## TRANSMITTALof OMAH ALEAD SITE SOILREMEDIATIO NFIL EFOLDER 

# -m^ l 

# \w y SAID # : Date : 

## Address : Ho ^ U^IU| ^ M Remediatio nContractor : Coasta l Environmenta l Group _ Year : 200 8 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vtde o ofpropert y (DVD ) \^/V^^r fMt( ^ 

# y Executiv e Summar y EPA-provide dproperty sketc h Signe dAcces s Agreemen t for subjec t property Signe dAcces s Agreement(s ) for adjacent property / Restoratio nAgreement Settlemen t document s (i.e. , for damag e or to replac e plants , etc. ) Confirmatio ndat a 

# y Photograph s -proPAr-ii ^ S^ d\[(UL \

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### As-buil t sketc h 4031646 9 

### Satisfactory restoratio nsigne db y Property Owner 

# ill Superfun d 

### Property close-ou t chec k lis t signe db y EP A D Descriptio nofarea s no t meetin g RO D cleanup criteri a Utility clearance s 1 / Property informatio nfro mDougla s Count y Assessor' s Offic e 

# y (ripfier-L u Acces s ci\eMi^ T D 

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WOR K STARTE D WORKCOMPELTE D ON : ON : / / / / 

### ^""^''•=C.\;(^c \VhViVSNn< ; Address : ^^ ^ SftXodUn^SV
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1 1 Notillcatio nLette r P ^ Acces s Agreemen t ]y \Restoratio nAfircemen t [ U Top.soil Samplin g (i f applicable ) O Disposal Samplin g (i f applicable ) 1 1 Garde nSamplin g (i f a|)|)licablc ) J 2 Utility Clearanc e JZ ^ Vidco/Photo s (Before ) nVidco/Photo s (During ) nVideo/Photo s (Aftci ) D Video/Photo s (3(I-Day ) Q Propert y Coni[)letio nAgreemen t nFina l Repor t Sent : / / Signed : " ^ / Z'= i /

O i Signed : ^ / Z ^ / £3j r / / / / / / Called : 3_/23_/6i
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## On:jl / \/O ^ On : / / On : / / On : / / Signed : / / I,s.sued : / / By : B>'=KAArr/S 3 ^y
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## CONTAC T FOR M Property ID #(9^r^3 ^ Property Address : 

# Rfy 7 \KV\\\^ S 

# y Initial Contact : Date : l-2g-oETime : Iti b Action : Spr\y p fa,^\( ^ Ccit l AAor^tL y Secon dContact : Date : Time : Action : Final Contact : Date : Time : Action : Final Action : Transmi t t o EP A D Othe r Action : D 

# p.nhh\n^ yyf A^5 ^ - 'v-.g q Comment : Owne r Commen t (s) : 

# Sit e ^i m CallK\(xv}iCi M KKDco'ioa . Coordinato r Commen t (s) :

### Dougla s County Accoun t Infonnatio n Pag e 1 o f 1 orma 

# 4 Dougla s County , Nebrask a Propert yRecor d - R240169000 0 Prin t Repor t NE W Featur e Parce l Dimension s availabl e ffi scal e 0-5 0 ft wes t o f90t h S t - ViewO n Ma p Informatio n i s vali d a s o f 2008-6-1 9 Treasurer' s Ta xRepor t Ne wFeatur e -•-»- •Aut o Sale s Searc h Owne r ROBBIN S CLIFFOR D A ETA L 5014SPAULDINGS T OMAH AN E 68104-000 0 Propert yInformatio n Ke yNumber : 016 9 000 0 2 4 Accoun t Type : Residentia l Parce l Number : 240169000 0 Parce l Address : 170 5 WILLI S A V OMAH AN E 68110-000 0 Lega l Description : VICTO R PLAC E LO T1 0 BLOC K0 E 5 F TL T1 1 & AL L 4 5 X 10 0 Valu e Informatio n 200 8 200 7 200 6 200 5 200 4 200 3 Lan d $400.0 0 $400.0 0 $400.0 0 $400.0 0 $400.0 0 $400.0 0 Improvemen t $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 Tota l $400.0 0 $400.0 0 $400.0 0 $400.0 0 $400.0 0 $400.0 0 Lan d Informatio n Acre s 0. 1 S F 4500. 0 U nit s 0. 0 Dept h 100. 0 Widt h 45. 0 Vacan t Ye s



