## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SA1D# : ^'h^^ ^ Date : Address : ^ ^ 1 ^ V \. \i > ^ T Remediatio nContractor : Envrionmenta l Restoration , LLC

_Year : _201 0 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S D Vide o o f property (DVD ) \)Befor e DAfter ^Basemen t D nExecutiv e Summary (Final Report ) l!>

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EPA-provide dproperty sketc h ^ Signe dAcces s Agreemen t fo r subjec t property D Signe dAcces s Agreement(s ) fo r adjacent property ^S s Restoratio nAgreemen t

D Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) Q Confirmatio ndat a D Photograph s _S Before DCre w Photo s D Durin g Excavation ^ So d D 30-day So dD 'llS y As-built sketc h ^ Completio nAgreemen t signe db y Property Owne r ^B^ ^ Property close-ou t chec k lis t signe dby EPA D Descriptio no f area s no t meetin g RO D cleanu p criteri a 1 ^ Utility clearance s S Property informatio nfromDougla s County Assessor' s Offic e B

y Propert y acces s checklis t T b - Contac t Lo g ° ! 

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### Environmenta l Restoratio nSignatur e Dat e / EPA CORsignatur e X Dat e

# V' / y^Q ^ ' \

Omah a Lea d Site—EP-R7-09-0 5 | f Environmenta l Restoration , LL C jf www.erllc.co m 

# EXECUTIV ESUMMARY : 33646-391 5 N 1 8 S T 

# No Issue s o r Concern s [ ^ Issues/Concern s Detai l Explanation :

# ^EP A EP A Propert y Clos e Ou t For m Omah aLea dSit e Propert y # ; ^SUM U Propert y Address : y^j^Ki . H S" T Date/Time : Owner' s Name : Vs C -6u3>TrNg-> ^ Quad s Excavated ; f l vf^3.^ B ( Contracto r Grou p : Environmenta l Restoratio n(ER ) Excavatio nGenera l Ye s N o 1 . I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? t / 2 . I f necessary , were th e correc t area s o f dri p zon e excavate dan drestored ? 1 Gradin g So dan dVegetatio n Ye s N o 1 . Doe s th e gradin g aroun dth e perimete r o f th e hous e i nexcavate darea s generall y slop e away fro mth e 1 ^ house ? 2 . Ha s so dbeenlai di nall area s tha t were excavated ? 

## * X 3 . Doe s th e so dappear to b e generall y health y an dgrowing ? (Onl y evaluat e if inspecte da t 30-day tim e • period) . 4 . Are sodde darea s generall y fir man devenl y graded ? i^J 5 . Are th e joint s betwee nth 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 hthat wate r wil l no t poo l o nth e property ? 7 . Wa s damag e t o landscapin g o r plant material s avoided ? • - Gates , Fence s an dRetainin g Wall s Ye s No 1 . D o gate s ope nan dclos e fi-eely? (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 ) 3 . Wa s damag e to gate s o r fence s avoided ? (i f applicable ) 

# I t 4 . Wa s damag e to retainin g wall s avoided ? (i f applicable ) ^ / Foundation , Sidin g an dGutter s Ye s No 1 . Wa s damag e t o sidin g o r tri mavoided ? •^ ^ 2 . Wa s damag e t o th e foundatio navoided ? ^ 3 . Wa s damag e t o window s avoided ? ^ 4 . Wa s damag e to windo w screen s o r doo r screen s avoided ? >y 5 . Wa s damag e to downspout s o r downspou t extension s avoided ? ^ Sidewalk s an dDriveway s (Concrete ) Ye s No 1 .Wa s damag e t o driveway surface s avoided ? 

## A/ X ^ 2 . Wa s damag e to walkway surface s avoided ? Inspectio nnotes :


### Remedia l an drestoratio nactivitie s complet e includin g 30-da y so dwarranty : ^X'^^y-^J^lLA/C ^ J^^CitcJ^JLa ^Date : ^/ZS^//< D EP A Representativ ePag e 1 o f 1

( Creat e Anothie rTicke t j [ Bac k t o Irth i Interne t ] [ Sen d Emai l ]

