• 

### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAI D # : ^b'^^ MDate : - Address : 4\ ^ \jOo& l t^t)C44 v ( W Remediatio nContractor : Envrionmenta l Restoration , LLC

_Year : _201 0 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f property (DVD ) jSBefor e DAfte r D Basemen t O y Ji dj^/H^/m y ^ Executiv e Summary (Fina l Report ) /f6^X ^ e , ns« . EPA-providedproperty sketc h * ^Signe dAcces s Agreemen t fo r subjec t property D Signe dAcces s Agreement(s ) for adjacen t property "* ^ Restoratio nAgreemen t

D Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) " ^ Confirmatio ndat a

\ £Photograph s ^SsBefor e DCre w Photo>C ] Durin g Excavatio nD So d S^'sO-da y So dD ^bv . As-built sketc h *^ ^ Completio nAgreemen t signe db y Property Owne r " ^ Property close-ou t chec k lis t signe db y EPA D Descriptio no f area s no t meetin g RO D cleanu p criteri a " ^ Utility clearance s ^B - Property informatio nfromDougla s County Assessor' s Offic e " ^ Property acces s checklis t 3026005 4 

### ^ Contac t Lo g •Superfun d 

# n/Lo/i o Environmenta l Restoratio nSignat u gnatur e EP A CO Rsignatur eDate "^*^"»"^ v 

### / @ -» j Omah a Lea d Site—EP-R7-09-0 5 8 ,\^^;^f Environmenta l Restoration , LL C VT ^ ^ * viftvw.cr1Ic.co m 

# EXECUTIV ESUMMARY : 4084 4 - 41 5 WOOLWORT H S T

• ^ t ; 

# NJ N O Issue s o r Concern s Q Issues/Concern s Detai l Explanation :A k .r.;?- - 

# EP A EP A Propert y Clos e Ou t For m Omah aLea dSit e 0U# 2 Propert y # : 

# ap^^ ^ PropertyAddress : Hv ? U>i>p)uJD(-t^ ^ Arc Date/Time : Owner'sName : '<V\^C> J V^^^'^KJ ' Quad s Excavated : S> t ,i^ < , f 9

^ n^l R Contracto r Grou p : Environmenta l Restoratio n (ER ) Excavatio n Genera l Ye s N o 1 . Ifnecessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 

# y 2 . Ifnecessary , were th e correc t area s ofdri p zon e excavate dan drestored ? ^ Gradin g So dan dVegetatio n Ye s No I . Doe s th e gradin g aroun dth e perimete r ofth e hous e i n excavate darea s generall y slop e away fromth e ^ house ? 2 . Ha s so dbee n lai din al l area s that were excavated ? ^ 3 . Doe s th e so dappear t o b e generall y health y an dgrowing ? (Onl y evaluat e if inspecte dat 30-day tim e period) . 4 . Ar e sodde darea s generall y fir man devenl y graded ? t ^ 5 . Are th e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte dat 30-day tim e period) . 6 . Wa s th e property grade dsuc hthat wate r wil l no t poo l o n th e property ? ^ 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 n an dclos e freely? (ifapplicable ) 2 . Wer e al l gate s o r fence s take n dow n durin g restoration activitie s re-installed ? (ifapplicable ) 3 . Wa s damage to gate s o r fence s avoided ? (ifapplicable ) 

# l i ^ 4 . Wa s damage to retaining wall s avoided ? (ifapplicable ) Foundation , Sidin g an dGutter s Ye s N o 1 . Wa s damag e t o sidin g o r tri mavoided ? ^ 2 . Wa s damag e t o th e foundatio n avoided ? K ^ 3 . Wa s damag e t o window s avoided ? l - ^ 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 dovmspou t extension s avoided ? ^y ' Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Wa s damag e t o driveway surface s avoided ? % ^ 2 . Wa s damag e t o wallcwa y surface s avoided ? \ ^ Inspectio n notes :

Remedia l an drestoratio n activitie s complet e includin g 30-da y so dwarranty : EP A Representati v 

# ^Jy^yL^.r.>X.^> ^ Date : S/j-lj/ 0

### Pas e 1 o f 2

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



### o YOU RTICKE T NUMBE RI S 2470321 . Origina l Cal l Date : 4/20/1 0 Time : 4:5 4 p i Wor k t o Begi n Date : 4/22/1 0 Time : 5:3 0 pi i • State : NE County : DOUGLAS Address : 41 5 Street : WOOLWORTH AV E Twp : 15 NRng : 13 E Sect-Qtr : 26-N W Twp : Rng : Sect-Qtr : Lega l Given : C 

