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

## SAI D # : 2.2^1 1 Date : 

# /lA/g 7 Address : ^7/ / D^^T ^ ArJ c Reinediatio n Contractor : Coasta l Environmenta l Grou p Year : 200 7 SOI LREMEDIATIO N PROPERT Y FIL E FOLDE RDOCUMENT S

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Omah a Lea d Sit ePropertyClassification : 120 0 • » Tota l Qua^^BSquar e Footag e t o b e Excavate d = 195 8 Tota l HBPlon e Linea rFootag e t o b e Excavate d = 0 i 1

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### 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 210194000 0 MIDLAN D MANAGEMEN T IN C 271 1 DEWE Y A V OMAH A 6810 5 C/

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http://webarc.co.douglas.ne.us/dcassessor/details.asp ? PARCELNB=210194000 0 http://webarc.co.douglas.ne.us:8080/RealWare1/details.do ? id=R210194000 0
Disclaime rMa 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 = 17 1 fee t appraisal , survey , o rfo rzonin g verification . 

### http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-.. . 4/25/200 7

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## Date : -f j g /0 7 Time : pfeW S Action : L'L^ V m . I ' l^s.s/^-<: ^ Date : Time : Action : Date : Time : Action : Transmi t t o EP A D Othe r Action : D

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## £ \ Consen t Fo rAcces s To Propert y RIGH TOFENTR YTO PRFMLSH S 

### Granto r (th e propert y owner ) consent s to andauthorize s th e Unite dState s Environmental Protectio n Agenc y (EPA ) or it s authorize drepresentatives , collectivel y th e Grantee , to enter andperfor mcertai n environmental respons e activitie s upo n th e followin g describe d premises :

Owner' s Name : •^."^L.^VA ^ 

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Daytim e Phone : Address : 

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# A.. t Address : Addresse sof Propertie s covere d by thi s Agreement : Address : Address : 

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# f r I Address : PlfRPOS F('> FRF.SPONS FACTIVITII-. S 

### Th e EP.A is requestin g acces s to collec t soil sample s an dremov e soil tha t contain s elevate dconcentration sof arseni c and/o r lea dan dma y pos e ahealt hhazardTh e soil willbe remove dandth e excavate darea(s ) vvil lbe replace dwit hclea n material s an d restore dThi s vvor k

is bein g performe dunder th e Omah aLea dSite Superfun dSit e remediatio n program . An EPA representativ e wil l contac t th e Granto r in-perso nto discus s th e wor k

to be performed , th e Granto r will hav e an opportunityto revie w an dapprov e th e planne dsoil removal , andrestoratio n wor k

before it begins . Onc e th e wor k

is finished , th e Granto r will be aske d to revie w th e wor k

an dconfir mtha t it is complet e an dmeet s wit hth e Grantor' s approval . Upon completion , th e Granto r will receiv e writte n documentatio n fro mEPA tha t th e property ' ha s been remediated . ENVIRONMENTA LRESPONS E ACTION. S 

### By signin g thi s Acces s Agreement , th e Granto r is grantin g th e EPA , it s employees , contractor s an dsubcontractor s th e right to ente r th e property ,at all reasonabl e time s an d wit hprio r notice , fo r

th e sol e purpos eof performin g th e work . Thi s acces s shal l remai n in effect unti l th e wor k

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

«Property_ID » 

### Pag e 1 of 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 or plant s that th e Granto r or th e Grantor' s tenan t ma y wis h t o save ; •Wate r andmaintai n replacemen t vegetation , includin g fertilizer application , a s necessar y subsequen t t o a n initial waterin g perio db y EPA ; •Abid e by healt handsafet y guidanc e provide db y EPA ; •Ifth e property i s rented , assis t EPA i n obtainin g tenan t approval for acces s to th e property to perfor mth e wor k

i f EPA i s unabl e t o obtai n suchaccess ; and •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 . AGRFEMT-:N T NO T T o INTF:RFL:R F 

