## TRANSMITTA Lo f

OMAHA LEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R

SAI D # : ^M RDate : f/[ol\ D Address : /92 7 Rinn<^. ySJ 

### Remediatio nContractor : Coasta l Environmenta l Group

_Year : lOlOARR A
SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S B ^ Vide o o f propert y (DVD ) B^ ^ Executiv e Summar y S^^ ^ EPA-provide dpropert y sketc h B ^ Signe dAcces s Agreemen t fo r subjec t propert y

" B Signe dAcces s Agreement(s ) fo r adjacen t propert y &

r Restoratio nAgreemen t -0 ^ Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) iy ^ Confirmatio n dat a &^ ^ Photograph s B ^ As-buil t sketc h ^S^' ^ Satisfactory restoratio nsigne db y Property Owne r ^oy ^ Propert y close-ou t chec k lis t signe db y EP A "n~ ~ Descriptio no f area s no t meetin g RO D cleanu p criteri a ^0''' ^ Utilit y clearance s ^0"" ^ Propert y informatio nfromDougla s Count y Assessor' s Offic e D D D


### Signatur e T)at e 3023730 3 Superfun d

# v v Propert yAcces s Checklis t Propert y ID : ^<L/ ^ n WOR K STARTE D ON : / / n WOR K COMPELTED ON : / / 

# pr.p.rn-Addr«, = j^j^ Zhnntu .- ^ o^*'' ^ Ri-,nY ) i'^OfhT K Address : -^

Phone : Fax : Cell/Pager : ^r^ ^ .^:^,, ^
C ] Notificatio n Lette r /\\Acces s Agreement ] 0 Restoratio n Agreement D Topso U Samplin g (if applicable ) D Disposa l Samplin g (if applicable ) D Garde n Samplin g (if appUcable ) 1 ^ Utilit y Clearanc e [ ^ Video/Photo s (Before ) GVideo/Photo s (During ) nVideo/Photo s (After) D Video/Photo s (30-Day ) nPropert y Completio nAgreement nFina l Report Ai r Monitorin g (a s applicable )
• communit y QCre w On : Results :

• Communit y • Cre w On : Results :

• communit y •Cre w On : Results : Renter : Phone : Fax : Cell/Pager : Additional Information :

Sent : / / By : 

## Signed: 2^/!2L/1 ^ By : Signed : 2^/£_/JV
_ By : 1 1 By : 1 1 By : 1 1 By : CaUed : 3 / H / \ Q By = 3/22-/l O On : 3 1 (l/_L O By : V' J ~(\ful!-/^i i AnJy On : / / By : On : / / By : On : / / By : Siened : / / By : Issued : / / By :
/ / By :
/ / By :
/ / By :

Omah a Lea d Sit e

## Dougla s Coimt y Accoun t Infc^^tio n Pag e 1 of 2 

# W
Dougla s County , Nebrask a Propert yRecor d - R152591000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t o f 52n d S t - Vle W O n Ma p Informatio n i s vali d a s o f 2009-11-1 9 Treasurer' s Ta xRepor t Ne wFeatur e - > ^ - > Aut o Sate s Searc h Owne r LITTLEJOH N BRIA N ETA L 1922BINNEYS T OMAH AN E 68110-000 0 Propert yInformatio n Ke yNumber : 

### 259 1 000 0 1 5 Accoun t Type : Residentia l Parce l Number : 152591000 0 Parce l Address : Lega l Description : 1922BINNEYS T OMAH AN E 68110-000 0 KOUNTZ E PLAC E LOT9 BLOC K1 0 5 0 X 12 4 Valu e Informatio n


### 200 9 200 8 200 7 200 6 200 5 200 4 Lan d $4,800.0 0 $4,800.0 0 $4,800.0 0 $4,800.0 0 $4,800.0 0 $4,800.0 0 Improvemen t $53,600.0 0 $53,600.0 0 $56,000.0 0 $56,000.0 0 $56,000.0 0 $17,800.0 0 Tota l $58,400.0 0 $58,400.0 0 $60,800.0 0 $60,800.0 0 $60,800.0 0 $22,600.0 0 Lan d Informatio n Acre s 

