## TRANSMITTA L of OMAHA LEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAID# : ^im^ ^ Date : \2/7n/lt> t Address : Mfj^ l ^e.\JOarr l '. Remediatio nContractor : Coasta l Environmenta l Group

_Year : lOlOARR A SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S S^ Vide o of propert y (DVD ) ^ Executiv e Stmimar y " y EPA-provide dpropert y sketc h V0' Signe dAcces s Agreemen t fo r subjec t propert y Q- Signe dAcces s Agreement(s ) fo r adjacen t propert y "Q^ Restoratio nAgreemen t -& ' Settlemen t document s (i.e. , fo r damag e or to replac e plants , etc. ) O^ Confirmatio ndat a i ^ Photograph s G^ As-buil t sketc h "^ Satisfactor y restoratio nsigne d by Propert y Owne r ^ Propert y close-ou t chec k lis t signe d by EP A -& Descriptio nofarea s no t meetin g RO D cleanu p criteri a VT Utilit y clearance s 'H ' Propert y informatio nfi'omDougla s Coimt y Assessor' s Offic e D D ; ^ ^ D ' \
.


### matur / . Dat e signature e 3021804 3 

# nil Superfun d^ \ 

## Propert yAcces s Checklis t PropertylD : (j^jg q Property Address : g D • WOR K STARTE D WORKCOMPELTE D ON : ON : / / / / Owner Address :



# mo o Dar+mM Ks^ . Plione : Fax : Cell/Pager : 

### Renter : Phone : Fax : Cell/Pager : 

### Additional Information :

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Notificatio nLette r Acces s Agreement Restoratio nAgreement Topso U Samplin g (if applicable ) Disposa l Samplin g (i f applicable ) Garde nSamplin g (i f applicable ) UtiUt y Clearanc e Video/Photo s (Before ) Video/Photo s (During ) Video/Photo s (After) Video/Photo s (30-Day ) Propert y Completio nAgreement Final Report Sent : / / Signed : 2_/^/i Q Sisned : / / / / 

### 7 / / / 

### CaUed : Ofe / t^-K l 1 0 

### On : riZj l f O On : / / On : / / On : / / Signed : / / Issued : / / By : By : By : By : By : By : ®y

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### By : yU 1 c ^ By : By : By : By : By : VJX^AK J 

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Ai r Monitorin g (a s appUcable) • Communit y Q Cre w Results : On : / / 

### By : 1 O Communit y Results : O Cre w On : / / By :

• Communit y Results : O Cre w On : / / By :

Omah a Lead Sit e

## Dpugla s Count y Accoun t InfoHaatio n Pag e 1 of 2 )jja^ t Dougla s County , Nebrask a Propert yRecor d - R215228000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f 52n d S t - VJO W Of l Ma p Informatio n i s vali d a s o f 2009-12-1 5 Treasurer' s Ta xRepor t Ne wFeatur e - • - > - • Aut o Sale s Searc h Owne r HOLSTE N ELLE N A C/ 0 MARYJ O BABCOC K 140 0 DARTMOUT H S T DENTO N TX 76201-171 8 Propert yInformatio n Ke yNumber : 522 8 000 0 2 1 Accoun t .Type : Residentia l Parce l Number : 215228000 0 Parce l Address : 454 1 SEWAR D S T OMAH AN E 68104-000 0 Lega l Description : SAUNDER S & HIMEBAUG H T O WALNU THIL L LO T1 1 BLOC K4 5 0 X 14 0 Valu e Informatio n Lan d Improvemen t Tota l 

### 200 9 $6,600.0 0 $66,400.0 0 $73,000.0 0 200 8 $6,600.0 0 $66,400.0 0 $73,000.0 0 200 7 $6,600.0 0 $66,400.0 0 $73,000.0 0 200 6 $6,600.0 0 $66,400.0 0 $73,000.0 0 200 5 $6,600.0 0 $49,900.0 0 $56,500.0 0 200 4 $6,600.0 0 $49,900.0 0 $56,500.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 6 7000. 0 1. 0 140. 0 50. 0 N o Impro t vemen Informatio n Buildin g 1



