## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID# : nl^l l Date - ^//(/Z£>0 7 Address : 

# 23Q( 

# S 3 1 SW f Remediatio nContractor : Coasta l Environmenta l Group

_Year : 2007 SOILREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S M Video o f propert y (DVD ) w Executiv e Summar y 0 EPA-provide dpropert y sketc h 0 SignedAcces s Agreemen t fo r

subject propert y D Si^e dAcces s Agreement(s ) fo r

adjacen t propert y WRestoratio nAgreemen t D Settlemen t document s (i.e. , fo r

damag e o r

to replac e plants , etc. ) s /

Confirmationdata WPhotograph s bei<K C ^ S)c l 30'0(iJ 0^ As-built sketchJ M Satisfactor y restoratio nsignedby Propert y Owne r M Propert y close-out chec k

lis t signedb y EP Ay/- ^ ^ 0 j D Descriptio no f area s not meeting ROD cleanu p criteri a D Utilit y clearance s D Propert y informationfromDougla s Count y Assessor' s Office

^ flM^LdupOA. D
f Dsn d 4031711 5 

# lllliiii l Superfun d

## Propert yAcces s Checklis t Pioiicit vID : 

# /76/ / PiopcMt vAddicss . J ^ i ~ S 3 I S t n n^^ORKST^,RTE D

WORKCOMPELTE D O N O N / / 

# BL C 

# H OVMIC I 

## dxr\ c>or- ^ Ad dles s
Phon e F.i\ : 

# ^y^^hx^SdSs:!
­ Cfll/Pauc r Rcnle i Ph(m c Fa x Coll/P.i«'o i Additioii.i l Iniu i in.itio n

L ] \ o f i fnatio n Lcttc i 

# ^

S \(.n.'s s \<"u'cmcn l ! j ^

Restoiatio n \<4ieeiiieii t ! ( Topsoi l Sainplini ; <i > applitiihle ) L J Disp<»sa l Sampliiii ; (i t applicahle' i d ] Gaidei i .Sainpliiii ; (i f appliiahle ) ^

litihf vCleaianc e Sen t '^lune d Siiiiic d

Calle d B v I Q I Z^//)?- ! B v <V' ' /p- / ^/ j B v B v B v B v B v n O n D

N ideo/Photo s (Befoie ) \ ideo/Photo s iDiiiinu ) Ni(leo/Photos(Afte i I \uleo'Pliolos(3(l-Dav ) O n On . O n O n Bv , B v B v B v n Piopert vCompletio n A'j; r eeinei K Si'^ned ­ 

### / B v, 1 1 Fina l Rep o r t Issiii d / 

### / Bv . Al l Moniloiin< ; (

1 1 Communit v 1 Results : a s applua l 

### D Cre w )le ) I i O n / / B v 1 n Communit v

, Results . 1 nc.ev v 1 1 O n / / B v L J CominiiiiK v 

### • Cie, , O n / / B v

_ __ . ( 1 Results Omah a Lea d Sit e

## Propert yAcces s Checklis t Propert y ID : 

# lli^ H nWOR K STARTE D ON : / / Propertv ' Adilrcs.s : D WORKCOMPELTE D ON : / / 

# S^o/^.'3l^^ f Owner : Renter : 

# lUtcia n/UoDZ-e Addrcs.s : (_ / Phone : Fax : Cell/Paj^er : Phone : Additiona l Inl'orination : 

# 301-/0^ ^ Fax : Cell/PaRcr : D Nolificatioi i Lette r Sent : / / By : \S LAcces. s Agiecmcn t Signed : Q ) 1 i9~ l O Z 

## By = /l/ci^ z Q
- Restoratio nAgreemen t Signed : L P1 /cZ l 0 ^ 

## B.V = /Z/Z y C

H Top.soi l Samplin g (if applicable ) 1 1 By : nDisposal Samplin g (if applicable ) 1 1 By : nGarde nSamplin g (if applicable ) 1 1 By : ~ ^ Llilit y Clearanc e Called : { p 1 f ? 1 C^ 

## ^yZ l nSllZ M • ^

Video/Photo s (Befoie ) 

