## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID* : B^^d-' ^ Date : ///^ ^ Address

- ^-S^^ O / V / ^ '^^ ^ Remediatio nContractor * Coasta l Environmenta l Grou p Year : '^^^f SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S "^T ^ Vide o o f propert y (DVD ) TExecutiv e SummBi y y ^ EPA-provide dpropert y sketc h ly Signe dAcces s Agreemen t fo r subjec t propert y Signe dAcces s AgFeenient(5 ) fo r adjacent propert y Restoratio nAgreemen t Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) Confiimalio D dat a 

## Photograph s / ^ ^C^-raMh ^ O^a^^rxu^WY ^ / S^K ? :y ^ As-bui hsketc h y Satisfactory restoratio nsigne db y Propert y Owne r UPropert y close-ou t chec k lis t signe db y EPA y .Descriptio no f area s no t meetin g RO D cleanu p criteri a Iy Utility clearance s

y ^ Property informatio nfromDougla s County Assessor' s Offic e 3026168 6 

# n* Superfun d <y ^ A V
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# ^ v Propert yAcces s Checklis t Propert y ID : 

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### PropertyAddress : Q t QS^ Q /jy /^'Sy nWOR K COMPELTED ON : / / Owner : li^^^/^; ^ fXiL C Renter : Phone : Fax : Cell/Pager : 

### Phone : HQZ ^ ^^jp ^ ^9^ 0 ^ Additional Information : Fax : Cell/Pager :

nNotificatio nLette r Sent : / / By : y

j Acces s Agreement Sisned : l O 1 ^^ll / 

## By:iCl,^a^i^

­ 1 ^ Restoratio nAgreement 

# svijieA./jQ_i^£: i a _ By : t/jy/h^
. D Topsoi l Samplin g (if applicable ) 1 1 

### By : D Disposa l Samplin g (if applicable ) 1 1 

### By : D Garde nSamplin g (if applicable ) 1 • 1 

### By : PUtilit y Clearanc e 

### CaUed: Jjl_f,l ^ 

## By = [jhLM^
. ^ Video/Photo s (Before) 

## On:i^lZS.'U

- By : D Video/Photo s (During ) On : / / By : nVideo/Photo s (After ) On : / / By : nVideo/Photo s (30-Day ) On : / / By : D Propert y Completio nAgreement Siened : / / By : nFinal Report Issued : / / By : Air Monitorin g (a s applicable ) nCommunit y QCre w On : / / 

### By : 1 Results :
nCommunit y Q Cre w On : / / By : Results :
nCommunit y D Cre w On : / / 

### By : 1 Results :
Omah a Lea d Sit e

## 1 Douglas Count y Accoun t Inforr-^+io n Pag e 1 of2
Dougla s County , Nebrask a Propert yRecor d - R160080000 0 Prin t Report
. 1 Vie wInteractiv e GI S Ma £ Informatio n i s vali d a s o f 2011-10-1 3 Treasurer' s Ta xReoor t 1 Ne wFeatur e ->->- • Subdivisio n Sale s Searc h Owne r BAL L JANIC E L 253 2 FLORENC E BLV D OMAH AN E 68110-000 0 Propert yInformatio n Ke yNumtier : 008 0 00001 6 Accoun t Type : Residentia l Parce l Number : 160080000 0 Parce l Address : 253 0 N 1 9 S T OMAH AN E 68110-000 0 Lega l Description : LAK E AD D LO T3 BLOC K2 N 1/ 2 30. 5 X 14 0 Valu e Informatio n \Lan d improvemen t Tota l 201 1 $300.0 0 $0.0 0 $300.0 0 201 0 $300.0 0 $0.0 0 $300.0 0 200 9 $300.0 0 $0.0 0 $300.0 0 200 8 $300.0 0 $0.0 0 $300.0 0 200 7 $300.0 0 $0.0 0 $300.0 0 200 6 $300.0 0 $0.0 0 $300.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 9 4340. 0 0. 0 140. 0 31. 0 Ye s



