## TRANSMITTAL of OMAH ALEA D SITE SOILREMEDIATIO NFIL EFOLDER 

# II SAID #: 

# Zlt'p ^ Date : 

# iH i l[\^ tmt j 9< Address : Remediatio nContractor ; Coasta l Environmenta l Grou p Year : 2010ARRA
SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 1/ Vide oof property (DVD ) Executiv e Summary EPA-provide dproperty sketc h Signe dAcces s Agreemen t fo r subject property Signe dAcces s Agreement{s ) fo r adjacent property Restoratio nAgreemen t Settlement document s (i.e. , fo r damag eor to replac e plants , etc. ) Confirmatio ndat a 

# V Photograph s [^ i:>yA(V^i\(M ^ {rf^Pil^CH ^ \^<^ ^ As-buil t sketc h Satisfactor y restoratio nsigne dby Property Owner 

# z Property close-ou t chec k lis t signe d by EP A Descriptio nof area s no t meetin g RO D cleanup criteri a 1 / 

### Utility clearance s 

## cu/ ' Propertviftformatio nfro mDougla s Count y Assessor' s Offic e 

# fy gnature 3021822 5 Superfun d

# ^ v Propert yAcces s Checklis t Property ID : 5 p (^ 3 Property Address : ; j | ^ 9'lYiinAS^
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## Phone : L^^^ ^ f^Qfj ^ Renter : Phone : Fax : Cell/Pager : Additional Information : Fax : Cell/Pager :
D Notificatio nLette r Sent : 1 1 J ^ Acces s Agreement 

### Signed : C? / / liQ
_ [ ^ Restoratio nAgreement Signed : c9v/0 ^ / V

O D Topsoi l Samplin g (if applicable ) / / D Disposa l Samplin g (if applicable ) / / nGarde nSamplin g (if applicable ) / / Q UtiUt y Clearanc e CaUed : oU/o 5 l\ 0 E ^ Video/Photo s (Before) 

### On : ^ r l I t o D Video/Photo s (During ) On : / / D Video/Photo s (After) On : / / nVideo/Photo s (30-Day ) On : / / f 

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### Signed : y_/222^ ^ \ ^ Final Report Issued : / / Ai r Monitorin g (a s appUcable)
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## Douglas Count y Accoun t Infojiutio n Pag e 1 of 2 )J||^ C # Dougla s County , Nebrask a Propert yRecor d - R152848000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f52n d S t - VJO WOi l Ma p Informatio n i s vali d a s o f2009-11-1 9 Treasurer' s Ta xRepor t Ne wFeatur e ^ • •^ Aut o Sale s Searc h Owne r WOMMOC KVIVIA N A
211 9 EMME TS T OMAH AN E 68110-000 0 Propert yInformatio n Ke yNumber : 

### 284 8 000 0 1 5 Accoun t Type : Residentia l Parce l Number : 152848000 0 Parce l Address : 211 9 EMME TS T OMAH AN E 68110-000 0 Lega l Description : KOUNTZ E PLAC E LOT6 BLOC K2 9 5 0 X 12 4 Valu e Informatio n Lan d Improvemen t Tota l 

### 200 9 $4,800.0 0 $47,600.0 0 $52,400.0 0 200 8 $4,800.0 0 $47,600.0 0 $52,400.0 0 200 7 $4,800.0 0 $42,400.0 0 $47,200.0 0 200 6 $4,800.0 0 $42,400.0 0 $47,200.0 0 200 5 $4,800.0 0 $42,400.0 0 $47,200.0 0 200 4 $4,800.0 0 $21,300.0 0 $26,100.0 0 Sale s Informatio n Sale s Dato : 

### 2006-06-2 9 Dee d Type : Q C Book : 200 6 Paga : 07952 0 Price : $0.0 0 Grantor : Wommocl < Vivia n Grantee : Wommac k Vivia n Valid/Invalid : Invali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 

