TECHNOLOCIES. INC. 

PROPERTY SUMMARY SHEET 

Omaha Lead Site Remedial Action Contract # EP-S7-10-05 

Said: 30738 PropertyAddress: 2108 SPENCER ST 

Executive Summary: 

• Issues Encountered: None 

• Issues Resolved: Paid $46.29 for water bill. 

• Unique Findings: 

• Other Relevant Information: 

• CONFIRMATION SAMPLING DATA/RESULTS: B2=330 PPM @ 6"; DZ= 288 PPM @ 13"; F2=275 PPM 

@2"; EA= 62 PPM @ Scrape. 

Attacliments: 

Documents Included in the Property File: Yes No N/A 

Property sketch provided by EPA pursuant to contract specifications V 

onto adjacent properties 

Other Documents: 

Signed Access Agreement; including access agreements obtained (if required) for crossing V 

Pre-excavation agreement details (if any are made with the Property owner) V 

Pre-Excavation digital video clip V 

Sampling data sheet V 

Post-Excavation digital video clip V 

Documentation - Completed EPA close-out checklist V 

As-Built sketch V 

Omaha Lead Site Database sample information document. V 

Signed form verifying satisfactory restoration V 

30 day SOD warranty pictures V 

Utility clearances document V 

Property information from Douglas County Assessor's office. V 

Settlement documents (i.e. for any damages, replacement of plants, etc.) V 

Site safety hazard analysis document with pictures. V 

Legend: Yes - Included in the File; No - Not included in the File; N/A - Does not Apply. 

Prudent Representative: tative: x v 

EPA Acceptance: 

Date: 

A^ Date: 

Prudent Technologies, Inc. | 2505 N. 24TH Street. Suite 308 jOmaha, NE 68110 USA | Tel. 402.504.1004 

Fax: 402.504.1005 

Environmental Engineering & Services | Remediation | Construction 
V 

Name: ^A^£> ^ /l/tAc H Omaha Leae? Site Date: ~?/t/»3 North Arrow 

Address: O/d?:? ^f^f^cB k 

Phone: OtO-z> ¥S~P'S^ . y-T ' 

Site Sketch Time: C'(?S~ f 

Team SiAr^O^An^Ti'^/cu.t^/^ ^ BV1D# 3o'>1 ^ XRF Code -^^^ ^ 

Sample Number Lead Concentration Confirmation Sample 

Lab 

RYDSCPLA-30738 

502ppm 

/^^^=^^ ^ ^ Tpm 

 ppm 

pprn 

^Ye s

^Ye s

^^Yes

Jg^Yes

£hYes

Yes

Yes

 1=1

 Q

 a

 0

 D

 D

 •

 No

 No

 No

 ivfo

 No

 Wo

 Wo

 0 

S 

H 

^ 

^ 

a 

D 

Sf'^^C^R 

'^r^oli o T oorl Qitp 46130 
PROPERTY ACCESS FORM 

Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency 

(EPA) to clean up lead-contaminated soils at a number ofproperties located in Omaha, Nebraska, including the 

property located at SL \ Oj ^ .^p^/l.tS£- y . The EPA requests your permission to allow Prudent to 

perform a soil cleanup at this property to remove lead-contaminated soil. By signing this form, the property owner 

grants permission to Prudent to perform activities related to the cleanup including soil sampling, removal of leadcontaminated soil, and restoration ofthe referenced property. 

If you have any questions about the soil cleanup planned for your property, please contact the Prudent 

OfTice for the Omaha Lead Site cleanup at (402) 733-1188. General questions about the Omaha Lead Site cleanup 

can be directed to the EPA Public Information Centers at (402) 731-3045 (South Omaha office) or (402) 991-9583 

(North Omaha office). 

Ifyour property has a gravel or dirt driveways or parking areas then the removal and replacement ofthe soil 

and/or gravel during the remediation process does not make your Illegal gravel/dirt driveways or parking areas legal. 

