TRANSMITTA L of OMAH A LEAD SITE 

SOIL REMEDIATIO N FILE FOLDER 

SAID#: 2Jl^(fi Date: J^Jn/oe 

Address: /O/ ^ S 2J^ S i 

Remediation Contractor: Coastal Environmental Group_ Year: 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Video of property (DVD) 

M Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

DD Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

D Settlement documents (i.e., for damage or to replace plants, etc.) 

Confirmation data 

^ Photographs ' 

As-built sketch 

tf Satisfactory restoration signed by Property Owner 

Sf Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

D Utility clearances 

D Property information from Douglas Coimty Assessor's Office 

D 

D , 

D 

4iM

Date 

40317695 

Superfund 
1

2

^

4

'

2

2. 

Final Report Property Check List (piease place with each file) cT-lCff(jp7 

Hard Copy information /A ,/ / J ^ JV 

1. Property Check List /^/ ^ ^ ^ 

2. Site Working Drawing Map 

3. EPA originals Map 

4. Douglas County Assessor's Map 

5. Property Contact Sheet 

Agreement 

1. Access Agreement 

2. Restoration Agreement 

Miscellaneous Documents 

1. Final Map from the Field 

2. Change Orders 

3. XRF Data 

4. Any emails or PO correspondences 

Property Completion 

1. Executive Summary 

2. AS BUILT 

3. Property Completion Agreement 

4. Any buyout info or reimbursement into 

5. Check or money order copies 

6. EPA Property Close Out Fonn 

7. Attached Begin Video 

Electronic Documentation 

Drawings 

1. EPA original 

2. Working Drawing 

3. AS Built.vso 

4. AS Built.jpg 

Photos 

 Begin Photos 

 During/Excavation Photos 

 Sod Photos 

 30-Day Sod Photos 

, 

Scanned Documents I 

 Final Documents i 

 Executive Summary 

Videos 

Begin Video 

My Movie 
% 

Property Access Checklist 

Pn>pcrtylD:J^j;^<^_ ^ 

D WORK STARTED ON: / / 

Propert D WORKCOMPELTED ON: / /_ y Acl(l.ess:-(^ 14 . <$, ^ (^ <;!:)-. 

•Address: 

10(4- S ,3^ S-tPhone: C,^ ^ - i^^ ^ 

l-ax: 

Cell/Paaer: bio-is7e^( 

1 1 Notifieation Letter 

^ Aeee.s.s A<»reenient 

F^ Restoration Agreement 

1 1 Top.soil Sani|)lin<; (if applieahle) 

1 1 Disposal Samplinji (if applical)le) 

r~l Gaiden Sainplin<> (if applieahle) 

^ Utility Clearanee 

j n Video/Photo.s (Before) 

j n Video/Photos (Durinj;) 

j n Video/Piiotos (Aftei-) 

D Video/Photos (3(I-Day) 

Cl Pro|)ei1.v Completion Agreement 

O '''""id Report 

Ail- IVIonitoring (as applieahle) 

\7\ ronuminity CH Crew On: 

Results: 

CH Community \7\ Crew On: 

Results: 

1 [H Community Q Crew On: 

Results: 

Renter: 

Plione: 

Tax: 

Cell/Pajjer: 

Additional Information: 

Sent: / / Bv: 

Signed: lO /5^ / 67 Bv: drvr;<; 

Signed: U-)/^<^/07 Bv: CKr^^ „. 1 1 By: 

1 1 By: 

1 1 By: 

Called By: : ij_/2_/0:r 

On: / / By: 

On: / / By: 

On: / / By: 

On: / / By: 

Signed: / / Bv: 

Issued: / / B,; - -

i 

/ / 1

1 

/ / By: . 1 

/ / By: 

Omaha Lead Site 
tl/' ^ '%-,.'^^ 

Total Quadf^Aquare Footage to be Excavated = 3102 

Property Classificatio .ificationn : 800/CHILD ^ U J [b^^|P^ ^ Total Drip^J I Linear Footage to be Excavated = 146 

Description of post excavation areas: Fl, front yard left-hand quadrant; F2, front yard right-hand quadrant; Bl. backyard left-hand quadrant; B2. backyard nght-hand quadrant; 