## •fw o LJ^^ ^ bOorfZ - Typ e o f Work : Excavating the entir e propert y 

## ^BiK^ ^ Locatio n o f Work : LOCAT E ENTIR E PROPERT Y 

# V , ' 8 Remarks : FA X AL L CLEAR S TO : (402)451-106 9 : SAI D #2004 4 Compan y ENVIRONMENTA L RESTORATIO N Contac t Name TRACY BRISTOW Phone : {402)451-131 4 Alt . Contac t Phone : (314)504-487 4 Wor k Being Don e For : EPA Dept h o f Excavation ; 1 2 Corne r Lot : NFront : Y Rear : Y Involve s Tunneling o r Horizonta l Borin g : NExplosives : N CXCAT V

LEVEL S MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F QWESTNE Servic e Are a Contac t Phon e Numbe r Utility Typ e CXCAT V CO X COMMUNICATIONS , INC HEID I 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 LEVEL 3 LEVEL S COMMUNICATIONS , LL C N A 

### Day : 877366834 4 Ah : Emerg : 877366834 4 MUD0 2 METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE R RICH/TRAFFI C 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0
http://wvAv.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asD?ret=< RFS I u T S /t/on/^ni/- !

## Page 2 of 2

0PPDGPR 6 OMAH A PUBLI C POWERDISTRIC T 

### EL M LOCATING Day : Alt : 406728934 3 406207149 4 Emerg : 888728934 3 QLNNEI FQWES T LOCALNETWOR K 

### EL M LOCATING Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QWESTN EQWES T LON GDISTANC E 

### Day : 800283423 7 Alt : 

## Emerg : 800283423 7

http://www.dhon.orgyirthintemet/DHONNoticeCreationMessageText.asp?ret=<RESULTS.. . 4/20/201 0

# f^m^^^mm SAiD # ^Q<>^ y Owner' s Name : D^cy H lUc^i y Daytim e Phone : y>{-^S7 7 \

l l l l I I • • - ^ . ^ - - . - - - -

_ _ . _. - _— _ 

### I Propert y Address : ^/ ^ k)oo j l/QQfJJt ^f''"'f^'-ff^~Z'! ^ 

# Propert y Acces s Checklis t 

# ^oW nWOR K STARTED ON : / / Propert y Address : V / g - [^^ ^ fc^gr^J ^ nWOR K COMPELTE D ON : / 1 Owner : /^ ; J. ; \L^:^i, i 

### Renter : Addres s 

# 'y^i^\y>oo\{/)or ^ PhoEie : Fax : Celt/Pager : Phone:^;(/ . C^Sl I Additiona l Information : Fax : CeSl/Pager : 

## ICtHC* cces s Agreemen t 

# s ^

Restoratio nAgreemen t Signed : Signed ; ^ 7 2 ­ 3/ 2 / K

> I \ 0 By : 

## By : 

# ^4 ^ 'M;g ^ 

## tV l 0 Vide o Propert y Before 

### o» i 

### yI ^ f ic > By : 5^ ^ 0 Digita l Photo s Before 

# O a:A_iAih . By : (C-z J Q Vide o Propert y After O a / / 

### By : nDigita l Photo s After On By : 0 Propert y Completio nAgreeinen t SigRed:_SfJlfJJ L By : '^J nFina l Repor t Signed : / / _ By : Additiona l Vide o o r Biglta t Photo' s Taken : j D Vide o D Digita l Phot o O n: / / By : 

## • I I Reason : ­ • 1 nVide o nDigital Phot o O n: / / 

## By : 1 Reason : | nVide o nDigita l Phot o O n: . / / By :

• 

### Reason : ' 1 nVide o nDigital Phot o O n: / / By : • • 1 Reason : • 1

Omah a Lea d Projec t 

### Wor k

Pla n Pag e 1 o f 1 9

# Consen t fo r Acces s t o Propert y SA5D # 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 nenvlroivmental respons e activitie s upo nth e followin g describe dpremises. : Owner' s Name;/>];<J:^ ' ^/.j^./
- | Daytim e Phone : (/Q2,-^/</ ^ 

### 75'9- 7 Address ; Addresse s of Propertie s covere db y thi s Agreement :

PURPOS EO FINVESTIGATIO N 

### Th e purpos e of th e remedia l activitie s i s t o remov e all soil s a t th e propert y whic hare containinate dwit hhazardou s substances , i nparticular lea dat concentration s greate r than , o r equal 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 dpropert y may includ e thefollovvin g activities : a .

