## TRANSMITTA L o f OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAK)# : 24 1 Date : Address : Remediatio n Contractor : /CQ^^J H 

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. SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S [ E TVide o ofproperty (DVD ) y Executiv e Summar y y EPA-provide dproperty sketc h B ' Signe dAcces s Agreement fo r subjec t property n Signe dAcces s Agreement(s ) fo r adjacent property B ^ Restoratio n Agreement y Settlement document s (i.e. , fo r damag e or t o replac e plants , etc. ) 0 Confirmatio n dat a y Photograph s y As-buU t sketc h 0^ Satisfactor y restoratio n signe db y Property Owner y Property 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 cleanup criteri a M Utilit y clearance s 

## y Property informatio n fromDougla s Count y Assessor' s Offic e D 

## D D



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### PROPERT Y SUMMAR Y Date : 01/23/200 9 Omah aLea dSite Remedial Actio n Contrac t ff EP-R7-07-06/0004 Month of : Dec/Jan Propert y Address : 200 3 PINKNEY ST 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 : ARE A NOT EXCAVATED , YB TREE , 5'X5 ' @ 23 8 PP M CONFIRMATIO N SAMPLIN G DATA/RESULTS : UD = 12 4 PP M (@ 6" ; YB = 82 PP M @ 6" ; DZ = 204 PP M @ 12" ;UD = 30 6 PP M @ 6" ; EA = 30 2 PP M @SCRAP E ATTACHMENT S 1) Propert y sketch provided by EP A pursuan t to contract specification s 2) SignedAcces s Agreemen t includm g acces s agreement s require dfo r crossing othe r propertie s 3) Pre-Excavation digita l vide o clip/photogr^h s 4) Post-Excavation digita l vide o cUp/photograph s 5) Documentation - CompletedClose-ou t Checklis t 6) As-Buil t sketch

i) Shall include final 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 tobe included in th e individua l propert y file, if available , or obtaine dinclude : i) Pre-excavation agreemen t detail s (i f an y ar e mad e wit h th e propert y owner ) ii ) Propert y Statu s For msigned by propert y owne r iii ) Excavation digita l vide oin MPEG , WM V (Window s Medi aVideo ) or SW F(Flash Player) forma t and/o r photogr^h s iv ) Signedfor mverifying satisfactor y restoratio n v) Description of area s no t meeting InterimRO D cleanu p criteria
.

TECHNOLOCIES , INC
.Fin d Recor d Backfill :

Sampl e Area : 36 1 - 200 3 PINKNE Y S T Owner :
n Owne rOccupie d Owne rName : JBRUMT NAOM I V Owne rAddressl :

• - - - Owne rAddress2 : |200 3 PINKNE Y ST City : State : Zi p Code : |OMAH A |N E |6811 0 Owne rPhone : Alternat e Phone :

' — Clea n U p Query Lea d Remainin g QueryI Propert yDamag e Query

Resident : Residen t Name : Propert yAddress : |200 3 PINKNE Y ST Zi p Code : |681i q , Residen t Phon e Contract : Contractor : )PRUDENT2008^ S Group : 

# C Assessment : Qualifyin g Grou p 

### |80 0 11 ^ Assessmen t XR F Date : 

# r " ""• " Assessmen t MaxXR F Value : 

### I 826.4TECHNOLOGIES , IN C 

# &EP k EP A Propert y Clos e Ou t Propert y # : Us ) Propert y Address : 2D O 1 > nV \k-uuzt
. ^ ^ Date/Time : Owner' s Name : Quad s Excavated : Y ^ ^ ; ^^ ^ Contracto r Grou p Pniden t Technologie s Excavatio n Genera l Ye s No 1 . I f necessary , wer e the correct quadrant(s ) excavatedan drestored ? ^ / 2 . If necessary , wer e the correct area s o f dri p zone excavatedan drestored ? i ^ Gradin g Sodan dVegetatio n Ye s N o 1 . Doe s the grading aroun dthe perimete r o

f Ih e hous e i n excavatedarea s generall y slop e awa y .- ^ fromthe house ? 2 . Has sodbeen lai di n all area s tha t wer e excavated ? t ^ 3 . Doe s the sodappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e if inspecteda t a3 0 ^ da

y tim e period) 4 . Ar e sodde dareas generall y firman devenl y graded ? ^ 5 . Ar e the joint s betwee n the sodstrip s generall y tight ? (Onl y evaluat e i f inspecteda t a3 0 da y 

### y tim e period) 6 . Wa s th e propert y gradedsud i tha t wate r wii] no t poo l o n the property ? -^ 7 . Wa s damage to landscaping o r plan t material s avoided ? 1 ^ Gates , Fence s an dRetainin g Wall s Ye s N o 1 . D o gate s ope n an dclos e freely? (I f applicable ) w ^ 2 . Wer e all gate s o r fence s take n dow n durin g restoratio n activitie s reinstalled ? (If applicable ) t ^ 3 . Wa s damage to gate s o r fence s avoided ? (IfappUcable ) ^ 4 . Was damage t o retaining wall s avoided ? (If applicable) 

# M Foundation , Sidin g an dGutter s Ye s N o 1 . Wa s damage t o the siding o r trimavoided ? u ^ 2 . Was damage t o th e foundation avoided ? t y 3 . Wa s damag e to window s avoided ? 

