## TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID# : Qiyf^ iDate : ^^-U W Address : 99^ ^ M- P/" ^ /4u ^ Remediatio nContractor : Envrionmenta l Restoration , LLC

_Year : _201 0 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S ^ Vide o o f property (DVD ) JZfeefor e DAfter D Basemen t D ^ Executiv e Summary (Fina l Report ) 

# X EPA-provide dproperty sketc h

^ Signe dAcces s Agreemen t for subjec t property •^ Signe dAcces s Agreement(s ) for adjacen t property Restoratio nAgreemen t
• Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) / Q Confirmatio ndat a ^ Photograph s JZ^efor e DCre w Photo s JZT)urin g Excavatio nD So d ^30-da y So dD ^ As-buil t sketc h / S Completio nAgreemen t signe db y Property Owne r y 0 Property close-ou t chec k lis t signe db y EP A D Descriptio nofarea s no t meetin g RO D cleanu p criteri a Utilit y clearance s Property informatio nfro mDougla s Coimty Assessor' s OfFice Property acces s checklis t ^f^iAd^ l hi^o A) 30261860 Contac t Lo g / J ^ yoLca^-h /o~ ^ Superfun d 

### ""Envirotimental Restoratio nSignatur e Dat e Dat e

# EP A EP A Propert y Clos e Ou t Form Omah aLea dSit e 0U# 2 Propert y # : ^171 3 Propert y Address : d?;iS
- N- ^pt h/fu < Date/Time : Owner' s Name : _£j7- y *• ( 0/ ^ , / . Quad s Excavated : "B l nvironmenta l Restoratio n (ER ) Contracto r Grou p : Envi r Excavatio nGenera l Ye s N o 1 . Ifnecessary , were th e correc t quadrant(s ) excavate dan drestored ? 

### y 2 . Ifnecessary , were th e correc t area s ofdri p zon e excavate dan drestored? 

# UJX Gradin g So dan dVegetatio n Ye s N o i y 

### house ? 2 . Has so dbee nlaidi nal l areas tha t wer e excavated ? i ^ 

### 3 . Doe s th e sodappea r t

o b e generall y health y an dgrowing ? (Onl y evaluat e ifinspecte da t 30-da y tim e period) . 4 . Ar e sodde darea s generall y firman devenl y graded ? • ^ 

### 5 . Ar e th e joint s betwee nthe sodstrip s generall y tight ? (Onl y evaluat e ifinspecte da t 30-da y tim e period) . 6 . Wa s th e propert y gradedsuc htha t wate r wil l not pool o nthe property ? y 7 . Wa s damage to landscaping or plan t material s avoided ? y Gates , Fence s an dRetainin g Wall s Ye s N o I . D o gates.ope nan dclos e freely? (i f applicable) 

# h k 2 . Wer e al l gate s o r fence s take ndow nduring restorationactivitie s re-installed ? (ifapplicable ) A/i ^ 3 . Wa s damage to gate s o r fences avoided ? (ifapplicable ) ^ 4 . Wa s damag e to retaining wall s avoided ? (ifapplicable ) 

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

# \[aM ^ U

# • 3 . Wa s damag e t o windows avoided ? 4 . Wa s damag e t o windo w screen s o r doo r screen s avoided ? 5 . Wa s damag e t o downspout s o r downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) N o Ye s 1 . Wa s damag e t o driveway surface s avoided ? 2 . Wa s damag e t o walkway surface s avoided ? Inspectio nnotes :



### Remedia l an drestoratio n activitie s complet e includin g 30-da y so dwarranty : EP A Representative;^-^;^y>^y$y£ A yy^^^tyUJ^JL^^ ^ ' Date : 9 / / /^/ 7^y'^*' ^ 

### i ^J ^ \ Omah a Lea d Site—EP-R7-09-0 5 \;^»S!^ ' Environmenta l Restoration , LL C 

# EXECUTIV ESUIVIMARY : 2979 3 282 5 N2 8 A V N o Issue s o r Concern s Q Issues/Concern s Detai l Fxnlanntinr^
­a g e 1 «j i 1

