### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 2707 0 DATE : 12/15/201 0 ADDRESS : 191 0 N 2 5 S T REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES . INC . YEAR : 201 0 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S B I PR E AN D POS TVIDE O O F PORPERT Y (DVD ) n ( EXECUTIVE SUMMAR Y a EPA-PROVIDE D PROPERT YSKETCH a SIGNE D ACCES S AGREEMEN TFO R SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FO R ADJACENTPROPERT Y H RESTORATIO N AGREEMEN T D SETTLEMENTDOCUMENTS (I.E. , FO R DAMAG E OR T O REPLACE PLANTS , ETC. ) 0 CONFIRMATIO N DAT A a PHOTOGRAPH S 0 AS-BUIL TSKETCH U SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R 0 PROPERT YCLOSE-OUTCHEC KLIS TSIGNE D B YEP A D DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A d UTILIT YCLEARANCE S d PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E 

### D D D 

# <y ^

qV^^' ' SIGNATUR E DATE 3026076 2 Superfunc iFin d Record 

### Backfill :

Sampl e Area : 2707 0 -191 0 N 2 5 S T Owner : n Owne rOccupie d Owne rName : JCFT YO F OMAHA Owne rAddressi : C/

O FINANC E DEP T Owne rAddress2 : fl81 9 FARNA M S T City : State : ZipCode : OMAHA N E ; 68183 - Owne rPhon e Alternate Phone :

Contract : Contractor : |PRUDENT2010_ S Contract Optio n jOPTIO N 2 Remediatio n Quer yLea d Remainin g Quer yPropert yDamag e Quer y

Use rProvide d Owne rInforniatio n Owne rName : Owne rAddress : i City : State : Zi p Code : 

# 1 Owne rPhone : Alternat e Phone :

Assessment : Qualifyin g Grou p 

### 400 Assessmen t Ma xXR F Valu e 

### 47 1 Resident : Residen t Name : 

# I Propert yAddress : 1191 0 N 2 5 S T Zi p Code : 168111 - Residen t Phon e 

# r

### PROPERT Y SUMMAR Y Date : 12/15/201 0 Omah aLea dSit e Reinedia l Actio nContrac t #EP-R7-07-0 6 TO# l Mont hof : Decembe r Propert y Address : 191 0 N2 5 S T A . EXECUTIV ESUMMAR Y A. l Issue s Encountered : NONE 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 : B l = 26 6 PP M @ 6" ; B 2 = 29 4 PP M @ 6" ; N O EASEMEN T ATTACHMENT S 1 ) Property sketc hprovide dby EPA 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 ndigital vide o clip/photograph s 4 ) Post-Excavatio ndigital vide o clip/photograph s 5 ) Documentatio n- Complete dClose-ou t Checklis t 6 ) As-Buil t sketc h­ i ) Shal l includ e fma l 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 di nth e individual property file , i f available , o r obtaine dinclude : i ) Pre-excavatio nagreemen t detail s (ifan y ar e mad e wit hth e property owner ) ii ) Property Statu s For msigne dby property owne r iii ) E.xcavationdigital vide o i nMPEG , 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 ) Descriptio no f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOGIES , INC .TECHNOLOGIIES . INC . 

# EP A Propert y Clos e Oo t Propert y # : JT/CT/ O Propert y .-^ddrcs-r . (1( 0 p- T-" ^ Date/Time : Owmer' s Name : (^ " vA-^., ^ ^^-^ 1 ( ^ Vv^A.Uc v Quad s ExcavatctJ : v3>( . ^ S ^ Contracto r Group : Pr«.((fen t Technologies , Inc. , Excavatio nGenera ! Ye s N o 1 I f neccssarv . wer e th e correc l quadrant(s ) e.xcavate dan drestored ? 

