## TRANSMITTA Lof OMAH ALEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R

SAID** : 2^2^14) 1 Date : hl5-/J
. Address : \^Lb U\AN\ \S4

- Remediatio nContractor : Coasta l Environmenta l Group ^ Year : ^_Q ) 2
. SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S W

M Vide o o f propert y (DVD ) V Executiv e Summar y 1 ^EPA-provide dpropert y sketc h L% / Signe dAcces s Agreemen t fo r subjec t propert y ly/

ASigne dAcces s Agreenient(5 ) fo r adjacen t propert y I r

Restoratio nAgreemen t Oilif PSettlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ] V Confirmatio ndat a 

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Photograph s ff i fi^<aw(riiQf\^^yrruterhoif vSq Q
^ As-buil t sketc h V Satisfactor y restoratio nsigne db y Propert y Owne r V Propert y close-ou t chec k lis t signe db y EP A fiji^Descriptio no f area s no t meetin g RO D cleanup criteri a i /

Utilit y clearance s H Propert y informatio nfro mDougla s Count y Assessor' s OfYic e

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Dat e 3026170 2 

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## Properl y Acces s Checklis t PropertylD : Zf\l^j,'\ nV/OB K STARTE D ON : / / D WOR K COMPELTED ON:
_ / / PropertyAddress : ((pj^,? , INACa^ i ^- ^ Rente r 

# Q^'"' ^ FrgLAvq\ nWarfc r Address : Phone : I^QZ^ZQ^^^ ^ 

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L6tr\ e Fax : Celi/Page r Additional Information : 

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# fets-^99--i?^^.r ^ Cell/Page r U)t^-'g)0 ^ - ^ftQC ^ D NotificationLette r 1 Sent : / / By : 1 ^ Acces s Agreement Signed : 4 /ii_/V | By : (2 1 Restoratio nAgreemen t Signed : _/Q / H 1 li
_ By : V^i^VlPu ^ 1 nTopsoil Samplin g (if applicable ) 1 1 By : U D Disposa l Samplin g (if applicable ) 1 1 By : D Garde nSamplin g (if applicable) * 1 1 By : Q ^ Utilit y Clearanc e Called : J^'OMJ ^ By : jl^U^/iy^-6»LrfT^ w By: ' -^i — aVideo/Photo s (Before ) On : / / D Video/Pboto s (During ) On : / / By : nVideo/Photo s (After) On : / / By : D Video/Photo s (30-Day ) On : / / By : D Property Completio nAgreement Signed : . / / By : D Final Report Issued : / / By : Ai r Monitorin e (a s applicable ) D Communit y D Cre w On : / / By : Results : O Communit y • Cre w On : / / By : i Results :
r~l Communit y D Cre w On : / / By : Results :
OmahaLea dSit e 1

### Dougla s County Accoun t Info ^ ~<atio n Pag e 1 of 2
Dougla s County , Nebrask a Propert yRecor d ­ R254488000 0 Informatio n i s vali d a s o f2010-8-3 0 Ne wFeatur e -»-•- » Prm t Report
. Vie winteractiv e Gi S Ma o

Treasurer' s Ta xRepor t Subdivisio n Sale s Searc h Owne r HARPE R FRANKLI N E 107 0 HARS H LAN E CASTALIA N SPRIN G T N 37031-000 0 Propert yInformatio n Ke yNumber : 448 8 000 0 2 5 Accoun t Type : Parce l Numbe r Parce l Address : Lega l Description : Residentia l 254488000 0 182 3 MIAM I S T OMAH AN E 68110-000 0 WRIGH TPLAC E LO T1 4 BLOC K0 3 0 X 6 8 5/ 8 FT Valu e Informatio n
201 0 200 9 200 8 200 7 200 6 200 5 Lan d $200.0 0 $200.0 0 $200.0 0 $200.0 0 $200.0 0 $200.0 0 Improvemen t $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 Tota l $200.0 0 $200.0 0 $200.0 0 $200.0 0 $200.0 0 $200.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 4 2070. 0 0. 0 69. 0 30. 0 Ye s



