## TRANSMITTALo f

OMAHALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID#: ^1^3 ^Date: Address : P9^r? S l/gtA<

_jf
Remediatio nContractor : Envrionmenta l Restoration , LLC

_Year : 201 0 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S H vVide o o f property (DVD ) ^^ISBefor e DAfter " S Basemen tD aExecutiv e Summary (Fina l Report ) a . EPA-providedproperty sketc h

• • Signe dAcces s Agreemen t for subjec t propert y
• Signe dAcces s Agreement(s ) fo r adjacen t property ~3 , Restoratio nAgreeraen t

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

•Photograph s JS^Befor e QCre w Photo s UDurin g Excavatio nD So d ^30-da y So dD " ^ As-buil t sketc h 

## r

r Completio nAgreemen t signe db y Propert y Owne r Propert y close-ou t chec k lis t signe db y EP A 

## n Descriptio no f area s not meetin g RO D cleanu p criteri a Utilit y clearance s 5 Propert y inforraatio nfromDougla s Count y Assessor' s OfTic e 51
- Propert y acces s checklis t V Contac t Lo g3026048 6 I iiiii i Illl l I I 

### D 

### Superfun d Environmenta l Restoratio nSignatur eDat e
^PATOR

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

# fYpJ D PrcpertyAddress : P^J " l/rf/t- C st Date/Time : Owner' s Name : Jl^^rrj
- ^y dJKr y Quad s Excavated : T^LUP . D ^ Contracto r Grou n: Enviro'nmenta l Re?( o oratio n(ER ) E.xcavatio nGenera l Ye s N o I . If necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? u ^ 2 . Ifnecessary , were th e correc t area s ofdri p zon e excavate dan drestored ? ^ Gradin g So dan dVegetatio n Ye s N o 1 . Doe s th e gradin g aroun dth e perimete r ofth e hous e inexcavate darea s generall y slop e away fromth e house ? 2 . Ha s so dbeenlai di nall area s that wer e excavated ? 3 . Doe s th e so dappear to b e generall y health y an dgrowing ? (Onl y evaluat e if inspecte dat 30-da y tim e period) . 4 . Are sodde darea s generall y fir man devenl y graded ? 1 / 5 . Are thejoint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e ifinspecte dat 30-day tim e period) . 6 . Wa s th e property grade dsuc hthat wate r will no t poo l o nth e property ? </ ^ 7 . Wa s damag e to landscapin g or plan t material s avoided ? * ^ Gates , Fence s an dRetainin g Wall s Ye s N o I . D o gate s ope nan dclos e freely? (ifapplicahle ) i ^ 2 . Were ai l gate s o r fence s take ndovr adurin g restorationactivitie s re-installed ? (ifapplicahle ) >/ ^ 3 . Wa s damag e to gate s o r fence s avoided ? (ifapplicahle ) 1 / 4 . Wa s damag e to retainin g wall s avoided ? (i f applicable ) 

## jsl L Foundation , Sidin g an dGutter s Ye s N o 1 . Wa s damag e t o sidin g or tri mavoided ? • ^ 2 . Wa s damag e t o th e foundatio navoided ? • ^ 3 . Wa s damag e to window s avoided ? 1 ^ 4 . Was damag e to windo w screen s o r doo r screen s avoided ? ^ 5 . Wa s damag e to downspout s o r downspou t extension s avoided ? • - Sidewalk s an dDriveway s (Concrete ) 1 . Wa s damag e to drivewa y surface s avoided ? 2 . Wa s damag e t o walkwa y surface s avoided ? [nspectio nnotes : > 

# J Ye s ^
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### Remedia l an drestoratio nactivitie s coraplet e includin g 30-da y so dwarranty : EP ARepresentative:,.^^^^^,^;^.-YMt ^ 

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# EXECUTIVESUMMARY : 4123 2 242 5 VAN E S T X 

