## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL E FOLDE R SAID#:^2I!ML

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## Date : Jlli^LllO ^ Address : ,3ML ^ P/rJTlCJ t A\ l Remediatio n Contractor : RP M nPrM 7 %r. ^ N^o qi» ^ ^ /AJ T , 7 Year : ^ U 1 ( j SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S [ /

Vide o of propert y (DVD ) aExecutiv e Summar y EPA-providedpropert y sketch 

# 7 SignedAcces s Agreemen t fo r

subject propert y D SignedAcces s Agreement(s ) fo r

adjaipen t propert y 0 Restoratio nAgreemen t D Settlemen t documents (i.e. , fo r

damage o r

to replac e plants , etc. ) 

# a Confinnatio ndata Photograph s 0 As-built sketch [ /

Satisfactor y restoratio nsignedby Propert y Owne r 0 Propert y close-out chec k

lis t signedby EP A nDescriptio nof area s no t meeting RO D cleanu p criteri a aUtilit y clearance s 

# d Propert y informationfromDougla s Count y Assessor' s Office D D 

# • Signature^" ^ Dat e 

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### PROPERT Y SUMMAR Y Date : 11/15/201 0 Omah aLea dSit e Reinedia l Actio nContrac t #EP-R7-07-0 6 TO# l Mont hof : Novembe r Propert y Address ; 241 5 PATRIC K A V 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 NSAMPLIN GDATA/RESULTS : F l = 8 1 PP M @ 2" ; B l = 12 0 PP M @ 2" ; B 2 = 36 5 PP M @ 2" ; E A = 11 1 PP M @ SCRAP E(~1" ) ATTACHMENT S 1 ) Property slcetchprovide 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 ndigita l vide o clip/photograph s 4 ) Post-Excavatio ndigita l vide o clip/photograph s 5 ) Documentatio n- Complete dClose-ou t Checklis t 6 ) As-Buil t sketch
i ) Shal l includ e fma l lea dlevel s v ) Legen d ii ) Contaminatio nlef 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 dinth e individual property file , ifavailable , o r obtaine dinclude : i ) Pre-excavatio nagreement detail s (i f an y ar e mad e withth e property owner ) ii ) Property Statu s Formsigne db y property owne r iii ) Excavatio ndigita l vide o i nMPEG , 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 no f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOGIES . INC .Fin d Record Remediatio n QueryI Lea d Remainin g Quer yI Propert yDamag e Query 

### Backfill :

Sampi e Area : 2744 6 - 241 5 PATRIC KA V Owner : n Owne rOccupie d Owne rName : ICTT YO F OMAH A Owne rAddressl : |C/ 0 RNANC E DEP T Owne rAddressZ : |181 9 FARNAI ^ ST City : State : ZipCode : lOMAH A |N E |68183 - Owne rPhon e Alternat e Phone : 

# 1 1

Contract : Contractor : jPRUDEI^T2010_S Contrac t Optio n lOPnO N 1 Use rProvide d Owne rInformatio n Owne rName : 

# 1 Owne rAddress : 

# 1 City : State : ZipCode : 

# 1 1 1 Owne rPhone : Altemat e Phone : 

# 1 • 1

Assessment : Qualifyin g Grou p pO O Assessmen t Ma xXR F Valu e j 

### 54 1 Resident : Residen t Name : [RESIDEN T Propert yAddress : |241 5 PATRIC KA V Zi p Code : |68111 - Residen t Phon e 

# ITECHNOLOGIES , INC . 

### Propert y # : Z 7 ^ ^ ^ Date/Time : Quad s Excavated : F1 , ^ ' i '2'Z - 

# EP A Propert y Clos e Ou t Propert y Address : Z- ^ • * ? pMr^cV l A ^J^ ^ Owner' s Name : ^"7+-i ^ o ^ (•^WA.OXV . 

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^ Contracto r Group : Pruden t Technologies , Inc. , Excavatio nGenera l Ye s N o 1 .If necessar\' , wer e tli e correc t quadrant(s ) excavate dan dreslored ? 

### 7 2 .If necessar> , wer e th e conec t area s of dri p zon e excavate dan drestored ? 

# y 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 nexcavate darea s generall y slop e awa y fro mth e house ? 

# y 2 .Ha s so dbee nlai di nal l area s tliat wer e excavated ? 

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

### 7 da

y tim e period ) 4 .Are sodde darea s generall y firman devenl y graded ? t ^ 5 .

Are th e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e ifinspecte dat a3 0 day i 7 tim e period ) 6 . . Wa s th e propert y grade dsuc htliat wate r will no t poo l o nth e property ? 

