## TRANSMTTTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL E FOLDE R SAI D # : a07;) 0 Date : ^i\L^lt O Address : 2.Lt7:7

_gyp{v>4n n^r f RemediationConlractor : Pf\]iAljl W"I^LIA \(\L

## Year : ^g/ 6 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S ffl a 

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## Vide o o f property (DVD ) Executiv e Summar y E PA-provide dpropert y sketc h Signe dAcces s Agreement fo r

subjec t property Signe dAcces s Agreement(s ) for adjacent property Restoratio nAgreement Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) Confixmationdat a Photograph s As-bnil t sketc h Satisfector y restoratio nsigne db y Property Owne 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 clearance s 

## Property informatio nfromDougla s County Assessor' s Offic e

Signature Dat e 3005418 3 Superfun dRn d Recor d Remediatio n QueryI Lea d Remainin g QueryI Propert yDamag e Query 

### Backfill :

Sampl e Area : 2072 0 - 242 2 POPPLETO N A V Owner : D Owne rOccupie d Owne rName : {HERNANDE Z ABELARD O Owne rAddressl : 

# r Owne rAddressZ : |242 2 POPPLETO N AV E Qty : State : Zi p Code : [OMAH A [N E J6810 5 Owne rPhone : Alternat e Phone : |(402 ) 346-362 0 Resident : Residen t Name : [HERNANDE Z ABELARD O Propert yAddress : |242 2 POPPLETO N A V 

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p Code ; |6810 5 Residen t Phon e 

# I Contract : Contractor : |PRUDENT2009_S Contrac t Optio n |OPnO N 2 Assessment : Qualifyin g Grou p )400/CHIL D Assessmen t Ma xXR F Value : 

# r 665.3 7

### PROPERT Y SUMMAR Y Date:t>|/15/201 0 | Omah aLeadSit e Remedial Actio n Contrac t #EP-R7-07-0 6 T0# 1 | Mont hof : j y | a\ J Propert y Address : 242 2 POPPLETO N AV E A . EXECUTIV ESUMMAR Y A. lIssue s Encountered : NON E A. 2Issue s Resolved : NON E A. 3Uniqu e Findings : NON E A. 4Othe r Relevan t Information : ARE A NO T EXCAVATE D PE RP.O . REQUEST ; F2/L S (10'X15' ) = 18 4 PP M @ SCRAP E CONFIRMATIO N SAMPLIN GDATA/RESULTS : F2 = 8 6 PPM @ 6" ; B 2 = 25 4 PPM @ 6" ; DZ = 35 3 PPM @ 12" ; N O EASEMENT ATTACHMENT S 1 ) Propert y sketc hprovidedby EP A pursuan t to contract 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 Checklist 6) As-Buil t sketc h­ i ) Shal l include final 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 items t o b e includedi n the individua l propert y file, i f available , o r obtainedinclude : i ) Pre-excavation agreemen t detail s (if an y ar e mad e wit hthe propert y owner ) ii ) Propert y Statu s For msignedby 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/o r photograph s iv ) Signedfor mverifying satisfactor y restoration v ) Description of area s no t meeting InterimRO D cleanu p criteria .TlCHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y # : .aOl^ O Propert y Address : Q^3 i Si , PopP'^+Z^^" ^ Date/Time : Owner' s Name : / ^ V)^-\ftw>l.c ) lT<-fYvcL-^M.€-!r ^ Quad s Excavated : Contracto r Group : Pruiricn t Technologies , Unc , Excavatio n Genera l Ye s No 1 .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 o f dri p zon e excavate dan drestored ? 

## y Gradin g So dan dVegetatio nYe s N o 1 .

Doc s lh e gradin g aroun dth e perimete r o f th e hous e i n excavate darea s generall y slop e awa y fromth e house ? 

# y 2 .Ha s so dbee n lai di n al l area s tliai wer e excavated ? / ^ . Doe s lh 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 day lim e period ) 

## y 4 .Are sodde darea s generall y fir man devenl y graded ? 

# y 5 .

Are U\ e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e if inspecte dat a3 0 da y tim e period ) 

# y 6 .Wa s lh e properl y grade dsuc htliat wate r will no t poo l o n th e property ? 

# y 7 .

Wa s damag e t o landscapin g o r plan t material s avoided ? i / Gates , Fence s an dRetainin g Wall sYe s No 1 .D o gate s ope n an dclos e freely ? (I f appUcable ) ^ 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 gale s o r fence s avoided ? (I f applicable ) / 4 , Wa s damag e l o retainin g wall s avoided ? (I f applicable ) / Foundation , Sidin g an dGutter s Ye s No 1 .

