TRANSMITTA L of OMAH A LEA D SITE 

SOIL REMEDIATIO N FIL E FOLDE R 

SAID #: 47;id3 Date: 3//6/as 

Address: .^^/ / 2 ^^3/ " 

Remediation Contractor: Coastal Environmental Group_ Year: 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

i Video of property (DVD) 

Executive Siraimary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

i 

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

Confirmation data 

Photographs 

As-built sketch 

4 Satisfactory restoration signed by Property Owner 

/ Property close-out check list signed by EPA 

D Description ofareas not meeting ROD cleanup criteria 

D Utility clearances 

D Property information from Douglas County Assessor's Office 

D 

D . 

D 

40317809 

Superfund 
Final Report Property Check List (piease place with each file) - , , - ^j. 

JIard Copy Information ^^ .1 C^ ^'y ^ 

\ Property Check Li.st tyj2 ' 

zx Site Working Drawing Map 

\ ^ EPA originals Map 

\ ^ Douglas County Asse.s.sor\s Map 

Property Contact Sheet 

.Agreement 

^^^Acccss Agreement 

3^Restoration Agreement 

Miscellaneous Documents 

lyFinal Map from the Field 

2. Change Orders 

^XR F Data 

4. Any emails or PO correspondences 

Property Completion 

1, Executive Summary 

g. ASBUIET 

'j^Propeily Completion Agreement 

4. Any buyout info or reimbursernent info 

5. Check or money order copies 

6. EPA Property Close Out Form 

Attaehed Begin Video 

Electroni c Documentatio n 

Drawings 

^^^^Ys^EPA original 

iv^ Working Drawing 

3. AS Built.vso 

4. AS Built.jpg 

Photos 

Begin Photos 

During/Excavation Photos 

Sod Photos 

30-Day Sod Photos 

Scanned Documents 

Final Documents 

Executive Summary 

Videos 

> . 

Begin Video 

2 My Movie 
Property Access Checklist 

Propert y ID: J. ^^ ^ ^ "K^ 

• WORK STARTED ON: /_ 

Property Address: ^^^1 1 ^ ^ ^ n WORKCOIVIPELTED ON: /_ 

Renter: ;CSri££3 CS'^LLJ-AxJ?. Address: Phone: 

Fax: 

Cell/Pajjei 

Owner • A^fonfYllZ 

(DYVNaK^,/^i£'^ 6^/0^ 

Phone Additional Information: '•(3^) 5R -1^4- Fax: 

Cell/Pajicr: 

• & Notification Letter Sent: ^1^ 1 02 - B.v: Myyty-K 

S " Access A<;reemcnt Signed: _^/^/De ­ ^y fG^L^iy 

Q ^ Restoration A<>recment signed: _5./ POi n2 ­ B.v: Sl^nJixMJi^CXr 

1 Topsoil Sampling (if applicable) 1 1 By: 

n Disposal Sampling (if applicable) 1 1 By: 

• Garden Sampling (if applicable) 1 1 By: 

^ Utility Clearance 

Called:^ ./-i7/07 - B>- lo/t 4ct . ( \^tZTT% 

^ Video/Photos (Before) On:? 1^ 1 _Ql ^y-H'^iyatiyy^ 

n Video/Photos (During) On: / / By: 

n Video/Photos (After) On: / / By: 

n Video/Photos (3(t-Day) On: / / By: 

O Pro|)erty Completion Agreement Signed: / / By: 

D Final Report Issued: / / By: 

Air Monitoring (as applicable ) 

1 1 Community n Crew On: / / 1 

Results: 

1 1 Community D Cre«' On: / / Bv: 

Results:

LJ Community 

Results: 

D Crew On: / / By: 

1 

Omaha Lead Site 
/^l60 

Total Qua' iquare Footage to be Excavated = 2900 

Property Classification: 800 Totai DnP?'one o Linear Footage to be Excavated = 0 

Legend North Arrow 

liiii'i Concrete 

Y/ \ To Be Excavated 

I I Existing Structure Scale 

•—•— • Fence 1 Inch = 20 feet or 1 grid = 5 x 5 ft 

'^Z ^ Permanent Landscaping 

— — — Quadrant Boundary 

Street Boundary AiYHGL 

Omaha Lead Site 

Omaha, Nebrasl<a 

Property Nunnber 

OLS-4720 8 

Property Address 

5611 S 24 ST 

Post Excavation Concentrations (ppm) 

