## TRANSMrrXA Lo f OMAHA LEA D SrT E SOI LREMEDIATIO N FIL EFOLDE R 

# SAI D # : ??C C ;^ nDate : 1 1 ' I 5 " I 0

Remediation Contractor : Pp t -. nPrM ^ l^rA^ N/TCOC , 

## if t <\ . //VK^ . 

## ? Year : cAj X ( j SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 

## ef Vide o o f propert y (DVD ) / 

## Executiv e Summar y ^ 

## EPA-providedpropert y sketch 

## E

f SignedAcces s Agreemen t fo r

subject propert y 

## n SignedAcces s Agreement(s ) fo r

adja^n t propert y ^ 

## Restoratio n Agreemen t ' 

### H ' 

## Settlemen t documents (i.e. , fo r

damag e o r

to replac e plants , etc. ) ^ 

## Confirmation data 

# d Photograph s 

# y As-btiilt sketch 

# y Satisfector y restoratio n signedb y Propert y Owne r ^ . 

## Propert y close-out chec k

lis t signedb y EP A D Descriptio n ofarea 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 D ilifcl w Qo^J^ , 

## Signatur e Dat e 3021834 7 

# • HHHI M Superfun d

### PROPERT Y SUMMAR Y Date : 11/15/201 0 Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO^ l Mont hof : Novembe r Propert y Address ; 311 6 FONTENELL EBLV D 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 = 8 7 PP M @ 2" ; EA = 11 3 PP M @ 2 " ATTACHMENT S 1 ) Property 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 digita l vide o clip/photograph s 5 ) Documentatio n - Complete dClose-ou t Checklis t 6 ) As-Built sketch

i ) Shal l includ e fma l lea dlevel s v ) Legen d ii ) Contaminatio n lef t behin darea s vi ) Contracto r identificatio n iii ) Property 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 obtainedinclude : i ) Pre-excavatio n agreement detail s (i f an y ar e mad e withth e property owner ) ii ) Property Statu s For msigne 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 ) forma t 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 .

TECHNOLOCIES
. INC
.Fin d Record Remediatio n Queryj Lea d Remainin g Quer yI Propert yDamag e Quer y 

### Backfill :

Sampl e Area : 8503 0 - 311 6 FONTENELL E B D Owner : Use rProvide d Owne rInformatio n
n Owne rOccupie d Owne rName : Owne rName : INEI^O N DONAL D V 

# 1 Owne rAddressl : Owne rAddress : 

# 1 ! Owne rAddress2 : |311 6 FONTENELL E BLV D City : State : Zi p Code : City : State : Zi p Code : (OMAH A|N E J68104 - 

## j 

# 1 r• Owne rPhon e Alternat e Phone : Owne rPhone : Alternat e Phone : 1(402 ) 457-400 7 )(402 ) 312-198 8 

# 1 1

Contract : Assessment : Contractor : JPRUDENT2010_ S I Qualifyin g Grou p 40 0 Contrac t Optio n OPTIO N 1 Assessmen t Ma xXR F Valu e 

### 49 0 Resident : Residen t Name : Propert yAddress : )311 6 FONTENELL E B D Zi p Code : )68104 - Residen t Phon e 

# I

### .))jg]ji-!")ikj\.1 : TKMNOLOGDES , EMC . •:<-y ? ' ' ''..-•-jv.^j u U 

# EP A Propert y Clos e Ou t Propert y # : ^'70 $ < ^ Propert y Address L^5 1 '( ^ ?*'^+<^-^l e Uv A Date/Time : Owner' s Name : %^oru>t.\c k

^^Sov\ Quad s Excavated: ' Contracto r Group : Pruden t Technologies , Inc. , 

### Excavatio n Genera l Ye s N o I . I f necessary , wer e the correct quadrant(s ) excavate dandrestored ? / 2 . I f necessary , wer e the correct area s o f drip zone e.xcavate dandrestored ? / Gradin g Sodan dVegetatio n Ye s N o 1 .

Doe s the gradin g aroun dthe perimete r o

f th e hous e i n excavatedarea s generall y slop e awa y fro mth e house ? 

## y 2 .

Has sodbeen lai din ai l area s tha t wer e e.\cavated ? 

# y 3 .

Doe s tl^ e sodappea r to be generall y health y andgrowing ? (Onl y evaluat e i f inspecte dat a3 0 da

y tim e period) 

# y 4 .

Ar e soddedarea s generally fint i an devenl y graded ? 

