### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID# : 542 3 Date : Address : 120 9 S 1 0 St . Remediatio nContractor : Environmenta l Restoration , LL C Year : 201 0 

# X D 

# X 

# X SOI LREMEDL^TIO N

PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f propert y (DVD ) J35efor e D After D Basemen t

D Executiv e Summary (Fina l Report ) EPA-provide dpropert y sketc h Signe dAcces s Agreemen t for subjec t propert y Signe dAcces s Agreement(s ) for adjacen t propert y Restoratio nAgreemen t Settlement

document s (i.e. , for

damag e o r

t o replac e plants , etc. ) Confirmatio ndat a J^ T Photograph s ja^efor e DCre w Photo s H^urin g Excavatio nD So d

^r5b-da y So dD As-buil t sketc h Completio nAgreemen t

signe db y Property Owne r Property close-ou t

chec k lis t signe db y EP A Descriptio no f

area s not meetin g RO D cleanu p criteria . Contaminatio nlef t behin d Utility clearance s Property informatio nfromDougla s County Assessor' s Offic e Property acces s checklis t Contac t Lo g 3026232 9



### fenvironniental Restoratio nSignatur e

* A CO Rsi^iatur e Dat e Dat e

# #EPA EP A Propert y Clos e Ou t For m Omah aLea dSit e Propert y # : 542 3 Date/Time : Quad s Excavated : F 2 Excavatio nGeneral Propert y Address : 120 9 S 1 0 St . Owner' s Name : Nanc y Calinge r Contracto r

Group : Environmenta l Restoratio n (ER ) ^JACAM T Lo t Ye s No 1 . I f necessary , wer

e the correct

quadrant(s ) excavatedandrestored ? v ^ 2 . I f necessary , wer

e th e correct area s of drip zone excavatedan

drestored ? 

## /Vi

o "Pg r kJj ^ Gradin g Sodan dVegetatio n house ? 2 . Has sodbee

nlaidi nall area s tha

t wer e excavated ? 3 . Doe s the sodappea

r to be generall

y health y an dgrowing ? (Onl

y evaluat e i f inspecteda

t 30-da y tim e period) . 4 . Ar e soddedarea s generall

y firmandevenl

y graded ? 5 . Ar e the joint s betwee

nthe sodstrip s generall

y tight ? (Onl

y evaluat e if inspecteda

t 30-da y tim e period) . 6 . Wa s the propert

y gradedsuc

htha t wate r will not poo l o nthe property ? 7 . Wa s damage to landscaping or

plan t material s avoided ? Ye s w ^ i ^

w ^ \. ^ t ^ No

Gates , Fence s an dRetainin g Wail s Ye s No 

# U l 1 . Do gate s ope

nan dclos e freely? (i f

applicable )


# - m 2 . Wer e all gate s or

fence s takendow

nduring restorationactivitie s re-installed ? (i f applicable ) 3 . Was damage t o gate s o

r fence s avoided ? (i f

applicable ) 1 ^ 4 . Was damage to retaining wall s avoided ? (if applicable ) 

## AJ i Foundation , Sidin g an dGutter s Ye s N o 1 . Wa s damage t o siding o

r tri mavoided ? 

# \fd^M: f lof 2 . Wa s damage t o the foundatio

navoided ? 3 . Was damage to window s avoided ? # 4 . Wa s damage to windo

w screen s or

doo r screen s avoided ? 5 . Was damage t o downspouts or downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ye s No 1 . Was damage t o drivewa

y surfece s avoided ? T7 ^ 2 . Was damage t o walkwa

y surfece s avoided ? Inspectio nnotes: , / i

Remedia l an drestoratio n activitie s complet e includin g 30-da y so dwarranty : EP A Representative ; yf ^



## 2^^J7^7&J^^^.UL ^ Date : / O Z^j i 2£>t (OMAH ALEA D SITE —EP-R7-09-0 5 ENVIRONMENTA L RESTORATION , LL C WWW.ERLLC.CO M



# . Q <


## EXECUTIV E SUMMAR Y 542 3 

### 120 9 S 1 0 S T



## N O ISSUE S O R CONCERN S ISSUES/CONCERN S DETAI L EXPLANATION :

### IRT

H On e Call Pag e 1 of 2
Ticke t Informatio n fo rTicke t 287602 8 BelowI s Th e Ticke t Tex t Followe d B yALis t Of Member

s Affecte d 

# jxt h Printe rFriendl yVersio n Origina l Cal l Date : 10/13/1 1 Wor k t o Begi n Date : 10/17/1 1 Time : 10:0 4 am Time : 10:1 5 am State : N E Address : 120 9 Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C County : DOUGLA S Street : S lOT H S T Sect-Qtr : 27-N E Sect-Qtr : Op : TIM2418 6 Place : OMAHA

