### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL EFOLDE R 

# SAID# : Jy^Y^ ^ Date : ^/f/6 ^ Address : HO( p S 4^ 3 S T Remediatio n Contractor : Coasta l Environmenta l Group

_Year : 200 7 SOI LREMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S B Vide o o f property (DVD ) 0 Executiv e Summary ' 0 EPA-provide dpropert y sketc h Q 7 Signe dAcces s Agreemen t fo r subjec t propert y D Signe dAcces s Agreement(s ) for adjacen t property 0 Restoratio n Agreemen t D Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) M Confirmatio n dat a M Photograph s ^ G

r As-buil t sketc h M Satisfactory restoratio n signe db y Property Owne r S

ZPropert y 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 n fromDougla s Coimty Assessor' s Offic e D D D 

### Dat e 4031790 3 Superfun d

## Fina l Repor t Propert y Chec k Lis t (piease plac e wit heac hfile) Har dCop y Informatio n 

# '/I5 U S 4^ ^ g 1 . Propeil y Chec k Lis t ^ 2 Sit e Workin g Drawin g Map EP A original s Ma p 

### IS 4 Dougla s Count y Asses.sor' s Ma p Propert y Contac t Shee t Agreemen t i S ' • Acces s Agreemen t r g 2 . Restoratio n Agreemen t Miscellaneou s Document s 01 . Fina l Ma p fromth e Fiel d • ^2 . Chang e Order s ng.l . XR FDat a ^ ^ 4 . An y email s o r P O correspondence s Propert y Completio n D I . Executiv e Summar y n 2 . A S BUIL T f2 ! 3 . Propert y Completio n Agreeinen t ^ 4 . An y buyou t inf o o r reimbursemen t int o l2r5 . Chec k o r mone y orde r copie s ^ 6 . EP A Propert y Clos e Ou t Form ^ 7 . Attache dBegi n Vide o Electroni c Documentatio n Drawing s I . EP A origina l jx2 . Workin g Drawin g a3 . A S Built.vs o •4 . A S Built.jp g Photo s I Begi n Photo s 

### i S I During/Excavatio n Photo s '"> So dPhoto s '^ 30-Da y So dPhoto s 

# 0 Scanne dDocument s 

# a Fina l Document s Executiv e Summar y Video s 

# a Begi n Vide o M y Movi e# 

## Propert yAcces s Checklis t Propert y ID : 

# 907^ B Propert y Address : 

# llOO'^.^iifS h 

# o^ne npyf^i^i ^ 3chkmn\~ f K Address : Phone : ^^[^O^l^' ^ Fax : Cell/Pager : D D WOR K STARTE D WOR K COMPELTE D ON : ON : / / / / Renter : Phone : Fax : Cell/Pager : Additiona l Information :

n Notificatio D Lette r Sent : / / Bv : [\ A Acces s Agreemen t Signed : [ p l/( f I 0 7 

# ^y-ylUan m ^ Restoratio n Agreemen t 

### Signed : i f i

j U l0 7 B v 

# HarCD S I I Topsoi l Samplin g (i f applicable ) Bv : I I Disposa l Samplin g (if applicable ) Bv : I I Garde n Samplin g (i f applicable ) B v Utilit v Clearanc e Called ; l( ) 1/ ^ l0 7 B 

## y^^]Si'li ^ Video/Photo s (Before ) On : (^ 3 I {^ 1 or B v 

### 1^;cir v Q ^ Video/Photo s (During ) On : " 7 / -t , I ^ 7 B v H Video/Photo s (After ) 

### On : J I 7 1 0 7 Bv : I S Video/Photo s (30-Da.v ) 

### On : fi/ ^ / 0 7 

# ^y "SPcV - Propert y Completio n Agreemen t Signed : ^ \I [0 1 6 7 Bv : 

# CK<^' s n Fina l Repor t Issued : / / B v Ai r Monitorin g (a s applicable ) n Communit v d ] Cre w On : / / Bv : Results : r~ l Communit y C D Cre w On : / / Bv : Results : n Communit y D Cre w On : / / Bv : Results : Omah a Lea d Sit eSquar e Footag e t o b e Excavate d = 132 5 PropertyClassification : 80 0 'e Linea rFootaq e t o b e Excavate d = 12 7



# f 

# r ^

Descriptio n o f post excavatio n areas : Fl . fron t yar d left-han d quadrant ; F2 , front yar d right-hand quadrant ; Bl , backyar d left-han d quadrant ; B2 . backyar d right-hand quadrant ; DZ , dri p zon e { 1 - 3 foo t are a o f sot ! aroun d th e foundatio n o f th e house) .