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl..
. 10/26/201 1

### 1 Dougla s County Accoun t Inforp^'^tion Pag e 2 o f 2

Locus t S i Locus t S t Locus t S t I D 2 

# 1

- Mapl e S I a Mapl e S t 

# i CortvyS t CortJii S l lyAlam i St W i Miam i S l z r o M Ohi o S I OMOS I 3 ^foS t 

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# t ^ 2 ? Ohi o St N HtfiS t 3 S t Cad yAv e Lake S t Lak e S t z z o 5 2 Z C O w ShretvTOo d Av e Willi s Av e Willi s Av e V«/pW s Av e "
Witt s Au e Victo rAv e Gran t St Gran t S i BL»r<tett e PBTk 

# C ' Ma p dat a ©201 1 Googl e RttrHAll A< ^ DI..V4.^4 A0 « Burdell e St Th e abov e ma p i s powere d byGooqIe , an d i s intende d t o provid e a genera l ide a o fa property' s location
. I f yo u requir e a mor e exact propertylocation , yo u ma yus e th e Interactiv e GI S Map s tha t ar e maintaine d byou r office
.



### http://douglasne.mapping-onIine.com/DougIasCoNe/static/accountinfo.jsp?accountno=Rl.
. . 10/26/201 1

### IRT H On e Cal l Pag e 1 o f 1
Digger s Hotlin * O f Nebrask a 

# irth

Hom e Ticke t Ticke t Creatio n Logou t Creat e Anothe rTicke t G o t o Hom e Pag e Sen d Emai l

• YOU R TICKE TNUMBE R I S 2889590
. Origina l Cal l Date : 10/28/1 1 Time : 5:2 1 p m Op : WENDY1879 0 Wor k t o Begi n Date : 11/01/1 1 Time : 5:3 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 253 0 Street : N19T H S T E Twp : 15 NRng : 13 E Sect-Qtr : 12-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATIO N Locatio n o f Work : ENTIR E PROEPRTY , INCLUDIN G TH E EASEMENT , AN D U P T O TH E : PEDESTAL . Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : EMAI L AL L CLEAR S TO : WLARA@COASTALGRP.NE T : UNSUR E I F CORNE R LOT . Compan y COASTA L ENVIRONMENTA L SERVIC E Contac t Nam e WEND Y LAR APhone : (402)991-119 9 Alt . Contac t JOS E CARDENA S Phone : (402)504-098 1 Wor k Bein g Don e For : COASTA L Dept h o f Excavation : 4 F T Corne r Lot : NFront : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N COXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Servic e Are a Cod e Servic e Are a Nam e Contac t Phon e Number s Utilit y Typ e COXCAT V CO X COMMUNICATION S IN C ELMCO X ELMCO X Day : (406 ) 72 8 ­ 934 3



### http://www.dhon.org/IRTHOneCall/Ticket/TicketCreation.aspx?ViewTicketID=87860 8 10/28/201 1

## Wend yLara From : IRTH.Net@qwest.co m Sent : Monday , Octobe r31 , 201 1 3:0 9 P M To : Wend yLar a Subject : Messag e fro m Qwes t

To : COASTA L ENVIRONMENTA L SERVIC E Voice : 402991119 9 Re : Messag e fro mQwes t Attn : Fax : WEND Y LARA 877662421 1 Messag e fro m Qwes t
Ticket : 288959 0 County : DOUGLA S Place : Omah a Address : 253 0 N19T H S T E QLNNEIC : Th e describe d di g are a o f you r locat e r^eques t ha s bee n checke d an d i s clea r fo r Qwes t Communication' s Loca l Network . I f yo u hav e an yquestion s pleas e cal l Qwes t a t 1-800-283-4237 .
Messag e fro mQwes t

Thi s messag e wa s generate d b ya n automate d system . Pleas e d o no t repl yt o thi s email .

## Wend yLar a From : agt_comm@irth.co m Sent : Sunday , Octobe r30 , 201 1 7:53 P M To : Wend yLar a Subject : Respons e t o Di g Reques t

To : COASTA L ENVIRONMENTA L SERVIC E Attn : WEND Y LAR A Voice : 402991119 9 Fax : 877662421 1 Re : Respons e t o Di g Reques t Thi s i s a n importan t messag e fro mOmah a Publi c Work s replyin g t o you r reques t t o locat e ou r undergroun d facilitie s i n a n are a describe d o n th e on e cal l cente r ticket .
Ticket : 288959 0 County : DOUGLA S Place : Omah a Address : 253 0 N19T H S T E OMAHACO F (Sewer) : Cit yo f Omah a Sewer
- N o Conflic t pe r inf o o n th e on e cal l ticke t OMAHACO F (Traffic) : Th e Cit yo f Omah a Traffi c Engineerin g Divisio n ha s determine d ou r facilit yi s no t i n conflic t wit h th e di g sit e provide d b yth e on e cal l center .

