## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAI D # : 252-3> o Date : \0J\%\'2^\ ^ Address : 3M-ll ^ L^fou^g-Wre , A v Remediatioii Contractor : pQt- > oPrM' 7 Wr- ^ t<yy.CiC ^ !• ? q.^ . /JMC ' > Year : '2-rOlO_ _ SOI LREMEDL\.TIO N PROPERT Y FIL EFOLDE RDOCUMENT S 2 f

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propert y (DVD) \ i Executiv e Siommai y aEPA-providedpropert y sketch 0 SignedAcces s Agreemen t fo r

subjec t propert y D SignedAcces s Agreement(s ) fo r

adjacen t propert y z f

Restoratio nAgreemen t D Settlemen t doctiments (i.e. , fo r

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o replac e plants , etc. ) (ZConfirmationdata aPhotograph s ' dAs-built sketch A Satisfactor y restoratio nsignedby Propert y O-wner: S C Propert y close-out chec k

Us t signedb y EP A D Descriptio nof area s not meeting RO D cleanu p criteri a 3 Utilit y clearance s • Propert y infonnatio nfro mDougla s Count y Assessor' s Office D D D 

## Signatur e Dat e 3026077 6 Superfun c

### PROPERT Y SUMMAR Y 

## f^Phhc A DaterjAJi ^ \ b Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-10-0 5 Mont hof : S^JMQ^^ . 

### Propert y Addres s 341 4 LAFAYETT EAV . A . EXECUTIV ESUMIVIAR 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 : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : F 2 = 27 3 PP M @ 8" , E A = 10 6 PP M @ SCRAP E ATTACHMENT S 1 ) Property sketc hprovide db y EP A pursuan t l 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 ndigital vide o clip/photograph s 4 ) Post-E.xcavatio 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 fma l lea dlevel s v ) Legen d ii ) Contaminatio nlef 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 nth e individual property file , i f available , o r obtaine dinclude : i ) Pre-excavatio n agreemen t detail s (ifan y are mad e wit hth e property owner ) ii ) Property Statu s Fon nsigne dby property owne r iii ) Excavatio ndigital vide o i nMPEG , 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 nofarea s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOGIES , INC .Fin d Record Remediatio n Quer yI Lea d Remainin g Quer yI Propert yDamag e Quer y Backfill :

Sampl e Area : 2523 0 - 341 4 LAFAYETT E A V Owner : n Owne rOccupie d Owne rName : I BOHANNO N LENZOL AH Owne rAddressi : 

# r Owne rAddressZ : |341 4 LAFAYETT E AV E City : State : Zi p Code : |OMAH A[N E |68131 - Owne rPhone : Alternat e Phone : (402 ) 551-190 9 

# r

Contract : Contractor : |PRUDENT_2010_S Contrac t Optio n |BAS E Use rProvide d Owne rInformatio n Owne rName : 

# 1 Owne rAddress : 

# 1 City : State : Zi p Code : 

# 1 1 1 Owne rPhone : Alternat e Phone : 

# 1 " 1

Assessment : Qualifyin g Grou p pO O Assessmen t MaxXR F Value : | 463.5 6 Resident : Residen t Name : I BOHANNO N LENZOL AH Propert yAddress : |341 4 LAFAYETT E A V Zi p Code : 68131 - Residen t Phon e^' 7 '^ TECHNOLOGIES , INC . i7-:i.^.. . 

# EP A Propert y Clos e Ou t Propert y # : ^^'^ ^ Propert y Address : 3 ^ ' '^ ^'^ ^ ^-^ ^ ^ Date/Time : Owner'sName : ie«.i^2^"'^c c l^\>cSXok.AnoV \ Quad s Excavated : p-7 _ Contracto r Group : Pniden t Technologies , Inc. , Excavatio nGenera l Ye s N o I .If necessary , wer e tli e correc t quadraiit(s ) excavate dan drestored ? / 2 .If necessary , wer e tli e correc t area s ofdri p zon e excavate dan drestored ? / Gradin g So dan dVegetatio n Ye s N o 1 .Doe s th e gradin g aroun dth e perimete r o f th e house i nexcavate darea s generall y slop e awa y / fro mtli e house ? 2 .Ha s so dbee n lai di nal l area s tha t wer e e.xcavated ? / :->

