## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL E FOLDE R SAID# : ;? ; S(^ ^ Date : Address : /O . ^ l j ^r XfRemediatio n Contractor : A^.^i^ h H^rli^Acj^ ^ .T^r . Year : ^2i»og SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S E

l Vide o o f propert y (DVD ) l?

f Executiv e Summar y • EPA-provide dpropert y sketc h aSigne dAcces s Agreemen t fo r subjec t propert y D Signe dAcces s Agreement(s ) fo r adjacen t propert y 0 Restoratio n Agreemen t n Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) 3 Confirmatio n dat a ^ Photograph s ^ As-buil t sketc h / Satisfactor y restoratio n signe db y Propert y Owne r E

l Propert y close-ou t chec k lis t signe db y EP A D Descriptio n o f area s no t meetin g RO D cleanu p criteri a laUtilit y clearance s 

### M Propert y mformatio n firomDougla s Count y Assessor' s Offic e D D D Signature/ ^ , ~ ~ ~ [ Diit e 4031071 6 Superfun d

### PROPERT Y SUMMAR Y Date : 01/23/200 9 Omah aLeadSite Remedial Actio n Contrac t #EP-R7-<)7-06/000 4 Monthof : Dec/Jan Propert y Address ; 150 8 N 4 S 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 Oflier Relevan t Information : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : B l = 18 5 PP M @ 6" ; E A = 25 1 PP M @ SCRAPE ATTACHMENT S 1 ) Propert y sketchprovidedb y EP A pursuan t to contract specification s 2 ) SignedAcces s Agreemen t including acces s agreements require dfo r crossing othe r propertie s 3 ) Pre-Excavation digita l vide o clip/photograph s 4 ) Post-Excavation digita l video cUp/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Buil t sketch i ) Shal l include final lea dlevel s v ) Legen d ii ) Contamination lef t behindarea s vi ) Contracto r identification iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e includedin th e individua l propert y file, i f available , or 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 ) o r SW F(Flas hPlayer) forma t and/o r photograph s iv ) Signedfor mverifyin g satisfactor y restoratio n v ) Descriptio n o f area s no t meeting InterimROD cleanu p criteria .

TECHNOLOCIES , INC .Fin d Record Clea n U p Query Lea d Remainin g QueryI Propert yDamag e Quer y 

### Backfill :

Sampl e Area : 8186 8 ­ 150 8 N 4 5 S T Owner : Resident : Contract : n Owne rOccupie d Residen t Name : Contractor : Owne rName : [PRUDENT2008_S [GREE N LE O C Propert yAddress : Group : Owne rAddressl : [150 8 N 4 5 S T Owne rAddress2 : 

### Zi p Code : 6810 4 Assessment : [451 9 S 14 8 S T Residen t Phon e Qualifyin g Grou p City : State : Zi p Code : [80 0 [OMAH A [N E [6813 7 Assessmen t XR F Date : Owne rPhone : Alternat e Phone : [(402 ) 991-339 6 [(402 ) 290-863 3 /Assessmen t MaxXR F Value : 

### 832

### TECHNOLOGIES , IN C 

# dER( V EP A Propert y Clos e Ou t Property# : B l 8 6 8 Propert y Address : I'^o^H'^SS T Date/Time : Owner' s Name : Quad s Excavated : ^^ j ^ ^ Contracto r Grou p Pruden t Technologie s Excavatio n Genera l Ye s No 1 .

If necessary , wer e the correct quadrant(s ) excavatedan drestored ? / 2 .If necessary , wer e the correct area s of drip zone excavatedandrestored ? > / Gradin g Sodan dVegetatio nYe s No 1 .Doe s the grading aroun dthe perimete r of th e hous e i n excavatedarea s generall y slop e awa y y ^ 

### fromthe house ? 2 .

Has sodbee n lai di n all area s tha t wer e excavated ? 

# y 3 .

Doe s the sodappea 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) 

# y 4 .Ar e soddedarea s generall y fir man devenl y graded ? 

## y 5 .

Ar e the joint s betwee n the sodstrip s generall y tight ? (Onl y evaluat e if inspecteda t a3 0 da y I X tim e period) 6 .Wa s the propert y gradedsuc htha t wate r wil l no t poo l on the property ? 

## y 7 . Wa s damage to landscaping o r plan t material s avoided ? 1 ^ 

### Gates , Fence s an dRetainin g WaUs/Ye s N o 1 

### 1 . D o gate s ope n andclos e freely? (IfappUcable ) l / 

### 2 . Wer e all gate s o r fence s taken dow n durin g restoration activitie s reinstalled ? (If applicable ) 

# y 3 . Wa s damage t o gate s o r fence s avoided ? (IfappUcable ) « / 4 . Wa s damage t o retainm g wall s avoided ? (IfappUcable ) 

# y Foundation , Sidin g an dGutter sYe s N o 1 . Wa s damag e to the siding or trimavoided ? 

# y 2 . Wa s damage to flie foundation avoided ? 

# y 3 . Wa s damage t o wmdow s avoided ? 

# y 4 . Wa s damage to window s o r doo r screen s avoided ? 

# y 5 . Wa s damage t o downspouts or downspou t extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete )Ye s No 1 . Wa s damage to drivewa y surface s avoided ? / 2 .

