## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL E FOLDE R SAI D # : r?fc^ ^ Date : M^I5-) 0 Address : Q OC ^ f^/Hf]Ni n A f Remediatio n Contractor : Pi?, , nPr^- f itr ^ NO<IOC| 

## \^<. ^ irsjy., i Year : /(J I ( j SOI LREMEDL\TIO N PROPERT Y FIL E FOLDE RDOCUMENT S \

/ Vide o of propert y (DVD ) 0 Executiv e Summar y H EPA-providedpropert y sketch 0 SignedAcces s Agreemen t fo r

subject propert y D SignedAcces s Agreement(s ) fo r

adja^n t propert y y Restoratio n Agreemen t n Settlemen t document s (i.e. , fo r

damag e o r

to replac e plants , etc. ) Q Confirmation data 'Z Photograph s 0 As-built sketch Satisfector y restoratio n signedb y Propert y Owne r Propert y close-out check lis t signedb y EP A D Descriptio n o f area s no t meeting RO D cleanu p criteri a y Utilit y clearance s 0 Propert y information fromDougla s Count y Assessor' s Office D D D 

## Signatur e Dat e 3021835 3 

# Mi l

Superfun d

### PROPERT Y SUMMAR Y Date : 11/15/201 0 Omah aLeadSit e Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l Month i of : November Propert y Address ; 4002 FRANKLIN S T A . EXECUTIV ESUMMAR Y A. 1 Issue s Encountered : NON E A. 2 Issue s Resolved : NON E A. 3 Uniqu e Findings : NON E A. 4 Othe r Relevant Information : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : F2 = 15 7 PP M @ 9" ; E A = 15 8 PP M @ SCRAP E (~1" ) ATTACHMENT S 1 ) Propert y sketc hprovidedb y EP A pursuan t to contract specification s 2 ) Signe dAcces 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 ) Post-Excavation digita l vide o clip/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Buil t sketch
i ) Shal l includ e final lea dlevel s v ) Legen d ii ) Contamination lef t behin darea s vi ) Contracto r identification iii ) Propert y addres s vii ) Dat e iv) BVI D numbe r 7 ) Othe r items t o be includedi n 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 hthe propert y owner ) ii ) Propert y Statu s For msignedb y propert y owne r iii ) Excavation digita l vide o i n MPEG , WM V (Window s Medi aVideo ) o r SW F(Flas hPlayer ) forma t and/o r photograph s iv ) Signe dfor mverifying satisfactor y restoration v ) Description of area s no t meeting Interi mRO D cleanu p criteria .

TECHNOLOCIES . INC .Fin d Recor d Remediatio n Quer yj Lea d Remainin g QueryI Propert yDamag e Query 

### Backfill :

Sampl e Area : 2629 4 - 400 2 FRANKLI N S T Owner : Use rProvide d Owne rInformatio n Resident : n Owne rOccupie d Owne rName : Owne rName : Residen t Name : IKELL Y MAR YC 

# I Owne rAddressl : Owne rAddress : Propert yAddress : |400 2 FRANKLI N ST Owne rAddress2 : Zi p Code : |371 7 N 11 4 Q R |68111 - City : State : Zi p Code : City : State : Zi p Code : Residen t Phon e JOMAHA |N E |68114 - 

# I Owne rPhon e Alternat e Phone : Owne rPhone : Altemat e Phone : 

# " 1

Contract : Assessment :
contractor : PRUDEWT201 0 S Qualifyin g Grou p |46 o Contrac t Optio n JOPTIO N 1 Assessmen t Ma xXR F Valu e j 522.7 9TECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y tf:,^^*^! Propert y Address : ^CX> t F^'f^ ' " ^ Date/Time : Owner' s Name : P-»"cW)>jrtA , \^t\(i\ Quad s Excavated : p2 ^ Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s N o I . I f necessary , wer e tli e correc t quadrant(s ) excavate dan drestored ? y 2 . I f necessary . wer e th e correc t area s o f dri p zon e excavate dan drestored ? 

