## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL EFOLDE R SATOfr . 

# im ^ Date ; 

# ^ 

# 1^7 Address : [ bZ\LrO[l<u { ^ V Remediatio nContractor : ?rli4jUV^ ' T^lU \ftt Year : _^£iU L SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 2

f Vide o of propert y (DVD ) Executiv e Summar y i f EPA-provide dpropert y sketch Signe dAcces s Agreemen t fo r

subjec t propert y D 

## Signe dAcces s Agreement(s ) fo r

adjacen t propert y 

# d Restoratio nAgreemen t D 

## Settlemea t documeat s (i.e. , fo r

damag e or t o replac e plants , etc. ) Confiimatio ndata Photograph s As-buil t sketc h Satisfector y restoratio nsigne db y Propert y Owner Q

f 

## Propert y close-out chec k

lis t signe db y EPA D 

## Descriptio nofarea s no t meetin g RO D cleanup criteri a Utilit y clearance s 

## Propert y information firomDougla s Count y Assessor' s Of&ce D D D 

## Signature Date 3026077 1 

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

### Backfill :

Sampl e Area : 2994 2 -162 1 LOCUS TS T Owner : Resident : Contract : 

# t n Owne rOccupie d Residen t Name : Contractor : Owne rName : |PRUDEr^T2009_S 

# r jCITYO F OMAH A PropertyAddress : Contrac t Optio n Owne rAddressi : 1162 1 LOCUS TS T [BAS E 

### Zi

p Code : Owne rAddressZ : 

### |6811 0 Assessment : )181 9 FARNA M S T Residen t Phon e City : State : Zi p Code : Qualifyin g Grou p 

# I |OMAH A |N E |6818 3 

# po o Owne rPhone : Alternate Phone : Assessmen t Ma xXR F Value : 

# " 1 

# t 50 0• • • •


### PROPERT Y SUMMAR V Date : /15/201 0 | Omah aLea dSit e Remedia l Actio nContrac t #EP-R7-07-0 6 TO# l | Mont hof : Q f f Propert y Address : 162 1 LOCUS T S T A EXECUTIV ESUMMAR Y A. l 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/RESULT S F l = 8 6 PP M % 6" ; F2 = 9 9 PP M @ 6" ; B l = 10 2 PP M @ 6" ; B 2 = 8 6 PP M @ 6" ; 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 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 sketc h­ i) Shal l includ e fma l leadlevel s v ) Legen d ii ) Contaminatio nlef t behin darea s vi ) Contracto r identificatio n iii ) Property addres s vii ) Date iv ) BVI D numbe r 7 ) Other item s t o b e include dinth e individua l property file , i f available , o r obtaine dinclude : i ) Pre-excavatio nagreemen t detail s (ifan y ar e mad e withth e property owner ) ii ) Property Statu s Fomi signe db y property owne r iii ) Excavatio ndigita l vide o inMPEG , WM V (Window s Medi aVideo ) or SWF(Flas hPlayer ) format and/o r photograph s iv ) Signe dfor mverifyin g satisfactory restoratio n v ) Descriptio nofarea s no t meetin g Interi mRO D cleanu p criteria .TECHNOLOGIES , INC . Propert y # : ^'^'t' ^ Date/Time : Quad s Excavated : R-' / P2-,R)/&v 

# EP A Propert y Clos e Ou t Propert y •\ddrcss : /^TJiouyhol' ~ Owner' s Name : ^-V- ^ ctS C>^vx3ik< ^ Contmcto r Group : Pniidcn l TccliiioJogies , F.veavatio n Genera l Ye s No 1 . i r iioccssMiv . wer e lh e correc l quridrant(s ) excavate dai drestored ? / 2 if necessary , wer e lli e conec l area s ofdri p zon e excavate dan dreslored ? / Gradin g So dan dVegetatio n Ye s N o 1 Doc s lh e gradin g aroun dth e penniete r ofth e hous e inexcavale darea s generall y slop e away / IVon i lh c house': ' 2 .Ha s sodbee nlai dn i al l area s Iha l wer e excavaled ? 

### y 3 .Doe s lh c so dappear lo b e generaJl y healUi y an dgrowing ? (Onl y evaluat e if inspecte da t a.3 0 da

y lim e period ) 

# y 4Ar c sodde darea s generalh ' llrman devenl y graded'. ' 

# d 5 .

Arc lh c joiiii s belwee nLh e so dsmp s generall y lighi ? (Onl y evaluat e if inspecte dat a.3 0 day lim e period ) 

# y 6 .Wa s lh e propeil y grade dsuc htlia t wale r wil l no l poo l o nlh e property ? / 7 .

Wa s damag e l o landscapin g or plant material s avoided ? 

