### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL EFOLDE R SAID# : '^ie'h^ ^ Date : Address : Mo!^ ^ ^^ZX^jJ' ^ 5 T Remediatio n Contractor : Envrionmenta l Restoration , LLC

_Year : 2010 _ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S r Vide o ofpropert y (DVD ) _bBefor e DAfter D BasementV; , ^U ) JkfSetflAy r N

^ Executiv e Summary (Fina l Report ) ^l ^ EPA-provide dpropert y sketc h ^ ^ Signe dAcces s Agreemen t for subjec t property nSigne dAcces s Agreement(s ) for adjacent propert y L K Restoratio n Agreemen t D Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) **S ^ Confirmatio n dat a K

Photograph s _^Befor e DCre w Photo s D i Durin g Excavatio nD So d BTSO-da y So dD ^Ss,^ As-buil t sketc h O

f Completio n Agreemen t signe db y Property Owner , Bs . Property close-ou t chec k lis t signe db y EP A D Descriptio n ofarea s not meetin g RO D cleanu p criteri a H

, Utility clearance s M

. Property informatio n fromDougla s Count y Assessor' s Offic e B . Property acces s checklis t 3026032 4 

### \ Contac t Lo g ( 3 Superfun d 

### Environmental Restoratio nSisnatur e . Date 

# ^i( ^

### ^ ' Onfiah a Lea d Site—EP-R7-09-0 5 Environmenta l Restoration , LL C ^ ..o * www.crllc.co m



## EXECUTIV ESUMMARY : 2639 9 - 403 9 DECATU RS T N o Issue s o r Concern s Q Issucs/Conccrn s Detai l Explanation :

# EPA EP A Propert y Clos e Ou t For m Omah aLea dSite Propert y # : 3lU^^ ^ Property Address : M D y ] ^UJ&v r •$ ? Date/Time : Owner' s Name : 'V>Afi L\^"<^V\Y \ Quad s Excavated : fe \ Contracto r Grou p : Environmenta l Restoratio n (ER ) Excavatio n Genera l Ye s N o y 1 . If necessary , were th e correc t quadrant(s ) excavate dan drestored ? 2 . Ifnecessary , were th e correc t area s ofdri p zon e excavate dan drestored ? . A Gradin g So dan dVegetatio n Yes N o 1 . Doe s th e gradin g aroun dth e perimete r ofth e house in excavate darea s generall y slop e awa y fromth e y ^ house ? 2 . Ha s so dbee n lai di n al l area s that wer e excavated ? 

### A 3 . Doe s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte dat 30-day tim e period) . 4 . Ar e sodde darea s generall y fir man devenl y graded ? 

### A 5 . Are th e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte dat 30-day tim e period) . 6 . Wa s th e property grade dsuc htha t wate r wil l no t poo l o nth e property ? A 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 n an dclos e freely ? (i f applicable ) 2 . Were al l gate s o r fence s take n dow n durin g restoratio n activitie s re-instailed ? (i f applicable ) 

# A Wa s damag e t o gate s or 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 Yes N o 1 . Wa s damag e t o sidin g or tri mavoided ? 

### A 2 . Wa s damag e to th e foundatio n avoided ? A 3 . Wa s damag e t o window s avoided ? 

### c V 4 . Wa s damag e t o windo w screen s o r doo r screen s avoided ? 

### A 5 . Wa s damag e t o downspout s o r downspou t extension s avoided ? 

### A Sidewalk s an dDriveway s (Concrete ) Yes N o 1 . Wa s damag e t o driveway surface s avoided ? 

### A 2 . Wa s damag e t o walkway surface s avoided ? 

## f^lk Inspectio n notes : ^



### Remedial an drestoratio n activitie s complete includin g 30-da y so dwarranty : EP A Remesentative:y^eJz?^^<^jZ^^^^k^'J!u:! ^ Date :

### Paa e 1 o f 1

" > I Creat e Anothe r Ticke t ] ( Bac k t o Irt hInteme t | Sen dEmai l 

### YOU RTICKE T NUMBE RI S 2537858 . Origina l Cal l Date : 7/07/1 0 Wor k t o Begi n Date : 7/09/1 0 Time : Time : 2: 2 6 pm 3:0 0 p m Op : TRACY2413 6 State : N E Address : 403 9 County : DOUGLA S Street : DECATU R S T Place : OMAH A Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 17-NE Sect-Qtr : Typ e o f Work : Excavating th e «"- Locatio n o f Work : LOCAT E ENTIF , Remarks : FA X AL L CLEAR S TO : [4 C 

# I M : SAI D #2639 9 

# r ^A \ ^ Compan y : ENVIRONMENTA LRES T Contac t Name : TRAC Y BRISTO W Alt . Contact : Wor k Bein g Don e For : EPA Dept h o f Excavation : 1 2 Corr . 

