## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID^ : 

# 3S28 0 Date : 3//// ^ 

# Address : y2Sd 0 7ejnpjp7hf \Si ~ Remediatio nContractor : _Coasta l Environmenta l Group

_Year : 200 7 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S SI Vide o o f property (DVD ) 10 Executiv e Summary c f

EPA-provide dpropert y sketc h t

/ Signe dAcces s Agreemen t for subjec t property D Signe dAcces s Agreement(s ) for adjacen t propert y i

/ Restoratio nAgreemen t D Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) 4

/ Confirmatio ndat a g

] Photograph s M As-buil t sketc h M Satisfactory restoratio nsigne db y Propert y Owne r \zf Property close-ou t chec k lis t signe db y EP A D Descriptio nofarea s not meetin g RO D cleanu p criteri a D Utility clearance s D Property informatio nfromDougla s County Assessor' s Offic e D D D 

# 4fe ^
4031778 4 

# Hil l Superfun d

## Fina l Repor t Propert y Chec k Lis t (piease plac e wit heac hfile) 3^^-^^ ^ HardCopy Informatio ndS(^7~17^Mfiuhs^d7~ ' K ^ Propert y Chec k Lis t \ . Sit e Workin g Drawin g Ma p \EP A original s Ma p V Dougla s Count y Asscs.sor' s Map ^ . Propert y Contac t Shee t ^Agreemen t

• X Acces s Agteemen t 2>Restoratio nAgreemen t IMisceHaneou s Document s Ps^ina l Ma p iro mtii e Fiel d 2 . Ciiang e Order s X XR FDat a 4 . An y email s o r P O airrespondence s Propert y Completio n 1 . Executiv e Summar y 2 . A S BUIL T 3'. . Propeit y Completio nAgreemen t 4 . An y buyou t inf o o r reimbursemen t int o 5 . Chec k o r mone y orde r copie s n\EP A Propert y Clos e Ou t Form NJ^Attachc dBegi nVide o

Electroni c Documentatio n Drawing s \EP A origina l 3 v Workin g Drawin g ,3 . A S Built.vs o 4 . A S Built.jp g Photo s Begi nPhoto s ^ 

### During/Exeavatio nPhoto s So dPhoto s 30-Da y So dPhoto s Scanne dDocument s Fina l Document s Executiv e Summar y Video s Begi nVide o \ 

### M y Movi e

# f i( m Propert yAcces s Checklis t PropertyID : ^^Z^ O D WOR K STARTE D ON :

_ / / D WOR K COMPELTE D ON : / / Propert y Ad d 

# Tlz^^yn7n^s^±^£^Si \ Renter : 

## 0>v.K-r : j/\^^; ^ W^^VVW- H A
- Addross : * J , ^ Phone : Fax : Cell/Pa<;cr : Additiona l Information : 

# Phono : f,cy^-4^( 7 Fiix : Cell/Pa«ei- : 1 n Notificatio n Lette r Sent : / / By : [E l Acces s A<!;reenien f Sij;ned:|0_/_4i_/cr ^ 

# ""' • Chcb.- - S Restoratio n Agreemen t 

### Siuned : 1 6 / ( D /0 7 

# ''"Chri' S 1 1 Top.soi l Samplins i (i f a|)plical)le ) / / By : [ 3 Disposa l Samplinj ; (i f applicable ) / / By : O Garde n Sainplin< { (i f applicable ) / / By : [ j ^

Utilit yClearanc e 

### Called : jt . / '2. / 6T j '^ yl* TI Z82.2 . Ij

^ Video/Photo s (Before ) 

### On:_a:/_^ / o T 

# ^ yKlrtfth co- ^ j n Video/Photo s (Durinj; ) On : / / By : j j D Video/Photo s (After ) On : / / By : 1 D Video/Photo s (3()-Day ) On : / / By : 1 1 Pro|)eit yCompletio n Ajjreemen t Sijined : / / By : 1 n Eina l Repor t Is.sued : / / By : Ai rIVIonitorinj ; (a s ap[)lieal)le )

