### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R 

# I97& ^ SAID# : /7/<^ ^ Date : 

## Address : /^<^ / S i '^^2 T Remediatio nContractor : _Coasta l Environmenta l Group

_Year : _2007 _ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S B ^ Vide o o f propert y (DVD ) B ^ Executiv e Summary ^ ­ ; L B ^ EPA-provide dpropert y sketc h E ^ Signe dAcces s Agreemen t for subjec t propert y D Signe dAcces s Agreement(s ) for adjacen t propert y WRestoratio nAgreemen t D Settlement document s (i.e. , for damag e o r t o replac e plants , etc. ) y Confirmatio ndat a ^y Photograph s ' As-buil t sketc h M Satisfactory restoratio nsigne db y Propert y Owne r M Propert y close-ou t chec k lis t signe db y EP A D Descriptio nofarea s no t meetin g RO D cleanu p criteri a D Utilit y clearance s D Propert y informatio nfromDougla s County Assessor' s Offic e D D ,

D -• ' '•••• • " • •

4031785 2 Superfun d

## Fina l Repor t Propert y Chec k Lis t (piease plac e wit heac htiie ) / Har dCop y rnformatio n| 7^^ / X Propert y Chec k Lis t | /y(y l yi . Sit e Workin g Drawin g Ma p I T C EPAoriginal s Ma p k y^ . Dougla s Count y Assessor' s Ma p

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r Propert y Contac t Shee t 

## / 7&~ > ^ t^S" ' O

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# t .S ' # 

## Propert yAcces s Checklis t PropertylD : 1^7(^ 5 D WOR K STARTE D ON : / / Propert y Address : j * ^ " ^ 1 nWORKCOMPELTE D ON : / / 

# ^ Z ^ ^+ . Renter : Owner : Cr\J<.i-Cc l fAfX.^ ^ Address : ' Phone : i6Z \^ 2 ^ Si- - Fax : Cell/Pager : Additiona l Information : Phone : 7op, - 279 . Z . Fax : Cell/Pager : 1 ^ Notificatio nLette r Sent : / / By : r x Acces s Agreemen t Signed : S / 1 7 / CJ By : Q Restoratio nAgreemen t Siened : 8 t Z\1 C 7 By : r~ l Topsoi l Samplin g (i f applicable ) 1 1 By : E

D Disposa l Samplin g (i f applicable ) 1 1 By : • Garde nSamplin g (i f applicable ) 1 1 By : H Utilit y Clearanc e Called : 8 / 24 / O' l 

# ^y „ ^ Video/Photo s (Before ) On : / / By : nVideo/Photo s (During ) On : / / By : nVideo/Photo s (After ) On : / / By : nVideo/Photo s (30-Day ) On : / / By : n nPropert y Completio nAgreemen t Signed : / / By : nFina l Repor t Issued : / / By : Ai r Monitorin g (a s applicable ) O Communit y C H Cre w On : / / 

### By : 1 Results : 1 1 Commimit y E H Cre w On : / / By : Results : E

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### By : 1 Results : Omah a Lea d Sit e

### ii*' „ Propert yClassification :

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# o Excavate d Are a Existin g btructur e • Fenc e ^ Quadran t Boundar y T r ee/Stiru b "•"' J Scal e 1 Inc h = 2 0 fee t o r1 gri d = 5 x5 f 

# '\

T V ' HydrfU : i-n..fvip< , '- 1 - \ J 1 F 1 F 2 1 B 1 Propert yNunnbe r OLS-1976 5 Propert yAddres s 152 1 S 2 5 S T

Pos t Excavatio n Concentration s B 2 Pla vAre ? Gar c D Z en

_ — Eas e>me n a ti e (ppm ) t r Desaiptio n of pos t excavatio n areas : Fl . frontyar d left-han d quadrant ; F2 , fron t yard right-han d quadrant ; Bl , backyard left-han d quadrant ; B2 , backyar d right-hand quadrant ; DZ , dn p zon e (1- 3 foo t are a of soi l aroun d th e foundatio n ofth e house) .Name : /\r;.r/^ / /^> 4 7 ^ Omah a Lea d Sit e Date : -/-/( > ' ^ 3 Nort h Arro w Addressi y::^.^ /