D2, drip zone {1-3 foot area of soil around the foundation of the house). 
Name: Uc^o.J Av\Jsi/^^,t-> Omaha Lead Site Date: /0' 5 ^' ^ North Arrow 

Address: fO/V S ZCP"^ <.i . Site Sketch Time: f : <; s' 

—_J:2 > Phone: 

Team \^l/»/ / i-^^^c^ LMC- 7 BVID # ^/(^t;:,,^ XRF Code 2^1 C^G<^ 

Sample Number 

Lead Concentration Confirmation Sample 

ppm -f'Yes a No ra;;^ 

- i ^ -f2-Yes n No B ^ PVcr^^ pXA - -gltfe^g^ ^ g < ppm 

ppm 6-) Yes n No Q; ; ^^r 

ppm gZYes n No ^ 

AAlQa 

ppm pZYes I ^ No n 

ppm Yes • No CD 

ppm Yes • No • Lab RDZSCPU-21666 

Result ,CH« 

4510ppm 

S.Z6^ S^-

Omaha Lead Site 

46130 
Douglas County Account Info^atio Q^^ t n Page 1 of2 

Dougla s County , Nebrask a Propert y Recor d - R171425000 0 

Print Report Information is valid as of 2007-10-10 View on Map Values not finalized until after Board of Equalization Treasurer's Tax Report 

Owne r 

ANDERSON DAVID E 

ETAL 

4805 N 107 ST 

OMAHA NE 68154-0000 

Propert y Informatio n 

Key Number: 1425 0000 17 

Account Type: Multiple Res 

Parcel Number: 1714250000 

Parcel Address: 1014 S 26 ST 

OMAHA NE 68105-0000 

Legal Description: MARSHS ADD LOT 4 BLOCK 9 1/2 VAC ALLEY ADJ & LOT 4 BLK 9 50 X 132.5 

Valu e Informatio n 

Land Improvement Total 

2007 

2006 

2005 

2004 

2003 

2002 

$13,200.00 

$13,200.00 

$13,200.00 

$13,200.00 

$13,200.00 

$0.00 

$72,400.00 

$65,000.00 

$65,000.00 

$65,000.00 

$65,000.00 

$0.00 

$85,600.00 

$78,200.00 

$78,200.00 

$78,200.00 

$78,200.00 

$0.00 

Sales Informatio n 

Sales Date: 2004-04-16 

Deed Type: QC Book: 2004 Page: 053839 

Price: $0.00 

Grantor: MARGE A ANDERSON 

Grantee: DAVID E ANDERSON 

Valid/Invalid: Invalid 

Exclusion Reason: Family Sale 

Lan d Informatio n 

Acres SF FF Units Depth Width Vacant 

0.15 6600.0 50.0 1.0 132.0 50.0 No 

Improvemen t

Building 1 

1

 Informatio n 

1 1 

http://douglasne.mapping-online.com/DouglasCoN e/static/accountinfo.jsp?accountno=Rl... 10/25/2007 
Douglas County Account Info^^tio a||^ n Page 2 of 2 t 

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CLICK TO ENLARGE IMAGE 

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CLICK TO ENLARGE IMAGE 

Square Footage: 1639.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: End Condition: Fair 

Owner Occupied: No Condo Square Footage: 0.0 

Built As: 2 Story Rooms: 7.0 

HVAC: Central Air to Air Units: 3.0 

Exterior: Frame Siding Baths: 2.0 

Interior: Drywall Bedrooms: 3.0 

Roof Cover: Composition Shingle Stories: 2.0 

Roof Type: Gable Foundation: Block 

Floorcover: Allowance Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1920 1997 0% 1920 87 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 818.0 

Basement Finished 400.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 2.0 

Porch End Screen 112.0 

Porch Slab Roof Ceil 54.0 

Porch Slab Roof Ceil 112.0 

Porch Slab w/Steps 63.0 

Porch Wood Deck 54.0 

User New windows 1.0 

http://douglasne.mapping-online.com/DouglasCoN e/static/accountinfo.jsp?accountno=Rl... 10/25/2007 
To: ^^-^VW 

Fax number: ^'y^-''^^/ ^ 

Date: /^y-z-y/o 7 Coastal Environmental Group, Inc. 

