## TRANSMITTALof OMAH A LEA D SIT E SOILREMEDIATIO NFIL EFOLDE R
SAID# : 

# 'K<o \ Date : ^ 

# u \\ \
Address : 

# 'hl'h Q '^}m\- ^ 4 r Remediatio nContractor : CoastalEnvironmenta l Group

_Year : _2010ARR A
SOI LREMEDIATIO N PROPERT V FIL EFOLDE RDOCUMENT S 

## 1 / Vide o ofpropert y (DVD ) 

# y

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### Executiv e Summar y EPA-provide dproperty sketc h Signe dAcces s Agreemen t fo r subjec t properl y Signe dAcces s Agreement(s ) fo r adjacent property Restoratio nAgreement Settlemen t document s (i.e. , fo r damag e or to replac e plants , etc. ) Confirmatio ndata Photograph s ( K S^^I^IIOM 

### ^ 6^AAVl^1?ot ^ \h^ ^ As-buil t sketc h Satisfactory restoratio nsigne db y Property Owner Propert y 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 Utility clearance s 

## y Property infomjatio nfro mDougla s County Assessor' s Office D



### Signatur e 3023732 7 Superfun d

## Propert y Acces s Checklis t PropertylD : i^^ ^ / nWOR K STARTE D ON : / / PropertyAddress ; 3$^^ ^ l-hhrvUl ^ nWORKCOMPELTE D ON : / /
Renter : 

## Q^"*""

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- Fax : Cell/Pager : 

## Phone : ^S^ " SllZ/<Sl'-"^^ ^ Additiona l Inforniation : Fax : Cell/Pager :
D Notificatio n Lette r Succes s Agreemen t K[^ ^ Restoratio nAgreemen t

D Topsoi l Samplin g (i f appUcable ) nDisposal Samplm g (i f applicable ) D Garde n Samplin g (i f appUcable ) H UtiUt y Clearanc e t^Video/Photo s (Before ) \ I JVideo/Photo s (During ) D Video/Photo s (After ) nVideo/Photo s (30-Day ) Q Propert y Completio n Agreemen t nFina l Repor t Ai r Monitorin g (a s appUcable )
• Commumt y • Cre w On : Results : GCommunit y D Cre w On : Results :

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## On : J O Jff J_ 0 On : / / On : / / On : / / Siened : / / Issued : / /
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### Dougla s County Accoun t I r^^^tio n Pag e 1 of 2
Dougla s County , Nebrask a Propert yRecor d - R202977000 0 Prin t Repor t Vie wInteractiv e GI S Ma o Informatio n i s vali d a s o f 2010-8-3 0 Treasurer' s Ta xReoor t Ne wFeatur e ••->• • Subdivisio n Sale s Searc h Owne r L0PF 7 ANTONI O 322 0 HAMILTO N S T OMAH AN E 68131-000 0 Propert yInformatio n Ke yNumber : 297 7 OOO O 2 0 Accoun t Type : Residentia l Parce l Numtier : 202977000 0 Parce l Address : 323 0 HAMILTO N S T OMAH AN E 68131-000 0 Lega l Description : PROSPEC TPLAC E LO T8 BLOC KH S 1/ 2 LT7 & E 1 0 FTS 1/ 2 Valu e Informatio n Lan d Improvemen t Tota l 201 0 200 9 200 8 200 7 200 6 2005 $1,100.0 0 $1,100.0 0 $1,100.0 0 $1,100.0 0 $1,100.0 0 $1,100.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $1,100.0 0 $1,100.0 0 $1,100.0 0 $1,100.0 0 $1,100.0 0 $1,100.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 9 4320. 0 0. 0 72. 0 60. 0 Ye s



### http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accoimtno=R202.
. . 9/2/201 0

## Pag e 1 of 2 %

" > I Creat e Anothe rTicke t [ Bac k t o Irti i Intemet I Sen d Emai l



## • YOURTICKE T NUMBE RI S 2630921
. Origina l Cal l Date : 11/01/1 0 Time : 10:5 8 a m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 11/03/1 0 Time : 11:3 0 a m State : N E County : DOUGLA S Place : OMAH A Address : 323 0 Street : HAMILTO NS T Twp : 15 NRng : 13 E Sect-Qtr : 16-N W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATIO N Locatio n o f Work : LOCAT E ENTIR E PROPERTY , AL L EASEMENT S AN D T O TH E PEDESTA L Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E I F CORNE R LOT . Compan y: COASTA L ENVIRONMENTA L SERVIC E Contact Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : COASTA L Dept h o f Excavation : 4 F T Come r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL 3 MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac t Phon e Number UtUit y Typ e
CXCAT V CO X COMMUNICATIONS , IN C HEIDI 

## Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7

LEVEL3 LEVEL3 COMMUNICATIONS , LL C N A 

## Day : 8773668344 Alt : Emerg : 8773668344

MUDO l METROPOLITA N UTILITIES DISTRIC T SAND Y 

## Day : 402504782 3 Alt : Emerg : 402504797 0

OMAHACO FCITYOFOMAHA-TRAFFIC.SEWE RRICH/TRAFFI C 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 

## http://vmw.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS..
. 11/1/201 0

### Pag e 2 of 2

0PPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T EL M LOCATIN G 

### At : 406207149 4 Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K Day :

EL M LOCATIN GAlt : 406728934 3 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 11/1/201 0OLS# : 2550 1 

# ^ ^ As-Buil t Drawin g ^ ^ Dat e Excavated : 11/4/201 0 Dat e USEP ASiane d Off : 11/23/201 0 COASTA L 

# (Jmah aLea dSuperfun dSit e Are a Sodden : 159 0 s a f t

26r-523 / Name : /}/t/^,\ > /<>/»(?? • . Address : 1i^-ic/jf4jmi7o',j.t, T Phone : SST'91,5 7 Oinah a Lea d SK e Sit e Sketc h Date : Time :f/(3/e>S-
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### Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
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## 2^6"^ / Name ; ^Jffo^, h Lojoe^z
. Acidress : 3^'^o//4^»^2£7c>f^^ T Phone : 551'fbS l Omah a Lea d Sit e Sit e Sketc h Date : Time : -7^37^1 - X-'^ o Nort h Arro wV

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### Granto ! (th e property ' owr^ei ) consenl Kt can d aulhorize s th e Unile d Slate s Enviionmenta l Protectio n Agency(FPA ) o i its aulhorize d representatives , collectivel y th e Grantee , t o ente ran d perforn n certai n environmenta l lespons e activitie s upo n th e followin g describe d premises : -•cr-zr—VJ 9 /

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ivnei' s Name : Ai

V-vJ ? Addres s o f Propert y covere d b ythi s 

# i;i?) Q Hcvm'il'hd K Agreement :
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 of lea d an d ma ypos e a healt h hazar d Th e area(s ) v^il 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 its 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 perfomied , th e Granto rwil l hav e a n opportunit yt o revie wan d approv e th e planne d soi l removai , an d restoratio n wor k befor e i t begins
. Onc e th e wor k i s finistied , 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 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 en 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 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 of 2

### I rCAE 1 A1 LKVI»0KKhK1Z. l CHOU ' • • • C



### ' Remov e obslruction s inciudin g boats , liaileis , vehicles , playscap e ilemr , woo d piles , do o houses , elc ; < Remov e i\owe \ bulb s o i piaiil s tha i th e Granto i o rth e Granloi' s lenen l ma yvv'is h t o save ; Wate ran d maintai n lepiacernen l vegetation , includin g ferliiize rapplicstion , a s necessary ' subsequen i t o a n initia l waterin g perio d b yEPA ; < Abid e b yheall h an d safet yguidanc e provide d b yEPA ;

' i l th e property ' i s rented , assis t EP Ai n obtainin g tenan t sppiova i fo i acces s l o th e property ' t o perfor m th e wor k Allo wvideotapin g and/o rphotographin g o f th e property , AGREEMENTNO TTO iNfTERFERE Th e Granto ragree s no l t o interler e o rtampe rwit h an yo f th e v^'ork 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 Iri 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 i Coasta l Environmenta l Group , a t (402 ) 991-119 9



## [ffl ! G I d o not gran t acces s t o mypropertie s f J I gran t acces s t o mypropertie s


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.

Paa e 2 o f2COA S T AL • MVIKONMBMTA L OROUP , INC
. 

