## TRANSMITTA Lof OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID# : hq^ ^Date : ^ | t ^ [ f fi Address : i^l ^ ^ >3 ^ ^ f Remediatio nContractor : Coasta l Environmenta l Group

_Year : _200fi _ SOI LREMEDIATIO N PROPERT Y nLEFOLDE RDOCUMENT S (

/ Vide o o f property (DVD ) WExecutiv e Siunmar y UEPA-providedproperty sketch y SignedAcces s Agreement fo r subject property -P ' SignedAcces s Agreement(s ) fo r adjacen t propert y \ l Restoratio nAgreement ^ Settlement document s (i.e. , fo r damag e o r to replac e plants , etc. ) J ^ Confirmationdata

C / Photograph s V 1 ^ ^ V ^Ct^n^- ^ X f ^ S^^rtfl^t n 

# A As-built sketch 

# A Satisfactor y restoratio nsigne db y Propert y Owner 

# A Propert y close-out diec k lis t signedb y EP A Descriptio no f area s no t meetin g RO D cleanup criteri a Utilit y clearance s ^ 

### Propert y informatio nfro mDougla s Count y Assessor' s OfHc e 

# ^\U\L „ ate 30054834 Superfun d

# p

Propert y Acces s Checklis t Property ID : \'\4^^ 1 D WORKSTARTE D ON : / / D WOR K COMPELTED ON; . Property Address : 2-\ZL > S ^^ ^ -J—l— Rente r 

## ^'^''
- VouGOUr N^soyv^rc l Address : ^ Phone : Fax : Cell/Pager . Phone : 2J-i 6 6^ } Additional Lnformation :
- ^ ^ Fax : Ceil/Page r D NotificationLette r Sent : / / By : ^ T Acces s Agreemen t Slgncd:3/|>£/ ^ 

## ^y-0j3C^xe ^ S^Restomtio nAgreemen t 

### Siene6:3^imfJ2 S 

## By : (V}cert ^ D Topsoil Samplin g (I f applicable ) 

### 11 By : D Disposa l Sampihi g (if applicable ) 

### 11 By : D Garde nSamplin g (if applicable ) 

### 11 By : 0 ^ Utilit y Clearanc e Called : ^/^y^Q Q 

### By:C|/2^/0 9 Q f Video/Photo s (Before ) OK3_I2^ I ^ 

## ^y-^-r\\x^K}siar\€\ \ i ^ Video/Pboto s (Daring ) On : ^ / / By : D Videort'hoto s (After) On : / / By : D Video«»hoto « (30-Day ) On : / / By : Q^vPropert y Completio nAgreement Signed;/ !ifl^io' ^ By : ' D Final Report Issued :/ / By : Ai r Monitorfn e (a s amilicablel D Communit y QCrc w On : / / By : 

## i Results : D Communit y QCre w On : / / By : . ReSDhs : 0 Commnnit y QCrc w On : / / By : Results : Omah a Lea d Sit e

## CONTACT FOR M Propert y I D # Propert y Address : Initial Contact : Secon dContact : Fina l Contact : Fina l Action : 

# V^\C\i(\x d Comment : Owner Comment (s) : Site Coordinato r Comment (s) : 

# \^q^ ^ a-\2(. o S-3^?> ^ Date : Time : Action :

Date : Time : Action : Date : Time : Action : Transmi t t

o EP AD Other Action : D 

# ^^Z--\^X' ^ O ^ ^'^'b-U)\^ ^

## Dougla s Coimt y Accoun t Inforra||io n Pag e 1 of 2 >rra||i o Dougla s County , Nebrask a Propert yRecor d - R254061000 0 Prin t Repor t NE WFeatur e - Parte ! Dimension s availabl e @ scal e 0-5 0 f ) wes t o f52n d S t - VlOWO n Ma p Informatio n i s vali d a s o f2009-9-1 5 Treasurer' s Ta xRepor t Ne wFeatur e • * • ^ •< * Aut o Sale s Searct i Owne r VAUGH N RICHAR D J ETA L 212 6 S 3 3 S T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 

### 406 1 000 0 2 5 Accoun t Type : Residentia l Parce l Number : 254061000 0 Parce l Address : 212 6 S 3 3 S T OMAH AN E 68105-000 0 Lega l Description : WINDSO R PLAC E LO T1 4 BLOC K0 5 0 X 14 0 Valu e Informatio n Lan d Improvemen t Tota l 

