## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID# : P?/y y Date : M-\-\ V Address : /Jo V O U s / Remediatio nContractor : Envrionmenta l Restoration , LLC

_Year : _201 0 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S j /

Vide o o f property (DVD ) _^Befor e DAfter D Basemen t D J

^ Executiv e Summary (Final Report ) ] ^ EPA-provide dproperty sketc h B ^ Signe dAcces s Agreemen t for subjec t property D Signe dAcces s Agreement(s ) for adjacent property 0 ^ Restoratio nAgreemen t D Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) \2 / Confirmatio ndat a \ ^ Photograph s ^Befor e DCre w Photo s l/Durin g Excavatio nD So d [/30-da y So dD J^

T As-built sketc h J? C Completio nAgreemen t signe db y Property Owne r y Q Property close-ou t chec k lis t signe dby EP A D Descriptio nofarea s no t meetin g RO D cleanu p criteri a >

0 Utility clearance s J, aProperty informatio nfromDougla s County Assessor' s Offic e ^ Property acces s checklis t (pine * V~eot>r\ )

~ ' 3026189 7 Contac t Lo g A ^ X/ard^- h /g/
- '""""""sujerfund

' Environmenta l Restoratio nSignatur e Dat e

EPA CO Rsignatur e T^ ^ Dat e

# EP A EP A Propert y Clos e Ou t Form Omah aLea dSite OU# 2 Propert y # ; cg?M ? PropertyAddress : /fo V aki o J'-J- . 

## Date/Time : Owner' s Name : Ac.*
- \jJ-<S<^i/^i ^ Quad s Excavated : F1,BI,S ^ Contracto r Grou p : Environmenta l Restoratio n(ER ) Excavatio nGeneral Ye s No 1 . Ifnecessary , wer e th e correct quadrant(s ) excavate dan drestored ? i 7 2 . Ifnecessary , wer e the correct areas ofdri p zon e excavatedan drestored ? 

# w Gradin g Sodan dVegetatio n Ye s No w ^ house ? 2 . Has sodbee nlaidi nal l area s tiiatwer e excavated ? -^ 3 . Doe s th e sodappea r t

o b e generally health y an dgrowing ? (Onl y evaluat e ifinspecte da t 30-da y tim e period) . 4 . Ar e soddedarea s generall y firman devenl y graded ? . ^ 5 . Ar e th e joint s betwee nth e 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 no t pool o nthe property ? « ^ 7 . Wa s damage t o landscaping o r plan t material s avoided ? • y Gates , Fence s an dRetainin g Wall s Ye s N o 1 . D o gates.ope nan dclos e freely? (ifapplicable ) 

## ^ K 2

- Wer e al l gate s or fence s take ndov mduring restorationactivitie s re-installed ? (ifapplicable ) 

## fJ i 3
- Wa s damage to gate s o r fence s avoided ? (ifapplicable ) yy 

### 4 . Wa s damage to retaining wall s avoided ? (ifapplicable ) 

### A/ A Foundation , Sidin g an dGutter s Ye s No 1 . Wa s damage to siding o r trimavoided ? 2 . Wa s damage to the foundatio navoided ? 

# ^Jar/f Alof e 3
- Wa s damage t o window s avoided ? 

### # ­ 4 . Wa s damage to windo w screen s or door screen s avoided ? 5 . Wa s damage t o downspouts o r downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Wa s damage to drivewa y surface s avoided ? ( / 2 . Wa s damage to walkwa y surface s avoided ? t / 

### Inspectio nnotes :



## Remedial an drestoratio nactivitie s complete includin g 30-day so dwarranty : EPA RepresentativerT^/^^ ^ ^f^- ^ ^Az ^ " Date : 3/3//Jo/ /

## i >t£ L \ Omah a Lead Site—EP-R7-09-05 l^mfa r' Environnoenta J Restoration . LL C V ^

'••t*w»1t' ' www.cr1lc.co m 

# EXECUTIV ESUMMARY : 2919 9 190 4 OHI O S T



# No Issue s o r Concern s [ ^ Issues/Concern s" > [ Create Anothe rTicke t ] [ Bac k t o Irt h Inteme t ] : [ Sen d Emai l 

