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

' • ' • . - ' • • . • . • ^ 

## SAID#: " / 7^^97 7 . . Date: ' ^/s/^0 7 Address : JlTk) ^ /jZ^nSCl^/ n Remediatio n Contractor : Coasta l Environmenta l Group

_Yea n 2007 SOI LREMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S 

# Z Vide o o f propert y (DVD ) Executiv e Summar y y EPA-provide dpropert y sketc h WSigne dAcces s Agreemen t fo r

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

adjacen t propert y WRestoratio n Agreemen t 5 r Settlement doctmient s (i.e. , fo r

damag e o r

t o replac e plants , etc. ) 

# r

A Confirmatio n data 

## Photograph s be^Qne , ^ (Jarin Q ) ^Q<n ^ 3DMr,J ^ fl^ As-buil t sketc hd V Satisfactor y restoratio n signe db y Propert y Owne r ^ - Propert y close-out chec k

lis t signedby EP A 7/^2/^2^ ^ Q- Descriptio n o f area s not meetin g RO D cleanu p criteri a D . Utilit y clearance s 0 Propert y information fix)mDougla s Count y Assessor' s Office



## a C ^ 

# ^xJjTJ y y^^^^^i^rX ^ ^'/^/j^ 7

Signatur e Dat e 4031712 4 

# flli l ouperfun d

## Propert yAcces s Checklis t PropertylD : l']'7^[ ) 

### D WORK STARTE D ON : / /_ Propert y Address : ^M ^ HdnS/ > 0)} i ^^^/VA I 

### n WORKCOMPELTE D ON : / / 0.yucr:.^ lO m71^71)^ 1 M Renter : Address : 

## Phone : ^^l^-I5i£ 0 Fax : Cell/Pii)ier : D Notificatio n Lette r ^ Acces s Agreemen t 1 ^ Restoratio n Agreemen t C ] Topsoi l Samplin g (ifapplicable ) n Disposa l Samplin g (if applicable ) n Garde n Samplin g (if applicalile ) "S L Utility Clearanc e QLVideo/Photo s (Before ) CS'

^ Video/Photo s (During ) S^Video/Photo s (After ) n Video/Photo s (30-Day ) C

H Propert y Completio n Agreemen t 1 1 Fina l Repor t A i rMoniiorin g (a s applicable )

M Communit yL J Cre w O n : Results : n Communit y\Z \ Cre w O n : Results : D Communit yQ Cre w O n : Results : Phone : Fax : Cell/Pajjcr : Additiona l Information :

Sent : / / 

### Signed : 5_/M/. ^ Signed : S iB^ I U l 1 1 1 1 1 1 Called : 5 " l3 0 lO l

On : S - 1 ^ % 0- 1 

## On:_liL/ii/X) 1 On:_i£/Ji£/J) l On : / / Signed : / / Lssued : / /
/ / By : / / By : / / By :

Omah a Lea d Sit e By : 

## ^yyJ?fS^'A/(^/Z0 5 

# »•>'

= fUZirco 5 By : By : By : 

# ^yy^/sh^ y By : 0c y By

= nA( ^ By : (liOA . By : By : By :

### Tota Tota l C^^Mn t Squar e Footag e to be Excavate d = 263 5 PropertyClassification : 80 0 Tot^^ J Zon e Linea rFootag e to be Excavate d = 51 

### ,%% h . l ( A

Descriptio n of pos t excavatio n areas ; F1 , fron t yar d left-han d quadrant ; F2 , fron t yar d right-hand quadrant ; Bl , backyard left-han d quadrant ; B2 , backyard right-hand quadrant ; OZ . dri p zon e (1- 3 foo t are a of soi l aroun d th e foundatio n of tti e house) .

