## TRANSMITTA Lo f

OMAH ALEA D SITE SOILREMEDIATIONFILEFOLDE R

-> 1 ^ SAI D 

# *:_M Date : 

# . Address : Q^l < ]M\ll\^>cy ^ ^ f Remediatio nContractor : _Coflstal Environmenta l Group _ SOI LREMEDIATIO N PROPERT Y nLEFOLDE RDOCUMENT S Vide o o f property (DVD ) Executiv e Summar y 

# 4 EPA-providedproperty sketch SignedAcces s Agreement fo r subject propert y SignedAcces s Agreement(s ) fo r adjacen t propert y 

## •c

r •f

r Restoratio nAgreement Settlement document s (i.e. , fo r damag e or to replac e plants , etc. ) Confinnatio ndata Photoglyph s (jC^A'llov nV fft I^^Q^fttW ^ As-built sketch Satisfactor y restoratio nsignedb y Propert y Owner Propert y close-out check lis t signedb y EP A Descriptio no f area s no t meetin g RO D cleanup criteri a 

# tr . Utilit y clearance s Propert y infonnatio nfro mDougla s Count y Assessor' s OfTic e Year ; 200 i

# r

V 

# V N ' Signature )ate 3005477 9 Superfun d» • « •


## Propert y Acces s Checklis t Property m : j<l)pj(L | Property Address : ^^^^,•||f^rV ^ D D

WOR K STARTE D WOR K COMPELTED ON : ON : / / /

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## ^^" ^ Krc ARij?^gy ^ Address :


# """" ^ ^n^
. .^n^
. 5^<r. r Fax : Cellffager
. (^^Q ^

^9^ 9 Rente r Phone : Fax : Cell/Pager : Additional Infonnation :

D NotHIcfltio nLette r ^ Acces s Agreement j2v ] Restoratio nAgreemen t D Topsoil Samplin g (if applicable ) D Disposa l Samplin g (i f applicable ) D Garde nSamplin g (i f applicable ) ^ Utilit y Clearanc e t3^Video/Photo s (Before ) 0 Video/Pboto s (Dnring ) D Video/Photo s (After) D Video/Photo s (30-Day ) [^Propert y Compietio nAgreema t D Final Report Sent : / / Signed : JQ./X/(2 . Signed : _/i/J_/ ^ / / / / / / 

## Callcd-iiL/3_<39
-

On ; [ D / r 3 / q On : / / On : / / On : / / Siffted : JJ_J^IJ2 $ Issued : / / By : By : By : By : By : By : 

## By : ^y
By : By : By : By : By : 

## \n\^ ; Aiop ^

Ai r Monitorin e (a s apoiicable ) DCommonlt y DCrc w Results : On : / / 1 

# 1
D Commnnit y Results : DCre w | On : / / 

### By : 1
DConmranft y Results : QCrc w On : / / By :

Omah a Lea d Sit e

## Dougla s Coimt y Accoim t I

ii£ujM|io n 

## Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R181606000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f 52n d S t - VJe W D O Ma p Infomiatio n i s vali d a s o f 2009-9-1 5 Treasurer' s Ta xRepor t Ne wFeatur e ^ ^ ^ Aut o Sale s Searc h Owne r ROSENE R KENNET H P ETA L 441 5 WILLIA M S T OMAH AN E 68105-000 0 Propiert yInformatio n Ke yNumber : 160 6 000 0 1 8 Accoun t Type : Residentia l Parce l Number : 181606000 0 Parce l Address : 441 5 WILLIA M S T OMAH AN E 68105-000 0 Lega l Description : MORTO N MEADOW S LOT4 BLOC K3 5 4 X 13 8 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $ 6,800.0 0 $ 165,400.0 0 $ 172,200.0 0 200 8 $ 6,800.0 0 $ 165,400.0 0 $ 172,200.0 0 200 7 $ 6,800.0 0 $146,600.0 0 $ 153,400.0 0 200 6 $ 6,800.0 0 $146,600.0 0 $ 153,400.0 0 200 5 $ 6,800.0 0 $146,600.0 0 $ 153,400.0 0 200 4 $ 6,800.0 0 $108,200.0 0 $ 115,000.0 0 Sale s Informatio n Sale s Date : 1997-06-0 4 Dee d Type : Book : 206 4 Page : 07 9 Price : $98,000.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 7 7452. 0 1. 0 138. 0 54. 0 N o Improvemen t Informatio n 

## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl8.. . 9/17/2009

### Dougla s County Accoun t In£arB||tio n Pag e 2 of 2

^^HHt j
Buildin g 1

441 5 Willia m S t RANC H



## . J 1 • S W

• rv r

»f » 

# ^^L_p^L_ r 1 "S*"** - CLIC KT Q ENLARG E IMAjg E CUC KT O ENLARG E IMAG E Squar e Footage : 1820. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : I Averag e Uni t Type : 

### Condition : : Goo d 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 : I 8. 0 Exterior : Fram e Viny l Untts : ! 1. 0 

### Interior : Plaste r Baths : 2. 5 Roo f Cover : Compositio n Sliingl e Bedrooms : 3. 0

Roo fType : 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 

### 192 5 0 % 192 5 8 3 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 

### 1. 0 Applianc e Fireplac e Masonr y 1. 0 Basemen t Bsmn t Blocl < 8 ft 1050. 0 Basemen t Minima l Finis h 650. 0 Fixtur e Bas e Fixture s 

### 1. 0 Fixtur e Bat h Ful l 2. 0 Fixtur e Bat h Hal f 1. 0 Garag e Detache d 484. 0 Porc h Sla b w/Step s 

### 16. 0

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R18. . . 9/17/200 9

### Pag e 1 of 2

Creat e Anothe rTicket ; Bac k t o Irt h Interne t '
. Sen d Emai j J


### YOU RTICKE T NUMBE RI S 2388326 . Origina l Cal l Date : 10/17/0 9 Time : 1:1 6 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 10/21/0 9 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 441 5 Street : WILLIA M S T Twp : 15 NRng : 13 E Sect-Qtr : 29-NW Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : Lea d Remediatio n Locatio n o f Work : INCLUD E AL L EASEMENT S LOCAT E ENTIR E PROPERT Y Remarks : FAX AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LO T 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 : 4f t Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N BSHPCLK S CXCAT V MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F



### Servic e Are a Contac t Phon e Number Utilit y Typ e BSHPCLK S NEBRASK AHEALT H SYSTE M N A Day : 402552346 0 Alt : 402552334 7 Emerg : 402559511 1
CXCAT V CO X COMMUNICATIONS , IN C HEIDI Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
MUD0 2 METROPOLITA NUTILITIES DISTRIC T SAND Y Day : 402504782 3 Ait : Emerg : 402504797 0
OMAHACO FCIT Y O FOMAHA-TRAFFIC.SEWE R RICH/TRAFFI C 

### Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 10/17/200 9

## Page 2 of 2

OPPDGPR 6 OMAH APUBLI C POWE RDISTRIC T N A 

## Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNNEI FQWES T LOCALNETWOR K N A 

## Day : 406728934 3 Alt : 4062071494 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.. . 10/17/2009OLS# : 1981 4 

# As-Buil t Drawin g Dat e Excavated : 10/28/0 9 Dat e USEP ASigne d Off : 11/10/0 9 COASTA L 

# Omah aLea dSuperfun dSit e ENVIItONMENTA L Are a Sodden : 2 1 s o f t C R O U r, IN C

f ­ Name : A^e/)n*/ A^^Stf^iC r Addres : Pho m ess : VV/^ " h7? l lj(i£U43= 3 i'l
. 5-6S S Omah a Lea d Sit e Sit e Sketc h Dat e Time : ^ Nort h AiTo w ) —1

