## TRANSMITTALof OMAHALEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R 

# A ^ H ji t SAID # : Date : Address : ll?, 1 \ ^ '^ ^ ^ y Remediatio nContractor : Coasta l Environmenta l Grou p Year : 2010ARR A
SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f property (DVD ) Executiv e Summary 

## 0 / EPA-provide dproperty sketc h Signe dAcces s Agreemen t fo r subjec t property JS
- 

### Signe dAcces s Agreement(s ) for adjacent property Restoratio nAgreemen t Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. )

~ & 

### Confirmatio ndat a



# A Photograph s W - b]0^irV ^ Y bo<^/nV n^ S^ ^ 

# A
. As-buil t sketc h 

# A Satisfactor y restoratio nsigne db y Property Owner 

# A Property close-ou t chec k lis t signe db y EPA Descriptio no f area s no t meetin g RO D cleanu p criteri a / Utility clearance s Property infgnnatio nfromDougla s County Assessor' s Offic e

3021752 0 

# IU I Superfun d

# ^ v Propert yAcces s Checklis t PropertylD : f^(J{Cl^ q Propert y Address : |72 7 K l W

Address :

Phone : 5)5
. qcQ ^ Fax : Cell/Pager :
D Notificatio nLette r yC i Acces s Agreement ro Restoratio nAgreement D Topso U SampUn g (if appUcable ) D Disposa l SampUn g (if appUcable) Q Garde nSampling (if appUcable)

- ^ UtUit y Clearanc e j ^Video/Photo s (Before) D Video/Photo s (During ) D Video/Photo s (After) D Video/Photo s (30.Day ) Q Propert y Completio nAgreement D Final Report Air Monitorin g (a s appUcable) QCommimit y QCre w On:
_ Results :

• Conununit y O Cre w On:
. Results : Q Communit y QCre w On:
. Results : nWOR K STARTE D ON : / / S f nWORKCOMPELTE D ON : / /
Renter : Phone : Fax : Cell/Pager : Additional Information :

Sent : / / By : 

## Signed : 2 113.'ID
. By : Signed : I ll^lJ O By : 1 1 By : 1 I By : 1 1 By : CaUed:O H / i- r A O By = cnUfy o On : ' A1 Ji l 1 0 

## ^r-iiJ-AJ y 

# c/Ac^AJ v On : / / By : On : / / By : On : / / By : Si£ned : / / By : Issued : / / By :
/ / 

### By : 1
/ / 

### By : . 1
/ / 

# 1

Omah a Lea d Sit e

## Dougla s Count y Accoun t Infora^io n Pag e 1 of 4
Dougla s County , Nebrask a Propert yRecor d - R240979000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e Id) scal e 0-5 0 ft wes t o f52n d S t - Vle WO H Ma p Informatio n i s vali d a s o f2009-12-1 5

. Treasurer' s Ta xRepor t Ne wFeatur e • * ^ • * Aut o Sale s Searc h Owne r REGA N KEVI N M ETA L 172 7 N 5 4 S T OMAH AN E 68104-000 0 Propert yInformatio n Ke yNumber : 097 9 OOO O 2 4 Accoun t Type : Residentia l Parce l Number : 240979000 0 Parce l Address : 172 7 N 5 4 S T OMAH AN E 68104-000 0 Lega l Description : WASHINGTO N HIL L LO T6 BLOC K2 N 63. 5 W13 6 FT63. 5 X 13 6 Valu e Informatio n
200 9 200 8 200 7 200 6 200 5 200 4 Lan d $13,700.0 0 $13,700.0 0 $13,700.0 0 $13,700.0 0 $13,700.0 0 $13,700.0 0 Imp rovemen t $224,700.0 0 $224,700.0 0 $224,700.0 0 $169,800.0 0 $169,800.0 0 $169,800.0 0 Tota l $238,400.0 0 $238,400.0 0 $238,400.0 0 $183,500.0 0 $183,500.0 0 $183,500.0 0 Sale s Informatio n Sale s Date : 2008-10-1 7 Dee d Type : Price : Grantor : Grantee : Vatld/lnvalld : W D $250,000.0 0 Genobl e Brett Josep h E Rega n Kevi n M Eta l Vali d SooAr :

ta l 200 8 Page : 10414 1

Excl Reason : usio n Sale s Date : 2006-09-0 1 Dee d Type : Price : Grantor : W D $247,500.0 0 Sawye rTravi s R eta l Booiir : 200 6 Page : 10513 1