### 200 9 $ 6,600.0 0 $148,800.0 0 $ 155,400.0 0 200 8 $ 6,600.0 0 $148,800.0 0 $ 155,400.0 0 200 7 $ 6,600.0 0 $148,800.0 0 $ 155,400.0 0 

### 200 6 $ 6,600.0 0 $119,800.0 0 $ 126,400.0 0 200 5 $ 6,600.0 0 $119,800.0 0 $ 126,400.0 0 200 4 $ 6,600.0 0 $119,800.0 0 $ 126,400.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 6 7000. 0 1. 0 140. 0 50. 0 N o Improvemen t Informatio n Buildin g 1



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R25.. . 9/17/2009

### Dougla s County Accoun t Infornjrtip n Pag e 2 of 2 rn|^ o y

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- CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1786. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Goo d

Buil t As : 2 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 7. 0 Exterior : Fram e Viny l Units : 1. 0 Interior : Drywal l Battis : 1. 5 Roo f Cover : Compositio n Shingl e Bedrooms : 4. 0

Roo fType : Gabl e Stories : 2. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinlde 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 191 8 0 0 % 191 8 9 1 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Unfinishe d Atti cW/floo r 985. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 985. 0 Fixtur e Additiona l Fixture s 1. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Fixtur e Bat h Hal f 1. 0 Garag e Detache d 720. 0 Porc h En d Scree n 210. 0



### http://dougIasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R25. . . 9/17/200 9Pag e 1 of 2

" > Creat e Anothe rTicke t Bac k t o Irt h Interne t Sen d Emai l
YOU RTICKE T NUMBE RI S 2372244 . Origina l Cal l Date : 9/24/0 9 Time : 4:5 7 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 9/28/0 9 Time : 5:3 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 212 6 Street : S 33R D S T Twp : 15 NRng : 13 E Sect-Qtr : 28-S W 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 : FA X AL L CLETUI 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 : yRear : 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 Are a Contac t Plion e Nunibe 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 LEVEL3 COMMUNICATIONS , LL C N A Alt : Emerg : 877366834 4 Day : 402504782 3 MUD0 2 METROPOLITA N UTILITIES DISTRIC T SAND Y Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y OFOMAHA-TRAFFIC.SEWE R RO NAlt : 402444516 1 Emerg : 402444516 0

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/24/200 9

## Pag e 2 of 2

0PPDGPR 6 OMAH APUBLI C POWE RDISTRIC T N A 

### Day : Alt : 406728934 3 406207149 4 Emerg : 888728934 3 QLNNEI FQWES T LOCALNETWOR K 

### N A 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3



## http://www.dhon.org/irthintemet/DHO>fNoticeCreation/MessageText.asp?ret=<RESULTS.. . 9/24/200 9OLS# : 1799 9 

# • As-Buil t Drawin g Dat e Excavated:10/7/0 9 Dat e USEP ASigne d Off : 12/1/0 9 COASTA L 

# Omah aLea dSuperfun dSit e ENVIRONMENTA L Are a Sodden : 174 6 s a f t G n O U r. IN C



### Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are a replace d wit h Are areplace dwit h Are a lef t bar e So d ' ' Rock/Mulc h 

### Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .

# ^Ii- y 

# SFgi.^ue ^
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## 5 T^AiyCAA/ ^ Omah a Lea d Sit e Date : P/AA/^ ^ Nort h Arro w ime : 

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^ ^ Phone : 4^Z , -A^fA l ~ TJz ^ Tea m 

## ;^!^Xg-.-<l^^^^^BVID # AA?? 9 XRFCod e '^oq Sampl e Numbe r Lead Concentratio n Confirmatio n Sampl e 2
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Tea m >ec<><gi:^^^f^^^BVID # Ay9f 9 XRFCod e I'Zol f Sampl e Numt>e r Lea d Concentratio n Confirmatio n Sampl e pp m / ^ Ye s D N o ^ \ pp m / 5 Ye s O N o 0 ^ 

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### N o •>*«'»t*lir :
COASTA l INVIRONHIItTA t 6 t O t l P IN C 

## Consen t fo t Acces 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 representetives , collectivel y th e Grantee , t o ente ran d perfon n certai n environmenta l respons e activitie s upo n th e followin g describe d premises : 