### 0.1 4 6200. 0 

### 1.0 124. 0 50. 0 N o Improvemen t Informatio n


## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl..
. 11/25/2009\ QM^ K 

### Dougla s County Accoun t Infq««^io n Pag e 2 of 2 #
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Buil t As : 2 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 10. 0 Exterior : Fram e Aluminu m Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 4. 0 — i 1 Roo fType : Hi p Stories : i 2. 5 Floorcover : Allowanc e Foundation : ! Bloci < Sprinkle rSquar e Footage : I 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 190 7 0 0 % 190 7 10 3 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 740. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Batl i Ful l 1. 0 Porch i En d Soli d Wal l 192. 0 Porc h Sla b Roo fCeilin g 48. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl.
. . 11/25/200 9

### Pag e 1 of 2

" > l l Creat e Anothe rTicke t 1 [ : Bac k t o Irt h Interne t
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### • YOU RTICKE T NUMBE RI S 2457556
. Origina l Cal l Date : 4/08/1 0 Time : 10:1 4 a mOp : ELIZABETH1879 0 Wor k t o Begi n Date : 4/12/1 0 Time : 10:4 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 211 9 Street : EMME T S T Twp : 15 NRng : 13 E Sect-Qtr : 10-NW 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 : FAX 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 : Y Involve s Tiinneling o r Horizonta l Borin g : N Explosives : N CXCAT V MAGELLAN MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

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

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

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* A/-C TT AX T MAGELLA NMIDSTREA M PARTNER S T^TM^ „ . MAGELLA N
. „ DEBORA H „ 

### Day : 918574709 8 Alt : Emerg : 918574709 8

MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0

OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R 

### RICH/TRAFFI C Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0

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. . 4/8/201 0

## Pag e 2 of 2

OPPDGPR 5 OMAH APUBLI C POWE RDISTRIC T ELM LOCATIN G 

## Day : 406728934 3 Alt : 4062071494 Emerg : 888728934 3
QLNNEI C QWES T LOCA LNETWOR K EL M LOCATIN G 

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

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. 4/8/201 03126 3 

# As-Buil t Drawin g C OASTA L 

# Omah aLea dSuperfun dSit e OLS#:3126 3 Dat e Excavated : 4/12/201 0 Dat e USEP ASigne d Off : 4/27/201 0 Are a Sodden : 300 6 sa ft Exterio rPain t Omah a Lea d Sit e Owne rName : yiVlA N AWOMMOC K • Goo d Sit e Sketc h Address : 211 9 EMME TST •Poo r Phone : H: W; ; g^o l pain t Sampl e Numbe r Lea d Concerrtralio n Sampl e Collecte d LA B Sample Collect ^ Firm : fr)F<^
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# n Date : RYBSCPXA-3126 3 F2 

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COASTA I ENVIRONHIKTA l cI o t l r. I h c 

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

### Granto r(th e propert yowner ) consent s t o an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA ) o rit s authorize d representatives , collectivel y th e Grantee , t o ente ran d perfor m certai n environmenta l respons e activitie s upo n th e followin g describe d premises : < p

Owner' s Name : Daytim e Phone : UzZZ^ ^ JO Q ^ 7

Addres s o fPropert y 

# t/7 ? y^^^i-^TT"^ / covere d bythi 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 flea d an d maypos e a healt h hazard

. Th e area(s ) wil l b e excavate d t o remov e contaminate d soil

. Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o it s origina l condition

. Thi s wor k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o fCoastal 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 

### Bysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , it s employees , contractor s an d subcontractors th e righ t t o ente rth e property , 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,AtO»f4lv

.
%^^^4r^ ^ COASTA L ' I PBO"
- C « O U rI X C 

### 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 sorplant s tha t th e Granto r orth e Grantor' s tenan t maywis h to save ; cWate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , as necessarysubsequen t to an initia l waterin g perio d byEPA ; e Abid e byhealt h an d safet yguidanc e provide d byEPA ; t Ifth e propert y is rented , assis t EP A in obtainin g tenan t approva l fo racces s to th e propert y to perfor m th e work

. cAllo wvideotapin g and/o rphotographin g ofth e property
. AGREEMEN TNO T TO INTERFER E 

### Th e Granto ragree s no tto interfer e ortampe rwit h an yofth e wort cactivities , orwit h an y ofth e wor k done , orwit h th e equipment 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 sorth e environment , orto allo wothers to us e th e propert y in suc h a manner . Should yo u hav e an yquestion s abou t thi s program , pleas e contact Coasta l Environmenta l Group , at (402 ) 991-119 9

(^

I gran t access to mypropertie s D I do not gran t acces sto mypropertie s

Sianaturl Signaturi B B Dat Dat e e Signatur e Dat e

D I woul d lik e to t) e presen t durin g an ysamplin g tha t is required

.