# a, j 

# '^A^ [ Involve s Tunnelin g o r Horizonta l Bo . CXCATV MUDO l OMAHACO F DP I 

# V 

# <^^A 7 %* Ser\'ic e Are a ouinbe r Utilit y Tjp e Day : 402934046 9 CXCAT V coy . COMMUNlCAnONS . JN C HEIDI Alt : 402934046 9 Emerg : 402932975 7 Day ; 402504782 3 MUDO l METROPOLITA N UTILITIE S DISTRICT SAND Y Alt : Emerg ; 402504797 0 Day : 402444719 7 OMAHACOFCIT Y O FOMAHA-TRAFFIC,SEWE R RICH/TRAFFI C Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 OPPDGPR 5 OUAYI A PUBUC POWE RDISTRICT EL M LOCATIN GAlt : 406207149 4 Emerg ; 888728934 3 Day : 406728934 3 QLNN E1 C QV^TiS T LOCA LNETWOR K EL M LOCATIN GAlt : 406207149 4 Emerg : 888728934 3 

### http://www.dhon.org/irthintemelOHONNoticeCreation/MessaKeText.asD?ret=<TiF<iTT i T Q nmi'-<r\- i r \

### WS3M M M Contac t Snformatio n Lo g SA!D # 

# ;iL39 9 rr^ < {7.^dr PaytSmePhone : ^0Z-^3Z-~7O0 ^ \ Propert y Address : QO ^ ^ 

# 1 Attempt t o contac t Date/tim e Nam e 3-B-^ V /7/: i 'O

O /. 7 33 D \A>-teJ-< > 

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### >'^AES^S ^ Propert yAcces s Checklis t SAID : 

# -zL'^ i nWOR K STARTR O \ Prnnert yAddress : Uf^ U WORKCOMPELTE D O N -.CAIM A 

### Owner : {J^^ ^ 7\ - Hcthf O Renter : }C^ ^ kg ^ ( j loileA ~ Address : Phone : q05'V^h ^ Fax : Cell/Pager : Additiona l Information : Phone : ^2'^3 ^ ' lOO l 

### Fax : (/Cl - 93t~70^ ^ Cell/Pager : Acces s Agreemen t 

### Signed : 3 / 10 1 IC > B y 

### 0 0 ^ Restoratio nAgreement Signed : ' ^ H O / j Q Vide o Property Befor e O n : S f iZL I h 

## ^y - 

## M [ 3 Digita l Photo s Befor e O n: S I2 i / t

p 

## ^y - : A I I Vide o Property .A-fte r O n / / 3y : • Digita l Phota s .A:fte r O n / / By : Propert y CompletionA.greemen t Signed ; 

# X/Z/i £ 3y: ^ •Fina l Repor t SigRed : / / By : Additiona l Video c r Digita l Photo' s Takeri :

Omsh a Lea d Projec t Wor k Pla n Pag e lo f 1 9

## ^i^: mm Consen t to r Acces s t o Propert y 3ASD #2fo^ ^ RIGH T O FENTRY T O PREMISE S 

### Granto r (ih e propert y owner) , consent.'^ t o an ds'-'.^houztaih e u i Jnite dState s Environmenta l Piuicciio n Agenc y (USEPA ) or it s authorize drepresentatives , collectivel y th e Grante e t o ente r an dperfor mcertai n environmenta l respons e activitie s upo nth e followin g describe dpremises :

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 , i nparticular lea dat concentration s greate r than.o r equa l t o 4C 0 part s per millio n (ppm) . REMEDIA LACTION S Th e environmenta l respons e action s t o b e perfomie do nsai dproperty ma y includ e th e followin g activities : a . Takin g photograph s and/c r vide o o f th e propeit y before , during , zridafte r remedial activities ; b . Locatin g equipmen t andmachiner y cn-sit e i npreparatio nfo r an di nth e cours e ofth e environmenta l response ; c . Plannin g an dimplementin g th e removal actic no nc r near Grantor' s propeity . d . Obtainin g sam.ple s fromGrantor' s propeity ; AGREEMEN T NO TT o INTERFER E Th e Granto r agree s no t t o interfere o r tamper v/it han y o f th e activitie s o r v.'cr k

done , c r the equipmen t use dto perfor mth e activities , or t o undertak e an y action s regardin g th e us e c f sai d propert y whic hwoul dten dt o endanger th e healt hc r welfar e ofth e Grantee s c r th e environment , o r

t o allov / other s t o us e th e property i nsuc h 

# m g I gran t acces s t o m y propertie s L J I d o Tio t gran t acces s t o rn- y propsitie s
Signature Sig.aattir e Bat e. — A.. . ^ ..-j J 

