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# y EPA-piovide dproperty sketc h 

## i / Signe dAcces s Agreement fo r subject propen y Signe dAcces s Agreement(s ) fo r adjacent properl y Restoratio nAgreemenl Settlemen t document s (i.e. , io \damag e o r t

o replac e plants , etc. ) Confinnatio n dat a 

### Photograph s ff r (r)oOv^pt ^ ; ^ (r><:^ATl^ M ^ 4- ^ As-buil l sketc h Satisfactory restoratio nsigne dby Property Owner Propert y close-ou t check lis t signe db y EP A Descriptio no f area s not meetin g RO D cleanu p criteri a 

# y Utilit y clearance s Propert y infonnatio nfro mDougla s County Assessor' s Offic e

3021884 5 

# w m Superfun d# 

# ^ v Property Acces s Checklis t PropertylD : ^SiZ S D WOR K STARTE D Propert y Address : ^^/ ^ QJ/t^ytAr , -^ V WORKCOMPELTE D n Owner : Renter : 

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## On:J(P / imjy > By : ta^ Video/Photo s (During ) On : / / By : D Video/Photo s (After ) On : / / By : D Video/Photo s (30-Day ) On : / / By : l~ l Propert y Completio nAgreemen t Siened : / / By : D Fina l Repor t Issued : / / By : Ai r Monitorin g (a s appUcable ) r~ | Communit y f" ) Cre w On : / / Results :

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# 1 1 1

## Douglas Count y Accotm t Infiamtio n Pag e 1 of 2 |a|^t : Dougla s County , Nebrask a Propert yRecor d ­ R221355000 0 Prin t Reoor t Informatio n i s vali d a s o f 2010-8-3 0 Vie wInteractiv e GI S Ma o Treasurer' s Ta xReoor t 1 Ne wFeatur e ^ - ^ - > Subdivisio n Sale s Searc h Owne r CITYO F OMAH A C/ 0 CITYFINANC E 181 9 FARNA M S T OMAH AN E 68183-000 0 Propert yInformatio n Ke yNumber : 135 5 000 0 2 2 Accoun t Type : E xGovernmen t Parce l Number : 221355000 0 Parce l Address : 281 6 CHARLE S S T OMAH AN E 68131-000 0 Lega l Description : SHINN S 3R D AD D LO T1 0 BLOC KYE 2 0 FTLT9 & W 2 0 F T4 0 X 127. 5 Valu e Informatio n Lan d Improvemen t Tota l 201 0 $0.0 0 $0.0 0 $0.0 0 200 9 $0.0 0 $0.0 0 $0.0 0 200 8 $0.0 0 $0.0 0 $0.0 0 200 7 $0.0 0 $0.0 0 $0.0 0 200 6 $0.0 0 $0.0 0 $0.0 0 200 5 $0.0 0 $0.0 0 $0.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widtt i Vacan t 0.1 1 5080. 0 0. 0 127. 0 40. 0 Ye s



## http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accoimtno=R22L. . 9/2/201 0

# ^ As-Buil t Drawin g COASTA L 

# Omah aLeadSuperfun dSite ENVmONHENTA L G « O U r.IN C OLS# : 2582 5 Dat e Excavated : 11/6/201 0 Dat e USEP ASigne d Off : 12/2/201 0 Are a Sodden : 129 5 s o f t
Address : :5<?/(. , rio«//,>< . Sf - Sit e SIcetc h Time : .^ ^ 

# "k Phone : 1 Tea m y^tf/*jyi,<.h^ll'j\i^'^' > BV1D # •^Jii^' ^ XR F Cod e 7^< ^ Sampl e Numtie r Lead Concentratio n Confirmatio n Sampl e five s C D N o O-" ' pp m gvf?gc:^l^A - ::?ggg g ^ ^ Z pp m 6 Ye s n N o B ^ pp m 8 1 Ye s • N o C3-: : 

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### Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are a replace d wit h Are areplace dwit h So d' ' Rock/Mulc h^ ^® ^ l^^ t ^*^ ° 

### Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .Name : C r/v ) t K(^Ji\y*i^i ^ Omah a Lea d Sit e Nort h Arro w—i Sit e Sketc h Address'~237kl£^S>I3!^f - Phone : ___ ^ 

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Omah aLea dSit e 4613 0'':-^ / c0 ; • s 1 AI C I C'J I f - c 

### C:oiif;eii \ ft; rAc^coi^i- . 'l o TioiK-^ii y RIGH TO F ENTR YT O PREW/IISE S 

### Granto i (th e pfopert) ' ownei ) conseiit. s t o an d aulhorize s th e Unite d State s Envitonmenta l Protectio n Agenc y(PPA ) o i its aulhorize d representatives , collectivel y th e Grantee , t o ente ran d perfor m certai n environmenta l respons e activitie s upor i th£ , followin g describe d premises : -^Z* ^

P ^C" ^ Owner s Name : Daytim e Phone : 

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, . Addres s o f Propert y covere d bythi s Agreement : 

# Zi.\k-...OMRby^ ^ .i>J : PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP Ai 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 of lea d an d maypos e a healt h hazar d Th e area(s ) vv'il l be excavate d t o remov e contaminale d soil . Th e remove d contaminate d soi l SN\\ \ b e replace d wit h clea n material s an d th e are a v^\\ \ 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 Site remediatio n program . Arepresentativ e of 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 performed , th e Granto rwil l have 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 i 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 , its employees , contractors sn d subcontractor s th e righ t t o ente rth e property , at al l reasonabl e time s an d witf i prio rnotice , fo rth e sol e purpos e o f performin g th e wor k 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 of 2cc;^S 1 AI
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### ' Remov e obstruction s includin g boats , iiaileis , vehicles , plgyscaf) ? iten-i.^ , woo d piles , do o houses , etc ;
' Remov e flov/e rbulb s o i piant s ttis t th e Granlo i o rth e GrarUci' s lensn l ma ywis h t o save ;
' Wale ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessary ' subsequen t t o a n initia l vv'aterin g perio d b yEPA ; < Abid e b yheall h an d safet yguidanc e provide d b yEPA ; I I f th e property ' i s rented , assis t EP Ai n obtainin g tenan t sppiovs l fo i acces s l o th e property ' l o perfor m th e work . I Allo wvideotapin g and/o rphotographin g o f th e properly . AGREEMEN THO 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 i wit h an y o f th e wor k done , o rwit h th e equipmen t use d o n hi s properly , o rt o undertak e an y action s regardin g th e us e o f sai d property ' whic 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

0 1 gran t acces s t o mypropertie s D I d o no t gran t access t o mypropertie s 

# ..,^yyy..y.(^.-±^-^ ^ ... . . TM Signatur e Dat e Signature Dal e
D I woul d lik e t cbe . presen t duririf i an ytsmpliri o ths l i s feqi'ired . • » • c



### Paa e 2 o f 2J . C c i A . S TA . L 

## Restoratio n Agreemen t Th e purpos e o f thi s agreement i s t o provid e amutual agreement a s t o condition s o f the property prio r to remediatio nactivities . Thi s wil l als o serv e a s documentatio nfo r th e purpos e o f assurin g that restoratio n activitie s are complete dt o th e satisfactio no f th e property owner an dth e Unite dState s Environmental Protectio nAgenc y (EPA) .

PropertylD : 1,t]^h5000 0 —Z^^'^ ^ Property Address : -^^/ ^ ^MA/ZZ-Sf ? <^ . Owner : fjj^ H Of = 0/viA^( ^ Phone : Onth e attache ddiagram(s ) indicate area(s ) to excavate , surfac e structure s andlandscapin g feature s and acces s location(s ) t o b e use db y th e contractors . Indicate distances , depths , materia l types , etc . Photographicall y andVideographicall y document th e existin g condition s ofth e propert y andth e basement i

f necessary . 

