SAID* : 25358 

### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R DATE : 1/1 5 ADDRESS : 113 2 N 2 0 S T REMEDIATIO N CONTRACTOR ; PRUDEN TTECHNOLOGIES . INC . YEAR : 20lt 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S •PR E AN D POS TVIDE O O F PORPERT Y(DVD ) EXE(:UTIV E SUMMAR Y EPA-PROVIDE D PROPERT YSKETC H 

# J SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN TPROPERT Y RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R TO REPLAC E PLANTS , ETC. ) c a CONFIRMATIO N DAT A PHOTOGRAPH S AS-BUIL TSKETCH 

# J SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R U PROPERT YCLOSE-OU TCHECKLIS TSIGNE D B YEP A n DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A • , UTILIT YCLEARANCE S m PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E D D ^ _ D

SIGNATUR E DAT E 3021828 0 Superfun d

### 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 Montl i of : Propert y Address : 113 2 N 2 0 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 2 = 27 5 PP M @ 13" ; N O EASEMEN T 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 sketc h­ 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 din th e individua l property file , i f available , o r obtaine dinclude : i ) Pre-excavatio n agreement detail s (ifan y ar e mad e withth e property owner ) ii ) Property Statu s Formsigne db y property owne r iii ) Excavatio n digita l vide o in 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 ofarea s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOGIES . INC .Fin d Record Remediatio n Quer y Lea d Remainin g Quer yPropert yDamag e Quer y 

### Backfill :

Sampl e Area : 2535 8 ­ 113 2 N 2 0 S T Owner : Use rProvide d Owne rInformatio n Resident : n Owne rOccupie d Owne rName : Owne rName : Residen t Name : | R AN D W CORPORATIO N Owne rAddressl : Owne rAddress : Propert yAddress : 1113 2 N 2 0 S T Owne rAddress2 : Zi p Code : 1561 6 FOR TST 168102 - City : State : Zi p Code : City : State : Zi p Code : Residen t Phon e lOMAH A|N E 168104 - Owne rPhon e Alternat e Phone : Owne rPhone : Alternat e Phone : 1(402 ) 457-597 9 |f402 ) 453-402 2

Contract : Assessment : Contractor : PRUDENT201 0 S Qualifyin g Grou p 40 0 Contrac t Optio n OPTIO N 1 Assessmen t Ma xXR F Valu e 

### 52 7TECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y # : Z'^^f^z ^ Propert y Address : "52 ­ A ) ­ ~2- 0 4+- - Date/Time : Owner' s Name : *Ku.f: ^ (^i?(ler^o ^ Quad s Excavated : ^"2 - Contracto r CJroup : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s N o L

, If necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 

# y 2 .If necessary , wer e th e correc t area s ofdri p zon e e.xcavate dan drestored ? 

## J Gradin g So dan dVegetatio nYe s N o 1 .Doe s th e gradin g aroun dth e perimete r o f th e hous e i n excavate darea s generall y slop e away fromtli e liouse ? 

## J 2 .Ha s so dbee n lai di n al l area s that were excavated ? 

## J 3 .Doe s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 da

v tim e period ) / 4 .Are sodde darea s generall y fin n an devenl y graded ? / 5 .Ar c tli e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 day tim e period ) / 6 .Wa s th e property grade dsuc htliat wate r wil l no t poo l o n tli e property ? / 7 .

Wa s damag e t o landscapin g o r plan t material s avoided ? / Gates , Fence s an dRetainin g Wall sYe s N o 1 .D o gate s ope n an dclos e freely ? (Ifapplicable ) / 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 ? (Ifapplicable ) / 4 .Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) / Foundation , Sidin g an dGutter sYe s N o 1 .Wa s damag e t o th e sidin g o r tri mavoided ? / 2Wa s damag e t o th e foundatio n avoided ? / 3 .

Wa s damag e t o window s avoided ? / 4Wa s damag e t o window s o r doo r screen s avoided ? / ."j .Wa s damag e t o downspout s o r downspou t extension s avoided ? / Sidewalk s an dDriveway s (Concrete ) Ye s No I Wa s damag e t o drivewa y surface s avoided ? 

