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

# SS'3 4 Date : A//^^/:2^^ 5 Addres s Remediatio nContractor : Coasta l Environmenta l Group

_Year : 200 7 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S B ^ Vide o o f propert y (DVD ) \>£^pn ^ 0 ^ Executiv e Summary [J

/ EPA-provide dproperty sketc h 0 ^ Signe dAcces s Agreemen t for subjec t propert y nSigne dAcces s Agreement(s ) fo r adjacen t propert y [ FRestoratio nAgreemen t D Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) ffl^ Confirmatio ndat a i

/ Photograph s [>f.-(-0<le , 3^2 0 '. ^ As-buil t sketc h, 0 ^ Satisfactory restoratio nsigne db y Property Ovrae r EPropert y close-ou t chec k lis t signe db y EP A IJ^IShl£>0~ J D Descriptio nofarea s no t meetin g RO D cleanu p criteri a D Utility clearance s u Propert y informatio nfi'omDougla s Count y Assessor' s Offic e

D 

### ignatur e < Dat T 4031287 4 

# liliiii i Superfun d

## Fina l Repor t Propert y Chec k Lis t (piease plac e wit heac hnie ) Har dCop y Informatio n Propert y Chec k Lis t Sit e Workin g Drawin g Ma p EP A original s Ma p Dougla s Count y Assessor' s Ma p Propert y Contac t Shee t Agreemen t i s 1 . Acces s Agreemen t " S " • Restoratio nAgreemen t IMiscellaneou s Document s /^l . Fina l Ma p fromth e Fiel d n2 . Chang e Order s ^Vf y ^3 . XR FDat a.

I~( 4 . An y email s o r P O correspondence s ^ r ^ Propert y Completio n ; ^ 1 . Executiv e Summar y S I 2 . A S BUIL T 3 .Propert y Completio nAgreemen t \ . An y buyou t inf o o r reimbursemen t int o Qs ^ Chec k o r mone y orde r copie s "^IS K 6 . EP A Propert y Clos e Ou t Form l H 7 . Attache dBegi nVide o Electroni c Documentatio n Drawing s K i I- EP A origina l ^^2 . Workin g Drawin g 3 . A S Built.vs o 4 . A S Built.jp g Photo s 1 Begi nPhoto s 2 During/Excavatio nPhoto s ^ So dPhoto s j i 4 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

# Property Acces s Checklis t PropcMt y lb : ^^^3" ^ nWOR K STARTE D ON :

_ / /_ D WORKCOMPELTE D ON : / / Pr»,>c.-r V Address : 'JYOS^'^JM^^S ^ 1 ^ ^ Renter : 

# ^'UiO:iLr ^ \Xo\ ^ Address : Phone : Fax : Cell/Pager : 

# Phonor^a: ) cg^-67<^^ 7 Additiona l I ni'onnation : Fax : |j ^ NotiCieatio nLette r 

### Smt'._^l£_l^- ^ Bv : ^c^ S cEAeees s A<;reement Signed : ^/_^422L 

## ^y - ^A^, ^ p s Restoratio nAjjreenien t 

## Signed:/0/X-/dS
­ B.v - ^A^f ^ 1 1 Top.soil Sam|)lin< 4 (if applieahle ) / / By : 1 1 Disposal Samplin< ; (i C a|)plieal)le ) / / By : 1 1 Garde nSainplin<> (if applieable ) / / By : ^ Utility Clearanc e 

## Called : fi_1 ^ l/lp
- „ ^ lo/9^€-his d J ^ Video/Photo s (Before ) 

## On: M^/a^J-O j nVideo/Photo s (Durinj; ) On : / / By : ^ Vidco/Plioto s (Aftci ) 

# On : IL/A. ^ 6 7 By : U i ch ^ nVideo/Photo s (3()-Dav ) On : / / By : ^ Propert y Completio nAjircemen t Signed : i ^ 5/0 7 

# ^y - (k^cs . 1' ^ Fina l Repor t Issued :/ / 

# ^y - Pi-h A Ai r IVIoiiitoiin u (a s a|)plieal>le ) • Coniniunit y • Cre w On : / / Results : nCommunit y O Cre w On : / / B, : Results : . • i l ­ 1 1 Communit y C H Cre w On : / / By : Results : Omah a Lea d Sit e

