## TRANSMITTA Lof OMAHA LEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID# : 3597 9 Date : Address : 501 3 N2 2 S t Remediatio nContractor : Environmenta l Restoration , LLC

_ Year : _201 1 SOI LBIEMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S X Vide o o f property (DVD ) ^^^a^for e DAfter 0 Basemen t D Executiv e Summary (Fina l Report ) EPA-providedproperty sketc h Signe dAcces s Agreemen t for subjec t property D Signe dAcces s Agreement(s ) for adjacen t property Restoratio nAgreemen t D Settlement document s (i.e. , for damag e o r t o replac e plants , etc. ) Confirmatio ndat a Photograph s yfatiox Q DCrewPhotos-'flDurin g Excavatio nD So d ,0^-da y So dD As-buil t sketc h Completio nAgreemen t signe db y Propert y Owne r Property close-ou t chec k lis t signe db y EP A D Descriptio no f area s no t nieetin g RO D cleanu p criteria . Contaminatio nlef t behin d y ^ Utility clearance s /U Property informatio nfro mDougla s County Assessor' s Offic e Property acces s checklis t ^ , ^ T 3026234 1 

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# EPA EP A Propert y Clos e Ou t For m Omah aLea dSit e Property* : 3597 9 Propert y Address : 501 3 N2 2 S t Date/Time : Owner' s Name : Ann e Brutsch e Quad s Excavated : F l Contracto r Group : 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 ? 

### y y 2 . I f necessary , wer e th e correc t area s ofdri p zon e excavate dan drestored ? ^Cif}JQi^{\ X (o T 

# "O T Gradin g So dan dVegetatio n Ye s N o 1 . Doe s th e gradin g aroun dth e perimete r ofth e house inexcavate darea s generall y slop e away fromth e 

## y house? 2 . Ha s so dbee nlai dinal l area s that wer e excavated ? \y 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-day tim e period) . 4 . Are sodde darea s generall y firman 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-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 ? y 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 1 . D o gate s ope nan dclos e freely? (i f applicable ) 

## A// 4 2 . Wer e al l gate s o r fence s take ndow ndurin g restorationactivitie s re-installed ? (i f applicable ) 

## A// i 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 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 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 ) 1 . Wa s damag e t o drivewa y surface s avoided ? 2 . Wa s damag e t o walkway surface s avoided ? Inspectio nnotes : / / ^ ^ 

## A ^ Ye s N o 

# >J(yQ^y[Q L A W

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# y Y N o



### Remedia l an drestoratio nactivitie s complet e includin g 30-da y so dwarranty : EP A Representative;.y^7^..^

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## Date : 11/^/^. (

# X OMAH ALEA D SITE — EP-R7-09-0 5 ENVIRONMENTA L RESTORATION , LL C WWW.ERLLC.CO M 

# y^"^^, , \ ' \ PHO^*' ' 

# EXECUTIV E SUMMAR Y 501 3 N 2 2 S T 

### 3597 9



# N O ISSUE S O R CONCERN S ISSUES/CONCERN S
DETAIL EXPLANATION :

### IRT H On e Cal l Pag e 1 o f 1

Ticke t Informatio n fo rTicke t 287932 8

Belo wI s Th e Ticke t Text Followe d B yALis t Of Member s Affecte d Printe rFriendl yVersio n Origina l Cal l Date : 10/17/1 1 Time : 10:3 1 pm Op : TIM2418 6 Wor k t o Begi n Date : 10/20/1 1 Time : 7:0 0 a m State : N E County : DOUGLA S Place : OMAHA Address : 501 3 Street : N22ND S T Twp : 15 NRng : 13 E Sect-Qtr : 03-N W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEAD REMOVA L Locatio n o f Work : LOCAT E TH E ENTIR E PROPERTY . Remarks : FA X AL L CLEAR S TO : (402)451-106 9 : 3597 9 Company ENVIRONMENTA L RESTORATIO N Contac t Nam e Phone : (402)451-131 4 x226 7 TI M SUTTON Alt . Contac t Phone : (402)306-234 7 CEL L Wor k Bein g Don e For : EP A Dept h o f E.xcavation : 2 4 INCHE S Corne r Lot : NFront : NRear : N Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N COXCATV MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Servic e Are a Utilit y Servic e Are a Nam e Contac t Phon e Number s Cod e Typ e COXCATV COX COMMUNICATION S IN C ELMCOX ELMCOX Day : (406)72 8 - 934 3 Alt : (406 ) 32 7 - 293 6 Emerg : (888 ) 72 8 - 934 3 MUDO l METROPOLITA N UTILITIE S SAND YMUDO l Day : (402)50 4 - 782 3 DISTRIC T Emerg : (402 ) 50 4 - 797 0 OMAHACO F CITYO F OMAHA - RICH/TRAFFI C OMAH A Day : (402 ) 44 4 - 719 7 TRAFFICSEWE R Alt : (402 ) 44 4 - 516 1 Emerg : (402 ) 444 - 516 0 0PPDGPR 5 OMAH APUBLI C POWE R CONSOLIDATE D Day : (800 ) 57 5 - 558 7 DISTRIC T CONSOLIDATE D Emerg : (800 ) 57 5 - 558 7 QLNNEI C QWES TLOCA L NETWOR K EL M QLNNEI C Day : (406)72 8 - 934 3 Alt : (406 ) 20 7 - 149 4 Emerg : (888 ) 72 8 -934 3 Vie wMa p


