## TRANSMITTA Lo f

OMAHA LEAD SIT E SOI LREMEDIATIO N FIL EFOLDE R SAID# : VAD<5"D' ^ 

### Date : Address : '^^^' ^ T.-W ^ ^ / Remediatio n Contractor : _Envrionmenta l Restoration , LLC

_Year : _2010_ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S D 

### Vide o o f property (DVD ) JSBefor e DAfte r D Basement ^ A o JzO^C/UST ^ t > Executiv e Summary (Final Report ) 1 3 EPA-provide dproperty sketc h a > Signe dAcces s Agreemen t fo r subjec t propert y D Signe dAcces s Agreement(s ) fo r adjacen t propert y aRestoratio nAgreemen t D Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) ^ Confirmatio ndat a

D Photograph s _ ^ Befor e DCre w Photo s •*Durin g Excavatio n D So d D 30-da y So dD ^ As-bui hsketc h

^ Completio nAgreemen t signe db y Propert y Owne r ^ Propert y close-ou t chec k lis t signe db y EP A D Descriptio no f area s no t meetin g RO D cleanu p criteri a ^ Utilit y clearance s

S . Propert y informatio nfro mDougla s Count y Assessor' s Offic e ^ Propert y acces s checklis t 3023792 3 ^ S Contac t Lo g liiiiiiiilii i g Superfun d Environmenta l Restoratio n Signatur e Dat e 

## S'27-l i • ^EPAC J at e

# ^EP A EP A Propert y Clos e Ou t Form Omah aLea dSit e Propert y #: _ 

## «Aogo ^ Propert y Address : 

# M . Date/Time : Owner' s Nam e Quad s Excavated : % { Contracto r Grou p : Environmenta l Restoratio n (ER ) Excavatio n Genera l Ye s N o 1 . Ifnecessary , wer e the correct quadrant(s ) excavatedan drestored ? y 2 . Ifnecessary , wer e the correct area s ofdri p zon e excavatedan drestored ? y Gradin g Sodan dVegetatio n Ye s N o i . Does the grading aroun dthe perimete r ofth e hous e i n excavatedarea s generally slope awa y fromthe house ? 2 . Ha s sodbee n laidi n all area s tha t wer e excavated ? 

# r U k 3 . Does th e so dappea r to b e generall y health y an dgrowing ? (Onl y evaluat e ifinspecte da t 30-da y time period) . ^ ___^_ ^ 

## Ai^ 4 . Are^edds darea s generall y fir man devenl y graded ? A/L 5 . Ar e thejoint s betwee n the sodstrip s generall y tight ? (Onl y evaltiat e ifinspecte da t 30-da y tim e period) . J ^ 6 . Wa s the propert y gradedsuc htha t wate r wil l no t pool o n the property ? 7 . Wa s damage t o landscaping o r plan t material s avoided ? y Gates , Fence s an dRetainin g Wall s Ye s N o 1 . Do gate s ope n an dclos e freely? (ifapplicahle ) 2 . Wer e all gate s o r fence s take n dow n during restoration activitie s re-installed ? (i f applicable ) 3 . Wa s damage to gate s or fence s avoided ? (ifapplicahle ) 

# t k 4 . Wa s damage to retaining wall s avoided ? (ifapplicahle ) Foundation , Sidin g an dGutter s Ye s No 1 . Wa s damag e to siding or tri mavoided ?

.y 2 . Wa s damag e t o the foundatio n avoided ? u ^ 3 . Wa s damage to window s avoided ? c ^ 4 . Wa s damage to window screen s or door screen s avoided ? ^ 5 . Wa s damage to downspouts o r downspou t extension s avoided ? \ y Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Wa s damage t o drivewa y sur&ce s avoided ? 2 . Wa s damag e t o walkwa 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 Representative : .^f^^.^ ^ /TT ^ ^)sJ^^;gc<-jJ4z:^= ^ Date : ^ji'^U O

## i\^ r '* Omah a Lea d Site—EP-R7-09-0 5 s ^^^ ^

8 Environmenta l Restoration , LL C ^yTy f wnww.effle.eo m 

# EXECUTIV ESUMMARY : 4050 5 - 257 7 TITU S A V 

# No Issue s o r Concent s [ ^ Issues/Concern s Detai l Expianation :I 

## Contac t Informatio n Lo g SAID # ^SO S Owner' s Name ; fig- M /y- ^ .Sv^{. [ \Daytim e Phone: ( (^C^jZ/S'S
- 7CAf Y I Propert y Address ; ^S7 ^ ^TT4u ^ Av C 

