## TRANSMITTA Lof OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R 

# yox i nif f SAI D # : Date : Address : 

# lu ^ LiftflM^M ' W t Remediatio nContractor : Coasta l Environmenta l Group
_ Year : 200 i ^ 

### SOI LREMEDIATIO N PROPERT Y HL EFOLDE RDOCUMENT S Vide o o f property (DVD ) Executiv e Summar y EPA-providedproperty sketch SignedAcces s Agreement fo r subject propert y SignedAcces s Agreenient(s ) fo r adjacen t propert y 

# A Restoratio nAgreement 

# A Settlement document s (i.e. , fo r damag e o r to replac e plants , etc. ) Confirmationdat a Photograph s ik ti?C^iyiVv ^ As-built sketch 

# A Satisfactor y restoratio nsigne db y Propert y Owner 

# A Propert y close-out check lis t signedb y EP A Descriptio no f area s not meetin g RO D cleanup criteri a Utilit y clearance s PropertjnHironnationfro mDougla s Count y Assessor s Office 

# y^ii o Dat e Superfun dPropert yAcces s Checklis t ProptrTj

- ID : 

# iSSD l • WORKST/VRTt D ON : D WOR K

COMPELTE D ON : Prope mAddr.» : 22.D H Lft\rmnr e AsJP
. Rente r Oxvncr : '^tpVyCXv- a "TKomjQ' b Address : Phone : Scimje , Pax

Cell/Pager : Phone : ^^ ^ -n«=,O q AdditiofiSi l Inlnrmnlion : F « v Ccll/Page r

•Norificatio n lette r Sent : / / By : 2J ACCC M AfTcemcB i Signed : ;L/22/ ^ *>• = Brya/ 7 (5 ' Restoratio n Agreemen t Signed : i/22-/ffl
. ^ yhr\iAjL n O Topsoi l Ssmplin g (i f applicuble ) / / By : D Disposa l Samplio g (i f applicable ) / / By : Q Gnrdc n Samplin g (i f apr)licable ) / / By : n Utilit yClearanc e Called : / / By : [0 ' Video/Phofo s (Before ) On:i/22/. ^ ^yCAL\(xy\^ D Video/Photo s (During ) On : / / B.> : n Video/Photo s (After ) On : / / By : D Video/Photo s (30-Day ) On : / / By : D Propert yCompielio n Aj;reemen ( Sir*cd : / / By : D Fina l Repor t Issued : / / By : Ai rMonitorin g {•i xapplicable )

D Communit yQ Cre w On : / / By : Results : D Communit yQ Cre w On : / / By : Results : 1 Q Communi M O Cr\: » On : / Bv : r , 1..
.

Omah a Lea d Srt e

## Propert y I D # Propert y Address : Initial Contact : Secon dContact : Final Contact : Fina l Action :

Comment : Owne r Comment (s) : Site Coordinato r Comment (s) : CONTACT FOR M



# • ^f)'^n \ X2_n M La^rmox- e A v Date : Time : Action : Date : Time : Action : Dale : Time : Action : Transmit l o EP AD Other Action : D

## Douglas Count y Accoun t Infonj^Bbn Pag e 1 of 2 )n||Bk) r
Dougla s County , Nebrask a Propert yRecor d - R l 13324000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f52n d S t - VleWO n Ma p Infomiatio n i s vali d a s o f2009-6-1 6 Treasurer' s Ta xRepor t Ne wFeatur e • • - •^ Aut o Sale s Searc h Owne r THOMA S RICHAR D 220 4 LARIMOR E AV E OMAH AN E 68110-000 0 Propert yInformatio n Ke yNumtier : 332 4 000 0 1 1 Accoun t Type : Residentia l Parce l Number : 113324000 0 Parce l Address : 220 4 LARIMOR E A V OMAH AN E 68110-000 0 Lega l Description : FORD S SARATOG ALO T1 4 BLOC K0 E 1 F TLT1 & AL L 4 4 X 13 5 Valu e Informatio n Lan d Improvemen t Tota l 

