## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID^ : SX^TLDate : ^H/d S 

## Address : 37 ^ A I 3 0 S ^ Remediatio nContractor : Coasta l Environmenta l Group

_Year : 200 7 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S ST

f Vide o o f propeit y (DVD ) 

## \MExecutiv e Summar y WEPA-providedpropert y sketch M SignedAcces s Agreemen t fo r

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

adjacen t propert y M Restoratio nAgreemen t D Settlemen t documents (i.e. , fo r

damage o r

to replac e plants , etc. ) i ZConfirmatioii^lat a i 7 Photograph s t /

As-built sketch y Satisfactor y restoratio nsignedb y Propert y Owne r 5 / Propert y close-out chec k

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## Fina l Repor t Propert y Chec k Lis t (pieasc plac e wit heac hnie ) ^ ^ Har dCop y Informatio n7^7C7~ ^ 1 . Propert y Chec k Lis t ] 2 . Sit e Workin g Drawin g Map [

, 1 FiP A original s ManI 4 . Dougla s Count y Asscs.sor' s Map j l 5 . i'roport y Contac t She d| Aijrecmen f 1 . Acces s Agreemen t 2 . Restoratio nAgreemen t IVIiiscellancou s Document s 1 . Fina l Ma p fro mth e Meld 2 . Chang e Order s 3 . XR FDat a 4 . An y email s o r P O eorrespondenee s Propert y Completio n 1 . Executiv e Summar y 2 . A S BUIL T 3 . Propeit y Completio nAgreemen t 4 . An y buyou t inf o o r reimbursemen t mi o 5 . Chec k o r mone y orde r copie s 6 . EP A Propert y Clos e Ou t Form 7 . Attache dBegi nVide o Electroni c Documentatio n Drawing. s 1 . EP A origina l 2 . Workin g Drawin g 3 . A S Built.vs o 4 . A S Built.jp g Photo. s Begi nPhoto s During/Excavatio nPhoto s So di'hoto s 30-Da y So dPholo s Scanne dDocument s Fina l Document s Executiv e Summar y Viideo s Begi nVide o M y Movi e 2

## Propert yAcces s Checklis t PropertylD : ^^^^^; ^ nWOR K STARTE D ON : / / 1 Propert y A.l(lre.s,s : J 5 . ^< ^ ^ f ^ ^ ^ nWOR K COMPELTE D ON : / / Owner : jN^^( ^ jj]77^^. 5 Renter : Address : Phone : 

# 37(^ \ Fax : Cell/Paser : 

# / ^ 7z777 / Additiona l Information ; 

# .^^„_@S-i^i^./3_^ir _ Fax : Cell/Paaer : Q r Notificatio nLette r Sent:_^/^/ ^ 

## ^y (^Les s up Acces s A<»reenien t 

## Signed: ^/Jf/^l5r «>•• = /^i'L^ X "n T Restoratio nAgreemen t Signed : 4-/<^/ ^ 

## "">'• • Oh/2y < 1 1 1 Top.soil Samplin " (i f ap|)licable ) / / By : nDispo.sa l Samplin " (i f a|)plicahle ) / / By : 0 Garde nSamplin g (i f applicable ) / / By : i'70fe>t:-c > ; @ Utility Clearanc e Called : t« ^ IX 1 qJ , ^ Video/Photo s (Before ) 

## On:5_/^/d^ ^ ^ y l4^yr4i^c ^ nVideo/Photo s (During ) On : / / By : D Vide<»/Photo s (After ) On : / / By : nVideo/Photo s (30-Day ) On : / / 

## By : 1 0 Propert y Completio nAgreemen t Signed : / / By : nFina l Repor t Issued : / / By : Ai r IVIonitorin g (a s a|)plical)l e 1 1 Communit y C U Cre n ) Results : On : / / 

