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

# A^0?70 ) Date : 

# <^ZfdB Address : y/^^S ' /^QnTl ^ Sf ^ Remediatio nContractor : _Coasta l Environmenta l Group _ Year : 200 7 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f property (DVD ) Executiv e Summary EPA-provide dpropert y sketc h Signe dAcces s Agreemen t for subjec t property Signe dAcces s Agreement(s ) fo r adjacen t property Restoratio nAgreemen t 

# Y Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) Confirmatio ndat a Photograph s As-buil t sketc h 

## i

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# y u Satisfactory restoratio nsigne db y Property Ovvne r Property close-ou t chec k lis t signe db y EP A Descriptio no f area s no t meetin g RO D cleanu p criteri a D 

### Utility clearance s D 

### Property informatio nfromDougla s County Assessor' s Offic e D D , D

4031789 4 

# niiiii i Superfun d

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l Sit e Workin g Drawin g Ma p |2 i EP A original s Ma p 14

1 Dougla s Count y Assessor' s Ma p p

j Propert y Contac t Shee t Agreemen t T f Acces s Agreemen t "^Restoratio nAgreernen t Miscellaneou s Document s | ] Fina l Ma p fromth e Fiel d 2 . Chang e Order s 

## 12 1 XR FDat a 4 , An y email s o r P O correspondence s Propert y Completio n A . Executiv e Summar y V 2 ,A S BUIL T

jl^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 g i EP A Propert y Clos e Ou t Fon n V/ 7 , Attache dBegi nVide o Electroni c Documentatio n Drawing s r nEP A origina l /(Z 7 Workin g Drawin g "^AA S Built.vs o \/4 . A S Built.jp g Photo s Begi nPhoto s During/Excavatio nPhoto s So dPhoto s 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

## Propert yAcces s Checklis t Propert y ID : 

# WizA O nWORK STARTE D ON : / / Propert y Addrc.s.s : ^qC^C j /jg/yZ S Sf
- 

### nWORKCOMPELTE D ON : / / Owner : Renter : 

# Ccar/'m p f/Oz M A(l<lre,s,s : Plionc : 

# -^ J Fax : Ccll/Pager : Phone : Additiona l Information : 

# (y/9-^e>n H Fax : Ccll/Pascr : D Notificatio nLette r Sent : / / By : PZ nAcces s A}>rccmen t Siuned : Zf l I.PPifP 

# ^y
- (IhziZ) Q^ Restoratio nAgreemen t 

## Siuned : Pl93lZ: p 

# ».>• = O.Dr h CD Topsoi l Samplin g (ifapplicable ) 

### 1 1 By : nDisposal Samplin g (ifapplicable ) 

### 1 1 By : CH Garde nSamplin g (if applicable ) 

### 1 1 By : E3 Utility Clearanc e 

### Called : ^/^/£ ^ 

## ^r- AidrCCS/' p .•'^SIIHU . ^ Video/Photo s (Before ) 

## On:_^/2^_a 7 By = ^vc k S^ Video/Photo s (During ) 

## On:X/a^ / ^7 

# ^y a\r)z x ^ Vidco/Photo s (After ) QIV.ZLISPS-CL I 

## By = ^(r K 0 Vidco/Photo s (30-Dav ) On : C| / -4
- / OT 

# By = R^'^c K 1^ Propert y Completio nAgreemen t Siuned : T IplLlCP f 

## By : CAC i S D Fina l Repor t Issued : / / By : Ai r IVIonitorin g (a s applicable ) CH Communit y CD Cre w On : / / 

### B y : II Results : nCo m m u nit y CH C rc w On : / / By : Results : CH Communit y CH Cre w On : / / By : Results :
Omah a Lea d Sit eTota l Qj^Hnt Square Footag e t o b e Excavate d =191 5 PropertyClassification : 80 0 TotallP KZon e Linea rFootag e t o b e Excavate d = 8 3 

# f ^

Legen d ^ ^ Y A ^ 1 YP ^ •—•— •

—— — <Q

> Concret e Excavate d Are a Existin g Structure Permanen t Landscapin g Fenc e Quadran t Boundar y Stree t Boundar y Tree/Shru b ^7- .



