### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAiD# : 1963 7 DATE : 1/1 5 ADDRESS : 145 9 S 1 1 ST REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES . INC . YEAR : 20l( ) 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S ^

PR E AN D POS TVIDE O O F PORPERT Y(DVD ) d EXECUTIV E SUMMAR Y m EPA-PROVIDE D PROPERT YSKETC H d SIGNE D ACCES S AGREEMEN TFO R SUBJECTPROPERT V D SIGNE D ACCES S AGREEMENT(S ) FO R ADJACEN TPROPERT Y Q RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENT S (I.E. , FO R DAMAG E O R T O REPLAC E PLANTS , ETC. ) m CONFIRMATIO N DAT A I D PHOTOGRAPH S I D AS-BUIL TSKETC H D SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R C

D PROPERT YCLOSE-OU TCHEC KLIS TSIGNE D B YEPA D DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A d l UTILIT YCLEARANCE S

• PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR' S OFFIC E D D D

SIGNATUR E DAT E 3021826 2 Superfun d

### PROPERT Y SUMMAR Y Date : 715/201 0 Omah aLea dSit e Remedia l Actio nContrac t #EP-R7-07-0 6 TO# l Mont hof : Propert y Address : 145 9 S 1 1 S T 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 Information : NON E CONFIRMATIO NSAMPLIN GDATA/RESULTS : y F l = ^PP M @/" ; B 2 = 7 6 PP M @ 4" ; E A = 6 2 ^ ^ PP M @ SCRAP E(~1" ) 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 ndigita l vide o clip/photograph s 5 ) Documentatio n- Complete dClose-ou t Checklis t 6 ) As-Built sketc h­ i ) Shal l includ e final lea dlevel s v ) Legen d ii ) Contaminatio nlef 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 individua l property file, i f available , o r obtaine dinclude : i ) Pre-excavatio nagreement detail s (i f any ar e mad e withth e property owner ) ii ) Property Statu s Formsigne db y property owne r iii ) Excavatio ndigita l vide o inMPEG , WM V (Window s Medi aVideo ) o r SWF(Flas hPlayer ) forma t and/o r photograph s iv ) Signe dfor mverifyin g satisfactory restoratio n v ) Descriptio no f area s no t meetin g Interi mRO D cleanu p criteria .

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

### Backfill :

Sampl e Area : 1963 7 -145 9 S 1 1 S T Owner : Use rProvide d Owne rInformatio n Resident : D Owne rOccupie d Owne rName : Owne rName : Residen t Name : ICASaOLARRY T Owne rAddressl : Owne rAddress : Propert yAddress : 11459 Sl l S T Owne rAddressZ : Zi p Code : 1162 0 SI O S T 168108 - City : State : Zi p Code : City : State : Zi p Code : Residen t Phon e lOMAH A IN E [68108 ­ 

# " I I Owne rPhon e Alternat e Phone : Owne rPhone : Alternat e Phone : 1(402 ) 345-831 3 1(402 ) 345-831 5
Contract : Assessment : Contractor : PRUDENT201 0 S Qualifyin g Grou p 40 0 Contrac t Optio n OPTIO N 1 Assessmen t Ma xXR F Valu e 536.9 6TECH^30LCX;I1ES , INC . 

# EP A Propert y C^ose Ou t Propert y #: ' l'^(^5 7 Propert y Address ; IH^" ^ 5 - 1 ^ "7"^ - Date/Time : Owner'sName : l~cccCo ^ C a" v i" o Quad s Excavated : p | ^ 2 _ Contracto r Group : Pondi'ifit Teclliir»o(ogic.<i , Inc. , Excavatio nGenera l Ye s N o I l i neccssarv . wer e th e correc i quadrant(s ) excavate daii drestored ? 

# y 2 .If nccess<)r\- , wer e th e correc t area s ofdri p zon e e.xcavate dan drestored ? / Gradin g So dan dVegetatio n Ye s No 1 .Doe s iJi e gradin g aroun dUTI C perimete r of th e hous e i nexcavate darea s generall y slop e away fromth e house ? / 2 .Ha s so dbee nUu dmal l area s tJia t wer e e.xcavated ? / .1 . Doe s th e so dappear t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte dat a3 0 day tim e period ) / 4 ,Ar e sodde darea s generall y fir man devenl y graded ? / S .Ar c th e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e if inspecte da t a3 0 day lun e penod ) / (>

. Wa s th e property grade dsuc htliat wate r wil l no t poo l o nlli e property'! ' / 7 .

Wa s dani.ig e l o landscapin g or plan t material s avoided ? / Gates , Fence s an dRetainin g WaiJi s Ye s N o ! . D o gale s ope nan dclos e freely ? (Ifapplicable ) / 2 Were al l gale s or fence s take n dow ndurin g restoratio nactivitie s reinstalled ? (If applicable ) / 3 Wa s damag e l o gate s o r fence s avoided ? (If applicable ) / -1 Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) / Foundation , Sadini ^ smd i Gutter s Te s N o 1 Wa s damag e l o th e sidin g o r tri mavoided ? 

