## TRANSMTTTA Lo f OMAH A LEA D SUE SOI LREMEDIATIO N FIL E FOLDE R SAI D # : )?>g/i/
- Date : \n j \!^(b ^ Address : .^?K f C %7 ^ A j Remediatio n Contractor : JXj\^l ^ fJL' 7^C y Year : "^rf) SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Q Vide o o f property (DVD ) aExecutiv e Summar y Q EPA-provide dproperty sketc h 0 Signe dAcces s Agreemen t fo r subjec t property D Signe dAcces s Agreement(s ) for adjacent property • Restoratio n^reemen t nSettlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) GiConfirmatio ndat a 2

1 Photograph s As-buil t sketc h Satisfector y restoratio nsigne db y Property Owne r Property close-ou t chec k lis t signe db y EP A D Descriptio no f area s no t meetin g RO D cleanu p criteri a B Utilit y clearance s 

## Property informatio nfromDougla s County Assessor' s OflBc e D D D 

## Signature / Dat e 3005426 3 

# lliH I Superfun dFin d Recotx l Remediatio n Queryj Lea d Remainin g QueryI Propert yDamag e Query Backfill :

Sampl e Area : 1381 4 ­ 321 4 S 3 2 A V Owner : Resident : Contract : D Owne rOccupie d Residen t Name : Contractor : Owne rName : JMARTINEZRICARDO T |PRUDEMT2009_ S JMARTINEZRICARDO T Propert yAddress : Contrac t Optio n Owne rAddressl : |321 4 S 3 2 A V |BAS E Zi p Code : Owne rAddress2 : |68105 Ass^ment : |321 4 S 3 2 AV E Residen t Phon e City : State : Zi p Code : 

# I Qualifyin g Grou p jOMAH A |N E |6810 5 |40 0 Owne rPhone : |(402 ) 614-536 5 Alternat e Phone : 

# " 1 Assessmen t Ma xXR F Value : 

# r 620.8 1

## ipwciipitiwir y SH INww^MWiy Date ; 10/15/200 9 | Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l I Mont hof : Septembe r Propert y Address : 3214S32A V A . EXECUTIV E SUMMAR Y A. 1 Issue s Encountered : NON E A ^ Issue s Resolved : NON E A 3 Uniqu e Findings : NON E A. 4 othe r Relevan t Information : ARE A NO T EXCAVATE D DZ/L S 18'X9 ' 21 3 PP M @ SCRAP E CONFIRMATIO N SAMPLIN GDATA/RESULTS : F l = 6 2 PP M @ 12'' ; F 2 = 3 0 PP M @ 10" ; B l = 14 8 PP M @ 10" ; D Z = 20 1 SCRAP E (~1 ) PP M @ 13" ; E A = 13 0 PP M @ ATTACHMENT S 1 ) 2 ) 3 ) 4 ) 5 ) 6 ) Propert y sketc hprovide db y EP A pursuan t t o contrac t specification s Signe dAcces s Agreemen t includin g acces s agreement s require dfo r crossin g othe r propertie s Pre-Excavatio n digita l vide o clip/photograph s Post-Excavatio n digita l vide o clip/photograph s Documentatio n - Complete dClose-ou t Checklis t 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 iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) othe r item s t o b e include di n th e individua l property file, i f available , o r obtainedinclude : i ) Pre-excavatio n agreement detail s (i f an y ar e mad e withth e property owner ) ii ) Propert y Statu s Formsigne 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 ) forma t 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 .

INDiTDJGfES.II CTEOINOLOGIBS , IN C Propert y # : f'J>fr(i 4 Date/Time : ^ » Quad s Excavated : pLrXiVZ/*^^ ^ 

# SERI \ EP A Propert y Clos e Ou t Propert y Address : '^'Z H $ ^ " ^ 2- AA> ^ Owner' s Name : <2.,^< : arcl^c * fKAtfV>.A(rz_
- 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 ? i / 2 .

If necessary , wer e the correct area s of dri p zone excavatedan drestored ? y Gradin g Sodan dVegetatio n Ye s N o 1 .

Doe s the grading aroun dthe perimete r of (h e hous e i n excavatedarea s generall y slop e awa y < / fromdi e house ? 2 .

Has sodbeen lai din all area s tha t wer e excavated ? iX 3 .

Doe s the sodappea r t o 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 ? ^ 5 .

Ar e the joint s betwee n the so dstrip s generall y tight ? (Onl y evaluat e if inspecteda t a3 0 da y 

## y tim e period) 6 .Wa s the propert y gradedsuc htha t wate r will no t poo l o n the property ? t y 7 .

Wa s damage to landscaping or plan t material s avoided ? y - Gates , Fence s an dRetainin e Wall s Ye s N o 1 .

D o gate s ope n an dclos e freely? (I f 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 damage t o gate s o r fence s avoided ? (I f applicable) 

## y 4 . Wa s damage to retaining wall s avoided ? (If applicable) 

# y Foundation , Sidin s an dGutter s Ye s No 1 .

Wa s damage t o the siding o r tri mavoided ? 

