## TRANSMITTA L o f

OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : ^ ^^^ U Date : 

## /2/^ / >oo S Address : 'h mS /Life ^ .S A Remediatio n Contractor : /^,.py^ . h ^tJ> , ^,<f^A,^ ^ ^JIV.. . Year : 2^o f SOI L REMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S Vide o o f propert y (DVD ) Executiv e Summar y EPA-providedpropert y sketch SignedAcces s Agreemen t fo r

subject propert y 

# n SignedAcces s Agreement(s ) fo r

adjacen t propert y Restoratio n Agreemen t Settlemen t document s (i.e. , fo r

damag e or t o replac e plants , etc. ) 

# V Confirmation data Photograph s As-built sketch Satisfactor y restoratio n signedb y Propert y Owne r Propert y close-out check lis t signedb y EP A D 

## Descriptio n o f area s no t meeting RO D cleanu p criteri a Utilit y clearance s Propert y infonnatio n fromDougla s Count y Assessor' s Office D 4030955 7 D D Superfun d -.9a mJLk f OU K 

## Signatuq ^

### PROPERT Y SUMMAR Y Date : 12/20/200 8 Omah aLea dSite Remedial Actio n Contrac t #EP-R7-07-06/0004 Monti i of : Nov/Dec . Propert y Addreas ! 371 8 PARKE RS T A . EXECUTIV E SUMMAR Y A. 1 Issue s Encowitered : NON E A. 2 Issue s Resolved : NON E A. 3 Uniqu e Findings : NON E A. 4 Odie r Relevan t Infonnation : NON E CONFIRMATIO N SAMPLIN G DATA/RESULTS : B l = 35 1 PP M @ 7" ; B 2 = 17 9 PP M @ 11" ; EA = 10 9 PP M @ SCRAPE . ATTACHMENT S 1 ) Propert y sketch provide db y EP A pursuan t to contract specification s 2 ) SignedAcces s Agreemen t including acces s agreement s requiredfo r crossing othe r propertie s 3 ) Pre-Excavatio n digita l vide o chp/photograph s 4 ) Post-Excavatio n digita l vide o chp/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Buil t sketch ­ i ) Shall include final lea dlevel s v ) Legend ii ) Contamination lef t behindarea s vi ) Contracto r identificatio n hi ) 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 propert y file, i f available , or obtaine dinclude : i ) Pre-excavatio n agreemen t detail s (i f an y ar e mad e wit h th e propert y owner ) u ) Propert y Statu s For msignedby propert y owne r hi ) Excavation digita l vide o mMPEG , WM V (Wmdow s Medi aVideo ) or SW F(Flas h Player) forma t and/or photograph s iv ) Signedfor mverifying satisfactor y restoratio n v ) Descriptio n o f area s no t meeting InterimROD cleanu p criteria .

TECHNOLOGIES , INC .Fin d Recor d Clea n U p Query Lea d Remainin g Query I Propert y Damag e Quer y Bacicfill :



### Sampl e Area : 8999 6 ­ 371 8 PARKE R S T Owner : Resident : Contract : n Owne rOccupie d Owne rName : CTT Y O F OMAH A Owne rAddressl : C/ 0 OT Y FINANC E Owne rAddressZ : 181 9 FARNA M S T 

### City : OMAH A Owne rPhone : (402 ) 444-518 0 Zi p Code : |6818 3 Altiernat e Phone : |(402 ) 444-614 0 Residen t Name : Propert y Address : 371 8 PARKE R S T 

### Zi

p Code : 16811 1 Residen t Phon e 

# r Contractor : PRUDENT2008_ S Group : Assessment : Qualifyin g Grou p |800 " Assessmen t XR F Date : Assessmen t MaxXR F Value : 

## I 808 '

### TECHNOLOGIES » IN C 

# &EP A EP A Propert y Clos e Ou t Propert y # : g-'^l'Jf c Propert y Address : il' ^ foi/^/i - Date/Time : Owner' s Name : Quad s Excavated : 1^ ' /

