### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL E FOLDE R SAID# : j5Z>(^4f e Date : Z/zy/p B Address : /^d(^ S / /

S H Remediatio nContractor : _Coasta l Environmenta l Group

_ Year : 200 7 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 0 Vide o o f property (DVD ) Executiv e Summary 0 EPA-provide dpropert y sketc h [ y Signe dAcces s Agreemen t for subjec t property D Signe dAcces s Agreement(s ) for adjacent property 0 Restoratio nAgreemen t D Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. )

- 0 Confirmatio ndat a Photograph s M As-buil t sketc h l Y Satisfactory restoratio nsigne db y Property Owne r s

/ Property close-ou t chec k lis t signe db y EP A D Descriptiono f area s no t meetin g RO D cleanu p criteri a D Utility clearance s D Property informatio nfro mDougla s Comity Assessor' s Offic e D D , D 

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EP Aoriginal. s Ma p \ ^ Dougla s Count y Assessor' s Ma p J v Propert y Contac t Shee t ^Agreemen t „\Acces s Agreemen t AXestoratio nAgreemen t Miscellaneou s Document s I\Fina l Ma p tro mth e Fiel d 2 . Chang e Order s \XR FDat a 4 . An y email s o r P O airrespondence s Propert y Completio n 1 . Executiv e Summar y 2 . A S BUIL T N3 . Propert y Completio nAgreemen t 4NA.n y buyou t inf o o r reimbursemen t inf o 5 . Chec k o r mone y orde r copie s \EP APropert y Clos e Ou t For m Tv^AttachedBegi nVide o Electroni c Documentatio n ^Drawing s • \r::,^ EP Aorigina l

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Photo s Begi nPhoto s During/Excavatio nPhoto s

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Propert yAcces s Checklis t Property ID : ^0(^^4 5 n WOR K STARTE D ON : _/ /_ n WOR K COMPELTE D ON : / / Property Address : (^^ ^ ^ n «^ ^ Renter : Owner : l\fX^fQS , Clo^VOl^cio . Address : Phone : Fax : 

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## Phone : yS3 ' 4-^1? ) Additiona l Information : Fax : Cell/Pager :

^ Notificatio nLette r Sent : / / 

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## 1 S Acces s Agreemen t 

## Signed : fe /2S / 0 7 By : ^ Restoratio nAgreemen t 

## Signed : S 1 2-5/ 6 1 By : C

D Topsoi l Samplin g (i f applicable ) 1 1 By : 1 1 Disposa l Samplin g (i f applicable ) 1 1 By : C

H Garde nSamplin g (i f applicable ) 1 1 By : 0 Utilit y Clearanc e 

## Called : _E_/2A / 0 ? [ H Video/Photo s (Before ) On : / / By : D Video/Photo s (During ) On : / / By : 1 n Video/Photo s (After ) On : / / By : 1 D Video/Photo s (30-Day ) On : / / By : C

H Propert y Completio nAgreemen t Signed : / / By : 1 1 Fina l Repor t Issued : / / By : Ai r Monitorin g (a s applicable ) I I Communit y C H Cre w On : / / By : Results : I I Communit y C H Cre w On : / / By : Results : I I Communit y C H Cre w On : / / By : Results : Omah a Lea d Sit eyy t 1^7^4-5 0 Tota l Quadran t Squar e Footag e t o b e Excavate d = 3 7 Propert yClassification : 80 0 tamri E Tnta^rj p Zon e Linea rFootao e t o b e Excavate d = 0 yI ­ 4 - 

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140 6 S 1 1 S T Pos t Excavatio n Concentration s (ppm ) B2 PlayAre a D Z Easemen t Garde n Othe r Descriptio n o f pos t excavatio n areas : Fl , fron t yar d left^ian d quadrant ; F2 , fron t yar d right-han d quadrant ; Bl , bad<yard left-han d quadrant ; B2 , backyar d nght-han d quadrant ; DZ , dri p zon e ( 1 - 3 foo t are a o f soi l aroun d th e foundatio n o f th e house) .

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# o Tree/Shru b B l Garde n Othe r1 — — Descriptio n ofpos t excavatio n area s Fl , fron t yar d left-han d quadrant ; F2 , fron t yard right-han d quadrant ; Bl , backyar d left-han d quadrant ; B2 , backyard nght-han d quadrant ; DZ . dri p zon e (1- 3 foo t are a of soi l aroun d th e foundatio n o t th e house) .Exterio rPain t Nort h Arrow Omah a Lea d Sit e Owne rName : ATKtQ S C<3i\/ad a (3^Goo d Sit e Sketc h Address : J^_a^/7i3l ^ • Poor 

### Phone : ^733-^31 3 w (55Q^ - V(2CX ) ce K Q No t paint Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Firm : Sample s Collecte d

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### M<;w ^ Legend : F 1 = Fron t Left , F 2 = Fron t Right , B 1 = Bac k Left , 8 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e as viewe d fro m th e street , facin g property 

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## CONTAC T FOR M 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) : 

