### TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDL\TIO NFIL EFOLDE R SAID# : Z.IZ'S ^ Date : ^-Z.Q-\ \ Address : "S 3 C>'7 pA-rri<~l( . IXu Q Remediatio nContractor ; Environmenta l Restoration , LL C Year : _201 0 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 1 /

Vide o o f property (DVD ) JzfBefor e Q Afte r GBasemen t D y Executiv e Summar> ' (Fina l Report ) ^ y EPA-provide dpropert y sketc h ^yy Signe dAcces s Agreemen t fo r subjec t property C Signe dAcces s Agreement(s ) for adjacen t property yy Restoratio nAgreemen t GSettlemen t document s (i.e. , fo r damag e or to replac e plants , etc. ) yy ^ Confirmatio ndat a

y ^ Photograph s jz f Before 3 Cre w Photo s jzf Durin g Excavatio nD So d /30-day So dG /

j As-buil t sketc h ^ y Completio nAgreemen t signe db y Propert y Owne r yy Property close-ou t chec k lis t signe db y EP A GDescriptio no f area s no t meetin g RO D cleanu p criteri a yy Utilitv ' clearance s y ^ Property informatio nfro mDougla s County Assessor' s Offic e yy Propert y acces s checklis t y Contac t Lo s
<2»-Z.O-l\ Environn-tenta ntal Restoratio nSignatur e 

# .y>^ y -ACO Rsignatur e

# EP A EP APropert y Clos e Ou t Form Omah aLea dSit e 3 S C: > - ? P/ v7-r<«!L/ ^

A o e 

### Propert y #:_2L1^I2S . 

### Propert y Address : Date/Time : Owner' s Name : -Jo.S « ^ ^/U->fe g 

### Quad s Excavated : B\ ~ PZ Contracto r Grou p : Environmenta l Restoratio n(ER ) Excavatio nGenera l Ye s N o 1 . L f necessary , were th e correc t quadrant(s ) excavate dan drestored ? 2 . I f necessary , were th e correc t area s o f dri p zon e excavate dan drestored ? y Gradin g So dan dVegetatio n Ye s N o I . Doe s th e gradin g aroun dth e perimete r ofth e house mexcavate darea s generall y slop e away fromth e house ? 2 . Ha s so dbee nlai dinal l area s that wer e excavated ? t ^ 3 . Doe s th e so dappear t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte dat 30-da y tim e period) . 4 . Are 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 i f inspecte dat 30-da y tun e period) . 6 . Wa s the property grade dsuc htha t wate r wil l no t poo l o nth e property ? • ' 7 . Wa s damag e to landscapin g o r plan t material s avoided ? ty Gates , Fence s an dRetainin g Wall s Ye s N o 1 . D o gate s ope nan dclos e freely? (i f applicable ) 2 . Were al l gate s o r fence s take ndovr adurin g restoratio nactivitie s re-installed ? (i f applicable ) 

### T ^ 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 ) Foundation , Sidin g an dGutter s Ye s N o 1 . Wa s damag e t o sidin g o r tri mavoided ? y " 2 . Wa s damag e to th e foundatio navoided ? V ^ 3 . Wa s damag e to window s avoided ? y 4 . Wa s damag e to windo w screen s o r doo r screen s avoided ? \y 5 . Wa s damag e t o dovsTispouts o r downspou t extension s avoided ? ^ Sidewalk s an dDriveway s (Concrete ) Ye s N o I . Wa s damag e to drivewa y surface s avoided ? 

### A/ A 2 . Wa s damag e t o walkwa y surface s avoided ? inspecuo o notes : , i 

# idccyeJ^ <^^m€ntyi ^ <Sdcl
Remedia l an drestoratio nactivitie s complet e includin g 30-da y so dwarranty : EP ARepresentativ.gr-7^IZ^J^.^^^^ . ^jLs ^ Date : ^U^/u

### / \© 7 '^ Omah a Lea d Site—EP-R7-O9-0 5 V<«^(wr ' Environmonta t Restoration , LL C \ > ywww.crilc.co m 

# EXECUTIV ESUMMARY ; 2723 0 336 7 PATRIC KAV E



# N o Issue s o r Concern s Q ] Issues/Concern s Detai l Fxninnntion
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### Pag e 1 of 2

