## TRANSMITTALof OMAHALEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAID# : 

# ^^IH < Date : 

# 1 ^ In )t Address : inln ^ \A\\^\^ i Hi\'HH W Remediatio nContractor : Coasta l Environmenta l Group

_Year : _2010ARRA
_ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f property (DVD ) Executiv e Summary EPA-provide dproperty sketc h Signe dAcces s Agreemen t for subjec t property 

# I T Signe dAcces s Agreement(s ) for adjacent property / 

### Restoratio nAgreemen t Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) - ^ 

### Confirmatio ndat a 

# V Photograph s m­ h^O^^rn ^ y ^(AVMW ^ 

### V 'V / l^lAi ^ ^ 1

/ As-built sketc h Satisfactory restoratio nsigne db y Property Owne r Property close-ou t chec k lis t signe db y EPA Descriptio no f area s no t meetin g RO D cleanu p criteri a Utility clearance s Property informatio nfi'omDougla s County Assessor' s Offic e

)ate

Superfun d^ \ 

## Propert yAcces s Checklis t Propert y ID : ^ ^ 0 I M S nWOR K STARTE D ON : __/__/
_ 

### Propert y Address : ^Q ^ ^ ^^ ^ [^ ^ ^ D WOR K COMPELTED ON : / / Owner : p^j^j.^,; ^ Rj^-k r . Renter : Address : Phone : Fax : 

# 5am e Cell/Pager : Phone : Additional Information : Fax : Cell/Pagen^C^^^ , <^3Ul< : D Notificatio nLette r Sent : / / By : S ^ Acces s Agreement 

## Signed : 2
. liUllO
. By : ^ Restoratio nAgreement Signed : Z
. / ^ ^ li O By : Q Topsoi l Samplin g (if applicable ) 1 1 By : Q Disposa l Samplin g (i f appUcable) 1 1 By : nGarde nSamplin g (if applicable ) I I By : ^ Utmt y Clearanc e CaUedO'! > AS O l\ 0 »y=CM/r;':iAi ^ U)f«^.
. Uf ^ nVideo/Photo s (Before) On:^l< 3 l<S>C5i O By : ^ nVideo/Photo s (During ) On : / / By : nVideo/Photo s (After) On : / / By : D Video/Photo s (30-Day ) On : / / By :
• Property Completio nAgreement Signed : / / By : nFinal Report Issued : / / By : Ai r Monitorin g (a s applicable ) Q Communit y QCre w On : / / By : Results :

• Communit y O Cre w On : / / 

### By : 1 Results : 1

• Conmiunit y • Cre w On : / / By : Results :

Omah a Lea d Sit e

## • ^Dougla s Count y Accoun t InfQ||^tio n Pag e 1 of 2 Qjll^ c Dougla s County , Nebrask a Propert yRecor d - R175054000 2 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal 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 f2009-12-1 5 Treasurer' s Ta xRepor t Ne wFeatur e •• ^ - • Aiit o Sale s Searc h Owne r EASTE R PATRICI AL 670 3 MINN E LUS ABLV D OMAH AN E 68112-000 0 Propert yInformatio n Ke yNumber : 505 4 000 2 1 7 Accoun t Type : Residentia l Parce l Number : 175054000 2 Piarce l Address : 670 3 MINN E LUSAB D OMAH AN E 68112-000 0 Lega l Description : MINN E LUS ALO T1 4 BLOC K1 1 LOT S 1 3 & 1 4 MINNI E LUS AAD D BL K1 1 Valu e Informatio n Lan d Improvemen t Tota l 200 9 

### $8,900.0 0 $83,100.0 0 $92,000.0 0 200 8 $8,900.0 0 $83,100.0 0 $92,000.0 0 200 7 $8,900.0 0 $83,900.0 0 $92,800.0 0 200 6 $8,900.0 0 $83,900.0 0 $92,800.0 0 200 5 $8,900.0 0 $83,900.0 0 $92,800.0 0 200 4 $8,900.0 0 $67,800.0 0 $76,700.0 0 Sale s Informatio n Sale s Date : 2004-07-2 4 Dieee fType : W D Book : 200 4 Page : 12904 0

Price : $100,000.0 0 Grantor : Mari o TWhit e eta l Grantee : Patrici a L Easte r Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0. 0 0. 0 1. 0 120. 0 105. 0 N o Improvement Informatio n 

