### • # 

## TRANSMnTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL E FOLDE R SAn)# : S7 IDate : i^jldcf i Address : !^^ ) 3,<^ V l <^y..U.y ^ n ~ Remediation Contractor : rK^^Jic ^ H^c A ^n^ o Year : ^wog> ^ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 3Vide o o f property (DVD ) Executiv e Summary 

# d EPA-provide dproperty sketc h 

# d Signe dAcces s Agreemen t for subjec t property Signe dAcces s Agreement(s ) for adjacen t propert y Restoratio n Agreemen t n Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) Confinnatio n dat a 1 3 Photograph s As-buil t sketc h 

# i Satisfector y restoratio n signe db y Property Owne r 

# t Property close-ou t chec k lis t signe db y EP A •Descriptio n o f area s no t meetin g RO D cleaniq > criteri a hUtiUt y clearance s 

## Property informatio n fromDougla s County Assessor' s Of&c e D D D 

## Signatur eI>at e 3021825 9 

# n i l Superfun dFin d Record Remediatio n Quer yI Lea d Remainin g QueryI Propert yDamag e Query Backfill :

Sampl e Area : 57 1 - 2431SPAULDZN G S T Owner : D Owne rOccupie d Owne rName : NABULS I AN D SERHAN INVES T LL C Owne rAddressl : C/

O ZAHE R A SERHAN Owne rAddress2 : 1652 9 WEI RS T City : State : Zi p Code : OMAH A [N E |6813 5 Owne rPhone : Altemat e Phone : 

## Resident : Residen t Name : 

# r Propert yAddress : J243 1 SPAULDIN G ST Zi

p Code : |6811 1 Residen t Phon e 

# I Contract : Contractor : |PRUDENT2009_S Contrac t Optio n OPnON 3 Assessment : Qualifyin g Grou p 40 0 Assessmen t Ma xXR F Value : I 460. 8

## jumwmmwmsBmsB x Date : 12/15/200 9 Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l Monthof : November Propert y Address : 243 1 SPAULDIN GS 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 GDATA/RESULTS : B 2 = 23 7 PP M @ 12" ; D Z = 59 1 PP M @ 13" ; N O EASEMENT ATTACHMENT S 1 ) Propert y sketchprovidedb y EP A pursuan t t o contract specification s 2 ) SignedAcces s Agreemen t including 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 clip/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Built sketch­ i ) Shal l includ e fina l lea dlevel s v ) Legend ii ) Contamination lef t behindarea s vi ) Contractor identification iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e includedi n th e individua l propert y file , if available , o r obtainedinclude : i ) Pre-excavation agreemen t detail s (i f an y ar e mad e wit hth e propert y owner ) ii ) Propert y Statu s For msignedb y propert y owne r iii ) Excavation digita l vide o i n MPEG , WM V (Window s Medi aVideo ) o r SW F(Flas hPlayer) forma t and/or photograph s iv ) Signedfor mverifying satisfactor y restoratio n v ) Description of area s not meeting InterimRO D cleanu p criteria .

TlHBINOiaKIiBjINi: .' TECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y # : 5"7 / Propert y Address : 2.^5 ' iyswJf^h r ^ Date/Time : Owner' s Name : ?'akjE.«
­ S ^ tV^ ^ Quad s Excavated : ^2,0 ^ Contracto r Group : Pruden t Technologies , Inc , Excavatio n Genera l Ye s N o 1 .

I f necessary , wer e th e correct quadrant(s ) excavatedandrestored ? / 2 .

I f necessar)' , wer e th e correct area s o f drip zone excavatedandrestored ? 

# y Gradin g So dan dVegetatio nYe s N o 1 .

Doe s the grading aroundthe perimete r o

f the hous e i n excavatedarea s generall y slop e awa y fro

mtlie house ? 

# y 2 .

Has so dbee n laidi n all area s tha t wer e e.xcavated ? 

# y 3 .

Doe s the sodappea r t

o b e generall y healtli y an dgrowing ? (Onl y evaluat e i

f inspecteda t a3 0 

# y da

v tim e period) 4 .

