### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SA1D# : ^SnM ^ Date : Address : ^'^'^ O Goxy A {VV" ^ Remediatio nContractor : Envrionmenta l Restoration , LLC

_Year : _2010 _ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S D Vide o o f property (DVD ) ^Befor e DAfter D Basemen t D i ^ Executiv e Summary (Final Report ) ^a. ^ EPA-provide dproperty sketc h

Ms ^ Signe dAcces s Agreement fo r subjec t propert y D Signe dAcces s Agreement(s ) fo r adjacen t propert y Ky^ Restoratio nAgreement D Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) u\ . Confirmatio ndat a D Photograph s j H Before DCre w Photo s D Durin g Excavatio nS So d D 30-day So dD 'K ^ As-buil t sketc h D Completio nAgreemen t signe db y Property Owne r N ^ Property close-ou t chec k lis t signe dby EPA D Descriptio no f area s no t meetin g RO D cleanu p criteri a ^"S v Utilit y clearance s l5« ^ Propert y informatio nfromDougla s Count y Assessor' s Offic e '""Hv ^ Propert y acces s checklis t ^ ^ 3023782 9

[>- ^ Contac t Lo g D Superfun d


### Environmenta l Restoratio nSignatur e Dat e 

## t^'ZZ' / / Dat e

### \ Omah a Lea d Site—EP-R7-09-0 5

0 Environmenta l Restoration , LL C 

# V- " ^

www.erilcco m ••tINWt* " 

# EXECUTIV ESUMMARY : 3574 9 - 222 0 GRAN D A V 

# [~K \N O Issue s o r Concern s Q Issues/Concern s Detai l Explanation :a % 

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

# VsnM ^ Propert y Address : 9L^'^ 0 QACAM/Q , VQ/ ' 

### Date/Time : Owner' s Name : CJSTO^^
- 

### CS"vy&Vn::>- 5 Quad s Excavated : Contracto r Grou p : Environmenta l Restoratio n(ER ) Excavatio nGenera l Ye s No 1 . Ifnecessary , were th e correc t quadrant(s ) excavate dan drestored ? 

### y 2 . Ifnecessary , were th e correc t area s o f dri p zon e excavate dan drestored ? y Gradin g So dan dVegetatio n Ye s No I . Doe s th e gradin g aroun dth e perimete r o f th e hous e i nexcavate darea s generall y slop e away fro mth e U house ? 2 . Ha s so dbee nlai di nall area s tha t were excavated ? y 3 . Doe s th e so dappear t o b e generall y health y an dgrowing ? (Onl y evaluat e if inspecte da t 30-day time ' period) . 4 . Ar e sodde darea s generall y fir man devenl y graded ? y 5 .

Are th e Joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e if inspecte da t 30-day tim e period) . ^ y 6 . Wa s th e property grade dsuc htha t wate r wil l no t poo l onth e property ? 7 . Wa s damag e to landscapin g o r plant material s avoided ? y Gates , Fence s an dRetainin g Wall s Ve s N o 1 . D o gate s ope nan dclos e fi-eely? (ifapplicable ) 

### l^' h 2 . Were al l gate s o r fence s take ndow ndurin g restoratio nactivities re-installed ? (ifapplicable ) 

## fJ ^ 3 . Wa s damag e to gate s o r fence s avoided ? (ifapplicable ) 

### y 4 . Wa s damag e to retainin g wall s avoided ? (ifapplicable ) 

## /OA r Foundation , Sidin g an dGutter s Ve s No 1 . Wa s damag e t o 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 to windo w screen s o r doo r screen s avoided ? t* ^ 5 . Wa s damag e to downspout s or downspou t extension s avoided ? •y Sidewalk s an dDriveway s (Concrete ) Ve s No 1 . Wa s damag e to driveway surface s avoided ? ^ ^ 2 . Wa s damag e t o walkway surface s avoided ? <.. • inspectio nnotes : /