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## Address: )Qr\' ^ f'(T^ y Sit e Sketc h 

# i' Dhnno '' Phon e 

# 2/tSi / 4^ce$ j Dat e O / XR F Cod e 

# ;a ^ y//^^- > ^^-.fe^^f/4\pnK^r°*«^ y Sampl e Numbe r Lea d Concentratio n Confimiatio n Sampl e 

## <^i ^

pp m Ye s • NO^,Z J 

## 2 ^^^m-^<.^ L Ye s • No^ja ^ Ye s Z2X^Mozf\ ^ Ye s j2^;^|^No^zr ^ Yes« n r'^N o •



# ^^^^^^^c^m A OmahaLea dSit e 46904.783-0 1

### Dougla s County Accoun t Informatio n Pag e 1 o f 1 Dougla s County , Nebrask a Propert yRecor d - R104038000 0 Prin t Repor t Informatio n i s vali d a s o f 2007-8-2 4 Vjewp n jyia p Value s no t finalize d unti l afte rBoar d o f Equalizatio n i Treasurer' s Ta xRepor t Owne r MOIS E WILLI E L P O BO X 3474 6 OMAH AN E 68134-000 0 Propert yInformatio n Ke yNumber : 403 8 000 0 1 0 Accoun t Type : Residentia l Parce l Number : 104038000 0 Parce l Address : 180 5 CORB YS T OMAH AN E 68110-000 0 Lega l Description : FLACK S SU B DIV-MILLAR D & LO T3 BLOC K0 3 0 X 7 8 5/8 Valu e Informatio n Lan d Improvemen t Tota l 200 7 $200.0 0 $0.0 0 $200.0 0 200 6 $200.0 0 $0.0 0 $200.0 0 200 5 $200.0 0 $0.0 0 $200.0 0 200 4 $0.0 0 $0.0 0 $0.0 0 200 3 $200.0 0 $0.0 0 $200.0 0 200 2 $0.0 0 $0.0 0 $0.0 0 Sale s Informatio n Lan d Informatio n Acre s S F F F Unit s Dept h Widt h Vacan t 0.0 5 2370. 0 30. 0 0. 0 79. 0 30. 0 Ye s Lan d Attribute s Attribut e Attribut e Descriptio n Improvemen t Informatio n



### http://douglasne.mapping-onHne.com/DouglasCoNe/static/accountinfo.jsp?accountno=R l 0.. . 10/5/200 7

### Dougla s Count yN E GI S Ma p LEGEN D Mino rStraet s 

### X ou t Majo rstreet * 

### X tuto rSAitt a InterstAte s 

### X IntMiUt M Parcel s 

# • parcel Z Hydr o 

### H 

## Drh/Bfib yWe^GUIDE l Disclaimer : Thi s ma p i s no t guarantee d t o b e accurate , correct , current , o r complet e an d conclusion s draw n ar e th e responsibilityof th e user .

## CONTAC T FOR M Propert y I D # Propert y Address : Initia l Contact : Secon dContact : Fina l Contact : Final Action :

Comment : Owne r Commen t (s) : Sit e Coordinato r Commen t (s) : 

# ^^s' ^

Date : Time : Action :

Date : Time : Action : Date : Time : Action : Transmi t t o EP A D Othe r Action : D

### X 

# i % 

### Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc . ^ < # www.coastalhazinat.co m COASTA L ENVIRONMENTA L CROUP . INC . 

# EXECUTIV ESUMMARY : 05534—180 5 CORB Y S T N o Issue s o r Concern s I I Issues/Concern s Detai l Explanation :

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

t an y tim e i nth e future , except thos e item s liste dbelow , i f any . Propert y ID : 

# ^52 , ProptrlyAddr... : /^ ^ ^At^^.J/
- Owner : 

## £ 1 lir.^SJ ? Phone : 

## Od: ) ic ^ - U^ie^ ] Restoratio n Item s i n Question :

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

j
[yr agre e restoratio ni s completed , excep t a s note d I I d o no t agre e restoratio n i s complete d


