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

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. ffl'v v ^ h< ^ m Address : Remediatio nConlractor : Coasta l Environmenta l Grou p Year : 2010ARR A SOI LREMEDIATIO N PROPERT Y FJL EFOLDE RDOCUMENT S Vide o o f property (DVD ) Executiv e Summar y / 

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# 7 Signe dAcces s Agreemen t fo r subjec t property Signe dAcces s Agreement(s ) fo r adjacenl property Restoratio nAgreement Seltlemen l document s (i.e. , fo r damag e o r to replac e plants , etc. ) Confirmatio n dat a 

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# 7 Property i«farmatio nfromDougla s County Assessor' s Office D

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## Douglas Count y Accoun t In^-natio n Pag e 1 of 2
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## http://douglasne.mapping-online.com/DouglasCoNe/static/accotjntinfo.jsp?accountno=R22..
. 9/15/201 0

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. . 9/15/201 0

### Pag e 1 o f 1 %

Creat e Anothe rTicke t ] [ Bac k t o Irt h Inteme t [ Sen d Emai l ]



### • YOURTICKE T NUMBERI S 2632024
. Origina l Cal l Date : 11/02/1 0 Time : 9:3 8 a mOp : ELIZABETH1879 0 Wor k t o Begi n Date : 11/04/1 0 Time : 10:1 5 a m State : N E Co\mty : DOUGLA S Place : OMAH A Address : 281 3 Street : N19T H AV E Twp : 15 NRng : 13 E Sect-Qtr : 10-NW-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATION Locatio n o f Work : LOCAT E ENTIR E PROPERTY , AL L EASEMENT S AN D T O TH E PEDESTAL Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E I F CORNE R LOT . Compan y: COASTAL ENVIRONMENTAL SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : COASTAL Dept h o f Excavation : 4 F T Corne r Lot : N Front : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Servic e Are a Contac t Phon e Numbe r Utilit y Typ e 

### Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , INC HEIDI 

### Ah : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUDO l METROPOLITA NUTILITIE S DISTRIC T SANDY 

### Ah : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y OFOMAHA-TRAFFICSEWERRICH/TRAFFIC Alt : 402444516 1 

### Emerg : 402444516 0 Day : 406728934 3 OPPDGPR 5 OMAH A PUBLIC POWE RDISTRICT EL M LOCATINGAlt : 406207149 4 

### Emerg : 888728934 3 Day : 406728934 3 QLNNEI C QWES T LOCA LNETWOR K 

### EL M LOCATIN GAlt : 406207149 4 Emerg : 888728934 3
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. . 11/2/201 0

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e OLS# : 2982 2 Dat e Excavated : 11/10/201 0 Dat e USEP ASiane d Off : 12/9/201 0 Are a Sodden : 122 0 s a f t 

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COASTA l INVIItONMIHU l CROU P I h C 

## Cofisentfo i Acces s T o Fropert 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 : ^ ^ 9 8 3 a

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# Z^/ 3 h 7 / 7 ^v ^ 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 o f lea d an d maypos 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 confim i tha t i t i s complet e an d meet s wit h th e Grantor' s approval
. Upo n compietion , 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 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

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# V COASTA L



### . / IHVIROMHfKTA L •• » BflO^t ^ C KO U P IK C 

### cRemov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , elc ; e 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 ; cWate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessarysubsequen t t o a n initia l waterin g perio d b yEPA ; c

Abid e b yhealt h an d safet yguidanc e provide d b yEPA ; • I f th 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
. cAllo wvideotapin g and/o rphotographin g o f th 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 wort ^

activities , o rwit 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 . Should 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 access t o m ypropertie s D i d o no t gran t acces s t o m ypropertie s

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F^g e 2 o f 2COA S T AL
• MV I MON M t NTA L O n O U P, INC
. 

## Restoratio n Agreemen t The purpos e ofthi 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 serve a s docimientation fo r

the purpos e of assuring tha t restoration activitie s ar e completedto the satisfactionof the propert y owne r an dthe UnitedState s Enviroiunenta l Protectio nAgency (EPA)
.

