## TRANSMITTALof OMAHALEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R

SAID 

# »-.3 m W\o ^1^ ^ Date : Address : Hl^c ? 4 1> ^ ^ f Remediatio nContractor : _Coasta i Environmenta l Group
_ Year : 200 1
SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S D 

### Vide o o f property (DVD ) Executiv e Summary EPA-provide dproperty slcetch 

## i 3 Signe dAcces s Agreemen t for subjec t property Signe dAcces s Agreement(s ) for adjacent property Restoratio nAgreemen t Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) Wftl] ^ t^H ' Confirmatio ndat a Photograph s ^ bfCMik^f^
. '^CA/i^fU ^ ^ ^'^ ^^ ^ D As-buil t sketc h Satisfactory restoratio nsigne db y Property Owner / Property close-ou t chec k lis t signe db y EPA —B - Descriptio nofarea s no t meetin g RO D cleanu p criteri a Utility clearance s Property informatio nfromDougla s County Assessor' s Offic e



# l l 

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### 3005451 1 Superfun d

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### Signed : iiL/iB'<2 ^ ^y-iAirlAnp ] \/ ] l\\fl^^fipli<
- O Topsoi l Samplin g (i fapplicuble ) / / By :< ^ O Disposa l Samplin g (r fapplicable ) / / By : O Gnrdc n Samplin g (i fapplicable ) / / By : D Uiilit vClearanc e Called : / / By : [ ^

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### On:^/2i/^9 ' By - 0 c-f-o^vf O D Video/Photo s (During ) On : / / By : D Video/Pholo s (After ) On : / / By : D Video/Photo s (30-Day ) On : / / By : D Propert yComplelio n Agreemen t Signed :/ / By : D Pin" ! Repor t Issued : / / By : Ai rMonitorin K(l U applicable )

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Omah a Lea d Sit e

## Douglas Coimt y Accoun t Intenatio n Pag e 1 of 3 mma z
Dougla s County , Nebrask a Propert yRecor d - R171920000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e ® scal e 0-5 0 n wes t o f52n d S t - VleVt fO n Ma p Informatio n i s vali d a s o f2009-5-1 2 Treasurer' s Ta xRepor t No wFeatur e - > - > ^ Aut o Sale s Searc h 

## Owne r WILBERGE R MICHAE L D ETA L 336 2 TAMM YS T BELLEVU E N E 68123-000 0 Propert yInformatio n Ke yNumlter : 192 0 000 0 1 7 Accoun t Type : Residentia l Parce l Numtter : 171920000 0 Parce l Address : 474 0 S 1 3 S T OMAH AN E 68107-000 0 Lega l Description : MAXWEL L & FREEMAN S AD D LO T8 BLOC K3 4 0 X 12 0 Valu e Informatio n
200 9 200 8 200 7 200 6 200 5 200 4 Lan d $5,600.0 0 $5,600.0 0 $5,600.0 0 $5,600.0 0 $5,600.0 0 $5,600.0 0 Improvemen t $62,200.0 0 $62,200.0 0 $62,200.0 0 $50,400.0 0 $50,400.0 0 $50,400.0 0 Tota l $67,800.0 0 $67,800.0 0 $67,800.0 0 $56,000.0 0 $56,000.0 0 $56,000.0 0 Sale s Informatio n Sale s Date : 

## 2004-03-1 5 Deec fType :

Price : W D $38,000.0 0 Book : 200 4 Page : 03398 6
Grantor : Monumen t Stree t Fundin g I I LL C Grantee : Michae l D Wilberge r Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 2004-01-2 9 Dee d Type : TR D Book : 200 4 Page : 01508 3 Price : $ 57,864.0 0 Grantor : STEFF I SWANSO N T R


## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R171..
. 6/6/200 9|M|1 £ 

## Douglas Count y Accovin t In|»matio n Pag e 2 of3

Grantee : MONUMEN TSTREE TFUNDIN G I I LL C Valid/Invalid : Invali d Exclusio n Reason : Foreclosur e Sale s Date : 1997-10-0 9 Dee d Type : Book : 207 7 Page : 66 9 Price : $ 45,000.0 0 Grantor - Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 1 4800. 0 1. 0 120. 0 40. 0 N o Improvemen t Informatio n Buildin g 1
4740S13S T SfconttRoo r 272 0 So ^ F t rt a •s U K DMKtI M

F m Floo r MpOS o n n rTseos q R su r f V Mi r H a 7i y
• n u 0 1 1 1/ 2 Stor y i smTmacm r Bnn t Block SI I TSeoSi ) F l