Regarding: /6/ V S ^<^S T 

/^^de^^e^-r&^Sy ^^ ^ f^^ n^^/^ T^ ^ ^ 

f^K -^ 0/^), sz-z -^067 'P^ ^ lof /C 
* * X X X X X X X X « * « X X 
 COMM. J0URN3©******««**********x DAT E OCT-27^k7 ***** TIME 07:51 ******** 


MODE = MEMORY TRANSMISSION 
 START=OCT-27 07:49 END=OCT-27 07:51 


FILE No.=065 


STN COMM. KEY NAME 
 STATION NAME/EMAIL ADDRESS/TELEPHONE NO. PAGES DURATION 


No. 


001 OK s 
 4025533014 010/010 00:01:21 


-ENVIRONMENTAL RESTORATION­

***** DP-3530 *********x*xxx*xxxxxxx 
 ***** - 712 322 4061- ********* 


Fax number: ^ 5-^ , 'Z^/cA 

Date: /aV-z-^/o 7 Coastol Environmental &roup. Inc. 

Regarding: /^/ 7 5 ^^S? " 

7^^4eeme7-^-r&^Sy 7-^t> /^x s^c/^L TC ^i: -

Al Kl)i^ 

[fyaz) S67- -ZtA^Cr 

T ^ t ?^ (-jiT) 32-Z -^06 / ApM^ lofjC 
1707N.42'^^ST. BAY17 

OMAHA, NE. 68111 DAVID'S ELECTRIC, 

OFFICE INC. 402-553-1565 

FAX 402-553-3014 

e/\iiihNn.A>ii<A^''7^ (\AI7 ) TO 

Date: 10-2.9'07 

R*i 

aUi^en t CiTorl Revf«w n Please Coinment D Please Reply D Please Recycle 

• Comments: 

P/a<s^ CA// 7^ ^ S?.^^ 

r.io ^''^^1 

10 3DVd oidiD3n3 saiAva PT0££9960f r£:£I /.006/66/0T 
OCT-27-2007 07:51 .jaiVIRONMEaJTA ^ra i L RESTORAJJOII 712 322 4061 P . 10 

CO * BTAI . 

Mditionii ConviMnts / InitoueSoiw: 

O ChMk the box If Owner does not want CEG to document interior foundation walls and possMe 

pfa-exieting damage. By cheddng Ihis tx>x CEG is not responsible for any damage done to the 

interior of house, including foundation cracks or fiseur^s. 

Qldano t ^EC C 

Data / ' Con^actor'a Slnlitiir? Daie ' 

Paoe fl of Cff 

TOTAL P.10 

f0 3DVci oiaio3i3 saiAva vi^zz^^z^v vz'-z\ z.006/66/01 
OCT-27-2007 07:50 IRONMEHTAL RESTORATIOK 712 322 40B1 P.VV 

*\ , 

'# ^ 

COAfTa i 

Consent For Access To Property 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consents to and authorizes the United States 

Environniental Protection Agency (EPA) or its authorized representatives, collectively 

the Grantee, to enter and perform certain environmental response activities upon the 

following described premiees'. 

Owner'e Nam*: Daytime Phone: "A 

Address of Property I0\<\-^ ^2^ ^ 

covered by this 

Agreement: 

PURPOSE OF RESPONSE ACTivmes 

The EPA is requesting access to collect soil samples and remove soil that contains 

elevated concentrations of lead and may pose a health hazard. The area(s) win be 

excavated to remove contaminated soil. The removed contaminated soil will t>e 

replaced with clean materials and the area will be restored lo its original condition. Ihis 

work is being performed under the Omaha Lead Superfund SKe remediatwn program. 

A representative of Coastal Environmental Group, contracted by USEPA. will contact 

the Grantor in-person to discuss the work to be performed, the Grantor will have an 

opportunity to review and approve the planned soil removal, and restoration work l>efore 

It begins. Once the work is finished, the Grantor will be asked to review the work and 

confirm that it Is complete and meets with the Grantor's approval. Upon completion, the 

Grantor will receive written documentation from EPA that the property has beer^ 

remediated. 

