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Address : _ ZyhAlt^SZLA A Reniediaiio n Conli;ictov : Coasta l Enxironmenta l Grou p Yeai : JOUIARR A 

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# 7

^ Sij^ne d Acces s Agreemen t fo rsubjec t propen y Signe d Acces s Agreement(s ) fo radjacen t properl y 

# 7 Restoralio n Agreemen t Setllemen l documenl s (i.e. , fo rdamag e o rt o replac e plants , elc. ) Confinnatio n dat a 

# 7 

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# 7 Satisfactor yrestoratio n signe d b yProperl yOwne r 

# 7 Propert yclose-ou l chec k lis t signe d b yEP A Descriptio n o farea s no t meetin g RO D cleanu p cnten a 

# 7 Utilit yclearance s 

# 7 Propen yinibfm^lio n fro m Dougla s Counl yAssessor' s Offic e 

# Z r Dat e 3023740 2 Superfun d; \ \ 

## PropertyAcces s Checklis t PropertylD : ^-^^t^u ^ Property Address : ,-^•3 . ^..rU>A>. ^ <j ^ D DWOR K STARTE D WOR K COMPELTE D ON : / /_ ON : __/__/
_ Owner : Address : Rente r Phone :
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n Notificatio n Lette r H Acces s Agreemen t ( ^ Restoratio nAgreemen t IITopsoil Samplin g (if applicable ) Q Disposa l Samplin g (i fapplicable ) Q Garde nSamplin g (if applicable ) Q ] Utilit y Clearanc e S Video/Photo s (Before ) D Video/Photo s (During ) D Video/Photo s (After) D Video/Photo s (30-Day ) L

D Propert y Completio nAgreemen t D Final Repor t Sent : / Signed : \ o / \V

A/ x.o Signed : v o / \ H / \ o / / / Called : u / "

b / i. o On : v j / yvA . /

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### Dougla s County Accoun t Infifcaatio n Pag e 1 of 2 

# l ^ a Dougla s County , Nebrask a Propert yRecor d - R200168000 0 Prin t Repor t Vie wInteractiv e GI S Ma o Informatio n i s vali d a s o f2010-8-3 0 Treasurer' s Ta xRepor t Ne wFeatur e -*-»- » Subdivisio n Sale s Searc h Owne r PHILLIP S J R FORRES T 263 6 BURDETT E S T OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : 016 8 000 0 2 0 Accoun t Type : Residentia l Parce l Number : 200168000 0 Parce l Address : 263 2 BURDETT E ST OMAH AN E 68111-OOO O Lega l Description : PATRICK S 2N D AD D LOT1 1 BLOC K9 5 0 X 12 0 Valu e Informatio n Lan d improvemen t 7ofa / 201 0 $500.0 0 $0.0 0 $500.0 0 200 9 $500.0 0 $0.0 0 $500.0 0 200 8 $500.0 0 $0.0 0 $500.0 0 200 7 $500.0 0 $0.0 0 $500.0 0 200 6 $500.0 0 $0.0 0 $500.0 0 200 5 $500.0 0 $0.0 0 $500.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 3 6000. 0 0. 0 120. 0 50. 0 Ye s



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R200.
. . 9/3/201 0Pag e 1 o f 1

[ Creat e Anothe rTicke t [ Bac k t o Irt h Interne t ] Sen d Emai l

• YOU RTICKE T NUMBE RI S 2637699 . Origina l Cal l Date : 11/08/1 0 Time : 5:4 9 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 11/10/1 0 Time : 6:1 5 p m State : N E County : DOUGLA S Place ; OMAH A Address : 263 2 Street : BURDETT E S T Twp : 15 NRng : 13 E Sect-Qtr : 09-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATIO N Locatio n o f Work : LOCAT E ENTIR E PROPERTY , AL L EASEMENT S AN D T O TH E PEDESTA L Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E I F CORNE R LOT . 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 ho f Excavation : 4 F T Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac t Phon e Numbe r Utilit y Typ e Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEIDI Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUDO l METROPOLITA NUTILITIE S DISTRICT SANDY Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACOFCIT Y O FOMAHA-TRAFFIC.SEWE R RICH/TRAFFIC Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 OPPDGPRS OMAH APUBLIC POWE RDISTRICT EL M LOCATIN GAh : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 QLNNEI C QWES T LOCA LNETWOR K EL M LOCATIN GAlt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 11/8/201 0

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# L 2789 5 Exterio rPain t Nort h Arrow 

### Omah a Lea d Sit e Owne rName : fORR^ES j PHILLIP S J R 

### •Goo d Sit e Sketc h Address : 263 2 BijRDiTTEST ^ 

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# 2789 5 Exterio rPain t Nort h Arrow Ortiah a Lea d Sit e Owne rName : FORRES TPHILLIPS J R •Goo d Sit e Sketc h Address : 263 2 BURDETTE S T 

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## Consen t fc fAcces s To Properti ' RIGH TOF ENTR Y TO PREMISE S 

