## TRANSMITTA Lof OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R 

# i m W^// ^ SAI D # : Date : 

# ^< aq

# n ^ ^ r Address : Remediatio nContractor : Coasta l Environmenta l Grou p Year : 20 0 * ! 

### SOI LREMEDIATIO N PROPERT Y nLEFOLDE RDOCUMENT S Vide o o f property (DVD ) Executiv e Summar y EPA-providedproperty sketch SignedAcces s Agreement fo r subject property SignedAcces s Agreement(s ) fo r adjacen t propert y / 

### Restoratio nAgreement Settlement dociunent s (i.e. , fo r damag e o r to replac e plants , etc. ) Confinnatio ndata Photograph s ^< ^ m "^ I^'^I^WM 

### ^ ^ H bpU^P^X^ ^ As-built sketch Satisfactor y restoratio nsignedb y Propert y Owner Propert y close-out check lis t signedb y EP A Descriptio no f area s no t meetin g RO D cleanup criteri a Utilit y clearance s Propert y informatkjipfromDougla s Count y Assessor' s OfTic e [ J 

### D D 

### Signature 30054475 Superfun d^ > 

# Propert y Acces s Checklist Property ro: 2.)^^ ! 1 Property Address : ;^J ^ 5 Zfi .^TT D D

WOB K STARTE D WOR K COIVIPELTE D ON : ON : / / / / 

# ^''^^ ' JAYfif ^ RoW^ O Address :

, Phone : 1^2 . VO?^C^.alU q Fax : Cell/Pager : Rente r Phone : Fax : Cell/Pager . Additional Infonnation :

D NotificationI^ettcr

. -0 ' Acces s Agreement

J S Restoratio nAgreement j D Topsoil Samplin g (I f applicable ) D Disposa l Samplhi g (if applicable ) D Garde nSamplin g (if applicable ) D Utilit y Clearanc e Q^VIdeo/Photo s (Before ) D Video/Photo s (Dnring ) D Video/Photo s (After) D Video/Photo s (30-Day ) ^Q^ropcrt y Completio nAgreement D Final Report Sent : / / Slgned:^-/!! ^ 

## Signed.^/4i./l 9 / / / / Called : /



### OniJL/'h^'A . On / / On ; / / O n '/ '/ ^ Signed : Issued : Bv : By : By : By : By : By : By : »y•hC-ti^l{ ^ By : By : By : By : By : Ai r Monitorin s (a s applicable ) D Communit y Q Cre w Results : On : / / By : O Communit y ResnHs : QCre w On : / / By : D Communit y Results : D Cre w | On : / / By :

Omah a Lea d Sit e• • 

## Dougla s Count y Accoun t I

[tj|tfn|||io n 

## Pag e 1 of 3 Dougla s County , Nebrask a Propert yRecor d - R211096000 1 Prin t Repor t NE WFaatur e - Parce l Dimension s availabl e (§ ) scal e 0-5 0 ft wes t o f52n d S t - VIe WO n Ma p Informatio n i s vali d a s o f2009-9-1 5 Treasurer' s Ta xReoor t Ne wFeatur e ->->- • Aut o Sale s Searc h Owne r ROBISO N JAME S E 85 7 S 2 8 S T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 109 6 00012 1 Accoun t Type : Residentia l Parce l Number : 211096000 1 Parce l Address : 85 7 S 2 8 S T OMAH AN E 68105-000 0 Lega l Description : REED S 2N D AD D LO T1 1 BLOC K0 W8 0 F TS 1/ 2 Valu e Informatio n Lan d /mproi^emen f Tota l 200 9 $3,000.0 0 $63,400.0 0 $66,400.0 0 200 8 $3,000.0 0 $63,400.0 0 $66,400.0 0 200 7 $3,000.0 0 $63,400.0 0 $66,400.0 0 200 6 $3,000.0 0 $49,600.0 0 $52,600.0 0 200 5 $3,000.0 0 $49,600.0 0 $52,600.0 0 200 4 $3,000.0 0 $49,600.0 0 $52,600.0 0 Sale s Informatio n Sale s Date : Dee d Type : Price : Grantor : 2001-09-1 5 W D $15,000.0 0 BooHr ; 219 1 Page : 70 2

Grantee : Valid/Invalid : Exclusio n Reason : Invali d Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 5 2240. 0 1. 0 80. 0 28. 0 N o Lan d Attribute s 

## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R21.. . 9/17/200 9• • 

### Dougla s County Accoun t I j||ui|a|io n 

### Pag e 2 of 3
Attribut e Attribut e Descriptio n Negativ e Influenc e Traffi c0 Improvemen t Informatio n Buildin g 1 Ss ; \ :

j.^fST-. " SeoondFlxj r Rrst Floo r 260. 0 sai l 712. 0 S<»f l

1 1/ 2 STOR YFINISHE D

n alaM t t « Mr ; rt

T « u . • I n l
CLIC KTO ENLARG E IMAG E Squar e Footage : ; 972. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Fai r

Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 7. 0 Exterior : Fram e Viny l Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : I 3. 0

Roo fType : [ Gabl e Stories : 1. 5 Floorcover : i 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 Buil t 191 6 0 % 191 6 9 3 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 ft 704. 0 Basemen t Finishe d 500. 0 Fixtur e Additiona l Fixture s 1. 0 1. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l Garag e Basemen t Singl e 1. 0 Porc h Enc l Soli d Wal l 96. 0 Porc h Ope n Sla b 400. 0 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R21. . . 9/17/200 9• • 

## Dougla s Count y Accoun t I

jjjIlijH^o n Pag e 3 of 3
Porc h Sla b Roo fCei l 112. 0 Use r Atti cFul l Finis h 260. 0 Use r 1-48 0 nois e 1. 0



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R21.. . 9/17/2009

### • • Pag e 1 of 2 # •

" > Creat e Anothe rTicke t 1; ^

Bac k tojrt h Interne t | i [ Sen d Emai l J



### • YOU RTICKE T NUMBE RI S 2380057 . Origina l Cal l Date : 10/05/0 9 Time : 4:2 8 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 10/07/0 9 Time : 5:0 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 85 7 Street : S 28T H S T Twp : 15 NRng : 13 E Sect-Qtr : 21-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATIO N Locatio n o f Work : INCLUD E AL L EASEMENT S LOCAT E ENTIR E PROPERT Y Remarks : FAX 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 : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : COASTA L Dept h o f Excavation : 4 F T Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL 3 MUDO l OMAHACO F 0PPDGPR 5 PAETE C QLNNEI C
UtiUt y

Servic e Are aContac t Phon e Numbe r Typ e 

### Day : 402934046 9 /-vz-A-r^ / CO X COMMUNICATIONS , TTCTT^ T CXCAT V TVT/- . HEID I 

### Alt : 402934046 9 IN C 

### Emerg : 402932975 7 Day : 877366834 4 LEVEL S LEVEL S COMMUNICATIONS , ^^ ^ 

### Alt : Emerg : 877366834 4 Day : 402504782 3 METROPOLITA NUTILITIE S MUDO l SAND Y 

### Alt : DISTRIC T 

### Emerg : 402504797 0 Day : 402444719 7 CIT Y O FOMAHA
- OMAHACO F RO N 

### Alt : 402444516 1 TRAFFIC.SEWE R 

### Emerg : 402444516 0 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 10/5/200 9• • • • 

## Pag e 2 of 2
Day : 406728934 3 

## 0PPDGPR 5 g;^^^^^"^^°^^ ^ N A Alt : 406207149 4 Emerg : 888728934 3 Day : 800289190 1 

### N O NEE D T O CAL L OU T PAETE C PAETE C COMMUNICATION S Alt : 

### EMERGENC Y Emerg : : 800289190 1 

## Day : 406728934 3 QLNNEI C QWES T LOCAL NETWOR K NA 

## Alt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 10/5/2009

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e

Name : .7*<"^<f- s O^^JTVP O Omah a Lea d Sit e 

### Date : lU3/o 3 Nort h Arro wj Address : t^r vT , =2i'l ^ Sit e Sketc h Time : ' Phone:/V<E'i-A?v4 - - 7.^35 ^ 

# ^ - 1

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### Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are areplace dwit hAre areplace dwit h Are alef t bar e So d' ' Rock/Mulc h 

### Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .• • • • 

### Name : ,7^"^<f" r^oSrn^ n Omah a Lea d Sit e 

## Date : lU^lo J Nort h Arro w 

### Address : ^T l .V , ^71 ^ Sit e Sketc h Time : ' ' 

### Phone:/*ioxJ^^ C ­ 7S'3 r Tea m / ^6yfrci^ l

# k i 1/.)^>^L . ioh 0 g5 7 5 ^^-n^5 ^

Name : Te^'-^^ ^ ^oht^^i"'- ) Address : "^T l S i ^71 ^ Phone:^V<?x;.^'/C r­ 7^ 3 r Omah a Lea d Sit e Sit e Sketc h 

### Date : 1U3/1D ? Time : ' Nort h Arro w

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COASTA l INVIROHH t KlA t C t O t l P IN C 

