### TRANSMITTA L OF OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# ; 2655 6 DATE : 12/15/201 0 ADDRESS : 343 2 DECATU R ST REMEDIATIO N CONTRAaOR : PRUDENTTECHNOLOGIES . INC . YEAR : 201 0 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S d PR E AN D POS TVIDE O OF PORPERT Y(DVD ) d EXECUTIV E SUMMARY d EPA-PROVIDE D PROPERT YSKETCH d SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT(S) FOR ADJACEN TPROPERT Y d RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E OR TO REPLAC E PLANTS , ETC. ) d CONFIRMATIO N DAT A [/PHOTOGRAPH S U AS-BUIL TSKETC H d SATISFAaOR YRESTORATIO N SIGNE D BYPROPERT YOWNE R d PROPERT YCLOSE-OUTCHEC KLIS T SIGNE D BYEP A D DESCRIPTIO N OF AREA S NO TMEETIN G RO D CLEANU P CRITERI A d UTILIT YCLEARANCE S d PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E 

# n D D

3hili > NATUR SIGNATUR E E - DATE 3021841 4 Superfun dFin d Record Remediatio n Quer yI Lea d Remainin g Quer y9 Propert yDamag e Quer y 

### Backfiii :

Sampl e Area : 2655 6 - 343 2 DECATU R S T Owner :

• Owne rOccupie d Owne rName : jWHU E ANTON E D Owne rAddressl : 

# 1 Owne rAddressZ : J351 2 DEWEYAV E # 5 City : State : Zi p Code : jOMAH A |N E J68105 - Owne rPhon e Altemat e Phone : j(402 ) 714-240 0 ' Contract : Contractor : PRUDENT2010_ S Contrac t Optio n jOPnO N 2 Use rProvide d Owne rInformatio n Owne rName : 

# 1 Owne rAddress : ! City : State : Zi p Code : 

# 1 1 1 "•-• • Owne rPhone : Alternat e Phone : 

# 1

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

### 49 0 Resident : Residen t Name : 

# I Propert yAddress : |343 2 DECATU R ST Zi p Code : |68111 - Residen t Phon e

### PROPERT Y SUMMAR Y Date : 12/15/201 0 Oinah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Montl i of : Decembe r Propert y Address ; 343 2 DECATU RS 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 Infonnation : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : F l = 19 0 PP M @ 6" ; E A = 20 0 PP M @ SCRAP E(~1" ) ATTACHMENT S 1 ) Property sketc hprovide db y EP A 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 digital 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 ) Propert y 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 ) Propert y Statu s For msigne db y property owne r iii ) Excavatio n digita l 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 ofarea s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOCiES . INC .TECHNOLOGIES , INC . 

### Property# : h^^'~^ ^ Date/Time : Quad s Excavated : r / ~ ~ ti ' 

# EP A Propert y Clos e Ou t Propert y Address : 1^^2 - OcS^^ ^ Owner' s Name : ^ V<\<3T ^ 

### € cOkY V ^ Contracto r Group : Pruden t Technologies , Inc. , E.\cavatio n Genera l Ye s N o 1 . I f necessarv , wer e the correct quadrant(s ) excavatedandrestored ? J 2 . I f necessarv , wer e th e correct area s o f drip zone excavatedandrestored ? / Gradin g Sodan dVegetatio n Ye s N o I .Doe s th e gradin g aroundth e perimete r o

f the hous e in excavatedarea s generall y slop e awa y fro mth e house ? ^ 2 .Has sodbee n laidi n all area s tha t wer e excavated ? 

### y '^

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

y time period) 

### y 4 .Ar e soddedarea s generall y finn andevenl y graded ? y 5 , Ar c tlie jonit s between tlie sodstrip s generall y liglit ? (Onl y evaluat e i f inspecteda t a3 0 da y y tun e period) 6 .Wa s the propert y gradedsuc htlia t wate r wil l not pool o n the property ? 

# y 7 . Wa s dainag e t o Lindscapin g o r plaii t material s avoided ? y 

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

D o gate s ope n andclos e freely ? (I f applicable ) 

## y 2 .

Wer e al l gate s o r fence s taken dow n during restoratio n activitie s reinstalled ? (I f apphcable ) y 3 .

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

## y 4 .Was damag e t o retaining 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 .

Was damag e t o tli e foundation avoided ? 3Was dainag e l o window s avoided ? y ^ 

### y 4 .

Wa s damag e t o window s o r doo r screen s avoided ? y 5 .Was damag e t o downspout s o r downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 Wa s damag e t o drivewa v surface s avoided ? Wa s damag e to walkwa y surface s avoided ?

