### TRANSMITTA L of OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAID# : \SHg 3 Date : Q^j<:JO H Address : ?lnl\ ^ V\aSCi3A \^ Remediatio nContractor : Coasta l Environmenta l Group

_Year : 200 8 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S JZ

' Vide o of property (DVD ) pf Executiv e Summar y 0 EPA-provide dpropert y sketc h... . ­" IZSigne dAcces s Agreemen t fo r subjec t propert y-' . ' K1| WSigne dAcces s Agreement(s ) fo r adjacen t propert y H' Restoratio nAgreemen t Htf i Settlemen t document s (i.e. , fo r damag e or to replac e plants , etc. ) 0 Confirmatio ndat a 

## 0 Photograph s I>rC>-.P^z-zgJljiJV ) ^ ovrjaJoJityv ^ scAj Y-n.c X S6 ^ J^r ' As-buil t sketc h ) 0 Satisfactory restoratio nsigne dby Property Owner 0 ' Propert y close-ou t chec k lis t signe d by EP A tl(

B Descriptio n of area s no t meetin g RO D cleanu p criteri a 0 ^ Utilit y clearance s 0 ^ Propert y informatio nfro mDougla s Count y Assessor' s Offic e 

## m^>e^ . Qj'^tx^ ^ oVf^^lc^ r B^ C^O^W f fi^fr^ 4031814 7 D Superfun d



### ^ ^ DJ Signatur e e ' Dat e

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WOR K STARTE D WOR K COMPELTED ON : ON: . 

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## "««'• • SS-^^-fM,.??- ^ Fax : Cell/Pager : Renter : Phone: Fax : Cell/Pager . Additional Information :

D NotificationLette r ^0'^Acees s Agreement j2 ^ Restoratio nAgreement D Topsoil Samplin g (if applicable ) Q Disposa l Samplin g (i f applicable ) D Garde n Samplin g (i f applicable ) J ^ Utilit y Clearanc e 0^Video/Photo s (Before ) D Video/Photo s (During ) nVideo/Photo s (After) D Video/Photo s (30-Day ) D Property Completio nAgreement D Fina l Report Sent : / / Signed : .3_/^/0 ^ 

### Signed : _3_/2^/C2 . / / / / / / Called: ^ /JC'/Q i

On:^/^/i! ^ On : / / On : / / On : / / Sisncd : J 1 Issued : / / By : 

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Omah aLea dSit e

## CONTAC T FOR M Propert y I D # Propert y Address : Initia l Contact : Secon dContact : Fina l Contact ; Fina l Action :

Comment : Owne r Commen t (s) : Sit e Coordinato r Commen t (s) : 

## ^^M-S ^ 3\-«»^ 5 H<?i^0.c:^l l

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## Date : Date : Dale : Time : Time : Time : Tran.smit t o EP A D Action : Action : Action : Othe r .Action : D1 

### Dougla s County Accoun t Informatio n Pag e 1 of 2
Dougla s County , Nebrask a Propert yRecor d - R173896000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e &
. scal e 0-5 0 f t wes t o f 90V n S t - ViewO n Ma p Informatio n i s vali d a s o f 2008-9- 4 Treasurer' s Ta xRepor t 1 Ne wFeatur e -»-•- > Aut o Sale s Searc h Owne r BEL L ROBER TB ETA L 363 5 HASCAL L S T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 389 6 000 0 1 7 Accoun t Type : Residentia l Parce l Number : 173896000 0 | | Parce l Address : 363 5 HASCAL L S T OMAH AN E 68105-000 0 Lega l Description : MELROS E HIL L LO T9 BLOC K6 5 0 X 12 4 Valu e Informatio n Lan d Improvemen t Tota l 1 200 6 $14,000.0 0 $76,300.0 0 $90,300.0 0 200 7 $14,000.0 0 $76,300.0 0 $90,300.0 0 200 6 $14,000.0 0 $76,300.0 0 $90,300.0 0 200 5 $14,000.0 0 $76,300.0 0 $90,300.0 0 200 4 $6,400.0 0 $76,300.0 0 $82,700.0 0 200 3 $6,400.0 0 $76,300.0 0 $82,700.0 0 Lan d Informatio n Acre s S F Unit s Oeptf i Widt h Vacan t 0.1 4 6200. 0 1. 0 124. 0 50. 0 N o Improvement Informatio n Buildin g 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17. . . 9/27/200 8