I f yo u hav e anyadditiona l question s pleas e contac t Omah a Publi c Works .

Thi s messag e wa s generate d b ya n automate d system . Pleas e d o no t repl yt o thi s email .

# • • 

# As-Buil t Drawin g
0LS# : 2892 3 

## COASTA L DAT E EXCAVATED:11/09/1 1 

## invironmenta l Group , DAT E USEP ASIGNE D OF F -.11/15/1 1 

## Inc
. ARE ASODDED : 123 8 

# Omah a Lea d Superfun d Sit e

2892 3 Omah a Lea d Sit e Exterio rPain t Nortt i Arro w Owne rNam* : JANIC E L BAL L I I Goo d Sit e Sketc h Address : 253 0 N 1 S S T I I Poo r

Phone : H 

# 1 [^"No t pain t Sampl e Numbe r Lea d Sampl e L A B Sample s Collecte d Concentratio n Collecte d Firm : (\Sr<r' \ fcg| hr ^ RYASCPXA-2892 3 F 1 

### P.H° I pp m Date : i o \^-<= > C ~ 

# ^ r • RYBSCPXA-2892 3 F 2 pp m B ^ Time : c t • . <- i «^ RYCSCPXA-2892 3 B 1 \ ^ 2 - pp m B ^ 

# • • Sample s Analyze d RYDSCPXA-2892 3 B 2 I - I 3 pp m B " RDZSCPX Aasoa s B 2

—pp m CD 

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# •

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# • • Tim e 

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## n^v ^ Legend : F 1 = Fron t Left , F 2 = Fron t Right
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. G Z • Garden
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ARE AREPLACE D WIT H ARE ALEF TBAR E ARE AREPLACE D WIT H SO D ROCK/MULC H 

### CONTRAC T# : EP-R7-09-0 6 COASTA L ENVIRONMENTA L GROUP , INC
.

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### Omah a Lea d Sit e Owne rName : JANIC E L BAL L • Goo d 

### Sit e Sketc h Address : 2530 N 1 9 S J • Poo r W : Phone : H 

# 1 P^^o t paint Sampl e Numbe r RYASCPXA-2892 3 F l Lea d Concentratio n pp m Sampl e Collecte d Uk B 

## D Sample s Coiiecte d Firm : h^^ \ ftg| ^ Date : i 0-ta.- o c RYBSCPXA-2892 3 F 2 pp m 

## D Time : < q ­. <_n ; RYCSCPXA-2892 3 B l RYDSCPXA-2892 3 B 2 RDZSCPXA2802 3 B 2 RGZCCPXA2802 3 6 Z RPZOCPX Aaooaa—P Z 

# 11 3 pp m pp m pp m pp m pp m 

## [ T (Z ' D D D D D D D D Sample s Analyze d XR F Unit : IQO l Book : jl^

Date : // ­ I H • O U Time : P m .
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# n Staff : M5U / Legend : F 1 = Fron t Left , F2 = Fron t Right , 8 1 = Bac k Left , B2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden
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Re v 4 04614 1 UI2 3( ) l 

# 2892 3 

# li
. •Il Exterio rPain t Nort h Arro w Omah a Lea d Sit e Owne rName : JANIC E L BALL 

### • Goo d Sit e Sitetc h Address : 2530 N_1 9 S T • Poo r W : Phone : H : 

# 1 0^o t pain t Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Firm : A^iHifi-SLfi^ I RYASCPXA-2892 3 F l pp m 

# 0 " D Date : iQ
_ '^'<='<2 > RYBSCPXA-2892 3 F 2 pp m 

# [ T D Time : CK
. Cjt ^ RYCSCPXA-2892 3 B l pp m 

# n Sample s Analyze d RYDSCPXA-2892 3 B2 pp m 

# I 1 3 D RDZSCPXA2802 3 B Z pp m 

# D XR F Unit : /00 7 Book : J7 3 

# D RGZSCPXA2802 3 S Z pp m 

# D Date : // - J H O b 

# D RPZOCPXA2002 0 P 2 pp m Time : Pnr , 

# n D Staff : M5U / Numbe ro f Sample s = ] ^ Legend : F 1 = Fron t Left , F2 = Fron t Right , B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , PZ = Pla y Al l quadrant s ar e a s viewe d fro m th e street , facin g propert y

