# • m TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL E FOLDE R SAE)# : S^ y Date : /0|K)<^' ^ 

## Address : 2^ft f ^ T. ^ ^JT. . ^/L Remediado n Contractor : J ^ _LJh f ^ >> ^ -^ ^ r ^ Year : ^ ^ ^ SOI LREMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S B

f 0 S 0 D ^ 

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## 0 D D D 

## Vide o o f prc^erty (DVD ) ^__ Execudv e Summar y EPA-provide dpropert y sketch Signe dAcces s Agreemen t fo r

subject propert y Signe dAcces s Agreement(s ) fo r

adjacen t propert y Restoratio n Agreemen t Settlement document s (i.e. , fo r

damag e or t o replac e plants , etc. ) Confirmation data

Photograph s As-buil t sketch Satisfector y restoratio n signe db y Propert y Owne r Propert y close-out check lis t signe db y EP A Descriptio n o f area s no t meetin g RO D cleanup criteri a Utilit y clearance s 

## Propert y informatio n fromDougla s Count y Assessor' s Ofi&c e

JSignatiir e ' Date 3005426 6 

# iiinii i Superfun dRn d Record Remediatio n Quer yI Lea d Remainin g QueryI Propert yDamag e Query Backfill :

Sampl e Area : 59 1 - 244 8 TEMPLETO N S T Owner : D Owne rOccupie d Owne rName : |DELACRUZCUADR AJUA N Owne rAddressl : |C/ 0 JUA N D E L ACRU Z CUADRA S Owne rAddressZ : )Z44 8 TEMPLETO N ST City : state : Zi p Code : |OMAH A [N E |6811 1 Owne rPhone : Altemat e Phone : 

# r Resident : Residen t Name : Propert yAddress : |244 8 TEMPLETO N ST Zi

p Code : |6811 1 Residen t Phon e 

# r Contract : Contractor : |PRUDENT2009_S Contrac t Optio n |BAS E Assessment : Qualifyin g Grou p 

# po o Assessmen t MaxXR F Value : 

# r 413. 2iHWiUHiiitiiv y *« i mffwtMg y 

### Date : 12/15/200 9 Omah aLea dSite Remedial Actioi i Contrac t #EP-R7-07-0 6 TO# l Monthof : November Propert y Address : 244 8 TEMPLETO N 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 othe r Relevan t Information : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : B 2 =19 0 PP M @ 6" ; D Z = 43 5 PP M @ 13" ; E A = 18 8 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 agreement s requiredfo r crossing othe r propertie s 3 ) Pre-Excavation digita l vide o clip/photograph s 4 ) Post-Excavation digita l vide o clip/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Buihsketch
i ) Shall mclud e final lea dlevel s v ) Legend ii ) Contamination lef t behindarea s vi ) Contractor identification iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s to b e includedi n the individua l propert y file, if available , or 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 mMPEG , WM V (Window s Medi aVideo ) or SW F(Flas hPlayer) forma t and/or photograph s iv ) Signedfor mverifying satisfactor y restoratio n v ) Description ofarea s not meeting hiterimRO D cleanu p criteria .

iHDiaffiEE^.ir^ .' TECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y # : ^ } Propert y Address : Slfk ^ Tcw<pLiU ^ ^ Date/Time : Owner' s Name : '^^cci^0cU.Cr^^ 1 (^^^c{ ^ Quad s Excavated : ^x . ^-j . Contracto r Group : Pruden t Technologies,Inc. , Excavatio n Genera l Ye s 1 .

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

# y 2 .

I f necessar>' , wer e (h e correct area s o f drip zon e excavatedandrestored ? 

# y Gradin g So dan dVegetatio n Ye s 1 .

Does th e grading aroundthe perimete r o

f the hous e i n excavatedarea s generall y slop e awa y fro

mth e house ? 

# y 2 .

Has sodbee n laidi n al l area s tha t wer e excavated ? 

# y 3 .

Doe s the so dappea r t

o b e generall y health y an dgrowing ? (Onl y evaluat e i

f inspecteda t a3 0 da

y tim e period ) 

# y 4 .

Ar e sodde darea s generall y fir mandevenl y graded ? 

# y 5 .Ar e th e joint s betwee n the so dstrip s generall y tight ? (Onl y evaluat e i

f inspecteda t a3 0 da y 

## y tim e period ) 6 . Wa s the propert y gradedsuc htlia t wate r wil l no t pool o n the property ? 

# y 7 . Wa s damage t o landscaping o r plan t material s avoided ? 

# y Gates , Fence s an dRetainin g Wall s Ye s 1 .

Do gate s ope n an dclos e freely ? (I f applicable) / 2 .

Wer e all gate s o r fence s take n dow n during restoratio n activitie s reinstalled ? (I f applicable ) 

# y 3 .

Wa s damage t o gate s o r fence s avoided ? (I f applicable) / 4 . Wa s damage t o retaining wall s avoided ? (I f applicable ) / Foundation , Sidin g an dGutter s Ye s 1 .

Wa s damage t o th e siding o r trimavoided ? / 2 .

Wa s damage t o the foundation avoided ? / 3 . Wa s damage t o window s avoided ? 

## y 4 . Wa s damage t o window s o r doo r screen s avoided ? 

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

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

Wa s damage t o drivewa y surface s avoided ? 