# r

Additiona l Comment s / Instructions :

Scheck thi s bo x i f cwns r doe s no t wan t E.R . t o ente r th e resident s t o documen t interio r foundatio n wall s sn dpossibl e preexistin g damage . By checkin g thi s bo x E.R . i s no t .responsibl e fo r an y damag e don e t o th e interior o

f house , includin g fcundatic ncrsck s c r fissurss .

PT i agre e Q I ^^ o ne t agrs e nI sgrs e nJ <^ o '"tO t sgr-i e

Owner' s Signatur e Dat e Contrsctcr' s Signsttir e Dat e

## Restoratio nAgreemen t Th e purpos e o f llii s agreemen t i s t o provid e amutua l agreemen t a s t c ccndition s u f properf y prio r t o ccritricto r aiiiiviiics . Tni 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 n o f th e propert y owne r an dth e Unite dState s Environraenta l Protectio n Agenc y (EPA) . 

## AL.3i 9 Propert y Address : V^^^ ^ Dp^<^h^r ~ Owner : 

## 0<^i 7 A /-li^hfl ' ~ Phone : 

## VJOV ^ O nth e attache ddiagram(s ) indicat e area(s ) t o b e excavate dan ddept ho f excavation , locatio no f al l known utilities , subsurfac e features , surfac e structure s ah dlandscapin g features , acces s location(s ) t o b e use dby . contractor , an dthe directio n o f North . Indicate distances , depths , materia l types , etc . Indicate digital photo s b y referencin g the photo-lo g numbe r witha n arro w indicatin g directio no f view . . ttem s t o b e remove db y Contracto r an dno t repSsced :

Faa e 1 of 2r;''g;^rrj55?S^ 3 i^ ^

FT l agre e Q I d o ac t s.gre e j i I agre a I 1 1 d o :::!c t apre e 

# A.^bJiJldJ- ­ Oivner' s Srgnatur e 

## Attachments Date Contractor' s Signatur e Bat e

Pag s 2 c f 2402451105 9 P-0 2 ..o.nan aKea ^ h^state^Ca^^ ^ REST0H.TIO « JUL-29-201 0 .08^3 8 ^ I 

## Propert y Completio n Agreemen t T;:IJ ugrsciTteiit liocumerit s tli e coiiipletio n o f remedial activitie s perfonne do n m y property. . M y signatur e wil l designat e thai I a msatisfie dwilhth e restoratio n o f my property , an dthat n o item s are in question , now , ot a

t an y lim e i n th e future , excep t thos e item s liste dbelow , ifany . 

# s^^p ^ 2r.^^fT'^ ~ Propert y AddfC K ^^^j ^ O^Ca^H^i r 

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# !5HI^^ZHiZ2^ x Restoratio n Itfim s in Qu<sation :

• I . 1 • • •" ! Item : Item : !t&m ; Ajida'cns t Cr:-u"-;n\s. :

• f c:S»'<- £!

• ti t Kiiii.•> i s ^.tinuJoCc-J, '.n-.t^ ' - ^ .^'fi' J l_S v Svjrie ri';tocet(:-; i i s C2i^5!.iii^ , i:ci:: r i s -.ot r I I f 'i o ?? t .--sri * iir.U.i-i.ci-.:- 3 i<Cir-.'.plettl 

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### 45ias v^uunc y Accoun t Informatio n Pag e 2 o f 2
Buildin g 1



### N o Sketc h Availabl e

Squar e Footage : 560. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r 

### Uni t Type : Condition : Goo d BuiltAs : 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 f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Gabl e Stories : 

### 1. 0 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 

### 190 5 0 0 % 

### 10 5 190 5 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 

### 1. 0 Basemen t Bsmn t Bloc k 8 f t 280. 0 Fixtur e Bas e Fixture s 

### 1. 0 Fixtur e Bat h Ful l 

### 1. 0 Porc h Enc I Soli d Wal l 240. 0 Porc h Sla b Roo f Ceilin g 

### 108. 0

http://douglasne.mapping-online.com/DouglasCoNe/static/apnoiir.+i"C .

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Pag e 1 o f I 07/21/1 0 10:53:0 8

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