### TRANSMITTA L o f OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 2>.^9.^o . Date : ij^.^jrQCiO ^ Address : ^/ i B / y ^.' T A S Remediatio n Contractor : Pi?,- , (^9-n- f h^4i-Nnir>qt^.lr,ti.^ . Year : fPflflS-Afl* ? SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S [Ef ' Vide o o f propert y (DVD ) 4031028 3 

### ^ Executiv e sTMTM ^ {|||||||Hg | B

^ EPA-providedpropert y sketch Superfun d B

^ SignedAcces s Agreemen t fo r

subject propert y D SignedAcces s Agreement(s ) fo r

adja(?en t propert y E

f Restoratio nAgreemen t D Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) B' Confirmatio n dat a 0 ^ Photograph s H^ As-buil t sketc h 0 ^ Satisfector y restoratio n signe db y Propert y Owne r S ^ 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 B ' Utilit y clearance s 0 ^ Propert y infonnatio n fromDougla s Count y Assessor' s Offic e D D D 

### Sigoati^ ^ ' "^ifat e

### PROPERT Y SUMMAR Y 1 Date : 01/23/200 9 Omah aLeadSite Remedial Actio n Contrac t #EP-R7-07-06/0004 Mond i of : Dec/Ja n Propert y Address : 411 8 N 2 5 A V 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 Otfier Relevan t Information : NON E CONFIRMATIO N SAMPLIN G DATA/RESULTS : B l = 11 2 PP M @ 6" ; F l = 9 3 PP M @ 6" ; E A = 12 6 PP M @ SCRAPE ATTACHMENT S 1 ) Propert y sketch provide dby EP A pursuan t t o contract specification s 2 ) SignedAcces s Agreemen t including acces s agreement s reqiure dfo r crossing othe r propertie s 3 ) Pre-Excavatio n digita l vide o clip/photograph s 4 ) Post-Excavatio n ^gita l vide o clip/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Buil t sketch ­ i) . Shall include , 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 includedin th e individua l propert y file, i f available , or obtainedinclude : i ) Pre-excavatio n agreemen t detail s (i f an y ar e mad e wit h the 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 ) forma t and/o r photogr^h s iv ) Signedfor mverifyin g satisfactor y restoratio n v ) Descriptio n o f area s no t meeting InterimROD cleanu p criteria .

TECHNOLOGIES , INC .Fin d Recor d Clea n U p Quer yI Lea d Remainin g Quer yI Propert yDamage Quer yI Backnil :

Sampl e Area : 3383 3 - 411 8 N 2 5 A V Owner : Resident : Contract : D Owne rOccupied Residen t Name : Contractor : Owne rName : 

### |PRUDErrr2008_ s 

# r |CLARK E BERTRA M L _ Propert yAddress : . Group : Owne rAddressl : |411 8 N 2 5 A V 

# r Zi p Code : Assessment : Owne rAddress2 : |6811 1 115 6 ESTAT E DR Residen t Phon e Qualifyin g Grou p City : State : Zi p Code : 

# L |PLAYZON E |CHICO ~ IC A; 19592 8 Assessment XRF Date : Owne rPhone : Alternat e Phone : ! .

_ ._ , )(530 ) 98 8 521 7 • |(530 ) 321-864 9 Assessmen t Ma xXR F Value : 

# I 7l 7x TECHNOLOGIES . IN C 

# &BV < EP A Propert y Clos e Ou t Propert y # : 3 3 8 3 2 > Propert y Address : 4 l I fi N V 5 A V Date/Time : Owner' s Name : Quad s Excavated : S O -f^l- J E A Contracto r Grou p Pruden t Technologie s Excavatio n Genera l Ye s 

## p o 1 . If necessary , wer e th e correc t quadrant(s ) excavatedan drestored ? 

### L ^ ^ 2 .If necessary , wer e the correc t area s o f drip zone excavatedan drestored ? ^ Gradin g So dan dVegetatio n Ye s No I .

Doe s the grading aroun dth e perimete r ofth e hous e i n excavatedarea s generaU y slop e awa y 

# iyr ~ fromthe house ? 2 .

Ha s so dbee n laidi n all area s tha t wer e excavated ? 3 .

Doe s the so dappea r t o b e generall y health y andgrowing ? (Onl y evaluat e if inspecteda t a3 0 da

y tim e period) 4 .

Ar e soddedareas generall y firman devenl y graded ? 

# P ^ 5 .Ar e the joint s betwee n the so dstrip s generall y tight ? (Onl y evaluat e if inspecteda t a3 0 da y tim e period) 

# Z
­ 6 .Wa s the propert y gradedsuc h tha t wate r will no t poo l o n th e property ? 

# Z ' 7 .

Was damage to landscaping o r plan t material s avoided ? Gates , Fence s an dRetainin g WaUs Ye s N o 1 .D o gate s ope n an dclos e freely? (If applicable ) 2 .Wer e all gate s o r fence s taken dow n durin g restoratio n activitie s reinstalled ? (I f applicable ) 1 / 3 .

