# TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R
SA1D# : Date : ^ 

# MM . Address : 

# n\ n\ i 

# ^^" ^ ¥ Remediatio nContractor : Coasta l Environmenta l Group

_Year : _2010ARRA
_ SOI LREMEDIATIO N PROPERT YFIL EFOLDE RDOCUMENT S Vide o o f propert y (DVD ) • Executiv e Summar y EPA-provide dpropert y sketc h Signe dAcces s Agreemen t fo r subjec t propert y Signe dAcces s Agreement(s ) for adjacen t propert y

• t / 

### Restoratio nAgreemen t Settlemen t document s (i.e. , for damag e o r to replac e plants , etc. ) Confimiatio n dat a 

### Photograph s M ^ [^fC\P<)Jf^\\s> ^ -) CT^j^^h^ ^ V 4. ^ As-buil t sketc h Satisfactor y restoratio nsigne db y Propert y Owne r Propert y close-ou t chec k lis t signe db y EP A Descriptio no f area s no t meetin g RO D cleanu p criteri a Utilit y clearance s Propertvififormatio nfro mDougla s Count y Assessor' s Offic e 

# u
D 

# V Dat e signatur e 3021871 1 Superfun d

### #


# Propert y Acces s Checklis t PropcTt>.ID : (pL).{:;^{3, g D WOR K STARTE D ON : J l
_ Propert y Address : |-^^ ^ K l ^ j .St
. D WOR K COMPELTE D ON : I I
Rcnte n O^vncr : /V|p,[ , y Q f^^r i t^j-f - Address : Phone : 

# SAM E Fax : Cell/Pager : Additiona l Information : Fax : K\4- : c^c . I> ^ I 

# KW k sst^uiQ-i a Cell^ager : 

### D NotificationLette r Sent : / / By : ^ Acces s Agreement Signed:) ! I\^l ^ By : ^ Restoratio nAgreement Signed : A//iC ^ By : LJ ' Topsoil Samplin g (if applicable ) / / By : O Disposa l Samplin g (i f applicable ) / / By : Q Garde nSamplin g (if applicable ) / / By : 1 ^ Utilit y Clearanc e Called : I/iy./O a By : ) | 

# Qfbh \ 

# /

( ^h ^ 0
. Video/Photo s (Before) 

### On:^/S-'J O BySs , 

## Mfi^-ddk
. '•;c i o,j^<>iP£

­ 

## pi^'icui^j^^l y nVideo/Photo s (During ) On : / / By : nVideo/Photo s (After) On : / / By : nVideo/Photo s (30-Day) On : / / By : L

D Property CompletionAgreement Siened : / / By : D Fina l Repor t Issued : / / By : ^ Ai r Monitorin g (a s applicable ) nCommunit y Q Cre w On : By : Results : C

UCommunit y O Cre w On : / / By : Results : C ] Communit y Q Cre w On : By : Results :
Omah a Lea d Sit e

## Dougla s County Accoun t Inf c ^tt^H^ r Pag e 1 of 3 Dougla s County , Nebrask a Propert yRecor d - R084369000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabi e (a ) scai e 0-5 0 ft wes t o f52n d S t - VJe 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 Sale s Searc h Owne r BRAND TADELIN E M 171 6 N 5 0 S T OMAH AN E 68104-000 0 Propert yInformatio n Ke yNumber : 436 9 000 0 0 8 Accoun t Type : Residentia l Parce l Number : 084369000 0 Parce l Address : 171 6 N 5 0 S T OMAH AN E 68104-000 0 Lega l Description : COUNTRYCLU B DIS TLOT3 BLOC K2 8 5 5 X12 0 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $16,500.0 0 $111,900.0 0 $128,400.0 0 200 8 $16,500.0 0 $111,900.0 0 $128,400.0 0 200 7 $16,500.0 0 $111,900.0 0 $128,400.0 0 200 6 $16,500.0 0 $111,900.0 0 $128,400.0 0 200 5 $16,500.0 0 $111,900.0 0 $128,400.0 0 200 4 $16,500.0 0 $107,200.0 0 $123,700.0 0 Sale s Informatio n Sale s Date : 1998-04-0 6 Dee d Type : D Book : 208 8 Page : 49 1 Price : $116,000.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 1993-09-2 2 Dee d Type : D Book : 196 1 Page : 09 9 Price : $84,950.0 0 Grantor :


## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO.
. . 10/23/200 9

## Dbugla s County Accoun t Inf < :^ni|||o r Pag e 2 o f 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 5 6600. 0 1. 0 120. 0 55. 0 N o Improvemen t Informatio n Buildin g 1 1 1/ 2 Stor / Fi n 171 6 N 5 0 S t
Msw n WDCODK K
ICrBintO mw 42 0 0 S q Ft rt r 91( 0 sq . n 7 9
KMiq l

BsmnaooS t WeOSqF I ui«M»iiiMiiin«>Hiiim«wi«rn n CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1406. 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 : Masonr yCommo n Bric k Units : 

