## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL EFOLDE R SAID# : ll/?&^ l • Date : 

# jojnfiQo ? Address : 

# 271U/ ZDP^ACirri ^ Remediatio n Contractor : Coasta l Environmenta l Group

_' Year : _2007 _ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f propert y (DVD ) Executiv e Summar y 1 / EPA-provide dpropert y sketch Signe dAcces s Agreemen t fo r

subject propert y Si^e dAcces s Agreement(s ) fo r

adjacen t propert y 

# , 0- Restoratio n Agreemen t • - . Settlement doctmient s (i.e. , fo r

damag e or to replac e plants , etc. ) Confirmation data Photograph s \)PCUA ^ QXOa.CA^a( \^ UDJI^JL . 

## As-built sketch Satisfactor y restoratio n signedb y Propert y Owne r Propert y close-out check lis t signedb y EP A '/l2J 27) 0 7 Descriptio n o f area s no t meeting ROD cleanu p criteri a 

# a Utilit y clearance s a'•'. 

## Propert y informationfromDougla s Count y Assessor' s Office

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4031709 0 Superfun d

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Scanne dDocument s ^Fina l Document s Vtxecutiv e Summary

Video s ^^egi n Vide o

My Movi e

## Propert yAcces s Checklis t Propert y ID : / /^^/ ^ / nWOR K STARTE D ON : / / n WORKCOMPELTE D ON : / / Propert y Ad<lrc.ss : ^Zb^/XCUJ CZrPJ- C 

### Owner : \/l^f^Q ^ ^fimZS S Renter : Address : Phone : Fax : Ccll/Piijicr : 

# '•""«= = Fax : 

# 73/'77^ 7 Additiona l Information : 

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## By : fdcy I T Restoratio n Agreemen t Signed : i ^ / S 1 O l 

## By : jfUc U n Top.soi l Samplin g (ifapplicable ) 1 1 By : n Disposa l Samplin g (if applicahlc ) 1 1 By : C

H Garde n Samplin g (ifapplicable ) 1 1 By : S i Utility Clearanc e Called : b 1 6 1 O l 

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# 1 Results : C

H Communit y C H Cre w On : / / 

# 1 Results : Omah a Lea d Sit eTota l Q^^Hbquar e Footag e t o b e Excavate d =161 7 Property< Classification : 80 0 Tot^HKon e Linea rFootaa e t o b e Excavate d = 0 

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# c ) \ S/Pro» * « f B 1 Ga r jen _ Oth e r Descriptio n c f pos t excavatio n areas ; F1 , fron t yar d left-han d quadrant ; F2 . fron t yar d right-hand quadrant ; Bl . backyar d left-han d quadrant ; B2 . backyar d nght-han d quadrant ; DZ , dn p zon e (1- 3 foo t are a o f sa l aroun d th e foundatio n cf th e house) .' ^Ht-.l'^'J;'35J -W ^ 

### Prin t Previe w Pag e 1 o f 1 Dougla s County-Omaha , N E 

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Parce l I D Owne r Nam e Propert y Addres s Cit y Zi p Owne r Addres s Owne r Addres s 2 Owne rCit y Owne r Stat e Owne rZi p Sec-Twn Rn g 052386000 0 HARNES S VERNO N L 276 2 DEA N C R OMAH A 6810 5 275 8 DEA N CI R OMAH A N E 6810 5 28-15-1 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 • . . ARBO R PLAC E 4 1 4 3 8 1/3X113. 5

http://webarc.co.douglas.ne.us/dcassessor/details.asp ? PARCELNB=052386000 0 http://webarc.co.douglas.ne.us:8080/RealWare1/details.do ? id=R052386000 0

Disclaimer : Ma p an d parce l dat a ar e believe d t o b e accurate , bu t accurac yi s no t Ma p Scal e guaranteed . Thi s i s no t a lega l documen t an d shoul d no t b e substitute d fo ra titl e search , 1 inc h = 17 3 fee t appraisal , survey , o rfo rzonin g verification . 

### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 5/3/200 7^ 

## CONTAC T FOR M Propert y ID # 

# AdH : Initia l Contact : Secon dContact : Fina l Contact : Fina l Action :

Comment : Owne r Commen t (s) : Sit e Coordinato r Commen t (s) : 

# //y y ^7^ ^ iZa ^ Cir mhn4^) Date : 5/.?o/o ? Time : ii3 o Action : Le-P-I - Alt-<>'VK c Date : Time : Action : Date : Time : Action : Transmi t t o EPA D Othe r Action : D



# Appf . (^-^^^^(^lllO D,.0"'^'i r 

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## Consen t Fo rAcces s T o Propert y RKJIITOI'ENTR Y T O PRI:MISI;. S 

### (iianto r (tli e propert y owner ) con.sents to an dauthorize s lli c Unite dStale s Bnvironmenla l Proleclio n Agenc y (El'A ) or it s autliorize drepresentatives , colleclivcl y ih c Grantee , to enter an dperfor mcertai n environmental respons e activitie s upon th e followin g describe d premises :

Owuer'. s Nniiic : Daytim e SMionc : 

# 0^g<:^o ^ JU,/^/^'^^'^' ^ 7.A^i> t 77Y 9

Addrcs.sc s of ' Propertie s cover thi. s Agreement : e db y Address : ^7& 3 Address : Address : Address : \><Lr^ ^ C^ty .

Address : PDRI'OSI ' Ol ' R|':SI'()NSIJ : ACTIVITII; S 

### Th e EP A i s requestin g acces s t o collec t soil sample s an dremov e soil tha t contain s elevate dconcentration s o f arseni c and/o r leadandma y pos e ahealt hhazard . Th e .soi l will b e remove dandth e excavate darea(s ) will b e replace dwit hClea n matenal s an d restored . Thi s wor k

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

n EP A representativ e will contac t the Granto r in-pciso n t o discus s Ihe wor k

to b e performed , th e Granto r will hav e a n opportunity t o revie w an dappiov e th e planne dsoil removal , an drestoiatio n wor k

before i t begins . Onc e th e wor k

i s finished , th e Granto r wil l b e aske dt o revie w the 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 n documentatio n (Vo mI'PA tha i th e propert y ha, s been remediated . ENVIRONMIiNTAI , Rl':.SPON.SI { ACTION. S 

### By 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 right t o enter th e property , a t al l reasonabl e time s an d wit hprio r notice , fo r th e .sol e purpos e o f performin g th e work . Thi s acces s shall remain i n effect until the wor k

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

«Propoi;l'. y ID » 

### Pag e I o f 2*l»p> ­



### ' Remov e obstruction s includin g boats , trailers , vehicles , playscap e itcm.s , wood piles , do g houses , etc ; " Remov e nowc r bulb s o r plant s tha t the Granto r or Ih c Grantor' s tenan t ma y wis h to save , *Wate r an dmaintai n replacement vegetation , includin g fonilizc r application , as necessar y sub.sequen t t

o a ninitia l waterin g perio db y EPA , '/\bid e b y healt han dsafet y guidanc e provide db y EPA , •I f th e propert y i s rented , assis t EP A i n obtainin g tenant approval fo r acces s t o the pioperty t o perfor mthe wor k

if EP A i s unabl e t o obtain .suc haccess ; an d /\llo w videotapin g and/o r photography of the propert y includin g exterio r an d interio r area s ofbuildings , A(IRI:I-:.MI:N T NO T T O 

### lNTi:Rn:Ri- : Ih e Granto r agree s not t

o interfere o r tamper wit han y ofth e activitie s o r wor k

done , o r the equipment usedl o perfor mthe activities , o r t

o undertake an y action s regardin g the us e of sai dpropert y whichwoul dtendto endanger the healt hor welfar e ofth e Grantee: ; (M

- the environment , or t

o allo w other s to us e the propert y i n suc hamanne r Shoul dyo u hav e an y question s about thi s program , plea.se conlac l


## 0 1 I g?-an? acces s (o m y propertie. sC H I do not gran t acces s < n m y propenic s 

# ZZ,.^ZZ^. ^ ^ Z> . /.'^-Jioo r Signatur eDat e Sigiialiir e Date Q I woul dlik e to b e presen t durin g an y samplin g that is required . Pag e 2 of 2 Kpropprr . y II'.' :

## Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s l o pro\id e a mutua l agrccnicn t as l o condition s o f properl yprio rt o remediatio n activities . Thi s wil l als o serv e as dccoiitaniiiialio n fo rlii cpurpos e o f assurin g thn t restoratio n aclivilie s ar e coniplcle d t o th e satisfaclio n o f lii cproperl yowne ran d th e Unite d State s En \ ironinenla ! Protectio n Accnc v(EPA) . PropertylD : |^^g^ , Propert yAddress : ^^^ ^

^^ ^

^,.^ ^ OtClNi.cp ^ IIA/I^KI.L.'-,'' , 1

""" " ^^>^l„„?^ ? .. . O n th e attache d diagrani(s ) indicat e nrea(s ) l o excavate d an d dept h o f excavation , locatio n o f al l knoNv 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 > contractor , an d th e directio n o f Nonh . Indicat e distances , depiiis . materia l t>pes . etc . indicai e dig:!;-. ! pliotv- s b \

referencin g th e photo-lo g niinihe rwit h a n arro windicatin g directio n o f \ iew . Item s T o B e Ramove d B yOwne rBefor e Star i O f Re:r.ed;at:cn : (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 rsspor.sibillty . 1 Item : 

# r)A>4-K.v> ^ 4t ^ ht r>7r")ut. K' Item : 1 Item : ^-- ^ 1 Item : y 1 Item : / 1 Item : / 1 1 Item : y Z | 1 Item : Pag e \ o \ \ ^ 

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# ^(p * Item s To B e Remove d B yContracto rDurin g Remediatio n Anr j JitofcfieBteee d (Us e additiona l sheet s a s necessary ) Item : 

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# • / 1 Item : / 1 Item : /

Item : 

### / Item : / 1 / ! I Item : /

Item : / Item : / Item : / Item : X Item : 

### -^ ' /

Pag e 2 

## ofj ^Item : Item ; Item : Item : Item : Item : Item : Item : Item : Item : Item : 

### Item : item : Item : Item : % 

### 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 ) 

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Pag e 3 

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

### Ite m Quantit y Uni t Conditlon/Type/Specie s

I'ro-c.sisliii g properl y :irc; i .ScuKir cI'cc l lli;i l I. s cm'cra i wil hj:r;i.s.s . 

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Nunilic ro f liec s > 2 inc h 

### o-covi , <:ScJv\^. -U ' I'iicl i Irnii k (liiiniclc r

I'iic h liun k (haniclc r 

# f

Nuniliei ' o f Sprinkle r /.ones . C'onlro l V;\lvcs . Timers . I Icails . elo . I'iae h ,\II:K-| I . 1 ;.ki1>l l ii f Ih r spiiiikK i i^i \ mi l

Niinibci " o f an d si/. col ' eac h jiiiiiien / flowe rlie d area . I'nc h .Sciuiir e l''ec l • \ll;iel i : i ski'lel l o f irl.ili\ r si/e s :iiu i iiKMlioii: . Pag e 4 o f 

# A l

## Ite m Quantit y Uni t Condition/Type/Specie s Agree dupo n valu e plan t malerial s lui l l o replace dIn ' coniracior . o f b e Nol e Ihl s \:llii r wil l lu use dI n I..MK­ ; l plilll l \oiklii i 11 1 ih e pii'piil v M W ne i " ' ' • • Agree dupo n lis i o f plan l malerial s Hin t wil l ti c re|ilace db y eonlraelor . Ho very specifi c am i delailed . I'ac h Iiu:llkl e : l .-.ki'l * ll u l wri c e:ul i pL'iii l w il l I T phiee d l' \ih e eolllKieln l Agree dupo n are ao f propeil v l o li e replace d wil hgras s ,sod . Ineliul e ; i skele h" I ll u aiea(s ) I n b e rephue dw illi gras s so d 

# tl > S V

Are ao f C'il y o r Clonnly properl y l o li e landseapet l pe r Ihei r re(|uiremenls . ,S F ilieiiuk a i e.' i I s ) . 1 ::kelei i o f Ih e

Pag e 5 

## o f 

## UAdditiona l Comment s / Instructions : 

### t,oe_^ ^ PL/' C C-xJ ­ 

## 'Ot .

H^hec k th e bo x if Owne 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 of house , includin g foundatio n crack s orfissures . 

