### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAiD# : 

### 2534 9 DATE : 1/1 5 ADDRESS : 241 8 CALDWEL L S T REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES . INC . YEAR : 

### 20lj ) 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S 

## K' ­ n f PR E AN D POS TVIDE O O F PORPERT Y(DVD ) /v\.-&Si«< i P»ei'D<"« ^ ^^^ ^ d EXECUTIV E SUMMAR Y m EPA-PROVIDE D PROPERT YSKETC H U SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN TPROPERT Y [ / RESTORATIO N AGREEMEN T n SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R TO REPLACE PLANTS , ETC. ) d CONFIRMATIO N DAT A a PHOTOGRAPH S d AS-BUIL TSKETC H m SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R Q PROPERT YCLOSE-OU TCHECKLIS TSIGNE D B YEP A D DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A d UTILIT YCLEARANCE S m PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E D D

^ ^ 

### .lilili L SIGNATUR E DAT E 

### 3021837 7 

# HHilHIi l Superfun d

### PROPERT Y SUMMAR Y Date : /15/201 0 Omah aLea dSit e Remedia l Actio nContrac t #EP-R7-07-0 6 TO# l Mont hof: Propert y Address : 241 8 CALDWEL LS 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 : F l = 20 0 PP M @ 8" ; B 2 = 6 9 PP M @ 4" ; N O EASEMEN T 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 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/photograph 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 nagreemen t detail s (i f an y ar e mad e wit hth e property owner ) ii ) Property Statu s Formsigne 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 mveriiyin g satisfactory restoratio n v ) Descriptio nofarea s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOCIES . INC .

# luMlWliW l 

# :.i^.l^Rft TECHNCHJOGIKS , INC . >.^i- « 

# EP A Propert y Clos e Ow t Propertv-# : 2-5 " 5^ ^ Propert y Address : 24' ^ /'^iJl^d l ^ ' Date/Time : Owner' s Name : Mffb<S(3 0 Z^r^ - Quad s Excavated : p f ^2 - Contracto r Group : Pruden t Technologies , fac, Excavatio nGenera l Ye 9 N o 1 . I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 

# y 2 . If necessary' , wer e th e correc t area s o f dri p zon e excavate dan drestored ? 

## y Gradin g So dan dVegetatio nYe s N o 1 . Doe s th e gradin g aroun dth e perimete r o f th e hous e i n excavate darea s generall y slop e awa y 

## y fromth e house ? 2 . Ha s so dbee nlai di n al l area s tha i 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 i f inspecte dat a3 0 

## y day tim e period ) 4 . Ar e sodde darea s generall y firman devenl y graded ? 

# y 5 . Ar c tli e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e if inspecte dat a3 0 da y 

# y tim e period ) 6 . Wa s tli e property grade dsuc htliat wate r wil l no t poo l o n th e property ? 

# y 7 . Wa s diiniag e t o landscapin g o r plan t material s avoided ? ^ Gates , Fence s an dRetainin g WaJS s Ye s N o ! . D o gate s ope nan dclos e freely ? (I f applicable ) 

# y 2 Were al l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (I f applicable ) 

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

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

# y Foundation , Sidin g an dGutter s Ye s N o 1 . Wa s damag e t o th e sidin g o r tri mavoided ? 

# y 2 . Wa s damag e to tli e foimdatio navoided ? 

# y 3 . Wa s damagcl o window s avoided ? 

## y 4 . Wa s damag e t o window s o r doo r screen s avoided ? 

# y 5 Wa s damag e t o downspout s o r downspou t extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Ye s N o I . Wa s damag e t o drivewa y surface s avoided'^ ' 

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

# -y

## Owner s comments :

Inspectio nnotes :

Remova l andrestoratio nactivate s complete includin g th e 30-da y so dwarranty . EP A Representativ e Bt>^^ ^ Date : tt\i\\ o

