## TRANSMITTALo f

OMAH A LEAD S I 

# i SOI LREMEDIATIO NFIL EFOLDE R SAI D # : 50Sq QDafg . Address : \^^ V Gor-teN j ^A . Remediatio nContractor : Environmenta l Restoration , LLC

_Year : 201 0 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S
^ Vide o o f property (DVD ) _^efor e DAfter D Basemen t D J ZExecutiv e Sunmiary (Fina l Report ) yZEPA-provide dproperty sketcl i Z u Signe dAcces s Agreemen t for subjec t propert y
• Signe dAcces s Agreement(s ) for adjacen t propert y /A Restoratio nAgreemen t

• Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) ^Confirmatio ndat a

Z A Photograph s _^^efor e DCrew Photo s G^urin g Excavatio n• So d X30-da ySod D A ^ As-buil t sketc 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 Descriptio nofarea s not meetin g RO D cleanu p criteri a Utility
- clearance s 

# y Propert y informatio nfromDougla s Count y Assessor's . Offic e Propert y acces s checklis t 3026191 1 

# ^ "7"" ; ,_ ,liiillHili l A ^

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### tnvironnienta l Restoratio nSignatur eDit ? 

## iSt'/^'f / Dat e

# EP A EP A Propert y Clos e Ou t For m Omah aLea dSit e Propert y # ; SO^^ O \%1. \ CJDI~>OS A% V . 

### Propert y Address : Date/Time : Owner'sName : \ADO&>Vt=»< Nor\^\AgA \ Quad s Excavated : F l /F 2 Contracto r Grou p : Environmenta l Restoratio n(ER ) Excavatio nGenera l 

# \j/7^/iJ r ID T Ye s N o 1 .Ifnecessary , were th e correc t quadrant(s ) excavate dan drestored? Z ^ 2 .tfnecessary , were th e correc t area s ofdri p zon e excavate dan drestored ? 

# 3 E Gradin g So dan dVegetatio n Ye s N o I . Doe s the gradin g woun dth o pfrrimutsr o f tho housa.i nexcavate darea s generall y slop e awa y fromth e house ? 2 .

Ha s so dbee nlai di nall area s tha t wer e excavated ? 3 . Doe s th e so dappea r to b e generall y health y an dgrowing ? (Onl y evaluat e if inspecte da t 30-da y tim e period) . 4 .

Ar e sodde darea s generall y fir man devenl y graded ? 5 .Are th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e if inspecte da t 30-da y tim e period) . 6 .Wa s th e property grade dsuc hthat wate r wil l no t poo l o nth e property ? l y 

### Wa s damag e to landscapin g o r plan t material s avoided ? 

### . X Gates , Fence s an dRetainin g Wall s Ye s N o 1 .D o gate s ope nan dclos e freely? (ifapplicable ) 2 .Wer e al l gate s o r fence s take ndow ndurin g restorationactivitie s re-installed ? (ifapplicable ) 

## • M ^ 3 .

Wa s damag e to 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 N o I .Wa s damag e to sidin g o r tri mavoided ? 2 .

Wa s damag e to th e foundatio navoided ? 3 .

Was damag e to window s avoided ? 

# MO.IUiA ' ia i 

# f r 4 .Wa s damag e to windo w screen s o r doo r screen s avoided ? 5 .

Wa s damag e to downspout s o r downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ye s N. D 

