TECHNOLOCIES . INC . 

## PROPERT Y SUMMAR Y SHEE T Oinah aLea dSit e Remedia l Actio nContrac t #EP-S7-10-0 5 Said : 3225 8 PropertyAddress : 361 4 N2 1 S T 

## Executiv e Siummary : Issue s Encountered : Non e Issue s Resolved : Non e Uniqu e Findings : Othe rRelevan t Information : Confirmatio n Samplin g data/results : F2=24 7 @ PP M @ 7" ; EA=32 5 PP M @ Scrape ; F l =17 1 PP M (SScrap e 2" ; DZ=18 1 PPM@3" . Attachments : Document s Include d i n th e Propert yFile : Ye s N o N/ A Propert ysketc h provide d b yEP Apursuan t t o contrac t specification s V ont o adjacen t propertie s

Othe rDocuments :

Legend : Ye s - Indude d I n th e File ; N o - Not Include d i n th e File ; N/ A- Doe s no t Apply . Signe d Acces s Agreement ; includin g acces s agreement s obtaine d (i frequired ) fo rcrossin g V Pre-excavatio n agreemen t detail s (i fan yar e mad e wit h th e Propert yowner ) V Pre-Excavatio n digita l vide o cli p V Samplin g dat a shee t V Post-Excavatio n digita l vide o cli p V Documentatio n - Complete d EP Aclose-ou t checklis t V As-Buil t sketc h V Omah a Lea d Sit e Databas e sampl e informatio n document . V Signe d for m verifyin g satisfactor yrestoratio n V 3 0 daySO D warrant ypicture s V Utilit yclearance s documen t V Propert yinformatio n fro m Dougla s Count yAssessor' s office . V Settlemen t document s (i.e . fo ran ydamages , replacemen t o fplants , etc. ) V Sit e safet yhazar d analysi s documen t wit h pictures . V Pruden t Representative : EP AAcceptance : ..\ ' Date : Date :



### Pruden t Technologies , Inc . | 250 5 N. 24TH Street , Suit e 30 8 jOmaha , N E6811 0 US Aj Tel . 402.504.100 4 j Fax : 402.504.100 5 Environmenta l Engineerin g & Service s j Remediatio nj Constructio nName : 0Y6^e . oco^^ ^ Address : 3 C ^ ^

* ^ -xi ^ Phone : f^0> ) ^/V-tf:72< r Omah a Lea d Sit e Sit e Sketc h Date : Time : 

### iC'-/- i Nort h Arro w



### Tea m zi/lc<^/^ig/fr 6 YUS ^

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## N o 2 ^ N o Q No E N o 0 No a No a No •

• z^is - OmahaLea dSite 4613 0

# PROPERT Y ACCES S FOR M Pruden t Technologies , Inc . (Prudent ) i s unde r contrac t wit hth e U . S . Environmental Protectio nAgenc y (EPA ) to cleanup lead-contaminate d.soil s a t anumbe r ofpropertie s locate di nOmaha . Nebraska , includin g th e property locate da t '^CB t M K f 2— \S ^ . Th e EP Arequest s you r permissio nl o allo w Prudent t o perfon nasoi l cleanu p a t thi s property ' to remov e lead-contaminate dsoil . B y signin g thi s form , th e property owne r grant s permissio nto Pruden t to perfor mactivitie s relate dt o th e cleanu p includin g soi l sampling , removal o f lead contaminate dsoil , andrestoratio nofth e reference dpropert)' . If

yo u hav e an y question s abou t th e soi l cleanu p planne dfo r you r propertj' , pleas e contac t th e Pruden t Offic e fo r th e Omah aLea dSit e cleanu p a t (402 ) 733-1188 . General question s abou t th e Omah aLea dSite cleanu p ca

nbe directe dto th e EP APubli c Informatio nCenter s a t (402 ) 731-304 5 (Sout hOmah aoffice ) or (402 ) 991-958 3 (Nort hOmah aoffice) . Ifyou r property ha s agrave l o r dir t driveway s o r parkin g area s the nth e removal andreplacemen t ofth e soi l and/o r grave l durin g th e remediatio nproces s doe s no t make you r illega l gravel/dirt driveway s or parkin g area s legal . Propertj ' Acces s Grante d By : Propertj ' Owne r Signature : (Pleas e Pri mName ) (Signature) 