### Owner' s Signature Date Contractor' s Signature I

# As-Buil t Drawing ^ COASTA L 

# "Omah aLea dSuperfun dSit e

Name : Omah a Lea d Sit e Address : )'^n," ? (\'Xk> V Sit e Sketc h Phnnp - ' 

# i '

XR F Cod e 

# °- ' '^Mr^ ^ •'-%^.^jkr.>^r'"« ^ :7a4 L Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e 

### .52 , (Sn^d:^ ^ pp m Ye s • N o F D 

# M S : ^ pp m Ye s • No^0 ^ 

### 3 iyffi'CPXR-^^^^ , 

# 5^ S pp m Yes • N o JZ!f\ ^ 

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Omah aLea dSite 46904.783-0 1 

### Legen d
Are a no t Excavate d Dripzon e Excavate d Quadrant s Excavate d 

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

# i S*? L 

# EP A EP A Propert y Clos e Ou t For m y^u j 

# L ^ Propert y #: ''yS^^H ' . ,Propert Propert y Address: Address: - J-MD - Date/Time : Owner' s Name: . // l jr Uj/^. ^ Quad s Excavated : Contracto r Crou p Excavatio nGenera l 1.

If necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 2.

If necessary , wer e th e correc t area s of dri p zon e excavate dan drestored ? Gradin g So dan dVegetatio n 1.Doe s th e gradin g aroun dth e perimete r ofth e hous e inexcavate darea s generall y slop e awa y fromth e house ? 2.

Ha s so dbee nlai d inall area s tha t were excavated ? 3.

Doe s th e sodappea r to be generall y healthy andgrowing ? (Onl y evaluat e if

inspecte d at a

30 da y time period ) 4.Ar e sodde darea s generall y firman devenl y graded ? 5.Ar e th e joint s t)etwee nth e so dstrip s generall y tight ? (Onl y evaluat e if inspecte d at a

30 da y tim e period ) 6.Wa s the propert y grade dsuc htha t water will not poo l on th e property ? 7.Wa s damag e to landscapin g or plan t material s avoided ? Gates , Fence s an d Retainin g Wall s 1, Do gate s ope n an d clos e freely? (I f applicable ) 2.Wer e al l gates orfence s take n dow n durin g restoratio n activitie s reinstalled ? (I f applicable ) 3.Wa s damag e to gate s orfence s avoided ? (I f applicable ) 4.

Wa s damag e to retainin g wall s avoided ? (I f applicable ) Foundation , Sidin g an dGutter s 1.

Wa s damag e to th e sidin g or tri mavoided ? 2.Wa s damag eto th e foundatio n avoided ? 3.

Wa s damag eto windows avoided ? 4.

Wa s damag eto windowsor doo r screen s avoided ? 5.Wa s damag e to downspout s or downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) 1.

Wa s damag e to drivewa y surface s avoided ? 2.

Wa s damag e to walkway surface s avoided ? 

# ^i ^ Ye s No ^

Ve s No i x ^ 1 ^

t ^ 1 ^ 

## i X Ye s Nu 

## x/U A/' L 

## A' ^ iJ ^ Ye s No 

# /( M /^ A /y i N I 

# Ph Ye s No 

# /^ A pl ^

## Owner s comments :

Inspectio nnotes :

Removal an drestoratio nactivate s complet e includin g th e 30-da y so dwarranty : EP A Representativ^,^^;^^;^!^;^ ^ \A^7 ^ Date :......: %

• J'-" : •'i - r.»'<* ' 

# 4 i PROPERTYCLEARANC E WORKSHEE T "^ Dat e Propert yI D 

### 11-09'O l 

## E^^' i Propert y Projec t Omah a Lea d - - Fixe d Pric e Addres s 

# /8o 5 C^r^ ^ s r Measuremen t XR F I D 0107-5 1 Count/Tim e Fiel d Shot s Sho t # Readin g Sampl e Are a Shot # Readin g Sampl e Are a 

### /fc

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### n s R2 . tJ- C

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### <^A-K i Aliguo t 1 I n Sit u Readin g Composit e Reading s (Bag ) Composit e Averag e

(Bag ) Composit e (Drie d & Sieved ) Analytica l Spil t Sen t 7 La b Numbe r Analytica l Result s 2 3 4 