## On:_i^lZ[/n Z ^r./ZiZl ^ D Video/Photo s (During ) On : / / By : 0 Vidco/Photo s (After ) 

### On:\Su/^/ ^ By : <UQ> N nVideo/Photo s (3()-Da.v) On : / / By : 1 1 Propert y Completio nAgreemen t Signed : / / By : nFina l Repor t Issued : / / By : Ai r Monitorin g (a s applicable ) nCommunit y O Cre w On : / / 

## By : 1 Results : 1 1 Communit y C H Cre w On : / / By : Results : C H Communit y C D Cre w On : / / By : Results :
Omah a Lea d Sit eTotal i Jran t Square Footag e t o b e Excavate d = 92 1 Propert yClassification : 80 0 Tot T I Zon e Linea rFootaa e t o be Excavate d = 8 2 

# V 

# <: r

Legen d

•—•— • 

# o Concret e Excavated Area Existin g Structur e Fenc e Pennanent Landscapin g Quadrant Boundar y Stree t Boundar y Tree/Shm b Descriptio n o 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-hand quadrant ; DZ , dri p zon e (1- 3 foo t are a of soi l aroun d th e foundatio n o f th e house) . Nort h Arro w
Scal e 1 Inc h = 2 0 fee t o r1 gri d = 5 x5 ft

..^ W S'^v F l .



# O '. ¥HG L -*i* i h~ F 2 B 1 Omah a Lea d Sit e Omaha , Nebraska Propert yNumbe r

OLS-1761 1 Propert yAddres s

230 1 S 3 1 S T Pos t Excavatio n Concentration s (ppm ) B2 Pla yAre a D Z Easemen t Garde n Othe r

## Property I D # Property Address : Initial Contac t : Secon dContac t :V

. Fina l Contac t Fina l Action :

Comment : Owne r Commen t (s) . Site Coordinato r Commen t (s) : CONTAC T FORM i^V-U W


## ^ V g ^ cpy . 

### ^ ^ \ 

## DaiQ : Z/^2'/o ? Time : /^f66 , U.- > Action : LzP-f
- l^o^x.^, , Date:^/l ^ ~Time:V4x^f ^ Action : UiZli^'^ . Date : Time : Action ; Transmi t to EP A D Othe r Action : D



## \o\c \"l't( / '^li ^ v^i"^' ^ l ^ "^^ ^ N'^Cl ^ IH v b?' f V ^ Y\{z ^ 'W ^ I'k'fv ^ f{t1i/H^ fVio^)h, \C Kv^-<>'"•'" ;

•" rniiv'" ' 

## Consen t Fo rAcces s To Propert y RKiHTOI'ENTRYTOPRIvMISIv S 

### Granto r (th e propert y owner ) consent s to andauthorize s the Unitec i State s Environmental Protectio nAgenc y (EPA ) or it s authorize drepresentatives , collectivel y th e Grantee , to enter andperfor mcertai nenviioninental respons e activitie s uponth e followin g describe d premises :

Owner' s Name : Daytim e Phone : /Tr , ^ 

### Address : „ 

## 5 . 

# f>^' ' II Address : Addresse sof Address : ' Pi'opertie s covere d by thi s Agreement : Address : Address : PuRPosi ; Ol ' Ri':spoN8i i AcTivrni' S Th e EP A

is requestin g acces s to collec t soil sample s an dremov e soil tha t contain s elevate dconcentration sof arseni c and/o r lea dandma y pos e ahealt hhazaid . Th e soi l willbe reiTiove dandth e excavate darea(s ) willbe replace dwit htlea ninaterial s an d restored . Thi s wor k

is bein g performe dunder th e Omah aLea dSite SuperfundSite remediatio nprogram . AnEP A representativ e will contac t th e Granto r in-perso n to discus s th e wor kto be performed , th e Granto r will hav e anopportunityto revie w andapprov e th e planne dsoi l removal , andrestoratio nwor k

before it begins . Onc e th e wor k

is finished, th e Granto r will be aske d to revie w th e wor k

andconfir mtha t it is complete an dmeet s wit hth e Grantor' s approval . Uponcompletion , th e Granto r will receiv e writte ndocumentatio n fro mEP A tlia t th e property ha s beenremediated . ENVIR()NMI:NTAI , RIJ.SPON.SI ; ACTION S 

