## TRANSMITTALo f

OMAHA LEA D SIT E SOILREMEDIATIO NFIL EFOLDE R
SAID # : 

# *57t n Date : 

# ^ U \] ^1 1 1 ^ ^< ^ ^ ^ Address : Reinediatio nContractor : Coasta l Environmenta l Group

_Year : _2010ARRA
_



# 7 

# 1

/ 

# s

i 7

^ 

### SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f property (DVD ) Executiv e Summar y EPA-provide dproperl y sketc h Signe dAcces s Agreemen t fo r subjec l property Signe dAcces s Agreement(s ) fo r adjacent property Restoratio nAgreement Settlemen t document s (i.e. , fo r damag e o r to replac e plants , etc. ) Confirmatio ndata Photographsffi r Oc<^R1[l ^ T t^^^Ht ^ A 4 ^ As-buil l sketc h Satisfactory restoratio nsigne db y Propert y Owner Property close-ou t chec k lis t signe db y EP A Descriptio nofarea s no t meetin g RO D cleanu p criteri a Utility clearance s Property informatio nfro mDougla s County Assessor' s Office

A 

# ^

I J Dat e '
Superfun d

## Propert yAcces s Checklis t Property ID : Propert yAddress ; 

# W ^ C j J- ^ jf\ J ^-f^^'^^l ^ n D

WOR K STARTE D WOR K COMPELTED ON : ON : _/ I l
_ I Owne r toarcss :
Phone ; \ \ Q Rente r Phone : Fta : Cell/Page r Additional Infonnation : Cell/Page r D Notificatio nLette r Ijq J Acces s Agrecmeti t t ^ Restoratio nAgreemen t D Topsoil Samplin g (if applicable ) D Diaposa l Samplhi g (if applicable ) 1 D Garde nSamplin g (if applicable ) ^ Utlli ^ Clearanc e 1^Video/Photo s (Before )

aVideo/Photo a(During ) D Video/Photo s (After) D Video^hoto s (30-Day ) D Propert y Completio nAgreement D Final Report Sent : / / Signed : j£3//t^//4 ^ 

### Sigfttd: UP//Ji l IQ
. 1 1 1 1 1 1 Called ; u l\1 \ o

On : v ^ / v^ / v o On : / / On : / / On : / / Signed : / / Issued : / / By : By : V*.t.\ c By : ,..>cVc By : By : By : 

# "y = vv/a/i o By : .,., . By : By : By : By : By : 

# lA^evNcL
.

Ai r Monitorin e (a s applicable ] nCommunit y D Cre w Results : On:
_ / / By :
D Communit y Results : Q Cre w On : _ / / By :

• Communit y Results : D Cre w On : / / By :

Omah a L«a d Sit e

## Dougla s Count y Accoun t I lio n 

## Pag e 1 o f 1
Dougia s County , Nebrask a Propert yRecor d - R052758000 2 Prin t Reoor t Vie wInteractiv e GI S Ma o Informatio n i s vali d a s o f 2010-8-3 0 Treasurer' s Ta xReoor t Ne wFeatur e -•-•• • Subdivisio n Sale s Searc h Owne r CITYO F OMAH A 181 9 FARNA M S T#91 0 OMAH AN E 68183-000 0 Propert yInformatio n Ke yNumlier : 275 8 000 2 0 5 Accoun t Type : E xGovernmen t Parce l Numlier : 052758000 2 Parce l Address : 97 1 N 2 5 S T OMAH AN E 68131-000 0 Lega l Description : ARMSTRONG S 1S TAD D LO T2 7 BLOC K1 LT2 6 & S 2 0 FTLT2 7 8 0 X 12 7 Valu e Informatio n Lan d Improvemen t Tota l 201 0 $0.0 0 $0.0 0 $0.0 0 200 9 $0.0 0 $0.0 0 $0.0 0 200 8 $0.0 0 $0.0 0 $0.0 0 200 7 $0.0 0 $0.0 0 $0.0 0 200 6 $3,500.0 0 $0.0 0 $3,500.0 0 200 5 $3,500.0 0 $0.0 0 $3,500.0 0 

## Sho w Al l Transaction s Lan d Informatio n Acre s S F Unit s DepO i Widt h Vacan t 0.2 3 10160. 0 1. 0 127. 0 80. 0



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R052..
. 9/2/201 0

### Pag e 1 of 2

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


### YOU RTICKE T NUMBE RI S 2630925
. Origina l Cal l Date : 11/01/1 0 Time : 10:5 9 a mOp : ELIZABETH1879 0 Wor k t o Begi n Date : 11/03/1 0 Time : 11:3 0 a m State : N E County : DOUGLA S Place : OMAH A Address : 97 1 Street : N25T H S T Twp : 15 NRng : 13 E Sect-Qtr : 15-SW,16-NE-S E 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 Tvmnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL 3 MUDO l OMAHACO F OPPDGPR S QLNNEI C



