## TRANSMITTALo f

OMAHALEAD SIT E SOI LREMEDIATIO NFIL EFOLDER SAID#: \'C&& D Date : 2.]7.^\Tf \ Address : ^Slf PS 84 St Remediatio nContractor : Coasta l Environmenta l Group

_Year ; 200 8
SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S [3 / Vide o o f CLX L 

### • propen y (DVD , ^^-^tCl^k ^ 4 f^^ , F^'K^"^ ^ W B ^ Executiv e Summary ^y EPA-provide dproperty sketc h [y Signe dAcces s Agreemen t fo r subjec t property 0

/ Signe dAcces s Agreement(s ) fo r adjacent propert ) y ^ Restoratio nAgreemen t Q/ ^ Settlement document s (i.e. , fo r damag e o r to replac e plants , etc. ) H

/ Confirmatio ndat a 

## Q

/ Photograph s (JG/^s, ^ W't.-e/nzaktwi ^ 0^COju}aLi<\ ^ y As-buil t sketc h y Satisfactory restoratio nsigne db y Property Owne r y Property close-ou t chec k lis t signe db y EPA |\|| ^ Descriptio no f area s no t meetin g RO D cleanu p criteri a \y Utility clearance s B ^ Property informatio nfro mDougla s County Assessor' s Offic e 

## y doAMj-fPT i D 

### Signature 

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### Propert yAcces s Checklis t Propcrt j ID : 1 ^ 3 ^ 0 nWOR K STARTE D ON : / / Propert y Address : 2.^J ^ <^ 3MST D WOR K COMPELTE D ON : / /
Owner : /.Ci|yr AAn.^<L)^On Rcnte n Address : ^^^y ^ Phone : Fa.\ : Cell/Pager
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D Notificatio nLette r 1 3 Acces s Agreemen t C^" Restoratio nAgreemen t D Topsoi l Samplin g (i f applicable ) D Disposa l Samplin g (if applicable ) nGarde nSamplin g (i f applicable ) 0 Utility Clearanc e 0 Video/Photo s (Before ) D Video/Photo s (During ) nVideo/Photo s (After ) D Video/Photo s (30-Day ) nPropert y Completio nAgreemen t

• Fina l Repor t Ai r Monitorin g (a s applicable ) D Communit y Q Cre w On : Results : C

D Communit} ' Q Cre w On : Results : O Communit j O Cre w On : Results : Sent : / / 

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## CONTAC TFOR M Propert y ID # Propert y Address : Inilia l Conlact : Secon dContact : Fina l Conlact : Fina l Action :

Commeni : Owne r Commen i (s) ;
Sit e Coordinato r 

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- Date : Date ; Date : Transmi t u Time : Time : Time : DEP AD 

### Aclion ; Action : Action-
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### Dougla s County Accoun t Informatio n Pag e 1 of 3
Dougla s County , Nebrask a Propert yRecor d - R194200000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f90t h S t - Vie wO n tVla p Informatio n i s vali d a s of2008-9- 4 Treasurer' s Ta xRepor t Ne wFeatur e -»->• * Aut o Sate s Searc h Owne r ANDERSO N LAURAL 281 5 S 3 4 S T OMAH AN E 68135-000 0 Propert yInformatio n Ke yNumber : 420 0 000 0 1 9 Accoun t Type : Residentia l Parce l Number : 194200000 0 Parce l Address : 281 5 S 3 4 S T OMAH AN E 68105-000 0 Lega l Description : PARKVAL E LOT4 BLOC K1 4 0 X 13 0 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $5,800.0 0 $81,300.0 0 $ 87,100.0 0 200 7 $5,800.0 0 $81,300.0 0 $ 87,100.0 0 200 6 $5,800.0 0 $67,300.0 0 $ 73,100.0 0 200 5 $5,800.0 0 $67,300.0 0 $ 73,100.0 0 200 4 $5,800.0 0 $67,300.0 0 $ 73,100.0 0 200 3 $5,800.0 0 $67,900.0 0 $ 73,700.0 0 Sale s Informatio n Sale s Date : 2007-09-1 0 Dee d Type : Q C SooAr ; 200 7 Page : 10625 9 Price : $0.0 0 Grantor : ANDERSO N GREGORYS Grantee : ANDERSO N LAURAL Valid/Invalid : Invali d Exclusio n Reason : Famil ySal e Sale s Date : 1990-04-1 8 Page : Dee d Type : Book : 187 7 42 7 Price : $48,000.0 0 Grantor :


### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19.
. . 10/7/200 8

### Dougla s County Accoun t Informatio 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 1 5200. 0 1. 0 130. 0 40. 0 N o Improvemen t Informatio n Buildin g 1

l i a

Firs t Floo r la p i» c 70 6 0s q n 15* S«con d Floo r 512. 0 s q ft. I6.(F , 

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CLIC KX0_E N LARGE
. IMAG E Squar e Footage : | 1218. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 6. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 2. 0

Roo fType : Gabl e Stories : 1. 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 191 5 0 % 191 5 9 3 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 672. 0


### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19.
. . 10/7/200 8

### Dougla s County Accoun t Informatio n Pag e 3 o f 3

Fixtur e Fixtur e Garag e Porc h Porc h Bas e Fixture s Bat h Ful l Detache d En d Soli d Wal l Sla b Roo fCei l 1. 0 1. 0 216. 0 105. 0 160. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19.
. . 10/7/200 8

### Pag e 1 of 2

W^ y Creat e Anothe rTicke t Bac k t o Irt h Interne t Sen d Emai l


### YOU RTICKE TNUMBE RI S 2157604
. Origina l Cal l Date : 10/17/0 8 Time : 7:4 5 p m Op : ELIZABETH18 7 9 0 Wor k t o Begi n Date : 10/22/0 8 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 2 81 5 Street : S 34T H S T Twp : 15 NRng : 13 E Sect-Qtr : 28-SW,33-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 PROPERT Y INCLUDIN G HOUS E AL L TH E WA Y T O TH E : STREET . Remarks : FA X AL L CLEAR S TO : (877)662-421 1 Compan y: COASTA L ENVIRONTffiNTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : coasta l Dept ho f Excavation : 4f t Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL 3 I«IUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F QWEST 2

Servic e Are a Contac t Phon e Numbe r Utilit y Typ e
CXCAT V CO X COMMUNICATIONS , IN C HEID I 

### Day : 402934046 9 Alt : 402934046 9 

### Emerg : 402932975 7 Day : 877366834 4 LEVEL 3 LEVEL 3 COMMUNICATIONS , LL C N AAlt : 

### Emerg : 877366834 4 Day : 402504782 3 MUD0 2 METROPOLITA NUTILITIE S DISTRIC T SAND Y Alt : 

### Emerg : 402504794 6 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R 

### RO NAh : 402444516 1 Emerg : 402444516 0

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.
. . 10/17/200 8

### Pag e 2 o f 2

OPPDGPR 6 OMAH APUBLI C POWE RDISTRIC T 

### N A Day : 406728934 3

Alt : 888728934 3 Emerg : 406728934 3
QLNNEI FQWES TLOCALNETWOR K 

### M A Day : 406728934 3

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QWEST 2 QWES TLON GDISTANC E 

### SAR A Day : 800283423 7

Alt : 303992192 6 Emerg : 800283423 7

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.
. . 10/17/200 8

# 9 As-Buil t Drawin g
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# Omah aLea dSuperfun dSit e

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### :t.^t5 ' Sit e Sketc h Tirne ; Phone : _ 

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## \i:\[:VjMJj:yfiV ^ BVID # K3^ O XR F Cod e 5'S' O I Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e P-SAS.^PX A- /5"SS Q flYe s n N o ^ pp m pp m fjYe s O N o ^ K i cs t ^X A- I y^s- ^ pp m ^,Ye s • N o g ^ P t C ix
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COASTA L ENVIRONMENTA l ' ^
. PBO'' * C « 0 U r. IN C 

## Consen t Fo rAcces s T o Propert y RIGH TO F ENTR YT O 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 rit s authorize d representatives , collectivel y th e Grantee , t o ente ran d perfor m certai n environmenta l respons e activitie s upo n th e followin g describe d premises :

Owner' s Name : / ? Daytim e Phone : 