^ i ^ Contracto r Grou p Pruden t Technologie s Excavatio n Genera l Ye s No 1 .Ifnecessary , wer e th e correc t qiiadrant(s ) excavatedan drestored ? / 

### 2 .I f necessary , wer e th e correc t area s of dri p zone excavatedandrestored ? / 

### Gradin g So dan dVegetatio n Ye s No 1 .Doe s th e grading aroundth e perimete r of the hous e i n excavatedarea s generall y slop e awa y / 

### fromth e house ? 2 . Ha s so dbeen lai di n al l area s tha t wer e excavated ? 

# y 3 .

Doe s th e so dappea r to b e generall y health y an dgrowing ? (Onl y evaluat e if inspecteda t a3 0 da

y tim e period) / 

### 4 .Ar e soddedarea s generall y fm n an devenl y graded ? / 

### 5 .Ar e th e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e i f mspecteda t a3 0 da y time period) / 

### 6 .

Was th e propert y grade dsuc h tha t wate r will not poo l on th e property ? / 

### 7 .

Was damage t o landscaping o r plan t material s avoided ? 

# y Gates , Fence s an dRetainin g Wal k Ye s N o 1 .D o gate s ope n an dclos e freely? (IfappUcable ) / 

### 2 .

Wer e al l gate s o r fence s taken dow n durin g restoratio n activitie s reinstalled ? (If applicable ) / 

### 3 .

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

# y 4 .

Was damage t o retainin g wall s avoided ? (IfappUcable ) / 

### Foundation , Sidin g an dGutter s Ye s N o 1 . Was damage t o th e siding o r trimavoided ? / 

### 2 .

Wa s damage to th e foundation avoided ? / 

### 3 .

Wa s damag e t o window s avoided ? / 

### 4 .

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

### S .Was damage t o 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 ? / 

### 2 . Wa s damage t o waUcwa y surface s avoided ? 

# y

## Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complet e includm g th e 30-da y so dwarranty : EP A Representativ e Ga ^ j^. ^ Date : ///ja/o » 

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### ^i^teted ; exo ^ ai note d ilbove .

. / •• • • •

immO d megs : 60 800 2 S «0 N :xe jPruden t Technologies , Inc . (Prudent ) i s unde r contrac t wit h th e U . S . Environmenta l Protection Agenc y (EPA ) t

o clea n u p leadcontaminate dsoil s a t anumbe r o

f propertie s locate di

n Omaha, Nebraska, includin g th e propert y locate da

t J . Th e EP A requests you r permissio n t

o allo w Pruden t to perfor masoi l cleanu p a

t thi s propert y to remov e lead-contaminate dsoil . By signin g thi s form , ttie propert y owne r grants permissio n to Pruden t t

o perfor m activitie s relatedt o th e cleanu p includin g soil sampling , remova l o

f lead-contaminate dsoil , an drestoration o f th

e reference dproperty . I f yo

u hav e an y question s abou t th

e soil cleanu p plaime dfo r you r property , pleas e contact Pruden t Administrativ e Cler k

fo

r the Omah aLea dSit e cleanup . Ms . Debora h Johnso n -a t (402) 733-1188 . Genera l question s abou t th

e Omah aLea dSit e cleanu p ca n b e directedto the EP A Public Infonnatio n Centers a t (402) 731-3045 (Sout h Omah aoffice ) o

r (402) 991-958 3 (Nort h Omah aoffice) . Propert y Acces s Grante dBy : < 1 /»^ S \/jAy/i £C "' ^ T^layiH^" ^ f ' ^eas e P?(n t Name ) Propert y Owne r Signature : (S^tuic ) (Date) PROPERTY INFORMATIO N (T o b e complete db y residen t and/o r property owner ~ pleas e print ) RESIDEN T NAME : Owne r Rente r RESIDEN T ADDRESS : KJ> ^ I F RENTAL , PROPERT Y OWNE D BY : OWNER' S MAILIN G ADDRESS ; 

