## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL EFOLDE R SAI D # : -^^^^ r Date : ^ Jldo' ^ Address : ;2.o(> , <L %. B A / Remediatio n Contractor : pr^-j^^ ^ ^- ^ . Tnc y Year : , 2^0 ^ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Q

^ Vide o o f propert y (DVD ) 3 ^ Executiv e Simimar y Q^ EPA-provide dpropert y sketc h Q ^ Signe dAcces s Agreement fo r

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

adjacen t propert y Q ^ Restoratio n .^reemen t 3 ^ Settlement document s (i.e. , fo r

damag e o r t o replac e plants , etc. ) B ^ Confinnatio n dat a \ ^ Photograph s a ^ As-buil t sketc h 0 ^ Satisfector y restoratio n signe db y Propert y Owner E

r

i*ropert y close-ou t check lis t signe db y EP A D Descriptio n o f area s no t meetin g RO D cleanxq ) criteri a w Utilit y clearance s 

## Ca ^ Propert y infonnatio n fro mDougla s Count y Assessor' s OfBc e D D D

., , Artfi ^ fM/< ^ 

## Signature / Date 3005423 0 

# P M Superfun d

### Date ; 9/15/200 9 Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l Monthof : Augus t Propert y Address ; 120 4 S 2 5 A V A . EXECUTIV E SUMMAR Y A. 1 Issue s Encountered : NON E A J Issue s Resolved : NON E A 3 Uniqu e Findings : NON E A. 4 Othe r Relevan t Information : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : F 2 = 140 PP M @ 15" ; G A = 9 7 PP M @ 15" ; B 2 = 8 3 PP M @ 13" ; EA = 12 5 PP M @ SCRAPE (~1 ) ATTACHMENT S 1 ) Propert y sketchprovidedb y EP A pursuan t t o contract specification s 2 ) SignedAcces s Agreemen t including acces s agreements require dfo r crossing othe r propertie s 3 ) Pre-Excavation digita l video 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 final lea dlevel s v ) Legen d ii ) Contamination lef t behm darea 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, i f 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 ) Propert y Statu s For msignedb y propert y owne r iii ) Excavation digita l vide o i n MPEG , WM V (Wmdow s Medi aVideo ) or SW F(Flas hPlayer) forma t and/or photograph s iv ) Signedfor mverifying satisfactor y restoration v ) Descriptio n o f area s no t meeting InterimROD cleanu p criteria .Rn d Recor d Remediatio n QueryI Lea d Remainin g QueryI Propert yDamag e Query Backfill :

Sampl e Area : 2092 5 ­ 120 4 S 2 5 A V Owner : Resident : Contract : D Ovme rOocupie d Residen t Name : Contractor : Owne rName : [TORRE S EMILI O PRUDENT200 9 S 

# I |TORRE S EMILI O Propert yAddress : Contrac t Optio n Owne rAddressl : J120 4 S 2 5 A V [BAS E 

# r Zi p Code : Owne rAddress2 : [6810 5 Assessment : J1204S25AV E Residen t Phon e City : State : Zi p Code : 

# I Qualifyin g Grou p |OMAH A [N E [6810 5 |800/CHIL D Owne rPhone : Altemat e Phone : Assessmen t hia xXR F Value : |(402 ) 341-562 1 

### I 109 6TECHNOLOGIBS , INC . 

# SEP A EP A Propert y Clos e Ou t Property* : %o^i. f Propert y Address : /^O ^ 5 2- S A / Date/Time : ff-l'r-C ^ Owner' s Name : £>yxri'V ^ iorfc > Quad s Excavated : pl- , Av , ^-j . Contracto r Grou p Pruden t Technologie s Excavatio n Genera l Ye s No 1 .

I f necessary , wer e the correct quadrant(s ) excavatedan drestored ? 

### y 2 . If necessary , wer e th e correct area s ofdri p zone excavatedan drestored ? i / Gradin g So dan dVegetatio n Ye s No 1 .

Doe s the grading aroundthe perimete r ofth e hous e i n excavatedarea s generally slop e awa y 

# y fromth e house ? 2 .Has sodbee n laidi n all area s tha t wer e excavated ? 

# y 3 .

Doe s th e sodappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e if inspecteda t a3 0 

## y da

y tim e period) 4 .

Ar e sodde darea s generall y fir man devenl y graded ? 

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

# y 6 .Wa s the propert y gradedsuc htha t wate r wil l not pool o n the property ? 

# y 7 . Was damag e t o landscaping o r plan t material s avoided ? 

# J 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 ) 

# y 2 .

Wer e all gate s or fence s taken dow n durin g restoration activitie s reinstalled ? (If applicable ) 

# y 3 .

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

# y 4 .

Was damage t o retaining wall s avoided ? (If applicable ) 

## y Foundation , Sidin g an dGutter s Ye s No 1 .

Was damag e t o the siding or trimavoided ? 

# y 2 . Was damag e t o the foundation avoided ? 

# y 3 . Was damage t o window s avoided ? 

## y 4 .

Was damage t o window s o r doo r screen s avoided ? 

