### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 2753 1 DATE : 12/15/201 0 ADDRESS : 432 7 GRAN TS T REMEDIATIO N CONTRACTOR : PRUDENT TECHNOLOGIES . INC . YEAR : 201 0 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S \ h PR E AN D POS T VIDE O O F PORPERT Y (DVD ) I D EXECUTIV E SUMMARY m EPA-PROVIDE D PROPERT YSKETCH d SIGNE D ACCES S AGREEMEN T FOR SUBJEC T PROPERT Y m SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN T PROPERT Y d i RESTORATIO N AGREEMEN T D SETTLEMEN T DOCUMENTS (I.E. , FOR DAMAG E O R T O REPLACE PLANTS , ETC. ) m CONFIRMATIO N DAT A m PHOTOGRAPH S 6 AS-BUIL T SKETCH

• SATISFACTOR YRESTORATIO N SIGNE D B Y PROPERT Y OWNE R m PROPERT YCLOSE-OUTCHEC KLIS T SIGNE D B Y EP A D DESCRIPTIO N O F AREA S NO T MEETIN G RO D CLEANU P CRITERI A

• UTILIT YCLEARANCE S d l PROPERT YINFORMATIO N FRO M DOUGLA S COUNT Y ASSESSOR'S OFFIC E D 

## D D ^^ ^ 3\llV ^ SIGNATUR E DAT E 3021859 3 Superfun dFin d Record 

### Backfill :

Sampl e Area : 2753 1 - 432 7 GRAN TS T Owner : n Owne rOccupie d Owne rName : I HABITA TFO R HUMANri YO F OMAHA ^ Owne rAddressl : Owne rAddress2 : |220 4 AME S AV E City : State : Zi p Code : JOMAHA" |N E )68110 - Owne rPhon e Alternat e Phon e 

# I 

# r

Contract : Contractor : JPRUDENT2010_ S Contrac t Optio n JOPTIO N 2 Remediatio n Quer yi Lea d Remainin g Quer yI Propert yDamag e Quer y

Use rProvide d Owne rInformatio n Owne rName : Owne rAddress :
City : 

# 1 State : 

# 1 Zi p Code : 

# 1 Owne rPhone : 

# 1 Alternat e Phone :

Assessment :



### = ~ Qualifyin g Grou p [40 0 Assessmen t Ma xXR F Valu e 

# 1 549.8 9 Resident : Residen t Name : Propert yAddress : |432 7 GRAN T S T Zi p Code : J68111 - Residen t Phon e 

# I

### PROPERT Y SUMMAR Y Date : 12/15/201 0 Oinah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Decembe r Propert y Address ; 432 7 GRAN T 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 GDATA/RESULTS : B l = 36 6 PP M @ 6" ; E A = 27 4 PP M @ SCRAP E (~1" ) ATTACHMENT S 1 ) Property sketc hprovide db y EP A pursuan t t o contrac t specification s 2 ) Signe dAcces s Agreemen t includin g acces s agreement s require dfo r crossin g othe r propertie s 3 ) Pre-Excavatio n digita l vide o clip/photograph s 4 ) Post-Excavatio n digita l 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 final lea dlevel s v ) Legen d ii ) Contaminatio n lef t behin darea s vi ) Contracto r identificatio n iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e include di n th e individua l property file, i f available , o r obtaine dinclude : i ) Pre-excavatio n agreement detail s (i f an y ar e mad e withth e property owner ) ii ) Property Statu s Formsigne db y property owne r iii ) Excavatio n digita l vide o in MPEG , WM V (Window s Medi aVideo ) o r SW F(Flas hPlayer ) format and/o r photograph s iv ) Signe dfor mverifyin g satisfactory restoratio n v ) Descriptio n o f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOCIES . INC .TECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y # : 2 7 6^ ' Propert y Address : H 3>2 7 &r<Ui-v9^ . Date/Time : Owner' s Name : 1Vv>^W \^r t^tvrv&nr v « ^ Quad s ExcaA'ated : ^ ( Contracto r Group : Pruden t Technologies,Inc. , Excavatio n Genera J Ye s N o I . I f necessary , wer e th e correct quaclrant(s ) excavatedandrestored ? / 

