## TRANSMITTA L o f OMAB A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : ^ 7 f^ /

Date : l-^f^l^^ X -S gi-j/ - 

## Address : C^ o 7 Remediatio n Contractor : J^'^sJi ^ i^cLi^dlt,^ . ^Llsyti ^ Year : .2x30 ^ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S ^ Vide o o f propert y (DVD ) ^ Executiv e Sununar y 0 EPA-provide dpropert y sketc h aSigne dAcces s Agreemen t fo r subjec t propert y D Signe dAcces s Agreement(s ) fo r adjacen t propert y E

f Restoratio n Agreemen t D Settlemen t dociunent s (i.e. , fo r damag e o r t o replac e plants , etc. ) [ /

Confirmation data 0 Photograph s 0 As-built sketch s f

Satisfactor y restoratio n signedby Propert y Owne r B

i Propert y close-ou t chec k lis t signe db y EP A D Descriptio n o f area s no t meetin g RO D cleanu p criteri a 0 Utilit y clearance s y . Propert y infonnatio n fiwmDoi^la s Count y Assessor' s OfBc e D 4030959 0 

### D g Superfun d 

## ignatuf e Date

### PROPERT Y SUMMAR Y Date : 12/20/200 8 Omah aLea dSit e Remedial Actio n Contrac t #EP-R7-07-06/0004 Mont h of : NovADec , Propert y Address ; 540 7 S 3 2 S T A . EXECUTIV E SUMMAR Y A. 1 Issue s Encoimtered : NON E A. 2 Issue s Resolved : NON E A. 3 Uniqu e Findings : NON E A. 4 Oflier Relevan t Infonnation : NON E CONFIRMATIO N SAMPLIN G DATA/RESULTS : B 2 = 26 1 PP M @ JT ; D Z = 10 4 PP M @ 12" ; F l = 21 2 PP M @ 8" ; F 2 = 13 5 PP M @ 8" ; E A = 15 0 PP M @ SCRAPE ATTACHMENT S 1 ) Propert y sketch provide dby EP A pursuan t to contract specification s 2 ) SignedAcces s Agreemen t including acces s agreement s requiredfo r crossing othe r propertie s 3 ) Pre-Excavation digita l vide o cUp/photogr^h s 4 ) Post-Excavation digita l vide o clip/photogrs^h s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Buil t sketch
i ) Shall include final leadlevel s v ) Legend ii ) Contamination lef t behindarea s vi ) Contracto r identification iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s to b e include din the individua l propert y file, i f available , or obtaiae dinclude : i ) Pre-excavatio n agreemen t detail s (i f an y ar e mad e wit h th e propert y owner ) ii ) Propert y Statu s For msignedb y propert y owne r iii ) Excavation digita l vide o i n MPEG , WM V (Window s Medi aVideo ) o r SW F(Flas h Player) fonna t and/o r photograph s iv ) Signedfor mverifying satisfactor y restoratio n v ) Desoiptio n o f area s not meeting InterimRO D cleanu p criteria .

TECHNOLOGIES , INC .Fin d Record I Clea n U p Query Lea d Remainin g QueryI Propert yDamag e Query 

### Backfill :

Sampl e Area : 4743 1 - 540 7 S 3 2 S T Owner : Resident : Contract : D Owne rOccupie d Residen t Name : Contractor : Owne rName : 

# r jPRUDENT2008_ S [JAIM E ENRIQU E Propert yAddress : Group : Owne rAddressl : |540 7 S 3 2 S T Owne rAddress2 : Zi p Code : [6810 7 Assessment : |540 7 S 3 2 S T Residen t Phon e Qualifyin g Grou p City : State : Zi p Code : 

# I J800/CHIL D jOMAH A [N E (6810 7 Assessmen t XR F Date : Owne rPhone : Alternat e Phone : 

# I |(402 ) 917-577 5 |(402 ) 917-357 8 Assessmen t MaxXR F Value : I 108 3

### TBCHNOIOGIBS , IN C Property* : Lfll)-'i> ) Date/Time : 

### Quad s Excavated : pl^jL j h ^ |>2 . 

# SER( V EP A Propert y Clos e Ou t Propert y Address : 5fP 7 5 32 . Sl
Owner' s Name : Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l 1 .

