### TRANSMITTA L o f OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 3?>;fc 7 Date : fj2 A It' s Address : SL g l \"^-^^ ^ ^ ^

SOI L REMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S 'i Vide o ofpropert y (DVD ) g

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Executiv e Summar y H EPA-providedpropert y sketch O r

SignedAcces s Agreemen t fo r

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

adja^^n t propert y aRestoratio n Agreemen t 3 Settlemen t document s (i.e. , fo r

damag e or t o replac e plants , etc. ) H Confirmation data aPhotograph s aAs-built sketch S

^ Satisfactor y restoratio n signedby Propert y Ovvne r aPropert y close-out chec k

lis t signedb y EP A D Descriptio n o f area s no t meeting RO D cleanu p criteri a aUtilit y clearance s 0 Propert y infonnatio n fix)mDougla s Coimt y Assessor' s Office D D D 

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### PROPERT Y SlIMMARY Date : Ol/H/200 9 Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-06/0004 Monti i of : Dec/Jan Propert y Address : 281 1 RUGGLE S S T A . EXECUTIV E SUMMAR 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 N SAMPLIN G DATA/RESULTS : D Z = 17 7 PP M @ 4" ; F 2 = 15 8 PP M @ 3" ; E A = 13 1 PP M @ SCRAPE ATTACHMENT S 1 ) Propert y sketch provide db y EP A pursuan t to contract specification s 2 ) SignedAcces s Agreemen t includin g acces s agreement s require dfo r crossing othe r propertie s 3 ) Pre-Excavation digita l vide o clip/photograph s 4 ) Post-Excavation digita l vide o chp/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Buil t sketch
i ) Shal l include final lea dlevel s v ) Legend ii ) Contamination lef t behindarea s vi ) Contracto r identification iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s to b e includedi n th e individua l propert y file, i f available , o r obtainedinclude : i ) Pre-excavatio n agreemen t detail s (i f an y ar e mad e wit h th e propert y owner ) ii ) Propert y Statu s For msignedby properly owne r iii ) Excavation digita l vide o i n MPEG , WM V (Window s Medi aVideo ) or SW F(Flas h Player) forma t and/or photogr^h s iv ) Signedfor mverifyin g satisfactor y restoratio n v ) Descriptio n o f area s no t meetin g hiteri mRO D cleanu p criteri a

TECHNOLOCIES , INC .Fin d Record Clea n U p Query Lea d Remainin g QueryI Propett yDamag e Quer y Backfill :

Sampl e Area : 3316 7 - 281 1 RUGGLE S S T Owner : n Owne rOccupie d Owne rName : I BRY E TASH A L Owne rAddressl : 

# r Owne rAddressZ : J281 1 RUGGLE S ST City : OMAH A State : Zi p Code : [N E |6811 1 Owne rPhone : Alternat e Phone : )(402 ) 505-988 2 ; |(712 ) 347-5600 Resident : Residen t Name ; BRYE TASH A L Propert yAddress : 1281 1 RUGGLE S S f Zi p Code : |6811 1 Residen t Phon e Contract : Contractor : |PRUDENT2008_ S Group : 

# 1 Assessment : Qualifyin g Grou p I PRIORIT Y Assessmen t XR F Date : 

# r~—~" ~ Assessmen t MaxXR F Value : I 504.9 7TECHNOLOGIES , INC , Propert y # : 3'2)\fe 7 Date/Time : Quad s Excavated : f2- ^ VZ.
- 

# EP A Propert y Clos e Ou t Propert y Address : 2&] \KLu»jl«< l ^ Owner' s Name : Contracto r Grou p Pruden t Technologie s Excavatio n Genera l 1 .I f necessary , wer e th e correct quadrant(s ) excavatedan drestored ? 2 .

If necessary , wer e th e correct area s o f dri p zon e excavatedan drestored ? Gradin g Sodan dVegetatio n 1 .Doe s the grading aroun dthe perimete r ofth e hous e i n excavatedarea s generall y slop e awa y fromthe house ? 2 .Ha s so dbee n laidi n al l area s dia t wer e excavated ? 3 .

Doe s th e sodappea r to b e generall y health y an dgrowing ? (Onl y evaluat e if inspecteda t a3 0 da

y tim e period) 4 .

Ar e sodde darea s generall y firman devenl y graded ? 5 .Ar e the joint s betwee n di e so dstrip s generall y tight ? (Onl y evaluat e if inspecteda t a3 0 da y tim e period) 6 .Wa s the propert y gradedsuc h tha t wate r will not poo l o n the property ? 7 .

Wa s damage to landscaping o r plan t material s avoided ? Gates , Fence s an dRetainin g Wall s 1 .D o gate s ope n an dclos e freely? (IfappUcable ) 2 .

Wer e all gate s o r fence s taken dow n durin g restoration activitie s reinstalled ? (I f applicable ) 3 .

