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

# l^^K . ^ . llt^h o SA1D# : I \/l ^ Date : Address : W' j HjCft^ H ^ f Remediatio nContractor : _CoflSta l Environmenta l Group

_ Year : _2O0A _ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 1 /

Vide o o f property (DVD ) H Executiv e Summai y EPA-provide dproperty sketch ^ 

### SignedAcces s Agreement fo r subject property SignedAcces s Agreement(s ) fo r adjacen t propert y 0 Restoratio nAgreement ^ 

### Settlement dociunent s (i.e. , fo r damag e o r to replac e plants , etc. ) / 

### Confinnatio ndat a 1 /

Photograph s ^Cfi^fijIiO ^ X XV c (/^^yKlf/i A 1 /

As-built sketc h Satisfactor y restoratio nsignedb y Propert y Owner

,

/ 

### Propert y close-out check lis t signedb y EP A -Q
­ Descriptio no f area s no t meetin g RO D cleanup criteri a M Utilit y clearance s Propert y informatio nfro mDougla s Count y Assessor' s Office


# t ( vA ^ T5ate " 3005478 6 

# M i Superfun d• •
^ 

## Propert yAcces s Checklis t Propert y ID : Propert y Address : 

# n^LU L 2f^l ^ n\c,l^ryj ^ ^ , D D WOR K STARTE D WOR K COMPELTED ON : __/__/ _ ON ; / / 

### O^ner : p^^^ ^ ^urr{t2]/\ Address : 

# Z5/ qUici^n j s f Phone : q<Da . fSqft . \OlZ.l P Fax : Cell/Pager : Renter : Phone : Fax : Cell/Pager : Additional Information :

' D Notificatio nLette r D ^ Acces s Agreement J ^ Restoratio n Agreement

D Topsoi l Samplin g (if applicable ) D Disposa l Samplin g (i f applicable ) D Garde nSamplin g (if applicable ) nUtilit y Clearanc e Cg^ideo/Photo s (Before ) nVideo/Photo s (During ) nVideo/Photo s (After ) D Video/Photo s (30-Day ) nPropert y Completio n Agreement D Final Report Sent : / / Signed : * * 1 i ^ 1 Cf ^ 

## Signed : ^/^/C2 3 / / / / / / CaUed : / / On : ° } 1 li? l O" ! On : / / On : / / On : / / Signed : / / Issued : / / By : By : By : By : By : By : By : By : By : By : By : By : By : OC7ft,x/iz >

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### Air Monitorin g (a s applicable ) O Communit y [ U Cre w Results : On : / / 

### By : 1 O Communit y Results : • Cre w On : / / 

### By : 1

• Conunimit y Results : dCre w On : / / 

### By : 1

Omah a Lea d Sit e

### ^ougla s Cotmty Accoun t Iafor|^tio n Pag e 1 of 2 b^r|^t i Dougla s County , Nebrask a Propert yRecor d - R222164000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f 52n d S t - VlevyO n Ma p Informatio n i s vali d a s o f 2009-9-1 5 Treasurer' s Ta xRepor t Ne wFeatur e ••••• • Aut o Sale s Searc h Owne r FOUNTAI N PETE R T 251 9 HICKOR YS T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 

### 216 4 000 0 2 2 Accoun t Type : Residentia l Parce l Number : 222164000 0 Parce l Address : 251 9 HICKOR YS T OMAH AN E 68105-000 0 Lega l Description : SHULL S 4T H AD D LOT1 6 BLOC K0 W 5 FTLT1 5 & AL L 3 5 X 12 0 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $4,000.0 0 $73,100.0 0 $77,100.0 0 200 8 $4,000.0 0 $73,900.0 0 $77,900.0 0 200 7 $4,000.0 0 $73,900.0 0 $77,900.0 0 200 6 $4,000.0 0 $63,100.0 0 $67,100.0 0 200 5 $4,000.0 0 $63,100.0 0 $67,100.0 0 200 4 $4,000.0 0 $63,100.0 0 $67,100.0 0 Sale s Informatio n Sale s Date : 

### 1999-09-0 2 Dee d Type : Book : 213 2 Page : 08 7 Price : $60,000.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 9 4200. 0 1. 0 120. 0 35. 0 N o Improvement Informatio n 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R22. . . 9/17/200 9