# yyn . ulK

- dlD'^ig.1 ^ ~AQ ^
Addres s o fPropert y covere d b ythi s Agreement :
PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EPAi s requestin g acces s t o collec t soi l sample s an d remov e soi l tha t contain s elevate d concentration s o flea d an d maypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t o remov e contaminate d soil
. Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o It s origina l condition
. Thi s wor k I s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o fCoasta l Environmenta l Group , contracte d byUSEPA , 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 hav e a n opportunit yt o revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e i t begins
. Onc e th e wor k i s finished , th e Granto rwil l b e aske d t o revie wth e wor k an d confir m tha t I t i s complet e an d meet s wit h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m EPAtha t th e propert y ha s bee n remediated
. ENVIRONMENTA L RESPONS E ACTION S 

### B ysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , it s employees , contractor s an d subcontractors 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 o fperformin g th e work
. Thi s acces s shal l remai n i n effec t unti l th e wor k ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :

Pag e 1 o f2,t O ST. , 

# M ^ g COASTA L ENVIKONMENTA L ••two-t*" ^ CROUP
. INC
.



### •Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; • 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 ; •Abid e b yhealt h an d safet yguidanc e provide d byEPA ; •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 INTERFERE 

### 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 , at (712 ) 352-018 8



## [33^ r I gran t acces s t o m ypropertie s D I d o no t gran t acces s t o m ypropertie s 

# ^Cjyc - r^^yo^x ^ ^^[n/o 8 Signatur e Dat e Signatur e Dat e

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.

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# iM COASTA L CNVIIONHENTA t C i O U f
. IN C 

### Consen t Fo rAcces s To Propert y RIGH T OF ENTR Y TO PREMISE S 

### Granto r(th e propertyowner) consent s to an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA) orit s authorize d representatives , collectivel y th e Grantee , to ente ran d perfor m certai n environmenta l respons e activitie s upo n th e followin g describe d premises :

Owner) s Daytim e Phone : ler ^ Name :

Addres s ofPropert y covere d bythi s 

# y^/ 7 I.JYy r Agreement : PURPOS E OF RESPONS E ACTIVITIE S 

### Th e EP A

is requestin g acces sto collect soi l sample s an d remove soi l tha t contain s elevate d concentration s oflea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l be excavate d to remov e 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 be restore d to it s origina l condition
. Thi s wor k is bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e ofCoasta l Environmenta l Group , contracte dbyUSEPA , wil l contact th e Granto rin-perso n to discus s th e wor k tobe performed , th e Granto rwil l hav ean opportunity to revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor eit begins
. Onc e th e wor k is finished , th e Granto rwil l be aske d to revie wth e wor k an d confir m tha t it Is complet e an d meets wit h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m EPAtha t th e property ha s bee n remediated
. ENVIRONMENTA L RESPONS E ACTION S 

### Bysignin g thi s Acces s Agreement , th e Granto r is grantin g th e EPA , it s employees , contractors an d subcontractors th e right to ente rth e property , at al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos eofperformin g th e wori<
. Thi s acces s shal l remai n in effect unti l th e wor k ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :
Pag e 1 of2COASTA L CHVmOffNFNTA l C I 0 U f
. IN C



### •Remove obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; • Remove 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 necessar ysubsequen t t o a n initia l waterin g perio d byEPA ; •Abid e byhealt h an d safetyguidanc e provide d byEPA ; • I fth e propertyi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propertyt o perfor m th e wori<
. •Allo wvideotapin g and/o rphotographin g o fth e property
. AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s not t o interfer e o rtampe rwit h an yofth 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 undertake an y action s regardin g th e us e o fsai d propertywhic 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 propertyI n suc h a manner . Shoul d yo u have an yquestion s abou t thi s program , pleas e contact Coasta l Environmenta l Group , a t (712 ) 352-018 8

[ B I gran t acces s t o m ypropertie s D I d o no t gran t acces s t o m ypropertie s

Ignitur e Dat e Signatur e Dat e

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

## \ Restoratio n Agreemen t Th e purpos e o f thi s agreemen t is t o provide amutua l agreemen t as t o condition s o f the propert y prior t

o remediationactivities
. Thi s wil l als o serv e a s documentatio nfo r th e purpos e o f assuring tha t restoration activitie s ar e completedt o th e satisfactionofth e property ' owne r an dth e UnitedState s Environmenta l ProtectionAgenc y (EPA)
. Propert y ID : / 5 ^ ^ 3 Propert y Address : ^J^/S " 5 ~)^'^ ^ i^~J~ Q^^""*" ' 7ou/'C K /4Ao/^r,<>Or x Phone : 

