## TRANSMTITA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL EFOLDE R SAm# : I4bi t Date : ^[k S Address : ^7^\\j^a<;,\ - % Y Remediatioi i Contiactor : 'PJrH/i/lr i ^(h . W . Year : S n I n SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 1 ^ Vide o o f property (DVD ) Executiv e Summai y EPA-provide dproperty sketc h 

# 4 Signe dAcces s Agreemeo t for subjec t propeit y DSigne dAcces s Agreement(s ) for adjacent property ^ 

## Restoratio nAgreemen t D Setdemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) dConfirmatio ndat a Photograph s As-buil t slcetch Satisfijctor y restoratio nsigne db y Property Ovme r Property close-ou t chec k lis t signe db y EP A •Descriptio no f area s no t meetin g RO D cleanu p criteri a Utilit y deazance s 

## Property informatio nfiomDougla s County Assessor' s OfG.c e D D D ^^^ ^ 

## Signatur e 'l^te " 3026242 1 

# llll l Superfun dFin d Record 

### Backfill :

Sampl e Area : 46 6 Owner : 

# t D Owne rOccupie d Owne rName : j FLOY D DURAN T Owne rAddressl : Owne rAddress2 : |221 1 LOCUS TST City : jOMAH A Owne rPhone : 

# t - 221 1 LOCUS TS T

State : Zi p Code : JN E J6811 0 Alternat e Phone : 

# 1 Remediatio n Quer yI Lea d Remainin g Quer yj Propert yDamag e Query



### Resident : Contract : Residen t Name : 

# r Propert yAddress : |221 1 LOCUS TS T Zi p Code : 6811 0 Residen t Phon e Contractor : PRUDENT2009_ S Contrac t Optio n OPnON 3 Assessment : Qualifyin g Grou p [40 0 Assessmen t Ma xXR F Value : 647. 2

### PROPERT Y SUMMAR Y Date;p/15/201 0 | Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-0 6 T0# 1 | Mont hof : fs c T Propert y Address : 221 1 LOCUS T 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 : ARE A NO T EXCAVATED ; U C = 29 9 PP M @ SCRAP E CONFIRMATIO N SAMPLIN GDATA/RESULTS : Y

A = 23 7 PPM @ 8" ; D Z= 25 2 PP M @ 10" ; Y C = 8 6 PP M @ 8" ; Y B = 169 PPM @ 10" ; 0 4 = 2 4 PP M @ 12" ; P Z= 28 3 PPM @ 12" ; G Z= 16 8 PPM @ 12" ; N O EASEMENT ATTACHMENT S 1 ) Propert y sketchprovidedb y EP A pursuan t t o contrac t specification s 2 ) SignedAcces s Agreemen t including acces s agreements requiredfo r crossing othe r propertie s 3 ) Pre-Excavation digita l vide o clip/photograph s 4 ) Post-Excavation digita l vide o clip/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Built sketch­ i ) Shal l includ e fina l 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 ) Othe r item s t o b e includedi n the individua l propert y file , if available , or obtainedinclude : i ) Pre-excavation agreemen t detail s (i f an y ar e mad e wit hthe 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 (Window s Medi aVideo ) o r SW F(FlashPlayer ) forma t and/or photograph s iv ) Signedfor mverifying satisfactor y restoration v ) Description of area s no t meeting InterimRO D cleanu p criteria .

TEGHNOLOCIES , INC .

### V j \j'?J ) ii ' 'ii'yi'h , ) TECHNOLOGIES , INC . Propert y# : ^( > Date/Time : Quad s Excavated : 'yA,'^t;/)a-;Y8/62 , cV/ = 

# EP A Propert y Clos e Ou t Propert yAddress : 22J l /^(MJ ^ 7 h Owncr'sNamc : At^va.^[ ^ F'^O N Contracto rGrnu|r : Prudcn l Tcchnolofiies , tne . 

### Excavatio n Genera l Ve s N o 1 .

I f necessary , wer e lii e correc i quadianl(s ) e.\cavatedandrestored ? / 2 .I f necessan' , wer e lli e correc i area s o f drip zon e excavate dandrestored ? / Gradin g So dan dVegetatio n Ye s N o 1 .

Doe s the giadin g aroundIh e perimete r o

f the hous e in excavatedarea s generall y slop e awa y fro

mlli c house ? / 2 .

