SA1D# : 2239 3 

### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R DATE : 12/15/201 0 ADDRESS : 70 4 S 2 5 A V REMEDIATIO N CONTRAaOR : PRUDEN TTECHNOLOGIES . INC . YEAR : 201 0 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S APR E AN D POS TVIDE O O F PORPERT Y(DVD ) \t l EXECUTIV E SUMMAR Y U l EPA-PROVIDE D PROPERT YSKETC H d l SIGNE D ACCES S AGREEMEN TFO R SUBJECTPROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FO R ADJACEN TPROPERT Y d RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENT S (I.E. , FO R DAMAG E O R T O REPLAC E PLANTS , ETC. ) m CONFIRMATIO N DAT A l b PHOTOGRAPH S m AS-BUIL TSKETC H c t SATlSFAaOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R a PROPERT YCLOSE-OU TCHEC KLISTSIGNE D B YEPA D DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A

• UTILIT YCLEARANCE S

• PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR' S OFFIC E D 

### D D

SIGNATUR E DAT E 3021862 9 

# M Superfun dFin d Record ] Backfill :

Sampl e Area : 2239 3 - 70 4 S 2 5 A V Owner : n Owne rOccupie d Owne rName : IHERMA N BRO S IN C Owne rAddressl : 

# 1 Owne rAddress2 : |256 5 STMARY S AV E City : State : Zi p Code : JOMAHA JN E |68105 - Owne rPhon e Alternat e Phone : 

# i ' Contract : Contractor : jPRUDENT2010_S Contrac t Optio n JOPTIO N 2 Remediatio n Quer y| Lea d Remainin g Quer yj Propert yDamag e Query

Use rProvide d Owne rInformatio n Owne rName : |,, „ Owne rAddress : 

## ICity : State : Zi p Code : 

# 1 1 1 Owne rPhone : Alternat e Phone : 

# 1

Assessment : Qualifyin g Grou p p»00 Assessmen t Ma xXR F Valu e f 489.2 9 Resident : Residen t Name : Propert yAddress : j70 4 S 2 5 A V Zi p Code : |68105 - Residen t Phon ePROPERT Y SUMMAR Y Date : 12/15/201 0 Omah aLea dSit e Remedia l Actio nContrac t #EP-R7-07-0 6 TO# l Mont hof : Decembe r Propert y Address : 704S25A V 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 : B l = 93 8 PP M @ 13" ; E A = 37 3 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 ndigita l 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 final lea dlevel 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 numbe r 7 ) Othe r item s t o b e include di nth e individual property file , i f available , o r obtaine dinclude : i ) Pre-excavatio nagreemen t 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 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 n o f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOCIES , INC .I TECHNbUOGnSS , iNC : Propert y # : 2-" ^ ^ "^ ^ Date/Time : \<^/l/20ft ) Quad s Excavated : ^ | 

# EP A Propert y Clos e Ou t Propert y Address : "TOM - S ^ S A^ / Owner' s Name : ^VJL T \C

_PtrN " ^ Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s N o I f 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 ? 

## A Gradin g Sodan dVegetatio n Ye s N o 1 .

Doe s the grading aroundthe perimete r ofth e hous e in excavatedarea s generally slop e awa y fro mth e house ? 

# y 2 .

Has sodbeenlaidi nal l area s tha t wer e excavated ? 

## y 3 .

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

y tim e period) 4 .Ar e soddedarea s generally fir mandevenl y graded ? 

## y 5 .Ar e tlie joint s between the sodstrip s generall y tiglit ? (Onl y evaluat e i f inspecteda t a3 0 da y 

# y tim e period) 6 .

Wa s the propert y gradedsuc hdia t wate r wil l not pool o n tli e property ? 

## y 7 .

Wa s damag e t o landscaping o r plan t material s avoided ? 

# y Gates , Fence s an dRetainin g "Walls Ye s N o 1 .

D o gate s ope n andclos e freely ? (I f apphcable ) 

# y 2 .

Wer e all gate s o r fence s takendow n during restoratio n activitie s reinstalled ? (I f apphcable ) 

## y 3 .

Wa s damag e t o gate s or fence s avoided ? (I f applicable ) 

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

# y Foundation , Sidin g an dGutter s Ye s N o I . Wa s damag e t o the siding o r trimavoided ? / 2 .Was damag e t o th e foundation avoided ? 

