SAID# : 

### 2517 2 

### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R DATE : 1/1 5 ADDRESS : 111 0 N2 0 S T REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES . INC . YEAR : 

### 201 ^ 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S 

# d PR E AN D POS TVIDE O O F PORPERT Y(DVD ) 

### ^ EXECUTIV E SUMMAR Y 

# d EPA-PROVIDE D PROPERT YSKETC H 

### ^ SIGNE D ACCES S AGREEMEN TFO R SUBJECTPROPERT Y SIGNE D ACCES S AGREEMENT(S ) FO R ADJACEN TPROPERT Y RESTORATIO N AGREEMEN T 

### U SETTLEMEN TDOCUMENT S (I.E. , FO R DAMAG E O R T O REPLAC E PLANTS , ETC. ) 

# k CONFIRMATIO N DAT A 

## T PHOTOGRAPH S 

## m AS-BUIL TSKETC H SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R PROPERT YCLOSE-OU TCHEC KLIS TSIGNE D B YEPA 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 3021828 4 

# lllll l Superfun d 

### N

### PROPERT Y SUMMAR Y Date : /15/201 0 Omah aLea dSit e Remedia l Actio nContrac t #EP-R7-07-0 6 TO# l Mont hof : Propert y Address ; 111 0 N2 0 S 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 NSAMPLIN GDATA/RESULTS : F 2 = 15 8 PP M @ 9" ; N O EASEMEN T 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 ndigita 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-Built 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 dinth e individual property file , i f available , o r obtainedinclude : i ) Pre-excavatio nagreement detail s (ifan y ar e mad e wit hth e property owner ) ii ) Property Statu s For msigne 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 no f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOGIES . INC .TECHNOLCXJIES , INC . 

# EP A Propert y Clos e Ou t Propert y # : 2^'"^ ^ Propert y Address : // / 0 /U - '7-(^^'^ - Date/Time : Owner'sName : (^fo^ixi- ^ CaKoov ^ Quad s Excavated : p'Z_ - Contracto r Group : Pniden t Technologies , Inc. , Excavatio nGenera l Ye s N o I .I f necessary , wer e lli e correc i quadrant(s ) excavate dan drestored ? / 2 .If necessary , wer e th e correc t area s ofdri p zon e e.xcavate dan drestored ? 

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

Doe s the gradin g aroundthe perimete r o

f th e hous e inexcavatedarea s generally slop e awa y / fro mthe house ? 2 .

Has sodbeenlaidi nall area s tha t wer e excavated ? / 3 .

Doe s the sodappea r t

o be generall y health y andgrowing ? (Onl y evaluate i f inspecteda t a3 0 da

y lime period) / 4 .Ar e soddedarea s generally finnan devenl y graded ? / 5 .Ar c tli e joint s betweenthe sodstrip s generall y tiglit ? (Onl y evaluat e i

f inspecte da t a3 0 da y tim e period) / 6 .Wa s the propert y gradedsuc hdia t wate r wil l not poo l o nth e property ? / 7 . Wa s damag e lo landscaping o r plan t material s avoided ? / Gates , Fence s an dRetainin g Wall s Ye s N o 1 .

Do gate s ope nandclos e freely ? (I f apphcable ) / 2 .

Wer e all gale s o r fence s takendow nduring restoratio nactivitie s reinstalled ? (I f applicable ) / 3 .

Wa s damag e t o gate s or fence s avoided ? (I f applicable ) / 4 .Was damag e t o retainin g wall s avoided ? (Ifapplicable ) / Foundation , Sidin g an dGutter s Ye s N o 

### 1 .

Wa s damag e t o the siding o r trimavoided ? / 2 Wa s damag e t o the foundationavoided ? / 3 .

