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### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 2732 0 DATE : 1/1 5 ADDRESS : 200 8 N 2 5 S T REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES . INC . YEAR : 201( ) 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S d PR E AN D POS TVIDE O O F PORPERT Y(DVD ) d EXECUTIV E SUMMAR Y

EPA-PROVIDE D PROPERT YSKETC H d SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT{S ) FOR ADJACEN TPROPERT Y d RESTORATIO N AGREEMEN T n SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R TO REPL^C E PLANTS , ETC. ) d CONFIRMATIO N DAT A H PHOTOGRAPH S d AS-BUIL TSKETC H d SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R d PROPERT YCLOSE-OU TCHECKLIS TSIGNE D B YEP A D DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A \yUTILIT YCLEARANCE S d PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E D D D 

### Qy-^' ysli h SIGNATUR E DAT E 3021840 2 Superfun d

### PROPERT Y SUMMAR Y Date : /15/201 0 Oinah aLea dSit e Remedia l Actio nContrac t #EP-R7-07-0 6 TO# l Mont hof : Propert y Address : 200 8 N 2 5 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 Relevan t Infonnation : NON E CONFIRMATIO NSAMPLIN GDATA/RESULTS : < 3 i. "

F l - 3 3 PPR l @ 6" ; F l • 7 6 PP M (g ) 68 ; E A = 27 8 PP M @ SCRAP E(~1" ) J , Q l - ^^ ^ PPi^ ^ ATTACHMENT S 1 ) Property sketc hprovide db y 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 n digita l vide o clip/photograph s 4 ) Post-Excavatio n digita l vide o clip/photograph s 5 ) Documentatio n - Complete dClose-ou t Checklis t 6 ) As-Bui hsketch
i ) Shal l includ e final 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 din th e individua l property file, i f available , o r obtaine dinclude : i ) Pre-excavatio nagreemen t detail s (i f an y ar e mad e withth e property owner ) ii ) Property Statu s Formsigne db y property owne r iii ) Excavatio ndigita l vide o inMPEG , WM V (Window s Medi aVideo ) o r SWF(Flas hPlayer ) format and/o r photograph s iv ) Signe dfor mverifyin g satisfactory restoratio n v ) Descriptio nofarea s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOCIES , INC .Fin d Recon j 

### Backfill :

Sampl e Area : 2732 0 - 200 8 N 2 5 S T Owner : n Owne rOccupie d 

### Owne rName : ICTTYOFOMAHA Owne rAddressl : |C/ 0 CIT YnNANC E Owne rAddress2 : |181 9 FARNA M S T City : State : Zi p Code : jOMAH A |N E |68183 - 

### Owne rPhon e Alternat e Phone : 

# f
Contract : contractor : |PRUDENn010 . . S Contrac t Optio n |OPTIO N 2 Remediatio n Quer yI Lea d Remainin g Quer yj Propert yDamag e Quer y


### Use rProvide d Owne rInformatio n Owne rName : Owne rAddress : 

## I City : State : Zi p Code : 

# 1 1 1 Alternat e Phone : Owne rPhone : 

# 1 1
Assessment : Qualifyin g Grou p [sO O Assessment Ma xXR F Valu e j 946 Resident : Residen t Name : 

# I Propert yAddress : |200 8 N 2 5 S T Zi p Code : |68111 - Residen t Phon e 

# ITECtlNOLOGlKS , INC . 

# EP A Fropert)' ' Clos e Ou t Pi-opcrt y #:'?- . 7 3'^C ) Fropemt y Address : ZC>6' ^ pT-^^J - Date/Time : Owner' s Name : <i"'"^- ^ ofOtT^K- ^ Quad s Esca'jated : ^ / Contracto r Group : Priuleint TecJmologics , Inc . Excavatio n Genera ) Ye s N o I I f necessfirv , wer e th e correc l quadrant(s ) excavatedandrestored ? 

## y 2 i r necessjiry . wer e th e correct area s o f drip zone excavatedan drestored ? / Gradin g So dan dVegetatio n Ye s N o ! 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 away fro mth e house ? / 2 .Ha s so dbee n lai di n al l area s tlia t wer e excavated ? / :i . Doe s (he ao dappear t o b e generail y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 day lim e period ) / 4 .Ar e sodde darea s generall y fir man devenl y graded ? / 5 .Ar c tli e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e if inspecte da l a3 0 day tun e period ) / (>

, Wa s th e property ' grade dsuc htlia t wate r wil l no t poo l o n tli e property ? / 7 .