# J y ­ 2Wa s damag e t o walkwa y surface s avoided ?

## Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e Q^A y ^pate : tlish iKrnNnroGiKs . IN C 

### A S - BUIL T DRAWIN G OL S n2535 8 Dal e Excavated : 11/10/201 0 

### OMAH A LEA D SUPERFUN D SIT E ISEP A Signed-Of f Date : 

### 2535 8 Exterio rPain t Omah a Lea d Sit e • Goo d Sit e Sketc h • Poo r Samplin g Address : 1132 N 2 0 S T [ J Not pal m Lea d Sampl e Sapnple s Collecle d Sampl e Numbe r LA B Concentratio n Collecte d Finn : RYASCPXA-2535 8 F 1 /ft p rom E f Date : ';-zZ'0 9 RYBSCPXA-2535 8 F 2 2 9 5 pp m 

# • Time : If.o o Ai ^ RYCSCPXA-2535 8 B l Z B Q ppm 

# • Sample s Analyze d RYDSCPXA-2535 8 B 2 5Z 1 pp m 

# I f D RDZSCPX A3636 8 O i rpp m 

### D D XR F Un i t : \hPtU1 . Book : m \ nOZCCPXA-2535 8 - G i ~ pp m 

# • Date : 

### D RPZOePXA-2535 0 ~ " pp m 

### D Time : ?V> s 

### D La b RYASCPLA-2535 8 Staff : MSVs l Resul t Numbe ro f Sample s = | ^ | l i 20 7 pp m = Fron t Right . B 1 = Bac k Left . 8 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden . P Z = Pia ^ Al l quac^rapt s are a s viewe d fro m Jh p street , facin g propert y T 

# ENTERE D MA Y2 9 200 9 

### 28 6 ^ 

### 5Z 1 B 2 = 27 5 PP M fl 13 " 

# s z .U3.^.. ^ 

## zo ^ t t — 

### Z°i S 

# leo . F t 

# a .

NLD5 L Rtf\-2'»'' K •'rettliN l 'I5-KOV-J,I 8 N O E,\SEMEN T

CONTRAC T # : EP-S7-10-0 5 PRUDENTTECHNOLOGIES , INC .

# &EP A Propert yCompletio n Agreemen t Thi s agreemen t documents the completion of remova l activitie s perfonnedo n the below listedproperty . Th e propert y owner' s signatur e indicate s tha t the propert y owne r i s satisfiedwit hthe restoration of the subject property , an dtha t no items ar e i n question , now , o r a

t an y tim e i n the future , excluding an y remaining warrant y (3 0 day s total ) except thos e items listedbelow , ifany . Propert y ID : Propert y Address : j ( 3ZK J ^O ^ S ^ Phone : Q 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 . 

# o I d o no t agre e restoratio n i s complete d a t (note d deficiencie s above )

Dat e

# jfKTK r Pruden t Technologies , Inc . (Prudent ) i s under conlrac t withth e U . S . Environmenta l Protectio n Agenc y (EPA ) t o clean u p lead
contfipjnate dsoil s a^ anumbe r o f

prmiertie s locate di n Omaha , Nebraska , includin g th e propeit y locate da t 12 ^ A / (y^ O " ^ ^' ' • Tli e EPA request s you r permissio n t o allo w Pruden t t o perfor masoi l cleanu p a t thi s piipert y t o remov e lead-contaminate dsoil . B y signin g thi s form , th e property 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 , removal o f lead-contaminate dsoil , an drestoratio n ofth e reference dproperty . If

yo u hav e an y question s abou t th e soi l cleanu p plaiuie dfo r you r property , pleas e contac t Pniden t Sout hOmah aOflic e for th e Otnah a LeadSit e cleanup,.at (402 ) 733-1188 ; 733-1455 . General questi<$ns)abou t th e Omah aLeadSit e cleanu p can b e directe dt o th e EP A Publi c hiformatio n Center s at (40Z) i 731-304 5 (Sout hOmah aof f Property Acces s Grante dB y 

# n 

# 6- f i/ 7 ^. r S / ^ (RHas e mnt Name ) V 

### ll/'i/Zof O Property Owne r Signatu i (Date ) "ROPERT YINFORMATIO N (T o b e complete d b yresiden t and/o rpropert yowne r~ please print ) RESIDEN TNAME : Owne r Rente r RESIDEN TADDRESS : ^ 