### 0.1 4 S F 6200. 0 Unit s 

### 1.0 Dept h 

### 124. 0 Widt h 5 0. 0 Vacan t 

### N o Improvement Informatio n Buildin g 1



## http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=Rl..
. 11/25/2009' ^ , 

### Pag e 2 o f 2 Dougla s County Accoun t Infq^|tio n

192 2 Binne y

•irTN*'* '
Fir d Fbo rJ M40S 4 A IRI I

21/ 2 Stor yUnf m Bsmtsctu n S'IDHF ; ^

•-;y CLIC KT O ENLARG E IMAG E CLICKJ-0_ENLARGEJMAG E Squar e Footage : 1715. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 2 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 7. 0 Exterior : Fram e Aluminu m Units : 1. 0 interior : , Drywal l Baths : 2. 0 Roo f Cover : ' Compositio n Shingl e Bedrooms : < 3. 0

Roo f Type : Hi p Stories : ; 2. 5 Floorcover : i Allowanc e Foundation : Bloc k Sprinitie rSquar e Footage : 0. 0 Yea rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 196 5 196 5 4 5 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Unfinishe d Atti cW/floo r 860. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 871. 0 Fixtur e Additiona l Fixture s 1. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 2. 0 Porc h En d Scree n 240. 0 Porc h Ope n Sla b 75. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl.
. . 11/25/200 9

### Pag e 1 of 2 ^

" > [ Creat e Anothe rTiclce t ] 1 Bacl ^ t o irt h Inteme t ] Sen d Emai l )



### • YOU RTICKE T NUMBE RI S 2440233
. Origina l Cal l Date : 3/17/1 0 Time : 9:2 7 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 3/22/1 0 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 192 2 Street : BINNE Y S T Twp : 15 NRng : 13 E Sect-Qtr : 10-NW 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 PEDESTA L Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LO T Compan y: COASTA L ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : coasta l Dept h o f Excavation : 4 f t Come r Lot : N Front : Y Rear : Y Involve s Tvinneling o r Horizonta l Borin g : N Explosives : N CXCAT V MAGELLAN MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C



### Service Area Contact Phon e Numbe r utmt y Typ e
CXCAT V CO X COMMUNICATIONS , IN C HEID I 

### Day : 402934046 9 Ah : 402934046 9 Emerg : 402932975 7
X

* A /-C T T A X T MAGELLA NMIDSTREA M PARTNER S x^TM^ „ . MAGELLA N, „ DEBORA H „ 

### Day : 918574709 8 Alt : Emerg : 918574709 8

MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0

OMAHACO FCIT Y O FOMAHA-TRAFFIC.SEWE R 

### RICH/TRAFFI C Day : 402444719 7

AU : 402444516 1 Emerg : 402444516 0

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 3/17/201 0

### Pag e 2 of 2

OPPDGPR 5 OMAH A PUBLI C POWE RDISTRICT EL M LOCATIN G 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNNEIC QWES T LOCA LNETWOR K EL M LOCATIN G 

### Day : 406728934 3 Ah : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 3/17/201 0

### 34 8 

# As-Buil t Drawin g ^
COASTA L 

# )m ; OMah aLeadSuperfun dSite OLS# : 34 8 Dat e Excavated : 4/1/201 0 Dat e USEP ASigne d Off : 4/27/201 0 Are a Sodden : 202 5 s o f t Exterio rPain t North Arro w Omah a Lea d Sit e Owne rName : • Goo d Sit e Sketc h Address : 192 2 BINNE YS T Phone : " W ; • Poo r Q Not pain t Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Firm ; Sample s Collecte d Sverdru p RYASCPXA-34 8 YA 656. 4 pp m 

