## TRANSMITTALo f

OMAHA LEA D SITE SOI LREMEDIATIO NFIL EFOLDER SAID#: 5^.'^(3 I Date : 

# 3/j5/i i Address : ^^\i. p tocV^g . ^ Remediatio nContractor : Coasta l Environmenta i Group

_Year : _2010ARRA
_ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f property (DVD ) 

## ti f Executiv e Summar y 

## 1 / EPA-provide dproperty sketc h Signe dAcces s Agreement " fo r subjec t property Signe dAcces s Agreement(s ) fo r adjacent property Restoratio nAgreemen t Settlemen t document s (i.e. , fo r damag e o r to replac e plants , etc. ) Confirmatio ndat a 1 / Photograph s \t f (k^Vd^^TlO M \tiiO^P\\\S ^ \^^ ^ 

## 1 / As-buil t sketc h Satisfactory restoratio nsigne db y Property Owner 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 

# A Utilit yclearance s 

### Property informatio nfromDougla s County Assessor' s Office



# w ^DatT

# v v Propert yAcces s Checklis t PropertylD : ^^2,2^\ Propert y Address : p ^ • * / A 

# C4^i(ifY ^ D D WOR K STARTE D WORKCOMPELTE D ON : ON : / // /
Owner : Addres s 

# I ^ £)y>ut/^t^ ^ Renter : Phone : Fax : 

## Phone T Fax : 

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. Tj^q ^ Cell/Pager : Additional Information : Cell/Pager : D Notificatio nLette r ^ Acces s Agreement l/Q
. Restoratio nAgreement D Topsoi l Samplin g (if applicable ) D Disposa l Samplin g (i f appUcable ) D Garde nSamplin g (if applicable ) Q UtiUt y Clearanc e ^ Video/Pboto s (Before ) nVideo/Pboto s (During ) D Video/Pboto s (After) D Video/Pboto s (30-Day ) nPropert y Completio nAgreement nFinal Report Sent : / / Signed:/^/^//( O Signed:/^//^/ ^ / / / / / / 

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Omah a Lea d Sit e

### Dougla s Cotmty Accoun t Ii^tti^PD n Pag e 1 of 2
Dougla s County , Nebrask a Propert yRecor d - R191772000 0 Informatio n i s vali d a s o f 2010-8-3 0 Ne wFeatur e Owne r CITYO F OMAH A C/ 0 PLANNIN G DEPARTMEN T 181 9 FARNA M S T#111 1 OMAH AN E 68183-000 0 Propert yInformatio n Ke yNumber : 177 2 000 0 1 9 Accoun t Type : E xGovernmen t Parce l Number : 191772000 0 Parce l Address : 331 6 CORB YS T OMAH AN E 68111-OOO O Lega l Description : OMAH AVIE W LO T 2 1 BLOC K1 2 5 0 X 12 0 Valu e Informatio n
201 0 200 9 200 8 200 7 200 6 200 5 Lan d $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 

### Sho wAl l Transaction s Improvemen t $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0
Lan d Informatio n Acre s 0.1 3 S F 6000. 0 Unit s 0. 0 Deptf i 120. 0 Prin t Reoor t Vie wInteractiv e GI S Ma o

Treasurer' s Ta xReoor t -»-^- » Subdivisio n Sale s Searc h

Tota l $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0

Widt h 50. 0 Vacan t Ye s



### http://douglasne.mapping-oiiline.coiii/DouglasCoNe/static/accoimtinfo.jsp?accountno=R191.
. . 9/3/201 0OLS# : 2932 1 

# As-Buil t Drawin g ^ Dat e Excavated : 10/8/1 0 Dat e USEP ASione d Off : 11/23/1 0 COASTA L 

# m h ah aLea dSuperfun d^ e Are a Sodden : 402 5 s q f t 

## 2932 1 Exterio rPaint Omah a Lea d Sit e Owne rName : Cm rO F OMAH A • Good Sit e Sketc h Address : 331 6 CORB YST • Poo r Phone : » 402-441-515 0 Q^No t pain t Sampl e Numt)e r Lea d Concentratio n Sampl e Collecte d LA B Firm
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# n D D Sample s Analyze d XR F Uni t lOCT J Book : /^ 9 RGZSCPX A2032 1 G Z pp m 

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### D D Time : Ao- ^ Staff : ^^u / Numbe ro f Sample s = Legend : F l = Fron t Lef L F 2 = Fron t Rigtit , B 1 = Bac k Left , 8 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Play A l quadrant s ar e a s viewe d fro m th e street , facin g propert y 

# ENTERE D SEPi O 8 m i 82=17 1 PPM@6 "

EA=153PPIWI@1 " 04614 1 012 3 

### Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are areplace dwit h Are areplace dwit h So d Rock/Mulc h Are alef t bar e 

### Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
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# 2932 1 Iv
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. Exterio rPaint Nort h Am w 

### Omah a Lea d Sit e Owne rName : CIT YOF OMAH A • Goo d 

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## D pp m 

# n D XR F Unit : 100 1 Book : \(o 9 RCZSGPX A2032 1 G Z pp m 

## D D Date : 9 - 11-OG > RPZCCPX A2032 1 P i pp m 

## D D Time : Ao ^ Staff : (^<, W Numbe ro f Sample s • Legend : F l = Fron t Left , F 2 = Fron t Right , B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , PZ = Pla y Al l quadrant s ar e a s viewe d fro m th e street^lacin g propert y f* • • ' • r• • • ' —

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# 2932 1 Exterio rPain t North Am^ w 

### Omah a Lea d Sit e Owne rName : CITYO F OMAH A • Good 

### Sit e Slcetc h Address : 331 6 CORB YS T • Poo r

Phone : " : 402-441-515 0 W : [3 ^

Not pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : RYASCPXA-2932 1 F l 

# llo 3 pp m 

# n Date : 

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. RYBSCPXA-2932 1 F 2 pp m 

## 2S 3 

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# a trt/ 1 • RYCSCPXA-2932 1 B l pp m 

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# D D Date : 9 • tl-OL , nnZCGPX A2032 1 - P Z pp m 

# D Time : 

### kry ^ 

# n Staff : 

## /v? w Numt)e ro f Sample s = ' ^ Legend : F l = Fron t Left , F 2 = Fron t Right , B l = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s are a s viewe d fro m th e street, , facin g propert y

Rev4

# 2932 1 Exterio rPain t NorthArro w 

## Omah a Lea d Sit o Owne rName : CIT YO F OMAH A • Goo d 

## Sit e Sketc h Address : 331 6 CORB YS T • Poor Phone : H : 402-441-515 0 W : 

### Q^No t pain t Lea d Sampl e Sample s Collecte d 

### Sampl e Numbe r LAB Concentratio n Collecte d Finn : >Hfe' S tNV^rt^ O 

### RYASCPXA-2932 1 F 1 

## liflL i pp m 

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# 2S 3 pp m 

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# I S \ pp m 

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# D Samples Analyzed RYDSCPXA-2932 1 8 2 

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# 0 ' D RDZOCPXA-2932 1 B Z pp m 

# D D XR F Unit : /Cn 7 Book: 

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# D D Date : 9 - / 2 - O ^ npZCCPXA'2032 1 P 2 pp m 

# D D Time : 

### A n ^ Staff : 

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"I O I'lopeii y RIGH TOF ENTR YTO PREIV/JISE S 

### Granlo t (th e property ' owner) consent s to an d aulhorize s th e Unite d State s Environmenta l Protectio n Agenc y(PPA ) o t its suthorize d representatives , collectivel y th e Grantee , t o enle ran d perfor m certai n environmenta l respons e activitie s upo n th e followin g describe d premises :

Owner' s l\!ame : Daytim e Phorie : 

# Cn^i crO i I//)/ ) I- i A
Addres s o f Propert y covere d b ythi s Agreement : 

# 331 ^ Ccf^'^"^^' '
PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EPAi s requestin g acces s t o collect soi l sample s an d remove soi l that conlain s elevate d concentration s of lea d an d maypos e a healt h hazard
. Th e area(s ) wil l be excavate d t o 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 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 Coasta l Environmenta l Group , contracte d b yUSEPA , wil l contact th e Granto rin-perso n t o discus s th e wor k t o b e performed , th e Granto rwil l have 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 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 property has bee n remediated
.
ENVIRONMENTA L RESPONS E 

### AcTioivi s B

ysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , its employees , contractor s an d subcontractor s th e righ t t o ente rth e properly , a l al l reasonabl e time s an d wit h prio rnotice , to 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 :

Pag e 1 o f 2 •» - c

### #

• '< ^

C C AS 1 AI l^Yl^o»^K^^•1tI •



### ' Remov e obstruction s incluciin g boats , Iraileis , vehicles , plgyscafi e \\^.\-\\^. , wooo piles , do o houses , etc ; < F^emov e flov/e i bulb s o i plant s tha i ih e Granto i orth e Grantni' s tenen t ma ywis h t o save ; Wale ran d maintai n teplacernen t vegetation , includin g ferliiize rapplicption , a s necessary ' subsequen t t o a n initia l V\'3terin g perio d byEPA ; < Abid e to yhealt h an d safet yguidanc e piovide d b yEPA ; ( I f th e property ' i s rented , assis t EP Ai n obtainin g tenan t appiova l fo i acces s l o th e propertyt o perfor m th e work
. I Allo wvideotapin g and/o rphotographin g o f th e properly
. AGREEMEN THO I T O INTERFER E 

