## TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAID# : HHl^' ^ Date : l^/(p// 0 Address : Q^O AMM & .S t RemediationContractor : Coastal Environmenta l Group
_ SOI LREMEDIATIO N PROPERT Y FIL EFOLDERDOCUMENT S y Video of propert y (DVD) y Executive Summar y y EPA-providedpropert y sketch jy SignedAcces s Agreemen t fo r

subject propert y y ^ SignedAcces s Agreement(s ) fo r

adjacen t propert y ^ RestorationAgreemen t Year : _2010ARRA
_

Yf e Settlemen t doctmients (i.e. , fo r

damage o r

t

o replac e plants , etc. ) y Confirmationdata y Photograph s ^ As-built sketch jy Satisfactor y restorationsignedb y Propert y Owne r / APropert y close-ou t chec k

lis t signedb y EP A #Descriptionofarea s not meeting RO D cleanu p criteri a ^ Utilit y clearance s j2 ^ Propert y informationfro mDouglas Coimt y Assessor' s Offic e D D D

3021807 4 

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## Propert yAcces s Checklis t Property IP = ' ^ ^ { Q [ j PropertyAddress : ^q^ ^ f^ j ^p ^ S ^ D D WORK STARTE D WORKCOMPELTE D ON : ON : . / // / 

# o^°«••=c^or^r9y lAJGiJbSn n Address : '
Phone:/^Q ^ ^5- / ^^7 7 Fax : Cell/Pager : Renter : Phone : Fax : Ccll/Pager : Additional Information :

• Notificatio nLette r {S f Acces s Agreement ^ Restoratio nAgreement Q Topsoil Sampling (i f applicable ) Q Disposa l Sampling (I f applicable ) D Garde nSampling (i f applicable ) [ S UtiUt y Clearanc e ( 3 Video/Photo s (Before) D Video/Photo s (During ) nVideo/Photo s (After ) nVideo/Photo s (30-Day) 0 Property Completio nAgreement D Final Report Sent : / / Signed: / 1/ J1/ O Signed : T/ 2^^ l f ^ 1 1 1 1 1 1 Called : oe > /03 > A O 

### On : y lZfl/ 0 On : / / On : / / On : / / Signed : / / Issued : / / By : By : 

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## 1 Air Monitorin g (a s applicable ) nConununit y D Cre w Results : On : / / By : 1

• Communit y Results : Q Cre w On : / / By : 1

• Communit y Results : [I ] Cre w On : / / By :

Omah a Lea d Sit e

### i^t i 

## Douglas Coimt y Accoim t Infoimation Pag e 1 of 2 • Dougla s County , Nebrask a Propert yRecor d - R160211000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s avaiiabl e @ scai e 0-5 0 ft wes t o f52n d S t - ViOWO 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 NEWSOM E JOSEP H P ETA L 290 2 N 4 8 S T OMAH AN E 68104-000 0 Propert yInformatio n Ke yNumber : 

### 021 1 000 0 1 6 Accoun t Type : Residentia l Parce l Number : 160211000 0 Parce l Address : Lega l Description : 290 2 N 4 8 S T OMAH AN E 68104-000 0 LAK E JAME S PAR KLO T1 2 BLOC KD 5 0 X 14 0 Valu e Informatio n


### 200 9 200 8 200 7 

### 200 6 200 5 200 4 Lan d $7,200.0 0 $7,200.0 0 $7,200.0 0 $7,200.0 0 $7,200.0 0 $7,200.0 0 Improvemen t $62,000.0 0 $62,000.0 0 $62,000.0 0 $62,000.0 0 $33,300.0 0 $33,300.0 0 Tota l $69,200.0 0 $69,200.0 0 $69,200.0 0 $69,200.0 0 $40,500.0 0 $40,500.0 0 Lan d Informatio n Acre s 

### 0.1 6 S F 7000. 0 Unit s 1. 0 Dept h 50. 0 Widt h 1 40. 0 Vacan t N o Improvement Informatio n Buiidin g 1



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl..
. 10/23/2009

### Dougla s County Accoun t Infoijj^tio n Pag e 2 of 2 ijll^t i

1 1/2StofyUnf m

""•••«»si r RrslFTcKj f lOM. C t v -JW ­

, ; EM«jj. « Bstiwi i Btoo k 8 m tlMO
CLIC KT O ENLARG E IMAG E Squar e Footage : 1084. 0 Percen t Complete : ; 100.0 % Perimete r0. 0 Quality : ' Averag e Uni t Type : Condition : Averag e

Buil t As : 1 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 5. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo fCover : Slat e Bedrooms : 2. 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 192 3 0 % 192 3 8 6 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Unfinishe d Atti cW/floo r 952. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 1260. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Basemen t Singl e 1. 0 Porc h En d Soli d Wal l 108. 0