## Owner s comments :

Inspectio n notes : v^^* ' 

# y ' y y " y -i " 

# yy,. y 

# yy y

# y ^ .^. ' ty 

# ^y ^



# y ^

yy

Remova l andrestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e n^^J l Date : ///^/ ^CHNOLOGIES , [NC . OL S #2655 6 Dat e Excavated : 11/02/201 0 liSEP A Signed-Of T Date :

Samplin g Address : 3i-5C . Sampl e Nutnbe r RYASCPXA - QGS5 C F 1 RYBSCPXA-,?555 C F 2 RYDSCPXA-jS><255^ B2 ROZSCPXA-gC5'5 g & g RCZSGPXA - t?g5ar g O Z RPZOCPXA - CZ^S C "P ^ 

### A S - BUIL T DRAWIN G OMAH A LEA D SUPERFUN D SIT E

Omah a Lea d Sit e Sit e Sketc h PeCafu r<3 t Lea d Sampi e Concenlralio n Coticcte d pp m 

## sf . 

# _Ln . 10 S pp m pp m ppf n pp m D pp m 

## a pp m 

### D Numbe rof Sample s = 

# J i LA B 

### D D 

## n D D D D 

# n J tSy53 ^ Exterio rPaint Nort h Arro w • Good 0No t paint Sample s Collecte d Firm : Dste : Time : XR F Unit :

Dat eF M t>R-J h fe-a5-^fe I '-3 6 fr ^ Sample s Analyze d dSHC ) Book. : 21' ^ - 1 ^ • o S Tim e ^ Staff : 

## rn.^i ^ Legerkd : F 1 = Fron t Left , F2 = Fron t Rigtit , B 1 = Bac k Left . B2 = Bac k Righ t D 2 = Dri p Zone , G Z = Garden , P Z = Play Al t quadrant s are a s view«< J troTn th « str«e1 , facm ^ propert y S£P-t.7 .



## i f ^ 

### .l.2Je . 

## X i 

# y 13^ . F l = 19 0 PP M r o 6 " 

# r F ! 

# r ^ •© • iAA ^ De;<:/t,tv./C-.s t RwilKiS.E LCM3I0J . WM.f, - K, A = 20 0 PP M ro ] SCRAP E(-!" ) CONTRAC T # : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC .P.00 2 R

X Date/Tim e 11/23^ 0 16:4 1 11/23/201 0 TU B 16 ! 3 3 PA X ^ QI002/00 3 

# SEF W Propert yCompletio n Agreemen t Thi dagxeenea t dpcumeal s th e cotnpletio o o f rexnova l aictivitie s perfonne do n tb e belo w liste dpropefty . Tb e propoct y ovvoor' s sigDatur e indicate s tihat th e piopert y ovm ai s satisfie dwit hth e restoratio nofth e subjec t property , an dtha t o o iten u ar e i n qoanGDa , now , o r a t an y tim e i n A e Aiture . excludin g an y remainin g wanan ^ (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y0) : Propevtj rAddress : "^^gf i ![;^* . r^cJr^* ^ «r1 ^ ^'^ ' ArNVL« ^ . T ^ VO^A'^ ^ . Pho«e : ^,^

_ a.M0 O RAStoratio n Item s i n Question :

Item : Itttm : Item : Item : Rem : ttem: Require dcomctfon s t o complet e th e property :

J\ ] I agre e restoratio n i s cocnpleted .

L J I d o no t agns e restoratio n i s complete d a t (note d deficiencie s alx>ve ) 

# (yd^^ , AaiJ/ ^ .Owner' s Signator e Dat e
SOO/ZOQT d OQfi l ZS:S l OlOZ/EZ/ Ul/^ ( 

### P.00 2 10/29/201 0 FR I 14)3 2 FA X ei002/00 3 RX Date/Tim e 10/29/201 0 14:3 9

——•— . . . . • P.002/00 3 

# • ^iiw2ffl2crfr^rtio8 " 

# w~

ftudMicTNhnologieaklna (PradoiOiiuodGrcMlrMvrid i iheU . S. Bnviramenti l Pmeelio n Agenc y(EPA)lodeui f lead ooBlaita ^ lafl Ktf a miiit e rfpiCMitiei iMOied ID Ooub ^ Netndc^ to jy^?Z - jTTfc/'^^/'.LATlieHPAiBiiiietoiwMfDeiMlalantoanowlYBAittPiw^ ^ pnpertytoiemoralead-eoalaminalBdsail . By5tgaillg1hilfbln^ibc|napertya1awgFMl&pc^llissi M to Pnident lopedbn n ictivide i felOBd t» th e dcnn p inctadin g MQ tanpUn & ceqMin l sflctd-oooti ^ tf vo u tw e an y flUMliem abou t Ifa

