### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID# : 55S(j)2 . Date : U-V- W Address : HOX V Scxr-g-VooT) ^ S^ . Remediatio nContractor : _Environmenta l Restoration , LLC

_Year : _201 0 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S J ^ Vide o o f property (DVD ) _^efor e DAfte r D Basemen t D ^ Executiv e Summary (Final Report ) ^ EPA-provide dproperty sketc h Signe dAcces s Agreemen t for subjec t property D Signe dAcces s Agreement(s ) for adjacen t property Restoratio nAgreemen t D Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) Confirmatio ndat a ^ Photograph s B^efor e DCre w Photo s jZlDurin g Excavatio nD So d ;2^0-da y So dD As-buil t sketc h 3026185 5 

### X Completio nAgreemen t signe db y Property Owne r jX Property close-ou t chec k lis t signe db y EP A Superfun d D Descriptio nofarea s no t meetin g RO D cleanu p criteri a X ^ Utility clearance s y Property informatio nfromDougla s County Assessor' s Offic e p ^ Property acces s checklis t n

/ Contac t Lo g

lenta l Restoratio nSignatur e Date



# _ ^ ^ y/v^/ / CO Rsignature " ~ / Dat e

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

## SbbG>Z PropertyAddress : ^02- l 'SjOora.A-oy. . S-V
Date/Time : Owner' s Name : TWGWNOL ^ 

### CuxAr--V'i'= ^ Quad s Excavated : F2 . Contracto r Grou p Environmenta l Restoratio n (ER ) Excavatio n Genera l Ye s N o 1 . Ifnecessary , were th e correc t quadrant(s ) excavate dan drestored? 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 

## s X house ? 2 . Ha s so dbee n lai di n al l area s tha t wer e excavated ? 

### i X 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 . Are sodde darea s generall y fir man devenl y graded ? 

### yy 5 . Are th e joint s betwee n th 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 o n th e property ? 

### v ^ 7 . Wa s damag e t o landscapin g o r plan t material s avoided ? . / Gates , Fence s an dRetainin g Wall s Ye s N o I . D o gate s ope n an dclos e freely? (ifapplicable ) Were all gate s o r fence s take n dow n durin g restoratio n activities re-installed ? (ifapplicable ) 3 . Wa s damag e t o gate s o r fence s avoided ? (ifapplicable ) 

### # 4 . Wa s damag e t o retainin g wall s avoided ? (ifapplicable ) Foundation , Sidin g an dGutter s Ye s No 1 . Wa s damag e t o sidin g o r tri mavoided ? 2 . Wa s damag e t o th e foundatio n avoided ? 

# Vfl^r^n-t rJQ- E Wa s damag e t o windows avoided ? 

# B 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 ? Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Wa s damag e t o driveway surface s avoided ? 

## A/A 2 . Wa s damag e t o walkwa y surface s avoided ? 

# v / Inspectio n notes : 

# 5 sd < 

# " Remedia l an drestoratio n activitie s complet e includin g 30-da y so dwarranty : EP A Representati v 

# J,jA:>_mi^cc^-sJ:u ^ Date : 

# 4llj^ H

### /^© 7 ' ^

Omah a Lea d Site—EP-R7-09-0 5 ^•«B^^^^ ^ Environmenta l Restoration , LL C \ ^ www.crllc.co m



# EXECUTIV ESUMMARY : 3556 2 402 1 SARATOG A S T



# No Issue s o r Concern s Q Issues/Concern s Detai l Fxnlanntion

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



### • YOU RTICKE T NUMBE RI S 2674606 . Origina l Cal l Date : 2/23/1 1 Time : 8:0 0 a m Op : ADAM2418 6 Wor k t o Begi n Date : 2/25/1 1 Time : 8:3 0 a m State : NE County : DOUGLA S Place : OMAH A Address : 402 1 Street : SARATOG AS T Twp : 15 NRng : 13 E Sect-Qtr : 05-N E 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 : 3556 2 Compan y: ENVIRONMENTAL 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 : N Involve s Tunneling o r Horizonta l Boring : NExplosives : N CXCAT V

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 , FN C HEIDI Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUDOr METROPOLITA NUTILITIES DISTRICT SAND Y MU D Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCITYOFOMAHA-TRAFFICSEWERRICH/TRAFFI C Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 OPPDGPR 5 OMAH A PUBLI C POWE RDISTRICT EL M LOCATIN G Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNNEIC QWES T LOCA LNETWOR K EL M LOCATIN G Day : 406728934 3

Ait : 406207149 4 Emerg : 888728934 3


### http://vA\av.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 2/23/201 1

## • Contac t hiformatio n Lo g

Owner^ s Name:" ^ I K^f^t ^ doffi j EJayttme Phone : C^^~ 7 <o l ' 7 Prop e ert y Address : ' . t-fQ^r l £'^r •<T( i * j C K 