Fl B2 Play Area 

F2 DZZ. Easement 

y Tree/Shrub Bl Garden other 

Description of post excavation areas: Fl. front yard left-fiand quadrant; F2, front yard rigfit-fiand quadrant: Bl, backyard left-fiand quadrant: B2, backyard hgfit-tiand quadrant: 

DZ, drip zone (1-3 foot area of soil around the foundation of the house). 
Total Qi l Bi t Square Footage to be Excavated = 2900 

Property ( Classification: 800 m} Totar m p Zone Linear Footage to be Excavated = 0 

y/ f/' F'^v L 1 

1 i

y fe> y v 

\ 

^ 

y y ^ y <y yy ^ 

/ y y yy Ns. 

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/ y y \ 

\ / y y S. ^ ^ y 

! y ; ^ y y \ 

yyy. 

y U ^ 2 y ^1013 sqft . ^975 sqft / 

/^Sl'ppm'S ^^446 ppm / 

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yy yy I 

y ^ y y y \ 

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% 

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-<^- '''^ ^.^ i>i 

Legen d North Arrow Omaha Lead Site 

^ ^ Concrete Omaha, Nebraska 

y/ \ To Be Excavated Property

 Number 

OLS-4720 8 1 Existing btmcture Scale ' 1 

Property Address • Fence 1 Inch = 20 feet or 1 grid = 5 x 5 ft 

B?y^ 5611 S 24 ST 

— Quadrant Boundary — ~ Post Excavation Concentrations (ppm) 

F1 R"? Plaw Area 1 3UU1I udi y 

• 

' ' • " F2 

Ease ;men t 

Tree/S irub k^'IM« ^ 

D Z_ — k> 

81 Garc ten _ Othe r

• 

Desaiption of post excavation areas: Fl, front ya"d left-hand quadrant; F2, front yard right-hand quadrant; Bl, backyard left-hand quadrant; B2, backyard nght-hand quadrant: 

DZ, drip zone {1-3 foot area of soil around the foundation of the house). 
47208 

Omah Exterior Paint North Arrow Owne a Lead Site r Name: ANTONIO G ESQUIVEL 

Site • Good Sketch Address: 5611 8 24 ST • Poor 

Phone: H:/ W: 

Q-"^rot paint 

Sample Lead Sample Samples Collected Number LAB Concentration Collected Firm: 

RYASCPXA-47208 Fl 0 "^CP^ ppm 

D Date: iO'\%' ^ 

RYBSCPXA-47208 F2 ^ V ppm D Time: \y - O3 ' Arr. 

RYCSCPXA-47208 Bl ¥'5 1 ppm [ ^ D Samples Analyzed RYDSCPXA-47208 82 '¥¥^y ppm D 

RDZSCPXA-4?208 D2 ppm D D XRFUn it: ^1' ^ Book: ^ ^ 

RGZSGRXA-47S08- - -GZ~ ppm D D Date: 

RPZSePXA-472e8 P£- ppm D D Time: A-/*! 

Staff: ly^ ^ Number of Samples • 4 u 

ENTEB.EI , n 

'<T}: .<rr^. 

^^ 1 '¥-f^ 

'S'^W y^ S\ 

f^ ...F;-.L. 

^T. 

