### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 4897 5 DATE : 12/15/201 0 ADDRESS : 4755 S 1 8 S T REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES . INC . YEAR : 201 0 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S H^PR E AN D POS TVIDE O O F PORPERT Y(DVD ) Q/EXECUTIV E SUMMAR Y &^EPA-PROVIDE D PROPERT YSKETC H -Q^IGNE D ACCES S AGREEMEN TFO R SUBJEC TPROPERT Y ASIGNE D ACCESS AGREEMENT(S ) FO R ADJACEN TPROPERT Y 13^EST0RATI0 N AGREEMEN T D SETTLEMEN TDOCUMENT S (I.E. , FO R DAMAG E O R T O REPLAC E PLANTS , ETC. )

• CONFIRMATIO N DAT A Q/'PHOTOGRAPH S "^D-^/OLA- > SO< ^ Q^S-B U I L TSKETC H B^TISFAAORYRESTORATIO N SIGNE D B YPROPERT YOWNE R

• PROPERTYCLOSE-OUTCHEC KLIS TSIGNE D BYEP A

• DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A H^TILIT YCLEARANCE S n PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E

' 3026284 5 

# • • Superfun d

DATEFin d Record Remediatio n Quer y Lea d Remainin g Quer y] Propert yDamag e Quer y 

### Backfill :

Sampl e Area : 4897 5 ­ 475 5 S 1 8 S T Owner : Use rProvide d Owne rInformatio n Resident :

• Owne rOccupie d Owne rName : Owne rName : Residen t Name : JiNIESTRAVALENTI N 0 JINIESTR AVALENTIN O Owne rAddressl : Owne rAddress : Propert yAddress :

1 14755 S 1 8 S T Owne rAddress2 : Zi p Code : !475 5 S 1 8 S T J68107 - City : State : Zi p Code : City : State : Zi p Code : Residen t Phon e [oMAH A |N E J68107 ­ 

# 1 1 Owne rPhon e 

### A l ternat e Phone : Owne rPhone : Alternate Phone : 1(402 ) 991-057 8 1 ! ] • ^ Contract : Assessment : Contractor : |PRUDENT2010_S Qualifyin g Grou p |PRIORrT Y Contract Optio n JOPTIO N 2 Assessmen t Ma xXR F Valu e | 

### 41 3

### PROPERT Y SUMMAR Y Date : 12/15/201 0 Oniah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Decembe r Propert y Address : 475 5 S 1 8 S 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 : /'^m A Ne^EXCAVATCD : yC(35'X50' ) = 31 1 PP M @ SCRi\P & G=>r>-(r\t^\t»^\Ot i Cef: TBcHlrv O D-Z./t.5 . Cl'^^ O = 163 5 pV" ^ @ 

### rp o IRe^^^- 3 , CONFIRMATIO N SAMPLIN GDATA/RESULTS : \y\t-s . 

### B l = 5 7 PP M @ 8" ; D Z= 43 1 PP M @ 13" ; E A = 7 4 PP M @ SCRAP E(-1" ) ATTACHMENT S 1 ) Property sketc hprovide dby EPA 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 digital vide o dip/photograph s 4 ) Post-Excavatio n digital 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 leadlevel s v ) Legen d ii ) Contaminatio n lef t behin darea s vi ) Contracto r identificatio n iii ) Property addres s vii ) Date iv ) BVI D numbe r 7 ) Othe r item s t o b e include di n th e individual property file, i f available , o r obtaine dinclude : i ) Pre-excavatio n agreemen t detail s (i f any ar e mad e wit hth e property owner ) ii ) Property Statu s For msigne dby property owne r iii ) Excavatio n digital vide o i n MPEG , WMV (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 .•

TECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y # : ^9-^ 7 5 Propert y Address : H*- ? ^ 5 f - ^ ^ "J f - Date/Time : Owner' s Name : 5 ^ ''-e'< ^ %'«<^« ^ Quad s Excavated : T) y S ) Contracto r Groop : Frwden t Techirnologies , Inc. , 

### Excavatio n Genera ! Ye s 1 .

I f necesscirv . wer e the correct qiiadiant(s ) e.xcavate dan drestored ? / 2 .

