### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID# : Vy^U o 

## Date : Z-Z^- W Address : iSf WKJ . 2^ ^ ^ T Remediatio nContractor : Envrionmenta l Restoration , LLC _ Year : 201 0 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 

# y Vide o o f propert y (DVD ) J36efor e J3^fte r D Basemen t D _ 

# y Executiv e Summary (Final Report ) EPA-provide dproperty sketch . Signe dAcces s Agreemen t for subjec t property D 

### Signe dAcces s Agreement(s ) for adjacent propert y 

# X Restoratio nAgreemen t

D 

### Settlemen t document s (i.e. , for damag e or to replac e plants , etc "^ 

# y Confinriatio ndat a



# y Photograph s Z l Before DCrev/PhotosJZ'Durin g Excavatio nD ^30-da y So dD 

# X As-buil t sketc h Completio nA.greement signe db y Property Ovv'ne r 

# y Propert y close-ou t chec k lis t signe db y EP A D 

### Descriptio no f area s no t meetin g RO D cleanu p criteri a 

# y Utilit y clearance s 

# y Propert y informatio nfrom. Dougla s County Assessor' s Offi c Propert y acces s checklis t 3026188 6 

### Contac t Lo g WcLCCr A Lo f 

# y Superfun d 

### -ZS- U Environmerk al Restoratio nSignatur e ^ 

### Date " 

## 70-/k-/ / HP A CO Rsignat i gnatur e Date

# EP A EP A Propert y Clos e Ou t For m Omah aLea dSit e Propert y # : "Zfa^ZG ? PropertyAddress : \?? U (\ K 2SS T Date/Time : Owner'sName : pAVt i o- ^ OwiaV^G L Quad s Excavated : 

## ^3 . Contracto r Grou p : Environmenta l Restoratio n (ER ) : & Excavatio nGeneral Ye s N o ] . Ifnecessary , wer e th e correc t quadrant(s ) excavate dan drestored ? yy 2 . Ifnecessary , wer e th e correct areas ofdri p zon e excavatedan drestored ? \/li/Uit i T irn " 

# a Gradin g Sodan dVegetation Ye s N o 1 . Doe s th e grading aroun dthe perimete r ofth e house i nexcavatedareas generall y slope awa y fro mth e 

## y house ? 2 . Ha s sodbee nlai di

nall area s tha t wer e excavated ? ,y 3 . Doe s th e sodappea r t

o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecteda t 30-da y tim e period) . 4 . Ar e soddedareas generaU y fir man devenl y graded ? ^ ^ 5 . Ar e th e joint s betwee nthe sodstrip s generall y tight ? (Onl y evaluat e .i f inspecteda t 30-da y tim e period) . 6 . Wa s the propert y grade dsuc htha t wate r wil l no t pool o nth e property ? 1^- 1 7 . Wa s damage to landscapin g o r plan t material s avoided ? ^ ^ Gates , Fence s an dRetainin g Wall s Ve s N o 1 . D o gate s ope nan dclos e freely ? (ifapplicable ) Wer e al l gate s o r fence s take ndow ndurin g restoratio nactivitie s re-installed ? (ifapplicable ) 

## TJA 3 . Wa s damag e to gate s o r fence s avoided ? (ifapplicable ) 4 . Wa s damag e t o retainin g wall s avoided ? (ifapplicable ) y 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 ? 

# ^jo^^^Ei ^ 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 ) Yes N o 1 . Wa s damage t o drivewa y surface s avoided ? 