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-J ? ^ %J r Sit e Sketc h Tme : f(3' ^ Phone : 7 ys •».• ' ^/i ? T<'/<<'<P- t * ^ i&av n y/./^y BVID # ^V7/. ­ < XR F Cod e / 30 ¥ Sampl e Numbe r Lea d Concentratio n Confinnatio n Sampl e 

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### B 

## DrtVMibyWehGUiDE l Disclaimer : Ttii s ma p i s not guarantee d t o b e accurate , correct , current , o r complet e an d conclusion s draw n ar e th e responsibilityo f th e user .

# f # 

## Propert y I D # Propert y Address : Initia l Contact : Secon dContact : Fina l Contact : Final Action :

Comment : Owne r Commen t (s) : Sit e Coordinato r Commen t (s) : CONTAC T FOR M |^7G S 

# i'DZ \S 

# 2.' b St Date : Time : Action :

Date : Time : Action : Date : Time : Action : Transmi t t o EP A D Othe r Action : D


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# I '•UrnK r fc,W-ftL''m 4Mj«<"(lt)r'A ; ( k , 

# m y^°i'^^^ . Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc . 

## V • j ^ www.coastalhazmat.co m COASTA L %- y ENVIKONMENTA L G R O U V . IN C 

# EXECUTIV ESUMMARY : 19765—152 1 S 2 5 S T I N o Issue s o r Concern s X Issues/Concern s Detai l Explanation : P O was issue dagif t certificate fromIndianCree k Nurser y #256 6 inth e amoun t o f $150.0 0 for flower be dare aremove ddurin g remediatio nactivitie s a t th e property .

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e Ibi d Ouadran t Squar e Foolag e k > b e EiicariratE d - 79 3 Tlila l DU P Zon e Unea rFootaq e to D e Excavate d - 10 2 Propeit yCbsEfllcalkn : 90 0 D Z replac e wit h soi l onl y an d remov e plant s an d d o no t replace . P O wil l remove d ;

al l smal l plant s sh e want s an d remov e ston e an d plac e i t o n th e porch .

7^^"^ ^ . pL5# : 19765 Date Excavated : 10/30/0 7 ^featt e US§f»A'§iinl a Off : ^M27to k

- • Feno e Pefmane m LandGcapn g Quadran i Boundar y Stree i Boundacy C

^ Tiee'snru D ^fjaarmm . fti, tea^*M MMMn d ^ OZ , «<iitm a ;i- 3 lb«CBnHafafiaMBii«d«M4»tnaMiei*«tV M MuM ^ Legen d Are ano t Excavate d^^yy \Dripzon e Excavate dKK ^ Quadrant s Excavate d Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .

# EP A ^ 

# EP A Propert y Clos e Ou t For m Property # : //y^^^ . Propert y Address : —(P ^ ^^y, ^ Date/Time : Owner' s Name: . ^<^^/g ^ if^^^ Quad s Excavated : Contracto r Crou p (jy(\<n'(}l\ ^ Ye s Excavatio nCenera l I .If necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 

# y 2 .Ifnecessary , wer e th e correc t area s ofdri p zon e excavate dan drestored ? 

## y Cradin K So dan dVegetatio n Ye s 1 .Doe s di e gradin g aroun ddi e perimete r ofth e hous e i nexcavate darea s generall y slop e awa y y fromth e house ? 