Propert>' Access Granted By: S-/4-//D^ ^ ^ - / \ O/ ^ ft 

(Please Print Name) 

Propert C^^JU^^UA^C^.'^ /^/^X - y Owner Signature: C^/ H 0^*'^^^ ^ ( ^ / ] t^^t ^

(Signature)

Property Accessed by: ( ^ V P .J ^v "Q. fvlrvl <!a.Jr^

 '^/<RC//. VA?^/ / 

 (Dale) 

 (Prudent Employee Name) 

PROPERTY INFORMATION (To be completed by resident and/or property owner - please print) 

1. RESIDENT NAME: *~,/^DH?Jt- / , , ^f^j^V / CT^net ^ ^ Renter 

2. IF RENTAL, PROPERTY OWNED BY: 

3. OWNER'S MAILING ADDRESS; A I O S Ct^^nd^'Sj C «^ V ~ 

4. OWNER'S TELEPHONE NUMBER - HOME: iHoZ. > '^^-^^ S WORK: (4o^ \ P^tZ-^ZXi O 

5. TENANT'S TELEPHONE NUMBER - HOME: ^SSSs\ WORK: ( ) 

6. AGE OF HOME?: ^ ^ YEARS. HOW LONG HAVE YOU LIVED HERE? .STO YEARS. 

7. HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? l ^ YES NO 

8. # OF OCCUPANTS UNDER AGE OF 7: Z> # OF OCCUPANTS AT OR OVER 7 YEARS OLD ^ 

9. # OF CHILDREN UNDER AGE OF 7 WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: 

10. COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS, ENTRY GATES, NEIGHBORING PROPERTY 

ETC.) A/^/^ ^ 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be Implemented by EPA under this 

agreement are pursuant to Section 104 of CERCLA, 42 U.S.C. 9604. EPA's right of access to the property is 

provided for in Section 104(e) of CERCLA, 42 U.S. C 9605(e), which provides entry for "determining the need for 

response, or choosing or taking any response action under this title, or otherwise enforcing the provisions of the 

title." 

Prudent Technologies Inc. 5600 S. lO'" St. Omaha, NE 68107, 

402.733.1188 (Office) 402.733.1883 (Fax) 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address Date: M - 2, 5 - I | : A) O 9 3p6A(\,«r . 

BVID: 30^3 Q Phone: ( 4 oi ) ©8 ^ "C^W ^ 

NOTICE TO BE GIVEN TO: (^WNER / TENANT BOTH 

No w MUCH NOTICE IS NEEDED/^ 24 HOURS 48 HOURS 72 HOURS 

OTHER NOTICE NEEDED (PLEASE SPECIFY): 

PHONE # AND NAME TO WHOM NOTICE NEEDS TO BE GIVEN: 

WILL NEIGHBORING PROPERTY NEED TO BE USED FOR ACCESS? YES (NO ^ 

IF NEIGHBORING PROPERTY WILL NEED TO BE ACCESSED WHAT IS THE ADDRESS: 

AA>^£>/l/€^ ' 

WAS AN ACCESS FORM OBTAINED FROM THE NEIGHBOR? YES C^T ) 

WILL A FENCE NEED TO BE TAKEN DOWN TO OBTAIN ACCESS? YESC^MQD 

IF ANSWERED YES TO NUMBER 12 PLEASE PROVIDE LOCATION OF FENCE: 

IS THERE PRE-EXISTING FACIAL DAMAGE TO THE PROPERTY AND IF SO PLEASE PROVIDED LOCATION AND DESCRIPTION 

OF SUCH: YES (^S ) SPECIFY: 

IS THERE PRE-EXISTING CONCRETE DAMAGE TO THE PROPERTY AND IF SO PLEASE PROVIDED LOCATION AND 

DESCRIPTION OF SUCH:/YfS ^ NO SPECIFY: 

Property Owne ^ ^Prudent» Employe ^.„,,.„j^^ e

SiznaiMrjy^ \&4/C/U: £\ ^ - /XITT^CI ^ \ Signature: G^<yjULelo"~V^>>&ta^^^i^^ srL 

DATE: 

Prudent Technologies Inc. 5600 S. lO"' St. Omaha, NE 68107, 

402.733.1188 (Office) 402.733.1883 (Fax) 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Inspection Form 

Date: LJ -^ 5 ^ / j Address: ^iD^ ) 'OpQ^tMA^ 

Phone: LjoCi %&lj BVID: 30 ^ 3 y 

Pre-Existing Dainage: Please write in detail and included location 

and description of daniage: 

Concrete Damage: 

V^ ( Y \ 

<>ywA dnay-dtt^tt^ y^^...^ t^i>iiJ~-a^ 

Facial Damage Including Siding: 