### Service Area Contact 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
LEVEL S LEVEL S COMMUNICATIONS , LL C N A Day : 877366834 4 Alt : Emerg : 877366834 4
MUDO l METROPOLITA N UTILITIE S DISTRIC T SAND Y Day : 402504782 3 Alt : Emerg : 402504797 0
OMAHACO FCIT Y O FOMAHA-TRAFFIC.SEWE RRICH/TRAFFI C Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 http://vmvkr.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 11/1/201 0

### Pag e 2 of 2

OPPDGPR S OMAH A PUBLI C POWE RDISTRIC T Alt : 406207149 4

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

EL M LOCATIN GAlt : 406728934 3 406207149 4 Emerg : 888728934 3

http://vvww.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 11/1/201 0

### 2506 7 

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e ENVIftONHCNTA L C « O U P
. IN C OLS# : 2506 7 Dat e Excavated : 11/4/201 0 Dat e USEP ASiqne d Off : 12/2/2 0 Are a Sodden : 271 5 s a f t Omah a Lea d Sit e Sit e Sketc h Samplin g Address : 97 1 N 2 5 S T Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Collecf e

Hected Concentratio n Fim n ? rTM C PfrT A RYASCPXA-2506 7 F 1 S02 - PPm M D Dat e Rll7ln q RYBSCPXA-2506 7 F 2 •^ 5 pp m D Tim e fiiii£i_Jyt \ RYCSCPXA-2506 7 B l ~IS S pp m Sample s Analyze d RYDSCPXA-2506 7 B 2 M o pp m nOZSOPX A2606 7 B Z pp m 

## a XR F Unit : lOftti ? Book : ZMZ C RGZSCPXA-2506 7 G Z 2. 0 pp m 

## n Dat e g • 2i > Qg ^ pp m D Tim e RYDSCPLA-2506 7 .La b 

### _B=
_ Staf f • Resul t 37. 8 pp m Numbe rof Sample s = j J ^ \

\ /

\ 

### m i u Legend : F l = Fron t Lefl , F 2 = Fron t Right , B l = Bac k Left , 8 2 = Bac k Rigfi t D Z = Dri p Zone , G Z = Garden , P Z = Pla y 

## ENTERE D xx ^ - ­ :AU 6 i 2 200 9



### M. 255r
.

Legen d Dri p Zon e Excavate d Concre't e Quadrant s Excavate d Are 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 Inc
.

## 2506 7 C\p ^ Lv\\l ^ Exterio rPain t Nort hArrort f Omah a Lea d Sit e • Good Sit e Sketc h • Poo r Samplin g Address : 97 1 N 25 ST P^ No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collect e lecte d Firm : ? F TM C P&T A RYASCPXA-2506 7 Fl SO 2.
. PPm M 

## D Date : R/lZlp q RYBSCPXA-2506 7 F2 -^ 5 pp m Time : B^^ H Ah A RYCSCPXA-2506 7 B1 1^ 5 pp m 

# n Sample s Analyze d RYDSCPXA-2506 7 B2 H£ > pp m RDZSCPX A2506 7 BZ pp m XR F Unit : IbRL ? Book : IMI P RGZSCPXA-2506 7 GZ LO pp m Date : g-2/?OC i pp m Tim e RYDSCPLA-2506 7 .La b 

# n Jfe ^ D Staf f ; Resul t 37. 8 pp m Numbe r of Sample s = [ ^ \ 

## ms u L D Legend : F1 = Fron t Left , F2 = Fron t Right , 81 = Bac k Left , B2 = Bac k Righ tDZ = Drl| D -gZ ^ Garden , PZ = Pla y Iti faclnoprope i A A l

l quadrant

quadrant s s ar

ar e

e a

a s s viewe

viewe d d fro

fro m

m In e e street

street , , facinapropert y 

# 'M p ^ 

# -fe f

gf o&^ e ENTERE D :AU 6 i 2 200 9



# ^^ ^YyYYy^ ^

## 2506 7 Exterio rPain t Nortt i Arro w Omah a Lea d Sit e 

### • Goo d Sit e Sketc h • Poor Samplin g Address : 97 1 N 2 5 S T ^f No t paint Sampl e Numbe r Lea d Sampl e LA B Concentratio n Collecte d RYASCPXA-2506 7 F l ^02 - PPm M 0 

