• • • • 

### TRANSMTTTA L o f OMAH A LEA D STI E SOI L REMEDIATIO N FIL E FOLDE R SAID# : jL ^ ^ ^ Date : 12, ) )^/^ 9 Address : l>t% l S C^l ^ ^ Remediatio n Contractor : rbviio^J
- ^ A Js^ o Year : '^v^ Q SOBLREMEDUTIO N PROPERT Y FIL E FOLDE RDOCUMENT S 0 Vide o o f propert y (DVD ) aExecutiv e Summar y aEPA-provide dpropert y sketch aSigne dAcces s Agreemen t fo r

subjec t propert y • Signe dAcces s Agreement(s ) fo r

adjacen t propert y aRestoratio n Agreemen t D Settlement document s (i.e. , fo r

damag e o r t o replac e plants , etc. ) Confirmatio n dat a 

# I Photograph s As-buil t sketc h ^ 

### Satisfector y restoratio n signe db y Propert y Owner 

# l i Propert y close-out check lis t signe db y EP A D Descriptio n o f area s no t meetin g RO D cleanup critai a H IUtilit y clearance s 

### aPropert y informatio n fromDougla s Count y Assessor' s Of&c e D D D 

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# iiinNiii i Superfun dFin d Recor d Backfill :

Sampl e Area : 1428 8 - 306 3 S 4 2 S T Owner : D Ovme rOccupie d Owne rName : jCORBO Y LI V T KCATHERIN E A Owne rAddressl : Owne rAddress2 : |306 3 S 4 2 ST aty : State : ZipCode : [OMAH A |N E |6810 5 Owne rPhone : Alternat e Phone : 

# 1 1 Remediatio n Quer yI Lea d Remainin g QueryI Propert yDamag e Query

Resident : Residen t Name : |CORBO Y CATHERIN E A Propert yAddress : |306 3 S 4 2 s r Zi p Code : [6810 5 Residen t Phon e 

# I " Contiact : Contractor : [PRUDENT2009_S Contrac t Optio n OFnON 3 Assessment : Qualifyin g Grou p [40 0 Assessmen t Ma xXR F Value : 

# r 515. 6

## wmsBwmswwattKMBs r Date : 12/15/200 9 Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l Month of : November Propert y Address ; 306 3 S 4 2 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 : ARE A NOT EXCAVATE D U C F2 4'X21 ' 28 7 PP M @ SCRAP E CONFIRMATIO N SAMPLIN G DATA/RESULTS : F 2 = 16 0 PP M @ 3" ; E A = 8 9 PP M @ SCRAPE H ) ATTACHMENT S 1 ) Propert y sketch provide dby EP A pursuan t t o contrac t specification s 2 ) SignedAcces s Agreemen t including acces s agreement s require dfo 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-Built sketch ­ i ) Shall includ e final lea dlevel s v ) Legend ii ) Contamination lef t behindarea s vi ) Contractor identification iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e includedi n th e individua l propert y file, if available , o r obtainedinclude : i ) Pre-excavation agreemen t detail s (i f an y ar e mad e wit h th e 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 ) or SW F(Flas h Player ) forma t and/o r photograph s iv ) Signedfor mverifying satisfactor y restoratio n v ) Descriptio n o f area s not meeting InterimRO D cleanu p criteria .

# EP A Propert y Clos e Ou t Propert y # : ri/-^5 ^ Propert y Address : 3,0^ * 5 b ^ ^ Date/Time : Owner' s Name : ^'ci-Wcr>v«< » fo.^op . Quad s Excavated : P- V Contracto r Group : Pruden t Technologii» , Inc. , Excavatio n Genera l 1 .I f necessary , wer e th e correct quadrant(s ) excavatedan drestored ? 2 .

If necessary , wer e th e correct area s of drip zone excavatedan drestored ? Gradin g Sodan dVegetatio n 1 .Doe s the grading aroundthe perimete r ofth e hous e i n excavatedarea s generall y slop e awa y fromth e house ? 2 .

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

Doe s th e so d^pea r to 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 soddedarea s generall y fir man devenl y graded ? 5 .Ar e th e joint s betwee n th e sodstrip s generall y tight? (Onl y evaluat e i f mspecteda t a3 0 da y tim e period) 6 .

Was th e propert y gradedsuc h tha t wate r will not poo l o n di e property ? 7 .

Wa s damage to landscaping o r plan t material s avoided ? Gates , Fence s an dRetainin g Wall s 1 .D o gate s ope n an dclos e freely? (I f applicable ) 2 .

Wer e al l gate s or fence s taken dow n during restoratio n activitie s reinstalled ? (If applicable ) 3 .

Wa s damage t o gate s o r fence s avoided ? (If applicable ) 4 .

Was damage t o retainin g wall s avoided ? (If applicable ) Foundation , Sidin g an dGutter s 1 .

Wa s damage t o th e siding o r trimavoided ? 2 .

Was damage t o the foundatio n avoided ? 3 .

Wa s damage to window s avoided ? 4 .

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

Was damage to walkwa y surface s avoided ? Ye s N o 

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## y y y Ye s N o / / / / / Ye s N o 

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### Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complet e including th e 30-da y so dwarranty : EP A Representativ e 

## £L . Date : ii/is/0 9 ^

## Propert yCompletio n Agreemen t Thi s agreement document s th e completion o f remova l activitie s performe do n th e belo w liste dproperty . Th e property owner' s signatur e indicate s tha t th e propert y owne r i s satisfie dwith th e restoratio n ofth e subjec t property , an dtha t n o item s ar e i n question , now , o r a t an y tim e i n th e future , excludin g any remaining warrant y (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y ID : Propert y Address : 'hOU' \"3 . M i 5 f Owner : (^ec4-Ke r i jO ^ (^orb^ y Phone : jHbl ^ ^SV-Q^^ S Restoratio n Item s i n Question :

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

J^ l agre e restoratio n i s completed , excep t a s note d above .

