## TRANSMITTALo f

OMAHA LEAD SIT E SOILREMEDIATIO NFIL EFOLDE R
SAID # : 

# M Date : 

# ^(^(l i Address : Kh[hC^ ^ "l ^ Remediatio nContractor ; Coasta l Environmenta l Grou p Year : 2010ARR A
SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 

# y Vide o o f property (DVD ) Executiv e Summary EPA-provide dproperty sketc h Signe dAcces s Agreemen t fo r subjec t property Signe dAcces s Agreement(s ) fo r adjacent property Restoratio nAgreemen t Settlemen t document s (i.e. , fo r damag e o r to replac e plants , etc. ) Confirmatio ndat a / 

### Photograph s As-buil t sketc h Satisfactory restoratio nsigne db y Property Owner / 

### Property close-ou t chec k lis t signe db y EPA

• S - 

### Descriptio nofarea s no t meetin g RO D cleanu p criteri a 

# y Utility clearance s 

# y Propertvjnfbrmatio nfro mDougla s County Assessor' s Offic e 

# / T

3021791 9 Superfun d

# ^ v Propert yAcces s Checklis t Property ID : lQ;3^q \ D WOR K STARTE D ON : __/__ / Propert y Address : ^^ ^ UlcXfa\ | 5^
. D WORKCOMPELTE D ON:__/__/
_ Owner:^ ^ [^j , ^]^QC<di
. Renter : 

# /y o i n Address
. ^

_. Phone : 

# 9J y ^OY ^ Fax : Cell/Pager : Phone : Additional Infomiation : 

# 6^ T 3i^5 M Fax : Cell/Pager : l~l Notificatio nLette r Sent : / / 

### By : Acces s Agreement Signed: y t^S'J Q By : Restoratio nAgreement Signed ; al/6 > I )t > 

# By : mi/ZC^/ O nTopso U Samplin g (if applicable ) / / 

### By : l~l Disposa l Samplin g (if applicable ) / / 

### By : l~ ] Garde nSamplin g (if applicable ) / / 

### By : 

# fi Utilit y Clearanc e CaUed ; C^b/V h/ \r-> By:o^^, ^ ^,^^ t 

# £ Video/Photo s (Before ) 

## On : ^iJ^lj Q 

# ^y'.ll/c/^/r.r/ S GVideo/Photo s (During ) On : / / 

### By : D Video/Photo s (After) On : / / 

### By : nVideo/Photo s (30-Day ) On : / / 

### By t |~ | Property Completio nAgreement Signed : / / By : D Final Report Issued : / / 

### By : Ai r Monitorin g (a s appUcable) Q Conununit y QCre w On : / / 

### By : Results :

• Communit y QCre w On : / / By : Results : Q Communit y QCre w On : / / By ; Results ;

Omah a Lea d Sit e 

### 1

## )ougla s Count y Accoun t Inforaotio n Pag e 1 of 2 rjM^ c Dougla s County , Nebrask a Propert yRecor d - R152455000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s avaiiabl e @ scal e 0-5 0 ft wes t o f52n d S t - VIe 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 KLINKACE KTHOMA S ETA L 1342 6 EDN AS T OMAH AN E 68138-000 0 Propert yInformatio n Ke yNumber : 245 5 000 0 1 5 Accoun t Type : Residentia l Parce l Number : 152455000 0 Parce l Address : 111 3 HICKOR YS T OMAH AN E 68108-000 0 Lega l Description : KOUNTZ E 5T H AD D LO T1 9 BLOC K4 E 3 7 N 1/ 2 LT1 8 & E 3 7 F T3 4 X 87-3 7 X 6 8 Valu e Informatio n
200 9 200 8 200 7 200 6 Lan d $3,100.0 0 $3,100.0 0 $3,100.0 0 $3,100.0 0 Improvemen t $39,100.0 0 $39,100.0 0 $39,100.0 0 $35,500.0 0 Tota l $42,200.0 0 $42,200.0 0 $42,200.0 0 $38,600.0 0 200 5 200 4 $3,100.0 0 $3,100.0 0 $35,500.0 0 $35,500.0 0 $38,600.0 0 $38,600.0 0 Sale s Informatio n Sale s Date : Dee d Type : Price : Grantor : 1999-01-1 1 $33,500.0 0 Book : 211 1 Paga : j 57 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 0.0 5 2516. 0 1. 0 68. 0 37. 0 N o Improvemen t Informatio n 