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R254.
. . 9/3/201 0

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### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R254.
. . 9/3/201 0

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• YOU R TICKE TNUMBE R I S 2883766
. Origina l Cal l Date : 10/22/1 1 Time : 1:3 6 p m Op : WENDY18 7 9 0 Wor k t o Begi n Date : 10/26/1 1 Time : 7:0 0 am State : N E County : DOUGLA S Place : OMAH A Address : 182 3 Street : Ml/y^ I S T Twp : 15 NRng : 13 E Sect-Qtr : 10-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATIO N Locatio n o f Work : INCLUDIN G EASEMEN T AN D U P T O PEDESTA L 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 O F CORNE R LO T Compan y: COASTA L ENVIRONMENTA L SERVIC E Contac t Name : WEND Y LAR APhone : (402)991-119 9 Alt . Contact : 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 : Y 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 utilit y Servic e Are a Nam e Contac t Phon e Number s Cod e Typ e 

## L i COXCAT V CO X COMMUNICATION S ELMCO X ELMCO X Day : (406)72 8 - 934 3 IN C Alt : (406 ) 32 7 - 293 6 Emerg : (888 ) 72 8 - 934 3 MUDO l METROPOLITA N UTILITIE S SAND YMUDO l Day : (402 ) 50 4 - 782 3 DISTRIC T Emerg : (402 ) 50 4 - 797 0 OMAHACO F CIT YO F OMAHA - RICH/TRAFFI C Day : (402 ) 44 4 - 719 7 TRAFFICSEWE R OMAH A Alt : (402 ) 44 4 - 516 1 r : —«-« . /Ar\'i \ AA Aac n



### http://www.dhon.org/IRTHOneCall/Ticket/TicketCreation.aspx?ViewTicketID=87110 9 10/22/201 1

## Wend yLar a Q ^

71(^7 ^ From : Sent : To : Subject : agt_comm@irth.co m Sunday , Octobe r23 , 201 1 6:5 7 A M Wend yLar a 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 fr'o 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 : 288376 6 County : DOUGLA S Place : Omah a Address : 182 3 MIAM I S T 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 an yadditiona l question s pleas e contac t Omah a Publi c Works .

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1 1

## Wend yLara 

# g^g^-i From : I RTH
. Net@qwest.co m Sent : Monday , Octobe r24 , 201 1 12:1 2 P M To : Wend yLar a Subject : Messag e fro m Qwes t

To : COASTA L ENVIRONMENTA L SERVIC E Attn : WEND Y LAR A Voice : 402991119 9 Fax : 877662421 1 Re : Messag e fro mQwes t Messag e fro mQwes t

Ticket : 288376 6 County : DOUGLA S Place : Omah a Address : 182 3 MIAM I S T QLNNEIC : Th e describe d di g are a o f you r locat e reques t ha s bee n marked . Qwes t Communication s Loca l Networ k facilitie s ar e presen t i n th e di g area , I f yo u hav e an yquestions ^ pleas e cal l Qwes t a t 1-800-283-4237 .
Messag e fro mQwes t

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# As-Buil tDrawin g OLS:2926 7 DAT E EXCAVATED:10/29/1 1 

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. COASTA L DAT E USEP ASIGNE D 0FF:1imi 1 ARE ASODDED : 800 

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COASTA l tttVIROHnlllM l « KOt l r . IN C 

## Consen t fo rAcces s T o Pfopert 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 : 

## /^/iX/^//;yWz*'ir/ ^ Owner' s Name : Daytim e Phone : ^^^^^.^^^^^ ^

Addres s o fPropert y covere d b ythi s Agreement : 

