## TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R 

# SAID# : 3^^/ ^ Date : /^/ J 0 3 i ^ Address : p . V / ^ /^/ / ^M < /fiyy ^
. Remediatio nContractor : _Envrionmenta l Restoration , LLC

_Year : 200 9 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S " 3
. Vide o o f property (DVD ) jaSefor e DAfle r D Basement j g l^^i/vJfJf l 3'^ ^ Executiv e Summar y (Fina l Report ) yy EPA-provide dpropert y sketc h jy ' Signe dAcces s Agreement for subjec t property D Signe dAcces s Agreement(s ) for adjacent propert y sy • Restoratio nAgreement D Settlement document s (i.e. , for damag e or t o replac e plants , etc. ) py ^ Confirmatio ndat a 15 ^ Photograph s ^ ^ Befor e nCre w Photos ^ During Excavatio nD So d J&'S0-da y SodD 3 As-buil t sketc h py Completio nAgreement signe db y Property Owne r 3y Property close-ou t chec k

lis t signe db y EPA D Descriptiono f area s not meetin g RO D cleanup criteri a ^ 3 Utility clearance s JSr

- Propert y informatio nfromDougla s County Assessor' s Offic e ^^ 3
. Property acces s checklis t ^ 3 Contac t Lo g 3026051 3 D ' /

/ 3 Superfun d 

# 3^i3^&y_ ^ "Environmerfta l Restoratio nSignatur e ^c ' 

## ~ 

# /^v/--^ 7 Dat e 

# ^-S-l l "Dat eo ' 

## ^\©7 % Omah a Lea d Site—EP-R7-09-0 5 i<^i^ ^

^

Environmental Restoration , LL C \ <{? www.erllc.co m


# EXECUTIV ESUMMARY : 38912—241 5 Kansa s St
. N o Issue s o r Concern s [ ^ Issues/Concern s
Detai l Explanation :

# Contac t Informatio n Lo g SAID # W^in Owner>sNan.e:p^s^ Y^i(^MNf\ ^ Daytim e Phone : ^CR^'^(p'^" ] PrcpertyAddress : 2H\S ' kAnA i Ay £
Attemp t t o contac t Date/tim e Nam e \,.yij)t i c n ^ ^ 

# y/^ ^ 

# r e- 1 BJ P

## Propert yAcces s Checklis t SAID : ^^'?/ 2 Propert y Address : i q1 i UfK^f^ < n D

WOR K STARTE D WORKCOMPELTE D ON : ON : / / / /
0>vner : |s,^.^ y -r,-.^^^f
. Address : Ilil S >fArl^ ^ ^^t Renter : Phone : Fa.x : Phone : ^pi„;;p ^ Fax : -bl^Z S Cell/Pager : Additiona l Information : Cell/Pager :

•R]
1 3 r~ l Acces s Agreemen t Restoratio nAgreemen t

Vide o Propert y Before Digital Photo s Before Vide o Propert y Afte r Signed : _^/J_/ ^ Signed : 9 / ' I O ^ O n "= ? / I / 0<? 

### On 9 I I I o 9 O n By : £ 0 G^Ult d By : fC i Bv^ieia
. By : c O rSv^^-ic^G.
. 

### By : rgp.R. y vl6v>Dgftso'^
D Digital Photo s After O n 

### Propert y Completio nAgreenien t 

### Signed : IP/^/J2 ^ nFina l Report Signed : .Additional Video o r Digita l Photo' s Taken : n Vide o D Digita l Phot o O n : Reason : / / 

### By : 1

n Vide o Reason : n Digita l Phot o O n : / / By :
D Vide o Reason : n Vide o 

### Reason : D

n Digita l Phot o Digita l Phot o O n O n :

:

...... . /
/ /
/ 

### By : By : 

### 1 |



### OmahC i Lea dProjac t Wor k

Pla n Pag e 1 of 1 9

# Consen t for Acces s t o Propert y SAID#3B1i l
RIGH T O FENTR Y T O PREMISE S 

### Granto r (th e propert y owTier) , 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 dperfor mcertai nenvironmenta ] respons e activitie s upo nth e followin g describe dpremises. :

Owncr^ s Name : ^^-^^ y ^jiLft^o K Daytime Phone : fL\Q-^)-70q ^ ^( Qg. ^ Address : 73 3 KA^A S Ai/ 5 Address : 

### Addresse s of Propertie s covere db y thi s Address : 

# 1 Agreenient : 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 propeii y whic har e contaminate dwithhazardou s substances , inparticular lea dat concentration s greate r tha no r equal to 40 0 part s pe r millio n(ppm)
. REMEDIA LACTION S 

### Th e environmenta l respons e action s t o b e performe do nsai dpropert}

- may inckid e th e followin g activities :
a .Takin g photograph s and/o r vide o o f th e propert y before , during , an dafter remedia l activities ; b
.