CLIC KTO ENLARG E IMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : 1028. 0 Percen t Complete : 100.0 % Perimete r0. 0 Quality : Averag e Uni t Type : Condition : Averag e

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 : 6. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo fCover : i Compositio n Shingl e Bedrooms : 3. 0

Roo fType : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k


## http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=R l 71..
. 6/6/2009

## Dguglas Count y Accoim t In&gnatio n Pag e 3 of 3 fiMms
Sprinkle rSquar e Footage : | 0. 0 rearSuff t Yea r Remodele d 191 2 199 7 Detai l Typ e Ad d O n Applianc e Basemen t Fixtur e Fixtur e Porc h Use r Percen t Remodele d 0 % Detai l Descriptio n Fenc e Chai n Lin k Allowanc e Bsmn t Bloc k 8 f t Bas e Fixture s Bat h Ful l Sla b Roo fCei l ASBESTO S Adjuste d Yea r Buil t 191 2 Physica l Ag e 9 5 Unit s 1. 0 1. 0 350. 0 1. 0 1. 0 188. 0 1. 0



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo,jsp?accountno=R l 71..
. 6/6/2009

## Propert y

ID # Property Address : Initial Contact : Secon dContact : Final Contact : Final Action :

Comment : Owne r Commen t (s) : Sit e Coordinato r Comment (s) : CONTACT FORM 

# l?>4 1 MIM D 

# s l- ^

s4 Date : Time : Action : Date : Time : Action : Date : Time : Action : Transmi t to EP AD Other Action : D

### Pag e 1 of 2

" > Creat e Anothe rTicke t Bac k t o Irt h Inteme t Sen d Emai l



### • YOURTICKE T NUMBERI S 2311554
. Origina l Cal l Date : 7/07/0 9 Time : 12:3 5 pm Op : ELIZABETH1879 0 Worlc t o Begi n Date : 7/09/0 9 Time : 1:1 5 pm State : N E County : DOUGLA S Place : OMAH A Address : 474 0 Street : S 13T H S T Twp : 14 NRng : 13 E Sect-Qtr : 03-NE-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lead remediatio n Locatio n o f Work : INCLUD E AL L EASEMENT S LOCAT E ENTIR E PROPERTY 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 : ELIZABETH Phone : (877)662-421 0 Wor k Being Don e For : coasta l Dept h o f Excavation : 4f t Corne r Lot : N Front : Y Rear : Involve s Tunneling o r Horizonta l Boring : N Explosives : N ATTNEBR l CXCAT V

DIGITE L LEVEL 3 MCINE B MUD0 2 OMAHACO F 0PPDGPR 6 PAETE C QLNNEI F QWESTNE

UtiUty Servic e Are a Contac t Phon e Numbe r Typ e 

### Day : 8002413624 9 ATTNEBR l ATT/T 

### Alt : Emerg : 8002413624 9 Day : 402934046 9 r-vf-AT M CO X COMMUNICATIONS , TTCTT^ T 

### Alt : 402934046 9 CXCAT V _j_ , HEID I 

### Emerg : 402932975 7 Day : 866562434 9 DIGITE L LIGHTCOR E N A 

### Alt : 800850904 8 Emerg : 866562434 9 Day : 877366834 4 LEVEL 3 COMMUNICATIONS , LEVEL S N A 

### Alt : LL C 

### Emerg : 877366834 4
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS..
. 7/7/200 9

### Pag e 2 of 2

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QWESTN EQWES T LON GDISTANC E 

### Day : 800289342 7 Alt : Emerg : 800289342 7 Day : 402504782 3 Alt : Emerg : 402504797 0 Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 800289190 1 Alt : Emerg : 800289190 1 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 800283423 7 Alt : Emerg : 800283423 7

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# Omah aLea dSuperfun dSit e 134 7 Exterio rPain t Nort h Arro w Omah a Lea d S t e Owne rName : •Goo d Sit e Sketc h Address:4740S1 3 S T •Poo r

Phone : H W : 

# ( D • n No t pain t Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Firm : Sverdru p RYASCPXA-134 7 Y A 329. 6 pp m [ 3 Date : RYBSCPXA-134 7 Y B pp m • 