# hs^ q

Owner' s Name :



# \/no^ nPi'rii^rr J I ?^h-5^5 M Addres s o fPropert y covere d li 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 flea d an d ma ypos 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 wori t i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o fCoasta 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 wori c befor e i t begins . Onc e th e wori ci s finished , th e Granto rwil l b e aske d t o revie wth e wori c an d confin n tha t r 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 ai l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e o fperformin 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 :
Page l of 2

### ..^^'L*'"* ,
COASTA L 

## A tPtVtaOHMtltrA L *'•• < •ROI** ' « « O U » I I t c


### « Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; e Remov 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 ; < Wate ran d maintai n replacemen t vegetation , includin g fertilizerapplication , a s necessar ysubsequen t t o a n initia l waterin g perio d b yEPA ; cAbid e b yhealt h an d safet yguidanc e provide d b yEPA ; * I fth 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 perforn n th e woric . cAllo wvideotapin g and/o rphotographin g o fth e property . AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s no t t o interfer e o rtampe rwit h an yo fth e wor k activities , o rwit h an y o fth 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 fsai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o fth 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 i Group , a t (402 ) 991-119 9 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 

# K'

ignatur e yJ ^ AASignatur e Date
D I woul d lik e t o b e presen t durin g an ysampiin g tha t i s required .

F>age2of 2

# ^iC A HL h COASTAl . 

## Restofatso n Agreemen t Tii e puipos e o f thi s agreemen t i s t o provid e amutua J 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 tiia t restoratio n activitie s ar e complete dt o th e satisfactio no f th e propert y owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA) .

Propert y ID : I - ^ QQ ' Propert y Address : ^1,( ^ <^ . "^^^^ ^ 

# I o^" ^ \/(x^.^QvV^ ^ ^ 

## '^sCVAax' < Phone : 2-MD^qf ^ O nA e attache ddiagram(s ) indicat e ai«a(s } t o excavate , surfac e structure s an dlandscapiri g feature s an d acces s locatiQn(s ) t o I w use dli y th e contractus . Indicate distances , depths , materia l types , etc . Photograpliicall y an dVideographiedl y documen t th e existin g condition s ofth e propeit y an dth e l)asement i f necessary . 

### Item s t o b e Remove d b yth e Owne rbefbr e Start o f Remediation : Th e lemoval . storage , oi&posal , and/o rretur n o f thes e item s i s th e Owner' s responeibility . 

# %iv)aM pl/on- b ^Vp e ^r,^ M

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## Item s t o b e Remove db y th e Contracto r Durin g Remediatio nan dWo t Replace d Item : Item : Hem : Item :

Pag e l o f* )COASTA L 

### Item s t o B e Remove d B yContracto rDurin g Remediatio n ancf^Replac:ed _ I Item : 

# ^i L 

# ( M D ^

: Ram : 

# J^D J 

# 6 i P ^ Item : < 

### I Item : I 

## Landscap e Inventor y Ite m 

## Quantity Unit Condition/Type/Specie s Pre-existin g proper ^ area , Quadrant s tha t wil l b e excavated , tha t 

# <b y i s covere dwit hgrass . Numbe r o f tree s > 2 inc h Eac h • \ trun k diameto
Numbe r o f tree s < = 2 inc h Eac h \ trun k diamete r Numbe r o f Sprinkle r Zones . Contro l Valves , 

# pOCJO^Ail^a ^ Ead i 

# y Timers . Heads , et c Aiiac hnskeicl i o l iW vpr'rklc i linmi ; Numbe r o f an dsiz e o f eac hgarden / flowo
- be d Eac h area . Squar e Fee t 

# V AtUul i C l skclcl i 11 1 ri!;ilivi " <i/i' S nn dloc;iiii>n s Vs . material s no t t o b e replacedb v contractor . 

## t \CI f Ihi" ' \HIII C Mil l hi . usr C W l li'U K . 1 TIHR ! \oiicJU' r 1( > lh e |}ri.i|)cri\ o « ner . Easemen t Area , t o b e Eacf a 

