## TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R q4'fS ' Date
- z/fsl^^OO ^ SAID# : Address : Remediatio nContractor : Coasta l Environmenta l Group

_Year : 2007 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S dVide o o f propert y (DVD ) WExecutiv e Summar y EPA-provide dpropert y sketch M SignedAcces s Agreemen t fo r

subject propert y 0 ^ Si^e dAcces s Agreement(s ) fo r

adjacen t propert y M Restoratio nAgreemen t D Settlement document s (i.e. , fo r

damag e or to replac e plants , etc. ) I M Confirmationdata s /

Photograph s W j A . S>n A M As-built sketch ^ Satisfactor y restoratio nsignedb y Propert y Owne r ^ Propert y close-out chec k

lis t signedby EP A '^/fl/O' Z D Descriptio no f area s not meeting ROD cleanu p criteri a B ^ Utilit y clearance s WPropert y informationfromDougla s Count y Assessor' s Office 

## 0 ^ taK>eA | ClrccJ^ S pJiecCJiSj
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## / Signatur e jignatur e 4031711 1 Superfun d

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4 Dougla s Count y Assessor' s Map Q^ 5 Propert y Contac t Shee t Agreemen t ^ 1 Aeees s Agieemen t ^ 2 Restoiatio nAgreemen t Miscellaneou s Document s g l 1 Final Ma p liomth e Fiel d B l 2 Chang e Oidei s d ^ XR FDat a I2

j 4 An y email s O I P O coiie^pondence s Piopert y Completio n Ll I E.Keeutiv c Summai y • 2 A S BUIL T Tg r 3 Propert y Completio nAgreemen t IS ' 4 An y buyou t int o o r reimbursemen t inf o J 3 5 Chec k 0 1 mone y ouie i copie s 

# f 6 EPA Piopert y Clos e Ou t Form 7 Attache dBegi nVide o Electroni c Documentatio n Drawing s ^ I EP A origina l g ^ 2 Workin g Diawin g ^ 3 A S Buil t v.s o ( 2 4 A S Buil t jp g Photo s S I Begi nPhoto s • 2 Dunng/E.xeavatio nPhoto s I ^ ^ So dPhoto s " Q 4 30-Da y So dPhoto s 

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# i Omati a Lea d Sit eTota l Qi^^At Square Footag e t o b e Excavate d = 81 6 

# ^\(^!,m' ) ^z^ M 1i5 ' PropertyClassification : 80 0 Tota l Driffpn e Linea rFootag e t o b e Excavate d = 135

Descriptio n of pos t excavatio n areas : Fl , fron t yar d left-han d quadrant ; F2 , fron t yar d ri^t-hand quadrant ; Bl , backyard left-han d quadrant ; B2 , backyar d right-han d quadrant ; DZ
. dri p zon e (1- 3 foot are a o fsoi l aroun d th e foundatio n ofth e house)
.

## 1749 5

rOwne rName : JAMI E RZADIN A Addres s 230 6 S 3 1 ST Phone
. H 402-553-592 1 ^/ » - f • yrt i I Sampl e Numbe r RYASCPXA-1749 5 F l RYBSCPXA-1749 5 F 2 RYCSCPXA-1749 5 B 1 RYDSCPXA-1749 5 B 2 RDZSCPXA-1749 5 D Z ROZOCPXA-1749 5 GZ rtPZGCTX A174QG P Z 

### Omah a Lea d Sit e Sit e Sketc h W402-345-717 8 ^ \r,AAe rf_t-)rt^k5:-f^Agrt" ^ Lea d Concentratio n Sampl e Collecte d LA B pp m 

