### TRANSMITTA L O F OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 2582 3 DATE : 1/1 5 ADDRESS : 282 6 CHARLE S S T REMEDIATIO N CONTRAaOR : PRUDEN T TECHNOLOGIES . INC . YEAR : 201 ^ 

### SOI L REMEDIATIO N PROPERT Y FIL E FOLDE R DOCUMENT S d PR E AN D POS T VIDE O O F PORPERT Y (DVD ) [

/ EXECUTIV E SUMMAR Y { 3 EPA-PROVIDE D PROPERT Y SKETC H [ Z SIGNE D ACCES S AGREEMEN T FOR SUBJEC T PROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN T PROPERT Y {^''^RESTORATIO N AGREEMEN T D SETTLEMEN T DOCUMENTS (I.E. , FOR DAMAG E O R T O REPLAC E PLANTS , ETC. ) Q^'^CONFIRMATIO N DAT A B PHOTOGRAPH S Ca^S-BUIL T SKETC H 0

^

SATISFACTOR Y RESTORATIO N SIGNE D B Y PROPERT Y OWNE R

• ^PROPERT Y CLOSE-OU T CHECKLIS T SIGNE D B Y EP A D DESCRIPTIO N O F AREA S NO T MEETIN G RO D CLEANU P CRITERI A ^UJ\UV f CLEARANCE S \yPROPERT Y INFORMATIO N FRO M DOUGLA S COUNT Y ASSESSOR'S OFFIC E D 

# n A«>S L Zhj n SIGNATUR E DAT E 

### 3021760 2 Superfun d

### PROPERT Y SUMMAR Y Date : /15/201 0 Omah aLeadSit e Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l Mont h of : Propert y Address : 282 6 CHARLE 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 Othe r Relevan t Information : wea k

foundatio n CONFIRMATIO N SAMPLIN G DATA/RESULTS :

B l = 17 5 PP M @ 2" ; B 2 = 24 0 PP M @ 3" ; N O EASEMENT ATTACHMENT S 1 ) Propert y sketc h providedb y EP A pursuan t to contract specification s 2 ) Signe dAcces s Agreemen t including acces s agreements requiredfo r crossing othe r propertie s 3 ) Pre-Excavation digita l vide o clip/photograph s 4 ) Post-Excavation digita l video clip/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Buil t sketch ­ i ) Shall includ e fina l lea dlevel s v ) Legen d ii ) Contamination lef t behin darea s vi ) Contracto r identification iii ) Propert y addres s vii ) Dat e iv) BVI D numbe r 7 ) Othe r items to be includedi n the individua l propert y file , if available , o r obtainedinclude : i ) Pre-excavationagreementdetails(i f an y ar e mad e wit h the propert y owner ) ii ) Propert y Statu s For msignedb y propert y owne r iii ) Excavation digita l video i n MPEG , WM V (Window s Medi aVideo ) o r SW F(Flash Player ) forma t and/o r photograph s iv ) Signedfor mverifying satisfactor y restoration v ) Description o f area s not meeting InterimRO D cleanu p criteria .

TECHNOLOCIES . INC .Fin d Record Remediatio n Quer y Lea d Remainin g Query! Propert yDamag e Query Backfill :

Sampl e Area : 2582 3 - 282 6 CHARLE S S T Owner : D Owne rOccupie d Owne rName : JCTT Y O F OMAH A Owne rAddressl : !c/0"aTYFINANCE " Owne rAddress2 : J181 9 FARNAM S T City : State : Zi p Code : JOMAHA 

## IN T J68183 - Owne rPhon e Alternat e Phone : 1(402 ) 441^15 0

Contract : Qjntractor : fPRUDENT2010_S Contrac t Optio n JOPTIO N 2 Use rProvide d Owne rInformatio n Owne rName : 

# f ' Owne rAddress :
City : state : Zi p Code : 

# r 1 •••' ! Owne rPhone : Altemat e Phone : 

# r .1

Assessment : Qualifyin g Grou p |40 0 Assessmen t MaxXR F Valu e 49 3 ^ Resident : Residen t Name : jLO T Propert yAddress : U82 6 CHARLE S ST Zi p Code : 168131 - Residen t Phon e 

# r

# JSMMM l TTECHNOLOGIES , INC . 

### Propert y # : 2-'?^' ^ ^ Date/Time : Quad s Excavated : ^ (16> 2_ 

# EP A Propert y Clos e Ou t Propert y Address : " Z ^2^^Wl^ > Owner' s Name : C^"' ^ 4 ^ Oty^'' ^ Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera ) Ye s N o I .I f necessary , wer e the correc t quadranit(s ) excavatedandrestored ? / 2 .I f necessary , wer e th e correc t area s o f dn p zon e excavatedandrestored ? / Gradin g Sodan dVegetatio n Ye s N o 1 .