Takin g photograph s and/o r vide o o f th e propert y before , during , an dafte r remedia l activities ; b .Locatin g equipmen t an dmachinery on-sit e i npreparatio nfor 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 nea r Grantor' s propeity . 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 interfer e o r tamper wit han y 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 propert y vv^hic hwoul dten dt o endange r th e healt ho r welfar e ofth e Grantee s c r th e envirorunent , o r t o allo w other s t o us e th e propert y i nsuc h ^ mI graa t acces s to my propertie s nI d o no t gran t acces s t o m y p-raperCies 

# /HuiL^ ' J/Co<^^^yi y ^'Z-' o Signature ^ Dat e Signatur e Dat e

## Addtteona i Comments / Instructions :

S 3 Chec k thi s bo x i f

owne r

doe s no t wan t E.R . t o enter th e resident s t o documen t interio r ?oundatio nVs/all s an dpossibl e preexistin g damage . B y checking thi s bo x E.R. i s not responsible fo

r

any damag e don e t o th e interio r

o

f

house , includin g foundationcrack s o r

fissures .



# "Pla g r~l Idonotagre e • "•£! ! lagre e ni d p tkii t agre e agre e 

# :^,4 ^ j^2'/ o Ovyner' s Signatur e Bat s Contractor' s Stgnattir e Bate

## Restoratio n Agreerrieri t Th e purpos e o f thi s agreemen t i s t o provid e amutua l agreement a s t o condition s o f propert y prior t

o contracto r activities . Thi s wil l als o serve , a s documentatio nfo r th e purpos e o f assurin g tha t restoratio n activitie s ar e completedt o the satisfactionof th e propert y owne r anddi e Unite dState s Environmenta l Protectio nAgenc y (EPA) .

PropertyAddress ; q^g - (/)oQ|(^oyvf h Owner : p^^^v^ ; t^iok ^ 

## Phone : g^j^ ^ (ffN-^ST ] 

# f

\ O nth e attache ddiagram(s ) indicat e area(s ) t o be excavatedanddept hof excavation , locatio nof all know n utilities , subsurfac e features , surface structure s aiidlandscaping features , acces s location(s ) t o b e usedb y contractor , an dthe directionof North . Indicat e distances , depths , materia l types , etc . Indicate digita l photo s b y referencin g th e photo-log numbe r wit ha narrow indicating directionof view . Stem s t o b e remove dby Contracto r ari dno t repSsced :

Pag e 1 o f 2

### I agre e C D I do no t agre e Q I agre e [ U I do :LC t agre e 

# ynocX y Owner' s Signature Dat e Contractor' s Signatur e Dat e Attachnnent s

Pzg e 2 o f 2I 

## Propert yCornpletio n Agreemen t Thi s agreemen t documents th e completionof remedia l activitie s performe do nm y property . M y ^"^r.atur e v/il l designat e that I amsatisfiedwit hth e restoratio no f m y property , an dtha t n o items ar e in question , now , o r a

t an y tim e i nth e future , except thos e item s Uste dbelow , i f any . SAID : 

## ^ 0 ^ PropertyAddress : qj ^ UJoolu^Ofi h Owner : /7)/^ ; tn!^K ^ Phone : L/c^. ^ l^/( ^ ^^^S'^q - 

### Restoratio nItem s i nQuestio n Ite m ite m



### AddEtiona l CoETijr.snts :

j I agre e restoratio ni s compieted , except a s noted 

# 13^ 1 agre e restoratio ni s completed , excep t s.s aote d I I d o no t agre e restoratio ni s coraplete d I I I d o no t agre e restoratio ni s completed

Gv/ner' s Signature ' Contractor' s Signatur e Dat e

### ^vyvic,^"- ^ >-.\jiim. ^ /-\ccou mluiormatio n Pag e 1 o f 2 Dougla s County , Nebrask a Propert yRecor d - R090240000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t o f 52n d S t - VJe W O H Ma p Informatio n i s vali d a s o f 2009-9-2 9 Treasurer' s Ta xRepor t Ne wFeatur e ->-•- • Aut o Sale s Searc h Owne r SMIT H SHARO N K 41 5 WOOLWORT H AV E OMAH AN E 68108-000 0 Propert yInformatio n Ke yNumber : 

### 024 0 000 0 0 9 Accoun t Type : Residentia l Parce l Number : 090240000 0 Parce l Address : 41 5 WOOLWORT H A V OMAH AN E 68108-000 0 Lega l Description : CREDI TFONCIE R LO T3 BLOC K2 1 1 5 F TSTRI P AD J O N N & E 5 5 FT55X14 7 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $5,400.0 0 

### $30,900.0 0 $36,300.0 0 200 8 $5,400.0 0 

### $30,900.00

­ $36,300.0 0 200 7 $5,400.0 0 $27,200.0 0 $32,600.0 0 200 6 $5,400.0 0 $27,200.0 0 $32,600.0 0 200 5 $5,400.0 0 $27,200.0 0 $32,600.0 0 200 4 $5,400.0 0 