# y 4 . Wa s damage t o window s or doo r screen s avoided ? 

### y 5 . Wa s damage to downspouts o r downspou t extension s avoided ? 

### y Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Wa s damage t o drivewa y surface s avoided ? / ^ 2 . Wa s damage to walkwa y surface s avoided ? 

# y

### Owner s comments :

Inspectio n notes :

Remova l an drestor ; ites complet e including th e 30-da y sodwarranty : EP A Representativ e 

# dLg f Date : /^T/^ A

# «ERI V Propert yCompletio n Agreemen t Thi s agreement document s th e completio n o f remova l activhie s performe do n th e belo w liste dproperty . Th e propert y owner' s signatur e indicate s tha t th e property owne r i s satisfie dwith th e restoratio n ofth e subjec t property , an dtha t n o item s ar e i n question , now , o r a t an y tim e i n th e future , excludin g an y 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 ; ^^^ 3 p.^j:^^ ^ <^ ^ Owner : M^^^ ; ^^^^ ^ Phone : t^r ^ -//5 3 .-ppcf ^ 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 agre e restoratio n i s completed , excep t a s note d above
. L J I d o no t agre e restoratio n i s complete d 

# /bJ2/\0 f

Owner' s Signatur e DatePruden t Technologies , Inc . (Pnjdent ) is unde r contrac t with th e US. Environmenta l Protectio n Agenc y (EPA ) to cleanup lead

contammate dsoil s at anumbe r ofpropertie s locate d in Omaha , Nebraska , includin g th e property locate dat

. Th e EP A request s you r permissio n to allo w Pruden t to performasoi l cleanu pat thi s propert y to remov e lead-contaminate dsoi lBy signin g thi s form , th e property 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 samplmg , removal oflead-contaminate dsoil , an drestoratio n ofth e reference dproperty If

yo u hav e any question s abou t th e soi l cleanu p planne dfor you r property , pleas e contac t Prudent' s Administrativ e Cler k for th e Omah aLea dSit e cleanup
. Ms Madhunm aDuru-a t (402 ) 733-1188 , 733-1455 . General question s abou t th e Omah aLea dSit e cleanu p ca n be directe dto th e EP A Publi c Informatio n Center s at (402 ) 731-304 5 (Sout h Omah aoffice ) or (402 ) 991-9583 (North Omah aoffice)
. Property Acces s Grante d nt : (Pleasf e Prin t Name ) Property Owne r Signatur e 

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. (Date ) (SignaSne ) PROPERT Y INFORMATIO N (T o be complete d by residen t and/o r propert y owne r — pleas e print ) RESIDEN T NAME : Owne r Rente r RESIDEN T ADDRES J V^A g 

## SV fiv^^^iJi/^ ^^^ ^ C-.gVl D ^ IF RENTAL , PROPERT Y OWNED BY :
OWNER' S MAILI N (TMipRESS ; 

## ' ^ Qw^^J ^ 1^, , (^< ^ U t> *\^ ^ • ^ OWNER' S TELEPHON E NUMBE R - HOME : _L WORK :
AG E OF HOME? : 

## \cr o 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 R OF CHILDREN 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 Y GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA L RESPONS E ACTIONS : Th e activitie s to be implemente dby EP A unde r this agreemen t ar e pursuan t to Sectio n 10 4 of CERCLA , 42 U S. C 960 4 EPA' s ngh t of

acces s to th e property is provide dfor in Sectio n 104(e ) of CERCLA , 42 U S C 960S(e) , whic h provide s entry for "determinin g th e nee dfor response , or choosin g or takin g an y respons e actio n unde r this title , or otherwis e enforcin g th e provision s ofth e titl e "
808 0 War d Partway , Suit e 40 5 250 5 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 , TX 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 

# V

### A S - BUIL T DRAWIN G OMAH A LEA D SUPERFUN D SIT E OLS# : 36 1 Dat e Excavated : 9/23/200 8 Dat e USEP A Signed-OfT : 

### 36 1 Omah a Lea d Sit e Owne rName : Sit e Sketc h Address : 2003^P1NKNEYJT

_ _ Phone : H Sampl e Numbe r RYASCPXA-36 1 Y A RYBSCPXA-36 1 YB RYCSCPXA-36 1 Y C RYDSCPXA-36 1 Y D RDZSCPXA-36 1 D Z RGZSCPXA-36 1 G 2 RPZSCPXA-36 1 P Z w : Lea d Sampl e LA B Concentratio n Collecte d 270 2 pp m 826. 4 pp m pp m 