Wa s damag e to window s avoided ? / 4 . Wa s damag e t o window s o r doo r screen s avoided ? / 5 . Wa s damag e lo downspout s o r downspou t extension s avoided ? / Sidewalk s an dDriveway s (Concrete ) Ye s N o I Wa s damag e t o drivewa v surface s avoided' ? / Wa s damag e t o walkwa y surface s avoided ? 

# T

## Owner s comments :

Inspectio nnotes :

Remova l an drestoratio nactivate s complete includin g th e 30-da y so dwarranty ; EP A Representativ e ^ ^ ^Date; 'I'^l uECHNOLOUIES . INC A S - BUIL T DRAWIN G OL S #2517 2 Dat e Excavated : 09/22/201 0 IISEP A Signed-Of T Date : OMAH A LEA D SUPERFUN D SIT E 2517 2 Exterio rPain t Omah a Lea d Sit e Owne rName : RALP H H FROS T • Goo d Sit e Sketc h Address : 111 0 N 2 0 S T Phone : " • W : • Poo r Q No t paint Sampl e Numbe r RYASCPXA-2517 2 F l Lead Concentratio n '2.2. 1 pp m Sampl e Collecte d H ' . . „ • Fir m Date : Sample s Collecte d y^f ^ H:r/f?iJ: - "9 - Z C S ' RYBSCPXA-2517 2 F 2 Time : l l 2s ' RYCSCPXA-2517 2 RYDSCPXA-2517 2 B l B 2 31 ^ 2.^/ 0 pp" i pp m

\2 ' E f D n Sample s Analyze d

- ROZ6GPXA-25^? a -02 ­ - pp m n D XR F Unit : 103 1 Book : 13' ^ -RGZSGPXA-g&l- W GZ ­ " pp m n D Date : l\--i-C<S ~ ~ pp m D D Time : /4>» y Numbe rof Sample s ­ -U . — Staff . d- A Legend : F 1 = Fron t Left . F 2 = Fron t Right , B l = Bac k Left . 8 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 viewe d fro m th e street , facin g propert y 

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# i ¥ — ^ -^ X : ^ \ 147^ ^ - ^ N O EA.SEME M CONTRAC T# : EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC .p.00 3 

### 15:4 6 402932689 2 R

X Date/Tim e 12/15/201 0 GINN Y HEBERL Y a 00 3 12/15/201 0 14:4 4 FA X 40293268 9 

### 12/15/201 0 153 0 ' 

## TO P.003A|D I 

# dE M PropertyCompletio n Agreemen t Thi s agreement docvonest s tfa e completio no f removal acdvitie s perforaw do ntiie belo w liste dproper^' . Th e propert y owner' s signature indicate s that di e propert y owner i s satisfie dwit htli e restonido nofth e subjec t property , an dtaa t n o item s ar e i nqueation , now , o r a t aiiy tim e i nth e future , exsiudiAg any remsinbi g warrant y (3 0 day atotal ) excep t thos e item s liste dbelow , ifany . Property n) : Property Addrass : » o *2^Hv . ^icy ­ 

## 4U . ^""'^e^ ^ PiH»e : 

## 4n;^-ioR - I?>} 1 Restoratio n Iten wI n QMStlon :

Item : Ham :

Rsquhtt d correetien ct o complvt e th t property :

0

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I agra a raotoratio n i s completed . E D I d o no t agre e restoretio n I s comptsto d a t (note d defiofende s atiovB )



### /6^r-<? ^ /-< / /r . La/f i Owaif u Sigiiatar e ^ Sat eP.00 1 

### R

X Date/Tim e 12/15/201 0 15:46 402932689 2 Qoo i 12/15/201 0 14:4 3 FA X 402932689| ^ GINN Y HEBERL Y

KNVIRONMXNTAL & CONSTROCTIO N 

## TSCHNOLOGH ^ INC . SIRVICB 8 

## OtiCVv ^

Pruden t Technologie s Inc . (Prudent ) I s unde rContrac t wit h th e U.S . £nvironmenta l Protectio n Agenc y(EPA) , Contrac t # R7'10-10248 , t o 

