## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL EFOLDE R 

# SAID #Xllf! b Date . 11-15-1 0 Addres s ;74A C ^lonflr N 9 r Remediatio nContracto r Pp,- , ryPiM-J itrA ^ N/XLOC , 

### l y g. . \c^., i Yea r <^ 0 I (J SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S C

f Vide o o f propert y (DVD ) IIIIUIIIIIIMHUIM 

### aExecutiv e Summar y Superfun d 

### EEPA-provide dpropert y sketc h H Signe dAcces s Agreemen t fo r subjec t propert y D Signe dAcces s Agreement(s ) fo r adjacen t propert y [^ Restoratio nA^eemen t D Settlemen t document s ( i e , fo r damag e o r t o replac e plants , etc. ) S l Confinnatio ndat a IZPhotograph s 1 7 As-buil t sketc h •' aSatisfector y restoratio nsigne db y Propert y Owne r ffl Propert y close-ou t chec k hs t signe db y EP A D Descriptio no f area s no t meetm g RO D cleanu p cnten a B ( 

### Utilit y clearance s Propert y mfonnatio nfromDougla s Count y Assessor' s Offic e D D D 

### Signatur e Dat ePROPERT 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 ho f Novembe r Propert y Addres s 243 5 BLOND O S T A EXECUTIV ESUMMAR Y A 1 Issue s Encountere dNON E A. 2 Issue s Resolve dNON E A. 3 Uniqu e Finding s NON E A 4 Othe r Relevan t Information * NON E CONFIRMATIO N SAMPLIN GDATA/RESULT S B l = 38 6 PP M @ 3" ; B 2 = 31 9 PP M @ 3" ; N O EASEMEN T ATTACHMENT S 1 ) Property sketc hprovide db y 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 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 sketc h­ i ) Shal l includ e fina l lea dlevel s v ) Legen d ii ) Contaminatio n lef t behin darea s vi ) Contracto r identificatio n 111 ) 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 individua l property file , i f available , o r obtaine dinclud e i ) Pre-excavatio n agreemen t 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 111

) Excavatio n digita l vide o i n MPEG , WM V (Window s Medi aVideo ) o r SWF(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 criteri a

TECHNOLOGIES , IN CFin d Record Remediatio n QueryLea d Remainin g Quer yPropert yDamag e Quer y Backfill :

Sampl e Area : 2718 0 Owner : ­ 243 5 BLOND O S T Use rProvide d Owne rInformatio n Resident :
n Owne rOccupie d Owne rName : Owne rName : Residen t Name : ICn YO F OMAH A Owne rAddressl : lC/ 0 FINANC E DEP T Owne rAddress2 : 1181 9 FARNAM S T City : (OKAH A~~ ~ Owne rPhon e State : Zi p Code : |N E 168183 - Alternat e Phone : Owne rAddress :
City : Owne rPhone : State : Zi p Code : Alternat e Phone : Propert yAddress : 1243 5 BLOND O S T Zi p Code : Residen t Phon e

Contract : Assessment :
Contractor : |PRUDENT2010
.. S Qualifyin g Grou p |40 0 Contrac t Optio n OPTIO N 1 Assessmen t Ma xXR F Valu e 52 7£5 ^ TECHNOLOGIES , IN C 

# ^ m EP A Propert y Clos e Ou t Propert y #^" 7 1^ ^ Propert y Addres s 2^45 ^ ^^^^^^ c ^" ^ Date/Time : Owner' s Name <^rv^/-/ S c^''>~» ^ Quad s £\ca\ated . o V Contracto r Group : P i uden t Technologies , Inc , Excavatio n Genera l Ye s N o 1 I f necessar y wer e th e correct quadrant(s ) excavatedandrestored'^ / 2 I f necessaiy wer e th e correct area s o f dn p zone excavatedandrestored ? / Gradin g Sodan dVegetatio n Ye s N o 1 Doe s th e gradin g aroundth e penmeter o

f th e hous e mexcavatedarea s generall v slop e awa y 

# y fro mth e house" ? 2 Ha s sodbeen laidin all area s tha t wer e excavated ? ^ 3 Doe s th e sodappea r to b e generall y health y andgrowing ? (Onl y evaluat e i

f mspecteda t a3 0 

### y da

y tun e penod ) 4 Ar e sodde darea s generall y firmandevenl y graded ? 

