### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 3225 0 DATE : 12/15/201 0 ADDRESS : 256 9 PRAT TS T REMEDIATIO N CONTRAaOR : PRUDENTTECHNOLOGIES . INC . YEAR : 201 0 

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### PROPERT Y SUMMAR Y Date : 12/15/201 0 Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Montl i of : Decembe r Propert y Address ; 256 9 PRAT T S T A . EXECUTIV ESUMMAR Y A. I 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 : ARE A NO T EXCAVATED : Fl/L S (i^XWr^'^ie ^ = 14 6 PP M @ SCRAP ECSx'xss' ^ CONFIRMATIO N SAMPLIN GDATA/RESULTS : F l = 7 7 PP M @ 2" ; E A = 6 8 PP M @ SCRAP E(~1" ) ATTACHMENT S 1 ) Propert y slcetchprovide 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 sketc h­ i ) Shal l includ e final lea dlevel s v ) Legen d ii ) Contaminatio n lef 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 di n th e individua l property file, i f available , o r obtaine dinclude : i ) Pre-excavatio n agreemen 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 n digita l vide o i n MPEG , WM V (Window s Medi aVideo ) o r SW F(Flas hPlayer ) format and/o r photograph s iv ) Signe dfor mverifyin g satisfactory restoratio n v ) Descriptio n o f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOCIES . INC .TECHNOLOGIfiS , INC . 

# EP A Propert y CSose Ou t Propert y # : 3,2,2- ^ C ) Propert y Address : Z^^ ^ (TOL^TV ^ 

### Date/Time : Owner' s Name : i\\}ccht^ O e A^JA Quad s Excavated : f- \ Contracto r Group ; PrucJein t Technologie.s , Bmc , Excavatio n Genera l Ye s N o 1 . I f necessary , wer e the correct quadrant(s ) excavatedandrestored ?

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### 2 . I f necessary , wer e the correct area s o f drip zon e excavatedandrestored ? / 

# y Gradin g Sodan dVegetatio n Ye s N o 1 . Doe s th e grading aroundthe perimete r o

f the hous e i n excavatedarea s generall y slop e awa y / fro

mth e house ? 2 . Has sodbee n laidi n all area s tha t wer e excavated ? / 3 . Doe s th e sodappea r t o be generall y health y andgrowing ? (Onl y evaluat e i

f inspecte da t a3 0 / da

y lim e period) 4 . Ar e soddedarea s generally fir mandevenl y graded ? / " 5 . Ar c tlie joint s betwee n the sodstrip s generall y tight ? (Onl y evaluat e i

f inspecte da t a3 0 da y / lim e penod ) 6 . Wa s the propert y gradedsuc htlna t wate r wil l not pool o n the property ? / 7 . Wa s diiniag e t o landscaping o r plant material s avoided ? 

# y Gates , Fence s an dRetainin g WaH » Ye s N o 1 . D o gate s ope n andclos e freely ? (I f applicable ) 

# y Wer e all gale s o r fence s taken down durin g restoratio n activitie s reinstalled ? (I f applicable ) 

# y Wa s damag e to gate s o r fence s avoided ? (I f applicable ) 

# y 4 . Was damag e t o retainin g wall s avoided ? (I f applicable ) Foundation , Sidin g an dGutter s Ye s N o I . Wa s damag e lo the siding o r trimavoided ? 

# A 2 Wa s damag e t o the foundation avoided ? 

# y y 

### .3 . Wa s dainag e l o window s avoided ? 

# y 4 . Wa s damag e t o window s o r doo r screen s avoided ? / 5 . Was damag e to downspout s o r dowiispou t extension s avoided ? / Sidewalk s an dDriveway s (Concrete ) Ye s N o Wa s damag e t o diivewa v surface s avoided ? 

### y Wa s damag e t o walkwa y surface s avoided ?

## 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 Q< ^ ^ ^Date: t'U''l" >

# IRI l CHNOLOGIES . INC . 

### A S - BUIL T DRAWIN G OL S #3225 0 Dat e Excavated : 10/28/201 0 

### OMAH A LEA D SUPERFUN D SIT E I'SEP A Signcd-OI T Date : 

### 3225 0 Omah a Lea d SK e Exterio r Paint Mod h Arro w Owne rName : PETE R T^RAYSO N Sit e Sketc h • Goo d Address : 2569 PRAT T S T Phone : H : w . • Poo r 

