## TRANSMITTA Lo f OMAH A LEA D SIT E son - REMEDIATIO NFIL EFOLDE R
SAID# : .^?^?'^. „Date : ////f// / 

## Address : . 9SS^ ^ /O ^ ^TT " Remediatio n Contractor : Coasta l Environmenta l Grou p Year : ^^/f 

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O PLANNIN G DEPARTMEN T 1819FARNA M ST#111 1 OMAH AN E 68183-000 0 Propert yInformatio n Ke yNumber : 127 8 000 0 1 7 Accoun t Type : E xGovernmen t Parce l Number : 171278000 0 Parce l Address : 285 8 OHI O S T OMAH AN E 68111-000 0 Lega l Description : MARIO N PLAC E LO T1 0 BLOC K0 5 0 X 12 7 Valu e Informatio n Lan d Improvemen t Tota l 201 1 $0.0 0 $0.0 0 $0.0 0 201 0 $0.0 0 $0.0 0 $0.0 0 200 9 $0.0 0 $0.0 0 $0.0 0 200 8 $500.0 0 $0.0 0 $500.0 0 200 7 $500.0 0 $0.0 0 $500.0 0 200 6 $500.0 0 $0.0 0 $500.0 0 

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## COASTA L 

# Omah aLea dSuperfun dSite Environmenta l Group , Inc
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CONCRET E DRI P ZON E EXCAVATE D QUADRANT S EXCAVATE D

ARE AREPLACE D WIT H ARE ALEF TBAR E ARE AREPLACE D WIT H SO D ROCK/MULC H 

### CONTRAC T# : EP-R7-09-0 6 COASTA L ENVIRONMENTA L GROUP , INC
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-<^ INVIItOHMIHIA ' ENVIKONHIHTA l l C R 0 U r. I h C 

## Consen t fo rAcces s To Propeii y RIGHT OF ENTR Y TO PREMISE S 

### Granto r(th e propert yowner ) consent s to an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA ) orit s authorize d representatives , collectivel y th e Grantee , to 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 : OtYVo W Daytim e Phone : HO>H>A.*A-<A'^Hf c 

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Addres s of Propert y covere d bythi s 

## ^e>s? 7 o\^ o -c ^ Agreement : PURPOS E OF RESPONS E ACTIVITIE S 

### Th e EP A is requestin g acces s to collec t soi l sample s an d remov e soi l tha t contain s elevate d concentration s of lea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l be excavate d to remov e contaminate d soil
. Th e remove d contaminate d soi l wil l be replace d wit h clea n material s an d th e are a wil l be restore d to it s origina l condition
. Thi s wor k is bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e of Coasta l Environmenta l Group , contracte d byUSEPA , wil l contac t th e Granto rin-perso n to discus s th e wor kto be perfomned , th e Granto rwil l hav e an opportunit y to revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e it begins
. Onc e th e wor k is finished , th e Granto rwil l be aske d to revie wth e wor k an d confir m tha tit is 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 

### Bysignin g thi s Acces s Agreement , th e Granto r is grantin g th e EPA , it s employees , contractor s an d subcontractor s th e righ t to ente rth e property , at al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e of performin g th e work
. Thi s acces s shal l remai n in 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 of 2c : C A5 1 *
. i I ^TI*0*>KI » Ta t I « D l » » I » C 

### Remov e obstruction s incljciin g bocls , tieileis , vehicles , picyscep e items , woo d piles , do g houses , etc : Remov e fiov»'e f bulb s o i plant s tha t th e Granto i o rth e Gientoi' s tenant ma ywis h t o save ; Wate ran d maintai n leplacemen t vegetation , includin g ferlilize i application , a s necessar) ' subsequen t t o a n initia l waterin g perio d b yEPA ; Abid e b yhealt h an d safet yguidanc e piovide d b yEPA ; I f th e propert yi s rented , assis t EP Ai n obtainin g tenan t approva l fo i acces s t o th e property ' t o perfor m th e work
. Allo wvideotapin g and/o rphotographin g o f th e property
. AGREEMEN TNO TT o IKHTERFER E 

### Th e Granto ragree s no t t o interfer e o rtampe i wit h an yo f th e W'orl < activities , o i wit 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 (402 ) 991-119 9 (

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

Dat e Signature Dat e
Q I woul d lik e t o b e piesen t durin g an ysamplin g the t i s requited
.

Pag e 2 o f 2

### V S C O AS TAL • NVIRONMINTA L CROUP , INC
. 

### Restoratio n Agreemen t The purpos e of thi s agreemen t i s to provide amutua l agreemen t a s to condition s ofth e propert y prior t o remediationactivities
. Thi s will als o serv e a s dociunentationfo r

th e purpos e o f assurin g tha t restoratio n activitie s ar e completedt o the satisfactionof the propert y owne r an dthe UnitedState s Envirorunenta l ProtectionAgency (EPA)
.

