## TRANSMITTA L o f OMAH A LEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : , 

# ^BS-^ ^ Date : 3/72y/o & Address : Remediatio n Contractor : Coasta l Environmenta l Group

_Year : 200 7 SOI LREMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S Vide o o f propert y (DVD ) Executiv e Summary M EPA-provide dpropert y sketc h

• i ZSigne dAcces s Agreemen t for subjec t property D Signe dAcces s Agreement(s ) for adjacen t propert y M Restoratio n Agreemen t D Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) M Confirmatio n dat a y Photograph s B ^ As-bui h sketc h y Satisfactory restoratio n signe db y Propert y Owne r y Propert y close-ou t chec k lis t signe db y EP A D Descriptio n o f area s no t meetin g RO D cleanu p criteri a D Utilit y clearance s D Propert y informatio n fromDougla s Count y Assessor' s Offic e D D , D 

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## Fina l Repor t Propert y Chec k Lis t (piease plac e wit h eac htiie ) ^5 " ^5 /

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­ jyfl . Propert y Chec k Lis t ,0- 2 Sit e Workin g Drawin g Ma p EP A original s Ma p Dougla s Count y Assessor' s Ma p Propert y Contac t Shee t ^Agreemen t ,H i I . Aeees s Agreemen t J^2 . Restoratio n Agreemen t Miscellaneou s Document s J ^ I . Fina l Ma p fromth e Fiel d X l 2 . Chang e Order s V ^ XR FDat a ''4 . An y email s o r P O eorrespondenee s ^YYY^MJ ( 

### Propert y Completio n D 1 . Exeeutiv e Summar y n 2 . A S BLJILT py7^ - Propert y Completio n Agreemen t y ^ 4 . An y buyou t inf o o r reimbursemen t info^O— ^ j2 l 5 . Chee k o r mone y orde r copie s ^(y J ^6 . EP A Propert y Clos e Ou t For m I U 7 . Attaehe dBegi n Vide o Electroni c Documentatio n Drawing s Q I . EP A origina l Q 2 . Workin g Drawin g iZl. l A S Built.vs o n 4 . A S Built.jp g Photo s 1 Begi n Photo s 2 During/Exeavatio n Photo s ^ So dPhoto s 4 30-Da y So dPhoto s Scanne dDocument s Fina l Document s Exeeutiv e Summar y Video s Begi n Vide o M yMovi e

# M 

# m Property Acces s Checklis t Propert y ID : (^5^^ ^ n WORKSlARTli D ON : / / n WOKKCOIMFELTE D ON : / / _ Properl y Addrc.s.s : -^^<L ^ 

## ^£UL a Renter : 

# '"'y'yiliTi y 07- QM^JL.- ^ Plione : Addres.s : ( J f \ 

## {"^{^TTbuxa.^. . ty^<s7^yaj ^ Fa\ : Ccll/Pawr : Phone : Additioiiit l Information : 

# -l^ y T^T^-^Si^ o I'il X Ccil/Pairc r Notificatio n Lcttci " Sent : XL/^/_^ ^ 

# ^iGJ^ : 3_ H Acces s Aj»rccnK>n t Si;4ned : ]±

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# u Kcstoiafio n A"rccnicn t Signed : IL/^/^2 - 

# ^7QJyy y D Top.soil Sani|)lin< ; (if applicable ) By : 

# 7 Dis|)osal Saniplins ; (if a|)|)lical)lc ) Bv : Garde n Sainplin " (if applicable ) Bv : Utility Clearanc e Called:/Z-/^42 : 

# ^yiy^jlh(^23rcy^jBA7^yy'/ ^P " Video/Photo s (Bcfoic ) 

# o».JiiS7i63
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# ^y-yju/ s D Video/Photo s (Durinj; ) On : B y : 

# n Video/Photo s (After ) On : Bv : 

# D Video/Photo s (30-Day ) On : / / Bv : Pr()|)crt y Completio n Aj>iccmenf Sijjncd : / / By : Fina l Repor t Issued : / / Bv : Ai rIVlonitorint ; (a s ap|)lical)lc ) j j n Coninuinif yD Cre w On : / / By : ResuKs : 1 1 Communit yJH ] Cre w On : / / Bv : Results : 1 L J Communit y[ H Cro v On : / / By : Results : 