### 200 9 $2,500.0 0 $51,000.0 0 $53,500.0 0 200 8 $2,500.0 0 $51,000.0 0 $53,500.0 0 200 7 $2,500.0 0 $51,000.0 0 $53,500.0 0 200 6 $2,500.0 0 $51,000.0 0 $53,500.0 0 200 5 $2,500.0 0 $6,300.0 0 $8,800.0 0 200 4 $2,500.0 0 $5,700.0 0 $8,200.0 0 L^n d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 3 5940. 0 1. 0 135. 0 44. 0 N o Improvemen t Informatio n Buildin g 1



## http://douglasne.mapping-online.com/DouglasCoNe/static/accoiintinfo.jsp?accoiintno=R l 13..
. 7/7/2009

### Dougla s County Accoun t Info : irijAb r 

### Pag e 2 of 2

"°"H J SWJtMICOIrsOr t m a tDi r u o
to o ^Kvnaetx r ITX B ug r»ooc ric o mi T ^ !a a « « ae - tOf f rmsur/fn*t e SWiBoolCalnoJi *

CLIC KTO ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1835. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Fai r

Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 9. 0 Exterior : Fram e Viny l Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 4. 0

Roo fType : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 190 0 0 % 190 0 10 9 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 ft 1235. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bati i Ful l 1. 0 Porc h Sla b Roo fCei l 48. 0 Porc h Sla b RoofCei l 24. 0 Porc h Sla b w/Step s 9. 0 Use r Atti cFul l Finis h 600. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R113.
. . 7/7/200 9

### Pag e 1 of 2

" > Creat e Anothe rTicke t ] [ Bac k t o Irt h Interne t ] 

### Sen d Emai l



### • YOU RTICKE T NUMBE RI S 2332232
. Origina l Cal l Date : Wor k t o Begi n Date : 8/03/0 9 8/05/0 9 Time : 12:2 9 p m Time : 1:0 0 p m Op : ELIZABETH1879 0
State : N E Address : 220 4 County : DOUGLA S Street : LARIMOR E AV E Place : OMAH A Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 03-NW,04-N E Sect-Qtr : Typ e o f Work : LEA D REMEDIATIO N Locatio n o f Work : INCLUD E AL L EASEMENT S LOCAT E ENTIR E PROPERT Y Remarks : FAX AL L CLEAR S TO : (877)662-421 1 : UNSUR E ABOU T 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 Corne r Lot : N Involve s Tunnelin g o r Horizonta l Borin g : N Front : Y Rear : Explosives : N CXCAT V MAGELLAN MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C



### Servic e Area Contact Phon e Numbe r Utiiit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
MAGELLA N Day : 918574709 8

MAGELLA NMIDSTREA M PARTNER S L PDEBORA H 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 RO N Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0

http://www.dhon.org/irihintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 8/3/200 9

### Pag e 2 of 2 

# mm

0PPDGPR 5 OMAH APUBLI C POWE RDISTRIC T N A Day : 406728934 3

Alt : 406207149 4 Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K

N A Day : 406728934 3

Alt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 8/3/200 9

# ^ As-Buil t Drawin g d |
COASTA L 

# Omah aLea dSuperfun dSit e

3550 1 Omah a Lea d Sit e Sit e Sketc h Owne rName : RICHAR D THOMA S Address : 220 4 LARIMOR E Ay
_

Phone : H 9<?(-^73 5 w. " Sampl e Numbe r Lea d Sampl e LA B Concentratio n Collecte d RYASCPXA-3550 1 F 1 pp m 

### D g4? ^ RYBSCPXA-3550 1 F2 ' M ' pp m 

### \3 A D RYCSCPXA-3550 1 B 1 pp m 

### D 3 S ^ RYDSCPXA-3550 1 8 2 pp m 

### B ^ 

# n RDZSCPXA-3550 1 D Z pp m 

# n -2-7
. U/r , RGZSCPXA-3550 1 G Z pp m 

### D RPZSCPXA-3550 1 P Z pp m 

### D 

# zo a La b RPZSCPLA-3550 1 Numbe ro f Sample s = / Resul t 21 5 pp m OLS# : 3550 1 Dat e Excavated:8/11/0 9 Exterio rPain t Nort h Arro w n Goo d p^-^oo r 

# I I I No t pain t ^ample s Collecte d Fir m . , Date : O ^ - L ^ • C^J-^ , Time : ?Zy^ d Qr ^ Sample s Analyze d XR F Unit : /OS" ? Book : I3 Z

