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## TRANSMITTA L o f

OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAK># : pro22 . Date : gyj
- K ^ r>^rA i Address : 3>2-Z O GvyJlx^JI o 11 ^ Remediatio n Contractor: r>\jQt ^ %^ . 2Vif. ^ Year: ^0O*= ^ SOI L REMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S 

# y Vide o o f OTOoertv (DVD ) 

# y Executiv e Summar y 

# y EPA-provide dpropert y sketch 

# y SignedAcces s Agreemen t fo r

subject propert y 

## D SignedAcces s Agreement(s ) fo r

adjacen t propert y 

# y Restoratio n A^eemen t 

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

damag e or t o replac e plants , etc. ) 

# y Confirmation data 

# y Photograph s 

# y As-built sketch 

# y Satisfector y restoratio n signedb y Propert y Owne r 

# y Propert y close-out chec k

lis t signedby EP A 

## D Descriptio n o f area s no t meeting ROD cleanu p criteri a 

# y Utilit y clearance s 

# y Propert y infomiatio n fromDougla s Count y Assessor' s Office D D 

## D Signatur e s/asji o Dat e 3005421 7 

# II I Illlli l Superfun dFin d Record Remediatio n Queryj Lea d Remainin g QueryI Propert yDamag e Query 

### Backfill :

Sampl e Area : 8502 2 - 322 0 FONTENELL E B D Owner :
n Owne rOccupie d Owne rName : [•miRT Y LL C Owne rAddressl : 

# r Owne rAddressZ : |351 0 DODG E ST City : State : Zi p Code : |OMAH A [N E |6813 1 Owne rPhone : Alternat e Phone : j(816 ) 322-636 5 

# I Resident : Residen t Name : 

# I ~ — Propert yAddress : |322 0 l=OhrrENELL E B D Zi p Code : |6810 4 Residen t Phon e 

# I Contract : Conlractor : jPRUDEr^n2009_S Contrac t Optio n BAS E Assessment : Qualifyin g Grou p |800/CHIL D Assessmen t MaxXR F Value : 

# r 100 2

### PROPERT Y SUMMARY Date : 9/15/200 9 Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l Month of : Augus t

. . . . „ . „ __ . _„. , . . _^ . . . .. . 

### Propert y Address : 322 0 FONTENELLE B D A . EXECUTIV E SUMMAR Y A. 1 Issue s Encountered : NON E A. 2 Issue s Resolved : NON E A J Uniqu e Findings : NON E A 4 othe r Relevan t Information : NON E CONFIRMATIO N SAMPLIN G DATA/RESULTS : B l = 16 8 PP M @ 6" ; B 2 = 17 7 PP M @ 6" ; D Z = 37 4 PP M @ 13" ; E A = 9 3 @ SCRAPE (~1 ) ATTACHMENT S 1 ) Propert y sketch provide db y EP A pursuan t t o contrac t specification s 2 ) SignedAcces s Agreemen t including acces s agreement s require dfo r crossing othe r propertie s 3 ) Pre-Excavatio n digita l vide o clip/photograph s 4 ) Post-Excavation digita l vide o clip/photograph s 5 ) Docxmientatio n - CompletedClose-ou t Checklis t 6 ) As-Built sketch
i ) Shall includ e final lea dlevel s v ) Legend ii ) Contamination lef t behindarea s vi ) Contractor identification iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e includedi n th e individua l propert y file, if available , o r obtainedinclude : i ) Pre-excavation agreemen t detail s (i f an y ar e mad e wit h th e propert y owner ) ii ) Propert y Statu s For msignedby propert y owne r iii ) Excavation digita l vide o in MPEG , WM V (Window s Medi aVideo ) or SW F(Flas h Player) fonna t and/or photograph s iv ) Signedfor mverifying satisfactor y restoratio n v ) Description o f area s not meeting InterimRO D cleanu p criteria . 

# liillil l TECHNOLOGIES . INC .

### TECHNOLOGIES . IN C Property* : *?Sb i2 . Date/Time : Quad s Excavated : /S' ; Q^ , D 2 

# ^EP A EP A Propert y Clos e Ou t Propert y Address : 32-2- 0 Q^t.JU
- ^ Owner' s Name : ^A^-et\Sfewevt^ Contracto r Grou p Pniden t Technologie s Excavatio n Genera l Ye s No 1 .

