## TRANSMITTALof OMAHALEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R
SA1D # : % ^ ^ 

# Date : ^ | 1 ^| U 

# Add.. : ^^^ ^ u y^* " y Remediatio nContractor : Coasta l Environmenta l Group

_Year : lOlOARR A SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 

# 1

/ Vide o ofpropert y (DVD ) Executiv e Summary EPA-provide dproperty sketc h Signe dAcces s Agreemen t for subjec t property
• r r Signe dAcces s Agreement(s ) for adjacent property 

# y Restoratio nAgreemen t Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) Confirmatio ndat a Photograph s i H t>^6n/fVmA/ \y tr?°6Q(t/^ni ^ < ^" ^ As-buil t sketc h / 

### Satisfactory restoratio nsigne db y Property Owner 

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

3021769 3 Superfun d

# 1 »

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## Propert yAcces s Checklis t [Pre

Property ID : ^30 , L/ ^ Property Address:'^^ ^ \ | 7, ^ ^T * D • WOR K STARTE D WOR K COMPELTED ON : ON : / / / / Owner ; Address :



# IZipy i Dtt r Cru M Phon e Fax : 

# 1Q1 ­ b? m Cell/Pager : 

# f > Renter : Phone : Fax : Cell/Pager : Additional Information :

D Notificatio nLette r ^ Acces s Agreement

S I Restoratio nAgreement D Topsoi l Samplin g (i f appUcable) D Disposa l Samplin g (if applicable ) D Garde nSamplin g (if applicable ) j Q UtiUt y Clearanc e Ca^ideo/Photo s (Before) D Video/Photo s (During ) nVideo/JPhoto s (After) nVideo/Photo s (30-Day ) Q Property Completio nAgreement D Final Report Sent : / / Signed : _2^/_ll./K ) Signed : 2^/lL/lD / / / / / / CaUed: 3 I 13 1 1 0

On : 1 I »0 / ( O On : / / On : / / On : 7 / Signed : / / Issued : / / By : By : By : By : By : By : By : By : By : By : By : By : By : 

### 'hHT.h a CC^^Wt ^

Ai r Monitorin g (a s appUcable) nCommunit y D Cre w Results : On : / / By : 1 Q Communit y Results : QCre w On : / / By :

• community Results : QCre w On : / / By : 1

Omah a Lea d Sit e

## Douglas Coimt y Accoun t I

n nm^on Pag e 1 of3 Dougla s County , Nebrask a Propert yRecor d - R201361000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e (9 ! scal e 0-5 0 ft wes t o f52n d S t - ViewO 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 SearcK i Owne r WRIGHTSEL L INVESTMENT S LL C ETA L 1265 7 DEE R CREE KD R OMAH AN E 68142-000 0 Propert yInformatio n Ke yNumber : 136 1 000 0 2 0 Accoun t Type : Residentia l Parce l Number : 261361000 0 Parce l Address : 393 3 N 2 3 S T OMAH AN E 68110-000 0 Lega l Description : PLAINVIE WLO T1 8 BLOC K3 5 0 X 12 4 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $7,000.0 0 $32,700.0 0 $39,700.0 0 200 8 $7,000.0 0 $32,700.0 0 $39,700.0 0 200 7 $7,000.0 0 $32,700.0 0 $39,700.0 0 200 6 $7,000.0 0 $32,700.0 0 $39,700.0 0 200 5 $7,000.0 0 $12,700.0 0 $19,700.0 0 200 4 $7,000.0 0 $11,500.0 0 $18,500.0 0 Sale s Informatio n Sale s Date : 2006-01-2 3 Dee d Type : QC M Book : 200 6 Page : 00779 6 Price : $0.0 0 Grantor : Latrel l Wrightsel l eta l Grantee : Wrightsel l Investment s Valld/lnvalld : Invali d Exclusio n Reason : Famil ySal e Sale s Date : 2006-01-0 9 Dee d Type : QC M Book : 200 6 Page : 00269 4 Price : $0.0 0 Grantor : Wrightsel l Investment s 

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

## Dougla s Count y Accoim t In&gjj^io n Pag e 2 of3
Grantee : Valld/lnvalld : 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 : Price : Grantor : Grantee : Valld/lnvalld : Exclusio n Reason : Lan d Informatio n Acre s S F 0.1 4 Latrel l Wrightsel l eta l Invali d Correctiv e Dee d 2006-01-0 6 QC M Book : $0.0 0 WRIGHTSEL L INVESTMENT S LL C LATREL L WRIGHTEL L ETA L Invali d Multipl e Owne r- Trad e 2004-11-1 6 QC M Book : $0.0 0 LATREL L WRIGHTSEL L ETA L WRIGHTSEL L INVESTMENT S LL C Invali d Multipl e Parce l Sal e 2001-01-0 5 200 6 Page : 00200 4

