### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 2839 2 DATE : 1/1 5 ADDRESS : 202 8 WILLI S A V REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES
. INC
. YEAR : 201 ^ 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S 0 PR E AN D POS TVIDE O O F PORPERT Y(DVD ) 0 EXECUTIV E SUMMAR Y 0 EPA-PROVIDE D PROPERT YSKETC H 0 SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN TPROPERT Y 0

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RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R TO REPLAC E PLANTS , ETC. ) \yCONFIRMATIO N DAT A ef PHOTOGRAPH S 0 AS-BUIL TSKETC H 0

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SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R 0^PROPERT YCLOSE-OU TCHECKLIS TSIGNE D B YEP A D DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A 0

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UTILIT YCLEARANCE S Q ' PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E 

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# QoJ n 3lllll l SIGNATUR E DAT E 3021831 2 Superfun d

### PROPERT Y SUMMAR Y Date : /15/201 0 Oniah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Propert y Address ; 202 8 WILLI S A V A . EXECUTIV ESUMMAR 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 Infomiation : NON E CONFIRMATIO NSAMPLIN GDATA/RESULTS :

F l = 7 7 PP M @ 3" ; F 2 = 6 6 PP M @ 3" ; B l = 7 5 PP M @ 3" ; B 2 = 8 3 PP M @ 3" ; N O EASEMEN T ATTACHMENT S 1 ) Property sketc hprovide db y 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 ndigita l vide o clip/photograph s 4 ) Post-Excavatio ndigital vide o clip/photograph s 5 ) Documentatio n- Complete dClose-ou t Checklis t 6 ) As-Built sketc h­ i ) Shal l includ e fina l 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 dinth e individual 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 ) Property Statu s Formsigne db y property owne r iii ) Excavatio ndigita l vide o in MPEG , WM V (Window s Medi aVideo ) o r SWF(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
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## R (/ )'TECHNOLOGIBS , INC . Propert y ft : 2-'^}>^2 - Date/Time : Quad s Excavated : Pl , p Z,^' | ^Z _ 

# EP A Propert y Clos e Ou t Propert y Address : Z^^S ' ^'' " '^ ^"^ ^ Owner' s Name : Pea^eu ^ (£>f^o \6K^p-^lX t (IIMUTCI^ Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s N o 1 . I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? / 2 , I f necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? / Gradin g So dan dVegetatio n Ye s N o 1 .Doe s th e gradin g aroun dth e perimete r o f th e hous e i nexcavate darea s generall y slop e awa y fromth e house ? / 2 .Ha s so dbee n lai di nal l area s that wer e excavated ? 

# y 3 , Doe s th e sodappea r t o b e generall y liealth y an dgrowing ? (Onl y evaluat e if inspecte da t a3 0 da

y tim e period ) 

# y Are sodde darea s generall y firman devenl y graded ? 4 

# y 5 .

Ar c tli e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte dat a3 0 day y (im e period ) 6 .Wa s th e property grade dsuc htliat wate r wil l no t poo l o ntli e property ? 

## X 7 .

Wa s dainag e t o landscapin g o r plan t material s avoided ? / Gates , Fence s an dRetainin g Wall s 1 . D o gate s ope n an dclos e freely ? (I f applicable ) 2 . Were al l gate s o r fence s take n dow ndurin g restoratio nactivitie s reinstalled ? (I f applicable ) Ye s y / No

3 . Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) 

## y 4 . Wa s damag e t o retainin g wall s avoided ? (I f applicable ) y Foundation , Sidin g an dGutter s Ye s N o ^ 1 .Wa s damag e t o th e sidin g o r ttimavoided ? 2 .Wa s damag e l o di e foundatio n avoided ? 

## y 3 .

Wa s damag e t o window s avoided ? 

# y y 4 .Wa s damag e t o window s o r doo r screen s avoided ? 5 .

Wa s damag e t o downspout s o r downspou t e.xtension s avoided ? y Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 Wa s damaa e l o diivewa v surface s avoided' ? 

### y / ^ 2 .Wa s damag e t o walkwa y surface s avoided ?

## Owner s comments :

Inspectio n notes : 

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Remova l andrestoratio n activate s complete includin g th e 30-da y so dwarranty . EP A Representativ e ^ Date : \\i'> V u

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. mc . OL S n 2839 2 Dat e Excavated : 11/23/201 0 IISEP A Signed-Of f Date : 

### A S ­ BUIL T DRAWIN G OMAH A LEA D SUPERFUN D SIT E 2839 2 Exterio rPain t North Mo w Omah a Lea d Sit e Owne rName : PLEASAN TGREE N BAPTIS T • Goo d Sit e Sketc h Address : 202 8 WILLI S AV

Phone : H : W : 

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CONTRAC T# : EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC
.