Date : /< g - / 3 -aS ~ Time : P/y i Staff : AA

Omah a Lea d Sit e 

## V/flatn f \o x Legen d Concre't e Dri p Zon e Excaval^e 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 

### Contract : # : EP-R7-07-0 5 Coasta l Environmenta l Grou p In c 4613 0

# 3550 1 Omah a Lea d Sit e Owne rName : RICHAR D TH0MAS
_ 

### Sit e Sketc h Address : 220 4 LARIMOR E A V Phone : H:991-^^3 5 W : Lea d Sampl e Sampl e Numbe r LA B Concentratio n Collecte d RYASCPXA-3550 1 F 1 pp m 

## D RYBSCPXA-3550 1 F 2 " M 

# ' 16 7 pp m 

## \2 A 

## D RYCSCPXA-3550 1 B 1 pp m 

## D RYDSCPXA-3550 1 8 2 pp m 

# n RDZSCPXA-3550 1 D Z pp m 

## D RGZSCPXA-3550 1 G Z 

# ii a pp m 

## D RPZSCPXA-3550 1 P Z pp m 

## D La b RPZSCPLA-3550 1 Numbe ro fSample s = : / Resul t 21 5 pp m Exterio rPain t Nort h Arro w
•Goo d 0-^o r ( Q No t pain t ^ample s Collecte d Firm : Date : Time : 

### pA- \ Sample s Analyze d XR F Unit : 

### 105 1 Book : /? Z Date : _ Time : 

### P/Y ] Staff : 

## A A

Omah a Lea d Sit e 4613 0 

# <mm\ y\f(yLu y\o \Omah a Lea d Sit e Owne rName : RICHAR D THOK/IA S Sit e Sketc h Addrass : 220 4 LARIMOR p A V

Phone:HL99l-<??3 5 w Lea d Sampl e Sample Numbe r LA B Concentratio n Collecte d RYASCPXA-3550 1 F l ^ pp m 

### D RYBSCPXA-3550 1 F 2 ' M 

## ' ffe 7 pp m 

### D RYCSCPXA-3550 1 B 1 pp m 

### D RYDSCPXA-3550 1 8 2 

## 575 " pp m 

### D RDZSCPXA-3550 1 D Z pp m 

### isa r D -2-21^1 ^ RGZSCPXA-3560 1 G Z pp m 

### D 

## 1 1 f \ RPZSCPXA-3550 1 P Z pp m 

### D 

# zo a U b RP2SCPLA-3550 1 Numbe ro fSamples = / Resul t 21 5 pp m 

### 3550 1 Exterio rPain t NorthArro w •Goo d 0''^oo r 

### ( Q No t pain t Sample s Collecte d Fir m Date : Time : 

### i^'y^c > p/ A Samples Analyzed XR F Unit : /05 1 Book : I3 Z

Date : / a - / 3 'OS ' Time : PAY I Staff : LA



### _ Omah aLea dSit e 4613 0 

## \/flCan f\o \COASTA L ENVIHONHENTA L CROUP
. INC
. 

## Consen t fo rAcces s T o Propert y RIGH TO F ENTR YT O 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 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 : 

# 1S3'0^o H

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 flea 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 fCoasta 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 fro m 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 subcontractors 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 fperformin g th e work
. Thi s acces s shal l remai n i n effec t unti l th e wor k ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :

Pag e 1 o f2S ' o 

### \ COASTA L

'• > 

### '—. # INVIRONHfNTA L A CROUP
. IN C


### •Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; •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 ; •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 ; •Abid e b yhealt h an d safet yguidanc e provide d b yEPA ; •I fth 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 fth 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 fth e wor k activities , o rwit h an y o fth 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 fsai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o fth 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
" ^ gran t access to m ypropertie s D I d o not gran t access t o m ypropertie s

Signatur e Dat e

G 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 f2C > * S T AI 

# Ro^toratfopi
. Agreemen t Th e purpos e o f thi s agreement i s t o provid e amutual agreement a s t o condition s ofth e propert y prio r to remediatio nactivities
. Thi s will als o serv e a s documentatio nfo r th e purpos e o f assurin g that restoratio n activitie s ar e complete dto th e satisfactio no f th e propert y owner andth e UnitedState s Environmenta l Protectio nAgency (EPA)
.