Tea m %«•>, \ ICin/tt' ^ jCr^i ^

BVI D # I' ^

^/ V XR F Code ^^Ol
. Sampl e Numbe r Lea d Concentratio n 

### l/>^±^ S i n ±1 ^ 

### iUI±&< ^ pp m pp m pp m pp m pp m pp m pp m Confirmatio n '^i'Ye s a /^ZYe s d S l Ye s a ^ZYe s C D ^2rYe s n 6 Ye s n Ye

s • Sampl e No n No n No Q No D No n N o • N o •

D Z = 6 1 PPIVl @ 6 "

EA=146PPIV1@1 "



### Legen d Concret e Dri p Zon e Excavate d 

# m Quadrant s Excavate d Are a replace d wit h Are areplace dwit h Are alef t bar e So d Rock/Mulc h 

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

# i a

# {6j i
Omah a Lea d Sit e Date : V ^ Nort h Arro w Addre s f ^

15 ' h/:l l U n>uj > J-/ , Sit e Sl<etc h Time : 

# M Phone ^ 7<g^)>5-5'6-5"4S S 

## CA^ ^ H^^ ^ ^5 W Tea m r«. u //<Jw/e^/<^<^/ ^ BVID # /* ? Wy XR F Cod e ^^CZ
. Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e 

## l^$ 

# ±g / //y 11 3 i5>l±- ^ 

## lBh±'ZO ' fUI±i ^ ^ICi±^ G pp m pp m pp m pp m pp m pp m pp m F/Ye s /^ZYe s /g l Ye s ^2.Ye s .^2^Ye s

. G Ye s Ye s n C D n 1 ^ n n • N o I^ J N o n N o C D

N o f ^ N o n N o D N o • 

### "1) 0 fO ^ 5Q3 >



# Wuu^^i ^ isr
.

# I Name : KeAn^jl ^ fCc^^^e r Omah a Lea d Sit e Date : 1 IjlO J Nort h Arro w Address^"^/S'\f:\\x ^ y ^ S-f
. Sit e Sketc h Time : ' lA^ O Phone ^ *fO^^S^(.>~^(^S S 

# C^ U 

# Mi^A ^ Tea m ^ o \/ C MC* \ J Crc y/ Q BVI D # / ^

W V XR F Cod e .5:^(3' Z Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e 

## evA.^cPk:AM^gf ^ '"''Ye s D N o I ^ pp m ^ /^ZYe s n N o [ ^ pp m 

# E /5/±.- ^ pp m ^/Ye s n N o n 

## IBI±'2C ^ pp m ^ZYe s [= J N o ^ pp m *^2rYe s D N o n ^

^lh±^Q > . G Ye s D N o n pp m pp m Ye s • N o •Name : /^^n^VAjg^Stf^e r Address : VV/g " h/.-</r<i*vu a S-f
. Ptione^VtfaTa-S-6-5- ' 

### y6s g Omali a l.ea d Sit e Sit e Skatct i Date : Time : 

# ?i ^ NorttiAnro w ) —i

Tea m %*, u IjCiut'xjCr^i ^

BVI D # /^^ N XR F Cod e 5^0-2
. Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e 

## m 

# Ta ti 3 /5>£<Z Z f^SI±£ ^ f-lfi±'^C > pp m pp m pp m pp m pp m pp m pp m F/Ye s ^/Ye s ^ZYe s />2ye s G Ye s Ye s D 1= ] O a a • No ^ No a N o a N o a N o C D No • No •

### .^^'^IT'V
COASTA l IHVlRONHIhTA l C R 0 ( I r. > N C 

## Consen t fo rAcces s T o Propeft 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 Slate s Environmenta i 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 : l^^)/ /
Owner' s Name : Daytim e Phone :

