### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAI D # : 2a^5? MDate : H-V- W Address : 99\- 7 ( Q ic \<u i Remediatio nContractor : Envrionmenta l Restoration , LLC

_Year : 201 0 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S ^Vide o o f propert y (DVD ) .^^efor e DAfte r D Basemen t D JZ T Executiv e Summary (Final Report ) / 0 EPA-provide dproperty sketc h 0 ^ Signe dAcces s Agreemen t fo r subjec t propert y D Signe dAcces s Agreement(s ) fo r adjacen t propert y Restoratio nA-greemen t
• Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) ^ Confirmatio ndat a ^ . Photograph s 2 J Befor e DCre w Photos^Durin g Excavarlc nD 3o d -jaOO-dav £od> g N t So p Af g //OM^OCUA/^ ^ /^^AJMA ) 

### fii^dT^ )

/ As-buil t sketc h yZ T Completio nAgreemen t signe db y Propert y Ov/ne r D

r Propert y close-ou t chec k lis t signe db y EP A

• Descriptio no f area s no t meetin g RO D cleanu p criteri a ^0 r Utilit y clearance s [ y Propert y informatio n&o mDougla s Count y Assessor' s Offic e >z

r Propert y acces s cliecklis t ^y 3026185 8 

### Contac t Lo g 

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### ~ Environmenta l Restoratio nSignatur eDat e //)'/'/-/ / Dat e

# EPA EP A Propert y Clos e Ou t For m Omah aLea dSit e Propert y # : I^'ttS^ ^ Propert y Address : 2.'gV" l S^ . \C^A- 0 

### Date/Time : Owner' s Name : UTT^V / pFgg,<- J 

### Quad s Excavated:] ] IBZ_ Contracto r Grou p : Environmenta l Restoratio n (ER ) Excavatio nGenera l 1 . Ifnecessary , were th e correc t quadrant(s ) excavate dan drestored? 2 . If necessary , were th e correc t area s o f dri p zon e excavate dan drestored ? \i/jiP(H\ T lo T Ye s yy 

# Kl N o
Gradin g So dan dVegetatio n Ve s N o house ? 2 . Ha s so dbeenlai di nal l area s that were excavated ? 

## y C-lO X ADA\Q^'^£.~ ^ / 3 . Doe s th e so dappear t o b e generall y health y an dgrowing ? (Onl y evaluat e ifinspecte dat 30-day tim e period) . 4 .

Are todda darea s generall y fir man devenl y graded ? y 5 .Are th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t 30-day tim e period) . 6 .Wa s th e property grade dsuc hthat wate r wil l no t poo l o nth e property ? \ ^ 7 .

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

## y Gates , Fence s an dRetainin g Wall s Ye s N o 1 .D o gate s ope nan dclos e freely ? (ifapplicable ) 

# 4 ­ 2 .Were all gate s o r fence s take ndow ndurin g restoratio nactivities 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 ) 

# I 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 navoided ? Wa s damag e t o windows avoided ? 

# "mu ^ u r 4.
- Wa s damag e t o windo w screen s o r doo r screen s avoided ? 

# 4 : 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 M 2 .Wa s damag e t o walkway surface s avoided ? 

## \!l k Inspectio nnotes :



### Remedia l an drestoratio nactivitie s complet e includin g 30-da y so dwarranty : EP A Representativer"^^ ^ S ^ 

### yUyy L Dat e 

# : W/ /

## / JQ. ^ \

Omah a Lea d Site—EP-R7-09^ 5 iJi^iiVrf C f Environmenta l Restoration , LL C \ , ,<< ^

www.crHc.coi m \rntyf


# EXECUTIV ESUMMARY : 2988 4 2817N19A V



# No Issue s o r Concern s Q Issues/Concern s
Detai l Exnlanntinn ­rag e i o r t
"> [ Creat e Anothe rTicke t ^ [ Bac k t o Irt h Interne t ] ( Sen d Emai l ]

• YOU RTICKE T NUMBE RI S 2668836 . Origina l Cal l Date : 2/04/1 1 Time : 7:4 0 a m Op: . ADAM2418 6 Wor k t o Begi n Date : 2/08/1 1 Time : 8:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 281 7 Street : N19TH AVE Twp : 15 NRng : 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 : 2988 4 : RESENDIN G DO E T O WORK EXTENDIN G Compan y: ENVIRONMENTAL RESTORATION 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 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 Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y MU D Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCITY O FOMAHA-TRAFFIC,SEWE R RICH/TRAFFI C Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 0PPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T EL M LOCATIN GAlt : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 QLNN EI 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. . . 2/4/201 1

