## TRANSMITTALo f

OMAH ALEA D SITE SOILREMEDIATIO NFIL EFOLDER
SAID# : 

# U<i l Date : 

# ^hji i Address : 

# ^K< i yo^'^Hdb u Ui/i ^ Remediatio nConlractor : Coasta J Environinenta l Group

_Year : _2010ARR A
SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 

# d Vide o o f property (DVD ) 

# td , Executiv e Summar y EPA-provide dproperty sketc h 

# d Signe dAcces s Agreemen t fo r subjec t property Signe dAcces s Agreement(s ) fo r adjacent property Restoratio nAgreement / 

### Settlement document s (i.e. , fo r damag e or t

o replac e plants , etc. ) Confirmatio ndat a •^y ~ 

# •y t/ Photograph s I K As-buil t sketc h (y^^^rru ^ -V C^o^ATlm^ f ^
Satisfactor y restoratio nsigne db y Property Owner Property close-ou t check lis t signe db y EP A Descriptio no f area s not meetin g RO D cleanup criteri a Utility clearance s Propert y informatio nfro mDougla s County Assessor' s Office

Superfun d

## Propert yAcces s Checklis t PropertylD : |^35/( ^ 

### D WORK STARTE D ON : __/__/
_ Propert y Address : -^^^ Fn/^len.il^^
. Rh/r J 

### nWORK COMPELTED ON : __/__/
_ Renter : Owner : ^^^Y ^ APnA^AP P Address : Phone : Fax : 

## SAM e Cell/Pager : Additiona l Information : Phone : (^2,-2,-)qrt 0 Fax : Cell/Pager :

nNotificatio nLette r Sent : / / By : ] ^ Acces s Agreemen t 

## Signed : 1 / 1

J / / O By : JTS * Restoratio nAgreemen t 

## Signed : 4^/3/jj^
. By : Q Topsoi l Samplin g (if applicable ) / / By : 1 1 Disposa l Samplin g (i f applicable ) / / By :

• Garde nSamplin g (i f applicable ) / / By : [ ^ Utilit y Clearanc e Called : O hI (T ^ I \ 0 

## »y = ok>/o^k o WVNA 4 ^ Video/Photo s (Before ) On:C>b / OZ t v o By=^f^^.
. nVideo/Photo s (During ) On : / / By : D Video/Photo s (After ) On : / / By : D Video/Photo s (30-Day) On : / / By :

• Propert y Completio nAgreemen t Signed : / / By : D Fina l Repor t Issued : / / By : Ai r Monitorin g (a s applicable )
• Communit y • Cre w On : / / By : Results :

• Communit y • Cre w On : / / By : Results : 1 1 Communit y C H Cre w On : / / By : Results :

Omah a Lea d Sit e> 

### Dougla s County Accoun t Info^|tio n Pag e 1 of 2 b^t i 

# t
Dougla s County , Nebrask a Propert yRecor d - R081154000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabi e @ scal e 0-5 0 f t wes t o f52n d S t - VleWO n 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 BANTNE R JOH N S ETA L 245 1 FONTENELL E BLV D OMAH AN E 68104-000 0 Propert yInformatio n Ke yNumber : 115 4 000 0 0 8 Accoun t Type : Residentia l Parce l Number : 081154000 0 Parce l Address : Lega l Description : 245 1 FONTENELL E B D OMAH AN E 68104-000 0 CLAIRMON TLOT3 2 BLOC K3 5 0 X 12 5 Valu e Informatio n
200 9 200 8 200 7 200 6 200 5 200 4 Lan d $6,400.0 0 $6,400.0 0 $6,400.0 0 $6,400.0 0 $6,400.0 0 $6,400.0 0 Improvemen t $63,700.00 ' $63,700.0 0 $63,700.0 0 $63,700.0 0 $44,400.0 0 $40,400.0 0 Tota l $70,100.0 0 $70,100.0 0 $70,100.0 0 $70,100.0 0 $50,800.0 0 $46,800.0 0 Lan d Informatio n Acre s 0.1 4 S F 6250. 0 Unit s 1. 0 Dept h 125. 0 Widt h 50. 0 Vacan t N o Improvement Informatio n Buildin g 1