# «EFA Propert yCompletio n Agreemen t Thi s agreemen t documents th e completion 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 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 in question , now , o r at an y tim e in 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 : Propert y Address : ^ Q ^<g ^ '^'''ULO s A"-^ ^ Owner : P n /^< g j 

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Owne r Date / / 

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# 1Pruden t Technologies , Inc . (Prudent ) i s unde r contrac t wit hth e U . S . Environmenta l Protectio nAgenc y (EPA ) t o clea nu p lead
contaminate dsoil s a t anumbe r o f

propertie s locate di nOmaha , Nebraska , includin g th e propert y locate da t ^Oalr l CO/tli i . Th e EP Arequest s you r permissio nt o allo w ftiident t o perfor masoi l cleanu p a t thi s propert y t o remov e lead-contaminate dsoil . B y signin g thi s form , tli e propert y owne r grant s permissio nt 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 no f th e reference dproperty . I f

yo u hav e an y question s abou t th e soi l cleanu p planne dfo r you r property , pleas e contac t Pruden t sout hoffic e .fo r 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 ca nb e directe dt o th e EP APubli c Informatio n Center s a t (402 ) 731-304 5 (Sout hOmah aoffice ) o r (402 ) 991-958 3 (Nort hOmah aoffice) . Propert y Acces s Grante dBy : I (Pleas e Prin t Name ) Propert y Owne r Signatur e ^i Q V J ^Signature ) PROPERT YINFORMATIO N (T

o b e complete d b yresident and/o rpropert yowne r—pleas e print ) RESIDEN TNAME : \ j C i r a iry r\n V • Owne r Rente r RESIDEN TADDRESS : . . .
I^^MNTAL , PROPERT YOWNE D BY : r- vy- \ f ) A
OWNER' S MAILIN G ADDRESS ;
OWNER' S TELEPHON E NUMBE R - HOME : J
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# i^.l2^i0^^Si l WORK : J i YEARS
. YE S NO NUMBERlO 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(VPLA YI N TH E YAR D FO R 5 HOURS ORMOR E PE R WEE K COMMENT S O R SPECIA L INSTRUCTIONS : (I.E/JSOGS , ENTR YGATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s t o b e implemente db y EP Aunde r thi s agreemen t ar e pursuan t t o Sectio n10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s right ofacces s t o th e propert y i s provide dfo r i nSectio n104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entr y fo r "determinin g th e 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 th e provision s o f th e title. " 8080 War d Parkway , Suit e 40 5 seoosios t 4242 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 68107 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 : (402)733-188 3 Fax : (210) 579-6577ENVIRONMENTA L& CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : ^OQ. ^ LOlllu A</- ^ Date : 

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Pruden t Employe e

808 0 War d Parkway , Sul i Lr>la^,y560 0 SI O S t 424 2 Medica t Driwb , Suit e 425 0 Kansa s City , M O 6411 4 It / rCAt (^(Zt/ ^ Omaha , Nebrask a 6810 7 Sa n Antoliio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)733-118 8 TRonenSTO ) 822-958 8 Fax : (816 ) 363-370 7 Fax : (402)733-188 3 Fax : (210 ) 579-«57 7

# 2839 2 Omah a Lea d Sit e Exterio rPain t Nortt i Arro w Owne rName : PLEASAN TGREE N BAPTIS T 

### • Goo d Sit e Sketc h 

# [ Address : 202 8 WILLI S A V • Popr ' Phone : H : W : 

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### Printed : No v 18,201 0 www.dcgis.org/dogi s

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" > Creat e Anothe rTicke t Bac k t o irt h inteme t Sen d Emai l 

### YOU RTICKE T NUMBERI S 2644873 . Origina l Cal l Date : 11/18/1 0 Time : 2:0 1 p m Op : SIVA1896 7 Wor k t o Begi n Date : 11/22/1 0 Time : 2:3 0 pm State : N E County : DOUGLA S Place : OMAH A Address : 202 8 Street : WILLI S AV E Twp : 15 NRng : 13 E Sect-Qtr : 10-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : SOI L LEA D REMEDIATIONPROJEC 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: 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 CXCAT V

MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Servic e Are a Contac t Phon e Numbe r Utilit y Typ e CXCAT V COX COMMUNICATIONS , IN C HEIDI 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
MUDO l METROPOLITA N UTILITIE S DISTRIC T SANDY 

### Day : 402504782 3 Alt : Emerg : 402504797 0
OMAHACOFCITY OFOMAHA-TRAFFIC,SEWE R 

### RICHA-RAFFI C Day : 402444719 7



### Alt : 402444516 1 Emerg : 402444516 0
0PPDGPR 5 OMAH A PUBLIC POWE RDISTRIC T EL M LOCATING 

### Day : 406728934 3 Alt : 406207149 4 

### Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K 

### Day : 406728934 3 EL M LOCATIN GAlt : 406207149 4 Emerg : 888728934 3 http://wvm.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 11/18/201 0

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