### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 1984 6 DATE : 1/1 5 ADDRESS : 150 5 S 2 8 S T REMEDIATIO N CONTRACTOR : PRUDEN TTECHNOLOGIES . INC . YEAR : 201 p i 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S . D /PRBAN D POS TVIDE O O F PORPERT Y(DVD ) rVv(£.5i^t. , PbeV'OC- O y^^" ^ I E 1 EXECUTIV E SUMMAR Y d EPA-PROVIDE D PROPERT YSKETC H l i SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y |l i SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN TPROPERT Y m RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R T O REPLACE PLANTS , ETC. ) i n CONFIRMATIO N DAT A 

# h PHOTOGRAPH S AS-BUIL TSKETC H SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R m PROPERT YCLOSE-OU TCHECKLIS TSIGNE D B YEP A D DESCRIPTIO N O F AREA S NOTMEETIN G RO D CLEANU P CRITERI A h UTILIT YCLEARANCE S D PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E D D D
^ ^ ^\xl\ ^ SIGNATUR E DAT E 3021858 4 Superfun d

### PROPERT Y SUMMAR Y Date : 12/15/201 0 Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Decembe r Propert y Address : 150 5 S 2 8 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 NSAMPLIN GDATA/RESULTS : B l = 6 7 PP M @ 4" ; N O EASEMEN T 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 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 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 dinth e individua l property file, i f available , o r obtainedinclude : i ) Pre-excavatio n agreement detail s (i f any ar e mad e withth e property owner ) ii ) Property Statu s For msigne 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 no f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOGIES , INC ,i Fin d Record 

### Backfill :

Sampl e Area : 1984 6 -150 5 S 2 8 S T Owner :
n Owne rOccupie d Owne rName : IMORELL O BERNAR D J Owne rAddressl : Owne rAddress2 : 11141 3 HICKOR YRD City : State : Zi p Code : lOMAH A |N E 168144 - Owne rPhon e Alternat e Phone : 1(402 ) 342-282 0

Contract : Contractor : PRUDENT201 0 S Contrac t Optio n pPTlO N 2 Remediatio n Quer yLead Remainin g Quer yPropert yDamag e Quer y

Use rProvide d Owne rInformatio n Resident : Owne rName : Residen t Name : Owne rAddress : Propert yAddress : 11505 3 2 8 S T Zi p Code : 168105 - City : State : Zi p Code : Residen t Phon e Owne rPhone : Alternate Phone :

Assessment : Qualifyin g Grou p 40 0 Assessmen t Ma xXR F Valu e 

### 48 1

### 3 'TECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y #: I<^B4 ^ Propert y Address : 15^0 5 "5
- 2^^ . Date/Time : Owner' s Name:'^vftjrd l I'^Tfll o Quad s Excavated : ^ \ Contracto r Group : Pruden t Technologies , Imc. , Excavatio n Genera l Ye s No 1.

If necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? i / 2.

If iiecessar>- , wer e th e conec t area sof dri p zon e excavate dan drestored ? / 

### Gradin g Sodan dVegetatio n Ye s No I.Doe s th e grading aroundth e perimete r of the hous e in excavatedarea s generall y slop e awa y fro mth e house'i ' / 2.

Has sodbee nlaid in all area s tha t wer e excavated ? / Doe s th e sodappea r to be generall y health y andgrowing ? (Onl y evaluat e if

inspected at a

30 da

y lime period) / 4.Ar e sodde 4 area s generall y fm nandevenl y graded ? / 5.

Ar c tlie joint s between tlie sodstrip s generally tight ? (Onl y evaluat e if

inspected at a

30 da y tim e period) / 6.Wa s the propert y gradedsuc htlia t wate r wil l not pool on the property ? 

# X 7.Wa s damag e to landscaping or plan t material s avoided ? / Gates , Fence s an dRetainin g WaUs Ye s No 1.Do gate s ope n andclos e freely ? (I f applicable ) / 2. Wer e all gate sor fence s takendow n during restoratio n activitie s reinstalled ? (I f applicable ) / 3. Wa s damag e to gate sor fence s avoided ? (Ifapplicable ) / 4. Wa s damag e to retainin g wall s avoided ? (Ifapplicable ) 

## y Foundation , Sidin g an dGutter s Ye s No 1. Was damag e to the siding or trimavoided ? 

# y 2. Was damag e to tli e foundation avoided ? / 3. Was damag e to window s avoided ? / 4. Wa s damag e to window s or doo r screen s avoided ? / 5. Was damag e to downspout sor downspou t extension s avoided ? / Sidewalk s an dDriveway s (Concrete ) Ye Ye

& & No I. Wa s damag elo drivewa v surface s avoided ? 1. Wa s damag e to walkwa y surface s avoided ? 

