## TRANSMITTA Lo f OMAH A LEA D STT E SOI LREMEDIATIO N FIL EFOLDE R SAID# : tS^-^^ C Date : ^ A ^ Address : .^3 ^ f ^ ^r/-/ f f^y^ f RemediatioiiContractor : . K-iirlPA f '~( e r LYear : ^0 1 n SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S D Vide o o f propert y (DVD ) D Executiv e Summar y D EPA-provide dpropert y sketch D Signe dAcces s Agreement fo r

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

adjacen t propert y D Restoratio nAgreement D Settlemen t document s (i.e. , fo r

damag e or t o replac e plants , etc. ) D ConfLrmado ndat a D Photograph s D As-buil t sketc h D Satisfactor y restoratio nsigne db y Propert y Owner • Property close-ou t check lis t signe db y EP A Q Descriptio no f area s no t meetii ^ RO D cleanup criteri a D Utilit y clearance s 

## D Propert y informatio nfromDougla s Count y Assessor' s Offic e D D D 

## liignature " ' Dat e 3026103 9 

# iiliii l Superfun dFin d Record Remediatio n QueryI Lea d Remainin g QueryI : Propert yDamag e Quer y 

### Backfill :

Sampl e Area : 2737 5 ­ 337 0 PATRIC KA V Owner : Resident : Contract : n Owne rOccupie d Owne rName : |MCNEILJANYC E Owne rAddressl : 

# 1 Owne rAddress2 : |337 0 PATRIC KAV E City : [OMAH A State : :,|N E 

# ^ 1 ZipCbde : |6811 1 Residen t Name : JMOOR E TOMMI E L Propert yAddress : [337 0 PATRIC KA V Zi p Code : [6811 1 j Residen t Phon e 

# I Contractor : |PRUDENT2009_S Contrac t Optio n [OPTIO N 1 Assessment : Qualifyin g Grou p [400/CHIL D j ; | :

Owne rPhone : 

# 1 Alternat e Phone : :| . . • Assessmen t Ma xXR F Value : 

# r 777.1 2

### PROPERT Y SUMMAR Y Date:3/15/201 0 | Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l | Mont hof : J^QG ^ Propert y Address : 337 0 PATRIC K AV E A EXECUTIV ESUMMAR 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 NSAMPLIN GDATA/RESULTS : B l = 7 9 PP M @ 13" ; B 2 = 10 4 PP M @ 13" ; D Z= 124 PP M @ 13" ; E A = 3 8 PP M @ SCRAP E(~1" ) ATTACHMENT S 1 ) Property sketc hprovide db y EPA 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 digital vide o clip/photograph s 4 ) Post-Excavatio ndigita 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 lef 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 din 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 For msigne db y property owne r iii ) Excavatio ndigita l vide o in MPEG , WM V (Window s Medi aVideo ) o r SW F(Flas hPlayer ) forma t and/o r photograph s iv ) Signe dfor mverifyin g satisfactory restoratio n v ) Descriptio no f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOCIES , INC .TECHNOLOGIES , INC . Property* : 2-737 S Date/Time : Quad s Excavated : S^ffyuy ^ 

# EP A Propert y Clos e Ou t PropertyAddress : 3S7 P fkrr}' ^ P^ Owner'sName : -foyyvm«- 6 VA^or<f ^ Contracto r Grou p Pruden t Tecnnologie s Excavatio nGenera l Ye s N o 1 .I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 

### y 2 .If necessary , wer e th e correc t area s ofdri p zon e excavate dandrestored ? 

## y Gradin g So dan dVegetatio n Ye s N o 1 .Doe s th e gradin g aroun dth e perimete r ofth e house inexcavate darea s generall y slop e away fromth e house? 

# y 2 .Ha s so dbee nlai din al l area s tha t wer e excavated ? 

# y 3 .

Doe s th e so dappear t o b e generall y health y an dgrowing ? (Onl y evaluat e ifinspecte dat a3 0 day tim e period ) 

# y 4 .Are sodde darea s generall y fir man devenl y graded ? 

## Y 5 .

Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte dat a3 0 day tim e period ) 

## Y 6 .Wa s th e property grade dsuc htha t wate r wil l no t poo l o nth e property ? 

## y ( ^ 7 .

Wa s damag e t o landscapin g o r plan t material s avoided ? Gates , Fence s an dRetainin g Wall s Ye s N o 1 .D o gate s ope nan dclos e freely? (Ifapplicable ) ^ 2 .Were al l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (Ifapplicable ) 

### Y 3 .

Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) 

## y 4 .Wa s damag 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 ? y 2 .Wa s damag e t o th e foundatio navoided ? y 3 .