ENVIRONMENTAL RESPONSE ACTIONS 

By signing this Access Agreement, the Grantor is granting the EPA, its employees, 

ccT^tractors 3r=d-subcontreeters-thc right te en^er the property, at-aW- reasonable flrros 

and with prior notice, for the sole purpose of performing the work. This access shaH 

remain in effect until the wod< has been satisfactorily completed. The Grantor also 

agrees to: 

Page 1 of z 


£0 39Vd Diai03i3 saiAva fI0££SS60 f f£:£ I /.006/66/0T 
OCT-27-2007 07:50 
 € IROMMHiTAL RESTORATION 712 3iiZ 4Ubl f.U* " 

9 

# 

:oasTA ; "•*". oi^'* " 

• Remove obstructions including boats, trailers, vehicles, playscape items, wood 

piles, dog houses, etc; 

• Remove Itower bulbs or plants that the Grantor or the Grantor's tenant may wish 

to save; 

• Water and maintain replacement vegetation, including fertilizer application, as 

necessary subsequent to an initial watering period by EPA; 

• Abide by health and safety guidance provided by EPA: 

• If the property is rented, assist EPA in obtaining tenant approval for access to the 

property to perform the work. 

• Allow videotaping and/or photographing of the property, 

AGREEME^^• NOT To iNIERFERg 

T.he Grantor agrees not lo interfere or :arrpdr MVT) ar.y cf :he AcrK activities, or with any 

cf the work done, or with ihe equipment used z-^ h's property. 3r to jr>dertake ary 

actions regarding the -se cf said property vx'-.ich v.c^'.d tend t i er.car.gsr :l".e nealth O' 

.-.elfa^e cf :he 3-ar.t*e= : ' t'-s r'i-D'.-.e.-: z: A. »"-•:, yjir.erri •;: ,se T'-S T"cerr; :.-. 

3.:r a nar-e-. 

:s£se ::r.'.= ;- -cas:£. r-.,-- 'c—sf 2.'.-. •' 5t "i" ^ 'r'54-is^-"~r 

v', rsrt «,:;cess rr- .v.. z.'cee-:fe5 

v."S.'. itct s i:-=p.'t-'..« 

^:;5:-^/()'Zf07 

Signature 

Qatt 

_ ! <M0 jl d like to b* present d;:rirg sr\y sarrfp'ir.g that is r e-qui red. 

-eoe 2 cf ? 

60 39Vd DiaiD3n3 saiAva 
 t'T0££Sg60P f£:£T Z00c/6Z:/0T 
CONTACT FORM 

Property ID # 2/^(^(^ 

Property 

Address: 77)7^^ ^ 2{^Sr 

Initial Contact: Date: A^/zA^ Time: /.J5 ^ Action: /^rrT-l^i^ieyH-F^//^^^ 

Second Contact: Date:/<y/4f Time: /"p^^^ Action: <^:^i^<y//Vz /'^<!!:<^ *~^>^ 

Final Contact: Date: Time: Action: 

Final Action: Transmit to EPA D Other Action: D 

Comment: 

Owner 7B06 /tApoysrComment (s): 

Site 

Coordinator 

Comment (s): 
X 

fAOL\ Omaha Lead Site—Fixed Price EP-R7-07-05 

g ^^^y ^ I Coastal Environmental Group Inc. 

r. . ^ www.coastalhazmat.com 

%PROi*^ COASTA L ENVIItONHENTtl 

C K O u P , IN C 

EXECUTIVE SUMMARY: 

21666—1014 S 26 ST 

No Issues or Concerns Issues/Concerns 

Detail Explanation: 
As-Built Drawing 

COASTA L Wn aha Lead Superfund Site 

Propeity CBBsimdMn: aoocuLD 

B1 leave concrete borders 

in place. Railroad tie wall 

ail cracked be careful 

other side has been fix 

already. Railroad ties in 

place F1 

L«gend QLS* : 21666 

, Date"^Ekcavated: 11/9/07 

tJate USiF*A Signed Off: 12/3/07 

North Arrow 

Scate •—•—» Fence 11nai-21}t6«tarigru-sx5t 

K<:| Pemianefit l.jTKlGca|]tig 

Quadrant Boundaiy 

Street Boundary Ft . II,V<K:CPI'..T:<7. nc FZ (^< Trtei'siTi* B1 

OZ. <*^ BM * <i-3 IMC «|M Dt I M anuBd «»IBuuMU i 4t rw nouM} 

Legen d 

Area not Excavated AA^ Dripzone Excavated

Ibital OuadranI Square Footage to be Excavated - 3iaz •Rjia Dflp Zone Unear Footage to oe ExcaratM -146 