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## Staf f-zz^z: ^ 

# ENTERE D JU N n 9 im h

Omah aLea dSit e 4613 0

### Dougla s County Accoun t Informatio n Pag e 1 o f 3
Dougla s County , Nebrask a Propert yRecor d Informatio n i s vali d a s o f 2007-1 1 -2 0 ­ R090419000 0 Prin t Repor t Vie wo n Ma p Treasurer' s Ta xRepor t Owne r ZADIN AJAMI E R 230 6 S 3 1 S T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumbe r 041 9 000 0 0 9 Accoun t Typ e Residentia l Parce l Number : Parce l Address Lega l Description
. 090419000 0 230 6 S 3 1 S T OMAH AN E 68105-000 0 CREIGHTON S 1 S TAD D LO T3 BLOC K4 4 7 X 12 0 Valu e Informatio n
200 7 200 6 200 5 200 4 200 3 200 2 Lan d $11,30 0 0 0 $11,30 0 0 0 $11,30 0 0 0 $11,30 0 0 0 $11,30 0 0 0 $ 0 0 0 Improvemen t $135,20 0 0 0 $108,70 0 0 0 $108,70 0 0 0 $108,70 0 0 0 $76,40 0 0 0 $ 0 0 0 Tota l $146,50 0 0 0 $120,00 0 0 0 $120,00 0 0 0 $120,00 0 0 0 $87,70 0 0 0 $ 0 0 0 Sale s Informatio n Sale s Dat e 2003-10-0 6 Dee d Typ e Price : Granto r Grante e W D $133,50 0 0 0 Nanc yADal yeta l Jami e R Zadin a Boo k 200 3 Pag e 21485 9

Valid/Invali d Exclusio n Reaso n nul l Sale s Dat e Dee d Type
. Price Granto r 1994-10-2 0 $64,00 0 0 0 Boo k 199 3 Pag e 49 5

Grantee :


### htt p //douglasn e mapping-onlin e com/DouglasCoNe/static/accountinf o jsp'?accountno=R O 12/18/200 7

### Dougla s County Accoun t Informatio n Pag e 2 of 3

Valid/Invalid : Exclusio n Reason : nul l Lan d Informatio n Acre s S F F F Unit s Dept h Widt h Vacan t 0.1 2 5640. 0 47. 0 1. 0 120. 0 47. 0 N o Improvemen t Informatio n Buildin g 1 

### L
. - ^ ""'F WFloo r 7* 4 0 3 F Secon d Floo r 7 « 0 s F AHache d 4(N.0S. F
Mi r 

## ""-la-ir ^ TW O STOR Y m m Bloc k a 1 1 7*4 0 S F CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1488. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Goo d Owne rOccupied : N o Cond o Squar e Footage : 0. 0 Buil t As : 2 1/ 2 Stor yUnfi n Rooms : 8. 0 HVAC : Centra l Ai rt o Ai r Units : 1. 0 Exterior : Fram e Stucc o Baths : 1. 0 Interior : Drywal l Bedrooms : 4. 0 Roo f Cover : Compositio n Shingl e Stories : 2. 5

Roo f Type : Gabl e Foundation : Block Floorcover : Allowanc e Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 190 5 0 0 % 190 5 10 2 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fenc e Chai n Lin k 1. 0 Ad d O n Unfinishe d Atti cW/floo r 744. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 744. 0 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO. . . 12/18/200 7

### Dougla s County Accoun t Informatio n Pag e 3 o f 3 iror m
Fixtur e Bas e Fixture s 1 0 Fixtur e Bat h Ful l 1 0 Garag e Attache d 40 8 0 Garag e Detache d 213 0 Porc h Sla b Roo f Cei l 16 0 0