### Dougla s County Accoun t Informatio n Pag e 2 of 2

160:4 r Enak>M d Scm n Wa t 64sq t 3*J g 8M0S. F M e

34, 9 •MUklDtf) , RANC H Btmn l Bloc k «I t 804. 0 S F CLIC KT O ENLARG E IMAG E CLIC KTO_ENLARG E IMAG E Squar e Footage : 884. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Goo d

Buil t As : Ranc h Cond o Squar e Footage : 0. 0

HVAC : Centra l Ai rt o Ai r Rooms : 4. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 2. 0

Roo f Type : Gabl e Stories : 1. 0 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 195 2 0 % 195 2 5 7 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fenc e Chai n Lin k 1. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 884. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 240. 0 Porc h En d Scree n 64. 0 Porc h Sla b Roo f Cei l 32. 0 Porc h Sla b Roo f Cei l 160. 0 Porc h Woo d Dec k 66. 0 Porc h Woo d Dec k 120. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=R17. . . 9/27/200 8

### Pag e 1 of 2

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

# C
YOU RTICKE T NUMBE RI S 2144097 . Origina l Cal l Date : 9/30/0 8 Time : 11:3 1 a m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 10/02/0 8 Time : 12:0 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 36 3 5 Street : HASCAL L S T Twp : 15 NRng : 13 E Sect-Qtr : 32-NE,33-N W Tv/p : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remidiatio n Locatio n o f Work : LOCAT E ENTIR E PROPERT Y STARTIN G FRO M TH E HOUS E AL L TH E : WA Y T O TH E STREET . 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 Contact Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : coasta l Dept h o f Excavation : 4f t Corne r Lot : N Front : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F QWEST 2

Servic e Are a Contac t Phon e Numbe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C 

### HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
MUD0 2 METROPOLITA NUTILmE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : 

### Emerg : 402504794 6
OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R 

### RO N Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0
0PPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T 

### N A Day : 406728934 3 Alt : 888728934 3 Emerg : 406728934 3


### http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/30/200 8

### Pag e 2 of 2

QLNN E1 FQWES T LOCA LNETWOR K 

### H A Day : 406728934 3

Alt : Emerg : 888728934 3 QWEST 2 QWES T LON GDISTANC E 

### SAR A Day : 800283423 7 Alt : 303992192 6 Emerg : 800283423 7



### http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/30/200 8

# As-Buil t Drawin g C OAST AL 

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### Consen t Fo rAcces s T o Propert 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 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 Name : Daytim e Phone :



# TwjVa. /yi?p7/ ^ S6S^GID<^1 3
Addres s o f Propert y covere d b ythi s Agreement : 

# %L% ^ "^^jm^ K ;s f PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP Ai s requestin g acces s t o collect 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 byUSEPA , wil 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 appnDv 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 property ha 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 , contractors an d subcontractors th e righ t t o ente rth e property , at 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 effect 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 2!f='^'*
. « ^ ^ ; V" • > " COASTA L C • 0 U r. IH C



### •Remove obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; •Remove 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 byEPA ; •Abid e byhealt h an d safetyguidanc e provide d byEPA ; •I f th e propertyi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propertyt 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 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 wothers 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 (712 ) 352-018 8

^

I gran t acces s t o m ypropertie s D • d o no t gran t acces s t o m ypropertie s 

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.