-W MlN 

5 • ^ < 

Omaha Lead Site 46130 
Douglas County Page 1 of 1 

Dougla s County , Nebrask a Propert y Recor d - R202595000 0 

Information is valid as of 2007-7-19 Print Report 

Values not finalized until after Board of Equalization View on Map 

Owne r 

ESQUIVEL ANTONIO G 

ETAL i^y .v>^ !.^r^/ 

4847 S 107 ST 

OMAHA NE 68127-0000 

Propert y Informatio n \ 

Key Number: 2595 0000 20 

Account Type: Industrial difd L sr -^"^ 

Parcel Number: 2025950000 ^ 0 IT- ^ I.O-2, 

Parcel Address: 5611 S 24 ST 'f'y>o OMAHA NE 68107-0000 

Legal Description: POTTER & COBBS 2ND ADD LOT 22 BLOCK 3 S 1 /2 25 X 130 

Valu e Informatio n 

2007 

2006 

2005 

2004 

2003 

2002 

Land 

$8,100.00 

$8,100.00 

$500.00 

$500.00 

$500.00 

$0.00 

Improvement 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

Total 

$8,100.00 

$8,100.00 

$500.00 

$500.00 

$500.00 

$0.00 

Sales Informatio n 

Date 

1999-10-11 

1997-08-25 

1997-08-02 

Type 

D M 

D M 

D 

Book 

2137 

2069 

2067 

Page 

581 

408 

297 

Price 

$107,000.00 

$82,000.00 

$800.00 

Lan d Informatio n 

Acres 

0.07 1 

SF 

3250.0 

FF 

25.0 

Units 

0.0 

Depth 

130.0 

Width 

25.0 

Vacant 

Yes 

Lan d Attribute s 

Attribute Attribute Description 

Improvemen t Informatio n 

http://douglasne.mapping-online.cx)m/DouglasCoNe/static/accountinfo.jsp?accountno=R202... 8/4/2007 
P«ree) ID 2025950000 

Parcel City Omaha 

Parcel Zip 6HI07-0000 

Owner Name Ksquivel Antonio G Elal 

Owner Address 

Owner Address 2 4847 S 107 St 

Owner City ' Omaha 

Owner State Ne 

Owner Zip 6HI27-0000 

Addition Poller A ('ohhs 2nd Add 

Acres 0.07 
CONTACT FORM 

Property ID # 

Property 

Address: 

Initial Contact: 

Second Contact: 

Final Contact: 

Final Action: 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

4720 & 

^<^il 3 24^1-. 

Date: of-oy-o?Time: 0;^-^' Action: /t.«//-.'^ Ac ^ 

Date: ^^-i/-oi Time: ^-"^^ Action: ^w ?iu,o 

Date: Time: Action: 

Transmit to EPA D Other Action: D 

idl- fy^ ^1 ot^^^r'i kM'rt o^'ir^^ 
m 

,*<^*^ ^ 

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

Coastal Environmental Group Inc. ^ ^ www.coastalhazmat.com 

COASTA L fNYIRONMENTAL 

CROUP , IN C 

EXECUTIVE SUMMARY: 

47208—561 I S 24 ST 

X No Issues or Concerns I I Issues/Concerns 

Detail Explanation: 
As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

Ibtal quadranl Square Foolage to be Enavaled - 2SQ0 

Propaty Classification: 800 iSat Di^t Zam Unear F«ilage to be ExcayJed - D 

B1 = 60 PPM @ 8" 

F1 = 57 PPM I 

^*^ ^ . OLS# : 4720 8 

^ Datetxcavated : 10/13/07 

t>alte USEP A Signe d Off : 11/29/07 

•— • Fence 

y ^ Pemianefit LandscaFA-ig 

Ouadian Boundary 

Stred Bcundary 

( ^ "nee'Stwi* 

0£ 9 ^ lan* < va IHC m a (rt M« «fwjM] « * ICHMai 

Area not Excavated 

1 incn -2aieetarigrH-&x&it 

\<t w HGL . F l _ 

FZ • ^ >-•- * 

9i«»drwit n,nf*ftMiiat**miam»tnM. si, 

Legen d 

Dripzone Excavated 

Oinaha Lead Site 

Omana. Mecosta 

FVoperty Nwnber 

OLS- 4.720e 

FVD perty Address 

3C11 S 24 ST 

Post Excavation Concentratiors 4ppm) 

B2 PlayArea 

DZ EaEemem 

Garden Other 

Quadrants Excavated 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
S3^ EPA 

EPA Property Close Out Form 

Property #: ^/yj. ^Oy> 

Date/Time: 

Quad Contractor Group ^ s Excavated: 

Excavation General 

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

2. Ifnecessary, were the correct areas ofdrip zone excavated and restored? 

Grading Sod and Vegetation 

1. Does 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? 

1 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? 

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

time period) 

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 

!. Do gates open and close freely? (If applicable) 

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

3. Was damage to gates or fences avoided? (If applicable) 

i 4. Wasdamage to retaining walls avoided? (If applicable) 

Foundation, Siding and Gutters 

1. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? 

3. Was damage to windows avoided? 

4. Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) 

1. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

¥^^ 

Yes No 

y 

^k 

Yes No 

l y 

^ 

^ ^ 

l y 

•^ 

>y 

iik 

Yes No 

tJJ^ 

/^Ay^ 

VA^ 

Yes No 

/JA 

^ ^ 

/JA 

/^^ 

^ ^ 

Yes No 

^ ^ 

li^ 
Property Completion Agreement 

This agreement documents the completion of remedial activilies performed on my property. My 

signalurc will designate thai 1 am salisficd with ihc rcsloralion of my property, and that no items are in 

questions, now. or at any lime in the future, except those items listed below, ifany. 