Re v4 04614 1 U12 3

# 2892 3 Exterio rPaint Nort h Arro w Omah a Lea d Sit e Owne rName : JANIC E LBALL 

### • Goo d Sit e Sketc h Address : 2530 N 1 9 S T • Poo r Phone : H : W : 

# 1 Q^o t pain t Sampl e Numbe r RyASCPXA-2892 3 RYBSCPXA-2892 3 RYCSCPXA-2892 3 RYDSCPXA-2892 3 RDZSCPXA2802 3 nOZSCPX A2602 3 F l F2 B 1 8 2 B Z G Z 

### RPZOCPX Aaooao—p z Lea d Sampl e LA B Concentratio n Collecte d pp m 

# D 52. ^ pp m 

# [ T D \^Z . pp m 

# \z r D 1 I' h pp m 

# c r D pp m 

# D D

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# D D Numbe ro fSample s = {_ ^ Sample s Collecte d Firm : As.wi | Qs \ t ^ Date : IO-IA-O C Time : g^-
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### — I :— AW c 

### I 

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. 

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. ..*P». t 046141.012 3COASTA l [HVtKONIIIHTA I c> 0 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 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 : .W>;c« , "^ovVN Daytim e Phone : Hogi
. ^Ht.^l'J.C O

Addres s o f Propert y covere d bythi s V 3 -a v g^S^b O \« ^ 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 f lea d an d maypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t o remov e contaminate d soil
. Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o its 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 Coastal Environmenta l Group , contracte d b yUSEPA , wil l contac t th e Granto rin-perso n t o discus s th e wor k t o b e performed , th e Granto rwil l hav e a n opportunit yt o revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e i t begins
. Onc e th e wor k i s finished , th e Granto rwil l b e aske d t o revie wth e wor k an d confir m tha t i t i s complet e an d meet s wit h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m EP Atha t th e propert y ha s bee n remediated
. ENVIRONMENTA L RESPONS E ACTION S 

### Bysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , it s employees , contractor s an d subcontractors th e righ t t o ente rth e property , a t al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e o fperformin g th e work
. Thi s acces s shal l remai n i n effec t unti l th e wor k ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :
Pag e 1 o f 2

### ^*^!^''* * 

## ^^. l
COASTA L tiiriiiO)iH(Kr« L cn o u rin c


### « Remov e obstruction s includin g boats , trailers , vehicles , playscap e Items , woo d piles , do g houses , etc ; cRemov 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 ; ft Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessarysubsequen t t o a n initia l waterin g perio d b yEPA ; cAbid e b yhealt h an d safet yguidanc e provide d b yEPA ; » I f th e propert yi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propert yt o perfor m th e work
. * Allo wvideotapin g and/o rphotographin g o f th e property
. AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s no t t o interfer e o rtampe rwit h an yo fth e wor k activities , o rwit h an y o 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 (402 ) 991-119 9

• ^ Q^^an t access t o m ypropertie s D I d o not gran t acces s t o m ypropertie s

Sianatur e Dat e Signatur e Dat e
D i woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.

Pag e 2 o f 2

### v * COA S T AL • MVinONHEHTA L C • O U P , INC
. 

## Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o provid e amutua l agreemen t a s t o condition s o f th e property prio r t o remediatio nactivities
. Thi s wil l als o serv e a s documentatio nfor 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 property owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA)
.

Property ID : r?$W7^ 3 

### Property Address : 

# as-sjc ^ >o ' t« H s v Owner : ^fl.^^. o ^^V \ 

### Phone : HD^
. -S^vo
. oy-toO L O nth e attache ddiagram(s ) indicat e area(s ) t o excavate , stufac e structure s an dlandscapin g feature s an d acces s location(s ) t o b e use db y th e contractors . Indicat e distances , depths , material types , etc . Photographicall y an dVideographicall y documen t th e existin g condition s ofth e property an dth e basemen t i f necessary . 

