### TRANSMITTA L o fOMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID # 

## A)^'>^ 3 DATE : 

# 5/<=2^/u ADRESS : Drj U )V l 7/ ) ^ REMEDIATIO N CONTRACTOR : COASTA L ENVIRONMENTA LGROU P Contract : EP-R7-09-0 6

SOI LREMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENTS 

# 7 Executiv e Summar y 

### / EPA-provide d propert ysketc h 

# 7 Signe d Acces s Agreemen t fo rsubjec t propert y Assigne d Acces s Agreemen t (s ) fo radjacen t propert y ^

Restoratio n Agreemen t hJc^ , Settlemen t document s (i.e. , fo rdamag e o rt o replac e plants , etc. )

H Confirmatio n dat a A

^

Photograph s SO D Pre-Excavatio n ~"
—Excavatio n 

### / As-Buil t sketc h \ \

Satisfactor yrestoratio n signe d b yPropert yOwne r ^ U Propert yclose-ou t chec k lis t signe d b yEP A A ^ Descriptio n o farea s o farea s no t meetin g RO D cleanu p criteri a V Utilit yclearance s Propert yInformatio n fro m Dougla s Count yAssessor' s Offic e / D ^ 

# 1 ^ %^ ^ 'Signature - e- CaASIAr v

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### 3026291 1 Superfun df p
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## Propert y Acces s Checklis t Propert)ID : '2-S'3Z' ^ nWOR K STARTE D ON : / / D WOR K COMPELTE D ON : / / [PJ^pcrt v Address : ^.^j^^ Q S \
- Rcnte n 

### ^'''^'--yu[[t\70f\V\)ck\'U\' ' '.Ac
- Phone : Fa.\ : Cell/Pager : Additiona l Int'ormntion : Fax :

Notificatio nLette r Sent : Bv : Acces s Agreemen t 

### Signed : 5 " /'24 / i I By : Restoratio nAgreemen t Signe d 

# yy^y Bv :

--! • j ] L J Topsoi l Samplin g (if applicable ) Bv : \IDisi)osa JSamplin g (Ifapplicable ) Bv : C

D Gjirdc nSfimplifl g (i f ap/)l/cal))e ) Bv : nIJtilirv'Clearanc e Called : By : D Video/Photo s (Before ) On : Bv :

• Video/Photo s (During ) On : Bv : nVideo/Photo s (After ) On : Bv ; D Video/Photo s (30-Da.v ) On : Bv : L J Propert y Corajjlefio nAgreemen t Signed : By : CJFina l Repor t Issued : Bv : Ai r Monitorin g (a s applicabl e O Communit y C UCre nIOn : / , / Results ; L J Community ' C U Crc^vOn : Bv : Results : InCommunit v C UCrci > On : / - B\ : Result.s ;
Omah a Lea d Sit e 

### http://douglasne.mapping-online.com/Doug!asCoNe/static/accountinfo,jsp?accountno=R]40.
. . 9/3/201 0 http://douglasne.mapping-online.coin/DougiasCoNe/static/accountinfo.jsp?accountno=R140.
. . 9/3/201 0

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o YOU RTICKE TNUMBE RI S 2784016 . Origina l Cal l Date : 6/29/1 1 Time : 9:0 8 a m Op : ALFONSO1 8 7 9 0 Wor k t o Begi n Date : 7/01/1 1 Time : 9:4 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 112 6 Street : N2OT H S T Twp : 15 NRng : 13 E Sect-Qtr : 15-NW-S 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 : (402)934-281 1 : PLEAS E INCLUD E AL L EASEMENTS . THAN K YOU ! Compan y: COASTA L ENVIRONMENTA L SERVIC E Contac t Name : ALFONS O Phone : (402)934-283 7 Wor k Bein g Don e For : Coasta l Dept ho f Excavation : 4f t Corne r Lot : NFront : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V LEVEL 3 MUDO l OMAHACO F OPPDGPR 5 QLNNEI C Utilit y Servic e Are a Contac t Phon e Numbe r Typ e 

