SAID# : 3411 0 

### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R DATE : 1/1 5 ADDRESS : 180 8 SHALE R S T REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES . INC . YEAR : 201 ^ 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S E I PR E AN D POS TVIDE O O F PORPERT Y(DVD ) m EXECUTIV E SUMMAR Y d . EPA-PROVIDE D PROPERT YSKETC H ^ SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT{S ) FOR ADJACEN TPROPERT Y m RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R TO REPLAC E PLANTS , ETC. ) d CONFIRMATIO N DAT A d PHOTOGRAPH S 0 1 AS-BUIL TSKETC H U SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R m PROPERT YCLOSE-OU TCHECKLIS TSIGNE D B YEP A D DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A d UTILIT YCLEARANCE S d PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E 

## D ^^_^ ^ 

# a a

SIGNATUR E DAT E 

# li i 3021838 2 Superfun d

### PROPERT Y SUMMAR V Date : /15/201 0 Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Propert y Address : 180 8 SAHLE RS T A . EXECUTIV ESUMMAR 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 :

F l = 20 4 PP M @ 6" ; D Z= 36 8 PP M @ 10" ; G Z= 21 4 PP M @ 6" ; E A = 21 9 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 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-Bui hsketch i ) Shal l includ e fma l lea dlevel 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 din th e individua l property file , i f available , o r obtainedinclude : i ) Pre-excavatio n agreement detail s (i f any 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 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 .

TECHNOLOCIES , INC .Fin d Record Remediatio n Query Lea d Remainin g Quer y PropertyDamag e Quer y 

### Backfill :

Sampl e Area : 3411 0 - 180 8 SAHLE R S T Owner : n Owne rOccupie d Owne rName : jWILSO N LAWRENC E Owne rAddressl : 

# r Owne rAddress2 : II8O 8 SAHLE R ST City : State : Zi p Code : 

### JoMAH A 

### (N E (esfiG - Owne rPhon e Altemat e Phone :



# —f

Contract : Contractor : JPRUDEN17010_ S Contrac t Optio n jOPTIO N 2 Use rProvide d Owne rInformatio n Owne rName : 

# 1 Owne rAddress : City : 

# I State : 

## 1 Zi p Code : 

## ! Owne rPhone : 

# 1 ' ' ^ Alternat e Phone :

Assessment : Qualifyin g Grou p 40 0 Assessmen t Ma xXR F Valu e f 583. 8 Resident : Residen t Name : jWIlioNLONZ O Propert yAddress : JI8O 8 SAHLE R ST Zi p Code : 168110 - Residen t Phon e 

# r~TECHNOLOGIES , INC . 

## y y \ -X 'p,^y\: . 

# EP A Propert y Clos e Ou t Propert y tf:"^^ I/ O Propert y Address : , / ^d' ^ ^aVX^ ^ / ^ ' Date/Time : Owner' s Name : /<^(«/^Ci^0^4/t^5•^' ^ Quad s Excavated;]^ ! . ^y ? ^^­ - Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s N o 1 If necessary , wer e th e correc l quadrant(s ) excavate daii drestored ? / 2 . If necessary , wer e th e correc t area s of dri p zon e excavate dan drestored ? / Gradin g So dan dVegetatio n Ye s No 1 .Doe s th e gradin g aroun dth e perimete r o f th e hous e i n excavate darea s generall y slop e away fromth e house ? / 2 ,Ha s so dbee n lai du i al l area s tha t wer e excavated ? 