### 1. 0 Interior : Drywal l Baths : 

### 1. 0 Roo fCover : Slat e Bedrooms : 3. 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 193 0 0 % 

### 193 0 7 9 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Applianc e Securit ySyste m 1. 0 Basemen t Bsmn t Bloc k 8 f t 986. 0 Carpor t Attache d 288. 0 

## http://douglasne.mapping-onIine.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO..
. 10/23/200 9

## Dougla s County Accoun t Inf i [j^n^l^ r Pag e 3 of 3

Fixtur e Fixtur e Garag e Porc h Porc h Use r Bas e Fixture s Bat h Ful l Basemen t Singl e En d Soli d Wal l Woo d Dec k 200 2 BO E 21 2 1. 0 1. 0 1. 0 108. 0 288. 0 1. 0



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO.
. . 10/23/200 9

## Pag e 1 o f 1

" > Creat e Anothe rTicke t | | , Bac k t o Irt h Interne t Sen d Eniai l |

YOU RTICKE T NUMBE RI S 2560605
. Origina l Cal l Date : 8/04/1 0 Time : 6:0 9 p m Op : 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 : 171 6 Street : N50T H S T Twp : 15 NRng : 13 E Sect-Qtr : 18-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 ho f Excavation : 4 F T Corne 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 Utility ' Typ e Day : 402934046 9 CXCAT V CO X CO M M U NI CATIONS , IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUDO l METROPOLITA NUTILITIE S DISTRICT SAND Y Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACOFCIT Y O FOMAHA-TRAFFIC,SEWE RRICH/TRAFFIC Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 OPPDGPR5 OMAH APUBLIC POWE RDISTRICT EL M LOCATIN GAlt : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 QLNNEI C QWES T LOCA LNETWOR K EL M LOCATIN GAlt : 406207149 4 Emerg : 888728934 3

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

### 0 

# f ' /:\i ^ ( / '
6488 4 

# C\ea r\. l Q^/feS OnMh t Lea d Sit e Sit e Sketc h S*inj»tln 8 AtWffBt.lTil^Mgis V $anf)0l « LA E Concentfit'or i CollcctF d • nv n RVASCPXA-6<8B 4 f l HSt pp m 

### D Dat t RVBSCPXA-64eS 4 F 2 

# s C Tim r RYCSCPXA-fi4M 4 B l El y 

### D &tT,p)e ! An a yze d RYOSCPXA4480 4 9 t 

### 8 7 f*" ^ 

### D RDZSCPXA<«4»S 4 0 2 

### Q I X«fUni l Boo k 23i ^ • " pp m 

### D D I Dal e „ IQf Q nt*eooif*M<'6«eo4 n g 

### D D ; TiPTK '
_ axL . Numbe ro fS«mp!e s •= [ 5 I } Q ) 

# rs w Lette< M f ' ' F'O' H tp n F 7 • ffon t RiaW
. B t * B«« * Left
. 8 2 » BKKRil ^ O Z •= Of * Z«>t
. 6 2 « 6«rtfen
. P Z • Pt» ' 

## gu-—-^^.. ^ >
OC TD 9 M M

# As-Buil t Drawin g C OASTA L 

# Omah aLea dSuperfun dSit e ENVinONHCNTA L GROUP , IN C 0L§# : ?4?? 4 Dat e Excavated : 8/10/201 0 V Dat e USEP ASiqne d Off : 9/10/2011 ; Are a Sodden : 85 5 s o f t lllllililllilillllliil l 6488 4 Exteno rPain t HoiihAnxM t Omah a Lea d Sit e •Goo d Sit e Sketc h n Poo r Samplin a Address : 171 6 N 5 0 S T [J ] No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r 

# I I LA B Concentratio n Collecte d Fir m RYASCPXA-6488 4 F l H S I pp m 

### D Dat e 

### <^-l^-Cf i RYBSCPXA-6488 4 F 2 ^fl « DOT H Tim e 

### D I'l o f>n \ RYCSCPXA-6488 4 B 1 __^5_pp m Sample s Analyze d RYDSCPXA-6488 4 8 2 8 7 pp m 

# n RDZSCPXA-6488 4 D Z *^ H pp m 

### D XR F Unit : GSHt > Book : li b ROZ00PXA-CH08 4 S 2 " ~ pp m 

### D Dat e 

### D / Q •/' Q •0 8 nPgOCPXA'6400 4 P 2

—pp m 

### D Tim e 

### D D Staff : 

### tan Numbe ro fSample s = | 5 I | 0 | 

# ns p Legend : F 1 = Fro m Left
. F 2 = Fron t Right
. B 1 = Bac k Left
. B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla> A N quadrant s ar e a s viewe d fro m th e street , facin g propert y

N
. 5c ? 5t: : R*%iA « CICHC O ^»-.\m-' «


## Legen d Concret e 

### Dri p Zone Excavate d Quadrant s Excavate d Are areplace dwi1: h Are areplace dwit h 

# D Are alef t bar e So d RocJc/Mulc h 

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

### 6488 4 Omah a Lea d Sit e tt*rfO i P»ili " Sit e Sketc h •Goo d n Poo
. S«mp*in o AddrMS:'7iew>0S T Q ] Ho t p*n ( Lea d Sampl e Concentratio n Collecte d Sampt e Numbe r LA B Sanvie * Contde d Fim , ptt ttf-^JRYASCPXA-e4«8 4 F l pp m D Dat e*f~/l-£> ^ RYBSCPXA-64e8 4 F 2 pp m D Tim ef/ e ^/ H RYCSCPXA-e4«« 4 B l ^ D 

