## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAI D # : UwO ^ Date : \^\ ^ j l ^ Address : L/t^ 1 QMI Q 

## n RemediationContractor : Coastal Enyironmenta l Group

_Year : _2010ARRA
_ SOILREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S t

/ Video o f propert y (DVD ) y Executive Summar y EPA-providedpropert y sketc h / 

## SignedAcces s Agreemen t fo r

subject propert y -H " Signe dAcces s Agreement(s ) fo r

adjacen t propert y U RestorationAgreemen t —H " Settlemen t documents (i.e. , fo r

damag e or t

o replac e plants , etc. ) 0 Confirmationdata fer Photograph s ^ ^ (r7o<%/mV| ^ \v^^|^^Wf ^ y As-built sketch Satisfactor y restoratio nsignedb y Propert y Owne r Propert y close-ou t chec k

lis t signedb y EP A -T

T Descriptionofarea s not meeting RO D cleanu p criteri a j /

Utilit y clearance s [J/ Property^iflfonjafatio nfro mDouglas Coimt y Assessor' s Offic e D D

Signatur e 3021801 8 

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^ Video/Photo s (Before ) D Video/Photo s (During ) D Video/Photo s (After ) D Video/Photo s (30-Day ) [~ | Propert y Completio nAgreemen t D Fina l Repor t Sent : / / Signed : ^ / Zl / I O Signed : M /t l / 1 0 / / / / / / CaUed:o M /l^/t o



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### Dougla s County Accoimt 

## Jj^uji^tio n Pag e 1 of 2
Dougla s County , Nebrask a Propeit yRecor d
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Treasurer' s Ta xRepor t Subdivisio n Sale s Searc h Owne r CITYO F OMAH A C/ 0 PLANNIN G DEPARTMEN T 181 9 FARNA M S T#111 1 OMAH AN E 68183-000 0 Propert yInformatio n Ke yNumber : 205 1 OOO O 0 9 Accoun t Type : E xGovemmen t Parce l Number : 092051000 0 Parce l Address : Lega l Description : 220 4 OHI O S T OMAH AN E 68110-000 0 DENISE S AD D LO T2 1 BLOC K1 5 7 X 12 2 Valu e Informatio n
200 9 200 8 200 7 200 6 200 5 200 4 Lan d $0.0 0 $0.0 0 $0.0 0 $600.0 0 $600.0 0 $600.0 0 Improvemen t $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 Tota l $0.0 0 $0.0 0 $0.0 0 $600.0 0 $600.0 0 $600.0 0 Sale s Informatio n Sale s Date : 1992-06-1 9 Dee d Type : D SooJIr : 217 1 Page : 63 3 Price : $300.0 0 Grantor : Grantee : Valid/lnvalid : Vali d Exclusio n Reason : 

### Sho wAl l Transaction s

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YOU RTICKE T NUMBE RI S 2473633
. Origina l Cal l Date : 4/23/1 0 Time : 1:1 4 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 4/27/1 0 Time : 1:4 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 220 4 Street : OHI O S T Twp : 15 NRng : 13 E Sect-Qtr : 09-SE,10-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 : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MAGELLANMUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

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

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

X

* A /-C TT A X T MAGELLA NMIDSTREA M PARTNER S T^cDi-v o AU MAGELLA Nj p 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 

### RlCHA^RAFFI C Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0

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OPPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T EL M LOCATIN G 

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

## Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

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. 4/23/201 0

# As-Buil t Drawin g OLS# : 2900 0 Dat e Excavated : 04/30/1 0 COASTA L 

# Omah aLea dSuperfun dSit e Dat e USEP ASiqne d Off : 05/20/1 0 Are a Sodden : 190 9 s o f t 

## X^OD O NIamf i 6«-»^/, ^ H./i J .'it.,>,if/t.> S Omah a Lea d Sit e Date : 5-/^'(? V Nort h Arro w SK e Sketc h Time : /«- ' Z 9 Phone : 

# r

Team^//fi//L.^i'if ^ {-^^^ ^ BVID #I^O^ ^ Sampl e Numbe r

Omah aLeadSite 4613 0 Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are a replace d wit h Are areplace dwit hW&i \ Are alef t bar e So d' ' Rock/Mulc h Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
.CN**©./
- 