### F3

y signin g thi s Acces s Agieement , th e Granto r is grantin g th e EPA , it s employees , contractor s andsubcontractor s th e right to enter th e propeity ,at al l reasonabl e time s an d wit hprio r notice . Fo r th e sol e purpos e of performin g th e work . Thi s acces s shall remai n ineffect until the wor k

ha s beensatisfactoril y completed . Th e Granto r als o agiee s to :

«Pj:opcrt; y T.D » 

### Pag e I of 2

### ' Remov e obstiuction s includin g boats , liaileis , vehicles , playscap e items , woo d piles , do g houses , etc , " Remov e llowe i bulb s oi plant s tha t th e Granto i o i th e Gianlor' s tenan t ma v wis h t o save , " VVate i an dmaintai nleplaccmen t vegetation , includin g feililizc i application , a s ncccssai y subsequen t to a ninitia l watenn g peno dby EPA , Abid e b y healt han dsalet y guidanc e piovide db y EPA , li'th c piopeit y i s rented , assis t CP Ai nobtainin g tenan t appiova i for acces s to th e piopeit y t o perlbi mth e woi k i f EP Ai s unabl e t o obtai nsuc haccess , an d
• Allo w videotapin g and/o i photogiaph y o f th e piopert y includin g exteiio i an d inteiio i aiea s ofbuilding s A(.R I I VI I N I No i T o INI I R i i R i 

### Th e Gianto i agiee s no t t o mteifei e o r tampe r withan y ofth e activitie s oi v^-oi k

done , o i th e equipmen t use dt o peifoi mth e activities , oi t o undeilak c any action s icgaidin g th e us e o f sai dpropeil v whic hwoul dlen dt o cndange i th e healthoi welfai e ofth e Giantco-
­ 0 1 tfie enviionment , oi t o allo w othei s t o us e th e pioport \i nsuc hamannc i Shoul dyo u ha\ c an y question s abou t thi s piogiam , picas e conlac l

I I I d o no t gian t acces s ( o m \piopeitic s gtiiji t acces s ( o m y piopertie s

Smiialiir c Dat e



## n L_

l I vvouk i like to b e picsen t duiiii g an v samplin g tha t i s leqtiiic d

Pag e 2 o f 2

« P..op e : r/

_11 '

## Restoratio n Agreemen t Th e purpos e o fthi s agreemen t i s t o provid e a nnilua l agreemen t as t o condmon s o fpropert vprio rt o remediatio n aclivilie s Thi s wil l als o serv e as decontaminatio n fo rth e purpos e o fassurin g tha t restoratio n activitie s ar e complete d t o th e satisfactio n o f Ih e propert vowne ran d th e Unite d Slate s environmenta l Protectio n Accnc v(EPA )

Propert vI D Propert yAddres s 

## ^Irt / Z. 3 1 5C - Owne r f(t-p.<t ^ 

# z n ^CtJt , Phon e 

# f -^e^^-^mfe
- ?)0l'l0^ 6 O n th e attache d diagrani(s ) indn.ai e area(s ) t o excavate d an d dept h o f excavatio n locatio n o f al l know n utilitie s subsurlac e features , surfac e structure s an d landscapin g feature s acces s locauon(>, ) t o b e I'se d b > contracto ran d (h e directio n o f Nort h lndii.at e distance s depili s niaieria l rvpe s et cI idic,;t e C^'L-'UI I plK''ti.^ ^ b

> referoncui g th e photo-lo g nu.iibe rvMl h a' l arro windicatin g directio n o fvle w 

### Item s T o B e Remove d B yOwne rBefor e Star t O f Retr^edict'or; , (Use 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 OA-ner' s rssponsibiht y Ite m 

## DUnfl^mc^S k ) o 

# V.Z . Item . \ Ite m ^^ ^ Ite m y^ ^ Ite m / Ite m / Ite m / Item . Paq e 1 o f/ ) ^ ^

# 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 : 

## \\^ic W[ ^ \z ~ -^T ^

<^:kz . OtiA^^A ^ a.^' k Item : 5 o f U^aO^i^/ . \^A^ L Xo^cA. , HiA ^ ^ A. V /Z^,ci-.. r Item : Item : 

