## TRANSMITTALo f

OMAH ALEA D SITE SOILREMEDIATIO NFILEFOLDER
SAID# : vgBl ^ 

## Date : l|Z7| U Address : 330 8 N i 2. ^ b t Remediatio nContractor : Coasta l Environmenta l Group

_Year : SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S / 

### Vide o o f property (DVD ) Executiv e Summary EPA-provide dproperty sketch 

## 'x/. Signe dAcces s Agreemen t fo r subjec t propert y Signe dAcces s Agreement(s ) fo r adjacent property / 

### Restoratio nAgreemen t Settlement document s (i.e. , fo r damag e or t

o replac e plants , etc. ) Confirmatio ndat a 

# r r Photograph s m(V^(^ATt^v i Y ^UK\irX\Jt/^ > ; / ^ As-buil t sketc h 

# 4 Satisfactor y restoratio nsigne db y Property Owner Property close-ou t chec k lis t signe db y EP A Descriptio no f area s no t meetin g RO D cleanup criteri a Utility clearai^ce s latio nfro mDougla s Count y Assessor' s Offic e 2010ARRA
_



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## Propert yAcces s Checklis t Propert y ID : ;:^/^y ^ Propert y Address : c^:^^ ^ ^ j q.^- f n nWOR K STARTE D WORKCOMPELTE D ON : ON : / // / 

# r Owner : pj^^.^^f^ ^

Address :



## 50S U himete^ K Phone : q^3, ^ q,<^| ^ Fax : Cell/Pager : W^rf^^A ^ 

## 3^ - Renter : Phone : Fax : Cell/Pager : Additional Information :

D Notificatio nLette r ^ Acces s Agreenient /C

j Restoratio nAgreenient D Topso U SampUn g (if appUcable) Q Disposa l Samplin g (if appUcable) GGarde nSampUn g (i f appUcable) ^ UtiUt y Clearanc e 'Q ^ Video/Photo s (Before ) D Video/Photo s (During ) D Video/Photo s (After) D Video/Photo s (30-Day ) r~l Propert y Completio nAgreement GFinal Report Sent : / / 

## Signed: H/ZL/i Q Siened : M l~ \1 \ 0 1 1 1 1 1 1 CaUed:O S IW/ l o On:i \ITDI ^ On : 1 1 On : 1 1 On : I I Siened : / / Issued : / / By : By : By : By : By : By : ^y = ^^h^U o VxJa<>ol^ 

## By = Gc^oxA O By : By : By : By : By : OtollV ) 1 

## (Wc> ^

Ai r Monitorin g (a s appUcable ) GCommunit y GCre w Results : On : / / By :
GCommunit y Results : GCre w On : / / By :
GCommunit y Results : GCre w On : / / By : 

# k Omah a Lea d Sit e

### ^Dougla s County Accoun t L||ya^io n Pag e 1 of 2 # « Dougla s County , Nebrask a Propert yRecor d - R130300000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t o fS2n d S t - VlO WO H Ma p Informatio n i s vali d a s o f2009-10-1 5 Treasurer' s Ta xRepor t Ne wFeatur e ^ - » • • Aut o Saie s Searc h Owne r FOXAL L COLLIN S ETA L C/

O ADRIEN E HIGGIN S 505 6 HIMEBAUG H S T OMAH AN E 68104-000 0 Propert yInformatio n Ke yNumber : 030 0 000 0 1 3 Accoun t Type : Residentia l Parce l Number : 130300000 0 Parce l Address : 330 8 N 2 4 S T OMAH AN E 68110-000 0 Lega l Description : HAWE S AD D LO T1 BLOC K0 N 1/ 4 3 3 X 128. 7 Valu e Informatio n Lan d Improvemen t Tota l 