# 1

Omah a Lea d Sit e

# I IA7fi)c777pEy 7 

# g^^6-. q Exterio rPaint Nort h Arro w 

# —t — Omah a Lea d Sit e Sit e Sketc h Own« rName : dlJ-^ J o P Omah a • Goo d iAddres s • Poo r Phone : H 

# w: vW - cryx/ \ [ J No t paint Sampl e Numbe r RyASCPXA - 25'553F i RVBSCPXA-^^y^ ^ F 2 RrCSCPXA-25g5 ^ B 1 RrDSCPXA-25-35- 5 B2 RDZSCPX A SffSfT S DZ RGZSCPX A SirSS 9 Q ^ Legend : F l = Fron t Left , F 2 Lea d Concentratio n Sampl e Collecte d LA B Sample s Collecte d Firm ; Asv o \ R ^ \

C>v=- » g 35 " pp m 

## E T 

## D Date : iq - \ 2 -£>C . <ST n pp m 

## 0 - 

## D Time : ji-.^ n 9^ ^ 33 3 33( 3 pp m pp m 

## 0 - 

## D D Sample s Analyze d

- pp m pp m 

## D D D D XR F Unit : Date : I QO T Book : /-/T~0 7 

# JZ I

" pp m 

## D D Tim e 

# A M . Numbe ro f Sample s = 4 - I Staff : 

## t^ATI L Fron t Right , B 1 = Bac k Left , B 2 = Bac k Righ t DZ = Dri p Zone . G Z = Garden , P Z = Pla y Al l quadrant s ar e a s viewe d from th e street , facin g propert y

### y'"^^ . UNITE D STATE S ENVIRONMENTA L PROTECTIO N AGENC Y 

# l3S i '"-"PKO''*' .<- " ' REGIO N Vl l 90 1 NORT H 5T H STREE T KANSAS CITY , KANSAS 6610 1 Octobe r 3 , 200 7 CIT Y OFOMAH A C/

O CIT Y FINANCE 181 9 FARNA M S T OMAH A NE 6818 3 BVID : 2585 9 Dea r Owner/Resident :

Yar dsoil on you r propert y locate da t 385 9 SEWAR D S T i n Omaha , N E wa s recently teste db y the U.S . Environmenta l Protectio n Agency (EPA) fo r lea dcontaminatio n a s par t ofth e OmahaLea dSuperfiin dSit e investigation . A sketchofyour propert y wit h the result s ofth e soil testin g i s enclose dwit h thi s letter . I n order to conduc t the soil sampling , you r yar dwas divide dint o anumbe r o f sections . A representativ e soil sample was then collecte dfro meachsection . A typica l yar di s divide dinto tw o front yar dsection s (F l an dF2 ) and tw o back yar dsection s (B l an dB2 ) In addition , afifthsample i s collecte dnea r th e foundation (drip zone or DZ) . Additiona l sample s ca n b e collecte dfromchildren' s pla y area s (PZ ) an dfromgarden s (GZ) , i f present . The actua l numbe r o f sample s collecte dfromyou r propert y depend s o n the siz e ofyou r yar dandwhethe r pla y area s o r garden s wer e identifie dan dsampled . Th e sample s collecte dfromyou r yar dwer e analyzedfo r the presenc e of lea dcontamination . Exposur e t o lea d contaminatio n ca n adversely affec t the developmen t an dbehavior o f young children . Als o enclose dwit hthi s letter i s aLea dFact Shee t fromthe Dougla s Count y Healt h Departmen t tha t provide s information about lea dexposure . I f children six year s o f ag e an dyounge r are livin g wit h you , or frequently spendtime i n you r home , we recommendyo u follow th e suggestion s containe don the fac t shee t to Projec t you r children fromlea dexposure . Following thes e tip s will greatly reduc e achild' s ris k o f having elevate dblood-leadlevels . If yo u have children six year s o r younge r livin g in you r home , we strongly recommendtha t yo u contac t you r doctor or th e Dougla s Count y Healt hDepartmen t a

