## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID# : VL^WX i Date : ^ | l5 " Address : InM O < ^ . ?> \MP . Remediatio nContractor : VYUliUl- V ^C K \ct ^ Year : c^ Q I Q SOILREMEDUTIO N PROPERTY FIL EFOLDE RDOCUMENT S ffl Vide o o f

propert y (DVD ) nExecutiv e Summar y 

# i E PA-provide dpropert y sketc h 

# 4 Signe dAcces s Agreemen t fo r

subjec t propert y D Signe dAcces s Agreement(s) fo r

adjacen t propert y II

I Rfistoratio nAgreemen t D Settlemen t document s (i.e. , fo r

damag e o r

to replac e plants , etc. ) EConfirmatio ndat a 

# i Photographs 

# i As-buil t sketc h 

# i Satisfector y restora.tio nsigne dby Propert y Owne r Propert y close-ou t dieck lis t signe db y EP A D Descriptio no f

area s no t meetin g RO D cleanu p criteri a 1 1 Utilit y clearance s 

# i Propert y infonnatio n fromDougla s Count y Assessor' s OfBc e D D D 

# ^ ^ ^ 

# _^y ^ JSignatui e Dat e 3026079 8 

# iiiii i Superfun dFin d Record Remediatio n QueryI Lea d Remainin g Quer yI Propert yDamag e Quer y 

### Backfill :

Sampl e Area : 2234 6 - 64 0 S 3 1 A V Owner : Resident : Contract : D Owne rOccupie d Residen t Name : Contractor : Owne rName : |ROSELAN D MAR KS PRUDENT200 9 S ODONNEL L PATRIC KS Propert yAddress : ContractOptjo n Owne rAddressl : 

### |64 0 S 3 1 A V [BAS E 

### Zi

p Code : Owne rAddress2 : 

### )6810 5 ; Assessment : 

### 62 4 S 3 1 AV E Residen t Phon e 

### City : State : Zi p Code : Qualifyin g Grou p 

# I OMAH A ;|N E ; |6810 5 j 

## po o 

# j : Owne rPhone : Alternate Phone : Assessmen t Ma xXR F Value : (402 ) 505-096 1 j(402 ) 630-499 5 \ I 839.14 1

### PROPERT Y SUMMAR Y Date;!^/15/201 0 | Omah aLea dSit e Remedia l Actio nContrac t #EP-R7-07-0 6 T0# 1 | Mont hof : •Ta[c 7 Propert y Address : 64 0 S 3 1 AV E 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 = 20 4 PP M @ 12" ; F 2 = 9 7 PP M @ 12" ; E A = 10 2 PP M @ SCRAP E(~1" ) 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 other propertie s 3 ) Pre-Excavatio ndigital vide o clip/photograph s 4 ) Post-Excavatio ndigital 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 individua l property file, i f available , 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 For msigne db y property owne r iii ) Excavatio ndigita l vide o inMPEG , 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 no f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOCIES , INC .TECHNOLOGIES . INC . Propert y# : 2.'2-3^4 P Date/Time : Quad s Excavated : f ^ , f=2_ _ 

# EP A Propert y Clos e Ou t Propert y .\ddress : Q> ^ ^ - 5 ' /4*^_ ^ Owner' s Name : (^&*<"v''cl<l OJ.o'r^r^^ ^ ConJraclo r Croup : Pni(!cn l Technologies , Inc. , Excav : Itio nGenera l Ye s No \ . I f neccssMPs . wer e ih e correc i quadrani(s ) excavate dan drestored ? / 2 . I f necessaiy . wer e th e correc i area s of dri p zon e excavale daji drestored ? / Gradin g So dan dVegetatio n 1 . Doc s th e gradin g aroun dIhe perimete r o f th e hous e ine.xcavate darea s generall y slop e away fro

mih e house ? Ye s / No 2 . 1 4 . 5 . 6 . Ha s sodbee nlai dinal l area s iJia l wer e excavaled ? Doe s ih e so dappear l o b e generall y healtli y an dgrowing ? (Onl y evaluat e if inspecte dat a3 0 da

v lim e period ) .KvQ . sodde darea s generall y finnan devenl y graded ? Are ih e joint s betwee nth e so dstnp s generall y tight ? (Onl y evaluat e i f inspecte dat a."l O da y lim e period ) Wa s th e properl y grade dsuc htlia t wate r wil l no l poo l o nth e property ? 