## A Gates , Fence s aiu i Retainin g Wall s Ye s No 1 .

D o gale s ope nan dclos e freely ? i I f applicable ) / 2 .Were all gate s or fence s take ndow ndurin g restoratio nactivitie s reinstalled; ' (If applicable ) / 3 .Wa s d;imag c t o gate s o r fence s avoided ? (Ifapplicable ) / 4 W.a s damag e t o retainin g w;ill s axoided ? (Ifapplicable ) / FouBuliition , Sidin g an dGutter s Ye s No I Wa s damag e to th e sidin g or Uini avoided ? / 2 .W;i s damag e l o lh e foundatio n avoided'/ ' / 3 . Wa s d;imag c l o window s avoided ? / 4 Wa s damag e t o \vindow s or doo r screen s avoided ? / .> Wa s daniag e t o downspout s or downspou t extension s avoided ? / Sidewalk s ;iiu i DriAOway s (Coiierete ) Ye s No i Wa s daiiLig c l o driveway surface s avoided'. ' / 2 . Wa s d;imat; e t o ^^•alk\\a^ ' suiface s .avoided ? 

# A

# 0^ 1 

# ^CxJ ^ ^t - Owner s comments :

Inspectio nnotes : nutonllBl O 

## d.A: p SP/f s ckscyy* "

/ieati^* ^



## Remova l andrestoratio nactivate s complet e includin g th e 30-da y so dwajranty : EP A Representativ e *-^^ ^ 

## Date : 

# ddM­ ija» >)3/000 3 ii^Nov.30 . 2009411:00A M OMA M PLANNIN G OEPT , 402-444-614 0 716 8 'P . 3 

# m\ hmH. I ; i ^ r Propett yCompletio n Agreemen t Thi s agreemen t document s tli e completio no f remova l activitie s performe do n th e belo w liste dproperly . Th e propeit y owner' s signatur e indicate s tlia i th e propert y owne r i s satisfie dwit hth e restoratio n o f th e subjec t property , <in dtha t i^ o item s ar c i n question , now , o r man y tim e i n th e fiuurc , excludin g an y remainin g warrant y O O day s total ) excep t tiios e item s liste dbelov^' , ifany . srjfi'vrx^ r i propert y ID :

Propert yAddrcs.s : / ^

Q / LoCW/iri - Sj i Owner : 

# \!AfA7dA^.-Jd£2zdAdfAf.izJl27.^A.^. ^ Restoratio n Item s i n Question :

Item : Item : 

# I \ Item : ! Item : i ! Item :

• ^»^^-*•'^'*^•."••Jc-"':i•^'r' n •im,n;'i"^'-f>*'--' -

Require d correction s t o complet e th e propisrty : 

# i

agre e restoratio n i s completed . % I— 1 I d o no t agre e restoratio n i s complete d a t (note d deficiencio s above )



# ffdf^cd ^ Owner' s Si.i;»fMu t Dat e

### No , 442 1 P . 4"'' — PLANNIN GDEPT . 402-444-614 0 ^^Oct , 9 . 2009 = 10:13A M 0M| |

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5 u/idtt r colilrst l wiU ) Ui c U . 5 . Environmenial l^foicclion Agonc y (lil'A ) i o cleanu p Icad manamipiiici i 5pil. « II I naumljc r o f

prapcrtie s locate di aOinnha , r-iebrafkf . includio g ijii : prcpen y loculc dn t jh73iJ...-IyACLPJi^(Z . _S^t.J - ri' * '^'' A rcquEBls your pfcmjissipj i ii > ailo w Prude ml o perfpr m? .loil cicair.i p a t Ulis pr^eil y u i n;!!^^^lajd-comamimite dsoi l 6 y .Mgning\hj s form , (h t pIOpoT^> - owne r aretil s ptiivusiw n\ o I'riitlisi H l o pcil'oi- m /ti:iniiiiV - ;cl;ii,! dU l Illi ; clcium p mcluJiiiti soi l sampling , rejnovs l oClcad-winiaoiiniilct i soil , an dresiijrdiiiM i o f lli c rcl'cromw l projWly . U'yDiilinv c an y qiieslioiwnbiiu l lh c soi l cloanup plminc dfo r you r property , pteiiS c conliic l ['rwUwu' s Icrlh c Om.lhf t 1 «ici .Sil c clcjimip a t (W2 ) ~ • • • , OciKsra l qucsuo w abou i lli c OnsK o Lea d.Siic clcamii i wr h e (liitiilu d10 lh c TiP A Publi c lAromilio nCenter s al (402 ) 7:il-30A S (SouU i 0>«;iJ w o(r.c.i> o i i.*02) V'yl-'J.'iR.' V CNori h(.)rH,ih ^ offioc) . Ih-opcri y .'\tt-.c5 S Gronvod ft> 

