### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID. : \<Oi i Date : ll|^^/ ^ Address : k>l ^ Oft f 4 < Remediatio nContractor : Coasta l Environmenta l Group

_Year : _200f t SOI LREMEDIATIO N PROPERT Y nLEFOLDE RDOCUMENT S Vide o o f propert y (DVD ) Executiv e Summar y EPA-providedproperty sketch / 

### SignedAcces s Agreement fo r subject propert y ' ^ SignedAcces s Agreement(s ) fo r adjacen t propert y 0 Restoratio nAgreement s /

Settlemen t document s (i.e. , fo r damag e o r to replac e plants , etc. )

- & Confirmationdata EPhotograph s Y As-built sketch l Y Satisfactor y restoratio nsignedby Propert y Owne r l A Propert y close-out check lis t signedby EP A

- ^ Descriptio nofarea s not meetin g ROD cleanup criteri a Utilit y clearance s 

# ' y Propert y informatio nfro mDougla s Count y Assessor' s Office [ J 

### D D 

# jpcmm h­ /i^/> y

^ Signatur e „„ / iDat e 3005451 7 

# IIMIli i Superfun d

### • • 

# d Propert y Acces s Checklis t Propc-tylD : ^^Q^g T Propcrt v Address : "^ ^ t T C'V X \ D D WOR K STARTE D WORKCOMPELTE D ON : ON : / / /_ / _
Afl(lross ^ 

### Address : < ? 

### C^^^ ^ 0 

### Renter : Phone : Fax : 

## Phone : Fax : 

## U?^ 0 ­ 2^^ ! Cell/Pager : Additiona l Inforn\ation : Cell/Pager :

n Iv / 1 5 7

C

D Notificatio nLette r

Acces s Agreemen t Restoratio nAgreemen t Topsoi l Samplin g (ifapplicable ) Sent : / / Sinned : \ i / ^ / ^ Sinned : 6 ? / g r /

C

) / / By : 

## By : .rt By : (, C By : [ 3 U S ^ [ 0

n Disposa l Samplin g (if applicable ) Garde nSamplin g (if applicable ) Utilit v Clearanc e Video/Photo s (Before ) Video/Photo s (During ) / / / / 

## Called : i/L/IL/_3
-

On:Jj^/:^/ ^ On : / / By : By : 

## B.v : e o B.v:A/iC k

/Rriai ^ By : D D E

H D Video/Photo s (After )

Video/Photo s (30-Day )

Propert y Completio nAgreemen t Fina l Repor t On : / / On : / / 

## Signed: 12-''^Z'/^ Z Issued : / / By : 

## By: B.v

= 

## B.v : /K^u k IAJM 

## J j

Ai r Monitorin g (a s applicabl e [ H Communit y \Y \Cre w ) Results : D Conununit \Q Cre w Results : On : On : /
/ /
/ Bv :
Bv : 

# 1

D Communit y D Cre w On : / / Bv : 

# 1 Results : 

# 1

Omah a Lea d Sit e• •



## Property I D # Property Address : Initial Contact : Secon dContact : Final Contact : Final Action :

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

# \'bOl % ^c>\ xOQI C Date : Time ; Action :

Date : Time : Action : Date : Time : Action : Transmi t t o EP A D Other Action : D

### Dougla s County Acco ; >jM^nfa|^ i tio n Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R230049000 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 - ViewO H Ma p Informatio n i s vali d a s o f 2009-5-1 2 Treasurer' s Ta xRepor t Ne wFeatur e ••-»••Aut o Sale s Searc h Owne r VOGE L CHARLE S W ETA L 301 2 OA KS T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 004 9 OOO O 2 3 Accoun t Type : Residentia l Parce l Number : 230049000 0 Parce l Address : 301 2 OA KS T OMAH AN E 68105-000 0 Lega l Description : SUMMI TAD D LO T1 6 BLOC K4 48. 4 X 128.2 5 Valu e Informatio n 