# IP^l ^ H>w t

Sr 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 flea 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 fCoasta l Environmenta l Group , contracte d b yUSEPA , wil l contact th e Granto rin-perso n t o discus s th e wor k t o b e perfonmed , 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 confin n tha t i t i s complet e an d meet s wit h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m EPAtha t th e property ha s bee n remediated
. ENVIRONMENTA L RESPONS E ACTION S 

### B

ysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , it s employees , contractors an d subcontractors th e righ t t o ente rth e property , a t al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e o 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 f2COASTA L IkVllOHHIKTA l C t O U rIR C 

### cRemov 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 ; cWate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessary ' subsequen 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 fth 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
. oAllo 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 equipmen t use d o n hi s property , o rt o undertak e an y action s regardin g th e us e o fsai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o fth e Grantee s o rth e environment , o rt o allo wother s t o us e th e 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

[V3^r « gran t acces s t o mypropertie s D ' d o no t gran t access t o mypropertie s

^//
. Signature Date

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

Page 2 o f2

## v. \ COA S T AL C • O U P
. IN C 

## Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o provid e amutual 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)
.

PropertylD : Q^q ^ (^T y Property Address : \9277 ^ VA-^ftYT. ; S: ^ Owner • V^^.r^ V W JC^ - 

### Plione : U\'=..-^'^;:)..VA-v o U\<^
. y^r^u. , ^ftO U O nth e attache ddiagram(s ) indicate area(s ) t o excavate , surfac e structure s an dlandscapin g feature s an d acces s location(s ) t o b e use db y th e contractors . Indicate distances , depths , material types , etc . Photographicall y an dVideographicall y document 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 fRemediation : Th e removai , storage , disposal , and/o rretur n o fthes e item s i s th e Owner' s responsibility
. Item : 

### ^f>M ^ 'Y"Co«^V< ^ V o V^o

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### Pag e 1 o f3

### V I COASTA L • NVinONnlNTA L CROUP
. IN C 

### Item s t o B e Remove d B yContracto rDurin g Remediatio n an d Replace d Item : <V^ \ \ 

## " ^

S ^ Item : Item : Item :


## Landscap e Inventor y Ite m Quantit y Uni t Condition/Type/Specie s Pre-existin g property area , Quadrant s that will b e excavated , that ^ \ i s covere dwit hgrass . Numbe r oftree s > 2 inc h Eac h trunk diamete r Numbe r o f tree s < = 2 inc h Eac h trunk diamete r Numbe r o f Sprinkle r Zones , Contro l Valves , Eac h Timers , Heads , etc . Attac hasketc ho f th e sprinkle r layout
. Numbe r o f an dsiz e o f eac hgarden/ flower be d Eac h area . Squar e Feet Attac hasketc ho f relativ e size s an dlocations
. Agree dupo nvalu e o f plan t material s no t t o b e replace db y contractor . $ Not e thi s valu e wil l b e use dt o issu e aplan t vouche r t o th e propert y owner . Easement Area , t o b e Eac h excavate d

Pag e 2 o f' ^

### VX COA S T AL O R O U P
. IN C Additiona l Comment s / Instructions : Th e cit yo fOmah a ordinance s ma yprohibi t yo u fro m usin g dir t o rgrave l area s o n you rpropert y a s driveway s o rvehicl e parkin g areas . Th e Environmenta l Protectio n Agenc y(EPA ) ma yb e removin g an d replacin g soi l underlyin g a grave l o rdir t are a o n you rpropert ytha 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 propert yi 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 l o rdir t are a a s a drivewa yo rparkin g area , no t withstandin g an yremova l o rreplacemen t o fsoi l b yth e EP A I fyo u hav e an yquestio n abou t legalit yo fa certai n drivewa yo rparkin g area , yo u ma ycontac t th e cit yo fOmaha' s Plannin g Departmen t a t (402 ) 444-5150
. O Pleas e chec k thi s bo xi fyo u understan d th e informatio n outline d above
.

• 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
. 

