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

# SAI D # : X/lol^ l Date : l l " I 5 " I 0 Address : ;^3/ C FwnNf n ^ f Remediatio n Contractor : Ppf , n/PrM- J itr ^ NI^OC , 

### I ? <^ . /iMr, . i Year : 6^U \( J SOI LREMEDL^TIO N PROPERT Y FIL EFOLDE RDOCUMENT S [?

f Vide o o f propert y (DVD ) B Executiv e Summar y Q EPA-provide dpropert y sketc h 0 Signe dAcces s Agreemen t fo r subjec t propert y D Signe dAcces s Agreement(s ) fo r adjacen t propert y ^ Restoratio nAgreemen t D Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) B Confinnatio ndat a 0 Photograph s G

T As-buil t sketc h g f Satisfactor y restoratio nsigne db y Propert y Owne r [f l Propert y close-ou t chec k hs t signe db y EP A D Descriptio no f area s no t meetin g RO D cleanu p criteri a 0 Utilit y clearance s 1 /

Propert y informatio nfromDougla s Count y Assessor' s Offic e D D D 

### 9l^ ^ : i i uli * 

### iture Signatur e D Dat e 3026202 8 Superfun d

### PROPERT Y SUMMAR Y Date : 11/15/201 0 Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Novembe r Propert y Address : 331 5 FRANKLI N S T A . EXECUTIV ESUMMAR Y A. I 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 l = 19 2 PP M @ 9" ; EA = 11 1 PP M @ SCRAP E(-1" ) ATTACHMENT S 1 ) Property sketc hprovide dby 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 othe r propertie s 3 ) Pre-Excavatio n digital vide o clip/photograph s 4 ) Post-Excavatio n digital vide o clip/photograph s 5 ) Documentatio n - Complete dClose-ou t Checklis t 6 ) As-Bui hsketch
i ) Shal l includ e final leadlevel s v ) Legen d ii ) Contaminatio n lef t behin darea s vi ) Contracto r identificatio n iii ) Property addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e include di n th e individual property file, i f available , o r obtaine dinclude : i ) Pre-excavatio n agreemen t detail s (i f any ar e mad e wit hth e property owner ) ii ) Propert y Statu s For msigne db y property owne r iii ) Excavatio n digita l vide o in MPEG , 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 n ofarea s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOGIES , INC .Fin d Recor d 

### Backfill : Remediatio n Quer yI Lea d Remainin g Quer yI Propert yDamage Quer y 

### Sampl e Area : 2615 1 - 331 5 FRANKLI N S T Owner : Use rProvide d Owne rInformatio n Resident :

• Owne rOccupied Owne rName : fCn YO F OMAH A Owne rAddressi : |C/ 0 PLANNIN G DEPARTMEN T owne rAddress2 : |181 9 FARNAM ST#111 1 City : State : JOMAHA|N E Zi p Code : Owne rPhon e 168183 - Alternat e Phone : Owne rName : 

# 1 Owne rAddress : 

# I City : Owne rPhone : 

# 1 

# ' State : Zi p Code : 

# 1 1 Alternat e Phone : 

# 1 Residen t Name : 

# I Propert yAddress : |331 5 FRANKLI N S T Zi p Code : |68111 - Residen t Phon e 

# I

Contract : Assessment : Contractor : |PRUDENT2010_S Qualifyin g Grou p |4b o Contrac t Optio n JOPTIO N 1 Assessmen t Ma xXR F Valu e j 

### 51 7

# pRlinRNT^i^ ^ 

# »EPA J^-^=^^^|pPi F II I II I IOLOGIK5. 1 

# EP A Propert y Clos e Ou t Propeit y # : Z6i^ ( Propert y Address : J ? ^ ^ rra•^ ^ > ^ Date/Time : Owner'sName : C?I«A ^ 

### OJ-(!5WuiU.< ^ Quad s Excavated : (^' ( Contracto r Group : Pruden t Technologies , Inc , Excavatio n Genera l Ye s N o 1 .