# • Time : 

# n RYCSCPXA-134 7 Y C 27 2 pp m g 

# a Sample s Analyze d RYDSCPXA-134 7 Y D 52 2 pp m 0 

### 0 RDZSCPXA-134 7 D Z 2369. 6 pp m g 0 XR F Unit : Book : RGZSCPXA-134 7 G Z pp m • Date : 11/7/199 9 

# a RPZSCPXA-134 7 P Z 402. 8 pp m 1 3 0 Time : 04:0 3 Staff : Numbe ro f Sample s = 5 3 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 OLS# : 134 7 Dat e Excavated : 7/15/O S Dat e USEP ASigne d Off:7/ 2 r/0 9 Are a Sodden : 153 0 s q f l

YB = 15 4 PP M @ 1 " Y D = 2 9 PP M @ 10 "

n46M l 012 3 

### Legen d 

# m Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are areplace dwit h Are a replace d wit h Are a lef t bar e So d Rock/Mulc h Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .o ( > 

## o
134 7 Exterio rPain t Nort h Arro w Omah a Lea d Sit e Owne rName : Sit e Sketc h •Good Address : 4740 S 1 3 S T •Poo r Phone : H : W : 

# (S )

•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-134 7 Y A 329. 6 pp m 

## a Date : . RYBSCPXA-134 7 Y B pp m 

## a 

# • Time : _ RYCSCPXA-134 7 YC 27 2 pp m 

### D Sample s Analyze d RYDSCPXA-134 7 Y D 52 2 pp m RDZSCPXA-134 7 DZ 2369. 6 pp m XR F Un i I : Book : RGZSCPXA-134 7 G Z pp m 

# • a Date : _ 11/7/199 9 RPZSCPXA-134 7 P Z 402. 8 pp m Time : _ 04:0 3 staff ; Numbe ro t Sample s = 5 Legend : Y A= Yard (NE) , Y B = Yar d (SE)

. YC = Yard (SW)

. Y D = Yard (NW) , DZ = Dri p Zone , G Z = Garden

. PZ = Pla y

nj<il41.0123 |

# ll-< ^ 134 7 Exterio rPain t Nort h An-o w 

### vPiL&a'iijQePmah a Lea d Sit e Owne rName : •Goo d 

### Sit e Sketc h Address : 474 0 S 1 3 S T •Poo r H : W : 

# ( D Phone : Q No t pain t Sampl e Numbe r Lead Concentratio n Sampl e Collecte d LA B Firm : _ Sample s Collecte d Sverdru D RYASCPXA-134 7 RYBSCPXA-134 7Y A Y B 329. 6 pp m pp m 

# • D D Date : _ Time : _ RYCSCPXA-134 7 RYDSCPXA-134 7 Y C Y D 272 52 2pp m pp m 

# D Sample s Analyze d RDZSCPXA-134 7 RGZSCPXA-134 7 DZ G Z 2369. 6 _pp m pp m 

## 12 1 

# • 0 D XR F Un i Date:
.t : Book : 11/7/199 9 RPZSCPXA-134 7 PZ 402. 8 pp m 

## 1 ^ 

# 0 Time:
. 04:0 3 Staff : Numbe rofSample s • Legend : Y A= Yar d (NE) , Y B = Yard (SE) , Y C = Yard (SW) , Y D = Yard (NW) , DZ = Dri p Zone , G Z = Garden , P Z = Pla y

^ 

# Y/;»y:*^/."-—- ^

Rev4 04614 1 012 3

# p 134 7 Exterio rPain t Nort h Anro w 

### OwnerName : tl ^

.Mi^Ugl - VP^Lgg^t^QgPmah a Lea d Sit e •Good Address : 4740 S 1 3 S TS'* ® Sketc h •Poo r Phone : H : W : 

# ® Q No t pain t Sampl e Numbe r RYASCPXA-134 7 Y A Lea d Concentratio n

329. 6 pp m Sampl e Collecte d 

# 0 LA B 

# D Firm : _ Date : _ Sample s Collecte d Sverdru p RYBSCPXA-134 7 Y B pp m 

# a D Time : _ RYCSCPXA-134 7 RYDSCPXA-134 7 YC Y D 27 2 52 2pp m pp m 

# 0 0 D 0 Sample s Analyze d RDZSCPXA-134 7 D Z 2369. 6 pp m 

# 0 0 XR F Uni 1 t: Book : RGZSCPXA-134 7 RPZSCPXA-134 7 G Z PZ 402. 8 pp m pp m 

# a 0 D 0 Date : _ Time : _ 11/7/199 9 04:0 3 Staff : Numbe ro fSample s = : 5 Legend : YA= Yar d (NE) , Y B = Yard (SE) , Y C = Yard (SW) , Y D = Yard (NW) , D Z = Dri p Zone , G Z = Garden , P Z = Pla y

