### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 3607 6 DATE : 12/15/201 0 ADDRESS : 211 5 BROWN E ST REMEDIATIO N CONTRACTOR : PRUDEN TTECHNOLOGIES . INC . YEAR : 

### 201 0 

### SOI L REMEDIATIO N PROPERT Y FIL E FOLDE R DOCUMENT S 

# 6 PR E AN D POS TVIDE O O F PORPERT Y(DVD ) EXECUTIV E SUMMAR Y EPA-PROVIDE D PROPERT YSKETC H SIGNE D ACCES S AGREEMEN TFO R SUBJECTPROPERT Y 

# n SIGNE D ACCES S AGREEMENT(S ) FO R ADJACEN TPROPERT Y RESTORATIO N AGREEMEN T 

# a SETTLEMEN TDOCUMENT S (I.E. , FO R DAMAG E O R T O REPLAC E PLANTS , ETC. ) 

# A CONFIRMATIO N DAT A 

# b PHOTOGRAPH S AS-BUIL TSKETC H SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R 

# A PROPERT YCLOSE-OU TCHEC KLIS TSIGNE D B Y EPA 

## D DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A UTILIT YCLEARANCE S 

# c 4 PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR' S OFFIC E
D D 

### <b^ ^ ,\is W SIGNATUR E DAT E 3021859 0 

# IIH I Superfun dFin d Record 

### Baclcfill : Remediatio n Quer yi Lea d Remainin g Queryj Propert yDamag e Quer y 

### Sampl e Area : 3607 6 ­ 211 5 BROWN E S T Owner : Use rProvide d Owne rInformatio n Resident : D Owne rOccupie d Owne rName : jCTT Y O F OMAH A Owne rAddressl : ja O QT Y RNANC E Owne rAddressZ : J181 9 FARNAM ST City : JOMAHA Owne rPhon e 

# 1 State : ZipCode : (NE" " |68I¥3 - Alternat e Phone : 

# ' i Owne rName : Owne rAddress : 

# r~~ — City : 

# I Owne rPhone : State : Zi p Code : 

# r Alternat e Phone : Residen t Name : JBJORGAAR D DENNI S Propert yAddress : |211 5 BROWN E S T Zi p Code : J68110 - Reslden t Phon e

Contract : Assessment : Contractor : PRUDEfiTZOl O S Qualifyin g Grou p J400/CHiL b Contrac t Optio n jOPTIO N 2 Assessmen t Ma xXR F Valu e j 649.3 9

### PROPERT Y SUMMAR Y Date : 12/15/201 0 Omah aLea dSit e Reinedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Decembe r Propert y Address ; 211 5 BROWN E 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 : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : B 2 = 5 4 PP M @ 4" ; E A = 6 3 PP M @ SCRAP E (~1" ) ATTACHMENT S 1 ) Property 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-Buil t sketc h­ 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 ) Propert y 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 obtainedinclude : i ) Pre-excavatio n agreemen t detail s (i f an y ar e mad e withth e property owner ) ii ) Propert y Statu s For msigne db y property owne r iii ) Excavatio n digita 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 n o f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOGIES , INC .TECHNOLCXJIES , INC . Propert y# : 3 ^

C>TQ ? 

### Date/Time : Quad s Excavated : ^"2 — 

# EP A Propert y Clos e Ou t Propert y Address. : ZI^" ^ Sroo S ir^^Sr H Owner' s Name : C i<+<>v > o«!rOrvuJ(Wfl { Contracto r Group : Pniden t Technologies , Inc. , Excavatio n Genera l Ye s N o I . I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 

# y 2 . I f necessiiry . wer e th e correc t area s o f dri p zon e excavate dan drestored ? 

# y 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 excavate darea s generall y slop e awa y 

# y fro mthe house ? 2 .Has sodbee n lai di n all area s tha t wer e excavated ? 

## y 1Doe s the sodappea r t

o b e generall y health y andgrowing ? (Onl y evaluate i f inspecte dat a3 0 da

y lim e period) ' 

# y 4 .

Ar e soddedarea s generally firman devenl y graded ? 

