## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL E FOLDE R SAK)# : ]\^/| j Date : Address : U\'^' \S > 2.1-S h Remediatio n Contractor : •r^iruJju ^ H'^i^xL^' . X^^ o ^®^ " - ^ •

SOI LREMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S E f Vide o ofproperty (DVD ) ^ Executiv e Summar

y 0 ^ EPA-provide dpropert y sketch y Signe dAcces s Agreemen t fo r subject propert y l 3 Signe dAcces s Agreement(s ) fo r adja(?en t propert y ^ Restoratio n Agreemen t D Settlement

document s (i.e. , fo

r damag e or t o replac e plants , etc. ) 0 ^ Confirmatio n dat a y Photograph s y As-built

sketch I FSatisfiactor

y restoratio n signe db y Propert y Owne r ^ Propert

y close-out check lis t signe dby EP A D Descriptio n o f

area s no t meetin g RO D cleanup criteri a ^ Utilit y clearance s 

## WPropert

y informatio n fromDougla s Count y Assessor' s Offic e D D D 

## Signatur ^ Ust o 4031073 6 

# IMiNilHH i Superfun d

### PROPERT Y SUMMAR Y Date : 01/23/200 9 Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-06/0004 Month of : Dec/Jan Propert y Address ; 412 3 S 2 2 S T A . EXECUTIV E SUMMAR Y A. 1 Issue s Encountered : NON E A. 2 Issue s Resolved : NON E A. 3 Uniqu e Fmdmgs : NON E A. 4 Othe r

Relevan t Infonnation : ARE

A NOT EXCAVATE

D B l LANDSCAP

E 12'X50 ' @ 39 0 PPM ; ARE A NOT EXCAVATE

D F l LANDSCAPE , BUS H 6'X7 ' @ 15 0 PP M CONFIRMATIO N SAMPLIN G DATA/RESULTS : B l = 21 3 PP M @ 10" ; F l = 14 8 PP M @ 12" ; D Z = 15 4 PP M @ 12" ; E A = 3 9 PP M @ SCRAPE ATTACHMENT S 1 ) Propert y sketch provide db y EP

A pursuan t t o contract

specification s 2 ) SignedAcces s Agreemen t including acces s agreements requiredfo r crossing othe

r propertie s 3 ) Pre-Excavation digita

l vide o clip/photograph s 4 ) Pbst-ExcaVatio

B digita l video clip/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Buil

t sketch
i ) Shal l include final 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, i f available , o

r obtainedinclude : i ) Pre-excavation agreemen t detail s (i f an y ar e mad e wit h the 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/o r photograph s iv ) Signedfor

mverii^on g satisfactoiy restoratio n v ) Descriptio n o f

area s no t meetin g InterimROD cleanu p criteri a

TECHNOLOCIES , INC .Fin d Recor d Backfill : Sampl e Area : 1194 1 - 412 3 S 2 2 S T Owner : Qea n U p Quer y

D Owne rOccupied Owne rName : [STEINHOF F CHARLI E A Owne rAddressl : Owne rAddress2 : |412 3 S 2 2 ST City : [OMAH A Owne rPhone : 1 State : Zi p Code : |N E ' J6810 7 Alternat e Phone : 

# 1 Resident : Residen t Name : [HANSO N RICHAR D C Propert yAddress : (412 3 S 2 2 S T Zi p Code : 6810 7 Residen t Phon e

Lea d Remainin g Quer

yI Propert

yDamage Quer

y

Contract : Contractor : |PRUDENT2008_S Group : Assessment : Qualifyin g Grou p I PLA Y ZON E Assessmen t XR F Date : 

