## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO N FIL E FOLDE R 

# SAI D # : /y^^7 7 Date : Address : //¥ / S 3 3 S f 

### Remediatio n Contractor : _Coasta l Environmenta l Group _ Year : 200 7 SOI LREMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S 

# A Vide o o f property (DVD ) Executiv e Sutnmary EPA-provide dpropert y sketc h D 

# Z D 

### Signe dAcces s Agreemen t for subjec t property Signe dAcces s Agreement(s ) fo r adjacen t property Restoratio n Agreemen t Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) Confirmatio n dat a 

# A Photograph s As-buil t sketc h Satisfactory restoratio n signe db y Property Owne r 

# A Property close-ou t chec k lis t signe db y EP A Descriptio n o f area s no t meetin g RO D cleanu p criteri a 

## u u Utility clearance s Property informatio n fromDougla s County Assessor' s Offic e 

## u D D , D 

# mp 7 Dat e 4031789 0 

# II I Superfun d

## Propert yAcces s Checklis t PropertylD : Q-Q^'j ^ Propert y Address : ///-/ / 3P^'^^P f n D

WOR K STARTE D WORKCOMPELTE D ON : ON : / / / / Owner : Address : // ^ (/// l

^ ^ ^ / Sn^'HlZZ l ^ 3'3^/j ^ Renter : Phone : Fax : Cell/Paser : Additiona l Information : fax : Ccll/Pager : D Notificatio n Lette r Sent : / / By : r ^ L J r~ l

Acccs, s Agrccnicn t

Restoratio n Agreemen t Topsoi l Samplin g (ifapplicable ) Siuned : ^n Signed : ' P / l9Z)lCp I^l0l / By : By : By : 

## /liarcz ^ /liArczp>

n Di,sposa l Samplin g (i f applicahlc ) / / By : n ^ i " ^ n Garde n Samplin g (ifapplicable ) Utilit y Clearanc e Video/Photo s (Before ) Vidco/Photo s (During ) / / Called : ^/^/^/ 7



## oiv.'Xti 5"/^) ^ On : / / By : By r By : 

## ^z/sUiU i fijcM By : n Video/Photo s (After ) On : / / By : n Vidco/Photo s (30-Day ) On : / / By : [H Properl y Completio n Agreemen t 1 1 Fina l Repor t Sijincd : Issued : / / / / By : By : 

# 1 Ai r IVIonitorin g (a s applicahlc ] UJ Communit y CH Cre w Results : On : / / 

# 1 II CH Communit y Results : CH Cre w On: _ / / 

# 1

CH Communit y Results : CH Cre w On: _ / / By :

Omah a Lea d Sit eTota l (^Wcan t Squar e Footag e t o b e Excavate d = 45 0 PropertyClassification : 80 0 Tola l ^^ppn e Unea rFootag e t o b e Excavate d = 12 4

Descriptio n o f post excavatio n areas : Fl , fron t yar d left-han d quadrant ; F2 , fron t yar d right-han d quadrant : Bl , backyar d left-han d quadrant ; B2 , backyar d right-hand quadrant ; DZ , dri p zon e (1- 3 foo t are 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 Dougla s County-Omaha , N E

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 123637000 0 SNETHE N KEVI N R 114 1 S33S T OMAH A 6810 5

114 1 S33S T 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 HANSCO M PLAC E 7 1 5 W 168, 8 F T 5 0 X 168, 8

http://webarc,co,douglas.ne.us/dcassessor/details,asp ? PARCELNB=123637000 0 http://webarc,co,douglas,ne,us:8080/REALWARE/details,do ? id=R123637000 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 = 31 7 fee t appraisal , survey , o rfo rzonin g verification . 