If necessary , wer e the correct quadrant(s ) excavatedan drestored ? 2 .

If necessary , wer e the correct area s of dri p zone excavatedan drestored ? Gradin g Sodan dVegetatio n 1 .Doe s the grading aroun dthe perimete r ofth e hous e i n excavatedarea s generall y slop e awa y fromthe house ? 2 .

Ha s so dbeen lai din al l area s tha t wer e excavated ? 3 .

Doe s the sodappea r to b e generall y health y andgrowing ? (Onl y evahiat e if inspecteda t a3 0 da

y lim e period) 4 .

Ar e soddedarea s generall y fu man devenl y graded ? 5 .

Ar e the joint s betwee n the sodstrip s generall y tight ? (Onl y evaluat e if inspecteda t a3 0 da y tim e period ) 6 .Wa s th e propert y gradedsuc h tha t wate r will not poo l o n the property ? 7 .

Was damage to landscaping o r plan t material s avoided ? Gates , Fence s an dRetainin g Wall s 1 .

D o gate s ope n an dclos e freely? (IfappUcable ) 2 .

Wer e all gate s o r fence s taken dow n during restoration activitie s reinstalled ? (I f applicable ) 3 .

Wa s damage to gate s o r fence s avoided ? (If applicable ) 4 .

Wa s damage to retainin g wall s avoided ? (IfappUcable ) Foundation , Sidin g an dGutter s 1 .

Was damage to the siding o r trimavoided ? 2 .

Wa s damage to the foundation avoided ? 3 .

Wa s damag e t o window s avoided ? 4 .Wa s damage to window s o r doo r screen s avoided ? 5 .Wa s damage to downspouts o r downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) 1 .Wa s damage to drivewa y surfece s avoided ? 2 .Wa s damage to walkwa y surface s avoided ? Ye s N o / / Ye s N o / / / / / / / Ye s N o / / 

## X 

# y Ye s N o 

# y X / / 

# y Ye s N o / 

# y

## Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complet e including th e 30-da y sodwarranty : EP A Representativ e fL ^ j^^ . Date : ,a/,/o s 

# M ^

## Propert yCompletio n Agreemen t Thi s agreemen t documents th e completion of remova l activitie s performedo n th e belo w liste dproperty . Th e propert y owner' s signatm^ e indicate s tha t th e propert y owne r i s satisfiedwit h th e restoratio n ofth e subject property , an dtha t no item s ar e i n question , now , o r a

t an y time i n th e fiiture, excluding an y remaining warrant y (3 0 day s total ) except thos e item s listedbelow , i f any . Propert y ID : Propert y Address : ^ ^ p - ^ O^ O5/ L •' V < ) 

### Owner : Q .^ . 7lo. ^ V ^ u ^ . . ^ "> . 

## Phone: ^ O A Restoratio n item s I n Question :

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

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L J I agre e i^storatio n I s completed , excep t a s note d above . L J I d o no t agre e restoratio n I s complete d 

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# ^ //-X- W ~ Xool ^ Owner' s Signatur e Dat ePruden t Technologies , Inc . (Piudent ) i s under contrac t withth e U . S . Environmental Protectio n Agenc y (EPA ) t o clean up lead
­ contaminate dsoil s a t anumber o f

propertie s locate di n Omaha , Nebraska , includin g th e property locate da t

. Th e EPA request s you r permissb n t o allo w Pruden t t o perfor masoi l cleaniq ) a t thi s property t o iemo\ e lead-contaminate dsoil . B y signin g thi s form, th e property owner grant s permissio n t o Pruden t t o perfor m activitie s relate dt o th e cleanup includin g soi l sampling , removal o f lead-contaminate dsoil , an drestoratio n o f th e reference dproperty . I f

