### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 2810 5 DATE : 12/15/201 0 ADDRESS : 276 0 GRAN T S T REMEDIATIO N CONTRACTOR : PRUDENT TECHNOLOGIES . 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 ) m EXECUTIV E SUMMARY m EPA-PROVIDE D PROPERT YSKETCH Q SIGNE D ACCES S AGREEMEN T FOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN T PROPERT Y l a RESTORATIO N AGREEMEN T D SETTLEMEN T DOCUMENTS (I.E. , FOR DAMAG E O R T O REPLACE PLANTS , ETC. ) m CONFIRMATIO N DAT A 0 PHOTOGRAPH S \

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AS-BUIL T SKETCH n SATISFACTOR Y RESTORATIO N SIGNE D B YPROPERT Y OWNE R E l PROPERT Y CLOSE-OUT CHEC KLIS T SIGNE D B YEP A D DESCRIPTIO N O F AREA S NO T MEETIN G RO D CLEANU P CRITERI A m UTILIT Y CLEARANCE S E PROPERT Y INFORMATIO N FRO M DOUGLA S COUNT Y ASSESSOR'S OFFIC E D D

SIGNATUR E DAT E 3021829 6 

# iIB i Superfun dFin d Record Backfill :

Sampi e Area : 2810 5 - 276 0 GRAN T S T Owner : D Owne rOccupie d Owne rName : ICTTYOFOMAH A Owne rAddressl : |C/ 0 CTT Y FINANC E Owne rAddress2 : J181 9 FARNAM ST City : State : Zi p Code : JOMAHA^ JN E [6818i- ~ Owne rPhon e Alternat e Phone : 1(402 ) 444-518 0 |(402 ) 444-6140 "

Contract : Contractor : jPRUDENT2blO_S Contrac t Optio n foPTlON ^ Remediatio n Quer y{ Lea d Remainin g Quer yj Propert yDamag e Quer y

Use rProvide d Owne rInformatio n Resident : Owne rName : Residen t Name : 

# 1 ' ' " Owne rAddress : Propert yAddress : i276 0 GRAN T ST Zi p Code : |68111 - City : State : Zi p Code : Residen t Phon e Owne rPhon e Alternat e Phone :

Assessment : Qualifyin g Grou p J40 0 Assessmen t Ma xXR F Valu e 

# 1 469. 3

### PROPERT Y SUMMAR Y Date : 12/15/201 0 Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Decembe r Propert y Address : 276 0 GRAN T 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 Infonnation : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : F l = 17 9 PP M @ 4" ; N O EASEMEN T ATTACHMENT S 1 ) Propert y 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-Buil t sketc h­ i ) Shal l includ e final 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 ) BVD 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 obtaine dinclude : i ) Pre-excavatio n agreement detail s (i f an y ar e mad e withth e property owner ) ii ) Propert y 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 ) format 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 .

ECHNOLOCIES . INC .^.. . •- V " •.-!••• . v i T v TECHNOLOGIBS , INC . 

# EP A Propert y Clos e Ou t Propert y # : 2^^^ / Propert y Add«.ss:2.'7^f> <^''^- ^ '^ ^ Date/Time : Owner' s Name : (Z'A ^ c«? . C fvu^V" ^ Quad s Excavated : " p \ Contracto r Group : Pruaen t Technologies , Inc. , Excavatio n Genera l Ye s N o 1 I f necessary , wer e th e correct quadrant(s ) excavatedandrestored ? 

# y 2 . I f necessary , wer e th e correc t area s o f drip zone excavate dandrestored ? V Gradin g Sodan dVegetatio n Ye s N o 1 .

Doe s th e gradin g aroun dthe perimete r o

f th e hous e in excavatedarea s generall y slop e awa y fro mthe house ? 

# y 2 .Ha s sodbeen lai din al l area s tha t wer e excavated ? 

# y 3 .

Doe s the sodappea r to b e generally health y andgrowing ? (Onl y evaluat e i

f inspecte da t a3 0 da

y tim e period) / 4 .Ar e soddedarea s generally firman devenl y graded ? / 5 .Ar e the joint s between th e sodstrip 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 grade dsuc htlia t wate r wil l not pool o n the property ? / 7 . Wa s damag e to landscapin g o r plan t material s avoided ? / Gates , Fence s an dRetainin g Wall s Ye s N o 1 . Do gate s ope n andclos e freely ? (I f apphcable ) / 

### 2 . Wer e al l gate s or fence s taken dow n diuin g restoratio n activitie s reinstalled ? (I f applicable ) / 

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

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

### Foundation , Sidin g an dGutter s Ye s N o I .Wa s damag e t o tli e sidin g o r trimavoided ? / 

### 2Wa s damag e t o tli e foundation avoided ? 

# y Was damag e t 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 ? Sidewalk s an dDriveway s (Concrete ) Ye s N o / I Wa s damag e l o drivewa y surface s avoided ? 2 .

