### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAI D # : 3>'^?>4nDate : Address : ?^^9> ^ U- ^^ ^ ^ ^ Remediatio nContractor : Envrionmenta l Restoration , LLC

_Year : _2010 _ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S NVide o o f property (DVD ) _'lS3efore DAfter D Basemen t ^ /i PmS/m^^uf ^ L\Executiv e Summary (Final Report ) ^ ^ EPA-provide dproperty sketc h

a

» Signe dAcces s Agreemen t fo r subjec t property D Signe dAcces s Agreement(s ) fo r adjacen t property 13
- Restoratio nAgreemen t ""^ y Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) ^S ^ Confirmatio ndat a

D Photograph s jSLBefor e DCre w Photo s D Diu^in g Excavatio nD So d ^ 30-day So dD X ^ As-bui hsketc h "S v Completio nAgreemen t signe db y Property Owne r l3v Property close-ou t chec k lis t signe db y EPA D Descriptio no f area s no t meetin g RO D cleanu p criteri a ^ Utility clearance s \ ] Property informatio nfro mDougla s County Assessor' s Offic e

S Property acces s checklis t i '

• v Contac t Lo g ! D i 

### Envirorunental Restoratio nSignatur e Dat e 

## /i'ZZ,-/ f 

# -44 ^ EPACO Rsignatur e ~ X Dat e

## Omah a Lea d Site—EP-R7-09-0 5 I ^s^y8 Environmenta l Restoration , LL C www.ei11c.co m : ^ 

# EXECUTIV ESUMMARY :

3334 7 - 392 3 N 2 5 S T 

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

### ENVIRONMENTA
RESTORATIO N 

# PROPERT Y CHANG EORDE R OMAH ALEA D Propert y I D #^3J^ 7 Propert y Addres s :^?^ 3 A/
- PS'i^sU
Owne r Nam e S-^^^k s lUl f Dat e S'-fS-Z o Comment s Owne r o f sai dpropert y reques t tha t E.R . remov e concret e sidewal k that' s i nth e excavatio nare at o acces s th e B- 1 qua dinstea do f gettin g o nth e driveway . E.R . wil l no t replac e an y concret e tha t wa s remove dan di s no t responsibl e fo r an y drainag e issue s du e t o remova l o f sidewalk . Owne r Signatur e Contracto r Signatur e

# -EP A EP A Propert y Clos e Ou t For m Omah aLea dSit e Propert y #:_JWY^_ Propert y Address : ^9>2 > Ni
- 9>5 ' f> T Date/Time : Owner' s Name : S-h^JiT^-V j t^U Quad s Excavated : fel Contracto r Grou p : Environmenta l Restoratio n(ER ) Excavatio nGenera l Ye s No 1. If necessary , were th e correc t quadrant(s ) excavate dandrestored ? ^ 2. If necessary , were th e correc t area s of dri p zon e excavate dan drestored? i ^ Gradin g So dan dVegetatio n Ye s No 1. Doe s th e gradin g aroun dth e perimete r of th e hous e inexcavate darea s generall y slop e away fromth e i / house ? 2. Ha s so dbee nlai d inal l area s tha t were excavated ? ^ 3. Doe s th e so dappear to be generall y health y an dgrowing ? (Onl y evaluat e if

inspecte d at 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 if

inspecte d at 30-day tim e period) . 6. Wa s th e property grade dsuc hthat wate r wil l no t poo l onth e property ? ^ 7. Wa s damag eto landscapin g or plan t material s avoided ? ^ Gates , Fence s an dRetainin g Wall s Ye sNo Do gate s ope nandclos e freely ? (i f applicable ) 2. Were al l gate s or fence s take ndow ndurin g restoratio nactivities re-installed ? (i f applicable ) 

# i i ^ 3. Wa s damag e to gate s or fence s avoided ? (i f applicable ) 4. Wa s damag eto retainin g wall s avoided ? (i f applicable ) Foundation , Sidin g an dGutter s Ye s No 1. Wa s damag eto sidin g or tri mavoided ? • " 2. Wa s damag eto th e foundatio navoided ? k ^ 3. Wa s damag eto window s avoided ? t ^ 4. Wa s damag e to windo w screen s or doo r screen s avoided ? 