## http://douglasne.mapping-onlihe.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl..
. 12/31/2009

### -Dougla s County Accoun t Infqs|wtio n Pag e 2 of 2 ttaj^l i 

# 0

Buildin g 1

670 3 Mim e Lusa Blvd 2 5lor y 

## U!^ ^ i t jffifif % ^, \ "WS^T '

CLIC KT O ENLARG E IMAG E Squar e Footage : i 1711. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Averag e 

### Condition : Buil t As : 2 Stor y Cond o Squar e Footage : 0. 0

HVAC : Centra l Ai rt o Ai r Rooms : 6. 0 Exterior : ; Masonr yCommo n Bricl < Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 3. 0

Roo fType : Gabl e Stories : 2. 0 Floorcover : ; Allowanc e Foundation : Bloc k 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 5 0 0 % 192 5 8 4 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Applianc e Fireplac e Masonr y 1. 0 Basemen t Bsmn t Blocl < 8 f t 768. 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 Garag e Detache d 361. 0 Porc h Sla b Roo fCeilin g 70. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl.
. . 12/31/200 9

### Pag e 1 of 2

" > [ Create Artothei^Tjcket ^

| ^ _BgckJo^lrt h jpteme t
. ] ; I ^en d Emai l ]


### YOU RTICKE T NUMBE RI S 2458435
. Origina l Cal l Date : 4/08/1 0 Time : 6:3 1 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 4/13/1 0 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 670 3 Street : MINN E LUS ABLV D Twp : 16 NRng : 13 E Sect-Qtr : 33-N 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 : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MAGELLANMETR O MUDO l OMAHACO F 0PPDGPR 5 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

X

* A/-C T T AX T MAGELLA NMIDSTREA M PARTNER S MAGELLA N^ p j^^^r^T , AU DEBORA H 

### Day : 918574709 8 Alt : Emerg : 918574709 8

METR O METR O COMM
. COLLEG E CHRI S 

### Day : 402457230 7 Alt : 402672703 3 Emerg : 402457231 3
MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y Day : 402504782 3 Alt : Emerg : 402504797 0
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 4/8/201 0

### Pag e 2 of 2

OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R 

### RICHATRAFFI C Day :

Alt : 402444719 7 402444516 1 Emerg : 402444516 0
0PPDGPR 5 OMAH APUBLI C POWE RDISTRIC T ELM LOCATIN G 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNNEI C QWES T LOCALNETWOR K ELM LOCATIN G 

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

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 4/8/201 0

# ^ As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e OLS# : 4014 5 Dat e Excavated : 4/13/201 0 Dat e USEP ASigne d Off : 6/24/201 0 Are a Sodden : 145 6 s a f t 

# los s Exteno rPain t NotthAno w1 Omah a Lea d S t e • Goo d Sit e Sketct i n Poo r Samplin a Address : 67o i MINN E LUS AB D 0 Not pain t

Lea d Sampl e Sample s Collecte d 1 Sampl e Numbe r LA B Conc e ntrati o n Collecte d Firm : FC ADB-A T RYASCPXA-401H 5 F 1 7 0 .pp m ^ D Date : h-3-0 ^ RYBSCPXA.4 0 1H 5 F 2 7 5 pp m ^ Time : 11 : S o A M 

# n RYCSCPXA-40m 5 B 1 .pp m m , 1^ 1 Sample s Analyze d 1 RYDSCPXA-4 0 IH i B 2 .pp m M D 1 1 ^ RDZSCPXA-40l^ i D Z .pp m 1 3 D XR F Unit : 109(o2
. Book : 2 H 1 .pp m n D Date : (B-7.O,
. O^ t n i 7 D .pp m D Time : ?r*-
. D Staff : MS W Numtte ro f Sample s = | 5 1 

# o l Legend : F l = Fron t Lef L F 2 = Fron t Right , 8 1 = Bac k Left
. 8 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla ' At ! quadrant s ar e a s viewe d rt) ^ ••^

e st^ee * racin g p^ope ^



### Legen d Concret e Dri p Zon e Excavatie d Quadrant s Excavate d Are a replace d wit h So d Are areplace dwit h Rock/hfulc h Are aleft bar e 