# 5^<^^ t i40 G3 \ l ^•+ . Date : Time : Action : Date : Time : Action : Date : Time : Action : Transmi t t o EP A D Othe r Action : D

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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 ENVIRONMENTA L CROUP . IN C 

# EXECUTIV ESUMMARY : 50648—140 6 S 1 1 S T X 

# N o Issue s o r Concern s I I Issues/Concern s Detai l Explanation :- - - 

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e

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### i ^ i O L.S# : 5064 8 D at e Ex t :avated : 8 /27/0 7 

## i Cat e USEP ASigne d Off : 9/7/0 7 Legen d Nort h Arro w Omah a Lea d Sit e =VJf j Concret e Omalia . Nebrask a VAT o B e Excavate d Propert yNumlje r OLS - 5064 8 Existin g Structur e Scal e 1 Propert yAddres s Fenc e 1 Inct i = 2 0 fee t o r1 gri d = 5 X 5 I t B?5 S 140 6 S 1 1 S T Quadran t Boundar y Pos t Exe s ivatio n Co r icentration s (ppm ) 1 1 ^ " ~ 

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DCTCfplio n o l po«t «c«v»tio n nrvi cF1 , tfon t yard lptt-h»n d qu»df»nt . F 2 Iron t yiir d right-Nind quadrint . Bl , buckyard left.han d quadiani , B2 , backyard righl-han d quadran l DZ , dri p zon e ( 1 - 3 too t ar« a o f aorl aroun d th e loundalio n o f th e houae ) Legen d Are a no t Excavate d Dripzon e Excavate d Quadrant s Excavate d Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p In c

# t P APropert y Clos e Ou t For m Propert y # : ^07^^P > Propert y Address : 7^7) ^ S 77^ ^ Date/Time : Owner' s Name : >f>C/A^/^ ^ y/7t7/7/X 4 Contracto r Crou p Quad i Excavated : Excavatio B Genera l Ye s No 1 .If necessary , wer e th e correc t quadranl(s ) excavate dan drestored ? 

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

### Ii k Gradin i So dan dVc«etatio B Ye s No 1 .Doe s th e gradin g aroun dth e perimeter ofth e hous e i nexcav ate darea s generall y slop e away y fromth e bouse ? 2 .Ha s so dbeenlai di nal l area s tha t wer e excavated ? 

### y 3 .Doe s th e sodappea r t o b e generall y health v andgrowing ? (On K evaluat e i f inspecte da t a3 0 da y tim e period ) 4 .

Ar e soddt darea s generall y fuTT i an devenly graded ? y 5 .Ar e th e Joint s betwee nth e so dstrip s generall y tight ? (Onl y e^aloat e i f inspecie da t a3 0 da y tim e period ) 6 .\^ a s th e property grade dsuc htha t wate r w ill no t poo l o nth e properr y '^ y

~ .Wa s damag e t o landscapin g o r p!a.n t Tiateriel s a ^ oided " 

## y
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### 11 ! .D o gate s 9pcnan dclos e Sreiy': ' ([f " applicable ) 

# y 1 1 Wer e al l gate s o r fence s take ndow ndurin g restoratio nac.iv' . tie s -ei^.s•^l!^d• ? .i f applicable ^ 1 ^ - 

# y \\ Wa s damag e t o gate s or fence s avoided ? 'I f applicable ) 13 . ^ ^ 

# 1 Wa s damag e t c retainin g u-all s avoided" ? vl f applicable; ! 

## I1 Foundatton , Sidia K

an dGutter s • ^ e s N o 1 .W'a s damag e t o th e sidin g or trima v oided ? 

### i J ^ Wa s damag i t o th e foundatio navoided ? 

### / / A 3 .Wa s damag e t o w indow s avoided ? 

### ^ A 4Wa s damag e t o window s o r door screen s avoided ? 

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Wa s damag e t o dovNitspout s o r dov^nspou t extension s avoided ? 

## ^ l ^ Sidewalk s an dDrtveway s (Concrete ) Ve s No 1 .Wa s damag e to drivev^a y surface s avoided' ; 

### Ht ^ 2 .Wa s damag e t o v^allcwa y surface s avoided' ? 

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### Owner s comments :

[nspec-tie nQctp« : 

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R£mc \al and:esicr2ti: naci ^ ale s con".p'ete includin g ihe I-0-da\ " so d^varrant} : EP.A. Representati n.Qt f 

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## Propert yCompletio n Agreemen t Thk s agrccnicn l docimient s the completio no f remedial activitie s perfonne do nm y properl y M y sigiialiii e will designate tha i i a msatisfie dwit hthe restoratio no f m y properly , an dtha t no ilem s ar e i n qiicslions . now . o r a

l an y lime i nihc riitine , excep t thos e ilem s liste dbelow , ifany . Propert y ID : tyQ^j/^ ^ l>to|Hi(yA.I(lic.s.s : /y^ ^ 5 - // ^ 

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# '' • AAjbi7f-< . Ti/n/y^ A Phone : 

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Owner' s Signatur ePROPERT YCLEARANC E WORKSHEE T
Dat e Propert yI D 

