## TRANSMITTALof OMAHALEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID# : 0,55//?( ^ Date : |/2/ | | Address : fSr)M" 7 S^UTglTt ^ S-\
- Remediatio nContractor : Coasta l Environmenta l Group

_ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f property (DVD ) 

# ^ y 

# xy l y Executiv e Summary EPA-provide dproperty sketc h Signe dAcces s Agreemen t for subjec t property Signe dAcces s Agreement(s ) for adjacent property Restoratio nAgreemen t Year : _2010ARR A

Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) Confirmatio ndat a 

## ty Photograph s As-built sketc h Satisfactory restoratio nsigne db y Property Owne r 

# g

/ Property close-ou t chec k lis t signe db y EPA Descriptio no f area s no t meetin g RO D cleanu p criteri a Utility clearance s Property informatio nfromDougla s County Assessor' s Offic e D D D
^ ^ 3021823 7 Superfun d# 

# vv Propert yAcces s Checklis t PropertylD : [^f;^i^l o Property Address : ^,-^g- | ^ex^rA'b^ . n nWORK STARTE D WORKCOMPELTE D ON : ON : / // / Owner : ft^ iVi A)<A\[A Address : ' 

# ^^--^'•eDs)'io uyA9>Q u Fax : " Cell/Pager : Renter : Phone : Fax : Cell/Pager : Additional Information :

D n ? s n D Q D S D n n D Q DNotificatio nLette r Acces s Agreenient Restoratio nAgreenient Topsoil Samplin g (if applicable ) Disposa l Samplin g (if applicable ) Garde nSamplin g (if applicable ) Utilit y Clearanc e Video/Photo s (Before) Video/Photo s (During ) Video/Photo s (After) Video/Photo s (30-Day ) Property Completio nAgreement Final Report Sent : / / Siened : 7 2 / / IO< i 

## Signed: iL l 1_'C H I I 1 1 1 1 CaUed:IZ1 2 . ICC \

On : / / On : / / On : / / On : / / Siened : / / Issued : / / By : By : By : By : By : By : 

## By = By : By : By : By : By : By : 

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Air Monitorin g (a s appUcable) • Communit y Q Cre w Results : On : / / By : 1

• Communit y Results : O Cre w On : / / By :

• Communit y Results : O Cre w On : / / By :

Omah a Lea d Sit e

## Douglas Count y Accoun t In|^aatio n Pag e 1 of 3 Dougla s County , Nebrask a Propert yRecor d - R090994000 0 Prin t Repor t NE WFaatur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f52n d S t - VIeWO n Ma p Informatio n i s vali d a s o f2009-10-1 5 Treasurer' s Ta xRepor t Ne wFeatur e -* ^ ^ Aut o Sale s Searc h Owne r KELLYBRIA N M ETA L 504 7 SEWAR D S T OMAH AN E 68104-000 0 Propert yInformatio n Ke yNumber : 099 4 OOO O 0 9 Accoun t Type : Residentia l Parce l Number : 090994000 0 Parce l Address : 504 7 SEWAR D S T OMAH AN E 68104-000 0 Lega l Description : CREIGHTO N PAR KLO T1 2 BLOC K4 W2 7 F TLT1 1 & E 2 6 F T5 3 X 15 0 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $ 7,000.0 0 $ 144,200.0 0 $ 151,200.0 0 200 8 $7,000.0 0 $ 144,200.0 0 $ 151,200.0 0 200 7 $7,000.0 0 $ 144,200.0 0 $ 151,200.0 0 200 6 $7,000.0 0 $ 144,200.0 0 $ 151,200.0 0 200 5 $7,000.0 0 $ 144,200.0 0 $ 151,200.0 0 200 4 $7,000.0 0 $ 105,400.0 0 $ 112,400.0 0 Sale s Informatio n Sale s Dato : 2008-02-2 8 Dee d Type : W D Book : 200 8 Page : 02144 1 Price : $153,300.0 0 Grantor : DRAK E COURTLAN D ETA L Grantee : KELLYBRIA N M ETA L Valid/Invalid : Vali d Exclusio n Reason : Sale s Dato : 1999-08-1 9 Dee d Type : Book : 213 0 Page : 57 2 Price : $ 111,000.0 0 Grantor : 

## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accoimtno=RO.. . 10/23/2009