### J)ougla s County Accoun t Jj^riMatio n 

### Pag e 2 of 2

Buildin g 1 1 1/ 2 STOR YFINISHE D

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S i i
Bsmrt eioc k 8 fl 8640S F iaM!m.HM.i.iiMi.m.iiuu».Mai;aa 3 XIC KT O ENLARG E IMAg E CLIC KTO ENLARG E IMAG E Squar e Footage : 1216. 0 Percen t Complete : 100.0 % Perimete r! 0. 0 Quality : ; Averag e Uni t Type : Condition : : Goo d

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 : 6. 0 Exterior : Fram e Viny l Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 2. 0

Roo f Type : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : i 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 191 2 0 % 191 2 9 7 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 864. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h En d Scree n 160. 0 Porc h Woo d Dec k 77. 0 Storag e Woo d 96. 0 Use r She d no t finishe d 1. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R22. . . 9/17/200 9

### Pag e 1 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 2381461 . Origina l Cal l Date : 10/07/0 9 Time : 9:5 3 a m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 10/09/0 9 Time : 10:3 0 a m State : N E County : DOUGLA S Place : OMAH A Address : 251 9 Street : HICKOR Y S T Twp : 15 NRng : 13 E Sect-Qtr : 28-N 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 : 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 : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : COASTA L Dept h o f Excavation : 4 F T Come r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL 3 MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F

Servic e Are a Contac t Phon e Number UtiUt y Typ e 

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

### HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 LEVEL3 LEVEL S COMMUNICATIONS , LL C N A 

### Alt : Emerg : 877366834 4 Day : 402504782 3 MUD0 2 METROPOLITA N UTILrnE S DISTRIC T SAND Y Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO N Alt : 402444516 1 Emerg : 402444516 0

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 10/7/200 9

### Pag e 2 of 2

0PPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T N A Day :

Alt : 406728934 3 406207149 4 Emerg : 888728934 3 QLNNEI FQWES T LOCA LNETWOR K

N A Day : 406728934 3

Alt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 10/7/200 9OLS# : 1931 6 Dat e Excavated : 10/13/0 9 Dat e USEP ASigne d Off : 12/2/0 9 

# As-Buil t Drawin g C OAST AL CNVIRONHENTA L Are a Sodden : 107 1 sof t 

# Omah aLea dSuperfun dSit e CROUP . INC . 

## 1931 6 Exterio rPain t Norfr i Arro w Omah a Lea d Sit e Owne rName : PETE R TFOUNTAI N Sit e Sketc h Address : 251 9 HICKOR YS T • Poo r Phone : H : 402-342-373 8 W • No t pain t 

### \ ; Sampl e Numbe r Sampl e Collecte d LA B Sample s Collecte d Finm : FDO> \ (Z. ^ \T o RYASCPXA-1931 6 

### D Date : f^ c­ 2. ' - P " < RYBSCPXA-1931 6 

### D Time : \ \' . S o p rv . RYCSCPXA-1931 6 RYDSCPXA-1931 6 RDZSCPXA-1931 6 nGZGCPXA-19310 - 

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# n n n n Sample s Analyze d 

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Omah aLeadSite 4613 0 

### Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are a replace d wit h So d Are areplace dwit h Rock/Mulc h Are aleft bar e 

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

# t 1931 6 

# r 9- S R

Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e r l Owne rNanne : PETE R TFOUNTAI N 

### Sit e Sketc h E3^oo d Address : 251 9 HICKORYS T • Poo r Phone : H : 402-342-373 8 W: Q Not pain t 

# x y Sampl e Numbe r Sampl e Collecte d LA B Firm : Sample s Collecte d p D O \ <2.. S \7c u RYASCPXA-1931 6 F l 

# o r D Date : f:>c. - 2.'-e>- ^ RYBSCPXA-1931 6 F 2 

## D Time : \ ^

'. 5 g > p r w RYCSCPXA-1931 6 RYDSCPXA-1931 6 B 1 B 2 

## D Sample s Analyze d RDZSCPXA-1931 6 D Z 

## nczGcrxA-iQoio—e z RPZGCPXA-193t € P Z 

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# 3 M Book : JJL I

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# 1931 6

rOwne rName : PETE R T FOUNTAI N Omah a Lea d Sit e Sit e Sltetc h Exterio rPain t Q^oo d Nortt i Anro w