### O/v ^ 

# T I I F RENTAL , PROPERT YOWNED BY : 

# //fr/?^ / 7 OWNER' S MAILIN G ADDRESS ; OVyNER' S TELEPHON E NUMBER - HOME : //<92 ^ ^ S Z-^O'Z^'L. ^ WOR K
AG E O F HOM E YEARS . HO W LON G HAV E YO U LIVE D HERE ? HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978 7 t O F OCCUPANT S UNDE R 7 YEAR S OLD : A///mmBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDE R O F CHILDRE N 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 RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s t o b e implemente db y EP A unde r this agreemen t ar e pursuan t t o Sectio n 104 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 entry 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 ofth e title. "

808 0 War d Parkway , Suit e 40 5 560 0 S . 10" * Stree t 424 2 Medica l Drive , Suit e 425 0 KansasCity , MO6411 4 Omaha , Nebrask a 6810 7 Sa n Antonio , T X 7822 9 Phone:(816)363-370 3 Phone : (402)733-145 5 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)733-188 3 Fax:(210)579-657 7l U il! . • ? fiOS' i 

# ./r^.^--.' I , /

/y- 1

0/1?/ ^

J^'^ y^^^d ^ _ / O ^^.vo03^>~ 7 ^7J'':?^v/( f '^:fr^y^'iL-) 0 ^ V ^ ' ^^?f) / SI .

~^5^^v3^2» / _d s 

## j ^ —*5«p ^

/vA-voj vs^o^ j s^o^o ^ /y-i02?^/ ^ 5/ ' TI'^ J O J 

# ¥ z g ^ ^ 

## S 5 ^^ ^ ;(HAi i r.9uo i



### •JM I 'S3^ra010K[H3'l l vcjj.:)iii?i:Si:jo:. i ^ /

• » =



# ; M

### ^ 

## 2535 8 Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e • Goo d 

### Sit e Sketc h • Poo r 

### Samolin a Address : n3 2 N 2 0 ST [ j No t paint

## N 

# LTGAL : 6 0 X 13 3 & 1/ 2 VA C 

# A Printed : No v 08,201 0 W Ww . dcg i s . org/dogi s

### Pag e 1 of 2 "> Creat e Anothe rTicke t Bac kto Irt h Interne t Sen d Emai l



### • YOU RTICKE T NUMBE R IS 2637907 . Origina l Cal l Date : 11/09/1 0 Time : 8:4 5 am Op : SIVA1896 7 Wor kto Begi n Date : 11/12/1 0 Time : 9:1 5 am State : NE County : DOUGLA UGLA S S Place : OMAH A Address : 113 2 Street : N20T H ST Twp : 15 NRng : 13 E Sect-Qtr : 15-NW-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e of Work : soi l lea d remediatio n projec t Locatio nof Work : LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)733-188 3 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 of Excavation : 6 FT Corne r Lot : Y Front : Y Rear : Involve s Tunnelin g or Horizonta l Borin g : NExplosives : 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 NA 

### 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 OF0MAHA-TRAFF1C,SEWE R 

### RICH/TRAFFI C Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . .11 /9/201 0

### Pag e 2 of 2
0PPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T Alt : 406207149 4

EL M LOCATIN G 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. . , 1 1 /9/201 0TEOHN ! lOUIOfla , .Hi C 

### CONSTHUCnO N 

## SIT E SAFET Y HAZAR D ANALYSI S SOLUTION S



## Address : 

# . 

# lh: : Crew : ^il4 > )/\ ^ Excavatio n Date : BackfiU Date :

Ite m Overhea dLine s Ga s Lin e Wate r Lin e Sewe r Lin e Septic^Leec h Fiel d Propane/Butan e Sidewal k Foundatio n Retainin g Wall s Fence s Tree s Structure s Drivewa y Sprinkle r Syste m Otlie r Cre w Forema n Conditio n Hazard s Correctiv e Actio n ^ - 

# h^ ' v^ 

# e^ ( ^ ^ 1—/ P irey O

• 

# ore a r ^

.— 

## Ipcc ^ cs« ^ tr ^ 

# o^

—

^ ^ 

## Sit e Safet y Offic e Date :

O M Wanf«wtany , Suit B 44 » SSOOSIOS t 424 2 Medica l Drive , Stdt e 726 0 ;ansasa|lyiW>«411 4 nhi'jilr a S810 7 Sa n Antonio , T X 7822 9 iMMia : (81< ) 36S>378 3 Plwn KfUO ) 733-118 8 Phone : (2t0 ) 822468 8 a cIMS ) 363.370 7 Fax : (402 ) 73»<188 3 Fax : (210 ) «TO-«57 7

# 4