### 2009 200 8 200 7 200 6 200 5 200 4 Lan d $6,300.0 0 $6,300.0 0 $6,300.0 0 $6,300.0 0 $6,300.0 0 $6,300.0 0 Improvemen t $87,400.0 0 $87,400.0 0 $87,400.0 0 $83,700.0 0 $83,700.0 0 $83,700.0 0 Tota l $93,700.0 0 $93,700.0 0 $93,700.0 0 $90,000.0 0 $90,000.0 0 $90,000.0 0 L^n d Informatio n Acre s 0.1 4 S F 6144. 0 U nit s 1. 0 Depti i 128. 0 Widt h 48. 0 Vacan t N o Improvement Informatio n Buildin g 1



### http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R230. . . 6/6/200 9• • 

### Dougla s County AccoMklnfqg^tio n Pag e 2 of 2 iU|klnfQ|^ t

1 WI - 16 0 3 Hi) M 

# n 1* 0 '9C ­ TI D

U V FiaFU H t1»05llF l 

### ' h V
. .5^ 1 I « ' 1

.. . 'iJ-M i Hi r r "• r^ o i i Ki r1 sgcmFi n 1 A(MCSaF l IOO ] 

# p " & « » ... r1

M " 1 Mt r 'So a

II%4C ^ F t DMldMriCM:M « 2J<5 « 1 1/ 2 STOR YFINISHE D CLIC KTO ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1808. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Fai r

Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 8. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 4. 0

Roo f Type : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle 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 190 0 0 0 % 190 0 10 9 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fenc e Chai n Lin k 1. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 ft 1174. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 234. 0 Porc h Ope n Sla b 189. 0 Porc h Sla b Roo f Cei l 84. 0 Porc h Sla b Roo f Cei l 270. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R230. . . 6/6/200 9

### http://www.dhoaor^ighiiitemet/DHONNoticeCreatioii/MessageText. . oi^ighi
Creat e Anothe rTicke t | Bac k t o Irt h Inteme t | Sen d Emai l 

### YOU RTICKE T NUMBE RI S  2300160 . Origina l Cal l Date : 6/22/0 9 Time : 12:4 4 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 6/24/0 9 Time : 1:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 301 2 Street : OA K S T Twp : 15 NRng : 13 E Sect-Qtr : 33-NE-NW Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : Lea m Remediatio n Locatio n o f Work : INCLUD E AL L EASEMENT . LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LOT . 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 : 4f t Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL 3 MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F 

### Servic e Are a Contac t Phon e Numbe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEID I Day : 402934046 9 Ah : 402934046 9 Emerg : 402932975 7 LEVEL S LEVEL 3 COMMLINICATIONS , LL C N A Day : 877366834 4 Alt : Emerg : 877366834 4 MUD0 2 METROPOLITA NUnLITIE S DISTRIC T SAND Y Day : 402504782 3 Alt : Emerg : 402504797 0 OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO N Day : 402444719 7 Ak : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 0PPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T N A Alt : 406207149 4
lo f 2 6/22/200 9 12:4 5 P Mht^:// www.dhoaor^jghlntemet/DHONNoticeCreation^essageTexL. . . 

# # —~ y Emerg : 888728934 3 Day : 406728934 3 QLNNEI FQWES T LOCA LNETWOR K

N A Alt : 4062071494 Emerg : 888728934 3

2 o f 2 6/22/200 9 12:4 5 P M

# WAs-Buil t Drawin g ^ COASTA L 

# Omah aLea dSuperfun dSit e

9 r 

# r Legen d *:•;« : Concret e Dri p Zon e Excavate d Quadrant s Excavate d 'AV.V . Are areplace dwit 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 .• • Name : 0;)J>aV ^ \)Ot o Omah a Lea d Sit e Date : Nort h Arro w—i Address : Sit e Sketc h Time : ^ 

