TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

q4'fS' Date- z/fsl^^OO^ SAID#: 

Address: 

Remediation Contractor: Coastal Environmental Group_ Year: 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

d Video of property (DVD) 

W Executive Summary 

EPA-provided property sketch 

M Signed Access Agreement for subject property 

0^ Si^ed Access Agreement(s) for adjacent property 

M Restoration Agreement 

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

IM Confirmation data 

s/ Photographs W j A. S>nA 

M As-built sketch 

^ Satisfactory restoration signed by Property Owner 

^ Property close-out check list signed by EPA '^/fl/O'Z 

D Description of areas not meeting ROD cleanup criteria 

B^ Utility clearances 

W Property information from Douglas County Assessor's Office 

0^ taK>eA| ClrccJ^S pJiecCJiSj 

D 

/ Signature jignature 

40317111 

Superfund 
Final Report Property Check List (Please place with each hic) 

Har d Cop y Informatio n 

^ I Propeily Check List 

(^ 2 Site Working Drawing Map 

3 EPA oiiginals Map 

1^4 Douglas County Assessor's Map 

Q^5 Property Contact Sheet 

Agreement 

^ 1 Aeeess Agieement 

^ 2 Restoiation Agreement 

Miscellaneous Documents 

g l 1 Final Map liomthe Field 

Bl 2 Change Oideis 

d ^ XRF Data 

I2j 4 Any emails OI PO coiie^pondences 

Pioperty Completion 

Ll I E.Keeutivc Summaiy 

• 2 AS BUILT 

Tgr 3 Property Completion Agreement 

IS' 4 Any buyout into or reimbursement info 

J 3 5 Check 01 money ouiei copies 

f 6 EPA Pioperty Close Out Form 

7 Attached Begin Video 

Electroni c Documentatio n 

Drawings 

^ I EPA original 

g^ 2 Working Diawing 

^ 3 AS Built v.so 

( 2 4 AS Built jpg 

Photos 

S I Begin Photos 

• 2 Dunng/E.xeavation Photos 

I ^ ^ Sod Photos 

"Q 4 30-Day Sod Photos 

a Scanned Documents 

Final Documenls a 2 Executive Summaiy 

Videos 

^ I Begin Video 

) S, 2- My Movie 
Property Access Checklist 

Pio\)eit\ ID j ~7-4-<^ f \ n V»ORKST'»kRTED ON 

P(()peit\ "XdclK'SN n VNORKCOMPELTED ON / /

zSc G S 8 1 S-iReniei • l«- - TTa.m;^ 2.^d:A.a 

I Add less Phone 

Faxi Cell/P.ifiei 

1 AdditioiKil IntoimAtion i Phone 74, 0 ' S2 74­ 1 P. . 

! Cell/Paiici 1 

a.\orifi(.tti(tn Lettei Sent J^/Xb'i X t B R^-Wv 

IXJ VUCNS Ajitcenunt ^mncd _S)/_t3/ 07 ' B 

Mr>J ^03 CJKW3 

ly . RestdicitKin \<jicement Smned ^ / |f> 0 7 _a3rl5>_ I I Topsoil Sciinplint; (if .ipplicihlei 

L ! Dispos.il S.implin'; fd applicible) 

n G.iiden S.iniplini; (if appliiahlc) 

-&e—6 ^ 

[ ^ ltlllt ^ CIc.ii.ince Called ^>ZL ^ 

<:>'^) /'^o M 

! • \uk'o/Photos(Befoic) On _g_'l^'_Q7 ^io k 

i I \ ideo' Photo*' (Dm inu) On 

^ \ ideo/Ph<»Jrt««(A«/ei) On S-!ZL'Oy B ':RkK 

n Nuleo'Photos (3(l-D.iM I On '' _ I B 

I I Pioperlv Completion .A'.iieemenl j Si;:nc'd '^ / e> / 0/^[ B 

C^bOS 

11 O Final Report Issued 

All M(Miitoiin<: (as applicable) 

' 0 Commumt\ Q Ci-e\^ i On / / B^ 1 

i Results- i 

t 

1 

; • Communit\ IZ!Cle^^ On / / Bx ! 