yo u hav e an y question s abou t th e soi l cleanup planne dfo r you r property , pleas e contac t Pruden t Administrativ e Cleri c for th e Omah aLeadSite cleanup . Ms . Deboia hJohnso n -a t (402 ) 733-1188 . General question s abou t th e Omah aLea dSite cleaiu p ca n b e directe dt o th e EP A Publi c Infomiatio n Center s a t (402 ) 731-304 S (Sout hOmah aofGce) o r (402 ) 991-958 3 (Nort hOmah aofiice) . Property Acces s Grante dBy : id^^'J^ / 9" ^ - ^ Oot , > ^ ^ "C ^ (Pleas e Prin t Nrnie ) Property Owner Signature : J^T ? ^Jft f ^ : ? at ' 7 "9 ^ T ^ 1^ 1 3 < \® » (Signature ) ' ~ (Date ) PROPERT Y INFORMATIO N (T o b e complete db y residen t and/o r propert y owne r - pleas e print ) RESIDEN T NAME : \ ejL^.jCU^\f ^ Owne r Rente r RESIDEN T ADDRESS :
I F RENTAL , PROPERT Y OWNED BY :
OWNER' S MAILIN G ADDRESS ; „ x> . o o ^
OWNER' S TELEPHON E NUMBER - HOME : J _ 

### _L WORK :
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 CHILDRENUNDE 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 , ENTR Y GATES , ETC. )

AUTHORITY FO RENVIRONMENTALRESPONS E ACTIONS ; Th e activitie s t o b e implemente db y EP A unde r thi s agreement are pursuant t o Sectio n 104 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f

acces s t o th e property i s providedfo r in Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 960S(e) , whic hprovide s entry for "determiningth e nee d for response , o r choosin g o r taking any respons e actio n under dii s title , o r otherwis e enforcin g theprovision s o f di e title. "

808 0 War d Parkway , Suit e 40 5 250 5 N . 24* ^ Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax:(816)363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7 

# I /

## y ^ AS - BUIL T DRAWIN G f ^
OLS# : 4743 1 DateEicavated : 11/12/200 8 USEP A Signed-OffDate : 

## OMAHA LEA D SUPERFUND SITE .

4743 1 

# ^n-Gi'-^ ^ Nort h AiKM r 

# 4n-s5i « °is:iisi r Swipfln a Addiwa : 5407S32S T Sampte'Numbe r Lead Concciitralio n Sampt o Collecta d

inca c LA B Sampfa s Colecie d RYASCPXA4743 1 RYBSCPXA-4743 1 nVOOOPM * IT-W I RVDSCPXA^743 1 Fl F2 Bt 82 IQS 3 £•7 ^ oo m

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CONTRAC T #: EP - R7-07-0 6 / 000 4 PRUDEN T TECHNOLOGtES , INC .

# t ENVIRONMENTA L & CONSTRUCTIO N 

## TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : 'oMo~ V S 32.*^ ^ S W Date : lopi|o g Phone ; Hogi
- ^V \- ^'^'^ S BVID : • Ite mN O Plant s & Permanen t Landscapin g T o Remai n I n Plac e O n Map Descriptio n & Locatio n



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# 7^ Ite mN O Descriptio n & Locatio n O n Map

Propert y Owne r Signature : {X'^-\.y^~^ ^ y
808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7'v 

## 4743 1 

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# s^T g n Poo r Samolin a Address : 540 7 S 3 2 S T 0 No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : FC A P^-S n RYASCPXA-4743 1 F l 

## D Date : G-^-n ^ RYBSCPXA-4743 1 F 2 0 5 H Po m 

# I n Time : /z : 1 5 j,y ^ • RVGGCPXA-4743 1 Bl - __!l__pp m 

# n Sample s Analyze d

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# n RDZSCPXA-4743 1 D Z Tig»< ^ pp m 

