# m m• • TRANSMITTA L o f OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : /'^lo ? Date : nJjKin ^ Address : L^n % f l 0_cr Af
lediationCoimactor : Rem e i^^Jj ^ h-^^ui , S^ o Year : ^^ 9 SOI L REMEDIATION PROPERTY FIL E FOLDE RDOCUMENT S 1 ^ ffl

Vide o o f

propert y (DVD ) Execirtiv e Suimnar y Q ti

l D H

EPA-provide dpropert y sketc h Signe dAcces s Agreemen t fo r

subjec t propert y Signe dAcces s A€reement(s) fo r

adja^sen t propert y Restoratio n Agreemen t Q Settlemen t docurne3Qts(i.e. , fo r

damag e o r

t o replac e pUmts , etc. ) Confirmatio n dat a Photographs As-buil t sketc h 

# i d 

# d D 

## D Satisfiactor y restoratio n signe dby Propert y Owne r Propert y close-ou t chec k

lis t signe db y EP A Descriptio n o f

area s no t meetin g RO D cleanu p criteri a Utilit y dearance s 

## Propert y infonnatio n fromDougla s Count y Assessor' s Of&c e D D 

## Signatur e 13S r 30054 1 0 7 

# I Superfun dFin d RecxMx J Remediatio n Quer yj Lea d Remainin g Quer yj Propert yDamag e Quer y Backfill :

Sampl e Area : 1230 7 - 400 3 S 2 5 S T Owner : Resident : Contract : D Owne rOccupie d Residen t Name : Contractor : Owne rName : [RESIDEN T |PRUDENT2009_S |SEMI N DELORE S M Propert yAddress : Contrac t Optio n Owne rAddressl : [400 3 S 2 5 s r OPnON B 

# I Zi p Code : Owne rAddress2 : [6810 7 Assessment : |231 7 DEERPAR KBLV D Residen t Phon e aty : ^ State : Zi p Code : 

# I Qualifyin g Grou p [OMAH A |N E |6810 8 |400/CHIL D Owne rPhone : Aitemat e Phone : Assessmen t MaxXR F Value : 

# r 569.4 5

### imWiWilWIYaiHMPffiMBS y Date : 12/15/200 9 Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l Month of : November Propert y Address : 400 3 S 2 5 S T 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 : F l = 7 3 PP M @ 13" ; F 2 = 21 2 PP M @ 13" ; D Z = 19 0 PP M @ 13" ; EA = 9 6 PP M @ SCRAPE (~1 ) ATTACHMENT S 1 ) Propert y sketch provide dby 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-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-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-excavatio n 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 ) forma t and/or photograph s iv ) Signedfor mverifying satisfactor y restoratio n v ) Descriptio n o f area s not meeting InterimRO D cleanu p criteria .

THCHNQiamEG^jlN!: .TECHNOLOGIES . INC . ^S®^j 

# EP A Propert y Clos e Ou t Propert y # : 12-3^ 7 Propert y Address : ^' S S 2 S ^ Date/Time : Owner' s Name : Q^Offc , S<:wOi« ^ Quad s Excavated : p ) p. i prz ^ Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s N o 1 .

I f necessary , wer e the correct quadrant(s ) excavatedandrestored ? / 2 .

I f necessary , wer e the correct area s o f drip zone excavatedandrestored ? / Gradin g So dan dVegetatio nYe s N o 1 .

Doe s the grading aroundthe perimete r o

f the hous e in excavatedarea s generall y slop e awa y / fro mthe house ? 2 .

Has so dbeen lai din all area s tha t wer e excavated ? 

### y 3 .

Doe s tlie sodappea r t

o b e generall y health y andgrowing ? (Onl y evaluat e i

f inspecteda t a3 0 da

y tim e period) 

# y 4 .

Ar e sodde darea s generall y firmandevenl y graded ? 

# y 5 .Ar e tlie 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) 

# y 6 .

Wa s the propert y gradedsuc h tha t wate r wil l not pool o n the property ? 

