## TRANSMITTALo f

OMAH A LEA D SIT E SOILREMEDIATIO NFIL EFOLDE R
SAID # 

# ^^<^T ) Date : \L/l ] Address : Yjo ^ \ \ h ^ ^ f Remediatio nContractor : Coasta l Environmenta l Group

_Year : _2010ARR A SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 

# 4 Vide o o f property (DVD ) • Executiv e Summary B EPA-provide dproperty sketc h M Signe dAcces s Agreemen t fo r subjec t property —9' / Signe dAcces s Agreement(s ) fo r adjacent property B Restoratio nAgreemen t 

## / Settlemen t document s (i.e. , fo r damag e o r to replac e plants , etc. ) ^B ^ Confirmatio ndat a



## / I ZPhotograph s \U ^ ^/!>Vt<V--^v\^ h^fAVAV-tr ^ V f* V As-buil t sketc h Satisfactor y restoratio nsigne db y Property Owner / 

### Property close-ou t chec k lis t signe db y EP A JJ

—Descriptio nofarea s no t meetin g RO D cleanu p criteri a Utility clearance s Property informatio nfro mDougla s Count y Assessor' s Offic e

Signature "^ Date 3021809 6 

# iilHllll l Superfun d^ 

## Propert yAcces s Checklis t PropertylD : ;:^3'=^(^( ^ nWOR K STARTE D ON : / / PropertyAddress : :^^ ^ /V l / 7 .S f nWORKCOMPELTE D ON : / / Owner: , )^^p ^ . IAIOA^/ I 

### Renter : Address : Phone : Fax : Cell/Pager : Phone:-7^-7_Qgq ^ Additional Inforniation : Fax : Cell/Pager : 

# Sam e

D Notificatio nLette r Sent : / / By : r ^ Acces s Agreement 

## Signed : 2^/2_// 0 By : p nRestoratio nAgreement Signed : 3 /(J_/A 9 By : D Topsoi l Samplin g (if applicable ) 1 1 By : D Disposa l Samplin g (if applicable ) 1 1 By : D Garde nSamplin g (if applicable ) 1 1 By : CS

^ Utilit y Clearanc e CaUed:f!)b/aL* ? /> 0 

## 8y = (5b>l'^ ^ /\ o
- VOirAv
. Vftrov 

### j aVideo/Photo s (Before) 

## On: 2-1 1 S'l l o By:V?^'/^?c/4 / 

## f, c -Andl y D Video/Photo s (During ) On : / / By : D Video/Photo s (After) On : / / By : D Video/Photo s (30-Day ) On : / / By : Q Propert y Completio nAgreement Siened : / / By : nFinal Report Issued : / / By :

- • • 

### Air Monitorin g (a s applicable )
• communit y • Cre w On : / / By : • 1 Results :

• Conmiunit y • Cre w On : / / 

### By : 1 Results :

• Communit y • Cre w On : / / By : Results :

Omah a Lea d Sit eDjougla s Cotmty Accoimt InfoiaMtio n Pag e 1 of 3 Dougla s County , Nebrask a Propert yRecor d - R070166000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f 52n d S t - VJe WO n Ma p Informatio n i s vali d a s o f 2009-12-1 5 Treasurer' s Ta xRepor t Ne wFeatur e -•-•• • Aut o Sale s Searc h Owne r JOHNSO N JAME S C ETA L 390 9 N 1 7 S T OMAH AN E 68110-000 0 Propert yInformatio n Ke yNumber : 016 6 000 0 0 7 Accoun t Type : Residentia l Parce l Number : 070166000 0 Parce l Address : 390 9 N 1 7 S T OMAH AN E 68110-000 0 Lega l Description : BOULEVAR D PAR KAD D LO T1 2 BLOC K9 N 4 0 FT4 0 X 16 0 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $ 7,000.0 0 $ 33,300.0 0 $ 40,300.0 0 200 8 $ 7,000.0 0 $ 32,000.0 0 $ 39,000.0 0 200 7 $ 7,000.0 0 $ 32,000.0 0 $ 39,000.0 0 200 6 $ 7,000.0 0 $ 28,000.0 0 $ 35,000.0 0 200 5 $ 7,000.0 0 $ 10,300.0 0 $ 17,300.0 0 200 4 $ 7,000.0 0 $ 9,300.0 0 $ 16,300.0 0 Sale s Informatio n Sale s Date : 2007-01-1 2 Dee d Type : W D SooIr : 200 7 Page : 00629 2 Price : $39,000.0 0 Grantor : HOUGHTO N DEWE YE ETA L Grantee : JOHNSO N JAME S C ETA L Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 1999-09-2 4 Dee d Type : Book : 213 5 Page : 35 7 Price : $ 12,000.0 0 Grantor :
http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accoimtno=RO.
. . 12/30/200 9

