## TRANSMITTA Lo f

OMAHALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R

SAI D Date : 

# v \w Address : \\0V 9 IV ' 'T T Remediatio nContractor : Coasta l Environmenta l Group
_ Year : 2 0
SOI LREMEDIATIO N PROPERT Y nLEFOLDE RDOCUMENT S /



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### Vide o o f propert y (DVD ) Executiv e Summar y EPA-provide dpropert y slcetch Signe dAcces s Agreemen t for subjec t propert y Signe dAcces s Agreement(s ) for adjacen t propert y Restoratio nAgreemen t Settlemen t dociunent s (i.e. , for damag e o r t o replac e plants , etc. ) Confirmatio ndat a Photograph s {pfiiNH ^ As-bui hsketc h - I \U tf(A]I^^O ^



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/ -I T Satisfactory 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 Propert y informatio nfromDougla s Couni y Assessor s Offic e


# f l h Dat e 30055462 Superfun d

### » • • •



## Propert y Acces s Checklis t PropertylD : ;?/ 2 3 q nWOR K STARTE D ON : / / D WOR K COMPELTED ON : / / PropertyAddre«://^^^^;2. ^ Owner : fV,^J ^ D i 7n/) ^ Rente r Address : Phone : Fax : Cell/Pager
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# I Acces s Agreement Signed;^/^/" ^ By : ^ Rcrtoratlo B Agreemen t 

## Slgncd:4i/_2/( ^ By : O Topsoil Samplin g (I f applicable ) By : GDisposa l Samplmg (if applicable ) / / By : (H

I Garde nSamplin g (if applicable ) By : 

# g Utilit v Clearanc e 

### Called:/^/3_/0 2 Q ^ Video/Photo s (Before ) On : Jo / 9/ 9 

### ^y-/Uib r D Video/Pboto s (Dnring ) On : / / By : nVideo/Photo s (After) On : / / By : D Video/Photo s (JO-D«y) On : By : " ^ Property Completio nAgrecmCT t Signed : 

## Ll_/ie^i0 3 By : D Fina l Report Issued : By : Ai r Monitorin e (a s applicabl e D Communit y D Cre w On : / / 

### By : 1 Rcsults :
nCommunit y • Cre w On : / / 

### By : 1 Resnhs :
n nCommunit y QCrc w | On : / / By : Rcsults :
Omah a Lea d Sit e• • 

## X)oiigla s Count y Accoun t I

j [j^arn^o n Pag e 1 of 2 y ^ Dougla s County , Nebrask a Propert yRecor d - R221639000 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 - Vle WO H Ma p Informatio n i s vali d a s o f 2009-9-1 5 Treasurer' s Ta xRepor t Ne wFeatur e ^ r * ^ Aut o Sale s Searc h Owne r DIZON APAMELAM 213 8 S 3 3 S T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 163 9 000 0 2 2 Accoun t Type : Residentia l Parce l Number : 221639000 0 Parce l Address : 110 2 S 2 2 S T OMAH AN E 68108-000 0 Lega l Description : SHULL S AD D LO T1 BLOC K2 N 3 7 F TLT1 3 7 X 6 0 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $ 2,900.0 0 $17,700.0 0 $ 20,600.0 0 200 8 $ 2,900.0 0 $17,700.0 0 $ 20,600.0 0 200 7 $ 2,900.0 0 $17,700.0 0 $ 20,600.0 0 200 6 $ 2,900.0 0 $ 13,900.0 0 $ 16,800.0 0 200 5 $ 2,900.0 0 $ 13,900.0 0 $ 16,800.0 0 200 4 $ 2,900.0 0 $ 13,900.0 0 $ 16,800.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 5 2220. 0 1. 0 60. 0 37. 0 

### N o Improvemen t Informatio n Buildin g 1



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R22..
. 9/17/2009• • 

### Dougla s County Accoun t I

riSMrr^t^ n Pag e 2 of 2

20.( r 

### RANC H Hrs l Floo r 16. 0 672 0 S F 38. 9

22. 0

BsfTT t Bloc k B ft 67Z.0S.F

. CLIC KTO ENUVRG E IMAG E Squar e Footage : 672. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Fai r