## By : 1 | | 1 1 Communit y Results : E H Cre> y On : / / 

## By : 1 1 1 Communit y Results : C H Cre w On : / / By :

Omah a Lea d Sit e

## 3236 2 Exterio rPain t Nort h Arrow 

### Omah a Lea d Sit e Owne rName : CHARLE S LEVERETT E • Goo d 

### Sit e Sketc h Address : 370 9 N 3 0 S T • Poo r [ J Not pain t

OmahaLea dSite 4613 0Omah a Lea d Sit e Owne rName : CHARLE S LEVERETTE Sit e Sketc h Address : 3709 N 3 0 S T Phone : JH.-^5li^5"V^ _ W : Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B RYASCPXA-3236 2 F 1 ___7^pp m 

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### Dougla s County Accoun t Informatio n Pag e 1 o f 1 iton r Dougla s County , Nebrask a Propert yRecor d - R182955000 0 Prin t Repor t Informatio n i s vali d a s o f 2007-8-2 4 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 1 Owne r WATER S DALLA S J 

# .4Si^ ^ 370 1 N 3 0 S T OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : 295 5 000 0 1 8 Accoun t Type : Multipl e Com m Parce l Number : 182955000 0 Parce l Address : 370 9 N 3 0 S T OMAH AN E 68111-000 0 Lega l Description : MYER S RICHARD S & TILDEN S AD D LO T7 BLOC K1 3 N 6 0 F TLT S 6 & Valu e Informatio n Lan d Improvemen t Tota l 200 7 $800.0 0 $0.0 0 $800.0 0 200 6 $800.0 0 $0.0 0 $800.0 0 200 5 $800.0 0 $0.0 0 $800.0 0 200 4 $0.0 0 $0.0 0 $0.0 0 200 3 $800.0 0 $0.0 0 $800.0 0 200 2 $0.0 0 $0.0 0 $0.0 0 Sale s Informatio n Sale s Date : 2007-04-2 1 Dee d Type : Q C Book : 200 7 Page : 04607 5 Price : $600.0 0 Grantor : Leverett e Charle s eta l Grantee : Water s Dalla s J Lan d Informatio n Acre s S F F F Unit s Dept h Widt h Vacan t 0.1 3 6000. 0 0. 0 1. 0 0. 0 0. 0 Ye s Lan dAttribute s Attribut e Attribut e Descriptio n Improvemen t Info r matio n 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R18. . . 9/27/200 7# 

## CONTAC T FOR M Property ID # 

# 7 ) ;^3l^3L Property Address : 

# 31o 9 ^ [ ^ 5 ^ Initial Contact : Date:^/^//l?-Time : Actio n 

# ion : /Iff y Secon dContact : Date : Time : Action : Final Contact : Date : Time : Actio n Fina l Action : Transmi t to EP A D Othe r Action : D

Comment : Owne r ' Commen t (s) : Site Coordinato r Commen t (s) :

### /Vfi^^' o o ^^^Z ° V^'^Tp *

^•^Lno- y 

### Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc . www.coastalhazmat.co m COASTA L ENVIRONMENTA L GROUP , INC . 

# EXECUTIV ESUMMARY : 32362—370 9 N3 0 S T X 

# 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 3236 2

Concret e pa d i s broke n remov e i fpossible . B 1 b e

awar e propert yextend s abou t 10 ' fro m woode n fence . Bi g tre e di g around .

'"Htah a I ts L Dat e Excavated : 10/23/0 7 Dat e USEP ASigne d Off : 12/5/0 7 4nl"K i 

### Legen d Are ano t Excavate d Dripzon e Excavate d 

### Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Quadrant s Excavate d 

### Grou p Inc ,

### S3l t 

# EPA EPA Propert y Clos e Ou t For m Propert y # : 

# 3Z37^Z . Propert y Addres s 

# : snb' f X i 3 o S- ^ Date/Time : Owner' s Name : Quad s Excavated : Contracto r Grou p Excavatio nGenera l 1 .I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 2 .If necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? Gradln e So dan dVefictatio n 1 . Doe s th e gradin g aroun dth e perimete r ofth e house i nexcavate darea s generall y slop e awa y fromth e house ? 2 . Ha s so dbeenlai dinal l area s that were excavated ? 3 . Doe s th e so dappea 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 mandevenl y graded ? 5 . Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e if inspecte da t a3 0 da y tim e period ) 6 . Wa s th e propert y grade dsuc htha t wate r will not poo l o nth e property ? 7 . Wa s damag e t o landscapin g o r plan t material s avoided ? Gates , Fence s an d Retaininj ; Wall s 1 .