### Item s t o b e Remove d b yth e Owne rbefor e Star t o f Remediation : Th e removal , storage , disposal , and/o rretur n o f thes e item s i s th e Owner' s responsibility .



### Item s t o b e Remove d b yth e Contracto rDurin g RemecJiatio n an d No t Replace d Item : ^ ,

Pag e 1 of .C O AS T/ k L e N V ( RON M I N TA L cn o u r. PN C 

### Item s t o B e Remove d B yContracto rDurin g Remediatio n an d Replace d

Ite m Landscap e Inventor y Quantit y Uni t Condition/Type/Specie s Pre-existin g property area , tha t wil l b e excavated , tha t i s covere dwit hgrass . 

# l^ y Quadrant s Numbe r of tree s > 2 inc h trun k

diameter Eac h Numbe r o f tree s <= 2 inch trun k

diameter Eac h Numbe r o f Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Attachasketc ho f the •sprinkle r layout . Each

Number o f an dsiz e o f eachgarden / flowe r be d area . Micicl i asketc hoi ' rel;ui\ e size s an dlocutions . Eac h Square Fee l Agree dupo nvalu e o f plan t material s no t t o b e replace dbv contractor . Not f thi s Nalii f \^il l l) C used( 0 issu e aplan t \oiiclio i I dth c proprrl \ ()\MiC'r . Easement Area , t o b e excavate d Eac h Pag e 2 of .»t!L . ) C O AS TA l L • NVtflONHENTA L CROUP . < N C

Th e cit yo f Omah a ordinance s ma yprohibi t yo u fro m usin g dir t o rgrave l area s o n you rpropert y a s driveway s o rvehicl e parkin g areas . Th e Environmenta l Protectio n Agenc y(EPA ) ma yb e removin g an d replacin g soi l underlyin g a grave l o rdir t are a o n you rpropert ytha t yo u ma yb e usin g a s a drivewa yo rvehicl e parkin g area . I f thi s i s th e case , yo u shoul d understan d tha t thi s removin g an d replacin g o f soi l doe s no t mea n tha t an yillega l drivewa yo rparkin g are a o n you r propert yi s mad e legal . T o th e contrary , yo u ma yb e cite d b yth e cit yi f yo u us e a grave l o rdir t are a a s a drivewa yo rparkin g area , no t withstandin g an yremova l o rreplacemen t o f soi l b yth e EPA . I f yo u hav e an yquestio n abou t legalit yo f a certai n drivewa yo rparkin g area , yo u ma ycontac t th e cit yo f Omaha' s Plannin g Departmen t a t (402 ) 444-5150 . Q Pleas e chec k thi s bo xi f yo u understan d th e informatio n outline d above .

n 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 .



# 01 a I agre e O I d o no t agre e 

# V^/4^ )wner' s Signatur e Contractor' s Signatur e Dat e Pag e 3 of .BVID # ZS8L S 

### XR F PROPERT Y SAMPL E SHEE T Dat e 

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# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

Supervise d By : 

## Certificat e o f Verificatio n

33 2 SOI L 2011-01-2 0 13:1 5 91.3 0 Fina l Av g o f 329-33 1 281 6 CHARLE S S T B 2 4 " C.PADILL A CONFIRMATIO N CLEA R

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E
pp m P b 273.54 3 Supervise d By : 

## Certificat e o f Verificatio n
32 9 SOI L 2011-01-2 0 13:1 3 30.2 6 Fina l 2582 5 281 6 CHARLE S S T B 2 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 25.22 4

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E
pp m P b 290.64 1 Supervise d By : 

## Certificat e o f Verificatio n

33 0 SOI L 2011-01-2 0 13:1 4 30.6 6 Fina l 2582 5 281 6 CHARLE S S T B 2 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 23.32 0

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E
pp m P b 276.18 9 Supervise d By : 

## Certificat e o f Verificatio n
33 1 SOI L 2011-01-2 0 13:1 5 30.3 8 Fina l 2582 5 281 6 CHARLE S S T B 2 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 23.28 1

