TRANSMITTA L of OMAH A LEAD SITE 

SOIL REMEDIATIO N FILE FOLDER 

SAID#: Jy^Y^ ^ Date: ^/f/6^ 

Address: HO( p S 4^ 3 S T 

Remediation Contractor: Coastal Environmental Group_ Year: 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

B Video of property (DVD) 

0 Executive Summary 

'0 EPA-provided property sketch 

Q7 Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

0 Restoration Agreement 

D Settlement documents (i.e., for damage or to replace plants, etc.) 

M Confirmation data 

M Photographs ^ 

Gr As-built sketch 

M Satisfactory restoration signed by Property Owner 

SZ Property close-out check list signed by EP A 

D Descriptionof areas not meeting ROD cleanup criteria 

D Utility clearances 

D Property information from Douglas Coimty Assessor's Office 

D 

D 

D 

Date 

40317903 

Superfund 
Final Report Property Check List (piease place with each file) 

Har d Cop y Informatio n '/I5U S 4^ ^ 

g 1. Propeily Check List 

^ 2 Site Working Drawing Map 

EPA originals Map 

IS4 Douglas County Asses.sor's Map 

Property Contact Sheet 

Agreement 

i S ' • Access Agreement 

rg 2. Restoration Agreement 

Miscellaneous Documents 

0 1. Final Map from the Field 

• ^ 2. Change Orders 

ng.l. XRF Data 

^ ^ 4. Any emails or PO correspondences 

Property Completion 

D I. Executive Summary 

n 2. AS BUILT 

f2! 3. Property Completion Agreeinent 

^ 4. Any buyout info or reimbursement into 

l2r5. Check or money order copies 

^ 6. EPA Property Close Out Form 

^ 7. Attached Begin Video 

Electroni c Documentatio n 

Drawings 

I. EPA original 

jx2 . Working Drawing 

a3 . AS Built.vso 

• 4. AS Built.jpg 

Photos 

I Begin Photos 

iS 

I During/Excavation Photos 

'"> Sod Photos 

'^ 30-Day Sod Photos 

0 Scanned Documents 

a Final Documents 

Executive Summary 

Videos 

a Begin Video 

My Movie 
# 

Property Access Checklist 

Property ID: 907^B 

Property Address: llOO'^.^iifSh 

o^nen pyf^i^i^ 3chkmn\~f K 

Address: 

Phone: ^^[^O^l^' ^ 

Fax: 

Cell/Pager: 

D

D

 WORK STARTED

 WORK COMPELTED

 ON:

 ON:

 /

 /

 / 

/ 

Renter: 

Phone: 

Fax: 

Cell/Pager: 

Additional Information: 

n NotificatioD Letter Sent: / / Bv: 

[\A Access Agreement Signed: [p l/(f I 0 7 ^y-ylUanm 

^ Restoration Agreement Signed: if ij U l0 7 Bv HarCDS 

I I Topsoil Sampling (if applicable) Bv: 

I I Disposal Sampling (if applicable) Bv: 

I I Garden Sampling (if applicable) Bv 

Utilitv Clearance Called; l() 1/ ^ l0 7 By^^]Si'li^ 

Video/Photos (Before) On: (^3 I {^1 o r Bv 1^;cirv 

Q^ Video/Photos (During) On: "7 / -t, I ^ 7 Bv 

H Video/Photos (After) On: J I 71 0 7 Bv: 

IS Video/Photos (30-Da.v) On: fi/ ^ / 07 ^y "SPcV- Property Completion Agreement Signed: ^\ I [0 1 6 7 Bv: CK<^'s 

n Final Report Issued: / / Bv 

Air Monitoring (as applicable) 

n Communitv d ] Crew On: / / Bv: 

Results: 

r~l Community CD Crew On: / / Bv: 

Results: 

n Community D Crew On: / / Bv: 

Results: 

Omaha Lead Site 
Square Footage to be Excavated = 1325 

Property Classification: 800 'e Linear Footaqe to be Excavated = 127 

f r^ 

Description of post excavation areas: Fl. front yard left-hand quadrant; F2, front yard right-hand quadrant; Bl, backyard left-hand quadrant; B2. backyard right-hand quadrant; 

DZ, drip zone {1 -3 foot area of sot! around the foundation of the house). 
Print Preview Page 1 of 1 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner City 

Owner 

State 

Owner Zip 

0825850000 

SCHLEMMER 

IRENE 

1106 S 43 ST 

OMAHA 

68105 

4909 BROWNE 

ST 

OMAHA 

NE 

68104 

Sec-Twn-Rng 

Owner 

Address 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Assessor 

Website Link 

29-15-13 

COMER ADD 

2 

2 

N 44 S 88 FT LT 1 

& N 44 S 88 E 48 FT 

44X100 

http://douglasne.mappingonline.com/DouglasCoNe/static/accountinfo.jsp? 

