## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R 

# SAI D # : , 7.U ^ Date : 3 J J j^ T AH^re.. . idl.y ^ Ai,^ ^ C- h Remediatio nContractor : fvUfUM ^ T^C K [\\ t . Year : P&l O SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Z

l Vide o o f propert y (DVD ) ffl Execvrtiv e Summar y 0 EPA-provide dpropert y sketc h H Signe dAcces s Agreemen t fo r subjec t propert y D Signe dAcces s Agreem.ent(s ) fo r adjacen t propert y 15 Restoratio nAgreemen t D Settlemen t docaiment s (i.e. , fo r damag e o r t o replac e plants , etc. ) GConfirmatio ndat a ffl Photograph s As-buil t sketc h 

# d Satisfactor y restoratio nsigne db y 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 aUtilit y clearance s 

## ffl Propert y informaJio nfromDougla s Count y Assessor' s Ofl5c e D D D 

## ^ ^ «l»t^ " Signature ' Dat e 3026077 7 

# illll l Superfun d

# I Fin d Recotx l Remediatio n Quer yI Lea d Remainin g Quer yI Propett yDamag e Quer y Backfill :



### Sampl e Area : 211 9 - 462 4 N3 9 S T Owner : Resident : Contract : D Owne rOccupie d Residen t Name : Contractor : Owne rName : [COLBER TBERNELL [PRUDENT2009_S jCOLBER TBERNELL Propert yAddress : Contrac t Optio n Owne rAddressi : [462 4 N 3 9 S T 

### OPTIO N1 

# 1 Zi p Code : Owne rAddressZ : 

### [6811 1 Assessment : J462 4 N 3 9 S T Residen t Phon e City : State : ZipCode : Qualifyin g Grou p 

# I [OMAH A [N E [6811 1 40 0 Owne rPhone : Alternat e Phone : Assessmen t Ma xXR F Value : |(402 ) 457-593 7 [(402 ) 598-349 5 

# I

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### PROPERT Y SUMMAR Y Date:'Vl5/201 0 | Omah aLea dSit e Reniedia l Actio nContrac t #EP-R7-07-0 6 T0# 1 | Mont hof : . ^ (J 6 ^ Propert y Address ; 462 4 N3 9 S T A EXECUTIV ESUMMAR Y A. l 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 : B I = 16 9 PP M @ 20" ; D Z= 19 0 PP M @ 15" ; E A = 11 7 PP M @ SCRAP E(~1" ) ATTACHMENT S 1 ) Property 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 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-Buil t sketc h­ i ) Shal l includ e fma l leadlevel 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 nunibe r 7 ) Othe r item s t o b e include di nth e mdividua l property file, if 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 Formsigne dby 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 nofarea s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOGIES , INC .TECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Properl y #:ZU ^ Propert y Address : L J k>7J 4 /V j • 3 9 S" ^ Date/Time : Owner'sName : 5o'->.rc\ ^ CoV\)<?<i'^ < Quad s Excavated : Coniracto r Groii|) : Pnulcn t Technologies , Inc . Excavatio nGenera l Ye s I . i r necessary , wer e th e correc l quadrant(s ) excavate dan dreslored? / 2 . i f iiecessar>- , wer e lh e correc t area s ofdri p zon e e.xcavate dan drestored ? / Gradin g So dan dVcoetatio n Ye s I . Doe s tli e gradin g aroiui dOi e perimete r oftii e lious e i nexcavate darea s generall y slop e away J fromth e house'.' ' 2 . Ha s so dbee nlai dinal l area s tlial wer e excavaled ? 

### y ?-<

. Doe s th e so dappea r l o b e generall y healtli y an dgrowing ? (Onl y evaluat e if inspecie da t a.^ 0 day lim e period ) / 4 . Ar e sodde darea s generall y fim i ;m devenl y graded ? / 5 . Are tli e jomt s belwee nth e so dstrip s generall y tight ? (Onl y evaluat e if inspecte da t a?^ 0 da y / lim e period ) 6 . Wa s lli e property grade dsuc htiia t wate r wil l no t poo l o nth e property ? / 7 . Wa s damag e to landscapin g o r phui t material s avoided ? / Gates , Fence s an dRetainin g Wall s Ye s 1 . D o gate s ope ntm dclos e freely ? (Ifapplicable ) / 2 . Wer e al l gate s o r fence s take ndow ndurin g restoratio nactiviiie s reinstalled ? (Ifapplicable ) 