## 81 - Ji4 rn^g > M^G«'i V OWNER' S TELEPHON E NUMBE R - HOME : J L WORK :



### - i 1 : 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 NUMBER 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 PLAY 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 J

AUTHORIT Y FO RENVIRONMENTA L RESPONSE ACTIONS ; 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 o f CERCLA, 4 2 U.S.C . 9604 . EPA' s righ t o

f acces s t o the propert y i s provide dfo r i

n Sectio n 104(e ) o

f CERCLA, 4 2 U.S . C 960S(e) , whic h provide s entr y fo r "determinin g the nee dfo r response , o r choosin g or takin g an y respons e action unde r thi s tide , o r otherwis e enforcin g the provision s o f th

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 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)579-657 7

## >ii S -vBUIL T ©RAWIN G X y. | OMAHA LIAD,ISUyEELEpyp,SfIIl i ;^ OLS# : 8999 6 Date Excavated : 10/16/200 8 USEP A SIpted-OffDate : 

## 8999 6 Exterio rPan t Q Goo d Omah a L^a d Sit * 6it a Sketc h n Poor Samplin a Addrasa : 371 8 PARKE R 3T [g f No t pain t 

# } Sampl e Numt)e r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Firm : FD A Fg->gVt / RYA8CPXA-S990e Fl 1.6 1 —pp m D Date : 10 - */- £ 

## =o T RYBSCPXA-A999 6 F2 _£a_pp m 

## a Time : 

## 2:oopi ^ RYCSCPXA-B9g0 6 Bl _f±2iL-PPn i 

## a Sample s Analyze d RYOSCPXA-809e 6 B2 0O & ow n 

## n RBasePMiMSS M BZ - pc m XRFUnM : Book : 

# i

~ D (^^Hl . /9 3 D nozoopw h Bopoo—e » __n__PP m Date : 

## n \p-\7.'O l D RPZOOPXA-OOOOf t • M D Time : 

## ^ L D Staff : MS W Mumbe r o( Sample s • 

## .Q j Legend : F1 - Fron t Left , F2 = Fron t Right , Bl == Back Left , B2 - Back Righ t OZ " Dri p Zone , GZ « Ganlen , PZ > Pla y Al <)U(ilran K « • M wMi d ko m ttM UnM . fkcn g pnpeit y 

# e £|^TBRE b 

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## I 371 8 r*«r * 

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xi !.•««€ * oCtSKl T II IS: I j ^^•:*r.v;''<fc" 3 I'.lf..^'.'* * fc>^.«>iir) EA = 10 9 PPM®SCRAP E

CONTRA a «: EP - R7-07-0 6 / 000 4 PRUDEN T TECHNOLOGIES , INC .ENVIRONMENTA L & CONSTRUCTIO N 

### TECHNOLOGIES , mC . SERVICE S 

# Propert y Statu s For m Address : ^Hg - *fo.r\c ^ «S*t - Date : Phone : BVID : Plan t & Permanen t Landscaping T o Remain I n Plac e Item # Descriptio n andLocatio n On Ma p

Pre-Existin g Conditio n of Structure s Doe s you r

Basemen t hav e ahistor y o f leaking ? Ye s —N o Item # Descriptio n & Location On Ma p

Propert y Owner^ ^ ,4^C>J^ A 

## Pruden t Employee Signature : ^ - > / Signature : 808 0 War d Parkway , Suit e 40 5 250514724' " Street , Suit e 308 4242 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Om«na , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Fax : (816 ) 363-370 7 Phone : (402)504-100 4 Fax : (402)504-100 5 Phone : (210)822-958 8 Fax:(210)579-657 7• V I

samplin g Address : 371 8 PARKE R ST _ Lea d Sampl e Numbe r Concentratio n RYASCPXA.8M9 6 F l RYBSCPXA-8p99 6 F 2 RYCSCPXA ^