### Day : 402934046 9 CO XCOMMUNICATIONS , HEID I CO X CXCATV 

### Alt : 402934046 9 INC COMMUNICATION S 

### Emerg : 402932975 7 Day : 877366834 4 LEVEL 3 LEVEL 3 N A 

### Alt : COMMUNICATIONS , LLC 

### Emerg : 877366834 4 Day : 402504782 3 METROPOLITAN MUDOl SAND Y MU D 

### Alt : UTILITIE S DISTRIC T 

### Emerg : 

### Day : 402444719 7 CIT Y O FOMAHA
- OMAHACO F RICH/TRAFFI C 

### Alt : 402444672 5 TRAFFICSEWE R 

### Emerg : 402444516 0

# o

nPDT^rDR^ OMAH APUBLI C POWERp , . , , ^ ^ .T^,., ^ 0PPDGPR 5 EL M LOCATIN G

QLNNEI C QWES TLOCALNETWOR K EL M LOCATIN G 

# o
Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3http://www.dhQa.ora^irthintemet/DHONNoticeCreation/MessageText.
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### • YOU RTICKE TNUMBE RI S 2772781 . Origina l Cal l Date : 6/16/1 1 Time : 8:4 4 am Op : ALFONSO18 7 9 0 Wor k t o Begi n Date : 6/20/1 1 Time : 9:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 112 6 Street : N20T H S T Twp : 15 NRng : 13 E Sect-Qtr : 15-NW-S 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 : ( 4 02)934-281 1 : PLEAS E INCLUD E AL L EASEMENTS . Compan y: COASTA L ENVIRONMENTA L SERVIC E Contac t Name : ALFONS O Phone : (402)934-283 7 Wor k Bein g Don e For : Coasta l Dept ho f Excavation : 4f t Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL S MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C 

### Utilit y Servic e Are a Contac t Phon e Numbe r 

### lyp e Day : 402934046 9 

### CO XCOMMUNICATIONS , CXCAT V HEID I Alt : 402934046 9 

### IN C Emerg : 402932975 7 Day : 877366834 4 

### LEVEL 3 LEVEL 3 COMMUNICATIONS , ^ ^ Alt : 

### Emerg : 877366834 4 Day : 402504782 3 METROPOLITANUTILITIE S MUDOl SAND YMUD Alt : DISTRIC T Emerg : 402504797 0 Day : 402444719 7 CIT Y OFOMAHA
- OMAHACO F RICH/TRAFFI C Alt : 402444672 5 TRAFFICSEWE R Emerg : 402444516 0 Day : 406728934 3 

### OMAHAPUBLI C POWE REL M 0PPDGPR 5 Alt : 406207149 4 

### DISTRIC TLOCATIN G

o f2 6/16/201 1 8:44 A Mhttp://www.dhQiu)rg'irthintemet/DHONNoticeCreation/MessageText.
. 

### Emerg : 888728934 3 QLNNEI C QWES TLOCALNETWOR K EL M LOCATIN G^'^ " Day : Alt : 406728934 3 406207149 4 4 Emerg : 888728934 3

2of 2 6/16/201 1 8:44 AM

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun d Su e Dat e Excavated : 7/8/201 1 Dat e USEP ASigne d Off : 7/26/201 1 Are a Sodden : 450 0 s a f t 

### 2532 3 

# iin i Exterio rPain t Omah a Lea d Sit e •Goo d Q Poo r Samplin g Address : ii2 6 N 2 0 S T Sit e Sketc h M Not pain t Lea d Sampl e Sanriple s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Fimt : FOf t n C\ S RYASCPXA-2532 3 F l 2H I pp m 

### D Date : ^-^^-O ^ RYBSCPXA-2532 3 F 2 Hfift pp m 

### D Time : ID-ff ) firf\ RYCSCPXA-2532 3 B l /AtJ ) co m 

### D Sample s Analyze d RYDSCPXA-2532 3 B 2 

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### D RDZOCPXA-2532 3 Bt ~ pp m 

### D XR F Unit : IOfl/.»2
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### D D Dat e (>02-0 ^ WPZ&CPXAr2532a - -p a ~ pp m 

### D D Tim e 

### D a n - Staff : Numbe ro fSample s = | ^ | | Q \ 

# _mw i Legend : F l = Fron t Left , F 2 = Fron t Rigtit , B 1 = Baci ( Left , B 2 = Bac k Rigti t D Z = Dri p Zone , G Z = Garden , P Z = Pla ; A H quadrant s ar

e a

s viewe d fro m th e street , faan g propeft y 

## ENTJfiKB U MA V > Q 'nn o pvoB ' ' t J «.vw v ^^ " B 2 = 57PPM@6 " riM T B1=172PPM@6 " ^^^ ^ f ^ ^

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# 1 

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# mmm m 1^ : I V -j f R«x->li M '.'reate d ft5-NovJ)8 

### Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are areplace dwit: hAre areplace dwit h Are a lef t bar e So dRock/Mulc h 

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

# /^Ili<4 v /U^y O ^ - ^ / / 

### 111
. J 

# Ililll l 2532 3 Exterio rPain t Nofl h Arro w 

### Omah a Lea d Sit e •Goo d 

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### 2^ / 

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### Fimi : FOf t % y ^ Date : 5-9^-0 9 Time : /P'.^g ) fl<V\ Sample s Analyze d ffDgOCrXA-2S323 BE
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# a D XR F Unit : lOfl/o l Book : 2* ^ i f^CZCCPX A2532 3 G Z ~ pp m 