# y j 2 . If necessan.. . wer e th e correc t area s of dri p zon e e.xcavate dan drestored ? 

# y Gradin g So diin dVegetatio n Ye s No 1 Doe s th e gradin g aroun ddi e perimete r o f th e house i nexcavate darea s generall y slop e away fro mlh e liouse ? / 2 .Ha s so dbee nlai dinal l area s ihat wer e excavaled ? / 3 Doe s di e .so dappea r to b e generaJl y health y ai dgrowing ? (Onl y evaluat e if inspecte dat a3 0 / da

y lim e period ) 

### y 4 .Are sodde darea s generall y firman devenl y graded ? 5 .

Arc di e joinl s belwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da l a3 0 day tim e period ) 

# y 6 .Wa s lli e property grade dsuc hdiat wate r wil l no t poo l o ndi e property ? 

# y 7 .

Wa s damag e to landscapin g o r plan t material s avoided ? 

# y Gates , Fence s an dRetainin g WalJ. s re s 1^ 0 1 .

D o gale s ope nan dclos e freely' ^ (If applicable ) 

# y 2 .Wer e al l gale s o r fence s lalce ndow ndurin g restoratio nactivitie s reinstalled ? (If applicable ) / 3 .Wa s d.Tmag e t o gate s o r fence s avoided ? (I f applicable ) 

# y 4 .Wa s dam;ig e l o relainin g wall s avoided ? (Ifapplicable ) 

# y Foundation , Sidin g iin dGutter s 1 Wa s damag e t o di e sidin g o r tri mavoided ? 2 Wa s damag e to th e foundatio navoided ? 3 . Wa s damag e t o vvindovv s avoided ? 4 . Wa s damag e l o window s o r doo r screen s avoided ? .-i

. Wa s damag e t o downspout s o r downspou t extension s avoided ? Ye s 

# y y / 

# y X N o

Siiilewalk s an dDriveway s (Concrete ) Ye s No Wa s damag e (o diivewa v surface s avoided ? 

# y Wa s damag e t o walkwa y surface s avoided ? 

# x \

## Owner s comments :

Inspectio n0Otes :

Reinova l an drestoratio nactivate s complete includin g th e 30-da y so dwarranty : EP A Representativ e ,0,.. ^ Date : „i„/, GECHS.OU.JU:ES . rwc . 

### A S - BUIL T DRAWIN G OL S n27C7 0 

### OMAH A LEA D SUPERFUN D SIT E l'SEP. 4 S:2.-;i-i-0/r IJats : 

### t 2707 0 Exteric vPain t ^!crt>lA^o< r Omah a Lea d Sit e • Goo d Samplin g Addms : 191 0 N 2 5 ST _ SiteSfcatc h D P'» f 1 PhOfW : H (402)342-282 0 AL T 0 ^ Notpatn t Sampf e Numbe r Lea d Concentratior* Sampt e Conecte d LA B Firm ; Sample s CoOet^e d RYASCP\A-2707 0 RVBSCPXA-2707 0F l F 2 Z'^ O ^2 5 Pl ^ 

### D D Date : Time ; _ 2 

## g ­ 12-07
­ 40 ^ RYCSCPXA-2707 0 RYDSCPXA-2707 0 B l B 2 41 1 HOf t ppn ) pp m 

### D D Sample s Analyze d r^DZDCrXA2707 0 B £ - pp m 

# n D XR F Unit . ioSt-l . Book ; Ift f riOZCCPXA2707 0 63 - npgscpx Aj7o?e—a z —

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### D D D D Dale : g-lS-0 7 Time : / 4 M Numbe rof Sample s = ^ Staff . JilsW - Legend : F 1 = Fron t Left . F 2 = Fron t Rigtit . B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P l - Pia y Al l qusdranr s ar e » s viewe d (ran i th e sueet , fadn g propert y 

# ENTERE D JU L 2 7 200 7 

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# Q . g )

Ai . ?e-.S h • Ciene d6.'r2/20tl ? I<M 7 1 0 N O E.'VSEMENT CONTRAC T# : EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC .

## ^ 1 Propert yCompletio n Agreemen t Tiii s agreemen t documents lh e completio n o f remova i activitie s performe d on . th e belo wliste d property . Th e properl yowner s signature indicate s tItat tli e propertyowne ri s satisfie d wit h th e restoratio n ofth e subjec t propert)' , an d tha t n o item s ar e i n question , now , o ra t an ytim e i n th e future , excludin g an y remainin g warrant) ' (3 0 day s totai ) cscep t thos e item s liste d below , ifany . Propert y ID ; Properl y Address : 

## /9/ 0 yyy- k 35 ^ S-j^ y Owner : 

## y77l-!A^ . y C7-,-,'> , i./\- . 1 Phone : 

## ^^^v/v
- V/^( f Restoratio n Item s i n Question :

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

# 1

agre e restoratio n i s completed , I I I d o no t agre e restoratio n i s complete d a t {note d deficiencie s above )

. /
• • * / 

# y . 

# - y zy/zy - y7yyzy-yy \ / I -/Pjiy:>y'Z/ - yO^ O Owner' s Signati/r ^ DatePniden t Teclinologies , Inc . (Prudent ) i s unde r conti-act witl i th e U . S . Envirorunenta l Protectio n.A.genc y fEP.A. ) t o cleanti p lead
containinate dsoil s s ^ mimbc r of

propertie s locate di nOmaha , Nebraska , includin g th e property locate da t IHI O ^ Cy ^ Q l Th e EP A request s you r permissio nt o allo w Pruden i t o perfor m. Tsoi l cleanu p a t thit ; properf y t o remov e lead-contaminate dsoil . B y signin g thi s form , th e propen y owne r grant s permissio nt 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-conlaminate dsoi l an drestoratio nofth e reference dproperty . Ifyo u hav e any question s abou t th e soi l cleanu p planne dfo r you r property , pleas e contac t Prudent.southoffic e fo r th e Omah aLea d Sil e cleanup-a l (402 ) 733-11S8 . Genera l question s abou t tli e Omah aLea dSit e cleanu p ca nb e directe dt o th e EP A Publi c Informatio n Center s a t (402 ) 731-304 5 (Sout hOmali aoffice ) or (402' ) 99I-.95S 3 (Norti i Omali aoffice) . Property .Acces s Gran t ante d^rl^^^l r/l D Pi^~'REULy > (Pleas e prin t Name ) Property Owne r Signamre: ! 

# loluji o (Date ) (T o b c compl ete d PROPERT Y INFORM ATIO N b y residen t anil/o r propert y owne r —pieasfijmjit ) RESIDEN TNAIVIE : \)/\rCA. ^ T * ^ ^ Rente r RESIDEN TADDRESS , 

# /? M /) o. <7lSSf . I F RENTAL , PROPERT YOWNE D 

# A^ A BY :
OWNER' S HiAILiN G ADDRESS ; 

# '(1^1 3 hHci 7 7ifLi /

i$ o 3yi^Ah/A,/o e i^^) W OWNER' S TELEPHON E NUMBE R - HOME : (7*^^ ) 3 // - ' 2" ^ 2^ D WORK : 

### J L AG E O F HOWIE ? 

# : /U/ A YEARS . HO W LON G HAV E YO U LIVE D HERE ? 

# /^/ A 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 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 WEE K 

### :/// ^ COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. ) 

# /Jl k

ALITHORITY FO RENX-TRONMENTA LRESPONS E.-\CT10NS , Th e activitie s t o b e i.mplemente db y EP A unde r this agreemen i ;ir

e pursuan t 1 0 Sectio n10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA'srigh t o f acces s t o th e property i s provide dfor inSectio n104(e)o f CERCLA , 4 2 U.S . C i'605(e) , whic hprovide s entry fo r "determinin g th e nee dfor response , o r choosin g o r laXin g an y respons e aclio n under liti s title , or otherwis e enforcin g th e provision s ofth e tille. " 808 0 War d Parkway , Suit e 4G £ 560 0 S "C - S t 424 2 Medica l Drive . Suit e 425 0 Kansa s City,'M O 6411 4 C'.rna.'-ja , Niebrastt a 6£l0 7 Sa n Antonio . TX 7822 9 Phone : (81S ) 363-370 3 Phone : (4G2) 73S-118 8 Phone : f210 ) 822-958 8 F.ix : (8ie j 36S-370 7 Fse : 1402 5 73.3-18E 3 Fax : (210 ! 579-657 7• 