### 2 . I f necessary , 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 the gradin g aroundthe perimete r o

f th e hous e i n excavatedarea s generall y slop e awa y / fro mthe house ? 2 . Has sodbeen laidi n al l area s tlia t wer e excavated ? / ?i

. Doe s the sodappea r t

o be generall y health y andgrowing ? (Onl y evaluate i f inspecteda t a3 0 da

y lime period) 

# y 4 . Ar e sodde darea s generally finn an devenl y graded ? 

# y 5 . Ar c the jontt s between the sodstrip s generall y tight ? (Onl y evaluat e i

f mspecteda t a3 0 da y / tim e penod ) 6 . Wa s the propert y grade dsuc htlia t wate r wil l not pool o n the property ? 

# y 7 . Wa s damag e t o landscaping o r plan t material s avoided ? 

# y Gates , Fence s an dRetainin g WaU s Ye s N o 1 . Do gate s ope n andclos e freely ? (I f apphcable ) 

# y 2 . Wer e al l gate s o r fence s take n dow n during restoratio n activitie s reinstalled ? (I f applicable ) 

# y 3 . Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) 

# y 4 . Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) 

# y Foundation , Sidin g an dGutter s Ye s N o ] . Wa s damag e t o the stding o r trimavoided ? 

# y 2 . Wa s damag e lo the foundation avoided ? / 3 . Wa s damag e l o window s avoided ? 

# y 4 . Wa s damag e t o window s o r doo r screen s avoided ? / 5 . Wa s damag e t o downspout s o r downspou t extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Yes , N o I Wa s daniaiJ e t o diivcwa v surface s avoided' ? 2 . Wa s damag e l 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 ARepresentativ e Bt>. „ -JOo^ Date : fill's/I PBrTTNDCDGlES . INC 

### A S - BUIL T DRAWIN G OL S #2753 1 Dat e Excavated : 10/21/201 0 USEP A Signcd-Of f Date : 

### OMAH A LEA D SUPERFUN D SIT E 2753 1 Exterio rPain t North An-o w Owne rName : CHARLES^ H LINDHORS T Omah a Lea d Sit e • Goo d Sit e Sketc h Address : 432 7 GRAN T S T • Poo r

Phone : H W : g'No t pain t 

# i Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Firm : Sample s Collecte d rv\fc.- b A^rv^ O RYASCPXA-2753 1 RYBSCPXA-2753 1 F l F 2 

## AZ . i^ o . pp m

. pp m 

# r n D Date : Time : i I / 0 ' /0< o 1 0 - t.* S a.fy \ RYCSCPXA-2753 1 RYDSCPXA-2753 1 B l 8 2 

## 55 0 35 1 pp m

. pp m 

# a D Sample s Analyze d -ROZSCPXA-37.W 4 B2 ­ pp m 

### D D XR F Uni t ino- 7 Book : U' J

RGZSCPXA.3753 1 RPZSCP,XA.2753 1 S Z PZ pp m pp m Numbe ro f Sample s = 

### D 

# n ' ­ 

# n D Dat e ll-7J^d(s > Time : P m Staff : yi^L J Legend : F 1 = Fron t Left , F 2 = Fron t Right , B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a

s viewed tro m th e street , facin g propert y,

B l =36 6 I'P M « 6 ' (j)W( L SSO 

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CONTRAC T tt : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC .

# SE m Propert yCompletio n Agreemen t Thi s agreement document s th e completio n o f remova l activitie s performe do n th e belo w liste dproperty . Th e propert y owner' s signature indicate s that th e propert y owner i s satisfie dwit hth e restoratio n ofth e subjec t property , andthat n o item s are i n question , now , o r at any tim e i n th e future , excludin g any remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Property ID : Property Address ; 432 7 6r^tnV5l . 

