## TRANSMITTALo f

OMAHA LEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID# : TApg O Date : Address : ZlO l Sl . XU" ^ "Ss^ . Remediatio nContractor : Environmenta l Restoration , LLC

_Year : _201 0 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S jA Vide o o f property (DVD ) O^efor e DAfter D Basemen t D •__ _ AAExecutiv e Summary (Fina l Report ) //AEPA-ptovide dproperty sketc h

J ZSigne dAcces s Agreemen t for subjec t property D Signe dAcces s Agreement(s ) for adjacent propert y JZRestoratio nAgreemen t

• Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) j A Confirmatio ndat a j /

Photograph s f/Befor e DCrewPhotosC/Durin g Excavatio nD So d ^so-da y So dD As-buil t sketc h / Q Completio nAgreemen t signe db y Propert y Owne r ZPropert y close-ou t chec k lis t signe db y EP A D Descriptio nofarea s no t meetin g RO D cleanu p criteri a Z ^ Utility clearance s A ^ Propert y informatio nfromDougla s Count y Assessor's . Offic e J ZPropert y acces s checklist^(^^«>4 x Pvv» ( ^<i»i^ 3 

## Z ^ V^ca j /n F Envirori r environmenta l Restoratio nSignatur e 3026191 4 

## ^"P^^"'^' ^ Dat e 

# 12 " I 

# r-l / Dat e

# EP A EP A Propert y Clos e Ou t For m Omah aLea dSit e Propert y # : l^O^ O PropertyAddress : HO l * ^ IC^'SrV . Date/Time : Owner' s Name : rfVOjrAo u W>jr\r > Quad s Excavated : "feT . Contracto r Grou p : Environmenta l Restoratio n (ER ) Excavatio n Genera ] 

## ylD.rzLrJ [ ^ Ye s N o / y 1 . Ifnecessary , were th e correc t quadrant(s ) excavate dan drestored ? 2 . Ifnecessary , were th e corrisc t area s ofdri p zon e excavate dan drestored ? M Q t>; ^ 

## Af A Gradin g So dan dVegetation Ye s N o ^ house ? 2 . Ha s sodbee n lai di n al l area s tha t wer e excavated ? . ^ 3 . Doe s th e so dappea r t

o be generall y heahh y an dgrowing ? (Onl y evaluat e i f inspecteda t 30-da y tim e period) . 4 . Ar e sodde dareas generall y firman devenl y graded ? ^ t 5 . Ar e th e joint s betwee n the so dstrip s generall y tight ? (Onl y evaluat e if inspecteda t 30-da y tim e period) . 6 . Wa s th e propert y grade dsuc htha t wate r wil l not pool o n th e property ? w ^ 7 , Wa s damag e t o landscapin g o r plan t material s avoided ? t - ^ Gates , Fence s an dRetainin g Wall s Ye s N o 1 . D o gate s ope nan dclos e freely? (ifapplicable ) 

# U l 2 . Were all gate s o r fence s take ndow n durin g restoratio n aaivitie s re-installed ? (ifapplicable ) >t/ A Wa s damag e t o gate s o r fence s avoided? ' (ifapplicable ) 4 . Wa s damag e t o retainin g wall s avoided ? (ifapplicable ) 

## /JA Foundation , Sidin g an dGutter s Ye s N o 1 . Wa s damag e to sidin g o r tri mavoided ? 2 . Wa s damag e to th e foundatio n avoided ? 3 . Wa s damag e t o windows avoided ? 

# \/^C^iv 4 (o ^ 4 ^ 4 . Wa s damag e to windo w screen s o r doo r screen s avoided ? 5 . Wa s damag e t o downspout s o r downspou t e.xtension s avoided ? Sidewalk s an dDriveway s (Coacrete ) Ye s N. o Wa s damag e t o drivewa y surface s avoided ? f)i i 2 . Wa s damag e t o walkwa v surface s avoided ? JJAL

Remedia l an drestoratio n activitie s complet e includin g 30-da y so dwarrant)-' : EP A Representative ; Date : S^/<//2J0^ ^ 

# ^/^^

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## \ Omah a Lea d Site—EP-R7-09-0 5 l-^^^^r f

Environmenta l Restoration , LL C 

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'••t»«o-i«^ ' 

### www.erllcco m 

# EXECUTIV ESUMMARY : 2909 0 270 7 N2 6 S T No Issue s o r Concern s Q Issues/Concern s Detai l Rxnlflnntion
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## Pag e 1 of 1

" > [ Creat e Anothe rTicke t ^ [ Bac k t o Irt h Internet ] Sen d Emai l

• YOU RTICKE T NUMBE RI S 2707703 . Origina l Cal l Date : Wor k t o Begi n Date : 4/08/1 1 4/12/1 1 Time : Time : 6:5 4 a m 7:1 5 a m 

