## TRANSMITTALof OMAHA LEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R SAI D #: 1^^1 5 Date : 12-3I'D 8 

### Address : I^I H P^n ^ "^ ^ Remediatio nContractor ; _Coasta l Environmenta l Group _ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f property (DVD ) 

# y Executiv e Summary EPA-provide dproperty sketc h Signe dAcces s Agreemen t for subjec t property Signe dAcces s Agreement(s ) for adjacent property 

# y Restoratio nAgreemen t Settlemen t document s (i.e. , fo r damag e or t o replac e plants , etc. ) / • 

### Confirmatio ndat a Year : 200 8

(j^x > rso d IcLiAper-^ J Photograph s pce - <L>f.cnj) ^5A

### ^ Q )CCA J

### /?i l D) n As-buil t sketc h 

# y Satisfactory restoratio nsigne db y Property Owne r Property close-ou t chec k lis t signe db y EPA 4031628 2 

### Descriptio nofarea s no t meetin g RO D cleanu p criteri a Superfun d 

# y Utility clearance s 

# y Property informatio nfromDougla s County Assessor' s Offic e 

# y C^rJr/uJr^>rrr\ D 

## 17 . ^\-n ^ Signatur e Dat e Ignature 

# ^/es/6 f

### »


## Propert yAcces s Checklis t PioiKMt y ID : |<^^\f; ) Propert y Address : ^3^-> ) ^ ^ ^ ^ ^ j D n WOR K STARTE D WORKCOMPELTE D ON : ON : / / /_ / _ Owner : "T T 

# is^A j K^lcr/^imic . ^ni % Renter : •Address : Phone : Fax : Ccll/Paaer : Phone : Fax : 

# LCHDlVHll^lC^ a Additionii l Information : Cell/ P 

# """•^^^1-3^ ^

nNotificatio nLette r ^J r Acces s Agreemen t {/

\Restoratio nAgreemen t [ U Topsoi l Samplin g (i f a|)plicable ) 1 1 Dis|)osal Samplin g (i f applicable ) C

H Garde nSamplin g (i f applicable ) 0 Utility Clearanc e [ ^ Video/Photo s (Before ) D Video/Photo s (During ) nVideo/Photo s (After ) D Video/Photo s (3(>-Day) nPro|)ert y Completio nAgreemen t D Fina l Repor t Sent : / / Sisjned : ' ^ / 0 \/ 0 % Sijincd : ^ /O l /o R / / / / / / 

### Called : K /

2 /O ^ 

## On:j; / ^/V\ On : / / On : / / On : / / Signed : / / Is.sued : / / By : Bv : By : By : By : 

## By : ^y-'^/Uo ^ 

# By : m

# I k 6 : O\L 

## :/vA U ' 1 By : By : 

## By: By: By : 

## 1

I I 

## 1 1



# 1 Ai r Monitorin g (a s applicabl e 1 1 Coniniuiiit y C H Cre w ) Results : On : / / 

# 1 j !
nC(Mnmunit > Results : C D Cre w On : / / Bv :
C

D Communit y Results : C D Cre w On : / / By :

Omah a Lea d Sit e

## CONTAC T FOR M Property I D # 

# m K Property Address : 

# \3|A?in e S t Initial Contact : Date : Time : Action : Secon dContact : Date : Time : Action : Final Contact : Date : Time : Action : Final Action : Transmi t t o EP A D Othe r Action : D 

# M? 2'104 0 Comment : Owne r Commen t (s) :

"71 0 

## Site 

# 7pf~f > Coordinato r Commen t (s) :

### .Dougla s County Accoun t Informatio n Pag e 1 o f 1 rn^i i Dougla s County , Nebrask a Propert yRecor d - R151925000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e ffi scal e 0-5 0 f l wes t of 90t h S t - VieW O n Ma p Informatio n i s vali d a s o f 2008-6-1 9 Treasurer' s Ta xRepor t Ne wFeatur e -•->- > Aut o Sale s Searc h Owne r ETHNI C SANDWIC H SHO P IN C 143 8 S 1 3 S T OMAH AN E 68108-000 0 Propert yInformatio n Ke yNumber : 192 5 000 0 1 5 Accoun t Type : Residentia l Parce l Number : 151925000 0 Parce l Address : 131 0 PIN E S T OMAH AN E 68108-000 0 Lega l Description : KOUNTZ E 3R D AD D LO T1 3 BLOC K9 W 7 0 F TS 1/ 2 L T1 2 & W 7 0 F T Valu e Informatio n Lan d Improvemen t Tota l j 200 8 200 7 200 6 200 5 200 4 200 3 $4,500.0 0 $4,500.0 0 $4,500.0 0 $4,500.0 0 $4,500.0 0 $4,500.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $27,000.0 0 $4,500.0 0 $4,500.0 0 $4,500.0 0 $4,500.0 0 $4,500.0 0 $31,500.0 0 Sale s Informatio n Sale s Date : 2003-10-0 1 Dee d Type : W D Book : 200 3 Page : 21855 5 Price : $ 22,000.0 0 Grantor : Kare n Ors i Grantee : Alfre d S Ors i eta l Valid/lnvalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 2 5250. 0 1. 0 75. 0 70. 0 N o