### y •?•>

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

## y 4 . Wa s damag e l o retainin g wall s avoided'! ' (Ifapplicable ) 

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

## y 2 . W;i s damag e t o th e foundatio navoided ? 

## y ."i

. 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 ? / 5 . Wa s damag e t o downspout s o r downspou t extension s avoided ? / —

Sidewalk s an dOrivcway s (Concrete ) Ye s 1 . W.i s (.i.iiuagc iu driveway snrface s avoided': ' 

### / 2 . Wa s daniag e l o walkway surl'ace s avoided ? 

# T N o

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# N j> ^ 

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Owner s comments :

Inspectio nnotes : 

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## Remova l an drestoratio nactivate s complet e including th e 30-da y sodwarranty : EP A Representativ e 9" ^ J ^ Date : il^l' ^

# (fcjctw.ijrT t Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio no f removal activitie s performe do nth e belo w liste dproperty . Th e property owner' s signatur e indicate s tha t th e property owner i s satisfie dwit hth e restoratio no f th e subjec t property , an dtha t n o item s ar e inquestion , now , o r a t an y tim e inth e future , excludin g any remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , ifany . Propert y ID : Propert y Address : ^ ^ < 7 i ^ :f i N ^ * 3 * ^ 

# S V Owner : g o V M >^ C i9,\\^ ^ ^ Phone : Restoratio n item s i n Question :

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

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

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### Owner' s Signatur e Date I

### # • TECHNOLOGIES , INC . Pruden t Technologies , Inc . (Prudent ) i s under contrac t withth e U . S . Environmenta l Protectio nAgenc y (EPA ) t o cleanu p lead
contamiiuite dsoijsiat anujnljer o f propertie s locate dinOmaha , Nebraslca , includin g th e property locate da t ^7( f p/

j f / U r / y J T T * Th e EPA request s yovi r permissio nt o allo w Pruden t t o performasoi l cleanu p a t tiii s p^peT^pt o remov e lead-contaminate dsoil . B y signin g this form , tli e property owne r grant s permissio nt o Pruden t t o perfom i activitie s relate dt o th e cleanu p includin g soi l sampling , reraova l o f lead-contaminate dsoil , an drestoratio nofth e reference dproperty . Ifyo u hav e an y question s abou t th e soi l cleanu p planne dfo r you r property , pleas e contac t Prudent' s Administraliv e Cler k fo

r th e Omah aLea dSit e cleanup . Ms . Siv aS Jampana-a t (402 ) 73.'^- l 188 . Genera l question s abou t th e Omah aLea dSit e cleanu p ca nb e duecte dt o th e EPA Publi c Informatio nCenter s a t (402 ) '73 1 -304 5 (Sout hOmah aoffice ) o r (402 ) 99 1 -958 3 (NorthOmah aoffice) . Property Acces s Grante dBy : 

# 5^^fv xClaLK^ o (Pleas e Prin t Name ) Property Owne r Signature : 

# 4 irv^j^V. . 

# C^ ^ jdAyAddhd^ l -fH
­ (Signature ) (Date ) PROPERT YINFORIVIATIO N (T o be complete d b yresiden t and/o rpropert yowne r —pleas e print ) RESIDEN TNAME : 

## ^/^r^ic f floJ^^.yj - Rente r RESIDEN TADORESS : 

# ^^ V f\ A 3 t ^^ ' I F RENTAL , PROPERT YOWNE D BY :
OWNER' S MAIUN G ADDRESS ; 

# S c '<X7h ^ 

# : ffo h i^i'^'^O ^ OWNER' S TELEPHON E NUMBER - HOM E WORK : 

### J 1 ^ ^ AG E O F HOME? : YEARS . HO W LON G HAV E YO U LIVE D HERE ? • ^ ^^^ YEARS . 

# 7 

# y „ HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978? YE S N O 

# O NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : NUMBER O F OCCUPANT S 7 YEAR S OL D AN O 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 INSTRUCTKJNS : (I.E . DOGS , ENTR YGATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s t o b e implemente dby EP A unde r this agreemen t ar e pursuan t t o Sectio n10 4 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s right ofacces s t o th e property i s provide dfo r i

nSectio n104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entr y 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 5 560 0 S 10" " Stree t 424 2 Medica l Drive , Suit e 425 0 KansasCity , M O 6411 4 Omaha , Nebrask a 6810 7 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)733-118 8 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402 ) 73 3 -188 3 Fax : (210 ) 579-657 7ENVIROiNMENTA L& CONSTRUCTIO N 

