## TRANSMITTA L o f OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAn)# : \.^a ^ Date : Address : ^1 v . ? . T '^ r A ^ Remediatioi i Contractor : f^^^-i r H^fl^^^J^^ . • TXn ^ . . Year : ^oS_ _ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 0 " Vide o ofpropert y (DVD ) _^____ H Executiv e Summar y aEPA-provide dpropert y sketc h E

l Signe dAcces s Agreemen t fo r subjec t propert y D Signe dAcces s Agreement(s ) fo r adjacen t propert y C dRestoratio n Agreemen t 2

] Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) D Confinnatio n dat a ^ Photograph s 0^ As-buil t sketc h 0 Satisfactor y restoratio n signe db y Propert y Owne r l

/ 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 ffl Utilit y clearance s 

## [t f Propert y informatio n fromDougla s Count y Assessor' s Offic e D D D 

## „/9r>^A y 3l>^l^ \ SignatUTQ A \.. . Dat e 4031072 8 

# nmn i

Superfun d

### PROPERT Y SUMMAR Y Date : 01/23/200 9 Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-06/0004 Month of : Dec/Jan Propert y Address : 230 3 S 3 2 AVE 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 Otihe r Relevan t Information : NON E CONFIRMATIO N SAMPLIN G DATA/RESULTS : F 1 = 106PPM(@6 " ATTACHMENT S 1 ) Propert y sketch provide dby EP A pursuan t to contract specification s 2 ) SignedAcces s Agreemen t includm g acces s ^reement s require dfo r crossing othe r propertie s 3 ) Pre-Excavatio n digita l vide o clip/photograph s 4 ) Post-Excavatio n digita 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 ) Legen d ii ) Contamination lef t behindarea s vi ) Contracto r identificatio n 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 , o r obtainedinclude : i ) Pre-excavatio n agreemen t detail s (i f an y ar e made wit h th e propert y owner ) ii ) Propert y Statu s For msignedb y propert y OAvne 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 photograph s iv ) Signedfor mverifying satisfactor y restoratio n v ) Descriptio n o f area s no t meeting InterimRO D cleanu p criteria .

TECHNOLOCIES , INC .Fin d Recor d I Clea n U p Query Lea d Remainin g Quer / I Propert yDamag e Quer y Backfill :

Sampl e Area : 1751 3 ­ 230 3 S 3 2 A V Owner : Resident : Contract : n Owne rOccupie d Residen t Name : Contractor : Owne rName : |KAZO R JEFFREY J |PRUDENT2008_ S |KAZO R JEFFREY J Owne rAddressl : Propert yAddress : 230 3 S 3 2 A V Group : 

# r—I - Owne rAddressZ : Zi p Code : [6810 5 Assessment : |230 3 S 3 2 AV E Residen t Phon e Qualifyin g Grou p City : State : Zi p Code : [PLA Y ZON E jOMAH A )N E [6810 5 Assessmen t XR F Date : Owne rPhone : Alternat e Phone : 

# I --_.„. ­ |(402 ) 344-814 1 |(402 ) 871-744 1 /^sessmen t MaxXR F Value : I 784.8 2TECHNQLOGIESbIN C 

# dE m EP A Propert y Clos e Ou t Propert y # : \ 1 ^ \5 Propert y Address : 53o 3 ^ 3 2-A V Date/Time : Owner' s Name : Quad s Excavated : P I y G P ^ Contracto r Grou p Pruden t Technologie s Excavatio n Genera l Ye s N o 1 .

I f necessary , wer e the correct qHadrant(s ) excavatedan drestored ? / 2 .

I f necessary , wer e the correct area s o f dri p zone excavatedan drestored ? / Gradin g Sodan dVegetatio n Ye s No 1 .

Doe s the grading arounddi e perimete r o f die hous e i n excavatedarea s generall y slope awa y fromthe house ? 

# y 2 .

Ha s sodbee n laidi n all area s tha t wer e excavated ? 

# y 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 soddedarea s generall y fir man devenl y graded ? / 5 .Ar e the joint s betwee n the sodstrip s generall y tight ? (Onl y evaluat e if inspecteda t a3 0 da y tim e period ) / 6 .