# 4/ y l i (Dale ) Propen yAccesse d by : 

# ,J^ ~ .0%^c-&J!!!^::X ­ (Pruden t Employe e Name ) PROPERT YINFORIVIATIO N (T o b e complete d b yresiden t and/o rpropert yowne r­ pleas e print ) RESIDEN TNAME : Y)<i i l^V) \ C Wle.et<LjS . fowner\ Rente r 2 . I F RENTAL , PROPERT YOWNE D BY : 

### 3 . OWNER' S MAILIN G ADDRESS ; Sf\Ht-" ' ( '' ^

SG^ M hO ^

2 J S H Q'^-^^oX^^ . f^ & ^ ^ ' 4 . OWNER' S TELEPHON E NUMBER - HOME : {HbZ. ) '"^( ^

^^^Ift^ORK : _L 

### J _ 5 . TENANT' S TELEPHON E NUMBER - HOME : X 

### yfO^KTZ L 6 . AG E O F HOME? : i ^.^^ ^ YEARS . HO WLON G HAV E YO U LIVE D HERE ? '^< > YEARS . 7 . 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 8 . # O F OCCUPANT S UNDE R AG E O F 7 : / ) # O F OCCUPANT S A TO R OVE R 7 YEAR S OL D 9 . # O F CHILDRE N UNDE R AG E O F 7 WH O PLA YI N TH E YAR D FO R 5 HOUR S O R MOR E PE R WEEK : 10 . COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , NEIGHBORIN G PROPERT Y ETC. ) AUTHORIT YFO R ENVIRONMENTA L RESPONS E ACTIONS : Th e activitie s t o b e implemente d b yEP Aunde rthi s agreemen t ar e pursuan t t o Sectio n 104 o fCERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o facces s t o th e propertyi s provide d fo ri n Sectio n 104(e) o fCERCLA , 4 2 U.S . C 9605(e) , whic h provide s entr yfo r"determinin g th e nee d fo r response , o rchoosin g o rtakin g an yrespons e actio n unde rthi s title , o rotherwis e enforcin g th e provision s o fth e title. " 

### Pruden t Technologie s Inc . 560 0 S . lO" " St . Omaha , N E68107 , 402.733.118 8 (Office ) 402.733.188 3 (Fax )ENVIROMVlENTA L& 

# NRUDEN ' CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

## Propert y Statu s For m Address : 3 fe I ^ | \ ; -2 . i ^ K Date : O*- / /

Z^ l ) T-' ^ • ( Phone : q^^^ ^ ^.^^ ^ _^^ ^ 

# BVID : 3ZZ5 ? ( > Z , NOTIC E T O B E GIVE N TO : OWNE R TENAN TBOT H l O ' o HO WMUC H NOTIC E I S NEEDED : 2 4 HOUR S 4 8 HOUR S 7 2 HOUR S OTHE R NOTIC E NEEDE D (PLEAS E SPECIFY) : PHON E # AN D NAM E T O WHO M NOTIC E NEED S T O BE GIVEN : WIL L NEIGHBORIN G PROPERT YNEE D T O BE USE D FO R ACCESS ? YE S /N O ;

^ I F NEIGHBORIN G PROPERT YWIL L NEE D T O B E ACCESSE D WHA TI S TH E ADDRESS : WA S A N ACCES S FOR M OBTAINE D FRO M TH E NEIGHBOR ? YE S (N O WIL L AFENC E NEE D T O B E TAKE N DOW N T O OBTAI N ACCESS ? YE S 

