### TRANSMITTA L of OMAH A LEA D SIT E SOI LREMEDIATIO N FIL EFOLDE R
SAID# : ^q C Date : \ j U j \ ^ Address : ^'^^ Y ^U ^ U Remediatio nContractor : Coasta l Environmenta l Group

_Year : _200f t SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o of property (DVD ) 

# k Executiv e Summary 5/

EPA-providedpropert y sketc h M Signe dAcces s Agreemen t fo r

subject propert y "H ' Signe dAcces s Agreement(s ) fo r

adjacen t propert y t /

Restoration Agreemen t ~B
­ Settlemen t document s (i.e. , for damag e or to replac e plants , etc. ) -B
­ Confirmatio ndat a ^ Photograph s ._ _' •• U As-buil t sketc h ^ Satisfactory restoratio nsigne d by Property Owne r \B 7 Property close-ou t chec k lis t signe dby EP A TI Descriptio nofarea s no t meetin g RO D cleanu p criteri a Utility clearance s / 

### Property informatio nfromDougla s Count y Assessor' s Offic e



## ^ 1 {( 7 Ignatur e Date / 3005547 5 

# H Superfun d

### Propert yAcces s Checklis t Property m ; (^ q 

# fe Propert yAddress : 2595 ( FUiSO n Av < D DWOR K STARTE D WOR K COMPELTED ON : ON: . _ / I I I 

### Owner . flon5v\r ^ ^•••"^ ^ V.KV ^ 

### H f(»V : ^.r^ni ^ Rente r Phone: Fax : 

### ">•" « Fax : 

### ^<nl'?^n 7 Cell/Pager : Additioaai biformation : Cell/Page r D NotificationLette r 0 Acces s Agreemen t Q f

Restoratio nAgreemen t D Topsoil Samplin g (I f applicable ) D Disposa l Samplin g (if applicable ) D Garde nSamplin g (if applicable ) Q Utilit y Clearanc e ^ Video/Photo s (Before ) O Video/Plioto s (Daring ) D Video/Photo s (After) D Video/Photo s (30-Day ) S|2 ^ Property Completio nAgreement [ ^ FinalRepor t Sent : / / Signed : ^/11./O ^ 

### Signed: 4_/jl./i[ 3 / / / / / / 

### Called : ^/I2_/i[f l

On : ^liXfil ^ On : / / On : / / On : / / 

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### By : 1

Omah a Lea d Sit e1 

## CONTACT FOR M Propert y I D # Propert y Address : Initia l Contact : Secon dContact : Fina l Contact : Fina l Action :

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• L'3^* 6 

# eUi^n n Av- c Date : Time : Action : Date : Time : Action : Date : Time : Action : Transmi t t o EP A D Othe r Action : D

### Dougla s Coimty Accoimt Inforte|io n Pag e 1 of 2 r|||i c Dougla s County , Nebrask a Propert yRecor d - R l 13472000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f52n d S t - ViewO n Ma p Informatio n i s vali d a s o f2009-8- 3 Treasurer' s Ta xRepor t Ne wFeatur e - • • • ^ Aut o Sale s Searc h Owne r HICKERSO N FLORENC E ETA L 259 8 ELLISO N AV E OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : 347 2 OOO O 1 1 Accoun t Type : Residentia l Parce l Number : 113472000 0 Parce l Address : 259 8 ELLISO N AV OMAH AN E 68111-000 0 Lega l Description : FOR TVIE WAD D LO T2 BLOC K0 S 66. 5 F TLT1 & S 66. 5 W1 0 FT66. 5 X 6 0 Valu e Informatio n Lan d Improvemen t Tota l 

### 200 9 200 8 200 7 200 6 200 5 200 4 $2,400.0 0 $2,400.0 0 $2,400.0 0 $2,400.0 0 $2,400.0 0 $2,400.0 0 $36,000.0 0 $36,000.0 0 $30,400.0 0 $30,400.0 0 $30,400.0 0 

### $13,600.0 0 $38,400.0 0 $38,400.0 0 $32,800.0 0 $32,800.0 0 $32,800.0 0 

### $16,000.0 0 Lan d Informatio n Acre s S F Unit s Depti i Widti i Vacan t 

### 0. 1 4620. 0 

### 1.0 66. 0 70. 0 N o Improvemen t Informatio n Buildin g 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R l 1.. . 8/22/200 9