I I Communit y C U Cre w On : Bv : Results : C

D Communit y C U Cre w On : / / Bv : Results : CU Communit yC U Cre w On : / / Bv : Results : Omah a Lea d Sit e

# 3528 0

Omah aLea dSit e 4613 0

## 3528 0 Exterio rPain t NorthArrow 

### Omah a Lea d Sit e rOwne rName : MARGI E WASHINGTO N • Goo d 

### Sit e Sketc h Address : 250 8 TEMPLETO N ST Phone : ^ Sampl e Numbe r RYASCPXA-3528 0 RYBSCPXA-3528 0 RYCSCPXA-3528 0 RYDSCPXA-3528 0 RDZCCrX A3528 0 RPZSCP.Y A3528 0 W : Lea d Sampl e Concentratio n Collecte d F l pp m F 2 pp m B l pp m 8 2 pp m ^ - 

### pp m n pp m • E 2 

### pp m D Numbe ro f Sample s = , H • Poo r ^ Q-H4o t pain t Sample s Collecte d LA B Firm : 

## D Dat e 

## D Tim e 

## D D D XR F Unit ; 

## D Date : 

## D Time : Staff : 

# o 

# y y P^ - yri^<^.7. k I U ^ y 

# S'0( ^ p^ ' Sample s Analyze d Book : 

# ^ A l 

# i 1 \(^-\^.c ^ 

# A ^ ^ 

# ENTERE D OC T 1 1 200 4 

## ^ ? 

# Z^' y 

# ':

-^4© » *r - 

### V 

# F ' 

# f. . i^q o 31 X "tr M F liCTo ^ ST- ' liL ^ Omah a Lea d Sit e 4613 0

### Dougla s County Accoun t Informatio n Pag e 1 o f KOTn c Dougla s County , Nebrask a Propert yRecor d - R164415000 0 Prin t Repor t Informatio n i s vali d a s o f 2007-8-2 4 Vie wo n Ma p Value s no t finalize d unti l afte rBoar d o f Equalizatio n Treasurer' s Ta xRepor t Owne r WASHINGTO N MARGI E 251 2 TEMPLETO N S T OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : 441 5 000 0 1 6 Accoun t Type : Residentia l Parce l Number : 164415000 0 Parce l Address : Lega l Description : 250 8 TEMPLETO N S T OMAH AN E 68111-000 0 LUK E & TEMPLETON S LO T1 5 B LOC K0 5 0 X 13 2 Valu e Informatio n 200 7 200 6 200 5 200 4 200 3 200 2 Lan d $500.0 0 $500.0 0 $500.0 0

$0.0 0 $500.0 0

$0.0 0 Improvemen t $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 Tota l $500.0 0 $500.0 0 $500.0 0

$0.0 0 $500.0 0

$0.0 0 Sale s Informatio n Lan d Informatio n Acre s 0.1 5 S F 6600. 0 F F 50. 0 Unit s 0. 0 Dept h 132. 0 Widt h 50. 0 Vacan t Ye s Lan d Attribute s Attribut e Attribut e Descriptio n Improvement Informatio n



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R16. . . 10/5/200 7

## CONTAC T FOR M Propeit y I D # 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) : 

# "^^yf O

Date : 77f/ ^ Time : //»^^ ^ Action : 7-0 y yy-Zk^^ ^ Date : Time : Action : Date : Time : Action : Transmi t t o EP A D Othe r Action : D

# a m %

: ,lt O ST., , 

### 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 ENVIRONMtNTA L C KO U P , INC . 

# EXECUTIV ESUMMARY : 35280—250 8 TEMPLETO NS T X 

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

# t , As-Buil t Drawin g COASTA L 

# mah aLea dSuperfun dSit e

r l Owne rMama:MARGI E WASHINGTO N AddrssE : 2Sa a TEMPinO N S T Ss-Tipl e Numtie f RYASCPXA-35;8 0 FTYB5CPXA-352B 0 RYCSCPXA-3S28 Q KYDSCPXA-3529' D Rr>?SGPx. Aasge o R l 

### 2aa 

### Woode n fenc e an d bi g tre e locate d i n B 1 an d B 2 als o ther e i s a n asphal t drivewa y throug h an d a do g kenne l locate d i n B2 .