# I - Assessmen t MaxXR F Value : I 609.3 3TECHNOLOGIES . IN C

Propert y # : )\'?4 l Date/Time : Quad s Excavated : &/ , F l D^ ^ 

# EP A Propert y Clos e Ou t Propert y Address : l^\2- ^ 5ZZ
- ^ Owner' s Name : Contracto r

Grou p Pruden t

Technologie s Excavatio n General 1 . I f necessary , wer

e th e correct

quadrant(s ) excavatedan

drestored ? 2 . I f necessary , wer

e th e correct

areas of dri p zone excavatedan

drestored ? Gradin g Sodan dVegetatio n 1 . Doe s the grading aroun

dth e perimete

r of th e hous e i

n excavatedarea s generall

y slop e awa

y fromth e house ? 2 . Ha s sodbee

n laidi n all area s tha

t wer e excavated ? 3 . Doe s th e sodappea

r t o b e generall

y health y an dgrowing ? (Onl

y evaluat e if inspecteda

t a3 0 da y tim e period) 4 . Ar e sodde darea s generall

y firman devenl y graded ? 5 . Ar e th e joint s betwee

n th e sodstrip s generall

y tight ? (Onl

y evaluat e if inspecteda

t a3 0 da y tim e period) 6 . Was th e propert

y gradedsuc

h tha t wate r wil l not pool on the pioperty ? 7 . Was damage t o landscapin g or plan t material s avoided ? Gates , Fence s an dRetainin g Wall s 1 . D o gate s ope

n an dclos e freely? (I f

applicable) 2 . Wer e all gate s or

fence s taken dow

n during restoration activitie s reinstalled ? (If applicable ) 3 . Wa s damage to gate s or

fence s avoided ? (If

applicable) 4 . Was damage t o retaining wall s avoided ? (If applicable) Foundation , Sidin g an dGutter s 1 . Wa s damage t o the sidin

g or trimavoided ? 2 . Wa s damage t o the foundatio

n avoided ? 3 . Was damage t o window s avoided ? 4 . Was damage t o vrindow s o r doo r screen s avoided ? 5 . Was damage t o downspouts or downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) 1 . Was damage t o drivewa y surface s avoided ? 2 . Was damage i o walkwa y surface s avoided ? Ye s / / N o

Ye s No / / / / / / 

# y Ye s N o / / / i / V « N o / / / / / Ye s No / /

### Owner s comments :

Inspectio n notes :
^'^"'^ ^ CoNomo^ j prteoDic ^ ouni ^ EP

Rcjcscouh



### Remova l andrestoratio n activate s complet e including th e 30-da

y so dwarranty : EP A Representativ e Q^ ^ jgL- . Date : //??/o ^

## Propert yCompletio n Agreemen t

Thi s agreemen t

document s th e completion o f remova l activitie s performe do n th e belo w liste dproperty . Th e propert y 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 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 : ^/Z 3 J J2.3-^ ^ i5/ . Phone : Restoratio n Kern s i n Questio n Ite m

agre e restoratio n i s completed , excep t a s note d above . L J I d o no t agre e restoratio n i s complete d

'wner' s Signatur e 

# \^biio r Dat e

# DMBEM X

Pruden t Technologies , Inc . (Pnident ) i s unde r cantrac t witl i th e U . S . Envinminenta l Protectic n Agenc y (EPA ) l o clea n up lead
contaminate dsoil s a t

anumbe r o f propertie s locate di n Omaha , Nebraska , includin g th e property locate da t

. Th e EP A requests you r

permissb n t o allo w Ptuden t t o perfor masoi l cleanu p a t

thi s property t o remove lead-contaminate dsoil . B y signin g tfais form, tfa e property owner

grant s pennissio n t o Pruden t t o perfon n activitie s relatedt o th e cleanu p includin g soi l sampling , removal o f lead«ontaminate dsoil , an drestoration o f tfa e refiaencedproperty . I f yo u hav e any question s abou t th e soi l cleanup planne dfor you r property , pleas e contac t

Prudent' s Administrativ e Clerk for th e Omah aLea dSite cleanup . Ms . Madurim aDun i -a t (402 ) 733-14SS . Goiera l question s abou t tfa e Omafa aLea dSit e cleanu p ca n b e directe dt o tfa

e EP A Publi c Infonnatio>qeirkr s a t (402 ) 731-304 5 (Soutf

aOmah aofGce ) o r

(402 ) 991-958 3 (NorthOmafa aoffice) . Propeit y Acces s Grante d Property Owne r

Signature :

RESIDEN T NAME : 

## Cjn^fW ^ SvelvrNVX^ ^ leas e Prin t Name ) (Signature ) 

# ^MQ ^ (Date ) PROPERT Y INFORMATIO N (T o b e complete db y reaiden t and/o r propert y owne r

- pleas e print ) Owne r Rente r RESIDEN T ADDRESS : 

## (^....^.oJU ^ F3 Q Q<3l o ' ^ I F RENTAL , PROPERT Y OWNED BY:; , I 

# f ^ g WNER' S MAILIN G ADDRESS ; 

## f^|v>wi . iU ^ Ll-i _ 

# &?(o 7 OyyNER' S TELEPHON E NUMBER-HOME : _ L
AG E O F HOME? : 

# ^-Ui^^ ^ YEARS . HO W LON G HAV E YO U LIVE D HERE ? WORK : ^ YEARS . HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978 ? NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : ' ^ 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 5 HOUR S O R MOR E PE R WEEK : 