## D RYBSCPXA-2506 7 F 2 ^ ^ pp m 

## D RYCSCPXA-2506 7 8 1 IS S pp m 

### [2 7 RYDSCPXA-2506 7 8 2 HC > pp m 

## \3 y RDZCOnX A2506 7 B E pp m 

## D RGZSCPXA-25D6 7 G Z Z O pp m 

# a pp m 

# n RYDSCPLA-2506 7 I Resul t .La b 37. 8 pp m Numbe ro f Sample s = [ ^ \ 

# ± Legend : F 1 = Fron t Left , F 2 = Fron t Right , B l = Bac k Left , B2 = Bac k Righ t A l quadrant s are as viewe d fro m th e street , faci i 

### ^iT-A '>^. ) ' i* ^ ' r,9^ A /^ ^ 7J , Sample s Collecte d Firm : ? F TM C VpT \ Date : R/lZlo' ? Time : fi-^H ^^ A Sample s Analyze d XR F Unit : IbRU l Book : 2ML >

Dat e g -22 ? QC t Tim e 

# Jn
. Staf f 

# ms w D

Z = DripZQpe^g Z = Garden , P Z = Pla y



# ^yy^tk
.

## 2506 7 Omah a Lea d Sit e Sit e Sketc h Samplin g Address : 97 1 N 2 5 S T Sampl e Numt)e r Lea d Sampl e Concentratio n Collecte d "-^^ RYASCPXA-2506 7 F l 

### ppm M H • RYBSCPXA-2506 7 F2 

# i5 - pp m RYCSCPXA-2506 7 8 1 pp m 

## \3 / U 

# 1g ? RYDSCPXA-2506 7 8 2 

## J±k
. pp m 

# u 7 ^ r^DZCGPX A2606 7 B Z 

# • / n pp m RGZSCPXA-2506 7 G Z pp m 

### [ Z D pp m 

# D n RYDSCPLA-2506 7 ; Resul t .La b 37. 8 pp m Numbe ro f Sample s = | ^ \ \ \ \ Exterio rPain t Nort h Airo w 

### • Goo d • Poo r [^No t paint Sample s Collecte d 

### Fimn : ? F TM C P^T A Date : R/lgJQ ? Time : fi:Mn At A Sample s Analyze d XR F Unit : 

### Jiifi^iZ ^ Book : Zfii ^ Date : __ 

### 2^o q Time : 

# fe Staff : 

### mZA ^ Legend : F l = Fron t Left , F 2 = Fron t Right , B l = Bac k Left , 8 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , PZ = Pla y A l quadrant s are as viewe d fro m th a street , facin g propeity^ LUCf



# N
. 253r
.

### \'7y 7 \ '',
. <P ' C G ^ ! 1 AI
' ' pf t t ^ ^^*•IP^0^'«1 ' i/. i ct cu I » •c 

### C;oiiKc-^ii \ fi) rAc:c;o.«;i - " i o rio|XHi( y RIGH TO F ENTR YT O PREMISE S 

### Granlo t (th e property ' ownef ) consenls
. t o an d authorize s th e i.inite d Slale s Environmenta l Protectio n Agency(PPA) o i its authorize d representatives , collectivel y th e Grantee , t o ente rsn d perfor m certai n environmenta l lespons e activitie s upor i th e followin g describe d premises - -j <y~}'^ /

^ ^
Ovi'nei' s Name : Daytim e Phone :

Addres s o f Propert 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 that contain s elevate d concentration s of lea d an d maypos e a healt h hazard Th e area(s ) wil l be excavate d t o remov e contaminate d soil
. Th e remove d contaminate d soi l wil l be 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 f Coasta l Environmenta l Group , contracte d b yUSEPA , wil 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 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 property has 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 , contractor s an d subcontractor s th e righ t t o ente rth e property , a t al l leasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e of performin g th e wor k 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 f 2

### I C C AS 1 AI I k V|^o»«^^ ^ tt i c n0 u » ^ *• i



### ' Remov e obstruction s incluf^in g boats , iraileis , vehicles , pl£ysca[) e he.m?- , woo d piles , do o houses , etc ;

' [Remov e flov/e i bLilb s o i plant s tfis t th e Granto i o rth e Grantoi' s tenan t ma ywis h t o save ; Wate ran d maintai n leplacernen l vegetation , includin g fertilize rapplicption , a s necessary ' subsequen t t ca n initia l waterin g perio d b yEP/\ ; < Abid e b yhealt h an d safet yguidanc e provide d b yEPA ; < I f th e propert yi s rented , assis t EP Ai n obtainin g tenan t appiova l fo i acces s l o th e propert yt o perfor m th e wor k Allo wvideotapin g and/o rphotographin g o f th e properly
. AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s no t t o interfer e o rtampe i wit h an yo f th e Vi'ork activities , o i wit 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 propert ywhic 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 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

0^9 1 D I d o no f gran t access t o mypropertie s I gran t acces s t o mypropertie s 

# .LOM Q ignatur e Dat e Signature Dat e

G f woul d lik t i o bt
. ptesen t duriti g an ysamplin o tha t i s lequiied
.