### Dougla s County Accoun t Infoan^io n Pag e 2 of 3 xma^ i
Grantee : Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 1999-04-0 6 Page : Dee d Type : Book : 212 7 42 7 Price : $ 10,000.0 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 4 6400. 0 1. 0 160. 0 40. 0 N o Improvemen t Informatio n Buildin g 1

390SN1TS T Saeon d FittOf 

### W

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. StS.Oa q •

FITS ! Floo r 3» r I d« » 

# 7 11 1 IIP
t 1, TSTOR Y•' - ^«T! ' Bsmn t Bloci i R I I 9ST5»«I
. CLIC KTO ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1474. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Fai r

Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 7. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo fCover : Compositio n Sliingi e Bedrooms : 4. 0

Roo f Type : Hip/Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO.
. . 12/30/200 9

## Qougla s Coimt y Accoim t Infojjm|tion Pag e 3 of3 )ij|^ C

Yea rBuil t 191 0 Detai l Typ e Ad d O n Applianc e Basemen t Fixtur e Fixtur e Garag e Porc h Porc h Yea r Remodele d 0 Percen t Remodele d 0 % Detai l Descriptio n Fenc e Chai n Lin k Allowanc e Bsmn t Bloc k 8 ft Bas e Fixture s Bat h Ful l Detache d En d Scree n En d Scree n Adjuste d Yea r Physica l Ag e Buil t 191 0 9 9 Unit s 1. 0 1. 0 958. 0 1. 0 1. 0 324. 0

25. 0 147. 0



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO..
. 12/30/2009

### Pag e 1 of 2

" > I ; Creat e AnotherTjcke t | , ^ Bac k t o Irt h Interne t I [; Sen d Emai l ]



### • YOU RTICKE T NUMBE RI S 2445484 . Origina l Cal l Date : 3/25/1 0 Time : 1:4 3 p mOp : ELIZABETH1879 0 Wor k t o Begi n Date : 3/29/1 0 Time : 2:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 390 9 Street : N17T H 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 : LOCAT E ENTIR E PROPERTY , AL L EASEMENT S AN D T O TH E PEDESTA L 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 FT . Come r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MAGELLA NMUDO l OMAHACO F OPPDGPR 5 QLNNEI C



### Servic e Are a Contac t Phon e Number UtiUt y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEIDI Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
»,

f A ^c T T A X T MAGELLA NMIDSTREA M PARTNER S r.cDr»T > AX I MAGELLA N. p DEBORA H Day : 918574709 8 Alt : 

### Emerg : 918574709 8
MUDO l METROPOLITA NUTILITIES DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0
OMAHACO FCIT Y O FOMAHA-TRAFFIC.SEWE R RICHA-RAFFI C 

### Day : 402444719 7

AU : 402444516 1 Emerg : 402444516 0
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 3/25/201 0

### Pag e 2 of 2

0PPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T ELM LOCATIN G 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNNEI C QWES T LOCALNETWOR K ELM LOCATIN G 

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

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 3/25/201 0OLS# : 3356 0 

# As-Buil t Drawin g ^ Dat e Excavated : 3/26/1 0 Dat e USEP ASiane d Off : 7/8/1 0 COASTA L ENViaONHCNTA L 

# Omah aLea dSuperfun dSit e Are a Sodden : 135 3 s o f t C • O U P
. INC
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" < PM^ ^ COASTA l INVIIOHKIItU I C I t O U P . I ft C 

## Consen t fo rAcces s T o Propert y RIGH TO F ENTRYTO PREIVIISE 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 : ^

Owner' s Name : Daytim e Phone : 

# 70 7 •0^'^ r
Addres s o f Propert y 

# 3-10 1 

# Ans T 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 that contain s elevate d concentration s of lead an d ma ypos e a healt h hazard
. Th e area(s ) wil l be excavate d t o remove contaminate d soil
. Th e remove d contaminate d soi l wil i be 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 , 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 revie wan d approve th e planne d soi l removal , an d restoratio n work 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 wor k 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 vinitte n documentatio n fro m 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 , It s employees , contractor s an d subcontractor s th e right t o ente rth e property , a t al i reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e of performin 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 agree s to :