## y ^ 5 .Ar e the joint s between tli e sodstrip s generall y tight ? (Onl y evaluat e i f inspecteda t a3 0 da y tim e period ) 

# y 6 .Wa s the propert y grade dsuc htlia t wate r wil l not pool o n tli e property ? / 7 .

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

# y 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 ) 

# y 2 .Were al l gate s o r fence s take n dow n durin g restoratio n activitie s reinstalled ? (I f applicable ) / 3 .

Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) 

# y Wa s damag e t o retainin g wall s avoided ? (I f applicable ) 

# y Foundation , Sidin g an dGutter s Ye s N o I .Wa s dainag e to th e sidin g o r tri mavoided ? 2 .Wa s damag e to th e foundatio n avoided ? 

# "7 y^ 3 .

Wa s damag e t o window s avoided ? 4 .Wa s damag e t o window s o r doo r screen s avoided ? 5 .

Wa s damag e t o downspout s o r downspou t extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Ye s y. N o 1 .Wa s damag e l o drivewa y swrface s avoided ? 

# f r -y 2 .Wa s damag e t o walkwa y surface s avoided ?

## 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 ^' ^ ^ ^ ^Date: io\(s\\ orRNDEDCIES . IN C 

### A S - BUIL T DRAWIN G OL S #8503 0 Dal e Excavated : 09/28/201 0 

### OMAH A LEA D SUPERFUN D SIT E I'SEP A Signcd-Of T Date : 

### 8503 0 Exteno rPain t Omati a Lea d Sit e • Goo d Sit e Sketc h Q^Poo f Samplin g Address : 311 6 FONTENELL E B D [ ] Not pain t Sampl e Numbe r Lea d Sampl e LAB Sample s Collecte d Concentratio n Collecte d Firm : p E Tuf
. DP.T. \ RYASCPXA-8503 0 F l pp m D Date ; 7/01/o ^ RYBSCPXA-8503 0 F 2 pp m 

### 11 5 

# • Time : l7-2f?PN \ RYCSCPXA-«503 0 B 1 pp m D 

## Jli o Sample s Analyze d RYDSCPXA-8503 0 B 2 

### IQ ? pp m D RDZSCPXA-8503 0 D Z pp m D 

### AH2^ XR F Unit ; IQSfr'Z - Book ; ZMfi > nGgOCPXA-0503 0 -e z pp m D D Dat e 1 I S -o'= t nPZOCPXA-B503 0 PZ - pp m D D Time : 

## nn . Staff : Numt>e ro f Sample s = 5 

## ns w Legend : F 1 = Fron t Left , F 2 = Fron t Right , B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla ; Al l quadrant s ar e a

s viewe d from tti e street , facin g propeit yA
. . e v

R<\

- :JK « rre^tfj : 'iri-SovJ « w^w ^ Toivn-EMEH_E tip . E A = 1I3PP M aj2 " CONTRAC T# : EP-S7-10-0 5 PRUDENTTECHNOLOGIES , INC
.

## x ^ Propert yCompletio n Agreemen t Thi s agreement document s th e completio n o f remova l activitie s performe do n th e belo w hste dpropert^ / Th e property owner' s signatur e indicate s tha t th e property owne r i s satisfie dvvit hth e restoratio n o f th e subjec t property. , an dtha t n o item s ar e i n question , now , o r at an y tim e i n th e future , excludin g any remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Property ID : Property Address : Mitt P-of^^ey\-p.(ll p 

# B n Owner : """ ^ 1 Phone : Restoratio n Item s im i Qyestion : ItetB : ttem : ttem : item : Item :
Require dcorrectiioirs s t o complet e th e property :

\n \ I agre e restoratio n i s completed , except a s note d abov e L J I d o no t agre e restoratio n i s complete d



# -W; ) ' Aj^ ^ 1o\\: > Dat ePniden t Technologies , Inc . (Prudent ) is unde r contrac t withth eU. S. Environmenta l Protectio n Agenc y (EPA ) to clean up lead

contaminate dsoil s at anumbe r ofpropertie s locate d in Omaha , Nebraska , includin g th e property locate dat dj l U p K()ftff£Al^Ll.f . Qt-V ^ • Tli e EP A request s you r permissio n to allo w Pruden t to performasoi l cleanu pat thi s propertyt o remov e lead-contaminate dsoil . By signin g thi s form , th e property owne r grant s permissio n to Pruden t to perform activitie s relate d to th e cleanu p includin g soi l sampling , remova lof lead-contaminate dsoil , an drestoratio nof th e reference dproperty . Ifyo 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 southoffic e ,for th e Omah aLea d Site cleanup-a t (402 ) 733-1188 . Genera l question s abou t th e Omah aLea dSit e cleanu p can be directe d to th e EP A Publi c Informatio n Center s at (402 ) 731-304 5 (SouthOmah aoffice ) or (402 ) 991-958 3 (NorthOmah aoffice) . Property Acces s Grante dBy : (Pleas e Prin t Name ) Propert y Owne r Signature : 