I f necessarv- . wer e th e correct area s o f drip zone e.xcavate dandrestored ? / Gradin g Sodan dVegetatio n Ye s 1 .

Doe s tlie grading aroundthe perimete r o

f the hous e in excavatedarea s generally slop e awa y / fro

miJi e house ? 2 .Has sodbee n laidi n cil l area s tha t wer e excavated ? / 3 .

Doe s iJi e sodappea r t

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

y lime period) / 4 .Ar e soddedarea s generall y fin nan devenl y graded ? / 5 .Ar c tlie joint s betwee n the sodstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 da y / lim e period) 6 . Wa s the propert y gradedsucl i llia t wate r wil l no t pool o n tlie property ? / 7 . Wa s damag e ( o landscaping o r plan t material s avoided ? / Gates , fence s an dRetainin g WaUs Ye s 1 . D o gate s ope n andclos e freely ? (I f appUcable ) 

# y 2 . Wer e all gate s o r fence s lal<:e n dow n dinin g restoratio nactivitie s reinstalled ? (I f apphcable ) / 3 . Wa s damag e t o gale s o r fence s avoided ? (I f applicable ) / 4 . Wa s damag e t o retaining wall s avoided ? (I f applicable ) / Foundation . Sidin g an dGutter s Ye s 

### 1 .

Wa s damag e t o the siding o r tri mavoided ? / 2 .

Wa s damag e t o the foundation avoided ? / 3 .

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

Wa s damag e t o window s o r doo r screen s avoided ? / 5 .Wa s damag e lo downspout s o r dowiispou t extension s avoided ? / Sidewalk s an dDriveway s (Concre<e ) Ye s Wa s damag e l o di'ivcway surface s avoided ? 

### N o

N

o

N

o

N o

N o 2 . Wa s damag e t o walkwa y surface s avoided ?

## Owner s commemts :

Inspectio n motes :

Remova l an drestoratio n activate s complet e includin g th e 30-da y sodwarranty : EP A Representativ e jQc^JL ^ ^Date: nj^ji^ ^rFINDECSCIES . INC . 

### A S - BUIL T DRAWIN G OL S #4897 5 Dat e Excavated : 10/19/201 0 

### OMAH A LEA D SUPERFUN D SIT E rSEPASigned-OffDate : 

### 4897 5 Exterio r Pain t titodf t Arro w Omah a Lea d Sit e Sit e Sketc h Owne rNamerVAiENTiN O INIESTR A • Goo d Addres8:4755Si8S T • Poo f Phone : H : 402-991-0578 W : 2 j No t paint Sampl e Numbe r Lea d Sampl e Sample s Collecte d IJVB Concentratio n Collecte d Firm : F tb A\ d S \ €v: T RYASCPXA-4897 5 F 1 

### 1^ 6

. pp m D Date : cf - -1 ^ r./- RY8SCPXA-4897 5 F 2 

# a " pp m 53 ' Time : -a , : '-!ct^>r»^ 

# /az . RYCSCPXA-4897 5 B 1 W' 3 pp m D E f Sample s /Analyzed RYDSCPXA-4897 5 8 2 -LU L pp m D RDZSCPXA-4897 5 D Z 7.3 ^ , pp m D XR F Ur.Jt : '^O Z Book : lO C 

## 0- RGilSCPX A 4807 6 G Z pp m D Date : ft^ - \l^O U RPZCCPX A4807 5 PS - pp m 

### D D Time : A H 

### D Staf f /MS W Numbe rof Sample s = 5~ Legend : F 1 = Fron t Lett . F 2 = Fron t Right , B 1 = Bac k Left , 8 2 = Bac k Righ t DZ = Dri p Zone , G Z = Garden , P Z = Pla y Al l quaijrant s ar e a s viewe d Inr rth e street , facin g propert y 

# ENTEEE D ^ \H 2S0 6

t/ y

CO^TA.MI^ATIO N LEF T BEHIN D PE RP.O . REQUEST : DZ/LS(rxr ) = 163 5 PP M - g SCRAP E(-1" )

CONTRAC T# : EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC .

# p RIDE N Prox:i(g)rt^ 7 CompEet8©[! i Aqir©®m®Eri ^ jj.'ftcf.vts . tji r 'ji'liipictsui'. ; Ol rfcl'j'jOVa i hO'CiVthc- b yci'iOnVie u Oi l i.uf ; DciCT v i.'.Sl&dp.ropeir v 

### Th e propern - owaev' s .iignatuj e f.ri.'jic.ate. s tha t th e propert y ov..'ne r i i ba^isfiedwit hih e festoratio no f th e siibjec f propert} - ari dthat ii o ite'-ni ;ire . i nquestion , now. , or a

l an} ' Urn e i n Th e fu^ire , excJudlin g any rer/iainni g waiTarit^ v (3 0 day s tola?. ) s.iicept thos e item s .li.?te dbeioi^ , if ajiy . Propert y ffi:: 

# AM.i.s:._ ^ Pr o pen t 

# ^^2^^!:..Jij!SK._.S-/^.^ ^ O'wil l SI T• • 

## ja/nc^l i 7 ! S:'<^ < r Q­ ^hn m 

# (HOI : 99 1 • 0^3J^__J m ^ / ^ -MS B Restof-^Hias': ! liiemi s 'ir s Qtaestion i Uteincii- ; Jten:^ ' 

## L_

llte,rr!. : 

# " H f lltemn' :

lltelTTii " Rs.qB.c!F&(i:f ! CG-rrsctiiojini s tr ; comiaileitp ; sirtis pTO'fos'rni)/ :

!J d i .^gre e lestoracio n i s compietefl , excep t a s note d above . i ! 1 a o r>o l acii-a e rsstoratio n i s ccmoistec ;


# ^OI^JLA^.,: ^ 

# ^7ir^ . 

# .J1-.U--IG L O-^vDeF' s Sigsiiiur e

# \o/i u

Pnide mTechnologies . Inc . (Prudent ) i s unde r contract , withth e U . S . EnvironraentaJ Protectio n Agenc y (EFA ) t o clean u p lead conumimale dsoil s ai^anumliett o f

propertie s locate di n Omalia , N ebraskx u includin g th e property locate da t ^r7^5 ^ < J 'a'* ' S f Th e EPA request.* ; you r permi,>;.'5io n t o allo w Pruden t t o perforr n aso U cleanu p a t thi. s propen y t o remov e lead-oontammate dsoil . B y signin g thi s form , th e property owne r grant s pennissio n t o Pruden t t o perfor m .activitie s relate dl o th e cleanu p includin g soi l sampling , remova l o f lead-contaminale dsoil , an drestoratio n oflh e reference dpropeny . U'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 Pruden t soutl i offic e for th e Omah aLead Site cleanup-a t (^02 ) 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 ) 73 1 -304 5 (SouthOmali aoffice ) or (402 ) 991-958 3 (NorthOmah aoffice) . Property Acces s (Jrante dB y ' • , (Pleas e Pri mName ) Property Owne r Signature : (Signature ) 

# •<v//A> ^ (Date ) PROPERT Y INFORMATIO N (T o b e co mpletc db y residen t and/o r proper1. y owne r —pleas e prinf) 

## RESIDEN TWAME : V Q \^V ^ V O Q - 1V^ ] ^S:\^(X3^ ^ « RESID I IDEN T ADDRESS : __ _ , I F RENTAL , PROPERT YOWNE D BY : 0WNER; S MAILIN G ADDKESS ; ^ c OWNER' S TELEPHON E NUMBE R - HOII/IE : (40^QQi ~ QS" 1 *£ > WORK : AG E O F HOfJIE? : YEARS . HO W LON G HAV E YO U LIVE D HERE ? YEARS . 