• YOU RTICKE T NUMBE RI S 25637524^ Origina l Cal l Date : 8/09/1 0 Time : 3:0 0 pm Op : TRACY2418 6 Wor k t o Begi n Date : ^8/11/1 0 Time : 3:3 0 pm j State : NE County : DOUGLA S Place : OMAH A Address : 391 5 Street : N18T H S T Twp : 15 NRng : 13 E Sect-Qtr : 03-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : Excavating th e entir e propert y Locatio n o f Work : LOCAT E ENTIR E PROPERTY Remarks : FA X AL L CLEAR S TO : (402)451-106 9 y SAI D #3364 6 | Compan y: ENVIRONMENTAL RESTORATIO N Contac t Name : TRAC Y BRISTOW Phone : (402)451-131 4 Alt . Contact : Phone : (314)504-487 4 Wor k Being Don e For : EPA Dept h o f Excavation : 12 " Corne r Lot : NFront : Y Rear : Involve s Tunneling o r Horizonta l Boring : NExplosives : N CXCAT V

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 HEIDI Day : 402934046 9 Ah : 402934046 9 Emerg : 402932975 7 MUDO l METROPOLITA NUTILITIES DISTRICT SAND Y 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 0PPDGPR 5 OMAH A PUBLIC POWE RDISTRICT EL M LOCATIN G Day : 406728934 3

Alt : 406207149 4

Emerg : 888728934 3 QLNNE1 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. . . 8/9/201 0

### I 

# SAm#'^^^y ^ I Owner' s Name : l^( ^ 3^(x->iA^v y Daytime Phone : V o < 3 '^«2^ 3 7(5" ^ Propert y Address : 3^/5 ^ ^/ . /S*" ^ 

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## Propert yAcces s Checklis t SAID : 33C/yQ > I Propert y Address : "^IS' ^/ • I ^^^ ^ 

### nWORKCOMPELTE D ON: '

Owner : Address : ^ C

^ ^ _fc^/A^ Y 1 Renter ; Phone : Fax : Phone : Fax : </53-^J7 ^ Cell/Pager : Additiona l Information : Cell/Pager : J2 ^ Acces s Agreemen t 1 2 Restoratio nAgreemen t Q Vide o Propert y Befor e 1 3 Digita l Photo s Befor e
• Vide o Propert y Afte r Signed : / 1 ^P / / S Signed : ) / '^ 1 j D O n: •> , / / 5 / / » O n '. 1 1 tc , 1 I d O n: / / By:/ ^ 

## By : er ) sy : yi A By : /M - By : nDigita l Photo s Afte r O n: / / By : . • J/ ^ Propert y Completio nAgreemen t Signed : ^ l^ ( / » ^ By:/< ^ nFina l Repor t Signed : / / By : Additiona l Vide o o r Digita l Photo' s Take r nVide o nDigita l Phot o O n : _r . Reason : nVide o nDigita l Phot o O n : _ Reason : 1 1 1 1 

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# 1 D Vide o Reason : nVide o 1 Reason : n
n Digita l Phot o Digita l Phot o O n O n :_
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Omah a Lea d Projec t Wor k Pla n Page l o f 1 9

### I 

## Consen t fo rAcces s t o Propert y S 33<^9( f 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 I^rotectio nAgenc y (USEPA ) or 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' s Name : Q C Ao u IA.^' V 

### Daytim e Phone : V5 3 'P37- ^ Address : 

## 3*?lS " K/ . 

## f^- ^ s-^ ^ Address : 

### Addresse s of Propertie s \ Address : 

### coveredb y thi s Agreement : Address : 

# l _ 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 propert y v»?hic hare contaminate dwit hhazardou s substances , inparticula r leadat concentration s greate r than.o r equa l t o 40 0 part s pe r millio n(ppm) . REMEDIA L ACTION S 

### Th e environmenta l respons e action s t o b e performe do nsai dpropert y ma y includ e the 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 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 near Grantor' s propeity . d .Obtainin g sample s fro mGrantor' s property ; A GREEMEN T NO T T O INTERFER E' • . 

### Th e Granto r agree s no t t

O interfere o r tampe r wit hany o f th e activitie s o r wor k done , o r th e equipmen t use dt o perfor mth e activities , or t o undertak e an y action s regardin g th e us e o f sai d propert y Vs^hic hwoul dten dto endange r th e healt ho r welfare 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 property i nsuc h ly ] I graffit acces s t o m y propertie s nI d o Eio t gran t acces s to m y propertie s
Signatur e Signatur e Dat e

### Additiona l Comment s / Instructions :

• Chec k thi s bo x

if owne rdoe s no t wan t E.R . to ente rth e resident s to documen t Interio r foundatio n wall s an d possibl e preexistin g damage . Bycheckin g thi s bo xE.R . is no t responsibl e fo ran ydamag e done to th e Interio r of house , includin g foundatio n crack sorfissures . 