## http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=R2.. . 12/30/2009 /

### Dpugla s County Accoun t Infojmatio n Pag e 2 of 2 :)aua l 

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^ ^ ^ ^^ -:.^. % ^ & 

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# W' ^ % ­ 1 \ CLIC K TO ENLARG E IMAG E Squar e Footage : 1020. 0 Perimete r 0. 0 Uni t Type :

Buil t As : Ranc h

HVAC : Centra l Ai r to Ai r Exterior : Masonr yCommo n Bric k Interior : Drywal l Roo fCover : Compositio n Shingl e

Roo f Type : Hi p Floorcover : Allowanc e YoarR.iii t ^®^' ' Percen t Tearauii i Remodele d Remodele d , 194 9 0 0% Detai l Typ e Detai l Descriptio n Ad d On Fenc e Chai n Lin k Applianc e Allowanc e Applianc e Securit ySyste m Basemen t Bsmn t Bloc k 8 ft Fixtur e Bas e Fixture s Fixtur e Bat h Ful l Garag e Attache d Porc h Sla b w/Step s •o r

M » •B T MP «c
"^"" ' CLIC K TO ENLARG E IMAG E | Percen t Complete : 100.0 % Quality : Fai r Condition : Averag e Cond o Squar e Footage : 0. 0 Rooms : 5. 0

Units : 1. 0 Baths : 1. 0 Bedrooms : 2. 0 Stories : 1. 0 Foundation : ' Bloc k Sprinkle rSquar e Footage : 0. 0 Adjuste d Yea r Physica l Ag e Bu/7 t 194 9 61 Unit s 1. 0 1. 0 1. 0 1020. 0 1. 0 1. 0 330. 0

24. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2. . . 12/30/200 9" > 

### Pag e 1 o f 1

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• YOU RTICKE T NUMBE RI S 2510405 . Origina l Cal l Date : 6/03/1 0 Time : 1:5 2 pmOp : ELIZABETH1879 0 Wor k t o Begi n Date : 6/07/1 0 Time : 2:1 5 pm State : N E County : DOUGLA S Place : OMAH A Address : 454 1 Street : SEWARD S T Twp : 15 NRng : 13 E Sect-Qtr : 17-N W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATION Locatio n o f Work : LOCAT E ENTIR E PROPERTY , AL L EASEMENT S AND T O TH E PEDESTA L 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 Being Don e For : COASTAL Dept h o f Excavation : 4 F T Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Boring : N Explosives : N CXCAT V MUDO l OMAHACO F 0PPD6PR 5 QLNNEI C Servic e Are a Contac t Phon e Number Utilit y Typ e 

### Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEIDI 

### Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUDO l METROPOLITA NUTILITIES DISTRICT SAND Y 

### Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y OFOMAHA-TRAFFIC,SEWE R RICH/TRAFFI C Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 OPPDGPR 5 OMAH A PUBLI C POWE RDISTRICT EL M LOCATIN G Alt : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 QLNN E1 C QWES T LOCA LNETWOR K 

### EL M LOCATIN GAlt : 4062071494 Emerg : 888728934 3
http://wAvw.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 6/3/201 0

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# As-Buil t Drawin g COASTA L 

# t mah aLea dSuperfun dSit e l ^ t ENVIKONMENTA L C I I O U P , INC
. OLS# : 8184 8 Dat e Excavated : 6/4/201 0 Dat e USEP ASiane d Off : 7/28/201 0 Are a Sodden : 179 0 s a f t 

### 8184 8 Exterio rPam t Omah a Lea d Sit e • Goo d Sit e Sketc h Samplin g Address : 454 1 SEWAR D S T Q Not pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r U B Concentratio n Collecte d Firm : ? E IN C P & T ^ RYASCPXA-8184 8 F 1 pp m 

## \ J D Date ; alzilcf ? RYBSCPXA-8184 8 F 2 pp m 

### \ J D Time : J&:aOAl- \ RYCSCPXA-8184 8 B l 

### S2 ^ pp m 

### D Sample s Analyze d RYDSCPXA-8184 8 B 2 9W 3 pp m 

### D RDZSCPXA-8184 8 D Z 

# _ai
. pp m 

### D XR F Unit : lOhU Z Book ; 2. ^ ROgOOrXA-8184 8 -6 Z pp m 

### D D Dat e 

### f t l l -o ^ Rri;ccrxA-ai8< 6 -PZ - pp m 

### D D Tim e .&ry . Staff ; Numbe ro f Sample s = [ 5 | | Q | 

## n^v / Legend : F 1 = Fron t Left , F 2 = Fron t Right
. B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla ; Al l quadrant s ar e a s viewe d fro m th e street , fatin g propert y^ LUEY 

# ENTERED HA Y2 8 200 9

SEVV/AK D "sr
. 

### Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are areplace d So d wit h Are a replace d wit h Rock/Mulc h Are a lef t bar e 

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

# tai l a K P

## ­ 8184 8 Cl t<\ y L.V - 6( > / o ^ Exterio rPain t Nort h A/TO W Omah a Lea d Sit e • Goo d Sit e Sketc h H'POO I Samplin g Address : 454 1 SEWAR D S T Q No t pain l Sampl e Numbe r Lea d Sampl e Sample s Collecte d LAB Concentratio n Collecte d Firm ; ffTuL
. Df S T A RYASCPXA-8184 6 F l

. pp m 

### D Dat e 

### ^Iz M RYBSCPXA-8184 8 F 2
. pp m 

### D Tim e ICISOA K SfrfCSCPXA-81B « B l (jp m 

## E J D Sample s Analyze d RYDSCPXA-8184 8 8 2 2H 3 pp m 

## 0 ' D RDZSCPXA-8184 8 D Z 

## .91
. pp m Q ' 

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### D D Dat e ( t l l -o q nrzccPXA-ei64 e -P2 - pp m 

# E D D Tim e Staf f Numbe ro f Sample s = 5 

## n^v / Legend ; F l = Fron t Left , F 2 = Fron t Right , B l = Bac k Lefl
. B 2 = & WD Z = Dri p Zone
. G Z = Garden
. P Z = Pla ;Omah a Lea d Sit e Sit e Sketc h Samplin g Address : 454 1 SEWAR D S T Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B RYASCPXA-8184 8 F 1 

### ^1 5 pp m 

## i J D RYBSCPXA-8184 8 F 2 

### ^? 8 pp m D RYCSCPXA-8184 8 B 1 

### SZ H pp m D RYDSCPXA-8184 8 B 2 

### 2H 3 pp m D RDZSCPXA-8184 8 D Z 

## 9 3 pp m 

### a f 

## n

_
_ pp m pp m D D D D Numbe ro f Sample s = [ 5 | | Q | 

### 8184 8 Exterio rPain t • Goo d g'Poo i Q Not pain t Sample s Collecte d Fimt;?FTKlt - DP>T A Date ; sJz\\ m Time; ICf-iO^ n Sample s Analyze d XR F Unit ; lOhU Z Book : Z*J I

Dat e /^ « Z Z-o ^ Tim e Staff ; 

## n^v / Legend ; F l = Fron t Left , F 2 = Fron t Right , B l = Bac k Left , B 2 = B i!t_D Z = Dri p Zone , G Z = Garden , P Z = Pla ;

### 8184 8 Exterio rPaint Nort h Arro w Omah a Lea d Sit e • Goo d Sit e Sketc h Samplin g Address : 454 1 SEWAR D S T Q Notpain t Sampl e Numbe r Lead Sampl e Sample s Collecte d LA B Concentratio n Collecte d Fimi : ? g TMC - DP > T> > RYASCPXA-81848 F 1 

### D 

### Date : alailc a RYBSCPXA-81848 F2 2,s e pp m 

### D Time : /&=2»C>A n RYCSCPXA-81848 B l _£2iL_PP-T « 

### D Sample s Analyze d RYDSCPXA-81848 B2 9 H 3 Do m 

### D RDZSCPXA-81848 D Z 

### aL_Pp m Of D XR F UnH : lOhU Z Book : 2M \ nogocrKA-84e48 - -G i
~ PO f 

### D 

## a Date : 6 - g 'O ^ nPiroor)(A.aio4e—PZ - ~ pp m 

### D Time : flvi Staff : nM ^ Numbe ro f Sample s = fs l | Q | Legend : F l = Fron t Left , F 2 : Fron t Right , B l ' Bac k Lefl , 8 2 ' Bac k Righ t D Z < > Dri p Zone
. G Z ^ Garden
. P Z « Pla ; A i ryvl«»>ed ^ Bi t yit , hel m prepartvALuE Y

