## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL EFOLDE R 

# SAI D # : cg.TO/ 9 Date : H ^ I 5 "" I 0 Address : S^^l f C^qrlf^ ^ f! f Remediatio n Contractor : Ppt-y^rfPr-iT f 7»/''-|<NodOC|i-{^«^^/rjci- ^ Year : SOI LREMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S 

# i Vide o o f propert y (DVD ) Executiv e Sununar y 

# i EPA-provide dpropert y sketc h Signe dAcces s Agreemen t fo r subjec t propert y 

# u Signe dAcces s Agreement(s ) fo r adja<?en t propert y ^ Restoratio n Agreemen t D Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) Confirmatio n dat a Photograph s As-biiil t sketc h 

# i Satisfactor y restoratio n signe db y Propert y Owne r Propert y close-ou t chec k hs t signe db y EP A 

### 0 Descriptio n o f area s no t meetin g RO D cleanu p criteri a 

# i Utilit y clearance s 

# i Propert y informatio n fromDougla s Count y Assessor' s Offic e D D 

### D '^<r ^ 4\1V ^ Signatur e Dat e 3021890 7 

# Miniiiiiii i Superfun dPROPERT Y SUMMAR Y Date : 11/15/201 0 Oinah aLea dSit e Reinedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Novembe r Propert y Address ; 283 4 CHARLE S S T A . EXECUTIV ESUMMAR 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 l = 22 7 PP M @ 9" ; N O EASEMEN T 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 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 fina l lea dlevel s v ) Legen d ii ) Contaminatio n lef t behin darea s vi ) Contracto r identificatio n iii ) Property 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 , ifavailable , o r obtaine dinclude : i ) Pre-excavatio n agreement detail s (i f an y ar e mad e wit hth e property owner ) ii ) Property Statu s Formsigne db y property owne r iii ) Excavatio n digita l vide o i n MPEG , WM V (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 n o f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOGIES . INC .Fin d Record Remediatio n QueryI Lea d Remainin g QueryI Propert yDamag e Query Backfill :

Sampl e Area : 2581 9 ­ 283 4 CHARLE S S T Owner : Use rProvide d Owne rInformatio n Resident : n Owne rOrnipie d Owne rName : jCTT YO F OMAH A Owne rAddressl : |C/ 0 CIT YFINANC E Owne rAddress2 : |181 9 FARNAM ST City : {OMAH A Owne rPhon e 

# r state : Zi p Code : (N E (68183 - Alternat e Phone : 

# 1 Owne rName : 

# 1 Owne rAddress : 

# 1 City : 

# 1 Owne rPhone : 

# 1 " State : ZipCode : 

# 1 1 Alternat e Phone : 

# 1 Residen t Name : [LO T Propert yAddress : (283 4 CHARLE S S T Zi p Code : (68131 - Residen t Phon e 

# I

Contract : Assessment : Contractor : (PRUDEMT2010_ S Qualifyin g Grou p |'4o 6 Contrac t Optio n (OPTIO N 1 Assessmen t Ma xXR F Valu e ( 530/ S ^ 'nBCHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y #:'2''7B'^ ^ Propert y Address : ^^"5 4 CV^iA ^ > Date/Time : Owner' s Name : <2i>C | c.,§^f>v^Wc ( Quad s Excavated : ^ ' Contracto r Group : Pruden t Technologies , Inc , Excavatio n Genera l Ye s N o 1 . I f necessary , wer e th e correct quadrant(s ) excavatedandrestored ? / 2 . I f necessary , wer e th e correct area s o f drip zon e excavatedandrestored ? / Gradin g Sodan dVegetatio n Ye s N o 1 .

Doe s th e grading aroundthe perimete r o

f th e hous e i n excavatedarea s generall y slope awa y fro mthe house ? / 2 .

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

## X 3 .

Doe s th e so dappea r to be generall y health y andgrowing ? (Onl y evaluat e i f inspecteda t a3 0 / da

y tim e period) 4 .

Ar e sodde darea s generall y firmandevenl y graded ? ^ 5 .Ar e the joint s between the so dstrip s generall y tight ? (Onl y evaluat e if inspecteda t a3 0 da y tim e period) 

## y 6 .Wa s the propert y gradedsuc htha t wate r wil l no t pool on the property ? 

## y 7 .

Wa s damage to landscaping o r plan t material s avoided ? / Gates , Fence s an dRetainin g Wall s Ye s N o 1 .

Do gate s ope n andclos e freely ? (I f applicable) / 2 .

Wer e all gate s o r fence s taken dow n during restoratio n activitie s reinstalled ? (Ifapplicable ) t T 3 .

Wa s damage t o gate s or fence s avoided ? (I f applicable ) 

# y 4 . Wa s damage t o retaining wall s avoided ? (I f apphcable ) 

# y Foundation , Sidin g an dGutter s Ye s N o 1 .

Wa s damage t o di e siding o r tri mavoided ? 

# y 2 . Wa s damage t o the foundation avoided ? 

## X 3 . Wa s damage to window s avoided ? 

## y 4 . Wa s damage to window s o r doo r screen s avoided ? y ^ 5 . Was damage to downspouts o r downspou t extension s avoided ? ^ Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Was damage to drivewa y surface s avoided ? 

# y 2 . Was damage t o walkwa y surface s avoided ? 

## y

### Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complet e includin g th e 30-da y so dwananty : EP A Representativ e jQ^„yk ^ Date : /o/fe//^CHNULOGIES , INC . 