Addres s o fPropert y ^jt/ i ^/V<r*~- ^ ^" ^ covere d b ythi s 

# yy/ ? Agreement : PURPOS E O F RESPONS E AACTIVITIE 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 ) 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 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 from EP Atha 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 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 wor k ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :
Pag e 1 o f2

### .,^«'"'> , 

## I COASTA L tttVI«OHH»KTA l 

## \^-^ A CROU P IN C 

### cRemov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; cRemov e flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t ma ywis h t o save ; 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 ; <Abid e b yhealt h an d safet yguidanc e provide d b yEPA ; •I fth e propert yi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propert yt o perfor m th e work
. oAllo wvideotapin g and/o rphotographin g o fth e property . AGREEMEN TNO TTO 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 tent l 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 mypropertie s D I d o no t gran t acces s t o mypropertie s

Signature Dat e
Q I woui d lik e t o b e presen t durin g an ysampiin g tha t i s required
.

Page 2 o f 2

# 4

Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o provid e amutua l agreemen t a s t o condition s o f th e properl y prio r t o remediatio nactivities . Thi s wil l als o serv e a s documentatio nfo r th e purpos e o f assurin g tha t restoratio n activitie s ar e complete dt o th e satisfactio no f th e propert y owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA) .

Propert y ID : /^•^/• ^ Propert y Address : ^ ^ |<^ V>^)lL/frv ^ ?- ^ Owner : ^^^./ v 

### Pbone : *3^\a
- S ^ ^ 3 O nth e attache ddiagram(s ) indicat e area(s ) t o excavate , surfac e structure s an dlandscapin g feature s an d acces s location(s ) t o b e use db y th e contractors . Indicat e distances , depths , material types , etc . Photographicall y an dVideographicall y documen t th e existin g condition s ofth e property an dth e basemen t i f necessary . 

## item s t o b e Remove db y th e Owner before Star t o

f

Remediation : The lemovai . storage , disposal , and/o r retur no f thes e itom s I s th e Owne r s responEibiiity . Kem : 

### '""^n.-i * 

# / /

1 ly<h^ ^ Kem : Kem : Kem :

Item s t o ia e Remove d b yth e Contracto rDurin g Remediatio n an d Wo t Replace d ^ ^ 

# L 

# ( ( 

# ^U^ A Kem : ^ Kem : Kem :


### Pag e 1o f 7

# p

COASTA L Item s t o B e Remove d B yContracto rDurin g Remediatio n jan d Replaced ^ Kem : Kem :

# ^ 9 Kem : Kem :



### Ite m Pre-existin g propert y area , tha t wil l b e excavated , tha t i s covere dwithgrass . 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 Numbe r o f Sprinkle r Zones , Contro l Valves . Timers , Heads , etc . Attachi l sketcl i ul tli e .'•r''''''l»lc i tiiv'.nii . Numbe r o f an dsiz e o f eac hgardeiv / flowe r l>e d area . AlliR h; i skcic hol a-!;niv f >i;'t' s nndloc;llilVI ^ Agree dupo nvalu e o f plan t material s no t t o b e replace db v contractor . N'OI r Ihi " \H1II C \\il l n i usrc ' 1 0 is;ii i i l ;)lHn ; louciu' : I dth e |3ro|)Cii > ui

< ner . Easemen t Area , t o b e excavate d 

### Quantit y



# ^ A 5

/ 

# y.^' ) Landscap e Inventor y Uni t Quadrant s

Eac h Eac h

Eac h

Eac h Squar e Fee t

S 

### Condition/Type/Specie s

Eac h 

### \y^"^—^-CA'''-^y-> \
^ Pag e 2 of
.#

COASTA L

Addftiona l Comment s / Instructions :

^-Ghec k th e tx) xr fOwne rdoe s no t wan t CE G t o documen t interio rfoundatio n vrall s an d possibl e pre-existin g damage
. Bycheckin g thi s t)o 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
.