e toi l dcamatPlimiedarvaurTBtiDcrtr.ptoiecBnlactPnidemSDiilhOi ^ Lea d Sit * eI(tttupL.t t (402) 733-1 1 B8;73J-1455 . Oeaeral^aetliantabeut^OmahaljaalSlMeleaAqpem^dinacedlothBBP A Publi c Infimiiatbi D Oon mat (402 ) 731404 5 (Sout hOmab aoffiM) . PwiertyAccBBiCimlEdBY : /MTAfua . D . iAtJ ^ (PlMtePiintNaaie ) Propen y Owae r Sleiatwe : | (Sipiaoin ) (DHU ) PROPERIYINFORUATIO N (Te

be completed byrccldco t and/o rpropertyowac r- plea R print ) RESIDEN TNAUE : /^fa^i P A^y ^ Ranle r ITAOORESS . . RESIDEN T AOORESS : ^ IF REKTAL , PROPpn Y OWNE D BY : OWNER' S MAILIN O ADDRESS ; OWNER' S TELEPHON E NUMBER-HOME : (4lt> ^ ^^ V " ^/<^ 0 WORK : AOEOFHQUE? : YEARS . HO W LON G HAV E YO U LIVE D HERE ? YEARS . HA S TN E EXTERIO R BEE N PAINTE D OR COVERE D VflT H SIDIN Q SINC E 1978 7 _YE S No NUMBE R OF OCCUPANTS UNDE R 7 YEAR S OLD: . . NUMBE R OF OCCUPANTS 7 YEAR S OL D AN D OLDE R NUMBE R OP CHILDRE N UNDE R 7 YEAR S OL D WH O PLA YIN TH E YAR D FO R 5 HOUR S OR MOR E PE R WEB C COMMENTSOR SPECIA L INSTRUC7X>NS : (LE . D06S . ENTR Y GATES , ETC. )

AUTHORTT Y PO R ENVIRONMENTA L RBSPOMSEACnOMS ; Theactivitie(lobe<n|ilanen4dbyEPAUDdcriiiisteM»>ai t iPB pianam t to Sectio n 10 4 of CEKOA , 42 U.S. C 9604 . EPA' s rielM Of neoc n to tbe piopat y is pnxrided ftr in Scsiia n 104(e ) of CERCL \ 42 U.S . C 9MS(e} , v^hid i pravldes enuy<b t *detennioIii g th e nee d Ib rnsponic , orcbeotia g orBd ^ acQ ricspei ^ tndertlii i iitle ^ oi oQiMwiw(Bftreia g tb e pigviiioo a of di a title; "

80B0 Wan l Parkway , Suit e 40 S SSO O 8.10' " Stree t 424 2 Medica l Drive , Suit e 426 0 Kansa s City . MO 6411 4 Omaha , Nebrask a IB10 7 San Antonio , TX 7822 9 Phorw . (K16) aed-370 3 Fax:(816)36M70 7 Phono : (402 ) 739-148 6 Pax : (402 ) n3-188 3 Pliona : (210)822-868 8 Fax:(210)579-657 7P.00 3 R

X Date/Tim e 1 0 14:3 9 10/29/201 0 FR I 14:3 2 FA X g|003/00 3 

# M . PMono s

TECHNOLOGIES , IfiC . I f I ENViRONMENTA L& CONSTfiOCnO N SERVICE S 

### Address: . Phone : 

# Propert y Statu s For m ^»^ ' BVID : 

# /0/z9/l O 

# yCLinJ - 

# 3 

# i Property Owne r Pniden t Employe e Signature : /Ak ^ / ? jjuht ^ Signstare :Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e • Goo d Sit e Sketc h 

# k • Poo r Samplin g Address : _34^ ^

i2a2^Ay r6 t 0 No t pam t Lea d Sampi e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Fir m 

