## TRANSMTTTA Lo f OMAH A LEA D STT E SOI LREMEDLVTIO N FIL EFOLDE R SAn)# : iFllff^ ^ Date : otlir ) ;3ol O Address : ,|Ul g CorU ) ^ V RemediationContiactor : IjVuAtiy^ ^ "Ull v \v\fl . Year : (^0\ 0 SOI LREMEDL^TIO N PROPERT YFIL EFOLDE RDOCUMENT S 0 Vide o o f propert y (DVD ) 2

IExecutiv e Summar y EEPA-provide dpropert y sketc h BJSigne dAcces s Agreemen t for subjec t propert y D Signe dAcces s Agreement(s ) fo r adja^«n t propert y ii ^ Restoratio nAgreemen t D Settlemen t document s (i.e. , fo r dami^ e o r t o replac e plants , etc. ) B J Confirmatio n dat a O

f Photograpih s 

## aAs-buil t sketc h 3 Satisfector y restoratio nsigne db y Propert y Owne r ffl Propert y close-ou t chec k lis t signe db y EP A D Descriptio no f area s no t meetin g RO D cleaniq ) criteri a Q Utilit y clearance s 

## Q

l Propert y informatio nfromDougla s Count y Assessor' s Offic e D D 

# n fetignatirte Dat e 3005419 1 

# • i i Superfun dRn d Recor d 

### Backfill :

Sampl e Area : 2969 3 -161 8 CORB YS T Owner : n Owne rOccupie d Owne rName : CTT YO F OMAH A Owne rAddressl : C/ 0 JAME S THEL E Owne rAddressZ : 181 9 FARNAM S T#111 1 

### aty : State : Zi p Code : OMAH A |N E |6818 3 Owne rPhone : AKemat e Phone : Remediatio n QueryI Lea d Remainin g QueryI Propert yDamag e Quer y

Resident : Residen t Name : Propert yAddress : |161 8 CORB YST Zi p Code : |6811 0 Residen t Phon e 

# I Contract : Contractor : |PRUDEi^T2009_S Contrac t Optio n OPTIO N 3 Assessment : Qualifyin g Grou p 40 0 Assessmen t MaxXR F Value : 

## I 42 ^

### PROPERT Y SUMMAR Y Date;0l/15/201 0 | Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l | Mont hof : ^(^ , f Propert y Address ; 161 8 CORB Y 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 N SAMPLIN GDATA/RESULTS : F l = 5 1 PPM @ 10" ; E A = 200 PPM @ SCRAPE(-1" ) ATTACHMENT S 1 ) Propert y sketchprovidedb y EP A pursuan t to contrac t specification s 2 ) SignedAcces s Agreemen t including acces s agreements 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 ) Documentation - CompletedClose-ou t Checklist 6 ) As-Buil t sketc h­ i ) Shal l include fina l lea dlevel s v ) Legen d 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 the individua l propert y file, if available , or obtainedinclude : i ) Pre-excavation agreemen t detail s (if an y ar e mad e wit hthe propert y owner ) ii ) Propert y Statu s For msignedby propert y owne r iii ) Excavation digita l vide o i n MPEG , WM V (Window s Medi aVideo ) or SW F(FlashPlayer ) forma t and/or photograph s iv ) Signe dfor mverifying satisfector y restoration v ) Description of area s not meeting InterimRO D cleanu p criteria .

TECHNOLOGIES , INC .•ITECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y # : <39(p9 3 Propert y Address : \{ji\ ^ Coxbv j 5 ^ Date/Time : la||/o 9 Owner' s Name : ^/K* , aS- aw^-^A.* ^ Quad s Excavated : Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s N o 1 . If necessary , wer e tli e correc t quadrant(s ) excavate dan drestored ? y 2 . If necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? 

### • Gradin g So dan dVegetatio n 1 . Doe s th e gradin g arouii dth e perimete r o f th e hous e i n excavate darea s generall y slop e awa y fro mth e house ? Ye s 

## • N o 2 . 3 . Ha s so dbee n lai di n al l area s that wer e excavated ? Doe s tli e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 da

y tim e period ) y y 4 . 5 . Ar e sodde darea s generall y firman devenl y graded ? Ar e di e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte dat a3 0 day tim e period ) 

### y y 6 . Wa s di e property grade dsuc htliat wate r wil l no t poo l o n th e property ? y 7 . Wa s damag e t o landscapin g o r plan t material s avoided ? y Gates , 1 . Fence s an dRetainin g Wall s D o gate s ope n an dclos e freely ? (I f applicable ) Ye s y N o 2 . Were al l gate s o r fence s take n dow n durin g restoratio n activitie s reinstalled ? (I f applicable ) y .1 . Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) 

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

# y Foundation , Sidin g an dGutter s 1 . 2 . Wa s damag e t o th e sidin g o r tri mavoided ? Wa s damag e t o tli e foundatio n avoided ? Ye s 

## y y N o

.3 . Wa s damag e l o window s avoided ? 