. Doe s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecie da t a3 0 day tim e period ) / 4 .Ar e sodde darea s generall y fir man devenl y graded ? / 5 .Ar e Ui e joint s betwee nth e so dstrip s generall y tight? (Onl y evaluat e i f inspecie dat a3 0 day tim e period ) / 6 .Wa s th e propert y grade dsuc htha i wate r vw U no t poo l o nth e property ? / 7 . Wa s dainag e l o landscapin g 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 nan dclos e freely ? (I f applicable ) 

# y 2 . Were al l gate s o r fence s take n dow ndurin g restoratio aactivitie s reinstalled ? (Ifapplicable ) 

# d 3 . Wa s damag e l o gate s o r fence s avoided ? (I f applicable ) 

## y 4 . Wa s daniag e t o retainin g wall s avoided ? (Ifapplicable ) 

# y Foundation , Sidin g an dGutter s Ye s N o 1 . Wa s damag e t o th e sidin g o r tri mavoided ? 

# d 2 . Wa s dainag e t o th e foundatio navoided ? 

# 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 ? 

# d 5 . Wa s damag e l 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 l o drivewa y surface s avoided ? 2 . Wa s damag e t o walkwa y surface s avoided ? 

# T A

## Owner s comments :

Inspectio nnotes :

Remova l andrestoratio nactivate s complet e includin g th e 30-da y so dwarranty : EP A Representativ e BC^JI.A ^ 

## Date : 9(fli o

# ra r;CHNOLOUIES , INC . 

### A S - BUIL T DRAWIN G OL S #2523 0 Dat e Excavated : 08/16/201 0 I'SEP. A Signed-or r Date : 

### OMAH A LEA D SUPERFUN D SIT E

Name : _ Omah a Lea d Sit e Date : SP:>d< - 5 Nort h Arro w Address : 3Y" / yyFA^in i Sit e Sketc h Time : ID-^S ^ Phone : 

# " y Tea m fi:i:f->p/f><:tiyir:c yBVID # TiSTl^ O XR F Cod e 

### 5Tg > Sampl e Numbe r Lea dConcentratio n Confimnatio n Sampl e f ' Ye s a N o S f a Ye s t n N o S 

### i xvcs/:yy/ } - z^^y^ ^ l3-i.ft/ 3 PP^ C H Ye s n N o H il2Ye s D N o H pp m 0( 1 Ye s C D N o B /7.- 7 6 Ye s • N o a Ye

s • N o •

CONTRAC T# : EP-S7-10-0 5 PRUDENTTECHNOLOGIES , INC . 4613 0

# m 8&tH H Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n o f removal activitie s performe don th e belo w liste dproperty . Th e propert y owner' s signatur e indicate s tha t th e property owner i s satisfie dwit hth e restoratio no f th e subjec t property , an dtha t n o item s ar e i nquestion , now , o r at any tim e in th e future , excludin g an y remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , ifany . Propert y ID : 

## :^>3 o Propert y Address : ^5 ^ 1 H L^^J^cc ^ o

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### Phone : Restoratio nItem s inQuestion :

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

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

# Gy/cAiiyg/^ r 3d)/ d Date 0 'Pruden i Technologies , Inc . (Prudent ) i s under contrac t wit hth e U . S . Environmental Protectio n Agenc y (EPA ) t o clean u p lead
contaminate dsoil s a t anumbe r ol'Dropertie s locate di n Omaha , Nebraska , includin g th e property locate da t 3MIM LA)-^N zTT f jfl V tj y Th e EP A request s you r pennissio n t o allo w Pruden t t o perfor masoi 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 i t o perfor m activiiie s relate dl o th e cleanu p includin g soi l sampling , removal o f lead-conlaminate dsoil , an drestoratio n ofth e reference dproperty . Ifyo u hav e any question s abou t th e soi l cleanu p planne dfo r your properly , pleas e contac i Pruden i Sout h(jinahu OIHc c fo r th e Omah a LeadSite cleanup,.at (402 ) 733-1188 ; 733-1455 . General question s aboy t th e Omah aLea dSil e cleanu p ca n b e directe dl o th e EP A Publi c Informalio n Center s al (402 ) 731^3^4 5 (Sout hOmah aoffice) . Property Acces s Grante dBy : Propen y Owne r Signatur i 

# <^^''^d/^J/M,.y_A^£.^y ^

PROPERT YINFORMATIO N (T o b e complete d b yresiden t and/o rpropert> ' owne r- please print ) RESIDEN TNAM E ' • P^y:-<^1 ' P l K n k a F\r\Cir \ eJwne ryRente r RESIDEN TADDRESS :

