### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 2700 2 DATE : 1/1 5 ADDRESS : 253 6 PARKE R S T REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES . INC . YEAR : 201(| ) 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S [ ^

PR E AN D POS T VIDE O O F PORPERT Y(DVD ) m EXECUTIV E SUMMAR Y EPA-PROVIDE D PROPERT YSKETC H SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y n SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN TPROPERT Y Q RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R T O REPLACE PLANTS , ETC. ) I D CONFIRMATIO N DAT A 0 PHOTOGRAPH S II I AS-BUIL TSKETC H C l SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R d PROPERT YCLOSE-OU TCHECKLIS T SIGNE D B YEP A

• DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A

• UTILIT YCLEARANCE S PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E D D D



## ^ V y y\\i\\ \ SIGNATUR E DAT E 

### 3021837 0 

# iil i Superfun d

### PROPERT Y SUMMAR Y Date : /15/201 0 Oniah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Propert y Address : 253 6 PARKE 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 Information : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : B 2 = 39 1 PP M @ 6" ; E A = 29 5 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 digital 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 sketc h­ i ) Shal l includ e fina l lea dlevel s v ) Legen d ii ) Contaminatio n lef t behin darea s vi ) Contracto r identificatio n iii ) Property addres s vii ) Dat e iv):[iBVI D numbe r 7 ) Othe r item s t o b e include din 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 ) Property Statu s For msigne db y property owne r iii ) Excavatio n digita l vide o in MPEG , WM V (Window s Medi aVideo ) o r SW F(Flas hPlayer ) format 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 .Fin d Record 

### Backfill : Remediatio n Quer y Lea d Remainin g QueryPropert yDamag e Query 

### Sampi e Area : 2700 2 Owner : ­ 253 6 PARKE R S T Use rProvide d Owne rInformatio n Resident :
n Owne rOccupie d 

### Owne rName : IMOBEC O INDUSmiE S Owne rAddressl : Owne rAddress2 : 11141 3 HICKOR YRD City : lOMAH A Owne rPhon e 1(402) 342-282 0 State : Zi p Code : IN E )68144 - Altemat e Phone : Owne rName : Owne rAddress : City : Owne rPhone : State : Zi p Code : 

# 1 Alternat e Phone : Residen t Name : Propert yAddress : |2536 PARKE R S T Zi p Code : 168111 - Residen t Phon e 

# I

Contract : Assessment : i Contractor : PRUDENT201 0 S Qualifyin g Grou p 40 0

Contrac t Optio n ]OPnO N 2 Assessment Ma xXR F Valu e 48 3

# LMUm-M X 'TECHNOUXJIES . INC . Propert y # : 27<^2- - Date/Time : Quad s Excavated : ^02 — 

# EP A Propert y Clos e Ou t Propert y Address : 2.53 6 (^^rt^ r 9k Owner' s Name : rAob€<f ^ 3r ^ - Contracto r Group : Pruden t Technologies , Bmc , 

### Excavatio n Genera l Ye s N o 1 . I f necessary , wer e th e correct quadrant(s ) excavatedandrestored ? / 2 . I f necessiiry . wer e th e correct area s of drip zone excavatedandrestored ? / Gradin g Sodan dVegetatio n Ye 9 N o 1 Doe s the gradin g aroundthe perimete r o

f the hous e in excavatedarea s generall y slop e awa y / fro mthe house ? 2 .

Has sodbeen lai din all area s tha t wer e excavated ? ^ 3 Doe s the so dappea r to b e generall y health y andgrowing ? (Onl y evaluat e i f inspectedat a3 0 da

y time period) 

## y 4 Ar e sodde darea s generally firmandevenl y graded ? 

## y 5 .Ar c tlie joint s between di e sodstrip s generall y tight ? (Onl y evaluat e i

f inspecteda t a3 0 da y 

# y tim e period) 6 .

Wa s the propert y gradedsuc htlia t wate r wil l not pool o n the property ? / 7 .

Wa s damag e ( 0 landscaping o r plan t material s avoided ? 