# i I agre e ni do no t agre e 

## Dla g re e nI do Bo t agre e

ler' s s Signatur e Dat e ^-" ^ Co s Owner' Sig i Contractor' s Signatur e Date

## Restoratio n Agreemers 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 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 : JJGV 6 Propert y Address : 

# 3 1 I S N . ISt ^



# it Owner : _S"U J r/ \ -C- I 

# ¥ - Phone : 

## VSj'.i37S ~ O nth e attache ddiagram(s ) indicat e area(s ) t o b e excavate dan ddeptho 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 db y contractor , an dth e directio no f North . Indicat e distances , depths , materia l types , etc . Indicat e digital photo s b y referencin g th e photo-lo g numbe r witha narro w indicatin g directio no f view . Ksm s t o b s remove d b yContracto ran d no t replsced :

Et&m : 

# Mpl^ci- ^ M l cSiU . ^acJ

Item : Item : Item :

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



# t s I agre e C U I cI o HO t agre e [ U I agre e Q I d o no t agre e 

# R c OwEBer' s Signatur e Contractor' s Signatur e Date Attachment s

Pag e 2 o f 2

### Thi s agreemen t documents th e completio no f remedia l activitie s performe do nm y property . M y signatur e wil l designat e tha t I amsatisfie dwithth e restoratio no f m y property , an dtha t n o item s ar e in question , now , o r at any tim e i nth e future , excep t thos e item s liste dbelow , i f any . SAID : 3J^VC r Propert y Address : 3^ ) S /Vf
- l^~* ^ S^ - Owner : ^ ( ^ 5c^.V\-c y 

### Phone : i/^ j . pJ75 ' Restoratio nStem s i nQuestion :

Additiona l Gommsnts :

^ I agree restoratio ni s completed , except as Eote d ]S> [ ! agre e restoratio ni s compEeted , excep t a s noted r I I d o ne t agre e restoratio ni s complete d I 1 I d o no t agre e restoratio ni s completed 

# llAL A o ^vvAA<!iei ^ Owner' s Signatur e CoKtractor' s SJgaatiir e n s st e

## Dougla s Count y Accoun t Intbrmatio n rag e i oi z Dougla s County , Nebrask a Propert yRecor d -11070145000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f 52n d St-VJe W O H Ma P Infonnatio n I s vali d a s o f 2009-12-3 1 Treasurer' s Ta xRepor t Ne wFeatur e ->->- > Aut o Sale s Searc h Owne r SWINE YR C 391 5 N 1 8 S T OMAH AN E 68110-000 0 Propert yInformatio n Ke yNumbe r 014 5 000 0 0 7 Accoun t Type : Residentia l Parce l Numbe r 070145000 0 Parce l Address : 391 5 N 1 8 S T OMAH AN E 68110-000 0 Lega l Description : BOULEVAR D PAR KAD D LO T1 4 BLOC K8 N 2 0 FT& S 2 0 F TLT1 5 4 0 X 12 5 Valu e Informatio n 200 9 200 8 200 7 200 6 200 5 200 4 Lan d $7,000.0 0 $7,000.0 0 $7,000.0 0 $7,000.0 0 $7,000.0 0 $7,000.0 0 Improvemen t $10,900.0 0 $15,800.0 0 $15,800.0 0 $15,800.0 0 $15,200.0 0 $13,800.0 0 Tota l $17,900.0 0 $22,800.0 0 $22,800.0 0 $22,800.0 0 $22,200.0 0 $20,800.0 0 Lan d Informatio n Acre s 0.1 1 S F 5000. 0 U nit s 1. 0 Dept h 125. 0 Widt h 40. 0 Vacan t N o Improvement Informatio n Buildin g 1



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R07.. . 1/19/201 0

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^I..* TI.WI H _^LjCKJ^N^gGEJMAgE _ _£UCKT£EN^RGEJMAgE _ Squar e Footage : J 1344. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : 

### Condition : Poo r Buil t As : 2 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : i Force d Ai r Rooms : 6. 0 Exterio r; Fram e Aluminu m Units : 1. 0 Interior : ' Drywal l Baths : 

### 1 0 Roo f Cover : Compositio n Shingl e Bedrooms : 

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## 1. 0 Basemen t Bsmn t Bloc k 8 ft 672. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 

## 1. 0 Porc h En d Scree n 20. 0 Porc h En d Scree n 140. 0



### http://douglasne.mapping-online.eom/DouglasCoNe/static/accountinfo.j sp?accountno=R07.. . 1/19/201 0

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