OLS * Dat e Excavated : 11/3/0 7 Dat e USEP ASigne d Off : 11/30/0 7 

## 3528 0 Omah a Lea d Sit e Sit e Sketc h

4<>i^n



### Legen d Are ano t Excavate d Dripzon e Excavate d Quadrant s Excavate d Contract : # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .

## st u 

# EP A EP A Propert y Clos e Ou t For m Propert y# : g>'^;?^SC ^ Propert yAddress : Zl'bOf j TfyL^p\e^j^/ \ ^f : Date/Time : [ ^

I g^o t Owner' s Name : A/l/^>j<>.- P \A^ Q ^yi ^ovf^ ^ Quad s Excavated : Contracto rGrou p C/' O St^^- 1 Excavatio nGenera l Ye s No 1 .If necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 2 .I f necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? Gradln c So dan dVegetatio n Ye s N o 1 .Doe s th e gradm g aroun dth e perimete r ofth e house i nexcavate darea s generall y slop e awa y fromth e house ? 2 .Ha s so dbee nlai dinal l area s that were excavated ? 3 .Doe s th e sodappea r t o b e generall y healthy andgrowing ? (Onl y evaluat e if inspecte da t a3 0 da y tim e period ) 4 .Ar e sodde darea s generall y fir man devenl y graded ? 5 .

Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e if inspecte da t a3 0 da y tim e period ) 6 .Wa s th e propert y grade dsuc htha t wate r will no t poo l onth e property ? 7 .

Wa s damag e t o landscapin g or plant material s avoided ? Gates , Fence s an dRetainin e Wall s Ye s N o 1 .D o gate s ope nan dclos e freely? (I f applicable ) 2 .Wer e all gate s or fence s take ndowndurin g restoratio nactivitie s reinstalled ? (I f applicable ) 3 .Wasdamag e t o gate s o r fence s avoided ? (I f applicable ) 4 .Wa s damag e t o retainin g wall s avoided ? (I f applicable ) Foundation , Sidio Kan d Gutter s Ye s N o 1 .

Wa s damag e t o th e sidin g o rtri m avoided ? 2 .Wa s damag e t o th e foundatio n avoided ? 3 .Wa s damag e t o window s avoided ? 4 .Wa s damag e t o window s o rdoo rscreen s avoided ? 5 .

Wa s damag e t o downspout s o rdownspou t extension s avoided ? Sidewalk s an d Driveway s (Concrete ) Ye s N o 1 .

Wa s damag e t o drivewa ysurface s avoided ? I 2 . Wa s damag e t o walkwa ysurface s avoided ?

## Owner s comments :

Inspectio nnotes :

^f7\insyy^j^Ti^ .

Remova l an drestoratio nactivate s complet e includin g th e 30-da y so dwarranty : EPA Representatiy^y^^,,^:^^^ , JL ^ Date : /f/^cp/o z

## Propert yCompletio n Agreemen t Thi s agreement document s th e completio no f remedia l activitie s performedo nm y property . My .signatur e will designate tha t I a msatisfie dwit hth e restoratio no f m y property , andtha t n o item s ar e i nquestions , now , or a

t any time i nthe future , excep t thos e item s listedbelow , ifany . Propert y ID : ^ ^QL^ Q Propert y Addre.ss : 

# Q.60 % T^^^f-h g S. t Owner : 

# Aloccxt V " vucAJKUvftf,^/ ! Phone: P^( ^ < J A-U\' ] ^ Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item : Additiona l Comments :

I A I agre e restoratio ni s completed , excep t a s note d I I d o no l ufjree restoratio ni s compiele d 

# iy?c^r^yy^' ' 7.yM-vZJ.,u.. , yy^' 0 7 wne r s Signgtur e 

### Date "ontractor' s Sisinatiir e Dat e IPROPFRT YC l EARANC F WORKSHEE T

Dal e Propert yI D 

## ll-O^-o l 35280 ^ Propert y Projec t Omah H Lea d - l"ixe d Pric e 

## 2 5 O S T^y^p/eZc ^ Addies s Measuremen I XR rI D 010 7 'i l Count/Tini e "iel d Shol s Shot * Readin g Sampl e Are a Sho t # ; Readin g Sampl e Are a 

