## TRANSMITTA L o f OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : I^H v Date : /2-/^J
- Jl^o i Address : 1 7 2. o j l S / 3 s f Remediatio n Contractor : /vo^.'/~'7^.i.u.<^j. y . ^intL . Year : 2L£>O S 

## SOI L REMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S
^ Vide o o f propert y (DVD ) M Executiv e Summar y aEPA-provide dpropert y sketch aSignedAcces s Agreemen t fo r

subject propert y D SignedAcces s Agreement(s ) for.adjacen t propert y ^ Restoratio n Agreemen t H Settlemen t document s (i.e. , fo r

damag e or t o replac e plants , etc. ) mConfirmation data s f

Photograph s 0

^ As-built sketch aSatisfactor y restoratio n signedb y Propert y Owne r H Propert y close-out chec k

lis t signedb y EP A D Descriptio n o f area s no t meeting ROD cleanu p criteri a 0 ' Utilit y clearance s 0 ^ Propert y infonnatio n fromDougla s Count y Assessor' s Ofific e D D 

## ni l 4030953 6 

# i

• Superfun d 

## ignatur ^ Si m 

## Dat e

### PROPERT Y SUMMAR Y Date : 12/20/200 8 Omah aLeadSite Remedial Actio n Contrac t #EP-R7-07-06/0004 Monf t of : Nov/Dec , Propert y Address ; 1720 % S 1 3 S T A . EXECUTIV E SUMMAR Y A. 1 Issue s Encouitered : NON E A. 2 Issue s Resolved : NON E A- 3 Uniqu e Findmgs : NON E A. 4 Olhe r Relevan t Information : NON E CONFIRMATIO N SAMPLIN G DATA/RESULTS ; D Z = 80 7 PP M @ 13" ; B l = 3 0 PP M @ 12" ; B 2 = 129 PP M @ 12" ; N O EASEMENT ATTACHMENT S 1 ) Propert y sketch provide db y EP A pursuan t t o contrac t specification s 2 ) SignedAcces s Agreemen t including acces s agreement s require dfo r crossing othe r propertie s 3 ) Pre-Excavatio n 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-Buil t sketch
i ) Shall include final lea dlevel s v ) Legen d ii ) Contamination lef t behindarea 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 includedi n th e individua l propert y file, i f available , or obtainedinclude : i ) Pre-excavatio n agreemen t detail s (i f an y ar e made wit h th 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 ) or SW F(Flas h Player) forma t and/or photograph s iv ) Signedfor mverifying satisfactor y restoratio n v ) Descriptio n o f area s no t meeting InterimROD cleanu p criteria .

TECHNOLOCIES , INC .Fin d Recor d Clea n U p Query Lea d Remainin g QueryI Propert yDamag e Query 

### Backfill :

Sampl e Area : 1919 0 ­ 172 0 1/ 2 S 1 3 S T Owner : Resident : Contract :
n Owne rOccupie d Owne rName : |HOLOC H JENNIFE R L Owne rAddressl : Owne rAddress2 : |171 6 S 1 3 S T City : [OMAH A Owne rPhone : State : Zi p Code : |N E |6810 8 Alternat e Phone : 

# 1 1 Residen t Name : 

# r Propert yAddress : 

### 1172 0 1/ 2 S 1 3 S T Zi

p Code : [6810 8 Residen t Phon e |(402 ) 490-300 8 Contractor : |PRUDErJT2008_S Group : Assessment : Qualifyin g Grou p |80 0 Assessmen t XR F Date : 

# r" ­ 

# " ~ Assessmen t MaxXR F Value : I 111 0

### TECHNOLOGIES ^ IN C 

# dEFV V EP A Propert y Clos e Ou t Propert y # : I'jI'i o Propert y Address : H^ * /i- 5 2J > ^ ^ Date/Time : Owner' s Name : Quad s Excavated : F^ ^ li' j B'^,D2
- Contracto r Grou p Pruden t Technologie s Excavatio n Genera l Ye s No 1 .I f necessary , wer e th e correct quadrant(s ) excavatedan drestored ? / 

### 2 .

I f necessary , wer e th e correc t area s of dri p zon e excavatedan drestored ? / 

### Gradin g Sodan dVegetatio n Ye s N o 1 .Doe s the grading aroundth e perimete r ofth e hous e in excavatedarea s generall y slop e awa y fromthe house ? / 

### 2 .Ha s so dbeen lai din al l area s tha t wer e excavated ? 

# y 3 .

Doe s the so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e if inspecteda t a3 0 da

y tim e period) / 

### 4 .

Ar e soddedarea s generall y fir man devenl y graded ? / 

### 5 .Ar e th e joint s betwee n th e sodstrip s generall y tight ? (Onl y evaluat e i f inspecteda t a3 0 da y tim e period ) / 

### 6 .Wa s th e propert y gradedsuc h tha t wate r will no t poo l o n th e property ? 

# y 7 . Was damage t o landscaping 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 n an dclos e freely? (If applicable ) / 

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

# y 3 .

Was damage t o gate s o r fence s avoided ? (If applicable ) / 

### 4 .

Wa s damage to 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 the siding or trimavoided ? 

