TEdHNOLoCI^S . fNC: . 

## PROPERT Y SUMMAR Y SHEE T Omah aLea dSit e Remedia l Actio nContrac t #EP-S7-10-0 5 Said : 2770 7 Propert y Address : 261 7 BURDETTES T 

## Executiv e Summary : Issue s Encountered : Non e Issue s Resolved : Non e Uniqu e Findings : Othe rRelevan t Information : Confirmatio n samplin g data/results : B2 = 35 9 PP M @ 2" ; EA=15 0 PP M @Scrape . Attachments : Document s Include d i n th e Propert yFile : Yes N o N/A Propert ysketc h provide d b yEP Apursuan t t o contrac t specification s V Signe d Acces s Agreement ; includin g acces s agreement s obtaine d (i f required ) fo rcrossin g V ont o adjacen t propertie s Pre-excavatio n agreemen t detail s (i f an yar e mad e wit h th e Propert yowner ) V Pre-Excavatio n digita l vide o cli p V Samplin g dat a shee t V Post-Excavatio n digita l vide o cli p V Documentatio n - Complete d EP Aclose-ou t checklis t V As-Buil t sketc h V Omah a Lea d Sit e Databas e sampl e informatio n document . V Signe d for m verifyin g satisfactor yrestoratio n V Othe rDocuments : 3 0 daySO D warrant ypicture s y Utilit yclearance s documen t V Propert yinformatio n fro m Dougla s Count yAssessor' s office . V Settlemen t document s (i.e . fo ran ydamages , replacemen t o f plants , etc. ) V Sit e safet yhazar d analysi s documen t v\/it h pictures . V Legend : Ye s - Include d i n th e File ; N o - Not include d i n th e File ; N/ A- Doe s no t Apply . Pruden t Representative : \y ^ EP AAcceptance : 3026303 5 Date : 

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# ...,y h Superfun d 

### Pruden t Technologies , Inc . | 250 5 N . 24TH Street , Suit e 30 8 |0maha , N E6811 0 US A | Tel . 402.504.100 4 j Fax : 402.504.100 5 Environmenta l Engineering s Service s | Remediatio n| Constructio n

## 2770 7 Exterio rPain t Nort h Arrow Omah a Lea d Sit e Owne rNJame : BERNAR D J MORELL O 

### • Gocx l Sit e Sketc h Ad d ress : 261 7 BURDETT E S T • Poo r

Phone : H : 402-342-282 0 W : r ^ No t pain t Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Firm : Sample s Collecte d FPfi . Ff e P O RYASCPXA-2770 7 RYBSCPXA-2770 7 RYCSCPXA-2770 7 RYDSCPXA-2770 7F l F 2 B l 8 2 2& 0 

# 1^2 . 2(i?C > ^3 8 pp m pp m pp m pp m 

# D D D D Date : Time : 5 jZW l ots > 3-S g p^ - Sample s Analyze d RDZQCr)(A-2770 7 ' nCgCCPiX A2770 7 & Z G Z pp m pp m 

# a D D XR F Unit : QO Z Dat e 5 '3J ­ Book : J.ft( o

O O RPZOGr)(A^2770 7 P £ pp m 

# D Time : 

### JIJ ^ Staff : 

## A15 W Numbe rof Sample s = | U Legend : F 1 = Fron t Lefl , F 2 = Fron t Right . B 1 = Bac k Left , B2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s are a s viewe d fro m th e street , facin g property 

# ^^ fM/ 1 HAV.26.2a0 5 \ 

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# 770 ^ PROPERT Y ACCES S FOR M Pruden t Technologies , Inc . (Prudent )is unde r contrac t wit hth e U. S. Environmental Protectio nAgenc y (EPA ) to clean up lead-contaminate dsoiL s at

anumbei 'of propertie s locate d inOmaha . Nebraska , includin g th e property locate d at