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

• YOU RTICKE T NUMBE RI S 2671009 . Origina l Cal l Date : Wor k t o Begi n Date : 2/14/1 1 2/16/1 1 Time : Time : 8:4 8 a m 9:1 5 a m Op : ADAM2418 6 State : N E Address : 282 5 County : DOUGLA S Street : N28T H AV E Place : OMAH A Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 09-NE-S E Sect-Qtr : 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 : 2 9 7 9 3 Compan y: ENVIRONMENTA L RESTORATIO N Contac t Name : ADA M Alt . Contact : Phone : Phone : (402)451-131 4 (636)288-961 6 Wor k Bein g Don e For : ep a Dept h o f Excavation : 24i n Corne r Lot : NFront : N Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Rear : N

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 MUDO l METROPOLITA N UTILITIE S DISTRICT SAND Y MU D Day : 402504782 3

Alt : Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TR/y='FIC,SEWE RRICH/TRAFFI C Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0 0PPDGPR 5 OMAH A PUBLI C POWE RDISTRICT EL M LOCATIN G Day : 406728934 3

Alt : 406207149 4 Emerg : 888728934 3 QLNN E1 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=<RESULTS. . . 2/14/201 1

## Contac t Informatio n Lo g SAID # 2^7^ 3
Owner' s Name : 

## _C i ^ r ^ /yma.h ^ PropertyAddress : 2Q2 S N J 

### Attemp t t o contac t Date/tim e Nam e ^\OLne. J acces s 

### fi/zV'o J 5 • • f)4ar 0 t-M^nS o l^ • t<,K > 

### r/3 ­

## Propert yFina l Repor t SAID : 2g|7f 3 Propert y Address : ?,tz S jy . 7^y ^ n D

WOR K STARTE D WOR K COIVIPELTE D ON : ON : / // / " Owner : Address : ^ ^ U ^ 0.^k ^ Renter : Phone : Fax : P''°"'= = Fax : O^oSryjK.^ S CaS'\8 5 /^02, ^ ^W-^-JW ^ Cell/Pager : Additional Information : Cell/Pager : fyi Acces s Agreemen t [ ^ Restoratio nAgreemen t 0 Vide o Propert y Befor e 0 Digita l Photo s Befor e U

D Vide o Propert y Afte r nDigita l Photo s Afte r JB'^roperty Completio nAgreemen t Signed : ^ / _2>^ / j<

o Signed : ^ / ^ / / o O n: ( Z/I O /3 6 O n: I t /

i Q / l o O n / / O n / / Signed:3 " l3f I I f »y ­ J ( 5 By ­ Q g By ­ j:^ . By

= 3- . ft^. By : N/A By : ^T^ O nFinalRepor t Signed : / / . By : EXECUTIV ESUMMAR Y

Omah a Lead Projec t Wor k Pla n Pag e 1 o f 1 9% % 

## Consen t fo rAcces s t o Propert y 

# SMD#2?r? 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 dperformcertai aenvironmenta l respons e activitie s upo nth e followin g describe dpremises :
Address : 

# Z0Z 5 / / Z 8 Ave. Address : Addresse s o f Propertie s covere db y thi s Address : 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 property whic hare contaminate dwit hhazardou s substances , inparticular lea dat concentration s greate r tha no r equal t o 40 0 part s pe r millio n(ppm) . REMEDIA L ACTION S 

### Th e envirormiental respons e action s t o b e performe do nsai dproperty may includ e th e followin g activities : Takin g photograph s and/o r vide o o f th e property before , during , an dafte r remedia l activities ; Locatin g equipmen t an dmachinery on-sit e inpreparatio nfor an dinth e cours e o f th e enviroimiental response ; c . Plannin g an dimplementin g th e remova l actio no no r near Grantor' s property . Obtainin g sample s fromGrantor' s property ; d . AGREEMEN T NO T T o INTERFERE 

### Th e Granto r agree s not to interfer e o r tampe r withany 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 imdertake 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 0 1 gran t acces s t o m y propertie s nI d o not gran t acces s to m y propertie s

Datc ^ 

### Signatur e Dat e

### '•JW^^ i " Additiona l Comment s / Instructions :

[3sChec 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 agre e nI d o no t agre e 

# J^r^ g re e C H I d o no t agre e 

# /

/^y-XJyfC^^^d 'T^'t^^^ ^ QeA.^y ^ '3'-3 r f / Owner' s Signatur e te 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 to contracto r activities . Thi s wil 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 no f th e property owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA) .