Paa e 2 o f 2C O A. S T A. U 

## Restoratio n Agreemen t Tti e purpos e o f thi s agreemen t i s t o provid e amutual agreement a s t o condition s o f th e property 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 that restoratio n activitie s are complete dt o th e satisfactio no f th e property owner andth e Unite dState s Environmental Protectio nAgenc y (EPA)
.

PropertylD : 0^7715 % OOO Z ^ 1y-n^C 7 PropertyAddress : <^-J j ^ ^i < ^ Owner : 

### / W ST " fi/yiAUa Phone : Onth e attache ddiagram(s ) indicate 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 . Indicate distances , depths , materia l types , etc . Photographicall y andVideographicall y document th e existin g condition s ofth e propert y andth e basement i

f necessary . 

### Item s t o b e Remove d b yth e Owne rbefor e Star t o f Remediation : Th e removal , storage , disposal , and/o rretur n o f thes e item s i s th e Owner' s responsibilit y



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

Pag e 1 of
.COASTA L C R O U *
. ) N C 

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



## Ite m Pre-existin g property area , tha t will b e excavated , tha t i s covere dwit hgrass . Number of tree s > 2 inch trun k

diameter Number of tree s < = 2 inch trun k

diameter Number of Sprinkler Zones , Contro l Valves , Timers , Heads , etc . .Attac hasketc hof the sprinkler lavout
. Number o f an dsiz e o f eac hgarden / flowe r be d area . Aiiachaskeic hof i-eiati\ f size s andlocaiion.s
. Agree dupo nvalu e o f plant material s no t t o b e replace dbv contiactor
. N'ot r thi s \jilii o nil l h e used(0 i'isti e aplan t louclic r 1( 1 th t propcrl > OWIKT
. Easement Area , to b e excavate d 

## Quantit y 

# •>$ /



# y 

# y y

H/i^ ^ Landscap e Inventor y Uni t Quadrant s

Eac h
Each

Eac h

Each Squar e Feet

$

Each 

# y O 7^i^,:y ^ /^Z£y^.^yyQ ^ Condition/Type/Specie s



# 7
. ^ / /

Pag e 2 of
.C O AS TA , L CMVinONHtNTA L CROUP
. IN C

Th e cit yo f Omah 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 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 withstandin g an yremova l o rreplacemen t o f soi l b yth e EPA
. 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 cit yo f Omaha' s Plannin g Departmen t a t (402 ) 444-5150
. Q Pleas e chec k thi s bo xi f yo u understan d th e informatio n outline d above
.

n 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 don e t o th e interio ro f house , includin g foundatio n crack s o rfissures
.

^ 

### I agre e nI d o no t agre e 10-I'i'( 0

Dat e 9ntractor' s Signatur e Dat e Pag e 3 of
.BVID # ZSO^l : 

### XR F PROPERT Y SAMPL E SHEE T Dat e 

## /- Z I 

## ­ z^o u Addres s Project Omah a Lea d ARR A Sampl e tim e am/p m XR F ID # .^^niL-L
. sampl e lengt h 3 0 se c

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## Z£ 8 L^ ^ 'iy\ o Averag e Readin g 

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## 8 ] Dept h 

## •f ' 7?i Gi Z ^ 

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Averag e Readin g Sampl e are a Dept h

Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h Averag e Averag e

Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h Averag e Averag e

Shot # Readin g RETES TAREA S Sampl e are a Shot # Readin g Sampl e are a

Averag e 

# Y ^- n 

# / Dept h Averag e Dept h

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_ Prin t 

# wi y

# H^rO ^

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 By : 

## Certificat e o f Verificatio n

29 1 SOIL 2011-01-2 1 16:3 3 90.7 0 Fina l Avg of 288-29 0 97 1 N 2 5 S T B l 4 " C.PADILL A CONFIRMATIO N CLEA R

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Blllerica , 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 286.57 2 Supervise d By : 