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

# a * Hon s Omah a Lea d Sit e Exterio rPain t Nort h Arro w 

### Sit e Sketc h •Goo d 

# © •Poo r Samplin g Address : 67o3_MlNN E LUS AB D 0 No t pain t Sampl e Numbe r Lea d Sampl e Sample s Collecte d 

# I I LA B Concentratio n Coiiecte d Fimi : FP APE > A T RYASCPXA-40iH i F 1 

### I d pp m 

# n Date : jj-S-O ^ RYBSCPXA-4 0 \^<
. F 2 

## 7 5 pp m 

## D Time : 1 1 •S o A/ ^ RYCSCPXA-40m 5 B 1 pp m 

# n Sample s Analyze d RYDSCPXA-4 0 IH i B 2 pp m 

## D RDZSCPXA-40 1 ^c
. D Z 

## ^ 5 ^ pp m 

## D XR F Unit : lOfib l Book : 2 H ) RQZOCPXA-4017 9 S i pp m 

## D D Dat e 

### 4* • 2 ^ • g> ^ nPZ6CPXA-4017 0 P2 - pp m 

## D D Tim e 

### i:=a
_ Staff : Numbe ro fSample s = | ^ \ \ Q 

# t^^ w Legend : F l = Fron t Left , F 2 = Fron t Right , B 1 = Bac k Left , B 2 = Bac k Righ t DZ = Dri p Zone , G Z = Garden , P Z = Pla ; Al l quadrant s ar e a s viewe d fro m th e street , facin g property



### fclMMiMHE Ll6^
. B i 

# -z
70
. .15. i 

# e

.F.j
. 

# fz
.

i iJkAe i i:«>-Nov-rif! 

### -l^ ' \VAt ^ 

## I 

# t MlN.Ne.U;^A.EP , 

# Q
±

^

1144701.01.1 3

### ^0\1 S Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e • Goo d 

### Sit e Sketc h n Poo r Samplin g Address : 67o^ MINN E LUS AB D 0 No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : FP ADBA J RYASCPXA-401H S F l _pp m 

## D Date : In-Z-O^ RYBSCPXA-4 0 IH3 F 2 

### 7 5 

## D Time : W-S o A/> ^

_

pp m RYCSCPXA-40m 3 8 1 

# i q 1 pp m 

## D Sample s Analyze d RYDSCPXA-4 0 IH5 B 2 - 7 l ^

_pp m 

# n 

# i

RDZSCPXA-40 1 i^ i D Z ^5 ^ pp m 

# a XR F Unit : lOfib?
. Book : Z H ) RQZOCnXA-4017 9 S S pp m Date : & • 2 ^ •g<s > 

## D D

— F»PZeCPXA4017 0 P2 - pp m 

## D Time : ?r> ^ 

# n Staff : 

### I^^ W Numbe ro fSample s = | ^ [ | Q Legend : F 1 = Fron t Left , F 2 = Fron t Right , B l = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla'
. Al l quadrant s ar e a s viewe d fro m fh e street , facin g propert y

• >



## .F l 

# f i 

# s 0 M^AtJ ^

^ ::5 & MIKNELW^ A 

## RP , Re\-2TM:) 8 Created : i:i6-No%

- 1144701.01.2 3

## ion s Omah a Lea d Sit e Exteno rPain t NoithAm w Sit e Sketcl i •Goo d n Poo r Samplin g Address : 67<O^MINN E LUS A so ^ No t pain t Sampl e Numbe r Lead Sampl e Sample s Collecte d 

# I t LA B Concentratio n Collecte d Firm : FDf t DRA T RYASCPXA-40iH i Fl JJC L .pp m 

## n Date : fc-g-O^ RYBSCPXA-40 IH 5 F2 

### JLS - .pp m 

## n Time : 11 - gp A M RYCSCPXA-40l\S Bl pp m D 

## AL Sample s Analyze d RYDSCPXA-40 l<i $ B2 pp m D RDZSCPXA-40 1 HS DZ 

## .iSi L .pp m D XR F UnK: IDflLT
. Book : 2M I rtOZOOPX A4017 0 6£ pp m D 

### D Date : &-20iO< ^ riPZOOPX A40170 P2 - D pp m 

### D Time : 

## _aa

_ Staff : 

### MS W Numbe r ofSample s «= | S I | Q | Legend : F1 = Fron t Left , F2 ••Fron t Right , Bl = Bac k Utt
. B2 » Bac k Righ t DZ " Dri p Zone , GZ - Garden , PZ - Pia ; Ad QuftdrBfit s OT 88 vtowBd from ttw street , todno propert y

Kevldt X Crated : 06-Kov4 8

### .•^^^ir^v *
COASTA l fNVIIOHHIItTA I C B 0 t l rI h C 

## Consen t fc F Acces s T o Propertj ^ 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 : ^ ^

^ ^
Owner' s Name : Daytim e Phone :

