## TRANSMITTA L o f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL E FOLDE R SAID# : 

## 2JCP3(C > 

# Date : "^/ll/o ? Addres s Remediatio n Contractor : _Coasta l Environmenta l Group

_Year : _2007 _ SOI LREMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S ^ Vide o o f property (DVD ) 0y, Executiv e Summar y ^ EPA-providedpropert y sketc h j ^ Signe dAcces s Agreemen t for subjec t propert y D Signe dAcces s Agreement(s ) fo r adjacen t propert y \f ^ Restoratio n Agreemen t D Settlement document s (i.e. , fo r damag e o r t o replac e plants , etc. ) 1 ^ Confirmatio n dat a ^ Photograph s ^ As-buil t sketc h 5 ^ Satisfactory restoratio n signe db y Propert y Owne r 1 ^ Propert y close-ou t chec k lis t signe db y EP A D Descriptio n ofarea s no t meetin g RO D cleanu p criteri a D Utility clearance s D Propert y informatio n fromDougla s Count y Assessor' s Offic e D 

## a ,

## Propert yAcces s Checklis t PropertylD : ^/(^^^{ ^ Propert y Addrcs.s : 5^/^ / /UC(5V7 l n D

WOK K STARTE D WORKCOMPELTE D ON : ON : / / / / Owner : Address : fX)l/l/ai ] SfnUJfJ f Renter : Phone :

Phone : Fax : }^ % ^376 7 Fax : Cell/Pager : Additiona l Information : Ccll/Pascr : D No i ificatio n Lette r [ S Acces s Aj:;reenien t N J Restoratio n Agreemen t C ] Topsoi l Samplin g (ifaitplicahle ) L J Disposa l Saniplinf ; (i f applicable ) IZ ! Ganle n Samplin) ; (ifapplicable ) [ ^ Utilit y Clearanc e ^ Video/Photo s (Before ) n Video/Photo s (Durin;; ) D Video/Photo s (After ) D Video/Photo s (3()-Day ) 1 1 Properl y Completio n Agreemen t 1 1 Fina l Repor t Sent : / / Signed : j2./<^//_ ^ 

### Signed : 5 " 1 99 1 _C J 1 1 1 1 1 1 

### Called : _^/^/(2 1

On : ^1^117 2 On : / / On : / / On : / / Signed : / / Issued : / / By : 

## ^r-lU(AtC01 ) ^r7Aano 5 By : By : By : 

# ^yy7risK7 ^ ^y-l(jc7 \ By : By : By : By : By : Ai r Monitorin g (a s applicable ) 1 C H Communit y O Cre w Results : On : / / By : C

H Communit y 1 Results : C H Cre w On : / / By : C

H Communit y Results : C H Cre w On : / / By :

Omah a Lea d Sit eQ^^an t Square Footag e t o b e Excavate d = 30 7 

# h PropertyClassification : 80 0 a^ B Zon e Linea rFootag e t o b e Excavate d = 9 8

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

# ^$D-in i h ^ (f^ '

Property I D # Property Address : Initial Contact : Secon dContact : Fina l Contact : Fina l Action :

Comment : Owne r Commen t (s) : Site Coordinato r Commen t (s) : CONTAC T FORM ^K.^ U :^M K/n^<.^. , Date:_ x ^^p-t Time : iMij ? Action : LtP ^ (o^ccU . .^ ^ Date: ^ ^S Time:t|^f K Action:/:^ ^ f. b j/^ f IM^g . Date : Time : Action : Transmi t to EP A D Othe r Action : O,-^^^"J:'^'.. .

'•» ( ,.HO-V* ^ 

## Consen t Fo rAcces s T o Propert y RIGH T O FE N TR Y I O PRI'MISIV S 

### Granto r (th e property owner ) consent s t o andauthorize s th e Unite dState s Environmental Protectio n Agenc y (EPA ) o r it s authorize drepresentatives , collectivel y th e Grantee , t o enter andperfon n certai n environmental respons e activitie s upo n th e followin g describe d premises :

Owner' s Name : Daytim e Phone : Address : ^^^ ^ ^^^ ^ Address : Addresse s of Address : Propertie s covere db y thi s Agreement : Address : i i 