## \)-i< > ^ y^ no^)Y . ^ ^ Phone : 

# 1
Tea m 

## b^aA\)klDl3 6 ^^BVI D # I50& 8 XR F Cod e ^^^2 . Sampl e Numbe r 

# 3 Confirmatio n Sampl e Lea d Concentratio n 

### />5 ^ -^ '/^ ^ 

## f ^ Ye s a N o $a r pp m pp m 

## f l Ye s ° N o ^ 

### ±S^^< Y NoISK ' pp m ft) Ye s D No"^ ^ pp m f 3 1 Ye s O 

### y^£>g ^ N o ^r ­ pp m 0 7 Ye s [= 1 

## dfzscpk A-f>5Pgrg ^ N o *a : pp m ^^Ye s • pp m rYe s • 

### N o • ^

^iNfaHttiAmw r 

### Tmm : 

# ^sj ^ ^Hff f^FKtffci( h 

### Miiitess : '301' Z O^ K jfj^'ft O Wtone : 3$^- Si9 ^ 

# 1 fb^cu^okiiM ^ ^^ # 8508 8 XRFCorf e 

# ^5^2 . iLea d Cainoamtfattior o Oonffmnaallia B

5 jR-f^sepJc/ ^

-f<^*5£>g g ^ * Ye s ^ 9 Ye s glYe s #5 7 Ye s a a a n No$a r iNt

o IS r



## ^3^jk : 

# ^ r• •

COASTA L ilOlteilMINIt l • • O U » . I ft c 

## Consen t Fo rAcces s T o Propert y RIGH TO F ENTR YT O PREMISE S 

### Granto r(th e propertyowner) 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 : Daytim e Phone :



# C.lnr.r|/^< ^

\\c^ \
Addres s o f Propert y covere d b ythi s Aoreement : 

# ,V,^ Z

# r^t . S I PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP AI s requestin g acces s t o collect soi l sample s an d remov e soi l tha t contain s elevate d concentration s o f lea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t o remove contaminate d soil
. Th e remove d contaminate d soi l wil l b e replace d v^t 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 v^r k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e of Coasta l Environmenta l Group , contracte d b yUSEPA , wil l contact th e Granto rin-perso n t o discus s th e wor k t o b e performed , th e Granto rv^l l hav e a n opportunityt o revie wan d approv e th e planne d soi l removal , an d restoratio n v^r k befor e i t begins
. Once th e wor k i s finished , th e Granto rMA Wb 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 vwitte n documentatio n fro m EP Athat th e property 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 , contractors 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 f performin g th e work
. Thi s acces s shal l remai n i n effec t unti l th e VA)r k

ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :
Pag e 1 of 2

## • tL^ *
COASTA l CNVIiOHfirflTA l C I « U *
. Il l 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 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 f th e propert yi s rented , assis t EP Ai n obtainin g tenant approva l fo racces s t o th e propert yt o perfor m th e work
. •Allo wvideotapin g and/o rphotographin g o f th e property . AGREEMEN TNO TTO INTERFER E 

### Th e Granto ragree s no t t o Interfer e o rtampe rwit h an yo f th e wor k activities , o rwit h an y o f th e wor k done , o rwit h th e equipmen t use d o n hi s property , o rt o undertak e an y action s regardin g th e us e o f sai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o f th e Grantee s o rth e environment , o rt o allo wother s t o us e th e propert yi n suc h a manner . 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 J^ i gran t acces s t o mypropertie s D I d o no t gran t acces s t o mypropertie s


## /A:>< ^ 

# ^ - e- - 

# yy' f Signatur e Date Signatur e Dat e
OI woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.

### • • # •

COASTA L 

## Restoratio n Agreemen t Th e purpos e ofthi s agreemen t i s t o provid e amutual agreemen t a s to condition s ofth e property prio r t o remediatio nactivities . Tlu s wil i als o serv e a s documentatio nfo r th e purpos e o f assurin g tha t restoratio n activitie s are complete dto th e satisfactio nof the propert)
- owne r andth e Unite dState s Environmental Protectio nAgency (EPA) .

Property ID : \SO< ^ Property Address : ^?/'^jf2

_ CDCK. ^ 

### *f ^ 

# \/o()p\ Phone : 

## (fiTyP- 2-^ ' O

nth e attache ddiagram(s ) indicate area(s ) t o excavate danddept ho f excavation , locatio no f all know n utilities , subsurfac e features , sgrfac e structure s andlandscapin g features , acces s location(s ) t o b e usedby contractor , andth e directio no f North . Indicate distances , depths , materia l types , etc . Indicate digital photo s b

y referencin g th e photo-lo g number wit ha nano w indicatin g directio no f view . 

