlai di nal l area s tliat wer e excavated ? ^ r^

. Doe s tli e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 day lim e period ) 

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

# y 5 . Ar c th e joint s betwee ndi e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte dat a3 0 day 

# y tim e period ) 6 . Wa s th e property grade dsuc htliat wate r wil l no t poo l o nth e property ? / 7 . Wa s damag e l o landscapin g o r plan t material s avoided ? 

# 7 Gates , Fence s an dRetainin g Wall s Ye s 1 . D o gate s ope ntrn dclos e freely ? (I f apphcable ) / Wer e al l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (I f applicable ) 

# y Wa s dainag e t o gate s o r fence s avoided ? (If applicable ) / 4 . Wa s damag e t o retainin g wall s avoided ? (If applicable ) 

# y Foundation , Sidin g an dGutter s Ye s ] Wa s damag e l o th e sidm g o r tri mavoided ? / 2 . Wa s damag e f o th e foundatio navoided ? / 3 . Wa s damag e l 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 ? ^ Sidewalk s an dDriveway s (Concrete ) Ye s Wa s damag e l o diivewa v surface s avoided ? 2 . Wa s damag e t o walkwa y surface s avoided' ? 

# y N o

N o

No

N o

No I

## Owner s comments :

Inspectio nnotes : 

# y , y

. Ay y

Remova l andrestoratio nactivate s complete includin g th e 30-da y so dwarranty : EP ARepresentativ e Oo^'A q^Date: i/xshi

# m rmrocoGiEs . IN C A S - BUIL T DRAWIN G OL S #2882 0 Dat e Excavated : 11/10/201 0 

### OMAH A LEA D SUPERFUN D SIT i rSEP A Signcd-Of T Date : 

## y^Tii^ m Exterio rPain t Omah a Lea d Sit e n Goo d Sit e Sketc h • Poo r Samplin g Address : &d i 1 1 Oht Q iST " (J3^o t pain t Sampl e Numbe r Lea d Sampl e Sample s Collected , Concentratio n Collecte d LA B 

### Firm : f ^ JH', , f^]7/^ W RYASCPXA - saaeof ^ 2ftC > pp m 

### D Date : lO-iU-^Z-O U RYBSCPXA-< f aaa ? F 2 2.4 Z pp m 

### D Tim e l2.-50?.y[ . 

### RYcscpxA-ajae o B I Ht H pp m 

### D Sample s Analyze d RYDSCPXA-^gga o B 2 3^1 ' pp m RDZSCPXACddS O O Z —pp m 

### D D XR F Unit : \CXiU fBook : 2^f t RGZOOPX AC880DG Z — pp m 

### D Date : 

## n

— RPZSCPXASaOd O P Z pp m 

### D Time : _EC1 . Staff : Numbe ro f Sample s = ^ 

# n^ w L Leflend : F l = Fron t Left , F 2 = Fron t Right . B 1 -Bac k Left , 8 2 = Bac k Righ t D Z = Dri p Zone . G Z = Garden , P Z = Ra y Al l quadrant s ar e a s viewe d fro m tti e street, facin g propert y ; - V 

### ENTERE D f - • r - 

### i OCT l 4201 0

B l =24 4 PP M a 6 " 3=10 . 

## HN ; r :i

^ 

# .61. : ...Y.. . .^ Z ( 4

, n

6ff»P i 

### ? r r - — >

^ 

### 2 ^ : Zf 2 

# a : , r z

^ . . 1 . - >

• ^5 ' y ^ 

# LOIilio.ST. . KevICXWH I Creau a 16.Mcy.0 8 E A = 13 5 PP M (fl ) SCRAP E(~I" ) CONTRAC T # : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC .

# %^dMr ^ Propert yCompletio n Agreemen t Thi s agreetnent document s th e completio no f remova l activitie s performedonth e belo w listedproperty . Th e propert y owner' s signature indicate s tha t th e propert y owne r i s satisfie dwit hth e restoratio no f th e subjec t property , andtha t n o item s are i nquestion , now , o r a

t any time i nth e future , excludin g an y remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , if any . Propert y ID : Propert y Address : ^g, ^ ^y^^. ^ ^y^^^ y _ 

## 0^^"'^'- = yr.k. y Or.^ ^ Phone : ( J ^/c^^, . c/^c/ ^ Restoratio nItem s i nQuestion : Item : Item : Item : 

### Item : Item : Item : Required correction s t o complet e th e property :

S

^

I 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 )



## 7'iy&v ' 7 0 Owner' s Signature Dat e

## TTaiNJ6iMrtit>x : Pmden t Technologies , taKlP ) i s und l t wiO nth e U . S . Environmental Protectio nAgenc y (EPA ) t o clea nup lead
contwllaate dsoil s a t a/um b I'hfrmnrTtiri^nriift ai nOmtihn , Nebraska , includin g th e propert y locate dat yCyy l yfnp^Arequest s your permissio nt o allo w Prudent t o perfor masoi l deann p a t this : t o remov e leacRS^Staminateds ' signin g thi s fcnm, th e propert y owner grant s peimissio nt o Pmdent to perfonn activitie s relate dto th e cleanup includin g soi l sampling , lemoval o f lead-contaminate dsoil , an drestoratio nofth e reference dproperty . Ifyo u hav e an> ' question s abou t th e soi l cleanup plaimedfor your pioperty , pleas e contac t Prudent Sout hOmah aOflic e for th e Omah a Lea dSit e cleanup.a t (402 ) 733-1188 ; 733,^5 . Genera l question s about th^i^ah aLea dSit e cleanup ca nb e directe dt o th e EPA Publi c Infoimation'Center s at (402 ) 7 3 l'304S'($o\ ^ Omdi a laofBce) .

< y1 Propert>
- Acces s Grante dBy : Prin t Name ) Propett\-Owne r Signature : >l ^ / 0/9-1/^01 0 ignature ) (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 : Owne r Rente r RESIDEN TADDRESS :
I F RENTAL , PROPERT YOWNE D BY : 

# C ' OWNlbt' S MAILIN G ADDRE^ : / Wy7 ^ y^yy / ^ OWNER ' •STELEPHOhJ i NUMBER-HOME : ( ) WORK : W 

### J I AG E O F HOME? : YEARS . HO WLON 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 7 _YE S 

### N O NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLO : . NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R O F CHILDRE NUNDE R 7 YEAR S OL D WH O PLAY I NTH 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. )

AUTHORTT Y FO RENVIRONMENTALRESPONS EACTIONS : Th e activitie s t o b e implemente db y EPAunder this agte«anen t are pursuant to Sectio n10 4 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s right ofacces s t o th e propert y i s provide dfo r inSectv) n104(e ) o f CERCL. \4 2 U.S . C 96Q5(e) , whic hprm'ide s entr y fo r "determinin g th e nee dfo r response , o r choosin g o r takin g an y respons e actio n under thi s title , o r otherwis e enforcin g th e provision s o f di e title. "

808 0 War d Parkway , Suit e 40 5 560 0 8.10" " Stree t 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6810 7 San Antonio , T X 7822 9 Phone : (816)363-370 3 Phone : (402)733-145 5 Phone : (210)822-958 8 Fax : (816)363-370 7 Fax : f402 1 733-1B8. ?

### TECHNOLOGIES , INC . Address : Phone : .^y / 

# Propert y Statu s For m ^y y 

# ^jr/ : Date : BVID :

Propertj ' Owne r Pruden t Employe e Signature : ^ ^7 / Signature :

# id&y ~ y^r^f^p m gd^g g ExtBrio rPain t Nort hAiR W Onnah a Lea d Sit e 

### • Goo d Sit e Sketc h 

### • Poo r Samplin g Address : &^ U Ohi a t ^ Q44a t pain t Sampl e Numbe r Lea d Sampl e |^ ^ Sample s Coneded . Concentratio n Collecte d ^ ^ RYASCPXA-f-^atfOF I Date : l6'lU''2J)J a 

### I8-IU'^2J)J I F(YBSCPXAr£86& ? P 2 Time : RYCSCPXA-ajaa O B i Sample s Analyze d RYDSCPXA-e5Q£ D B 2 

### ,^«^/« Do mB * I ^ nDZCOPX A CQOC O O E —pp m D D XR F Unit : SOeUgL . Bod e .2 ^ 

## nozcopx Ae86£po z • • — po m n D Date: _ —pp m D O Time: _ 

# -E n Staff . Numbe ro fSamfde s = l^ | J 

# U USh ^ Legend : F l = Fron t Left , F 2 = Fron t Right , B l =>Back Left , B 2 = Bac k Righ t D Z = Dri p Zone . G Z = Garden , P Z = Pla y A

O qiJabant s ar a a s wawB d from tf wstreet , facing propert y 1 . . ^•.. • 

## S M WTEMiJS D : Ay...J...7. : ­ 

# y/v ^ ^/A/ OC Ti: 4 

## 2010 !

..... . :3^-cp . ,.. ' 

# ijrkviyy .

.............. . 