# ^ ^ S

Nort h Arro w Omah a Lea d Sit e 

### j^r . Omatia , Nebraska Propert yNumbe r N OLS-2067 0 Scal e Propert yAddres s 1 Inc h = 2 0 fee t o r1 gri d = 5 x5 ft 295 5 HARRI S S T Pos t Excavatio n Concentration s (ppm ) F 1 8 2 Pla yAre a F 2 DZ Easemen t 8 1 Garde n Ottie r Descriptio n of post excavatio n area s Fl . fron t yar d left-tian d quadrant ; F2 , fron t yar d rigtit-tian d quadrant ; Bl , bacityar d left-tian d quadrant ; B2 , backyar d hgtit-tian d quadrant ; DZ , dri p zon e {1- 3 foo t are a of soi l aroun d th e foundatio n o f tti e tiouse )

## late : ~lM ^ Nort h Arro w Address : ,'^'^•5'5 " Z/cjrr , j 5 P Sit e Sketc h ime : J\o O f f 

# i n Name : O YPn'^ i < ^

^^C H jei n ^ Omah a Lea d Sit e Dat e 

## - 3 Tim e Phone : {H^2)^/D ^ - £>H H Z \ 

# ~^A ^ A l BVID # o C^^-~\Z > XRFCod e 5'^^ ( Tea m P--^^^^/''>y\Jjtu z Sampl e Numbe r Lead Concentratio n Confirmatio n Sampl e 

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### Prin t Previe w Pag e 1 o f 1 Dougla s County-Omaha , N E

Parce l I D Owne r Nam e Propert y Addres s Cit y Zi p Owne r Addres s Owne r Addres s 2 Owne rCit y Owne r Stat e Owne rZi p 091771000 0 FLOY D COURTNE Y 295 5 HARRI S S T OMAH A 6810 5
295 5 HARRI S S T OMAH A N E 6810 5 Sec-Twn-Rn g Owne r Addres s Additio n Bloc k Lo t Lega l 1 Lega l 2 Lega l 3 Lega l 4 Assesso r Websit e Lin k 28-15-1 3

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http://douglasne,mapping online.com/DouglasCoNe/static/accountinfo,jsp ? accountno=R09177 1 OOO O Disclaimer : Ma p an d parce l dat a ar e believe d t o b e accurate , bu t accurac yi s no t Ma p Scal e guaranteed . Thi s i s no t a lega l documen t an d shoul d no t b e substitute d fo ra titl e search , 1 inc h = 9 8 fee t appraisal , survey , o rfo rzonin g verification . 

### http://www.dogis.org/dogi s alias/dogis/piintPreview.aspx?PrintOptData=Dougla s County-.. . 6/16/200 7

## Property ID # Property Address : Initial Contact : Secon dContact : Final Contact : Fina l Action :

Comment : Owne r Commen t (s) : Site Coordinato r Commen t (s) : CONTAC T FORM 

# 90Z1 D ^15 5 Zarri s S- . Date : izHz > XimA^^zA ^ Action : WY> ' Date:// ^ Time : /03<
- Action : PZZ^-ZI^^ ^ 

## Date : Titne : Action : Transmi t t o EP A D Othe r Action : D

1 

# I^Ppi-paZ . Y»^-o l £io:o o pZJ'/i v Z^? 0 JCC-tS^Z^ZlMTf h

1COASTA L ENViRONMENTA L GROUP . INC . \c Z 

## 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'sName : (jlufhe U flo^J^^^m/A f Daytim e Phone : h^^^T/ ^

Addres s o f Propert y covere d b ythi s 

# ZZ'^6 5 Mir/ s M Agreement : 

# ipM^if . ZV Zz m 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 f lea 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 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 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 wor k an d confir m tha t i t i s complet e an d rneei 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 yha s bee n remediated . ENVIRONMENTA L RESPONS E ACTION S 

### Bysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , it s employees , contractor s an d subcontractors 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 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 f 2 

# 9o^n oCOASTA L ENVIRONMENTA L CROUP , INC . 

## \

p 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 necessarysubsequen t t o a n initia l waterin g peno d b yEPA ; Abid e b yhealt h an d safet yguidanc e provide d b yEPA ; Ifth 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 property . AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s no t t o interfer e o 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 equipment 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 Coastal Environmenta l Group , a t (877 ) 234-6270 .



# 0l g I gran t access t o m ypropertie s D I d o not gran t access t o m ypropertie s
Signatur e Dat e

^ 1 

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

Pag e 2 o f 2COASTA L [ NVIRONMENTA L 

## Restoratio n Agreemen 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 property prio r t o remediatio nactivities . Thi s wil l als o serv e a s documentatio nfor 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) .

