0 

### TRANSiVIITTA L O F OiVIAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 2872 2 DATE : 12/15/201 0 ADDRESS : 260 8 N 3 3 S T REMEDIATIO N CONTRAaOR : PRUDENTTECHNOLOGIES . INC . YEAR : 201 0 

### SOI L REMEDIATIO N PROPERT Y FIL E FOLDE R DOCUMENT S [ ^

PR E AN D POS T VIDE O O F PORPERT Y (DVD ) d EXECUTIV E SUMMARY d EPA-PROVIDE D PROPERT Y SKETCH SIGNE D ACCES S AGREEMEN T FO R SUBJEC T PROPERT Y D SIGNE D ACCES S AGREEMENT(S) FO R ADJACEN T PROPERT Y a RESTORATIO N AGREEMEN T n SETTLEMENT DOCUMENTS {I.E. , FOR DAMAG E O R T O REPLACE PLANTS , ETC. ) [ ^

CONFIRMATIO N DAT A 1 3 PHOTOGRAPH S a AS-BUIL T SKETCH

• SATISFACTOR Y RESTORATIO N SIGNE D B Y PROPERT Y OWNE R [ ^

PROPERT Y CLOSE-OUT CHEC KLIS T SIGNE D B Y EP A D DESCRIPTIO N O F AREA S NO T MEETIN G RO D CLEANU P CRITERI A ^

UTILIT Y CLEARANCE S a PROPERT Y INFORMATIO N FRO M DOUGLA S COUNT Y ASSESSOR'S OFFIC E 

## D D D ^Vv^\^'^^'' SIGNATUR E DATE 3026075 6 Superfun dFin d Record Remediatio n Quer y Lea d Remainin g Quer y: Propert yDamag e Quer y •—~~^ - ' . —- • —- — - —•—^^.-^—^^ — 

### Backfill :

Sampl e Area : 2872 2 - 260 8 N 3 3 S T Owner : D Owne rOccupie d 

### Owne rName : JCTT Y O F OMAH A Owne rAddressi : JC/0^3T Y FINANC E Owne rAddress2 : 1181 9 FARNA M S T City : State : Zi p Code : lOMAH A ^ |N E |68183 - 

### Owne rPhon e Alternat e Phone : j(402 ) 441^15 0 ~ r " Contract : Contractor : PRUDENT201 0 S Contrac t Optio n jOPnoFT T Use rProvide d Owne rInformatio n Owne rName : 

# 1 Owne rAddress : 

# 1 State : ZipCode : City : ; • r—. ^ 1 1 

# ^ 1 1 Owne rPhone : il 

### Alternat e Phone : ^

! Assessment : Qualifyin g Grou p |40 0 Assessment Ma xXR F Valu e 48 8 

# 1 Resident : Resident Name : 

## I^

T -— — Propert yAddress : 1260 8 N 3 3 S T Zi p Code : 168111 - Residen t Phon e 

# I

### PROPERT Y SUMMAR Y Date : 12/15/201 0 Oniah aLea dSit e Reinedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Decembe r Propert y Address ; 260 8 N 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 Othe r Relevan t Infomiation : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : B l = 22 0 PP M @ 6" ; E A = 15 1 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 othe r propertie s 3 ) Pre-Excavatio n digita l vide o clip/photograph s 4 ) Post-Excavatio n digita l vide o clip/photograph s 5 ) Documentatio n - Complete dClose-ou t Checklis t 6 ) As-Built sketc h­ i ) Shal l includ e fina l lea dlevel s v ) Legen d ii ) Contaniinatio n lef t behin darea s vi ) Contracto r identificatio n iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e include din th e individual property file , i f available , o r obtaine dinclude : i ) Pre-excavatio n agreement detail s (i f an y ar e mad e withth e property owner ) ii ) Property Statu s Formsigne db y property owne r iii ) Excavatio n digita l vide o i n MPEG , WM V (Window s Medi aVideo ) o r SW F(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 .• HECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y # : 2-^72-'Z - Propert y Address : Z(£>C/? > M "^ ^ 91 % D ate/Time : Owner'sName : (TTVIA^ C)-$-<^WVA.VVX\ ^ 

### Quad s Excavated : ^\ Contracto r Group : PrMtSen t Technologies , Inc. . Excavatio n Genera l Ye s N o I .if necessary , wer e th e correct quadrant(s ) excavatedandrestored ? / 

### 2 .I f necessiiry . wer e th e correct area s o f drip zone excavatedan drestored ? 

## y Gradin g So dan dVegetatio n Ye s N o I .

Doe s th e gradin g aroundth e perimete r o

f th e hous e in excavate darea s generally slop e awa y 

# y fro mth e liouse ? 2 .Has sodbee n laidi n all area s tlia t wer e excavated ? 

## y 3 .

Doe s tli e sodappea r to b e generall y health y andgrowing ? (Onl y evaluate i f inspecteda t a3 0 da

y tim e penod ) 

# y 4 .Ar e sodde darea s generally fir man devenl y graded ? y ^ 5 .Ar c the joint s between the sodstrip s generally tiglit ? (Onl y evaluat e i

f inspecteda t a3 0 da y 

# y tun e penod ) 6 .

Wa s the propert y gradedsuc htlia t wate r will not pool o n th e property ? 