Wa s dajiKige ( o landscapin g or plan t material s avoided ? / Gates , Fence s an dRetainin g Wall s Ye s N o 1 . D o gate s ope n an dclos e freely ? (I f applicable ) / 2 , Wer e al l gale s o r fence s take n dow n diuin g restoratio nactivitie s reinstalled ? (I f applicable ) / .3 Wa s damag e l o gate s o r fence s avoided ? (I f applicable ) / 4 . Wa s damag e t o retainin g wall s avoided ? (I f applicable ) / Foundation , Sidin g an dGutterf ) Ye s N o 1 Wa s damag e t o th e sidin g o r tri mavoided ? / 2 Wa s damag e t o th e foundatio n avoided' ^ / 3 Wa s damag e t o window s avoided ? / 4 Wa s damag e t o window s o r doo r screen s avoided ? / -" j 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 I Was damag e t o diivewa y surface s avoided ? / Wa s damag e t o walkwa y surface s avoided ? /

## Owner s comments :

Inspectio n notes : 

# r ^ y ^ y cyl i y

Remova l an drestoratio n activate s complete includin g th e 30-da y so dw^airanty : EP A Representativ e A ^ J^ , ^Date : ///g// /THNOIOtilFS . IN C 

### A S - BUIL T DRAWIN G OL S # 2732 0 Dat e Excavated : 10/07/201 0 

### OMAH A LEA D SUPERFUN D SIT E rSF.P ASigned-OfTDate : 

## ^T5Z O Exterio rPain t Omah a Lea d Sit e • Goo d Sit e Sl<etc h • Poo r Samplin g Address : -Z-O C 

### S + g'No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : P g T^iC . r>f t %.k RYASCPXA-Z7a2 0 F l H S ppm 

### [ y D Date : nll'^ll Q RYBSCPXA-Z732 0 F 2 3 H ppm 

## o r D Time : q-OOA> A RYCSCPXA-Z732 0 B 1 -f« 8 ppm \ 2 ' 

# n Sample s Analyze d RYDSCPXA--1732 0 B 2 ?0 3 ppm 

# a RDgOOnX At73a o D 2 _ = pp m 

# n a XR F Unit : Book : 2JCC & RGZCOPX Aa7aa o e z . n pp m 

# a a Date : RPZGOPX A*7»^ 0 P Z _ = pp m 

# • n Time : 

## I t L Staff : A75tx / Numbe rof Sample s = Legend ; F 1 = Fron t Left , F 2 = Fron t Right , 8 1 = Bac k Left , B 2 = Bac k Rigfi t D Z = Dri p Zone , G Z = Garden , PZ = Pla y Al l quadrant s are a s viewe d fro m th wstreet , facin g property 

## I : tJSTJ D 

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CONTRAC T # : EP-S7-10-0 5 PRUDENTTECHNOLOGIES , INC .

# SEPA Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio no f removal activitie s performe do nth e belo w liste dproperty . Th e property owner' s signatur e indicate s that th e propert y owne r i s satisfie dwit hth e restoratio no f th e subjec t property , an dthat n o item s ar e i n question , now , o r at an y tim e i nth e future , excludin g an y remainin g warranty (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Property ID : Property Address ; ^^^ J ^^^^^ ^ ^^^^t b ^4^4 . Owner : yt k M /^/>^/ig3 - 

### Phone : L,L/L(-L,^H y 

### Restoratio n item s i n Question :

item : Item : 

### item : item : item : Item :

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



### ^^-Ociv^c r ~^0/ d DatePniden i Technologies , Inc . (Prudent ) i s unde rcontrac t wit h th e U . S . Environmema l Proteciio n Agenc y(EPA ) t o clea n u p Icad coniantinate d soil s a l a numbe rofpropertie s locate d i n Omaha , Nebraska , includin g ih cpropen ylocated a t t/OO j AJ . iS' ^ 6T" . . The EP Arequest s you rpermissio n t o allowPruden l l o perrorm a soi l cleanu p a t thi s propert yt o remov e lead-contaminated soil . B ysignin g thi s form , th e propert yow-nergrant s peimissio n l o Prudent t o perfon n activitie s related t o th e cleanu p includin g soi l sampling , remova l o f lead<onlaminalc d soil , an d restoratio n ofth e referenced property . Ifyo u hav e an yquestion s abou t Ih e soi l clcmu p planne d fo r)'ou rproperty , pleas e contac t Pruden l south ofTic e .fo rth e Omah a Lea d Sit e cleanup-a t (402 ) 733-1188 . General questions abou t th e Omah a l.cad Site cleanu p ca n b e directe d t o th e EP APubli cInformatio n Center s a

t (402 ) 731'3045 (South Omah a olTice ) o r(402 ) 991-958 3 (Nort h Omah a ofTicc) . Propert yAcces s Granted By : A/.'///^ ? tv i // • /-uiyAi ^ (Pleas e Prin t Name ) 