### y 2 . Ha s so dbee nlai dinal l area s that were excavated ? 3 . Doe s th e sodappear t o b e generall y healdi y andgrowing ? (Onl y evaluat e if inspecte da t a3 0 da y tim e period ) 4 . Ar e sodde darea s generall y fui nandevenl y graded ? y ^ 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 property grade dsuc htha t water will not poo l onth e property ? y ^ 7 . Wa s damag e t o landscapin g o r plan t material s avoided ? ty Gates , Fence s an dRetainin g Wall s Ye s 1 . D o gate s openandclos e freely? (Ifapplicable ) /\/ ^ 2 . Wer e all gate s o r fence s take ndov mdurin g restoratio nactivitie s reinstalled ? (Ifapplicable ) 

# t y 3 . Wasdamag e t o gate s o r fence s avoided ? (Ifapplicable ) A) A 4 . Wasdamag e t o retainin g wall s avoided ? (Ifapplicable ) 

## //A Foundation , SidiDKan dGutter s Ye s 1 .Wa s damag e t o th e sidin g o r tri mavoided ? y ^ 2 .Wa s damag e t o th e foundatio navoided ? 

### y 3 .Wa s damag e t o windows avoided ? l y ^ 4 . Wa s damag e t o windows o r doo r screen s avoided ? y ^ 5 . Wa s daraag e t o downspout s o r downspou t extension s avoided ? y Sidewalk s an d Driveway s (Concrete ) Ye s 1 .

Wa s damag e t o drivewa ysurface s avoided ? Ky ^ 2 .Wa s damag e t o walkwa ysurface s avoided ? y '" "

- No

N

o

N

o

N

o

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## Inspectio nnotes :

Removal an drestoratio nactivate s complet e includin g th e 30-da y so dwarranty : EPA Representati ve„^--7^2k^^A.;^^^^^X^^?^

—Date : ///y^/o 7

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio no f remedial activitie s performe donm y property . My signature vvil l designat e tha t I a msatisfie dwilhth e restoratio no f m y property , andthat n o item s ar e i n questions , now , o r a

t an y tim e inth e future , excep t thos e item s liste dbelow , i f any . Propert y ID : 7<^^Z ^ Propert y Addres s 

# -yn / ^ 

# Z'y^ r Owner : (2£iy<ry ^ ^JTZ - Phone : 

# yoH ' ZvQ'T. - Restoratio nItem s i nQuestion : Item : Item : Item : Item : Item : 

### Item : Additiona l Comments :

^^^^S l agre e restoi-atio ni s completed , excep t a s note d I1 d o no t agre e restoratio ni s complete d 

### Dat e ' Contractor' s Signatur e I

### Omah aLea dSuperfun dSit e Miscellaneou s Landscapin g Replacemen t Certificat e Propert y Owne r Crysta l Mat z Propert y Addres s 152 1 S . 2 5 S T 

### Propert y Identificatio nNumbe r 1976 5 Materia l Remove d Replacemen t Valu e Flowe r be dare a $150.0 0
Tree s Itemize d shrubs/bushe s ft 

### Tota l $150.0 0 Th e acceptanc e o f th e replacemen t certificat e andth e signatur e belo w i s ful l acknowledgemen t b y th e property owne r that thi s i s afai r andreasonabl e compensatio n for plan t material s remove ddurin g remediatio nactivities , bu t no t plante do r installe db y th e governmen t o r it' s contractors . Th e tota l amoun t o f $ 150.0 0 ha s bee nreceive db y th e owne r inth e for mo f agif t certificate , #Z^py" . t o b e utilize da t IndianCreek Nursery . 

# -yy/ /

^ 7/'3-^- 7 Propgt y Owner' s Signat Dat e Contractor' s Signatur e Dat e

### INDIA NCREE K NURSER Y 

# 256 6 Omaha' s Bes t Kep t Gardenin g Secre t 30 3 Nort hSaddl e Creek Road Omaha , Nebrask a68131-222 9 (402 ) 558-590 0 

# Gif t

Certificat e

I NTH EAMOUN T OF : 

