SAID# : 2912 1 

### TRANSMITTA L O F OIVIAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R DATE : 1/1 5 ADDRESS : 141 1 OHI O S T REMEDIATIO N CONTRAaOR : PRUDEN TTECHNOLOGIES . INC . YEAR : 20ll ^ 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S d PR E AN D POS TVIDE O O F PORPERT Y(DVD ) d EXECUTIV E SUMMAR Y EPA-PROVIDE D PROPERT YSKETC H SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT{S ) FOR ADJACEN TPROPERT Y

• RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R TO REPLAC E PLANTS , ETC. ) Q CONFIRMATIO N DAT A m PHOTOGRAPH S d l AS-BUIL TSKETCH SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R PROPERT YCLOSE-OU TCHECKLIS TSIGNE D B YEP A D DESCRIPTIO N O F AREA S NOTMEETIN G RO D CLEANU P CRITERI A [ ] UTILIT YCLEARANCE S

• PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E D D D

SIGNATUR E DAT E 3021830 6 Superfun d

### PROPERT Y SUMMAR Y Date : /15/201 0 Omah aLea dSit e Remedia l Actio nContrac t #EP-R7-07-0 6 TO# l Montl i of : Propert y Address : 141 1 OHI O 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 NSAMPLIN GDATA/RESULTS : F 2 = 9 3 PP M @ 8" ; N O EASEMEN T 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 ndigita l vide o clip/photograph s 4 ) Post-Excavatio ndigita 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 nlef 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 dinth e individual property file , i f available , o r obtaine dinclude : i ) Pre-excavationagreemen t detail s (i f any ar e mad e withth e property owner ) ii ) Property Statu s For msigne db y property owne r iii ) Excavatio ndigita l vide o inMPEG , WM V (Window s Medi aVideo ) o r SWF(Flas hPlayer ) format and/o r photograph s iv ) Signe dfor mverifyin g satisfactory restoratio n v ) Descriptio no f area s no t meetin g Interi mRO D cleanu p criteria .

TEGHNOLOCIES . INC .K 

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# i" n » (/ )TECHNOLOGIES , INC . Propert y # : 7 " ^ ^ 2
- \ Date/Time : Quad s Excavated ; F'Z- — .-•. . ;>^ ^ t^x^M:^ ^ 

# EP A Propert y Clos e Ou t Propert y Address ; t*^^ * ^^^ 0 9t~ , Owner' s Name : C~>-*^yi , oS ^ OvwiW \ Contracto r Group : Prurien t Technologies , Inc. , Excavatio nGenera l Ye s No 1 .If necessary , wer e th e correc l quadrant(s ) excavate dan drestored ? / 2 . I f necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? 

# y Gradin g So dan dVegetatio n Ye s N o 1 .Doe s th e gradin g aroun dth e perimete r o f th e hous e i n excavate darea s generall y slop e awa y 

# y fro mth e house ? 2 .Ha s so dbee nlai di n al l area s tha t wer e excavated ? / 3 .

Doe s tli e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e if inspecte da l a3 0 da

y tim e period ) 

# y 4 . Ar e sodde darea s generalh ' fimi an devenl y graded ? 

### y 5 , Ar c th e joint s betwee nth e so dsuip s generall y tight ? (Onl y evaluat e if inspecte dat a3 0 day 

# y tim e penod ) 6 .Wa s th e propert y grade dsuc htliat wate r wil l no t poo l o n tli e property ? 

# y 7 .

Wa s dainag e l o landscapm g o r plan t material s avoided ? 

# y Gates , Fence s an dRetainin g Wall s Ye s N o 1 .

D o gate s ope nan dclos e freely ? (I f applicable ) 

# y Were al l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (I f applicable ) 2 

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

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

# y Foundation , Sidin g an dGutter s Ye s N o 1 .Wa s damag e t o th e sidin g o r tri mavoided ? 

# y 2 .Wa s damag e t o th e foundatio navoided ? 

# y 3 .

Wa s damag e t o window s avoided ? 

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

# y 5 .Wa s damag e t o downspout s o r downispout extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Ye s N o Wn s dniuaoe t o drivewa v surface s avoided'^ 

# y ^ Wa s damag e to walkwa y surface s avoided ? 2

## Owner s comments :

Inspectio nnotes :

Remova l andrestoratio nactivate s complete includin g th e 30-da y so dwarranty : EP A Representativ e Q ^ ?9 ^ ^Date: /2|g/r o;CHNOUXJIES . INC . 

### A S - BUIL T DRAWIN G OL S #2912 1 Dat e Excavated : 10/07/201 0 

### OMAH A LEA D SUPERFUN D SIT E ISEP A Signed-Of T Date : 

### 2912 1 Exterio rPain t Omah a Lea d Sit e • Goo d Sit e Sketcl i • Poor Samplin g Address : I4 i i OHI O S T [3 ^ No t paint Sampl e Numbe r Lea d Sampl e Sample s Collecte d LAB Concentratio n Collecte d Firm : FDA - FP , C S RYASCPXA-2912 1 F l i I 3 po m 

## n Date : RY8SCPXA-2912 1 F2 HS O pp m 

## n \Z:o O prv v Time : RYCSCPXA-2912 1 B l Jj . pp m 

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## n^v i LO_ l Legend : F l = Fron t Left , F 2 = Fron t Right , B l = Back Lett , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , PZ = Play Al l quadrant s ar e a s viewe d fro m th e street , facin g propert y 

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N O EASEMEN T CONTRA a # : EP-S7-10-0 5 PRUDEN T TECHNOLOGIES , INC . 

