### TRANSMITTA Lo f OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : r^.^an dDate : l^ j ^^ j %cc ^ Address : ^^^ 3 N ^/.<^- f Remediation Contractor : pj?(.jr::)gf\l" f ~l9c.-{H^oic>Ci£S . jc^c.- 1 Year : c^Q O 8 SOI LREMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S \ X Vide o o f

propert y (DVD ) \ X Executive Summar y t x EPA-proyidedpropert y sketch 0 ' SignedAcces s Agreemen t fo r

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

adjacen t propert y y Restoratio n Agreemen t D Settlemen t documents (i.e. , fo r

damage o r

to replac e plants , etc. ) ' y Confirmation data y Photograph s S ^ As-built sketch S^ Satisfactor y restoratio n signedby Propert y Owne r M Propert y close-out chec k

lis t signedby EP A D Descriptio n o f area s not meeting RO D cleanu p criteri a y Utilit y clearance s D Propert y infonnatio n fromDougla s Count y Assessor' s Office D 4030957 6 

### D D ' Superfun d „/^nriX^,sM f - 2.h9ic 9 

### Signatur e v' ^ Dat ePROPERT Y SUMMAR Y Date : 12/20/200 8 Oinah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-06/000 4 Mont hof : Nov/Dec . Propert y Address : 35 3 N 4 1 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 Findings : NON E A. 4 Othe r Relevan t Information : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : F 2 = 29 4 PP M @ 6" ; D Z = 8 8 PP M @ 6" ; E A = 18 1 PP M @ SCRAP E ATTACHMENT S 1 ) Propert y sketc hprovide db y 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 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-Buil t sketch
i ) Shal l includ e final lea dlevel s v ) Legen d ii ) Contaminatio n left : behin darea s vi ) Contracto r identificatio n iii ) Property addres s vii ) Dat e iv ) BVT 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 ) fte-excavation agreemen t detail s (i f any ar e mad e wit hth e propert y ovraier ) ii ) Property Statu s Formsigne db y property owne r iii ) Excavatio n digita l vide o i n MPEG , WM V (Window s Medi aVideo ) o r SWF(Flas hPlayer ) fonna t and/o r photograph s iv ) Signe dfor mverilyin g satisfactory restoratio n v ) Descriptio n o f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOGIES , INC .Rn d Recor d Backfill :

Sampl e Area : 2360 7 - 35 3 N 4 1 S T Owner : n Owne rOccupied Owne rName : I RILE Y THOMA S C Owne rAddressl : Owne rAddressZ : |35 3 N 4 1 ST City : State : Zi p Code : OMAH A |N E [6813 1 Owne rPhone : Alternat e Phone : (402 ) 553-571 7 Qea n U p Quer y Lea d Remainin g Quer yI

Resident : Residen t Name : [RILE Y "mOMA S C Propert yAddress : [35 3 N 4 1 S T Zi

p Code : [6813 1 Residen t Phon e Propert yDamag e Quer y

Contract : Contractor : jPRUDEMT2008_S Group : 

# I—: — Assessment : Qualifyin g Grou p jPLA Y ZON E Assessmen t XR F Date : 

# I ~ ~ Assessmen t Ma xXR F Value : I 626.6 7TECHNOLOGIES , INC . 

# oEP A EPA Propert y Clos e Ou t Propert y # : '2.Zi>d~ ) Property Address : 3 ^ " 3 ' V 4 ' ^ Date/Time : Owner' s Name : Quad s Excavated : f~ ^ ^ 02
- Contracto r Grou p Pruden t Technologie s Excavatio n General Ye s 1 .

I f necessary , wer e the correct quadrant(s ) excavatedan drestored ? / 2 . I f necessary , wer e the correct areas o f dri p zon e excavatedan drestored ? / Gradin g So dan dVegetatio n Ye s 1 .

Doe s the gradin g aroun dthe perimete r ofth e hous e i n excavate darea s generall y slope awa y fromthe house ? / 2 .