## y 5 Ar e tli e )oint s between th e sodstnp s generally tight ? (Onl y evaluat e i f inspecte da t a3 0 da y 

## y time penod ) 6 Was th e propert y gradedsuc htlia t wate r wil l not pool on the property ? 

## y 7 Was damag e t o landscaping o r plan t matenal s avoided ? 

## y Gates , Fence s an dRetainin g Wall s Ye s N o I D o gate s ope n andclos e freely ? (I f applicable ) / 2 Wer e all gale s o r fence s taken dow n dunn g restoratio n activitie s reinstalled ? (I f apphcable ) 

# y 3 Was damag e t o gate s or fence s avoided ? (I f applicable ) ^ 4 Was damag e to retainin g wall s avoided ? (I f applicable ) 

### y Foundation , Sidin g an dGutter s Ye s N o 1 Was damag e to th e siding o r tn mavoided ? 

## y 2 Was damag e t o tli e foundation avoided ? 

# X 3 Was damag e to window s avoided ? / / 4 Was damag e t o window s or doo r screen s avoided ? 5 Was damag e to downspout s o r downspou t extension s avoided ? 

# y Sidewalk s an dDnvewa> s (Concrete ) Ye s ^ N o 1 Was damag e to dnvcwa v surface s avoided ? 2 Was damag e to walkwa y surface s avoided ? 

### -y ^

### Owner s comments :

Inspectio n notes :

t.ftRO' ^ fctCM



### Remova l andrestoratio n activate s complete includin g th e 30-da y so dwajrant y t I 

### EP A Representativ e ^an_A« , ^Dat e iA)'u]i aiCHNULOUIES . IN C 

### A S - BUIL T DRAWIN G OLS #2718 0 Dat e Excavate d9/24/201 0 

### OMAHA LEAD SUPERFUND SIT E USEP A Signed-OI T Dat e 

### 2718 0 Exteno rPaint Nort h Arro w Owne rNam e NFA i L REYNOLD S Omah a Lea d Sit e • Goo d Addres s 243 5 BLOND O S TSit e Sketc h • Poo r Phon e H w 

# I Q No t paint Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Fir m RYASCPXA-27ie O F 1 D Dat e 

### FD A {^/ m RYBSCPXA-2718 0 F 2 pp m 

## n Tim e 

# 5qcy pp m RYCSCPXA-2718 0 B 1 pp m D 

### 1( 6 o r Sample s Analyze d RYDSCPXA-2718 0 B 2 pp m 

## n pnzsrpxA?7io o -ez ­ pp m D D XR F Uni t —rf - 

### Boc k

33
. RezacpxA-2 / iBO ~ js i pp m D D Dat e 

### • 1 e^ " -nPirOCPXA-27TB g ^ z pp m D D Tim e _ 3 Staff
_ 

# fe Numbe ro f Sample s = y

Omah aLcd dSite 4 6 n o N O EASEMEN T CONTRAC T# • EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , IN C

# &EP A Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio no f remova l activitie s performe do n th e belo w liste dproperty Th e propert y owner' s signatur e indicate s tha t th e propert y owne r i s satisfie dwithth e restoratio no 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 an y Propert y ID ; y j \^Q Propert y Addnas : f^^ ^ J^^r^ o 5T . Owner . (^^ ^ ^ ^ ^^^ ^ Phone
- {y ^ ^^ ^ ^ g ^ Restoratio n Item s i n Questio n

Item : Item
. 

### Item : Item : Item : Item : Require d correction s t o complet e th e propert y

L J I agre e restoratio n i s complete d | 2 I d o no t agre e restoratio n i s complete d a t (note d deficiencie s above ) 