## Restoratio n Agreemen t The piupos e of thi s agreemen t i s t o provide amutua l agreemen t a s to condition s of the propert y prior to remediationactivities
. Thi s will als o serve a s documentationfo r the piupos e of assuring tha t restoratio n activitie s ar e completedt o the satisfactionof the propert y owne r an dthe UnitedState s Environmenta l ProtectionAgency (EPA)
.

Propert y ID : ^S^ O 1 Propert y Address : ^ S dHor^ i I-K5- K

s 7 Owner:4y^^^~J ^ ^ Plione : 4r6a-^^^^S'77 ^ 

### O

nthe attacheddiagram(s ) indicat e area(s ) to excavate , surface structure s an dlandscapin g feature s an d acces s location(s ) t o b e usedby 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 Star t o f Remediation : Th e removal , storage , disposal , and/o rretu m ofthes e item s i s th e Owner' s Fesponsibility
. ttem : 

## yLJcyi ^ Kem : Item : Kem :

item s t o b e Remove d b y th e Contracto r Durin g Remediatio n an d No t Reoiace d Kem : 

# yOo- ^ Kem : Kem : Kem :

Page l of
.COA S T AL • NVIMONHK N TAL O • O U P , INC
. 

## item s t o B e Remove d B yContracto rDurin g Remediatio n an d Repiace d Kem : 

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# <So ^ Item :
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## Landscap e inventory Ite m Quantit y Uni t Condition/Type/Specie s Pre-existing propert y area , Quadrants tha t wil l b e excavated , tha t i s coveredwit hgrass . Numbe r of tree s > 2 inc h Eac h ^ ^ 

### trun k

diamete r Nimibe r of tree s <= 2 inc h Eac h 

# ^ 7 trun k

diamete r Numbe r of Sprinkle r Zones , Control Valves , Eac h Timers , Heads , etc . Attac hasketc hof th e sprinlde r layout
. Numbe r of an dsize of eac hgarden / flowe r bed Eac h area . 

### Squar e Fee t Attac hasketc ho f relative size s an dlocations
. Agree dupon value of plan t material s not to b e replacedb v contractor . Not e thi s valu e will b e usedt o issu e aplan t voucher t o th e propert y owner . Easemen t Area , to b e Eac h excavated
Pag e 2 of
.COA S T AL o n o u p , INC
.
Additiona l Comment s / Instructions : Th e cit yo f Omah a ordinance s ma yprohib Kyo 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 underiyin 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 wKhstandin g an yremova l o rreplacemen t o f soi l b yth e EP A 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
. O Pleas e chec k thi s bo xi f yo u understan d th e informatio n outline d above
. 

# -^^•v c ?^^HVTA (

D 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 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
. 

### ~@N Iagre e C H I d o no t agre e

Owner' s Signatun e Date Contractor' s Signatur e Date Pag e 3 o f

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

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Supervise d By : 

## Certificat e o f Verificatio n

2 0 SOI L 2011-01-1 2 12:0 9 90.9 5 Fina l Avg of 17-1 9 323 0 HAMILTO N S T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

# 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 91.77 4 Supervise d By : 

## Certificat e o f Verificatio n

1 7 SOI L 2011-01-1 2 12:0 7 30.5 7 Fina l 2550 1 323 0 HAMILTO N S T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 14.21 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 80.05 8 Supervise d By : 

## Certificat e o f Verificatio n

1 8 SOI L 2011-01-1 2 12:0 8 30.1 9 Fina l 2550 1 323 0 HAMILTO N S T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

±

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# 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 78.41 3 Supervise d By : 

## Certificat e o f Verificatio n

1 9 SOI L 2011-01-1 2 12:0 9 30.1 9 Fina l 2550 1 323 0 HAMILTO N S T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

±

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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

Supervise d By : 

## Certificat e o f Verificatio n

2 4 SOI L 2011-01-1 2 12 ; 1 2 91.7 1 Fina l Av g o f 21-2 3 323 0 HAMILTO N S T B 2 4 " C.PADILL A CONFIRMATIO N CLEA R

# 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 220.46 0 Supervise d By : 

## Certificat e o f Verificatio n

2 1 SOI L 2011-01-1 2 12:1 0 31.3 1 Fina l 2550 1 323 0 HAMILTO N S T B 2 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 20.36 3

