## TRANSMITTA Lof OMAH A LEA D SIT E SOI LREMEDIATIO N FIL EFOLDE R SAI D # : 

# ^MH ^ Date : 

# I 

# k Address : 

# li n 

# f]^ u ^ f Remediatio n Contractor : Coasta l Environmenta l Group _ Year : 200 1 SOI LREMEDIATIO N PROPERT Y nLEFOLDE RDOCUMENT S 5

/ Vide o o f property (DVD ) Executiv e Summar y 

# e i EPA-provide dproperty sketch SignedAcces s Agreement fo r subject property SignedAcces s Agreement(s ) fo r adjacen t propert y 

## t / Restoratio n Agreement Settlement docimient s (i.e. , fo r damag e o r to replac e plants , etc. ) Confirmation dat a Photograph s % o ^^ ^ h ^ ^ \ H jS^^irjL ^ As-built sketch Satisfactor y restoratio n signedb y Propert y Owner Propert y close-out check lis t signedby EP A Descriptio n o f area s no t meetin g RO D cleanup criteri a Utilit y clearance s PropertyjafSfmaiio n fro mDougla s Count y Assessor' s Office

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Owner : 

## 1Sro& e -\Vv>Y\p<=;e n Rcnier Addres s

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## " " 'l-\4-\f?<^' ^ F«x : Ccll/Pager . D NotiHc^jfio n Lette r J

^ Acce u Agrcemen i j ^ Restoratio n Agreeme m D Topsoi l Samplin g (i f applicubic ) D Disposa l Simplin g ( Kapplicable ) D Ciirdc n Samplio g (i f applicable ) JS ' Uiilit vClearanc e ^ ^ Video/Photo s (Before )

• Video/Photo s (During ) D Video/Pholo s (After ) D Video/Phol M (30-Day ) D Pro|»crt. vComplelio n Agreemen t D Fina l Rcpo n Ai rMonitorin g (a s applicable )

D Communit y D Cre w Oo : Rc5ulls : D Comrounir> ' O Cre w On : Results : D Communi s D Crv> v On : ResulU : Phone : FH.V : Cell/Pager : Additionu l IntorwAtiw .

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### 0f^:3.'Jl'C> ^ On : / / On : / / Oo : / / Siened : / / Issued : / /

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## CONTACT FOR M Propert y I D # ^\\4 X Propert y Address : ^X\ X Vx<yZ€ h \ Initial Contact : Date : Time : Action : Secon dContact : Date : Time : Action : Fina l Contact : Date : Time : Action : Fina l Action : Transmi t to EP A D Other Action : D

Comment : Owner Commen t (s) ; Site Coordinato r Comment (s) :• • 

### Douglas Count y Accoun t I

[i|£^i||^io n 

### Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R221650000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f 52n d S t - Vle W O n Ma p Informatio n i s vali d a s o f 2009-8- 3 Treasurer' s Ta xRepor t Ne wFeatur e ->->• • Aut o Sale s Searc h Owne r THOMPSE N BRUC E A ETA L 351 1 WOOLWORT H AV E OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 165 0 000 0 2 2 Accoun t Type : Residentia l Parce l Number : 221650000 0 Parce l Address : Lega l Description : 221 2 PIERC E S T OMAH AN E 68108-000 0 SHULL S AD D LO T3 BLOC K2 E 1/ 2 S 1/ 2 3 0 X 91. 5 Valu e Informatio n 200 9 200 8 200 7 200 6 200 5 200 4 Lan d $3,300.0 0 $3,300.0 0 $3,300.0 0 $3,300.0 0 $3,300.0 0 $3,300.0 0 Improvemen t $24,100.0 0 $24,100.0 0 $24,100.0 0 $33,100.0 0 $33,100.0 0 $33,100.0 0 Tota l $27,400.0 0 $27,400.0 0 $27,400.0 0 $36,400.0 0 $36,400.0 0 $36,400.0 0 Lan d Informatio n Acre s 0.0 6 S F 2730. 0 Unit s 1. 0 Dept h 91. 0 Widt h 30. 0 Vacan t N o Improvement Informatio n Buildin g 1