# I
Sample s Analyze d RYDSCPXA-«488 4 B 3 pp m D 

# -az . RDZSCPXA-0488 4 D 2 

## -Hi L

. PPn TM D XR FUm t (»SHt > Book : 22 ^ rtoeoop wo«o9 4 o e pp m D D Da w 10

- / O O Q nr'gooPM»-«46»<—f t pp m D D T'me £B Q Staf fPTS O Numbe ro fSample s « [ f f[ | Q [ Legen d F l • Fron t Len , F 2 • Fro m RigM
. 8 1 * Bac k Left
. B 2 • Bac k Righ l O Z « Dn p Zon e G Z -^

Garden , P Z « Pt » M 4u**ant * *r « wvi«w M t^i n W o »«r«*
. iKx g p«ee«n y

## 6488 4 Exterio rPain t Omah a Lea d Sit e •Goo d Sit e Si(etc h n Poo r Samplin g Address : 171 6 N 5 0 S T [ 3 No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r Concentratio n Collecte d U B 

### Fimi: F mPg-A r RYASCPXA-6488 4 F l H S I pp m 

# a Date : f-lt-Qf y RYBSCPXA-e488 4 F 2 ^ 3 ) pp m Time : 1'I P f>jv \ 

## D RYCSCPXA-6488 4 B 1 ^ S pp m 

# n Sample s Analyze d RYDSCPXA-6488 4 8 2 8 7 pp m 

# • RDZSCPXA-6488 4 D Z H H pp m XR F Unit : GSH O Book : lt d 

# I I n nozoor)(A-64oe4—e z " " pp m Dat e /O'/Q-Q g 

### D D •nPZOCPXA-6400 4P 2

—pp m 

### D Time : 20Q
_ 

# n Staff : 

### <^L J Numbe ro fSample s = [ 3 I | Q | Legend : F l = Fron t Left
. F 2 = Fron t Right
. 8 1 = Bac k Left
. 8 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla> Al l quadrant s ar a a s viewe d fro m th e street , facin g propert y

Re\' y* » Cre.ilrtl
. ;f»-,\Mg-(» » 

# ^^jS\p ^ ^COASTA l
'* < POO't ' 

# Consen t fc fAcces s T o PrapeFt)/ 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 perforn n certai n environmenta l respons e activitie s upo n th e follov^in g describe d premises ; / A'\--fyiL 

# (^67 4 Daytim e Phone :

I Addres s o fPropert y

covere d b ythi s 

# /7/. ^ 

# A5 0 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 flea d an d ma ypos e a healt h hazard
. Th e area(s ) v»^ill 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 its 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 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 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 EP Atha t th e propert y ha s bee n remediated
.
ENVIRONMENTA LRESPONS 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 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 fperformin g th e work
. Thi s acces s shal l remai n i n effec t unti l th e wor1 < ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :

Pag e 1 o f2

# w
,*-^*°_*"v
.

' /

COASTA L ''+ /

r5 * IffVIBOHHIKTA l ' l "ROl* - c « o u rIX C 

### e 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 ; cWate 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 b yEPA ; cAbid e b yhealt h an d safet yguidanc e provide d b yEPA ; fI 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
. cAllo wvideotapin g and/o rphotographin g o fth e property
. AGREEMEN TNO TT o INTERFER E 

### Th e Granto ragree s no t t o interfer e o rtampe rwit h an yo fth e wor k activities , o rwit h an y o fth e wor k done , o rwit h th e equipmen t use d o n hi s property , o rt o undertak e an y action s regardin g th e us e o fsai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o fth e Grantee s o rth e environment , o rt o allo wother s t o us e th e propert yi n suc h a manner . Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contac t Coasta l Environmenta l Group , a t (402 ) 991-119 9

[^^gran t acces s t o m ypropertie s G ' d o not gran t access t o mypropertie s 

# i..,...^/

- //-/3- ^ Signature Dat e Signature Dat e
O 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 f2

### ^ \ COASTA L CNVIHONM C NTA L CROUP , INC
. 

# Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o provid e amutual agreemen t a s t o condition s o f th e property prio r to remediatio nactivities
. Thi s wil l als o serv e a s documentatio nfor th e purpos e o f assurin g tha t restoratio n activitie s are complete dt o th e satisfactio no f th e property owne r an dth e Unite dState s Environmental Protectio nAgenc y (EPA)
.

Property ID : ^^WS ^ Property Address : (7/ 6 P60 ^ Owner : /^OtLlO t g^^y^A J C T 

## Phone : ^^^-^1^^ QG ^ ^ GGl ^ Onth e attache ddiagram(s ) indicate area(s ) t o excavate , surfac e structure s andlandscapin g feature s and acces s location(s ) t o b e use dby th e contractors . Indicate distances , depths , material types , etc . Photographicall y andVideographicall y document th e existin g condition s ofth e property andth e basement i f necessary . 

