## Propert y Acces s Checklis t Property ID : ^Z-lcSSL ? D WOR K STARTE D ON : D WOR K COMPELTED ON: _ Property Address : L\' p ^ ^ NIA<W ^ St * 0>ync n Rente r 

# Loi s Rm^e,r \ Phone : Address : - y



# HimMasDA5 f Fax : Cell/Page n Phone : Additional Information : 

# 4* ^ ^'^'=1 ? Fax : Cell/Page n D NotificationLette r Sent : / / By : 

# 1 ^ Acces s Agreement 

## Signed : 9_/i.09 . By : ^ Restoratio nAgreemen t 

### Signed: 3_/^/ ^ By : D Topsoil Samplin g (if applicable ) / / By : 

# 1 D Disposa l Samplhi g (if applicable ) / / By : D Garde nSamplin g (if applicable ) / / By : D Utilit y Clearanc e Called : / / By : O Video/Photo s (Before ) On : / / By : D Video/Photo s (During ) On : / / By : D Video/Photo s (After) On : / / By : D Vldeo«»hot0 8 (30-Day ) On : / / By : D Property Completio nAgreement Signed : / / By : D Final Report Issued : / / By : _ ^ Ai r Monitorin e (a s applicabl e D Communit y QCrc w On : / / By : Results : D Conununit y QCre w On : / / By : ResuHs : Q Communit y QCnj w On : / / By : Results : Omah aLea dSit e 3005479 4 

# nnii i Superfun d

## Douglas Count y Accoun t Ii]|Hjmatio n Pag e 1 of 2 o&aa s Dougla s County , Nebrask a Propert yRecor d - R161864000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f52n d S t - Viev ^ O n Ma p Informatio n i s vali d a s o f2009-8- 3 Treasurer' s Ta xRepor t Nev wFeatur e - •^ - •Aut o Sale s Searc h Owne r ENGMA N LOI S M 424 7 MASO N S T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 186 4 000 0 1 6 Accoun t Type : Residentia l Parce l Number : 161864000 0 Parce l Address : 424 7 MASO N S T OMAH AN E 68105-000 0 Lega l Description : LEAVENWORT H HEIGHT S LO T22 2 BLOC K0 4 5 X 10 8 Valu e Informatio n Lan d Improvemen t Tota l 

## 200 9 $5,600.0 0 $82,800.0 0 $88,400.0 0 200 8 $5,600.0 0 $82,800.0 0 $88,400.0 0 200 7 $5,600.0 0 $82,800.0 0 $88,400.0 0 200 6 $5,600.0 0 $82,800.0 0 $88,400.0 0 200 5 $5,600.0 0 $64,500.0 0 $70,100.0 0 200 4 $5,600.0 0 $64,500.0 0 $70,100.0 0 Sale s Informatio n Sale s Date : 2008-07-2 5 Dee d Type : Q C Booilr : 200 8 Page : 07577 9 Price : $0.0 0 Grantor : SOUKU P CIND YR Grantee : ENGMA N LOI S M E Valid/Invalid : Invali d Exclusio n Reason : Famil ySal e Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 1 4860. 0 1. 0 108. 0 45. 0 N o Improvemen t Informatio n 

## http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=R16.. . 8/22/2009

### Dougla s County Accoun t Injamatio n Pag e 2 of 2 ij^jm a
Buildin g 1



## is mT I

" Silt * ^— ^ l!?!. ^ 5.*IAPJ"——
- 

# RANC H CLIC KTO ENLARG E IMAG E CLIC KTO ENLARG E IMAG E 

### ] Squar e Footage : 1002. 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 : Centra l Ai rt o Ai r Rooms : 5. 0 Exterior : Fram e Stucc o Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 2. 0

Roo fType : Gabl e Stories : 1. 0 Floorcover : Allowanc e Foundation : 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 191 6 0 % 191 6 9 0 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Blocl < 8 f t 974. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 308. 0 Porc h En d Scree n 160. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R16. . . 8/22/200 9

## CONTACT FOR M Propert y ID # 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) : 

## x\C)*h W M?.^- ^ ^^Q.soK ^ 

## S V Date : Time : Date : Time : Date : Time : Transmi t t o EP AD Action : Action : Action : Othe r Action : D

## Pag e 1 of 2 #

" > Creat e Anothe rTicke t |rj ^ Bac k t o Irt h interne t , ] SendEmaX I ] iL-.u . i > ­



