## TRANSMITTA L o f OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : -^•:).s\ ^ Date : Address : ^i\ 0 jS J ) g - &1 - Remediatio n Contractor : \^Ja ^ j - HI".i>i>.J^^' ^ ."TVi r

y Year : -2-0 0 P SOI L REMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S E

f Vide o ofpropert y (DVD ) E T Executiv e Summar y tE

^ EPA-provide dpropert y sketc h 

## C

T Signe dAcces s Agreemen t fo r subjec t propert y IlT SignedAcces s Agreement(s ) fo r

adjacen t propert y Q

^ Restoratio n Agreemen t W^ Settlemen t document s (i.e. , fo r

damag e o r t o replac e plants , etc. ) 0 ' Confiimation data c

f

Photograph s 0 As-buih sketch y Satisfactor y restoratio n signedby Propert y Ovvne r 0

^ Propert y close-out chec k

lis t signedby EP A • Descriptio n o f area s not meeting RO D cleanu p criteri a H' Utilit y clearance s y Propert y infonnatio n fromDougla s Count y Assessor' s Office D D D 

## Signatuj * Dat e

### PROPERT Y SUMMAR Y Date : 01/23/200 9 OmahaLea dSit e Remedia l Action Conirac t #EP-R7-07-06/000 4 Montii of : Dec/Ja n | Propert y Address : 381 0 N1 8 S T A . EXECUTIV E SUMMAR Y A. 1 Issue s Encountered : NON E A. 2 Issue s Resolved : NON E A 3 Uniqu e Findings : NON E A. 4 Other Relevant Infonnation : NON E CONFIRMATIO N SAMPLIN G DATA/RESULTS : B l = 8 6 PP M @ 6" ; B 2 = 127 PPM @ 7" ; E A = 1 PPM @ SCRAP E ATTACHMENT S 1 ) Propert y sketch provide dby EP A pursuan t to contract specification s 2 ) SignedAcces s Agreemen t includin g acces s agreement s require dfo r crossing othe r propertie s 3 ) Pre-Excavation digita l vide o clip/photograph s 4 ) Post-Excavation digita l video clip/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Buil t sketc h ­ i ) Shal l include fina l lea dlevel s v ) Legen d ii ) Contamination lef t behindarea s vi ) Contracto r identification iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s to b e includedin th e individua l propert y file, i f available , o r obtainedinclude : i ) Pre-excavatio n agreemen t detail s (i f an y ar e mad e wit h th e propert y owner ) ii ) Propert y Statu s For msignedby propert y owne r iii ) Excavation digita l vide o in MPEG , WM V (Window s Medi aVideo ) or SW F(Flas h Player) forma t and/or photograph s iv ) Signedfor mverifying satisfactor y restoratio n v ) Descriptio n o f area s no t meeting InterimRO D cleanu p criteria .

TECHNOLOCIES , INC .Fin d Recor d H 

### Backfill :

Sampl e Area : 3293 9 Owner : n Owne rOccupie d Owne rName : |COMB S CAROLY N G Owne rAddressl : Owne rAddress2 : |3902IDAS T City : |OMAH A Owne rPhone : |(402 ) 884-749 8 Clea n U p Query Lea d Remainin g QueryI



### ­ 381 0 N 1 8 S T Resident : Residen t Name : 

# r Propert yAddress : |381 0 N 1 8 ST Zi p Code : |6811 0 Residen t Phon e State : Zi p Code : |N E |6811 2 Alternat e Phone : 

# 1 ­ Propert yDamag e Query

Contract : Contractor : Group : Assessment : Qualifyin g Grou p 

### 11200 Assessmen t XR F Date : Assessmen t MaxXR F Value : 

### 1254. 2

### TECHNOLOGIES , IN C 

# &BV < EP A Propert y Clos e Ou t Propert y # : 3 ?*?i« J Propert y Address : 3 8( 0 t i 1 8 3 TDate/Time : Owner' s Name : Quad s Excavated : & h B'2. ^ C' V Contracto r Grou p Pruden t Technologie s Excavatio n Genera l Ye s N o 1 .If necessary , wer e the correct qHaclrant(s) excavatedan drestored ? / 

### 2 .

I f necessary , wer e the correct area s o f dri p zone excavatedan drestored ? 

# y Gradin g Sodan dVegetatio n Ye s N o 1 .Doe s the grading aroun dth e perunete r o

f the hous e i n excavatedarea s generall y slop e awa y fro mthe house ? 

# y 2 .

Ha s sodbeen 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 da

y tim e period) 

# y 4 .

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

# y 5 .Ar e the joint s betwee n th e so dstrip s generall y tight? (Onl y evaluat e if inspecteda t a3 0 da y tim e period) 

# y 6 .Wa s the propert y gradedsuc h tha t wate r will no t poo l o n th e property ? 

# y 7 .

Was damage to landscaping o r plan t material s avoided ? 

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

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

# y 2 .

Wer e al l gate s o r fence s taken dow n durin g restoratio n activitie s reinstalled ? (I f applicable ) 

# y 3 .

Was damage t o gate s o r fence s avoided ? (I f applicable ) 

# y 4 .

Wa s damage t o retaining wall s avoided ? (If applicable ) 

# y Foundation , Sidin g an dGutter s Ye s No 1 .Wa s damage to the siding o r trimavoided ? 

# y 2 .

Was damage t o the foundation avoided ? 

# y 3 .

Was damage to window s avoided ? / 

### 4 .

Wa s damage to window s o r doo r screen s avoided ? 

# y 5 .Wa s damag e to downspouts or downspou t extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Ye s No 1 .Wa s damage to drivewa y surface s avoided ? 