## http://douglasne.mapping-onUne.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=Rl..
. 12/30/2009

### )ougla s County Accoun t Infortajdo n Pag e 2 of 2 r|Mg c

Buildin g 1

EnelSeMW M 60 0 s r ; «« ;

a u W C Rr d Floo r i 874. 0 S F
. sel f 1 0 ff L , 1 2 O

f
Sla b Roo f Ceilin g 14 0 s q I 11/ 2 Stor yUnfinishe d Bsmn I BlMl i 8 H 87 4 a S F CLIC KTO ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 874. 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 yUnfi n Cond o Squar e Footage : 0. 0 HVAC : 1 Force d Ai r Rooms : 5. 0 Exterior : Fram e Aluminu m Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 2. 0

Roo f Type : Gabl e 

### Stories : ; 1. 5 Floorcover : Allowanc e Foundation : I 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 8 0 % 190 8 10 2 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Unfinishe d Atti cW/floo r 864. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 874. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h En d Scree n 60. 0 Porc h Sla b Roo fCeilin g 140. 0 Use r POO R ROO F 1. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl.
. . 12/30/200 9Pag e 1 of 2

" > [; Greate^Anothe£Ticke t J ] L „ _Bj^ckjojrt h interne t I I Sen d Emai l



### • YOURTICKE T NUMBE RI S 2569551
. Origina l Cal l Date : 8/17/1 0 Time : 9:2 3 a m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 8/19/1 0 Time : 10:0 0 a m State : N E County : DOUGLA S Place : OMAH A Address : 111 3 Street : HICKOR Y S T Twp : 15 NRng : 13 E Sect-Qtr : 27-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 Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : COASTA L Dept h o f Excavation : 4 F T Come r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N ATTNEBR l CXCAT V LEVEL 3 MCINE B MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F

Servic e Are a Contac t Phon e Numbe r Utmt y Typ e
ATTNEBR l ATT/T 

### Day : 8002413624 9 Alt : Emerg : 8002413624 9

CXCAT V CO X COMMUNICATIONS , W C HEID I 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7

LEVEL 3 LEVEL S COMMUNICATIONS , LL C N A 

### Day : 877366834 4 Alt : Emerg : 877366834 4

MCINE B MC I N O CAL LPE R MEMO 

### Day : 800289342 7 Alt : Emerg : 800289342 7
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 8/17/201 0

### Pag e 2 of 2

MUD0 2

OMAHACO F

0PPDGPR 6

QLNNEI F METROPOLITA NUTILITIE S DISTRIC T

CIT Y O FOMAHA

TRAFFICSEWE R

OMAH A PUBLI C POWE R DISTRIC T

QWES T LOCALNETWOR K SAND Y

RICH/TRAFFI C

EL M LOCATIN G

EL M LOCATIN G 

### Day : 402504782 3 Alt : Emerg : 402504797 0 Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS,
. . 8/17/201 0

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e QL$# : 1939 1 Dat e Excavated : 8/11/201 0 Dat e USEP ASiqne d Off : 10/19/2Q1 Q Ar? ? $<fW^n : 214 Q § q f t Name : lh^.,<^<
. Kii^kare/ C Omah a Lea d Sit e Date : ^////t - ^ NorthAfTO w Address : (|1 ^

tt<.-l ^ ryr..' ; 4
. Sit e Sketc h Time : ^.'^ t Phone: , ^^(^-(,7^ 7 ->

- ^
lear n | V ( u^</HtCm{. A BVID # 

## h^^ i XR F Cod e •g'-S"^ / Sampl e Numbe r Lead Concentratio n Confirmatio n Sampl e
• ^Ti
. i -2. 0 F , Yes n N o ^ pp m f l Yes n N o 1^ 3 fi, Yes • N o o; ^ r^Ye s ° N o 2 ^ 0 i Yes O N o C ^ pp m Yes n N o • pp m Yes • N o •

_ L 8 1 = 11 1 PP M ( D Z = 22 1 PPM @ 10 "

F 2 = 5 1 PP M @ 6 "

Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are a replace d wit h So d ' ' Are areplace dwit h Are alef t bar e Rock/Mulc h Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p In cName : / ili,'A<'>« i KAn^ka/e/K ' Omah a LeadStt 6 Date : (/J/2/'0~' > Nort h Arrowr Address : f | (
. ^

H'ui- D r^'^ , ^ , Sit e Sketc h Time : ^/H. S 

### Phone : 9^tL'G75 7 ' ' 

# 4 i

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# /I5"f f XR F Cod e ^^^ / Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl i F s Ye s I ^ N o ^;; ^ pp m 

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# \' \% # Name : //lx'/''^< , I C it^^Cace/ C Omah a Lea d Sit e Date : 0^/2//o' > Nort h Arro w Address : fll 3 ttlfk^r^S-^ ' Sit e Sketc h Time : "i.'H S Phone : 5<^(.- 4 75 7 ^
Tea m \f ^ i{\\Ci^ < rk(
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### iK.t77.^^y^yy^ ^ /9y^ /Name : 

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## Kluisk&Ce/ C Omah a Lea d Sit e Date : Nort h Arro w 

### Address : i n ^ tti^or^54 , Sit e SItetc h Time : 

# Phone : ^BIl42l2_ ? 

# 4

Tea m 

# ]I^.\L^./ ^ (m^/ \ BVID # 

# h'i'i i XR F Cod e ^-^^ / Sampl e Numbe r Lea d Concentratio n Confimnatio n Sampl e F » Ye s C D 

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# N o 2 x Da-Ye s n N o 13 ^ pp m Ye s n 

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COASTA l IMVItDHRIKIIL l cI 0 u r . IN C 

## Consen t fc f Acces 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 ^ctiyijie g upo n th e followin g describe d premises : ^

Owner' s Nam e Daytim e Phon e r s Name : ^ , n 

# -^/,rr^,>^Ll//^kial y Addres s o f Propert y 

# 111 3 H^^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 tha t contain s elevate d concentration s o f lea d an d ma ypos 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 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 hav e a n opportunit yt o revie wan d approv e th e planne d soi l removai
. 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 EP Atha t th e propert y ha s bee n remediated
.
ENVIRONMENTA L RESPONS E ACTION S 

### Bysignin 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 righ t t o ente rth e property , a t al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e o fperfomnin 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 of2

### .,*^'""* , COASTA L



### . J tN*IIONKfKT« l C « O U rI Kc 

### t Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; e Remov e flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t 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 ; eAbid 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
. eAllo 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 wor k activities , o rwit h an y o f th e wor k done , o rwit h th e equipment 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 f th 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

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

# ly^-'bi o Dat e Signatur e Dat e

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 2C OA S T AL 

## Restoratio n Agreemen t The purpos e of thi s agreemen t i s to provide amutxxa l agreemen t a s t o condition s of thepropert 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 completedt o the satisfactionof the propert y owne r andth e UnitedState s Environmenta l ProtectionAgency (EPA)
.

Propert y ID : (< f 3* ^ / Propert y Address ; fffz ^ l ^ ldZt)r\ j 5^ 7 Piione ; c^gtc y - 3^t=, H 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 usedb y the contractors . Indicat e distances , depths , materia l types , etc . Photographicall y an dVideographicall y documen t theexisting condition s ofth e propert y an dthebasemen t if necessary . 

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

## (/{-WKJ ^ 

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. 

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Kem :
Kem :



## Item s t o b e Remove d b yth e Contracto rDurin g Remediatio n an d No t Replace d Kem : 

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item :

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Kem :
Kem : 

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## Ite m Landscap e Inventory Quantit y Uni t Condition/Type/Specie s Pre-existing propert y area , tha t will b e excavated , tha t i s coveredwit hgrass . Quadrants
Numbe r of tree s > 2 inc h trun k

diamete r 

# e y Eac h Numbe r of tree s < = 2 inc h trun k

diamete r Eac h Numbe r of Sprinkle r Zones , Control Valves , Timers , Heads , etc . Attac hasketc ho f th e sprinkle r layout
. Eac h

Numbe r of an dsize of eachgarden / flowe r bed area . Attac hasketc ho f relative size s an dlocations
. Eac h Squar e Fee t Agree duponvalue of plan t material s not to b e replacedb v contractor . Not e thi s valu e wil l b e usedto issue aplan t voucher to th e property owner . Easemen t Area , t o b e excavated / Eac h 