### 200 9 $500.0 0 $56,200.0 0 $56,700.0 0 200 8 $500.0 0 $56,200.0 0 $56,700.0 0 200 7 $500.0 0 $52,400.0 0 $52,900.0 0 200 6 $500.0 0 $52,400.0 0 $52,900.0 0 200 5 $500.0 0 $52,400.0 0 $52,900.0 0 200 4 $500.0 0 $17,100.0 0 $17,600.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 9 4224. 0 1. 0 128. 0 33. 0 N o Lan d Attribute s Attribut o Attribut o Descriptio n Negativ e Influenc e Traffi c1 Improvemen t Informatio n Buildin g 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl.
. . 10/22/200 9

### Dougla s County Accoun t I

[j£|j|M^io n 

### Pag e 2 o f 2 # #
Rarwi i mudDK k 330 8 N 2 4 S t ww n C m OflTw r

. F M FlM > t-
. I

I2 C
ErKl5oldW « 1.1 4 C'S q C l
BumBbcUai t !IS40S 4 F l CLIC KTO ENLARG E IMAG E Squar e Footage : 1140. 0 Percen t Complete : ; 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

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 Sidin g Units : 1. 0 Interior : Drywal l Battis : 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 2. 0

Roo fType : Hi p Stories : 1. 0 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 0 198 8 0 % 191 3 9 6 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Applianc e Fireplac e Masonr y 1. 0 Basemen t Bsmn t Bloc k 8 f t 984. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 576. 0 Porc h En d Soli d Wal l 144. 0 Porc h Woo d Dec k 24. 0 Use r Bus yStreet-10 % 1. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl.
. . 10/22/200 9

### Pag e 1 o f 1

Creat e Anothe rTicke t Bac k t o Irt h Inteme t ,g_._-^o ^ 

# ] E IL—?gQ^^[OgJJ--i |



### • YOURTICKE T NUMBERI S 2560596
. Origina l Cal l Date : 8/04/1 0 Time : 6:0 3 p mOp : ELIZABETH1879 0 Wor k t o Begi n Date : 8/09/1 0 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 330 8 street : N24T H S T Twp : 15 NRng : 13 E Sect-Qtr : 09-NE,10-N W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATIO N Locatio n o f Work : LOCAT E ENTIR E PROPERTY , AL L EASEMENT S AN D T O TH E PEDESTA L Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E I F CORNE R LOT . Compan y: COASTA L ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : COASTAL Dept h o f Excavation : 4 F T Come r Lot : N Front : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Servic e Are a Contac t Phon e Numbe r Utilit y Typ e 

### Day : 402934046 9 CXCAT V COX COMMUNICATIONS , INC HEIDI 

### Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUDO l METROPOLITA NUTILITIE S DISTRICT SANDY 

### Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCITYOFOMAHA-TRAFFICSEWE RRICHA'RAFFIC Alt : 402444516 1 

### Emei^ : 402444516 0 

### Day : 406728934 3 0PPDGPR 5 OMAH APUBLIC POWE RDISTRICT EL M LOCATINGAlt : 406207149 4 

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


### http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 8/4/201 0

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e ENVIKOMMEMTA L C « O U P
. IM C OLS# : 3131 2 Dat e Excavated : 8/12/201 0 Dat e USEP ASigne d Off : 11/2/201 0 Are a Sodden : 107 0 s a f t 

### 3131 2 Exterio rPain t Omah a Lea d Sit e H Goo d Sit e Sketc h • Poo r Samplin g Address : 330 B N 2 4 S T r | Notpain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Rrm : fp B PB.3 P RYASCPXA-3131 2 F l pp m 

### D Dat e *;-"^ 0 -Of e RYBSCPXA-3131 2 F 2 pp m 

### D Time : •7,--< » p-|V^ - RYCSCPXA-3131 2 B l 

### 37 i

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### D Sample s Analyze d RYDSCPXA-3131 2 B 2 

### 182
. , pp m 

### D RDZSCPXA-3131 2 D Z pp m 

### D XR F Unit : Ctf^ O Book : TJC D nOZOCPXAOISI Z 8 2 pp m 

### D Date : j^ - r 7 ' O Q 

## n nPgGCPX A3131 2 Pg - . pp m 

### D Time : 

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### Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are areplace d So d wit h Are a replace d wit h Rock/Mulc h Are a lef t bar e 

