## TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID# : iaZ^2,9 > Date : U Jjh/o' f Address : ^<^I9 . ^ '2 D ^ Remediatioi i Contractor : P-?^^nlo^J- . ^^ck .TnOC j Year : _QLO<^I —

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## SOI LREMEDUTIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f uroTJert v (DVD > Executiv e Summar y EPA-provide dpropert y slcetc h Signe dAcces s Agreemen t fo r

subject propert y Signe dAcces s Agreemeat(s ) fo r

adjacen t propert y Restoratio n Agreemen t Settlemen t document s (i.e. , fo r

dami^ e or t o replac e plants , etc. ) Confinnatio n dat a Photograph s As-built sketch Satisfector y restoratio n signe db y Propert y Owner Propert y close-out check lis t signe db y EP A Descriptio n ofarea s no t meeting ROD cleanup criteri a Utilit y clearance s 

## Propert y information fiomDougla s Count y Assessor' s Offic e



## TSSo T 3005415 9 

# in i Superfun dRn d Recor d 

### Backfill :

Sampl e Area : 1243 3 - 391 8 S 2 7 S T Owner : n Owne rOccupie d Owne rName : |BAI Z PEDR O Owne rAddressl : Owne rAddress2 : |391 8 S 2 7 ST City : State : ZipCode : |OMAH A |N E |6810 7 Owne rPhone : Alternat e Phone : 

# 1 Remediatio n QueryI Lea d Remainin g QueryI

Resident : Residen t Name : |BAI Z PEDR O Propert yAddress : 

### |391 8 S 2 7 S T Zi p Code : J6810 7 Residen t Phon e 

# r~ — Propeit yDamag e Query

Contract : Contractor : |PRUDENT2009_S Contrac t Optio n 

### [oFriON l Assessment : Qualifyin g Grou p pOO/CHIL D Assessmen t Ma xXR F Value : 679.0 5

### Date : l|/lS/200 9 | Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l | Mont hof : Octobe r Propert y Address : 391 8 S 2 7 S T A . EXECUTIV E SUMMAR Y A. 1 Issue s Encountered : NON E A. 2 Issue s Resolved : NON E A J Uniqu e Findings : NON E A. 4 Othe r Relevan t Information : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : B l = 5 8 PP M @ 6" ; D Z = 7 4 PP M @ 13" ; F 2 = 6 5 PP M @ 6" ; P Z = 3 0 PP M @ 6" ; E A = 13 9 PP M @ SCRAPE (~1 ) ATTACHMENT S 1 ) Propert y sketchprovidedb y EP A pursuan t t o contract specifica,tions 2 ) SignedAcces s Agreemen t including acces s agreement s requiredfo r crossing othe r propertie s 3 ) Pre-Excavation digita l vide o clip/photograph s 4 ) Post-Excavation digita l vide o clip/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Built 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 item s t o b e includedi n th e individua l propert y file, if available , o r obtainedinclude : i ) Pre-excavation agreemen t detail s (i f an y ar e mad e wit hth e propert y owner ) ii ) Properl y Statu s For msignedby propert y owne r iii ) Excavation digita l vide o i n MPEG , WM V (Window s Medi aVideo ) or SW F(Flas hPlayer ) forma t and/o r photograph s iv ) Signedfor mverifying satisfactor y restoratio n v ) Description o f area s not meeting InterimRO D cleanu p criteria .4 TECHNOLOGIES . INC . Propert y # : I 2^3 3 Date/Time : Quad s Excavated : |J)yP2;D2.^ F^ Excavatio n Genera l xaE?S g 

# EP A Propert y Clos e Ou t Propert y Address : Z*h S S 2. 7 Sr Owner' s Name : (Acr^c^Jj^i , v^<t < 2 _ Contracto r Grou p Pruden t Technologie s
1 .

If 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 1 .

Doe s th e gradin g aroun dth e perimete r ofth e hous e i n excavate darea s generall y slop e awa y fromth e house ? 2 .Ha s so dbee n lai di n al l area s tha t wer e excavated ? 3 .

Doe s th e so dappear t o b e generall y health y an dgrowdng ? (Onl y evaluat e i f inspecte dat a3 0 day tim e period ) 4 .Are sodde darea s generall y fir man devenl y graded ? 5 .Ar e th e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte dat a3 0 day tim e period ) 6 .Wa s th e property grade dsuc htha t wate r wil l no t poo l o n th e property ? 7 .Wa s damag 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 .Wer e al l gate s o r fence s take n dow n durin g restoration activitie s reinstalled ? (I f applicable ) 3 .Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) Wa s damag e t o retainin g wall s avoided ? (I f applicable ) Foundation , Sidin g an dGutter s 1 .

Wa s damag e t o th e sidin g o r tri mavoided ? 2 .Wa s damag e t o th e foundatio n avoided ? 3 .

Wa s damag e t o window s avoided ? 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 extension s avoided ? Sidewalk s an dDriveway s (Concrete ) 1 .

Wa s damag e t o driveway surface s avoided ? 2 .