### http://www.dhon.org//IRTHOneCall/TicketA^iewTicket.aspx?ticketID=86542 3 1/9/201 2ENVIRONMENTA L
RESTORATIO N 

# Question s t o answe ra t th e hous e 1 Doe s th e ma p matc h th e property ? \ | L ^ 2 I s ther e a dog ? r\cr > 3 I s ther e anythin g tha t nee d t o b e moved ? lik e a ca ro rboat ? f\ o 4 Doe s th e propert yhav e eas yaccess ? M^.' ^ 5 I s th e propert yEasy , Norma l o rHard ? r\C>r~rr>0^ l 5 I f no . i s ther e a propert yw e ca n ge t acces s from? _ 7 I s soi l goin g t o hav e t o b e shuttle d out ? (Nc s 8 I s th e propert yai l han d work ? A o 9 I s ther e a retainin g wall ? fV o 1 0 I s i t i n ba d shape ? 1 1 i s ther e unde rgroun d lin e t o th e garage ? (\ o 1 2 i s ther e a sewe rclea n out ? f\ o 1 3 I s ther e an yhazard s i n th e yard ? r\c ? 1 4 I s th e sidin g ol d o n th e house ? V Q- V 1 5 Tr yt o leav e th e tim e fram e oper \ whe n w e wil l b e there ? v/g_f ^ . L-V'"0-'S>V \ CJQJ N -^^Lfscj ^

i s I f the ynee d a notic e Mar k i t bi g o n th e map . Tryt o leav e i t a t a 2 4 hou rnotic e only l 1 7 Wha t kin d material s ar e nee d fo rreplacement ? (\or\ ^ I S I s ther e zoysi a gras s a t th e propert y( Re d rla. g thi s propertY)? _ 1 9 I s thi s propert yboarde rlin e o n routine ? C\O i 2 0 I s ther e sentimenta l ite m b e awar e of ? •VvjO Q -W-ejt.- ^ 2 1 Ca n w e us e th e driveway ? \jCS >

2 I s th e propert ylin e marke d i n th e excavatio n areas ? s j 

### 4. ^ Sig n \^,: ^ ^'^jSX^t^r ^

## Contac t Informatio n Lo g SAID # 5^A"1 ^ Owner' s Name : Anne . "^vx-V^jcV^e , Daytim e Phone : L^Ol. - »A& & -Cj>ZH \ Propert yAddress : 50\' b K i . "Z Z ^+ . 

### Attemp t t o contac t Date/tim e Nam e

## Propert yAcces s Checklis t SAID : 

## 55^1 S D WOR K STARTE D ON : / / Propert y Address : 5C:5\^ ^ K ^ . ZT-* ^ S ^ D WOR K COMPELTE D ON : __/__ / Owner : ftr^nc ly^^^tC^ ^ Renter : Address : Phone : Fax : Cell/Pager : Phone : Additiona l Information : Fax : Cell/Pager : 1 3 Acces s Agreemen t Siened : ? / ^ / U By : 13 ^ S Restoratio nAgreemen t Signed : * 2 l ^ / K By^Tj ^ ^ Vide o Propert y Befor e 

## O n: ? 

## /J^/ H By : TU 3 H Digita l Photo s Befor e O n: ^ l^ l W 

### By : -r j 3 1 1 Vide o Propert y Afte r O n: / / By : D Digita l Photo s Afte r O n: / / By : S , Propert y Completio nAgreemen t Siened : ^ o P ^ I | ( By:(ej O

• Fina l Repor t Siened : / / By : Additiona l Vide o o r Digita l Photo' s Taken : nVide o nDigita l Phot o O n: / / By : Reason : D Vide o D Digita l Phot o O n: / / By : Reason : D Vide o D Digita l Phot o O n: / / By : Reason : nVide o nDigita l Phot o O n: / / By : Reason :

## Consen t fo rAcces s t o Propert ySAID#_^^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 ente r an dperfor mcertai nenvironmenta l respons e activitie s upo nth e followin g describe dpremises : Owner' s Name : ftt^rse. "St^cv-V^cV* ^ Daytim e Phone : HOX-'AS^-Cp'2H \ Address : 

## ^^\ S U ZT.^ ^ '^ . 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 a t th e property whic hare contaminate dwithhazardou s substances , i nparticular leada t concentration s greate r thanor equal to 40 0 part s pe r millio n(ppm) . REMEDIALACTION S Th e environmenta l respons e action s t o b e performe do nsai dproperty ma y includ e th e followin g activities : a .Takin g photograph s and/o r vide o o f th e property before , during , an dafte r remedial activities ; b .Locatin g equipmen t an dmachinery on-sit e inpreparatio nfor andinth e cours e ofth e environmenta l response ; c .Plannin g an dimplementin g th e remova l actio nonor near Grantor' s property . d .Obtainin g sample s fromGrantor' s property ; . AGREEMEN T NO T T O INTERFERE 

