### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SMDU : 2756 4 DATE : 1/1 5 ADDRESS : 422 3 GRAN TS T REMEDIATIO N CONTRACTOR : PRUDEN TTECHNOLOGIES . INC . YEAR : 

### 20 1 ^ 

### SOI L REMEDIATIO N PROPERT Y FIL E FOLDE R DOCUMENT S E l PR E AN D POS TVIDE O O F PORPERT V (DVD ) 3023756 8 d EXECUTIV E SUMMAR Y 

# lil M Superfun d 0 ' EPA-PROVIDE D PROPERT YSKETC H t ^

SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y E J SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN TPROPERT Y d RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R TO REPLAC E PLANTS , ETC. ) 0 CONFIRMATIO N DAT A E f PHOTOGRAPH S Q AS-BUIL TSKETC H D SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R E J PROPERT YCLOSE-OU TCHECKLIS T SIGNE D B YEP A D DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A d UTILIT YCLEARANCE S 0 PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E D 

# n

£^•1 ^ g/t8/ " SIGNATUR E DAT E

### PROPERT Y SUMMAR Y Date : /15/201 0 Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Propeit y Address : 422 3 GRAN 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 l = 27 2 PP M @ 2" ; B 2 = 6 2 PP M @ 2" ; E A = 28 0 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 n digita l vide o clip/photograph s 4 ) Post-Excavatio n digital vide o clip/photograph s 5 ) Documentatio n - Complete dClose-ou t Checklis t 6 ) As-Buil t sketch
i ) Shal l includ e final lea dlevel s v ) Legen d ii ) Contaminatio n lef t behin darea 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 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 withth e property owner ) ii ) Propert y Statu s Formsigne db y property owne r iii ) Excavatio n digita l vide o i n MPEG , WM V (Window s Medi aVideo ) o r SW F(Flas hPlayer ) format and/o r photograph s iv ) Signe dfor mverifyin g satisfactory restoratio n v ) Descriptio n o f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOGIES , INC .Fin d Record Backfill :

Sampl e Area : 2756 4 - 422 3 GRAN T S T Owner : [ U Owne rOccupie d Owne rName : j BATTL E J R ROBER TE Owne rAddressl : Owne rAddress2 : |421 9 GRAN TS T City : State : Zi p Code : jOMAH A N E )68111 - Owne rPhon e Alternat e Phone : |(402 ) 558-109 8 |f402 ) 551-596 0

Contract : Contractor : PRUDENT201 0 S Contrac t Optio n |OPTIO N 1 Remediatio n Quer yI Lea d Remainin g Quer yI Propert yDamag e Quer y

Use rProvide d Owne rInformatio n Resident : Owne rName : Residen t Name : 

# I Owne rAddress : Propert yAddress : 

# r )422 3 GRAN TST Zi p Code : J68111 - City : State : Zi p Code : Residen t Phon e 

# I 

# r Owne rPhone : Alternat e Phone : 

# r " r

Assessment : Qualifyin g Grou p pO O Assessmen t Ma xXR F Valu e \ ~ 508.3 2TECHNOUXJIES , INC . 

# EP A Propert y Clos e Ou t Propert y # : '2.~ l /^ ^ Propert y Address:l\'2JZ3 > ^f*^" ^ ^ ^ - Date/Time : Owner' s Name : '(?*'Ur\ r <S*tH e 3f , Quad s Excavated : ^ 1 ,B'2 ^ Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s 1 .

I f necessary , wer e th e correct quadrant(s ) excavatedandrestored ? 

# J 2 .

I f necessary , wer e th e correc t area s o f drip zone e.xcavate dandrestored ? / 

### Gradin g Sodan dVegetatio n Ye s 1 .

Doe s tl^ e gradin g aroun dth e perimete r o

f th e hous e i n excavate dare.a s generally slop e awa y fro mth e house ? 

## y 2 .

Has sodbeen lai di n al l area s tlia t wer e excavated ? / 3 .

Doe s th e so dappea r t o b e generally health y andgrowing ? (Onl y evaluate if inspecte dat a3 0 

# y da

y time period ) 4 .

Ar e soddedarea s generally firmandevenl y graded ? / 5 .

Ar e di e joint s between th e sodstrip s generall y tight ? (Onl y evaluate i f inspecte da t a3 0 da y / tim e period) 6 .Was th e propert y grade dsucl i tliia t wate r will no t poo l on th e property ? / 7 .

Was damag e t o landscapin g o r plan t material s avoided ? 