PropertylD : 2^<^; ^ 

### Property Address : ^S5'A^4l^j^/ 3 ^ 7 Owner : Phone : 

# W-zAS7 A Onth e attache ddiagram(s ) indicate area(s ) to excavate danddept ho f e.xcavation , locatio no f all know n utilities , subsurfac e features , surfac e structure s andlandscapin g features , acces s location(s ) to b e usedb y contractor , andth e directio no f North . Indicate distances , depths , material types , etc . Indicat e digita i photo s b

y referencin g th e photo-lo g number 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 . 

# 6«-^n' 5 

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# ^£^c.t cz^j^^iiPiz(/je / Item : Item : Item : Item : Pag e 1 of .

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COASTA L ENVIRONMENTA L CROUP . IN C 

### Item s T o B e Remove d B vContracto rDurin q Remediatio n An d No t Replace d (Us e additiona l sheet s a s necessary ) Item : 

# ^mct ^tzt^oxi k Z>^z^~n^e54a^<>^^ Item : 

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# TcA^r/ ^ ^^/A f Item : 

# rLi^ry-^-f^i^&j^K S Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 2 

# of_k .COASTA L ENVIRONMENTA L CROU P 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 ) Item : 

# P^ b Ite m 

# S W ^ Item : 

# f^^YlC ^ Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 3 o f _U _I COASTA L P4VIRONMENTA L C H O U P . IN C



### Ite m

Pre-existin g property area , tha t wil l b e excavated , tha t i s covere dwit horass .

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

Numbe r o f tree s < = 2 inch trun k diamete r

Numbe r o f Sprinkle r Zones , Contro l Valves . Timers , Heads , etc ,

. \nac hasketc ho f th e sprinkle r la \out .
Numbe r o f an dsiz e o f eac hgarden/ tlowe r be d area . ,\nac hasketc ho f relativ e size s an dlocations . 

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

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

# ( W Square fee t

Each

Eac h

Each

1 - . Eac h ^ ^ # Square Feet

Pag e 4 

## o f

i sCOASTA L 

### Ite m Quantit y Uni t Condition/Type/Specie s 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 wil l b e use dt o issu e aplan t vouche r t o th e propert y owner . Agree dupo nlis t o f plan t material s that wil l b e replace db y contractor . B e ver y specifi c an ddetailed . Includ e asketc hof were eac hplant wil l b e place d b \th e contractor . Each

Agree dupo nare ao f property t o b e replace d wit hgras s sod . Includ e asketc ho f th e area(s ) t o b e replace dwit h iiras s sod . ^ S F

Are ao f Cit y o r Count y property t o b e landscape d pe r thei r requirements . S F Includ e are a(s ) a skeic hof th e

Easemen t Area , t o b e excavate d S F

Pag e 5 o f 

# k .COASTA L CROU P IN C 

### Additiona l Comment s / Instructions : 

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-

O 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 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 f house , includin g foundatio n crack s o rfissures .

I agre e H H I d o no t agre e 

## bbpo i Owner' s Signatur e ^ Dat e Contractor' s Signatur e Pag e 6 o f ^PROPERT YCLEARANC E WORKSHEE T

Dat e Propert yI D 

# O' l i q m sryPT' ) Propert y Projec t Omah a Lea d —Fixe d Pric e 

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## "77 

# -ZS 4 c~Z ] XR F Correcte d Valu e -- > 5 (£> ^ (us e catibratio n char t o rad d 2 0 % t o value ) 

# 4^ S(i , Sampl e Are a 

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### \(Pi ' (Baq ) Sieved ) 7 2 

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### Zr A 

## f Z^-UZ ' I I'-l ! Composit e Reading s (Bag ) Composit e Averag e

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### ^ irf ^ 3 4 5 

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# n Sampl e Are a Pass/Fai l ? Aliquo t 1 I n Sit u Readin q Composit e Reading s (Bag ) Composit e Averag e

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• • 2 0 % t o value ) US E ADDIIIOHA I SHEET SI F HEEDE D XR F Technician' s Signitur eTota l a^ ^ n t Square Footag e t o b e Excavate d =191 5 Propert yClassification : 80 0 Tota l ^.. ^ Zon e Linea rFootag e to b e Excavate d = 8 3 

# ( f f ^



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Legen d Nort h Arro w Omah a Lea d Sit e t ^ r Omaha , Nebraska i l Concret e Y Z Excavate d Are a Propert yNumbe r N OLS-2067 0 [gfec l Existin g Structure Scal e Propert yAddres s ^ ^ Permanen t Landscapin g 1 Inc h = 2 0 fee t o r1 gri d = 5 x5 ft 295 5 HARRI S S T •—•— • Fenc e