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

### ' ' Dougla s County Accoun t Info|^|tio n Pag e 2 of 2 

## • j^t i 

# t

MS I FONTETCU E B D

1 0 I I ff llS.O«q.l
. 1 0 «" l

• >I«<l94 *

—JJ * 3ST0R Y BlimStKliSI t 0409 0 n <?ygtST 9 ENLARG E IMAG ^ CLIC KTO ENLARG E IMAG E Squar e Footage : 

### 1439. 0 Percen t Complete : 

### 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 2 Stor y Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 5. 0 Exterior : Fram e Sidin g Units : 

### 1.0 Interior : Drywal l Baths : 

### 1. 5 Roo fCover : Compositio n Shingl e Bedrooms : 3. 0

Roo fType : Gabl e Stories : 2. 0 Floorcover : Allowanc e Foundation : Bloc k Sprinlde 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 191 5 0 % 191 5 9 5 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fenc e Chai n Lin k 1. 0 Applianc e Allowanc e 

### 1. 0 Basemen t Bsmn t Bloc k 8 f l 624. 0 Fixtur e Bas e Fixture s 

### 1.0 Fixtur e Bat h Ful l 

### 1.0 Fixtur e Bat h Hal f 

### 1.0 Garag e Detache d 240. 0 Porc h En d Scree n 180. 0 Porc h Sla b RoofCei l 192. 0



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

### Pag e 1 o f 1 )

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## ^M\^'

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### • YOU RTICKE T NUMBE RI S 2513399
. Origina l Cal l Date : 6/07/1 0 Time : 6:0 0 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 6/10/1 0 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 245 1 Street : FONTENELL E BLV D Twp : 15 NRng : 13 E Sect-Qtr : 08-S W 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 Corne r Lot : N Front : Y Rear : 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 Nunibe r Utilit y Typ e
CXCAT V CO X COMMUNICATIONS , IN C HEID I 

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

MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Day : Alt : 402504782 3 Emerg : 402504797 0
OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R RICH/TRAFFI C Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0
OPPDGPR 5 OMAH APUBLI C POWE RDISTRIC T 

### EL M LOCATIN G Day : 406728934 3

Alt : 406207149 4

Emerg : 888728934 3
QLNNEI C QWES T LOCALNETWOR K 

### EL M LOCATIN G Day : 406728934 3

/Ut : 406207149 4

Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 6/7/201 0

### Ticke t Tex t an dMa p display ih r Ticket : #251339 9 Pag e 1 of 2 

# S i
Origina l Cal l Date : 6/07/1 0 Time : 6:0 0 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 6/10/1 0 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 245 1 Street : FONTENELL E BLV D Twp : 15 NRng : 13 E Sect-Qtr : 08-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATIO N Locatio n o f Work : LOCAT E ENTIR E PROPERTY , AL L EASEMENT S AN D T O TH E PEDESTA L Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E I F CORNE R LOT . Compan y: COASTA L ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : COASTA L Dept h o f Excavation : 4 F T 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 COMMUNICATIONS , IN C HEID I 

### Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE RRICH/TRAFFI C 

### Alt : 402444516 1 Emerg : 402444516 0 

### Day : 406728934 3 OPPDGPR 5 OMAH APUBLI C POWE RDISTRIC T 

### 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

ViewMa p Clos e Ma p


### http://www^.dhon.org/irthintemet/MessageText/MessageTextAndMap.asp?NoticelD=DHO.
. . 6/7/201 0

# As-Buil t Drawin g COASTA L 

# Omah aLeadSttperfun dSite • MVIKOHMCHTAt •R e U r . IH C OLS# : 6351 6 Dat e Excavated : 6/15/201 0 Dat e USEP ASigne d Off : 7/14/ 2 6351 6 Are a Sodden : 477 0 s a f t 1 

## II I ExtahofPair t Omah a Lea d Sit e 0 Goo d Sit e Sketc h •Poo r Samplin g Address : 245 1 FONTENELL E B D Q Not pain t Lea d Ssmpt o Sample s Collecte d Sampl e Numbe r LA B Concenlralio n Colecte d Fim» : RYASCPXA-6351 6 F l pp m D Date : i-ii>-oi > RYBSCPXA-6351 6 F 2 pp m D Time : 3:1 0 fW i RYCSCPXA-635i e B l pp m HU 3 