t 444 ­ 782 5 andarrang e to hav e their bloo dteste dfo r lead , if you hav e no t alread y done so . The EP A i s currently excavating an dreplacin g yar dsoi l on residentia l propertie s wit h lea dconcentration s abov e 800 part s pe r million (ppm) . The attache dresult s will b e usedb y the EP A to determine if you r propert y i s eligibl e fo r asoil cleanu p a t thi s time . Ifan y portio n ofyou r property , excluding th e are aimmediately aroundthe hous e (drip zone) , i s abov e 800 ppm , th e EP A will contac t yo u i

n th e fijture to arrang e fo r remova l ofth e contaminate dsoil . Excavate dportion s o f yard s will b e backfille dt o the origina l grade wit hclea n soil an dlawn s will b e re-establishe dwit hsod . Thi s wor k

i s being conducte dby th e EP A a t no cos t t

o the homeowne r o

r occupant . I n general , th e EP A i s concerne dabout soil s i n residentia l area s tha t exceed40 0 ppm , bu t studie s on actua l contaminate dsoil s i n Omahaar e require dto establis hafinal cleanu p level a t the OmahaLea dSite . Thes e studie s are currently underway . I n the meantime , the EP A i s als o excavatin g an dreplacin g soil s tha t excee d40 0 pp ma t chil d car e facilitie s andpropertie s wher e children wit helevate dbloo dlea dlevel s reside . A t thi s time , exposur e t

o soil s containin g lea da t concenfration s les s tha n 40 0 part s pe r millio n ar e no t considere dasignifican t enough healt h threa t to tak e action . I f area s ofyou r propert y awa y fromthe foundation excee d40 0 ppm , bu t are belo w th e current 80 0 pp mactio n level , the EP A ma y include you r propert y i

n a fiiture cleanu p action . The EP A will contac t you i n th e fiitur e t o arrang e fo r soil cleanu p if the lea dlevel s i n you r yar dexcee dthe final cleanu p level tha t i s determine dfo r th e site .

### Pag e 1 of 2 tsimmons(glkgs.he.ne t From : "N E DIGGER S L " <info(gne-diggers.com > To : <tsimmons(gcoastalhazmaLcom > Sent : Monday , Novembe r05 , 200 7 12:1 5 P M Subject : Re : NE-Diggers.co m - LOCAT E Contractor s Reques t For m DIGGER S HOTLIN E PRESENT S TH E 'N O WAIT ' N.I.T.E.S . TICKE T ENTRY ! Avoi d length ywai t tim e - Immediat e ticke t numbe rrespons e - Use rha s acces s t o al l issue d tickets . FRE E trainin g sessions . Contac t Conni e o rLis a a t 402-330-186 6 fo rfurthe rinformation .

****************************************************************** * 

### Ticket #192972 4 Wor k t o begi n date : 11-07-0 7 a t 1230p m Th e utilitie s w e wil l notifyare...CIT Y O F OMAH ATRAFFI C & SEWER , COX , MUD , OPPD , QWEST , mcleo d I f ther e ar e an yothe rutilitie s beside s thos e mentione d above , yo u wil l nee d t o notifythe m yoursel f an d an y privatel yowne d line s wil l no t b e located . Origina l Messag e From : tsimmons(gcoastalhazmat.co m To : info(gne-diggers.co m Sent : Monday , Novembe r05 , 200 7 10:5 0 A M Subject : NE-Diggers.co m - LOCAT E Contractor s Reques t For m NE-Diggers.co m - LOCAT E Contractor s Reques t For m Name : Rit a Alt . Name : Phone:712352018 8 Alt . Phone : Email : tsimmons@coastalhazmat.co m Calle rID : 1879 0 Company : Coasta l Environmenta l Grou p Typ e o f work : lea d excavatio n Fo rWhom : EP A Ho w Deep : Oft . 36in . Explosives : N o Corne rLot : N o Fron t o f Property : Ye s Rea ro f Property : Ye s Tunneling/Boring : N o



### 11/5/200 7

### Pag e 2 of 2 County : Dougla s City : Omah a Address : 385 9 Sewar d S t Directions : Wher e o n Property : locat e entir e propert y Township : Range : EorW : Section : 1/