### TECHNOLOGIES , ESC . SERVICE S 

# Propert y Statu s For m Address : iff^ i A ^ ^" l ^^ ^ Date : 

## Phone : ^7? ^ ^^f^d ^ ^3.6 ^ BVID : ItemNO Plant s & Permanen t Landscapin g T o Remai n I n Plac e O

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Propert y Owne r Pruden t Employe e Signature : /M ^ fhstAiAd ^ Signature : / ^

808 0 War d Parkway , Suit e 40 5 560 0 S 10' " Stree t 424 2 Medica l Drive , Suit e 425 0 KansasCity , M O 6411 4 Omaha , Nebrask a 6810 7 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)733-118 8 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)733-188 3 Fax : (210 ) 579-657 7

### #

PCHNOl.OGIF.S . IN C 

### A S - BUIL T DRAWIN G 01,.S#:2tl 9 Dat e KNtavattd : »S/lH/20« 9 

### OMAH A LEA D SUPERFUN D SIT E i:sr<:i' A Signcd-OtTnatt :

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### / V? ^ ^- ^ OmahaLea dSit e 46904.783-0 1 E. \= 11 7 PP M V J S f K.VPi : (1" ) CONTRAC T# : E P - R7-07-0 6 T0# 1 PRUDENTTECHNOLOGIES , INC .• • • • 

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Parce l I D 160377000 0 Additio n LAK E VIE W AD D Owne r Nam e COLBER T BERNEL L Bloc k Propert y462 4 N 3 9 , . Addres s S T Cit y OMAH ALega l 1 LT S 1 & Zi p [6811 1 Lega l 2 Owne r Addres s ' Lega l 3 Owne r Addres s 2 462 4 N 3 9 S T Lega l 4 Owne r Cit y OMAH A Acre s 

### 0.1 4 TVp a curG r Owne r N E 1 ^ , . , http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp ? Stat e parc=160377000 0 Lin k Assesso rhttp://douglasne.nnapping - Owne r 6811 1 Websit e online.com/DouglasCoNe/static/accountinfo.jsp ? Zi p iUn k accountno=R160377000 0 Sec-Twn Rn gX \ACm,y ^ 1 . V/.1 . ^t f 

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### YOU RTICKE T NUMBE RI S 2338413 . Origina l Cal l Date : Wor k t o Begi n Date : 8/11/0 9 8/13/0 9 Time : Time : 1:2 0 p m 1:4 5 p m Op : SIVA1896 7 State : N E Address : 4 62 4 County : Street : DOUGLA S N3 9T H S T Place : OMAH A Twp : 15 NRng : 13 E Twp : 16 NRng : 13 E Lega l Given : C Sect-Qtr : 05-NE-S E Sect-Qtr : 32-S E 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 : ( 4 02)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 : SIVAJAMPAM 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 : N Involve s Tunnelin g o r Horizonta l Borin g : NFront : Y Explosives : N Rear : Y ALT87 2 CXCAT V METR O MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Servic e Are a Contac t Phon e Nunibe r Utilit y Typ e 

### Day : 406728934 3 ALT87 2 WINDSTREA M COMMUNICATIO N 

### N AAlt : 406207149 4 Emerg : 888728934 3 

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

### HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 402457230 7 METR O METR O COMM . COLLEG E 

### CHRI S Alt : 402672703 3 Emerg : 402457231 3 Day : 402504782 3 MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y Alt : 

### Emerg : 402504797 0

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### ir'ag e / o r z Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO N 

### Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 0PPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T N A 

### Alt : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 QLNN E1 C QWES T LOCA LNETWOR K N A 

### Alt : 406207149 4 Emerg : 888728934 3

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