Ar e sodde darea s generall y fir man devenl y graded ? / 5 .Ar e Ui e joint s betwee n the so dstrip s generall y tight ? (Onl y evaluat e i

f inspecteda t a3 0 da y 

# y tim e period ) 6 .

Wa s the propert y gradedsuc htha t wate r wil l not pool on the property ? 

# y 7 .

Wa s damage t o landscaping o r plan t material s avoided ? 

# y Gate s Fence s an dRetainin g Wall sYe s N o 1 .

Do gate s ope n an dclos e freely ? (Ifapplicable ) / 2 .

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

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

Wa s damage t o retaining wall s avoided ? (Ifapplicable ) / Foundation , Sidin g an dGutter sYe s N o 1 .

Wa s damage t o tlie siding o r trimavoided ? / 2 .

Wa s damage t o the foundatio n avoided ? / 3 .

Wa s damage t o window s avoided ? / 4 .

Wa s damage t o window s o r doo r screen s avoided ? / 5 .Wa s damage t o downspouts o r downspou t extension s avoided ? , / Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Wa s damage t o drivewa y surface s avoided ? / 2 . Was damage t o walkwa y surface s avoided ? 

## < j

## Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complet e including th e 30-da y sodwarranty : EP A Representativ e da/^'i^L. j ^Date: ifho/o ^FRO M : ZPiS COR P LL C FAX NO . : 40 2 99 1 553 3 Oct . 2 3 280 9 12:03P M P I



# .:?/« & r^f ^ Propert yCompletio n Agreemen t Thi s asrcesRCJit document s th e uotnpietio n o f remova l activitie s performe don th e belo w Ji'«e dproperty . Th e propert y owner s signarur e indicate s tha t th e propertj
- owne r i s satisfie dwith th e iisstorario n o f th e subjec t property , an dtha t n o iterr s ar e in question , now , o r a

r an y rim e i n ih e future , excludin g an y remainin g wairant y <3 0 day s totai ) excep t thos e itfem s Jiste dbelow , i f isny . Propert y [D : Propert y .Address : _ 2 l-^ \^\S po-.s ^ \A'tr^si J g} ^ 

### Owner : :Zcxt^. r ,<V,* ^ Lc . ^ Phone ; Restontle n item e f n Quoetion : Itam : lt»m : item : Item ; it«m : Item ; I Require dcorrection s t o corjiplet e th e property :

I agre e restoratio n i s completed , excep t a s note d abcve . C J I d cno t agre e restoratio n i s coniplete d

/C ? - T > 3 - < ^

^ ^ Owner' s i > ignatur e Dat e

prtrtf t /znnnlS i IV J ZS'i l e003/C?/0 1PrudeD t Technologies , Inc . (Prudent ) i s unde r contrac t withth e U . S . Enviromnenta l Protectio n Agenc y (EPA ) t o clea n u p lead
pties locate di n Omaha , Nebraska , includin g th e propert y locate da t

.Th e EP A request s you r permissio n t o allo w Pruden t t o performasoi l cleanu p a t thi s bte dsoil . B y signin g thi s form , th e property owne r grant s permissio n t o Pruden t t o perform 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 Prudent' s Administrativ e Clerk for th e Omah aLea dSit e cleanup . Ms . Siv aS . Jampana-a t (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 at (402 ) 731-304 5 (SouthOmah aoffice ) o r (402 ) 991-9583 (NorthOmah aoffice) . Property Acces s Grante dBy ; 

# i ( 'Z^l\e ^ ^^r^lxi k / ^ (Pleas e Prin t Name ) Property Owne r Signature : 

# V/^ ^ (Signature ) 

# 3 (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 T NAME : 

# \JcLc.n(\' h Owne r Rente r RESIDEN T ADDRESS :
I F RENTAL , PROPERT Y OWNE D BY : . OWNE R ' S MAILIN G ADDRESS ; , \ ^_ i ^ 1 / ^. ^ / A/- ^ 