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

### Pag e 1 o f 1

" > Creat e Anothe rTicke t Bac k t o Irt h Inteme t Sen d Emai l 

# ] [
YOURTICKE TNUMBE RI S 2510362
. Origina l Cal l Date : 6/03/1 0 Time : 1:4 0 pm Op : ELIZABETH1879 0 Wor k t o Begi n Date : 6/07/1 0 Time : 2:1 5 pm State : NE County : DOUGLA S Place : OMAH A Address : 290 2 Street : N48TH S T Twp : 15 NRng : 13 E Sect-Qtr : 07-NE-SE,08-NW-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATION Locatio n o f Work : LOCAT E ENTIR E PROPERTY , AL L EASEMENT S AND 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: COASTAL ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Being Don e For : COASTAL Dept ho f Excavation : 4 F T Corne r Lot : N Front : Y Rear : Y Involve s Tunneling o r Horizonta l Boring : N Explosives : N CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Servic e Are a Contac t Plion e Numbe r Utilit y Typ e Day : 402934046 9 CXCAT V CO XCOMMUNICATIONS , IN C HEIDI Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUDO l METROPOLITA NUTILITIES DISTRICTSAND Y Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT V O FOMAHA-TRAFFICSEWE RRICH/TRAFFI C Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 OPPDGPR 5 OMAH APUBLIC POWE RDISTRICT EL M LOCATIN G Alt : 406207149 4 Emerg : 888728934 3 

### Day : 406728934 3 QLNNEl C QWES TLOCA LNETWOR K 

### EL M LOCATIN GAlt : 4062071494 Emerg : 888728934 3

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. . 6/3/201 0

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### Consen t fo rAcces s T o Property ' RIGH TO F ENTR YT O PREMISE S 

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

Owner' s Name : Daytim e Phone : ^ ^ ^,,^ ^ —»

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

### Th e EPAi s requestin g acces s t o collect soi l sample s an d remove soi l tha t contain s elevate d concentration s o flea d an d maypos e a healt h hazard

. Th e area(s ) wil i 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 b 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 byUSEPA , vtril l contact th e Granto riri-perso n t o discus s th e wor k t o b e perfomned , th e Granto rwil l have a n opportunityt o revie wan d approv e th e planne d soi l removal , an d restoratio n wor k before 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 , its employees , contractors an d subcontractors th e righ t t o ente rth e property , a t al i 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 f27 ^ —* *
COASTA L tNVmOhHtKTl l ^^CP^O ^ C R O U rIMC

. 

### cRemov 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 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

. t 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

t n I gran t acces s t o mypropertie s D I d o no t gran t access t o mypropertie s 

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

.

Page 2 o f2

# ^ c > - COASTA L C n O U * * •H € 

## RestoratioF i 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 properl 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 restoratio n activitie s ar e complete dt o th e satisfactio no f th e propert y owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA)
.

PropertylD : ~~jqi'r>C ( PropertyAddress : < } J^O ^ / UC | <t "S ^ Owner : ^\G<,qo UV YeO^S^nM L Phone : 

# M S 7" ) O nth e attache ddiagram(s } indicat e aiiea(s } t o excavate , surfac e structure s an dlandscapin 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 necessaiy
. 

### item s t o b e Remove d b yth e Owne rbefor e Start o fRemediation : The removal , storaqe , disposal , arid/o rretur n ofthes e itom s i s th e Ownerl s responsibility

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- Quadrant s 

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Additiona l Comment s / Instructions : Th e cit yo fOmah a ordinance s ma yprohibi t yo 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 underlyin 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 replacin 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 j 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 withstandin g an yremova i o rreplacemen t o fsoi l b yth e EPA

. 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 cit yo fOmaha' s Plannin g Departmen t a t (402 ) 444-5150
. Q ^ Pleas e chec k thi s bo xi fyo u understan d th e informatio n outline d above

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. 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

.

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# 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 377.96 0 Supervise d By : 

## Certificat e o fVerificatio n

46 6 SOI L 2010-07-0 1 16:0 9 30.6 2 Fina l 7419 4 290 2 N 4 8 s t B l 4 " N

. LOPE Z confirmatio n non e

± Erro r ± 27.24 7• • 

# 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 46 7 Mod e SOI L Tim e 2010-07-0 1 16:1 0 Duratio n 30.6 2 Sequenc e Fina l Flag s BVI D 7419 4 ADDRES S 290 2 N 4 8 s t QUADRAN T B l DEPH T 4 " XR F TEC H N

. LOPE Z MIS C confirmatio n NOT E non e

pp m ± Erro r P b 382.83 0 ± 27.54 4 Supervise d By :