Property ED : ^ r ^<y O ^perty Address : 7_/2Lc> M La^rivw^rg
. t K wL,VN,c-.,rd , T \t s Qifv^f t \Phone ; G, ^ ^ CfyO^ \ O nth e attache ddiagram(s ) indicat e area(s ) to excavate , surfac e structure s an dlandscaping feature s an d acces s location(s ) to b e usedb y th e contractors . Indicat e distances , depths , materia l types , etc . Photographicall y an dVideographically documen t th e existin g condition s ofthe propert y andth e basement i

f necessary . 

## Stems t o b e Remove db y th e Owne r befor e StaK
. o f

Remediation : '\\K i .c-r.ovc.i : giof5r6 , C'i£;obfc.i, fciio/ot iEt.;i:'i o. ' tlit-Hf e iifciri ai!

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## r Kem : 

# M\^mt>y {{jtM< h \Kem :

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- r " 

### Kem :



## Item s t o b e Remove db y th e Contracto r Durin g Remediatio nan dNo t Replace d Item : 

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# r c- ^ 

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## Landscap e Inventory Ite m Quantity ' Uni t Condction/Type/Specie s Pre-existin g propert y area , that wil l be excavated , tha t is covere dwit hgrass . Quadrant s 

# HiAiC\ A Number of tree s > 2 inch trun k

diameter % Eac h
Number of tree s <= 2 inch trunk diameter 

## ny Eac h
Number of Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Auach r. sketch ut Uu

- >rti.il,lci l;;<iui ; 

# A Each

Number of an dsiz e of eachgarden / flower bed area . Alliicl i w ski'icli ol rfliUiM' biZiT

- nn dIcrjiiioni
. \ Each Square Fee t 

# yi\j t kh(h ^

Agree dupo nvalu e of plant material s no t to be replace d bv contractor . "c;: ' !';;•
. ' , ll ' • . J. \y

­ :'£•'( ' .( • '>''. : ••: ,i'.-'.\i

- 

# SA S

u Ar 11
. Easement Area , tobe excavate d Each 

# V "fT C i^^^n^iM ^ 

# 1 Pag e 2 of
.» " A , S 1 / •L



# r AddKiona l Conrtment s / Instructions :

Q I Chec k th e box"r fOwne rdoe s not wan t CE G t o documen t interio rfoundatio n wall s an d possibl e pre-existin g damage
. B ycheckin g thi s bo xCE G i s not responsibl e fo ran ydamag e don e t o th e interio ro fhouse , includin g foundatio n crack s o rfissures
. 

# 9 I agre « nI d o no * agre e 

# 1-^i A
. _£ ^£i£m&&z
. Owner' s Signature Contractor' s Signatur e Dat e 

### Pag e 3 of
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# Prin t £,UijiLbg: ^ Ca&ego 5

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

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pp m Erro r P b 169.30 5 ± 15.74 6 Supervise d By : L»t^QPSlC i

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

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pp m P b 132.54 0 Supervise d By : 

## Certificat e o fVerificatio n

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± Erro r ± 14.35 0

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pp m P b 106.28 6 Supervise d By : 

## Certificat e o fVerificatio n

296 7 SOI L 2009-08-1 1 14:2 1 30.2 3 Fina l 3550 1 220 4 Larymor e av e B 2 Nicola s 8 CLEARANC E

± Erro r ± 13.05 0

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 148.79 6 Supervise d By : 

## Certificat e o fVerificatio n

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± Erro r ± 14.95 6

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 296 9 Mod e SOI L Tim e 2009-08-1 1 14:2 1 Duratio n 121.6 2 Sequenc e Fina l Flag s AVERAG E ADDRES S QUAD/ZON E B 2 INSPECTO R Nicola s DEPT H 8 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P b Supervise d By : A^/t^tj^lTjJ A

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 297 4 Mod e SOI L Tim e 2009-08-1 1 14:2 4 Duratio n 121.7 6 Sequenc e Fina l Flag s AVERAG E ADDRES S -2204^t^ymore^ e QUAD/ZON E D Z INSPECTO R Nicola s DEPT H 1 2 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P b 

### [_203jaiIi J ± Supervise d B y 

# F^r/sni?o x

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 231.20 7 Supervise d By : 