Typ e o f Work : LEAD REMOVA L Locatio n o f Work : LOCAT E ENTIR E VACAN T LO T Remarks : FA

X AL L CLEAR S TO : (402)451-106 9 : 542 3 Company: ENVIRONMENTA L RESTORATIO N Contac t Name : TI M SUTTO N Alt . Contact : CEL L Wor k Bein g Don e For : EP A Dept h o f Excavation : 2 4 INCHE S Corne r Lot : N Involve s Tunnelin g o r Horizonta l Borin g : N COXCATV LEVEL 3 MCINE B MUD0 2 Phone : (402)451-131 4 x226 7 Phone : (402)306-234 7 Front : NRear : N Explosives : N OMAHACO F 0PPDGPR 6 QLNNEI F Servic e Are a Cod e 1COXCAT

V

LEVEL 3 MCINE B MUD0 2 OMAHACO F

0PPDGPR 6 QLNNEI F Servic e Are a Nam e

COX COMMUNICATION S IN C

LEVEL 3 COMMUNICATIONS , LLC MC I METROPOLITA N UTILITIE S DISTRIC T CIT YO F OMAHA TRAFFICSEWE R OMAH APUBLI C POWE R DISIRIC T QWES TLOCA L NETWOR K Contac t ELMCOX ELMCO X

LEVEL 3 LEVEL 3 MCINE B MCINE B SAND YMUD0 2 RICH/TRAFFI C OMAH A

CONSOLIDATE D CONSOLIDATE D EL M QLNNEI F Phon e Number s Day : (406 ) 72 8 - 934 3 Alt : (406 ) 32 7 - 293 6 Emerg : (888)728-934 3 Day : (877 ) 36 6 - 834 4 Emerg : (877 ) 36 6 - 834 4 Day : (800 ) 28 9 - 342 7 Emerg : (800 ) 28 9 - 342 7 Day : (402 ) 50 4 - 782 3 Emerg : (402 ) 50 4 - 797 0 Day : (402 ) 44 4 - 719 7 Alt : (402 ) 44 4 - 516 1 Emerg : (402)444-516 0 Day : (800 ) 57 5 - 558 7 Emerg : (800 ) 57 5 - 558 7 Day : (406 ) 72 8 - 934 3 Alt : (406 ) 20 7 - 149 4 Utilit y Typ e



### http://www.dhon.org//IRTHOneCall/TicketA^iewTicket.aspx?ticketID=86107 6 1/4/201 2

## Contac t Informatio n Lo g 

## SAID# 5H^ 3

Owner' : ' s Name : ^d/lc V Q Uj PC \Daytime Phone : [L/^ ^ ^^ 1 P ' ^^ Q Propert yAddress : /<^0* 7 Ji^ - 

## / O ^ JJ Attemp t t o contac t

._ _ 

### Date/tim e Nam e

## Propert yAcces s Checklis t

SAID : ^^^ 3 Propert y Address : ld<> J S . /O ^ sf . D WOR K STARTE D ON : D WOR K

COMPELTE D ON : _ / l _ I I Owner ; g- r Renter : Address : Phone : (^pp . ) S^S ' ' J^PCe f Fax : Phone : Fax : Cell/Pager : Cell/Pager : Additiona l Information :

1 2 Acces s Agreemen t [ B Restoratio nAgreemen t EVide o Propert y Befor e 1 ^ Digita l Photo s Befor e • Vide o Propert y Afte r nDigita l Photo s Afte r ^ Propert y Completio nAgreemen t d j Fina l Repor t Signed : ? A ^ / ' / Signed : 7 /«^-' /

' ^ 

## O n:3_/^'^/i L O n: ^ I^Hl M O n: /

/ O n: /

/ Signed : I'^ l 3^ 1 W Signed : /

/ By : ^ 0

By : pj i By : iC O By:ie ^ By : By : By : fi > By : Additiona l Vide o o r

Digita l Photo' s Taken : D Vide o D Digita l Phot o Reason : nVide o nDigita l Phot o Reason : nVide o nDigita l Phot o O n O n O n : /

/
: / /
: / / By :

By : By : Reason : nVide o n Digita l Phot o Reason : O n : / / By : /

## Consen t fo rAcces s t o Propert ySAID # S^- 3

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 dperformcertai nenvironmenta l respons e activitie s upo nth e followin g describe dpremises : Owner' s Nam

e 

# ~ R OAC y ^cJi(A^-^ r

Daytim

e Phone : /Y'^^)S>7 ^ -^C g

Addresse s o f

Propertie s covere db y thi s Agreement : Address : 

# /^ 7 ^ - 

# f d ^^ f Address : Address : Address : Address : 

# 1 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 property whic har e contaminate dwithhazardou s substances , i nparticular leada t concentration s greate r

tha no r equal t o 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 dproperty ma y 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 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 near Grantor' s property . 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 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 perfor

mth 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 o f

th e Grantee s o r

th e environment , o r t o allo w other s t o us e th e property insuc h O^gra i I gran t acces s t o m

y propertie s Q I do no t gran t acces s t o m

y propertie s Signatur e / J Da

> 

# .JJL&S'/ L

Signatur e Dat eChec k thi s boxi 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 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 f house , includin g foundatio n crack s o rfissures .