# ~y

## Owner s comments :

Inspectio nnotes :

Remova l an drestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e 9"^-A^ Date : ii\i)\ o

# I 1984 6 • CIIN()1.0GIt;S . INC 

### A S - BUIL T DRAWIN G Ol,S # 1984 6 Dat e Kxcavaled : 10/20/201 0 

### OMAH A LEA D SUPERFUN D SIT E ISEPASigncd-OffDaU- :

Samplin a Address : 1505 S 2 6 S T Sampl e Numbe r RYASCPXA-1984 6 RY8SCPXA-1984 6 RYCSCPXA-1984 6 RYDSCPXA-1984 6 r;DgOOPXA-1004 G RCZCCP W 10846 . RPaSCP.X A19811 6 F l F 2 B l B 2 -« Z - O i J U . Omah a Lea d Sit e Sit e Sketc h
Lea d Sampl e LA B Concemratio n Collecte d



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Dat e lOIO I fO l Time : AA I Staff : AlSk / Legend : F l = Fron t Left . F 2 = Fron t Right . B l = Bac k Left . 8 2 = Bac k Rigli t D Z = Dri p Zone . G Z = Garden , P Z = Pla y AH quadr^r^ s ar e a s viewe d fro m th e street , faan g propert y 

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

# oEfV ^ Propert yCompietio n Agreemen t Thi s agreement documents th e completio no f remova l activitie s perfonne do n th e belo w liste dproperty . Th e property owner' s signatur e indicate s tha t th e property owne r i s satisfie dwithth e restoratio no f th e subjec t property , an dtha t n o item s ar e in question , now , o r at any tim e inth e future , excludin g an y remainin g warranty (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Property ID : Properl y Address : - ^ 

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- Owner : Phone : Restoratio n Kern s inQuestion :

Item : Item : Item : Kem : Item : Item :



## Blagre ( 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 )



# gy ^

LNTJjJ^t^ ^ OWner'^Signatur e / ^ Dat e '

### 'w' -
Pruden t Techno\ogies , Inc . (Prudent ) i s unde r contrac t wit hth e U . S . Environmenta l Proiectio n Agenc y (EPA ) t o clea n u p lead
contaminate dsoi U a t anumbt t (^propertie s locate din Omaha , Nebraska , includin g th e propert y locate dat f ^ 6 . O ^ (s ) f s c/* " Th e EP A request s you r permissio n t o allo w Pruden i 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 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 , remova l o f lead-contaminate dsoil , an drestoratio n ofth e reference dproperty . I f yo 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 i southoffic e for th e Omah aLea d Site cleanup-a l (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 ) 731-304 5 (SouthOmah aoffice ) o r (402 ) 991-958 3 (NorthOmah aoffice) . Property Acces s Grante dBy : 0Ofify/^/< D /^Qf^lf/j^ O (Pleas e Prin t Name ) Property Owne r Signatu i 

## ^ll,^aA/t-)^/ydl/ ^ /^//(/f O (Signature ) (Date ) PROPERT Y INFORMATIO N (T o b e complete db y residen t and/o r propert y owne r —pleas e print ) RESIDEN TNAME : ^IkCA ^ ^ i^ O " ^ Rente r RESIDEN TADDRESS : 

## /5d 5 y^6 . Z ^ S f I F RENTAL , PROPERT YOWNE D BY :
OWNER' S MAILIN G ADDRESS ; 

## //y/ 3 /^ ' }c/<n(LC ^ 1 ^ . Or^AHA^AJ a ^27/^ f OWNER' S TELEPHON E NUMBE R - HOME : Kl^l j 3 H 2 ^ X' j ^ ° WORK : 

### J L 

# Jj[l _ AG E O F HOM E 7:^! ^ 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 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 WEE K COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. ) 

# /^[ A

Al.rrHORIT 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 Seclio n10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s right o f

acces s t o th e propert y i s provide dfor i n Sectio n 104(e ) o f CERCLA , 4 2 U . S . C 9605(e) , whic hprovide s entr y for '"detenninin g th e nee dfo r response , or choosin g o r takin g an y respons e actio n unde r liti 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 7822 9 Phone : (816 ) 363-370 3 Phone : (402 ) 733-118 8 Phone : (210)822-958 8 Fax : (81S ) 363-370 7 Fax : (402 ) 733-188 3 Fax : (210)579-657 7

## 1984 6
Samplin g Address : 150 5 S 28 S T Sampl e Nuiribe r RYASCPXA-1984 6 F 1 RYBSCPXA-1984 6 F 2 RYCSCPXA-1984 6 B l RYDSCPXA-1984 6 B 2 RDZOOPXA-1904 G B Z 

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## Pag e 1 of 2

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

## YOURTICKE T NUMBE RI S 2618629 . Origina l Cal l Date : 10/15/1 0 

### Time : 4:0 3 p m Op : SIVA1896 7 Wor k t o Begi n Date : 10/19/1 0 

### Time : 4:3 0 p m State : N E 

### UGLAS Place : OMAH A Address : 150 5 Street : S 28T H S T Twp : 15 NRng : 13 E Sect-Qtr : 28-N E 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 : 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-ll f 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 3 MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F

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
MUD0 2 METROPOLITA N UTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : 

## Emerg : 402504797 0
OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R 

## RiCHmiAFFI C Day : 402444719 7



## Alt : 402444516 1 Emerg : 4024445160 Day : 406728934 3 

## http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret-<RESULT., . 10/15/201 0

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0PPDGPR 6 OMAH A PUBLI C POWE RDISTRICT EL M LOCATIN G 

## Alt : 406207149 4 Emerg : 888728934 3 QLNNEI FQWES 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=<RESULT.. . 10/15/201 0ENVIRONMENTA L & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SOLUTION S 

# Sit e Safet yHazar d Analysi s Address : J^O^ ^ §:i^^^ ^ U K Ex. . Crew : P / o v»vivAr Bf . Date:/0-^-^ ^

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# 7) 1 

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