# y 7 . Wa s damag e f o landscapin g or plan t material s avoided ? 

# y Gates , Fence s an dRetainin g Wall sYe s N o 1 .D o gate s ope ntm dclos e freely ? (I f applicable ) / 2 .Were al l gate s o r fence s take n dow ndurin g restoratio nactivitie s reinstalled ? (I f applicable ) 

## y 3 . Wa s damag e l o gate s o r fence s avoided ? (Ifapplicable ) 

# y 4 . Wa s damag e ( o retainin g wall s avoided ? (Ifapplicable ) 

# y Foundation , Sidin g an dGutter s Ye s N o ! . Wa s damag e t o th e sidin g o r tri mavoided ? 

# y 2 Wa s damag e to th e foundatio n avoided ? 

# y 3 .Wa s damag e t o window s avoided ? 

# J 4 .Wa s damag e t o window s or doo r screen s avoided ? 

# J 5 .Wa s damag e f o downspout s o r downspou t extension s avoided ? ^ Sidewalk s an dDriveway s (Concrete )Ye s No I .Wa s dajnag e (o drivewa y surface s avoided ? 

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

# y

## Owner s comments :

Inspectio nnotes :

Remova l andrestoratio nactivate s complete includin g th e 30-da y so dwarranty : EP A Representativ e .^La^iLDate : lo/saji hCHNDCDGIES , FNC . 

### A S - BUIL T DRAWIN G OL S #2744 6 Dat e Excavated : 9/28/20f 0 

### OMAH A LEA D SUPERFUN D SIT E I'SEPA Signed-Of f Date : 

### 2744 6 Exterio rPain t Omah a Lea d Sit e Samplin g Address : 241 5 PATRIC KAV • Goo d Sit e Sketc h • Poo r Phone : H : (402)342-282 0 ALT : [7 ] No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concenfratio n Collecte d 

# I Fir m RYASCPXA-2744 6 F 1 .^L H pp m Dat e RYBSCPXA-2744 6 F 2 2 ; R pp m 

### D Time : RYCSCPXA-2744 6 B 1 "iO ^ pp m 

### D Sample s Analyze d RYDSCPXA-2744 6 B 2 BH l pp m 

### D nDZCOPX A2744 6 B ^ •~ pp m 

# n XR F Unit : 65V 2 Book : ig^ L 

### D RGZGCrXA-2744 0 e2 - — pp m 

# n D Date : g-/y-0 7 La b RYASCPLA-2744 6 

### D D Tim e AI L —pp m -Resul t 41 6 pp m Staff : A1SI V Numbe ro f Sample s = i i / Legend : F 1 = Fron t Left , F 2 = Fron t Rigtit , B l = Bac k Left , B 2 = Bac k Rigti t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s are apA/iaw^^ m th e street , facin g propert y

CONTRAC T # : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC .^ = ^ 

## Propert yCompletio n Agreemen t Thi s agreement document s the completio no f remova l activitie s performedo nth e belo w liste dpropeily . Th e propert y owner' s signatur e indicate s tha t the propert y owne r i s satisfiedwit hth e restoratio no f th e subjec t property , andtha t no item s are i nquestion , now , or a

t an y time i nth e future , excludin g any remainin g warrant y (3 0 day s total ) excep t thos e item s listedbelow , i f any . Propert y ID : Propert y Address : ^ y / p p ^ /,., . ^ . /?.< : Owner : ^.' • / .,.^ : ^•;;^^ ^ ^ , Phone : ^- ^ v'/tA^/VV / Restoratio n Item s I n Question :



### Item : Item : 

### item : Item : Item : 

### Item :

\M \ agre e restoratio n i s completed . L J i d o no t agre e restoratio n i s complete d a t (note d deficiencie s above )



## rh y y i 

# 70/ ^ Owner' s Signaluir e Dat ePruden t Technologies , Inc . (Prudent ) i s unde r contrac t withth e U . S . Environmenta l Protectio nAgenc y (EPA ) t o cleanu p lead
contaminate dsoils.at anumbe r ofpropertie s locate di nOmaha , Nebraska , includin g th e propert y locate da t yQl \r^T/'Icly . . Th e EP A request s you r permissio nt o allo w Pruden t t o performasoi l cleanu p a t thi s property t o remov e lead-contaminate dsoil . 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 nofth 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 Pruden t southoffic e .fo r th e Omah aLea d Sit e cleanup-a t (402 ) 733-1188 . Genera 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 a t (402 ) 73 1 -304 5 (Sout hOmali aoffice ) o r (402 ) 991-958 3 (NorthOmah aoffice) . Property Acces s Grante dBy ; l^ll/l/?f ^ l-^K^3^'h (Pleas e Prin t Name ) Property Owne r Signature : ' ^ ' (Siffli a (Date ) (Signature ) PROPERT Y INFORMATIO N (T o b e complete db y residen t and/o r propert y oivne r — pleas e print ) RESIDEN TNAME : Owna r Rente r RESIDEN TADDRESS: , 