# y Gates , Fence s an dRetainin g WalJ s .Yes N o 1 . Do 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 diuin g restoratio n activitie s reinstalled ? (I f applicable ) 

# y 3 .

Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) 

# y 4 .

Wa s damag e f o retainin g wall s avoided ? (I f applicable ) ^ Foundation , Sidin g an dGutter s Ye s N o 1 .Wa s damag e t o th e sidin g o r tri mavoided ? 

# y I .Wa s damag e t o th e fomidatio n avoided ? 

## y Wa s damag e t o window s avoided ? 4 .

Wa s damag e t o window s o r doo r screen s avoided ? 

# y Wa s damag e t o downspout s o r downspou t extension s avoided ? 5 

# y Sidewalk s an dPrivcway s (Concrete ) Yes , N o 1 .Wa s damag e l o drivewa y surface s avoided ? 2 . Wa s damag e t o walkwa y surface s avoided ? /

## Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e '^'^3 ^ ^Date: W^" ^HTHNOLOGIES . INC . 

### A S - BUIL T DRAWIN G OL S #2700 2 Dat e Excavated : 10/20/201 0 

### OMAH A LEA D SUPERFUN D SIT E ISEP A Signed-Of T Date : 

### 2700 2 Exterio rPain t Omah a Lea d Sit * Samplin g Addrass : 253 6 PARKE R S T Sit e Sketc h • Goo d n,Poo r Phone : H (402)342-2820 ALT : 0 Not pain t \ Lea d Sampl e Sample s Coliecte d Sampl e Numbe r LA B ConcentratiOf i Collecte d Fir m F/>> 4 F3-Oe > RYASCPXA-2700 2 F 1

. pp m 

### D Date : f-IZ-o:] - RYBSCPXA-2700 2 F 2 =^^ 2 . PP" i 

### D Tlm e y• ? 6 ^/y ? RYCSCPXA-2700 2 B l 

### 37 2 pp m 

# n Sample s Analyze d RYDSCPXA-2700 2 8 2 

### JLfld . . PP" ! 

# i D RD^SCPX; ^ 3700 3 

### -e z pp m XR F Uni t ikSH l Book : id f 

### D D nozocrx A 3700? pp m Date : a • H ' <? ? 

### D D nngCCPX A 2700 2 -PB - pp m Time : ,At I 

# n n Staff : AteW Numbe rof Sample s =ULegend : F l • Fron t Lef t F 2 = Fron t Right . B l = Bac k Left , B2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , PZ - Pla y Al l quad f ant s ar e a s viewe d fro m th e street , facin g propert y 

# ENTERE D i\i l I 7 200 7 

# & 0 mB 2 = 39 l PPM@6 " 

### 37 1 H8 3 

### .S> 1 

# i } ^

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### ^ } ^. 3 

### F / F 2 

# ^ ? 3 0 5 

## a3 z 

# I - ^ I'lAl K farjiii rJ t E. 4 = 29 5 PP M aSCRAP E(~1" > Crcac dcl^'Mi n lo-U W CONTRAC T# : EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC .

# ^JBV < Propert yCompletio n Agreemen t Thi s agreemen t documents the completion of remova l activitie s performedo n the below listedproperty . Th e propert y owner' s signatur e indicate s tha t the propert y owne r i s satisfiedwit hthe restoratio n of the subject property , an dtha t no item s ar e i n question , now , o r a

t an y tim e i n the future , excluding an y remaining warrant y (3 0 day s total ) except thos e item s listedbelow , if any . Propert y ID : Propert y Address : ' ^ < y O . C . 