# e £y^t/yLyL A Propert y0\vne rSignamre : /yyCW'/\ j yx/^y^/yS-Oc-f'c/OJi l ' IA ' (Signature ) (Date ) PROPERT YINFORMATIO N ('f o b e completed b yresiden t and/o rpropertyowne r- plcis e print ) RESIDEN TNAME : Owne rRente r RESIDEN TADDRESS : j l
I F RENTAL , PROPERT YOWNE D BY : OWNER' S MAILIN G ADDRESS ;



### li/' ) J^^Yit ^ ^^^CC/.SL;U//I fOt^ U Aj e 6^(i \ OWNER' S TELEPHON E NUMBE R - HOME : ( ) WORK :



### yi(i}. \ WV-vjt^r; ^ 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 ? ^YES . 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 WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTRYGATES , ETC. )

AUTHORITYFOR ENVIRONMENTA L RESPONS E ACTIONS ; Th e aciiviiie s l o b e implemented byEP Aunde rthi s agreemen t ar

e pursuant t o Sectio n 10 4 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s righ t ofaccess l o th e propert yi s provide d fo ri n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic h provide s enti yfo r"detemiinin g Ih e nee d fo rresponse , o rchoosin g o rtakin g any response actio n unde rthi s title , o i otherwise enforcin g th e provision s ofth e tiile. " 808 0 War d Parkway , Suit e 40 5 SSOOSIOS t 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6810 7 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phono : (402)733-118 8 Phone : (210)822-968 8 Fax:(816)363-370 7 Fax:(402)733-188 3 Fax:(210)579-657 7

## 2732 0 Exterio rPain t Nort h AiTO W 

### Omah a Lea d Sit e • Goo d Sit e Sketc h Q^Poo r Samolin a Address : 200 8 N 25 S T • No t paint Sampl e Numbe r Lead Concentratio n XR F LA B Sample s Collecte d RYASCPXA-2732 0 F 1 

## U2t2lL-.PP " \ D Fimi:Pgli/g . IE)M\A / 

### RYBSCPXA-2732 0 F2 <^ML ? pp m Date . Illzt^ltf l 

# n RYCSCPXA-2732 0 B l .?ID 1 

### ppm Time : ft-MgMA 

## D RYDeOPX A2732 0 BS - ' - pp m 

### Sample s Analyze d 

## D RDZSCPXA-2732 0 DZ 

## \l^ Q pp m D XR F Unit : IQftfia . Book: ZSCi t RCZSGPX A2732 0 62 - • ~ pp m 

## D D Date : 11/23/ ^ RPZCX}nXA-2702 0 P Z " " pp m 

## D D Tim e 

## Ba a Numbe ro f Sample s = | ^ | [ ( ^ \ Staff : 

## MS W Legend : F l = Fron t Left , F2 = Fron t Rigtit , B l = Bac k Lett , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla ^ AB quacCrant s ar e a s viewe d fr9 m th e street , fadn g propert y r- ^ ) i t 1 1 

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YOU RTICKE T NUMBE RI S 2609474 . Origina l Cal l Date : 10/05/1 0 Time : 4:3 8 p m Op : SIVA1 8 96 7 Wor k t o Begi n Date : 10/07/1 0 Time : 5:1 5 p m State : N E County : DO.UGLA S Place : OMAH A Address : 200 8 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 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 LEVEL 3 MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Servic e Are a Contac t Phon e Nunibe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEIDI Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 LEVEL S LEVEL S COMMUNICATIONS , LL C N A Day : 877366834 4 Alt : Emerg : 877366834 4 MUDO l METROPOLITA N UTILITIES DISTRIC T SAND Y Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRICH/TRAFFI C Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 http://www.dhon . org/irthlntemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 10/5/201 0

### Pag e 2 of 2

OPPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T ELM LOCATIN G 

### Alt : 406207149 4 Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K Day :

EL M LOCATIN GAlt : 406728934 3 406207149 4 Emerg : 888728934 3

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### m c CONSTRUCTIO N SOLUTION S 

## SIT ESAFET Y HAZAR D ANALYSI S Addres s 

# : ._..^i_._^.--2.C.£?r
- Excavatio n Date : Crew : BackfiU Date :

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 Driveway Sprinkle r Syste m Othe r Cre w Forema n Conditio n Hazard s Correctiv e Actio n c^< ~ O C 1

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