### htt p //douglasn e mapping-onlin e com/DouglasCoNe/static/accountinf o jsp'^accountno=R O 12/18/200 7Pag e 1 of 2

" > Creat e Anothe rTicke t Bac k t o Irt h Interne t Sen d Emai l
YOU RTICKE T NUMBE RI S 1875849 . Origina l Cal l Dat e 8/28/0 7 Tim e 1 5 7 p m O p LORI1879 0 Wor k t o Begi n Dat e 8/30/0 7 Tim e 2 3 0 p m Stat e N E County : DOUGLA S Place : OMAH A Address : 230 6 Stree t S 31S T S T Twp : 15 NRn g 13 E Sect-Qtr : 28-S W Twp Rn g Sect-Qtr : Lega l Given . C Typ e o f Work : LEA D REMEDIATIO N Locatio n o f Wor k LOCAT E ENTIR E PROPERTY . Remarks : RESENDIN G DU E T O WOR K EXTENDING . Compan yCOASTA L ENVIRONMENTA L SERVIC E Contac t Nam e LOR I Phon e (712)352-018 8 Al t Contact
- NON E Wor k Bein g Don e Fo r EP A Dept h o f Excavation : 36 " Corne r Lo t Y Front : Y Rear . Y Involve s Tunnelin g o r Horizonta l Borin g . NExplosives : N CXCAT V LEVEL S MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F QWEST 2
Servic e Are a Contac t Phon e Numbe r Utilit y Typ e Da y402934046 9 CXCAT V CO X COMMUNICATIONS , INC HEID I Al t 402934046 9 Emer g 402932975 7 Da y 877366834 4 LEVEL 3 LEVEL 3 COMMUNICATIONS , LL C N A Al t Emer g 877366834 4 Da y 402504782 3 MUD0 2 METROPOLITA NUTILITIE S DISTRIC T EDWINAAl t Emer g 402504794 6 Da y 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R RO N Al t 402444516 1 Emer g 402444516 0

htt p //ww w dho n org/irthintemet/DHONNoticeCreation/MessageTex t asp'>ret=<RESULT S 8/28/200 7

### Pag e 2 of 2

0PPDGPR 6 OMAH A PUBLI C POWERDISTRIC T N A 

### Da y Al t Emer g 406728934 3 888728934 3 QLNNEI FQWES T LOCALNETWOR K N A 

### Da y Al t Emerg 406728934 3 888728934 3 QWEST 2 QWES T LON GDISTANC E SAR A 

### Da y Al t Emer g 800283423 7 303992192 6 800283423 7

htt p //ww w dho norg/irthintemet/DHONNoticeCreation/MessageTex t asp'^ret=<RESULT S 8/28/200 7

## CONTAC T FORM Property I D # 

# in^'^ e Property Address : 

# S^C: ^ 

# S 3 | it
. 

## Initial Contact : Date : Time : Action : Secon dContact : Date : Time : Action:
_ Final Contact : Date : Time : Action : Final Action : Transmi t to EP A D Othe r Action : D

### 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 ENVIItONHENTtl
. CROUP , IN C 

# EXECUTIV ESUMMARY : 17495—230 6 N3 1 S T

X 

# No Issue s o r Concern s I I Issues/Concern s Detai l Explanation :

# As-Buil t Drawin g ^
COASTA L 

# u m ah aLea dSuperfun dSt <

Tota l Quadran t Squar e Footag e t o b e Excavate d = 61 6 Propert yClassificatio n 80 0 Tota l Dn p Zon e Linea rFootag e t o b e Excavate d = 13 5 

### Alle y 

# u a

^Z^4f , !liJ —

F l = 13 3 PP M ( 

# t-4' ^ 6 " 

# O

OLS# : 1749 5 Dat e Excavated : 9/4/0 7 Dat e USEP ASigne d Off : 9/11/0 7 Legen d ': V > J Concret e Omah a Lea d Sit e Omaha
. Nebrask a Yy ^ m[| | •—•— • ^^

^ Excavate d Are a

Existin g Structi^ e Fenc e Permanen t Landscapin g Scal e 1 Inct i ' 2 0 fee t o r1 gri d « 5 x5 » Propert yNumbe r OLS-1749 5 Propert yAddres s 2306 S 3 1 S T