4 Section : Township : Range : EorW : Section : 1/

4 Section :



### 11/5/200 7

### Dougla s County Accoun t Informatio n Pag e 1 o f 1 Dougla s County , Nebrask a Propert yRecor d - R192512025 0 Prin t Repor t Informatio n i s vali d a s o f 2007-10-1 0 Vie wo n Ma p Value s no t finalize d unti l afte rBoar d o f Equalizatio n Treasurer' s Ta xRepor t Owne r CIT Y O F OMAH A 1 77f t f^dy>:>/ ^ C/ O CIT Y FINANC E 181 9 FARNA M S T OMAH A N E 68183-000 0 <oyr^/yad > " ^ ^ PropertyInformatio n Ke yNumber : 251 2 025 0 1 9 Accottn t Type : E xGovernmen t Parce l Number : 192512025 0 Parce l Address : Lega l Description : 385 9 SEWAR D S T OMAH A N E 68111-000 0 ORCHAR D HIL L AD D RE P 8 * L OT 1 BLOC K0 5 0 X 13 8 | Valu e Informatio n Lan d Improvemen t Tota l 200 7 200 6 200 5 200 4 200 3 200 2 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 

### $0.0 0 $0.0 0 

### 1 Lan d Informatio n Acre s 0.1 5 S F 6900. 0 F F 0. 0 Unit s 0. 0 Depth^^O f '/1138. 0



### i l 

## l i Widt h 50. 0 Va can t N o



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R l 9.. . 1 1 /2/200 7

## Douglas County 

## NE GIS 

## Map

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

Comment : Owne r Commen t (s) : Sit e 1 Coordinato r

Commen t (s) : CONTAC T FOR M 

# r G ^5t7>^J

x : 

# S Q 

# 0 Date:///4,M' ? Time : Action : ^T^^yt

Date : ' Time : Action : ' Date : Time : Action : Transmi t t o EP A D Othe r Action : D

J*•''''"'"* . 

### r^fi^' o Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 ((ifl & i^^^v ' I Coasta l Environmenta l Grou p Inc . ^'^^^^ F v^^^^ * www.coastalhazmat.co m

%PBoTt ^ COASTA L ENVIRONMENTA L C I t O U P . IN C 

# EXECUTIV E SUMMARY : 25859—332 0 HAMILTO N S T ^ N o Issue s o r Concern s | ^ Issues/Concern s Detai l Explanation :

# As-Buil t Drawin g C OAST AL 

# Omah aLea dSuperfun dSit e CNVinONHCNTA L O ft O U P . INC . 

# L\,y7>c07e y

Phrtn* : .-J... - j - yr!--> y [ 3 No l p a rtt ^ Srtlllp^ e NumDe r r::Ciinentr?Tfio n Ccillec:E d Firm : Ag. ^ i ft-s. 1 t^b - Date : 1-a . — 1. 2 -c^c . 

## S' wrnf. - J l-l^r - p . Rrcscpxv^53j- j B l I ] RVDECPX ^ 5535 3 B 2 

# m Z ] >i;tJ2SC.rX.< V ;gjg5''j-t g " 3p m D .XRF Unit : /OQ T DOCK : !T 7 " 33 m U 

# n Date : / -/ T ' O T Tin-« ; i^^ l 

# a NunillO rCf ^rimplt S = LeceriJ : F l = f-"rcn : LE:1 , FI : = Fron t RJgh ^ (

3 I - K?c k l.Rrt t5 7 = : Bac k RiG'> l D Z = Dri p Zon e Li Z = (iardfi n h V = (Jlfi y 

## -r 0£ C :l ' B' iii^ g

F

2 = 17 1 PP M @ 6 " p i '+^1 ' '^' ' ^ "^* ^

WM< I ni; i -<^/^ : .; > 0LS# : 2585 9 Dat e Excavated : 11/8/0 7 Dat e USEP ASigne d Off : 12/4/0 7 Legen d Are ano t Excavate diTZy i Dripzon e Excavate dK ^ Quadrant s Excavate d Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .

## S* L 

# EP A EP A Propert y Clos e Ou t For m Propert yAddress : 3&5 ^

'5fcWJ<trc l Propert y# : ^(^<^6 ^ Dflte/Time : u /a^ q Owner' s Name : CL>'-f ya f Amo-Kt V Quad s Excavated : Contracto rCrou p CWZ L ytg*- ! Ye s N o Excavatio n Genera l 1 .I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? y ^ 2 . I f necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? 