Pag e 1 o f2COASTA L mriiioNKticii i 

### €

Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; cRemov e flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t ma ywis h t o save ; « Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessarysubsequen t t o a n initia i waterin g perio d b yEPA ; cAbid e b yhealt h an d safet yguidanc e provide d b yEPA ; •I f th e propert yi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propert yt o perfor m th e work
. cAllo wvideotapin g and/o rphotographin g o f th e property
. AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s no t t o interfer e o rtampe rwit h an yo f th e wort < activities , o rwit h an y o f th e wor k done , o rwit h th e equipmen t use d o n hi s property , o rt o undertak e an y action s regardin g th e us e o f sai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o 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 . Should 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 y Slg r D I d o not gran t acces s t o m ypropertie s I gran t access t o m ypropertie s 

# i

^

<^g./^2// ^ Dat e Signatur e Dat e 

## ©fw o woul d iik e t o b e presen t durin g an ysamplin g tha t i s required
.

Pag e 2 o f 2

### ^ COA S T AL • MV I nO M M S NTA L C 1 1 O U P , INC
. 

## Restoratio n Agreemen t The purpos e ofthi 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 documentationfo 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) .

Propert y ID : "zr^^^* ^ PropertyAddress ; 37 ^ A j /V^T^ Owner : J^^^flQ ? ^ JiT'ty^C^'S C U ; 

### Plione ; -707-0^ ^ 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 usedby the contractors . Indicat 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 if necessary . Item s t o b e Remove d b yth e Owne rbefor e Star t o f Remediation : Tli e removai , storage , disposai , and/o rretur n o fthes e item s i s th e Owner' s responsibility
. item : 

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# ( I p laHt j i~ o l e A / Kr^o j - C Item : 

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# n y 

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0 1 Kem : 

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## Landscap e Inventor y Ite m Quantit y Uni t Condition/Type/Specie s Pre-existin g propert y area , 

# F^/f? ^ Quadrant s that wil l b e excavated , that i s covere dwithgrass . Numbe r o f tree 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 Fee t 

# i t < 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 v contractor . $ Not e thi s valu e wil l b e use dt o issu e aplan t 

# 0
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# O. XCOASTA L • MVinONNINTA L O ft O U P
. IHC
.
AddKiona l Comment s / Instructions : Th e cKyo f Omah a ordinance s ma yprohib Kyo 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 f soi l doe s no t mea n tha t an yiiiega i 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 cKyo fOmaha' s Plannin g Departmen t a t (402 ) 444-5150
. I^PIeas e chec k thi s bo xi f yo u understan d th e Informatio n outline d above
. 

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d l Chec k th e bo xi f Owne 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
.



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# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Biilerica , 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

Pb Supervise d By : 

### Certifi c

9 0 SOI L 2010-03-2 7 13:0 3 91.3 9 Fina l 

### r^a-OLgZrfiS J 390 9 N 1 7 s t F 2 6 " N
. LOPE Z confirmatio n non e

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

## Certificat e o f Verificatio n XL3t-3902 2 Readin g N o 8 7 Mod e SOI L Tim e 2010-03-2 7 13:0 2 Duratio n 30.4 5 Sequenc e Fina l Flag s BVI D 3356 0 ADDRES S 390 9 N 1 7 s t QUADRAN T F 2 DEPH T 6 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e
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# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Biilerica , 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 158.50 6 Supervise d By : 

## Certificat e o f Verificatio n

8 8 SOI L 2010-03-2 7 13:0 3 30.5 4 Fina l 3356 0 390 9 N 1 7 s t F 2 6 " N
. LOPE Z confirmatio n non e

± Erro r ± 18.97 4

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Biilerica , 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 144.20 3 Supervise d By : 

## Certificat e o f Verificatio n

8 9 SOI L 2010-03-2 7 13:0 3 30.4 0 Fina l 3356 0 390 9 N 1 7 s t F 2 6 " N
. LOPE Z confirmatio n non e

± Erro r ± 18.24 9

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Biilerica , 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 By : 

## Certificat e o f Verificatio n

8 1 SOI L 2010-03-2 7 12:5 7 91.2 1 Fina l

vgo f 78-8d~ l 390 9 N 1 7 s t D Z 10 " N
. LOPE Z confirmatio n non e

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 197.13 3 Supervise d By : 