# &.}A^e ^ ^-^— ^ 1 ^^ ^ s Item : Item : / Item : / Item : / / Item : / Item : Z Item : Z Item : y ^ Item : > / Item : Z Item: / \
Pag e 2 o f 

# i £

### Item s T o B e Remove d B yContracto rDurin g Remediatio n An d H o (Us e additiona l sheet s a s necessary ) Item : 

### (X-\)C /ZnrJ^ s 

## A/i, ^ L?^;r] c iV o S z A/.f.A ^ Item : 

### [LM^z ) Item : / ^ item : / Item : / Item : / Item : / / Item : / Item : / Item : / Item : / Item : Z / Item : Item : / Item :

Pag e 3 of . 

# k

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

## Ite m Quantity
l'ic-c\i,slin g ]-)ic)pcrl y arci i tlinl i,s covere dvvil hgriis,'^ .

Niiinbc r ol ' tree s > 2 inc h trun k dinnictc r
[ 

# 2

Nunihe r (if tree s < = 2 inc h trun k diamete r \ /

Numbe r o f .Sprinkle r /ones , Cciiitro l Valves , Timers , 1 lends , etc , Allae haskelel i ii \th e s|innklei
- layoiil . 

# f

Numbe r o f an dsi/ e o f eac hgarden / I'ldwc r be d area , Allae haskele ho f relaliv e 

# f 1 Uni t

Squar e fee t 

## Condition/Type/Specie s

liac h 

## Z>^ynZ { 1

I inc h

I'ac h \

liac h .Squar e I'ee t size s an diDcalunis . Pag e 4 o f ^

# ((0 * Ite m Quantity Uni t Condition/Type/Specie s Agree dii]io nvalu e ol ' ]ilan l malerial s no l I c b e rejihicccLb y eontiaclor . Niii e I Ill s \alii e wil l b e irse d1( 1 issu e ; i plaii l viiiiehe i 1( 1 Ih e propeil v o\ \iie i Agreet l upo nlis t o f plan l malerial s Ihal wil l b o replace db y coniracior . H e vei y speeifi c an ddelailed . I'inch Ineliid e askele ho l wer e e.-iel i pl.iii l wil l b e place d b \tli e eoiiti.K'lo i Agree dupo nare ao f ]ii'o|ieity l o b e replacet l Will i gras s sod , 

### S ¥ Inelud e askele hu l Ih e arca(s ) l o b e u-plaee dwil h i:ras s s i u

l
Are aofCil v o r C:ouiily pro]ierl v l o b e landscapci l pe r thei r rec|uireinenls . Sh
Iiieliiil e ; i skele h>'! ' ili e are aI s i 4t ? ot . 

# W Wv ' .S,t ' 

# h

Pag e 5 

# ofi ^

# K0 ^

Additiona l Comment s / Instructions :

n 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 . Bycheckin 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 .



## 0 1 ag r C ] I do not agre e tgic c 

### nI d o not agre e agre e 

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# c 

# \i^ m Ovvner'sfiisnatu r Dat e Coiwractor' s Signatur e Dat e Page s of \ jTotal ' Nira i I t Squar e Footag e t o b e Excavate d = 92 1 Propert y Classification : 80 0 

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## 1 1 1 1 1 Legen d NorthArro w Omah a Lea d Sit e fV ' •' AConoEt e Omatia . Nebrask a [/"/ j Excavate d Are a PropertyNumbe r OLS-1761 1 f1 Existin g Structur e Scal e •—•— • Fenc e PropertyAddres s 1 Inc h = 2 0 fee t o r1 gri d = 5 x5 tt 230 1 S 3 1 S T K ^ Permanen t Landscapin g ^

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- Projec t Omah a Lesi j - - Fixe d Pric e 

## XRFIDOiQ7-5 / Measuremen t Count/Tim e clibrEtio n Verificatio n C^e ; ;k s 

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### Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc . vvww.coastalhazmat.co m 