### nI d o no t agre e 

# vn/;^ \^ Contr^tS»;^ig i Dat e Signature Dat e

# FA X COVE R SHEE T OMAH A 

# COASTA L 

# Fa x

To : From : Frankli n Harpe r Wend yLara Fa

xNo
. 615.452.216 7 Pages : 5 Phone : 615.452.430 5 615.804.980 6 Date : 10/21/201 1 Re : 182 3 Miam i S t cc : 

### ^Urgen t ^Fo rRevie wnPleas e Commen t ^Pleas e Repl ynPleas e Recycl e

• Comments : Enclose d yo u wil l fin d th e paperwor k necessar yt o star t th e lea d remediatio n process . Pleas e sig n an d retu m th e fomn s provide d t o th e addres s liste d above
. I fyo u can , pleas e fa xth e sheet s bac k a s soo n a s possible , sinc e w e ar e awaitin g a respons e t o star t th e lea d remediatio n before th e groun d freezes
. I fyo u hav e an yquestion s o rconcems , pleas e fee l fre e t o cal l m e a t 402.991.1199
. Than k you . Wend yLara Sit e Coordinatio n
Coasta l Environmenta l Group , Inc
. —8(a) , HU B Zone , MBE , DB E 241 1 Marth a Stree t Omaha , N E 6810 5 (402 ) 991-119 9 ext
. 361 2 offic e (877)662-421 1 fa x (402)432-694 7 cel l w.lara@coastalgrp.ne t www.coastalgrp.ne t

COASTA L Form 2 4 

### Revogi o

# FA X COVE R SHEE T OMAH A

CONFIDENTIALIT YNOTICE : Th e informatio n containe d i n thi s facsimil e messag e an d attachment(s ) i s intende d fo rth e sol e confidentia l us e o fth e designate d recipient(s ) an d ma y contai n confidentia l an d privilege d informatio n otherwis e protecte d b ylaw
. An yunauthorize d review , dissemination , distributio n o rcopyin g o fthi s informatio n i s strictl yprohibited
. I fyo u hav e receive d thi s communicatio n i n error , pleas e notif yu s immediatel yvi a telephon e an d destro yal l copie s ofth e origina l message . AN YSIT E —AN YSITUATIO N —EVER YTIM E Certifie d MB E • DB E • 8(a ) • HU B ZON E

241 1 Marth a Stree t • Omaha , N E 6810 5 877-662-421 0 • Fa x877-662-421 1 • www.coastalgrp.ne t

COASTA L Form 2 4 Rev091 0BVID # 

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pp m P b 209.35 5 Supervise d By : 

## Certificat e o fVerificatio n

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pp m P b 208.89 3 Supervise d By : 

## Certificat e o fVerificatio n

1 8 Soi l 2011-11-0 4 09:5 2 32.5 9 pp m 2 Fina l 2926 7 182 3 MIAM I B l 13 " PATLA N CONFORMATION S CONFORMATION S

±Erro r ±18.88 1SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

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pp m P b 216.22 3 Supervise d By : 

## Certificat e o fVerificatio n

1 9 Soi l 2011-11-0 4 09:5 3 30.5 5 pp m 2 Fina l 2926 7 182 3 MIAM I B l 13 " PATLA N CONFORMATION S CONFORMATION S

± Erro r ± 19.98 1SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

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pp m P b 202.95 0 Supervise d By : 

## Certificat e o f Verificatio n

2 0 Soi l 2011-11-0 4 09:5 3 31.6 5 pp m 2 Fina l 2926 7 182 3 MIAM I B l 13 " PATLA N CONFORMATION S CONFORMATION S

± Erro r ± 19.15 1

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

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pp m P b 249.64 9 Supervise d By : 

## Certificat e o f Verificatio n

2 5 Soi l 2011-11-0 4 09:5 6 90.7 2 pp m 2 Fina l Av g o f 22-2 4 182 3 MIAM I E A 1 " PATLA N EX-SITU S CONFORMATION S

