## TRANSMITTA Lo f OMAH A LEA D STI E SOI LREMEDIATIO NFIL EFOLDE R Date : SAID#:_g2il i 

# 4 4 ^ Address : 1^?? , ^ 3 S faf Remediatio nContractor : ^y^alUl i "V^LI A

## I ^NfL . Year : ^0 1 0 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f propert y (DVD ) Executiv e Summar y EPA-provide dpropert y sketch Signe dAcces s Agreemen t fo r

subjec t propert y Signe dAcces s .^eement(s ) fo r

adjacen t propert y Restoratio nAgreemen t Settlement document s (i.e. , fo r

damag e or t o replac e plants , etc. ) Confirmatio n data Photograph s As-built sketc h Satisfector y restoratio nsigne db y Propert y Owner Propert y close-out chec k

lis t signe db y EPA Descriptio n o f area s no t meetm g RO D cleanup criteri a Utilit y clearance s 

## Propert y informationfromDougla s Count y Assessor' s Of&ce

Signature Dat e 3026072 7 

# iili l Superfun dFin d Record 

### Backfill :

Sampl e Area : 534 4 - Owner : n Owne rOccupie d Owne rName : |BUESCHE R BRIA N Owne rAddressi : Owne rAddressZ : |1322S35AV E City : jOMAH A Remediatio n Quer yI Lea d Remainin g QueryI 

### 132 2 S 3 5 A V Resident : Residen t Name : JKOH N JEFFREYT Propert yAddress : J1322S35A V Zi p Code : |68105 Residen t Phon e State : Zi p Code : 

# 1 |N E |68105 Owne rPhone : Alternat e Phone : 

# ' 1 Propert yDamag e Quer y

Contract : Contractor : jPRUDEI^fT2009_ S Contrac t Optio n jOPnO N 1 Assessment : Qualifyin g Grou p j40 0 j 674. 4

### PROPERT Y SUMMAR Y Date : ///15/201 0 | Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 T0# 1 | MPQt hof ; \\j 0\ f 

## i- m Propert y Address : 132 2 S 3 5 AV E A . EXECUTIV ESUMMAR Y A. l 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 l = 5 5 PP M @ 6" ; F 2 = 10 2 PP M @ 6" ; D Z= 5 4 PP M @ 12" ; E A = 9 6 PP M @ SCRAP E(-1" ) ATTACHMENT S 1 ) Propert y 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 cUp/photograph s 5 ) Documentatio n- Complete dClose-ou t Checklis t 6 ) As-Buil t sketc h-. i ) Shal l includ e fma 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 di n th e individua l propert y file, i f available , o r obtaine dinclude : i ) Pre-excavatio n agreemen t detail s (ifan y ar e mad e withth e property Owner ) ii ) Property Statu s Formsigne db y property owne r iii ) Excavatio ndigita l vide o i nMPEG , 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 .

TECHNOLOGIES , INC .' TECHNOLOGIES , EMC . 

### Property # : 5'^'^' ^ Date/Time : Quad s Excavated : r * ,pZ,PZ . 

# EP A Propert y Clos e Ou t Property Address : \'3'2-7 . $ - "? > A-" ^ Owner' s Name : 6j-\rci,v ^ ^u€^cW * <" Contracto r Group : Pruden t Technologies , Inc. , Excavatio nGenera l Ye s N o 1 . I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? l / 2 . If necessary , wer e th e correc t area s of dri p zon e excavate dan drestored ? 

# y Gradin g So dan dVegetatio nYe s N o 1 .Doe s th e gradin g aroun dth e perimete r of th e house i nexcavate darea s generall y slop e awa y

- / fromLli e house ? 2 .Ha s so dbee nlai di nal l area s tha t wer e excavated ? 

# y 3 .

Doe s tli e so dappear t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 day tim e period ) 

# y 4 .Are sodde darea s generall y fir man devenl y graded ? / 5 .

Are di e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e if inspecte dat a3 0 day / tim e period ) 6 .Wa s th e propert> ' grade dsuc htliat wate r wil l no t poo l o nth e property ? / 7 .

Wa s damag e to landscapin g o r plan t niaterial s avoided ? / Gates , Fence s an dRetainin g Wall sYe s No 1 .D o gate s ope n an dclos e freely ? (Ifapplicable ) / 2 , Wer e al l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (I f applicable ) / 3 .