# 1 http://douglasne.mapping-online.eom/DouglasCoNe/static/accountinfo. j sp?accovmtno=R2..
. 12/3 1 /200 9

## Douglas Count y Accoun t Infonaatio n Pag e 2 of 4

Grantee : Valid/Invalid : Exclusio n Reason : Sale s Date : Dee d Type : Price : Grantor : Grantee : Valid/Invalid : Exclusio n Reason : Sale s Date : Dee d Type : Price : Grantor : Grantee : Valid/Invalid : Exclusio n Reason : Sale s Date : Dee d Type : Price : Grantor : Grantee : Valid/Invalid : Exclusio n Reason : Sale s Date : Dee d Type : Price : Grantor : Grantee : Valld/lnvalld : Exclusio n Reason : Sale s Date : Dee d Type : Genobl e Brett J eta l Vali d

2005-07-2 9 W D Book : 200 5 Page : 09329 1 $239,750.0 0 Jeffre yMetzne reta l Travi s R Sawye reta l Vali d

2002-05-1 5 W D Book : 221 1 Page : 44 1 $195,000.0 0

Vali d

1999-02-2 0 D Book : 211 9 Page : 74 2 $180,000.0 0

Vali d

1996-11-2 1 D Book : 205 0 Page : 32 6 $139,500.0 0

Vali d

1995-04-2 3 D Book : 200 3 Page : 29 7 

## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2..
. 12/31/2009

### Dougla s County Accoun t Infoia^io n Pag e 3 of4 trjl^i c

Price : $ 118,500.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 9 8704. 0 1. 0 136. 0 64. 0 N o Improvemen t Informatio n Buildin g 1 

## Verifie d

MSOF P

2( r12 1 ittsiaeva i

t j c firtftx r _1Z!L
. 

# TW O STORY

CLIC KT O ENLARG E IMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : 1994. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 2 Stor y Cond o Squar e Footage : 0. 0

HVAC : Centra l Ai rt o Ai r Rooms : 7. 0 Exterior : Masonr yCommo n Bric k Units : 1. 0 Interior : Drywal l Baths : 3. 5 Roo fCover : Compositio n Shingl e Bedrooms : 3. 0

Roo fType : Hi p Stories : 2. 0 Floorcover : Allowanc e Foundation : Bloc k Sprinl^ie rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 193 8 193 8 7 1 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 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2.
. . 12/31/200 9

## DQugla s Count y Accoun t Infoi|jB||ion Pag e 4 of 4
Applianc e Basemen t Basemen t Fixtur e Fixtur e Fixture Garag e Porc h Porc h Fireplac e Masonr y Bsmn t Bloc k 8 ft Finishe d Bas e Fixture s Bat h Ful l Bat h Hal f Attache d En d Scree n Sla b RoofCeilin g 1. 0 1069. 0

445. 0 1. 0 3. 0 1. 0 240. 0

96. 0 96. 0



## http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=R2..
. 12/31/2009

## Pag e 1 o f 1

BVID - 64«>3 ^ Create Anothe rTicke t Bac k t o Irt h Inteme t I [Sen d Emai l ] 

# ] [

• YOU RTICKE T NUMBE RI S 2475444
. Origina l Cal l Date : 4/26/1 0 Time : 3:2 9 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 4/28/1 0 Time : 4:0 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 172 7 Street : N54T H S T Twp : 15 NRng : 13 E Sect-Qtr : 18-N W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATIO N Locatio n o f Work : LOCAT E ENTIR E PROPERTY , AL L EASEMENT S AN D T O TH E PEDESTA L Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E I 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 : 4 F T • Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac t Phon e Nunibe r Utilit y Typ e 

### Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I 

### Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCITY O FOMAHA-TRAFFIC.SEWE R 

### RICH/TRAFFI C Alt : 402444516 1 Emerg : 4024445160 Day : 406728934 3 OPPDGPR 5 OMAH APUBLI C POWE RDISTRIC T ELM LOCATIN GAlt : 406207149 4 

### Emerg : 888728934 3 Day : 406728934 3 QLNNEI C QWES T LOCA LNETWOR K EL M LOCATIN G Alt : 406207149 4 Emerg : 888728934 3



### http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 4/26/201 0

### 8493 9 

# As-Buil t Drawin g A COASTA L 

# Omah aLea dSuperfun dSit e ENVIKOHMEMTA L G • O WP

. IM C OLS# : 8493 9 Dat e Excavated : 4/30/201 0 Dat e USEP ASigne d Off:5/19/201 0 Are a Sodden : 64 5 s o f t Omah a Lea d Sit e Exterio rPain t Sit e Sketc h •Goo d n Poor Samplin g Address : 172 7 N 5 4 S T ( 3 No t paint Sampl e Nurnbe r Lead Sampl e Sample s Collecte d LA B Concentratio n Collecl ^ Firm : RYASCPXA-8493 9 F l I I Q pp m 

### D Date : h 'S-e" ! RYBSCPXA-8493 9 F 2 UHZ

. pp m 

# i D Time : II-.5 0 A M RYCSCPXA-8493 9 B 1 Z3 0 pp m 

### D Sample s Analyze d RYDSCPXA-8493 9 B2 22. 9 pp m 

### D RDZSCPXA-8493 9 D Z ? L° l pp m 

### D XR F Uni l : loftfe ^ Book : ZH U RCZ6CPX A84030 -6 2

— pp m 

### D Date : - ^ -1 0 Cfi l o V nriiocPXA'04000—P 2 11 3 pp m Time : Arv , 

### D Staff:

. m^l ^ Numbe ro f Sample s = | I g \ \ Q Legend : F l = Fron t Left , F2 = Fron t Right , B 1 = Bac k Left

. 8 2 = Bac k Righ t D Z = Dri p Zone , G 2 = Garden

. PZ = Pla ; A H quadrant s ar e a s viewe d fron n th e street , facin g propeft y 

# ENTERED

Legen d Conoret e Dri p Zon e Excava-te d Quadrant s Excavate d Are areplace d So d wit h Are a replace d wit h Rook/Mulc h ' ' Are a lef t bar e 

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

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### /i ^ 8493 9 Omah a Lea d Sit e Exterio rPair. l Sit e Sketc h • Goo d n Poo r Samplin g Address : 172 7 u s< S T [ g No t pain t Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Fin m Sample s Collecte d PP

AP g A T RYASCPXA-8493 9 RYBSCPXA-Wes e RYCSCPXA-8493 9 RYDSCPXA-8493 9 RDZSCPXA-8493 9 F 1 F 2 B 1 B 2 D Z li q UiT L 23C > 2.Z B 3 tt' ^ pp m pp m ppm pp m pp m 

# f D D D 

## n Dat e Tim e ^-5-tf 1 I I ­• ^ ^ AA> I Sample s Analyze d XR F Unit ; _liiai,'Z

_ Book : 2 H f « nCZCCPX A8«03 0 6 2

—Pp m 

## n Date : 1-1 0 o q

, ynPZOCPXA-0400 0 P Z 

### 111
. pp m D Time : 

### A ^ Numtie ro fSample s = | c\ D \ Q | Staff : /vi^L o Legend : F 1 ~ Fron t Left

. F 2 = Fron t Right , B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = P(a : Al l quadrant s ar e a s viewe d from th e sireet , facin g propert y 