### iV / Zo t ZS 1 

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# 2'1 5 Sampl e Are a ^•2 - »f-L » Pass/Fail ? I n Sit u Composit e Composit e Analytica l Aliguo t Composit e Reading s La b Analytica l Readin g Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 18 0 (Bag ) Sieved ) ? 2 

### i n I9 S 3 i k l 12 0 

# /^y 4 li b n f XR F Correcte d Valu e - > 5 (us e calibratio n char t o rad d 

### 19 ^ J.O S 2 0 % t o value ) Sampl e Are a Pass/Fai l ? I n Sit u Composit e Composit e Analytica l Aliguo t Composit e Reading s La b Analytica l Readin g Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 (Bag ) Sieved ) 7 2 3 4 XR F Correcte d Valu e —> 5 (us e calibratio n char t o rad d 2 0 % t o value ) Sampl e Are a Pass/Fai l ? I n Sit u Composit e Composit e Analytica l Aliguo t Composit e Reading s L a b Analytica l Readin g Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 (Bag ) Sieved ) • > 2 3 4 XR F Correcte d Valu e -- > 5 (us e calibratio n char t o rad d 2 0 % t o value ) Sampl e Are a Pass/Fai l ? Aliquo t I n Sit u Composit e Composit e Analytica l Composit e Reading s La b Analytica l Readin g Averag e (Drie d & Spil t Sen t (Bag ) (Bag ) Sieved ) 7 2 1 Numbe r Result s 3 

## r 4 XR F Correcte d Valu e —> 5 (us e calibratio n char t o rad d 2 0 % t o value ) l/ WAUBIIIONA l SMtfl' i I f XR F Tec h nician' s Siqnitur e Q\j \ J^JLASLSU ^ hX)jM\CM ^ NffDi n

• jtfSuL t ^'7£»K..i ^

## ^ 'dlds-^ l fl^ o ^^9/<=)6S S ^ . 

# [P^h e ^/# t Nam e Omah a Lea d Sit e Ad(jress : )Qr). < COTH. / Sit e Sketc h Phnno
- ' \ Phon e 

# f/fs y4^ce$ j Date O . ' . T M ^ BV1D # XR F Cod e 

# 'llhk^^'^^' X <-?^ - y^ , 

# ^2=? ^ Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e 

## 1 ^yA-srf>)(n-.^- 7 (Sfyj-t-S f pp m Ye s • No^ _ 

### 2 j<.Vt<.-brPyQ-c^^^ > ]46^. ^ pp m Ye s • No^^.0 ^ ^ Ye s • x ^ N o J^f\ , pp m pp m 

## Ye s jz r 1,'r^No^j^ r Yes« n 'N o • 

# 4 pp m 

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# f^^^M ^ Omah aLea dSit e 46904.783-0 1 

## r ^• COASTA L L * C \ J 9 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( j authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA ) o rit s authorize d representatives , collectivel y th e Grantee , t o ente ran d perfor m certai n environmenta l respons e activitie s upo n th e followin g describe d premises : Owner' s Name : Daytim e Phone : ^ 7 ^ (^^^ ^

Addres s o f Propert y 

# /S^^^^/^ y5"/ ^ covere d b ythi s Agreement : -URPCS E O F RESPCMS E N . iE S 

### Th e EP A' s -equestin g acces s : o collect soi l sa r ie s an d :-er,:\ e :-cr,ta:n s elevate d concentration s of lea d an d ~a yccs e a healt h hazard . Th e area(s } wil l b e excavate d t o remov e contaminate d soil . Th e rencve d contaminate d soi l wil l b e 'epia'ce d wit h ctea n material s an d th e a'e a wil l b e restore d t o it s origina l condition . Tf-.^ s A--epreseptativ e c f Coastal Environmenta l G-oup , contracte d b yUSEPA . wil l contac t :n e Granto rin-perso n t o discus s th e \vo' k t cb e cerfcrmed . th e Granto r.vil ! hav e a n opportunit yt o revie wan d approv e th e planne d soi l 'emcval . an d restoratio n wcrxbefcr 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 Granto rs approval . Upo n completion , th e Granto rwil l i-ece've writte n documentatio n *ro m EP Atha t th e propert yha s bee n 'em.ediated . EK'VIRCNIMENT.A L RESPONS E ACTION S 