## Certificat e o fVerificatio n

297 0 SOI L 2009-08-1 1 14:2 3 30.5 9 Fina l 3550 1 220 4 Larymor e av e D Z Nicola s 1 2 CLEARANC E

± Erro r
± 18.28 8

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 297 1 Mod e SOI L Tim e 2009-08-1 1 14:2 3 Duratio n 30.2 7 Sequenc e Fina l Flag s BVI D # 3550 1 ADDRES S 220 4 Larymor e av e QUAD/ZON E D Z INSPECTO R Nicola s DEPT H 1 2 SAMPL E TYP E CLEARANC E NOT E

pp m Erro r ± P b 205.33 3 17.44 4 Supervise d By :

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 182.59 7 Supervise d By : 

## Certificat e o fVerificatio n

297 2 SOI L 2009-08-1 1 14:2 4 30.6 5 Fina l 3550 1 220 4 Larymor e av e D Z Nicola s 1 2 CLEARANC E

± Erro r ± 16.55 0

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 193.62 7 Supervise d By : 

## Certificat e o fVerificatio n

297 3 SOI L 2009-08-1 1 14:2 4 30.2 5 Fina l 3550 1 220 4 Larymor e av e D Z Nicola s 1 2 CLEARANC E

± Erro r ± 17.26 7

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 297 9 Mod e SOI L Tim e 2009-08-1 1 14:2 8 Duratio n 121.8 6 Sequenc e Fina l Flag s AVERAG E ADDRES S 220 4 Larymor e av e QUAD/ZON E G Z INSPECTO R Nicola s DEPT H 8 SAMPL E TYP E CLEARANC E NOT E

± Erro r P b ± 16.63 3 pp m 187.08 3 Supervise d By : A^A^WcA s

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 184.33 7 Supervise d By : 

## Certificat e o fVerificatio n

297 5 SOI L 2009-08-1 1 14:2 6 30.2 7 Fina l 3550 1 220 4 Larymor e av e G Z Nicola s 8 CLEARANC E

± Erro r ± 16.84 7

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 232.04 5 Supervise d By : 

## Certificat e o fVerificatio n

297 6 SOI L 2009-08-1 1 14:2 6 30.6 7 Fina l 3550 1 220 4 Larymor e av e G Z Nicola s 8 CLEARANC E

± Erro r ± 18.31 1

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 127.79 7 Supervise d By : 

## Certificat e o f Verificatio n

297 7 SOI L 2009-08-1 1 14:2 7 30.2 4 Fina l 3550 1 220 4 Larymor e av e G Z Nicola s 8 CLEARANC E

± Erro r 13.95 1

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 297 8 Mod e SOI L Tim e 2009-08-1 1 14:2 8 Duratio n 30.6 8 Sequenc e Fina l Flag s BVI D # 3550 1 ADDRES S 220 4 Larymor e av e QUAD/ZON E G Z INSPECTO R Nicola s DEPT H 8 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P b 204.15 2 ± 17.42 4 Supervise d By :



## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o MnH p 298 4 «;nT i

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 298 1 Mod e SOI L Tim e 2009-08-1 1 14:3 0 Duratio n 30.1 5 Sequenc e Fina l Flag s BVI D # 3550 1 ADDRES S 220 4 Larymor e av e QUAD/ZON E easemen t INSPECTO R Nicola s DEPT H 1 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 58.87 2 ±10.35 4 Supervise d By :

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 298 2 Mod e SOI L Tim e 2009-08-1 1 14:3 0 Duratio n 30.1 5 Sequenc e Fina l Flag s BVI D # 3550 1 ADDRES S 220 4 Larymor e av e QUAD/ZON E easemen t INSPECTO R Nicola s DEPT H 1 SAMPL E TYP E CLEARANC E NOT E

pp m Erro r P b 53.64 3 9.90 8 ± Supervise d By :

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 298 3 Mod e SOI L Tim e 2009-08-1 1 14:3 1 Duratio n 30.4 5 Sequenc e Fina l Flag s BVI D # 3550 1 ADDRES S 220 4 Larymor e av e QUAD/ZON E easemeri t INSPECTO R Nicola s DEPT H 1 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 62.71 3 ±10.84 0 Supervise d By :