### Remedia l an drestoratio nactivitie s complet e includin g 30-da y so dwarranty : EP A Representativ e 

# zi^4Uiu^-JiZr £ Date : 

# M ^1 Clll^ ^ 1 V/ X 1

" > [ Creat e Anothe rTicke t ~ ] [ Bac k t o Irt h Interne t ] [ Sen d Emai l ]
YOU RTICKE T NUMBE RI S 256ieiB p Origina l Cal l Date : 8/05/1 0 Time : 9:4 7 a m Op : TRACY2418 6 Wor k t o Begi n Date : 8/09/10 | Time : 10:1 5 a j State : N E County : DOUGLA S Place : OMAH A Address : 222 0 Street : GRAN D AV E Twp : 15 NRng : 13 E Sect-Qtr : 03-NW,04-N E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : Excavatin g th e entir e propert y Locatio n o f Work : LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)451-106 9 : SAI D #3574 9 Compan y: ENVIRONMENTA L RESTORATIO N Contac t Name : TRAC Y BRISTO W Phone : (402)451-131 4 Alt . Contact : Phone : (314)504-487 4 Wor k Bein g Don e For : EP A Dept h o f Excavation : 1 2 Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Servic e Are a Contac t Phon e Nuinbe r Utilit y Typ e Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEIDI Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUDO l METROPOLITA N UTILITIE S DISTRICT SAND Y Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRICH/TRAFFI C Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 0PPDGPR 5 OMAH A PUBLI C POWE RDISTRICT EL M LOCATIN G Alt : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 QLNN E1 C QWES T LOCA LNETWOR K EL M LOCATIN G Alt : 406207149 4 Emerg : 888728934 3

http://wv^rw.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 8/5/201 0:K4^gjg^^sgJB ^ H 

## Contac t Snformatio n Lo g SA!D # 

# 5^7V f S'r ^ • o^ o I Owner' s Name:^QH j (^(g ^ /2- M .^U^Ju ^ | Daytim e Phone : ^--/Q; ^ ~q4X.-^^\\ I Propert y Address : 2ZZ O & rA^' ^ 

### Attemp t t o contac t Date/tim e Jam e C^.ll^c \i-e ^ fy).fiS'r,y^ ^ 

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_ / /_ / Owner : ^^^/>. ^ /^/ H 

## •Ij^ i Renter : Address:^^^ ^ ^^^ ^ Phone : Fax : Cell/Pager : Phone : t^^^-^/ ^ -^^/ / Additiona l Infonnation : Fax : Cell/Pager : 1 4' ^ Acces s Agreemen t 

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## By : tl/eJ ( [S'^estoratio nAgreemen t Signed : ^ / V / /C ? 

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### O n: ^ / 3 /(" D Ey^i/k ^ Digita l Photo s Before O n: ^ / J T / (t> 

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### Signed : <Sr ' /

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### By : pp r~ l Fina l Repor t Signed : / / By : .Additiona l Vide o c r Digita l Photo' s Take.fi : D Vide o nDigita l Phot o O n: / / By : Reason : nVide o nDigita l Phot o O n: / / 

### By : 1 ReasoEi : D Vide o D Digita l Phot o O n: / / ^ 1 Reason : j

nVide o nDigita l Phot o O n: / / 

### By : 1 Reason :

Omah a Lea d Projec t Wor k Pla n Page l of 1 9

### |0^lr5;^?i\va ^ P I 

## Consen t to rAcces s t o Propert y 

## SA!D# RIGH T O FENTRY T O PREMISE S 

### Granto r (th e property owner) , consent.; ; to an dnv.^hc-nzti ; Lh e 'Jnile dState s Environmenta l Piwicciio nAgency (USEPA ) or it s authorize drepresentatives , collectivel y th e Grante e t o ente r an dperfor mcertai nenvironmenta l respons e activitie s upo nth e followin g describe dpremises. : I Owner' s Name : (^^g/g ^ t?/o4- f Daytim e Phone : L^Q^
- ^/ ^ - d^/ / Address : 

## Izsz o Gfcun f Address : Addresse s o f Propertie s coveredb y this Address : Agreement : Address : Address : PURPOS EO FINVESTIGATIO N 

### Th e purpos e of th e remedia l activitie s i s to remov e al l soil s a t th e propert y vviiic har e contaminate dwit hhazardou s substances , i nparticular lea da t concentration s greate r than.o r equal t o 40 0 part s per millio n(ppm) . REMEDIA LACTION S Th e environmenta l respons e action s t o b e perfomie do nsai dproperty ma y includ e th e followin g activities : a .