### $19,400.0 0 $24,800.0 0 Lan d Informatio n ••.cre s S F Unit s Dept h Widt h Vacant 0.1 8 8085. 0 1. 0 147. 0 55. 0 N o Impro t Informatio n vemen Buildin g 1



### http://douglasne.mapping-onIine.com/DouglasCoNe/static/accountinfo.jsp?accountao=R09. . . 10/6/20n Q

### LvuLiym i \„uuiu} ' /Accoun t inrormatio n Pag e 2 o f 2 

# P I 1 1/ 2 StoryFi n 41 5 Woolwort h A v 

# i y M 

# • -•ja w ^ 

# f ^ 4 

# f:m' \

^lj|y^^^^^M-_ _ 

# SMHHHIH H ; CLIC KT O ENLARG E IMAG E Squar e Footage : 936. 0 Perimete r 0. 0 Uni t Type :

Buil t As : 1 1/ 2 Stor yFi n HVAC : I Force d Ai r Exterior : Fram e Sidin g Interior : Drywal l Roo f Cover : i Compositio n Shingl e

Roo f Type : Gabl e Floorcover : Allowanc e ^^?n-ri.iv^ ; . n 1 ]

Yea rBuil t Yea r Remodele d Percen t Remodele d 189 0 0 0 % Detai l Typ e Detai l Descriptio n Applianc e Allowanc e Basemen t Bsmn t Bloc k 8 f t Fixtur e Bas e Fixture s Fixtur e Bat h Ful l Porc h Sla b Roo f Cei l Porc h j Sla b Roo f Cei l Use r\ Hal f o f 2n d floo rfi n pe rowne r • ?)?.l) Si t F l

"^-v''-*-: ! >- ; CLIC KT O ENLARG E IMAG E Percen t Complete : Quality : Condition : Cond o Squar e Footage : Rooms :

Units : Battis : Bedrooms : Stories : Foundation : Sprinkle rSquar e Footage : \ 100.0 % Averag e Fai r 0. 0 6. 0 1. 0 1. 0 2. 0 1. 5 Bloc k 0. 0 "*"£/"' • P-ys/ca/Xg e 189 0 11 9 Unit s 1. 0 792. 0 1. 0 1. 0 120. 0 120. 0 1. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinf o .jsp?accountno=R09.. . 10/6/200 9

### ENVIRONMENTA L AS-BUILTDRAWIN G i^ivlAH ALEA D SUPERFUN D SIT E RESTORATIO N 2004 4 Nort h Arro w Omati a Lea d Sit e Owne rName : SHARO N KSMIT H Sit e Sketc h Address : 41 5 WOOLWORT H A V

Phone ; H : 402-346-548 0 W ; 

# i Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Firm : ' F D P i Z \ S 'Z)\ s RYASCPXA-2004 4 F l ^i 7 pp m V . n Date ; 0-= ; - :: ? o - o- t RYBSCPXA-2004 4 F 2 C^'S ^ pp m Cl , g ] 

## D Time : \3 - . .Pl S < p r^^ RYCSCPXA-2004 4 B l ___4j^^

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# n Sample s Analyze d RYDSCPXA-2004 4 8 2 3 0 pp m Q-L Q 

# n RD2SCPXA-2004 4 D Z ^6^ 3 pp m D2.B I XR F Unit : 9yy \ Book : 

# n —RGZSGPXA-2004 4 G2 ­ pp m ' n 

# a Date: C."'ZM{ZZ'^ \ RPZSCPXA-2004 4 P Z ':7L J I pp m ^ - Time : La b RyASCPLA-2004 4 Staff : 

# n Numbe ro f Sample s = Resul t 55 6 pp m SAI D #2004 4 DAT E EXCAVATE D 5-5-1 0 DAT E EP ASIGNE D OF F 5-21-1 0

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### Environmenta l Restoratio n LL C^ ^ 

# K Mlilllillll i 200 ^ Owne rName : SHARON . KSMIT H Address : 41 5 WOOLWORT H AV Phone : H : 402-346-543 G W : 

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# i

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# S Date : o-= ; - ^ c . - o- i 

### ^ l 7 pp m ^ . • RYBSCPXA-2004 4 F 2 

# 6 ^ pp m Time : \ P . • . fis 9 ^ 

# n RYCSCPXA-2004 4 B l ^&' ^ pp m Sample s Analyze d RYDSCPXA-2004 4 B 2 .^ ^ pp m 

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Pag e 1 o f 1 05/07/1 0 14:38:1 5

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