'2.^/' ^ &U.^O^^fTG . S f Th e EPA request s you r permissio n to allo w Pruden tto perfor masoi l cleanu pat thi s propert y

to remov e lead-contaminate dsoil .By signin g thi s form , th e property owne r grant s permissio n to Prudent to perfor mactivitie s relate d to th e cleanu p includin g soi l sampling , removalof lead contaminate dsoil , andrestoratio n of th e reference dproperly . If

yo u hav e any question s abou t th e soi l cleanu p planne dfo r you r property , pleas e contac t th e Pruden t Offic e fo r th e Omah aLea dSit e cleanu p at (402 ) 733-1188 . General question s abou t th e Omah aLeadSit e cleanu p ca

n

be directe d to th e EP A Publi c Informatio nCenter s at

(402 ) 731-304 5 (Sout hOmah aoffice ) or (402 ) 991-958 3 (Nort hOmah aoffice) . If

you r property ha s agrave lor dir t driveway s or parlving area s thenth e removal andreplacemen t of th e soi l and/o r grave l durin g th e remediatio nproces s doe s no t make you r illega l gravel/dirt driveway s or parkin g area s legal . l^roi'erl y Aijtes. s Grante d (Pleas e Prin t Name ) 1./

?

/ • / Propert y Owne r Signatur e 

# : yi (Signature) (Dale ) Propert v Accesse dby : v "^ , f i , ) ,- i i ;' (Pruden t Employe e Name ) 

### l.:lA-U-i_»-Vi-_ : .KvL.kALt;.t::L.t.-.:L..- . T o b co m pi e pleas e print ) PROPERT YINFORMATIO N (Tob e e complete d byjresiden t and/p rprqpert^f owne r­ 1 RESIDEN TNAME : O L U Li 1/ / / 1 l\ A\ \

IIJ } Owne rRente r 2. IF RENTAL , PROPERT YOWNE D BY : 3. OWNER' S MAILIN G ADDRESS ; 4. OWNER' S TELEPHON E NUMBER - HOME : _J WORK : _L 

### J Z 5. TENANT' S TELEPHON E NUMBE R - HOME : ( ) WORK : J _ 6. AG E OF HOME? : YEARS . HO W LON G HAV E YO U LIVE D HERE ? YEARS . 7. HA S TH E EXTERIO R BEE N PAINTE DOR COVERE D WIT H SIDIN G SINC E 1978 ? YE S NO 8. #OF OCCUPANT S UNDE R AG E OF 7: #OF OCCUPANT S AT OR OVE R 7 YEAR S OL D 9. # OF CHILDRE N UNDE R AG E OF 7 WH O PLA Y IN TH E YAR D FO R 5 HOUR SOR MOR E PE R WEEK : 10 . COMMENT SOR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , NEIGHBORIN G PROPERT Y AUTHORIT YFO R ENVIRONMENTA L RESPONS E ACTIONS : Th e activitie s to be implemente dbyEP Aunde rthi s agreemen t are pursuan t to Sectio n 10 4of CERCLA , 42 U.S.C . 9604 . EPA' s righ tof acces s to th e propertyis provide d fo r in Sectio n 104(e ) of CERCLA , 42 U.S . C 9605(e) , whic h provide s entr yfo r"determinin g th e nee d fo r response , orchoosin g ortakin g an yrespons e actio n unde rthi s title , orotherwis e enforcin g th e provision s of th e title. " 

### Pruden t Technologie s Inc . 560 0 S. 10' " St . Omaha , NE68107 , 402.733.118 8 (Office ) 402.733.188 3 (Fax )

### TECHNOLOGIES , INC . ENVIRONMENTA L& CONSTRUCTIO N SERVICE S 

### Addres s 

# : mHllrdi ^ Propert y Stat , FO TM ^^^ ^ ^J^^j^ ^

NOTIC E TO BE GIVE N TO 

### : ) (^NER V 

### mitiER J TENAN TBOT H 

# f^^'^ ^ VdcMIt t HO W MUC H NOTIC E IS NEEDED : (2 4 HOUR S ) 48 HOUR S 72 HOUR S OTHE R NOTIC E NEEDE D (PLEAS E SPECIFY) : PHON E # AN D NAM E TO WHO M NOTIC E NEED S TO BE GIVEN:/ » i 