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R15. . . 7/17/200 8l i aMv k 

### (Result s 1 - 1 o f 1 ) ~ Ethni c Sandwic hSho p Omah aNE~ Simpl e Searc h~ Perfor mbusin.. . Pag e 1 o f 2 

# A Wh yOnlin e Degree s ar e HO Tselec t a Program r^. ^ NexTag= J Educatio n Inf o T*e h

_lOmeOwilScliedlll e HeaHhCa. e Granhi cOesia n B ^ 3
. Ear n Mor e Hursin a Eniiineerin a Hom e Peopl e Searc h Busines s Searc h Revers e Looku p Are a & ZI P Code s Plannin g Guide s LOGI N

Busines s Searc h Brows e Categorie s

Businesse s Searc h for : Ethni cSandwic h Sho p I n Omah a N E ^ Searc h Option s

Ethni cSandwic h Sho p Result s Name s wit h Ethni cSandwic h Sho p Sho wOnlin e Produc t Result s Result s 1 - 1 o f 1 ^Jl^gsult ! an d viewtn j • Narro wM ySearc h ^^^ J Sho wMor e Categorie s Enlarg e Ma p Result s

Sor

t Standar d | A- Z | Dislanc e | Ratrn g | Lgc^LOnt yShowresult s wllhin : 1 5 mile s Show : I S pe rpass You r••arc h ar« a wa ^ axpandt d t o provid * th ^ b«> t ivBUlt^ possibl e Al l LIsUng B Repor t Incorrec t Listing s > A d d t o Mvlnf b AddressBooi < ' .Edi t O Ethni cSandwic h Sho p Sav e t o Outloo k Products - Sandwiche s B e th e firs t t o Rat e I t J Appear s i n th e Category : Pin t S I ! Restaurant s j 143 8 S 13t h Street
. Omaha
. N E 6810 8 (402)422-104 0 ; mor e inf o phon e ma p i 

## ZAGATSURVE Y Zaga t Surve y Ge t tnjste d restauran t rating s an d reviews , menus , photo s map s & more . zagaLcg m

22n d Stree t Landin a Woo d Fire d Gril l Clic k Her e t o Se e Ou rMen u (310)548-440 0 

## CHOWHOUN D Fo rTho M Wh o Uv » To E M Rea l opinions , review s & advic e Ge t restauran t recommendation s no w chowhound.co m RESTAURANT.COM * lAT
. DRINK
. SAV i MONIT
. Restau rant,co m Sav e A t Restaurant s I n You rAre a Ge t $2 5 Gif t Certificate s Fo r$1 0 Restaurant.co m 

### ACTIV E DINE R «CO M ActiveDiner.co m Fin d tha t perfec t restaurant . Rea d review s an d recommendations
. activedtner.co m

Mamasourc e Fin d th e bes t restaurant s nea ryou , revievi/e d b yloca l Moms
. wwvv.mamasource,.co|T | Repor t Incorrec t Listing s ' Hav e a Business ? Wan t Mor e Customers ? Fin d them.here , Result s 1 - 1 o f 1

^ Searc h Option s 

### http://yellowpages.superpages.com/listings.jsp?SRC=comwp&CS=L&MCBP=true&C=Et. . . 7/17/200 8

### (Result s 1 -1 o f 1 ) ~ Ethni c Sandwic hSho p Omah aN E~ Simpl e Searc h~ Perfor mbusin.. . Pag e 2 o f 2

Buslness M Searc h for : Ethni cSandwric h Sho p i n Omah a N E { ^^^|g^ ^ 

# BB i fmn l h v • perpages.co m

Abou t U s I Advertis e | Affiliat e Progra m | Job s | Co_nta_ct__Us

_| Develope rAP I | BIO Q [ Privacy| Hel p | Sit e Ma p Busines s Searc h byStat e | Ot yWhit e Page s | Nam e Popularit y| WhitePagesx a | 41 1 .corn . Revers e Phon e | Revers e Addres s | Are a Codes | ZI P Codes
n a t s you r^UU G k*reai c&co n b2 0 - 65 9 34 0 - 61 9
Copyrigh t ".^ i 1996-200 7 WhrtePage s co m Al l fight s reserved
. oticy
. Lega l Notic e an d Twm s unde rwhic h thi s servic e i s provide d t o you .



