### .. / '


### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID# : 22/? ^ Date : ^f/^ 6 Address : 333 ^ O ^ / ST " Remediatio nContractor : Coasta l Environmenta l Group

_Year : _2007 _ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S B Vide o o f property (DVD ) 4

\Executiv e Summary EPA-provide dpropert y sketc h fi] Signe dAcces s Agreemen t for subjec t propert y D Signe dAcces s Agreement(s ) fo r adjacen t property H Restoratio nAgreemen t D Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) 

# 4 Confirmatio ndat a Photograph s _^_ As-buil t sketc h Satisfactory restoratio nsigne db y Propert y Owne r Property close-ou t chec k lis t signe db y EP A D Descriptio nofarea s no t meetin g RO D cleanu p criteri a D Utility clearance s D Property informatio nfromDougla s Coimty Assessor' s Offic e D D , D • • ' 

# ^^.^<!^^/0^^^<gdJft^ ^ ignatur^ 4031772 4 Superfun d

## Fina l Repor t Propert y Chec k Lis t (piease plac e wit heac hfile) Har dCop y Informatio n —t^^ropert y Chec k Lis t —^T'Sit e Workin g Drawin g Ma p —3 : EPA original s Ma p ,.-4r'15ougla s County Assessor' s Ma p --5r~Propert y Contac t Sheet Agreemen t ,r---trAcces s Agreemen t

-2rRestoratio nAgreemen t Miscellaneou s Document s 1 . Final Ma p fromth e Fiel d 2 . Chang e Order s 3 . XRFDat a 4 . An y email s o r P O correspondence s Propert y Completio n .^•'•'^rExecutiv e Summary ^^A S BUIL T .^^-3 T

### Property Completio nAgreemen t f\B^ - Any buyou t inf o o r reimbursemen t inf o 7]f ^ 5 . Chec k o r mone y orde r copie s \y/() . EPA Property Clos e Out Fon n l/l . Attache dBegi nVide o Electroni c Documentatio n Drawing s ^^.-'tT ' EPA original -^-ZT^Working Drawin g

- ^ A S Built.vs o A T A S Built.jp g

Photo s /--^egi nPhoto s ^During/Excavatio nPhoto s ^^o dPhoto s /-30-Da y So dPhoto s Scanne dDocument s ^^.^---Fina l Document s ^--'-Executiv e Summary \. 7 ^ ^ Video s — ^ L^^ ^ 

# /^egi nVideo--l):=^^5cc;s;^=s^;^^=^57?rr^ ^ "'j:::i^M y Movie

## Propert yAcces s Checiclis t Propert y ID : /^^/^ ^ nWORK STARTE D ON : / / Propert y Addrcs.s : p^-j^ ^ ^ ^/^S f 

### nWORKCOMPELTE D ON : / / 0>vncr : (iQ^^ f tir^-tl A Renter : Address : ^ ^ 5 . ^/^St ^ Phone : Fax : Cell/Pagcr : 

### Phone : ^/// ­ yQ^C j Additiona l Information : 

### 1 Fax :

Cell/Pager :

• D Notlticatio nLette r Sent : / / By : S Acces. s Agreemen t 

### Signed : j5_/^/i2 7 

# «>• = /Uara) 5 Q Re.storatio nAgreemen t 

### Signed : 5 1 QB l O l 

# »•>' = Mrx^D 3 nTopsoi l .Samplin g (irapplical>lc ) 

### 1 1 By : nDispo.sa l .Samplin g (i f applicable ) 

### 1 1 By : d l Garde nSamplin g (ifapplicable ) 

### 1 1 By : H i Utilit y Clearanc e 

### Called : T / 30 l C f 

## ^y-^n67kic ^ EIVideo/Photo s (Before ) 

## On : ^l33lJ7 l B.y = ITJ'OIA . H^Vidco/Photo s (During ) 

### On : U 1 ^ r /O' l 

## B.y : /Zi6 K 0 ^ Video/Photo s (After ) 

### On : 1^ 1- 1 /(f^ 

## \ir.[UoiA nV><leo/Photo. s (3()-Day ) On : / / By : Q ^ Properl y Completio nAgreemen t 

### Siened : b l 7 1^ 1 B.V : /Z/C^ \ C

H Fina l Repor t Issued : / / 

### By : Ai r IVIonitorin g (a s applicable ) L

H Communit y C H Cre w On : / / 

### By : Results : D Communit y Q Cre w On : / / 

### By : Results : C

H Communit y C H Cre w On : / / 

### By : Results :
Omah a Lea d Sit eTota l Q^^^t Square Footag e t o b e Excavate d = 143 9 Property( Classification : 120 0 # Tota^ ^ Zon e Linea rFootaq e t o b e Excavate d = 0 i ; i i i i 1 i 1 1 1 