### Dougla s County Accoun t InforflMtion Pag e 2 of 2

2*9 8 ELLISO N A V

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### RANC H CLIC KTO ENLARG E IMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : 964. 0 Percen t Complete : 10 0 0 % Perimete r' 0. 0 Quality : Fai r Uni t Type : Condition : ; Fai r

Buil t As : Ranc h Cond o Squar e Footage : 0. 0

HVAC : Force d Ai r Rooms : 5. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : \ Drywal l Baths : i 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 2. 0

Roo f Type : Gabl e Stories : 1. 0 Floorcover : Allowanc e Foundation : Bloc k 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 Buii t 194 9 0 % 194 9 5 9 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Canop y 44. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 964. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R l 1.. . 8/22/200 9

### Pag e 1 of 2

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Irt h Intemet \ j [ Sen d Ernajl ;



## • YOU R TICKE T NUMBE R I S 2362522 . Origina l Cal l Date : 9/12/0 9 Time : 4:5 4 pmOp : ELIZABETH1879 0 Wor k t o Begi n Date : 9/16/0 9 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 259 8 Street : ELLISO NAVE Twp : 16 NRng : 13 E Sect-Qtr : 33-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lead remediatio n Locatio n o f Work : LOCAT E ENTIR E PROPERTY , AL L EASEMENT S AND T O TH E PEDESTA L Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LO T Compan y: COASTA L ENVIRONMENTA L SERVIC E Contac t Name : ELIZABETH Phone : (877)662-421 0 Wor k Being Don e For : coasta l Dept h o f Excavation : 4f t Corne r Lot : N Front : Y Rear : Y Involve s Tunneling o r Horizonta l Boring : N Explosives : N CXCAT V MAGELLA NMETR O MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Servic e Are a Contac t Phon e Numbe r UtiUty Typ e CXCAT V CO X COMMUNICATIONS , IN C 

### HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 Day : 918574709 8 MAGELLA NMAGELLA NMIDSTREA M PARTNER S L PDEBORA H Alt : 

### Emerg : 918574709 8 Day : 402457230 7 METR O METR O COMM . COLLEG E CHRI S 

### Alt : 402672703 3 Emerg : 402457231 3 Day : 402504782 3 MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Alt : Emerg : 402504797 0

http'://vmw.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 9/12/200 9

### Pag e 2 of 2

OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRON 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0
OPPDGPR 5 OMAH APUBLI C POWE RDISTRIC T N A 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNNEI C QWES T LOCALNETWOR K N A 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

http://vmvir.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/12/200 9

# As-Buil t Drawin g OLS# : 69 6 Dat e Excavate d :9/25/0 9 COASTA L 

# Omah aLea dSuperfun dSit e Dat e USEP ASigne d Off : 10/23/0 9 Are a Sodden : 147 6 s a f t 

### 69 6 Owne rName : Address : 259 8 EL L ISO N A V Omah a Lea d S Sit e Sketc h t e Exterio rPain t • Goo d Nort h Arro w / \ Phone : » W : • r~ l Poo r

No t pain t i Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Firm ; Sample s Collecte d Sverdru p RYASCPXA-69 6 Y A 140. 4 pp m 0 

### D Date : RYBSCPXA-69 6 RYCSCPXA-69 6 RYDSCPXA-69 6 Y B Y C Y D 6 0 66. 7 pp m pp m pp m 0 0 • 

# a 0 D Time ; Sample s Analyze d RDZSCPXA-69 6 RGZSCPXA-69 6 RPZSCPXA-69 6 D Z G Z P Z 60. 8 pp m pp m pp m g l • • 

# n n n XR F Unit ; Date : Time : 12/7/199 9 12:5 9 Boo k
Numbe ro f Sample s = 4 1 Staff : Legend : Y A= Yar d (NE) , Y B = Yar d (SE) , Y C = Yar d (SW) , Y D = Yar d (NW)
. D Z = Dri p Zone , G Z = Garden , P Z = Pla y

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# M t 69 6 

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_ • Goo d Address : 2598 ELLISO N A V 

### Sit e SItetc h 

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# n Time : 

