## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL EFOLDE R SAT O # : 7. 7 llP ^ Date : /iJ i Address : ^ Z D U . 7 ^ T 5^ ^ Reinediatio n Contractor : V^^MM T

## ^J^(lir < \i\ C • Yea n^O l 0 SOI LREMEDIATION PROPERTY FIL EFOLDE RDOCUMENT S IZ

f

Vide o o f

propert y (DVD ) a

f

Executiv e Summar y / 

## EPA-provide dpropert y sketc h ^ 

## Signe dAcces s Agreemen t fo r

subjec t propert y • Signe dAcces s Agreement(s) fo r

adia^en t propert y / 

## Restoratio nAgreemen t D Settlemen t document s (i.e. , fo r

damag e o r

to replac e plants , etc. ) 

# a Confirmatio ndat a Photographs / 

## As-buil t sketc h / 

## Satisfector y restoratio n signe dby Propert y Owne r / 

## Propert y close-ou t chec k

lis t signe db y EP A D^ Descriptio no f

area s no t meetin g RO D cleanu p criteri a Utilit y clearance s 

## Propert y informatio n firomDougla s Count y Assessor' s Of&c e D D D 

## isignatur e "• • Dat e 3026073 2 

# iiii i Superfun dFin d Recor d 

### Backfill :

Sampl e Area : 2716 3 - 192 0 N 2 5 S T Owner : n Owne rOccupie d Owne rName : 

### • (SUNBURS TPROPERTIE S IN C Owne rAddressi : Owne rAddressZ : |751 9 S 13 7 AV E City : State : Zi p Code : [OMAH A |N E |6813 8 Owne rPhone : Alternat e Phone : 

# 1

% Remediatio n Queryi Lea d Remainin g QueryI Propert yDamag e Quer y

Resident : Residen t Name : 

# I Propert yAddress : )1920N25S T 

### Zi

p Code : |6811 1 Residen t Phon e 

# I Contract : Contractor : |PRUDENT2009_S Contrac t Optio n |OPnO N 2 Assessment : Qualifyin g Grou p 

# po o Assessmen t Ma xXR F Value : I 591.0 7

### PROPERT Y SUMMAR Y Date : /15/201 0 Omah aLea dSit e Remedia l Actio nContrac t #EP-R7-07-0 6 T0# 1 Mont hof : Propert y Address : 192 0 N2 5 S T A EXECUTIV ESUMMAR Y A. 1 Issue s Encountered : NON E A. 2 Issue s Resolved : NON E A. S Uniqu e Findings : NON E A. 4 Othe r Relevan t Information : CONFIRMATIO NSAMPLIN GDATA/RESULTS : F l = 5 8 PP M @ 13" ; D Z= 30 1 PP M @ 12" ; B l = 17 3 PP M @ 16" ; E A = 24 4 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 other propertie s 3 ) Pre-Excavatio ndigital 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 final lea dlevel s v ) Legen d ii ) Contaminatio nlef t behin darea s vi ) Contracto r identificatio n iii ) Propertv ' addres s vii ) Dat e iv ) BVIDiiumbe 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 nagreemen t detail s (ifan y ar e mad e withth e property owner ) ii ) Property
- Statu s For msigne db y property ' owne r iii ) Excavatio ndigita l vide o inMPEG , WM V (Window s Medi aVideo ) o r SW F(Flas hPlayer ) forma t and/o r photograph s iv ) Signe dfor mverifyin g satisfactory restoratio n v ) Descriptio nofarea s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOGIES , iNC .TECHNOLCXJIES . INC . 

### Property # : TS I I ttf'' ^ Date/Time : Quad s Excavated : p ) , ^2
- 9 i 

# EP A Propert y Clos e Ou t Propert y Address : X'^T/ b /O
- Z S ff . Owner'sName : \cLir\a , H<2.vv^t/ \ Contracto r Group : Pruden t Technologies , Inc , Excavatio nGenera l Ye s N o I . I f necessary , wer e lli e correc t quadrant(s ) excavate dan drestored ? / 2 . I f necessary , wer e th e correc t area s of 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 of th e house i nexcavate darea s generall y slop e awa y fromHi e house ? / 2 .Ha s so dbee nlai di nal l area s tliat wer e excavated ? / 3 .