### Item s T o B e Remove d B yOwne rBefor e Star t O f Remediation : (Us e additiona l sheet s a s necessary ) Th e removal , storage , disposal , and/o rretu m o f thes e item s i s th e Owner' s responsibiiity
. Item : 

# ^l^i i ^m a[ \pkin K \ n)n e <F^Kio d Item : Item : Item : Item : 

### Kem : Item : Item : Pag e 1 of
.

### # •

COASTA L cM o u r. t » • c 

### Item s T o B e Remove d B yContracto rDurin g Remediatio n An d No t Replace d (Us e additiona l sheet s a s necessary ) Item : 

# f ^ p^c A c/rri M p/r.jYi ^ f/^-^ f

^iTLiYi d Item : Item : Item : Item : Item : Item : Kem : Item : Item : Kem : Item : Item : Item : Item :

Pag e 2 of
.C p AS TAL 

### Item s T o B e Remove d B yContracto rDurin g Remediatio n An d Replace d (Us e additiona l sheet s a s necessary )

Ite m 

# I Item : ^

Item : Kem : Item : Kem : Item : Kem : Kem : Item : Kem : item : Item :

PageSof
.

### • •

COASTA L t N * IMONMf t NTA I cn o wrIN C 

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

## Item

Pre-existin g propert y area , tha t wil l b e excavated , that i s covere dwit hgrass .

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

Numbc r o f tree s <= 2 inc h trunk diamete r

Numbe r o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Attac hasketc ho f th e sprinkle r layout .
Numbe r o f andsiz e o f eac hgarden/ flowe r be d area . Attac hasketc ho f relativ e size s an dlocations . 

## Quantit y 

# f

\

\ 

# t ) v\<= >



# n^ Uni t Condition/Type/Specie s
Squar e fee t



### • , Eac h

Eac h

Each

Eac h Square Fee t

Pag e 4 of
.

### • •

COASTA L I N ViMOMH * N TA t C M O W rI N C 

# IIte m

Agree dupo nvalu e of Diant material s no t t o b e renlace dbv contractor . Note thi s valu e wil l b e use dt o issu e aplan t vouche r t o th e propert y owner . Agree dupo nlis t o f plant material s tha t wil l b e replace dby contractor . B e very specifi c anddetailed . Includ e asketc ho f were eac hplan t wil l b e place d b y th e contractor . Agree dupo nare ao f property t o b e replace d wit hgras s sod . Includ e asketc ho f th e arca(s ) t o b e replace dwit h gras s sod . Are ao f City o r Count y property t o b e landscape d pe r thei r requirements . Includ e asketc ho f th e area(s )

Easemen t Area , t o b e excavate d 

## Quantit y Uni t 1 Condition/Type/Specie s

\ $



### \ Eac h 

# f

^ S F 

# y": ^ S F

S F 

## 1

Pag e 5 of
.• •
C OAST A I.

AddKiona l Comment s / Instructions : 

# % dro p o^ ? o- ^ ^^^^ ^

J ^ Chec k th e bo x if Owne rdoe s no t wan t CE G to documen t interio rfoundatio n wail s an d possibl e pre-existin g damage
. Bycheckir^ thi s bo xCE G is no t responsibl e fo ran ydamag e don e to th e interio rof house , indudin g foundatio n crack s orfissures
.
J^ I agre e Q I do no t agre e

wner' Co&tractor* Svnatar e Dat e Owner' s s Signatur

Signatur e e / / Dat Dat e e Contractor' s s S^ata r 

### Pag e 6 of
.Dat e Projec t XRFID #

Shot # 

## 7D 0 J2D 1 

# 3 m ^ DJ L Averag e

Shot # 

## "UlO ' 1^-1 1 

# 1^35 : UTI S Averag e

Shot *

Averag e

Shot #

Averag e la b sampl e # XR F PROPERT YSAMPL E SHEE T 

## £,-?>o-n q Omah a lea d F P Zn d yea ropilo n Readin g Sampl e are a >^^jt\1. ^ %•5.T^«^AH•'ar q 

# D r Dept h 

## 151.? . ±vi.r u H.2fi9±l!5.<K 7 \1\.1 \ ±\1S.l ^ Readin g 

## 3^.q23;^.7 T 

## t l 11^.^ 2 m.gi^^.to^ i ^T.?»utio. n Hf i Q Q 1 . Readin g

Readin g

La b resul t Sampl e are a 

# i i Dept h 

# m . q.(i > Sampl e are a Dept h Addres s Sampl e tim e sampl e lengt h Shot # 

# loE ' JD L JMCO L J1Q3 L

Averag e

Shot #

Averag e

Shot #

Averag e
RETES TAREA S Sampl e are a Shot # Dept h Averag e Sampl e are a XR F Avg
. 