# :^ n Attemp t t o contac t Date/tim e Nam e 

## (^ct^jhi&kd- ^ 

# ^'3/-/ 6 a^ ^ 

# 4 i

)

'

## Propert yAcces s Checklis t SAID : ^OSO S n WOR K STARTED ON ; / / Propert y Address : ^>S 7 7'Tv4c> 5 h'^X
- D WORKCOMPELTE D ON : / / Owne n Q^^^:^. ^ ^r ^ Renter ; Address : Phone : 50t'vv< _ Fax ; Cell/Pager : Phone ; (c/o^]c^sS
- yu ~W Additiona l Information : Fax : Cell/Pager :

^ Acces s Agreemen t Signed:/^ / (I/O ? By:;^^ / I2 J Restoratio n Agreemen t Signed ; 17 / I-p/o ? 

## By: 

## 1^/ 7 0^Vide o Propert y Before O n ; S f / 7 A/ v o By : Ci ^ H^Digita l Photo s Befor e O n ; S /2Jto/\ o By = Af e n Vide o Propert y Afte r O n : / / By : D Digita l Photo s Afte r O n : / / By : 1 ^ Propert y Completio n Agreement Signed : ^ 1 H 1 t O By : ^ n Fina l Repor t Signed : / / 

### By : 1 Additiona l Video o r Digita l Photo' s Taken : n Vide o n Digita l Phot o O n : / / Bv : Reason ; n Vide o n Dieita l Phot o O n : / / Bv ; Reason ; n Vide o n Dieita l Phot o O n ; / / Bv : Reason ; n Vide o n Dieita l Phot o O n : / / Bv : Reason :

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

## Consen t fo rAcces s t o Propert ySAID # ^f75o 5 RIGH T O FENTR Y T O PREMISE S 

### Granto r (th e propert y owner) , consent s t o andauthorize s th e Unite dState s Environmenta l Protectio n Agency (USEPA) o r

it s authorize drepresentatives , collectively th e Grante e t o ente r an dperformcertain enviroiunenta l respons e activitie s upon th e followui g describe dpremises ; I Owner' s Name : Cp^a\d i t A<

_^ ^vc - H Daytime Phonej^;t ) ¥SS'
- "yC e 7 ¥ Addr« » ^^^^ , TVATJ S A^>-< _ Address ; 1 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 a t th e propert y whic har e contaminate dwit hhazardou s substances , in particula r

lea da t concentration s greater than.or eqtia l t o 40 0 part s per millio n (ppm) . REMEDIALACTION S Th e enviromnental respons e action s t o b e performedo n saidpropert y ma y includ e the following activities : a .Taking photograph s and/or video o f th e propert y before , during , an dafte r

remedia l activities ; b .Locatin g equipmen t andmachiner y on-site i n preparatio n fo r

an di n th e cours e ofth e environmenta l response ; c .Planning an dimplementing th e remova l actio n o n or nea r

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 to interfer e or tampe r

wit han y o f th e activitie s or wor k

done , or th e equipmen t use dt o perfonn th e activities , o r

t o undertak e an y action s regardin g th e us e o f said property whic hwoiddten dto endange r

th e healt hor 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 y msuc h r~

l I gran t acces s t o m y propertie sQ I d o no t gran t acces s to m y propertie s 

# lld27L0 9 Signatur e Dat e

### Additional Comment s / Instructions :

^Chec k thi s bo xi f owne rdoe s no t wan t E.R . t o ente rth e residents 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 not responsibl e fo ran ydamag e don e t o th e interio ro f house , includin g foundatio n crack s o rfissures .

Kt l I agre e D I d o no t agre e F l I agre e H I I d o not agre e 

# //-//-^ f Contractor' s Signatur e Dat e

## Restoratio n Agreemen t Th e purpos e of thi s agreemen t i s t o provide amutua l agreemen t a s t o condition s o f propert y prior t o contracto r activities . Thi s will als o serv e a s documentation fo r th e purpos e o f assurin g tha t restoratio n activitie s ar e completedt o the satisfactio n o f th e propert y owne r andth e Unite dState s Environmenta l Protectio n Agency (EPA) .