Locatin g equipmen t an dmachinery on-sit e i npreparatio nfo r an di nth 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 fro mGrantor' s property ; AGREEMEN T NO T T o INTERFER E 

### Th e Granto r agree s no t t o interfer e o r tampe r withan y o f th e activitie s o r work done , o r th e equipmen t use dt o perfom i th e activities , o r t o undertak e an y action s regardin g th e us e o f sai d propert y whic hwoul dten dt o endange r th e healtho r welfar e ofth e Grantee s o r th e environment , o r

t o allo w other s t o us e th e propert> ' i nsuc h [f ] 1 gran t acces s t o ni y propertie s nI d o no t gran t acces s t o m y propertie s

Signature ! Dat e Signatur e Dat e

### Sketc h o fadditiona l instructions

.

### Additiona l Comment s / Instructions :

J M Chec k thi s bo xi fowne 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

. B ycheckin g thi s bo xE.R

. i s no t responsibl e fo ran ydamag e don e t o th e interio ro fhouse , includin g foundatio n crack s o rfissures

.

^la g I 1 1 d o no t agre e I d o no t agre e asjre e 

# hy)}^U ^ Owner'slSignatur e Dat e G<§^tr)ictor' s Sig n atur e 

### l)at e /

## Restoratio n Agreemen t The purpos e ofthi s agreement i s to provide amutua l agreement a s to condition s o f propert y prior to contracto r activities
. Thi s wiil als o serv e a s documentatio nfo r the purpos e of assurin g tha t restoratio n activitie s ar e completedto th e satisfactiono f the propert> ' owne r andth e UnitedState s Environmenta l Protectio nAgency (EPA)
.



## SA>n: 3g^/ l Propert y Address : 2^,y ^^^^ ^ p^^ g 

### ^^'C^>^o ^
O

nthe attacheddiagram(s ) indicat e area(s ) t o be excavatedan ddept hof excavation , locationofal l know n utilities , subsurface feamres , sutfiice structure s an dlandscaping features , acces s location(s ) to be use db y contractor , andth e directionofNorth
. Indicat e distances , depths , materia l t\'pes , etc . Indicat e digita l photo s b

y referencing th e photo-lo g numbe r wit ha narrow indicating directiono f view
.
Item s t o b e remove d b yContracto ran d no t replaced : j Item : 

## h x

Item : Item : CD\A.ff\Efi
- M-^Ar\ + A! ^ AD(fA s S^bbt D Item :
Item :
Item :
Item :

Pag e 1 o f2

### I agre e n1 d o no t agre e 1 d o no t agre e ^ 

# ^p.i ^ ^^/rwc k ryi-n30 ^ /^//V ^ ? bate / O^vner's'Signatur e Dat e Attachment s

Pag e 2 o f2

## Propert yCompletio n Agreemen t
Thi s agreemen t docuinent s th e completio no f remedia l activitie s performe do nm y property . M y signatur e wil l designat e tha t I a msatisfie dwit hth e restoratio no f m y property , an dtha t n o item s ar e i n question , now , o r at an y tim e i nth e future , excep t thos e item s liste dbelow , i f any . SAID : ^Vi/ a Propert y Address : ^^I S fyanj<^ J /V ^ 

### Owner : p^\sy f^ir^r^J-6 ( 

# Phone : ^/^X ) 703^0,3 3 Restoratio nItem s inQuestion :

Item : Item : Item : Item : Item : Item : Additiona l Comments :

jj y 1 agree restorationis completed , excep t a

s note d p\\agree restoratio nis completed , excep t as note d f ! I I I d o no t agree restorationis complete d L J I <l o no t agree restoratlon-iS;complete d 