SAID : ^cin^ 2 PropertyAddress : ^.f^Z S M 2^ ^ 

# ^r:^!!: : r^ n ^- f.^^Wu^ Phone : 

# r f O nth e attache ddiagram(s ) indicate 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 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 , material types , etc . Indicate 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 b yContracto ran d no t replaced :

Item : iyty)lcu'^ . ^ v«5s^v/A.-/vJ a^^e^cL< : 

### cury k Aot i Item : Item : Item : Item : Item : Item :

Pag e 1 o f2SSfe^T 

### % »^SMSZ2 ^ %

I agre e n I do no t agre e ^J!2^'agre e n I d o no t agre e 

# ^^y^^~^7 \yl¥'4^'^yy ) T^t^ ^ CUL^C ^ ^-J/-/ / vifer' s Si&n^r e Date Contractor' s Signatur e Dat e Attachmen t

Pag e 2 o f 2

## ''s/'Mar . 31 . 2011-'7:27A[ r OMAH APLANNIN GDEPT , 402-444-6 ' Jo , 481 4 P . 2'°°''" "


# Propert y Completio nAgreemen t Thi s agreeme mdocumeat s di e completio ao f remedia J activitie s perfonne do nm y property . M y signatin e wlU designat e that I a msatisfie dwith* aicstotatlo no f m y propeity , an dtha t n o Item s ar e i a qu^tion , now , o r at an y tim e i nth e fiiture, excep t thos e itan s liste dbelow , ifany . SAID : 

## ?J11^ 3 Propert y AddreHs: ,^ ^ ^ . ^ ^ ^ Owner : Ffconet 

# ? % ^ 

### tM^ ' ^U^^f i t\rvytU''t ^ Rotttoratlo n(tsm ainQuestion :

ttam: ttem: 

### item : ttam : itam : 

### item : Additiona l CommontB :

P^l I agre e restomUoii M coinFictsd , osap t a i noted .i^^ere e restoratio ni s ooinpleted « excep t a

< not«d Q I do DA t agr« e rextoratlo ai 5 cvmpleted C J I do no t Agre e reitoratio o l « complete d 

### J/'/yf!in^
- ;v/ / Owner ' Dat e O>ntractor* 9 SIgniitnr e Dat e

### Douglas County NE 

### GIs 

### Map

Disclaimer: This map is not guaranteed 10 be accurate, correct, current, or complete and conclusions drawn are the responsibility of Ihe user.

### Dougla s County Accoun t Infaspatio n lagp i 

### Pag e 1 o f 2 Dougla s County , Nebrask a Propert yRecor d ­ R075504000 0 Informatio n i s vali d a s o f 2010-8-1 6 Ne wFeatur e ­ • • • ^ Prin t Repor t Vie wInteractiv e GI S Ma p

Treasurer' s Ta xRepor t Subdivisio n Sale s Searc h Owne r CIT YO F OMAH A C/ O PLANNIN G DEPARTMEN T 181 9 FARNA M S T#111 1 OMAH AN E 68183-000 0 Propert yInformatio n Ke yNumber : 550 4 OOO O 0 7 Accoun t Type : E xGovemmen t Parce l Number : 075504000 0 Parce l Address : Lega l Description : 282 5 N 2 8 A V OMAH AN E 68111-000 0 CATALP A2N D AD D LO T1 BLOC K0 4 6 X 12 8 Valu e Informatio n 201 0 200 9 200 8 200 7 200 6 200 5 Lan d $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 Improvemen t $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 Tota l $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 