SAID : ypSo S 

### PrcpertyAddress ; QS7 7 Tl-h i /4t ^ Phone : 

# ^ J 

# Vss - yc ^ O n th e attache ddiagFam(s) indicat e area(s ) to b e excavatedan ddeptf aof excavation , locatio n of all know n utilities , subsurface features , sur&ce structure s an dlandscapm g features , acces s location(s ) t o b e usedb y contractor , an dthe direction ofNorth . Indicat e distances , depths , materia l types , etc . Indicat e digita l photo s b y referencin g the photo-lo g numbe r wit ha n arrow indicating direction o f view . Kem s t o b e remove d b yContracto ran d no t replaced :

Item : 3c . oi l 

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_* .rJ'4r h Item : JcV< _ 

## ^ y ^ 

## 7^ ^ 3 ttem: f4-o.rvv^f>^^.v<&( ~ L^) i , ( T-cr-v^-kx ^ 

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## s 

# ^y ^ pt<^yvk ^ Item : Item : Item : Item :

Pag e 1 o f 2Additiona l Comment s / Instructions :



# jS i agre e • I d o not agre e • I agre e • I d o no t agre e

Owner' s Signatur e 

# /JTZiA f Contractor' s Signatur e Dat e 

### Attachment s

Pag e 2 o f 2* "—f l - J ' -"• a—• • - -"W
- - Thi s agreemen t document s th e completio n o f remedia l activitie s performe do n m y property . My signatur e wil l designat e tha t I a msatisfie dwit hth e restoratio n o f my property , an dtha t n o item s ar e in question , now , o r a t an y tim e i n th e future , excep t thos e Item s Uste dbelow , i f any . 

## J/osos i Propert y Address : OS l 7 'TA^A/ S Owner : 

# m A\ ^ ?-C«-'i»-^ g f<^' ^ 

# 5.vd t Phone : RgsSofsOo n item s I n QusstJcrs : 

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Ksm : Sliem :

Ai^tSltEcna ? G«-rT:tv;5irii:3 :

J0 1 £gr& 3 restcr£.£io aE S cE-mjateied, except s s n-ate J r > SsgrssrestarsitionIsztx^^Vd.z.i,esc'sp-tasscts d I 1 1 do Kct £gi-£- 3 r=:tor£tIo- 3 i s CQi^jpfetc d 

# A2£S7'77/J-/^ _ FI0+
­ Conti-acter' s Stsaataf s

### Dougla s Coimt y Accoun t Information Pag e 1 of2 Dougia s County , Nebrask a Propert yRecor d - R175069000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-S O f t wes t o f 52n d S t - VJe W O n Ma p Informatio n i s vali d a s o f 2009-12- 1 Treasurer' s Ta xRepor t Ne wFeatur e -•-•- > Aut o Sale s Searc h Owne r SNEL L GERALDIN E D ETA L 257 7 TITU S AV E OMAHAN E 68112-000 0 Propert yInformatio n Ke yNumber : 506 9 OOO O 1 7 Accoun t Type ; Residentia l Parce l Number : 175069000 0 Parce l Address : 257 7 TITU S A V OMAHAN E 68112-000 0 Lega l Description : MINN E LUS ALO T7 BLOC K1 2 4 4 X 12 0 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $ 5,900.0 0 $ 66,900.0 0 $ 72,800.0 0 200 8 $ 5,900.0 0 $ 66,900.0 0 $ 72,800.0 0 200 7 $ 5,900.0 0 $ 57,400.0 0 $ 63,300.0 0 200 6 $ 5,900.0 0 $ 57,400.0 0 $ 63,300.0 0 200 5 $ 5,900.0 0 $ 57,400.0 0 $ 63,300.0 0 200 4 $ 5,900.0 0 $ 42,900.0 0 $ 48,800.0 0 Sale s Informatio n Sale s Date : 2004-11-1 5 Dee d Type : Q C Book : 200 4 Page : 14934 4 Price : $0.0 0 Granto r Gar yD Snel l Grantee : Geraldin e D Snel l Valid/Invalid : Invali d Exclusio n Reason : Famil ySal e Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 2 5280. 0 1. 0 120. 0 44. 0 N o Improvemen t Informatio n 

### http://dougIasne.mapping-online.com/DouglasCoNe/static/accountrnfo.jsp?accountno=Rl.. . 12/16/200 9

### Dougla s Count y Accoun t Informatio n
Buildin g 1

CLICKXO_ENLARG E IMAG E Squar e Footage : i 1261. 0 Perimete ri 0. 0 Uni t Type :

Buil t As : 1 1/ 2 Stor yFi n HVAC : Centra l Ai rt o Ai r Exterior : Fram e Aluminu m Interior : Drywal l Roo f Cover : Compositio n Shingl e

