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### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL E FOLDE R SAID# : :207<^ Y Date : /o//s/^ 7 Address : /A3 3 S . / / S ^ Remediatio n Contractor : Coasta l Environmenta l Group

_Year : 2007 SOI LREMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S ^ 

### Vide o o f propert y (DVD ) Executive Summar y 

# 7 EPA-providedpropert y sketch SignedAcces s Agreemen t fo r

subject propert y D SignedAcces s Agreement(s ) fo r

adjacen t propert y M Restoratio n Agreemen t D Settlemen t document s (i.e. , fo r

damag e o r

to replac e plants , etc. ) Confirmation data 

# 7 Photograph s M As-built sketch M Satisfactor y restoratio n signedby Propert y Owne r i P Propert y close-out check lis t signedby EP A D Descriptio n o f

area s no t meeting ROD cleanu p criteri a D Utilit y clearance s D Propert y information fro mDougla s Count y Assessor' s Offic e D D ,
D ' • • ' " • ^ ^ # ^ 4031790 0 

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^ Acces s Agreemen t ^ Restoratio n Agreemen t Miscellaneou s Document s [+

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## Electroni c Documentatio n Drawing s 1_

Q EPA original ] ^ Workin g Drawin g ^Sr A S Built.vs o -^ . A S Buih.jp g Photo s V Begi n Photo s -/puring/Excavatio n Photo s \ySp dPhoto s w^-Da y So dPhoto s Se^nne dDocument s ^•TiH^ l Document s Executiv e Summary

Video s '^egi n Vide o ^y<A y Movi e

## Propert yAcces s Checklis t Propert yID : ^ 7 (^ ^ n WOK K STARTE D ON : / / _ Propert y A.hlres.s : /^3 3 3 / l^~Sf . n WOR K COMPELTE D ON : / / Renter : Owner : ^7^6Hni/P l Ppl P P Address : / MO O pr^r>KUr x(\w . Plionc : Fax : Cell/Pajjer : Phone : . ^ /(^^ ^

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, . ^^^ ^ Additiona l Information : Fax : Ccll/Paser : 0 Notificatio n Lette r Sent : By : Acccs. s A);recmen t Siuned : ^ Ip lO l 

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Omah a Lea d Sit e

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## CONTAC T FOR M Property I D # 

# ^01(/ 1 Property Address : 

# i^^ds-ii'^ P Initial Contact : Date : Time: _ Action: _ Secon dContact : Date : Time : Action: _ Final Contact : Date : Time : Action : Final Action : Transmi t t o EP A D Othe r Action : D

Comment : Owne r Commen t (s) : Site f^VOvN^ r

fi.dveM JV^il W\teMwKCS j Coordinato r Commen t (s) :ADDITIO NNO . oOOO O CIT Y LOT S LEGA L DE3CR 1 1 3 3 1 i/ 6 T T LT- S 5 i 3 S 7 rzon LO T 6 HAL F SEC T TOWl ^ LEGAl 2 . 3 1 1/ 6 X 132 . 4 6 8 BLOC K 26 1 I^S E PLA T Li 11 7 3CRIPTI0N '

EFl-ADF B EF5-PNF B PF6-EAF B

PAR C 332 9 OCO O 1 1 F B 2 4 STATU S 2 CLAS S R EXEMP T 0 EXEMP T TYP E TA X DISTRIC T 010 0 SI D F - PRO P HOUS E HAL F DI R STREE T NAM E TYP E SUFFI X AP T ARE ASI P COD E ADDRES S G123 3 3 Cl l S T C» a 6810 8 OWNE R INFORMATIO N NAM E KEN??ET H Q*MILLERETA LDAT E O FLAS T CHANG E 03-08-200 6 + 140 0 FRitNKLI N AV E #14 0 BK/P GO RDOC #1368/56 4 ADD RHC*E3TEA D DELET E CIT Y cour;ci L BLUFF S S T l A ZI P 515C S NO N N^UlvIERI C SI P COD E CURREN T VALU E HOMESTEA D \"EA R DAT E LAT©- - IMPR- - --T'JTAL- - PAR RS NNUMBE R T I C D PC T \,7iLU E 199 9 05-21-199 9 410 0 0 410 0 SE E

ADDITIO NNO . 12 7 4 0 LO T 2 HAL F BLOC K 1 HAL F FORES T HIL L 3EC T TOW NRANG E PLA T 011 7 nT''5t'*^~'T"D "

## Consen t Fo rAcces s To Propert y RjGH T O FENTR Y T O PREVOSF S 

### Granto r (th e property owner ) consent s t o andauthorize s th e Unite dState s Environmenta l Protectio n Agenc y (EPA ) o r it s authorize drepresentatives , collectivel y th e Grantee , t o ente r an dperfor mcertai n environmenta l respons e activitie s upo n th e followin g describe d premises ;

Owner' s Name : Daytim e Phone : 

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- ry , M'.lU r Address : ^2.3 3 

# s w s>- v ^wsaL a k J Address : Addresse s o f Propertie s covere d b y Address : thi s Agreement : Address : Address : 

