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

# SAID# : ^O^ l Date : 9>4/^ 7 Address : /3I B S 3d ) fi^jj^ Remediatio nContractor : Coasta l Environmenta l Group

_Year : _2007 _ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S
^ Vide o o f propert y (DVD ) 53 ^ Executiv e Summary \y EPA-provide dproperty sketc h M Signe dAcces s Agreemen t for subjec t propert y D Signe dAcces s Agreement(s ) for adjacen t propert y M Restoratio nAgreemen t D Settlement document s (i.e. , for damag e o r t o replac e plants , etc. ) ^ Confinnatio ndat a B ^ Photograph s M As-buil t sketc h M Satisfactory restoratio nsigne db y Propert y Owne r B ^ Propert y close-ou t chec k lis t signe db y EP A vf' Descriptiono f area s no t meetin g RO D cleanu p criteri a D Utilit y clearance s D Propert y informatio nfi'omDougla s County Assessor' s Offic e D
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4031787 2 

# ril l Superfun d

# m Propert y Acces s Checklis t PropertylD : ,'^$-1 1 D WOR K STARTE D ON : / / D WORKCOMPELTE D ON : / / Propert y Address : /3/ ^ S. 3 0 f\\l- t - Owner : ^ ^ tfO/ ^ tJ i D W I t 2. 

## R'^"*'^'­ = fLo5in a Address : ^3/ g S,0^}/\^ ^ Phone : ^^/^.^/^ ^ Fax : Cell/Pager : 

### Phone : (j^Q-QW X Additiona l Information : Fax : Cell/Pager :

nn Notificatio nLette r Sent : / / Bv : 0 ^ Acces s Agreemen t Signed : 4 1 d'^ l 0 ^ 

## ^r-Marco s M B^Kestoratio nAgreemen t Signed : V 1 ^6' 1 O l 

## By = Marco 5 M cnTopsoi l Samplin g (i f applicable ) 1 1 By : nDisposa l Samplin g (if applicable ) 1 1 By : f~

l Garde nSamplin g (i f applicable ) 1 1 By : M Utilit y Clearanc e CMed : Pl l ^10 2 

# ^y-^^rpfshkc Lirn^iRs ] O^Video/Photo s (Before ) On:^ l 9^10 1 

## ^y-/ZicKr . ^ Video/Photo s (During ) 

## On:^/^ / on By : £iap D^Video/Photo s (After ) 

### On:_g:/^ / C>- 1 

## ^y - fcic H nVideo/Photo s (30-Dav ) On : / / By : \ 2 Propert y Completio nAgreemen t Signed : ^ I [ 1 O' l 

## ^y liitlA r~ 1 Fina l Repor t Issued : / / Bvi Ai r IVIonitorin g (a s applicable ) 1 1 Communit y CH Cre w On : / / 

## 1 Results : O Communit y • Cre w On : / / 

## By : II Results : nCommunit y CH Cre w On : / / By : Results :
Omah a Lea d Sit eExcavate d = 317 3 PropertyClassification : 80 0 

# OUJfIt : Sandt a<csimdt^s:^§t^zrsiT.Z Footaq e t o b e Excavate d = 5 5

Descriptio n of pos t excavatio n areas : Fl , fron t yar d left-han d quadrant : F2 , fron t yar d nght-han d quadrant : Bl , backyard left-han d quadrant : B2 , backyar d right-hand quadrant : DZ , dn p zon e (1- 3 foo t are a o f soi l aroun d th e foundatio n o f th e house) .

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

Parce l I D Owne r Nam e Pmpert 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 Sec-Twn Rn g 123748000 0 ESTRAD A SANDR A 1318S30A V OMAH A 6810 5
131 8 S 3 0 AV E OMAH A N E 6810 5 28-15-1 3 Owne r Addres s Additio n Bloc k Lo t Lega l 1 Lega l 2 Lega l 3 Lega l 4 Ol d Assesso r Sit e Ne w Assesso r Sit e HANSCO M PLAC E 1 0 5 E 14 2 F TLO T5 50X14 2
http://webarc.co.douglas.ne.us/dcassessor/details.asp ? PAR C EL N B = 123748000 0 http://webarc.co.douglas.ne.us:8080/RealWare1/details.do ? id=R123748000 0

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 = 17 1 fee t appraisal , survey , o rfo rzonin g verification . 

### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-.. . 4/25/200 7

## Propert y I D # Propert y Address : Initia l Contact : Secon dContact : Fina l Contact : Fina l Action :

Comment : Owne r Commen t (s) : Sit e Coordinato r Commen t (s) : CONTACT FORM

^\^ ^



### / ^

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# 131 5 S . 30f^^, . . ^ ,^,^^(^^ ^ Date : [{ A Time : ^^'-" l Action : ^OH^lPi/li! ? fiffbutryn^Hf

Date : Time : Action : Date : Time : Action : Transmi t t o EP A D Othe r Action : D

## Derech o o Concentimient o par a e l Acess o a l a Propieda d DERECH O PAR AENTRA R AL APROPIEDA D 

### Otorgant e (dueno(a ) d e propiedad ) l e d a consentimient o yautoriz a a l a Agenci a par a l a Proteccio n de l Medi o Ambient e d e Lo s Estad o Unido s (EPA ) o a s u representante s autorizados , e n conjunt o e l Cesionario , a entra rya lleva ra cab o alguna s actividade s ambientale s e n l a propieda d descrit a a continuacion : " ^ ^ Duefi o d e l a Propiedad : H.rU. ^

^^SL . Numero Telefonico : Ao2. ­ Co<S O - 6332 - Direccion : . ^ S 3D^^ ^ AvA £ 

### Om,^U a M e 

# &i Direccio n d e la(s ) Direccl6n : | Propiedad(es ) Direccion : Cubieta(s ) po rest e Acuerdo : Direccion : 1 Direccion : PROPCSIT O D E ACTIVIDADE S AMBIENTALE S 

### E l EP Asolicit a e l acess o a s u propieda d par a collecta rmuestra s d e tierr a ypar a remove rtierr a qu e tien e alt a concentracione s d e plom o qu e podri a se rpeligros o par a s u salud . EI(Las ) area(s ) d e tierr a contaminad a sera n excavada s par a s u remocion . L a tierr a ser a reemplazad a co n tierr a limpia s yel(las ) area(s ) sera(n ) restaurado(s ) a s u condicio n original . Est e trabaj o ser a realizad o baj o e l program a d e remediacio n "Omah a Lea d Superfun d Site " U n representant e d e "Coasta l Environmenta l Group" , contratad o po re l "USEPA " contactar a a l Otorgant e e n person a par a discuti re l trabaj o po rrealizarse . E l otorgant e tendr a l a oportunida d d e revisa ryaproba re l pla n d e remocio n d e tierr a ye l pla n d e restauracio n ante s d e qu e e l trabaj o empiece . Habiendos e cumplid o e l trabajo , e l s e l e pedir a a l otorgant e qu e revis e e l trabaj o yqu e d e f e d e qu e e l trabaj o h a sid o efectuad o e n s u totalida d yd e acuerd o a su s condiciones . E n cuant o s e termin e e l trabajo , e l "USEPA " l e enviar a documentacio n po rescrit o a l otorgant e dand o constanci a d e qu e l a remocio n e n s u propieda d h a sid o efectuada . ACCIONE S D E LARESPONDENCI AAMBIENTAL . 

### A l firma rest e Acuerd o d e Acceso , e l Otorgant e l e conced e e l derech o a l a EPA , su s empleados , contratista s ysubcontratista s e l ingres o a s u propiedad , e n hora s razonabl e yco n previ o aviso . Est e derech o est a limitad o exclusivament e par a l a realizacio n d eC^t D S7-4 .
o 

## \ .^o * 

### est e trabajo . Est e derech o exclusiv o ylimitad o d e acces o estar a e n vigenci a hast a qu e e l trabaj o hay a culminad o satisfactoriamente . E l Ortogant e tamibe n acced e a : •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 perio d b yEPA ; •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 . •Allo 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 wor k 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 . Shoul d you hav e an yquestion s abou t thi s program , pleas e contac t Coasta l Environmenta l Group , a t (??? ) ???-???? . ^

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 C

H

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

## Restoratio n Agreemen t E

l proposit o d e est e acuerd o e s par allegar aun entendimient o mutu o sobre la s condicione s d e su propieda dante s d e comenzar la s actividade s de remediacion . Este acuerd o tambie n l e servir acom o documentacio n al a'"USEPA " par apode r asegura r qu e actividade s d e restauracio n s e hayan cumplid o e n s u totalida dy al asatisfaccio nd e el(la ) dueno(a ) de l apropiedad .