Kev2<XJI I Cmte Anft-Kn-J W W&Ut
SEWAW > ST
.,*-'":*'•* , COASTA l (NVItONHIRU l C I t 0 U rIH C 

## Consen t fo rAcces s T o Propert y RIGH TO F ENTRYTO PREMISE S 

## Granto r(th e propert yowner ) consent s t o an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA) o rits authorize d representatives , collectivel y th e Grantee , t o ente ran d perfor m certai n environmenta l respons e activitie s upo n th e followin g describe d premises : Ifl^tj ^

Owner' s Name : / Daytim e Phone : ^^^^^^^ ^

Addres s o f Propert y 

# /f f / ^ez^/iy ) 5 7 covere d bythi s 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 that contain s elevate d concentration s of lea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l be excavate d t o remove 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 Lead Superfun d Sit e remediatio n program . Arepresentative o f Coasta 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 reviewan d approve th e planne d soi l removal , an d restoratio n wor k before i t begins
. Once th e wor k i s finished , th e Granto rwil l b e aske d t o reviewth e work an d confir m tha t Ki s complet e an d meets wit h th e Grantor' s approval
. Upo n completion , th e Granto rviril l receive writte n documentatio n fro m EP Athat th e propert y has bee n remediated
. ENVIRONMENTA L RESPONS E ACTION S 

## B

ysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , its employees , contractor s an d subcontractor s th e right t o ente rth e property , at al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e of performin g th e work
. Thi s acces s shal l remai n i n effec t unti l th e wori ( has bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :
Pag e 1 of 2

## X COASTA L tllVIIIONHIKTt t ^.P^O**- ^ C t O U rI I f C 

### cRemov e obstruction s Includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; cRemov e flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t ma ywis h t o save ; « Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessarysubsequen t t o a n initia l waterin g perio d b yEPA ; cAbid e b yhealt h an d safet yguidanc e provide d b yEPA ; f I f th e propert yi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propert yt o perfor m th e work
. * Allo wvideotapin g and/o rphotographin g o f th e property . AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s no t t o interfer e o rtampe rwit h an yo f th e wor k activities , o rwit h an y o f th e wor k done , o rwit h th e equipmen t use d o n hi s property , o rt o undertak e an y action s regardin g th e us e o f sai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o f th 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 . Should 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 D I d o not gran t acces s t o m ypropertie s
^ ; 

# ; - ?-/ g Signatur e Dat e Signatur e Dat e
Q I woul d lik e t o b e presen t durin g an ysamplin g tha t I s required
.

Pag e 2 o f 2COA S T AL 

## Restoratio n Agreemen t The purpos e ofthi s agreemen t i s to provide amutua l agreemen t a s to condition s ofth e propert y prior to remediationactivities . Thi s will als o serve a s documentationfo r

the purpos e o f assuring tha t restoratio n activitie s ar e completedto the satisfactiono f the propert y owne r an dthe UnitedState s Environmenta l ProtectionAgency (EPA) .

PropertylD ; "^/^^^ Propert y Address ; ^^l/ / 5^/^/ ) <^ ^ Owner ; (^^/< / ^ . y^^<r77:?>V ^ 

## Phone ; ^fifaZ.)-^6(/.^7l' C Onthe attacheddiagram(s ) indicat e area(s ) to excavate , surface structure s an dlandscapin g feature s an d acces s location(s ) to b e usedby the contractors . Indicat e distances , depths , materia l types , etc . Photographicall y an dVideographicedl y documen t the existing condition s of the propert y an dthe basemen t if necessary . 

## Item s t o b e Remove d b yth e Owne rbefor e Start o f Remediation : Th e removai , storage , disposal , and/o rretur n o f thes e item s i s tii e Owner' s responsibility
. Item : 

# Awv. ^

^o^ S f o \) ^ ^-oPoc^ f Item : Item : Kem :


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

Kem : ^ Item : Kem :

Page l of
.COA S T AL 

## Item s t o B e Remove d B yContracto rDurin g Remediatio n an d Replace d 1 Kem :

Kem : Kem : Kem : r 

### Landscap e Inventor y Ite m Quantit y Uni t Condition/Type/Specie s ^-7 — 

### Pre-existing propert y area , Quadrants tha t wil l b e excavated , tha t 

# d i i s coveredwit hgrass . Numbe r of tree s > 2 inc h Eac h trun k

diamete r 

# 0- Numbe r of tree s < = 2 inc h Eac h 

# a trun k

diamete r Nimibe r of Sprinkle r Zones , Control Valves , Eac h Timers , Heads , etc . Attac hasketc ho f th e sprinkle r layout . 