# y Gradin g So dan dVegetatio n Ye s N o 1 .Doe s th e gradin g aroun dth e perimete r o f th e hous e i n excavate darea s generall y slop e awa y fro mth e house ? 

# y 2 .Ha s so dbee n lai di n al l area s diat wer e excavated ? 

## y 3 .

Doe s tJi e so dappea r t o b e generall y healdi y an dgrowing ? (Onl y evaluat e if inspecte da t a3 0 y ^ da

y tim e period ) 4 .Ar e sodde darea s generall y finn an devenl y graded ? y ^ 5 .

Ar e th e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte dat a3 0 day 

# y tim e period ) 6 .Wa s th e propert y grade dsuc htliat wate r wil l no t poo l o n th e property ? 

## y 7 .

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

## y Gates , Fence s an dRetainin g Wall s Ye s N o 1 .Do gate s ope n cin dclos e freely ? (I f applicable ) 2 .Wer e all gate s or fence s taken dow n during restoratio n activitie s reinstalled ? (I f applicable ) Wa s damag e t o gate s or fence s avoided ? (I f applicable ) Was dainag e t o retainin g wall s avoided ? (I f applicable ) Foundation , Sidin g an dGutter s Ye s N o 1 . Wa s damag e t o th e sidin g o r tri mavoided ? 

# y 2 . Wa s damag e to tli e foundatio n avoided ? 

# y 3 . Wa s damag e l o window s avoided ? 

# y 4 .Wa s damag e t o window s o r doo r screen s avoided ? 

# y 5 .Wa s damag e t o downspout s o r downspou t extension s avoided ? ^ Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Wa s damag e l o drivewa y surface s avoided ? 

# y 2 . Wa s dainag e t o walkwa y surface s avoided? . 

# y

## Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e fL„y^ ^ Date : lojisli o

### 2629 4 1THNOL(XJIES . INC . 

### A S - BUIL T DRAWIN G OL S U 2629 4 Dat e Excavated : 09/20/201 0 I'SEP. ASigned-Of TDate : 

### ^ OMAH A LEA D SUPERFUN D SIT E

Exterio rPain t Nort h Arro w Omah a Lea d Sit e Owne rName : RICHAR D I KELLY Sit e Sketc h • Goo d Address : 400 2 FRANKLI N S T • Poo r 

# t

Phone : H ; w : Q No t pain t Lea d Sampl e Sample s Collecte d Concentratio n Collecte d Sannpl e Numbe r LA B Fir m 

## ri) Atcjdf A RYASCPXA-2629 4 F l pp m 

### D Dat e '=1-1
- o H RYBSCPXA-2629 4 F 2 pp m 

### D Tim e 

# i RYCSCPXA-2629 4 B 1 pp m 

### D 

# i d Sample s Analyze d RYDSCPXA-2629 4 B 2 pp m 

### D ^np^r;^r^(fl^ l rnm—DZ ~ pp m XR F Unit : 

## n RG.?SCPYft,?fi?':ii i GZ ­ pp m 

## n Date : O^-^LA,.^ ^ 

### D RPZSCP.YA.262'a 4 BZ - pp m 

### D Numbe ro f Sample s = i 7

- J 

## ENiTERE D SE P 1 0 200 4

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### 2 5 ' * - — :
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# ... n n Sa-b ; Wdt K ^Tht^l^Ul ^ 7>^
- Omah aLeadSite 4613 0 E. \= 15 8 PP M fd i SCR.\P E CONTRAC T# : EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC .

### Thi s agreement document s th e completio n o f remova l activitie s performe do n th e belo w hste dpropertv ' Th e property owner' s signatur e indicate s tha t th e property owne r i s satisfie dwithth e restoratio n ofth e subjec t property , an dtha t n o item s ar e in question , now , o r a

t an y tim e 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 , i f any . Property ID : Propert y Address : LI^ Q 

## ^ FroLr>\ C ^(- \ 

## S' t r - Owner : 

# Kco-u r VI^^CJU . Phone : 

# Q Restoratio n Item s i n Qyestiom :

Keni : item : Dte m Stem : Ite m Ite m 

### Require d correction s t o complet e th e propeirty : 

# f agre e restoratio n i s completed , excep t a s note d abov e d o no t agre e restoratio n i s complete d 

# Id)y3-yy) y Dat e^ \

. I Pruden t Technologies , Inc . (Prudent ) i s unde r contrac t withth e U . S . Environmenta l Protectio n Agenc y (EPA ) t o clean u p lead
coptaminate dsoika t anumbe r ofpropertie s locate di n Omaha , Nebraska , includin g th e propert y locate da t KX>C ^ 2-

—f'^y^Qjr y fc-l I V l Th 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 perfor m activitie s relate dt o th e cleanu p includin g soi l sampling , remova l o f Iead-contaminale dsoil , an drestoratio n ofth e reference dproperty . Ifyo u hav e an y question s abou t th e soi l cleanu p planne dfor you r property , pleas e contac t Pruden t southoffic e .fo r th e Omah aLea d Site cleanup-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 Publi c Informatio n Center s a t (402 ) 73 1 -304 5 (SouthOmah aoffice ) o r (402 ) 991-958 3 (Nort hOmah aoffice) . Property Acces s Grante d 

# ^.tkryjiyj i Prin t Name ) 

### jyT j ' ' (Pfeay : Property Owne r Signature : / . 

# ±yfyM^ ^ (Signature ) (Date ) PROPERT Y INFORMATIO N o b e complete db y residen t and/o r propert y owne r — pleas e print ) RESIDEN T NAME : Owne r Rente r 

# I . ^"^^y^fi^.yy.^j/y. . y I F RENTAL , PROPERT YOWNE D BY :
OWNER' S MAILIN G ADDRES S 

# •j'/ n 7 ^ //y,uy ^ y^ i v-y^-/^^^ ^ OWNER' S TELEPHON E NUMBE R - HOME : WORK :

t> 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 FO R 5 HOUR S O R MOR E PE R WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTRY GATES , ETC. )

ALrrHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : 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 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f

acces 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 9605(e) , whic hprovide s entry for "detcmninin g th e nee dfor response , o r choosin g or takin g an y respons e actio n unde r thi s title , o r otherwis e enforcin g th e provision s ofth e title. " 808 0 War d Parkway , Suit e 40 5 560 0 S 1 0 S t 424 2 Medica l Drive , Suit e 425 0 Kansa s City,'M O 6411 4 Onnaha , Nebrask a 6810 7 Sa n Antonio , TX 7822 9 Phone : (816 ) 383-370 3 Phone : (402 ) 733-118 8 Phone : (210)822-958 8 Fax:(816)363-370 7 Fait : (402 ) 733-188 3 Fax:(210)579-657 7ENVfRONMENT.A L & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE. S 

# y . rrope i Propert y Statu s For m Date : Address : V^^.Z ^7^ytfiyt/^^Tyi y BVID : 

## Phone : ^.^ ^ ­ ^f/-^^^/ /

Propert y Owne r Pruden t Employe e Signature : 808 0 War d Parkway , Suit e 40 5 Kansa s City , M O 6411 4 Phone : (816 ) 363-370 3 ^ , 

## Signature : 560 0 S 1 0 S t Omaha , Nebrask a 6810 7 Phone : (402)733-118 8

c.. . i»n'\ \ ti t <oo ^ fledical Drive , Suit e 425 0 Sa n Antonio , TX 7822 9 Phone : (210)822-958 8 Ci v I'Ht WS70J:KT 7