Omah a Lea d Site 

C3rnan^ selxa&u 

Property N«nber 

OLS- 21 see 

Property Address 

1014 5 26 ST 

Post Excavation Concentrations <ppm) 

B2 PlayArea 

DZ Easeinent 

Garden oiner 

l?Q<?^ Quadrants Excavated 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
smL EPA 

EPA Property Close Out Form 

Property #: 3 \ /^ (n L Property Address: \i^\-\ S ^ ^ ^ -

Date/Time: \i l:i,^ Owner's Name: Da\j» d A^c(-f Tso/"^ 

Quad Contractor Group Csi^ OL^ACK ) s Excavated: 

Excavation General Yes

I. If necessary, were the correct quadrant(s) excavated and restored? 

2. If necessary, were the correct areas of drip zone excavated and restored? 

Grading Sod and Vegetation 

Yes

1. Docs the grading around the perimeter ofthe house in excavated areas generally slope away 

from the house? 

2. Has sod been laid in all areas that were excavated? 

3. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 

day time period) 

4, Are sodded areas generally firm and evenly graded? 

5. Are the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day 

time period) 

y 6.

 Was the property graded such that water will not pool on the property' 

7. Was damage to landscaping or plant materials avoided? 

Gates, Fences and Retaining Walls Yes 

1. Do gates open and close freely? (Ifapplicable) fOA 

2. Were all gates or fences taken down during restoration activities reinstalled? (If applicable) 1^^ 

3. Was damage to gates or fences avoided? (Ifapplicable) hik 

4. Was damage to retaining walls avoided? (Ifapplicable) y 

Foundation, Siding and Gutters 

Yes 

1. Was damage to the siding or trim avoided? y 

2. Was damage to the foundation avoided? y 

3. Was damage to windows avoided? y 

4. Was damage to windows or door screens avoided? 

y 

5. Was damage to downspouts or downspout extensions avoided? 

l y 

Sidewalks and Driveways (Concrete) Yes

I. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

 No 

 No 

No 

No 

 No 
Inspection notes: 

Removal and restoration activates complete including the 30-day sod warranty: 

EPA Representanv&^^^^^^,i^vj;^^^b-WZ^ Date: /7ys/c 7 
Property Completion Agreement 

This agreement documenls the completion of remedial activities performed on my property. My signature 

will designate that I am satisfied with the restoration of my property, and that no items are in questions, 

now, or at any time in the future, except those items listed below, if any. 

Property ID: ^ ^ ( ^ ( ^ ^ 

Property Address: I ci, I <dl., <:: o f 

_ ^ 

Phone: JA^A-) ^B^ - I ^(. ^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

gree restoration is completed, except as noted 

 I I do not agree restoration is QOinpleted 

//'30'O7 \y7cAf/<W^-^ £ fim; ^ > 

Owner's Signature Date Contractor's Signature Date 

I
4 1 * 

(• ^ PROPERTY 

Date Property ID lhc)9-o-j jaki ^ 

Property Project Omaha Lead -~ Fixed Price Address M <;. 2^ sr 

Measurement XRF ID 0107 51 

Count/Time 

Field Shots 

Shot # Reading Sample Area Shot * Reading Sample Area 

Bl (,9 BA~ e 

93 2i/8 bZ [I' H 

ILH 6>b f^l 4'(* 

1751 (.3 F7 V-{« 

»3C l i fii tl-ft 

Sample Area tA-e 

I n Situ Composite Composite Analytical 

Aliquot Composite Readings Lab Analytical 

Readinq Average (Dried & Spilt Sent Number Results 1 (Baq) Sieved) ? 

2 ^V 3 l i 

(Bag) 

4 68 7? 

XRF Corrected Value - > 

5 (use calibration chart or add 

20% to value) 11 

Sample Area D l lz-i4 Pass/Fai l ? 

In Situ Composite Composite Analytical 

Aliquot Composite Readings Lab Analytical 

Readinq Average (Dried & Spilt Sent (Bag) Number Results 1 (Baq) Sieved) 7 

2 23^ 

3 l ^ T 

Z53 4 2,48 

XRF Corrected Value - > 

5 (use calibration chart or add 

31U 20% to value) 

Sample Area Fl M-t, Pass/Fai l ? 