# ,\/y/y < / / /

• < . » 

# y-yy%b\ \ t>Wp$l '

• — 

# r-i-4«. —

" 

## ...-.TBO. : 1 -XtX- . 

# ,..i.f.i. i , yi . ,... . . \ ',. . y <...*•....'.... > 4

, • '. . y r . •••>*....•>- « • 

# y- . \ ^' i : I'W" ^ 

# ;

L.o.Hlio.sr.. ; £ ^

Rev300S£ LCiutal : 16M>y.0 g 04«141.012 3

# 201 1 OHI O ST : 4 5 X 12 2 

# A Printed : De c 10,201 0 www.dcgis.o r g.'dogi s

### Pag e 1 o f 1

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

### YOURTICKE T NUMBERI S 2627992 . Origina l Cal l Date : 10/27/1 0 Time : 3:3 9 pm Op : SIVA1896 7 Wor k t o Begi n Date : 10/29/1 0 Time : 4:1 5 pm State : N E UGLA S Place : OMAH A Address : 201 1 Street : OHI O S T Twp : 15 NRng : 13 E Sect-Qtr : 10-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : SOI L LEA D REMEDIATIONPROPJEC T Locatio n o f Work : LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)733-188 3 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 : Y 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 Numbe r Utilit y Typ e CXCAT V COX COMMUNICATIONS , INC HEIDI 

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

### Day : Alt : 

### 402504782 3 Emerg : 402504797 0 OMAHACOFCITY OFOMAHA-TRAFFIC,SEWE R RICH/TRAFFIC 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 OPPDGPR5 OMAH APUBLIC POWE RDISTRIC T 

### EL M LOCATIN G Day : 406728934 3



### Alt : 406207149 4

Emerg : 888728934 3 QLNN EI 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=<RESULT. . . 10/27/201 0GRAHAM , WESTO N& ANDER ^ 1 tndHn i *Ptovidet s ^^ 'usto mPainting , Windows , Constructio nan dEvironmenta l Soludoa ^ 

## SIT E SAFET YHAZAR D ANALYSI S PROPERT Y ADDRESS : 

# 201 1 Ohi o Stree t EXCAVATIONCREW : /y}ci/7iy/y yi^ ^

i f BACKFIL L CREW : EXCAVATIO N BEGI N DATE : BACKFIL L BEGI N DATE : 

# t 7 I 

# f n / £ 0 . EXCAVATIO N EN D DATE : 

## ro/fi > BACKFIL L EN D DATE : ^ OPERATOR' S SIGNATURE : ^yt/f/:y7i^s l i^ydyCy OPERATOR' S SIGNATURE : ITE M (YES ) (NO ) CONDITIO N HAZARDOU S (YESV(NO ) CORRECTIV E ACTIO N OVERHEA D LINE S GA S LIN E PROPANE/BUTAN E SEPTIC/LEEC H FIEL D SEWERLIN E WATE R LIN E DRIVEWA Y 

## A^ O \

^ C 7 y y^r^ P Vt * S 7 ^ v-*.»k . C'^ivL . C4>^^^^ ^

FENCE S FOUNDATIO N 

## V fs PocO ^

RETAININ G WALL S 

### rJC ?

SIDEWAL K 

# ^ o ^ o SPRINKLE R SYSTE M STRUCTURE S (I.E . HOUSE , GARAGE,ETC. ) OTHE R yJ O tJ' ^

250 5 Nort h24 * Street , Suit e 211- A Omah aN E68110-227 9 (402) 402-502-206 8 www.gwaentetprise8.co m (402) 451-372 8 (Fax)Payrol l Service s Huma n Resourc e Service s Taxpay * Retiremen t Service s Direc t Deposi t COBR AAdministratio n 

