### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID# : \ 0 b l t Date : V ^ \\ o Address : ^\\ \^MM^ ^ ^ \ Remediatio nContractor : Coasta l Environmenta l Group

_Year ; _200f l SOI LREMEDIATIO N PROPERT Y nL EFOLDE RDOCUMENT S 0 Vide o o f property (DVD ) EExecutiv e Summar y U JEPA-provide dpropert y sketc h I ZSigne dAcces s Agreemen t fo r subjec t propert y
• Q ^ Signe dAcces s Agreement(s ) fo r adjacen t propert y 

# a / Restoratio nAgreemen t Settlemen t dociunent s (i.e. , fo r damag e o r t o replac e plants , etc. ) - B
­ Confinnatio ndat a

GPhotograph s V W ^ Y i^(/^^'SW ^ ^ f^ M^^'fuy ^ / 

### As-buil t sketc h Satisfactor y restoratio nsigne db y Propert y Owne r WPropert y close-ou t chec k lis t signe db y EP A " n " Descriptio no f area s no t meetin g RO D cleanu p criteri a w Utilit y clearance s [Y Propert y informatio nfro mDougla s Count y Assessor' s Offic e

~T5at 5 3005447 1



# _ J

Superfun d

# p

Property Acces s Checklis t Propert y ID : \<^f^-t( „ D WOR K STARTE D ON: . / / D WORKCOMPELTE D 0N: _ / / Propert y Address : ^•^[\'$^V^U\r a Rente r 

## Q^"*' ^ Vl\\^tar< > \Lj^C\csrci( \ Address : Phone: Fax : Cell/Pager : Phone : 0\^ . IMM ^ Additioaa l Information : Fax : Cell/Page n D Notificatio nLette r Sent : / . By : Acce u Agreement Slgned:^/R/C g By : ^[ ^ Restoratio nAgreemen t Signed:11/B./ ^ By : O Topsoi l Samplin g (I f applicable)
. / / By : Q Disposa l Samplhi g (if applicable ) / /
. By : O Garde nSamplin g (i f applicable ) By : « Utilit v Clearanc e Called:^/Z L02 . By : 

# ^mr)" ^ O Video/Photo s (Before ) On : / / By : D Video/Pboto s (Dnring ) On : / / By : D video/Photo s (After) On : / / By : D Video/Photo s (30-Day ) On : / / By : 

# f Propert y Completio n Agreemai t By : 

### Signed: ^/^//9 2 Final Report Issued : / / By : Ai r Monitorin e (a s applicabl e D Communit y DCrc w On : / / By : Results : D Comnmnit y QCrei r On : / / By : Resuhs : DConunnnit y QCrc w On : / / By : Results :
Omah a Lea d SKe

# u

Propert y I D # Propert y Address : Initial Contact : Secon dContact : Fina l Contact : Fina l Action : 

# W|\\\vri m Comment : Owner Comment (s) : Site Coordinato r Comment (s) : CONTACT FOR M \%/o1C o 

# M?.\ \%W^f\ e ^ 

## Date : Time ; Action :

Date ; Time : Action : Date : Time : Action : Transmit t

o EP A D Other Action : D 

# qS^-\Ml4 X• • 

# ^ v Propert yAcces s Checklis t Propert y ID : 

## )ftfa-?f a nWOR K STARTE D ON : / / Propert y Address : 

## q^ \.svvk-i/) ^ D WORKCOMPELTE D ON : / / Renter : Owner : 

# VilWia mKrA-cW^yir v .^ r Address : Phone : 

## ^3/ 1 Shirlcx ^ Fax : Cell/Pager : 

### Phone:/^^Q3- ) gy ^ /jy^y ^ Additional Information : Fax : Cell/Pager :

nNotificatio nLette r Sent : / / By : ^ Acces s Agreement 

## Signed:^/11/Q q 

## By:p c { A Restoratio nAgreement 

## Signed: gL/l3_/<3 i = By ^C . D Topsoi l Samplin g (i f appUcable) / / By : D Disposa l Samplin g (i f applicable ) / / By : Q Garde nSamplin g (i f applicable ) / / By : nUtiUt y Clearanc e CaUed : / / By : D Video/Photo s (Before ) On : / / By : D Video/Photo s (During ) On : / / By : nVideo/Photo s (After) On : / / By : D Video/Photo s (30-Day ) On : / / By : nProperty Completio nAgreement Siened : / / By : D Final Report Issued : / / By : Air Monitorin g (a s appUcable ) IZ