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

# /^-Y^v ^

S-vna U 9^0^ ^ Item : Item : Item :



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

Item : Item : Item :

Pag e 1 o f/- ,COASTA L eNVIKONME N T AL 

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

# Cor j Item : 

# ^fc | Item : Item :



## Ite m Pre-existin g property area , tha t will b e excavated , tha t i s covere dwit hgrass . Number o f tree s > 2 inc h trunk diameter Numbe r o f tree s < = 2 inc h trunk diamete r Numbe r o f Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Attac hasketc ho f the sprinkler layout
. Number o f an dsiz e o f eac hgarden/ flower be d area . Attac hasketc ho f relativ e size s andlocations
. Agree dupo nvalu e o f plan t material s no t to 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> ' owner . 

# F l F \

Landscap e Inventor y Quantit y Uni t Quadrant s 

# F l

Eac h \ Eac h 

# j r

Eac h ^
Eac h / Square Feet 

# X $ 

## Condition/Type/Specie s 

# Bh'^n^p X

Easement Area , to b e Eac h excavate d 

# ^^<^\y\ ^ Qc^l'^ ^ 

# V

Pag e 2 o f^COASTA L BNVmONMCNTA L CROUP , INC
.


### Additiona l Comment s / Instructions : Th e cit yo fOmah a ordinance s ma yprohibi t yo 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 fsoi l doe s no t mea n tha t an yillega l 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 EPA
. 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 cit yo fOmaha' s Plannin g Departmen t a t (402 ) 444-5150
. {

^

Pleas e chec k thi s bo xi fyo u understan d th e informatio n outline d above
. 

# 3 Oh ^ AJof\6€ stftff T

•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
.



# Kli agre e O Id o no t agre e

Owner' s Signatur e "^ Dat e Contractor' s Signatur e Dat e 

### Pag e 3 of
.

# ^^Jr y ni ^

K'^ToL^
. ^.RFiD ^ •^. ^ --rif : ihO ' i ; if-/( C Cl'c a ! ihO ! ^ j5;r.t, r rfe i
Deol!- i ue|j: n •-..veraqf : 

# Hi t 

# I S c / -•.'irao e
I Sho l # I _Read^no_

_I Sampl e area ) Sho t # Readi r fSainpii rireB i 

# A n __pepu h 

# A ' L^epl ; 

### / M'.'era'j e


# : /> « t IT . 

# F l 

# r^ "

.•eraq s 

# i n W /

JwKi ; A^ •Rp;^: y F:f.3air. a i Saiiipl e are a |



# 1/

4 it' ^ iWffy^ ,

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

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

Supervise d B y 

## Certificat e o fVerificatio n

10 2 SOI L 2011-02-0 8 11:3 5 90.9 3 Fina l Avg o f 99-10 1 171 6 N5 0 S T EA 1 " C.PADILL A CONFIRMATIO N CLEA R

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

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

pp m P b 161.37 7 Supervise d By : 

## Certificat e o fVerificatio n

9 9 SOI L 

### 2011-02-0 8 11:3 3 30.1 9 Fina l 6488 4 171 6 N 5 0 S T EA 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 19.56 9

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

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

pp m P b 127.99 2 Supervise d By : 

## Certificat e o fVerificatio n

10 0 SOI L 2011-02-0 8 11:3 4 30.5 4 Fina l 6488 4 171 6 N5 0 S T EA 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 16.03 9

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

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

pp m P b 138.54 0 Supervise d By : 

## Certificat e o fVerificatio n

10 1 SOI L 

### 2011-02-0 8 11:3 5 30.2 0 Fina l 6488 4 171 6 N 5 0 S T EA 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 18.82 2

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

XL3t-3902 2 Readin g N o Mode 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

9 8 SOI L 2011-02-0 8 11:3 1 90.9 5 Fina l Av g of 95-9 7 171 6 N5 0 S T LS 1 " C.PADILL A CONFIRMATIO N CLEA R

# 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 9 5 Mod e SOI L Tim e 2011-02-0 8 11:3 0 Duratio n 30.2 2 Sequenc e .Fina l Flag s BVI D 6488 4 ADDRES S 171 6 N5 0 S T QUADRAN T LS DEPH T 1 " XR F TEC H C.PADILL A MIS C CONFIRMATIO N NOT E CLEA R

pp m ±Erro r P b ±15.70 2 113.46 6 Supervise d By :

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

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

pp m P b 123.27 8 Supervise d By : 

## Certificat e o fVerificatio n

9 6 SOI L 2011-02-0 8 11:3 0 30.5 6 Fina l 6488 4 171 6 N5 0 S T LS 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 14.48 9

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

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

pp m P b 128.24 8 Supervise d By : 

## Certificat e o fVerificatio n

9 7 SOI L 

### 2011-02-0 8 11:3 1 30.1 7 Fina l 6488 4 171 6 N 5 0 S T L S 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 16.78 6

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H 

### MIS C NOT E

Supervise d By : 

