### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SA1D# : ^t)'S^lp' ^Date : Address : 

# \^^ ^ 

# ^ ^ b Av . Remediatio nContractor : Envrionmenta l Restoration , LLC

_Year : _2010 _ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S
^ Vide o o f property (DVD ) ^b^efor e D After D Basement ^ ZJ U h?^f1^M y ^ ^ Executiv e Summar y (Final Report ) Ih^^CMyj/ , ^H , EPA-provide dpropert y sketc h ^B ^ Signe dAcces s Agreemen t fo r subjec t propert y
• Signe dAcces s Agreement(s ) fo r adjacen t propert y ^H ^ Restoratio nAgreemen t D Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) ^^S ^ Confirmatio ndat a S .

Photograph s _ ^ Befor e D Cre w Photo s NDurin g Excavatio nD So d ^ 30-da y So dD N . As-buil t sketc h ^ ^ Completio nAgreemen t signe db y Propert y Owne r h i Propert y close-ou t chec k lis t signe db y EP A D Descriptio no f area s no t meetin g RO D cleanu p criteri a " ^ Utilit y clearance s ^ S ^ Propert y informatio nfro mDougla s Count y Assessor' s Offic e ^'•^S s Propert y acces s checklis t "^^^ Contac t Lo g 3026058 9 

### D 

### Superfun d Environmental Restoratio nSignatur e Date

^ EPACORsignatur e ~/ y Dat e

### jQy- i Omah a Lea d Site—EP-R7-09-0 5 ^^^ ^

J Environmenta l Restoration , LL C ^

www.crllc.co m • ' I ,.ma-i^ ^ 

# EXECUTIV ESUMMARY : 20263-131 5 S 3 0 A V ^^""f^ nN o Issue s o r Concern s Q Issues/Concern s Detai l Explanation :

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

# :^t)au> 3 PropertyAddress : \3>) ^ ^ 3 ^ m Date/Time : Owner' s Name : CSovC ^ ^l^rw » Quad s Excavated : JJ ) Contracto r Grou p : Environmenta l Restoratio n(ER ) Excavatio nGenera l Ye s N o 1 . Ifnecessary , wer e th e correc t quadrant(s ) excavate dandrestored? • ^ 2 . Ifnecessary , wer e th e correc t area s ofdri p zon e excavate dan drestored? ^ Gradin g So dan dVegetatio n Ye s No 1 . Doe s th e gradin g aroun dth e perimete r ofth e hous e i nexcavate darea s generall y slop e away fromth e house ? ^ 2 . Ha s so dbee nlai di nal l area s that wer e excavated ? • ^ 3 . Doe s th e so dappear to b e generall y healthy andgrowing ? (Onl y evaluat e ifinspecte dat 30-day tim e period) . 4 . Ar e sodde 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 ifinspecte dat 30-day tim e period) . 6 . Wa s th e property grade dsuc hthat water will no t poo l o nth e property ? ^ 7 . Wa s damag e to landscapin g o r plan t material s avoided ? ^ ^ Gates , Fence s an dRetainin g Wall s Ye s No 1 . D o gate s ope nan dclos e freely? (ifapplicable ) 

### /vT A 2 . Wer e al l gate s o r fence s take ndow ndurin g restoratio nactivitie s re-installed ? 3 . Wa s damag e to gale s o r fence s avoided ? (ifapplicable ) (ifapplicable ) 

## A/ ^ ^y 4 . Wa s damag e to retainin g wall s avoided ? (ifapplicable ) 

## A/ i Foundation , Sidin g an dGutter s Ye s No 1 . Wa s damag e to sidin g o r tri mavoided ? y ^ 2 . Wa s damag e to th e foundatio navoided ? y 3 . Wa s damag e to windows avoided ? ^ y ^ 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 ? y Sidewalk s an dDriveway s (Concrete ) 1 . Wa s damag e to drivewa y surface s avoided ? 2 . Wa s damag e to walkway surface s avoided ? 