Ha s sodbee n lai di n al l area s tha t wer e excavated ? / 3 .

Doe s the so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i

f inspecteda t a3 0 da

y tim e period) / 4 .

Ar e sodde dareas generall y fir man devenl y graded ? / 5 .Ar e the joint s betwee n the so dstrip 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 htha t wate r wil l not pool on th e property ? / 7 .

Was damage t o landscapin g or plan t material s avoided ? / Gates , Fence s an dRetainin g Wall s Ye s 1 .

D o gate s ope n an dclos e freely? (IfappUcable) 

# y 2 . Wer e al l gate s o r fences take n dow n durin g restoration activitie s reinstalled ? (I f applicable) 

# y 3 . Was damage to gate s o r fence s avoided ? (IfappUcable) 

# X 4 . Was damage to retaining wall s avoided ? (I f applicable) 

# y Foundation , Sidin g an dGutter s Ye s 1 . Was damage t o th e siding o r tri mavoided ? 

# y 2 .Wa s damage to the foundatio n avoided ? 

# y 3 .

Was damage to window s avoided ? 

# y 4 . Wa s damage to window s o r doo r screen s avoided ? / 5 . Was damage to downspouts o r downspou t extension s avoided ? / Sidewalk s an dDriveway s (Concrete ) Ye s 1 . Was damage to drivewa y surface s avoided ? / 2 . Was damage t o walkwa y surface s avoided ? 

# T N o

N

o

N

o

N

o

N o

### Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complet e including th e 30-da y sodwarranty : EP A Representativ e J^c ^ yg ^ Date : /a/a/o? ?

# &EPA Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n o f remova l 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 dwithth e restoratio n ofth e subjec t property , an dtha t n o item s ar e in question , now , o r at an y tim e in th e ftiture, excludin g any remainin g warranty (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y ID : Propert y Address : 

## fN j M V <^\ — 

# 3 ^ < - M Restoratio n Item s i n Question :

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

L J I 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 

# 7/-y^ ^ - X P Dat ePruden t Technologies , Inc . (Prudent ) i s unde r contrac t wit h th e U . S . Environmenta l Protectio n Agenc y (EPA ) t o clea n up lead
contaminate dsoil s a t anumbe r o f

prqwrtie s locate di n Omaha , Nebraska , includin g th e propert y locate dat

. Th e EP A request s you r permissb n t o allo w Pruden t t o performasoi l cleanu p a t thi s propert y t o remov e lead-contaminate dsoil . B y signin g this form , fte propert y owner grant s permissio n t o Pruden t t o perform activitie s relate dt o th e cleanu p includin g soi l sampling , remova l o f lead-contaminate dsoil , an drestoratio n o f th e reference dproperty . I f

yo u hav e an y question s abou t th e soi l cleanip ) planne dfor you r property , pleas e contac t Prudent' s Administrativ e Clerk fo r th e Omah aLea dSite cleanup . Ms . Madurim aDur u -a t (402 ) 733-1455 . 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 Informationpeoter s a t (402 ) 731-304 5 (Soud i Omah aofBce ) o r (402 ) 991-9583 (Norfli Omah aofQce) . Property Acces s Grante dBy : 

## /Z/L^ V leas e Prin t Name ) Property Owne r Signi (Date ) PROPERT Y INFORMATIO N (T o b e complete db y residen t and/o r propert y owne r —pleas e print ) RESIDEN T NAME : '^Tho/T)/^ ^ -f i XT)TdfU^^Ti - 7 Z ICl.\ 7 X^T ^

Renter RESIDEN T ADDRESS : 

# U ^( ^

Shc^^r^ OM^H ^ AJ £ 6?/3 / 35 5 I F RENTAL , PROPERT Y OWNE D BY :
OWNER' S MAILIN G ADDRESS ;
OWNER' S TELEPHON E NUMBER - HOME : ^0'2 . S^DOj^- ^ i ^ WORK :
AG E O F HOME ? 