### Address : PuRPosi;Ol - Ri'SPONSi ; Aciivrriiv s Th e EPA i s requestin g acces s t o collec t soi l sample s andremov e soil that contain s elevate dconcentration s o f arseni c and/o r leadan dma y pos e ahealt hhazard . Th e soil wil l b e remove dandth e e.xcavatedarea(s ) will b e replace dwit hclea n material s and restored . Thi s wor k

i s bein g performe dunde r th e Omah aLea dSite Superfun dSite remediatio n program . A

n EPA representativ e will contac t th e Granto r in-perso n t o discus s th e wor k

t o b e performed , th e Granto r will hav e a n opportunity t o revie w andapprov e th e planne dsoil removal , an drestoratio n wor k

before it begins . Onc e th e wor k

i s finished, th e Granto r will b e aske dt o revie w th e wor k

andconfir mtha t i t i s complet e andmeet s wit hth e Grantor' s approval . Upo n completion , th e Granto r wil l receiv e writte n documentatio n fromEP A that th e propert y ha s been remediated . ENVIRONMI'NTAI . RivSPONsi ; ACTION S 

### B y signin g thi s Acces s Agreement , th e Granto r i s grantin g th e EPA , it s employees , contractor s andsubcontractor s th e right t o ente r th e property , a t al l reasonabl e time s an d wit hprio r notice , fo r th e sol e purpos e o f performin g th e work . Thi s acces s shal l remai n in effect unti l th e wor k

ha s bee n satisfactoril y completed . Th e Granto r als o agree s to :

«Property_ID » 

### Pag e 1 of 2•-Ww ^



### •Remov e obstmction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; • Remov e flower bulb s o r plant s tha t th e Granto r or th e Grantor' s tenant ma y wish t o save ; • Water andmaintai n replacemen t vegetation , includin g fertilizer application , as necessar y subsequen t t

o a n initia l waterin g perio db y EPA ; • Abid e b y healt handsafet y guidanc e provide db y EPA ; • I f th e property i s rented , assis t EP A i n obtainin g tenan t approval fo r acces s t o th e propert y to perfor mth e wor k

i f EPA i s unabl e t o obtai n suchaccess ; an d • Allo w videotapin g and/o r photograph y o f th e property includin g exterio r an d 1/ ^ -interio r areaaofbuildings . Ac.Rf:i':Mi-: N T No r T o INTI-:RFI:RI : 

### Th e Granto r agree s not to interfere or tampe r wit han y ofth e activitie s o r wor k

done , o r th e equipment usedt o perfor mth e activities , o r t o undertake an y action s regardin g the us e o f sai dpropert y whic hwoul dten dt o endange r th e heah ho r welfare of th e Grantee s o

r th e environment , or to allo w other s to us e th e propert y i n suchamanner . Shoul dyo u hav e an y question s about thi s program , pleas e contac t

04 gran t acces s t o m y propertie sD > d o no t gran t acces s t o m y propertie s 

# TA^h ^ Signatur eDat e Signatur e Dat e

L

J 1 wouldlik e t o b e present durin g an y samplin g that i s required . Pag e 2 of 2 «ProDeit v ID :

## Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o provid e amutual agreemen t a s t o condition s o f property prio r t o remediatio n activities . Thi s wil l als o serv e a s decontaminatio n fo r th e purpos e o f assurin g that restoratio n activitie s ar e complete dt o th e satisfactio n o f th e property owne r andth e Unite dState s Environmental Protectio n Agenc y (EPA) .

PropertylD : ^//^^ O Property Address : S^i ^ /HaSOi l -SV " 

## P'^""^ ^ ^^i/>-3i3 1 On th e attache ddiagram(s ) indicate area(s ) t o e.xcavatedanddept ho f excavation , locatio n o f all know n utilities , subsurfac e features , surfac e structure s andlandscapin g features , acces s location(s ) t o b e use dby contractor , andth e directio n o f North . Indicate distances , depths , material types , etc . Indicate digital photo s b

y referencin g th e photo-lo g number wit ha n arro w indicatin g directio n o 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 . Item : Item : Item : item : Item : Item : Item : Item : Pag e 1 of _ ( .

# '4=- - 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 : 

# iit ^ ?Z(lo^^t S'id ^ i QmS 7 Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 2 of . 

# G^^^f » 

### 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 : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 3 o f ^

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

### Ite m

Pre-existin g propert y are a tha t i s covere dwil hgrass .