### A S - BUILT DRAWIN GJ T OL S #2581 9 Dat e Excavated : 9/22/201 0 

### OMAH A LEA D SUPERFUND SIT E USEP AS^ned-Of f Date :

Name : _5 _ Omah a Lea d Sit e Date : ^////r / . Nort h Arro w Address : Sit e Sketc h Time : j '-^ i Phone : _ Tea m iil'-tw^/ - XR F Cod e 

# ^^^ y Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampi e J Z l f - Ye s n N o S ' JS;^: ^ pp m r.Ye s • N o S-" '

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## Propert yCoinp(etio n Agreemen t Thi s agreemen t document s th e completio n o f removal activitie s perfonne don th e belo w liste dproperty . Th e property owner' s signature indicate s that th e properf y owner i s satisfle dwit hth e restoratio n o f the subjec t properfy , an dthat n o item s ar e i n question , now , o r at any tim e i n th e future , excludin g any remainin g warranf y (3 0 day s tota! ) excep t thos e item s liste dbelow , i f any . Property ID : 

# 25fii l Propert yAddraa : ^^-^l / ^H^gLR S ^ . Owner : 

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6 ^ M f \ Phone : 

# (t/oi ) ^^ ^ 'H n Restoratio n Hem s I n Question :

Item : Kem : Item : Item : Item : Require d correction s t o complet e th e properfy :

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 )

^H)wner'»signatur e

0Pruden t Technologies , Inc . (Prudent ) i s unde r contrac t withth e U . S . Environmenta l Protectio n Agenc y (EPA ) t o clean u p lead contaminate dsoil s at anumbe r ofpropertie s locaie di n Omaha , Nebraska , includin g th e propert y locate da t ^/).b*- ( C^I/yPt^Lz ^ • Tli e EP A request s you r permissio n t o allo w Pruden t t o performasoi l cleanu p a t thi s property 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 perfor m activitie s relate dt o th e cleanu p includin g soi l sampling , remova l o f lead-contaminate dsoil , an drestoratio n ofth e reference dproperty . Ifyo u hav e an y question s abou t th e soi l cleanu p planne dfor you r property , pleas e contac t Pruden t southoffic e _fo r th e Omah aLea d Site cleanup-a t (402 ) 733-1188 . Genera l question s abou t th e Omah aLea dSit e cleanu p can b e directe dt o th e EP A Publi c Informatio n Center s at (402 ) 731-304 5 (SouthOmal moffice ) o r (402 ) 991-958 3 (NorthOmah aoffice) . Property Acces s Grante dBy : 

### A^ / ll]r> ^ Lu'k/ ^ (Pleas e Prin t Name ) Property 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 TNAME : Rente r RESIDEN TADDRESS : 

### ^ ^i - I F RENTAL , PROPERT YOWNE D BY : OWNER' S MAILIN G ADDRESS ; 

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O/^ U x/ € ar^ ^ 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 INSTRUCTIONS : (I.E . DOGS . ENTRY GATES . ETC. )

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

acces s t o th e propert y i s provide dfor i n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry for "determinin g th e nee dfor response , or choosin g o r 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 5 560 0 S t o S t 424 2 Medica i Drive , Suit e 425 0 Kansa s City.'M O 6411 4 Omaha . Nebrask a 6810 7 Sa n Antonio . TX 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

### TECHNOLOGIES , INC . E^rV'^IRO^MElVTAL & CONSTRUCTIO N S£RVICE. S 

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### Propert y Owne r Pruden t Employe e Signature : Signature : 808 0 War d Parkway . Suit e 40 S 560 0 S 1 0 S t edica t Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6810 7 Sa n Antonio . TX 7822 8 Phone : (816 ) 363-370 3 Phone : (402)733-118 8 Phone : (210)822-958 8 C-.. . /one * ^C ^ tTrt T C* . filAO l T4t 4004

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### YOU RTICKE T NUMBE RI S 2592076 . Origina l Cal l Date : 9/14/1 0 Time : 5:2 1 p m Op : SIVA1896 7 Wor k t o Begi n Date : 9/16/1 0 Time : 5:4 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 283 4 Street : CHARLE S S T Twp : 15 NRng : 13 E Sect-Qtr : 16-N E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : soi l lea d 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 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 o f Excavation : 6 F T Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r 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 Phon e Numbe r Utilit y 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 N UTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFIC.SEWE R 

### RICH/TRAFFI C Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/14/201 0

### Pag e 2 of 2

OPPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T EL M LOCATIN G 

### Alt : 406207149 4 Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K Day :

EL M LOCATIN GAlt : 406728934 3 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/14/201 0

### ENVIRONMENTA L ENGINEERIN GAN D CONSTRUCTIO N 

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## Sit e Safety Offic e Date :

808 0 WanHtarkMy , Suito4I S Item s emy ; II04411 4 SSOOSIOS t Omidaa , Nctaatt a «8ia 7 424 2 Medica l Drive , Stdt s 726 0 Sa n Antonio , T X 7822 9 Pfione e f81t)36»-a?0 3 faa c1816 ) 363'37II 7 1>lMnr . i402)73S-1ia 8 Fax : («n)73»<1S8 3 Phone : (2t0 ) 822-«588 Fax : (210 ) 6r9-65 n