Ha s so dbee n laidi n al l area s Iha l wer e excavated ? 

## y 3 .

Does Ih e sodappea r t

o be generall y healtli y andgrowing ? (Onl y evaluate i f inspecteda t a3 0 da

y lim e period) y " 

### 4 .

Ar e sodde darea s generall y firman devenl y graded ? y 5 .Ar e ihe joint s belwee n the sodstrip s generall y tighl ? (Onl y evaluat e i f inspecteda t a3 0 da y lim e period) y 6 .Wa s Ih e pioperly grade dsuc htlia t wate r wil l no l pool o n the property ? y 7 . Wa s damage lo landscaping o r plan t material s avoided ? ( / Gates , Fence s an dRetainin g Wall sVc s N o 1 .

D o gale s ope n andclos e freely ? (I f applicable ) 

# y 2 .

Wer e al l gale s o r fence s taken dow n during restoratio n activitie s reinstalled ? (I f applicable ) 

### y 3 .

Wa s damage l o gale s or fence s avoided ? (Ifapplicable ) 

## y 4 .

Wn s damag e lo reiaining wall s avoided ? (Ifapplicable ) / Foundation , Sidin g an dGutter sYe s N o 1 .

Wa s damag e lo ihe siding o r irimavoided ? 

# y 2 .

Wa s damag e lo the foundaiion avoided ? 

# y 3 .

Wa s damag e l o window s avoided ? 

# y 4 .

Wa s damag e l o window s or doo r screen s avoided ? 

# y 5 .Wa s damage lo downspout s or downspou t extension s avoided ? 

## y Sidewalk s an dDriveway s (Concrete. )Ye s N o 1 .

W;is (laiiiMg c l o drivewa y surface s avoided ? / 2 .Wa s damage l o walkwa y surface s avoided ? 

### y

## ^ ^ U ^Cub f S ^ Owne n comments :

Ilnspectio n notes :

.O " 

### f .



## Remova l an drestoratio n activate s complet e includin g th e 30-da y so dwarrant y EP A Representativ e 

# -a - ^ 

## Date : l7t37'e >.,SSS> L 

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n o f removal 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 property owne r i s satisfie dwithth e restoratio n ofth e subjec t property , an dtha t n o item s ar e i n question , now , o r a t an y tim e in th e future , excludin g any remaininj ; warrant y (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert;'I D 

### Propert : Address : p ? 3/ / lO£4/-St ^ ^* h Owner : Vo^^rr ^

^^ti ^ Phone : H^\ - glj,^ l 

# t Restorat o n Item s i n Question : 

## S o d jOrJ ^ ^<g>i ^ HMiJkilay l C4^w6he4 r&yj A ii ^ AIU^I , S^/J^ O 

## ftpS^i' hM^ ^

^^ ^

I^L O /Ly^^^iA-^i h /g?^5=^ . Item : Item : I correction s t o complet e th e property :

ag rs e restoratio n I s completed . 

## n I d o lo t agre e restoratio n i s confiplete d a t (note d deficiencie s above )



## \

a^ . :2lU . 

# /7-//-€ > 9 Owner ' I Signatur e Dat e 

# tPruden t Technologies , Inc . (Pnident ) is unde r contrac t wil hth e U. S. Environmenta l Protectio n Agenc y (EPA ) to clea n up lead containiiute djoil s al anunibe rof propertie s locate din Omaha , Nebraska , includin g th e propert y locate d at iJ3/ / ufjCj^J.^'r Sjr . Th e EP A request s your , pemiissio n to allo w Pruden t to performasoi l cleanu p at thi s property to remov e lead-contaminate dsoil . By signin g thi s fonn , ^ e property owne r grant s permissio n to Pruden t to perform activitie s relate dto th e cleanu p includin g soi l sampling , remova l of lead-contaminate 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 dfor you r property , pleas e contac t Prudent' s Adiiiiiii.-itniiiv c Cler k for th e Omah aLea dSit e cleanup . .M.s . Siv: i .S . .I;iini-):in.i-a t (402 ) 7.13-I INS . Genera l question s abou t th e Omah aLea dSit e cleanu p ca nbe directe d to th e EP A Publi c InformBtio n Center s at (402 ) 731-304 S (SouthOmah aoffice ) or (402 ) 991-958 3 (NorthOmah aoffice) . Property Acces s Grante dBy : 