200 4 Page : 16076 7

D Book : 217 1 Page : 65 3 $23,000.0 0

Vali d

Unit s Dept h Widt h Vacan t 6200. 0 1. 0 124, 0 50. 0 N o Improvemen t Informatio n Buildin g 1



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

### Dougla s County Accoun t I n i^l^ion Pag e 3 o f 3

393 3 N 2 3 a . • ;sf f

• <

CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 936. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Poo r

Buil t As : Ranc h Cond o Squar e Footage : 0. 0

HVAC : Centra l Ai rt o Ai r Rooms : 5. 0 Exterior : Fram e Viny l Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 3. 0

Roo fType : Gabl e Stories : 1. 0 Fioorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 yea rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 190 4 0 % 190 4 10 5 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fenc e Chai n Lin k 1. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 461. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 480. 0 Porc h En d Scree n 60. 0 Porc h En d Scree n 133. 0



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

### Pag e 1 of 2

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### YOU RTICKE T NUMBE RI S 2440697 . Origina l Cal l Date : 3/18/1 0 Time : 12:4 7 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 3/22/1 0 Time : 1:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 393 3 Street : N23R D S T Twp : 15 NRng : 13 E Sect-Qtr : 03-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n Locatio n o f Work : INCLUD E AL L EASTMENTS . LOCAT E ENTIR E PROPERT Y Remarks : FAX 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 : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N ALT87 2 CXCAT V MAGELLAN MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

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### Phon e Numbe r Utilit y Typ e
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### Day : 406728934 3 Ah : 406207149 4 Emerg : 888728934 3
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MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0
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### Pag e 2 of 2

OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R 

### RICHATRAFFI C Day :

AW . 402444719 7 402444516 1 Emerg : 402444516 0
0PPDGPR 5 OMAH APUBLI C POWE RDISTRIC T ELM LOCATIN G 

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### Day : 406728934 3 AU : 406207149 4 Emerg : 888728934 3

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# ^ As-Buil t Drawin g ^ Dat e Excavated : 3/29/201 0 Dat e USEP ASigne d Off : 6/11/201 0 COASTA L 

# OTiahaLea dSuperfun dSt e EMViaONMtNTA L Are a Sodden : 337 5 s a f t « « O U P , INC
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### Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p In c

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COASTA I INVIRONKCkTA l C I 0 U rI h C 

## Consen t fo rAcces s T o Propert y RIGH TO F ENTRYTO 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 rits 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 : 1/1, 1 iL' Z

Owner' s Name : Daytim e Phone :

Addres s o fPropert y covere d b ythi s 

# ?755^ i fh ^ 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 that contain s elevate d concentration s oflea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t o remove contaminate d soil
. Th e remove d contaminate d soi l wil l b e replace d 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 work I s bein g performe d unde rth e Omah a Lead Superfun d Site remediatio n program . Arepresentative o fCoasta l 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 have a n opportunit yt o reviewan d approve th e planne d soi l removal , an d restoratio n work before I t begins
. Once th e work i s finished , th e Granto rwil l b e aske d t o reviewth e work an d confir m tha t i t i s complet e an d meets wit h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receive writte n documentatio n from EP Athat th e propert y has 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 , its employees , contractor s an d subcontractor s 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 ofperformin 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 ajgreesto :

Pag e 1 o f2

### ^ COASTA L INViaONKtKTt l 

### 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 maywis 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 ; e Abid 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
. « Allo 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 wothers t o us e th e propert yi n suc h a manner . Should yo u hav e an yquestion s abou t thi s program , pleas e contact Coasta l Environmenta l Group , a t (402 ) 991-119 9 

# H' I gran 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 signature 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 f2COASTA L 

## 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 Environmental Protectio nAgenc y (EPA) .

Property ID : ^^(^4" j ^ T ^ Property Addressr^^y^T ^ ^ ^ " Owner : 

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. item : 

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Pag e 1o f^COASTA L 

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## Ite m Pre-existin g property area , that will b e excavated , that i s coveredwithgrass . Numbe r o f tree s > 2 inc h trun k diamete r Numbe r o f tree s < = 2 inc h trun k diamete r Niimbe r o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Attac hasketc ho f th e sprinkle r layout
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. Agree dupo nvalu e o f plan t material s no t to b e replace db v 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 . Fasemen t Area , to b e excavate d 

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Pag e 2 of
.C O AS TAL o n o u r. INC
.
Additiona i 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 EPA
. 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
. 