## / Q \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 3 ^^^ ^

I Coasta l Environmenta i Grou p Inc . ^T^^ ^

www.coa8talhazmat.co m Xppoit' ^ COASTA L INVIIONHENTA L C >0 U P , IN C 

# EXECUTIV ESUMMARY : BVID #2582 5 - (281 6 CHARLE S ST ) No Issue s o r Concern s Issues/Concern s Detail Explanatio ndA L 

## EP A Propert y Clos e Ou t For m Propert y if : Propert y Address : Date/Time : Owner' s Name: . /i. . ,fl t Quad s Excavated : Contracto r Grou p ( ^ Yes N o Excavatio nGenera l 1 . I f necessaiy , wer e th e correc t quadnuit(s ) excavate dan drestored ? / 2 . I f necessary , wer e th e conrc t area s ofdri p zon e excavate dan drestored ? / Yes No Gradin g So daa dVegeUtto a I . Doe s th e gradin g aroun dd» e perimete r ofth e hous e inexcavate darea s generall y slop e away 

### / fromth e house ? 

# T 2 . Ha s so dbeenlai di nal l area s that wer e excavated ? 3 . Doe s th c so dappea r l o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 

# y da y tim e period ) .^— ^ 4 . Ar e sodde darea s generall y firman devenl y graded ? 

# y 5 . Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 da y / tim e period ) 6 . Wa s th e propeit y grade dsuc hthat waie r wil l no t poo l o nth e propeny ? 

# y 7 . Wa s damag e l o landscapin g o r plant material s avoided ? 

# r Gates . Fence s an dReUfailp g Wal b V M N O I I . O o gate s ope nan dclos e freely? (Ifapplicable ) / 2 . Wer e al l gate s o r fence s take ndow ndurin g restoratio naclivilie s reinsulied ? (Ifapplicable ) 

# y 3 . Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) - / 1 . Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) 

# 7 Foundation , SidinRan dGatter s Ye s N o I . Wa s damag e t o th e sidin g o r ai mavoided ? 

# y 2 . Wa s damag e l o Ih e foundatio navoided ? / 3 . Wa s damag e l o window s avoided ? / 4 Wa s damag e t o window s o r doo r screen s avoided ? 

# J 3 . Wa s damag e i o downspout s o r downspou i extension s avoided ? / Sidewalk s an dDriveway s (Concrete ) Yes No I . Wa s damag e l o drivewa y surface s avoided ? 

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

## J

## OM'Dcr s comments :

ninspectio nnotes :

Removal andresloratio nactivate s complete includin g th e 30-da y so dwarranty : EPA Representativ e 9^ ^ Date : (4?iiq _# 

# 'Zj ^ Propert yCompletio n Agreemen l \U\ i agiecmc m duiuineni } (h e complclto n o l icmcdiit l aclivme s perloime d n n mypiopeil yM y.Mgnaiui c wil l dCMgnai cIha l I a m salisfie d wil h th e icsioralio n o f m ypropeily . <tn d ih? ! n o iiei m are i n question s now . o ra i an ylim e i n ih e fulur rcxcep i ihos cHem s li&iec ) bdoM , i f an y 

# r^np7M;m;'^is-^L r' " ^ ' ^ n^p.rtyAdd,» vl^j ^

„Ci3^fi^^3._> t _. - - . Owner : (^~ ^ S^_JCX L _.C20'>.<ah\.O_ . 

## !:!T1!^ . ..<'Mol^.HH.H-..^LHL^ . Resloratio n Item s i n Question : Item : Itam : Hem : Itam : Item : U I - I P J.g- l Hem : Additiona l Comments ;

lfii \ nfr rrrtloiDlio n i « comptclrd , r>«cp l n t noiri l I J I il o nn i ii|>i'f rir)ioi-*ii«i i Acomplftr d l i O o?J-A>^JU'^l( l 

# till Otviiri'»Sicnaitii r l)*i r Cont i uriAi' t SignaliHt ' DAi r