## y 7 .

Wa s diiniag e f o landscaping o r plan t material s avoided ? ^ Gates , Fence s an dRetainin g Wall s 1 . D o gate s ope n andclos e freely ? (I f apphcable ) Ye s / N o 2 . Wer e al l gate s o r fence s taken dow n dinin g restoratio n activitie s reinstalled ? (I f appUcable) 3 . Wa s damag e t o gate s or fence s avoided ? (Ifapplicable ) 

# y y 4 . Wa s damag e to retainin g wall s avoided ? (Ifapplicable ) 

## y Foundation , Sidin g an dGutter s Wa s damag e t o the siding o r trimavoided ? Yes , N o Was damag e t o the foundation avoided ? Wa s damag e l o window s avoided ? 4 . Wa s damag e t o window s or doo r screen s avoided ? 

# y y -i . Wa s damag e t o downspout s o r downspou t extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Wa s damag e ( o diivewa y surface s avoided ? / 2 . Was damag e t o walkwa y surface s avoided ? 

## y

## Owner s comments :

Inspectio n notes :

Reraova l an drestoratio n activate s complet e includin g th e 30-da y so dwarranty . EP A Representativ e v"^- ^ ^Date: \\\•^\ ^KHNOLOCIES . INC . 

## AS - BUIL T DRAWIN G OL S #2872 2 Dat e Excavated : 10/07/201 0 

## OMAH A LEAD SUPERFUND SIT E I'SEPA Signed-OI T Date : Name- . Ch . cfO/yioU o Omah a Lea d Sit e Date : Bf/g/oi / N o * Aro w Address : 3(^0 ^ fJ . i?.3.'^.S 4 Sit e Sketc h Time : 9.'V S Phone : 

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# tiri,:.Jf/.lLy^ ^ Bvio^MlTA . XR F Cod e 

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\ = 15 l PPM@SCR,4PE(~I"' ) Omah aLea dSii e 46130 CONTRACT # : EP-S7-10-0 5 PRUDENTTECHNOLOGIES , INC .

# SEP A Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n o f remova l activitie s performe do n th e belo w liste dproperty . Th e propert y o\vner' s signatur e indicate s tha t th e propert y o\yne r i s satisfie dwit hth 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 in th e future , excludin g an y remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , ifany . Propert y ID : ^ 

## Si^l^ ^ Propert y Address : 360 ^ iUorH v33rJ l S\f^A - Owner : 

## '> u yCVY-AU V 

# c Phone : Hoj-MWH-HJi^ ^ 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 agre e restoratio n i s completed . \Z } I d o not agre e restoratio n i s complete d at (note d deficiencie s above )



## 9'Muuy,^-^oy O Owner' s Sign i Dat ePniden t iVchnoloyies . Inc . (Prudent ) i s unde rconu.ic l wil h lh cU . S . Environmenia l Proieciio n Agency(RPA ) l o clea n u p lead comaminalc d soil s a l a liiinibc rorjirbpchic s Ihcale d i n Oni.ilia . Nebraska , includin g lh cproperl ylocate d a l yb0 6 A/jfl/ y y/Jtry . S -J - . Jli e HP Arequests you rpermissio n t o allo wPruden i t o perfor m a soi l cleanu p a l ihi s propert yl o remov e le.ia-contaminaie d soil . H ysignin g Ihi s form , th e properl yowne rgrant s permissio n t o Pruden i t b pcrfbrn i activiiie s relate d l o th e cleanu p includin g soi l sampling , remova l o f lead-contaminale d soil , an d restoratio n ofth e reference d property . ifyo u have .-iii yquestion s abou t th e soi l cleanu p planne d fo rjou rproperty , pleas e contact Pruden i sout h pITic c.fo rlh cOni.iii a Lea d Sii e cle.iiiui>-.n l (402 ) 733-118S . Genera l (|uesiion s abou l lh e Om.Tli a Lea d Sit e cleanu p ca n bedireclc d t o th e EP APubli cInformalio n Ceiilcr s a l (402 ) 731-304 5 (.Sout h Omah a office ) o r(402 ) 99 1 -958 3 (Nort h Omah a ofTice) . Propert yAcces s Grante d By : /^//J/l-hvy. . Z.-^z/^'/i i ^. (Pleas e Prin t Name ) Propert yOwne rSignamre : %^ W y rpT ^ -/ ^ SyC7iiy27Jj L '/ y (Signature ) (Date ) PROPERT Y INFORMATIO N (T o b ccomplete d b yresiden t and/o rpropert yowne r- pic.is e print ) RESIDEN T NAME : Owne r Rente r RESIDEN T ADDRESS : 

