### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDL4TIO NFIL EFOLDE R SAID# : ^1o<^ z Date : M-\-\\ Address : /J® / oA/ o i/ - Remediatio n Contractor : Envrionmenta l Restoration , LLC

_Year : _201 0 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S ^ Vide o o f propert y (DVD ) _J^efor e DAfter D Basemen t D U Executiv e Summary (Fina l Report ) J ^ EPA-provide dpropert y sketc h J/ i Signe dAcces s Agreemen t for subjec t propert y D Signe dAcces s Agreement(s ) fo r adjacen t property ^ Restoratio n Agreemen t

D Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) 2r Confirmatio n dat a j aPhotograph s 2 1 Before DCrewPhotosC/Durin g Excavatio nD So d ;2^30-da y So dD JZ) As-buil t sketc h A ^ Completio n Agreemen t signe db y Propert y Owne r / 0 Propert y close-ou t chec k lis t signe db y EP A D Descriptio n o f area s no t meetin g RO D cleanu p criteri a A ^ Utilit y clearance s yE T Propert y informatio nfromDougla s Coimt y Assessor' s Offic e > 0 Propert y acces s checklis t C. p t f\^ \1 ^ P O r i ^ ^ ^ . 3026189 8

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### 1PACO Rsignatiir e / Dat e

# EP A EP A Propert y Clos e Ou t For m Omah aLea dSite OU# 2 Propert y #:__£7o9 £ PropertyAddress : /So / Ohi o j-y , 

### Date/Time : Owner' s Name : f A 7orA-C r 

### Quad s Excavated : P 7 r.? , 3 J Contracto r Grou p : Environmenta l Restoratio n(ER ) Excavatio nGeneral Ye s No 1 . Ifnecessary , wer e th e correct quadrant(s ) excavatedan drestored ? j ^ 2 . Ifnecessary , wer e th e correct area s ofdri p zon e excavatedan drestored ? 

## j/k . Gradin g So dan dVegetatio n Ye s N o 

## \ A house ? 2 . Has sodbee nlaidi n al l area s tha t wer e excavated ? 

## A 3 . Doe s th e sodappea r t

o b e generall y health y an dgrowing ? (Onl y evaluat e ifinspecte da t 30-da y tim e period) . 4 . Ar e soddedarea s generall y fir man devenl y graded ? 

## A 5 . Ar e th e joint s betwee nthe sodstrip s generall y tight ? (Onl y evaluat e i f inspecteda t 30-da y tim e period) . 6 . Wa s th e propert y gradedsuc htha t wate r wil l no t pool o n the property ? y 7 . Wa s damage to landscaping o r plan t material s avoided ? 1 ^ Gates , Fence s an dRetainin g Wall s Ye s N o 1 . Do gatesope n an dclos e freely? (ifapplicable ) 2 . Wer e al l gate s o r fence s take n dow nduring restorationactivitie s re-installed ? (ifapplicable ) i * ­ 3 . Wa s damage t o gate s o r fence s avoided ? (ifapplicable ) 4 . Wa s damage t o retaining wall s avoided ? (ifapplicable ) Foundation , Sidin g an dGutter s Ye s N o 1 . Wa s damage t o siding o r trimavoided ? 2 . Wa s damage to the foundatio navoided ? 

# v^ma f ( Ct p 3 . Wa s damage to window s avoided ? 

# "7* " 4 . Wa s damage to windo w screen s o r doo r screen s avoided ? 5 . Wa s damage to downspouts or downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Wa s damage to drivewa y surface s avoided ? 

# 7 ^ 2 . Wa s damage to walkwa y surface s avoided ? Inspectio nnotes :


### Remedial an drestoratio nactivitie s complete includin g 30-day so dwarranty : EP A Representative : -^/JjjA^tT^i^ ^ •^//J.^L/t. . 

# Date : ^34 I/ . (^''^*'< , 

## * \i^S h ^ Omah a Lead Site—EP-R7-09-05 \^3^^ ' Environmenta l Restoration , LL C V V www.cr1lc.co m

'*<»«OiTi' * 

# EXECUTIV ESUMMARY : 2909 2 150 1 OHIOS T



# No Issue s o r Concern s Q ] Issues/Concern srag e i oi z
[ Creat e Anothe rTicke t ] [ Bac k t o Irt h Interne t ] ' [ Sen d Emai l YOU RTICKE T NUMBE RI S 2671019 . Origina l Cal l Date : Wor k t o Begi n Date : 2/14/1 1 2/16/1 1 Time : Time : 8:5 2 a m 9:1 5 a m Op : ADAM2418 6 State : N E Address : 150 1 County : Street : DOUGLAS OHI O S T Place : OMAH A Twp : 15 NRng : 13 E Sect-Qtr : 10-SE-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lead soi l remova l Locatio n o f Work : LOCAT E ENTIR E PROPERTY Remarks : FA X AL L CLEAR S TO : (402)451-106 9 : 2909 2 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 Being Don e For : ep a Dept h o f Excavation : 24i n Corne r Lot : NFront : NRear : Involve s Tunneling o r Horizonta l Boring : NExplosives : N CXCAT V

MCINE B MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Servic e Are a Contac t Phon e Numbe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 -
MCINE B MC I N O CAL LPE R MEMO Day : 800289342 7 Alt : Emerg : 800289342 7 MUDOl METROPOLITA NUTILITIE S DISTRIC T SAND Y MU D Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCITYOFOMAHA-TRAFFICSEWE RRICH/TRAFFI C Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 2/14/201 1rttg c . 6 U l z .

OPPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T EL M LOCATIN G 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K EL M LOCATIN G 

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

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 2/14/201 1

## Contac t Informatio n Lo g SAID#_^12 ^ Owner' s Name ; 

# 'l^ ­ ro i Daytime Phone : Cf(^ ' '^C/^^^ //^ ^ PropertyAddress : ]^Q I Q^JJ O ^T " 

### Attemp t t o contac t Date/tim e Nam e ^rrc-*i€b u p i2e/ 0 

## <fyf ^

### SAID : 2'^O^ Z Propert y Address : /^TJ # 

### Propert yFina l Repor t n WOR K STARTED D WOR K COMPELTE D ON : ON : / // / Owner : 

### Y-. . ToihJf/ L Address : 2^ 3 ^ . 

### iG ^ «5 r BLD . iWliS Z <.*^KJ - Shte O Phone : 

### ^A?2-.g*V^-//^ ^ Fax : Cell/Pager : Renter : Phone : Fax : Cell/Pager : Additional Information :

1 3 1 ^ 1 3 [ ^ n n J G n Acces s Agreemen t

Restoratio nAgreemen t Vide o Propert y Befor e Digita l Photo s Befor e Vide o Propert y Afte r Digita l Photo s Afte r

Propert y Completio nAgreemen t FinalRepor t Signed : 1^ 1 fi I/ O Signed:/ Z/ & li O O n:lt/8/i o O n: I Z / t

/ 1 0 O n:_l_l _ O n: / / 

### Si2ned: 3 /l l / U Signed : / / 

### By : a> . By

= :r./P By : j^f l By^T P By : N/ A By : By : i$£ ) By : EXECUTIV E SUMMAR Y

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

## Consen t for Acces s t o Propert y SAID #A^^Z . RIGH T O FENTR Y TO 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 n envirormiental respons e activitie s upo nth e followin g describe dpremises :

Owner' s Name : j< ^ TlJ^\ ^ Daytime Phone : ^QZ'3H^'/J")' ^ Address : ,_- ^ / ^ - - 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 s,a t th e property whic hare contaminate dwit hhazardou s substances , inparticular lea dat concentration s greate r thano 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 perfonne dc nsai dpropert y ma y includ e th e followin 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 ntli 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 fro mGrantor' s property ; AGREEMEN T NO T T O INTERFER E 

### Th e Granto r agree s no t t o interfer e o r tampe r withan y 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 an y action s regardin g th e us e o f sai d propert y whic hwoul dten dt o endange r th e healt ho r 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 i n suc h IT H gran t acces s t o m y propertie s O I d o not gran t acces s t o m y propertie s



## ^ , ./li^-' f 2.0^ 0 Dat eAdditiona l Comment s / Instructions :



### E^hec 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 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 rof house , includin g foundatio n crack s o rfissures .

[XHTagre e O I d o no t agre e J/T l agre e I 1 1 d o no t agre e

Owner' s Signatur e Dat e Contractor'sSignatur e Date

# H
Restoratio n Agreemen 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 prio r t o contracto r activities . Thi s wil l als o serv e a s documentatio n for 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 : 

# z^o^ z PropertyAddress : ) 5"^ , Q^XT Q ^T . Owner : ^ j^jj^^^f ^ Phone : O nth e attache ddiagram(s ) indicate area(s ) t o b e excavate dan ddeptho f excavation , locatio n o 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 . Indicat e distances , depths , material types , etc . Indicate digital photo s b y referencin g th e photo-lo g number withan arro w indicatin g directio no f view . Item s t o b e remove d b yContracto ran d no t replaced :

item : 

### / l u C/lUCit^T ^ 0 / T// ^ P^;/^^TA ' C'jfy ^ /^ ^ /^^gSJe^^^P . Item : Item : Item : Item : Item : Item :

Pag e 1 o f 21^ 1 agre e d l I d o no t agre e ^ 0 I agre e C H I d o no t agre e

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

Pag e 2 o f 2

## Propert yCompletio n Agreemen t Thi s agreemen t documents th e completio n o f remedia l activitie s perfonne do n m y property . M y signatur e wil l designat e that I amsatisfie dwit hth e restoratio n o f m y property , an dtha t n o item s ar e in question , now , o r at an y tim e in th e future , excep t thos e item s liste dbelow , i f any . SAID : 

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## /< • TottjeA- . Phon e 

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# / ^ -Ti^.j^y. ^ 1:-A9-;k^/ A ^:^C\%^J:^/^X ^ -^\I:^\K\ / Owner' s Signatur e Dat e Contractor' s Signatur e Dat e

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### Dougla s County Accoimt intbrmatio n I'ag e I o t I Dougla s County , Nebrask a Propert yRecor d - R021016000 0 Prin t Reoor t Vie wInteractiv e GI S Ma o Informatio n i s vali d a s o f 2010-8-1 6 Treasurer' s Ta xReoor t Ne wFeatur e ->->• * Subdivisio n Sale s Searc h Owne r BRUNKE N S ETA L 250 3 N 1 6 S T# 8 OMAH AN E 68110-000 0 Propert yInformatio n Ke yNumber : 101 6 000 0 0 2 Accoun t Type : Residentia l Parce l Numbe r 021016000 0 - Parce l Address : 150 1 OHIOS T OMAH AN E 68110-000 0 Lega l Description : LAND S SEC-TWN-RG E 10-15-1 3 E 4 8 W 10 6 FTSU B L T7 TA X LT8 & E 4 8 W 43 6 FTTAX L T9 Valu e Informatio n 201 0 200 9 200 8 200 7 200 6 200 5 Lan d $500.0 0 $500.0 0 $500.0 0 $500.0 0 $500.0 0 $500.0 0 Improvemen t $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 Tota l $500.0 0 $500.0 0 $500.0 0 $500.0 0 $500.0 0 $500.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 7 7680. 0 0. 0 160. 0 48. 0 Ye s



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