### http://yellowpages.superpages.coni/listings.jsp?SRC=comwp&CS=L&MCBP=true&C=Et. . . 7/17/200 8

### Pag e 1 of 2

" > Lp , Create Anothe rTicke t Back t o Irt h Internet Sen d Emai l 

### YOU RTICKE T NUMBE RI S 2097361 . Origina l Cal l Date : 8/02/0 8 Time : 12:4 0 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 8/06/0 8 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 131 0 Street : PIN E S T Twp : 15 NRng : 13 E Sect-Qtr : 27-N E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remidiatio n Locatio n o f Work : LOCAT E ENTIR E PROPERT Y AL L TH E WA Y T O TH E STREET . Remarks : FAX AL L CLEAR S TO : (877)662-421 1 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 : Y Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N ATTNEBR l CXCAT V LEVEL S MCINE B MCLEODN E MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F QWEST 2
Servic e Are a Contac t Phon e Numbe r UtiUt y Typ e ATTNEBR l ATT/T 

### Day : Alt : Emer g 8002413624 9 8002413624 9
CXCAT V CO X COMMUNICATIONS , IN C UCTTM "^"^ ^ 

### Day : Alt : Emerg : 402934046 9 402934046 9 402932975 7
LEVEL 3 LEVEL 3 COMMUNICATIONS , LL C N A 

### Day : Alt : Emerg : 877366834 4 877366834 4
MCINE B MC I N O CAL LPE RMEMO 

### Day : Alt : 800289342 7 Emerg : 800289342 7
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 8/2/200 8Pag e 2 of 2

MCLEODN EMCLEODUS A N O NEE D T O CAL LOU T EMERGENC Y Day : 800289190 1 Alt : Emerg : 800289190 1
MUD0 2 METROPOLITA NUTILITIE S DISTRIC T EDWIN A Day : 402504782 3 Alt : Emerg : 402504794 6
OMAHACO F CIT Y O FOMAHA
TRAFFICSEWE R RO N Day : 402444719 7 Ah : 402444516 1 Emerg : 402444516 0
OPPDGPR 6 OMAH A PUBLI C POWE R DISTRIC T N A Day : 406728934 3 Ah : 888728934 3 Emerg : 406728934 3 QLNNEI FQWES T LOCA LNETWOR K N A Day : Alt : 406728934 3 Emerg : 888728934 3 QWEST 2 QWES T LON GDISTANC ESARA Day : 800283423 7 Alt : 303992192 6 Emerg : 800283423 7

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 8/2/200 8

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e

NaiTie : ( Address : Phone : Ws
. . . , f^/AA ^ Or f '^'^'h"'^'^/ 1 Omah a Lea d Sit e Sit e Sketc h Date: Time ; ~I)/^g/^ 3 ' / '• / n Nort h Arro w

Dat e Excavate d Dat e USEP AS g Are a Sodde d Tea m /hly S Pxi V i Sampl e Numbe r RYA5<:-PX A­ /5?I 5 R.VOS<^PxA­ iq^i ^

La

b RYDSCPLA-19815
. Result 88 5 pp m OLS# : f981 5 8/11/200 8 nc d Off:19/10n!00 9 : Q sd i f t BVI D # (' ^ C ( O Lea d Concentratio n Zl6otl l 

# t luu- o 1 a i



## .- r pp m pp m pp m pp m pp m pp m pp m XR F Cod e 

### '??^t 

# y Confirmatio n Sampl e

' , Ye s C D 

### )lYe s n Ye s Q Ye

s • N o ^ ^ N o IS ^ ^ : N o ET ^ -- \ 

### N

o n cy N o D ^ N o C D No • 

### ;-"x:

U J —=::^:::zrZ
. B 2 = 480 PP M @ 13 " Eiectric?! '

Pol e ! 

# - y 

# I P ^ 

# 'X i 

# 1^
_ _L . F 1 =21 0 PP M @ 13 " ^yyF 2 = 429@13 "
' ^ 

# rpxiss :

Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are a replace d wit h So d' ' Are areplace dwit h Rock/Mulc h Are aleft bar e 

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

# P^V ^ (s^nof ^Name : y^<^ \ - _j
_ Omah a Lea d Sit e Date : F>/^^/^ S Nort h AiTO w Address : /^/A4 X 0>4 , Sit e Sketc h Time : ' F n Phone : ^^^--^"7/ /
Tea m /H] ^ ?:LIV , 

### BVID #(^ ^ ( C XR F Cod e 

# ^^ n Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl i RYA5<^PX A- /57< S n (Ye s < 

## 2 ^ P.yft4cPX A- 197/ 5 ^ t f 0 t 3 

# f pp m 

## N o ^ pp m Ye s ._

_L J •N o S ^ g.YoS^PxA - l<?5?l' ; Ye s C H ^- ^ N o 1 ^ - \ pp m 

# • f e pp m 

## o- ^ 

# N o n O r pp m )iYe s O N o n- ^ Ye s n pp m N o D Ye s • Lab RYDSCPLA-19815
. pp m N o • Resul t 88 5 pp m =^ = 

# (5 ) ,-34 : = F "g y'T 

# r ^ 

# ^ m i ^ 

# i% i \ Y 

# 7o^i$ 5 -^==~ % 

# r ' ^ ^ 2K? i ^ 

# -d < 

# K^^: ^ ^ 

# ,\ u I P \ 

# te '2
. ~~ < -=* ^ 

# 3>3^< ) ti// o & . 

# I ^4|^±t( ^ i n < 

## ^? i



# i • ^ 

# ^

i VjN^ ^ 

# kk S ^ ^ 

# o ^ -^2S ^ " ^ 

# ^ - I ^ k ^ ^ 

## 4^= ^ 

# i4 J 

# i^na :COASTA L ENVmONHEHTA l 'ftiw^ ^ C I O U r. IN 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 : ra \ P
. Owner' s Name : 