### op : TIM2418 6 State : N E Address : 270 7 County : DOUGLA S Street : N26TH S T Place : OMAH A Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 09-S E Sect-Qtr : Typ e o f Work : Lea d Soi l Remova l Locatio n o f Work : LOCAT E ENTIR E PROPERTY Remarks : FA X AL L CLEAR S TO : (402)451-106 9 : SAI D # 2909 0 Compan y: Contac t Name : Alt . Contact : ENVIRONMENTAL RESTORATION TI M SUTTO N Phone : (402)451-131 4 x226 7 Phone : (402)306-234 7 Wor k Being Don e For : EPA Dept h o f Excavation : 2 4 i n Corne r Lot : NFront' : N Involve s Tunneling o r Horizonta l Boring : NExplosives : N CXCAT V

MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Rear : N

Servic e Are a Contac t Phon e Numbe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEIDI Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUDO l METROPOLITA NUTILITIE S DISTRICT SAND Y MU D Day : 402504782 3

Alt : Emerg : 402504797 0 OMAHACO FCITYOFOMAHA-TRAFFICSEWERRICH/TRAFFIC Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 0PPDGPR 5 OMAH A PUBLI C POWE RDISTRICT EL M LOCATING Day : 406728934 3 Alt : 406207149 4

Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K

EL M LOCATIN G Day : 406728934 3

Ait : 406207149 4 Emerg : 888728934 3 

## http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 4/8/201 1I'ag e i 01 1

[ Creat e Anothe rTicke t ] [ Bac k t o Irt h Intemet ] j [ Sen d Emai l ) 

### YOU RTICKE T NUMBE RI S 2691585 . Origina l Cal l Date : 3/22/1 1 Time : 9:5 9 a m Op : ADAM241 8 6 Wor k t o Begi n Date : 3/24/1 1 Time : 10:3 0 a m state : NE County : DOUGLA S Place : OMAH A Address : 270 7 Street : N26TH S T Twp : 15 NRng : 13 E Sect-Qtr : 09-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : Lea d Soi l Remova l Locatio n o f Work : LOCAT E ENTIR E PROPERTY Remarks : FA X AL L CLEAR S TO : (402)451-106 9 : SAI D # 2909 0 Compan y: ENVIRONMENTAL RESTORATION Contac t Name : ADA M Phone : (402)451-131 4 Alt . Contact : Phone : (636)288-961 6 Wor k Being Don e For : EPA Dept h o f Excavation : 2 4 i n Corne r Lot : NFront : NRear : N Involve s Tunnelin g o r Horizonta l Boring : NExplosives : N CXCAT V

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 HEIDI 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUDO l METROPOLITA NUTILITIES DISTRICT SAND Y MU D 

### 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 0PPDGPR 5 OMAH A PUBLI C POWE RDISTRICT EL M LOCATIN G 

### Day : 406728934 3

Alt : 406207149 4 

### Emerg : 888728934 3 QLNN EI 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. . . 3/22/201 1

# t

Contac t Informatio n Lo g Z^C/f 6 

## SAID #
II Owner^ s Name : /yj^lg , JV i Mjflu Q | Daytime Phone : ^3 ^ 5^/-Y6^6 ? || Propert y Address : ^" ^ ' / AA'Z^U ' ^ ^ Attemp t to contac t Date/tim e Nam e 

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Address : ^^.V^ ^ /^. ^ SV


## O^cJ/^c^ ^ ^'£ 1 Phone : HbZ-5']I ' ^4L> n ^ Fax : Cell/Pager : Renter : Phone : Fax : Cell/Pager : Additiona l Information :

Acces s Agreemen t CS^Kestoratio nAgreemen t f^^^ide o Propert y Befor e QKoigita l Photo s Befor e I I Vide o Propert y Afte r nDigita l Photo s Afte r ^ Propert y Completio nAgreemen t I I Fina l Repor t S\gntA:'^ l 2^ 1 iL Signed:"^ ^ iZ I [ ( O n 

## ••3.12-il L O

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O n / / O n / / Signed : ^ / ^ l^ ( Signed : / / By : By : By : By : By : By : 

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EXECUTIV ESUMMAR Y

Omah a Lead Projec t Wor k Pla n Page l o f 1 9

## Consen t fo rAcces s t o Propert ySNXM^^O^ O RIGH T O FENTR Y T O PREMISE S 

### Granto r (th e property owner) , consent s t o an dauthorize s th e Unite dState s Environmenta l Protectio nAgenc y (USEPA ) o r it s authorize drepresentatives , collectivel y th e Grante e t o ente r an dperfon ncertai nenvironmental respons e activitie s upo nth e followin g describe dpremises :

Owner - 5 Name : /^^// j flA j IAJ\//UH / 

### \Daytime Phone : fQ^
- ^7/ ' H( a7 ^ Address : 

# 210 1 H ZU ^ Address : Addresse s o f Propertie s covere db y thi s Address : Agreement : Address : Address : PURPOS EO FINVESTIGATIO N 

### Th e purpos e o f th e remedia l activitie s i s t o remov e al l soil s at th e property whic hare contaminate dwithhazardou s substances , i nparticular lea dat concentration s greate r thano r equa l t o 40 0 part s pe r millio n(ppm) . REMEDIA L ACTION S 

### Th e environmenta l respons e action s t o b e performe do nsai dproperty may includ e th e followin g activities : a .