## 2629 4 Omah a Lea d Sit e Exterio rPain t Nort hArro w Owne rName : RICHAR D L KELL Y 

## Sit e Sketc h • Goo d Address : 4002 FRANKLI N S T • Poo r 

# t Phone : H : yv : • No t pain t Sampl e Numbe r Lea d Sampl e Sample s Collecte d 

# i LA B Concentratio n Collecte d 

## Fimi : P M bCJ^r ^ RYASePXA-2629 4 F l pp m 

# n Date : ' J -' J • 0* 4 RYBSCPXA-2629 4 F2 pp m 

# n Time : l^.'S O RYCSCPXA-2629 4 B 1 pp m 

# D Sample s Analyze d RYDSCPXA-2629 4 8 2 pp m 

# n nnrnrr¥ A ?n?ni—oz ^ pp m 

# n XR F Unit : 

## ^A:LBook: ^ RG.7fiCPYA?fi?n( 1 GZ — pp m 

# n D Date : (^-\^.f^^- | RP^SCPYA.?6'Z0 4 RZ - pp m 

# D D 

# n Numbe ro f Sample s = * / 

# ENTERE D SE P 1 0 200 4

% \ . 

## \t) X



# 2i ' 

# mnicLifosr o 

# a ... 0 59.- ^ . J L • I • 'I M V ^•^^^^ ^ 

# .^im L 

# H^KU/o.sr . Omah aLea dSit e 4613 0

## N 

# 400 2 Frankli n S t 

# A fe^ 

### Printed : No v 16,201 0 www.dcgis.org/dogi s

### Pag e 1 o f 1

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



### . YOU RTICKE T NUMBERI S 2594301 . Origina l Cal l Date : 9/16/1 0 Time : 3:0 1 pm Op : SIVA1896 7 Wor k t o Begi n Date : 9/20/1 0 Time : 3:3 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 400 2 Street : FRANKLI NS T Twp : 15 NRng : 13 E Sect-Qtr : 17-NE 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: PRUDENT 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

MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Servic e Are a Contac t Phon e Numbe r Utility Typ e CXCAT V COX COMMUNICATIONS , IN C HEIDI 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUDO l METROPOLITA N UTILITIE S DISTRIC T SANDY 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACOFCITY OFOMAHA-TRAFFIC,SEWE R RICHA-RAFFI C 

### Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0 OPPDGPR5 OMAH A PUBLIC POWE RDISTRIC T EL M LOCATING 

### Day : 406728934 3 Alt : 406207149 4 

### Emerg : 888728934 3 QLNN E 1 C QWES T LOCA LNETWORK 

### EL M LOCATIN G Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 

### http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/16/201 0

### ENVIRONMENTA L ENGINEERIN GAN D CONSTRUCTIO N ISDMNmoeffiB , I 

### SOLUTION S 

## SIT E SAFET Y HAZAR D ANALYSI S Address : ^OO ^ fM\^) U " M Excavatio n Date : -UM . Crew : /^/^/l / Vamkf J Backfil l Date :

Ite m Conditio n Hazard s Correctiv e Actio n Overhea dLine s Gas Lin e C,£y0J i • ^ 

## Wate r Lin e (yiy)cyi l 

## Sewe r Lin e ^ 

## Septic/Leec h Fiel d 

# yy/y f Propane/Bntan e Sidewal k Foundatio n 

## Retainin g Wall s yty^L . Fence s Tree s Stmcture s Driveway Sprinkle r Syste m Othe r Cre w Forema n Sit e Safety Offic e Date : y^y / < C a 

# j2 ^ i^rs J iT^i^ltL

8080 Wanfeariony . auitBr40 5 

### seoosios t 424 2 Medica l Drive , Stlit s 7250 KanasGi|y.HO«411 4 Ontirfia , NateiM a <8t0 7 Sa n Antonio , T X 7822 9 Phone : (81<)36S'370 3 PHens : (402)733-110 8 Phone : (2t0 ) 82Z-i958 8 Fax : {81S) 363-370 7 Fax : (402)733^188 3 Fax : (210)67»-657 7