Rev4 046141012 3

# 1347 Exterio rPain t Nort hArro w 

### Omah a Lea d Sit e Owne r Name : 

### •Goo d Sit e Sketc h Address : 474 0 S1 3 S T 

## • Poo r W : Phone : H : 

# (S )

•Notpain t Sampl e Numtie r RYASCPXA-134 7 Y A RYBSCPXA-134 7 Y B RYCSCPXA-134 7 Y C RYDSCPXA-134 7 Y D RDZSCPXA-134 7 D Z RGZSCPXA-134 7 G Z RPZSCPXA-134 7 P Z Legend : Y A= Yar d (NE)

. Y B = LKK I Concentratio n

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# 0 

# a LA B 

# a 

# • Firm : Date : Tirr»e : Sampt e Coitecte d Sverdru p
27 2 2369. 6 52 2 pp m pp m pp m 

# 0 0 0 

# n 0 0 Sampt e ArBlyze d XR F Uni t Book : 402. 8 pp m pp m 

# n 0 

# a 0 Date : __ Time : 11/7/199 9 04:0 3 Staff : Numbe ro f Sampt e •= • Yan j (SE) , Y C = Yar d (SW)

. Y D = Yar d (NW) , D Z = Dri p Zone , G Z = GanJen

. P Z = Pla y

Brv 4 046]41i)]Z 3COASTA l (•l>i|OII«INT> l •I O U P
. IH C 

## 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 :

Owner' s Name : 

### = flj^HA^ L / L t
. r5Sff& i ^ay^m e Phone :

Addres s o fProperty 

# //7 ^ ^ i- ^ ^r
. 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 tha t contain s elevate d concentration s o flea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t o renfx>v 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 confim n 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 

### B ysignin 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 fperformiri g th e work
. Thi s acces s shal l remai n i n effec t unt M th e wor k ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :

Pa0e1of 2

# m COASTA t C I « t l r , I * c



### •Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; •Remov e flowerbulb 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 necessar ysubsequen 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 pnapertyi 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 TTO 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 properl 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 (712 ) 352-018 8

^ 1 gran t acces s t o mypropertie s Q I d o no t gran t acces s t o m ypropertie s

Signatur e / Oat e Signature Dat e

OI woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.c^'-y % S T^ L iraVIMONIiMrAl , C KO b l rI N C



### 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 dt o th e satisfactio no f th e propert y owner an dth e Unite dState s Environmental Protectio nAgenc y (EPA)
.

Property lO'-^= ^ i > W7 Property Address : ^ ^i/ 0 ^ J 3 S4 ' |<Hi«Hif : 

### O nth e attache ddiagram(s ) indicate area(s ) t o excavate , surfac e structure s an dlandscapin g feature s an d acces s location(s ) t o b e usedb y th e contractors . Indicat e distances , depths , matenal types , etc . Photographicall y andVideographically document th e existin g condition s ofth e propert y an dth e basement if necessary . 

### Item s t o b e Remove d b yth e Owne rbefor e Star t o fRemediation : Th e removal , storaqe
. disposal , and/o rretur n o fthes e item s i s th e Owne rs responsibility
. item : 

# /lA^^^A^l l PlJl - Kem : Item : Item :

Pag e 1 of

.C J M S T M L


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Item :



## Ite m Pre-existin g propert y area , tha t wil l b e excavated , tha t i s covere dwit hgrass . Numbe r o f tree s > 2 inc h trun k diamete r Numbe r o f tree s < = 2 inc h trun k diamete r Numbe r o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Atiac hr . sketcli o t th e .vrrviklc i kvu-u i Numbe r o f an dsiz e o f eac hgarden / flovre r be d area . Aiiacl i -dsketc ho f relativ e size s an dlocation^
. Agree dupo nvalu e o f plan t matenal s no t t o b e replace db v contractor . Not e llii' i w.liK ' nii i hi '
• jsfc ' ; c issu e aj)!«n ' \OiKi:e i 1( 1 (li e prnpcr: \ o^

^ ner . Easranen t Area , t o b e excavate d 

## Landscap e Inventory Quantit y 

# ^ K 

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### IKiona l Comment s / instructions : ^ ^ 1

•Chec k th e boxi 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 iso xCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro fhouse , includin g foundatio n crack s o rfissures

.

