## TRANSMITTALof OMAHALEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAI D # : H^f5^ 7 Date : \^/7r^/l O Address : 5Q0 7 ^ IR ' S- f Remediatio nContractor : Coasta l Environmenta l Group

_Year : _2010ARRA
_ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S '0 ^ Vide o o f propert y (DVD ) ^ Executiv e Stmimar y "Q

^ EPA-provide dproperty sketc h ^ Signe dAcces s Agreemen t for subjec t property 'B ' Signe dAcces s Agreement(s ) for adjacent property Q ^ Restoratio nAgreemen t • ^ Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. )

• 0' Confirmatio ndat a iT

r Photograph s & As-built sketc h

"Q Satisfactory restoratio nsigne db y Property Owne r E

f Property close-ou t chec k lis t signe db y EPA •& • Descriptio nofarea s not meetin g RO D cleanu p criteri a 0 * Utility clearance s H' Property informatio nfromDougla s County Assessor' s Offic e D D
. D 

# 1 0 iMlLy ^ ^^y ^ IZ/IP/IC , Signatur e J
_Dat e 3021803 7 

# iiin n Superfun d

# ^ v Propert y Acces s Checklis t PropertylD : lfg5 q/ PropertyAddr», : ^^-^ ^ ^ ^n ^ _ n D

WORK STARTE D WORKCOMPELTE D ON : ON : / / / / 

# o^"'^'- ^ r-|.).]U.rnnr- ) V/iU^Xp ~ Atldress : 

## Phone: ^Q^ j B ftM ^ ( ^ ^ .^ T Fax : Cell/Pager : Renter : Phone : Fax : Cell/Pager : Additional Information :

D Notificatio nLette r 15

^ Acces s Agreement ^ Restoratio nAgreement GTopsoil Sampling (i f applicable ) D Disposa l Samplin g (i f applicabie ) D Garde nSamplin g (i f applicable ) i ^ Utmt y Clearanc e Q^ideo/Photo s (Before) 1 D Video/Photo s (During )

D Video/Photo s (After ) nVideo/Photo s (30-Day ) 1 nProperty Completio nAgreement 1 D Final Report Sent : / / SignedJ 1 /)LL/i2 9 Signed:) ! /J^/Q Q 

### / / / / / / CaUed : 1 / iWjtlCP l On:_LL / V^l ^ On : / / On : / / On : / / Siened : / / Issued : / / By : By : By : By : By : By : By : By : By : By : By : By : |5^//4 ^

Ai r Monitorin g (a s appUcable) GCommunit y Q Cre w Results : On : / / By : 1
0 Communit y Results : • Cre w On : / / By :
D Communit y Results : Q Cre w On : / / By :

Omah a Lea d Sit eSmaa e 

## Douglas Count y Accoim t In|Mmation Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R041375000 2 Prin t Repor t NE WFaatur a - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f52n d S t - VIe WO H Ma p Informatio n i s vali d a s o f2009-10-1 5 Treasurer' s Ta xRepor t Ne wFeatur e ^ • * • * Aut o Sale s Searc h Owne r FLORE Z PEDR O ETA L 500 2 S 1 8 S T OMAH AN E 68107-000 0 Propert yInformatio n Ke yNumber : 

### 137 5 000 2 0 4 Accoun t Type : Residentia l Parce l Number : 041375000 2 Parce l Address : 500 2 S 1 8 S T OMAH AN E 68107-000 0 Lega l Description : SOUT H OMAH ACIT YLOT S LO T2 BLOC K10 5 AL L LO T1 & N 1/ 2 LO T2 BL K10 5 65X13 0 Valu e Informatio n Lan d Improvemen t Tota l 

### 200 9 $4,800.0 0 $34,000.0 0 $38,800.0 0 200 8 $4,800.0 0 $35,700.0 0 $40,500.0 0 200 7 $4,800.0 0 $40,000.0 0 $44,800.0 0 200 6 $4,800.0 0 $40,000.0 0 $44,800.0 0 200 5 $4,800.0 0 $40,000.0 0 $44,800.0 0 200 4 $4,800.0 0 $40,000.0 0 $44,800.0 0 Lan d Informatio n 4crs s S F Unit s Dept h Widt h Vacan t 