## rOj C Daytim e Phone : y-ZZ

—) 0 t-/- O

Addres s o f Propert y 

# l3\ aF\ne . 

# «S4
­ covere d b ythi s Agreement : 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 remove 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 remov e contaminate d soil
. Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o it s origina l condition
. Thi s wor k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o f Coasta l Environmenta l Group , contracte d byUSEPA , 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 rwil l hav e a n opportunityt 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 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 , at 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 effect unti l th e wor k has bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :
Pag e 1 of 2%^^^ ^ COASTA L t PBOt *6 • O U f
. I h C



### •Remove obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; • Remove 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 byEPA ; •Abid e b yhealt h an d safetyguidanc e provide d b yEPA ; •I f th e propertyi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propertyt o perfor m th e work
. •Allo wvideotapin g and/o rphotographin g o f th e property . AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s not 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 of sai d propertywhic 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 wothers t o us e th e propertyi 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 , at (712 ) 352-018 8

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

Signatur e Dat e

r~ l I woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.

## Restoratio n Agreemen t The purpos e of thi s agreement i s t o provid e amutua l agreement a s to condition s of th e propert y prior to remediatio nactivities . Thi s will als o serv e a s documentatio nfo r the purpos e o f assurin g tha t restoratio n activitie s ar e completedt o the satisfactio nof th e propert\ ' owne r an dthe UnitedState s Environmenta l Protectio nAgenc y (EPA) . I Propert y ID : f<^9)^ ^ Propert y Address : ^^^ ^ p;^ g < ^ Owne r 

## • P^^i C SrxJircy>r^ JKo ^ 

# phonefq ^ ^2yy i 

# y-.^s^ r 

# B

O

nthe attache ddiagram(s ) indicat e area(s ) t o excavatedan ddeptl i of excavation , locationof al l known utilities , subsurface features , surface structure s an dlandscaping features , acces s location(s ) t o be use db y contractor , an dthe directiono f North . Indicat e distances , depths , materia l types , etc . Indicat e digita l photo s b

y referencin g th e photo-lo g numbe r wit ha n arrow indicating directionof 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 rretur n o f thes e item s i s th e Owner' s responsibility
. Item : 

## KioKlc ; Item : Item : item : 

### Item : Item : Item : Item : Pag e 1 o f ( ^

# i^ ^

k COASTA L r» - V I MOMimMTAl
. G R O U riM C 

### Item s To 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 : Item : Item : Ite i Item : Item : Kem :

Pag e 2 o f C o• ^
COASTA L 

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

### SX) ^ Item : 

# sy i 

# F'P ^ f) f t^ a Item : item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 3 of
.C O AS Tft U 

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

## Ite m

Pre-existin g propert y area , tha t will b e excavated , tha t is covere dwit hgrass .

Number of tree s > 2 inch trun k

diameter

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

diameter

Number o f Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Attachasketchof th e sprinkler layout .
Number of an dsize o f eac hgarden / flowe r be d area . Attachasketchof relativ e size s andlocations . 

## Quantit y 

# f

t

r a



# 3



# o 

# a U Unit
Squar e fee t 

## Condition/Type/Specie s

Eac h - .

Eac h

Eac h

Eac h Squar e Fee t

Pag e 4 of
.COASTA L I M VIMONrtt N TA t 

### Ite m Agree dupo nvalu e of plan t material s no t to b e renlace dbv contractor . Note thi s valu e wil l b e use dto issu e aplan t vouche r t o th e propert y owner . Agree duponlis t o f plan t material s tha t will b e replace db y contractor . B e ver y specifi c an ddetailed . Include askeicii of wer e eac hplan t wil l be place d by th e contractor . Agree dupo nare aof propert y t o b e replace d wit hgras s sod . Include asketcho f th e area(s ) to be replace dwit h gras s sod . Are ao f Cit y o r Count y propert y to be landscaped per their requirements . Include asketcho f th e aie a(s )

Easement Area , to b e excavate d 

### Quantit y 

# y Urii t

$

Eac h 

### Condition/Type/Specie s

S F ' •


# kllf r S F - 

# 0 S F

Pag e 5 of
.C O AS T AL e « • wr . IM C 

### Additional Comment s / Instructions :

Q Chec k th e tx} xi f Owne rdoe s not wan t CE G t o documerr t interio rfoundatio n wall s an d possibl e pre-existin g damage
. B ycheckin g thi s boxCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro f house , includin g foundatio n crack s o rfissures.

• lihTBo t agre e

Contractor' s Statur e Pag e 6 of
.T o who m i t ma yconcern : 1 understan d an d acknowledg e tha t Coasta l Environmenta l Grou p has advise d m e o f th e following : 1
.

Cit yordinance s d o no t prohibi t backfil l o f a propert yusin g crushe d rock ; an d 2
.

Restriction s ma yprohibi t thi s roc k backfil l i f th e inten t i s t o us e th e backfille d are a a s a rock-onl y (n o har d surfacing ) parkin g lo t o rdrive , o ri f th e backfil l i s par t o f a pla n t o chang e th e property' s lan d use . I herebyaccep t tha t Coasta l Environmenta l Grou p wil l backfil l m ypropert ya t 131 0 Pin e Street , Omaha , N E wit h roc k an d tha t 1 wil l no t us e th e propert ya s a rock-backfille d parkin g are a no rwil l th e lan d us e b e changed
.