I agre e OI d o no t agre e 

# fl/ll/cA ^ P ' W/^ ^ f^^Cnoo.ii! ^ to\i^\no ^ ner' s Signature /Dat < / f Contractor' s Signatur e ' llat e

### BVI D # iSH I XRF PROPERTY SAMPL E SHEE T Dat e 1H5-O S Addres s 

# H-Ne.S.I?. M Projec t Omah a lea d F P 2nc l yea roptio n Sampl e tim e @>/p m 

# m m . 1 XR F ID # sampl e lengt h 3 0 se c ?i^0<^ ^ Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a 

# no?

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# £2
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# H ^ f^.Z8^iO«D T IMMl ^ 

### 1H.72f^l\.lo < ^ Dept h 

## 1HP 5 ]l0\.7.nt\in.') % 

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# • i3 ~ Averag e n«X.- | t I U t p Averag e Ho
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# \^i z Averag e 29
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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 1 la b sampl e # La b resul t Sampl e are a XR F Avg
. Signatur e 

## JU^Q A 

# printgli M ine>i h Creec h

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 140 6 Mod e SOI L Tim e 2009-07-1 5 10:1 4 Duratio n 121.6 5 Sequenc e Fina l Flag s AVERAG E ADDRES S QUAD/ZON E D Z INSPECTO R Nicola s DEPT H 1 2 SAMPL E TYP E CLEARANC E NOT E

± Erro r P b ± 16.59 S Supervise d 

# ^r&OMm A

# 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 257.46 8 Supervise d By : 

## Certificat e o fVerificatio n

140 2 SOI L 2009-07-1 5 10:1 2 30.6 0 Fina l 134 7 474 0 s 1 3 s t D Z Nicola s 1 2 CLEARANC E

± Erro r
± 20.29 6

# 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 245.16 7 Supervise d By : 

## Certificat e o f Verificatio n

140 3 SOI L 2009-07-1 5 10:1 3 30.4 8 Fina i 134 7 474 0 s 1 3 s t D Z Nicola s 1 2 CLEARANC E

± Erro r ± 19.75 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-3208 9 Readin g N o 140 4 Mod e SOI L Tim e 2009-07-1 5 10:1 4 Duratio n 30.0 1 Sequenc e Fina l Flag s BVI D # 134 7 ADDRES S 474 0 s 1 3 s t 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 50.88 1 ±10.06 8 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 161.26 6 Supervise d By : 

## Certificat e o fVerificatio n

140 5 SOI L 2009-07-1 5 10:1 4 30.5 6 Fina i 134 7 474 0 s 1 3 s t D Z Nicola s 1 2 CLEARANC E

± Erro r
± 16.27 9

# 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-3208 9 Readin g N o 144 8 Mod e SOI L Tim e 2009-07-1 5 14:5 0 Duratio n 121.3 6 Sequenc e Fina i Flag s AVERAG E r3»K?^U,4^*«l;**4 J ADDRES S ^r740nrr3rs l QUAD/ZON E 

### P Z INSPECTO R Nicola s DEPT H 8 SAMPL E TYP E RETES T NOT E

± Erro r pp m P

b ± Supervise d B y 

# : ^^fr& 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 144 4 Mod e SOI L Tim e 2009-07-1 5 14:4 8 Duratio n 30.2 9 Sequenc e Fina l Flag s BVI D # 134 7 ADDRES S 474 0 s 1 3 s t QUAD/ZON E PZ INSPECTO R Nicola s DEPT H 8 SAMPL E TYP E RETES T NOT E

pp m ±Erro r P

b 87.01 8 ±12.70 6 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 144 5 Mod e SOI L Tim e 2009-07-1 5 14:4 8 Duratio n 30.5 0 Sequenc e Fina i Flag s BVI D # 134 7 ADDRES S 474 0 s 1 3 s t QUAD/ZON E P Z INSPECTO R Nicola s DEPT H 8 SAMPL E TYP E RETES T NOT E

pp m ±Erro r P

b 81.26 2 ±12.18 1 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 144 6 Mod e SOI L Tim e 2009-07-1 5 14:4 9 Duratio n 30.1 4 Sequenc e Fina i Flag s BVI D # 134 7 ADDRES S 474 0 s 1 3 s t QUAD/ZON E PZ INSPECTO R Nicola s DEPT H 8 SAMPL E TYP E RETES T NOT E

pp m ±Erro r P

b 74.27 8 ±11.69 1 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 144 7 Mod e SOI L Tim e 2009-07-1 5 14:5 0 Duratio n 30.4 3 Sequenc e Fina l Flag s BVI D # 134 7 ADDRES S 474 0 s 1 3 s t QUAD/ZON E PZ INSPECTO R Nicola s DEPT H 8 SAMPL E TYP E RETES T NOT E

pp m ±Erro r P

b 62.18 7 ±10.89 2 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 AVERAG E ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