### Prin t Previe w Pag e 1 o f 1 Dougla s County-Omaha , N E

Parce l I D Owne r Nam e Propert y Addres s Cit y Zi p Owne r Addres s Owne r Addres s 2 Owne rCit y Owne r Stat e Owne rZi p 082585000 0 SCHLEMME R IREN E 110 6 S 4 3 S T OMAH A 6810 5 490 9 BROWN E S T OMAH A N E 6810 4 Sec-Twn-Rn g Owne r Addres s Additio n Bloc k Lo t Lega l 1 Lega l 2 Lega l 3 Lega l 4 Assesso r Websit e Lin k 29-15-1 3

COME R AD D 2 2 N 4 4 S 8 8 F TL T 1 & N 4 4 S 8 8 E 4 8 F T 44X10 0 http://douglasne.mapping online.com/DouglasCoNe/static/accountinfo.jsp ? accountno=R082585000 0 Disclaime rMa p an d parce l dat a ar e believe d t o b e accurate , bu t accurac yi s no t Ma p Scal e guaranteed . Thi s i s no t a lega l documen t an d shoul d no t b e substitute d fo ra titl e search , 1 inch = 17 7 fee t appraisal , survey , o rfo rzonin g verification . 

### http://www.dogis.org/dogi s alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 6/7/200 7

## Property I D #

Initial Contact : Secon dContact : Final Contact : Fina l Action :

Comment : Owne r Commen t (s) : Site Coordinato r Commen t (s) : CONTAC T FOR M 

# 90W ) Date:j7/^_Time:^f ^ 

## AzUoxr._MMMt^' ^

Date : Time : Action : WU- P Date : Time : Action : Transmi t to EP A U Othe r Action : D

' 

# U|j . VA7^P ^ \aApc , Cifpn^ ./ -"»^l <

COASTA L ENVIRONMENTA L GROUP , INC . 

## * Consen t Fo rAcces s T o Propert y­

,-• • • • I ' •" , > • - . 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 :

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

SJS^^ ^ 

### vrliLx ^ 

# SIP^T^^I^"^^^ ^ Agreement : 

## Q ^/77S ^ 

# PyplTtJ^ . PURPOS E O F RESPONS E ACTIVITIE S 

# OP 2 "^ Q^^y^p 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 Coastal 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 . ,;;V s 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 : . . . . - , A Pag e 1 o f 2 

# ^016 8

# i m \^'";o *c CASTA; . ENVIRONMENTA L CROUP , i N C 

### •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 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 . •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 equipment 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 (877 ) 234-6270 . I gran t access t o m ypropertie sQ I d o not gran t access t o m ypropertie s 

### J O 

### a,^^ 7 

# yu i jp/cypfAtwrnK y ( Z Ignatur e ^^p 7 Signatur eDat e Q 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 f 2« ^ ^ COASTA L ENVIRONMENTA L CROUP . INC . 

## Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o provid e amutual agreemen t a s t o condition s o f th e property 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 are complete dt o th e satisfactio n o f th e property owne r an dth e Unite dState s Environmenta l Protectio n Agenc y (EPA) .

Propert y ID : f[g ­ 

## 1^ ^ Propert y Address : ^' 

## U ^ ^ ' 

## y 

## y . Owner : \\ - f

i

\t

- 

### ^ y 

## P. \ 

## P\l ' ^ ' ^ - Phone : L 

## IS l '3 < On th e attache ddiagram(s ) indicate area(s ) t o excavate dan ddept ho f excavation , locatio n o f all know n utilities , subsurfac e features , surfac e structure s andlandscapin g features , acces s location(s ) t o b e usedby contractor , andth e directio n o f North . Indicate distances , depths , material types , etc . Indicate digital photo s b y referencin g th e photo-lo g number wit ha n arro w indicatin g directio n o 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 : 

# iJoiWItem : y Item : Item : Item : 1 Item : 1 Item : 1 Item : 

# y Pag e 1 of .COASTA 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 : 

# r yyp- M ii" i Item : 

# f 

# y,^ „ \I' . 

# t^'^ H Vi . Item : 

## '7\f\\A \yvA\y p ^ 

## 3 Item : Item : Item : 

## 7 Item : Item : Item : 

### 7 Item : Item : Item : Item : / Item : Item :

Pag e 2 of .( ^ COASTA L ENVIRONMENTA L CROUP . INC . Item s T o B e Remove d B yContracto rDurin g Remediatio n An d Replace d (Us e additiona l sheet s as necessary) Item : 

## 1 , ^ Vfr 

## \^7i - 

# f j ' i t ) W4 . 

## Y^C' ^ Item : /^(AA|ni y 

## \im h 

# V ' . yiw ' I' ' / "tfy'f f t'/A ­ 

# ^ 1 Item : / Item : / Item : 

# y Item : 

# y Item : 

## 7 Item : , / Item : Item : / Item : Item : Item : Item : Item :

r , Pag e 3 of .COASTA L ENVIRONMENTA L CROUP . INC . 