Was damag e to walkwa y surface s avoided ? 

# y

## 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 ^" ^ J^ , ^Date: \b\t'\\i 6

# IRI l (.'HNOliXJlES . INC 

### A S - BUIL T DRAWIN G OL S #2810 S Dat e Excavated : 10/07/201 0 I'SEP A Signed-Of f Date : 

### OMAH A LEA D SUPERFUN D SIT E 2810 5 Exterio rPaint Nou n Arro w Owne rName : CIT Y O F OMAH AOmah a Lea d Sit e • Goo d Address : 2760 GRAN T S T Sit e Sketc h • Poo r Phone : " .t02r«ll-615 0 W ; • ''No t pain t 1 1

Lea d Sampl e Sample s Collecte d 1 Sampl e Numbe r LA B Concentratio n Collecte d Firm ; ^5^^ - -^''^^ r RYASCPXA-2810 5 F l ^W ^ Do m 

### B ^ D Date ; o"'-c»-o t RYBSCPXA-2810 5 F 2 7<^ S Dpn n 

### 0' D Time : *^-iC/»^ . RYCSCPXA-2810 5 B l Zo6 ? Dom 

### 0 0 Sample s Analyze d 1 RYDSCPXA-2810 5 B2 /o" 1 Do m 

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## n -ROZSCPXA-26t0 5 O Z • Dom 

### D D XR F Uni t !cx=>- i Book : f^ ^ .La b RYCSCPLA-2810 5 • Dom 

### D D Date : ~1-?, 1 -n{ t ^Resul t 26 9 pp m pp m 

### D Time : P, ^ 

## a Staff : f^\<,,- , Numbe ro f Sample s 

### = H Legend : F l = Fron t Left , F 2 = Fron t Rigtit . B 1 = Bac k Left , B 2 = Bac k Righ t DZ = Dri p Zone . G Z = Garden . P Z = Pla y Al l quadrant s ar e a s viewe d fro m th e street , faon g propert y



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&f>KNT' D T N O E.ASEME M CONTRAC T # : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC .

# &EPA Propert yCompletio n Agreemen t Thi s agreemen t documents th e completio n o f remova l activitie s performe d o n th e belo wliste d property . Th e propertyowner' s signature indicate s that th e propertyowne ri s satisfie d wit h th e restoratio n o f th e subject property , an d that n o item s ar e i n question , now , o ra t an ytim e i n th e future , excludin g an y remainin g warranty(3 0 day s total ) excep t thos e item s liste d below , i f any . 

### Propert y ID : Propert y Address ; ^-^^^ ^ t^.A^.lSrf/c U Owner ; Phone ; 

# '^/vV- v^v f Restoratio n Item s i n Question :

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

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



## ^f ^ (ykk>x r-Jd/C ^ DatePruden t Technologies , Inc . (Pnidcni ) is unde rcontract wit h th e U. S. Environnicnia l Protectio n Agency(EPA ) lo clea n up lead contaminate d soil s at a numbe r of propertie s locate d In Omalia . Nebraska , includin g th e propertylocate dat 3/ir O 6^^/v/- iSJ/t-t-j - . Th e EP Arequests you rpermissio n to allo wPruden t to perfor m a soi l cleanu p at thi s propert y to remov e lead-contaminate d soil . Bysignin g thi s form , th e propertyoune rgrant s permissio n to Pruden t to perror m activitie s relate d lo Ui e cleanu p includin g soi l sampling , remova l of lead-contaminate d soil , an d restoratio n of th e reference d property . If yo u have an yquestion s abou t th e soi l cleanu p planne d fo ryou rproperty , pleas e contac t Pruden t sout h ofTice .fo rth e Omah a Lea d Sit e cicanup-a t (402 ) 733-1188 . Genera l question s abou t th e Omah a l.ea d Sit e cleanu p ca nbe directe d to th e EP APubli cInfomiolio n Centersat (402 ) 731-304 S (Soul h Omah a office ) or(402 ) 991-9S8 3 (Nort h Omah a ofrice) . Propert yAcces s Grante d By : <<y.///i/v t L.,yt<^r ) (Pleas e Prin t Name) 

# i.jT/y A Propert yOwne rSignature : 

### s-Ory-fjo/ Q (Date ) V /y i (Signature ) PROPERT YINFORMATIO N (T obe complete d byresiden t and/o rpropert yowne r~ pleas e print ) RESIDEN TNAME : Owne r Rente r RESIDEN ADDRES 3EN T S :
IF RENTAL , PROPERT YOWNE D BY : OWNER' S MAILIN G ADDRESS ;