# ] Pimpt^S F(^ FRFSP<:)NS F.ACTIVITIE S 

### Th e EP.- \i s requestin g acces s t o collec t soil sample s an dremov e soil tha t contain s elevate dconcentration s of arseni c and'o r leadan dma y pos e ahealt hhazardTh e soil wil l b e remove dandth e excavate darea(s ) wil l b e replace dwit hclean material s and restore dThi s wor k

i s bein g performe dunde r th e Omah aLeadSit e Superfun dSite remediatio n program . A

n EP A representativ e will contac t th e Granto r in-perso n t o discus s th e wor k

to b e performed , th e Granto r will hav e a n opportunity t o review an dapprov e th e planne dsoi ! removal , andrestoratio n wor k

befor e it begin s Onc e th e wor k

i s finished, th e Granto r wil l b e aske dt o revie w th e wor k

an dconfir mtha t i

t i s complet e andmeet s wit hth e Grantor' s approval Upon completion , th e Granto r will receiv e writte n documentatio n fromEP A that th e propert>- ha s bee n remediate d ENVtRONNlENTA LRESPONS E ACTION S 

### B y signin g thi s Acces s Agreement , th e Granto r i s grantin g th e EPA , it s employees , contractor s an dsubcontractor s th e right t o enter th e property , a t all reasonabl e time s and wit hprio r notice , for th e sol e purpos e o f performin g th e wor k

Thi s acces s shal l remai n in effec t unti l th e wor k

ha s bee n satisfactoril y complete dTh e Granto r als o agree s t o

ttProperty ID » 

### Pae e 1 of 2•<' / y



### •Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; • Remov e flower bulb s o r plant s that th e Granto r o r th e Grantor' s tenan t ma y wis h t o save ; •Wate r an dmaintai n replacemen t vegetation , includin g fertilize r application , a s necessary subsequen t t o a n initial watering perio db y EPA , •Abid e b y healt han dsafet y guidanc e provide db y EPA ; •I f th e property i s rented , assis t EP A i n obtainin g tenan t approva l for acces s t o th e property t o perfor mth e work i f EP A i s unabl e t o obtai n suc haccess ; an d •Allo w videotapin g and/o r photograph y o f th e property includin g exterio r and interio r area s o f buildings . AGREEMEN T NO T T O INTERFER E 

### Th e Granto r agree s no t t o interfer e o r tampe r wit hany o f th e activitie s o r wor k

done , o r th e equipmen t use dt o performth e activities , o r t o undertak e any action s regardin g th e us e o f sai dpropert y whic hwoul dten dt o endange r th e healt ho r welfar e o f th e Grantee s o r

th e environment , o r t o allo w other s t o us e th e property i n suc hamanner . Shoul dyo u hav e an y question s abou t thi s program , pleas e contac t

H * gran t acces s t o my propertie sH H I d o no t gran t acces s t o my propertie s 

# AI "ft /^ ^ ^^2^.Ar»JiS-^> ^ Signatur e ^ ^ Dat eSignatur e • T Dat e
[~1 1 woul dlik e t o b e presen t durin g any samplin g tha t i s required .
Pag e 2 o f 2 «Propert y ID »

# m Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s l o pro \id e amutua l agreemen t a s l o condition s o f propert> prio r l o remediatio n activities . Thi s wil l als o sen e a s decontaminatio n fo r th e purpos e o f assurin g that restoratio n activitie s are complete dt o the satisfactio n o f th e property owne r an dth e Unite dState s En \ironmental Protectio n Agenc y (EPA) .

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### lY M 1 i e r Phone : /^j^ ^ _.^q ^ - - H^[ K O n th e attache ddiagram(s ) indicate arca(s ) t o c\ca\atc danddept ho f e\ca\ation , locatio n o f al l known utilities , subsurfac e feanjres . surfac e structure s andlandscapin g features , acces s location(s ) l o b e usedb \ contractor , an dthe directio n of North . Indicat e distances , depths , material t > pes . et c Indicate digita l photo s b \referencin g th e photo-lo g number wit ha n arrow indicatin g directio n o f ^ ic w 

### Item s T o B e Remove d B yOwne rBefor e Star t O f Remediation : (Us e addrtiona l sheet s a s necessary )
Item : 

## Kldfw- ^ Item : item : Item : Item : Item : Item : Item : Pag e 1 of t pItem 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 as necessary )

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Pre iMlcting property are a tha t i s coveredwit hgrass .

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Numbe r o f tree s <= 2 inch trunk diamete r

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### QZc h Xhec k th e bo xi f Owne rdoe s not wan t CE G t o documen t interio rfoundatio n wall s an d possibl e pre-existin g damage . Bycheckin 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 .

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## 1 i i Legen d Nort h Arro w Omah a Lea d Sit e 1 ji.v 3 concret e Omatia , Nebrask a 1 y ^ ExcavatedAre a Propert yNumbe r1 OLS-2076 7 ri j Existin g Structur e •

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# k- PROPERT Y CLEARANC E WORKSHEE T

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g Coasta l Environmenta l Grou p Inc . >7~*^^ ^

www.coastalhazmat.co m ^•"-puay ^ COASTA L ENVIRONMENTA L C KO U P , ( N C . 

