## TRANSMITTALo f

OMAHALEA D SIT E SOILREMEDIATIO NFIL EFOLDE R
SAID#^ : 

# I'l l V ^ Date : ^ 

# 1 1 Addres.s : felV M'^ 1 " ^ T Remediaiio nContractor : Coasta l Environmenta l Grou p Year : _20]0ARR A

/
/



# y A A A "k r 

# A SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f property (DVD ) Executiv e Summar y EPA-provide dproperl y sketc h Signe dAcces s Agreemen t fo r subjec t property Signe dAcces s Agreement(s ) fo r adjacent property Restoratio nAgreement Settlemen t documenl s (i.e. , fo r damag e or l o replac e plants , etc. ) Confirmatio n dat a 

### Photograph s 1 f t pp C/^iXXU; ^ y OpZ/)(i/rac ^ ^ i<c^ ^ As-buil l skelc h Satisfactory restoratio nsigne db y Property Owner Property close-ou t chec k lis t signe db y EPA Descriptio no f area s not meetin g RO D cleanu p criteri a Utility clearance s Property informatio nfro mDougla s County Assessor' s Offic e



## 0 ^ 

# jT' ^ l j Date 3021882 1 

# H i Superfun d

## Propert yAcces s Checklis t Propert y ID : 2'\\'y n D WOR K STARTE D ON : / /_ Properl y Addres s D WORKCOMPELTE D ON : / /
Owne r _C.»V> ^ fi£ OAt.«LV«
. Address : Cell/Pager : Phone : Additiona l Inlormation : HcfV.HH«A
. Ha.M» > Fax : Ccll/Pager :

• Notificatio nLette r Sent ; / / Bv : B Acces s Agreemen t Siened : \ p / t

M / u

> By : ¥*w y ^ Restoratio nAgreemen t Signed : ua/v» \A o By : t o Ve t O Topsoil Samplin g (if applicable ) / • / By : Q Disposa l Samplin g (if applicable ) By : / / 1 Q Garde nSamplin g (i f applicable ) / / By : S I Utilit y Clearanc e Called:, « / v« . / v

» By : Q

D Video/Photo s (Before ) On : i o / \v \/

l o By : D Video/Photo s (During ) On : / / By : D Video/Photo s (After ) On : / / Bj : D Video/Photo s (30-Day ) On : / / By : O Propert y Completio nAgreemen t Siened : / / By : 1 • Fina J Repor t {.•isued : / / By : Ai rMonitorin g (as applicable )

D Communit y• Cre w On : / / 

# z: i By : Results : D Community ' D Cre w| On : / / | By : Results :

Omah a Lea d Sit e 

# 1

### Dougla s County Accoun t I n

## ^^B^io n Pag e 1 of 2
Dougla s County , Nebrask a Propert yRecor d Informatio n i s vali d a s o f2010-8-3 0 Owne r CITYO F OMAH A C/ 0 PLANNIN G DEPARTMEN T 181 9 FARNA M S T OMAH AN E 68183-000 0 Propert yInformatio n ­ R092033000 0 Prin t Report , Vie wInteractiv e GI S Ma p

Treasurer' s Ta xReport , Ne wFeatur e - ^ ." ^ - ^ Subdivisio n Sale s Searc h

Ke yNumber : Accoun t Type : Parce l Number : Parce l Address : Lega l Description : Valu e Informatio n 203 3 OOO O 0 9 E xGovernmen t 092033000 0 221 3 MIAM I S T OMAH AN E 68110-000 0 DENISE S AD D LO T5 BLOC K1 5 0 X 12 2
Lan d Improvemen t Tota l 201 0 $0.0 0 $0.0 0 $0.0 0 200 9 $0.0 0 $0.0 0 $0.0 0 200 8 $0.0 0 $0.0 0 $0.0 0 200 7 $500.0 0 $0.0 0 $500.0 0 200 6 $500.0 0 $0.0 0 $500.0 0 2005 $500.0 0 $0.0 0 $500.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 4 6100. 0 0. 0 122. 0 50. 0 Ye s



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R092.
. . 9/3/201 0

### Dougla s County Accoun t In^Batio n Pag e 2 of 2 % '



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### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R092.
. . 9/3/201 0