### 0.1 9 8450. 0 

### 1.0 130. 0 65. 0 N o Improvemen t Informatio n Buiidin g 1



## http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=RO.,
. 10/23/2009fiKm£ 

### Dougla s County Accoun t Infi«matio n Pag e 2 of 2

nwif-' ^ r ­ r r 

## I y 

# d Frs t Floo r riSOsqf t



### " i %*«ir • ' Bwnr t Bloc * 8 H 71 2 0 sq . R.

CLIC KT O E N LARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1170. 0 Percen t Complete : I 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Poo r

Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 7. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo fCover : Compositio n Sliingi e Bedrooms : 4. 0

Roo fType : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : 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 190 0 199 2 0 % 190 0 10 9 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f l 712. 0 Fixtur e Additiona l Fixture s 1. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h En d Soli d Wal l 120. 0



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. . 10/23/200 9

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• YOU RTICKE T NUMBE RI S 2507232 . Origina l Cal l Date : 6/01/1 0 Time : 2:3 1 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 6/03/1 0 Time : 3:0 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 500 2 Street : S 18T H S T Twp : 14 NRng : 13 E Sect-Qtr : 03-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 Come r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL 3 MUD0 2 OMAHACO F OPPDGPR 6 QLNNEI F

Servic e Are a Contac t Phon e Numbe r UtiUt y Typ e 

### Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I 

### Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 LEVEL 3 LEVEL S COMMUNICATIONS , LL C N A 

### Alt : Emerg : 877366834 4 Day : 402504782 3 MUD0 2 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

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. . 6/1/201 0

## Pag e 2 of 2

OPPDGPR 6 OMAH APUBLI C POWE RDISTRIC T EL M LOCATIN G 

## Day : 406728934 3

Alt : 406207149 4 

## Emerg : 888728934 3 QLNNEI FQWEST LOCA LNETWOR K

EL M LOCATIN G 

## Day : 406728934 3

Alt : 406207149 4 

## Emerg : 888728934 3

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



## • YOU R TICKE T NUMBE R IS 2413610 . Origina l Cal l Date : 11/26/0 9 Time : 2:5 8 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 12/02/0 9 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 500 2 Street : S 18T H S T Twp : 14 NRng : 13 E Sect-Qtr : 03-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 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 : 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 LEVEL S MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F



### Servic e Are a Contac t Phon e Number Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEIDI Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
LEVEL3 LEVEL S COMMUNICATIONS , LL C N A Day : 877366834 4 Alt : Emerg : 877366834 4
MUD0 2 METROPOLITA NUTILITIES DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0
OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRICH/IRAFFIC Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0

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## Pag e 2 of 2

OPPDGPR 6 OMAH APUBLI C POWE RDISTRIC T 

### N A 

## Day : 406728934 3 Alt : 4062071494 Emerg : 888728934 3 QLNNEI FQWES T LOCA LNETWOR K 

### N A 

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

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. 11/26/2009Pag e 1 of 2

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

• YOU RTICKE T NUMBE RI S 2407205 . Origina l Cal l Date : 11/16/0 9 Time : 9:1 9 a m Wor k t o Begi n Date : 11/18/0 9 Time : 10:0 0 a m State : N E County : DOUGLA S Address : 500 2 Street : S 18T H S T Twp : 14 NRng : 13 E Sect-Qtr : 03-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATIO N Op : ELIZABETH1879 0
Place : OMAH A

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 : 4 F T Come r Lot : N Involve s Tunnelin g o r Horizonta l Borin g : N Front : Y Explosives : N Rear : CXCAT V LEVEL 3 MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F

Servic e Are a Contac t
CXCAT V CO X COMMUNICATIONS , IN C HEIDI

LEVEL S LEVEL S COMMUNICATIONS , LL C N A

MUD0 2 METROPOLITA NUTILITIES DISTRIC T SAND Y

OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRICH/TRAFFI C Phon e Numbe r Utilit y Typ e Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 Alt : Emerg : 877366834 4 Day : 402504782 3 Alt : Emerg : 402504797 0 Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0

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0PPDGPR 6 OMAH APUBLI C POWE RDISTRIC T N A 

## Day : 406728934 3 Alt : 4062071494 Emerg : 888728934 3 QLNNEI FQWES T LOCALNETWOR K 

### N A 

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

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# Wt e ENVmONHINTA L C • O U P
. IN C OLS# : 4854 7 Dat e Excavated : 6/10/201 0 Dat e USEP ASiqne d Off : 7/28/201 0 Are a Sodden : 348 7 s a f t 

