### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 2773 3 DATE : 1/1 5 ADDRESS : 251 7 BURDETTE S T REMEDIATIO N CONTRACTOR : PRUDEN TTECHNOLOGIES . INC . YEAR : 20l{ ) 

### SOI L REMEDIATIO N PROPERT Y FIL E FOLDE R DOCUMENT S 0 PR E AN D POS T VIDE O O F PORPERT Y (DVD ) Q

T EXECUTIV E SUMMAR Y 0 EPA-PROVIDE D PROPERT Y SKETC H 0 SIGNE D ACCES S AGREEMEN T FOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN T PROPERT Y H RESTORATIO N AGREEMEN T D SETTLEMEN T DOCUMENTS (I.E. , FOR DAMAG E O R TO REPLAC E PLANTS , ETC. ) m CONFIRMATIO N DAT A m PHOTOGRAPH S O ^ AS-BUIL T SKETC H G

/ SATISFACTOR YRESTORATIO N SIGNE D B Y PROPERT Y OWNE R M 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 m UTILIT Y CLEARANCE S Q PROPERT Y INFORMATIO N FRO M DOUGLA S COUNT Y ASSESSOR'S OFFIC E D D D

SIGNATUR E D DAT E 3021758 4 

# lllll l Superfun dPROPERT Y SUMMAR Y Date : /15/201 0 Omah aLea dSit e Reinedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof: Propert y Address : 251 7 BURDETT E S T A . EXECUTIV E SUMMAR Y A. l 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 l = 29 5 PP M @ 6" ; E A = 11 0 PP M @ 2 " ATTACHMENT S 1 ) Property sketc hprovide dby EPA 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 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 sketc h­ i ) Shal l includ e fina l leadlevel 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 di n th e individua l property file , ifavailable , o r obtaine dinclude : i ) Pre-excavatio n agreemen t detail s (ifan y ar e mad e wit hth 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 ofarea s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOGIES , INC .Fin d Record Remediatio n Query Lea d Remainin g Query Propert yDamag e Quer y Backnil :

Sampi e Area : 2773 3 - 251 7 BURDETT E S T Owner : D Owne rOccupie d Owne rName : JMOBEC O INDUSTRIE S Owne rAddressi : Owne rAddress2 : |ll41 3 HICKOR Y R D City : State : Zi p Code : lOMAH A [N E J68144 - Owne rPhon e Altemat e Phone : j(402 ) 342-282 0 

# 1

Contract : Contractor : jPRUDEm7010_ S contrac t Optio n foPTlON T Use rProvide d Owne rInformatio n Owne rName : 

## i Owne rAddress : 

# 1 City : ! State : 

# y i Zi p Code : Owne rPhone : Alternat e Phone :

Assessment : Qualifyin g Grou p ^40 0 Assessmen t Ma xXR F Valu e 520.9 4 Resident : Residen t Name : Propert yAddress : 1251 7 BURDETT E S T Zi p code : J68111 ^ Residen t Phon e 

# r - —;-.:-•'-'•f^ ~ CA^- \/p . 

# Ymmm i TECHNOLCXJiife, INC ; 

# EP A Propert y Clos e Ou t Propert y # : Z77^ 3 Propert y Address : 251" 7 '<d>ur.^ ^ ^ • Date/Time : Owner' s Name : pf[ffi^£0 > "^X^v^. . Quad s Excavated : ^ ^ Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s LI f necessar> . wer e the correct qiiadrant(s ) excavatedandrestored ? / 2 . I f necessary , wer e th e conec t area s o f drip zone excavatedaiidrestored ? / Gradin g Sodan dVegetatio n Ye s 1 .

Doe s th e grading aroundth e perimete r o

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

Has sodbeen lai di n all area s tha t wer e excavated ? / 3 .

Doe s th e sodappea r t o be generall y health y andgrowing ? (Onl y evaluate i f inspectedat a3 0 / da

y time period) 4 Ar e soddedarea s generally firman devenl y graded ? 