# 1 Vur^, r S^ h Owner : Phone : Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item :

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 )



# A^coSltd i .^^J'^ c Lu , I1/9.3// 0 ^ p" Dat e 

# (yA\Ay>y)i^<6^^ ^

# ^"^m . Pruden t Technologies , Inc . (Prudent ) is unde r contrac t withth e U. S. Enviromnenta l Protectio n Agenc y (EPA ) to clea n up lead

contanupate dsoilaa t anumbe r ofgropertie s locate d in Omaha , Nebraska , includin g th e propert y locate dat rJiC)-PJ y rQiJL& A o ' Th e EP A request s you r permissio n to allo w Pruden t to performasoi l cleanu p at

thi. s property to remov e lead-contaminate dsoil . By signin g thi s form , th e propert y owne r grant s permissio n to Pruden tto perfor m activitie s relate d to th e cleanu p includin g soi l sampling , remova l of Iead-contaminale dsoil , an drestoratio n ofth e reference dproperty . Ifyo u hav e an y question s abou t th e soi l cleanu p planne dfor you r property , pleas e contac t Pruden t southoffic e fo r th e Omah aLea d Site cleanup-a t (402 ) 733-1188 . Genera l question s abou t th e Omah aLea dSit e cleanu p ca nbe direae d to th e EP A Publi c Informatio n Center s at (402 ) 731-304 5 (Sout hOmah aoffice ) or (402 ) 991-958 3 (NorthOmah aoffice) . Propert y Acces s GrantedBy : S^IJ^/j/H l /S^Off. e LC O F Q ^ I^^OXR e P O X"^!^ ' JZ>'« ^ (Pleas e Prin t Name ) Property Owne r Signature] ^ (Date ) 'PROPERT Y INFORMATIO N (T o be complete d by residen t and/o r propert y owne r —pleas e print ) RESIDEN TNAME : \)/kCJ^/J T /-O f (_(^Owne O Rente r RESIDEN TADDRESS : 

# J,?? A pAfike/i x r IF RENTAL , PROPERT YOWNE D BY : 

# /yj L
OWNER' S MAILIN .IN G

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ADDRESS ; ; ^ ^ittt T
OWNER' S TELEPHON E NUMBE R - HOME : jtOi^ ) 3 l 1 ' ^ R ^ O WORK : 

### J L AG E OF HOME? : ^j\ ^ YEARS . HO W LON G HAV E YO U LIVE D HERE ? NJ ^ YEARS . HA S TH E EXTERIO R BEE N PAINTE D OR COVERE D WIT H SIDIN G SINC E 1978 ? YE S NO /^ / Pf NUMBE R OF OCCUPANT S UNDE R 7 YEAR S OLD : NUMBE R OF OCCUPANT S 7 YEAR S OL D AN D OLDE R 

# fj y NUMBE R OF CHILDRE NUNDE R 7 YEAR S OL D WH O PLA Y INTH E YAR D FO R 5 HOUR S OR MOR E PE R WEEK : COMMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTRY GATES , ETC. )

AllTHORIT Y FO RENVIRONMENTA LRESPONS E ACTIONS : Th e activitie s to be implemente dby EP A unde r this agreemen t are pursuan t lo Sectio n 10 4 ofCERCLA , 42 U.S.C . 9604 . EPA' s right of

acces s to th e propert y is provide dfor in Sectio n 104(e ) of CERCLA , 42 U.S . C 9605(e) , whic hprovide s entry for ""determinin g th e nee dfor response , oi

- choosin g or takin g an y respons e aclio n unde r thi s title , or otherwis e enforcin g th e provision s ofth e title. " 808 0 War d Parkway , Suit e 40 5 66G 0 S10 St 424 2 Medica l Drive , Suit e 42S 0 Kansa s City , MO 6411 4 Omaha . Nebraslt a 5810 7 Sa n Antonio . TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402 ) 733-118 8 Phone ; (210 ) 822-958 8 Fax:(816)363-370 7 Fat : (402 ) 733-188 3 Fax:(210)579.657 7ENVIRONMENTA L& CONSTRUCTIO N 

### TECHNOLOGIES , INC , SERVICE S 

# ^ Propert y Statu s For m Address : Xj^<'^<^^ A VAoreXL o '' ^ PpODerW ^ ^^*^ ' Phone : BVID : O L 

# CAWV - t o ^



# -c^^t^Z Q Y^cxhoc^ ^ (K^ ^ -M o ptrii . Q^ e

808 0 War d Parkway , Suit e 40 5 560 0 S 1 0 S t 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 68107 N Sa n Antonio , T X 7822 9 Phono : (816 ) 363-370 3 Phone : (402)733-118 8 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)733-188 3 Fax : (210 ) 579-657 7o 

