## TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID # : 

# IZL 8 Date : /^i/^^ ? Addres s Remediatio nContractor : Coasta l Environmenta l Group

_Year : 200 7 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 0 ^ Vide o o f property (DVD ) beio<" ^ 0^ Executiv e Summary 0 ^ EPA-provide dproperty sketc h y Signe dAcces s Agreemen t fo r subjec t propert y D Signe dAcces s Agreement(s ) fo r adjacen t propert y Q ^ Restoratio nAgreemen t D Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) mConfirmatio ndat a iZ

f Photograph s ^jC-acu j {kJ^jOi ^ CCti J OwnM e^ryij)nk<fr\^ S6<= 1 0 ' As-buil t sketc h ^ Satisfactory restoratio nsigne db y Property Owne r (0 ^ Property close-ou t chec k lis t signe db y EP A/' / i / 2Z^ O ^ D Descriptiono f area s not meetin g RO D cleanu p criteri a D Utilit y clearance s B ^ Property informatio nfro mDougla s County Assessor' s Offic e yVrp^(!4-H ^ (lC.c.t<. s C^MipkLs ^ ^ rjmJTlJr'rfbni n D 

# /m^ ^ 4031288 7 Superfun dl . 

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Fina l Repor t Propert y Chec k Lis t (piease plac e wit heac hfile) Har dCop y Informatio n 1 . Propert y Chec k Lis t 2 . Sit e Workin g Drawin g Ma p 3 . EP A original s Ma p 4 . Dougla s Count y Assessor' s Ma p 5 . Propert y Contac t Shee t Agreemen t 1 . Acces s Agreemen t 2 . Restoratio nAgreemen t Miscellaneou s Document s 1 . Fina l Ma p fro mth e Fiel d 2 . Chang e Order s 3 . XR FDat a 4 . An y email s o r P O correspondence s Propert y Completio n 1 . Executiv e Summar y 2 . A S BUIL T 3 . Propert y Completio nAgreemen t 4 . An y buyou t inf o o r reimbursemen t inf o 5 . Chec k o r mone y orde r copie s 6 . EP A Propert y Clos e Ou t For m 7 . Attache dBegi nVide o Electroni c Documentatio n Drawing s 1 . EP A original 2 . Workin g Drawin g 3 . A S Built.vs o 4 . A S Built.jp g Photo s Begin Photo s During/Excavatio n Photo s So dPhoto s 30-Day So dPhoto s Scanne dDocument s Fina l Document s Executiv e Summar y Video s Begi n Vide o M

y Movi e

## Propert yAcces s Checklis t Propert y ID : D WOR K STARTE D ON : 

# -1^ ^ WORKCOMPELTE D ON : Propert y Addre.s.s : ^Q^ . S 1 ^ S t n Owner : Renter : 

## "• fhszy. ^ y^oy M 

# i ^ Addres s Phone : Fax : Cell/Pager : Additiona l (nt'ormation : 

## Pho"^- - (Y^g^KTo^-.T/A ? Fax : Cell/Pa«er : -S " Notificatio nLette r Sent : ^7^/03 : Bv : JULOL-CA.! ^ -S ^ Acces s Agreemen t Signed : 9 / r?O l 6 ^ 

## ^ y ?i<^:^V,-f/ - T 3 Restoratio nAgreemen t Signed : _^/^/i ^ 

## By - i^e^ciLcjjdtt nTopsoi l Sam|)lin g (if applicable ) / / By : [ U Disposal Samplin g (if applicable ) / / By : O Garde nSamplin g (if applicable ) / / Bv : K

Utilit y Clearanc e Called : ^ MT/O ? ^ Video/Photo s (Before ) 

## On:_5/^/6 ^ By: Zic^kruPtf — C

H Video/Photo s (During ) On : / / Bv : * nVideo/Photo s (After ) On : / / By : nVideo/Photo s (30-Day) On : / / By : 1 1 Propert y Completio nAgreemen t Signed : / / By : D Fina l Repor t Is.sued : / / By : Ai r Monitorin g (a s applicabl e r~ l Communit y C H Cre w On : / / By : Results :1 Q Communit y O Cre w On : / / Bv : Results : 1 [ U Communit y O Cre w On : / / By : Results : Omah a Lea d Sit e^ 

## a^H s 

# 3^ < Tota l Qua^^HSquar e Footag e to be Excavate d = 35 4 Propert yClassification : 80 0 ip^n Tota l Drip^n eLinea rFootag e to be Excavate d = 11 3



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## Sout h 12 Stree t Legen d Nort h Arro w Omah a Lea d Sit e |v,:':; j Concret e Omaha , Nebrask a K/ 1 Excavate d Are a Propert yNumbe r 1 I Existin g Structur e Scal e OLS-126 8 •—•— • yy X Fenc e Permanen t Landscapin g 1 Inc h = 20 fee tor1 gri d = 5 x5 ft Propert yAddres s 430 2 S 12 ST