# X J ^ ftvl5U/V F-l/ O (Please4>rm t Name ) Property Owne r Signature : 

### \ o - 

### I­ (Signafjfe ) (Date ) PROPERTi r INFORMATIO N (Tob e e complete

complete d d b

b y

y iciiden

iciiden t t and/o and/o r r p propert y owne r —pleas e print ) RE8IDEN TNAME : (Owne r Rente r 

# hi/K^c( r Ho ye t RESIDEN TADDRESS : 

# ?^ H l^ocrty^' t ^i - IF RENTAL , PROPERT YOWNE D BY : OWNER' S MAILIN G ADDRESS ; 

# Sam t 

# mwi-n& i -^J"* ' OWNER' S TELEPHON E NUMBE R - HOME : ( f*^** ) 

### J 1 

## 7 / / AG E OF HOME? : ' YEARS . HO W LON G HAV E YO U LIVE D HERE ? YEARS . HA S TH E EXTERIO R BEE N PAINTE D OR COVERE D WTT H SIDIN G SINC E 1978 ? ^YE S NO . NUMBE R OF OCCUPANT S UNDE R 7 YEAR S OLD : c7 NUMBE R OF OCCUPANT S 7 YEAR S OL D AN D OLDE R 

# •

2? NUMBE R OF CHILDRE N UNDE 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 : COMMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. ) 

# (Pa^ s K^ ?

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s to be implemente d by EPA unde r this agreemen t ar e pursuan t lo Sectio n 10 4 ofCERCLA , 42 U.S.C . 9604 . EPA' s righ t ofacces s lo lli e property is provide dfor in Sectio n 104(e ) of CERCLA , 42 U.S . C 9605(e) , whic hprovide s entr y fo r "determinin g th e nee dfo r 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 ofth e title. "

808 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 , MO 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : 1816 ) 363-370 7 Fax : 1402)504-100 5 Fax : (210 ) 579-657 7ENVIROiVMENTA L & C0NSTRlJCT10 ^ 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : (33/ / l^Ctfi f i'^ - Date : 

## /0^7-0? ' H09 . -yr/ ^ S7(f i Phone : BVID : Ite mN O Plant s & Permanen t Landscaoin e T o Remai n I n Plac e O n Ma p Descriptio n & Locatio n . , ^ /^ . S..j J 

# J

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Pre-Existin g Conditio n o f

Structure s Doc s you r Basemen t hav e ahistory o f

leaking ? Ye s No ^ 

## Ite mN O Descriptio n & Locatio n , , r - , % / jk ^ j L^ O n Ma p

Propert y Owne r Pruden t Employe e Signature : (^Uv. ^ I^w ? Signature : J^(C L 808 0 War d Parkway , 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 Ohnnn - IAI\'> \ 7t 1 -flO OrcFlNOI/KUES . INC . 

### A S - BUIL T DRAWIN G t)LS#:46 6 Dat e Kxcavatcd : 10/19/2011 9 

### OMAH A LEA D SUPERFUN D SIT E 1,8KP A Signfd-Ot r Diito : 

### "^G C Exteno rPain t Nort h jUrro w Oniah a Lea d Sit e • Goo d Sit e Sketc h 0 Poo r Samplin g Address : d. ^ 1 1 LOOUS 7 (3f - |~ 1 Not pain t 

### \ Lea d Sampl e Sample s Collecte d Concentratio n Collecte d Sampl e Numbe r LA S 

### Firm : I'^yerd n f n RYASCPXA - ^ Q Y A Q ^ Q pp m 

### [ T 

## n Date : RYBSCPXA - I.I.Q Q Y B 

### D Time : RYCSCPXA - tf.C Q Y C *fC ^ po m 

## n Sample s Analyze d RYDSCPXA - H-Q C Y D ^.=? 0 pp m 

# • RDZSCPXA - ^ Q D Z G C ^ Do m XR F Unit : Book ; RGZSCPXA - '^G Q G Z Y^( p pp m 

# • Date : G - fl - .9. 9 RPZSCPXA - *f(2 Q P Z 7(3 d Do m Time : .9;/ / Staff : Numbe ro f Sample s 

### = 1 1 O Legend : YA = Yar d (NE) , Y B = Yar d (SE) . Y C = Yar d (SW) . Y D = Yar d (NW) , D Z = Dri p Zone , G Z = Garden , P2 = Pla y Al l quadrant s ar e a a ucwe d fro m th e street , (aclr g propertyAuJB.' i