P

b Supervise d B y 

## Certificat e o fVerificatio n

144 3 SOI L 2009-07-1 5 14:4 5 121.8 8 Fina l ^vq'oM439-144 2 J s 1 3 s t Y D Nicola s 1 0 CLEARANC E

# P 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 143 9 Mod e SOI L Tim e 2009-07-1 5 14:4 3 Duratio n 30.4 0 Sequenc e Fina i Flag s BVI D # 134 7 ADDRES S 474 0 s 1 3 s t QUAD/ZON E Y D INSPECTO R Nicola s DEPT H 1 0 SAMPL E TYP E CLEARANC E NOT E

pp m±Erro r P

b 28.75 7 ±8.54 1 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 31.39 2 Supervise d By : 

## Certificat e o fVerificatio n

144 0 SOI L 2009-07-1 5 14:4 4 30.4 5 Fina l 134 7 474 0 s 1 3 s t Y D Nicola s 1 0 CLEARANC E

± Erro r
± 8.69 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-3208 9 Readin g N o 144 1 Mod e SOI L Tim e 2009-07-1 5 14:4 5 Duratio n 30.6 6 Sequenc e Fina i Flag s BVI D # 134 7 ADDRES S 474 0 s 1 3 s t QUAD/ZON E Y D INSPECTO R Nicola s DEPT H 1 0 SAMPL E TYP E CLEARANC E NOT E

pp m±Erro r Pb 26.52 1 ±8.09 7 Supervise d By :

# 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-3208 9 Readin g N o 144 2 Mod e SOI L Tim e 2009-07-1 5 14:4 5 Duratio n 30.3 7 Sequenc e Fina l Flag s BVID # 134 7 ADDRES S 474 0 s 1 3 s t QUAD/ZON E Y D INSPECTO R Nicola s DEPT H 1 0 SAMPL E TYP E CLEARANC E NOT E

pp m±Erro r P

b 30.11 0 ±8.65 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 137 3 Mod e SOI L Tim e 2009-07-1 4 14:3 8 Duratio n 121.7 5 Sequenc e Fina l Flag s AVERAG E ADDRES S /^vg~o f1369312 ; r74 0 s 1 3 s t QUAD/ZON E Y B INSPECTO R Nicola s DEPT H SURFAC E SAMPLE TYP E Insitu s NOTE

pp m Erro r Pb ^§±^ 3 ±/8.36 3 " 7 Supervise d By : (^C^yUljB^ 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 BVID # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P

b 106.96 4 Supervise d By : 

## Certificat e o f Verificatio n

136 9 SOI L 2009-07-1 4 14:3 3 30.0 1 Fina l 134 7 474 0 s 1 3 s t Y B Nicola s SURFAC E Insitu s

± Erro r
± 16.41 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 137 0 Mod e SOI L Tim e 2009-07-1 4 14:3 7 Duratio n 30.7 0 Sequenc e Fina l Flag s BVID # 134 7 ADDRES S 474 0 s 1 3 s t QUAD/ZON E Y B INSPECTO R Nicola s DEPT H SURFAC E SAMPL E TYP E Insitu s NOT E

pp m ±Erro r P b 91.15 2 ±14.39 1 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 192.90 2 Supervise d By : 

## Certificat e o fVerificatio n

137 1 SOI L 2009-07-1 4 14:3 8 30.5 9 Fina l 134 7 474 0 s 1 3 s t Y B Nicola s SURFAC E Insitu s

± Erro r
± 20.16 2

# Therm o SCIENTIFI C Therm o Fishe r Scientifi c 90 0 Middlese x Turnpik 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 225.41 5 Supervise dBy : 

## Certificat e of Verificatio n

137 2 SOIL 2009-07-1 4 14:3 8 30.4 5 Fina l 134 7 474 0 s 1 3 s t Y B Nicola s SURFAC E Insitu s

± Erro r
± 22.48 4

## Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5

- ^^_^

_ , Coasta l Environmenta l Grou p Inc , \^^^^ ^

www.coastalhazmatco m '"tPRott ^ COASTA L iNVIIONNIIITA l E H O U P , IH C 

# EXECUTIV ESUMMARY : BVID #1347 - (474 0 S 1 3 ST )
No Issue s o r Concern s Q Issues/Concern s Detail Explanation :• » • • 