# y 3 .

Doe s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e if inspecte dat a3 0 day tim e penod ) 

# y 4 .Ar e sodde darea s generall y fim i an devenl y graded ? / 5 ,

Ar c tli e joint s betwee n th e so dstrip s generall y light ? (Onl y evaluat e if inspecte dat a3 0 day lim e penod ) 

# y 6 .Wa s th e property grade dsuc htliat wate r wil l no t poo l o n di e property ? 

# y 7 .

Wa s dainag e l o landscapin g o r plan t material s avoided ? / Gates , Fence s an dRetainin g WalJ s Ye s No 1 .D o gate s ope n an dclos e freely ? (I f applicable ) 

## y 2 . Were al l gate s or fence s take n dow n durin g restoratio n activitie s reinstalled ? (I f applicable ) 

## y 3 . Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) 

# y 4 . Wa s damag e t o retainin g wall s avoided ? (I f applicable ) 

# y Foundation , Sidin g an dGutter s Ye s N o 1 .

Wa s damag e t o th e sidin g o r tri mavoided ? 

## y 2 .Wa s damag e (o th e foundatio n avoided ? 

# ~y Wa s dainag e l o window s avoided ? 4 .Wa s damag e t o window s o r doo r screen s avoided ? 

# y 5 .

Wa s damag e t o downspout s o r downspou t extension s avoided ? 

# r Sidewalk s an dDriveway s (Concrete ) Ves , N o I Wa s damag e t o diivewa y surface s avoided ? Wa s damag e t o walkwa y surface s avoided ? ^

## Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complete includin g th e 30-da y so dwarranty : '^'"> y Date a\«\' ° EP A Representativ e ^_L^Date : :TCHNOLOUIES . [NC . AS - BUIL T DRAWIN G OLS#341I 0 Dat e Excavated : 11/03/201 0 OMAH A LEA D SUPERFUN D SIT E USEP A Signed-Of f Date : Name ; >»-^/J/=^ Date : 4:^/^7^^ ^ Nort h Arro w >»->/J^= ^ ^

/ Oinah a Lea d Sit e Address : Address'~7a^a^^y^< ^ /Jrgy_4^ ^ , _ ,. ^. - ^ Sit e Sketc h Time : /VS ^ Phone : ('<J^Z- 4 4/^/-OZ<2 ^ 

# t '/—y—^^^ ^ XR F Cod e jfi^O g Tea m 2./k:/f/T?^^Jf/S,/ j BVID # 3y//< ^ Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e /?y;4r?C^A W - JV// g rf'tf-'? ^^ V ppm /=7Ye s n No ^ /gy^/ V ppm /=zYe s C3 No 51 ^ /^.YCySCPX A - JV//< ? ^/Ye s Q No ^ ^ «?g-? J^' ^ ppm No 5!!! ^ /?r)zscpy A - AN-ti o 3^*'e s CD No S ^ --5-V> 9 ^^- 6 pp m <3 Ye sa Noer pp m Ye s a No •

EA = 21 9 PP M i® SCRAP E(-1" ) Omah aLea dSit e 4613 0 CONTRAC T #: EP-S7-10-0 5 PRUDENTTECHNOLOGIES , INC .

# AEP A Propert yCompletio n Agreemen t Thi s agreement 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 owner' s signatur e indicate s tha t th e property owne r i s satisfie dwithth e restoratio n ofth e subjec t property , an dtha t n o item s ar e in question , now , o r at an y tim e i n th e future , excludin g any remainin g warranty (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Property ID : 

## Z^hH o Property Address ; \<^Q ^ <)^V^V ^ ^ ^ Owner : 1 (Xy^<fvwf

_\A3'A'SCV > 

### Phone : 

## ^s\-v^•!)9^• n Restoratio n Kem 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 . I I d o no t agre e restoratio n i s complete d a t (note d deficiencie s above )