# h . HA S TH E EXTERIO R BEE N PAIfyiTE D O R COVERE D WIT H SIDIN G SINC E 1978? YE S 

# 7x^ ° NUMBER 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 

# 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 WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. ) AUTHORIT Y EO RENVIRONMENTA LRESPONS EACTIONS . Th e activitie s t o b e implemente dhy EPA unde r thi s agreemen t ar

e pursuan t l 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 dfo r i n Sectio n 104(e ) o f CERCLA , 4 2 U..S . C 9603(e) , whic hprovide s enU- y for "detenninin g th e nee dfor response , o r choosin g o r takin g an y respons e aclio n mider tlii s title , or otherwis e enforcin g th e provision s o f th e title. " SOS O ififarc S Pd i kwav . Stfir e -v;: : I'K-'^ t iY!';(!i--:a l Grivi; , Oiii w 425 0 t < a n sa s C ity , M O 6 < 1 1 • ( '•j.-r n Aniorijo . T X 7*22.' ! Pncne : t8t6 ) 36i-J70 ? '>'',V:,Vt- : -c-.:! ; TVS-'- ' i^."iii!; : i2i0 ) i';22-^>^f;l ^ j^ax . ;81S ; 3S3-:;70 7 C ' .' • . ' : H i

### '.'ONHTRt.icrroi' ^ 

### TECHNOLOGIES , INC . 

# Propert y Statu s For m Address : <^_5- ^ 5 " /^liv j Date : /o/> / jZOilJ i BVID : ^^^y ^ 

## Phone : HOZ-^IZ ^ ^^5 ? ^^T)/A L /U2^AS ' ^ { k^ ^ I ) I CL£nA ^ TZ ) €^cA^j<ir T^ > ^ 5- 6 b T^^^ f ^i-r6^' i TTct ^ uc/ > ^^ ^

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# ^xr^^^r i f ^ $" ^

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# A^( ; 

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# V

Pruden t E m Signature : /X ^ 3(!Sf i War d Par^WBv.rTijrr o ^'O. S 2 ;; ; IVieriica i Di'ivt vOtittf ! 4aEi: ) ,\ansa s Citv . M O eill- i tiari» . i^leorash.i i lifc'iO' i :-ar , Ariionw , T X 78ii a pnone ; fS-tfi t :5S3-:i70 " hr-tife : ;au2 , ri::-' - i-s a (0.i(;i . ­1 r^- ^ T-in ^

## 4897 5 Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e Owne rName : VALENTIN O INIESTR A n Goo d 

### Sit e Sketc h Address:4755Sl8S T • Poo r

Phone : H : 402-991-057 8 W : 2 ^ Not pain t Lea d Sampi e Sample s Collecte d Sampl e Numbe r l-A B Concentratio n Collecte d Firm : FCbf t \ R 5 \ CaiT " RYASCPXA-4897 5 F 1 n & pp m 

# n Date ; C c ; -ir. - g^ ^ RYBSCPXA-4897 5 F 2 

## /8 I pp m Time : "^z , : M c.. p ^^ RYCSCPXA-4897 5 B l pp m 

## Hi 2 Ef D Sample s Analyze d RYDSCPXA-4897 5 B 2 pp m 

# 1) 3 0 - D RD2SCPXA^897 5 D Z 

# -1231 . pp m 

## 0 - D XR F Unit : ^Q Z Book : JO U RGZSCrX A4807 6 G Z pp m 

## D Date : Tp " \{^-OC P 

# n pp m 

## D Time : La b RYBSCPLA-4897 5 

### A J ^ "Resul t Staff : 190pp m Numbe ro f Sample s • P T 

# Ms w Legend : F l = 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 l quadrant s are as viewe d fro m th e street , facin g property