### conduc t Lea dSoi l Rennedietio n i n Omaha , Nebrasica . A s o f thi s dat e w e hav e complete d wor k o n you rproperty . W e woul d lik e t o d o a n hspectto n o f th e wor k don e an d ge t som e clos e ou t fomn s signed . Thi s i s ou rlas t attemp t a t contactin g you , pleas e ge t i n touch wit h u s o rsen d i n th e signe d clos e ou t form s i n th e pre-stampe d envelope s a s soo n a s possible . I f yo u hav e an yquestion s pleas e fee l fre e t o cal l ou rOmah a soi l fiel d offic e a t 402-733-118 8 o raddres s al l email s t o rBhreathafiPprudentweb.com . Ou rfa xnumbe rI s 402^733-1883 . Yo u ca n als o visi t th e EP Awebsit e www.epa.govyiead/pubs/leadlnfo.ht m fo radditiona l informatton .

808 0 War d Parkway , Suit e 40 5 

### 560 0 SIO" * S t 424 2 Medica l Drive , Suit e 726 0 KarMs a CRy . M O 6411 4 Omaha . (Nebrask a 6810 7 Sa n Antonio . TX7822 9 Phone : (816 ) 36&-370 3 Phone : (402)733-118 8 Phone : (210 ) 822-858 8 Fa r(816 ) 363-370 7 Fax : (402)733-144 5 Fax : (210 ) 579^57 7



# eoo/ioo' d (Xt A 

### OC S I 0L0Z/5L/2 iPruden t Technologies , Inc . (Pmdeirt ) i s unde r contrac t withth e U . S . Environmenta l Protectio nAgenc y (EPA ) t o clea n u p lead contaminate dsoil s a t anumbe r o f

propertie s locate dinOmaha , Nebraska , includin g th e propert y locate da t |^~y.- 0 p J 2- 0 ^N' ^ . Tli e EP A request s you r permissio n t o allo w Pruden t t o performasoi l cleanu p at thi s property t o remov e lead-contaminate dsoil . B y signin g thi s form , th e propert y owne r grant s permissio nt 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 . I f yo u hav e an y question s abou t th e soi l cleanu p plamie dfor you r property , pleas e contac t Pruden t southoffic e for 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 canb e directedt o th e EP A Publi c Infonnatio n Center s a l (402 ) 731-304 5 (SouthOmah aoffice ) o r (402 ) 991-958 3 (NorthOmah aoffice) . Property Acces s Grante dBy : 

## >r,c . 

# M . bcT * 

## r (Pleas e Prin t Name ) 

# Cj^.^ . (2„r7 1 9-/^-; o Property Owne r Signature : (Signature ) (Date ) PROPERT YINFORMATIO N

. (T p b e complete db y residen t and/o r propertj ' owne r —pleas e print ) RESIDEN TNAME : Rente r \

j K C.A.^O r

Owne r RESIDEN TADDRESS : 

# \

I yo N J I)oH v ^ I F RENTAL , PROPERT YOWfNE D BY : OWNER' S MAILIN G ADDRESS ; f ' O 

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# (.1^10 ^ OWNER' S TELEPHON E NUMBE R - HOME : J L WORK : 

### J 1 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 O OLDE R NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLA YI N TH 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 , ENTR YGATES , 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 n10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f

acces s t o th e propert y i s provide dfor i nSectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry for "determinin g th e nee dfor response , or choosin g o r takin g an y respons e actio n imder 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 8 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 , T X 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)579-657 7

### TECHNOLOGIES , INC . ENVrRONMEtVT.AL A CONSTRUCTIO N SERVICE. S 

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## Propert y Ow i Pruden t Employe e Signature : 808 0 War d Parkway , Suit e 40 5 560 0 S 1 0 S t :a l Drive , Suit e 425 0 KansasCity , MO6411 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 Cv - /JA'lt Ti t .lOO- ^