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

f inspecte da t a3 0 da y 

# y tim e period) 6 .

Wa s the propert y grade dsuc htlia t wate r wil l not pool o n the propert)' ' 7 .Wa s dainag e t o landscapin g o r plan t material s avoided ? 

# y Gates , Fence s an dRetainin g Wail s Ye s N o 1 . D o gate s ope n an dclos e freely ? (I f appUcable ) / 2 .Were al l gale s o r fence s take n dow n durin g restoratio n activitie s reinstalled ? (Ifapplicable ) / 3 .Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) 

# y 4 .Wa s damag e l 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 the siding o r trimavoided ? 

## y 2 .Wa s damag e ( o the foundalion avoided ? 

# y Wa s damag e l o window s avoided ? 

# y 4 .

Wa s damag e t o window s o r doo r screen s avoided ? 

# y Was damag e t o downspout s o r downspou t extension s avoided ? / 

### Sidewalk s an dPriveway s (Concrete ) Ye s v-N o 

# T f Wa s damag e t o diivcwa v surface s avoided'^ 2 .Was damag e l o walkwa y surface s avoided ?

## Ovner s coinments :

Inspectio n notes :

Remova l andrestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e ^ ^ •^n ^ ^Date : ,iUi\i o

# ra CHNOLOGIES . INC . 

### A S - BUIL T DRAWIN G OL S # 3607 6 Dat e Excavated : 10/20/201 0 

### OMAH A LEA D SUPERFUN D SIT E I SEP ASigned-Of f Date :

Oinah a Lea d Sit e 

### Data . <\m\^ ^ Nortt i Arro w Address : ^ " Sit e Sketc h Time : A ol ^ Phone : Tea m 

# j^M L BVID # ^iaOlC y XR F Cod e 

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# VSampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e 

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A = 6 3 PP M aS C RAP E (~1" ) Omah aLea dSite 4613 0 CONTRAC T # : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC .

# SEP A Propert yCompletio n Agreemen t Thi s agreemen t document s th e compietio n o f remova l 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 propert y owne r i s satisfie dwit hth e restoratio n o f th e subjec t property , an dtha t n o item s ar e i n question , now , o r at an y tim e i n th e future , excludin g an y remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , i f any . PropertyID : 

## [^^0^ 6 Propert yAddress : 

## ;2n r /3/\QUA/£ - Sr/jf-^- y Owner : 

## ^v/ U , ;TL/^-vY^l ^ Phone : 

## ^ ^oj^(^W - HJ i V/ - Restoratio n item s i n Question :

Item : item : Item : Item : item : item : Required correction s t o complet e th e property :

L

^

I agre e restoratio n i s completed . L J I d o no t agre e restoratio n i s complete d a t (note d deficiencie s above )



### '^-'//ji,<^„4(/-J'oi o Owner' s SIg l Dat ePnidcnl Technologies , Inc . (Prudeni ) i s unde r contrac t wit hth e U . S . Environmenta l Protectio n Agenc y (EPA ) t o clea n up Icad
conlaminate dsoil s a l anutnbe r o f

propertie s locate di n Omalia . Nebraska , includin g the propen y locate da t J Iir fnoi^yyf
- >S^"«- ' / The EP A request s you r permissio n t o allo w Prudeni t o perror masoi l cleanup a t thi s propert y to remov e Icad^contaminatedsoil . B y signin g thi s fomi , llie propert y owne r grant s permissio n t o Prudent to perfor m activitie s relate dt o th e cleanu p includin g soil sampling , remova l of lead-contaminate dsoil , an drestoratio n ofth e reference dpropeny . Ifyo u hav e an y question s abou t th e soi l cleanup planne dfo r you r property , pleas e contac t Prudeni sout h offic e .for th e Omah aLea d Site cleanup-at (402 ) 733- t 188 . General question s about th e OmahaLea dSite cleanup ca n b e directe dt o th e EP A Publi c Informatio n Center s a t (402 ) 731-304 5 (SoutJ i Omah aoffice ) or (402 ) 991-958 3 (Nort h Omah aoffice) . Propert y Acces s Grante dBy : i^lHlAi ^ L.iyU(l i y (Pleas e Prin t Name) Propert y Owne r Signature : 