## y 5 .Wa s damage t o downspouts or downspou t extension s avoided ? 

### y Sidewalk s an dDriveway s (Concrete ) Ye s No 1 . Was damage t o drivewa y surface s avoided ? ^ 2 . Was damage to walkwa y surface s avoided ? 

## y

# \^oi ^ S 

# ^ ^ ^^ ^
Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complet e includin g th e 30-da y so dwarranty : EP A Representativ e j9„^yQi^ Date : 8//9/a< ^

## 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 fiimre , 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 yID : Propert yAddress : Q o «- t Q ^

2 ^ ^ 

## A^ ^ O^"^'- ^ ^rvJfUe o ^^rr'^e ^ Phone : C,o2_ . '^M \ ­ S'^Z. V Restoratio n Item s i n Question :

item : Item : Item : Item : Item : Item : Require d correction s t o complet e th e property :

p AI agre e restoratio n i s coinpleted .

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



## g>|13 | g ^ 

# Orri'l' ^ \ Ofyc. ^ Owner' s Signatur e Date IPruden t Teclinologies , Inc . (Pmdent ) i s unde r contrac t wit hth e U . S . Environmenta l Protectio n Ageaic y (EPA ) t o clea n iq ) lead
contaminate dsoil s at anumbe r ofpropertie s locate di n Omaha , Nebraska , includin g th e propert y locate da t

. Th 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 , di e property owne r grant s pennissio n t o Pruden t t o perform activitie s relate dt o th e cleaava p includin g soi l sampling , remova l o f lead-contaminate dsoil , an drestoratia n ofth e reference dproperty . I f

yo u hav e an y question s abou t th e soi l cleanu p plaime dfor you r propeity , pleas e contac t Prudent' s Administrativ e Clei k for th e Omah aLea dSit e cleanup . Ms . Siv aS . Jampana-a t (402 ) 733-1188 . Oenera l question s abou t th e Oinah aLea dSit e cleanu p ca n b e directe dt o th e EP A Publi c hiformatio n Center s at (402 ) 731-304 5 (SouthOmah aoffice ) o r (402 ) 991-958 3 (NorthOmah aoffice) . Property Acces s Grante d 

### By : i^yuii^^^^l^ ^ (Pleas e Prin t Name ) Property Owne r Signature : 

## ^yy ^ ..^^ ^ j£/US/ ^ (Date ) (Signitturc ) ^ 7 PROPERT Y INFORMATIO N • (T o b e compkte d b yresiden t and/o rpropert yowne r—pleas e prfait ) RESIDEN T NAME : Rente r RESIDEN T ADDRESS : AN^C T 

## C5*^aA ^ toe . g>g/ o 5 I F RENTAL , PROPERT Y OWNE D BY :
OWNER' S MAILIN G ADDRESS ;
OWNER' S TELEPHON E NUMBE R - HOME : ( Mfl U ^Hl - '^iJl ^ I WORK :
AO E O F HOME? : _iUD J YEARS . HO W LON O HAV E YO U LIVE D HERE ? < ^ YEARS . HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WTT H SIDIN O SINC E 1978 ? YE S " "N O NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : ^ NUMBER 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 O WH O PLA Y I N TH E YAR D FO R 6 HOUR S O R MOR E PE R WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOOS . ENTR Y GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS E ACTIONS : Th e activitie s t o b e implemente db y EP A unde r thi s agreemen t ar e pursuan t t o Sectio n 10 4 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s right ofacces s t o th e property i s provide dfor i n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 960S(e) , whic hprovide s entry fo r "determinin g th e nee dfo r response , o r choosin g o r takin g an y respons e actio n unde r this title , o r otherwis e enforcin g th e provision s ofth e 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 7ENVBRON.MENTA L CONSTRUCn O 

### TECHNOLOGIES , INC . SERVIC I 

# Propert y Statu s For m Address : 12 . © M 3 2-SH ^ A>-^ c Date : i^|l3h t Phone : ^02 ' H^f c - 3S$2

- BVID : ^.^'Fa. S 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 ^ V Cl-2 , p . ( p 

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Pre-Existin g Conditio n o f Structure s Doe s you r Basemen t hav e ahistor y o f leaking ? Ye s "^\N o r ^ Ite mN O Descriptio n & Locatio n O n Ma p Q, ^ K>a«Hs.&t<i ' Xc« 0 Cf^JtXtJ A 

## -at - t>n»^ e u» ^

Propert y Owne r Pruden t Employ e Signatiire : Signature :

808 0 War dParkway , Suite 405 2505 N . 24" ^ street , Suite 30 8 4242 Medica l Drive , Suite 42S 0 KansasCity , M O 6411 4 Omaha , Nebrask a 6811 0 San Antonio , TX7822 S Dhnna
- /«1« 1 IRI-ITfl t Phnnn - UO? ) .^04-100 4 Phona : (210)822-958 8JIES , INC . 

