## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL EFOLDE R SAI D # : '^^119 ^ Date : H ^ I 5 " I 0 Address : ^(6 3 (\} . 0 ^ cS + Remediation Contractor : p!?f-,r7Pr^'- f

T^-r- ^ f^jococ ^ ]•?•<>. . irsid'^ i Year : ^(J j ( J SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S \ i Video of propert y (DVD ) ffl Executiv e Summar y EPA-providedpropert y sketch SignedAcces s Agreemen t fo r

subject propert y SignedAcces s Agreement(s ) fo r

adjacen t propert y Restoratio n Agreemen t D Settlemen t documents (i.e. , fo r

damag e o r

to replac e plants , etc. ) 

# i Confirmation dat a Photograph s As-built sketch Satisfector y restoratio n signedby Propert y Owne r 

# i Propert y close-out chec k

Us t signedby EP A D Descriptio n o f

area s no t meeting RO D cleanu p criteri a C Utilit y clearance s I I Propert y information fromDougla s Coimt y Assessor' s Office D D D 

## Signatur e Dat e 3026080 8 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 : 410 2 N 1 8 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 : AREA NO T EXCAVATED : DZ/L S (4'X4' ) = 10 9 PPM @ SCRAPE CONFIRMATIO N SAMPLIN GDATA/RESULTS : F 2 = 5 9 PP M @ 4" ; D Z= 9 3 PP M @ 13" ; E A = 6 2 PP M @ SCRAP E(~1" ) ATTACHMENT S 1 ) Property sketc hprovide dby EPA 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 digital 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 ) Property addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e include di n th e individual property file , if available , o r obtaine dinclude : i ) Pre-excavatio n agreemen t detail s (i f any ar e mad e wit hth e property owner ) ii ) Property Statu s For msigne dby property owne r iii ) Excavatio n digital vide o i n MPEG , WMV (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 Recor d j Backfill :

Sampl e Area : 3377 8 - 410 2 N 1 8 S T Owner : n Owne rOccupie d Owne rName : JSTEINKAM P LO U A Owne rAddressl : Owne rAddress2 : )410 2 N 1 8 S T City : State : Zi p Code : lOMAH A ||N E |68110 - Owne rPhon e Alternat e Phone : 

# 1

Contract : Contractor : |PRUDENT2010_S Contrac t Optio n JOPTIO N 1 Remediatio n Quer yLea d Remainin g Quer yI Propert yDamag e Quer y

Use rProvide d Owne rInformatio n Owne rName : 

### ) Owne rAddress : 

# 1 City : State : Zi p Code : 

# i • • 1 • • Owne rPhone : Alternat e Phone : 

# 1 • 1

Assessment : Qualifyin g Grou p |40 0 Assessmen t Ma xXR F Valu e j 509.5 6 Resident : Residen t Name : SPECKSYLVI A Propert yAddress : J410 2 N 1 8 S T Zi p Code : J68110 - Residen t Phon e 

# I2 ' TECHNOUDGIES . INC . Propert y # : "S'57''7 ^ Date/Time : Quad s Excavated : / ^ 2.^ , p 

# EP A Propert y Clos e Ou t Propert y Address : 9 '^ ^ ^ Owner' s Nanrae : Z^- c -^-reT-t^ \^LtJ-«w: ^ Contracto r Group : Pruden t Technologies , Inc. , E.Kcavatio n Genera l I .

] f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 2 .If necessary , wer e th e correc t area s of dri p zon e e.xcavate dan drestored ? Gradin g So dan dVegetatio n 1 .

Doe s th e gradin g aioun dth e perimete r of th e house in excavate darea s generall y slop e awa y fro mtli e house ? Ha s so dbee n lai din aJ l area s tlia t wer e e.xcavated ? 3 .

Doe s tli e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e if inspecte da t a3 0 da

y tim e period ) 4 .

Are sodde darea s generall y fir man devenl y graded ? ."i

. Are Lli e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e if inspecte da t a3 0 day tim e period ) 6 .

Wa s ih e propert y grade dsuc htliat wate r wil l no t poo l o n th e property ? 7 .