Doe s the gradin g aroundthe perimete r o

f th e hous e i n excavate darea s generall y slop e awa y / fro

mthe house ? 2 .

Has sodbeen laidin all area s tha t wer e excavated ? / 3 .

Doe s the sodappea r t

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

y tim e period) / 4 .Ar e soddedarea s generally fir mandevenl y graded ? 

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

f inspecte da t a3 0 da y tim e penod ) 

# y 6 .Wa s th e propert y grade dsuc h tlia t wate r wil l not poo l on the property ? / Wa s damag e l o landscaping o r plan t material s avoided ? 7 

# y Gates , Fence s an dRetainin g WaU s Ye s N o 1 . Do gate s ope n andclos e freely ? (I f apphcable ) / 2 , Wer e all gate s o r fence s taken dow n during restoratio n activitie s reinstalled ? (I f applicable ) 

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

# y 4 . Was damag e t o retainin g wall s avoided ? (I f applicable ) 

# y Foundation , Sidin g an dGutter s Yes/N o tes x 1 Was damag e t o tl^ e sidin g o r trimavoided ? Wa s damag e t o tlie foundation avoided ? 

# r Wa s damag e t o window s avoided ? 4 ,Wa s damag e t o window s o r doo r screen s avoided ? 

# y 5 .Wa s damag e lo downspout s or downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ycs / N o I .Was damag e lo diivewa y surface s avoided ? 

# y 2 .

Wa s damag e to walkwa y surface s avoided ?

## Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e Qc^M ^ Date : n\is\ mTTlNOI.OUIES . IN C 

## AS - BUILT DRAWIN G OI.S S 2582 3 Dat e Kxcavated : 10/07/201 0 I SEPASigncd-OITOalc : 

## OMAH A LEAD SUPERFUND SIT E

Name : L i +"v^ o 4 CVnaii? ! Omah a Lea d Sit e Date : Nort h Arro wV Addres s "Z-'t^^'J, : OI.N^/t^ s S / Sit e Sketc h Time : Phone : t 

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Omah aLea dSit e 4613 0 CONTRA a # : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC .'^M ^ BO M 

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n o f remova l activitie s performe d o n th e belo w liste d property . Th e propert yowner' s signature indicate s tha t th e propert yowne ri s satisfie d wit h th e restoratio n o f th e subjec t pi'opcity , an d that n o item s ar e i n question , now , o ra t an ytim 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 d below , i f any . Propert y ID : Propert y Address : 

# c^U b ci.xu , y Owner : 

### r'// | Y ^,X;../. J Phone : 

### '
- '(0)
- '-/V V '(j^i j Restoratio n Item s i n Question :

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

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

' \ / ' • I 'yf r( ,• • / / . / • / u Owner' s Signat u 

# ; t \:y.y^ - Dat e 

# yPrudent Technologies , Inc . (Prudent ) i s unde rcontrac t wit h Ih e U . S . Environmenta l Protectio n Agenc y(EPA ) t o clea n u p Icad conjj|ninate d soil s a t a numbe ro f properties located i n Omaha . Nebraska , includin g th e propert ylocated a t r<j>/ - Th e EP A request s you rpermissio n to allo w Prudent t o pcrror m a soi l cleanu p a t thi s 

## ^S2jt ^ propcrtyl 6 remov e Icnd-contaminatc d soil . B ysignin g thi s Torm , tji c properl yowne rgrant s permissio n t o Pruden t to perfon n activitie s related to Ih e cleanu p includin g soi l sampling , remova l o f lead-contaminate d soil , and restoratio n ofth e rercrcncc d property . I f yo u hav e an yquestion s abou t th e soi l cleanu p planne d fo ryou rproperty , pleas e contac t Pruden t sout h ofTic e .fo rth e Omaha Lea d Site cleanup-a t (402 ) 733-1188 . Genera l question s abou t th e Omah a Lea d Sit e cleanu p ca n b e directe d t o th e EP A Publi c Infonnatio n Center s a

t (402 ) 731-304 5 (Sout h Omaha office ) o r(402 ) 991-958 3 (Nort h Omah a office) . Propert yAcces s Granted By : AV///^ ^ H'C-cU/Tn h I ? (Pleas e Prin t Name ) Propert yOwne rSignature : 