### http://www.dogis.org/dogi s alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-.. . 5/29/200 7

## Property I D # Property Address : Initial Contact : Secon dContact : Fina l Contact : Fina l Action :

Comment : Owne r Commen t (s) : Site Coordinato r Commen t (s) : CONTAC T FORM .?65"7- 7 ^U , 

## iJM I S.3 ^ Date : Z\f2Jo y Time:i'-()b ^ Action : L^cj . becoW.- ; Date : "^74. ^ Time : H-t?* ^ (> hAction : \MoO ^ (/\ ^ po<9f L Date : Time : Action ; Transmi t t o EP A D Othe r Action : D

^ 

# V ^ IVt:^^ i^fKV^ ^

# i ^ Restoratio n Agreemen t Th e purpos e of thi s agreemen t i s to pro\id e amutual agreemen t a s to condiiion s o f property prio r t o reinediatio n aclivilies . Thi s will als o serv e a s decontaminatio n fo r th e purpos e o f assurin g tiia t restoratio n activitie s are complete dt o th e satisfactio n o f tii e property oune r andth e Unite dState s Environmenta l Protectio n Acenc v (EPA) ,

Propert yID : 

# ^.^^ m Property Address : 1^1^.^ / ^ '\Pp{* ' 'n\ ' O V 4 n p r• ' y. - M . _/ ^ . i l / . , I I y . - 

### Onner : 

## '^\\z \^'\Ai'\W(y \ Phone : V 

# o ^Iv ^ 

# z<^^ On the artaclie ddiagram(s ) indicate area(s ) to excavate danddept ho f excavation , locaiio n o f all known utilities , subsurfac e features , surfac e structure s an dlandscapin g features , acces s location(s ) to be use db v contractor , andth e directio n of North . Indicate distances , depths , material txpes . etc . hidicat e digita l pliot.^ s h

v referencin g th e photo-lo g numbe r wit ha n arrow indicaiin g directio n of v iew . 

### Item s T o B e Ramove d B yOwne rBefor e Star t O f Remediaticr. : (Us e additiona l sheet s a s necessary ) Th e removal , storage , disposal , and/o rretur n c f thes e item s i s th e Owrer' s rsspcr.sibillty . Item : 

# i- y 

# hi t ^ Item : y ^ Item : / ^ Item : ^ Item : y ^ Item : y ^ Item : ^ y Item : / Z Paq e 1 o f (/ ' T

### 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 0

### 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 : 

# fI^H
- ij \\)f(h/ ? Item : Item :



### Paq e 3 o f UV^s S 

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

### Ite m

Pre-existin g propert yare a tha t i s covere d wit h grass .

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

Numbe ro f trec b • = 2 inc h trun k diamete r

Numbe ro f Sprinkle r Zones . Contro l Valves , Tiniers . Heads , etc . Attac h a sketc h o f th e sprinkle rlavout .
Numbe ro f an d siz e o f eac h garden ' flovse rbe d area . Anac h a sketc h o f relativ e size s an d locations . 

### Quantit y Uni t Condition/Type/Specle s

Square feet



# w \ Eac h 

## 1( 7

y 

# y Eac h 

# y Eac h



### y 

# r Eac h Square Fee t

Pag e 4 o f M *

### Ite m Quantit y Uni t Conditlon/Type/Specie s Agree dupo n valu e o f plant material s not to b e replace dbv contractor . Note thi s valu e use dt o issu e vouche r t o the owner . wil l b e a plant propert y Agree dupo n lis t of plant material s tha t will b e replace dby contractor . B e ver y specifi c anddetailed . Each Includ e asketc ho f wer e eac hplant wil l be place d b

v th e contractor . ,'\gree dupo n are ao f properr v to b e replace d wit hgras s sod . Includ e asketcho f tli e area(s ) to b e replace dwit h siras s sod . 

### y 

# U SF

Are ao f Cit v o r Count y propen v t o b e landscape d pe r thei r requirements . SF 

# tfe f bv> ^

(^ ^ A Includ e are a(s ) a sketchof the



### Pag e 5 of l iAdditiona l Comment s / Instructions :



# - Wl/| « iiei^Hb(?f t



# - \\y i tlohfy^i^O i f \

• Chec k th e bo xi f Owne rdoe s not wan t CE G t o docutnen t interio rfoundatio n wall s an d possibl e pre-existin g damage . B ycheckin g thi s boxCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro f house , includin g foundatio n crack s o rfissures .