# ENTERE D

### 8493 9 Omah a Lea d Sit e Exterio rPain t Nort h Arrow Sit e Sketc h • Goo d nPoo r Samplin g Address : 172 7 N 5 4 S

T ( 2 No t pain t Sampl e Numbe r RYASCPXA-8493 9 F l Lea d Concentratio n

_LL3
_ pp m Sampl e Collecte d LA B 

## n Fir m Dat e Sample s Collecte d fP APg-A J



### h-S-e ^ RYBSCPXA-8493 9 RYCSCPXA-8493 9 RYDSCPXA-8493 9 RDZSCPXA-8493 9 F 2 B 1 B 2 D Z loH ^ 23 0 2.Z S
• ? lt° l pp m pp m pp m pp m 

# i D D 

## n n Tim e ir-^OAA A Sample s Analyze d XR F Unit : Ift^t. ^ Book : iM C RCZ6CPX A8<03 0 G 2

—pp m 

## n Date : 7 - ( 0 • o° l o V f>PZCiOPXA-0400 9 P i IZ 3 pp m 

## n Tim e f\r ^ Numbe ro fSample s = | fc [ | Q Staf f /^<,l ^ Legend : F l = Fron t Left , F 2 = Fron t Right

. B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla ; A H quadrants are a s viewe d from th e street , facin g propert y 

# ENTERE D

L.'N..54.S-T..
- Rev :oi.i S rroalJd

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# . r t. ^ ^- e v^ " 

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# 8493 9 Exterio rPain t Nort h An'o w 

### Omah a Lea d Sit e • Goo d 

### Sit e Sketc h n^Poo r 

### Samplin g Address : 172 7 N 5 4 S T Q Not pain t Sampl e Numtw r RYASCPXA-8493 9 RYBSCPXA-8493 9 RYCSCPXA-8493 9 RYOSCPXA-8493 9 RDZSCPXA-8493 9 nCZSCPXA8403 0 J l nrZOGPX A0403 0 Lead Sampl e 

### Sample s Collecte d 

# i i LA B Concentratio n Collecte d 

### Flmi : fmPfiA T F l pp m 

## D Date : h'S-fi* ^ pp m F 2 

## D Time : / / •' 5g > AA A B l 23d > Dom 

## D Sample s Analyze d B 2 Z2. 8 po m 

## D D Z • ? &>Q po m 

## D XR F Unit : Ihfit.?

. Book : ZMf o 6 Z

—pp m 

## D Date : " 7 • > 0 -a/ ^ P Z 

### 1 1 ^ po m 

## D Time : ^r* * Staff : 

## nsu ? Numbe rofSample s = | Q \ \ Q | Legend : F l = 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 , P Z = Pla ; A O qua(feant s ar a a s vieiwe d fro m th e street , fadn g propert y ^^a^^f^^a^aJk^i^^^^ ^ 

## y r % 

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### * * -

COASTA l [NVIIONHCRU I c« 0 I I rIN C 

## Consen t fc fAcces s T o Property ' 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 Agency(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 : 

# 9^9b l { li^f^( ^ Owner' s Name : Daytim e Phone : ^ «- v, * ^

(j*^c : 

# ni l K J 

# 'SV? / Addres s o fPropert y 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 collec t soi l sample s an d remov e soi l tha t contain s elevate d concentration s o flea d an d ma ypos e a healt h hazard

. Th e area(s ) wil l b e excavate d t o 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 fCoastal Environmenta l Group , contracte d b yUSEPA , v^ril 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 conflm i 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 rv«l l receiv e v»n-itten documentatio n from 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 subcontractor s th e righ t t o ente rth e property , a t al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e o 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 f2..*^"''"'f

.