# • o

I F ANSWERE D YE S T O NUMBE R 1 2 PLEAS E PROVID E LOCATIO N O F FENCE : I S THER E PRE-EXISTIN G FACIA L DAMAG E T O TH E PROPERT YAN D I F S O PLEAS E PROVIDE D LOCATIO N AN D DESCRIPTIO N OFSUCH : YE S N O SPECIFY : I S THER E PRE-EXISTIN G CONCRET E DAMAG E T O TH E PROPERT YAN D I F S O PLEAS E PROVIDE D LOCATIO N AN D DESCRIPTIO N O F SUCH : YE S N O SPECIFY : 

### \yCyU . ^- ^ T ) fi.^- ^ ^- ^ '^- ^ Pruden t Employe e ^/ nJ Signature : Pruden t Technologie s Inc . 560 0 S . lO" " St . Omaha , N E68107 , 402.733.118 8 (Office ) 402.733.188 3 (Fax )ENVIRONMENTA L& CONSTRUCTIO N 

### TECHNOLOGIES , INC , SERVICE S 

## Propert y Inspectio nFor m Address : 3 4* ^ K i 7^ \<>\^ - Date : LJ-30-l | Phone : ^03 . - II H - n U k i BVID : b 9 ­ 

# Pre-Existin g Damage : Pleas e writ e i ndetai l an dinclude dlocatio n an ddescriptio no f damage : Concret e Damage :

. ' re x cX c S L

Facia l Damag e Includin g Siding :



# m ije..c O -|^32i=^ , OU^JlXA . ' ^ d-- ^ v-v.C ^ V^- ^ " ^ ''i ' 

### Doe s Basemen t hav e histor y o f leakin g o r flooding? YE S \NO y

Doe s Homeowne r wan t so dreplace di nall areas? ( YES / N O IfN O pleas e provid e wha t area s ar e no t t o b e sodde dan dwha t need s t o b e rcjilace dinstea dof so d(i.e . mulch , rock , leav e bare ) if mulc ho r roc k pleas e specif y wha t typ e an dcolor ;

ANY OTHE RDAMAG EO RREQUESTS :

Propert y Owne r Pruden t Employe e Signatu r 

# ^^y~ - Signature : DAT E DATE :• • ENVmONM£NTAL & CONSTRUCTION 

### TECHNOLOGIiES , INC . SERVfCES 

# XM F CLEARANC E SMEE T PROPERTYADDRESS : 3^7/ ^ / V ^ 1 ^" ^ PROPERTY IB : 5'^' ^ ^ ^ z MAFHA S BEENREVSEWEB AN D N O MISSED AREA S EXIST , r-: ? 

# WA S CONTAMINATIO NLEF T BEHIND ? I FYE S WHER EAN D MMENSIONS i 

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### Propert y # : '* ^ '7.7-.'^' ^ Property-Address : '5'5^-fH-/\ J 2.. \y^- . Date/Time : Owner' s Name : f-P^'Wi ^ ' e M -^C'Vi S Quad s Excavated : p ! , P2 - tO'2 l Contracto r Group : Pruden t Technologies , Inc. , E.xcavatio nGenera l Ye s N o 1 .I f necessary , wer e th e correc t quadra]it(s ) excavaie dan drestored ? 

### J 2 .If necessary , wer e th e correc t area s ofdri p zon e excavate daii drestored ? 

# y Gradin g So dan dVegetatio n Ye s N o 1 .Doe s th e gradm g ajoun dUi e perimete r of th e house inexcavate darea s gener;ill y slop e awa y fro mtli e house ? / 2 .Ha s so dbee nlai dinall area s tha t were excavated ? 