Addres s o fPropert y covere d b ythi s 

# ^7^ ^ y^m e ^^^S> ^ B O Agreement : PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP Ai s requestin g acces s t o collec t soi l sample s an d remov e soi l tha t contain s elevate d concentration s o flea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t o remov e contaminate d soil
. Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o its origina l condition
. Thi s wor k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o fCoastal 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 from EP Atha t th e propert y ha s bee n remediated
. ENVIRONMENTA L RESPONS E ACTION S 

### Bysignin 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 reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e o fperforrtiin g th e work
. Thi s acces s shal l remai n i n effec t unti l th e wor k ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :

Pag e 1 o f2,•» —*»
. % V;rj*=fjr^' » COASTA L INriaONHIKTl l '<tp„oit ^ c n o U rI K C 

### cRemov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; e Remov e flowe rbulb sorplant s tha t th e Granto r orth e Grantor' s tenan t maywis h to save ; ( Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , as necessarysubsequen t to an initia l waterin g perio d byEPA ; cAbid e byhealt h an d safet yguidanc e provide d byEPA ; f Ifth e propert y is rented , assis t EP A in obtainin g tenan t approva l fo racces s to th e propert yto perfor m th e work
. 6 Allo wvideotapin g and/o rphotographin g ofth e property
. AGREEMEN TNO T TO INTERFER E 

### Th e Granto ragree s no tto interfer e ortampe rwit h an yofth e wor k activities , orwit h an y ofth e wor k done , orwit h th e equipment use d on hi s property , orto undertak e an y action s regardin g th e us e ofsai d propert ywhic h woul d ten d to endange rth e healt h or welfar e ofth e Grantee sorth e environment , orto allo wothers to us e th e propert y in 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 , at (402 ) 991-119 9
I gran t access to mypropertie s D i do no t gran t acces s to mypropertie s

sianatur ' ' Signatur e Dat e Signature e

Dat Date e

D I woul d lik e to be presen t durin g an ysamplin g tha t is required
.

Pag e 2 of2••• COASTA L • MVIRONHa M TAL O • O U P
. INC
. 

## Restoratio n Agreemen t The purpos e of thi s agreemen t i s to provide amutua l agreemen t a s to condition s of the propert y prior to remediationactivities
. Thi s will als o serve a s docimientationfo r the purpos e of assuring tha t restoration activitie s ar e completedto the satisfactionof th e propert y owne r an dthe UnitedState s Environmenta l ProtectionAgency (EPA)
.

Propert y ID : L | Q|\J ^ ^ Propert y Address : ^y^- ^ ^/HMi £Lu^ i Owner : >?^^^, ^ ^^^f^ ^ I Phone : ^ ^ ^^
. ^^ ^ /^^we^rg
. 5 ^ e>¥^ ^ O

nthe attacheddiagram(s ) indicat e area(s ) to excavate , surface structure s an dlandscapin g feature s an d acces s location(s ) to b e use dby 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 t i f necessary . 

## Item s t o b e Remove d b yth e Owne rbefor e Start o fRemediation : Th e removal , storage , disposal , and/o rretu m o fthes e Item s i s th e Owner' s responsibility
. Kem : 

## XfDKi( r Kem : Kem : Kem :


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

## won ^ Kem : Kem : Kem :

Pag e 1 of
.C O AS T AL • MVIHONHINTA L O • e U P
. INC
. 

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

## ^ o t 

## L 1 

# So o 

# — 

# ?2
. Kem : *
Kem : Kem :


## Landscap e Inventor y Ite m Quantit y Uni t Condition/Type/Specie s Pre-existing propert y area , Quadrants tha t wil l b e excavated , tha t 

# 52
. i s coveredwit hgrass . Numbe r of tree s > 2 inc h Eac h 

# 3 trun k

diamete r Nimibe r o f tree s <= 2 inc h Eac h trun k

diamete r 

# 5
Numbe r of Sprinkle r Zones , Control Valves , Eac h Timers , Heads , etc . 

# ^ A Attac hasketc ho f th e sprinkle r layout
. Numbe r of an dsize of eachgarden / flowe r bed Eac h area . 

# 'T^ Squar e Fee t Attac hasketc ho f relative size s an dlocations
. Agree dupo nvalue of plan t material s not t o b e replacedbv contractor . $ Not e thi s valu e wil l b e usedto issue aplan t 