Propert y ID : Sl9>)ft^ ^ 

### PropertyAddress : r^^^ ^ (^; ^ ^ Owner : C iJjl A

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nthe attacheddiagram(s ) indicat e area(s ) to excavate , surface structure s an dlandscapin g feature s an d acces s location(s ) to b e use db y the contractors . Indicat e distances , depths , materia l types , etc . Photographicall y an dVideographicall y documen t the existing condition s ofth e propert y an dthe basemen t if necessary . Item s t o b e Remove d b yth e Owne rbefor e Start o f Remediation : Th e removal , storage , disposal , and/o rretur n o f thes e item s i s th e Owner' s responsibility
. Item : 

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_COASTA L • NVmONMKNTA L GROUP
. INC
. 

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## Ite m Pre-existing propert y area , tha t wil l b e excavated , tha t i s coveredwit hgrass . Numbe r of tree s > 2 inc h trun k

diamete r Numbe r o

f tree s < = 2 inc h trun k

diamete r Nimibe r of Sprinkle r Zones , Control Valves , Timers , Heads , etc . Attac hasketc hof the sprinkle r layout
. Nimibe r of an dsiz e o f eac hgarden / flower be d area . Attac hasketc ho f relative size s an dlocations
. Agree dupo nvalue of plan t material s not to b e replacedbv contractor . Not e thi s valu e will b e usedto issue aplan t voucher to th e propert y owner . Easemen t Area , to b e excavate d 

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Pag o 2 o f 3• w O A 5 T A L C M O U «• , IM C
Additiona l Comment s / Instructions : Th e cit yo f Omah a ordinance s ma yprohibi t yo u fro m usin g dir t o rgrave l area s o n you rpropert y a s driveway s o rvehicl e parkin g areas . Th e Environmenta l Protectio n Agenc y(EPA ) ma yb e removin g an d replacin g soi l underlyin g a grave l o rdir t are a o n you rpropert ytha t yo u ma yb e usin g a s a drivewa yo rvehicl e parkin g area . I f thi s i s th e case , yo u shoul d understan d tha t thi s removin g an d replacin g o f soi l doe s no t mea n tha t an yillega l drivewa yo rparkin g are a o n you r propert yi s mad e legal
. T o th e contrary , yo u ma yb e cite d b yth e cit yi f yo u us e a grave l o rdir t are a a s a drivewa yo rparkin g area , no t withstandin g an yremova l o rreplacemen t o f soi l b yth e EPA
. I f yo u hav e an yquestio n abou t legalit yo f a certai n drivewa yo rparkin g area , yo u ma ycontac t th e cit yo f Omaha' s Plannin g Departmen t a t (402 ) 444-5150
. leas e chec k thi s bo xi f yo u understan d th e informatio n outline d above
.

„ 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 e-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
. 

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pp m P b 84.66 1 Supervise d By : 

## Certificat e o f Verificatio n

7 0 Soi l 2011-08-2 0 15:1 7 30.1 8 pp m 2 Fina l 2883 3 285 8 Ohi o s t F l 6 " KIN G confirmatio n confirmatio n

± Erro r ± 15.23 8

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

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pp m P b 69.43 6 Supervise d By : 

## Certificat e o f Verificatio n

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± Erro r ± 14.43 2

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

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pp m P b 73.01 9 Supervise d By : 

## Certificat e o f Verificatio n

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± Erro r ± 14.39 7

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

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pp m P b 63.26 8 Supervise d By : 

## Certificat e o f Verificatio n

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pp m P b 60.45 6 Supervise d By : 

## Certificat e o f Verificatio n

7 4 Soi l 2011-08-2 0 15:2 1 30.1 7 pp m 2 Fina l 2883 3 285 8 Ohi o s t E A l " KIN G EX-SITU S confirmatio n

±Erro r ±13.71 8

# 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 Unit s Sigm a Valu e Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 65.09 1 Supervise d By : 

## Certificat e o f Verificatio n

7 5 Soi l 2011-08-2 0 15:2 2 30.1 6 pp m 2 Fina l 2883 3 285 8 Ohi o s t E A 1 " KIN G EX-SITU S confirmatio n

± Erro r ± 14.04 4

# 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 Unit s Sigm a Valu e Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E 

## Certificat e o f Verificatio n

7 6 Soi l 2011-08-2 0 15:2 3 30.1 3 pp m 2 Fina l 2883 3 285 8 Ohi o s t E A 1 " KIN G EX-SITU S confirmatio n
pp m ± Erro r P b 64.25 7 ± 14.04 2 Supervise d By :

## /1|^ \ 3 ^^^Z I \y^^ ^ 

## Omah a Lea d Site—Fixe d Pric e EP-R7-09-0 6 Coasta l Environmenta l Grou p Inc
. www.coastalhazmat.co m V I COASTA L INVIIONMINTA L G I O U P
. IN C 

# EXECUTIV ESUMMARY : BVID #28833

- (285 8 OHI O ST ) No Issue s o r Concern s [ ^ Issues/Concern s
Detai l Explanation:' ^ 