Erro r 23.76 1

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

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pp m P b 231.12 1 Supervise d By : 

## Certificat e o fVerificatio n

2 2 Soi l 2011-11-0 4 09:5 5 30.2 0 pp m 2 Fina l 2926 7 182 3 MIAM I E A 1 " PATLA N EX-SITU S CONFORMATION S

Erro r ± 22.96 6SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

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pp m P b 259.50 0 Supervise d By : 

## Certificat e o f Verificatio n

2 3 Soi l 2011-11-0 4 09:5 6 30.2 0 pp m 2 Fina l 2926 7 182 3 MIAM I E A 1 " PATLA N EX-SITU S CONFORMATION S

± Erro r ± 24.25 8SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

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pp m P b 258.32 7 Supervise d By : 

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### ^"" ^ 

## Omah a Lea d Site—Fixe d Pric e EP-R7-09-0 6 Coasta l Environmenta l Grou p Inc
. www.coastalhazmat.co m .. . v J 

### COASTA L 

# EXECUTIV ESUMMARY : BVID #29267(182 3 MIAM I ST )
No Issue s o r Concern s Issues/Concern s Detai l Explanation:81003 11/02/201 1 17:1 7 FA X 171258607. ' Offic e He x 097 1

COASTA L 

## Anpert y Comidetio nAgreemen t Thi s apaeawn t documnt s di e oompleliono f remedia l activitie s perfonne do o my pm p Tt y My sisnature wili designate Aat I a msttiifie dwit hth e Msunatid nof myppoperty , an dtha t o o iteou i ar e i i qasitloa , ooweratio y dat e i ndi e fntnxe , excep t thos e iieoi s lisie dbelow , ifuy 

### ftapotym : ao^^yT N PropertyAddress : VCKOLT S VA^^^-
. SA Owne r F«^^V\\.> v Nx. ^ Phone : UV<^-ftr> H
Rcstorotio D Item s i nQuestion : kem : Item : Itegn : hem : Bern :

Additioaa l Coauneats :



### Q^ag r 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 

# M'' l \\h/\ \ Owner' s Signature Dat e Dat e

2 d 90efr-39t^l. 9 esudje}U 3 jedJB H d/gig o i , i , e o '^O N

# lEP A EPAPropert y Clos e Ou t For m 

# ^^^t^ n• r..^H v AdHr^
. Jm3_jm.^QiLi i ProperlA ' M : Dale/Tlroe : Quad s Exca\«(ed : _^\
_ Conlraclo r Grou p {JO(Ki-Tt\/ \ Excavatio nGenera l I
.If Dfccssao' , were ih c correc t quadrant(s ) excavate dan drestored ? 

# y z
2
.If nccessan,' , were th e correc t area s ofdri p zon e excavate dan drestored ? 

# y
Gradin g So dan dVegeUtio n Ve s K o Doc s tli e gradin g aroiin dl.h e perimete r ofth e hou.<; e i

nexcavate darea s generall y slop e awa y from(h e house ? 

# 7
2
.Ha s so dbee nlai di nall area s that wer e excavated ? 3
.

Doe s the sodappea r t

o b e generall y health y an dgrowing ? (Onl y evaluat e if inspecte da t a3 0 da y tim e period ) 

# y 4
.

Al t sodde darea s generall y TUTT Ian devenl y graded ? Ar c 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 

# y lim e period ) 

# L
. 5 6
.Wa s the propen y grade dsuc htha t wate r wil l no ! poo l o nthe property ? 

# 'Tyr~ \ 7Wa s damag e l o landscapin g o r plan t material s avoided ? Gaiei , Fence s an dRctaipin g Wall s V e s N o !
.D o gate s ope nandclo.s e freely? (I f applicable !
" T 