# y 3 .

Doe s tii e so dappear to b e generall y healtli y an dgrowing ? (Onl y evaluat e if inspecte dat a3 0 day tim e period ) 

# y 4 .Are sodde darea s generall y fir man devenly graded ? / 5 .Ar e tli e joint s betwee nvli e so dstrip s generall y tight ? (Onl y evaluat e if inspecte da t a3 0 da y tim e period ) 

# y 6 .Wa s th e property grade dsuc hIha l wate r wil l not poo l onth e property ? / 7 .

Wa s daniag e t o landscapin g or plan t materiaJ s avoided ? / Gates , Fence s an dRetainin g Walllls Ye s N o 1 .

D o gate s ope nan dclos e freely ? (Ifapplicable ) 

# y 2 .Wer e al l gate s o r fence s talve ndow ndurin g restoratio nactivitie s reinstalled ? (Ifapplicable ) / 3 .

Wa s damag e to gale s o r fence s avoided ? (Ifapplicable ) / 4 .Wa s damag e to retainin g wall s avoided ? (If applicable ) / Foundation , Sidin g an dGutter s Ye s N o I . Wa s dajnag e to th e sidin g o r tri mavoided ? 

# y 2 . Wa s damag e to th e foimdatio navoided ? / 3 . Wa s daniag e to window s avoided ? / 4 . Wa s damag e to window s or doo r screen s avoided ? 

# y 5 . Wa s damag e to downspout s or downspou i e.-^tension s avoided ? 

# y Sidewalk s ann dDriveway s (Concrete ) Ye s N o 1 . Wa s daniag e to dnvewa y surface s avoided ? / 2 . Wa s da.mag e t o walkwa y surface s avoided ? /

### Owmer s c©mm«inits :

Inspectio nDiioites ;

Remova l an drestoratio nactivate s complet e includin g th e 30-da y so dwarranty : EP ARepresentati^v e Q*^ " ^ Dale - \lllln^ _

### A S - BUIL T DRAWI N# Sampl e Araa : SiZS U - 361 4 N2 1 ST . Dst e Excavated : 08/31/201 1 

### OIVIAH ALEA D SUPERFUN D SIT E Sampla dBy : Isac c 

### CONTRACT # : EP-S7-10-0 5

Name : iJ.''.'-i:,. i • • < : c

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PrudentTechnologies , Ir.c . | 250 S N . 24T H Str-eet , Suit e 30 8 |Omalia , ^ E331: 0 US A| Toi . <02.504.1C0 4 | Fax : 402.504.ICC 5 Environmenta l ^ngir.esrin g & . Service s \P.er.iediatio a| Constructio n 4613 0Pnoperf yM o Clean-ii p M b I Sampl e t-dR S ^VOGfffBH C KCpiVr ' Sampl e Area : 3225 8 - 361 4 N 2 1 S T Sa.T.pl e Dat e - Quadran t Paramet e » XR F R e - XR F Re s .•.jEn ^ r^ MskerPtac e ' LeadRfiiMffiaJ',.^ ^ Sample d B . 4 Q AConfirme e - Lab J 8ai.^11D 1 LEA D 18 1 mgAc g 3 ! 

## g . . _ISSA C N/ A 8 /31/201 1 E l LEA D 32 5 m9''k g 1 ISSA C N/ A — + - 

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# <i>trr \ Propert yCoinpletio n Agreemen t Thi s agreemen t document s th e completio no f remova l activitie s performe donth e belo w liste dproperty . Th e property owner' s signatur e indicate s that th e property owne r i s satisfie dwit h(he restoratio nofth e subjec t property , an dtha t n o item s are inquestion , now , o r at any tim e i nth e future , excludin g any remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , if any . Property ID : ^^^^'j p PropertyAddress : 3^/V //-^^ - ^ Owner : 

# OtUA/lTlF^t A Restoratio n Item s i n Question :

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

# 5T I I agre e restoratio n i s completed . I I d o no t agre e restoratio n i s complete d a t (note d deficiencie s above )



