### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID# : 250^ S Date : ^-lU- U Address : H^ \K ^ . ZS* ^ 'S' ^ • Remediatio nContractor : Environnienta l Restoration , LLC

_Year : _201 0 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S
^ Vide o ofpropert y (DVD ) J3^for e DAfter D Basemen t D y Executiv e Summary (Final Report ) y ^ EPA-provide dpropert y sketc h / Q Signe dAcces s Agreemen t for subjec t property
• Signe dAcces s Agreement(s ) for adjacen t property jy Restoratio nAgreemen t

D Settlement document s (i.e. , for damag e o r t o replac e plants , etc. ) y Confirmatio ndat a / 0 Photograph s jzlsefor e DCre w Photos^H^urin g Excavatio nD So d X30-da y So dD y As-buil t sketc h jy Completio nAgreemen t signe db y Property Owne r / O Property close-ou t chec k lis t signe db y EP A D Descriptio nofarea s no t raeeting RO D cleanu p criteri a y Utilit y clearance s y Property informatio nfro mDougla s Coimty Assessor' s Offic e 

# X Property acces s checklis t ^ ^ _^3026208 0 Contac t Lo g X ^cL^^ l lo- f Superfun d 

### Environinenta l Restoratio nSignatur e Date Date

# EP A EP APropert y Clos e Ou t For m Omah aLea dSit e Propert y # : Z50^ B Propert y Address : 9S\Is A. ZS" ^ 'SsV . Date/Time : Owner' s Name : fecf rvOufi A OTvorcWc i Quad s Excavated : F\-'h \-'^ Z Contracto r Grou p : Environmenta l Restoratio n(ER ) Excavatio nGenera l Ye s N o 1 . If necessary , were th e correc t quadrant(s ) excavate dan drestored ? v ^ 2 . I f necessary , were th e correc t area s ofdri p zon e excavate dan drestored? 

## 7 M Gradin g So dan dVegetatio n Ye s N o 1 . Doe s th e gradin g aouii J lli t pt i iiiiLl^ i o f LII Lhous e inexcavate darea s generall y slop e away fromth e l / house? 2 . Ha s so dbee nlai di nal l area s that were excavated ? v ^ 3 . Doe s th e so dappear to b e generall y health y an dgrowing ? (Onl y evaluat e if inspecte dat 30-da y tim e period) . 4 . Ar e sodde darea s generall y fir man devenl y graded ? ^ 5 . Arethejointsbetwee nth e so dsfrip 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 onth e property ? v ^ 7 . Wa s damag e t o landscapin g o r plan t material s avoided ? ^ Gates , Fence s an dRetainin g Wall s Ye s N o I . D o gate s openan dclos e freely? (i f applicable ) 2 . Were al l gate s o r fence s take ndow ndurin g restoratio nactivitie s re-installed ? (i f applicable ) 

# -f A 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 ? 2 . Wa s damag e t o th e foundatio navoided ? \/&C^Xt\.{ ' 

## U V 3 . Wa s damag e t o windows avoided ? 

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

## I 5 . Wa s damag e to downspout s o r dovraspou t e.xtension s avoided ? 

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

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

# S E inspectio nnotes : . , 

## [Mr a/ui /VLet^ t ^' ^
Remedia l an drestoratio nactivitie s complet e includin g 30-da y so dwarranty : EP ARepresentative:
- 

# '^/T^ ^ ^>. . JL ^ Date : ^//3// /

## / JQ ^ \ Omah a Lea d Site—EP-R7-09-0 5 I •^^^y ^ ' Environmenta l Restoration . LL C



# EXECUTIV ESUMMARY : 2509 5 98 1 N2 5 S T

N o Issue s o r Concern s [ ^ Issues/Concern s Detai l FAnlnnnrinn - _

### Pag e 1 of 2

" > [ Creat e Anothe rTicke t ] [ Bac k t o Irt h Interne t ] 

### Sen dEmai l

• YOU RTICKE T NUMBE RI S 2664760 . Origina l Cal l Date : 1/17/1 1 Time : 7:4 6 a m Op : ADAM241 8 6 Wor k t o Begi n Date : 1/20/1 1 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 98 1 Street : N25T H S T Twp : 15 NRng : 13 E Sect-Qtr : 15-SW,16-NE-S E 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 : 2509 5 Compan y ENVIRONMENTA L RESTORATIO N Contac t Nam e ADA M Phone : (402)451-131 4 Alt . Contac t Phone : (636)288-961 6 Wor k Bein g Don e For : ep a Dept h o f Excavation : 2 4 inc h Corne r Lot : NFront : NRear : Involve s Tunnelin g o r Horizonta l Borin g : NE.xplosives : 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 3 COMMUNICATIONS . LL C N A 