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R24. . . 7/17/200 8

# f Pag e 1 of 2

Creat e Anothe rTicke t 

### Bac k

t

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### • YOU RTICKE T NUMBE RI S 2094105 . Origina l Cal l Date ; Wor k t o Begi n Date ; 7/29/0 8 7/31/0 8 Time : Time : 5:4 0 p m 6:1 5 p m Op : ELIZABETH1879 0 State : N E Address : 170 5 County : DOUGLA S Street : WILLI S AV E Place : OMAH A Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 10-S W Sect-Qtr : Typ e o f Work : lea d remidiatio n Locatio n o f Work : LOCAT E ENTIR E PROPERT Y AL L TH E WA Y T O TH E STREET . Remarks : FAX AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LO T Compan y: COASTA L ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : coasta l Dept h o f Excavation : 4f t Corne r Lot : N Involve s Tunnelin g o r Horizonta l Borin g : N Front : Y Rear : Explosives : N CXCAT V MAGELLAN MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac t Phon e Numbe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C 

### HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MAGELLA NMAGELLA NMIDSTREA M PARTNER S LPTONY A 

### Day : 918574709 8 Alt : 

### Emerg : 918574709 8
MUDO l METROPOLITA NUTILITIE S DISTRIC T EDWIN A 

### Day : 402504782 3 Alt : 

### Emerg : 402504794 6
OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R 

### RO N Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret-<RESULTS. . . 7/29/200 8

# f Pag e 2 of 2
Day : 406728934 3 0PPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T N A 

### Alt : 888728934 3 Emerg : 406728934 3 Day : 406728934 3 QLNN E1 C QWES T LOCA LNETWOR K 

### NA Alt : 

### Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 7/29/200 8

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e 2833 9 Exterio rPain t Nort h Arro w1 Owne rName : CLIFFOR D AROBBIN S Omah a Lea d Sit e • Goo d Address : 170 5 WILLI S A V

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# \ 1 Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d RYASCPXA-2833 9 F 1 pp m 

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### D Date : f^.Obo S RYBSCPXA-2833 9 F 2 pp m 

### D Time : to-'l o RYCSCPXA-2833 9 B l pp m 

### D Sample s Analyze d RYDSCPXA-2833 9 B 2 pp m 

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Omah aLeadSu e 4613 0 

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### Contrac t # : EP-R7-07-0 5 Coasta l Enviroiunenta l Grou p In c

## 2833 9 Owne rKamii : CLIFFOR D AROBBIN S Omah a Lea d Sit e Address : 170 5 WILLI S A V ^'* ® Sketc h Phone : H ; W : Sannpl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B RYASCPXA-2833 9 F l 3^ 1 pp m 

# n RYBSCPXA-2833 9 F 2 3V< 9 pp m 

# n RYCSCPXA-2833 9 B l 

# 3Z2 . pp m 

## D RYDSCPXA-2833 9 8 2 

### tZSO l ppm 

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## 12." ^ Date : 

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## 2833 9 Omah a Lea d Sit e Owne rNJamn : CLIFFOR D AROBBIN S 

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# n RYBSCPXA-2833 9 F 2 

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## D D ROiIOCPKA-g000 9 S? ­ 

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# i Sample s Collecte d 

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Date ; 'J-l-oS ' Time : P ^ Staff : Z./ 4



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# Cm' ' # COASTA L [HVIIONHtNTA l C • O V F . IM C 

## Consen t Fo rAcces s T o Propert y RIGH TO F ENTR YT O PREMISE S 

### Granto r(th e propertyowner) consent s t o an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA ) o rit s 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 .

Owner' s Name : CL ] f fD^ V p^H\V\' > Daytim e Phone : M^C-fol/ ^

Addres s o f Propert y covere d b ythi s Agreement : 

# hn ' viiLi ^ m
PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EPAi s requestin g acces s t o collect soi l sample s an d remov e soi l tha t contain s elevate d concentration s o f lea d an d ma ypos e a healt h hazard . Th e area(s ) wil l b e excavate d t o remove 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 wor k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o f Coasta l Environmenta l Group , contracte d byUSEPA , wil l contact th e Granto rin-perso n t o discus s th e wor k t o b e performed , th e Granto rwil l hav e a n opportunit yt o revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e i t begins . Onc e th e wor k i s finished , th e Granto rwil l b e aske d t o revie wth e wor k 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 receiv e writte n documentatio n fro m EPAtha t th e property ha s bee n remediated . ENVIRONMENTA L RESPONS E ACTION S 

### Bysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , it s employees , contractor s an d subcontractors th e right t o ente rth e property , a t al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e of performin g th e work . Thi s acces s shal l remai n i n effect unti l th e wor k ha s bee n satisfactoril ycompleted . Th e Granto rals o agree s to :
Pag e 1 o f 2

### s*^*'* * # COASTA L INViaONMfWTA l



### •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 necessar ysubsequen 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 fth 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 fsai 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 yo u hav e an yquestion s abou t thi s program , pleas e contac t Coasta l Environmenta l Group , a t (712 ) 352-018 8

G3>^ran t acces s t o m ypropertie sD I d o no t gxan t acces s t o mypropertie s 

# pj/A.ya , yy/^ . v-^f. ^ ^ ,/y7 ^ ^h l Dat e Slgnj^ur e Dat e
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I woul d lik e t o b e presen t durin g an ysamplin g tha t i s required .