## (^{ i Ye s N o Gradin g So d an d Vegetatio n 1 .Doe s th e gradin g aroun dth e perimete r ofth e hous e i n excavate darea s generall y slop e awa y 

### U A fromth e house ? Ha s so dbeen lai di n al l area s that were excavated ? i ^ 3 .Doe s th e sodappea r t o b e generall y healthy an dgrowing ? (Onl y evaluat e if inspecte da t a3 0 da y tim e period ) 4 .Ar e sodde darea s generall y fir man devenl y graded ? 5 .

Ar e th e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e if inspecte da t a3 0 da y tim e period ) ^^______ _ 1 .Wa s damag e t o landscapin g or plan t material s avoided ? Ai f Gates , Fence s an dRetainin g Wall s Ye s N o 1 .D o gate s open an dclos e freely? (I f applicable ) / ^ ^ 2 .Wer e al l gate s or fence s take n dov mdurin g restoratio n activitie s reinstalled ? (I f applicable ) 

### /s/ ^ 3 .Wa s damag e t o gate s or fence s avoided ? (I f applicable ) 

## 0 ^ 4 . Wa s damag e t o retainin g wall s avoided ? (I f applicable ) 

## tJ A 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 ? 

### \J A 2 .Wa s damag e t o th e foundatio n avoided ? 

### ,J ^ 3 .Wa s damag e t o window s avoided ? 

### A/ A 4 .Wa s damag e t o windows o r doo r screen s avoided ? 

### jJ A 5 .Wa s damag e t o downspout s o r downspou t extension s avoided ? fJ( ^ J Sidewallt s an d Driveway s (Concrete ) Ye s No I . Wa s damag e t o drivewa y surface s avoided ? A/A 2 . Wa s damag e t o walkway surface s avoided ?

## Inspectio n notes :

Remova l an drestoration activate s complet e including th e 30-da y sodwarranty : EP A Representat i V Date : 7y/<7/t7 7^ ^ 

## Propert yCompletio n Agreemen t Till s agreement document s the completio n o f remedia l activitie s perfonne do n m y property . My signature will designate tha t I a msatisfie dwit h th e restoratio n o f m y property , an dtha t no item s ar e i n questions , now , or a

t any time i n the fiiture , excep t thos e item s listedbelow , ifany . Propert y ID : D / ^ g f^C ( l^opert y Address : >2^^f^C ^ 9.fXMO.r l Owner : 

## Phone: 444 C g:^/^^ ^ Restoratio n Item s i n Question :

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

agre e restoratio n i s completed , excep t a s note d I I d o no t agre e restoratio n i s complete d A<^ ' 

# M- y Owner' s Signatur e / / Dat e 

### Contractor' s Siiaiature / I

# llljyyy > '^y^j))cap^ y # ^5<^53 ^ Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e OwntffName : CIJ- W o P Omah a ^. ^ ^ , , ^ • Goo d 

## wvddress:_A3Ag

_

cyg^arr / c9 /

^•* ^

^''^*^ ^ • Poo r Phone : H : 

## w.y<4<~f7<sis 7 ^ [ 3 No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : A'SV J \ R's . \ l:^v=. . 

### RrAscpxA - es8S3^ ^ g35'pp m 

## {z r D Date : la - t a -gg . 

### __dI Q pp m 

## D Time : '• ' i*? Q P* ^ 

### RY'CSCPXA-25g5 ^ B 1 33J 3 pp m 

## D Sample s Analyze d 

### RYDSCPXA-SffQS S B 2 33 Q pp m 

## D RPZSCPX A QffQS O D Z pp m 

## D D XR F Unit : /QO T Book : 

### JJ Z RGZSCPX AS^8S 9 ^' ^ • " pp m 

## D D Date : /-/T-Q T 

### RfZCCPX A CiPQff a P Z " pp m 

## D D Time : >^/l/ ^ 

### Staff : (S7U1 L I \r7r^^'S>^''77ZS^ f ^ . Numbe ro f Sample s = [ T Legend : F l = Fron t Left , F 2 = Fron t Right , B l = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a s viewe d fro m th e street , facin g propert yPROPERT Y CLEARANC E WORKSHEE T