Wa s damag e t o walkway surface s avoided ? Ye s N o 

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## Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complet e including th e 30-da y so dwarranty : EP A Representativ e S^,n.j ^ Date : /o///^ c ^jj^fa^* * "^V" ^

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n o f removal activitie s performe do n th e belo w liste dproperty . Th e propert y 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 a t 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 : . ^ c i 1 ^ S 

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# U _ Owner : ^Y'^A^< ^ ^'iO-'* ^ Phone : ^ Restoratio n Kern s i n Question :

Item : Item : Item : Item : Item : Item :

Q/ 1 agre e restoratio n i s completed . L J I d o no t agre e restoratio n i s complete d a t (note d deficiencie s above ) 

# ^I^^A-^gJ ^ Owner' s Signatur e Dat e

# mm TECHNOLOGIES , INC . Pruden t Technologies , Inc . (Prudent ) is unde r contrac t wit hthe U.S. Enviranmenta l Protection Agenc y (EPA ) to clea n

up lead
contaq)U)^Bf l soil sat anum ^ of proDcrties located in Omaha , Neliraska , includin g th e propert y located at Oy/o ' .. S f Ql ^ S Y ^. Th e EP Arequests you r permissio n

to allow Pniden t to perfor masoil cleanu pat thi s propert yto remov e lead-contaminate dsoil .By signin g thi s form, tiie propert y owne r grants peimissionto Pruden t to perfor m activitie s related to the cleanu p includin g soi l sampling , remova l of

lead-contaminate dsoil , an drestoration of

the reference dproperty . If yo u hav e an y question s abou t the soil cleaniq ) plannedfo r you r property , pleas e contac t Pnident' s Adminislrative Cler k

fo

r th e Omah aLea dSit e cleanup . Ms . Siv a S. Jampana-a t (402) 733-1188 . Qenera l question s abou t th e OinahaLea dSit e cleanvq ) ca n

be directed to the EP APublic Infomiatio n Centers at

(40 ^ 731-3045 (Sout hOmah aoffice ) or (402) 991-958 3 (Nort hOinahaoffice) . Propert y Acces s Grante d 

# By : JMerg?<jf^ ^ Pa s <^ (Pleas (Pleas e ftint Nvne ) ' e Prin t NM Propert y Owne r Signature : 

# iM-f.rrcig S RQ,^ ^ 7-1/'O f (Date) (Signature) ^ PROPERT Y INFORMATIO N (Tobe complete d by residen t and/o r property owne r —pleas e print ) RESIDEN T NAME : Rente r RESIDEN T ADDRESS : IF RENTAL , PROPERT Y OWNE D BY : OWNER' S MAILIN G ADDRESS ; 

# '$aM € -HOME : r^^-^ l 7JV
- OWNER' S TELEPHON E NUMBE R • HOME : l''^' ^ 

## (^7^'; i WORK : ( ) AO E OF HOME? : YEARS . HO W LON O HAV E YO U LIVE D HERE ? I O YEARS . HA S TH E EXTERIO R BEE N PAINTE D OR COVERE D WIT H SIDIN G SINC E 1978 ? _YE S NO 

# I NUMBE R OF OCCUPANT S UNDE R 7 YEAR S OLD : NUMBE R OF OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R OF CHILDRE N UNDE R 7 YEAR S OL D WH O PLA Y

IN TH E YAR D FO R 5 HOURS OR MOR E PE R WEEK : COMMENT S

OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONSE ACTIONS : Th e activitie s to be implemente d by EP A unde r thi s agreemen t ar

e pursuan t to Sectio n 10 4 ofCERCLA , 42 U.S.C . 9604 . EPA' s righ t of

acces sto the propert y

is provide dfo r in Sectio n 104(e ) of CERCLA, 42 U.S . C 9605(e) , whichprovide s entr y fo r "determining the needfo r response , or choosing or

taking an y respons e actio n unde r thi s title , or

otherwis e enforcin g the provision s ofth e title. " 8080 Ward Parloway , Suit e 405 5600 S 10* " Stree t 4242 Medica l Drive , Suit e 425 0 KansasCity , MO6411 4 Omaha , Nebrask a 68107 Sa n Antonio ,TX 7822 9 Phone : (816 ) 363-3703 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 & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

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Parce l I D 040341000 0 Additio n Owne r BAI Z Bloc k Nam e PEDR O Propert y 391 8 S2 7 Lo t Addres s S T Cit y OMAH ALega l 1 Zi p 

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### 2Pag e 1 of 2

" > Creat e Anothe rTicke t ] [ Bac k t o Irt h Interne t ) Sen d Emai l 

## YOURTICKE T NUMBERI S 2360626 . Origina l Cal l Date : 9/10/0 9 Time : 8:1 2 a m Op : SIVA1896 7 Wor k t o Begi n Date : 9/14/0 9 Time : 8:4 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 391 8 Street : S 27T H S T Twp : 15 NRng : 13 E Sect-Qtr : 33-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : SOI L LEA D 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 : FA X AL L CLEAR S T O (402 ) 73 3 188 3 : UNSUR E CORNER S Compan 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 F T Corne r Lot : NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N ATTNEBR l CXCAT V LEVEL 3 MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F
Servic e Are a Contac t Phon e Nuniber Utilit y Typ e Day : 8002413624 9 ATTNEBR l ATT/ T Alt : Emerg : 8002413624 9 Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 LEVEL 3 LEVEL S COMMUNICATIONS , LL C N AAlt : Emerg : 877366834 4 Day : 402504782 3 MUD0 2 METROPOLITA N UTILITIES DISTRICT SAND Y Alt : Emerg : 402504797 0
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/10/200 9

### Pag e 2 of 2

OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE RRO N Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0 0PPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T N A Day :

Alt : 406728934 3 406207149 4 Emerg : 888728934 3 QLNNEI FQWES T LOCA LNETWOR K

N A Day : 406728934 3

Alt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/10/200 9

### DS > ENVIRONMENTA L & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SOLUTION S 

# Sit e Safet yHazar d Analysi s Address : ?7^ r S > J ^ Y Crew : Date : P'/ f ^? ^

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