Wa s damage to walkwa y surface s avoided ? ( /

## Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complet e including th e 30-da y so dwarranty : EP A Representativ e ^c^^^ ^ Date : tlz»/o j

# EF A « « 

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n o f removal activitie s perfonne do n th e belo w liste dproperty . Th e propert y owner' s signature indicate s that th e propert y owner i s satisfie dwit hth e restoratio n o f th e subjec t property , an dthat n o item s are in question , now , or at any tim e i n th 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 : - Propert y Address : ^jr^, ^ ^ ISOf? :

• .'.^• . 

### N J 

### M<: ^ A. ^ o^"'='- = [^c . rs^r^. ^ Pbone : Restoratio n lt«n s in Question :

Item : Rem : Item : Item : 

### Kem : Item :

jX I I agre e restoration i s completed , excep t a s note d above . L H I d o no t agre e restoratio n I s complete d 

# / ^ a7-<^> ? Dat ePruden t Technologies , Inc . (Prudent ) i s unde r ccntrac t wit hth e U . S . Environmenta l Protectio n Agenc y (EPA ) t o clea n v p lead contaminate dsoil s a t anumlser ofpropertie s locate di n Omaha , Nebraska , includin g th e propert y locate da t

. Th e EP A request s you r permissb n t o allo w Pruden t t o perfoi masoi l cleaniq ) at thi s propert y t o remov e lead-contaminate dsoil . B y signin g thi s form, th e propert y owne r grant s permissio n t o Pruden t t o perfon n activitie s relate dt o tfa e cleanu p includin g soi l sampling , remova l oflead-contaminate dsoil , an drestoratio n o f tiie re^ence dpropeity . I f

yo u hav e any question s abou t tfa

e soi l cleanu p planne dfor you r property , pleas e contac t Pruden t Administrativ e Cler k fo r th e OmahaLea dSit e cleanup . Ms . Deboia hJohnso n -a t (402 ) 733-1188 . Genera l question s abou t tfa

e OmahaLea dSit e cleaiu p ca n b e directe dt o th e EP A Publi c Informatio n Centei s a t (402 ) 731-304 5 (SouthOmafa aofQce ) o r (402 ) 991-9583 (Nortf aOmah aoffice) . Propert y Acces s Grante dBy: . 

# Ze. ^ ^yf^e^i^ j 'leas e Prin t Name ) Propert y Owne r Signature : (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 T NAME : \ / CK - r^A^W-A ~ Owne r Rente r RESIDEN T ADDRESS : 

## g > ^ C^^U^^.r . k> f d>^Vt) ^ I F RENTAL , PROPERT Y OWNE D BY : 

## ypf i ^ OWNER' S MAIUN G ADDRESS ; 

# <k w c^^u^sA ^ M-g , ^S'l' ^ 7 OWNER' S TELEPHON E NUMBER-HOME : ( \ ^'^ ^

" «^4^'>WORK : AG E O F HOME? : \(Jl P ' YEARS . HO W LON G HAV E YO U blVE B 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 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 CHILDRENUNDE R 7 YEAR S OL D WH O PLA Y I NTH 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. )

AUTHORrr Y FO RENVIRONMENTA LRESPONS E ACTIONS : Th e activitie s t o b e implemente db y BP A unde r tfais agreemen t ar e pursuan t t o Sectio n 10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f

acces s t o th e propert y i s providedfo r i n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry for "determiningth e nee dfor response , o r choosin g o rtaking an y respons e actio n unde r tfai s title , o r otfaerwis e enforcin g tfaeprovision s o f Ifa

e title. "

808 0 War d Parkway , Suit e 40 5 2505 N . 24" * Street , Suit e 30 8 4242 Medica l Drive , Suit e 425 0 Kansa s City , MO 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-«577

## • A S ^ BUIL X I>RAWEV G <:

• 0]VL^}tEAli!"Stl'EKiptJNi> . SlTE^fi ^ OLSH : 8186 8 Dat e Excavated : 12/06/200 8 USEP A Signcd-Of f Date : ^ 

# sid ^ Exterio rPain t NHSIAIIO V Omah a LM d Sif » QGoo d SMtSMtc h Q Poo r a-ypAddiM Kiso a M Ji g fi^- Q Notpaln t SampiesCoaeGlec t SomiileNuiiiiie r 

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# n Die : Q - ft . - of l RYB8CPXArflM« « F 2 

## D Time : liOf t p-rfl . RYCSCPXA-aiM e B l gag - M m 

# a &ainpto s Analyza d RYDSCf>)(A-Sl8< S B Z 3Cf e op m 

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### MS W ugaml : P I > Fron t Len , F 2 « Fra M reght. 81 B Bac k LB4 L 8 2 « BM * Rig N O Z >'Oii p Zone . G Z » Ganteh . PZ=Pla y A l QHiiAwSw # S i 4MM B tan V w AN ^ iKlnQ |MpMt f 