# PAYCHE X Ban k Reconciliatio n Handboo k Sen/ice s Garnishmen t Paymen t Servic e Stat e Unemploymen t Insuranc e Servic e 

# 201 0 Payrol l Calenda r Workers ' Compensatio n Paymen t Servic e Sectio n 12 5 (FSAan d POP ) Tim e an d Attendanc e 263 7 Sout h 158t h Plaza , Suit e 10 0 Huma n Resourc e Administratio n Onlin e Report s Omaha , N E 6813 0 Grou p Healt h Insuranc e Phon e 402-331-660 0 / Fa x402-339-235 3 

### January Februar y Marc h s M T W T F S S M T W T F S S M T W T F S

• ' 2 1 2 3 4 5 6 1 2 3 4 5 6 ^ 4 5 6 7 8 9 7 8 9 1 0 1 1 1 2 1 3 7 8 9 1 0 1 1 1 2 1 3 1 0 1 1 17_1 8 1 2 1 9 1 3 2 0 1 4 2 1 1 5 2 2 1 6 2 3 1 4 

# • - 1 6 1 7 1 8 1 9 2 0 1 4 1 5 1 6 1 7 1 8 1 9 2 0 2 4 

# • 2 5 2 6 2 7 2 8 2 9 3 0 2 1 2 2 2 3 2 4 2 5 2 6 2 7 2 1 2 2 2 3 2 4 2 b 2 6 2 1 3 1 2 8 2 8 2 9 3 0 3 1

S M T W T F S S M T W T F S M WTF S 4 5 6 7 

# • ' 8 2 9 3 ! 1 0 2 3 4 5 6 7 1 8 8 ^y "9 ' ' "3 1 1 0 4 ^ 1 1 5 1 2 9 | 1 0 1 1 1 2 1 3 1 4 1 5 1 1 1 8 1 2 1 9 1 3 2 0 1 4 2 1 1 5 2 2 1 6 2 3 1 7 2 4 1 6 2 3 1 7 2 4 1 8 2 5 1 9 2 6 2 0 2 7 2 1 2 8 2 2 2 9 1 3 2 0 1 4 2 1 15 : 

# J 2 2 1 6 2 3 1 7 2 4 1 8

2 5 1 9 2 6 2 5 2 6 2 7 2 8 2 9 3 0 3 0 3 1 2 7 2 8 2 9 3 0 • 

### Augus t September 8 M T W T F S M WTF M W * ' 2 3 

### 5r~ 6 4 • ' 6 7 8 9 1 0 1 0 1 1 1 2 1 3 1 4 1 0 1 1 1 1 1 2 1 3 1 4 1 5 1 6 1 7 15 " 1 6 1 7 1 8 1 9 2 0 2 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 8 1 9 2 0 2 1 2 2 2 3 "2 4 2 2 2 3 2 4 2 5 2 6 2 7 1 9 2 0 2 1 2 2 2 3 2 4 2 5 2 5 2 6 2 7 2 8 2 9 3 0 3 1 2 9 3 0 3 1 2 6 2 7 2 8 .3 0 

### Octobe r Novembe r December S M T W T F S 

# s M T W T F S 

### s M T W T F S 1 2 1 2 3 4 5 6 1 2 3 4 3 10 4



# • " 5 1 2 6 1 3 7 1 4 8 1 5 9 1 6 7 1 4 8 1 5 9 1 6 1 0 1 7 

# • '' 1 8 1 2 1 9 1 3 2 0 5 1 2 6 1 3 7 1 4 8 1 5 9 1 6 1 0 1 7 1 1 1 8 17 1 8 1 9 2 0 2 1 2 2 2 3 2 4 2 5 2 6 2 7 2 8 2 9 3 0 2 1 2 2 2 3 2 4 2 5 • 2 6 2 7 1 9 2 0 2 1 22 ! 2 3 2 4 • 2 5 • 3 1 2 8 2 9 3 0 2 6 2 7 2 8 2 9 3 0 3 1

_ • Mos t bank s ar e close d ^ En d o fquarte rprocessin g Nationa l o rReligiou s Holida y- Paychex/bank s ar e close d (allo wa n extr a da yfo rdirec t deposit ) (date s subjec t t o change ) (allo wa n extr a da yfo rdirec t deposit ) 

### Than k yo u for choosin g Paychex ! N

^ Visi t ou rWe b sit e a t www.paychex.co m

# I