# p /AQL \ § ^^^L I ^yZA 

## Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Envlronmenta l Grou p Inc
.

www.coa8talhazmat.co m COASTA L mVIIOIIHEIITA l a lour
. IH C 

# EXECUTIV ESUMMARY : BVID #35501-(2204 LARIMOR EAVE )
No Issue s o r Concern s | ^ Issues/Concern s Detail Explanation :

# 0 0

. 1 

# EP A V 

# EP APropert y Clos e Ou t For m Property Addms:>^^gAimi5^ ^ Property 4 : 3fc60A
. „ Datc/Tlnic : 

## Ow^y * Nam. : ^3Ap£f^<A,V(tf{^ ^
. ^ > Quad s Excavated : 'Y ^ (^l^ff, € Contracto rGrou p /^nrtf^Vv X 9 V\<\fGV\<neft0 1 Ye s No Excavatio nGeaera l 1
.If necessary , vtrer e th e correc t quadrant(s ) excavate dandrestored ? 2
.i f necessaiy , wer e th e correc t area s ofdri p zone excavate dandrestored ? 

# y
Gradin g So d an d Vegetatio n Ye s N o I
.

Doe s the gradin g aroun dth e perimeter ofth e hous e i nexcavate darea s generally slop e awa y 

# Z A fromth e house ?__^
_ 2
.Ha s so dbee nlai dinal l area s tha t were excavated ? 

## \y 3
.

Doe s th e so dappear to b e generally healthy an dgrowing ? (Only evaluate if inspecteda t a3 0 

# A day tun e period ) 

# \ A 4
.

Ar c soddedarea s generally firman devenly graded ? 

### y S
.Ar e th e joint s betweenth e so dstrip s generally tight ? (Only evaluate if inspecte da t a3 0 da y 

# IA ' tim e period)
____ ^ 6
.Wa s the propert y grade dsuchtha t wate r will nol poo l o nthe propert>' ? 

# y 7
.Wa s danug e t o landscapin g o r plan t material s avoided ? Gates , Fence s aa d Retainin g Wail s Yes > o 1
.D o gate s ope nan dclos e freely? (Ifappiicable ) 2
.Were all gate s or fence s takendow ndurin g restoratio nactivitie s reinstalled ? (ifappiicable ) 

# Z ' 3
.Wa s damag e t o gate s o r fence s avoided ? (Ifappiicable ) 

# Z ' 4
.

Wa s damag e t o retainin g wall s avoided ? (Ifappiicable ) 

# Z ^ Foundation , Sidin g an dGutter s I
.Wa s damag e l o th e sidin g o r tri mavoided ? 

# W
2
. Wa s damage t o the foundationavoided ? 

# Z ^ A
. 3
.Wa s damag e to window s avoided ? 

# y 4Wa s damag e to window s or doo r screen s avoided ? 

# - A
5
. Wa s damage t o downspout s o r downspoul extension s avoided ? 

# Z
Sidewalk s an dDriveway s (Concrete ) Vcsy^ o 1
.Wa s damag e to driveway surface s avoided ? 2
.Wa s damage t o walkwa y surface s avoided ?

## Owner s comments :

Inspectio nnotes :

Remova l an drestorationaclivale s complet e including lh e 30-da y sodwarranty : EP A Representativ e 

# n l)A,Ayt.l ADate : ^ 2( p 0 ^

LJiT n

## Propert yCompietio n Agreemen t Thi s agreemen t document s th e completio no f remedial aclivme s perioime do nm y properl y M y signaiur e will designat e ihai I a msatisfie dwit hthe rcstoralio no f m y propeily
. andiha i n o iiem s ar e i nquestions , now , o r al an y lime i nth e future , excep t Ihos e ilem s liste dbelow , ifan y Propert y ID : 3>^^ ^ | Propert y Address : Q20l- / L^^lVKO/ ^ 

### 0"»^' - t^Tt^Vvc^ d Phone : ^a^:^,^<^ ^ Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item :
Additiona l Comments :

I Hgrc cI'cxtoralio n i % completed , rxccp i a s note d [_ | I d o no t a) ; re crcsroratio n i s complete d