I D d e Propiedad : HeCt^r : ^ t rr,er> e Z Direccion : -^-^^ ^ ^ ^^ ^ ^_ ^ 0 Vv ^ ^ W A K> € 

## G8\0 S Dueiio : Numer o d e Telefono : qcT^ - ^^0 ' b332_ E

nla(s ) diagrama(s ) fijado, indic ael (los ) area(s ) aexca v a r y l aprofundidadde excavacion , ubicacio n de tod o la s empresa s de servici o public o sabido , caracteristica s subterraneo , estructura s de superfici e y caracteristica s de paisaje , sito s d e acces o qu e estarausad o po r e

l contractor , y direccio n de norte . Indic adistancias . proflmdidades , tipo s d e materials , etc . Indic afoto s digitale s po r referenciend o e l numero de photo-lo g co n un aflechaindicand o l adireccio nde s u vista . 

### Articulo s qu e Estara m Removid o po re l Duen o Ante s d e l a Emplez a d e Remediacion : (Us a Ma s Hoja s S i Se a Necessario ) L a removimiento , almacenaje , disposicion , y/ o l a devolucio n d e esta s articulo s e s l a responsibilida d del(la ) Dueno(a) . Articulo : Articulo : Articulo : Articulo : Articulo : Articulo : Articulo : Pagin a 1 

## of_Lz_

### Articulo s Qu e Estara n Quitad o Po rE l Contracto rDurant e D e Remediacio n YN o Reemplazad o (Us a Ma s Hoja s S i Se a Necessario ) Articulo : (vjlori e Articulo : Articulo : Articulo : Articulo : Articulo : Articulo : Articulo : Articulo : Articulo : Articulo : Articulo : Articulo : Articulo : Articulo :

Pag e 2 

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### Articulo s Qu e Estara n Removid o Po rE l Contracto rDurant e D e Remediacio n Y Reemplazad o (Us a Ma s Hoja s S i Se a Necessario ) Articulo : Ko^ ^

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### Aticul o

Are ad e propieda dqu e est a cubiert o co n past o anteriormente .

Numer o d e arbole s co n un tronc o > 2 pulgada s e n diametr o

Numer o d e arbole s co n u n tronc o < = 2 pulgada s e n diametr o

Numer o d e zona s d e regadores , Valvula s d e Control , Reguladores , Cabezas , etc . Fij auncroqui s de l pland e regadores . Number o d e y tomaii o d e cad ajardin/flo r enl acam a d e flores . Fij auncroqui s de l pland e tomailo s relative s y localizacion . 

### Inventari o d e Paisaj e (Us a Ma s Hoja s S i Se a Necessario ) 

### Cantida d Uni t Condicion/Tipo/Especi a

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### Aticul o Cantida d Uni t Condicion/Tipo/Especi a El valo r convien e en d e materiale s d e planta s n o esta r repuest o po r contractor . Notaest e valo r usad o issua r comprobant e par a a l dueno . estar a u n planta s L alist aconvien e en d e materiale s d e planta s qu e

estar arepuest o po r el contractor . Est 6 muy especific o y detallado . Cad a 

# fV^ ^ h'r s y m Incluy e un acroqui s d e l a posicio nd e cad aplant a estar apuest o po r el contractor . El are aconvien e e nd e l a propieda destar repuest o co npasto . Incluy e un acroqui s d e l a posicio nde l area(s ) esta r repuest o co npasto. . S F

Are ad e propieda dd e Ciuda do Condad o estar arreglad o e l paisaj e par asu requisites . S F Incluy e area(s ) un acroqui s de l

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### Pag e 1 o f 3 tsimmons(glkgs.he.ne t From : "Lehma n Carlton " <ctl(gctlehman.net > To : <France-lsetts.Pauletta@epamail.epa.gov > Cc : "Brow n Ron " <r.brown@erllc.com> ; <tsimmons@coastalhazmaLcom> ; "Mart i Cieslik " < marticieslik@aewe.com> ; "Marco s Mateus " <mmateus{genviroservicesgroup.com > Sent : Friday , Jun e 01 , 200 7 9:1 4 A M Subject : Re : Damag e Clai m 131 8 S 3 0 A V - BVI D 2021 1 