# ^Uiki o (Signature ) (Date ) 

## "'^.Vs^^*-
. PROPERT YINFORMATIO N J, (T o be complet ^ by residen t and/o r p propert y owne r — pleas e print ) RESIDEN TNAME : Owne r Rente r RESIDEN TADDRESS : 

## 3 // ^ Fo /V TlAJtL L €^ 3^ / & IF RENXAL , PRQP55T YGOWNE D BY :

OWNER' S MAILIN ; . .IN G ADDRESS ADDRESS ^ v,^ ^ 

# 3\( U v^^YN>u > ^ \ VJ (^ OWNER' S TELEPHON E NUMBE R - HOME : f^? ^ Y^ f " 2-^7^ ^ WORK : J L AG E OF HOME ? 

# 5^ YEARS
. HO W LON G HAV E YO U LIVE D HERE ? 

# 2x YEARS
. HA S TH E EXTERIO R BEE N PAINTE D OR COVERE D WIT H SIDIN G SINC E 1978 ? ^ _2\_YE S NO

^ NUMBE R OF OCCUPANT S UNDE R 7 YEAR S OLD : I NUMBE R OF OCCUPANT S 7 YEAR S OL D AN D OLDE R <V. ^ IST S NUMBE R OF CHILDRE NUNDE 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 : 

## ±2 _ COMMENT S OR SPECIA L INSTRUCTIONS^I.E
. DOGS , ENTR YGATES , ETC. ) 

# tr

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS i Th e activitie s to be implemente dby EP A unde r thi s agreemen t ar e pursuan t to Sectio n 10 4 ofCERCLA , 42 U.S.C . 9604 . EPA' s righ t ofacces s to th e propert y is provide dfor in Sectio n 104(e ) of CERCLA , 42 U.S . C 9605(e) , whic hprovide s entry for "determinin g th e nee dfor response , or choosin g or takin g an y respons e actio n unde r thi s title , or otherwis e enforcin g th e provision s of th e title. " 808 0 War d Parkway , Suit e 40 5 580 0 S 10 St 424 2 Medica l Drive , Suit e 426 0 Kansa s City.M O 6411 4 Omaha , Nebrask a 6810 7 Sa n Antonio
. TX 7822 9 Phone : (816 ) 363-370 3 Photie : (402)733-116 8 Phone : (210)822-988 8 Fax : (816)363-370 7 Fan : <402 i 733-188 3 Fax : (210 ) 579-667 7ENV[ROiNMEi\T.\L & CONSTRUCTIO N 

## TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : 3// ^ foNTl^N€LL i S^*/T> Date : ^/^ijOi O I O 

## Phone : ^^_^^_2f ^ BVID : J5c ? 3 0 

# /<r^^7>//?< : AOC A6 h

u l YLAA/? ^ 

# KtMoO l Oi^' O f^ca ^ O^y ^ C^xYtoU- ^ ^ ^ KJ lic^vuive i Fsy^^i ^ S^yf^(>/^( ^ ^KcAvitr T ^ ((1' 5 ^ ^ 

# \)o ^ i^^^ l l? e /jyy f^Sri)^ . "yc ? /Uoin7=' y OuJiyK€i r ^t^/j^uen^ ^ (Zs^,yv*^v^ {x^y-WkKy J 3-' ^ ht^ r J

Propert y Owne i Pniden t Employe e 

# "^^.U^ ^ Signature : Signature : 808 0 WardParkway . Suit e 40 5 560 0 S 1 0 S t 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 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 ) 822-968 8 C-.W
. /O'IC t ie- * '»TA T C.»v . tAt\t \Ti l '400 1 i:..v . tt^rw e70JS«7 7^'. ^ 

## 8503 0 Omah a Lea d Sit e Exterio rPain t Nort nArro w Sit e Sketc h • Goo d G/Poo r Samplin g Address : 311 6 FONTENELL E BD Q Not pain t Sampl e Numbe r Lea d Concentratio n Sampt e Coitecte d LA B 