## , •. 

## y AAA' ^ y^^CJ> t I'ropcn y C)win;r Slg i A S (Signnturc ^ (VJ^w ) i : PROPERT Y INFORMATIO N (T o bi ; complctc U h) ' rCTidoi t and/o r proper^ - ovjne r — p)«3is « print ) RESIDEN T NAME : 7 /y ^ , Owne r Rente r RESIDEN TADDRESS . . PROPSR t F RENTAL , PROPERTV ' OWNE D BY : OWNER' S MAILINGAOORES S 

# Sr . <CAL^/A/^^ . /U ^ 

# ^ (t/^- ^

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# pr/ f OWNER' S TEl.EPHONf e NUMBE R• HOME- . (7^-V' , 7/ V ~ - ^ ^- J / WORK : J )-

_ _ „ „ 

## A// f ^ ' AG EQ FHOME? ; YKARS . MO W LON G HAV E YO U LIVE D HERS ? YEARS . /l/dp "AP^^ TM EEXTERIO RBEE NPAfNTE O O RCOVERe O WITH SIDIN GSINC E1978 ? ___,_YE S __ „ N O

/1^\£NUWIBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : NUMBE R Q F OCCUPANT S 7 YEAR S OL D AN D OLDE R /^^fY^NUMSE R Q F CHILDRE N UNDE R 7 YEAR S OL D W» 0 PLAYI N TH E YAR D FO R S HOUR S O R MOR E PE R WEEK : COMMENT S O R SPECfA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. )

l" i iVi^-'.'jir.iV: r.irivi;! . StjiV'. ; 42Sr , • '^."'i'l'.-.A- s Ci;v . fii O '.!'•";. ; Ss? i .ih-,^ioiv<,vTX7a2t< >Oo/OOO T 

### 442 1 

### P . 5 

### PLANNIN GOEPT , 402-444-614 0 i U 

### Oct . 9 , 2009' '



# i TECHNOLOGIE.S , ]i.NC , Js . 

# I Propert y Statu s For m '\y^m^ ^07-H^H-ycy i , ^........lyj?^,,<?.t.t•^: ? I ItemN O j Pktit s & Pe t utanen t Landscapin g T o Rema mI nPiac e I O aMa p I Deseriptioti i & .LocatW H

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# ^ J /J^A^y^^yy ­ECiTN(M.O(itr,S , INC . 

### A S - BUIL T DRAWIN G 01,S#:29'J4 2 Diif cI'Ai-iivatid : l(>/2K/2()(» 9 

### OMAH A LEA D SUPERFUN D SIT E i:SKl',\Slj>nci\-01Tl)atc ; 

# ili l Hlllil l 2994 2 Exiario rPain t Mort h Arro w Omah a Lea d Sit e • Goo d Sit e Sketc h npoo r Samplin e Address : 162 1 LOCUSTS T I^No l pain t Sampl e Numbe r Lea d Sampl e Sample s Colleae d LiV B Concentratio n CoUecte d F-rm : TOg ) Ff t Of t RYASCPXA-2994 2 F l 5 0 0 pp m 

## a Date : ^)?. ^ \f7 l RYBSCPXA-2994 2 F 2 1-l-Z.Z . pp m 

## n Time : |27 P RYCSCPXA-2994 2 B l HS l pp m Sample s Analyze d RYDSCPXA-2994 2 B 2 3 1 7 pp m 

# I d D RDZeorXA-2&04 2 -B2 - pp m 

## u XR F Unit : Lj^HT . Book : V\ h 

# n nG2CCPXA-20Q4 g 62 - — pp m

- 

# • n Dat e 7 6 - / O -O l La b RYDSCPLA-2994 2 pp m 

### D Tim e A M -Resul t 40 6 pp m Staff : ^^^ ^ Numbe ro f Sample s = 1 4 ' / Legend : F l = Fro m Left , F 2 = Fron t Right , B l = Bac k Left , B 2 = Bac k Righ t D Z - Dri p Zone , G Z = Garden , P 2 = Pla y Al l quadrarM s ar e a s viewe d fro m Ih e street , facin g propert y 

# ENTERE D -opt - r : -1 - •y^'-- f - ­



### .H5. 1 

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# P $.1 . .S Z 

# A 1 

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# \='.f.\ -. \ n

-HiOtli L ./-.QAUi t f / N O P.ASr.MK M

CONTRAC T# : E P - R7-07-0 6 T0# 1 PRUDENTTECHNOLOGIES , INC .