# '^".N/MiO-mv^CM(j/ ^ \\\i3\cp \

. ; .v ! er' s Signatur e Dat e

# EP A EP APropert y Clos e Ou t For m Omah aLea dSite 0U# 2 Propert) ' #:__2$i:^/i ^ Propert y Address : ^::7-^5V^^/X K 

## ^ l 3 mJA ^ /{J/ £ 

## Date/Time : yX / Owner' s Name : 3ry Ajy.Pl/^Py3. ^ ^ Quad s Excavat<^d:/^ / /X^ , /^//£;z- / Contracto r Grou p : Environmenta l Restoratio n(ER ) Excavatio nGenera l Ve s N o 1
. Ifnecessary , wer e the correc t qiiadrant(s ) e.xcavate dan drestored ? 

# z 2
. If necessaiy , wer e the correc t area s ofdri p zone e.xcavate dan drestored ? 

# T Gradin g So dan dVegetatio n Ve s N o 1
. Doe s tli e gradin g aroun dth e perimete r ofth e hous e i nexcavate darea s generall y slop e awa y fromth c house ? 

# 7 / 2
. Has so dbee nlai di nal l area s tha t wer e excavated ? 3
. Doe s th e so dappea r t o b c generall y health y an dgrowing ? (Onl y evaluat e ifinspecte da t 30-da y tim e period)
. 4
. Ar e sodde darea s generall y fir man devenl y graded ? 

## y 5
. Ar c thejoint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e ifinspecte dat 30-da y tim e period)
. 6
. Wa s th c properl y grade dsuc htha t wate r wil l not poo l o nth e property ? v / 7
. Wa s damag e t o landscapin g o r plan t material s avoided ? / 

### Gates , Fence s an dRetainin g Wall s Yes N o 

### 1
. D o gate s ope nan dclos e freely ? (ifapplicahle ) 2
. Wer e all garc s o r fence s take ndow ndurin g restoratio naclivitie s re-installed ? (i f applicable ) ^ 3
. Wa s damage t o gate s o r fence s avoided ? (ifapplicahle ) 4
. Wa s damag e to retainin g wall s avoided ? (if applicable ) Foundation
. Sidin g an dGutter s Ve s N o 1

. Wa s dam.nge t o sidin g o rtri m avoided ? / 2

. Wa s damag e l o th e foundatio n avoided ? / 3

. Wa s damag e t o window s avoided ? / 4

. Was damag e to windo wscreen s o rdoo rscreen s avoided ? / 5
. Wa s dainag e t o downspout s o rdownspou t extension s avoided ? / Sidewalk s an d Driveway s (Concrete ) 1

. Wa s damag e t o drivewa ysurface s avoided ? 2

. Wa s damag e t o walkwa ysurface s avoided ? 

### Inspectio nnotes : ^- ^ 

## 'Vol^^cu3 c df^^' M " ^ ^"' ^ y- , Ves y 

# y N o



### Remedia l an drestoratio nactivitie s complet e includin g 30-da y so dwarrant) :

EP ARepresen t scntativ,e:^y^^yy>;^^,^?:^j?%i^ ^ 

## Date : l]I^O'\

### Dougla s Count y Accoun t ij^tmalio n Pag e 1 o f3

Dougla s County , Nebrask a Propert yRecor d - R060072000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t west o f52n d S t - Vle wO n Ma p Informatio n i s vali d a s o f2009-8- 3 Treasurer' s Ta xRepor t Ne wFeatur e ->->- * Aut o Sale s Searc h Owne r MIRAND ARUBE N ETA L 241 5 KANSA S AV E OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : \ 007 2 OOO O 0 6 Accoun t Type : Residentia l Parce l Number : 

### 060072000 0 Parce l Address : 241 5 KANSA S A V OMAH AN E 68111-000 0 Lega l Description : BELL E ISL E LO T5 BLOC K1 E 1/ 2 L T6 & AL L 67. 5 X 136.4 9 

### Valu e Informatio n
200 9 200 8 200 7 200 6 200 5 200 4 

### Lan d $3,200.0 0 $3,200.0 0 33,200.0 0 $3,200.0 0 $3,200.0 0 53,200.0 0 

### Im t provemen t $56,500.0 0 556,500.0 0 349,900.0 0 $49,900.0 0 $49,900.0 0 $44,900.0 0 Tota l $59,700.0 0 _$59,700.0 0 $53,100.0 0 $53,100.0 0 $53,100.0 0 $48,100.0 0 Sale s Informatio n Sale s Date : 2009-02-1 8 Dee d Type : W D Book : 200 9 Page : 