——— iQ ? Quadran t Boundar y Stree t BourxJar y Treo.'Shru b F l F 2 B 1 Pos t Excavatio n Concentration s (ppm ) B 2 Pla yAre a D Z Easemen t Garde n Othe r DwcripTta n o fpoe t mcavatto n artta*
. f ^ fron t yar d iBft-han d quadrant
. P 2 fron t yar d right-han d quadran t B l backyar d Imft-tran d quadran rB3 , backyar d rigfit-han d quadran t DZ
. dn p zort c(1. 3 fo d ara a o f toi l aroun d th a foundatio n o ftt wfiouH ) Legen d Are ano 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

## ILP A

# Propert y Clos e Ou t F o 

# i TM Property. : ^^325 1 

### Propert y Addrew : ZZSO( ' 5 " 5/^ ^ Datc/Tinc : 

### Owner' s Name : ,/Ayi^i e 'ZF4A/AJ ^ 

### Quad s Excavated : Contracto r Grou p Excavatloi i Genera l Ye s No 1 I f necessary , wer e th e correc t quadram(s ) excavate dan drestored' ' 

# y 2 If necessay , wer e th e correc t area s of dn p zon e excavate dan drestored' ' 

## y Gradin g So dan dVegetatio n Ye s No 1 Doe s th e gradin g aroun dth e penmete r ofth e hous e incxca \ate darea s generall y slop e av,a y fromth e bouse' ' y ^ 2 Ha s sodbeenlai di nal l area s tha t wer e excavated' ' ^ 3 Doe s th e sodappea r t o b e generall y healthy andgrow ing' ' (On! \evaluat e i f inspecte da t a3 0 da y tun e penod ) 4 Ar e soddt darea s generall y fir man devenl y graded' ' ^ 5 Ar c th e joint s Ijerwee nth e so dstnp s generall y tight' ' (Onl> evaluat e i f inspecte da t z 3 0 da v tim e period ) 6 Wa s th e property grade dsuc htha t w ater v

i ill not poo l onth e propen)' ' ^ 1 7 Wa s damag e t o landscapm g o- - pla.n t matenal s avo'ded" ' Giiic v Fence s an dRciainin s naib >e $ N o 1 D o gate s openan dclos e freeh'' (Fapplicable ) ^ 2 Wer e all gate s or fence s take ndov-i i durin g Tsioraiio nacf v fit s '•eipsulled' ^ ir2prlicable' i ^ 3 Wa s damag e t o gate s or fence s avoided' ' (I f applicable ) K ^ 4 Wa s damag e t o retainm g v»-a!l £avoided'^ (I f applicable ) 4 ^ Foundation , SidiB g an dGutter s \e s S o 1 Wa s damag e t o th e Siding or tn mavoided'^ 2 Wa s damag e t o th e foundatio navoided'^ 3 Wa s damag e t o vMndow s avoided' ' 1 ^ 4 A'a s damag e t o window s or door screen s avoided' ' 5 Wa s damag e t o do^^•nspouts or downspout extension s cvoided " Sidevtalli s an dDriveway s (Concrete ) >e s N o 1 Wa s damag e to dnvev*ay surface s avoided' ' L ^ 2 Wa s damag e t o walkwa> surface s avoided' ' U ^

### Owner s comments :

!n<pe<rtiGQ note* : rf



### R.emc\a l md-estcrano nacuxa'e s ccTc'et e 'nc'jdir e ihe I-O-da v so d'>-'arT£i^r ^ EP. A Represe.nta t 

## Dat e f -/ /

-a V

## Propert yCompletio n Agreemen t Thi s agreement document s th e completio no f remedia l activitie s performe donm y property . M y signature will designate that I a msatisfie dwit hth e restoratio no f m y property , an dthat n o item s ar e inquestions , now , or a

t any time i nth e fiiture , excep t thos e item s liste dbelow , if any . Propert y ID : j ~76f^ h Propert y Address : '2^'^{ ^ 5 ^/S T Owner : J/^^f ^ 'Z^t^/A^ A Phone : 

## -7<^6 / -^g-y Y Restoratio n Item s i n Question :

Item : Item : Item : Item : 