Buil t As : Ranc h Cond o Squar e Footage : 0. 0

HVAC : Force d Ai r Rooms : 3. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 1. 0

Roo fType : Gabl e Stories : 1. 0 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r YearBuii t Physica l Ag e Remodele d Remodele d Buil t 188 6 0 % 188 6 12 3 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fenc e Chai n Linl < 1. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 ft 672. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h Sla b RoofCei l 64. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R22.
. . 9/17/200 9

### Pag e 1 of 2

" > [ Creat e Anothe rTicke t | Bac k t o Irt h Interne t I Sen d Emai l |



### • YOU RTICKE T NUMBE RI S 2388343
. Origina l Cal l Date : 10/17/0 9 Time : 1:5 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 : 110 2 Street : S 22N D S T Twp : 15 NRng : 13 E Sect-Qtr : 22-SW,27-N W 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 : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V DOCOINF S LEVEL 3 METHODI S MUDO l MUDO 2 OMAHACO F 0PPDGPR 5 0PPDGPR 6 PAETE C QLNNEI C QLNNEI F

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

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

DOCOINF S DOUGLA S COUNT Y INFORMATIO NSERVICE S ALLA N 

### Day : 402510724 2 Alt : 402444718 8 Emerg : 402510724 2

LEVEL 3 LEVEL 3 COMMUNICATIONS , LL C 

### N A 

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

METHODI S METHODIS T HEALT H SYSTEM S 

### Day : Alt : 888847475 7 Emerg : 888847475 7
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.
. . 10/17/200 9Pag e 2 of 2

MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y Day : 402504782 3 Alt : Emerg : 402504797 0

MUD0 2 METROPOLITA NUTILITIE S DISTRIC T SAND Y Day : 402504782 3 Alt : Emerg : 402504797 0

OMAHACO F CIT Y O FOMAHA

TRAFFIC,SEWE R RICH/TRAFFI C Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0

OPPDGPR 5 OMAH APUBLI C POWE R DISTRIC T N A Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

OPPDGPR 6 OMAH APUBLI C POWE R DISTRIC T N A Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

PAETE C PAETE C COMMUNICATION S N O NEE D T O CAL L OU T EMERGENC Y Day : 800289190 1 Alt : Emerg : 800289190 1
QLNN E1 C QWES T LOCALNETWOR K NA Day : Alt : 406728934 3 406207149 4 Emerg : 888728934 3
QLNN E1 FQWES T LOCALNETWOR K NA Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.
. . 10/17/200 9OLS# : 2128 4 Dat e Excavated:10/23/0 9 

# As-Buil t Drawin g Dat e USEP ASigne d Off : 11/10/0 9 COASTA L Are a Sodden : 107 1 sof t 

# Omah aLea dSuperfun dSit e

Name : V^u^ n /^flnf(n<it ^ Oinah a Lea d Sit e Date : 6-/?'^. 7 NorthArro w - | Address : I/OT - S • ^^Z" " Sit e Sketc h Time : ?-:ZOot ^ Phone : V£>2, - 5VZ-7^ 3 ^ ^
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### Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are a replace d wit h Are a replace d wit h Are a lef t bar e So d Rock/Mulc h Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .

# t l | 0
i—Name : M»t^< t 0>/hfUytkc ^ Omah a Lea d Sit e Date : Nort h Arro w— i m r - Address : l/a z g . 

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### Consen t fo rAoccis s T o Propferf y RIGH TO F ENTR YT O PREMISE S 

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

Owner' s Name : Daytim e Phone : 

### K>)iyit. KDj-2fino > , 

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- 3g><^ 3 [ Addres s o fI Propert y covere d b ythi s Agreement : 

# W^ l <^ 1 1 s> . PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EPAi s requestin g acces s t o collect soi l sample s an d remove 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 its origina l condition
. Thi s wor k i s bein g performe d underth 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 perfonmed , th e Granto rwil l have a n opportunityt 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 vwitte n documentatio n fro m EP Atha t th e property has bee n remediated
. ENVIRONMENTA L RESPONS E ACTION S 

### B

ysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , it s employees , contractors 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 effect unti l th e wor k has bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :

Pag e t o f2C0AS 1 A i IPt fIROHHIKTA L C R O U » • f C 

### fRemov e obstruction s includin g boats , trailers , vehicles , playscap e items , wo piles , do g houses , etc ; od fRemov e flowe rbulb s orplant s tha t th e Granto r orth e Grantor' s tenan t ma y w to save ; is h Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , necessary ' subsequen t to an initia l waterin g perio d byEPA ; as
rAbid e byhealt h an d safet yguidanc e provide d byEPA ;

' Ifth e propert yis rented , assis t EP A in obtainin g tenan t approva l fo racces s th e propert y to perfor m th e work
. to t Allo wvideotapin g and/o rphotographin g ofth e property
. AGREEMEN TNO T To INTERFER E 

### Th e Granto ragree s no t to interfer e ortampe rwit h an y ofth e wor k activities , orwit h an y ofth e wor k done , orwit h th e equipmen t use d on hi s property , orto undertak e an y action s regardin g th e us e ofsai d propert ywhic h woul d ten d to endange rth e healt h or welfar e ofth e Grantee s orth e environment , orto allo wother s to us e th e propert yin 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 (402 ) 991-119 9

Qigran t acces s to mypropertie s G ' do no t gran t access to mypropertie s

Signatur e e v ^ / ^***/AA/W 1 

### Dat e v y V ^ ' ^^^^/t)h//P ) Signature

D I woul d lik e tobe presen t durin g an ysamplin g tha t is required
.

Page 2 of2

# RESTORATIO NCHANGEORDE R OMAHALEAD Propert y I D #J l a8 ^ Propert y Addres s / /

Q X L^
. ;i;i ^ S^T Owne r Nam e C^ ( H ^\j^m^U [)O.<J(V)AY^ 

# llgT T Dat e \^-^ft-Q ^ Comment s nmivlgtL S UJ^AT T P€AJ2 ^ QA ) 

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Owne r Signatu r Contracto r Signatur e 

# ^vPfi)l/)Upf[ f pka J

## Restoratso R Agreemen t Th e purpos e of thi s agreemen t i s t o provide amutua l agreemen t as t o condition s ofth e propert y prior t

o remediatio nactivities
. Thi s will als o serv e a s documentationfo r th e purpos e of assuring tha t restoration activitie s are completedt o th e satisfactio nof th e propert y owne r an dthe UnitedState s Environmenta l Protectio nAgenc y (EPA)
. Propert y ID : ^ 12B ^ Propert yAddress : /|p 2 "^ "22 - "^ ^ 

### Owner : Q > o>,, _ 

## Phone : ':^^7^^B<^ ^ O

nth e attacheddiagram(s } indicat e area(s ) to excavate , surface structure s an dlandscaping feature s an d acces s location(s ) t o b e use dby th e contractors . Indicat e distances , depths , materia l types , etc . Photographically an dVideographicall y documen t th e existing condition s ofthe propert y an dthe basemen t i

f necessary . item s t o b e Remove d b yth e Owne rbefor e Start o f Remediation : Th e I enoval
. storage , disposal , and/o rretur n o f thes e Itom s I s th e Owner' s responeibility
. 