## n Sample s Analyze d RYDSCPXA^351 6 B 2 pp m 

# i

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. 6y5*f O Book : 22. 6 Date : 

## n pp m D 1 0 -zo-o e pp m 

# i n 20 1 q D Time : 

## .fin
_ Staff : Numbe ro fSample s = [ f j D \ \ Q | 

## nsu ? Legend : F 1 = Fnon t Left
. F 2 = Fron t Ri

i ic k Righ t D Z = Dri p Zone , G Z = Garden
. P Z = Pla ; A i [•at , fadn g prapcft y

R«%'3UU t OMIttt
. 2i>-.\l*0 8

Legen d

Concret e 

# m Dri p Zon e Excavate d Quadrant s Excavate d Ara areplace dwit 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 In c) ^ 

# ,\ \ 

# ^ ' p 1 ^ 

# ( l "

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. O ^ 

# lo'^} VO Omah a Lea d Sit e Ext^io rPain t [P ] Goo d Sit e Sketc h •Poo r Samplin g Address : 245 1 FONTENELL E B D [ ] Not pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Fimi : FZ» V PB - AJ RYASCPXA-6351 6 F l Hlt i pp m D Dat e 1-li>-D t RYBSCPXA-635i e F 2 —5513—pp m D Tim e Z-I O pfr t RYCSCPXA-6351 8 B l *^3 0 pp m D Sample s Analyze d RYDSCPXA-6351 6 8 2 .^2
. It pp m D ROzscpxA-essi e O Z 20 1 <^ on m D XR F Unit : (pS'i O Book : 22. 6 GZS-fci - I J 5 pp m D Date : 1 0 -zo-o e nPgCCPX A6361 6 -PZ - pp m D D Time : Br , Staff : fTK O Numbero fSample s = 1 ^ | | Q [ Legend : F l = Fron t Left , F 2 = Fron t Riq b P Z = Pla< n ^j»^> ^


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# SoOHMO' y

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6351 6 Omah a Lea d Sit e Ex^o rPain t Sit e Sketc h 1 3 Goo d
•Poo r Samplin g Address : 245 1 FONTENELL E B D Q Not pain t Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Finn : Sample s Collecte d FO^ - PB - A J RYASCPXA-6351 6 RYBSCPXA-6351 6 RYCSCPXA-8351 6 RYDSCPXA-6351 6 F l F2 B l B 2

HU 3 pp m _5]13_pp m ^3 0 Do m j? 2 ( p pp m 

# I D D D D Date : Time : -?-/^-^ g 3 : /< ? /?/y i

Sample s Analyze d RDZSCPXA-6351 6 D Z 2.0 1 " ^ pp m 

### D XR F Unit : (ttSH O Book : 2Z a GZf-kff 3 ­ 5 pp m 

### D Date : / Q -Z O -0 & nrzocPX Aeasi g -P i —pp m Numbe ro fSample s = [ ^ | 

### D | Q | Time : Staff : 

# 3n
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# iiiiiii i il l I I 6351 6 Exterio rPain t Nort h Arro w Omah a Lea d Sit e ( g Goo d Sit e Sketc h •Poo r Samolin a Address : 245 1 FONTENELL E B D •No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r 

# i LA B Concentratio n Collecte d Fir m RYASCPXA-6351 6 F l pp m 

### D Dal e 

### i-/i>'Oe > RYBSCPXA-6351 6 F 2 pp m 

### D Tim e 3:lOpn t RYCSCPXA-6351 6 B 1 pp m 

### D Sample s Analyze d RYDSCPXA-6351 6 8 2 pp m 

### D RDZSCPXA-6351 6 D Z 20 1 q pp m 

### D XR F Unit : (DS'J O Book : ll. h pp m GZS-h i 

## 14 5 D Date : /0-ZO-O & nrzccpX Asosi o -P i pp m 

### D Time : By > •_ _ Staff : fT KO Numbe ro fSample s = [ ^ Legend : F l = Fron t Left , F 2 = Fron t Right , 8 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Ganjen , P Z = Pla ; Al l quadrant s ar « a s vievje d fro m th e straat , facin g propart y ^araoj t I f f 