### Inspectio nnotes : Ye s ^ y N o



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

### ENVIRONMENTA L
RESTORATIO N 

# RESTORATIO NCHANG EORDE R OMAH A LEA D Propert y I D #2ot(J h Propert y Addres s / 3 f ^ t > • "^Z ^ A\J € Owne r Nam e J/gc ^ L• SAATT S 

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

### YOU RTICKE T NUMBE RI S 2497473 . Origina l Cal l Date : 5/19/1 0 Time : 2:0 2 p m Op : TRACY2418 6 Wor k t o Begi n Date : 5/21/1 0 Time : 2:3 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 131 5 Street : S 30T H AV E Twp : 15 NRng : 13 E Sect-Qtr : 28-NE-NW Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : Excavatin g th e entiir e propert y Locatio n o f Work : LOCAT E ENTIR E PROPERT Y Remarks : FAX AL L CLEAR S TO : (402) 4 51-106 9 : SAI D #2026 3 Compan y Contact Nam e Alt . Contact ENVIRONMENTA L RESTORATIO N TRAC Y BRISTO W Phone : ( 4 02) 4 51-131 4 Phone : (314)504-487 4 Wor k Bein g Don e For : EP A Dept h o f Excavation : 1 2 Corne r Lot : Involve s Tunnelin g o r Horizonta l Borin g : CXCAT V LEVEL 3 MUD0 2 OMAHACO F NFront : Y NExplosives : N

0PPDGPR 6 QLNNEI F Rear ;

Servic e Are a Contac t Phon e Nunibe r Utility Typ e 

### Day . 402934046 9 CXCAT V CO X COMMUNICATIONS , INC HEID I 

### Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 LEVEL 3 LEVEL 3 COMMUNICATIONS , LL C NA 

### Alt : Emerg : 877366834 4 Day : 402504782 3 MUD0 2 METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Alt : 

### Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCITYOFOMAHA-TRAFFIQSEWE RRJCH/TRAFFI C Alt : 402444516 1 

### Emerg : 402444516 0 http://www.dhon.org/irthinternet/DHONNoticeCreation/]VlessageText.asp?ret=<RESULTS. . . 5/19/201 0

### Pag e 2 o f 2

0PPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T EL M LOCATIN G 

### Day :

Alt : 

### 406728934 3 406207149 4 

### Emerg : 888728934 3 QLNNEIFQWES T LOCA LNETWOR K

EL M LOCATIN G 

### Day : 406728934 3

Alt : 406207149 4 

### Emerg : 888728934 3

http://www.dhon.org/irthinternet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 5/19/201 01 

## Contac t Informatio n Lo g SA8D # o?OP0. 3 ^^^ ^ 6/6''3GQ S Owner'sName : "^ajcJP —^/niV s Daytim e Phone : ^ ^iPC^^ ' 1 Propert yAddress : 13^ 3 5 - ^^' ^

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

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### nWOR K COMPELTE D ON : / / Owner : ^ 3^cf c Sv^t^J ^ Renter : Address : „ r\ Phone : Fax : Cell/Pager : Phone : '=f^'^C^< / Additiona l Information : ' Fax : Cell/Pager : [3 3 Acces s Agreemen t Signed : S^ 7c?i ^ / (t> By : <^l ^ [i ^ Restoratio nAgreemen t Signed : ^ i^J > ll O By : (U ) bd ' Vide o Propert y Befor e On: ,c ; / ,< ; / /.-t ) 

### By : A. 0 Digita l Photo s Befor e On :^/^/jD . By = / ^ • Vide o Propert y Afte r On: / / By : nDigita l Photo s Afte r On: / / By : 0 Propert y Completio nAgreemen t Signed : C o ll 7 / / O By : ^ nFina l Repor t Signed : / / By : Additiona l Vide o or Digita l Photo' s Taken : D Vide o nDigita l Phot o On: / / "B, : Reason : D Vide o • Digita l Phot o On: / / By : Reason : i D Vide o nDigita l Phot o | On: / / 

### By : 1! Reason : j D Vide o nDigita l Phot o On: / / 

### By : 1 II Reason :

Omah a Lea d Projec t Wor k Pla n Pag e 1 of 19

## Consen t fo rAcces s t o Propert y PO30 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 Environmenta l 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' s Name : \joictc

_ J/vt//- ^ DaytimePhone : ^//
- J^<l5 y Address : 

# L3/S 5 ' 30 ^ 

# I'^o ^ 1 Address : Addresse s o f Propertie s covere db y thi s Address : Agreement : Address : Address : PURPOS EO FINVESTIGATIO N 

### Th e purpos e of 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 , inparticula r leada t concentration s greate r thano r equal t o 40 0 part s pe r millio n(ppm) . REMEDIA L ACTION S 

### Th e environmenta l respons e action s t o b e perfomie do nsai dpropert y 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 dafte r remedia i activities ; b .Locatin g equipmen t an dmachinery on-sit e i npreparatio nfo r an di nth e cours e ofth e enviromnenta l response ; c .