Pag e 2 of2C O AS T AL O KO U P

. INC

. 

## 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 ofth e propert y prio r t o remediatio nactivities
. Thi s wil l als o serv e a s documentatio nfor th e purpos e o f assurin g that restoratio n activitie s ar e complete dt o th e satisfactio nofth e propert y owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA)
.

Property ID : 

# 5/;^ 3 Propert y Address : ^^ ^ ^/^^yT^X ^ Owner ; 

# y/zyyAA y'(^(rpA^An^cjc - Phon e 

# ^ a
O nth e attache ddiagram(s ) indicate 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 . Indicate distances , depths , material types , etc . Photographicall y an dVideographicall y document th e existin g condition s ofth e property an dth e basement i f necessary . 

## Item s t o b e Remove d b yth e Owne rbefbr e Start o fRemediation : Th e removal , storage , disposal , and/o rretu m o fthes e item s i s th e Owner' s responsibility

. Kem : VJ>1PY1 ^ Kem :
Kem :
Kem :



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

## _^2iiii;2sil__-—L^s^iS2akj Kem :
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Page l of_32
­C O AS T AL • MVmOMMIMTAI

. o n e u p . INC

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## Landscap e Inventory Ite m Quantit y Uni t Condition/Type/Specie s Pre-existing propert y area , Quadrants tha t wil l b e excavated , tha t 

# h\ M i s coveredwit hgrass . Numbe r of tree s > 2 inc h Eac h trun k

diamete r 

# 1
Nimibe r of tree s <= 2 inc h Eac h trun k

diamete r Numbe r of Sprinkle r Zones , Control Valves , Eac h Timers , Heads , etc . Attac hasketc hof th e sprinkle r layout
. Numbe r of an dsize of eac hgarden / flowe r bed Eac h area . Squar e Feet Attac hasketc hof relative size s an dlocations
. Agree duponvalue ofplant material s not to b e replacedb v contractor . Not e thi s valu e wil l b e usedto issu e aplan t voucher to th e property owner . Easemen t Area , t o b e Eac h 

# u excavated ^ 

# 5 1
Pag e 2 of

.C O AS T AL a •o u p . INC

.

Additiona l Comment s / Instructions : Th e cit yo fOmah a ordinance s ma yprohib Kyo 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 underiyin 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 repiacin 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 wKhstandin g an yremova l o rreplacemen t o fsoi l b yth e EP A 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 cKyo 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

.

D 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

.



### ^ I agre e Q Ido
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# Tiierm ® SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , M A0182 1 

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 46 9 Mod e SOI L Tim e 2010-05^1 0 17:1 6 Duratio n 90.3 4 Sequenc e Fina l Flag s AVERAG E ^Avg-of-466-468 — ADDRES S I—211 9 Emme t st- — QUADRAN T B l DEPT H 1 0 TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D : 8.33 0 Z r 471.36 8 ± 16.24 8 S r 172.75 5 ± 9.13 0 U < LO D : 15.74 5 R b 71.48 0 ± 6.86 0 T h 17.92 1 ± 8.78 8 -178.830_

_ ± - 18.36 6 S e < LO D 5.93 2 A s 25.61 0 ± 16.42 7 H g < LO D ; 13.04 6 Z n 166.18 6 ±
. 22.76 9 W < LO D •^• ^ ' )0.49 3 C u 44.51 1 yy ± /22.26 0 N i < LO D / J / 77.66 5 C o < LOD / '^ 215.67 5 