accountno=R0825850000 

Disclaimer Map and parcel data are believed to be accurate, but accuracy is not Map Scale guaranteed. This is not a legal document and should not be substituted for a title search, 1 inch= 177 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 6/7/2007 
Property ID # 

Initial Contact:

Second Contact:

Final Contact:

Final Action:

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

90W) 

 Date:j7/^_Time:^f ^ AzUoxr._MMMt^'^ 

 Date: Time: Action: WU- P 

 Date: Time: Action: 

 Transmit to EPA U Other Action: D 

' 

U|j . VA7^P^ \aApc, Cifpn^. 
/ 

-"»^l < 

COASTA L ENVIRONMENTA L 

GROUP , INC . 

* Consent For Access To Property ­ ,-• • • • I ' •" , > • - . 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consents to and authorizes the United States 

Environmental Protection Agency (EPA) or its authorized representatives, collectively 

the Grantee, to enter and perform certain environmental response activities upon the 

following described premises: 

Owner!*? Name: Daytime Phone: yp(7Ji- ^.S'/^ ^ SJS^^ ^ 

vrliLx^ 

SIP^T^^I^"^^^^ 

Agreement: Q ^/77S ^ PyplTtJ^. 

PURPOSE OF RESPONSE ACTIVITIES OP2 "^ Q^^y^pThe EPA is requesting access to collect soil samples and remove soil that contains 

elevated concentrations of lead and may pose a health hazard. The area(s) will be 

excavated to remove contaminated soil. The removed contaminated soil will be 

replaced with clean materials and the area will be restored to its original condition. This 

work is being performed under the Omaha Lead Superfund Site remediation program. 

A representative of Coastal Environmental Group, contracted by USEPA, will contact 

the Grantor in-person to discuss the work to be performed, the Grantor will have an 

opportunity to review and approve the planned soil removal, and restoration work before 

it begins. Once the work is finished, the Grantor will be asked to review the work and 

confirm that it is complete and meets with the Grantor's approval. Upon completion, the 

Grantor will receive written documentation from EPA that the property has been 

remediated. ,;;Vs 

ENVIRONMENTAL RESPONSE ACTIONS 

By signing this Access Agreement, the Grantor is granting the EPA, its employees, 

contractors and subcontractors the right to enter the property, at all reasonable times 

and with prior notice, for the sole purpose of performing the work. This access shall 

remain in effect until the work has been satisfactorily completed. The Grantor also 

agrees to: . . .. - ,A 

Page 1 of 2 

^0168 
\^'";o im *

 c CASTA; . ENVIRONMENTA L 

CROUP , i N C 

• Remove obstructions including boats, trailers, vehicles, playscape items, wood 

piles, dog houses, etc; 

• Remove flower bulbs or plants that the Grantor or the Grantor's tenant may wish 

to save; 

• Water and maintain replacement vegetation, including fertilizer application, as 

necessary subsequent to an initial watering period by EPA; 

• Abide by health and safety guidance provided by EPA; 

• If the property is rented, assist EPA in obtaining tenant approval for access to the 

property to perform the work. 

• Allow videotaping and/or photographing of the property. 

AGREEMENT NOT TO INTERFERE 

The Grantor agrees not to interfere or tamper with any of the work activities, or with any 

of the work done, or with the equipment used on his property, or to undertake any 

actions regarding the use of said property which would tend to endanger the health or 

welfare of the Grantees or the environment, or to allow others to use the property in 

such a manner. 

Should you have any questions about this program, please contact Coastal 

Environmental Group, at (877) 234-6270. 

I grant access to my properties Q I do not grant access to my properties 

JO a,^^7 yui jp/cypfAtwrnKy (Z 

Ignature ^^p7 Signature

 Date 

Q I would like to be present during any sampling that is required. 

Page 2 of 2 
« ^ ^ 

COASTA L ENVIRONMENTA L CROUP . INC . 

Restoration Agreement 

The purpose of this agreement is to provide a mutual agreement as to conditions of the property prior to 

remediation activities. This will also serve as documentation for the purpose of assuring that restoration 

activities are completed to the satisfaction of the property owner and the United States Environmental 

Protection Agency (EPA). 

Property ID: f[g ­

1^^ 

Property Address: ^' U^ ^' y y. Owner: \ \- f i\ t- ^y P.\ P\l' ^' ^-

Phone: L

ISl '3< 

On the attached diagram(s) indicate area(s) to excavated and depth of excavation, location of all known 

utilities, subsurface features, surface structures and landscaping features, access location(s) to be used by 

contractor, and the direction of North. Indicate distances, depths, material types, etc. Indicate digital photos 

by referencing the photo-log number with an arrow indicating direction of view. 

