SAID# : 2559 3 

### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R DATE : 1/1 5 ADDRESS : 363 9 CHARLE S S T REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES . INC . YEAR : 

### 20l t SOI L REMEDIATIO N PROPERT Y FIL E FOLDE R DOCUMENT S 

### G f PR E AN D POS T VIDE O O F PORPERT Y (DVD ) 

# d EXECUTIV E SUMMAR Y 

# d EPA-PROVIDE D PROPERT Y SKETC H SIGNE D ACCES S AGREEMEN T FOR SUBJEC T PROPERT Y U SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN T PROPERT Y 

# I RESTORATIO N AGREEMEN T D SETTLEMEN T DOCUMENTS (I.E. , FOR DAMAG E O R TO REPLAC E PLANTS , ETC. ) CONFIRMATIO N DAT A PHOTOGRAPH S 

# t i AS-BUIL T SKETC H 

# t i SATISFACTOR Y RESTORATIO N SIGNE D B Y PROPERT Y OWNE R 

## t i PROPERT Y CLOSE-OU T CHECKLIS T SIGNE D B Y EP A 

## u DESCRIPTIO N O F AREA S NO T MEETIN G RO D CLEANU P CRITERI A UTILIT Y CLEARANCE S 

## tll PROPERT Y INFORMATIO N FRO M DOUGLA S COUNT Y ASSESSOR'S OFFIC E 

## a D D 3023754 3 

# un m Superfun d



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SIGNATUR E DAT EPROPERT Y SUMMAR Y Date : /15/201 0 Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Propert y Address ; 363 9 CHARLE S 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 Othe r Relevan t Information : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : G Z = 32 1 PP M @ 6" ; D Z = 14 5 PP M @ 6" ; E A = 6 8 PP M @ SCRAP E (~1" ) 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 clip/photograph s 4 ) Post-Excavatio n digita l vide o clip/photograph s 5 ) Documentatio n - Complete dClose-ou t Checklis t 6 ) As-Buil t sketch 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 iii ) Property addres s vii ) Dat e iv ) BVI 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 obtainedinclude : i ) Pre-excavatio n agreement detail s (ifan 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 i n 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 o f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOCIES . INC .Fin d Record Remediatio n Quer yI Lea d Remainin g Query| Propert yDamag e Quer y Backfill :

Sampl e Area : 2559 3 - 363 9 CHARLE S S T Owner : n Owne rOccupie d Owne rName : I MILLE R CHARLE S E Owne rAddressl : 

# I Owne rAddress2 : |363 9 CHARLE S ST City : State : Zi p Code : lOMAH A ~ |N E |68131 - Owne rPhon e Alternat e Phone : 1(402 ) 553-208 6

Contract : Contractor : JPRUDENT2010_ S Contrac t Optio n lOPnO N 1 Use rProvide d Owne rInformatio n Owne rName : 

# 1 Owne rAddress : 

## 1 City : State : ZipCode : 

# 1 i 1 Owne rPhone : Alternat e Phone : 

# 1 1

Assessment : Qualifyin g Grou p [40 0 Assessmen t Ma xXR F Valu e [ 697. 2 Resident : Residen t Name : I MILLE R CHARLE S E Propert yAddress : |363 9 CHARLE S S T Zi p Code : |68131 - Residen t Phon e 

# ITECHNOLOGIBS , INC . 

# EP A Propert y Clos e Ou t Propert y # : U)'^^! / Propert y Address : 3 (^^" ^ CWs>j~'^C ^ 9^ . Date/Time : Owner' s Name : CW^e ^ ^r^- T Quad s Excavated : VZ i (<>Z — Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s N o I I f necessary , wer e th e correct quadrant(s ) excavatedandrestored ? / 2 .

I f necessary , wer e th e correc t area s o f drip zone excavatedandrestored ? / Gradin g Sodan dVegetatio n Ye s N o 1 .