# y Gates , Fence s an dRetainin g Wall s Ye s 1 . D o gate s ope n andclos e freely ? (I f applicable ) / 2 . Wer e all gate s o r fence s talce n dow n durin g restoratio n activitie s reinstalled ? (I f applicable ) / 3 . Was damag e t o gate s or fence s avoided ? (I f applicable ) / 4 . Wa s damag e to retainin g wall s avoided ? (I f applicable ) / Foundation , Sidin g an dGutter s Ye s 1 .

Wa s damag e t o the sidin g o r trimavoided ? 

# y 2 .Was damag e t o Ui e fomidation avoided ? 

# y 3 .

Wa s damag e t o window s avoided ? 

# y 4 .

Was danmg e t o window s or doo r screen s avoided ? 

# y 5 .Was damag e t o downspout s o r downspou t extension s avoided ? / Sidewalk s an dDriveway s (Concrete ) Ye s 1 .

Was damag e t o diivewa y surface s avoided ? / ^ 2 .

Wa s damag e to walkwa y surface s avoided ? N o

N

o

N

o

N o

N

o

## Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e SQ" ^ ^Date: izlish o;CHNOLlX;iES , INC . 

## A S - BUIL T DRAWIN G OLS#2756 4 Dat e Excavated : 11/03/201 0 USEP ASigned-Of f Date : 

## OMAHA LEAD SUPERFUND SIT E

Owne rName : ROBER T E BATTI E J R 

## 2756 4 Exterio rPain t Omah a Lea d Sit e Address : 422 3 GRANTS !

Phone : H : Sampl e Numbe r R'l'ASCPXA-aTJO a RYBSCPXA-2756 4 RYCSCPXA-2756 4 RYDSCPXA-2756 4 RD/SCHAA-27564 . nczocpx A 27sa x RPZSCPXA-2756» . H F 2 & 1 B 2 XIZ . -e z P i ­ 

## .EIS[TE.HS D SE P 1 ;f l ZOOV :

B2=62PPM@2 " w : Lea d Concentratio n pp m



## ^3 X 

# a pp m 

# m pp m ^pp m pp m pp m pp m Numtie ro f Sample s = • Good Sit e Sketc h Sampl e Collecte d D O

^ 

# c r D D D • Q LA B Firm : D Date : D Time : D D Poo r No t pain t Sample s Collecte d 

# m . 9/?/r y /?<<;//• > Sample s Analyze d D XR F Uni t D Date : _ D Time : _ Staff : ^ 

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# V

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A = 28 0 PP M @ SCRAP E (-1" ) CONTRAC T# : EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC .

# SER A Propert y Completio 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 property owner' s signatur e indicate s tha t th e property owne r i s satisfie dwithth e restoratio n o f th e subjec t property , an dtha t n o item s ar e in question , now , o r at an y tim e i n th e future , excludin g any remainin g warranty (3 0 day s total ) excep t thos e item s liste dbelow , i f any .

Restoratio n Item s i n Question :

W I agre e restoratio n i s completed . LJ I d o no t agre e restoratio n i s complete d a t (note d deficiencie s above ) 

# /^/fC ) A/ ) ^ 0 Owner' s Signatur e Date , 

# V Yr* I ­ 

### iJCH^CiiOCisis , ivj- : Pruden t Technologies , Inc . (Prudent ) i s unde r contrac t withth e U . S . Environmenta l Protectio n Agenc y (EPA ) to clean u p lead
contaminate dsoils^ l anumbe r ofpropertie s locate di n Omaha , Nebraska , includin g th e property locate da t M'^'2-' ^ MrrCMM " S V Th e EP A request s you r permissio n t o allo w Pruden t t o perfor masoi l cleanu p a t thi s propert y t o remov e l4ad-contaminate dsoil . B y signin g thi s form , th e property owne r grant s permissio n t o Pru.1en l l 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 of-.h e reference dproperty . If

yo 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 t .••i-;i: h( . .>:ii;i:': i t )|IK\ - fo r th e Omah a Lea dSit e cleanup , a t (402 ) 733-1188 ; 733-1455 . Genera l question s abou t th e Omah aLeadSit e cleanu p can b ; directe dl o th e EP A Publi c Informatio n Center s at (402 ) 731-304 5 (SouthOmah aoffice) . Propert y Acces s Grante dBy : (Pleas e Pri mName ) Propert y Owne r Signature : (Signature ) PROPERT YINFORMATIO N [T o be complete d byresiden t and/o rpropert yowne r— pleas e print ) rrob e ^ , . ^ - . r^ RESIDEN TNAME : l/ AfCLwl " loi rUJlH ^ Rfi^fe'pfl-lUf.^tKwna ^ -