### 11 5 

### J ^ 2 26 / 

### ^ 6 

### ^A- S 

## fti '^' C

- Sampl e Are a 

# eA' S I n Sit u Cortiposit e ! Composit e Analytica l L a b Analytica l Readin q Averag e (Drie d & Spil t Sen t (Bag ) Aliquo t Composit e Reading s Numbe r Result s 1 (Baq ) Sieved ) -f n ^ 3 2 

### /B 9 

# i n 4 

## Zo J XR F Correcte d Valu e — > '5 (us e calibratio n char t o rad d 

## Z3 T 2 0 % t o ualue ) Sampl e Are a 

### R l V- 6 Pass/Fai l ? I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s L a b Analytica l Readin q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 tS-2 . (Baq ) Sieved ) • > 2 t 

### ? 7 3 

### • P / 7 i 

# 77 A '/(> XR F Correcte d Valu e - > S 

### IZ O (us e calibratio n char t o rad d 

# h . % 2 0 % t o ualue ) Sampl e Are a Pass/Fai l ? I n Sit u Composit e 1 Composit e Analytica l Aliquo t Composit e Reading s L a b Analytica l Readin q Averag e i (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 (Baq ) Sieved ) -> 2 3 A XR F Correcte d Valu e -- > • ; (us e calibratio n char t o rad d 2 0 % t o ualue ) 

### _ Sampl e Are a Pass/Fai l ? I n Sit u composit e Coinposit e Analytica l Aliquo t Composit e Reading s L a b Analytica l Readin g Averag e (Drie d & Spil t Sen t (Bag ) Number , Result s ! Sieved: )

XR F Corre'cte d Valu e -- > Uus e calibratio n char t o rad d |20 % t o ualue ) Sampl e Are a Pass/Fai l ? I n Sit u Aliquo t Composit e Composit e Analytica l Composit e Reading s Readin q L a b Analytica l Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s

—(Bag ) Sieved ) 7

XR F Correcte d Valu e — > (us e calibratio n char t o rad d 2 0 % t o ualue ) ni l lllll l I innA t I.Il l XI' F Ic-rhninaii' s Siqniliir p .If f Dil l

## Kl.^
- 1^ 1 2 . 2,-Z , y 

# \Q2myn£y^' ^ / C^ujCLcL - ^ 

## 3528 0

OmahaLea dSit e 4613 0y^ ^ "'"/. ^ 

# w COASTA L ENVIRONMENTA L C P 0 O F IN 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 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 : 

## /VIA^/ ^ Owner' s Name : Daytim e Phone : 

# t^A57//i0^r7h 7 V/^l-56<y^¥C7 T Addres s o f Propert y 

# 'Z^t^5 ZZr^fUfat n 5r 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 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 f Coastal Environmenta l Group , contracte d b yUSEPA , wil i 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 ! removal , an d restoratio n wor k befor e i t begins . Onc e th e wor k i s finished , th e Granto rwil l b e aske d t o revie wth e wor k an d confir m tha t i t i s complet e an d meet s wit h th e Grantor s approval . Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m EP Atha t th e propert yha s bee n remediated . ENVIRONMENTA L RESPONS E ACTION S 

### B ysignin 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 of performin g th e work . 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 f 2y*- ° "'-"v . /.^B ^ 

# ^ M •• ^ ."^'**' / COASTA L
< ""O^* - G « 0 U P IN 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 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 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 Coastal Environmenta l Group , a t (877 ) 234-6270 .