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

### Ite m

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

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/ flower be d area . Attac hasketc ho f relativ e size s an dlocations . 

### Quantit y 

# Y- ^ 

# I 

# r Q- ^

\U3 \ iP'I v C) ' Uni t

Squar e feet

Eac h

Eac h

Eac h

Eac h Squar e Fee t 

### Condition/Type/Specie s 

# P P

\I v ]i7&' .

Pag e 4 of .( ^ COASTA L 

### Ite m Quantit y Uni t Condition/Type/Specie s Agree dupo n valu 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 e use dt o issu e aplan t vouche r t o th e propert y owner . Agree dupo n lis t o f plan t material s that 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 b y th e contractor . Agree dupo n are ao f property t o b e replace d wit hgras s sod . Includ e asketc ho f th e area(s ) t o b e replace dwit h gras s sod . Are ao f Cit y o r Count y property 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 

# 7!/W7H^t'^ ^ 

# , r $ 

# p Eac h

S F 

# \P .

S F

S F

Pag e 5 of .COASTA L ENVIRONME N TAL CROUP , INC . Additiona l Comment s / Instructions :



# - ^/ryi ' L^r^^\pi\ /

\p [ -IP - [iyfyppp j 3 - \)7 ^ h'P L %y\r\o p 

# u C\yW ^ \P P 

# h ^ ^-^Y^I^ X 

# yttti^v^ ^ \t/ ^ Pf^' ^ Hfi^a^ , ^P\'itP^( : /yi|^( ^ P/f/pri/^/\p\ r

• Chec k th e bo xi f Owne 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 boxCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro f house , includin g foundatio n cracks o rfissures .

p ] I agre e n I d o no t agre e

y 

# C^li ^ 

# PY X ^X'.' ^ Owner' s Signatur e Date extractor' s Signatur e DaJ e O

Pag e 6 

### o f f/:Tota l (!^Van t Squar e Footag e t o b e Excavate d = 132 5 Tota l Dn p Zon e Linea rFootag e t o b e Excavate d = 12 7



# ', n

Desaiptio n o f pos t excavatio n areas : F1 . fron t yar d len.ttan d quadrant ; F2 , fron t yar d rigM.4ian d quadrant : Bl , badtyar d left.lian d quadrant ; B2 , backyar d right-han d quadrant ; DZ . dr ^ zon e (I. 3 too l are a o f sd l aroun d tli e foundation o f th e house) .

# Date : l/y^j/rf ? Name : A^ 5 Description : ^ ^^^^ ^ 5/:>^7 ^ ^jty^^y^/7 ) r7^co7 ^ OAJ rJT ^PROPERT Y CLEARANC E WORKSHEE T 

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# 23 3 Q\ 3 

# (l(>J7Qln 7 Omah a Lea d - - Fixe d Pric e 0107-5 1

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# 52 M' ' Composit e Reading s (Bag ) 

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Confidentia l 6/5/200 7 Pag e 1 o f 2

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# ins o

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# 64# ) 511 0

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# 551 0 -4^7 n f;3 0 Hi^ O iSK O ^ 2 0 

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# ID# : 707^^ 7 

# Date : 7//^^ 7 Nam e : (^/T/j f 

## 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 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 

### % y COASTA L ENVIItONHENTA L GROUP , IN C 

## EXECUTIV ESUMMARY : 20788—110 6 S 4 3 S T 

# I No Issue s o r Concern s X 

# Issues/Concern s Detai l Explanation : P

O was give n achec k

fromCoasta l i

n the amoun t o f $28.1 1 as compensation fo r

one mont hwate r

bil l usage .