Takin g photograph s and/o r vide o o f th e propert} ' before , during , an dafter remedial activities ; b .Locatin g equipm.ent andmachiner y 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 removal actio no nor near Grantor' s propeity . d .Obtainin g sample s fromGrantor' s propeity ; AGREEMEN T NO T T O INTERFER E 

### Th e Granto r agree s no t t o interfere or tampe r withan y o f th e activitie s o r Vv'or k

done , o r the equipmen t use dt o perfor mth e activities , or to undertak e an y action s regardin g th e us e o f sai d propert y whic hwoul dten dt o endanger th e healthor welfar e o f th e Grantee s c r th e environment , o r

t o allo w other s t o us e th e property i nsuc h I gran t acces s to m y propertie s n ] I d o no t gran t acces s to m y propertie s

Signature Signature Dat e

# r Additions l Comment s / Instructions :

l^

p Chec k thi s bo xi 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 sn 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 s t o th e interio ro f house , includin g foundatio n crack s o rfissures
.

Q I d o no t agre e 

# Dl- g F ] I d o no t agre e re e

Contractor' s Signatiir e Dat e

## Restoratio nAgreemen t Th e purpos e o f Lhis agreemen t i s t o provid e amutual,agrep.rnen t a s t o ccnditiori s o f propert y jarib r t o ccntracto r acuvilies. ' Thi s wil l "als o serv e a s documentatio nfo r 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 propert y ovvner an dth e Unite dState s Environmental Protectio nAgenc y (EPA) .



## SAID : S^fV ^ PropertyAddress : .^^^j^^^g^j^ ^ 

## J^IZ O Q-i^' / Owner : (^^^/ ^ l^^/^fl^ i 

## fPhone : y^^.^/^.^^/ / O nth e attache ddiagram(s ) indicat e area(s ) t o b e excavate dan ddeptho f excavation , locatio no f al l known utilities , subsurfac e features , surfac e structure s an dlandscapin g features , acces s location(s ) t o b e usedby contractor , an dthe directio no f North . Indicate distances , depths , materia l types , etc . Indicate digital photo s b y referencin g the photo-lo g numbe r witha narro w indicatin g directio no f view . Item s t o b e remove db y Contrscto r sn dno t replaced :

Fag e 1 of 2SK^r^pjj^^" " " ^


### Additiona l Comment s / Instructions :

I agre e nI d o no t £gre e 

## Di s I 1 1 d o ao t agre e » 

# "-M A O^vner' s Signatur e Ccntractor' s Signatur e Dat e 

## Attachment s

Pag e 2 o f 2

## Propert yCompietior i Agreemen t Tliiii-agreemen t document s th e cori'ipletio 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 : 3'57</ f Property Address : ^^ ^ C> Cri^ ^ 0>^"^'- = Qorod t rfui-^U ^ Phone : Qoi^^/Z
- 0(^/ / Restoratio nItem s I nQuestion :

Additfona ! Comments :

r agre e restoratio nis completed , excep t as note d Ix l 1 agre e restoratio ni s completed , except a

s note d I I I d o na t agre e restorationis completed I j I d o not agre e restoratio ni s complete d 

# tl^ 6 Owner' s Signatur e Bat eDougla s County , Nebrask a Propert yRecor d - R200419000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t of 52n d S t - Vie W O n Ma p Informatio n i s vali d a s o f 2009-12-1 5 Treasurer' s Ta xRepor t Ne wFeatur e -J ' - > - > Aut o Sale s Searc h 

## Owne r JUSTU S CONCI E E M 222 0 GRAN D AV E OMAH AN E 68110-000 0 Propert yInformatio n Ke yNumber : 041 9 000 0 2 0 Accoun t Type : 