## Propert yCompletio n Agreemen t Thi s agreemen t documeni s Ih e completio n o l remedia l acliviiie s perloime d o n myproperly
. M ysignaiui e wil l designat e Iha l I a m satisfie d wit h th e restorado n ofm 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 futuie , except thos e item s liste d below , i f an y

PropertylD : '^If^^^ ^ PropertyAddress : g,^^ ^

^v ^ -E ^ Owner : Q^^ ^

^ ^

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. >M-rL ' "^\\ V \..JL»-^V v Phone : ^ ^ ^_^^ ^ ^ V^^HO , Restoratio n Item s i n Question :

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Item : Item : Item : Additiona l Comments :

ry

j I ayrc crr.^toralio n i s compieled , excep t a s note d [ I I d o no t Ajjre cresloratio n i. s conipletc d 

## iZ'Z^LJ y7tif ; 

# £ ^ /h ^ 

# fy^y ^ Owne r Dat e Contrarlor' s Signalur c Dal e

## EP A Propert y Clos e Ou t Form Propert y H : 

# .ZKMJl
. Propert y Addresir
. ~.2l£^—QM0 ^ Dete/Tlne : Owtier' s Wttint:
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. C f t V < ) f

Q<feg=Sig= Qu»d i ExcEvalfd : ContrGClo rGrou p L<5t<5'!l?L_ L Excavatio nGcncrti Vt s N o 1
. I f necessBiy i ^cr c the correct qiiadrant(s ) excavete dan drestored ? / 2
. I f necessary , wer e th e correel area s o f dri p zon e excavaiedwi drestored ? / Gradin g So dan dVegctalion Ye s N o 1 Doe s th e grBdin g aroun dth e pcrimeie r ofthe hous e i nexcavaiedareas generall y slope awa y F^ fromtb e house ? \-.-/

­ 2
.Ha s so dbee nlaidi nal l area s tha t wer e excavaied ? iDoe s th e lo dappea r t

o b e generally health y an dgrowing ? (Onl y evaluat e i

f inipertrda t f

i ?

0 

# 7 day tim e period ) 4
.

Ai r sodde darea s generall y fir man devenl y graded ? / SAre thcjoint s t>etwee nth e sodstrip s generall y tight ? (Onl y tvalual t i

f inspecie da t i 3 0 da y time period ) 

# y 6 . Wa s th e propen y gradedsuc htha i waie r wil l no l pool o nih c property' ' 

# 7 I 7
. Wa s damag e to landscaping o r plan t maierial t avoided ? 

### / Gales
. Fence aa» dReuinin g Wall s _ Ve j .N( i I ! D o gate s ope nan dclos e freely? (I f applicable) 2
. Wer e al l gate s o i fence s take ndow nduring restorationaciivitie s reinstalled ? (I f applicabk) 

### / }
. Wa s damag e t

o gate s o r fence s avoided ? (I f applicable) 

# y 4
. Wa s damag e to retaining wall s avoided ? (I f applicable) 

# 7 Foupdation , SidJB K

an dGutter s Ve s .No
- 1
.Wa s damag e t

o the siding o r trimavoided ? 2
.Wa s damag e t

nth e foundatio navoided ? Was damag e t

o window s avoided ? 

# " A 4Was damag e t

o window s o r doo r screen s avoided ? — / ' Wa s damag e to downspouts o i downspou l extension s avoided ? 1 

# y Sidewalk s an dDriveway s (Concrett ) Vcs N o 1
. Was damag e t

o drivewa y surface s avoided ? 

# A 2
. Wa. s damag e l

o walkwa y surface s avoided ? 

# "y

## OM-ners comreients :

Inspectio nnotes :

Rernova l an dresloratio nactivate s complete includin g th e 30-da Y so dwarranry ; HP A Representativ e ^ J H Dale : «»li*l "

# 0

P^opl'^l^ O w ni T .Vsisfssnicn t o f

Performanc e Kon n \nic-iKii nKecf'\er > an dKeiiuesinK-n i ^l.• | i \HK\ ) Omali aLead.Superfun d,Sill '

• 2(10 9 201( 1 

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.. . Instruction s (o th e Piopcrr y Owner ; Thi s for msene." ; i nrecordth e Propen y f.)wner s assessment (i

f petfnnnanc e (Incentiv e I Qua)jt \.Assiiranct " .Suneillanc e Plan ) in\ol\in ^ th e liste dremeriialKi nconlracior
. as applicabl e i c the Omah aLead.Site
. Thi. * for mdocument ? the iimelincs j ofpunc hlisl re.<;(i)uiion
. busines s ieJaiHin.s
. compiain i lesciluiio nan dihcuvejal ) qualilv or\\(ir k I f nee dht
. ih e Pr()pen\Owne r !))i!> u\[\r/ c \h] s fom i U ' te c di dproblem. ^ an do r issue s not speciricail\tie dle t c

nassiane d jicltiie.'-s
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. oiitrucior' s Wor k

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