### 3 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 prio 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 ycompleted . Th e Granto rals o agree s to :

Paa e 1 o f 2COASTA L

'* i PRO"'* ' C P C I , P N 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 necessar ysubsequen 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 ofth e propert y, , *'.- , AGREEMEN TNO TTO INTERFER E - . . ,-„^ . :.' ,"' ; Th e Granto ragree s ne t t cinterfer e c 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 eqjipm:.en t ^.se d o n hi s property , c rt o 'jnderfiak e an y action s i^egardin g th e Lis e o f sai d propert ywhic h woul d ten d t o endange rth e healt h o r A'el'^a'' e o f th e G'a'^'^ee s ' " *'" e —~\,''C^'^e'' * c" " s'lc wcthe'' S t cus e th e orcpertv ' ' ^
Shoul d yo u hav e an yquestion s abou t tni s p:-0Gram , pleas e contac t Ccasta ' Envi^onrrienta l Group , at-S?? ) 234-e2:"0 . • " I gran t scces s t c.TV propertie s 1 d o no t gran t acces s t o mypropertie s

Sionatur e ^ Date / ' Sionatur eDat e
I woul d lik e t o b e presen t durin g an ysam.plin g tha t i s required .

Paa e 2 o f 2COASTA L 

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

Propert yID : 

# ^^^ V Propert y Address : /^^ ^ ^>g ^ S 7 

## Q""^'- = Ur/// ^ /Pf^/$£ ^ Phone: ^7 ^ . (^Z^ ^ O nth e attache ddiagram(s ) indicate area(s ) to excavate dan ddept ho f excavation , locatio nof all know n utilities , subsurfac e features , surfac e structure s an dlandscapin g features , acces s location(s ) to be usedb y contractor , an dth e directio no f North . Indicate distances , depths , material types , etc . Indicate digita l photo s b y referencin g the photo-lo g numbe r wit ha narro 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 f thes e item s i s th e Owner s responsibility . Item : 

# a OAJ C Item : Item : Item : Item : Item : Item : Item : 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 : i 

# ^m^/ /

^^^ii^' ^ ^ ^o:y^ S Item : 

# '
Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : !

Item :

Pag e 2 of .COASTA L C N O W r. I W e 

### 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 : 

# ^ol > Item : 

# 5 < ^!/6 ^ Kern : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 3 of .COASTA L 

## Landscap e Inventory (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 dwithgrass .

Numbe r o f tree s > 2 inch trunk diamete r

Numbe r o f tree s «' = 2 inch trunk diamete r

Numbe r o f Sprinkle r Zones . Contro l Valves . Timers . Heads , etc . .Auac haiketcl" . o f ih e iprinkle:
- la. \out .
Numbe r o f an dsiz e o f eac hgarden / flower be d area . .-"'.uaci' i ;• ; :>keic! i oi'i-cla;i\ c '•ize s an dlocations . 

## Quantit y Uni t Condition/Type/Specie s
Squar e feet 

# -lo t Each

• 

# A/ l Each

Each 

### /

Each 

### ^ Squar e Fee t

Pag e 4 of .COASTA L 

## Ite m Quantit y Uni t Condition/Type/Specie s Agree dupo nvalu e of Dian t material s no t t o b e reolace db v contractor . Not e thi s valu e will b e use dt o issu e aplan t vouche r t o th e propert y owner . Agree dupo nlis t of plant material s that wil l be replace dby contractor . B e very specifi c an ddetailed . includ e asketc hof vser e eac hplant wil l be place d b \th e contracK>r . Agree dupo nare aof property t o b e replace d wit hgras s sod . Iriclude asketc hof ihc area(s ) l o b e replace dN'vit 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 a-kekT i i.; ' ;|-.c
are ais !

Easemen t .Area , t o b e excavate d 1 1 

# <^ j $



### < / Each

! S F



## D^t^tHlAJ^h S F

S F

Pag e 5 of .COASTA L • NVinONHEMTA L C n O U P . INC . 

### Additiona l Comment s / Instructions :

n 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 damage . Bycheckin 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 crack s o rfissures .

Q^agre e C ] I d o no t agre e

Owner' s Signatur e Dat e Contractor' s Signature Pag e 6 of .