## y 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 ? 

### y Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Wa s daiuiige t o drivewa y surface s avoided ? 

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

## 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 dour , i ^ Date : /z/jt/o f

## No . 705 0 P . 2«"/ooo 3 ^ov.25 . 200 9 10:17A M OM/|^PLANNIN GDEPT . 402-444-614 0



# Propert y Completio n Agreemen t Thi s {igrtemenl document s th e completio n o f removal activitie s performe don th e belo w liste dproperty . Th e property owner' s sigiiatur c indicate s tlia t th e properl y owner i s satisfie dwit hth e restoratio n o f di e subjec t i:roperi:y , an dtiia c n o item s ar c in . question , now , o r a t any tim e i n th e flilurc , cKcIudiiig an y remaiiiin i warranty (3 0 day s total ) excep t thos e item s liste dbelow , i f any . «<T3>UtafMnt.»M»vAnU«hH«ri — 

### 5 Propert) - I D I Property Addreti s 

# ''^.^Mtl^.^Cs>rhy ^ , ^ } Owner : !J^/lAl.>g5l?.—J^giE?ria<ab : Phone : 

# y ; ^ 

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### OM ^ PLANNINGDEPT . 402-444-614 0 looct . 9 . 2009*10:12A M

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### 10.442 1 P. 2 

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## TECHNOLOGIES , INC . TfXINiw^U* ^ •••—^• 1 I 

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# 0 1WmCJI.OlilF.S . INC . 

## A S - BUIL T DRAWIN G ()I,S#:2969 3 Dat e KM-axattd : lll/2S/20() 9 

## OMAHA LEAD SUPERFUND SIT E 1>>KP. \Signe dOir Dote : 

## 2969 3 Exterio rPain t Nort h Arro w Omah a Lea d Sit e • Goo d Sit e Sketc h D-Poo r Samplin g Addrsss : I6I8CORB YS T Q No t pain t 

# i Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Firm : Sample s Collecte d RYASCPXA-2969 3 F l 

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## .Qj Staff : MS W Legend : F 1 = Fron t Left , F 2 = Fron t Right , B 1 = Bat * Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s are a s vlawa d fro m th e atrect , fadn g propert y 

## ENTERjE D OC T 0 2200 7



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## 2969 3 Exterio rPain t Nort h AIr^!^^ • 

### Omah a Lea d Sit e • Goori Sit e Sketc h n^Poo r Samplin g Address : 161 8 CORB YS T { J No t pain t 

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## D Date : q]?. ^ \0 1 RYBSCPXA-2969 3 F 2 

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• YOU RTICKE T NUMBE R IS 238.3468 . Origin.^. . Cal l Date : 10/0^-/0 9 Wor k t. O H.egir . Ddte : lO/l-i/0 9 Tiic.e : 10:2 4 am Time : 11:0 0 am Op ; SIVA1896 7 State : Ul Address : 161 8 County : DOUGLA S Street : CORB Y ST Place : OMAH A Twp : Ib^ i Rng : Twp : R-'ig : Lega l Given : C 13 E Seci-.-Qtr : IC-SE-S W Secc-Qtr : Typ e of :\fork : SOI L LEA D REMEDIATIO NPROJEC T Locati':? n of Work : LOCAT E ENTIR E PROPERT Y Remark:- : yA X AL L CLEAR S "'O : { 40 2 • •• 3 j -1 b3 3 : FA X .••\[.:L . CLEAR S TO (402 ) 73 3 liS 3 : UNS'JR E CORNE.R S Comj)a.-i y: PRrjDF.M T TECHt^OLOGIE: S Conta.-.i" . 1,'ame : SIV A.JAMPA.--;: \ Phone : (402)733-118 8 Wor k •Vj..i-, qDon.- ^ For : EP A Dept h •::• • E.xcavation : 6 FT C.-;rno r Lot : N Involve.'.- : Tuniisl.i.n g or Horizonta l Borin g : N Front : Y Explosives : N CXCAT V MAGELLA NMUDO l OMOLHACO F 0PPDGPR 5 QLNNEI C Rear :

Servic e .\re a Contac t Phon e Numbe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS . INC HEID I Day : 402934046 9 Alt : 402934046 9 Einerg : 402932975 7 MAGEl.LAM MAGHLI.AN MIDSTREAM PARTNER S LP DEBORA H Day : Alt : 918574709 8 

### Emerg : 918574709 8 MUDO l ME I-KOi'OLrrA N UTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCIT Y

OFOMAHA-TRAFFICSEWE RRO N Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0
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### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNNEI C QWES T LOCALNETWOR K N A 

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



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### TECHNOLOGiES , i^iC .



## Address : lQj.Sz-C<zy. . 

# ere. : ff f ^— Date : J O /ro-n ^ 

# ^^y^Ac^yj/1^ ^

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## Overhea dLkiei ? 

## y^J L Ga s Lin e \ \are r 1-hi e SeNse r

I.iji e Septi c / Leec h fiel d PrG|>a!ieRutan e Sidewal k foundatio n Retainin g \ \ali s Fence s Tree s Bushe s .^_/ i 1^ ^ 

## Structure s Driveway " 1 

## Sprinkie r S>ste m -y^^ ~ 

## Othe r Crc n Forema n '"^iv e S^j^.'ff n Officer * .y^^ ^