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# n RDZSCPXA-69 6 DZ 

# :i ^ 60. 8 pp m 

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# a 

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COASTA l IHVIftONn l KTA l 

# \

y cR o u rIN C 

### Consen t fc f Acces s T o Propert y RIGH TO F ENTR YT O PREMISE S 

### Granto r(th e propertyowner) consent s t o an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA ) o rits authorize d representatives , collectivel y th e Grantee , t o ente ran d perfor m certai n environmenta l respons e activitie s upo n th e follov/in g describe d premises : 

# fia/^^c e Owner' s Name : Daytim e Phone : 

# ^3 /

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Addres s o fPropert y covere d b ythi s 

# P'Z^' ^ CkUSV A^ Agreement : PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EPAi s requestin g acces s t o collect soi l sample s an d remove soi l tha t contain s elevate d concentration s o flea d an d maypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t o remov e contaminate d soil
. Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o its origina l condition
. Thi s wor k i s bein g perfomie d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o fCoasta l Environmenta l Group , contracte d b yUSEPA , v\nl l contact th e Granto rin-perso n t o discus s th e wor k t o b e perfonned , th e Granto rwil l hav e a n opportunityt o revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e i t begins
. Onc e th e wor k I s finished , th e Granto rwil l b e aske d t o revie wth e wor k an d confim i tha t i t I s complet e an d meet s wit h th e Grantor' s approval
. Upo n completion , th e Granto rvinl l receiv e writte n documentatio n fro m EPAtha t th e property ha s bee n remediated
. ENVIRONMENTA L RESPONS E ACTION S 

### B

ysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , its employees , contractors an d subcontractors th e righ t t o ente rth e property , a t al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e o f performin g th e work
. Thi s acces s shal l remai n i n effec t unti l th e wor k ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :
Pag e 1 o f2V^-yy-^ J COASTA L

" ' PflO^ * C > O U > 1 » C 

### *Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; cRemov e flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t ma ywis h t o save ; cWate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessary ' subsequen t t o a n initia l waterin g perio d b yEPA ; cAbid e b yhealt h an d safet yguidanc e provide d b yEPA ; » I fth e propert yi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propert yt o perfor m th e work
. « Allo wvideotapin g and/o rphotographin g o fth e property . AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s no t t o interfer e o rtampe rwit h an yo f th e wor k activities , o rwit h an y o fth e wor k done , o rwit h th e equipmen t use d o n hi s property , o rt o undertak e an y action s regardin g th e us e o fsai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o fth e Grantee s o rth e environment , o rt o allo wother s t o us e th e propert yi n suc h a manner . Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contac t Coasta l Environmenta l Group , a t (402 ) 991-119 9

1

^

gran t acces s t o mypropertie sD I d o no t gran t acces s t o mypropertie s

Signatur e Dat e SignatureDate
DI woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.

Page 2 o f 2C O' Ai T A:. ^ C n O ^ r 

## RestoratSoF ^

Agreemen t Th e purpos e ofthi s agreemen t i s t o provid e amutua l agreemen t a s t o condition s ofth e propert y prio r t o remediatio nactivities . 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) .

Propert y ID : <^^ ^ Propert y Address : f^f ^ AR/y/^PJA J \Owner : 

## i^lyC>/ek^7U^€ Z Phone : 

# ^r/pZ97> i O nth e attache ddiagram(s ) indicat e area(s ) t o excavate , surfac e structure s andlandscapin g feature s and acces s location(s ) t o b e use db y th e contractors . Indicat e distances , depths , material types , etc . Photographicall y an dVideographicall y documen t th e existin g condition s ofth e propert y an dth e basemen t i f necessary . 

### item s t o b e Remove d b yth e Owne rbefor e Star t o fRemediation : fh e lenoval
. storage , disposal , and/o rretur n o f thes e item s i s th e Owner s responeibility
.
Kem : 

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## l-andscap e Inventor y Ite m Quantit y Uni t Condition/Type/Specie s Pre-existin g propert y area , Quadrant s 

# f/ that wil l b e excavated , tha t i s covere dwithgrass . Nuinbe r o f tree s > 2 inc h Eac h trun k diamete r 

# y
Numbe r o f tree s < = 2 inc h Eac h ^ trun k diamete r Numbe r o f Sprinkle r Zones . Contro l Valves , Eac h Timers , Heads , etc . ^ Miat h a skcicl i o l th e '.pi'i'lvlo i l;;y;ui ; Numbe r o f an dsiz e o f eac hgarden / flowe r be d Eac h 