### " a ^ Nmnbe r of an dsize of eac hgarden / flowe r bed Eac h area ; Squar e Fee t Attac hasketc hof relative size s an dlocations . Agree duponvalue of plan t material s not to b e replacedb v contractor . Not e thi s valu e wil l b e usedto issue aplan t voucher to th e propert y owner . Easemen t Area , to b e Eac h 

# (?evJ('w ^ fe>uf/$" excavated Pag e 2 of
.COA S T AL


### AddKiona l Comment s / Instructions : Th e cit yo f Omah a ordinance s ma yprohib Kyo 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 Agency(EPA ) ma yb e removin g an d replacin g soi l underlyin g a graye 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 f thi s i s th e case , yo u shoul d understan d tha t thi s removin g an d replacin g o f soi 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 f yo u us e a grave l o rdir t are a a s a drivewa yo rparkin g area , no t wKhstandin g an yremova l o rreplacemen t o f soi l b yth e EPA
. I f yo u hav e an yquestio n abou t legalityo f a certai n drivewa yo rparkin g area , yo u ma ycontac t th e cK yo f Omaha' s Plannin g Departmen t a t (402 ) 444-5150
. 

# • ^ leas e chec k thi s bo xi f yo u understan d th e informatio n outline d above
.



# L G Chec k th e bo xi f Owne 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 f house , includin g foundatio n crack s o rfissures
. 

### O I d o no t agre e 

# C ^ (%r£AA^ ^ Owner' s Signatur e Date Cdntractor' s Signatur e Date Pag e 3 of
.

# p BV\D#_Sl£^l 3 XR F PROPERT YSAMPL E SHEE T Dat e 

### Addres s 

### H<^ [ ^jji ^ ^ r 

# 9-/-/ ^ Projec t Omah a Lea d ARR A 

### Sampl e tim e am/p m XR F ID # ^l!73^ ^ 

### sampl e lengt h 

### 3 0 se c

Shot # Readin g Sampl e are a Shot # 

# . 3 ^ 1 ^ ^ / ^ 

# U . MH . .J ^ /fff^H r^ Dept h 

# 9^< r J^2 ^ ^ / i ( ^ 

# (a ± ^ ( f Averag e 

# l^hz o Averag e

Shot # Readin g Sampl e are a Shot # Dept h 

### Averag e Averag e

Shot # Readin g Sampl e are a Shot # Dept h 

### Averag e Averag e
RETES TAREAS Shot # Readin g Sampl e are a Shot # Dept h 

### Averag e Averag e Signature
. 

# M Prin t 

# ,nU ^ CMlf^Qf i Readin g Sampl e are a 

# ^/^i-c: ^ ^^^^ ^ 

# \-d:/ ^ Dept h 

### \\^:^< ^ 

# U L ^"h h ^ O Readin g Sampl e are a Dept h

Readin g Sampl e are a

• Dept h

Readin g Sampl e are a Dept h

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

## Certificat e o f Verificatio n XL3t-3902 2 Readin g N o 29 7 Mod e SOI L Tim e 2010-07-0108:1 2 Duratio n 91.7 4 Sequenc e Fina l Flag s AVERAG E -jA553 f ?Q40Qfi..
. —r ; ADDRES S ^''^^'^SsilSewar d s t QUADRAN T E A DEPH T 1 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e
Erro r pp m P b ^^::::—2l^^t72A•^>'.py^;.•*'^s^?=^-7a-l9..84 l Supervise d By : 

# mn^d ^

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

## Certificat e o f Verificatio n XL3t-3902 2 Readin g N o 29 4 Mod e SOI L Tim e 2010-07-0 1 08:1 0 Duratio n 30.5 9 Sequenc e Fina l Flag s BVI D 8184 8 ADDRES S 454 1 Sewar d s t QUADRAN T E A DEPH T 1 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e
pp m Erro r P b 217.12 4 ± 20.02 4 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Biilerica , 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 204.64 3 Supervise d By : 

