HNOLOCIES , INC . 

## PROPERT Y SUMMAR Y SHEE T Omah aLea dSit e Remedia l Actio n Contrac t #EP-S7-10-0 5 Said : 5564 2 Propert y Address;200 7 MIAM I S T Executiv e Summary : •Issue s Encountered : Non e •Issue s Resolved : Non e •Uniqu e Findings : •Othe rRelevan t Information : •CONFIRMATIO N SAMPLIN G DATA/RESULTS : F2 = 28 3 PP M @4" ; B2 = 26 5 PP M @>4" ; EA=32 6 PP M @3" . Attachments : Document s Include d i n th e Propert yFile : Ye s N o N/ A Propert ysketc h provide d b yEP Apursuan t t o contrac t specification s V ont o adjacen t propertie s

Othe rDocuments :

Legend : Ye s - include d i n th e Flle ; N o - Not include d i n th e File ; N/ A- Doe s no t Apply . Signe d Acces s Agreement ; includin g acces s agreement s obtaine d (i f required ) fo rcrossin g V Pre-excavation agreemen t detail s (ifan yar e mad e wit h th e Propert yowner ) V Pre-Excavatio n digita l vide o cli p V Samplin g dat a shee t V Post-Excavatio n digita l vide o cli p V Documentatio n - Complete d EP Aclose-ou t checklis t V As-Buil t sketc h V Omah a Lea d Sit e Databas e sampl e informatio n document . V Signe d for m verifyin g satisfactor yrestoratio n V 3 0 da ySO D warrant ypicture s V Utilit yclearance s documen t V Propert yinformatio n fro m Dougla s Count yAssessor' s office . V Settlemen t document s (i.e . fo ran ydamages , replacemen t o f plants , etc. ) V Sit e safet yhazar d analysi s documen t wit h pictures . V Pruden t Representative : ^i 'EP AAcceptance : 

# Y r o y 3026176 5 ^ ^ ' Date : Date : 

# lll l Superfun d 

### Pruden t Technologies , inc . | 250 5 N . 24T H Street , Suit e 30 8 |Omaha , N E 6811 0 US A | Tel . 402.504.100 4 j Fax : 402.504.100 5 Environmenta l Engineerin g & Service s | Remediatio n j Constructio n

# iniJIHili l SS64 2 Omah a Lea d Sit e Exterio rPain t Nort h Arro w 

### Sit e Sketc h • Goo d • Poo r Samplin g Address : 200 7 MIAM I S T ^ No t pain t 

# r Sampl e Numbe r Lead Sampl e Sample s Collecte d 

# i LA B Concentratio n Collecte d Firm : FD A FBC & RYASCPXA-55642 F 1 1 3 H pp m 

## D Date : 6//7/0 7 RYBSCPXA-55642 F 2 5^ 8 pp m 

## D Time : 'Z-'Z ^ 

# ' fl ^ RYCSCPXA-55642 B 1 3 I I pp m 

## D Sample s Analyze d RYDSCPXA-55642 B2 •5"*/ ? pp m 

## D RDZaCPXA-.5504g B Z " pp m 

# n XR F Unit : (afH2 . Book : 

# n jai . RQZOGPXA-S504 2 9 2 ~ pp m 

# a Date : 9/24/0 7 

## D nPZCCPX A666'i a P2 - • " pp m Time : 

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# n am . Staff : Numbe rof Sample s = '• t | 

# 7l3 V Legend : F 1 = Fron t Left , F2 = Fron t Right , B l = Bac k Left , B2 = Bac k Righ t DZ = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a s viewe d fro m th e street , facin g propert y 