# 1 

# iiniiiiii i ^ I I 2707 0 Exterio rPain t Nort h Arrow 

### Omah a Lea d Sit e Samplin q Addrew : 191 0 N 2 5 S T 

### Sit e Sketc h • Goo d • Poo r Phone : »• (402)342-282 0 ALT : 0 " Not pain t Lea d •Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Fir m RYASCPXA-2707 0 F 1 

## Z ^ 

## 0 PP ' m 

## D Date ; RYBSCPXA-2707 0 F 2 Time ; 

## 4 0 A / • 

# n ^ RYCSCPXA-2707 0 B l 

## fi n _pp m 

# 1/ D Sample s Analyze d RYDSCPXA-2707 0 B 2 

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## D RDZQCPXA-2707 0 B Z pp m 

# n XR F Unit : iaSHl . Book : Iftt f 

## D nGZGCnXA^2707 0 GZ - pp m 

## D Date : 8-i5-0 7 

## D RPZCCnX A2707 O 9 Z pp m 

# n Time : 

# Ai^ . D Staff : 

## H5 W Numbe ro f Sample s = / J Q Legend : F l ^ Fron t Left , F 2 = Fron t Right , B l = Bac k Left , 8 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadfant s ar e a s viewe d fro m th e street , facin g property 

# ENTERE D \ JUL272O0 7 

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### Pag e 1 of 2

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### • YOU RTICKE T NUMBE RI S 2618632 . Origina l Cal l Date : 10/15/1 0 Time : 4:0 3 p m Op : SIVA1896 7 Wor k t o Begi n Date : 10/19/1 0 Time : 4:3 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 191 0 Street : N25T H 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 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 Contac t Name ; SIV AJAMPAMA 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 , INC HEID I 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 LEVEL S LEVEL S COMMUNICATIONS , LLC N A 

### Day : 877366834 4 Alt : Emerg : 877366834 4 MUDOl METROPOLITA NUTILITIE S DISTRJC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE R RICH/TRAFFI C 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 

### http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 10/15/201 0

### Pag e 2 o f 2

. . . . Alt ; 406207149 4 0PPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T EL M LOCATIN G Emerg : 888728934 3 Day : 406728934 3 QLNNEI C QWES T LOCA LNETWOR K

EL M LOCATIN GAlt : 406207149 4 Eiiierg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. .: . 10/15/201 0TEOHNOUMISS , INC . 

### CONSTRUCTIO N SOLUTION S 

## SIT ESAFfeT Y HAZARD ANALYSI S Address : .y^-J^L.->JL.J±: . Excavatio n Date : -U2y..£.y^ o Crew : 

## Backfi U Date : JTip^u^iU O

Ite m Overhea dLine s Ga s Lin e Wate r Lin e Sewe r Lin e Septic/Leec h Fiel d Propane/Butan e Sidewal k Foundatio n Retainin g Wall s Fence s Tree s Structure s Drivewa y Sprinkle r Syste m Othe r Cre w Forema n Conditio n Hasutrd s Correctiv e Actio n ^ ^ / j;^-* . ) /w<fi>< . _ , C.5r » /Pfev O 

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Sit e Safet y Offic e Date :

808 0 Waid'RariBMay . Suit e 40 5 iSSOOSIOS t 424 2 Btedica l Drive , Suit e 725 0 Kansa s Gify , iaO«411 4 Omaha , Nduask a €810 7 Sa n Antonio , T X 7822 9 Phone : (8T6)363';37a 3 PtKMW : (402)733-118 8 Phone : (210)822,958 8 Fax : (8tfi ) 363-370 7 Fax : (402)733-^188 3 Fax : (210 ) 579-657 7

# 191 0 /^^eS ^