## VV Os/^T v2.^00 0 j Name ; Crr,«/wH./i J Mfif^t-^ S Omah a Lea d Sit e Date : S-^-o< ^ Nort h AiTo wI -

Address : Z^^VCOir/ n 9/
- Sit e Sketc h Time : lo : Z 9 Phone : 

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Omah a Lea d Sit e 4613 0• 

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name : CiTfJt*
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COASTA l IMVIRORH f KIA l cft 0 ur . IN 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 : B^lP'^'ZHO^^

Owner' s Name : Daytim e Phone : uwne r s

Addres s o f Propert y covere d b ythi s 

# ^ZO ^

oHfo 5- r 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 it s origina l condition

. Thi s wor k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o fCoasta l Environmenta l Group , contracte d b yUSEPA , wil l contac t th e Granto rin-perso n t o discus s th e wor k t o b e performed , th e Granto rwil l hav e a n opportunit yt o revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e i t begins

. Onc e th e wor k i s finished , th e Granto rwil l b e aske d t o revie wth e wor k an d confir m tha t i t i s complet e an d meet s wit h th e Grantor' s approval

. Upo n completion , th e Granto rwil l receiv e writte n documentatio n 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 f performin g th e wori(

. Thi s acces s shal l remai n i n effec t unti l th e wori t ha s bee n satisfactoril ycompleted

. Th e Granto rals o agree s to :

Page l of 2.^^'"*'^t

.

COASTA L IflVlaeilHfKTA l C ft O U rIR C 

### t 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 ywis h t o save ; < 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 ; t Abid e b yhealt h an d safetyguidanc e provide d byEPA ; « I f th e propertyi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propertyt o perfor m th e work

. cAllo 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 wor k activities , o rwit h an y o f th 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 f sai d propertywhic h woul d ten d t o endange rth e healt h o r welfar e o f th e Grantee s o rth e environment , o rt o allo wother s t o us e th e propertyi 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
^\ g I gran t acces s t o m yproperties D I d o no t grant acces s t o m ypropertie s



## t^-^l-rc ^ Signatur e Dat e

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

.

Pag e 2 o f 2C O AST AL
• MVI«OMH>MTA L a • O U P

. IHC

. 

## Restoratio n Agreemen t The purpos e of thi s agreemen t i s t o provide amutua l agreemen t a s t o condition s of the propert y prior t o remediationactivities
. Thi s will als o serve a s documentationfo r

the purpos e o f assuring tha t restoration activitie s ar e completedt o the satisfactionof the propert y owne r an dthe UnitedState s Environmenta l ProtectionAgency (EPA)
.

PropertylD : ^^fjQ Q Propert y Address ; •2>Z^^f Ol^,f , «!?T

. 

### Owner : 

# Orc Yc^ rQfHtH ^ 6.( 1 Uicmt 7 Plione : 

# y^^

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nthe attacheddiagram(s ) indicat e area(s ) t o excavate , surface structure s an dlandscapin g feature s an d acces s location(s ) to b e usedby the contractors . Indicat e distances , depths , materia l types , etc . Photographicall y an dVideographicall y documen t the existing condition s ofth e propert y an dthe basemen tif necessary . 

## Item s t o b e Remove d b yth e Owne rbefor e Start o f Remediation : Th e removal , storage , disposai , and/o rretu m o f thes e item s i s th e Owner' s responsibility

. item : 

# yoh ^ item :
item :
item :



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

Page l of

.C OA S T AL 

## Item s t o B e Remove d B yContracto rDurin g Remediatio n an d Replace d Kem : 

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## 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 tnm k diamete r Numbe r o f tree s < = 2 inc h trun k diamete r Numbe r o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Attac hasketc ho f th e sprinkle r layout
. Numbe r o f an dsiz e o f eac hgarden/ flower be d area . Attac hasketc ho f relativ e size s an dlocations
. Agree dupo nvalu e o f plan t material s no t t o b e replace db v contractor . Not e thi s valu e wil l b e use dt o issu e aplan t vouche r t o th e propert y owner . Easemen t Area , t o b e excavate d 

## Quantity Landscap e Inventor y Unit Quadrant s

Eac h
Eac h

Eac h

Eac h Squar e Fee t

$

Eac h 

## Condition/Type/Specie s

Pag e 2 of

.^ C O AS T AI

. • NViaOMMBMTAI

. aaoup . INC

.