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

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# V^^cK^V ^ ^^ ^ ^'^-^^^ 3131 2 -&?^Tr~-~U ^ Exterio rPain t Nofl h Arro w Omah a Lea d Sit e Q'GOOC I Sit e Sketc h • Poo r Samplin g AdcJress : 330 8 N 2 4 S T Q No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : Ft? R PB.3 P RYASCPXA-31312 " F l • 2^ ^ pp m 

# \Z \ D Date : Sl O -Og , RYBSCPXA-3131 2 -¥ 2 -.?6 3 pp m D Tim e ^-.Q O p-rA
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## £t L Staff : MSU / nbe ro f Sample s • 

# H Legend : F 1 =^Frd m teft ; F 2 =Tront^ht
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. P Z = Pla y Al l quadrant s ar e a s viewe d fro m th e street , facin g propert y 

# y y

R«v2lX)8..1 A(realtd : l?-Mar.O «

## 3131 2 Exterio rPain t Nort h Arro w Omah a Lea d Sit e Q^Goo d Sit e Sketc h • Poo r Samplin g Address : 330 8 N 2 4 ST r~ l No t pain t Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Firm : Sample s Collecte d FPft PB.3 P RYASCPXA-3131 2 F l _25L^L_PP m 

### D Date
. S-1 0 'Of e RYBSCPXA-3131 2 F 2 • ?6 3 pp m 

### D Time : -7,-.0 & ^-tA RYCSCPXA-3131 2 RYDSCPXA-3131 2 8 1 B2 3"7 M ")8 Z pp m pp m 

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# n Sample s Analyze d RD2SCPXA-3131 2 D Z pp m 

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### D P M Staff : M?V ^ Numt)e ro fSample s = | 5 ^ | | Q | Legend : F l = Fron t Left
. F 2 = Fron t Right
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.
COASTA I EflVIIOHHIHt« t C « O t l r. I h C 

## Consen t fc fAcces s T o Prop&rt 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 :

Owner' s Nam e Daytim e Phone : y^Z) ' -^P ^

Addres s o fPropert y 

# ^^ a K i -zM:^ ­ 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 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 be 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 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 perfomned , th e Granto rwil l hav e a n opportunit yt o reviewan 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 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 vwitte 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 agree s to :

Pag e 1 o f2COASTA L ' ^ Z ^ IKVmONKfKTt l ^ 1 PROt t 6 * O U rt N 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 ; « 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 ; 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
. 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 wothers 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



# i 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^ (f' SIg i Dat e Signatur e 

# f 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 f2C O AS TAL I H O U P , INC
. 

### Restoratio n Agreemen t The purpos e of thi s agreemen t is to provid e amutua l agreemen t as to condition s ofth e propert y prior to remediationactivities
. Thi s will als o serve as documentationfo r

the purpos e of assuring tha t restoration activitie s ar e completed to the satisfaction of the propert y owne r an dthe UnitedState s Environmenta l ProtectionAgenc y (EPA)
. Propert y ID : 3/5/;2

- Propert y Address ; g,^^ ^ J ^^f" ^ ^n"
.

: j iR o (^*^ / li
. J ^ Phone 

### : qp^^ , O^C^ ^ Onthe attacheddiagram(s ) indicat e area(s ) to excavate , surface structure s an dlandscapin g feature s an d acces s location(s )tobe used by 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 to be Remove d byth e Owne rbefor e Start of Remediation : Th e removal , storage , disposal , and/o rretu m of thes e item s is th e Owner' s responsibiiity
. Item : 

# An\ ^ fSfYini fp/(i/)f s VciTix ^ Hem : Kem : Item :



### Item s tobe Remove d byth e Contracto rDurin g Remediatio n an d No t Replace d Item : 

### h.r^^^ ^

-SYV^nJ J plfiAV ^ \of f WW./v> \ Kem : Kem : Kem :



