## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL E FOLDE R SAn)# : nSi" ) Date : Address : , ^ I U S 3 S h Remediatio n Contractor : 'f^^^t ^ "JetXiJlr,.:. ^ , ^Y\C, ^ 

## Year : , SD'^^a .

SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S IE TVide o o f

propert y (DVD ) aExecutiv e Sxunmar y 0 EPA-provide dpropert y sketc h 0 Signe dAcces s Agreemen t fo r subjec t propert y D Sigjoe dAcces s Agreement(s ) fo r adjacen t propert y 0 Restoratio nAgreemen t 0 Settlemen t

document s (i.e. , fo r

damag e o r

t o replac e plants , etc. ) 0 Confinnatio ndat a 0 Photograph s As-buil t sketc h 0 Satisfector y restoratio nsigne db y Propert y Owne r 0 Propert y close-ou t chec k lis t signe db y EP A • Descriptio no f

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

### [ ZPropert

y information fromDougla s Count y Assessor' s Office D . D D 

### Signature/

^ Dat e 4031070 6 

# ill ! Superfun dPROPERT Y SUMMAR Y Pate ; 01/23/2U0 9 Omah aLea dSit e Remedia l Actio n Contrac t f f £P-R7-07-U6/U0U4 Monti i of : Oec/Ja n Propert y Address ; 213 8 S 3 3 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 Oflie r

Relevan t

Infonnation : ARE A NO T EXCAVATE D B l LANDSCAPE , TRE E3'X26 ' @ 24 2 PP M CONFIRMATIO N SAMPLIN GDATA/RESULTS : B l = 54 7 PP M @ 12" ; B 2 = 27 4 PP M @ 6** ; P Z ^17 7 PP M @ 12" ; F l = 40 6 PP M @ 10" ; D Z= 49 6 PP M @ 12" ; F 2 = 25 1 PP M @ 6" ; E A = 36 3 PP M @ SCRAP E ATTACHMENT S 1 ) Propert y sketc hprovide db y EP A pursuan t t o contrac t

specification s 2 ) Signe dAcces s Agreemen t includin g acces s agreement s require dfo r crossin g othe r

propertie s 3 ) Pre-Excavatio n digita l vide o chp/photograph s 4 ) Post-Excavatio n digita l vide o clip/photograph s 5 ) Documentatio n - Complete dClose-ou t Checklis t 6 ) As-Buil t

sketc h- i ) Shal l includ e fma

l lea dlevel s v ) Legen d ii ) Contamioatio n lef

t behin darea s vi ) Contracto r identificatio n ui ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e include di n th e individua l propert y file, i f available , o r

obtainedinclude : i ) Pre-excavatio n agreement detail s (i f

an y ar e mad e withth e propert y owner ) ii ) Propert y Statu s For msigne db y propert y owne r iii ) Excavatio n digita l vide o mMPEG , WM V (Window s Medi aVideo ) o r SW F(Flas hPlayer ) format and/o r photogr^h s iv ) Signe dformverifyin g satisfactoi y restoratio n v ) Descriptio n o f

area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOCIES, INC .Fin d Record

Backfill : Sampl e Area : 1786 9 - 213 8 S 3 3 S T Owner : Clea n U p Query

n Owne rOccupie d Owne rName : ICOLLET T PAMEL AM Owne rAddressl : 

# I Owne rAddressZ : |213 8 S 3 3 ST City : OMAH A Owne rPhone : State : Zi p Code : [ N E [6810 5 Alternat e Phone : (402 ) 342-386 3 Lea d Remainin g QueryI Propert yDamag e Quer y
Resident : Residen t Name : jCGLLET TPAMEL AM Propert yAddress : )213 8 S 3 3 S

T Zi p Code : [6810 5 Residen t Phon e 

# I Contract : Contractor : |PRUDENT2008_S Group : Assessment : Qualifyin g Grou p jPLA Y ZON E Assessmen t XR F Date : 

# I Assessmen t MaxXR F Value : I 788.6 5TECHNOLOGIES , IN C

Property* : /"?$^ ^ Date/Time : Quad s Excavated : %\ , (^y , Pz , P' , fl ^ O'L . 