### ^sTclJ i
NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDE R 

# 3

COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS E ACTIONS ; Th e activitie s t o b e implemente db y EP A unde r thi s agreemen t are pursuan t

t o Sectio n 104 o f

CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f acces s t o th e property i s providedfo r i n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 960S(e) , wfaic hprovide s entry for

"determiningth e nee dfor

response, o r

choosin g o r

tikin g any response actio n unde r tfais title , o r

otherwis e enforcin g theprovision s o f tfa e title. "

808 0 War d Parkway , Suit e 40 5 Kansa s City , M O 6411 4 Phone : (816 ) 363-370 3 Fax : (816 ) 363-370 7 250 5 N . 24* ^ Street , Suit e 30 8 Omaha , Nebrask a 6811 0 Phone : (402)504-100 4 Fax : (402)504-100 5 424 2 IMedica l Drive , Suit e 425 0 Sa n Antonio . T X 7822 9 Phone : (210)822-958 8 Fax : (210 ) 579-657 7OLS# : 1194 1

Dat e Excavated : 10/04/200 8 USEP A Sl^ied-OITDate : 

### A S - BUit T DRAWIN G OMAH A LEAD SIIPEMtiN D SITE .

Owne rNanrw ; CHARU e ^s-rAf-g y Addreas : <4i-g:i& S . 1 ^ ^4 , Phono : H

t W : Omah a Lea d Sit e Sit e Sketc h Exterio rPain t Q-Goo d • Poo r (g^No t pain t 

# n ± Nort h Amt H
Sampl e Numbe r RYASCPXA - IW m F l RYBSCPXA-ttW t F 2 RYCSCPXA-n#i n B l RYDSCPXA-M»t n B 2 RDZSCPXA-ll»* H D Z nozcopKAtwn—e z RPZSCPXA-H»« H P 2 Lea d Concentratio n
5it. 1 3l 3 pp m

pp m pp m pp m pp m pp m pp m Sampl e Collecte d 

## i T n S3 ^ U\ B 

# • n D 

# n D D Sample s Collecte d Firm : (VVE S KM^e M Dale : to|ai/Ot o Ttfne : t \

OOofii^ ^

,La b RYBSCPLAr1194 1 Numbe rO f Sample s = • L Sa^.i M .10 4 1 LJSL- l 2 Resul t Sample s Analyze d XR F Unit : iOC n Book : JjS ^ Date : 1 -O ^

-g)< j Time : StafF : 

### 1 -ot ^

. J.'.^Pf!!' . _= Fron t Right , B 1 = Bac k Left , B 2 = Bac k

Righ l D Z = Dri p Zone , G Z = Garden , P Z = Pla y Ai rquadrant s »i e j » viewe d fw n tn e ttrsMJicinsproperty.. .

04tHlj»l2 3
CONTRA a # : E P - R7-07-0 6 / 000 4 PRUDEN T TECHNOLOGIES , INC .

### TECHNOLOGIES , INC . ENVIRONMENTA L & CONSTRUCTIO N SERVICE S 

# Propert y Statu s For m Address : ^^^ ^

S 2.2r>* J S K 

### Phone : Ite mN O O n Map Hoji
- ^\ o - CSS2 > Plant s & Permanen t

Landscapin g T o Remai n I n Plac e Descriptio n & Locatio n



## " ^ ' S / ? I^.aq r^ U l 0

Doe s you r

Basemen t

hav e ahistory o

f leaking ? x " 

### Descriptio n & Locatio n ^ Pre-Existin g Conditio n o

f Structure s Ye s '^- ^ No

Propert y Owne r Signa l Pruden t Employe i Signature :

808 0 Ward Parkway , Suit e 40 5 Kansa s City , MO 6411 4 Phone : (816 ) 363-370 3 Fax : (816 ) 363-3707 250 5 N . 24* ^ Street , Suit e 30 8 Omaha , Nebrask

a 6811 0 Phone : (402)504-100 4 Fax : (402)504-100 5 4242 Medica l Drive , Suit e 425 0 Sa n Antonio , T

X 7822 9 Phone : (210)822-958 8 Fax : (210 ) 579-6577Owne rName ; CkARLi e ^^TA^^g y 