### y 5. Wa s damag eto downspout s or downspou t extension s avoided ? ^ Sidewalk s an dDriveway s (Concrete ) Ye s No 1. Wa s damag e to driveway surface s avoided ? l ^ Wa s damag eto walkway surface s avoided ? V Q ^n,,^<X ASt«L.AaJ(L L CP^^^^P A 

### ^y Mv g^ y qgi^c i -^rXAk ^ (^\c^^ A Inspectio nnotes : 

### O^&itt,\o r Sdc l Remedia l an d ajitivitie 0-da y so dwarranty : restoratio nactivitie s complet complet e includin includin g 3( EP ARepresentativ e Date : 

## tativeK^/^y^;;^:^^^^/-^ , ^X.:?! ^ ZP

### Pag e I of 2

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



### • YOU RTICKE T NUMBE RI S 255958 ^ Origina l Cal l Date : Wor k t o Begi n Date ; State : N E Address : 392 3 Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C 8/04/1 0 8/06/lC f Time : Time : 6 7 5 6 1 5 a m am 

# 1 Op : TRACY2418 6 County : D C Street : N )UGLA S 25T H S l Place : OMAH A Sect-Qt r Sect-Qt r 04-S E Typ e o f Work : Excavatin g th e entir e propert y Locatio n o f Work : LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)451-106 9 mSAI D #3334 7 / Compan y ENVIRONMENTA L RESTORATIO N Contac t Nam e TRAC Y BRISTO W Alt . Contac t Wor k Bein g Don e For : EP A Dept h o f Excavation : 12 " Corne r Lot: Involve s Tunnelin g o r Horizonta l Borin g : ALT87 2 CXCAT V MUDO l OMAHACO F Servic e Are a ALT87 2 WINDSTREA M COMMUNICATIO N

CXCAT V CO X COMMUNICATIONS , IN C

MUDO l METROPOLITA NUTILITIE S DISTRIC T

OMAHACO FCIT Y O FOMAHA-TRAFFIC.SEWE R Phone : (402)451-131 4 Phone : (314)504-487 4 NFront : Y Rear : NExplosives : N

0PPDGPR 5 Contac t 

### EL M LOCATIN G

HEID I

SAND Y



### RICH/TRAFFI C QLNNEI C Phon e Numbe r Utilit y Typ e 

### Day : 406728934 3 Ah : 406207149 4

Emerg : 888728934 3 Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 Ah : 

### Emerg : 402504797 0 Day : 402444719 7 

### Ah : 402444516 1 Emerg : 402444516 0 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 8/4/201 0

### Pag e 2 of 2

0PPDGPR 5 OMAH APUBLI C POWE RDISTRIC T Day :

EL M LOCATIN GAh : 406728934 3 406207149 4 Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K Day : 406728934 3

EL M LOCATIN GAh : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 8/4/201 0

## Contac t InformatBo n Lo g 

# SAID#J33^? ^ Owner' s Name : SfrtrvU- r Propert y Address : ^'\ZZ UwU M . i.S^^ ' Daytime Phone : V62, ^ Tb'f
­ //V o


### Attemp t t o contac t Date/tim e ujivf^orx i C P ^t>*^ ^ Nam e /\.ct - Prt:6.1 ^ 

# t-i)-) o '^'> ^ 

# A2> ­

'

## Propert yAcces s Checklis t SAID : J33V ? n WORK STARTED n WORKCOMPELTE D Propert y Address : •aog ^ A j ^S"* * •<"/ • Owner : ^y^^[^ ^ \]^\ l Renter : Address : Phone : Fax : Cell/Pager : Additiona l Information : Phone : Vd< : \To l - 1W O Fax : Cell/Pager : S^Acces s Agreemen t Signed : V / ZZ / t O By : ZicJr ^ 

## fktiCl . iS l Restoratio nAgreemen t Signed : / / By : Q ^ Vide o Propert y Befor e O n: V / 2Zrit > By : "V * ^ J L i^£6^j e H^Digita l Photo s Befor e O n' . H 1 ze . 1 l o By : 