# ^:^^£i^y77:^y^li^7y y 7 ISSUED TO: 

### {yty^h i TfUty COMPl.rMKNTSOF : 0^*1^^!^^^ ^ QU^tAym.^njL.Jl ^ EXPIRATIO NDATE : /^" S -CS ^ 

### Authorize dSignatur e 

# t 

# y I^T^r - /^ / S^^^ yPROPERTYCLEARANC E WORKSHEE T
Dat e Propert yI D 

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# /97& r Propert y Projec t Omah a Lea d - - Rxe d Pric e 

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fr - Addres s Measuremen t XR F I D 0107-5 1 Count/Tim e Fiel d Shot s Shot * Readin g Sampl e Are a Sho t # Readin g Sampl e Are a 

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## 53 7 5y / XR F Correcte d Valu e -- > 5 (us e calibratio n char t o rad d 2 0 % t o value ) 

# n i Sampl e Are a 

### BA'\j J Pass/Fai l ? I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s La b Analytica l Readin q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 (Baq ) Sieved ) 7 2 

### l o t 3 / ? / 

# IZ Z A / 3 3 XR F Correcte d Valu e -- > 5 (us e calibratio n char t o rad d 

# I5 i 2 0 % t o value ) Sampl e Are a Pass/Fai l ? 

## ^ 1 H' L I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s La b Analytica l Readin q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 

### 3f / (Baq ) Sieved ) 2 (f.7 . 

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# s r XR F Correcte d Valu e - > 5 

### 25 - (us e calibratio n char t o i ad d 

## lo S 1 2 0 % t o value ) Sampl e Are a 

### h i f/' O Pass/Fai l ? I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s La b Analytica l Readin g Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s I (Baq ) Sieved ) 

### 7 8 2 f 5 

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# 2( i 2 0 % t o value ) Sampl e Are a Pass/Fai l ? I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s La b Analytica l Readin q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 (Baq ) Sieved ) 7 2 3 4 XR F Correcte d Valu e — > 5 (us e calibratio n char t o rad d 2 0 % t o value ) _ \ n { ADDIIIONA I SHHI S t l XR F Technician' s Siqnitur e U f f I U n

## /''•^Z' ^ i^VG 5 COASTA L ENVIRONMENTA L CROUP . INC . 

## 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 :

Owner' s Nam e Daytim e Phon e 

# y^y-no^^Xl^D~ ^ -yM.1 . L.ui- 1 •E-.^aa.i^.T-Juf cH ..d.i i -i— u h.-j-Mjmr^ rT . Mnn.--T-Y i i nm-m.i . „m,.t.m m nrn.nit^iT o Addres s o f Propert y 

# y?-~ { 

# 5 . 7 ^ 'sy . covere d b ythi s Agreement : 

# ^ryrsya,hJ ^ (-^fo S 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 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 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 yha s bee n remediated . ENVIRONMENTA L RESPONS E ACTION S 

### Bysignin 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 f 2vV ^ «. P COASTA L -w.1. - ENVIRONnENTA L

•'t

PBO-1*" ^ GROUP . 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 ma ywis 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 ofth e property . AGREEMEN TNO TT O INTERFERE 

### Th e Granto ragree s no t t o interfer e 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 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 . Should yo u hav e an yquestion s abou t thi s program , pleas e contac t Coasta l Environmenta l Group , a t (877 ) 234-6270 . 

# y gran t acces s t o m ypropertie s D I d o not gran t acces s t o m ypropertie s

~^ Dat e Signatur e Dat e D I woul d lik e t o b e presen t durin g an ysamplin g tha t i s required .

Pag e 2 o f 2COASTA L C N O U ^ IN C 

### Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o provid e amutual agreement a s t o condition s ofth e property prio r t o remediatio nactivities . Thi s wil l als o serv e a s documentatio n for th e purpos e o f assurin g that restoratio n activitie s ar e complete dt o th e satisfactio nofth e propert y owne r andth e Unite dState s Environmental Protectio nAgenc y (EPA) .