## a Date ; RYBSCPXA-34 8 Y B 25 7 pp m 

## a Time : RYCSCPXA-34 8 RYDSCPXA-34 8 Y C Y D 555, 6 pp m pp m 

# • a n Sample s Analyze d RDZSCPXA-34 8 D Z 1948. 8 pp m 

## n XR F Unit ; Book : RGZSCPXA-34 8 G Z

. pp m 

### D 

## a Date : 6/2/199 9 RPZSCPXA-34 8 P Z .pp m 

## a D Time : 14:2 5 Staff : Numbe ro f Sample s = Legend : Y A= Yar d (NE) , Y B = Yar d (SE)

. Y C = Yar d (SW) , Y D = Yar d (NW) , D Z = Dri p Zone , G Z = Garden , P Z = Pla y



### Legen d Concret e Dri p Zon e Excavate d 

# m Quadrant s Excavate d Are a replace d wit h Are areplace dwit h Are alef t bar e So d Rock/Mulc h' ' 

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

# g ^ ^ 34 8 C\ffr^ < \J ^ 

# e l o^/:>ii

. Exterio rPain t North Arro w 

### Omah a Lea d Sit e Owne rName : 

### • Goo d Sit e Sketc h / ^ Address : 192 2 BINNE YST

_ 

### • Poo r W : Phone : *^ ' Q Not pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : Sverdru p RYASCPXA-34 8 VYA; ; 656. 4 pp m 

## 0 D Date : RYBSCPXA-34 8 Y B 25 7 pp m 

## 0 D Time : RYCSCPXA-34 8 Y C 555. 6 pp m 

## D Sample s Analyze d RYDSCPXA-34 8 Y D pp m 

## D D RDZSCPXA-34 8 D Z 1948. 8 pp m 

## 12 1 

# a XR F Unit : Book : RGZSCPXA-34 8 G Z pp m 

# a D Dat e 6/2/199 9 RPZSCPXA-34 8 P Z pp m 

# • D Time : 14:2 5 Staf f Numbe ro f Sample s = 4 Legend : Y A= Yar d (NE) , Y B = Yar d (SE)

. Y C = Yar d (SW) , Y D = Yar d (NW) , D Z = Dri p Zone , G Z = Garden , P Z = Pla y



# 70 3 

# 5

# i l

Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e Owne rName : • Goo d 

### Sit e Sketc h Address : 192 2 BINNE YST • Poo r W : Phone : H : Q Not pain t 

## 34 8

Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Firm : Sample s Collecte d Sverdru p RYASCPXA-34 8 656. 4 Date : RYBSCPXA-34 8 25 7 Time : RYCSCPXA-34 8 RYDSCPXA-34 8 Sample s Analyze d RDZSCPXA-34 8 Book : RGZSCPXA-34 8 6/2/199 9 RPZSCPXA-34 8 14:2 5 Numbe ro f Sample s = 4 Legend : Y A= Yar d (NE) , Y B = Yar d (SE) , Y C = Yar d (SW) , Y D = Yar d (NW) , D Z = Dri p Zone , G Z = Garden , P Z = Pla y

%'\( ^ 

## i)p^H-P(^X '

'I'M ,



## A ^

6IW£ YS T

:. ^ ^

^ 

### cnBI/VNE V Re

v 4

- 046141.012 3 

## c^St-)/^Ae^ |

### 34 8 Exterio rPain t Nort h AiTo w Owne rName : Omah a Lea d Sit e • Goo d Address : 192 2 BINNE YS T

Sit e Sketc h • Poo r Phone : H : W • No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : Sverdru p RYASCPXA-34 8 Y A 656. 4 pp m 