### Granto r(th e propert yovi/ner) consent s to an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA ) orit s authorize d representatives , collectivel y th e Grantee , to ente ran d perfor m certai n environmenta l respons e activitie s upo n th e followin g describe d premises ;

Owner' s : Daytim e Phone : er s Name Name : ^i_ 

# /i/A'u2iA7_hirej T
• ^ Addres s ofPropert y 

# y^^ Z f^o-rdetV ^ , f covere d bythi s Agreement :
PURPOS E OF RESPONS E ACTIVITIE S 

### Th e EP A is requestin g acces s to collec t soi l sample s an d remov e soi l tha t contain s elevate d concentration s oflea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l be excavate d to remov e contaminate d soil
. Th e remove d contaminate d soi l wil l be replace d wit h clea n material s an d th e are a wil l be restore d to it s origina l condition
. Thi s wor k is bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e ofCoasta l Environmenta l Group , contracte d byUSEPA
. wil l contac t th e Granto rin-perso n to discus s th e wor kto be performed , th e Granto rwil l hav e an opportunit y to revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e It begins
. Onc e th e wor k is finished , th e Granto rwil l be aske d to revie wth e wor k an d confir m tha tit is 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 

### Bysignin g thi s Acces s Agreement , th e Granto r is grantin g th e EPA , it s employees , contractor s an d subcontractor s th e righ t to ente rth e property , at al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e ofperformin g th e work
. Thi s acces s shal l remai n in 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 of2

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### « 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 ma ywis h t o save ; « Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessary ' subsequen 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 perfor m th e work
. 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 l Group , a t (402 ) 991-119 9

0 n gran t acces s t o m ypropertie sQ I d o no t gran t access t o mypropertie s

Date ^ ySignatureDat e 

## loyH-i o Q I woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
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Pag e 2 o f2COASTA L CNVIflONMCNTA L C R O U r. INC
. 

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

PropertylD : Z^-jy% f \ PropertyAddress : ^ ^ J ^ f } O r Je^fY^ ' 

# ^ T Owner : fh l (h i ^ S J rf^ . P ^ OT ^ 5 T 

## Phone : j^^Y S^ 7^/ . O nth e attache ddiagram(s ) indicate area(s ) t o excavate , surfac e structure s andlandscapin g feature s and acces s location(s ) to b e use db y th e contractors . Indicate distances , depths , material types , etc . Photographicall y andVideographicall y document th e existin g condition s ofth e propert y andth e basement if necessary . Item s t o b e Remove d b yth e Owne rbefor e Star t o fRemediation : Th e removal , storage , disposal , and/o rretur n o fthes e item s i s th e Owner' s responsibility
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## 1of 2 .^ « ^ COASTA L CNVIROHMENTA L C KO U P , INC
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## Ite m Pre-existin g property area , tha t will b e excavated , tha t i s covere dwit hgrass . Numbe r o f tree s > 2 inc h trunk diamete r Numbe r o f tree s < = 2 inch trunk diamete r Numbe r o f Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Attac hasketc ho f the sprinkle r layout
. Numbe r o f andsiz e o f eac hgarden/ flower be d area . Attac hasketc ho f relativ e size s an dlocations
. Agree dupo nvalu e o f plant material s no t to b e replace db v contractor . Not e thi s valu e wil l b e use dt o issu e aplant< ^ vouche r t o th e propertj ' owner . Easement Area , to b e excavate d 

## Quantit y 

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Pag e 2 

# . 1COASTA L ENVIRONMENTAI
. C R O U I
Additiona l Comment s / Instructions : Th e cit yo fOmah 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 fthi s i s th e case , yo u shoul d understan d tha t thi s removin g an d replacin g o fsoi 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 fyo 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 fsoi l b yth e EPA
. I fyo u hav e an yquestio n abou t legalit yo fa certai n drivewa yo rparkin g area , yo u ma ycontac t th e cit yo fOmaha' s Plannin g Departmen t a t (402 ) 444-5150
. I I Pleas e chec k thi s bo xi fyo u understan d th e informatio n outline d above
. 

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Z I Chec k th e bo xi fOwne rdoe s no t wan t CE G t o documen t inte;iorfound^tio n wall s an d possibl e pre-existin g damage
. B ycheckin g thi s bo xCE G i s no t resppnsibl e fgr^n ydamag e don e t o th e interio ro fhouse , includin g foundatio n crack s o rfissures
.