Number o f tree s > 2 inch trunk diamete r

Number o f tree s < = 2 inc h trun k

diamete r

Numbei - o f Sprinkle r Zones , ConU'o l Valves , • fimers , Heads , etc . Allaehasketc ht> f th e sprinkle r la\x)iil . Number o f andsiz e of eachgarden/ flower bed area . Allacii askeleho f relativ e si/e s an dlocations . 

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

# tfo C Square feet 

# 0 fiach • 

# 7 ) i Eac h



# 0 luich i

f'ac h Square Fee t i j Pag e 4 o f (/ >

## IV Ite m Agree dujio n valu e o f jilan t malerial s no l l o b e rejilace db v contractor . Not e thi s \alu e wil l h e use dl o issu e aplan l x'ouehc r l o th e jiropei"l \ owne r Agree dupo n lis t o f plan t malerial s lha l wil l b e replace db y contractor . H e vei y specifi c an ddetailed . Includ e askele ho f wer e eac hplan t wil l b e jilaee d I n lli c ccmliacUir , Agree du|-)o n are ao f projierl y t o b e replace d wil hgras s st)d . Inelud e askeic h ol ' th e area(s ) l o b e replace dwit h gras s sod . Are ao f Cil y o r Couni y propeil y l o h e landscape d pe r thei r requiremenis . Includ e askelel i o f th e are a( s ) 

### Quantit y Uni t

$ 

### Condition/Type/Specie s 

# /hAA-A ^ f^lAj I 7^/ ^

liac h 

# k ^ S F

S F'

Pag e 5 o f v>Additiona l Comment s / Instructions :



# s ^ / CA ^ 

# i^^^ f y^ ^

• Chec k th e bo xi f Owne rdoe s not 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 not responsibl e fo ran ydamag e don e t o th e interio rof house , includin g foundatio n cracks o rfissures .



# Sf C agre e n I d o no t agre e 

## D l agre e n I do no t agre e 

# 5^p9^^ 7 Ovvner' s Sijrnatur e Dat e Contractor' s Signatur e Dat e Pag e 6 o f ( j

## ID# : Date : 

## Name : ZH^B L ^|i3|o %



## JC.'c k V . Description : Ha s £ >^ WStC-l-c ^ o P S C Co^i^U L-RCFEPT V C:=AKiNC H vVCPKS'-£E ~ )^- . Dat e Propert yI D 

# fhirQjf A AlllSU : Propert y Projec t Omah a Lea d - - Fixe d Pric e 

# A\\ 9 M^s^^ r Addres s Measuremen t XR F I D 

# OlOl - 5 1 Count/Tim e Fiel d Shot s Sho t # Readin g Sampl e Are a Sho t # 

# 1 -7g/ . 

### 7 . 1?-(M " 

## T^ g T57 . \7-(M Sampl eAre a 

# F> \a-m' ' I n Sit u Composit e Aliquo t Composit e Reading s Readin g .Averag e (Bag ) (Bag ) 

## I K _^9 - 

# 3 4 -§ t .2

_ XR F Correcte d Valu e -- > 

## it ^ 

# 1 3 (us e calibratio n char t o - ic C ZC-Z ct cvalue ) Sampl eAre a 

## TT ? /?-(U - I n Sit u Zomposit e i^iiajc t Ccrpcsit e Re.^c:rc « Readin o Averag e (Bag ) (Bag ) ^ ^ 

## T ^ = 

# ZI O

\o \ XR F Correcte d Valu e -- > (us e calibratior . char t o rac e 

## cSb i 20'^ ct cvalue ) Sampl e Are a I 

# B 7 )7-m " I n Sit u Composit e Aliquo t Composit e Reading s Readjn g Averag e (Bag ) 

# :m i (Bag ) -^[2 . 

### e-1 3 Q S I 

# i l 9 4 -^g - I Z I XR F Correcte d Valu e -- > 

## 4 9 |(us e calibratio n char t o rad d '20 % t o value ) \\ $ Sampl e Are a { I n Sit u Composit e Aliquo t Composit e Reading s Readin g Averag e (Bag ) (Bag ) 1 Confidentia l Readin g Sampl e Are a

Pass/Fai l ? Composit e Analytica l La b Analytica l (Drie d & Spil t Sen t Numbe r ReSiJit s I Sieved ) 7

Pass / Fai l Ccmposit e Anaiytica l La b 'Drie d & Spit t Sen t Nwmbe r i Sieved ) ! ?