Wa s damage t o gate s o r fence s avoided ? (IfappUcable ) 4 .

Wa s damage to retainin g wall s avoided ? (If applicable ) Foundation , Sidin g an dGutter s 1 .Wa s damage t o th e siding o r trimavoided ? 2 .

Wa s damage t o the foundation avoided ? 3 .

Wa s damage to window s avoided ? 4 .Wa s damage to window s o r doo r screen s avoided ? 5 .Wa s damage to downspouts o r downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) 1 .Wa s damage t o drivewa y surface s avoided ? 2 .Wa s damage to walkwa y surface s avoided ? Ye s No 

# y l y Ye s No y 

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## AJ A Ye s No / 

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### Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complet e includm g th e 30-da y so dwarranty : EP A ^QmQSQn\A\xy&y^/^x^^^^c^.^jJly:g & Date : ^-^//l/dt 'PAG E 0 1 OCA C 12/B1/200 8 16:2 9 402738207 1 

# &EP A Propert y Compl&tlo n Agreemen t Hii s asnoooen t doctmclit ath e completio n o f removal activitie i perfbrmc do n th o belo w lisu dproperly . Th e propor ^ owiw' i tSfgatot n intUcate c tin t th e proptnt y owne r i s satisfie dwid i th e rcstontio ao f th « 9abj«C T ptoperty , an dihii t t n item s ar e i n quostion , now . o r n t an y tim e i n th e faam , excludin g aa y renulniD g wsmati f (3 0 lay s total ) excep t tho M itenz s lsM«dbelow , i f any . TrofmtfJD : 

## m^r^A^^y-^: ^ 2^q^ ^ H^W^^l^ ^ s ^ Owmer . 

## \<Ui\iJK » l&y- ^ FhoM' . 

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ItM n ReqiiliM f corntlM m to compM B H M property :

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# M: y V - a Dat e
rnn/Ta n J iiiW i T-r n onn ri n rPruden t Technologies , Inc . (Prudent ) is unde r contrac t with th e U. S. Environmenta l Protectio n Agenc y (EPA ) to clea n up lead
contaminate dsoil s at anumbe r ofpropertie s locate d in Omaha , Nebraska , includin g th e ptopert y locate dat

. Th e EP A request s you r permissio n to allo w Pruden tto performasoi l cleanu p at thi s property to temov e lead-contaminate dsoil . By signin g this form , th e property owne r grant s permissio n to Pruden tto perform activitie s relate d to th e cleanu p includin g soi l sampling , remova lof lead-contaminate dsoil , an drestoratio n of

th e reference dproperty . If

yo u hav e an y question s abou t th e soi l d/tUm p planne dfo r you r property , pleas e contac t Pruden t Administrativ e Clerk fo r th e Omah aLea dSit e cleanup . Ms . DeborattfJohnso n -^a t (402 ) 733r l 188 . Genera l question s abou t th e Omah aLea dSit e cleanu p ca n be directe d to th e EP A Publi c InformjilSi/Center s a/(^02 ) 73y3J»4 5 (South Omah aoffice ) or (402 ) 99 1 -9583 (North Omah aoffice) . Property Acces s Grante dBy : (Plea * Prin t Name ) r Property Owne r Signature : 

# ^^4^/^t^# ^ (Date ) PROPERT Y INFORMATIO N (T o be complete d by residen t and/o r propert y owne r ~ pleas e print ) RESIOENTNAME : 

### "^ \ gv,/gi . Owne r7 Rente r ^ RESIOEN T ADDRESS ; r \

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# -S t fio^vrj^s^ tj ^ c ^ I t I IF RENTAL , PROPERT Y OWNE D BY :
ER' S MAILIN G ASpRESS ^ i ATORESS ; 

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# SL OWNER' S TELEPHON E NUMBE R - HOME : J 1. WORK :
AG E OF HOME ? 

# ,M f YEARS . HO W LON G HAV E YO U LIVE D HERE ? HA S TH E EXTERIO R BEE N PAINTE D OR COVERE D WIT H SIDIN G SINC E 1978? NUMBER OF OCCUPANT S UNDE R 7 YEAR S OLD : NUMBER OF OCCUPANT S 7 YEAR S OL D AN D OLDE R 

# _3 _ NUMBER OF CHILDRE N UNDE R 7 YEAR S OL D WH O PLAYIN TH E YAR D FO R 5 HOUR S OR MOR E PE R WEEK : COMMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. )

