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

# SAID# : 27)^I7 LDate : lo/lSJd Y Address : jX^ l S " / / S T Remediatio n Contractor : _Coasta l Environmenta l Group

_Year : 200 7 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f property (DVD ) Executiv e Summary 7 EPA-provide dpropert y sketc h WSigne dAcces s Agreemen t for subjec t property D Signe dAcces s Agreement(s ) fo r adjacen t propert y WRestoratio n Agreemen t D Settlemen t docviment s (i.e. , fo r damag e o r t o replac e plants , etc. ) M Confirmatio n dat a WPhotograph s • B ^ As-buil t sketc h \ ^ Satisfactory restoratio nsigne db y Propert y Owne r mProperty close-ou t chec k lis t signe db y EP A D Descriptio n o f area s no t meetin g RO D cleanu p criteri a D Utility clearance s D Property informatio nfro mDougla s County Assessor' s Offic e D D ,
n ' • • ­ ­ • 

# 4 ^
4031790 6 

# iiiil i Superfun d

# aO^IZ - '^^ ^ M St . Fina l Repor t Propert y Chec k Lis t (piease plac e wit heac hfile) Har dCop y Informatio n Property Chec k Lis t Site Workin g Drawin g Ma p EPA original s Ma p Dougla s County Assessor' s Ma p Property Contac t Sheet Agreemen t llj Acces s Agreemen t • t^Restoratio n Agreemen t

Miscellaneou s Document s DJFina l Ma p fromth e Fiel d 2 . Chang e Order s g ] XRFData 4 . Any email s o r P O correspondence s Propert y Completio n iT^Executiv e Summar y 2 . A S BUIL T 12 1 Property Completio n Agreemen t

4 . Any buyou t inf o o r reimbursemen t inf o 5 . Chec k o r mone y orde r copie s t ^ EP A Property Clos e Out For m • ^T^AttachedBegi n Vide o



## Electroni c Documentatio n Drawing s jT I EP A original [X J Workin g Drawin g t3 \A S Built.vs o

4 . ASBuilt.jp g Photo s VBegi n Photo s During/Excavatio n Photo s \/So dPhoto s y30-Da y So dPhoto s

Scanne dDocument s Fina l Document s vExecutiv e Summary

Video s "^gi n Vide o ^•^ y Movi e

## Propert yAcces s Checklis t Propert y ID : ^c ? t\\ 2 - B'WOR K STARTE D ON : 05/ j 7/ C<j / Propcrt y Address : \2.'2- \ %> \\ ^ V nWOR K COMPELTE D ON : / / Owner : MamCV j P\'rtr \^CC/\uSs ^ Renter : Address : c^- J 2,-1 ' pf e r^^ ^ VQ^CAJ - Phone : Fa\ : Cell/Pager : Additiona l Infor m ation : Phone : ^Ql, ^ >MSS - -2- 3 "2 ^ Fax : Cell/Pager : r i Notificatio n Lette r Sent : By : 0 Accc s Signed : 05A U lO l CCC.S. S Agreemen t By : iX^r^^ \ A \ y Restoratio nAgreemen t Signed : oS / II , /p H By : I I Top.soi l Samplin g (i f applicable ) By : I I Disposal Samplin g (if applicable ) Bv : I I Garde n Samplin g (if applicable ) 

### -e^nfeV^t-rtr r By : T' » ''^^^•-^ ^ 

## 0 1 M litv Clearanc e 

## Called : J2_/£2/iZ 7 

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## On:^/£L/_Q T ^y - QycX ^ Q ^ Video/Photo s (30-Day ) 

## On:J_iy7i/X n By : 

# djcjr x 0 ^ Propert y Completio n Agreemen t 

## Signed : 7 / f) iC J 

# ^y - e hf y ^ I I Fina l Repor t Issued : Bv : Ai r Monitorin g (a s applicable ) • Communit y Q Cre w On : / / By : Results : jj ICH Communit y Cl Cre w On : / / By : Results : n Communit y CU Cre w On : / / By : Results : Omah a Lea d Sit ec 1-^ 1 

# C^^ ' i M 

# i ^— ' ^ u c /u ^ / Tota l Qi^^i t Squar e Footag e t o b e Excavate d = 1672 PropertyClassification : 80 0 Totffl^P p Zon e Linea rFootag e t o b e Excavate d = 0 L I O t < y^ y 1 ^ . y.....M ^ 0 0 (i^w l ^. J C O ^ [>' V '^ 1 ^ ^ ^ 