## Certificat e o fVerificatio n

9 4 SOI L 

### 2011-02-0 8 11:2 8 90.7 4 Fina l Av g o f91-9 3 171 6 N 5 0 S T F l 4 " C.PADILL A CONFIRMATIO N CLEA R

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E
pp m P b 68.65 6 Supervise d By : 

## Certificat e o fVerificatio n

9 1 SOI L 

### 2011-02-0 8 11:2 6 30.5 3 Fina l 6488 4 171 6 N 5 0 S T F l 4 " C.PADILL A CONFIRMATIO N CLEA R

±

Erro r ±

12.85 1

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

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

pp m P b 71.63 5 Supervise d By : 

## Certificat e o fVerificatio n

9 2 SOI L 

### 2011-02-0 8 11:2 7 30.1 2 Fina l 6488 4 171 6 N 5 0 S T F l 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 14.69 3

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

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

pp m P b 85.15 4 Supervise d By : 

## Certificat e o fVerificatio n

9 3 SOI L 

### 2011-02-0 8 11:2 8 30.0 9 Fina l 

### 6488 4 171 6 N 5 0 S T F l 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 16.21 4A ^ <: * 

## Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
. www.coastalhazmat.co m COASTA L ENVIRONMENTA L CROUP , INC
. 

# EXECUTIV ESUMMARY : BVI D #64884-(171 6 N5 0 ST )

X 

# N o Issue s o r Concern s Issues/Concern s Detai l Explanation: -DONBAPINK EWALKE D TH EPROPERT YON9/10/201 0

# EP APropert y Clos e Ou t For m Propert y Address : 

### Propert y #:ij2ldBB ^ rropen y /iouress ; -/ V -.Ip i / A Date/Time : Owner' s Name: . /c..^Cly.[ ' f ^ Qusd s Excavated'
. Contracto r Grou p C/lCl^'Tt X^ Ye * N o Excavatio nGenera l 1
.I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 

# u- " 2
.I f necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? Ye s IV o Gradin g So dan dVenetatio n I .

Doe s th e gradin g aroun dth e perimeie r ofth e hous e inexcavaieri area s generall y slop e awa y fromth e house ? 2
.Ha s so dbeenlai dinall area s that wer e excavated ? 3
.Doe s th e so dappea r to b e generall y health y andgrowing ? (Onl y evaluat e if inspecte da t a3 0 

# Z^" ^ da y tim e period ) 4
.Ar e sodde darea s generall y firman devenl y graded ? ' ^ 5
.Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e if inspecte da t a3 0 da y 

# c Y tim e period ) 6 . Wa s th e property grade dsuc hthai wate r wil l no t 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 dRctoinln g Wall s Ye s N o I .D o gate s openandclos e freely? (I f applicable ) 

## iy { Wer e al l gate s or fence s take ndow ndurin g restoratio naclivilie s reinstalled ? (If applicable ) 

## ly 3
. Wa s damag e t o gate s or fence s avoided ? (I f applicable ) 

# "C? ' <!
. Wa s damag e t o retainin g wall s avoided ? (I f applicable ) 

# y Foundation , Sidin g an dGnKer s Ve s .N o I .

Wa s damag e t o th e sidin g o r tri mavoided ? 

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

# T:^ ^ Wa s damag e l o window s avoided ? ^ 4 Wa s damag e t o window s or doo r screen s avoided ? 

# V 5
. Wa s damag e t o downspout s o r downspou t extension s avoided ? 

# ( y Sidewalk s an dDriveway s (Concrete ) Vc s N o 1
.Wa s damag e to drivewa y surface s avoided ? 

# i/^ : j L 2 ,

Wa s damag e t o walkwa y surface s avoided ? 

# z^ ^

## OMtier s comnienls :

jinspectJo nno<es :

Removal an drestoratio nactivate s complej^ e iqcludin g the 30-da y so dwarrapry : HP ARepresenlaiiv e 

# P^>--Ut/^/l L

## Propert yCompletio n Agreemen t
I'hi s agieemen l documeni s Ih e complclio n o t remedia l aclivilie s perloime d o n m yproperly
. M ysignatur e wil l designat e llia l I a m satisfie d wit h th e restoratio n o fm yproperty , an d that n o item s ar e i n questions , now , o rat an ylim e i n th e future , excep t thos e item s liste d below , i fan y

Propert yID : [jp^p^ Q LJ [ Propert y Address : )- | |( ^ / ^ g ^ ^|~

­ 

# ^:!!!!!i_^deJjjO£__Br-a^ ^ 

# 2 Phone : 

# ^vo o yip'={ ' iddi ^ Restoratio n Item s i n Question :

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

| X | 1 ayrc cICitoralio n wcompleted , excep t a s note d yI I d o no t a(;re crestoratio n wconiplelcr i

Owiici' s Signatur e / Dat e ' Contia i tor' s Signatur e D a

## Wate rBil l Settlemen t

Propertj ' I D 6488 4 Propert y Addres s 171 6 N50' " Stree t Tenan t Adelin e Brand t 

# 58."^ ^ I hav e receive dfromth e contractor , Coastal Environmental Grou p Inc . (Coastal) , th e su mo f $_fo r wate r usag e require dto maintai nth e sod
.