### 1 . Wa s damag e t o drivewa y surface s avoided ? 

## HJ k 2 , Was damag e to walkwa y surface s avoided ? iZ 

### [nspectio nnotes :



### Remedia l an drestoratio nactivitie s complet e includin g 30-da y so dwarranty : EPARepresentativ e 

# /9/J^t£0>^A/^y^X< ^ Date: ^V^AD/ /

### y'"'^^< . Omah a Lea d Site^EP-R7^9^ S Environmenta t Restoration , LL C '* . j ^ www.erltc,c<» n 

# EXECUTIV ESUMMARY : 5059 0 182 1 CORB YS T



# N o Issue s o r Concern s Q ] issues/Concern s Detai l Exnlanafinn ­

## Pag e 1 o f 1

" > [ Creat e Anothe rTicke t ^ [ Bac k tolrt h Inteme t ] [ Sen d Emai l ]
YOU RTICKE T NUMBE RI S 2707705 . Origina l Cal l Date : Wor k t o Begi n Date : 4/08/1 1 4/12/1 1 Time : Time : 6:5 6 a m 7:1 5 a m Op : TIM2418 6 State : NE Address : 182 1 County : DOUGLA S Street : CORBY S T Place : OMAH A Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 10-S W Sect-Qtr : Typ e o f Work : Lea d 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 : SAI D # 5059 0 Compan y: ENVIRONMENTAL RESTORATION Contac t Name : TI M SUTTO N Alt . Contact : Phone : (402)451-131 4 x226 7 Phone : (402)306-234 7 Wor k Being Don e For : EPA Dept h o f Excavation : 2 4 i n Corne r Lot : NFront : N Involve s Tunnelin g o r Horizonta l Boring : NExplosives : N CXCAT V

MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Rear : N

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 MUDO l METROPOLITA NUTILITIES DISTRICT SANDY MU D Day : 402504782 3

Alt : Emerg : 402504797 0 OMAHACO FCITYOFOMAHA-TRAFFICSEWERRICH/TRAFFI C Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0 0PPDGPR 5 OMAH A PUBLI C POWE RDISTRJCT 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

Alt : 406207149 4 Emerg : 888728934 3 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 4/8/201 1I'ag e 1 o t 1

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

• YOU RTICKE T NUMBE RI S 2691640 . Origina l Cal l Date : 3/22/1 1 Time : 10:1 3 a m Op : ADAM2418 6 Wor k t o Begi n Date : 3/24/1 1 Time : 10:4 5 a m State : NE County : DOUGLA S Place : OMAH A Address : 182 1 Street : CORBY S T Twp : 15 NRng : 13 E Sect-Qtr : 10-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : Lea d 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 : SAI D # 5059 0 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 : 2 4 i 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 Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUDO l METROPOLITA NUTILITIES DISTRICT SAND Y MU D Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFIC.SEWE RRICH/TRAFFI C Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 OPPDGPR 5 OMAH A PUBLI C POWE RDISTRICT EL M LOCATIN GAlt : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 QLNN E1 C QWES T LOCA LNETWOR K EL M LOCATIN GAlt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 3/22/201 1

## Contac t Informatio n Lo g 

# SAID#6br^ O 

# im^io _ Owner' s Name:./,,3 , ^ ^^y^ x r,^ ^ Daytim e Phone : ^Tr " ^// ' l^( > II Property Address : /^2. / Co^Jh/ ? -ST ­ 

# 1 1 1 Attemp t to contac t Date/tim e Nam e ^.« rA\s< ^ OJ- * il'Gi o 

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## Propert yAcces s Checklis t SAID : /^<^^ 0 D WORK STARTE D ON : _/ l_ 

### Property Address:/g^ ; ^^^ g ^ D WORK COIVIPELTE D ON : I I Owner : rAf^j^is^Ngi^i^t / f(r.^<M, ^ f"^ ^ '•*'"*" = Address : Phone : Fax : Cell/Pager : Phone : Additiona l Information : Fax : Cell/Pager : I7T Acces s Agreemen t Siened:* ^ / c2/l ( 

## By : ^i ; Q^Restoratio nAgreemen t Siened : r , IKSZH. K 

## By: © [2r Vide o Propert y Befor e On:J:J/J^/U . 

## By : £ 3 •'-T)igita l Photo s Befor e 

### On•.j:^/m.'JL 

## By: t ^ nVide o Propert y Afte r O n: / / By : D Digita l Photo s Afte r O n: / / By : " ^ Propert y Completio nAgreemen t 

### Signed : . ^ / f

1 I f By:/ ^ nEina l Repor t Signed : / / By : Additiona l Vide o o r Digita l Photo' s Taken : nVide o nDigita l Phot o O n: / / By : Reason : D Vide o nDigita l Phot o O n: / / By : Reason : D Vide o nDigita l Phot o O n: / / By : Reason : nVide o nDigita l Phot o O n: / / By : Reason :