# j6^ \ leas e chec k thi s bo xi fyo u understan d th e informatio n outline d above
. 

## ^

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.

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. 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
. 

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# Therm o

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

## Certifi c XL3t-3902 2 Readin g N o 39 1 Mod e SOI L Tim e 2010-03-3 1 13:5 6 Duratio n 91.4 1 Sequenc e Fina l Flag s AVERAG E (rr^Avg-or388=39 0 ADDRES S 393 3 N 2 3 s t QUADRAN T D Z DEPH T 10 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e
Erro r P b Supervise d By :• 

# 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 38 8 Mod e SOI L Tim e 2010-03-3 1 13:5 5 Duratio n 30.4 1 Sequenc e Fina l Flag s BVI D 3364 3 ADDRES S 393 3 N 2 3 s t QUADRAN T D Z DEPH T 10 " XR F TEC H N
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pp m ± Erro r P b 201.94 9 ± 21.02 8 Supervise d By :• 

# 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 38 9 Mod e SOI L Tim e 2010-03-3 1 13:5 5 Duratio n 30.5 1 Sequenc e Fina l Flag s BVI D 3364 3 ADDRES S 393 3 N 2 3 s t QUADRAN T D Z DEPH T 10 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e
pp m ± Erro r P b 210.04 2 ± 21.19 2 Supervise d By :

# ft 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 39 0 Mod e SOI L Tim e , 2010-03-3 1 13:5 6 Duratio n 30.4 9 Sequenc e Fina l Flag s BVI D 3364 3 ADDRES S 393 3 N 2 3 s t QUADRAN T D Z DEPH T 10 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e

pp m ± Erro r P b 20.87 2 214.51 0 ± Supervise d By :

# t 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 39 5 Mod e SOI L Tim e 2010-03-3 1 13:5 9 Duratio n 90.7 4 Sequenc e Fina l Flag s AVERAG E rAv g o t 392-394^—- j ADDRES S "-igs s N~23-s t QUADRAN T easemen t DEPH T 1 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e

Supervise d B y

# t 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 39 2 Mod e SOI L Tim e 2010-03-3 1 13:5 7 Duratio n 30.1 4 Sequenc e Fina l Flag s BVI D 3364 3 ADDRES S 393 3 N 2 3 s t QUADRAN T easemen t DEPH T 1 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e
pp m ± Erro r P b ± 24.69 9 243.28 3 Supervise d By :• 

# 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 39 3 Mod e SOI L Tim e 2010-03-3 1 13:5 8 Duratio n 30.5 2 Sequenc e Fina l Flag s BVI D 3364 3 ADDRES S 393 3 N 2 3 S t QUADRAN T easemen t DEPH T 1 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e
pp m ± Erro r P b 252.81 5 ± 22.43 0 Supervise d By :

# ft 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 39 4 Mod e SOI L Tim e 2010-03-3 1 13:5 9 Duratio n 30.0 8 Sequenc e Fina l Flag s BVI D 3364 3 ADDRES S 393 3 N 2 3 s t QUADRAN T easemen t DEPH T 1 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e
pp m ± Erro r P b 241.82 8 ± 24.54 8 Supervise d By :

# ft 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 38 7 Mod e SOI L Tim e 2010-03-3 1 13:5 3 Duratio n 91.4 0 Sequenc e Fina l Flag s AVERAG E rAvg-Dr384^36___ 3 ADDRES S S§337r23s t QUADRAN T B 2 DEPH T 6 " XRFTEC H N
. LOPE Z MIS C confirmatio n NOT E non e

# ft 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 38 4 Mod e SOI L Tim e 2010-03-3 1 13:5 1 Duratio n 30.3 9 Sequenc e Fina l Flag s BVI D 3364 3 ADDRES S 393 3 N 2 3 S t QUADRAN T B 2 DEPH T 6 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e

± Erro r pp m P b ± 27.14 7 355.20 3 Supervise d By :

# ft 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 38 5 Mod e SOI L Tim e 2010-03-3 1 13:5 2 Duratio n 30.4 7 Sequenc e Fina l Flag s BVI D 3364 3 ADDRES S 393 3 N 2 3 s t QUADRAN T B 2 DEPH T 6 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e
pp m ± Erro r P b 332.90 1 ± 26.53 2 Supervise d By :

