## TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID# : ^y^ ^ Date : Address : /p ^ Q LU2 ^ -^ r Remediatio nContractor : Envrionmenta l Restoration , LLC

_Year : _2010_ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S D Vide o o f property (DVD ) JlSBefor e DAfter \l , Basemen t D IS » Executiv e Summary (Final Report ) Q EPA-provide dproperty sketc h N

. Signe dAcces s Agreemen t for subjec t property NSigne dAcces s Agreement(s ) for adjacent property S Restoratio nAgreemen t D Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) ^ Confirmatio ndat a

D Photograph s DsPefore DCre w Photos ^ Durin g Excavatio n\ 1 So d D 30-day So dD NAs-buil t sketc h ^Ss . Completio nAgreemen t signe db y Property Owne r ^ Property close-ou t chec k lis t signe db y EPA D Descriptio nofarea s no t meetin g RO D cleanu p criteri a ^S ^ Utility clearance s

^ S Property informatio nfromDougla s County Assessor' s Offic e

^ Property acces s checklis t 3023792 4 H Contac t Lo g Superfun d D 

### Date " 

## S'Z7'l i Dat e

# EPA EP APropert y Clos e Ou t For m Omah aLea dSit e Propert y # : Mb^^g* ^ PrcpertyAddress : (^^fS LA ^ 'j^H "S f Date/Time : Owner'sName : \/)aiCO ^ l^i^i- l Quad s Excavated : fei Contracto r Grou p : Environmenta l Restoratio n(ER ) Excavatio nGenera l 1 . Ifnecessary , wer e th e correc t quadraiit(s ) excavate dan drestored ? 2 . Ifnecessary , wer e th e correc t area s ofdri p zon e excavate dan drestored? Ye s y 

## y N o
Gradin g So dan dVegetatio n 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 dbee nlai di nal l area s tha t wer e excavated ? 3 . Doe s th e so dappear t o b e generall y health y an dgrowing ? (Onl y evaluat e ifinspecte da t 30-day tim e period) . 4 . Ar e sodde darea s generall y firman devenl y graded ? 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 wil l no t poo l onth e property ? 7 . Wa s damag e t o landscapin g o r plant material s avoided ? Ye s ^y y y

w ^ y ^ N o

Gates , Fence s an dRetainin g Wall s 1 . D o gate s ope nan dclos e freely ? (ifapplicahle ) 2 . Were al l gate s o r fence s take ndow ndurin g restoratio nactivitie s re-installed ? 3 . Wa s damag e t o gate s o r fence s avoided ? (ifapplicahle ) 4 . Wa s damag e to retainin g wall s avoided ? (ifapplicahle ) (ifapplicahle ) Ye s 1 ^ u ^ t ^ 

## fO A N o

Foundation , Sidin g an dGutter s 1 . Wa s damag e to sidin g o r tri mavoided ? 2 . Wa s damag e to th e foundatio navoided ? 3 . Wa s damag e t o window s avoided ? 4 . Wa s damag e t o windo w screen s o r doo r screen s avoided ? 5 . Wa s damag e t o downspout s o r downspou t extension s avoided ? Ye s K ^

. ^

,_ , ^ ^

, N o

Sidewalk s an dDriveway s (Concrete ) 1 . Wa s damag e t o driveway surface s avoided ? 2 . Wa s damag e t o walkway surface s avoided ? Ye s ^ *- ^ N o Inspectio nnotes :


### Reniedia l an drestoratio nactivitie s complet e includin g 30-da y so dwarranty : %.ly/7y7^%A>x^ . yJa ^ 7//s//< ^ EP ARepresentativ^i'V^ ^ Date :

### fi^ yOmah a Lea d Site—EP-R7-09-O 5 ^

^^^Zm . ? Environnienta l Restoration , LL C ^T"^^ ^

www.er1lc.co m



# EXECUTIV ESUMMARY : 40959-691 2 N2 4 S T N o Issue s o r Concern s Q ] Issues/Concern s Petai l Exoianation :

### ENVIRONMENTA L
RESTORATIO N 

# PROPERT Y ACCES S SIGN-OF F OMAH ALEA D Propert y I D #_i/29:£ ^ Propert y Addres s ^9^ ^ y ^y^ ^ cizLZ.zz.<>j^A^ ^ ^ ^ j ^ Owne r Nam e bJ^ai/-lAzS^j/ i jz ^ Dat e S^-3>}-JL ) Comment s Owne r of propert y ha s agree dt o allo w E Rt o cros s thei r propert y t o gai nacces s t o th e adjacen t propert y wher e excavatio nwor k wil l b e performed . E Rwil l restor e thi s propert y t o it s origina l conditio nafte r wor k i s completed . Owne r Signatur e AA^JM ^ 

