## TRANSMITTA Lof OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAI D # : 

# \^^M V Date : 

# ^ r vi ^ Address : >^ll ( l^CNf H ^ < Remediatio nContractor : Coasta l Environmenta l Group _ Year : 200 J SOI LREMEDIATIO N PROPERT Y nLEFOLDE RDOCUMENT S Vide o o f property (DVD ) Executiv e Siunmar y EPA-provide dproperty sketch / 

### SignedAcces s Agreement fo r subject property SignedAcces s Agreement(s ) fo r adjacen t propert y / 

### Restoratio nAgreement Settlement document s (i.e. , fo r damag e o r to replac e plants , etc. ) Confinnatio ndata Photograph s ^)C(^MV ^ X % t h^cC^fC^ n As-built sketch Satisfactor y restoratio nsigne db y Propert y Owner IB ' 

### Propert y close-out check lis t signedby EP A Descriptio no f area s no t meetin g RO D cleanup criteri a 

# V . Utilit y clearance s PropertyjirfSfn^tio nfro mDougla s Count y Assessor' s Office

# ^ m 

# U

Propert y Acces s Checklis t Property ID : j (^9jj ^ JD ^ PropertyAddress:-^;^;g^j^,j.|p;^ . <| ^ n D

WOB K STARTE D WORKCOMPELTE D ON : ON : / / / / O^vncr : 

## Mr\y^QriP . CQrmm A Address :
Plione: Fax : 

# ?M\'VM\ p CelMPnge n Rente r Phone : Fax : Cell/Page n Additional Information :

D NotificationLette r fj ^ Acces s Agreement ^ Restoratio nAgreemen t D Topsoil Samplin g (if applicable ) D Disposa l Samplmg (if applicable ) D Garde nSamplin g (if applicable ) j ^Utilit y Clearanc e ]3C . Video/Photo s (Before ) D Video/Pboto s (Dnring ) D Video/Photo s (After) nVideo/Photo s (30-Day ) D Property Completio nAgreemoi t nFinal Report Sent : / / 

### Signed : ^/3D/Q9 . 

### Signed : ^/fiD/CEl / / / / / / 

## cMt&.lQ_ i ±_iC 9 On:^i3D.( M On : I I On : / / On : / / Signed : / / Issued : / / By : By : By : By : By : By : 

# By : mjslrP i By : By : By : By : By : By : 

# 1 Ai r Monitorin e (a s apDlicabie] O Communit y Q Cre w Results : On : / / 

### By : J D Communit y Results : Q Cre w On : / / By : j D Communit y Results : Q Cro w On ; / / 

### By : J

Omah a Lea d SK e• • 

## Dougla s Count y Accoun t ^|£ana^o n Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R122008000 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 - VlO 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 CORCORA N MARJORI E ETA L 332 8 HICKOR YS T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 200 8 000 0 1 2 Accoun t Type : Residentia l Parce l Number : 122008000 0 Parce l Address : 332 8 HICKOR YS T OMAH AN E 68105-000 0 Lega l Description : GRIFFI N & SMITH S AD D LO T8 BLOC K0 W 5 4 1/ 2 FTS 1/ 2 SU B 2 O F 54. 5 X 13 2 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $ 6,800.0 0 $ 154,600.0 0 $ 161,400.0 0 200 8 $ 6,800.0 0 $ 154,600.0 0 $ 161,400.0 0 200 7 $ 6,800.0 0 $ 154,600.0 0 $ 161,400.0 0 200 6 $ 6,800.0 0 $ 126,200.0 0 $ 133,000.0 0 200 5 $ 6,800.0 0 $ 126,200.0 0 $ 133,000.0 0 200 4 $ 6,800.0 0 $ 126,200.0 0 $ 133,000.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 6 7260. 0 1. 0 132. 0 55. 0 N o Improvemen t Informatio n Buildin g 1



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accoimtno=R12.. . 9/30/2009• • 

### Dougla s County Accoun t I

n tJ|u*n|g^o n 

### Pag e 2 of 2

4^0 ^ 1 ^ 

### H ' " ! " «540«q.ft ­ '0 1 r»«Ftco t •H I l i e TW O STOR Y 

## J Bsirr t aioc * 8 r t 77S0S.F . i,',main.i.tj.i.iiM».t.-w»iii.'U'jrjM.Hi3aaa CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1681. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Goo d Uni t Type : Condition : Goo d

Buil t As : 2 Stor y 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 : 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Gambre l Stories : 2. 0 Floorcover : i Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 192 6 0 0 % 192 6 8 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 f t 775. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 480. 0 Porc h Ope n Sla b 214. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno= R12.. . 9/30/200 9• • • • 

## CONTACT FOR M Propert y I D # 

# /f^ f Propert y Address : 

# 53ullAcLtfS 7 Initial Contact : Date : t// f Time : f^S l Actio n ^ _ Secon dContact : Date : ^ ^ ^ Time : /'^/ y Action : 5^> ^ tt///' a Final Contact : Date : Time : Action : Final Action : Transmi t to EP A D Other Action : D 