PropertylD : iq^^l^ ^ | | Propert y Address : i K /

t C 

### Z ^ ^^ 

# s y ^""^•• ^ Ct,^s U /v\y ^ Phone : ^ ^ , ; -j^S-ZlfiT . Onth e attache ddiagram(s ) indicate area(s ) t o e.xcavatedanddept ho f e.xcavation . locatio no f all know n utilities , subsurfac e features , surfac e structure s andlandscapin g features , acces s location(s ) t o b e use db y contractor , andth e directio no f North . Indicate distances , depths , material types , etc . Indicate digital photo s b

y referencin g th e photo-lo g number wit ha n arro w indicatin g directio no f view . 

### 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 ) Th e removal , storage , disposal , and/o rretur n o f thes e item s i s th e Owner' s responsibility . Item : 

# y i %(r^i l p/w ^ 4 ylo^jt^e-tz^' s Item :
' S V 0 WJi KJb X \ L vJ«N ^ Item : / Item : Item : Item : Item : Item : Pag e 1 of .COASTA L cn o u r. IN C 

### 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 : 

## ^ n S^/" / ^\0y y\y\ rbtL J Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 2 of ._ COASTA L ENVIRONMENTA L CROUP . IN C 

### Item s T o B e Remove d B yContracto rDurin g Remediatio n An d Replace d (Us e additiona l sheet s a s necessary ) Item : 

# yo] i Item : 

# S o 0 Item : 

## 1>- r •^.-i-/ . Sol i >>^^.Ll ^ MfJ^sJ p . S'civi-ltus,'' ^ Item : * 

# 1 Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

— , .

Pag e 3 of .

—J - .:'iA<>jiA n •,:• . .•-•:....^ . .J-. •1 COASTA L



## Ite m
Pre-existin g property area , tha t wil l b e excavated , that i s covere dwit hgrass .

Numbe r o f tree s > 2 inch trun k diamete r

Numbe r o f tree s < = 2 inch trun k diamete r

Numbe r o f Sprinkle r Zones . Contro l Valves , Timers . Heads , etc . .Anac hasketc ho f th e sprinkle r la>out . ! Numbe r o f an dsiz e o f eac hgarden/ flower be d area . .Attac hasketc ho f relativ e size s an dlocations . 

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

## Quantit y Uni t Condition/Type/Specie s 

# 11 3 Squar e feet



# f Each 

# f Eac h 

# f Each

Eac h Squar e Feet /

Pag e 4 of .COASTA L INVINONME N T AL CROU P INC . 

## Ite m Quantit y Uni t Condition/Type/Specie s Agree dupo nvalu e of plan t material s no t t o b e replace db v contractor . Not e thi s valu e wil l b e use dt o issu e aplan t vouche r t o th e propert y owner . Agree dupo nlis t o f plan t material s that wil l b e replace dby contractor . B e very specifi c an ddetailed . Includ e asketc hof were eac hplan t wil l b e place d b y th e contractor . Agree dupo nare ao f property ' t o b e replace d wit hgras s sod . Includ e asketc ho f th e area(s ) t o b e replace dwit h gras s sod . Are ao f City o r Count y propert> ' t o b e landscape d pe r thei r requirements . Includ e askeic ho f th e area(s )

Easemen t Area , to b e excavate d 

# hy 

# y $ 

# /-illt^jU^^ '

/ Each


# 19 3 S F



# ^ 1 S F

S F

Pag e 5 of ." _^_. . ._-,. ^ X

COASTA L rNVIRONMCNTA L CROUP . IN C 

### Additiona l Comment s / Instructions :

• Chec k th e box if Owne rdoe s no t wan t CE G to documen t interio rfoundatio n wall s an d possibl e pre-existin g damage . Bycheckin g thi s boxCE G is no t responsibl e fo ran ydamag e don e to th e interio r of house , includin g foundatio n cracks orfissures . 

## 0T a agre e nI do no t agre e 

# ^/-^/-J 7 

# i/fyt—y^yrf ] / Owner' s Signatur eV Dat e /Cor f tractor' s Signatur e 

### Pag e 6 of .