### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 3125 9 DATE ; 1/1 5 ADDRESS : 303 0 EMME TS T ^ ^ REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES . INC . YEAR : 20l| ) 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S d PR E AN D POSTVIDE O O F PORPERT Y(DVD ) d EXECUTIV E SUMMAR Y M EPA-PROVIDE D PROPERT YSKETC H d SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y n SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN TPROPERT Y d RESTORATIO N AGREEMEN T n SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R TO REPLAC E PLANTS , ETC. ) d CONFIRMATIO N DAT A d PHOTOGRAPH S d AS-BUIL TSKETC H Q SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R m PROPERT YCLOSE-OU TCHECKLIS TSIGNE D B YEP A D DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A

• UTILIT YCLEARANCE S m PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E D D D 

# ft^^ 3M L SIGNATUR E DAT E 

### 3021842 3 

# iHI I Superfun d

### PROPERT Y SUMMAR Y Date : /15/201 0 Oinah aLea dSit e Remedia l Actio nContrac t #EP-R7-07-0 6 TO# l Mont hof : Propert y Address : 303 0 EMME T 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 : B 2 = 41 6 PP M @ 13" ; E A = 9 6 PP M @ 6 " ATTACHMENT S 1 ) Property sketc hprovide db y EPA 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 digital 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 sketch
i ) Shal l includ e fina l 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 ) BVI 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 wit hth e property owner ) ii ) Property Statu s For msigne db y property owne r iii ) Excavatio n digita l vide o in MPEG , 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 n ofarea s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOCIES , INC .Rn d Record Remediatio n Quer yI Lea d Remainin g Quer y, Propert yDamag e Query 

### Backnii :

Sampi e Area : 3125 9 - 303 0 EMME TS T Owner : Use rProvide d Owne rInformatio n Resident : n Owne rOccupie d Owne rName : Owne rName : Residen t Name : (BATE S KEIT H A 

# r~— ^ Owne rAddressl : Owne rAddress : Propert yAddress : 

# r jSOB O EMME TS T Owne rAddressZ : Zi p Code : J P 0 BO X 1142 9 168111 - City : State : Zi p Code : City : State : Zi p Code : Residen t Phon e JOMAHA 

### JN E lesiii - 

# ' I 

# p - I Owne rPhon e Alternat e Phone : Owne rPhone : Altemat e Phone : 1(402 ) 457-544 3 1(402 ) 917^20 2

Contract : Assessment : Contractor : JPRUDENT2010_ S Qualifyin g Grou p |40 0 Contract Optio n JOPTIO N 2 Assessmen t Ma xXR F Valu e | 489.7 23 TTECHNOlJOGliSS , INC . 

# EP A Fropert y Clos e Ou t Propert y # : ' 3-1 ^ "2
- 6 ^ Propert y Atldress : 5<3"5< 3 t h^r^v^i " ^"^ ^ Bate/Time : Owner' s Name : ^ «.T4-v ^ ^.cc^e ^ Quad s Excavated : V "Z. . Contracto r Group : Prwilfinf TecltiniologicS i Unc.. , Excavatio n Genera J Ye s No I .I f necessarv . wer e Ihe correc l quadraiit(s ) excavate dan drestored ? / 2 .If necessar}' . wer e th e correc t area s o f dri p zon e excavate dan drestored ? / Gradin g So dan dVegetatio n Ye s N o 1 .Doe s th e gradin g aroun dth e perimete r of th e hous e i n excavate darea s generall y slop e away fromth e house'. ^ / 2 .Ha s so dbee n lai di n al l area s that wer e excavated ? / Doe s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte dat a3 0 day tim e period ) / 4 .Ar e sodde darea s generall y fir man devenl y graded ? / 5 .Ar c tli e jomt s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 dai y / tim e penod ) () . Wa s th e property grade dsuc htlia t wate r wil l no t poo l o n th e property' ^ / 7 .

Wa s daiuiig e t o landscapin g or plan t material s avoided ? / Gates , Fence s an dKetainin g WaU s 1 . D o gate s ope nan dclos e freely ? (I f applicable ) Ye s / N o 2 Were al l gale s or fence s take n dow ndiuin g restoratio nactivitie s reinstalled ? (If applicable ) / 3 Wa s daiu;;g e t o gate s o r fence s avoided ? (I f applicable ) / -1 . Wa s damag e t o retainin g wall s avoided ? (If applicable ) / Foundation , Sidin g an dGutter s Wa s damag e l o th e sidin g o r tri mavoided ? Wa s damag e t o th e foundatio n avoided ? Wa s dama£; e l o window s avoided ? Yes ^ 

# y

y 4 . Wa s damag e l o window s o r doo r screen s avoided ? 5 Wa s damag e f o downspout s o r downspou t extension s avoided ? 

# y
Sidewalk s an dBrivcway s (Concrete ) Ye s ^N o Wa s damag e t o diivewa y surface s avoided' ? 

# 7 f Wa s damag e t o walkwa y surface s avoided ? 

# y ­ 2

## Owner s comments :

Inspectio n notes : ^ A

V 

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## Remova l an drestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e 06 " A H ^Date : il^iti lrHNDEDGlES . INC . 