### 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 , o r to undertake any action s regardin g th e us e o f sai d property whic hwoul dten dt o endange r th e healthor welfare ofth e Grantee s or th e environment , o r

to allo w other s to us e th e property insuc h IK II gran t acces s t o m y propertie sO I d o no t gran t acces s t o m y propertie s 

### (JM/^D , 

## 1^^k^!ilU . iW^ P-Oi / Signatur e ' Dat e Signatur eDat e

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Additiona l Comment s / Instructions :

*4 o ''^)OiQ£rf\xX\' V

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Chec k thi s boxi f owne 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 . Bycheckin g thi s boxE.R . i s no t responsibl e fo ran ydamag e don e t o th e interio ro f house , includin g foundatio n crack s o rfissures .

K I I agre e Q I d o no t agre e S i agre e O I d o no t agre e

Owner' s Signature Dat e Contractor' s Signatur e Date

## E2:^sc:^^^:;i» 5 

## 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 t o 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 nofth e property owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA) .

SAID : 

# ss^n s Property Address : ^ON* ^ 

## VA . 17-'^*2»- V Owner : firNp,^ "^^OIVSJCVN C Phone : i^CTL - v\S^ - Ci>7.^ V 

### Onth e attache ddiagram(s ) indicate area(s ) to b e excavate danddept ho f e.xcavation , locatio no f all known utilities , subsurfac e features , surfac e structure s andlandscapin g features , acces s location(s ) t o b e use dby 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 :

Item : 

# PAOV C or^d^uc V bor^ k ^ejf\c£ . *for--Wo5yr> Item : Item : Item : Item : Item : Item :

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

[ 3 I agre e nI do no t agre e |S< ] I agre e nI do no t agre e 

# ^>.oCtt&
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Signatur e e Dat e Contractor's^Sienat u Signatur e Dat e Attachmen t

Pag e 2 of 2

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio no f remedial activitie s performe donm y property . My signatur e wil l designat e tha t 1 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 any tim e i nth e future , excep t thos e item s liste dbelow , if any . SAID : 

# ^^I S Propert y Address : 

## 5Ci\? . U . Z^* ^ SA- . Owner : 

### f\r\T\L "fer-u.-V^.cWe . Phone : Restoratio n Item s i n Question :

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

l/ X I agre e restoratio ni s completed , excep t a s note d^J^'H I agre e restoratio ni s completed , excep t a s note d I I I d o no t agre e restoratio ni s complete d| | I d o not agre e restoratio nIs complete d 

# y^.y (^..^.yptfc T id-^^-i \C . ^ '"''-^-'f Owner' s Signatur e Dat e Contractor' s Signatur e Dat e

### Uougia s County Accoun t Intormatio n Pag e I of 2 Dougla s County , Nebrask a Propert yRecor d - R200492000 0 Prin t Repor t Vie wInteractiv e GI S Ma o Informatio n i s vali d a s o f 201 1 -7-1 5 Treasurer' s Ta xRepor t Ne wFeatur e ->*->- * Subdivisio n Sale s Searc h Owne r BRUTSCH E ANN E M 1 501 1 N 2 2 S T

OMAH AN E 68110-000 0 Propert yInformatio n Ke yNumber : 049 2 000 0 2 0 Accoun t Type : Residentia l \ Parce l Number : 200492000 0 Parce l Address : 501 3 N 2 2 S T OMAH AN E 68110-000 0 Lega l Description : PATRICK S 2N D SARATOG AAD D LOT9 BLOC K7 5 3 X 12 8 Valu e Informatio n 201 1 201 0 200 9 200 8 200 7 200 6 Lan d $500.0 0 $500.0 0 $500.0 0 $500.0 0 $500.0 0 $500.0 0 

### Sho wAl l Transaction s Improvemen t $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 Tota l $500.0 0 $500.0 0 $500.0 0 $500.0 0 $500.0 0 $500.0 0 Lan d Informatio n Acre s 0.1 5 S F 6784. 0 U nit s 0. 0 Dept h 128. 0 Widt h 53. 0 Vacan t Ye s



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R20. . . 7/26/201 14 Uougia s Count yAccoun t Intormatio n Pag e 2 o t 2

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Th e abov e ma p i s powere d bvGooqie , an d i s intende d t o provid e a genera l ide a o f a property' s location . I f vo u reauir e a mor e exac t orooert vlocation , vo u mavus e th e Interactiv e GI S Map s tha t ar e maintaine d b vou r office .



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R20. . . 7/26/201 1

### 9 *>« " "-"1- . ENVIRONMENTA L 

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Pag e 1 o f 1 10/27/1 1 13:11:5 3.f'-s "

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