## n 331. 2 pp m 401. 6 pp m pp m pp m 

### 0 

# • • Numbe ro f Sample s = : 4 D 

## a a D 

# n • • Exterio rPaint Nort h Arro w • Goo d • Poo r Q ] No t paint Sample s Collecle d Firm : _ Sverdru p Date:
. Time : . Sample s Analyze d XR F U m t : Book : Date:
. 6/8/199 9 Time:
. 11:2 6 Staff : Legend : Y A = Yard (NE) , Y B = Yar d (SE) , Y C = Yard (SW) , Y D = Yard (NW) , DZ = Dri p Zone , G Z = Garden , P Z = Pla y

UD=124PP M o 6 " ARE A NO T EXCAVATE D |Y B TREE , SX- S Sq . F t :f

f 23 8 PPM j

D Z = 204PPMC«!12 "

MA P ERRO R SID E WAL K

CONTRAC T # : E P - R7-07-0 6 / 000 4 PRUDEN T TECHNOLOGIES , INC
.

# MOD E •n n ECHNOLOGIES , INC . 

# Propert y Statu s For m Address : e?l6cs 3 T ? t \ Vl4/v^<»-*. j C ( 

### Date : Phone : BVID : 

## ^5'2.-10<\ ^ Plant s & Pernianen t Landscapm g Item# O

n Ma p Descriptio n an dLocatio n

Pre-Existin g Conditio n o f

Structure s Doe s you r

Basemen t hav e ahistor y of leaking ? Ye s No Item# Descriptio n & Locatio n O

n Ma p

Propert y Owne r Pruden t E : Signalu n 

# K 4y.9 ^ 808 0 War d Parlcway , Suit e 40 5 250 5 N
. 24' " Street , Suit e 30 8 424 2 Medica l Drive
. Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 ^ "Sa n ArtlDniDrTX^82-2 9 Phone:(816)363-370 3 Fax : (816 ) 363-370 7 Phone : (402)504-100 4 Fax : (402)504-100 5 Phone : (210)822-958 8 Fax : (210 ) 579-657 7

# 36 1 Exterio rPain t NorthArro w 

## Omah a Lea d Sit e Owne rName:
. 

### • Goo d Sit e Sketc h Address : 200 3 PINKNE Y S T • Poor Phone : ^ W : • No t pain t Sampl e Numbe r RYASCPXA-36 1 YA Lea d Concentratio n

270. 2 pp m Sampl e Collecte d 

# 0 LA B 

## D Finn : Date: Sample s Collecte d Sverdru p RYBSCPXA-36 1 Y B 

# lflP ^ pp m 

# 0 D Time : RYCSCPXA-36 1 RYDSCPXA-36 1 Y C Y D 331. 2 pp m .pp m 

# D 0 

# a a Sample s Analyze d RDZSCPXA-36 1 RGZSCPXA-36 1 RPZSCPXA-36 1 D Z G Z P Z ^^^ ^ .pp m

. pp m .pp m 

# Q 

# a D D 

# n D XR F Unit : Date : Time : 6/8/199 9 11:2 6 Book :
Staff : Numbe ro f Sample s = I 4 Legend : Y A = Yar d (NE) , Y B = Yar d (SE) , Y C = Yar d (SW) , Y D = Yar d (NW) , D Z = Dri p Zone
. G Z = Garden , P Z = Play



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### • YOU RTICKE T NUMBE RI S 2132416 . Origina l Cal l Date : 9/16/0 8 Time : 11:1 2 a m Op : RAMITA1896 7 Wor k t o Begi n Date : 9/18/0 8 Time : 11:4 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 200 3 Street : PINKNE Y S T Twp : 15 NRng : 13 E Sect-Qtr : 10-N W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATIO NPROJEC T FO R SOI L 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 : RAMIT A Phone : {402)733-145 5 Alt . Contact : Phone : (402)733-118 8 Wor k Being Don e For : EP A Dept h o f Excavation : 6 FT Corne r Lot : NFront : Y Rear : Involve s Tunneling o r Horizonta l Borin g : NExplosives : N CXCAT V

MAGELLA NMUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Servic e Are a Contac t Phone Number Utilit yTyp e CXCAT V CO X COMMUNICATIONS , IN C HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
MAGELLA N MAGELLA N MIDSTREA M PARTNER S L P TONY A 

### Day : 918574709 8

Alt : 

### Emerg : 918574709 8
MUDO l METROPOLITA N UTILITIES DISTRIC T SAND Y 

### Day : 402504782 3

AU : 

### Emerg : 402504794 6
OMAHACO FCIT Y O FOMAHA-TRAFFIC.SEWE R 

### RO N Day : 402444719 7

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OPPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T 

### N A Day : 406728934 3

Alt : 888728934 3 Emerg : 406728934 3 QLNNE l C QWES T LOCA L NETWOR K 

### N A Day : 406728934 3

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