## 4854 7 Exterjprl^ain t NorthArro w Q'Goo d •Poo r Q Notpain t

Omah aLea dSit e 4613 0 

### Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are a replace d wit h So d Are a replace d wit h Rock/Mulc h Are a lef t bar e 

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

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. Owne rName : PEDR O FLOR^ t Address : 500 2 S 1 6 S T

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### > Q Not pain t Sample s Collecte d Firm : 9. £C<V \
. ^ .N l • Date : ] 0 •^'^•'- X Time : l o : 3.5 ^ Knr \ Sample s Analyze d XR F Unit : % [ Q Book' ^ ?! ) Date : Time : Staff ;

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### D Date : } 0 •.J-^- M RYBSCPXA-4854 7 F 2 __M^Pp m 

### D Time : I O : 33 ^ A> ^ 'T^CSCPXA-48ai »

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Omali a Lea d Sit e 4613 0

## 4854 7
rOwne rNanw : PEDR O FLORE g ' Addrew:S002Si8S T

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Omah a Lea d Site 46130,*^^*;^*V , COASTA l IHVIItONfllHTA t C R O t l r. IN C 

## Consen t fc rAcces s T o Pfopert 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 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 : . /vd^//r--),.- ­

Owner' s Name : Daytim e Phone : 

# 6\o riie-rrvvG } xJaScrs i ^ ^
Addres s o fPropert y covere d b ythi s 

# 5"°o ^ 

# 5/5 ^ Agreement : PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EPAi s requestin g acces s t o collect soi l sampie 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 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 , v\nl l contact 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 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 writte n documentatio n fro m EPAtha t th e property 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 , contractore 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 effect unti l th e wor k ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to ;
Pag e 1 o f2COASTA L tNVtnONHIKTA L C t O U P I KC 

### ( Remov 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 yw t o save ; is h

« Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessar ysubsequen t t o a n Initia l waterin g perio d b yEPA ; cAbid e b yhealt h an d safet yguidanc e provide d b yEPA ; • 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
. »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 yofth e wori cactivities , 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 mypropertie s D i d o no t gran t access t o mypropertie s

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

Page 2 of 2

## 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 propert 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 restoiatio n activitie s ar e complete dt o th e satisfactio nofth e property owne r an dth e Unite dStale s Environmenta l Protectio nAgenc y (EPA) .

Propert y ID : 

# '^T7 ' Propert y AddreM : C^Q Q a _5 . \ g ) ^ ^ Owner : g^ ^ v"\" G/fyy ^ Phone : ^^U| ^ y^c^ ^ Mg j Q^^^Z . O nth e attache ddiagram(s ) indicat e area(s ) t o excavate , surfac e structure s andlandscapin g feature s and 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 d b yth e Owne rbefor e Start o fRemediation : Th e lenoval
. storage , disposal , and/o rretur n o fthes e itom s I s th e Owne rs responeibility
.

Kem : Kem :



### Hem s t o b e Remove d b yth e Contracto rDurin g Remediatio n an d Wo t Replace d

Page l of
.;"^- - COASTA L 

## Item s t o B e Remove dBy Contracto r During Remediatio nan dRepiace d Kem : 

# i ) 

# ^Wbi / ^- ^

Kem : ' ^

/ / ) Kem :



## Item Ljindscap e Inventor y Quantity Uni t 

## Condition/Type/Specie s Pre-existing propert y area , tha t will b e excavated , tha t i s coveredwft hgrass . 

# ir V 

# .%H^ ^ Quadrants Numbe r o f tree s > 2 inc h trun k

diameter \ Eac h Numbe r o f tree s < = 2 inc h trun k

diamete r Eac h Numbe r o f Sprinkle r Zones . Control Valves , Timers , Heads , etc . Aiiac h : i skeicl ro l ilit f '•ri'i'klo rl;;y'.>u i Eac h

Numbe r o f an dsiz e of eachgarden / flowe r be d area . AlUitl i il skt'l'j h1) 1 rdlilivi. ' M?f S nn dlocaiiciK \ Eac h Squar e Feet Agreeduponvalu e of plan t material s no t to b e replace db v contractor . Vol e l!".t ' \Hill cVMI I h i csi' C 1 0 is;u ( i l 'linn ! \oin-JH' : I d lli e |;ro))crl > u>

< ncf
. Easemen t Area , to b e excavated Eac h
Pag e 2 of
.COASTA L r. h o u f, » N c

< Additiona l Comment s / Instructions : 

### \ 

# \ri^^Q ^ W^ ^

0 Chec k th e bo xi fOwne rdoe s no t wan t CE G t o documen t Interio rfoundatio n walls arK J possibl e pre-existin g damage
. B ycheckini g thi s bo xCE G i s no t responsible fo ran ydamag e don e t o th e interio ro fhouse , includin g foundatio n crack s o rfissures
.