Results. 

d Comimiiiitx [nCie\» } On. / / B-

Resultsi

Omatia Lead Site 
^\(^!,m' Total Qi^^A t Square Footage to be Excavated = 816 ) ^z^M 1i5' 

Property Classification: 800 Total Driffpne Linear Footage to be Excavated = 135 

Description of post excavation areas: Fl, front yard left-hand quadrant; F2, front yard ri^t-hand quadrant; Bl, backyard left-hand quadrant; B2, backyard right-hand quadrant; 

DZ. drip zone (1-3 foot area of soil around the foundation ofthe house). 
17495 

r Owner Name: JAMIE RZADINA 

Address 2306 S 31 ST 

Phone. H 402-553-5921 

 ^/ » -f •yrti I

Sample Number 

RYASCPXA-17495 Fl 

RYBSCPXA-17495 F2 

RYCSCPXA-17495 B1 

RYDSCPXA-17495 B2 

RDZSCPXA-17495 DZ 

ROZOCPXA-17495 GZrtPZGCTXA 174QG PZ 

Omaha Lead Site 

Site Sketch 

W 402-345-7178 ^ 

\r,AAer f_t-)rt^k5:-f^Agrt"^ 

Lead 

Concentration 

Sample 

Collected LAB 

ppm a 

ppm D 

7/lo 

ppm 

ppm 

ppm 

ppm D 

n

• 

• 

ppm D a 

Number of Samples = ^ 

Extenor Paint Nortti Arrow 

• Good 

• Poor 

[j]^^ t paint 

Samples Collected_j_ 

Firm Fr^NiDfefACutfPcT i l-^ri'j 

Date O(o\C\7l0' \ 

Time Q:M-f i 

Samples Analyzed 

XRF Unit ^ / "2^ Book ^ ' 

Date '7//<g>/a'ir^ ~ 

Time y^y ^ 

Staff -zz^z: ^ 

ENTERED 

JUN n 9 imh 

Omaha Lead Site 46130 
Douglas County Account Information Page 1 of 3 

Dougla s County , Nebrask a Propert y Recor d

Information is valid as of 2007-11 -20 

­ R090419000 0 

Print Report 

View on Map 

Treasurer's Tax Report 

Owne r 

ZADINA JAMIE R 

2306 S 31 ST 

OMAHA NE 68105-0000 

Propert y Informatio n 

Key Number 0419 0000 09 

Account Type Residential 

Parcel Number: 

Parcel AddressLegal Description. 

0904190000 

2306 S 31 ST 

OMAHA NE 68105-0000 

CREIGHTONS 1 ST ADD LOT 3 BLOCK 4 47 X 120 

Valu e Informatio n 

2007 

2006 

2005 

2004 

2003 

2002 

Land 

$11,300 00 

$11,300 00 

$11,300 00 

$11,300 00 

$11,300 00 

$0 00 

Improvement 

$135,200 00 

$108,700 00 

$108,700 00 

$108,700 00 

$76,400 00 

$0 00 

Total 

$146,500 00 

$120,000 00 

$120,000 00 

$120,000 00 

$87,700 00 

$0 00 

Sales Informatio n 

Sales Date 2003-10-06 

Deed Type 

Price: 

Grantor 

Grantee 

WD 

$133,500 00 

Nancy A Daly etal 

Jamie R Zadina 

Book 2003 Page 214859 

Valid/Invalid 

Exclusion Reason null 

Sales Date 

Deed Type. 

PriceGrantor 

1994-10-20 

$64,000 00 

Book 1993 Page 495 

Grantee: 

http //douglasne mapping-online com/DouglasCoNe/static/accountinfo jsp'?accountno=RO 12/18/2007 
Douglas County Account Information Page 2 of3 

Valid/Invalid: 

Exclusion Reason: null 

Lan d Informatio n 

Acres SF FF Units Depth Width Vacant 

0.12 5640.0 47.0 1.0 120.0 47.0 No 

Improvemen t Informatio n 

Building 1 

L . -^ 

""'F W Floor 7*4 03 F Second Floor 7 « 0 s F 

AHached 

4(N.0S.F 

Mir ""-la-ir^ 

TWO STORY 

mm Block a 11 

7*4 0 S F 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1488.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Good 