### / voucher to th e property owner . Easemen t Area , t o b e 

# y-e.^s ^ (i^'^^ H excavated 

# it-' ) Eac h
Pag e 2 of
. 

# 7C OA S T AL • NVmONMa N T AL a a o u p , INC
.


### AddKlona l Comment s / Instructions : Th e cit yofOmah a ordinance s ma yprohib Kyo u fro m usin g dir t orgrave l area s on you rpropert y as driveway s orvehicl e parkin g areas . Th e Environmenta l Protectio n Agency(EPA ) ma y

be removin g an d replacin g soi l underlyin g a grave l ordir t are a on you rpropert ytha t yo u ma y

be usin g as a drivewa y orvehicl e parkin g area . Ifthi s is th e case , yo u shoul d understan d tha t thi s removin g an d replacin g ofsoi l doe s no t mea n tha t an yillega l drivewa yorparkin g are a on you r property Is mad e legal
. To th e contrary , yo u ma y

be cKe d byth e cit y Ifyo u us e a grave l ordir t are a as a drivewa y orparkin g area , no t wKhstandin g an yremova l orreplacemen t ofsoi l byth e EPA
. Ifyo u have an yquestio n abou t legalityofa certai n drivewa yorparkin g area , yo u ma ycontact th e cK yofOmaha' s Plannin g Departmen tat (402 ) 444-5150
. Q^eas e chec k thi s bo x Ifyo u understan d th e Informatio n outline d above
.
• Jj - \^2 ^ v>u ^ vi^n a Uf^^ ^ ST-w«^
.

^hec k th e bo x ifOwne rdoe s no t wan t CE G to documen t interio rfoundatio n wall s an d possibl e pre-existin g damage
. Bycheckin g thi s bo xCE G is no t responsibl e fo ran ydamag e don e to th e interio rpf<house , includin g foundatio n crack s orfissures
. 

### nIdo no t agre e

Owner' s Signatur e Dat e ' s Sienatur e Contractor' 

### s Signatur e Dat e 

### Pag e 3 of
.

### BVID # WDlHS " XR F PROPERT YSAMPL E SHEE T Date Projec t XR F ID# 

# :^-//>'/ o Omah a Lea d ARR A 

# 'y^>< ^ Addres s Sampl e tim e sampl e lengt h Sho t # Readin g Sampl e are a 

# s£ ^ Shot # 

# 5 ^ 

# mr Id^i^/' r //• h t - / - ^ Dept h 

# 7 ^ Averag e // g t / T Averag e

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

### Averag e Averag e

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

### Averag e Averag e
RETES TAREAS Shot #



### Averag e Signatur e 

# m^ l^fri^ ^ f^^0 ^ /n<•r^r^ ^

Lu ^ P> M am/p m 

### 30 se c Readin g Sampl >ampi e e

are a a 

# wr7 7 Dept h 

# V>^//: >
^ ^ ^ / O

Readin g Sampl e are a Dept h

Readin g Sampl e are a Dept h

Readin g Sampl e are a Dept h

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 38 5 Mod e SOI L Tim e 2010-05-1 0 12:1 7 Duratio n 90.3 4 Sequenc e Fina l Flag s AVERAG E -^Avq~O f 382T3O 4 ADDRES S "^70 3 Minn e lus a blv d QUADRAN T E A DEPT H 1 " TYP E CONFIRMATIO N INSPECTO R N
. LOPE Z

pp m Erro r M o < LO D 7.85 6 Z r 419.10 5 ± 14.97 6 S r 163.56 1 ± 8.64 4 U < LO D 14.68 4 R b 69.98 5 6.54 0 T h 11.64 2 -7.45 9 •118.39 1 It " "14.85 4 < LO D 5.43 8 A s < LO D 19.65 7 H g < LO D 12.25 0 Z n 147.78 4 20.95 8 W < LO D 84.05 1 C u 30.95 6 20.36 8 N

i < L O 75.08 2 C o < 174.02 0 Fe 175 0 377.38 6 M n 4' 94.28 1 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , 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
pp m M o < LO D Z r 421.20 5 S r 165.51 5 U < LO D R b 69.29 5 T h < LO D P b 119.96 4 S e < LO D A s < LO D H g < LO D Z n 155.24 5 W < LO D C u 36.67 7 N i < LO D C o < LO D F e 17687.79 9 M n 495.54 2 Supervise d By : 