I agre e I 1 1 d o no t agre e '^0 1 agre e I 1 1 d o no t agre e 

### A / f ^ H Of : ^y

j 

### Pt^ ' Owner' s Signatur e Dat e Contractor' s Signatur e /^--^<--< ^ Date

## 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

t o contracto r

activities . Thi s wil l als o serv e a s documentatio nfor 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 property owne r

an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA) . SAID : ^ya_ 7 Property Address : /9~O j ^ ft> ^ M - 

### Owner : ^1(^0 /

O^imJt T Phone : (t/ o qj ) (^"^ ^ J^< ^ f O nth e attache ddiagram(s ) indicate area(s ) t o b e excavate dan ddept ho f excavation , locatio no f

al l know n utilities , subsurfac e features , surfac e structure s an dlandscapin g features , acces s location(s ) t o b e use db y contractor , an dth e directio no f North . Indicate distances , depths , material types , etc . Indicate digital photo s b y referencin g th e photo-lo g number 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 : Item : ' ^ ' ^ 

### t-»f-r^ « a d S Item : Item : Item : Item : Item :

Pag e 1 o f 2

### H I agre e nI d o no t agre e pT l agre e Q I d o no t agre e

^^^^ ^ -^ - 'sSigfia i 

# /A ^ CnjC .

'^^it^Oy ^ >wner' s Signature Attachmen t Da U Contractor' s SigHiur e Dat e

Pag e 2 of 2

## Propert yCompletio n Agreemen t

Thi s agreemen t

document s th e completio no f remedia l activitie s performe do nm y property . My 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 in 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 Property Address : /^ j ^ /gti . ^/ . Owner : ^( ^ g ^ ^J ^

^ 

### inp ^ 

## I Phon^y>^ 3 ^s r-^ s - ^^L P J Restoratio n Item s i n Question : Item : Item : item : Item : Item : item : Additiona l Comments :

I IWagre 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 l^f l agre e restoratio n i s completed , excep t as note d I I I d o no t agre e restoratio n i s complete d



## /^-^f/ / Contractor' s Signa l Date

### Dougla s Count

y Accoun t InfojaMitio

n Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d Informatio n i s vali d a s o f 2011-8-1 2 - R032293000 0 Prin t Repor t Vie wInteractiv e GI S Ma p Treasurer' s Ta xRepor t Ne wFeatur e - > - ^

« 4 Subdivisio n Sale s Searc h Owne r CALINGE R NANC Y 121 5 S 1 0 S T OMAH AN E 68108-000 0 Propert yInformatio n Ke yNumber : Accoun t Type : Parce l Number : Parce l Address : Lega l Description : 229 3 000 0 0 3

Residentia l 032293000 0 120 9 S 1 0 S T OMAH AN E 68108-000 0 CITYLOT S LO T4 BLOC K26 2 S 6 6 FTLT S 3 6 6 X 132 Valu e Informatio n 201 1 201 0 200 9 200 8 200 7 200 6 Lan d $2,200.0 0 $2,200.0 0 $2,200.0 0 $2,200.0 0 $2,200.0 0 $2,200.0 0 Improvemen t $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 Tota l $2,200.0 0 $2,200.0 0 $2,200.0 0 $2,200.0 0 $2,200.0 0 $2,200.0 0 Lan d Informatio n Acre s

- 0.2 3 S F 10032. 0 Unit s 0. 0 Dept h 152. 0 - Widt h

66. 0 Vacan t

- Ye s

lnttn-//Hr»iialn<:nf » mannino.nnlin p f'.nm/Dniiain<;r'n'Mp/«:tatir./nr.mnntinff S i.<;n9ap,cniintnn=Rn' ^ " 8/17/90 1 1

### Dougla s County Accoun t InfojBatio n )m^ i 

### Pag e 2 of 2 

# i:-^ -

Th e abov e ma p i s powere d byGoogle , an d i s intende d t o provid e a genera l ide a o f a property' s location . I f yo u requir e a mor e exac t propert ylocation , yo u ma yus e th e Interactiv e GI S Map s tha t ar e maintaine d b you r office .

httn://dou&la.sne.manning-nnline.cnm/r)nnplasCnNe/static/accnimtinfn.i.«;n?accnnntnn=RO' ^ 8/17/90 1 1ENVIRONMENTA L