### rag e i oi i

" > [ Creat e Anothe rTicket ] [ Bac k t o Irt h Internet ] | [ Sen d Emai l ]
YOU RTICKE T NUMBE RI S 2667198 . Origina l Cal l Date : 1/26/1 1 Time : 3:4 7 pm Op : ADAM2418 6 Wor k t o Begi n Date : 1/28/1 1 Time : 4:1 5 p m state : N E County : DOUGLA S Place : OMAH A Address : 281 7 Street : N19T H AVE Twp : 15 NRng : 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 : 2988 4 Compan y: ENVIRONMENTA L RESTORATION 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 , IN C HEIDI Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUDO l METROPOLITA NUTILITIES DISTRICT SANDY MU D Day : 402504782 3 Alt : Emera : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R RICH/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 QLNN E1C QWES T LOCA LNETWOR K EL M LOCATIN G Day : 406728934 3

Alt : 406207149 4

Emerg : 888728934 3

htt p ://www.dhon.org/irthinteraet/D H ONNoticeCreation/MessageText.asp?ret-<RESULTS.. . 1 /26/201 1

## Contac t Informatio n Lo g 

# ;)'?ss' ^ SAID # Daytim e Phone : J / Q • J^/ ^ / ^ j / '^j ^ PropertyAddress : Pg| 7 ^ . (<fB ^ -hiJ ^ 

### Attemp t t o contac t Date/tim e Nam e / 2 />-/ o / 0^oi > 

# g

## Propert yAcces s Checklis t SAID : 

# ;?^^ ^ Property~Address : ^ Srl O A j l ^ ^'C
- D D WOR K STARTE D WOR K COIVIPELTE D ON : __/__/_ ON : / / Owner ; Renter : Address : 

# Jln o M /'/'^ ^ Phone : Fax : Cell/Pager ? 

### Phone : (/67,-^</ G­ 3 H jr ' Additiona l Information : Fax : Cell/Pager : ^ ^ Acces s Agreemen t Signed : 12- 1 6^ 1 / 6 ©Restoratio nAgreemen t Signed:/Z
­ I Of f 11 0 Q'^de o Propert y Befor e O n •.)' L lo ^

li b [^l^-fllgita l Photo s Befor e O n-.12
- lol f I l o nVide o Propert y Afte r O n nDigita l Photo s Afte r O n Q T Propert y Completio nAgreemen t Signed : ^ I ^ I I f 

### By : /^Z ) nFina l Repor t Signed : / / By : Additiona l Vide o o rDigita l Photo' s Taken :

n Vide o D Digita l Phot o O n : / / By : Reason : 

# 1 n Vide o n Digita l Phot o O n : / / 

### By : 1 Reason : D Vide o D Digita l Phot o O n : / / By : Reason : n Vide o n Digita l Phot o O n : / / By : Reason :

## Consen t fo rAcces s t o Propert ySAID # J^l^s' / 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 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 nenviroiunenta l respons e activitie s upo nth e followin g describe dpremises : Daytim e Phone : %2,--3'iU-3i f 9 ^ Address : ^^ ^ ^ / ^ ^^i ^ ^ ^ Address : 1 

### Addresses o f Propertie s Address : 

### covere db y thi s Agreement : Address :1 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 a t th e propert y whic hare contaminate dwit hhazardou s substances , i nparticular leada t concentration s greate r tha no r equal t o 40 0 part s pe r millio n(ppm) . REMEDIA LACTION S Th e environmenta l respons e action s t o b e performe do nsai dproperty ma y 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 inpreparatio nfo r an dinth e cours e ofth e environmenta l response ; c .Plarmin 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 withany o f th e activitie s o r work 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 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

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

## 'fCuXUj ^ 1,/jlAjy/ ^ I7.,i^% 0 I S Signatur e Dat e Signatur e Dat e

### Additiona l Comment s / Instructions : 

# ^/fc*- f -^ ^

BP Chec k thi s boxi 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 . 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 .

Ij M I agre e Q I d o no t agre e ^\I agre e H H I d o no t agre e

Owner' s Signatur e Date Contractor'sSignatur 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 that restoratio n activitie s are 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) .