# 4 1 Restoratio n Agreemen t Th e purpos e ofthi s agreemen t i s to provid e amutua l agreemen t a s t o condition s ofth e propert y prio r l o 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 dto th e satisfactio nofth e propert y oune r an dth e Unite dState s Environmental Protectio nAgenc y (EPA) .

Propert yID : 

# T F ^ Propert y Address : V^pt ; \|y/UU 4 hit Owner : C/Llf^/| V f^gl^g^/H ^ Phone : 

# Oi^yio^<\ O nth e attache ddiagram(s ) indicate area(s ) to excavate danddept ho f e.xcavation . locationo f all know n utilities, subsurfac e features , surfac e structure s an dlandscapin g features , acces s !ocation(s ) t o be use dby contractor , an dth e directio no f North . Indicate distances , depths , material t>pes , etc . Indicate digita l photo s b

y referencin g th e photo-lo g numbe r wit ha narrow indicating directio no 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 fthes e item s i s th e Owner s responsibility . Item : 

# ii:^l4 6 2_ Item : Item : Item : Item : Item : Item : Item : Pag e 1 of . ^^ COASTA L 

### 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 )

Pag e 2 o f^ C O A S TA L 

### 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 : 1 / , 

# \t^ u ^ t Vvyyy/c, ---^^_ ^ Item : J Item : y Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : 7 Item : Item : Item :

Pag e 3 of .

# ¥
COASTA L 

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

### Ite m

Pre-existin g propert yarea , tha t wil l b e excavated , tha t i s covere d wit h grass .

Numbe ro ftree s > 2 inc h trun k diamete r

Numbe ro ftree s •' = 2 inc h irun k diamete r

Numbe ro fSprinkle r Zones . Contro l Valves . Timers . Heads , etc . Aiiac h a sketcl i u! ' ih c ipi'iiikle: " !;i \ oui .
Numbe ro fan d siz e o f eac h garden / flowe rbe d area . -L'e s nnJ . locations . 

### Quantit y Uni t Condition/Type/Specie s
% 

# ' ^u r^W > Squar e fee t

/ ) Eac h 

# jy Eac h 

### i 

# y Eac h

Eac h Squar e Fee l 1 i 

# ( P Pag e 4 o f

# m ^

-COASTA L 

### 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 \alu e «il l b e use d t o issu e a plan t \ouche rt o ih e propert > 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 fwer e eac h plan t \\\\ \ b e place d h \

th e contracior . Agree d upo n are a o f propert vt o b e replace d wit h gras s sod . ':ii.'h:d e a v^eic h u: ' th e .iieais ! t o b e :cp|-.K'L- J •.' - •th , L;'a-. > >od .

•Are a o f Cit yo rCount ) propert yt o b e landscape d pe rthei rrequireinents . ! riti,:l.l c; -i-.i'i,-! ' K' \ : ! t .1 ; c'. ! I S !

Easemen t .Area . 1 0 b e excavate d 

### Quantit y

y 

# 0-

y

\ 

# ) l Uni t

$

Eac h

SF 

### Condition/Type/Specie s

S F

SF

Pag e 5 o f^: O A S T A L


### Additiona l Comment s / Instructions :

• Chec k th e bo xi fOwne rdoe s no t wan t CE G t o documen t interio rfoundatio n wall s an d possit>i e pre-existin g damage . B ycheckin g thi s bo xCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro fhouse , includin g foundatio n crack s o rfissures .



## G3^ g Q I d o no t agre e agre e

itur e Dat e [Contractor' s Signatur e 

### Pag e 6 

# <^ yXR F PROPERTY

### SAMPL E SHEE T BVID # 

# i%^^ ^
Dat e Projec t XR F ID # 

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Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h Averag e Averag e
RETES TAREA S Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a ^ Dept h 

# y y y ^ 

# / 

# / y Dept h Averag e Averag e

la b sample * La b resul t Sampl e are a XR F 

### Avg . Signatur e 

## Prin t \K^G n KffH V

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1 

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 168 0 Mod e SOI L Tim e 2008-08-0 2 17:2 7 Duratio n 120.9 1 Sequenc e Fina l Flag s AVERAG E fAv g of 1676-167 9 ADDRES S 170 5 Willi s a v QUAD/ZON E B 2 INSPECTO R lope z DEPT H ! 4 SAMPL E TYP E CLEARANC E NOT E

Supervise d B y

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E Pr'P E NOT E

pp m P b 11.19 9 Supervise d By : 

## Certificat e o f Verificatio n

167 6 SOI L 2008-08-0 2 17:2 5 30.3 2 Fina l 2833 9 170 5 Willi s a v B 2 lope z 4 CLEARANC E