Propert yOwne r 131 0 Pin e Stree t

### BVID # 

# Af e XRF PROPERT Y SAMPL E SHEE T Dat e 

### ^ 1 C' V Addres s 

## bi o hvi e s r Projec t Omah a lea d F P 2n d yea roptio n 

### Sampl e tim e am/p m XR F ID # sampl e lengt h 3 0 se c ^>^-^ ^ Shot # 

# m i m i

Mo _ Averag e

Shot # 

# TW"

^oo ^ Averag e

Shot #

Averag e

Shot #

Averag e la b sampl e # 

# r^Hi m Readin g 

## \\r{.n t l^-l L 'Il-vqv t ti-o' ^ '^•oz t Z% M \r\-%-h> i 'Z.L^ ^ 

# I
^ %
. O H t Readin g 

## ^i^.lS t Kx ^^•).n f 7^. h 

## iPl.^^ t IU < ^I'^o'i t Di- ^ ^\V-Iv t Readin g

Readin g

La b resul t 

# It4 l Sampl e are a 

# h Dept h 

## J i l ^^•^' \ Sampl e are a 

# f l Dept h 

## K " \^.\- ) Sampl e are a Dept h

RETES TAREA S Sampl e are a Dept h Shot # 

# v(^y ~

aii i M . 

# m . Averag e

Shot # ^ ^ ^ 

## lav" ^ Loc L Averag e

Shot #

Averag e

Shot #

Averag e Sampl e are a XR F Avg
. 

## P I U4 1 Signatur e Readin g Sampl e are a 

## SbP-^3 t ^'g-l;
. 

# tfr^.^'^Vt-l- y 

# k ^I'^.'l Kt t^-I K Dept h 

# E^i^smzE ^ M?t?.l< t ^^.r ]
Readin g 

## ^l.^ U -^l
­ "7^.1^ t ^1( 1 

# I (b-4^ r n-^- ^ ^ 

## n - i c j : Z^.7/ 

# U^.^ i
Readin g

Readin g 

# y n Sampl e are a ^ 

# a Dept h 

## XV l 

# ^^T- > Sampl e are a Dept h

Sampl e are a Dept h



## Prin t ^l^f^S
. MATT^ ^


## (R C i;i^f M/y ^

f^f - (isn^f^^^rPTVA£Ml/i/ |

.•[^I« ' .•^•..-. ( .iL'lA ' .- L
. :.: " it.\:'.ff.-.>
.

# 4 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 2647.20 0 Supervise d By : 

## Certificat e o f Verificatio n
199 2 SOI L 2008-08-1 1 09:0 5 30.3 0 Fina l 1981 5 131 0 Pin e s t F l LOPE Z SURFAC E UNOFFICIA L US E CAL.know n sample s

± Erro r ± 73.75 5

## Repor t Numbe r Dat e Reported : 

# /l ^

Midwes t 08-290-234 8 10/16/0 8 Account : Dat e Received : 2066 6 10/14/0 8 

# Vi yLaboratories , inc l Page : 1 o f 1 Dat e Sampled : 1361 1 B Stree t • Omaha , Nebrask a 68144-369 3 • (402 ) 334-777 0 • FA X (402 ) 334-912 1 • www.midwestlabsf^/»|3/0 8 

### COASTA L ENVIRONMENTA L GROU P MARCO S MATEU S 241 1 MARTH AS T OMAH AN E 6810 5 OMAH ALEA D PO/Projec t # : OL S 200 8 Analysi s As Detectio n Analys t Verifie r Performe d Receive d Unit s Limi t Metho d Dat e Dat e Lab number : 149278 2 Sampl e ID : QC-19815-F 1 131 0 PIN E S T Lea d (total ) 169 7 pp m 5 ICA P rrd/10-1 5 bab/10-1 6



# (uy^< ^ leathe rRami g ativew ' Clien t Service Representative ^ heattier@midwesttabs.co m (402)829-989 1 Th e result(s ) Issued o n thi s repor t onlyreflec t th e analysi s o f th e sample(s) submitted
. Fo rapplicabl e test paramaters , Midwes t Laboratories I s I n complianc e wit h NELA C requirements
. Ou rreport s an d letter s are fo rth e exclusiv e an d confidentia l us e o f ou rclient s an d ma yno t b e reproduce d I n wtioi e o ri n part ; no rma yan yreferenc e b e mad e t o th e work , th e results , o rth e compan yi n an yadvertising , new s release , o rothe rpubli cannouncement s withou t obtainin g ou rprio rwritte n authorization
.