## Consen t fo rAcces s t o Propert y SAID # 

# Sb'A ^ RIGH T O FENTR Y T O PREMISE S 

### Granto r (th e property owner) , consent s to 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 dperfor mcertai nenvironmenta l respons e activitie s upo nth e follovin g describe dpremises : Owner' s Name ^ 7i^<ift nA/CW-iOl ^ Daytim e Phone : Address : 

# /y^ f (WU / Address : ^ 

### Addresse s o f Propertie s Address : 

### coveredb 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 propert y whic hare contaminate dwit hhazardou s substances , i nparticular leada t concentration s greate r tha no r equal to 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 : 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 ofth e envirormiental response ; c .Plaimin 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 withan y o f th e activitie s o r work done , o r th e equipmen t use dt o perfor mth e activities , o r t o undertak e an y 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

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

Signatur e Dat e

### Additiona l Comment s / Instructions :

D Chec 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 ro f house , includin g foundatio n crack s o rfissures .

nI d o no t agre e J ^ I agre e nI d o no t agre e
Contractor'srSignatur 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 propert y 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 ovmer an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA) .

SAID : 

# ^or^A ) PropertyAddress:/^^ / ^^^ ^ . ^ Phone 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 . Indicat e 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 replace d

Ite m 

# htp/(^C / <J / /u/c u liJi H oU' l Sd'///UO^o^J J Item : Item : item : item : Item : (tern :

Pag e 1 o f 2

### nI d o no t agre e 

# i^ I agre e Q I d o no t agre e 

# ^--^- w y/^yr \ Contractor' s Signatur e Date Attachmen t

Pag e 2 of 2

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio no f remedial activitie s performe do nm y property . My signature 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 i n question , now , o r at any tim e i nth e future , excep t thos e item s liste dbelow , i f any . SAID : 

# • 

# Gos-
- "7 0 PropertyAddress : ^^^ / ^q^^ f ^ST J Plion e Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item : Additiona l Comments :

\j/y^ \agre e restoratio ni s completed , excep t a s note d Jj dI agre e restoratio ni s completed , excep t a s note d I I I d o no t agre e restoratio ni s complete d I I I d o no t agre e restoratio ni s complete d 

### Qa^jCt^Ibr- ^ S-^-\ \ 

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### Date * Contractor' s S

### Dougla s Count y Accoun t Info^^^tio n Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R203058000 0 Prin t Repor t Vie wInteractiv e GI S Ma p Informatio 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 MCKEL L 3 HOUSTO N ETA L P O BO X 1178 4 OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : 305 8 OOO O 2 0 Accoun t Type : Residentia l Parce l Numbe r 203058000 0 Parce l Address : Lega l Description : PRUYNE S SU B DI V LO T3 2 LO T2 BLOC K0 3 0 X 7 8 Valu e Informatio n Lan d Improvemen t Tota l 201 0 $200.0 0 $0.0 0 $200.0 0 200 9 $200.0 0 $0.0 0 $200.0 0 200 8 $200.0 0 $0.0 0 $200.0 0 200 7 $200.0 0 $0.0 0 $200.0 0 200 6 $200.0 0 $0.0 0 $200.0 0 200 5 $200.0 0 $0.0 0 $200.0 0 

### Sho wAl l Transaction s

Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 5 2340. 0 0. 0 78. 0 30. 0 Ye s



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2. . . 11/19/201 0

### Dougla s Count y Accoun t Info'^^-'tio n Pag e 2 of 2

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 of a property' s location . I f yo u requir e a more exact propertylocation , yo u ma yus e th e Interactiy e GI S Map s tha t ar e maintaine d b you r office .



### http://doug!asne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2. . . 11/19/201 0

### ENVIRONMENTA L AS-BUILTDRAWIN G ^ OMAH ALEA D SUPERFUN D ^ RESTORATIO N 

# ^053 0 Exterio rPain l Nort h Arro w Omah a Lea d Sit e Owne rName : Tejshc t /Jcxit^So/ ^ • Goo d Sit e Sketc h Address : /gZ. ^ Cer4>i f S-/- ­ • Poo f Phone : H : g yo-Vg'gg'w : r~ l No t pain t Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Coltecfe d Firm : RYASCPXA-5-0ir=) 0 F l 

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