[ ^ I agre e OI d o no t agre e

Owner' s Signatnr e Date Coniractor' s Signature Date Pag e 3 of
.

# m
BVID#<^8fbM- | XR F PROPERT YSAMPL E SHEE T Date ^-/-/ ^ Addres s .^iCTJ Z ^ 1 ft s r Projec t Omah a Lea d ARR A 

### Sampl e tim e am/p m XR F ID# sampl e lengt h 30 se c

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Readin g Sampl e are a Dept h

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 45 8 Mod e SOI L Tim e 2010-07-0 1 15:3 8 Duratio n 92.1 1 Sequenc e Fina l Flag s AVERAG E ^H> t 4bb-4b / -^^^^ '-"^ ' ADDRES S )0 2 S 1 8 s t QUADRAN T E A DEPH T 1 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e
pp m ±Erro r
Supervise d B y

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Blilerica , 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 184.86 5 Supervise d By : 

## Certificat e o f Verificatio n

45 5 SOI L 2010-07-0 1 15:3 7 30.5 5 Fina l 4854 7 500 2 S 1 8 s t E A 1 " N
. LOPE Z confirmatio n non e

± Erro r ± 19.79 7

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 179.55 2 Supervise d By : 

## Certificat e o fVerificatio n

45 6 SOI L 2010-07-0 1 15:3 7 30.6 1 Fina l 4854 7 500 2 S 1 8 s t E A 1 " N
. LOPE Z confirmatio n non e

± Erro r ± 19.43 1

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 159.82 4 Supervise d By : 

## Certificat e o f Verificatio n

45 7 SOI L 2010-07-0 1 15:3 8 30.9 5 Fina l 4854 7 500 2 S 1 8 s t E A 1 " N
. LOPE Z confirmatio n non e

± Erro r ± 18.37 0

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 45 4 Mod e SOI L Tim e 2010-07-0 1 15:3 5 Duratio n 91.5 7 Sequenc e Fina l Flag s AVERAGE ^|^M5| S ^SS ^ ADDRES S 00 2 S QUADRAN T D Z DEPH T 13 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e

P b Supervise d By : 

# iCMlM ^

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequence Flag s BVI D ADDRES S QUADRANT DEPH T XR F TEC H MIS C NOTE
pp m Pb 111.25 9 Supervise d By : 

## Certificat e o fVerificatio n

45 1 SOI L 2010-07-0 1 15:3 4 30.5 5 Fina l 4854 7 500 2 S 1 8 s t DZ 13 " N
. LOPEZ confirmatio n non e

± Erro r ± 15.91 4

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Biilerica , 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 108.25 3 Supervise d By : 

## Certificat e o f Verificatio n

45 2 SOI L 2010-07-0 1 15:3 4 30.5 1 Fina l 4854 7 500 2 S 1 8 s t D Z 13 " N
. LOPE Z confirmatio n non e

± Erro r ± 15.93 5

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 128.37 4 Supervise d By : 

## Certificat e o fVerificatio n

45 3 SOI L 2010-07-0 1 15:3 5 30.5 1 Fina l 4854 7 500 2 S 1 8 s t D Z 13 " N
. LOPE Z confirmatio n non e

± Erro r 16.82 8

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Biilerica , M A0182 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
pp m P b 1^^- ^ 'y j Supervise d 

## Certificat e o fVerificatio n

45 0 SOI L 2010-07-0 1 15:3 3 91.5 7 Fina l

• 47=449 ^ r00 2 S 1 8 s t B l 6 " N
. LOPE Z confirmatio n non e
Erro r JS25 6

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 44 7 Mod e SOI L Tim e 2010-07-0 1 15:3 1 Duratio n 30.5 8 Sequenc e Fina l Flag s BVI D 4854 7 ADDRES S 500 2 S 1 8 s t QUADRAN T B l DEPH T 6 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e
pp m Erro r P b 117.03 9 ± 16.40 9 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Biilerica , 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 113.23 6 Supervise d By : 