COASTA L CNVmOHHIKTA L < l PRO * i t o V t I I t Q 

### t Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; e Remov e flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t ma ywis h t o save ; « Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessarysubsequen t t o a n initia l waterin g perio d b yEPA ; «Abid e b yhealt h an d safet yguidanc e provide d b yEPA ; • I 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

. 6Allo wvideotapin g and/o rphotographin g o fth e property
. AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s no t t o interfer e o rtampe rwit h an yo fth e wor k activities , o rwit h an y o fth e wor k done , o rwit h th e equipment use d o n hi s property , o rt o undertak e an y action s regardin g th e us e o fsai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o fth e Grantee s o rth e environment , o rt o allo wothers t o us e th e propert yi n suc h a manner . Should you 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 Olgran t access t o m ypropertie s D I d o not gran t acces s t o m ypropertie s

Signatur e Dat e

G I woul d lik e t o b e presen t durin g an ysamplin g tha t i s required

.

Pag e 2 o f2COA S T AL 

## Restoratio n Agreemen t The purpos e of thi s agreemen t i s to provide amutua l agreemen t a s to condition s of the propert y prior to remediationactivities
. Thi s will als o serve a s documentationfo r th e purpos e of assuring tha t restoration activitie s ar e completedto th e satisfactiono f th e propert y owne r an dthe UnitedState s Environmenta l ProtectionAgency (EPA)
.

PropertylD ; O^ f ^5*7 " Propert y Address : |~7/'' 7 K j 

# ^3- r Owner : 

## AK - ^^A^y j
• 2 J tr . o^c^7- ^ Phon e 

# ^SSQ^ 4 O

nthe attacheddiagram(s ) indicat e area(s ) to excavate , surface structure s an dlandscapin g feature s an d acces s location(s ) to b e usedb y the contractors , hidicat e distances , depths , materia l types , etc . Photographicall y an dVideographicall y documen t the existing condition s ofth e propert y an dthe basemen t i

f necessary . Item s t o b e Remove d b yth e Owne rbefor e Star t o fRemediation : Th e removai , storage , disposal , and/o rretu m ofthes e item s i s th e Owner' s responsibiiity

. Hem : 

# /4K V fi^yi-^ ^ ^ o W^-^fc
. lu^ r Hem :
Kem :
Kem :



## item s t o t> e Remove d b yth e Contracto rDurin g Remediatio n an d No t Replace d Kem : . 

# ^ (c^vv'h ' fe p ^ l^^fl'tiAl J Kem : ^ "
Kem :
Kem :

Page l 

# - aCOA S T AL O • O U P

. INC

. 

## Item s t o B e Remove d B L 

## Contracto rDurin g Remediatio n an d Reolace d Kem :
Kem : i
item :
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## Ite m Pre-existing propert y area , tha t wil l b e excavated , tha t i s coveredwit hgrass . Numbe r of tree s > 2 inc h trun k

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

diamete r Numbe r of Sprinkle r Zones , Control Valves , Timers , Heads , etc . Attac hasketc hof th e sprinkle r layout
. Numbe r of an dsize of eac hgarden / flower bed area . Attac hasketc ho f relative size s an dlocations
. Agree dupo nvalue of plan t material s not t o b e replacedbv contractor . Not e thi s valu e wil l b e usedto issu e aplan t voucher to th e property owner . Easemen t Area , t o b e excavate d 

# y ^ A

Landscap e Inventor y Quantit y Uni t ConditionH'ype/Specie s 

# y Quadrants 

# y A Eac h 

# z F,ac h 

# A Fach



# y Eac h Squar e Fee t 

# A y $



### ^0^ ^ Eac h

Pag e 2 o f^COA S T AL • MVIHOMHBHTA L a ft O U P , INC

.