## • YOURTICKE T NUMBE RI S 2362527 . Origina l Cal l Date : 9/12/0 9 Time : 6:2 8 p mOp : ELIZABETH1879 0 Wor k t o Begi n Date : 9/16/0 9 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 424 7 Street : MASO NS T Twp : 15 NRng : 13 E Sect-Qtr : 20-SE-S W 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 : 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 Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : coasta l Dept h o f Excavation : 4f t Come r Lot : N Involve s Tunnelin g o r Horizonta l Borin g : N Front : Y Explosives : N Rear : Y ALTS7 2 UNOTE L BSHPCLK S CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac t 

### Phon e Numbe r UtiUt y Typ e ALT87 2 WINDSTREA M COMMUNICATIO NN A 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 BSHPCLK S NEBRASKAHEALT H SYSTEM 

## N A Day : 402552346 0 Alt : 402552334 7 Emerg : 402559511 1 CXCAT V CO X COMMUNICATIONS , IN C 

### HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 

## Day : 402504782 3 METROPOLITA NUTILITIE S MUDO l SAND Y 

## Alt : DISTRIC T 

## Emerg : 402504797 0 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS., . 9/12/2009

### Pag e 2 of 2

OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO N

0PPDGPR 5 OMAH APUBLI C POWE RDISTRIC T N A
QLNNEI C QWES T LOCALNETWOR K 

### N A

ANDREW UNOTE L UNIVERSIT Y O FNEBR/OMAH A TAYLO R 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 402554359 9 Alt : 402554303 6 Emerg : 402554264 8

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/12/200 9

## Pag e 1 of 2 %

" > [ . __^Creatj 3 Anothe rTteket j [;Ba^^ ^ Interne T Sen d Emai l



## • YOURTICKE T NUMBE RI S 2365470 . Origina l Cal l Date : 9/16/0 9 Time : 10:5 3 a m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 9/18/0 9 Time : 11:3 0 a m State : N E County : DOUGLA S Place : OMAH A Address : 424 7 Street : MASO NS T Twp : 15 NRng : 13 E Sect-Qtr : 20-SE-S W 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 : FAX AL L CLEAR S TO : (877)662-421 1 : tJNSUR E O F CORNE R LO T 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 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 ALT87 2 BSHPCLK S CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C UNOTE L

Servic e Are a Contac t Plion e Nunibe r Utilit y Typ e ALT87 2 WINDSTREA M COMMUNICATIO NN A Day : Alt : 406728934 3 406207149 4 Emerg : 888728934 3 BSHPCLK S NEBRASKAHEALT H SYSTEM N A Day : Alt : 402552346 0 402552334 7 Emerg : 402559511 1 CXCAT V CO X COMMUNICATIONS , IN C HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y Day : 402504782 3 Alt : 

## Emerg : 402504797 0 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 9/16/2009

### Pag e 2 of 2 %

OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO N 

### Day : Alt : 402444719 7 402444516 1 Emerg : 402444516 0 0PPDGPR 5 OMAH APUBLI C POWE RDISTRIC T N A 

### Day : Alt : 406728934 3 406207149 4 Emerg : 888728934 3 QLNNE l C QWES T LOCALNETWOR K N A 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 UNOTE LUNIVERSIT Y O FNEBR/OMAH A ANDREW TAYLO R 

### Day : 402554359 9 Alt : 402554303 6 Emerg : 402554264 8

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 9/16/200 9OLS# : 2105 6 

# As-Buil t Drawin g ^ Dat e Excavated:9/22/0 9 Dat e USEP ASigne d Off : 11/10/0 9 C OASTA L 

# Omah aLea dSuperfun dSit e Are a Sodden : 135 6 s o f t ENVmOMHENTA L ; n o u r , INC .

Name : _ Omah a Lea d Sit e Date : 

### ^-/^ ^ NorthArro w Address : Stt e Sketc h Time : Phone : Tea m "Vh^ yy^A/A-^/$jK> s BVID # 7/<r5" ^ XR F Cod e fTV O ' ^ Sampl e Numbe r Lea d Concentratio n Confimiatio n Sampl e Z 7 I XZ. J pp m fl-ie s a N o K3 |FYft<; rOxA - 2.)o.v C a-7 3 ^3 ^ pp m ^iYe s n N o c a pp m , 7 I Ye s Q N o C B fVnSrPXA - Z/o.s£ . pp m 

## f?Ye s • N o B pp m ^2Ye s • N o ^ pp m Ye s • N o a pp m 

# • N o •



### IV^^C' f "//. OmahaLeadSit e 4613 0 

### Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are a replace d wit h Are areplace dwit h Are alef t bar e So d Rock/Mulc h 