### E l D Date : '_ RYBSCPXA-34 8 Y B 25 7 pp m 

### B D Time : RYCSCPXA-34 8 Y C 555. 6 pp m 

### D Sample s Analyze d RYDSCPXA-34 8 Y D pp m 

### D D RDZSCPXA-34 8 D Z 1948. 8 .pp m 

### E l D XR F Unit : Book : RGZSCPXA-34 e G Z .pp m 

### D D Date : 61Q/199 9 RPZSCPXA-34 8 PZ .pp m 

### D D Time : 14:2 5 Staff : Numbe ro f Sample s = | 4 ! Legend : YA= Yard (NE) , Y B = Yard (SE) , YC = Yar d (SW) , Y D = Yar d (NW) , D Z = Dri p Zone , G Z = Garden

. P Z = Pla y

Hcvt ­•> —*»
. V*----
— o * COASTA l 

## Consen t fo rAcces s T o Propert y RIGH TOF ENTR YT O PREMISE S 3^ ^ 

### 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 rit s 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 :
Daytim e Phone :

Addres s o f Propert y covere d b ythi s Agreement : 

# ]^t^ 2 (^/>7^ < 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 f lea d an d maypos 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 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 revie wan d approv e th e planne d soi l removal , 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 from EP Atha t th e propert y ha s bee n remediated
.
ENVIRONMENTA L RESPONS E ACTION S 

### Bysignin 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 , fo rth e sol e purpos e o f performin g th e work
. Thi s acces s shal l remai n I n effec t unti l th e wor k ha s l}ee n satisfactoril ycompleted
. Th e Granto rals o agree s to :

Pag e 1 o f 2COASTA l



### . / tftVlllONH(KTA l '•• » BRort ^ C I I O U rt N C 

### e Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; e Remov 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 ; cWate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessar ysubsequen 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 ; •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
. cAllo wvideotapin g and/o rphotographin g o f th e property
. AGREEI^EN 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 equipment 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 . 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

• >J^grtfn t acces s t o m ypropertie s D I d o no t gran t acces s t o m ypropertie s

c^-;^; / '

^ Signatur e / Dat e Signatur e Dat e

O 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 2C O AS TAL 

## Restoratio n Agreemen t The purpos e of thi s agreemen t i s to provide amutua l agreemen t a s to condition s of the propert y prior t o remediation activities
. 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 satisfactionof the propert y owne r an dth e UnitedState s Enviroimienta l Protection Agency (EPA)
.

Propert y ID ; 2, ^ Propert y Address : /^^-T

- ^.•^-.^•^.
. ^ F Phone : ^ ^ ^ ^\S ^ (C ^ O

nthe 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 usedb y the contractors . Indicat e distances , depths , materia l types , etc . Photographicall y an dVideographicall y documen t the existing condition s ofth e 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 removal , storage , disposal , and/o rretur n o f thes e item s i s th e Owner' s responsibility
. Kem : 

# • fyucC^

. Item :
Kem :
Kem :



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

### Itam

- V Ke m
Item :
Kem :

Page l 

# -J
.C O AS T AI
. aMVIKONHaHTA L O R O U r. INC

. 

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

# <>o. (

Kem : 

### 1 Kem :

Kem :



## \Ite m

Pre-existing propert y area , tha t wil l b e excavated , tha t i s coveredwit hgrass . Numbe r of tree s > 2 inc h trun k

diamete r Numbe r of tree s < = 2 inc h trun k

diamete r Numbe r of Sprinkle r Zones , Control Valves , Timers , Heads , etc . Attac hasketc hof th e sprinkle r layout
. Numbe r of an dsiz e o f eac hgarden / flower bed area . Attac hasketc ho f relative size s an dlocations
. Agree dupo nvalue of plan t material s not to b e replacedb v contractor . Not e thi s valu e wil l b e usedt o issue aplan t voucher t o th e property owner . Easemen t Area , t o b e excavated 

## 1 Quantit y 

# f > t 

# 1

/ 

# g f

/ 

# ^ h c^^\y^A> L 

# ^<J i -C.1 4 v/t.yn.p'^ -

Landscap e Inventor y Uni t ConditionH'ype/Specie s Quadrants

Eac h
Eac h

Eac h

Eac h Squar e Fee t

$

Eac h

Pag e 2 

# f l<5 < C O AS T AL

Additiona 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 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 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 yiiiega i 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 legalit yo f a certai n drivewa yo rparkin g area , yo u ma ycontac t th e cKyo f Omaha' s Plannin g Departmen t a t (402 ) 444-5150
. B Pleas e chec k thi s bo xI f yo u understan d th e Informatio n outline d above
.