Chec k Numbe r 215 2 Valu e of Chec k $58.9 6 Mad e Ou t T o Adelin e Brand t Descriptio n ofSettlemen t T o reimburs e tenan t fo restimate d wate rcharge s o n thei rMU D monthl yinvoices
. M ysignatur e belo wi s acknowledgemen t o fth e receip t o fth e su m liste d above , whic h I furthe r acknowledg e t o b e fai rcompensatio n an d ful l paymen t fo rth e above , an d releas e Coasta l Environmenta l Grou p Inc
. fro m furthe robligation s o rliability
.



# AJ
. 7-^^y ^ f/yM^^^(/-y - c^l^c ^ Owner' s Signature f^ Dat e Contractor' s Signature Dat e
-^•
- ^y-...--.f—•v»^..-w>-..—^^—pj— ^ '•-*7.----—'T.'^',- ^ . >"•'?'.^'-y^r^ t 

## 215 2 COASTA LENVIRONMENTA LGROU P INC
. 27-5/104 0 00 3 241 1 MARTH ASTREE T 6247372904 OMAHA , N E 6810 5 

# ^IZ'gh Q DAT E I'A

YTO ORDE R 

# l\ ^ ftrlP.lmji ?)V-DJaC^ t 

# $5S ^ ?ii^-^>u3^Qjy>^'^' ' iOD ' DOLLAR S 

# a

WH KFarg o Dank
. N.A
. Nebrask a wedsfargcco m FO R 

# ?^V/ D M<k m\1\\^N6 0 

# i^^V\A^\Ph ^ C^CPt-- ^ i : lOiiOODOSfli : E
. EU73 7 E^OUH ' 

### 0E15 E

### Account : 231039-113795 2 

## Brya nMurra y 172 3 Harne y St •Om a SITECOORDIONATO R ADELIN E M. BRAND T e-mail : customer_serviceiI'mu c Sen/ic e address : 1716N50THS T 241 1 Marth aSt Billin g dat e Omaha , NE 6810, S Cal l 554.777 7 ifyo u smel l gas . Previou s balanc e Office : [402)991.119 9 << Paymen t receive d -T h No charg e to chec k ga s leaks
. Hav e heatin g Fax : C877 ) 662,421 1 Tol l Fre e Curren t charge s syste m checke d ever yyea r bya qualifie d Mobile : (402 ) 504.299 5 Ne wbalanc e 

### i heatin g contractor
. Kee p chimney s an d flue s Certifie d MBE*DBE*8(a)*Hu b Zon e 

# •Tota l due | fre e ofdebris
. You rbudge t paymen t of$69. 1 Budge t Variances : Currenr Detail sofcurren t charges : 

## GA S RESIDENTIA LRAT E A: Au g 17 to Se p 17 25 0 " Mete rNumbe r41854 2 

# P Curren t rea d (actual) : 248 1 - Previou s rea d (actual) : 247 6 = 5 CC F 125 - Ga s Use : 5 CC F x1.00 5 (hea t value ) = 5.02 5 therm s 16 day s 2.59 4 therm sat 0.500 3 • $1.3 0 

# | j 

# .J 

# 1

. n i>: t Mo^ ' ne e Ja n Fe b Mai
. Ap i Ma yJu n Ju l Au g Se p 15 day s 2.43 1 therm sat 0.594 1 1.45 You rGa s Us e Servic e Charg e 13.0 0 Ga s Cos t • $15.7 5
•Pas t 12 Month s Q Pas t 13-2 4 Montli s Ga s Infrastructur e Replacemen t 3.0 0 Thi s Mont h Las t Yea r Billin g units : 5 5 Us e pe rday : 0. 2 0. 2 Averag e cos t pe rday : $0.6. 1 $0.5 5 Numbe rofday s in billin g cycle : 3T 32 

## WATE R RESIDENTIA LRAT E W-1 : Au g 17 to Se p 17 Mete rNumbe r286510 6 Size : 5/8-inc h Curren t rea d (actual) : 33 7 - Previou s rea d (actual) : 29 9 = 38 CC F

Wate rUse : 38.00 0 CC F or28,42 4 gallon s 9.00 0 CC Fat 0.961 4 = $8.6 5 

# 1_ LiM i L 21.00 0 CC Fat 1.345 1 = 28.2 5 Oct NovDe cJa n Fe b Ma i Ap i Ma yJu n Ju l Au g Se p 8.00 0 CC Fat 1.729 8 = 13.8 4 You rWate rUs e Servic e Charg e 5.2 2 Pas t 12 Montli s Q Pas t 13-2 4 Montti s Wate rCos t • $55.9 6 Wate rInfrastructur e Replacemen t 3.0 0 "Thi s Mont h Las t Yea r Billin g units : 38 9 Budge t Paymen t Pla n Interes t 0.0 1 CR Us e pe rday : 1. 2 0. 3 Averag e cos t pe rday : $2.0 3 $0.5 1 Cit y ofOmah a Sew/e r 13.4 9 Numbe rofday s in billin g cycle : 31 32 Sale s Ta x 6.3 8 •Curren t Char g es $97.5 7

