0 SAID# : 28029 

### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R DATE ; 1/1 5 ADDRESS : 261 3 GRAN T S T REMEDIATIO N CONTRAaOR : PRUDEN T TECHNOLOGIES . INC . YEAR : 20l4 > 

### SOI L REMEDIATIO N PROPERT Y FIL E FOLDE R DOCUMENT S ^

PR E AN D POS T VIDE O O F PORPERT Y (DVD ) ^

EXECUTIV E SUMMAR Y ^

EPA-PROVIDE D PROPERT Y SKETC H I ^

SIGNE D ACCES S AGREEMEN T FOR SUBJEC T PROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN T PROPERT Y H RESTORATIO N AGREEMEN T D SETTLEMEN T DOCUMENTS (I.E. , FOR DAMAG E O R T O REPLAC E PLANTS , ETC. ) M CONFIRMATIO N DAT A PHOTOGRAPH S [ Z AS-BUIL T SKETC H ETSATISFACTOR Y RESTORATIO N SIGNE D B Y PROPERT Y OWNE R \ S PROPERT Y CLOSE-OU T CHECKLIS 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 Y CLEARANCE S

• '^PROPERT Y INFORMATIO N FRO M DOUGLA S COUNT Y ASSESSOR'S OFFIC E D D D 

## ^-B-Jfc - il'l n JRE ^ SIGNATURE^ * " DAT E 

### 3021761 6 Superfun d

### PROPERT Y SUMMAR Y Date : /15/201 0 Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Montl i of : Propert y Address : 261 3 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 G DATA/RESULTS :

F 2 = 12 1 PP M @ 6" ; E A = 28 3 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 dfor 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 Checldis t 6 ) As-Bui hsketch 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 ) Property addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e include din th e individua l property fde , i f available , o r obtaine dinclude : i ) Pre-excavatio n agreemen t 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 i n MPEG , WM V (Window s Medi aVideo ) o r SWF(Flas hPlayer ) forma t 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 .Fin d Recor d 

### Backfill :

Sampl e Area : 2802 9 - 261 3 GRAN T S T Owner :

• Owne rOccupie d 

### Owne rName : lOTY O F OMAH A Owne rAddressl : |C/ 0 PLANNIN G DEPARTMEm " Owne rAddressZ : /|181 9 FARNA M S T #111 1 jCity : State : Zi p Code : ; lOMAH A ~ |N E 168183 - Owne rPhon e Alternat e Phone : 

# r
Contract :

Contrac t Optio n JOPTION 2 Remediatio n Query Lea d Remainin g QueryI Propert yDamag e Quer y


### Use rProvide d Owne rInformatio n Owne rName : 

# 1 Owne rAddress : 

# 1 City : State : Zi p Code : 

# 1 1 1 Alternat e Phone : Owne rPhone : 

# 1 " 1

Assessment : Qualifyin g Grou p |46 o Assessment Ma xXRF Valu e j 733. 6 Resident : Residen t Name : |TtNANTS-9UNITAFT . Propert yAddress : )261 3 GRAN T S T Zi p Code : |68111 - Residen t Phon e

### 3 TECHNOIXXJIES . INC . 

### Property# : Z'6C>2J \ Date/Time : Quad s Excavated : Y "2 ^ 

# myGr h EP A Propert y Cllos e Ou t Propert y Address : Z^^' ^ ^"^^^ ^ ^ • Owner' s Name : C^i-<^ °S-^v'''^ \ Contracto r Group ; Fruden t Technologies , Inc. , Excavatio n Genera l Ye s N o 1 . I f necessary , wer e the correct quadrant(s ) excavatedandrestored ? / 2 , I f necessary , wer e th e correct area s o f drip zone e.xcavate dandrestored ? / Gradin g So dan dVegetatio n Ye s N o 1 .

Doe s th e grading aroundth e perimete r o

f th e hous e i n excavatedarea s generall y slop e awa y 

# y fro mthe house ? 2 .Has sodbee n laidi n all area s tha t wer e excavated ? 

# y 3 .

Doe s the sodappea r t

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

y tim e period) 

# y 4 .

Ar e soddedarea s generall y firmandevenl y graded ? 

# y 5 .Ar e die joint s betwee n tlie sodstrip s generall y tight ? (Onl y evaluat e i

f inspecte da t a3 0 da y 

# X tim e period) 6 . Wa s the propert y gradedsuc 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 aa dRetainin g Wall s Ye s N o 1 .

D o gate s ope n andclos e freely ? (I f apphcable ) 

# y 2 .

Wer e all gale s o r fence s taken dow n durin g restoratio n activitie s reinstalled ? (I f applicable ) 

## y ^ Wa s damag e t o gate s or fence s avoided ? (I f applicable ) 

# y 4 .Was damag e to retainin g wall s avoided ? (I f applicable ) 

# y Foundation , Sidin g an dGutter s Ye s N o Wa s daniag e t o the siding o r trimavoided ? 

# y ^ 2 .Wa s daniag e t o the foundation avoided ? 

# y 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 ? 

# y^ 5 .Wa s daniag e lo downspout s or downspou t extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 .

Wa s damag e t o diivewa v surface s avoided'?* 2 .Wa s damag e t o walkwa y surface s avoided ?

## Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e Qo^- ^ __Date ; lZ['\\\t >

# ra CHNOLOGIES , INC , 

### A S - BUIL T DRAWIN G OL S #2802 9 Dat e Excavated : 10/18/201 0 

### OMAH A LEA D SUPERFUN D SIT E ISEPASigned-OfTDate : Omah a Lea d Sit e Exterio rPain t 

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### D Time : P M 

### D Staff : MS>* / Numbe ro f Sample s = I Legend : F 1 = Fron t Left , F 2 = Fron t Right , B l = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al [ quadrant s ar e a s viewe d fro m th e street , facin g propert y • 'I— * » i S « 

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# .&.8ftNT.5r ; Rev2U«i.B L Creaio d 16-Mir>Jl 8 E A = 28 3 PP M fl SCRAP E (-1 ' CONTRAC T # : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC .I 

# SEP A Propert yCompletio n Agreemen t Thi s agreemen t docinnent s the completio n of remova l activitie s performedo n th e belo w listedpropert)' . Th e propeil y owner's signature indicate s tha t the propert y owne r i s satisfie dwit hthe restoratio n o f the subjec t propeity , an dtha t no item s ar e i n question , now , o r a

t an y tim e i n th e future , excludin g an y remainin g warrant y (3 0 day s total ) except thos e item s listedbelow , i f any . Propert yID : Propert yAddress : .>^ l / • . /; . i • 1 / Owner : f . •• / / . ./,• • Phone : '/<• / v'/ V '/.>'/ / Restoratio n Item s i n Question :

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

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



## ^y y 

# A i iZi l Owner' s Signati i r e 

### Dat ePnident Technologies , Inc . (Prudent ) Is unde rcontrac t wit h Ih e U,S. Envlionmenla l Protectio n Agenc y(ilPA ) lo clea n up Icad contaminalci i soil s at a numbe rof properties locatedin Omalia , Nebraska , includin g th e propert ylocated al ixdl h G^^ A J SPt-<' r. Th e EP Arequest s you rpennissio n to allowPruden t to perrorm a soi l cleanu p at thi s propert ylo remov e lead-conlaminaled soil . Bysignin g Ihi s form , tii cpropert yowne rgrant s permissio n to Pruden t to perform activitie s related lo th e cleanu p includin g soi l sampling , remova l oflead-conlaminate d soil , and restoratio n of th e rerercnce d properly . iryo u hav e an yquestion s abou t th e soi l cleanu p planne d fo ryou rproperty , pleas e contac t Pruden t sout h offic e .ForIh e Omaha Lea d Site cleanup-a t (402 ) 733-1188 . Genera l question s abou t th e Omah a Lea d Site cleanu p co n be directe d to th e EP APubli c Informatio n Center s al (402 ) 73 1 -304 5 (Sout h Omaha ofTice )or(402 ) 99 1 -958 3 (Nort h Omaha oiTice) . Propert yAcces s Granted By : A/'i/l:A-r* \ LMAJI J (Pleas e Prin t Name ) Propert yOwne rSignat u S'-O t / -J0( O V t > (Signature) Sien a (Date ) PROPERT Y INFORMATIO N (T o be complete d byresiden t and/o rproperl yowne r~ pleas e print ) RESIDEN T NAME : Owne r Rente r T ADDRESS ^ ^ RESIDEN / \ 

# 2y,i % ^a ^ "yr IF RENTAL , PROPERT Y OWNE D BY : OWNER' S MAILIN G ADDRESS ; OWNER' S TELEPHON E NUMBE R - HOME : J L WORK : AG E OF HOME? : YEARS . HOW LON G HAV E YO U LIVE D HERE ? YEARS . HA S TH E EXTERIO R BEE N PAINTE DOR COVERE D WIT H SIDIN G SINC E 1978 7 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 OF 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 : COMMENT S OR SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTRY GATES , ETC. )

AUTHORIT Y FO R ENVIRONMENTA L RESPONS E ACTIONS i Th e activitie s lo be implemcnlc d byEP Aunde rIhi s agreemen t ar

cpursuan tlo Sectio n 10 4 of CERCLA , 42 U.S.C . 9604 . EPA' s righ t of acces slo Ih e propert y is provide d fo r in Sectio n 104(e ) of CERCLA , 42 U.S . C 960S(e) , whic h provides entr yfo r"determinin g lh e nee d fo rresponse ,orchoosin g ortakin g an yrespons e actio n unde rihi s title , orotherwise enlbrcin g th e provision s of th e title. " 808 0 War d Parkway , Suit e 40 6 5600 S 10 St 424 2 Medica l Drive , Suit e 425 0 Kansa s City , MO 6411 4 Omaha , Nebrask a 6810 7 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)733-118 8 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)733-188 3 Fax : (210 ) 579-657 7

# ^^Qg. 9 Exterio rPain t Noit h Arro w 

### Omah a Lea d Sit e • Goo d 

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## 25 u pp m 

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### CONSTRUCTIO N 

## mc . SOLUTION S 

## SIT E SAFET Y HAZAR D ANALYSI S Addres s 

# , 2,fc/ V <ryr.Jh/y Excavatio n Date : Crew : Backfil l Date :

Ite m Conditio n Hazard s Correctiv e Actio n Overhea dLine s c^ ^ Ga s Lin e e ^ Wate r Lin e 

# h^ ^ \ J 

## Sewe r Lin e Septic/Leec h Fiel d Propane/Butan e ' — 

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## Structure s tr ^ 

## Driveway 

# o* — Sprinkle r Syste m Othe r ^ 

## Cre w Forema n Sit e Safet y Offic e Date :

»OWai«f«>rtMay . Suit e 4d S I S los t 424 2 Medica l Driva , Suit a 725 0 OmdAa rtMmM a tt107 Sa n Antonio , T X 7822 9 taoK(8«t ) 3^<370 3 Pliona : (402)733-118 8 Phone : (210 ) 822-468 8 D

C fStt ) 363>370 7 Fax : (4<ia)73»488 3 Fax : (210 ) W»<67 7x' J

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