—— —Quadran t Boundar y Stree t Boundar y 

# s A i V HG L Fl Pos t Excavatio n Concentration s (ppm ) B2 Pla yAre a F2 DZ Easemen t cQ ) Tree/Shru b 81 Garde n Othe r Descriptiono fpos t excavatio n areas : Fl , fron t yar d left-han d quadrant ; F2 , fron t yar d right-hand quadrant ; Bl , backyar d left-han d quadrant ; B2 , backyar d right-han d quadrant ; DZ , dri p zon e (1- 3 foot are a ofsoi l aroun d th e foundatio n ofth e house) .Tota l QilHIht Squar e Footag e to be Excavate d = = 35 4 Propert yClassification : 80 0 ^ 

## F Tota l Dri^on e Linea rFootaq e to ti e Excavate d = = 11 3 

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Omah a Lead Sit e Omaha , Nebrask a Propert yNumbe r, OLS-126 8 Propert yAddres s

430 2 S 12 ST Pos t Excavatio n Concentration s (ppm ) 1 D 7 Pla wAro 3 1 DUU[ I Jdi y 1 .V, , <.q»,l ^ ree l 1 F2 Eas e me n Tr ee/ S iru b '^- ^ — Gar c e n _ Oth e 

# o 1 Bl Descriptio n of pos t excavatio n areas : Fl , fron t yar d left-han d quadrant ; F2 . fron t yard right-han d quadrant ; Bl , backyard left-han d quadrant ; B2 , backyard right-hand quadrant ; DZ , dri p zon e (1- 3 foo t are a of soi l aroun d th e foundatio n of th e house) .v^ ' 

## 126 8 Exterio rPain t North Arro w Omah a Lea d Sit e Owne rName : ^MJ: . Zoivid U Q ] Goo d Sit e Sketc h Address:4302S12S T • Poo r

Phone : H : yfir-^Mr/^ z 7 / W : 

# (S ) Q Not pain t Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d . . _ Firm : Sample s Collecte d Sverdru p RYASCPXA-126 8 Y A 661. 6 pp m Iv l 0 Date : RYBSCPXA-126 8 Y B 267. 6 pp m RT ) F l Time : RYCSCPXA-126 8 RYDSCPXA-126 8 Y C Y D 232. 8 172. 5 pp m pp m Iv l 0 n n Sample s Analyze d RDZSCPXA-126 8 D Z 854. 4 pp m [7 1 n XR F Unit : Book : RGZSCPXA-126 8 G Z ppm n n Date : 11/7/199 9 RPZSCPXA-126 8 P Z ppm n n Time : 01:2 9 Numbe ro f Sample s = 5 ; 1 i 1 Staff : Legend : Y A= Yard (NE) , Y B = Yard (SE) , Y C = Yard (SW) , Y D = Yard (NW) , D Z = Dri p Zone , G Z = Garden , P Z = Pla y

04614 1 012 3

# 9^ ^ r 

# m COASTA L *- E N V I f l 0 N n [ N t I t L C • C t f•« 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 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 . •Allo wvideotapin g and/o rphotographin g o fth e prcpety . AGREEMEN TNO TTO iNi'ERFER E Th e Granto ragree s ne t t o irter^er e o rts-^^pe rwit h ar. yo fth e /v'c k activities , o rwit h an y o fth e wor k done , o rwit h th e eq^iprrien t wSe d o n "^i 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 ..•olfprc i '^. f•'h o :'^'-p>~+oe c'^ ' ^^.S . c—• , .'r o "-r-a" * — - - - cM'^'i/v.. ' •^•h,ttr c*' > c p *''* P '"i'''-,f-,pr+,, ' ' n 

### Shoul d yo u hav e an yquestion s abou t t""^ * pTograr. . oleas e co-,:ac t Coasta l Envi-onTienta l Group , a t ;877 ) 234-52:^0 . ^

[ gran t acces s t o .r ypropertie s 1 d o T\O\ . gran t acces s t o rryproperie s 

# ^-/^ ' 

# o 7 Signatyj*^^^-;;;?^''t--^/ Date Signatcir eDat e

: I woul d lik e t o b e p.-esen t durin g sn ysamplin g tha t i s required .

Paae 2 o f2COASTA L 

## Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o provid e amutual agreemen t a s t o condition s o f th e property prior to remediatio nactivities . Thi s will als o serv e a s documentatio nfo r th e purpos e o f assurin g that restoratio n activitie s ar e complete dto th e satisfactio no f th e propert y owne r andth e Unite dState s Environmental Protectio nAgenc y (EPA) .