### Residentia l Parce l Number : 200419000 0 Parce l Address : 222 0 GRAN D A V OMAH AN E 68110-000 0 Lega l Description : PATRICK S SARATOG AAD D LO T7 BLOC K 0 6 4 X 12 5 Valu e Informatio n 200 9 200 8 200 7 200 6 200 5 200 4 Lan d $2,100.0 0 $2,100.0 0 $2,100.0 0 $2,100.0 0 $2,100.0 0 $2,100.0 0 Improvemen t $49,500.0 0 $50,600.0 0 $50,600.0 0 $50,600.0 0 $21,800.0 0 $19,800.0 0 Tota l $51,600.0 0 $52,700.0 0 $52,700.0 0 $52,700.0 0 $23,900.0 0 $21,900.0 0 Lan d Informatio n Acre s 0.1 8 S F 8000. 0 Unit s 1. 0 Dept h 125. 0 Widt h 64. 0 Vacan t N o Improvement Informatio n Buildin g 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2. . . 12/22/200 9222 0 GRAN D A V IR?/ "

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1 1/2ST0I?YFI N Ml!»lll;H!fclililiMiMIM|.W<tiiri!l»'#A.-Hl-Hi n CLIC KTO ENLARG E IMAG E CLIC KT O ENLARG E IMAG E 

# [zzz : Squar e Footage : 1512. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Fai r

Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 7. 0 Exterior : Fram e Viny l Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 2. 0

Roo f Type : Hip/Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 yea rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 190 5 0 % 190 5 10 4 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Unfinishe d Atti cW/floo r 988. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 ft 984. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h En d Soli d Wal l 32. 0 Porc h Sla b Roo f Ceilin g 176. 0



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2.. . 12/22/2009

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### ENVIRONMENTA L AS-BUILTDRAWIN G 

## W A lAH ALEA D SUPERFUN D SIT E RESTORATIO N
Omah a Lea d Sit e Sit e Sketc h Samolin a Address : 222 0 GRAN D A V Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B RYASCPXA-3574 9 RYBSCPXA-3574 9 RYCSCPXA-3574 9 RYDSCPXA-3574 9 RDZSCPXA-3574 9 F 1 F 2 B 1 B 2 D Z pp m pp m pp m pp m pp m 

# I n n n D 

# n nOgOCPXA-3&74 9 nPZSGPX A3574 0 GS P 2 - pp m pp m 

## D 

# n n n Numbe ro f Sample s = | ^ | | Q | 

## 3574 9 Exterio rPain t Nort h Arro w • Goo d < 12 ^ Poo r • No t pain t Sample s Collecte d Firm : ?
. E - C C g-K - Date : B-l - C H Time : 

### I : i( o fA . Sample s Analyze d XR F Unit : lOfiiC^I
. Book ; ^T 5

Dat e 

### ^-7 7 :i2 9 Tim e Staf f 

### (^S W Legend : F 1 = Fron t Left , F 2 = Fron t Rigtit , 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 arera s viewe d fron i (h e stree t facin g propert y, <^——-— L

Quadran t axcavala d DrI o Zon a Excavate d Co«ttaininatk> n l-af l Bahin d /««^M*..M«. « « , C O o- rAAA C c r»« • aiv^w^ww^^^ai^A^^ I D^^«» 4 ^^ir^«^»^ « *. « I t ^

# Illlfl l 3574 9 Exterio rPaint Nort hArro w 

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### Sit e Sketc h [2 ^ Poo r Samplin g Address : 222 0 GRAN D A V Q Not pain l Sampl e Numbe r RYASCPXA-3574 9 RYBSCPXA-3574 9 RYCSCPXA-3574 9 RYDSCPXA-3574 9 F 1 F2 B 1 B 2 Lea d Concentratio n pp m pp m pp m pp m Sampl e Collecte d 

# I LA B 

# n n D 

# n Firm : Date : Time ; Sample s Collecte d 

## T>.E. c-c . etc S-\-o H Sample s Analyze d RDZSCPXA-3574 9 D Z pp m 

# n XR F Unit : lof^l
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# n n Date ; ^-7 7 ­ ^ RPZOCPXA-3574 0 Pi ­ pp m 

# n n Tim e Ti3a
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### ^S W Legend : F 1 = Fron t Left , F 2 = Fron t Right , B l = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Play Allquadrantsarela s viewe d fro m th e street , facin g property"iSo^ra-AaOtCi. ^>i ^

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v 200 8 Created- . 12-Apr-0 8 044701.0 1 2. 1

## ENVIRONMENTA L XR F DAT AENTR YLO G
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# Therm o Billerica , MA 0182 1

SCIENTIFI C

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