## y i

/ / / 

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

## y Gates , Fence s an dRetainin g Wall s 1 . D o gaic s ope nan dclos e freely ? (If applicable ) 2 . .V Were al l gale s o r fence s tal^e ndo^v ndurin g restoratio nactivitie s reinstalled ? (If applicable ) Wa s damag e l o gale s o r fence s avoided ? (If applicable ) Ye s 

# y y 

# 7 No

4 . Wa s damag e l o relainin g wall s avoided ? (I f applicable ) 

# y Foundation , Sidin g an dGutter s I . Wa s damag e l o ih c sidin g or tri mavoided ? 2 Wa s daniag e l o th e foundatio navoided ? Ye s 

# y 

# y N o

3 . Wa s damag e l o window s avoided ' 

# y -i . Wa s dainag e l o windows o r doo r screen s avoided ? 

# y 5 . Wa s damag e l o do'wnspoul s o r downspou t extension s avoided ? / Sidewalk s an d Driveway s (Concrete ) Ye s No I . W.i. ^ IIMMIM'J. C I O drivewa vsiirlace s avoicled': ' 

# y 2 . Wa s damag e l o walkwa^ ' surface s avoided ? 

# 7

## Owner s comments :

Inspectio nnotes :

pyio^e/ir y OcjjiiCc ,



## Remova l an drestoratio nactivate s complet e including th e 30-da y sodwarranty : EP A Representativ e 7)^ ^ yj ^ Date : s/s^/z dENVIRONMENTA L& CONSTRUCTIO N TECHNOLOGIE S SERVICES 

# PROPERT Y CONTAC T ATTEMPT S Propert y ID ; •2^^^^ ^ Propert y Address : f ^ i ^ ^ • " ^ ( mxg _ Owne r Name : (f^orck T C>d(^.^y \\ Owne r Phone : (o"^ o '^^^^ S Belo w pleas e fin dalistin g o f unsuccessfu l attempt s t o reac hth e abov e propert y owner . Dat e i&me Initial s Resul t 

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# S B C^xiJU j P.^ . rf 

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# 5-S-/6 ) Sigi^tur e Dat e Pruden t Technologies , Inc. , P o s/s/i i Acknowledgmen t signatur e Dat e EP A 808 0 War d Partcway , 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 , iM O 6411 4 Omalia , Nebrasl o 6811 0 Sa n Antonio , TX 7822 9 Phnne : /d02 ) S04-100 4 Phone : (210)822-958 8ENVTRONMEIVT.A L& 

# mm m CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : Date : l|5|'^ ^ Phone : BVID : Ite mN O Plant s & Permanen t Landscapin g T o Remai nI nPlac e O nMa p Descriptio n& Locatio n

Y^ ^

^ (y ^

Q_a^<yc^^.y yK ^ oA ^ o ^ 

# d M.^^—'4^ ^ a\yr~^/XA ^ \Z t ^lAyA^^r.^^ . y k h . 9 0 Pre-Existin g Conditio no f Structure s Doe s you r Basemen t hav e ahistor y o f leaking ? Ye s N o Ite mN O Descriptio n& Locatio n O nMa p

Propert y Own e Pruden t Employe e lgilat^^e ^

808 0 UUar d Parkwav . Suit e 40 5 250 5 N . 24' " Street . Suit e 30 8 424 2 Medica l Drive . Suit e 425 0Pruden t Technologies , Inc . (Pnident ) i s unde r contrac t withIh e U . S . Environmenta l Protectio nAgenc y (EPA ) l o clea nu p lead contaminate dsoil s at anumbe r ofpropertie s locate dinOmaha , Nebraska , includin g th e property locate da t

. Th e EP A request s you r pennissio nt o allo w Pruden t t o perfor masoi l cleanu p a t thi s property t o remov e lead-contaminate dsoil . B y signin g thi s form , th e property owne r grant s permissio nt o Pruden t t o perform 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 . Ifyo u hav e an y question s alxju t th e soi l cleanu p planne dfo r you r property , pleas e contac t Prudent' s Administniti\ e Cler k for th e Omah aLea dSite cleanup . Ms . Siv aS . .laiiipana-at (402 ) 733-1188 . Genera l question s abou t th e Omali aLea dSit e cleanu p ca nb e directe dt o th e EP A Publi c Informatio nCenter s at (402 ) 73 1 -304 5 (Sout hOmah aoffice ) o r (402 ) 991-9583 (NorthOmah aoffice) . Property Acces s Grante dBVy-^ f^T/^ ^ Cil T ^ ^ ( 7 ^cJir/t^Ay^=^ C (Pleas e Prin t Name ) 