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

# ft 9|l( ^ ^'S^l^ ^ r^^Qn-^ ^ 1 ^ : Name : _ Omah a Lea d Sit e Date : 

## ^-3^ } Nort h Arro w Address ; 9 2 1 7 t^i5o h Sit e Sketct i Time ; Phone : '^p~L-^T/ - fffT -



### t ^ ^^A h 

### ^ / . nah a Lea d Sit e 46130

# 1 ^ Name : Omah a Lea d Sit e Date : 

## f-3^ } Nort h Arro w Address : 

### 9 1 1 7 i^i5i h Sit e SIcetc h Time : Phone : 

### '-i c-2^-^r/ - *ffT - Tea m / k ^ Yx^/^/j^fe" ^ BVI D # 7/.r5" ^ XR F Cod e 'S'FT O ^ Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e pp m 

## /^/Ye s ° N o 1 3 f'^n.'^cii xA- z-iovi: . 

### a-7 3 r 2. ; pp m /"Z-Ye s O N o E l pp m . 7 / Ye s Q N o C B pp m /^?Ye s • N o 1 3 gKr^S^PKA- - :^|os- u pp m N o ^ pp m ^ Ye s • N o n pp m Ye s a 

### N o •



## hi^AA h "y/. OmahaLeadSite 4613 0.•v^'l^^V , COASTA l fHVIXONnihTA l CROUP . IN C 

## 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 : 

### Ldp , 

# ^r . ^i^'^i ^ Addres s o fPropert y covere d b ythi s Agreement : 

# ^2^ 7 k^o n^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 remove soi l tha t contain s elevate d concentration s o flea d an d maypos 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 fCoasta 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 perfomied , th e Granto rwil l hav e a n opportunityt 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 EPAtha 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 right 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 fperformin g th e wori^ . 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 f2

### e COASTA L INVtKOMHtKTA l C I t O U » IN C



### * 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 ; ( Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , necessar ysubsequen t t o a n initia l waterin g perio d b yEPA ; a s

« 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 . e>

Allo 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 gran t acces s t o mypropertie s D I d o no t gran t acces s t o m ypropertie s ^ fy^ ^ 'r-^^'^^y^^ ^ 9l7.9^\6 ^ Sibnature Date Signature Date
DI woul d iik e t o b e presen t durin g an ysamplin g tha t i s required .

Page 2 o f2COASTA L c« o u rIN C 

## Restoratio n Agreemen t Tli e purpos e o f thi s agreemen t i s t o provid e amutua l agreemen t a s t o condition s ofth e propert y prio r t o remediatio nactivities . Thi s wil l 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 dt o th e satisfactio no f th e propert y owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA) .

Propert y ID : ' 7 lO*^/ ; Propert y Address : t^- ^ OiyviMvr
- 1/2 U 7 ^ ^ ^.^v , ^t Owner : l .. ^ y_ Phone : ^5/^ ^ O nth e attache ddiagram(s ) indicat e area(s ) t o excavate dan ddept ho f excavation , locatio no f al l know n utilities , subsurfac e features , surfac e structure s an dlandscapin g features , acces s location(s ) t o b e use db y contractor , an dth e directio no f North . Indicat e distances , depths , materia l types , etc . Indicat e digita l photo s b y referencin g th e photo-lo g numbe r withanarro w indicatin g directio no f view . 

### Item s T o B e Remove d B yOwne rBefor e Start O fRemediation : (Us e additiona l sheet s a s necessary ) Th e renK>val , storage , disposal , and/o rretur n o fthes e item s I s th e Owner' s responsibility . Item : 

# 4-^, 1 ? U . Item : / / / Item : / Item : / Item : / Item : / Pag e 1 of .COASTA L fl >

* V « ft O H r * t M TA L C I t O M r. t M c 

### Item s T o B e Remove d B yContracto rDurin g Remediatio n An d No t Replace d (Us e additiona i sheet s a s necessary ) Item : 

## ^ gt.U^t4-.Ui ^ 'yy^^^j l Pl^Jb > Item : Item : Kem : Kem : Item : Kem : Kem : Item : Item : Kem : Kem : Kem : Item : Kem :

Pag e 2 of .C g AS T AL •NVtftOMntMTA L C n o u rI N c Item s T o B e Remove d B yContracto rDurin g Remediati'o n An d Replace d (Us e addKiona l sheet s a s necessary ) Item : 

# " ^ /^o ; 

# / g / Item : Item : Item : Kem : Kem : Kem : Kem : item : Item : Kem : Kem : Item : Item : Item :

Pag e 3 of .COASTA L CN' vIRO N MI M TA L C « O U r. t M C 

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

## Item

Pre-existin g property area , tha t wil l b e excavated , tha t i s covere dwithgrass .