### Item : Item : Additiona l Comments : 

# t agre e restoratio ni s completed , except a s noted I do not agre e restoratio ni s complete d



# ,

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# n /Owner' s Signatnr j Dat e Contractor' s Signatur e

# f mm PROPERTYCLEARANC E WORKSHEE T

Dat e Propert y ID 

# ^-"i^c-t - 

# 77^ ^ Propert y ~ ^ Projec t Omaln a Lea d -- Fixe d Pric e Addres s 

## r^3 o 

# O -3 3 / Measuremen t XR F ID OlO?^^ ! Count/Tim e 

# 3e^s ^
Fiel d Sliot s Shot * Readin g Sampl e Are a Sho t # Readin g Sampl e Are a

Sampl e Are a 

# £4-fr :r/n>-' > In Sit u Composit e Composit e Analytica l La b Analytica l Readin q Averag e (Drie d & Spil t Sen t Aliquo t Composit e Reading s Numbe r Result s (Bag ) ? 1 (Baq ) Sieved ) 2 

### /4. Z 3 

### /Z.5 - 

# HP 4 

### /^r > XR F Correcte d Valu e - > 5 (us e calibratio n char t orad d 2 0 % to value ) 

# n'9 , Sampl e Are a 

## - Pass/Fai l ? I n Sit u Composit e Composit e Analytica l 

## 1)2 : 

## @ /V ^ iL La b Analytica l Aliquo t Composit e Reading s Readin q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s (Bag ) Sieved ) ^ 

# ^o 7M

ctfe \ XR F Correcte d Valu e —> (us e calibratio n char t orad d 2 0 % to value ) Sampl e Are a -LL
. Pass/I=ai l ? 

### TP ^ 

# Ffi f 6. I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s La b Analytica l Readi n Averag e (Drie d & Spil t Sen t ^ (Bag ) Numbe r Result s (Bag ) Sieved ) 

# 3 % 

## / 3 . 

## ^02
. 

# \'iZ > TZ i XR F Correcte d Valu e —> (us e calibratio n char t orad d 

# '=Z Z 

# Mt 2 0 % to value )

• / ^ Sampl e Are a 

# -^^ l •' ^ Pass/Fai l ? Composit e Composit e Analytica l Aliquo t Composit e Reading s La b Analytica l Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 

# ± Bag ) Sieved ) 

# vv D XR F Correcte d Valu e —> (us e calibratio n char t orad d ^ ^ 2 0 % to value ) 

# M. Sampl e Are a Pass/Fai l ? In Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s La b Analytica l Readin q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s (Bag ) Sieved )

XR F Correcte d Valu e —> (us e calibratio n char t orad d 2 0 % to value ) (;s > AODinait M SHFF H I I XR F Technician' s Signitur e HF Fil l 11I t Square Footag e t o b e Excavate d = 81 6 i p zLon e Linea rFootag e t o ti e Excavate d = 13 5

Legen d life M Concret e ^y/ \ Excavate d Are a llS^ I Existin g Structur e
• •— • Fenc e p^ ^ Permanen t Landscapin g

—— —Quadran t Boundar y Stree t Boundar y O Tree/Shru b 

## Sout h 3 1 Stree t i]i^H/^eo dO b Nort h Arro wV Omah a Lea d Sit e pip£ - Omaha , Nebraska Propert yNumbe r

OLS-1749 5 Scal e Propert yAddres s 1 Inc h = 2 0 fee t o r1 gri d = 5 x5 f t 230 6 S 3 1 S T „K' l Sla, „ Pos t Excavatio n Concentration s (ppm ) Fl
. B2 PlayAre a 

# jJJtV V HG L F2 DZ Easemen t JllJ^i ^ * ' ^ I lyrlroGcnLogif: , Itw
. B l Garde n Ottie r DesCTiptio n o f pos t excavatio n areas : F1 , fron t yard left-han d quadrant ; F2 , fron t yar d right-hand quadrant : B1 , bad<yar d left-tian d quadrant : B2 , backyard nght-tian d quadrant ; DZ , dri p zon e (1- 3 foot are a of soi l aroun d th e foundatio n o f th e tiouse)
.i^^° »'-</ ,
COASTA L ENVIRONHENTA L '"r