# N o Issue s o r Concern s [] ] Issues/Concern s IXMai l l;M7lan;iiinn :Pag e 1 of 2

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YOU RTICKE T NUMBE RI S 2608336 . Origina l Cal l Date : 10/04/1 0 Time : 6:3 4 p m Op : ADAM241 8 6 Wor k t o Begi n Date : 10/07/1 0 Time : 7:1 5 am State : N E County : DOUGLA S Place : OMAH A Address : 242 5 Street : VAN E S T Twp : 16 NRng : 13 E Sect-Qtr : 27-SW,28-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LANDSCAPIN G Locatio n o f Work : LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : ( 4 02)451-106 9 : 4123 2 Compan y ENVIRONMENTA L RESTORATIO N Contac t Nam e ADA M Phone : (402) 4 51-131 4 Alt . Contac t Phone : (636)288-961 6 Wor k Bein g Don e For : EP A Dept ho f Excavation : 2 4 i n Corne r Lot : NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V MAGELLAN ? MCINE B MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Utilit y Servic e Are a Contac t Phon e Numbe r Typ e Day : 402934046 9 CXCAT V CO XCOMMUNICATIONS , FN C HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 918574709 8 MAGELLA NMIDSTREA M MAGELLAN P DEBORA H Alt : PARTNER S LP Emerg : 918574709 8 Day : 800289342 7 N O CAL LPER MCfNEB MC I Alt : MEM O Emerg : 800289342 7 Day : 402504782 3 METROPOLITA NUTILITIE S MUDO l SAND Y Alt : DISTRIC T Emerg : 402504797 0

htt p ://www.dhon.org/irthinternet/DHONNoticeCreation/MessageText.asp?ret=<RE S ULTS.. . 10/4/201 0

### Pag e 2 of 2

OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE RRICH/TRAFFI C 

### Day : 402444719 7 Ah : 402444516 1 Emerg : 402444516 0
OPPDGPR 5 OMAH APUBLI C POWE RDISTRIC TELM LOCATIN G 

### Day : 406728934 3 Ah : 406207149 4 Emerg : 888728934 3 QLNN E1 C QWES TLOC ALNETWOR K EL M LOCATFNG 

### Day : 406728934 3 Ah : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 10/4/201 0Therm o Fishe r Scientifi c 90 0 Middlese. x Tumpik e 

# Therm o Billerica , M A 0182 1

SCIENTIFI C

SAI D ADDRK.S S .SAMPI. K AKKA OI'KK A IO RDKP l H ; iXOIK.S . 1 2010-09-2 9 13:40 4123 2 242 5 vane D Z RICH surfac e Is b2w(,Paulen268.4 7 ±51.9 1 2 2010-09-2 9 13:40 4123 2 242 5 vane D Z RICH surfac e lsb2w(Pauletl219.6 0 ±40.9 3 3 2010-09-2 9 13:3 9 4123 2 242 5 vane D Z RICH surfac e I s b2w(Paule n178.8 3 ±43.7 1 4 2010-09-2 9 13.3 8 4123 2 242 5 vane D Z RICH surfac e Is b2 w(Paulet t 122.0 7 ±36.5 7 5 2010-09-2 9 13:3 8 4123 2 242 5 vane D Z RICH surfac e lsb2w(Pauletl91.9 1 ±33.1 7 6 2010-09-2 9 13:3 7 4123 2 242 5 vane D Z RICH surfac e I s b2 w(Paulet i 57.62 ±29.9 5

09/30/1 0 07:57:4 6 Pag e I o f 1

### Pag e 1 of 2

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


### YOU RTICKE TNUMBE RI S 2595180 . Origina l Cal l Date ; 9/17/1 0 Time : 1:1 3 p m Op : ADAM241 8 6 Wor k t o Begi n Date : 9/21/1 0 Time : 1:4 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 242 5 Street : VAN E S T Twp : 16 NRng : 13 E Sect-Qtr : 27-SW,28-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LANDSCAPIN G Locatio n o f Work : LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : ( 4 02)451-106 9 

### i 41232 ^ Compan y: ENVIRONMENTA L RESTORATIO N Contac t Name : ADA M Phone : (402)451-131 4 Alt . Contact : Phone : (636)288-961 6 Wor k Bein g Don e For : EP A Dept h o f Excavation : 2 4 Corne r Lot : NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V MAGELLAN P MCINE B MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Utilit y Servic e Are a Contac t 