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# I'ROPERT Y ACCES S FOR M Pruden t Technologies , Inc . (Prudent )is unde r contract wit hthe U. S. Environmenta l Protectio n Agenc y (EPA)to clea n

up lead-contaminated^ll s at ainumboBJ T propertie s located in Omaha, Nebraska , including the propert y located at^di ^ Dn^/^t/i l j? Y ^ ^ ^ ^ request s you r permissio n

to allow Pruden tto perfor masoil cleanu p

at

thi s propert y

tp remove lead-contaminatedsoil .By signing thi s form, th e propert y owne r grant s permission to Pruden t to perfor mactivitie s relate d

to the cleanu p including soi l sampling , remova l of leadcontaminatedsoil , an drestoration ofth e reference dproperty . If

yo u have an y question s about the soil cleanu p planne dfo r you r property , pleas e contac t the Pruden t Oflic e fo r th e Omah aLeadSit e cleanu p at (402 ) 733-1188 . Genera l question s abou t the OmahaLea dSit e cleanu p ca

n

be directed to th e EP A Publi c Informatio n Centers at

(402 ) 73I-304 S (Sout hOmah aoffice )or (402 ) 991-958 3 (Nort hOmaha'office) . Ifyour propert y has agrave l or dir t driveway s or parking area s the n the remova l an dreplacemen t ofth e soil and/o r grave l during the s s no t e r Illega l gravel/dir t driveway s or parking area s legal . le

rcmediatuu rcmediatuu i i proces

proces s doe doe s no t mak mak e you

you r illega l gravel A Propert) ' Acces s Grante d 7 [ (Pleas e Prin t Name ) Property Owne r Signatur e (Si^ature ) (Date ) Property Accesse dby . (Pruden t Employe e Name ) PROPERT Y INFORMATIO N (T o b&completed|| ^ residen t and/o rpropert yowne r- pleas e print ) 1. REBIDENTNAME : Owne r Rente r 

# JM 6^^ . 2. IF RENTAL , PROPERT Y OWNE D BY : 

### 3. OWNER S MAILIN GADDRESS :P^ 6, Bx . lid^ ^ ^/A/fJ/ J J fll^ ^^^^ ^ 4. OWNER' S TELEPHON E NUMBE R - HOME : (^ ^ > O^/"^'^ * WORK : t ) 5. TENANT' S TELEPHON E NUMBE R - HOME : ( 1 WORK : J L 6. AG E OF HOME? : / / - YEARS . HO W LPN G HAV E YO U LIVE D HERE ? 7. HA S TH E EXTERlOFrBE»l^;4l^C(r6brCOHERE D WIT b 8. # OF OCCUPAKT S UNDE R AG E OF 7: # OF OCCUPANT S APO R OVE R 7 YEAR S OL D 9. # OF CHILDRE N UNDE R AG E OF 7 WH O PL A E YAR D FO R 5 HOUR S OR MOR E PE R WEEK : 10 . COMMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATESTNEIGHBORIN G PROPERT Y ETC. ) 

# PV ht f lud& e - (e moetctmMl ' /W ' ^ -/wii^/ l ffi/P^ ^ AUTHORIT Y FO R ENVIRONMENTA L RESPONS E ACTIONS : Th e activitie s to be imptemente d te I by EP A unde r thi ^ | / . JLjifi£ agreemen t ar e pursuan t to Sectio n 104 of CERCLA , 42 U.S.C . 9604 . EPA' s righ t of acces s t t o o tl

th e propert y is /t/jF S QCV^' ^ erminln th e nee dfa r provide d fo r In Sectio n 104(e ) of CERCLA , 42 U.S . C 9605(e) , whic h provide s entryfb r"determinin g g I response , orchoosin g ortakin g an yrespons e actio n unde rthi s title , orotiierwis e enforcin g th e provision s of th e 11 thf A^ 

# /AMI7 

# bcsi/^ ^ Pruden t Technologie s Inc . 560 0 S. IO** * St . Omaha , N£68107 , 402.733.118 8 (OfTice ) 402.733.188 3 (Fax )ENVIRONMENTAL& 