PROt'-" ^ C R 0 U rIN C 

## 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 authonze s th e Unitec i State s Environmenta l Protectio n Agenc y(EPA ) o rit s authonzec i 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 descnbe d premise s 

# 1 Owner' s Name : Daytim e Phone : '^Uf ^ 3^'^' ^ 

# 2.5/Y 5 3/^7
- Acte6 > TM ^ ^UI L^ccjes 3 T- G Addres s o fPropert y covere d b ythi s Agreement : 

### PuRPOS E O F RESPONS E ACTIVITIE S 

### Th e EP AIS 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 hazar d Th e area(s ) wil l b e excavate d t o remov e contaminate d soi l Th e remove d contaminate d soi l wil l b e replace d wit h clea n matenal s an d th e are a wil l b e restore d t o it s ongina l conditio n Thi s wor k IS bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n progra m Arepresentativ e o f Coasta l Environmenta l Group , contracte d b yUSEPA , wil l contac t th e Granto rin-perso n t o discus s th e wor k t o b e performed , th e Granto rwil l hav e a n opportunit yt o revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e I t begin s 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 approva l 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 remediate d
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 subcontractor s th e righ t t o ente rth e property , a t al l reasonabl e time s an d wit h pno rnotice , fo rth e sol e purpos e o f performin g th e wor k Thi s acces s shal l remai n i n effec t unti l th e wor k ha s bee n satisfactoril ycomplete d Th e Granto rals o agree s t o

Pag e 1 o f2V.V1E 0 S7< , vV ^

^ * COASTA L ENVIRONMENTA L 'f L PBO-"*- " CROU P IN 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 watenn g peno d b yEPA , •Abid e byhealt 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 wor k •Allo wvideotapin g and/o rphotographin g o fth e propert y AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s no t t o interfer e o rtampe rwit h an yo f th e wor k activities , o rwit h an y o f th e wor k done , o rwit h th e equipmen t use d o n hi s property , o rt o undertak e an y action s regardin g th e us e o f sai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o f th e Grantee s o rth e environment , o rt o allo wother s t o us e th e propert yi n suc h a manne r Should yo u hav e an yquestion s abou t thi s program , pleas e contac t Coastal Environmenta l Group , a t (877 ) 234-627 0

T ^ 

### O I d o not gran t access t o m ypropertie s 

# z \ gran t access t o m ypropertie s
Signatm e / V Dat e ^'(4>'<T J Dat e @,/ 6 Signatur e

12

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

Paq e 2 o f2

# 4 1 i # COASTA L ENVIRONMENTA L C R C U r. 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 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 : (^j^j^-^^Z^C^CUVvO ^
Addres s of Propert y covere d b ythi s 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 f lea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t o remov e contaminate d soil
. Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o it s origina l condition
. Thi s wor k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o f Coasta l Environmenta l Group , contracte d b yUSEPA , wil l contac t th e Granto rin-perso n t o discus s th e wor k t o b e performed , th e Granto rwil l hav e a n opportunit yt o revie wan d approv e th e planne d soi l removal , an d restoratio n 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 v/it 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 fperformin 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 f2ifc^'****% * COASTA L *>, , ^*0 ^ ENVIRONHENTA L ^ ' "BO^* - C • 0 U rIN C 

### •Remov e obstruction s includin g boats , trailers , vehicles , playscap e 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 maywis 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 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 f th e wor k activities , o rwit h an y o f th e wor k done , o rwit h th e equipmen t use d o n hi s property , o rt o undertak e an y action s regardin g th e us e o f sai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o f th e Grantee s o rth e environment , o rt o allo wother s t o us e th e propert yi n suc h a manner . Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contac t Coasta l Environmenta l Group , a t (877 ) 234-6270
.
^ 1 I gran t acces s t o m ypropertie s G I d o no t gran t acces s t o m ypropertie s

^g'natur e ( / Dale ' Signatur e Dat e
QI woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.