r~l l d o no t agre e 

## CAQRdf ) Ibntractor' s Signatar e Dat e Pag e 3 <•

BVI D 

# , M^ H XR F PROPERTY SAMPL E SHEE T Dat e 

## /0-2^-D H Addres s ^t/K^W///,o.rvN< ; .'=:i Proiec t Omah a lea d F P 2n d yea roptio n Sampl e tim e am/p m XRFID # sampl e lengt h 3 0 se c

Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a 9 6 

### IG< ^

^ U ^ o 3Vitt i 

### 'St , \tfn±\ n 

# e < ^ W / 

### /6Wt/ 8 

# PH
. tZ H t If : Dept h ^2
. YLJ ^ 

### 1 0 Dept h 

# e o 1 " Averag e 

# /V 6 ti c Averag e 

# C> l ±12 . Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a 6 0 

# iiizjti a QiZ
.

6-2 , « 5 c It / Dept h Dept h 0 R 

## iF^^i n '^- ^ 

# ^/ t w (^ '

qy^ ^ / ^ 8 3 1>2.7J^^ ^ Averag e / 7 " ^ w Averag e Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h Averag e Averag e
RETES TAREA S Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h 

## y ^ l X / Averag e Averag e la b sampl e # La b resul t Sampl e are a XR F Avg
. Signature , 

# Prin t

\KHAL nV^r^ sX 

# * A
ii^A^ \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 I J^^ ^

° Coasta l Environmenta l Grou p Inc
. ^^^^ ^ Sr^^y ^ www.coa8talhazmat.co m ''^ ^ %PRO^" ^ COASTA L INVIIONHtNTA L G I 0 U P , INC ' 

# EXECUTIV ESUMMARY : BVID #19814-(441 5 WILLIA M ST ) No Issue s o r Concern s Issues/Concern s Detail Explanation :

# dE m « 

# EP APropert y Clos e Ou t For m 

# mif f „^,,^.mxMM£ ^ "s ^ Propert y #:
_ Propert y Address: * 7; DatcHlmc : Owncr' i i Name:

Name: . . iJa/S.^-Q
. MJS.-**J . ... J J r .y\,' j> . Quad ! Excavattd ; £)'g
- . ^ ^ Contracto r Grou p A^ftr9^,yf7t ^ Qnyr- U Py j Ye s No Excavatioi i Genera t I.

If necessary , were th e correc t quadrant(s ) excavate dandrestored ? 2.

If necessary , were th e correc t area s of drip zone excavate dan drestored ? 

# IP '
Ye s JN o Gradin g So dan dVegetatlo B 1.

Doe s th e gradin g aroun dth e perimeter ofth e hous e inexcavate darea s generally slop e awa y fromIhe house ? 

# y 2.Ha s so dbee nlai d inal l area s tha t wer e excavated ? 3.

Doe s th e sodappear tobe generally healthy an dgrowing ? (Only evaluate if

inspecte d at a

30 

# y' day time period ) 4.

Ar e soddedarea s generally fir man devenly graded ? 

# y 5.Ar e th e joint s betwee nth e so dstrip s generally tight ? (Only evaluate if

inspecte d at a

30 da y tim e period ) 

# y 6,Wa s the propert y grade dsuchtha t water will no t poo l onthe propert>' ' 

# y 7.Wa s damag e to landscapin g or plan t material s avoided ? 

## lA Gates , Fence s an dRetainin g Wail s Ve s No I.

Do gate s ope nan dclos e freely? (Ifappiicable ) 

### [ y 2.Were all gate s or fence s takendow ndurin g restoratio nactivitie s reinstalled ? (If applicable ) 

# y 3.

Wa s damage to gate s or fence s avoided ? (Ifappiicable ) 

# y 4.Wa s damag e to retainin g wall s avoided ? (Ifappiicable ) ^ ^ Foundation , SidinKan dCutler s Ye s JW o 1.

Wa s damage to th e sidin g or tri mavoided ? 