# ^^s-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e Propert ylin e divide d b y 1bta l Quaik^ar t Square Footag e l o b e Excavate d • 132 5 

### railroa d tie s leav e I n place . lat a Di yzon e unBafFooQo e tone Excaate a 12 7



### D o no t remov e 1 pol e it' s th e neighbors . On e onl y clothe s lin e discar d an d smal l plants , ros e bush . Replac e lav a roc k unde r dec k an d othe rarea s a s before . Bric k border , rov e a s neede d an d replac e I n F 2

/ 

# ra "^^ i C )

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>:••..«••' . ?:.•:.•;'••• I 

# 3 3 5k>Lt h * 3 Stie e Note :Dec k i s Elevate d Nort i AnTM T Omah a Lea d Sit e Otnana . Neorast a Dat e Excavated:6/28/0 7 Prapert yNumbe r i^^gen d 0LS# : 2078 8 Dat e USEP A Signe d Off : 9/ 1 1/0 7 0LS^i|l78 8 Sal * t'x'y \ Pemaner t Land&capin g Rnopefl yAddres s 1 lnc»i-2DfBetor l grtd-SxS n 110 6 S 4 3 S T •» • Fence Quattan l ao(nla> r Pos t Excavatio n Ccncentrartiar s (ppm ) Stree t Boundar y 

## • HGl . F1 _ B 2 Playwe a V / ^ F 2 D Z Easemefi t (yTYee^Shru b Bl ' Gaiae n otie f • <ilpaatMa»«iMMi M P I •M«1l>t4ll«MM4uMrintf3.n«i>lMI«p»M M <MfM KM , llflVM t M MlMumM KC b«cM « Kt^Hm t q)iir»«« t Legen d Are ano t Excavate d Dripzon e Excavate d <V> ^ Quadrant s Excavate d Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .

## s ^ 

# EP A EP A Propert y Clos e Ou t For m Propert y# : oCT'S' ^ Propert yAddress : //^ ^

yp 3 3 ^ Date/Time : Owner' s Name : :Jp,oj ^

cSc>»/_p/-y/JT n ^sj y Quad s Excavated : Contracto rGrou p Excavatio n Genera l Ye s N o 1 . I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 

## y y 2 . If necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? Gradlu K So dan dVecetatio n Ye s No 1 . Doe s th e gradin g aroun dth e perimete r o f th e house i n excavate darea s generall y slop e away 

## y fromth e house ? 2 . Ha s so dbee n lai di n al l area s that were excavated ? y 3 .Doe s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e if inspecte da t a3 0 / da y tim e period ) 4 . Ar e sodde darea s generall y fuman devenl y graded ? / 5 . Ar e th e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e if inspecte dat a3 0 da y y tim e period ) 6 . Wa s th e property grade dsuc htha t wate r wil l no t poo l on th e property ? 

# y 7 . Wa s damag e t o landscapin g o r plant material s avoided ? 

# y Gates , Feoce s an dRetainin g Wall s Ye s No 1 . D o gate s open an dclos e freely? (I f applicable )/v/- * 2 . Wer e al l gate s o r fence s take n dow n durin g restoratio n activitie s reinstalled ? (I f applicable ) ^ 3 . Wa s damag e t o gate s o r fence s avoided ? (I f applicable )^ ^ 4 . Wasdamagetoretainin g wall s avoided ? (I f applicable )/jA ^ Foundation , Sidin g an dGutter s Ye s No 1 . Wa s damag e t o th e sidin g o r tri mavoided ? . ^ 2 . Wa s damag e t o th e foundatio n avoided ? \ y 3 . Wa s damag e t o window s avoided ? i ^ 4 . Wa s damag e t o window s o r doo r screen s avoided ? i - ^ 4^- ­ 5 . Wa s damag e t o downspout s o r downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ye s No 1 . Wa s damag e t o drivewa y surface s avoided ?^ f 2 . Wa s damag e t o walkwa y surface s avoided ? 

# 3

## Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complet e includin g th e 30-day so dwarranty : EP A Representativ e ^/^^^^v^^.^.M^JL^ ^ Date: f 77-^ 7

# WP r Propert yCompletio n Agreemen t Tlii s agreemen t docuinciU s Ih c completio n o f remedia l activitie s performedo n m y properly . M y signatur e wil l designate lha l I a msatisfiedwit hthe restoratio n of m y property , an dtha i no ilcm s ar c i n questions , now . o r

a

l an y tim e i n th e future , except thos e ilcm s listedbelow , i f

any . Properl yID : 

# mm. Propert y Adtlrcs.s : AA I -S C (/ ^ -5 / Owner : 

## •TJLe^ ^ ^.Hi^fA^^± ^ Phone : a^[.^i^lp 1 Restoratio n Item s i n Question :

item : item : Item : Item : Item : Item :