In Situ Composite Composite Analytical 

Aliquot Composite Readings Lab Analytical Readinq Average (Dried & Spilt Sent (Bag) Number Results 1 08 (Baq) Sieved) 7 

2 IH 9/ 3 

4 

<5- //V Jd toz. 6{, XRF Corrected Value --> 

S lOlo (use calibration chart or add 

20% to value) /13 

Sample Area F i ^-y Pass/Fai l ? 

I n Situ Composite Composite Analytical 

Aliquot Composite Readings Lab Analytical Readinq Average (Dried & Spilt Sent (Bag) Number Results 1 («8 (Baq) Sieved) 7 

2 tz. ft? 3 <?1 I S 4 ni l ' \ &?\ 

XRF Corrected Value --> 

5 U (use calibration chart or add 

20% to value) 

"fJ 

Sample Area P.\ U-fi Pass/Fail ? 

Aliquo I n Situ Composite Composite Analytical t Readin Composite Readings Lab Analytical q Average (Dried & Spilt Sent 1 (Bag) Number Results 10 (Baq) Sieved) 7 

2 

L'i 

3 <t>H n

U i*/ 4 (,0 

XRF CorrecteWd Value - > S 7(. (use calibration chart or add 

20% to value) w 

{l\ i AttOIIIONAl SHtff i If 

XRF NFFtn I) Technician's Siq -t"- A^T^^TT^A^iT^ .-"^r^.^ 
I t / 

Tota^Mhrant Square Footage to be Excavated = 3102 

Property Classification: 800/CH UJik^f^i/L 'rTotSfli. M p Zone Linear Footage to be Excavated = 146 

?>vob: 

Desaiplion of post excavation areas: Fl, front yard left-hand quadrant; F2, front yard right-fiand quadrant; Bl, backyard left-hand quadrant; B2, backyard right-hand quadrant: 

DZ, drip zone (1-3 foot area of soil around the foundation of the house). ••'-•.?S*­
ll -w^l, 

RESTORATION CHANGE ORDER 

OMAHA LEAD 

Property ID # ZlC^^ ^ 

Property Address IQH 5 ^C^ ^ 

Owner Name 7^'J( ^ ANJ"^^^ ^ 

Date tlj^/ol 

Comments 

ort^ /-szPQsr -rneAE t.QOT3 . LBAIIF^ ^^ '^elj^Mj 

Owner Signature 

Contractor Signature C^T^ i 
i.^"*'^^* ' CCOASTA O A S T iL I ENVIRONMENTA L 

C B 0 U P . IN C 

Consent For Acces s To Property 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consents to and authorizes the United States 

Environmental Protection Agency (EPA) or its authorized representatives, collectively 

the Grantee, to enter and perform certain environmental response activities upon the 

following described premises: 

Owner'sName: J^-^ v i " Daytime Phone: 

Address of Property 

covered by this 

Agreement: 

PURPOSE OF RESPONSE ACTIVITIES 

The EPA is requesting access to collect soil samples and remove soil that contains 

elevated concentrations of lead and may pose a health hazard. The area(s) will be 

excavated to remove contaminated soil. The removed contaminated soil will be 

replaced with clean materials and the area will be restored to its original condition. This 

work is being performed under the Omaha Lead Superfund Site remediation program. 

A representative of Coastal Environmental Group, contracted by USEPA, will contact 

the Grantor in-person to discuss the work to be performed, the Grantor will have an 

opportunity to review and approve the planned soil removal, and restoration work before 

it begins. Once the work is finished, the Grantor will be asked to review the work and 

confirm that it is complete and meets with the Grantor's approval. Upon completion, the 

Grantor will receive written documentation from EPA that the property has been 

remediated. 

ENVIRONMENTAL RESPONSE ACTIONS 

By signing this Access Agreement, the Grantor is granting the EPA, its employees, 

contractors and subcontractors the right to enter the property, at a!! reasonable times 

and with prior notice, for the sole purpose of performing the work. This access shall 

remain in effect until the work has been satisfactorily completed. The Grantor also 

agrees to: 

Page 1 of 2 
•t - ^'*r m 

COASTA L 

• Remove obstructions including boats, trailers, vehicles, playscape items, wood 

piles, dog houses, etc; 

• Remove flower bulbs or plants that the Grantor or the Grantor's tenant may wish 

to save; 

• Water and maintain replacement vegetation, including fertilizer application, as 

necessary subsequent to an initial watering period by EPA; 

• Abide by health and safety guidance provided by EPA; 

• If the property is rented, assist EPA in obtaining tenant approval for access to the 

property to perform the work. 