# %r»djai A*^i2A'uLiirH 3 excavate d Pag e 2 - ^

### #

C O AS'» AL


### i Additiona l Comment s / Instructions : 

# i 4<V o \o'i U ^oj^'^^f\vXJ-& r %)/i^ ^



# L. / Q Chec k th e txu c if

Owne r (toe s no t wan t CE G to documen t intefio r foundatio nwall s an dpossibl e pre-existin g damage .By checddng thi s bo x CE G is no t responsibl e fo r an y damag e don e to th e interio r of house , bidudin g fburtdatio ncrack s or fissures .
O Ido no t agre e

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## 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 INVIIONHENTA L G I O U P . IN C 

# EXECUTIV ESUMMARY : BVID #17999-(212 6 S 3 3 ST ) No Issue s o r Concern s [ ^ Issues/Concern s Detail Explanation :

# EPA EPAPropert y Clos e Ou t For m Propert y Address:
- Propert y # : Yl^^^ . — — ^ ^ Datc/Tlroc : Owner' s Name: . .i^/y^ . Contracto r Grou p Quad s Excavated : Ye s N o Excavatio nGcHem l I . If necessatyi were th e correc t quadrant(s ) excavate dan drestored ? 2 , I f necessary , were th e correc t area s ofdri p zon e excavate dandrestored ? 

## L.- ^ Gradin g So dan dVegetatio n Ye s 1^ 0 1 . Doe s the gradin g aroun dth e perimeter ofth e hous e i nexcavate darea s generally slop e awa y 

# r r fromth e house ? 

# i7 " 2 . Ha s so dbee nlai dinal l area s tha t wer e excavated ? 3 . Doe s the so dappear t

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

# r^ ­ day time period )___^- _ 4 . Are soddedarea s generall y Fin nan devenl y graded ? 

# r ^ 5 . Ar e th e joint s l>etwee nth e so dstrip s generally tight ? (Only evaluate i f inspecteda t a3 0 da y 

# y ^ tim e period) 6 . Wa s the propert y grade dsuchtha t waie r wil l no t poo l o nth e property' ? 

# y 7 . Wa s damag e t o landscapin g o r plan t material s avoided ? 

# y Gates , Fence s an dRctaJnln g Wall s Ye s e s N . 

# y

(M l 1 . O o gate s ope nandclos e fieely ? (Ifappiicable ) 

# y 2 . Wer e all gate s or fence s talce ndow nduring restoratio nactivilie s reinstalled ? (irapplicable ) 3 . Wa s damage to gate s or fence s avoided ? (Ifappiicable ) 4 . Wa s damag e t o retainin g wall s avoided ? (Ifappiicable ) 

# "6 ^

Foundation , Sidia g an dGutter s Ye s N o 1 . Wa s damage to th e sidin g or trimavoided ? 

# y 2 . Wa s damag e t o th e foundationavo>ided ? 

# y Wa s damag e to window s avoided ? 

# y_ 4 Wa s damag e to window s o r doo r screen s avoided ? 

# y 5 . Wa s damag e to downspout s or downspoul extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 Wa s damage to driveway surface s avoided ? 

# r/ . 2 . Wa s damag e to walkwa y surface s avoided ? 

# z ^

## 'Ort'Dcr s comnients :

Inspectio nnotes :

Remova l an drestorationaclivale s complet e iiicluding th e 30-da y sodwarranty : EP ARepresentativ e 

# JAo ^ n/:liL y Date : /xj l f^JKl l

# L « (



## Propert yCompletio n Agreemen t riii s agreemen t document s th e completio n o fremedia l activitie s perioime d o n m yproperl yM ysignatur e wil l designat e tha t I a m satisfie d wit h th e restoratio n o fm yproperly , an d tha i n o item s ar e i n questions , now , o ra l an ylim e i n Ih e futui-e , excep t Ihos e ilem s liste d below , ifan y

Propert y ID : nqO{( ^ Propert yAddress : 2,\^.\ D t S ?>? ) S ^ O^nc : K\cVlO>y?XMaUC|\A. A 

### Phone : 2M0'F)Olff ^ Restoratio n item s i n Question :

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

I N 1 fl|>rccI'CsrorAlio n i t compleled , cxccp i a s note d [_ J I rio no t aure crtstorittia n i s compleler i 

# (7(ft/Af/4 A AY/^ ^

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# Cn^oA^^j'^ ^ iiliU ^ Owner' s Signatiii rAj Dat e ontiarloi' s Signatur e Dat e