### s'-i/^yyj/ O (Signalun; ) (Date ) PROPERT Y INFORMATIO N (T o b e complete d b yresiden t and/o rproperl yowne r- - pleas e print ) f^ESlDEN T NAME : Owne r Rente r RESIDEN T ADDRES S 

# 'r\..A. ^ R t fiN^^i^ lO b ^«' I f 2 I F RENTAL , PROPERT Y OWNE D BY : OWNER' S MAILIN G ADDRESS ; OWNER' S TELEPHON E NUMBE R - HOME : J L WORK :



### KHO^ \ ^NH ' ^(jf-i y AG E O F HOME? : YEARS . HOW LON Q 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 N UNDE R 7 YEAR S OL D WH O PLA Y I 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. )

AUTHORIT Y FO R ENVIRONMENTA L RESPONS E ACTIONS ; Th e activitie s t o b e implemented b yEP A unde rthi s agreemen t ar

e pursuant to Sectio n 10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s right o f acces s t

o th e propert yi s provide d fo ri n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9ft05(c) , whic h provides entr yfo r"determinin g th e nee d fo rresponse , o rchoosin g o rtakin g an yrespons e actio n unde rthi s title , o rotherwise enforcin g th e provision s o f th e title. " 808 0 War d Parkway , Suit e 40 5 SSOOSIOS 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)822-058 8 Fax : (816 ) 363-370 7 Fax : (402)733-188 3 Fax:(210)679-657 7

### Name : C t "^v i o n Otwatt A Omah a Lea d Sit e Date : Nort h Arro w —i 

### ^ SK e Sketc h Time : 

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### Printed : De c 08 . 201 0 www.dcgis.org/dogi s

### Pag e 1 of 2
" > Creat e Anothe rTicke t ) Bac k to Irt h Inteme t Sen d Emai l 

### YOU RTICKE T NUMBE R IS 2609454 . Origina l Cal l Date : 10/05/1 0 Wor k to Begi n Date : 10/07/1 0 

### Time : Time : 4:3 1 pm 5:0 0 pm Op : SIVA1896 7 State : NE Address : 2826 ' County : DOUGLA Street : CHARLE S ST 

### UGLA S 

### S Place : OMAH A Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 16-N E Sect-Qtr : Typ e of Work : SOIL . LEA D REMEDIATIO NPROJEC T Locatio n of 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 AJAMPAM A Phone : (402)733-118 8 Wor k Bein g Don e For : EP A Dept h of Excavation : 6 FT Corne r Lot: N Front : Y Rear : Involve s Tunnelin g or Horizonta l Borin g : N Explosives : N CXCAT V LEVEL 3 MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Servic e Are a Contac t Pbon e Numbe r Utilit y Typ e 

### Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I 

### Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 LEVEL S LEVEL S COMMUNICATIONS , LL C NA 

### Alt : Emerg : 877366834 4 Day : 402504782 3 MUDO l METROPOLITA N UTILITIE S DISTRIC T SAND Y 

### Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y OFOMAHA-TRAFFIC,SEWE R 

### RICH/TRAFFI C Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 10/5/201 0IBOHNOLOi^B , 

## mc . CONSTRUCTIO N SOLUTION S 

## SIT E SAFET Y HAZAR D ANALYSI S Address : 

# 212J ^ 

# cUJ ^ ^ L Excavatio n Date : Crew : BackfiU Date : —

Ite m Overhea dLine s Ga s Lin e Wate r Lin e Sewe r Lin e Septic/Leec h Fiel d Propane/Butan e Sidewal k Foundatio n Retainin g WaU s Fence s Tree s Structure s Driveway Sprinkle r Syste m Othe r Cre w Forema n Conditio n Hazard s Correctiv e Actio n CPi<
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te n WvtfVortamy . Suit e 40 5 

### isaoosios t 424 2 fifedical Drive , Suit s 725 0 (amasCi|ly;MO«4ll 4 Owafaa . MttorjUk a0010 7 Sa n Antonio , T X 7822 9 ifian K(SK ) Ses-STO S Plioiw : (4aZ)733-11t t Phone : (210 ) 822-«58 8 :«K:f»tS)36»470 7 Fax : (402)733^t8« 3 Fax : (210)«r9-657 7