I Communit y • Cre w On : / / 

### By : 1 Results : nCommunit y Q Cre w On : / / 

# 1 Results : IZ

J Communit y O Cre w On : / / By : Results :
Omah a Lea d Sit e

### t)ougla s Coimt y Accoun t U^riji^o n Pag e 1 of 2 

# u
Dougla s County , Nebrask a Propert yRecor d - R233234000 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 - Vle W O H 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 KOTCHIA N J R E TWILLIA M F 431 1 SHIRLE YS T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 323 4 OOO O 2 3 Accoun t Type : Residentia l Parce l Number : 233234000 0 Parce l Address : 431 1 SHIRLE YS T OMAH AN E 68105-000 0 Lega l Description : TWINRIDG E AD D LO T3 BLOC K1 4 5 0 X 10 3 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $ 5,700.0 0 $186,500.0 0 $ 192,200.0 0 200 8 $ 5,700.0 0 $ 162,900.0 0 $ 168,600.0 0 200 7 $ 5,700.0 0 $175,500.0 0 $ 181,200.0 0 200 6 $ 5,700.0 0 $175,500.0 0 $ 181,200.0 0 200 5 $5,700.0 0 $175,500.0 0 $ 181,200.0 0 200 4 $ 5,700.0 0 $120,300.0 0 $ 126,000.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 1 5150. 0 1. 0 103. 0 50. 0 N o Improvemen t Informatio n Buildin g 1

N o Imag e Availabl e



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accotmtno=R23.. . 9/17/200 9

### Dougla s Count y Accoun t I^^a^o n Pag e 2 of 2 # •

UmeWoiJtwl: ! ' t a

I f r c P C Fuiinnn i IJliOr f t i a r jw«t»r t Kill * T t n«it Blnc k S • - 111 4 0 i d :sil» > Rt^ ^ Cti l if f V. 1


# . . ' ' m -n,5" " II C 1 CUC KT O ENUVRG E IMAG E | Squar e Footage : 1797. 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 : Masonr yCommo n Bric k Units : 1. 0 Interior : Drywal l Baths : 2. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 yearBu// f yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 193 8 0 0 % 0 7 2 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Applianc e Fireplac e Masonr y 1. 0 Basemen t Bsmn t Bloc k 8 ft 1214. 0 Basemen t Fai rFinis h 324. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 2. 0 Garag e Attache d 180. 0 Porc h Sla b Roo f Cei l 32. 0 Porc h Sla b Roo f Cei l 60. 0 Porc h Sla b w/Step s 64. 0 Porc h Woo d Dec k 250. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R23.. . 9/17/200 9

# n Pag e 1 of 2 # •

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



### • YOURTICKE T NUMBE RI S 236919 L Origina l Cal l Date : 9/21/0 9 Time : 5:3 2 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 9/23/0 9 Time : 6:0 0 pm State : N E County : DOUGLA S Place : OMAH A Address : 431 1 Street : SHIRLE Y S T Twp : 15 NRng : 13 E Sect-Qtr : 29-N W 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 PROPERTY 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 Being Don e For : COASTA L Dept h o f Excavation : 4 F T Come r Lot : N Front : Y Rear : Y Involve s Tunneling o r Horizonta l Boring : N Explosives : N ALTS7 2 BSHPCLK S CXCAT V MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F
Servic e Are a Contac t Phon e Numbe r UtUit y Typ e Day : 406728934 3 ALT87 2 WINDSTREA M COMMUNICATIO N N AAlt : 406207149 4 Emerg : 888728934 3 Day : 402552346 0 BSHPCLK S NEBRASKA HEALT H SYSTE M N AAlt : 402552334 7 Emerg : 402559511 1 Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUD0 2 METROPOLITANUTILITIE S DISTRIC T SAND Y Alt : Emerg : 402504797 0