Doe s the gradin g aroun dthe perimete r o

f the hous e i n excavate darea s generall y slop e awa y fro mth e house ? / 2 .Has sodbee n lai di n al l area s tha t wer e excavated ? / "i. Doe s tJi e sodappea r to b e generall y health y andgrowing ? (Onl y evaluate i f inspecte da t a3 0 da

y tim e period) / 4 Ar e sodde darea s generally fin n andevenl y graded ? / 5 .Ar e tlie joint s between the sodstrip s generally tight ? (Onl y evaluat e if inspecte da t a3 0 da y / tim e period) 6 .

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

Wa s damag e t o landscapin g o r plan t material s avoided ? / Gates , Fence s an dRetainin g WaU s Ye s N o 1 .

D o 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 or fence s avoided ? (I f applicable ) 

# y 4 .Wa s damag e to 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 the sidin g o r trimavoided ? 

# y 2Wa s damag e l o the foundation avoided ? 

# y Was damag e t o window s avoided ? 

# y 4 .Wa s damag e to window s o r doo r screen s avoided ? 5 .Was damag e l o downspout s o r downspou t extension s avoided ? 

# i \ Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 Wa s damag e l o drivewa y surface s avoided' ? / 2 . Wa s damag e to walkwa y surface s avoided ? 

# y

### 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 9" ^ jQ» ^ ^Date: \\\tt\ wI'HNOLOGIFS . INC 

### A S - BUIL T DRAWIN G OL S #2559 3 Dat e Excavated : 11/10/201 0 

### OMAH A LEA D SUPERFUN D SIT E 1SEP. 4 SIgned-OI T Date j

Name : Omah a Lea d Sit e Address : Sfc^1r/^/*«i.£ 5 5 T Sit e Sketc h Phone : _ Tea mK-Vg/^-/,</ ; r^^ K BVmi t ^S5'' f 3 Sampl e Numbe r Lea d Concentratio n pp m pp m 3Sot ^ B pp^i; 5 

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# ijBV i Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n o f remova l activitie s perfonne do n th e belo w liste dproperty . Th e propert y owner' s signatur e indicate s tha t th e property owne r i s satisfie dwithth 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 in th e future , excludin g an y remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , ifany . Propert y ID : 

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# -XO / o wner' s Signatur e Dat e I( Piuden t Technologies , Inc . (Prudent ) i s unde r contrac t wit hthe U . S . Environmenta l Protectio n Agenc y (EPA ) to clea n u p leadcontaminate dsoil s a t anumbe r ofpropertie s locate di

n Omaha, Nebraska, includin g th e propert y locate da

t

. Th e EP A requests you r permissio n to allow Pruden t to perfor masoi l cleanu p a

t thi s propert y to remov e lead-contaminate dsoil . B y signin g thi s form , th e propeit y owne r grants permissio n to Pruden t t

o perfor m activitie s relatedt o the cleanu p includin g soil sampling , remova l o

f lead-contaminate dsoil , an drestoration ofth e reference dproperty . I f yo

u have an y question s abou t the soi l cleanu p planne dfb r you r property , pleas e contact Pruden t Sout hOmah aOffic e fo r the Omaha Lea dSit e cleanup,.a t (402) 733-1188 ; 733-1455 . Genera l question s abou t the Omah aLea dSit e cleanu p ca n b e directe dt

o th e EP A Public hiformatio n Center s a

t (402) 731-3045 (Sout h Omah aoffice) . 

# th.yU.^A^'A l^ilU r Propert y Acces s Grante dBy : (Pleas e Prin t Name ) 

# dAM'.yy-'?^ / ^^- ' [/y » Propert y Owne r Signature : (Date ) (Signature) <= ^ / i PROPERT Y INFORMATIO N (T o b e completed b yresiden t and/o rpropert yowne r- pleas e print ) RESIDEN T NAME : 

# ["yuyM ^

elk . m\< y Owner > Rente r RESIDEN T ADDRESS : I F RENTAL , PROPERT Y OWNE D BY : OWNER' S MAILIN G ADpRESS ; . - , / i / ) OWNER' S TELEPHON E NUMBE R - HOME : I^OL ) S^S'j-.3.6 ^ ( ^ WORK : J 1 AG E O F HOME? : YEARS . HO W LON G HAV E YO U LIVE D HERE ? A) D YEARS . v/^Y E 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 : 0 NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R O F CHILDRENUNDE R 7 YEAR S OL D WH O PLA Y I NTH E YAR D FO R 5 HOUR S O R MOR E PE R WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. )