Pag e 2 of2COASTA L 

## Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s to provid e amutual agreemen t a s to condition s ofth e property prio r to remediatio nactivitie s Thi s wil l als o serv e a s documentatio nfo r th e purpos e o f assurin g that restoratio n activitie s are complete dto th e satisfactio nofth e propert y owne r an dth e Unite dState s Environmental Protectio nAgenc y (EPA )

PropertylD . \'ldq ^ Propert y Address : "Ji^^J c C "^l S'-f- Owner : 

### NiM/Vh c Z< a<///> . Phone
. 

### y<;^
­ 7^ C ' 3>2 . 7 V O nth e attache ddiagram(s ) indicate area(s ) t o excavate danddept ho f excavatio nlocatio no f all know n utilities , subsurfac e features , surfac e structure s andlandscapin g features , acces s location(s ) to be usedb y contractor , andthe directio no f Nort hIndicate distances , depths , materia l t>'pes , et c Indicate digita l photo s b

y referencin g the photo-lo g number wit ha nano w indicatin g 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 fthes e item s i s th e Owner' s responsibilit y Ite m 

## p/^u^ y f"/oi> J ^^ S Ite m Ite m Item
. Item Item : Ite m Item :
Pag e 1 of ,

# CP >
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 ­ 

### ^ ^ ^ f^^/ ^ /^ky- ^ 6)U3-^6 V M^' r/C^/iui ^ Ite m Qr/ci't rfe^^ C,.^an J fZ>?
. ^ O Pt'-<J : g/ u A\^c / Ite m Ite m Ite m

Pag e 2 o f

### 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 ) Ite m 

# J i / / Ite m 

# ^ot: > Ite m

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 , that wil l b e excavated , that I S covere dwit hgras s

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

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

Numbe r o f Sprinkle r Zone s Contro l Valves , Timer s Head s et c .^^ac hasketcl i o t th e s-piinklei ld\ou t

Numbe r o f andsiz e o f eac hgarden/ flower bed are a Attac hasketc ho f relativ e size s andlocation s 

## Quantit y 

# ^ 5 /

^ 

# 0 0 0 Uni t Condition/Type/Specie s

Squar e fee t

Each

Each

Each

Each Squar e Feet

Pag e 4 o f

### Ite m Quantit y Uni t Conditlon/Type/Specie s Agree dupo nvalu e o f plan t material s not t o b e replace db y contracto r Not e thi s valu e use dt o issu e vouche r t o th e owne r wil l b e a plan t property ' Agree dupo nlis t o f plan t material s tha t wil l b e replace db> contracto r B e ver y specifi c an ddetaile d Eac h Includ e asketc ho f wer e eac hplan t wil l b e place d b \th e contracto r Agree dup(."> nare ao f propert x t o b e replace d wit hgras s so d Includ e asketc ho t th e area(s ) t o b e replace dwith sras s so d S F

Are ao f Cit \o r Count s propert ) t o b e landscape d pe r thei r requirement s 

# -rzz3 ^

S F Includ e area(s ) a sketc ho f th e



# ^^^/n^^zr r

Pag e 5 o fAdditiona l Comment s / Instructions :



# - 4aes ^

rize^ZSz^ 5 3/s r/ r^L^e h

• Chec k th e boxi 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 damag e B ycheckin g tfii s bo xCE G i s no t responsibl e fo ran ydamag e don e t o th e inteno ro fhouse , includin g foundatio n crack s o rfissure s



# Is U jagre e I 1 1 d o no t agre e 

## D l agre e I I I d o no t agre e 

# 1

^pyvc^ y lolMner'sSignatiii ^ Date * ^ Pkg e 6 o f ZicfQr'' % Signatur e Dat e