—— —Quadran t Boundar y Pos t Excavatio n Concentration s (ppm ) F 1 . B 2 PlayAre a Stree t Boundar y F 2 DZ Easemen t Z P Tree/Shru b B l Garde n Othe r Descriptio n of pos l excavatio n area s Fl , tron t yard left-han d quadrant . f2 . fron t yar d ngtit-han d quadrant , Bl , backyard left-han d quadrant : B2 , backyar d nght-han d quadrant . DZ . dn p zon e (1- 3 foot are a o t soi l aroun d th e foundatto n ofth e house )X 

### vA^' o Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 {(^f ^ ^^^V ^ S Coasta l Environmenta l Grou p Inc . ^^^^^ ^ \y^^ ^

www.coastalhazmat.co m %pnoit ^ COASTA L ENVIKONMENTA L CROUP , INC . 

# EXECUTIV ESUMMARY : 20670—295 5 HARRI S S T N o Issue s o r Concern s | ^ Issues/Concern s Detai l Explanation :

# As-Buil t Drawin g COASTA L 

### % 

# mah aLea dSuperfun dSit e Tota l Quadran i Squar e Footag e to b e Excavate d = 191 5 Propen yClassificatio n 80 0 Tota l Dri p Zon e Linea rFootag e t o be Excavate d = 83

DescrfHionorpos t excavatio n area s Ft , fro m yar d lon-rian d ouadrant . F2 . fro m yar a risfithan d quadrant . Bl . tiackyar d le)1,nan d quadrant . B2 . backyar d riQm,lian 3 Quadrant , DZ , an p zon e (1- 3 foo t are a o f soi l aroun d tri e foundatio n oflfi e nouse ) 

### Legen d Are ano t Excavate d Dripzon e Excavatet d Quadrant s Excavate d 

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

# SEP A ^ * A Propert y Clos e Ou t For m Propert y #: ^ 6 70Propert y Address : .. V Property . A'^^'^A^^^' ^ Datc/TiBc : r f zZ/ZZ/^r/^eY Z \ PZA^ A Owner' s Name : ZP/ZZ/^r/^SY 

# 'r Quad t Eicavated : Contracto r Grou p ^ Excavatto nGenera l Ye s No 1.If necessary , wer e th e correc t quadram(s ) excavate dan drestored ? t ^ 

### y 2.If ncccssa^ , wer e th e correc t area s ofdri p zon e excavate dan drestored ? Grad>n £So dan dVetctatio n Ye sNo 1.Doe s th e gradin g aroun dth e peruneter ofth e hous e inexcavate darea s generall y slop e away fromth e house? 2.Ha s so dbeenlai dinal l area s tha t wer e excavated ? y 3.Doe s th e sodappea rto be generall y healthy andgrowing ? (Onl y cNcluat c if

inspecte d at a

30 da y tim e period ) 4.

Ar e sodde darea s generall y fuman devenl y graded ? 

### y 5.

Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y e%alaat e if inspecte d at z

30 da y tim e period ) 6.Wa s th e property grade dsuc htha t water wil l not poo l onth e prope-r y ? 

### ! y Wa s dairag e to landscapin gor pla-i t rriaterial s avoided ? \ y Gum s Peace s an dRcuinin t '^al b \e s No 1 Do gate s openan dclos e freely'' (Ifapplicable ) ^^ Wer e all gate sor fence s lake ndow ndurin g restoratio nact; \itie s rei n :*.a!lec ? ..ifapplicable ) y 3, Wa s damag e to gate s or fence s avoided ? (Ifapplicable ) • 4. Wa s damag e tc retainin g wall s avoided ? ^I f applicable ) A// ^ ' Foundation , Sidia t >D dGutter s >e s No 1, Wa s damag e to th e sidin gor trimavoided ? %^ 2.W4 s damag e tc th e foundatio navoided ? L ^ 3,Wa s damag e to window s avoided ? ^- ^ 4 Wa s damag e to window s or door screen s avoided ? / -
­ 1 5.Wa s damag eto dowTispout s or dov»7ispo'j t extension s avoided ? y { Sidewait u an dDriveway s (Concrete ) Ves No I, Wa s damag e to drivev^a y surface s avoided ? i ^ 2, Wa s damag e to wallo w

ay surface s avoided ? l y

### Owner s comments :

Inspectio nDCte<: 

## (PO/u/zzu^e . j O c^^ZuJ^ y A YytSriK^ify ^ S O A .

Remc%a l an drestoratio nacti\ate s corr:c'e1 e includin g "h e T-O-da y ?o d'>A,arrantA' : EP.A Representat i ntative.^y^I^^^^A^W.jyL^3te : '^/^'^/^ . ^

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