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

### Day : 402504782 3 Alt : 

### Emerg : 402504797 0
OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE RRICH/TRAFFI C 

### Day : 402444719 7 Alt : 402444516 1 

### Emerg : 402444516 0
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 1/17/201 1

### Pag e 2 of 2

0PPDGPR5 OMAH APUBLI C POWE RDISTRIC T EL M LOCATIN G Day :

Alt : 406728934 3 406207149 4 Emerg : 888728934 3 QLNNEIC 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=<RESULTS. . . 1/17/201 1

## Contac t Informatio n Lo g SAID#t??^<^9' 5
Owner-sName : "^^^^J , /^eJk i | Daytim e Phone : 3*/ ^ "^.P^ Q 

### Property Address : ^^(/\i . 9<"£D . 

### ^- / Attemp t t o contac t Date/tim e Nam e A^CJC^ S -^ ^

S St^t^ J t^l'J-l - l O 

### ^ B

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## lil' U ^ ^

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# i Propert yAcces s Checklis t SAID : -^^o9 S nWOR K STARTE D ON : / / D WORKCOMPELTE D ON : / / Propert y Address : ^ai A J ^S ' M ' Owner : P,e^^^^ ^ Yr^fL^W O Renter : Address : ^^ J A / ^3
- S + Phone : Fax : Cell/Pager : Additiona l Information : Phone : V o 2-3^2-^62 0 Fax : Cell/Pager : I S Acces s Agreemen t Signed:/ 21 2%-H O 

## «y=r.fi.,-^)U. ^ S Restoratio nAgreemen t Signed : J'2 ^ l'2Xll ° 

## ^r-2.Q>^^U ^ 1 3 Vide o Propert y Befor e O n:l T / 22.// 0 By£.<?^/. ^ H Digita l Photo s Befor e 

### On-l-LiyLlh By : C . P>v-VL« ^

• Vide o Propert y Afte r O n:/ / By : nDigita l Photo s Afte r O n:/ / By : S'^iopert v Completio nAgreemen t Signed : 3>c?< e / t ( By:<^< ' 1 1 Fina l Repor t Signed :/ / By : Additiona l Vide o o rDigita l Photo' s Taken :

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

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

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

# Consen t for Acces s t o Propeit y SAID#_2£!il £ RIGH T O FENTR Y T O PREMISE S 

### Granto r (th e properl y owner) , consent s to 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 dperformcertai nenvironmenta l respons e activitie s upo nth e followin g describe dpremises ;

Owner' s Name : Daytim e Phone : ^QT^- S ^1-2t 2 O 

### G»£eAAT^ o P-\oec>\r )

Address : 

### ?g; l , J -2 ^ i^ r Addresse s o f Propertie s covere db y thi s .\ ddress : Address : 

# ,thc/^A) r LO T Agreement : Address : Address : PURPOS EO FINVESTIGATIO N 

### Th e purpos e o f th e remedia l activitie s i s t o reinov e al l soil s a t th e property whic har e contaminate dwit hhazardou s sijbstances , i nparticular leada t cofiCenTi-ations greate r thano r equa l ;: D 40 0 part s pe r inillio n(nprn) . .REMEDIAL ACTION S 

### Th e envircmneGlal re:po!:s e :ici".icTx S i-zlv d :-iJ3..-h:L i

• Vi-,,- . nf: c • [c: S 

### Takia g photograph s und'i r video -A•h e vicpe^'^' y bz-ibr?; , diii^ng . -^-. dufte r JirYi^diK i ?.ctivities ; Locatin g equipmen t and,•'•^^c'li^?^ • :n-'::t e ":• . :;;-i;:^??.":": n:'?' ' -r-: ' T-
- \V Z^?v?c e cf--^ ^ • Tn\-iromi' ; ents, l resp o nse ; ?'ama g andImpIemerLiing Th e -^rnvov^ ! P<~:J'.: : 

### ••: , • • 'i.-. C•.i^^•:,•• \ . \-:\.^''\: , 1}brainin g sample s fro mGraritcr' s propeit^ ; AGR£E:\!EN T MO T T O INTERFERE 

### Th e Granto r agree s no t t o interfer e or tampe r .viL han y :? f ch e activitie s o r wror k

done , o r th e equipmen t use dto performth e activities , or to undertak e an y action s regardin g iii e us e of sai d propert> ' whic hwoul dten dt o endange r the healthc r welfa,i e c f ;h e Grantee s <j r th e envirormient , o

v l o ,?J^. w other s '. o us e tli e propert y in"uch \y \J,- . i . 'f. o Jir i gi.-£:n t 2.z~.^Z'3 , y j "n y p£'Gp'Ssti^;S . I grK,_it ECi-^r. s f, o :r; y rjr0'pe-i:is. 3

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## Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o provid e amutua l agreemen t a s to condition s o f propert y prio r to contracto r activities . Thi s vvil l als o serv e a s documentatio nfor th e purpos e o f assurin g that restoratio n activitie s ar e complete dt o th e satisfactio nofth e property owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA) .