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. '* . ^ — » O M • 14 . U v' 1 - 4 O+ i oout n n oi l "8 6 . A i t „ _i „ Legen d Nort h Arro w Omah a Lea d Sit e [5^:;^ ] Concret e Omaha , Nebraska \y/ \ ExcavatedAre a Propert yNumbe r Lk J R> S fcxisting Structur e • Fenc e Scal e 1 Inc h = 2 0 fee t o r1 gri d = 5 x5 ft OLS-2091 2 Propert yAddres s

122 1 S 1 1 S T

—— —

• Quadran t Boundar y y^ \ Pos t Excavatio n Concentration s (ppm ) P 1 P O DlQwAm o udi y T I^I H - s • • MHJ!.. 0 F 2 DZ Ea s sme nt ; — 

# o T r ee/S hru b 

# v^ B 1 Gar ( Jen _ Oth e r Descriptio n o f post excavatio n areas : F1 , fron t yar d left-han d quadrant ; F2 , fron t yard right-han d quadrant ; Bl , backyar d left-han d quadrant ; 92 , backyar d right-hand 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) .

## C k Consen t Fo rAcces s T o Propert y RIGH T O FENTR Y T O PRFMI.SF S 

### Granto r (th e propert y 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 andperfor mcertai n environmental respons e activitie s upo nth e followin g describe d premises :

Owner' s Name : 

### Daytim e Phone :



# Na^^C ^ An n f(\tLc n lAA'^ t 

## ^02- ' M<;< : ~ "2-7) 8 M Address : 

## I2_^ t ^ I V S f (^fyyak g N ^ Addresse s of Address : 

## l^-Z- ^ S 1 \ s ^ C^v^^aU ^ Nje ^ Propertie s covere db y Address : thi s Agreement : Address : Address : PURPOS EO FRFSPONS F

### AcTivrrii:. s Th e EP.A . i s requestin g acces s t o collec t soil sample s andremov e soil tha t contain s elevate dconcentration s o f arseni c and/o r lea dan dma y pos e ahealt hhazard . Th e soil will b e remove dandth e excavate darea(s ) will b e replace dwit hclea nmaterial s an d restore dThi s wor k

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

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

to b e performed , th e Granto r will hav e a nopportunity t o revie w andapprov e th e planne dsoil removal , andrestoratio n wor k

before i t begins . Onc e th e wor k

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

andconfir mtha t i

t i s complet e andmeet s wit hthe Grantor' s approval . Upon completion , th e Granto r will receiv e writte ndocumentatio n fro mEPA tha t th e propert y ha s beenremediated . ENVIRONMI^NTALRESPON.S EACTION 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 and wit hprio r notice , fo r the sol e purpos e o f performin g th e work . Thi s acces s shall remai n i n effect unti l th e wor k

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

«Property_ID » 

### Pag e 1 of 2

## £ %

•Remov e obstruction 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 o r th e Grantor' s tenant ma y wis h t o save ; •Wate r andmaintai n replacemen t vegetation , includin g fertilizer application , a s necessary subsequen t t o a ninitial waterin g perio dby EPA ; •Abid e by healt handsafet y guidanc e provide db y EPA ; •If th e property i s rented , assis t EP A i nobtainin g tenan t approval fo r acces s t o th e property to perfor mth e wor k

i f EPA i s unabl e t o obtai nsuchaccess ; and •Allo w videotapin g and/o r photograph y o f th e property includin g exterio r and interio r area s o f buildings . AORFEM}-:N T NO T T O IN

### rERFF:R F Th e Granto r agree s no t t o interfere or tampe r wit han y of th e activitie s or wor k

done , or th e equipmen t use dt o perfor mth e activities , or t o undertak e an y action s regardin g the us e o f sai dproperty whic hwoul dten dt o endange r th e healt hor welfare of th e Grantee s o

r th e environment , or to allo w other s t o us e th e propert y i nsuchamanner . Shoul dyou hav e an y question s abou t thi s program , pleas e contac t

H LI gran t acces s t o m y propertie s I I I d o no t gran t acces s t o m y propertie s 

# CP3h\''M-a77tj ^ ^AcU i JL ^ 

### Dat e Ignatur e Dat e ^rop€^rU j (^k) i . ^ y 

### I 1 1 wouldlik e t o b e presen t durin g an y samplin g that i s required . Pag e 2 o f 2 «Propert y ID :

# i ^ Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o pro\id e a mutua l agreemen t a s t o condition s o f propert yprio rt o remediatio n activities . Thi s wil l als o serv e a s decontaminatio n fo rth e purpos e o f assurin g tha t restoratio n activitie s ar e complete d t o th e satisfactio n o f tli e propert youne ran d th e Unite d State s Environmenta l Protectio n Agenc y(EPA) .

Propert yID : " X O < ^

\

"2 - Propert yAddress : UCL\ ) WO- . - V 1 1 5 ^ f - ri<v \ ;^Wa . 