## CONTAC T FORM Property I D # 

# iW o Property Address : 

# MAytkiisdo/z i ^ y Initial Contact : Date : oJ^3/c 7 Time : gg3 0 Action : l^ ^ \^r2oc.k^ i Secon dContact : Date:J o Time : i^^ o Action : ^1/^M ^ HC& ^ 

## Fina l Contact : Date : Time : Action : Fina l Action : Transmi t t o EP A D Othe r Action : ^

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

# Villi Uv^h \\\^ i \^ ^ "[ - Pu^^ ^ fM/i r

### £T t 

## Consen t Fo rAcces s T o Propert y RKHI T O FENTR Y T O PRFMLSH S 

### Granto r (th e propert y owner ) consent s t o an dauthorize s th e Unite dState s Environmental Protectio n Agenc y (EPA ) or it s authorize drepresentatives , collectivel y th e Grantee , t o enter an dperfomi certai n environmental respons e activitie s upo n th e followin g descnbe d preinises :

Owner' s Name : Daytim e Phone : 

## l A r>\ . 

## Ui/J^^nr.J A v.) A 9V^ - /.y/. o Address : 2IPS ' y^ n <,&(y ^ o ) ( u<S> Address : 

### Addresse s of Propertie s covere db y Address : thi s Agreement : Address : Address : PuRPosi : o r Ri-:.sp()Nsi - ACTIVITII- S 

### Th e EP. \i s requestin g acces s to collec t soil sample s an dremov e soil tha t contain s elevate dconcentration s o f arseni c and/o r lea dandma y pos e ahealt h hazard . The soil will b e remove dan dth e excavate darea(s ) will b e replace dwit h clean material s and restored . Thi s wor k

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

n EP A representativ e will contac t th e Granto r in-perso n t o discus s th e wor k

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

before i t begins . Onc e th e wor k

i s fmished , th e Granto r will b e aske dt o review th e wor k

an dconfir mtha t i

t i s complet e andmeet s wit h th e Grantor' s approval . Upon completion , th e Granto r will receiv e writte n documentatio n fro mEPA tha t th e propert y ha s been remediated . ENVIRONMFNTAI . 

### Rr-.spoN.si.- : AcrioN. 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 andsubcontractor s th e right t o enter th e property , a t all reasonabl e time s an d wit h prio r notice , fo r

th e sol e purpos e o f pertbrinin g th e work . Thi s acces s shal l remai n i n effect unti l th e wor k

ha s been satisfactoril y complete dTh e Granto r als o agree s to :

«Property_ID » 

### Pag e 1 o f 2• ^KlBi ^



### •Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; •Remov e Howe r bulb s or plant s tha t th e Granto r or th e Grantor' s tenant ma y wish t o save ; •Water andmaintai n replacemen t vegetation , includin g fertilizer application , a s necessar y subsequen t to a n initial waterin g perio db y EPA ; •Abid e b y healt h andsafet y guidanc e provide db y EPA ; •If th e property i s rented , assis t EPA i n obtainin g tenan t approval fo r acces s to th e property to perfor mth e wor k

if EPA i s unabl e to obtai n such access ; an d •Allo w videotapin g and/o r photograph y o f th e property includin g exterio r an d interio r area s ofbuildings . AC.RI:I-:MI: N i' No r T o 1NTI:RFI:R[- : 

### Th e Granto r agree s no t t o interfere or tamper wit h an y of th e activitie s o r wor k

done , o r th e equipmen t use dto perfor mth e activities , or t o undertake an y action s regardin g th e us e of sai dpropert y whic h woul dlendto endange r th e healt h or welfare ofth e Grantee s o

r th e environment , o r to allo w other s t o us e th e propen v i n such amanner Shoul dyou hav e any question s abou t thi s program , pleas e contac t

^I gran t acces s t o m y propertie s Q I d o no t gran t acces s to m y propertie s y' l /r /4:£^Ly>^^^^i- n JAJ ^ Signatur e Dat e y Signatur e Dat e

L

J I woul dlik e t o b e presen t durin g an y samplin g that i s required . Pag e 2 of 2 «PropeL-r.y_ID :

# m ^
Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o pro\id e a mutua l agreemen t a s t o condition s o f propert yprio rt o remediatio n aclivilies . Thi s wil l als o ser\ e as decontaminatio n fo rth e purpos e o f assurin g tha t restoratio n activitie s ar e complete d t o th e satisfactio n o f th e propert yo\\ne ran d th e Unite d State s Environmenta l Protectio n Agenc y(EPA) .

