### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL E FOLDE R 

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## g.na ^ ^^^' • Address : /oo K ^Tlyir^^y ^ flL ^ Remediatio n Contractor : /^.3..,-/
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### Vide o ofpropert y (DVD ) Executiv e Stimmar y EPA-provide dpropert y sketc h Signe dAcces s Agreemen t fo r subjec t propert y Signe dAcces s Agreement(s ) fo r adjacen t propert y Restoratio nAgreemen t Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) Confinnatio ndat a Photograph s As-buil t sketc h Satisfactor y restoratio nsigne db y Propert y Owne r Propert y close-ou t chec k lis t signe db y EP A Descriptio no f area s no t meetm g RO D cleanu p criteri a Utilit y clearance s 

### Propert y mformatio nfromDougla s Count y Assessor' s Offic e

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­ )at e 4031075 1 Superfun dPROPERT Y SUMMAR Y Date : 01/23/200 9 Omah aLea dSit e Remedia l Actio n Contrac t #£P-R7-07-0(i/000 4 Mond i of : Dec/Ja n Propert y Address : 100 3 TURNE RB D A . EXECUTIV ESUMMAR Y A,l , Issue s Encpmitered : NON E A. 2 Issue s Resolved : NON E A. 3 Uniqu e Findings : NON E A. 4 Otbe r Relevan t Infonnation : ARE A NO T EXCAVATE D F l LANDSCAP E3'X20 ' @ 72 4 PP M CONFIRMATIO N SAMPLIN GDATA/RESULTS : D Z= 4 8 PP M @ 12" ; F 2 = 21 6 PP M @ 4" ; E A = 5 2 PP M @ SCRAP E ATTACHMENT S 1 ) Propert y 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 dfo r crossin g othe r propertie s 3 ) Pre-Excavatio n digita l vide o chp/photograph s 4 ) Post-Excavatio n digita l vide o clip/photogr^h 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 Ui) Property addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e includedi n th e individua l propert y file, i f available , o r obtaine dinclude : i ) Pre-excavatio n agreemen t detail s (i f an y ar e mad e withth e propert y 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 ) format and/o r photograph s iv ) Signe dformverifyin g satisfactory restoratio n v ) Descriptio n o f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOGIES , INC .Fin d Recor d Clea n U p Quer yI Lea d Remainin g Quer yI Propett yDamage Quer yI Backfill :

Sampl e Area : 2172 4 - 100 3 TURNE R B D Owner : 

### Resident : Contract : n Owne rOccupied Residen t Name : Contractor : Owne rName : MCGRAN E RYAN K jPRUDENT2008_S [MCGRAN E RYA N K Propert yAddress : Group : Owne rAddressl : 100 3 TURNE R B D 

# I Zi p Code : Assessment : Owne rAddress2 : |6810 5 1100 3 TURNE R BLV D Residen t Phon e Qualifyin g Grou p City : State : Zi p Code : |800/CHIL D jOMAH A |N E |6810 5 Assessmen t XR F Date : Owne rPhone : Alternat e Phone : 

## I • |(402 ) 345-077 5 |(402 ) 212-910 2 Assessmen t MaxXR F Value : I 114 9TECHNOLOGIES , IN C Property* ; a?/7^ ^ Date/Time : Quad s Excavated : It-Zj f2 ^ S( \ 

# «EF A EP A Propert y Clos e Ou t Propert y Address : l0O3'fo«r\el S S n Owner' s Name : Contracto r Grou p Pruden t Technologie s Excavatio n Genera l Ye s N o 1 .

If necessary , wer e the correct quadrant(s ) excavatedan drestored ? / 2 .

If necessary , wer e the correct area s of dri p zone excavatedan drestored ?

. / Gradin g Sodan dVegetatio n Ye s No 1 .Doe s th e grading aroun dthe perimete r of Ih e hous e in excavatedarea s generall y slope awa y fromthe house ? 

# y 2 .Has so dbee n lai di n all area s tha t wer e excavated ? 

# y 3 .

Doe s the sodappea r to b e generall y health y an dgrowing ? (Onl y evaluat e if inspecteda t a3 0 

# y da

y tim e period) 4 .

Ar e soddedarea s generall y fir man devenl y graded ? 

# y 5 .

Ar e the joint s betwee n the sodstrip s generall y tight ? (Onl y evaluat e i f inspecteda t a3 0 da y tim e period) 

# y 6 .

Wa s the propert y gradedsuc htha t wate r will no t poo l o n the property ? 