## Attemp t t

o contsc t -AiCinCS S -(br/^ J •>'^'^* '

## Propert yAcces s Checklis t SAID : -ySSCs ^ D WOR K STARTE D ON : __/__/ _ PropertyAddress : ^gj^ / S'^r^'fo'J ^ D WOR K COMPELTE D ON : / l _ Owner : •• i / /^ /• Renter : Address : ^^3
- _p,,, ^ ^ 4 Phone : Fax : Cell/Pager : Phone : Additional Information : 

# csi^ - 3^n Y Fax : Cell/Pager : S Acces s Agreemen t Signed : / 1^ ^ ll 

### By : 'i^ d [S ' Restoratio nAgreemen t Signed: / 1^ ^ K 

### By : -p o ^ Vide o Propert y Befor e 

### On -.O
- / "? llL By : ^ . J . I ^ Digita l Photo s Befor e 

### On: «= 2 / ? / /r By : ^.3 . nVide o Propert y After On: / / By : nDigita l Photo s Afte r On: / / By : [^ Propert y Completio nAgreemen t 

### Signed : J_/:>/// ( 

## By:ieD nFinalRepor t Signed : / / By : 

### .^idditiona l Video or Digita l Photo' s Taken : 1 On : / / By : nVide o n Digita l Phot o Reason : D Vide o n Digita l Phot o On : / / By : Reason : nVide o n Digita l Phot o On : / / By : Reason : nVide o nDigita l Phot o On : / / 

### By : 1 Reason :

Omah a Lea d Project Wor k Pla n 

### Pag e 1 of! 9

## Propert yAcces s Checklis t SAID : -JSSC^ ^ PropertyAddress : ^/gj / Str^^jo^ ^ D D WORK STARTE D WORKCOMPELTB D ON : / / ON:__/__/ _ Owner : -Ti^ ^ Address : y^^
­ ^ ^ C^r-^ k j^^^^ ^ j4 Renter : Phone : Fax : • •^ ' — ­ ....-••—

Phone : Fax : Q,SV
- ^'7 / Cell/Pager : Additiona l Information : Cell/Pager : S ^ S I 1 ^ n Acces s Agreemen t

Restoratio n Agreemen t

Vide o Propert y Befor e Digita l Photo s Befor e Vide o Propert y Afte r Signed : / /«2< V ( / Signed: / 1^ ^ K 

## O

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## By: (t . J . By : n [ ^ n

Digita l Photo s After

Propert y Completio nAgreemen t FinalRepor t O n: / / 

## Signed: J_/.P/// ^ Signed : / / By : 

## By:'ie D By : .Additiona l Vide o o r Digita l Photo' s Taken : nVide o n Digita l Phot o O n: Reason : / / By :

nVide o Reason : n Digita l Phot o O n: / / By : | n Vide o Reason : nDigita l Phot o O n : / / By :

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

Omah a Lea d Project Wor k Pla n 

### Pag e 1 o f 1 9

## Consen t fo rAcces s t o Propert y SAID # 5try6 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 Environmental Protectio nAgenc y (USEPA ) o r it s authorize drepresentatives , collectivel y th e Grante e t o enter an dperfom i certai nenvironmenta l respons e activitie s upo nth e followin g describe dpremises :

Owner'sName : "1^^ ^ j Or4( i Daytim e Phone : Q^ y. ^i l ^

• ! • 1 1 —1 -*¥ 1 • - ^ . . . ^ ^ - Address : 

## c/o^ f S^rtK-f o f j t \ 

# . 4 . Address : c / Addresse s o f Propertie s Address : covere db y thi s 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 whic har e contaminate dwit hhazardou s substances , i n particular leada t concentration s greater thano r equa l t o 40 0 part s pe r millio n(ppm) . REMEDIA L ACTION S 

### Th e environmenta l respons e action s to b e performe do n sai 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 dafte r remedial activities ; b .Locatin g equipmen t an dmachiner y on-sit e i n preparatio n for an din th e cours e o f th e environmental response ; c .Plannin g andimplementin g th e removal actio n o n o r nea r 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 interfer e o r tampe r wit hany 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 undertake 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 healtho r welfare ofth e Grantee s o r th e environment , o r

t o allp w other s t o us e th e property in suc h IKIgran t acces s to m y propertie s Q I d o no t gran t acces s t o m y propertie s

- y ^ 

# 'i L Signatur e Signatur e Dat e

### n Chec k thi s boxi f owne rdoe s not 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 f house , includin g foundatio n crack s o rfissures .



## D l agre e d l I d o no t agre e I 1 1 agre e nI d o no t agre e

Owner' s Signatur e 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 amutua l 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 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 property owner an dth e Unite dState s Enviromnental Protectio nAgenc y (EPA) .



