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### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 2956 2 DATE : 1/1 5 ADDRESS : 421 9 BINNE YS T REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES . INC . YEAR : 201( ^ 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S H PR E AN D POS TVIDE O O F PORPERT Y(DVD ) d EXECUTIV E SUMMAR Y

EPA-PROVIDE D PROPERT YSKETCH d SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN TPROPERT Y o f RESTORATIO N AGREEMEN T n SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R T O REPLAC E PLANTS , ETC. ) d CONFIRMATIO N DAT A \f i PHOTOGRAPH S d AS-BUIL TSKETCH d SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R d PROPERT YCLOSE-OU TCHECKLIS TSIGNE D B YEP A D DESCRIPTIO N O F AREA S NOTMEETIN G RO D CLEANU P CRITERI A m UTILIT YCLEARANCE S 11 1 PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E D D D ^ j ^ i\t'V ' SIGNATUR E DAT E

### 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 ; 421 9 BINNE Y 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 : NON E CONFIRMATIO NSAMPLIN GDATA/RESULTS : F 2 = 17 7 PP M @ 6" ; 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-Bui hsketch 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 dinth e individua l property file, i f available , o r obtaine dinclude : i ) Pre-excavatio nagreement detail s (ifan y ar e mad e withth 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 ) forma t and/o r photograph s iv ) Signe dfor mverifyin g satisfactory restoratio n v ) Descriptiono f area s no t meetin g Interi mRO D cleanu p criteria .

ECHNOLOGIES . INC .Fin d Record Remediatio n Quer yLea d Remainin g QueryPropert yDamag e Quer y 

### Backfill :

Sampl e Area : 2956 2 - 421 9 BINNE YS T Owner :

• Owne rOccupie d Owne rName : FLEMIN G MARSHAL Owne rAddressl : Owne rAddress2 : 421 7 BINNE YS T City : State : ZipCode : lOMAH A N E 68111 - Owne rPhon e Alternat e Phone : (402 ) 453-695 9 (402 ) 422-399 9

Contract : Contractor : PRUDENT2010_ S Contrac t Optio n lOPTlO N 1 Use rProvide d Owne rInformatio n Resident : Owne rName : Residen t Name : Owne rAddress : Propert yAddress : 421 9 BINNE YST Zi p Code : 68111 - 

### City : State : Zi p Code : Residen t Phon e I Owne rPhone : Alternat e Phone :

Assessment : Qualifyin g Grou p J40 0 Assessmen t Ma xXR F Valu e 

### 503.6 3' TECHNOLOGIES , INC ! 

# EP A Propert y CJos e Ou t Propert y # : '2AA?(^ ^ Propert y Address : ^Z > ^ ^^.-^ir^e- ^ '^ . Date/Time : Owner' s Name : IU.a.r£k» . p(£wv."('\' \ Quad s Excavated : p " 2 Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s N o 1 .I f necessary , wer e th e correct quadrant(s ) excavate dandrestored ? 

# • 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 gradin g aroim dth e perimete r o f th e hous e i n excavate darea s generall y slop e awa y / fromth e house ? 2 .Ha s so dbee nlai di n al l area s tha t wer e excavated ? / ,^

. Doe s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e if inspecte da t a3 0 day lun e period ) 

# y 4 .Ar e sodde darea s generall y fm n an devenl y graded ? 

# y 5 .Ar c th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e if inspecte dat a3 0 day lim e period ) 

# y 6 . Wa s th e propert y grade dsuc htliat wate r will no t poo l o n di e property ? 

# y 7 .Wa s damag e l o landscapin g o r plan t material s avoided ? 

# A Gates , Fence s an dRetainin g Wall s 1 . D o gate s ope nan dclos e freely ? (I f applicable ) Ye s / N o 2 . Wer e al l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (I f applicable ) / 3 , Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) 4 . Wa s damag e t o retainin g wall s avoided ? (I f applicable ) 

# y y Foundation , Sidin g an dGutter s 1 Wa s damag e t o th e sidin g o r tri mavoided ? 2 Wa s damag e l o th e foundatio navoided ? Ye s / 

## y N o

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 damag e t o downspout s o r downspou t extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Wa s damag e l o diivewa y surface s avoided ? 

# y 2 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 i9» - - ^ Date : ta.|g|t bC'llNOlOCIIRS . INC . 

### A S - BUIL T DRAWIN G ()I,.S#29S6 2 Dal e Kxcavated : 09/28/201 0 I SEP A Signed-Of l Date : 

### OMAH A LEA D SUPERFUN D SIT E 2956 2 Exterio rPain ! Nort h Aro w Omah a Lea d Sit e Owne rName : MARSH AL FLEMIN G • Goo d Sit e Sketc h Address : 421 9 BINNE YS T • Poo r Phone : ^ 402-453-695 9 W402-422-399 9 [Q-'flo l paint 

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' — — • ' • • VJ- : N O E.ASEMEN T CONTRAC T# : EP-S7-10-0 5 PRUDENTTECHNOLOGIES , INC .