## BVID#Jf)QM
. ?D\1 - oak L 1S- V J IL. : \ ^ sm m 3 0 se c Readin g 

### Vl^lti l \T. l 

### nViiH-Siy^.n ^ lD.^ft ±11/7 1 THULl^t-^L
. Sampl e are a ££:

^ 

## M/^' '

Dept h <K1. U ±iL j Readin g Sampl e are a Dept h

Readin g Sampl e are a Dept h

Readin g Sampl e are a Dept h

Signature
. 

# (^M ? Sb u 

## Prin t P\\oA\nP:M ^ Cac.{'re b

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 70 4 Mod e SOI L Tim e 2009-06-3 0 16:2 0 Duratio n 121.2 9 Sequenc e Fina l Flag s AVERAG E p ^ o f 700-703 ] ADDRES S 301 2 oa k 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 T21.70 7 J ± f 13.77 7 , ; Supervise d By : (^CM^Jtyo 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 89.40 3 Supervise d By : 

## Certificat e o f Verificatio n

70 0 SOI L 2009-06-3 0 16:1 8 30.5 3 Fina l 1508 8 301 2 oa k s t D Z nicola s 1 2 CLEARANC E

± Erro r ± 12.10 9

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 70 1 Mod e SOI L Tim e 2009-06-3 0 16:1 9 Duratio n 30.1 1 Sequenc e Fina l Flag s BVID # 1508 8 ADDRES S 301 2 oa k 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 Pb 83.03 7 ±11.89 3 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 151.79 8 Supervise d By : 

## Certificat e o f Verificatio n

70 2 SOI L 2009-06-3 0 16:2 0 30.1 7 Fina l 1508 8 301 2 oa k s t D Z nicola s 1 2 CLEARANC E

± Erro r ± 15.23 9

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 70 3 Mod e SOI L Tim e 2009-06-3 0 16:2 0 Duratio n 30.4 8 Sequenc e Fina l Flag s BVI D # 1508 8 ADDRES S 301 2 oa k s t QUAD/ZON E D Z INSPECTO R nicola s DEPT H 1 2 SAMPL E TYP E CLEARANC E NOT E
Erro r pp m P b ± 15.86 8 162.58 9 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 70 9 Mod e SOI L Tim e 2009-06-3 0 16:2 5 Duratio n 122.0 0 Sequenc e Fina l Flag s AVERAG E fAv g o f 705-70 8 ADDRES S ^0l2-o-a1cs f QUAD/ZON E easemen t INSPECTO R nicola s DEPT H 1 SAMPL E TYP E CLEARANC E NOT E
Erro r pp m ± P

b ± Supervise d By : hpC^ijBt£eA \

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 70 5 Mod e SOI L Tim e 2009-06-3 0 16:2 2 Duratio n 30.5 3 Sequenc e Fina l Flag s BVI D # 1508 8 ADDRES S 301 2 oa k s t QUAD/ZON E easemen t INSPECTO R nicola s DEPT H 1 SAMPL E TYP E CLEARANC E NOT E
pp m ±Erro r Pb 88.78 0 ±12.10 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 116.42 6 Supervise d By : 

## Certificat e o f Verificatio n

70 6 SOI L 2009-06-3 0 16:2 3 30.4 8 Fina l 1508 8 301 2 oa k s t easemen t nicola s 1 CLEARANC E

± Erro r ± 13.72 9

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 70 7 Mod e SOI L Tim e 2009-06-3 0 16:2 3 Duratio n 30.4 1 Sequenc e Fina l Flag s BVI D # 1508 8 ADDRES S 301 2 oa k s t 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 70.54 8 ±11.21 9 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 74.65 6 Supervise d By : 

## Certificat e o f Verificatio n

70 8 SOI L 2009-06-3 0 16:2 5 30.5 8 Fina l 1508 8 301 2 oa k s t easemen t nicola s 1 CLEARANC E