Wa s the propert y gradedsuc h tha t wate r will not poo l o n th e property ? 

# y 7 .

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

# y 3 . Was damage to gate s o r fence s avoided ? (If applicable ) / 4 . Wa s damage to retaining wall s avoided ? (IfappUcable ) / Foundation , Sidin g an dGutter s Ye s N o 1 .

Was damag e to the siding o r trimavoided ? 

# y 2 .

Wa s damage t o the foundation avoided ? 

# y 3 . Wa s damage to window s avoided ? 

# y 4 . Wa s damage to window s o r doo r screen s avoided ? / 5 . Was damage to downspouts o r downspou t extension s avoided ? / Sidewalk s an dDriveway s (Concrete ) Ye s No 1 . Wa s damage to 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 drestoratio n activate s complet e including th e 30-da y so dwarranty : EP A Representativ e ^c ^ J^L ^ Date : /Ms'Ja y

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completion o f remova l activitie s performedo n th e belo w listedproperty . The propert y owner' s signatur e indicate s tha t th e propert y owne r i s satisfiedwit h th e restoratio n ofth e subject 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 , excluding an y remaining warrant y (3 0 day s total ) except thos e item s listedbelow , if any . Propert y ID : Propert y Address : Xl-^Q- ^ ^ , ? > Z^ ^ fVH> . Owner : "J^- l 

## ^c^-2.a C
Restoratio n Item s i n Question :

Item : 

# go d 

# O ) Item : Item : 

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

# n

yH- 1 agre e restoratio n i s completed , excep t a s note d above . I I d o no t agre e restoratio n i s complete d 

# I L ^/ > 

# ^ ^ Dat e IPruden t Technologies , Inc . (Prudent ) i s unde r contrac t wit h th e U . S . Environmenta l Protectio n Agenc y (EPA ) t o clea n a p lead
contaminate dsoil s a t anumbe r ofpropertie s locate di n Omaha , Nebraska , includin g tfa e propert y locate da t

. Th e EP A request s you r permissb n t o allo w Pruden t t o performasoi l cleanu p a t thi s propert y t o remo w lead-contaminate dsoil . B y signin g this form , th e propert y owne r grant s permissio n t o Pruden t t o perform activitie s relate dt o th e cleanu p includin g soi l sampling , remova l oflead-contaminate dsoil , an drestoratio n o f tfa

e reference dproperty . I f

yo u hav e an y question s abou t tfa

e soi l cleanu p planne dfo r you r property , pleas e contac t Pruden t Administrativ e Clerk fo r th e Omah aLea dSit e cleanup . Ms . Madhurim aDur u -a t (402 ) 733-1188 . Genera l question 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 Center s a t (402 ) 731-304 5 (Soutf aOmah aofBce ) o r (402 ) 991-9583 (Nortf aOmah aoffice) . Propert y Acces s Grante dBy : Propert y Owne r Signature : (Date ) PROPERT Y INFORMATIO N (T o 9 t complete db y residen t and/o r propert y owne r - pleas e print ) RESIDEN T NAME : Owne r Rente r RESIDEN T ADDRESS : 

# ^3^ 3 

# 3- ^1Y \

### « j 

### Avf- ^ 

# lo e 

# Q^\ o ^ I F RENTAL , PROPERT Y OWNED BY :
OVVNER' S MAILIN G ADDRES S [ \ ^
OWNER' S TELEPHON E NUMBER - HOME : < > WORK :
AG E O F HOME ? I ft\o YEARS . HO W LON G HAV E YO U LIVE D HERE ? ^=> ^ YEARS . 