Numbe r o f tree s > 2 inc h trun k diamete r

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

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

## Quantity



## B l



# 1

/ 

# f Unit

Squar e fee t

Eac h

Eac h

Eac h

Eac h Squar e Fee t 

## Condition/Type/Specie s

• ^

Pag e 4 of .COASTA L 

### Ite m Quantit y Agree dupo nvalu e o f plan t material s no t t o b e replace db v contractor . Not e thi s valu e wil l b c use dt o issu e aplan t vouche r t o th e propert y 

# p owner . Agree dupo nlis t o f plan t material s tha t wil l b e replace db y contractor . B e ver y specifi c an ddetailed . Includ e asketc ho f wer e eac hplan t wil l b e place d 

# A b y th e contractor . Agree dupo nare ao f propert y t o b e replace d wit hgras s sod . Includ e asketc ho f th e 

# A area(s ) t o b e replace dwith gras s sod . Are ao f Cit y o r Count y propert y t o b e landscape d pe r thei r requirements . Includ e asketc ho f th e are a(s ) 

### /

Easemen t Area , t o b e excavate d 

### \ 

### Urii t Condition/Type/Specie s

$

Eac h

S F

S F

S F 

### ^ e^i,^A\^<L^^\^< >

Pag e 5 of .C OAST AL • MV*R«HMCHTA L • «iewr . IM C AddKiona l Comment s / Instnicttons : 

### ^^^ \ \ toeej? . VLc^c l KJ <k.\yy.^^__

J^Chec k th e bo x if Owne rdoe s no t wan t CE G to documen t inferio rfoundatio n wall s an d possibl e pre-existin g damage . Bycheckin g thi s bo xCE G is no t responsibl e fo ran ydamag e don e to 4i e interio r of house , indudin g tbundatto n crack s orfissures.

I agre e O I do no t agre e

ner' Dat e Contractor' s Sienatsr e Owner' s s Signatur

Signatur e e Dat e Pag e 6 of .BVI D 

# ,cZ/05 6 XR F PROPERTY SAMPL E SHEE T Dat e Projec t 

# q-zjz-cp f Omah a lea d F P 2nc l yea roptio n Addres s Sampl e tim e 

## H2.H h am/p m XRFID # sampl e lengt h 3 0 se c

Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a 

## <5o i H O 2 . ^0 3 

### '^O H ^« n 

# 5

? in ^ ^( o t I I 

# t q

t- u ti o ^ Dept h » " 

# ^^6 U o n O d ^o ^ "\y o /^ s -^ ^ ^f £ 

# g i Dept h Averag e 

# llli Q Averag e 

# 17^-' ^ Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h Averag e Averag e

Shot # Readin g Sampleare a Shot # Readin g Sampl e are a Dept h Dept h Averag e Averag e RETES TAREA S Shot # Readin g Sampl e are a Shot * Readin g Sampl e are a Dept h [Dept h Averag e Averag e la b sampl e # La b resul t Sampl e are a XR F Avg . Signatur e ^ 

# prinir,UftrtV-rtVAC^oi?€< ;

## i\QL\ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 I ^^^^A L I Coasta l Envlronmenta l Grou p Inc . ^^^^y ^^^T # www.coa8talhazmat.co m XpROrt?^^ COASTA L iMVIIOHNIMTA l GlOUP . IM C 

# EXECUTIV ESUMMARY : BVID #21056-(424 7 MASO NST ) No Issue s o r Concern s [ ^ Issues/Concern s Detail Explanation : -COASTA LTO RE-IMBURS ETH EPO FO RACLEMATIS PLANT . (COMPLETE D 01/30/10 ) -COASTA LTO PU T BACK TH ECLOTHES LIN E(COMPLETE D 11/9/09 )

### # 

## Propert yDamag e Settlemen t

Property ID 2105 6 Property Addres s 4247 Maso nS t Owner Loi s Engmen Phon e (402) 551.939 2 I hav e receive dfromth e contractor , Coasta l Environmenta l Grou p Inc . (Coastal) , th e su mo f $8.0 0 t o compensat e for plant s tha t wer e remove ddurin g th e remova l o f lea dimpacte dsoi l fixjm th e property . Compensatio ntyp e Check 188 4 Valu e o f Check ; $8.00 Check t o th e orde r o

f Loi s Engmen Descriptio n o fDamag e 

### Whil e excavatin g 424 7 Maso nS t (BVI D 21056 ) Coasta l damage dsom e plant s beyon dsalvage . Property owne r receive dachec k for th e amoun t o f $8.0 0 dollar s for th e replacemen t ofth e plant s an driver rock . M ysignatur e belo wacknowledge s th e replacemen t o fm yplant ; further , I acknowledg e tha t thi s wor k wa s complete d satisfactor yan d withi n m yan d releas e Coasta l Environmenta l Group , Inc . fro m luilhei - ofrliqatlop s o rliabilit yrelate d t o thi s property . 

