### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL EFOLDE R SAID# : P77<:. aDate : U-\-l\ Address : <^^^ ^ A/
- /' A A^M ^ Remediatio n Contractor : Envrionmenta l Restoration , LLC

_Year : _201 0 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S jX " Vide o o f property (DVD ) ^^^^for e DAfter D Basemen t D

—X Executiv e Summary (Fina l Report ) X EPA-providedpropert y sketc h Signe dAcces s Agreemen t for subjec t propert y D Signe dAcces s Agreement(s ) for adjacen t propert y Restoratio n Agreemen t
• Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) X ^ Confumatio n dat a y f Photograph s /Q Before DCre w Photos_,J2^urin g Excavatio nD So d J2^0^a y So dD ^ As-built sketc h X Completio n Agreemen t signe db y Property Owne r jX Property 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 Utilit y clearance s Property informatio n fro mDougla s Count y Assessor' s Offic e Property acces s checklis t
„ , , 3026189 5 

### Contac t Lo g Vacayi' ' ^7 ^

Superfun d 

### Envirotimenta l Restoratio nSignatur e Dat e 

# /a-iZ' / / Date

# EP A EP A Propert y Clos e Ou t Form Omah aLea dSite OU# 2 Property# : ^?76> a PropertyAddress : tP^^ f A / /f'^7h ^ Date/Time : Owner' s Name : %^ 7 T^rr y Quad s Excavated : FIjFJ.'BljB S Contracto r Grou p : Environmenta l Restoratio n (ER ) Excavatio n General ^fjIX'Jlh ^ I oT " Ye s N o 1 . Ifnecessary , wer e the correct quadrant(s ) excavatedan drestored ? 

# y 2 . Ifnecessary , wer e the correct areas ofdri p zon e excavatedan drestored ? Gradin g So dan dVegetatio n Ye s N o 

### y house ? 2 . Ha s sodbee n lai dmail area s tha t wer e excavated ? y ^ 3 . Doe s th e sodappea r t

o be generall y health y an dgrowing ? (Onl y evaluat e i f inspecteda t 30-da y tim e period) . 4 . Ar e sodde darea s generall y fir man devenl y graded ? \ y ^ 

### 5 . Ar e th e Joints betwee nth e sodstrip s generall y tight ? (Onl y evaluat e ifinspecte da 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 ? xy 

### 7 . Wa s damage to landscaping o r plan t material s avoided ? iy Gates , Fence s an dRetainin g Wall s Ye s N o 1 . Do gates.ope nan dclos e freely ? (ifapplicable ) 2 . Wer e al l gate s o r fence s take ndow n during restoration activitie s re-installed ? (ifapplicable ) 

# it M 3 . Wa s damag e t

o gate s o r fence s avoided ? (ifapplicable ) 4 . Wa s damag e to retaining wall s avoided ? (ifapplicable ) Foundation , Sidin g an dGutter s Ye s N o 1 . Wa s damage t o siding o r tri mavoided ? 2 . Wa s damage t o the foundatio n avoided ? 3 . Wa s damage t o window s avoided ? 

# \J/lM(\i ' Jrr E 1 ^ 4 . Wa s damage t o window screen s or door screen s avoided ? 5 . Wa s damage t o downspouts o r downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Yes N o 1 . Wa s damage to drivewa y surface s avoided ? ^ ^ 2 . Wa s damage t o walkwa y surface s avoided ? K W Inspectio n notes :


## Remedial an drestoratio n activitie s complete includin g 30-day so dwarranty : EP A Representativ e 

## Date : 3/^U^ H ^

## fjQl^ \

Omah a Lea d Site—EP-R7-09.0 5 5 -S^feji - ^ Environnfienta l Restoration , LL C \2 . J p www.crllc.co m 

# EXECUTIV ESUMMARY : 29762 2809N19A V X No Issue s o r Concern s Q ] Issues/Concern s Detai l Fynlanarinn :[ Creat e Anothe rTicke t " ) [ Bac k t o Irt h Interne t ] Sen d Emai l |

• YOU RTICKE T NUMBE RI S 2670466 . Origina l Cal l Date : 2/10/1 1 Time : 4:4 6 p m Op : ADAM2418 6 Wor k t o Begi n Date : 2/14/1 1 Time : 5:1 5 pm State : NE County : DOUGLA S Place : OMAH A Address : 280 9 Street : N19T H AVE Twp : 15 N.Rng : 13 E Sect-Qtr : 10-NW-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 : 2976 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 : Involve s Tunnelin g 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 , IN C HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y MU D Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFIC.SEWE R RICH/TRAFFI C Day : 402444719 7 Alt : 402444516 1 Emera : 402444516 0 0PPDGPR 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. . . 2/10/201 1

## Contac t Informatio n Lo g SAI D ^^n ^
OwneV s Name : Daytim e Phone : V^Z-i^f/-<^yg^ ^ [ ' C - Propert y Address : J}St7c£^ / ^ '

1 

### Attemp t t o contac t Date/tim e t Nam e 

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## Propert yAcces s Checklis t SAID : 

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WORKSTARIE D WOR K COIVIPELTE D ON : ON :
Address : 

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­ <^^^ ^ Fax : Cell/Pager : Phone : Fax : Cell/Pager : Additiona l Information :

B^^Acces s Agreemen t CS^estoratio nAgreemen t [Q/Vldeo^ropert y Befor e Q^,<B^a l Photo s Befor e nVide o Propert y Afte r n Digita l Photo s Afte r >Q^Propert y Completio nAgreemen t

O Fina l Repor t Signed:^//^// ^ Signed:/Z
- //^ / ^ O 

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Additiona l Vide o o r Digita l Photo' s Taken : nVide o D Digita l Phot o
Reason : nVide o Reason : D Vide o D D Digita l Phot o Digita l Phot o / By : By :