## y 2 .Was damage to th e foundation avoided ? 

# y 3 .

Was damag e t o window s avoided ? / 

### 4 .

Was damag e t o window s or doo r screen s avoided ? / 

### 5 .Wa s damage to downspouts o r downspou t extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Wa s damage to drivewa y surfece s avoided ? / 

### 2 . Was damage t o walkwa y surface s avoided ? 

# y

## Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complet e including th e 30-da y so dwarranty : EP A Representativ e Qr, ^ Mr ^ Date : ///v/^f >

# &EFA Propert yCompletio n Agreemen t Thi s agreemen t documents tiie completio n o f remova l activitie s perfonne don th e belo w listedproperty . The propert y owner' s signatur e indicate s tha t th e propert y owne r i s satisfiedwit h th e restoratio n o f th e subject property , an dtha t n o item s ar e i n question , now , or a

t an y time i n th e fiiture, excluding an y remaining warrant y (3 0 day s total ) except thos e item s liste dbelow , ifany . Propert y ID : Proper ^ Address : /v^. ^ A , 5 a^* ^ .5 ^ Owner : ^^ ^ iXr>[oc)c ^ " • . [Phone ; ^O'X.^ul'^ o ­ 2 Q- Q B 

### Riestoratio h Item s i n Questio n

Item : Item: . Kem : Item : Itenri : Item :

S^ l agre e restoratio n i s completed , excep t a s note d above . L J I d o no t agre e restoratio n i s complete d



# I M OCK^J > / Q 

### /^d/tTX > 

# /Of/\/V ­

Owner' s Signatur e Dat ePruden t Technologies , Inc . (Pnident ) is unde r contrac t wit h the U S Environmenta l Protectio n Agenc y (EPA ) to clea n up lead
contaminate dsoil s at

anumbe r ofpropertie s locate d in Omaha , Nebraska, includin g th e propert y locate d at Th

e EP A requests you r permissio n to allo w Pruden t to perfor masoil cleanu p

at

thi s propert y

to remov e lead-contaminate dsoil .By signin g thi s form , the propert y owne r grants permissio n

to Pruden t to perfor m activitie s relate d to the cleanu p includin g soi l sampling , remova l of

lead-contaminate dsoil , an drestoration ofth e reference dproperty . If

yo

u hav e an y question s abou t th

e soi l cleanu p planne dfo r you r property , pleas e contac t Prudent' s Administrativ e Cler k

fb

r the Omah aLea dSit e cleanup . Ms . Madhurim aDur u -a t (402) 733-1188 , 733-1455 . Genera l question s abou t the Omah aLea dSit e cleanu p ca n

be directe d

to the EP A Publi c Informatio n Centers at

(402) 731-3045 (Sout h Omah aoffice ) or (402) 991-958 3 (Nort h Omah aoffice ) Propert y Acces s Grante d 

# By A =^Hk h 

# AW x=>c- H

, 1 ^i'leas e f nmName ; Propert y Owne r Sig i 

## U^: ^ ( \'(Signature ) (Date ) PROPERTY INFORMATIO N (T o brtomplete I implete d d by resident and/o r property owne r ~ plea§ e print ) RESIDEN T NAME : Owne r Rente r RESIDEN T ADDRESS : 

## 11P D 

# ^' S ITS ^ S t d^t^^A ^ i3^_Q%^^ ^ IF RENTAL , PROPERT Y OWNED BY : LJtLj T OWNER' S MAILIN G ADDRESS ; 

# Au ^ c : o fr^^aJL^vMe

_ ^ / 3 OWNER' S TELEPHON E NUMBER-HOME : r) WORK :
AG E OF HOME? : I tT V ' YEARS . HO W LON G HAV E YO U LIVE D HERE ? YEARS . HA S TH E EXTERIO R BEE N PAINTE D OR COVERE D WIT H SIDIN G SINC E 1978? CVE S "NC r 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 CHILDREN 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 , ENTR Y GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA L RESPONSE ACTIONS : Th e activitie s to be implemente d by EP A unde r thi s agreemen t ar

e pursuan t to Sectio n 10 4 ofCERCLA , 42 U S C. 960 4 EPA' s nght of

acces s to the propert y is provide dfo r in Sectio n 104(e )of CERCLA, 42 U S. C 9605(e) , whic h provide s entr y fo r "determinin g th e nee dfo r response ,or choosin g or

takin g an y respons e actio n unde r thi s title ,or otherwis e enforcin g th e provision s ofth e titl 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 , MO 6411 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 7OLS# : 1919 0 Dat e Excavated : 9/18/200 8 Dat e USEP A SigMd-Off : 1919 0 Omah a Lea d SIt a Extono rP*m t Nort i AmMr Sit e Sketc h • Goo d • Poo r Samplin g Addrasi : l720_i/ 2 S 1 3 S T Q No t pein t Sampl e Numbe r RYASCPXA-1819 0 F 1 RYa8CPXA-1918 0 F 2 RYCSCPXA.1919 0 B l RYDSCPXArlflI M B 2 RDZSCPXA-19ie O D Z RoggepxA-iBiM—e e ^La b RYBSCPLA-1919 0 "Resul t 552pp m . Lea d Sampl e Concenlratio n Collecte d