Wa s damag e l o gale s o r fence s avoided ? (I f applicable ) / 4 .Wa s damag e l o retainin g wall s avoided ? (If applicable ) / Foundation , Sidin g an dGutter sYe s N o 1 .Wa s damag e t o Ui e sidin g o r tri mavoided ? / 2 .Wa s damag e l o di e foundatio navoided ? / 3 .Wa s damag e l o windows avoided ? / 4 .Wa s damag e t o windows o r doo r screen s avoided ? • / 5 , Wa s damag e t o downspout s o r downspou t extension s avoided ? / Sidewalk s an dDriveway s (Concrete )Ye s N o 1 .Wa s damag e to drivewa\ ' surface s avoided ? i ^ 2 .Wa s damag e t o walkwa y surface s avoided ? /

# j^2 - 

# ^ 3 5 A v

Owner s comments :

Inspectio nnotes :



## p«" ^ 

# y - I I <i. ^



## Remova l an drestoratio nactivate s complet e including th e 30-da y sodwarranty : EP A Representativ e jQc* nj^iu ^ Date : i f i t ji b• f'T" ^ •F"^"'i\i - •'•"••f p ^-jf«3ii^i^j3 ­ 

# ^^ ZZ/fl m 

# ^m?^yr^iy Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio nof removal activitie s performe d on th e belo w liste dproperty . Th e property owner' s signatur e indicate s tha t th e property owner is satisfie dwit hth e restoratio nofth e subjec t property , an dtha t no item s ar e in question , now , or at any tim e inth e future , excludin g any remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , ifany . Proper t ID : Propert; ' Address : j^g Q 5 . 3S" ^ /j ^ Owner : DA^ ^

-fSl/^s^/" " Phone : 

## 4Po>-3^lb-?y7 3 Restoratio n Item s in Question :

Item : ^A'U^- O Glh^y^J' — ~^ ^icP^f-c^' ^ fi^yiiyiiJ>'t-/y i fe.yY^oyy^ Item : Item : 3 0 Ac ^

^ l.y ^

'^J ^ d^^cjj/r p Zj - dre< ^ j ^ S/^yu.)r<~ - ^.^ . Item : Item : Item : Require d correction s to complet e th e property: . 

# czy^ 

# c--^ ^ ^^- ^ ky/p>Z i li fi BTagr f 56 restoratio n is co m 

# -—r'^ ^ l^zy^AyJ:y ^ "f:^- . D I do iencie s 

## s above ) lo t agre e restoratio n is complete d at (note d deficiencie 

# /y^^-0 ^ Owner'»Signatur e Dat e

## NO . • « 

### TBCHNOLOGEES , INC . fiudwti Technoiogies , Inc . (Ptudao ) i s undo : concno x \vil hthi t U . S , Enviroomenta l Prouctic n Afjmc y (HPA) tu cle w u p Icad coDiabiiiiintedsoi b a ^ numbe r otpfopeftie n iocdte di nQ i tuha , Nebraska , iocludin g th e pcopcii y locitte da t | [ 3 p 3 - ^ . ' 3 C^A ^ . , Th e EP A regui st s yourpenmsnit mt o flll<wPnadeat t o pafon n asoi l clearm p at thi s property t o remov b lea<l<aiitaiiiiiiato dsed . B y sigoin g t hs fonn . Ui e propeit y owne r giaui s pqroussio n t o Pruden t t o perform aetfvjtic i reltite dt o th e cteaoa p meludio g soi l sampling , r e mova l o f Iea<i-ooja[amii>at«dsoil , an drestoratio n o f flie reforenee dproperty . Ifyo u hav « an y qoestion aabou t th e soi l clc&n.u p pUans dI v you r property , pleas e contac t Pruiieni' s Ailmimsiroiivu Clcf k for th e Omah aLea dSit e aleanj^ ^ Ma . Sw aS . J.'unpiii'm- M (402 ) nvnXH . Genera l question s abou t th e Omah aI^ea dSit e cletuni p ca n b e directe dt o th e EP A Publi c In&tmntio hCcntd s e t (402 ) 7 ' 1-304 3 (SomhOniah aoflfioe ) o r (402 ) 991-95S 3 ^oithOmah aoffice) . Property Acces s Grante dB y 