Wa s damag e to gate s or fence s avoided ? (If applicable ) 

# Z ^ 4 .Wa s damage t o retaining wall s avoided ? (I f applicable ) Foundation , Sidin g an dGutter s Ye s N o 1 .

Wa s damag e t o the siding o r trimavoided ? 

# y . 2 . Was damage to the foundation avoided ? 1 / 3 .

Was damage to window s avoided ? 

# P / 4 .Was damage to window s o r doo r screen s avoided ? 

# y 5 .Was damag e to downspouts or downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ye s y p 1 .

Wa s damag e to drivewa y surface s avoided ? 

# 1 / 2 .

Wa s damage t o walkwa y surface s avoided ?

### Owner s comments :

Inspectio n notes :

Remova l andrestoratioii_activate s compl^i; b including the 30-da y so dwarrpty : EP A Representativ e 

# MT K l{/Al< y Date : U 6 O f

# ^ P A Propert yCompletio n Agreemen t Thi s agreement document s th e completio n o f removal activitie s performe do n th e belo w liste dproperty . Th e propert y owner' s signature indicate s that th e property owner i s satisfie dwith th e restoratio n ofth e subjec t property , an dthat n o item s are in question , now , o r a t any tim e i n th e future , excludin g an y remainin g warranty (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Property ID : Property Address : Mi'l^ j S 

# as v f(\ ^ ' --<:J : Owner : Phone : Restoratio n Hem s i n Question :

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

## yi/^e d -h ^ iy^ ^ ^^< ^ <^^> ^ ^ .p"" ^ ^/ooj- .

M I agre e restoratio n I s completed , excep t a s note d at}ove . l l I d o no t agre e restoratio n i s complete d 

# /:>-p.i( , - a 3 wher' s Signature Dat e

\ ^Pniden t Technologies , Inc . (Pnident ) i s unde r contrac t with th e V . S . Environmenta l Protectio n Agenc y (EPA ) t o clea n u p lead
contaminate dsoil s a t anumbe r o f

propertie s locate di n Omaha , Nebraska , includin g th e propert y locate da t Th e EP A requests you r permissio n tO'allo w Pruden t t o perfor masoi l cleanu p a t thi s property t o remove lead-contaminate dsoil . B y signin g this 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 sampling , remova l 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 cleanu p planne dfo r you r property , pleas e contac t Pruden t Administradv c Cler k fo r th e Omah aLea dSit e cleanup . Ms . Deborah Johnso n -a t (402 ) 733-1188 . Genera l quesdon s abou t th e Omah aLea dSit e cleanu p ca n b e directe dt o th e EP A Publi c Informatio n Ccmer s a t (402 ) 731-304 5 (South Omah aoffice ) o r (402 ) 991-958 3 (Nort h Omah aoffice) . Property Acces s Grante dBy : 

### / ? LJ/J^ ^

- ^ (Pleas e Prin t Name ) Propert y Owne r Signature : (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 NAM E 

## A/OLCXJI ^



# fol — Owne r Rente r RESIDEN T ADDRESS : 

## 9.,S^^ - Ay^ ^ 6-V^^^JUA . 

## k3 ^ 4S H O I F RENTAL , PROPERT Y OWNE D BY: v, . \ / OWNER' S MAILIN G ADDRESS ; y ^ 

# /w ^ sc.,..J U M ^ es M D
OWNER' S TELEPHON E NUMBER-HOME : X 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 FOR 5 HOUR S O R MOR E PE R WEEK : -COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. ) / - AUTHORIT Y FO RENVIRONMENTA L RESPONS E ACTIONS ; Th e activitie s t o b e implemente db y EP A unde r this agreemen t ar e pursuan t t o Sectio n 104o f CERCLA , 4 2 U.S.C . 9604 . EPA' s tigh t ofacces s t o th e propeit y i s provide dfo r i n Sectio n 104(e)o f CERCLA , 4 2 U.S . C 9605(e) , whic h provide s enti y fo r "determinin g di e nee dfo r response, o r choosin g o r takin g an y respons e actio n unde r this title , o r otherwis e enforcin g th e provision s o f th e title."

808 0 War d Parkway , Suit e 40 5 2S0 5 N . 24* ^ Street , Suit e 30 8 424 2 Metiica 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 \ .