± Erro r ± 11.35 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-3208 9 Readin g N o 67 4 Mod e SOI L Tim e 2009-06-3 0 12:5 7 Duratio n 121.4 5 Sequenc e Fina l Flag s AVERAG E ^^?g"oF67D^73 ^ ADDRES S 3m2-oai<-st-— ' QUAD/ZON E F l INSPECTO R nicola s DEPT H 1 0 SAMPL E TYP E CLEARANC E NOT E
pp m ± Erro r P

b 145.997 / ± Supervise d By : ^(l^tgfe) ^

# 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 67 0 Mod e SOI L Tim e 2009-06-3 0 12:5 5 Duratio n 30.3 4 Sequenc e Fina l Flag s BVI D # 1508 8 ADDRES S 301 2 oa k s t QUAD/ZON E F l INSPECTO R nicola s DEPT H 1 0 SAMPL E TYP E CLEARANC E NOT E
pp m ±Erro r P b 36.91 9 ±8.77 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 f Verificatio n XL3t-3208 9 Readin g N o 67 1 Mod e SOI L Tim e 2009-06-3 0 12:5 6 Duratio n 30.4 1 Sequenc e Fina l Flag s BVI D # 1508 8 ADDRES S 301 2 oa k s t QUAD/ZON E F l INSPECTO R nicola s DEPT H 1 0 SAMPL E TYP E CLEARANC E NOT E
pp m ±Erro r P b 47.20 3 ±9.82 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 47.50 8 Supervise d By : 

## Certificat e o f Verificatio n

67 2 SOI L 2009-06-3 0 12:5 7 30.5 5 Fina l 1508 8 301 2 oa k s t F l nicola s 1 0 CLEARANC E

± Erro r ± 9.63 5

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 52.35 6 Supervise d By : 

## Certificat e o f Verificatio n

67 3 SOI L 2009-06-3 0 12:5 7 30.1 5 Fina l 1508 8 301 2 oa k s t F l nicola s 1 0 CLEARANC E

± Erro r ± 10.17 0

### A^* % 

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

I ^^^^ ^ Coasta l Environmenta l Grou p Inc
.

www.coastalhazmatco m v ^ ^ ''^LP^oA^ COASTA L S 1 0 U P , IN O 

# EXECUTIV ESUMMARY : BVI D #15088
- (301 2 OA K ST ) 

# py ] No Issue s o r Concern s \A \Issues/Concern s Detail Explanation :

# f i EwB» ^ 

# EP A Propert y Clos e Ou t Form PropertyU : jf/^ ^ . , Propert y Datc/Tinc : Owner' s Quad s Excavattd : \) ^ , f I Contracto r Ye s N o Excavatio nGenera l 1 .i f necessary , were th e correc t quadrant(s ) excavate dandrestored ? 2 .I f necessary , were th e correc t area s ofdri p zon e excavate dan drestored ? 

# C ^ GradlD g So dan dVegetatio n Ye s N o I .Doe s the gradin g aroun dthe perimeier ofth e hous e i nexcavate darea s generally slop e awa y 

# c r fromth e house ? 2 .Ha s sodbee nlai dinall area s tha t wer e excavated ? 

# 1/ ' 3 .Doe s the so dappear r

o b e generall y healthy an dgrowing ? (Onl y evaluate i f inspecteda t a3 0 day tim e period ) 4 .Are soddedarea s generally fir man devenly graded ? S .Are th e joint s t>etwee nth e so dstrip s generally tight ? (Onl y evaluate i f inspecte da t a3 0 da y 

# A tim e period) 6 .Wa s the propert y grade dsuchtha t wate r wil l nol poo l o nth e property ? 

# y y 7 .

Wa s damage t o landscapin g o r plan t material s avoided ? Gates , Fence s an dRetainin g Wail s Ves N o I .D o gate s ope nan dclos e freely? (I f applicable ) 2 .Were all gate s or fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (If applicable ) 

## U ^ 3 .

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

# 17 ^ 4 .Wa s damage t o retaining wall s avoided ? (Ifapplicable ) 

# u ^ Foundation , Sidia g an dGntler s I .Wa s damage t o th e sidin g or tri mavoided ? 

# Y f 2 .Wa s damage to the foundationavoided ? ^	 ^ 3 .Wa s damage t o window s avoided ? 4 .Wa s damage t o window s o r doo r screen s avoided ? 

# A- ^

Ai
. 5 . Wa s damage t o downspout s o r downspou l extension s avoided ? 