## D XR F Unit : fo.'^H O Book : 2l R RCgOCPXA-4743 1 6 E pp m 

# n Date : fl-21'QR 

## D nPZSOPXA-4740 1 PZ- " pp m 

## D Time : Ar>- » 

## D Staff : ^\S W Numtie ro f Sample s = | I f | j Q | Legend : F l = Fron t Left , F 2 = Fron t Right , B l = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Ra y Al l quadrant s ar e a s vievwe d fro m th e street , feeing pcxjpert y 

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### http://www.dogis.or^|^s_alias/do^s/printPreview.aspx?PrintOptDa . Prin t Preview 

## ^sj m Dougla s County-Omaha , N E

Parce l I D 142459000 0 Sec-Twn-Rn g 09-14-1 3 Owne r Nam e JAIM E ENRIQU E Additio n JblltRSAD D Propert y Addres s 540 7 S 3 2 S T Bloc k 8 Cit y OMAH A Lo t 8 Zi p 6810 7 Lega l 1 8 2 8 F T Owne r Addres s Lega l 2 28X5 5 Owne r Addres s 2 540 7 8 3 2 S T Lega l 3 Owne rCit y OMAH A Lega l 4 Owne r Stat e N E Treasure r Websit e Un k http://webapps.do t comm.org:8080/TreasTax/ f aces/page s /taxinfo . jsp?parc = 142459000 0 Owne rZi p 6810 7 Assesso r Websit e Un k http : //dou g lasne . mapping-online , com/Dou g lasCoNe/sta t i c /accountinfo.jsp?accountno=R142459000 0 Disclaimer : Ma p an d parce l dat a ar e believe d t o b e accurate , bu t accurac yi s not Ma p Scal e guaranteed . Thi s i s not a lega l documen t an d shoul d not b e substitute d fo ra titl e search , 1 inc h = 1 2 fee t appraisal , survey , o rfo rzonin g verification .

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### YOU RTICKE T NUMBE RI S  2168929 . Origina l Cal l Date : 11/04/0 8 Time : 10:3 4 a m Op : MADHURIMA1896 7 Wor k t o Begi n Date : 11/06/0 8 Time : 11:0 0 a m State : N E County : DOUGLA S Place : OMAH A Address : 540 7 Street : S 32N D S T Twp : 14 NRng : 13 E Sect-Qtr : 09-NW Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n fo r soi l Locatio n o f 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 : MADHURIM A Phone : (402)733-118 8 Alt . Contact : Phone : (618)401-222 3 Wor k Bein g Don e For : ep a Dept h o f Excavation : 6 f t Corne r Lot ; NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g ; NExplosives : N CXCAT V MCLEODN E METR O MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F 

### Utilit y Servic e Are a Contac t Phon e Numbe r Typ e Day : 402934046 9 CO X Alt : 402934046 9 CXCAT V COMMUNICATIONS , IN C ^^^° ^ Emerg : 402932975 7 Day : 800289190 1 N O NEE D T O CAL L MCLEODN E MCLEODUS A Alt : OUT EMERGENC Y Emerg : 800289190 1 Day : 402457230 7 

## METR O COMM . METR O CHRI S Alt : 402672703 3 

## COLLEG E Emerg : 402457231 3 Day : 402504782 3 METROPOLITA N MUD0 2 SAND Y Alt : UTILITIE S DISTRIC T Emerg : 402504797 0 CIT Y O FOMAHA
- Day : 402444719 7 OMAHACO F RO N TRAFFICSEWE R
lof 2 11/4/200 8 10:3 4 A Mhttp://www.dhon.org/j^fcntemel/DHONNoticeCreation/MessageText. . 

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Alt : 402444516 1 Emerg : 402444516 0 0PPDGPR 6 OMAH A PUBLIC POWE R DISTRIC T N A Day : Alt : Emerg : 406728934 3 888728934 3 : 406728934 3 QLNNEIF QWES T LOCA L NETWOR K N A Day : Alt : Emerg : 406728934 3 888728934 3

2 o f 2 11/4/200 8 10:3 4 AM