Q 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 roLhouse , includin g foundatiorvcrack s o rfissures

.



### 0 1 agre e ^ ^ ^ ] I d o no t agre e

Owner' s Signnur e u Date * Contractor' s Signatur e Date Pag e 3 of

.

# f

BVID # 

# •5M2 > XR F PROPERT Y SAMPL E SHEE T Dat e 

# '/-zsw^: ) Addres s 

# Re- z b'^^^yF ^ Projec t Omah a Lea d ARR A Sampl e tim e am/p m XR F ID # 

## ^D^ ^ sampl e lengtl i 3 0 se c Shot # Readin g Sampl e are a Shot # Readin g Sarnpl e are a 

## Q<: i 

# <5.S^i9-d ^ 

# ^ A 

# 2 ^ ^a^ST ^ ^ ^ 

## ^55 c ^t/ f ^? > Dept h 

# :M
. ^/ ^

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## ^.9 ^ 

# ^%-t^? , / " 

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. /3' '

• / - Averag e o?9< ^ - - o < 3 

### Averag e y: ^

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

# 3M ± i ^ ^ / ^ 

## •( i 

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

RETES TAREA S Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h Averag e Averag e Signatur e 

# ^Wyii2 A Prin t 

# intZ%iMK£Aiiin
.

# 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 B y 

## Certificat e o f Verificatio n

96 0 SOI L 2010-04-2 3 09:3 9 91.4 8 Fina l
192 2 Binne yst~^~^ ^ easemen t 1 " N
. LOPE Z Confirmatio n non e

# 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 284.01 8 Supervise d By : 

## Certificat e o f Verificatio n

95 7 SOI L 2010-04-2 3 09:3 7 30.4 4 Fina l 34 8 192 2 Binne ys t easemen t 1 " N
. LOPE Z Confirmatio n non e

Erro r 22.17 0

# 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 293.85 0 Supervise d By : 

## Certificat e o f Verificatio n

95 8 SOI L 2010-04-2 3 09:3 8 30.4 6 Fina l 34 8 192 2 Binne ys t easemen t 1 " N
. LOPE Z Confirmatio n non e

± Erro r
± 22.60 1SCIENTIFI 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 297.83 2 Supervise d By : 

## Certificat e o f Verificatio n

95 9 SOI L 2010-04-2 3 09:3 9 30.5 8 Fina l 34 8 192 2 Binne ys t easemen t 1 " N
. LOPE Z Confirmatio n non e

± Erro r
± 22.83 2

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

## Certificat e o f Verificatio n XL3t-3902 2 Readin g N o 96 8 Mod e SOI L Tim e 2010-04-2 3 09:5 2 Duratio n 91.9 0 Sequenc e Fina l Flag s AVERAG E rAvg-of- 965-967 - ADDRES S —T:922"Bi r Binne ys t QUADRAN T D Z DEPH T 13 " XR F TEC H N
. LOPE Z MIS C Confirmatio n NOT E non e

Supervise d B y

# 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 NOTE

pp m Pb 785.01 5 Supervise d By : 

## Certificat e o f Verificatio n

96 5 SOIL 2010-04-2 3 09:5 1 30.6 6 Fina l 34 8 192 2 Binne y s t DZ 13 " N
. LOPEZ Confirmatio n non e



### ± Erro r 

### ± 36.96 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 791.23 8 Supervise d By : 

## Certificat e o f Verificatio n

96 6 SOI L 2010-04-2 3 09:5 1 30.6 4 Fina l 34 8 192 2 Binne ys t D Z 13 " N
. LOPE Z Confirmatio n non e