Owner Occupied: No Condo Square Footage: 0.0 

Built As: 2 1/2 Story Unfin Rooms: 8.0 

HVAC: Central Air to Air Units: 1.0 

Exterior: Frame Stucco Baths: 1.0 

Interior: Drywall Bedrooms: 4.0 

Roof Cover: Composition Shingle Stories: 2.5 

Roof Type: Gable Foundation: Block 

Floorcover: Allowance Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1905 0 0% 1905 102 

Detail Type Detail Description Units 

Add On Fence Chain Link 1.0 

Add On Unfinished Attic W/floor 744.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 744.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO... 12/18/2007 
Douglas County Account Information Page 3 of 3 irorm 

Fixture Base Fixtures 10 

Fixture Bath Full 1 0 

Garage Attached 408 0 

Garage Detached 2130 

Porch Slab Roof Ceil 160 0 

http //douglasne mapping-online com/DouglasCoNe/static/accountinfo jsp'^accountno=RO 12/18/2007 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 1875849. 

Original Call Date 8/28/07 Time 1 57 pm Op LORI18790 

Work to Begin Date 8/30/07 Time 2 30 pm 

State NE County: DOUGLAS Place: OMAHA 

Address: 2306 Street S 31ST ST 

Twp: 15N Rng 13E Sect-Qtr: 28-SW 

Twp Rng Sect-Qtr: 

Legal Given. C 

Type of Work: LEAD REMEDIATION 


Location of Work LOCATE ENTIRE PROPERTY. 


Remarks: RESENDING DUE TO WORK EXTENDING. 


Company COASTAL ENVIRONMENTAL SERVICE 


Contact Name LORI Phone (712)352-0188 


Alt Contact- NONE 


Work Being Done For EPA 


Depth of Excavation: 36" Corner Lot Y Front: Y Rear. Y 


Involves Tunneling or Horizontal Boring . N Explosives: N 


CXCATV LEVELS MUD02 OMAHACOF 0PPDGPR6 QLNNEIF QWEST2 


Service Area Contact Phone Number Utility Type 

Day 4029340469 


CXCATV COX COMMUNICATIONS, INC HEIDI Alt 4029340469 

Emerg 4029329757 

Day 8773668344 

LEVEL3 LEVEL3 COMMUNICATIONS, LLC NA Alt 

Emerg 8773668344 

Day 4025047823 

MUD02 METROPOLITAN UTILITIES DISTRICT EDWINA Alt 

Emerg 4025047946 

Day 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RON Alt 4024445161 

Emerg 4024445160 

http //www dhon org/irthintemet/DHONNoticeCreation/MessageText asp'>ret=<RESULTS 8/28/2007 
Page 2 of2 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA 

Day

Alt 

Emerg

 4067289343 

 8887289343 

QLNNEIF QWEST LOCAL NETWORK NA 

Day

Alt 

Emerg

 4067289343 

 8887289343 

QWEST2 QWEST LONG DISTANCE SARA 

Day

Alt

Emerg

 8002834237 

 3039921926 

 8002834237 

http //www dhon org/irthintemet/DHONNoticeCreation/MessageText asp'^ret=<RESULTS 8/28/2007 
CONTACT FORM 

Property ID # in^'^e 

Property 

Address: S^C:^ S 3| it . 

Initial Contact: Date: Time: Action: 

Second Contact: Date: Time: Action:_ 

Final Contact: Date: Time: Action: 

Final Action: Transmit to EPA D Other Action: D 
Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

www.coastalhazmat.com 

COASTA L ENVIItONHENTtl. 

CROUP , IN C 

EXECUTIVE SUMMARY: 

17495—2306 N 31 ST 

X No Issues or Concerns I I Issues/Concerns 

Detail Explanation: 
As-Built Drawing ^ 

COASTA L um aha Lead Superfund St< 

Total Quadrant Square Footage to be Excavated = 616 

Property Classification 800 Total Dnp Zone Linear Footage to be Excavated = 135 

Alley 

u a 

^Z^4f, !liJ— 

Fl = 133 PPM ( 

t-4'^ 6" 

O 

OLS#: 17495 

Date Excavated: 9/4/07 

Date USEPA Signed Off: 9/11/07 

Legend 

':V >J Concrete 

Omaha Lead Site 

Omaha. Nebraska 

Yy ^

m[| |

•—•— •

^^ ^

 Excavated Area 

 Existing Structi^e 

 Fence 

 Permanent Landscaping 

Scale 

1 Incti ' 20 feet or 1 grid « 5 x 5 » 

Property Number 

OLS-17495 

Property Address 

2306 S 31 ST 

— — —

iQ?