# lA ^ Sidewalk s an dDriveway s (Copcrcle ) Ycs/N o 1 .

Wa s damage t o drivewa y surface s avoided ? 

## A 2 , Wa s damage t o walkwa y surface s avoided ? 

# lY' ^

## Ov^'ners comments :

Inspectio nnotes : 

# Ayrim l Alt-u^ur ^ A)f ^ (P^^^ ^
A^ y XYl c£ert^/n ^ .AUAUAI/^'^^ ^

Remova l an drestorati(Drjactivale s ccDqiplete^incjj^din g th e 30-da so warranty :

JO-da y y so d dwarranry : EP A Represenlaliv e LACY> \ 

# Date : 7A/0 7

# • t

Propert yCompletio n Agreemen t /'Ill s agreemen t document s (he complclio no f remedial activilies performe do nm y prc>|x,Tty . M y siijiKitur e will desii^nal e thai I a msalislie dwilhth e restoratio nofm y properly , an dlha t n o item s nr e i nquestions , now . o r a t an y tim e inth e future , excep l thos e ilem s liste dbelow , ifany . Pi ­ opert yID : Proporty A<Idrc.ss : ^0/ 2 Q^U i S^ ^ Owne r 

# (3Sw « jy-cL ^ Phone : 

# yo2-J^30A^£'iS:2 . Restoratio n Item s i n Question :

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

py I nyrc f restointio ni s contplctc<l , excep t a s note d I ' d o no t aurc c rcstorHtio ni s complete d 

# ..^'A
- Y 

# AYMY j Owncr'.s-Sign ntur e Dat e I ffontrnrtor' s Siijnatnr e Date I

# 4
Wate rBil l Settlemen t

Property I D 1508 8 Property Addres s 301 2 Oa k

S t Tenan t Mr . Charle s Voge l

I hav e receive dfh) mth e contractor , Coastal Environmental Grou p Inc . (Coastal) , th e sumo f $ 50.6 8 for wate r usag e require dt o maintai nth e sod . Check Number 171 6 Valu e o f Check $50.7 8 Mad e Ou t To Charle s Voge l 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 ful l paymen t fo rth e above , an d releas e Coasta l Environmenta l Grou p Inc
. fro m furthe robligation s o rliability
. 

# ,^A A ^^^-^ / ^ 7 ?e(^it^co ^ lDl2.ICA h Owner' s Signature Date Da l Contractor' s Signature Dat e T-^WH*».v:)i i f'V'. - »yv--';a,riaj^'';//;"- ^ 'jS^^«-<''^'?"-- : .'vj^'JJI^g.-Ti^' . "^ ' ^•'AJ7.^'A . '^" ^ •''•"^ " S'^;' ' ' . 

## 171 6 COASTA L ENVIRONMENTA L QROU P INC
. 241 1 MARTH ASTREE T OMAHA , N E 6810 5
PA

YT O TH E 

# CHfAfl ^ Vpt.ft ORDE RO F_ 

# iL m vr

VIMIsFafgoBinli.N A NlbTHk l wHbfargaco m FO

R 

# W/i ^ l^m /

^o\ i ^^ ^ 1:101*0000Sai : £ziU7i7iROU« ' 0171E
.D Remot e XD : Rpag e o f 

### rrain:m.Lxt u uxi
- S 3uin-Y , im . Wk : d4 4 «WB U 

## \m/<^^ m m i<»:4 s 

### mi e r . uuc/uu e
Afxount : 128811-117177 1 

# J L 172 3 Harne yS t • Omaha , N E 6810 2 » 402.554.666 6 CHARLE S W.VOQB
. 9-inall : cuutanmrj68fv(Co<8nxKtonaha.oof n * wsbsRs : wwwjnuduinuhajtxx n 

### METROPOLITA N Swvlo e addrau : 301 2 OAKO T UTILITIE S DISTRIC T liv e Green
. 7ftfn(fiJ k Bmngdat o Au g 7.200 9 Cal l 81 1 befor e yo u di g i n you ryard , buB d a PrsMuu s luuuio e $62.8 1 fence, eto . Col l a t ieas t tw o workin g day s i n Payman t reoalve d -Than k yo u 70.0 0 C R advance
. UUfilia s wif l mar k gas , water , eleatric , Cunen t ohaig M 104.2 7 cabl e an d phon e lines
. N o charg e fo rthi s Newbaiana e 97.1 8 