### Dougla s County Accoun t In|^natio n Pag e 2 o f 3
Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 8 7950. 0 1. 0 150. 0 53. 0 N o Improvemen t Informatio n Buildin g 1 1. 5 StoryUnfi n 504 7 Sewai^ S

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CLIC KTO ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1053. 0 Percen t Complete : 100.0 % Perimete r0. 0 Quality : Goo d Uni t Type : Condition : Averag e

Buil t As : 1 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 5. 0 Exterior : Masonr yCommo n Bric k Units : 1. 0 Interior : Drywal l Baths : 2. 5 Roo fCover : Compositio n Shingl e Bedrooms : 2. 0

Roo fType : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k 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 194 0 0 % 194 0 6 9 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fenc e Chai n Lin k 1. 0 Applianc e Allowanc e 1. 0 Applianc e Fireplac e Masonr y 1. 0 Applianc e Securit ySyste m 1. 0 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinf o .jsp?accountno=RO.. . 10/23/200 9

### t^^ a 

## Douglas Coimt y Accoun t It^^atio n Pag e 3 of3
Basemen t Basemen t Fixtur e Fixtur e Fixtur e Garag e Porc h Porc h Use r Bsmn t Bloc k 8 ft Finishe d Bas e Fixture s Bat h Ful l Bat h Hal f Basemen t Singl e Ope n Sla b Ope n Sla b SE E NOTE S 1263. 0 400. 0 1. 0 1. 0 1. 0 1. 0 100. 0 210. 0 1. 0



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO.. . 10/23/2009

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### • YOURTICKE T NUMBE RI S 2415903 . Origina l Cal l Date : 12/02/0 9 Wor k t o Begi n Date : 12/04/0 9 Time : 9:5 3 a m Time : 10:3 0 a m Op : ELIZABETH1879 0 State : N E Address : 504 7 County : DOUGLA S Street : SEWARD S T Place : OMAH A Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 18-N E Sect-Qtr : Typ e o f Work : LEA D REMEDITION Locatio n o f Work : INCLUD E AL L EASEMENT S LOCAT E ENTIR E PROPERTY Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LO T Compan y: COASTAL ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : {877)662-421 0 Wor k Being Don e For : 4 F T Dept h o f Excavation : COASTAL Corne r Lot : N Involve s Tunnelin g o r Horizonta l Boring : N Front : Y Explosives : N CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Rear :

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### Day : 402444719 7

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### Day : 406728934 3 Alt : 4062071494 Emerg : 888728934 3 QLNNEIC QWES T LOCA LNETWOR K

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### Consen t fo rAcces s T o Propeft 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 : 

# ^n/^ ^ K^ui^ ^ ^jlo H Me^M Addres s o fPropert y covere d b ythi s Agreement : 

# S^H f5tivJ/^^ D ^t 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 flea 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 wori < I s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o fCoasta 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 wori t 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 y ha 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 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 f2..*^"'"> , COASTA L IHVIROHHIKTA L 

# '*\y y C I O U > IH C


### « Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; cRemov 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 ; cWate 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 ; cAbid e b yhealt h an d safet yguidanc e provide d b yEPA ; « I fth 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 . ft 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 fth e wort< activities , o rwit h an y o fth 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 fsai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o fth 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 (402 ) 991-119 9

^

I gran t acces s t o m ypropertie s D I d o no t gran t acces s t o m ypropertie s 

# rKM/ ^ signatur e Dat e Signature Date
D I woul d lik e t o b e presen t durin g an ysamplin g tha t i s required .

Page 2 o f2

### « 

### »*^'*!r'v . COASTA I tHVUtONH fKTA l CROUP . 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 :

Owner' s Name : Daytim e Phone :

Addres s o fPropert y covere d b ythi s Agreement : 

# 5/^ WI '^^OAMirrJi sf 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 flea 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 wori ( i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o fCoasta 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 perfonned , 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 wori ( befor e i t begins . Onc e th e wori ( i s finished , th e Granto rwil l b e aske d t o revie wth e wori < 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 y ha 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 prio rnotice , fo rth e sol e purpos e o fperformin g th e woric . 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 f2

### y

COASTA L

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### « Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; cRemov 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 ; cAbid e b yhealt h an d safet yguidanc e provide d b yEPA ; •I fth 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 perfon n th e work . eAllo 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 fth e wor k activities , o rwit h an y o fth e wort < 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 fsai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o fth 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 (402 ) 991-119 9 \2 l I gran t acces s t o mypropertie s D i d o no t gran t acces s t o mypropertie s 