 Quadrant Boundary 

Street BourxJary 

 Treo.'Shrub 

Fl

F2

B1

Post Excavation Concentrations (ppm) 

 B2 Play Area 

 DZ Easement 

 Garden Other 

DwcripTtan of poet mcavatton artta*. f^ front yard iBft-hand quadrant. P2 front yard right-hand quadrant Bl backyard Imft-trand quadranr B3, backyard rigfit-hand quadrant 

DZ. dnp zortc (1.3 fo d araa of toil around tha foundation of ttw fiouH) 

Legen d 

Area not Excavated Dripzone Excavated Quadrants Excavated 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group In c 
ILPA Property Close Out Fo iTM 

Property.: ^^325 1 Property Addrew: ZZSO(' 5" 5/^ ^ 

Datc/Tinc: Owner's Name: ,/Ayi^i e 'ZF4A/AJ^ 

Quads Excavated: Contractor Group 

Excavatloii General Yes No 

1 If necessary, were the correct quadram(s) excavated and restored'' y 

2 If necessay, were the correct areas of dnp zone excavated and restored'' y 

Grading Sod and Vegetation Yes No 

1 Does the grading around the penmeter ofthe house in cxca\ ated areas generally slope av,ay 

from the bouse'' y^ 

2 Has sod been laid in all areas that were excavated'' ^ 

3 Does the sod appear to be generally healthy and grow ing'' (On!\ evaluate if inspected at a 30 

day tune penod) 

4 Are soddtd areas generally firm and evenly graded'' ^ 

5 Arc the joints Ijerween the sod stnps generally tight'' (Onl> evaluate if inspected at z 30 dav 

time period) 

6 Was the property graded such that w ater vi ill not pool on the propen)'' ^ 

1 

7 Was damage to landscapmg o-- pla.nt matenals avo'ded"' 

Giiicv Fences and Rciainins nai b >e$ No 

1 Do gates open and close freeh'' (Fapplicable) ^ 

2 Were all gates or fences taken dov-ii during Tsioraiion acfv fits '•eipsulled'^ ir2prlicable'i ^ 

3 Was damage to gates or fences avoided'' (If applicable) K^ 

4 Was damage to retainmg v»-a!l£ avoided'^ (If applicable) 4 ^ 

Foundation, SidiBg and Gutters \es So 

1 Was damage to the Siding or tnm avoided'^ 

2 Was damage to the foundation avoided'^ 

3 Was damage to vMndows avoided'' 1 ^ 

4 A'as damage to windows or door screens avoided'' 

5 Was damage to do^^•nspouts or downspout extensions cvoided" 

Sidevtallis and Driveways (Concrete) >es No 

1 Was damage to dnvev*ay surfaces avoided'' L ^ 

2 Was damage to walkwa> surfaces avoided'' U ^ 
Owners comments: 

!n<pe<rtiGQ note*: rfR.emc\al md-estcranon acuxa'es ccTc'ete 'nc'jdire ihe I-O-dav sod '>-'arT£i^r^ 

EP.A Represe.ntat Date f -/ / -a V 
Property Completion Agreement 

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

will designate that I am satisfied with the restoration of my property, and that no items are in questions, 

now, or at any time in the fiiture, except those items listed below, if any. 

Property ID: j ~76f^ h 

Property Address: '2^'^{ ^ 5 ^/S T 

Owner: J/^^f ^ 'Z^t^/A^ A 

Phone: -7<^6/ -^g-yY 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

t

agree restoration is completed, except as noted 

I do not agree restoration is completed 

, il m l ^ n 

/Owner's Signatnrj Date 

Contractor's Signature 
f 

mm 

PROPERTY CLEARANCE WORKSHEET 

Date 

^-"i^c-t-

Property ID 77^ ^ 

Property 

~ ^ 

Project 

Omalna Lead -- Fixed Price Address r^3o O -3 3 / 

Measurement XRF ID 

OlO?^^! 