## Certificat e o fVerificatio n

38 2 SOI L 2010-05-1 0 12:1 6 30.1 1 Fina l 4014 5 '670 3 Minn e lus a blv d E A 1 " CONFIRMATIO N N
. LOPE Z
Erro r : 7.76 6 ± 14.98 8 ± 8.68 4 • 15.05 0 ± 6.54 9

: 10.68 8 ± 14.93 6

I 5.57 5 : 19.67 5

• 11.55 6 ± 21.21 2 J 78.47 1 ± 20.68 3

I 74.10 7 * 175.20 6 ± 378.95 6 ± 93.74 2

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 38 3 Mod e SOI L Tim e 2010-05-1 0 12:1 7 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 4014 5 ADDRES S 670 3 Minn e lus a blv d QUADRAN T EA DEPT H TYP E 

## r CONFIRMATIO N INSPECTO R N
. LOPE Z
pp m Erro r M o < LO D : 7.93 4 Z r 418.36 3 ± 15.02 2 S r 165.88 5 ± 8.72 7 U < LO D : 14.46 8 R b 69.38 4 ± 6.51 2 T h 14.97 1 ± 7.80 8 P b 121.88 9 ± 15.08 7 S e < LO D 5.45 6 A s < LO D 19.89 7 H g < LO D 12.87 5 Z n 141.07 1 ± 20.78 7 

## w C u < LO D 38.75 7 : ± 88.42 5 21.01 0 N i < LO D : 73.44 8 C o < LO D : 175.12 0 F e 17869.05 5 ± 382.40 2 M n 502.70 0 ± 95.33 9 Supervise d By :

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 38 4 Mod e SOI L Tim e 2010-05-1 0 12:1 7 Duratio n 30.1 2 Sequenc e Fina l Flag s BVI D 4014 5 ADDRES S 670 3 Minn e lus a blv d QUADRAN T E A DEPT H 1 " TYP E CONFIRMATIO N INSPECTO R N
. LOPE Z
Erro r pp m M o < LO D I 7.86 8 Z r 417.74 8 ± 14.91 6 S r 159.28 4 ± 8.52 1 U < LO D : 14.53 4 R b 71.27 7 ± 6.56 0 T h 12.05 4 ± ' 7.44 3 P b 113.32 1 ± 14.53 9 S e < LO D 5.28 3 A s < LO D 19.40 0 H g < LO D 12.31 9 Z n 147.03 6 ± 20.87 5 < LO D 85.25 7 

## w

• C u < LO D 29.11 6 N i 104.62 1 ± 51.79 4 C o < LO D J 171.73 4 F e 16948.69 1 ± 370.80 0 M n 498.54 9 ± 93.76 3 Supervise d By :

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 38 1 Mod e SOI L Tim e 2010-05-1 0 12:1 4 Duratio n 90.6 5 Sequenc e Fina l Flag s AVERAG E ^^Avg75r378^ E ADDRES S 670 3 Minn e lus a blv d QUADRAN T B 2 DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N
. LOPE Z

pp m Erro r M o < LO D : 8.10 2 Z r 483.74 2 ± 16.06 2 S r 163.51 5 ± 8.72 5 U < LO D ; 14.87 8 R b 71.25 6 ± 6.64 5 T h 11.56 0 ± 6.82 4 

## r-pb
. S e - 45.554
. < LO D : _: 10:31 6 5.55 r A s 14.79 7 ± 9.54 9 H g < LO D : 12.67 5 Z n 99.54 9 ± 18.22 8 W < LO D 85.08 6 C u < LO D 30.41 8 N i < LO D 73.48 2 C o < LO D 193.85 0 F e 20929.83 0 ± 416.36 4 M n 609.38 5 ± 103.14 9 C r < LO D 307.28 6 V < LO D 653.91 5 T i < LO D ^^>­ — - 29rh.81 2 S c < LO D ^«-'^ : 195.05 4 C a K 

## < \.o\y 22135.82 6 : ±y 5«2.67 2 9326.94 4 S < LO D 306.81 1 

## y^^^ y * Supervise d By : y 

# y ^ ^ 

# r­

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 37 8 Mod e SOI L Tim e 2010-05-1 0 12:1 2 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 4014 5 ADDRES S 670 3 Minn e lus a blv d QUADRAN T 8 2 DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N
. LOPE Z

pp m Erro r M o < LO D 8.20 5 Z r 500.21 4 ± 16.36 3 S r 160.43 2 ± 8.68 4 U < LO D 14.78 8 R b 72.60 5 ± 6.70 9 T h 13.75 1 ± 7.04 0 P b 41.20 6 ± 10.02 8 S e < LO D 5.65 0 A s 19.64 9 ± 9.61 4 H g < LO D 12.83 0 Z n 109.74 7 . ± 19.08 5 W < LO D 89.26 1 C u < LO D 30.78 9 N i < LO D 75.34 3 C o < LO D 194.80 9 Fe 21168.51 8 ± 420.54 2 M n 606.97 7 ± 103.72 6 Supervise d By :