# SEP A Propert yCompletio n Agreemen t Thi s agreement document s th e completio no f remova l activitie s performe do nth e belo w liste dproperty . Th e property owner' s signatur e indicate s tha t th e property owne r i s satisfie dwithth e restoratio nofth e subjec t property , an dtha t n o item s ar e inquestion , now , o r at any tim e inth e future , excludin g any remainin g warranty (3 0 day s total ) excep t thos e item s liste dbelow , ifany . Propert y Address : i ^ ^A ^ ^ B : tJjJe^ ^ 

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

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

Owner' s Signatur e 

### Q Dat ePruden t Technologies . Inc . (Prudent ) i s unde r contrac t withth e U . S . Environmenta i Protectio nAgenc y (EPA ) t o cleanu p lead contaminate dsoU s a t anumbe r ofpropertie s locate dinOmahzi , Nebraska , includin g th e propert y locate da t r"^! ^ Jylf^r)€j J ^7 " ''^^^ Z? hrequest s you r permir.siOT i t o allo w Pruden t t o performasoi l cleanu p a t thi s property tc f renwv e lead-confaminate dsoil . B y signin g thi s form , th e property owne r grant s permissio nt o Pruden t t o perform activitie s relate dt o tht f cleanu p includin g soi l sampling , remova l o f lead-contaminate dsoil , an drestoratio nofth e reference dproperty . t f 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 Pruden t southofTice for th e Omah aLea d Site cleanup-.\ t (402 ) 73.3- 1 188 . Genera l question s abou t th e Omah aLea dSit e cleanu p canb e directe dt o th e EP A Publi c Informatio n Center s a t (402 ) 731-304 5 (Sout hOmah aoffice ) or (402 ) 991-958 3 (NorthOmah aoffice) . Property Acces s Grante dBy . A'l3r"'5n3U ' '^HnO( ^ (Pleas e Prin t Name ) Property Owne r S i

ignatur e / / / ^U^A^l . 

# \Af-/^^^t o (Date ) PROPERT Y INFORMATIO N (T o b e complete db y residen t and/o r propert y OTvne r ~ pleas e print ) RESIDEN TNAME : /-^< i r S A«3 . rt-C,H t /tSL r Rente r RESIDEN TADDRES S .,— ^ SS I
I F RENTAL , PROPERT YOWNE D BY : OWNER' S MAIUN G ADDRES S OWNER' S TELEPHON E NUMBE R - HOM E 

## : i^a , /A'3-3y 3 4 WORK : J > AG E O F HOME? : l^C > YEARS . HO W LON G HAV E YO U LIVE D HERE ? ^ AYEARS . HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978 ? YE S X ^ N O NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : D NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDE R 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. )

A l UHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s t o b e implemente db y EP A unde r thi s agreemen t ar

e pursuantt o Sectio n10 4 ofCERCLA , 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 nSectio n104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry for •'detenmnin g th e nee dfor response , or choosin g o r takin g an y respons e actio n unde r 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 B S 's i .S t 424 2 Medica l Drive , Suit e 425 0 ^»ns^ s City . M O 6411 4 Phone : (816 ) 363-370 3 Fax : (816 1 363-370 7 Orruha . l\JetM3£k 2 9S1S 7 Phone : {432 f 725'iie e

Fax ; t*02 i 733-t8g 3 Sa n Antonio , T X 7S22 d Phone : (210 ) 622-SS8 8 Fax ; (210 ) 679-S67 7ErSV(ROiN!>]EiVT,4iL & CONSTRUCTIO N StRVTCF.. S 

### TECHNOLOGIES , INC . 

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# Il l 2956 2 Exterio rPaint Nort h Arro w Owne rName : MARSH AL FLEMIN G Omah a Lea d Sit e • Goo d Address : 421 9 BINNEYS TSit e Sketc h • Poo r Phone : H 402-453-695 9 W: 402-422-399 9 0^o t paint Sampl e Numbe r Lea d Sampl e |. g 

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### • YOURTICKE T NUMBERI S 2596239 . Origina l Cal l Date : 9/20/1 0 Time : 11:0 2 a m Op : SIVA1896 7 Wor k t o Begi n Date : 9/22/1 0 Time : 11:3 0 a m State : N E County : DOUGLA S Place : OMAH A Adciress : 421 9 Street : BINNE Y S T Twp : 15 NRng : 13 E Sect-Qtr : 08-NE-NW-SE-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : SOI L LEA D REMEDIATIONPROJEC T Locatio n o f Work : 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 : 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 MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Servic e Are a Contac t Phon e Nunibe r Utilit y Typ e CXCAT V COX COMMUNICATIONS , INC HEIDI 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUDO l METROPOLITA NUTILITIE S DISTRIC T SANDY 

### Day : 402504782 3 Alt : 

### Emerg : 402504797 0 OMAHACO FCITY O FOMAHA-TRAFFIC,SEWE R RICHH-RAFFI C 

### Day : 402444719 7

Alt : 402444516 1 

### Emerg : 402444516 0 0PPDGPR 5 OMAH A PUBLIC POWE RDISTRIC T EL M LOCATING 

### Day : 406728934 3 Alt : 406207149 4 

### Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K 

### EL M LOCATIN G Day : 406728934 3



### Alt : 406207149 4

Emerg : 888728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/20/201 0

# M m ENVIRONMENTAL ENGINEERIN GAN D CONSTRUCTIO N TBeHMOLOOSS, IN C 

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### iseeosios t 424 2 Medica l Drive , Suit e 725 0 Kansa s CiDr;ilO«411 4 Omatei , Mobrailt a 8810 7 Sa n Antonio , T X 7822 9 Phone : (818 ) 363A370 3 Phone : (402)733-118 8 Phone : (210)822:^958 8 Fa e (818 ) 363-^70 7 Fax : (402)733^188 3 Fax : (210)579-657 7/



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