AUTHORFf Y FO RENVIRONMENTA L RESPONS E ACTIONS ; Th e activitie s to be implemente dby EP A unde r thi s agreemen t ar e pursuan t to Sectio n 104 of CERCLA , 42 U.S.C . 9604 . EPA' s right of

acces s to th e propert yis provide dfor in Sectio n 104(e ) of CERCLA , 42 U.S . C 9605(e) , whic h provide s entt y for "determinin g th e nee dfor response , or choosin g or takin g an y respons e acdo n unde r this title , or otherwis e enforcin g th e provision s of th 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 , MO 6411 4 Omaha , Nebrask a 6811 0 Sa n 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 7OLS# : 33167 Dat e Eicavated : 10/27/200 8 USEP A Signed-OffDate : 3316 7 Exterto n Pajr t NiMtt i Airo w Oinah a Lea d Sit e Owtie rWaiw ; TASH A L BRY E Q-goo d Sit e Sketc h AddreM-.28i i RUGGLE S a t • Poo r Phone : H : 402-gO»^e 2 W . 712-347-560 0 

# 4 . Q No t pain) Sampl e Numbe r Lea d Sampl e /-.A B Sample s Colleote d &)ncentra(io n Collectej*^'-'^ ^ Firm : RyASCPXA-3316 7 F 1 / O l co m Date : g-^Z-gS- ' PYBSCPXA-3316 7 F2 ^0 ^ DPf P 

## c/y a Time : ^'. ^ " ^ RyCSCPXA-3316 7 B l / f t 7 ppn n 

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## D Sample s Analyze d RYDSCPXA-3316 7 B 2 —-JHZ-pp m RDZSCPXA-3316 7 D 2 D XR F Unit : /03 7 Book : .iO . ROgOOPM-DOIfl f -et - Sga* ? pp m D D Date; _ ^-^-gA* " -pa — D Tine : /'^j y 

## a " " pp w staff : _ ^/ > Numbe rof Sample s > ^ \ Legend : F l = Fron t Left , F2 = Fror t RIgM , B l = BacKLeft . B 2 = Bac k Righ t DZ - Dri p Zone , G Z = Garden , P Z - Pla y Al l qutdrinl * ar » a t linwu d (to m th e atiMt , tadno pramt y

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CONTRA a # : E P - R7-07-0 6 / 000 4 PRUDEN T TECHNOLOGIES , INC .ENVIRONMENTA L & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : Date : \ o 5 ^ | A ^ ^ Phone ; ^ \3 ^ C:>'^n U BVID : Ite mN O lant s & Permanen t Landscapin g T o Remai n I n Plac e O n Ma p Descriptio n & Locatio n 

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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 Sa n Antonio , T X 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• • 

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# 3316 7 Omah a Laa d Sit e Own e rItome : TASH A L BRY E Sit e Skete h AMn»:2& M RUGGLE S S T Phone : » • 402-505-^68 2 W 712-347-S$(X > S wnpl e Numbe r Lea d Concentratiot i CoHecta*^*^ ^ RY;fiCPXAr3316 7 F 1 pp m 

# 10 1 PYIlSCPXA-33167 F 2 

## .SfiJ S pp m RYisCPXA.3316 7 B 1 pp m 

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# 33 . RD;SCPXA-3316 7 DZ 

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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 182877000 0 BRY E TASH A L 281 1 RUGGLE S S T OMAH A 6811 1 281 1 RUGGLE S S T OMAH A N E 6811 1 Sec-Twn Rn g Additio n Bloc k Lo t Legal l Lega l 2 Lega l 3 Lega M Treasure r Websit e Un k Assesso r Websit e Un k 04-15-1 3 MYER S RICHARD S & TILDEN S AD D 7 3 50X12 5

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### Sen d Emai l YOU R TICKE T NUMBE R I S i 2157993 . Origina l Cal l Date : 10/20/0 8 Time : 9:2 6 a m Op : MADHURIMA1896 7 Wor k t o Begi n Date : 10/22/0 8 Time : 10:0 0 a m State : NE County : DOUGLA S Place : OMAH A Address : 281 1 Street : RUGGLE S S T Twp : 15 NRng : 13 E Sect-Qtr : 04-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lead remediatio n projec t fo r soi l 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 : MADHURIM A Phone : (402)733-118 8 Alt . Contact : Phone : (618)401-222 3 Wor k Being Don e For : ep a Dept h o f Excavation : 6 f t Corne r Lot : NFront : Y Rear : Involve s Tunneling o r Horizonta l Boring : NExplosives : N CXCAT V

MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C 

### Servic e Are a Contac t Phon e Nunibe r Utility Typ e CXCAT V CO X COMMUNICATIONS , IN C HEIDI Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUDO l METROPOLITA N UTILITIES DISTRIC T SAND Y Day : 402504782 3

Alt : Emerg : 402504794 6 OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO N Day :

Alt : 402444719 7 402444516 1 Emerg : 402444516 0 0PPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T N A Day : 406728934 3

Alt : 888728934 3 Emerg : 406728934 3 ^ ^ Day : 406728934 3 QLNN E 1 C QWES T LOCA L NETWOR K
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