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

## Pr©peft yCompletio n Agreemeo t Thi s agreement document s th e completion o t remova l activitie s perfonne do n tii e belo w Jisie dpropeiTy . Th e property owner' s signatur e indicate s that th e property oM'ne r i s satisfie dwithth e restoratio n o f th e subjec t property , an dthat n o item s ar e in question , now , o r a

t an y tim e i n th e future , excludin g any remainin g warrant y (3 0 day s totai ) excep t thos e item s liste dbelow , i f any . Propert y ' 

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Require d correction s t o compielt e th ®

property "

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

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### Jwneir' s SigBaKur e mwPiiidc mTechnologies . In c (Prudenl ) i s unde r eontraci , wit hih e U . S . Environmenta l Protectio n Agene v (EPA ) t o I'leai ) uj i le-icl
contaminate dsoil s a t . T numbe v ofpropertie s locate di n Omalia ^ Nebraslta , includin g th e property locate da t Tli e KPA . 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 .laivitie s relate dl o th e cleanu p includin g soi l sampling , remova l o f Iead-contaminale dsoil , an drestoratio n o f tb e reference dpropert y Ifyo u hav e an y question s abou t th e soi l cleanu p planne dfo r you r propeny , pleas e conta aPruden t southoffic e fo r th e Omah aLea d Site cleanup-a t ('102 ) 733-1188 . Genera l que.stion s abou t th e Omah aLeadSit e cleanu p ca n b e directe dt o th e EP A Publi c Informatio n Cenler s a t (402 ) 73 1 -.?04 5 (Sout hOmah aoffice ) o r (402 ) 991-958 3 (NorthOmah aoffice) . Property .A.cces s (jranie dB y ^ fPleas e Print Name 1 ' Propert y Owne r h'ignatiir 

## lCLr2A--y ) (Date" )

RESIDEN TMAME : Owne r Rente r RE-SIDEN TADDRESS : -_ . ^ f^y i yr ^ A. » , ^ 

# ^ q ! F RENTAL . PROPERT YOVrfWE D BY :

OWNE R

/VNER' S MAILIN G ADDRESS ; „ . x- \ fl • O i
ER' S TELEPHON E NUMBE R - HOftfiE : _ 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 NUMBER 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 , ENTR YGATES , ETC. )

..UlTHORIT Y FO RE?-IVlRONMENTA LRESPONS EACTIONS , Th e activitie s t o b e implemente db y F.P A unde r this agreemen t ar

e pui^suaitri o Sectio n 10 4 ofCERCLA , 4 2 U S.C . 9604 . EPA' s ngh t ofacces s t o th e propert y i s provide dfor i n Sectio n 104(e ) o f CERCLA . 4 2 11. H C 9f>()5(e) , whic hprovide s entr y for "detei-miningth e nee dfo r response , o r choosin g or takin g any icspuns e aolio u under tin s title , o r otherwis e enforcin g th e provision s c f th e title. " g08 0 War dPamwav . ^.'..im . • •rfiji ) :•. . '.i ) .S ' •c'.'*? . i'/u;i.t)cai 'Lirivfi , ;5uii! t 421Jt t Kansa s Citv . M O 6 4 n.-:! . .^vi n Antonio , T X /(J'ii S Phone : (816 ) 363-570 3 '^tion- y |210)[l2i!.S8ei l •-9% : ;81S ; 363-S70- ' i-'fi f <4n;i ^ ••::;).•;!<!!: :£:Nvu;<:>rv.Mif;iv!.i.i.,,s i 

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## 3225 0 Exterio rPain t Nort hArro w 

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# A Printed : No v 22 , 201 0 www.dcgis.org/dogi s

### Pag e 1 o f 1

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

### YOURTICKE T NUMBERI S 2622427 . Origina l Cal l Date : 10/20/1 0 Time : 5:2 5 p m Op : SIVA1896 7 Wor k t o Begi n Date : 10/22/1 0 Time : 6:0 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 256 9 Street : PRAT T S T Twp : 15 NRng : 13 E Sect-Qtr : 04-SE,09-N E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : soi l lea d remediatio n projec 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

MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Servic e Are a Contac t Pbon e Numbe r Utility Typ e CXCAT V COX COMMUNICATIONS , INC HEID I 

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

### Day : 402504782 3 Ait : Emerg : 402504797 0 OMAHACO FCITY OFOMAHA-TRAFFICSEWERRICH/TRAFFIC 

### Day : Alt : 

### 402444719 7 402444516 1 

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

### Day : 406728934 3 Alt : 406207149 4 

### Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K EL M LOCATING 

### Day : 406728934 3 Alt : 406207149 4 

### Emerg : 888728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 10/20/201 0

### ENVIRONMENTAL ENGINEERm C AN D CONSTRUCTIO N TEeHMOUkSSS , INC . 

### SOLUTION S 

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