# tlA^ /' ? 

# Li f(ejoti~ J

Pag e 2 

# OIJ LC OA S T AL • NVinOMMaMTAI
. o a o u p , IN C


### AddKiona l Corhment s / Instructions : Th e cK yof Omah a ordinance s ma yprohib Kyo u fro m usin g dir t orgrave l area s on you rpropert y as driveway s orvehicl e parkin g areas . Th e Environmenta l Protectio n Agency(EPA ) ma y

be removin g an d replacin g soi l underlyin g a grave l ordir t are a on you rpropert ytha t yo u ma y

be usin g as a drivewa y orvehicl e parkin g area . If thi s is th e case , yo u shoul d understan d tha t thi s removin g an d replacin g of soi l doe s no t mea n tha t an yillega l drivewa yorparkin g are a on you r propert yis mad e legal
. To th e contrary , yo u ma y

be cKe d byth e cit y ifyo u us e a grave l ordir t are a as a drivewa y orpartcin g area , no t wKhstandin g an yremova l orreplacemen t of soi l byth e EP A Ifyo u have an yquestio n abou t legalit yof a certai n drivewa yorparkin g area , yo u ma ycontac t th e cK yof Omaha' s Plannin g Departmen tat (402 ) 444-5150
. CU Pleas e chec k thi s bo xifyo u understan d th e informatio n outline d above
. 

# '5- ' a.]^ o yi ( 

# Uny^ ^ -A
o ali A ^ io e

D Chec k th e bo x if Owne rdoe s no t wan t CE G to documen t interio rfoundatio n wall s an d possibl e pre-existin g damage
. Bycheckin g thi s bo xCE G is no t responsibl e fo ran ydamag e don e to th e interio rof jf^use
. includin g foundatio n crack s orfissures
.

^Contractor' Sien i !ontractor' s s Signatur e Date Pag e 3 of;

### 1 BVI D s /^'31 1 

### XR F PROPERT Y SAMPL E SHEE T

' Dat e • 

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

## Certificat e o f Verificatio n XL3t-3902 2 Readin g N o 11 2 Mod e SOI L Tim e 2011-01-2 6 12:1 2 Duratio n 91.6 0 Sequenc e Fina l Flag s AVERAG E Av g o f 109-11 1 ADDRES S 111 3 HICKOR YS T QUADRAN T E A DEPH T 1 " XR F TEC H C.PADILL A MIS C CONFIRMATIO N NOT E CLEA R

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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 240.83 0 Supervise d By : 

## Certificat e o f Verificatio n

10 9 SOI L 2011-01-2 6 12:1 1 30.3 2 Fina l 1939 1 111 3 HICKOR YS T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 23.68 2

# 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 255.58 9 Supervise d By : 

## Certificat e o fVerificatio n

11 0 SOI L 2011-01-2 6 12:1 1 30.6 5 Fina l 1939 1 111 3 HICKOR YS T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r 21.52 5

# 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 263.90 6 Supervise d By : 

## Certificat e o fVerificatio n

11 1 SOI L 2011-01-2 6 12:1 2 30.6 3 Fina l 1939 1 111 3 HICKOR YS T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 21.65 2

# 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

P b Supervise d By : 

## Certificat e o fVerificatio n

10 8 SOI L 2011-01-2 6 12:0 9 90.3 6 Fina l Av g o f 105-10 7 111 3 HICKOR YS T F2 6 " C.PADILL A CONFIRMATIO N CLEA R

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

## Certificat e o f Verificatio n XL3t-3902 2 Readin g N o 10 5 Mod e SOI L Tim e 2011-01-2 6 12:0 8 Duratio n 30.1 3 Sequenc e Fina l Flag s BVI D 1939 1 ADDRES S 111 3 HICKOR YS T QUADRAN T F 2 DEPH T 6 " XR F TEC H C.PADILL A MIS C CONFIRMATIO N NOT E CLEA R

pp m ±Erro r P b 50.88 9 ±13.31 2 Supervise d By :