• Allow videotaping and/or photographing ofthe property. 

AGREEMENT NOT TO INTERFERE 

The Grantor agrees not to interfere or tamper with any ofthe work activities, or with any 

of the work done, or with the equipment used on his property, or to undertake any 

actions regarding the use of said property which Vi/ould tend to endanger the health or 

/v'elfare of the Grantees or the environment^ or tc allow others tc use the property ;n 

such a manner. 

Should you have any questions about this program, oiease contact Coastal 

Environmental Group, at (877) 234-5270. 

grant access to my properties ; 1 do not grant access to my properties 

/ % nature Date Sienature

 Date 

n I would like to be present during any sampling that is required. 

Paae2 cf2 
COASTA L ENV IRON MV NTAL C M O U r . INC . 

Restoration Agreement 

The purpose of this agreement is to provide a mutual agreement as to conditions of the property prior to 

remediation activities. This will also serve as documentation for the purpose of assuring that restoration 

activities are completed to the satisfaction of the property owner and the United States Environmental 

Protection Agency (EPA). 

Property ID: Z/&U^ 

Property Address: /(^7C 7 ^ ^(^^T " 

Owner: P^^/^//AU/:^t;^^A7 ~ 

Phone: ^^^ ' /K^- ^ ^/f) ' ^l-^ l 

On the attached diagram(s) indicate area(s) to excavated and depth of excavation, location of all known utilities, 

subsurface features, surface structures and landscaping features, access location(s) to \y& used by contractor, and 

the direction of North, hidicate distances, depths, material types, etc. Indicate digital photos by referencing the 

photo-log numt)er with an arrow indicating direction of view. 

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

The removal, storage, disposal, and/or retum of these items is the Owner's responsibility. 

Item: '^;>^/?77/^7/fyiy7^ tP^rA^e-z^Ty ^-^/V^ffV^^ 7T^^AAy4^r S 

Item: 

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Page 1 of / ^ 
COASTA L 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

A(-^^ 5A)i/f//P/^AJT^^ /epr - 3e^7777>, Item: 

Item: 

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Page 2 of <C 
COASTA L INVIROMHKNTA L 

CROUP , INC . 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

Item: 

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Item: 

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Page 3 of < ^ 
COASTA L INVIROMMINTA L CROUP . INC . 

Landscape Inventory 

(Use additional sheets as necessary) 

Item 

1 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch 

1 trunk diameter 

Number of trees <= 2 inch 

trunk diameter 

Numl)er of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Attach a sketch of the 

sprinkler layout. 

Number of and size of 

each garden/ flower bed 

area. 

Attach a sketch of relative 

sizes and locations. 

Quantity 

?2y^ 

3 

A/l 

^ 

( ^ 

Unit 

Square feet 

Condition/Type/Species 

1 

Each 

Each 

Each 

Each 

Square Feet 

1 

Page 4 of 6P 
C O A S T A L 

Item Quantity 1 Unit Condition/Type/Species 

Agreed upon value of 

plant materials not to be 

replaced by contractor. 

Note

used

 this value will be 

 to issue a plant (7 $ 

voucher to the property 

owner. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketch of were 

0 Each 

each plant will be placed 

by the contractor. 

Agreed upon area of 

property to be

with grass sod. 

 replaced '^Z'/B 

Include a sketch of the 

SF 1 

area(s) to be replaced with 

grass sod. 

•rSBe 

Area of City or County 

property to be landscaped 

per their requirements. ;SF' 

[ 

Include a sketch of the 

area (s) 

Easement Area, to be 

excavated SF 

Page 5 of. A 
COASTA L 

Additional Comments / Instructions: 

- J^e?Hou^4/^ 5^A///7UAU7 3 AAJ/) SuSHeS AA7}i 

• Check the box if Owner does not want CEG to document interior foundation walls and possible 

pre-existing damage. By checking this box CEG is not responsible for any damage done to the 

interior of house, including foundation cracks or fissures. 

I 11 agree HH I do not agree 

- Ow _ i .vner's Signature Date Contractor's Signature Date 

Page 6 of C^