Count/Time 3e^s^ 

Field Sliots 

Shot * Reading Sample Area Shot # Reading Sample Area 

Sample Area £4-fr:

 r/n>-'> 

In Situ 

Composite Composite Analytical Lab Analytical 

Readinq Average (Dried & Spilt Sent Aliquot Composite Readings 

Number Results (Bag) ? 1 

(Baq) Sieved) 

2 

/4.Z 

3 

4 

/^r

/Z.5

> 

- HP XRF Corrected Value - > 

5 

(use calibration chart or add 

2 0 % to value) 

n'9, 

Sample Area - Pass/Fai l ? 

I n Situ Composite Composite Analytical

1)2: @ /V^

iLAliquo Lab Analytical t Composite Readings Readinq 

Average (Dried & Spilt Sent 

(Bag) 

Number Results (Bag) Sieved) 

^ 

^o 7M XRF Correctectfed Valu\ e —> 

(use calibration chart or add 

2 0 % to value) 

Sample Area -LL. Pass/I=ail ? TP^ Ffif 6. I n Situ 

Composite Composite Analytical Aliquot Composite Readings 

Lab Analytical 

Readin 

Average (Dried & Spilt Sent ^ (Bag) 

Number Results (Bag) Sieved)

3 % 

/ 3 . ^02. \'iZ> TZi XRF Corrected Value —> 

(use calibration chart or add

'=ZZ 

Mt 2 0 % to value) 

• / ^ 

Sample Area -^^ l

•' ^ Pass/Fai l ? 

Composite Composite Analytical

Aliquot Composite Readings 

Lab Analytical Average (Dried & Spilt Sent (Bag) 

Number Results

± Bag) Sieved) 

vvD XRF Corrected Value —> 

(use calibration chart or add

^ ^ 2 0 % to value) M. 

Sample Area Pass/Fai l ? 

Aliquo In Situ Composite Composite Analytical t 

Readin Composite Readings 

Lab Analytical q Average (Dried & Spilt Sent (Bag) 

Number Results (Bag) Sieved) 

XRF Corrected Value —> 

(use calibration chart or add 

2 0 % to value) 

(;s> AODinaitM SHFF H I I XRF Technician's Signiture HF Fil 11 l
It Square Footage to be Excavated = 816 

ip zLone Linear Footage to tie Excavated = 135 

Legend 

lifeM Concrete 

^y/ \ Excavated Area 

llS^ I Existing Structure 

• •— • Fence 

p^ ^ Permanent Landscaping 

— — — Quadrant Boundary 

Street Boundary 

O Tree/Shrub 

South 31 Street 

i]i^H/^eod Ob North Arrow V Omaha Lead Site 

pip£ - Omaha, Nebraska 

Property Number 

OLS-17495 

Scale 

Property Address 1 Inch = 20 feet or 1 grid = 5 x 5 ft 2306 S 31 ST 

„K' l Sla,„ Post Excavation Concentrations (ppm) 

Fl . B2 Play Area jJJtVV HG L 

F2 DZ Easement JllJ^i ^ * ' ^ I lyrlroGcnLogif:, Itw. Bl Garden Ottier 

DesCTiption of post excavation areas: F1, front yard left-hand quadrant; F2, front yard right-hand quadrant: B1, bad<yard left-tiand quadrant: B2, backyard nght-tiand quadrant; 

DZ, drip zone (1-3 foot area of soil around the foundation of the tiouse). 
i^^° »'-</, 

COASTA L ENVIRONHENTA L '" r PROt'-"^ C R 0 U r IN C 

Consent For Access To Property 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consents to and authonzes the Uniteci States 

Environmental Protection Agency (EPA) or its authonzeci representatives, collectively 

the Grantee, to enter and perform certain environmental response activities upon the 

following descnbed premises 

Owner's Name: Daytime Phone: '^Uf ^ 3^'^' ^ 1

2.5/Y 5 3/^7- Acte6> TM^ ^UIL ^ccjes3 T-G 

Address of Property 

covered by this 

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 matenals and the area will be restored to its onginal 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 pnor 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 
V.V1E0 S7< , 

vV^ ^ * 

COASTA L ENVIRONMENTA L 

'f L PBO-"*-" CROU P 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 watenng penod 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 of the property 