^J~Oi 

Does Basement have history of leaking or flooding? (^ES^TN O 

Does Homeowner want sod replaced in all areas? (^ES ^N O If NO please provide what 

areas are not to be sodded and what needs to be rep?9ced1nstead of sod (i.e. mulch, rock, 

leave bare) if mulch or rock please specific what type and color: 

<SL 

ANY OTHER DAMAGE OR REQUESTS: 

Property Ownc]/ ^ ^ Prudent Employee 

Signature: (^JLA*AJL.O*-0 'V^-^4/2^V^.OHS> 

DATE: d)S ^ ^S-j :^r / DATE: S [ <aS I I I 
ORUD ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

XRF CLEARANCE SHEET 


PROPERTY ADDRESS: UjO^ Sp^jHCli^ 


PROPERTY ID: ^ti"l ^"^ 


/ 

MAP HAS BEEN REVIEWED AND NO MISSED AREAS EXIST: NO 

WAS CONTAMINATION LEFT BEHIND? IF YES WHERE AND DIMENSIONS: S^^^ 

fZjLSiV?yL^ ' 

CREW: \\^o ^ DATE DEPTH QUADRANT READING 

"XRF TECH: lv^i:Jn/A5^^A, 

READINGS DOCIJMENTED IN 

"1 % 

1 y 

Fl 

F2 

Bl 

^1 ^ 

LOG BOOK?LYES) NO 6='/ B2 3.^0 

GARDEN 

PLAYZONE 

%l% 

;>-' ' 

i2>'^ 

.-s 

EASEMENT 

IZ 

njz> 

&.Z 

'Z%'i 

IZZ r^cz) 

1 
# 

TECHNOLOGIBS, INC 

EPA Property Close Out 

Property #: %C>1 3'S ' PropertyAddress: 2^X0^ $f*«.c-e^^>-

Date/Time: Owner's Name: ^^N/S'-V-Q- ^CAC . ^ 

Quads Excavated: p2 1 V^x^' Z Contractor Group: Prudent Technologies, Inc, 

Excavation General Yes No 

1. If necessary, were tlie correct quadrant(s) excavated and restored? / 

2. If necessary, were the correct areas of drip zone excavated and restored? / 

Grading Sod and Vegetation Yes No 

1. Does the grading around the perimeter of the house in excavated areas generally slope away / fi-om the house? 

2. Has sod been laid in all areas that were excavated? / 

3. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 / day time period) 

4. Are sodded areas generally firm and evenly graded? / 

5. Are the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day / time period) 

6. Was the property graded such tliat water will not pool on the property? / 

7. Was damage to landscaping or plant materials avoided? / 

Gates, Fences and Retaining Walls Yes No 

1. Do gates open and close freely? (If apphcable) / 

2. Were all gates or fences taken down during restoration activities reinstalled? (If ^plicable) / 

3. Was daniage to gates or fences avoided? (If applicable) / 

4. Was daniage to retaining walls avoided? (Ifapplicable) / 

Foundation, Siding and Gutters Yes No 

1. Was dajnage to the siding or trim avoided? y 

2. Was daniage to the foundation avoided? / 

3. Was daniage to windows avoided? y 

4. Was damage to windows or door screens avoided? / 

5. Was damage to down^wuts or dovmspout extensions avoided? / 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to diiveway surfaces avoided? / 

2. Was daniage to walkway surfaces avoided? y 
# 

Owners comments; 

Inspection notes: 

Removal and restoration activates complete including the 30-day sod warranty: 

EPA Representative 6*^A>s ^Date: ^/^^^ 
AS - BUILT DRAWIN ^ Sample Area: 307a« - :ilO« Spencer St 

Date Excavated: 08/18/2011 OMAHA LEAD SUPERFUND SITE Sampled By: Lfohnson 

CONTRACT #: EP-S7-10-05 

Name: ^/K«a&» /Zft/>f// Omaha Lead Site 

Address: O/O? sfifMrC R Site Sketch 

Phone; Oioz> •fS^-pSi 7^ 

Team ttArJ^r/HJ^THyt^/»i' ^ BVID# 3^ ? 3 ^ 

Sample Number Lead Concentration 

2 5^3^/ 3 „„„ 

ppm 

ppm RYDSCPLA-30738 

Lab 502 ppm 

Data; > North Arrow —i •/^/g Time; r):oS~ f 

XRF Code ^-^^v- Confirmation Sample 

^Ye s a No E 

'^Yes a No 13 

iJfYes O No 0 

B^Yes a No C] 

£izYes a No 23 

Yes • No a 

Yes n No n 

1­

^2 = 33(1 PPM k 6" jr^zf-^. 