# W ^ ^Owner' s Signatur e

# D)RUDE !

. ' Ms^ , 

### ^ j

Pniden t Technologies , In c (Prudent ) i s unde r contrac t withth e U S Environmenta l Protectio n Agenc y (EPA ) t o clea n u p lead
contaminate dsoil s at anumbe r o f

propertie s locate di n Omaha , Nebraska , includin g th e propert y locate da t ^/• ? ^ rilt^aft i Hi e CP A request s you r permissio n t o allo w Pruden t t o performasoi l cleanu p a t thi s propert y l o i emov e lead-contaminate dsoi l B y signin g thi s form , th e propert y owne r grant s permissio n t o Pruden t t 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 o f th e reference dpropert y I I 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 southoffic e _fo r th e Omah aLea d Sit e cleanup-a t (402 ) 733-118 8 Geneia 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 at (402 ) 731-304 5 (SouthOitiali aoffice ) o r (402 ) 991-958 3 (Nort hOmah aoffice ) Propert y Acces s Grante dB y Chill i A/ ^ l—yyUAJi h (P i

'leas e Pnn t Name ) Property Owne r Signatur e 

# IJz5c4Ly ^ (Sigjiature ) (Date ) PROPERT Y INFORMATIO N (T o b e complete db y residen t and/o r propert y owne r ~ pleas e pnnt ) RESIDEN TNAM E Rente r ^ RESIDEN TADDRES S 

## o ^ M ?>.s r 

# 8\^'^^fc
. I F RENTAL , PROPERT YOWNE D B Y
OWNER' S MAILIN G ADDRESS ,
OWNER' S TELEPHON E NUMBE R - HOM E J L WOR K

it^(\ ^ J^Jj^-Hji^ y AG E O F HOME ' YEAR S HO W LON G HAV E YO U LIVE D HERE ' YEAR S 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 OL D NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R O F CHILDRE NUNDE 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 WEE K COMMENT S O R SPECIA L INSTRUCTION S ( I E DOGS , ENTRY GATES , ET C ]

AUTHORI l Y ^O RENVIRONMENTA LRESPONS EACTIONS . Th e activitie s t o b e implemente dby EP A unde r thi s agreomen i ar e pursuan t t o Sectio n 10 4 o f CERCLA , 4 2 U S C 960 4 EP A s righ t o f

acces s t o th e propert y i s provide dfor i n Sectio n 104(e ) o f CERCLA , 4 2 U S C 9605(e ) whic hprovide b ent i y for detennmin g th e nee dfor response , oi choosin g o r takin g an y respons e actio n unde r thi s titl e o r otherwis e enforcin g th e provision s o f th e titl e " 808 0 War d Parkwa ySuit e 40 5 560 0 S 1 0 S t 424 2 Medica l Driv e Suit e 425 0 Kansa s Cit y'M O 6411 4 Omah a Mebrask a 6810 7 Sa n Antoni o T X 7822 9 Phon e (816)363-370 3 Phon e (402)733-118 8 Phon e (210)822-958 8 Fax(816)363-370 7 F? xi402 ) 733-188 3 Pa x (210)579-657 7EN\rRO\'MEi\TAL & CONSTRUCTION 

### TECHNOLOGIES , S£RVICE S 

# Propert y Statu s For m Address : 

# Olda ^ U ^ Dale : ^|\3\\ 0 Phone : BVID :

^ Q^( ^ 

# u , t = ^ 

# g ) .^o^ n K ) ^^ ^ ^ ^

< : ^ ^ 

# ^



# ^ M 

# rlr^ ^ o> ^ -^t ^ ^ 

# od i CK^^- ^ c^^l- S CLP-WOJC ^ 0 v^^^L ^ 

# M . V/ac . .C»^tA-'' \ 

# 3 O W <^

_ ? ] ­ rcx\r \ VAt ^ 

# ai s ^ V ? 

# O 3 \'^2' ^ 'PUfet^c^ e IT J \ s H s _. _Fl o rejr i c 

# @ i? q f 4 ^r,\\r ^ V.>A> ^



### Propert y Owne r Pruden t Employe e Signature : Signature : / 808 0 War d Parkwa ySuit e 40 6 560 0 S 1 0 S t ^^^iSiedica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6810 7 Sa n Antonio
. TX 7822 9 Phon e (816)363-370 3 Phon e (402)733-118 8 Phon e (210)822-958 8

# n 2718 0 Omah a Lea d Sit e Owne rNam e NEA L L REYNOLD S 

### Sit e Sketc h Address - 2435 BLOND O S T Phon e H w Lea d Sampl e Numbe r Concentratio n RYASCPXA-2718 0 RYBSCPXA-2718 0 RYCSCPXA-2718 0 RYDSCPXA-2718 0 R l ReZ3CPXA-2 / Iti U • KJiiLljCDJ'k^.'HJ O Numbe ro f Sample s =