### Firm : Sample s Collecte d RYASCPXA-8503 0 RYBSCPXA-8503 C RYCSCPXA-8503 0 RYDSCPXA-8503 0 F l F2 B l B2 

## 10 3 

# ;i 5 H'^O

10 5 pp m pp m pp m pp m 

# c/ D 

# • D D Date : Time : 7/C>ili:>' ^ 12,-25? h Sample s Analyze d RDZSCPXA-8503 0 D Z 

## IHZ pp m 

## D XR F Unit : 

## I08 RBook : ZHie . RGZGCPXA-eSOO O RPZCCPXA-8.5Q30 8 2 PZ ­ — pp m pp m 

# • D 

# n Date : _ 

### Time : 

## 1 -f S -o ^ Numbe rof Sample s = I 3 ^ j Q Staff : 

# <ns w Legend : F 1 = Fron t Left , F2 = Fron t Right , B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone
. G Z = Garden , P Z = Pla : Al l quadrant s ar e a s viewe d fro m th e street , facin g propert yA ; t cV

Crtiittd ' orMNnvJ:' S 0447ni u i ; 3 W»>v- K TGWTENJEI_I. £'b'D .

### ^ ^ Pag e 1 o f 1 

# 3M ^ mh-hdJ e Slvd , K . % ^

http://douglasne.mapping-online.com/assessdoc/Photos/04/R2414490000000 1 .jp g 9/14/201 0

## H 

# A Printed : No v 16,201 0 www.dcgis.org/dogi s

### Pag e 1 o f 1

" > Creat e Anothe rTicke t Bac k t o Irt h Inteme t Sen d Email s 

### YOURTICKE T NUMBERI S 2597347 . Origina l Cal l Date : 9/21/1 0 Time : 11:0 4 a m Op : SIVA1896 7 Wor k t o Begi n Date : 9/23/1 0 Time : 11:3 0 a m State : N E County : DOUGLA S Place : OMAH A Address : 311 6 Street : FONTENELL E BLV D Twp : 15 NRng : 13 E Sect-Qtr : 08-N W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : SOI L LEA D REMEDIATIONPROJEC T 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 : SIV AJAMPAM A Phone : (402)733-118 8 Wor k Bein g Don e For : EP A Dept h o f Excavation : 6 F T Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : 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 COX COMMUNICATIONS , IN C HEID I 

### Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUDO l METROPOLITA N UTILITIE S DISTRICT SANDY 

### Alt : 

### Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCITY OFOMAHA-TRAFFIC,SEWE RRICH/TRAFFIC Alt : 402444516 1 

### Emerg : 402444516 0 Day : 406728934 3 0PPDGPR 5 OMAH A PUBLIC POWE RDISTRIC T EL M LOCATINGAlt : 406207149 4 

### Emerg : 888728934 3 Day : 406728934 3 QLNNEI C QWES T LOCA LNETWOR K EL M LOCATINGAlt : 406207149 4 

### Emerg : 888728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/21/201 0

### ENVIRONMENTA L ENGINEERIN GAN D CONSTRUCTIO N 

## tBOHNOLoenp , mc . SOLUTION S 

## SIT ESAl^T Y HAZARD ANALYSI S Address : --3llJji--^LJ2i2£siL£U£. . Excavatio n Date : Crew : 

## Backfi U Date : —

Ite m Conditio n Hazard s Correctiv e Actio n Overhea dLine s ^ ! ^ 

## u>Jg r

pnuf ^ Gas Lin e 

# y Wate r Lin e Sewer Lin e 

# -f r £ 1 

## Septic/Leec h Fiel d Propane/Bntan e Sidewal k irr. ^ ^fiAyjSs>^Bt ^ c^€^ 

## Foundatio n Retainin g Wall s 4yr^ 

## Fence s j^: i 

## Tree s G 6 ^ 

## Structure s Driveway f^ftf-Zt^gt^g/-- ^ 

## Sprinkle r Syste m Othe r Cre w Forema n Sit e Safet y Offic e Date :

m o WaitfBMlMwiy . Suit e 40 5 

### seoosios t 424 2 Medica l Drive , Suft e 726 0 KaMwGi|y;iK>«411 4 Oinatiai f Nctaaifc a 0810 7 Sa n Antonto , T X 7822 9 Pfione : (8ft ) 3tt|3?Q 3 PlMiw : (402)733-110 8 Phone : (210)822458 8 Fax : |8ffi)363«370 7 Fax : (402)733^108 3 l=ax : (210 ) 679-657 7

# 311 6 6 1 W'OZ-^o/ n