### N/ ^ <^^I 0 ^ ^""" = K ) ;^rNC ^ ' a^r . M^^^°^ ^ Phone : L ^

^ j _ ^ -"MC^ - "^ S 5^ ^ O n th e attache d diagram(s ) indicat e area(s ) t o excavate d an d dept h o f excavation , locatio n o f ai l know n utilities , subsurfac e features , surfac e structure s an d landscapin g features , acces s locaiion(s ) t o b e use d b v contractor , an d th e directio n ofNonh . Indicat e distances , depths , materia l t}pes . etc . Indicat e digita l photo s bvreferencin g th e photo-lo g numbe rv^it h a n arro windicatin g directio n o f view . 

### item s T o B e Remove d B yOwne rBefor e Star t O f Remedisticr: : (Us e additiona l sheet s a s necessary ) Th e removal , storage , disposal , and/o rretur n o f thes a item s i s th e Owner' s rssponsibility . Item : 

### MorvC , Item : \ Item : \ Item : \ Item : \ Item : \ V Item : Item : Pag e 1 o f U> ^

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# M o Item : Item : Item : Item : Item : \ Item :

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Pag e 3 

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# v ( ^ Landscap e Inventor y (Us e additiona l sheet s a s necessary ) 

### Ite m

Pre-existin g propert yare a tha t i s covere d wit h grass .

Numbe ro f tree s > 2 inc h trun k diamete r

Ndiiibe ro f tree s • = 2 inc h trun k diamete r

Numbe ro f Sprinkle r Zones . Contro l Valves . Timers . Heads , etc . Attac h a sketc h o f th e sprinkle rIavout . Numbe ro f an d siz e o f eac h garden ' flowe rbe d area . Attac h a sketc h o f relativ e size s an d locations . 

### Quantit y 

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. Square feet

Eac h

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### Ite m Agree d upo n valu e o f plan t material s no t t o b e replace d b vcontractor . Not e thi s valu e v.\\ \ be use d t o issu e a plan t vouche rt o th e propert y owner . Agree d upo n lis t o f plan t material s tha t wil l b e replace d b ycontractor . B e ver yspecifi can d detailed . Includ e a sketc h o f were eac h plan t wil l b e place d b yth e contractor . .Agree d upo n area o f propert yt o be replace d wit h gras s sod . Includ e a sketc h o f th e area(s ) t o be replace d wit h gras s sod . Are a o f Cit vo rCount y propen yt o be landscape d pe rthei rrequirements . includ e a sketc h o f th e are a (s ) 

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# ^W~l Ov>nei ^ Signature Dat e Pag e 6 o f [ ^ •-tctor' s Signature Dat e; « I 

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## E_ J • Fenc e Propert yAddres s : 1lnc h = 2 0 feet o r1 gri d = 5 X 5 ft 122 1 S 1 1 S T ixV S ^ ^ ^ Quadran t Boundar y Pos t Excavatio n Concentration s (ppm )

- Stree t Boundar y F l B 2 PlavAre e ^ HydrO-oi^wL'Xlit . IT r 

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# l ^ i Y B l Gar cJen _ _ Oth e r Descriptio n o ( pos t excavatio n areas : Fl . fron t ya m left.han d quadrant : F2 . fran t yar d rigM.han d quadran t Bl , tiacltyar d left.^ian d quadran t B2 . tiackyar d right^iand quadran t OZ . ith p zon e (1- 3 foo t are a o f so n anxn d th e foundatio n d tti e tiouse) .PROPERT YCLEARANC E WORKSHE E Dat e Propert y ID 

# C)[t\() l ,\f)l - Propert y Projec t Omah a Lea d -- Fixe d Pric e Addres s 

# I77.(SI I 5T Measuremen t XR F ID 

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# 1

VS E iDEITICr^' L 5-:f ; . " XR F Technician' s Signitur e ^EEEE D 

# /Y\\,/r\Q ^

Confidentia l 5/2/0 7 Pac e 2 o f 2X 

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

### *> y COASTA L ENVHtONHENTA L CROUP . INC . 

# EXECUTIV ESUMMARY : T H 

# 20912—122 1 SOUT H 11^ " S T N o Issue s o r Concern s Issues/Concern s Detai l Explanation :

# As-Buil t Drawin g ^ COASTA L 

# Omah aLea dSuperfun dSit e

Tota l Quadran t Squar e Footag e t o b e Excavate d = 167 2 Propert yClassification : 80 0 Tota l Dri p Zon e Linea rFootag e t o b e Excavate d = 0 l i l 1 1 1 ! - • • i

