### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID# : 5"t^M 0 I Date : Address : TjK^ I 0 \ ^ \ ^ ^ ^ Remediatio nContractor : Environmenta l Restoration , LLC

_Year : _201 0 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S JZ! ^ Vide o o f property (DVD ) jaiSefor e D After D Basemen t D J2 ^ Executiv e Summary (Fina l Report ) jd ^ EPA-provide dproperty sketc h y dSigne dAcces s Agreemen t for subjec t property D Signe dAcces s Agreement(s ) for adjacen t property ja ^ Restoratio nAgreemen t D Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) y ^ Confirmatio ndat a J3 ^ Photograph s _^Befor e DCre w Photos.0T)urin g Excavatio nD So d ^0-da y So dD C K As-built sketc h 2 7 Completio nAgreemen t signe db y Property Owne r y ZProperty close-ou t chec k lis t signe db y EP A D Descriptio no f area s not meetin g RO D cleanu p criteri a ^ Utility clearance s

2

i Property informatio nfromDougla s County Assessor' s Offic e j dProperty acces s checklis t 3026220 0 

### ^ Contac t Lo g / 

### Envir a ronmenta l Restoratio nSignatur e Date /EPA CO Rsignatur e / Date

# EP A Property Clos e Ou t Form Omah aLea dSite 

# ^l^r A Propert y Address : ^Dl O M H 1> r Propert y # : SCiH o Dateyrime : Owner' s Name : 0. ^ o f

Omi ^ Quad s Excavated : m ^ Contracto r Grou p : Environmenta l Restoratio n(ER ) \llkCAUr U) r Ye s N o Excavatio n Genera l 1 . If necessary , were th e correc t quadrant(s ) excavate dan drestored ? v ^ 2 . [ f necessary , were th e correc t area s o f dri p zon e excavate dan drestored ? 

### 7/ A Ye s N o Gradin g So dan dVegetatio n 1 . Doe s th e gradin g aroun ddi e perimete r o f th e hous e inexcavate darea s generall y slop e awa y fromth e / • house ? 2 . Ha s so dbee nlai di nall area s that were excavated ? 3 . Doe s th e so dappear t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t 30-da y tim e period) .^ / ' 4 . As e sodde darea s generall y firman devenl y graded ? 5 . Are th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evahiat e if inspecte dat 30-da y tim e period) . 6 . Wa s th e propert y grade dsuc hthat wate r wil l no t poo l o nth e property ? 

### 7 7 . Wa s damag e t o landscapin g o r plan t material s avoided ? 

### V L Ye s N o Gates , Fence s an dRetainin g Wall s I . D o gate s ope nan dclos e freely? (i f ^plicable ) 2 . Were al l gate s o r fence s take ndow ndurin g restoratio nactivitie s re-instolled ? (i f applicable ) ^ 3 . Wa s damag e t o gate s o r fence s avoided ? (i f applicable ) 4 . Wa s damag e t o retainin g wall s avoided ? (i f applicable ) 

# ± Ye s N o Foundation , Sidin g an dGutter s 1 . Wa s damag e t o sidin g o r tri mavoided ? 2 . Wa s damag e t o th e foundatio navoided ? 

# Q I 

# -\

1 HJ^^ - Trf * 3 . Wa s damag e t o window s avoided ? 4 . Wa s damag e t o windo w screen s o r doo r screen s avoided ? 5 . Was damag e t o downspout s o r downspou t extension s avoided ? Ye s N o Sidewalk s an dDriveway s (Concrete ) I . Wa s damag e t o drivewa y surface s avoided ? 2 . Wa s damag e t o walkwa y surface s avoided ? Inspectio nnotes : 

### Remedial an drestoratio nactivitie s complet e includin g 30-da y so dwarranty : EPA Representative : ^^JzdU >^^ ^ JL? ^ I>ate : P/^/ / i o^^^^r ^



### - i Omah a Lea d Site—EP-R7-09-0 5 \taSiiiCii!rm , ^ Environmenta l Restoration , LL C V j ^

www.crllc.co m 

# EXECUTIV ESUMMARY : 50401-207 0 N 1 8 S T



# No Issue s o r Concern s Q J Issues/Concern s Detai l Rxniannrirtn :

### Pag e 1 of 2

[ Creat e Anothe rTicke t • j [ - . Bac k t o Irt h interne t ; Sen d Emaj L , 

### YOU RTICKE T NUMBE RI S 2626049 . Origina l Cal l Date : 10/25/1 0 Time : 6:3 9 p m Op : ADAM2418 6 Wor k t o Begi n Date : 10/28/1 0 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 207 0 Street : N18T H S T Twp : 15 NRng : 13 E Sect-Qtr : 10-SW,15-N 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 PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)451-106 9 : 5040 1 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 Bein g Don e For : EP A Dept h o f Excavation : 2 4 i n Corne r Lot : NFront : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V LEVEL 3 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 LEVEL 3 LEVEL S COMMUNICATIONS , LL C NA 