Propert yID : / 2 6 g 

### Property Address : ^}(? 2 J 1 2 I T 

## J- r Owner : /Inqj c Zun^ejC j Phone : 

## iZol ' ^dZ'Jh S Onth e attache ddiagram(s ) indicate area(s ) to excavate danddept ho f e.xcavation . locationo f all known utilities , subsurfac e features , surfac e structure s andlandscapin g features , acces s location(s ) t o be usedb y contractor , andthe directio no f North . Indicate distances , depths , materia l types , etc . Indicate digital photo s b

y referencin g the photo-lo g number wit ha narro w indicating directio no f view . Item s T o B e Remove d B yOwne rBefor e Star t O fRemediation : (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 responsibility . Item : 

### OiAJ/ie ^

^AV M rcvo^v* ; el l Sr^ . 

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> Item : dj^S^r/ l (jO(\ ' flc/i^^Jn X|o- > c c P- + \ \ 

## X 

## t a n Item : Item : Item : Item : Item : Pag e 1 o fCOASTA 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 : 

# a I Ua^( ^ S-^'^< - SorM- ^ e^bj ^ 

# O Z 4)/ ^ Item : 

# S ^ J 

# p/^f - (e U 

# ^t/. V Item : 

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por^'^ L 

## b^ fety/i ^ Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 2 of .COASTA L & H O U » • . IN C 

### 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) 1 Item : > / /

Item : 

# y o Item : 

## ^h^—^^^^^--'^^^L^..^.^^i^.J^-~^ ^ Item : Item : Item : Item : Item : Item : Item : Item : ! Item : Item : Item : Item :



### Pag e 3 of .COASTA L 

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

## Ite m
Pre-existin g property area , that will b e excavated , tha t i s covere dwit hgrass .

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

Number o f tree s < = 2 inch trunk diamete r

1 Nuinbe r o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Anac hasketc ho f the sprinkle r laNOut . Numbe r o f andsiz e o f eac hgarden/ flower bed area . Attac hasketc ho f relativ e size s an dlocations . 

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

Each \ 

# t Each

Each 

### /

Each Squar e Feet /

Pag e 4 o fCOASTA L 

## Ite m Agree dupo nvalu e of plan t material s no t t o b e replace db v contractor . Not e thi s valu e will b e use dt o issu e aplan t \ouche r t o th e propert y owner . Agree duponlis t of plant material s that will b e replace dby contractor . B e ver y specifi c anddetailed . Includ e asketc ho f were eac hplant will be place d b\ ' th e coniraciur . Agree dupo nare ao f property t o b e replace d wit hgras s sod . Includ e asketc hof the area(s ) to b e I'eplaced\>.it h gras s sod . 1 .Are ao f Cit y or Count y property to b e landscape d per thei r requirements . Includ e askeicl i o f tii c are a(s )

Easemen t .Area, t o b e excavate d 

## Quantit y Uni t Condition/Type/Specie s 

# X $

Each 

### / 

# M S F 

## 1

S F

S F

Pag e 5 of

### # COASTA L 

### Additiona l Comment s / Instructions : 

## 'Vla^- i (l^p- 7 0- V \c»r.i^' 5



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• Chec k th e boxi fOwne 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 boxCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro fhouse , includin g foundatio n crack s o rfissures . 

# i a I agre e E H I d o no t agre e OwK&^fSigirafure^-'' ^ Dat e ..ontractor' s Signature Pag e 6 of .X 

# p V N 

### /Vfi^ \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 I ^^^^ ^

° Coasta l Environmenta l Grou p Inc . S^y^^ ^

www.coastalhazmat.co m %PRoi« ^ COASTA L ENVIKONMENTA L C H O U < • . IN C 

# EXECUTIV ESUMMARY : 01268-^30 2 S 1 2 S T N o Issue s o r Concern s Q ] Issues/Concern s Detai l Explanation :

# S I As-Buil t Drawin g COASTA L 

# mah aLea dSuperfun dSit e

Tota l Quadran t Squar e Footag e t o b e Excavate d - 35 4 Propert yClassification : 80 0 Tota l Dri p Zon e Linea rFootaq e t o b e Excavate d = 11 3 0LS# : 126 8 

## 1 1 i M Dat e Excavated : 10/8/0 7 1 Dat e USEP ASigne d Off : 11/5/ C 7 i 

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## L _ J i / 1 1 1 1 1 ~ i ' , ;1 . t ': 1 1 1 1 D 2 1 [• • ^__. J 85 4 p f

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Sout h 1 2 Stree t 1 

## 1 i . . 1 Legen d Nortt i Arro w Omah a Lea d Sit e I^J . Concret e Omaha . Nebrask a l/'y l Excavate d Are a Propert yNumbe r OLS-126 8 Existin g Structur e Scal e > Fenc e . , ^ Propert yAddres s Inc h = 2 0 fee t o r1 gri d = 5x 5 ft IxV

^ 430 2 S 1 2 S T [Y<

^ , =i,i.=,i=,i . i.=,,u=.,<,f..,, ap Quadran t Boundar y ^ ^

TM Pos t Excavatio n Concentration s (ppm )

- Stree t Boundar y

_F 1 B 2 PlavAre a ,. " ,7^ . 

