## TRANSMITTA L of OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : .^qqa ^ Date : (^ l j c^,?, j ^Qn ^ Address : ^7/< ) y ^ ^ ^- f Remediatio n Contractor : 1^/^ , i rv s n^l9zUi\intnqff-JL . It^O j Year : ^<^^9-JPofl ^ SOI L REMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S 0 ^ Vide o of propert y (DVD ) 13

^ Executiv e Summar y B ^ EPA-providedpropert y sketch \ s SignedAcces s Agreemen t fo r

subject propert y D SignedAcces s Agreement(s ) fo r

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

damag e o r

t o replac e plants , etc. ) 12

^ Confiimatio n data B ^ Photograph s B ^ As-built sketch S ^ Satisfactor y restoratio n signedb y Propert y Owne r ^ Propert y close-out check lis t signedb y EP A D Descriptio n o f area s no t meeting RO D cleanu p criteri a 0^ Utilit y clearance s Q

^ Propert y information fromDougla s Count y Assessor' s OfiBc e D D ' D

### PROPERT Y SUMMAR Y Date : 01/23/200 9 Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-06/0004 Mont h of : Dec/Ja n Propert y Address : 471 0 N 3 6 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 Oflier Relevan t Information : NON E B 2 = 19 9 PP M @ 6" ; LANDSCAP E = 13 9 PP M ( @ SCRAPE ATTACHMENT S 1 ) Propert y sketch provide db y EP A pxirsuan t t

o contrac t specification s 2 ) SignedAcces s Agreemen t including acces s agreement s require dfo r crossing othe r propertie s 3 ) Pre-Excavatio n digita l vide o clip/photogr^h s 4 ) Post-Excavatio n digita l vide o cUp/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Buil t sketch i) . Shall includ e final lea dlevels , v ) Legend ii ) Contamination lef t behin darea s vi ) Contracto r identificatio n iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e includedin th e individua l propert y file, i f available , o r obtaine dinclude : i ) Pre-excavation agreemen t detail s (i f an y ar e made wit h th e propert y owner ) ii ) Propert y Statu s For msignedby propert y owne r iii ) Excavation digita l vide o i n MPEG , WM V (Window s Medi aVideo ) o r SW F(Flas h Player ) fomia t and/or photograph s iv ) Signedfor mverifying satisfactor y restoratio n v ) Descriptio n o f area s no t meetin g InterimRO D cleanu p criteria .

TECHNOLOGIES , INC .Fin d Recx)r d Backfill :

Sampl e Area : 3493 6 - 471 0 N 3 6 S T Owner : n Owne rOrrjjpie d Owne rName : (JOHNSO N S R JUUA N H Owne rAddressl : Owne rAddress2 : )471 6 N 3 6 ST City : State : Zi p Code : JOMAHA )N E |6811 1 Owne rPhone : Alternat e Phone :

' - - — 

# - j . Qea n U p Query Lea d Remainin g Quer y I

Resident : Residen t Name : [TENANT S Propert y Address : |4710N36S T Zi

p Code : |6811 1 Residen t Phon e Propert y Damag e Quer y

Contract : Contractor : |PRUDENT2008^S Group : Assessment : Qualifyin g Grou p |PLA Y ZON E Assessmen t XR F Date : Assessmen t Max XR F Value : I 701.0 5TECHNOLOGIBS , IN C 

# SE M EP A Propert y Clos e Ou t Propert y # : 3^'=^3>4 . Propert y Address : ^n/ c W3 < S T Date/Time : Owner' s Name : Quad s Excavated : B 0 - y ef t Contracto r Grou p Pruden t Technologie s Excavatio n Genera l Ye s /N o 1 .If necessary , wer e th e correc t quadrant(s ) excavatedan drestored ? 

# 'zr~ 2 . If necessary , wer e th e correc t area s o f dri p zone excavatedan drestored ? 

### L / Gradin g So dan dVegetatio n Ye s No 1 .

Doe s th e grading aroundth e perimete r o f the hous e i n excavatedarea s generall y slop e awa y fromth e house ? 