# JAA \Mr^¥'//Jo .AA^SurC y

Comment : Owner Comment (s) : Site Coordinato r Comment (s) :

### Pag e 1 of 2 ^
Creat e Anothe rTiclce t 

### | i :-::?JpypJr!l l Interne t J SendEmaj l ]



### • YOU RTICKE T NUMBE RI S 2376746 . Origina l Cal l Date : 10/01/0 9 Time : 7:5 8 a m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 10/05/0 9 Time : 8:3 0 a m State : N E County : DOUGLA S Place : OMAH A Address : 332 8 Street : HICKOR Y S T Twp : 15 NRng : 13 E Sect-Qtr : 28-NW 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 : FAX 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 S MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F



### Servic e Area Contac t Phon e Numbe r Utilit y Typ e Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 LEVEL S LEVEL 3 COMMUNICATIONS , LL C 

### N A Alt : Emerg : 877366834 4 Day : 402504782 3 MUD0 2 METROPOLITA NUTILITIE 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. . . 10/1/200 9

### Pag e 2 of 2 ^ 

### 0PPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T N A Day : 406728934 3

Alt : 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/ 1 /200 9OLS# : 1934 8 ( ^ 

# As-Buil t Drawing ^ Dat e Excavated : 10/9/0 9 Dat e USEP ASigne d Off:12/1/0 9 COASTA L Are a Sodden : 306 0 s o f t 

# Omah aLea dSuperfun dSit e

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# .= 3 INSITU S W/ EPA^ss a GZ 3 = 28 3 PP M @ 1 " r



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Legen d Dri p Zon e Excavate d Concret e Quadrant s Excavate d Are areplace dwit h Are areplace dwit h So d Rock/Mulc h Are alef t bar e Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .

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## Consen t fc F Acces s T o PropeFt 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 rits 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 :

• n X



### Owner' s Name : 

# Ml^PJ^l^ UOYi&lo^ A Daytime Phone : '^^\^lA[ / ^^ '

Addres s o f Propert y covere d b ythi s Agreement : 

# '^7^ ^Vhc^^^ l^ < 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 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 . Arepresentativ e o f Coasta l Environmenta l Group , contracte d b yUSEPA , vinl 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 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 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 at 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 rais o agree s to :
Pag e 1 o f 2.<^"'"*^t . COASTA L 

### v ^ tNVmONHtKTA l



## < ^

« 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 ; e 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 byEPA ; « Abid e b yhealt h an d safetyguidanc e provide d byEPA ; « I f th e propertyi s rented , assis t EPAi n obtainin g tenan t approva l fo racces s t o th e propertyt o perfor m th e work . « t Allo wvideotapin g and/o rphotographin g o f th e property . AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s not t o Interfere 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 propertywhic 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 propertyi n suc h a manner . Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contact Coasta l Environmenta l Group , a t (402 ) 991-119 9 0 I gran t acces s t o m yproperties D I do not grant acces s to m ypropertie s



# . ,:.r ? (LM.^i 7 0 9 Signatur e Dat e Q I wouic i lik e t o b e presen t tiurin g an ysamplin g tha t i s required .

Pag e 2 o f 2COASTA I 

### Restofcdtso n Agreemen t Th e purpos e ofthi s agreemen t i s t o provid e amutua l agreemen t a s t o condition s ofth e propert y prio r t o remediatio nactivities . Thi s wil l als o serv e a s documentatio nfbr th e purpos e o f assurin g tiu t restoratio n activitie s ar e complete dt o th e satisfectio no f th e propert y owne r an dth e Um'te dState s Environmenta l Protectio nAgenc y (EPA) . 

# Td W Propert y Address : 

# 552.f t HfCHonji a I Owoe n 

### Mnif^Or\g . C.nYCJnrti/ \ Phone : 3^\,^0^7XX \ O nth e attache ddiagiam(s ) indicat e area(s ) t o excavate , surfac e structure s an dlandscapin g feature s an d acces s locationCs ) t o b e use db y th e contractors . Indicat e distances , depths , materia l types , etc . Photographicall y an dVideographicall y documen t th e existin g condition s ofth e propert y an dth e Insemen t i f necessary . 