### ^ J ­ y T ee/ S iru b V^w * 8 1 G ar c e n _ _ Oth e r Descriptio n o l pos t excavatio n area s Fl , fron t yar d left.han d quadran t F2 . fron t yar d rigtu-han d quadrant , Bl , aackyar d left-rtan d quadrant . B2 , backyar d ngtittian d quadrant . DZ . dri p zon e { 1 - 3 foo t are a o fsoi l aroun d th e foundatio n o fth e house ] 

## 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 Inc .

## ^) t 

# EP A EP APropert y Clos e Ou t For m Propert y #: 

# 1?^-^. . Propert y Address: - rro|n:ri /%uurc33;yi ' '* ^ —'^ ' ' ^—1»- ^ Date/Time : 

### Owner' s Name: . /jr^yC^. . '^Zt'^Z^ ^ Quad s Excavated : Contracto r r Grou p

Crou o ^ Excavatio nGenera l Ye s No 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 drip 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 perimete r of th e house inexcavate darea s generall y slop e awa y 

### y fromthe house ? 2.

Ha s so dbeenlai d inal ! area s that were excavated ? xZ . 3.

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

inspecte d at a

30 da y time period ) y 4.

Ar e soddedarea s generall y fir man devenly graded ? 

# J 5.Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e if

inspecte d at a

30 da y tim e f)eriod ) ___^ _ 

### y 6.Wa s the propert y grade dsuchtha t water will not poo l onth e property ? 

### y 7.Wa s damag e to landscapin g or plan t material s avoided ? 

### u y Gates , Feoce s an dRetainin g Wall s Ye s No 1. Do gate s openandclos e freely? (If applicable ) 

### y 2.Wer e al l gate s or fence s take ndowndurin g restoratio nactivitie s reinstalled ? (Ifapplicable ) 

### y 3.

Wasdamag e to gate s or fence s avoided ? (I f applicable ) i / 4. Wasdamagetoretainin g wall s avoided ? (I f applicable ) 

### y Foundation , SidioK an dGutter s Ye s No 1.

Wa s damag e to th e sidin g or tri mavoided ? 

## y 2.Wa s damag e to th e foundatio navoided ? 

### y 3.

Wa s damag eto windows avoided ? 

## y 4.Wa s damag e to window s or doo r screen s avoided ? t / 5.

Wa s damag eto downspout s or downspou t extension s avoided ? l y Sidewalk s an dDriveway s (Concrete ) Ye s No 1.

Wa s damag eto driveway surface s avoided ? 

## y 2.

Wa s damag e to walkway surface s avoided ? 

## y

## Owner s comments :

Inspectio nnotes :

Remova l an drestoratio nactivate s complet e includin g th e 30-da y so dwarranty : EPARepresentativ e 9c ^ yff ^ Date : //Z^Z<^ ^

# (p > Propert yCompletio n Agreemen t Thi s agreement document s th e completio no f remedial activitie s performe do nm y property . M y signature will designat e tha t 1 a msatisfie dwit hth e restoratio no f m y property , andthat no item s are i n questions , now . or a

t an y time i nth e future , excep t thos e item s liste dbelow , i f any . Propert y [D : 

# /^:t> - Propert y Address : .,0^ ^ < ^ /V ^ Jj^y* ^ Owner : Restoratio n Item s i n Question :

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

J^ I a^ic c restoratio ni s completed , excep t a s note d I I d o not agre e restoratio ni s complete d

Dat e Contractor' s Signatur e Dat e I

# r^^ ^ 5 . ^ it . P'oper. yCi,^ssif:calion : 80 0 ^WCTUl^b'^Z p C . • = I Z . "



## Sout h 1 2 Stree t Legen d Nort h Arrow liiii* ] Concret e Y/ \ Excavate d Are a \ I Existin g Structur e Scal e •—•— • Fenc e 1 Inc h = 2 0 fee t o r1 gri d = 5 x5 ft yy ^ Permanen t Landscapin g

—

——Quadran t Boundar y Stree t Boundar y F1 _ <Q ) Tree/Shru b F 2 B l Tota l QL^^ V Squar e Footag e t o b e Excavate d = 35 4 )n[^8n 6 Tota l DriiWln e Linea rFootag e t o b e Excavate d =11 3



# I

^

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