# v^-^o-\ ^ t>^ner' $ Signatur e Date IPniden t Technologies . In c (Prudent ) is unde r ccjntract withth eU. S. Environmenta l Protectio n Agenc v fEPA ) to dea nup le-ad conumnijlec l sgii s at anumbe r of

propojiesrlocate d in Omaha , Nebraska , includin g th e property locate dat /cy//c ) ^I^nAr^'^ ^ ^^ / ''"''' ^ '^.^f ^ request.' ; you r permissio n to allo w Pniden t to performasoi l cleanu p at

tJii.- : fropertvT o remov e lead-contarainate dsoil . Bv signin g thi s ibrm . th e property owne r grant s permissio n to Pruden l to perfor m activitie s relate d lo th e cleanu p includin g soi l sampling , remova l of

lead-contaminate dsoil , an drestoratio n ofth e reference dpropen y 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 Pruden l southoffic e fo r th e Omah aLead Site cleannp-a t (•='02 ) 733-1188 . Genera l question s abou t th e Omah aLeadSit e cleanu p ca nbe directe d to th e EPA Publi c Informatio n Center s at (402 ) 73 1 -304 5 (SouthOmah aoffice )or (402 ) 991-958 3 (NorthOmah aofilce) . 

# L a c^/cw^c g to ) Is^ y Propert y .Acces.> ; (Jrante dBy . (Pleas e Print Name ) '2,01 0 Property Owne r Signatu r (Signature ) ) ' (Date ) PROPERT Y IWFORMATIO M (T obe complete d by residen t and/o r propert y owne r - pleas e prinr ) RESIDEN TWAME : Owne r Rente r 

# 5^1^ ^ RESIDEN TADDRESS : 

# /ff0 3 ^/^i-t-Le ^ 3y ^ iF RENTAL . PROPERT YOWNE D BY ; OWNER' S MAILIN G ADDRES J OWNER' S TELEPHON E NUMBE R - HOME : (H^ h h~l 1 - ^ 1 ^ ^ WORK : ( ) AG E OF HOME? : YEARS . HO W LON G HAV E YO U LIVE D HERE ? YEARS . 

### U^ E HA S TH E EXTERIO R BEE N PAINTE D OR COVERE D WIT H SIDIN G SINC E 1978 ? \ yYE S WO NUMBE R OF OCCUPANT S UNDE R 7 YEAR S OLD : Q NUMBE R OF OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R OF CHILDRE N UNDE R 7 YEAR S OL D WH O PLA Y IN TH E YAR D FO R 5 HOUR S OR MOR E PE R WtEK ' COMMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. )

.UlTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS i Th e activitie s tobe implemente d by EPA unde r thi s agreemen t ar

e pursuan t lo Sectio n 10 4 ofCERCL A 42 U.S.C . 9604 . EP.A' s ngh t ofacces s to th e propert yis provide dfor in Sectio n 104(e ) ol ' CERCLA . 42 O. S C 9603(e) , whicli . provide s entr y for "detenninin g th e nee dfo r response ,or choo.sin gor lalaii g an y respons e actio n under tin s title , or otherwis e enforcin g th e provision s ofth e titl e " e08 0 i'Varc t Paikvjay , antr<= • •••?'i? . M';it(r.ti l Oriv*! . OiiU R fiV-i ^ Kansa s City . MO fi-J-l \-i . .'frcK-;iB , [•.ierrJrt^^K^ s Siii : rpi n r.rifon«> . Th . /.'v*.':? ! Phone : (816 ) 363-270 3 •?ttcfu; :

. !,ir . -3.x : (SIS' ) •iZi-':7r\ iENVIRONMENTAL * CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m. XddTtss:/308SAJ^C6r2-'^T - Date : /0/P^'^r < Phone : BVID : 3y// 0 ^/Z>/ A 

# L/I.C£A S A( ^ f\^ 'h^ ^ f^ l ^ ^ycAsJAr e 4 ^^>^ ^

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# f-iA^'bf W-y^^ly . / s yi/y > y^^x^^A j Ae^ A jA^^yuc^a ^

Propert y Ow n Pruden t E natur e 

# (Z{AAJ2^/CJ? \A ) {}UMV \ Signature ^ 

# yiy^''2<s / ^TO O 0 War d PJifkway , Suit e 40 5 S60 0 S 1 0 S t 424 2 Medica l Drive . Suit e 425 0 Kansa s Crty.M O 6411 4 Omaha , Nebrask a 681 0 San Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)733-118 8 Phone : (210)822-958 8