• Poor Q No t pain t

Omah aLeadSit e 4613 0

## 1931 6 Omah a Lea d Sit e Exterio rPain t NorthArro w Owns rName : PETE R TFOUNTAI N 

### Sit e Sketc h D'^o d Address : 251 9 HICKORYS T • Poo r

Phone : H : 402-342-373 8 W £ } No t pain t 

# J Nd ; Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Co m Collecte d Fimi : gDft \ g> & \TC J RYASCPXA-1931 6 F l 

### D Date : CiC - 2.t-t>' < RYBSCPXA-1931 6 F 2 

### D Time : > t' . S o p r ^ RYCSCPXA-1931 6 B l 

### D Sample s Analyze d RYDSCPXA-1931 6 B 2 

# a RDZSCPXA-1931 6 D Z 

### E T XR F Unit : ^ \ \ Book : 

# \ A D nCZOGPXA-1991 0 

### D Date:_rUaX_DJ 4 

### D RPZ3CPXA-1901 0 P Z Time:

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# n n Statf : 

# ^5 E Numt)e ro f Sample s = | ^ F\U<> j C»U-<-* 3 

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COASTA l iNvtROHn i mx t ct o u rIN C 

### Consen t fo rAcccis s T o Pfopfcfl 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 Slate 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 i respons e activitie s upo n th e followin g describe d premises : Daytim e Phone : 3^^y^/^ ^

Addres s o f Propert y covere 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 f lea 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 b e 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 f Coasta 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 perfomied , 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 writte 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 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 has bee n satisfactoril ycompleted . Th e Granto rals o agree s to :
Pag e 1 o f 2

### s COASTA L tNVtNONKrKTA t « » O U > IM C 

### Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; f 

### Remov e flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t ma yw t o save ; is h i Wate 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 ; ( Abid e b yhealt h an d safet yguidanc e provide d b yEPA ; * I f th 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 . tAllo wvideotapin g and/o rphotographin g o f th 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 f th 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 f sai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o f th 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 gra r G I d o no t gran t access t o mypropertie s I gran t acces s t o mypropertie s

Signature Dat e
G I woui d iik e t o b e presen t durin g an ysamplin g tha t i s required .

Pag e 2 o f 2

### # 

# (C Q COASTA L 

## RestoratsoF i Agireemsn t Th e purpos e of thi s agreemen t i s to provide amutua l agreemen t a s t o condition s ofth e propert y prior t

o remediatio nactivities . Thi s will als o serv e as documentation fo r th e purpos e o f assurin g tha t restoratio n activitie s are completedt o th e satisfactio n ofth e propert y owne r andthe UnitedState s Environmenta l Protectio nAgenc y (EPA) . Propert y ID : /^^/ ^ Propert y Addr^:^57 ^ ^}^j^y^y / ^ T Owner : 

# ^2IJ,J^Z^ ^ O

nth e attacheddiagram(s ) indicat e area(s ) t o excavate , surface structure s an dlandscaping feature s an d acces s iocation(s ) to b e use dby th e contractors . Indicat e distances , depths , materia l types , etc . Photographically an dVideographicall y documen t th e existing 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 Start o f Remediation : Th e renoval . storage , di&posal , and/o rretur n o f thes e itom s I s th e Owner' s responsibility . 

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Page l of . 

# i .- : ^ COASTA L 

### Item s t o B e Remove d ByContracto rDurin g Remediatio n andRepiace d t ttem: I . ttem: 

# w ^ ttem: ttem: L ^ 

### Landscap e Inventor y Ite m Quantit y Uni t Condition/Type/Specie s Pre-existin g propert y area , Quadrant s tha t wil l b e excavated , tha t * i s covere dwithgrass . Numbe 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 . Aiiat hi l sketc ho l tlii r 

### ^ '•rr'nkk' i li>\'.)iii . Numbe r o f an dsiz e o f eac hgarden / flower be d Fxr M area . Squar e Fee t Aiiac hi l skcicl i ol rcNiiivf 

### ^ iizi- s nndlnc;iiiiiti s Agree dupo nvalu e o f plan t material s no t t o b e replace db v contractor . S \cU ' ll'ii ' NHIU C wil l rii . 