Roo f Type : Gabl e Floorcover : Allowanc e Yea rBuil t Yea r Remodele d Percen t Remodele d 192 4 0 % Detai l Typ e Detai l Descriptio n Applianc e Allowanc e Applianc e Fireplac e Masonr y Basemen t Bsmn t Bloc k 8 f t Fixtur e Bas e Fixture s Fixtur e Batt i Ful l Garag e Detactie d Porc h Enc l Soli d Wal l Use r Atti cFul l Finis h 

### Pag e 2 o f 2

25T 7 T*u l Av * 1 I C Stor yF m '•'^sra ^

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CLIC KT O ENLARG E IMAG E Percen t Complete : 100.0 % Quality : Averag e Condition : Averag e Cond o Squar e Footage : 0. 0 Rooms : 6. 0

Units : 1. 0 Baths : 1. 0 Bedrooms : 3. 0 Stories : 1. 5 Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Adjuste d Yea r Physica l Ag e Buil t 192 4 8 6 Unit s 1. 0 1. 0 901. 0 1. 0 1. 0 320. 0 128. 0 320. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.js p ?accountno=Rl.. . 12/16/200 9

### Fre e Peopl e Searc h| WhitePage s Pag e 1 o f 1 

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## Geraldin e D Snel l I s thi s you ? Edi t 257 7 Titu s Av e Omaha , N E 68112-322 7 

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### http://www.whitepages.com/search/FindPerson?firstname_begins_with=l&flrstname=ger. . . 12/17/200 9

### ENVIRONMENTA L ^ AS-BUIL TDRAWIN G •DMAH ALEA D SUPERFUN D SIT E RESTORATIO N 4050 5

LESEN S Quadran i excavate d Dfi p Zor> e Excavate d C<>ntannif»atio n Lef t Bohin d 

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

## 4050 5 Exterio rPain t Nort h Arrcv / Omah a Lea d Sit e • Goo d Sit e Sketc h Q^Poo r Samplin g Address : 2577 TiTU S A V 

# J Q No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : P g • C-d - £-K - RYASCPXA-4050 5 F 1 pp m 

### D Date : S-2ti?-Q « RYBSCPXA-4050 5 F 2 I 5 Z pp m 

### D Time : IQ : 1* ^

f\-t^ - RYCSCPXA-4050 5 8 1 ii2ie_pp m 

# n Sample s Analyze d RYDSCPXA-4050 5 8 2 fi_Lppm 

# n 

# t RDZSCPXA-4050 5 D Z IZH I pp m 

### D XR F Unit : CoS^ O Book : 22J Q Rczscpyu^i 'tosos—sz ­ ~ pp m 

# n Date : Ip-Ql'Q B RPZSCPXA-4050 5 P Z Z3 S pp m 

# \ y n Tim e 

### lca . Staff : Numbe ro f Sample s = IGJ | Q | 

# ^^u ; Legend : F l = Fron t Leff , F 2 = Fron t Right , 8 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla ; Al l quadrant s ar e a s viewe d fro m th e street , facin g propert y

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Inilc. v 1 Ini c AV I \:H.-\(.: K ADDKK.S S SA.MI'IJ ; AKI'. A pi'KKA l ou DKI' I I I N O IK S SAI D I'll 1 2010.09.0 9 13.1 6 Avg o f 2388-2391257 7 titu s a v D Z jimm y 6 final clearanc e 97.5 8 ± 17.9 5 2 2010.09.0 9 13:1 6 257 7 titu s a v D Z jimm y 6 final clearenc e 4050 5 103.0 8 ± 18.2 4 3 2010.09.0 9 13:1 5 257 7 titu s a v D Z jimm y 6 final clearanc e 4050 5 9 3 7 4 ± 17.7 7 4 2010.09.0 9 13.1 4 257 7 titu s a v DZ jimm y 6 final clearanc e 4050 5 95.9 1 ± 17.8 5 5 2010-09.0 9 13:1 3 Avg . of2384-238 ( 257 7 titu s o v B l jimm y 4 final clearanc e 12 2 5 4 ± 18.3 0 6 2010-09.0 9 1 3 1 3 257 7 titu s a v B l jimm y 4 final clearanc e 4050 5 119.7 2 ± 18.20 7 2010-09-0 9 1 3 1 2 257 7 titu s a v B l jimm y 4 final clearanc e 4050 5 12 4 7 8 ± 1 8 44 g 2010-09-0 9 13:1 2 257 7 titu s a v B l jimm y 4 final clearanc e 4050 5 123.1 2 ± 1 8 27

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