# ^yLali@ratffiri ( 1361 1 B Street « Omaha , Nebrask a 68144-369 3 - (402 ) 334-777 0 « FA X (402 ) 334-912 1 < •www.midwestlabs.co m ACCOUNTNUMBE R 

### CHAI N O F CUSTOD YRECORD : Ye s N o P I IPrWAR F nPHF R N l JMRP R 

### REPORT&BILLT O | IDENTIFICATIO N | COPYT O | y^a.sTV^X Cr\^/iroIv.Yv^.evvV£^ \ 

# M\\ 

# M.AV ^ ZI P ZI P PHON E ( ) 

### PHON E (/77)^^5_V^/ ^ PROJ
. NO
. PROJECTNAME/COMPANY : 

## Oi^tKhc ^ ee i COMPANY ; (Signature ) 

# OLS 

# :u)o 2 Ceo,rh 4 £n^ '

SAMPLE R 1 ; (Siqnature ) I j 

### /O i c6(o^s
. lo p e-z ^

SAMPL E ID/LOCATIO N 

# l>lCHtsi5-fi-mr\Di ^ io M 

# IM . / 

# r


# E ff Kvrzt mffi'"3R!" 

## i ' ff ^ 

## ^ / i ! g -'--^r 

### 1 

# r­ ^' ^ M 2g9a ^

i

Relinquishe d by : (Signature ) Dale/Tim e Receive d by ; (Signalure ) Coole rarrive d intacl : Yes__rrNo
_

. femperatur e o n Arriva l C/iC) : Keiinquisne a oy : (i>ignature ) bate/ 1 im e Keceive a oy ; {i^ignawre ) 

## 4^ ­ ^reserve d i n Field ; Ye§
_ _N 0 • Remarks ; Relinquishe d by : (Signature ) Date/Tim e Receive d i n La b by ; (Signalure ) Chaln-of-Custod ywil l hav e a signatur e upo n receip t bu t n o subsequen t signature s '^^ ^ 02/0 2 Distribution : Origina l accompanie s shipment ; copyl o Coordinato rFiel d File s • Matri xCode : S O - Soil , W A- Water , S L - Sludge , OT- Othe r 

### L Ou rreporL s En d Isfcsr s er e fo rth e e);cL'ST.' 6 eri d conndentfa l us s c " ci rc.wzvn z iu i rr.a yriu t t e reprooL-ce d • - whoi e o i r . pert , .-o rmc ysn yrefe:eriC £ b s rr.sc K t o th e vi-o'-k , th e rssijiis
. c rSi e C0rr:pEr.j ' i' l anyco'vertlsing , riEW-'E'relarse , c rcthe. - publi c£'.-i:.CL/ricer.-,£rit s "•'ithci' ' oL'-ielniri C CJ : o'-a rvi-Til-er, cJfhorii.E?ior
.

### 1 

# A<9 k Miciwes t ir: ^ •<iz : 

# V[ / LaiioratorleS riitc l
1361 1 B Stree t • Omaha , Nebrask a 68144-369 3 • (402 ) 334-777 0 • FA X (402 ) 334-912 1 • www.midwestlabs.co m ACCOUNTNUMBE R 

### CHAI N O F CUSTOD YRECORD : Ye s N o P I IRrHA.siPnRnFRNlIMRF R 

### REPORT&BILLT O IDENTIFICATIO N COPYT O ^O^JTCM
. Cr\\/iVDIVYVA.eVV.'Vcik\



# c^H W M^AVo
. ZI P ZI P 

### PHON E (/77)^^;2-%/ ^ PHON E ( ) PROJ
. NO
. PROJECTNAME/COMPANY ; 

# J 2 f/y j O L nC ^ COMPANY ; • (Signature ) ^^^ 1 g ^ ^ ^ 

# I0L 5 M0 2 SAMPLE R ; (Signature ) / 1 

### / O i cojo^Z lo p 

# ez La b Number/Orde r# (Interna l Use ] SAMPL E ID/LOCATIO N TIM E 

# /Sc-UFis-ff-mnjuis t loi M %'O D / 

# r

Relinquishe d by ; (Signature ) Dale/Tim e ^Recei v eceive d (Signa l Coole ramve d intact ; Ye s No
. qjisne a by ; \^tgnatt M uate/ 1 im e ecerve o by ; {urgnawre , Temperatur e o n Arriva l ('/4C) ; ^reserve d i n Field : Ye s N o Relinquishe d by ; (Signalure ) Date/Tim e Receive d i n La b by : (Signalure ) Remarks ; Chaln-of-Custod ywil l hav e a signatur e upo n receip t bu t n o subsequen t signature s ^^^ ^ 02/0 2 Distribution : Origina l accompanie s shipment ; copyt o Coordinato rFiel d File s • Matri xCotJe : S O - Soil , W A- Water , S L - Sludge , O T- Othe r Ou rreport s en d letter s jr e fo rtn e er,clysf\' e sn d co.ifidentiE l lis s c f ou - cjisnt s Efi caia yno t be reproo'i'ce d ' n whol e o i r . pert , ro rrric yE-n yreference b z msc e t o th e wo'li , th e resulis , o rtfi e compan yir
. anyao'vertisirig , risvi'sreissse , o rethe rpubli cenricuncemsnt s (vitficu t obieiniri g C^ T"j'io rwritie. i EL'thoriiEtior:
.

