### TRANSMITTA L o f OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : q/^^ « 

## Date : ij^9. j ^syn, ^ Address : c?<a3 H 

## •ii o £st±c & BID . Remediatio n Contractor : Pb-tDgM- / I'hC-lAtwr^t/ir^iv.^.lrsuL^ . Year : ^Ani^--Dnrf ] SOI L REMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S 

# y y y 1

/ Vide o of orooert v a)VD > Executiv e Sununar y EPA-providedpropert y sketch SignedAcces s Agreemen t fo r

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

adjacen t propert y 

# y D Restoratio n Agreemen t Settlemen t document s (i.e. , fo r

damag e or t o replac e plants , etc. )

.

1 ' •'
­

' •

' 

# y y 

# y y y D 

# y y D Confirmation data Photoeraph s As-built sketcli Satisfactor y restoratio n signedb y Propert y Owne r Propert y close-out chec k

lis t signedby EP A Descriptio n o f area s not meeting RO D cleanu p criteri a Utilit y clearance s Propert y information fromDougla s Count y Assessor' s Office D D

; 

### A
­ ­ ^ Signatur ^ 3l/9/o< l Dat e

' ^ ' ­ ^ 

### 40311292 

# iimiiiiui 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 Monti i of : Dec/Jan Propert y Address : 203 8 FLORENC E BV D 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 Otiie r Relevan t Information : NON E CONFHlMAT«>N^AMPLTNGT)AT2i/RESULTS : B l = 21 5 PP M @ 4" ; B 2 = 15 8 PP M @ 24" ; F l = 21 4 PP M @ 4" ; F 2 = 17 2 PP M @ 24" ; EA = 14 5 PP M @SCRAP E ATTACHMENT S 1 ) Propert y sketch providedb y EP A pursuan t to contract specification s 2 ) SignedAcces s Agreemen t including acces s agreement s requiredfo 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) . AsrB.uil 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 ) Oflie r item s t o b e iaclude din th e iffdividHa l piropat y file, i f available , o r dbtajtiedificMe : i ) Pre-excavation 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 (Wmdow s Medi aVideo ) or SW F(Flas h Player) forma t and/or photograph s iv ) Signedfor mverifyin g satisfactor y restoratio n v ) Descriptio n o f area s no t meeting InterimROD cleanu p criteria .

TECHNOLOCIES , INC .Fin d Record Clea n U p Query Lea d Remainin g QueryI Propert yDamag e Query Backfill :

Sampl e Area : 9090 8 - 203 8 FLORENC E B V Owner : Resident : Contract : n Owne rOccupie d Residen t Name : Contractor : Owne rName : jPRUDEI^OOS^ S |MORELLO BERNAR D J ....-.__.... , Propert yAddress : Group : Owne rAddressl : |203 8 FLORENC E B V 

# U- , Zi p Code : Assessment : Owne rAddressZ : 

# r~~ r J1M1 3 HICKOR Y R D Residen t Phon e Qualifyin g Grou p City : State : Zi p Code : |80 0 jOMAH A ! |N E (6814 4 Assessmen t XR F Date : Owne rPhone : Alternat e Phone : 

# L . |(402 ) 342-282 0 ] 

# 1 Assessmen t MaxXR F Value : —.-•: : 

# I 

# si rTECHNOUX;iES.INC 

# SER^ EP A Propert y Clos e Ou t Property# : '=fo°ioS . Propert y Address : cSfoSS,-pl-o/ier i C 6 & y Date/Time : Owner' s Name : Quad s Excavated : aiyB2. y ft > fl. ^ Ef t Contracto r Grou p Pruden t Technologie s Excavatio n Genera l Ye s No 1 .If necessary , wer e the correct quadrant(s ) excavatedan drestored ? 

# 7 7 2 . Ifnecessary , wer e the correct area s ofdri p zone excavatedan drestored ? 

# 7 ^ Gradin g So dan dVegetatio n Ye s gf l 1 .

Doe s the grading aroun dthe perimete r o

f the hous e i n excavatedarea s generall y slop e awa y fromthe house ? 2 .