### / J A 2 . Wa s damage to walkwa y surface s avoided ? 

# y fnspectio nnotes :

Remedia l an drestoratio n activitie s complet e includin g 30-da y so dwarranty : EP A Representative ; 

# M . ^=- L 

# M^J^u ^ Date : 

# 4XJ L

## ," " l O "x , Omah a Lead Site—EP-R7-09-05 ^

3j^v ^

^ Environmenta l Restoration , LL C '-tpwi* " 

# EXECUTIV ESUMMARY : 26826-181 1 N25S T



# No Issue s o r Concern s Q ] Issues/Concern s Detai l F.xnlanatinn ­" > [ Creat e Anothe rTicke t ^ [ Bac k t o Irt h Interne t ] Sen d Ennai l



### • YOU RTICKE T NUMBE RI S 2664766 . Origina l Cal l Date : 1/17/1 1 Time : 7:5 3 a m Op : ADAM241 8 6 Wor k t o Begi n Date : 1/20/1 1 Time : 7:1 5 am State : N E County : DOUGLA S Place : OMAH A Address : 181 1 Street : N25T H S T Twp : 15 NRng : 13 E Sect-Qtr : 16-N 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 : 2682 6 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 : NExplosives : N CXCAT V LEVEL S MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Servic e Are a Contac t Phon e Numbe r Utility 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 MUD Day : Alt : 402504782 3 Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFlC,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 1rag e z oi z

0PPDGPR5 OMAH A PUBLI 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

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## Contac t Informatio n Lo g 

# SAID#/68^ G Owner'sName : Q ^ ^ y ^^^/ ^ | Daytim e Phone : if ^ - ^y V - ^74^ ^ I PropertyAddress : \^\\fj . Z^ ^ 57 ^ Attemp t t o contac t Date/tim e 

### Nam e CAu ^ u/« » fl-«t»oe^ il-iol O %X»fi ^ TT/J . ^^fcte ' ^ f>e(Jii^ fr ycuu n 

### l l ' 3 - I O 

### J > LSP rssf - u>'' ^ cjjT' ^ (Li-J-' O 

# :r A ^Si^-'yc ^ o^ . /<j-'?••/' ? T:/? . C-^Arf^c^^c ' -^ rKJCC'KU*-'^^" ^ 

### /•n- K -^ D /e o F'\yecf i Co/Mplt+.'(»/ > ^•f- n

## Propert y Final Report s^°>=26B^ 6 PropertyAddress : /g/ / yy, . t<r ^ S H n D

WOR K STARTE D WOR K COMPELTE D ON : ON: . / // / Owner : CJTT V OF0^*U< . Address : 

### 16^ 1 f/htWKrt ^ 'ST ' Renter : Phone : Fax : 

# 1

Phone : t/b2,-WHt j . q^t/ g 

### Fax : ^^/Sl-q^^'ClH O Cell/Pager : Cell/Pager : Additiona l Information :

PrAcces s Agreemen t •P l Restoratio nAgreemen t jy ] Vide o Propert y Befor e Jx T Digita l Photo s Befor e nVide o Propert y Afte r Sisned : J^ l /Sl/* > Sianed:/ ^ 1 L T i / o O n-.f^llSi/r^ O ny^liS'/K ^ O n•._l_l _ 

### By - -ri ^ ^T-TP 

### Bycr ^ By=rr-z ? By : N/A nDigita l Photo s Afte r .•PT^Propert v Completio nAgreemen t O n: / / Siened:-i ? l7( ^ i / C By : By:^. ^

• Fina l Repor t Sisoed : / / By : EXECUTIV ESUMMAR Y

Omah a Lea d Projec t Wor k Pla n Pag e 1 o f 1 9

### ^^Dec . 15 . 201 0 1:24PM^ ^ Om^f \ PLANNIN G DEPT . 402-444-614 0 130 0 P. 2'^'^'^^'''''^ ^

/ • ^ 

# Consent fo r

Acces s t o Propert y SAiD #2C(>S>2C> RIOH T OPgi^TR Y TO PREMISE S 

### Granto r (th e property ovvner) , consent s t o an dauthorize s ^ e Unite dState s Envirotunento l Protectio nAgenc y (USEPA ) o r it s authorize drepresentatives, coUeotively th e Grante e t o ente r an dperfoi mcertai nenvironmental respons e activitie s upo nth e followin g describe dpremises :