### Oonsenlfo i Acccis s T o Propfert 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 rit s 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 followin g describe d premises :

Owner' s Name : Daytim e Phone : ^3^ ' Y' Z ^ ^

Addres s o f Propert y 

# 8^ 7 ^ -Z^^-rcovere d b ythi s 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 ma ypos 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 be replace d wit h clea n material s an d th e are a wil l b e restore d t o it s origina l condition . Thi s wor k i s bein g performe 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 byUSEPA , wil l contact th e Granto rin-perso n t o discus s th e wor k t o b e perfomned , 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 confir m 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 rwil l receiv e vwitte n documentatio n fro m EP Atha t th e property has 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 , it s employees , contractors an d subcontractors th e righ t t o ente rth e property , at al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e of 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 f 2

### c g C 0 AS * ! Ai tftVINOhHrKTA l CROU * I H C 

### Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; rRemov 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 ; '- Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessar ysubsequen t t o a n initia l waterin g perio d b yEPA ; fAbid 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 . t 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 fth 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



## 0t g D I d o no t gran t access t o mypropertie s I gran t acces s t o mypropertie s 

# t-i\-o ^ 2>* o Signature Dat e Signature Oat e
D I woul d lik e t o b e presen t durin g an ysamplin g tha t i s required .

Pag e 2 o f 2

### /

COASTA L C N O U . 

## Restorataor ^

Agreemetr t Th e purpos e o f thi s agreemen t i s t o provid e amutua l agreemen t a s t o condition s o f th e propert y prio r t o remediatio nactivities . Thi s wil l als o serv e a s documentatio nfo r 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 : Zj9f / Propert y Address : J^^ y ^ ^J'S T Owner : Phone : 

# ,<^y-^^^ ^ O nth e attache ddiagram(s ) indicat e area(s ) t o excavate , surfac e structure s an dlandscapin g feature s and acces s location(s ) t o b e use db y th e contractors . Indicat e distances , depths , matena l types , etc . Photographicall y andVideographicall 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 : Th e removal , storage , disposal , and/o rretur n o f thes e itom s i s th e Owne rs responsibility . ttem: 

### 'C7^C < Item : 

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ttem: ttem:



### item s t o b e Remove d b yth e Contracto rDurin g Remediatio n an d Wot Replace d ttem: ttem : ttem:

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# -^^/2 Item :
s Item :



### Ite m Pre-existin g propert y area , tha t wil l b e excavated , tha t i s covere dwithgrass . Numbe r o f tree s > 2 inc h trun k diamete r Numbe r o f tree s < = 2 inc h trun k diamete r Numbe r o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Aiiat h; i sketcl i ul lli e ••rrii'klo i lin'.Ki i Numbe r o f an dsiz e o f eac hgarden / flower be d area . Aiii\chi l skclcl i 1) 1 rfliiiiv o M/i- s nndloc;lIilMl ^ Agree dupo n'ralu e o f plan t material s no t t o b e replace db v contractor . Vol* ' l!-ii ' \HIU C *MI I h i usi't ' 10 is;u i . 1 plan : VOIIIIK TI dlli f |;ri!))cil \ u\

y ner . 

### Landscap e Inventor y Quantit y Unit



# 6 Z Quadrant s
Eac h Eac h 

### / ^ 

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7 f a Eac h 

# V . Pjid i Squar e Fee t 

# 4' s Conditionrrype/Specie s

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Easemen t Area , t o b e Eac h excavate d 

### / Pag e 2 o f 

### ^

# ^^r~ m C O AS 1 AL D >

• O U ' , IN C
I. Additiona l Comment s / Instructions : 

### |

— 3uf^ e i^ l ykuu€<f T^a** ^ -foyi^JcMcnA^ , 5 bA^€ > -o e 42jePf^^^UCH .

Q Check th e bo x i

f Owne r doe s no t wan t CE Gto documen t interio r foundatio nwall s andpossibl e pre-existin g damage . B y checkin g thi s bo x CE Gi s no t responsible fo r

an y damag e don e t o the interio r o

f house , includin g foundatio ncrack s o r fissures . STagre c r~1 1 do no t agre e 

# f- f-;^-c ? ^wtJer' s Signatur e Contractor' s Signatur r Date ""G^ s Date Pag e 3 o f 

## - 7

# m . BVID#_^_2i 7 XRF PROPERTY SAMPL E SHEE T Dat e Addres s 

# //?/?/ h ^S9 - ^ ^ ^ ^ Projec t Omah a lea d F P 2n d yea roption Sampl e tim e am/p m XRFID # sampl e lengt h 3 0 se c __Shot# _ Readin g Sampl e are a __Shot # Readin g Sampl e are a 