### # 

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

# ;2f76 ^ RIGH T OFENTR YTO PREMISE S 

### Granto r (th e property owner) , consent s to an dauthorize s th e Unite dState s Environmenta l Protectio n Agenc y (USEPA ) or it s authorize drepresentatives , collectivel y th e Grante e to ente r an dperfor mcertai n environmenta l respons e activitie s upo nth e followin g describe dpremises : I Own i Daytim e Phone : ^Z-'^fZ-^f ^

Oer' sName : 

# ll>he^4
- Pey r KM^ : JZ^^ ^ /U / ^ ^" ^ Address : Addresse sof Propertie s covere dby thi s Address : Agreement : Address : Address : PURPOS E OFINVESTIGATIO N 

### Th e purpos eof th e remedia l activitie s is to remov e al l soil s at th e property whic hare contaminate dwithhazardou s substances , in particular lead at concentration s greate r tha nor equal to 40 0 part s per millio n (ppm) . REMEDIAL ACTION S 

### Th e environmenta l respons e action s to be performe don sai dproperty ma y includ e th e followin g activities : a.Takin g photograph s and/o r vide o of th e property before , during , an dafter remedia l activities ; b.

Locatin g equipmen t an dmachinery on-sit e in preparatio nfor an d in th e cours e of th e environmenta l response ; c.Plannin g an dimplementin g th e remova l actio n on or near Grantor' s property . d.

Obtainin g sample s fromGrantor' s property ; AGREEMENT NO T TO INTERFER E 

### Th e Granto r agree s no t to interfere or tampe r withany of th e activitie s or wor k

done , or th e equipmen t use dto perfor mth e activities , or to undertak e an y action s regardin g th e us eof sai d property whic hwoul dten dto endange r th e healthor welfareof th e Grantee s or th e envirormient , or

to allo w other s to us e th e propertyin suc h [ gran t acces s to my propertie s Q I do no t gran t acces s to my propertie s

ignatur ' Dat e Signatur e Dat e Signatur e e#



### • Chec k thi s boxi f own^ 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 pclssibl e preexistin g damage . Bycheckin g thi s bo xE.R . i s no t responsibl e fo ran ydamag e done/t o th e interio ro f house , includin g foundatio n crack s o rfissures .



## • I agr6e n I d o no t agre e I 1 1 agre e n I d o no t agre e

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 propert y prio r t o contracto r activities . Thi s wil l als o serv e a s documentatio n fo r th e purpos e o f assurin g that restoratio n activitie s ar e complete dt o th e satisfactio n o f th e property ovsoie r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA) .

SAID : 

# ;?f76^ . PropertyAddress : 2 ^ f / / /^^ ^ Phone : 

## H(ny On th e attache ddiagram(s ) indicate area(s ) t o b e excavate dan ddept ho 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 n o f North . Indicate distances , depths , material types , etc . Indicat e digital photo s by referencin g th e photo-lo g number wit ha n arro w indicatin g directio n o f view . Item s t o b e remove d b yContracto ran d no t replaced : 

# (ccc e ^ 1 at^g^ s k>\\\ \I^Ja J ^o^ \^ ^ocl , Ite m Item : item : Item : Item : Item :

Pag e 1 o f 2

### iQ l agre e E H I d o no t agre e Jyf J agre e E H I d o no t agre e

Owner' s Signatur e D/t e Contractor' ^ Signatur e Date Attachmen t

Pag e 2 o f 2

### # 

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio nof remedial activitie s performe don my property . My signatur e wil l designat e that I

amsatisfie dwit hth e restoratio nof my property , an dthatno item s ar e in question , now , or at an y tim e inth e ftiture, excep t thos e item s liste dbelow , ifany . SAID : 

# 2^nio7 ^ Property Address 29 ^ / I /^'^" ^ ^aaress : : / Py) ' Owner : 

### Phone : ^^ ^ ^^<J^^ ^ Restoratio n Item s in Question :

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

# L

|/_f i agre e restoratio n is completed , excep t as note d ]yf \ agre e restoratio n is completed , excep t as note d I I I do no t agre e restoratio n is complete d I 1 I do no t agre e restoratio n is complete d 

# lUZM ^

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## Douglas Coimt y Accoun t Informatio n Page 1 of 2 Dougia s County , Nebrasic a Propert yRecor d - R174513000 0 Prin t Repor t Vie wInteractiv e GI S Ma p Informatio n i s vali d a s of 2010-8-1 6 Treasurer' s Ta xRepor t Ne wFeatur e -* Subdivisio n Sale s Searc h Owne r PERR YROBER TN 433 7 OHI O S T OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : 451 3 000 0 1 7 Accoun t Type : Residentia l Parce l Number : 174513000 0 Parce l Address : 280 9 N 19A V OMAH AN E 68110-000 0 Lega l Description : MILLAR D & CALDWELL' S AD D LO T3 6 BLOC K0 N 48.2 5 W 10 6 FT48.2 5 X 10 6 Valu e Informatio n Lan d Improvemen t Tota l 201 0 $500.0 0 $0.0 0 $500.0 0 200 9 $500.0 0 $0.0 0 $500.0 0 200 8 $500.0 0 $0.0 0 $500.0 0 200 7 $500.0 0 $0.0 0 $500.0 0 200 6 $500.0 0 $0.0 0 $500.0 0 200 5 $500.0 0 $0.0 0 $500.0 0 Lan d Informatio n T Acre s S F Unit s Dept h Widt h Vacan t 0.1 1 5088. 0 0. 0 48. 0 106. 0 Ye s



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