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### 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 tninl c 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
. Head.s , etc . Aiiai hasketc ho l ili f "•rr't'klc i liiv'.ni i Numbe r o f an dsiz e o f eac hgarden / flowe r be d area . Alliicli i l skt'if hol ri.-!iiii\t. ' MZO S nndlociilicin N Agree dupo nvalu e o f plan t material s no t t o b e replace db v contractor . \cl c iM"
. ^»Il^l c \\\\ \n t \:%f C 1 0 livu i
. 1 ;ilaii i mtiilii.' : 1( 1 lli e |ira|)cii > ii\» ner . Easemen t Area , t o b e excavate d 

### Landscap e Inventor y Quantit y 

# \\KU X

T 

# I S 

# 9 Unit Quadrant s

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### Condition/Type/Specie s 

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! Additiona l Comment s / instructions :



# L
.
Q Chec k th e tx> xi fOwne rdoe s no t wan t CE G t o documen t interio rfoundatio n walls an d possibl e pre-existin g damage
. B ychecldn g thi s tK} X CE G I s no t responsibl e fo ran ydamag e don e t o th e interio ro fhouse , includin g foundatio n cradk s o rfissures
.



# \m^ nI d o no t agre e agre e

\Owner* s signatur e Date Olntractor' s Signature Date Pag e 3 of
.

### BVID#_ZJL2_8^ XR F PROPERTY SAMPL E SHEE T Dat e 

# i0-33- 0 y Addres s 

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RETES TAREA S Shot # Readin g Sampi e are a Shot # Readin g Sampl e are a Dept h Dept h Averag e Averag e la b sampl e # La b resul t Sampl e are a XR F Avg
. Signatur e 

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Prin t 

# C\mxm \Oc(m( \

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

## Certificat e o fVerificatio n XL3t-3207 5 Readin g N o 53 2 Mod e SOI L Tim e 2009-10-2 4 08:2 9 Duratio n 120.0 0 Sequenc e Fina l Flag s AVERAG E fAvg'^o f528^53 1 "T j LOCATIO N 110 2 s 2 2 s t INSPECTO R VENTR Y COR 1 f l COR 2 6 MIS C clearenc e NOTE ep a gu n Use rLogi n EP A

pp m Erro r -Pb /

. • " 91.20 1 ± l b
. 19 6 C d < LO D 20.60 6 A g < LO D 14.78 8 S r 112.17 4 ± 8.43 4 U < LO D 21.94 3 R b 52.78 2 ± 6.71 1 T h < LO D 13.53 6 S e < LO D 5.93 4 A s < LO D 19.75 0 H g < LO D 13.18 1 Z n 102.46 6 ± 20.29 3 W < LO D 78.33 5 C u < LO D 32.34 9 N i < LO D 74.58 3 C o < LO D 175.30 3 F e 16587.32 0 ± 423.75 2 M n 450.48 5 ± 106.06 9 C r < LO D 115.06 8 V < LO D 324.47 3 T l < LO D 724.40 8 S c < LO D 70.95 7 C a < LO D 1246.16 1 K < LO D 1544.90 0 S < LO D 1213.00 9 Supervise d By : C^KJ ^ 

# m . !ei )

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

XL3t-3207 5 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s SAMPL E LOCATIO N INSPECTO R CO R 1 CO R 2 MIS C NOT E Use rLogi n

P b C d A g S r U R b T h S e A s H g Z n W C u N l C o F e M n C r T l S c C a K S pp m 188.41 1

< LO D < LO D 105.83 7

< LO D 50.48 2 < LO D < LO D < LO D < LO D 162.56 5

< LO D 38.47 6 < LO D < LO D 19298.42 4

500.73 9

< LO D < LO D < LO D < LO D < LO D < LO D < LO D 

## Certificat e o f Verificatio n

52 8 SOI L 2009-10-2 4 08:2 7 30.0 0 Fina l 2128 4 110 2 s 2 2 s t VENTR Y f l 6 clearenc e ep a gu n EP

A

± ±

' ± ±

± ±

± ± Erro r 21.71 5 21.01 1 15.21 8

8.41 5 23.59 1

6.87 3 15.35 7 6.73 3 27.83 9 13.03 9 25.04 6 77.50 6 22.99 7 80.93 2 193.09 9 466.49 2 113.09 9 171.88 6 512.80 0 1164.75 2