Additiona l Comment s / instructions : Th e cK yo f Omah 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 f thi s i s th e case , yo u shoul d understan d tha t thi s removin g an d replacin g o f soi 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 f yo 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 f soi l b yth e EP A I f yo u hav e an yquestio n abou t legalit yo f a certai n drivewa yo rparkin g area , yo u ma ycontac t th e cKyo f Omaha' s Plannin g Departmen t a t (402 ) 444-5150

. |~ | Pleas e chec k thi s bo xi f yo u understan d th e informatio n outline d above

.

O Chec k th e bo xi f Owne 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 done t o th e interio ro f house , includin g foundatio n crack s o rfissures

. 4^ 1 agre e / ] C U I d o no t agre e 

## (f\^rgAth J Owner' s Signalur e \Date Contrac t Contractor' s Signatur e Date Pag e 3 of

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pp m Erro r M o < LO D 8.35 4 Z r 498.29 1 ± 16.43 0 S r 155.06 4 ± 8.60 4 U < LO D 16.24 4 R b 78.03 6 ± 7.08 2 T h 13.76 4 ± 6.97 0 P b 8.98 3 779 5 8.42 1

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

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434.73 9 Supervise d By : 

## Certificat e o f Verificatio n

55 6 SOI L 2010-05-1 1 16:3 2 30.1 1 Fina l 2900 0 220 4 Ohi o s t F 2 6 " CONFIRMATIO N N

. LOPE Z

±Erro r 8.19 3 ± 16.04 4 ± 8.36 9 15.70 1 ± 6.97 0

: 9.16 9 ± 9.10 4 5.84 1 ; 12.70 2 : 12.57 0 ± 16.22 8

: 87.82 2

• 30.15 1 ± 51.33 0

I 185.27 5 ± 406.80 7 ± 91.29 4

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 55 7 Mod e SOI L Tim e 2010-05-1 1 16:3 3 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 2900 0 ADDRES S 220 4 Ohi o s t QUADRAN T F 2 DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D 8.38 6 Z r 505.56 4 16.54 9 S r 155.75 2 8.62 0 U < LO D 16.26 9 R b 77.56 0 7.07 2 T h 20.46 8 7.62 8 P b 26.88 9 8.98 4 S e < LO D 6.10 6 A s 13.46 2 8.38 3 H g < LO D 12.86 4 Z n 67.86 4 16.30 8 W < LO D 90.41 0 C u < LO D 30.87 5 N i < LO D 75.10 2 C o < LO D 191.30 7 F e 20172.42 0 ± 413.04 3 M n 377.69 2 i 89.07 8 Supervise d By :

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPT H TYP E INSPECTO R

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## w C u N i C o Fe M n pp m < LO D 507.50 4 161.05 1

< LO D 78.96 6 15.03 9 26.50 3 < LO D 14.08 0 < LO D 68.10 5 < LO D 46.39 5 < LO D < LO D 20639.33 6 487.28 5 Supervise d By : 

## Certificat e o f Verificatio n

55 8 SOI L 2010-05-1 1 16:3 3 30.1 1 Fina l 2900 0 220 4 Ohi o s t F 2 6 " CONFIRMATIO N N

. LOPE Z

Erro r : 8.48 3 ± 16.69 6 ± 8.82 2

; 16.76 4 ± 7.20 3 ± 7.17 0 ± 8.86 2 J 5.43 8 ± 8.41 3

: 13.03 7 ± 16.36 9

: 87.11 9 ± 22.22 6

: 73.62 2 : 194.70 4 ± 420.75 5 ± 96.72 7

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

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pp m Erro r M o < LO D I 7.96 5 Z r 390.78 6 ± 14.64 2 S r 158.07 6 ± 8.55 8 U < LO D : 15.04 1 R b 76.12 3 ± 6.83 1 T h 19.47 0 ± 9.34 0 n h b e ——^Jk U 7fl A < LO D 7 • X 

## ^6Si 5 A s < LO D J 28.16 3 H g < LO D : 12.76 7 Z n 222.80 2 ± 25.12 0 

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: ^^21.29 2 72^ 7 >/ra3.58 9 Fe 18929.95 9 / ' ±/ ^

