### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 3142 1 DATE : 12/15/201 0 ADDRESS : 303 9 PINKNEYS T REMEDIATIO N CONTRACTOR : PRUDENTTECHNOLOGIES . IN C YEAR : 201 0 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S c f PR E AN D POS TVIDE O O F PORPERT Y(DVD ) n ( EXECUTIV E SUMMARY \ d EPA-PROVIDE D PROPERT YSKETCH d SIGNE D ACCES S AGREEMEN TFO R SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT(S) FOR ADJACENTPROPERT Y d RESTORATIO N AGREEMEN T

• SETTLEMEN TDOCUMENT S (I.E. , FOR DAMAG E OR T O REPLACE PLANTS , ETC. )

• CONFIRMATIO N DAT A Q

5 PHOTOGRAPH S 

# 4 . AS-BUIL TSKETCH SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R 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 Q UTILIT YCLEARANCE S [ ^

PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E 

# • D 

## t^ M 8lJ*^* ' SIGNATUR E DATE 3026078 4 Superfun dFin d Record Remediatio n Quer y[ Lea d Remainin g Quer yPropert yDamag e Quer y Backfill :

Sampl e Area : 3142 1 - 303 9 PINKNE YS T Owner : Use rProvide d Owne rInformatio n n Owne rOccupie d Owne rName : Owne rName : DAILE YFRAN KE Owne rAddressi : Owne rAddress : 

### 1 " • Owne rAddress2 : J311 3 N 3 0 S T City : State : Zi p Code : City : State : Zi p Code : lOMAH A 

### IN E J68111 ­ 

# ir Owne rPhon e Alternat e Phone : Owne rPhone : Alternat e Phone : )(402 ) 880-691 2 

# 1

Contract : Assessment : Contractor : PRUDENT2010 . . 5 Qualifyin g Grou p J400 Contrac t Optio n J OPTIO N 2 Assessmen t Ma xXR F Valu e f 493. 8 

## 1 1 Resident : Residen t Name : Propert yAddress : 1303 9 PINKNE YS T Zi p Code : |68111 - Residen t Phon e 

# i

### PROPERT Y SUMMAR Y Date : 12/15/201 0 Omah aLea dSit e Reniedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Decembe r Propert y Address : 303 9 PINKNE Y S T A . EXECUTIV ESUMMAR Y A. l 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 Information : POLE , TRE E& CONCRET EO N TH EWES T SID EO FTH EPROPERT Y CONFIRMATIO N SAMPLIN GDATA/RESULTS : F l = 14 2 PP M @ 10" ; E A = 11 2 PP M @ SCRAP E(~1" ) ATTACHMENT S 1 ) Property sketc hprovide dby EP A pursuan t t o contrac t specification s 2 ) Signe dAcces s Agreemen t includin g acces s agreement s require dfo r crossin g othe r propertie s 3 ) Pre-Excavatio n digital vide o clip/photograph s 4 ) Post-Excavatio n digital vide o clip/photograph s 5 ) Documentatio n - Complete dClose-ou t Checklis t 6 ) As-Built sketc h­ i ) Shal l includ e fina l lea dlevel s v ) Legen d ii ) Contaminatio n lef t behin darea s vi ) Contracto r identificatio n iii ) Property addres s vii ) Date iv ) BVI D numbe r 7 ) Othe r item s t o b e include di n th e individual property file , i f available , o r obtaine dinclude : i ) Pre-excavatio n agreement detail s (ifan y ar e mad e wit hth e property owner ) ii ) Property Statu s For msigne dby property owne r iii ) Excavatio n digita l vide o i n MPEG , WMV (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 n ofarea s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOCIES , INC .TECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propcitv# : ^^f^' i Pj-opert y Address : 303* ^ PmV:-r^«- ^ ^h Date/Time : lOf2. Z(2y>l V Owner'sName : FVCL/VIC
- t>c« J 1*^. / Quad s Excavated : Contracto r Group : Pruden t Technologies , Unc , Excavatio n Genera l ('e s No I L t necessarv . wer e lli e correc l quadrant(s ) excavate daii drestored' ^ y 2 , If necessary , wer e th e correc t area s ofdri p zon e excavate dan drestored ? 