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

The removal, storage, disposal, and/or return of these items is the Owner's responsibility. 

Item: 

iJoiWItem: 

y 

Item: 

Item: 

Item: 1 

Item: 1 

Item: 1 

Item: 

y 

Page 1 of. 
COASTA L 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

r

yyp-M ii"i 

Item: 

f y,^ „ \ I' . t^'^H Vi. Item: 

'7\f\\A\ yvA\yp ^3 

Item: 

Item: 

Item: 

7 

Item: 

Item: 

Item: 7 

Item: 

Item: 

Item: 

Item: / 

Item: 

Item: 

Page 2 of. 
( ^ 

COASTA L ENVIRONMENTA L CROUP . INC . 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

1, ^ V fr \^7i- fj ' i t) W4. Y^C'^ 

Item: 

/^(AA|niy \imh V '. yiw ' I'' / "tfy'ff t'/A­ ^ 1 

Item: / 

Item: 

/ 

Item: 

y 

Item: 

y 

Item: 

7 

Item: 

, / 

Item: 

Item: 

/ 

Item: 

Item: 

Item: 

Item: 

Item: 

Pag r, e 3 of. 
COASTA L ENVIRONMENTA L 

CROUP . INC . 

Landscape Inventory 

(Use additional sheets as necessary) 

Item 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch 

trunk diameter 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Attach a sketch of the 

sprinkler layout. 

Number of and size of 

each garden/ flower bed 

area. 

Attach a sketch of relative 

sizes and locations. 

Quantity 

Y-^ 

I 

r 

Q-^ 

\ U3\ 

i P 'Iv C)' 

Unit 

Square feet 

Each 

Each 

Each 

Each 

Square Feet 

Condition/Type/Species 

PP 

\ Iv ]i7&'. 

Page 4 of. 
( ^ 

COASTA L 

Item Quantity Unit Condition/Type/Species 

Agreed upon value of 

plant materials not to be 

replaced bv contractor. 

Note this value will be 

used to issue a plant 

voucher to the property 

owner. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketch of were 

each plant will be placed 

by the contractor. 

Agreed upon area of 

property to be replaced 

with grass sod. 

Include a sketch of the 

area(s) to be replaced with 

grass sod. 

Area of City or County 

property to be landscaped 

per their requirements. 

Include a sketch of the 

area (s) 

Easement Area, to be 

excavated 

7!/W7H^t'^^ 

,r $ 

p Each 

SF \P. 

SF 

SF 

Page 5 of. 
COASTA L ENVIRONME N T A L 

CROUP , INC . 

Additional Comments / Instructions: 

- ^/ryi' L ^r^^\pi\/ \p[ -IP- [iyfypppj 3 - \)7^ h'PL 

%y\r\op

u 

 C\yW^ \P P

h 

^ ^-^Y^I^X yttti^v^^ 

\ t/^ Pf^'^ Hfi^a^ , 

^P \ 'itP^(: /yi|^(^ P/f/pri/^/\p\r 

• Check the box if Owner does not want CEG to document interior foundation walls and possible 

pre-existing damage. By checking this box CEG is not responsible for any damage done to the 

interior of house, including foundation cracks or fissures. 

p ] I agree n I do not agree 

y C^li ^ PYX ^X'.'^ 

Owner's Signature Date extractor's Signature DaJe 

O 

Page 6 of f/: 
Total (!^Vant Square Footage to be Excavated = 1325 

Total Dnp Zone Linear Footage to be Excavated = 127 

', n 

Desaiption of post excavation areas: F1. front yard len.ttand quadrant; F2, front yard rigM.4iand quadrant: Bl, badtyard left.liand quadrant; B2, backyard right-hand quadrant; 

DZ. dr^ zone (I.3 tool area of sdl around tlie foundation of the house). 
Date: l/y^j/rf ? 

Name: A^ 5 

Description: 

^ ^^^^^ 5/:>^7^ ^jty^^y^/7) r7^co7^ OAJ rJT ^ 
PROPERTY CLEARANCE WORKSHEET 

^^7??;? 

1101^343 ^ 

Reading Sample Area 

Pass/Fail ? 

Composite Analytic Lab Analytical (Dried & al Spilt Numbe Results Sieved) Sent ? r 

Pass/Fail ? 

Composite Analytic Lab Analytical (Dried & al Spilt Numbe Results Sieved) Sent? r 

Pass/Fail ? 

