### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# ; SA-^H O DATE : 'l<5 - 

### ADDRESS : A-4-^ S > ^

3. ^ S. 7 REMEDIATIO N CONTRAaOR : PRUDENTTECHNOLOGIES . INC . YEAR:_2oi L 

### SOI L REMEDIATIO N PROPERT Y FIL E FOLDE R DOCUMENT S Q PR E AN D POS T VIDE O O F PORPERT Y (DVD ) o f EXECUTIV E SUMMAR Y EPA-PROVIDE D PROPERT Y SKETCH 

# y SIGNE D ACCES S AGREEMEN T FOR SUBJEC T PROPERT Y n SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN T PROPERT Y RESTORATIO N AGREEMEN T D SETTLEMEN T DOCUMENTS (I.E. , FOR DAMAG E O R TO REPLAC E PLANTS , ETC. ) n CONFIRMATIO N DAT A PHOTOGRAPH S AS-BUIL T SKETC H 

### 0/ = SATISFACTOR Y RESTORATIO N SIGNE D B Y PROPERT Y OWNE R 1 3 PROPERT Y CLOSE-OU T CHECKLIS T SIGNE D B Y EP A D DESCRIPTIO N O F AREA S NO T MEETIN G RO D CLEANU P CRITERI A

• UTILIT Y CLEARANCE S iz f PROPERT Y INFORMATIO N FRO M DOUGLA S COUNT Y ASSESSOR'S OFFIC E 

### D D >\\a\\ \ ^ ATURt DAT E SIGNATUR E 3021889 1 Superfun d

### PROPERT Y SUMMAR Y Date : /15/201 0 Oinah aLea dSit e Remedial Actio n Contrac t i

t EP-R7-07-0 6 TO# l Mont hof : Propert y Address ; 442 5 N 22 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 : B 2 = 5 7 PP M @ 4" ; N O EASEMENT ATTACHMENT S 1 ) Propert y sketc hprovidedb y EP A pursuan t to contract specification s 2 ) Signe dAcces s Agreemen t including acces s agreement s requiredfo r crossing othe r propertie s 3 ) Pre-Excavation digita l video clip/photograph s 4 ) Post-Excavation digita l vide o clip/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Buil t sketch­ i ) Shall includ e fina l lea dlevel s v ) Legen d ii ) Contamination lef t behindarea s vi ) Contractor identification iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r items to be includedi n th e individua l propert y file, ifavailable , o r obtainedinclude : i ) Pre-excavation agreemen t detail s (if an y ar e mad e wit hth e propert y owner ) ii ) Propert y Statu s For msignedb y propert y owne r iii ) Excavation digita l vide o i n MPEG , WM V (Window s Medi aVideo ) o r SW F(FlashPlayer ) fonna t and/or photograph s iv ) Signedfor mverifying satisfactor y restoration v ) Description of area s not meeting Interi mRO D cleanu p criteria .

TECHNOLOGIES . INC .Fin d Record Remediatio n Quer yi Lea d Remainin g QueryI Propert yDamag e Quer y Backfill :

Sampi e Area : 3427 0 ­ 442 5 N 2 2 S T Owner : Use rProvide d Owne rInformatio n Resident : n Owne rOccupie d Owne rName : jOMAH AHOUSIN G AUTHORIT Y Owne rAddressl : |a O RNANC E Owne rAddressZ : |54 0 S 2 7 S T City : OMAH A Owne rPhon e State : Zi p Code :

~ |N E |68105 -

Alternat e Phone : 

# I Owne rName : 

## 1 Owne rAddress : 

# 1 City : 

# 1 Owne rPhone : 

## 1 

# " State : ZipCode : 

# 1 1 Alternat e Phone : 

# r Residen t Name : 

# r Propert yAddress : |442 5 N 2 2 S T Zi p code : |68110 - Residen t Phon e 

# I

Contract : Assessment : Contractor : |PRUDENT2010_S Qualifyin g Grou p [To b Contrac t Optio n iGPnON l Assessmen t Ma xXR F Valu e | 533.5 7TECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y #:1''^^^ ^ Propert y Address : ^^2. 9 V 2Z
- 7T ' Date/Time : Owner' s Name : Oh-«X/ t Hoa^Tc/vfrv , ^ uVl^rTVvi , Quad s Excavated : Y ) 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 quadjrant(s) excavatedandrestored ? 1 ^ 2 .

