### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 3333 5 DATE : 12/15/201 0 ADDRESS : 391 9 N 2 5 A V REMEDIATIO N CONTRAaOR : PRUDENTTECHNOLOGIES . IN C YEAR : 201 0 

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

• EXECUTIVE SUMMARY d EPA-PROVIDE D PROPERT YSKETCH 0 SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT(S) FOR ADJACEN TPROPERT Y 0 RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R TO REPLAC E PLANTS , ETC. ) H CONFIRMATIO N DAT A 0 PHOTOGRAPH S 0 AS-BUIL TSKETCH d SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R d PROPERT YCLOSE-OU TCHEC KLIS TSIGNE D B YEP A D DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A d UTILIT YCLEARANCE S d PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E D , D D

SIGNATUR E DAT E 3021832 3 

# nii i

Superfun dFin d Record 

# J i Backfill :



### Sampl e Area : 3333 5 - 391 9 N 2 5 A V Owner :

• Owne rOccupie d Owne rName : jWHUNE R DORETHAW Owne rAddressl : 

# 1 Owne rAddress2 : J391 5 N 2 5 AV E City : JOMAHA State : |N E Zi p Code : |68111 - Owne rPhon e |(402 ) 455-216 7 

# 1 Alternat e Phone :



### Contract : Contractor : JPRUDENT2010_ S Contrac t Optio n (OPTIO N 1 Remediatio n Quer yj Lea d Remainin g Quer yyPropert yDamag e Query 

# !z J

Use rProvide d Owne rInformatio n Owne rName : Owne rAddress :
City : State : Zi p Code : 

# r Owne rPhone : Alternat e Phone :

Assessment : Qualifyin g Grou p |40 0 Assessmen t Ma xXR F Valu e [ 522.4 6 Resident : Residen t Name : 

# I Propert yAddress : |3919N25A V Zi p Code : J68111 - Residen t Phon e

### PROPERT Y SUMMAR Y Date : 12/15/201 0 Oinah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Decembe r Propert y Address : 391 9 N 2 5 A V 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 Information : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : B l = 10 8 PP M @ 6" ; E A = 7 7 PP M @ SCRAP E(~1" ) 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 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 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 din th e individua l property file, i f available , o r obtaine dinclude : i ) Pre-excavatio n agreement 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 ) forma t and/oi
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 .TECHNOUXJIES , INC . 

### Propert y # : 3a,*i.'?> $ Date/Time : /o/i.2^/2^, o Quad s Excavated : ^ (^ 

# EP A Propert y Clos e Ou t Propert y Address : "BPW ^ N I S /^ v Owner' s Name : l^o V <. ^ O . U 3 h(\t i ej T Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s N o 1 . I f necessary , wer e th e correct quadrant(s ) excavatedandrestored ? y 

### 2 . If necessary , wer e the correct area s o f drip zone e.xcavate dan drestored ? ly 

### Gradin g Sodan dVegetatio n Ye s N o 1 . Doe s the gradin g aroundthe perimete r o

f th e hous e in excavatedarea s generall y slop e awa y 

# y fro mthe liouse ? 2 . Has sodbeen lai di n all area s tha t wer e e.xcavated ? ^ 

### 3 . Doe s tli e sodappea r t

o b e generall y healtli y andgrowing ? (Onl y evaluat e i f inspecteda t a3 0 

## y da

y time period )

• 

### 4 , Ar e soddedarea s generally finn an devenl y graded ? 

### y 5 . Ar e the joint s between the sodstrip s generall y tight ? (Onl y evaluat e i

f inspecteda t a3 0 da y 

### y tim e period) 6 . Wa s the propert y grade dsuc htha t wate r wil l Oo t pool on th e property ? 

# y 7 . Wa s damag e t o landscaping o r plan t material s avoided ? 

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

### 2 . Wer e all gate s o r fence s taken dow n during restoratio n activitie s reinstalled ? (I f applicable ) 

### y 3 . Wa s damag e t o gate s or 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 dGutter s Ye s N o 1 . Was damag e l o the siding o r U-ii n avoided ? 

# y 2 . Wa s damag e t o th e foundation avoided ? 

## y 3 . Wa s damag e t o window s avoided ? 

## y 4 . Wa s damag e t o window s o r doo r screen s avoided ? ^ y 

### 5 . Wa s damag e t o downspout s o r downspou t extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Wa s damag e t o drivewa y surface s avoided ? 

## y 2 . Was damag e t o walkwa y surface s avoided ? 

# y

## Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e <^ ^ ^Date: n/s-f/u ,rHNDCDGIES , INC . 