Wa s damag e t o landscapin g or plan t material s avoided ? Gates , Fence s an dRetainin g Wall s 1 .D o gale s ope n an dclos e freely ? (I f applicable ) 2 .Wer e 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 diunag e to gate s o r fence s avoided ? (I f appiicabie ) 4 .Wa s damag e l o retainin g wall s avoided ? (I f applicable ) Foundation , Sidin g an dGutter s f .Wa s damag e t o th e sidin g o r tri mavoided ? 2 .Wa s daniag e l o th e foundatio n avoided ? 3 .Wa s dainag e t o window s avoided ? 4 .Wa s damag e t o window s o r doo r screai s avoided ? 5 .

Wa s damag e ( o downspout s o r downspou t extension s avoided ? Sidewiilk s an dDriveway s (Concrete ) 1 .

Wa s damag e l o drivewa y surface s avoided ? 2 .Wa s damag e l o walkwa y surface s avoided ? Ve s N o 

# y / Ye s N o / / / / 

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## Owner s coimmeiiiits :

Imspection notes :

Remova l an drestoratio n activate s complete includin g th e 30-da y sodwarranty : EP A Representativ e Qo^'::So n Date : lohih oECHNDTOCIES , INC . 

### A S - BUIL T DRAWIN G OL S #3377 8 Dat e Excavated : 9/28/201 0 

### OMAH A LEA D SUPERFUN D SIT E USEP A Signed-OI T Date :

Name ; ;i>f/ ^ i ? ^'•< - Omah a Lea d Sit e Date ; o-^-'-'' ^ ^

^ Nort h Arrow /^ddress ; HiC i / V ly^ i Sit e Sketc h Time : / i / 5 Phone . -11 ^ I - 'V * '2-/^ 5 / y^-^y^ y Tea m 

# _^^V i BVI D #^£ZZZ _ XR F Cod e Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e A^fYe s a N o 0 3 fiVB^c.yy(f i - ?yrv ^ pp m /^ZYe s n N o E pp m / ; / Ye s a N o S y>ZYe s a N o ca ­ /'Z_Ye s C D N o S - Ye s C 3 No n Ye s • No n

Omah aLeadSite 4613 0 CONTRAC T# : EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC .

# tlo n Aq\mem@ m Thi s agreemen t documents th e completio n o f removal activitie s performe don tli e belc w liste dpToperTy', Th e property owner' s signatur e indicate s tha t th e propert} ' owne r i s satisfie dwit hth e restoratio n ofth e subjec t property , an dtha t n o item s are in question , now , o r a

t any tim e i n th e future , e.K.cludin g any remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , if any . Propert y DD : Property A.ddress : 4(0 ^ K i 1 ^ f K ^ W Owner : 

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# /d-/y/ o DatePnide mTechnologies , inc . (Prudent ) i s unde r contrac t withth e U . S . Environmenta l Protectio n Agenc y (EPA ) t o clean u p lead
coiAMi^i^ivle dsoil s a ] ^lumbe r o f

propertie s locate din Omaha , Nebraska , includin g th e property locate da l ^f7y^-/7 . y ^ /C I " ^ ^"f^ ^ EPAreque.-it s your permis.sio n l o allo w Pruden t t o performasoi l cleanu p at llii s pro'pert y to'remov e lead-coAlauninale ds^il . B y signin g thi s form , th e property owne r grant s permissio n t o Pruden t l o perform activitie s relate dt o th t cleanu p includin g soi l sampling , remova l o f lead-conlaminate dsoil , an drestoratio n ofth e reference dproperty . Ifyo u hav e an y question s abou t th e soi l cleanu p planne dfo r 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 aLeadSil e cleanu p ca n b e directe dt o th e EP A Publi c Informatio n Center s a l (402 ) 7 3 I -304 5 (Sout hOmah aoffice ) o r (402 ) 991-958 3 (Non hOmali aoffice) . Property Acces s Granle dBy : ^ ^- i (Pleas e Prin t T Propen y Owne r Signatur e 

# °\jlCih o (Date ) ^yPROPERT YINFORMATIO N (T o b e complete db y residen t and/o r propert y owne r —pie ; RESIDEN TNAME : [jsK . /\ - ^V'vVXld O rOr ^ Rente r RESIDEN TADDRESS :
I F RENTAL , PROPERT YOWNE D BY : OWNER' S MAILIN G ADDRESS : OWNER' S TELEPHON E NUMBE R - HOME : ('7(3 7 > ^ ^ j " <^^7^(Z > WORK : AG E O F HOME? : 1 . S YEARS . HO W LON G HAV E YO U LIVE D HERE ? G ? YEARS . HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978? X YE S N O NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : C/ > NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBER O F CHILDREN.UNDE R 7 YEAR S OL D WH O PLA YI 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 YGATES , ETC. )