# y 7 . Wa s damage t o landscaping o r plan t material s avoided ? 

# y Gates , Fence s an dRetainin g Wail sYe s N o 1 .

Do gate s ope n andclos e freely ? (I f applicable ) / 2 .

Wer e all gate s o r fence s take n dow n during restoratio n activitie s reinstalled ? (I f applicable ) 

# y 3 .

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

# y 4 .

Wa s damag e t o retainin g wall s avoided ? (I f applicable ) 

### y Foundation , Sidin g an dGutter s Ye s N o 1 .

Wa s damage t o the siding o r tri mavoided ? 

# y 2 .

Wa s damage t o the foundation avoided ? 

# y 3 .

Wa s damage t o window s avoided ? 

# y 4 .

Wa s damage t o window s o r doo r screen s avoided ? 

# y 5 .Wa s damage l o downspouts o r downspou t extension s avoided ? / Sidewalk s an dDriveway s (Concrete )Ye s N o 1 . Wa s damage lo drivewa y surface s avoided ? / 2 . Wa s damage t o walkwa y surface s avoided ? i /

### Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complet e includin g th e 30-da y sodv^arranty : EP A Representativ e ><9^.3 ^ ^Date: njasjo' )-.^-7=^^- . -r-.^ . '•••••

I I'-i k I H i /?! f '- ; ! t 

## 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 liste dproperty . Th e property owner' s signatur e indicate s tha t th e propert y owne r 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 future , excludin g any remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y ID : 1 Propert y Address : 

# ^'^^ J S ^ y^ s-s r 1 Owner : 1 Phone : Restoratio n item s i n Question :

Item : Item : Item : Item : Item : Item : Require dcorrection s t o complet e th e property :

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

# br^yuj^
- 

# Lli 4 

# H Owner' s Signatur e Date I

### TECHNOLOGIES , T^C . ProdtaaTetikmoVo^es , toe. (jTOden Q is unAc i con!aaawfe\to\J . S.tovnioifltvectoAProtectio n Agenc y (EPA ) to clean up lead
contanniial ^ soWs^ l at]wtibe> ' ofpsopertie s locate d in Omaha , Hebraslui , includin g th e property locate d at

^QQ Q S O*- ^ S y . Th e EP A request e you r pennissio n to allo w Pruden tto perfor masoi l cleanu p at thi s property to remov e lead-contanrinate dsoil . By signin g thi s form , th e property owne r grant s pennissio n to Pruden t to perfor m activitie s relate d to th e cleanu p includin g soi l sampling , remova lof lead-contaminate dsoil , an drestoratio n of

th e reference dproperty . If

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 Adminjs(r2tiveiilcrk,fo r th e Omah aLea dSit e cleanup . Ms . Siv aS Jampana-a t (402 ) 73-VllSii . Geiiera l question s abou t th e Omah aLea dSit e cleanu p ca n be [^^Tc^rter s at (402 ) 731-304 5 (Sout h oman aou.«,. . v^- . directe d to th e EP A PubU c Informatio n Center s at (402 ) 73 1 -304 5 (Sout h Omah aoffice ) or (402 ) 991-9583 (North Omah aoffice) . Propert y Acces s Grante d By Property Owne r Signator e (Signature ) PROPERT Y INFORMATIO N Cr .^.Idea^o property owne r - pleas e prm. ) (T o b b e

e complete

complete d d b

b y

y resldeji^o r r prop . y y y 7a^JJO I Owner Qente r ^ ^ RESIDEN T NAM E RESIDEN T ADDRESS : 