### Q^'""'
- toiU fc. \^mjLM\ ^ 4 (huL\x( L Phone : 

## ^t)Z-H?l-'?b^ l Restoratio n Item s i n Question :

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

^3^ 1 agre e restoratio n i s completed .

L J I d o no t agre e restoratio n I s complete d a t (note d deficiencie s above )



## H 

# \<fjzoio dwaef^ s Signature Dat eRX Date/Tim e 10/08/201 40 2 45 7 401 2 

### ^2010 

### 0 12:3 0 P.00 2 

### Oct . 8. 201 0 12:28P MHafta t fo r Humanit y No , 141 4 P. 2 

# a0al

Pruden t Technolofiu , Inc . (Prudeni ) ii unde r c«n(i«c t wil hth e U. S. Envjronincnti l Protectio nAgenc y (EPA ) to clee n up lead
ctulaminMc dsoil ! at anumbe rof prapenie t locate dinOmiht , Nebraiki ^ includin g II K propen y locate d at ^^2- 7 q»7iVl'rari . Th e EP Arequest s you r penniMio nlo allo w Pnidoi tlo perfon nasoi l clcani vat thi s propert y to itmov e lesd-MnUminatc dsoil . By sigDin e thi t fomi , th e propert y ovnte r grant s permissio n to Pniden t to pcrfbn n activitie s relate d to th e cleanu p Includin g toi l sampling , remova l of lead-contaminate dsoil , an drestoratio nofth e refirtoee dproperty . Ifyo u hav e an y questio mabou t th e toi l cleanu p planne dfbr you r property , pleat e contac t Pruden t soul hofBc e ior th e Omah aLea d Sit e cleanup-a t (402 ) 733-118S . Genera l question s abou t th e Omah aLea dSit e cleanu p ca n be directe d to ih e EP APubli c Inibrmalio n Center s al (402 ) 731-304 5 (Soul hOmali aoffice ) oi (402 ) 991-9S8 3 (Non hOmah aoffice) . Propert y Acces s Crantc dBy : y^eist Prin t Nafie ) Propert y Owne r Sigoatu i 

# MIIJM O lignaluie ) ^ (Date ) PROPERTYINFORIMATIO N (T o be coapletc d by t-eiidta t and/o r properi y owne r ­ pleas e print ) RESIDEN TNARAE : •—^^^——.^^_^^_____^^.^^ ^ /owne rJ Renls r RESIDENI T TADDRESS :

A[)DRES S

_A^ ^ irneNTy , PROPER W OWNE D BV : OWNER' S MAILIN G ADDRESS : OWNER' S TELEPHON E NUMBER-HOME : l^Sfl- \ i{T~ l ^ ^^*5~ l WORK : 

### J 1 AG E OF HOME? : h/< l YEARS . HOW LON G HAV E YO U LIVE D HERE ? YEARS . HAS TH E EXTERIO R BEE N PAINTE D OR COVERE D WIT H SIDIN G SINC E 1076 ? ^YE S

NO NUMBE R OF OCCUPANT S UNDE R 7 YEAR S OLD : NUMBE R OF OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R OP CHILDRE N UNDE R 7 YEAR S OL D WH O PLA Y

IN TH E YAR D FO R S HOUR S OR MOR E PE R WEEK : COMMENTS OR SPECIA L INSTRUCTIONS : (I.E . DCQ8 , ENTR YGATES , ETC. )