### http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 9/21/200 9• • • • 

### Pag e 2 of 2

OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO N

0PPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T N A
QLNNEI FQWES T LOCALNETWOR K N A 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/21/200 9

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfiin dSit e 1867 6 Omah a Lea d Sit e Exterio rPain t Nort h Arrow Owne rName : WILLIA M F KOTCHIA N J R E T Sit e Sketc h • Goo d Address : 431 1 SHIRLE YS T • Ppo r

Phone : H : 402-932-144 2 W : [2^o t pain t Sampl e Numbe r Sample s Collected i , LA B Firm : frO AMoe.-(iiQ-rfl/Jovki i RYASCPXA-1867 6 F l Date : rX ^ I Z I j ^ 4 RYBSCPXA-1867 6 F 2 Time : 12-2 ^ RYCSCPXA-1867 6 B 1 Sample s Analyze d RYDSCPXA-1867 6 B 2 

# 3 ^ RDZSCPXA-1867 6 D Z XR F Unit : ^ \ \

Book^V P \ La b RYDSCPLA-1867 6 

## ~l 3, - Date : Resul t 309pp m Time : Staff : D Numbe ro f Sample s = 

## cjp - eg - : ^ OLS# : 1867 6 3at e Excavated:9/30/0 9 

# ENTERED ; Dat e JSEP ASione d Off : 10/19/0 9 J U N 2 R 'iuu * \re a Sodden : 60 3 s o f t

J ! ^ ^tnx r

Retainin g Wal l

uman aLea aiit e 4613 0 Legen d Concret e k/>o l Dri p Zon e Excavate dIQOO I 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 Coast^a l Environment:a l Grou p Inc .

## 1867 6

4613 0

# It ^[I' h 1867 6 Omah a Lea d Sit e Exterio rPain t Nort h Arro w Owne rName : WILLIA M F KOTCHIA N J R E T 

### Sit e Sketc h • Goo d Address : 431 1 SHIRLEYS T • Ppo r Phone : H : 402-932-144 2 W : 

# I [2^o t pain t Sampl e Numbe r RYASCPXA-1867 6 RYBSCPXA-1867 6 RYCSCPXA-1867 6 RYDSCPXA-1867 6 RDZSCPXA-1867 6 F l F2 B 1 B2 D Z Lea d Concentratio n pp m i \ " ^ pp m pp m pp m 

## _t4-2x2>pp m pp m Sampl e Sample s Collecte d J , LA B Collecte d Firm : f^ ^

KJQt^-rilCutJ/JCni^ i \ S 

## D Date : bCp/2( ( /0 4 

## D Time : \2'2 A Sample s Analyze d 

## D XR F Unit ; T N I \ Book : V P \ 

## D 

# n D

4613 0

## 1867 6 Omah a Lea d Stt e Exteito rPain t NoH h Ano w Ovvne rName : WILLIA M F KOTCHIA N J R E T Stt e Sketc h D Goo d Address : 4311 SHIRLE YS T gppo r

Phone : H : 402-932-144 2 w . GS^Io t pain t Sampl e Numbe r Lea d Conce n

tnceritrati o Sampl e Collectm l LA B Sample s Collecte d Firm : f<O AKlofc-tUcurt/JgAH ; t S RYASCPXA-1867 6 RYBSCPXA-1867 6F 1 F 2 pp m pp m 

### D D Date:rXP/^(|r? 4 Time : / 7. ' 2. A RYCSCPXA-1867 6 RYDSCPXA-1867 6 B l B 2

_ pp m

. PP" TM 

# s r Sample s Analyze d RDZSCPXA-1867 6 D Z La b RYDSCPLA-1887 6 _J^_2L2>pp m pp m 

# n D D XR F Unit : ^ \ \ BookiV P \ Resul t 30 9 pp m pp m 

### D D 

## CP-gZ - Number o f Sample s = |cir' 4 | I 

# ENTEBE D JU N 2 8 iW h 

# (q ^ 

# #• 4 Sf . \ )



# a . 5 . \ ^ 

# x ^ 

# I P ^ 

# f ^ : V * 

# ^S3 \ 

# 2i- : \ot- potZC^rt : 

# s ^ ^v-(^"- ) ^ Oinah aLea dSit e 4613 0? 

# W COASTA l IHVtItOMKIKT& l CROUP
. IN C 

## Consen t fo rAcces 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 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 :



