## TRANSMITTA L o f OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAE ) # : '^^^IZ- Date : fl\\6 ~ Address : TJ l 2S : "B^ifVUii ^ fVyf , Remediatio n Contractor : 9A)1(UJP A 

## ^TM l \ ^ Year : ^ M O SOI L REMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S Vide o o f property (DVD ) 

# d Executiv e Summary EPA-provide dproperty sketc h 

# d Signe dAcces s Agreemen t for subjec t propert y D Signe dAcces s Agreement(s ) for adjacen t propert y Q

l Restoratio n Agreemen t D Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) I D Confirmatio n dat a



# 1 Photograph s As-buil t sketc h Satisfectory restoratio n signe db y Propert y Owne r Propert y close-ou t chec k lis t signe db y EP A aDescriptio n o f area s no t meetin g RO D cleaniq ) criteri a Utilit y clearance s 

# 'j Property informatio n fromDougla s County Assessor' s Offic e D D D 

## isignature ' Dat e 3021797 5 

# liii n Superfun dFin d Recor d Remediatio n QueryI Lea d Remainin g QueryI Propert yDamag e Query Backfill :

Sampi e Area : 3982 2 ­ 272 5 BAUMA N A V Owner : Resident : Contract : n Owne rOcoiple d Owne rName : |HOWAR D ERI C Owne rAddressl : Residen t Name : [JOHNSO N YVONN E R Propert yAddress : |272 5 BAUMA N A V Contractor : |PRUDENT2009_S Contrac t Optio n jOPnO N 2 Owne rAddress2 : |272 5 BAUMA N AV E City : (OMAH A State : |N E Zi p Code : |6811 2 Zi p Code : |6811 2 Residen t Phon e 

# I— " Assessment : Qualifyin g Grou p |40 0 " Owne rPhone : Altemat e Phone : 

# 1 Assessmen t MaxXR F Value : 

# r 513. 6

### PROPERT Y SUMMAR Y Date ; QjHS/lOl O | Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l | Mont h of : M O V Propert y Address ; 272 5 BAUMA N AV E 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 7 PP M @ 13" ; D Z = 3 2 PPM @ 12" ; B 2 = 22 6 PPM @ 12" ; E A = 18 6 PPM @ SCRAPE (~1" ) ATTACHMENT S 1 ) Propert y sketch providedb y EP A pursuan t t o contrac t specification s 2 ) SignedAcces s Agreemen t including acces s agreement s requiredfo r crossing othe r propertie s 3 ) Pre-Excavation 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 sketc h ­ i ) Shal l include fina l lea dlevel s v ) Legen d ii ) Contamination lef t behindarea s vi ) Contracto r identification iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e includedin th e individua l propert y file , if available , or obtainedinclude : i ) Pre-excavation agreemen t detail s (if an y ar e mad e 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(Flash Player ) forma t and/or photograph s iv) Signedfor mverifying satisfactor y restoratio n v ) Description ofarea s not meeting InterimRO D cleanu p criteria .

TECHNOLOCIES , INC .:$^SZ e TECHNOLOGIBS . INC . 

# EP A Propert y Clos e Ou t Propert y # : S ^ ^2 . 1 ^ Propert y Address : 2 - 7 2. S t^to/i^vft^ A / Date/Time : Owner' s Name : U-evv^S C Uo^'W.'^d ^ Quad s Excavated : C7 ^ rf ^ Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s 1 .

I f necessary , wer e the correct quadrant(s ) excavatedandrestored ? 

### y 2 .

I f necessary , wer e th e correct area s o f drip zon e excavatedandrestored ? / Gradin g So dan dVegetatio n Ye s I .

Doe s tlie grading aroundthe perimete r o

f th e hous e i n excavatedarea s generall y slop e awa y fro mthe house ? 

## y 2 .

Ha s sodbee n laidi n al l area s dia t wer e excavated ? 

# 7 3 .

Doe s tli e so dappea r to be generall y health y andgrowing ? (Onl y evaluat e i

f inspecte da t a3 0 da

y tim e period ) 

# 7 4 .

Ar e sodde darea s generall y firn i andevenl y graded ? 