### y Gradin g So dan dVegetatio n Ye s No I .Doe s Ui e gradin g aroun dtJi e periinete r ofth e hous e in excavate darea s generall y slop e away fro mth e liouse ? / 2 .Ha s so dbee n lai di n al l area s Uia l wer e excavated ? y .V Doe s th e so dappea r l o b e genenili y health y an dgrowing ? (Onl y evaluat e if inspecte da t a3 0 da

y tim e j.ieriod. ) 

### y 4 Arc sodde darea s generall y fir man devenl y graded ? 

### y 5 .

Are di e joint s belwee n th e so dstnp s generall y light ? (Onl y evaluat e i f inspecte dal a3 0 day y tim e period ) 6 .Wa s th e property grade dsuc htlial wate r wil l no t poo l o n di e property ? y 7 Wa s d:miag e l 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' ' (Ifapplicable ) 7
-1 Were al l gate s or fence s tal<;e n dow n durin g restoratio n activitie s reinstalled ? Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) Wa s damag e l o retainin g wall s avoided ? (Ifapplicable ) (I f applicable ) Ye s y y 

### y A No

Foundation , Sidin g an dGutter s 1 Wa s dainag e to th e sidin g o r tri mavoided ? 2 Wa s damag e to th e foundalio n avoided ? Ye s / / No

3 Wa s damag e t o window s avoided ? 4 . Wa s daniag e t o window s or doo r screen s avoided' ^ / 

## 7 ." ) Wa s damag e l o downspout s o r downspou t extension s avoided ? / Sidewalk s an dDriveway s (Concrete ) I Wa s damat; e l o diivewa v surface s avoided ? 2 . Wa s damag e t o walkwa y surface s avoided ? Ve s / 

## y No

### Owner s coimments :

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### Remova l aitdrestoratio n activate s complet e includin g th e 30-day so dwarranty : EP A Representativ e Qa ^ j ^ Date : io[ts|' orrfTKDTOGlES . IN C OL S #3142 1 Dat e Excavated : 10/19/201 0 IISEP A Signed-Of f Date :

Owne rName : FRANK J DAILE Y Address : 303 9 PINKNE YS T

Phone : H : Sannpl e Nunnbe r RYASCPXA-3142 1 F l RYBSCPXA-3142 1 F 2 RYCSCPXA-3142 1 B l RYDSCPXA-3142 1 8 2 f^DZGCPXA-314g 1 B ? RCZCCPXAOMg l QZ ­ -RrZGCrXA-3142 1 PZ 

## ENTERE D AU G 1 2 20Q 4 

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A = 11 2 PP.M'&SCR.\P E CONTRAC T# : EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC .

## Propert yCompletio n Agreemen t Thi s agreemen t documents 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 that th e property owne r i s satisfie dwit hth e restoratio n ofth e subjec t property , an dtha t n o item s are i n question , now , o r a

t any tim e i n th e future , excludin g any remainin g warranty (3 0 day s total ) excep t thos e item s liste dbelow , ifany . Property ID : Property Address : 

# • SOS M Pir\.li ^ Owner : 

### Phone : Restoratio n Item s i n Question :

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

# < s 

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I I 1 agre e restoratio n i s completed . I I 1 d o no t agre e restoratio n i s complete d a t (note d deficiencie s above ) 

# D Asfd / \om\d Owner' s Signatur e Date• • / Pnidcii l Technologies , Inc . (Prudent' ) i s unde r conti-aci wilhth e U . S . Envirommemal Proteclio n .A.genc Y (EPA ) t o clean u p lead
conKuiiinatc dsoil s a t anumbe r o f

propenie s locaie di n Omaha , Nebraska , includingth e property locate da l

. Th e El-'A rcquesl s your permissio n l o allo w Pniden t t o performasoi l cleanu p a t thi. s propen y l o remov e lead-conlaminalc dsoil . B y signin g this form , th e property owne r grant s permissio n t o Pruden i t o perform activitie s relate dt o th e cleanu p includin g soi l sampling , remova l o f lead-containinate 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 dfo r you r property , pleas e contac t Pruden i souti i offic e .fo r th e Omah aLea d Su e cleanup-a t (402 ) 733- 1 188 . Genera l question s abou t Ui

e Omali aLea dSit e cle.anu p ca n b e directe dt o th e EP A Publi c Informalio n Center s a l (402 ) 7 3 1-304 5 (SouthOraah aoffice ) or (402 ) 991-958 3 (NorthOmah aoffice) . Property Acces s Granie dBy : t (Pleas e Pnjti Najne ) Property Owne r .Signature 

# i^-syy/ f (Dale ) PROPERT Y INFORIVIATIO N (Tob e complete db y residen t aiid/o r propert y oivne r ~- pleas e print ) RESIDEN TNAME : 

### V O- t CciLvJ ^ \(nV- ~ Owne r Rente r RESIDEN TADDRESS : . 

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## ^-^ ^ ^' ^ y t t J \ U PROPERT YOWNE D BY :
OWNER' S MAILIN G ADDRES S 