# J^" ^ f . ' 

### .•.iOMAHALEADSlJEERFIlSn)SIT E>: OLS# : 3383 3 Date Excavated : 11/24/200 8 USEP A Sii^-Of f Date : 

### 3383 3 Exterio rPain t Nort h Arro w Omah a Lea d Sit e • Goo d Sit e Sketc h • Poo r Samplin g Addrast : 411BN2SA V [3 f No t pain t Lea d Sampl e Sample s Collecte d Sampl a Numbe r U B Concentratio n Collecte ledfi d Firm : PF g.C . e.l^ . RYASCPXA-3383 3 F1 CBI. S pp m 

## a' Date : ^-Z^-S - RYBSCPXA-33B3 3 F2 I «t 6) pp m D Time, 2'l^i>'f« ' RYCSCPXA-33e3 3 Bl 5 5 6> pp m 

## a Sample s Analyze d RYDSCPXA-3383 3 B2 20 2 oo m 

## n • negoopx/^Doeaa S i - " PP" ' D XRFUnB : CoS'-l n Book : 20 1 -RczsopxA-saew - -e z ^ pp m D Date : 

### ^•28-o e RPZSCPXA-3383 3 PZ IH S pp m Time : Nf ^ 

# • La b RYASCPLA-3333 3 Staff : MS W Numbe r of Sample s = [ 3 1 | j | i^Resul t 71 7 pp m Fro m Right . B1 = Bac k Lett , B2 = Bec k Righ tOZ - Dri p Zone , GZ = Garden , PZ = Ple y Al l quadranc s an as rfnnd Ira n th a itnat . racing propM y t ' • : " '

EA = 12 6 PP M @ SCRAP E

CONTRA a #: EP - R7-07-0 6 / 000 4 PRUDEN T TECHNOLOGIES , INC .ENVIRONMENTA L & 

# >RUDEN ' CONSTRUCTIO N 

### TECHNOLOGIES , MC . SERVICE S 

# Propert y Statu s For m Address : Hi\ ^ ^ 2,^t V A^e^ ^ »«*« = ^M^'^* ^ Phone : BVID : Ite mN O Plant s & Permanen t Landscapin g T o Remai n I n Plac e OnMa p Descriptio n & Locatio n

Pre-Existin g Conditio n of Structure s DoesyourBasementhaveahistor y o f

leaking ? Ye s No Ite mN O Descriptio n & Locatio n OnMa p

Propert y Owne r Pruden t Employe e \ 

### Signature : Signature :

808 0 War d Parkway , Suit e 40 5 250 S N . 24* ^ Stree t Suit e 30 8 424 2 Medica l Drive , Suit e 426 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)822-968 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7i'rin t Preview http://www.dogis.org/dogis_alias/dogis/prmtPreview.aspx7PrintOpt . 

## Dougla s County-Omaha , N E

Parce l I D 143369000 0 Sec-Twn-Rn g 04-15-1 3 Owne r Nam e CLARK E BERTRA M L Additio n KENDALL S AD D Propert y Addres s 4118N25A V Bloc k 6 Cit y OMAH A Lo t 2 Zi p 6811 1 Lega l 1 8 5 F T L T 1 & N 4 0 FT Owne r Addres s Lega l 2 45X13 2 Owne r Addres s 2 15 6 ESTAT E D R Lega l 3 Owne rCit y CHIC O Lega l 4 Owne r Stat e C A Treasure r Websit e Lin k http://webapps.dotcomm . or g :8080/TreasTax/faces/page s /taxinfo . jsp?parc = 143369000 0 Owne rZi p 9592 8 Assesso r Websit e Lin k http://douglasne.mapping-online.com/DouglasCoNe/stati c /accountinfo.jsp?accountno=R143369000 0 Disclaimer : Ma p an d parce l dat a ar e believe d t o b e accurate , bu t accuracyi s no t Ma p Scal e guaranteed . Thi s i s not a lega l documen t an d shoul d no t b e substitute d fo ra titl e search , 1 inc h = 2 7 fee t appraisal , survey , o rfo rzonin g verification .

lof l 11/5/200 8 8:5 3 A M

### Pag e 1 o f 1

" > Creat e Anothe rTicke t Bac k t o Irt h Interne t Sen d Emai l 

### YOU RTICKE T NUMBE RI S 2178656 . Origina l Cal l Date : 11/19/0 8 Time : 2:2 2 pm Op : MADHURIMA1896 7 Wor k t o Begi n Date : 11/21/0 8 Time : 2:4 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 411 8 Street : N25TH AVE Twp : 15 NRng : 13 E Sect-Qtr : 04-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n wor k fo r soi l Locatio n o f Work : LOCAT E ENTIR E PROPERTY 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 : MADHURIM A Phone : (402)733-118 8 Alt . Contact : Phone : (618)401-222 3 Wor k Being 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 Boring : NExplosives : N CXCAT V

MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Servic e Are a Contac t Phon e Numbe r Utilit y Typ e 

### Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C 

### HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUDO l METROPOLITA N UTILITIE S DISTRICT SAND Y Alt : 

### Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFIC.SEWE RRO N Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 0PPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T N A Alt : 888728934 3 Emerg : 406728934 3 Day : 406728934 3 QLNN E 1 C QWES T LOCA L NETWOR K N A Alt : 

### Emerg : 888728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret-<RESULT. . . 11/19/200 8