AiriHORlT Y FO RENVIRONMENTA LRBSPONS B ACTIONS ; Th e activitie s to be implemenle d by EP Aunde r thi s agreemen t ar e pursuan t to Seclio n10 4 ofCERCLA , 42 U.S.C . 9504 . EPA' s righ tof acces s to th e propeit y is provide dfor inSectio n104(e ) of CERCLA , 42 U.S . C 960S(c) , whic hprovide s entr y fbr "deteiminio g th e nee dfbr retponte , or choosin g or takin g an y respons e aciio n unde r thi s title , oi otherwis e enforcin g Ih c ptoWsion s of th e title. " 808 0 War d Parkway , Suit e 40 S 660 0 SI O St 424 2 Madica l Driva . Suit e 425 0 Kansa s City , MO 6411 4 Omaha , Nebnick a 6810 7 San Antonio , TX 7822 9 Phone:(816)363-370 3 Phona : (402 ) 733-118 8 Phone : (210 ) 822-068 8 Fax : (816 ) 363-370 7 Fax : (402)733-188 3 Fax:(210)679-657 7ENVraONMENTAL& CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : ^ ^^- | (l(fo^vsj ^ %\ ^ Date : 

# l0((^ f , Phone : BVID :

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## ) f 1 5 ClC _ Propert y Owne r Signature : 808 0 War d Parkway , Suit e 40 5 Kansa s City , M O 6411 4 Phone : (816 ) 363-3703 Fax : (816 ) 363-3707 560 0 S 1 0 S t Omaha , Nebrask a 6810 7 Phone : (402)733-118 8

Fax : (402)733-188 3 4242 Medica l DriveTSuit e 425 0 Sa n Antonio , T X 7822 9 Phone : (210)822-958 8 Fax : (210 ) 579-657 7

## 2753 1 Exterio rPaint Nort h Arro w Omah a Lea d Sit e Owne rName : CHARLE S H LINDHORS T • Goo d Sit e Sketc h Address : 432 7 GRAN T S T • Poo r Phone : H : W : g^No t pain t

Numbe ro f Sample s = ; ^ Sampl e Numbe r RYASCPXA-2753 1 F l Lea d Concentratio n pp m Sampl e Collecte d LA B 

# D Finn : Date : Sample s Collecte d Wtfct ) ftWmO H/Ot/o( o RYBSCPXA-2753 1 F2 

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# D Time : tO - l ^

a-rv \ RYCSCPXA-2753 1 RYDSCPXA-2753 1 RDZSCPXA2763 1 RGZSCPXA-2753 1 RPZSCPXA2753 1 B l B 2 DZ ^ 6 Z PZ 

## S?Q. , 35 1 pp m pp m pp m pp m pp m 

# m r u D 

# n n D D 

# n n Sample s Analyze d XR F Uni t 

## JQQX . Book : i32 _ Date : J l 

## K'CX p Time : QT > Staff : /%i ^ Legend : F 1 = Fron t Left . F2 = Fron t Right , B l = Bac k Left , B 2 = Bac k Righ t D Z = Dn p Zone , G Z = Garden , PZ = Pla y Al l quadrant s ar e a s viewe d fro m th e street , facin g propert y, (ipiJ C 

# ENTERE D 3i5 7 SSO 

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### Printed : No v 16,201 0 www.dcgis.org/dogi s______ TEOHMOtaiMa . 

## mc . CONSTRUCTIO N SOLUTION S 

## SIT E SAFfeT Y HAZAR D ANALYSI S Address : —M^^-jS^tocL^L Excavatio n Date : f<^l^^\^ — Crew : Backfi U Date : iMAiJJ A

Ite m Overhea dLine s Ga s Lin e Wate r Lin e Sewe r Lin e Septic/Leecl i Fiel d Propane/Butan e Sidewal k Foundatio n Retainin g Wall s Fence s Tree s Structure s Drivewa y Sprinkle r Syste m Othe r Cre w Forema n Conditio n c ^ ^ 

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### seoosios t 424 2 Itodica l Drive , Suit e 726 0 (ansa * caiy ; »04411 4 Sa n Antenk) , T X 78229 OnrtiHL-M<bi3SfcB B8T0 7 • bona : fgW ) 38»gW P Phone : (2tO ) 822-0688 VUanr . (402)733-110 8 te: fSliS ) 363.370 7 Fax : (210)«7M«7 7—-»»»%• • /f _