# 2994 2 Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e • Goo C 

### Sit e Sketc h • Poo r 

### Samplin g Address : 1621 LOCUS TS T 

# r I^No t pain t Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Fir m Sampie s Collecte d RYASCPXA-2994 2 RYBSCPXA-2994 2 RYCSCPXA-2994 2 RYDSCPXA-2994 2 F 1 F 2 B l B 2 

## mLZ . '^ 5 1 3 1 7 pp m pp m pp m pp m 

# ra' n n r: i Dat e Tim e 

# _a.lza.K 2 _J2:i P

Sample s Analyze d r?Dg6GPXA-2994 2 &g r pp m 

# n n XR P Unit : Cff^H V Book : 1<^ 5 RCZSGPX A2004 2 G ^ 

### _ ppr n 

# n D Date : 7 6 • /£ > ­ O l La b RYDSCPLA-2994 2 

### - pp m 

## D 

# a Tim e 

# Ai ± SResul t 40 6 pp m Numbe ro f Sample s = | M / Staff ; 

# ns> ^ Legend : F l = Fron t Left , F 2 = Fron t Right , B l = Bac k Lefl , B 2 - Bar. k Righ t D Z = Dri p Zone , G Z • Garden , P Z = Pla y Al l quadrant s ar e a s viewe d fro m th e strf-et , faciri g propert y 

# ENTERE D

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## Dougla s County-Omaha , NE

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 

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Sec-Tw n -Rn g 234449000 0 CITYO F OMAH A 162 1 LOCUS T S T OMAH A 6811 0 C/

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### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s Count.. . 10/14/200 9

### Pag e 1 o f 2

" > [ Creat e Anothe rticke t f | Bac k l o Irt h Interne t ~ ] Sen d Emai l 

### YOU RTICKE T NUMBE. H I S 23S3464 . Origiric-i . Cal l Dd-^e : 10/09..n 9 '.'"ifie : lU:-;: 3 a n Op : SIVA18g6' / Work r..- ^ riegi n r.Jav.e : 10/1';,''0 9 'y::ae- . .L;!.:0( ) a m State : HI : County : DOUGLA S Place : OMAH . Addres: s : 162 1 Sti-Gol ; : LOCU.ST S T Twp : ' ^,)? j Se:;-.-Qtr : IC-NE-NW-SE-S W Twp : Rng : Sect-Qtr : Lega l Giiven : C Typ e o f Work : SOI L LEA D P.Li'IEDIATIO NPROJEC T Locatio n o f Work : LOCAT E ENTIR E ?RC?ERT'i ' Remark:; : FA X AL L Ck.RARS 'VO : (402)731-183 3 : FA X AL L CLL.ARS T O (402 ) 73 3 1^)8 3 : UNSUR E CORNF'.R S Compai- y: PR.[iDFN T TECHNOLCG T ^y : Contac t Name : S l v' AJAHPA.M/ V Pho;ie : (402 ) 733-1, ; Wor k L..:- . n c Doii e For : EP A Dept h ..:' ! Exc-^ va t .L-r, ; 6 F' i Corne r Lot : I Front : Y R^ar : Invo l ^'e. s Tunri c 1. j r-.." j c^ r HO J .i.centa l Lorin g : I' E.xplosives : N CXCAT V MAGELLANMUDO l OMAHACO F OPPDGPR. S QLNNEI C

Servic e A se a Contac t Phon e Numbe r JUtilit y Typ e 

### Day : 402934046 9 

### cxc A i V CO X C(.)MMUNIC:ATIONS . IN C 

### HEID I Alt : 402934046 9 Emern : 402932975 7 Day : 918574709 8 MAGl:l,LA N MAGF.LLA N MIDSTREAM PARTNER S LPDEBORAH Alt ; 

### Ernerg : 918574709 8 Day : 402504782 3 MUDOl METROPOLITA N UTILITIE S DISTRIC T SAND Y 'Alt :



### . . •' ' Emerg : 402504797 0 Day : 402444719 7 OMAIIACOI - CiT Y O FOMAHA-TRAFFICSEWE R/'RO M Alt : 402444516 1 

### Emerg : 402444516 0 http:.Vv\a\\v.dhon.org/ii1hintcniei/DHO'NN^blice.C.'-eation/MessageText.asp?ret-=<RESl.lLTS.. . 10/9/200 9

### Pag e 2 o f 2 Day : 406728934 3 0PPDGPR5 OMAH A PUBLI C POWE RDISLRIC T N A Alt : 406207149 4 Einerg : 888728934 3 QLNNEIC QV/ES r LOCA LNETWOR K

N A Day : 406728934 3

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