I F RENTAL , PROPERT YOWNE D BY :
OWNER' S MAILIN G ADDRESS ;
OWNER' S TELEPHON E NUMBER - HOME : J _ WORK : 

### % - ^ AG E O F HOME? : ll/\ l 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? Ly^^ 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 N UNDE R 7 YEAR S OL D WH O PLAYI 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. ) CjriX^ ^ [<LAtl<2- . ' nJj O U ^ '^ ' • L ,
AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activiiie s t o b e implemenle dby EP A unde r thi s agreemen t are pursuan t l o Sectio n 10 4 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s right ofacces s t o th e property i s provide dfo r i

n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry fo r "determinin g th e nee dfo r response , o r choosin g or takin g any respons e actio n unde r this lille , or otherwis e enforcin g th e provision s o f th e litle. "

808 0 War d Parkway , Suit e 40 5 560 0 S . 10' " Stree t 424 2 Medica l Drive , Suit e 425 0 KansasCity , M O 6411 4 Omaha , Nebrask a 6810 7 Sa n Antonio , T X 7822 9 Phone:(816)363-370 3 Phone : (402)733-145 5 Phone : (210)822-958 8 Fax : (816)363-370 7 Fax : (402)733-188 3 Fax : (210 ) 579-657 7ENVIRONMENTA L& CONSTRUCTIO N 

### TECHNOLOGIES , INC . SERVICE S 

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## Dougla s County-Omaha , N E

Parce l I D Owne r Nam e Propert y Addres s City Zi p Owne r Addres s Owne r Addres s Owne r City Owne r Stat e Owne r Zi p 060762000 0 BOHANNO N LENZOLAH 341 4 LAFAYh11 E A V OMAH A 6813 1 341 4 LAFAYETT E AV E OMAH A N E 6813 1 Additio n Bloc k Lo t Legal 1 Legal 2 Lega l 3 Lega l 4 Acre s Treasure r Websit e Lin k Assesso r Websit e Lin k BEMI S PAR K 2 9 44X126.9 5

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• YOU RTICKE T NUMBE RI S  2569963 . Origina l Cal l Date : 8/17/1 0 Time : 1:1 1 p m Op : SIVA1896 7 

### Wor k t o Begi n Date : 8/19/1 0 Time : 1:4 5 p m 

### State : N E County : DOUGLA S Place : OMAH A 

### Address : 341 4 Street : LAFAYETT E AV E 

### Twp : 15 NRng : 13 E Sect-Qtr : 16-N W 

### Twp : Rng : Sect-Qtr : 

### Lega l Given : C Typ e o f Work : Lea d Soi l 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 Company: PRUDENT TECHNOLOGIE S Contac t Name : SIV AJAMPAM A Phone : (402)733-118 ! 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 CXCATV LEVEL S MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Utilit y Servic e Are a Contac t Phon e Numbe r Typ e Day : 402934046 9 CXCATV CO X COMMUNICATIONS , IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 LEVEL S COMMUNICATIONS , LEVEL S NA Alt : LL C Emerg : 877366834 4 Day : 402504782 3 METROPOLITAN UTILITIE S MUDO l SAND Y Alt : DISTRIC T Emerg : 402504797 0 Day : 402444719 7 CIT Y O FOMAHA
- OMAHACO F RICH/TRAFFI C Alt : 402444516 1 TRAFFICSEWE R Emerg : 402444516 0 dhon.org/irthinternet/. ../MessageTextas.. . 1/ 2

## OPPDGPR 5 OMAHA PUBL T DISTRIC T TOWE R EL M LOCATIN G ||Day : Ah : 406728934 3 406207149 4 Emerg : 888728934 3 

## QLNNEI C QWES T LOCALNETWOR K EL M LOCATIN G Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

dhon.org/irthinternet/. ../MessageTextas.. . 2/ 2TECHMOL(Hil£S , INC . 

### ENVIRONMENTAL ENGINEERIN GAN D CONSTRUCTIO N SOLUTION S 

## SIT ESAFET Y HAZAR D ANALYSI S 

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424 2 Medica l Drive , Suit e 725 0 808 0 Waii d BartMiay . Suit e 40 5 560 0 S 1 0 S t Sa n Antonio , T X 7822 9 Kansa s City , H O 6411 4 Omaha , Nebrask a 6810 7 Phone : (210)822.958 8 Phone : {816)363-370 3 Phone : (402)733-118 8 Fax : (210 ) 579-657 7 Fax : (816 ) 383^370 7 Fax : (402)733-188 3