### YOU RTICKE T NUMBE RI S 2671017 . Origina l Cal l Date : 2/14/1 1 Time : 8:5 2 a m Op : ADAM2418 6 Wor k t o Begi n Date : 2/16/1 1 Time : 9:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 190 4 Street : OHI O S T Twp : 15 NRng : 13 E Sect-Qtr : 10-S W 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 : 2919 9 Compan y: ENVIRONMENTA L RESTORATIO N Contac t Name : ADA M Phone : (402)451-131 4 Alt . Contact : Phone : (636)288-961 6 Wor k Bein g Don e For : ep a Dept h o f Excavation : 24i n Corne r Lot : NFront : NRear : N Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Servic e Are a Contac t Phon e Nuinbe r Utilit y Typ e 

### Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEIDI 

### Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUDO l METROPOLITA NUTILITIES DISTRICT SAND Y MU D Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCITYOFOMAHA-TRAFFICSEWERRICH/TRAFFI C Alt : 402444516 1 

### Emerg : 402444516 0 Day : 406728934 3 0PPDGPR 5 OMAH A PUBLI C POWE RDISTRICT EL M LOCATIN GAlt : 406207149 4 

### Emerg : 888728934 3 Day : 406728934 3 QLNN E1 C QWES T LOCA LNETWOR K EL M LOCATIN GAlt : 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 

# SA\D#J±133 . Owner^sName : ^( ^ U^a>1> > hfifi & PUOE : 

### I Daytime Phone : qQl'S^ ^ PropertyAddress : (g^ ^ C^VitC i <TX^ ' Attemp t t o contac t Date/tim e Nam e i2'8-i O JTA 4J:<W ^ Q(^ . ,2'<i>iC > 

### JT A

• ' ­

# Propert y Final Repor t 1 SAID : 2^1^* ^ 1 Propert y Address:/<5J^^ ^ ^^^ Q ^ ^ n D

WOR K STARTE D WOR K COMPE LlE D ON : ON : / // / 

## ^^^^^'•kt ^ Kjf^-z^Q . 7/^M^ s Address : 

## Phone : LjOl--3^ i . ^^Z'- \ Fax : Cell/Pager : 

## P/ta^
- Renter : Phone : Fax : Celi/Pager : Additional Information :

H 0 S H

• D 1 ^ DAcces s Agreemen t

Restoratio nAgreemen t Vide o Propert y Befor e Digita l Photo s Befor e Vide o Propert y Afte r Digita l Photo s Afte r Propert y Completio nAgreemen t Fina l Repor t Signed : l « / *

^ /I * Signed : (z , /* ^ /J o O n: I Z / *= ^ /1 0 O n: 12 . / "= 1 / 1 6 O n:_/_/_ O n : / / Signed : 3 1-^ Z 1 / f Signed : / / By::f.A . By:5:A
By : n.f l 

## By: c m By : By : By:-;? ^ By : N/A

EXECUTIV E SUMMAR Y

Omah a Lead Projec t Wor k Pla n Pag e 1 of 1 9

# Consen t for Acces s t o Propert y SAID#^'9/"? ^ 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 dperformcertai nenviromnenta l respons e activitie s upo nth e followin g describe dpremises :

Owner' s Name : y}^ ^ \]Jg(jDTK7
- Daytim e Phone : ^ -3^/-'^^ ^ Address : ^^^^ ^ ^ 

# l^o H w a^r " Address : Addresse s of Propertie s Address : covere db y thi s 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 da t 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 enviroimienta l respons e action s t o b e performe do nsai dpropert y 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 dafter remedia l activities ; b .Locatin g equipmen t an dmachinery on-sit e inpreparatio nfor 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 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 interfer e o r tampe r withany o f th e activitie s o r work done , o r th e equipmen t use dto performth e activities , o r t o undertak e 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 propert y i nsuc h I gran t acces s t o m y propertie s nI d o no t gran t acces s t o m y propertie s ^ 

# Ai.d) . -P l 'MS . >a.-q-i D Signatur e Dat e 

### Signatur e Dat e

### Additiona l Comment s / Instructions :



## Pe rAHo^^ ^

o*^ THt " PdoPsJt-r / HC h Chec k thi s bo xi 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 . 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 f house , includin g foundatio n crack s o rfissures .

