### TRANSMITTA L O F OIVIAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# ; 3339 6 DATE : 12/15/201 0 ADDRESS : 391 0 N 2 2 ST REMEDIATIO N CONTRAaOR : PRUDENTTECHNOLOGIES . INC . YEAR : 201 0 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S G ( PR E AN D POS TVIDE O O F PORPERT Y(DVD ) [ ^

EXECUTIV E SUMMAR Y Cfl EPA-PROVIDE D PROPERT YSKETC H d SIGNE D ACCES S AGREEMEN TFO R SUBJECTPROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FO R ADJACEN TPROPERT Y [ J RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENT S (I.E. , FO R DAMAG E O R T O REPLAC E PLANTS , ETC. ) d CONFIRMATIO N DAT A Cj ( PHOTOGRAPH S a AS-BUIL TSKETC H 1 3 SATISFACTORYRESTORATIO N SIGNE D B YPROPERT YOWNE R \ h PROPERT YCLOSE-OU TCHEC KLISTSIGNE D B YEPA D DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A o fUTILITYCLEARANCE S d PROPERT YINFORMATIO N FRO M DOUGLA S COUNTYASSESSOR' S OFFIC E D D D ^e/> ^

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### PROPERT Y SUMMAR Y Date : 12/15/201 0 Omah aLea dSit e Remedia l Actio nContrac t #EP-R7-07-0 6 TO# l Mont hof : Decembe r Propert y Address : 391 0 N2 2 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 2 = 36 0 PP M @ 6" ; E A= 15 3 PP M @ SCRAP E(~1" ) ATTACHMENT S 1 ) Property sketc hprovide db y EP Apursuan 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/phojograph 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 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 di nth e individual property file, i f available , o r obtaine dinclude : i ) Pre-excavatio nagreement 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 ndigita l vide o inMPEG , WM V (Window s Medi aVideo ) o r SWF(Flas hPlayer ) format 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 .TECHNOLCXJIES , INC . 

# EP APropert y Clos e Ou t Propert y # : 

## -^33^ ^ :

> Propert y Address:"^ ^ 1 0 ^ " ^^?"^
- Date/Time : Owner' s Name : CK^O ^ o^Or^aW a Quad s Excavated : g> 2 Contracto r Group : Pruden t Technologie,s , Inc. , Excavatio n Genera l Ye s N o 1 .I f necessary , wer e th e correc l quadrant(s ) excavatedandrestored ? / 2 . I f necesscui' , wer e th e correct area s o f drip zone excavatedandrestored ? / Gradin g So dan dVegetatio n Ye s N o 1 Doe s th e gradin g aroun dth e perimete r of th e hous e i nexcavate darea s generall y slop e away / fromth e house': ^ 2 .Ha s so dbee nlai din al l area s tha t wer e excavated ? 

# y 3 .

Doe s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e if inspecte da t a3 0 day tim e period ) • / 4 .Are sodde darea s generall y finnan devenl y graded ? 

# y 5 .

Ar e th e joml s betwee ntli e so dstnp s generall y light ? (Onl y evaluat e if inspecte dat a3 0 da y tim e period ) / 6 .Wa s th e property grade dsuc htliat wate r wil l no t poo l o n di e property ? 7 .

Wa s dainag e ( o landscapin g o r plan t material s avoided ? 

# y Gates , Fence s an dRetainin g Wall s Ye s N o 1 .D o gate s ope nan dclos e freely' ^ (I f applicable ) 

# y I .Wer e al l gate s or fence s talcendow ndurin g restoratio nactivitie s reinstalled ? (I f apphcable ) / ' 3 .

Wa s damag e t o gate s o r fence s avoided ? (I f apphcable ) / ' Wa s damag e l o retainin g wall s avoided ? (I f applicable ) / Foundation , Sidin g an dGutter s Yes , 

### ys o 1 .Wa s damage lo the siding o r trimavoided ? / 2Wa s damag e t o the foundation avoided ? / 3 .

Wa s damag e ( o window s avoided ? / ^ 4 .Wa s damage t o window s o r doo r screen s avoided ? 

# y 5 .Was damage t o downspout s o r downspou t extension s avoided ? / Sidewalk s an dDriveway s (Concrete ) Yes , N o 1 Wa s damag e l o diivewa v surface s avoided ? 

# y Wa s damag e t o walkwa y surface s avoided ? 

# y ^

## Owner s comments :

Inspectio nnotes :

Remova l an drestoratioi\activate s complete includin g th e 30-da y so dwarranty : EP ARepresentativ e '^ ^ Date : •A'''' "^rTTNDtXJClES . INC , 

### A S - BUIL T DRAWIN G OL S n3i3'i 6 Dal e Kxcavated : 10/07/201 0 

### OMAH ALEA D SUPERFUN D SIT E rSF.P ASigned-r) ^ Date : 

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### .N-.22..ST ; Rcv2it(«B L rrcato J I6.\ia\J)) i E A= l. yPP M a S ( RAP E (-1" ) CONTRAC T# : EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC .

# ^^fcnl« ^ Propert yCompletio n Agreemen t Thi s agreement document s th e completio no f remova l activitie s performedonth e belo w liste dproperty . Th e propert y owner' s signature indicate s tha t th e propert y owner i s satisfie dwit hth e restoratio no f th e subjec t property , andtha t n o item s are i nquestion , now , o r a

t any time inth e fiiture , excludin g any remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , if any . Propert y ID : Propert yAddress ; g.^/ ^ ^^^^; , ^^6'/^ / 

### Owner : ^/•^ \ o l O'^v^ty^ - 

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### Item : Required con'ection s t o complet e th e property :

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I agre e restoratio n i s completed . LJ i d o no t agre e restoratio n i s complete d a t (note d deficiencie s above )



### /( ^ yVowcyy^^i y-yo i 0 Dat ePruden t Technologies . Inc . (Prudent ) i s unde rcontrac l wit h Ih cU . S . Environmenta l Protectio n Agenc y(EPA ) t o clea n n p lead coninminaic d soil s at a numbe ro fpropertie s locate d i n Omaha . Nebraska , includin g th e propen ylocate d at i?yU l A/ , y?,).Ai J Sr/ce'-/ ~ Th e EP Arequest s )'0u rpermissio n t o allo wPruden t t o pcrrom i a soi l cleanu p at (hi s propert yt o remov e lead-contaminate d soil . B ysignin g thi s roim , lli e propert yowne rgrant s permissio n t o Pruden t t o perfon n Bclivitic s relate d t o th e cleanu p includin g soi l sampling , remova l oriead-coniaminate d soil , an d restoratio n o fth e reference d property . I fyo u hav e an yquestion s abou t Ih e soi l cleanu p planne d fo ryou rproperty , pleas e contac t Pruden t soul h ofTic c.fo rth e Omah a l.ea d Sit e cleanup-a t (402 ) 733-1188 . Genera l question s abou t Ih e Omali a Lea d Sit e cleanu p ca n b e directe d l o Ih e EP APubli cInformation ' Centers a t (402 ) 731-304 S (Sout h Omah a office ) o r(402 ) 99 1 -958 3 (Nort h Omali a office) . Propert yAcces s Grante d By : /w///«3/v \ // • L^lfCAjt ^ (Pleas e Prin t Name ) Propert yOwne rSignature : PROPERT YINFORMATIO N (T o b e complete d b yresiden i nnd/o rpropert yowne r- - pleas e print ) RESIDEN TNAME : Owne r Rente r RESIDEN TADDRESS : 

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# A / 2 X ^ ^ I F RENTAL , PROPERT YOWNE D BY :

OWNER' S MAILIN G ADDRESS ;



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K^0>^ \ hHH - ^f/^ t AG E O F HOME? : YEARS . HO WLON 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 7 _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 NUNDE R 7 YEAR S OL D WH O PLA Y I NTH 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 Y GATES , ETC. )

AUTHORIT YFO R ENVIRONMENTA L RESPONS E ACTIONS ; Th e activitie s t o b e implemente d b yEP Aunde rthi s agreemen t are pursuan t l o Sectio n 10 4 ofCERCLA . 4 2 U.S.C . 9604 . EPA' s righ t ofacces s t o Ih e propert yi s provide d fo ri n Sectio n 104(e ) o f CERCLA . 4 2 U.S . C 9605(e) , whic h provide s entryfo r"detemiinin g th e nee d fo rresponse , o rchoosin g o rtakin g an yrespons e actio n unde rllii s lillc , u rotherwis e enforcin g th e provision s o fIh e title. " 808 0 War d Parkway , Suit e 40 5 

### seoosios t 4242^edica l Drive , Suit e 426 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6810 7 . Sa n Antonio . T X 7822 9 Phone : (816 ) 363-370 3 Phona : (402)733-118 8 Phone : (210)822-968 8 Fax : (816 ) 363-370 7 Fax : (402)733-188 3 Fax : (210 ) 579-6S7 7

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## .N.-.22..S T R(n'2008.B L Created : l6.May'.0 S (MdH1.0n 3

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# A Printed : No v 16,201 0 www.dcgis.org/dogi s

### Pag e 1 of 2
" > Creat e Anothe rTicke t Bac k t o Irt h Inteme t Sen d Emai l 

### YOU RTICKE T NUMBE RI S 2609470 . Origina l Cal l Date : 10/05/1 0 Time : 4:3 6 p m Op : SIVA1896 7 Wor k t o Begi n Date : 10/07/1 0 Time : 5:0 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 391 0 Street : N22N D S T Twp : 15 NRng : 13 E Sect-Qtr : 03-S W 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 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 : NFront : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N ALT87 2 CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Servic e Are a Contac t Plion e Numbe r Utilit y Typ e Day : 406728934 3 ALT87 2 WINDSTREA M COMMUNICATIO N EL M LOCATIN G Alt : 406207149 4 Emerg : 888728934 3 Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE RRICH/TRAFFI C Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 

### http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 10/5/201 0

### Pag e 2 of 2
0PPDGPR 5 OMAH APUBLI C POWE RDISTRIC T Alt : 406207149 4

EL M LOCATIN G Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K Day : 406728934 3

EL M LOCATIN GAlt : 406207149 4 Emerg : 888728934 3

http://www.dhon . org/irthintemet/DHONNoticeCreation/MessageText.asp?ret-<RESULTS.. . 10/5/201 01<:NU1JNE£RIN GAN D 

### CONSTRUCTIO N SOLUTION S 

## SIT ESAl^T Y HAZARD ANALYSI S Address : 

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Ite m Conditio n Hazard s Correctiv e Actio n Overhea dLine s ^y^
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## Sprinkle r Syste m ^ . , . 

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### seoosios t 424 2 Medica l Drive . Suft e 726 0 OmtJOL , Mibriilr n S81C 7 Sa n Antonio , T X 7822 9 Phone : fsi o 3n>370 3 nwne : f4aa)733-11S 8 Phone : (2tO ) 822458 8 fao cfSIS ) SSS-STO r F a c (4eZ)73»488 3 Fax : (210 ) 6r9-«57 7

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