Has sodbee n lai di n all area s tha t wer e excavated ? 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 

# 7" " da

y tim e period) 4 .

Ar e soddedarea s generall y firman devenl y graded ? 

# 7 ^ 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 tim e period) ^ • ^ 6 .

Was the propert y gradedsuc h tha t wate r will no t poo l o n th e property ? l y ' y ­ ^ ^ 7 .

Was damage t o landscaping o r plan t material s avoided ? Gates , Fence s an dRetainin g Wall s Ye s No 1 .D o gate s ope n an dclos e freely? (IfappUcable ) 

# 7y ~ 2 .

Wer e all gate s o r fence s taken dow n durin g restoration activitie s reinstalled ? (I f applicable ) 

### y " 3 .

Wa s 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 .

Wa s damag e to the siding o r trimavoided ? 

# ~7 7 2 .

Wa s damage t o the foundatio n avoided ? ^ ' ~ ^ 3 .

Was damag e t o window s avoided ? 

## X ^ y _ 4 .Was damage t o window s o r doo r screen s avoided ? 

### 7 - T y ' 5 .

Was damage t o downspouts o r downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ye s No 1 . Was damage to drivewa y surface s avoided ? 

# 7 7 y _ 2 . Wa s damage to waUcwa y surface s avoided ? 

# l y

### Owner s comments :

Inspectio n notes :

Remova l andrestorationactivate s e jncludin e so on activate s complet complet e includm g g th

th e 30-da 30-da y y so d dwarranty

warranty : : EP A Representativ e

## TK h 

# "gf p tf Propert yCompletJo n Agreemen t Thi s agreemen t documents th e completion of remova l activitie s performedo n th e below liste dproperty . 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 no item s ar e i n question , now , or a

t an y time i n th e fiiture, 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 : ^c>-? » ? ^ l=^\r)<~ ^ . - , 

## & 1 ^ O^"*"-' '^^/.. A J ? Uf^r«O0 « Phone : ^ '-—^ Restoratio n Item s i n Question :

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

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



## TMAOA^ L Owner' s Signatur e 7 7 Dat ePiuden t Technologies , Inc . (Piudent ) i s unde r contrac t wit h th e U . S . Enviicnmenta l Protectic n Agenc y (EPA ) t o clea n u p lead
contaminate dsoil s a t anumj)er o f

propertie s locate di n Omaha , Nebiaska , includin g tfa e propert y locate da t

. Th e EP A requests you r peimissb n t o allo w IMtden t t o peifor masoi l cleanu p a t thi s propert y t o remove lead-contaminate dsoil . B y signin g (hi s forni , th e propert y owne r grant s pennissio n t o Pruden t t o perfor m activitie s relatedtoth e cleanu p includin g soi l sampling , removal o f lead-contammate dsoil , an drestoiation o f di e refeiencedpropeity . I f

yo u hav e any question s abou t tfa

e soi l cleanif ) planne dfoi you i propeity , pleas e contac t Pniden t Administrativ e Clei k foi tfa e Oinah aLea dSit e cleanup . Ms . Deborah Johnso n -a t (402 ) 733-1188 . G«ia:a l question s abou t th e Omah aLea dSit e cleam p ca n b e directe dt o th e EP A Publi c Infonnatio n Center aa t (402 ) 731-304 5 (South Omah aofSce ) o i (402 ) 991-958 3 (North Omah aofiice) . Propert y Acces s Giante dBy ; 

### XAi/^ ^

XT'. TVSOflELL O

. (Pleas e Prin t Name ) Propeit y Owne i Signature : PROPERT Y INFORMATIO N KT o b e 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 : 