### Additiona l Comment s / instructions : Th e cit yo fOmah a ordinance s ma yprohib Kyo u fro m usin g dir t o rgrave i area s o n you rpropert y a s driveway s o rvehicl e parkin g areas . Th e Environmenta i Protectio n Agency(EPA ) ma yb e removin g an d replacin g sol i underiyin g a grave l o rdir t are a o n you rpropertytha t yo u ma yb e usin g a s a drivewa yo rvehicl e parkin g area , i fthi s I s th e case , yo u shoul d understan d tha t thi s removin g an d replacin g o fsoi l doe s no t mea n tha t an yIllega l drivewa yo rparkin g are a o n you r propertyi s mad e legal

. T o th e contrary , yo u ma yb e cite d b yth e cit yi fyo u us e a grave i o rdir t are a a s a drivewa yo rparkin g area , no t wKhstandin g an yremova i o rreplacemen t o fsoi l b yth e EPA

. I fyo u have an yquestio n abou t legalityo fa certai n drivewa yo rparkin g area , yo u ma ycontact th e cK yo fOmaha' s Plannin g Departmen t a t <402 ) 444-5150

. leas e chec k thi s bo xi fyo u understan d th e informatio n outline d above

. 

# e^ ^ /

G Chec k th e bo xi fOwne rdoe s no t wan t CE G t o documen t interio rfoundatio n wall s an d possibl e pre-existin g damage

. B ycheckin g thi s bo xCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro fhouse , includin g foundatio n crack s o rfissures

. 

### Q l agre e 

# A> ' G I d o no t agre e 

# ^.m^^j? ^ "

^

ontractor' s Signatur e Date Page s 

# tnj L

## XR F PROPERT Y 

## SAMPL E SHEE T Dat e Addres s 

# ^USp K Projec t Omah a Lea d ARR A 

### Sampl e tim e XR F ID # sampl e lengt h

Shot # Readin g Sampl e are a Shot # 

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so z \jil t \ \ Dept h 

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RETES TAREA S Shot # Readin g Sampl e are a Shot # Dept h ^./-^ ^ ^ Averag e . / / Averag e Signatur e ^ . / ^ - - ^ - 

# Prin t UkyO ) Ur(^ ^ BVID#_OJ5J3 J 

# /9-^9-^3vs- r am/p m 

### 3 0 se c Readin g Sampl e are a Dept h

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Readin g Sampl e are a Dept h

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 50 4 Mod e SOI L Tim e 2010-05-1 8 13:1 6 Duratio n 90.6 4 Sequenc e Fina l Flag s AVERAG E ' Av g o f501-50 3 ADDRES S 172 7 N 5 4 s t QUADRAN T F 2 DEPT H 4 TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D : 8.16 7 Z r 492.74 3 ± 16.26 6 S r 149.84 9 ± 8.42 8 U < LO D 14.86 0 R b 76.63 1 ± 6.86 8 T h 15.77 8 ± 7.45 5 P b 60.60 3 ± 11.51 3 S e < LO D 5.29 8 A s 18.12 6 ± 10.67 3 H q < LO D 12.37 9 Z n 92.83 9 ± 17.89 2 W < LO D

• ...--" ' 85.44 9 C u 36.63 3 21.11 7 N I < LO D

. ,„--' ' /74.08 7 C o < LO P ; / 198.21 2 F

e M n 21304.38 5 611.69 2 

## ±y ' 422.75 1 103.90 5 Supervise d By : \ , y/ ^ 

# T

_

# 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 50 1 Mod e SOI L Tim e 2010-05-1 8 13:1 4 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 8493 9 ADDRES S 172 7 N 5 4 s t QUADRAN T F 2 DEPT H 4 TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D J 8.25 8 Z r 494.17 2 ± 16.40 4 S r 154.81 7 ± 8.60 5 U < LO D 15.10 5 R b 77.72 1 ± 6.96 8 T h 17.47 3 ± 7.67 3 P b 61.14 8 ± 11.64 8 S e < LO D I 5.61 4 A s 18.84 6 ± 10.81 1 H g < LO D : 12.24 7 Z n 84.51 8 ± 17.54 7 W < LO D : 89.65 6 C u 35.85 4 ± 21.21 8 N I < LO D 72.85 3 C o < LO D \ 199.56 7 Fe 21447.82 6 ± 426.67 0 M n 579.91 4 ± 102.35 9 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 MiddlesexTurnpik 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 QUADRAN T DEPT H TYP E INSPECTO R

pp m M o < LO D Z r 480.43 9 S r 152.26 0 U < LO D R b 78.56 8 T h 15.22 0 P b 61.31 5 S e < LO D A s 18.56 9 H g < LO D Z n 97.43 9 W < LO D C u 48.50 8 N I < LO D C o 199.11 9 Fe 21040.78 1 M n 640.87 4 C r < LO D V < LO D T l 3612.50 5 S c < LO D C a < LO D K 12274.25 1 