### http://douglasne.mapping-online.coin/DouglasCoNe/static/accountinfo.jsp?accoimtno=R22.. . 8/22/2009Dougla s Count y Accoun t I t^^||H^io n Pag e 2 of 2 • •

*•• • » _ 

## RANC H ""iiir""" * (

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l* V
a>iia»j,iiH.i.iiMa.Mw.iii.%t».fc»j.'a m 'sr.irt^ifSimt m CLIC KTO ENLARG E IMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : 602. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

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

HVAC : Force d Ai r Rooms : 6. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1.0 Roo f Cover : Compositio n Shingl e Bedrooms : i 3. 0

Roo f Type : Gabl e Stories : 1. 0 Floorcover : i Allowanc e Foundation : I Bloc k Sprinlde 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 188 6 0 % 188 6 12 3 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 532. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h Sla b Roo f Cei l 84. 0 Porc h Woo d Dec k 16. 0 Storag e Woo d 60. 0

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R22. . . 8/22/200 9

### Pag e 1 of 2

" > Creat e Anothe rTici<e t ] Bacl < t o Irt h Interne t ] : [ Sen d Emai l )



### • YOURTICKE T NUMBE RI S 2356579 . Origina l Cal l Date : 9/03/0 9 Time : 1:0 5 pm Op : ELIZABETH1879 0 Wor k t o Begi n Date : 9/08/0 9 Time : 1:3 0 pm State : N E County : DOUGLA S Place : OMAH A Address : 221 2 Street : PIERC E S T Twp : 15 NRng : 13 E Sect-Qtr : 27-NW,28-N E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lead remediatio n Locatio n o f Work : INCLUD E AL L EASEMENT S LOCAT E ENTIR E PROPERTY Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LOT . Compan y: COASTA L ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Being Don e For : coasta l Dept h o f Excavation : 4f t Come r Lot : N Front : Y Rear : Involve s Tunneling o r Horizonta l Boring : N Explosives : N CXCAT V LEVEL 3 METHODI S MUD0 2 OMAHACO F 0PPDGPR 6 PAETE C QLNNEI F Utilit y Servic e Are aContac t Phon e Number Typ e 

### Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , ^^^, 1 

### Alt : 402934046 9 IN C 

### Emerg : 402932975 7 Day : 877366834 4 LEVEL3 LEVEL S COMMUNICATIONS , ^ ^ 

### Alt : 

### Emerg : 877366834 4 Day : 888847475 7 METHODIS T HEALT H METHODI S 

### Alt : SYSTEMS 

### Emerg : 888847475 7 Day : 402504782 3 METROPOLITA N UTILITIES MUD0 2 SAND Y 

### Alt : DISTRICT 

### Emerg : 402504797 0 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 9/3/200 9

### Pag e 2 of 2 Day : 402444719 7 OMAHACO FJ^FIC^EWE R^° ^ ^^^ ' Alt : 402444516 402444516 1 1 Emerg : 402444516 0 Day : 406728934 3 0PPDGPR 6 g;^^^^^^^°^ ^ NA Alt : : 406207149 406207149 4 4 Emerg : 888728934 3 Day : 800289190 1 PAETE C PAETE C COMMUNICATION S EM^GeTCY^"^ ^ ^^ ^ ^' * Alt : Emerg : 800289190 1 Day : 406728934 3 QLNNEI FQWES T LOCA LNETWOR K

NA Alt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/3/200 9C-S# : 2114 2 Dat e Excavated:9/15/0 9 Dat e USEP ASlatte d Off : 9/24/0 9 

# As-Buil t Drawin g COASTA L Are a Sodden : 178 5 sof t 

# Omah aLea dSuperfun dSit e

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Oinah aLea dSit e 4613 0
Quadrant s Excavate d Are areplace dwit h Are areplace dwit h \M ^ Are alef t bar e So d' ' Rock/Mulc h 