Wa s damag e t o window s avoided ? 

### Y Y 4 .Wa s damag e t o window s o r doo r screen s avoided ? 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 driveway surface s avoided ? / 2 .Wa s damag e t o walkway surface s avoided ? y /

# 3^7 0 foHrd LAve Owner s comments :

Inspectio nnotes :

__ / J * t

s o Sf(/A/ArV . ^ ^ 

# '-/«/o ? yyy



# . y.y « - •'" . .I,<.v ° 

# 4 t \ ^ «



## Remova l an drestoratio nactivate s complet e includin g th e 30-da y so dwarranty : EP ARepresentativ e J? ^ A y Date : ^//f//f l

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n o f removal activitie s performe do n 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 n o f th e subjec t property , an dtha t n o item s ar e in question , now , o r at an y tim e inth e future , excludin g any remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y ID : PropertyAddress : 33-1 0 PgJhr^rt/
­ v..^- ^ 

### Phone : Restoratio n Item s i n Question :

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

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


# y^^y ^ 

# y o - 

# J - o< ^ DatePruden t Technologies , Inc . (Pmdent ) i s unde r contrac t withth e U . S . Environmenta l Protectio n Agenc y (EPA ) t o clea n u p lead
contaminate dsoil s at anumbe r ofpropertie s locate din Omaha , Nebraska , includin g th e propert y locate dat

. Th e EPA request s your permissio nl o allo w PnuJen l t o perfon n asoi l cleami p a t this property t o remov e lead-contaminate dsoil . B y signin g thi s form , th e property owne r grant s peraiissio n l o Pruden t l 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 cleanu p planne dfo r you r property , pleas e contac t Prudent' s Ailmini.'iLniiivc Cle.r k fo

r th e Omah aLea dSit e cleanup . Ms . .Si\, i S . .tMiiiii:iiui-a t (402 ) 73?- ! ISS . Genera l question s abou t th e Omah aLeadSit e cleanu p can b e directe dt o th e EP A Publi c Informatio nCenter s at (402 ) 73 1 -304 5 (Sout hOmah aoffice ) or (402 ) 991-958 3 (NorthOmah aoffice) . Property Acces s Grante dBY
- \MITN Y C C fl O / IC. [ I (Pleas e Prin t Nain e



# . . Q-'^^-^.^v o nrysL-J ) i-iyo i Property Owne r Signature : Pate ) ry \ J (Signature ) PROPERT YINFORMATIO N (T o b e complete d b yresiden t and/o rpropert yowne r—pleas e print ) RESIDEN TNAIVIE : Cfc^^' l T< ' ^^«•/^P > / Rente r RESIDEN TADDRESS : 

## ?y? . T O P CxS-y . r > 1^^- ^ C b "WiJU ^ U-e

_^ S 1 1 I F RENTAL , PROPERT YOWNE D BY :
OWNER' S MAILIN G ADDRESS ;
OWNER' S TELEPHON E NUMBE R - HOME : ( uL ^ ^ ^ ^ " ^ fs' K1 \ WORK : 

### lHf!P\ QS ^ ' - g S(^ C 

# ' F AG E O F HOME ? 

# [(f O YEARS . HO W LON G HAV E YO U LIVE D HERE ? HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIOIN G SINC E 1978 ? NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : YNUMBER 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. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s t o b e implemente db y EP A unde r this agreemen i ar e pursuan t t o Sectio n 10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s right o f

acces s t o th e property i s provide dfor in 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 an y respons e actio n unde r thi s title , o r otherwis 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 Kansa s City , M O G411 4 Omaha , Nebrask a 6811 0 San 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 7ii>:i\viK<.5i'S!>ai:.i'N«Ai ^ v v 

### <'<;? NS'ruuc!'50.i N 

### TECHNOLOGIES , BMC . SCKVICE S 

# Propert y Statu s For m Address : Phone : 

# k Ite mN O O nMa p 

# P \
^•Z Ite mN O O nMa p -^ B ^ D '\>o}rr>c}c ^ A v/^-<

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Date : " ^ M" ^ I ^ M02.
- <^'^ ^ - 2- ^ ^ ^ BVID : Plant s & Permanen t Landscapin g T o Remai nI nPlac e Descriptio n& Locatio n (DLP- ^ 

# <fcl r e o Wu< cM-^.- ^

Pre-Existin g Conditio no f Structure s Does you r Basemen t hav e ahistor y o f leaking ? Yes N o Descriptio n & Locatio n o 