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nth e attache ddiagram(s ) indicat e area(s ) t o excavatedan ddept ho f excavation , locatio no f al l know n utilities , subsurface feauires , syrface structure s an dlandscaping features , acces s location(s ) t o b e use db y contractor, an dth e directiono f North
. Indicat e distances , depths , materia l types , etc . Indicat e digita l photo s b

y referencin g th e photo-lo g numbe r wit ha narro w indicating directiono f view
. Item s T o B e Remove d B yOwne rBefor e Star t O fRemediation : (Us e additiona l sheet s a s necessary ) Th e removal , storage , disposal , and/o rretur n o ftiies e item s i s th e Owner' s responsibility
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Item : 

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### Landscap e Inventory (Us e additiona l sheet s as necessary ) 

### Ite m

Pre-existing propert y area , tha t will b e excavated , tha t i s coveredwit hgras s

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 

# 1

Numbe r of Sprinkle r Zones , Control Valves , Timers , Heads , etc . Attachasketc ho f the sprinkler layout
.
Nuinber o f an dsize o f eac hgarden / flowe r bed area . Attachasketcho f relativ e size s an dlocations
. 

### Quantit y 

# 0 ' 

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Eac h

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# 7 '

Pag e 4 of_ ^- • - < »
COASTA L 

### Ite m Quantit y Agree d upo n valu e o f plan t material s no t t o b e renlace d b vcontractor
. Not e thi s >alu e wil l b e use d t o issu e -Aplan t 

# y
vouche rt o th e propert y owner . Agree d upo n lis t o fplan t material s tha t wil l b e replace d b ycontractor
. B e ver yspecifi can d detailed
. 

# y Includ e a sketc h o fwer e eac h plan t wil l b e place d b yth e contractor
. Agree d upo n are a o f propert yt o b e replace d 

# $ 7 wit h gras s sod
. Includ e a sketc h o fth e area(s ) t o b e replace d wit h 

# 7 ^ gras s sod
.

Are a ofCit yo rCount y propert yt o b e landscape d pe rthei rrequirements
. 

# V
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### Urii t

$ 1 

### Conditlon/Type/Specie s

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S F

S F

S F 

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Pag e 5 o f 

## L PC O AS T AL

Additiona l Comment s / Instructions :


# 6-11^ ^ ^H\[iy AO-^iC^
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•Chec k th e txj x ifOwne rdoe s no t warr t CE G to documen t interio rfoundatio n vrall s an d possibl e pre-existin g damage
. Bycheckin g thi s boxCE G is not responsibl e fo ran ydamag e don eto th e interio r ofhouse , includin g foundatio n crack sorfissures.

0 Iagre e Q I do no t agre e 

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## ISlO^fc" ! BVID # J015_ D XR F PROPERT YSAMPL E SHEE T 

## [C\-Z%yeio' ^ Addres s 

## ^^1^'^ > 7^H^d L Oman a lea d F P 2n a yea roptio n Sampl e tim e am/p m 

## ^7n^c) , sampl e lengt h 3 0 se c

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## Repor t Number : Dat e Reported : 

# /•iN^/lidwes t 08-357-219 5 12/23/0 8 

## Account : Dat e Received : 2066 6 12/18/0 8 

# V| < Laboratories , Inc I Page : 1 o f 1 Dat e Sampled : 1361 1 B Stree t • Omaha , Nebrask a 68144-369 3 • (402 ) 334-777 0 • FA X (402 ) 334-912 1 • www.midwestlab3|2^8/0 8 

### COASTALENVIRONMENTA LGROU P MARCO S MATEU S 241 1 MARTH AS T OMAH AN E6810 5 QC-1535 0 2815S34THS T PO/Projec t # : OLS-200 8 Analysi s A s Detectio n Analys t Verifie r Performe d Receive d Unit s Limi t Metho d Dat e Dat e La b number : 152036 9 Sampl e ID : F l