### s < LO D Supervise d By : 

## Certificat e o fVerificatio n

50 2 SOI L 2010-05-1 8 13:1 5 30.4 2 Fina l 8493 9 172 7 N 5 4 s t F 2 4 CONFIRMATIO N N

. LOPE Z

Erro r J 8.09 2 ± 16.01 8 ± 8.45 8

: 14.48 8 ± 6.86 3 ± 7.38 1 ± 11.48 8 4.87 5 ± 10.68 3 12.57 4 ± 17.98 7 80.26 5 ± 21.90 8 76.02 3 ± 131.02 7 ± 418.18 5 ± 104.63 6

: 456.70 0 : 851.32 8 ± 1997.98 8

: 163.09 7 : 5337.90 3 ± 7026.70 6 256.01 6

' •

# 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 50 3 Mod e SOI L Tim e 2010-05-1 8 13:1 6 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 8493 9 ADDRES S 172 7 N 5 4 s t QUADRAN T F 2 DEPT H 4 TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D 8.15 3 Z r 503.61 9 ± 16.37 6 S r 142.47 0 ± 8.22 1 U < LO D 14.98 6 R b 73.60 3 ± 6.77 4 T h 14.64 2 ± 7.31 1 P b 59.34 5 ± 11.40 3 S e < LO D 5.40 4 A s 16.96 2 ± 10.52 4 H g < LO D 12.31 6 Z n 96.56 1 ± 18.14 2 W < LO D 86.42 6 C u < LO D 30.33 8 N i < LO D 73.38 5 C o < LO D 198.52 9 F e 21424.55 1 ± 423.39 9 M n 614.28 8 ± 104.72 1 Supervise d By :^^•^to»'•<^-

. 

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

o Coasta l Environmenta i Grou p Inc

. \^^^^ ^

www.coa8talha2mat.co m ''^tno^^ COASTA L HTIIONNIIITA l SIO U r , i n C 

# EXECUTIV ESUMMARY : BVID #84939-(172 7 N5 4 ST )
No Issue s o r Concern s \ ^ Issues/Concern s Detail Explanation : DA NGARVE Y WALKE D TH EPROPERT Y O N5/19/1 0

### SMI i 

# EP A EP APropert y Clos e Ou t For m Propert y#:_Sii33 a Datc/Tlmc : Quad s Excavated : Contracto r Grou p Excavatio B Genera l 1
.

I f necessaiy , wer e th e correc t quadrant(s ) excavate dan drestored ? 2
.

I f necessaty , wer e th e correc t area s o f dri p zon e excavate dan drestored ? Gradin g So d an d Vegrtatio n I
.Doe s th e gradin g aroun dth e perimete r ofth e hous e i nexcavate darea s generall y slop e away fromtli e house ? , 2
.

Ha s so dbee nlai di nal l area s tha t wer e excavated ? 3
.

Doe s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte dat a3 0 da y tim e period ) 4
.Ar e sodde darea s generall y firman devenl y graded ? 5
.

Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte dat a3 0 day tim e period ) 6
.Wa s th e propert y grade dsuc hthat wate r wil l no t poo l o nth e property ? 7
.

Wa s danug e t o landscapin g o r plan t material s avoided ? Gates , Fence s an d Retainin s Wal b 1

.