## A 5 .Ar c tlie joint s betwee n the sodstrip s generall y tight ? (Onl y evaluat e i

f inspecteda t a3 0 da y tim e period) 

## A 6 .Wa s the propert y gradedsuc htlia t wate r wil l not pool o n the property ? 

# y 7 .

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

# y Gates , Fence s an dRetainin g Wall s Ye s i .D o gate s ope n andclos e freely ? (Ifapplicable ) / 2 .

Wer e all gate s o r fence s taken down durin g restoratio n activitie s reinstalled ? (Ifapplicable ) / 3 .

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

# y Foundation , Sidin g undGutter s Ye s 1 .

Wa s damag e t o the siding o r tri mavoided ? / 2 .

Wa s damag e t o the foundation avoided ? 

# y 3 . Was damag e l o window s avoided ? / 4 . Wa s damag e t o window s o r doo r screen s avoided ? 

# y 5 . Wa s damag e t o downspout s o r downspou t extension s avoided ? / Sidewalk s an dDriveway s (Concrete ) Yes . I Wa s damag e lo diivewa y surface s avoided'^ 

## A T 2 .

Wa s damag e t o walkwa y surface s avoided ? N o

N

o

N

o

N

o

N o

### Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complete includin g th e 30-da y sodwarranty . EP A Representativ e a'^! ^ ^Date: M\\\[ OECHNOIOGIES , INC . 

### A S - BUIL T DRAWIN G OL S t t 2773 3 Dat e Exc a v

a red : 10/04/201 0 

### OMAH A LEA D SUPERFUN D SIT E I SEP ASigncd-Of f Date : 

# zn3 3 Nam e lV\ol>ec e XAalut^-rit. i Omah aLeadSite Dat e •fA''*-Acs - Nort hArro w Address : Asi-ya^AtfiTr e *r Sit e Sketc h Time : \t:'h O Phone : Tea m csA'- ^ /fit'. y BVID # 

# v^73 3 XRFCod e /g3 7 Bt><}I A • 13 3 Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e Z-/ASCPX.A{ - 2773 3 

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A = IIOPPV I fl 2 " OmahaLea dSit e 46130 CONTRAC T# : EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC . I

# AEF A Propert yCompletio n Agreemen t Thi s agreemen t documents the completion of remova l activitie s performe do 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 , ifany . Propert y ID : Propert y Address : ^ " 5 i T 

## ^i) r At - H e K\ r Owner : Phone : Restoratio n Item s i n Question :

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

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



### Owner' s Signatur e / Dat i- \

Pruden t Technologies , Inc . (Prudent ) i s unde r contrac t withth e U . S . Environmenta l Protectio n Agenc y (EPA ) t o clea n u p lead conlaminate dsoil s at anumbe r o f

tj^opertie s locate di n Omaha , Nebraska , includin g th e propert y locate dat ^ O i" T f^a'J^^Cie.TT ^ -^r " 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 remov e 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 , remova l o f lead-contaminate dsoil , an drestoratio n ofth e reference dproperty . I f yo u hav e an y question s abou t th e soi l cleanu p plaime dfor you r property , pleas e contac t Pruden t southoffic e for th e Omah aLea d Sit e cleanup-a t (402 ) 733-1188 . Genera l question s abou t th e Omah aLea dSit e cleanu p can b e directe dt o th e EP A Publi c Informatio n Center s at (402 ) 731-304 5 (Sout hOmah aoffice ) o r (402 ) 991-958 3 (NorthOmah aoffice) . Property Acces s Grante dBy : 

### IdSkt^^Il D YV^OdBLAUf i (Pleas e Prin t Name ) Property Owne r Signa l 

## ^QjtlA/ ^ 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 : Rente r RESIDEN T ADDRESS : 

## Qyvv^U ^ y0 9 (S^S^lu y I F RENTAL , PROPERT Y OWNE D BY : , ^ . OWNER' S MAILIN G ADDRESS ; 

## Rf s r\i,^,^A. ^ to p &«\ U 

# H 

# t f OWNER' S TELEPHON E NUMBE R - HOME : l^f^ ) 3l^ ' 2.^^- ^ WORK : J » AJ/ A AG E O F HOME? : YEARS . HO W LON G HAV E YO U LIVE D HERE ? 