# 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 206.92 1 Supervise d By : 

## Certificat e o f Verificatio n

2 2 SOI L 2011-01-1 2 12:1 1 30.2 4 Final 2550 1 323 0 HAMILTO N S T B 2 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 21.90 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 BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 177.09 9 Supervise d By : 

## Certificat e o f Verificatio n

2 3 SOI L 2011-01-1 2 12:1 2 30.1 6 Fina l 2550 1 323 0 HAMILTO N S T B 2 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 21.07 7

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

I Coasta l Environmenta l Grou p Inc
. V~*^<< ? www.coastalhazmat.co m

^"Lntiy ^ COASTA L INVIHONHIHTA t C a o U P , IN C 

# EXECUTIV ESUMMARY : BVID #25501-(323 0 HAMILTO N ST )
No Issue s o r Concern s [ ^ Issues/Concern s Detai l Explanation : -DANGARVE Y WALKE D TH EPROPERT Y O N11/23/201 0

## EP A Propert y Clos e Ou t For m 'Jsfy\'^t - Propert y # : <y^SO
. I Date/Tlrae : Owner' s Name: , / ^

rlm^^^uiiyP ^ H ^ Quad s Excavated : Contracto rGrou p Excavatio nGeneni l 1
.

I f necessaiy , wer e th e coirec t quadnnt(s ) excavate dan drestored ? 2
.If necessaiy , wet e th c corrrc i area s ofdri p zon e excavate dao drestored ? Gradin g So d an d Vegetatio a I
.Doe s tb e gradin g aroun dth e periinete r ofth e hous e inexcavate darea s generall y slop e away fromtfa e house ? 2
.Ha s so dbee nlai di nal l area s that wer e excavated ? 3
.Doe s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e ifinspecte da t a3 0 da y tim e period ) 4
.Ar e sodde darea s generall y fir man devenl y graded ? 5
.

Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e ifinspecte da t a3 0 da y tim e period ) 6
.Wa s th e property grade dsuc hthat wate r wil l not poo l o n th e property ? 1
.

Wa s damag e l o landscapin g o r plan t material s avoided ? Gates
. Fence s ant i Remnln g Wal b I i
. D o gate s ope nan dclos e freely? (t f applicable ) 2
.Wer e al l gate s o r fence s take ndow ndurin g restoratio n activitie s reinstalled ? (I f applicable ) 3
.Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) 4
.Wa s damtg e t o retainin g wall s avoided ? (Ifapplicable ) Foundation , SidiflKan dGntfe n I
.Wa s damag e l o th e sidin g o r ni mavoided ? 2
.Wa s damag e t o Ih e Toundatio navoided ? 3
. Wa s damag e l o window s avoided ? 4 Wa s daniag e t o window s o r doo r screen s avoided ? S
.Wa s damag e t o downspout s o r downspou t extension s avoided ? Sidewalk s an d Drfaeway s (Concrete ) 1
.Wa s damag e t o drivewa y surface s avoided ? 2
.Wa ^ damag e t o walkwa y surface s avoided ? Ye s No 

### / y Ye s N o



### y 

## y y 

# y y y 

## y Ye s N u



### / / / / Ye s N o / / 

# y 

# y y Ye s N o 

### / 

### y

## Ort'oer s comments :

I 

## ninspectio nnotes :

Removal an drestoratio n activate s complel e includin g th e 30-da y so dwarranty : EP A Representativ e ^^> 1 Date:^___jilt3|io
_

## Propert yCompletio n Agreemen t Thi s agreemen l document s Ih e compiclio nol remedial aclivilie s perloime d on my properl yMy signalui e will designat e ihai I amsatisfie dwit hth e restoralio nof my properly , an dtha ino item s ar e inquestions , now . or al an y lim e in th e fulure , excep l thos e ilem s liste dbelow ,if an y Propert y ID : ^'t>^ V I 

### PropertyAddress : 3^3 0 /-hTn^-Othn ^ -=2 ^ 

# ^^7 ^ "m-S^VT f Restoratio n Item s in Question :

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

b s 1 R|:rc cicstorAlio n \s compleled , excep t as nnler i [ I I rto no t AKre crcslorAtin n it complete d

Dat e arioi' ' s s Sienatur e Dal e

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