Properl yID : 

### C^^^ D Propert yAddress : ')2c< rl 4 • Ai g ^co..'. — 

# J3 k 4 ^ Owner : e>v-»- ^ 

### [M./ L >A~». A c^l f Phone : 

## ^e>7 \ ^^( ^ ' l^f^C P O n th e attache d diagram(s ) indicat e area(s ) t o excavate d an d dept h o f excavation , locatio n o f al l know n utilities , subsurfac e features , surfac e structure s an d landscapin g features , acces s location(s ) t o b e use d hv contractor , an d ih c directio n ofNonli . Indicat e distances , depths , materia l t}pes . etc . Indicat e digita l phot.^s hvreferencin g th e photo-lo g numbe rV Kit h a n arro windicatin g directio n of \ iew . 

### Item s T o B e Ramove d ByOwne rBefor e Star t O f Re.T.ediatior. : (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 Ovvner' s .'•sspcr.sibillty . Item : 

### V>U/v>^ ^

.'/\ 'j>oU . I A ^ v^-^wVO ^ t^- X 

### fi^MACItem : Item : Item : Item : Item :

Pag e 1 

# o\Jl _Item s T o B e Remove d B yContracto rDurin g Remediatio n A (Us e additiona l sheet s a s necessary ) Item : 

## A l l r>^^^- U t ^ ^/?,.-^ ^ -^^• n > 4-^ ^ {/yx^^WZ \ Item : 

# r Item : \ Q - P j2i^ ^ 

## ^vSl l t9n..^V^«^r ? /l/^>^. /2^-^tA v ? 3 / i ^Z item :


## 4.\g/ ? ^ I CI/o 9 Item : Item : Item : Item : Item : Item : Item : Item : Item :
Paq e 2 o f i /v ^



### Ite m

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

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

« Numbe rol'troo s • ^ 2 inc h trun k diamete r

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

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

### Quantit y Uni t Condition/Type/Specle s
Squar e fee t

. 

## ^Oo.< ; C^%f4^^ ^ Eac h

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llac h ^

# i Eac h

Eac h 

### ^6 0 Square Fee t

Pag e 4 o f ( /

### v5r ^ 

### Ite m Agree dupo n valu e o f plant material s not to b e replace dbv contractor . Note thi s valu e wil l b e use dt o issu e aplant vouche r to the propert y owner . Agree dupo n list o f plan t malerial s tha t will b e replace db y contractor . B e ver\ ' specifi c an ddelailed . Includ e asketc hof wer e eac hplant vsil l b e place d b v th e coniracior .

Are ao f Cii v o r Couiii y propert v l o b e landscape d pe r thei r requiremenis . Includ e asketcho' l the are a(s ) 

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

Eac h GAAIJ ^ ^C^-T^* ? 

### '^^•^/^ ^

SF

SF



### Paq e 5 of GAdditiona l Comment s / Instructions :

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## [g^ecl ^hec 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 no t responsibl e fo ran ydamag e don e t o th e interio ro f house , includin g foundatio n cracks o rfissures .

^ I s^src e I I I d o no t agre e a"re c I I ! d o no t agre e 

### D I a g 

## A m^7^ 9 7o9 ­ Owner' s Si<'tiiitur c Dat eTota l Q ' uar e Footag e t o b e Excavate d = 263 5 Propert yClassification : 800 Tot a Unea rFootag e t o b e Excavate d = 5 1

Dasafptio n o f pos t excavatio n areas : F1 . fion t yar d let(4ianc l quadran t F2 . tnon t yar d ri^n-hand quadrant : 61 . backyar d left.tian d quadrant ; 82 . tiackyar d fi^-han d quadrant : DZ . dri p zon e (1- 3 Iba l are a 0 1 soi l aroun d th e foundatio n o f th e house) .