# 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 47 6 Mod e SOI L Tim e 2010-07-0 1 16:1 6 Duratio n 92.1 0 Sequenc e Fina l Flag s AVERAG E sAyggSSaaSS^Sii^^-^-- ^ ADDRES S ^90 2 N 4 8 s t QUADRAN T B 2 DEPH T 4 " XR F TEC H N

. LOPE Z MIS C confirmatio n NOT E non e

P b 22.20 0 Supervise d B y 

# -.^SMMim
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# 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 251.70 9 Supervise d By : 

## Certificat e o fVerificatio n

47 3 SOI L 2010-07-0 1 16:1 5 30.6 0 Fina l 7419 4 290 2 N 4 8 s t B 2 4 " N

. LOPE Z confirmatio n non e

± Erro r ± 22.14 1

# 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 239.48 5 Supervise d By : 

## Certificat e o fVerificatio n

47 4 SOI L 2010-07-0 1 16:1 5 30.6 0 Fina l 7419 4 290 2 N 4 8 s t B 2 4 " N

. LOPE Z confirmatio n non e

Erro r 22.42 3

# 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 240.60 4 Supervise d By : 

## Certificat e o fVerificatio n

47 5 SOI L 2010-07-0 1 16:1 6 30.9 0 Fina l 7419 4 290 2 N 4 8 s t B 2 4 " N

. LOPE Z confirmatio n non e

± Erro r
± 22.03 5

# 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 48 0 Mod e SOI L Tim e 2010-07-0 1 16:1 9 Duratio n 91.7 6 Sequenc e Fina l Flag s AVERAG E ADDRES S **^290 2 N 4 8 s t QUADRAN T D Z DEPH T 13 " XR F TEC H N

. LOPE Z MIS C confirmatio n NOT E non e

pp m ± Erro r P b 772.819* * ^ ' ± 37.97 6 Supervise d B y 

# :_%£aai2 a

# 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 47 7 Mod e SOI L Tim e 2010-07-0 1 16:1 8 Duratio n 30.3 9 Sequenc e Fina l Flag s BVI D 7419 4 ADDRES S 290 2 N 4 8 s t QUADRAN T D Z DEPH T 13 " XR F TEC H N

. LOPE Z MIS C confirmatio n NOT E non e

pp m Erro r P

b 750.77 5 ± 37.37 6 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 BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 780.19 4 Supervise d By : 

## Certificat e o fVerificatio n

47 8 SOI L 2010-07-0 1 16:1 9 30.6 9 Fina l 7419 4 290 2 N 4 8 s t D Z 13 " N

. LOPE Z confirmatio n non e

± Erro r 38.20 4

# 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 787.48 8 Supervise d By : 

## Certificat e o fVerificatio n

47 9 SOI L 2010-07-0 1 16:1 9 30.6 8 Fina l 7419 4 290 2 N 4 8 s t D Z 13 " N

. LOPE Z confirmatio n non e

Erro r 38.34 8

# 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 48 8 Mod e SOI L Tim e 2010-07-0 1 16:2 9 Duratio n 91.7 6 Sequenc e Fina l Flag s AVERAG E ^iii<Avg«bf'«485-48'7*' " ADDRES S 290 2 N 4 8 s t QUADRAN T EA DEPH T 1 " XR F TEC H N

. LOPE Z MIS C confirmatio n NOT E non e

pp m ± Erro r P

b 133.32 9 ± 16.59 5 Supen^se d B, : ^/ ) ^fjfflZ )

# 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 124.90 3 Supervise d By : 

## Certificat e o fVerificatio n

48 5 SOI L 2010-07-0 1 16:2 7 30.5 4 Fina l 7419 4 290 2 N 4 8 s t E A 1 " N

. LOPE Z confirmatio n non e

± Erro r
± 16.13 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 134.67 9 Supervise d By : 

## Certificat e o fVerificatio n

48 6 SOI L 2010-07-0 1 16:2 8 30.6 6 Fina l 7419 4 290 2 N 4 8 s t EA 1 " N

. LOPE Z confirmatio n non e

± Erro r ± 16.66 7

# 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 48 7 Mod e SOI L Tim e 2010-07-0 1 16:2 9 Duratio n 30.5 6 Sequenc e Fina l Flag s BVI D 7419 4 ADDRES S 290 2 N 4 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

Erro r pp m P

b ± 16.98 1 140.40 6 Supervise d By :^S' ^ — * * 

## iJOk^ i Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc

. ^

www.coastalhazmatco m '"tpno*" ^ COASTA L A l G lO U P

. I I I C 

# EXECUTIV ESUMMARY : BVID #74194-(290 2 N4 8 ST )
No Issue s o r Concern s | ^ Issues/Concern s Detail Explanation : -DA NGARVE Y WALKE D TH EPROPERT Y O N7/27/1 04 