[p[ l Jigrc c restoratio n i. s coinplrtr<l , excep t a s note d ! I il o no t agre e rcstorationri s complete d 

## C^yLyyS()Jy/rJy4/n^/my y yy//n/^ 3

Owner'.i ( Signatur e Dat e Signatur e I

## Propert yDamag e Settlemen t

Propert y I D 2078 8 Propert y Addres s 1106S . 43"'S t Owne r Iren e Schlemme r Phon e 402-451-355 2

I hav e receive dfromth e contractor . Coasta l Environmenta l Grou p Inc . (Coastal) , asu mo f $ 28.1 1 a s compensatio n for on e month wate r bil l reimbursement . Coasta l Environmenta l 150 2 Grou p Inc . Chec k No . Valu e o f Chec k $28.1 1 Mad e Ou t T o Iren e Schlemme r Descriptio n o f Miscellaneou s PropertyDamag e Reimbursemen t fo ron e month' s wate rbil l exces s fo rassistin g wit h wate rth e so d a t 110 6 S . 43" * S t a t th e completio n o f lea d remediatio n a t thi s property . M ysignatur e belo wi s acknowledgemen t o f th e receip t o f th e su m liste d above , whic h I furthe r acknowledg e t o b e fai rcompensatio n fo rth e miscellaneou s propert ydamag e describe d abov e an d releas e Coasta l Environmenta l Grou p In c fro m furthe robligation s o rliabilit yrelate d t o thi s propert y damage .

Owner' s Signatur e Date Contractor' s Signatur e

Pag e 1 o f 1COASTA L ENVIRONMENTA L GROU P INC . 

### 150 2 82 5 S 26T H S T 27-5/104 0 00 3 COUNCI L BLUFFS , l A5150 1 624737290 4 

### 9/(Q/O V _DAT E PA

YT O TH E ORDERO F 

# J $ za.' '

^ ^

Saciurli y ^ ^

Featiira t 1* 1 DelStI * o n .DOLLAR S U U BocH. WelJ

s Farg o Bank , NA Nebrask a wdIsfargo,co m 

## FO

RlA^;^n^?K ^ "R"l( i i:iDl.0D005fli : &Bit7 3 7 5qOi.ii'COl5D E

« HARt.«^JD ."JERT Y VENTUR E

# J . yM' ' 7 ^ AcoOiint : 260950-112305 7 7i 172 3 3 Harne y S t • Omaha , NE aBTO 2 • 402.554.666 6 e-mail : custome rservice@mudnebr.co m •website : www.mudomaha.co m 'd b NE^TO : V- . IREN E D. SCH,/£MME R \ L Servic e adHress : 1106S43RDS Tj) P t Billin g dat e Au g 10,200 7 Previou s balanc e $0.0 0 

# ^.pp \ FINA LBIL L* %\ \ Paymen t receive d 0.0 0 Curren t charge s 63.6 1 Than k

yo u fo r being avaluedcustomer .If yo u Ne wbalanc e 63.6 1 have an y questions , call 554.6666 . Pleas e include 

## ^ Tota l du e Au g 28 , 200 7 $63.6 1 thi s accoun t numl)e r andservic e addres sin an y II paymen t is receive d afte rdu e date , a lat e fe e wil l be assesse d on ga s an d wate rcharges . correspondence . You rGa s Us e Detail s of curren t charges : GA S RESIDENTIA L RAT E Ju l 10toAiijig^10 _

Meie r Numbe r 32708 8 23 i 

# 1. . Curren t rea d(actual) : 504 6 - Previou s rea d(actual) : 503 8 8 CC F 12 Ga s Use : 8 CC F x1.02 4 (hea t value ) = 8.19 2 therm s 9 day s 2.37 8 therm s at 0.746 4 = $1.7 7

" SE P OC TNO V DE C JA N FE B MA R AP R MAY JU N JU L AU G 22 day s 5.81 4 therm s at 0.8227 = 4.7 8 Servic e Charg e12.0 0 Ga s Cos t 

### $18.5 5 1 Pas t 12 Month s 9 ^»^ t ^3'^' * Montli s / Thi s Mont h Las t Yea r Billin g units : 8 I n/ a Us e pe rday : 0. 2 \ n/ a Averag e cos t pe rday : $0.6 1 \ » ^ Nutnbe r of day sin billin g cycle : 31 n/ a You rWate rUs e WATE R RESIDENTIA L RAT E W-1 : Ju l 10 to Au g 10 Mete r Numbe r 2686286 4 Size : 5/ 8 -inc h Currentrea d(actual) : 199 4 - Previou s rea d(actual) : 197 2 = 22 CC F Wate rUse : 22.00 0 CC F or16,45 6 gallon s 9.00 0 CC F at 0.872 0 = $7.8 5 SE P OC T NO V DE C JA NFE B MA R AP R MA Y JU NJU L AU G 13.00 0 CC F at 1.220 0 = 15.8 6 Servic e Charg e 4.4 0 • Wate rCos t $28.1 1 • Pas t tZ Montti s g Pas t 13-2 4 Month s Thi s Mont h Las t Ye a rCity of Omah a Sewe r 