# Ifi^^l l ^2*«* ^ 

# 12i . 0 ^ 2 f Dept h Dept h 

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# S 22 z Averag e y^ t ^ / 3 Averag e ^h'^Z^ ^ Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a I3ept h Dept h Averag e Averag e

Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h Averag e Averag e
RETES TAREA S Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h Averag e Averag e la b sampl e # La b resul t Sampl e are a XR F Avg . Signatur e 

# ?(fhHj(b A Prin t r 

# Vi^ir ^ Co^iJOn ^

## Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta i Grou p Inc . www.coastalhazmat.co m COASTA L iNVIIOmiillTA l clour , IN C 

# EXECUTIV ESUMMARY : BVI D #21991-(85 7 S 2 8 ST ) 

# No Issue s o r Concern s I I Issues/Concern s Detai l Explanation :4 

# fciy^ EP A Propert y Clos e Ou t For m Properl y# : 2 - t ^< ^ [. . Propert y Addr^ . , ^ i ^ ^ ^ ' '^>fc
­ Datc/Tlroe : Owner' s Name: . .JtJj^yyyJS i . TK'-^-'^'^^ ^ 

### Quad s Excavated ; p * £ Contracto rGrou p U^»^9^430>. / 4/fc«K.-U 3 Ye s N o Excavatio nGenera l 1 . If necessary , were th e conec t quadrant(s ) excavate dandrestored ? 

# r x 2 . If necessary , were th e correc t area s ofdri p zone excavate dandrestored ? 

# y Gradin g So d an d Vegetatio n Ye s N o I . I)oe s the gradin g aroun dth e perimeter ofth e hous e i nexcavate darea s generall y slop e awa y 

# r x fromth e house ? 

# 1?- ^ 2 . Ha s so dbee nlai dinall area s tha t wer e excavated ? 3 . Doe s th e sodappear to b e generelly healthy an dgrovring ? (Onl y evaluate if inspecte da t a3 0 L X ^ da y time period ) 4 . Ar e soddedarea s generall y fuman devenl y graded ? 

# y 5 . Ar e th e joint s betwee nth e so dstrip s generally tight ? (Only evaluate if inspecte da t a3 0 da y 

# y tim e period) 6 . Wa s the propert y grade dsuchtha 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 malerial s avoided ? 

# y Gates , Fencc i an dRetatotn g Wall s Ve s N o I . D o gate s ope nan dclos e freely? (Ifapplicable ) ^ ^ ' 2 . Wer e all gate s or fence s lakendow ndurin g restoratio nactivitie s reinstalled ? (If applicable ) 

# -y 3 . Wa s damage t o gate s o r fence s avoided ? (Ifapplicable ) 

# y 4 . Wa s damag e t o retainin g wall s avoided ? (I f applicable ) Foundation , SidiB g an dGutler s Ye s N o 1 . Wa s damag e t o th e sidin g or tri mavoided ? 2 . Wa s damage t o th e foundationavoided ? 

# 7 3 .Wa s damag e l o window s avoided ? 

# y -y ^ Wa s damage to window s o r doo r screen s avoided ? 

# y 5 . Wa s damage t o downspout s or downspoul extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Wa s damage to driveway surface s avoided ? 

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

# y

## Of^'oer s comments :

Inspectio nnotes :

Remova l an drestoratio nactivate s complet e including th e 30-da y so dwarranty : EP ARepresentativ e UnY ] PriJhjL ^ Date : J O 30M

# f

Propert yCompletio n Agreemen t Ihi s agreemen t documenl s th e complclio n o fremedia l acliviiie s perloime d o n m yproperl yM ysignalur e wil l designat e tha t I a m satisfie d wit h Ih e restoralio n o fm yproperly , an d Iha l n o iiein s ar e i n questions , now , o ra l an ylim e i n ih e fulure , excep t thos e ilem s liste d below , ifan y

Properr yID : ^ ]qq \ Propert y Address : ft^^-| <^ ^_( ^ 5>^ _ Owner : , ) ^m ^

KDWAq-^/ ^ 

### Phone : l^Qp . ]^ ^

_UHQ Q Restoratio n Item s i n Question :

Item ; Item : Item : Item : Item : Item :

\/ Q I nyrc crestoratio n i t completed , cxccp l a » nntei l [_ | I rto nn t aurc crestoratin n i t complete d

Dat e Conti j Dal e ont i arlor' s Signatur e