Pass/Fai l ?

, Composit e jAnsIytica l La b i Anaiytica l

j (Drie d & Spli t Sen t Number i Result s : Sieved ) '

Pass/Fai l ? Composit e Analytica l La b Analytica l (Drie d & Spil t Sen t Numbe r Result s • > Sieved )

-se e ­ 13 ! 4 ^ ^ 5 XR F CiBHbe d Valu e ~ > (us e calTbratic n char t o rad d 2 0 % t o value ) 1 1 

## !

, | 

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

(Bag ) Composit e (Drie d & Sieved ) Analytica l Spil t Sen t La b Numbe r Analytica l Result s 2 3 4 XR F Correcte d Valu e —> 1 ! 1 (us e calibratio n char t o rad d

.. . .. . 2 0 % t o value ) X*<, p .sc*".P'C'2' ' O « . . 1 ,. u 

# v\/Al i J^T ^

Confidentia l

## I Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc . ^ < # www . coasta l haz m at . co m COASTA L INVmONMENTi l CROUP . INC . 

## EXECUTIV E SUMMARY : 21686—341 9 MASO N STREE T I N o Issue s o r Concern s Issues/Concern s Detai l Explanation : Property Owne r was issue dagif t certificat e in th e amoun t o f $100.0 0 for bushe s an dshrub s remove d durin g excavation .

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e Tota l Ouadran t Squar e Footag e t o t> e Excavate d = 30 7 Propert yClassiticatton : 80 0 Tota l Dfi p Zon e Linea rFootag e t o b e Excavate d = 9 8

t^Maso n Stree t Nort h Arro w Omah a Lea d Sit e Omaha . Nebrask a Legen d g^s^-jieg i i^ ^

Dat^Excavated:6/9/0 7 Propert yNumbe r Dat e USEP A Signe d Off:7/2/0 7 OLS-2168 6 Scal e Propert yAddres s Permarwn t Landscapin g 1 Inc h = 2 0 feet o r1 gri d = 5 xS ft 341 9 MASO N S T • •— • Fenc e

——— Quadran t Boundar y Pos t Excavatio n Concentration s (ppm ) Fl . 8 2 Pla yAre a Stree t Boundar y F 2 D Z Easemen t 

## t 5 gB;g. ­ <Q ) Tree/Shru b B 1 Garde n Othe r D«sct^Kv i a f pos l «KC«V<IIK3( I «f«a s F1 . (ran i yar d lnn.|ian d quadrar^ . F2 . fion t yar d righl-han d quadran t B1 . bacityar d l«ft-han d quBdrap-it . B2 . backyar d nghl-hart d quadran t DZ . ik vzon e <1' 3 foc i aro a o f sor t aroun d tf w foundatto n o f it w house ) Legen d Are a no t Excavate d Dripzon e Excavate d Quadrant s Excavate d Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .

# m ^ Propert yCompletio n Agreemen t Thi s agreemen t documciU s tli c completio n o f remedia l activitie s perfonne do n m y property . M y signatur e wil l dcsignal c tha t i a msatisfie dwit htli c restoratio n o f m y properly , andlhal n o ilcm s arc i n questions , now . o r a

l an y lim e i n ih c fulurc , excep t thos e ilcm s liste dbelow , if any . Propert yID : 

# ^/[/^( ^ Pr<,pcrt v Adilrcss : ^4/ ^ H IgSQTl SJ Owner : 

# LUi///7iiy i Sf/)LUl U Phone : 

## V^ ^ -.^/^ ^ -n i i^a > in i Restoratio n Item s i n Question :

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

iicrc c i-estoratio n i s completed , excep t H

S note d \Qi\iv.i ­ I I d o no t agrcc-restoratio n i s complete d 

# i1 ^



# 7 0~7-f ~ Dat e I

### Omah aLea dSuperfun dSit e Miscellaneou s Landscapin g Replacemen t Certificat e Propert y Owne r 

# '\l\/\iim M ^i:DW^u Propert y Addres s 

# Ml ^ ^^7^ ^ ^ - Propert y Identiflcatio n Numbe r 

# i^ m Materia l Remove d Replacemen t Valu e Flowe r be dare a Tree s Itemize d shrubs/bushe s 

## 470 " Tota l 

## O V ^ 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 by th e property owne r that thi s i s afai r an dreasonabl e compensatio n for plan t material s remove ddurin g remediatio n activities , bu t no t plante do r installe dby th e governmen t o r it' s contractors . Th e total amoun t o f $ [ ha s bee n receive dby th e owne r iir th e for mo f agif t certificate , #'^V ^ . t o b e utilize da t \n\7lf^ A (T^ y y\y[7y^ \^ . 