### Restoratio n Agreemen t The purpos e o f thi s agreement i s to provid e amutua l agreement a s to condition s of th e propert y prio r t

o remediatio nactivities . Tlii s will als o serv e a s documentatio nfo r the purpos e o f assurin g tha t restoratio n activitie s ar e completedt o the satisfactio n of the propert y owne r an dthe UnitedState s Environmenta l Protectio n Agenc y (EPA) . Propert y ID : 

# i yi n Propert y Address : T ' ^ T ^ e x 5" C C K 

# 2 V Phone : 

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nthe attache ddiagram(s ) indicat e area(s ) t o excavatedan ddepti i o f excavation , locationo f al l know n utilities , subsurface features , syrface structure s an dlandscaping features , acces s location(s ) t o b e usedb y contractor , an dthe direction o f North . Indicat e distances , depths , materia l types , etc . indicat e digita l photo s b

y referencing the photo-lo g numbe r wit ha n arrow indicating direction o f view . 

### Item s T o B e Remove d B yOwne rBefor e Start 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 : 

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### Item s To 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 : ' ^ Item : Item : Kem : Item : item : Item : Item : Item : Item : Nem : Item : Item : Item : Kem :

Pag e 2 of
.C O AS T AL C M O U P IN C 

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Pag e 3 of/ >COASTA L



### Ite m

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Number of tree s > 2 inch trun k

diameter

Number o f tree s <= 2 inch trunk diameter

Number of Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Attachasketchof the sprinkler layout .
Number of an dsize o f eac hgarden / flowe r be d area . Attachasketcho 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
Squar e fee t

Eac h

Eac h

Eac h

Eac h Squar e Fee t

Pag e 

## 4o ffe­COASTA L 

## Item Agree dupo nvalu e of Dian t material s no t to b e renlace dbv contractor . Note thi s valu e will 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 tha t will b e replace db y conn-actor . B e ver y specifi c an ddetailed . Include asketcho f wer e eac hplan t wil l b e place d b

y th e contractor . Agree dupo nare aof property to b e replace d wit hgras s sod . Include asketcho f th e area(s ) to be replace dwit h gras s sod . Are ao f Cit y o r Count y propert y t o be landscaped per thei r requirements . Include asketc ho f th e are a(s )

Easement Area , to be excavate d 

## Quantity 

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### D Chec k th e bo xi f Owne rdoe s no t wan t CE G t o documen t inteno rfoundatio n wall s an d possibl e pre-existin g damage
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JPTagre e Q I d o no t agre e

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# 3/2 ^ Owner' s Signature Date Contractor' s Signature Pag e 6 oF
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SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

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pp m P b 268.11 0 Supervise d By : 

## Certificat e o f Verificatio n

158 8 SOI L 2008-10-1 7 12:5 6 30.2 6 Fina l 1345 3 363 5 hascal l PZ Ventr y 6 CLEARANC E

± Erro r ± 19.38 2

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1 

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 159 4 Mod e SOI L Tim e 2008-10-1 7 13:0 0 Duratio n 120.7 3 Sequenc e Fina l Flag s AVERAG E ^Av g o f 1590-159 3 ADDRES S 363 5 hascal l QUAD/ZON E easement * INSPECTO R Ventr y DEPT H SAMPL E TYP E I CLEARANC E NOT E

P b Supervise d B y

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1 

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 159 0 Mod e SOI L Tim e 2008-10-1 7 12:5 8 Duratio n 30.1 8 Sequenc e Fina l Flag s BVI D # 1345 3 ADDRES S 363 5 hascal l QUAD/ZON E easemen t INSPECTO R Ventr y DEPT H 1 SAMPL E TYP E CLEARANC E NOT E
pp m ±Erro r P b 62.40 9 ±10.18 8 Supervise d By :' ' :><^" Vff'f-7- "i^^ - ~'TZ ~ • '^•
- 'Ww ^ '* f 

# Therm o

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 159 1 Mod e SOI L Tim e 2008-10-1 7 12:5 9 Duratio n 30.2 1 Sequenc e Fina l Flag s BVI D # 1345 3 ADDRES S 363 5 hascal l QUAD/ZON E easemen t INSPECTO R Ventr y DEPT H 1 SAMPL E TYP E CLEARANC E NOT E
pp m ±Erro r P b 59.66 8 ±10.06 3 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E
pp m P b 69.65 4 Supervise d By : 

