### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL EFOLDE R SAJD# : Ami^" ^ Date : H ^ I 5 ^ I 0 Address : ^<^<:J S f^lOdd O SJ " Remediatio nContractor : Pbf- > r?PrM- 7 Jo-r M N<^OC , \'?-<. . /ror-.^ i Year : /> U 1 ( J 

### SOI LREMEDDinO N PROPERT Y FIL EFOLDE RDOCUMENT S Z

f Vide o o f propert y (DVD ) H Executiv e Summar y 0 EPA-provide dpropert y sketc h aSigne dAcces s Agreemen t fo r sub j ec t propert y D Signe dAcces s Ag?reement(s ) fo r adjacen t propert y 

# I Restoratio nAgreemen t 

### D Settlemen t documents (i.e. , fo r

damag e or to replac e plants , etc. ) B Confiimation data aPhotograph s aAs-built sketch aSatisfactor y restoratio n signedb y Propert y Owne r IJPropert y close-out chec k

lis t signedby EP A D Descriptio n o f

area s not meeting RO D cleanu p criteri a [I I Utilit y clearance s 1 2 Propert y informatio nfromDougla s Count y Assessor' s Offic e D D ] D

< ^ . V ^ Signatur e Dat e 3026106 0 Superfun dPROPERT Y SUMMAR Y Date : 11/15/201 0 Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Novembe r Propert y Address : 252 5 BLOND O S T A . EXECUTIV ESUMMAR Y A. l 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 GDATA/RESULTS : B l = 30 0 PP M @ 3" ; E A = 14 3 PP M @ 2 " 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 n digital vide o clip/photograph s 4 ) Post-E.xcavatio n digital vide o clip/photograph s 5 ) Documentatio n - Complete dClose-ou t Checklis t 6 ) As-Buil t sketch
i ) Shal l includ e fina l 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 db y 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 .Fin d Record Remediatio n Quer y Lea d Remainin g Quer yj Propert yDamag e Quer y Backfill :

Sampl e Area : 2713 9 - 252 5 BLOND O S T Owner :

• Owne rOccupie d Owne rName : iCm rO F OMAH A Owne rAddressl : JC/ O PLANNIN G DEPARTMENT Owne rAddress2 : J1819FARNAMST#111 1 City : State : Zi p Code : OMAH A |N E J68183 - Owne rPhon e Alternat e Phone :

Contract : Contractor : )PRUDENT2010_ S Contrac t Optio n |0FTON T Use rProvide d Owne rInformatio n Owne rName : 

# 1 Owne rAddress :
City : State : Zi p Code : 

## j Owne rPhone : Alternate Phone : 

# 1 1

Assessment : Qualifyin g Grou p |40 0 Assessmen t Ma xXR F Valu e 

# 1 50 5 Resident : Residen t Name : 

# I Propert yAddress : )252 5 BLONDO S T Zi p Code : J68111 - Residen t Phon e 

# 1 ~~ "TECHNOLOGIES . EMC . 

# !&cP A EP A Propert y Clos e Ou t Property* : 2-"7'^ ^ PropertyAddress : Z^^ ^ Bb-Jl O Date/Time : Owner' s Name : G-.i~ix ^ cr^ci^w^v Wtfc Contracto r Group : Pruden t Technologies , Inc. , Quad s Excavated : 2> \ Excavatio n (Jenera l 1 .

I f necessary , wer e the correct quadrant(s ) excavatedan drestored ? 2 .

I f necessary' , wer e the correct area s o f dri p zon e excavatedan drestored ? Gradin g So dan dVegetatio n 1 .

Doe s the grading aroundthe perimete r o

f the hous e i n excavatedarea s generall y slope awa y fro mlh e house ? 2 .

Has so dbee n lai di n al l area s tha i wer e excavated ? 3 .

Doe s the so dappea r t

o be generall y health y an dgrowing ? (Onl y evaluat e ifinspecte da t a3 0 da

y tim e period ) 4 .

Ar e sodde darea s generall y fim i an devenl y graded ? 5 .Ar e Ui e joint s betwee n th e so dstrip 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 htlia t wate r wil l no t poo l o n the property ? 7 , Wa s dainag e t o landscaping o r plan t material s avoided ? Gates , Fence s an dRetainin g Wall s 1 .

Do gate s ope n an dclos e freely ? (I f applicable) 2 . Wer e all gate s o r fence s take n dow n during restoration activitie s reinstalled ? (I f applicable) 3 , Wa s damage t o gate s o r fence s avoided ? (I f applicable) 4 .

Wa s damage t o retaining wall s avoided ? (Ifapplicable ) Foundation , Sidin g an dGutter s 1 .

Wa s dainag e t o tlie siding o r ttimavoided ? 2 .