### 01519 0 Price : $45,000.0 0 Grantor : I K H INVESTMEN TPROPERTIE S IN G ETA L Grantee : MIRAND ARUBE N ETA L Validllnvalid : I vali d Exclusio n Reason : Sale s Date : 1997-06-3 0 Dee d Type : 

### 'D 

## " 1 Book : 206 4 Page : i 42 3 Price : ! $46,000.0 0 Grantor :



### http://douglasne.mapping-online.eom/DouglasCoNe/static./accountinfo.jsp?accountno=R060.
. . 9/1/200 9a^jpi c 

## Dougla s Count y Account lo^rnatio n Pag e 2 o f 3

Grantee : Validllnvalid : Vali d Exclusio n Reason : Sale s Date : \ 1997-04-1 1 Dee d Type : Book : 206 1 Page : | 50 7 Price : $37,000.0 0 Grantor : Grantee : Validllnvalid : Invali d Exclusio n Reason : \ invali d Sal e Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.21 9248. 0 

### 1. 0 

### 136. 0 68. 0 N o Improvement Informatio n Buildin g 1 

### TW O STOR Y EndS.o^3!)Vall4{; / li. O fa' j a 12 0 j •iv] "J.

. I 1 4 D

^
. ..v„,^ l Firss B«i r as s 0 tr i « • I b 12,f f a. c 26. 0 ZSi y f

. Secon d Ffoo rtc i ri 852 0 '" • Bn a Scir i Wal l 13

2 0 i.'»*tew.!a«i!ti.jTii!^i'>Wf'tiii ! mo CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : i 1704. 0 Percen t Complete : I 100.0 % Perimete r\ 0. 0 Quality ; j Fai r Uni t Type : Condition : ! Fai r

Buil t As : 2 Stor y Cond o Squar e Footage : 0. 0

HVAC : Force d Ai r Rooms : 6. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo fCover : j Compositio n Shingl e Bedrooms : 3. 0

Roo fType : { Gabl e Stories : 2. 5 Floorcover : i Allowanc e Foundation : Bloc k



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno==R060..
. 9/1/200 9

## Dougla s Count y Account Inj|fc|iatio n Pag e 3 o f 3 1 ^

Yea rBuil t 191 5 Deta/7 Typ e Applianc e Applianc e Basemen t Fixtur e Fixtur e Fixtur e Garag e Porc h Porc h Yea r Remodele d 0 Percen t Remodele d 0 % Detai l Descriptio n Allowanc e Fireplac e Masonr y Bsmn t Bloc k 8 ft Additiona l Fixture s Bas e Fixture s Bat h Ful l Detache d Enc l Scree n Enc l Scree n Sprinkle rSquar e Footage : 0. 0 Adjuste d Yea r Physica l Ag e Buil t 191 5 9 3 Unit s 1. 0 1. 0 852. 0 1. 0 1. 0 1. 0 440. 0 182. 0

24. 0



## http://douglasne.mapping-online.comyT)ouglasCoNe/static/accountinfo.jsp?accountno=R060..
. 9/1/200 9

### Dougla s Count yN E GI S Ma p

LEGEN D Mino rStreet s 14 1 14 1 14 4
^ OOw , Majo rStreet s - /

n4)orSt/««t » y V ^

Kij^rXtius b

Interstate s 

# i 1 ^ y(rtteaute s 1 Q Parcel s 1 [—

1 Hydr o ! 1 !



## Dr^/enb y tVc?if7GtJ,ID E Disclaimer : Thi s ma p i s no l guaranteei l to b e accurate , correct , current , o r complet e an d conclusion s draw n ar

e th e responsibilityofth e user .