AUTHORIT Y FO RE N VIRONMENT.A LRESPONS EACTIONS : Th e artivitie s t o b e implemente db y EP A unde r this agreemen t arc 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 Ih e property i s provide dfo r in Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) . whic hprovide s entry for "detenninin g th e nee dfo r response , or choosin g or takin g an y respons e actio n under thi s title , o r otherwis e enforcin g th e provision s ofth e titie. " 808 0 War d Parkway . Suit e 40 5 560 0 S iQ-S t 424 2 Medica l Drive , Suit e 425 0 Kansa s City.'M O 64I U Ornaha . Nebrask a 6310 7 Sa n Antonio . T X 7822 9 Phone : (81S ) 363-370 3 Phone : ;402 > 753.116 8 Phone : {210)822-968 8 Fax : (816)363-370 7 Fait ­ (402 t '33-188 3 Fax : (210)579-667 7ENVfRONMENTALJ t 

# IRUDEN ' CONSTRUCTIOi S 

### TECHNOLOGIES , INC . SERVICE. S 

# Propert y Statu s For m Address : ljIQ ZA J /(^ ^ ST " Dat e Phone: BVID: 3 5 77S ' l^ryi/ic L/(^r/ZyJA ^ l{pi . y ^ f T) X f^- Z^ CLJ^/) ^ 

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Propert y Ow n Prudent Signatur e 808 0 War d Parl(yay , Suit e 40 5 560 0 S 1 0 S t 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M p 6411 4 Phone : (816 ) 3B3-370 3 Omaha , Nebrask a 6810 7 Phone ; (402)733-118 8 Sa n Antonio , T X 7822 9 Phone : (210)822-958 8 C-.« ­ lOAC ^ tC ^ •»Trt 7 C..., . lAri^ l Ti- t ^oo• >I—Name : Omah a Lea d SKe Date : 

### y/^y<: y Nort h Arro w Address : H/O I /J / /g'^j ^ Sit e Sketc h 

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### YOURTICKE T NUMBE RI S 2600864 . Origina l Cal l Date : 9/24/1 0 Time : 4:5 4 p m Op : SIVA1896 7 Wor k t o Begi n Date : 9/28/1 0 Time : 5:3 0 p m State : NE County : DOUGLA S Place : OMAH A Address : 410 2 Street : N18TH S T Twp : 15 NRng : 13 E Sect-Qtr : 03-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : soi l lead remediatio n projec t Locatio n o f Work : LOCAT E ENTIR E PROPERTY 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 : EPA Dept h o f Excavation : 6 FT Corne r Lot : NFront : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : 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 CXCAT V CO X COMMUNICATIONS , IN C HEID I 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUDO l METROPOLITA N UTILITIE S DISTRICT SAND Y 

### Day : 402504782 3 Alt : 

### Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R RICH/TRAFFIC 

### Day : 402444719 7 Alt : 402444516 1 

### Emerg : 402444516 0 0PPDGPR 5 OMAH A PUBLI C POWE RDISTRICT EL M LOCATIN G 

### Day : 406728934 3

Alt : 406207149 4 

### Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K 

### EL M LOCATIN G Day : 406728934 3

Alt : 406207149 4

Emerg : 888728934 3
httD://www.dhon.ore/irthintemet/DHONNoticeCreation/MessageText.asD?ret=<RESULTS. . . 9/24/201 0

### ENVIRONMENTAL ENGINEERIN GAN D CONSTRUCTIO N TECHNOUfiflES , IN C 

### SOLUTION S 

## SIT E SAFfcT Y HAZAR D ANALYSI S 

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nask a6810 7 424 2 Medica l Drive , Suit e 725 0 Sa n Antonio , T X 7822 9 Phone : (8t6)36»70 3 Plume : (4 03)733-118 8 Phone : (2t0 ) 822.958 8 Fa s (8 1 [6)363^370 7 Fax : (40 2 ) 733^188 3 Fax : (210 ) 579-657 7