# y Wer e all gate s or fence s take ndow ndurin g restoratio naciiviiie s reinstalled ? (Ifapplicable ) 3
.

Wa s damag e to gate s or fence s avoided ? (Ifapplicable ) 

# y A

.Wai s damag e to retainin g wall s avoided ? (Ifapplicable ) 

# T , Foupdation
. .Siding an dGuMer ? Ye s . .N u Wa s damag e to th e sidin g or tri mavoided ? 

# y Wa s damag e t nthe foundalio navoided ? 

# y Wa s damag e to window s avoided ? 

# x y ^'A'a s datnag e to window i o r doo r Kreen s avoided'

- 

# H ^-Wa s damag e to Jowdspoui s mduwri>pe)u i i-xieniion. s a\i)idcd! ' Sidewaik i «n dDriveway s (Coucrcic ) \'i V >(. '

' 1 Wa s damag e 1 0 drivewe y surface s Hvoided ' 

# T Wa i damag e t o v^ulkwa s Mirfacei avoided'. ' /

## Qwne ncomments :

inspectio nnotes :



# 9^^ ' Re,nov„ , ^ drou.a<, TM »U,v.>. s c,.TMple, e .ncl.din g ,h
. M,-d. y sodw„m„..y :

r-",,,i
.11/02/201 1 17:1 7 FA X 171236 f 4 Offic e He x 007 1 8100 4



### Propel ^ Owne r Attestncn t « S PerfornaBc e Fo- m Aacric mRecovo y an dRdnvestment Act (ARRA) Qnah aLea dSi^aAin dSit e 201 1 Remediatio aConaactor : COASTA LEnvnonmeptal Group - EP-SLl-09-06 Propert y Identifie r Numbe r Qpy aVy \ PropertyAddress : Vfe^^j k VJ.\».^

- T^ ^ 

### Propert y Owner' s Name : Ww^v\\ ^ U^^«y> ^ (Akov e infonmctionw b e filledou tfay di e icmediati u conmcto r prio r t o utUiaaii nby ih< ; EP ACOR ) 

### lartroetioB s t o th e Piwiei H Ower ; Thi s fbtmscnv s t o ncoi dth e Pnipeft y Owner' s itsessmen t o f perfb^I)lnc^!(Incent I l-Quaiit y Assunnc e Surveillaoc e Plan ) involvin g th e liste dremedialio ncooiractor , a s api iic»bl e to th e Omaha Lea dSite
. Thi s for mdocuneai s th e timdines s o f pnnchlis t resolotiaa , businei i leLrtions , complaio t resohitio aanddi e overall qualit y o f woric
. If nee dbe , di e Propert y Owne r siay i tJliH thi s fonnt o recor d problem s and/or issue s not specificaU y tie dt o a nassigne deddiess , for example , bwiies s idatioii s tha t generally don t follow guideline s set fort hi nth e Peifonnanc e Wor k

Statement
. Th e Propert y Owner will indicat e his/her assessmen t o f performanc e w i 'httt r contractor' s wori c b y chcckSng aumerica l ratin g o ntk e tah k bcki w usin g tb e sumerical defin i 'ioc s fromth e raitin g scal e beloiw , th e signAdateth e forok 9-1 0 "exceUcBt* ' 7- 8 •Veiygood " 5

^ "aeceptabfe* ^ 3- 4 

### -poo r 1-2 "ver ypoor " 

### Pimmi j Owaer' e Afseasmento f ^"fc'-iwacfe IfayrprJi^ e th e Contractor* s Work 1 0 5 9 _ ^ 4 8 >^ ^ 3 7 2 6 1 AdditioDa i CoiPJweBt s fromEP ACORfentieial ; cositittn e o abac k nee e if needen H

Propert y Owne r Signature : 

# yytd-* ^ •f'Ci ' Cp^i^l ^ Date : -/y L?-^^ /

» g d 90Efr-29^l. 9 esudJeiuqjedJB H d/cioni.icnAO M