# e, 2.7 9 Sillin g units : 22 n/ a Sale s Ta x 

### 4.1 6 Us e pe rday : 0. 7 n/ • Curren t Charge s 

### $63.6 1 Averag e cos t pe rday : $0.9 7 n/ a Numbe r of day s in billin g cycle : 31 n/ a Pleas e retur n thi s portio n of th e bil l wit h payment . •We canno t accep t credi t car d oron-lin e payments . • Pleas e do no t stapl e paymen t to bill . 

# k 172 3 Harne y St • Omaha , NE 6810 2 • 402.554.666 6 e-mail : customer_servic e @ mudnebr.co m 

# ) metropolita n website : www.mudomatia.co m V UTILITIE S DISTRIC T 

### 000260950112305700000006361 7 Du e on orbefor e Au g 28 : $63.6 1 If paynnen tis receive d afte rdu e date , a lat e fe e wil l l.li..l..l....llll....l„l,.I.I..II...I.I.I..III.Ml.l.... . be assesse d on ga s an d wate rchatges . . IREN E D. SCHLEMME R Amoun t Paid : 6y^ ? r\ 490 9 BROWN E S T OMAH A N E 68104-232 4 PO BO X 360 0 OMAHA NE 68103-060 0 Account : 260950-112305 7 0057 8 zzz x

## Understandin g you rbil l 1 . Ga s an dwate r ar e measure dby volume . Th e uni t o

f measur e i s acubi c foot .

Water : 1 ccf = 10 0 cu . ft . = 74 8 gallon s 1 mgal = 1,00 0 gallon s Gas : 1 ccf = 10 0 cu . ft . = 1 ther m 1 mcf = 1,00 0 cu . ft . = 1 0 therm s 2 . THERM . Heat energ y i s measure di n Britis hThermal Unit s (Btus) . 100,00 0 Btu s = 1 Therm . For ever y therm bille d(show n a s abillin g uni t o

n th e revers e side) , yo u bu y 100,00 0 Btu s o f hea t energy . 3 . HEATINGVALUE . Gas.contain s varyin g amount s o f hea t energy . Instea do f payin g fo r volum e o f gas , yo u ar e billed fo

r hea t energy containe din th e ga s you used . The heatin g valu e i s th e factor whic hconvert s th e volum e (ccf ) to th e hea t energy (Therm) . 4 . ESTIMATES . T o kee p rate s low , bill s ar e estimate dfou r time s ayear an dwhe n w e don' t hav e acces s to th e meter . Estimate s ar e base do n numbe r o

f day s in th e billin g period , temperature s an dpas t use . An y differenc e between th e estimat e an dvolume use di s adjuste dwit hth e next actua l reading . 5 . PRESSUR EFACTOR . Adjust s metere dga s us e t o compensate fo r variation s i n meterin g an datmospheri c pressure . 6 . SERVIC ECHARGE . Monthly fe e associate dwit hyour rat e schedul e fo r meter reading , billing , collections , equip ment an dfacilitie s maintenance . Thes e ar e cost s incurre d eve n i f no ga s o r water i s used . Budge t Pla n Th e Budge t Pla n even. s ou t seasona l differences i n you r utilit y bill . Yo u pa y th e sam e amoun t ever y mont han dear n interest whe n you r budge t paymen t results i n acredi t balance . Cal l 554.666 6 t o sig n up . 