# y 2 Wa s damag e l o (h e foundatio navoided ? 

# y 3 Wa s damag e l o window s avoided ? 

# y 4 ,Wa s damag e l o window s o r doo r screen s avoided' ' 

# y ^ ' 5Wa s damag e t o downspout s o r downspou l extension s avoided ? 

# y lidewalk s an dDi-iivcway< i (Concrete ) Ye s ! Wa s dama-i e (o diivewa \surface s a\'0ided' " 

# y Wa s damag e t o walkwa y surface s avoided' ' 

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## Owner s connments :

Inspectio nnotes :

Remova l an drestoratio nactivate s complete includin g th e 30-da y so dwarranty : EP A Representativ e A^j ^ Date : ///2// ^(-•HNOLOC;IF:S . INC . 

### A S - BUIL T DRAWIN G OLS#l%3 7 Dat e Excavated : 10/04/201 0 

### OMAH A LEA D SUPERFUN D SIT E I'SEP A Signcd-OfTDate : 

### 19637 Exterio rPain t Nort h Arro w Omah a Lea d Sit e Owne rName : LARR YTCASCI O Q Goo d Sit e Sketc h Address : 145 9 S 1 1 S T_ QRoo r

Pfione : « w [ 3 Not pain t Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d Firm : Sample s Collecte d RY/\SCPXA-1963 7 RYBSCPXA-1963 7 RYCSCPXA-1963 7 RYDSCPXA-196.37 

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# &BVi Propert yCompletio n Agreemen t Thi s agreenien t documents the completionof remova l activitie s performe do nthe below listedproperty . Th e propert y owner' s signatur e indicate s tha t the propert y owne r i s satisfiedwit hthe restoratio nof the subject property , an dtha t no item s ar e i nquestion , now , o r a

t an y tim e i nthe 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 ; | L ^ ^ qc^ ^ | ( <;^.y ^ 

## Owner: LoLt r u CouU^O - Restoratio n Item s i n Question :

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L— l I 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 )



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### Dat ePmden t Technologies , Inc . (Prudent ) i s unde r contrac i withth e U . S . Enviromnenta l Protectio n Agenc y (EPA ) t o cleanu p lead contaminate dsoil s a t anumhe r o f

propertie s locate dinOmaha , Nebraska , includin g th e propert y locate da t ICj^r l ^ /y ^ j"^" ^ Tl^ e EP A request s you r permissio n t o allo w Pruden t t o performasoi 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 nt o Pruden t t o perform 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 planne dfor you r property , pleas e contac t Pruden t soutl i offic e for th e Omah aLea d Site cleanup~a t (402 ) 733-1188 . Genera l question s abou t tli e Omah aLea dSite cleanu p can b e directe dt o th e EP A Publi c Informatio n Center s a t (402 ) 731-304 5 (SouthOmah aoffice}_o r (402 ) 991-958 3 (NorthOmah aoffice) . Propert y Acces s CJrantedBy : (Pleas e Prin t Name ) Property Owne r Signatur e (Date ) 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: yyf^T^y ^ ^^j TCj ^ Owne r RESIDEN TADDRESS : /^/^C ? -X'Vv^/ ^ /^ ^ I F RENTAL , PROPERT YOWNE D BY : OWNER' S MAILIN G ADDRESS ; 

# y<^<^ 3 y^^.^v^^^>^/^ 4 ^' ^ OWNER' S TELEPHON E NUMBE R -IWWE TVl6^-^/C^JCj/C ^

(^""IAIORK : J 1 AG E O F HOME? : -.<ir ^ YEARS . HO W LON G HAV E YO U LIVE D HERE ? S,^ ^ YEARS . 

# e n HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978 ? YE S <2^

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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 WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. ) 

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AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS ^ Th e activitie s t o b e implemente db y EP A unde r thi s agreemen i ar e pursuan t l o Sectio n10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s right o f

acces s t o th e propert y i s provide dfor i nSectio 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. " 308 0 War d Parkway , Suit e 40i 3 560 0 S ^:{ > S t 'slV L Medica l ^ma , Suit e 42S 0 Kansa s City.'M O 64 1 Ii 4 Crnaha , l\ietorasIis6S1ii ? I5a n Antortio , TX 7822 9 Phone:(816)363-370 3 Photie : ;402 ; 733..t1P; g Phofn> ; (210)822.968 8 Fax : (816 ) 363-370 7 f^si ; i40'i!'•7,3.-i88: ; FHX : (210 ) 679-667 7ENVFROINMENTAL & CONSTRtCTIO N 

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

### YOU RTICKE T NUMBE RI S 2602930 . Origina l Cal l Date : 9/28/1 0 Time : 11:2 3 am Op : SIVA1896 7 Wor k t o Begi n Date : 9/30/1 0 Time : 12:0 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 145 9 Street : S IIT H S T Twp : 15 NRng : 13 E Sect-Qtr : 27-N 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 : UNSUR E CORNER S Compan y: PRUDEN T TECHNOLOGIE S Contac t Name : SIV AJAMPAM A Phone ; ;402)733-ll E 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 Borin g : N Explosives : N CXCAT V LEVEL 3 MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F 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 LEVEL S LEVEL S COMMUNICATIONS , LL C N A 

### Day : 877366834 4 Alt : Emerg : 877366834 4 MUD0 2 METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R 

### RICH/TRAFFI C Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/28/201 0

## Page 2 of 2
OPPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T EL M LOCATIN G 

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

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## Emerg : 888728934 3

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