## : y Fe 25457.15 6 ' 467.39 6 

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### 109J6 S 

## / y ^ Supervise d By : /

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 46 6 Mod e SOI L Tim e 2010-05-1 0 17:1 4 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 3126 3 ADDRES S 211 9 Emme t s t QUADRAN T B l DEPT H 1 0 TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D : 8.41 0 Z r 472.97 9 ± 16.35 6 S r 171.07 7 ± 9.13 7 U < LO D : 16.37 3 R b 70.75 1 ± 6.93 2 T h 17.61 0 ± 8.72 8 P b 168.48 7 ± 17.98 5 S e < LO D : 5.98 2 A s 27.66 1 ± 16.20 6 H g < LO D : 13.11 7 Z n 171.28 8 ± 23.24 9 W < LO D I 92.57 1 C u 61.11 3 ± 23.64 8 N i < LO D ; 77.07 2 C o < LO D ; 209.96 2 Fe 23705.48 0 ± 453.82 4 M n 633.44 7 ± 107.56 4 Supervise d By :

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 46 7 Mod e SOI L Tim e 2010-05-1 0 17:1 5 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 3126 3 ADDRES S 211 9 Emme t s t QUADRAN T B l DEPT H 1 0 TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D : 8.46 2 Z r 464.82 7 ± 16.14 5 S r 173.96 9 ± 9.15 4 U < LO D : 15.27 7 R b 74.35 6 ± 6.91 0 T h 16.24 3 ± 8.75 6 P b 190.86 8 ± 18.86 2 S e < LO D : 5.69 4 A s 30.22 7 ± 17.00 5 H g < LO D 13.46 6 Z n 153.46 8 ± 22.18 3 W < LO D : 95.50 7 C u 37.45 6 ± 21.77 9 N i < LO D : 78.62 8 C o < LO D : 221.90 9 F e 26822.66 2 ± 479.71 2 M n 737.92 8 ± 114.36 6 Supervise d By :

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 46 8 Mod e SOI L Tim e 2010-05-1 0 17:1 6 Duratio n 30.1 2 Sequenc e Fina l Flag s BVI D 3126 3 ADDRES S 211 9 Emme t s t QUADRAN T B l DEPT H 1 0 TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D : 8.11 7 Z r 476.29 7 ± 16.24 1 S r 173.21 7 ± 9.09 8 U < LO D : 15.58 6 R b 69.33 3 ± 6.73 8 T h 19.90 8 ± 8.88 0 P b 177.13 4 ± 18.25 2 S e < LO D 6.12 1 A s < LO D 24.10 3 H g < LO D 12.55 6 Z n 173.80 3 ± 22.87 5 W < LO D I 83.40 0 C u 34.96 3 ± 21.35 4 N i < LO D : 77.29 5 C o < LO D : 215.15 3 Fe 25843.32 4 ± 468.65 2 M n 635.26 2 ± 107.66 3 Supervise d By :

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 46 1 Mod e SOI L Tim e 2010-05-1 0 16:4 5 Duratio n 90.3 2 Sequenc e Fina l Flag s AVERAG E fAv g o f458-46 0 ADDRES S 211 9 Emme t s t QUADRAN T B 2 DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D : 8.29 4 Z r 449.44 6 ± 16.29 4 S r 176.06 0 ± 9.41 2 U < LO D \ 15.04 9 R b 71.05 6 ± 6.90 3 T h 16.97 5 ± 10.14 9 >-. ,



### Se- S

. , 336.16 1 ...-<rLO D ' •± """" ' : , _25.103

. 6.50 4 A s 36.47 2 ± 22.24 3 H g < LO D • 13.66 0 Z n 257.46 9 ± 28.14 6 W < LO D : 100.72 3 C u 48.48 3 ±^. ^
— ) 23.48 9 N i < LO D ^.^^ : / 80.44 2 C o < LO D / •/ ^

213.00 9 Fe M n 24224.13 / 608.92 6 

# y 

# y ^ y ^ V

. 465.86 1 108.33 5 ' Supervise d By : x

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 45 8 Mod e SOI L Tim e 2010-05-1 0 16:4 3 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 3126 3 ADDRES S 211 9 Emme t s t QUADRAN T B 2 DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

M o Z r S r U R b T h P b S e A s H g Z n W C u N i C o Fe M n pp m < LO D 458.77 9 182.75 4