RESTORATIO N

Samplin s Address : /S0 3 < 3 /C ' iS f Sampl a Numbe r RYASCPXA - .5V<? 3 F" ! RYBSCPXA - S'ifZ S F 2 RYCSCPXA - SfS S B 1 RYDSCPXA - if*fS 3 B 2 Lea < Concent i itio n tt\£ . l^U L RDZGOPKA - -e z

-6Z RPZSCPX A -pa Numb e Logend : F l - Fron t Left . F 2 " Fron t Right . E 1

SAID * 542 3 DAT E EXCAVATE D 10-18-1 1 DAT E EP ASIGNE D OF F 10-27-1 1 ARE ASODDE D 2S1 0 S Q F T AS-BUIL TDRAWIN G OMAH ALEA D SUPERFUN D SIT E Contract * EP-R7-09-0 5 

## ^7X-:^-^^ \ Omah a Lea d Sit e Sit e Sketc h Extefio rRam i • Coo d f^Poo r n Not pain t 

## SHS ^ ^4ortt 1 Arro w

iffi _ pp m pp m pp m pp m pp m pp m pp m Sampl e Collecte d 

## o r o r • a • LA B 

## o n • • • o l Samp>le s = Sample s Collecte d Firm : BEJJ^C- ^

PE> V4 . Dal e ikll u Time : 'h-Ctt>Vr \

Siunple s Analyze d XR F Unit : Dat e Time : Staf f t^nS TBoo k g,? / A M

= Baci i Lett . B 2 » Baci t Righ t D Z « Dri p Zone . G Z * • Garden . VZ . «

= Pla y \ aff « a s >WM»»e l from th e •InMl , «Km g propvft y

SJTKx l Quadran t Excavate d ['V$'V$^' ' LEGEN D Dri p Zon e Excavate d Lead Soi l Remainin g Easemen t Excavate d Environmenta l Restoratio n LL COmah a Lea d Sit e Sit e Sketc h Samplin g Address : /^Q S c 5 / O <3 ^ Exterio rPain t • Goo d 0 Poo r • No t pain t Nort h Arro w 

## 1 Sampl e Number RYASCPXA - S^Z 5 F1 RYBSCPXA - 5Y2 5 "^

2 RYCSCPXA - S*f-6 5 B1 RYDSCPXA - S*i.e 3 B 2fiDZSCPXARGZSCPXA - -B Z

-«Z RPZSGPXA - -P2 - Lea d Concentratio n 3Si 4 ppm H-Q S pp m ( 5 7 pp m ^C 7 pp m pp m • " pp m pp m Sampl e Collecte d 

# • D D LA B 

### D 

# n D 

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# n n Numbe ro f Sample s = Sample s Collecte d Firm : P g tiAc . P & VJ ^ Date : 'llyjl u Time : 3:Cx^Fl- \ XR F Unit : Date : Time : Staff : Sample s Analyze d QOBi TBook

: ^^ | A M 

## Mi'il N Legend : F l = Fron t Left , F 2 = Fron t Right , B 1 = Bac k Left , B 2 = Bac k

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Collecte d 

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# ^^M . JMh L Legend : F 1 = Fron t Left , F 2 = Fron t Right , B 1 = Bac k Left , B 2 = Bac k

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SCIENTIFI C Therm o Fishe r Scientifi c 90 0 Middlese x Turnpik e Billerica , M A 0182 1

2011-10-1 8 15:2 4 2011-10-1 8 15:2 4 2011-10-1 8 15:2 4 2011-10-1 8 15:2 3 2011-10-1 8 15:2 0 2011-10-1 8 15:2 0 2011-10-1 8 15:1 9 2011-10-1 8 15:1 8 Av g of983-98 5

Av g o f 979-98 1 120 9 s 1 0 S t 120 9 s 1 0 S

t 120 9 s 1 0 S

t 120 9 s 1 0 S

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t 120 9 s 1 0 S

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. F 2 F 2 F 2 lADDUKS S SAMI'I. KAKK A OI'KUA'I'O KDKI ' JIMM Y JIMM Y JIMM Y JIMM Y JIMM Y JIMM Y JIMM Y JIMM^ ' surfac e

surfac e surfac e surfac e 4 4 4 4 fina l clearanc e

fina l clearanc e fina l clearanc e fina l clearanc e fina l clearanc e final clearanc e fina l clearanc e fina l clearanc e 542 3 542 3 542 3 542 3 542 3 542 3 364.5 8 ± 28.7 9

346.2 2 ± 28.1 4 383.6 2 ± 29.5 1 363.9 1 ± 28.7 3 92.4 5 ± 17.4 6 91.0 9 ± 17.2 1 84.2 7 ± 16.9 7 102.00 ± 18.1 8

Pag e I o f

1 10/20/1 1 15:09:5 5