I I d o no t agre e restoratio n i s coinplete d 

# //////^ f

Owner' s Signatur e Date IPruden 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 u p lead
coo^mm^te<Lsoil s a t anmnbe r o f

oropci^i^ s locate di n Omaha , Nebraska , includin g th e propert y locate da t ^d/l aO 5 •* T o L JF"^ . 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 this form , th e property owne r grant s pennissio n t o Prtjden t t o perfor m activitie s relate dt o th e cleanu p includin g soi l sampling , remova l o f lead-cotitaminate dsoil , an drestoratio n ofth e reference dproperty . I f

yo u hav e an y question s abou t th e soi l cleanu p planne dfor you r property , pleas e contac t Prudent' s Ailniiiii.NiriKivi.
- Cler k for fhe Omah aLea dSit e cleanup , M~: . .Sis a. S .l.inip.iu j -a t (402 ) 7,^.'- l is>i . 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 (South Omah aoffice ) o r (402 ) 991-958 3 (North Omah aoffice) . Property Acces s Grante dBy : (Pleas e Prin t Name ) Property Owne r Signature . (Signature ) ( (Date ) PROPERT Y INFORMATIO N iletedKjb yresiden t and/o rproper ^ owne r— pleas e print ) iT o b e comp i RESIDEN T NAME : Owne r Rente r RESIDEN T ADDRES S 

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- I F RENTAL , PROPERT Y OWNE D BY :
OWNER' S MAIUN G ADDRESS ; 

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­ fm , 5^l-0S3 3 OWNER' S TELEPHON E NUMBE R - HOME : WORK :

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# £ 2 

# 1 £ 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 WPT H SIDIN G SINC E 1978 ? V YE S N O NUMPE R O F OCCUPANT S UNDE R 7 YEAR S OLD : C yNUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDE R IB E NUMBER O F CHILDRE N UNDE R 7 YEAR S OL D WH O PLA Y I 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 Y GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA L RESPONS E ACTIONS : TTi e activitie s t o b e implemente db y EP A unde r this agreemen t ar e pursuan t t o SecUo n 10 4 ofCERCLA , 4 2 U S.C . 9604 . EPA' s righ t o f

acces s to th e property i s provide dfor i n Sectio n 104(e ) o f CERCLA , 4 2 ( J .

S C 9605(e) , whic h provide s entry fo r "determinin g th e nee dfo r response , o r choosin g o r takin g an y respons e actio n unde r this title , or othenvis e enforcin g th e provision 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 KansasCity , 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 7ENV[RONlVrENT,\L & CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : 

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# f^m^^d d ?K_ ^ 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 Omaha . Nebrask a 6810 7 San Antonio , T X 7822 9 Phone : (816 ^ 363-370 3 tifr\r\na . tAn'i \ Ti l ilO O

# ii n • CHNOUHJIKS . INC . 

### A S - BUIL T DRAWIN G OLS# : 1428 8 Dat e Kxcavated : 10/14/200 9 i;SKP.\Signe«l-OirDate : 

### OMAHA LEAD SUPERFUND SIT E

Name : _ Omah a Lea d Sit e Date : %/n//r Z Nort h Ano w Address : Slt « Sketc h Time : I'.T t Phone :

ARIC. A NO T EX f AVATED ; 2/l,'C(4'X21")=109PP M Id : St,'RAP K f~l" )

CONTRAC T # : E P - R7-07-0 6 T0# 1 PRUDENTTECHNOLOGIES , INC .Name : _ Omah a Lea d Sit e Date : ^//a//7 3 Nort h Arro w Address : Sft e Sketc h Time : I'lTi ^ Phone : _ TeamJll£S__Gisy< = BVI D # __Z^±2X5 L XR F Cod e /l ^ Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e RrA5<lPX A - 1^7.? ^ pp m 

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## Dougla s County-Omaha , N E

Pame l I D Owne r Nam e Propert y Addres s Cit y Zi p Owne r Addres s Owne r Addres s Owne r Cit y Owne r Stat e Owne r 121800000 0 CORBO Y LI V T R CATHERIN E A 306 3 S 4 2 S T OMAH A 6810 5

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### • YOURTICKE T NUMBE RI S 2381403 . Origina l Cal l Date : 10/07/0 9 Time : 9:2 9 a m Op : SIVA1896 7 Wor k t o Begi n Date : 10/09/0 9 Time : 10:0 0 a m State : N E County : DOUGLA S Place : OMAH A Address : 306 3 Street : S 42N D S T Twp : 15 NRng : 13 E Sect-Qtr : 32-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 : (402)733-188 3 : FA X AL L CLEAR S T O (402 ) 73 3 188 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 MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F Servic e Are a Contac t Phon e Nuniber Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUD0 2 METROPOLITA N UTILITIES DISTRICT SAND Y 

### Day : 402504782 3

Alt : 

### Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO N 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 OPPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T N A 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 10/7/2009

### Pag e 2 of 2 Day : 406728934 3 QLNNE l FQWES T LOCA L NETWOR K 

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