# IR H CHNOLOGIES . INC 

### A S - BUIL T DRAWIN G OL S #2534 9 Dat e Excavated : 10/21/201 0 rSEP A Signed-Of f Date : 

### OMAH A LEA D SUPERFUN D SIT E 

## 2^3^* ? Name : /yltisc a XnAvtWit, i Omah a Lea d Sit e Date ; . Nort h Anm r /Wdress : 3 . V / » r./tci 9 K,£U . S / Sft e Sketc h Time : Phone ; Tea m ff-t* ^ <. s A.f* ^ BVID # ^S'i^ f f

XR FCod e /g>g 7 gooj^ ' J3 Z Sampi e Numbe r Lea d Concentratio n Confirmatio n Sampl e gY/»irg/>XA-gg3q ? ^ 7 pp m f ' Ye s a N o QJ ^ 

## :i 5 

# i F a Ye s a gMCS^A>XA-^S3tJ< ? pp m 

### N o c r 2,(2 - pp m ^ / Ye s • N o Q ; ^^ ^ pp m /JaYe s n 

### N o cz r pp m YB b O N O D pp m -Ye s • N o C D pp m V6S n 

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# E J

Oinah a l^a d Sit e 4613 0 CONTRAC T# : EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC .

# %EP A Propert yCompletio n Agreemen t Thi s agreemen t documents the completiono f remova l activitie s performedo nthe below listedproperty . Th e propert y owner' s signatur e indicate s tha t the propert y owne r i s satisfiedwit hthe restoratio nof the subject property , an dtha t no item s ar e i n question , now , o r

a

t an y tim e i n the future , excluding an y remaining warrant y (3 0 day s total ) except thos e items listedbelow , if any . Propert y ID : 

# ^Y^ ^ (jjyiy^^t: ; Owner : Phone : Restoratio nKerns i nQuestion : Item : Item : Rem : Item : Item : Item : 

### Require dcorrection s t o complet e th e property :

L&Tagr i 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 ) 

# /Kdtaisyu^'y^< ^ l \/^3// Q Owner' s Signatur e Dat e 

# O^^fDj^O^^ ^^>®V : Pruden t Technologies , Inc . (Prudent ) i s unde r contrac t withth e U . S . EnvironmentaJ Protectio nAgenc y (EPA ) t o clea nu p lead contaminate dsoil s at a,numbe r o f

m£pertie s locate di nOmaha , Nebraska , includin g th e property locate da t r 9 (t- l o (_c^({C O 0)j - Of f Th e EP A request s you r permissio nt o allo w Pruden t t o performasoi l cleanu p at this properti ' t o remov e lead-contaminate dsoiLB y signin g thi s form , th e property owne r grant s permissio nt o Pruden t t o perfor m activitie s relate dt o th e cleanu p includin g soi l sampling , remova l o f lead-contaminate dsoiLan drestoratio nofth e reference dproperty . Ifyo u hav e an y question s abou t th e soi l cleanu p planne dfor you r property , pleas e conta aPruden t southoffic e for th e Omah aLea d Site cleanup-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 (SouthOmalt aoffice ) o r (402 ) 991-958 3 (NorthOmah aoffice) . Property Acces s Grante dBy : 

### ^^I/Z^ik/I D yvi/)i^^Ll nf^o' ^ py\OB^ 9 ZTAJO . T^^Q , (Pleas e Prin t Name ) Property Owne r Signatu i 

## ')jiUt^/^jyUL^<^ ' /o/lljf d / ^ (Signature ) (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 TNAME : '^AjC/^Ai T Lt l T Rente r RESIDEN TADDRESS : 

# 'cZ¥i ^ CALjQiy^s/j- ^

sr . I F RENTAL , PROPERT YOWNE D BY : OWNER' S MAILIN G ADDRESS ; OWNER' S TELEPHON E NUMBE R - HOME : 1'°^ ) 3l2 - Z ^2- 0 WORK : 

### J 1 AG E O F HOME? : AJ/1 ^ YEARS . HO W LON G HAV E YO U LIVE D HERE ? /^ / F l YEARS . HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978 ? YE S N O A*/A 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 