### Pag e 1 o f 1 %
[ Creat e Anothe rTicke t ] Bac k t o Irt h Inteme t ] Sen d Emai l



### • YOU RTICKE T NUMBERI S 2627871
. Origina l Cal l Date : 10/27/1 0 Time : 2:2 8 pm Op : ELIZABETH1879 0 Wor k t o Begi n Date : 10/29/1 0 Time : 3:0 0 pm State : N E County : DOUGLA S Place : OMAH A Address : 221 3 Street : MIAM I S T Twp : 15 NRng : 13 E Sect-Qtr : 09-SE,10-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATIO N Locatio n o f Work : LOCAT E ENTIR E PROPERTY , AL L EASEMENT S AN D T O TH E PEDESTAL Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E I F CORNE R LOT . Compan y: COASTAL ENVIRONMENTAL SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : COASTAL Dept h o f Excavation : 4 F T Corne r Lot : N Front : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCATV 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 , INC HEIDI 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
MUDO l METROPOLITA NUTILITIE S DISTRIC T SANDY 

### Day : 402504782 3 Alt : Emerg : 402504797 0
OMAHACOFCIT Y OFOMAHA-TRAFFICSEWERRICH/TRAFFIC 

### Day : 402444719 7 Alt : 402444516 1 

### Emerg : 402444516 0
OPPDGPR5 OMAH APUBLIC POWE RDISTRIC T EL M LOCATING 

### Day : 406728934 3 Alt : 406207149 4 

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

### EL M LOCATIN G Day : 406728934 3

Alt : 406207149 4

Emerg : 888728934 3
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.
. . 10/27/201 0

# ^ As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e OLS# : 2912 0 Dat e Excavated : 11/1/201 0 Dat e USEP ASigne d Off : 12/2/201 0 Are a Sodden : 137 0 s a f t 

### 2912 0

Omah aLea dSil e

Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are areplace d So d wit h Are areplace dwit h Rock/Mulc h Are alef t bar e Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
. 4613 0

### % 

# 2912 0 \ o /:i ^

4613 0% 

# 2912 0 Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e Owne rName : WILLIA M PHILMO N • Goo d 

### Sit e Sketc h Address : 221 3 MIAM I ST • Poo r Phone : H : • No t pain t

Omah aLea dSit e 4613 0

# 2912 0

Omah aLea dSite 4613 0t c; ; s " I AI I ^ M ^ 0 h K I
. W
. I 

### ('A)\\i::i\\ \1r; f /y(.:('.v.i r 'l C !"U)|K-li y RIGH TO F ENTR YT O PREMISE S 

### Gtgnlo t (th e pfopert^ ' ownei ) consei'il h t o sri d aulhoiize s th e l'nite d Slate s Fnvironmenta l Protectio n Agenc y(F-PA) o i it s authorize d representatives , collectivel y th e Grantee , t o ente rsn d perfor m certai n envitonmenta ! lespons e activitie s upo n th e followin g describe d premises :

Owner s kame : ^; Aar f0,rn ^ i/X - Da^flim e Phone : i-^L^L/ - c/ i \^ y

Addres s o fPropert y covere d b ythi s 

### <^^/ 3 rfltfi^r^' i S^<-^ Z Agreement :
PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP Ai s requestin g acces s t o collec t soi l sample s an d remov e soi l tha t contain s elevate d concentration s o flea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t o remov e 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 fCoasta l Environmenta l Group , contracte d b yUSEPA , wil l contac t 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 removai , 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 meet s wit h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m EP Atha t th e propert y ha s bee n remediated
.
ENVIRONMENTA L RESPONS E ACTIOW S 

### B ysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , it s employees , contractor s an d subcontractor s th e righ t t o ente rth e property , a t al l reasonabl e time s an d wit h prio rnotice , to rth e sol e purpos e o fperformin g th e wor k Thi s acces s shal l remai n i n effec t 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?C C AS "1 / I '. * V U 0 » •••

• f• U I C f l C I ' ' 

### ( Remov e obstruction s incluriin g boats , tiaileis
. ve.hiciGs , i';lay&.cai)C - iK-'Tir , WCKJ O 

### piles , do o tiouses , etc ; I [Remov e fiovi'e i bulb s o i pient s tha t th e Granto i o t th e Giaritoi' s tc-iicn t ma yw t o save ; is h Wate ran d maintai n leplacernen t vegetation , includin o iertili/e rapplication , a s necessary ' subsequen 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 fth e properl yi s rented , assis t EP Ai n obtainin g tenan t api:)iov8 ! fo i th e propert yt o perfor m th e work
. acces s t o I Allo wvideotapin g and/o rphotographin g o l th e property
. AGREEMEN THO I T 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 i wit h an y o fth e wor k done , o rwit h th e equipmen t use d o n hi s properly , 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 fth 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 (402 ) 991-119 9

I gran t acces s t o m ypropertie s • I d o no t gran t acces s t o m ypropertie s 

# .£^^ytyj z /Y-^y-z'^yo

Signature ^ Dat e Signatur e Dat e

G I >vo;Jio ' [fkt i t o b e nfesen i ciu.tirij j an ysannpljrt ctha i i s lepniieo
. • • • c

Pao e 2 of2C O AS TAL C M O U P
. t N C 

## Restoratio n Agreemen t Tli e purpos e o f thi s agreemen t i s t o provid e amutual agreement a s t o condition s o f th e property prio r t o remediatio nactivities
. Thi s wil l als o serv e a s documentatio nfo r th e purpos e o f assurin g that restoralio n activitie s are complete dt o th e satisfactio no f th e property owne r an dth e Unite dState s Environmental Protectio nAgenc y (EPA)
.