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

### YOU RTICKE T NUMBE RI S 2806925 . Origina l Cal l Date : 7/27/1 1 Time : 1:3 2 p m Op : TIM2418 6 Wor k t o Begi n Date : 7/29/1 1 Time : 2:0 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 336 7 Street : PATRIC K AV E Twp : 15 NRng : 13 E Sect-Qtr : 09-SW,16-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 : ( 4 02) 4 51-106 9 : 2723 0 Compan y: ENVIRONMENTA L RESTORATIO N Contac t Name : TI M SUTTO N Phone : (402)451-131 4 x226 7 Alt . Contact : Phone : (402)306-234 7 Wor k Bein g Don e For : EP A Dept h o f Excavation : 2 4 i n Corne r Lot : NFront : NRear : 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 , INC HEID I CO X COMMUNICATION S 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
LEVEL 3 LEVEL 3 COMMUNICATIONS , LL C N A 

### Day : 877366834 4 Alt : Emerg : 877366834 4 MUDOl METROPOLITA NUTILITIE S DISTRIC T SAND Y MU D 

### Day : 402504782 3 Alt : Emerg : OMAHACO F CIT Y O FOMAHA
TRAFFIC,SEWE R RICH/TRAFFI C OMAH A 

### Day : 402444719 7 Alt : 402444672 5 -Emerg : 4024445160 :


### littn-//www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 7/27/201 1

### Pag e 2 of 2

OPPDGPR 5 OMAH APUBLI C POWER DISTRIC T ELM LOCATIN G 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K EL M LOCATIN G 

### Day : Alt : 406728934 3 406207149 4 Emerg : 888728934 3

hftn-//wvv,T, v Hhon.or£T/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 7/27/201 1

## Contac t Informatio n Lo g 

# SAID#^'7^3< ^

Owner' s Name : "Xc^r^^ Pk ^P>ob< L| Daytim e Ph»"e : ^ b Z- ^5^-7^^ ^ Propert y Address : 3 3C.' 7 P/x^-r-^^k i ^x/^ C Attemp t t o contac t Date/tim e Nam e 3 -/V-/ y4y:^>^^ ^ 

# G ^ r)^^r-^< ^ 

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# X AV^ ^ \O r TiiS i 1-25- av^iOCi (Z.iCcjd.va.+io' ^

## Propert yAcces s Checklis t SAID : 

## ^"?^3 o Propert y Address : 3 3 C-; ; Pc^r.^g l /^OP D D WOR K STARTE D WOR K COMPELTE D ON : ON : / // l_ Owner : Addres s 

## • '^oseg^if ^ y^^^k> ^ Renter : Phone : Fax : Phone : Fax : 

## s^2L ^ <^3?-'a^4 ? Cell/Pager : Additiona l Information : Cell/Pager :

^ Acces s Agreemen t 

## Signed: ^//57_l l By^< ^ 0 S S ^ n Restoratio nAgreemen t Vide o Propert y Before Digita l Photo s Befor e Vide o Propert y Afte r Signed : " > f 1^ 1 \\ O n-.^Ij^l^ ^ 

## O

n:3_/(3_ / n O n: / / By^o ^

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### By

= <Cftt By : D ^ Digita l Photo s Afte r

Propert y Completio nAgreemen t O n: Signed : / F I H / I( ( By : 

### By : 'g D nFina l Repor t Signed : / / By : Additiona l Vide o o r Digita l Photo' s Taken : D Vide o nDigita l Phot o O n: i Reason :

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

### By : By : 

### 1 

# 1

nVide o Reason : nDigita l Phot o O n: / / 

### By : 1

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

# 1

## Consen t fo rAcces s t o Propert y SAID#2--iz^ ' RIGH T O FENTR Y T O PREMISE S 

### Granto r (th e propert y 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 nenvironmenta l respons e activitie s upo nth e followin g describe dpremises :

Owner'sName : ~Xo^>,^V ^ ^^ ^ ^ ^ | Daytim e Phone : ^02^'g^^^-l^ ^ 3 

### </o7_^^3»9-:2::^C 9 9( ^ Address : _.. ^ Address ; Addresse s o f 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 al l soil s at th e propert y whic har e contaminate dwit hhazardou s substances , i nparticula r lea da t concentration s greate r tha no r equa l 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 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 propert y before , during , an dafte r remedia l activities ; b .

Locatin g equipmen t an dmachiner y on-sit e i npreparatio nfo r 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 nea r Grantor' s propert} ^ 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 interfer e o r tampe r wit han y 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 dt o endange r th e healt ho r welfar e 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 propert y i nsuc h I gran t acces s t o my propertie s Q I d o QO t gran t acces s t o m y propertie s 

# d\dk . Mgnatilr ^ \J Date Signatur e Date

### Additiona l Comments / Instructions :

Xr-^4c-.^».^ rCfe>Ofv<lA.4-<e>^v . p ^^t.^ - 0\Jug-g > (^o.'vS'CV^ v 

### JjQ^hec k thi s bo xi fowne 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 fhouse , includin g foundatio n crack s o rfissures .