# mJDE N CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

## Propert y Statu s For m Address : ^^^ 1 ^//fM. ) 5 Y ""*' = 7'/ ^ ' / / 

# Phone : ^^ ^ ^ 3 y^ ^^j j BVID : 5"5VVS ^ NOTIC E T O B E GIVE N TO : /^OWNER / TENAN T BOT H 

# y ^ ^ HO W MUC H NOTIC E I S NEEDED ! 2 4 HOURS/ 4 8 HOUR S 7 2 HOUR S } ( 2 4 HOURS / 48 1 OTHE R NOTIC E NEEDE D (PLEAS E SPECIFY) : PHON E # AN D NAM E TO WHO M NOTIC E NEED S TO BEGiVEN : ' / 

# -3^1-^^ / ^dimij ( /fi/mei^ ^ l^ ^ ooic e mf^ l WILL NEIGHBORIN G PROPERT Y NEE D T O B E USE D FO R ACCESS ? YE S 1 I F NEIGHBORIN G PROPERT Y WIL L NEE D T O B E ACCESSE D WHA T I S TH E ADDRESS :

WA S A NACCES S FOR M OBTAINE D FRO M TH E NEIGHBOR ? YE S ( ^ /IL L AFENC E NEE D T O B E TAKE N DOW N TO OBTAI N ACCESS ? YE : 

# js(^7 ) I F ANSWERE D YE S TO NUMBE R 1 2 PLEAS E PROVID E LOCATIO N O F FENCE : I S THER E PRE-EXISmi G FACIA L DAMAG E TO TH E PROPERT Y AN D I F S O PLEAS E PROVIDE D LOCATIO N AN D DESCRIPTIO N O F SUCH : YE S jji^jjv'SPECIFY : 

# l/iK/lA / 

# /

l/>f- I S THER E PRE-EXISTIN G CONCREI E DAMAG E TO TH E PROPERT Y AN D I F S O PLEAS E PROVIDE D LOCATIO N AN D DESCRIPTIO N O F SUCH : YE S ( NO ^

SPECIFY : 

# 'TiiCM/ f

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# T : Pruden t £ Signature : Signature : DATE : -f - /^ ' Pruden t Technologie s Inc . 560 0 S . lO" * St. Omaha , N E 68107 , 402.733.118 8 (Office ) 402.733.188 3 (Fax )ENVIRONMENTAL& CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# r Pmpert y Inspectio n For m

Address : ^^^ 7 IYl//^fiAI ^ T Date : ^^/3^' H Phone : ^d^'S j hASt 3 / BVID : Soi^i ^ 

# Pre-Existin g Dainage : Pleas e writ e i n detai l an dinclude dlocatio n an ddescriptio n of damage : Concret e Damag e fJA/^AfJ i 

# LM .

Facia l Damag e Includin g Siding : 

# tJL ^ 

## Doe s Basemen t hav e history o f

leakin g o r flooding ? VE S N O 

# MtS W 

# 'iH ^

Doe s Homeowne r wan t so dreplace di n al l areas T YE ^ N O IfN O pleas e provid e wha t area s ar e no t t o h e sodde dan dwha t need s t o h e replace dinstea do f

so d(i.e . mulch , rock , leav e bare ) if mulc ho r roc k pleas e specif y wha t typ e an dcolor e 

# 6utl l f/csS ^ mm ^ pfi/fiith ^ hef mOJM M 

# lesi/^ i 

# I M^/ ^ M^pir mDl/^tAJl5i/)A J Mo/l 6 U/JiJ/ > d/ i lAJ£>/l\ i \\OTHE RDAMAGE O RREQUESTS : J ht6/l/} k

Propert y Owne r Pruden t Empi Signature : Signature : DATE : "7 " / DATE : 7"/ ? / /Em'lRONMINTA L& CONSTRUCTION 