## Certificat e o f Verificatio n

7 8 SOI L 2010-03-2 7 12:5 5 30.4 4 Fina l 3356 0 390 9 N 1 7 s t D Z 10 " N
. LOPE Z confirmatio n non e

± Erro r ± 19.90 5

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Biilerica , 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 198.59 9 Supervise d By : 

## Certificat e of Verificatio n

7 9 SOI L 2010-03-2 7 12:5 6 30.1 6 Fina l 3356 0 390 9 N 1 7 s t D Z 10 " N
. LOPE Z confirmatio n non e

± Erro r ± 22.20 3

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Biilerica , 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 188.97 0 Supervise d By : 

## Certificat e o f Verificatio n

8 0 SOI L 2010-03-2 7 12:5 7 30.6 1 Fina l 3356 0 390 9 N 1 7 s t D Z 10 " N
. LOPE Z confirmatio n non e

± Erro r ± 19.39 0

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

## Certificat e o f Verificatio n XL3t-3902 2 Readin g N o 7 7 Mod e SOIL Tim e 2010-03-2 7 12:5 1 Duratio n 91.0 2 Sequenc e Fina l Flag s AVERAG E 

### CStg-of-74-76 / ADDRES S 390 9 N 1 7 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

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 121.33 9 Supervise d By : 

## Certificat e o f Verificatio n

7 4 SOI L 2010-03-2 7 12:5 0 30.3 9 Fina l 3356 0 390 9 N 1 7 s t easemen t 1 " N
. LOPE Z confirmatio n non e

± Erro r ± 16.67 3

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

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

pp m P b 140.27 1 Supervise d By : 

## Certificat e o f Verificatio n

7 5 SOI L 2010-03-2 7 12:5 1 30.4 8 Fina l 3356 0 390 9 N 1 7 s t easemen t 1 " N
. LOPE Z confirmatio n non e

± Erro r ± 17.52 0

# Therm o SCIENTIFI C Therm o Fishe r Scientifi c 90 0 Middlese x Turnpik e Bilierica , M A 0182 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 133.04 7 Supervise dBy : 

## Certificat e of Verificatio n

7 6 SOIL 2010-03-2 7 12:5 1 30.1 5 Fina l 3356 0 390 9 N1 7 s t easemen t 1 " N
. LOPE Z confirmatio n non e

± Erro r ± 19.08 6

## /^A. i Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 I ^^^2 L s Coasta l Environmenta i Grou p Inc
. vl ^ ^ ^ \*^^ ^

www.coastalhazmat.co m ^'•t«iO^'=^ COASTA L mVIIOHHEIIT U Ciour , IN C 

# EXECUTIV ESUMMARY : BVID #33560-(390 9 N1 7 ST ) No Issue s o r Concern s [ ^ Issues/Concern s Detail Explanation : -DA NGARVE Y WALKE D TH EPROPERT Y O N7/8/201 0

## EP A Propert y Clos e Ou t For m Propert y # : lihS.hO
. Propert y Addr«s : ^^^ ^ ^ , ^ ^ SV . Daten'lmc : Owner' s Name: . /i>lrKtr\P>f.
. . . ^J^fJ O ^"^ ^ - - Quad s Excavated : Contracto r Grou p Yes No Excavatio nGenera l 1 . I r necessaiy , wer e th e correc t quadfant(s ) excavate dan drestored ? 

### • 2 . I r necessary , wer e th e correc t area s o r dri p zon e excavale dan drestored ? 

### y Ye s N o Gradin g So dan dVegetotki B I . Doc s tl w gradin g aroun dth e perimete r ofth e hous e i nexcavate darea s generall y slop e away 

## y fromth e house ? 2 . Ha s so dbee nlai di nal l area s that wer e excavated ? 

# y 3 . Doe s th e so dappea r l o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte dai a3 0 

### y da y tim e period ) 4 . Ar c sodde darea s generall y firman devenl y graded ? 

## y 5 . Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 da y 

## y tim e period ) ' ^
_ 6 . Wa s th e property grade dsuc hthat wate r wil l no t poo l onth e property ' 

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

# ~ y Gates . Fence s an dRemaln g Wal b Ve s N o I 1 . O o gate s ope nan dclos e freely? (t f applicable ) 

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

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

## y Foundatioo , Sidin g an dGntle n Ve s N o 1 . Wa s damag e t o th e sidin g o r tri mavoided ? 

## y 2 . Wa s damag e t o th e foundationavoided ? 

## y ? . Wa s damag e t o window s avoided ? 

## y 1 4 Wa s dainag e t o window s o r doo r screen s avoided ? 

# y 3 Wa s damag e i o downspout s o r downspou l extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Ye s N o 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

## Ort'Der s comments :

Inspectio nnotes :

Removal andresloratio nactivate s complel e includin g the 30-da y so dwarranty : EPA Representativ e QQ ^ :A ^ Date : z/g/A ?