## S ^
OWNER' S TELEPHON E NUMBE R 

# -HOME : m, . bl? - i> m S^ / J 1 AG E O F HOME ? 

# . 7 0 YEARS . HO W LON G HAV E YO U LIVE D HERE ? 

# A . YEARS . HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978 7 

### V ^ YE S N O NUMBER O F OCCUPANT S UNDE R 7 YEAR S OLO : NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBER O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLA Y I N TH 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 Y FO RENVIRONMENTA LRESPONS E ACTIONS , Th e activitie s t o b e implemente db y EP A unde r thi s agreemen t ar e pursuan t t o Sectio n 10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t 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 entry fo r "determinin g th e nee dfor response , o r choosin g o r takin g an y respons e actio n unde r this title , o r otherwis e enforcin g th e provision s ofth 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 KansasCity , MO6411 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 7

# IRUDEN T ^TECHNOLOGIES , INC . 

# Propert y Statu s For m Address : QfS l SfJuMtf^ J ^" ^ ^ Date : ^/^s/0 9 Phone : *fO^-^7S'&f2 7 Ice/ Q ^^^°
- ^^ ^ Plant s & Permanen t Landscapin g Item # O

n Ma p Descriptio n an dLocation

Pre-Existin g Conditio n o f

Structure s 

# r Doe s you r

Basemen t hav e ahistor y o f

leaking ? Ye s —No ~ - Ite m# Descriptio n & Location On Ma p

Propert y Owne r Signature?:? ^ Pruden t Employee iployee i 

## Signatur e 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 , Nebraslt a 6811 0 San Antonio , T X 7822 9 Phone ; (816 ) 363-370 3 Phone : (402 ) 504-100 4 Phone ; (210)822-958 8 iti AC \ '!»*?' > '^•m- ^

### 57 1 RJllNOj.OOIF.S . INC . 

### AS - BUIL T DRAWIN G OI..S#:57 1 Dat e Ksiavati-d : 09/29/200 9 

### OMAH A LEA D SUPERFUN D SIT E I SEP A Signed-Of f I>atc :

Exterio rPain t Nont l Arro w Omah a Lea d S te Owne rName : • Goo d Sit e Sketc h Address : 243 1 SPAULDIN G ST • Poo r

Phone : H: W: 

# (S ) 

# - Q No t pain l Lea d Sannpl e Sample s Collecte d Sampl e Numbe r LA B Concentra t on Collecte d Firm ; Sverdru p RYASCPXA-57 1 YA25 0 _pp m 0 Date : 

# a RYBSCPXA-57 1 YB 270. 6

_ pp m 0 Time : 

# a RYCSCPXA-57 1 YC 460. 8

_ pp m 0 

### D Sample s Analyze d RYDSCPXA-57 1 YD 23 7

_pp m 0 

### D RDZSCPXA-57 1 DZ 2209. 6

_pp m 0 

### D XR F Uni t Boo k RGZSCPXA-57 1 GZ

_pp m n Date : 10/26/199 9 

# n RPZSCPXA-57 1 PZ _pp m • Time : 09:3 2 

# n Staff : Numbe r of Sample s = 5 Legend ; YA = Yar d (NE) , YB = Yar d (SE) , YC = Yar d (SW) , YD = Yar d (NW) . DZ = Dri p Zone , GZ = Garden , PZ = Pla y 

### SPAULDIN<5 ST . 

# yyyyyyyyyy . 

# VZZZy ,

ALLE Y NO F.ASF.MK M CONTRAC T #: EP - R7-07-0 6 T0# 1 PRUDENTTECHNOLOGIES , INC .