## y 2 .

Wa s damage to the foundatio n avoided ? 

# y 3 . Wa s damage t o window s avoided ? 

## y 4 . Wa s damage to window s o r doo r screen s avoided ? ^ 5 . Was 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 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 an drestoratio n activate s complet e including th e 30-da y sodw^arranty : EP A Representativ e f3L ^ ^ Date : 9/fs/o< } 

# 7

## Propert yCompletio n Agreemen t Thi s agreement document s th e completio n o f removal activitie s performe do n th e belo w liste dproperty . Th e property owner' s signatur e indicate s tha t th e property owner 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 at 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 : -^ 2 . V M > S 3'2^' > c i ^ ^^< ^ 0^°e'- = ^tcXfl^cJL M^cc^tn^^eL' ^ Phone : ^ Restoratio n Item s i n Question :

item : Item : Item : Item : Item : Item : 

# f I agre e restoratio n i s completed . I d o no t agre e restoratio n i s complete d a t (note d deficiencie s above )

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• ' f'—=~ : '— 7 Date Owner' s Signatur ePruden t Technologies , Inc . (Prudent ) i s unde r contrac t wit h th e U . S . Environmenta l Protectio n Agenc y (EPA ) t o clean up lead
contaminate dsoil s a t anumbe r o f

propertie s locate di n Omaha , Nebraska , includin g th e property locate da t

. Th e EP A request s you r permissio n t o allo w Pruden t t o perfor masoi l cleanu p a t thi s property t o remove lead-contaminate dsoil . B y signin g thi s form , th e property owne r grant s permissio n t o Pruden t t o perfor m activitie s relate dt o th e cleanu p includin g soi l sampling , removal o f lead-contaminate dsoil , an drestoratio n ofth e reference dproperty . I f

yo u hav e any question s abou t th e soi l cleanu p planne dfor you r property , pleas e contac t Prudent' s Administrativ e Cler k for th e Omah aLea dSit e cleanup . Ms . Madhurim aDur u -a t (402 ) 733-1188 , 733-1455 . Genera l question s abou t th e Omah aLeadSit e cleanu p ca n b e directe dt o th e EP A Publi c hiformatio n Center s a t (402 ) 731-304 5 (Sout h Omah aoffice ) o r (402 ) 991-9583 (Nort h Omah aoffice) . Propert y Acces s Grante dBy : 1\C<LH-^"JI ^ f > / ^ AI^T]\ > £"2.
­ (Pleas e Prin t Name ) Property Owne r Signature : 

## y-^'p'd) ^ (Date ) PROPERT Y INFORMATIO N (T o b e complete db y residen t and/o r propert y owne r - pleas e print ) RESIDEN T NAME : cPJ f ra rrJL o M^u r\ n A€_- g Rente r RESIDEN T ADDRESS :

32.1 M S <2>Q^f\X

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## V ^ C=%\ ^ ^ I F RENTAL , PROPERT Y OWNED BY :
OWNER' S MAILIN G ADDRESS ; *^^^^^ ^ OWNER' S TELEPHON E NUMBER - HOME : J L WORK :
AG E O F HOME ? 

## •.3o l YEARS . HO W LON G HAV E YO U LIVE D HERE ? YEARS . 

## J;^ , HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978 ? E S N O NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : Q NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDE R 

# 5
- NUMBER O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLA Y I N TH 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. )

AUTHORIT Y FO RENVIRONMENTA L RESPONS E ACTIONS : 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 right o f

acces s t o th e property i s provide dfor i n Sectio n 104(c ) o f CERCLA , 4 2 U.S . C 9605(e) , whic h provide s entry for "determinin g th 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 th e provision s ofth e title. "
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 , TX 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 7ENVfRONMENTA L& CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

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### OMAHA LEAD SUPERFUND SIT E

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• YOU RTICKE T NUMBE RI S 2320456 . Origina l Cal l Date : 7/17/0 9 Time : 2:4 4 p m Op : SIVA1896 7 Wor k t o Begi n Date : 7/21/0 9 Time : 3:1 5 p m State : NE County : DOUGLA S Place : OMAH A Address : 321 4 Street : S 32N D AVE Twp : 15 N Rng : 13 E Sect-Qtr : 33-N W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Worl< : soi l lead remediatio n projec t Locatio n o f Work : LOCAT E ENTIR E PROPERTY Remarks : FA X AL L CLEAR S TO : (402)733-188 3 : FA X AL L CLEAR S T O (402 ) 73 3 188 3 : UNSUR E CORNER S Conpan 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 FT Corne r Lot : NFront : Y Rear : Involve s Tunneling o r Horizonta l Boring : NExplosives : N CXCAT V

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Servic e Are a Contac t Phon e Numbe r Utilit yTyp e Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUD0 2 METROPOLITA N UnLITIE S DISTRIC T SAND Y Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCITYOFOMAHA-TRAFFICSEWE RRO N Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 0PPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T N A Alt : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 QLNNEI FQWES T LOCA LNETWOR K N A Alt : 406207149 4 Emerg : 888728934 3
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