# c/ ' 2 .

Ha s so dbee n lai di n al l area s tha t wer e excavated ? 

# 77 ­ 3 .

Doe s th e sodappea r to b e generall y health y andgrowing ? (Onl y evaluat e if inspecteda t a3 0 

# z" ­ da

y tim e period ) 4 .

Ar e soddedarea s generall y fir man devenl y graded ? 

# Z 5 .Ar e th e joint s betwee n th e sodstrip s generall y tight? (Onl y evaluat e if inspecteda t a3 0 da y time period ) 

# y 6 .Was th e propert y gradedsuc h tha t wate r will not poo l o n the property ? « / 7 .

Was damag e t o landscaping o r plan t material s avoided ? ^ ' Gates , Fence s an dRetainin g Wall s Ye s N o 1 .D o gate s ope n an dclos e freely? (If applicable ) 2 .

Wer e al l gate s o r fence s taken dow n during restoratio n activitie s reinstalled ? (I f applicable ) 

# Z ' 3 .

Was damag e t o gate s o r fence s avoided ? (If applicable ) 

# 1 7 Z . 4 .Was damag e t o retainin g wall s avoided ? (IfappUcable ) Foundation , Sidin g an dGutter s Ye s ^b 1 .

Was damag e to th e siding o r trimavoided ? 2 .

Wa s damag e t o th e foundatio n avoided ? ^ ' 3 .

Wa s damag e to window s avoided ? 

# Z ^ 4 .Wa s damag e to window s o r doo r screen s avoided ? 

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

# y Sidewalk s an dDriveway s (Concrete ) Ye s No 1 .

Wa s damage to drivewa y surface s avoided ? 2 .

Wa s damage to walkwa y surface s avoided ?

### Ovi^ner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complet e jncludin g th e 30-da y so dwarranty : EP A Representativ e 

# e 0 ^ Ll £ Da. : //^/^' ^

# dER A Propert y Completio n Agreemen t Thi s agreemen t document s th e completio n o f remova l activitie s perfonne do n tiie belo w liste dproperty . Th e propert y owner' s signatur e indicate s &at th e propert y owner i s satisfie dwith th 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 any tim e i n th e future , excludin g any 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 : Li" ! I n 

## M 

## ^C+ ^ 

# ^.v - '^^ ^ Owner : Phone : Restoratio n Item s i n Question :

Kem : Hem : Item : Item : Item : Item : Require d correcfion s t o complet e th e property :

L J I agre e restoration I s completed , excep t a s note d above . O i d o no t agre e restoratio n i & complete d


# X I ^ Owner' s Signatar e Dat ePruden t Technologies , Inc . (Piudent ) i s unde r contrac t wit h di e U . S . Environmenta l Protectio n Agenc y (EPA ) to clea n u

p lead contwjnate dsoil s a t animAer of

piopertie s locatedi n Omaha, Nebraska , includin g th e propert y locateda t V7/ 0 A/ . 3(r ^ .sy . Th e EP A request s you r permissb n t o allo w I^en t to perfor masoil cleaniq > a t thi s propert y to remov e lead-contammate d soil . B y signin g thi s form, the propert y owne r grant s permissio n t o Pruden t to perfor m activitie s relatedto the cleanu p includin g soil sampling , remova l o f lead-contaminate dsoil , an drestoration of ihe reference dproperty . I f yo

u have an y question s abou t th

e soil cleanu p planne d for you r property , pleas e contac t Pruden t Administrative Cler k

fo

r th e Omah aLea dSit e cleanup . Ms . Debora h Johnso n -a t (402) 733-1188 . Graiera l question s abou t th e Omah aLea dSit e cleaiup ca n b e directedt o the EP A Public Informatio n Centers a t (402) 731-304S (Sout h Omah ao£Bce ) or (402) 991-958 3 (Nort h Omah ao£Bce) . Propert y Acces s Grante dBy : <JL ^ \I Af> J JI}/|A/.^OA / " ^ l/i/"i j i \ f j' A (Pleas e Prin t Name ) ' Propert y Owne r Signature : (Sign^ure ) (Date ) PROPERTY INFORMATIO N (T o b e complete dby residen t and/o r property owne r —pleas e print ) RESIDEN T NAME : Oo h M.SO/\ ) , \Jl(ltjihl l A