# /lf?^^nAM 7 ^_3/is7)i_ Property Owner' s Signatur e Dat e Contractor' s Signatur e

### INDIAN CREEK NURSER Y 

# 253 0 Omaha' s Bes t Kep t Gardenin g Secre t 30 3 Nort hSaddl e Cree k Roa d Omaha , Nebrask a68131*222 9 (402 ) 558-590 0 

# Gif t

Ce r ificat e PAT E I N TH E AMOUN T OF : ISSUE D T O 

## : }jJjJi\nfy i ^OLMJ I COMPLIMENT S 

## ov.CDash J Sic/ , EXPIRATIO N DATE : ^ ~<i O "^O o J J . \A J A

AuthorizedSignatur e

# SEP A 

# i A Propert y Clos e Ou t Fo r 

# r f Propert y # : 

# ^M ^ Propert y Addre« : ^4l^/UOSO ^ S^ - Datc/TlBc : Owner' s Name : /Al/llA/r i ^WlM/ l Quad s Excavated : Contracto r Grou p Excavatio B Gencrs l Yr t N o I . I f nccessa.'y , wer e th e correc t quadrant(s ) excavate dan drestored ? ^ 2 . I f ncccssaty , wer e th e correc t area s o f dri p zon e excavate dJin drestored* ] Gradin g So dan dVetetotio B Ye s N o 1 . Doe s th e gradin g aroun dth e perimeter ofth e hous e i r excav ate darea s generall y slop e away y fromth e bouse? 2 . Ha s so dbeen lai dL n al l area s tha t wer e excavated ? 3 . Doe s th e sodappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 i / da y tim e period ) 4 . .\r e sodde darea s generall y fir man devenl y graded ? Ar c th e jcLnts betwee n th e so dstrip s generall y tight ? (Onl y e \aloat e i f inspecte da t z !- 0 da y tim e period ) ^<Jv>v< - V^- ^ '^2. " , ^ jT^k . (fSt T fjKvic/^ ) 6 . Wa s th e property grade dsuc htha t w ater \

^ ill no t poo l or . th e prope'T N ? y ^ 7 . ^'a s damag e t o landscapin g or plan t maieriEl s a< . cidec ? Gaicv , Peace s aa s RciainiD f '^ai b Ve s N o '. . D o gate s open an dclos e freely" (Ifapplicable ) AAA2 . Wer e all gate s or fence s lake n dowi t durin g restoratio n acti \itie s reir. : '^!!e-c ? ..Tapplicabit^) ! 3 . Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) 

## /^ K 4 . Wa s damag e t c retabir. g wall s avoided ? i,! f applicable ) 

## /r> ^ Foundation , Sidis g an dGutter s Ves Nc 1 . Wa s damag e t o th e sidin g or tri mavoided ? 

## 7 2 . W ^ damag e t o th e foundatio n avoided ? y 3 . Wa s damag e t o window s avoided ? ^ 4 Wa s damag e t o window s or doo r screen s avoided ? ^ 5 . Wa s damag e t o downspout s or downspout extension s avoided ? <„. - Sidewalk s an dDrtveway s (Concrete ) Ve s No I . Wa s damag e t o drivewa y surface s avoided ? /i/ A 2 . Wa s damag e t o wallcwa y surface s avoided' ; 

### y 

## 1

### Owner s comments :

Inspectio n nctes : 

# -/ - 

# ^^J< - c) f 

# iJ^/e r d/n&n c /o r s o J . h.^^^^/ ^ iyJ^ ^



### Remc\'a l an drestcratio n act hate s corr.p'et e includin g th e 30-day so d-v*.arrant}" : EP A Represer . Date : 77jAy7£ ? y