## Propert yCompletio n Agreemen t ihi s agieemen i documenl s lh e complclio n ofremedia l activitie s perioime d o n mypiopert yM ysignature wil l designal e llia l I a m satisfie d wit h lh e restoralio n o fm yproperly , an d iha l n o item s ar e i n questions , now , o ra l an ylim e i n th e fuluie , excep l Ihos e ilem s liste d below , i fan y



### Property ID : ~^^ < PropertyAddress : "^^^ J] J 1 ^ 'S^T"^ ^ Owner : f^^^,^e' ^ ryJli^'JrYY ^
Restoratio n Item s i n Question :

Item : 

# VjefAo
. M^^ e Dt . Item : 

### Item ; Item : Item : Item : Additiona l Comments :



# y restoralio n i s completed , rxccp t a s note d S ^ 1 HfC C I ( [_ J I d o no l af>re cresroratin n i > complele d 

# /r^ c Dat e Cunt i arloi' g Sicnaliir cDal e

## Wate rBil l Settlemen t

Property I D 33560 Property Addres s 390 9 N1 7 S t Tenant Janie s Johnso n

1 hav e receive d fromth e contractor . Coasta l Environmenta l Grou p Inc . (Coastal) , th e sumo f $ 13.8 7 for wate r usag e require dt o maintai nth e sod
. Check Number 195 4 Valu e o f Check $13.8 7 Mad e Ou t T o Jame s Johnso 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
. IM

ysignatur e belo wi s acknowledgemen t o f th e receip t o f tli e su m liste d above , wliici i I furtlie r acknowledg e t o b e fai rcompensatio n an d fui i paymen t fo rth e above , an d releas e Coasta l Environmenta i Grou p Inc
. fro m furthe robligation s o rliability
.



### Contractor' s Signature Date COASTA L ENVIRONMENTA L GROU P INC
. 

## 1954 241 1 MARTH ASTREE T OMAHA , N E 68 1 O S 27-S/104 0 00 3 6247372904 

# iHi o ' o DAT E PA YTO TH E ORDE RO f 

# A}mfi9 > Jijnnffip n $13 ^ 'Vf\K^H)0(\/{\A^llO O

. DOLLAR S @ WklliFirgoSafik.MA
. NAw b vwlsfai^ixo m FO R 

# 1^^/ D 5:?fsi..r > ^^[$ \ k

\

n^<^ y^fius^M ^ a&Qi ^ 1:101.000 0 sa n E.2l«7i7E=10l,ii ' OnS U
HartvxJOwlt f

### @ ^

'•A: > 

### > L 'j;! ^ 

# Propert y Owne r Assessmen t o f Performanc e For m America nRecover y an dReinvestment Act (ARRA ) Omah aLea dSuperfundSite 2009/201 0 Remediatio nContractor : Coasta l Environmenta l Grou p - EP-R7-09-0 6 Propert y Identifie r Number ; .'^ ^ 0~C ^ O Propert y Address : 3*^( 3 H K i i Propert y Owner' s Nam e 

# u .lannfer s u<?)V\f^^.(O^ A Instruction s t o th e Propert v Owner : Thi s for mserve s to recor dth e Propert y Owner' s assessment o f 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 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
. If 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 relations that generally don' t follo w theguideline s set fort hi nthe Perfonnanc e Wor k

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

b y checldn g annmerica l ratin g o nth e tabl e bdo w usin g th e numerica l definition s fro m the ratin g scal e below , thensig n& 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 Perfonnanc e Regardin g th e Contractor' s Wor k 1 0 5 8 \ y3 7 2 6 1 Propert v Owne r Additiona l Comment s from(optional ; continu e o nbac k pag e i f needed ) Propert y Owne r Signature ; 

# O^^/r^/f o