# 1\ . x ^ ^ yj^y^^yi y/zy^yy^ f. "signature / "" " " Dat ^ / SignatureDate

n

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

Page 2 of 2

# iZU ^ COASTA L 

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

Propert y ID : ^55^ ^ Propert y Address : c^^g^ y f •^t^'I'l^r ? Owner : ^^^^ ^ ^^^^ y Phone: 

## •(&^]lo^-H6'^ H O nth e attache ddiagram(s ) indicat e area(s ) t o excavate , surfac e stnicture s andlandscapin g feature s and acces s location(s ) t o b e use db y th e contractors . Indicat e distances , depths , material types , etc . Photographicall y andVideographicall y documen t th e existin g condition s ofth e property an dth e basemen t i f necessary . 

### Item s t o b e Remove d b yth e Owne rbefor e Start o fRemediation : Th e lemoval . storaqe , disposal , and/o rretur n o fthes e itom s i s th e Owner' s respon s bilily . Item : 

## ^f^4LL - yZiOi 6 item : / Item : 

### / item : '



## item s t o b e Remove db y th e Contracto r During Remediatio nan dNot Replace d Item : 

# (^y^Ul^lO/ f^z^4L. L rLy4JZ < Item : item : Item :
Page l of .1 COASTA L 

### Item s t o B e Remove d 

## B y Contracto r Durin p Remediatio n an d Replacecf Item : ^cP D - 

## r l Item : <70'll . ' 

# n item : Item : 

## Ljindscap e Inventor y item Quantity Unit Condition/Type/Specie s Pre-existin g propert y area , Quadrant s that wil l b e excavated , tha t i s covere dwithgrass . 

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

# y Numbe r o f tree s < = 2 inc h Eac h 

# z trun k diamete r Numbe r o f Sprinkle r Zones . Contro l Valves , Eac h Timers , Heads , etc . 

# y Aiiat hasketcl i ul (lit
- Numbe r o f an dsiz e o f eac hgarden / flowe r be d Eac h area . Squar e Fee t Aiuith. 1 skcicl i ol rc!;iiiv(. ' <izi' S niidloc;lIi(l|l^ Agree dupo nvalu e ofplan t material s no t t o b e replace db v contractor . S VCU ' ll'ii
- ^Mlll C Nul l n i USl'O ' 1 0 li-.U l . 1 pittll i / > oiii.-;\f ; !( / ill f |;rii)icrl \ iiMiier . Easemen t Area , t o b e Rach excavate d 

# ^fi> Pag e 2 of .C O AS 1 AL IMVtnOMn i HTA t D » O U » , IN C ! Additiona l Comment s / Instructions :



# L.

^ ^ Chec k th e t» xifOwne rdoe s no t wan t CE G to documen t interio rfoundatio n walls an d possibl e pre-existin g damage . Bycheckin g thi s t>o xCE G is no t responsibl e fo ran ydamag e don e to th e interio r ofhouse , includin g foundatio n crack s orfissures . 

### Q I do no t agre e 

# 0^ 7^}< \9j,0r\C[\QOS \\?lilcP i Owner* s Signatur e | Date e t t Qmtractor' Signature Contractor' s s Signat u Date Pag e 3 of .

### BVID#_4SSi A XR F PROPERT YSAMPL E SHEE T Dat e 

### i Z
- ^^O ^ Addres s Projec t Omah a Lea d ARR A Sampl e tim e XR F iD # sampl e lengt h 

### <^^i?a: a Shot # Readin g Sampl e are a Shot # ^ ^ 

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RETES TAREA S Shot # Readin g Sampl e are a Shot # Dept h Averag e Averag e 

# ?j^QMmh > fjQl>ti l CAI7K)I}QJ \ c:oH9 ' ^euy^AA i <.* ­ am/p m 3 0 se c Readin g Sampl e are a Dept h

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# 9 • Therm o

SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1 

## Certificat e of Verificatio n XL3t-3902 2 Readin g N o 4 5 Mod e SOI L Tim e 2009-12-0 7 16:5 3 Duratio n 91.0 0 Sequenc e Fina l Flag s AVERAG E rAyg-of-42-44—- n ADDRES S ^5047_seward-st ^ QUADRAN T F l DEPH T 6 " XR F TEC H R . VENTR Y MIS C clearenc e NOT E ngn c
pp m ± Erro r P b 12i?;33 ^ 