394.33 3 M n 417.98 3 / ^89.24 8
^ 

# i: x 

# y Supervise d By : y ^SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , M A0182 1 

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 56 0 Mod e SOI L Tim e 2010-05-1 1 16:3 5 Duratio n 30.4 3 Sequenc e Fina l Flag s BVI D 2900 0 ADDRES S 220 4 Ohi o 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 7.98 1 Z r 400.67 9 ± 14.82 8 S r 158.28 2 ± 8.58 8 U < LO D 14.65 4 R b 79.00 7 ± 6.90 3 T h 14.36 1 ± 9.14 1 P b 278.22 1 ± 22.04 7 S e < LO D 6.26 8 A s < LO D 28.48 8 H g < LO D 13.18 9 Z n 239.38 6 i 26.06 6 

## w < LO D 92.73 2 C u < LO D 30.98 2 N i < LO D 74.07 9 C o < LO D 185.77 2 Fe 19101.35 0 ± 397.22 3 M n 399.40 4 ± 88.30 3 C r < LO D 313.23 9 V < LO D 681.95 3 T i 3410.71 4 ± 2254.45 8 S c < LO D 263.85 0 C a 10799.40 4 ± 4638.12 9 K 12106.36 8 ± 7012.64 7 S < LO D 14524.60 9 Supervise d By :

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPT H TYP E INSPECTO R

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 C r V T i S c C a K S pp m < LO D 385.79 1 160.48 2

< LO D 74.70 9 25.83 1 237.79 6

< LO D 40.35 9 < LO D 206.04 7

< LO D 40.76 2 < LO D < LO D 18620.76 8

466.71 1

< LO D < LO D 2675.38 4 < LO D 12322.04 8 18117.34 8 < LO D Supervise d By : 

## Certificat e o fVerificatio n

56 1 SOI L 2010-05-1 1 16:3 5 30.4 2 Fina l 2900 0 220 4 Ohi o s t E A 1 " CONFIRMATIO N N

. LOPE Z

: ± ±

; ± ± ±

I ±

: ± : ±

• J J : ± :

; ±

: ± ±

: Erro r 8.00 6 14.55 3 8.59 7 15.07 8 6.77 8 9.61 2 20.44 9

6.12 2 18.48 7 12.22 9 24.20 7 86.59 7 21.14 0 72.48 2 183.86 2 390.33 8

92.73 7 317.84 5 553.62 4 1449.92 1

232.32 5 4808.96 3 8173.82 9

331.81 0

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 56 2 Mod e SOI L Tim e 2010-05-1 1 16:3 6 Duratio n 30.1 0 Sequenc e Fina l Flag s BVI D 2900 0 ADDRES S 220 4 Ohi o 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 7.90 7 Z r 385.88 8 ± 14.54 5 S r 155.46 5 ± 8.49 0 U < LO D : 15.39 1 R b 74.65 3 ± 6.81 2 T h 18.21 9 ± 9.26 5 P b 263.32 3 ± 21.39 7 S e < LO D 5.62 5 A s < LO D 28.27 2 H g < LO D 12.88 4 Z n 222.97 3 ± 25.08 6 < LO D ; 86.05 6 

## w C u 53.43 3 ± 22.08 2 N i < LO D : 71.20 2 C o < LO D I 181.13 3 F e 19067.75 8 ±• 395.43 9 M n 387.83 4 ± 86.70 5 Supervise d By :

# 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 AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

Supervise d B y 

## Certificat e o f Verificatio n

127 1 SOI L 2010-04-2 9 15:1 6 90.6 0 Fina l _9L1268r1?7n_ ^ 10 4 OHI O S T EASEMEN T 1 " O

. BARAJA S In-situ s clea r

# 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 206.65 1 Supervise d By : 

## Certificat e o f Verificatio n

126 8 SOI L 2010-04-2 9 15:1 4 30.1 9 Fina l 2900 0 220 4 OHI O S T EASEMEN T 1 " O

. BARAJA S In-situ s clea r

± Erro r
± 21.30 7

# 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 155.53 4 Supervise d By : 

## Certificat e o f Verificatio n

126 9 SOI L 2010-04-2 9 15:1 5 30.1 9 Fina l 2900 0 220 4 OHI O S T EASEMEN T l " O

. BARAJA S In-situ s clea r

i : Erro r 18.70 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 167.50 2 Supervise d By : 