# ft 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 38 6 Mod e SOI L Tim e 2010-03-3 1 13:5 3 Duratio n 30.5 4 Sequenc e Fina l Flag s BVI D 3364 3 ADDRES S 393 3 N 2 3 s t QUADRAN T B 2 DEPH T 6 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e
pp m ± Erro r P b 333.76 1 ± 26.30 0 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-3902 2 Readin g N o 23 8 Mod e SOI L Tim e 2010-04-1 5 07:3 0 Duratio n 91.9 3 Sequenc e Fina l Flag s AVERAG E Ayg.X)«35=23 7 ADDRES S 1.3933-1^23^ 1 QUADRAN T F 2 DEPH T 6 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non 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 fVerificatio n XL3t-3902 2 Readin g N o 23 5 Mod e SOI L Tim e 2010-04-1 5 07:2 9 Duratio n 30.7 9 Sequenc e Fina l Flag s BVI D 3364 3 ADDRES S 393 3 N 2 3 s t QUADRAN T F 2 DEPH T 6 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e
Erro r pp m P b 134.74 1 ± 17.52 9 Supervise d By :

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 23 6 Mod e SOI L Tim e 2010-04-1 5 07:2 9 Duratio n 30.3 8 Sequenc e Fina l Flag s BVI D 3364 3 ADDRES S 393 3 N 2 3 s t QUADRAN T F 2 DEPH T 6 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e
pp m Erro r P b 137.87 8 ± 17.77 7 Supervise d By :

# 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 23 7 Mod e SOI L Tim e 2010-04-1 5 07:3 0 Duratio n 30.7 6 Sequenc e Fina l Flag s BVI D 3364 3 ADDRES S 393 3 N 2 3 s t QUADRAN T F 2 DEPH T 6 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e
Erro r pp m P b 142.83 9 ± 17.92 9 Supervise d By :

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

I ' Coasta l Environmenta l Grou p Inc
. S^r^^r ^

www.coa8talhazmat.co m ^"i^y ^ COASTA L ENVIIONHINTA L C t O U P , IH C 

# EXECUTIV ESUMMARY : BVID #33643-(393 3 N2 3 ST ) No Issue s o r Concern s [ ^ Issues/Concern s Detail Explanation : DA NGARVE Y WALKE D TH EPROPERT Y O N6/11/1 04 

## EP APropert y Clos e Ou t For m Propert y«»:_22iMi: ^ Date/Time : Quad s Excavated : Excavatio nGcnerml 1 .

i f necessuy , wer e th e correc t qtuulrant(s ) excavate dan drestored? 2 .I f necessary , wer e th e correc t area s o f dri p zon e excavale dan drestored? Gradin g So dan dVcgglatio B I .Doc s th e pvdin g aroun dth e perimete r ofth e hous e i nexcavate darea s generell y slop e away fromth e house ? , 2 .HI S so dbee nlai di nal l area s that 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 da t 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 generell y tight ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period ) 6 .Wa s th e property grade dsuc hthat wate r wil l not poo l onth e properly ? 7 .Wa s damag e l o landscapin g o r plant material s avoided ? Gates , Fence s an dRcuinln s Wall s 1 .O o gate s ope nan dclos e freely? (I f applicable ) 2 .Wer e al l gate s o r fence s take ndowt i durin g restorationactivilie s reinstalled ? (I f applicable ) 3 .

Wa s damag e t o gate s o r fence s avoided ? (Ifappiicable ) 4 .Wa s damag e t o reiainhig wall s avoided ? (I f applicable ) Foundation , SidiaKan d Gntler 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 ? 5.Wa s damag e t o window s avoided ? Wa s damag e t o window s o rdoo rscreen s avoided ? 5.Wa s damag e t o downspout s o rdownspou l extension s avoided ? Sidewalk s an d Driveway s (Concrete ) 1 .