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

## Certificat e o f Verificatio n XL3t-3902 2 Readin g N o 10 6 Mod e SOI L Tim e 2011-01-2 6 12:0 9 Duratio n 30.1 8 Sequenc e Fina l Flag s BVI D 1939 1 ADDRES S 111 3 HICKOR YS T QUADRAN T F 2 DEPH T 6 " XR F TEC H C.PADILL A MIS C CONFIRMATIO N NOT E CLEA R

pp m ±Erro r Pb 56.82 2 ±13.67 0 Supervise d By :

# 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 46.30 2 Supervise d By : 

## Certificat e o f Verificatio n

10 7 SOI L 2011-01-2 6 12:0 9 30.0 5 Fina l 1939 1 iil 3 HICKOR YS T F 2 6 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r
± 13.42 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 AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

Supervise d By : 

## Certificat e o fVerificatio n

10 4 SOI L 2011-01

- 2 6 12:0 7 90.6 1 Fina l Av g o f 101-10 3 111 3 HICKOR YS T B l 4 " C.PADILL A CONFIRMATIO N CLEA R

# 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 118.30 9 Supervise d By : 

## Certificat e o f Verificatio n

10 1 SOI L 2011-01-2 6 12:0 5 30.2 0 Fina l 1939 1 111 3 HICKOR YS T B l 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r
± 17.41 8

# 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 106.81 2 Supervise d By : 

## Certificat e o fVerificatio n

10 2 SOI L 2011-01-2 6 12:0 6 30.2 1 Fina l 1939 1 111 3 HICKOR YS T B l 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 16.95 2

# 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 108.55 2 Supervise d By : 

## Certificat e o f Verificatio n

10 3 SOI L 2011-01-2 6 12:0 7 30.2 0 Fina l 1939 1 111 3 HICKOR YS T B l 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 17.51 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 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 0 SOI L 2011-01-2 6 12:0 4 90.7 0 Fina l Av g o f97-9 9 111 3 HICKOR YS T D Z 10 " C.PADILL A CONFIRMATIO N CLEA R

# 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 192.83 0 Supervise d By : 

## Certificat e o fVerificatio n

9 7 SOI L 2011-01-2 6 12:0 2 30.2 1 Fina l 1939 1 111 3 HICKOR YS T D Z 10 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 21.67 7

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Biilerica , MA0182 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 239.82 9 Supervise d By : 

## Certificat e o f Verificatio n

9 8 SOI L 2011-01-2 6 12:0 3 30.2 5 Fina l 1939 1 111 3 HICKOR YS T D Z 10 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 23.85 0

# 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 231.73 1 Supervise d By : 

## Certificat e o f Verificatio n

9 9 SOI L 2011-01-2 6 12:0 4 30.2 4 Fina l 1939 1 111 3 HICKOR YS T D Z 10 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 23.24 1

## / yM L \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 5 ^^^ ^

o Coasta l Environmenta l Grou p Inc
. V^*^! ^

www.coastalhazmat.co m %p„oT«< ^ COASTA L
• NVmONMENTA L C a o U P , IM C 

# EXECUTIV ESUMMARY : BVID #19391-(111 3 HICKOR Y ST )
No Issue s o r Concern s \ ^ Issues/Concern s Detail Explanation : -DA NGARVE Y WALKE D TH EPROPERT Y O N10/27/201 04 

## EP A Propert y Clos e Ou t For m Propert y # : / * y>^y
. Propert y Address : Date/Time : Owner' s NBin r Quad s Excavated : Contracto r Grou p CPtftjyvz^^ V
Excavatio nGenera l 1
.

i f neccssuy , wer e tli c correc t quadrant(s ) excavate dan drestored ? 2
.I f necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? Gradin g So dan dVcgcCBtio B 1
.Doe s th e gradin g aroun dth e perimeie r ofth e hous e i nexcavale darea s generall y slop e away fromth e house ? 2
.Ha s so dbee nlai di nal l area s that wer e excavated ? i
.Doe s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period ) 4
.Ar e sodde darea s generall y (irman devenl y graded ? 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 )
. 6
. Wa s th e propert y grade dsuc hthat wate r wil l not poo l onth e property ^ 

# r 7
. Wa s damag e t o landscapin g o r plant material s avoided ? Gates , Fence s an d Reutaln s Wal b 1
.D o gate s ope n an d clos e freely? (I fapplicable ) 2
.Wer e al l gate s o rfence s take n dow n durin g restotatio n activiiie s reinstalled ? (I fapplicable ) 3
.Wa s damag e t o gate s o rfence s avoided ? (Ifappiicable ) 4
.Wa s damag e t o retainin g wall s avoided ? (Ifappiicable ) FouDdatioD , Sidin g an d Gnt fer s t
.Wa s damag e t o th e sidin g o rtri m avoided ? 2
.