Composite Analytic Lab Analytical (Dried & al Spilt Numbe Results Sieved) Sent ? r 

Date 

Project 

XRF ID 

Shot # 

233 

Q\3 

(l(>J7Qln7 

Omaha Lead -- Fixed Price 

0107-51 

Reading Sample Area 

W%i m m '^'7 P 

Aliquot 

1 

2 

3 

4 

5 

Aliquot 

1 

2 

3 

4 

5 

Aliquot 

1 

2 

3 

4 

5 

Sample Area 

I n Situ 

Reading 

Sample Area 

I n Situ 

Reading 

Sample Area 

I n Situ 

Reading 

96 

^ ^ 

0)5 

37 

FA-f 

Composite Readings 

(Bag) 

+/- 0 ppm ^

s? +/- 0 ppm 

77 +/- 0 ppm 

Dei2-/q" 

Composite Readings 

(Bag) 

37 +/- 0 ppm 

4(1, +/- 0 ppm 

q g +/- 0 ppm 

XRF Corrected Value ~ > 

(use calibration chart or add 

20<Vb to value) 

52 M'' 

Composite Readings 

(Bag) 

-71 

+/- 0 ppm 

+/- 0 ppm l « 

TH +/- 0 ppm 

••-:Sv::,;.|i;!-

Property ID 

Property 

Address 

Measuremen 

t 

Count/Time 

Field Shots 

Shot # 

Composite 

Average 

(Bag) 

bO 

75 

Composite 

Average 

(Bag) 

bb 

93 

Composite 

Average 

(Bag) 

54 

G? 

Confidential 6/5/2007 

Page 1 of 2 
R( Z-4*^ 

Composite Readings 

(Bag) 

l(j ^ 

+/- 0 ppm 

+/- 0 ppm IS4 

+/- 0 ppm \0\ 

XRF Corrected Value —> 

(use calibration chart or add 

2 0 % to value) 

Composite Readings 

(Bag) 

+/- 0 ppm 

+/- 0 ppm 

+/- 0 ppm 

XRF Correaed Value - > 

(use calibration chart or add 

20<Vo to value) 

i2iLg V7<^r\ 

J 

Pass/Fall ? 

Analytic Lab Analytical 

al Spilt 

Numbe Results Sent ? r 

Pass/Fail ? 

Analytic Lab Analytical 

al Spilt Numbe Results Sent ? r 

USE ADDITIONAL SHEETS IF 

NEEDED 

Aliquot 

1 

2 

3 

4 

5 

Aliquot 

1 

2 

3 

4 

5 

XRF Technician's 

Signiture 

Sample Area 

I n Situ 

Reading 

\77 

'=34 

117 

171 

104 

I n Situ 

Reading 

Composite 

Average 

(Bag) 

\^Q 

€)8 

Composite 

Average 

(Bag) 

Composite 

(Dried & 

Sieved) 

Composite 

(Dried & 

Sieved) 

Confidential 6/5/2007 

Page 2 of 2 
XRF DAILY CALIBRATION WORKSHEET 

•^-te oij,mo7 

Project Omaha Lead - Fixed Price 

XRF 0107-51 ID OlOTS ^ 

Measurement Count/Time 30 sec 

Calibration Verification Checks 

Reading Blank Low Med 

True Value 0.0 ppm 18.9 ppm 1152.0 ppm 

120% 22.7 ppm 1394.4 ppm 

80% 15.1 ppm 929.6 ppm 

^\C J 

inso 

Precision Measurements 

Average 

Within +/- 20% of True Value to Pass Calibration Check 

Precision Measurement Check 

Replicate Blank Low Med 

1 m^ 

2 m 

3 123 

4 Q20 

5 m(\ 

6 /flO 

7 iia) 

Mean Concentration 

Standard Deviation 

Relative Standard Deviation 

Relative Standard Deviation 

Less than 20% 

Confidence Interval @ .95 --> #VALUEI 

Method Detection Limit #VALUE! 

Average Confidence Interv| #VALUE 

High 

5532.0 ppm 

6638.4 ppm 

4425.6 ppm 

64#) 

5110 

High 

5510 

-4^7n 

f;30 

Hi^O 

iSKO 

^ 2 0 fqf) 

#VALUE! 
ID#: 707^^7 

Date: 7//^^7 

Name : (^/T/jf 

Description: 

//C/^ 5 y35 ^ 

/i7f;Sl> y'^ /7^y>//fc^ -^ F/eC&aJ^5-^/^ J/J 

Puyh. (cy/7 c^pyf a </--za&a) 
I

Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

% www.coastalhazmat.com y COASTA L ENVIItONHENTAL 

GROUP , IN C 

EXECUTIVE SUMMARY: 

20788—1106 S 43 ST 

 I No Issues or Concerns X Issues/Concerns 

Detail Explanation: 

PO was given a check from Coastal in the amount of $28.11 as compensation for one month water bill 

usage. 
^^s-Built Drawing 

COASTA L Omaha Lead Superfund Site 

Property line divided by 

1btal Quaik^art Square Footage lo be Excavated • 1325 railroad ties leave In place. lata Diy zone unBafFooQoe tone Excaatea 127 Do not remove 1 pole it's 

the neighbors. One only 

clothes line discard and 

small plants, rose bush. 