# 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 198 2 Mod e SOIL Tim e 2008-08-0 9 15:3 0 Duratio n 120.8 2 Sequenc e Fina l Flag s AVERAG E fAv g o f 1978-198 1 ADDRES S |131 0 Pin e s t QUAD/ZON E INSPECTO R LOPE Z DEPT H 

# t 3 SAMPL E TYP E NOT E CLEARANC E

Supervise d B y

# 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 437.83 1 Supervise d By : 

## Certificat e o f Verificatio n
197 8 SOI L 2008-08-0 9 15:2 7 30.2 1 Fina l 1981 5 131 0 Pin e s t B l LOPE Z 1 3 CLEARANC E

± Erro r ± 26.76 4

# 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 323.46 4 Supervise d By : 

## Certificat e o f Verificatio n
197 9 SOI L 2008-08-0 9 15:2 8 30.1 7 Fina l 1981 5 131 0 Pin e s t B l LOPE Z 1 3 CLEARANC E

± Erro r ± 23.03 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 505.02 8 Supervise d By : 

## Certificat e o f Verificatio n
198 0 SOI L 2008-08-0 9 15:2 9 30.2 9 Fina l 1981 5 131 0 Pin e s t B l LOPE Z 1 3 CLEARANC E

± Erro r ± 28.97 5

# 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 477.83 5 Supervise d By : 

## Certificat e o f Verificatio n
198 1 SOI L 2008-08-0 9 15:3 0 30.1 5 Fina l 1981 5 131 0 Pin e s t B l LOPE Z 1 3 CLEARANC E

± Erro r ± 27.98 4

# 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 198 7 Mod e SOI L Tim e 2008-08-0 9 15:3 5 Duratio n 123.9 7 Sequenc e Fina l Flag s AVERAG E Av g o f 1983-198 6 ADDRES S • 131 0 Pin e s t — • QUAD/ZON E |B 2 INSPECTO R DEPT H LOPE Z 

## il 3 SAMPL E TYP E CLEARANC E NOT E

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 500.63 6 Supervise d By : 

## Certificat e o f Verificatio n
198 3 SOI L 2008-08-0 9 15:3 2 30.2 9 Fina l 1981 5 131 0 Pin e s t B 2 LOPE Z 1 3 CLEARANC E

± Erro r ± 28.32 9

# 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 472.89 3 Supervise d By : 

## Certificat e o f Verificatio n
198 4 SOI L 2008-08-0 9 15:3 3 30.2 0 Fina l 1981 5 131 0 Pin e s t B 2 LOPE Z 1 3 CLEARANC E

± Erro r ± 27.75 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 519.94 4 Supervise d By : 

## Certificat e o f Verificatio n
198 5 SOI L 2008-08-0 9 15:3 4 30.6 3 Fina l 1981 5 131 0 Pin e s t B 2 LOPE Z 1 3 CLEARANC E

± Erro r ± 28.98 8

# 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 429.56 2 Supervise d By : 

## Certificat e o f Verificatio n
198 6 SOI L 2008-08-0 9 15:3 5 32.8 5 Fina l 1981 5 131 0 Pin e s t B 2 LOPE Z 1 3 CLEARANC E

± Erro r ± 26.43 4

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1 

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 200 2 Mod e SOI L Tim e 2008-08-1 1 10:2 5 Duratio n 120.9 8 Sequenc e Fina l Flag s AVERAG E I Av g o f 1998-200 1 ADDRES S 131 0 Pin e s t QUAD/ZON E |F 1 INSPECTO R LOPE Z DEPT H SAMPL E TYP E ^CLEARANC E NOT E

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 199 8 Mod e SOI L Tim e 2008-08-1 1 10:2 3 Duratio n 30.1 4 Sequenc e Fina l Flag s BVI D # 1981 5 ADDRES S 131 0 Pin e s t QUAD/ZON E F l INSPECTO R LOPE Z DEPT H 1 3 SAMPL E TYP E CLEARANC E NOT E
pp m Erro r P b 214.18 4 ± 19.35 8 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 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 253.37 9 Supervise d By : 

## Certificat e o f Verificatio n
199 9 SOI L 2008-08-1 1 10:2 3 30.0 8 Fina l 1981 5 131 0 Pin e s t F l LOPE Z 1 3 CLEARANC E

±Erro r ±20.61 8

# 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 162.25 9 Supervise d By : 

## Certificat e o f Verificatio n

200 0 SOI L 2008-08-1 1 10:2 4 30.4 8 Fina l 1981 5 131 0 Pin e s t F l LOPE Z 1 3 CLEARANC E

± Erro r ± 16.85 5

# 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 200 1 Mod e SOI L Tim e 2008-08-1 1 10:2 5 Duratio n 30.2 8 Sequenc e Fina l Flag s BVI D # 1981 5 ADDRES S 131 0 Pin e s t QUAD/ZON E F l INSPECTO R LOPE Z DEPT H 1 3 SAMPL E TYP E CLEARANC E NOT E
pp m ±Erro r P b 213.09 4 ±18.64 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 AVERAG E ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