AUTHORFT Y FO RENVIRONMENTA LRESPONSE ACTIONS : Th e activitie s t o be implemente db y EP A unde r thi s agreemen t ar

e pursuan t to Sectio n 10 4 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s right of

acces s to the propert y i s provide dfo r i

n Sectio n 104(e ) o

f CERCLA, 4 2 U.S . C 9605(e) , whic hprovide s entr y fo r "determinin g the nee dfo r 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 the provision s ofth e title. "

8080 Ward Parkway , Suit e 40 5 5600 8.10' " Stree t 4242 Medica l Drive , Suit e 425 0 KansasCity , MO 6411 4 Omaha , Nebrask a 6810 7 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-3703 Phone : (402)733-145 5 Phone : (210)822-958 8 Fax : (816) 363-370 7 Fax : (402)733-188 3 Fax : (210 ) 579-657 7

### corHsTRocrro ^ TECHNOLOGIES , INC , 

# Propert y Statu s For m Address : -^ ^ j< ^ CL^^i^ ^ ^^**' " ///^/z^/ O Phone ; 

# /ne^iAc - /]->g^^f 5 A'^ ^ Q > I f i > 

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# I Tea m i^Jy>^A^mi:^ y BVI D 

# #^SS^ 3 XR F Cod e 

# 7B B Sampl e Numbe r Lea d Concentratio n Confinmatio n Sampl e pp m 

## F' Ye s tn No 12 1 

## yye'scf='x ^ •• ^^^ ^ pp m ^2 Ye s 1= 1 No 12 pp m Ye s n No Q 

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# A T^TIP ^ Printed : No v 04 , 201 0 www.dcgis.org/dogi sPag e 1 of 2

" > Creat e Anothe r Ticke t Bac k tojrt h Interne t Sen d Emai l 

### YOURTICKE T NUMBERI S 2634306 . Origina l Cal l Date : 11/04/1 0 Time : 8:3 1 a m Op : SIVA1896 7 Wor k t o Begi n Date : 11/08/1 0 Time : 9:0 0 a m State : N E UGLA S Place : OMAH A Address : 363 9 Street : CHARLE S S T Twp : 15 NRng : 13 E Sect-Qtr : 16-NW,17-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 : N Front : Y Rear ; Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL S 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 HEIDI 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 UTILITIES DISTRICT SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCIT Y OFOMAHA-TRAFFIC,SEWE R RICH/TRAFFI C 

### Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0 

### Day : 406728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 11/4/201 0

### Pag e 2 of 2

OPPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T EL M LOCATIN G 

### Alt : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 QLNNEI C QWES T LOCALNETWOR K EL M LOCATIN GAlt : 406207149 4 

### Emerg : 888728934 3

http://vmw.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 11/4/201 0

### ENVIRONMENTA L ENGINEERIN G AN D CONSTRUCTIO N SOLUTION S 

## SIT E SAFET Y HAZAR D ANALYSI S Addres s Excavatio n Date : llJO^cfil O Cre w Backfil l Date :

Ite m Conditio n Hazard s Correctiv e Actio n Overhea dLine s 

# T^i^o^r Ga s Lin e 

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## Foundatio n 

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## Fence s J0 ± Tree s ( ^ 

## Structure s Driveway 

# oA . 

# m ^ Sprinkle r Syste m 

## Jld . Othe r n D 

## Cre w Forema n Sit e Safet y Offic e Date :

r . Sutt e 4I B S800S108 t 424 2 Medica l Drive , Suit s 725 0 lC«ly;ilO«411 4 OmMa , Nafanafca tttor Sa n Antonto , T X 7822 9 Phona : gi6)a6>'370 3 l>lMne : (4a2)733-11S 8 Phone : (210V822«S8 8 Fa e (81C ) 363-370 7 Fax : (4a2)73»<ta8 3 Fax : (210)679-657 7