# C^'cui^'te^ ,

Propert y Owne r Pruden t Employe ^ Signature : Signature :

808 0 War d Parkway , Suit e 40 5 250 5 H . 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 San 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 7

# m CHN()L()GIF..S . INC . 

### A S - BUIL T DRAWIN G OI,.S#:27J7 5 Diili ; KMiivjited : 08/21/200 9 

### OMAH A LEA D SUPERFUN D SIT E l>iF.P. \Signcd-Of f Date : 

# illiiliil i 2737 5 Owne rName : TOMMI E L MOOR E Omah a Lea d Sit e Exterio rPain t No * Arro w • Goo d Address : 3370 PATRIC KA V ®'* ^ Sketc h 5>f^o r Phone : H : W : • ha d pain t

Omah aLea dSit e 4613 0

CONTRAC T # : E P - R7-07-0 6 T0# 1 PRUDEN T TECHNOLOGIES , INC .

## 27.^7 5 uxleia rPain t r-Jii-rt i Ainir w 

### Omdh a Lea d Sit e Owne rName : T0r»1MI E L MOOR E 

### Skt e Sketc ^ Address : ^37 0 HATRIC KA V

Phone : • ^

' ^ [~ ] No l p.nr.' ! Sampl e Numbe r RYASCPXA-2?37i > =1 Concentratio n 1 2 7 pfj-T i Cotlecte d

# DLA B 

# u Firr r S3n:>p)e & Coiiecte d I^O AQf^/G; ' RYBSCPXA-2737 5 

### r ? 1 (< i "- i ?i:>'r i Tme . -. 4 . .- M RYCSCP>CA-2737 5 B 1 7 "c i 1 :i3i n KYDSCPXA-2/'37 6 RDZSCPXA-?737 5 RPZSePJt«r2737 5 9 2 & 2 E 2 77 7

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## Prin t Preview Page 1 of 2 Dougla s County-Omaha , N E

Parce 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 Zi p Sec-Twn Rn g 254700000 0 MCNEI L JANYC E 337 0 PATRIC KA V OMAH A ;6811 1 337 0 PATRIC K AV E OMAH A N E 6811 1 

### 09-15-1 3 Additio n Bloc k Lo t Lega l 1 Lega l 2 Lega l 3 Lega l 4 Acre s 1/1 /

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### 9 9 40X119. 5

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### 2

### Pag e 1 o f 2

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### • YOU RTICKE T NUMBE RI S 2336468 . Origina l Cal l Date : 8/07/0 9 Time : 3:3 9 p m Op : SIVA1896 7 Wor k t o Begi n Date : 8/11/0 9 Time : 4:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 337 0 Street : PATRIC K AV E Twp : 15 NRng : 13 E Sect-Qtr : 09-SW,16-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 : FAX AL L CLEAR S TO : (402)733-188 3 : FAX AL L CLEAR S T O (402 ) 73 3 188 3 : UNSUR E CORNER S Compan y: PRUDEN T TECHNOLOGIE S Contac t Name : SIVAJAMPAI-I 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 LEVEL 3 MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Servic e Are a Contac t Phon e Numbe r Utility Typ e CXCAT V CO X COMMUNICATIONS , IN C 

### HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 LEVEL S LEVEL 3 COMMUNICATIONS , LL C 

### N A Day : 877366834 4

Alt : Emerg : 877366834 4 MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : 

### Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R 

### RO N Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0

## Pag e 2 o f

2

0PPDGPR5 OMAH A PUBLI C POWE RDISTRIC T N A Day : 406728934 3

Alt : 406207149 4 Emerg : 888728934 3 QLNNEI C QWEST LOC/U . NETWOR K

N A Day : 406728934 3

Alt : 406207149 4 Emerg : 888728934 3

### j > ENVIRONMENTA L & CONSTRUCTIO N SOLUTION S 

# Sit e Safet yHazar d Analysi s 

# f ^ Address ; 3 3 l O T^jC/^jt : r^c ^ Crew : ~^ifv\& J L^ ^ ^^' ^ '{^•"--y^^r
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Ky 808 0 Wir dParkway , Suit e 40 5 250 5 N . 24" ^ Street , Suit e 30 8 424 2 Medica l Drive , Suit e 725 0 Kansa s Oily . M O 6411 4 Omatia , Nebrastt a6811 0 Sa n Antonio . T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax . (8IS I 363-370 7 Fax : (402)504-100 5 Fax ; (210 J 579-657 7

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