Replace lava rock under 

deck and other areas as 

before. Brick border, rove 

as needed and replace In F2 

/ 

ra "^^ i 

C ) 

EA- E = 60 PPM 

>:••..«••' . 

?:.•:.•;'•••I 33 

5k>Lth *3 Stiee 

Note: Deck is Elevated 

Nort i AnTMT Omaha Lead Site 

Otnana. Neorasta 

Date Excavated:6/28/07 

Praperty Number 

i^^gend 0LS#: 20788 

Date USEPA Signed Off: 9/1 1/07 0LS^i|l788 

Sal* 

t'x'y\ Pemanert Land&caping Rnopefly Address 1 lnc»i-2DfBetorl grtd-SxSn 1106 S 43 ST •

 » • Fence 

Quattanl ao(nla>r Post Excavation Ccncentrartiars (ppm) 

Street Boundary 

• HGl . F1_ B2 Playwea 

V /

 ^ F2 DZ Easemefit 

( y TYee^Shrub Bl ' Gaiaen otief 

• <ilpaatMa»«iMMiM PI •M«1l>t4ll«MM4uMrintf3.n«i>lMI«p»MM <MfMK M, llflVMt M MlMumMK C b«cM« Kt^Hmt q)iir»««t 

Legen d 

Are a no t Excavate d Dripzon e Excavate d <V>^ Quadrants Excavate d 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
s ^ EPA 

EPA Property Close Out Form 

Property #: oCT'S' ^ Property Address: //^ ^ y p 3 3 ^ 

Date/Time: Owner's Name: :Jp,oj ^ cSc>»/_p/-y/JTn ^sj y 

Quads Excavated: Contractor Group 

Excavation General 

Yes No 

1. If necessary, were the correct quadrant(s) excavated and restored? 

y 

y 2. If necessary, were the correct areas of drip zone excavated and restored? 

GradluK Sod and Vecetation 

Yes No 

1. Does the grading around the perimeter of the house in excavated areas generally slope away y from the house? 

2. Has sod been laid in all areas that were excavated? 

y 

3. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 

day / time period) 

4. Are sodded areas generally fum and evenly graded? / 

5. Are the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day y time period) 

6. Was the property graded such that water will not pool on the property? 

y 

7. Was damage to landscaping or plant materials avoided? y 

Gates, Feoces and Retaining Walls 

Yes No 

1. Do gates open and close freely? (If applicable) /v/-* 

2. Were all gates or fences taken down during restoration activities reinstalled? (If applicable) ^ 

3. Was damage to gates or fences avoided? (If applicable) ^^ 

4. Wasdamagetoretaining walls avoided? (If applicable) /jA^ 

Foundation, Siding and Gutters Yes No 

1. Was damage to the siding or trim avoided? 

.^ 

2. Was damage to the foundation avoided? \ y 

3. Was damage to windows avoided? 

i ^ 

4. Was damage to windows or door screens avoided? 

i - ^ 

5 4^- ­ . Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfaces avoided? ^ f 

2. Was damage to walkway surfaces avoided? 3 
Owners comments: 

Inspection notes: 

Removal and restoration activates complete including the 30-day sod warranty: 

EPA Representative ^/^^^^v^^.^.M^JL^ ^ Date: f 77-^7 
WPr 

Property Completion Agreement 

Tliis agreement docuinciUs Ihc completion of remedial activities performed on my properly. My 

signature will designate lhal I am satisfied with the restoration of my property, and thai no ilcms arc in 

questions, now. or al any time in the future, except those ilcms listed below, if any. 

Properly ID: mm. Property Adtlrcs.s: AA I -SC (/ -5 ^ / 

Owner: •TJLe^^ ^.Hi^fA^^±^ 

Phone: a^[.^i^lp 1 

Restoration Items in Question: 

item: 

item: 

Item: 

Item: 

Item: 

Item: 

[p[l Jigrcc restoration i.s coinplrtr<l, except as noted 

 ! I ilo not agree rcstorationris completed 

C^yLyyS()Jy/rJy4/n^/myy yy//n/^3 

Owner'.i( Signature Date Signature 

I
Property Damage Settlement 

Property ID 20788 

Property Address 1106S. 43"'St 

Owner Irene Schlemmer 

Phone 402-451-3552 

I have received from the contractor. Coastal Environmental Group Inc. (Coastal), a sum of $ 28.11 as 

compensation for one month water bill reimbursement. 