^ 

### I asrc e I I I d o no t agre e 

# n«< ^ I I I do no t agre e asre c

Owne rs Signatur e Dat e Pag e 6 o f _ U ictor' s Signatur e Dat e

# r .i * —S f #

-« C PKOt*- ^ 

## 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 Environmental Protectio n Agenc y (EPA ) o r it s authorize drepresentatives , collectivel y th e Grantee , to ente r an dperfor mcertai n environmenta l respons e activitie s upo n th e follovsing describe d premises :

Owner' s Name : «Owner_NaLme » 

## \^) M ^ 

# viefHt^ Davtim e Phone : 4^ ^ ^ «Secon dOwne r Nanie » 

### Address : «Property_Address » Address : | | ^ ^ ^ ^ ^^1 ^ ^ ^ Addresse s of Address : Propertie s covere dby * thi s Agreement : Address : Address : P L

### RPOS E O FRESPONS EACTIMTIE S 

### Th e EP.A i s requestin g acces s t o collec t soi l sample s andremov e soi l tha t contain s elevate dconcentration s o f arseni c and'o r leadan dma y pos e ahealt hhazard . Th e soi l wil l b e renio\e dandth e e.xcavatedarea(s ) wil l b e replace dwit hclean material s an d restored . Thi s wor k

i s bein g performe dunde r th e Omah aLea dSil e Superfun dSite remediatio n program . A

n EP.A representativ e wil l contac t th e Granto r in-perso n t o discus s the wor k

to b e performed , th e Granto r wil l hav e a n opportunity t o revie w an dapprov e th e planne dsoi l removal , an drestoratio 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 re\ie w th e wor k

an dconfir mthat i l i s complet e an dmeet s wit hth e Grantor' s approval . Upo n completion , th e Granto r wil l receiv e writte n documentatio n fro mEPA tha t th e property ha s bee n remediated . ENVIRONMENT.A LRESPONS E ACTION 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 andsubcontractor s th e right t o ente r th e property , a t all 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 shal l remai n i n effec t unti l th e wor k

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

«Frcperf / 

### Paa e 1 o f 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 tha t th e Granto r o r th e Grantor' s tenan t ma y wis h t o save ; Water an dmaintai n replacemen t vegetation , includin g fertilizer application , a s necessary subsequen t to a n initial waterin g perio dby EPA ; Abid e b y healthan dsafet y guidanc e provide db y EPA ; Ifth e propert y i s rented , assis t EPA i n obtainin g tenan t approval fo r acces s to th e property t o perfor mth e wor k

if EPA i s unabl e t o obtai n suc haccess : an d Allo w videotapin g and/o r photograph y o f th e property includin g exterio r and interio r area s o f buildings . .AGREEMEN T NO T T O INTERFERE 

### Th e Granto r agree s no t t o interfere o r tampe r vvit han y ofth e activitie s or wor k

done , o r th e equipmen t use dt o perfomi th e activities , o r to undertak e an y action s regardin g th e us e o f sai dproperty whic hwoul dlen dto endange r th e healt hor welfar e ofth e Grantee s o r

th e en v ironment . o r t

o allo w other s to us e th e property i n suc hamanner . Shoul dyo u hav e any question s about thi s program , pleas e contac t ???? ? ???'; ' a t ???-??'?
­ 009 9


### 1 gran t acces s t o my propertie s I I I d o not gran t acces s t o m y propertie s ^ 

# 2SIfiAiHi l yAj^iuizi^x.

_J^^A^ ^ >ignatur e Dat e ^Signatur e D4* e

I I 1 v^oul dlik e t o be presen t durin g an y samplin g tha t i s required .
Pag e 2 o f 2 (P-.-ro-r, . TT vPROPERTY CLEARANC E WORKSHEE T