### TECHNOLOGIES , INC . SERVICE S 

# XR F CLEARANC E SMEE T PROPERT Y ABBRESS ^ "^ ^ •u\'- - \J \/*,. , 

# y^ - TT V 

# IB : r^b't*^ ^ AA ^ HA S BEEN REVIEWE D AN D N O MISSE D AREA S EXIST : fYE S . N O WA S CONTAMINATIO N LEF T BEHIND ? I FYE S WHER E AN D DIMENSIONS : ^y' / CREW : Kxy^y ^ DAT E DEPT H QUADRAN T } READING F l 

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# yyy GARDE N PLAYZON E

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### EASEMEN T "^Z--; . y- "lECHNOLOGIBS , INC . 

### Propert y # : ^ 5 64^2 - Date/Time : Quad s Excavated : p'Zi^'i . 

# SEPA EP A Propert y Clos e Ou t PropertyAddress : 2LOe>" 7 K^A.«rv">'7'V . Owner' s Name : PjfVr'C^C - Sit^ilcr ^ Contracto r Group : Pniden t Technologies , Inc. , Excavatio n Genera l Ye s N o 1 .

I f necessary , wer e tli e correc t quadrant(s ) excavatedan drestored ? / 2 .I f necessary , wer e th e correct area s o f drip zon e excavatedandrestored ? / Gradin g Sodan dVegetatio n Ye s N o 1 Doe s th e grading aroundthe penmete r o

f th e hous e i n excavatedarea s generall y slop e awa y fro mtli e house ? / 2 .

Has sodbee n laidmall area s tha t wer e excavated ? / 3 .

Doe s th e so dappea r to b e generall y health y an dgrowing ? (Onl y evaluate i f mspectedat a3 0 da

y time period) / 4Ar e soddedarea s generally fir man devenl y graded ? 

# y 5 .

Ai e tli e joint s between th e so dstrip s generall y tight ? (Onl y evaluat e i

f inspecteda t a3 0 da y time period) / 6 .

Was th e propert y gradedsuc htha t wate r wil l not pool on th e property ? 

# y 7 .

Was damag e t o landscaping o r plan t material s avoided ? / Gates , Fence s an dRetainin g Wall s Ye s N o 1 D o gate s ope n andclos e freely ? (I f apphcable ) / 2 .

Wer e al l gate s o r fence s taken dow n during restoratio n activitie s reinstalled ? (I f applicable ) / 3 .

Was damag e l o gate s or fence s avoided ? (I f applicable ) / 4 Was damag e t o retainin g wall s avoided ? (I f applicable ) / Foundation , Sidin g an dGutter s Ye s N o 1 Was damag e t o th e siding o r trimavoided ? / 2 .

Was damag e t o th e foundation avoided ? / 3 .

Was dainag e to window s avoided ? / 4Was damag e t o window s o r doo r screen s avoided ? 5Was damag e t o downspout s or downspou t extension s avoided ? / Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 Was damag e t o drivewa y surface s avoided ? / 2 . Was damag e t o walkwa y surface s avoided ? 

# y

## Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complete includin g th e 30-da y so dwarranty ; EP A Representati^ve P* ^ j^ > ^Dale : ulsaj n" A :i4N0L0Cies . i»ic . 

### AS - BUILT DRAWIN G Sampl e Area : 5564: 2 - :2UU 7 Miam i S t Dat e Excavated : 08/29/201 1 

### OMAH A LEA D SUPERFUND SIT E Sample dBy : Issa c 

### CONTRAC T # : EP-S7-10-0 5 5564 2 Omah a Lea d Sit e Extwio rPan t Sit e Sketc h • Goo d n Poo r samplin g AddiMs : 200 7 MIAM I 3T ^ Not pain t Sampl e Numbe r Lea d Sampl e LA B Sample s Collecte d Concentratio n Colle ^ 