Wa s damag e t o th e foundatio n avoided ? 3
.Wa s damag e t o window s avoided ? Wa s dainag e t o window s o rdoo rscreen s avoided ? 5.Wa s damag e t o downspout s o rdownspou l extension s avoided ? Sidewalk s an dDriveway s (Concrete ) I
.Wa s damag e l o drivewa y surface s avoided ? 2
.Wa s damag e t o wallcwa y surface s avoided ? Yes No 

## y 

# y Yes No / 

## J J 

## y 

## J y 

# V Ye

s N o 

## J 

## J J y \ a N o 

## J J

• 1 

## y



# J j
Yic s N o 

### J L 

# V* 

## Ort'Der s comments :

pinspectio nnotes : 

# y ^ 

# yy Removal andrestoratio nactivate s complete includin g the 30-da y so dwarranry : EP ARepresentaliv e ^f ^ ^ Date : to\ti^ ' 1 0

## Propert yCompletio n Agreemen t This agreement documenl s the complclio no f remedia l aclivilie s perloime do nm y piopert y M y signalui e wil l designat e tha t I a msatisfiedwit hIh e restoralio no f m y properly , an dtha i no items ar e i nquestions , now , o r a

l any lim e i

nthe future , excep l Ihos e ilem s lisiedbelow , i f any Piopert y ID : f^^^^ l Properr y Address : j f-2 ^ H\C,]^C\ J ^ V Owncr:^! ^ ^

|^ ^ j ^ UlCXCP.( c 

### Phone : e^q q-3 3 6 M Restoratio nItem s inQuestion :

Item : 

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

## A r t {AM4J ^ 

## ^T y'^hfu ^ 

# C M i (

[rjv l Hyrc c r CKtorAlio ni s completed , excep t a s noler i i s complete d

Dat e Cuntiarfoi' s Sicnadir c Dat e

# ® # 

# Propeit y Owne r Assessment of Performanc e For m America nRecover y an dReinvestmen t Act (ARRA) OmahaLea dSuperfun dSit e 2009/201 0 ^CEIVE D Remediatio nContractor : Coasta l Envimnme^ta l Grou p - EP-R7-09-d 6 ^^ ^ ^ ^ "M Propert y Identifie r Number : \*\'^^\SUPfiRp r TV^.
. _^
_ Propert;Address : Id s H.cJ^fy^
. '"'''^DDIVISIO N Propert y Owner' s Name;-Torv- y W4irACjCxr.P.i<
. Instruction s to th e Propert y Owner : Thi s fon nserve s t o recor dth e Property Owner' s assessmen t o f perfonnanc e (Incentiv e 1

- Quality Assuranc e Surveillanc e Plan ) involvin g th e liste dremediatio ncontractor, a s applicabl e t o th e Omah aLea dSite
. Thi s formdocumoit s th e timelines s o f pimc hlis t resolution , busines s relations , complain t resolutio nan dth e overal l qualit y o f woik
. I f nee dbe , th e Property Owne r ma y utiliz e thi s formt o recor dproblem s and/o r issue s no t specificall y tie dt o anassigne d address , for example , busines s relation s that generall y don' t follo w th e guideline s se t fort hi nth e Performanc e Work Statemen t Th e Property Owne r wil l indicat e his/he r assessmen t o f performanc e withth e contractor' s wor k

b y checkin g anumerica l ratin g o ntli e tabl e belo w usin g th e numerica l definition s from th e rating scal e below , tha i sig n& dat e th e form. 9-1 0 "excellent " 7- 8 "very good " 5- 6 "acceptable " 3- 4 "poor " 1-

2 "very poor " Propert y Owner' s Assessmen t o f Performanc e Regardin g th e Contractor' s Wor k 1 0 5 9 / ^ 4 8 3 7 2 6 1 Propert y Owne r Additiona l Comment s fro m(optional ; continu e o nbac k pag e i f needed )
Propert y Owne r Signature : ( I \\)f\\{j A . J ^Date : ^0^FC>'^2J ^