# y 7 .

Wa s damage to landscaping o r plan t material 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? (If applicable) 

# y 2 .

Wer e all gate s o r fence s taken dow n durin g restoration activitie s reinstalled ? (If applicable ) 

# y 3 .

Wa s damag e to gate s o r fence s avoided ? (If applicable) 

# y 4 .

Was damage to retaining wall s avoided ? (If applicable) 

# y Foundation , Sidin g an dGutter s Ye s N o 1 . Wa s damag e to the siding o r trimavoided ? 

# y 2 . Wa s damage t o the foundatio n avoided ? 

# y 3 .

Wa s damage t o window s avoided ? 

# y 4 .Was damage to window s o r doo r screen s avoided ? 

## y 5 .Wa s damage to downspouts o r downspou t extension s avoided ? 

## y Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 .

Wa s damage t o drivewa y surface s avoided ? • ' y 2 .

Was damage to walkwa y surface s avoided ?

### Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complet e including the 30-da y so dwarranty : EP A Representativ e < ^ j ^Date : //sp/o' ;

# SEF W Propert yCompletio n Agreemen t Thi s agreemen t document s the completion of remova l activitie s performedo n the belo w liste dproperty . The propert y owner' s signatur e indicate s tha t th e propert y owne r i s satisfiedwit hthe restoratio n of th e subject property , an dtha t n o item s ar e i n question , now , or a

t an y time mthe fiitiu-e, excluding an y remaming warrant y (3 0 day s total ) except thos e item s listedbelow , i f any . Propert y ID : Propert y Address : 

# 1 r.0 3 T"^^^^' > foO Owner : Phone : Restoratio n Item s I n Question :

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



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I agre e restoration' s completed , excep t a s note d above . C H I d o no t agi^ e restoration i s complete d 

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•wner' s Sfgiiatur e Dat ePruden t Technologies , Inc . (Prudent ) i s unde r contrac t wit hth e U . S . Environnienta l Protectic n Agenc y (EPA ) t o clea n u p lead
contaminate dsoil s at anumbe r ofpropertie s locate di n Omaha , Nebraska , includin g Ifa e propert y locate da t /po 3 "TuTne- r 6ft/e f Th e EP A request s you r permissb n t o allo w Pruden t t o performasoi l cleanu p a t thi s propert y t o iemo\f e lead-contaminate dsoil . B y signin g thi s form , th e propert y owne r grant s permissio n t o Ptuden t t o perform activitie s relate dt o th e cleanu p includin g soi l sampling , remova l o f lead-contaminate dsoil , an drestoratio n o f di e tefeience dproperty . I f

yo u hav e any question s abou t th e soi l cleanu p planne dfo r you r property , pleas e contac t Pniden t Administrativ e Clerk fo r th e Omah aLea dSit e cleanup . Ms . Deboral i Johnso n -a t (402 ) 733-1188 . Genera l question s abou t th e Omah aLea dSit e cleanu p ca n b e directe dt o th e EP A Publi c Infonnatio n Center s a t (402 ) 731-304 5 (SouthOmah aofBce ) o r (402 ) 991-9583 (Nort hOmah aofBce) . Propert y Acces s Grante dBy : Vi.s } (^-» \1 ^ Cj-j'rc^t \tt.­ (Pleas e Prin t Name )



# l(.l-S r Propert y Owne r Signature : (Signature ) (Date ) PROPERT Y INFORMATIO N (T o b e complete db y residen t and/o r propert y owne r - pleas e print ) C RESIDEN T NAM E : ^Vrt^r v IV\ ^ Grec«\g . Owner , Rente r RESIDEN T ADDRESS : /Q0 3 "To>rnP. r(iLc J I F RENTAL , PROPERT Y OWNE D BY :
OWNER' S MAIUN G ADDRESS ;
OWNER' S TELEPHON E NUMBE R - HOME : l^O ^ ) , ^ Vi " -ol' ^

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### J 1 AG E O F HOME? : ^ O YEARS
. HO W LON G HAV E YO U LIVE D HERE ? . 0 YEARS
. 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 NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : ? NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLA Y I N TH E YAR D FO R 5 HOURS O R MOR E PE R WEEK : 

## 0 COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s t o b e implemente db y EP A unde r this agreemen t ar e pursuan t t o Sectio n 10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f

acces s t o th e propert y i s providedfo r i n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entr y for "determiningth e nee dfor response , o r choosin g o r takin g an y respons e actio n unde r thi s title , o r otherwis e enforcin g theprovision s o f th e title. "

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 4242 Medica l Drive , Suit e 425 0 Kansa s City , MO 6411 4 Omaha , Nebrask a 6811 0 Sa n AntonicT X 7822 9 Phone : (816 ) 363-3703 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax:(816)363-370 7 Fax : (402)504-100 5 Fax : (210) 579-6577