Re

v 4 046141.012 3

### Pag e 1 o f 1

lULY200 3 - DOUGLA S COUNT YASSESS O 

# ^7^- ^ S / T ^- h

http://douglasne.mapping-online.com/assessdoc/Photos/33/R l 728210000000 1 A.jp g 10/5/201 0

## K 

# Lega l Description : 4 5 x 13 0 

# A SI S * 

### Printed : Oc t 12.201 0 vvww.dcgis.org/dogi sPag e 1 of 2

" > Create Anothe rTicke t Bac k to Irt h Internet Sen d Emai l YOU RTICKE T NUMBE RI S 2614390 . Origina l Cal l Date : 10/11/1 0 Time : 4:2 7 p m Op : SIVA1B96 7 Wor k t o Begi n Date : 10/14/1 0 Time : 7:1 5 am State : N E County : DOUGLA S Place : OMAH A Address : 475 5 Street : S 18T H S T Twp : 14 NRng : 13 E Sect-Qtr : 03-NW-S W 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 PROPERT Y Remarks : FA X AL L CLEAR S TO : ( 4 02)733-188 3 : UNSUR E CORNER S Compan y: PRUDEN T TECHNOLOGIE S Contac t Name : SIV AJAMPAMA 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 : NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : N.Explosives : N CXCAT V DIGITE L LEVEL S MUD0 2 OMAHACO F 0PPDGPR 6 PAETE C QLNNEI F Utilit y

Servic e Are a Contac t Phon e Numbe r Typ e Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , INC HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 866562434 9 LIGHTCOREA CENTURYLIN K DIGITEL N A Alt : 800850904 8 COMPAN Y Emerg : 866562434 9 Day : 877366834 4 LEVEL S COMMUNICATIONS , LEVEL S N A Alt : LL C Emerg : 877366834 4 Day : 402504782 3 METROPOLITA N UTILITIE S MUD0 2 SAND Y Alt : DISTRIC T Emerg : 402504797 0 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 10/11/201 0

### Pag e 2 of 2

CIT Y O FOMAHA - OMAHACO F TRAFFICSEWE R OMAH A PUBLI C POWE R 0PPDGPR 6 DISTRIC T
PAETE C PAETE C COMMUNICATION S QLNNEI FQWES T LOCALNETWOR K RICH/TRAFFI C

ELM LOCATIN G
N O NEE D T O CALLOU T EMERGENC Y
EL M LOCATIN G 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 800289190 1 Alt : Emerg : 800289190 1 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

http://'www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 10/11/201 0

### SOLUTION S 

## SIT ESAFfeT Y HAZAR D ANALYSI S 

# Address : —l^-^^-JA^t . Excavatio n Date : -Lo]!3\^^: , Crew : Backfi U Date : '^11MJ± .



## Ite m Overhea 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 < ^ ^ 

# e ^ ^ ^ ' 

# Jt 7

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# orc a/' ^

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## pc£ ^ c?f ^ dp^ ^ 

# o*

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## Hazard s Correctiv e Actio n U C (= • fp ire^ ^



## Sit e Safet y Offic e Date :

> Vtfanf-1?artaBay . Sut e 44 K 550 0 S 1 0 S t 424 2 Medica l Drive , Suit e 725 0 iGay;uafi4ii 4 Oiii^dia r Netan^k a6810 7 Sa n Antonio , T X 7822 9 Hon g (816 ) 3gj.37n 3 Fliene : (402 ) 733-118 8 Phone : {2t0 ) 822-358 8 ax : (SW ) 363^370 7 Fax : (4ia2 ) 733^188 3 Fax : (210 ) 579-657 7

# H75 5 5l8'^S r

wI ff 

# j l i ^ IZoi o