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 37 9 Mod e SOI L Tim e 2010-05-1 0 12:1 3 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 4014 5 ADDRES S 670 3 Minn e lus a blv d QUADRAN T B 2 DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N
. LOPE Z
Erro r pp m M o < LO D : 8.02 2 Z r 484.45 9 ± 16.02 7 S r 161.01 1 ± 8.64 4 U < LO D 14.28 1 • R b 67.07 1 ± 6.42 1 T h 12.22 0 ± 6.88 1 P b 48.91 2 ± 10.57 7 S e < LO D 5.42 9 A s < LO D 14.56 9 H g < LO D 12.07 8 Z n 94.98 2 ± 17.64 9 < LO D ', 77.62 7 

## w C u 31.43 4 ± 20.40 0 N i < LO D I 72.73 5 C o < LO D I 191.14 4 Fe 20759.70 5 ± 413.60 9 M n 546.06 2 ± 99.24 6 Supervise d By :

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 38 0 Mod e SOI L Tim e 2010-05-1 0 12:1 4 Duratio n 30.4 3 Sequenc e Fina l Flag s BVI D 4014 5 ADDRES S 670 3 Minn e lus a blv d QUADRAN T B 2 DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N
. LOPE Z

pp m Erro r M o < LO D ; 8.07 9 Z r 466.55 3 ± 15.79 5 S r 169.10 1 ± 8.84 6 U < LO D : 15.56 5 R b 74.09 2 ± 6.80 4 T h < LO D I 9.83 0 P b 46.54 4 ± 10.34 2 S e < LO D 5.57 4 A s < LO D 13.98 1 H g < LO D 13.11 8 Z n 93.91 8 ± 17.94 9 W < LO D 88.36 9 C u < LO D 29.86 7 N i < LO D 72.36 9 C o 215.06 6 ± 130.39 8 F e 20861.27 3 ± 414.94 1 M n 675.11 8 ± 106.47 4 C r < LO D 305.57 2 V < LO D 773.26 6 T i < LO D 3067.66 2 S c < LO D 265.72 9 C a 10767.67 0 ± 4915.82 5 K 18931.42 6 ± 8907.05 3 S < LO D 330.69 1 Supervise d By :

### .'^*!1^^>
. 

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

I Coasta l Environmenta l Grou p Inc
. v i V*^^! ^

www.coastalhazmat.co m ^ ^ ^'•iPno^'' ^ COASTA L C 1 0 U P
. IH C 

# EXECUTIV ESUMMARY : BVID #40145-(670 3 MINNELUS ABLVD ) No Issue s o r Concern s [~ | Issues/Concern s Detail Explanation : DA NGARVE Y WALKE D TH EPROPERT Y O N6/24/1 0

# SEPA • 

# EP APropert y Clos e Ou t For m 

# Lno 3 ^^^.^t>X_iIS(K6\vci Property# : ^0/^5L
. Propert y Address: * - Date/Time : . Owner' s Name:
. ^ Contracto r Grou p Quad s Excavated : Ye s N o Eicavatto nGenera l I
. If necessvy , were th e coirec t quadTant(s ) excavate dandrestored ? / 2
. If necessary , were th e correc l area s o f drip zone excavate dandrestored ? Gradin c So dan dVeselatio n 