# EXECUTIV ESUMMARY : 17611—230 1 S . 31' * STREE T 

# No Issue s o r Concern s I I Issues/Concern s Detai l Explanation :

# ^ As-Buil t Drawin g (ffiiah aLea dSuperfun d 

# s R Tota l Quad-a m Sc-jare Footag e l o E < Excavate d = 92 1 Propert yCHwilicatKW) , 80 0 Tota l Dn p Zon e bnea rFootag e l o b e Excavate d » 8 2



### Legen d Are ano t Excavate d}f// ADripzon e Excavate dtXX M Quadrant s Excavate d 

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

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n o fremedia l aclivilie s perfonne d o n m yproperly . M y signatur e wil l designat e tha i I a m salisfic d wil h th e restoratio n o fm yproperly , an d iha l n o item s arci n questions , now . o ra l an ytim e i n ih cfuture , excep t thos e item s liste d below , i fany .

Pnipcrt yID : 

# ini£i i Propert yAddress : 

# p-y^D i s . ,^/ f s-h . Owner : 

# l\zUoa n Mooz ^ Phone : 

# W^'/09f 5 Restoratio n Item s i n Question :

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

^;.| i iiKiTO restonitio n i s eompletetl , excep t a s note d I I d o no t apre crestoratio n i s complete d
Owner*^ij;nalur c7 Dat e ^!7niTractor' s Signatur e Dat e I

# >»tK A CT 

# A Propert y Clos e Ou t F o 

# f Propert y# : _ 

# nbl l Propert yAddress : 9^30 1 O ^ Ol- ^ ST - Datc/Tlmc : Owner* ! Name : AUa/JJ ) MOOr-t ^ Quad s Excavated : Contracto rCrou p ^ Excavatio nGencn l Ye s 1 I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? u ^ 2 I f necessafy , wer e th e correc t area s of dn p zon e excavate dan drestored' ' * ^ Gradin £So dan dVcceUtio n Ye s 1 Doe s th e gradin g aroun dth e penmete r ofth e hous e mexcavate darea s generall y slop e away fromth e bouse ? i - ^ 2 Ha s so dbeenlai dmal l area s tha t wer e excavated' ' • ^ 3 Doe s th e sodappea r t o b e gcnerall ) healthy andgrowing' ' (On K evaluat e i f inspecte da t a3 0 da y tmi e penod ) t ^ 4 Ar e sodde darea s generall y fir man devenl y graded' ' L ^ 5 Aj e th e jomt s betwee nth e so dstnp s generall y tight' ' (Orl > e \aluat e i f inspecte da t z 3 0 da\ u ^ tini K penod ) 6 Wa s th e property grade dsuc htha t wate r v* ill no t poo l onth e prooeny' ' % ^ 7 Wa s damag e t o landscapm g o r plan t TT-.aienai s 2vo>ded'" ' 1 — Gmlirv FCDCC S anit RcUinin t >^a)i s Ye s 1 D o gate s openan dclos e freeh "^ (I f applicable ) u ^ 2 Wer e all gate s or fence s take ndoNv- ndurin g restoratio nacti \"le s reipctc,iied " :,I f apclicable ) 1— 3 Wa s damag e t o gate s or fence s avoided' ' (I f applicable ) t ^ 4 Wa s damag e t o retamin g wall s avoided' ' (I f applicable ) 

# tJi
Foundation , SidiDKan dGutter s \e s 1 Wa s damag e t o th e sidm g or tn ma \oided' ' u 2 Wa s damag e t o th e foundatio navoided' ' . ^ 3 Wa s damag e t o window s avoided' ' L ^ 4 Wa s damag e t o window s o r door screen s avoided' ' l ^ 5 Wa s damag e t o dovMispout s o r dow-nspou t extension s avoided' ' t ^ Sidewalk s an dDriveway s (Concrete ) Ye s 1 Wa s damag e t o dnvewa y surface s avoided' ' iJ4 ^ 2 Wa s damag e t o waUrwa v surface s avoided' ' ^ N o

N o

No

N

o

No

## Owner s comments :

Inspectio nnotes :

Remc\a l an drestoratio nacti\ate s coT'p'ete inc'udirg th e 30->:!a \sodwarrant A EP. A Representativ^6-y^Ii^^X^C^^^^«^^=4^^ ^ 7-/^-^ 7