## ••^7 . 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? 

# X YE S N O NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OL D NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDE R 

# a . NUMBE R O F CHILDRENUNDE 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 , ENTR Y GATES , ETC. |

AUTHORIT Y FO RENVIRONMENTA L RESPONS E ACTIONS : Th e activitie s t o b e implemente db y EP A unde r thi s agreemen t ar e punuan 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 propert y i s providedfo r i n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic h provide s entry for "determiningth e nee dfor response , o r choosin g o r takin g an y respons e actio n unde r thi s title , o r otherwis e enforcin g theprovision s ofth e title. "

808 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 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7t.:^jiii:'.r;i: k ^ : ^ 5 ^ 

# ^:d.:xm7mm^mm7i m OLS# : 2360 7 

### ^ i O.MAHArLE'Aa>iSIJPEREUlVO;SEp#| ' Dat e Excavated : 10/18/200 8 USEP A Signed-OfTDate :
Name : '/'•^-"- ^ ^//:-/ / Address : IS- } 4 / '//•^ ^ Phone ; Vi i ­ rr 5 -T? / 7 Omah a Lea d Sit e Stt e Sketc h Date : Time : ^//7/^ 7 i-'^ ^ Nort h Arro w

Team / />^/ / X z M >ir>^a"<<*^BVl D # 2 J 6 ^

} XR FCod e Sampl e Numbe r Lea d Concentratio n Q,ZC.Tt/S. I



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

# mn m rECHNOLOGIES , INC . 

# Propert y Statu s For m Date : Phone : BVID : Address : SS 3 1 ^ M \ S V



### Plant s & Permanen t Landscapin g Item # O n Map Descriptio n an dLocatio n *TN?^~S«=—b^v;^\^ ^ •r\e'£-^—b o hsr ­ 

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Pruden t E m Signatvire : 

# VA 808 0 War d Parkway , Suit e 40 5 250 5 N . 24 * Street , Suit e 30 8 424 2 Medica l Drive , Suit e 42^ ) Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax ; (816 ) 363-370 7 Fax : (402)504-100 5 Fax:(210)579-657 7

### HX'-l , Omah a Lea d Sit e Date : 67 J 7 7o ? Nort h Arro w Name : _lZj^£iif ^ ^ 

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Parce l I D Owne r Nam e Property Addres s {Cit y \zi p Owne r \ Addres s Owne r Addres s 2 Owne r \cit y

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

### YOU RTICKE T NUMBE RI S 2145004 . Origina l Cal l Date ; 10/01/0 ? Time : 10:0 1 am Op : RAMITA1896 7 Wor k t o Begi n Date ; 10/03/O J Time : 10:3 0 a m State : N E County : DOUGLA S Place : OMAH A Address : 35 3 Street : N41S T S T Twp : 15 NRng : 13 E Sect-Qtr : 17-SE,20-N E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n projec t fo r soi l 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 Nam e RAMIT A Phone : (402)733-145 5 Alt . Contac t Phone : (402)733-118 8 Wor k Bein g Don e For : ep a Dept h o f Excavation : 6f t Corne r Lot : NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N BSHPCLK S CXCAT V MCLEODN E MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Servic e Are a Contac t Phon e Numbe r Utility Typ e BSHPCLK S NEBRASKA HEALT H SYSTEM N A Day : 402552345 9 Alt : 402552334 7 Emerg : 402559511 1 CXCAT V COX COMMUNICATIONS , INC HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MCLEODN E MCLEODUS A N O NEE D T O CAL L OU T EMERGENC Y Day : 800289190 1 Alt : Emerg : 800289190 1 MUDOl METROPOLITAN UTILITIE S DISTRIC T SAND Y Day : 402504782 3 Alt : 

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### Pag e 2 o f 2

CIT Y O FOMAHA
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