### Phon e Numbe r Typ e 

### Day : 402934046 9 CXCAT V CO XCOMMUNICATIONS , IN C HEID I 

### Ah : 402934046 9 Emerg : 402932975 7 Day : 918574709 8 MAGELLA NMIDSTREA M MAGELLAN P DEBORA H 

### Alt : PARTNER S LP 

### Emerg : 918574709 8 Day : 800289342 7 N O CAL LPE R MCINE B MC I 

### Alt : MEM O 

### Emerg : 800289342 7 Day : 402504782 3 METROPOLITA NUTILITIE S MUDOl 

### SAND Y Ah : DISTRIC T 

### Emerg : 402504797 0 http://www.dhon.org/irthinternet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/17/201 0

## Contac t Informatio n Lo g SAID # H\x.T» ^ 

# Ce Q G>S9 ' W ^ M \ •- L-XK-L.\?^^- | - 0,- 1 z. e Owner' s Name : ^^ ^ e.^^be.^ ^ Daytim e Phone : cVg> \- Cguyg , \ Propert y Address : ^.^z S Nfao e g,^ - 

### Attemp t t o contact Date/tim e Nam e

• ^C<J^,ii > -(orrvi. S 5^/rto / 

## ^•Or-| o 3'-^°r" ^ ^ 

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# Propert y Final Repor t SAID : yy^j, ^ PrcpertyAddress : Q-Vj ^ IAJA- C

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WOR K STARTE D WORKCOMPELTE D ON : ON : / // / 

### Owner : S Ur j l^.ijUrc , 1 Address : '' / — 7

Phone : CeST ' YYyS ~ Fax : Cell/Pager : Renter : Phone : Fax : Cell/Pager : Additiona l Information :

0 ^ Acces s Agreemen t 0 " Restoratio nAgreemen t \Z\Vide o Propert y Befor e
• Digita l Photo s Befor e 1 1 Vide o Propert y Afte r nDigita l Photo s Afte r 0 Propert y Completio nAgreemen t nFina l Repor t Signed : P / S>^// « Siened : P1 ^ f 1 <'t i O n:%_I1UIJ Q O n•.bllStli O O n•.JJ_ O n: / / Sianed : f'^ l 77 1 cSigned : / / By : By : By : By

= By : By : By : By : ( ^ fZ ^ S< ^ AP , N/ A
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EXECUTIV ESUMMAR Y

Omah a Lea d Projec t Wor k Pla n Pag e Io f 1 9

## Consen t fo rAcces s t o Propert y SAID # 4^/cP^ ^ RIGH TO FENTR Y T O PREMISE S 

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

Owner' s Nam e : S Urry '^ y ji}Ji.rc j \Daytim e Phone : Ce S f - f^7 S Address : 

# av^ s IAA ^ J-/ . 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 all soil s at th e property whic hare contaminate dwithhazardou s substances , i nparticular lea dat concentration s greate r thanor equal t o 40 0 part s pe r millio n(ppm) . REMEDLA LACTION 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 remedial activities ; b .Locatin g equipmen t an dmachinery on-sit e i npreparatio nfor an dinth e cours e ofth e environmental response ; c .

Plannin g an dimplementin g th e remova l actio no nor near Grantor' s property . d .Obtainin g sample s fromGrantor' s property ; AGREEMEN T NO T T O INTERFER E 

### Th e Granto r agree s no t t o interfere o r tampe r withany o f th e activitie s o r wor k

done , o r th e equipmen t use dt o performth e activities , o r t o undertak e any 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 ofth e Grantee s o r th e environment , o r

t o allo w other s to us e th e property i nsuc h Igran t acces s to m y propertie s C U1 d o not gran t acces s t o m y propertie s ^


### Signatur e ^ A Dat e / d Signatur e Dat e

### Additional Comment s / Instructions :

•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
. 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 fhouse , includin g foundatio n crack s o rfissures
.

I agre e I d o no t agre e I 1 1 agre e nI do not agre e 

# J)\h^.Sr>i D Dat e Contractor' s Signatur e Dat e

## 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 property prio r to contracto r activities . Thi s wil l ais o serv e a s documentatio nfor th e purpos e o f assurin g that 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 Environmental Protectio nAgenc y (EPA) .