## j?ri& ^ \?Lj^eU y (PlMi e Prin t Name ) Propert y Ownar Sigoaiure : 

### //>'i?0-6 ^ PROPERT YINFORMATIO N (T o b e complete d b yrotd i s t And/o ripropert yowne r- pleas e print ) RESIDEN TNAME : 

## 3rc^/i ^ Dt^^d ^ Rente r RESIDEN TADDRESS : J . 

## i3»3*^ . 3>5r Au^ ^ 6,/vJ ^ A/ E 6>f/^S ' I PRENTAL , PROPERT Y OWNE D BY : ER' S MAILIN G ADDRESS; , ^ ^ . xi . • « i % ^ OWNER' S TELEPHON E NUMBER - HOME : t^O& i 3*{(if^>7' S WORK : 

# lO d 

# 2 ^ AG E O f HOME? : YEARS . HO W LON G HAV E YO U LIVE D HERE ? YEARS . HA S Ti^ E EXTERK3 R BEE N PAINTE D O R COVEREotwiT H SIDIN G SINC E 1878 ? >A ^ ^

.YE S N O INUMB^ R O F OCCUPANT S UNDE R 7 YEAR S OLD : l'> ^ NUMBE R O F OCCUPANT S 7 YEAR S OL O AN D OLDE R NUMBER O F CHILDRE N UNDE R 7 YEAR S OL O WH C i PLA YI N TH E YAR D FO R 5 HOUR S O R MOR E PE R WEEK : I cbMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOIbS , ENTR YQATES . ETC. ) / W .

lun^Olil T Y FO RENVIRONMENTA LRESPONS EACTI < JNS : Th e activiiie s t o b e implemenle db y EP A unde r thj s agrecsneo t i^visu i at o Sectio n10 4 ofCERCLA , 4 2 U.S.C . 9604 . EP JV S li ^ o f acces s t o ih c ptoperty i s providec l Co r i n SeeHio n 104<« > o f dERCLA , 4 2 U.S . C 9€0S{e) , vvbit^ provide s am y for "detentiinin g di e tiee dfor response , o r (ihooging o r takin g an y respons e Actio n ujode r tbi s title , o r otherwis e enforcin g AJ S provision s o f th e tit l

808 0 Wlr^iParkw^y , Suit e 40 5 Kansa s < C|ty,'M 0 61*-(l 4 Phone : (Sifi ) 363-370 3 Pax : (81J€)|i6S-370 7 560 O S 10 " stree t Omaha , I Nebrask a 6S10 7 Phone : (402 ) 73 3 -118 8

Fax : ( < 02 ) 733-188 3 424 2 Medica l Drive , Suit e 42S 0 Sa n Antonif> , T X 7822 9 Phone : (210)822-958 8 Fax ; (210 ) 579-657 7• • 

### NO . 150 2 P . 3/ 3 NOV. 4 . 200 9 12;03P M ENVIRONMENTA L* COIVSTRUCTIO N SERVICE S 

# Propertj y Statu s For m Addrei i 

# Date:/0»/^ ? Phon I 

# : \HO V 34(O - 

# ^?y 3 BVID : ItemN l Plaat s «f ePermanen t Landscapin g T o Remai aI nPlac e OnMa k Descriptio n& Locatio n \v \ ^ 

# u < L>

d 

## i_*/- ^ ^''^ ^ '^^ ^ 

# Ciw^V i ^ TH )

Conditio ao f

Structure s 1 you r Basemen t hav e ahistory o f

leakin g 

# X Ite mN O Descriptio n& Locatio n O nMa p y" \ tv^/t-fif . 

# A M ^ -H ^ ^p/.v.k)«/ - s^^ ^ r f \ 

# o^l y <^ J ^^ ^ ^ ^ frt&^y^f^ '

Propert y Owne r Pmden t Employe e 

# A B^ignati ; Signature :

I iOS O War d P^^ \ py , Surt p 40 5 fleOO SIO * Stree t 424 2 McdkM l Drive , Suit o 42S 0 Kansa s Ctty , M O >4n> ; Omjha , Nebrask a6810 7 San Aotonio , T X 7822 9 : >hon6 : (816 ) 5703 , Phene : (402)733-118 8 Phone : (210)822458 8 =aj< : (iB16 ) I 383'3 7 7 Fan : (402)733-188 3 Fax : (210 ) 579-857 7