/U^ , R^r^^i ^ Sh ^ ^:/ c 1/1 / O^y^Lc ^

f^( rOi l 13 , OWNER' S TELEPHON E NUMBER-HOME : J L WORK : AG E OF HOME? : YEARS . HO W LON G HAV E YO U LIVE D HERE ? YEARS . HA S TH E EXTERIO R BEE N PAINTE D OR COVERE D WIT H SIDIN G SINC E 1078 7 YE S NO NUMBE R OF OCCUPANT S UNDE R 7 YEAR S OLD : 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 6 HOUR S OR MOR E PE R WEEK : COMMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. )

AUTHORIT YFO R ENVIRONMENTA L RESPONS E ACTIONS ; Th e activitie s to be implemente d byEP Aunde rthi s agreemen t ar

e pursuan t to Sectio n 10 4 of CERCLA , 42 U.S.C . 9604 . EPA' s righ t ofacces s to th e property is provide d fo r in Sectio n 104(e ) of CERCLA , 42 U.S . C 9605(e) , whic h provide s entryfo r'deteiminin g th e need fo rresponse , orchoosin g ortakin g an yrespons e actio n unde rthi s title , orotherwis e enforcin g th e provision s of Ih e title. " 808 0 War d Parkway , Suit e 40 6 560 0 SI O St 424 2 Medica l Drive , Suit e 425 0 Kansa s City , MO 6411 4 Oinaha , 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)733-188 3 Fax : (210 ) 679-657 7

## 2810 5 Exterio rPain t Nort h Arro w 

### Owne rName : CIT Y O F OMAH AOmah a Lea d Sit e • Goo d Address : 2760 GRANT S T

Sit e Sketc h • Poo r Phone : H : 402-441-515 0 W : CJ^Io t pain t \ Sampl e Numt>e r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Fir m RYASCPXA-2810 5 F l 

# _iiLd_PP m D Date : o^-a^-o ^ RYBSCPXA-2810 5 F2 

### ?g>5 " pp m 

# c r D Time : ^'•l^^A^ , RYCSCPXA-2810 5 B l 

### "Z-O ^ pp m 

# 0 ' 0 Sample s Analyze d RYDSCPXA-2810 5 B2 /n l pp m 

# D • RDZOCPXA-2010 5 BZ - pp m 

# n n XR F Unit : Icx^- i Book : t^< ) ^La b R^VS:SCPLA'281Q6 pp m 

# D D Date : 1 - ^. i ' 

# nu . SR^til t 269pp m pp m 

# u a Time : P ^ Staff : Msx. i Numbe ro f Sample s = i H Legend : F l = Fron t Lefl , F2 = Fron t Right , B 1 = Bac k Left , B2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a s viewe d fro m th e street , facin g propert y 

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Creat e Anothe rTicke t Bac k t o Irt h Inteme t i I Sen d Eifnai l 

### YOURTICKE T NUMBE RI S 2609477 . Origina l Cal l Date : lO/05/lo ' Time : 4:3 8 p m Op : SIVA1896 7 Wor k t o Begi n Date : 10/07/1 0 Time : •5:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 276 0 Street : GRANT S T Twp : 15 NRng : 13 E Sect-Qtr : 09-S E 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 PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)733-188 3 : UNSUR E CORNER S Compan y: 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 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 SAND Y 

### Day : Alt : 402504782 3 Emerg : 402504797 0 OMAHACOFCITY O FOMAHA-TRAFFIC.SEWE RRICH/TRAFFIC 

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

### EL M LOCATIN G Day : 406728934 3



### Alt : 406207149 4

Emerg : 888728934 3 QLNNE] C QWES T LOCA LNETWORK. 

### EL M LOCATIN G Day : 406728934 3

Alt : 406207149 4

Emerg : 888728934 3 http://wwv^.dhon.org/irthinteraet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 10/5/201 0TeDHNOU»fl«| . 

### me . CONSTRUCnc W SOLUTION S 

## SIT E SAFfeT Y HAZARD ANALYSI S Address : ~^.i£P-^iaivJ:. ^ Excavatio n Date ; lol^l^'^^ ^ Crew : Backfi U Date : t£d3li^l' ^

Ite m Overhea dLine s Ga s Lin e Wate r Lin e Sewe r Lin e Septic/Leecl i Fiel d Propane/Butan e Sidewal k Foundatio n Retainin g Wall s Fence s Tree s Structure s Drivewa y Sprinkle r Syste m Othe r Cre w Forema n Conditio n Hazard s Correctiv e Actio n c^< - o c r - /f ? rr ^ 

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## Sit e Safety Offic e Date :

le wWmtltaitany . S«rito40 5 I SI O a t 424 2 Medica l DHva , Suite 726 0 tonaas CHIy ; MO^^H ^ Omala , Nafaiaak a «810 7 Sa n Antonio , T X 7S22 9 )|iaas:tS1O36»370 3 ^ K|8W ) 383-470 7 Plwn K(W^TSS-lia s Fax : (4a2)73»*1«8 3 Phone : (2t0 ) <2Z-«688 Fax : (210 ) 679-6677