D o gate s ope n an d clos e freely? (I f applicable ) 2 .Wer e al l gates o rfence s take n dow n durin g restoratio n activitie s reinstalled ? (I f applicable ) 3 .Wa s damag e t o gate s o rfence s avoided ? (I f applicable ) 4 .Wa s damag e t o retainin g wall s avoided ? (I f applicable ) Foundation , Sidiof ( an d Gutter s 1 .

Wa s damag e t o th e sidin g o rtri m avoided ? 2 .Wa s damag e t o th e foundatio n avoided ? 3 .

Wa s damag e t o window s avoided ? 4 .Wa s damag e t o window s o rdoo rscreen s avoided ? 5 .

Wa s damag e t o downspout s o rdownspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) 1 .Wa s damag e to drivewa y surface s avoided ? Wa s damag e t o walkway surface s avoided ? Ye s No 

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## Inspectio nnotes :

Remova l an drestoratio nactivate s complet e includin g th e 30-da y so dwarranty : EPA Representati v^g^-7^^^^4^_^ ^ ^^^.NXZ ^ 

## Date : 772/jr7^ 7

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio no f remedia l activitie s performe do nmy property . M y signatur e wil l designat e tha t I a msatisfie dwithth e restoratio no f m y property , an dtha t n o item s ar e inquestions , now , o r at an y tim e inth e future , excep t thos e item s liste dbelow , ifany . Propert y ID : =i)^^^(^ ^ Propert y Addre.s.s : O^'^Q^ ] ^ p^W\ ' ^ Owner : J^^^^ ^ ^^^^- ^ 

### Phone : {HQ-^S^Q I

### - [O,/^ ^ Restoratio n Item s i n Question :

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

I "TTagre e restoratio nI s completed , except as noted I I d o no t agre e restoratio nis completed 

# izMo 7 Owner' s Signatur e Dat e Contractor' s Signatur e Dat e IOmah aLea dSit e 4613 0

# ^m PROI'ERT YCLEARANC E WORKSHEE T

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## F ) y- e Composit e Reading s (Bag ) 

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Pass/Fai l ? Analytica l La b Spil t Sen t Numbe r ?



### — Pass/Fai l ? Analytica l La b Spil t Sen t Numbe r

Pass/Fai l ? Analytica l La b Spil t Sen t Numbe r 7

Pass/Fai l ? Analytica l La b Spil t Sen t Numbe r 7 Analytica l Result s

Analytica l

Result s

Analytica l

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Analytica l

Result s

Analytica l

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ilS I AUD I I ItlHA l SU t I I \l l XR F Ipchnlrian' s Slqnltcir o H H n t I )1 • » .MK . * • ••'( •i, ; ./'Y' - -.'«i«(i.Hjit«'*Jr^'«W r 

# M COASTA L [NVIRONHENTA l C R O U f , IH C 

## Consen t Fo rAcces s T o Propert y RIGH TO F ENTR YT 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 : 'Tj^ ^ • 7 ^^ ^ Owner' s Name : 

# A-z^s J , bJ/^r^ ^ Daytim e Phone :

Addres s o f Propert y 

# 37<^ f 7 7 SO^ y covere d b ythi s Agreement : PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP Ai 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 . Arepresentativ 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 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 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 f2f 

### <	 # COASTA L ENVIRONMENTA L CROUP . INC .



### •Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; •Remov e flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t maywis h t o save ; •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 ; •Abid 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 . •Allo 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 yofth 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 (712 ) 352-018 8



## [0 ! I gran t acces s t o m ypropertie s D I d o no t gran t acces s t o m ypropertie s 

# %Z<^' a7 Signatu n Dat e Signatur e Dat e

d l

I woul d lik e t o b e presen t durin g an ysamplin g tha t i s required .COASTA L 

### Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o provid e a mutua l agreemen t as t o condition s ofth e propert yprio rt o remediatio n activities . Thi s wil l ais o serv e a s documentatio n fo rth e purpos e o f assurin g tha t restoratio n activitie s ar e complete d t o th e satisfactio n ofth e propert yowne ran d th e Unite d State s Environmenta l Protectio n .Agenc y(EP.A) .