# ^ H ^ 5 -P^Jhr: ^ t rfW- ^ I F RENTAL , PROPERT YOWNE D BY :
OWNER' S MAILIN G ADDRESS ;
OWNER' S TELEPHON E NUMBE R - HOME : J L WORK :



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## <-o^ y AG E O F HOME? : YEARS . HO W LON G HAV E YO U LIVE D HERE ? 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 : 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 WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTRY GATES , ETC. )

AUTHORIT Y FO RENVTRONIvIENTALRESPONS EACTIONS : Th e activitie s t o b e implemente db y EP A unde r thi s agreemen t ar e pursuan t t o Sectio n10 4 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f

acces s toth e propert y i s provide dfor i nSectio n104(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 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 , TX 7823 9 Phone : (816 ) 363-370 3 Phone : (402 ) 733-118 8 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax ; (402 ) 733-188 3 Fax : (210 ) 579-667 7ENVIRONMENTAL * CONSTRUCTtOl S SERVICE S 

### TEGHNOLOGIES , INC . 

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Propert y Owne r Pruden t Employe e Signature : Signature : 808 0 War d Parkway , Suit e 40 5 560 0 S 1 0 S t fledica l Drive , SuK e 425 0 KansasCity , M O 6411 4 Omaha , l^tebrask a 6810 7 Sa n Antonio , T X 7822 8 Phone : (816 ) 363-370 3 Phone : (402)733-118 8 Phone : (210)822-958 8

## 2744 6 Exterio rPain t NorthArro w Omah a Lea d SH e Samplin g Address : 241 5 PATRIC KA V SK o Sketc h 

### • Goo d • Poo r Phona : H : (402)342-282 0 ALT : 

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No t pain t Sampl e Numbe r Lea d Sampl e Sample s Collecte d 

# I LA B Concentratio n Collecte d Firm : ft) APS-C C RYASCPXA-2744 6 F 1 pp m 

## Q l Date : '^-f l -Ql - RYBSCPXA-2744 6 F2 

## 2>f t pp m 

## D Time : fO'c^i ^ Qn \ RYCSCPXA-2744 6 B l 

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## D Sample s Analyze d RYDSCPXA-2744 6 B2 ^"i l pp m 

# n nDgGOPXA27M 6 B S pp m 

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# n XR F Uni t (DSH I Book : /8 ¥ ROZOCPXA£744 0 62 - pp m 

## D D Date : B-lie^T f pp m La b RYASCPLA-2744 6 Time : A H 

# n n ^Resul t 416pp m Staff : iUSi, ^ Numbe ro f Sample s = t ^

/ Legend : F 1 - Fron t Left . F 2 = Fron t Right , B 1 = Bac k Left , B 2 = Bac k Rigti t D Z = Dri p Zone , G Z = Garden . P Z = Play Al l quadrant s a m ji^^nftt^ifo m th e street , facin g propert y & 

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

### YOU RTICKE T NUMBE RI S 2592079 . Origina l Cal l Date : 9/14/1 0 Time : 5:2 2 p m Op : SIVA1 8 96 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 : 241 5 Street : PATRIC K AV E 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 projec 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 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 S 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 NUTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFIC,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. . . 9/14/201 0

## Pag e 2 of 2

0PPDGPR5 OMAH A PUBLI C POWE RDISTRIC T EL M LOCATIN G 

## Alt : 406207149 4 Emerg : 888728934 3 QLNNEIC QWES T LOCA LNETWOR K

EL M LOCATIN G 

## Day : 406728934 3

Alt : 406207149 4 

## Emerg : 888728934 3

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

### ENVIRONMENTA L ENGINEERIN GAN D TEOHMOLOMBB , mc . 

### CONSTRUCTIO N SOLUTION S 

## SIT ESAFET Y HAZAR D ANALYSI S Address : -2fVl#_^^-c^_^ _ Excavatio n Date : Crew :

Ite m Overhea dLine s Ga s Lin e Wate r Lin e Sewer Lin e Septic/Leec h Fiel d Propane/Butan e Sidewal k Foundatio n Retainin g Wall s Fence s Tree s Structure s Driveway Sprinkle r Syste m Othe r Cre w Forema n Backfi U Date :

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## Sit e Safet y Offic e Date :

SSOOSIOS t 424 2 Medica l Drive , Sttt s 726 0 lCi)ly;Ma«411 4 OmaiU rNetaaBh a 6810 7 Sa n Antonio , T X 7822 9 Phone : (MC ) 3^^370 3 l^hofie : (402)733-118 8 Phone : (210 ) 822.4S8 8 Fa c(816 ) 363-370 7 Fax : (402)73»'188 3 Fax ; (210 ) 679-S57 7

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