A Q I agre e d l I d o no t agre e J^^ ^ agre e C H I d o no t agre e

Owner' s Signatur e Date Contractor'sSignatur e Date

# Restoratio nAgreemen t Th e purpos e o f thi s agreenien t i s t o provid e amutua l agreement 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 tha t restoratio n activitie s ar e complete dt o th e satisfactio no f th e propert y ovrae r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA) .

SAW : 2,01 1 q ^ PropertyAddress : (t^QC / QHC O SV
Owner : ^ ^ K^^g^r ^ r O nth e attache ddiagram(s ) indicate area(s ) t o b e excavate dan ddept ho 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 , material types , etc . Indicate digital photo s b y referencin g th e photo-lo g number withanarro w indicatin g directio no f view . Item s t o b e remove db y Contracto r an dno t replaced :

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



# 'ikRJiC e L^rr H ^t >

_Qj [ agre e O I do no t agre e ^^PT l agre e Q I do no t agre e 

# f]);>i ^ Aif o in~^-i n -p- Q ^^^AAJtt ^ ^-2X-2DV l Owner' Owner' s s Signatur

Signatur e Date Contractor' Contractor' s Signatur e Dat e 

## Attachmen t ^

Pag e 2 of 2

## Propert yCompletio n Agreemen t Thi s agreement documents the completionof remedia l activitie s performe do nm y property . M y signatur e will designat e tha t I a msatisfiedwit hth e restorationo f m y property , an dtha t no item s ar e i n question , now , o r a

t an y tim e i nthe fiiture , except thos e items listedbelow , ifany . 

## SMD-.l^t^ ^ Propert y Address : ^e^ ^ QfjC p <^7 ^ Owner : 

# ke : {^f^u^rA^ r Phone : c/^T-
- 2lH l Restoratio n Item s i n Question :

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

^\ | I agre e restoratio n i s completed , excep t as note d 1/1 1 agre e restoratio n i s completed , excep t as note d I 1 1 d o no t agre e restoratio n i s complete d I I I d o no t agre e restoratio n i s complete d 

## VM/U , 

# & 1 'Jur O ,^-ai-/ l '- p q S..-:tt» , 2,-2S-Zoi \ Owner' s Signatur e Dat e Contractor s Signatur e Dat e

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# WhitePage s Fin d Peopl e | Fin d a Busines s 

## Jame s APric e I s tlii s you ? Edi t m 261 1 Florenc e Blv d Omaha , N E 68110-211 0 

### (402 ) 341-588 4 Job : Ac e Weldin g Repairing . Presiden t Kno wme ? As k m e t o updat e m ylistin g

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# l l i Willt e A'j « 

## fiirr © 201 0 Microsoft Corporatlli h © 20i}jg(^)g| Q ©AN D Listin g date : Nov . 200 9 Nam e popularit yan d nam e meanin g fo rfirs t nam e Jame s an d las t nam e Price .



### http://www.whitepages.com/search/Replay7faceboo k count=2&linkedincount=0&Iower==.. . 8/20/201 0^XU.t J ^..'V/\.«Jil b T A

. X^'WX^t.AJ.l b %.k.L±.\JM.l.i.X*.^^».\Jl, X Dougla s County , Nebrask a Propert yRecor d - R203064000 0 Prin t Reoor t Vie wInteractiv e GI S Ma o Informatio n i s vali d a s o f 2010-8-1 6 Treasurer' s Ta xReoor t Ne wFeatur e -•-•- > Subdivisio n Sale s Searc h Owne r AC E WELDIN G AN D REPAIRIN G IN C C/