# Ho wt o i€fec h u s ^ V e-mail : customer_service@mudnebr.iio m iCA N 24/ 7 accoun t informatio n 504.702 5 Bil l question s 7:3 0 a.m . - 5:1 5 p.m. , Monday-Friday 554.666 6 Past du e bil l question s 504.7002 Turn-on/shut-off (allow7 workin g days ) 554.666 6 Mete rReadin g Hotlin e 504.700 8 Natura l ga s equipmen t permit s 504.702 8 Othe rdepartment s 504.700 0 TD D 24/ 7 servic e lin e 504.700 3 Gas , wate remergencie s (fre e 24/7 service ) 554.777 7 website : www.mudomaha.co m Readin g you rmete r 1 . INSID EMETER S WITHOUT REMOTEREADING

DEVICES . As aconditio n o f service , customer s agre e t o provid e acces s fo r M.U.D . t o rea dmeters . 2 . INSIDEMETERS WIT H REMOT EREADIN GDEVICES . Customer s agre e t o provide writte n reading s o n inside ga s an dwater meter s whe n requested . Thes e reading s tell i f th e inside an doutside reading s agree . Variance s o r under estimate s wil l b e billed . 3 . ENCODER , RECEIVER , TRANSMITTE R(ERT) . Som e customer s hav e ERT s o n thei r meter s t o allow u s t o rea d meter s vi aradi o signals . W e instal l ERT s fo r new constructio n an dselecte dmete r changes . Hea t Ai d Fun d Contribut e to th e Hea t Ai dFun db y callin g 554.666 6 o r write th e amoun t o

n th e fron t o

f thi s statement . Th e amount yo u specif y wil l begin amonthly pledg e to help our disable dan d elderly neighbor s wit hthei r utilit y bills . Al l donation s ar e tax-deductible .

T o pa yyou rbil l 1 . Mail your check o r mone y orde r wit hth e botto mportio n o

f th e bill in th e retur n envelop e provided . 2 . Brin g th e entire bill t o th e M.U.D . office , 1723 Harney St . (7:3 0 A.ivi.-5:1 5 P.M. , weekdays) , to your bank , saving s an d loa n associatio n o r som e Hy-Ve e grocer y stores . 3 . Bank draf t payments : You r financial institutio n auto maticall y deduct s th e balanc e du e on th e du e date . Yo u receiv e abill ever y mont hi n advanc e o f th e withdrawal . 4 . Contac t your bank to arrang e on-lin e bill payment service . W

e ar e unabl e to accep t credi t cards , debi t car dpayment s o r

payment s vi aou r website . ()2()7ma m

## Ryk:^^7i^7 n Account : 260950-112305 7 172 3 Harne y St • Omaha , NE^pb 2 • 402.554.666 6 e-mail : customer_service@mudnebr.co m • website : www.mudomaha.co m 

# k metropolita n IREN E D. SCHLEMME R UTIUTE S DISTRIC T Servic e ad d ess : 110 6 S 43R D Billin g dat e Au g 13,200 7 Previou s balanc e $63.6 1 <r ^ FINA LBILL__ ^ Paymen t receive d 0.0 0 Curren t charge s Than k

yo u fo r being avaluedcustoi^er .If yo u 0.0 0 Ne wbalanc e63.6 1 have an y questions , cal l 554.6666 . Pleas e include thi s accoun t numbe r andservic e addres sin an y 

## > Tota l du e Au g 28 , 200 7 $63.6 1 If paymen t is receive d afte rdu e date , a lat e fe e wil l \m assesse d on ga s an d wate rcharges . correspondence . Detail sofcurren t charges : • Curren t Ctiarge s $0.0 0 : ^ - 

## yj^Hu P ^M^^^^^^-^->^^YWZ:()L:3 ^

rJAPijuJ^^ •T\L / 

# IP w<^7y ^ -^y-v^^Lyf rry ­ p j p ' y p (^73¥U'V^^ ^ ;^,^y U H^yP J (&W-^^ ^ 

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

Pleas e retur n thi s portio n of th e bil l wit h payment . •We canno t accep t credi t car d oron-lin e payments . • Pleas e do no t stapl e paymen t to bill . 

# A 172 3 Harne y St • Omaha , NE 6810 2 • 402.554.666 6

I I infitrODfllltR n e-mail : customer_service@mudnebr.co m website : www.mudomatia.co m W 1 /

UTIUTE nSTRIC

UTlLITe S CMSTmC T T 0002609501123057000000063617 Du e on orbefor e Au g 28 : $63.6 1 If paymen tis receive d afte rdu e date , a lat e fe e wil l I.II..I..I....IIII,.MI.,I,.I.I..II...I.I.I..IIIM.I.I,...,II I be assesse d on ga s an d wate rcharges . IREN E D. SCHLEMME R Amoun t Paid : 490 9 BROWN E ST OMAH ANE 68104-232 4 PO BO X 360 0 OMAH ANE 68103-060 0 FINA L BIL L 0950 9

## Understandin g you rbil l 1 . Ga s an dwate r ar e measure dby volume . Th e uni t o

f measur e i s acubi c foot .