• I d o no t agre e S I I agre e [ H I d o no t agre e

Dat 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 amutual agreemen t a s t o condition s o f property prio r to contracto r activities . Thi s will als o serv e a s documentatio nfo r 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) .

SAID : 2.- 7 23 0 Property Address : ^ ^^- ^ ^.rv-^^ ^ > c o^o* . "^-y^- l Pi\-t-<-x«:vr /^ ^ Owner : i o- s <:-P^>
- c -oQij O be . Phone : 

## ^<^'2^-%%H-l<^^l > 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 andlandscapin g features , acces s location(s ) t o b e use db y contractor , andth e directio no f North . Indicate distances , depths , material types , etc . Indicate 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 replaced :

Ite m ^" S . SS \ Ct i 

### •« . r<-^'voc? c C^joci r <^^' ^ ^>^-?.- r<. i '<k r C o^tLreA,^ ^ 

### » fi' - Item . 

### V 6 KAo4 . 

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### Uj<.brKjJei . 

# f . ' V I' f Item : 

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Pag e 1 o f2

### Additiona l Comment s / Instructions :

^ Wie_^6ciu.,/vAr«^< i 4- 0 ti>« ^ r«iL<.4-<br^A ^ SfeAicA -

J agre e n I d o no t agre e 

# dj i agre e nI d o no t agre e 

# oivi U g-^ii^ w Dat e ractor's^ignatur e Contracto r 

### Date Attachmen t

Pag e 2 o f2

## Propert yCompletio n Agreemen t Thi s agreement document s th e completio no f remedial activitie s performe do nm y property . My signatur e will designat e that I a msatisfie dwit hth e restoratio no f m y property , an dthat n o item s ar e i n question , now , o r at an y time i nth e future , e.xcep t thos e item s liste dbelow , if any . SAID ; py^t > Property Address : J'jC&' y ^'^r[c ^ ^] ^ Owner ; -353 ^ \ ^ G^uie . P''»"<Y^- ; Cyy f 'P-PC^ f Restoratio n Item s i n Question :



### Item : Item : Item : Item : 

### Item : Item : 

### Additiona l Comments :

jg5^__agre e restoratio ni s completed , excep t a s note d P > I I agre e restoratio ni s completed , e.xcep t a s note d I I I d o no t agre e restoratio ni s complete d I I 1 d o no t agre e restoratio ni s complete d 

## \i3PZhAji M rner'sjSfgnatur e 

# r/o/f / Dat e 

# II Contractor ' :tor' s Signa^Jff e 

## ^-/G- W Date

### Dougla s Count y Accoun t Informatio n Pag e 1 o f 3 Dougla s County , Nebrask a Propert yRecor d - R254720000 2 Prin t Repor t Vie wInteractiv e GI S Ma p Informatio n i s vali d a s o f2011-2-1 4 Treasurer' s Ta xRepor t Ne wFeatur e -*-+- •Subdivisio n Sale s Searc h Owne r GAUBEJOSEP H ETA L 670 3 S 16 4 AV E OMAH AN E 68135-000 0 Propert yInformatio n Ke yNumber : 472 0 000 2 2 5 Accoun t Type : Residentia l Parce l Number : 254720000 2 Parce l Address : 336 7 PATRIC KA V OMAH AN E 68111-000 0 Lega l Description : | YAL E PLAC E LO T11 7 BLOC K0 AL L L T11 6 & S 1 0 F TL T11 7 IRRE G Valu e Informatio n Lan d Improvemen t Tota l 201 0 < 52,400.0 0 $32,400.0 0 $34,800.0 0 200 9 $2,400.0 0 $43,000.0 0 $45,400.0 0 200 8 $2,400.0 0 $43,000.0 0 $45,400.0 0 200 7 $2,400.0 0 $43,000.0 0 $45,400.0 0 200 6 $2,400.0 0 $43,000.0 0 $45,400.0 0 200 5 $2,400.0 0 $43,000.0 0 $45,400.0 0 Sale s Informatio n Sale s Date : 2003-02-2 5 Dee d Type : W D Book : 223 6 Page : 31 6 Price : $32,500.0 0 Grantor : \ WILLIA M LE E Grantee : DARREL L KRISTOPHE R ANDERSO N 1 Valid/Invalid : j Vali d Exclusio n Reason : 

### Sho wAl l Transaction s

Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 2 5440. 0 1. 0 136. 0 40. 0 N o 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R254. . . 3/4/201 1

### Dougla s County Accoun t Informatio n Pag e 2 o f 3 Improvemen t Informatio n Buildin g 1
336 7 PATRIC KA V ^tk^iixlit mit fiilST 