SAIP : J^il^d- f 

### Propert y Address : ^9'/ 7 / V / ^ ^9^ ^ Owner : ^^; ^ f?^^ / 

## Phone : y^^-,^/^ . y^V/" ^ Onth 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 by 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 repiaced :

Itemy ] 

# Ai l (MfG L 

# u>A3^.J0 b 

# ^M ) / / 

### 4 , ^Cu^Jey i Item : Item : Item : Item : Item : 1 Item :

Pag e 1 o f 2

### \y \I agre e U U I d o no t agre e j^ 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 of 2

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

amsatisfie dwit hth e restoratio nof my property , an dtha t no item s ar e in question , now , or at an y tim e inth e future , excep t thos e item s liste dbelow , ifany . 

# sA»p : j^l'ffF W Propert y ^^/ H Jl / / ^ ^€
­ ' Address

Address : y3(r/^ / Owner : 

### Phone : 3^^^^^/ ^ ^ 

### Restoratio nItem s inQuestio n Item : Item : Item : Item : Item : Item : Additiona l Comments :

\j^\agre e restoratio nis completed , excep tas note d .J'HTagre e restoratio n is completed , excep t as note d I I I do no t agre e restoratio n Is complete d I I I do no t agre e restoratio n is complete d 

# fjJX^/jyy ^ Z-7-2-g/ /

-y^ ^ Okl^^ ^ J'f . / ' Owner' s Signatur e Dat e Contractor' s Signatur e Dat e

### Dougla s Coimt y Accoimt Infaa k

io n Pag e I of 2 Dougla s County , Nebrask a Propert yRecor d - R220688000 0 Prin t Repor t Vie wInteractiv e GI S Ma p Informatio n i s vali d a s of 2010-11-1 6 Treasurer' s Ta xRepor t Ne wFeatur e ->->• • Subdivisio n Sale s Searc h Owne r PERRY RUTHI E L 282 0 N 1 9 AV E OMAH AN E 68110-000 0 Propert yInformatio n Ke yNumber : 068 8 OOO O 2 2 Accoun t Type : Residentia l Parce l Number : 220688000 0 Parce l Address : Lega l Description : 281 7 N 1 9 A V OMAH AN E 68110-000 0 SHERWOOD S SU B DI V LO T5 BLOC K1 6 0 X 8 1 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 0.1 1 S F 4860. 0 Unit s 0. 0 Dept h 81. 0 Widt h 60. 0 Vacan t Ye s



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

### Dougla s Count y Accoun t InfiMt io n Pag e 2 o f 2

Ohi o S t

POWERE D BV Map data 6001 0 Googte i Th e abov e ma p I s powere d byGoogle , 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 mayus 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/accountinfo.js p ?accountno=R2.. . 11/19/201 0

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A\',KK.\C; K Ani)ui;s. s SAMI'LKAIIIC A OI'KUAIO K NOTK S SAI D I 2011-02-0 9 11-.0 4 Av « o f 532-53 4 2817 n 1 9 av . E Z RO N surfac e fina l clearanc e 311.3 2 ±29.3 2 2 2011-02-0 9 11:0 4 2817 n 1 9 av E Z RO N surfac e final clearanc e 2988 4 276,1 0 ±27.7 0 3 2011-02-0 9 11:0 4 28171 1 1 9 av ! E Z RO Nsurfac e final clearanc e 2988 4 323.0 1 ± 30.0 6 4 2011-02-0 9 11:0 3 281 7 n 1 9 av E Z RO N; surfac e final clearanc e 2988 4 334.8 4 ± 30.1 8 5 2011-02-0 9 10:5 5 Av B o f 528-53 0 28171 1 1 9 av n 2 RO N 8 final clearanc e 96.0 2 ±17.7 3 6 2011-02-0 9 10:5 5 2817 n 1 9 av B 2 RO N 8 final clearanc e 2988 4 105.2 3 ± 18.1 0 7 2011-02-0 9 10:5 5 2817 n 1 9 av Q2 RO N8 final clearanc e 2988 4 86.8 7 ± 17.1 0 8 2011-02-0 9 10:5 4 2817 n 1 9 av B 2 RO N8 final clearanc e 2988 4 95.9 6 ± 17.9 9 9 2011-02-0 9 10:5 1 Av g of524-52 6 2817 n 1 9 av B l RO N8 final clearanc e 45.9 5 ± 14.0 8 1 0 2011-02-0 9 10:5 1 2817 n 1 9 av B l RO N 8 final clearanc e 2988 4 47.9 6 ± 14.3 0 I I 2011-02-0 9 10:5 0 2817 n 1 9 av B l RO N8 final clearanc e 2988 4 38.4 7 ±13.3 9 1 2 2011-02-0 9 10:5 0 2817 n 1 9 av B l RO N8 final clearanc e 2988 4 51.4 3 ± 14.5 6

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