< LO D 73.67 8 23.04 4 335.86 7

< LO D 50.37 7 < LO D 249.16 9

< LO D 54.86 2 < LO D < LO D 24815.25 6 569.41 5 Supervise d By : I ± ± ; ± ± ±

: • ± J ± /

: ±

: : ± ± Erro r 8.40 5 16.41 7

9.54 8 14.68 7

6.94 5 10.57 3 25.08 6

7.08 4 22.56 4 12.96 9 27.60 0 98.02 3 23.83 7 80.78 2 215.21 0 470.09 9 105.61 4

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 45 9 Mod e SOI L Tim e 2010-05-1 0 16:4 4 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 3126 3 ADDRES S 211 9 Emme t s t QUADRAN T B 2 DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D : 8.14 3 Z r 446.48 7 ± 16.02 5 S r 172.40 4 ± 9.20 3 U < LO D : 15.57 4 R b 69.85 7 ± 6.84 1 T h 17.59 4 ± 10.08 5 P b 338.79 0 ± 24.84 7 S e < LO D 5.84 5 A s < LO D 32.47 4 H g < LO D 12.91 5 Z n 240.12 5 ± 26.74 1 W < LO D 89.71 8 C u 48.88 8 ± 22.83 2 N i < LO D ; 75.39 9 C o < LO D : 211.50 8 Fe 25085.67 8 ± 467.99 4 M n 665.50 9 ± 110.02 8 Supervise d By :

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 46 0 Mod e SOI L Tim e 2010-05-1 0 16:4 5 Duratio n 30.1 0 Sequenc e Fina l Flag s BVI D 3126 3 ADDRES S 211 9 Emme t s t QUADRAN T B 2 DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

M o Z r S r U R b T h P b S e A s H g Z n W C u N i C o F e M n pp m < LO D 443.07 3 173.02 2

< LO D 69.63 4 < LO D 333.82 5

< LO D 36.20 5 < LO D 283.11 2 138.56 2 41.70 0 < LO D < LO D 22771.45 3 591.88 5 Supervise d By : : ± ±
±

±• ±
± ± ±

: : ± ± Erro r 8.33 4 16.43 9

9.48 6 14.88 7 6.92 2 14.68 4 25.37 5

6.58 3 22.51 4 15.09 5 30.09 6 76.28 5 23.79 9 85.14 6 212.31 0 459.48 9 109.36 5

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 45 7 Mod e SOI L Tim e 2010-05-1 0 16:4 2 Duratio n 90.3 5 Sequenc e Fina l Flag s AVERAG E r—-Avg15r454-45 6 - - ADDRES S ^-^211 9 Emme t s t QUADRAN T E A DEPT H 1 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D : 8.08 1 Z r 475.71 6 ± 15.82 3 S r 172.45 4 ± 8.86 0 U < LO D : 14.33 2 R b 65.03 3 , ± 6.33 2 T h < LO D 12.51 0 ~C r" Se

—­ —-•'n"7"00 o 227.883

. 

### ' < Lb b '.•.•...•• ±: • : 19.89 4 5.86 7 A s < LO D ; 26.05 5 H g < LO D : 12.61 7 Z n 174.74 4 ± 22.49 0 W < LO D : 85.594 , C u 36.64 6 ± --'^0.692 ; N i < LO D 73.48 0 C o Fe < LO D 19369.47 1 / 

# y ; ± 183^ 4 396:46 8 M n 547.67 8 / ± /97.99 8 Supervise d By : ^ 

# ^ y

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 45 4 Mod e SOI L Tim e 2010-05-1 0 16:4 1 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 3126 3 ADDRES S 211 9 Emme t s t QUADRAN T E A DEPT H 1 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m M o < LO D Z r 485.52 7 S r 172.95 1 U < LO D R b 62.97 0 T h < LO D P b 238.99 1 S e < LO D A s < LO D H g < LO D Z n 174.97 6 W < LO D C u < LO D N i < LO D C o < LO D F e 19685.04 5 M n 483.96 4 Supervise d By : Erro r 8.08 5 ± 16.01 1 ± 8.90 6 14.64 2 ± 6.30 7 12.14 0 ± 20.41 4 6.20 2 26.43 4 12.94 0 ± 22.57 6 86.26 2 30.09 3 75.56 2 187.04 5 ± 400.95 3 ± 94.23 2