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

# ^^ V C 7 ^ 

# er e Name : lYjf^ cTl^Oin^Ser ^ Omah a Lea d Sit e Date : 7//g/i;' ^ Nort h Arro w Sit e Sketc h Time : •f.V ^ 

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# erc e Omah aLeadSit e 4613 0Omah aLea dSit e Date : T/Zf/l' ^ : ^3 3 i: ^ XiPi/t , St ,

OmahaLeadSit e 4613 0Name : : (W f IjJOinf^e n Omah a Lea d Sit e Date : zWi . Nort h AiTO W Address : Sit e Siwtc h Time : 'ff/ ^ Phone : 

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# ^5:^ / Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e F" . Ye s a No — P« Ye s a No 13 — «» Ye s a No cr " P. . Ye s ° No C^ - No CB " pp m No I= i pp m No •

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# ?'erc e 3^ . Omah aLea dSit e 4613 0^€X> BUf , COASTA L INVIKONniRTA I C ft O 1 1 f . IN C 

## Consen t fo rAcces s T o Properti ' 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 : 

### ^"^'*^7H-J5*^ 3

Owner' s Name : Daytime Phone : 

## brooeTVxoM^ev ^ Addres s o f Propert y covere d b ythi s Agreement : 

# ^2} 7 PkJ-<.^^i
- 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 wot 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 from 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 vmtk . 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 2^^V ) «r4, , 

# v ^ ^ COASTA L tftVtRONHFKTA l 

## \:,o y C R O U » IN C t Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; cRemov 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 ; cWate 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 ; cAbid 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 . 6 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 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 (402 ) 991-119 9 I gran t acces s t o mypropertie s D I d o no t gran t acces s t o mypropertie s

Signature Date
D I woul d lik e t o b e presen t durin g an ysamplin g tha t i s required .

Page 2 o f 2• • COASTA L INVmONnrNrA L C n O U r. IN C 

## Restoratio n Agreemen t Th e purpos e o f thi s agreement i s t o provid e amutual agreement a s t o condition s ofth e propert y prio r t o remediatio n activities . 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 n o f th e propert y owner an dth e Unite dState s Environmenta ] Protectio n Agenc y (EPA) . \

O n th e attache ddiagram(s ) indicate area(s ) t o excavate , surfac e structure s an dlandscapin g feature s an d acces s Iocatioti(s ) t o b e use db y th e contractors . Indicate distances , depths , materia l types , etc . Photographicall y andVideographically document th e existin g condition s ofth e propert y andth e basement i f necessary . 

### Item s t o b e Remove d b yth e Owne rbefor e Star t o f Remediation : Th e removal , storage , disposal , and/o rretur n o f thes e item s i s th e Owner' s responsibility . Item : ^t^c . \ \ 

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, , , .. . 

### item s t o b e Remove d b y\ th e Contracto r Durin g Remediatio n an d No t Replace d ttem: ^rw, < 

# •?\^. w ttem: r Item : / ttem: 

# J f

Page l o f ^• • « «
COASTA L rNVlMONH f NTAI . c• o i > r. IN C 

### 'Item s t o B e Remove d B yContracto rDurin g Remediatio n an d Replace d ttem: <^^ 1



### Item Pre-existin g property area , that wil l b e excavated , that i s covere dwit hgrass . Number o f tree s > 2 inc h trun k

diamete r Number o f tree s < = 2 inc h trunk diameter Number o f Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Attachasketchol ' the sprinkler liivoui . Number o f andsiz e o f eac hgarden / flowe r be d area . Atuic hi l sketcho f relativ e size s nn dloc;lti(ln.^ . Agree dupo n valu e o f plant material s no t t o b e replace db v contractor . Not e thi s \alii e will h e use dlo issu e H plan t voiielie r to th e propert y 0^\ner . Fnsement Area , t o b e excavate d 