## Certificat e o f Verificatio n

127 0 SOI L 2010-04-2 9 15:1 6 30.2 2 Fina l 2900 0 220 4 OHI O S T EASEMEN T 1 " 0

. BARAJA S In-situ s clea r

± Erro r
± 19.69 8

## iy^^ \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 I ^^^ ^

I Coasta l Environmenta i Grou p Inc

. v l ^ J ' Vr^^I ^

www.coastalhazmatco m %tp„oT*'' ^ COASTA L ENVIIONHINTA l G a o U P , IN C 

# EXECUTIV ESUMMARY : BVID #29000-(2204 OHI O ST )
No Issue s o r Concern s j ^ Issues/Concern s
Detai l Explanation : • DA NGARVE Y WALKE D TH EPROPERT Y O N5/20/1 0• • 

# • 4

EP A Propert y Clos e Ou t For m Propcirtj r # : 2=^0O. Q
. . Propert y Address- y Datemmc ; Owner' s IHamc:..^PiM

. Vjij.n^y^

. • • — Quad s Excavated : Contracto r Grou p ^ Ye s N o Excavatio nGcnen l 1
.

I f necessaiy
. wer e th e conec t qu8drant(s ) exc avate dan drestored ? 

## • 2
.I f necessary , wer e th e correc t area s ordri p zon e excavate dan drestored ? / Ye s No I Doe s th e tradin g aroun dth e perimete r ofth e hous e i nexcavate darea s generall y slop e away fromth e house ? Gradin g So dan dVegetetto a

2
.Ha s so dbeenlai di nal l area s that wer e excavated ? / 3
.

Doe s th e so dappea r to b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period ) / 4
.Ar e sodde darea s generall y fim i an devenl y graded ? / 5
.

Ar e th e Joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 da y / titn e penod ) 6
.Wa s th e properl y grade dsuc hthat wate r wil l no l poo l onih e property ' 7
.

Wa s damag e t o landscapin g o r plan t malerial s avoided ? 

# 7

Gates , Fence s an dRcuinlD x Wall s Ye s N o 1
.D o gate s openan dclo."! e freely? (I f applicable ) 

## y 2
.Wer e al l gate s o r fence s talie ndow ndurin g restoratio nactivitie s reinsialied ? (I f applicable ) / 3
.Wa s damag e t o gate s o r fence s avoided ? (Ifappiicable ) / 4
.Wa s damag e t o retainin g wall s avoided ? (Ifappiicable ) / Foundation , SiJiflgaB dGntler s Ye s N o I
.

Wa s damag e t o th e sidin g o r tri mavoided ? / 2
.Wa s damag e t o th e foundatio navoided ? / ?
.Wa s damag e t o window s avoided ? 

## J 1Wa s dainag e t o window s o r doo r screen s avoided ? 

# 7
2
.Wa s damag e i o downspout s o r downspou l extension s avoided ? 

# 7
Sidewalk s an dDriveway s (Concrete ) Ye s N o I
.Wa s damag e l o drivewa y surface s avoided ? 2 ,

Wa s damag e t o walkwa y surface s avoided ?• • 

## Owner s comments :

jlnspectio nnotes :


# y if

i fi %



## Removal andrestoratio nactivate s complet e includin g the 30-da y so dwairanty : EP A Representativ e Bt0>ii M Date : ^/W* ^

### • • « •



## Propert yCompletio n Agreemen t
riii s agreemen t documenl s lli e complclio n ofremedia l aclivtiie s perloime donmypropert y Mysignalur e wil l designal e Iha l I am satisfie d wil h th e resloralio n of mypropeily

. an d iha lno item s ar e in questions , now , oral an ylim e in th e future , except thos e item s liste d below , ifan y

Piopcrr yID : 2<^0O O Propert yAddress : 220 M OV\i O ^ . 

### Owner : <^,-^y ^jj,]^ ^ C^ ^ p ^ DY^MOK
. DkftavA * t.tit i ^ - , ^
. i/ y \ n - ^ Jill/ / 1 1 '\ yi ^ ^ 

# Pbone : M\x^''^{9, n ftriF ^u^'^2^ ^ Restoratio n Item s in Question :



### Item : Item : Item : Item : Item : Item :

p e l 1 ayrc crestoralio n is completed , excep t as note d [_ J I rio no l ai;re cresloratio n is complete d

Owner' s Sijgnatiir r Dato O M Sienatur Cbnt i actor' s Signatur e Dal e

## '.2S 1 

# Em d Propert y Owee r AsgessEaeitt o f FerfcrMJEEice For m America nRecover y an dReinvestmen t Ac t (AlRREpFUAI D DIV/SIO M Omah aLea dSuperfun dSit e 2009/201 0 Remediatio nComtractor : Co&stgl Environmenta l Grou p - EP-R7-09-0 6 Propert y Identifie r Number : T-^OO O Propert y Address : Xto M rk\^r ^ SV-.
. Propert y Owaer' s Ncme : \^{l l IAAKQ-S K 