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OLS# : 2172 4 Dat e Excavated : 11/13/200 8 USEP A Sl^ied-OfTDate : 

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CONTRAC T# : E P - R7-07-0 6 / 000 4 PRUDEN TTECHNOLOGIES , INC
.ENVIRONMENTAL ! CONSTRUCTI O 

### TECHNOLOGIES , INC . SERVIC E 

# Propert y Statu s For m Address:/<:?o 3 Tort^^ r ^}^< ^ Date : ///<3'/ < c^ r Phone : 3V5'-07-75 ' BVID : Plant s & Permanen t Landscapin g T o Remai n I n Plac e Descriptio n & Locatio n

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_ 808 0 War d Parkway , Suit e 40 5 250 5 N . 24* ^ Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 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

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## Dougla s County-Omaha , N E

Parce l I D Owne r Nam e Propert y Addres s Cit y Zi p Owne r Addres s Owne r Addres s 2 Owne rCit y Owne r Stat e Owne rZi p 172310000 0 MCGRAN E RYAN K 100 3 TURNE R B D OMAH A 6810 5
100 3 TURNE R BLV D OMAH A N E 6810 5 Sec-Twn-Rn g Additio n Bloc k Lo t Lega l 1 Lega l 2 Lega l 3 Lega l 4 Treasure r Websit e Lin k Assesso r Websit e Un k 21-15-1 3 MAYN E PLAC E 4 2 6 44X12 5

http://webapps.dotcomm.org:8080/TreasTax/faces/page s /taxinfo.jsp?parc=172310000 0 http://douglasne.mapping-online.com/DouglasCoNe/stati c /accountinfo.jsp?accountno=R172310000 0 guaranteed . Thi s i s not a lega l documen t an d shoul d not b e substitute d fo ra titl e search , . .— .__. . . , , . : , . . . 1 inc h - 2 5 fee t appraisal , survey , o rfo rzonin g verification .

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### Sen dEniai l YOU RTICKE T NUMBE RI S i 2168934 . Origina l Cal l Date : 11/04/0 8 Time : 10:3 7 a m Op : MADHURIMA1 8 96 7 Wor k t o Begi n Date : 11/06/0 8 Time : 11:0 0 a m State : N E County : DOUGLA S Place : OMAH A Address : 100 3 Street : TURNE R BLV D Twp : 15 NRng : 13 E Sect-Qtr : 21-SW,28-N W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n fo r soi l 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 : MADHURIM A Phone : (402)733-118 8 Alt . Contact : Phone : (618)401-222 3 Wor k Bein g Don e For : ep a Dept h o f Excavation : 6 f t Corne r Lot : N Front : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL 3 MCLEODN E MUDO l MUD0 2 OMAHACO F 0PPDGPR 5 0PPDGPR 6 QLNNEI C QLNNEI F 

### Utilit y Servic e Are a Contac t Phon e Numbe r 

### Typ e Day : 402934046 9 

### CO X CXCAT V HEID I Alt : 402934046 9 

### COMMUNICATIONS , IN C Emerg : 402932975 7 

### Day : 877366834 4 LEVEL 3 LEVEL 3 N A Alt : COMMUNICATIONS , LL C Emerg : 877366834 4 Day : 800289190 1 N O NEE D T O CALL MCLEODN EMCLEODUS A Alt : OUT EMERGENC Y Emerg : 800289190 1 Day : 402504782 3 METROPOLITA N MUDO l SAND Y Alt : UTILITIE S DISTRIC T Emerg : 402504797 0

lof 2 11/4/200 8 10:3 7 AMhttp://www.dhon.org/^intemet/DHONNoticeCreation/MessageText.. .


### MUD0 2 METROPOLITA N UHLITIE S DISTRIC T SAND Y Day : Alt : Emerg : 402504782 3 :402504797 0 

### OMAIL\COF CIT Y O FOMAHA
TRAFFICSEWE R RO N Day : Alt : 402444719 7 402444516 1 Emerg ::402444516 0 

# 0PPDGPR 5 °E^T"^""°'*'^ ^ 

# N A Day : 406728934 3 Alt : 888728934 3 Emerg : 406728934 3 0PPDGPR 6 O; ^ PUBLIC POWE R^ ^ Day : Alt : 406728934 3 888728934 3 Emerg : 406728934 3 

### QLNNEI C QWES T LOCA L NETWOR K N A Day : Alt : Emerg : 406728934 3

: 888728934 3 

### QLNNEIF QWES T LOCA L NETWOR K N A Day : Alt : 406728934 3 Emerg ::888728934 3

2 o f 2 11/4/200 8 10:3 7 A M