## Certificat e o fVerificatio n

44 8 SOI L 2010-07-0 1 15:3 2 30.5 3 Fina l 4854 7 500 2 S 1 8 s t B l 6 " N
. LOPE Z confirmatio n non e

± Erro r ± 16.13 6

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 112.62 1 Supervise d By : 

## Certificat e o fVerificatio n

44 9 "^ SOI L 2010-07-0 1 15:3 3 30.4 6 Fina l 4854 7 500 2 S 1 8 s t B l 6 " N
. LOPE Z confirmatio n non e

± Erro r ± 16.22 4

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 44 6 Mod e SOI L Tim e 2010-07-0 1 15:2 9 Duratio n 91.8 1 Sequenc e Fina l Flag s AVERAG E uri!tvg»Sf5443i44 S : ADDRES S 500 2 S 1 8 s t QUADRAN T F l DEPH T 4 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e

± Erro r pp m P b 18.23 5 150.19 2 Supervise d B y 

# -^AfJll U

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Biilerica , 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 151.24 9 Supervise d By : 

## Certificat e o fVerificatio n

44 3 SOI L 2010-07-0 1 15:2 8 30.6 0 Fina l 4854 7 500 2 S 1 8 s t F l 4 " N
. LOPE Z confirmatio n non e
Erro r 18.33 2

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 157.03 9 Supervise d By : 

## Certificat e o fVerificatio n

44 4 SOI L 2010-07-0 1 15:2 9 30.6 5 Fina l 4854 7 500 2 S 1 8 s t F l 4 " N
. LOPE Z confirmatio n non e

± Erro r ± 18.53 8

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Biilerica , 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 142.28 6 Supervise d By : 

## Certificat e o fVerificatio n

44 5 SOI L 2010-07-0 1 15:2 9 30.5 6 Fina l 4854 7 500 2 S 1 8 s t F l 4 " N
. LOPE Z confirmatio n non e

± Erro r ± 17.83 5

### y^> * Omali a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
. www.coastalhazmatco m ^ ^ COASTA L INVIIONHINTA l C •O U P , IH C 

# EXECUTIV ESUMMARY : BVID #48547-(500 2 S 1 8 ST ) No Issue s o r Concern s I I Issues/Concern s Detail Explanation : -DA NGARVE Y WALKE D TH EPROPERT Y O N7/28/1 0'CciS L 

## EP APropert y Clos e Ou t For m Propert ytf-.Mft.'^H.l , . PropertyAddreair.>jl'^|

- ^jJ^i^^Ji^JJa-i. , Datcmme ; ZZmr Ow^r' « Name: , /. % J H^-T^.^J . W^(^' ^ Quad s Excavated : Contraclo r Gron p Chq^T ^ I Ye s N o Excavatioi i Genem i 1 .If necessny , wer e the correct q(uuiiant(s } exc avatedan drestored ? / 2 .I f necessary , wer e the correct area s ofdrip zon e excavatedan drestored ? / Gradin g So dan dVeteCatio a Yes N o I .Doe s the gnuling aroundthe perimete r ofth e hous e i nexcavatedarea s generall y slope awa y / fromtb e house ? 2 .Ha s sodbee nlai dinall area s tha t wer e excavated ? / 3 .Doc s the so dappea r t

o b e generally health y an dgrowing ? (Onl y evaluat e i

f inspecte da t a3 0 / day tune period) 4 .Are sodde darea s genetally firman devenl y graded ? / 5 .

Are th e joint s betwee nth e so dstrip s generall y tight ? (Only evaluat e i

f inspecte da t a3 0 da y time period ) 

## y 6 .Wa s the propen y gradedsuc htha t wate r wil l no t pool o nthe property' ' 

## y 7 .Wa s danug e t o landscaping or plan t material s avoided ? 

# r y Gates . Fence s aatl RcUteini j Wall s { 1 . D o gate s ope nan dclo!(efi««ly ? (Ifappiicable ) 

# l- ^ Were al l gate s o r fence s take ndow nduring restorationactiviiie s reinstalled ? (I f applicable) 3 . Wa s damag e to gate s o r fence s avoided ? (Ifappiicable ) Yes / 

### y y N u

't . Wa s damag e to tetainin g wall s avoided ? (Ifappiicable ) Foupdation , SidhiRao dGntler s 

# i z Ye s N o t . Wa s damag e t o th e siding or trimavoided ? • ' 2 . Wa s damag e t o the foundatio navoided ? 

## y Wa s damag e t

o window s avoided ? 