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## Sout h 2 1 Stree t Lege n d Nort h Arro w Omah a Lea d Sit e Concret e Omaha , Nebraska [Vl l 

## \VA Excavate d Are a Propert yNumbe r Existin g Structur e OLS-2219 5 

# w M Scal e • Fenc e Propert yAddres s ' 1 incti = 2 0 fee t o r1 gri d = 5 x5 ft B?

\ •7 Q 83 5 S 2 1 S T Permanen t Landscapin g fW i

- Quadran t Boundar y Pos t Excavatio n Concentration s 5 (ppm )

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# x^m i 

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) T ree/ S hru b \ /(V.1 ^ < * • 8 1 Ga r den _ _ oth e r Descriptio n o f pos t excavatio n areas : Fl , fron t yar d left-han d quadrant ; F2 , fron t yard right-lian d quadrant ; Bl , backyar d left-han d quadrant ; B2 , backyard nght-han d quadrant ; DZ , dri p zon e ( 1 - 3 foo t aiB a o f soi l aroun d th e foundatio n o f th e house) .

### Prin t Previe w Pag e 1 o f 1 

## ^WQ 5 Dougla s County-Omaha , N E

Parce l I D Owne r Nam e Propert y Addres s Cit y Zi p 1 Owne r Addres s Owne r Addres s 2 Owne rCit y Owne r Stat e Owne rZi p Sec-Twn Rn g 174544000 0 GREE N ROBER TB 83 5 S 2 1 S T OMAH A 6810 8
431 5 S 2 2 S T OMAH A N E 6810 7 22-15-1 3 Owne r Addres s Additio n Bloc k Lo t Lega l 1 Lega l 2 Lega l 3 Lega l 4 Ol d Assesso r Sit e Ne w Assesso r Sit e MILLAR D PLAC E 1 1 6 50X13 2

http://webarc.co-douglas.ne-us/dcassessor/details.asp ? PARCELNB=174544000 0 http://webarc.co.douglas.ne.us:8080/ReaiWare1/details.do ? id=R174544000 0
Disclaimer : Map an d parce l data ar e believe d to be accurate , bu t accurac yi s no t „ Sral p guaranteed . Thi s i s no t a lega l documen t an d shoul d no t be substitute d fo ra titl e search , . . . *

__. _, . appraisal , survey , o rfo rzonin g verification . 

### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 4/25/200 7

## CONTAC T FORM 

# n/L\^ < Property I D # Property Address : Initial Contact : Date : s aTime : 1 -Polt ^ Action : ^U*^ ^ If^L^ ^ W« ^ ^ Secon dContact : Date : Time : Action : Final Contact : Date : Time: ^ Action : Final Action : Transmi t t o EP A D Othe r Action : D

Comment : Owne r Commen t (s) : Site Coordinato r Commen t (s) : 

# \lC ^ (jMh i Y^m < C47 ^ ^H-^l'U }

t^ /L5 | 

# A/to . (A ^ 

# \WSb ^ V ?^^ HM ^ 

# ^/f 1 ^/ftt* , ^ Hwf« i ^'l ^ ''^^ 1 Af < Wi'^ ^

## Consen t Fo rAcces s T o Propert y RIGH T O FENTR Y T O PREMISE S 

### Granto r (th e property owner ) consent s t o an dauthorize s th e Unite dState s Environmenta l Protectio nAgenc y (EPA ) o r it s authorize drepresentatives , collectivel y th e Grantee , t o ente r an dperfor mcertai nenvironmental respons e activitie s upo nth e followin g describe d premises :