## I OC T I 5 200 8 .JZl f 

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COASTA l INVIROHM I KTA l t PflO^t ^ C I t O t J r. IM C 

## Consen t fc F Acces s T o Froperl ^ 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 representatK'es , collectivel y th e Grantee , t o ente ran d perforn n certai n environmenta l respons e activitie s upo n th e followin g describe d premises : / ^ , 

# ?yS/ ( Owner' s Namee Daytim e Phone : J^'^'/z^ O

Addres s o fPropert y covere d b ythi s Agreement ;
PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP Ai s requestin g acces s t o collec t soi l sample s an d remov e soi l tha t contain s elevate d concentration s o 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 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 perfonmed , 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 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 motv ^ 

### - »

COASTA L IHVIHOMHIKTA L C KO U > I WC



### « Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , wo piles , do g houses , etc ; o d
cRemov e flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t ma yw t o save ; is h fWate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , necessary ' subsequen t t o a n initia l waterin g perio d b yEPA ; a s
cAbid e b yhealt h an d safet yguidanc e provide d b yEPA ; e I fth e propert yi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s th e propert yt o perfor m th e work
. t o
•^

Allo 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

I gran t acces s t o m ypropertie s Q I d o no t gran t acces s t o m ypropertie s 

# hlH d Dat e Signatur e Dat e

Q I woul d lik e t o b e presen t durin g an ysatnplin g tha t i s required
.

Pag e 2 o f2COASTA L 

## Restoratao nAgceemsn t Th e purpos e o f thi s agreemen t i s t o provid e amutual agreeme ma s t o condition s ofth e properl y 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 ar e complete dt o th e satisfactio no f th e property owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA)
.

PropertylD : \^'^f^]( ^ Propert y Address : 2.^,^ ) \=h/tfm ^ 1 1 f , P)W H Owner : ^\c^r \t^VtMgj^ ^ Phone : q^:^-\Q^ O O nth e attache ddiagram(s ) indicat e area(s ) to excavate , surfac e structure s andlandscapin g feature s and acces s location(s ) to b e use db y th e contractors . Indicate distances , depths , material types , etc . Photographicall y andVideographicall y documen t the existin g condition s ofth e property an dth e basemen t i f necessary . 

### item s to b e Remove d b yth e Owne rbefor e Star i o fRemediation : T •h e i ; riova;
. storaqe , disposal , and/o rretur n o fthes e itom s i s th s Owner' s '•espon£ibiiity
. item : 

### :>(li2
_



### . . /
ttem : j Item : 

### /

Item s t o b e Remove d b yth e Contracto rDurin g Remediatio n an d iV]o t Replace d Item : 

## f^oKl C Item : 

# f Item : 

### \ Item : L Page l ofCOASTA L 

### Item s t o B e Remove d B yContracto rDurin g Remediatio n an d Replace d em : ^ , ^
;em : ^ Ke m 

# -^Af7 ^ g;^/:? ^ Item : Item :



### Ite m Pre-existin g propert y area , that wil l b e excavated , that i s covere dwit hgrass . Numbe r o f tree s > 2 inc h trunk 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 . Aiinth; i s^L'icl i ol ilic ' '•rr'r-'kio i l;!\'.ui
. Numbe r o f an dsiz e o f eac hgarden / flower be d area . All;i(.l i
. 1 skoic h1) 1 rc!;iliv f jiZf S nndloc;iiiiMi i Agree dupo nvalu e o f plan t material s no t to b e replace db y contractor , •^'clc ;li ' \Y.\\\ Q vui ! n i usri
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### Quantit y 

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### Landscap e Inventor y Uni t Condition/Type/Specie s Quadrant s

Eac h
Eac h

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S

Easemen t Area , t o b e Eac h excavate d 

# 1^ ^ 7^Ac\ ; Y \< s
Pag e 2 of
.COASTA L

I Additiona l Comment e / Instructions : 

# ^4(y s

Q Chec k th e bo x ifOwne rdoe s no t wan t CE G to documen t interio rfoundatio n walls an d possibl e pre-existin g damage
. Bycheckin g thi s bo xCE G is no t responsibl e fo ran ydamag e don e to th e interio r ofhouse , includin g foundatio n crack sorfissures
.
Q I do no t agre e