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# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1

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# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1

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# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1

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15 5 SOI L 2011-01-2 1 13:4 7 90.4 6 Fina l Avg o f 152-15 4 263 2 BURDETT E S T B 2 6 " 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 

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 15 2 Mod e SOI L Tim e 2011-01-2 1 13:4 6 Duratio n 30,1 4 Sequenc e Fina l Flag s BVI D 2789 5 ADDRES S 263 2 BURDETT E S T QUADRAN T B 2 DEPH T 6 " XR F TEC H C.PADILL A MIS C CONFIRMATIO N NOT E CLEA R
Erro r pp m P b < LO D 14.93 6 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1 

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 15 3 Mod e SOI L Tim e 2011-01
- 2 1 13:4 7 Duratio n 30,1 9 Sequenc e Fina l Flag s BVI D 2789 5 ADDRES S 263 2 BURDETT E S T QUADRAN T B 2 DEPH T 6 " XR F TEC H C.PADILL A MIS C CONFIRMATIO N NOT E CLEA R

pp m Erro r P b < LO D 14.74 0 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1 

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 15 4 Mod e SOI L Tim e 2011-01-2 1 13:4 7 Duratio n 30,1 3 Sequenc e Fina l Flag s BVI D 2789 5 ADDRES S 263 2 BURDETT E S T QUADRAN T B 2 DEPH T 6 " XR F TEC H C.PADILL A MIS C CONFIRMATIO N NOT E CLEA R
pp m ±Erro r P b < LO D 13.94 3 Supervise d By :X 

### Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
. V •-o * www.coastalhazmat.co m

%PR0^t<:'' ^ COASTA L ENVIKONnENTA L GROUP , IN C 

# EXECUTIV ESUMMARY : BVI D #2789 5 - (263 2 BURDETT EST ) N o Issue s o r Concern s | ^ Issues/Concern s Detai l Explanation :

## EP APropertj ' Clos e Ou t For m Propert y # : . JiZSSJ.
. Proptrt y Adtlrtjs : Uate/Tlrot : Owntr' s Namr : /.- . Quad s ExcBvtiifd ; Confracto r Grou p

- Co»tTl* L Excavatio nGenera l _J^t; ^ N o I1 . If necc.^sao' , ^'er e th e corrtc l quadrantfs ) excavate dan dresiored ? 

# J /

' 2 . If netcbsar>' , wer e th e correc i area s ofdn p /on e excavale dan drestored' ' 

# \y
_ 1 - Gradin g So dan dVrgetatio n ..Y£5__IM': ­ ! 1 Doe s th e gradin g aroun dth e pcrimeie r ofth e hous e i nexcavale darea ? generall y SIUIK
- a\va y i ;__fromth e Iiouse ?
_ 

## 1 ^ J 2 . Ha s so dbee nlai di nal l arrs s tha i wer e excavated ? y S Doc s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e if inspecte dai a3 0 

### I y da y tim e period ) I4 . .\r e sodde darea s generall y firman devenl y graded ? 

# i
. 1
. _ i "5 /Vr e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspccie da t a? nda y y tim e period )
_ 6 . Wa s th e propert y grade d.^uc htha i wate r wil l no l poo l <i nih r prnpeny'- ' ' y 1 i
. 7 . Wa s damag e t o landscapin g o r plan i material s avoided'; ' 

## i y Gatei
. F f oce s ao dRetjinln g Wall s D o gate s ope nan dclo.<;e freely? (I f applicable ) 2 Wer e al l gate s ot fence s take ndow ndurin g resloralio nactiviiie s reinsialled; ' (I IapDlicahk; ! "1 . Wa s damag e t o gate s o r fence s avoided' ' (Ifapplicablc J "1 Wa s damag e 1 0 retainin g wall s avoided' ' (Ifapplicable )

r oundaiion , Sidin g an dGuKfr ; _ Ve s .N^ c 1 Wa s darrag e t o th e sidin g o r tri mavoided ? 

# y z 7 Wa s damag e t o th e foundatio navoided' '

~. Wa s damag e l o window s avoided' '

''IWa.< ; damag e t o window s ot doo r screen s avoided' ' yI

• t -• • Wa.- , damag e t o dowiispoui s n i downspou i txiensiun s avoidci.1' ' 

### / ! Sidewalk s an dDriveway. i (Concrete ) Ve s _^f • 1 Wa s damag e t o drivewa y surface s avoided. ' 

# ~y ­ 2 . Wa s damag e t o walkwa y surface s avoided' ' yI

### O M ner s comrT?en<s :

[p.^Dectio nnotes :

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_ ___Q ^ ^
_ .n^le : ij/j/r
.

## V Propert yCompletio n Agreemen t
I'hi s agieemen i documenl s lh e LOinplclio n c l remedia l aclivme s perlonne d o n m yproperl yM ysignatur e wil l de.signal e iha l I a m sali.sfie d wil h lh e resloralio n o fm ypropeily
. an d iha i n o iiem.< ; ar e i n queslion,«.
. now , o ra l an yiint e M I ih e fuiure , excep l ihos e Hem s liste d below , ifan y

Propert y ID : -y ^ ryi
. v i Property ' Address : ^^^^ ^ 'bV^ytVr t ^ f Phone : Restoratio n Item s i n Question : 

### I Item :

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

# L

[^ J I ajiff cresloralio n i s complrled , r)rccp l * s nnler i [_ J I rio no l a;;rf crrsioiatin n iii.omplcicr i UOI/t^ld ' 0«iicr'. s Signatm r Conl i arlor' s Signalur e