I f necessary , wer e th e correct area s o f drip zone excavatedan drestored ? 

## y Gradin g Sodan dVegetatio n Ye s N o 1 .

Doe s the gradin g aroun dth e perimete r o

f th e hous e i n excavatedarea s generall y slop e awa y fro mthe house ? / 2 .

Has sodbeen laidi n all area s tha t wer e excavated ? 

# y 3 .

Doe s the sodappea r t

o be generall y health y andgrowing ? (Onl y evaluai e i f inspecte da t a3 0 

# y da

y lim e period) 4 Ar e soddedarea s generally fim i an devenl y graded ? 

# y 5 .Ar c tlie joint s belween the sodstrip s generall y light ? (Onl y evaluat e i

f inspecteda t a3 0 da y 

# y tim e period) 6 . Wa s th e propert y grade dsuc htl\a t wate r wil l no l pool on the property ? 

### y 7 . Wa s damag e t o landscapin g o r plan t material s avoided ? ^ Gates , Fence s an dRetainin g Wail s Ye s N o 1 .

D o gate s ope n andclos e freely ? (Ifapplicable ) y ^ 2 .

Wer e all gale s o r fence s lalce n dow n during restoratio n activitie s reinstalled ? (Ifapplicable ) 

# y 3 .

Wa s damag e t o gate s or fence s avoided ? (I f applicable ) y 4 .Was damag e to retainin g wall s avoided ? (I f applicable ) 

### y Foundation , Sidin g an dGutter s Ye s N o 1 Wa s dajnage t o the sidin g o r trimavoided ? 

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

# y 3 .

Wa s damag e l o window s avoided ? 

# y 4 Wa s damag e t o window s o r door screen s avoided ? 

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

# y Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 Wa s damag e lo diivewa v surface s avoided ? / 2 Wa s damag e t o 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 ^"^ ^ ^Date: >U«1 "niSOLO(JIES . IN C 

### A S - BUIL T DRAWIN G OLS#3427 0 Dat e Excavated : 11/17/201 0 

### OMAH A LEA D SUPERFUN D SIT E I SEP ASigned-Of f Date : 3427 0 Exterio rPain ( Omah a Lea d Sit e Owne rName : BORGESO N JOHN A • GcxJ d Sit e Sketc h Address : 442 5 N 2 2 S T • Poo r

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# SE m 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 propeity owner' s signatur e indicate s that th e property owner i s satisfie dwit hth e restoratio n o f th e subjec t propeity , an dthat 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 warranty (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Property ID : Property Addreas ; 4^ 5 N . 22" ° S t Owner : Omah a Housin g Authorit y 

### Phone : 402-444-6900x25 1 Restoratio n Item s i n Question :

item : Th e sit e i s sno wcovere d a t thi s tim e an d th e so d i s dormant . Bein g unabl e t o Item : Inspec t th e sod ; OiH Acanno t b e certai n o f satisfaction . Pruden t agree s tha t Item : wanrant yo f wori ci s extende d durin g winte rmonth s throug h spring , i f so d doe s no t ttem: tak e roo t an d becom e health yb yth e en d o f spring , Pruden t t o b e responsibl e fo r ttem: replacin g so d a t tha t time . ttem: Require d correction s t o complet e th e property : 

# r

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

J . '^ > 

# -//W A 7 P Owner' s Signature / / DatePniden t Technologies , Inc . (Pnident ) i s unde r contrac t wit hth e U . S . Envinaimeotal Prot^'crASBnc y (EPA ) t o clean u p lead
contaminate dsoil s at anundie r o f