## A S - BUIL T DRAWIN G OLS #3333 5 Dat e Excavated : 10/4/201 0 

## OMAHA LEA D SUPERFUND SIT E USEP ASigBcd-Of f Date : 

## 3333 5 Nort h Arro w Omah a Lea d Sit e Exterio rPain t Owne rName : DORETH AW WHITNE R Sit e Sketc h • Goo d 

### y \ Address : 391 9 N 2 5 A V • Poo r Phone : « : 402.455-2167 W: [g^No t paint Sampl e Numbe r Lead Sampl e „ ^Samples Collecte d Concentratio n Collecte d ^'^* ^ Firm : HE . fX X \ L t RYASCPXA-3333 5 F l 2- 1 I pp m 

## W n Date : I Q -0 5 - Cp T " pp m 

## n D Time : B^JS O A.T ^ RYCSCPXA-3333 5 B l 5Z2 . pp m 

## \3 rn Sample s Analyze d RYDSCPXA-3333 5 B2 3 s o pp m RDZSCPXA-33aa 5 BU r " pp m D D XR F Unit : /£>3 7 Book : /g 3 RGZSCPXA-3333 5 G Z g<? ^ pp m "M " e-" ' n Date : / ^ - Z- g -^f T • RP2SGPXA-3-33-3 5 -P Z Time : ~ pp m D D 

## MA . Staff : LA Numbe rof Sample s = M Legend : F l = Fron t Left , F 2 = Fron t Right , B l = Bac k Left , B 2 = Back Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al i quadrant s are a s viewe d fro m th e street , facin g propert y

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

## Propert yC©mp8etlo n Agreemen t Thi s agreement document s th e completion of remova l activitie s perfonne don th e belo w liste dpropert y Th e propert> owner' s signatur e indicate s tha t th e property owne r is satisfie dwithth e restoratio n ot th e subjec t property , an dtha tno item s ar e in question , now , or at an y tim e in th e future , excludin g any remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , if any . Property ID : Property Address : -y(( ^ |\ ^ cj^f ^ A\i- t ^ Owner : j" ^ 

## \)c^(ethc i \hllnU)e'L Phon e 

### •• Uo i u<;t;-'0^'^? ' Restoratio n llteni s io Questioini :

Require d correction s to complet e tih e property : 

### O^M^i} ^ ^^ ^^)>/ f due/ 4fn^ ccM<?c i

ly ] I agre e restoratio n is completed , excep t as note d above . I 1 do no t agre e restoratio n is complete d 

# "^^muM , -'IvJA^.-. . Date Owmer' s Sigiuatur e IPruden t Techjiologies , Inc . (Prudent ) i s utide r contrac t withth e U . S . Environmenta l Protectio n Agenc y (EPA ) t o clean u p lead
Cjyitaminate dsoil s at^ anumbe r o f

propertie s locate di n Omaha , Nebraska , includin g th e propert y locate da t y ( / I 'M ' o \7 ^ ^ y • ni e EPAreque.st, s you r permis.sio 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 pennissio 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 dpropert y 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 Pruden t southoffic e fo r th e Omah aLea d Site cleanup-a t (402 ) 733-1188 . Genera l question s abou t th e Omah aLea dSit e cleanu p can b e directe dt o th e EP A Publi c Informatio n Center s a t (402 ) 731-304 5 (Sout hOmah aoffice ) o r (402 ) 991-958 3 (NorthOmah aoffice) . Property Acces s Grante dBy : 

# D^P/ftfi ^ \lht U f r (Pleas e Prin t Name ) Property Owne r Signature : 

## i!}MLth*t } ^.kU i (Signature ) (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 TNAM E 

# : Dordh ^ \^/^lif/^/-/ ^ ^g^nec ^ Rente r RESIDEN TADDRES S ESS : , ,Ly j
I F RENTAL , PROPERT YOWNE D BY : OWNER' S MAILIN G ADDRESS ; OWNER' S TELEPHON E NUMBE R - HOME : {HOjL \ ^5^'^IL l WORK : jHOO- S ^^ ^ 110 0 AG E O F HOME? : 

# M YEARS . HO W LON G HAV E YO U LIVE D HERE ? tS ' 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 : N A 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 Y GATES . ETC. )

ALrrHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS ; Th e activitie s t o b e implemente db y EP A unde r thi s agreemen t ar e pursuan t t o Sectio n 10 4 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s right ofacces s t o th e propert y i s provide dfor i n Sectio n 104(e ) o f CERCLA , 4 2 U. S C 9605(e) , whic hprovide s enti^ y for "detenninin g th e nee dfor response , or choosin g o r takin g an y respons e actio n undei
- thi s title , or otherwis e enforcin g th e provision s o f th e title. " 808 0 War d Parkv/ay , Suit e 40 5 560 3 S % v S t 424 2 Metftca l Drive , Suit e 426 0 Kansa s City . M O 6411 4 Omatia . ?«e*wask a SS10 7 Sa n Antonio . T X 7822 9 Phone : (816 ) 363-370 3 Phone : ifiOl - 72S-t1S « Phone : (210 ) 822-&SS 8 Fax ; (816 ) 363-370 7 Fax : {492 ) TZS-tSS B Fax ; (210 ) 579-667 7ENVlROiNMEiMAL A 