Dat e Propert yI D 

## jyo^'O i JZ5SS 1 Propert y Projec t Omah a Lea d - - Fixe d Pric e Addres s ^g5 ^ Sgv>^ ^ S T Measuremen t XR F I D 0107-5 1 Count/Tim e Fiel d Shot s Sho t # Readin g Sampl e Are a Shot * Readin g Sampl e Are a y»? > 

### 1 1 n IrZ . 4-( * bUl a f.A-K i 

## tf

c

Sampl e Are a 

## F Z ^-( ^ I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s La b Analytica l Readin g Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 2 / 0 (Bag ) Sieved ) ? 2 

### n t 

## n l 3 

### /« 6 

# n i 

# n i 4 

# m m XR F Correcte d Valu e -- > 5 (us e calibratio n char t o rad d 

## 21 ^ 2 0 % t o value ) 

## Z\1 > Sampl e Are a Pass/Fai l ? 

### ^ A -^ / I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s La b Analytica l Readin q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 (Baq ) Sieved ) 2 

### ^ 9 3 C T 

# ^ 7 4 

### (ef t XR F Correcte d Valu e -- > 5 (us e calibratio n char t o rad d 

## S O 2 0 % t o value ) Sampl e Are a Pass/Fai l ? I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s La b Analytica l Readin q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 (Bag ) Sieved ) 7 2 3 4 XR F Correcte d Valu e -- > S (us e calibratio n char t o rad d 20 % t o value ) Sampl e Are a Pass/Fai l ? I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s La b Analytica l Readin q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 (Baq ) Sieved ) • ? 2 3 4 XR F Correcte d Valu e — > (us e calibratio n char t o rad d 2 0 % t o value ) Sampl e Are a Pass/Fai l ? I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s La b Analytica l Readin q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s (Bag ) Sieved ) • ?

XR F Correcte d Valu e -- > (us e calibratio n char t o rad d 2 0 % t o value ) i n i AUD I I IOHA I miii i i , XR F Technician' s Siqnitur e n f f II I I I 5

# m COASTA L '•»>

• y ENVIRONHENTA l C I I 0 U f , IN C 

### Consen t Fo rAcces s T o Propert y RIGH T O F ENTR Y T O PREMISE S 

### Granto r(th e propert yowner ) 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 :



## i 

# (^// yo rOnn^ A Owner' s Name : Daytim e Phone : 7^^ ' 5IS O 

# (l/4cc 5 cy^ju e Addres s o f Propert y covere d b ythi s 

# S^^f ^^ity^ b ST . Agreement : PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP A i s requestin g acces s t o collec t soi l sample s an d remov e 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 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 . A representativ e o f Coasta l Environmenta l Group , contracte d b yUSEPA , wil l contac t th e Granto rin-perso n t o discus s th e wor k t o b e performed , th e Granto rwil l hav e a n opportunit yt o revie w an 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 w th 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 propert y 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 , contractor s an d subcontractor s 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 f 2.T""**^* 'C O A S T A I COASTA L IWVmOWMiNTA l C • O U P . I t« C



### Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; Remov e flowe rbulb s orplant s tha t th e Granto r orth e Grantor' s tenan t maywis h • 

### to save ; •Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , as necessar ysubsequen tto an initia l waterin g perio d byEPA ; •Abid e byhealt h an d safet yguidanc e provide d byEPA ; • If th e propert y is rented , assis t EP Ain obtainin g tenan t approva l fo racces s to th e propert yto perfor m th e work . •Allo w videotapin g and/o rphotographin g of th e property . AGREEMEN T NO T To INTERFER E 

### Th e Granto ragree s no tto interfer e ortampe rwit h an y of th e wor k activities , orwit h an y of th e wor k done , orwit h th e equipmen t use d on hi s property , orto undertak e an y action s regardin g th e us e of sai d propert ywhic h woul d ten d to endange rth e healt h or welfar e of th e Grantee s orth e environment , orto allo wother s to us e th e propert y in suc h a manner . Shoul d you hav e an yquestion s abou t thi s program , pleas e contac t Coasta l Environmenta l Group , at (712 ) 352-018 8

-B l gran t acces s to mypropertie s• I do no t gran t acces s to mypropertie s 

# 7u. ^ ^^y^ 7 Signatur / Dat e Signatur eDat e e '

O I woul d lik e to be presen t durin g an ysamplin g tha t Is required .COASTA L CMVinOMMSNTAi . C n O U r . IN C 

## Restoratio n Agreemen t Th e purpos e o f thi s agreement i s t o provid e amutual agreement a s to condition s o f th e property prio r t o remediatio n activities . Thi s will als o serv e a s documentatio n fo r th e purpos e o f assurin g that restoratio n activitie s ar e complete dt o th e satisfactio n o f th e property owner an dth e Unite dState s Environmental Protectio n Agenc y (EPA) .