# f^^y^/i^ l Contracto r Signatur ePag e 1 of 3

" > [ Create Anothe rTicke t 1 [ Bac k t o Irt h Internet ] Sen d Emai l YOU RTICKE T NUMBE RIS"^2569893 ? Origina l Cal l Date : 8/17/1 0 Time : 12:0 6 p m Op : TRACY241 8 6 Wor k t o Begi n Date : "8/19/10 ' Time : r2:3 0 p k State : N E County : DOUGLAS Place : OMAH A Address : 691 2 Street : N24T H S T Twp : 15 NRng : 13 E Sect-Qtr : 03-NW-SW,04-NE-SE,09-NE-SE,10-NW-S W Twp : 15 NRng : 13 E Sect-Qtr : 15-NW-SW,16-NE-SE,21-NE,22-N W Twp : 16 NRng : 13 E Sect-Qtr : 27-SW,28-SE,33-NE-SE , 34-NW-S W 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 #4095 9 f Compan y ENVIRONMENTA L RESTORATIO N Contac t Nam e TRAC Y BRISTO W Phone : (402)451-131 4 Alt . Contac t Phone : (314)504-487 4 Wor k Bein g Don e For : EP A Dept h o f Excavation : 12 " Corne r Lot ; NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g ; NExplosives : N ALT87 2 ATTNEBR l CRGHTO NCXCAT V DOCOINF S ENERG Y LEVEL 3 MAGELLAN P MCINE B METR O MUDO l OMAHACO F OPPDGPR S PAETE C QLNNEI C

Servic e Are a Contac t Phon e Numbe r Utilit y Typ e ALT87 2 WINDSTREA M COMMUNICATIO N ELM LOCATIN G Day : 406728934 3 Ah : 406207149 4 Emerg : 888728934 3 ATTNEBR l ATT/T Day : 8002413624 9 Alt : Emerg : 8002413624 9 CRGHTO NCREIGHTO NUNIVERSIT Y DAV EMCATE E Day : Alt : 402280278 0 402510199 5 Emerg : 712545461 6 Day : 402934046 9 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 8/17/201 0

### Pag e 2 o f 3

CXCAT V
DOCOINF S

ENERG Y

LEVEL 3

MAGELLAN P

MCINE B

METR O

MUDO l

OMAHACO F

OPPDGPR S

PAETE C QLNNEI C CO X COMMUNICATIONS , IN C DOUGLA S COUNT Y FNFORMATIO NSERVICE S
ENERG Y SYSTEM S C O
LEVEL 3 COMMUNICATIONS , LL C
MAGELLA NMIDSTREA M PARTNER S LP
MC I

METR O COMM . COLLEG E
METROPOLITA NUTILITIE S DISTRIC T
CIT Y O FOMAHA TRAFFIC,SEWE R OMAH APUBLI C POWE R DISTRIC T
PAETE C COMMUNICATION S

QWES T LOCA LNETWOR K 

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EL M LOCATIN G Alt : 402934046 9 Emerg : 402932975 7 Day : 402510724 2 Alt : 402444718 8 Emerg : 402510724 2 Day : 402346906 6 Alt : 402346912 8 Emerg : 402346912 8 Day : 877366834 4 Alt : Emerg : 877366834 4 Day : 918574709 8 

## Ak : Emerg : 918574709 8 Day : 800289342 7 Alt : Emerg : 800289342 7 Day : 402457230 7 Alt : 402672703 3 Emerg : 402457231 3 Day : 402504782 3 

## Ah : Emerg : 402504797 0 Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 Ak : 406207149 4 Emerg : 888728934 3 Day : 800289190 1 Alt : Emerg : 800289190 1 Day : 406728934 3 Ak : 406207149 4 http://v^ww.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 8/17/201 0

### Pag e 3 of 3 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 8/17/201 0

## Contac t Informatio n Lo g SAID#^^y<9 ^

Attemp t t o contac t Date/tim e Nam e /-.l9-//> / f/:^0/> ^ /C.cLinw.' s 

# S'3/'/ ^ f(^ ^ 

# ftb

## Propert y Acces s Checklis t I SAID : ^ 5?^~-y p WORKSTARTF. D I Prnnert y .Address : I =7 . Lll l / < bL . GWORKCOMPELTE D ON : / / j 