# AJA . YEARS . 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 : NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLA YI N TH E YAR D FO R 5 HOUR S O R MOR E PE R WEE K 

# : W ^ COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. ] 

### AJ/ A

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s t o b e implemente db y EP A unde r this agreemen t ar e pursuantt o Sectio n 10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA'srigh t o f

acces s t o th 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 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 S60 0 S 1 0 S t 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Onnaha . Nebrask a 6810 7 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402 ) 733-118 8 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (4021733-188 3 Fax : (210 ) 579-557 7ENVfRONMEiVTA L & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# ^2^ P gurdeioPropert y Statu s For m 

# ..'^1 ^ Address : Dat e Phone : Ho;^-3H2_-;?^2^< ^ BVI D 

# A)i>o ^ t/ftc ^ (c,( r

Propert y Owne r Pruden t Employe e Signature : Signature : 808 0 War d Parkway , Suit e 40 5 560 0 S 1 0 S t 424 2 nOedft^ l Drive , Suit e 425 0 KansasCity , M O 6411 4 Phone : (816 ) 363-370 3

.. . /0<ie % IC- t OTA T 

# l^ - 

# "^jz l Omaha , Nebrask a 6810 7 Phone : (402)733-118 8 Sa n Antonio , TX 7822 9 Phone : (210)822-958 8, . 

# 2773 3 Name : Mokoa o XKJ/W*-frit s Omah a Lea d Sit e Date . »/^»-/i ^ Address : ^<n'^A>M0fi7re^T - Sit e Sketc h Time : /^'S O Phone : 

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# A Printed : No v 30 , 201 0 www.dcgis.org/dogi siittp://www.dlion.org/irtiiintemet/DHONNoticeCreation/MessageText.asp?ret=%3CRESU. . Creat e Anothe rTicke t 1 1 Bac k t o Irt h Interne t | Sen d Emai l



### • YOU RTICKE T NUMBE RI S  2605480 . Origina l Cal l Date : 9/30/1 0 Time : 12:3 4 p m Op : SIVA1896 7 Wor k t o Begi n Date : 10/04/1 0 Time : 1:0 0 p m State : N E County : DOUGLA S Place : OMAHA Address : 251 7 Street : BURDETT E S T Twp : 15 NRng : 13 E Sect-Qtr : 09-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : soi l lea d 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 Compan y: PRUDEN T TECHNOLOGIE S Contac t Name : SIV AJAMPAMA 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 OPPDGPR S QLNNEI C 

### Servic e Are a Contac t Phon e Numbe r UtiUt y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEIDI Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUDO l METROPOLITA N UTILITIES DISTRICT SAND Y Day : 402504782 3 Alt : 

### Emerg : 402504797 0

lo f 2 9/30/201 0 12:3 4 P Mhttp://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=%3CRESU. . 

### OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R RICH/TRAFFI C Day : 402444719 7



### Alt : 402444516 1 Emerg : 402444516 0 0PPDGPR 5 OMAH A PUBLI C POWE RDISTRICT EL M LOCATIN G Day : 406728934 3



### Alt : 406207149 4 Emerg : 888728934 3 QLNN E1 C QWES T LOCA LNETWOR K EL M LOCATIN G Day : 406728934 3



### Alt : 406207149 4 Emerg : 888728934 3

2 of 2 9/30/201 0 12:3 4 P MINC . 

### CONSTRUCTIO N SOLUTION S 

## SIT E SAJtT Y HAZARD ANALYSI S /JvuJ? ^ A K Addres s : 7AA}'? Excavatio n Date : Crew : 

## Backfil l 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 c A ^ 

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## Sit e Safet y Offic e Date :

n o WanfVaftany . Sut o 40 5 seoosios t 424 2 Medica l Drive , Stdt e 72S 0 • III!mt ynn t 111 1 Onrtha , Mih i Ml f 010 7 Sa n Antonio , T X 7822 9 iKne : (8fS ) 363*37V 3 Phone : (402)733-118 8 Phone : (2tO ) fl22-«588 BCfSI O 363^370 7 Fax : (402)733^88 3 Fax : (210 ) 679-657 7

# ^KCKu r Lt> r 

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