### <^.'. X 

## fk6i U r~ l Vide o Propert y Afte r O n: / / By : nDigita l Photo s Afte r O n: / / By : p Q Propert y Completio nAgreemen t Signed : iS^/t^f / t o By : 

## ^- 0 nFina l Repor t Signed : / . / 

# Il L Additional Vide o o r Digital Photo' s Taken : D Vide o n Digita l Phot o O n : / / 

### By : 1 Reason : D Vide o D Digita l Phot o O n / / By : Reason : D Vide o n Digita l Phot o O n By : Reason : n Vide o n Digita l Phot o O n / / By : Reason :

Omah a Lead Projec t Work Pla n Page l o f 1 9

## Consen t fo rAcces s t o Propert y 

# SAiD #J3JV ? RIGH T O FENTR Y T O PREMISE S 

### Granto r (th e property owmer) , 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 dperfor mcertai nenvironmenta l respons e activitie s upo nth e followin g describe dpremises, :

PURPOS EO FINVESTIGATION 

### Th e purpos e o f th e remedia l activitie s i s to remov e all 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) . REMEDL^ LACTION 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 dafter remedia l activities ; b . Locatin g equipmen t an dmachinery on-sit e inpreparatio nfo r an di nth e cours e o f th e envirormiental response ; c . Plannin g an dimplementin g th e removal actio no no r near Grantor' s property . d . Obtainin g sample s fi-omGrantor' s property ; A.GREEMENT NO T T O INTERFERE 

### Th e Granto r agree s not t o interfere or tampe r withan y o f th e activitie s o r work done , o r th e equipmen t use dt o 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 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 

# Sl^r gran t acces s to ray propertie s nI d o no t gran t acces s to m y propertie s 

# ^JLAydl J <^^^-/ ^ Signatur e Dat e Signatur e Dat eAdditiona l Comment s / Instructions : 

## Aa^t . c4hv ^ 4>vq-n : 

## ^c^ b / ^L;>\AC C

0^Chec 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 .

Q^Ia ; gre e nI d o no t agre e 

## QT ^ L J I d o no t agre e agre e 

# ^JJV ^ ^At/ C VZ^/s<?r 0 Dat e Contractor' s Signature 

### riate '

## 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 propert y 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 owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA) .



### SAID : 333C/ 7 Propert y Address : 0 0 ^ « > • 

# Zs r ^^ ' ^""^^ ,^4^nl^ v lA^ W Phone : y^^N ^ ^< ; . ^^^ ^ O nth e attache ddiagram(s ) indicate 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 andlandscapin g features , acces s location(s ) t o b e use db y contractor , an dtli e directio no f North . Indicate distances , depths , materia l types , etc . Indicat e digital photo s b y referencin g th e photo-lo g nimiber 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 :

Pag e 1 o f 2

### Additiona l Comment s / Instructions : 

## iCtlS/'Ac c A: ^ 

# b z

Q^ ! C H I d o no t agre e I 1 1 agre e nI d o no t agre e agre e 

# Ldj /

^/-j;^-/ ^ tAcJt fcrlV ^t'jt/ ^ 

### ^o/ O Date Contractor' s Signatur e 'Date ' Attachment s

Pag e 2 o f2

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio nof remedia l activitie s performe d onmy property . My d( siffnat T a satisfie dwit hth e restoratio nof y property an dtha t no item s ar ein signatur e wil l designat ee

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### question , now , or at any SAID : 3337?
- Propert y Address : J^^ S AJ . '^S ' .5/-
- Owner : ^ 4 (^ ^ y^/ ; Phone : ^^^\ ^ -^^ g - / /c/ p Restoratio nItem sinQuestion :

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ISCI j agre e restoratio n is completed , excep tas note d |\ | I agre e restoratio n is completed , excep t as note d I I f do no t agre e restoratio n is complete d I I Ido no t agre e restoratio n is complete d