## algr s I gran t acces s t o m ypropertie s Q I d o no t gran t acces s t o m ypropertie s 

# -6-<^ 7 signature / - ^ Dat e Signatur eDat e

nI 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 2COASTA L 

### Restoratio n Agreemen t Th e purpos eof thi s agreemen t is to provi(J e amutual agreemen t as to condition s ofth e propert } prio r to remediatio nactivities . Thi s wil l als o serv e as documentatio nfo r

th e purpos e of assurin g tha t restoratio n activitie s ar e complete d to th e satisfactio nofth e propert > owne r an dth e Unite dState s Environmental Protectio n.Agenc y (EP.A) . Propert y ID : ^ ^ '7<3< 0 Propert y .Address : 'Z.'yTy^ 

### lyy^^ y ^ T Owner : 

### z77y)'7t^7 ^ Ciy^^-57y7xyy?7^^zy Phone : 

# y7z)z ^ ^z^-y/^y y Onth e attache ddiagram(s ) indicate area(s ) to e.\ca\ate dan ddept h

of e\ca\ation . locatio n of al l know n utilities, subsurfac e features , surfac e structure s andlandscapin g features , acces s location(s )to be used by contractor , andthe directio n of Nonh . Indicate distances , depths , material types , etc . Indicate digita l photo s by referencin g th e photo-lo g number wit h

an arrow indicatin g directio n of \iew . 

### Item s To Be Remove d By Owne rBefor e Star t Of Remediation : (Us e additiona l sheet s as necessary ) -r.'-.s . -^ cr. ' c- 5 I .-•,.,.. , _, f s ir e '_•••:"£ ' - ^ : u; 1;(. , Item : ^ ^ 

# jh7Zz^7rr/i ^ ' \ Item : y ^ | 

# 1 y^Aycy y 

# \ "^ V ^ ll Item : j 1 | i

' Item : j j Item : | 1 Item : 

### 1 Item : Pag e 1 ofCOASTA 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 : 

# i J ^/J^ ^ Item : Item : Item : Item : Item : 

### Item : I Item :



### Item : ! Item ; 

### I Item :

Item : Item : Item : Item :

Pag e 2 o fCOASTA L 

### Item s T o B e Remove d B yContracto rDurin g Remediatio n An d Replace d (Us e additiona l sheet s a s necessary ) Item : 

# 3y ) Item : 

# 307Z ^ Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 3of .COASTA L 

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

### Ite m Quantit y Uni t Condition/Type/Specle s Pre-e\isiin g property area , tha t uil l b e excavated , tha t Square fee t is coxere dwit harass .

Numbe r o f tree s "• 2 inch Eac h trLin k

diamete r 

## ^77i^ ^ 

# y y Number o

f t.'-ees ^ Zinct : ! ;:'Lr: k diamete r i

\\:n:\ii: \o f Sprinkl e Zcincs . Cojiiro l \':ii\'e ^ 1 :mir:-s . Heads , etc . Eac h

NumiDe r oi " an dsi/ e o f eac hgarde nllowe r bed area . Eac h Squar e Feet

Pag e 4 o fCOAST A 

### Ite m Quantit y 

## Uni t Conditlon/Type/Specie s Agree d upo n valu e of plan t material s no t to be replace d bycontractor . Not e thi s \alu e «il l be use dto issu e aplai u vouche r lo th e propen y owner . Agree dupo nlis t of plant material s tha t will be replace d by contractor .Be \er y specifi c an ddetailed . lac h 'nJ.iJ e :• -keic h .^ f -.ver c c.-,ch plan i i\':\ \ 'oi : pk.cc ^ .Agreedupo n propen yto be \\iit i iiras s sod . area of replace d Sf

.'^.re a o

f f i \ r C;i or Couni uni \ y ; \/ i P' - open ytobe landscape^ ; /y7'/^7/^r^&^ ' per ilieir reauiremenis .

Easemen t .•\rea .lo he cvcasaie d

Pag e 5 of .COASTA L

Additiona l Comment s / Instructions : 

# ^(^W/ ^ z^O z7^z7ey§l! > yz^^^Ttzz y /)7 ^ /^Tz/^ b 7€/ ^ :7 5

i m 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 bo xCE 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 crack s o rfissures .



# H1 ^ agre e nI d o no t agre e 

# L< 7 7 d- 6 

# ^(7 9 Owner' s SignOTur e Dat e Contractor' s Sianatur e Pag e 6 o f