### Yes N o I
. Doe s the gradin g aroun dth e perimeter ofth e hous e i nexcavate darea s generally slop e awa y 

## y fromth e house ? 2
. Ha s so dbee nlai dinal l area s tha t were excavated ? 

## y 3
. Doe s th e sodappear t

o b e generally healthy an dgrowing ? (Onl y evaluate if inspecteda t a3 0 

## y day time period ) 4
. Ar e soddedarea s generally Hr man devenly graded ? 

### / S
. Ar e di e joint s betwee nth e so dstrip s generally tight ? (Only evaluate if inspecte da t a3 0 da y 

### / tim e period) 6
. Wa s di e propert y grade dsuchtha t water will not poo l o nth e propeny ? 

## y 7
. Wa s danug e t o landscapin g o r plan t material s avoided ? 

## y Gates , Fence s aa dRetainla g Wall s Ye s N o 1
. D o gate s ope nandclos e freely? (tfapplicable ) 

### y 2
. Wer e al l gate s o r fence s takendow ndurin g restoratio nactivitie s reinstalled ? (Ifapplicable ) 

### y 3
. Wa s danug e t o gate s or fence s avoided ? (Ifapplicable ) 

### y 4
. Wa s danug e l o retainin g wall s avoided ? (Ifapplicable ) 

### y Fouodadon , SidlnKan dGutter s 

### Ye s N o t . Wa s damage t o th e sidin g o r tri mavoided ? 

## y 2
. Wa s damag e t o the foundationavoided ? 

### y 3
. Wa s damag e t o window s avoided ? 

# y 4
. Wa s damag e to window s or doo r screen s avoided ? 

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

### • Sidewalk s an dDriveway s (Concrete ) Ye s N o 1
. Wa s damag e l o drivewa y surface s avoided ? / 2
. Wa s damage t o walkwa y surface s avoided ? /^ 

## Owner s comments :

Inspectio nnotes :

Remova l an dreslorationaclivale s complete including the 30-da y so dwarranty : EP ARepresentativ e jQ^3 ^ Date : g/sy/ic ^

## Propert yCompletio n Agreemen t Thi s agreemen t documenl s lh e completio no t remedial acliviue s perloime do nm y properl y M y signalui e will designat e ihai I a msalisfie dwit hth e restoraiio no f m y propeily
. an dIha l n o item s ar e i n queslions
. now , o r a l an y lime i nth e future , excep t Ihos e ilem s liste dbelow , if an y PropertylD : ^ 0 / <

^ S " Prope r ( y Address : 

## C.n0 3 (Y\,i.r.^
. UJS( K 

## felvH. Ownc r 

## 'i^rx\rc\'cAtK
. ^c.^Vj2, r Phoiie : 

## S"t2 » '^^f,f ^ Restoratio n Item s i n Question :

Item : 

## hr/)ii3 Afi j O/tAc
. 

# f^ ^ 

# I ^ 

# p^h^,%

- ^^m^Dip c Item : ivia. i I • u u Item : Item : Item : Item : Additiona l Comments : 

# ) S 1 8grc cI c.ftorolio n Kcompleted , excep t a s nofei t d o no t a|;re crestoratio n i s complete d 

## y^i ^ Owner' s Signatiir r Dat e Cont i arlor' s Sicnnlnr cDal e• • 

# Propert y Owne r Assessmen t o f Performanc e For m America nRecover y an dReinvestment Act (ARRA) RECEIVFT I OmahaLeadSuperfundSit e 2009/201 0 JU N2 8 201 0 Remediatio nContractor : Coasta l Environmenta l Grou p - EP-R7-09-ffP^^^^^^^^^^^ ^ DIVISIO N Propert y Identifie r Number ; ^ 0 / ^ ^ Propert y Address : l O 'H ) g? , /^t C t^tl € Propert y Owner' s Name : YOXkjCyjJ!* ^ (^!^
. Instruction s t o tli e Propert v Owner : Thi s for mserve s to recor dth e Propert y Owner' s assessment o f perfonnanc e (Incentiv e 1

- Quality Assuranc e Siuvdllanc e Flan ) involvin g th e liste dremediatio ncontractor , a s applicabl e to th e Omah aLea dSite
. Thi s formdocument s th e timelines s o f punchlis t resolution , busines s relations , complaint resolutio nan dth e overal l qualit y o f work
. I f needbe , the Propert y Owne r may utiliz e thi s for mto recor dproblem s and/o r issue s no t specifically tie dto a nassigne d address , for example , busines s relation s that generally don' t follo w the guideline s set fort hinthe Pofbrmanc e Wor k

Statement
. Th e Propert y Owne r will indicat e his/her assessment o f perfonnanc 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 ninnerica l defuiition s fVo m the ratin g scal e below , thensign& date th e form
. 9-1 0 "excellent " Q ^ 'Ver y good " 5- 6 "acceptable " 3- 4 "poor " 1-

2 "ver y poor " Propert v Owner^ s Assessmen t o f Performanc e Regardin g th e Contractor' s Wor k 1 0 5 ^ 

### Propert v Owne r Additiona l Comment s from(optional ; contJBu e o nbac k pag e if needed )
Propert y Owne r Signatu