## Bl"* ! ugrc c O I do no t agre e 

## Di. ^ agre e n I do no t agre e

Onncr'. s Signatur e Contmctor'. .Siuniiltir Dat e Dal e Coiitriietor'. s s .SiKiiiiltir c c Pag e 6 of \ Jfootag e t o b e Excavate d = 161 7 a rFootaq e t o b e Excavate d = 0

Legen d

' . ; Concret e 

# E a Excavated Are a m S Existin g Structur e •—•— • Fenc e i'N ^ Permanent Landscapin g

———Quadrant Bourxjar y Stree t Boundar y (yTree/Stwu b NorthArro w Scal e 1 Inc h = 2 0 fee t o r1 ari d = 5 x5 ft

.^'•^ . F l . F 2 B 1 Omah a Lea d Sit e Omatia . Nebraska Propert yNumbe r

OLS-1684 1 Propert yAddres s 276 2 DEA N CI R Pos t Excavatio n Concentration s (ppm ) B 2 PlayAre a D Z Easemen t Garde n Othe r I?escrip(io n o f pos t excavalio n areas : F1 . fron t yar d left^-fian d quadrant : F2 , fron t -.-?- ; '^r^.'ian d quadrant ; B1 . t^ackyar d )eft.han d quadrant ; B2 . backyar d rigtil-tian d quadrant ; DZ . dri p zon e (1- 3 foo l are a o f soi l aroun d th e foundatio n o f It whouse) .PRCF=RT \ C'.E.JiRANC t 'A'UhM-.Li i ^ - Dat e Projec t XR F I D 

# 0/01221/ n Omah a Lea d - - Fixe d Pric e 

# 0/01-5 1 Propert yI D Propert y Addres s Measuremen t Count/Tim e 

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1 Composit e (Drie d & 1 Sieved ) Pass/Fai l ? Analytica l Spil t Sen t

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# 1 I 1 Aliquo t -^ 2 3 4 5 Sampl e Are a I n Sit u Readin g I Composit e Reading s (Bag ) 1 ' i 1 XRF Correcte d Valu e -- > (us e calibratio n char t o rad d 2 0 ^ t o value ) Composit e Averag e

(Bag ) 

# 1 Composit e (Drie d & Sieved ) 

# \ Pass/Fai l ? Analytica l Spil t Sen t • > 

# 1 La b Analytica l 1 1

Sampl e Are a Pass/Fai l ? I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s La b Analytica l Readin g Averag e (Drie d & Spil t Sen t Numbe r Result s ( Bfls ; (Bag ) Sieved ) 7 1 Confidentia l 5/2/0 7 cec e 15 3 4 , . ^ 

## j XR F Correcte^^Bu e — > (us e callbrati^^har t o rad d 20<H > t o value ) 

# 1 * Sampl e Are a Pass/Fai l ? Aliquo t 1 I n Sit u Readin g Composit e Reading s (Bag ) Composit e Averag e

(Bag ) Composit e (Drie d & Sieved ) Analytica l Spil t Sen t > La b Numbe r Analytica l Result s 2 3 4 XR F Correcte d Valu e - > 

### 1 5 (us e calibratio n char t o rad d 20% b t o value ) 

### : ; ( y.R. ^

Technic'a n s S aritu' e

Confidentia l = ':'2 7 'cC c^ Z- ' i .

### 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 COASTA L ENVIRONMENTA L GROUP , IN C 

# EXECUTIV ESUMMARY : 16841—276 2 DEA N CI R

X 

# N o Issue s o r Concern s I I Issues/Concern s Detai l Explanation :

# ^ As-Buil t Drawin g jS L COASTA L 

# Omah aLea dSuperfun dSit e Tota l Quadran t Squar e Footag e t o b e Excavate d =161 7 Propert yClassHicalion : 80 0 Tota l Dri p Zon e Linea rFootag e t o be Excavate d = 0