# y 2 . Was damage t o walkwa y surface s avoided ? 

## y

## Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complet e including th e 30-da y so dwarranty : EP A Representativ e j9c ^ A ^ Date : /h^iJo f

# • A Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n o f remova l activitie s performe do n th e belo w liste dproperty . Th e propert y owner' s signatur e indicate s tha t th e propert y owne r i s satisfie dwit h th e restoratio n o f th e subjec t property , an dtha t n o item s ar e i n question , now , o r a t an y tim e i n th e future , excludin g an y remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y ID : Propert y Address ; ^^^ Q t Q \gHv ^ Phone : ( J Restoratio n Hem s I n Question :

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

L J I agre e restoratio n i s completed , excep t a s note d above . E H I d o no t agre e restoratio n i s complete d 

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^ OLStf : 3293 9 Dat e Excavated : 7/11/200 8 Dat e US£PA Signed-OfT : 

## 3293 9 Omah a Lsad Site Exterio rPB M NonhMio w Owne rWam» : CAROLY N G COMB S 

### Sit * Sketc h • Goo d Address : 38ip_N 1 8 S T • Poo r Ptionr . .H : g,^h i - i!:i5£. . w . • No t pain t Les d Sampl e Sample s Coltecte d Sampl e Numbe r LA B Concentralio n Collecte d 

### Firm : .fM-ilEZZii . RYASCPXA-3293 9 F l 

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### CONTRAC T # : EP - R7-07-0 6 / 000 4 PRUDEN T TECHNOLOGIES , INC .'-'''-&&&= £ • T ; * f. \ 

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## ^M.dijvL^'- ^ 'ECHNOLOGIES , INC . 

# r Address : Phone : Item# O

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# Propert y Statu s For m 'i'ilD t\ l / ^ J- ^ Date : 

# BVID : 3Z.f5'? ' Plant s & Permanen t Landscapin g Descriptio n andLocation

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# 3293 9 Exterio rPain t Nort h Arro w Omah a Lea d Sit e H Owne rName : CAROLY N G COMB S • Goo d Sit e SIcetc h Address : 381 0 N 1 8 ST • Poo r

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## Prin t Preview Pag e 1 o f 1 Dougla s County-Omaha , N E

te^-s 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 r Cit y Owne r Stat e Owne r Zi p 151235000 0 COMB S CAROLY N G 381 0 N1 8 S T OMAH A 6811 0 390 2 ID A S T OMAH A N E 6811 2 Sec-Twn Rn g Additio n Bloc k Lo t Lega l 1 Lega l 2 Lega l 3 Legal 4 Treasure r Websit e Lin k Assesso r Websit e Lin k 03-15-1 3 KIRKWOODAD D 3 5 S10FTLT4&N25F T 3 5 X 14 0

http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp ? parc=151235000 0 http://douglasne.mapping online.com/DouglasCoNe/static/accountinfo.jsp ? accountno=R151235000 0 Disclaimer : Ma p an d parce l dat a ar e believe d t o b e accurate , bu t accuracyi s no t Ma p Scal e guaranteed . Thi s i s no t a lega l documen t an d shoul d no t b e substitute d fo ra titl e search , 1 inc h = 4 3 fee t appraisal , survey , o rfo rzonin g verification . 

## http://\vww.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas%20County-Omah.. . 6/12/200 8

# gJ2^lD ifile:///C:/Users/lorcl|«pis%20my%20shepherd/Desktop/STREETS/. , 

### rcua o Creat e Anothe rTicke t . i BacI c t o Irt h Interne t 

### Send Emai l YOU R TICKE T NUMBE R I S  2077764 . Origina l Cal l Date : 7/09/0 8 Time : 12:3 8 p mOp : RAMITA1896 7 Wor k t o Begi n Date : 7/11/0 8 Time : 1:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 381 0 Street : N18T H S T Twp : 15 NRng : 13 E Sect-Qtr : 03-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e c f Work : LEA D REMIDEATIO N Locatio n o f Work : ENTIR E PROPERT Y LOCAT E ENTIR E PROPERT Y Remarks : FAX AL L CLEAR S TO : (402)504-100 5 : UNSUR E CORNE R Compan y: PRUDEN T TECHNOLOGIE S Contac t Name : RAMIT A Phone : (402)504-100 4 Alt . Contact : Phone : (402)452-980 6 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 CXCAT V MAGELLA NMUDO l OMAHACO F 0PPDGPR 5 QLNNEI C 

## Utilit y Servic e Are a Contac t Phon e Numbe r lyp e Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEIDI Alt : 402934046 9 Emerg : 402932975 7 Day : 918574709 8 MAGELLA N MIDSTREA M MAGELLA N TONY A Alt : PARTNER S L P Emerg : 918574709 8 Day : 402504782 3 METROPOLITA N UTILITIES MUDO l EDWIN A Alt : DISTRIC T Emerg : 402504794 6 Day : 402444719 7 

## OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO N Alt : 402444516 1 Emerg : 402444516 0 

## OMAH A PUBLIC POWE R Day : 406728934 3 

## 0PPDGPR 5 

## N A DISTRIC T lof 2 7/9/200 8 1:1 9 P Mfile:///C:/Users/lor(giBis%20my%20shepherd/Desktop/STREETS/. . rcUSf i 

### Alt : 888728934 3 Emerg : 406728934 3 Day : 406728934 3 

## QLNNEl C QWES T LOCA L NETWOR K 

## N A Alt : 

## Emerg : 888728934 3

2 o f 2 7/9/200 8 1:1 9 P M