Doe s tli e so dappear t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 da

y tim e period ) / 4 .Are sodde darea s generall y firman devenl y graded ? 

# 7 5 .Are tli e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e if inspecte dat a3 0 day tim e period ) 

# J 6 .Wa s tli e property grade dsuc hthat wate r wil l no t poo l o nth e property ? 

# y 7 .

Wa s damag e l o landscapin g o r plan t material s avoided ? 

# y Gates , Fence s an dRetainin g Wail s Ye s N o 1 .D o gate s ope nan dclos e freely ? (If applicable ) 

# 7 2 .Wer e al l gate s o r fence s take ndow n durin g restoratio nactivitie s reinstalled ? (I f applicable ) - / 3 .

Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) 

# y 4 . Wa s damag e to retainin g wall s avoided ? (Ifapplicable ) 

# y Foundation , Sidin g an dGutter s Ye s N o 1 .Wa s damag e t o di e sidin g o r tri mavoided ? 

# y 2 . Wa s damag e to tli e foundatio n avoided ? 

# y 3 . Wa s diunag e l o windows 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 downspout s o r downspou t extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Ye s N o f 1 .

Wa s damag e to driveway surface s avoided ? 

# y 2 .Wa s damag e t o walkwa y surface s avoided'. ? 

# y

# m ^ 

# M c^ r s ^

Owner s comments :

Inspectio nnotes :

Remova l an drestoratio nactivate s complet e including th e 30-da y so dwarranty : EP A Representativ e 9 ^ - ^ Date : z\ n|( P.;jKiiW».c?iiria(rt'r;SvJ'-'. ' M 03r ­ ^1 ? 

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio no f removal activitie s perfomie donth e belo w liste dproperty . Th e property owner' s signatur e indicate s tha t th e property owner i s satisfie dwit htli e restoratio no f th e subjec t property , an dthat n o item s ar e inquestion , now , o r a t any time i nth e tliturc , excludin g any remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , ifany . Propert y ID : 

# Si^\C 3 Propert y Ad d 

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

# y/i ^ Date10/28/200 9 12:5 5 FA I 402393766 0 CREDI T ADVISOR S 

### 1)00 3 O c t 2 8 200 9 12!17P M NT TECHNOLOGIE S 4 0 0 0 5 

### p.: 2

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### Jj C aiNtttX ^ TEUEPHON ENUTtfBE R- HMEf t Cft ^ ~ iiy^O-'^7d » WORK : < • ) ^ l / ^ 'j^iAUEO F HOME7 : YEAR3 . KO WLON O HAVEVOU LIVE D HERE ? 

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### I

# X 11100 2 CREDI T ADVISOR S 10/28/200 9 12:5 4 FA X 402393766 0 NT TECHNOLOGIE S 40 0 0 5 

### P- 3 O c t 2B 200 3 12217P N
,CONS T la.if.TJO ^ 

### TECHNOLOGIES , INC . 

# Propert y Statu s For m Address : ^ /? ^ f / 2 ^ ^^ ^

- 

# Date : 

# 3 r/^5 * Address : • i * *M- ^ ' " ^ ^ ^ ' - Date : 

# /o/^k//> f Ite m Pl OnMa p l>escriptio n& Locatio n, j

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## A S - BUIL T DRAWIN G 01,.S#:2716 3 Date Kvi-avaUd : 11/10/200 9 LSKP.^Sijimd-OlTnato : 

## OMAHA LEAD SUPERFUN D SIT E 2716 3 Omah a Lea d Sit e Exlsfio rPai m Nort h Arro w Owne rName ; INNE R CIT YRESOURCE S D Address : 1920_N_2 5 S T Sit e Sketc h [yGood • Poo r Phone : H : W : • No t pain t Sampl e Numbe r RYASCPXA-2716 3 F l Lea d Concentratio n

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# n D Sample s Analyze d RDZSCPXA-2716 3 D Z , pp m 

### D XR F Unit : 3/" ^

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# n n Date : Time : (^-7-^1 7 p'^->r 7 Numbe ro f Sample s = Staff : pycyy^ n

Omah a Lea d Sil e 4 6 n o CONTRAC T# : E P - R7-07-0 6 T0# 1 PRUDEN TTECHNOLOGIES , INC .