## Certificat e o f Verificatio n
159 2 SOI L 2008-10-1 7 13:0 0 30.2 1 Fina l 1345 3 363 5 hascal l easemen t Ventr y 1 CLEARANC E

±Erro r ±10.66 8l ^ •*:- • 

# Therm o

SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E Pt'P E NOT E
pp m P b 55.79 1 Supervise d By : 

## Certificat e o f Verificatio n
159 3 SOI L 2008-10-1 7 13:0 0 30.1 3 Fina l 1345 3 363 5 hascal l easemen t Ventr y 1 CLEARANC E

± Erro r ± 9.94 3

# m 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 ^^tPROtt' ^ COASTA L INVItONHENTA L C « O U P , INC
. 

# EXECUTIV ESUMMARY : BVI D #1345 3 - (363 5 HASCAL LST ) N o Issue s o r Concern s [ ^ Issues/Concern s Detail Explanation : N O ISSUE S PENDING .

### ^ i ^ 

# EP A EP A Propert y Clos e Ou t For m Propert y# : \^^5 ^ Propert y Address : Date/Time : Owner' s Name:~^ ^ Quad s Excavated : ^-^N^^'S^ t Contracto rGrou p (^jfYll ^ 

# nvtronnoen ^ Excavatio nGenera l Ye s N o I .I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? • ^ 2 .I f necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? ^ Gradin K So dan dVeccUtio nYe s No 1 .Doe s th e gradin g aroun dth e perimete r o f th e house i nexcavate darea s generall y slop e awa y fromth e house ? 1 ^ 2 .Ha s so dbee nlai din al l area s that were excavated ? 

## 0 3 .Doe s th e sodappear t o b e generall y healthy an dgrowing ? (Onl y evaluat e if inspecte da t a3 0 da y tmi c period ) 4 .

Ar e soddedarea 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 water will not poo l o nth e property ?

- ^ 7 .Wa s damag e t o landscapin g o r plant material s avoided ? 

## 0 Gates , Fence s an dRctainini ; Wall sYe s N o 1 . D o gate s openan dclos e freely? (If applicable ) u ^ 2 .Wer e al l gate s or fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (I f applicable ) 

### y 3 .Wa s damag e t o gate s or fence s avoided ? (If applicable ) x ^ 4 .Wa s damag e t o retainin g wall s avoided ? (I f applicable ) 

### A M Foundation , Sidin g an dGutter s Ye s N o 1 .Wa s damag e t o th e sid'm g o r tri mavoided ? c / 2 .Wa s damag e t o th e foundatio navoided ?

. ^ 3 .Wa s damag e t o window s avoided ? ^ 4 .Wa s damag e t o window s or doo r screen s avoided ? ^ 5 , Wa s damag e to downspout s o r downspou t extension s avoided ? 1 ^ Sidewalti s an dDriveway s (Concrete )Ye s N o 1 .Wa s damag e t o drivewa y surface s avoided ? a ^ 2 .Wa s damag e t o walkwa y surface s avoided ? 1 ^

## O •'ner s comments :

Inspectio nnotes :

Remova l an drestoratio nactivate s complet e includin g the 30-da y so dwarranty : EPA '^^VT^^^i\\2.\\v^^,^0J^j0^^^ ^ Date : ///^/s .

# Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio no f remedial activitie s performe do nm y property . M y signatur e wil l designat e tha t I amsatisfie dwithth e restoratio no f m y property , an dtha t n o item s ar e inquestions , 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 : / J ^^J Propert y Address : Owner : fujiUc . 

# Phone : ^JJ ^ 1 C T S ^ Bal l 

# J^^J rra^yccj / f T

Restoratio n Item s i n Question :

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

]0 \I agre e restoratio ni s completed , excep t a s note d I I d o no t agre e restoratio ni s complete d



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