"Dat 7 ' ^ Sienaturr Date Pag e 3 of Owner' s Sign Dat e e / ' Contractor' Contractor' s s SignatureBVID # 

## ^3S[U ) XR F PROPERT Y SAMPL E SHEE T Dat e Projec t XR F ID #

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_ 

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# 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 127 8 Mod e SOI L Tim e 2010-07-1 9 08:4 9 Duratio n 91.7 3 Sequenc e Fina l Flag s AVERAG E Av g o f1275-127 7 ADDRES S 245 1 Fontanell e blv d QUADRAN T EA DEPH T 1 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e

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 BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 122.01 6 Supervise d By : 

## Certificat e o fVerificatio n

127 5 SOI L 2010-07-1 9 08:4 8 30.6 0 Fina l 6351 6 245 1 Fontanell e blv d EA 1 " N
. LOPE Z confirmatio n non e

± Erro r ± 16.13 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 125.25 2 Supervise d By : 

## Certificat e o fVerificatio n

127 6 SOI L 2010-07-1 9 08:4 9 30.5 7 Fina l 6351 6 245 1 Fontanell e blv d EA 1 " N
. LOPE Z confirmatio n non e

± Erro r ± 16.31 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 XRFTEC H MIS C NOT E

pp m P b 114.08 0 Supervise d By : 

## Certificat e o fVerificatio n

127 7 SOI L 2010-07-1 9 08:4 9 30.5 6 Fina l 6351 6 245 1 Fontanell e blv d EA 1 " N
. LOPE Z confirmatio n non e

± Erro r ± 15.93 7

# 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

128 2 SOI L 2010-07-1 9 08:5 2 91.7 2 Fina l Av g o f 1279-128 1 245 1 Fontanell e blv d F l 6 " N
. LOPE Z confirmatio n non e

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

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

pp m P b 157.87 2 Supervise d By : 

## Certificat e o fVerificatio n

127 9 SOI L 2010-07-1 9 08:5 1 30.5 8 Fina l 6351 6 245 1 Fontanell e blv d F l 6 " N
. LOPE Z confirmatio n non e

± Erro r ± 18.06 7

# 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 139.85 0 Supervise d By : 

## Certificat e o fVerificatio n

128 0 SOI L 2010-07

- 1 9 08:5 2 30.5 5 Fina l 6351 6 245 1 Fontanell e blv d F l 6 " N
. LOPE Z confirmatio n non e

± Erro r ± 17.27 0

# 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 XRFTEC H MIS C NOT E

pp m P b 158.86 4 Supervise d By : 

## Certificat e o fVerificatio n

128 1 SOI L 2010-07-1 9 08:5 2 30.5 9 Fina l 6351 6 245 1 Fontanell e blv d F l 6 " N
. LOPE Z confirmatio n non e

± Erro r ± 18.13 0

# 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

P b Supervise d B y 

## Certificat e o fVerificatio n

128 6 SOI L 2010-07-1 9 08:5 5 91.4 4 Fina l Av g o f1283-128 5 245 1 Fontanell e blv d F2 6 " N
. LOPE Z confirmatio n non e

# 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 63.62 8 Supervise d By : 

## Certificat e o fVerificatio n

128 3 SOIL 2010-07-1 9 08:5 4 30.4 8 Fina l 6351 6 245 1 Fontanell e blv d F2 6 " N
. LOPE Z confirmatio n non e

± Erro r ±

12.86 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 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 72.16 2 Supervise d By : 

## Certificat e o fVerificatio n

128 4 SOI L 2010-07-1 9 08:5 5 30.4 8 Fina l 6351 6 245 1 Fontanell e blv d F2 6 " N
. LOPE Z confirmatio n non e

± Erro r ± 13.37 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 64.71 7 Supervise d By : 

## Certificat e o fVerificatio n

128 5 SOI L 2010-07

- 1 9 08:5 5 30.4 8 Fina l 6351 6 245 1 Fontanell e blv d F2 6 " N
. LOPE Z confirmatio n non e