. • K)wne n Rente r RESIDEN T ADDRESS :

I F RENTAL , PROPERT Y OWNE D BY : 

# h/r h

OWNER' S MAILIN G ADDRESS ; 

# ^"TfTi^ e r^- s ojp0i/ f OWNER' S TELEPHON E NUMBER - HOME : (ft>dL ) 70 S 'S / 0 V " WORK : 

### J 1 / AG E O F HOME? : I YEARS . HO W LON G HAV E YO U LIVE D HERE ? ' 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 : ( 0 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 Y I N TH E YAR D FO R 5 HOUR S O R MOR E PE R WEEK :



# 1 COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA L RESPONSE ACTIONS : Th e activitie s to b e implemente dby EP A unde r thi s agreemen t ar

e pursuan t to Sectio n 10 4 of CERCLA, 4 2 U.S.C . 9604 . EPA' s righ t of

acces s t o the propert y i s providedfo r i

n Sectio n 104(e ) of CERCLA , 4 2 U.S . C 9605(e) , whic h provide s entr y for "determiningthe nee d for response , or choosing or tikin g an y respons e actio n unde r thi s title , o r otherwis e enforcin g theprovision s of the title. "

808 0 War d Parkway , Suit e 40 5 250 5 N . 24* " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7

### A S - BIJttTJDiRAWBfG ; OMAHA LEAD SUPERFUND SIT E / ^ OLS# : 3493 6 Dat e Excavated : 11/20/200 8 USEP A Signed'OffDate : 

### 3493 6 Exterio rPsin t Ncft h Arno w Onnah a Lea d Sit e Own« rNam* : RAYMON D L CARLISL E • Goo d Sit e Sketc h Address : <710 N 3 6 S T .._jt x

Phone : *^ - 402-932-699 6 W : 402-633-165 2 [J^ f No t pain t Sampi e Numbe r Lea d Sampl e LA B Sample s Collectec f Concentratio n Collecte d Firm : M£ ^ M ^}i^ ­ RY/iiSCPXA-3493 6 F l D Date: _3d±QS____- _ • RYBSCPXAr3493 6 F 2 D Time : 3iS &

RYCSCPXA-3493 6 B l LSI.

_ pp m D Sample s Aralyze d RYDSCPXA-3493 6 B 2 —HA i _ppn i 

# o r a RDZSCPXA-3493 6 D Z • - /(S-^. . w> m I T ' 

# • XR F Uni t /i93 7 Boolt: 13 2 nOilOOPK A 0400 6 6 2 .pp m Date : RP2SCPXA-3493 6 P 2 ^ S pp m 

# • Time : P'/ H La b RPZSCPLA-3493 6 Numbe r o

f Sample s = ' 5 

### t Staff : 

## J ^ Resu H 73,4pp m lA<^^r> M Fron t Right , B l = Bac k Left . B 2 > Bac k Righ t D Z = Dri p Zone , G Z >= Garden . P Z = Pla y Al l quadrani a it^f t viewed flwnth t ttreei . Iicn g prapol y ^

CONTRAC T # : E P - R7-07-0 6 / 000 4 PRUDEN T TECHNOLOGIES , INC .ENVIRONMENTA L & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : ^7/ 0 Ncr ^ ^^ ^ S,f - 

## Date : 1//l3^jo % Phone ; CVOa ) ^I^-<ii n o r (^02 ) S22-/(,^ ^ 

## BVID : 3V93 4 Ite mN O Plant s & Permanen t Landscapin g T o Remai n I n Plac e O n Ma p Descriptio n & Locatio n 

# N 0 pli\^ h ^ ^^ ^

Pre-Existin g Conditio n o f

Structure s DoesyourBasementhaveahistor y of leaking ? Ye s No / y Ite mN O Descriptio n & Locatio n O n Ma p