± Erro r 36.83 3

# 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 757.05 2 Supervise d By : 

## Certificat e o f Verificatio n

96 7 SOI L 2010-04-2 3 09:5 2 30.6 0 Fina l 34 8 192 2 Binne ys t D Z 13 " N
. LOPE Z Confirmatio n non e

± Erro r ± 36.31 0

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

## Certificat e o f Verificatio n XL3t-3902 2 Readin g N o 95 2 Mod e SOI L Tim e 2010-04-2 3 09:2 9 Duratio n 90.9 9 Sequenc e Fina l Flag s AVERAG E _Ayg-ot949;-951 : a > ADDRES S ClX±922-B1lTrTey's t QUADRAN T YC DEPH T 6 " XR F TEC H N
. LOPE Z MIS C Confirmatio n NOT E non e

pp m Erro r P b Supervise d By : 

# )CMM!1 A

# 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 184.94 3 Supervise d By : 

## Certificat e o f Verificatio n

94 9 SOI L 2010-04-2 3 09:2 7 30.4 5 Fina l 34 8 192 2 Binne ys t YC 6 " N
. LOPE Z Confirmatio n non e

± Erro r ± 19.05 6

# 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 179.44 1 Supervise d By : 

## Certificat e o f Verificatio n

95 0 SOI L 2010-04-2 3 09:2 8 30.0 5 Fina l 34 8 192 2 Binne ys t YC 6 " N
. LOPE Z Confirmatio n non e

± Erro r
± 21.18 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 BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 199.58 8 Supervise d By : 

## Certificat e o f Verificatio n

95 1 SOI L 2010-04-2 3 09:2 9 30.4 9 Fina l 34 8 192 2 Binne ys t YC 6 " N
. LOPE Z Confirmatio n non e

± Erro r 19.91 8

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

## Certificat e o f Verificatio n XL3t-3902 2 Readin g N o 94 8 Mod e SOI L Tim e 2010-04-2 3 09:2 6 Duratio n 91.2 7 Sequenc e Fina l Flag s AVERAG E r—Avg-of-945=94 2 ADDRES S 1922-BmneyLSt
_ QUADRAN T Y A DEPH T 6 " XR F TEC H N
. LOPE Z MIS C Confirmatio n NOT E non e

Erro r P b 25.20 4 pp m
Supervise d By : 

# ^Cai^QJ M

# 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 330.80 1 Supervise d By : 

## Certificat e o f Verificatio n

94 5 SOI L 2010-04-2 3 09:2 4 30.5 1 Fina l 34 8 192 2 Binne ys t Y

A 6 " N
. LOPE Z Confirmatio n non e

± Erro r 24.70 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 306.53 7 Supervise d By : 

## Certificat e o f Verificatio n

94 6 SOI L 2010-04-2 3 09:2 5 30.5 9 Fina l 34 8 192 2 Binne ys t Y

A 6 " N
. LOPE Z Confirmatio n non e

± Erro r
± 23.92 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 314.15 9 Supervise d By : 

## Certificat e o f Verificatio n

94 7 SOI L 2010-04-2 3 09:2 6 30.1 7 Fina l 34 8 192 2 Binne ys t Y

A 6 " N
. LOPE Z Confirmatio n non e

± Erro r
± 26.98 0^ 0 STA f •y ^

— 

## i^^y i * • 

## Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 1 ^^^X p ­ Coasta l Environmenta l Grou p Inc
. ^^S^ ^ Vf^^l ^

www.coastalhazmatco m ^^" ^ %pnoi« ^ COASTA L iNVIIONHEIITA L CROUP

. IN C 

# EXECUTIV ESUMMARY : BVID #348-(192 2 BINNE Y ST )
No Issue s o r Concern s [ ^ Issues/Concern s Detail Explanation :

# aEPA EP A Propert y Clos e Ou t For m 

# 4
. Propert y# ; '3W^
. . . Datc/Tlmc : • ^ ^ 

## 2S7 D Owner' s Name:
. ii_i^r\(t > Quad s Excavated : Contracto r Grou p Ye s N o Excavatio n Gcnen l 1
. I f necessaiy , were th e correc t quadrant(s ) excavate dan drestored ? 