### Quantit y

/ 

### Landscap e Inventory Uni t Quadrant s

Eac h Eac h

Eac h

Eac h SquareFee t

$

Eac h 

### Condition/Type/Specie s

Pag e 2 O f ^I ^ COASTA L

HVIIIOMnl.«4TA t O It O U P . IN C Addttlonal Comment s / Instructions :

k

Chec k th e box if Owne rdoe s not wan t CE G to documen t interio rfoundatio n wall s an d possibl e }re-existin g damage . Bycheckin g thi s txi xCE G is no t responsibl e fo ran ydamag e don e to th e interio r of house , includin g foundatio n cracksorfissures . Q I do no t agre e

ontractor' ' Dat e 'Owner' s Signat u Contractor' s s Signatur

Signatur e e Pag e 3 

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# ¥ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta i Grou p inc . ^ ^ www.coastalhazmat.co m COASTA L INVItOIIHINTA L s a o u r , IN C 

# EXECUTIV ESUMMARY : BVID #21142-(221 2 PIERC EST ) No Issue s o r Concern s Issues/Concern s Detail Explanation :^ 

## ifco^B ^ 

## EP A Propert y Clos e Ou t For m Propert y # : Date/Time : Quad s Excavated ; ^ 1 . T Vy l J ^ V/ l ^ \^ . Contracto rGrou p CJPT^7Tn ^ Ye s N o Excavatioi i Genera l 1 . If necessny , were th e correc t quadrant(s ) excavate dandrestored ? (X- ' 2 . If necessary , were th e correc t area s ofdri p zone excavate dan drestored ? 

### cX ' Ye s N o Gmdlo g So d an d Vcgctatioi i 1 .Doe s the gradin g aroun dth e perimeter ofth e hous e i n excavate darea s generall y slop e awa y fromth e house ? 2 .Ha s so dbee n lai din al l area s tha t wer e excavated ? 3 .Doe s th e sodappear t o b e generall y health y an dgrowing ? (Onl y evaluat e if inspecte da t a3 0 da y time period ) 4 .Are soddedarea s generally fir man devenly graded ? 5 .

Ar e th e joint s betwee n th e so dstrip s generally tight ? (Only evaluate if inspecte da t a3 0 da y 

# ~ 7 tim e period) 6 .Wa s the propert y grade dsuchtha t water wil l no t poo l o n the property ? 

### v / 7 .

Wa s danug e t o landscapin g o r plan t material s avoided ? ^ ' Gates , Fence s an dRctainiB g Wal b Ve s N o I . D o gate s ope n an dclos e freely? (Ifapplicable ) 

## U - ' 2 .Wer e all gate s or fence s taken dow n durin g restoralio n activitie s reinstalled ? (irapplicable ) 

### ly 3 .Wa s danug e t o gate s o r fence s avoided ? (Ifapplicable ) ( / 4 .

Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) FouDdation , Sidin g an dGntter s Ye s N o I .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 n avoided ? c / 3 . Wa s damag e t o window s avoided ? 

# IP ' 4 . Wa s damage t o window s or doo r screen s avoided ? 

# -y ' 5 . Wa s damag e l o downspout s o r downspou t extension s avoided ? 

# T? " Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 .Wa s damag e l o drivewa y surface s avoided ? 

# 3 ^ 2 .Wa s damage t o walkwa y surface s avoided ?

## Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complete includin g the 30-da y so dwarranty : EP A Represenlaliv e 

# l)( ^ IVJ/ ^ Dale : .^/^f

### Propert yCompletio n Agreenrien t Ihi s agreeme m documenl s Ih e complclio n o f remedia l acliviiie s perCoiinedo n m yproperl yM ysignatur e wil l designat e iha i I a m satisfie d wil h th e resloralto n o f m yproperly , an d lhat n o item s ar e i n questions , now , o rat an ylim e i n th e future , excep t Ihos e Hem s liste d below , ifan y

Propert yID : ^)|*-; ^ Propert yAddrcM : Owner : Phone : Restoratio n Item s i n Question :

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