Wa s damag e t o th e sidin g o r tri mavoided ? 

# y 2 .Wa s damag e t o th e foundatio n avoided ? / 3 Wa s damag e l o window s avoided ? / 4 .Wa s dainag e l o window s o r doo r screen s avoided ? i / ."i

.Wa s damag e l o downspout s o r downspou t extension s avoided ? / Si(ie^valk s :in dDriveway s (Concrete ) Ycs ^ No I W;i s dnmag c l o drivcwu y surfHce s avoided' ' 2 . Wa s damag e l o walkwa y surface s avoided ? 

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## Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complet e includin g th e 30-da y so dwarranty : EP A Representativ e S^JSL . 

## Date : /?//»/o ^

# 1

Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n o f removal activitie s perf c le do n th e belo w liste dproperty . crni ( Th e propert y owner' s signatur e indicate s tha t th e propert y owne r i s latisfie dwithth e restoratio n o f th e subjec t prroperty , an dtha t n o item s ar e i n question , now , o r a t any 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 a

i y Propert; ^ ID : 

# t Properl yAddrMi : Qj^^ . /^fl/UM/aj * ^l> e 

### Owner : /^y^/^f,/ ^ /^/rll^/^Je^ . Phone : 

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- ^Vd-3^Z 0 Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item : Require d correction s t o complet e th e property :

I agre e restoratio n i s completed . I I I d o no t agre e restoratio n i s complete d a t (note d deficiencies ; a b Dve )



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### Owner' s Signatur e DatePruden t Technologies , Inc . (Prudent ) i s unde r contrac t wit hth e U . S . Environmenta l Protectio nAgenc y (EPA ) t o clea nu p lead
contaminate dsoil s a t anumbe r o f

propertie s locate di n Omaha , Nebraska , includin g th e propert y locate da t

. Th e EP Arequest s you r permissio nt o allo w Pruden t t o perfor masoi l cleanu p a t thi s propert y t o remov e lead-contaminate dsoil . B y signin g thi s form , tli e propert y owne r grant s permissio nt 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 no f th e reference dproperty . I f

yo 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 Administrativ e Cler k fo r th e Omah aLea dSit e cleanup . Ms . Debora hJohnso n-a t (402 ) 733-1188 . Genera l question s abou t th e Omah aLea dSit e cleanu p ca nb e directe dt o th e EP APubli c Informatio nCenter s a l (402 ) 731-304 5 (Sout hOmah aoffice ) o r (402 ) 991-958 3 (Nort hOmah aoffice) . Propert y Acces s Grante d (Pleas e Prin t Name ) Propert y Owne r Signature : (signature ) <»V ^ (Date ) PROPERT YINFORMATIO N (T o be complete d byresiden t and/o rpropert yowne r~ pleas e print ) RESIDEN T NAME : Owne r Rente r RESIDEN T ADDRESS :



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# ihkkiri o OWNER' S MAILIN G ADD^E^SS ;
OWNER' S TELEPHON E NUMBE R - HOME : J L WORK :
AG E O F HOME? : I ^ ^ YEARS . HO W LON G HAV E YO U LIVE D HERE ? J' D YEARS . 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 OLD : NUMBER O F OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLAY I 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 Aunde r thi s agreemen t ar e pursuan t t o Sectio n10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f

acces s t o th e propert y i s provide dfo r i n Sectio n104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entr y fo r "determinin g th e nee dfo r 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 o f th 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 , M O 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 : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7ENVIRONMENTA L «& CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : ^^rr L PofpUhv N A^-< . Date : Iblt^o" ] Phone : BVID : Ite mN O Plant s & Permanen t Landscapin g T o Remai n I n Plac e O n Ma p Descriptio n & Locatio n



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Pre-Existin g Conditio n o f Structure s Doe s you r Basemen t hav e ahistor y o f leaking ? Yes * ^ N o 

# 5 Ite mN O O n Ma p Descriptio n & Locatio n 

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Propert y Owne r 

### Pruden t Employe e Sig i r«f t 

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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 , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7rFCHKnTTjniF.s . TNC . 