# ENTBBB B Exteno rPaih t Ncrt h Arro w • Goo d • Foo r 

# i Q Notpam t Sample s Collected
. 

### Fir m FC ^ 6c^/D H Dat e g Z ^ O H TTme Kg^oS ' Sample s Analyse d XR F Uni t ' ^ i, D Book
. S 3 Date - q'.l.g>(LP ~ Trme-
. r0 Staf f 

# fe

z s s r

EtO^O O S' T Omah aLea dSite 4613 a

## N 

# 243 5 Blond e s t 

# A ^ 

### Printed : No v 16,201 0 wvvw.dcgi s org/dogi s

### Pag e 1 of 2

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


### YOU RTICKE T NUMBE RI S 2592077 . Origina l Cal l Date : 9/14/1 0 Time : 5:2 2 p m Op : SIVA1896 7 Wor k t o Begi n Date : 9/16/1 0 Time : 5:4 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 243 5 Street : BLOND O S T Twp : 15 NRng : 13 E Sect-Qtr : 09-SE,10-SW,15-NW,16-N E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : soi l lea d remediatio n project 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 : 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 LEVEL 3 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
LEVEL S LEVEL S COMMUNICATIONS , LL C N A 

### Day : 877366834 4 Alt : Emerg : 877366834 4
MUDO l METROPOLITA N UTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0
OMAHACO FCIT Y O FOMAHA-TRAFFlC,SEWE R 

### RICHA-RAFFI C Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/14/201 0

### Pag e 2 of 2

OPPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T EL M LOCATIN G 

### Alt : 406207149 4 Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K Day :

EL M LOCATIN GAlt : 406728934 3 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/14/201 0

### ENVIRONMENTA L ENGINEERIN GAN D CONSTRUCTIO N TEftHMomcmi , mc . SOLUTION S 

## SIT ESAFfeTY HAZAR D ANALYSI S 

# ._^W< ^ Address : Excavatio n Date : 

# ^der , • ^ 

## Crew : Backfil l Date :

Ite m Conditio n Hazard s Correctiv e Actio n Overhea dLine s \jj^'^ f*^^ ' 

## Ga s Lin e fljMT : 

## Wate r Lin e ^/P ^ Sewe r Lin e 

# M Septic^Leec h Fiel d ^ 

## Propane/Butan e L ^ 

## Sidewal k /)exr r tiXrJZ^k'to l /fjf,}t(?/ ^ 

## Foundatio n r Retainin g Wall s ir ^ 

## Fence s li o Tree s \/ M /*^ > 

## Structure s 

# ^f ^ ^r-,^ . M.lf<J<- ' 

## Driveway 1/7/ 0 

## Sprinkle r Syste m r ^ Othe r Cre w Forema n Sit e Safety Offic e 

# U ^ ^ T

aoaow i iRfBi(taM|y.Suito40 5 SGOO I 

### sios t 424 2 Medica l DrivB . Stdt s 725 0 C«y.llff«411 4 ORnta,Nil i Sa n Antonio , TX7«22 9 [8W ) 36X^3103 . Ptam : ( « l2)73S-11fl 8 Phone : (2t0 ) 822.-J958 8 ftnc(81 t6K363'4?ll 7 Fao c (40 2 )73»<1tt 3 Fax : (210 ) «7»457 7'-'fyp^:' ' • ' l'''""--.^. , ."'""" i .^<J.'''\ ' ^.iill.-'^'!>-''>y»^-w-^
. 

# ^^^-?^:#r^£--^ "

. ^'

"--
. •r^'ii'i: ^ 4-'*^llf^ > kj# - •--'• ^ ^"• £ ^^r % ' "".fe€;if''^<»,:>. ^ ^ ^ ^ '*'^* * V ^" 

# 1 i^' ­ ^ ; L 

## y'^^^.^k-^y'' ' f•^%'^^:^,:u-^/'v^^.-^^^^^v - ;-: t • • ' v--.: ^ /" ^ 

# 4 •" '