# ^ P A EP A Propert y Clos e Ou t Propert y Address : 2.)2 ? S "i? , S ^ Owner' s Name : Contracto r

Grou p Pruden t

Technologie s Excavatio n Genera l 1 . I f necessary , wer

e th e correct

quadrant(s ) excavatedan

drestored ? 2 . If necessary , wer

e th e correct

areas ofdri p zone excavatedan drestored ? Gradin g Sodan dVegetatio n 1 . Doe s th e grading aroun

dthe perimete

r ofth e hous e in excavatedarea s generall y slope awa

y fromthe house ? 2 . Ha s sodbee

n laidin all area s tha

t wer e excavated ? 3 . Doe s the sodappea

r t o b e generall

y health y an dgrowing ? (Onl

y evaluat e if inspecteda

t a3 0 da y tim e period) 4 . Ar e sodde darea s generall

y fir man devenl y graded ? 5 . Ar e th e joint s betwee

n th e sodstrip s generall

y tight? (Onl

y evaluat e i f inspecteda

t a3 0 da y time period) 6 . Was th e propeit

y gradedsuc

htha t wate r wil l not poo l o n th e property ? 7 . Was damage t o landscaping or plan t material s avoided ? Gates , Fence s an dRetainin g Wall s 1 . D o gate s ope

n an dclos e freely? (If

applicable) 2 . Wer e all gate s or

fence s taken dow

n during restoration activitie s reinstalled ? (If applicable ) 3 . Was damag e t o gate s or fence s avoided ? (IfappUcable) 4 . Was damage t o retaining wall s avoided ? (If applicable ) Foundation , Sidin g an dGutter s 1 . Wa s damag e t o th e siding o r trimavoided ? 2 . Was damage t o th e foundatio n avoided ? 3 . Was damage t o window s avoided ? 4 . Wa s damage t o window s o r doo r screen s avoided ? S . Wa s damag e t o downspouts or downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) 1 . Wa s damag e t o drivewa y surface s avoided ? 2 . Wa s damag e t o walkwa y surface s avoided ? Ye s 

## y y No

Ye s No 

# y y y 

### y y 

## y y Ye s No y 

## y 

# y y Ye s No 

### y y 

## y y y Ye s No 

## y 

# y

### 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 0o^: ^ Date : /-2f-<>f ^TECHNOLOGIE S 

## PROPERT Y CONTAC T ATTEMPT S ENVIRONMENTA L& CONSTRUCTION SERVICE S


### PropertgJTO : 

## n9<f.<= \ 

## Propert y Address : r? ! ? g * ^ 9.:^ . j^ f Owne r Name Owne r Phone : 

## -PrQfv^g

/ ^—r.cfLf^r r Belo w pleas e fin dalistin g of unsuccessfu l attempt s t o reac hth e abov e propert y owner . Dat e 

## j4QaJn ^ Tim e

^r^ n 

## Initial s



## _g_2 L Resul t

^ g I M GL.^t f c ftff^ r-P^ g PiAHTC . 

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I^i?Tlv42jS8-of l 

# 1 i4M^i A f^.DC I . ^ ^ JfK./ ^ ^ r ^ ,rV*,ft»AMr-> 5 ^ 

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## hi,(i'0< \Q-(^<y P ^.A/^'Tno^w ^ ^,^- w P/) . v-tx-Vvw^^ ^ Signatur e Dat e Pruden t Technologies , Inc. ,

y 

## Acknowledgmen t

signatur e Dat e EP A 8080 Ward Parkway . Suit e 40 5 Kansa s City , M O U11 4 Phon* : (816 ) 36^70 3 6007600 d1132

3 :E 0 800 3 O

E33 Q 2S0 C N . 24" * Sfreet , Suit e 30 8 Omaha , Nebrask a 6811 0 Phone : (402)504-100 4 Fax : f402 1 $04-1005 424 2 Medica l OnVe , Suit a 7250 Sa n Antonio , T

X 7822 9 Phone : (210)822-968 8 Fax : (210 ) 579-6577Pruden t Technologies , Inc . (Prudent ) i s unde r contrac t withth e U . S . Environmental Protectio n Agenc y (EPA ) t o clean u p lead contaminate dsoil s a

t anumbe r ofpropertie s locate di n Omaha , Nebraska , includin g th e propeit y locate dat

. Th e EP A request s you r

permissio n t o allo w Pruden t t o perfor masoi l cleanu p a

t thi s property t o temov e lead-contaminate dsoil . B y signin g thi s form, th e property owne r grant s permissio n t o Pruden t t o perfor m activitie s relate dt o th e cleanu p includin g soi l sampling , removal oflead-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

Prudent' s Administrativ e Cler k for th e Omah aLea dSit e cleanup . Ms . Madhurim aDuni-a t (402 ) 733-1188:733-1455 . General question s abou t th e Omah aLea dSit e cleanu p can b e directe dt o th e EP A Publi c Informatio n Center s at (402 ) 731-304 5 (Sout

hOmah aoffice ) o r

(402 ) 991-958 3 (North Omah aoflice) . Ptopert yAccess Grante d By : ^^/irYYtS\ A [_j b i ["^J^ T (Pleas e Prin t

Name ) Property Owne r

Signatu i (Signature ) T (Date ) PROPERT Y INFORMATIO N (T o be complete d b yresiden t and/o rpropert yowne r—pleas e print ) RESIDEN T NAME : 

## filw^ei. Co((.fr f Rente r RESIDEN T ADDRESS : 

## <3} r(y^K^.^JUj> ^ CgA^^j T l£RENTAL , PROPERT YOWNE p BY : OWNER' S MAIUN G ADDRESS ; ^ , , / - OWNER' S TELEPHON E NUMBER - HOME : (^>2. ) WORK : AG E O F HOME? : 1 £ ^ YEARS . HO W LON G HAV E YO U LIVE D HERE ? I / YEARS . 