If necessary , wer e th e correct quadrant(s ) excavatedan drestored ? / 2 .

If necessary , wer e the correct areas of dri p zone excavatedan drestored ? / Gradin g Sodan dVegetatio n Ye s N o 1 .

Doe s th e grading aroundthe perimete r ofth e hous e i n excavatedarea s generall y slop e awa y fromth e house ? / 2 .Ha s sodbee n laidi n al l area s tha t wer e excavated ? / 3 .

Doe s the sodappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecteda t a3 0 / da

y tim e period) 4 .

Ar e sodde darea s generall y fir man devenl y graded ? / 5 .Ar e the joint s betwee n the sodstrip s generall y tight ? (Onl y evaluat e i

f inspecteda t a3 0 da y tim e period) i / 

### 6 .

Was th e propert y gradedsuc h tha t wate r wil l not pool o n th e property ? / 7 . Was damag e t o landscaping or plan t material s avoided ? / Gates , Fence s an dRetainin g Wal k Ye s N o 1 . D o gate s ope n an dclos e freely? (I f applicable ) 

## v/ 2 .Wer e al l gate s or fence s taken dow n during restoratio n activitie s reinstalled ? (I f applicable ) 

# y 3 .

Was damage to gate s or fence s avoided ? (I f applicable ) 

# y 4 . Wa s damage t o retaining wall s avoided ? (I f applicable ) 

# y Foundation , Sidin g an dGutter s Ye s No 1 . Was damag e t o th e siding o r trimavoided ? / 2 . Was damag e t o th e foundation avoided ? / 3 .

Was damage t o window s avoided ? 

# y 4 .

Was damage t o window s or doo r screen s avoided ? / 5 .Was damage t o downspouts or downspou t extension s avoided ? / Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 .

Was damage t o drivewa y surface s avoided ? / 2 . Was damag e t o walkwa y surface s avoided ? 

# y

## Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complet e includin g th e 30-da y so dwarranty : EP A Representativ e Sc ^ J0 ^ Date : s/s>/oy

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n o f removal activitie s performe do n th e belo w hste dproperty . Th e propert y owner' s signatur e indicate s tha t th e propert y owner i s satisfie dwith th e restoratio n o f th e subjec t property , an dtha t n o item s ar e i n question , now , o r a t an y tim e i n th e fiiture , excludin g an y remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y ID : Propert y Address : 32-2J O 

### "^ ^ O 

### ^ f ey v «1LG . 

# R ^ Owner : 4|^^^e ^ ^_^U^.^. ^ Phone : Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item :



### M J I agre e restoratio n i s completed . L J I d o not agre e restoratio n i s complete d a t (note d deficiencie s above )


# ??-/<?- ^ Owner' s Signatur e Dat ePruden t Technologies , Inc . (Pnident ) i s unde r contrsc t with th e U . S . Enviranmenta l Protectio n Agenc y (EPA ) t o clea n u p lead
cantaminate dsoil s a t anumbe r ofpropertie s locate di n Omaha , Nebraska , includin g th e propert y locate da t

. Th e EP A request s you r permissia n t o allo w Ruden t t o performasoi l cleaniq ) a t thi s property t o remov e lead-contaminate dsoil . B y signin g thi s form , di e property owne r grant s pencnissio n t o Pruden t t o perfor m activitie s relate dt o th e cleanu p includin g soi l sampling , remova l o f lead-cantaminate dsoil , an drestoratio o ofth e reference dproperty . I f

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 Prudent' s Administrativ e Clei k fo r th e Omah aLea dSit e cleanup . Ms . Siv aS . Jampana-a t (402 ) 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 PubU c Informatio n CeqtO^a t (402 ) 731-304 5 (South Omah aofifioe ) o r (402 ) 991-938 3 (North Omah aoflice) . 