### Th e Granto r agree s not to interfer e or tampe r wit han y ofth e activitie s or wor k

done , o r th e equipmen t use dt o perfor mth e activities , or t o undertake an y action s regardin g th e us e of sai dproperty whic hwoul dten dt o endange r th e healt ho r welfare ofth e Grantee s o

r th e environment , or to allo w other s t o us e th e propert y i n suchamanner . Shoul dyou hav e an y question s abou t thi s program , pleas e contac t

I gran t acces s t o m y propertie s I I 1 d o no t gran t acces s t o m y propertie s
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J I wouldlik e t o b e presen t durin g any samplin g that i s required .
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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 serv e a s decontaminatio n fo rth e purpos e o f assurin g tha t restoratio n aclivitie s ar e complete d t o th e satisfactio n o f th e propert youne ran d th e L'nite d State s Environmenta l Protectio n Agenc y(EPA) .

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O n th e attache d diagram(5 ) indicat e area(s ) t o excavate d an d dept h o f excavation , locatio n o f al l kno\s n utilities , subsurfac e features , surfac e structure s an d landscapin g features , acces s locatioii(s ) t o b e use d b v contractor , an d th e directio n o f Nonh . Indicat e distances , depths , materia l types , etc . hidicat e digita l photc^ s h vreferencin g th e photo-lo g numbe rv^it h a n arro w indicatin g directio n o f \ iew . 

### Item s T o B e Remove d ByOwne rBefor e Star t O f Remediation : (Us e additiona l sheet s a s necessary ) Th e removal , storage , disposal , and/o rretur n o f thes a item s i s th e Owrer' s .'sspcrsibirty .((^ > Item s T o B e Remove d B yContracto rDurin g Remediatio n An d No t Replace d (Use additiona l sheet s as necessary) Item : / Item : 7 Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : /



# - y / « / Item : \ \ / Item : / Item : / Item : 7
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Pre-existin g propert y are a tha t i s covere duit hiirass .

Numbe r o f tree s > 2 inc h trunk diamete r

Numbe r o f tree s inc h trunk dianiete r

Numbe r o f Sprinkler Zones . Contro l VaKes . Timers . Heads , etc . Attac haskeic ho f th e sprinkle r la\Dut .
Numbe r o f an dsiz e o f eac hgarden ' flowe r be d area . Anac hasketc ho f relativ e size s an dlocations . 

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

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

Eac h

Eac h

Eac h

Each Square Fee t
Pag e 4 o f ' ^ 1 ­

### Ite m Quantit y 

### Uni t Condition/Type/Specie s Agree dupo n valu e o f plant material s not to b e replace dbv contractor . Not e thi s valu e use dto issu e vouche r t o th e owner . wil l b e a plant propert y Agree dupo n list o f plant material s tha t will b e replace dby contractor . B e ver y specifi c anddetailed . Eac h Includ e asketc hof wer e eac hplant wil l be place d b \th e contractor . .Agreedupo n are ao f propert y to b e replace d wit hgras s sod . Includ e asketc ho f the area(s ) to b e replace d\\ith cras s sod . S F

Are ao f Cit \or Countv ' propert N t o b e landscape d pe r thei r requiremenis . S F Includ e are a(s ) a sketchof the

Pag e 5 

# of iAdditiona l Comments / Instructions : \yy7
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• Chec k th e bo xi f Owne rdoe s not wan t CE G t o documen t inteno rfoundatio n wall s an d possibl e pre-existin g damage . B ycheckin g thi s boxCE G i s not responsibl e fo ran ydamag e don e t o th e inteno ro f house , includin g foundatio n crack s o rfissures .

I asre e I I I d o no t agre e I I I d o no t agre e 

### D i sagre e Pag e 6 o f _5 : ichor' s Signatur e

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### Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc . wwwxoastalhazmat.co m COASTA L ENVIRONMENTA L C n 0 U P , INC . 