## r M PBy p _ RYASCPXA-2G55(;F 1 

## D Dat e RYBSCPXA-<f555C ; F 2 

## I 3 1 pp m 

## D Tim e RYCSCPXA-^(i"55 ^ B 1 

## Z 9 S pp m 

## D Sample s Analyze d RYDSCPXA-jf(^55( ^ B 2 

## / Z 

## 6 pp m 

## D 

# I

• ReZSCPXA-gt^JJt ^ D Z ~ ~ pp m 

## D XR F Unit : GSH D Book : 21" ^ 

## D RCZCCPXACC5 ^ C Z "• " pp m 

## D Dat e ' / ^ - c-Q g 

## D pp m 

## D Tim e 

## D m . Staff , 

# r?.5L.. > Numbe ro f Sa m pie s = j 4 

## !J2. . Legend : F 1 = Fron t Left , F 2 = Fron t Right . 8 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P 2 Play Al l quadrants ar e as viewe d fro m th e street , facin g propert y 

## S£P- 1 .7.>Ma---- ;

• * ; •> /

• •J • < 

# ;z^5-. . 

# I n 14 ^ / 

## 52

^

. . . 

# ^y f

^ / 

# ',;i 3 " ^ V 

# f z f ' 

# y y ( , > 

# 1 : 

# y ( • • • • ...-. / i//?kj q r * : •Dfc/vTv. ^ 'S t Re v 2 1 :i»8B L Cr e «L-d . )6-!vf4 y •o;- ' '.*1,4 I

# 343 2 DECATU RS T 

# A IP iihJ T Printed : De c 02,201 0 www.dcgis.org/dogi s

### 10/29/201 0 kwww.dhon.org/irthinternet/DHONNotic.. . Creat e Anothe rTicke t Bac k t o Irt h Inteme t Sen d Emai l j^VjAa*r*^^Li.->'./ ^ ..•'••J ­ . : . • ^---.-. i • .-.•.^w^lC^^.^b•'^^m»^>-•*«n^..T^J» " ­ . r . 1 • ...•f».:^...'n...:..-.M..^.4l ­



### • YOURTICKE T NUMBE RI S 2630014 . Origina l Cal l Date : 10/29/1 0 Wor k t o Begi n Date : 11/02/1 0 Time : 3:1 4 p m Time : 3:4 5 p m Op : SIVA1896 7 State : N E Address : 343 2 County : DOUGLA S Street : DECATUR S T Place : OMAHA Twp : 15 NRng : 13 E Sect-Qtr : 16-N W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : Lea d Soi l 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 Company: 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 : NFront : Y Rear ; Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCATV LEVEL S MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Servic e Are a Contac t Phon e Numbe r 

## utmty Typ e Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 LEVEL S LEVEL S COMMUNICATIONS , LL C 

## N A Day : 877366834 4 AH : Emerg : 877366834 4 MUDOl METROPOLITA N UTlLrnE S DISTRIC T 

## SAND Y Day : 402504782 3 Ak : Emerg : 402504797 0 OMAHACO F CITYOFOMAHA TRAFFIC,SEWER RICH/TRAFFI C Day : 402444719 7 AH: 402444516 1 Emerg : 402444516 0 dhon.org/irthinternet/.../MessageText.as. . 

### 1/ 2

### 10/29/201 0 ^^vww.dhon.org/irthinternet/DHONNotic.. . 

## 0PPDGPR 5 OMAHA PUBLIC POWE REL M ^Day : 406728934 3 406207149 4 uffuui-i o DISTRIC T LOCATIN G^ ' ^"^^"^^'^^' ^ Emerg : 888728934 3 QLNNEI C QWES T LOCALNETWOR K FTM T^^A^TTXT ^ LOCAllN O 

## Day : 406728934 3 Ak : 406207149 4 Emerg : 888728934 3

dhon.org/irthinternet/. ../MessageText.as.. . 2/ 2ENVIRONMENTA L & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SOLUTION S 

# Sit e Safet yHazar d Analysi s

Crew: ^ Bf . 

# Date = ll' - y l O CQixectly e Ite m Conditio n H^zardS ^ Overhea dLine s Ga s Lin e 

# lyw y Wate r Lin e Sewer Lin e Septi c / Leec h field Propane/Butan e 

# ^ y Sidewalk 

# ^ o r 

# C/^c K Pl y i^acyA - / ' b/ x ^ 

## Foundatio n ^ ^ 

## Retainin g Wall s Fence s Trees / Bushe s 

# S Z LyyfC^ h AOo J 

# '/- O Structure s ^^^< ^ 

## Drivewa y ^ 

## Sprinkle r System Othe r Cre w Forema n Sit e Safet y Office r 

# <y ^ <v-rT^ . 808 0 War d Partcway , Suit e 40 5 250 5 N . 24* " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 725 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