# 7 - 3 -^ / Property Owne r Signature : (Date ) PROPERT Y INFORMATIO N CT

o b e complete db y residen t and/o r propert y owne r —pleas e print ) RESIDEN TNAME : r>.^^^ ^ ^yj ^ . Owne r Rerrte r RESIDEN TADDRESS : 

# g)M o S ^ \^^ I F RENTAL , PR < OWNE D BY :



# PoT 0 ' FNcxcA^ J OWNER' S MAILIN G ADDRESS ; 

# b ^ '' ^ 

# ^ C^K.^J'V A N-^- ^ OWNER' S TELEPHON E NUMBE R - HOM E WORK : AG EO FHOME ? 

# : J o f YEARS . HO W LON G HAV E YO U LIVE D HERE ? 

# y YEARS . HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WTT H SIDIN G SINC E 1978? -TES " 

### -NO - 

### ^- ACL A '-^*» . 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 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 are pursuan t t o Sectio n10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s right o f

acces s to th e property i s provide dfo r inSectio n104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry for "determinin g th e nee dfo r response, o r choosin g or taldn g an y respons e actio n unde r this 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 , M O 6411 4 Omaha , Nebrask a 6811 0 San 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 7

### ^ ve t 

### 2.0 ^ ^- ^JIES . INC . 

## A S - BUILT DRAWIN G OLS#:2234 6 Dat e Excavated : 07/20/200 9 USEP A Signed-Of f Date : 

## OMAHA LEAD SUPERFIM D SIT E

Omafta'LeatfSit e Owne rName : MAR KS ROSELAN D Sit e Sketc h Address : 640 S 3 1 A V Phone : H : W ; Sampl e Numbe r RYASCPXA-2234 6 RYBSCPXA-2234 6 RYCSCPXA-2234 6 RYDSCPXA-2234 8 RDZSCPXA-2234 6 RCZSCPXA2234 6 ispgscpx Aaaa4 o Numbe ro f Sample s UQ" ^ 

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## h^- i Propert yAddres s • Fence 1 Inc h = 2 0 fee t o r1 gri d = 5 x5 f t >(y > 64 0 S 3 1 A V ^

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## 2234 6 Noittt/tgia m 

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## Pag e 1 of 2

v " > Create Anothe rTicke t Bac k t o Irt h Intemet Sen d Emai l



## . YOURTICKE T NUMBE RI S 2313576 . Origina l Cal l Date : Wor k t o Begi n Date : 7/09/0 9 7/13/0 9 Time : 11:0 0 a m Time : 11:3 0 am Op : SIVA1896 7 State : N E Address : 64 0 County : DOUGLA S Street : S 31S T AV E Place : OMAH A Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 21-S W Sect-Qtr : 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 : 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 AJAMPAMA 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 Involve s Tunnelin g o r Horizonta l Borin g : N Front : Y Explosives : N Rear : CXCAT V LEVEL 3 MUDO l OMAHACO F 0PPDGPR 5 TE C 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 , ^^ ^ 

### Day : 877366834 4 Alt : Emerg : 877366834 4 MUDO l METROPOLITA NUnLITIE S DISTRIC T SAIvTO Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO F CIT Y O FOMAHA TRAFFICSEWE R RO N 

## Day : 402444719 7 Alt : 402444516 1 Emerg : 4024445160 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 7/9/2009

### Pag e 2 of 2 / •



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### N A Day :

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### Alt ; 406728934 3 An^-^rin- i AC A 

### 406207149 4 Emerg : 888728934 3 PAETE C QLNNEI C PAETE C COMMUNICATION S QWES T LOCA LNETWOR K ^J^^^STCY^^^ ^ ^^ ^

N A Day : 800289190 1 ''^'^• Emerg : 800289190 1 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESlJLTS. .. 7/9/200 9

## D S ENVIRONMENTA L & CONSTRUCTIO N TECHNOLOGIES , INC . SOLUTION S 

# Sit e Safet yHazar d Analysi s 

# C D Address : ^c(( 5 ^ . 3 ( /^c/ g Crew : ^ ^ J Date : __A2z3j-^3 — Ite m 

## Overhea dLine s Ga s Lin e Wate r Lin e Sewer Lin e Septi c / Leech fiel d 

## Propane/Butan e Sidewalk Foundatio n Retainin g Wall s Fence s Tree s Structure s Drivewav Sprinkle r System Othe r Cre w Foreman Conditio n 

# h y htyrto d JUJ* ­ & ' ^ 

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# 28/2009

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