Owner' s Sicnamr r atrarior' s Signature• 

## Wate rBil l Settlemen t

Property ID 3550 1 Propert y Addres s 220 4 LARIMOR EAV E Tenan t RichardThoma s

I have receivedfro mthe contractor , Coasta l Environmenta l Grou p Inc
. (Coastal) , the su m

of $ 48.5 1 fo r wate r usag e required to maintain the sod
.
Check Number 171 8 Valu e of Check $48.5 1 Mad e Ou t To Richar dThoma s Descriptio n of Settlemen t To reimburs e tenan t fo restimate d wate rcharge s on thei rMU D monthl yinvoices
. Mysignatur e belo w is acknowledgemen t of th e receip t of th e su m liste d above , whic h I furthe r acknowledg e to be fai rcompensatio n an d ful l paymen t fo rth e above , an d releas e Coasta l Environmenta l Grou p Inc
. fro m furthe robligation s orliability
.

wner* Sienatur Owner* s s Signatur e e Dat Dat e e Sienatur Contractor' s s Signatur e e Dat e
COASTA L ENVIRONMENTA L GROU P IN C 241 1 MARTH ASTREE T OMAHA , NE 6810 5 

## 171 8 27-V104000 3 624737290 4 

## n

VMhFi>gDBaili.NA
. IWinik l wMllifiitflffnii i FO R 

# %m/IATA M 

# l^m<i k i: 101*0000Ba n E.21.737EIOI^H - oi7i aAccount : 251208-114828 1 RICHAR D E
. THOMA S Senric e addreaa : 220 4 LARIMOR E AV E Cal l Sb^^.TTT/ I f yo u smel l gas . N o charg e t o chec k ga s leaks
. Hav e heatin g syste m checke d ever yyea rb ya qualifie d heatin g contractor
. Kee p chimney s an d flue s fre e o f debris
.

60 0 ' 

# 1 300 ­ 

# liii l

0
_ Oc t No vDe cJa n Fa b Ma rAp rMayJu n Ju l Au g Se p You rGa s Us «

•Paa l 1 2 Month * • PlB*l13-e « Month s Thi s Montt i Las t Yea r Billin g units : 1 3 3 7 Us e pe rday : 0. 4 1. 2 Averag e cos t pe rday : $0.7 3 $1.6 8 Numtie ro f day s i n billin g cycle : 3 0 3 0

Oc t No vOa cJa n Fa b Ma rAp rMayJu n Ju l Au g Sa p You rWate rUs e Pas t 1 2 Month s Pas t 13-2 4 MonUi a Ttii s Montt i L^s t Yea r Billin g units : 2 0 2 Us e pe rday : 0. 7 0. 1 Averag e cos t pe rday : $1.0 8 -$0.2 7 Numlwro fday s i n l)illjn g cycle : 3 0 3 0 172 3 Harne yS t • Omaha , N E 6810 2 • 402.554.666 6 e-mail : customer_service@mudomaha.co m • website ; www.mudomaha.co m Billin g dat e Se p 24,200 9 Previou s balanc e Paymen t receive d -Than k yo u Curren t charge s Ne w balanc e 

## •Tota l du e Oc t 9 , 200 9 You rbudge t paymen t o f $222.0 0 i s du e Oc t 9,2009
. Budge t varianoea :

Curren t =-$1542 4 Tota l = -$247.8 4 

### METROPOLITA N UTILITIE S DISTRIC T

XJNtQittri
. Think Blue
. $222.0 0

222.0 0 C R 222.0 0 222.0 0 

## $222.0 0

Detai b o f curren t charges : 

## GA S RESIDENTIA L RAT E A : Au g 1 9 t o Se p 1 8

Mete rNumbe r32051 4 Curren t rea d (actual) : 67 1 - Previou s rea d (estimate) : 65 8 - ^

1 3 CC F Ga s Use : 1 3 CC F x1.02 2 (hea t value ) = 13.28 6 therm a

1 3 day s 5.75 7 therm s a t 0.528 3 < $3.0 4 1 7 day s 7.52 9 therm s a t 0.463 2 < 3.4 8 Servic e Ctiarg e 12.0 0 Ga s Cos t k $18.5 2 Ga s Infrastructur e Replacemen t 30 0