±Erro r ±12.88 4

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

P b Supervise d B y 

## Certificat e o fVerificatio n

129 0 SOI L 2010-07-1 9 09:0 1 91.4 7 Fina l Av g o f1287-128 9 245 1 Fontanell e blv d B l 6 " N
. LOPE Z confirmatio n non e

# 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 57.99 2 Supervise d By : 

## Certificat e o fVerificatio n

128 7 SOI L 2010-07-1 9 09:0 0 30.5 4 Fina l 6351 6 245 1 Fontanell e blv d B l 6 " N
. LOPE Z confirmatio n non e

± Erro r ± 12.60 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 BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 47.71 0 Supervise d By : 

## Certificat e o fVerificatio n

128 8 SOI L 2010-07-1 9 09:0 0 30.4 9 Fina l 6351 6 245 1 Fontanell e blv d B l 6 " N
. LOPE Z confirmatio n non e

±Erro r ±12.04 4

# 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 48.68 5 Supervise d By : 

## Certificat e o fVerificatio n

128 9 SOI L 2010-07-1 9 09:0 1 30.4 4 Fina l 6351 6 245 1 Fontanell e blv d B l 6 " N
. LOPE Z confirmatio n non e

± Erro r ±

12.15 0

# 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 By : 

## Certificat e o fVerificatio n

130 2 SOI L 2010-07-1 9 09:1 1 91.6 6 Fina l Av g o f 1299-130 1 245 1 Fontanell e blv d D Z 13 " N
. LOPE Z confirmatio n non e

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Blllerica , 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 33.59 3 Supervise d By : 

## Certificat e o fVerificatio n

129 9 SOI L 2010-07-1 9 09:0 9 30.5 6 Fina l 6351 6 245 1 Fontanell e blv d D Z 13 " N
. LOPE Z confirmatio n non e

± Erro r ± 10.96 8

# 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 29.99 6 Supervise d By : 

## Certificat e o fVerificatio n

130 0 SOI L 2010-07-1 9 09:1 0 30.5 2 Fina l 6351 6 245 1 Fontanell e blv d D Z 13 " N
. LOPE Z confirmatio n non e

±Erro r ±10.70 7

# 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 37.48 8 Supervise d By : 

## Certificat e o fVerificatio n

130 1 SOI L 2010-07-1 9 09:1 1 30.5 8 Fina l 6351 6 245 1 Fontanell e blv d D Z 13 " N
. LOPE Z confirmatio n non e

± Erro r ±

11.32 2

### 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 %PRo-(* ^ COASTA L ENVIRONHENTA L CROUP , INC
. 

# EXECUTIV ESUMMARY : BVI D #63516-(245 1 FONTENELL EBLVD )

\ 

# N o Issue s o r Concern s [ ^ Issues/Concern s Detai l Explanation : DA NGARVE Y WALKE D TH EPROPERT Y ON7/14/1 0

## EP APropert y Clos e Ou t For m Propert yff : Date/Tline : Quad s Excavated : 

# J^252( ^ Propert y Address:'-z^'j ' Owner' s Name:./^_^£^^^ ^ Contracto rGrou p Excavatio D Genera l I
. I f necMsar>' , wer e th e correc t quadrant(s ) excavate dan drestored ? Yes y N o
2
. If necessary , wer e th e correc i area s o f drip zon e excavale dan drestored ? y Gradio K So dan dVettetatio n I
. Doe s th e gradin g aroun dth e perimete r ofth e hous e i nexcavate darea s generall y slop e awa y fromlh e house ? Ye s 

### • N o
2
. Ha s so dbee nlai di nal l area s that were excavated ? 3
. 4
. 5
. Doe s th e so dappea r to b e generall y health y an dgrowing ? (Onl y evaluat e if inspecte da t a3 0 da y time period ) Ar e sodde darea s generall y Fin nandevenl y graded ? 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 tim e period ) 

## . y y y 6
. Wa s th e property grade dsuc htha t wate r wil l not poo l o nth e property' ' 

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

## y Gates , Fence s sn dRelainln e Wall s B I 1
. D o gate s openandclos e freely? (Ifapplicable ) V « 

## y N u
2 , Wer e all gate s or fence s taJte ndowndurin g restoralio nacliviiie s reinstalled ? (Ifapplicable ) y 3
. Wa s damag e t o gate s or fence s avoided ? (Ifapplicable ) 

## y 'I
. Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) 

### y FouDdstion,SidioKan dGutter s Ve s .N o 1
. Wa s damag e l o th e sidin g o r tri mavoided ? 

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

### y

— 1 3
. Wa s damag e l o window s avoided ? 