32.76 7 1252.97 4 1275.84 4 1140.30 4 Supervise d By : V

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

XL3t-3207 5 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s SAMPL E LOCATIO N INSPECTO R COR l CO R 2 MIS C NOT E Use rLogi n

P b C d A g S r U R b T h S e A s H g Z n W C u N i C o F e M n C r T l S c C a K S pp m 77.93 0 < LO D < LO D 112.44 2

< LO D 53.83 2 < LO D < LO D < LO D < LO D 99.73 7 < LO D < LO D < LO D < LO D 15221.33 2

495.88 9

< LO D < LO D < LO D < LO D < LO D < LO D < LO D Supervise d By : 

## Certificat e o fVerificatio n

52 9 SOI L 2009-10-2 4 08:2 8 30.0 0 Fina l 2128 4 110 2 s 2 2 s t VENTR Y fl 6 clearenc e ep a gu n EP

A

±

± ±

± Erro r 14.58 2 20.09 0 14.62 7

8.44 2 20.74 8

6.63 7 12.77 8

5.41 7 18.72 0 13.15 8 19.99 2 71.11 8 31.74 7 70.14 9 166.49 7 406.14 7 109.42 2 121.40 0 307.76 2 315.16 6 103.63 1 1052.90 0 1233.25 6 984.98 7 V

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

## Certificat e o fVerificatio n XL3t-3207 5 Readin g N o 53 0 Mod e SOI L Tim e 2009-10-2 4 08:2 8 Duratio n 30.0 0 Sequenc e Fina l Flag s SAMPL E 2128 4 LOCATIO N 110 2 s 2 2 s t INSPECTO R VENTR Y CO R 1 f l CO R 2 6 MIS C clearenc e NOT E ep a gu n Use rLogi n EP A

P b C d A g S r U R b T h S e A s H g Z n W C u N l C o F e M n C r T l S c C a K S pp m 49.42 8 < LO D < LO D 115.71 2

< LO D 55.59 1 < LO D < LO D < LO D < LO D 61.19 8 < LO D 46.77 3 < LO D < LO D 15996.36 2

419.24 7

< LO D < LO D < LO D < LO D < LO D < LO D < LO D ± ±

± ±

± ±

± ± Erro r 11.89 4 20.24 0 14.26 0

8.22 9 20.61 7

6.53 0 12.53 4

5.48 4 15.59 4 13.71 1 16.65 3 82.39 0 21.95 4 73.23 0 168.15 4 401.20 4

99.71 0 128.75 3 245.04 9 801.19 6

40.20 7 1589.75 1 1867.73 9 1477.74 2 Supervise d By : V

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

XL3t-3207 5 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s SAMPL E LOCATIO N INSPECTO R COR l CO R 2 MIS C NOT E Use rLogi n 

## Certificat e o fVerificatio n

53 1 SOI L 2009-10-2 4 08:2 9 30.0 0 Fina l 2128 4 110 2 s 2 2 s t VENTR Y f l 6 clearenc e ep a gu n EP

A

P b C d A g S r U R b T h S e A s H g Z n 

## w C u N l C o F e M n C r T l S c C a K S pp m 49.03 5 < LO D < LO D 114.70 5

< LO D 51.22 4 < LO D < LO D < LO D < LO D 86.36 6 < LO D < LO D < LO D < LO D 15833.16 4

386.06 4

< LO D < LO D < LO D < LO D < LO D < LO D < LO D Supervise d By : ±

± ±

± ± Erro r 12.59 0 21.08 3 15.04 7 8.64 9 22.81 4

6.80 5 13.47 6

6.10 2 16.84 8 12.81 4 19.48 0 82.32 7 30.22 4 74.01 9 173.46 3 421.16 4 102.04 4 38.23 4 232.28 2 616.51 7 107.22 5 1089.02 0 1802.76 3 1249.00 5 V