### Sho wAi l Transaction s

Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 3 5888. 0 0. 0 128. 0 46. 0 Ye s



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R07. . . 8/21/201 0

### Dougla s Count y Accoun t InfaM?atio n Pag e 2 o f 2

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### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R07. . . 8/21/201 0

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

# llllllllllllilllllllililll l 2979 3 Exterio rPain t Nort h Arro w Omah a Lea d Sit e Owne rName : CIT Y

OF OMAH A Sit e Sketc h • Goo d Ad d ress : 282 5 N 28 AV • Poo r

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## D Date : I'T-QU ? RYBSCPXA-2979 3 F2 Z"Z- H pp m 

## D Time : '~ ^ •3-5>I>YV \ RYCSCPXA-2979 3 B1 (aC) ^ pp m 

# sr D Sample s Analyze d RYDSCPXA-2979 3 B2 37- 0 pp m 

# n nDgOCrXA-2079 0 B2 pp m 

## D XR F Unit : lOQ- i Book ; l5 ^ RQZ3CPXA-2979 0 Q? pp m 

## D D Date : ~i -i"i
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## D D Time : 

### A/ ^ 

## D Staff : AISVA / Numbe r ofSample s • Legend : F1 = Fron t Left , F2 = Fron t Right , B l = Bac k Left , B2 = Bac k Righ t DZ = Dri p Zone , GZ • Garden , PZ = Pla y Al l quadrant s ar e as viewe d fro m th e street , facin g propert y

LEfiEN Q t)fl o Zon e Excavate d Contaminatio n Lef t Behin d Quadran t flxcavatad r>/i>»«.•'..^ « M. C D D- 7 n n n c Cai^vxia^'^v^vwv. M »*4«« t ^)«^^4 ^ ^««4* ^ ^

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# 2979 3 Owne rName : CIT YO F OMAH A Address : 282 5 N 2 8 A V Phone : H ; Sampl e Numtje r RYASCPXA-2979 3 RYBSCPXA-2979 3 RYCSCPXA-2979 3 RYDSCPXA-2979 3 RDgGGrXA-2979 3 RQZOCPXA-2979 3 RrZOCr)(A-2979 3 F l F2 B l B 2 B Z Q ? P g W : Lea d Concentratio n 

# Ms ^ Z-^' i 

## ^r>, ^ 

## 3Z O Omah a Lea d Sit e Sit e Sketc h Sampl e LA B Collecte d pp m 

# D pp m 

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# D D pp m 

# D D Numbe ro f Sample s • Legend : F l = Fron t Left , F 2 = Fron t Right , B 1 = Bac k Left , B2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , PZ = Pla y Al l quadrant s are a s viewe d fro m th e street , facin g property 

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# V^ S Oyn \ Sample s Analyze d XR F Unit : too l Book : 15 9

Dat e ~ 1 -n - OG > Tim e 

# Ai ± Staff : /V|£VA / 

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### Omah a Lea d Sit e Owne rName : CIT YO F OMAH A • Goo d 

### Sit e Sketc h Address : 282 5 N 2 8 A V • Poo r Phone : ^ W : IV fNo t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : m^ S ^^ ^ K M RYASCPXA-2979 3 F l 

## ifiU
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## D Date ; 1 - 1 -Du > RYBSCPXA-2979 3 F 2 

## I'^' i _pp m 

## D Time : "^'^SQAV A RYCSCPXA-2979 3 B l 

## ^r) 3 _pp m 

## D Sample s Analyze d RYDSCPXA-2979 3 B 2 32. 0 pp m 

## D RDgGCrXA-2Q70 3 B Z pp m 

## D D XR F Unit : IOO I 

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## D D Date : 1 - il - OC g RrZOCP)(A-2070 3 P Z pp m 

## D D Time : Ai ^ Staff : rV1S\A/ Numbe ro fSample s = i U J Legend : F l = Fron t Left , F 2 Fron t Right , B 1 = 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 ar e a s viewe d fro m th e street , facin g propert y 

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02/15/1 1 14:33:2 2 Pag e 1 o f 1

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