### 7 5 .Ar e tlie joint s betwee n the sodstrip s generall y tight ? (Onl y evaluat e if inspecteda t a3 0 da y tim e period ) 

# 7 6 .Wa s tlie propert y gradedsuc h tlia t wate r wil l not pool on the property ? 

# 7 7 .

Wa s damage t o landscaping o r plan t material s avoided ? 

# 7 Gates , Fence s an dRetainin g Wall s Ye s 1 .

D o gate s ope n an dclos e freely ? (I f applicable ) / 2 .

Wer e al l gate s o r fence s taken dow n during restoratio n activitie s reinstalled ? (I f apphcable ) / 3 .

Wa s damage t o gate s o r fence s avoided ? (I f applicable ) / 4 .

Wasdamag e t o retaining wall s avoided ? (I f applicable ) / Foundation , Sidin g an dGutter s Ye s I .

Wa s damage lo tlie siding o r trimavoided ? / 2 .Wa s damag e t o tlie foundation avoided ? / 3 .

Wa s damage lo window s avoided ? / 4 .

Wa s damage t o window s o r doo r screen s avoided ? / 5 . Wa s damage lo downspout s o r downspou t extension s avoided ? 

## 7 Sidewalk s an dDriveway s (Concrete ) Ye s 1 . Wa s damage lo drivewa y surface s avoided ? / 2 . Wa s damage t o walkwa y surface s avoided ? i / N o

N

o

N

o

N

o

N

o

### ^ 9 3- 5 Sojurr ah Ai/^L ^ Owner s comments :

^ 

### Inspectio n notes : 

# f tto * efi 

# y^ 

# ty }

Remova l andrestoratio n activate s complet e includin g th e 30-da y so dwarranty : EP A Representativ e Qo ^

### J ^ Date : ij<i(' *-sr^ 

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n o f remova l activitie s perfcjrme d o n th e belo w liste dproperty . Th e propjert y owner' s signatur e indicate s tha t th e propert y owne r i s latisfie dwith th e restoratio n o f th e subjec t pjroperty , an dtha t n o item s ar e i n question , now , o r a t any tim e i n th e future , excludin g any remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , i f ai y Propert : 'ID : 

### Propert;'Address : 3. 7 ^ FBcj^ y f ^ O^/ i 417,^ ^ Owner : 

# \i^x\^Q . VAax^Xitr A Phone : Restorato n item s i n Question :

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

3

6 restoratio n i s completed . 

## D I d o lo t agre e restoratio n i s complete d a t (note d deficiencie s abbve ) agr|3 e



# ( 2 /2(Q 9 Owner' s Signatur e Dat ePruden t Technologies , Inc . (Prudent ) i s unde r contrac t with th e U . S . Environmenta l Protectio n Agenc y (EPA ) t o clean u p lead atg dj^il s a t anumbe r orpropertie s locate di n Omaha , Nebraska , includin g th e propert y locate da t Jifttgi A fliJ£^ . Th e EP A request s you r permissio n t o allo w Pruden t t o perfor masoi l cleanu p a t thi s propert y t o remov e lead-contaminate dsoil . B y signin g thi s form , th e propert y owne r grant s permissio n t o Pruden t t o perform activitie s relate dt o th e cleanu p includin g soi l samphng , remova l o f lead-contaminate dsoil , an drestoratio n ofth e reference dproperty . I f

yo u hav e an y question s abou t th e soi l cleanu p plaime dfo r you r property , pleas e contac t th e Pruden t Ofiic e fo r th e Omah aLea dSite cleanu p a t (402 ) 733-1188 . Genera l question s abou t th e Omah aLea dSite cleanu p can b e directe dt o th e EP A Publi c Informatio n Center s a l (402 ) 731-304 5 (South Omah aoffice ) o r (402 ) 991-958 3 (North Omah aoffice) . Property Acces s Grante d1 (Pleas e Prin t Name)^v ^ Property Owne r SigmOure : X \} ^ OTS^/ H J^L^^cOiMS ^ ^ \^ ( C ?