# I Fimi : fD A Ri-C£ > RYASCPXA-SSe4 2 F l —Lil—pp m D Date : ei//7/? 7 RyBSCPXA-5564 2 F 2 ^a B ptw i D Time : Z -Z v pn \ RYCSCPXA-SS64 2 B l 3 I > pp m D Sample s Analyze d RYDSCPXA-SSe4 2 B 2 ^*^ i pp m D 

# i WPJeoCPKA-5504 8 -ez " • PPt n D XR F Unit : ta^Hl . Book : 79 3 ROn00P)(A-ii!i04 2 -o a ~ pp m 

## a D Date : f j 2.t,/O t RPZSCPX AMB< a -PS - D 

# I D Time - A m 

# • Stan Myii / ~ Numlie ro f Sample s • 

# 1 . / I Legend : F l = Fron t Left , F 2 = Fron t Right . B l = Bac k Left . B 2 = Bac k Righ t D Z = Dil p Zone , G Z » Garden . P Z - Pla y Al l quadnm t tr a n wawi d flDm Via •MM . Ikein g papeft y 

# ENTERE D I .:3.iv >^y^.....;f . B 2 = 26 5 PP M ( O 4 " 

# 8(:...!.. . ^



### . . 2a>7I^IAMISr . i 

# -1-6 5 i E A= 32 6 PP M (S > 3" ^ . 8 

# i 0 -PI : F2 . I n = 28 3 PP M @ 4 "

. Af/4A1 / 3T : . . H n4 i^M«a d»A^>i7li,4^3 7

Pruden t Technoiogles , In c | 250 5 N . 24TH Street , Suit e 30 8 fOmaha , N E6811 0 US A| Tel . 402.504.1004 1 Fax : 402.504.100 5 Environmenta l Engineerin g & Service s | Remediatio n | Constructio n^ i X Cu t "J W ziAstenttinf l 'T/Selection - ^ Replac e 

## • a ySpellln s J ^ A I M •1 0 • :r " — ' ^ Copy J i Deicendin g ^Advanced ' ^Sav c • • Ge

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eFitte r. , Refres h ^_ , ^Mor c Si: < to S¥M( n • / B ^RemoveSor t •/Tog^ u Piire rAH , X 0«W e - -3*'"' ' Fi t Foi m Windows . »( Select ' Clipboar d Sor t & Ptite r ' Rtcotd i Fin d Windo w Tex t formattin g Remedistio n Quer vI I LeddRernarmgQuerv| Pfoprt vDamag e Quer y| LBWE J PWpart y Wf o I Cl«ian-m » M b Sampl e Info cuaWiiie r CaM s | SiJimMi t Hepa w Sampl e Area : 5564 2 200 7 MIAM I ST

sairoi s uat e . Uuadran t .t Paramet e . XR F K< . ^ XRP n» t . Exc. Marke rPlac e . Lead Remaini n • in ; . sample d B .t UAuonfirme c. La&_Re s 9|^ H B2 LEA O 2i' j mg'k g 4 ISSA C N/ A 6-29-2unE 1 LEA D j2b-nrx q ISSAC II' A 8/23«)11iF 2 LEAO 283:m9fk B 4 D B ISSA C M/ A 1 LEA D imgrk g ,M,' A .* 0 • •

\Rmiiit. n 1 , . w» 1 • * It o Fiiu r1 SetK h • Ji i •,, ' ,.;., ; f . ., 1 li l 

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# SEP A Propert yCompletio n Agreemen t Thi s agreemen t document s Ui e completion of remova l activitie s performedo n the below listedproperty . Th e propert y owner' s signalure indicate s tha t the propert y owne r i s satisfiedwit hthe restoratio n of th e subject property , and . tha t n o items ar e i n question , now , or a

t aii y lim e i n th e fulure , exclusJiin g an y remainrrig warrant y (3 0 day s lotal ) except thos e items listedbelow , ifany . 