## y 4 Wa s damag e t o window s or doo r screen s avoided ? 

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

### y Sidewalk s an dDriveway s (Coocrele ) Ye s N o Wa s damag e to drivewa y surface s avoided ? 2
. Wa s damag e l o walkway surface s avoided ? 

# V

## OM'tier ^ comments :

Hn s pectjo nno<es :

Removal andresloratio nactivate s complel e includin g the 30-da y so dwarranr y EP ARcpreseniaiiv e B^ ^ Date : TJHI' ^

## Propert yCompletio n Agreemen t
I'hi s agreeme m ciocumenls
. lh e complclio n ot remedia l acliviiie s perCoiinec i on myproperly
. Mysignatur e wil l designat e iha l I am satisfie d wit h (h e restoralio n of myproperly , an d tha i no ilem s ar e in queslions
. now , or al an ylim e:n th e future , excep l ihos e ilem s hsle d below , ifan y



## '''"p^ ' ^y ^^ ISL^J M Property Address : ^g^ j fi^ j^^,^,^^G; ^ Owner : -$ ^ U ^ '^AyyJeY^JlA ^ Phone : 

# ^h^ - MO ) Restoratio n Item s in Question :

Item : Item : Item : Item : Item :
Additiona l Cedents : {?^;5t,^ejpJ?C > ^ \fi ^ TzP^iSCe J ''\£-l-( (

\V\ j ayrc crestoratio nis completed , excep t as noler l [ I I rio no l ai>rf crestoratio n is complete d

)wiicr' s Signatur e Dal e Sipnalm Dal e Cont i actor' s Signatur e e

### 3^o 

# UPI^p,j^Tp,|Propert y Owne r Assessmen t of Performanc e For m AmericanRecovery an dReinvestmen t Ac t (ARRA ) JU L1 2 201 0 Omah aLea dSuperfundSite 2009/201 0 SUPERFUN D DIVISIO N Remediatio nContractor : Coasta l Environmenta l Grou p - EP-R7-09-0 6 Propert y Identifie r Number : ^3S7(g a. Propert y Address : ^U^\~PiTy\X&^UX ^ l^jU ^ Propert y Owner' s Name : ^^J6ui ^^VvT/fy/jZA ^
. Instruction s t o tli e Propert y Owner : Thi s for mserve s to recordth e Property Ovmer' s assessmen t o f performanc e (Incentiv e 1

- Quality Assuranc e Surveillanc e Plan ) involvin g th e liste dremediatio ncontractor , a s applicabl e t o th e Omah aLeadSite
. Thi s for mdocument s th e timelines s o f punc hlis t resolution , busines s relations , complain t resolutio nan dth e overal l quality o f work
. If nee dbe , th e Property Owner may utiliz e thi s for mt o recordproblem s and/o r issue s no t specificall y tie dt o a nassigne d address , fo r example , busines s relation s that generall y don' t follo w th e guideline s set fort hi nth e Performanc e Wor k

Statement
. Th e Property Owne r wil l indicat e his/he r assessmen t o f performanc e withth e contractor' s wor k

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

2 "very poor " Propert y Owner' s Assessmen t of Performanc e Regardin g th e Contractor' s Wor k


## 6<~^VA Pja ^ ( , if ] 

# iy)oW y ^^ ^ ^-^#ie< ^

Propert y Owne r Signature : V^4^,e^i ^

# (0 ^ Wate rBil l Settlemen t

Propert y I D 6351 6 Propert y Addres s 245 1 Fonteneil e B D Tenan t Joh nBantne r

I hav e receive dfromth e contractor , Coastal Environmental Grou p Inc
. (Coastal) , th e sumo f $ 30.3 2 for wate r usag e require dt o maintai nth e sod
.
Chec k Numbe r 209 3 Valu e o f Chec k 30.3 2 IVIad e Ou t T o Joh nBantne r Descriptio n o fSettlemen t T o reimburs e tenan t fo restimate d wate rctiarge s o n thei rMU D monthl yinvoices
. M ysignatur e belo wi s acl^nowledgemen t o fth e receip t o fth e su m liste d above , whic h t 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
.