Owner' s Name : Daytim e Phone : ! u \']0'> ^ 'l/

l ^ 

### Address : r
• / I r 

### Address : 

## C 14^ ^ ^ 7 ' I^Clhf4,6f - ) Addresse s o f Address : Propertie s covere db y r -- . 

### thi s Agreement : Address : « < 

# 7 ^u r ^ ^ 

# KMw^ ) Address : PURPOS EO FRESPONS EACTIVITIE S 

### Th e EP A i s requestin g acces s t o collec t soi l sample s an dremov e soi l that contain s elevate dconcentration s o f arseni c and/o r lea dan dma y pos e ahealthhazard . Th e soi l wil l b e remove dan dth e excavate darea(s ) wil l b e replace dwithcleanmaterial s an d restored . Thi s wor k

i s bein g performe dunde r th e Omah aLea dSite Superfun dSite remediatio nprogram . AnEP A representative wil l contac t th e Granto r in-perso nt o discus s th e wor k

t o b e performed , th e Granto r wil l hav e a nopportunity t o revie w an dapprov e th e planne dsoi l removal , an drestoratio nwor k

before i t begins . Onc e th e wor k

i s finished, th e Grranto r wil l b e aske dt o revie w th e wor k

andconfir mthat i t i s complet e an dmeet s withth e Grantor' s approval . Upo ncompletion , th e Granto r wil l receiv e writte ndocumentatio n fromEP A that th e property ha s bee nremediated . ENVIRONMENTA LRESPONS 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 an dsubcontractor s th e righ t t o ente r th e property , a t all reasonabl e time s an d wit hprio r notice , for th e sol e purpos e o f performin g th e work . Thi s acces s shall remai n i neffect unti l th e wor k

ha s bee nsatisfactoril 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 that th e Granto r o r th e Grantor' s tenan t ma y wis h t o save , •Wate r an dmaintai nreplacemen t vegetation , includin g fertilizer application , a s necessary subsequen t to a ninitial waterin g perio db y EPA ; •Abid e b y healt handsafet y guidanc e provide db y EPA ; •Ifth e property i s rented , assis t EPA 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 ofbuildings . AGRFEM!-:NT NO T T O INTFRFER F 

### Th e Granto r agree s no t t o interfer e o r tampe r wit hany ofth e activitie s or wor k

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

r th e environment , or to allo w other s to us e th e propert y i nsuchamanner . Shoul dyou hav e an y question s about thi s program , pleas e contac t
I gran t acces s t o my propertie sC D ' d o no t gran t acces s t o m y propertie s
Signatur eDat e Signatur e Dat e

r nI wouldlik e t o b e presen t durin g an y samplin g that i s required . Pag e 2 of 2 «Property_ID :

# ip ^ Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o provid e a mutua l agreemen t as t o condiiion s o f propert yprio rt o reniediaiio n aclivilies . Thi s uil l als o serv e a s decontaminatio n fo rth e purpos e o f assurin g tlia t restoralio n aclivitie s ar e complete d t o th e satisfactio n o f lli e propert yowne ran d tii e Unite d State s Environmenia l Protectio n Agenc y(EPA) .

Propert vID : TPfAQ ^ Propert yAddress : (7t / L , 'y^<^ ^

C^ ^ 

### Owner : p^^ip ( (^ |L^ ^ Phone : 

## \^\ ^ 

## 107^ 1 O n th e attache d diagram(s ) indicat e area(s ) t o e,\cavate d an d dept h o f excavation , locatioi i o f al l know n utilities , subsurfac e features , surfac e structure s an d landscapin g features , acces s locatioii(s ) t o b e use d b v contractor , an d th e directio n o f North . Indicat e distances , depths , materia l t^pes . etc , I:idic;it e digita l plioto s hvreferencin g th e photo-lo g numbe rwit h a n arro windicatin g directio n of view . Item s T o B e Ramove d B yOwne rBefor e Star t O f Re.medisticr; : (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 rsspor.sibillty . Item : 

## \o-i ^ < ^ ^ y Item : Item : ^^ ^ y Item : y / " Item : 

# y ^ Item : y ^ Item : y ^ Item : y ' ( o Pag e 1 of _ 1

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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 : Item : 

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Paq e 2 o 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 :

Pag e 3 o f 

## ( f^ 

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

### Ite m

Pre-existin g propeil yarea tha t i s covere d uit h grass .

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

Numbe ro f tree s • = 2 inc h tnm k diamete r

Numbe ro f Sprinkle r Zones . Contro l Valves . Timers , Heads , etc . Attac h a sketc h o f ili e sprinkle rlavout . Numbe ro f an d siz e o f eac h garden' ' flowe rbe d are a Attac h a sketc h o f relativ e si.^es an d locations . 