Wa s damage t o the foundatio n avoided ? 3 .

Wa s dainag e t o window s aA'oided ? 4 .

Wa s damage t o window s o r doo r screen s avoided ? 5 .Wa s daniage t o downspouts o r downspou t extension s avoided ? Sidewalk. s an dDriveway s (Concrete ) 1 .

Wa s damage t o drivewa y surface s avoided ? 2 .

Wa s damage t o walkwa y surface s avoided ? Ye s N o 

## y ^ Ye s N o 

### y 

## y y ^ 

### y

^ ^ Ye s N o 

### y y ^ y y Ye s N o y

. / 

## y y y Ye s N o 

## y ^

### Owner s commemts :

Inspectio n notes :

1



### Remova l andrestoratio n activate s complet e includin g th e 30-da y so dwajranty : EP A Representativ e B^- ^ ^Date: | 0ECHNOLOUIES , INC . 

### A S - BUIL T DRAWIN G OL S #2713 9 Dat e Excavatefl : 9/24/201 0 

### OMAH A LEAD SUPERFUND SIT E USEP A Signed-Of r Date : 

### 2713 9 Exterio rPain t Nort h Arro w Omah a Lea d Sit e • Goo d Sit e Sketc h • Poo r 

### 1 SamDiin q Address : 252 5 BLOND O S T Q4jo t pain t 

# 1 Sampl e Numbe r Lea d Concenlratio n Sampl e Collecte d LA B Sample s Coliecie d Firm : V E T^r . O R TC . RYASCPXA-2713 9 RYBSCPXA-2713 9 F 1 F2 2.Q5 "

13 1 pp m pp m D D Dale : l[n/oft Time : (:Y , F H RYCSCPXA-2713 9 RYDSCPXA-2713 9 B 1 8 2 'iZ° l

6> H pp m pp m \ ^ D Sample s Analyze d RO20CrXA-2713 9 -B 2 —pp m D D XR F Unit : 0)51 0 Book : 2J 3 RQZOCrXA"2710 9 -e ? —pp m D D Date : 1-2S"-O S RPZSCPXA'g713 9 -PZ ­ — pp m D D Time : Ar ^ gU b RYCSCPLA-2713 9

- « Resul t 50 5 pp m Numbe rof Sample s •
= / Staff : M3L J Fron t Right , B 1 Bac k Left , B 2 = Bac k Righ l D Z = Dri p Zone , G Z = Garden , P Z = Play Al l quadrant s ar e a s viewe d fro m th e street , facin g propert y .HEAVY. . GWWT H JU L 2 4 200 8 Ml' ^ 

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v200 8 Cn . £.• 4 - '.i S PPR] ( f 2 - CONTRAC T # : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC .

# SEPA Propert yCompletio n Agreemen t Thi s agreement document s th e completio n o f remova l activitie s performe do n th e belo w liste dproperty . Th e propert y owner' s signature indicate s that th e propert y owner I

s satisfie dwit hth e restoratio n o f th e subjec t property , an dthat n o item s are i n question , now , o r a

t any time i n th e future , excludin g an y remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , if any . Property ID : •i' ) j^c j PropertyAddress : ^c^2- ^ ^^, ^ ^ ^ ^^"^'• ^ CIT Y G Fo^An ^ 

## Phone : M^H^'IZ ^ Restoratio n Item s i n Question :

Item : Item : Hem : Item : Hem : Hem :

O I agre e restoratio n i s completed . LJ I d o not agre e restoratio n i s complete d a t (note d deficiencie s above )

,^/©wner' s S^natur e

# ¥ RUDE N

Pruden t Technologies , Inc . (Prudent ) i s unde r contrac t wit hth e U . S . Environmenta l Protectio n Agenc y (EPA ) t o clean u p lead
conlagjinate dsoil s a l anumbe r ofpropertie s locate di n Omaha , Nebraska , includin g th e property locate da t A-^J'*~ i fr>)oVVdiO ^V " . Tli e EP A request s you r permissio n t o allo w Pruden t t o performasoi l cleanu p a t thi s property t o remov e lead-contaminate dsoil . B y signin g thi s form , th e property 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 sampling , 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 planne dfo r you r property , pleas e contac t Pruden t southoffic e for th e Omah aLea d Site cleanup-a t (402 ) 733-1188 . Genera l question s abou t th e Omah aLeadSite cleanu p ca n b e directe dt o th e EPA Publi c Infonnatio n Center s a t (402 ) 731-304 5 (Sout hOmah aoflice ) o r (402 ) 991-958 3 (NorthOmah aoffice) . Property Acces s Grante dBy : yi/l)Cit ^ // , U^yiyAjl ) (Pleas e Prin t Name ) Property Owne r Signaiure : 