## 188 4 OMAHA , N E 68105 

# ^^li o 27-5/104000 3 624737290 4 DAT E 

## '^^t^AcrlJ)\ Afni^ma n 

# $ g &

. DOLLAR S 0 0»iaii * o n WUknigogank,ltA . FO R 

## W\\ ) 9JChifi 42H 1 MM.SrtnXf - '^^VuMy^ / d^lQl^r ^ 

## • 1101.00005ai : &21,737Bqoi,ii - oiaai . 

# t C^-t-A- *

ner' s Signatur e Dat e 

### Contractor' s Signatur e Dat e Pag e 1 of1

# EPAPropert y Clos e Ou t For m Date/Tlroc : Quad s Excavated : Contracto rGrou p C> 0 Ye s N o Excavatio nGenera l 1 .

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 ofdri p zon e excavate dan drestored ? 

# t y ^ Ye s N o Gradin g So dan dVegetatio n 1 .Doe s th e gradin g aroun dth e perimete r ofth e hous e inexcavate darea s generaU y slop e away 

# z r fromth e house ? 2 .Ha s so dbee nlai di nal l area s tha t wer e excavated ? 

# l y 3 .

Doe s th e so dappea r t o b e generall y health y andgrowing ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period ) ___ ^ 4 .Ar e sodde darea s generall y nr man devenl y graded ? 5 .

Ar c th e joint s behvee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 day 

# v r tim e period ) 6 .Wa s th e propert y grade dsuc htha t wate r wil l no t poo l o nth e property ? 7 .

Wa s damag e t o landscapin g o r plan t material s avoided ? Gates . Fence s an dRetainin g Wall s 1 .D o gate s ope nan dclo.s c freely? (Ifappiicable ) Wer e al l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinsulled ? 3 .Wa s damag e t o gate s o r fence s avoided ? (Ifappiicable ) 4 .Wa s damag e t o retainin g wall s avoided ? (Ifappiicable ) Foupdation , Sidin g an dGuHer s I .Wa s damag e t o di e sidin g o r tri mavoided ? 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 o r doo r screen s avoided ? 5 .

Wa s damag e t o downspout s o r downspou l extension s avoided ? Sidewalk s an dDriveway s (Concrete ) 1 Wa s damag e l o drivewa y surface s avoided ? 2 .Wa s damag e t o walkwa y surface s avoided ? 

# Z Z y Ve s No 

# z A (Ifappiicable ) 

# Z 7 

# z^n • y ' i Yes N o

^	 ' 

# y x y Yes y , No 

# l7 t

## Owner s comments :

Inspectio nnotes :

Remova l an drestorationactivate s cowplet * including th e 30-da y sodwarra n EP ARepresentativ e AJCT K 

## U^lAJ ^ Date : \{ffO .

# % m

Propert yCompietio n Agreemen t Jhi s agreemen t documeni s the compielio no l remedial acliviiie s perfoiine donm y properl y M y signaiur e Wil l designal e ihal I a msatisfie dwit hlhe rcstoralio no f m

y propeily , andiha l n o iiem s ar e i n questions , now , o r a l an y lim e i

nth e future , excep l Ihos e ilem s hsle dbelow , ifan y Propert ytP : C:^\Cf^ L Propert y Address : L(gLtf: ^ t^A^.^OV n51 " Owner : /^t S f^YXAAJ^y^A 

### Phone : ^<=5\^q' ^ Restoratio n Item s i n Question :

Item : 

## 9 u "f cUQ74e5^:nJ B 

# v^/4c KOx " Item : 

# Ci^^A^:ii > PL^f

- ^^PLx^c^ t Item : Item : Item : Item : Additiona l Comments :

i^Jsl,«('rc crcstoralio n i s complcttd , excep t a s noler t [ I I rto no t a^re crestoratio n i s complele d

Owner' s Signatur e Dat e Cont i actor' s Signatur e Date '