### D D Date : ( g •0 1 -Q^ ^ WPZ5CPXA-2532 3 P 2 ~ pp m 

# n D Time : P m Numbe ro fSample s = | ^ | | Q j Staff : f^W Legend : F i = Fron t Left , F 2 = Fron t Right , 8 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla ; Al l quadrant s ar e a s viewe d fro m th e street , facin g property 

# ENTERE D MA V 2 9 200 9 

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### Omah a Lea d Sit e •Goo d 

### Sit e Sketc h n Poo r Samplin g Address : 112 6 N 2 0 S T 2 No t pain t Sampl e Numbe r RYASCPXA-2532 3 RYBSCPXA-2532 3 RYCSCPXA-2532 3 RYDSCPXA-2532 3 RDZOCPXA-2532 3 nOZOOPX A2532 3 RPZSePXA-2532 3 F l F 2 B l B 2 B S G Z P S Lea d Concentratio n Sampl e Collecte d LA B 

## JM L 

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­ pp m pp m pp m pp m 

# I D D D D pp m pp m pp m 

## D D D D D 

# a Numbe ro fSample s = | ^ | | Q Sample s Collecte d 

## Fimi : fdf \ n (\:S Date : ^-I'Jj-C M Time : lO'-'J ) fli^ Sample s Analyze d XR F Unit : \0(i(s2
. Book : Z M i

Date : ( o -O l -O ^ Time : P m Staff : M^U / Legend : F 1 = Fron t Lefl , F 2 • Fron t Right , B l = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla ; Al l quadrant s ar e a s viewe d fro m th e street , facin g property 

# ENTERE D 

# e ? MAV2 9 200 9 

## 57 3
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# y
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## 2532 3 Exterio rPain t Nort h Arrc w 

### Omah a Lea d Sit e •Goo d 

### Sit e Sketc h Q Poor Samplin g Address : 112 6 N 2 0 S T [ 2 No t paint Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d 

## Fimi : f m S> h J\ S RYASCPXA-2532 3 F l 

## 2H I pp m 

# n Date : ^-V-CH t RYBSCPXA-2532 3 F 2 

# j±5a
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## D Time : JP'- ^ f^ft \ RYCSCPXA-2532 3 B l ^eRl p Do m 

# a Sample s Analyze d RYDSCPXA-2532 3 B 2 

# I 5\

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# n RDZOCPXA-2532 3 BZ ­ ~ pp m XR F Unit : lOflj^g Z Book : 2 H i 

## D RCZOGPX A2532 3 G Z 

## D " * pp m Date : g » •Ol-O' ^ 

# n RP2SCPXA-2532 9 P S 

## D "•pp m Time : ? m 

# n D Staff : n$U r Numbe rofSample s • 

# 5 ] Legend : F l = Fron t Left , F2 • Fron t Right , B 1 = Back Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z • GanJen , P Z = Pla ; Al l quadrant s ar e a s viewe d fro m th e street , facin g property 

# ENTERE D 

# Q
. MAV2 9 200 9 ^57 3 

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COASTA l CkvUQluilxiJi l ct e V rI * « c 

### Conseri i fo rAcces s T o Froperi) ' RIGH TO F ENTRYTO PREMISE S 

### Granto r(th e propert yowner ) consents t o an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA) o rits 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 : U Q O ' Lir a ^ Daytim e Phone : , , ^^ ^

Addres s o fPropert y covere d b yttii s 

# \iaQ 9 N ' 2 ^ ^V- Asreement : 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 that contain s elevate d concentration s oflea d an d ma ypos 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 work i s bein g performe d unde rth e Omah a Lead Superfun d Site remediatio n program . Arepresentative o fCoasta 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 perfomned , th e Granto rwil l hav e a n opportunit yt o reviewan d approve th e planne d soi l removal , an d restoratio n wor k before i fbegins
. Once th e wor k i s finished , th e Granto rwil l b e aske d t o reviewth e work an d confir m tha t I t i s complet e an d meets wit h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receive writte n documentatio n fro m EP Athat th e propert y has 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 , its employees , contractor s an d subcontractor s th e righ t t o ente rth e property , at al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e ofperformin g th e work
. Thi s access 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 of2

# O O yy!' %
COA.STA L [hVIRONH fKTA L 

### * ' y C KO U rI KC 

### cRemov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; cRemov 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 necessary ' subsequen t t o a n initia l waterin g perio d b yEPA ; fAbid e b yhealt h an d safet yguidanc e provide d b yEPA ; « I fth 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
. e Allo wvideotapin g and/o rphotographin g o fth e property
. AGREEMEN TNO TT O INTERFERE Th e Granto ragree s no t t o interfer e o rtampe rwit h an yo fth e wor k activities , o rwit h an y o fth 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 fsai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o fth 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 t Coasta l Environmenta l Group , a t (402 ) 991-119 9

Q I gran t acces s t o m ypropertie s G I d o no t gran t access t o m ypropertie s

Signaturt^ Dat e Signature Dat e
Q I woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.