# vf 2.Wa s damag e lo th e foundationavoided ? 

# Y 3.

Wa s damag eto win<k>w s avoided ? 4.

Wa s damag e tc window sor doo r screen s avoided ? - ^ • 5.Wa s damageto downspout s or downspoul extension s avoided ? 

# y Sidewalk s an d Drivcway i (Concrete ) Ye s No 1.

Wa s damag e 10 drivewa y surface s avoided ? ^ 2.

Wa s damage to walkwa y surface s avoided ? 

# T? '

# • Owner s comments :

Inspectio nnotes :

Remova l an dreslorationactivate s complete includin g the 30-da y so dwarranty : EP ARepresentativ e / jCT hiJOy^A ^ D-dXt.jI/fO/0 ?

## Propert yCompletio n Agreemen t Ihl i agreemen t documeni s lh e compielio n o fremedia l acliviiie s perioime d o n m yproperl yM ysignatur e wil l designal e iha l I a m satisfie d wil h th e restoratio n o fm ypropei'ly , an d tha i n o item s ar e i n questions , now , o rat an ylim e i n Ih e future , excep t ihos e ilem s liste d below , ifan y

Propert y fD : 

# mi E Properl yAdd,,.,
. ^t^f< rQ ), • liUs^> M •= . "^T Owner : 

## '" • jAO ^ ^^serl^d/ ^ Phone : 

# ^?7r?
- J/a^ ^ Restoratio n Item s i n Question :

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

lyTTlnirc c(c.^torflfio n Kconiptcced , excep t K S noler t [_ ) I rto no t Jt^'re crcsioratin n i i complete d

S Sipnaliit cOAI C nfisfini' s SignRliir cPropert yOwne rSatisfactio n Surve y-^^200 3 Omah a Lea d Superfun d Si t S / lOC n r-, . 

# 200 8 ^^^^f^f=UN D 

# oivisio i Remediation Contractor : Coasta l Environmenta i Grou p Coast a . 

# V Propert yIdentifie rNumber: , 

# m i Propert yAddress : ^^1 5 

# SAtZ - Properl yOwner' s Wame : 1/f^J ^ r-^fi^g^t'^'t — (abov e informatio n t o b e fille d ou t b yremediatio n contracto rprio rl o deliver yo ffor m l o Propert yOwner ) Instruction s t o Propert yOwner : Thi s for m i s provide d t o yo u a s a mean s o ftryin g t o captur e you rleve l o fsatisfactio n wit h th e worl ( o ftti e above-identifie d remediatio n contractor , a s applicabl e t o th e soi l cleanu p actio n a t you r property . Th e U.S
. Environmenta l Protectio n Agenc y(EPA ) i s ver yintereste d i n you ropinio n regardin g th e worl < performe d b yit s contractors . Thi s for m i s intende d t o provid e a n eas ymean s fo ryo u t o expres s you ropinio n abou t th e wor k performe d o n you rproperty . Please indicat e you rleve l ofsatisfactio n wit h th e contractor' s wori t b yselectin g a numerica l ratin g {rangin g fro m 1 t o 10) usin g th e followin g ratin g scale , the n pleas e sig n an d dat e th e for m an d retur n i t t o th e USEP Ai n th e attache d self-addresse d & stampe d envelope , (additiona l comment s ma y als o b e provide d i n th e spac e below , a t th e optio n o fth e propert yowner. ) 9-1 0 "excellent " 7- 8 "verygood " 5- 6 "acceptable " 3- 4 "poor " 1-2 "verypoor " Propert yOvvner' s Satisfactio n Ratin e Regardin g Contractor' s Wor k 5 ( ^

8 3 7 2 6 1 Additiona l Comment s fro m Propert yOwne r(optional : continu e t o bac k o

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Propert yOwner' s Signature : Date:_ ^ 

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