# :SAA 3 

# y . g>o ^ Qp s fOys=siAs ^ £>"^(l \ OWNER' S TELEPHON E NUMBE R - HOME : J L WORK :
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 FOR 5 HOUR S O R MOR E PE R WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTRY GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s t o b e implemenle dh y EPA unde r this agreemen t are pursuan t l o Sectio n 104 ofCERCLA . 4 2 U.S.C . 9604 . EP.A' s ngh t o f

acces s l o th e propert y i s provide dfor i n Sectio n 104(e ) o f CERCLA , <1 2 U.S . C 9605(e) , whic hprovide s entry fo r "detenninin g th e nee dfor response , or choosin g o r lakni g an y respons e aclio n under thi s title , or otherwis e enforcin g th e provision s ofth e tille. " 808 0 War d Parkway , Suit e 40 6 560 0 8 1 0 S t 424 2 Medica l Drive . Suit e 425 0 Kansa s City,'M O 6411 4 Omafia , Nebrask a6810 7 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402 ) 733-11& 8 Phone : f210 ) 822-958 8 Fax:(816)363-370 7 Fax : (402 ) 733-18S 3 .Pax : (210)579-657 7ENV[RO;NMEi\T.AL & 

# mmv N CCNSTRLICTIO N 

### TECHNOLOGIES , INC . SERVICE. S 

# Propert y Statu s For m_^ ^, . Address : "^O' ^ c^ p;^^^ ^ ^ ^ Date:/^- 5 ^ ^ ^ ^'^ '^ti\ ^ ^ Date : 

# Phone:/^57__^^/ ^ BVID :



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Propert y Owne r Pruden t Employ e Signature:-/>g>^y f /^pUy^f ^ Signature :

. 4() 808 0 War d Parkway Parkway , Suit e 40 5 5 / 560 0 S 10 St 

# -—y^ — KansasCity , MO 6411 4 Omaha , Nebrask a 6810 7 424 2 fmiica l Dr^e , Suit e 425 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402 ) 733-118 8 tr>Ac: \ o o OTrt T Phone : (210 ) 822-958 8

# 3142 1 Omah a Lea d Sit e Exterio rPain t Nort h Arro w Owne rName : .FRANK f DAILEY ^ 

### Sit e Sketc h • Goo d Address : 3039^NKNE YST ^ • Poo r 

# I Phone : H : W : Q Not pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r Concentratio n Coliecie d LA B 

## Firm: f D f \

!Clc\3/ k RYASCPXA-3142 1 F l pp m 

## D Date : Sjljo H 

# H M RYBSCPXA-3142 1 F 2 ^ pp m 

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# n RYCSCPXA-3142 1 B l

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# 32 . 

# i D Sample s Analyze d RYDSCPXA-3142 1 B 2 

## D RDZGCnXA-314i2 1 -B2 - pp m 

## D XR F Unit : 0\ \ Bbck:'2S _ 

## D P.CZSCPX A31112 1 @? r pp m 

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# Legal Description : 3 8 X 12 8 

# A Printed : Oc t 08 . 201 0 www.dcgis.org/dogi s

### Ticke t Tex t an dMap display fc^cket : #260983 1 Pag e 1 o f 2 Origina l Cal l Date : 10/06/1 0 Wor k t o Begi n Date : 10/08/1 0 Time : 9:0 1 a m Time : 9:3 0 am Op : SIVA1896 7 State : N E Address : 303 9 County : DOUGLA S Street : PINKNE Y S T Place : OMAH A Twp : 15 NRng : 13 E Sect-Qtr : 09-NE-N W 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 : ( 4 02)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 : 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 Utilit yTyp e CXCAT V CO X COMMUNICATIONS , FN C HEID I 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
MUDO l 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 5 OMAH A PUBLI C POWE RDISTRJC T 

### EL M LOCATING Day : Alt : 406728934 3 406207149 4 Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K 

### EL M LOCATIN G Day : 406728934 3



### Alt ! 406207149 4 Emerg : 888728934 3

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### http://www.dhon.org/irthintemet/MessageText/MessageTextAndMap.asp?NoticeID=DHO. . . 12/6/201 0

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### CONSTRUCTIO N SOLUTION S 

## SIT ESAFET Y HAZARD ANALYSI S Address : .—'^7XS-±-lLaki^ . ^ 

## Excavatio n Date : A^JldLLLl . Crew : Backfil l Date : —l^llflkp -

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 

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## Sit e Safet y Offic e Date :

080 Wanl'l?arfciMay , Suit e 40 5 560 0 S 1 0 S t 424 2 Medica l Drive , Suit e 725 0 lansa s City ; M O «411 4 OmalB , Nebrask a 6810 7 Sa n Antonio , T X 7822 9 fume : (816 ) 363-370 3 Ptione : (402)733-118 8 Phone : (210 ) 822^958 8 ax : (816 ) 363-370 7 Fax : (402)733^188 3 Fax:(210)579-657 7• ilJ^ '