Coastal Environmental 1502 Group Inc. Check No. 

Value of Check $28.11 

Made Out To Irene Schlemmer 

Description of Miscellaneous Property Damage 

Reimbursement for one month's water bill excess for assisting with water the sod at 1106 S. 43"* St at the 

completion of lead remediation at this property. 

My signature below is acknowledgement of the receipt of the sum listed above, which I further 

acknowledge to be fair compensation for the miscellaneous property damage described above and 

release Coastal Environmental Group Inc from further obligations or liability related to this property 

damage. 

Owner's Signature Date Contractor's Signature 

Page 1 of 1 
COASTAL ENVIRONMENTAL GROUP INC. 1502 

825 S 26TH ST 27-5/1040 003 

COUNCIL BLUFFS, lA 51501 6247372904 

9/(Q/O V _DATE 

PAY TO THE 

ORDEROF J $ za.' ' 

^ ^ Saciurliy ^ ^ Featiirat 1* 1 DelStI* on .DOLLARS UU BocH. 

WelJs Fargo Bank, N A 

Nebraska 

wdIsfargo,com 

FOR lA^;^n^?K^ "R"l(i 

i:iDl.0D005fli : &Bit73 7 5qOi.ii'COl5DE « HARt.«^JD ."JERTY VENTURE 
J . yM'' 

7 ^ AcoOiint: 260950-1123057 7i 

17233 Harney St • Omaha, NE aBTO2 • 402.554.6666 

e-mail: customer service@mudnebr.com •website: www.mudomaha.com 

'db NE^TO : 

V-. IRENE D. SCH,/£MMER

 \ L 

Service adHress: 1106S43RDST j) P t 

Billing date Aug 10,2007 

Previous balance $0.00

^.pp\ FINAL BILL * %\\ 

Payment received 0.00 

Current charges 63.61 Thank you for being a valued customer. Ifyou 

New balance 

63.61 have any questions, call 554.6666. Please include ^ Total due Aug 28, 2007 $63.61 this account numl)er and service address in any II payment is received after due date, a late fee will be assessed on gas and water charges.

correspondence. 

Your Gas Use 

Details of current charges: 

GAS RESIDENTIAL RATE Jul 10toAiijig^10_ Meier Number 327088 23i 

1.. 

Current read (actual): 5046 - Previous read (actual): 5038 8 CCF 

12 Gas Use: 8 CCF x 1.024 (heat value) = 8.192 therms 

9 days 2.378 therms at 0.7464 = $1.77 

" SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG 22 days 5.814 therms at 0.8227= 4.78 

Service Charge 12.00 

Gas Cost 

$18.55 

1 Past 12 Months 9 ^»^t ^3'^'* Montlis / 

This Month Last Year 

Billing units: 8 I n/a 

Use per day: 0.2 \ n/a 

Average cost per day: $0.61 

\ » ^ 

Nutnber of days in billing cycle: 31 n/a 

Your Water Use 

WATER RESIDENTIAL RATE W-1: Jul 10 to Aug 10 

Meter Number 26862864 Size: 5/8 -inch 

Currentread (actual): 1994 - Previous read (actual): 1972 = 22 CCF 

Water Use: 22.000 CCF or 16,456 gallons 

9.000 CCF at 0.8720 = $7.85 

SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG 13.000 CCF at 1.2200 = 15.86 

Service Charge 4.40 

• Water Cost 

$28.11 • Past tZ Monttis g Past 13-24 Months 

This Month Last Year City of Omaha Sewer e,2.79 

Silling units: 22 n/ a Sales Tax 4.16 

Use per day: 0.7 n/ • Current Charges $63.61 

Average cost per day: $0.97 n/ a 

Number of days in billing cycle: 31 n/ a 

Please return this portion of the bill with payment. • We cannot accept credit card or on-line payments. • Please do not staple payment to bill. 

k 1723 Harney St • Omaha, NE 68102 • 402.554.6666 

e-mail: customer_service @ mudnebr.com

) metropolitan website: www.mudomatia.com V UTILITIES DISTRICT 

0002609501123057000000063617 


Due on or before Aug 28: $63.61 

If paynnent is received after due date, a late fee will l.li..l..l....llll....l„l,.I.I..II...I.I.I..III.Ml.l..... be assessed on gas and water chatges. . 

IRENE D. SCHLEMME R Amount Paid: 6y ^

 ? r \ 4909 BROWN E S T 

OMAH A N E 68104-2324 

PO BOX 3600 

OMAHA NE 68103-0600 

Account: 260950-1123057 

00578 

zzzx 
Understanding your bill 

1. Gas and water are measured by volume. The unit of 

measure is a cubic foot. 