### Item s t o b e Remove d b yth e Owne rbefor e Start o f Remediation : Th e lenoval . storaqe , disposal , and/o rretur n o f thes e item s I s th e Owner' s responsibility . Hem : 

## 1 n u n c^ > Kem : ^ — ttem: ^ ^ - ^ Item : ^^,^^ ^



### item s t o b e Remove d b y th e Contracto r Durin g Remediatio n an d No t Repiace d Item : 

# V'ou ^ e-v \ 

# U J ^ ' — " ^,,-'­ ^ Item :

__ ^ ^ ^ ^ ttMTi: ^^^-^ ^ Kem : - ^ ^ Pag e I o f ^COASTA L C k

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# ^^' 7 1^ 1 y H ^ V T ttem: 

# j \J\^ t ho ^ 

# ^ ^ ^ \^ |
Lands(»ip e Inventor y Item Pre-existin g propert y area , tha t wil l b e excavated , tha t i s covere dwit hgrass . Numbe r o f tree s > 2 inc h tnm k diamete r Numbe r o f tree s < = 2 inc h tnm k diamete r Numtw r o f Sprinkle r Zones . Contro l Valves , Timers , Heads , et c All.ith!i sketc ho l ills ' sprinklc i t;!v'.>u i Numbe r o f an dsiz e o f area . AiMili ; t skoicl i o l rdiiiivi. ' MZi- s nn dloc;iiii>ii s Agree dupo nvalu e o f plan t material s no t t o b e teplace db v contractor . Voi r II>' ' Miiti c «il l n i csri ' 10 li'.u i . 1 |i)Hni \niii.;ii' r 1( 1 lli e |;ro()fil > i>

« ner . Easemen t Area , t o b e excavate d 

## Quantity



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# \ ^ U \K'(th4^^e ^ Pag e 2 -" ^COASTA L

! Additiona l Comment s / Instnictkms : I \

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 , tndudirt g foundatio n crack s o rfissures .

P^ I agre e O I d o no t agre e

Cohtractor' s Signatar e Dat e Pag e 3 of .

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## fnCMl^ ^ 9\nn\» ^ Cfmp S

## i^SL \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 IJ^^^ ^

° Coasta l Environmenta l Grou p Inc . v l V~*^ ^

www.coastalhazmat.co m ^PHO^" ^ COASTA L C lO V p . IN C 

# EXECUTIV ESUMMARY : BVID #19348-(332 8 HICKOR Y ST )

~x \No Issue s o r Concern s | ^ Issues/Concern s Detail Explanation : -COASTA LTO CLEA NU PTH EMUDD Y DRIVEWAY . (COMPLETE D 11/7/09 ) -COASTA LREPAIRE D TH ECONCRET ECRACK S O NTH EDRIVEWAY . (COMPLETE D 4/15/10 )

# m KtfiL a 

## EP A Propert y Clos e Ou t For m PropertyAddre,3r^>^? ^ fi HH^KD ^ j.^
- Propert y ff; i'^gS^ft , Date/Tim e Quad s Excavated : Yy ^ Y^ l D ^ Contracto r Grou p T CH'^r n^ qrCiJ p • Ye s N o Excavatlo aGeacral 1 .i r necessaiy , wer e th e correct quadrant(s ) excavatedan drestored ? i 7 2 .If necessary , wer e th e correct area s o r dri p zon e excavaiedaodrestored ? Ye s N o GradlD g So daa dVenetatlo B 1 .Doe s Ih e gmding aroundth e perimete r ofth e hous e inexcavaiedarea s generall y slop e awa y fromtb e house ? 

# l y 2 .Ha s sodbee nW db i all area s tha t wer e excavated ? 

# y ^ J .Doe s Ih e so dappea r t

o b e generally health y an dgrowing ? (Only evaluat e if inspecteda t a3 0 

# 7 day tim e period) __ ^ 4 .Al t sodde darea s generally firman devenl y graded ? 

# 17 5 .Ar e th e Joints betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i

f inspecteda t a3 0 da y 

# K tim e period) 6 . Wa s the propert y gradedsuc htha t wate r wil l no t pool o nth e prnpeny' ' 

### ly ' 7 .

Wa s damtg e t o landscaping or plan t material s avoided ? 

### Lx ' Gates , Fence s andRetatala g Wall s Ye s N o I 1 . O o gate s ope nan dcloiie freely? (Ifapplicable ) 

### U ^ 2 . Were al l gate s o r fence s take ndow nduring restoralionactivilie s reinstalled ? (I f applicable) 

# \y ' 3 .

Wa s damag e t o gale s o r fence s avoided ? (Ifapplicable ) 

# \ y 4 .Wa s damag e t o retaming wall s avoided ? (Ifapplicable ) 

# 7 Foundation , Sidiag an dGatler s Ve s JN o \ . Wa s damag e t o th e siding o r trimavoided ? 2 .Wa s damag e t o the foundationavoided ? Wa s damag e to window s avoided ? 4 Wa s damage to window s o r doo r screen s avoided ? 5 Wa s damag e t e downspout s o r downspou t extension s avoided ? 

# y - Sidewalk s an d Driveway s (Coacrete ) Yes N o 1 .Wa s damag e to drivewa y surface s avoided ? 

# 1 \ 2 .Wa i damag e l o walkwa y surface s avoided ? 

# p '

# mfH. Ort'oer s comments :

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