I f necessary , wer e tli e correct quadrant(s ) e.^ccavaie dandrestored ? 2 .I f necessary , wer e the correct area s o f drip zon e excavatedan drestored ? / 

### Gradin g So dan dVegetatio n Ye s N o 1 .Doe s the grading aroundthe perimete r o

f th e hous e i n excavatedarea s generall y slop e awa y fro mthe house ? ' / 2 .Has sodbee n laidi n all area s tha t wer e excavated ? / 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) / 4 .Ar e sodde darea s generall y firman devenl y graded ? / 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 tim e period) / 6 .Wa s the propert y gradedsuc htha t wate r wil l no t poo l o n the property ? / 7 .

Wa s damag e t o landscaping o r plan t material s avoided ? / Gate s Fence s an dRetainin g Wall s Ye s N o 1 .

D o gate s ope n an dclos e freely ? (I f apphcable ) / 2 .Wer e all gate s o r fence s take n dow n during restoratio n activitie s reinstalled ? (I f apphcable ) 

## J 3 .

Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) / 4 .Was damag e t o retaining wall s avoided ? ( Fapplicable) ^ Foundation , Sidin g an dGutter s Ye s N o 1 .Was damag e t o tli e siding o r tri mavoided ? / 2 .

Wa s damag e t o the foundatio n avoided ? / 3 .

Was damage to w i ndow s avoided ? / 4 .Was damag e t o window s o r doo r screen s avoided ? / 5 .

Was damag e t o downspouts o r downspou t extension s avoided ? 

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

Was damag e t o drivewa v surface s avoided ? / 

### 2 . Was damag e t o walkwa y surface s avoided ? 

# T

### Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complet e includin g th e 30-da y so dwajranty : EP A Representativ e ^^. ^ A... ^ Date : , o jefi oJIES , INC . 

### A S - BUBL T DRAWIN G OL S #2615 1 Dat e Excavated : 9/17/201 0 USEP A Signed-OfTDate : 

### OMAHA LEA D SUPERFUND SIT E 

# iiiiii i illl l 2615 1 Exterio rPain t Nort h Arro w Omah a Lea d Sit e • Goo d Sit e Sketc h n Poo r SamDiin a Address : 331 5 FRANKLI N S T [ 3 No t pain t Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Firm : Ft> ADB-A T RYASCPXA-2615 1 F 1 3 5 5 pp m 

### E f D Date : i > -f-^ f RYBSCPXA-2615 1 F2 

### n< 1 pp m 

### E f D Time : 3 '• 0 0 p m RYCSCPXA-2615 1 B 1 

### *1 1 pp m 

### E f D Sample s Analyze d RYDSCPXA-2615 1 8 2 pp m [E f 

### D 

# s n nDZSCPXA-2615^ 9 2 pp m D 

### D XR F Unit : jDfl&T - Book : 2 M I r^OZCCrXA-2615 1 G i - pp m D 

### D Date : 1 • et X -o g nPZGGPXA-gOIG I PZ- - pp m 

### D D Time : Ar ^ Staff : fvtjUft / Numbe ro f Sample s = | t | [ | Q | Legend : F l = Fron t Left , F2 = Fron t Right , B 1 = 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

s vievue d fro m th e street , lacin g propert yAiit- ^ 

# ENTBRE D JU N 1 9 200 3 

### 9 5 

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= . ^ ' W A ^ fli?ftN.il<:U N 5 T Rcv;oOX..1; > rrearcd : lJ-Mar-0 8 E A = J11 1 PP M iS ; SCRAP E CONTRAC T # : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC .

# »EF ^ Propert yCompletio n Agreemen t Thi s agreement document s th e completio n o f remova l activitie s performe don th e belo w liste dproperty . Th e propert y owner' s signature indicate s that th e propert y owner i s satisfie dwit hth e restoratio n ofth e subjec t property , an dthat n o item s ar e in question , now , o r at any tim e i n th e future , excludin g an y remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , if any . Property ID : 

# '6/S I Propert yAddress ; 33 ! S f^t^JfCUA J 5r . 

### Owner : 6T V n f C^Arl A Phone : 

### ^ffl) vv^
- yzt/f i Restoratio n Item s i n Question :



### Item : Item : 

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

^

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



### ner' s S^natar ePruden t Technologies , Inc . (Prudent ) i s unde r contrac t withth e U . S . Enviroiunenta l Protectio n Agenc y (EPA ) t o clean u p lead
contaminate dsoil s a t anumbe r o f

propertie s locate di n Omaha , Nebraska , includin g th e propert y locate dat 3?>l\•fpyt-^ Icli/ \• Tli 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 , th e property 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 sampling , remova l o f lead-contaminate dsoil , an drestoratio n ofth e reference dproperty . Ifyo u hav e an y question s abou t th e soi l cleanu p planne dfor you r propeny , pleas e contac t Pruden t southoffic e _fo r th e Omah aLea d Site cleanup-a t (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 a t (402 ) 731-304 5 (SouthOmah aoffice ) o r (402 ) 991-958 3 (NorthOmah aoffice) . Property Acces s Grante dBy ; UflUl^/y \(-^yU.! ^ ^ (Pleas e Prin t Name ) Property Owne r Signature : 

## n-..-Q^.A:Po/ o (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 : 

### Ci L o( - (0Awa^9 - (Owner ^ Rente r % RESIDEN TADDRESS : f ) v^

I F RENTAL , PROPERT YOWNE D BY :
OWNER' S MAILIN G ADDRESS ;
OWNER' S TELEPHON E NUMBE R - HOME : J L WORK :
AG E O F HOME? : YEARS . HO W LON G HAV E YO U LIVE D HERE ? YEARS . 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 NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R O F CHILDRE NUNDE R 7 YEAR S OL D WH O PLA Y I NTH 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 , ENTRY GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : 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 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s right o f

acces s t o th e propert y i s provide dfor i n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , wliic hprovide s entry for "determinin g th e nee dfor response , or 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. " 808 0 War d Parkway . Suit e 40 5 560 0 S 1 0 S t 424 2 Medica l Drive , Suit e 425 0 Kansa s City.'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 : f402 i 733-188 3 Fax : (210 ) 579-657 7

# r

ENX'IROiVMEiNTAL & 

# IRUDF.N ' CONSTRUCTIO N 

### TECHNOLOGIES , INC . SHRVICE- S 

# Propert y Statu s For m Date : ^ | y ^ \ ^ d O L CLCL ^ BVID :
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### Propert y Owne r Pniden t Employe e Signature : Signature : 

# 1 808 0 War d Parkway , Suit e 40 5 560 0 S 1 0 S t nedica l Drive , Suit e 425 0 Kansa s City , 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 /0<1C \ O O -STrt T"/•'\ . j ' ^ 

## 2615 1 

# ilililllliilliliilll l Omah a Lea d Sit e tixteno rHain t r''iort hArro w 

### Sit e Sketc h 

### G ^<^ ^ n Poo r Samplin g Address; . FRANKLI N ST [ ^

No t pain t \ Lea a bampi e 

### Sampie s Coilected Sampi e Numbe r LA B Concentratio n Cottecte d RY.ASCPXA-2615 1 F 1 pp m 

# a RYBSCPXA-2615 1 RYCSCPXA-2615 1 RYDSCPXA-2615 1 F 2 B l B 2 

# A l pp m pp m ppr n 

## [Ef 

## D 

# a D Time : 2l£^_y2Al_ . Sample s An-alyze d RDZGCPX.A-2615^ 9 2 pp m 

# n G j XR F Unst : \0^(a1 ^

Book : 2 M i RGZSGPX^,-261S 1 S * pp m 

## G G Date : 7-g> 2 ­ o<= > Rnz56P'KA.-2615 1 PS - PplTl 

# n 1 T'^i e ^ ^

j j o j 1 Staff : Hi W Legend : f- 1 = Fron t Left , F 2 = Fron t Right , B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dn p Zorse , G Z = Garoen , P Z = Pla y A