### Day : 877366834 4 Alt : Emerg : 877366834 4 MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRICH/TRAFFI C 

### Day : 402444719 7 Alt : 402444516 1 

### Emerg : 402444516 0 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 10/25/201 0

### Pag e 2 of 2
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=<RESULT. . . 10/25/201 0

# i^^ff ^ Contac t Informatio n Lo g 

# E 

# _ M Owner' s Name ; 

# Li-iii ^ O ^ 

### i?ICni^lr \ Daytime Phone : V^ ' Propert y Address : Z-Qn o A J • <. % S. T 

### SAID # 7 5 40 * 

### SZ)^/^ / 

# D Attemp t t o contac t DateAim e Nam e^:^ . • ^f'O ^ 

## Propert yFina l Repor t SAID : nWORK STARTED ON : __/__/

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# i^m> v Propert y Address : D WOR K COMPELTE D ON : / / ^7^^ ^ ^ > f ^ ^- ^ Renter : 

## ^^"^•• ^ OA ^ o ^ Omr^l^. . Address : ^ Phone : Fax : Cell/Pager : 

## Phone : //yV l (/^ ^ Additional Information : 

## Fax : Y^yd^/y , 

# 77¥ o Ceil/Pager : [Z

l Acces s Agreemen t Siened : 5?/2^f O 

## By : J 6 IZ

J Restoratio nAgreemen t Signed : ^/2^/i a By : vJ 5 \2 dVide o Propert y Befor e O n:_3./il2/J O By

= r)l 5 0 Digital Photo s Befor e O n: 9 //' O / V O By : O g D Vide o Property Afte r O n:_/_/ _ By : N/ A nDigital Photo s Afte r O n: / / By : Ss ? Propert y CompletionAgreement Signed : 1 1 / /(b / ( O By : -j^/ ? D Fina l Report Signed : / / By : EXECUTIV ESUMMAR Y

Omah a Lead Projec t Wor k Pla n Page l of 1 9

## Consen t fo rAcces s t o Propert y SAID # S^^of RIGH T O FENTR Y TO 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 dperfon ncertai nenvironmenta l respons e activitie s upo nth e followin g describe dpremises :

Owner' s Name : Daytim e Phone : (_{jJil - tX2ti ^ 

## i l l % - ^ 

# Z l Address : 

# 1107 0 Kl . 

# 18" - .5 / Address : Addresse s of 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 all soil s at th e property whic hare contaminate dwit hhazardou s substances , inparticular lea da t concentration s greate r thano r equa l t o 40 0 part s pe r millio n(ppm) . REMEDIA LACTION S Th e enviroiunenta l respons e action s t o b e performe 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 l activities ; b .Locatin g equipmen t an dmachinery on-sit e i npreparatio nfor an di nth e cours e o f th e environmenta 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 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 wdt hany o f th e activitie s o r wor k

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 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 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 nI d o no t gran t acces s t o m y propertie s > 

## ^^('-dlujud-'^\,( \ Signatur e D^t e Signatur e Date 

# 1Additiona l Comment s / Instructions :

M^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 •Toundatio 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 . 

# Jgf l I agre e nI d o no t agre e ^ I agre e nI d o no t agre e •^'^-\ ^ Owner' s Signatur e E^( 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 agreement 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 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) .

SAID : 

## So^ o I Propert y Address : 

## zx)7 0 A/ . /<? • sr Owner : C l -<?>>x<>> ^ U , 

# £ . ^ <W^/^ - ^2,V ^ O nth e attache ddiagram(s j 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 dby contractor , an dth e directio no f North . Indicat e distances , depths , material types , etc . Indicat e digital photo s b y referencin g th e photo-lo g number witha narro w indicatin g directio no f view . Item s t o b e remove d byContracto ran d no t replaced :

Item : jdf^[ci,cJ l t ^ , / CD O Item : Item : Item : Item : Item : Item :

Pag e 1 o f 2Additiona l Comment s / Instructions :

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# Kl i agre e [ H I d o no t agre e

Owner' s ^gfl ^ Date Contractor' s Signatur e Dat e Attachmen t

Pag e 2 o f 2^ ^ L "Nov . 16 . 201 0 7:57Ar" ^ OMA^LANNIN G OEPT . 402-444-614 0 Jo . 015 7 P . l/l^oa/"^ : 

## Proport yCompletio n Agreemen t Thi s Agreement documenl ath e completio no f remedia l actlvitief i performe do nmy proper^ . N4i y signatur e 'wil l designat e that I amsatisfie dwitl i di e resftozatiD no f my property , an dtiiat n o item s ar e in quesdon , noyr , o r a t an y tim e i nth e fiiture, excep t thos e item s liste dbelow , ifany . SAID : *^'^c4e i I Propert yAddress : 2JSir > A/ . If f .tT Q>ifiktg : J^ft l yf ^ ^K^t-VA^, , 

## ''''o"' ' ^^^U^af i ^ 

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Rem : Itofn : Nam : Itam ; Mom : Item : Additiona l Comments :

^ I Bgre « rcatoratiOAi s compkted , txcap t wnote d I agre o restoratio n i s completod , excep t a a note d \ O I d o netagre o rtitorBtia n i s complete d L ] I ul o no t agre e restoraHo a i a compiete d 

# 7/'/<^d 0 Contractor' g Signatur e Dat a

### ENVIRONMENTA L AS-BUILTDRAWIN G OMAH ALEA D SUPERFUN D 

# 9h . RESTORATIO N

Owne rName : J^HQ Address : 207 0

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Quadran t OKcavato d ContMninatio n Lir W Bahtn d 

### Contrac t # : EP-R7^9-0 5 Environmenta l Restoratio n LL C

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