### / USI'L ' 10 Miw . . 1 riian ; >nin.ln.'.
- 1( 1 lli e (}ro))ciI > in ' ner . Easemen t Area , t o b e 

## ^ ^ e?A^6d!^-^yC / excavate d 

### ( / Eac h
Pag e 2 

# „' >C O AS 1 AL I > « VIMOMM I HTA » e l l a u r. • N c \Additiona l Comment s / Instructions : 

# I- ^ /^/yi'u e ^>^/^ ^ Arztj>6 ^ / ^ ^=7e^>Air^z ^ I



# L . Q Chec k th e bo xi f Owne 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 bo xCE G 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 .

agre e Q I d o no t agre e

I Dat e ' JContractor' s Sienaturr Dat e Pag e 3 of .

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## Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta i Grou p inc . wvin*.coa8taihazmat.co m v j — COASTA L Clour . IN C 

# EXECUTIV ESUMMARY : BVID #19316-(251 9 HICKOR Y ST ) No Issue s o r Concern s [ ^ Issues/Concern s Detail Explanation : '

# m EP A ^ 

# EP A Propert y Clos e Ou t For m Property# : \^^i] ^ , , Property Addrcaa-^7\>\^j 0 ^^' \ 

## jOiM — Date/Time : 

### Owner' s Name: . .C^ f J

^ sf^
- >0 r Quad s Excavated : 1^ 1 J^ 7 . f) ? Contracto r Grou p CCYif^ n \ Ye s N o Excavatio n Genera l 1 .If necessaiy , were th e correc t quadrant(s ) excavate dandrestored ? 

# 1 ^ 2 . If necessary , were th e correc t area s ofdri p zone excavate dandrestored ? 

# u ^ Ye s N l Gradin g So dan dVcgetatto n 1 .Doe s th e gradin g aroun dth e perimeter ofth e hous e i nexcavate darea s generall y slop e awa y ftx)mth e house ? . 2 .Ha s so dbee nlai din al l area s tha t wer e excavated ? 

# t/ ' 3 .Doe s th e sodappear to b e generall y health y an dgrowing ? (Onl y evaluate if inspecteda i a3 0 

## \ y day time period ) 4 .

Ar e soddedarea s generall y Rr man devenly graded ? 5 .

Ar e th e joint s betwee n th 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 dsuchtha t wate r wil l no t poo l o nlhe propert>' ' ^ ^ 7 .

Wa s danug e t o landscapin g o r plan t material s avoided ? Gates , Fence s an dRetainin g Wall s Ye s 1^ 0 I .D o gate s ope nan dclos e freely? (Ifappiicable ) Were all gate s or fence s taken dow ndurin g restoratio nactivitie s reinstalled ? (Ifappiicable ) 

# 17 " 3 .Wa s damage t o gate s or fence s avoided ? (Ifappiicable ) 4 .Wa s damag e t o retainin g wall s avoided ? (Ifappiicable ) Foundation , Sidin g an dGutter s Ye s N o 1 .Wa s damag e l o th e sidin g o r tri mavoided ? 

# 1/ ' 2 .Wa s damage t o th e foundation avoided ? 

# ly " 3 .Wa s damag e t o window s avoided ? 

# I Z 4 Wa s damage t o window s o r doo r screen s avoided ? 

## \ y 5 . Wa s damage t o downspout s o r downspout extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Ye s /J o I . Wa s damag e t o driveway surface s avoided ? ^ ^ 2 . Wa s damage t o walkwa y surface s avoided ? w /

## , Owner s comments :

Inspectio nnotes :

Remova l an drestoratio nactivate s complet e includin g lh e 30-da y so dwarranty : EP A Representative kJo hlj)riJly^Jf> ^ Date:/^/^^V ^ 7

### #



## Propert yCompletio n Agreemen t Thi s agreemen t documeni s lh e completio n o l remedia l acliviiie s perioime d o n m ypropertyM ysignatur e wil l designat e iha i I a m satisfie d wit h th e rcstoralio n o f m ypropeity , an d tha t n o item s are i n questions , now . o ra l an ylim e i n th e ftjlure, excep t those ilem s liste d below , ifan y Propert yID : \()^y ^ Propert yAddr». : 25 1 q ( ^ fc^l^On J . ^ Owner : p^p_ ^ ^xjrH^Tl^ A 

### Phone : qo^,,^q^,^|2.^ ^ Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item : Addttiona l Comments :

I c^torfliio n i t compleled , excep t a s noter i [ I I H o no t aKre crcsromtio n i i complete d 

# : /V>y^, f 9.cr,cof?0f ^

\Olz?.lcf l Owner' s Sigtifltiri f Dat e Contrarlo i 's Signaiur e Dal e