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 45 5 Mod e SOI L Tim e 2010-05-1 0 16:4 1 Duratio n 30.1 2 Sequenc e Fina l Flag s BVI D 3126 3 ADDRES S 211 9 Emme t s t QUADRAN T E A DEPT H 1 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D J 8.12 0 Z r 479.51 9 ± 15.90 9 S r 178.69 8 ± 9.02 1 U < LO D : 14.27 3 R b 64.15 6 ± 6.29 8 T h < LO D : 12.25 1 P b 225.42 1 ± 19.78 1 S e < LO D : 5.40 6 A s < LO D * 26.06 2 H g < LO D : 12.35 9 Z n 170.83 1 ± 22.23 5 W < LO D I 82.62 3 C u 39.47 4 ± 20.87 5 N i < LO D : 72.45 4 C o < LO D : 182.69 0 Fe 19359.12 7 ± 396.90 2 M n 616.74 6 ± 102.10 5 Supervise d By :

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 45 6 Mod e SOI L Tim e 2010-05-1 0 16:4 2 Duratio n 30.1 2 Sequenc e Fina l Flag s BVI D 3126 3 ADDRES S 211 9 Emme t s t QUADRAN T E A DEPT H 1 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D 8.03 8 Z r 462.10 2 ± 15.55 0 S r 165.71 4 ± 8.65 3 U < LO D 14.08 2 R b 67.97 2 ± 6.39 2 T h 17.57 0 ± 8.75 9 P b 219.23 8 ± 19.48 7 S e < LO D 5.99 2 A s < LO D 25.67 0 H g < LO D 12.55 1 Z n 178.42 5 ± 22.65 9 W < LO D J 87.89 7 C u 44.37 3 ± 21.14 0 N i < LO D : 72.42 6 C o < LO D : 180.83 7 Fe 19064.23 8 ± 391.54 8 M n 542.32 5 ± 97.65 5 Supervise d By :

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

? Coasta l Environmenta l Grou p Inc

. ^^^ ^ v"^^i ? www.coastalhazmat.co m '^^' ^

^"tPBO^* ^ COASTA L I M 6 I O U r , IH C 

# EXECUTIV ESUMMARY : BVID #31263-(211 9 EMME T ST )
No Issue s o r Concern s Q Issues/Concern s
Detail Explanation :

## EP APropert y Clos e Ou t For m ;/ 7 Propert y Address: : 2\\ ^ 9tU\W\f f ^ .- ^ Propert y # : -^1^0^ DBteH'ifnc : dlXlig^K^

- Owner' s N-me:.^)\\\nX ^ ,.\K}S\(r)rrr\CX ) Quad s ExcHvaled ; Contracto r Crou p OnTPf^dZ i 

# TTJoZy) : Ye s N o Excavatio nGenera l 1
.I f necessaiy , wer e th e correc t quadrant(s ) excavate dan drestored ? 2
.I f necessary , wer e th e correc t area s ofdri p ron e excavate dao drestored ? ^ " Gradin g So dan dVcicefatto n Ye s ^ o Doe s th e gradin g arovm dth e perimete r ofth e hous e inexcavaie darea s generall y slop e awa y fromth e house ? , 

# y y 2
.Ha s so dbee nlai di nal l area s tha t wer e excavated ? .1
.Doe s th e so dappea r to b e generall y health y andgrowing ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period ) 4
.Ar e sodde darea s generall y nr mandevenl y graded ? 

# \ y

• J

—--*
­ j 5 Ar e ihejoint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e if inspecte da t a3 0 da y : , ^ tim e period ) j

' 6
. Wa s th e property grade dsuc hthat wate r wil l not poo l onth e propeny" ' ^ ^ 

# r 7
. Wa s damag e t o landscapin g o r plant material s avoided ? 

## i X
Gates
. Fence s an dRetalnlp g Wall s 

# ~iy' " i
.D o gate s openan dclos e freely? (Ifapplicable ) 2Wer e all gate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (Ifapplicable ] 3
.Wa s damag e t o gate s or fence s avoided ? (Ifapplicable ) A

.Wa s damag e 1 0 retainin g wall s avoided ? (Ifapplicable ) 

# y \

Foundatton , SidJBRan dGatler s Ye s .N o I
.Wa s damag e t o th e sidin g o r tri mavoided ? 