Dcscriplio n o l pos i «N09vabo n area s f1 . hontyardlen-htindquadran rF 2 Iron t yard nghl-lwH l quadrant ; Bl . twckyw d left-han d quadran t BZ.bacityar d nght-han d quadrant . OZ . dri p zon a (1- 3 tool ara a o l srr f aroun d Ili a loundabo n cllh a houaa ) 

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

# m # ^ 

# Propert yCompletio n Agreemen t Thi s agreemen t document s the completio n of remedia l activitie s performedo n m y properly . M y signatur e will designate tha i 1 a msatisfiedwit hthe restoratio no f m y property , an dtha t no item s ar c i n qucslions , now , o r

a

t

an y tim e i n th e future , except thos e item s liste dbelow , i f

any . [PropertylD ; ^ ^^ ^

Propert y A<l.lrcs.s : ^^^ ^ ^^ ^ ^_ ^ iik . Onncr : \iti.y\c.K ^ U Ag.jA.-uc; C 

### Phone : Ho^ > "^^^V-^^H ^ Restoratio n Item s i n Question :

Item : i Q o i|i>^'~ . \ ^ v 

### Kem : item : Item : Item : Item : 

# , J Additiona l Comments : \_cpyw-i-~ ^ "T-< ^ ' LT-LVW U J^ I <* ^



# 0 1 agre e rrstomtio n i. s completed , excep t a s note d II d o no t apre e restoiatjo n i s complete d

^ 

## /e^/v xHm^y^^^ ^ 

# lUl n • V Owner' s Signatur e Dat e Ounractor'. s Signat u Dal e r e I

# &EPP i % 

# A Propert y Clos e Ou t Fo i D^ m Propert y #: . f/ ^ ^4 (Propert y Address : ^^70^ . p^d ^ Datc/TlBc : 

### Owner' s Name : Quad s Excavated : Contracto r Grou p Excavatio n Genera l 1 .I f necessary , wer t th e correc t quadrant(s ) excavate dan drestored ? 2 .I f necessa.'v , wer e th e correc t area s o f drip zon e excavate dan drestored ? Gradin g So dan dVesetatio n 1 .Doe s th e gradin g aroun dth e peruneter ofth e hous e inexcavate da-^ea s generall y slop e away fromth e bouse ? 2 .Ha s so dbee n lai di n al l area s tha t wer e excavated ? 3 .

Doe s th e w dappea r t o b e generall y healthy an dgrowing ? (Onl v evaluat e i f inspecte da t a3 0 da y tim e period ) 4 .

A n sodde darea s gcnerall v fuman devenl y graded ? 5 .

Ar e th e joint s betwee n th e so dstrip s generall y tight ? (Onl y e\alaat e i f inspecie da t z 3 0 da y tim e period ) 6 .Wa s th e property grade dsuc htha t wate r viill no t poo l on th e propeT } ? 7 .Wa s damig e t o landscapin g o r pla.n t rrialerial s avoided ? GMICS , Fence s aai i Rcuinin f nalt o 1 .E> o gate s open an dclos e freely? (Ifapplicable ) L . Wer e all gate s o r fence s take n dow n durin g rtsioraiio n acti\ . tie s reir.iialled ? :,. T applicable ) 3 . Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) 4 . Wa s damag e t c retainin g v-all s avoided ? ^I f applicable ) 

## A/ A Foundation , Sidii t an dGuttc n 1 .Wa s damag e t o th e sidin g or tri mavoided ? ^ h 2 .wi s damag e t o th e foundatio n avoided ? ^ ^ 3 . Wa s damag e 1 0 window s avoided ? fj/ ^ 4 Wa s damag e t o window s or door screen s avoided ? K)/ V 5 .Wa s damag e t o downspout s or downspout extension s avoided ? J A , Sidewall u an d Driveway s (Coacrete ) 1 .

Wa s damag e t o drivewa ysurface s avoided ? 2 .Wa s damag e t o wallowa \ surface s avoided ? 

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### [ Owner s comments :

Inspectio n nctes :

Remova l andrestoratio n acii \ate s complet e includin g th e 30-dav " so d•^arrantA- : EP. A "^txir^^tvmx^^ry^tyi^ ^ Date : 7/z^/z) 7