H quadrants are as viewsii'ro m th e street rarjn g propen yA^it V



### \Nhl K ...fjJV^NKUN , 5X . Rev "i)ii « V t frMtrri
- I'i-\-Sar-l) »M ^ ^ 

# A Printed : Nov 16,201 0 vvww.dcgi s org/dogi s

### Pag e 1 o f 2

" > Creat e Anothe rTicke t Bac k t o Irt h Interne t Sen d Emai l 

### YOU RTICKE T NUMBE RI S 2592084 . Origina l Cal l Date : Wor k t o Begi n Date : State : N E Address : 331 5 Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C 9/14/1 0 9/16/1 0 Time : Time : 5:2 5 6:0 0 p m p m Op : SIVA1896 7 County : DOUGLA S Street : FRANKLI NS T Place : OMA H A

Sect-Qtr : 16-NW Sect-Qtr : Typ e o f Work : soi l lea d remediatio n projec 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 : UNSUR E CORNER S Compan y: Contac t Name ; PRUDEN T TECHNOLOGIE S 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: Involve s Tunnelin g o r Horizonta l Borin g : CXCAT V LEVEL S MUDO l OMAHACO F NFront : Y NExplosives : N

0PPDGPR 5 QLNNEI C Rear :

Servic e Are a Contac t CXCAT V CO X COMMUNICATIONS , IN C HEID I

LEVEL S LEVEL 3 COMMUNICATIONS , LL C NA

MUDOI METROPOLITA N UTILITIE S DISTRIC T SAND Y

OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE RRICH/TRAFFI C Plion e Numbe r 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 Alt : Emerg : 877366834 4 Day : 402504782 3 Alt : Emerg : 402504797 0 Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Utilit y Typ e



### Day : 406728934 3 

### http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/14/201 0

### Pag e 2 o f 2
Alt * 406207149 4 0PPDGPR5 OMAH A PUBLI C POWE RDISTRIC T EL M LOCATIN G Emerg : 888728934 3 Day : 40672S934 3 QLNNEIC QWES T LOCA LNETWOR K

EL M LOCATIN GAlt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthmtemet^HONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/14/201 0

### ENVIRONMENTA L ENGINEERIN GAN D CONSTRUCTIO N 

### lECHNOuiess , mc . SOLUTION S 

## SIT ESAFfeT Y HAZAR D ANALYSI S 

# .3d2 S Address : Excavatio n Date : Cre w Backfil l Date :

Ite m Conditio n Hazard s Correctiv e Actio n Overhea dLine s Ga s Lin e Wate r Lin e Sewe r Lin e Septic/Leec h Fiel d Propane/Bntan e Sidewal k Foundatio n Retainin g Wall s Fence s Tree s stmcture s Drivewa y Sprinkle r Syste m 

# 3^ 6 MjJ L 

# S/A HL h 

# i[/ 4 nJ ^ Othe r Cre w Forema n C . 

## Sit e Safet y Offic e Date :

888 0 WanffiartBMay . Suit e 40 5 560 0 SI O S t 424 2 Medica l Drive , Suit e 725 0 Kansa s Gi|y.lloe411 4 Omaiia , Nebrask a 6810 7 Sa n Antonio , T X 7822 9 Pfiane : ^6 ) 363-370 3 •Phone : (402)733-118 8 Phone : (2t0).822:<958 8 Fax : (8 ^ 363^70 7 i^ K(402)733^188 3 Fax : (210 ) 579-657 7JV'! ' THi^pSi' W

•*«* : 

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