### Th e Granto ragree s not t o interfer e ortampe rwit h an yof th e wor k activities , o i wit h an y o

f th e wor k done , orwit h th e equipmen t use d o n hi s properly , o rt o undertak e an y action s regardin g th e us e of sai d propertywhic h woul d ten d t o endange rth e healt h or welfar e o f th e Grantee s o rth e environment , o rt o allo wother s to us e th e propertyi n suc h a manner . Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contact Coasta l Environmenta l Group , a l (402 ) 991-119 9
,0 1 gran t acces s t o m ypropertie s D I d o no t gran t acces s t o m ypropertie s 

# „_.^. ^
....... ^ ...z^ir^v-/^...
_ • 'signatur e Dal e Signature Dat e
Q Iwoui dlike , t o b e pfesen t dUFiti g an y sampliri c Uia t i s leqi'ired ,

Paa e 2 o f 2C O A. s Ti», L CNVINONHCNTA L CROUP , IN C 

## Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o provid e amutual agreement a s t o condition s o f th e property 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 that restoratio n activitie s ar e complete dt o th e satisfactio no f th e property owner andth e Unite dState s Environmental Protectio nAgenc y (EPA)
. '7JG'X. 

### 7 \

Property ID : ffi^y^^^^JeOj/. / ^{-^^00 0 " ^?^ ^ / Property Address : 

## ^ Hh^ b Cc^B \ ^T
. Owner : 

### On'' < Of - OA/iAHf \ Phone : 

# ^ w 

# nnf ) O nth e attache ddiagram(s ) indicate area(s ) t o excavate , surfac e structure s andlandscapin g feature s and acces s location(s ) t o b e use db y the contractors . Indicat e distances , depths , materia l types , etc . Photographicall y andVideographicall y document th e existin g condition s ofth e propert y andth e basement i

f necessary . 

### Item s t o b e Remove d b yth e Owne rbefor e Star t 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 s t o b e Remove d b yth e Contracto rDurin g Remediatio n an d No t Replace d item :
Item :

Ite m

Pag e 1 o f yC O AS TA , L (NVIHONMENTA L CROUP , IN C 

### Item s t o B e Remove d B yContracto rDurin g Remediatio n an d Replace d

Ite m Landscap e Inventor y Quantit y Uni t Condition/Type/Specie s Pre-existin g property area , tha t will b e excavated , tha t i s covere dwit hgrass . Nuniber of tree s > 2 inc h trun k

diameter Numbe r o f tree s <= 2 inc h trun k

diameter 

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ir- ^ 

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Eac h
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. 

# 0 Eac h

Numbe r of an dsiz e o f eachgarden / flowe r be d area . .Altaci i askelc hof relati\ f size s anc l locations
. Eac h Square Fee t
Agree duponvalu e o f plan t material s no t to b e replace dby contractor . Not e thi. s \iilu f uil l h c usedlo issu e aplan t ^(»llclle| • I dtli c propcil ) 0\MU'l'
. Easemen t Area , t o b e excavate d


### Pag e 2 o f y

# 1 #
C O A S T A » U
• MVinONMfNTAt
. CROUP
. IN 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 mayb 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
. C ] Pleas e chec k thi s bo xi f yo u understan d th e informatio n outline d above
. 

# ^Oea ^ oJ' ^ ^ ^Wu^^^"^^^- ^

n Chec k th e bo xi f Owne rdoe s no t wan t CE G l o documen i interio rfoundatio n wall s an d possibl e pre-existin g damage
. B ycheckin g thi s bo xCE G i s no l responsibl e fo ran ydamag e don e t o th e inlerio ro f house , includin g foundaiio n crack s o rfissures
. 

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# 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 AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m 

## Certificat e o f Verificatio n

16 9 SOI L 2011-01-1 2 18:5 0 90.9 9 Fina l Av g o f 166-16 8 331 6 CORBYS T B 2 6 " C.PADILL A CONFIRMATIIO N CLEA R

± Erro r ± 19.74 8 

# 'm^J ^

# 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 141.00 8 Supervise d By : 

## Certificat e o f Verificatio n

16 6 SOI L 2011-01-1 2 18:4 9 30.2 1 Fina l 2932 1 331 6 CORBYS T B 2 6 " C.PADILL A CONFIRMATIIO N CLEA R

i : Erro r ± 18.93 5

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A.0182 1

XL3t-3902 2 Readin g N o Mod e Tinri 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 133.14 8 Supervise d By : 