# Mom o 110 2 3il 2 i^t o WILL NEIGHBORIN G PROPERT Y NEE D TO BE USE D FO R ACCESS ? YE S NO IF NEIGHBORIN G PROPERT Y WILL NEE D TO BE ACCESSE D WHA T IS TH E ADDRESS :

WA S AN ACCES S FOR M OBTAINE D FRO M TH E NEIGHBOR ? YE S NO

/IL L A FENC E NEE D TO BE TAKE NDOW N TO OBTAI N ACCESS ? YE S NO 

# \y F ANSWERE D YE S TO NUMBE R 12 PLEAS E PROVID E LOCATIO N

OF FENCE : IS THER E PRE-EXISTIN G FACIA L DAMAG E TO TH E PROPERT YAN DIF SO PLEAS E PROVIDE D LOCATIO N AN D DESCRIPTIO N OF SUCH : YE S NO SPECIFY : IS THER E PRE-EXISTIN G CONCRET E DAMAG E TO TH E PROPERT YAN D IF SO PLEAS E PROVIDE D LOCATIO N AN D DESCRIPTIO N OF SUCH : YE S NO SPECIFY : 

### Propert y Owne r Pruden t Em p Signature : Signature ; DATE : \ti i 

### Pruden t Technologie s Inc . 560 0S. 10" ' St . Omaha , NE68107 , 402.733.118 8 (Office ) 402.733.188 3 (Fax )ENVIRONMENTAL * CONSTRUCTIO N SERVICE S 

### TECHNOLOCIES , INC . 

## « ^ Propert y Inspectio n For mi i 

# Address : Mll ' $Utditt f ShT>^te:^/23/ H Phone : M0^^3^22-? ^ BVID : Jl ' 

# Pre-Existin g Damage : Pleas e writ e in detai l an dinclude dlocatio n an ddescriptio nof damage : Concret e Damage :

Doe s Homeowne r wan t so dreplace di nal l areas ? YE S N O I f N O pleas e provid e wha t area s ar e no t t o b e sodde dan dwha t need s t o b e replace dinstea do f so d(i.e . mulch , rock , leav e bare ) i f mulc ho r roc k pleas e specif y wha t typ e an dcolor : 

# a ANY OTHE RDAMAG EO RREQUESTS :

Propert y Owne r Pruden t Employe e Signature : Signature : DATE : DATE :

### TECHNOLOGIES , INC . ENVIRONMENTA L& CONSTRUCTIO N SERVICE S 

# XR FCLEARANC ESHEE T PROPERT Y .ADDRESS : 2-^ 7 /Sv/rt/^He .

/ 

# PROPERT Y ID : 35/(5 y MAPHA S BEE NREVIEWE D AN D N O MISSED AREA S EXIST : /¥E S , ..•• ' N O WA S CONTAMINATIO N LEF T BEHIND ? I FYE S WHER EAN D DIMENSIONS : 

# iy CREW : \COAy\-- / XR FTECH:/J^q,aA'" ' DAT E DEPT H QUADRAN T F l F 2 READING 

# READING S D05SI=lMENTE D LOGBOOK ? YE S NO •1/i ^ ^ • " 

### B l B 2 GARDE N •••« 7 

### FLAYZON E 

# l y 5 EASEMEN T 

# ig< 3 ——'—# 

# JliiM i •reCHNOLOGIES , INC . 

# ^•^EP A EF A Propert y Clos e Ou t Propert y #:^770 7 Propert y Address ^ 2 <©'" 7 6K«st.eH e 'J^ : Date/Time : Owner' s Name : ^<? r vv a«>< ^ Ha\^\\ o Quad s Excavated : ^2_ Contracto r Group : Pruden t Technologies , inc. . Excavatio nGenera l Ve s N o I . I f necessary , wer e Oi e correct quadrant(s ) excavatedan drestored ? / 2 . I f necessar\' , wer e the correct area s o f drip zon e excavatedan drestored ? / Gradin g Sodam dVegetatio n Ye s N o • 1 . Doe s th e grading aroundtli e perimete r o

f the hous e i nexcavatedarea. s generall y slop e awa y / fro mlli e house ? 2 .