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# Phone : j /// ^ J/ f I ^
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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 usedby the contractors . Indicat e distances , depths , materia l types , etc . Photographicall y an dVideographicall y dcxnmien 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 rretu m o f thes e item s i s th e Owner' s responsibiiity
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## Item Quantity Pre-existing propert y area , tha t wil l b e excavated , tha t 

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# ' } trun k

diamete r Numbe r of tree s < = 2 inc h trun k

diamete r 

# £ > Numbe r of Sprinkle r Zones , Control Valves , Timers , Heads , etc . 

# y Attac hasketc ho f the sprinkle r layout
. Numbe r of an dsize of eac hgarden / flowe r bed area . 

# y Attac hasketc ho f relative size s an dlocations
. Agree duponvalue o f plan t material s not to b e replacedbv contractor . Not e thi s valu e wU l b e 

# y

usedt o issu e aplan t voucher t o th e property owner . Easemen t Area , to b e excavated / 

## Landscap e Inventor y Unit Quadrants
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## Condition/Type/Specie s



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### Addttiona l Comment s / Instructions : Th e ctt yo f Omah a ordinance s ma yprohibt 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 i Protectio n Agency(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 ctte d b yth e ctt yi f yo u us e a grave l o rdir t are a a s a drivewa yo rparkin g area , no t wtthstandin g an yremova l o rreplacemen t o f soi l b yth e EPA
. I f yo u have an yquestio n abou t legalit yo f a certai n drivewa yo rparkin g area , yo u ma ycontact th e ctt yo f Omaha' s Plannin g Departmen t a t (402 ) 444-5150
. n Pleas e chec k thi s bo xi f yo u understan d th e informatio n outline d above
. 

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Q 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
.

r^lagre e O I d o no t agre e

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# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 B y 

## Certificat e o f Verificatio n

18 4 SOI L 2011-01-1 4 11:1 7 90.9 5 Fina l Av g o f 181-18 3 281 3 N 1 9 AV E B 2 13 " C.PADILL A CONFIRMATIO N CLEA R

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 219.89 1 Supervise d By : 

## Certificat e o f Verificatio n

18 1 SOI L 2011-01

- 1 4 11:1 6 30.2 0 Fina l 2982 2 281 3 N 1 9 AV E B 2 13 " C.PADILL A CONFIRMATIO N CLEA R
Erro r ± 22.58 4

# 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 162.67 7 Supervised
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## Certificat e o f Verificatio n

18 2 SOI L 2011-01-1 4 11:1 6 30.2 2 Fina l 2982 2 281 3 N 1 9 AV E B 2 13 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 19.38 4

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

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pp m P b 214.90 4 Supervise d By : 

## Certificat e o f Verificatio n

18 3 SOI L 2011-01-1 4 11:1 7 30.5 3 Fina l 2982 2 281 3 N 1 9 AV E B 2 13 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 19.52 1

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

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## Certificat e o f Verificatio n

18 8 SOI L 2011-01

- 1 4 11:2 0 90.7 5 Fina l Av g o f 185-18 7 281 3 N 1 9 AV E E A 1 " C.PADIL U CONFIRMATIO N CLEA R

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

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pp m P b 211.93 6 Supervise d By : 

## Certificat e o f Verificatio n

18 5 SOI L 2011-01-1 4 11:1 8 30.2 3 Fina l 2982 2 281 3 N 1 9 AV E E A 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 20.78 9

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Blllerica , 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 239.18 6 Supervise d By : 

## Certificat e o f Verificatio n

18 6 SOI L 2011-01-1 4 11:1 9 30.2 9 Fina l 2982 2 281 3 N 1 9 AV E E A 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 21.76 5

# Therm o SCIENTIFI C Therm o Fishe r Scientifi c 90 0 Middlese x Turnpik e Billerica , M A 0182 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 232.59 8 Supervise d By : 

## Certificat e of Verificatio n

18 7 SOIL 2011-01-1 4 11:2 0 30.2 3 Fina l 2982 2 281 3 N1 9 AV E E A 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 21.72 5X y*^Z'*'^ s 

## /l0^ \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
. • f
. j ^ www.coastalhazmat.co m — %P„oi« ^ COASTA L ENVI>ONH[NT* L GROUP , IN C 