### A S - BUIL T DRAWIN G OL S #3125 9 Dat e Excavated : 10/18/201 0 

### OMAH A LEA D SUPERFUN D SIT E I'SEP ASigned-Of TDate : 

### 3125 9 Exterio rPain t NorthArro w Omah a Lea d Sit e Owne rName : KEIT H ABATE S • Goo d Sit e Sketc h Address : 303 0 EMME TS T n Poo r

Phone : H : W : ^ No t pain t 

# 1 Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Firm ; RYASCPXA-3125 9 F 1 Q 1 pp m 

### D Date : RYBSCPXA-3125 9 F2 2.2. q pp m 

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### D Time : g- 3 6 (^- ^ RYCSCPXA-3125 9 B 1 -^Of i pp m 

### D Sample s Analyze d RYDSCPXA-3125 9 B 2 ^qr > pp m 

### B D RDZSCPX A3125 0 OZ pp m 

### D D XR F Uni t lOO n Book : iisP i -ReZSePXA-3125 9 S Z pp m 

### D D Date : B-r^|-O U RPZ9CPXA-3120 9 PZ pp m 

### D D Time : p m Staff : MS\A / • Numbe ro f Sample s = Legen d F l= Fron t Left , F 2 = Fron t Rigtit , B 1 = Bac k Left , B2 = Bac k Rigti t D Z = Dri p Zone . G Z = Garden , P Z = Pla y Al l quadrant s ar e a

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VjOaVl^ . Ct-t-vVi- l S t EA = 9 6 PP M (ff i 6 " CONTRAC T# : EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC .

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## Propert yCompletio n Agreemen t Thi s agreemen t documents the completion o f remova l activitie s performe do n the below listedproperty . Th e propert y owner' s signatur e indicate s tha t the propert y owne r i s satisfiedwit hthe restoratio n ofth e subjec t property , an dtha t no items ar e i nquestion , now , o r a

t an y tim e i n the fiiture, excliiding an y remaining warrant y (3 0 day s total ) except thos e items listedbelow , i f any . Propert y ID : Propert y Address : ^^^f ) l j JO'^l^^d;^- ~ Owner : 

### Phone : L^^l - S'^^- S Restoratio n Item s i n Question :

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

I I agre e restoratio n i s completed . it/r l d o no t agre e restoratio n i s complete d a t (note d deficiencie s above )



### Owner' s Signatur e Dat eENVIRONMENTAL& CONSTRUCTION TECTHNOLOGIE S SERVICE S 

# PROPERT Y CONTAC T ATTEMPT S Propert y n> : 2>\'75' ^ Propert y Address ; 3Q3 o €Av»vig ^ S. ^ Owne r Name : ICjt»H > 12>ak i Owne r Phone : Ly5> ^ —S^^^ ^ Belo w pleas e fin dalistin g o f unsuccessfu l attempt s t o reac hth e abov e propert y owner . Dat e Tim e Initial s Resul t U/27^' 0 il'.cn a p>0
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# /A/-/ > Dat e Pruden t Technologies , Inc. , Acknowledgmen t signatur e Dat e EP A 808 0 War d Parlcway , Suit e 40 6 250 5 N . 24* ^

Stree t Suit e 30 8 424 2 Medica l Drive , Suit e 725 0 Kansa s CHy , M O 6411 4 Omaha . Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phnnn - (AlA ) 363-370 3 Phone : (402)604-100 4 Phone : (210)822-958 8

# "m . Pmden t Technologies , Inc . (Prudent ) is unde r contrac l withth eU. S. Enviromnenta l Protectio n Agenc y (EPA ) to clean up lead
contaminate dsoilsa t anumbe r ofDpspertie s locate d in Omaha , Nebraska , includin g th e propert y locate dat 2o^ O 3-yy)y>ia/ ' i Th e EP A request s you r permissio n lo allo w Pruden l to performasoi l cleanu pat thi s property to remov e lead-contaminate dsoil . By signin g thi s form , th e propert y owne r grant s permissio n to Pruden t to perfor m activitie s relate d to th e cleanu p includin g soi l sampling , remova l of lead-contaminate dsoil , an drestoratio n ofth e reference dproperty . Ifyo u hav e an y question s abou t th e soi l cleanu p planne dfor you r property , pleas e contac t Pruden l 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 ca nbe directe d to th e EP A Publi c Informatio n Center s at (402 ) 731-304 5 (SouthOmali aoffice ) or (402 ) 991-958 3 (NorthOmah aoffice ) Property Acces s Grante dBy : \ y y I I j,.-~.^ (Pleas (Pleas e e Prin

Prin t t Name ) 

# Azy^^-^EAA^ i^//// d Property Owne r Signatur e (Date ) y ^ (Signature ) XT Tf 

# Y PROPERT YINFORMATIO N /fi l be complete dby residen t and/o r propert y owne r —pleas e print ) RESIDEN TNAME : Owne r Rente r RESIDEN TADDRESS; —r" ) . «» . /\ >< f .^ ^ . ^ 

