## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL E FOLDE R SAro# : jl^)0 O Date : StoJ^^^// ; J>fflQ3 , Address : Z3>o 1 Spa^ui ^ x J Remediatioi i Contractor : J^.^^J - T^^k . !I^ ^ . ^ Year : j2flQ^ SOI LREMEDIATIO N PROPERT Y FILE FOLDE RDOCUMENT S ^ Vide o o f property (DVD ) ^ Executiv e Summary 0f

^ EPA-provide dproperty sketc h e f

Signe dAcces s Agreemen t for subjec t property D Signe dAcces s Agreement(s ) for adja^ien t property y Restoratio nAgreemen t y Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) y Confirmatio ndat a y Photograph s y As-buil t sketc h 0 ^ Satisfector y restoratio nsigne db y Property Owne r 0 ^ Property close-ou t chec k lis t signe db y EP A D Descriptio no f area s no t meetin g RO D cleanu p criteri a M Utilit y clearance s 

## y Property mformatio n fix>mDougla s County Assessor' s Ofi&c e D D D 

# SSat ^ I&t e 3005421 8 

# IMlli i Superfun dRn d Record Remediatio n Quer yI Lea d Remainin g QueryI Propert yDamag e Quer y 

### Backfill :

Sampl e Area : 1410 0 - 330 7 SPRIN G S T Owner : Resident : Contract : D Owne rOccupie d Residen t Name : Contractor : Owne rName : [POWER S SCOT T A |PRUDENT2009_S jPROSOSK I JENNIFE R Propert yAddress : Contrac t Optio n Owne rAddressl : |330 7 SPRIN G ST [BAS E Zi p Code : Owne rAddressZ : |68105 Assessment : |330 7 SPRIN G ST Residen t Phon e City : State : Zi p Code : Quaiifyin g Grou p 

# I jOMAH A |N E |6810 5 pOO/CHl S Owne rPhone : Alternat e Phone : Assessmen t MaxXR F Vaiue : 

# 1 1 

# r 506.8 6IIHIIOIHMKII Wm w IWIMNgttfc V 

### Date : 9/15/200 9 Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l Monthof : Augus t Propert y Address : 3307 SPRIN GS 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 Information : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : B l = 204 PP M @ 4" ; N O EASEMENT ATTACHMENT S 1 ) Propert y sketchprovidedb y EP A pursuan t t o 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 clip/photograph s 4 ) Post-Excavation digita l vide o clip/photograph s 5 ) Dociuuentation - CompletedClose-ou t Checklis t 6 ) As-Built sketch­ i ) Shall includ e final lea dlevel 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 t o b e includedi n th e individua l propert y file, i f available , o r obtainedinclude : i ) Pre-excavation agreemen t detail s (i f an y ar e mad e wit hth 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 ) or SW F(Flas hPlayer ) forma t and/or photograph s iv ) Signedfor mverifying satisfactot y restoratio n v ) Description of area s not meeting InterimRO D cleanu p criteria .

nilCHNQlOCIES:iNC :

### TECHNOLOGIES . INC . 

# BEP A EP A Propert y Clos e Ou t Propert y # : '^'^ ^ ^ Propert y Address:' 5 $0 7 SC*^ ^ ^ ' Date/Time : ,5-l>-0 ^ Owner' s Name : S^CJ ^ {^'•"^T-^* - 

### Quad s Excavated : S' i Contracto r Grou p Pruden t Technologie s Excavatio n Genera l Ye s N o 1 . If necessary , wer e th e correct quadrant(s ) excavatedan drestored ? 

## y 2 . If necessary , wer e th e correct area s ofdri p zone excavatedan drestored ? / 

### Gradin g Sodan dVegetatio n Ye s N o 1 . Doe s th e gradin g aroundth e perimete r o

f th e hous e in excavatedarea s generally slop e awa y 

# y fromth e house ? 2 . Ha s sodbeen lai di n all area s tha t wer e excavated ? 

# y 3 ! Doe s the sodappea r t o b e generally health y an dgrowing ? (Qnl y evaluat e if iiiBpecte da t a3 0 

# y da

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

# y 5 . Ar e th e joint s betwee n th e sodstrip s generall y tight ? (Onl y evaluat e i f inspecteda t a3 0 da y 

# y tim e period) 6 . • Was the propert y graded3uc htha t wate r iVil l not pool o n the property ? " 

# y 7 . Was damag e t o landscaping or plan t material s avoided ? 

# y Gates , Fence s an dRetainin g Wall s Ye s N o 1 . D o gate s ope n an dclos e freely? (If applicable) / 

### 2 . Wer e all gate s or fence s taken dow n during restoration activitie s reinstalled ? (If applicable ) 

# y 3 . Was damag e t o gate s or fence s avoided ? (If applicable ) 

# y 4 . Was damag e t o retaining wall s avoided ? (If applicable ) 

# y Foundation , Sidin g an dGutter s Ye s N o 1 . Was damag e t o th e siding o r trimavoided ? 

# y 2 . Was damag e t o the foundation avoided ? 

# y 3 . Was damag e t o window s avoided ? 

# y 4 . Was damag e to window s or doo r screen s avoided ? 

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

# y Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Was damag e t o drivewa y surface s avoided ? / t / 

### 2 . Was damag e t o walkwa y surface s avoided ?

# 30 ? 

# Sf'^ ^ S ^ Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complet e includin g th e 30-da y so dwarranty : EP A Representativ e A A Date : s/zy/o /