Has so dbee nlaidi nal l area s tlia l wer e excavated ? 

## y 3 .

Doe s th e sodappea r to be generall y healtii y an dgrowing ? (Onl y evaluate i f inspecteda t a3 0 da

y time period) / 4 .

Ar e soddedarea s generall y fim i an devenl y graded ? / 5 .Ar e tli e joint s betwee ntli e so dstrip s generall y tight ? (Onl y evaluat e i

f inspecteda t a3 0 da y time period) 

# y 6 .

Wa s tlie . propeit y gradedsuc htlia t wate r wil l no t poo l o nthe property ? 

# y 7 .

Wa s damage t o landscaping o r plan t material s avoided ? 

# y Gates , Fence s an dRetainin g Wall s Ye s N o ] . Do gate s ope nan dclos e freely ? (I f applicable ) / 2 .

Wer e all gate s o r fence s takendow nduring restorationactivitie s reiiistalled ? (I f apphcable ) / 3 . Was daraag e l o gate s o r fence s avoided ? (T f applicable ) 

## y 4 . Wa s damage t o retaining wall s avoided ? (I f applicable ) / Foimnidfttion , Sidin g an dGutter s Ye s N o 1 .

Wa s damage to the siding o r tri mavoided ? / 2 .

Wfi s damag e t o Ui e foundatio navoided ? 

# y 3 .

Was damag e t o v\ando\vs avoided ? 

# y 4 .

Wa s damag e t; o window s o r doo r screen s avoided ? 

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

# y Sidewalk s an dDriveway s (Comcrete) Ye s N o 1 . Wa s damag e t o dJivewa y surface s avoided ? 

# ~7 \ 2 . Was damag e t o walltwa y surface s avoided ? 

# y

## i # 

## j Owissr s c&mmsni&i .

Inspectiio o iTiotes: :

Remova l an drestoratio nactivate s complete includin g th e 30-da y so dwarranty : EP A Represent3tr:/- e Date : 9 li t h irECHNOLOGlES , tNC . 

### A S - BUIL T DRAWIN G OLS#2770 7 Dat e E-vcavated : 07/14/20J 1 

### OMAH A LEA D SUPERFUN D SIT E .Sample d By : Issa c 

### 2770 7 Exterio rPain t North Arro w Owne rName : BERNAI^ D J MORELLO Omah a Lea d Sit e • Goo d Address : 26 U BURDETT E STSit e Sketc h • Poo r

Phone: . H : 402-342-282 0 W : 

### \ [3 ' Not pain t Sampl e Numbe r Lead Sampl e LA 8 Sample s Collecte d Concentratio n Collecte d Fimi : Tpg . T o .0 ^ RyASCPXA-2770 7 F l 2& 0 pp m 

### D Date : _S]Z<^ 1 C'C ^ RY8SCPXA-2770 7 F 2 i5 1 pp m 

### D Time : S ' Sr t p)-.- ­ RYCSCP)CA-2770 7 B l 2 ( f O pp m 

### D Sample s Analyze d RYDSCPXA-2770 r B 2 ^•^ S pp m 

### D ISO2OGPXA"2770 7 • -B Z pp m 

### D XR F Unit : QO Z Book : Ifii n 

## n • nCZSCPXi A3770; ^ -J3 Z pp m 

## n [Tate : 

### D 

### 5-3'-g^- ^ -P g pp m 

## a Time : 

### D 

# rtn Staff : Numlje r of Sample s = l i 

### A»5 W Legend : F 1 = Fron t Left , F 2 = Fron t Right , B l = Bac k Left , B 2 = Bac k Righ t D 2 = Dri p Zone , G 2 = Garden , P Z = Pla y Al l quadrant s ar a a t viewe d fro m th e sliest , facin g propert y 

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CONTRAC T# : EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC .Sampl e M b 