# 3o-^> o g^w^ ^ S f C)(NuA ^ tO( s 6g^(/ f IF RENTAL , PROPERT YOWNE D BY : 

# ^oy\ < %r^.Uy> . OWNER' S MAILINOADDRESS ; 

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## gr V f^touJL ^ M|E rQ^( { (^ OWNER' S TELEPHON E NUMBE R - HOME : ( ^b^ ) M 3 '~ ? *~ cS> ^ H ^ORK :
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 1978 ? 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 ROF CHILDRE N UNDE R 7 YEAR S OL D WH O PLA Y IN TH E YAR D FO R 5 HOUR S OR MOR E PE R WEEK : COMMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s to be implemente dby EP A unde r thi s agrcemen i ar e pursuan t to Sectio n10 4 ofCERCLA , 42 U.S.C . 9604 . EPA' s righ t of

acces s to th e propert yis provide dfor inSectio n 104(e ) of CERCLA , 42 U.S . C 9605(e) , whic hprovide s enti y for '"detenninin g th e nee dfor response , or choosin g or takin g an y respons e aclio n under thi s title , or otherwis e enforcin g th e provision s ofth e title. " 808 0 War d Parkway , Suit e 40 5 560 0 S tO St 424 2 Medica l Drive , Suit e 425 0 Kansa s City.M O 6411 4 Omaha . Webrask a 6810 7 Sa n Antonio . TX 7822 9 Phone : (816 ) 363-370 3 Phone : •;402 ) 733-116 8 Phone ; (210)822-968 8 Fax : (816 ) 363-370 7 Fair : (402 ) 733-188 3 Fax : (210 ) 679-667 7ENVIRONMENTA L& CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m. . Addres s 

# = 30-3 0 Q^,,^ ^ ^ ,D„e:fO///// o Phone : BVID :

Proj^ert y Owii | Pruden t Employe e Signature : Signature : 808 0 War dPa i 560 0 SI O S t Medl<;a l Drive , Suit e 425 0 Kansa s City , IM O 6411 4 Omaha , Nebraslt a 68107 Sa nAntonio , T X 7822 9 Phone : (816 ) 363-370 3 Fax : (816 ) 363-370 7 Phone : (402)733-118 8 Fax : (402)733-188 3 Phone : (210)822-958 8 Fax : (210 ) 579-657 71 

## 3125 9 Owne rName : KEIT H ABATE S Address : 303 0 EMME TS T Phone : H : W : Omah a Lea d Sit e Sit e Sketc h Exterio rPaint • Goo d n Poo r 0' ^ No t pain t Nort h Amj w \ Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Firm : Sample s Collecte d J* ^

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## D Date : ^ItZ-lOf o RYBSCPXA-3125 9 RYCSCPXA-3125 9 RYDSCPXA-3125 9 RDZSCPXA3125 9 RGZSCPXA-312S 9 F2 B 1 8 2 D Z G Z 

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### YOURTICKE T NUMBERI S 2614186 . Origina l Cal l Date : 10/11/1 0 Wor k t o Begi n Date : 10/14/1 0 Time : Time : 2:1 9 pm 7:1 5 a m Op : SIVA1896 7 State : N E Address : 303 0 County : DOUGLA S Street : EMME T S T Place : OMAH A Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 09-NE-N W Sect-Qtr : 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: PRUDEN T TECHNOLOGIE S Contac t Name : SIV AJAMPAM A Phone : (402)733-118 8 Wor k Bein g Don e For : EPA Dept ho f Excavation : 6 F T Corner Lo t Involve s Tunnelin g or Horizonta l Borin g CXCAT V MUDO l OMAHACO F0PPDGPR 5 N NExp l

QLNNEI C Front : osives : Y N Rear : Y

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
MUDO 1 METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCITY O FOMAHA-TRAFFICSEWERRICH/TRAFFIC 

### Day : Alt : 

### 402444719 7 402444516 1 

### Emerg : 402444516 0 0PPDGPR 5 OMAH A PUBLIC POWE RDISTRICT EL M LOCATING 

### Day : 406728934 3 Alt : 406207149 4 

### Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K EL M LOCATING 

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

### http://www.(ihon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 10/11/201 0

### ENVIRONMENTAL ENGINEERIN GAN D CONSTRUCTKW V ICDHIIOUMMBS , INC . 

### SOLUTION S 

## SIT ESAFET Y HAZAR D ANALYSI S Address : ^O^ g Crew :

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Hazard s Correctiv e Actio n

Sit e Safet y Offic e Date :

seoosios t 424 2 Medica l Drive , Stdt e 7250 >(aty;iio««ii 4 Omdiia , NaiMaak a 6B10 7 Sa n Antonio , T X 78229 Phao K(8W)3P'3?D 3 Ptan K(402)733-1ia 8 Phone : (2t0)e22-«58 8 Ra cfSn ) 363470 7 Fa c(402)733^1«8 3 Fax : (210)«7»«57 7

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