0 4 = 24P1> M « 12 " ' ^

\RV. \.NOT EXC A \.\TED ; L C

- 29 9 PP M f l S f RAPF . (-1" )

LOCUS T Sxr . N O KASKMEN 1 CONTRAC T# : E P - R7-07-0 6 T0# 1 PRUDEN TTECHNOLOGIES , INC .

## ^G C Omah a Lea d Sit e Sit e Sketc h Exterio rPain t • Goo d 0 Poor NorthArro w Samplin g Address : ^^1 7 L-C^dUT^ l (37 " Q No t pain t \ Sampl e Numbe r RYASCPXA - *^ Q Y A Lea d Concentratio n Sampl e Collecte d LA B 

## D Fimi : Date : Sample s Collecte d 

## t^\/&rcfrt/ n / RYBSCPXA - ^C C Y B 

## D Time : RYCSCPXA - ^ Q RYDSCPXA - H-G C Y C

Y D *^ ^ DPT l ___^3Q.PP m 

# n n Sample s Analyzed RDZSCPXA - ^(^ ^ D Z (2G. ^ pp m 

# n XR F Uni t Book: RGZSCPXA - *^ Q G l *f'H o pp m 

## D Date : G-a - .9. 9 RPZSCPXA- *fC( ^ P Z 7Q d pp m 

## D Time : Q:/ / Staff : Numbe ro f Sample s = 

## I I Legend : Y A= Yard (NE) , Y B = Yard (SE),'Y C = Yar d (SW) . Y D = Yar d (NW) . D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrants ar e as viewe d fro m tfi e street , facing property ^ hjjJa ^

### Prin t Previe w Pag e 1 of 2

'.•>5ii> ' 

## Dougla s County-Omaha , N E

Parce l I D Owne r Nam e Propert 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 Sec-Twn Rn g 073584000 2 FLOY D DURAN T 221 1 LOCUS TS T OMAH A 6811 0
221 1 LOCUS TS T OMAH A N E 6811 0 10-15-1 3 Additio n Bloc k Lo t Lega l 1 Lega l 2 Lega l 3 Lega l 4 Acre s Treasure r Websit e Lin k Assesso r Websit e Lin k CAI N PLAC E 0 1 3 LOT S 11-1 2 & 120X146.7 5

0.3 8 http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp ? parc=073584000 2 http://douglasne.mapping online.com/DouglasCoNe/static/accountinfo.jsp ? accountno=R073584000 2 

### http://\vww.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 9/16/200 9Pag 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 2379835 . Origina l Cal l Date : 10/05/0 9 Time : 1:5 8 p m Op : SIVA1896 7 Wor k t o Begi n Date : 10/07/0 9 Time : 2:3 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 221 1 Street : LOCUS T S T Twp : 15 NRng : 13 E Sect-Qtr : 09-NE-SE,10-NW-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : SOI L LEA D REMEDIATIO NPROJEC T Locatio n o f Work : LOCAT E ENTIR E PROPERT Y Remarks : FAX AL L CLEAR S TO : (402)733-188 3 : FA X AL L CLEAR S T O (402 ) 73 3 188 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 : NFront : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V MAGELLA NMUDO 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 MAGELLA N MAGELLA N MIDSTREA M PARTNER S L P DEBORA H Day : 918574709 8 Alt : Emerg : 918574709 8 MUDO l METROPOLITA N UTILITIE S DISTRIC T SAND Y Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFIC.SEWE R RO N Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 10/5/200 9

## Pag e 2 of 2

0PPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T 

### N A 

## Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNN E1 C QWES T LOCALNETWOR K 

### N A 

## Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 10/5/2009

### ENVIRONMENTA L S . CONSTRUCTIO N 

### TECHNOLOGIES . INC . SOLUTION S 

# Sit e Safet yHazar d Analysi s 

# ( b Address : J2Jli 7 y:ocu% 7 Crew::^t^<N< > U J ^JJ'^^O'V J 

## Bf . Date : y«c ? 5 o *>



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