± Erro r ± 7.11 6

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E PI'P E NOT E
pp m P b 21.40 1 Supervise d By : 

## Certificat e o fVerificatio n
167 7 SOI L 2008-08-0 2 17:2 5 30.2 2 Fina l 2833 9 170 5 Willi s a v B 2 lope z 4 CLEARANC E

± Erro r ± 7.76 4

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1 

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 167 8 Mod e SOI L Tim e 2008-08-0 2 17:2 6 Duratio n 30.1 4 Sequenc e Fina l Flag s BVI D # 2833 9 ADDRES S 170 5 Willi s a v QUAD/ZON E B 2 INSPECTO R lope z DEPT H 4 SAMPL E TYP E CLEARANC E NOT E
pp m ±Erro r P b 22.44 8 ±7.89 3 Supervise d By :• • 

# Therm o

SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E Pi'P E NOT E
pp m P b 22.73 2 Supervise d By : 

## Certificat e o f Verificatio n

167 9 SOI L 2008-08-0 2 17:2 7 30.2 3 Fina l 2833 9 170 5 Willi s a v B 2 lope z 4 CLEARANC E

± Erro r ± 7.88 6• % 

### Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc . www.coastalhazmat.co m COASTA L ENVHONNENTA L GROUP . IN C 

# EXECUTIV ESUMMARY : BVI D #2833 9 - (170 5 Willi s Ave. ) 

# No Issue s o r Concern s I I Issues/Concern s Detai l Explanation :

## Sit . 

# EP A EP A Propert y Clos e Ou t For m Propert y Propert y Address: " Date/Tim e 

# 'Z':::yzzy^^ykm ^ Quad s Excavaled : ^ ^ Contracto rGrou p (j7)0r^fiRt Excavatio nGenera l 

## V^ACftNf TIS ) \ Ye s 1 .If necessary , wer e th e correc t quadrant(s ) excavate dan drestored? 

### i / 2 .If necessary , wer e th e correc t area s ofdri p zone excavate dandrestored ? > / Gradin K So dan dVecetatio n Ye s 1 Doe s the gradin g aroun dth e perimete r ofth e hous e i nexcavale darea s generall y slop e awa y fromth e house ? y 2 . Ha s so dbee nlai dinall area s tha t were excavated ? 

# y 3 . Doe s th e sodappear to b e generall y healthy an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 da v time period ) 4 . Ar e soddedarea s generall y fir man devenl y graded ? 

## x/ 5 . Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Only evaluat e ifinspecte da t a3 0 da y tim e period ) 6 . Wa s the propert y grade dsuc htha t water will not poo l o nth e property' ' 

# y 7 . Wa s damag e t o landscapin g or plan t material s avoided ? 

# y Gates , Fence s an dRetainin g Wall s Ye s 1 .D o gate s ope nandclos e freely ? (Ifapplicable ) Wer e all gate s or fence s take ndov mdurin g restoratio nactivitie s reinstalled ? (Ifapplicable ) 3 .Wa s damag e t o gate s or fence s avoided ? (Ifapplicable ) 

# A) F 4 .Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) Foundation , SidiD g an d Gutler s Y e s 1 .

Wa s damag e t o th e sidin g o rtri m avoided ? 1 2 .Wa s damag e t o th e foundatio n avoided ? 3 .Wa s damag e t o window s avoided ? ^ ^ 4 .

Wa s damag e t o window s o rdoo rscreen s avoided ? r 5 .Wa s damag e l o downspout s o rdownspou l extension s avoided ? \ > Sidewalk s an dDriveway s (Concrete ) Ye s 1 .Wa s damag e to driveway surface s avoided ? # 2 .Wa s damag e to walkway surface s avoided ? N o

N

o

N o

N o

N o

## Owner s comments : %



## Inspectio nnotes :

Removal an drestoratio nactivate s complete includin g the 30-da y so dwarranty : EPA Represent^tp<;^^^,^^.^^>^^\Xg ^ Date : E^dt• • 

## Propert yCompletio n Agreemen t This agreemen t document s the compleliono f remedia l activitie s pertbiine do n m y property . M y signature wil l designate tha t I a msatisfie dwit hth e restoratio no f m y properly , an dIha l n o ilein s ar e i n questions , now , or a

l an y lim e i n th e future , except thos e item s liste dbelow , ifany . Property ID : d ^ ^ ^' ^ f Property Address : / J ^ f VUTIZl ^ A^ d 

## Q— - ClxfPo. A(S?AV;^ ^ Phone : Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item :

I I I agre e restoratio n I s completed , excep l a s note d I I I d o no ( ayrc crestoratio n i s complete d 

# M H y O^ii-r' s Signatur e Dato y Contractor' s Signatur e Dal e