## „ 2 f > 3 9 ; ^ 

## B dOv^o^Ur x K k 6^/ 1 o ore-v \c-e . I F RENTAL , PROPERT Y OWN^BY : WNEB^ B 

# 8(

= KAp^-giL o ?(g»»g|.f \j l OWNER' S MAILIN G ADDRESS ; 

# H;cVL^r j Q ^ O^-^rJ U VJP ^

(><i\^ ^ OWNER' S TELEPHON E NUMBER-HOME : J L 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 NO 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 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 : Th e activitie s t o b e in^jlementedb y EP A unde i this agreemen t ar e puisuan t t o Sectio n 10 4 o f CERCLA , 4 2 U. S C 960 4 EPA' s right o f

acces s t o th e propeit y i s providedfo i mSectio n 104(e ) o f CERCLA , 4 2 U.S . C 960S(e) , whic h provide s enti y foi "deteiminingth e nee dfoi response , o i choosin g o r Iddn g an y response actio n unde i tfai s title , o i otherwis e enforcin g tfaeprovision s o f tiie title. "

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 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 7r . *>i'ASlri,BUIL T DRAWTNiS: ' 7y7^^ . OIM- . 9090 8 Dat e Excavated : 11/03/200 8 IXS£P A Sigpied-OfrOate : v . 9090 8 Moth Am w Omah a Lea d Sit e Exterio r Pain t SH a Sketc h • Gao d • Poo r Sa»r»p«r g Addraaa : 203 8 FLORENC EB V [^No t pain t Sampl e Numtie r Lsa d Sampl e LA B Sample s Collecte d Concentratio n CoUecte d Rmi . FJ A HUJ-C C RYASCPXA-g090 B F l • Saf i pp m D Pete : \ ^ 7 1 /O" ? RYBSCPXA-OOW a F 2 Time . \2.-\ 0 p m RYCSCPXA-9080 8 B l U .6 0 I , PP* " Sample s Analyze d RYDSCPXA-eO«0 8 B 2 

# t u RDZOCPXA'WW B -O i U XR F Unit ; CJiH t Book - 13l3 _ «OgOOPX/^W90 0 6 2 D 

## u Pete : I J ' Q< e • Q l • " oo m 

## n D Trm e JH H Lr t RYBSCPtA-90e0 8 

## a Staff : i«lS ^ SROSU K 43 2 pp m Numba ro f Sample s • j t f [ ^ j | Legend : F l = Fmn t Left , F 2 e Fron t Ripm , B l = Bac k LerLB ? * Bap k Rig M O Z - Oil p Zone . G Z =" Garden , P Z - Pla y A l quadiart* ir e n vmiBm ^ A•km . Mcln Q prapen y 

## ENTlFHE D ^0VS>2':;L. ^ 

## l^PI:...^! ^ B2=1S«PPM@24' ' B l = 215EPM@4' '


## . U 

# I i^t i

5 5 e 

# I ^4 1 Fi:... f 

## F? . F 1 = 214PPM@ 4 

# n ^ F2 = 172PPM@24 "

• .FI?r*i'!«:t' . .<?•;{, . DA ] c«« dMinorroxT U E A = 14 5 PP M @ SCRAP E

CONTRAC T# : E P - R7-07-0 6 / 000 4 PRUDEN TTECHNOLOGIES , INC .ENVIRONMENTAL * CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : 5lo2> ^ CrlorcjvvC e B J ^ ^^^^ ' i^/l^h o Phone : BVID : Ite mN O Plant s & Permanen t Landscapin g T o Remai n I n Plac e O n Map Descriptio n & Locatio n 

# to P

Pre-Existin g Conditio n of Structure s Doe s you r Basemen t hav e ahistory o f

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

\ 

# I ropert y Owne i Pruden t Employe e Signature d ignature : 

## ^Ly- ^ 

## M808 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 Onnaha , 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

## 9090 8 Exteho rPain t r4arthAna w Omah a Lea d Si t • Goo d Sit e Sketc h Samplin g Addjess 203 8 FLORENC E BV [g^Nr t pain t ;ress : : 