# SoL^l- K fl^l'/Ol ' Propert y Projec t Omah a Lea d - - Fixe d Pric e 

# liJN , S lis t Addres s Measuremen t XR F I D 0107-5 1 Count/Tim e 

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## loucyl—l' ^ yiS) ^ j ^ Tota l Quadran t Squar e Footag e t o b e Excavate d = 3 7 Propert yClassification : 80 0 Tota^fc o Zon e Linea rFootaa e t o b e Excavate d = 0 

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Scal e 1 Inc h = 2 0 fee t o r1 gri d = 5 x5 ft Omah a Lea d Sit e Omaha , Nebrask a Propert yNumbe r OLS-5064 8 Propert yAddres s

140 6 S 1 1 S T Pos t Excavatio n Concentration s (ppm ) Fl . B 2 Pla yArea F 2 D Z Easemen t 8 1 Garde n Othe r Desaiptio n o fpos t excavatio n areas : F1 . fron t yar d left-han d quadrant ; F2 . fron t yar d right-han d quadranl ; Bl , bacl<yard left-han d quadrant ; B2 , backyar d nght-han d quadrant ; D2 , dri p zon e ( 1 - 3 foo t are a o fsoi l aroun d th e foundatio n o f th e house) .^vit o sr< . COASTA L 

# \

y 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 Environnnenta 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 : ^'^i^^i ^ CAA/A^ ^ Daytim e Phone : — 7 "ZTP , c J Q " t^-^ k
Addres s o fPropert y covere d b ythi s 

# \^t^( p s fls r 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 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 fCoastal 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 subcontractors 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 f2\ ,,o *COASTA L r):a , eC ^ ENVIRONMENTA L 'it PR0l*-< ^ GROUP , INC . 

### •Remov e obstruction s includin g boats , trailers , vehicles , playscape 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 necessarysubsequen 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 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 . •Allo wvideotapin g and/o rphotographin g o fth 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 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 (877 ) 234-6270 .

ffigr I gran t access t o m ypropertie s Q I d o not gran t access t o m ypropertie s 

# yZ-^c ^ ^ .^..-ilt^c n Signatur e Dat e Signatur eDat e G 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 f2

### Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o provid e amutual agreeinen t a s t o condition s ofth e propert> ' prior t o remediatio nactivities . Thi s will als o serv e a s documentatio nfo r th e purpos e o f assurin g tha t restoratio n activitie s ar e complete dto th e satisfactio no f th e propert y owne r an dth e Unite dState s Environmental Protectio nAgenc y (EPA) .

Property ID : (^0(^7 ^ Propert yAddress : | C^Q ^ 5 [ \ ^ ^ Q»ner : A^tQbgjg^S a <CAVAt>A 

### Phone : 

# r55-qai 3 Onth e attache ddiagram(s ) indicate area(s ) t o e.xcavate danddept ho f e.xcavation . locationo f all known utilities , subsurfac e features , surfac e structure s andlandscapin g features , acces s location(s ) t o be usedb y contractor , andthe directio no f North . Indicate distances , depths , materia l types , etc . Indicate digital photo s b

y referencin g the photo-lo g number wit ha n arro w indicating 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 : Item : Item : Item : Item : Item : 

### Item : Item : Pag e 1 o fCOASTA L 

### 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 : 

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Pag e 2 o fCOASTA L 

### 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 : 

## 5<3 b Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 3 o fCOASTA L 

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

## 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 inch trunk diamete r

Number o f tree s <= 2 inch trunk 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 andsiz e o f eac hgarden,/ flower bed area . .Attac hasketc ho f relaii\ e size s an dlocations . 

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## Ite m 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 will b e use dt o issu e aplan t \ouche r t o th e propert y owner . Agree dupo nlis t of plant material s that will b e replace db y contractor . B e ver y specifi c anddetailed . Includ e asketc hof wer e eac hplant will be placed b

y th e comracioi' . Agree dupo nare ao f property t o b e replace d wit hgras s sod . Includ e asketc hof the ai-ea(s ) to b e replace duit h gras s sod . .Are ao f Cit y o r Count y propert) ' to b e landscape d pe r thei r requirements . Includ e asketc hof tlic are a(s )

Easemen t .Area, t o be excavate d 

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Pag e 5 o fCOASTA L ENVIRONMENTA L CROUP . INC . Additiona l Comment s / Instructions :

• Chec k th e bo xi fOwne rdoe s no t wan t CE G t o documen t interio rfoundatio n wall s an d possibl e pre-existin g damage . B ycheckin g thi s bo xCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro fhouse , includin g foundatio n crack s o rfissures .



### 0^ 1 agre e nI d o no t agre e 

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# - ye^y- 7 Owner' s Signatur e Dat e Contractor' s Signatur e Dat e ^ Pag e 6 of .

# n CONTAC T FORM Property I D # Property Address : Initial Contact : Secon dContact : Final Contact : Final Action :

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

# yM/ y Tkyyyy ^ Date : Time : Action :

Date : Time : Action : Dale : Time : Action : Transmi t to EP AD Othe r Action : D



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