### Account : 321025-113409 5 JASO N HARVE Y Sen/ic e address : 151 9 BERR YAV E 

### Sav e checks , postag e an d stamps
. Pa yyou rbil l on-line
. W e accep t al l majo rcredi t cards
. G o t o www.mudomaha.co m an d clic k o n "m y account. " # • 172 3 H^iineyS I = On-is.: ­ c-rTiai: : cus:*.:-^. ' ic'^:-: ^ \

•,r\.'ij 

## METROPOLIJA N UTILITIE S DISTRIC T



### Liv

eGreen
. IcimB\\,,i , Billin g dat e Ju l 6 , 201 0 Previou s balanc e $289.7 6 Paymen t receive d -Than k yo u 130.0 0 C R Curren t charge s 84.2 0 Ne wbalanc e 243.9 6 

# •Tota l du e Ju l 21 , 201 0 $243.9 6 H paymen t i s receive d afte rdu e date , a lat e fe e wil l b e assesse d o n ga s an d wate rcharges
.

4 0 ' 2 0 - 

# I I

0 Au g Se p Oct No u Oe cJa n Fe b Ma rAp i Ma yJu n J u You rGa s Us e

•Pas t 1 2 Month s O Pas t 13-2 4 Month s Thi s Mont h Las t Yea r Billin g units : 3 1 n/ a Us e pe rday : 0. 9 n/ a Averag e cos t pe rday : $1.0 4 n/ a Numbe ro fday s i n billin g cycle : 3 3 n/ a
2 0 ­ 1 0 ­ 0 Au g Se p Oct ^4o vDe cJa n Fo b Ma i Ap rMayJu n Ju l You rWate rUs e

•Pas t 1 2 Month s Q Pas t 13-2 4 Month s Thi s Montt i Las t Yea r Billin g units : 1 8 n/ a Us e pe rday : 0. 5 n/ a Averag e cos t pe rday : $0.9 3 n/ a Numbe ro fday s i n billin g cycle : 3 3 n/ a Detail s o fcurren t charges : 

### GA S RESIDENTIA LRAT E A : Ma y2 6 t o Ju n 2 8

Mete rNumt>e r45745 6 Curren t rea d (actual) : 25 6 - Previou s rea d (actuao : 22 5 = 3 1 CC F

Ga s Use : 3 1 CC F x1.00 2 (hea t value ) = 31.06 2 therm s

6 day s 5.64 8 therm s at 0.549 5 = $3.1 0 2 7 day s 25.41 4 therm s at 0.546 0 = 13.8 8 Servic e Charg e 13.0 0 Ga s Cos t • 

### $29.9 8 Ga s Infrastructur e Replacemen t 

### 3.0 0

WATE R RESIDENTIA LRAT E W-1 : Ma y2 6 t o Ju n 2 8 Mete rNumt>e r290860 6 Size : 5/ 8 -inc h Cun-en t rea d (actual) : 3 3 - Previou s rea d (actual) : 15=1 8 CC F

Wate rUse : 18.00 0 CC F o r13,46 4 gallon s 9.00 0 CC F a t 0.961 4 = $8.6 5 9.00 0 CC F a t 1.345 1 = 12.1 1 Servic e Charg e 5.2 2 Wate rCos t •$25.9 8 Wate rInfrastructur e Replacemen t 3.0 0 Cit yo fOmah a Sewe r 16.7 3 Sale s Ta x 5.5 1 •Cunen t Charge s $84.2 0

Pleas e retur n thi s portio n lo t th e bil l wit h payment.' •Pleas e d o no t stapl e paym ^ e-mail : customerjBervice@mudomaha.co m

website : www.mudomaha.co m METROPOLITA N
U TI L1 lie s DISTRIC T 

## 000321025113 4 0 9 5000000 2 4396 5 685 0 001 0 M U R P 0 6 0707201 0 NYNNN Y0 1 00397 1 l723HameyS t •Omaha,N E 6810 2 JASO N HARVE Y 

### Du e o n o rbefor e Ju l 21 : $243.9 6 151 9 BERR YAV E I fpaymen t i s receive d afte rdu e date , a lat e fe e wil l OMAH AN E 68107-355 4 b e assesse d o n ga s an d wate rcliarges
. Amoun t Paid : 

### ||l||,|„l||..l..l,„|,l|ll.,.||.ll||..|,lll,||l|l.,|,..ll,.,l||
. METROPOLITA N UTILITIE S DISTRIC T P O BO X360 0 OMAH AN E 68103-060 0 Q Chec k bo xan d indicat e chang e o fmailin g addres s 

### ..l..tl|.,|ll|l.||,.l,t|,|„...||||,|ll,|||.l|,...l„.,.lll.l||. | o rtelephon e number s o n th e reverseside
. Giv e t o th e Hea t Ai d Fund
. Se e www.mudomaha.co m Monthl ydonatio n - Add : n$ 2 D$ 3 D$ 5 Other$
_ Account ; 321025-113409 5

### Account : 321025-113409 5 # • Pag e 3 o f4 JASO N HARVE Y Servic e address : 151 9 BERR YAV E 

### T o hel p u s bette rserv e you.. . O n th e da yyou rmete ri s schedule d t o b e read , pleas e secur e dog s awa yfro m you rmeter
. Kee p shrub s an d bushes.trimme d and.awa y fro m meters
.