# r Sampl e Nt mbe r Lea d Sampt o UB Sample s

Co I Concentntio n Collecte d Firm : Ffl 4 RYASCPXA-9090 8 F l C] Date :U / / RYBSCPXA-9090 8 F2 

## _±aj l pp m Time : \lU q pm RYCSCPXA-9090 8 B1 

### Cl Sample s Aniiyze d RYDSCPXA-9090 8 B2 

### 818 \ pp m 

### CI RDZOCPXA-DOaB O -O Z pp m 

# n XRFUnit : tkSHZ . Bookria i 9090 0 Q g tf^QZOOPXA pp m 

## D Date : //ufi ^ 

# 2 .pp m 

## D CI Time : La b RYB^CPLArgOSO a 

# L ^La b " ^Resul t 43 2 pp m NumberLfSamples=[j O Q ^ I «»«« : iMSte ^ Legend : Fl >• Fn^n t Left , F2 = Fron t Right , B^ = Bac k Left , Ri g It DZ = Dri p Zone , GZ = Gapen , PZ = Pla y tacnoprepo^ 

# ENTERE D KOVi D 2 

## '2M l 

# m\..[ m

i\y.\.\^ . I I •
: 8c( . 

## 55f t

*l*^ ^ 

# t F.l.';..!. . If?- . 

# ; I i : I ;

. '.0?rw4^ . '^A-i tm i Cnmt . ViV * VlVtM- M 046141.012 3

### Print Preview Pag e 1 o f 1 Dougla s County-Omaha , N E

Parce l I D Owne r Nam e Pmpert 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 113905000 0 MORELL O BERNAR D J 2 0' 3 ?

1141 3 HICKOR Y R D OMAH A N E 6814 4 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 10-15-1 3 FRANKU N SQUAR E 0 9 N40F T 40X14 0

http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp ? parc=113905000 0 http://douglasne.mapping online.com/DouglasCoNe/static/accountinfo.jsp ? accountno=R113905000 0 Disclaime rMa p an d parce l dat a ar e believe d t o b e accurate , bu t accurac yi s no t Ma p Scal e guaranteed . Thi s i s no t a lega l documen t an d shoul d not b e substitute d fo ra titl e search , 1 inct i = 7 2 fee t appraisal , survey , o rfo rzonin g verification . 

### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 10/1/200 8

### Pag e 1 of 2

" > Create Anothe rTicke t Bacl < t o irtl i interne t 

### Sen dEmai l

• YOURTICKE T NUMBERI S 2163697 . Origina l Cal l Date : 10/28/0 8 Time : 11:2 8 a m Op : MADHURIMA1 8 96 7 Wor k t o Begi n Date : 10/30/0 8 Time : 12:0 0 p m State : N E County : DOUGLA S Place : OMAH A Adciress : 203 8 Street : FLORENC E BLV D Twp : 15 NRng : 13 E Sect-Qtr : 10-SW,15-N W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatito n wor k fo r soi l Locatio n o f Work : LOCAT E ENTIR E PROPERT Y Remarks : FAX 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 Bein g 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 Borin g : NExplosives : N CXCAT V LEVEL 3 MAGELLANMUDO 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 : 877366834 4 LEVEL S LEVEL S COMMUNICATIONS , LL C N AAlt : Emerg : 877366834 4 

### Day : 918574709 8 MAGELLA N MAGELLA N MIDSTREA M PARTNER S L P TONY A Alt : 

### Emerg : 918574709 8 Day : 402504782 3 MUDO l METROPOLITA N UTILITIE S DISTRIC T SAND Y Alt : 

### Emerg : 402504797 0 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.. . 10/28/200 8

### Pag e 2 of 2 ^ ( 5 

### 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 QLNNEl C QWES T LOCA L NETWOR K N A 

### Alt : 

### Emerg : 888728934 3

http://www.dhon.org/irthinternet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.. . 10/28/200 8