### VCo-VieJrv't a n A r<M\\lia m Addres s o f Propert y covere d b ythi s Agreement : PURPOS E O F RESPONS E 

### AcTivrriE 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 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 t 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 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 b yUSEPA , 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 wod t befor e i t begins
. Onc e th e wor k i s finished , th e Granto rwil i b e aske d t o revie wth e wod ^ an d confin n 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 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 , it s 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 vmxk
. Thi s acces s shal l remai n i n effec t unti l th e wori t ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :
Pag e 1 o f 2

# ^^':r'> » COASTA L trfrmoNHiKTA L '*V.P«o.v / I *( C CROU P €

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 ; t 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 ; eAbid 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
. eAllo 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



# k 1 gran t acces s t o mypropertie s G I d o no t gran t acces s t o mypropertie s 

# Tddu A^lu ^ 9'//-^} ? SIgnat i Date Signatur e Date
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 2«-- * 

# :c: » COASTA L 

## Restoratio n Agreemen t Th e purpos e of thi s agreemen t i s to provide amutua l agreemen t as t o condition s ofth e propert y prior t

o remediatio nactivities . Thi s wil l als o serv e a s documentationfo r th e purpos e o f assurin g tha t restoration activitie s ar e completedt o th e satisfactio nofth e propert y owne r an dthe UnitedState s Environmenta l Protectio nAgenc y (EPA) . Propert y ID : V^dQ , Proper ^ Addi^^^2iV\_;^l^ir \ 

## Owaer : vsfsWx^iun nXUMUoyj^ r ^ 

## Phone : qB^^tl4M2 , O

nth e attacheddiagram(s ) indicat e area(s ) to excavate , surface structure s an dlandscaping feature s an d acces s location(s ) to b e usedby 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 dthe basemen t i

f necessary . item s t o b e Remove d b yth e Owne rbefor e Star t o f Remediation : Th e lemoval
. storage , disposal , and/o rretur n o f thes e item s i s th e Owner' s responsibiiity
. Kem : 

## Kvv u btv^KX U <p\ojrv ^ k > <Qe ^ ^^£x>te d Item : Item : Item :

Item s t o b e Remove d b yth e pohtracto rDurin g Remediatio n an d Wot Replaced ^ Item : 

# /WSimM ^\ojnA S VeP4
- Vy^ ^ Item : 

# t f
Item : Item :
Page l 

## Of i

# i«S & COASTA L C k ' «• I ) V IH I Kern s t o B e Remove d B yContracto rDurin g Remediatio n an d Repjace d i Item :

Msm : 

## -^n ^ 

## F t QJ M 

## oe - Item : Item : u . 

### Ite m Pre-existin g propert y area , that wil l b e excavated , tha t i s covere dwithgrass . Numbe r o f tree s > 2 inc h tnm 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 . Aii.nt hnski'icl i o l lli e i.pr'r-'kloi iHV'.ni i Numbe r o f an dsiz e o f eac hgarden / flowe r be d area . Aimth: i sIvL'lcl i 1) 1 ri.-!:itivi. ' <\-/x- % nndloc;lIilVl ^ Agree dupo nvalu e o f plan t material s no t t o b e replace db v contractor . Voi r l!-.i ' \HIII C V\(I I n i i;sri.. ' 1 0 li" . U t . 1 plHli ; >OIK;R'.
- t( , (h e i;-0|)crl > o nner . Easemen t Area , t o b e excavate d 