### Owner' s SignaMre' / Date Contractor' s Signatur e Date

### Dougla s County Accoun t Intbrmatio n Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R184044000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t o f52n d S t - Vle WO n Ma p Infonnatio n i s vali d a s o f2009-12-3 1 Treasurer' s Ta xRepor t Ne wFeatur e ->"->- + Aut o Sale s Searc h Owne r HAL L JESSI E R ETA L 392 3 N 2 5 S T OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : 404 4 000 0 1 8 Accoun t Type : Residentia l Parce l Number : 184044000 0 Parce l Address : Lega l Description : 392 3 N 2 5 S T OMAH AN E 68111-000 0 NORRI S SU B DI V LO T6 BLOC K0 4 2 X 10 0 Valu e Informatio n 200 9 200 8 200 7 200 6 200 5 200 4 Lan d $2,200.0 0 $2,200.0 0 $2,200.0 0 $2,200.0 0 $2,200.0 0 $2,200.0 0 Improvemen t $15,500.0 0 $15,500.0 0 $15,500.0 0 $15,500.0 0 $6,800.0 0 $6,200.0 0 Tota l $17,700.0 0 $17,700.0 0 $17,700.0 0 $17,700.0 0 $9,000.0 0 $8,400.0 0 Lan d Informatio n Acre s 0.0 9 S F 4200. 0 Unit s 1. 0 Dept h 100. 0 Widt h 4 2. 0 Vacan t N o Improvemen t Informatio n Buildin g 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.js p ?accountno=R l 8.. . 1/18/201 0

### Dougla s County Accoun t Intormatio n f ag e 4 ^ o t 2

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H i t
\tI Zam v Fb>^i«<l CLIC KT O ENLARG E IMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : 1248. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Poo r

Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 7. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Plaste r Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 4. 0

Roo fType : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 191 0 0 % 191 0 10 0 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 ft 856. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h Cvr d Woo d Dec k 153. 0 Use r Atti cFul l Finis h 392. 0 Use r Sourc e # 2. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.js p ?accountno=R l 8.. . 1/18/201 0

### ENVIRONMENTA L AS-BUILTDRAWIN G . 'OMAH ALEA D SUPERFUN D SITE ( 

### RESTORATIO N 

# IIII I I I IIIII ! 3334 7 Exterio rPain t Nort h Arrow Omah a Lea d Sit e Owne rName : JESSI E R HAL L • Goo d Sit e Sketc h Address : 392 3 N 2 5 S T • Poo r

Phone : H 4»o2-451-483 l w [yfNo t pain t Sat-npl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Firm : RYASCPXA-3334 7 F l 2,11 . f pp m 

## 0 " 

# n Date : RYBSCPXA-3334 7 F 2 

### 1 12 . pp m 

## Q ' Time : 

## D RYCSCPXA-3334 7 B l 

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# n pp m 

# n Date : ^••z y' ^q , 

# a RPiracrx A3334 7 p y — pp m 

# n Time : 

### A M 

# a Staff : 

### MS\^ ' Numbe ro fSample s - Legend : F l = Fron t Left . F 2 = Fron t Right , B l = Bac k Left , B 2 = Bac k Righ t D Z •- Al l quadrant s ar e a s viewe d fro m th e street , faci n Dri p Zone . G Z = Garden . P Z = Pla y 

# EJ^TIEE D SAI D # 3334 7 DAT E EXCAVATE D 8-13-1 0 DAT E EP ASIGNE D OF F 8-25-1 0

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## D 

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## D Sample s Analyze d RYDSCPXA-3334 7 B 2 

## Z6 3 pp m 

## D ROZSCPXA-3334 7 D Z H - 4 pp m 

## D XR F Unit : 9Q ^ Book ; // g %fii-3^34 7 G ^ pp m 

# n D Date : _ 

## ^•z y ' a L ^ f—~~P ? pp m 

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Not pain t Sampl e Numbe r Lead Sampl e Sample s Collecte d LA B Concentratio n Collecte d Firm : p:t:> Aj f<^\ C N 

## 0 " RYASCPXA-3334 7 F l pp m 

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## iil X pp m 

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# 1 I 

## +1 

## +1 +1 c5 > 

# s 0 -- • <-

> 1 0 

# r 0 ca X "S o 

# 1 1 0 

# i
11 1 1 1 i, 1 1 1 1 i 1 1 1 1 ! 1, 1, 1 1. 1, 1 1 '. I 1 1