### Owner : kJctrr-c ^ "~pc*^ ' Renter : Address : Phone : Fax : Cell/Pager : 

### Phone : V^; i ^ -J/^-^^ ^^^--g - Additional Infortnation : Fax : Cell/Pager : p T Acces s Agreement Signed : / /A/ / /p 

## By ^ ^ . A M Restoratio nAgreement Signed : I f ^ 1 / / ^ 

# ^y - 

# 'P.p • S Vide o Property Befor e O n ' } I XHI 

### By : / ^ I ^ Digital Photo s Befor e O n * ) / 1-i l (» By : /y 5 I I Vide o Property Afte r O n / By : 

### D Digital Photo s Afte r O n / / 

### By : [ S Propert y Completio nAgreement Signed : 1 / 7 / / & 

## By : ez / Q Fina l Report Signed : / / By : 

### Additiona l Vide o o r Digita l Photo' s Taken : nVide o nDigita l Photo T O n: /

Omah a Lea d Projec t 

### Wor k

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# Consen t to r Acces s t o Propert y SAID #V b 9 ^ ^ RIGH T O FENTR Y T O PREMISE S 

### Granto r (lh e property owner) , consent s t o an dauthorize s ih e Unite dState s Environmenta l Fioleciio nAgericy (USEPA ) or it s authorize drepresentatives , collectivel y th e Grante e t o ente r an dperfon ncertai nenvironmenta l respons e activitie s upo nth e followin g describe dpremises : cig M 

# i ^ Daytim e Phone : </eJI . ­ </S^ S — j't f &" ^ j Address : 

# /y^/: ^ /^^ysr/ . Address : Addresse s o f Propertie s coveredb 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 at th e property wliic hare 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 performe do nsai dproperty may includ e th e followin g activities : Takin g photograph s and/o r vide o o f th e propeit y before , during , an dafter remedial activities ; Locatin g equipmen t andmachinery on-sit e i npreparatio nfor an di nth e cours e ofth e environmenta l response ; c . Plannin g an dimplementin g th e remova l actio no nor near Grantor' s property . Obtainin g sample s fromGrantor' s property ; d . AGREEMEN T NO T T O INTERFER E Th e Granto r agree s no t t o interfere o r tampe r withan y o f th e activitie s o r work done , o r th e equipmen t use dto 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 endanger th e healtho r welfar e ofth e Grantee s or th e environment , o r

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

# (f„y^^. , y.iy ^ y 2-i ^ m Signatur e Dat e Signatur e Dat e

### ^J^^gg ^ ^ Additiona l Comment s / Instructions :

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



# 0 II agre e 

# n I d o no t agre e 

# F I agre e nI d o no t agre e 

# ^ uMx ^ f . f^l-Z{^) d /';A/,/t > Owner' s Signatur e Dat e

## Restoratio n Agreemen t Th e purpos e o f Lliis agreenien t i s t o provid e amutua l agrep.rnent a s t c condition s u f property prio r t o contracto r acliviiies . Tni s wil l als o serv e a s documentatio nfo r 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 propert y owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA) . 1 SAID : 

## ¥7>9/r' ^

Propert y Address : 

## (Ar/J L A A 

# % 4 ^ ^ Owner : 

### /t//c^ nl^tS^ I Phone : 

### ^z>:> . - 

### VAS - 

## as&^'S ' O nth e attache ddiagram(s ) indicat e area(s ) t o b e excavate dan ddept ho f excavation , locatio nofal l known utilities , subsurfac e features , surfac e stmcture s ah dlandscapin g features , acces s location(s ) t o b e use dby contractor , an dth e directio nofNorth . Indicate distances , depths , materia l types , etc . Indicate digital photo s b y referencin g the 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 : 

## K-e./y^i^-e . u/iTh . yci M Item :

Pag e 1 o f2Additiona l Comment s / Instructions :



### \7\ 1 agre e nI d o no t agre e agre e c nI d o no t agre e 

# L:£77 L Owner' s Signatur e Date Dat e Attachment s

Pag e 2 o f 2

# Propert y Completio nAgreemen t Till s agreemen t document s th e completio nof remedia l activitie s performe donmy property . My signatur e wil l designate tha t 1 amsatisfie dwithth e restoratio n of my property , an dtha t no item s ar ein question , now , or at any tim e inth e future , excep t thos e item s liste dbelow , if any . SAID : fof ^ - ^ Propert y Address : (^'J/ ^ // . Q^/7 £ ^ . Owner : UJ^rrt A '7^-K . 