AGREEMENT NOT TO INTERFERE 

The Grantor agrees not to interfere or tamper with any of the 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 

T ^ 

z 

O I do not grant access to my properties 

\ 

grant access to my properties 

Signatme / V Date ^'(4>'<TJ

Date @,/6 Signature 

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

Paqe 2 of 2 
41 i# 

COASTA L ENVIRONMENTA L 

C R C U r . INC . 

Consent For Access 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: (^j^j^-^^Z^C^CUVvO^ 

Address of Property 

covered by this 

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 v/ith 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 
ifc^'****%* COASTA L *>, , ^*0 ^ ENVIRONHENTAL 

^ ' "BO^*- C • 0 U r 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 of the property. 

AGREEMENT NOT TO INTERFERE 

The Grantor agrees not to interfere or tamper with any of the 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. 

^ 1 I grant access to my properties

 G I do not grant access to my properties 

^g'nature ( / Dale' 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 also serve as documentation for the purpose of assuring that restoration 

activities are completed to the satisfaction ofthe property owner and the United States Environmental 

Protection Agency (EPA) 

PropertylD. \'ldq ^ 

Property Address: "Ji^^J c C "^l S'-f-

Owner: NiM/Vhc Z<a <///>. 

Phone. y<;^­ 7^C ' 3>2. 7 V 

On the attached diagram(s) indicate area(s) to excavated and depth of excavation 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 t>'pes, etc Indicate digital photos 

by referencing the photo-log number with an anow 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 

p/^u^y f"/oi>J ^^ S 

Item 

Item 

Item. 

ItemItem: 

Item 

Item: 

Page 1 of, 
CP> 

Item s TO Be Remove d By Contractor Durin g Remediation An d Not Replaced 

(Use additional sheets as necessary) 

Item­

^ ^ ^ f^^/ ^ /^ky- ^ 6)U3-^6V M^' r /C^/iui ^ 

Item 

Qr/ci't r fe^^ C,.^an J fZ>?. ^ O Pt'-<J: g/ u A\^c / 

Item 

Item 

Item 

Page 2 of 
Items TO Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item 

Ji / / 

Item 

^ot:> 

Item 

Page 3 of 
COASTA L 

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 diameter 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinkler 

Zones Control Valves, 

Timers Heads etc 

.^^ach a sketcli ot the 

s-piinklei ld\out 

Number of and size of 

each garden/ flower bed 

area 

Attach a sketch of relative 

sizes and locations 

Quantity 

^ 5/ 

^ 

0 

0 

0 

Unit Condition/Type/Species 

Square feet 

Each 

Each 

Each 

Each 

Square Feet 

Page 4 of 
Item Quantity Unit Conditlon/Type/Species 

Agreed upon value of plant 

materials not to be 

replaced by contractor 

Note this value

used to issue

voucher to the

owner 

 will be 

a plant 

 property' 

Agreed upon list of plant 

materials that will be 

replaced b> contractor Be 

very specific and detailed Each 

Include a sketch of were 

each plant will be placed 

b\ the contractor 

Agreed up(.">n area of 

propertx to be replaced 

with grass sod 

Include a sketch ot the 

area(s) to be replaced with 

srass sod 

SF 

Area of Cit\ or Counts 

propert) to be landscaped 

per their requirements 

-rzz3^ 

SF 

Include

area(s) 

a sketch of the 

^^^/n^^zrr 

Page 5 of 
Additional Comments / Instructions: 

- 4aes^ rize^ZSz^5 3/sr / r ^L^e h 

• Check the box if Owner does not want CEG to document interior foundation walls and possible 

pre-existing damage By checking tfiis box CEG is not responsible for any damage done to the 

intenor of house, including foundation cracks or fissures 

IsU jagree I 11 do not agree D l agree I I I do not agree 

1 

^pyvc^y 

lolMner'sSignatiii^ Date* ^ Pkge 6 of ZicfQr''% Signature Date