### % 

# Consen t fo rAcces s t o Propert y SAID # 3Ml l RiCiMTO FENIR Y T O PRHMISC S 

### Granto r (th e properl y owner) , conseul s U ) an dcUilhorizc s th e Unile dState s Environmenta l Protectio nAgenc y (USEP.A ) o r il s atithori/e dreprcsent.itivcs , collectivel y th o Grante e t o ente r an dperfor mcertai ncJivironmciitii l respons e activitie s upo nth o followin g describe dprcrnise.s. :

Owncr'NName : ^^^^ y rAii^AM^r \ Daviim e P 

# ^^^z^:miikiz£Z ]
.\ddrcss : 

### 2HI ^ KArsft s Av t Address : .Addresse s of I'rope r tie s covere db y thi s Addrcs.s : Ay;reefi]c«it : .Address : Address : PijRpo.s EOl

- INVESTIGATIO N 

### Th e pufjios e o f th e remedia l acliviiie s i s l o remov e al l soil s a t ih c properl y wJiic har e contntninate dvvit hhazardou s stibstances , i nparticula r lea da l concentration s greaie r than.o r eqLj;i ! t o 40 0 part s pe r rniUio n(ppm)
. RF.MEDIAl.
. ACTION S Th e environmenla l respons e action s t o h e performe do nsai dproperl y ma y includ e lh e follo\vin g activities : H

.Takin g photograph s and'o r vide o o f th e propeii y before , during , an dafie r remedia l fictjvilies ; b
.

l.ocntin g cquiptncn l an dmachiner y on-sit e i npreparatio nfo r an dinth e cours e ofth e environmenta l response ; c .Plannin g an dimpiemeniin g Id c remova l actio no no r nea r Grantor' s properiy , d
.

Obtainin g sample s fror nGranlor^ s property ; .^GRF.e.-\tF.N T No r T o iKTHriFflR L i'Ji e Granto r agree s no t to interfer e o r tampe r wii han y o f th e aclivitie s o r wor k done , o r th e ei|Liipmen t u.se dto perfor mlh e activities , o r t o undertak e an y action s regardin g th c us e o f sai d propert y whic hwoul dten dt o endange r th e hc-i^U hoi ' welfar e o f th e Grantco s o r th e onvirotiinen L o r

t o allo w other s t o ti-se th e propert y insuc h f\

\I{^ran t acces s U > m y propertie s [_] I tl o iitt l Ibrant acces s f o m y proportic s

Si"naturi ' i Dnt e ii^i'iittir e I)Mi ^

### • 

# m 

# 9

1

^

Chec k thi s boxi fovi/ne rdoe s not wan t E.R

. t o ente rth e resident s l o documen t interio r foundatio n v/afi s an d possibt e preexistin g damage

. B ycheckin g thi s boxE.R

. i s no t responsibl e fo ran ydamag e don e t o th e interio rof house , indudin g foundatio n crack s o rfissures

.



# W I jigrc e 

# n I I ] d n MO t il g rc c 

# D l O I fl o HO l agre e 

### vire c 

# C)a;M J 0-Wi AlX^|'Y^<^t^

. ^-0\3f \ Owi)LT"s\si(;iiinur cI)H(L ' C\»nlr;ic(or* s Signatur e Daf e

### " ^


# Restoratio n Agreemen t Th e purpos e ofthi s .'igreenient i s t o provid e ainulual agreemen t a. s to cotidiiion s o f propeit\ ' prio r l o contracto r uctiviiics
. Thi s wil l als o serv e a s documetitaiio nfo r th e purpos e o f assurin g tha i restoratio n flctivilics ar c complete dt o the

- sarisfactio nv> f th e property owne r andth e Unite dState s l?.iivironmon(a l Protectio nAgenc y (PPA)
. 

# pAlD : 3g^) i

Propert y AddrE.s.v
. ^^^ ^ f/^^^, ^ f.^ ^ 

### '^^^"'-''• ' bi^.s V r^•lL^>.o ^ 

# •^"""^•

- 3.Dl-^^ 3 O nth e atlnchc ddiLi!^ri-;}m(s ) iiidicar e arc;i(.s ) t o bc exciivate djiiiddcplho f exc;iv;ttion , locatio no f ni l know n vnilidc-s , subsurfiic e iealures , surfhc c structurc j andlaiidscapin g features , acces s localion(s ) t o b e usc db y coidractor , an dtii c directio no f Nortii
. hulical e dist;inccs , dcpifis , material lype.s , etc . hidicat e digital photo. s b y referencin g tli e photo-lo g luunlier wit ha narro w indicmin g directio no f view
.