Dat e Propert yI D 

# (V4)?)^^ 7_OS-i n Propert y Projec t Omah a Lea d — Fixe d Pric e Addres s 

## iiM\Sr s -y^'^- ^ t>1easuremen t XR F I D 0107-5 1 Count/Tim e Fiel d SInot s Sho t # Readin g Sampl e Are a Shot # Readin g Sampl e Are a

7. Z \ie . 

### hA - u. ) y(-C \ 

## Lx

a ^PZ . \ 7 -' M ^ 7 _ \<?/ „ l^ t r,-t- -
Sampl e Are a 

# f;n-u ^ 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 (Bag ) Numbe r Result s 1 (Baq ) Sieved ) 7 2 

## ZIL . 3 \loC > 4 Q O 

# 12 5 XR F Correcte d Valu e - > 5 (us e calibratio n char t o rad d 20 % t o value ) 

# i5 G Sampl e Are a 

### .> 7 p-iS' - 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 (Bag ) Numbe r Result s 1 (Bag ) Sieved ) 7 2 

### i^? ^ 3 Z Z 

# \CP \ 4 i^: ^ XR F Correcte d Valu e - > 5 (us e calibratio n char t o rad d 

## \3G . 20»/ o t o value ) Sampl e Are a Pass/Fai l ? 

# r \

^- ^ I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s La b Analytica l Readin q Averag e (Drie d & Spil t Sen t (Bag ) 7 Numbe r Result s 1 l-a- ^ (Bag ) Sieved ) 2 i<^ ^ i'V^ 3 1Z\C ^ -2JCX J 

# l?6 . 4 \-l< ^ •Zil ^ 7JS3 - > XR F Correcte d Valu e 5 (us e calibratio n char t o rad d 20 % t o value ) 

# c53 3 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 q Averag e (Drie d & Spil t Sen t (Bag ) 7 Numbe r Result s 1 (Bag ) Sieved ) 2 3 4 XR F Correcte d Valu e - > 5 (us e calibratio n char t o rad d 20 % t o value ) 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 q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 (Bag ) Sieved ) 7 2 3 4 XR F Correcte d Valu e - > 5 (us e calibratio n char t o rad d 20 % t o value ) US E ADOIIWHA I SHEET S I F HEEDE D XR F Teclinician' s Signitur e

### /ZOL \ S ^^^ ^

I V/^^TP *

%«a^ ^ 

### 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 ENVIRONMENTA L G H O u P . INC . 

# EXECUTIV E SUMMARY : 20577—114 1 S . 33'''S T

X 

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

# As-Buil t Drawin g COASTA L 

# Dmah aLea dSuperfun dSit e
Tota l Quadran t Squar e Footag e t o b e Excavate d = 45 0 Propert yClassification : 80 0 Tota l Dri p Zon e Linea rFootag e t o b e Excavate d » 12 4 Propert yextend s a n oth$ r2 2 fee t 

# O Q 

# O

EA=12 5 PP M

. !^ . j,-i.,-A-r--'-'.4.,---!.-A>>0 ' 

# mm^ Sout h 3 3 Stree t Legen d pLS#:2057 7 Nort h Arro w Omah a Lea d Sit e Oinaha , Nebrask a [^f e ^cavated : Propert yNumbe r te USEP Afeigned Off:6/29/0 7 OLS - 2057 7 Scal e

- * F«rKe Propert yAddres s 1 Inc h = 2 0 fee t o r1 gri d » 5 x5 f t Permanen t Landscapin g 114 1 S 3 3 S T

——— Quadran t Boundar y Pos t Excavatio n Concentration s (ppm ) Stree t Boundary F 1 . B 2 Pla yAre a 