## Certificat e o f Verificatio n

16 7 SOI L 2011-01-1 2 18:4 9 30.5 2 Fina l 2932 1 331 6 CORBYS T B 2 6 " C.PADILL A CONFIRMATIIO N CLEA R

± Erro r ± 16.65 0

# 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 240.48 4 Supervise d By : 

## Certificat e o f Verificatio n

16 8 SOI L 2011-01-1 2 18:5 0 30.2 6 Fina l 2932 1 331 6 CORBYS T B 2 6 " C.PADIL U CONFIRMATIIO N CLEA R

± Erro r 23.65 9

# 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 AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

P b Supervise d By : 

## Certificat e o f Verificatio n

17 3 SOI L 2011-01

- 1 2 18:5 3 90.9 7 Fina l Av g o f 170-17 2 331 6 CORBYS T E A 1 " C.PADILL A CONFIRMATIIO N CLEA R

± Erro r ± 18.90 3 

# M 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 143.34 0 Supervise d By : 

## Certificat e o f Verificatio n

17 0 SOI L 2011-01-1 2 18:5 1 30.2 1 Fina l 2932 1 331 6 CORBYS T E A 1 " C.PADILL A CONFIRMATIIO N CLEA R

± Erro r ± 18.99 5

# 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 157.07 6 Supervise d By : 

## Certificat e o f Verificatio n

17 1 SOI L 2011-01-1 2 18:5 2 30.5 7 Fina l 2932 1 331 6 CORBYS T E A 1 " C.PADILL A CONFIRMATIIO N CLEA R

± Erro r 18.00 9

# Therm o S C I E N TI F I 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 161.22 3 Supervise d By : 

## Certificat e o f Verificatio n

17 2 SOI L 2011-01-1 2 18:5 3 30.1 9 Fina l 2932 1 331 6 CORBYS T E A 1 " C.PADILL A CONFIRMATIIO N CLEA R

Erro r 19.70 4• S r ^^

_^ 

## 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 •' I PROl * COASTA L [NVKONNiNTA l GROUP
. IN C 

# EXECUTIV ESUMMARY : BVID #29321-(331 6 CORB Y ST )
No Issue s o r Concern s Issues/Concern s Detail Explanation : -DA NGARVE Y WALKE D TH EPROPERT Y O N12/2/201 04 

# s ^ EP A Propert y Clos e Ou t For m Propert yff : _ 

## 2-'^5?- } Propert y Address : Date/Ttme ; Owner' s Name:
. /4
. Quad s Excavated : Contracto r Grou p Excavatio nGenera l 1
.

I f necessary , wer c th e correc t quadnint(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 ? Gradin g So dan dVcKctatJo n 1
.

Doe s th e gradin g aroun dth e perimeie r ofth e hous e i n excavale darea s generall y slop e away fromtb e house ? 2
.Ha s so dbeenlai dmal i area s that wer e excavated ? J
.Doe s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period ) ^ 4
.Ar e sodde darea s generall y firman devenl y giaded ? 5
.

Ar e di e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t t

3 0 da y tim e period )
. _ 6
.Wa s th e properl y grade dsuc hthat wate r wil l not poo l o nth e property ' 7
.

Wa s damag e t o landscapin g o r plan t material s avoided ? Gates , Fence s an dReUtain g Wall s 1
.D o gate s ope n an dclo.s e freely? (I f applicable ) 2
.Wer e al l gate s o r fence s take ndow n durin g restoratio nactivitie s reinstalled ? (I f applicabk ) 3
.Wa s damag e t o gate s o r fence s avoided ? (t f applicable ) A

.Wa s damag e 1 0 retainin g wall s avoided ? (Ifapplicable ) Foundation , Sidin g an dGntler s I
.Wa s damag e t o th e sidm g o r tri mavoided ? 2
.Wa s damag e t o fh e foundatio navoided ? 3
.Wa s damag e t o window s avoided ? Wa s damag e t o window s o r doo r screen s avoided ? 5
.

Wa s damag e l o downspout s o r downspou i extension s avoided ? Sidewalk s an d Driveway s (Coocrtte ) I
.

Wa s damag e l o drivewa y surface s avoided ? 2
.Wa s damag e t o walkwa y surface s avoided ? Ye s N o

Ye s N o

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# T J Yes N u / / / / Ye s N o / / / 

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s N o 

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## OM'oer s comments :

I 

## [inspectio nno<es :

Removal andresloratio nactivate s complel e includin g the 30-da y so dwarranry : EP A Representativ e ^'^ ^ Date : tt\t\^ o

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### Propert y Addrc» ^ ^.^l i -C^OfS ^ Js A Owner : 

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. Restoratio n Ilem s i n Queslion : Item : llem : Item : I I i.jt
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### . I Additiona l Comments :



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