### Name : "^^/y^y' ^ Omah a Lea d Sit e Date : Nort h Arro w 

### M6Tessy7^i^-.X^y9yM ~ ^ T Sit e Sketc h Time : Phone : i^(/^Z-J - 47-f / -<:?24C ^ 

# t y^oj ) Tea m 2^yf^/f/T^y/f/S'// /

BVI D # 3^y/y > XR F Cod e ^^O Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e ^ /=?Ye s n 

### N o 5 ^ /?ys.'sr.py A- 3'/// o tQi - v vpp m /^Ye s n 

### N o 5 ^ /?YCSCPy A- 3^/J O pp m ^/Ye s n 

### N o g ^ yiYDSCPX A' 3¥J/ 0 pp m ^^Ye s 1 ^ 

### N o ^^ y -———-^ —pp m 

### /^nzscPX A- 3¥// o Crzte s C D 

## N o SV _ /?a7SCpy A- 3¥/i o 5^/ 3 ^C 3 pp m ( 3 Ye s n N o er" ^ PPn n 

### Ye s • 

## N o •

Omah aLea dSit e 4613 0

### Pag e 1 o f 1



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### Printed : De c 10.201 0 www.dcgi s org/dogi s

### Pag e 1 o f 1

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



### • YOURTICKE T NUMBERI S 2631204 . Origina l Cal l Date : 11/01/1 0 Time : 12:5 9 pm Op : SIVA1896 7 Wor k t o Begi n Date : 11/03/1 0 Time : 1:3 0 pm State : N E County : DOUGLA S Place : OMAH A Address : 180 8 Street : SAHLE R S T Twp : 15 NRng : 13 E Sect-Qtr : 03-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : SOI L LEA D REMEDIATIONPROJEC T Locatio n o f Work : LOCAT E ENTIR E PROPERTY Remarks : FA X AL L CLEAR S TO : (402)733-188 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 : EPA 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

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 DISTRIC T SANDY 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCITY OFOMAHA-TRAFFICSEWERRICH/TRAFFIC 

### Day : Alt : 

### 402444719 7 402444516 1 

### Emerg : 402444516 0 0PPDGPR 5 OMAH A PUBLIC POWE RDISTRICT EL M LOCATING 

### Day : 406728934 3 Alt : 406207149 4 

### Emerg : 888728934 3 QLNNEI 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. . . 11/1/201 0

### ENVIRONMENTAL ENGINEERIN GAN D CONSTRUCTIO N TEeHNOUiGffis , mc . 

### SOLUTION S 

## SIT E SAF*:T Y HAZAR D ANALYSI S 

## Address : Z^^ji_ , 

# kLcSj L Excavatio n Dat e 

# •.lyi:^ Crew ; /CC^J1:^LIJJ1JJU ^ Backfi U Date :

Ite m Conditio n Hazard s Correctiv e Actio n Overhea dLine s y^fc^ yA '^ ^ 

## Ga s Lin e 

# y l 'cy/'/i^ r 

## Wate r Lin e /?<yr,^c L 

## Sewer Lin e Septic/Leec h Fiel d Propane/Butan e Sidewal k Foundatio n Retainin g Wall s 'F'c^ir 

## Fence s Tree s Structure s 

# po^ r Driveway 

# eac? r Z^^Urr^ J Sprinkle r Syste m 

# ,A/// f othe r Cre w Forema n Site Safet y OfTic e Date :

808 0 WHi f eaftany . Suit e 40 5 424 2 Medica l Drive , Suit e 725 0 

### iseoosios t Kaua s G^ . 1I06411 4 Sa n Antonio , T X 7822 9 ebiask a 6810 7 Phone : (8t6 ) 363-370 3 Phone : (2t0 ) 822^958 8 Phone : (402)733-118 8 Fax:(816)363-370 7 Fax:(210)579-657 7 ^aac . (402)733^188 3

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