Lea d (total ) 17 3 mg/k g 5 EP A601 0 rrd/12-2 2 kkh/12-2 2 

### La b number : 152037 0 Sampl e ID : B 2

Lea d (total ) 77. 3 mg/k g 5 EP A601 0 rrd/12-2 2 kkh/12-2 2 

### U b number : 152037 1 Sampl e ID : EASEMEN T

Lea d (total ) 11 1 mg/k g 5 EP A601 0 rrd/12-2 2 kkh/12-2 2



### leathe rRami g / / Clien t Servic e Representative^/ heather@midwestlabs.co m (402)829-989 1 Th e result(s ) issue d o n thi s report onl yreflec t th e gnalysi s o fth e sample(s ) submitted
. Fo rapplicabl e tes t paramaters , Midwes t Laboratorie s i s i n complianc e wit h NELA C requirements
. Ou rreport s an d fetter s ar e fo rth e exclusiv e an d confidentia l us e o fou rclient s an d ma yno t b e reproduce d i n whol e o ri n part , no rma yan yreferenc e b e mad e t o th e work , th e results , o rth e compan yi n an yadvertising , new s release , o rothe rpubli cannouncement s withou tobtainin g ou rprio rwritte n authorization
.

# "^ > [L£fe@[?®G®PD(
1361 1 B Stree i • Omaha , Nebraska 68144-369 3 = (402 ) 334-777 0 ° FA X (402 ) 334-912 1 = www.mldwestlabs.co m ACCOUNTNUMBE R 

### CHAI N O F CUSTOD YRECORD : Ye s 

## N o PURCHAS E ORDE R NUMBER . 

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. C l c\.,Mn o PI T- riih o • Matri xCode ; S O - Soil , W A- Waler , S L -.Sludge , O T- Olhe r. -^.—- — ' rpff-ffir rh. cc-r.^, - Ou i ,'-£po!'£ s cii cIEKS.' S i-. i fo rth e eiicluE'v e sri cconi-oentic ! us s o ' o-j - ciisivt s tn: - r^a yriO i i e leprur.i.'ct o '? , who ; e 0

1 i: : pc.'"! , f';;' ' ".s vETA 1

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 216 4 Mod e SOI L Tim e 2008-10-2 8 10:2 3 Duratio n 123.2 2 Sequenc e Fina l Flag s AVERAG E Av g o f2160-216 3 ADDRES S 281 5 s 3 4 s t QUAD/ZON E B 2 INSPECTO R Ventr y DEPT H 6 SAMPL E PI'P E CLEARANC E NOT E

Supervise d B y

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 108.92 4 Supervise d By : 

## Certificat e o fVerificatio n

216 0 SOI L 2008-10-2 8 10:2 0 31.5 8 Fina l 1535 0 281 5 s 3 4 s t b 2 Ventr y 6 CLEARANC E

± Erro r ± 13.04 4

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 77.24 8 Supervise d By : 

## Certificat e o fVerificatio n

216 1 SOI L 2008-10-2 8 10:2 2 30.5 2 Fina l 1535 0 281 5 s 3 4 s t B 2 Ventr y 6 CLEARANC E

± Erro r ± 11.27 5

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 56.15 7 Supervise d By : 

## Certificat e o fVerificatio n

216 2 SOI L 2008-10-2 8 10:2 2 30.1 5 Fina l 1535 0 281 5 s 3 4 s t B 2 Ventr y 6 CLEARANC E

±Erro r ±10.09 1

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

XL3t-3208 9 Readin g N o Mode Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E Pr-P E NOT E

pp m P b 71.15 7 Supervise d By : 

## Certificat e o fVerificatio n

216 3 SOI L 2008-10-2 8 10:2 3 30.9 7 Fina l 1535 0 281 5 s 3 4 s t B 2 Ventr y 6 CLEARANC E

± Erro r ± 10.89 4

# f Therm o

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 216 9 Mod e SOI L Tim e 2008-10-2 8 10:2 7 Duratio n 122.9 7 Sequenc e Fina l Flag s AVERAG E Av g o f2165-216 8 ADDRES S 281 5 s 3 4 s t QUAD/ZON E F l INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

Supervise d B y

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 216 5 Mod e SOI L Tim e 2008-10-2 8 10:2 5 Duratio n 30.8 5 Sequenc e Fina l Flag s BVI D # 1535 0 ADDRES S 281 5 s 3 4 s t QUAD/ZON E F l INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P b 46.87 6 ± 9.55 7 Supervise d By :• 

# Therm o

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E PI'P E NOT E

pp m P b 91.04 4 Supervise d By : 