Pro perty ID: C/y/Q ^ 

Property Address: ^1^,/ / < " ^4/ ^ ' T 

Owner: /f^rOM/ o it'^<pi//(/f^l ^ 

Phone: -?'/^ , //y j ( J ""^ 5/fVi^^/ 

Restoration Items in Question: 

Item: 

item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

l y ^ 

y \ I iij^i't'c restoiation is completed, except as noted 

 I I do not agree r'estoration is completed 

Owncr's Signature / Date Contractor's Signature 

I
11 a 

I 9 CO 7,5.6 I ~, jtL ^ f l , . .— Total Quae ^^ftuar e Footaae to be Excavated = 2900 •S^^-^; 

Property Classification. 800 - J QlxAb ^ — C\ ^* 0 ^ ^ "'"°'^' 3:^^n e Linear Footage to be Excavated = 0 

^'^ ^ 

Utl'Z^l H 

5^/3'^/2. 

^'^ / V/-

HS' 

y'-^' 

(lo'li.'i'l L 

Legend North Arrow Omaha Lead Site 

Concrete Omatia, Nebraska 

• 

To Be Excavated Propert 1^

y Number 

Existing OLS-4720 8 Structure Scale 

Fence Property Address 

1 Inch = 20 feet or 1 grid = 5 x 5 ft 

Pernnanent Landscaping 

5611 S 24 ST 

Quadrant Boundary Post Excavation Concentrations (ppm) 

Street Boundary Fl . B2 PlayArea 4 \ V HG L 

F2 DZ Easement 

Tree/Stirub Bl Garden Other 

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

DZ, dnp zone (1-3 fool area of soil around the foundation of the house) 
Inspection notes: 

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

EPA Representati ve^^^R/^^^;^^ , ^, JI/:^^y_p M ///^f/4 x 
I q 0 0 7 ^ c Y)y ^ n / K -»Total Quae _are Footage to be Excavated = 2900 i c ^ 

P,'operty Classification. 800 A GUAb^b-?: /fe? '^ C Total Dl _^Wnee Linear Footage to oe Excavated = 0 *

.A

^••^!^j \ 

MZ-z z H y-^' 

^5" 

^^^/ v/. 

Legend 

Concrete 

ZZ To Be Excavated 

Existing Structure 

Fence 

Permanent Landscaping 

Quadrant Boundary 

Street Boundary 

Tree/Shrub 

L.i:;f',C'C'l '< 

'>\i\'0 

North Arrow Omaha Lead Site 

Omaha, Nebraska 

Scale 

1 Inch = 20 feet or 1 gnd = 5 x 5 ft 

Property Number 

OLS- 47208 

Property Address 

5611 S 24 ST 

3 

O V HG L Fl . 

F2 

Bl 

Post Excavation Concentrations (ppm) 

82 Play Area 

DZ Easement 

Garden Other

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

DZ. dnp zone (1-3 foot area of soil around the foundation of Ihe house) 
PROPERTY CLEARANCE WORKSHEET 

Date Property I D V 7 Z0<& lo-is-1^1 

Property Project Omah a Lead -- Fixed Price Addres s TUi X. zy^^ s^^

Measuremen t XRF ID 0107-5 1 Count/Tim e 

Field Shots 

Sho t # Readin g Sampl e Are a Sho t # Readin g Sampl e Are a 

/J9 ^ 2 t 4 - s 

( 7 0 4r7 f i v-u. 

116 faO g l c- g 

>ik> 5 3 Sz^ t- B 

Sampl e Are a B/i-s I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s L a b Analytica l Readin q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 

1 (Bag ) Sieved ) 7 

2 5"o 

3 ^ 7 s-i 

4 r o XRF Corrected Value —> 

5 (use calibration chart or add 

2 0 % to value) ^r 

Sampl e Are a f \ w-c* Pass/Fai l ? 

I n Sit u Composit e Composit e Analytica l 

Aliquo t Composit e Reading s L a b Analytica l Readin g Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 H9 (Bag ) Sieved ) ? 