## /h^F^^ o V (y " ' (Signature ) (Date ) PROPERT Y INFORMATIO N (T o b e complete db y residen t and/o r propert y OHTie r—please_grint ) RESIDEN TNAME : 

### FFi-F \--r/ * F)yy)al n Owner > Rente r RESIDEN TADDRESS : 

## F:I^^ S 8 \T i f^ A g ^ ^JF
I F RENTAL , PROPERT YOWNE D BY :
OWNER' S MAILIN G ADDRESS ; 

## /// ^ Pkr^Ary, Fl . . F/.' l L//f f

O^ U M F 6 Fj [ ^ y / OWNER' S TELEPHON E NUMBE R - HOME : J _ WORK :
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 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 NUMBE R O F CHILDRE NUNDE R 7 YEAR S OL D WH O PLA Y I NTH E YAR D FOR 5 HOUR S O R MOR E PE R WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTRY GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS . Th e activitie s l o b e implemente db y EP A unde r this agreemen i ar e pursuan t l o Sectio n 10 4 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s righ l o f acces s l o th e propert y i s provide dfori n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) . whic hprovide s entry fo r ""detemiinin g th e nee dfor response , or choosin g or takin g an y respons e actio n under tlii s title , o r otherwis e enforcin g ih e provision s ofth e title. " 808 0 War d Parkway . Suit e 40 5 S l BO

O S 1 0 S t 424 2 Medica l Drive , Suit e 425 0 Kansa s City . 'M O 6411 4 Omaha . Nebrask a 6210 7 San Antonio . T X 7322 9 Phone : (816 ) 363-370 3 Phon e : (402 J 733-118 8 Phone : (210 ) 822-958 8 Fax : (816 ) 363-370 7 Fax : (402 ) ;•33-188 3 Fax:(210)579-657 7ENVfROiV!MEi\T.AL & CONSTRUCTIO N 

### TECHNOLOGIES , INC . S£RVICE. S 

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### Propert y Owne r Pruden t Employe e Signature : Signature : 808 0 War d Parkway , Suit e 40 5 560 0 S 1 0 S t edica l Drive , Suit e 425 0 KansasCity , M O 6411 4 Omaha , Nebrask a 6810 7 Sa n Antonio , T X 7822 8 Phone : (816 ) 363-370 3 Phone : (402 ) 733-118 8 Phone : (210)822-958 8

# Hiiiiiiiiuimiiiii i 2713 9
• 

### Omah a Lea d Sit e ^ P Exterio rPain t ,Mc-ri n .^no w 

### Sit e Sketc h Sampitn g Address : 252 5 BLOND O S T j Q-^Vo t patn t 

# 1 h r Sampl e Numbe r RYASCPXA-2713 9 RYBSCPXA-2713 9 RYCSCPXA-271.3 9 RYC-SCPXA-2713 9 RDZGCPXA'2713 9 F 1 F 2 8 1 B 2 9 ? KrZ3CP.XA'-2"M3 9 P^
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## jtam y Fron t Right , 8 1 - Bac k Left . B 2 = B ac k Righ t C' Z = Dn p Zone , G Z = Garden , P Z = Pla y A

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# A Printed : No v 15.201 0 ww w .dcgis,org/dogi s

### Pag e 1 of 2

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### YOU RTICKE T NUMBE RI S 2592074 . Origina l Cal l Date : 9/14/1 0 Time : 5:2 0 p m Op : SIVA1896 7 Wor k t o Begi n Date : 9/16/1 0 Time : 5:4 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 252 5 Street : BLOND O S T Twp : 15 NRng : 13 E Sect-Qtr : 09-SE,16-N E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : soi l lea d remediatio n projec 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: NFront : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V LEVEL 3 MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Servic e Are a Contac t Phon e Numbe r Utility Typ e CXCAT V CO X COMMUNICATIONS , IN C HEID I 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
LEVEL S LEVEL S COMMUNICATIONS , LL C NA 

### Day : 877366834 4 Alt : Emerg : 877366834 4
MUDOl METROPOLITA N UTILITIE S DISTRIC T SAND Y Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRICH/TRAFFI C Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 

### http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/14/201 0

### Pag e 2 o f 2

0PPDGPR5 OMAH A PUBLI C POWE RDISTRIC T EL M LOCATIN G 

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808 0 Wanfiaaftany . Suite40 5 560 0 S 1 0 S t 424 2 Medica l Drive , Suit e 725 0 Kansa s Gay;ilO«411 4 etaask a 6810 7 Sa n Antonio , T X 7822 9 Phone : 1(816 ) 363-370 3 Piwne : (402)733-118 8 Phone : (2T0 ) 822-.958 8 FtefSte ) 363470 7 T^ K(402)733-188 3 Fax : (210)679-657 7