# %EP A Propert yCompletio n Agreemen t Thi s agreemen t 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 propert y owne r i s satisfie dwit hth e restoratio n ofth e subjec t property , an dtha t n o item s ar e i n question , now , o r at an y tim e i n th e fiiture , excludin g any remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y ID : Propert y Address : "^'^ Q -7 

# S J ^ Owne r Phone : ^ 

### Restoratio n Item s i n Question :

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

LJ 1 agre e restoratio n i s completed , excep t a s note d above . LJ I d o no t agre e restoratio n i s complete d 

# 1 .

Owner' s Signaturi Dat ePruden t Technologies , Inc . (Prudent ) i s unde r contrac t wit hth e U . S . Environmenta l Protectia n Agenc y (EPA ) t o clea n u p lead contaminate dsoil s a t anumbe r ofpropertie s locate di n Omaha , Nebraska , includin g th e propert y locate da t

. Th e EP A request s you r permissio n t o allo w Pmden t t o performasoi l cleanu p at thi s property t o remov e lead-cantaminate dsoil . B y signin g thi s form , th e property owne r grant s permissio n t o Pruden t t o perfor m activitie s relate dt o th e cleanu p includin g soi l sanpling , remova l o f lead-contaminate dsoil , mi drestoratio n ofth e reference dproperty . I f

yo u hav e an y question s abou t th e soi l cleani^ } plaime dfor you r property , pleas e contac t Prudent' s Administrativ e Clerk fo r th e Omah aLea dSit e cleanup . Ms . Siv aS . .lampana-a t (402 ) 733-1188 . Genera l question s abou t th e Omah aLea dSit e cleanu p ca n b e directe dt o th e EP A Publi c hifoimatio n Center s a t (402 ) 73 1 -304 5 (SouthOmah aoffice ) o r (402 ) 991-958 3 (Nort hOmah aoffice) . Propeit y Acces s Grante dBy : (Pleas e Prin t Name ) Property Owne r Signature : 

# i £ 

# m n (Si^iature ) (Date ) PROPERT Y INFORMATIO N (T

o b e completed b yresMcm t and/o rpropert yowne r—pleas e prtut ) RESIDEN T NAME : Owne r Rente r RESIDEN T ADDRESS : 330 1 S p ^ ' ^ 

## K> ^ 

## C y »\ . I F RENTAL , PROPERT Y OWNE D BY : OWNER' S MAIUN G ADDRESS ; OWNER' S TELEPHON E NUMBE R - HOME : < 'l O ) J2.\ Z - S o V{ ^

WORK : AO E O F HOME? : 

# -.'^^H^ . HO W LON O HAV E YO U LIVE D HERE ? 

# A YEARS . HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WTT H SIDIN O SINC E 1978 7 _YE S 

### N O

. / NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OL D 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 6 HOUR S O R MOR E PE R WEEK : 

# _ I _ COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOOS . ENTR Y OATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS E ACTIONS : 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 n 10 4 ofCERCLA , 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 n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry for "detenninin g tb e nee dfb r response , o r choosin g o r takin g an y respons e actio n unde r thi s title , o r otherwis e enforcin g th e provision s ofth e title. "

808 0 Ward Parkway , Suit e 405 2505 N . 24* ^ Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , MO 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 Favn-\n \ K7Q-fiS7 7ENVlRONM£.MA L CONSTRLCn C 

### TECHNOLOGIES , INC . SERVIC I 

# Propert y Statu s For m Address : ^HglB^o^^i!tiilA^&^B& ^ ^ Date : '^ \i ^ ' °' ' Phone : ^t i 2 . - a^\' 2 - gf ^2^1 ^ BVID : Ite mN O Plant s «& Permanen t Landscapin g T o Remai n I n Plac e O n Ma p Descriptio n & Locatio n 

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808 0 War d Parltway , Suit e 40 5 250 5 N . 24 " Street . Suit e 30 8 424 2 IMedica l Drive , Suit e 425 0 KansasCity , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phnn» ! r402 ) 504-100 4 Phona : (210)822-958 6PRUDEN T TECHNOLOGIES , INC . 

## 2202 5

56891 9 (8/08 )JES , INC . 

## A S - BUIL T DRAWIN G OLS#:1410 0 Dat e Excavated : 07/14/200 9 

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• YOU RTICKE T NUMBE RI S 2302335 . Origina l Cal l Date : 6/24/0 9 Time : 11:4 8 am Op : SIVA1896 7 Wor k t o Begi n Date : 6/26/0 9 Time : 12:3 0 p m State : N E County : DOUGLA S Place : OMAH A Aciciress : 330 7 Street : SPRIN G S T Twp : 15 NRng : 13 E Sect-Qtr : 33-N 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 : FA X AL L CLEAR S T O (402 ) 73 3 188 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 : NFront : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V

MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F 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 Emeig : 402932975 7 MUD02 METROPOLITA N UTILITIE S DISTRICT SAND Y Day : 402504782 3

Alt :

Emeig : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO N Day : 402444719 7 Alt : 402444516 1 Emeig : 402444516 0 OPPDGPR 6 OMAH A PUBLI C POWE RDISTRICT N A Day : 406728934 3 Alt : 406207149 4 Emeig : 888728934 3 QLNNEIFQWES T LOCA LNETWOR K

N A Day : 406728934 3 Alt : 406207149 4 Emeig : 888728934 3ENVIRONMENTA L & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SOLUTION S 

# Sit e Safet yHazar d Analysi s ^ Address : 32o" ) Sp^/y,e , Crew : (p AK$vt6^// v f^x/f/ ^ 

# Bf . T/jT-c/ y Date : < ^ -^5" » <:? 5 

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