# zc.\ ^ ^ do ; 

## 57 1 Exterio rPain t Nort h Arro w Omah a Lea d Sit e Owne rName : • Goo d Sit e Sketc h Address : 243 1 SPAULDIN G S T • Poo r

Phone:_ H W : 

# (S ) 12

] No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : _ Sverdru p RYASCPXA-57 1 Y A 25 0 pp m 

# a Date : _ RYBSCPXA-57 1 Y B 270. 6 pp m 

# a Time : _ -» • RYCSCPXA-57 1 Y C 460. 8 pp m 

# a m Sample s Analyze d RYDSCPXA-57 1 Y D 23 7 : pp m 

# a RDZSCPXA-57 1 D Z 2209. 6 pp m 

# a t : XR F Un i Book : RGZSCPXA-57 1 G Z L_PPn n 

# • Date : _ 10/26/199 9 RPZSCPXA-57 1 P Z _PP m 

# a D Time : _ 09:3 2 Staff: . Numbe rb f Sample s = 5 

# D Legend : YA= Yar d (NE) , Y B = Yard (SE) , YC = Yar d (SW) , Y D = Yar d (NW) , D Z = Dri p Zone , G Z = Garden , P Z = Pla y 

## SPAULD1JM 6 S T 

# y//////y// z ^77777 . ^



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# I \ 

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### Prin t Previe w Pag e 1 of 2 

## Dougla s County-Omaha , N E

Parce l I D Owne r iNam e Propert y Addres s 

### \cit y Zi p Owne r Addres s Owne r Addres s Owne r City Owne r Stat e Owne r 

### \zi p 171473000 0 NABULS I AN D SERHA N INVES T LL C 243 1 SPAULDIN G S T OMAH A 6811 1 C/

O ZAHE R A SERHA N 1652 9 WEI R S T OMAH A N E 6813 5 Additio n Bloc k Lo t Legal 1 Legal 2 Lega l 3 Legal 4 Acre s Treasure r Websit e Lin k Assesso r Websit e Lin k MARYSVILLEAD D | 1 8 50X12 8

0.1 4 http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp ? parc=171473000 0 http://douglasne.mapping online.com/DouglasCoNe/static/accountinfo.jsp ? accountno=R171473000 0 

### http://www.dogis.org/dogis_aIias/dogis/printPreview.aspx?PrintOptData=DougIa s County-.. . 9/16/200 9

2Page l of 2

" >

• YOU RTICKE T NUMBE RI S 2374922 . Origina l Cal l Date : 9/29/0 9 Time : 9:5 3 a m Wor k t o Begi n Date : 10/01/0 9 Time : 10:3 0 a m State : N E Address : 243 1 Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C County : DOUGLA S Street : SPAULDIN G S T

Sect-Qtr : 04-S E Sect-Qtr : Typ e o f Work : SOI L LEA D REMEDIATIO NPROJEC T Locatio n o f Work : LOCAT E ENTIR E PROPERT Y Remarks : FAX AL L CLEAR S TO : (402)733-188 3 : FA X AL L CLEAR S T O (402 ) 73 3 188 3 : UNSUR E CORNER S Compan y: PRUDEN T TECHNOLOGIE S Contac t Name : SIVAJAMPAM A Wor k Bein g Don e For : EP A Dept h o f Excavation : 6 F T Corne r Lot: N Involve s Tunnelin g o r Horizonta l Borin g : N Op : SIVA1896 7 Place : OMAH A

Phone : (402)733-118 8
Front : Y Rear : Explosives : N ALT87 2 CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac t ALT87 2 WINDSTREA M COMMUNICATIO N N A

CXCAT V CO X COMMUNICATIONS , IN C HEID I

MUDO l METROPOLITA N UTILITIE S DISTRIC T SAND Y

OMAHACO FCIT Y O FOMAHA-TRAFFIC.SEWE R RO N Phon e Numbe r Utilit y Typ e Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 Alt : Emerg : 402504797 0 Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0ENVIRONMENTA L & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SOLUTION S 

# ( D Sit e Safet yHazar d Analysi s Address : J4/3 / :^^ ^ Crew : -^^ y Date : 'y-jj^g' t



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## Site Safet > Officer

808 0 Wa\|/ f arl<v/ay . Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive . Suit e 725 0 KansasCity , 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 : (407 1 «nA.-(nr\J :