Pag e 2 o f2COASTA L
•NVI*OMMIMT* L C p

l O U P
. IHC
. 

## Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s to provid e amutual agreemen t a s to condition s o f th e property prio r to remediatio nactivities
. Thi s wil l als o serv e a s documentatio nfo r th e purpos e o f assurin g tha t restoratio n activitie s are complete dt o th e satisfactio no f th e property owner andth e Unite dState s Environmental Protectio nAgenc y (EPA) .

Propert y ID : ;;)53,;:;) ^ Propert y Address : |yg( ^ ^ [ g( ^ ^ 

### Owner : ^(^ ^ Qr^e>XS.(^\ ^ Phone : 4Q ^ )^c;^^ , ^eQ;: j O nth e attache ddiagram(s ) indicate area(s ) to excavate , surfac e structure s an dlandscapin g feature s an d acces s location(s ) t o b e usedby th e contractors . Indicate distances , depths , material types , etc . Photographicall y andVideographicall y document th e existin g condition s ofth e propert y andth e basement if necessary . Item s t o b e Remove d b yth e Owne rbefor e Star t o fRemediation : Th e removal , storage , disposal , and/o rretu m o fthes e item s i s th e Owner' s responsibility
.

Item s t o b e Remove d b yth e Contracto rDurin g Remediatio n an d No t Replace d

Pag e 1 of
.

# o o
Item s to Be Remove d ByContracto rDurin g Remediatio n an d Replace d Item : 

# 'Sr^ V ^ .-^rv l •• fil, fi^StF;:) Item : Item : Item :


## Landscap e Inventor y Ite m Quantit y Unit Condition/Type/Specie s Pre-existin g propert y area , Quadrant s tha t wil l be excavated , tha t IS covere dwit hgrass . Numbe rof tree s > 2 inc h Eac h trun k diamete r ^ Numbe r of tree s <= 2 mc h Eac h & trun k diamete r Numbe rof SpnnkJe r Zones , Contro l Valves , Eac h Timers , Heads , etc . 

# s? Attac hasketc h of th e sprinkle r layout
. Numbe r of an dsiz e of eac hgarden / flowe r be d Eac h area . Squar e Fee t Attac hasketc h of relativ e size s an dlocations
. ^ Agree dupo nvalu e of plan t material s no tto be replace d bv contractor . $ Not e thi s valu e wil l be & . use d to issu e aplan t vouche r to th e propert y owner . Easemen t Area , to be Eac h excavate d 

# f^^ ^

Pag e 2 of

# o o

COASTA L rMVlMONMINTA l cn o u rIN C
Additiona l Comment s / Instructions : Th e cit yofOmah a ordinance s ma yprohibi t yo u fro m usin g dir torgrave l area s on you rpropert y as driveway s orvehicl e parkin g areas . Th e Environmenta l Protectio n Agenc y(EPA ) ma y be removin g an d replacin g soi l underlyin g a grave l ordir t are a on you rpropert ytha t yo u ma y be usin g as a drivewa yorvehicl e parkin g area . Ifthi s is th e case , yo u shoul d understan d tha t thi s removin g an d replacin g ofsoi l doe s no t mea n tha t an yillega l drivewa yorparkin g are a on you r propert yis mad e legal
. To th e contrary , yo u ma ybe cite d byth e cit y ifyo u us e a grave l ordir t are a as a drivewa yorparkin g area , no t withstandin g an yremova l orreplacemen t ofsoi l byth e EPA
. Ifyo u hav e an yquestio n abou t legalit y ofa certai n drivewa yorparkin g area , yo u ma ycontac t th e cit y ofOmaha' s Plannin g Departmen tat (402 ) 444-5150
. leas e chec k thi s bo xifyo u understan d th e informatio n outline d above
. # 

# \^ a 00 9rc:^erVa %

Chec k th e bo x ifOwne rdoe s no t wan t CE G to documen t interio rfoundatio n wall s an d possibl e pre-existin g damage
. Bycheckin g thi s bo xCE G is no t responsibl e fo ran ydamag e don e to th e interio r ofhouse , includin g foundatio n crack s orfissures
. n 11 do no t agre e 

# MiimiS-M-i l Factor' Signature Date ' Date CoFitractor' s s Si g Pag e 3 of