# JO d M\anv(cSt - Owne r 

## jvrexCiC ^ Srft»Lv3g:-i- ^

(J^^kj\w.\X ^ 

# 'Jq /-^Q^8 l Restoratio n Item s i n Question :

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

\z \ I agre e restoratio n i s completed . I I d o no t agre e restoratio n i s complete d at (note d deficiencie s above )



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• YOU RTICKE T NUMBE RI S 2813849 . Origina l Cal l Date : 8/04/1 1 Time : 12:2 6 p m Op : ASHLEIGH1896 7 Wor k t o Begi n Date : 8/08/1 1 Time : 1:0 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 200 7 Street : MIAM I S T Twp : 15 NRng ; 13 E Sect-Qtr : 10-S W Twp : Rng ; Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D SOI L 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 : ASHLEIG H ANIKPUT A Phone : (402)733-11 ^ Wor k Bein g Don e For : EP A Dept h o f Excavation : 6F T Corne r Lot : NFront : Y Rear ; Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Utilit y Servic e Are a Contac t Phon e Numbe r Typ e Day : 402934046 9 CO X HEID I CO X CXCATV COMMUNICATIONS , Alt : 402934046 9 COMMUNICATION S IN C Emerg : 402932975 7 Day : 402504782 3 MUDOl METROPOLITA N UTILITIE S DISTRIC T SAND Y MUD Alt : Emer g Day : 402444719 7 OMAHACO F CIT Y O FOMAHA TRAFFICSEWE R RICH/TRAFFI C OMAH A Alt : 402444672 5 Emer g 402444516 0 Day : 406728934 3 0PPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T EL M LOCATIN G Alt : 406207149 4 Emerg : 888728934 3 QLNNEI C QWES T LOCA L NETWOR K EL M LOCATIN G Day : Alt : 406728934 3 406207149 4

o f 2 8/4/201 1 12:2 7 P Mhttp://www.dhon.orr'^hintemet/DHONNoticeCreation/MessageText. . 

## Ernerg : 888728934 3

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# irt Hom e Ticke t Ticke t Creatio n Logou t Creat e Anothe rTicke t G o t o Hom e Pag e Sen d Emai l

• YOU R TICKE T NUMBE R I S 2831593 . Origina l Cal l Date : 8/25/1 1 Time : 11:1 3 a m Op : ASHLEIGH1896 7 Wor k t o Begi n Date : 8/29/1 1 Time : 11:3 0 a m State : N E County : DOUGLA S Place : OMAH A Address : 200 7 Street : MIAM I S T Twp : 15 NRng : 13 E Sect-Qtr : 10-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : SOI L REMEDIATIO NWOR K Locatio n o f Work : ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)733-188 3 : EMAI L AL L CLEAR S TO : AANIKPUTA@PRUDENTWEB.CO M : UNSUR E CORNE R Compan y PRUDEN T TECHNOLOGIE S Contac t Nam e ASHLEIG H ANIKPUT A Phone : (402)733-118 8 Alt . Contac t NON E Wor k Bein g Don e For : EP A Dept h o f Excavation : 6 F T Corne r Lot : NFront : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C



## http://www.dhon.org/IRTHOneCall/Ticket/TicketCreation.aspx?ViewTicketID=80393 3 8/25/201 1

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# P Analysi s Complete dB y i \f ^>< - K . fc- RA >°? ' Pruden t Technologie s Healt handSafet y Officer Ite m Overhea dPowe r Line s Ga s Lines ' Wate r Line s Sewe r Lin e Septi c Tank Propane/Butan e Foundatio n (DZ ) Drivewa y Sid e walk Tree s Plants/Garde n GZ Acces s t o Property Bu.^ y Stree t (nee dt o clos e of

f Lane ) Han dDi g Pets /bees/wasps/ticks/re d ants/spider s Poiso n Ivy/Poiso n OaJ < Miscellaneou s Locatio n FJ F 2 B l B 2 Conditio n 

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