## Wate rBil l Settlemen t

Propert y ID 134 7 Propert y Addres s 4740 S 1 3 S T Tenan t Jeremy Evan s

I have receivedfro mthe contractor , Coasta l Enviroimienta l Grou p Inc
. (Coastal) , the su mof $ 68.02fo r wate r usag e require dto maintain the sod
.
Chec k Number 180 9 Valu e o f Check $68.0 2 Mad e Ou t T o Jerem y Evan s Descriptio n o f Settlemen t T o reimburs e tenan t fo restimate d wate rcharge s o n thei rMU D monthl yinvoices
. M ysignatur e belo wi s acknowledgemen t o f th e receip t o f th e su m liste d above , whic h i furthe r acknowledg e t o b e fai rcompensatio n an d fui i paymen t fo rth e above , an d release , Coasta l Environmenta l Grou p inc
. fro m furthe robligation s o rliability
.



## /37L/jy^yiyH^[7/7^AAyi n//P-^S-^ 9 ^ jm^l ^ 

# lobhlo ^ ligfiatu n Owner' s Sieiiatur e Contractor' s Signatur e Dat e

Pag e 1 o f 1Account : 102902-121447 3 Pag e 2 o f3 JEREM YD
. EVAN S Genne e addrew : 474 0 8 1 ST H 8 T Cal l 81 1 befor e yo u di g i n you ryard , buil d a fenoe , etc
. Cal l a t leas t tw o 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
.

200 " 

# II J 100 ­ 

# lll l

0
. S ^ M < ^ 0 « J WF ^ M WAp rMa yJu n JO I Ai « YourOMU M

•ra«1tMDatl M •MattMNMoo M Thi s Mont h Lu t Yea r Billin Q unte : 1 8 1 4 U M pe rda y0. 6 0. 4 Averag e ooe t pe rday : $0.77 $1.0 6 Numbe rofday s i n billin g cycle : 33 3 3
4 0 ~ 2 0 ­ 

# 1

0
. S*pOo(NevOKJ«iF*UarAp(MayJu n Ju l Au g You rWate rUs e

•MMItMMMk a •M«1S««llaMd » Thi s Mont h Las t Yea r Billin g units : 3 2 6 Us e pe rday : 1. 0 0. 2 Averag e oee t pe rday : $15 3 $0.3 9 Numbaro t day s i n blln g eyele
. 3 3 3 3 172 3 Harne yS i •Omah a N E 6810 2 •40 2 554.666 6 e-nnat ' fjstome i setv we-amudomdh a cci r•WM I su e ^r.:- * ••i.icl i min d ..MH I 

## METROPOLITAN UIIL'TIE S DTSTRIC T Billin g dat e Au g 5.200 9 Liv e Green

. Thin k Bw- r Previou a balano e $175.5 3 Paymen t receive d -Than k yo u 50.0 0 O R Curren t oharge * 92.6 7 Ne wbalano e 218.2 0 

## •Tota l du e Au g 20,200 9 $218.2 0
« payman t i t ne«M* d alte rdu » date , •l*l B t M iwil i b a aMMM d o n ga a an d <Ml> rehauB M

Datal a t H ounen t ohaigas : 

## QA S RESIDENTIA L RAT E A : Ju n 2 6 t o Ju l 2 9

Mete rNumba r42978 2 Curren t ree d (aotuai) : 89 3 > Previou * rea d (aotuai) : 87 5 - 1 8 CC F Ga s Use : 1 8 CC F x1.02 4 (hea t value) » 18.43 2 therm s

6 day a 2.79 3 therm a a t 0.496 6 - $1.3 9 2 8 day s 15.63 9 tfwrms a t 0.528 6 - 8.2 6 Servio e Charg e 12.0 0 Ga s Coa t •$21.6 5 Ga s Infraatnictur e Replaoamen t 3.0 0



## WATE R RESIDENTIA L RAT E W-1 : Ju n 2 6 t o Ju l 2 9 Mate rNumba r283184 9 Size : 5/8 -bto h Curren t rea d (aoiuao : 38 8 •Previou a rea d (aotuao : 35 6 • •3 2 CC F Wate rUse : 3200 0 CC F o r23,93 6 gallon s 9.00 0 CC F a t 0.961 4 - $8.6 5 21.00 0 CC F a t 1.345 1 ' 28.2 5

2.00 0 CC F a t 1.7298 ' 3.4 6 Servioe Charg e 48 6 Wate rCos t > $45.2 2 Wate rInfrastructur e Replacemen t 2.0 0 Lat e Paymen t Charg e 1.4 8 

# ^' t Cit yo fdmah a Sewe r 1 3 3 5 Sale s Ta x 5.9 7 P Curren t Charge s $926 7
Pleas * retu m thi s portio n o fth a Mi l paymen t •Plsased o no t stapl e paymen t t o bill
. 