Takin g photograph s and/o r vide o o f th e property before , during , an dafter remedia l activities ; b .Locatin g equipmen t an dmachinery on-sit e i npreparatio nfor an dinth e cours e o f th e environmenta l response ; c .

Plannin g an dimplementin g th e remova l actio no no r near Grantor' s property . d .Obtainin g sample s fromGrantor' s property ; AGREEMEN T NO T T o INTERFERE 

### Th e Granto r agree s no t t o interfere o r tampe r withany o f th e activitie s o r work done , o r th e equipmen t use dt o perfor mth e activities , o r t o undertak e an y action s regardin g th e us e o f sai d property whic hwoul dten dt o endange r th e healtho r welfare o f th e Grantee s o r th e enviromnent , o r

t o allo w other s t o us e th e property i nsuc h <r

v I gran t acces s i o m y propertie s Q I d o no t gran t acces s t o m y propertie s 

# MA.JA ^ -^/V/ / Signatur e /7 Dat e Signatur eDat e

### n Chec k thi s boxi f owne rdoe s no t wan t E.R . t o ente rth e resident s t o documen t interio r foundatio n wall s an d possibl e preexistin g damage . Bycheckin g thi s bo xE.R . i s no t responsibl e fo ran ydamag e don e t o th e interio ro f house , includin g foundatio n crack s o rfissures .

^^Q l agre e [11 1 d o no t agre e ^^ I agre e C H I d o no t agre e

Owner' s Signatur e Z * Date Contractor' s Signatur e Date

## Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o provid e amutual agreemen t a s t o condition s o f propert y prio r t o contracto r activities . Thi s wil l als o serv e a s documentatio nfor th e purpos e o f assurin g tha t restoratio n activitie s ar e complete dt o th e satisfactio no f th e property owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA) .

SAID : ^?Df ^ Property Address : J27 6 7 / ^ Z U ^ Owner : AlAlO^le , Al A k/yjU/ U Phone : HbZ-°>'7l ' V ^ ^ ^ O nth e attache ddiagram(s ) indicate area(s ) t o b e excavate dan ddept ho f excavation , locatio no f al l know n utilities , subsurfac e features , surfac e structure s an dlandscapin g features , acces s location(s ) t o b e use db y contractor , an dth e directio no f North . Indicate distances , depths , material types , etc . Indicat e digital photo s b y referencin g th e photo-lo g number wit ha narro w indicatin g directio no f view . item s t o b e remove d b yContracto ran d no t replaced : I I Item : / ] 

# dW f ^I J Afga' 5 Liifi i So^ h bod . Item : Item : Item : item : item : Item :

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### A ^Q'Tagre e Q I d o no t agre e [^ I agre e Q I d o no t agre e

^ Owner' s Signatur e 1 / Date Contractor' 5 Signatur e Date Attachmen t

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### • 

### % 

## Propert yCompletio n Agreemen t Thi s agreement documents th e completionof remedia l activitie s performe do nm y property . M y signatur e will designat e tha t I a msatisfiedwit hth e restoratio nof m y property , an dtha t no item s ar e i n question , now , o r a

t an y tim e i nthe future , except thos e items listedbelow , ifany . SAID : 290 W PropertyAddress : JA.'TO l fij Z ^ 

# ^ F Owner : /^^/ ^ m ^ ^ ( U l A Phone : 

# 'Aoz-i3'7 F^&>n(^ Restoratio n item s i n Question :

item : 

# "^^^^^Hd^lC^^^IJ^l^^ ^ ^-x A 

## '^^"^'JZ ^ M^/L./U2 ^ item : Item : Additiona i Comments :

^^T l agre e restoratio ni s completed , excep t as noted l/\ l I agre e restoratio ni s completed , excep t a s noted I I I do no t agre e restoratio ni s complete d I 1 1 d o not agre e restoratio nis compiete d

Owner' s Signatur e Dat e Contractor' s Signatur e Dat e

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### (402 ) 571-467 6 Age : 50-5 4 u 1- l- l Kennet h N Wray , Household : , .. . " Lyn n Wray , Kno wme ? As k m e t o updat e m ylistin g 