3G> C on m
&67 . .pp f 2/^ / co m 

# • Numbe ro f Sample s = [ g " LA B 

## D t r 

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# C D Sample s Collecte d Firm - FPf t F^.Oj i Dale . SU»loft ' Tune . U'.< » ptf t Sample s Analyze d XRFUn« : G6H O Book : 20 1

Dale : C-/2-O Q Time : P/ ^ Staff : AISK " Legend ' h i = Fron t Lett , F 2 = Fron t Right , B l ' Bac k Left , B 2 • > Bac k Rioh t D Z = Dn p Zone , G Z = Ganlen , P Z = Pla y Al l qu a I tbtet , hct i J pvpert y

kev ! .TiMi d 3I4*C« 7 N O EASEMEN T

CONTRA a # : E P - R7-07-0 6 / 000 4 PRUDEN T TECHNOLOGIES , IN C

### ECHNOLOGEES , INC . 

# n Propert y Statu s For m Address : V/.* > '/^^ S |^V V %\ ^ Date : Phone : BVID : Plant s & Permanen t Landscapin g Item # On Ma p Description andLocatio n A l l fU

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## Pre-Existin g Conditio n o f

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Propert y Owne r Pruden t Empl Signature : ignature^^^^^^^ ^ WDVQCV^ J 

# ^ \ A 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 4*250 Kansa s City , 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 : (402)504-100 5 Fax:(210)579-657 7

# 19190 Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e • Goo d 

### Sit e Sketc h • Poo r Samplin g Address : 172 0 1/ 2 S 1 3 S T [ 2 No t pain t Sampl e Numbe r Lea d Concentratio n Firm : Sample s Collecte d FPf t Ffe.O R RYASCPXA-1919 0 F l Date : 5\2 > \C) ^ RYBSCPXA-1919 0 F 2 Time : U'-d O pt A RYCSCPXA-1919 0 B 1 RYDSCPXA-1919 0 B 2 Sample s Analyze d RD2SCPXA-1919 0 D 2 XR F Unit : 6i6H O Book : 20" ? RQ2SCPXA-1919 0 -« 2 

### Date : g-/2-Q 9 Time : P n La b RYBSCPLA-1919 0 _s Resul t 55 2 pp m Numbe ro f Sample s Staff : h^ W Legena : h i = 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 = Play Al l quadracfeMir e a < wieiofr t frn m tt ystreet , facin g propert y

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## • YOURTICKE T NUMBE RI S 2132385 . Origina l Cal l Date : 9/16/0 8 Time : 10:5 8 a m Op : RAMITA1896 7 Wor k t o Begi n Date : 9/18/0 8 Time : 11:3 0 a m State : N E County : DOUGLA S Place : OMAH A Address : 172 0 Street : S 13T H S T Twp : 15 NRng : 13 E Sect-Qtr : 27-NE-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATIO NPROJEC T FO R SOI L Locatio n o f Work : , ACTUA L PROPERT Y T O B E EXCAVATE D I S 172 0 1/ 2 S 13T H S T : 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 : RAMIT A Phone : (402)733-145 5 Alt . Contact : 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 : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N ATTNEBR l CXCAT V LEVEL S MCINE B MCLEODN E MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F QWEST 2
Utilit y

Servic e Are a Contac t Phon e Nunibe r Typ e 

## Day : 8002413624 9 ATTNEBR l ATT/ T 

## Ah : Emerg : 8002413624 9 Day : 402934046 9 CO X COMMUNICATIONS , CXCAT V HEID I 

### Ah : 402934046 9 IN C 

### Emerg : 402932975 7 

## Day:^ 877366834 4 LEVEL S COMMUNICATIONS , LEVEL 3 

### N A 

## Alt : LL C 

## Emerg : 877366834 4 Day : 800289342 7 

## W? i http://www.dhon.org/irthinternet/DHONNoticeCreation/MessageText.aSp?ret=<RESULTS.. . 9/16/200 8

## Pag e 2 of 2

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MUD0 2 METROPOLITA N UTILITIE S DISTRIC T

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QLNNEI FQWES T LOCA L NETWOR K
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SAND Y



### RO N

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## Ah : Emerg : 8002893427 Day : 800289190 1 Ah : 

## Emerg : 800289190 1 Day : 402504782 3 Ah : Emerg : 402504794 6 Day : 402444719 7 Ah : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 Ah : 888728934 3 Emerg : 406728934 3 Day : 406728934 3 Ah : Emerg : 888728934 3 Day : 800283423 7 Ah : 303992192 6 Emerg : 800283423 7

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# 5? r http://www.dhon.org/irthinternel/DHONNoticeCreation/MessageText.a2p?ret=<RESULTS.. . 9/16/200 8