### f \^ \o f DiM/^Ktf ^
Instruction s t o th e Propert v Owner : Thi s for mserve s to recor dth e Propert y Owner' s assessment of performanc e (Incentive 1

- Quality Assuranc e Surveillanc e Plan ) involvin g th e liste dremediationcontractor , as applicable to th e Omah aLea dSite
. Thi s for mdocument s th e timelines s of punc hlis t resolution , busines s relations , complaint resolutio nan dth e overal l qualit y of work
. I f nee dbe , the Propert y Owne r ma y utiliz e thi s for mto recor dproblem s and/o r issue s not specifically tie dt o a nassigne d address , for example , busines s relation s that generally don' t follo w th e guideline s set fort hi nthe Performanc e Wor k

Statement
. Th e Propert y Owne r will indicate his/he r assessment o f performanc e wit hth e contractor' s wori c b y checkin g anumerica l rstic g o nth e tabl e belo w usin g th e numerica l definition s fro m th e 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 " Propert y Owner' s Assessmen t of

f Performanc e Regardin g th e Contractor' s Wor k 1 0 5 9 4 8 y3 7 2 6 Propert y Owne r Additiopa i Comment s fro m(optional ; continu e o nbac k pag e i f ffiecded)
Propert y Owne r Signature : jW>^^7^ ^ V Date : /r-A ^ '-^d/j )

# zn ]

EP A Assessment of Performanc e For m America nRecover y an dReinvestmen t Ac t (ARRA ) Omah aLea dSuperfun dSit e 2009/201 0 Remediatio nContractor : Coasta l Environmenta l Grou p - EP-R7-09-0 6 Propert y Identifie r Number : iP^dO O Propert v Address : 2Z0 M r^V^i D ?s\-
. Propert y Owner' s Name : ISil l LuKxiSW
. (Abov e ii^ormationto b e filledou t b

y the remediationcontracto r prior to utilizationby the EP A COR ) :ti***4i4t4i4c4>*4'***************<t'********************************'^4>*****>l>>l>**>|i*4<*>l>**>| i 

## Instruction s t o EP A COR : Thi s for mserve s t o recor dth e COR' s assessmen t o f performance (Incentive 1 - Qualit y Assuranc e Siu^^eillance Plan ) involving th e listedremediatio ncontractor , a s applicable to th e OmahaLea dSite
. Thi s for mdocuments the timelines s o f punchlis t resolution , busines s relations , complaint resolutio nandth e overall qualit y o f work
. If needbe , EP A ma y utiliz e thi s for mto recordproblem s and/or issue s no t specificall y tiedto a nassignedaddress , fo r

example , busines s relation s tha t generally don' t follow the guideline s se t fort hinthe Performance Wor k Statement
. The CO Rwil l indicate his/he r

assessmen t o

f

performanc e wit hth e contractor' s wor k

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

2 "ver y poor " Ass e ssmen t o

f

Performa n 1 0 5 9 4 8 y 3 7 2 6 1 Additional Comment s fro mEPA CO R(optional ; continu e o nbac k pag e if needed )

EPA CO RSignature : A«^t^

_Date : tjioji o

## ^ 2900 0 

# NOTE S

RE : 220 8 OHI O S T 220 4 OHI O ST

JUL Y17 , 201 0

- W E RECEIVE D INFORMATIO N FRO M TOD D (TODD' S SOD ) STATIN G THA TH E SA WABULLDOZE R O N TH E SOD , O N PROPERT Y220 8 OHI O ST

.



### July 19 , 201 0 -ON E O F OU R SIT E COORDINATOR S WEN TT O TH E HOUS E T O INSPEC TTH E CLAI M AN D NOTICE D THA TTH E GROUN D HA D BAR E SOIL,WA S LEVELED , AN D AL L TH E SO D WA S REMOVED , FRO M PROPERT Y220 8 OHI O S TAN D ALS O FRO M TH E NEIGHBORIN G PROPERTY , 220 4 OHI O ST , WHIC H I S ANOTHE R PROPERT YTHA TCOASTA L DI D TH E LEA D REMEDIATIO N FOR

.

"SUPERVISOR S WER E NOTIFIE D IMMEDIATELY *