### ...MT.1.5.2MI: .

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### z9 ^ M M^':S t E A = 25 1 PP M @ SCRAP E



### CONTRAC T # : E P - R7-07-0 6 / 000 4 PRUDEN T TECHNOLOGIES , INC .CONSTRUCTIO N 

## TECEEN^ttpGIES , INC . SERVICE S 

# Propert y Statu s For m Address : Date : Phone : BVID : Ite mN O Plant s & Permanen t Landscapin g T o Remai n I n Plac e O n Ma p Descriptio n & Locatio n 

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## Propert y Owne r Pruden t Employei Signature > Signature :

250 5 N . 24*^ ' Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 808 0 War dParkway , Suit e 40 5 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Kansa s City , M O 6411 4 Phone : (402)504-100 4 Phone : (210)822-958 8 Phone : (816 ) 363-370 3 Fax : (402)504-100 5 Fax : (210 ) 579-857 7 Fax : f816 ) 363-370 7

# 815<b 8 Biterio rPain t North An w 

# 1 Omah a Lea d Sit e QGoo d 

### Sit e Sketc h n Poo r Samplin g Address : I50 a H H S SJ - • No t pain t Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Finn : f^D A D B ; ffT RYASCPXA-5186 8 F l "ZCTt pp m 

## D Date : Q-/fao « RYBSCPXA-8IB6f t F 2 ZS 4 pp m 

## D Time : iV3f> p-nr^ . RYCSCPXAr8l8« e B 1 S32 . pp m 

## D Sample s Analyze d RYDSCPXA-0IM B B 2 366 > pp m 

## D 6 0 pp m RDZSCPXA-ai8« e i^ z 

## D XR F Unit : ^&^ 0 Book : 22. 0 RQZ0CPXA"ft»* 6 O Z PP* n 

## D D Dat e 

## lO-IT-O d pp m 

# n p m RPZSCPXA ' 

## D Time : Staff : 

### M€> W Numbe f o f Sample s = [ 5 Legend : F l = Fron t Left , F 2 = Fron t Right , B l = Bad e Left . B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Ganteh . P Z = Pla y A l qiMdianl s ai e as viewe d tra m th e straet . fadn g propart y •

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### Prin t Previe w Pag e 1 o f 1 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 2 Owne r Cit y Owne r Stat e Owne r Zi p 215248000 0 GREE N LEO C 1508N4 5 S T OMAH A 6810 4 4519S14 8 S T OMAH A N E 6813 7 Sec-Twn Rn g Additio n Bloc k Lo t Lega l 1 Lega l 2 Lega l 3 Lega l 4 Treasure r Websit e Lin k Assesso r Websit e Lin k 17-15-1 3 SAUNDER S & HIMEBAUG H T O WALNU T HIL L 4 3 1 N 7 0 F T LT S 3 2 & 81.5X7 0

http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp ? parc=215248000 0 http://douglasne.mapping online.com/DouglasCoNe/statlc/accountinfo.jsp ? accountno=R215248000 0 Disclaimer : Ma p an d parce l dat a ar e believe d t o b e accurate , bu t accurac yi s no t Ma p Scal e guaranteed . Thi s i s not a lega l documen t an d shoul d not b e substitute d fo ra titl e search , 1 inc h = 5 9 fee t appraisal , survey , o rfo rzonin g verification . 

### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 12/2/200 8

### Pag e 1 of 2

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

### YOU RTICKE T NUMBE RI S 2185585 . Origina l Cal l Date : 12/03/0 8 Time : 2:5 8 p m Op : MADHURIMA1896 7 Wor k t o Begi n Date : 12/05/0 8 Time : 3:3 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 150 8 Street : N45T H S T Twp : 15 NRng : 13 E Sect-Qtr : 17-NW Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n wor k fo r soi l 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 : MADHURIM A Phone : (402)733-118 8 Alt . Contact : Phone : (618)401-222 3 Wor k Bein g Don e For : ep a Dept h o f Excavation : 6 f t Corne r Lot : NFront : NRear : N Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V MCLEODN E MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C 

### Servic e Area Contact Phon e Numbe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEID I Day : Alt : 402934046 9 402934046 9 Emerg : 402932975 7 MCLEODN E MCLEODUS A N O NEE D T O CAL L OU T EMERGENC Y Day : Alt : 800289190 1 Emerg : 800289190 1 MUDO l METROPOLITA N UTILITIE S DISTRIC T SAND Y Day : Alt : 402504782 3 Emerg : 402504797 0 OMAHACO F CIT Y O FOMAHA - TRAFFIC.SEWE R RO N Day : Alt : 402444719 7 402444516 1 Emerg : 402444516 0 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 12/3/200 8

## Pag e 2 of 2 Day : 406728934 3 OMAH A PUBLIC POWE R 0PPDGPR5 N A 

## Alt : 406207149 4 DISTRICT 

## Emerg : 406523771 7 Day : 406728934 3 QLNNEIC QWES T LOCA L NETWOR K

N A 

## Alt : 406207149 4 Emerg : 406523771 7

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