)99 6 B l RYDSCPXA-8)99 6 B 2 RDZoopxA'Owee—B » WQBBePX A 0 WO O O Z nPZOOPXA9>9Q 6 P Z 

# 3 ± jn ^

gQ g Omah a Lea d SK o €it e Skatc h Sampl e 

# I LA t Collecte d pp m 

# D pp m 

# a pp m 

# n pp m 

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# D pp m 

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# a Numt>er o Samples : Exterio rPain t • Goo d n Poo r [

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## Date : 10-^-^ 2 Time : Pf l Staff . MS W 

# 8999 6 tarthAirow \

Legend : F l « Froij t Left . F 2 = Fron t Right . B 1 - Bac k Left , B 2 = Bac k Rig h DZ » Drt p Zone . G Z = Ganfen . PZ ^ Play Ali)UBdrar t I area s viewe d fro m th e UteeLtair ) propert y 

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# i . .j?Aiti<€^.s:n . R w 5 Cnecd : tfM^ U r 11:15:1 5 046141.012 3

### Pag e 1 o f 1 

## Prin t Previe w 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 192572023 4 CIT Y O F OMAH A 371 8 PARKE R S T OMAH A 6811 1 C/ 0 CIT Y FINANC E 181 9 FARNA M S T OMAH A N E 6818 3 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 Un k Assesso r Websit e Un k 17-15-1 3 ORCHAR D HIL L RE P N O 7 * 0 2 60X13 0

http://webapps.dotcomm.org:8080/Trea8Tax/face8/pages/taxinfo.jsp ? parx;=192572023 4 http://d o uglasne . m a pping online.com/DouglasCoNe/statlc/accountinfb.jsp ? accountno=R192572023 4 Disclaime rMa p an d parce l dat a ar e believe d t o b e accurate , bu t accurac y i s no t Ma p Scal e guaranteed . Thi s i s no t a lega l documen t an d shoul d no t b e substitute d fo ra titl e search , 1 inc h a 8 0 fse t appraisal , survey , o rfo rzonin g verification .

### Pag e 1 of 2

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



### • YOU RTICKE T NUMBE RI S 2149455 . Origina l Cal l Date : 10/07/0 8 Wor k t o Begi n Date : 10/09/0 8 Time : 11:5 0 a m Time : 12:1 5 p m Op : RAMITAl896 7 State : N E Address : 371 8 County : DOUGLA S Street : PARKE R S T Place : OMAH A Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : Sect-Qtr : 17-N E Typ e o f Work : lead remediatio n projec t 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 : RAMIT A Phone : (402)733-145 5 Alt . Contact : Phone : (402)733-118 8 Wor k Being Don e For : ep a Dept h o f Excavation : 6 f t Corne r Lot : NFront : Y Rear : Involve s Tunneling o r Horizonta l Boring : NExplosives : N CXCAT V

MCLEODNE MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Utilit y 

### Servic e Area Contact Phon e Numbe r Typ e 

### Day : 402934046 9 /-v/ - A T M CO X COMMUNICATIONS , HEID I 

### Alt : 402934046 9 CXCAT V ^ ^ 

### Emerg : 402932975 7 Day : 800289190 1 N O NEE D T O CAL L OU T MCLEODN E MCLEODUS A 

### Alt : EMERGENC Y 

### Emerg : 800289190 1 Day : 402504782 3 METROPOLITA N UTILITIE S MUDO l 

### SAND Y Alt : DISTRIC T 

### Emerg : 402504794 6 Day : 402444719 7 CIT Y O FOMAHA - OMAHACO F 

### RO N Alt : 402444516 1 TRAFFICSEWE R 

### Emerg : 402444516 0 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 10/7/200 8

### Pag e 2 of 2 Day : 406728934 3 Alt : 888728934 3 0PPDGPR 5 XSCT"^'^'''"'''^^ ^ 

### N A Emerg : 406728934 3 Day : 406728934 3 QLNNEI C QWES T LOCA L NETWOR K N A 

### Alt : 

## Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 10/7/200 8