Property ID : Z.' O S ^5 ^ Property Address : 

# ^n . Owner : (Tyitt ^ Q ^ yT^^^T/y ^ ty/yy/Ayf ^ 

## Phone : 77 ^ ' S^Z^ Q O n th e attache ddiagram(s ) indicat e area(s ) to excavate danddept h o f excavation , locatio n o f all known utilities , subsurfac e features , surfac e structure s andlandscaping features , acces s location(s ) t o b e use db y contractor , and the direction o f North . Indicat e distances , depths , materia l types , etc . Indicat e digita l photo s b y referencing the photo-lo g numbe r wit h a n arro w indicating direction o f view . 

### Item s T o B e Remove d B yOwne rBefor e Star t O f Remediation : (Us e additiona l sheet s a s necessary ) Th e removal , storage , disposal , and/o rretur n o f thes e Item s i s th e Owner' s responsibility . 

### Item : / oy->€: ' 

### Item : Item : Item : Item : 

### Item : Item : 

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# T Pag e 

### 1 o f ^COASTA L • MVIRONM C NTA L CROUP . IN C 

### Item s T o B e Remove d B yContracto rDurin g Remediatio n An d No t Replace d (Us e additiona l sheet s a s necessary ) Item : 

# 7o^£ ' Item : Item : ^ ^ ^ Item : \ Item : \ / / / Item : / Item : / 

## 1 '*®'" " / 1 Item : / Item : / Item : / " Item : ' 1 Item : /
Pag e 2 o f ^COASTA L KMVIRONMBNTA L CROUP . INC .

Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : 

### Item s T o B e Remove d B yContracto rDurin g Remediatio n An d Replace d (Us e additiona l sheet s a s necessary )



# •

b 

# 5 o/ C



# 7

Pag e 3 of . 

# 0< ^ COASTA L SNVIROMNSNTA L CROUP . IN C 

### Landscap e Inventor y (Us e additiona l sheet s a s necessary ) 

## Ite m

Pre-existin g propert y area , tha t will 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 . Attac h asketc ho f th e sprinkle r layout . Numbe r o f an dsiz e o f eac h garden / flowe r be d area . Attac h asketc ho f relativ e 

## Quantit y 

# pz y

^ 

# (

y 

# y 

# 0 Uni t Condition/Type/Specie s

Squar e fee t

Eac h

1 Eac h

Eac h

Eac h Squar e Feet size s an dlocations .
Pag e 4 o f _COASTA L KNVIRONNCNTA L CROUP . IN C 

## ite m Agree dupo n valu e o f plan t material s no t t o b e replace db v contractor . Not e thi s valu e wil l b e use dt o issu e aplan t vouche r t o th e propert y owner . Agree dupo n hs t o f plan t material s tha t wil l b e replace db y contractor . B e very specifi c an ddetailed . Includ e asketc ho f were eac h plan t wil l b e place d b y th e contractor . Agree dupo n are ao f propert y to b e replace d wit h gras s sod . Includ e asketc ho f th e area(s ) t o b e replace dwit h gras s sod . Are ao f City o r County propert y t o b e landscape d pe r thei r requirements . Includ e asketc ho f th e are a(s )

Easemen t Area , t o b e excavate d 

## Quantity Uni t Condition/Type/Specie s 

# y $ 

# 7 Eac h

S F 1 1 

## /y7eysi2u^ye > S F

S F

Pag e 5 of . ^COASTA L • NVtRONMSNTA L CROUP . IN C 

### Additiona l Comment s / Instructions :



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O 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 cracks o rfissures .

• Q I agre e Q I d o no t agre e 

# 1^ iyYL..,ryK'<^ ^ C'y - ^yyy. . nkh- ? Owner' s Signatur e ' Date Contractor' s Signanir e Dat e Pag e 6 o f < ^