## 700 2 Exterio rPain t Nort h Arro w Omah a Lea d Sit e Q Goo d Samplin g Addrms : 253 6 PARKE R S T Sit e Sketc h g^Poo r PItOfW : H : (402)342-282 0 ALT: ^ No t paint 

# f Sampl e Numbe r Lea d Concentratio n Sampl e Coliecte d LA B Fir m Sample s Coliecte d RYASCPXA-2700 2 F 1 

# 3 0 5 pp m 

## D Dat e RYBSCPXA-2700 2 RYCSCPXA-2700 2 RYDSCPXA-2700 2F2 B 1 B 2 

# A12 . 3 7 2 pp m pp m pp m 

## D D D Tim e u , ?< 0 fry] . Sample s Analyze d nDzccpX; ^ 27002—e z pp m 

## D D XR F Unit : LSH 2 Book : [ ^ RGZGCPX A 2700 2 G^ ­ R^zccp^ ^ 27002—PZ pp m pp m 

## D D 

# n Date : B • i J Time : A M ­ Q l Numbe ro f Sample s ~ 

# A Staff; m i Legend : F l = Fron t Left , F 2 = Fron t Righ t B l = Bac k Left , B2 = Bac k Righ t D Z = Dri p Zone , G Z = Gandem , PZ = Play Al l quadrant s ar e a s viewe d fro m th e street , facin g property

# 253 6 Parker S t 60x3 0 

# A

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### Printed : No v 30 , 201 0 www . dcgis . org/dogi s

### Pag e 1 of 2

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



### • YOU RTICKE T NUMBE RI S 2618623 . Origina l Cal l Date : 10/15/1 0 Time : 4:0 0 p m Op : SIVA1896 7 Wor k t o Begi n Date : 10/19/1 0 Time : 4:3 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 253 6 Street : PARKE R S T Twp : 15 NRng : 13 E Sect-Qtr : 16-N E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : SOI L LEA D REMEDIATIO NPROJEC 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 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 : NFront : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V LEVEL 3 MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Servic e Are a Contac t Phon e Numbe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEID I 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
LEVEL S LEVEL S COMMUNICATIONS , LL C 

### N A 

### Day : 877366834 4 Alt : Emerg : 877366834 4
MUDO l METROPOLITA N UTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0
OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R 

### RICHATRAFFI C Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 http://www.dhon.org/irthmternet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 10/15/201 0

## Pag e 2 of 2

0PPDGPR5 OMAH A PUBLI C POWE RDISTRICT EL M LOCATIN G 

## At : 406207149 4 Emerg : 888728934 3 QLNNEIC 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.. . 10/15/201 0TEOHNOLOraB . 

### mc . CONSTRUCTKW y SOLUTION S 

## SIT ESAf^T Y HAZAR D ANALYSI S Addres s 

# : -^£L-4.-j(^life:^ ^ Excavatio n Date : Crew : BackfiU Date :

Ite m Overhea dLine s Ga s Lin e Wate r Lin e Sewe r Lin e Septic/Leec h Fiel d Propane/Butan e Sidewal k Foundatio n Retainin g Wall s Fence s Tree s Structure s Driveway Sprinkle r Syste m Othe r Cre w Forema n Conditio n Hazard s Correctiv e Actio n
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## Pc^ ^ CS'^'C ^ t^^k ^ CJ* —

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## Sit e Safet y Offic e Date :

m o WtatfVarfcmy . Sirito40 5 SSOOSIOS t 424 2 Medica l Drive , Suit e 725 0 (ana s Citr;lK>«411 4 Oiittta , NabnAk a «810 7 Sa n Antonio , T X 7822 9 ihone : (SIS ) 3O|370 3 Plwna : (4fl2)733-11S S Phone : (2t0 ) 822458 8 Fax : (402)73»«1S8 3 Fax ; (210 ) 5T9-657 7

# ^d^ta . ^