### Quantit y

\

^ ^ \



# vl o

\

\ 

### Landscap e Inventor y Uni t Condition/Type/Specie s Quadrant s

Eac h Eac h

Eac h

Eacf a Squar e Fee t

S 

# ^^^^^«; 5 P,e ^ v-v s Eacf a Pag e 2 

# ^J L• '""S i COASTA L O' h O U " • • « C
f Additiona l Comment s / Instructions : 

# QjiM X--'? > dojix? ) \ncadLVOukOo ^



# L

j ^

Chec k th e tx) X if Owne rdoe s no t wan t CE G to documen t interio rfoundatio n walls an d possibl e ^pre-existin g damage
. Bycheckin g thi s bo xCE G Is no t responsibl e fo ran ydamag e don e to th e

interio r of house , includin g foundatio n crack s orfissures
.
Q I do no t agre e

Contractor' s s Sienatnr e e » Date Date Signatur Pag e 3 of XBVID # f^la'^ C 

### XR F PROPERTY SAMPL E SHEE T Dat e Project 

# '^\MO' A Omati a lea d F P 2n d yea roptio n Addres s Sampl e tim e ^4^\ \ 'SWtri^ ^

< ^ ^ am/p m XRFID # 

### 7.n^(Ji»><\ sampl e lengt h 3 0 se c

Shot # Readin g 

# \ifT\ k Sampl e are a 

# £±
. Shot # 

# JM M

ItM . Readin c 

# s^ : Sampl e are a 

# E L lH2y ^ i > Dept h 

## Ikt O 

# mi ­ 33 1 3f

t > Dept h Averag e \2f ^

J-j ^ Averag e 

# 3(:M ' Shot # Readin g Sampl e are a Shol # Readin g Sampl e are a 

## MiU t 

# W ^ 

# 3 ^ 2 o ^^ 

# ? ^ ^ ^ ^ 

# ^7 0 % 

# J ^ Dept h 

# 7 5 Dept h Averag e 

# ^\ ^



# 9 ^ Averag e Sho t # 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^OCfiMM
. 

# Prin t YjAf^^to n Cacpi^H

### /\^^ ^ t I
.. . . . . Omah a 

### Lea d Site—Fixe d Pric e EP-R7-07-0 5
_ Coasta l Environmenta l Grou p Inc
. vl \m^Ui^- ' ~ ~ '' ^^S!^o ^ V • J? www.coastalhazmat.co m %PHOt* ^ COASTA L CIOUP , IH C INVItOMMENTA l 

# EXECUTIV ESUMMARY : BVID #18676-(431 1 SHIRLE Y ST ) No Issue s or Concern s Q Issues/Concern s Detail Explanation : -COASTA L

TO REIMBURS E$200.00 FO RPLANTS REMOVE D (COMPLETE D 1/30/10 )4 

# EP A ^ 

## EP A Propert y Clos e Ou t For m Property # ; \v( p ll g ^ , Datc/Tlmc : ^ Quad s Excavated : r\^ P ^ Contracto r Grou p Co^'fYf l Ye s N o Excavatio D GcBcral I . If necessaiy , were th e correc t quadrant(s ) excavate dandrestored ? 2 . If necessary , wer e th e correc t area s ofdri p zon e excavate dan drestored ? Gradin g So dan dVcgetatJo n I . Doe s the gradin g aroun dth e perimeter ofth e hous e i nexcavate darea s generally slop e awa y ^ fromth e house ? ,^- . 

## I P ' 2 . Ha s so dbee nlai dinall area s tha t were excavated ? 3 . Doe s th e sodappear to b e generall y healthy an dgrowing ? (Onl y evaluate if inspecte da t a3 0 

# 1? ^ day time period ) 4 . Ai « soddedarea s generall y fu man devenl y graded ? 5 . /Vr 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 will not poo l o nth e property* ? 