## WATE R RESIDENTIA L RAT E W-1 : Au g 1 9 t o Se p 1 8

Mete rNumt)e r8833605 6 Size : 5/ 8 -inc h Curren t rea d (actual) : 160 7 - Previou s rea d (estimate) : 158 7 •= 2 0 CC F Wate rUse : 20.00 0 CC F o r14,96 0 gallon s 9.00 0 CC F a t 0.961 4 - $8.6 5 11.00 0 CC F a t 1.345 1 - 14.8 0 Servic e Ctiarg e 4.8 6 

# 7 > -> \ Wate rCos t > $28.3 1 Wate rInfrastructur e Replacemen t 2.0 0 Budge t Paymen t Pla n Interes t 0.0 7 C R Cit yo f Omah a Sewe r11.5 7 Sale s Ta x4.4 3 •Curren t Charge s $67.7 6Account : 251208-114828 1 RICHAR D E
. THOMA S Sen/ic e address : 220 4 LARIMOR E AV E Cal l 81 1 t)efor e yo u di g i n you ryard , buil d a fence , etc
. Cal l a t leas t hwo workin g day s i n advance
. Utilitie s wil l mar k gas , water , electric , cabl e an d phon e lines
. N o charg e fo rthi s service
.

600 " 

# 1 1 300 ­

0 

# _hiiiiilB J Se p O d No vOe cJa n Fab Ma cAp rMa yJu n Ju l Au g You rGa s Us e

•l>iBst12MaMli s B Past 13« 4 Month s Ttii s Mont h l^tYea r Billin g units : 3 6 1 8 Us e pe rday : 1. 2 0 6 Averag e cos t pe rday : $11 7 $1.2 6 Numtie ro f day s i n billin g cycle : 3 0 2 9

Se p Oc t No vDe cJa n Fe b Ma i Ap i Ma yJu n Ju l Au g You rWate rUs e Past 1 2 Montli s B Pes t 1»a 4 Montli s Ttii s Montt i Las t Yea r Billin g units : 1 1 3 Us e pe rday : 0. 4 0. 1 Averag e cos t pe rday : $0.6 4 $1.0 6 Numt>e ro f day s i n tiillin g cycle : 3 0 2 9 172 3 Harne yS t • Omaha , N E 6810 2 • 402.554.666 6 e-mail : customer_serviceemudomaha.co m • website : www.mudomaha.co m Billin g dat e Au g 25 , 200 9 Previou s balanc e Paymen t receive d -Than k yo u Curren t charge s Ne wbalanc e 

## •Tota l du e Se p 9,200 9 You rbudge t paymen t o f $222.00 i s du e Se p 9,2009
. Budge t variances :

Curren t ==-(1540 1 Tota l = (93.6 0 

### METROPOLITA N UTILITIE S DISTRIC T

Liv eGreen
. T^OT* 5k
.

$222.0 0

222.0 0 C R 222.0 0 222.0 0 

## $222.0 0

Detail s o f cunen t citarges : 

## GA S RESIDENTIA L RAT E A : Ju l 2 0 t o Au g 1 9

Mete rNumbe r32051 4 Curren t rea d (estimate) : 65 8 - Previou s rea d (actual) : 62 3 » 3 5 CC F

Ga s Use : 3 5 CC F x1.01 5 (hea t value ) = 35.52 5 therm s

1 2 day s 14.21 0 therm s a t 0.528 6 ­ $7.5 1 1 8 day s 21.31 5 therm s a t 0.5283 ° 11.2 6 Servic e ctiarg e 12.0 0 Ga s Cos t • $30.7 7 Ga s Infrastructur e Replacemen t 3.0 0



## WATE R RESIDENTIA L RAT E W-1 : Ju l 2 0 t o Au g 1 9 Mete rNumbe r8833605 6 Size : 5/ 8 -inc h Curren t rea d (estimate) : 158 7 - Previou s rea d (actual) : 1576' ° 1 1 CC F

Wate rUse : 1 1 00 0 CC F o r8,22 8 gallon s 9.00 0 CC F a t 0.961 4 = $8.6 5 2.00 0 CC F a t 1.345 1 - 2.6 9 Sen/ic e Charg e 4.8 6 Wate rCos t • $162 0 Wate rInfrastructur e Replacemen t 2.0 0 

# yW-T

- Cit yo f Omah a Sewe r 11.5 7 Sale s Ta x 4.4 5 •Curren t Charge s $67.9 9