## y AWa s damag e to window s o r door screen s avoided ? 5 . Wa s damag e t o downspouts o r downspou l extension s avoided ? 

# y y Sidewalk s an dDriveway s (Concrete ) 1 . Wa s damag e to drivewa y surface s avoided ? 2 . Wa s damag e to walkwa y surface s avoided ? Ye s 

# T 

# T N o

## Ort'Der s conunents :

j
. . . 

### ..^ c 

## jlnspectio nnotes : ^^ ^

\* « 1



## Removal andrestoratio nactivate s complel e includin g the 30-da y so dwarranry : EP ARepresentativ e ^" ^ ) ^ Date : l\z?l!Q_ ^

# 4

Propert yCompletio n Agreemen t ihi s agreemen l documents th e complclio n o l remedia l activitie s perloime d o n mypropert yM ysignature wil l designal e ihai I a m satisfie d wit h ih e restoralio n o fm yproperly , an d iha i n o item s ar e m questions , now , o ra l an ylim e i n th e future , excep l Ihos e ilem s liste d below , i fan y

Propert yID : UQ^^V-A n 

### Prope r t y Address
. 5Q. ^ 2 ! S 1 ft 5 ^ ^''""••^^^^Uli^^f-r^^r^ ^ 

# pho'"'=6iQ£Lj^gq - ifi^f s - ^ Ve)i 

# r^og) ^ n /c . U 

# - Restoratio n Item s i n Question :

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

V ^y^JP ^ ' 7 ftd I "fc cicstomlio n Kcompleted , excep t a s note d ^fp^/* ^ " ^ [Nr I d o no t atjre crestomtio n i; ; complete d 

### < ^ ~U •Z-C^i T 

# ^M ^

Owner' s Signatur e Dal e Conl i actor' s Sienatur e Dal e

## i^ ) 

## Propert y Owne r Assessmen t o f

Performanc e For m America nRecover y an dReinvestmen t Ac t (ARRAJfEpprrrn i Omah aLea dSuperfun dSit e ^*JVED 2009/201 0 JU L3 0 201 0 Remediatio nContractor : Coasta l Environmenta l Grou p - EP-R7-09-0 6 ^^^'^^^ ^ DlVlSTn^ f Propert y Identifie r Number : MB5M~ / Propert y Address : ,^Vy:) 7 5 / 8 Sr Propert y Owner' s Name : f-^t iv\l(^ r lyv ^ \(n\nd^ 7 Instruction s t o th e Propert y Owner ; Thi s fonnserve s to recordth e Propert y Owner' s assessment of performanc e (Incentiv e 1

- Quality Assuranc e Surveillanc e Plan ) involvin g th e liste dremediatio ncontractor , a s applicabl e to th e Omah aLea dSite
. Thi s for mdocument s th e timelines s o f punchlis t resolution , busines s relations , complaint resolutio nan dtK e overal l qualit y o f work
. If needbe , th e Propert y Owne r may utiliz e thi s for mto recor dproblem s and/o r issue s not specifically tie dto a nassigne d address , fo r

example , busines s relation s tha t generally don' t follo w the guideline s set fort hinth e Performanc e Wor k

Statement . Th e Propert y Owne r wil l indicate his/her assessment of perfonnanc e wit hth e contractor' s wor k

b y checkin g anumerica l ratin g o nth e tabl e belo w using th e numerica l definition s iix) m th e ratin g scal e below , thensign& dat e th e form
. 9-1 0 "excellent " 7- 8 "ver y good " 5- 6 "acceptable " 3- 4 "poor " 1-

2 "very poor " Propert v Owner' s Assessmen t o

f Performanc e Regardin g th e Contractor' s Wor k 1 0 9 

# ) L _A

_5 4 8 3 7 2 6 1 Propert v Owne r Additiona l Comment s fro mrootional ; continu e o nbac k pag e i f needed )
Propert y Owne r Signature : ( ^ ' ^Dat e