# ?jn o ? i\ i -^ ^ Ti r I F RENTAL , PROPERT Y OWNE D BY :

OWNER' S MAILIN G ADDRESS ; 

### ///^ / fi^rnA m S k ^^; L lll l /y^ M yy - b/i/'- ^ OWNER' S TELEPHON E NUMBE R - HOME : J L WORK : 

### yo-<\'ik'i - ^/^v / 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 R ENVIRONMENTA L RESPONS E ACTIONS : Th e activitie s lob e implemente d b yEP Aunde rthi s agreenien t .ire pursuan t t o Sectio n 10 4 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f .ncces s l o lh cpropert yi s provide d fo ri n Sectio n 104(c ) o f CERCLA . 4 2 U.S . C 9605(e) . whic h prpvide s enlryfn r'deiemiinin g th e nee d fo rresponse , o rchoosin g o rtakin g an yrespons e actio n unde rihi s title , o rotherwis e enforcin g th e provision s ofth e title. " 808 0 War d Parkway , Suit e 40 5 S600S10SI . 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)363r370 7 Fax : (402)733-188 3 Fax : (210)579-657 7Name : Ci ^

D t O/I^i^k a Omah a Lea d Sit e 

### Date : ^//S/p ^ Nort h Arro w Address : Si^n R iJ . ?3lMS i Sit e Sketc h 

### Time : 9'V ^ Phone : 

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# m/^^rj/mlilL^^' ^ ^ BviD#_^22^A _ XR F Cod e 

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# t-:'JfTtV/- i Omah aLea dSit e 4613 0

## H 

# 260 8 N 3 3 ST : 4 0 X 10 0 

# li i Printed : De c 06 , 201 0 www . dcgis . org/dogi s 

# A

### Pag e 1 o f 1

" > 

### Creat e Anothe r Ticke t Bac k t o Irt h Inteme t 

### I Sen dEmai l YOURTICKE T NUMBERI S 2609466 . Origina l Cal l Date : 10/05/1 0 Time : 4:3 5 pm Op : SIVA1896 7 Wor k t o Begi n Date : 10/07/1 0 Time : 5:0 0 pm State : N E County : DOUGLA S Place : OMAH A Address : 260 8 Street : N33RD S T Twp : 15 NRng : 13 E Sect-Qtr : 09-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Worlc : SOI L LEA D REMEDIATIONPROJEC T Locatio n o f Work : LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)733-188 3 : UNSUR E CORNER S Company ' : PRUDENT 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 Tunneling ' o r Horizonta l Borin g : NExplosives : N CXCAT V

MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Servic e Are a Contac t Phon e Numbe r Utilit y Typ e CXCAT V COX COMMUNICATIONS , INC HEIDI 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUDO l METROPOLITA N UTILITIE S DISTRICT SANDY 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCIT Y OFOMAHA-TRAFFIC,SEWE R RICH/TRAFFIC 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 OPPDGPR5 OMAH A PUBLIC POWE RDISTRICT 

### EL M LOCATIN G Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNN E 1 C QWES T LOCA LNETWOR K EL M LOCATING 

### Day : 406728934 3 Alt : 406207149 4 

### Emerg : 888728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 10/5/201 0

### CONSTRUCTIO N 

## ,me . SOLUTION S 

## SIT E SAFET Y HAZAR D ANALYSI S Address : .i^^O' B N ^. S f ^ Excavatio n Date : ^^1 ^b ^ Crew : Backfi U Date : (^I'^h ^

Ite m Overhea dline s Ga s Lin e Wate r Lin e Sewe r Lin e Septic/Leec h Fiel d Propane/Butan e Sidewal k Foundatio n Retainin g Wail s Fence s Tree s Stracture s Drivewa y Sprinkle r Syste m Othe r Cre w Forema n Conditio n c ^ ^ 

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## Sit e Safet y Offic e Date :

560 0 8108 1 424 2 Medica l Drive , Stdt B 725 0 a»gjif i 1106411 4 ifiOtO T Sa n Antonio , T X 7822 9 O KI8I 9 363'3' V (402)733-110 8 Phone : (2tO>822458 8 : (SIS ) 383nS7l0 7 Fa E (402 ) 73»*108 3 Fax : (210 ) 6T9-«57 7

# ZC/08 > f^ 3 S t A 

# I ZI'3/20/ 0