# P ^ Call s SMiewaf t Repai r ^ Sampl e Area : 2770 7 - 261 7 BURDETT E Sampl e Dat e • Quadran t H Paramet e . >K F R e ­ :<R F Re s » Ex c ­rMarke rPlac e ­ Lea d Remaini n » Ins » Sample d B - t Q AConinne c» Lab_Re s 7/14/201 1 B 2 LEA D 35 9 mgdcg 2 D ISSA C N-' A 7.-U.'2011E 1 LEA D 15 0 m.g.'k g 1 L ) L 3 ISSA C fi' A * LEA D mg'k g 0 • , • fi' A

Record : M SearchSampi e M b caNs SideMaf t 

# 1 > Sampl e Area : 2770 7 - 261 7 BURDETT E S T Lab_Resu l ^ La b Resul t Unit ' » . _ Rerrrarks h

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Recori t M Searc h -Iii L

# %iEP/ k

Thi s agifeeinecii t doeainenli s th e campbtion ; of rewiova J activitie s performe d ontfi e beJo^A ' fis,te dptr-opeity . Th e pro-piert y owner' s sigiaature irxficate s thai t the-ptopeiit y ©.wtie r is satisfie dwitlt i th e restoraticM s of tfa e stLbjecJ . pirepert}}: , arad i tliatno istem s ar e tn . c|uestton, , nom , OFai t any tim e inth e ftiKitFe , exciudifi g aii y remaimin g warrant y (.3 0 day s total! ) excep: t thos e i,liein.s , liste dbetow , if any . IPiroperJ j 

# '" ^ 2llv~ l / Propert y AddB»ss : ^^ 7 

# iSi/fidl •It s 

# sr Owner : 

# !k£4JAgJ > M^el b Fhooe : 

# 7^.^'^f ^ RestoraSon : Itesn s inQuestton :

Iterv K 

### Eiem : Ren K iienr . Iftetm : Reqatire dcorsFectk>n s to Cfym^i e th e |pgrop«rty :

Ui

4 t agre e Fes4ofatfo nis compteted . I\ do not . ag#e e restoratio n rs complete d st (rtote ddeficierieie s above )

Owmer'^ s Sigisaittr .r

e y / / Date ' / 

### Ihttp://www.dhon.or|jMTintemet/DHONNoticeCreation/MessageText. . Creat e Anothe rTicke t Bac k t o Irt h Interne t Sen d Emai l 

### YOU RnCKE T NUMBE RI S 2792140 . Origina l Cal l Date : 7/11/1 1 Time : 8:3 7 am Op : ASHLEIGH1896 7 Wor k t o Begi n Date : 7/13/1 1 Time : 9:0 0 am State : N E County : DOUGLA S Place : OMAH A Address : 261 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 : LEA D SOI L 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: Contac t Name : PRUDEN T TECHNOLOGIE S ASHLEIG H ANIKPUT A Phone : (402)733 -118 8 Wor k Bein g Don e For : EP A Dept h o f Excavation : 6F T Corne r Lot ; Involve s Tunnelin g o r Horizonta l Borin g : CXCAT V MUDO l OMAHACO F 0PPDGPR 5 NFront : Y NExplosives : N

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### Utilit y Servic e Are a Contac t Phon e Numbe r Typ e CO X Day : 402934046 9 HEID I CO X CXCAT V COMMUNICATIONS , Alt : 402934046 9 COMMUNICATION S IN C Emerg : 402932975 7 Day : 402504782 3 METROPOLITAN MUDOl SAND Y MUD Alt : UTILITIE S DISTRIC T Emerg : Day : 402444719 7 

### CITY O FOMAHA - RICH/TRAFFI C OMAHACO F Alt : 402444672 5 

### TRAFFICSEWE R OMAHA Emerg : 402444516 0 Day : 406728934 3 

### OMAHA PUBLI C 0PPDGPR 5 ELM LOCATIN G Alt : 406207149 4 

### POWE RDISTRIC T Emerg : 888728934 3 Day : 406728934 3 

### QWES T LOCAL QLNNEI C EL M LOCATIN G Alt : 406207149 4 

### NETWOR K

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