# EXECUTIV ESUMMARY : BVID #29822-(281 3 n1 9 ave ) No Issue s o r Concern s | ^ Issues/Concern s Detail Explanation :

# E EP A Property ' Clos e Ou t For m Propert y tl : O Propert y AddrwTy^-W-J-^! ^ V^i^fS, / Date/Tlrac : _ _ Ouad u ExcBvslfd : W ^ Confracto rGrou p __C^AVTV^VL ^ Ejicavatlo nGenera l •^e * ^ o I f necessary , were (h e correc i quadranl(s ) excavate dandrestored' ' 

# y+- i 2 I f nctessar>' , wer e th e correc t area s ofdn p ?orj e excavate dandrcstoied' ' Ye s ^< ) Gradin g So d an d VctteUtio n ! I Doe s th e gradin g aroun dth e perimete r oftti e hous e inexcavaicri area s generall y SIOIH

- i)wa \ 

# y y I from(b e house ? 2 Ha s so dbee nlai dinal l area s tha t were excavated ? 

# y i Doc s the so dappea r t o b e generall y health y an dgro-wing' ' (Onl y evaluat e i f inspecte da i a?0 I da y tim e period ) 4 Ar e sodde darea s generall y fir mandevenl y graded' ' 

# 'y\

I V - ^ Ar e th e joint s behvee nth e so dstrip s generall y fight ? (Onl y evaluat e i f inspccie da t a3 0 da y I 4 tim e period )
_ 

# y r 6 Wa s the property grade dsuc htha i water wil l nol poo l o nih f propertv' ' 

# ^ Y

- J - ­ 7 Wa s dHfnige t o landscapin g o r pla mmaterial s avoided' ' 

# ; y I

- J Gate?
. Feacc i an dReiainin g Wall s \[- } ^l ' D o gate s ope nan dclos e freely? (I f applicable ) Wer e al l gate s o i fence s take ndowt i durin g restoratio nactivitie s remsialled ? ( K

apolicahl f i
^ Wa s damag e t o gate s or fence s avoided ? (Ifapplicable ) 

# A 

# /.

_. ; '1 Wa s damag e t o retainin g wall s avoided' ' (Ifapplicable ) foupdaiion , Sidin g an dCuner s _ Ves , N c 1 I Wa s diunBge t o th e sidin g o r tri mavoided' ' 

### T-/T" " • , I 2 Wa s damag e i nth e foundatio navoided' ' Wa s damag e i c window s avoided' ' 

# y- '
dWa s damag e t o window s o r doo r screen s avoided' ' 

# y\ ' 

# ; Wa. s damag e t o downspoui s n r downspou i txien.sion s a^•l)ldcd• ' Sidewalk i an dDriveway s (Copcrete ) > c s > f Wa s damag e l o drivewa y surface s avoided ' 

# 7 '
2
. Wa s damag e t o walkwa y surface s avoided' ' I

### OMper 5 rommenls :

In.spectio nnote*; :

ReiDOva l an dresloiatio nHtlivalf. s fompiel e includin g lh e .^0-da y .so dwaniiiiry \t\°iVv > 

### VrP A Hcf}respntiHtivc Date ;V 

## Propert yCompletio n Agreemen t riii i agieemen i documenl s (li e complclio n o l remedia l aclivme s perlonne d o n myproperl yM y.signalui e wil l designat e tha i I a m satisfie d wil h th e restoratio n o f m yproperly , an d iha l n o uem s ar e m questions , now , o ra l an ytun e i n th e fuluie , excep l ihos e item s liste d below , ifan y

Propert y FD : Propert y Address : /J^/ ^ A / ' /'^Al/ ^ 

## ^ 

## ^^^f
. ^ A 7 

## , Owne : jycm;i Z/^<> ^ 

# ?7< 7 • ?>V/ K Restoratio n Item s i n Question :

Item : Item :
!•• • I «l | I U
. Item : Item : Item : Item : Additiona l Comments :



# L

I ly\ ayrc cI rstoralio n i s completed , rxccp l a s nole d [ I I rio no t «i;rr crestoratio n 'wcomplete d 

### 9 Owiier'.< i Sicn»tiir rDat e /ConOarioi' s Signadir e