# mu m CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVFCE S 

# Propert y Statu s For m Address : 1>'?/ ^ hJS-C^ ' ^^i f Date : ^'.^^/ ^ Phone : %^ ' HS^'^ll ^ 7 BVID : 

# 7^-^.^^&u^ . Av-c^ ^ P ^ I

Propert y Owne r Pruden t Employe e Signature ; ^mH^-Ap^^Ltyi ^ Signature : 

# ' ^^oBadi^
­ r ^ 808 0 War d Parkway , Suit e 40 5 S60 0 S 1 0 S t 424 2 Medica l Drive , Suit e 425 0 Kansa s City . M O 6411 4 Omaha , Nebrask a6810 7 Sa n lirAonU> , T X 7823 9 Phone : (816 ) 363-370 3 Phone ; (402)733-118 8 Phone : (210)822-958 8•. :^-u.*C;-^ . •"-i^.ii-:.I . 

# 3333 5 Exterio rPain t Nort h Arro w Omah a Lea d Sit e Owne rName : DORETH AW WHiTNE R 

### • Goo d Sit e Sketc h 

# y \ Address : 391 9 N 25 A V • Poo r Phone : H ; 402-455-2167 W : 0^ 1 pain t Sampl e Numbe r Lea d Sampl e „ /Sample s Collecte d Concentratio n Collecte d ^ ^ 

# Firm : JlL__miiM . RYASCPXA.3333 5 F 1 

### Z l i pp m 

# u yO Date : / O ~ 03 > - OC T RYDOCPXAOOOO O T g "• pp m Time : Q:^^C > A/V^ RYCSCPXA-3333 5 B 1 

### SZ2 . pp m 

# la y u Sample s Analyze d RYDSCPXA-3333 5 B 2 3g g pp m 

### [& ^ D nOZCGPXA3333 5 B2 - pp m 

# D D XR F Unit : 

### /^3 7 Book: 13 3 RG2SCPXA-3333 5 G Z 

### 30* 4 pp m "M ' cyn Date : 

# / a - Z 8 -as ­ nPZOCPXA3333 5 PZ- Time : 

### - " pp m D D 

## JJA , Staff : 

### L A Numbe ro f Sample s = M Legend : F l = Fron t Left , F2 = Fron t Right , B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a s viewe d fro m th e street , facin g property

Ilev4
- M6141.0I2 3

## K 

# 3919N25A V 

# A Printed : De c 02 , 201 0 www.dcgis.org/dogi shttp://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=%3CRESU. . Create Anothe rTicke t | PBac k t o Irt h Internet Sen d Emai l 

## YOURTICKE T NUMBE RI S  2605489 . Origina l Cal l Date : 9/30/1 0 Time : 12:3 9 p m Op : SIVA1896 7 Wor k t o Begi n Date : 10/04/1 0 Time : 1:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 391 9 Street : N25T H AV E Twp : 15 NRng : 13 E Sect-Qtr : 04-S 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 AJAMPAMA 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 CXCATV MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C 

## Servic e Are a Contac t Phon e Numbe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEIDI Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUDO l METROPOLITA N UTILITIES DISTRICT SAND Y Day: 402504782 3 Alt : 

## Emerg : 402504797 0

lo f 2 9/30/201 0 12:3 9 P M

### http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=%3CRESU. . 

## 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 RDISTRICT EL M LOCATIN G Day : 406728934 3



## Alt : 406207149 4 Emerg : 888728934 3 QLNNEIC QWES T LOCA LNETWOR K EL M LOCATIN G Day : 406728934 3



## Alt : 406207149 4 Emerg : 888728934 3

2 o f 2 9/30/201 0 12:3 9 P M

### ENGINEERIN GAN D CONSTRUCTIO N SOLUTION S 

## SIT ESAFifcT Y HAZAR D ANALYSI S 

# ?9/ ^ yV'aSyhA: > Address : Excavatio n Date : Crew : BackfiU Date :

Ite m Conditio n Hazard s Correctiv e Actio n Overhea dLine s <^J^^/^^'g/ 0 - ^ " ^ 

## Gra s Lin e 

## Wate r Lin e Sewer Lin e Septic/Leec h Fiel d Propane/Butan e Sidewal k OJ ^ 

## Foundatio n ciC ^ 

## Retainin g Wall s Fence s <=i/< ^ tS>^ * 

## Tree s Structure s Driveway ayy . 

## Sprinkle r Syste m Othe r Cre w Forema n Sit e Safety Offic e Date :

M80¥fvd«artaMay , Suit e 40 5 9MOS108 t 424 2 Medica l Drive , Stdt e 725 0 tGilr<'K>«411 4 iliij«luitt1C 7 Sa n Antonio , T X 7822 9 : (819 ) 36S>370 3 Pfwno : (402 ) 733-11* 8 Phone : (2t0 ) 82Z-458 8 FacfStS ) 363.370 7 Fax : f402 ) 733^188 3 Fax : (210 ) 579-857 7

# 39/9 H Z¥ ^ B l

B l 

# '/^^/i^' ^