# ;<5e/^ r

^W^/^ ^ Property Acces s Grante dBy : (Pleas e Prin t Name ) Property Owne r Signature : 

# hd6rO ^ (Signature ) (EJate) PROPERT Y INFORMATIO N (T o b e compkte d b yresiden t and/o rpropert yowne r—pleai M print ) RESIDEN T NAME : OlQ u ^T * TLlMliA ^ JT s Owne r Rente r RESIDEN T ADDRESS : 

## /N^l ^ NX^ - £)S^ ^ I F RENTAL , PROPERT Y GOMNE D BY :
OWNER' S MAILIN G ADDRESS ; 

## ?> S I O J^^^fl- » 

# -Sfc L * OWNER' S TELEPHON E NUMBER-HOME : J L WORK :
AO E O F HOME? : 

### \<SO ^ YEARS . HO W LON Q HAV E YO U LIVE D HERE ? " ^ YEARS . HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WfT H SIDIN O 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 I NUMBE R O F CHILDRENUNDE R 7 YEAR S OL D WH O PLA Y I NTH E YAR D FO R 5 HOUR S O R MOR E PE R WEE K COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. )

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 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s righ t ofacces s t o th e propert y i s provide dfor i n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 960S(e) , whic h provide s entry for "determinin g th e nee dfor 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 provisio n ofth e title. " 

# Qi«M. | ) , 1 ^

808 0 War d Parkway , Suit e 40 5 250 5 N . 24* ^ Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Oinaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-«57 7i^NVTRONMEiVTAL . CONSTRUCn O SERVIC E 

# Propert y Statu s For m Address : -^J . 2. o r^^-^AV-Cj^tiL t ^ O Date : Phone : BVID : Ite mN O Plant s & Permanen t Landscapin g T o Remai n I n Plac e O n Ma p Descriptio n & Locatio n )0o«^€
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leaking ? Ye s N o Ite mN O Descriptio n & Locatio n O n Map 

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## Propert y Owne r Pruden t Employe e Signature : Signature :

808 0 War dParkway , Suit e 40 5 250 5 N . 24* ^ street . Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s city , M O 6411 4 Omaha , Nebrask a6811 0 Sa n Antonio , T X 7822 9 Phone:(816)363-370 3 Phone : (402)504-100 4 Phone : (210 ) 822.gs8 « FAY ; IMK\'\R'\.V7n- 7HNULUOES , INC . 

## A S - BWL T DRAWIN G OLS#:8S02 2 Dat e Excavated : 06/29/200 9 

## OMAHA LEA D SUPERFUND SIT E USEP A Signed-OiTDate : 

## 85022 Nort h AfTW f Exterio rPain t Sit e Sketc h Omah a Lea d Sit e • Goo d l g Poo r Samplin g Address : 322 0 FONTENELL E B D • Not pain t Sampl e Numbe r RYASCPXA-8502 2 F l Ua a Concentratio n Sampl e Collecte d LA B 

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Rn-mo i Cwaut . l8-,Si«<l l 04470 1 X1I.2 3 E A = 9 3 PP M @ SCRAP E (-1" )

CONTRA a # : E P - R7-07-0 6 TO# l PRUDENTTECHNOLOGIES , INC .

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## Pag e 1 o f

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• YOU RTICKE T NUMBE RI S 2298580 . Origina l Cal l Date : 6/19/0 9 Time : 9:3 2 a mOp : SIVA1896 7 Wor k t o Begi n Date : 6/23/0 9 Time : 10:0 0 a m State : N E C oun t y : DOUGLA S Place : OMAH A Address : 322 0 Street : FONTENELL E BLV D Twp : 15 NRng : 13 E Sect-Qtr: . 08-N 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 PROPERTY Remarks : FA X TUi L CLEAR S TO : (402)733-188 3 : FA X AL L CLEAR S T O (402)73 3 188 3 : UNSUR E COMMENT 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 Numbe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEID I Day : 402934046 9 Alt : 402934046 9 Emeig : 402932975 7 MUDO l METROPOLITA N UTILITIE S DISTRICT SAND Y Day : 402504782 3

Al t

Emeig : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFnC,SEWE RRO N Day : 402444719 7 Alt : 402444516 1 Emeig : 402444516 0 OPPDGPR 5 OMAH A PUBLI C POWE RDISTRICT N A Day : 406728934 3 Alt : 406207149 4 Emeig : 888728934 3 QLNNEI C QWES T LOCA L NETWOR K

N A Day : 406728934 3 Alt : 406207149 4 Emeig : 888728934 3ENVIRONMENTA L & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SOLUTION S 

# Sit e Safet yHazar d Analysi s Address : S^Z-c > ?4»«-/«g>»g// g 

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Fax : (402)504-100 5 424 2 Medica l Drive , Suit e 725 0 San Antonio , T X 7822 9 Phone : (210 ) 822-958 8 Fax:(210)579-657 7w^"
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