## Certificat e o f Verificatio n

28 8 SOIL 2011-01-2 1 16:3 1 30.2 1 Fina l 2506 7 97 1 N2 5 S T B l 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r

±• 25.63 6

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 286.31 4 Supervise d By : 

## Certificat e o f Verificatio n

28 9 SOI L 2011-01-2 1 16:3 2 30.3 0 Fina l 2506 7 97 1 N 2 5 S T B l 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 25.97 2

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Blllerica , 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 315.26 6 Supervise d By : 

## Certificat e o f Verificatio n

29 0 SOI L 2011-01-2 1 16:3 3 30.1 9 Fina l 2506 7 97 1 N 2 5 S T B l 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r ± 26.90 8

## I vA ^

'^ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 3 J^^^ L I Coasta l Environmenta l Grou p Inc
. \y^y ^ www.coastalhazmat.co m ^PRoit* * COASTA L INVIIONHINTA l 6 D O U P , IN C 

# EXECUTIV ESUMMARY : BVID #2506 7 - (97 1 N2 5 ST ) No Issue s o r Concern s [ ^ Issues/Concern s Detail Explanation : -DANGARVE Y WALKE D TH EPROPERT Y O N12/2/201 0

### « 

## EP A Propert y Clos e Ou t For m Proptrt yff : ^SOCeT h Datc/Time : fame ! /: \7-^S ^ ^ nj^ i V^/^^*^^*'^ ^ Owner' s f^ame:
. fu..} y Quad s Eicavaltd : |V 1 Contracto r Group
. Excavatio nGenera l 1. If necessaiy , wer e th e correc t quadrant(s ) excavate dan drestored ? Ye s / No
2. If necessary , wer e th e correc t area s ofdri p zon e excavale dan drestored ? / Gradin g So dan dVitetetlo B !. Doe s th e gradin g aroun dth e perimete r ofth e hous einexcavate darea s generall y slop e away fromth e house ? Yes / No
2.Ha s so dbee nlai dinal l area s that wer e excavated ? / J.Doe s th e so dappea r to be generall y health y an dgrowing ? (Onl y evaluat e ifinspecte d at a

30 da y tim e period ) 

# y 4.Ar e sodde darea s generall y (in nan devenl y graded ? 

# y S.Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e iflnspecte d at a

30 da y 

## y tim e period )__. . _. 6.Wa s th e property grade dsuc hthat wate r wil i no t poo lonth e property ? / 7.

Wa s damag e lo landscapin g or plant material s avoided ? / Gates
. Fence s an dRemaln g Wal b Ve s No 1. Oo gate s openan dclo.s e freely? (Ifapplicable ) / 2.Wer e al l gate s or fence s take ndow ndurin g restoratio nactivitie s reinsulled ? (I f applicable ) / 3.Wa s damag e to gate s or fence s avoided ? (Ifapplicable ) 4.Wa s damag e lo retainin g wall s avoided ? (Ifapplicable ) 

# 7
Foundation , SidlB Ran dGa(ler « Ye s No I.Wa s damag e to th e sidin g oriri mavoided ? / 2.Wa s damag e to Ih e foundatio navoided ? 

# J ."
.Wa s damag e io window s avoided ? 

# 7 ^Wa s damag e to window s or doo r screen s avoided ? / S.Wa s damag e to downspout s or downspou i extension s avoided ? 

# 7 Sidewalk s an d Driveway s (Concrete ) 

# f No 1.Wa s damag e to drivewa y surface s avoided ? 2.Wiff l damag e to walkwa y surface s avoided ? 

# r

### % 

## Ort'ner s comraents :

jlin.' ! pectio nno<es :

Removal andresloratio nactivate s complete includin g lhe 30-da y so dwarranry : EP A Representativ e ^ ^ Date : vl\L^"*
_

## Propert yCompletio n Agreemen t ri)i » ygrecme m doculTlenl^ Ih e coinplcho n o l reinediK l aclivme s perlonne d o n mypioperl yM ysignaiuit r wil l designat e iha i I s m satisfie d wit h ih e rcsioialio n o f m yproperly , nn d iha l n o uem s ar e m question s now . o r8 1 an ylim e i n ih e future , except ihos e Hem s liste d below , ifan y
Propert yAddrm : ^ f / " 7 J ^ ^ " 7 X Owne,^£J^__^ ^ ^QAnQy^Ct
. 

# 'y!Z--Sd,oL^y.yH-.Aydl/dlx.

.. J Restoratio n Item s I n Question : Item : Horn : lism : Item : ttem :

• ^ wi»ug7»r»i-i 3 Item : Additiona l Comments : 

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