### ..±, 1 2i & fki t floo r 74S.0H).1t . 1 1CSTOR V UNFI N B««n t Btoc k S1 1 74 S 0 sq . ft. ^#-« t ft CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 748. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 1 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 5. 0 Exterior : Fram e Viny l Units : 

### 1. 0 Interior : Drywal l Baths : 

### 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 2. 0

Roo fType : Gabl e Stories : 

### 1. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 

### 192 5 0 % 

### 192 5 8 5 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Unfinishe d Atti cW/floo r 340. 0 Applianc e Allowanc e 

### 1.0 Basemen t Bsmn t Bloc k 8 ft 748. 0 Fixtur e Bas e Fixture s 

### 1.0 Fixtur e Bat h Ful l 

### 1. 0 Porc h En d Scree n 28. 0 Porc h En d Scree n 

### 96. 0 Porc h Sla b Roo fCeilin g 

### 16. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R254. . . 3/4/201 1

### Dougla s Count y Accoun t Inforniatio nPag e 3 o f 3

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 ofa property' s location . I f yo u requir e a mor e exact propertylocation , yo u ma yus 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.jsp?accoLmtno=R254. . . 3/4/20 1

### ENVIRONMENTA L AS-BUILTDRAWIN G OMAH ALEA D SUPERFUN D SIT E RESTORATIO N 2723 0 Exterio rPain t Omah a Lea d Sit e 0 Goo d Sit e Sketc h • Poo r Samplin g Address : 336 7 PATRIC KA V n No t paint 

### \ Lead Sampl e LA B Sample s Collecte d Concentratio n Collecte d Sampl e Numbe r Firm : FPf l B.U),C C RYASCPXA-2723 0 F I pp m 

## 8 1
- D Date : l-"7-0 & RYBSCPXA-2723 0 F 2 pp m 

### D Time : ?,'•«/ & f ^ 

### fi_L_ RYCSCPXA-2723 0 B 1 pp m 

### D Sample s Analyze d RYDSCPXA-2723 0 B 2 

# 33 1 pp m 

### D 

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RDZSCPXA-2723 0 D Z pp m 

### D XR F Unit : GSH O Book : 20 3 ncgcGr)o»>-27e3o—© z pp m 

### D Date : O l - 2. Z - 0 6 RPZSCP.X A2733 0 P2 . pp m 

## n D Time : 

## £t L Staff : ^SUi / Numbe ro fSample s = _ ^ Legend : F 1 = Fron t Left . F 2 = Fron t Right , B l = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s are a s viewe d fro m th e street , facin g p f SAI D # 2723 0 DAT E EXCAVATE D 8-3-1 1 DAT E EP ASIGNE D OF F 8-18-1 1

ARE ASODDE D 131 2 S Q F T

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

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# a i _ pp m F 2 pp m B 1 pp m B 2 pp m D Z 

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v E Z JIMM Y surfac e fina l clearanc e 2723 0 124.1 6 ± 19.0 3 3 2011-08-0 3 14:1 1 3367 Patrick a

v E Z JIMM Y surfac e fina l clearanc e 2723 0 103.47 ± 18.1 1 4 2011-08-0 3 14:1 1 3367 Patrick a

v E Zrr?»'*- . JIMM Y surfac e final clearanc e 2723 0 111.5 4 ± 18.6 3 5 2011-08-0 3 13:5 9 Av g ofl811-18 1 : 3367 Patrick a

v D Z JIMM Y 1 3 final clearanc e 87.6 7 ± 17.0 4 6 2011-08-0 3 13:5 9 3367 Patrick a

v DZ JIMM Y 1 3 final clearanc e 2723 0 85.04 ± 16.9 2 7 2011-08-0 3 13:5 9 336 7 Patrick a

v DZ JIMM Y 1 3 final clearanc e 2723 0 97.9 0 ± 17.62 8 2011-08-0 3 13:5 8 336 7 Patrick a v DZ JIMM Y 1 3 final clearanc e 2723 0 80.0 6 ± 16.5 8 9 2011-08-0 3 13:5 3 Av g o f 1807-180 ! 336 7 Patrick a

v B l JIMM Y 1 0 final clearanc e 50.5 3 ± 14.2 3 1 0 2011-08-0 3 13:5 3 336 7 Patrick a

v B l JIMM Y 1 0 final clearanc e 2723 0 50.3 0 ± 14.2 5 1 1 2011-08-0 3 13:5 3 3367 Patrick a

v B l JIMM Y 1 0 final clearanc e 2723 0 57.5 8 ± 14.8 7 1 2 2011-08-0 3 13:5 2 3367 Patrick a

v B l JIMM Y 1 0 final clearanc e 2723 0 43.7 0 ± 13.5 9

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Pag e 1 o f1 08/03/1 1 14:37:1 4

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