SAID : 

## 2<o9< y Propert y Address : ^<X \ 

## t J ^ < s / Owner : ^tiLf\^^<: > fV\ o 

### G-c W C 7 Phone : 

### IA\>2'^^ Z-l^t O Onth e attache ddiagram(s ) indicat e area(s ) to b e excavate dan ddept ho f excavation , locatio nofal l known utilities , subsurfac e features , surfac e structure s andlandscapin g features , acces s location(s ) t o b e usedb y contractor , an dth e directio no f North . Indicate distances , depths , material 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 d b yContracto ran d no t replaced :

Fsg a \ o f2

### 1 I "i d o fTjO t .•igrce ' l^ j 1 Eigre e 

### I d o co t ftgree

Ov/fier' s ,'i%f!atur e 

## Attachment 

# 4.> ^ Contractor s Sig-iatur e Dat e

Pag e 2 o f 7

,• 

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio nof remedial activitie s performe don my property . My signatur e wii i designat e that I

amsatisfie dwit hth e restoratio nof my property , an dthat no item s are in question , now , or at any time inth e future , excep t thos e item s liste dbelow , ifany . SAID : 2^09$ : Propert y Address : <^ ^ } /U ^S ' s- h Owner : 

### B>cg.nAg-t: > r^oftgll o Phone : Vol
- ZHl
- Z&Z o Restoratio n Item s in Question :

Item : Item : Item : Item : Item : Item : Additiona l Comments :

I K I _ lyT l agre e restorritio nis completed , excep t as note d a,gre e restoratio n is corapleted , excep tas note d |»n l do l I I I do not agre e restoratio n is complete d no no t agre e restoratio n is complete d 

# j/z^ A &A^^AA J Owner' s Signatur e 

### Dat e

### Dougla s County Accoun t Informatio n rag e t oi z Dougla s County , Nebrask a Propert yRecor d - R052759000 0 Prin t Reoor t Vie wInteractiv e GI S Ma o Informatio n i s vali d a s o f2011-3-3 1 Treasurer' s Ta xReoor t Ne wFeatur e ->->- • Subdivisio n Sale s Searc h Owne r MORELL O BERNAR D J 1141 3 HICKOR YR D OMAH AN E 68144-000 0 Propert yInformatio n Ke yNumbe r 275 9 OOO O 0 5 Accoun t Type : Residentia l Parce l Numbe r 052759000 0 Parce l Address : 98 1 N 2 5 S T OMAH AN E 68131-000 0 Lega l Description : ARMSTRONG S 1S TAD D LO T2 7 BLOC K1 N 4 0 F T4 0 X 12 7 Valu e Informatio n Lan d Improvemen t Tota l 201 0 $200.0 0 $0.0 0 $200.0 0 200 9 $200.0 0 $0.0 0 $200.0 0 200 8 $200.0 0 $0.0 0 $200.0 0 200 7 $200.0 0 $0.0 0 $200.0 0 200 6 $200.0 0 $0.0 0 $200.0 0 200 5 $200.0 0 $0.0 0 $200.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 1 5080. 0 0. 0 127. 0 40. 0 Ye s



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accoimtno=R05. . . 4/13/201 1

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

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 o fa property' s location . I f yo u requir e a mor e exac t propert ylocation , 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.jsp?accoimtno=R05. . . 4/13/201 1

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

### RESTORATIO N 

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# ZS'OJS ' Name ; ger^* ^ Address : ^'R i ^ /yhrell o

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# Z^O?S ' Name ; Ber/'»'~ d Mor e H o Address : 5^ / A^ai""* ^ Phone : Omah a Lea d Sit e Sit e Sketc h Date : Time : Nor m Arro wr

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1 2011-01-1 9 10:2 7 2 2011-01-1 9 10:2 7 3 2011-01-1 9 10:2 7 4 2011-01-1 9 10:2 6 5 2011-01-1 9 10:2 3 6 2011-01-1 9 10:2 3 7 2011-01-1 9 10:2 3 8 2011-01-1 9 10:2 2 9 2011-01-1 9 10:2 1 1 0 2011-01-1 9 10:2 1 I I 2011-01-1 9 10:2 0 1 2 2011-01-1 9 10:2 0 AVKH.VC K Av g o f 250-25 2

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