Plannin g an dimplementin g th e remova l actio no no r near Grantor' s property . d .Obtainin g sample s fro mGrantor' s property ; AGREEMEN T NO T T o INTERFER E 

### Th e Granto r agree s no t t o interfere 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 undertak e an y action s regardin g th e us e o f sai d propert y whic hwoul dten dto endange r th e healt ho r welfare o f th e Grantee s o r th e enviromnent , o r

t o allo w other s t o us e th e property i nsuc h I gran t acces s t o my propertk s [ U I d o no t gram t acces s to m y propertie s

Signatur e Dat ey ^ 

### ro 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 done t o th e interio ro f house , includin g foundatio n crack s o rfissures .



### R^- I agre e n1 do iio t agre e I I i agre e \// \I do no t agre e

Contractor' s Signatur e Date

### Restoratio n Agreennen t Th e purpos e o f thi s agreement i s t o provid e amutua l 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 nfo r 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 propert y owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA) .

SAI D 

### '• 3^03-C^ 3 PropertyAddress : /^^ S S
- ZTC ^ A"* ^ Owner : -JZ^J ^ ^r^f-fs . . . . Phone : f^^.^Pog ^ O nth e attache ddiagram(s ) indicat e 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 an dlandscapin g features , acces s location(s ) t o b e use db y contractor , an dth e directio no f North . Indicat e distances , depths , materia l types, etc . Indicat e digital photo s b y referencin g th e photo-lo g numbe r wit ha narro w indicatin g directio no f view . item s t o b e remove db y Contracto r an dno t replaced ; Item : 

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### Thi s agreemen t documents th e completio no f remedia l activitie s performe do nm y property . M y signatur e wil l designat e tha t I amsatisfie dwithth e restoratio no f m y property , an dtha t n o item s ar e in question , now , o r at any tim e i nth e future , excep t thos e item s liste dbelow , ifany . SAID : P0^6 3 Propert y Address : / 3/ 3 S > .Jto ^ /ft*< . O w 

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### PT l agree restorationis completed, excep t a

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### LyuLiiita s «^uLmi y Accoun t inrormalio n Pag e 1 o f 2 Dougla s County , Nebrask a Propert yRecor d - R123791000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f 52nc i S t - Vie W O n Ma p Informatio n i s vali d a s o f 2009-12-3 1 Treasurer' s Ta xRepor t Ne wFeatur e ^ '- ^ -> • Aut o Sale s Searc h Owne r SMIT S JAC KL ETA L 53 4 COOPE R R D ASHLAN D N E 68003-550 5 PropertyInformatio n Ke yNumber : 379 1 OOO O 1 ­ 2 Accoun t Type : Muitipl e Re s Parce l Number : 123791000 0 Parce l Address : Lega l Description : 131 5 8 3 0 A V OMAH AN E 68105-000 0 HANSCO M PLAC E LO T1 9 BLOC K1 1 5 0 X 15 0 Valu e Informatio n 200 9 200 8 200 7 200 6 200 5 200 4 ^ Lan d $6,800.0 0 $6,800.0 0 $6,800.0 0 $6,800.0 0 $6,800.0 0 $6,800.0 0 Improvemen t $58,500.0 0 $58,500.0 0 $58,500.0 0 $60,200.0 0 $60,200.0 0 $60,200.0 0 Tota l $65,300.0 0 $65,300.0 0 $65,300.0 0 $67,000.0 0 $67,000.0 0 $67,000.0 0 Lan d Infor m atio n Acre s 0.1 7 S F j 7500. 0 j Unit s j 1. 0 Dept h 150. 0 Widt h 50. 0 Vacan t N o Improvement Informatio n Buildin g 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.isp?accountno= R12.. . 1 /18/901 0i^uugia s <._.uuni y Accoun t miormauo n I'ag e ZO t 2

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