### Supen,isedBy : qXlMMI S

# t • Therm o

SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E
pp m P b 56.77 1 Supervise d By : 

## Certificat e o fVerificatio n

4 2 SOI L 2009-12-0 7 16:5 2 30.3 8 Fina l 6556 6 504 7 sewar d s t F l 6 " R . VENTR Y clearenc e ngn c

± Erro r ± 11.56 5•• •• 

# Therm o

SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1 

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 4 3 Mod e SOI L Tim e 2009-12-0 7 16:5 2 Duratio n 30.5 0 Sequenc e Fina l Flag s BVI D 6556 6 ADDRES S 504 7 sewar d s t QUADRAN T F l DEPH T 6 " XR F TEC H R . VENTR Y MIS C clearenc e NOT E ngn c
pp m Erro r P b 76.55 5 ± 12.72 9 Supervise d By :

# m• # • 

# Therm o

SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E
pp m P b 67.95 5 Supiervise d By : 

## Certificat e o fVerificatio n

4 4 SOI L 2009-12-0 7 16:5 3 30.1 2 Fina l 6556 6 504 7 sewar d s t F l 6 " R . VENTR Y clearenc e ngn c

± Erro r ± 13.90 5

# i

Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc . ^ : ^ www.coastaihazmat.co m COASTA L (ll«l>ONNINTA L 6 I O U P . IH C 

# EXECUTIV ESUMMARY : BVID #65566-(504 7 SEWARD ST ) No Issue s o r Concern s |~~ | Issues/Concern s Detai l Explanation : -COASTA LT O REVISI TTH ESO D INTH ESPRIN GO F2010 . ALS O T O REPLAC EA CONCRET ESPLASHBLOCK . (COMPLETE D 4/28/10 )

- DANGARVE Y WALKE D TH EPROPERT Y O N5/6/1 0

# A

EP APropert y Clos e Ou t For m P-P^rt,n : /^S?4> > PropertyAddr^.
- ^^^^"^^"^ ^ DateHlme : Owner' s Nime:..^./gO^T! ! & Qusd i Excavaied : Contracto r Grou p CZy^S ] Ye s N o Excavatio nCcnen l 1 .Ir necessaiy , wer e th e conec t qiudnuit(s ) excavate dan drestored ? 

## y 2 .I f necessary , wer e th e contc t area s o f dri p zon e excavaie dao drestored ? 

## y GradlD ESo dan dVcKetatio n Ye s N o I . IDoe s th e gradin g aroun dth e perimete r ofth e hous e i nexcaviale darea s generall y slop e away fromth e house ? / 2 . Ha s so dbee nlai di nal l area s tha t wer e excavated ? 

# y 3 . Doe s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte dat a3 0 da y tim e period ) 

# y 4 . Ar c sodde darea s generall y firman devenl y graded ? 

# y 5 . Ar e th e joint s twtwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period ) 

### y 6 . Wa s th e property grade dsuc hthat wate r wil l no l poo l onth e property ^ 

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

# y Gates , Fence s an dRctatoin g Wal b Ye s N o I I . D o gate s ope nan dclos e freely? (Ifapplicable ) 

### y Wer e al l gate s o r fence s talce ndow ndurin g restoratio nactivitie s reinsulled ? (Ifapplicable ) / 3 .

Wa s damig e t o gate s o r fence s avoided ? (Ifapplicable ) / A

. Wa s damag e t o retainin g wall s avoided ? (ifapplicable ) / Foundation , SidiB K an dGoiter s Yes N c 1 .Wa s danug e t o th e sidin g o r tri mavoided ? / 2 .Wa s damag e t o th e foundatio navoided ? / 3 . Wa s damag e t o window s avoided ? / AWa s damag e t o window s o r doo r screen s avoided ? / 5 .

Wa s damag e t o downspout s o r downspou l extension s avoided ? ^ Sidewallt s an dDriveway s (Concrete ) Ye s N o 1 .

Wa s damag e t o drivewa y surface s avoided ? / 2 .Wa s damag e t o walkwa y surface s avoided ? 