## Certificat e o f Verificatio n
29 5 SOI L 2010-07-0108:1 1 30.5 7 Fina l 8184 8 454 1 Sewar d s t E A 1 " N
. LOPE Z confirmatio n non e

± Erro r ± 19.47 9

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 218.64 9 Supervise d By : 

## Certificat e o f Verificatio n
29 6 SOI L 2010-07-0 1 08:1 2 30.5 8 Fina l 8184 8 454 1 Sewar d s t E A 1 " N
. LOPE Z confirmatio n non e

± Erro r 20.02 0

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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

Supervise d By : 

## Certificat e o f Verificatio n
29 3 SOI L 2010-07-0 1 08:0 8 91.7 7 Fina l 454 1 Sewar d s t B l 6 " N
. LOPE Z confirmatio n non e

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRANT DEPH T XR F TEC H MIS C NOTE
pp m Pb 169.90 3 Supervise d By : 

## Certificat e o f Verificatio n
29 0 SOIL 2010-07-0 1 08:0 7 30.5 7 Fina l 8184 8 454 1 Seward s t B l 6 " N
. LOPEZ confirmatio n non e

± Erro r ± 19.24 8

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Biilerica , 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 182.71 5 Supervise d By : 

## Certificat e o f Verificatio n
29 1 SOI L 2010-07-0 1 08:0 7 30.5 9 Fina l 8184 8 454 1 Sewar d s t B l 6 " N
. LOPE Z confirmatio n non e

± Erro r ± 19.84 9

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Biilerica , 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 201.22 8 Supervise d By : 

## Certificat e o f Verificatio n
29 2 SOI L 2010-07-0 1 08:0 8 30.6 1 Fina l 8184 8 454 1 Sewar d s t B l 6 " N
. LOPE Z confirmatio n non e

± Erro r ± 20.66 5

## /\0. \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 I ^^^ 7 I Coasta l Environmenta l Grou p Inc
. V

^

• >« ? www.coastalhazmat.co m ^^i-no y COASTA L CNVIIOIINENTA L S 1 0 U P , IN C 

# EXECUTIV ESUMMARY : BVID #81848-(454 1 SEWAR D ST ) No Issue s o r Concern s | ^ Issues/Concern s Detai l Explanation : -DA NGARVE Y WALKE D TH EPROPERT Y O N7/27/1 0

# m 0 % 

# EP A Property Clos e Ou t For m L/SV ( Seu»^^^ . Propert y f» : 

# fTi^ve
. Propert y Address : Datc/Tlmc : Owner' s Name: . i^ , -.la ^ Quad s Excavated : Contracto r Grou p Ye s No Excavatio nGenen l 1 .

I f necessaiy , wer e th e correc t quadiant(s ) excavate dan drestored ? 

### y 

## y 2 .i f necesswy , wer e th e correc t area s ofdri p zon e excavale dao drestored ? Gradin g So dan dVcgetotio B Yes N o I Doe s th e tradin g aroun dth e perimete r ofth e hous e incxcavaie darea s generall y slop e away 

### y fromtb e house ? 2 . Ha s so dbeenlai di nal l area s that wer e excavated ? 

## y 3 .Doe s ih e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period ) 4 . Ar c sodde darea s generall y fir man devenl y graded ? 

### y 5 .

Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period ) ^ _ y 6 . Wa s tb e property grade dsuc hthat wate r wil l no t poo l onth e property ? y 7 .

Wa s damag e t o landscapin g o r plant material s avoided ? 