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### - Sout h 1 1 Stre e ! ! ' ' ' ' t t i l l ! Legen d OLS#'2091 2 ' NorthArro w Omah a Lea d Sit e Omatia . Nebrask a • Dat ^ Exdavated : 6/6/0 7 i -^ ^ Propert yNumbe r Dat e USEFASIqhe d Off : 7/1P/Q 7 OLS-2091 2 istin g Structur e 

# c r Propert yAddres s J E> Scal e 1 Inc h = 2 0 feet o r1 gri d = 5 X5 ft b<V J 122 1 S 1 1 S T 5 ^ , ^,,,.0,.^., . .^.........OK.,, ^

——_ Quadran t Boundar y Pos t Excavatio n Concentration s (ppm )

- Stree t Boundar y F l B 2 PlavAre a /' \ 

# (9^ 1 T H<3 L F 2 D Z Easeme n T r ee b nnj D -fV*- ^ B l Gar c )en _ Ottie r1 y •* « Oescrvtto n o f pos l eircavanc n area s ^1 . Iron t yar d lefttian d quadram . f 2 . tror t yard nght-nar^d quadrant . Bl . backyar d len-han d quadran t B2 . backyar d ngh t han d quadrant . DZ . dr^ > ron e ( 1 - 3 foo t are a a t ^o * aroun d ttn e loundafjo n o l tli e houne ) 

### Legen d ^



### Are ano t Excavate d Dripzon e Excavate d Quadrant s Excavate d Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p In c

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n o f remedial aciivilie s performe do nm y properly . My signatur e wil l designat e that I a msatisfie dwit hth e restoratio n o f m y property , andthat n o item s are i n questions , now , o r a

t an y tim e i n th e future , excep t thos e item s liste dbelow , i f any . Propert y ID : 

# PC3[79 _ Propert y Address : 

# 1P9TY7T[W3F . Owner : 

# Nanc a7PtPiu/r 3 Phone : 

### P5'D'^ - 

## 9-3't7> ^ Restoratio n Item s i n Question :

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

p^ I iigrc c rcstoi-atio ni s completed , excep t a s notic d I I d o no t agre e restoratio n i s complete d 

### VyMyi' ^ Da^ c ' Contractor ^ Signatur e I

# aEPA• EP A Propert y Clos e Ou t For m Propert y# : 

## PCPtig - Propert yAddress : l^-^- l ^/(y3P - Date/Time : Owner' s Name : KlCinCL j /U{ieiUjN 7 Quad s Excavated : Contracto rGrou p y 

### Excavatio n General Ye s N o I .If necessary , wer e th e correct quadrant(s ) excavatedandrestored ? y 2 .If necessary , wer e th e correct areas of dri p zon e excavatedan drestored ? 

### y Gradin g So dan dVecetatio n Ye s N o I .

Doe s the grading aroundthe perimete r o

f the hous e i nexcavatedarea s ge r lerall y slope awa y t ^ 

### fromthe house ? 2 .Ha s sodbee n laidi n all area s tha t wer e excavated ? y 3 .

Doe s the so dappea r t o be generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 ^ 

### da

y tim e period) 4 .

Ar e sodde darea s generally fir man devenl y graded ? ly 

### 5 .Ar e th e joint s between the sodstrip s generall y tight ? (Onl y evaluat e if inspecteda t a3 0 da y L ^ 

### tim e period ) 6 .Was the propert y gradedsuc htha t wate r wil l no t pool o n the property ? y 

### 7 .

Wa s damag e t o landscaping or plan t material s avoided ? 

### y Gates , Fence s andRetainini ; Wall s Ye s N o 1 .

D o gate s ope n an dclos e freely? (I f applicable ) i^^ > 

### 2 .

Wer e al l gate s o r fence s taken dow nduring restorationactivitie s reinstalled ? (If applicable) 

### y 3 .

Wa s damag e t o gate s o r fence s avoided ? (If applicable ) 

### y 4 .Was damag e t o retaining wall s avoided ? (If applicable ) 

# y ^ Foundation , Sidin K

an dGutter s Yes N o 1 .Wa s damag e t o th e siding o r tri mavoided ? AIA ' 

### 2 .Wa s damag e to the foundation avoided ? 

### fi" ­ 3 .

Was damag e to window s avoided ? > 

### 4 .Wa s damag e t o window s o r doo r screen s avoided ? 

## <0 ^ 5 .Was damag e to downspouts o r downspou t extension s avoided ? M> r Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Wa s damag e to drivewa y surface s avoided ? y 

### 2 . Wa s damag e to walkwa y surface s avoided ? y

## Owner s comments :

Inspectio n notes :

Remova l andrestoration activate s complet e including th e 30-da y so dwarranty : EP A Representaliv€^^^^.^^^;^^^e^^,h74:2 ^ Date : 7//6'/ ^ 7