## SAID : //pj- ^ PrcpertyAddress : ^^JlS ' \Yan ^ ^JV " 

## Ow"^"" : Slurr y l^ydL<r 9 Phone : O nth e attache ddiagram(s ) indicat e area(s ) t o b e excavate dan ddept ho 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 use dby contractor , an dth e directio nofNorth . Indicate distances , depths , material types , etc . hidicat e digital photo s b y referencin g th e photo-lo g numbe r 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 :

Item : 

# "/iM-fc ^ 2£>or«=ic c 

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## ^'<^lL<.x J i^< ^ 

# /^ U v/ ^ -pL , '^x P Item : Item : Item : Item : Item :

Pag e 1 o f2

### Additiona l Comment s / Instructions :

I agre e nI d o no t agre e C UI agre e C UI d o no t agre e ^ 

# ^1/ )

Owner' s Signatur e Contractor' s Signatur e Dat e Attachmen t

Pag e 2 o f2

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio no f remedial activitie s performe donm y property . M y signatur e wil l designat e that I a msatisfie dwit hth e restoratio no f m y property , an dthat n o item s ar e i n question , now , o r at any tim e i nth e future , excep t thos e item s liste dbelow , if any . SAID : 

## VY^3 D Propert yAddress : ^yj) ^

P^/I C -T/ - Owner : J^l^rr/(L^J ^ ^ Phone : 

## /y<^'r-yV7J
Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item :
inuuiiiCMa i \.rOmSiiSiiIS
.

Tr4j l agre e restoratio n i s completed , excep t a s note d l\ 1 I agre e restoratio n i s completed , excep t a s note d I I I d o no t agre e restoratio n i s complete d I I I d o no t agre e restoratio n i s complete d 

# lo-^l^^ic > Owner' s Signatur e Dat e Contractor' s Signatur e Dat ej-.'uuyia av-.^vjuiiij ' rA.v.,v^uuu i iiiiwiiiiainji i rag e 1 U l J Dougla s County , Nebrask a Propert yRecor d - R174843000 0 Prin t Repor t Vie wInteractiv e GI S Ma p Informatio n i s vali d a s o f2010-8-1 6 Treasurer' s Ta xRepor t Ne wFeatur e - > -4 ^

- > Subdivisio n Sale s Searc h Owne r RYDBER G SHERR YK 242 5 VAN E S T OMAH AN E 68112-000 0 Propert yInformatio n Ke yNumber : 484 3 000 0 1 7 Accoun t Type : Residentia l Parce l Number : 174843000 0 Parce l Address : Lega l Description : 242 5 VAN E S T OMAH AN E 68112-000 0 MINN E LUS ALO T2 4 BLOC K2 4 4 X 11 5 Valu e Informatio n 201 0 200 9 200 8 200 7 200 6 200 5 Lan d $4,400.0 0 $4,400.0 0 $4,400.0 0 $4,400.0 0 $4,400.0 0 $4,400.0 0 Improvemen t $64,400.0 0 $64,400.0 0 $64,400.0 0 $68,200.0 0 $68,200.0 0 $68,200.0 0 Tota l $68,800.0 0 $68,800.0 0 $68,800.0 0 $72,600.0 0 $72,600.0 0 $72,600.0 0 Sale s Informatio n Sale s Date : 1990-08-3 0 Dee d Type : Price : Grantor : D $34,250.0 0 Book : 188 6 Page : 06 8

Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n T Acre s S F Unit s Dept h Widt h Vacan t 0.1 1 5060. 0 1. 0 115. 0 44. 0 N o Improvemen t Informatio n


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

HVAC : Centra l Ai rt o Ai r Rooms : 6. 0 Exterior : Fram e Stucc o Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo fCover : | Compositio n Shingl e Bedrooms : 3. 0

Roo fType : j Hi p Stories : \ 2. 0 Floorcover : I 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 192 3 0 0 % 192 3 8 5 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 638. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 320. 0 Porc h Enc l Scree n 91. 0 Porc h Sla b Roo fCeilin g 24. 0 Porc h Sla b w/Step s 35. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl7. . . 8/20/201 0

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## SIT E RESTORATIO N

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