# A
. •-mail : cuatorner_yarvJae9mudonsUu i oo m iwabaK a wwwmudomaha«o m METROPOLITA N UTiLim S OfSTRI C I 000102902121447300000021820 2 1723Hamey8 l •Omaha,N £68102 - 402.5S 4 666 6 eSS

O 002 0 M U R P 0 6 0806200 9 YNNNN V 0 1 00O«1 6aS>e

. 

# EP A EP APropert y Clos e Ou t For m Propert y tf : {?^'^ l
. . , Propert y Address

­ M 7 H O % fi ? " Daten-lme : -7/1^/0 ^ Owner' s Name ; . jT l i C H^^- *
. 1 Tlf^W Quad s Excavated : YQ^DX , PZ Contracto r Grou p Ppifltb l fiiiulferwiAnif Ye s > Excavatio nGenemI 1
.If necessary , were th e correc t quadrant(s ) excavate dandrestored ? 

# I T
2
. I f necessary , were th e correc t area s ofdri p zon e excavate dandrestored ? 

# u ^
Gradin g So dan dVegclatio B Ye s N o I
.Doe s the cradin g aroun dthe perimeter ofth e hous e i nexcavate darea s generally slop e awa y fromth e house ? 

# "3 ^ 2
.Ha s sodbee nlai dinall area s tha t wer e excavated ? 3
.

Doe s th e sodappea r t

o b e generally health y an dgrowing ? (Only evaluate i f inspecteda t a3 0 

## l y ^ day time period ) 

# y^ 4
.Are soddedarea s generally Hr man devenly graded ? S :Are th e joint s t>etwee nthe so dstrip s generally tight ? (Only evaluate if inspecteda t a3 0 da y l y ^ time period) 6
.Wa s the propert y grade dsuchtha t wate r will no t poo l o nthe propeny ? 7
.

Wa s danug e t o landscapin g o r plan t material s avoided ? Gates , Fence s an dRetatoln g Wall i Yes N o 1
.

D o gate s ope nandclos e freely? (Ifapplicable ) 2
.Were all gate s or fence s takendow ndurin g restoratio nacliviiie s reinstalled ? (Ifapplicable ) ^	 ^ 3
.

Wa s damage t o gate s or fence s avoided ? (Ifapplicable ) 

### L ^ ^ 4
.Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) Foupdation , Sidinnan dGntter s Yes N o I
.Wa s damage t o th e sidin g or trimavoided ? 

## u - ^ 2
.Wa s damag e t o the Foundatio navoided ? 

### L / ' 3
.

Wa s damag e to window s avoided ? 4
.

Wa s damag e 1 0 window s o r doo r screen s avoided ? ly- ^ 

# z: ^ 5
.

Was damage t o downspout s o r downspoul extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ye s N o 1
.Wa s damage 1 0 drivewa y surface s avoided ? 

# 3 2
.Wa s damage t o walkwa y surface s avoided ?

## Owner s comments :

Inspectio nnotes :

Remova l an drestorationactivate s complete including th e 30-da y sodwarranty : mactivate s complete inciuain g tn e ju-aa y so awarraniy EP ARepresenlaliv e L.3cr> \ 

# Q ^ {LL LDate:^^6^
.

### #



## Propert yGompietio n Agreemen t

DII S agreeme m documenl s th e completio n o f remedia l activitie s perlbime d o n mypropert yM ysignature wil i designat e that I a m satisfie d wit h th e restoratio n o f m yproperty , an d tha i n o item s ar e i n questions , now , o ra t an ylim e i n th e future , except thos e item s liste d below , ifany

. Propert yID : \ ^ H~ / Propert yAddress : L j J if Q J f ^ j " f Owner : M'ck^tS^ l W/\ l h^^^- ^ "^ _^ 

## Phone : ^ 9/
- ^ / P^^ ~ C^l / yJ^^^i O Restoratio n Item s i n Question :

Additiona l Comments :

I Kyyaffre crestoratio n 'ta completed , excep l a s noled I I I H o no l ajjre cresloratio n i s complete d
.

0»viic»'' $ Signatur e D»tp/ 1 Contractor' s Signature Dafe