## /^I A NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLA YI N TH E YAR D FO R 5 HOUR S O R MOR E PE R WEE K 

### •yj/ ^ COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ET C 

# . , /^/ A

AllTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS ; Th e activitie s t o b e implemente db y EP A unde r this agreemen t ar e pursuan t f

o Sectio n10 4 o f CERCLA , 4 2 U S.C . 9604 . EPA' s right o f

acces s t o th e propert y i s provide dfo r i nSectio n104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s enti y for '"detemiinin g th e nee dfor .response , or choosin g or takin g an y respons e actio n under tlii s title , o r otherwis e enforcin g th e provision s ofth e title. " 808 0 War d Parkway , Suit e 40 5 560 0 S 1 0 S t 424 2 Medica l Drive , Suit e 425 0 Kansa s City,'M O 6411 4 Omaha , Nebrask a S810 7 Sa n Antonio , TX 7822 9 Phone : f816 ) 363-370 3 Phone : (402 ) 733-118 8 Phone : (210)822-958 8 Fax : <816 > 363-370 7 Faie ; (402 1 733-188 3 Fax:(210)579-667 7' ^ ^ 

# 2^3^* ? Name : /)1di>ef. n JT/i^^vifi-.e ^ Omah a Lea d Sit e Date : . Nort h Arro w Address : a V / « <JUJ } SJ£ U ^ Sit e SIcetc h Time : Phone : 

### Tea m >»ai O <. s A^ ^

BVID # ^ S " 3 ^ / 5

^ XR F Cod e l03 1 RooiL i \3 Z Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampi e pp m ^ ' Ye s C D N o CB ^ F a Ye s n N o 5 ^ ^ /

Ye s n N o o ; "fc- ^ pp m /5 a Ye s C ] N o ^ -I I pp m YO B P N o D H pp m Y6 8 a N O a Z pp m 'Y6 S • 

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### a



# w ' i l l * r• ! < ! i l l * I ' * 'II *

Omah aLea dSit e 4613 0

## N 

# l i 241 8 Caldwel l St . 

# A "WW^ ' Printed : De c 08.201 0 www . dcgis . org/dogi s

### Pag e 1 of 2

" > Create Anothe rTicke t Bac k t o Irt h Internet Sen d Emai l 

### YOU RTICKE T NUMBE RI S 2618627 . Origina l Cal l Date : 10/15/1 0 Time : 4:0 2 p m Op : SIVA1896 7 Wor k t o Begi n Date : 10/19/1 0 Time : 4:3 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 241 8 Street : CALDWEL L S T Twp : 15 NRng : 13 E Sect-Qtr : 15-NW,16-N E 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 PROPERTY , 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 AJAMPAM A 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 : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL 3 MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac t Phon e Numbe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEID I 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 LEVEL 3 LEVEL S COMMUNICATIONS , LL C N A 

### Day : 877366834 4 Alt : Emerg : 877366834 4 MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R 

### RICHATRAFFI C Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 10/15/201 0

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

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

EL M LOCATIN GAlt : 406728934 3 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 10/15/201 0

### CONSTRUCTIO N .mc . SOLUTION S 

## SIT ESAFfcT Y HAZAR D ANALYSI S Address : -MlSL . Cidi^n dJ^ . Excavatio n Date : Crew : 

## Backfi U Date :

Ite m Overliea dLine s Ga s Lin e Wate r Lin e Sewe r Lin e Septic/Leec h 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 Hazard s Correctiv e Actio n c^< - O C i » C i rei ^ 

# e ^ 

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# a*- —

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## Sit e Safet y Offic e Date :

M O VManfBariomy . Suto4( K SSOOSIOS t 424 2 Medica l Drive , Suft e 726 0 iGiir;Ma«4ii 4 Onridni , NitanM a 0810 7 Sa n Antonio , I X 7822 9 Plwiie : (403)733-110 8 Phone : (2t0 ) 822-M8 8

Fax : (40Z ) 733-488 3 Fax : (210 ) 679-657 7

# ZilSCMhmu . ^ 

# IZlZlZoi o k J