- # \ i 

i 

-\" ..4 a 

—-< > I-iT-)^ 

DZ = 288 PPM @ 13" 

EA = 62 PPM (S) SCRAPE 

^ ^ 

I

2h-^/>k^' if^

y ^ ^ y/f . ^ y

.6P^rJC£ ^ 

i

I

-ii

I 

 -\ 

•-{• -

i 

il|- . • 

i 14 

 if 

i

F2 = 275 PPM @ 2" 

;i 

I 

Prudent Technologies, Inc. j 2505 N. 24TH Street, Suite 308 jOmaha, NE 68110 USA j Tel. 402.504.1004 j Fax: 402.504 1005 

Environmental Engineering & Services | Remediation j Construction 
I miLi nc^pAfft . t f%«3*«DN m l y 4^UEi f •ain^ E «^u o J I-! 

Praperty M o Clean-ufi M b | Sample ams 

Sample Area: 3073 8 - 210 8 SPENCER ST 

I f i Sample Date - Quadrart ^ ) Paramete - -XRF R« » XRF Res . Exc. Marker Race - {Lead Remainin » ins -r Sampled B H QA Confirmee -JlabjF 

i 8/18/2011 B2 LEAD 330 mgrtcg 6 • Ll Ljohnson N/A 

:_j 8/18/2011 D1 LEAD 288 m^'kg 13 n Ljohnson WA •

i 8/18/2011 El LEAD 62 mg/kg 1 D Ljohnson WA •

8/18/2011 F2 LEAD 276 mg/kg 2 D 1 0 Ljohnson .N/A 

LEAD i mg/kg d N/A to • t • 

: . •,:. . _-.. ^ . • _ _ 

. • " "'•­ ' • . 

-• • • 

^ q — 

- --­

_ 1 ' _ • 

• • . • , - • - ­ r ^ ' • ­ ­ ^ . 

- ­ . . • . 

• 

1 Record; N .| • M^ | £,!.,:„-.., 'seardi < L­- 1 
'J^ ^ L • I L 

nufMuly InfiD M b Sample M b 

Sample Area: 3073 8 210 8 SPENCER ST 

Lab_Resul >• Lab Result Unit: - Remarks 

0 mg/kg 

0 rng,-'kg 

0; nr>gykg 

0, mg/kg 

m^l(g_ 

Record: M •I h: 'if; H? Filtfr 'SeSfCtl' I < 
%EPA 

Property Comp8etion Agreement 

This agreeiTienI:' documents, the. complettbn of removaJ. activities pcFformed OD the below feted peopeirty. 

The property cswtier's. sigaaiture indicates that the property owmer is satisfied with the restoration of tliie 

sufeject property^ and that no hems are in; qaesttoh.,, now,, or at any time in the future,, exciuding anj: 

remaining wariranty (JO days, total) except those itejBws listed below, if any. 

PropertylD: '3 0 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

H;em: 

Item: 

Requtired corrections to complete the property: 

^ ^ I agree restofation is completed. 

[ I t do aoi. agree restoration is eompleted at (rroted deficiencies above) 

ny.- > ^ 

Owner^ Signaterre 
•HH| ^^^^^•^ ^^^^^^^1 

^^^^^^^^^^^^1 ^^^^ H r.\ '^^^^^^M ^^l^^^^^^^^^^^l ^^^^H '^ -- ^^^Hl ^^^^^H ^^1' ' ^^>-^'lH 

.^^^^^^^^H • '- j^^^^^^^^^ l 

1

^^^1 

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^MBBi^HBani HHHHHHHHHMHHIHH 

IRTH One Call Page 1 of 1 

Diggers htotline 

Of 

Nebraska 

Home Ticket 

Ticket Creation Logout 

Create Another Ticket Send Email 

• YOUR TICKET NUMBER IS 2828190 . 

