## TRANSMITTA Lof OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R

SAID # : 

# y)^^ \ Date : \(^ 1 J W 

# 11 1 f y b y Address : Remediatio nContractor : Coasta l Environmenta l Group

_Year : _2010ARRA
_ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f property (DVD ) Executiv e Summar y EPA-provide dproperty sketc h Signe dAcces s Agreemen t fo r subjec t propert y Signe dAcces s Agreement(s ) fo r adjacen t property Restoratio nAgreemen t Settlement document s (i.e. , fo r damag e or to replac e plants , etc. ) Confirmatio ndat a Photograph s ' t f (i^Cf^^^fWH Y '^'X>]^VAl1i( M \^<7 ^ As-buil t sketc h Satisfactor y restoratio nsigne db y Property Owner Propert y close-ou t chec k lis t signe dby EP A Descriptio nofarea s no t meetin g RO D cleanup criteri a Utility clearance s Property^hfonnatio nfro mDougla s Count y Assessor' s Offic e 

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# l^^lI\ Ignature Date i 3021853 2 

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## ^yo^U^lt o Q Video/Photo s (Before ) On : / / By = Vixr V D Video/Photo s (During ) On : / / By : D Video/Photo s (After) On : / / By : D Video/Photo s (30-Day ) On : / / By : nProperty Completio nAgreement Signed : / / By : D FinalRepor t Issued : / / By : Ai r Monitorin g (a s appUcable )

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## By : 1 Results :

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### Dougla s County Accoun t I :



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### Pag e 1 of 3
Dougla s County , Nebrask a Propert yRecor d - R142356000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s avaiiabi e ( S scai e 0-5 0 f t wes t o f52n d S t - VleWO n Ma p Informatio n i s vali d a s o f 2010-2-1 6 Treasurer' s Ta xRepor t Ne wFeatur e ••-•• • Aut o Sale s Searc h Owne r GAUDREA U BENJAMI N S
331 7 BUR TS T# 1 OMAH AN E 68131-000 0 Propert yInformatio n Ke yNumber : 235 6 OOO O 1 4 Accoun t Type : Residentia l Parce l Number : 142356000 0 Parce l Address : 11 1 S 3 8 S T OMAH AN E 68131-000 0 Lega l Description : JEROM E PAR KLO T3 BLOC K1 0 4 5 X 16 7 Valu e Informatio n Lan d Impro vemen t Tota l 200 9 $13,100.0 0 $134,800.0 0 $147,900.0 0 200 8 $13,100.0 0 $134,800:0 0 $147,900.0 0 200 7 $13,100.0 0 $134,800.0 0 $147,900.0 0 200 6 $13,100.0 0 $81,500.0 0 $94,600.0 0 200 5 $13,100.0 0 $81,500.0 0 $94,600.0 0 200 4 $13,100.0 0 $81,500.0 0 $94,600.0 0 Sale s Informatio n Sale s Date : 2004-05-1 0 Dee d Type : W D Book : 200 4 Page : 13129 4 Price : $120,000.0 0 Grantor : Thoma s VanBell e Eta l Grantee : Benjami n Gaudrea u Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 1996-01-2 6 Dee d Type : D Book : 202 5 Page : 21 5 Price : $76,000.0 0 Grantor :


### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R142.
. . 3/2/201 0Dougla s Count y Accoun t I ^ , tio n Pag e 2 of 3

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 7 7515. 0 1. 0 167. 0 45. 0 N o Improvemen t Informatio n Buildin g 1 

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Buil t As : 2 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 15. 0 Exterior : Fram e Sidin g Units : 1.0 Interior : Drywal l Baths : 3. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 5. 0

Roo fType : Stories : 2. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle 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 190 5 0 % 190 5 102 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Blocl < 8 ft 960. 0 Basemen t Finishe d 400. 0 Fixtur e Additiona l Fixture s 1. 0