# TI ^ 

## Owner s comments :

jinspectio nnotes :

Remova l an dreslorationactivate s complele includin g th e 30-da y so dwarranry : EP ARepresentative 9^^ ^ ^ Dale ; 5!^ ^ ^' ^

## Propert yCompletio n Agreemen t rin s agreemen i documenl s Ih e complclio n o l remedia l acliviiie s perloime d o n m ypioperl yM ysignatur e wil l designat e tha i i a m satisfie d wit h Ih e restoralio n o fm yproperly , an d tha i n o item s ar e i n questions , now , o ra l an ylim e i n th e future , excep t thos e ilem s liste d below , ifan y

Propert yID : (^^^^j ^ Propert yAddress:^^^^- ^ ^^^Qafr \ ^ Owner:-^y^^ ^ Vf>\ \ 

# onou n vn\ a Phone : Restpratio n Item s i n Question :

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

P\ \ I ayrc cI'cstoralio n » completed , excep t a s noler i i Z I rianni «i>re ccesiorfltio n i s complete d 

# ^^mHr^ o ^CAMJOC ^ 

# ? 2 2y{]\ d Owncr'. « Sicnariir r\ Dat e ta*< . '7F1_> . ...<«..' . c:>~-I . Gontrarlor' s Signiiliir c ' ' Dal e rv_. ­

# DECEIVE D ^r' H 0 ^ 2011 1 rropettYOv/nerSeVisfECiio n Surve y Q j JDCO n nm ^ Omah a Lea d Superfun d Si t ^^^^^WN D DlVlS m 200 8 Remediatio n Contractor : Coasta l Environmenta l Grou p Propert yIdentifie rNumber : (.^^OQjf p Propert yAddress : g^rNU I ?.e\lOnrr l g A Propert yOwner' s Name : "^r'lOy ^

Vl^^^^ U (abov e informatio n to be fille d ou t bvrem^djjbtio n contracto rpnort o deliver y offor m lo PropertyOwner) Instruction s to Propert yOwner : Thi s for mis provide d to yo u as a mean s oftryin g to captur e you rleve l ofsatisfactio n wit h th e wor kofth e above-identifie d remediatio n contractor , as applicabl e to th e soi l cleanu p actio n at you r property . Th e U.S . Environmenta l Protectio n Agenc y(EPA )is ver yintereste d in you ropinio n regardin g th e w^or k performe d byit s contractors . Thi s for m is intende d to provid e an eas ymean s fo ryo u to expres s you ropinio n abou t th e wor k performe d on you rproperty . Pleas e indicat e you rleve l ofsatisfactio n wit h th e contractor' s wor kbyselectin g a numerica l ratin g (rangin g fro m 1 to 10 ) usin g th e followin g ratin g scale , the n pleas e sig n an d dat e th e for m an d retur n it to th e USEP A in th e attache d self-addresse d & stampe d envelope , (additiona l comment s ma y als o be provide d in th e spac e below , at th e optio n ofth e propert yowner. ) 9-1 0 "excellent " 7- 8 "ver ygood " 5- 6 "acceptable " 3- 4 "poor " 1-2 "ver ypoor " Propert vOwrner' s Satisfactio n Ratin g Regardin g Contractor' s Wori t 10 5 9 A 

# CD 3

7 2 6 1 Additiona l Comment s fro m Propert yOwne r(optional : continu e to bac> >ntinufctobac>< < < ofpae e ifneeded ! 

## I'^^^^PO ^
Propert yOwner' s Signature : V j^wT L A^ Date : ^ <\/\ftfl* ^ ^L >

## Wate rBil l Settlemen t

Property ID 6556 6 Property Addres s 5047 SewardS t Tenan t Mr . BrianKeU y

I have receivedfromthe contractor . Coasta l Environmenta l Grou p Inc . (Coastal) , the su mof $ 13.87 fo r wate r usag e requiredto maintain the sod . Check Number 192 7 Valu e o f Check $13.8 7 Mad e Ou t T o Bria nKell y Descriptio n o fSettlemen t T o reimburs e tenan t fo restimate d wate rcharge s o n thei rMU D monthl yinvoices . M ysignatur e belo wi s acknowiedgemen 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 an d ful l paymen t fo rth e above , an d releas e Coasta l Environmenta l Grou p Inc . fro m furthe robligation s o rliability .


# ^iQ[\n^(y i ^/i3|i o Contractor' s Signatur e Dat e 

## y 

# 1927 COASTA L ENVIRONMENTA L GROU P INC . 27-6/1040 003 241 1 MARTH ASTREE T 624737290 4 OMAHA , N E 6810 5 • O\\2^l 0 DAT E PA

Y7 U TH E 

# J $/3 ^ ORDEi i o r Faaia n : DOLLAfVS P*i*>l > MUhFvgKBlnk.NA .