### Pauletta , W e visite dwithMr . Hecto r Jimene z thi s momin g an dobtaine dfina l sign-of f (Completio nAgreement ) for th e wor k

complete da t hi s property . H e state dh e wa s please dwithth e wor k

an dhadn o issue s o r

property damag e claims . Th e drive-way was seriousl y deteriorate d an dcracke dbefor e wor k

commenced , whic hMr . Jimene z ha s acknowledged . Inth e future , ca nth e PI C office s as k ifth e property owne r ha s mad e an y attempt s t o contac t th e Contracto r an di f no t t o pleas e as k th e property owne r t o cal l us ? Al l th e property owner s hav e ou r phon e number s andcontac t informatio na t th e tim e the y sig nth e Acces s & Restoratio nAgreements . Property owners , wh o are owe dareplacemen t vouche r fo r landscap e materials , wil l receiv e it onc e th e wor k

i s complete dan dameetin g ca

nb e schedule dt o obtai nasigne dCompletio nAgreement . Carlto n

O nMay 31 , 2007 , at 3:4 0 PM , France-Isetts.Pauletta@epamail.epa.go v wrote : > > 

### > Forwarde db y Paulett aFrance-lsetts/SUPR/R7/USEPA/U S o n > 05/31/200 7 > 03:4 0 PM- — > 

### > "Mar y Castaneda " > <mcastaneda@air s > 

### > oilwater.com > T o > Danie l > 05/31/200 7 03:2 2 Garvey/SUPR/R7/USEPA/US@,EPA . > P M Paulett a 6/1/200 7

### Pag e 2 o f 3
> France-lsetts/SUPR/R7/USEPA/ > y S@EP > A , <r.brown@erllc.com > 

### > c > c > Robert > Feild/SUPR/R7/USEPA/US@EPA . > <fdillon@airsoilwater.com> , > Debbi e Kring/0EP/R7/USEPA / > US@EPA , > Donal d > Bahnke/SUPR/R7/USEPA/US@EPA . > Vicki e Damm/ENSv7R7/USEPA/US@EP A > 

### > Subjec t > Damag e Clai m131 8 S 3 0 A V - BVI D > 2021 1 > > > > > > > > > > > > > > 

### > Original Messag e > 

### > Sent : Thursday , May 31 , 200 7 3:1 1 PM > To : mcastaneda(g),airsoilwater.co m > Subject : Cal l in131 8 S 3 0 A V - Sampl e Are a2021 1 > Cal l Date : 31-May-0 7 > Calle r Name : Francisc aJimene z > Phone : (402)680-633 2 > > 

### > Comments : Curren t owner s are Hecto r & Francisc aJimene z (previou s > owner ­ > Estrada ) Pleas e mak e acorrectio ninth e oracl e system , DC A indicate s > Jimene z a s owners....Mary > > 

### > P O i s requestin g follow-u p fromcontracto r for Damag e t o th e cemen t > driveway > that wa s cracke db y th e bobcat...Als o state dthe y wer e promise da > vouche r 6/1/200 7

### Pag e 3 o f 3
> for th e ros e garde nandsmal l tre e that wer e remove db y > Coastal...State d > thi s wor k

wa s complete dove r tw o week s ago . Pleas e cal l t o discus s >thi s > issu e pe r Mrs . Jimene z Mar y > > > > > >



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### Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 s % Coasta l Environmenta l Grou p Inc . www . coasta l haz m at . co m ^ # •'t-PKtitt ^ COASTA L ENVIKONHENTA L C R 0 U r. INC . 

## EXECUTIV ESUMMARY : 20211—131 8 S . 3 0 Av e I I N o Issue s o r Concern s X 

## Issues/Concern s Detai l Explanation : Property Owne r wa s issue dagif t certificate fromIndianCreek Nursery inth e amoun t o f $ 300.0 0 for 1 5 ros e bushe s remove ddurin g excavation .

# As-Buil t Drawii ^ COAST AL 

# Omah aLea dSuperfun dSit e

Tota l Quadran t Squar e Footag e t o b e Excavate d = 317 3

Tota l Dri p Zon e Linea rFootaq e t o b e Excavate d = 5 5

Osscf^ibo n o f pol l excavatio n ofefln . F l tron t yar d left-han d quadrant . P2 . fron t yar d rigli t han d quadrant . Bl . backyar d left-han d quadrant . B2 . laacltyar d nght-han d quadrant . OZ , drpzon e (1- 3 fa d af«Q i o f Mi d aroun d th e foundatio n ofth e house ) Legen d Are ano t Excavate d ,/2 ! Dripzon e Excavate d Quadrant s Excavate d Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .

# &ESV f Propert yCompletio n Agreemen t Thi s agreemen t documents th e completio n o f removal activitie s performe don th e belo w liste dproperty . Th e property owner' s signatur e indicate s that th e property owne r i s satisfie dwit hth e restoratio n ofth e subjec t property , an dtha t n o item s ar e i n question , now , o r at an y tim e in th e future , excludin g an y remainin g so dwarranty (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert yID : ^^ / / Propert yAddress : /3/ ^ ^ ^ 3 0 MV^ - Owner : HZC-fO rJ l fTl^nt Z 

### Phone : OP)0-(£33 ^ Restoratio n Item s i n Question :

Item : Item : Item : j Item : Item : Item : Require d correction s t o complet e th e property : S <
- •X^ .

J e restoration-i s comfffeted , excep t a s note d above . I I d o no t agre e restoratio n i s complete d



## oT ­ Owner' s Signature Dat e I

### Omah aLea dSuperfun dSit e Miscellaneou s Landscapin g Replacemen t Certificat e Propert y Owne r HICVD ^ r ^ -LVJkq^X ^ 

# P . Propert y Addres s 

## \Z\9 . 5 2> a Av L Propert y Identificatio nNumbe r PCST K 

## Zcn.\ ^ Materia l Remove d Replacemen t Valu e Flowe r be dare a
Tree s Itemize d 1 5 OJOS' L 

### shrubs/bushe s Tota l Th e acceptanc e o f th e replacemen t certificat e an dth e signatur e belo w i s ful l acknowledgemen t b y th e property owne r that thi s i s afair an dreasonabl e compensatio n for plan t material s remove ddurin g remediatio nactivities , bu t no t plante do r installe db y th e govemmen t o r it' s contractors . Th e total amoun t o f $ 3o c .c O ha s bee nreceive dby th e owne r i nth e for mo f agif t certificate , #ZHl-? i , t o b e ufilize da t tL-y\^iA n(_<2^^'Oc

_KWirc^g ^ t.e v . 

# (^:yf)^ ^ ( ^ ^ ^^ ^ Property Owner' s Signatur e Date Contractor' s Signatur e Date- - 

# aEPA• EP A Propert y Clos e Ou t For m Propert y #: _ Q-OS^l i Propert Propert y y Address

Address : : /3^:65^3Mi^
- Date/Time : Owner' s Name : Quad s Excavated : Contracto r Grou p Excavatio nGeneral Ye s I.

If necessary , wer e th e correct quadrant(s ) excavatedan drestored ? 

### i P l ^ 2.

If necessary , wer e th e correct areas of dri p zon e excavatedan drestored ? Gradin g So dan dVecetatio n Ye s 1.Doe s the grading aroundth e perimete r ofth e hous e in excavatedarea s generall y slope awa y fromthe house ? 2. Ha s sodbee nlaid inall area s tha t wer e excavated ? v ^ 3.Doe s the so dappea r to be generall y health y an dgrowing ? (Onl y evaluat e

if

inspecte d

at a

30

- da

y tim e period) 4. Ar e sodde darea s generally fir man devenl y graded ? ^ 5.Ar e the Joints between the sodstrip s generall y tight ? (Onl y evaluat e if

inspected at a

30 da y ^ tim e period ) 6.Wa s th e propert y gradedsuc htha t wate r wil l not pool on the property ? 1 ^ ^ 7.Was damag e to landscapingor plan t material s avoided ? Gates , Fence s andRetainin g Wall s Yes 1.

Do gate s ope n an dclos e freely? (Ifapplicable ) 0A2.Wer e all gate sor fence s take n dow nduring restoration activitie s reinstalled ? (Ifapplicable ) 3. Was damag e

to gate sor fence s avoided ? (Ifapplicable ) i X 4.Wasdamagetoretainin g wall s avoided ? (Ifapplicable ) t^ x Foundation , Siding an dGutter s Yes 1. Wa s damag e

to the sidin g or tri mavoided ? i ^ 2. Wa s damag e

to the foundatio navoided ? ^ 3. Was damag eto window s avoided ? ^ 4. Wa s damag eto window sor doo r screen s avoided ? c^ 5.

Was daraage to downspout sor downspou t extension s avoided ? ^ Sidewalk s an dDriveway s (Concrete ) Ye s I. Wa s damag e

to drivewa y surface s avoided ? t ^ 2.Was damag eto walkwa y surface s avoided ? ^ No

No

No

No

No

### Owner s comments :

Inspectio nnotes :

Remova l an drestorati^g^activates^spmplet ^ indudin g the 30-da y so dwarranty : EP A Representative^^yr^;*^^^^?^^ 7^^^^^^*^b=^^^ ^ Date : ^ ^A

—^<^ ^ 7