O JAME S PRIC E 261 1 FLORENC E BLV D OMAH AN E 68110-000 0 Propert yInformatio n Ke yNumber . 306 4 OOO O 2 0 Accoun t Type : Residentia l Parce l Number : 203064000 0 Parce l Address : 190 4 OHI O S T OMAH AN E 68110-000 0 Lega l Description : PRUYNE S SU B DI V S 1/ 2 LO T3 4 LO T2 BLOC K0 3 0 X 8 0 Valu e Informatio n 201 0 200 9 200 8 200 7 200 6 200 5 Lan d $300.0 0 $300.0 0 $300.0 0 $300.0 0 $300.0 0 $300.0 0 Improvemen t $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 Tota l $300.0 0 $300.0 0 $300.0 0 $300.0 0 $300.0 0 $300.0 0 Sale s Informatio n Sale s Date : Dee d Type : Price : Grantor : 1997-02-1 2 D M $70,000.0 0 Book : 2 05 4 Page : 04 7

Grantee : Valid/Invalid : Exclusio n Reason : Vali d Lan d Informatio n Acre s 0.0 5 S F 2400. 0 Unit s 0. 0 Dept h 80. 0 Widt h 30. 0 Vacan t Ye s



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R20. . . 8/20/201 01 u^v ^ 2 , U l 2 , i^uug,ia s v^uuiii ^ /-vi.;cuuii i iiuuiiiiauui i

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### ENVIRONMENTA L AS-BUILTDRAV\/IN G OMAH ALEA D SUPERFUN D SIT » RESTORATIO N 

## 2919 9 Exterio rPain t Nort h Arro w Omah a Lea d Sit e Owne rName : AC E WELDIN G & REPAIRIN G • Goo d Sit e Sketc h Address : 190 4 OHI O S T • Poo r

Phone : H : W : 

# 1 [Zp-1^o t pain t Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Sample s Collecte d 

### Firm : ASUJAA I I> ^ RYASCPXA-2919 9 F l 5' 3 5 pp m 

### D Date : 7-/ V "O-f e RYBSCPXA-2919 9 F 2 Q l pp m 

# n Time : /O : 3 0 RYCSCPXA-2919 9 RYDSCPXA-2919 9 B l 8 2 511 . L e I 8 pp m pp m 

# n n Sample s Analyze d pp m 

# n n XR F Unit : \CS3~ \ Book : IS' ^ RGZSCPX A29189- ­ G Z pp m 

# n n Date : 

## ' d ­ \-o ^ -RP2SePXA-2&49 9 P Z pp m 

### D 

# n Time : 

## A «^ — Numbe ro f Sample s = ^ Staff : Wi.\iJ > Legend : F 1 = Fron t Left , F 2 = Fron t Right , B l = 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 

# ENTERE D
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### Omah a Lea d Sit e Owne rName : AC E WELDIN G & REPAIRIN G • Goo d 

### Sit e Sketc h Address : 190 4 OHI O S T Q ] Poo r

Phone : H : W : g^o t pain t 

### Lead Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d 

## Firm : ASU/AA I I>M ^ RYASCPXA-2919 9 F l 

## ^ 3 5 _pp m 

## D Date : 7-/ V "c ^ RYBSCPXA-2919 9 F 2 _pp m 

## D Time : /O : 3 0 

# _a i RYCSCPXA-2919 9 RYDSCPXA-2919 9 8 1 8 2 

### 612 . LcI 8 

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# u D XR F Unit : \OS \ Book : \S ^ RGZSCPXA-2949 9 GZ ­ pp m 

# a D Date : B ­ \-0(j g -RP£SePXA-2m9 9 PZ pp m 

# n D Time : t\,fv ^ Numbe ro f Sample s = / ^ Staff : n.<w > Legend : F l = Fron t Left , F 2 = Fron t Right , B l = Bac k Left , 8 2 = Bac k Rigli t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s are as viewe d fro m th e street , facin g property 

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Exterio rPain t Nort h A r o w Omah a Lea d Sit e Owne rName : AC E WELDIN G & REPAIRIN G Q Goo d Sit e Sketc h 

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# r ENTERE D

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