3 0 ' 1 5 -

^ 0 Ju ! Au g Se p Ocr l r»i wDe ^ .'a n Fe* ; Ma i Ap rM? yJu n You rGa s Us e

•Pas t 1 2 Uootti s B Pas t 13-2 4 Month s Thi s Mont h Las t Yea r Billin g units : 2 8 n/ a Us e pe rday : 1. 3 n/ a Averag e cos t pe rday : $1.2 9 n/ a Numbero fday s i n billin g cycle : 2 2 n/ a
2 0 ~ 

### 1 1 0 ­ 0 ^ Ju l Au g Se p Oct No vOe cJa n Fe b Ma i Ap rMayJ u n You rWate rUs e

•Pas t 1 2 Uontti s B Pas t 13-2 4 Montl w Thi s Mont h Las t Yea r Billin g units : 1 5 n/ a Us e pe rday : 0. 7 n/ a Averag e cos t pe rday : $0.9 9 n/ a Numtae ro fday s i n billin g cycle : 2 2 n/ a 

# ± Pleas e retur n ttii s portio n o f e-mail : customer_service@mudomaha.co m

website : www.mudomaha.co m METROPOLITA N UrUtllE S DISTRIC T 685 0 002 0 M U R P 0 3 06042010 YNNNN Y0 1 00021 5 172 3 Harne yS t •Omaha , N E 6810 2 JASO N HARVE Y 151 9 BERR YAV E OMAH AN E 68107-355 4 

### „llll|...|||l.,..,.||.i,n,.l,(.,l|ll.l||ll..l,|llj|„|l,.,.|,j
.
Q ] Chec k tx> xan d Indicat e chang e o fmailiri g addres s o rtelephon e number s o n th e reverseside
. 

### SHUT-OF F NOTIC E ENCLOSE D 

## # # 172 3 Harne yS i ^-Omaha
. i>^E53ior ^

- ^:02.554.6S6 S e-rnail ; cusiome r££:r\':ccf.:-rT.U'J:;rr;yh3.curr i -^

•,vcr.'£i:c-
. '.".•..v..rr.'j'Jc'.'n?l:2.-:crr
. 

## METROPOLITA N UTILITIE S DISTRIC T Billin g dat e Ju n 3,201 0 

### ImQiKn/fhiithBhic
. Previou s balanc e $0.0 0 Paymen t receive d 0.0 0 Adjustment s 168.5 4 Curren t charge s 121.2 2 Ne wisaianc e 289.7 6 

# •Tota l du e Ju n 18 , 201 0 $289.7 6 I fpaymen t i s receive d afte rdu e date , a lat e fe e wil l b e ae&esse d o n ga s an d wate rcharges
. Detail s o fcurren t charges : 

### GA S RESIDENTIA LRAT E A : Ma y4 t o Ma y2 6

Mete rNumbe r45745 6 Curren t rea d (actual) : 22 5 - Previou s rea d (actual) : 19 7 = 2 8 CC F Ga s Use : 2 8 CC F x1.01 2 (hea t value ) = 28.33 6 therm s

2 2 day s 28.33 6 therm s at 0.549 5 = $15.5 7 Servic e Charg e 9.5 3 Ga s Cos t •$2 5 1 0 Ga s Infrastructur e Replacemen t 2.2 0



### WATE R RESIDENTIA LRAT E W-1 : Ma y4 t o Ma y2 6

Mete rNumbe r290860 6 Size : 5/ 8 -inc h Curren t rea d (actual) : 1 5 - Previou s rea d (actual) : 0=1 5 CC F

Wate rUse : 15.00 0 CC F o r11,22 0 gallon s 15.00 0 CC F at 0.9614 = $14.4 2 Servic e Charg e 3.8 3 Wate rCos t •$18.2 5 Wate rinfrastructur e Replacemen t 2.2 0 Cit yo fOmah a Sewe r 12.2 7 Tur n O n Charg e 57.0 0 Sale s Ta x 4.2 0 •Curren t Charge s $121.2 2 Detail s o fadjustments :

Accoun t Balanc e Transferre d $168.5 4 •Tota l Adjustment s $168.5 4 th e bil l Wit h paymeht
. •Pleas e do~not~stapl e jSayirienrtoTnj r


### 000321025113409500000028976 5 Du e o n o rbefor e Ju n 18 : $289.7 6 I fpaymen t i s receive d afte rdu e date , a lat e fe e wil l b e assesse d o n ga s an d wate rcharges
. Amoun t Paid :
METROPOLITA N UTILITIE S DISTRIC T P O BO X360 0 OMAH AN E 68103-060 0



### . l.,.,||l|l,|ll.,||.l,ll.||lll|l|ll,|,ll||||.,.,l.|.,.„.l|.ll .l ,
Account : 321025-113409 5 

# 1