### Pag e 1 of JCOASTA L 

## Item s t o B e Remove d B yContracto rDurin g Remediatio n an d Reolace d Kem : 

# So l k Sot > - :^^tvs ^ z,oiz.[ ^ Kem : 1 / 1
Kem : Kem :



## ite m Pre-existin g propert y area , that wil l b e excavated , that i s covere dwit hgrass . 

## Landscap e Inventor y Quantity 

# ^^ ) vz . Unit Quadrant s 

## Condition/Type/Specie s

Numbe r o f tree s > 2 inc h trunk diamete r Eac h
Numbe r o f tree s < = 2 inc h trunk diamete r Eac h
Numbe r o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Attac hasketc ho f th e sprinkle r layout
. 

# M A

- Eac h

Numbe r o f an dsiz e o f eac hgarden/ flower be d area . Attac hasketc ho f relativ e size s an dlocations
. Eac h Squar e Fee t
Agree dupo nvalu e ofplan 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 vouche r t o th e propert y owner . $

Fasemen t Area , t o b e excavate d Eac h
Pag e 2 of
.C O A5 TAL O • O U F
. INC
.


### Additiona l Comment s / Instructions : Th e cit yo fOmah a ordinance s ma yprohib Kyo u fro m usin g dir t o rgrave i area s o n you rpropert y a s driveway s o rvehici e parkin g areas . Th e Environmenta l Protectio n Agenc y(EPA ) ma yb e removin g an d repiacin g soi i underiyin g a grave i o rdir t are a o n you rpropert ytha t yo u ma yb e usin g a s a drivewa yo rvehici 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 repiacin g o f soi i 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 cKe 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 wKhstandin g an yremova i o rreplacemen t o fsoi i b yth e EPA
. I fyo u have an yquestio n abou t legaiK yo fa certai n drivewa yo rparkin g area , yo u ma ycontact th e cK yo fOmaha' s Plannin g Departmen t a t (402 ) 444-5150
. Q Pieas e chec k thi s bo xi fyo u understan d th e informatio n outline d above
.

Q 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
. 

### O I d o no t agre e

Ontractor' s Signatur e Date Pag e 3 of
.

## BVI D #3/3ll
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# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurhpik e Billerica , M A0182 1

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Supervise d By : 

## Certificat e o fVerificatio n

12 1 SOIL 2011-01

- 1 9 13:0 7 90.8 6 Fina l Avg of 118-12 0 330 8 N 2 4 S T B 2 4 " 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

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pp m P b 236.36 4 Supervise d By : 

## Certificat e o fVerificatio n

11 8 SOI L 2011-01-1 9 13:0 6 30.2 9 Fina l 3131 2 330 8 N 2 4 S T B 2 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 23.10 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 237.52 8 Supervise d By : 

## Certificat e o fVerificatio n

11 9 SOI L 2011-01-1 9 13:0 7 30.3 3 Fina l 3131 2 330 8 N 2 4 S T B 2 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 23.70 3

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 12 0 Mod e SOI L Tim e 2011-01-1 9 13:0 7 Duratio n 30.2 4 Sequenc e Fina l Flag s BVI D 3131 2 ADDRES S 330 8 N 2 4 S T QUADRAN T .B 2 DEPH T 4 " XR F TEC H C.PADILL A MIS C CONFIRMATIO N NOT E CLEA R

pp m ± Erro r P b 231.94 2 ± 23.63 3 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 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 7 SOI L 2011-01-1 9 13:0 3 90.5 4 Fina l Avg of 113-11 5 330 8 N 2 4 S T D Z 13 " 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 89.68 7 Supervise d By : 

## Certificat e o fVerificatio n

11 3 SOI L 2011-01-1 9 13:0 1 30.2 4 Fina l 3131 2 330 8 N 2 4 S T D Z 13 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 15.95 2

# 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 64.25 9 Supervise d By : 

## Certificat e o fVerificatio n

11 4 SOI L 2011-01-1 9 13:0 3 30.1 8 Fina l 3131 2 330 8 N 2 4 S T D Z 13 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 14.40 8