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R142.
. . 3/2/201 0

### Dougla s County Accoun t I

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### Pag e 3 of 3

Fixture Fixtur e Porc h Porc h Use r Use r Use r Bas e Fixture s Bat h Ful l Sla b Roo fCeilin g Sla b Roo fCeilin g 2n d floo r Atti cFul l Finis h windo wA/C 1. 0 3. 0 16. 0 140. 0 910. 0 356. 0 1. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R142.
. . 3/2/201 0

## Pag e 1 of 2

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## • YOURTICKE T NUMBE RI S 2542702
. Origina l Cal l Date : 7/13/1 0 Time : 12:3 1 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 7/15/1 0 Time : 1:0 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 11 1 Street : S 38T H S T Twp : 15 NRng : 13 E Sect-Qtr : 20-N E 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 Contact Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : COT^TA L Dept h o f Excavation : 4 F T Come r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N BSHPCLK S CXCAT V MUDO l OMAHACO F OPPDGPR S PAETE C QLNNEI C UNITEO M UNOTE L

Servic e Are a Contac t Phon e Numbe r UtUit y Typ e
BSHPCLK S NEBRASK AHEALT H SYSTEM N A Day : Alt : 402552346 0 402552334 7 Emerg : 402559511 1

CXCAT V CO X COMMUNICATIONS , IN C HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7

MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y Day : 402504782 3 Alt : Emerg : 402504797 0

OMAHACO F CIT Y O FOMAHA

TRAFFIC.SEWE R RICH/TRAFFI C Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 

## http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS..
. 7/13/201 0

### Pag e 2 of 2

OMAH A PUBLI C POWE R 0PPDGPR 5 DISTRIC T

PAETE C PAETE C COMMUNICATION S

QLNNEI C QWES T LOCA LNETWOR K

UNIT EPRIVAT ENETWORK S UNITEO M LL C - OMAH A

UNIVERSIT Y O F UNOTE L NEBR/OMAH A ELM LOCATIN G

N O NEE D T O CAL LOU T EMERGENC Y

ELM LOCATIN G

ELM LOCATIN G

ANDRE WTAYLO R 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 800289190 1 Alt : Emerg : 800289190 1 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 402554359 9 Alt : 402554303 6 Emerg : 402554264 8

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 7/13/201 0

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e OLS# : 2303 1 Dat e Excavated : 7/19/201 0 Dat e USEP ASiane d Off : 7/30/201 0 • 

### 23«?t ^ Exterio rPain t Nortt i AiTo w Omah a Lea d Sit e • Goo d Sit e Sketc h Q^Poo r Samolin a Address : 11 1 S 3 8 ST • Not pain t Sampl e Numbe r Lead Sampl e LA B Sample s Collecte d Concentratio n Collecte d Firm : £P±_aBl^S ^ RYASCPXA-2303 1 F l ^ 7 < pp m 

### D Date ; T-Vg-tf ^ RYBSCPXA-2303 1 F2 pp m 

## s r D Time : Id:^ ^ A. n RYCSCP,X A2303 1 B4 - pp m 

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. B l = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a s viewe d fro m th e street, facin g propert y



### Legen d
Concret e Dri p Zon e Excavate d Quadrant s Excavate d 

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Are a replace d wit h Are a replace d wit h Are a lef t bar e Scx i Rock/Mulc h 

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### Omah a Lea d Sit e • Good 

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Re v2008.3 A 044701.01.2. 1%


### 2ir&yi ^ Exterio rPain t Noiti i Arro w Omah a Lea d Sit e • Goo d Sit e SIcetcl i Q^oo r Samplin g Address : 111S38S T Q No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numt>e r LA B Concentratio n Collecte d Firm : f^P AdR / S ^ RYASCPXA-2303 1 F l • ^ 7 / pp m 

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## Consen t fc i Acces s T o Propertj ^ 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 : Z3D 3 