## Certificat e o fVerificatio n

216 6 SOI L 2008-10-2 8 10:2 6 30.8 9 Fina l 1535 0 281 5 s 3 4 s t F l Ventr y 6 CLEARANC E

± Erro r ± 12.29 2

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 168.10 2 Supervise d By : 

## Certificat e o fVerificatio n

216 7 SOI L 2008-10-2 8 10:2 7 30.6 4 Fina l 1535 0 281 5 s 3 4 s t F l Ventr y 6 CLEARANC E

± Erro r ± 15.99 1

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 216 8 Mod e SOI L Tim e 2008-10-2 8 10:2 7 Duratio n 30.5 9 Sequenc e Fina l Flag s BVI D # 1535 0 ADDRES S 281 5 s 3 4 s t QUAD/ZON E F l INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 73.89 6 ±11.04 4 Supervise d By :

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 215 9 Mod e SOI L Tim e 2008-10-2 8 10 : 1 8 Duratio n 122.9 2 Sequenc e Fina l Flag s AVERAG E Av g o f2155-215 8 ADDRES S 281 5 s 3 4 St QUAD/ZON E easemen t INSPECTO R Ventr y DEPT H 1 SAMPL E TYP E CLEARANC E NOT E

Supervise d B y

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 215 5 Mod e SOI L Tim e 2008-10-2 8 10:1 6 Duratio n 30.6 0 Sequenc e Fina l Flag s BVI D # 1535 0 ADDRES S 281 5 s 3 4 s t QUAD/ZON E easemen t INSPECTO R Ventr y DEPT H 1 SAMPL E TYP E CLEARANC E NOT E

pp m Erro r P b 113.91 1 13.30 3 Supervise d By : t.,LL^J^ii. J (jUJyn^^

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 128.33 3 Supervise d By : 

## Certificat e o fVerificatio n

215 6 SOI L 2008-10-2 8 10:1 7 30.5 8 Fina l 1535 0 281 5 s 3 4 s t easemen t Ventr y 1 CLEARANC E

± Erro r ± 14.10 3

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 113.95 8 Supervise d By : 

## Certificat e o fVerificatio n

215 7 SOI L 2008-10-2 8 10 : 1 8 30.4 6 Fina l 1535 0 281 5 s 3 4 s t easemen t Ventr y 1 CLEARANC E

± Erro r ± 13.09 6

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 215 8 Mod e SOI L Tim e 2008-10-2 8 10:1 8 Duratio n 31.2 8 Sequenc e Fina l Flag s BVI D # 1535 0 ADDRES S 281 5 s 3 4 s t QUAD/ZON E easemen t INSPECTO R Ventr y DEPT H 1 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 89.94 0 ±12.12 1 Supervise d By :

### /t|tt^' o Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 S J^^2 ^

I Coasta l Environmenta l Grou p Inc
. V^^^Tj ? www.CGastalhazmat.co m

^^tin.ott' ' COASTA L ENVmONMENTA L CROUP , INC
. 

# EXECUTIV ESUMMARY : BVI D #1535 0 - (281 5 S 3 4 ST ) 

# IINo Issue s o r Concern s [ ^ Issues/Concern s Detai l Explanation: HOMEOWNE RRECEIVE D COMPENSATIO NFO RTH ESUM O F$ 25.0 0 FO RTH E REPLACEMEN TCOS TO FPLANT S THA TWHER EDESTROYE D DURIN GTH E REMOVA LO FLEA D IMPACTE D SOIL
.

# ^^EPA ^ - 

# EP APropert ) Clos e Ou l Form Prop«rt > ft : \5"?^ 5 C ^ Proptrt ) Addrrss : ^^iS1^...3Hi ^ ^ DBit/Tlnt : Owner' s N.mt : 1 A^VC k ^vnA<^^^(\ n QuBd s Excsvalfd : F \an dfS ^ ConlrBCto r Crou p OnaSVc v \Pn M y^A^ ^ X^O UI Excivatlo D GtDcre l Yc ^ N o 

## r If necessary , wer e th e correc l quadrant(s ) excavate dan dresiored ? 

# y ]
2 If necessary , wer e th e correc l area s ofdri p zon e excavaie dan drestored' ' 

# ivtt GradlD KSo d an d VcfcUlio n V « N o 1 Doe s th e gradin g aroun d di e perimete rofth e hous e i n excavaie d area s generall yslop e awa y y from Ib e house ? 2 Ha s so d be« n lai d i n al l area s tha t wer e excavaied ? y 3
. Doe s th e so d appea rl o b e generall yhealth yan d growing' ' (Onl yevaluat e i finspecie d at a 3 0 