Owaer-sWamt : CTT Q 

### Af T C\»A^W ^ Daytim e Phone ; 4tw,»f/tjV-t/Z*/ 6



## ""''" ^ (^1 1 H . 1/ f ^ . Addren ; Afidresms o f Propertle i covere dby thi s Address : Agreemeiit : 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 dwithhazardou s substances ^ i nparticula r lea dat concentration s greate r tha no r equa l t o 40 0 part s pe r millio n(ppm) . REMEDIA LACTION S Th e environmenta l respons e action s t o b e peifoime 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 propeity before , during , an dafter remedial activities ; Locatin g equipmen t an dmachinei y on-sit e i npreparatio nfor an di nth e cours e ofth e environmental response ; c . Plannin g an dImplementin g lh e remova l actio no no r near Grantor' s property . Obtainin g sample s firom Gnmtor' s property ; d . AOREEMEN T NOTT O fNTRRFqp n 

### Th e Granto r agree s no t t o inteifix e o r tampe r withany o f th e activitie s o r woil c done , o r th e equipmen t use dt o perfon nth e activities , o r t o undertak e any action s regardin g th e us e o f sai d property 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 ^ 

### gran t acces s to m y propertie s Q I d o no t gran t acces s t o m y propertie s 

# /yi)o-c)o^ ^ Dat e Signatur e Dat ei Z 

## Dec . 15 . 201 0 1:24PM^' ^ QU. mPLANNIN GDEPT . 402-444-6 ' Jo . 1300 P . 3t^«93/«« 5 

# f f

AddWonai Comment s / iQLatructions :



# x)o r fir ^TiUKJue ^o ) n^ € fif^P>^TV Tchec k thi s bo x i f owne r doe s no t wan t E.R . t o ente r th e resident s t o documen t interio r foundatio nwall aan dpossibl e preexistin g damage . B y cheddn g thi abo x E.R . I s no t responsibl e fo r an y damag e don e t o th e Interio r of house , indudin g foundatio ncrack s o r fissures . 

## H^h i

TSJ agre e • I d o no t agre e 

# £f l Agre e mI d o no t agre e

Contractor' s Signatur e Owner' s SiebaMre DateJo , 1300 P . 42l«o'»/J0 5 

### • ^Dec . 15 . 20 1 :24PM'" " OM^AN APLANNIN GDEPT , 402-444-6 1



## Rsstoratio n Agraemen t Th e purpos e o f thi s agreemen t i s t o provid e amutual agreemen t a s to condition s o f propert y prio r t o contracto r activities . Thi s wil l als o serv e a s documentatio nfor th e puqjos e o f assurin g tha t restoratio n activitie s ar e complete dt o th e satisfactio no f th e property owner ao dth e Unite dState s Environmenta ! Protectio nAgenc y (EPA) .

SAID : 

# ^2L^2 L PropertyAddress : /^/ / ^ ^C^^ST " P^»^''^C ^ n r ciM^A .
—Vi^ T ar—ofl E O nth e attache ddlag)Fam(s) indical e area(s ) t o b e excavate dan ddept ho f excavationi locatio no f al ) kno>v n utilities , subsurfac e features , surfiioe structure s an dlandscapin g features , acces s locadon(s ) t o b e use db y contractor , an ddi e directio no f North . Indicate distances , d^iths , material types , etc . Indicat e digita l photo s b y referencin g th e photo-io g number wit hanarro w indicatin g directio no f view . Itsm s t o b e remove db y Contracto r an dno t reptaeed : ttem: Item ; Itam : ttam: Item : Kem : Kem :

Pag a Iot ai2 n 

## ec . 15 . 201 0 1:24PM**' ' OMiH APLANNIN GDEPT . 402-444-614 0 30 0 P . 5'^"'"5''''° ^ 

# f<

AddKiona l Comment s / Inabuctlons :

1% ! agre e O I ^ o BO t agre e 

# y i agr« e O I d o no t agre e 

## /CiP^i'-yo7 ^ |,^ ^

S^^-*^^*:^ ^

S-v- W Owner ' Dat e Contiractor' s Signatur e Dat e Attachmen t

Pag e 2 o f 2>J4 . J. U J.J . j.j.iut j rnuij~jjuui>j.ij y 'iiac~'i'fi-oca o 1 njon j 1 ujiuiuo/tJKjj. u r-t l f I U

