## PROPERT Y SUMMAR Y SHEE T Omah aLea dSit e Remedia l Actio nContrac t #EP-S7-10-0 5 Said : 1028 3 Propert y Address : 454 1 S 1 8 St . 

## Executiv e Summary :
• Issue s Encountered : Non e
• Issue s Resolved : Non e
• Uniqu e Findings : Non e
• Othe rRelevan t Information : Non e o CONFIRMATIO N SAIVIPLIN G DATA/RESULTS : B l = 12 4 PP M @ 13" ; E A= 8 3 PP M @ SCRAP E Attachments : Document s Include d i n th e Propert yFile : Yes N o N/ A Propert ysketc h provide d byEP Apursuan t t o contrac t specification s V ont o adjacen t propertie s Signe d Acces s Agreement ; includin g acces s agreement s obtaine d (i f required ) fo rcrossin g V Pre-excavatio n agreemen t detail s (i f an yar e mad e wit h th e Propert yowner ) V Pre-Excavatio n digita l vide o cli p V Samplin g dat a shee t V Post-Excavatio n digita l vide o cli p V Documentatio n - Complete d EP Aclose-ou t checklis t V As-Buil t sketc h V Omah a Lead Sit e Databas e sampl e informatio n document . V Signe d for m verifyin g satisfactoryrestoratio n V Othe rDocuments : 3 0 daySO D warrant ypicture s V Utilit yclearance s documen t V Propert yinformatio n fro m Dougla s Count yAssessor' s office . V Settlemen t document s (i.e . fo ran ydamages , replacemen t o f plants , etc. ) V Sit e safet yhazar d analysi s documen t wit h pictures . V Legend : Yes - Include d i n th e File ; N o - No t include d i n th e File ; N/ A- Doe s no t Apply . Pruden t Representative : (U^.-JIUAJUIAA-'^'-*' ^ EP AAcceptance : zJtf^^'^ ' Date : Date : 3/"2.1 / I 2 _


### Pruden t Technologies , Inc . j 250 5 N. 24TH Street , Suit e 30 8 [Omaha , N E6811 0 US A| Tel . 402.504.100 4 | Fax : 402.504.100 5 Environmenta l Engineerin g & Service s | Remediatio n| Constructio nk iM-'^Kcin^>>:M4Ha']»^!ib;nr2 < •.*-<Mrt'*M'»^i»Visi»e'S'h-iV*'l'Vj-i«i;;4*rfi.'.<.V,;. , 

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# in 11 10283 Exterio rPain l Nort h Arro w| i Owne rName : JAC KMCiMTiR E Omah a Lea d Sit e 

## 1 [vfCoo d Acidress : 454 1 S 18 STSit e Sketc h 

# ^- ^ 

# 1 Phone : H: 402-391-2598 W: j • No t paint Sampl e Numbe r Lea d Sampl e LA B Sample s Collecte Collecte d d Concentratio n Collecte d Firm : 

# s RYASCPXA-1028 3 Fl 

## ZO O pp m 

## D Date : 

## i^h^ h s RYBSCPXA-1028 3 F2 

## iZ O pp m 

## D Time : (.'3 0 RYCSCPXA-1028 3 B1 

## 39 6 pp m 

## D Sample s Analyze d RYDSCPXA-1028 3 B2 

## 3*? / pp m RDZSCPXA-1028 3 DZ 

## 33f pp m 

# n XR F Unit : 

### /(?5 7 Book : lH- 3 nCZSGPX. A1028 3 & ? pp m 

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## D Date : _ 

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## D D Time : 

## P ^ D Staff : 

## MA . Numbe r of Sample s • 

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Item : Item : item : Item : Item : item : Requirec t correction s t o complet e tli e property :

agre e restoratipr > i s completed . I I d o no t aigre e restoratio n i s complete d at (note d deficiencie s above ) 

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### Pag e Iof 2 "> Cieat e Anotfie rTidte t 

### Bacf c to hrt hlitfeme t Sen dEmai l J] YOU RTICKE T NUMBE R IS 2766036 . -ry ^ Origina l Cal l Date: : 6/09/1 1 Time : 8:5 2 am Op : SIVA1896 7 Wor kto Begi n Date: . 6/13/1 1 Time : 9:1 5 am

•* • :••' . UGLA S S Address : 454 1 Street : S 18T HST State : NE County : DOUGLA Place : OMAH A Twp : 14 NRng : 13 E Sect-Qtr : 03-NW-S W Twp : Rng : Sect-Qtr : Lega l Given : C '" ^ - • ''• ' Typ e of Work : lea d soi l remediatio n project Locatio n o i Work : LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (4021733-188 3 : UNSUR E CORNER S •'.• • - *% a Compan y: PRUDEN T TECHNOLOGIE S Contact Name : SIV AJAMPAM A Phone : (402)733-118 8 Wor k Bein g Don e For : EP A•• , " '/. , Dept h of Excavation : 6 ft Corne r Lot : NFront : Y Rear : Involve s Tunnelin gor Horizonta l Borin g ; NExplosives : N CXCAT V DIGITE L LEVEL 3 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 , IN C HEID I 

### Ah : 402934046 9 Emerg : 402932975 7 Day : 855742606 2 niniTP i LIGHTCOR EACENTURYLIN K .. . 

### Alt : 800850904 8 UIOIIb LCOMPAN Y ^ ^ 

### Emerg : 855742606 2 Day : 877366834 4 LEVEL 3 COMMUNICATIONS , LEVEL S 

### NA Alt : LL C

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### Emerg : 877366834 4 Day : 402504782 3 METROPOLITA NUTILITIE S MUD0 2 

### SAND Y Alt : DISTRIC T 

### Emerg : 402504797 0 http://www.dhon.org/irthinternet/DHONNoticeCreation/Messag,eText.asp?ret-<RESULTS. . . 6/9/201 1

### Pag e 2 o f 2
CITYOFOMAHA - OMAHACO F TRAFFICSEWE R OMAH APUBLI C POWER OPPDGPR 6 DISTRIC T
PAETE C PAETE C COMMUNICATION S QLNN E1 FQWES T LOCA LNETWOR K RICH/TRAFFI C


### EL M LOCATIN G
N O NEE D T O CAL L OU T EMERGENC Y
ELM LOCATIN G 

### Day : 402444719 7 Alt : 402444672 5 Emerg : 402444516 0 Day : 406728934 3 Alt : 406207149 4 Einerg : 888728934 3 Day : 800289190 1 Alt : Emerg : 800289190 1 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

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### http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 6/9/201 1

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