## EXECUTIV E SUMMARY : 20767—123 3 SOUT H 1 1 S T N o Issue s o r Concern s | ^ Issues/Concern s Detai l Explanation :

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e
Tota l Quadran t Squar e Footag e t o b e Excavate d '315 0 Propert yClassificatio n 80 0 Tota l DnpZon e Linea rFootag e to tj e Excavate d = 0

Legen d Q|_S# : 2076 7 Dat e Excavated : 6/7/0 7 Pat e USHPA'Si^ni^ d Off : 7/10/0 7 I ^ Ex-shn g S'ructui e Scal e • — • — • Fenc e 1 Inc h " 2 0 (eet o r1 gri d » 5 x5 ft Pennanen t Landscapin g

—— —Quadran t Boundar y Pos t Excavatio n Concentration s (ppm ) Stree t Boundar y F l B 2 Pla yAre a 

# "A ) I HC5 L F 2 D Z Easemen t Q ) 7ntlStmt o 8 1 Garde n Othe r OeKTiptta n o f poa t evc«vaao n are M F l fron t yard left-Mfit f quadran t F2 . front yar d rigntJwn d quadran t B 1 badtyan j laR-han d quadran t B2 . badcyar d nght-han d quadran t O Z laipzan a [l-Stootareaotsc^arounddw^ourdabonorth a houaa ) 

### Legen d Are a no t Excavate d Dripzon e Excavate d Quadrant s Excavate d Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .

## Propert yCompletio n Agreemen t Tlii s agreemen t document s th e completio n of remedia l activitie s performe d on my property . My signatur e wil l designat e tha t1 amsatisfie dwit hth e restoratio n of my property , andthat no item s are in questions , now , or at any tim e in th e future , excep t thos e item s liste dbelow , if any . Propert y ID : 

# ^7(7 1 Property Address : ^^Zj ^ <^ /1^ ^ S P Owner : 

# 17-tnntH i PiPl< ^ Phone : 

# 5 ^ 5-^^7 6 Restoratio n Item s in Question : II Item : Y\? ) vkvM^s 

### 'V v Q.^^os^ ' &l^ ^ 1 Item :

Item : Item : Item : Item : Additiona l Comment s t o Vn<5/u,k/v . >c? ^ NCU-S ,

(^^^JT Lagre e restoratio n is completed , except as noted I 1 do no t agre e restoratio n is completed 

### ,S...'L
- I-' ) Ll > Owner' s Si;>na)tur c Dat e Contractor' s Signatur e )ate' ^ I

# aEPA• EP A Propert y Clos e Ou t For m Propert y # : yOlb' ^ Propert y Address ; l^3? > Sj/'fPf - Date/Time : Owner' s Name : ^- ^ 11/177/ ] 1^11/ 7 y Quad s Excavated : Contracto rGrou p Excavatio n General Ye s N o 1 . If necessary , wer e th e correct quadrant(s ) excavatedan drestored ? y 2 . I f necessary , wer e th e correct areas of dri p zon e excavatedan drestored ? 

### x y Gradin g So dan dVecetatio n Ye s N o 1 .

Doe s the gradm g aroundthe perimete r o

f the hous e i n excavatedarea s generall y slope awa y i . y fromthe house ? 2 .Ha s sodbee n lai di n all area s tha t wer e excavated ? \y ^ 3 .

Doe s the so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspected a t a3 0 u/ " da

y tim e period ) 4 .

Ar e sodde darea s generally fir man devenl y graded ? l y 5 .

Ar e th e joint s between the sodstrip s generall y tight ? (Onl y evaluat e if inspecteda t a3 0 da y • ^ tim e period ) 6 .

Wa s th e propert y grade dsuc htha t wate r wil l no t pool o n the property ? m ^ 7 .

Wa s damag e t o landscaping o r plan t material s avoided ? ^ ^ Gates , Fence s andRetainin s Wall s Yes N o 1 .

D o gate s ope n an dclos e freely? (I f applicable ) ^ ^ 2 .Were al l gate s o r fence s take n dow n during restoration activitie s reinstalled ? (If applicable) 

### y 3 .

Wa s damag e t o gate s o r fence s avoided ? (If applicable ) y 4 .

Was damag e t o retainin g wall s avoided ? (If applicable ) *; > Foundation , Sidin x an dGutter s Yes N o 1 .Wa s damag e t o th e sidin g o r tri mavoided ? ^ ^ 2 .

Wa s damag e to the foundatio n avoided ? ^ ^ ^ ^ 3 .

Was damag e to window s avoided ? 4 .Was damag e to window s o r doo r screen s avoided ? 

# u* 5 .Was damag e to downspout s o r downspou t extension s avoided ? 

# n Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Wa s damag e to drivewa y surface s avoided ? y 2 . Wa s damag e to walkwa y surface s avoided ? 

### y

### Owner s comments :

Inspectio n notes :

Remova l an drestoration activate s complet e including the 30-da y so dwarranty : EP A Representatjve^T^^kz^JcC^^^^^'^^lg ^ Date : Tyyy/C ) 7