# 1 ^ UHNOl.OUrF.S . INC . 

## AS - BUIL T DRAWIN G O l ,S«:53J 4 Oiit c Kxiiivatid : 1 l/lf./2(l(>! ) 

## OMAHA LEAD SUPERFUN D SIT E rsKl'.VSignecl-OtTniito :

OmahaLea dSit e 46904.783-0 1 CONTRAC T# : E P - R7-07-0 6 T0# 1 PRUDEN TTECHNOLOGIES , INC .C'tm-ahaLeai 3 Sit e •lt9!:^.7J(5-! ; I

## I"7 ? 

## ^ 1^ : A' '

## Prin t Preview Page 1 o f

2 Dougla s County-Omaha , N E

Parce l I D 070247000 0 Additio n BOULEVAR D TERRAC E Owne r Nam e BUESCHE R BRIA N Bloc k 2 Propert y Addres s 1322S3 5 A V Lo t 

## e Cit y OMAH A Lega l 1 

### 46X123. 2 Zi p 6810 5 Lega l 2 Owne r Addres s Lega l 3 Owne r Addres s 2 1322S3 5 AV E Lega l 4 Owne r Cit y OMAH A Acre s 

### 0.1 3 Owne r Stat e N E Treasure r Websit e Lin k http://webapps.dotcomm.org;8080/TreasTax/faces/pages/taxinfo.jsp ? parc=070247000 0 Assesso rhttp://douglasne.mapping Websit e online.com/DouglasCoNe/static/accountinfo.jsp ? Lin k accountno=R070247000 0 Sec-Twn Rn g

### Page l of 2

" > 

# E i i

• YOU RTICKE T NUMBE RI S 2400729 . Origina l Cal l Date : 11/05/0 9 Wor k t o Begi n Date : 11/09/0 9 Time. : Time : 9:1 5 a m 9:4 5 a m Op : SIVA1896 7 State : N E Address : 132 2 County : DOUGLA S Street : S 35T H AV E Place : OMAH A Twp : 15 N Twp : Rng : 13 E Rng : Sect-Qtr : 28-N W Sect-Qtr : Lega l Given : C Typ e o f Work : SOI L LEA D REMEDIATIO NPROJEC 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)733-1.18 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 LEVEL 3 MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F Servic e Are a Contac t Phon e Nunibe r Utility Typ e CXCAT V COX COMMUNICATIONS , IN C 

### HEID I Day ; 402934046 9 Alt : 402934046 9 Emer? : 402932975 7 LEVEL 3 LEVEL 3 COMMUNICATIONS , LL C N A 

### Day : 877366834 4 Alt : 

### Emerg : 877366834 4 MUD0 2 METROPOLITA N UTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : 

### Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R RICH/TRAFFI C 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0ENViRONMEWTA L & CONSTRUCTION 

### TECHNOLOGIES , INC . SOLUTION S 

# C D Sste Safet y Hazar dAnalysi s

i^iyXZ 

## Address : /JZ ZS i J S Crew : 

# Bf.M i Date : / / ^ ^ 5 Correctiv e 

# Ite m Conditio n Hazard s Actio n Overhea dLine s ^c<>c P /r7cy//-t/)/< & 

## Ga s Lin e hu^-tsJ . /l»*v ^ ./o'c^g.'i- ^ 

## Wate r Lin e 

# + - h Sewe r Lin e .^Critx J A/9^ J /Che:..*-/-^ 

## Septi c / Leec h fiel d / u ^ 

## Propane/Butan e /t^' ^ 

## Sidewaj k 

# y * ^ t^S ^ /p/fujg. ^ 

## Foundatio n '/~'^~i i 

## Retainin g Wall s y y ^ 

## Fence s ^ C~r ^ 

## Trees / Bushe s /^(ly f 

## Structure s -P^t . 

## Drivewa v 

# A /X- - £JiiS - ^ A,>/-.,^c^» ^ 

## Sprinkle r Syste m Ayy i 

## Othe r Cre w F Sit e Safety Office r

808 0 War d Parkway . Suit e 40 5 250 5 N . 24" ' Street , Suit e 30 8 424 2 Wedica i uri'/e . Suit e 725 0 KsnsasCity , M O 6411 4 Oniaha , NebrasK a6811 0 Sa n Antonio , T X 7822 3 Phone : (816 ) 363-370 3 Phone : (402) 504-100 4 Phone : (210 ) 822-968 6 • Cs v lino s cr\/...ie\r, c

# m2 2