## Item s t o b e Remove d b yth e Owne rbefor e Start o f Remediation : Th e removal , storage , disposal , and/o rretu m o f thes e item s i s th e Owner' s responsibility
. Item : f^iri M ^vr»nk\ \ -rA a r^V< ; \r > 

# W <a/xv.*r l Item : item : Item :

Item : P\«f>v A '\J\OVVNV*
. 

# \.c v VoW^J i Item : ^ ^ Item : Item :


### Page l o f ! >

### V S COASTA L • MVIROHHa N TAI
. G • O U P
. INC
. 

### Item s t o B e Remove d B yContracto r Durin g Remediatio n an d Reolace d Item :

• Soi V 

### i ^ A Item : Item : Item :


## Landscap e Inventor y Ite m Quantit y Uni t ConditionH'ype/Specie s Pre-existing propert y area , V^ L Quadrants tha t wil l b e excavated , tha t i s coveredwit hgrass . Numbe r oftree s > 2 inc h Eac h ? • trun k

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

diamete r / Numbe r of Sprinkle r Zones , Control Valves , 

# f Eac h Timers , Heads , etc . Attac hasketc hof th e sprinkle r layout
. Nimibe r of an dsize of eac hgarden / flowe r bed Eac h area . Squar e Fee t / Attac hasketc hof relative size s an dlocations
. Agree dupo nvalue o f plan t material s no t to b e replacedb v contractor . 

# 0 $ Not e thi s valu e will b e usedto issu e aplan t voucher t o th e property owner . Easemen t Area , t o b e 

## N*
. Eac h 

### • ^rt^ir^ a'^e.V^H s excavated
Pag e 2 o fT >

### VS COA S T AL • NVmONHB N T A L O • O U P
. INC
.


### Additiona l Comment s / Instructions : Th e cit yof Omah a ordinance s ma yprohibi t yo u fro m usin g dir t orgrave l area s on you rpropert y as driveway s orvehicl e parkin g areas . Th e Environmenta l Protectio n Agency(EPA ) ma y

be removin g an d replacin g soi l underlyin g a grave l ordir t are a on you rpropert ytha t yo u ma y

be usin g as a drivewa yorvehicl e parkin g area . If thi s is th e case , yo u shoul d understan d tha t thi s removin g an d replacin g of soi l doe s no t mea n tha t an yillega l drivewa yorparkin g are a on you r propert y is mad e legal
. To th e contrary , yo u ma y

be cite d byth e cit yifyo u us e a grave l ordir t are a as a drivewa yorparkin g area , no t withstandin g an yremova l orreplacemen tof soi l byth e EPA
. If yo u have an yquestio n abou t legalit yof a certai n drivewa yorparkin g area , yo u ma ycontact th e cit yof Omaha' s Plannin g Departmen tat (402 ) 444-5150
. Q-Pleas e chec k thi s bo xifyo u understan d th e informatio n outline d above
. 

## H?

__ ^

[S<^hec k th e bo x If Owne rdoe s no t wan t CE G to documen t interio rfoundatio n wall s an d possibl e pre-existin g damage
. Bycheckin g thi s bo xCE G is no t responsibl e fo ran ydamag e don e to th e interio r of house , includin g foundatio n crack s orfissures
. 

## ©TUgre e Q I do no t agre e
-1 ? ' Owner' s s Signatur

Signatur e e Date Contracto r ignature 

## IQ
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# U Averag e

Shot #

Averag e

Shot #

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

# ay Averag e



### Prin t BDWkR O KiA^ 6

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Unit s Sigm a Valu e Sequenc e Flag s AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 85.35 7 Supervise d B y 

## : Ag r Certificat e o fVerificatio n

5 5 Soi l 2011-11-0 9 12:2 5 90.4 4 pp m 2 Fina l Av g o f 52-5 4 253 0 n1 9 s t E A 1 " KIN G EX-SITU S confirmatio n

± 

## y .

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Unit s Sigm a Valu e Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 79.93 0 Supervise d By : 

## Certificat e o fVerificatio n

5 2 Soi l 2011-11-0 9 12:2 3 30.1 1 pp m 2 Fina l 2892 3 253 0 n1 9 s t E A 1 " KIN G EX-SITU S confirmatio n