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## Prin t Preview Page 1 of 2 Dougla s County-Omaha , N E

Parce l I D Owne r Nam e Propert y Addres s City Zi p Owne r Addres s Owne r Addres s Owne r City Owne r Stat e Owne r Zi p 194489000 0 SUNBURS T PROPERTIE S IN C 192 0 N 2 5 S T OMAH A 6811 1
7519S13 7 AV E OMAH A N E 6813 8 Additio n Bloc k Lo t Lega l 1 Lega l 2 Lega l 3 Legal 4 Acre s Treasure r Websit e Lin k Assesso r Websit e Un k PARKER S AD D 5 1 8 3 2 F T 32X12 0

0.0 9 http://webapps.dotconnm.org:8080/TreasTax/faces/pages/taxinfo.jsp ? parc=194489000 0 http://douglasne.mapping online.com/DouglasCoNe/static/accountinfo.jsp ? accountno=R194489000 0 

## http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 9/2/2009

2

### Page l of 2

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# i a e il M

• YOU RTICKE T NUMBE RI S 2398003 . Origina l Cal l Date : 11/02/0 9 Time : 11:0 9 a m Op: . SIVA1896 7 Wor k t o Begi n Date : 11/04/0 9 Time : 11:4 5 a m State : N E County : DOUGLA S Place : OMAHA . Address : 192 0 Street : N25T H S T Twp : 15 NRng : 13 E Sect-Qtr : 09-SE,16-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 : FAX AL L CLEAR S TO : (402)733-188 3 : UNSUR E CORNER S Compan y: PRUDEN T TECHNOLOGIE S Contac t Name : SIVAJAMPAM A Phone : (402)733-118 8 Wor k Bein g Don e For : EP A Dept h b f Excavation : 6 F T Corne r Lot : NFront : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CiXCAT V

LEVEL S MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Servic e Are a Contac t Phon e Nunibe r UtUit 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 NA 

### Day : 877366834 4 Alt : Emerg : 877366834 4 MUDO l METROPOLITA N UTILITIE 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

### Page 2 

### of 2 

### Day: 4067289343 OPPDGPRS OMAHA PUBLIC POWER DISTRICT NA 

### Alt: 406207 1494 

### Emerg: 8887289343 

### Day: 4067289343 QLNNElC QWEST LOCAL NETWORK NA 

### Alt: 406207 1494 

### Emerg: 8887289343E.'VViRONJViENTA L & COr-^!STRUCTiO.\ ' 

### TECHNOLOGIES . INC . SOLUTiON S 

### ^ 

# t e baf-9tyHazar d Analyss s .\ddress : 7^y. O /J , ^ Crew : Date : y y S -c^ ^ S / •



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## Propane/Butan e Ayy t 

## Sidewal k Jc:>s^ ^ O^tf ^ ^/yuje-ts-J ^ 

## Foundatio n J ^ 

## Retainin g Wall s •ct ^ 

## Fence s

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## Trees / Bushe s j±h . iiS _ 

## Structure s /t^TA t 

## Drivewa v yj­ ^ 

## Sprinkte r Syste mi yt^. ^ Crew^orema n Sit e Safet v Office r

80S 0 War d Parkway , Suit e 40 5 250 £ i\ . 24 " Strest , Suit s 3C- 2 AZ'Y i Medica i Drive , Suit e 72£i : :<ap.sas City , M O 6411 4 Omatia . Nebras!< a 6811 0 Sa n Antunio , T X 7822 S Phone : (816 ) 3S3-370 3 Phone : i402 i .504-100^ Pfione : (210).Si'2-S5S e Pa v (in?. ! SO^r-100 5 ?.,>: : (210) 573-€57 7