Jtem s t o b e remove d b yContracto ran d no t replaced :

Rem : 

## Item : bg'it/gtA/A y^'S P{2dP ycf^Acfi-i?r > Item :
item :
Item :
iiem :


### Item :

Pag e 1 o f2

### # •



# b 9 Tai i re c Q 1 d o no l a*;rc c L J Tagre e E H 1 d o no t iifjre t 

# ^;^.|<V ) V<\W^%i A(3i^0\'-0^ l CoiitriuMor' s Sinn;Uiir c Dat o O Vv I I CT'SV S i K n: H ll r e D ai u 

## Attachments

## ENVIRONMENTA L AS-BUIL TDRAWIN G )MAH ALEA D SUPERFUN D SIT E RESTORATIO N 

# liyiiiiiiiiiii i 3891 2 tmo'iti fPain l rjyrt h Arro w 

### Omah a Lea d Sit e
•Goo d 

### Sit e Sketc h B^Poo r Samplin g Address : ?• » 1 5 KANSA S A V Q No t pain t Cea d Sampl e Samfrfe s Collecte d Sampl e Numbe r 

# I LA B Concentratio n Coflecle d Fir m pp . C C £f C RYASCPXA-3891 2 F l 

### £ S l pp m 

## D Dat e l l - i:^ - a y RYBSCPXA-3891 2 F 2 

### H 3 5 pp m 

## D Tim e "^ •0 i A-HA.

. RYCSCPXA-J891 2 8 1 

### I 3 5 pp m Sarrple s Analyye d RYDSCPXA-3891 2 B 2 

### i^( o pp m 

# n RDZSCPXA-3891 2 0 2 

### 1532
. pp m 

## D Boo k XR F Uni t 

# 21 ± nczecpxA-aftoia—G Z pp m 

## D D Dai e _ 

### / * 2 / pp m 

## D Tim e _ 

# n flro Staf f 

## JTbidl

. Numt>e ro fSampie s = | ^ | [ Q | 

# n Legend ; F l = Fron t Left

. F 2 = Fron t Rtght , B l = Bac k Le«

. 8 2 = Bac k Righ t D Z = Dri p Zone

. G Z = Garden

. P Z = Pla y Al t qu»drant 9 M V A S vi«r«n j Iro m tt>* %;rnct , l»i; i



### TT T Ottadran t excavate d D fI p Zon o Excavato d 

# il l Contaminatio n Lof t Bohin d |~*p , , i 

## Contrac t # : EP-R7-09-0 5 Environmenta l Restoratio n LL C

# ifll l 1891 2
Exterio rPain t Nort h Arro w 

## Omah a Lea d Sit e •Goo d 

## Sit e SIcetct i 0^oo r Samplin g Address : 241 5 KANSAS AV Q] No t pain t Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Fir m Sample s Collecte d It ^

C-C
­ E-K: - RYASCPXA-3891 2 RYBSCPXA-3891 2 RYCSCPXA-3891 2 RYDSCPXA-3891 2 Fl F2 81 B2 

## 5-5- / 

# H3 5 \5 5 15 6 pp m pp m pp m pp m 

# D D D D Dat e Tim e U - I2> - Qg " 9 ••C- l A - (w.

- Sample s Analyze d RD2SCPXA-3891 2 nCZSGPX A3801 2 •nPZSCPX A3801 2 DZ G2 PZ ­ 

# '')5i Z pp m pp m pp m 

# D D D D D XR F Unit : Date : _ Time : _ 

# G6H 0 n -2 / Aea
. Book : 

# 21 ±

Numbe r ofSample s = [ .5 | | Q | Staff : 

# rQ^U > Legend : Fl = Fron t Left , F2 = Fron t Right , 81 = Bac k Left , B2 = Bac k Righ t DZ = Dri p Zone , GZ = Garden , PZ = Pla y Al l quadrant s ar e as viewe d fror ^ th e street , faan g propert y



### K^-»>^. i f\ V Re

v;o<)S. N Crcolcd : :6-Feb-0 S

# 3891 2 

# L 3 I K r l u

. J 

### Omah a Lea d Sit e Exterio rPain t North Arro w 

### • Goo d Sit e Sketc h 0^oo r 

# r Samplin g Address : 241 5 KANSAS A V •Not pain t Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Firm : Samples Collecte d 

### ?e

. c cE. K RYASCPXA-3891 2 F l pp m 

# D Date : W ­ It^'OS
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