# T:^ ^ 7 . Wa s danug e t o landscapin g o r plan t material s avoided ? Gates , Fence s aa dRctafaiin g Wall s Ve s N o I . D o gate s ope nan dclos e freely? (Ifapplicable ) 2 . Were all gate s or fence s taken dow ndurin g restoratio nactivitie s reinstalled ? (If applicable ) 3 . Wa s damage t o gate s o r fence s avoided ? (Ifapplicable ) 4 . Wa s damage t o retainin g wall s avoided ? (Ifapplicable ) 6 ^ ' FouDdatton , Sidia g an dGutler s Ye s N o I . Wa s damag e l o th e sidin g o r tri mavoided ? i^ ' 2 . Wa s damage t o th e foundationavoided ? ^ 3 . Wa s damag e t o window s avoided ? L ^

Wa s damag e t o window s o r doo r screen s avoided ? 5 . Wa s damage t o downspout s or downspoul extension s avoided ? Sidewalk s an dDrivcway i (Concrete ) Ye s N o 1 . Wa s damage t o drivewa y surface s avoided ? ^ ' 2 . Wa s damage t o walkwa y surface s avoided ?

## Owner s comments :

Inspectio nnotes :

Remova l an drestorationaclivale s complet e including th e 30-da y so dwarranty : EP A Representativ e

### Propert yCompletio n Agreemen t Thi s agreemen t documenl s th e completio n o l remedia l activitie s perloimec t o n m yproperl yM ysignatur e wil l designat e lha t I a m satisfie d wil h th e restorado n o f m ypropeily , an d Iha l n o item s ar e i n questions , now , o ra l an ylim e i n th e future , excep t ihos e ilem s liste d below , ifan y

Propert y ID : [gl^ll , Prope r t y Address : i^'X i \ 

## 4k, r If M 

### .S- ^ Owne r ' ti . IV i rt-^r^ V ^ a^c^rCK. ^ Phone : 

## Ho3^-^33
- IMV 5 Restoratio n Item s i n Question :

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

# ^+' M n^eM^20C ) lo ^

PlcJ- ^ r^/^^<sc/->^/ >

1 )i(>rccI Ktoraiio n \ % completed , excep t a s noier i [ I I H o no l «(;re crcslorfltio n i s complete d 

# in^ i Ownp/' s Signafiir r Cont i artor' s Signatur e Dal e

## Propert yDamag e Settlemen t

Property ID 1867 6 Property Addres s 431 1 Shirley St Owner WUUaniKotchra n Phon e (402) 93^. 1 .1442 I hav e receive dfromth e contractor , Coasta l Enviromnenta l CJrou p Inc . (Coastal) , th e su mof $200.0 0 to compensat e for plant s an driver roc k tha t wer e remove ddurin g th e remova l of lea dimpacte dsoi l fro m th e property .

Compensatio ntyp e Check 1880 Valu e of Chec k $200.00 Chec k to th e orde r of WilUa mKotchran DesCTiptio n of Damaa e Whil e excavatin g 431 1 Shirle y St (BVI D 18676 ) Coasta l damage dsom e plant s beyon dsalvage . Property owne r receive dachec k for th e amoun tof $ 200.0 0 dollar s for th e replacemen t ofth e plants . Mysignatur e belo wacknowledge s th e replacemen t of myplants ; further , I acknowledg e tha t thi s wor k wa s complete d satisfector yan d withi n myan d releas e Coasta l Environmenta l Group , Inc
. fro m furthe robligation s orliabilit yrelate d to thi s property . 

## 188 0 COASTA L ENVIRONMENTA L GROU P INC
. 27-5/104000 3 241 1 MARTH ASTREE T 624737290 4 OMAHA , NE 6810 5 

# 1^11 0 DAT E 

# 'c^^T^^tjMiMd^^^^trm. 

# smf '

twarir f P«Mai« *

. DOLLAR S OalBll tan 

# -jiA)o hiJAnaMd(ind'yj< ^ Q

Wel h FwBoBank,ttA
. Nabral a wtttifi i flOuOOin



### .. . ^VID\<^lt)7l o HM^i^lO j 

# ^^<u3t w Cfe^-^ ^ luouoooosai : E.21.737E^OU" ' oiaa o 

# ^fifyue. ^ y^SD-Jid/ dfOe^y^4iy ^ 0^3D jiO Owner' s Sjenatur ir e

e Date Contractor' s Signatur e Date Pag e 1 of 1