## ) ^^rrfff^ n ^/?'^^^' ^ Owner' s Name : ^ ^ Daytim e Phone : 

# 5T

- Addres s o fPropert y 

# l/ ( 5 ^ ^ 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 coile d soi l sample s an d remov e soi l that 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 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 wor k i s bein g performe d unde rth e Omah a Lead Superfun d Site remediatio n program . Arepresentative o f Coasta l Environmenta l Group , contracte d b yUSEPA , v^l 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 revie wan d approve th e planne d soi l removal , an d restoratio n wor k before i t begins

. Once th e wor k i s finished , th e Granto rwil l b e aske d t o reviewth e work an d confir m tha t Ki s complet e an d meets wit h th e Grantor' s approval

. Upo n completion , th e Granto rwil l receive vw-itte 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 bo& n satisfactoril ycompleted

. Th e Granto rals o agree s to :

Pag e 1 o f2

### c COASTA L mrmoNHiKTu i cn o u P I Kc 

### t Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; x O Remov e flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t ma ywis h y - 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 ; eAbid 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

. e

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 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 

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ran t access t o m ypropertie s D I d o not gran t acces s t o m ypropertie s 

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DI 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 2t


### ^ ^ C OA S T AL a n o u p . INC

. 

## 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 ofth e propert y prior to remediationactivities
. Thi s will als o serve a s docimientationfo r the purpos e of assuring tha t restoration activitie s ar e completedto the satisfactionof th e propert y owne r an dthe UnitedState s Environmenta l ProtectionAgency (EPA)
.

PropertylD : 2<^6>? / Propert y Address : jl l 5 J ^ •^-r
. 

### Owner : ^V^j ; ^g, , ^^^^" ^ Piione : ^^ ^ (yil^l^4 U O

nthe attacheddiagram(s ) indicat e aFea(s) to excavate , surface structure s an dlandscapin g feature s an d acces s location(s ) to b e usedby the contractors . Indicat e distances , depths , materia l typeis , etc . Photographicall y an dVideographicall y documen t the existing condition s ofth e propert y an dthe basemen t if necessary . 

## Item s t o b e Remove d b yth e Owne rbefor e Start o f Remediation : Th e removai , storage , disposal , and/o rretur n o fthes e item s i s th e Owner' s responsibility

. Kem : 

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## Landscap e Inventor y Item Quantity Unit Conditlon/Type/Specie s Pre-existing propert y area . 

# f-i/O ^ Quadrants tha t wil l b e excavated , tha t i s coveredwit hgrass . Numbe r of tree 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 , 

# y Eac h Timers , Heads , etc . Attac hasketc ho f th e sprinkle r layout
. Numbe r of an dsize of eac hgarden / flowe r bed Eac h area . 

# 2 Squar e Fee t Attac hasketc ho f relative size s an dlocations
. Agree duponvalue of plan t material s not t o b e / replacedbv contractor . / 

# 7



# 7 $ Not e thi s valu e wil l b e usedto issue aplan t voucher to th e property 1 

### owner . Easemen t Area , to b e excavated
Pag e 2 of

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# 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 Sequenc e Flag s AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

Supervise d B y 

## Certificat e o fVerificatio n

10 8 SOI L 2011-01-2 1 12:5 9 90.6 5 Fina l Av g o f105-10 7 11 1 S 3 8 S T F l 6 " C.PADILL A CONFIRMATIO N CLEA R

# 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 Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 224.07 2 Supervise d By : 

## Certificat e o f Verificatio n

10 5 SOI L 2011-01-2 1 12:5 7 30.2 0 Fina l 2303 1 11 1 S 3 8 S T F l 6 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 22.81 1

# 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 Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 176.52 6 Supervise d By : 

## Certificat e o f Verificatio n

10 6 SOI L 2011-01-2 1 12:5 8 30.2 3 Fina l 2303 1 11 1 S 3 8 S T F l 6 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r
± 20.73 0

# 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 Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 146.02 2 Supervise d By : 