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### http://www.whitepages.com/search/FindPerson7firstnam e begins_with=l&firstname=marl.. . 8/20/201 0

### Dougla s Count y Accoun t Intbrmatio n Pag e 1 of 2 Dougia s County , Nebrask a Propert yRecor d - R201585000 0 Prin t Reoor t Informatio n i s vali d a s o f 2010-8-1 6 Vie wInteractiv e GI S Ma o Treasurer' s Ta xReoor t Ne wFeatur e ->->- > Subdivisio n Sale s Searc h Owne r WYN N MARLAM 624 4 REA D S T OMAH AN E 68152-000 0 Propert yInformatio n Ke yNumber : 158 5 000 0 2 0 Accoun t Type : Residentia l Parce l Numbe r 201585000 0 Parce l Address : 270 7 N 2 6 S T OMAH AN E 68111-000 0 Lega l Description : POP E PLAC E LO T2 BLOC K1 S 1/ 2 2 0 X 12 0 Valu e Informatio n Lan d Improvemen t Tota l 201 0 $200.0 0 $0.0 0 $200.0 0 200 9 $200.0 0 $0.0 0 $200.0 0 200 8 $200.0 0 $0.0 0 $200.0 0 200 7 $200.0 0 $0.0 0 $200.0 0 200 6 $200.0 0 $0.0 0 $200.0 0 200 5 $200.0 0 $0.0 0 $200.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 5 2400. 0 0. 0 120. 0 20. 0 Ye s



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.Jsp?accountno=R20. . . 8/20/201 0

### Dougla s Count y Accoun t Informatio n Pag e 2 of 2



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### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo,)sp?accountno=R20. . . 8/20/201 0

### ENVIRONMENTA L AS-BUIL TDRAWIN G OMAH ALEA D SUPERFUN D S ^ RESTORATIO N 

## 2909 0 Exterio rPain t Nort h Arro w Omah a Lea d Sit e Owne rName : MARLAM WYN N • Goo d Sit e Sketc h Address : 270 7 N _26^ T • Poo r Phone : H : w . [g^o t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r Concentratio n Collecte d Firm : /V'J'MN J i^f ^ K(V \

— ' 1 RYASCPXA-2909 0 F 1 

## Z.1 ^ pp m 

## D Date : ^ -.^N-QV ; RYBSCPXA-2909 0 F 2 

## .5 ^ pp m 

## D Time ; ^^ , r' ^ RYCSCPXA-2909 0 B 1 

## Z6 ^ pp m 

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# n Sample s Analyze d RYDSCPXA-2909 0 B 2 pp m 

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## E Z RDZOCPXA-2009 0 -Q i pp m 

# n n XR F Unit : /OO ^ Book : J^* ^ • RGZ3GPXA-2909 0 pp m 

# n n Date : 9,-7: ^ - ^(^ ^ „La b RYDSCPl-A-2909 0 pp m 

## D 

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### Aerx . s Resul t 57 5 pp m Staff : Z7si ^ Numbe ro f Sample s = '-j Legend : F 1 = Fron t Left , F 2 Fron t Right , B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a s viewe d fro m th e sf»et , facin g propert y \ 

## ze6 "W ^ 

# ENTEllE D 1 AlJG 2 1 200 5 SAI D # 2909 0 5.70 7 ^ 3J c DAT E EXCAVATE D 4-18-1 1 ? DAT E EP ASIGNE D OF F 5-4-1 1 B2=114PPM@8 "

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### Omah a Lea d Sit e Owne rName : MARL AM WYN N • Goo d 

### Sit e Sketc h Address : 270 7 N 2 6 ST •* « — • Poo r Phone : H : W : 0^o t pain t Lea d Sampl e Sample s Coiiecte d Sampl e Numbe r LA B Concentratio n Coiiecte d Firm : /^\,N } E:(V\ ^ KO A RYASCPXA-2909 0 F 1 pp m 

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## Hi l pp m 

## E f RDZOCrXA-20Q9 0 9 Z pp m 

## D 

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## D D Date : 8 - ?.; 3 .La b RYDSCPLA-2909 0 pp m 

## D D Time : 

# A iCQ _ 2 Resul t 575pp m Numbe ro f S 

# ± Staff : /^•5t ^ Legend : F 1 = Fron t Left , F 2 = Fron t Right , B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s are a s viewe d fro m th e stn»et , facing.property 

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### Sit e Sl<etc h Address : 270 7 N 2 6 ST • Poo r ^ *

Phone : H : W : [g^o t pain t Sampl e Numbe r Lea d Concentratio n Sampl e Coiiecte d LA B Firm : Sample s Coiiecte d /^\A } E(v \ KfA RYASCPXA-2909 0 RYBSCPXA-2909 0F l F 2 

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