±Erro r ±14.66 0

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 5 3 Mod e Soi l Tim e 2011-11-0 9 12:2 4 Duratio n 30.1 6 Unit s pp m Sigm a Valu e 2 Sequenc e Fina l Flag s BVI D 2892 3 ADDRES S 253 0 n 1 9 s t QUADRAN T E A DEPH T 1 " XR F TEC H KIN G MIS C EX-SITU S NOT E confirmatio n
pp m ±Erro r P b 77.90 6 ±14.48 6 Supervise d By :

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Unit s Sigm a Valu e Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 98.23 4 Supervise d By : 

## Certificat e o f Verificatio n

5 4 Soi l 2011-11-0 9 12:2 5 30.1 7 pp m 2 Fina l 2892 3 253 0 n 1 9 s t E A 1 " KIN G EX-SITU S confirmatio n

± Erro r ± 15.76 2

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

## Certificat e o f Verificatio n XL3t-3902 2 Readin g N o 5 9 Mod e Soi l Tim e 2011-11-0 9 12:2 7 Duratio n 90.5 4 Unit s pp m Sigm a Valu e 2 Sequenc e Fina l Flag s AVERAG E Av g o f56-5 8 ADDRES S 253 0 n 1 9 s t QUADRAN T F 2 DEPH T 6 " XR F TEC H KIN G MIS C confirmatio n NOT E confirmatio n
pp m ± Erro r P b 126.70 1 ± 18.32 6 

# ty—y ^ Supervise d By :

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Unit s Sigm a Valu e Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 135.28 6 Supervise d By : 

## Certificat e o f Verificatio n

5 6 Soi l 2011-11-0 9 12:2 6 30.2 2 pp m 2 Fina l 2892 3 253 0 n1 9 s t F 2 6 - KIN G confirmatio n confirmatio n

± Erro r ± 18.57 8

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Unit s Sigm a Valu e Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 127.26 2 Supervise d By : 

## Certificat e o f Verificatio n

5 7 Soi l 2011-11-0 9 12:2 7 30.1 6 pp m 2 Fina l 2892 3 253 0 n 1 9 s t F 2 6 " KIN G confirmatio n confirmatio n

± Erro r ± 18.31 6

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Unit s Sigm a Valu e Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 117.55 5 Supervise d By : 

## Certificat e o f Verificatio n

5 8 Soi l 2011-11-0 9 12:2 7 30.1 6 pp m 2 Fina l 2892 3 253 0 n1 9 s t F 2 6 " KIN G confirmatio n confirmatio n

± Erro r 18.08 5

## iyjQL \ Omah a Lea d Site—Fixe d Pric e EP-R7-09-0 6 I ^^^ ^

I Coasta l Environmenta l Grou p Inc
. T^^*~r p www.coastalhazmat.co m COASTA L ENVIIONMENTA L S t o U P
. IN C 

# EXECUTIV ESUMMARY : BVID #28923

- (253 0 N1 9 ST ) No Issue s o r Concern s | ^ Issues/Concern s Detai l Explanation :

### COASTA L 

## Propert y Completio nAgreemen t Thi s agreemen t documents the completionof remedial activitie s performe do nm y property . M y signatur e wil l designat e tha t I a msatisfiedwit hthe restoration of m y property , an dtha t n

o items ar e i

nquestion , now o r a

t an y tim e inth e future , except thos e items listedbelow , ifan y PropertylD : Z^l ^ , PropertyAddress : Z5J 0 J U I f <>i ~ Owner : c)o^AVc e 6o>\ \ Phone : r'-io2. ) -yHr . ^7^07 ^ Restoratio nItem s i nQuestion : Item : Item : Item : Item : Item : Item :
Additiona l Comments :

I agre e restoratio n i n completed , excep t a s note d L J I d o no t agre e restoratio n i s complete d 

# OdJ i il''"' ' n-iH-i \ }wner' s Signatur e Dat e

# ^ 1 EP A Property ' Clos e Ou t Form 

# Z3J o / J ns T Propert y tl : Diitc/Tirae : Propert y Address: ' -=V ^ ; ^
- " " Qusd i Excavaled : 

# m t Con(r8c«o rCrou p Owner' s Name:./,-.
. JjoVrS
. yo ^ C
. « C k $ vjft^ ^ Vf

* N o LxccvBtlo D Genera l 1
. If necessary , ^'cr e th e correc t qtiadr?nt(s ) excavate dandrestored ? I 2
. If necessary , wer e th e correc t area s ofdri p zon e excavate dan drestored ? 