# X Propert y Pruden t Employe e Signatur e Signature :

808 0 War d Parkway , Suit e 40 5 250 5 N . 24* ^ Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebraslc a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7

### Pag e 1 o f 1

Auaus t 200 7 - DOUGLA S COUNT Y ASSESS O 

# ^-JI O K f

3 t Sfhttp://douglasne.mapping-onIine.com/assessdoc/Photos/01/R10236900020001.jp g 11/19/200 8

### Prin t Previe w Pag e 1 o f 1 Dougla s County-Omaha , N E

Parce l I D Owne r Nam e Propert y Addres s Cit y \zi p Owne r Addres s Owne r Addres s 2 Owne r Cit y Owne r Stat e Owne r \zi p 102369000 2 JOHNSO N S R JULIA N H 471 6 N 3 6 S T OMAH A 6811 1

471 6 N 3 6 S T OMAH A N E 6811 1 Sec-Twn Rn g Additio n Bloc k Lo t Lega l 1 Lega l 2 Lega l 3 Lega l 4 Treasure r Websit e Lin k Assesso r Websit e Lin k 05-15-1 3 EPWORT H 0 1 0 AL L LOT S 9 & 1 0 101.6X12 8

http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp ? parc=102369000 2 http://clouglasne.mapping online.com/DouglasCoNe/static/accountinfo.jsp ? accountno=R102369000 2 Disclaimer : Ma p an d parce l dat a ar e believe d t o b e accurate , bu t accurac y i s no t Ma p Scal e guaranteed . Thi s i s not a lega l documen t an d shoul d not b e substitute d fo ra titl e search , 1 inc h = 9 3 fee t appraisal , survey , o rfo rzonin g verification . 

### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s Count.. . 11/18/200 8

### -^.v-'Sinj^y f



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### Pag e 1 of 2

" > Creat e Anothe rTicke t ^ . Bac k t o Irt h Interne t i; : > Sen d Emai l 

### YOURTICKE T NUMBE RI S 2176550 . Origina l Cal l Date : 11/17/0 8 Time : 10:4 8 a m Op : MADHURIMA1896 7 Wor k t o Begi n Date : 11/19/0 8 Time : 11:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 471 0 Street : N36T H S T Twp : 15 NRng : 13 E Sect-Qtr : 04-NW,05-NE Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n wor k fo r soi l Locatio n o f Work : LOCAT E ENTIR E PROPERTY 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 : MADHURIM A Phone : (402)733-118 8 Alt . Contact : Phone : (618)401-222 3 Wor k Bein g Don e For : ep a Dept h o f Excavation : 6 f t Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Boring : N Explosives : N CXCAT V

METR O MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C SPRNTPC S Servic e Are a Contac t Phon e Numbe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C 

### HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 METR O METR O COMM . COLLEG E 

### CHRI S Day : 402457230 7 Alt : 402672703 3 Emerg : 402457231 3 MUDO l 

### Day : 402504782 3 METROPOLITANUTILITIE S DISTRICT SAND Y Alt : 

### Emerg : 402504797 0 OMAHACO F CIT Y O F OMAHA-TRAFFIC,SEWE RRO N 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESlJLT.. . 11/17/200 8

### Pag e 2 of2 Day : 406728934 3 OPPDGPR S OMAH A PUBLI C POWE RDISTRIC T N A 

### Alt : 888728934 3 Emerg : 406728934 3 Day : 406728934 3 QLNNEI C QWES T LOCAL NETWOR K N A 

### Alt : Emerg : 888728934 3 Day : 402537180 0 SPRNTPC S SPRIN T SPECTRU M L P 

### Alt : 402537181 0 Emerg : 800521057 9



### http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?retr=<RESULT.. . 11/17/200 8