## Certificat e o f Verificatio n

10 7 SOI L 2011-01-2 1 12:5 9 30.2 2 Fina l 2303 1 11 1 S 3 8 S T F l 6 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r
± 18.74 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 11 2 Mod e SOI L Tim e 2011-01-2 1 13:0 2 Duratio n 90.8 3 Sequenc e Fina l Flag s AVERAG E Avg of 109-11 1 ADDRES S 11 1 S 3 8 S T QUADRAN T D Z DEPH T 13 " XR F TEC H C.PADILL A MIS C CONFIRMATIO N NOT E CLEA R

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 Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 460.28 4 Supervise d By : 

## Certificat e of Verificatio n

10 9 SOI L 2011-01-2 1 13:0 0 30.2 8 Fina l 2303 1 11 1 S 3 8 S T D Z 13 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r
± 31.04 3

# 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 Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 373.26 7 Supervise d By : 

## Certificat e o fVerificatio n

11 0 SOI L 2011-01-2 1 13:0 1 30.1 8 Fma l 2303 1 11 1 S 3 8 S T D Z 13 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r
± 28.65 0

# 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 Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 356.65 4 Supervise d By : 

## Certificat e o f Verificatio n

11 1 SOI L 2011-01-2 1 13:0 2 30.3 7 Fina l 2303 1 11 1 S38S T D Z 13 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r
± 24.62 8

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

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

Supervise d By : 

## Certificat e o fVerificatio n

11 6 SOI L 2011-01-2 1 13:0 4 90.5 9 Fina l Avg of 113-11 5 11 1 S 3 8 S T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

# 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 Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 115.89 9 Supervise d By : 

## Certificat e o f Verificatio n

11 3 SOI L 2011-01-2 1 13:0 3 30.2 1 Fina l 2303 1 11 1 S 3 8 S T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r

• ± 16.92 3

# 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 Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 129.19 3 Supervise d By : 

## Certificat e o f Verificatio n

11 4 SOI L 2011-01-2 1 13:0 3 30.1 8 Fina l 2303 1 11 1 S 3 8 S T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r
± 17.64 7

# 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 Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 130.40 9 Supervise d By : 

## Certificat e o fVerificatio n

11 5 SOI L 2011-01-2 1 13:0 4 30.2 0 Fina l 2303 1 Ill s 3 8 S T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r 17.49 9

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

I Coasta l Environmenta l Grou p Inc

. v l ^ ^ S^~^j ^ www.coastalhazmat.co m %PBoT« ^ COASTA L ENVIIONNINTA L C I O U P

. IN C 

# EXECUTIV ESUMMARY : BVID #23031-(11 1 S 3 8 ST )
No Issue s o r Concern s [ ^ Issues/Concern s Detai l Explanation : -DANGARVE Y WALKE D TH EPROPERT Y O N7/30/1 0S : ^ 

## EP APropert y Clos e Ou t For m

, . Propert y Addresr.-.Vil_2» ^ 2£j—SA-

- Propert y # : ^^?> \ Datenime : Owner' s Name : yc-Pg^^^J

- ,fi!.^V>^t^^" i Quad s Excavaied : Contracto r Grou p Ye s Excavatio nGeaera l I
.

i r necessaiy , wer e th e correc t quadnint(s ) excavate dan drestored ? 

# y 2
.i r necessary , wer e th e correc t area s ofdri p zon e excavaie dan drestored ? 

# y Gradin g So dan dVeKetetto n Ye s I
.Doe s th e gradin g aroun dth e perimete r ofth e hous e i nexcavaie darea s generall y slop e away fromtb e house ? 