## SrvsjL t v_j i HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978 ? NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : ^ NUMBER O F OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLA Y I N TH E YAR D FO R 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 ; Tfa 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 104 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s right o f

acces s t o th e propert y i s providedfo r i n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic h provide s entry for "determinin g tfa e nee dfor response, o r cfaoosing o r takin g an y response actio n unde r thi s title , o r otfaerwis e enforcin g tfaeprovision s o f tfa

e title. "

808 0 War d Parkway , 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 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

### AS-BUIL T DRAWIN G ~ S OMAHA LEAD SUPERFUND SIT E OLS# : 17S1 3 Dat e Excavated : 10/10/200 8 USEP A SIpwd-OffDate : 

# /Tsr/ 3

Omah aIjeai Sit e 4613 0 

# S~ST7v ^ E A = 26 0 PP M @ SCRAP E CONTRAC T # : E P - R7-07-0 6 / 000 4 PRUOEN T TECHNOLOGIES . IN C1 ENVIRONMENTA L & CONSTRUCTIO N TECHNOLOGIES , INC . SERVICE S

Address : Phone : Ite mN O O n Ma p

Ite mN O O n Ma p 

# Propert y Statu s For m Date : BVID : Plant s & Pennanen t Landscapin g T o Remai n I n Plac e Descriptio n & Locatio n

^.^ ^

Pre-Existin g Conditio n o f Structure s Doeijyour.Basementhaveahistor y o f leaking ? Ye s 

### No >M^4A-«!^«^ J^ ^ >^ftr . Descriptio n & Locatio n

Propert y Owne i Pruden t Employee y Signature: . , Signature : V 808 0 War d Parkway , 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 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 74613 0

### Pag e 1 o f 1

Marc h 200 7 DOUGLA S COUNT Y ASSESS O 

# 330^ S 3<?AY f

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### Prin t Preview Pag e 1 o t 1 Dougla s County-Omaha , N E

Parce l I D Owne r Nam e Propert y Addres s Cit y Zi p Owne r Addres s Owne r Addres s 2 Owne r Cit y Owne r Stat e Owne r Zi p 090462000 0 KAZO R JEFFRE Y J 230 3 S 3 2 A V OMAH A 6810 5
230 3 S 3 2 AV E OMAH A N E 6810 5 Sec-Twn Rn g Additio n Bloc k Lo t Lega l 1 Lega l 2 Lega l 3 Lega l 4 Treasure r Websit e Lin k Assesso r Websit e Lin k 28-15-1 3 CREIGHTON S 1S T AD D 6 1 7 47X127. 5

http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp ? parc=090462000 0 http://douglasne.mapping online.com/DouglasCoNe/static/accountinfo.jsp ? accountno=R090462000 0 Disclaimer : Ma p an d parce l dat a are believe d t o b e accurate , bu t accurac y i s no t Ma p Scal e guaranteed . Thi s i s no t a lega l documen t an d shoul d no t b e substitute d fo ra titl e search , 1 inc h = 5 4 fee t appraisal , survey , o rfo rzonin g verification . 

### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 9/24/200 8

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

### YOURTICKE T NUMBE RI S 2145003 . Origina l Cal l Date : 10/01/0 8 Time : 10:0 0 a mOp : RAMITA1896 7 Wor k t o Begi n Date : 10/03/0 8 Time : 10:3 0 a m State : N E County : DOUGLA S Place : OMAH A Address : 230 3 Street : S 32N D AV E Twp : 15 NRng : 13 E Sect-Qtr : 28-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n projec 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 Bein g Don e For : ep a Dept h o f Excavation : 6f t Corne r Lot : NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V LEVEL 3 MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F QWEST 2
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 : 877366834 4 LEVEL S LEVEL 3 COMMUNICATIONS , LL C N AAlt : Emerg : 877366834 4 

### Day : 402504782 3 MUD0 2 METROPOLITA N UTILITIES DISTRIC T SAND Y Alt : 

### Emerg : 402504794 6 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO N Alt : 402444516 1 

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### Pag e 2 of2

0PPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T N A 

### Day : Alt : 406728934 3 888728934 3 Emerg : 406728934 3 QLNN E 1 FQWES T LOCA L NETWOR K 

### N A Day : 406728934 3 Alt : 

### Emerg : 888728934 3 QWEST 2 QWES T LON G DISTANC E 

### SAR A Day : 800283423 7

Alt : 303992192 6 Emerg : 800283423 7

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