### eervtee . 

## • Tota l du e Au g 25,200 9 $97.1 8 >p1>ifnti»inD«lwirtallif€>MidaKaMi*i»ttfa«i«niiin>rtam—andwIirohMg—
.

soo " ­ 2S0-^ 

# llll
.

0 . , aeipCMNfwD«i.MFibMirAprlta|Ju n M-f m YoiirQasllB a • nntiaMMaH i • PMti»M«Mai M IM a Mort h LaatYOa r BflBn g untts : S S 1 7 Ua o pa rdsy : 0. 7 0. 6 Amrag * oas t pa rday : $0.8 4 $12 8 NumtMiro f day * I n Uliln g oyoki : 3 1

BepaattatOeoJenPihtttrfifrmvJi m M f m You rWala rUa « in i • nmuMw i TW B Mont h LMtYaar BBHn g un8a : 3 4 1 3 Uaape r day : Averag o oos t pa r day : 1. 0 $1.8 4 0. 4 $0.6 9 Numbaro f day ain MRn o oyeto : 3 3 3 1 

### QA S RESIDENTIA L RAT E A : Ju l 1 t o Au g 3 Mete rNundie r318^ 2 Ounen t rea d «MbMo: 622 2 - Pmrtou a rea d toatkiwiB}: 620 0 - 2 2 CO F

Qe e Use : 2 2 CC F x1.02 3 (hoa t value ) » 22.60 6 therm s

2 day s 1.38 4 therm a a t O.S>ffi3 - $0.7 2 3 1 day a 21.1421hemmat0.S286 - 11.1 8
, SarvloaOhartta 12.0 0

QasCos t ' • k 

### $23.90 Qu m Infiraatruolui e Reptauemen t 

### 3.00

WATE R RESIDENTIA L RAT E W-1 : Jo l II O Au g 3 Mete rNumbe r284822 0 8lz8:a«-ha h Cunen t raadfteiwQ: 88 3 - Prevtou a rea d (Mtbnaia} : 62 9 « 3 4 CC F

Wcde rUse : 34.00 0 CC F o r26,43 2 galbn a 9.00 0 CO F a t 0.9814 - $8.8 8 21.00 0 CC F a t 1.348 1 - 28.2 S

4.00 0 CC F a t 1.729 8 - 8.0 2 Sorvfai e Chart s 4.8 6 Wate rCos t • $48.68- ^ 

# < o Water Infrastructure neplooemon t 

### 2.00 / Lat a Paymen t Charg e 1.4 8 <

^

o f Omah a Sewe r 18.4 8 SahMTa x 6.7 2 ^

Curren t Charge e $104.2 7 neoM i Mu m thi s portio n o f th a b m wfll i poymont . • Ploaood o ito C otopl o ppyiiiuH t l o Mil
. 

# J L WBDMRB * WMf.inudoRiflnBjOOi n METBOPOUTA N UTILITIE I DliTIIC t 

### 000128811117177100000009718 6 17S3HBinay8 t • Omaha,NEM1Q2 * 402.654.668 8 6850001 0 MunPOToeaaaoosyNNNNyoioosBs s 

### Du a o n o rbefor e Au g 25 : $97.1 8 CHARLE S W.VOQE L 301 2 OA K8 T I f paynMti t k NNiivB d allt rdu a dati Ka iBl i (t o wB I OMAH Ar c68108^70 4 b a MnHWM M o n as Kan d watB f VVU9M
. Amoun t Paid : 

### .l|||l|||l|i,|,ill„||.,.l.l|..ti).|I..„||„|.i||||.,li||.l|l,. , METOOPOUTA N U11UTIE 8 DtSTRlCfT POBOXS60 0 OMAH AN E S8103M0 0 

### j.,I|.I„..II.,|„.l|,||I|.lll„„|,IIIII,.I.II.I.|I|.,I..,J.|II | GUvat o th o Haa t A M Fund
. 8MiwMMr.inudDmaha.ao(n
. MontMydonaUon-Add:n$eD93a$ 9 Ot»wr$
_ Account : 128811-117177 1