### SAID : 3S^(^ S PropertyAddress : y"o;t^ / J<Kr'^4x>ja , /f ^ Owner : ^'KoMct^ ^ C>>Jt'4-t 5 

### Phone : 

# Usy.Jiy Y Onth e attache ddiagram(s ) indicate area(s ) t o b e excavate dan ddeptho f excavation , locatio no f all know n utilities , subsurfac e features , surfac e structure s andlandscapin g features , acces s location(s ) t o be use db y contractor , an dth e directio no f North . Indicate distances , depths , material types , etc . Indicat e digita l photo s by referencin g th e photo-lo g number wit hanarro w indicatin g directio no f view . Item s t o b e remove d b yContracto ran d no t replaced :

Hem : 

# K<fl<=^<: ^ A H -gK^ccUQ^ec^ ^/^ ^ ^/ M ^o J Item : 

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borc^\c) .'TprV/i/c/c n r{:^'\J . Item : Item : ^ / item : 

### Item : Item :

Pag e 1 o f 2

### I agre e Q I do no t agre e ^ i 

### CU I do no t agre e

Owner' s s Signatur

Signatur e e /Date / Contractor' s Signatur e Dat e 

## Attachments

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 perfonne do nm y property . M y signatur e wil l designat e that I a msatisfie dwithth e restoratio no f my property , an dtha t n o item s ar e i n question , now , o r at an y tim e i nth e future , excep t thos e item s liste dbelow , ifany . 

### SAID : 3SSU ^ PropertyAddress : Y<^ f _rtr«}7^« i « \ 

# 5i . 0^"^'- = /L^.J Cur4. A Phone : CcS y - J i 7 ^ Restoratio nItem s i nQuestion : Item : item : item : Item : Item : item : Additiona l Comments : 

### L . 

# 6l9AC«f^ec l Oiho^'^X^akrini i

ly l 1 agre e restoratio n i s completed , excep t a s note d jy A I agre e restoratio n i s completed , e.xcept a s note d I r d o no t agre e restoratio ni s complete d I I I d o no t agre e restoratio nIs complete d

0 ^

<^0 ^ 

### Owner' s Signatur e Dat e Contractor' s Signatur e Dat e I

### Dougla s Coimt y Accoun t InfoH i 'o n Pag e 1 of 2 M j i Dougia s County , Nebraslt a Propert yRecor d - R080461000 0 Prin t Repor t Vie wInteractiv e GI S Ma p Infomriatio n i s vali d a s o f 2010-11-1 6 Treasurer' s Ta xRepor t Ne wFeatur e "*->- > Subdivisio n Sale s Searc h Owne r CURTI S THOMA S R ETA L 402 5 SARATOG AS T OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : 046 1 OOO O 0 8 Accoun t Type : Residentia l Parce l Number : 080461000 0 Parce l Address : 402 1 SARATOG AS T OMAH AN E 68111-000 0 Lega l Description : CENTRA L PAR KLO T5 BLOC K1 7 6 0 X 12 5 Vaiu e Informatio n Lan d Improvemen t Tota l 201 0 $ 1,100.0 0 $0.0 0 $ 1,100.0 0 200 9 $ 1,100.0 0 $0.0 0 $ 1,100.0 0 200 8 $ 1,100.0 0 $0.0 0 $ 1,100.0 0 200 7 $ 1,100.0 0 $0.0 0 $ 1,100.0 0 200 6 $ 1,100.0 0 $0.0 0 $ 1,100.0 0 200 5 $ 1,100.0 0 $0.0 0 $ 1,100.0 0 

### Sho wAl l Transaction s

Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 7 7500. 0 0. 0 125. 0 60. 0 Ye s



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountao=RO. . . 11/19/201 0

### Dougla s Count y Accoun t In f 

# ' H 'o n Pag e 2 o f 2

-ts t ' ' Evangelicall y iuttwrarOiurct i Fort S t FortS t -:r<i' > "»? . •"- o 

# n Z 2 Camde n Av e ^ 4 3 > 3 M E . Golde n HiBt i i n Brown e S« wCemeter y Brownes t . , .iS 2 BrowfieS t Saratog a S t

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Fowte rAv e POWERE D B V Ma p dat a @I201 0 Google ' Th e abov e ma p i s powere d b yGoogle , 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 more exact propertylocation , yo u ma yus e th e Interactiv e GI S Map s tha t ar e maintaine d b you r office .



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinf o .jsp?accountno=RO.. . 11/19/201 0

### ENVIRONMENTA L AS-BUIL TDRAWIN G I OMAH ALEA D SUPERFUN D SITE ^ RESTORATIO N Name : t-U^ | J V^ih'iU r Omah a Lea d Sit e Dat e Nbrt hArro w 

### Address i 4n 7, t 5^c>^h><j ^

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