# y 3 .

Was damag e to window s avoided ? 

# y ­

- 4 . Wa s damag e t o window s o r door screen s avoided ? 

# y 5 . Wa s damag e t o downspout s or downspou t extension s avoided ? 

# y Sidewallt s an dDriveway s (Conci-ete ) Ye s N o Wa s damag e t o drivewa y surface s avoided ? 2 .Wa s damag e t o walkwa y surface s avoided ? I

### Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e • SG/ Q X ^ ^Date; n|gi| o=CHNOl,OUIES , INC . 

### AS - BUIL T DRAWIN G OL S # 22393 Dat e Kxcavatcd : 10/18/201 0 

### OMAH A LEA D SUPERFUN D SIT E ISEPASigncd-OtTDatc : 2239 3 Exterio rPain t Omah a Lea d Sit e Owne rName : HERMA N BRO S INC • Goo d Sit e Sketc h Address : 70 4 S

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# &EP^ Propert y Completio n Agreemen t Thi s agiMinen t documiBaf s ^ B coinplBtio n o f remova l activitie s peifonne da atiie belo w liste dpropeily . Th e jvopert y ovvner's . signatur e indicate s tha t Ifa e property owne r i s satisfie dwithth e restoratioii o f Hi e subjec t property , and , Ifaa t n o items , ar e i n question , now , o r a t an y tim e i n th e future , excludin g an y i«mainin g wairant y (3 0 day s tota O excep t thos e item s liste dbelow , i f any . .-. . . PropertyQ) : Propert yAddreas : "-loL j . 

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# Bla g Q t d o no t agre e restoratio ni s complete da t (note ddeficiencie s above ) 

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. CONSTIUICnO N TECBNOLOQIES , mC . 6ERVIC K 

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# /^AA o Signature : 80B 0 war d PmiicMV . Sull a 40 5 SSflBSlOS t 434 2 Madloa t Drive , SiiK a 426 0 Kanaa a City , M O 6411 4 Omsha , Nabraik a 6810 7 BanAntonto , I X 7S32 8 PIWIWS (SIE J 363-370 3 Phono : (402 ) 733- 1 la a Phena : (210)622468 8 Fax : |S18 ) 383470 7 Fax : (402)733-1«B 3 Par.(2iS)S7ft« n Off ^ 61'Q i Airtvienm i 

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### Pag e 1 of 2

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### YOU RTICKE T NUMBE RI S 2610371 . Origina l Cal l Date : 10/06/1 0 Time : 12:5 7 p m Op : SIVA1896 7 Wor k t o Begi n Date : 10/08/1 0 Time : 1:3 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 70 4 Street : S 25T H AV E Twp : 15 NRng : 13 E Sect-Qtr : 21-S 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 : 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 : EP A Dept h o f Excavation : 6 F T Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL S MUDO l OMAHACO F 0PPDGPR 5 TE C QLNNEI C Utilit y Servic e Are aContac t Phon e Number Typ e 

### Day : 402934046 9 CXCAT V CO X COMMUNICATIONS . ^^^ ^ 

### Alt : 402934046 9 IN C 

### Emer g 402932975 7 Day : 877366834 4 LEVEL S LEVEL S COMMUNICATIONS , ^ ^ 

### Alt : Emer g 877366834 4 Day : 402504782 3 METROPOLITA N UTILITIE S MUDO l SAND Y 

### Alt : DISTRIC T 

### Emer g 402504797 0 Day : 402444719 7 CIT Y O FOMAHA - OMAHACO F RICH/TRAFFI C 

### Alt : 402444516 1 TRAFFIC,SEWE R 

### Emerg : 402444516 0 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 10/6/201 0

### Page 2 of 2

OMAH A PUBLI C POWE R 0PPDGPR 5 EL M LOCATIN G DISTRIC T
N O NEE D T O CAL LOU T PAETE C PAETE C COMMUNICATION S EMERGENC Y QLNN EI C QWES T LOCA LNETWOR K EL M LOCATIN G 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 800289190 1 Alt : 

### Emerg : 800289190 1 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 10/6/201 0

### SOLUTION S 

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