## y Gradin g So dan dVe^cUtk>i i Y M N O Doc s th e gradin g aroun dth e perimete r oflh e bous e i ne xcavaierl area s generall y slop e awa y fromtb e house ? 2
. Ha s so dbeenlai dinal l area s that wer e cjicavated ? 

# y i Doe s th e sodappea r l o be eenerall y health y andgrowing ? (Onl y evaluat e i f insprrir da t n3 0 

### / da y tim e period ) 4
. Ar e sodde darea s generall y fir mandevenl y graded ? 

# yy...

_ 5 Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t i 3f ) da y tim e period ) 

# y- \ 6 . Wa s th * propen y grade dsuc hthai waie r wil l not poo l o nth e property' ' 

# A.y.
. 7 .

Wa s damig e t o landscapin g o r plant material s avoided ? 

### \ / 

# r Gates
. Fence s Ba dRcUtnln g Wall s V « N( i n
—• D o gate s openandclos e freely? (Ifapplicable ) 2
. Wer e al l gate s or fence s take ndow ndurin g restoratio naciiviiie s reinsulled ? (II applicable ) 

### / 

# Z A .1
. Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) 

# y 1
. Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) 

### / Foundaiion , SidiBKin dGnUtr s Ves , N o 1
. Wa s damag e t o th e sidin g or tri mavoided ? 

# r
2
. Wa s damag e t o the foundatio navoided ? Wa s damag e l o window s avoided ? 

# V I 4 WB. S damag e t o window s or doo r screen s avoided ? 

# L / Wa s damag e l o down.spoui s oi down.spoui extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Vc i N o 

# 7­ 1
. Wa s damag e t o drivewa y surface s avoided ? 

### - / 2
. Wa s damag e l o v^alkwa y surface s avoided ?

## OM-ners commenls :

Fn.iipectionno<fs :

Removal andre.slorationaclivale. s complel e includin g the 30-da Y so dwarranry : HP A Rcpresentaiiv e Q ^ J ^ Dale : i\\**^* ^

### @ 

### Propert y Owne r Assessmen t o f Performanc e For m America nRecover y an dReinvestmen t Ac t (ARRA ) OmahaLea dSuperfun dSit e 201 1 RemediationContractor : COASTA LEnvironmenta l Grou p - EP-R7-09-0 6 Propert y Identifie r Number : 2..^ ? Z- 3 PropertyAddress : . 2. 5 'JO M I H i T Propert y Owner' s Name : Oo-AJc g Q>CK\ \ (Abov e informatio nt o hi e tille dou t b y th e remediatio ncontracto r prio r t o utilizatio nb y th e EP A COR ) 

### Instruction s t o th e Propert v Owner ; Thi s for mserve s to recor dthe Propert y Owner' s assessmen t of perfonnanc e (Incentive 1

- Qualit y Assuranc e Surveillanc e Plan) involving the listedremediationcontractor , as applicable to th e Omah a Lea dSite
. Thi s for mdocuments the timelines s o f punchUs t resolution , busines s relations , complain t resolutionan dth e overall qualit y o f work
. If needbe , th e Propert y Owne r ma y utiliz e thi s for mt o recor d problem s and/o r issue s no t specificall y tie dto a nassignedaddress , fo r example , busines s relation s tha t generall y don' t follow guideline s se t fort hi nthe Performance Wor k

Statement
. The Propert y Owne r will indicat e his/he r assessmen t of performance wit hthe contractor' s wor k b y checkin g anumerica l ratin g o nth e tabl e below using the numerica l definition s fix)mth e rating scale below , the sign& dat e the form
. 9-1 0 "excellent " 7- 8 "ver y good " 5- 6 "acceptable " 3-4 "poor " 1-

2 "ver y poor " Propert y Owner' s Assessment of Performanc e Regardin g th e Contractor' s Work 1 0 -C l 5 9 4 8 3 7 2 6 • 1 Additional Comment s fromEPA COR(optional ; continu e o nbac k pag e i f needed)
Propert y Owne r Signa t 

# U))AAU Zn,.„ . Z-/^'%Ol l