# m :=!.CrEPT ^ C:SAR.iNC = ACF.KS'-EE T

Dat e Propert yI D 

# O(o\\io\a= h Propert y Projec t Omah a Lea d - - Fixe d Pric e Addres s Measuremen t XR F I D 

## OICTT-^ / Count/Tim e Fiel d Shot s Sho t # Readin g Sampl e Are a Sho t # 

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# V 7 i^'IU' ^ I n Sit u Composit e Aliquo t Composit e Reading s Readin g Averag e (Bag ) (Bag ) 

## jQb - • ^ XR F Correcte d Valu e -- > (us e calibratio rct-zr t o - ic : 

# Q ? ;C'».' c t c va'ue l Sampl e Are a 

# F ^ 4-( n I n Sit u i Composit e ^^qJC t Ccrpcsrt e Reading s Readin a Averag e (Bag ) CBag ) 

## ^ J _ 

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# 5 sampl e Are a | \^ 2 U)-^ " I n Sit u Composit e Aliquo t Composit e Reading s Readin g Averag e (Bag ) 1 1 ^ ^ (Bag ) Confidentia l 5/2/0 7 * • 

# JJ39 Q .^o 5 1-W^.irc m RL O

Readin g Sampl e Are a

! i Pass/Fai l ? Composit e Analytica l La b Analytica l

(Drie d & Spil t Sen t Numbe r Result s Sieved ) 7

Pass/Fai l ? Icmposit e Analytica l La b , .'knaiytiCa ! (Drie d & jSpi KSen t Resii't E Sieved l ! ?

Pass/Fai l ? | Composit e Analytica l La b i Anaiytica l (Drie d & Spil t Sen t Number i Result s Sieved )

Pass/Fai l ? Composit e Analytica l La b Analytica l (Drie d & Spil t Sen t Numbe r Result s Sieved )
C=- p • - ' T^ 

# q^ w 

# 3 XR F Co^Hk^Mu e -- > iliilratio ch (us e caiiOTatio n n char t orad d 2 0 % to value ) Sampl e Are a fA7 \ i X } I n Sit u Aliquo t Composit e Reading s Readin g (Bag ) 1 2 

## ZI Z 3 i J l 4 

### 3- 7 XR F Correcte d Valu e ~ > c (us e calibratio n char t orad d 20O/f e to value ) :C'".r,:c'an s S'sritu ' Pass/Fai l ? Composit e

Averag e

(Bag ) Composit e (Drie d & Sieved ) Analytica l Spil t Sen t La b Numbe r Analytica l Result s 

# 75

1 i| 

# A 

# /nZ ^

Confidentia l

# m > XR F DAIL Y CAUBRATIO N WORKSHEE T 

## ^-^-nn\{in\Cr { Projec t Omah a Lea d —Fixe d Pric e 

## XRFIDQl^-^^-X^ I Measuremen t Count/Tim e Calibratio n Verificatio n Check s Readin g Blan k Lo w Me d Tru e Valu e 0. 0 pp m 18. 9 pp m 1162. 0 pp m 120 % 22. 7 po m 1394. 4 pp m 80 % iS. l re m 929. 6 oc m 

## (Oi n \npy )

Precisio n Measurement s Averag e Precisio n Measuremen t Chec k Replicat e Blan k Lo w Me d 1 

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# m n Mee' - :.'ve:-::=:i:G' - Scancar c Deviato n Restiv e Sra.ncarc : De^'ict.o n Re:s:v e S-.c~zi- z Zi J izz ' -es s the - 20'" ; Confidenc e Interva l (5 ) .95-- > -VALUE ! Metho d Detectio n Limi t rVALUE ! Averag e Confidenc e Interva l jrVALUE ! Hig h 5532. 0 pp m 5638. 4 pp m 4^125. 6 po m