Supervise d B y 

## Certificat e o f Verificatio n

200 7 SOI L 2008-08-1 1 10:2 9 120.9 9 Fina l I'Av g o f 2003-200 6

131 0 Pin e s t | F 2 *LOPE Z §1 3 • CLEARANC E

# 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 542.98 7 Supervise d By : 

## Certificat e o f Verificatio n

200 3 SOI L 2008-08-1 1 10:2 6 30.1 2 Fina l 1981 5 131 0 Pin e s t F 2 LOPE Z 1 3 CLEARANC E

± Erro r ± 31.90 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 375.72 2 Supervise d By : 

## Certificat e o f Verificatio n

200 4 SOI L 2008-08-1 1 10:2 7 30.3 1 Fina l 1981 5 131 0 Pin e s t F 2 LOPE Z 1 3 CLEARANC E

± Erro r ± 25.84 8

# 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 416.47 0 Supervise d By : 

## Certificat e o f Verificatio n

200 5 SOI L 2008-08-1 1 10:2 8 30.2 6 Fina l 1981 5 131 0 Pin e s t F 2 LOPE Z 1 3 CLEARANC E

± Erro r ± 27.33 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 383.10 7 Supervise d By : 

## Certificat e o f Verificatio n

200 6 SOI L 2008-08-1 1 10:2 9 30.3 0 Fina l 1981 5 131 0 Pin e s t F 2 LOPE Z 1 3 CLEARANC E

± Erro r ± 26.27 0

### Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
. www.coastalhazmat.co m COASTA L ENVHONnENTA L CROUP , INC
. 

# EXECUTIV ESUMMARY : BVI D #1981 5 - (131 0 PIN EST )

X 

# N o Issue s o r Concern s I I Issues/Concern s Detai l Explanation : N O ISSUE S PENDING .

# ^ m 

# EP A EP A Propert y Clos e Ou t For m Propert y # : \^?l ^ Propert y Address : \'2>\ Q PtTvffi . & k Date/Time : Owner' s Name : X'CCyCx X ^ijcr Quad s Excavated : p t F^ X^ ^ ^ Q Contracto rCrou p CrA'^VflL l T)r%!Mrtiwrn0r\\di f Excavatio nGenera l 

# V/IC^A/O T|_yo- I Ye s No 1 .If necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? ( / 2 . I f necessary , wer e th e correc t area s ofdri p zon e excavate dan drestored ? 

# y Gradin g So dan dVegetatio n Ye s N o 1 .Doe s th e gradin g aroun dth e perimete r o f th e hous e i nexcavate darea s generall y slop e awa y ^ fromth e house ? 2 .Ha s so dbeenlai dinal l area s that were excavated ? CofVCrc-4 ^ -k ) b«
- l>6cLre d / 3 .Doe s di e so dappea r t o b e generall y healthy andgrowing ? (Only-evaluat e if inspecte da t a3 0 da y tim e period ) 

### A/i ^ 4 .

Ar e sodde darea s generall y fm nandevenl y graded ? 

### A ^ 5 .Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e if inspecte da t a3 0 da y tim e period ) 6 .Wa s th e propert y grade dsuc htha t water wil l not poo l onth e property ? l ^ 7 .Wa s damag e t o landscapin g o r plant material s avoided ? 

## tlf ^ Gates , Fence s an dRetainin g Wall s Ye s N o I .D o gate s openan dclos e freely ? (Ifapplicable ) 2 .Wer e al l gate s o r fence s take ndowndurin g restoratio nactivities reinstalled ? (Ifapplicable ) 

# jfe " 3 .Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) 4 .

Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) Foundation , Sidin g an dGutter s 1 Vts N o 1 .Wa s damag e t o th e sidin g o r tri mavoided ? 2 .Wa s damag e t o th e foundatio navoided ? ; 

# 0 1 3 .Wa s damag e t o window s avoided ? 4 .Wa s damag e t o window s or doo r screen s avoided ? 5 .Wa s damag e t o downspout s o r downspou t extension s avoided ? Sidcwallt s an d Driveway s (Concrete ) Ye s N o 1 .Wa s damag e to drivewa y surface s avoided ? 2 .

Wa s damag e t o walkway surface s avoided ? / - ^

## j O rner s comments : ^ P^ ^ 

# 1

; l



### ' ^

* v '\


### f 1 ' 

## 1 Inspectio nnotes :

• 1 j 

### 1 i j

•

j 

## 1

• j

• i f f f 

# .1

;; [ 

## Remova l an drestoratio nactivate s complet e includin g th e 30-da y so dwarranty : EPA Representat 

# ^^^^^^^^^L . -^4^ ^ Date : y/o/d 3

# '«i ^ Propert yCompletio n Agreemen t This agreement document s the completionot remedia l activitie s performedo nm y property . M y signature wii l designate tha t I a msatisfie dwit hth e restoratio no f m y property , an dtha t n

o item s ar e i nquestions , now , o r a

t an y tim e i nth e future , except thos e item s liste dbelow , ifany . Property ID : / Q V I C Property Address : J}/ ^ ^IJJ ESJ
­



### ^"^ ' JTrtxcy/C yA> -
Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item :

agre e restoratio n I s completed , excep t a s note d ^ I I d o no t ajjM C restoratio n i s complete d 

# y Owner' s Signature / J I