2 -rz ^ 1 

3 ^? Cr^ ^ 7 

4 i^'t 4'4' 

XRF Corrected Value - > 

5 b'fc (use calibration chart or add 

T( 2 0 % to value) 

Sampl e Are a Rl L-fe Pass/Fai l ? 

I n Sit u Composit e Composit e Analytica l 

Aliquo t Composit e Reading s L a b Analytica l Readin g Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 5-C (Baq ) Sieved ) 7 

2 $"t.

4 

3 

^

V

G

B 

l \,

'^

n 

b Uo XRF Corrected Value —> 

5 b l (use calibration chart or add 

2 0 % to value) 75' 

Sampl e Are a ttt fe-ft Pass/Fai l ? 

I n Sit u Composit e Composit e Analytica l 

Aliquo t Composit e Reading s L a b Analytica l Readin g Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 t,l (Bag ) Sieved ) • > 

2 Si ^ t 3 ico 

4 5 1 hn S5 XRF Corrected Value - > 

5 ^/ (use calibration chart or add \ D ^ 

2 0 % to value) 

Sampl e Are a Pass/Fai l ? 

I n Sit u Composit e Composit e Analytica l Aliguo t Composit e Reading s L a b Analytica l Readin q Averag e (Drie d 81 Spil t Sen t (Bag ) Numbe r Result s 1 (Baq ) Sieved •> ) 

2 

3 

4 

XRF Corrected Value - > 

5 (use calibration chart or add 

2 0 % to value) 

^^^^ y ".y VC'-*."^^ 

l/.9f /IDDIIIOK/I l SHIFI S I I 

XRF Technician's Signiture mion i 
Page 1 of2 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 1912773. 

Original Call Date: 10/12/07 Time: 1:35 pm Op: LORI18790 


Work to Begin Date: 10/16/07 Time: 2:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 5611 Street: S 24TH ST 


Twp: 14N Rng: 13E Sect-Qtr: 09-NE,10-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD EXCAVATION 


Location of Work: LOCATE ENTIRE PROPERTY 


Remarks: UNSURE IF CORNER: EXTENDING WORK 


Company COASTAL ENVIRONMENTAL SERVICE 


Contact Name LORI Phone: (712)352-0188 


Alt. Contact NONE 


Work Being Done For: EPA 


Depth of Excavation: 3FT Corner Lot: N Front: Y Rear: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV DIGITEL LEVEL3 MCI MCLEODNE METRO MUD02 


OMAHACOF 0PPDGPR6 QLNNEIF QWEST2 SPRINTNE 


Service Area Contact Phone Number Utility 

Type 

CXCATV COX COMMUNICATIONS, 

INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

DIGITEL LIGHTCORE NA 

Day:

Alt:

 8665624349 

 8008509048 

Emerg: 8665624349 

LEVEL3 LEVEL3 

COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MCI MCI NO CALL PER MEMO 

Day: 8002893427 

Alt: 

Emerg: 8002893427 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/12/2007 
Page 2 of2 

MCLEODNE

METRO

MUD02 

OMAHACOF 

OPPDGPR6 

QLNNEIF

QWEST2 

SPRINTNE 

 MCLEODUSA 

 METRO COMM. COLLEGE 

METROPOLITAN UTILITIES 

DISTRICT 

CITY OF OMAHATRAFFICSEWER 

OMAHA PUBLIC POWER 

DISTRICT 

 QWEST LOCAL NETWORK

QWEST LONG DISTANCE

SPRINT COMMUNICATIONS 

CO 

DO NOT CALL OUT 

EMERGENCIES PER MEMO 

CHRIS 

EDWINA 

RON 

NA 

 NA 

 SARA 

Day: 


Alt: 


Emerg 


Day: 


Alt: 


Emerg-


Day: 


Alt: 


Emerg: 


Day: 


Alt: 


Emerg: 


Day: 


Alt: 


Emerg: 


Day: 


Alt: 


Emerg: 


Day: 


Alt: 


Emerg: 


Day: 


Alt: 


Emerg: 