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= VALUE '• • • • 

# fit .-P " 

# RESTORATIO N CHANG E ORDE R OMAH A LEA D Propert y I D # _ 

# yv/ b Propert y Addres s yios ^ UAJ^ ^ CQ- n 

# h > U A Owne r Nam e J^ mhttirmn^t^f ' Dat e C/ H 167 Comment s Kr^^2.) T 4-if ^ i Z y^^u.i h iJjc. y 7 ^ g ^ i



# Owne r Signatur e Contracto r Signature^^-^^H^ A

## y^^ \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 

# \

y Coasta l Environmenta l Grou p Inc . www.coastalhazmat.co m COASTA L ENVtItONMENTA L CROUP , INC . 

# EXECUTIV E SUMMARY : 17990—220 5 Hansco mBlv d

N o issue s o r concern s X 

### Issue s o r concern s


# Detai l Explanation : P O was compensate dfo r flower bed s that wer e remove ddurin g excavatio n with agif t certificat e from India n Cree k Nursery i n th e amoun t o f $350.00 .

# As-Buil t Drawin g COASTA t 

# Omah aLeadSuperfun d " c Tota l Quadran t Squar e Footag e t o b « Excavate d • 263 5 Propert yC»»««iCcJi>ion - 80 0 Tota l Dr< p Zon vUnea rFootafl o t o b e Excavate d « 5 1 

### Alle y

Hansco m Boulevar d ,!^ f " ^ OLS#:17g9 0 ty ^

Dat e Excavated:6/16/0 7 'bat e USEP A Signe d Off-.7/2/0 7 NorthArro w Omah a Lea d Sit e Omaha . Nabraaic a PropeftyNumbe r

OLS-1799 0 Scal e
» » » Permarwc U Landscapin g F«nc * 11rfct i > 2 0 feet o r1 gri d > S x5 ft PropertyAddres s 220 5 HANSCO M BLV D

——— Ouadran I Boundar y ^^•Hv Pos t Excavatio n Concentration s (ppm ) <Q

> Stree t Boundar y

Tr««/Sh«ut > Fl . F 2 B l B 2 O Z Carda n Pla yAre a Easemen t Ottta r Qu«»«n 2 rj . tton t yar d nj^.»»(w d qua^an r8 1 ttackyw ^ fc»«.h««l qsi»*.«r n 02 . oacltywt f n^tt-tMni S 9uwKar4 . DZ . dn p x«n * (1. 3 tool M« « o f %o » mtotMi d V m ' 

### Legen d Are anot : Exca\rate d ^ Dripzon e Excavate d Quadrant s Excavat«d l 

### Contrac t # : EP-R7-07-0 5 Coastia l Environmenta l Grou p Inc .

# m » Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n o f remedia l activitie s perfonne don m y properly . M y signatur e wil l designat e that I a msatisfie dwilh tli e restoratio n o f m y properly , andthat n o item s arc i n questions , now . o r a

t an y lim e i n th e future , excep t thos e item s liste dbelow , if any . Pnipcrt vID : 

# n'y^ o Pmpcrt yAddress : 

# ^0 6 HzuwLZY i fblzr l Owner : 

# -^o m Hinmjiz X Plione : 

# ?)^b - 15U 0 Restoratio n Item s i n Question : Item : Item : Item : Item : Item : Item : Additiona l Comments :

^_ J I iifii'c c restonitio n i s (-oinpletc<l , excep t a s note d I I d o no t aprc o i-estoratio n i s complete d 