~ ~ ' (Signature?- ^ ^ (Date ) PROPERT Y INFORMATIO N (T o b e complete db y residen t and/o r propert y owne r — pleas e print ) RESIDEN T NAME : 

## (?£AIS ^ M y^7)/lJy ^ (g ^ Rente r RESIDEN T ADDRESS : 

## ^l^yUAt/MaT ? Ho e I F RENTAL , PROPERT Y OWNE D BY : OWNER' S MAILIN G ADDRESS ; 5^^ ^ 

# ^

nn - 

# ^99' ^ OWNER' S TELEPHON E NUMBE R - HOME : S WORK : 

### J 1 AG E O F HOME? : ^ YEARS . HO W LON G HAV E YO U LIVE D HERE ? " ^ YEARS . HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978? YE S ^ N O \/w n 

# 0 NUMBE R 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 

# 3 NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLA Y I N TH E YAR D FO R 6 HOUR S O R MOR E PE R WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. ) 

## (2^2 ^

AUTHORIT Y FO RENVIRONMENTA L RESPONS E ACTIONS : Th e activitie s t o b e implemente db y EP A unde r thi s agreemen t ar e pursuan t t o Sectio n 10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t ofacces s t o th e property i s provide dfo r i n Sectio n 104(e)o f CERCLA , 4 2 U.S . C 9605(e) , whic h provide s entry fo r "determinin g th e nee dfo r response , o r choosin g o r takin g an y respons e actio n unde r thi s title , o r otherwis e enforcin g th e provision s ofth e title. "

one n \M-.W M O'.ri.i i ocn c K I •>;•' " ctro<k t Ciiit o 7n g A.'iA' yf.hai\\c-^ \ nritf A Qiift A A9A nFE«t M l«thN«KHNT<( S I J & 

### TECHNOLOGIES , INC . SSRftVIO& S 

# Propert y Statu s For m P7ar Bc^Tn ^ f^U ^ Date : Address : Phone : BVID : Ite mN O Plant s & Permanen t Landscapin g T o Remai n I n Plac e O n Map Descriptio n & Locatio n

Pre-Existin g Conditio n o f

Structure s Doe s you r Basemen t hav e ahistory o f

leaking ? Ye s No v Ite mN O Descriptio n & Locatio n O n Ma p 

## Pt: 1 - Ctack ^ a/\c l Uo^io7 \// i «5/>/ja/ / ^r^v^ e f^ 3 -^ CrcLtk f

I7 \C07lCret€ .

Propert y Owne r Pruden t Employe e S i Signature : (/y ^

^S(S0jWtotflSai4nny,3uite-40 5 ;250S'N.>24'^tiEet,'SiJfte.'30 8 (Omaha,rKebiaskat681i1 0 t^^axae i (Stsir:3G3^3ZQ 3 ^Ptione : ((402)^5044100 4 P?lii;iK ­ l^H>):ScI:i;?fSS• ­ FFax:;f816X363;370 7 Fax : ff402)'504-ia0 5 Rar ^ (KM»WTi'-iR^7'7 VraiNOlXXilES . INC . 

### A S - BUIL T DRAWIN G OI.S#a9H2 2 Dat « K\cavah-d : 11/10/200 9 t:SKP. \Signcd-Ofn>ale : 

### OMAH A LEA D SUPERFUN D SIT E

r- \ Name ; 7 ^ r

Address : _± _ 1 Phone ; 7 /L7 OC • J • • 7 - Omah a Lea d Sit e Sit e Sketc h Date ; Time ; •? - jJ ­ r' • . ' C 3 Nort h Arro w 1 V

Tea mA l /i.v'-Hi f ("/- Q BVI D # Sampl e Numbe r 1 t ^ H Ks > CP)C/ ^ ­ ;^ ? " O X . 