### i Phone :

### • TASJ'AT^^ ^ Restoratio nItem sinQuestion :

jJC ) I agree restoraiio n

is completed, excep t as note d Nj I agre e restoration is completed, excep t as note d I 1 I do no t agree restoratio n

is complete d I I I do no t agre e restoration is complete d 

# /y7ZM?^j 7 9-9-/ A Owner' s Signature rim Dat e e Contractor' s Signatur e DateDougla s County , Nebrask a Propert yRecor d - R174849000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 tt wes t o f52n d S t - Vle WO P Ma p Informatio n i s vali d a s o f2009-12-1 5 Treasurer' s Ta xRepor t Ne wFeatur e ->->- •Aut o Sale s Searc h Owne r TEA L WARRE N R ETA L T R 691 2 N 2 4 S T OMAHAN E 68112-000 0 Propert yInformatio n Ke yNumber : 484 9 OOO O 1 7 Accoun t Type : Residentia l Parce l Number : 174849000 0 Parce l Address : Lega l Description : 691 2 N 2 4 S T OMAHAN E 68112-000 0 MINN E LUS ALO T3 BLOC K3 4 6 X 12 0 Valu e Informatio n 200 9 200 8 200 7 200 6 200 5 200 4 Lan d $4,500.0 0 $4,500.0 0 $4,500.0 0 $4,500.0 0 $4,500.0 0 $4,500.0 0 Improvemen t $58,700.0 0 $58,700.0 0 $54,500.0 0 $54,500.0 0 $54,500.0 0 $42,100.0 0 

### Total $63,200.0 0 $63,200.0 0 $59,000.0 0 $59,000.0 0 $59,000.0 0 

### $46,600.0 0 Lan d Informatio n Acre s 0.1 2 S F 5520. 0 Unit s 1. 0 Dept h 

### 120. 0 Widt h 

### 46. 0 Vacan t N o Improvement Informatio n Buildin g 1



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl.. . 12/22/20091 ay e z U l Z

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### Percen t Complete : i 100.0 % Perimete r1 0. 0 Quality : i Averag e Uni t Type : Condition : ! Averag e

Buil t As : < Ranc h Cond o Squar e Footage : 0. 0

HVAC : Centra l Ai rt o Ai r Rooms : 5. 0 Exterior : Fram e Aluminu m Units : 

### 1.0 Interior : Drywal l Baths : 

### 1.0 Roo fCover : Compositio n Shingl e Bedrooms : 2. 0

Roo fType : Gabl e Stories : 

### 1.0 Floorcover : Allowanc e Foundation : Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 192 0 0 % 

### 192 0 8 8 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Unfinishe d Atti cW/floo r 228. 0 Applianc e Allowanc e 

### 1.0 Applianc e Fireplac e Masonr y 

### 1.0 Basemen t Bsmn t Bloc k 8 f t 

### 1056. 0 Fixtur e Bas e Fixture s 

### 1.0 Fixtur e Bat h Ful l 

### 1.0 Garag e Detache d 

### 180. 0 Porc h Enc l Soli d Wal l 

### 96. 0

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl. . . 12/22/200 9

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# n Date : lnl2^] M RYBSCPXA-4095 9 F2 pp m 

# n Time : INOSAhA RYCSCPXA-4095 9 Bl 1 p.° l pp m 

# n Sample s Analyze d RYDSCPXA-4095 9 82 pp m 

### D RDZSCPXA-4095 9 DZ 

## A l l pp m 

### D XR F Unit : fnfl& Z Book : 2.^( o ncgecpx A4005 0 -€2 - pp m 

### D D Dat e Tf3-o q RrgGOr)(A-4095 0 P2 - pp m 

### D D Tim e CttL . Staff : Numbe r ofSample s = 

## ns W _Q _ Legend : Fl = Fron t Left , F2 •Fron t Right , Bl = Bac k Left , B2 = Bac k Righ t DZ = Dri p Zone , GZ = Garden , PZ = Pla ; Al l quadrant s are as viewe d fro m th e street , facin g property

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