Water : 1 ccf = 10 0 cu . ft . = 74 8 gallon s 1 mgal = 1,00 0 gallon s Gas : 1 ccf = 10 0 cu . ft . = 1 ther m 1 mcf = 1,00 0 cu . ft . = 1 0 therm s 2 . THERM . Hea t energy i s measure di n Britis hThermal Unit s (Btus) . 100,00 0 Btu s = 1 Therm . Fo r ever y therm billed(shown a s abilling uni t o

n th e revers e side) , yo u bu y 100,00 0 Btu s o f hea t energy . 3 . HEATIN GVALUE . Ga s contain s varyin g amount s o f hea t energy . Insteado f payin g fo r volum e o f gas , yo u ar e billed fo

r hea t energy containe di n th e ga s yo u used . Th e heatin g valu e i s th e factor whic hconvert s th e volum e (ccf ) to th e heat energy (Therm) . 4 . ESTIMATES . T o kee p rate s low , bill s ar e estimate dfou r time s ayea r an dwhe n w e don' t hav e acces s to th e meter . Estimate s ar e base don numbe r o

f day s i n th e billin g period , temperature s an dpa.s t use . An y differenc e between th e estimat e an dvolume use di s adjuste dwit hth e next actua l reading . 5 . PRESSUR EFACTOR . Adjust s metere dga s us e to compensat e for variation s i n meterin g an datmospheri c pressure . 6 . SERVIC ECHARGE . Monthly fe e associate dwit hyour rat e schedul e fo r meter reading , billing , collections , equip ment an dfacilitie s maintenance . Thes e ar e cost s incurre d eve n i f n o ga s o r water i s used . Budge t Pla n Th e Budge t Pla n even s ou t seasona l differences i n you r utilit y bill . Yo u pa y th e .sam e amoun t ever y mont han dear n interest whe n you r budge t paymen t results i n acredi t balance . Cal l 554.666 6 t o sig n up . 

# Ho wt o r#ic h u s . e-mail : customer_service@mudnebr.cor n V 504.702 5 ICA N 24/ 7 accoun t informatio n . * _ Bil l question s 554.666 6 7:3 0 a.m . - 5:1 5 p.m. , Monday-Friday 504.7002 Past du e bil l question s 554.666 6 Turn-on/shut-off (allow7 workin g days) 504.700 8 Mete rReadin g Hotlin e 504.702 8 Natura l ga s equipmen t permit s 504.700 0 Ottie rdepartment s 504.700 3 TD D 24/ 7 servic e lin e 554.777 7 Gas , wate remergencie s (fre e 24/7 service ) website : www.mudomatia.co m Readin g you rmete r 1 . INSIDEMETER S WITHOUT REMOT EREADING DEVICES . As aconditio n o f service , customer s agre e t o provid e acces s for M.U.D . t o rea dmeters . 2 . INSID EMETERS WIT H RJEMOT EREADIN GDEVICES . Customer s agre e to provide writte n reading s o n inside ga s an dwater meter s whe n requested . Thes e reading s tel l i

f th e in.sid e an doutside reading s agree . Variance s o r under estimate s wil l b e billed . 3 . ENCODER , RECEIVER , TRANSMITTE R(ERT) . Som e cu.stomer s hav e ERT s o n thei r meter s to allow u s t o rea d meter s vi aradi o signals . W e instal l ERT s fo r new constructio n an dselecte dmete r changes . Hea t Ai d Fun d Contribut e t o th e Hea t Ai dFun db y callin g 554.666 6 o r write th e amount o

n th e fron t o

f thi s statement . Th e amount yo u specif y wil l begi n amonthly pledg e to help ou r disable dan d elderly neighbor s wit hthei r utilit y bills . Al l donation s ar e ta.x-deductible .

T o pa yyou rbil l 1 . Mail your check o r mone y orde r wit hth e botto mportio n o

f th e bill i n th e retur n envelop e provided . 2 . Brin g th e entire bill to th e M.U.D . office , 172 3 Harney St . (7:3 0 A.M.-5:1 5 P.M. , weekdays) , t o your bank , saving s an d loa n associatio n o r som e Hy-Ve e grocer y stores . 3 . Bank draf t payments : You r financial institutio n auto maticall y deduct s th e balanc e du e o n th e du e date . Yo u receiv e abill ever y mont hi n advanc e o f th e withdrawal . 4 . Contac t your bank to arrang e on-line bill payment service . W

e ar e unabl e to accep t credi t cards , debi t cardpayment s o r

payment s viaou r website .