# r y Gates . Fence s an dRetatelo g Wal b Vc s N u I 1 . O o gate s ope nan dc\o$ t freely? (I f applicable ) 

### y 2 . Wer e al l gate s o r fence s take ndow ndurin g restoratio naclivilie s reinstalled ? (I f applicable ) 

### y 3 .Wa s damag e t o gate s o r fence s avoided ? (Ifappiicable ) 

### y 4 .Wa s danug e t o reuining wall s avoided ? (Ifappiicable ) 

# y Foundation , SIdiii Kan d Gntlcr s Ye s N o I
. Wa s damage t o th e sidin g o rtri m avoided ? 

# y 2
. Wa s damage t o th e foundatio n avoided ? 

## y 1 ?
. Was damage t o window s avoided ? 

# y 4 Wa s damage t o window s o rdoo rscreen s avoided ? 

## y 5 . Was damage i o downspouts o rdownspou l extension s avoided ? 

## y Sidewalk s an dDriveway s (Concrete ) Yes N o I . Wa s damag e l o drivewa y surface s avoided ? 

# ~ 7 2 . Wa s damag e t o walkwa y surface s avoided ? 

# ~ 7I 

## Ort'Dcr s comments :



## [inspectio nnotes :

0 iV » 1 

# V

Removal andresloratio naclivale s complel e includin g th e 30-da y so dwarranty : EP A Represenlaliv e ^" ^ j ^Dale : 7/11)1 0

# '^^' ^ Propert y Owne r Assessment of Performanc e For m ^U H ^ ^ ^' ^ AmericanRecovery an dReinvestmen t Ac t (ARRA ) —f^TT k

nWlSlO NOmah aLea dSuperfun dSite SOTEBFONDD^ ^ 2009/201 0 Remediatio nContractor : Coasta l Environmenta l Grou p - EP-R7-09-0 6 Propert y Identifie r Number : ^S^^f j Propert y Address : <^5'^ / ~^^CL>U^<g f ^7 " ^ Propert y Owner' s Name : '^^y^'* ^ ^r ^ f^o^<^^^^^— ***i^**i^**ili*****:i^:^^J^:^itii^ii ^lil^^,^l^,^^i^^f^,^^^^^:llliitim^^^i^L^itt** * ^ 

## Instruction s t o th e Propert v Owner : Thi s for mserve s to recor dth e Propert y Owner' s assessmen t o f performanc e (Incentive 1

- Qualit y Assuranc e Surveillanc e Plan) involving th e liste dremediationcontractor , a s applicable to the OmahaLea dSite . Thi s for mdocuments th e timelines s o f pxmc hlis t resolution , busines s relations , complain t resolutio nan dth e overall qualit y of work . I f

needbe , th e Propert y Owne r ma y utiliz e thi s for mto recor dproblem s and/or issue s not specificall y tie dto a nassigned address , fo r

example , busines s relation s tha t generall y don' t follow the guideline s se t fort hi nth e Performance Wor k

Statement . The Propert y Owne r

will indicat e his/he r

assessmen t of performanc e wit hthe contractor' s wor k

b y checkin g anumerica l ratin g onth e tabl e belo w using th e numerica l definition s fi-om the rating scale below , the nsign& dat e th e form . 9-1 0 "excellent " 7- 8 'Ver y good " ^ "acceptable "

- 4 "poor " 1-

2 'Ver y poor " Propert v Owner' s Assessment o

f

Performanc e Regardin g th e Contractor' s Work 1 0 5 _____ 9 4 8 3 7 2 6 V . 1 Propert v Owne r Additiona l Conmient s fro m(optional ; continu e o nbac k pag e if needed ) Propert y Owne r Signature : iiicl/n y l i ^&&kh y Date : h^ 1^ ' lO .

## Propert yCompletio n Agreemen t ihi s agieemen i documenl s ih e complclio n o l remedia l acliviiie s peribnne d o n mypiopert yM ysignature wil l designal e iha l I a m salisfie d wit h Ih e restoralio n o f m yproperly , an d tha i n o item s ar e i n questions , now , o ra l an ylim e i n th e future , except Ihos e ilem s liste d below , i f an y

Propett yID : ^/^Y 6 Propert yAddress : q^-q i S^^^JQU ^ "BT ^ Own c '• • ^H^JS^^O^ O l^JL^Ci^H^^L.*
. Ul^ ^

/I
. f-hL^TtK l Phone : ^L/^^^'^^ Q Restoratio n Item s i n Question :

Item : Item : Item ; Kem : Item : Item : Additiona l Comments :

fX l I agre e lestoralio n wcompleted , excep l a $ note d [_ J I d o nn t a|;re crestoratio n \ \ complete d 

# i&SajP ^ G-^-^ o Owner' s SignatiH f Dat e Contrarlor' s Signatur e Dat e