Original Call Date: 8/22/11 Time: 2:18 pm Op: ASHLEIGH18967 


Work to Begin Date: 8/24/11 Time: 2:30 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2108 Street: SPENCER ST 


Twp: 15N Rng: 13E Sect-Qtr: 10-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD SOIL REMEDIATION PROJECT 


Location of Work: ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (402)733-1883 


: EMAIL ALL CLEARS TO: AANIKPUTA@PRUDENTWEB.COM 


: UNSURE CORNERS 


Company PRUDENT TECHNOLOGIES 


Contact Name ASHLEIGH ANIKPUTA Phone: (402)733-1188 


Alt. Contact NONE 


Work Being Done For: EPA 


Depth of Excavation: 6 FT Corner Lot: N Front: Y Rear: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


http://www.dhon.orgARTHOneCall/Ticket/TicketCreation.aspx?ViewTicketID=799519 8/22/2011 
http://www.dhon.OMjj|thintemet/DHONNoticeCreation/MessageText. oi||i|lhi .

Create Another Ticket Back to lilh Intemet SendEmai 

• YOUR TICKET NUMBER IS 2819898. 

Original Call Date: 8/11/11 Time: 4:40 pm Op: ASHLEIGH18967 


Work to Begin Date: 8/15/11 Time: 5:15 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2108 Street: SPENCER ST 


Twp: 15N Rng: 13E Sect-Qtr: 10-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD SOIL REMEDIATION PROJECT 


Location of Work: LOCATE ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (402)733-1883 


: UNSURE CORNERS 


Company : PRUDENT TECHNOLOGIES 


Contact Name: ASHLEIGH ANIKPUTA Phone: (402)733-1188 


Work Being Done For: EPA 


Depth of Excavation: 6FT Corner Lot; N Front: Y Rear: 


Involves Tunneling or Horizontal Boring ; N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Utility Sei^ce Area Contact Phone Nuinber Type 

COX Day: 4029340469 

HEIDI COX CXCATV COMMUNICATIONS, Alt: 4029340469 COMMUNICATIONS INC Emerg: 4029329757 

Day: 4025047823 

METROPOLITAN MUDOl SANDY MUDOl Alt: UTILITIES DISTRICT 

Emerg: 4025041910 


Day: 4024447197 


CITY OF OMAHA- RICH/TRAFFIC OMAHACOF Alt: 4024446725 TRAFFICSEWER OMAHA 

Emerg: 4024445160 


Day: 4067289343 


OMAIL\ PUBLIC 0PPDGPR5 ELM 0PPDGPR5 Alt: 4062071494 POWER DISTRICT 

Emerg: 8887289343 


Day: 4067289343 
 QWEST LOCAL QLNNEIC NETWORK ELM QLNNEIC Alt: 4062071494 


lof2 8/11/2011 4:40 PM 
http://www.dhon.or|Htfhintemet/DHONNoticeCreation/MessageText. [>n|||hir ... 

Emerg: 8887289343 

2 of 2 8/11/2011 4:40 PM 

V 

2108 SPENCER ST 

«j§ 

Printed: Apr 04, 2011 A www .ticgis.org/dogi.s 
^liilliilMiBitilMillitflllMiillMlitlliieiHil^ ^ 

PRUDENT TECHN0L0GIE9IVC. UMB BAIHA . 35375 

8080 WARD PARKWAY, SUITE 405 ^^fJ^t^^JlJ}," ° 

KANSAS CITY, MO 64114 iB-ea/ioio 

(816) 363-3703 

g PAY TO THE 

g ORD^OF 

't)i^))(.MM^^7i^ r^ OLLARS 

CHECK AMOUNT NOT TO EXCEED $2000 

mt mmmif jossmm /^ 1 

II'0 3 5 3 75M ' mOlOOOEiTSi : ii'^fl 7 Ifl&qEiq Sn' 

PRUDENT TECHNOLOGIES, INC. 35375 

PRUDENT TECHNOLOGIES, INC. 35375 

• Iillllli II Hill I III • 

610649(4/11) 004911 Rcv 10/10 
ApC^Vo^. \ 'z> \ '^\cywtV\\-^^^ ^ \j-e_- V CJ C-fc Vi \> \ 

^_____-, ^«0 ^ VwCVv V ^v ^ 

Account : 271065-1146263 Basso 

1723 Harney St • Omaha, NE 68102 • 402.554,6666^ SANDRA, ROACH e-mai!?guslomer_s6iVice®mlid.orrK(haiioiTi • «/efasitet www.mudoir^ajcprn METROPOLITAN 

Seiyibe address: 2108 SPENCER ST .QTltltl& S DilSTRie i 

Billing date Sep 9; 2011 Call 402.554.7777 If you smell gas: Previous balance $0.00 

Payment received \ - . " " O.OQ 

No charge to check gas leaks. Have heating Current charges 98.00 

syistem cheeked every year by a qualified New balance .98.00 

heating contractor Keep chimneys and flues 

> total due Sep 27, 2011 $98.66 free of debrjS:.