ST > 

### v^ K o l P<v<^o r 

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio no f remedia l activitie s performe do n m y property . M y signatur e wil l designate tha t I a msatisfie dwithth e ntstorado no f my property , an dtha t n o item s ar e in question , now , o r at an y tim e i nth e future , excep t thos e item s liste dbelow , i f any . SAIP ; 20etC p Propert y Address : ;^/ / ^ , ^ ^ j ^ <>^* " a ^ af ^ rtMA^A Phoi.e;^.q^q.tj2l/ 5 Restoratio n Kam at

n Queation : Rem : item : Hem : Item : ttam: Item ; Addittona t Commenls : 

# ~1 k } 1 1 agre e reitorado nb campleted , «xc«pt n notu l ypH"agr« e restoratio ni s eompleted , e^iGep t n

s note d i^i^ aatl i agree remrano ni acompiete d i i I U dQo t a^e e resvartifo ni ) completed 

## /7r/ZL-Pb/l

Dat e Contractor' s Signatur e Dat el^UUK'O ^ *^*- ^ iiiiu i lllCLliyjL L ±<A.p.\ . 1 yj ±£ - J^ B uiiij ' .rv^v^v^uii i Dougla s County , Nebrask a Propert yRecor d - R194551000 0 Prin t Repor t Vie wInteractiv e GI S IVIa D Informatio n i s vali d a s o f 2010-8-1 6 Treasurer' s Ta xRepor t Ne wFeatur e - ^ - > '- > Subdivisio n Sale s Searci i Owne r CLEAV E TEMPL E CM E CHURC H 243 1 DECATU R S T OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : 455 1 000 0 1 9 Accoun t Type : E xReligiou s Parce l Number : 194551000 0 Parce l Address : 181 1 N25S T OMAH AN E 68111-000 0 Lega l Description : PARKER S AD D LO T8 BLOC K7 N 3 3 F TL T7 & N 3 3 W 1 6 FT3 3 X 7 6 Valu e Informatio n Lan d Improvemen t Tota l 201 0 $0.0 0 $0.0 0 $0.0 0 200 9 $0.0 0 $0.0 0 $0.0 0 200 8 $0.0 0 $0.0 0 $0.0 0 200 7 $0.0 0 $0.0 0 $0.0 0 200 6 $0.0 0 $0.0 0 $0.0 0 200 5 $0.0 0 $0.0 0 $0.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 5 2508. 0 0. 0 76. 0 33. 0 Ye s



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### 2682 6 Exterio rPain t Omahi a Lea d Sit e Owne rName : CLEAV E TEMPL E CM E CHU R • Goo d Sit e Sl<etci i Address : 181 1 N 2 5 S T • Poo r

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### D -RGZSCP>;A-2«82« - GZ . pp m D Date : LP0 5 

### D pp m D Time : A M 

### D Staff : MSU / Numtje ro f Sample s = A ' Legend : F l = Fron t Left , F 2 = Fron t Right , 8 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Ai l qua<lrant s ar e a s viewe d fro m th e street , facin g propert y 

# MNTEUB B HA v 3 0 z m SAI D #2682 6 DAT E EXCAVATE D 1-19-1 1 DAT E EP ASIGNE D OF F 3-1-1 1

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# iiiiiiiiiiiiiiiii n 2682 6 Exterio rPain t Nort hArrow Omah a Lea d Sit e Owne rName:.CLJAV E TEMPL E CM E CHU R • Goo d Sit e Sketc h Ad d ress : M l N25S T

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## D Date ; G cj-.DC. - o fe RYBSCPXA-2682 6 F 2 

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## D D D D XR F Unit : 9D ^ Date : ( ^ 0 5 Book : 

## i ^ RR 2 pp m 

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# M.TEE B M Y 3 0 m 

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## D D XR F Unit : Q0 2 Book : lb( ^ .RGZSCPXA-2682- 6 G Z pp m 

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