# ..JMHH ^ S-Qc-i-Jui O (Signature ) (Date ) PROPERT Y INFORMATIO N (T o bccomplete d b yresiden i and/o rpropert yowne r~ pleas e print ) RESIDEN T NAME : Ovi^ne r Rente r RESIDEN T ADDRESS ; lESS : /vt^*
- 

# 3d i I F RENTAL , PROPERT Y OWNE D BY : OWNER' S MAILIN G ADDRESS ; OWNER' S TELEPHON E NUMBE R - HOME : J L WORK : 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 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 CHILDRE NUNDE 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 INSTRUCnONS : (I.E . DOGS , ENTR Y GATES , ETC. )

AUTHORITY FO RENVIRONMENTA L RESPONS E ACTIONS ; The activitie s t o b e implemente db y EP A unde r Ihi s agreement are pursuan t t o Seclio n 10 4 of CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f

acces s t o the propen y i s provide dfo r i

n Sectio n 104(c) o f CERCLA , 4 2 U.S . C 960S(e) , whic hprovide s entr y fo r "detenninin g th e needfo r response , o r choosin g o r takin g an y respons e aciio n unde r thi s title , o r otheru'is e enforcin g th e provision s o f the title. " 808 0 War d Parkway , Suit e 40 6 560 0 S 1 0 S t 424 2 Medica l Drive , Suit e 426 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6810 7 San Antonio , T X 7822 9 Phone:(816)363-370 3 Phone : (402)733-118 8 Phone : (210)822-958 8 Fax:(816)363-370 7 Fax : (402)733-188 3 Fax : (210 ) 579-657 7

## ItpHAi ^ 

# Name: Dsinn b honopohc j Omah a Lea d Sit e Date ; 

## 02 > Nort h Arro w 

# 3 M Sit e Sketc h Time : 

### : _iL2 j Addres s Phone : \ Tea m 

# -ftl^ ^ BVID # T-laOK o XRFCode . 

# 5-^ ^ / Sampl e Numtie r Lea d Concentratio n Confirmatio n Sampl e


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Omah aLea dSit e 4613 0

### Pag e 1 o f 1 

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SEPTEMBE R 200 8 - DOUGLA S COUNT Y ASSESS O



### http://douglasne.mapping-online.com/assessdoc/Photos/03/R20049000000001.jp g 10/5/201 0

# 211 5 BROWNE ST : 53X10 8 

# A Printed : De c 03 , 201 0 www.dcgis.org/dogi s

### Pag e 1 o f 1

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

### YOU RTICKE T NUMBE RI S 2609460 . Origina l Cal l Date : 10/05/1 0 Time : 4:3 3 pm Op : SIVA1 8 96 7 Wor k t o Begi n Date : 10/07/1 0 Time : 5:0 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 211 5 Street : BROWN E S T Twp : 15 NRng : 13 E Sect-Qtr : 03-N W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : SOI L LEA D REMEDIATIONPROJEC 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: PRUDENT 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

MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Servic e Are a Contac t Phon e Nuinbe r Utility Typ e CXCAT V CO X COMMUNICATIONS , INC HEIDI 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUDO l METROPOLITA N UTILITIE S DISTRIC T SANDY 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACOFCITY OFOMAHA-TRAFFICSEWERRICHATRAFFI C 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 OPPDGPR5 OMAH A PUBLIC POWE RDISTRIC T EL M LOCATING 

### Day : 406728934 3 Alt : 406207149 4 

### Emerg : 888728934 3 QLNN E 1 C QWES T LOCA LNETWOR K 

### EL M LOCATIN G Day : 406728934 3

Alt : 406207149 4

Emerg : 888728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 10/5/201 0

### ENVIRONMENTAL ENGINEERIN GAN D CONSTRUCTIO N 

## iscMNoui^BS , mc . SOLUTION S 

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### seoosios t 424 2 Medica l Drive , Suit e 72S 0 ICansa s Cl|y;iia«411 4 Omalia , Nabiasic a 6810 7 Sa n Antonio , T X ^22 9 Rwne : (818 ) 36S47Q 3 Phone : (402)733-118 8 Phone : (2t0 ) 82Z-S68 8 Fax : (8W)i363>'370 7 Pta c(402)733^188 3 Fax : (210)579-657 7

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