## t-- " 2
. If necessary , were th e correc t area s o f drip zone excavate dan drestored ? 

# u- '
Gradin g So dan dVeaelatlo n Ye s N o I
. Doe s th e gradin g aroun dth e perimeter ofth e hous e i nexcavate darea s generally slop e awa y 

## L^^ fromth e bouse ?
. 2
. Ha s so dbee nlai din al l area s tha t were excavated ? 

## ly^ ' 3
. Doe s th e sodappear to b e generall y healthy an dgrowing ? (Onl y evaluat e if inspecte da t a3 0 

### \ y ' da y time period ) 4
. Ar e soddedarea s generall y firman devenly graded ? 

### / / ' S
. Ar e th e joint s betwee nth e so dstrip s generally tight ? (Only evaluat e if inspecte da t a3 0 da y 

### l y ' tim e period ) \ 6 , Wa s th e propert y grade dsuchtha t water will no t poo l o nth e property ? 

### i^ ' 7
. Wa s damag e t o landscapin g o r plan t material s avoided ? 

## \ y Gates
. Fence s an dRelataJB g Wail s Ye s N o 1
. D o gate s ope nandclos e freely? (Ifapplicable ) 

### t ^ " 2
. Wer e al l gate s o r fence s talien dow ndurin g restoratio nactivitie s reinstalled ? (Ifapplicable ) 

# I/ " 3
. Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) 

## U- ^ 4
. Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) Foundation , SidiflKan dGntler s Ye s N o I
. Wa s damage t o th e sidin g o r tri mavoided ? 2
. Wa s damag e t o th e foundation avoided ? 

# i ^ ^ 3
. Wa s damag e t o window s avoided ? 

## i^ ' 4
. Wa s damag e t o window s or doo r screen s avoided ? S
. Wa s damage t o downspout s o r downspout extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ye s N o 1
. Wa s damag e t o drivewa y surface s avoided ? 

## 1 / 2
. Wa s damage t o walkwa y surface s avoided ? 

### L ^

## Owner s comments :

Inspectio nnotes :

Remova l an drestoratio naclivale s complet e includin g th e 30-da y so dwarranty : EP A Representativ e Dcrv i iS^j^. ^ Dale : ^/^7/^0/ 0

## Propert yCompletio n Agreemen t
Ihi s agreemen t document s th e complclio n o l remedia l acliviiie s perloime d o n m yproperl yM ysignatur e wil l designat e tha t I a m satisfie d wit h (h e rtitoraCio n o f m yproperly , an d (hat n o item s ar e i n questions , now , o rat an ylim e i n th e future , excep t thos e item s liste d below , i f an y

Propert yID : 3 ( J 2^ Propert yAddress : lOf^Z , P^mfX^X J l4 - Owner : \2 ^ -"....
. I • iV i _'
. I ' ; / ^ a a _- z /- I L? ' -^rr - \ Phon e 

# ^.^^^^.--sof e -^(c N Restoratio n Item s i n Question :

item : Item : ^W^^ ^ • U • 10 1 1 1 Item : Item : Item : Item :

. Additiona l Comments :

Rgrc crestoraiio n i * complcled , exccp i a s note d ^ [ I I d o mi l WiK crestorfttio n i s complete d 