# y 2 . Wa s damage t o walkwa y surface s avoided ? 

# y " N

o

N o

N o

N o

N o

## Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complet e including th e 30-da y sodwarranty : EP A Representativ e Q^ ^ -j^ ^ Date : /i/ioja f

## Propert yCompletio n Agreemen t Tlii 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 fiiture , 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 : 

# r^i^- M y e^A> ^ ^nleh^— D f Owner : J ^ ^ 

# -P Phone : Restoratio n Item s i n Question :

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

L J 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 )

Date 

# 1 0 j'^jo ^Pruden t Technologies , Inc . (Prudent ) i s unde r contrac t withth e U . S . Enviroiunenta l Protectio n Agenc y (EPA ) t o clea n u p lead
CQDtaminate dsoil s at anumbe r o f

propertie s locate di n Omaha , Nebraska , includin g th e propert y locate dat ^H'i afi^JtAfil^Tfyif i ^ T r - ^ * ^^ ^ request s you r permissio n t o allo w Pruden t t o performasoi l cleanu p at thi s property t o remov e l&d-contaminate dsoil . B y signin g thi s form , tli e propert y owne r grant s permissio n t o Pruden t t o perform activitie s relate dt o th e cleanu p includin g soi l sampUng , 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 th e Pruden t Offic e for th e Omah aLea dSite cleanu p at (402 ) 733-1188 . Genera l 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 (NorthOmah aoffice) . Property Acces s Grante dBy : (Pleas e Prin t Name ) Property Owne r Signature : X^^ 3 (Signature ) (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 TNAME : (jUQl A UQ/luCtJ'Z . JyUOd^ Q ^wieT ^ Rente r RESIDEN T ADDRESS :
I F RENTAL , PROPERT Y OWNE D BY :
OWNER' S MAILIN G ADDRESS ; 

# 5, C A 

## n/l- e

. OWNER' S TELEPHON E NUMBE R - HOME : fl^) I j/" ' /- ^ ^

7 WORK : AG E O F HOME? : 

# 1 0 YEARS . HO W LON G HAV E YO U LIVE D HERE ? ( ^ YEARS . 

# v/ v HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978 ? V^ YE S N O NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : C ? 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 : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , 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 are pursuan t t o Sectio n 10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t 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 for "detenninin 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. "

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### TECHNOLOGIES , INC . S»iERVICB. S 

# Propert y Statu s For m Address : ^V'/ ^ ^ ^ny/e^y i ^^ • 

# Date : f^'^^O ^ Phone ; V/ ^ :: ? - a/ 7 " VV.5^^ / /f ^ <?/ / 3 

# BVID: 3S^^^ 9 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

Pre-Existin g Conditio n o f Structure s Does you r Basemen t hav e ahistor y o f leaking ? Ye s V ^ N o

— 

### Ite mN O O n Ma p Descriptio n & Locatio n

Propert y Owne r Pruden t Employe e Signatur e Signature :
^«B0WsitFPaMnrafy,3utte'4Q 5 '2505 : M. '24"'^Strset^uite:30 8 «. fAf2ii!l&2lttCr6lL)'5iv«.-3iiir;K>;..>.ii :'.. ' iKanss f Cfty;«ae4tf 4 'Omaha, ! ltet)iaska:6S 1 f O 3S2 I i«Art tm-i u ,T T .V7C.;i:r: ' Phone ; {WSfSSOi^Slta Phone : (402)504-100 4 FFax : (816r<S63S370 7 Fax : 1(402 ) 504-100 5 F?«LME;!I>>'err s =?•?•:• "ICHNOLOGIES , INC . OLS#:59 1 

## A S - BUIjL T DRAWIN G Dat e E\cavated : 09/22/200 9 USEP A Signed-OfrDate : 

## OMAHAiiEMSt ^ 59 1 Exterio rPain t Nort h Arro w Omah a Lea d Sit e Owne rName : • Good Sit e Sketc h Address : 2448 TEMPLETO N S T • Poo r 

# (S ) Phone : H ^ W- Q No t pain t Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Firm : Sverdrup . RYASCPXA-69 1 YA 413. 2 pp m 

### E l D Date : RYBSCPXA-59 1 Y B 229. 2 pp m Time : 

# n RYCSCPXA-59 1 Y C 34 S pp m 

### E l Sample s Analyze d 

### D RD2SCPXA-59 1 D Z 489. 2 pp m 

### E l D XR F Uni t Bool e RGZSCPXA-59 1 G Z .pp m 

### D D Date : 10/24/199 9 RPZSCPXA-59 1 P Z .pp m 

### D D Time : 12:3 1 

# a staff : RYDSCPXA-59 1 Y D 255. 8 pp m 

### E l

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## 244 8 TEMPLETO N S T ?A ,

## Prin t Preview Pag e 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 \ 2 Owne r \Cit y Owne r Stat e Owne r 

### \zi p 164413000 0 DELACRUZCUADR A JUA N 244 8 TEMPLETO N S T OMAH A 6811 1
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" > [ Creat e Anothe rTicke t ] [ Bac k t o Irt h Interne t J Sen d Emai l
YOU RTICKE T NUMBE RI S 2361235 . Origina l Cal l Date : 9/10/0 9 Time : 2:1 2 p m Op : SIVA1896 7 Wor k t o Begi n Date : 9/14/0 9 Time : 2:4 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 2 4 4 8 Street : TEMPLETO NS T Twp : 15 NRng : 13 E Sect-Qtr : 03-NW,04-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 : 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 Bein g Don e For : EP A Dept h o f Excavation : 6 F T Corne r Lot : NFront : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V MAGELLA NMUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Servic e Are a Contac t Phon e Number Utilit y Typ e Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 918574709 8 MAGELLA N MAGELLA N MIDSTREA M PARTNER S L P DEBORA H Alt : Emerg : 918574709 8 Day : 402504782 3 MUDO l METROPOLITA N UTILITIES DISTRICT SAND Y Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R RO N Alt : 402444516 1 Emerg : 402444516 0

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OPPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T N A 

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### NA Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

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### TECHNOLOGIES , INC . SOLUTION S 

# Sit e Safet yHazar d Analysi s C D Address : j2^<y$

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