### Quantit y 

# V h 

# H r li ^ Uni t
Square feet

Eac h

E.u h

Eac h

Eac h Square Fee t 

### Condition/Type/Specle s 

# [LOT M

Pag e 4 o f ( /

### Ite m Agree d upo n valu e o f plan t material s no t t o be replace d b vcontraclor . Not e thi s valu e wil l b e use d t o issu e a plan t vouche rl o th e propert y owner . Agree d upo n lis t o f plan t material s tha t v^il l be replace d b ycontractor . B e ver yspecifi can d detailed . Includ e a sketc h o f vver e eac h plan l wil l be place d b yth e contraclor . .Agree d upo n area o f propert yt o be replace d vv-ii h gras s sod . Includ e a skeie h o f th e area(s ) l o be replace d wit h gras s sod . Are a ofCit vo rCouni v propen vl o be landscape d pe rihei rrequirements . Includ e a sketc h o f th e are a (s )

. 

### Quantit y

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### Additiona i Comments / Instructions :

• 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 boxCE G i s not responsibl e fo ran ydamag e don e t o th e interio ro f house , includin g foundatio n cracks o rfissures .



## Q^ i I ajire e I 1 1 d o not agre e 

## Di^ g I I I d o no t agre e ;i2re e 

# 7J^^^K!A^ce^7M- ^ Owner' s Signatur e 

### Dat e Pag e 6 of . ictor' s Signatur e Dat e-- - « 

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## S o ut h 2) 1 Sitr e 

## e t 1 Lege n d Nort h Arro w Omah a Lea d Sit e Omaha , Nebrask a Concret e Excavate d Are a 

## V

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## b ^ 1 Inc h = 2 0 fee t o r1 gri d = 5 x5 f t 83 5 S 2 1 S T Permanen t Landscapin g Quadran t Boundar y Pos t Excavatio n Concentration s (ppm ) Udr y V • Oui-o q C IIK. ' F 2 Eas e !me n 

## 5^ . ; • D Z _ t

— 

# O T r ee/ S hru b ^ B 1 Gar c len _ Oth e r Descriptio n o f pos t excavatio n areas : Fl , fron t yar d left-han d quadrant : F2 , fron t yard riglit-hand quadrant ; B1 , backyard left-lian d quadrant : B2 , backyard riglnt-han d quadrant : DZ , dri p zon e ( 1 - 3 foo t are a of soi l aroun d th e foundatio n o f th e house) .PROPERT YCLEARANC E WORKSHE l 

# 'm > 2zq s 83^^21^' ^ Dat e Projec t XR F I D
Shot * 

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## /Yl t XAT ^

Confidentia l 5/2/0 7 Pag e 2 o f 2^ 

### iyjOL \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 S J^^^ ' I Coasta l Environmenta l Grou p Inc . V^'^T ^

www.coastalhazmat.co m ^ ^"tPRoi* ^ COASTA L ENVIRONMENTIkt . CROUP . INC 

# EXECUTIV ESUMMARY : 22195—83 5 SOUT H 21^ ^ S T

^ N o Issue s o r Concern s | ^ Issues/Concern s Detai l Explanatio n

#

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dS f TO

Tota l Qua(jran t Squar e Footag e t o b e Excavate d = 143 9 Propert y( DIassiflcatlon : 120 0 Tota l Dri p Zon e Linea rFootag e t o b e Excavate d = 0 1 1 1 1 I 1 1 1 1 i : i 1 1 ; 1 1 1 1 1 1 : 1 ^ 

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### Sout h 2 1 Stree t Legen d OLS#:2219 5 Nort h Arro w Omah a Lea d Sit e Omalia . Nebrask a Dat e Excavated : 6/4/0 7 Dat e US f le d Off : 6/8/0 7 Propert yNumbe r OLS-2219 5 Kisiin g SU i i_ ^ c jctur e Scat e Propert yAddres s 1 Inc h = 2 0 feet o n gri d = 5 X 5 f l b^V ^ 8 3 5 S 2 1 S T g^ ^ . >r.,,, = .. = ., . ,.=..v.i.^,>... M Quadran t Boundar y ——_ Pos t Excavatio n Concentration s (ppm )

- Stree t Boundar y P 1 R 7 Pla vArp a ^yflfr)(..V) l iHj. . K. i F 2 ri Z Easemen t T ee/ S hru b > , W,v** * B l Ga r Jen _ oth e r_ 

## li5P^/ I ^ 

# c DescrptKX i o f pos t excavatio n area s F 1 , fror t yar d lett-hart d qModrant : F2 . fran t yar d rignt-han d quadrant . Bl , backyar d left-han d quadran t B2 . backyar d right-han d quadrant , DZ . dri p zon * ( 1 - 3 foo t ara a o f soi l aroun d th e foumtotfo n o f th a hom* ) 

### Legen d Are ano t Excavate d|/yy j Dripzon e Excavate dQQQ ^ Quadrant s Excavate d Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .

# ^EP A

# ^ EP A Propert y Clos e Ou t For m :s7 . Propert y #: .2^/^.6 ^ Propert Propert yAddress Address : : ^^jS ' S'^/^SA Datc/TlBc : Owner' s Name : Quad s Excavated : Contracto rGrou p Excavatk> nGenera l Ye s No 1.

If necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? i / 2.

If necessa'y , wer e th e correc t area s ofdri p ron e excavate dan drestored ? 1 / Gradin g So daa dVctctatio a Ye sNo 1.Doe s th e gradin g aroun dth e perimeter ofth e house ir excav ate da.'-ea s generall y slop e away ^^ fromth e house ? 2.

Ha s so dbee nlai d inal l area s tha t wer e excavated ? . / 3.

Doe s th e so dappea rtobe generall y health y an dgrowing ? (Onl y evaluat e if

inspecte d at a

30 da y tim e period ) -S'*- " >vc>l^ 5 4.Ar e sodde darea s generall y fir man devenl y graded ? 1 / 5.Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evalaat e if inspecte d at aI Oday 

## • X tim e period ) 6.Wa s th e property grade dsuc htha t water w ill no t poo l on th e prc^pei } ? 

## y 7. Wa s damag e to landscapin gor pla.n t material s avcided " 

## 1 y \\ Gates , Fence s an dRcuinin t >^all s Ves .N o 1 Do gate s openan dclos e freely? (Ifapplicable ) 

## y 2. Wer e all gate s or fence s take ndow nduri.ng rrstoratio nactiv i:ie s re^ns'^iiec ? .ifspr l icabie ) , i ^ 1 3.

Wa s damag e to gate s or fence s avoided ? (I f applicable ) ly ^ ! 

### 1 t 4.Wa s damag e tc retainin g wall s avoided ? (Ifapplicable ) 1 i ^ i Foundation , Sidia f an dGutter s Ve s N c I 1.

Wa s damag e to th e sidin gor trimavoided ? 

### ^ k 2.Wa s damag e to th e foundatio navoided ? f) ^ 3.

Wa s damag e to window s avoided ? 

## ON 4.Wa s damag e to window s or door screen s avoided ? K) ^ 5.Wa s damag e tc dovMispout s or downspout extension s avoided ? 

## pK Sidewalk s an dDrtveway s (Concrete ) Ves No 1 1.Wa s damag e to dri vew ay surface s av oided ? 

### ^)f ^ / / 2.

Wa s damag e to walkwav surface s avoided ?

# 1 Owner s comments :

Inspectio nnotes : / , • / i , ^ S 

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### Remova l an drestoratio nacti\ate s corr.p'.ete includin g th e }0-da> ' so d•^'^arranrv- : EP A Representative^;^ ^ Date : ^ oAr ^ r^^J

# «ER^ * Propert yCompletio n Agreemen t Thi s agreemen t documents th e completio no f removal activitie s performe do nth e belo w liste dproperty . Th e property owner' s signatur e indicate s tha t th e property owne r i s satisfie dwit hth e restoratio nofth e subjec t property , an dtha t n o item s are i nquestion , now , o r at an y tim e i nth e future , excludin g any remainin g so dwarranty (3 0 day s total ) excep t thos e item s liste dbelow , i f any . 1 Propert yID : 

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Propert yAddres s 

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^.ffitSt - Owner : 

# 'fhoblrf (::7r7-t- 7 Phone : 

# ui^-^od" ) Restoratio n Item s I n Question :

Item : , . . jZ. : 'i \YT^ ^ '- \ item : 

### Item : Item : Item : Item : Require dcorrection s t o complet e th e property :

v\ \ I agre e restoratio n i s completeci , excep t a s note d above . I I d o no t agre e restoratio n i s complete d 

# Irl-' ^ Dat e 

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