D o gate s ope n an d clos e freely? (I fapplicable ) 2

.Wer e al l gates o rfence s take n dow n durin g restoratio n activitie s reinstalled ? (I fapplicable ) 3

.Wa s damag e t o gate s o rfence s avoided ? ( I fapplicable ) 4

.Wa s damag e t o retainin g wall s avoided ? (I fapplicable ) FouDdathta , Sidin g an d Gatler s 1

.

Wa s damag e t o th e sidin g o rtri m avoided ? 2

.Wa s damag e t o th e foundatio n avoided ? 3

.Wa s damag e t o window s avoided ? 4

.Wa s damag e t o window s o rdoo rscreen s avoided ? 5
.Wa s damag e t o downspout s o rdownspou t extension s avoided ? Sidewalk s an d Driveway s (Concrete ) I

.Wa s damag e t o drivewa ysurface s avoided ? 2

.Wa s damag e t o walkwa ysurface s avoided ? Ye s N o / 

## A Ye s N o /

. X 

# A A A A
•

^ Ye s N o 

### y A

1

/ y Ye s N o 

## y y y y ty " Ye s N o



### y y

## Owner s comments :

Inspectio nnotes :

Remova l andrestorationactivate s complete including the 30-da y so dwarrant y EP ARepresentativ e ^^« ^ Date : $1^^^^' °

## Propert yCompletio n Agreemen t Ihi s agreemen l docuinenl s lh e coniplclio n o fremedia l aclivilie s perfbimc d o n m yproperl yM ysignatur e wil l designat e tha i I a m satisfie d wit h th e resloralio n o fm yproperly , an d Iha l n o item s are i n questions , now , o ra l anylim e i n th e future , excep t ihos e ilem s liste d below , ifan y Propert yfD : ^t j ^ 3 Q Propert yAddress : (1)2. 1 A i S H 5-V - 

### Phone : '^{^''^0^^ ^ '^ Restoratio n Item s i n Question :

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

JA l I Dgrc crcxroralio n 1 5 compleled , eiccp l a t nofer i [_ | I fl o npt-Mrc cresloratio n i s complete d 

# 9,cnrPii m '^hzJ M c 4 Conl i arioi' s Signatur e Dal e

### IZH3 ]


# Propert y Owne r Assessmen t of Perform America nRecover y an dReinvestment Act (

A OmahaLea dSuperfundSit e , -, ^ni n 2009/201 0 ^^'^ ^ ^ ' ^^^ ^ Remediatio nContractor : Coasta l Enviro nmenta l Grou p - EP-RT-wU ^ E"'* ^ ^ D DIvlblu N Propert y Identifie r Number : Q*-\^'^ ^ " " Propert y Address : l"l? nS \f ^ f^ ' Propert y Owner' s Name;-7T^i^ t j ^eop Y \
Instruction s t o th e Propert y Owner : Thi s for mserve s to recor dth e Propert y Owner' s assessment o f perfoimanc e (Incentiv e 1

- Qualit y Assuranc e Surveillanc e Flan ) involvin g th e liste dremediatio ncontractor , a s applicahl e to th e Omah aLea dSite
. Thi s for mdocument s th e timelines s o f punchlis t resolution , busines s relations , complaint resolutio nandth e overal l qualit y o f work
. I f nee dbe , the Propert y Owne r ma y utiliz e thi s for mto recor dproblem s and/o r issue s no t specifically tie dto a nassigne d address , for example , busines s relation s that generally don' t follo w the guideline s set fort hi nthe Performanc e Wor k

Statement , Th e Propert y Owne r will indicate his/her assessment o f performanc e wit hth e contractor' s wor k

b y checkin g anumerica l ratin g o nth e tabl e belo w usin g the numerica l definition s fto m th e ratin g scal e below , thensign& dat e th e 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 Assessmen t o f Performanc e Regardin g th e Contractor' s Work 1 0 9 / 4 8 ^ 3 7 2 6 1 Propert y Owne r Additiona l Comment s fro m(optional ; continu e onbac k pag e i f needed )
Propert y Owne r Signatur e