### ^1^^' % Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 o ^^^ ^

I Coasta l Environmenta l Grou p Inc
. ^'^s^ ^ SLJ^^^J ^ www.coastalhazmatco m "^ ^ ^-i.Pno^' ^ COASTA L ENtltONHEMTA l G • O U r . IN C 

# EXECUTIV ESUMMARY : BVID #21284-(110 2 S 2 2 ST )
No Issue s o r Concern s j ^ Issues/Concern s Detail Explanation : -COASTA LT O PU T FENC EAN D BARRIER S BAC K UP
. (COMPLETE D 11/8/09 ) -COASTA LT O BACKFIL LAL LHOLE S AN D LEVE LOU T TH EYAR D B Y TH ESIDEWALK S

AN D I NFRON T O FTH EPROPERTY
. (COMPLETE D 11/8/09 ) -PROPERT Y WA S WALKE D B Y TH EEP AO N11/10/0 9

# 4 tala a 

# EP APropert y Clos e Ou t For m Propert y # : S\Qs^^
. Propert y Address:

- ­ Date/Tlroc : Owner' s Name:
. ^ Quad s Excavated ; K i ^ pJ2 ^ ^ p ^ Contracto r Grou p _ Ye s N o Excavatio nGenera l 1
.I f necessaiy , were th e correc t quadrant(s ) excavate dandrestored ? 

# \y ^ 2
.If necessaiy , were th e correc t area s o f drip zone excavate dao drestored ? 

### \ y ^ Gradin g So dan dVegetatio n Ye s N o I
.Doe s the gradin g aroun dth e perimeter ofth e hous e i nexcavate darea s generall y slop e awa y fromth e house ? ^ 2
.Ha s so dbee nlai dinal l area s tha t wer e excavated ? 

## l^ ^ 3
.

Doe s the sodappear to b e generall y healthy an dgrowing ? (Only evaluate if inspecteda t a3 0 i ^ ^ day time period ) 4
.Ar e soddedarea s generall y fir man devenly graded ? 5
.

Ar e th e joint s betweenth e so dstrip s generally tight ? (Only evaluate if inspecte da t a3 0 da y ~ ^ ' tim e period ) 6
. Wa s the propert y grade dsuchtha t wate r will no t poo l o nthe propert>' ? 

# U " 7
. Wa s dainag e t o landscapin g o r plan t material s avoided ? 

### \ y ^ Gates , Fence s an dRetainin g Wall t Ye s N o I
. D o gate s ope nan dclos e freely? (Ifapplicable ) 

### l y ^ 2
. Wer e all gate s or fence s takendow ndurin g restoratio nactivitie s reinstalled ? (If applicable ) 

### l y ' 3
. Wa s damag e t o gate s or fence s avoided ? (Ifapplicable ) \^ ' 4
. Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) \^ ' Foundation , Sidin g an dGmier s Ye s N o 1
.Wa s damag e l o tli e sidin g o r tri mavoided ? 

### Lx ' 2
.Wa s damag e t o the foundationavoided ? 

## \ y ' 3
.Wa s damag e t o window s avoided ? 

# y 4
. Wa s damag e t o window s o r door screen s avoided ? 

## \y ' 5
. Wa s damage l o downspout s or downspoul extension s avoided ? 

### \ y Sidewalk s an d Driveway s (Concrele ) Ye s N o 1
. Wa s damage l o driveway surface s avoided ? 

### t y 2
. Wa s damag e t o walkwa y surface s avoided ? 

### t y

## Owner s comments : #



## Inspectio nnotes :

Remova l an drestorationactivate s complet e including th e 30-da y so dwarranty : EP ARepresenlaliv e Ugv > naJLtla y D'dXt : l j /d/d 9

# L Propert yCompletio n Agreemen t [Ill i agreemen t docuinenl s lh e complcliono f remedia l acliviiie s perloimedo nm y pioperly M y signalur e wil l designate tha i I a msatisfiedwit hlh e restoraliono f m y propeiiy
. an dIha l n o items ar e i nquestions , now , o r a

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