Property ID : QS{l2i > Property Address : ^^, 3 ^,^^ ; ^^^ ^ Owner : Z2/- K c^t

- ZZm^y^l ^ Phone : H'JH-^i^'-i Z O nth e attache ddiagram(s ) indicat e area(s ) t o excavate , surfac e stmcture s andlandscapin g feature s and acces s location(s ) t o b e use db y th e contractors . Indicate distances , depths , material types , etc . Photographicall y andVideographicall y document th e existin g condition s ofth e propert y andth e basement i

f necessary . Item s t o b e Remove d b yth e Owne rbefor e Star t o f Remediation : Th e removal , storage , disposal , and/o rretur n o f thes e item s i s th e Owner' s responsibilit y



### Item s t o b e Remove d b yth e Contracto rDurin g Remediatio n an d No t Replace d Item : Item : Item : Item :

Pag e 1 o f 2COASTA L tNVIRONMrNTA L CROUP , ) N C 

### Item s t o B e Remove d B yContracto rDurin g Remediatio n an d Replace d

Landscap e Inventor y Ite m Quantit y Uni t Condition/Type/Specie s Pre-existin g property area , Quadrant s tha t will b e excavated , tha t 

# N i s covere dwit hgrass . Number o f tree s > 2 inch 

# J i ~ Eac h trunk diamete r Number o f tree s < = 2 inc h 

# M- y Eac h trunk diameter Numbe r o f Sprinkler Zones , Contro l Valves , Eac h Timers , Heads , etc . Attachasketc hof the .sprinkle r layout
. Number o f andsiz e o f eac hgarden / flowe r be d Eac h area . Square Feet Alt;icl \asketc hof reiiiti\ e -.ize s an dlocaticm.s
. Agree dupo nvalu e o f plant material s no t t o b e replace db y contractor . \()t c thi s Milii f will he 'isf di o issiit

- i \pliiii l (URIU TH I till ' proptri ) l)> \!UT
. Easement Area , to b e Each excavate d
Pag e 2 o fSC O AS Ty * L CROUP
.
Additiona l Comment s / Instructions : Th e cit yo fOmah a ordinance s ma yprohibi t yo u fro m usin g dir t o rgrave l area s o n you rpropert y a s driveway s o rvehicl e parkin g areas . Th e Environmenta l Protectio n Agenc y(EPA ) ma yb e removin g an d replacin g soi l underlyin g a grave l o rdir t are a o n you rpropert ytha t yo u ma yb e usin g a s a drivewa yo rvehicl e parkin g area . I fthi s i s th e case , yo u shoul d understan d tha t thi s removin g an d replacin g o fsoi l doe s no t mea n tha t an yillega l drivewa yo rparkin g are a o n you r propert yi s mad e legal
. T o th e contrary , yo u ma yb e cite d b yth e cit yi fyo u us e a grave l o rdir t are a a s a drivewa yo rparkin g area , no t withstandin g an yremova l o rreplacemen t o fsoi l b yth e EPA
. I fyo u hav e an yquestio n abou t legalit yo fa certai n drivewa yo rparkin g area , yo u ma ycontac t th e cit yo fOmaha' s Plannin g Departmen t a t (402 ) 444-5150
. l

^

Pleas e chec k thi s bo xi fyo u understan d th e informatio n outline d above
.



# J
. 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 possibl 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
.



# Oi l agre e Q I d o no t agre e 

## y^c)^Z'^dJ o '^CtlftAUi^ Dat e Contractor' s Signatur e Dat e Pag e 3 o fjS
.

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 7 2 Mod e SOI L Tim e 2011-01-1 9 11:3 4 Duratio n 91.5 5 Sequenc e Fina l Flag s AVERAG E Av g o f69-7 1 ADDRES S 221 3 MIAM I S T QUADRAN T E A DEPH T 1 " XR F TEC H C.PADILL A MIS C CONFIRMATIO N NOT E CLEA R

pp m P b 242 , Supervise d By :

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 236.02 4 Supervise d By : 

## Certificat e o f Verificatio n

6 9 SOI L 2011-01-1 9 11:3 3 30.6 5 Fina l 2912 0 221 3 MIAM I S T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 19.91 1