## A S - BUIL T PRAWING OLS#:2092 5 Dat e Excavated : 07/25/200 9 USEP A Slgned-OffDate : 

## OMAH A LEA P ^in^RFllN P SIt E 20925 Exterki rPain t in/ithAiro w QOoo d Omah a Lea d Sit e Sit s Sketc h Q^oo r Swnplln g Address : 1204S2SAV Q No t pain t Sampl e Numbe r Lea d Conoentratto n Sampl e Collecte d LA B Firm : Sample s Collecte d V^ KfP>/D Q RYAscRYi Aaooae—F 4 D Date : <o - Vl - Q5 t RYBSCPXA-2092 5 F 2 JOQ & Do m D Time : 2' . ^C > p RYCSCPX A3003 S RYDSCPXA-2092 6 B l B 2 li, H PP W pp m D D Sample s Analyze d RDJOGPXA-aOOa B B Z .pp m D XR F Uni t CkSH O Book : 2o a RGZSCPXA-2092 5 G Z ^7 0 pp m \S f Date : l-QT-'-Qf t RPZSCPX Aaooa s P Z La b R6Z8CPLA-2002 S S Resul t 85 7 pp m pp m Numbe ro f Sample s = | 

### D ^

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## a ) | Time : Staff : P/ 1 M^U /
I IU . I I —I IVt KkOll , I & < 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 quadrant s ar

e a

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A = 12 5 PP M 'a , SCRAP E (-1" ) CONTRAC T # : E P - R7-07-0 6 T0# 1 PRUDEN T TECHNOLOGIES , IN C

### Omah a Lea d Sit e Sit e Sketc h Samolln a Address : 1204 5 2 5 A V Sflrrd cNumbe r 

### ftY;\3i;p.v/> aooa s RYBSCPXA-2D92 5 RYDSCPXA-2Q92 5 R02GgpxA-goga RGZSCPXA.2C92 5 L.3 5 RGZ3CPLA-2092 5 'Re^'ii i S57pp m Nijnj^C ' of Siirnplo s = 

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# n ppn- . 

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## D D 2092 5 Ext«nc r»3tn t 

### • Gool [3^PcD r Q No i pain t Sample s Collecte d c--i:e . U3-tl^OS ^ Sample s Analyas o XR F Unit ; G^^ a SooX : 2g>f i

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### T^ri e P/ i

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120 4 S 2 5 AV E OMAH A N E 6810 5 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 27-15-1 3 SHULL S 2N D AD D 8 1 E 3 0 N 61. 5 F T LT 2 &N61.5F T 61.5X9 0 fTttp://webapps.dotcomm.org:8080/TreasTax/faces/page s /taxinfo.jsp?parc=221815000 0 http://douglasne.mapping-online.coni/DouglasCoNe/stati c /accountinfo.jsp?accountno=R221815000 0 Disclaimer : Ma p an d parce l dat a ar e believe d t o b e accurate , bu t accurac yi s not 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 = 2 8 fee t

### Pag e 1 of 2

• ' "> Creat e Anothe rTicke t Bac k t o Irt hInterne t Sen d Emai l 

### YOU RTICKE T NUMBE RI S 2313600 . Origina l Cal l Date : 7/09/0 9 Time : 11:1 9 a m Op : SIVA1896 7 Wor k t o Begi n Date : 7/13/0 9 Time : 12:0 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 120 4 Street : S 25TH AVE Twp : 15 NRng : 13 E Sect-Qtr : 28-NE Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : soi l lead remediatio n projec t Locatio n o f Work : LOCAT E ENTIR E PROPERTY Remarks : FA X AL L CLE7VR 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 Being Don e For : EP A Dept h o f Excavation : 6 F T Corne r Lot : N Front : Y Rear : Involve s Tunneling o r Horizonta l Boring : N Explosives : N CXCAT V LEVEL 3 MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F
Servic e Are a Contac t Phon e Nunibe r UtUit y Typ e 

### Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C 

### HEID I Al t 402934046 9 Emerg : 402932975 7 Day : 877366834 4 LEVEL3 LEVEL S COMMUNICATIONS , LL C N A 

### Alt : Emerg : 877366834 4 Day : 402504782 3 MUD0 2 METROPOLITA N UTILITIES DISTRIC T SAND Y Alt . Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y OFOMAHA-TRAFFICSEWE RRO N Al t 402444516 1 Emerg : 402444516 0
http://www.dhoii.org/irthiiiternet/DHONNoticeCreatioii/MessageText.asp?ret=<RESULTS. . . 7/9/200 9

### Pag e 2 of 2

0PPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T N A 

### Day : 406728934 3 Al t 406207149 4 Emerg : 888728934 3 QLNNEI FQWES T LOCA L NETWOR K N A 

### Day : 406728934 3 Al t 406207149 4 Emerg : 888728934 3



### http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 7/9/200 9ENVIRONMENTA L & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SOLUTION S 

# Sit e Safet yHazar d Analysi s Address : /J^o H S . JL S ^p ^ Crew : -^ ^ Date : ^ ' /^
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