### _ / 2
.Ha s so dbee nlai di nal l area s that wer e excavated ? 

### / 3
.

Doe s th e so dappea r to b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte dai a3 0 da y tun e period ) ; 

# y 4
.Ar e sodde darea s generall y firman devenl y graded ? 

# y 5 ,Ar e th e joint s t)etwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period ) 6
.Wa s th e propen y grade dsuc hthat wate r wil l no t poo l onth e property' ' 

## y y 

# r 7
. Wa s damag e t o landscapin g o r plan t material s avoided ? 

## y y
Gates
. Fepce aan dRetatoln g Wall s Ye s I 1
. O o gate s openan dcio.s e freely? (Ifappiicable ) 

# y 2
.Wer e al l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinsulled ? (I f applicable ) 

# r
3
.Wa s danug e t o gate s o r fence s avoided ? (I f applicable ) / 4
.Wa s damag e t o reuinin g wall s avoided ? (Ifappiicable ) 

# 7
FouDdatioB , Sidintaa dGnlte n Ye s 1 Wa s dainag e t o th e sidin g o r tri mavoided ? / 2
.Wa s danng e t o th e foundatio navoided ? 

# y "y

.Wa s damag e t o window s avoided ? 

# y 4Wa s damag e t o window s o r doo r screen s avoided ? 

# y 5
. Wa s damag e l o downspout s o r downspou l extension s avoided ? 

# J
Sidewalk s an dDriveway s (Concrete ) Ye s I
. Wa s damag e t o drivewa y surface s avoided ? / 2
. Wa s damag e t o walkwa y surface s avoided ? 

## y > .

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N o

Nl )

N

o

N o

### OM'DCF S 

## comments :

jln.«:pectio nnotes :

Removal andresloratio nactivate s complete includin g th e 30-da y so dwarranty : EPARepresentativ e JS Lj^ LDate : TiSOJl o

## Propen yCompletio n Agreemen t
Ihi s agreemen t documents th e completio n o t remedia l activiiie s perloime d o n mypropert yM ysignaiui e wil l designat e ihat I a m satisfie d wit h th e restoralio n o fm yproperly , an d tha i n o item s ar e i n queslions

. now . o ra t an ylim e i n th e future , except Ihos e item s liste d below , i fan y PropertylD : 9,T^^ \ Propert y Address : ^^ ^ ^ -^ ^ ^ ^ Owne r 

### ^•^fr^ yCbxatAA.Arp ^

W V Phone : 

### ^0^-Vl^^Vr^^' B Restoratio n Item s i n Question :

Item : ttem : Item : Item : Item : Item :

lY I I agre e i'e.«toralio n i s complcled , excep t a s note d [_ J i d o no t «i;re crestorApo s i i como^e d

Cont i arlor' s Signatur e if DaU r

# Propert y Owner Assessmen t

o f

Performancef'orH r America nRecover y an dReinvestmen t Ac t (/^R)8A^ 4 201 0 Omah at^^^^erfun dSitg^jp^j^^ ^ ^^^ ^

Remediatio nContractor : Coasta l Environmenta l Grou p - EP-R7-09-0 6 Propert y Identifie r Nuniber : CX'y^?> \ Propert y Address : \\ \<;. ^ ^f t ?^
. Propert y Owner' s Name : '^wV v C^r...^Xron.,
. Instruction s t o th e Propert v Owner : Thi s for mserve s to recor dth e Propert y Owner' s assessmen t of performanc e (Incentiv e 1

- Qualit y Assuranc e Surveillanc e Plan ) involvin g th e liste dremediatio ncontractor , a s applicabl e to th e Omah aLea dSite
. Thi s formdocument s th e timelines s of punchHs t resolution , busines s relations , complaint resolutio nandth e overal l qualit y of work
. I f needbe , the Propert y Owne r ma y utiliz e thi s for mto recor dproblem s and/or issue s no t specifically tie dto a nassigne d address , for example , busines s relation s tha t generally don' t follo w the guideline s set fort hi nthe Perfonnanc 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 annmerica i ratin g o nth e tabl e belo w usin g th e nmnerica l deiinition s fix>m the 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 v Owner' s Assessment o f Performanc e Regardin g th e Contractor' s Wor k 

# 10 _X ­ 

# ^ 9 8 4 3 7 2 6 1 Propert v Owne r Additiona l Comment s fro m(optional ; continu e onbac k pag e i f needed l
Propert y Owne r Signature : /^// Y .^^/ ^ ^Date : / l^ f