Propert yID : J^Z'^6? ^ Propert vAddress : ^7^ ^

y{ J ^(^^ ( 

### 0>^ner : ^^^^^^^^ 5 UyATW^^ ^ Phone : 

# 3DQ ' y^6 ^ O nth e attache ddiagram(s ) indicate area(s ) to e\ca\ate dan ddept ho f e\ca \ation . locatio no f all kno\\ n utilities , subsurfac e features , surfac e structure s an dlandscapin g features , acces s location(s ) t o be usedb v contractor , an dthe directio no f North . Indicate distances , depths , materia l t>pes . etc . Indicai e digita l photo s b

v referencin g th e photo-lo g number wit ha narrow indicatin g directio no f \iew . 

### 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 ) ^*^''"sc —

"'spcS'! . s^^r* " "-*.'•'•" " r'^t^'c*£^ '*£-^ c' c'^ ^ 0''.'''t^' " ^ r3'^'"*'^S''^''!* \

. c, . - . c. Ite m 

# CAC S Item : 

# /A yS J 

# yf(y4i7 > t^od h T^IT^UA ^ Item : item : Item : Item : Item : Item : Pag e 1 o fCOASTA L 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 : 

# /Uoz^yz y Item : Item : Item : Item : Item : Item : Item : 

### Item : Item ; Item : Item : Item :

Pag e 2 o fCOASTA L Item s T o B e Remove d B yContracto rDurin q Remediatio n An d Replace d (Us e additiona l sheet s a s necessary ) Item : 

# ^^ h Item : 

# "S^a- K[ ^ Item : ^— _ 

# (-f ^ '^JG^y^O ^ Item : Item : Item : 

# y i Item : 1 1 Item : 

# 1 i Item : i Item :
: Item : 

# 1 1 Item : ! Item : 1 Item :

Pag e 3 o fCOASTA L 

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

### Ite m 

## Quantit y Uni t 

## Condition/Type/Specie s

Pre-exisiin g property area , tha t will b e excavated , tha t Square fee t i s co\ere dwit hurass .

Numbe r o f nee s trunk diainete r • 2 inch / Eac h

• Ni.;:ibie r ot ' iree s I trunk diai^ieier inch

Nuiiibc r ill ' sprinkle r .'Lvnci . Contro ! \'a!\'es . ! :n:e:-? . Heads , etc . Eac h

Numbe r o f an dsiz e o f eac hyardo nHowe r bed area . Eac h Sauar e Feet

Pag e 4 o fCOASTA L 

## Ite m Quantit y Uni t Condition/Type/Specie s .Agree dupo n\alu e o f plan t material s no t t o b e replace db v contractor . Not e ihi s \alu t «il ! b e use dt o !s<u e aplan t \ouche r u i rh e p!-(>per: > ooi'

i r.t'f . 

# 7 7 

# 7 7

7 s

Agree dupo nlis t o f plan t material s tha i wil l b e replace db y contractor . B e \er y specifi c an ddetailed . l:-,c!ud e :• ; ^kelcl l .••! ' •••..c;-. - i-:,c hplan t '.\il ! b e pl;.cr u .' • V .r. c •.vn:i^vu' ! 

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## 1 1 1 i -A.fe ao f C;t_ \o r Count y I propertNt o b e iar.dscape d I pe r thei r recMiremetiis .

Pag e 5 of

### r

COASTA L 

### Additiona l Comments / Instructions : » , /__

_

, / . ,,k_A , *? ^ s - o 

# /f^/ l T' O A/7^0l ^ y/M ^ // ^ /c/6« p r o 

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# - ^/!>^,yy y ^^^taz/rm ^ (^/^'^ ^

• 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 boxCE 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 .



### [ / l agre e E H I d o no t agre e 

# '/jd ^ "^-ty- o 7 O

w ner' s Signatur e Dat e Contractor' s Signatur e 

### Pag e 6 of .