# f i Address : UH. ^ S . -O . ^ . Phone : H : w Omah a Lea d Sit e Sit e SIcetc h Exterio rPain t

• Poo r Q3''No t pain t 

# laii

Nort hAno w
Sampl e Numbe r RYASCPXA-1 1 <l m RYBSCPXA-ll^ m RYCSCPXA-lim. | RYDSCPXA-U>if C RDZSCPXA-ul l nOZOOPXA RPZSCPXA-U>*V I P Z „La b RYBSCPL V SResul t 11) 1 F l F 2 B 1 8 2 D Z 

## -ez Lea d Concentrajtio n 

# m ±Li l 2 ^ .^ift l 

### 31 3 r1194 1 pp m

- = Fron t Right , B 1 pp m pp m pp m pp m pp m pp m pp m Sampl e Collecte d 

## E f
D lA B

Numbe r< >

fSample s = ( p Firm : Sample s Date : ia.\3L

\ /cx a Collecte d Time : W 00<x w Sample s \naiyze d 

## /pe n Book : l^< ^

= Bac k Left , B 2 = Bac k

Riih t D Z = Dri p Zone , G Z = Ciarden , P Z = Play Al l quadran

t i ar e as viewe d from th e street , i icin g propert y 

# EN^EilE D

### Pag e 1 o f 1

.UGUS T 200 3 - DOUGLA S COUNT Y ASSESSO R 

# lfli^5S^J?S T

http://douglasne.mappmg-online.com/assessdoc/Photos/33/R22427500000001.jp g 9/25/200 8

### Prin

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### Dougla s County-Omaha , N E

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 224275000 0

STEINHOF F CHARLI E A 412 3 8 2 2 S T OMAH A 6810 7

412 3 S 2 2 S T OMAH A N E 6810 7 Sec-Twn Rn g Additio n Bloc k Lo t Lega l 1 Lega l 2 Lega l 3 Lega l 4 Treasure r Websit e Lin k Assesso r Websit e Lin k 34-15-1 3

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### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 9/25/200 8" > 

### Pag e 1 of 2

Creat e Anothe rTicke t Bac k t o Irt h Interne t Sen d Emai l



### • YOURTICKE T NUMBE RI S 2144792 . origina l Cal l Date : 10/01/0 8 Wor k t o Begi n Date : 10/03/0 8 State : N E Address : Time : Time : UGLA S 8:4 2 a

m 9:1 5 a m Op : RAMITA1896 7

Place : OMAH

A 412 3 Twp : 14 NRng : 13 E Twp : 15 NRng : 13 E Lega l Given : C Sect-Qtr : 03-NW Sect-Qtr : 34-S W Typ e o f Work : lea d remediatio n wor k fo r soi l Locatio n o f Work : LOCAT E ENTIR E PROPERT Y Remarks : FA

X AL L CLEAR S TO : : UNSUR E CORNER S (402)733-188 3 Compan y Contac t Nam e Alt . Contac t PRUDEN T TECHNOLOGIE S

RAMIT A Phone : (402)733-145 5 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 ATTNEBR l CXCAT V LEVEL S MCLEODN E MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F QWEST 2
Servic e Are a
ATTNEBR

l ATT/

T Contact Phon e Number 

### Day : 8002413624 9 Ah : 

### Emerg : 8002413624 9 Utilit y Typ e

CXCAT V CO

X COMMUNICATIONS , ^^jj^ j IN C 

### Day : 402934046 9 Ah : 402934046 9 Emerg : 402932975 7 LEVEL 3 LEVEL

S COMMUNICATIONS , .^ ^ 

### Day : 877366834 4 Ah : 

### Emerg : 877366834

4 MCLEODN

E MCLEODUSA NO NEE D TO CAL

L OU T Qay : 800289190 1 EMERGENC

Y 

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### Pag e 2 of 2

MUD0 2

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0PPDGPR 6 METROPOLITA N UTILITIES DISTRIC T CIT Y O FOMAHA

TRAFFICSEWE

R OMAH A PUBLI C POWE R DISTRIC T SAND Y

RO N

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### Emerg : 800289190 1

Day : 402504782 3 Ah : Emerg : 402504794 6 Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 Alt : 888728934 3 Emerg : 406728934 3 Day : 406728934 3 Ah : 

### Emerg : 888728934 3 Day : 800283423 7 Ah : 303992192 6 Emerg : 800283423 7

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