^

Rente r 

## Coo^T ^

^ RESIDEN TADDRESS : I F RENTAL , PROPERT Y OWNE D BY : OWNER' S MAILIN G ADDRES S
OWNER' S TELEPHON E NUMBE R - HOME : J _ 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 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 LRESPONS EACTIONS ; Th e activitie s to b e implemente db y EPA .mder thi s agreemen t ar e pursuan t t o Sectio n 10 4 o f CERCLA , 4 2 U.S.C , 9604 . EPA' s righ t o f

acces s t o th e property i s provide dfo r I

n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entr y for "determinin g th e nee dfor response , o r choosin g o r takin g an y respons e actio n unde r thi s title , o r otherwis e enforcin g th e provision s o f th e title. "

808 0 War d Parkway , Si;''!; - •• : iw&tiica l Drive . 5uit B 426 0 Kansa s City , M O e-i-.-'i'- . Sai l AiHOiii o Xt . "822 ? "hone : (816 ) 363-3~f "ENVIRONMENTA L& CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : q'X':2_' ^ C J ^eL^^Jl

—S^t " ^^^^ ' ^'^l^^^^ ^ Phone : qo2. ' 3>X - ^33- 6 BVID : 

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Pruden t Employe e

# lirilllllllllll l 2756 4 Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e Owne rName : ROBER T E BATTL E J R 

### Sit e SItetc h • Goo d Address : 422 3 GRAN TS T • Poo r Phone : H : W: • No t pain t Sampl e Numbe r ryi'A3CPXA-2700 4 RYBSCPXA-2756 4 RYCSCPXA-2756 4 RYDSCPXA-2756 4 RUZbCHXA-27664 - RGZS6PX A2756< l RPZSCPX A27564 ­ H F 2 B 1 B 2 J3Z . « Z PZ Lea d Concentratio n 

# .3 1 # 

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### Printed : De c 15,201 0 www.dcgis.org'dogi s

### Pag e 1 of 1 "> Creat e Anothe rTicke t Bac k to Irt h Interne t Sen d Emai l 

### YOU RTICKE T NUMBE R IS 2628349 , Origina l Cal l Date : 10/28/1 0 Wor k to Begi n Date : 11/01/1 0 Time : Time : 8:4 8 am 9:1 5 am Op : SIVA1896 7 State : NE Address : 422 3 County : DOUGLA S Street : GRANT ST Place : OMAH A Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 08-SE-S W Sect-Qtr : Typ e of Work : omah a soi l rememediatio n projec t Locatio n of Work : LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)733-188 3 Compan y: PRUDENT TECHNOLOGIE S Contac t Name : SIV AJAMPAM A Phone : (402)733-118 8 Wor k Bein g Don e For : EP A Dept h of Excavation : 6F T Corne r Lot : Involve s Tunnelin g or Horizonta l Borin g : CXCAT V

MUDO l OMAHACO F 0PPDGPR 5 Y Front : N Explosives :

QLNNEI C Y N Rear : Y

Servic e Are a ;;;ontac t Phon e Numbe r Utilit y Typ e CXCAT V COX COMMUNICATIONS , INC 

### lElD l Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUDO l METROPOLITA N UTILITIE S DISTRIC T SAND AND Y 

### Day : 402504782 3 Alt : 

### Emerg : 402504797 0 OMAHACOFCITY OFOMAHA-TRAFFIC,SEWE RRICH/TRAFFI C 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 0PPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T 

### EL M LOCATIN G 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWORK EL M LOCATING 

### Day : 406728934 3 Alt : 406207149 4 

### Emerg : 888728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 10/28/201 0TECMNOLOGtES , INC . 

### ENVIRONMENTA L ENGINEERIN GAN D CONSTRUCTIO N SOLUTION S 

## SIT E SAFET Y HAZAR D ANALYSI S Address : -^^-S^..£i.tQ.t\A„.SL\ . Excavatio n Date : ~U~^^~J P 

# Crew : t^L^-O . Backfil l Date : -J-^~-^~~~~ .

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# "V ^ Septic/Leec h Fiel d 

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## Foundatio n 

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## Drivewa y <Qi>^ ^ 

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_ Cre w Forema n Sit e Safet y Offic e Date :

808 0 Wan f Partany , Suit e 40 5 560 0 S 1 0 S t 424 2 Medica l Drive , Suit e 725 0 Kansa s Oty , MO 6411 4 Omaha , Nebrask a 6810 7 Sa n Antonio , T X 7822 9 Phone:(816)363-370 3 Phone : (402)733-118 8 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)733-188 3 Fax : (210 ) 579-657 7

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