# (^C^u^^y ^

fw J yi6v/ntr^ s Sig\ i Signature Date Contractor' s Signature Date

COASTA L ENVIRONMENTA L GROU P INC
. 

## 209 3 241 1 MARTH ASTREE T 27-5/104 0 00 3 OMAHA , N E 6810 5 6247372904 

# '^\^\] 0 DAT I



# - TM,\-'jQh nh(yx^mi r %^& ­ 

# nV\A>iPUtund^^li<n )

VMIIlFacgollink.N A (Mxask a «vctbfif9}.cof n 

# -gVlt ) Ifl^lt ^ 2^\'^\i(^^-j^^hOtn ^ (L6€ ^ ^ FO R

i : IDUOODOBai : E)a»,737E10Uii * 0Ed 3

## Wate rBil l Settlemen t

Propert y I D 6351 6 Propert y Addres s 245 1 Fontenell e Bv d1 Tenan t Joh nS
. Bantne r

I hav e receive dfromth e contractor , Coastal Environmenta l Grou p hic
. (Coastal) , th e su mo f $ 60.6 9 for wate r usag e require dt o maintai nth e sod
.
Chec k Numbe r 204 4 Valu e o f Chec k $60.6 9 Mad e Ou t T o Joh nS
. Bantne r | Descriptio n o fSettlemen 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
.



# 9nrnccii^nr ^

"^ 1 I n jit ) Contractor' s Signatur e ' Date 

## 2044 OMAHA, N E 6810 5 

# MJAK L 27-5/104 0 00 3 624737290 4 DAT E 

# \\

m 1 ^ 

# $ld 3

. OOLIARS fi ! S WHI i Farg o Bank
. N A Nebcaik a wcltsfatgo.co m 

## i:ioi,oooD5fli : &51,737Eqoun - 050m ,

## Propert yDamag e Settlemen t

Propertyl D 6351 6 Propert y Addres s 245 1 Fontenell e B D Owne r Joh nBantne r Phon e 402.933.190 0 

### I receive dfromth e contractor , Coasta l Enviroimiental Grou p hic
. (Coastal) , th e sumo f $100.0 0 t o compensat e for removal o f aPfitzer bus hdon e durin g th e remediatio no f lea dimpacte dsoi l fromth e property .

Compensatio ntyp e Chec k 207 0 Valu e o f Chec k $100.0 0 Chec k t o th e orde r of Joh nBantne r Descriptio n o fDamag e 

### Whil e excavatin g 245 1 Fontenell e B D (BVI D 63516 ) Coasta l presumabl y damage davariety o f flowers
. Property owne r receive dachec k for th e amount o f $100.0 0 dollar s for th e replacemen t ofth e flowers
. Coastal reviewe dth e pre-excavatio nphoto s an ddetermine dthat th e flower s ha dbee nremoved
. Coasta l agree dt o pa y apre-determine damoun t for th e replacemen t ofth e flowers
. M ysignatur e belo wacknowledge s th e presume d damag e o n th e interio rwall ; further , I acknowledg e tha t thi s wor k wa s complete d satisfactor yan d withi n m yan d releas e Coasta l Environmenta l Group , Inc
. fro m furthe robligation s o rliabilit yrelate d t o thi s prope r COASTA L ENVIRONMENTA L GROU P IN C 27-5/104 0 00 3 624737290 4 241 1 MARTH ASTREE T OMAHA , N E 6810 5 

# ^h\l ^ DAT i 

### $ 

# (X f PA

Y T O TH E
. ORDERO F5 K 

# i(iiltlBQ^%, — a 0«<al M o n
. DOL l AR S B*c k

WelKFar90Bank.N A weRsfargaco m



## , : 101.000058. : g,!i.737aioi.. ' OBO7 D 

# y ­ Owner' s Signature Date Colitractor' s Signature Date
Pag e 1 o f1