Water: 1 ccf = 100 cu. ft. = 748 gallons 

1 mgal = 1,000 gallons 

Gas: 1 ccf = 100 cu. ft. = 1 therm 

1 mcf = 1,000 cu. ft. = 10 therms 

2. THERM. Heat energy is measured in British Thermal 

Units (Btus). 100,000 Btus = 1 Therm. For every therm 

billed (shown as a billing unit on the reverse side), you buy 

100,000 Btus of heat energy. 

3. HEATING VALUE. Gas.contains varying amounts of heat 

energy. Instead of paying for volume of gas, you are billed 

for heat energy contained in the gas you used. The heating 

value is the factor which converts the volume (ccf) to the 

heat energy (Therm). 

4. ESTIMATES. To keep rates low, bills are estimated four 

times a year and when we don't have access to the meter. 

Estimates are based on number of days in the billing 

period, temperatures and past use. Any difference between 

the estimate and volume used is adjusted with the next 

actual reading. 

5. PRESSURE FACTOR. Adjusts metered gas use to 

compensate for variations in metering and atmospheric 

pressure. 

6. SERVICE CHARGE. Monthly fee associated with your 

rate schedule for meter reading, billing, collections, equipment and facilities maintenance. These are costs incurred 

even if no gas or water is used. 

Budget Plan 

The Budget Plan even.s out seasonal differences in your utility bill. 

You pay the same amount every month and earn interest when your 

budget payment results in a credit balance. Call 554.6666 to sign up. 

How to i€fech us ^ 

V 

e-mail: customer_service@mudnebr.iiom 

iCAN 24/7 account information 504.7025 

Bill questions 

7:30 a.m. - 5:15 p.m., Monday-Friday 554.6666 

Past due bill questions 504.7002 

Turn-on/shut-off (allow 7 working days) 554.6666 

Meter Reading Hotline 504.7008 

Natural gas equipment permits 504.7028 

Other departments 504.7000 

TDD 24/7 service line 504.7003 

Gas, water emergencies (free 24/7 service) 554.7777 

website: www.mudomaha.com 

Reading your meter 

1. INSIDE METERS WITHOUT REMOTE READING 

DEVICES. As a condition of service, customers agree 

to provide access for M.U.D. to read meters. 

2. INSIDE METERS WITH REMOTE READING DEVICES. 

Customers agree to provide written readings on inside gas 

and water meters when requested. These readings tell if 

the inside and outside readings agree. Variances or underestimates will be billed. 

3. ENCODER, RECEIVER, TRANSMITTER (ERT). Some 

customers have ERTs on their meters to allow us to read 

meters via radio signals. We install ERTs for new 

construction and selected meter changes. 

Heat Aid Fund 

Contribute to the Heat Aid Fund by calling 554.6666 or write 

the amount on the front of this statement. The amount you 

specify will begin a monthly pledge to help our disabled and 

elderly neighbors with their utility bills. All donations are 

tax-deductible. 

To pay your bill 

1. Mail your check or money order with the bottom portion 

of the bill in the return envelope provided. 

2. Bring the entire bill to the M.U.D. office, 1723 Harney St. 

(7:30 A.ivi.-5:15 P.M., weekdays), to your bank, savings and 

loan association or some Hy-Vee grocery stores. 

3. Bank draft payments: Your financial institution automatically deducts the balance due on the due date. You 

receive a bill every month in advance of the withdrawal. 

4. Contact your bank to arrange on-line bill payment service. 

We are unable to accept credit cards, debit card payments 

or payments via our website. 

()2()7mam 
Ryk:^^7i^7n 

Account: 260950-1123057 1723 Harney St • Omaha, NE^pb 2 • 402.554.6666 

e-mail: customer_service@mudnebr.com • website: www.mudomaha.com k metropolitan 

IRENE D. SCHLEMMER 

UTIUTES DISTRICT 

Service add ess: 1106 S 43RD 

Billing date Aug 13,2007 

Previous balance $63.61 

<r^ FINAL BILL__^ 

Payment received 0.00 

Current charges Thank you for being a valued custoi^er. If you 0.00 

New balance 63.61 have any questions, call 554.6666. Please include 

this account number and service address in any > Total due Aug 28, 2007 $63.61 If payment is received after due date, a late fee will \m assessed on gas and water charges.

correspondence. 