# '^dfo z S c^r^e^-^c ^

OWNER' S MAILIN G ADDRESS ; ^ ^ ^ ^ </]UL ^ P^L U 

### £1 ^

OWNER' S TELEPHON E NUMBE R - HOME : {'M'ir ^ f^3-^3^ ^

WORK :
AO E OF HOME? : / / 3 ^ YEARS . HO W LON G HAV E YO U LIVE D HERE ? >S ^

YEARS . HAS TH E EXTERIO R BEE N PAINTE D OR COVERE D WPf H SIDIN G SINC E 1978 ? _YE S NO 

## A/c^yf// ^ NUMBE R OF OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R OF OCCUPANTS UNDE R 7 YEAR S OLD : I J w" IMBB P n NU M 

# Tm :>4iLDRE N UNDE R 7 YEAR S OL D WH O PLA Y

IN TH E YAR D FO R S HOURS OR MOR E PE R WEEK : COMMENT S

OR SPECIA L INSTRUCTIONS : (l,E . DOGS , ENTR Y GATES . ETC. ) 

# jy ^ & r.Ays/D ^
AUTHORIT Y FO RENVIRONMENTA L RESPONS E ACTIONS : Th e activitie s Vo be implemente dby EP A unde r thi s agreemen t ar e pursuan t to Sectio n 10 4 ofCERCLA , 42 U.S.C . 9604 . EPA' s righ t of

acces s to th e property is provide dfor in Sectio n 104(e ) of CERCLA , 42 U.S . C 9605(e) , whic h provide s entr y fo r "detenninin g th e nee dfo r response , or choosin g or takin g an y respons e actio n unde r this title , or otherwis e enforcin g th e provision s ofth e title. "

808 0 Ward Parkway , Surt e 405 5600 S 10 * stree t 424 2 Medica l Drive , Suit e 4250 Kansas Cfty , MO 6411 4 Omaha , Nebrask a 68107 Sa n Antonio , TX 7822 9 Phone:(316)363-370 3 Phone : {402)733-118 8 Phone : (210)822-958 8 Fax : (816 ) 383-370 7 Fax : (402)733-188 3 Fav - !'>"• ' —

### TECHNOLOGIES , INC , 

# Propert y Statu s For m Address : ^^0 3 ^ . ^ 6 ^ Date:/^-/7"^ / Phon e 

# :^5J - 3:i^i m 6r/ l ^^ A fg/ / BVID : 

# /^^^ y 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

Pre-Existin g Conditio n o f Structure s 

# y Doe s you r Basemen t hav e ahistor y o f leaking ? Yes N o Ite mN O Descriptio n & Locatio n O n Ma p

Propert y Owne r Pruden t E Signature:^^»(^jd/.,^/Y/<*/?>^^ ^ Signature : 

# L_

803 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 Omaha , Nebrask a 6811 0 San Antonio . T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402 ) 504-100 ^ Phone : (210)822-958 8 Fax : (816 ) 363-370 " Pax : l'402 ) 504-100 5 -ax : (210 ) 5'9-65? T"c;n\() i ;u!ifs . IXC . 

### A S - BUIL T DRAWIN G

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### OMAHA LEAD SUPERFUND SIT E

Name : Omah a Lea d SIt a Date : : 9/04/g ^ Nort h Arrow —1 Addres H^i H 1C5 ^ Sit e Sketc h Time : s : . Phon e < - Tea m N\-\Vfc\l^ft<V N ts\^ \ 0 . ^? . BVI D # 1 7 3 o 1 XR F Cod e 

## ^t^^ V Sampl e Numbe r Lea d Concentratio n Confimiatio n Sampl e 

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

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### Prin t Preview Pag e 1 of 2 Dougla s County-Omaha , N E

I i 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 040471000 2 SEMI N DELORE S M 400 3 S 2 5 S T OMAH A 6810 7 231 7 DEERPAR K BLV D OMAH A N E 6810 8 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 SOUT H OMAH A CITY LOT S 3 6 1 1 S 4 2 W 5 0 F T LT 1 1 4 2 X 5 0

0.0 5 http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp ? parc=040471000 2 http://douglasne.mapping online.com/DouglasCoNe/static/accountinfo.jsp ? ' accountno=R040471000 2


### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 9/17/2009

### Pag e 1 of 2

" > [ Creat e Anothe rTicke t ] [ Bacl< t o Irt h Intemet ] Sen d Emai l



### YOURTICKE T NUMBE RI S 2396438 . Origina l Cal l Date : 10/29/0 9 Time : 1:3 5 p m Op : SIVA1896 7 Wor k t o Begi n Date : 11/02/0 9 Time : 2:1 5 p m State : NE County : DOUGLAS Place : OMAH A Address : 400 3 Street : S 25T H S T Twp : 14NRng : 13 E Sect-Qtr : 04-N E Twp : 15 NRng : 13 E Sect-Qtr : 33-S E 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 PROPERTY 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 Being Don e For : EPA Dept h o f Excavation : 6 FT Corne r Lot : N Front : Y Rear : Y Involve s Tunneling o r Horizonta l Boring : N Explosives : N ALT87 2 ATTNEBR l CXCAT V

LEVEL 3 METR O MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F
Servic e Are a Contac t Piion e Numbe r Utilit y Typ e 

### Day : 406728934 3 ALT87 2 WINDSTREA M COMMUNICATIO N N A 

### Alt : 406207149 4 Emerg : 888728934 3 Day : 8002413624 9 ATTNEBR l ATT/ T 

### Alt : Emerg : 8002413624 9 Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I 

### Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 LEVEL S LEVEL S COMMUNICATIONS , LL C N A 

### Alt : 

### Emerg : 877366834 4 http://www.dhon.org/irthinternet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.. . 10/29/2009

### Pag e 2 of 2

METR O METR O COMM . COLLEG E CHRI S 

### Day : 402457230 7 Alt : 402672703 3 Emerg : 402457231 3 MUD0 2 METROPOLITA N UTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFIC.SEWE R 

### RICH/TRAFFI C Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0 0PPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T N A 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNNEI FQWES T LOCA L NETWOR K N A 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

http://wvm.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 10/29/200 9ENViRONMENTA L & CONSTRUCTiO N 

### TECHNOLOGIES , INC . SOLUTION S 

# Sit e Safet yHazar d Analysi s E \ 

# .^/'7- ^ Address : Vg^ ^ S
- 2S^ ^ Crew : 

# ^^•itS
- 7 Date : yt>-:si<:>G* i 

### Correctiv e Ite m Conditio n Hazard s Actio n 

## Overhea dLine s 3<-rftf i HnuHi^^^/nui l h»nfii ^ 

## ^s e yae«v ^ 

## Ga s Lin e A/»r J /C'0^< > 

# 1 ^ 'Ufli^ t 

## Wate r Lin e -f

## Sewe r Lin e Aunjs L l^a^ J /^t^*A e 

### Septi c / Leec h fiel d JU± . 

## Propane/Butan e .js^y L 

## Sidewal k Z^^eetiz
- • ^« ' ^^i<(Ar rf y 

## Foundatio n • hC'K . 

## Retainin g Wall s /^g«^ ^ 

## Fence s Tf't" ' 

## Trees / Bushe s Af, , 

## Structure s .A/ ^ 

## Drivewa y 

# /L. . t/f<9^/^^/C ^ 

## Sprinkle r Syste m 

## juy L Othe r Cre w Forema n Sit e Safet \ Offfce r 

# ^V^- ^ '^--^9!^-^ ^^^ ^

aos o War d Parkv.'ay . Suit e 'a S iSO ^ h; . l- i ' Scr&si . jH^t s J O KansasCity . M O 64-i1 4 OrriiJ-!;: , i^!sbiask£ : SS11 0 S.-ir : A;ilcniO . T. X Phone : iSlfi i 363-370 3 Phone : I'+Oa ; 5Gi-lnu 4 :"^hOi!e : (210 : 3 :-S58 S .'0^i:; i TC: ­ F;-ix : /'JOc i S04-''00 ^'xa^m^taam m