 , •' ­ ' Your budget payment of $98.00 Is duBSep'27, 2011. Budget variani^s:' 

Current =-$8.16 Totar = -$200!46 ;';-

Details of ciirront charges: . ' 

GAS RESIDENTIAL RATE A: Aug 3 to Sep 1 

250 Metier Number 437050 , : 

Current read (actugj): 2809 - F^revious read (giS!Hii5:.279^ = 14 CCF 

t??r,­ ^ Gas Use: 14 CCF x 1.026 (hegj;.vallie);= 14.364 th^^rms : •r

 : • 29 days 14.364,therms aiO;dQ07 = i; $8:48 ;.; .' -

C^ Nov bee JdU;eb Mar Apr M&y.Jun Jiil .fiai Sep Service Charge •''••• ' ' ; 14:00. V

• V Your Gas lise' "" 

•;• .Gas Cost. • .••'.•'.•. % v^ •;;- Y :;';Z^-.$22.48 

Gas Infrastructure Rgplacernent -..iZ '>.• 3.00 

Past 12 Monttia.. a Past 1394 MontliB 

This Month ,La.st Year 

BUM unite: 

14 ' 32 

USepBre^ : 0.5 1.1 

Aserage OUit ((iSr day: $0.90 . $1.26-

Number of days in billing osfde: ' 29 29. 

WATER RESIDENTIAL RATE W-1: Aug 3 to Sep 1 

Metisf Number5890735 Size: 5/!8-inch 

Current read (actual): 261 -, Previous |-ead (actual): 242 =19 CCF ^ ' 10 ­ VVaterUs^e: 19.005) GCFor 14.212 gallons v . 

' 9.6o6 CCF at 1.0191 = $9.17' 0 . 

IbllillllllLBl 10:005 CCF at 1.4258- 14.26 Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Si Service Charge

 10.77 Your Water Use . 

WaterCost ' • • •., .• . -,;.. ; ;: $34.20-rll.Ol •". • • Past 12 Months Q Past 13^1M Montlis Water Infrastructure Riesplacement • v, :u; - ;. ' 

This .Month Last Year Budget Payment Plan Interest 

0.03 CR Billing units: 

19 13 

Use per day: 0.7 0.4 Cityiof Omaha Sewer 20-32-17/ ^ 

Average cost per day: $1.40 $0.81 Sales Tax 5.87 

Number of days in billing cycle: 29 29 . >, Current Charg^is $89.84 

X Please retum this portion of the bill with payment^ • Ple^ase do not staple payment to bill 

e-mail: customer_service@mudomaha.com 

website: www.mudomaha.com 

METROPOLITAN 

urjLiriES oisraicT Q0027106511A626300 6850 0010 MRRP0909102011YNNNNY01 005159 0013 

1723HameySt • Omaha.NE68102 

SANDIW ROACH 

Due on or before Sep 27: 

2108 SPENCER ST Your budget payment of $98.00 is due Sep 27. 

OMAHA NE 68110-1945 

Amount Paid: 

lii»li<l>'i|i'i"liii<i|M'<"i II I'll>i'>"ill<i 

METROPOLITAN UTILITIES DISTRICT 

PO BOX 3600 

OMAHA NE 68103-0600 

Q Check box and indicate change of mailing address 

or telephone numbers on the reverse side. 

«'i>il<'«iiliiii<l IN|i|l"|i||<iillMI>ii>li>l"l>l>'>' 

Give to the HeatAid Fund. Seewww.mudomaha.com. 

Monthly donation - Add: n$ 2 n$ 3 n$ 5 Other$_ Account: 271065-1146263 

CO05 
,f46263 

.; 2108 SPENCER ST 

checks, postage and stamps. 

Pay your bill on-line. 