# 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 77.84 9 Supervise d By : 

## Certificat e o fVerificatio n

11 5 SOI L 2011-01-1 9 13:0 3 30.1 2 Fina l 3131 2 330 8 N 2 4 S T D Z 13 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 15.55 5

## i^JJL i Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 I ^^^ yI Coasta l Environmenta l Grou p Inc
. V"^^ ^

www.coastalhazmat.co m ^^tPBOi** * COASTA L ENymONMENTA L G K0 U r . IN C 

# EXECUTIV ESUMMARY : BVID #31312-(330 8 N2 4 ST ) No Issue s o r Concern s |~ ] Issues/Concern s Detail Explanation : -DA NGARVE Y WALKE D TH EPROPERT Y O N11/2/201 0

## d% 

## EP APropert y Clos e Ou t For m Propert y #:^,L5iJ^l ^ Propert y A-dr«.^j2LJiLZH.. ^ Date/Time : Owner' s Name:
. .^j/Vlfi f QQP
. , TMff^i ^ Quad s Excavaied : Contracto r Grou p (Vyi?^!^ ! Eicavatio nGcnem l 

### Ye s N o 1
.I f necessaiy , wer e th e correc t quadrant(s ) excavate dan drestored ? 

### / 2
.I f necessary , wer e th e correc i area s ofdri p zon e excavaie dan drestored ? 

# y Gradin g So daa dVcKetetto B Yes No I
.Doe s th e {radin g aroun dth e perimne r ofth e hous e i nexcavate darea s generelty slop e awa y fromth e house ? 

# y 2
.Ha s so dbee nlai di nal l area s tha t wer e excavated ? 

# y 3
.

Doe s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte dat a3 0 

## y da y tim e period )
_ ^ 4
.Ar e sodde darea s generall y flrman devenl y graded ? 

# y S
.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 tim e period ) 

# y 6
.Wa s th e propert y grade dsuc hthat wate r wil l not poo l onth e pmpen\> ^ 

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

## y Gates , Fence s an d Rcuteia s Wal k Ye s N o 1
.

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

# y 2
.Wer e al l gate s p rfence s take n dow n durin g restoratio n activiiie s reinsulled ? (I fapplicable ) 

### y y 3
.Wa s danug e t o gate s o rfence s avoided ? (Ifapplicable } A
.Wa s damag e t o retainb g wall s avoided ? ( 1 fapplicable ) 

# y Foundation , SidioRan dGntler s 

### Ye s N o I
. Wa s damag e t o th e sidin g o r tri mavoided ? 

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

# y 3
. Wa s damag e l o window s avoided ? 

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

# y 2
. Wa s damag e t o downspout s o r downspou l extension s avoided ? 

## y Sidewalk s an dDriveway s (Concrete ) 1
. Wa s damag e l o drivewa y surface s avoided ? 2 , Wa s damag e t o waDcwa y surface s avoided ? Ye s N o / 

## yI 

## 0>»'Der s comments :

jinspectio nnotes :

Remova l an drestorationaclivale s complele includin g ih e 30-da y so dwarranty : EP ARepresentative ^^ ^
. . Dale : uli/fe
_

## Propert yCompletio n Agreemen t I'hi s agreemen t documenl s Ih e complclio n ofremedia l acliviiie s perloime d o n myproperl yM ysignature wil l designal e liia l I a m satisfie d wil h ih e restoralio n o fm yproperly , an d tha i n o ilem s ar e i n questions , now , o ra l an ylim e i n th e future , excep l llios e ilem s liste d below , ifan y

Propert yID : 3/5/ ^ Propert yAddress : :^^^ ^ ^ ^L \ % T Owner : AdnCfUnf i Ml^lfl S 

### Phone : [-(^5 , q^riA\/ , Restoratio n Item s i n Question :

Item : Item : Item :

' Item : 1 Item :

' Item :

K^ l tt^re e rcxtorafio n i s completed , excep t as note d [_ ] I doiio l a|;rr crestoratio n ii h complete d 

# k U gnatiir r^ '—^at c' / Con n arlor' s Signatur e Dal e 1