# 1

## Propert yCompletio n Agreemen t Thi s agreement document s th e completio no f remova l activitie s performedonth e belo w liste dproperty . Th e propert y owner' s signature indicate s tha t the propert y owner i s satisfie dwit hth e restoratio no f th e subjec t property , an dtha t no item s are i nquestion , now , o r a

t an y time i nth e future , excludin g any remainin g warrant y (3 0 day s total ) except thos e item s liste dbelow , if any . Propert y ID : Propert y Address : j^^ ^ ^j^, ^ .C-Zz-c^- f 

### Owner : ^fL^ y H^U - Phone : G6/ty^/'WP^ ^ Restoratio n Item s I n Question :

Item : Item : 

### Item : Item : Item : 

### Item : Require dcorrection s t o complet e th e property :

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

# yyy/yyjy ^ Qr-()cy:>oi( ) rner' s Signatur e (_ / DatePruden t Technologies , Inc . (Prudent ) I s unde rcontrac l wit h th e U . S . Environmenta l Protectio n Agenc y(EPA) t o clea n u p lead contamintte d soil s a t a numbe ro Tproperties located i n Omaha , Nebraska , includin g th e propeit ylocated a t /V/ / Ohii'' ^ SH-f<.t'T ~ Th e EP Arequest s you rpeimisslo n t o allowPruden t t o perform a soi l cleanu p a t thi s propert yt o remov e lead-contaminated soil . B ysignin g thi s foim , th e propert yowne rgrant s permissio n t o Pruden t l o perform activitie s related t o th e cleanu p includin g soi l sampling , remova l o f lead-contaminated soil , an d restoratio n o f th e referenced propcit)' . I f yo u hav e an yquestion s about Ih e soi l cleanu p planned fo ryou rpropeity , pleas e contac t Pruden t sout h oflic e .fo rth e Omaha Lea d Site cleanup-a t (402 ) 733-1188 . General question s abou t th e Omaha Lea d Site cleanu p can b e directe d t o th e EP APubli cbiformatio n Center s a l (402 ) 73 1 -304 5 (Sout h Omaho office ) o r(402 ) 99 1 -958 3 (Nort h Omaha office) . Propert yAcces s Granted By : /i^///// q i^ y// « ^-U^/H h (Pleas e Prin t Name ) Propert yOwne rSignature : ^yy / 

## S(ki'PO/ 0 (Signature ) (Date ) PROPERT YINFORMATIO N (T o b e complete d byresiden t and/o rpropert yowne r- pleas e print ) RESIDEN TNAME : Owne r Rente r RESIDEN TADPRESS : . 

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# -4«/ L I F RENTAL , PROPERT YOWNE D BY : OWNER' S MAILIN G ADDRESS ; OWNER' S TELEPHON E NUMBE R - HOME : J L WORK : AG E O F HOME? : YEARS . HOW 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 6 HOUR S O R MOR E PE R WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. )

AUTHORIT YFO R ENVIRONMENTA L RESPONS E ACTIONS ; Th e activilic i l o b e implemented byEP Aunde rthi s agreemen t ar

e pursuant t o Sectio n 10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s righ t ofaccess t o th e propert yi s provide d fo ri n Sectio n 104(c ) o f CERCLA , 42 U.S . C 9605(e) , whic h provides entr yfo r"detemiinin g th e nee d fo rresponse , o rchoosin g o rtakin g anyrespons 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 5 660 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 , TX 7822 0 Phone : (816 ) 363-370 3 Phone : (402)733-118 8 Phone : (210)822-968 8 Fax : (816 ) 363-370 7 Fax : (402)733-188 3 Fax : (210 ) 579-657 7

# 2912 1 Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e • Goo d 

### Sit e SIcetc h n Poo r f Samplin g Address : 141 1 OHI O ST QNo t pain t Sampl e Numbe r Lead Sampi e Sample s Collecte d Concentratio n Collecte d Firm ; 

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

## YOURTICKE T NUMBERI S 2609473 . Origina l Cal l Date : 10/05/1 0 Wor k t o Begi n Date : 10/07/1 0 Time : Time : 4:3 7 p m 5:0 0 p m Op : SIVA1896 7 State : N E Address : 141 1 County : UGLA S Place : OMAH A Twp : 15 NRng : 13 E Sect-Qtr : 10-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : SOI L LEA D REMEDIATIO NPROJEC 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: NFront : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V MCINE B 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
MCINE B MC I N O CAL LPER MEMO 

## Day : 8002893427 Alt : Emerg : 8002893427
MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFIC.SEWE RRICH/TRAFFI C 

### Day : Alt : 402444719 7 402444516 1 Emerg : 402444516 0 

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

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OPPDGPR 5 OMAH A PUBLI C POWE RDISTRICT EL M LOCATIN G 

## Day : 406728934 3

Alt : 406207149 4 

## Emerg : 888728934 3 QLNNEIC 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 0TEOHNOUOnES , INC . 

### ENVIRONMENTAL ENGINEERIN GAN D CONSTRUCTIO N SOLUTION S 

## SIT E SAF*:T Y 

## EtAZAR D ANALYSI S 

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808 0 VKait f BarioBay . Sut e 40 5 560081 0 S t 424 2 Medica l Drive , Suit e 72S 0 Kansa s Gtty . M O 6411 4 Omaha , Ncbnsfe a 6810 7 Sa n Antonio , T X 7822 9 Phone : 1816 ) 363^70 3 Plione : (402)733-118 8 Plione : (210)822-.958 8 Fax:(816)363-370 7 l^x : {402)733'188 3 Fax : (210)579-657 7