# V'^/Z I Owner' s Signatur e ' Date I^/^^^^^^^^^^^^^^B ^ ^^^^^^^^^^^ H 

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• YOU R TICKE TNUMBE R I S 2840506 . Origina l Cal l Date : Wor k t o Begi n Date : 9/06/1 1 9/08/1 1 Time : Time : 2:2 1 p m 2:3 0 p m Op : ASHLEIGH1896 7 State : N E Address : 361 4 County : DOUGLA S Street : N21S T S T Place : OMTUi A Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 03-SW,10-N W Sect-Qtr : Typ e o f Work : LEA D SOI L REMEDIATIO NPROJEC T Locatio n o f Work : ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)733-188 3 : EMAI L AL L CLEAR S TO : AANIKPUTA@PRUDENTWEB.CO M : UNSUR E CORNER S Compan y Contac t Nam e Alt . Contac t PRUDEN T TECHNOLOGIE S ASHLEIG H ANIKPUT A NON E 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 ALT87 2 CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C



### http://www.dhon.org/IRTHOneCall/Ticket/TicketCreation.aspx?ViewTicketID=81535 6 9/6/201 1

### IRTH On e Cal l Pag e 1 o f 1

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### Hom e Ticke t Ticke t Creatio n Logou t Creat e Anothe rTicke t G o t o Hom e Pag e Sen d Emai l

• YOU R TICKE TNUMBE R I S 2836533 . Origina l Cal l Date : Wor k t o Begi n Date : 8/31/1 1 9/02/1 1 Time : 11:4 0 a m Time : 12:0 0 p m Op : ASHLEIGH1896 7 State : N E Address : 361 4 County : DOUGLA S Street : N21S T S T Place : OMAH A Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 03-SW,10-NW Sect-Qtr : Typ e o f Work : LEA D SOI L REMEDIATIO NPROJEC T Locatio n o f Work : ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)733-188 3 : EMAI L AL L CLEAR S TO : AANIKPUTA@PRUDENTWEB.CO M : UNSUR E CORNER S Compan y Contac t Nam e Alt . Contac t PRUDEN T TECHNOLOGIE S ASHLEIG H ANIKPUT A NON E 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 Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N ALT87 2 CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Rear : Y



### http://www.dhon.org/lRTHOneCall/Ticket/TicketCreation.aspx?ViewTicketID=81029 1 8/31/201 1

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### Hom e Ticke t Ticke t Creatio n Logou t Creat e Anothe rTicke t G o t o Hom e Pag e Sen d Emai l

• YOU R TICKE TNUMBE R I S 2831312 . Origina l Cal l Date : Wor k t o Begi n Date : 8/25/1 1 8/29/1 1 Time : Time : 9:1 8 a m 9:3 0 am Op : ASHLEIGH1896 7 State : N E Address : 361 4 County : DOUGLA S Street : N21S T S T Place : OMAH A Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 03-SW,10-NW Sect-Qtr : Typ e o f Work : LEA D SOI L REMEDIATIO N Locatio n o f Work : ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)733-188 3 : EMAI L AL L CLEAR S TO : AANIKPUTA@PRUDENTWEB.CO M : UNSUR E CORNER S Compan y Contac t Nam e Alt . Contac t PRUDEN T TECHNOLOGIE S ASHLEIG H ANIKPUT A NON E Phone : (402)733-118 8 Wor k Bein g Don e For : EP A Dept h o f Excavation : 6F T Corne r Lot : NFront : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N ALT87 2 CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C



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onproperty Sewe r Lin e If utilitie s ar e no t locate dcontac t Supervisor , Safet y Septi c Tan k Personne l t o notif y the mof issu e Propane/Butan e G o to anothe r property to wor k

as directe d Foundatio n(DZ ) 

# •iS&c l Drivewa y Sid e walk 

# M Tree s Plants/Garde nG Z Acces s t o Property Bus y Stree t (needto clos e of

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# b- ^ Pet s /bees/wasps/ticks/re d ants/spider s Poiso nIvy/Poiso nOa k Miscellaneou s (^OiGJX'^' *

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