8002891901 


8002891901 


4024572307 


4024572313 


4025047823 


4025047946 


4024447197 


4024445161 


4024445160 


4067289343 


8887289343 


4067289343 


8887289343 


8002834237 


3039921926 


8002834237 


8005210579 


8005210579 


http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/12/2007 
q 00 73.0 quare Footage to be Excavated = 2900 _ , ^ ^ <- /* / K -r^ l°t3' uuaiT^ jquare r-ooiage lo utt cxcavtiiKu - i3uu Property Classification: 800 J j 0?U.Ab2>— O A g i^C : Total Dl'.- --one Linear Footage to be Excavated = 0 

n .La..^ 7;<?Z-Z^!^/#^ y 

~U>TlCll H 

Legend North Arrow 

Concrete 

To Be Excavated 

Existing Structure Scale 

Fence 1 Inch = 20 feet or 1 grid = 5 x 5 ft 

Permanent Landscaping IVxi 

Quadrant Boundary 

Street Boundary V HG L 

o Tree/Shrub 

Omaha Lead Site 

Omaha, Nebraska 

Property Nunnber 

OLS- 47208 

Property Address 

5611 S 24 ST 

Post Excavation Concentrations (ppm) 

B2 Play Area 

DZ Easement 

Garden Other 

Description of post excavation areas: Fl , front yard left-hand quadrant; F2, front yard rigfit-fiand quadrant; 81 , backyard left-hand quadrant; B2. backyard right-hand quadrant: 

DZ. drip zone (1-3 foot area of soil around the foundation of the house). 
,^^'°J''^e, 

COASTA L ENVI R ONM t NTAL 

C R 0 U f , 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's Name: Daytime Phone: 

/tn-fo^.o G Cs^<.f ire / 

Address of Property 

covered by this y^// S- ZY ^ J \ 

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 all 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 
p*

 COASTA L i*"

 f NVIHOHMENTAI " i PRO-(«-* CROUP . IN C 

• 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 would tend to endanger the health or 

welfare of the Grantees or the environment, or to allow others to use the property in 

such a manner. 

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

Environmental Group, at (877) 234-6270. 

EMi grant access to my properties

 D I do not grant access to my properties 

Signaturee " I/ Dat Datee Signature

 Date 

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

Page 2 of 2 
COASTA L 

Restoration Agreement 

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

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

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

Protection Agency (EPA). 

Property ID: l/j2^ ^ 

Property Address: ­ !5i>// S- 2 V/ S f-

Owner: 

pinior\ic> ^ CS(7cf; y e / 

Phone: 

h i- 3/^-^/ ^ ^y 

On the attached diagram(s) indicate area(s) to e.xcavated and depth of e.xcavation. location of all known 

utilities, subsurface features, surface structures and landscaping features, access location(s) to be used by 

contractor, and the direction of North. Indicate distances, depths, material types, etc. Indicate digital photos 

by referencing the photo-log number 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 return of these items is the Owner's responsibility. 

Item: 

iloy](£ 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 1 of 
COASTA L 

tlNVlHONMEiSITAt . 

C R O U f IM C 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

nouL- Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 2 of 
COASTA L 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

^ . Z 

Item: 

J ' C> 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item; 

Item: 

Item: 

Item: 

Page 3 of 
Landscape Inventory 

(Use additional sheets as necessary) 

Item 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch 

trunk diaineter 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinkler 

Zones. Control Valves. 

Timers, Heads, etc. 

.Attach a sketch of the 

sprinkler laxoui. 

Number of and size of 

each garden/ llower bed 

area. 

.Atiacli a skeich of i-elaii\e 

sizes and locations. 

Quantity 

2lt>o 

A 

y 

y 

^ 

Unit 

Square feet 

Each 

Each 

Each 

Each 

Square Feet 

Condition/Type/Species 

Page 4 of 
COASTA L 

Item Quantity Unit Condition/Type/Species 

Agreed upon value of 

plant materials not to be 

replaced bv contractor. 

Note this value will be 

used to issue a plant 

\oucher to the propert> 

owner. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketch of were 

each plant will be placed 

b\ the coniractoi'. 

Agreed upon area of 

property to be replaced 

with grass sod. 

Include a ^kelch of ilie 

area(s) to he replaced \\iih 

grass sod. 

.Area of City or Count)' 

property to be landscaped 

per their requirements. 

Include a ^keu'li of the 

nrea (si 

Easement .Area, to be 

excavated 

y 

$ 

Each 

/ ^ 

2<iOO SF 

1 3 

SF 

SF 

Page 5of. 
COASTA L 

Additional Comments / Instructions: 

• 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 agree n I do not agree 

A i(f,fio ^J^^'oA 0 7- /f ~oi . c^T-yp'-'oy 

Owner's Signature / Date ^^y ^j^^-^ntractor' . s Signature Date 

Page 6 of.