^e accept MasterCard and Visa. Go to 

www.mudomaha.com and click on "my 

account." 

250 " 

125 ­ ...kllll. . Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Ju 

Your Gas Use 

• PBst12Monttw B Pest 13 ^ months 

This Month Last Year 

Billing units: 17 12 

Use per day: 0.5 0.4 

Average cost per day: $0.84 $0.70 

Numtier of days In billing cycle: 33 33 

20 

lUil iiiu 

Aug Sep Oct Nov Dec Jan Fab Mar Apr May Jun Jul 

Your Water Use 

Past 12 Months B Past 13M Uonths 

This Month Last Year 

Billing units: 5 5 

Use per day: 0.2 0.2 

Average cost per day: $0.48 $0.42 

Number of days in billing cycle: 33 33 

1723 Harney st •Omaha.NE 68102 •402.554.6666 MCTOnpn i ITAM 

e-mail: customer_servic9@mudomaha.com • website: www.mudomaha.com IViC I nUrUL I IMI M 

UTILITIES DISTRIC T 

Billing date Jul 6, 2011 

Previous balance $98.00 

Payment received 0.00 

Current charges 98.00 

New balance 196.00 

• Total due JuJJl^^ l $196.00 \ ^ 

Your budget payment of $196.00 is due Jul 21,20211 , Budget variances: . \^ l VTN 

Cun«nt =-(34.63 Total = -(183.67 

Details of ourrent charges: 

GAS RESIDENTIAL RATE A: May 26 to Jun 28 

Meter Number 437050 

Current read (actual): 2770 - Previous read (actual): 2753 » 17 CCF 

Gas Use: 17 CCF x 1.019 (heat value) = 17.323 therms 

6 days 3.150 therms at 0.5709 ° $1.80 

27 days 14.173 therms at 0.5794 = 8.21 

Service Charge 14.00 

Gas Cost • $24.01 

Gas Infrastructure Replacement 3.00 

IIUiy,f!Vi^i%>)" 

WATER RESIDENTIAL RATE W-1: May 26 to Jun 28 

Meter Number 2890735 Size: 5/8 -inch 

Current read (actual): 231 - Previous read (actual): 226 ° 5 CCF 

Water Use: 5.000 CCF or 3,740 gallons 

5.000 CCF at 1.0191 = $5.10 

Service Charge 5.97 

Water Cost • $11.07 

Water Infrastructure Replacement jlOO 

Budget Payment Plan Interest 0.01 CR 

City of Omaha Sewer 17.16 

Sales Tax 4.14 

—>.-. Current Charges $63.37 
Srf:e Job Hazard ABarysL mvi s 

.A ddress .y. Da(e.„(^l/lZ^ 

AnalY.si.s Completed By___/^ 

Location 

I „J' ^ 

I <'.)''oi be;id Pov.-e,; Line.'-: 

Ct>ndifioni Hazard.s 

FlecfrociJtion 

Gas L.ine.s 

Waler Lines 

.Sower L.inc 

Sepiic Tank 

Pj'opafie/Butji.oeF(.M.;nda(i'.)»yyDZ)y 

Driven*'.3V --I Zf 

Underground 

Uriirlies 

Gas, water 

leaks 

Side wrtik 

W^n-'pfs/Jji j1vj9sj^f!<, 

I Trees 

Pl.^nL'-A.^arden CiZ 

Ac'.ees.s to Properly 

ny __ 

Bury Sfree! fiieed (o close, 

off l.'ine) 

i !-hi.r.d r.>j.y. 

Pelf, /bees.'wasps/tick.s/red 

:iiii I £/spi<.lers 

Pol.'-:on ivy/Poison Oak 

l'viiS':i:.Jia.i7eous 

Prudent Technologies Health and Safety' Officer 

t (frrc'ctive Action 

Call Digger Hotline Prior to perl.bnn locates prior lo 

beginning work on property 

lliiitililies are not located conlact Si:i.pe.rvi.sor, Salely 

Per.sonnel to nptd'Y Hicin of issue 

(5o lo anoihcr prop^ftyjir^vork a.s directed 

^/ivtoi/_a..ef^,f^ll 

'..Itanges in condilions re:;uliiiig in additional 

safely asscs.sn)eijl if'appliea.ble 

.Audited bv %. \1 1.1 
"T 2 10 8