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 251.03 7 Supervise d By : 

## Certificat e o f Verificatio n

7 0 SOI L 2011-01-1 9 11:3 4 30.3 1 Fina l 2912 0 221 3 MIAM I S T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r 23.64 2

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 240.48 5 Supervise d By : 

## Certificat e o f Verificatio n

7 1 SOI L 2011-01-1 9 11:3 4 30.5 9 Fina l 2912 0 221 3 MIAM I S T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 20.58 7

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

P b Supervise d By : 

## Certificat e o fVerificatio n

6 8 SOI L 2011-01-1 9 11:3 2 92.3 8 Fina l Av g o f65-6 7 221 3 MIAM I S T F l 4 " C.PADILL A CONFIRMATIO N CLEA R

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 200.83 3 Supervise d By : 

## Certificat e o f Verificatio n

6 5 SOI L 2011-01-1 9 11:3 0 30.9 1 Fina l 2912 0 221 3 MIAM I S T F l 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 19.07 4

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 231.28 6 Supervise d By : 

## Certificat e o f Verificatio n

6 6 SOI L 2011-01-1 9 11:3 1 30.5 6 Fina l 2912 0 221 3 MIAM I S T F l 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r 20.68 8

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 188.78 4 Supervise d By : 

## Certificat e o f Verificatio n

6 7 SOI L 2011-01-1 9 11:3 2 30.9 1 Fina l 2912 0 221 3 MIAM I S T F l 4 " C.PADILL A CONFIRMATIO N CLEA R

Erro r 18.83 4I,
. .. . , . — 

### / jO k \ Omah a 

### a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
. M . j ^

www.coastalhazmat.co m 

### ^sg ^ '^tPROit^ COASTA L INVIIONNENTA L GROUP , IN C 

# EXECUTIV ESUMMARY : BVID #29120-(221 3 MIAM I ST ) No Issue s or Concern s | ^ Issues/Concern s Detail Explanation : -DANGARVE Y WALKE D TH EPROPERT YON12/2/201 0

# i^
EP APropcrt> ' Clos e Ou t For m Proptrt y Addrwr
. - >**'* ' *^^«"^ ^ "^ ^ Dste/Tlrne : Owner' s Neni t / : & ^ g t Oi>ry>,V.v-- = Quad s F.xravHi^d : Y \ Contratlo rCrou p _ (bA^1>t\ y Propert y *( ; aiS\>.D^
.
E;icava(|o n Grntni l 1 I fneccssar)' , wer e th ccorrec t quadrant(j ) excavate d an d restored' ' 2 I fneccssar)' , wer e (h e correc t areas o fdn p /on e excavate d an d restored' ' C radJD g So d an d VrncUlio p Ve s t^i i 1 Doe s th e gradin g aroun d th e perimete rofth e hous e i n excavairr i area ? generall y^ki| Kawa \ from th e house ? 2 Ha s so d bee n lai d i n al l area s tha t wer e excavated ? 

# z
i Doc s Ih e sodappear to b e generall y healthy an dgrowling ? (Onl y ev?tluaie i f inspertr da t a3 0 da y tim t ptriod )
_. . 

## AZ \ 4 /\r e sodde d area s generall yfir m an d evenl ygraded' '

' ' Ar e th e joint s betwee n th e so d strip s generall yfigh f (Onl yevaluat e i finspccic d a t a I' D da y 

### ^ / / lim e period )
_^ 

### r 6 Wa s th e propert ygrade d suc h tha i wate rwil l rio i poo l n n ih t proptnv' ^ 1 Wa s damag e t o landscapin g o rplan t material s avoided' ' 

### ; /
Gates
. Ftncc s ap d Rcuioln g Wall s D o gate s ope n an d clos e freely^ fi fappli ( able ) • / : , Wer e al l gates o i fence s take n dow n durin g restoratio n acliviiie s reinstalled' ' (I I apolicahlf '
^ Wa s damag e t o gate s o rfence s avoided ? (Ifappiicablc j 

### J yi
. 1 Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) 

# \.^ y roundatioQ , Sidin t an d Cutler s ____ Vc>

_N c I Wa s damag e l o th e sidin g o rtri m avoided ^ ? W'as damag e t n th e foundatio n avoided' ' Wa s damag e t cwindow s avoided' '

^ Wa s dannag e t o window s o rdoo rKreen s avoided' ' 

# y y^ i • - (

. ' Wa. < damag e t o downspout s o rdownspou t txien.sion j aMiidcd ' 

### / I Sidewalk s an d Driveway s (Concrete ) > f S M ­ 1 Wa s damag e t o drivewa ysurface s avoided ' 2
. Wa s daniBg e t o walkwa ysurface s avoided' ' 

# 1 y "

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