propeitie s locate di n Omaha . Ndjtaska , includin g th e property locate da t442 5 N . 22° ^ Street . Th e EPA request s you r pennissio n t o allo w Pniden t t o peifimn asoi l cleaniq i at this jaapat y t o remov e lead-contaminale dsoil . B y signin g tlii s fonn , th e propert y owne r grant s permissio n t o Prudent t o perfor mactivitie s rdate dt o th e cleanu p inchidin g soi l sampling , removal o f lead-ccmtamiiuite dsoil , an drestoration o f di e reference dproperty . Ifyo u hav e an y question s abou t th e soi l cleanu p plaime dfor you r propeity , pleas e contac t Pruden t soud i ofiSce fa t ib t Omah aLead Sit e cleanup-a t (402 ) 733-1188 . General question s abou t flie Omah aLeadSit e cleanu p can b e directe dt o di e EPA Publi c Informatio n Center s a t (402 ) 731-304 S (Sout hOmah aoffice ) o r (402 ) 991-958 3 (Noiti i Omah aoffice) . Piopert y Acces s GrantedBy : Stanle y Timm . Executiv e Directo r fo r Omah aHousin g Authorit y lieas e Prin t Name ) Propert y Owne r Signature : .TJifZ^MAA ^ V(AAl^l'*^^- ' 11-09-1 0 (Date ) PROPERT Y INFORMATIO N (T o b e complete db y residen t >nd/o r propert y owne r —pleas e print ) RESIDEN T NAME : Vacan t Lo t Owne rRente r RESIDEN T ADDRESS : N/

A^Z- g A / Zv^' f Sj-f-^f ^ I F RENTAL , PROPERT^ T OWNE D BY : Th e Omah a HousIn Q Authorit y OWNER' S MAILIN G ADDRESS ; 54 0 S . 27' " Stree t OWNER' S TELEPHON E NUMBE R - WORK : (40 2 ) 444-690 0 x25 1 AG E O F HOME? : _N/ AYEARS . HO W LON G HAV E YO U LIVE D HERE ? N/ AYEARS . 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 W A NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : _N/ANUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLOE R W A NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLAY I N TH E YAR D FO R 5 HOUR S O R MOR E PE R WEEK : W A COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS,'ENTR Y GATES , ETC. )

AUTHORITY FORENVIRONMENTALRESPONS E ACTIONS : Th e activitie s t o b e implemente db y EP A unde r this agreement ar e pursuan t t o Sectio n 104 ofCERCLA , 4 2 U,S,C . 9604 , EPA' s ri^t o f acces s t o di e propert y i s provide dfor i n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entr y for "detenninin g tfa e nee dfo r response , o r choosin g o r takin g any respons e actio n under Ihi s title , o r oUierwis e enfonsing th e provision s o f tfa

e tide. "
808 0 War d Parkway , Suit e 40 5 560 0 S 1 0 S t 424 2 Medica l Drive , SuK e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6810 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 Fax : (402)733-188 3 Fax:(210)579-657 7ENVIRONMENTA L & CONSTRLCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

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## 3427 0 Exterio rPam t Ntocth^to w 

### Omah a Lea d Sit e Owne rName : BORGESO N JOH N A • Good 

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• YOURTICKE T NUMBE RI S 2642265 . Origina l Cal l Date : 11/15/1 0 Time : 4:0 8 p m Op : SIVA1896 7 Wor k t o Begi n Date : 11/17/1 0 Time : 4:4 5 p m State : N E County : DOUGLA S Place : OMAHA Address : 442 5 Street : N22ND S T Twp : 15 NRng : 13 E Sect-Qtr : 03-NW-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : Lea d Soi l Remediatio n Projec 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 Company; PRUDENT 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 CXCATV MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Servic e Are a Contac t Phon e Nunibe r Utility Typ e Day : 402934046 9 CXCATV CO X COMMUNICATIONS , IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 MUDOl METROPOLITA N UTILITIE S DISTRIC T 

## SAND Y Day : 402504782 3 AH : Emerg : 402504797 0 OMAHACO F CIT Y O FOMAHA
TRAFFICSEWE R RICH/TRAFFI C Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 OPPDGPR 5 OMAH A PUBLI C POWE R DISTRIC T EL M LOCATIN G Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 dhon.org/irthintemet/.../MessageText.as. . 1/ 211/15/201 0 ^^vww.dhon.org/irthintemet/DHONNotic.. . 

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## Excavatio n Date : Crew : Backfil l Date :

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