# ^^^>| 0 FoGo^Aym ^ H-z^-iC ) Dat e Cont i arlor' s Sienalur cDal e

### @



## AP R 2 9 201 0 

# P Iopert y Owne r A.s?&s?meE t

o f

pGrfSUPfiRflrf^MlVlSIO N America n Recovei y an dRei n vestmen t Ac t (ARRA ) Omah aLea dSupei-ftjn dSit e 2009/201 0 Rfimedistio n CoBtrfictor : Coistfc l EaviroBEufcnt dGrou p - EP-llTjl9^ 6 Proper^ " Identifie r Number : :5M? ) ' P , v V Propert y Ov^-Ecr' s Hmc : ^nnA f J-VVV-f i \0>V\r \ lEftrttcticn s t o th e Propert y Owner : Thi s for mserve s to recor dth e Propert y Owner' s assessment o f performanc e (Incentiv e 1

- Qualit y Asstiranc e Surveillanc e Plan ) involvin g the liste dremediatio ncontractor , as applicabl e t o th e Oraah aLea dSite
. Thi s for mdocument s th e timelines s o f punchlis t resolution , busines s relations , complaint resolutio n an dth e overal l qualit y of work
. I f nee dbe , the Propert y Owne r ma y utiliz e thi s for mt o recor dproblem s and/o r issue s not specifically tie dt o a nassigned address , fo r example , busines s relation s tha t generally don't follo w the guideline s se t fort hi nth e Performanc e Wor k

Statement
. Th e Propert y Owne r will indicate his^e r assessment o f performanc e wit hthe contractor' s wori c b y checkin g s aumerics l retin g onth e ttbl e belo w usin g th e numerica l definition s firo m the ratin g scal e below , then sign & dat e th e form
. 9-1 0 "excellent " 7- 8 "ver y good " 5- 6 "acceptable " 3- 4 "poor " 1 - 2 "ver y poor ' ^ , » ' 

### Propert y Owner' s Assessmen t of Performanc e Regardin g th e Contractor' s Work 1 0 

## i C 5 9 4 8 3 7 2 6 1 

### Propert y Owne r AddttioneECoimmemt s frotK.(oiptioirk£l ; coatmu e o nbac k pag e i f neede d
Propert y Owne r StgnEture : 4 ) y^-y/A—^-—-" ' Bst e

# EP A Assessment o f

Performanc e For m AmericanRecover y andReinvestmen t Ac t (ARRA) OmahaLea dSuperfun dSit e 2009/201 0 Remediatio n Contractor : Coasta l Environmenta l Grou p - EP-R7-09-0 6 Propert y Identifie r Number : "^M ^ ^_
_ Propert y Address : 1<^'Z2
. '^'\y^r^y^J j 'S\ - Propert y Owner' s Name : V^r/a.r N LlwA\p\.r ^ ~ (Abov e informatio nt o b e filled out b y th e remediatio n contracto r prio r t o utilizatio nb y th e EP A COR ) 

## Instruction s t o EP A COR : Thi s for mserve s t o recor dth e COR' s assessmen t o f performanc e (Incentive 1 - Qualit y Assuranc e Surveillanc e Plan ) involving the listedremediation contractor , a s applicable t o the OmahaLea dSite
. Thi s for mdoctmients the timelines s of pimc hlis t resolution , busines s relations , complain t resolutio n an dthe overall qualit y o f work
. If needbe , EP A ma y utiliz e thi s for mto recor dproblem s and/or issue s not specificall y tie dto a n assignedaddress , fo r

example , busines s relation s tha t generally don' t follow the guideline s se t fort hin th e Performance Wor k Statement
. Th e CO Rwill indicat e his/he r

assessmen t o f performanc e wit hthe contractor' s wor k

by checkin g anumerica l ratin g onth e tabl e belo w using the numerica l definition s fromth e rating scale below , then sign & dat e th e form
. 9-1 0 "excellent " 7- 8 "ver y good " 5- 6 "acceptable " 3- 4 "poor " 1-

2 "ver y poor " EPA' s Assessment o

f

Performanc e Regardin g th e Contractor' s Wor k \Q X

## 5 8 3 7 2 6 1 Additional Comment s fromEPA CO R(optional ; continu e o n bac k pag e if needed )

EPA CO RSignatur e 

# : LXv/L/ / Date: XA/M/( )