# <^A l HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978? r-YE8 — NO ' NUMBER O F OCCUPANT S UNDE R 7 YEAR S OLD : C / NUMBER O F OCCUPANT S 7 YEAR S OL D AN D OLOE 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 Y GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s t o b e implemente db y EP A unde r this agreemen t ar e pursuan t

t o Sectio n 10

4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s right o f acces s t o th e property i s provide dfor i n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry fo r "determinin g th e nee dfor response , o r

choosin g o r

takin g any respons e actio n unde r thi s title , o r

otherwis e enforcin g th e provision s ofth e title. " 808 0 War d ParKway , Suit e 40 5 Kansa s City , M O 6411 4 Phone : (816 ) 363-370 3 Fax : (816 ) 363-370 7 250 5 N . 24' " Street , Suit e 30 8 Omaha , Nebrask a 6811 0 Phone : (402)504-100 4 Fax : (402)504-100 5 424 2 Medica l Drive , Suit e 425 0 Sa n Antonio , T X 7822 9 Phone : (210)822-958 8 Fax : (210 ) 579-657 7OLS# : 1786 9

Dat e Excavated : 10/03/200 8 USEP A Signed-OfTDate : AS-BUIL T DRAWIN G ' ! ^

' OMAHA LEA P SUPERFUND SIT E 

# •-4^ ^ Name : _

, .. — - , /^ddressT"777j y-J

yJTJ^, _ Phone : V^'a~ . J-y.Z - .y^g^ ^ Oinah a Lead SIta Date : py/A^ ^ Sit e Sketc h Time : Nort h AnD W
Tea m ^sr/^jZ-Lf i y^^f^ d BVI D # /y^i i 9 XR F Code 5'S"<: > " ^ Sampl e Numbe r g y fe^tP;^ A - y7<t ? Lea d Concentratio n

^ • ^ " ppm "•^^» ' ppm

pp m Confinnatio n Sampl e

/2LYe 5 t=

3 5^Ye s a • ^ Ye s • No 0 ^ N o 5 ^ N o 0t ; No ^ ^ No 0S - No E T N o •

ARE A NO T EXCAVATE D [B l LANDSCAPE , TREE ; 3'X36 ' @ 24 2 PPM ] ^ F 1 = 406PPM@10' ' 

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# 1 

# ff- ^ +- V 

## 7q - 

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# 5^^r / J F 2 = 25 1 PP M ©6 " c5S^/- ^ rr-i Omah aLea

dSit e E A » 36 3 PP M @ SCRAP E 4613 0 CONTRA a # : E P - R7-07-0 6 / 000 4 PRUDEN

T TECHNOLOGIES , INC .4613 0

# ItUBENT L rECHNOLOGIES , INC . — 

# Propert y Statu s For m Address : ^}>< ^ ^ 7;i,^ 4 g t Phone : Item # On Ma p Date : BVID : Plant s & Permanen t

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# • X Item# On Ma p Description & Location

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

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### TECHNOLOGIES , INC . ENVIRONMENTA L& CONSTRUCTIO N SERVICE S 

# REIMBERSEMENT FO R231 8 S . 3 3 ST . PLANT PRICE S FROM INDIA N CREEK

NURSER Y 2Clemanti s 39.9 8 4 0 Lil y o f

th e valle y 40.0 0 6 Climbin g rose s 149.9 4 1 2 Iri s 47.8 8 5 4 Daffodil s 47.9 4 6 0 Tulip s 29.9 4 3 3 Rosebus h824.6 7 4 Agastach e 39.9 6 2 Echinace a19.9 8 23Hast a253.0 0 5 Yucc a74.9 5 1 8 Popp y 107.8 2 2 Mum s 19.9 8 2 Phlo x 21.9 8 1 4 Dais y 139.8 6 2 0 Tiger/Da y Lill y 199.8 0 1 1 Peon y 219.8 9 2 Lila c bus h29.9 8 1 Linde n tre e 159.0 0 2 Snowbal l bus h69.9 8 6 Lila c bus h(commo n whit e purple ) 89.9 4 Labo r 300.0 0 Wate r bil l reimbursemen t

41.5 3

Tota l 2,968.0 0 Previou s chec k

- 2,368.0 0 Remainin g 600.0 0

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

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### Prin

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Parce l I D Owne r Nam e Property 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 254058000 0

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### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 9/24/200 8