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1 Additiona l Comment s / Instrucfions : 

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Chec k th e bo xi fOwne rdoe s no t wan t CE G t o documen t interio rfoundatio n wall s an d possibl e pre-existin g damage
. B ycheckin g thi s boxCE G i s not responsibl e fo ran ydamag e don e t o th e interio rof house , includin g foundatio n crack s o rfissures.

jW^ I agre e Q I d o no t agre e

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## /^O. \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 3 ^^^ 7 \^^' y a Coasta l Environmenta l Grou p Inc
. www.coa8talhazmat.co m M ^p ^ COASTA L ENVKONMENTA l ca o u r , IN C 

# EXECUTIV ESUMMARY : BVID #696
- (259 8 ELLISO NAVE ) No Issue s o r Concern s [ ^ Issues/Concern s Detail Explanation :Stl L 

# EP A EP APropert y Clos e Ou t For m t^»a) is^^ g Bl»"5o^^V(3^ Propert y # : \ p ^IP , . . . 

# STeSN^rjSimSffi^gZ X Date/Time : Quad s Excavated ; V- \ Contracto r Grou p /^^M-Zt T Ye s No Excavatio nGenera l 1 .If necessary , were th e correc t quadnmt(s ) excavate dandrestored ? 

# V [ 2 .If necessary , were th e correc t area s o f drip zone excavate dandrestored ? 

### c y ^ Gradin g So dan dVegetatio n Ye s N o I .Doe s the gradin g aroun dth e perimeter ofth e hous e i nexcavate darea s generall y slop e awa y 

# y fromth e house ?^____ _ 2 .Ha s so dbee nlai dinal l area s tha t wer e excavated ? 

# y 3 .Doe s th e sodappear to b e generall y healthy an dgrowing ? (Onl y evaluate if inspecte da t a3 0 

# y da y tun e period ) 4 .Ar e soddedarea s generally fir man devenly graded ? 

# y 5 .Are th e joint s betwee nth e so dstrip s generally tight ? (Only evaluate if inspecte da t a3 0 da y tim e period) ! / 6 ,Wa s the propert y grade dsuc htha t wate r will no t poo l o nth e property ? 

# y 7 .

Wa s danug e t o landscapin g o r plan t material s avoided ? 

### l y Gates , Fence s an dRctatnln g Wall s Ve s N o 1 . D o gate s ope nandclos e freely? (Ifapplicable ) 

# l y 2 . Wer e all gate s or fence s takendow ndurin g restoratio nactivitie s reinstalled ? (Ifapplicable ) 

# 1? ' 3 . Wa s damag e t o gate s or fence s avoided ? (Ifapplicable ) 

# - y IP^ ­ 4 .

Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) Foundation , Sidin g an dGutter s Ye s N o I .Wa s damag e t o th e sidin g o r tri mavoided ? 

# y 2 .Wa s damag e t o th e foundationavoided ? 3 .

Wa s damag e to window s avoided ? | : 

# y ^ 4 .Wa s damag e to window s or doo r screen s avoided ? 5 .Wa s damage to downspout s o r downspoul extension s avoided ? 

# y ^ Sidewalk s an dDriveway s (Concrete ) 

### Ye s y< o 1 . Wa s damag e t o drivewa y surface s avoided ? 

# ~ y 2 . Wa s damag e t o walkwa y surface s avoided ? 

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## Owner s coinments :

Inspectio nnotes :

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## Removal an drestoratio nactivate s complete including th e 30-da y so dwarranty : EP ARepresentativ e 1 )cr> . /)^/, . ^ _, Date : /^6.7 ,

## Propert yCompletio n Agreemen t Ihi s agreemen i documeni s th e complclio no f remedial acliviiie s perloimc do nm y properl y M y signalur e will designat e ihal I a msatisfie dwilhth e restoratio no f m y propeily , andIha l n o item s ar e i nquestions , now , o r al an y lime mth e fiiture , excep t ihos e ilem s liste dbelow , if an y Propert yID : \^C^^ p Propert y Address : 2.5^ ^ ElitSP n Owner : P\or€r>C£
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## Phone : i4Q| . q5 ( ^ aAQ l Restoratio n Item s i n Question :

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

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