# I y\r^i.viy\ky ^ } ? ^A ^ Lea d Concentratio n XRFCode^L^loM Confirmatio n Samp I '^/Ye s C D Ye s Q >l e

6

A,.vr/-<. , TTTiTTiIT j J7 ~ Omah aLea dSit e i: A = 18 6 PP M aSrK.M'i : (1" ) 4613 0

CONTRAC T # : E P - R7-07-0 6 T0# 1 PRUDEN T TECHNOLOGIES , INC .• •

7: } /,. . On»h aLt M Stc t 4613 0.1! - • - ' iwarnpw.: -.r^-.vfjp^­



## 2 5 BAUMAh . Marc h 200 7 DOUGLA S COUNT Y ASSES S

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Parce l I D Owne r Nam e Propert y Addres s Cit y Zi p Owne r Addres s Owne r Addres s 2 Owne r Cit y Owne r Stat e Owne r Zi p Sec-Twn Rn g 175316000 0 HOWAR D ERI C 272 5 BAUMA N A V OMAH A 6811 2 272 5 BAUMA N AV E OMAH A N E 6811 2 33-16-1 3 Additio n Bloc k Lo t Lega l 1 Lega l 2 Lega l 3 Lega l 4 Acre s Treasure r Websit e Lin k Assesso r Websit e Lin k MINN E LUS A 2 5 7 44X12 0

0.1 2 http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp ? parc=175316000 0 http://douglasne.mapping online.com/DouglasCoNe/static/accountinfo.jsp ? accountno=R175316000 0 

### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 9/2/2009

# i Pag e 1 of 2

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# i E

. YOU RTICKE T NUMBE RI S 2398961 . Origina l Cal l Date : 11/03/0 9 Time : 10:2 6 a m Op : SIVA1896 7 Wor k t o Begi n Date : 11/05/0 9 Time : 11:0 0 a m State : N E County : DOUGLA S Place : OMAH A Address : 272 5 Street : BAUMA NAV E Twp : 16 NRng : 13 E Sect-Qtr : 33-N E 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 : (402)733-188 3 : UNSUR E CORNER S Compan y: PRUDEN T TECHNOLOGIE S Contact Name : SIVAJAMPAM 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: NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g NExplosives : N CXCAT V MAGELLA NMETR O MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Servic e Are a Contac t Phon e Numbe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS . IN C HEID I 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 A > f A r^c T T A X T MAGELLA N . . „MAGELLA N MIDSTREA M PARTNER S T-,I:D/->D A U DEBORA H 

### Day : 918574709 8 Alt : Emerg : 918574709 8 METR O METR O COMM . COLLEG E CHRI S 

### Day : 402457230 7 Alt : 402672703 3 Emerg : 402457231 3 MUDO l METROPOLITA N UTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0ENVIRONMENTA L & CONSTRUCTIO N SOLUTION S TECHNOLOGIES , INC . 

## Q J 

## Sit e Safet y Hazar d Analysi s Address : 771X 5 <3/f^„^^ , 

## Ex . //-?--^ ^ Crew : ^j . (8^hY ^ Th/ziPxM^-' / Date : 'i / ^ • & ^ 

## Item Overhea dLine s Gas Lin e Wate r Lin e Sewer Lin e Septi c / Leec h fiel d 

## Propane/Butan e Sidewal k Foundatio n Retainin g Wall s Fence s Tree s /h^jk^ s Structure s Driveway Sprinkle r Syste m Othe r Cre w Forema n f^O\(i\)\lA^d ^ 

## Conditio n 9c:^5- ^ 7\^ n et J ) I A y ^ yyy f

^», . A y ^ T-cij c ^/f* '

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## Correctiv e Hazard s Actio n t>^^f/ij>^i > A** J }oc^-i~ e 

### 1 Jy^^.- / /c^cuffd- ^

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## Site Safet y Officer

808 0 War d Parkway , Sutt e 40 5 2505 N . 24 * Street , Suit e 30 8 424 2 Medica l Drive , Suit e 725 0 Kansa s City . M O 6411 4 Omaha , Webrask a 6811 0 San Antonio , T X 7822 9 Phone : (81S i 383-370 3 Phone : (402)604-100 4 Phone : (210 ) 622-9gRf l Fax : <81S 1 363-370 7 Fax : t'403 » t.t\A.titti c