## 2517 2 Exterio rPain t Nort h Arro w Omah a Lea d Sit e Owne rName : RALP H H FROS T 

### • Goo d Sit e Sketc h Address : 1110N20S T 

### • Poo r Phone : Jj i ____ _ W : Q Notpain t Sampl e Numbe r Lea d Concentratio n Firm : Sample s Collecte d /^< » Hrt/l^t J RYASCPXA-2517 2 F l Date : "j-ZQ-S - RYBSCPXA-2517 2 F2 

### Time : / / Zs - RYCSCPXA-2517 2 81 . RYDSCPXA-2517 2 8 2 Sample s Analyze d nDZCCPX A3617 2 D2 ^ XR F Unit : \0¥ 1 Book : I? 3 nCZOCPX A2617 2 62 - Date : 

## W-'^-a ^ nPZSCPX A2617 2 —PZ ~ Numbe ro f Sample s = Time : Staff ; 

## yias 

# AA . Legend : F 1 = Fron t Left , F2 = Fron t Right . B l = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden . PZ = Pla y Al l quadrant s ar e a s viewe d rro m th e street , feeing propert y 

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### Printed : De c 10.201 0 www.dcgis.org/dogi s/irthi r 

### Ticke t Tex t an dMa p displa y fo r Ticket : #259212 128

8 http://www.dhoaorg/irthintemet/MessageText/MessapTextAndMap.a. . Origina l Cal l Date : -9/14/1 0 Time : 5:4 9 pm Op : SIVA1896 7 Wor kto Begi n Date : 9/16/1 0 Time : 6:1 5 pm State : NE County : DOUGLA S Place : OMAH A Address : 111 0 Street : N20T HST Twp : 15 NRng : 13 E Sect-Qtr : 15-NW-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e of Work : soi l lea d remediatio n project Locatio nof Work : LOCAT E ENTIR E PROPERT Y Remarks : FAX 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 of Excavation : 6 FT Corne r Lot : N Front : Y Rear : Involve s Tunnelin g or Horizonta l Borin g : N Explosives : N CXCAT V LEVEL 3 MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C 

### Servic e Are a Contac t Phon e Numbe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 LEVEL 3 LEVEL S COMMUNICATIONS , LL C NA Day : 877366834 4 Alt : Emerg : 877366834 4 MUDOl METROPOLITA NUTILITIE S DISTRIC T SAND Y Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO F CIT YOFOMAHA TRAFFICSEWE R RICH/TRAFFI C Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 0PPDGPR 5 OMAH A PUBLI C POWE R DISTRIC T EL M LOCATIN G Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNN E 1C QWES T LOCA LNETWOR K EL M LOCATIN G Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

lo f 2 12/23/201 0 11:1 3 AM

### Ticke t Tex t an dMa p displa y fo r Ticket : #259212 http://www.dhoaorg/idiiintemet/MessageText/MessageTextAndMap.a , 12 8

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### 2

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### CONSTRUCTIO N 

## mc . SOLUTION S 

## SIT ESAFfeT Y HAZAR D ANALYSI S Address : ^iSi^^^JdUd L Excavatio n Date : Crew : Backfil l Date :

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 Wall s Fence s Tree s Structure s Driveway Sprinkle r Syste m Othe r Cre w Forema n Conditio n Hazard s Correctiv e Actio n c^< - U C 1—(r > <r<V 3 

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## Sit e Safet y Offic e Date :

1080 WMf«aila«ay . Sute40 S SSOOSIOS t 424 2 Medica l Drive , StiM e 726 0 ansasCi|yiaK>e411 4 Omtta , ftabraek a 4810 7 Sa n Antonio , T X 7822 9 •hone : (SK ) Ses-STO S Phone : (402 ) 733-118 8 Phone : (2t0 ) 822-e68 8 :ff:(S16)363'470 7 Fax : (402)733^88 3 Fax : (210)«r»-<5r 7

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