Details of current charges: 

• Current Ctiarges $0.00 : ^ -

yj^Hu P ^M^^^^^^-^->^^YWZ:()L:3^ rJAPijuJ^^•T\L/ 

IP w<^7y^ -^y-v^^Lyfrry­ p j p ' y p 

(^73¥U'V^^ ^ ;^,^y U 

H^yPJ (&W-^^ ^ 

y^o:x -^S/-3^ s 

Please return this portion of the bill with payment. • We cannot accept credit card or on-line payments. • Please do not staple payment to bill. 

A 1723 Harney St • Omaha, NE 68102 • 402.554.6666 

I I infitrODfllltRn e-mail: customer_service@mudnebr.com 

W1 / UTIUTE UTlLITeS nSTRIC CMSTmCTT website: www.mudomatia.com

0002609501123057000000063617 


Due on or before Aug 28: $63.61 

If payment is received after due date, alate fee will I.II..I..I....IIII,.MI.,I,.I.I..II...I.I.I..IIIM.I.I,...,III 
 be assessed on gas and water charges. IRENE D. SCHLEMMER Amount Paid: 4909 BROWNE ST 

OMAHA NE 68104-2324 

PO BOX 3600 

OMAHA NE 68103-0600 

FINAL BILL 

09509 
Understanding your bill 

1. Gas and water are measured by volume. The unit of 

measure is a cubic foot. 

Water: 1 ccf = 100 cu. ft. = 748 gallons 

1 mgal = 1,000 gallons 

Gas: 1 ccf = 100 cu. ft. = 1 therm 

1 mcf = 1,000 cu. ft. = 10 therms 

2. THERM. Heat energy is measured in British Thermal 

Units (Btus). 100,000 Btus = 1 Therm. For every therm 

billed (shown as a billing unit on the reverse side), you buy 

100,000 Btus of heat energy. 

3. HEATING VALUE. Gas contains varying amounts of heat 

energy. Instead of paying for volume of gas, you are billed 

for heat energy contained in the gas you used. The heating 

value is the factor which converts the volume (ccf) to the 

heat energy (Therm). 

4. ESTIMATES. To keep rates low, bills are estimated four 

times a year and when we don't have access to the meter. 

Estimates are based on number of days in the billing 

period, temperatures and pa.st use. Any difference between 

the estimate and volume used is adjusted with the next 

actual reading. 

5. PRESSURE FACTOR. Adjusts metered gas use to 

compensate for variations in metering and atmospheric 

pressure. 

6. SERVICE CHARGE. Monthly fee associated with your 

rate schedule for meter reading, billing, collections, equipment and facilities maintenance. These are costs incurred 

even if no gas or water is used. 

Budget Plan 

The Budget Plan evens out seasonal differences in your utility bill. 

You pay the .same amount every month and earn interest when your 

budget payment results in a credit balance. Call 554.6666 to sign up. 

How to r#ich us . 

e-mail: customer_service@mudnebr.corn 

V 

504.7025 ICAN 24/7 account information . * _ 

Bill questions 

554.6666 7:30 a.m. - 5:15 p.m., Monday-Friday 

Pas 504.7002 t due bill questions 

554.6666 Turn-on/shut-off (allow 7 working days) 

Mete 504.7008 r Reading Hotline 

Natura 504.7028 l gas equipment permits 

Ottie 504.7000 r departments 

504.7003 TDD 24/7 service line 

Gas 554.7777 , water emergencies (free 24/7 service) 

website: www.mudomatia.com 

Reading your meter 

1. INSIDE METERS WITHOUT REMOTE READING 

DEVICES. As a condition of service, customers agree 

to provide access for M.U.D. to read meters. 

2. INSIDE METERS WITH RJEMOTE READING DEVICES. 

Customers agree to provide written readings on inside gas 

and water meters when requested. These readings tell if 

the in.side and outside readings agree. Variances or underestimates will be billed. 

3. ENCODER, RECEIVER, TRANSMITTER (ERT). Some 

cu.stomers have ERTs on their meters to allow us to read 

meters via radio signals. We install ERTs for new 

construction and selected meter changes. 

Heat Aid Fund 

Contribute to the Heat Aid Fund by calling 554.6666 or write 

the amount on the front of this statement. The amount you 

specify will begin a monthly pledge to help our disabled and 

elderly neighbors with their utility bills. All donations are 

ta.x-deductible. 

To pay your bill 

1. Mail your check or money order with the bottom portion 

of the bill in the return envelope provided. 

2. Bring the entire bill to the M.U.D. office, 1723 Harney St. 

(7:30 A.M.-5:15 P.M., weekdays), to your bank, savings and 

loan association or some Hy-Vee grocery stores. 

3. Bank draft payments: Your financial institution automatically deducts the balance due on the due date. You 

receive a bill every month in advance of the withdrawal. 

4. Contact your bank to arrange on-line bill payment service. 

We are unable to accept credit cards, debit card payments 

or payments via our website.