### A S - BUIL T DRAWIN G ()F,.S#:2072 0 Dat e KxiovaUd : ll/()2/2Ut> 9 

### OMAH A LEA D SUPERFUN D SIT E ISHP A .Signcd-OIT Date : 

### Name : .^Afi'/W o HsTmnje ^ Omah a Lea d Sit e 

### Address : 2'iZ X fppp/^'f'ot , f\\ / Sit e Sketc h 

### Phone:i^«^pa\3^fe^ 3 <ea. O Team^^/w.^/^./1/OoJPf ^ BVID # S£y7X D Sampl e Numbe r Lea d Concentratio n 

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XR F Cod e ^^^S D Confirmatio n Sampl e N o i R /=iYe s n N o S N o Q l Si - Ye s C D N o O 52 ^ Ye s ° N o a & Yes JS L Yes • N o N o n D

OmahaLeadSite 4613 0 CONTRAC T # : E P - R7-07-0 6 T0# 1 PRUDEN TTECHNOLOGIES , INC .

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

# t t Dougla s County-Omaha , N E

Parce l I D Owne r Nam e Propert y Addres s City Zi p Owne r Addres s Owne r Addres s Owne r \Cit y Owne r Stat e Owne r Zi p 221810000 0 HERNANDE Z ABELARD O 242 2 POPPLETO N A V OMAH A 6810 5 242 2 POPPLETO N AV E OMAH A N E 6810 5 Additio n Bloci c Lo t Lega l 1 Lega l 2 Lega l 3 Legal 4 Acre s Treasure r Websit e Lin k Assesso r Websit e Lin k SHULLS2NDAD D 7 1 7 60X16 8

0.2 2 http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp ? parc=221810000 0 http://douglasne.mapping online.com/DouglasCoNe/static/accountinfo.jsp ? accountno=R221810000 0 

### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 9/2 1 /200 9

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YOU RTICKE T NUMBE RI S 2388965 . Origina l Cal l Date : 10/19/0 9 Time : 10:4 1 a m Wor k t o Begi n Date : 10/21/0 9 Time : 11:1 5 a m State : N E Address : 242 2 Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C County : DOUGIA S Street : POPPLETO NAV E

Sect-Qtr : 27-NW,28-N E Sect-Qtr : Op : SIVA1896 7 Place : OMAH A

Typ e o f Work : SOI L LEA D REMEDIATIO NPROJEC 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 Contact Name : SIVAJAMPAM 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: Involve s Tunnelin g o r Horizonta l Borin g , : N NFront : Y

Explosives : N Rear : Y CXCAT V LEVEL 3 METHODI S MUD0 2 OMAHACO F OPPDGPR 6 QLNNEI F
Servic e Are a Contac t CXCAT V CO X COMMUNICATIONS , IN C HEID I

LEVEL S LEVEL3 COMMUNICATIONS , LL C N A

METHODIS METHODIS T HEALT H SYSTEMS

MUD0 2 METROPOLITA N UTILITIE S DISTRIC T SAND Y Phon e Numbe r Utilit y Typ e Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 Alt : Emerg : 877366834 4 Day : 888847475 7 Alt : Emerg : 888847475 7 Day : 402504782 3 Alt : Emerg : 402504797 0

### % % Pag e 2 of 2

OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R RICHn-RAFFI C Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0 0PPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T NA Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNNEI FQWEST LOCA LNETWOR K NA Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

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TECHNOLOGIES , INC . ENVIRONMENTA L & CONSTRUCTIO N SOLUTION S ( ^ 

# Sit e Safet yHazar d Analysi s Address : J?v^ ^ /ly>^/«7fe ^ ^^9^^ ^ 

# Ex . /0'?,0-0' ^ Crew : f j ^ Date : /o.J^uo' i


# Item Overhea dLine s Ga s Lin e Wate r Lin e Sewer Lin e Septi c / Leec h field Propane/Butan e Sidewal k Foundatio n Retainin g Wall s Fence s Trees / Bushe s Structure s Drivewa y Sprinkle r Syste m Othe r Cre> \Forema n 

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808 0 Warf i Parkway . Suit e 40 5 250 5 N . 24 ' Street , Suit e 30 8 424 2 Medica l Drive . Suit e 725 0 Kansa s City , M O 6411 4 Omaha , I\!et)r3sk a 6811 0 San Antonio . T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402 ) 504-100 4 Fax:(816)363-370 7