Wa s damag e t o drivewa y surface s avoided ? 2 .Wa s damag e t o walkwa y surface s avoided ? Yes No 

## y 

## y Ye s N o 

## y 

## y y 

## y 

# y / Ve s N u / 

# y V

/ Ye

s N o 

## J / / 

## J

Ye s N o 

### / 

# 7

## Ort'oer s comments :

rinspectio nnotes :

Remova l an dreslorationactivale s complet e includin g th e 30-da y so dwarranty : EP ARepresentative Qc^^^Ju j Date : Bfu/i o 

# 7ttSa 

## Propert yCompletio n Agreemen t lln s agreemen t documenl s th e complclio n o t remedia l acliviiie s perioime d o n myproperl yM ysignaiui e wil l designat e iha l I a m satisfie d wit h ih e restoratio n o fm yproperty , an d tha i n o item s ar e i n questions , now , o ra l an ydin e i n th e future , except liios e ilem s ttslc d below , i fan y

Properr yID : ^-^X^jJ ^ Propert yAddress : 0 ^ ^ ^ K \ nl ^ , ^ ^ Phone : Restoratio n Item s i n Question :

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

# L

Additiona l Comments :


# L
n^ AI Agre e restoralio n i s completed , exccp l a s note d [ J I rio no t scre e resforat/n n i s complelec t

ir k

J.
. _* ^
. . « *> • Owner' s Signatiir rDat e Contrarior' s Signatur e Dal e

## 109 )


# Propert y Owne r Assessmen t of Perf d America nRecover y an dReinvestmen t Act (AlRJlA ) .. Omah aLea dSuperfun dSit e JU N0 ^ ^"' " 2009/201 0 .^ rsn/icin M 

# SUPERFUN D OIVISIO N r: t..oasU l l Envirqnm c Remediatio nContractor : Coasta Environmenta l Grou p - EP-R7-09-0 6 Propert v Identifie r Nnmber : .^^?iilflVI' S Propert y Address : ?M?P » TK I 7. % " ^ Propert y Owner' s Name : Uif\ri^<^A\\(\N;p^EjyNPAt- < Instruction s to th e Propert v Owner ; Thi s for mserve s to recor dth e Propert y Owner' s assessmen t of perfonnanc e (Incentive 1

- Qualit y Assuranc e Surveillanc e Plan ) involvin g th e liste dremediatio ncontractor , as applicable to th e Omah aLea dSite
. Thi s for mdocument s th e timelines sof punchlis t resolution , busines s relations , complaint resolutio nandth e overal l qudit y of work
. If needbe , th e Propot y Owne r may utiliz e thi s for m

to recordproblem s and/o r issue s not specifically tie d to anassigne d address , fo r example , busines s relation s that generally don' t follo w the guideline s set fort h

inthe Perfonnanc e Wor k

Statement . Th e Propert y Owne r will indicate his/her assessment of perfomianc e wit hth e contractor' s wor k

by checkin g anumerica l ratin gonth e tabl e belo w usin g the numerica l definition s fro m th e ratin g scal e below , thensign& date th e form
. 9-1 0 "excellent " 7- 8 "ver y good " 5- 6 "acceptable " 3- 4 "poor " 1-

2 "ver y poor " Propert v Owner' s Assessmen t of Performanc e Regardin g th e Contractor' s Wor k 10 5 

# d) S
Propert y Owne r Additiona l Coanment s fro m(optional ; continu e onbac k pag e if needed l 

## K Propert y Owne r Signature : /y-S?./ ^ l \^ llyP H Date: , / /

'//j / /( .

## Wate rBil l Settlemen t

Propert y I D 3364 3 Propert y Addres s 393 3 N2 3 S t Tenan t Lene l R . Gill s

I hav e receive dfromth e contractor , Coasta l Environmenta l Grou p Inc . (Coastal) , th e sumo f $ 42.9 4 for wate r usag e require dt o maintai nth e sod
. Chec k Numbe r 203 7 Valu e o f Chec k $42.9 4 Mad e Ou t T o Mary D . Anderso n Descriptio n o f Settlemen t T o reimburs e tenan t fo restimate d wate rcharge s o n thei rMU D monthl yinvoices
. M ysignatur e belo wi s acknowledgemen t o f th e receip t o f th e su m liste d above , whic h I furthe r acknowledg e t o b e fai rcompensatio n an d ful l paymen t fo rth e above , an d releas e Coasta l Environmenta l Grou p Inc
. fro m furthe robligation s o rliability
.


# ^^r ^

OnWtef' s Signatur e "*' ' *-^ ^ Dat e Contractor' s Signatur e 

## Tyi^W^M^m^.jyi^yM^^^-y^yi^Syj^ ^ COASTA L ENVIRONMENTA L GROU P INC
. 

## 203 7 241 1 MARTH ASTREE T 27-5/104000 3 OMAHA
. N E 68 1 O S 624737290 4 

# 7(50|li l DAT E PA

Y ORDE R 

# ^^'^ ' Un d f?
. 

# 6111 5 

# $ 4 ^ foito-aw/uirf'*7M?~

. DOLLAR S fi Si i WdhFugoIaiKN A IMiiuk i 

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