## EXECUTIV E SUMMARY : 22811—271 1 DEWE Y 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 

# Omah aLea dSuperfun dSit e

Tota l Ouadran t Squar e Footag e t o b e Excavate d = 195 8 Propert y Clasaficatio n 120 0 Tota l Dri p Zon e Linea rFootag e t o b e Excavate d = 0

Oata^tona l aostencamaboratea i F t fron t yard let t han d auadrar l F 2 fron t yard nghl-nan d Quadran t B 1 bachyaf d left-han d quadran t B ? backyar d iiciht-han d qu.id ^ DZ , dn p £on c( 1 3 too t are a a t so M aroun d tn e foundibo n o f th e tiouse ) 

### Legen d Are ano t Excavate dl/// i Dripzon e Excavate dQQ<y i Quadrant s Excavate d Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .

# ^ P A Propert yCompletio n Agreemen t Thi s agreemen t documents th e completio n o f removal activitie s performe don th e belo w liste dproperty . Th e property owner' s signatur e indicate s tha t th e property owne r i s satisfie dwit hth e restoratio n ofth e subjec t property , an dthat n o item s ar e i n question , now , o r at any tim e i n th e future , excludin g any remainin g so dwarranty (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert yID : Propert yAddress : ^7/ / Cy(J/fjJfj\/l . Owner : Phone : Restoratio n Item s i n Question : 

## y^-uy/c. . - ^

yjyT ^ Item : Item : i Item : Item : 1 Item : 

# 1 

# 1

Require d correction s t o complet e th e property :

S^ l agre e restoratio n I s completeci , excep t a s note d above . C H I d o no t agre e restoratio n i s complete d

4)at e y

# aEPA• EP A Propert y Clos e Ou t For m Propert y # : ^9-B y Propert y Address : ^^TZ/i^^^^^^t ^ Date/Time : Owner' s Name : /Inf.Ul/'U J .S/'/UfS-i'rDry ) Quad s Excavated : [lU D y Contracto r Grou p Excavatio n General Ye s N o \ . If necessary , wer e th e correct quadrant(s ) excavatedandrestored ? d y 2 . If necessary , wer e th e correct areas o f dri p zon e excavatedan drestored ? 

### y Gradin g So dan dVecetatio n Ye s N o 1 . Doe s th e grading aroundthe perimete r ofth e hous e i n excavatedarea s generall y slope awa y 

### y fromthe house ? i y 2 . Ha s sodbee n lai di n all area s tha t wer e excavated ? 3 . Doe s the so dappea r t o be generall y health y an dgrowing ? (Onl y evaluat e i f i nspecteda t a3 0 t y da

y tim e period) 4 . Ar e sodde darea s generally fir man devenl y graded ? ^ 5 . Ar e th e joint s between the sodstrip s generall y tight ? (Onl y evaluat e if inspecteda t a3 0 da y

- ^ time period ) 6 . Wa s th e propert y grade dsuc htha t wate r wil l no t pool o n the property ? 7 . Wa s damag e t o landscaping or plan t material s avoided ? Gates , Fence s andRetainin g Wall s 1 . D o gate s ope n an dclos e freely? (Ifapplicable ) 2 . Wer e al l gate s o r fence s taken dow n during restoration activitie s reinstalled ? 3 . Wa s damag e t o gate s or fence s avoided ? (Ifapplicable ) 4 . Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) Foundation , Siding an dGutter s 1 . Wa s damag e t o th e sidin g or tri mavoided ? 2 . Wa s damag e to the foundatio n avoided ? 3 . Was damag e to window s avoided ? 4 . Wa s damag e t o window s o r doo r screen s avoided ? 5 . Was damag e to downspout s o r downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) 1 . Wa s damag e to drivewa y surface s avoided ? 2 . Was damag e t o walkwa y surface s avoided ? < ^ " ^ 

### P

A Yes N o (I

f applicable)//. • 

### fi k fJ k 

### V

A / A IJ ^ Yes N o

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### ^J ^ ^/

A Ye s 

# y N o

### Owner s comments :

Inspectio n notes :

Remova l an drestoration activate s complet e including the 30-da y so dwarranty : EP A Representatiye-'7^I^^fc;(f\l:^^;fe>tX ^ Date : / - /J Z -Q 7