### y da ylim e period ) 4 Ar e sodde d area s generall yfir m an d evenl ygraded' ' 

### y 5 Ar e th e joint s betwee n th e so d stnp s generall ylight ? (Onl yevaluat e ifmspecie d a i a 3 0 da y y lim e period ) 6 Wa s th e proptcrrygrade d suc h tha i wate rwil l no t poo l o n ih e property' ' y 7 Wa s damig e t o landscapin g o rplan i material s avoided' ' 

### y 1 Gates , FcDcc a an d RdjinlD C Walt s Ve s N o 1 D o gate s ope n an d clos e freely' ' (Ifapplicable ) y 2 Wer e al l gate s o rfence s lake n dowT i durin g resloratio n acnvine s reinstalled' ' (I fapplicable ) 

### y 1 3 Wa s damag e t o gate s o rfence s avoided ? (I fapplicable ) y 4 Wa s damig e t o retainin g wall s avoided ? (Ifapplicable ) 

### y FouDdation , Sidia g an d Gulier s Ye s N o 1 Wa s damag e t o th e sidin g o rtri m avoided ? y 2 Wa s damag e t o th e foundatio n avoided ? 

# y 3 Wa s damag e l o window s avoided' ' y 4 Wa s damag e l o window s o rdoo rscreen s avoided' ' y ^ Wa s daruag e l o downspoul s o rdownspou l extension s avoided' ' y j Sidewalk s an dDriveway s (Concrelt ) Ve s ,N o Wa s damag e l o drivewa y surface s avoided ' 

### _A/ ^ 2 \^'ii 5 damag e l o v»allcwa y surface s a\oided' ^ 

# y

## O tDe?- $ comments :

Remova l an dresloralio naclivale s complei e inclu{jin g ih e 30-day so duanani )
F P A

## Propert yCompletio n Agreemen t Thi s agreemen t document s th e completiono f remedia l activitie s perloime do nm y properly M y signalur e wil l designate tha i i a msatisfie dwit hth e restoratio nof m y property , an dtha i n o items are i nquestions , now , o r a

l an y tim e i nthe future , excepi thos e items listedbelow , ifan y Propert y ID : ^^:2^f ^ Propert y Address : ^Q^/ ^ ^ ^L^^fJ O ^ ^ Owner : \—CK.\
. 

## P^rse^ n r-^O" ^

Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item :
Additiona l Comments :

1^ 1 agre e restoratio n I s completed , excep i a s nole d I I rio no l aijre crestoratio n I s complcle d 

# dijo r

c>^jjy(X-
_ 

## I-VVWA D O L Owner' s Signatiir e Dat e ontracfor' s Signatur e Dat e I

## Propert yDamag e Settlemen t

Propert y I D 1535 0 Propert y Addres s 281 5 S 3 4 S T Owne r Laur aAnderso n Phon e 402.390.212 6
I tiav e receive dachec k fromth e contractor , Coasta l Environmenta l Grou p Inc
. (Coastal) , for th e sumo f $25.0 0 for th e replacemen t cos t o f plant s that wher e destroye ddurin g th e removal o f lead-impacte dsoi l fromth e property .

Compensatio nTyp e Chec k 168 9 Valu e o f Chec k $25.0 0 Chec k t o th e Orde r o f Laur aAnderso n Descriptio n o fDamag e Coasta l Environmenta l Grou p wil l reimburs e Ms
. Anderso n fo rth e plant s destroye d durin g th e remediatio n fo rLea d at 281 5 S 3 4 S T M ysignatur e belo wacknowledge s th e receip t o fth e chec k liste d above ; further , I acknowledg e tha t th e compensatio n amoun t i s fai rfo rth e replacemen t cos t o fth e plant s an d releas e Coasta l Environmenta l Group , Inc
. fro m furthe robligation s o rliabilit yrelate d t o thi s property
.



## yoxyo - 

# \y ^ h^O L 12

- 

# k i o f 

# \n'Tilo ^ Owner' s Signatur e Date Contractor' s Signature Date

Pag e 1 o f1