# J t / • HGI . F 2 D Z Easemen t \ y TrG«.'Shnj b 

# l^ V l X 

# - J i •= • HyHr,,.,.,, ! ,„; „ II K Bl ' Garde n Othe r ^^PTM- ^ Descriptio n o t pos t evcavatio n araa s Ft . front yar d l»ft-t^an d quadrant : F2 . fro m yar d n^jtil-tian d quadrant : B 1 backyar d lett-han d quadran t B2 . backyar d nght-han d quadran i OZ , d(T>2an«|t- 3 tootaiee i a t soi l groun d th a toundvlio n o f lli « house ) Legen d Are a no t Excavate d Dripzon e Excavatec i Quatdrant 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 th e completio n o f remedial activitie s perfonne don m y property . M y signatur e wil l dcsignal c tha t I a msalisfic dwit hth e restoratio n o f m y property , andthat n o item s arc i n questions , now . or a

t an y lim e i n th e future , cxccp l thos e item s liste dbelow , ifany . Propert yID : 

# ^^^57- 7 Property Address : j / J_J / ^ ^ 33 ^ S A ovvner : 

# Z^i'i n Sz^tAuP i Phone : 

# 7^97
- ^oA A Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item : Additiona l Comments :

L ^ I iigro o restonitio n i s coinplete<l , excep t H

S note d I I d o not aprc c restoratio n i s coniptrtc d 

# AI1XJ 7 OWncr' s Signat u 

### Dat e I

# SEP A % 

# A Propert y Clos e Ou t F o 

# t Propert y # : 

# ^^7- 1 Propert y Address : / /^ / S . 33'^S'i r Date/Time : Owner' i Name : Z J Z Z ^ PneZH i n Quad s Excavated : Contracto r Grou p Excavatio n Gcnen l 

### Yes N o 1 . I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? ^ 2 . I f ncccssa^ , wer e th e correc t area s ofdri p zon e excavate dan drestored ? l y Gradln £So dan dVesctatio aYe s N o 1 .Ooe s th e gradin g aroun dth e perimeter ofth e hous e in excavate darea s generall y slop e away t ^ fromth e botue ? 2 . Ha s so dbeen lai di n al l area s tha t were excavated ? i ^ 3 .

Doe s th e sodappea r t o b e generall y healthy an dgrowing ? (Onl v evaluat e if inspecte da t a3 0 

### y da y tim e period ) 4 . Ar e sodde darea s gcnerall v fir man devenl y graded ? L ^ 5 . Ar e th e joint s twtwee n th e so dstrip s generall y tight ? (Onl y e% aloat e i f inspecte da t z ? 0 da y * X tim e period ) 6 . Wa s th e property grade dsuc htha t water w ill no t poo l o r th e propet)" ]j * ^ 7 . Wa s damag e t o landscapin g o r plan t material s avoided ?4 ^ Galc v FCDCC S aa dRcuinin t '^aii s Ye s .N o '. . D o gate s open an dclos e freely? ifapplicable ) ^ 1 2 , Wer e all gate s or fence s lake n dov^T i durin g restoratio n acti' i itie s reir>.s'ji!!ed ? ifapplicable ) j » ^ 1 3 . Wa s damag e t o gate s o r fence s avoided ? (I f applicable )• 4 . Wa s damag e t c retainin g » • all s avoided ? (.Ifapplicable )u ^ , Foundation , SidiB f an dGutter s Yes S' o 1 , Wa s damag e t c th e sidin g or trimavoided ? 

### y 2 . Wa s damagf e t o th e foundatio n avoided ? t ^ 3 , Wa s damag e t o window s avoided ? ^ 4 . Wa s damag e t o window s o r door screen s avoided ? «*- ' 5 , Wa s damag e t c downspout s o r downspout extension s avoided ? Sidewalk s an dDriveway s (Concrete ) \es No 1 , Wa s damag e t o drivewa y surface s avoided ? jjj ^ 2 , Wa s daraag e t o walkwa y surface s avoided ? 

### t y 1

## Inspectio n nctes :
laf d' ' ^ '^

— ^KA-^-a
- ­



## Remc\'a l an drestcration acihaie s con".p!et e includin g ih e 30-da y sod'^^arrant}' : EP.' \Representative^ 

# >Jc^j t ^/^f/zz y