# s # 

## EP APropert y Clos e Ou t For m Propert y# : Propert yAddress: * ^.»-Q C Date/Time : Owner' s Name;

. /fe
- o^" ^ Quad s Excavated : Contraclo rGrou p _ Excavatio nCcBem l 1
. I f neccssmy , wer e th e conec t quadi3nt(s ) excavate dan drestored ? 2
. I f necessary , wer e th e correc i area s o f dri p zon e excavale dan drestored? Gradin c So dan dVcmlatlo B Doe s th e endin g aroun dth e perimete r ofth e hous e i nexcBvaie darea s generall y slop e away fromtb e house ? Ha s so dbee nlai di nal l area s tha t wer e excavated ? Doe s th e so d^>pear t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period ) Ar e sodde darea s genetall y firman devenl 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 ) Wa s th e property grade dsuc hthat wate r wil l not poo l onth e prnpertV ) Wa s damag e t o landscapin g o r plant material s avoided ? Gates
. Fence s an dRctataio « Wal b 1
. O o gate s openan dclos e freely? (I f applicable ) 2
. Wer e al l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinsulied ? (I f applicable ) 3
. Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) 4
. Wa s damag e t o retaining wall s avoided ? (Ifappiicable ) Foundation , SidiORan dCoder s 1
. 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 ? 3
. Wa s damag e t o window s avoided ? Wa s damag e t o window s or doo r screen s avoided ? 5 , Wa s damag e t o downspout s o r downspou l extension s avoided ? Sidewalk s an d DrKeway s (Concrete ) I

. Was damage t o drivewa ysurfaces avoided ? 2
. Wa s damage t o walkwa ysurfaces avoided ? Ye s N o 

## y y Ye s N o 

## y 

## y 

## y y y y J i Ye s N o /

## y 

## y / Ye s .N o 

## y y —1 / 

### • / ] Ye

s N o 

# T

# i # O^'oer s comments :

I 

## [Inspectio nnotes :

Removal andrestoratio naclivale s complete includin g the 30-da y so dwarranty : EP ARepresentaliv e <ft» , ^ Date : '^ij^'lly L

### / #



## Propert yCompletio n Agreemen t /hi s agreemen l documenl i th e complclio n o fremedia l aclivilie s perroime d o n mypiopert yM ysignalui e wil l designat e Iha l I a m satisfie d wil h Ih e restoralio n o fm yproperly , an d lha t n o item s ar e i n questions , now , o ra l an ylim e i n th e future , except Ihos e ilem s liste d below , i fan y

Propert yJD : __2^A^6 ^ 

### PropertyAddress : ^^ ^ ^ ^^S f Owne r •^^• ^ 

# J±hcl9rr ^ Phoiie : 

# Vr/-ff^?-?
- Restoratio n Item s i n Question :

Item : 

# A^iP-^ r O o 

# ^H-e- T r^i A 6 ^ 0>rh^ ^ A-t>oi/<L ^ ^cxycxc , (z.. ^ ttem : 

# A 

# 0 ^ Item : Item : Item : Item :
Additiona l Comments :

jy i I agre e restoralio n i s compleled , rxccp t a s note d [J I (i o no l afjre cresloratio n 'n complete d

O^ci/ s Signatur / Date ' ' Cunt i arior' s Signnture Dal e

# # 1 ^ Propert y Owne r Assessment of Performanc e For m America nRecover y an dReinvestmen t Act (ARRA) OmahaLea dSuperfim dSit e 2009/201 0 Remediatio nContractor ; Coasta l EnvirOTimental Grou p - EP-R7-09-0 6 Propert y Identifie r Number ; '-^l^ ^ Propert y Address ; '^ ^ ^ ^ ^ ^ ^ Propert y Owner' s Name ; "^jp^Mjg ^ y[fiji!>9nfr ^ Instruction s t o tli e Propert v Owner ; Thi s for mserve s t o recor dth e Property Owner' 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 foimdocument s th e timelines s o f pimc hlis t resolution , busines s relations , complain t resolutio nan dth e overal l quality o f work
. I f nee dbe , th e Property Owner may utiliz e thi s for mt o recor dproblem s and/o r issue s not specificall y tie dt o anassigne d address , for example , busines s relation s tha t generall y don' t follo w th e guideline s set fort hinth 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 work b y cliecldn g anumerica l ratin g o nth e tabl e belo w usin g th e ntmierical definition s from th e ratin g scal e below , the nsig n& dat e th e form
. •nrrrrD-WTTDT x 9-1 0 "excellent " JUL2 ? 201 0 7- 8 'Veiygood " JUL<i<i£Ui u 5- 6 "acceptable " SUPERFUN D DIVISIO N 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 5 9 _^^

_ 4 7 2 

### 6 1 Propert v Owne r Additiona l Comment s fro m(optional ; continu e o nbac k pag e i f needed )
Propert y Owne r Signature ; .^^L-^^ ^ r A/>-^'-w

—^Dat e