## 7 , A 6 7 

# 21^ 7 Owner' * Signatur e Dat e Contractor'. s Signatur e Dat e I

### ( ^ 

## Omah aLea dSuperfun dSit e Miscellaneou s Landscapin g Replacemen t Certificat e Propert y Owne r 

## Wz^(ZfV\a,ij, f

I c nry \ Propert y Addres s 

# g^<^s - t i ./^•^^c^cnr ^ 

# '(^i->\ Propert y Identificatio n Numbe r W'^'^C/ Materia l Remove d Replacemen t Valu e Flowe r be dare a 

# ^ 3s-o.' °
Tree s Itemize d shrubs/bushe s Tota l 

# %Sa. ^ Th e acceptanc e o f th e replacemen t certificat e an dth e signatur e belo w i s fiill acknowledgemen t b y th e property owne r that thi s i s afair an dreasonabl e compensatio n fo

r plan t material s remove ddurin g remediatio n activities , bu t not plante do r installe db y th e governmen t o r it' s contractors . Th e tota l amoun t o f $ JSQ.* " 

### ha s bee n receive db y th e owne r i n th e for mo f agif t certificate , #^^S ^ , t o b e utilize dat ^v^.L.\^ ^ C/UAJ C 

### / ItA^/L'sc.d-' r • Property Owner' s Signatur e Dat e Contractor' s Signatur e Dat e

# SEP A "PAPropert y Clos e Ou t F^ i Propert y# : Propert yAddress : 99D57kU%C0f n /3lz d Datc/TlBic : Owner' s N.»e;-^^/? 7 /-^^ADMy^y Quad s Excavated : Contracto rGrou p Excavatio B Genera l Ye s N o 1 . I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? ^ 2 . I f necessa^ , wer e th e correc t area s o f dri p zon e excavate dan drestored ? t- ^ Gradin c So dan dVcfcUtio n Ye s !S o 1 .Doe s th e gradin g aroun dth e perimeter ofth e hous e in excavate darea s generall y slop e away L- ^ fromth e house ? 2 .

Hassodbeenlaidinallareasthatwereexcavated? ^ ^/^^S^''^'^ ^ ''•^ ^ ^ri:P^ / ^ 3 .Doe s th e w dappea r t o b e generall y healthy andgrowing ? (On K evaluat e . f '.nspecte da t a3 0 da y tim e period ) 4 .Ar e sodde darea s generall y fir man devenl y graded ? L ^ 5 .AJ T th e joint s betwee n th e so dstrip s generall y tight ? (Onl y esaloat e i f inspecte da t z 3 0 da y tim e period ) 6 .Wa s th e property grade dsuc h tha t water wil l no t poo l on th e prope' n ? ( ^ l ^ 7 .

Wa s damag e t o landscapin g o r pla.n t material s avoided ? Gates , FCDCC S aa aRctainio t Waii s ! . D o gate s ope n an dclos e freely? (Ifapplicable ) 

# ^ z Ve s .N o 2 . Wer e all gate s or fence s take n dow n durin g restoratio n aciiv itie s rei n siallec ? 3 . Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) 4 \*'a £damag e t o retainin g wall s avoided ? (Ifapplicable ) ,ifapplicable ) 

# y i

/ ( y 

## 1 i Foundation , Sidii t an dGutter s Ves N o 1 .Wa s damag e t o th e sidin g or trims \oided ? i ^ 2 .W ^ damag e t o th e foundatio n avoided ? \ ^ 3 .

Wa s damag e t o window s avoided ? L ^ 4Wa s damag e t o window s or doo r screen s avoided ? ^ 5 . Wa s damag e t o downspout s o r downspout extension s avoided ? t^ ^ Sidewalk s an d Driveway s (Concrete ) 1 1 . Wa s damag e t o drivewa ysurface s avoided ? A^ \ n N o 2 . Wa s damag e t o waUrwa ysurface s avoided ? 

# y 1

1

## Owner s comments :

Lnspeci c oe,« . , U r S Z ^3St > { Z f U ^ ^- ^ '^-^ ^


# /^OfLck v6J^d LOci^l^ f ^< ^

^

Removal an drestoratio n acii\ate s complet e includir. e th e 30-da v sod'v^'arranr^' ; EPA Representativ 

## Date : 7 / < y yA ^ 7