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

# 1 I

."
. Wa s damag e t o window s avoided ? AWa s damag e t o window s o r doo r screen s avoided ? f , Wa s damag e t o downspout s o r downspou t extensions avoided ? 

# y\' ~ Sidewafk s an dDriveway s (Concrete ) Ye sNo 1
. Wa s damag e to drivewa y surface s avoided ? 

## i/ " 2 , Wa s damag e t o walkwa y surface s avoided ?

## G*M'rier s comnienifs :

Fn.spectio nnotes :

^,y24 ^ yU^^UTW- ^

Removal andresloratio n s complel e includin g e 30-da y so warran y va i an arestoratio nactivate activate s complete incjuding th the JU-da y sod dwarranty : EP A

Rc kpresentativ e /J<ml)fljLs4> ^ Date : y/$ ? IJ^/V

## Propert yCompletio n Agreemen t lln s agreemeni documenl s Ih e complclio n ot remedia l acliviiie s perloime d on my propert y

My signature wil l designal e iha l I amsatisfiedwit hthe restoratio nof my properly , an dtha i no ilein s ar e inquestions , now , or al any lim e inthe future , except ihos e ilem s lisledbelow , ifan y Propert y ID : 3,y^^^3
_ Propert y Addrcss:^!^ ^ ^^^^\^ 

## Q""^'-

- l/|V/iVi ^ H)r^ry\fvncJK 2 P''^"^

- ^5i?>
. ^gp ^ Restoratio n Item s in Question :

Item : Item : 

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

PQ I Agre e ccftoraiio nit completed , rxccp las note d [_

j I do not ayrt c resiorntin n is complete d

Owner' s Signatiir c Dat e Ciint i artoi' Si g Dal e Ccintiartoi' s s Sicnalnrc

# Oss)

^01 0 America nRecover y an dReirwestmen t Ac t (ARJIA) Ul\^j ^ >• OmahaLta dSi^pef^.n dSite ^^^S/H A 

## 2009/201 0 ^^ ^ Remedifitic nContractor : CoitCt- l EnvironMeKtE J Grou n- EP'_R7;ji9-_0 6 Prcpei-t>, ' kdendfier NuBiber ; '2t)^in ^ Propert y Address : 7J) ^ f..rAvy\P^

- f^
. Property OwQer' s Name : \jnh/O A}ir)>vo/yy^r-JC
lmftructioa. 5 t o tb e Frcpert v Owner : Thi s for mserve s to recor dth e Propert y Ovmev' s assessment o f performanc e (Incentive 1

- Qualit y Assuranc e Surveillanc e Plan ) involvin g the liste dremediatio ncontractor , as applicable to th e Omah aLea dSite
. Thi s for mdocument s th e timelines s of punchlis t resolution , busines s relations , complaint resolutio nandth e overal l qualit y of work
. Ifnee dbe , the Propert y Owne r ma y utiliz e thi s for mt o recor dproblem s and/or issue s not specifically tiedt o a nassigned address , fo r example , busines s relation s tha t generally don' t follo w the guideline s se t fort hi nth e Performanc e Wor k

Statement
. Th e Propert y Owne r will indicate his/her assessment o f performanc e wit hth e contractor' s wor k

b y checkin g aautnerica l ratin g o nth e Cabl e belo w usin g th e numerica l definition s firo m the ratin g scal e below , thensign& date th e form
. 9-1 0 "excellent " 7- 8 "ver y good " 5- 6 "acceptable " 3-4 "poor " 1-

2 "ver y poor " Owner' s Assessmep t of Performanc e Regardin g th e Contracror' s Work 1 0 _!

_5 9 4 8 3 7 2 6 1 

### Propert y Owne r Additiona l Comment s fro mfoptJongl ; continu e o nbac k PER C 

### i f needed )

Propert y Owne r Signatur e 

# ^Ltz ^