## TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAI D # : ^f n^?i U .Date : iZ/fO/l D Address : Ll?) \Floffin^^j ^ ^ d RemediationContractor : Coastal Environmenta l Group

_Year : 2010ARR A SOI LREMEDIATIO N PROPERT Y FIL EFOLDERDOCUMENT S • ^ Video of propert y (DVD ) B ^ Executive Summar y
• EPA-providedpropert y sketc h B Signe dAcces s Agreemen t fo r subjec t propert y fl~ Signe dAcces s Agreement(s ) fo r adjacen t propert y M Restoratio nAgreemen t TTSettlemen t document s (i.e. , fo r damag eo r t o replac eplants , etc. ) \S ^ Confirmatio ndat a aPhotograph s M As-buil t sketc h M Satisfactor y restoratio nsigne db y Propert y Owne r ^ Propert y close-ou t chec k lis t signe db y EP A

- &Descriptio no f area s no t meetin g RO D cleanu p criteri a B ^ Utilit y clearance s "s

TPropert y informatio nfromDougla s Coimt y Assessor' s Offic e D D
signatur e^ T Dat e 3021777 8 

# mil l Superfun d

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## Propert yAcces s Checklis t Propert y ID : q^^ ^ D WORK STARTE D ON : / / Propert y Address : ^- ^ 3 1 n^^f^.^r o PS D D WORKCOMPELTE D ON : / / Renter : 

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# 5 P Fax : Cell/Pager : Phone : Additional Information : 

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nNotificatio nLette r Sent : / / By : 

### Acces s Agreement Signed : O S / S M / l

O By : M>c» c 

### Q Restoratio nAgreement Signed : O T / ^

M / V

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### D Topsoi l SampUn g (i f applicable ) / / By : 

### Q Disposa l Samplin g (i f applicable ) By : " /

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### D Garde nSampling (i f applicable ) / / By : 

### H Utilit y Clearanc e CaUed:aSL/_2fe/_iQ . By = OT/^9./, O 

### w«i u Q Video/Photo s (Before) On : o^ l :iM/ 1 0 By : Vi«..W^ 

### D Video/Photo s (During ) On : / / 

### By : nVideo/Photo s (After) On : / / 

### By : nVideo/Photo s (30-Day ) On : / / 

### By : nPropert y Completio nAgreement Siened : / / 

### By : D Fina l Report Issued : / / 

### By : Air Monitorin g (a s applicable ) D Communit y Q Crew On : / / By : Results : O Communit y O Cre w On : / / By : Results : nCommunit y [U Cre w On : / / By : Results :
Omah a Lea d Sit e

## Dougla s Count y Accoun t Injumatio n Pag e 1 of 2 ijum s Dougla s County , Nebrask a Propeit yRecor d - R194736000 0 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 - VIe W O n Ma p Informatio n i s vali d a s o f 2009-1 1 -1 9 Treasurer' s Ta xRepor t Ne wFeatur e ->->- • Aut o Sale s Searc h Owne r LIES TJAME S K 673 1 FLORENC E BLV D OMAH AN E 68112-000 0 Propert yInformatio n Ke yNumber : 473 6 000 0 1 9 Accoun t Type : Residentia l Parce l Number : 194736000 0 Parce l Address : 673 1 FLORENC E B D OMAH AN E 68112-000 0 Lega l Description : PARKWOO D LO T1 9 BLOC K1 W14 0 FTLO T1 8 & W 14 0 FTN 1/ 2 66.0 6 X 14 0 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $7,600.0 0 $54,300.0 0 $61,900.0 0 200 8 $7,600.0 0 $54,300.0 0 

### $61,900.0 0 200 7 $7,600.0 0 $51,000.0 0 $58,600.0 0 200 6 $7,600.0 0 

### $51,000.0 0 $58,600.0 0 200 5 $7,600.0 0 

### $51,000.0 0 $58,600.0 0 200 4 $7,600.0 0 $51,800.0 0 $59,400.0 0 Sale s Informatio n Sale s Date : 

### 1997-08-2 8 Dee d Type : Book : 207 8 Page : n o Price : $46,000.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 

### 0.2 1 9240. 0 

### 1.0 140. 0 66. 0 

### N o Improvemen t Informatio n 

## http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=Rl.. . 11/25/2009n^sm z 

### Dougla s County Accoun t IiAjpiatio n Pag e 2 of 2
Buildin g 1

«73 1 FLOREhlC E B D

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. • 7M.D»q. « s o 21 «

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.
CLIC KTO ENLARG E IMAG E Squar e Footage : 1480. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : • Averag e Uni t Type : 

### Condition : Fai r

Buil t As : 2 Stor y Cond o Squar e Footage : 0. 0 HVAC : i Force d Ai r Rooms : 10. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : ' Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Gabl e Stories : 1. 5 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 191 5 0 % 191 5 9 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 Bloc k 8 ft 764. 0 Basemen t Fai rFinis h 60. 0 Fixtur e Bas e Fixture s 1. 0 1. 0 Fixtur e Bat h Ful l Garag e Detache d 324. 0 Porc h En d Scree n 184. 0 Porc h Sla b RoofCeilin g 30. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl. . . 11/25/200 9

## Pag e 1 of 2 "> Creat e Anothe rTicke t Bac kto Irt h Interne t [i_^Sen d Emai l ] 

## YOU RTICKE T NUMBERIS 2503445 . Origina l Cal l Date : 5/26/1 0 Time : 11:2 6 am Op : ELIZABETH1879 0 Wor k to Begi n Date : 5/28/1 0 Time : 12:0 0 pm State : NE Covuity : DOUGLA S Place : OMAH A Address : 673 1 Street : FLORENC E BLV D Twp : 16 NRng : 13 E Sect-Qtr : 27-SW,34-N W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e of Work : LEA D REMEDIATIO N Locatio n of Work : LOCAT E ENTIR E PROPERTY , AL L EASEMENT S AN D TO TH E PEDESTA L Remarks : FAX AL L CLEAR S TO : (877)662-421 1 : UNSUR E IF CORNE R LOT . Compan y: COASTA L ENVIRONMENTA L SERVIC E Contact Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : COASTA L Dept h of Excavation : 4 FT Come r Lot : N Front : Y Rear : Involve s Tunnelin g or Horizonta l Borin g : N Explosives : N CXCAT V MAGELLANMCINE B MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a 

### Contac t Phon e Number Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEID 

### I 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
MAGELLA N MAGELLA NMIDSTREA M PARTNER S LP 

### DEBORA H 

### Day : 918574709 8 Alt : Emerg : 918574709 8
MCINE B MC I 

### NO CALLPE R MEM O 

### Day : 800289342 7 Alt : Emerg : 800289342 7
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.. , 5/26/201 0

### Pag e 2 of 2

OMAHACO FCIT Y O FOMAHA-TRAFFIC.SEAVE RRICH/TRAFFI C 

### Day : 402444719 7

Alt : 402444516 1 

### Emerg : 402444516 0 0PPDGPR5 OMAH A PUBLI C POWE RDISTRIC T EL M LOCATIN G 

### Day :

Alt : 

### 406728934 3 406207149 4 

### Emerg : 888728934 3 QLNNEIC QWES T LOCA LNETWOR K

EL M LOCATIN G 

### Day : 406728934 3

Alt : 406207149 4 

### Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 5/26/201 0

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# Remot e ID : Rpag e o f
;o> t 3 44 8 O K74103
. 4-709 8 4-746 6 >1 1 ow i n g OneCa l Tykgenc ydi g .-ton : COASTA L ENVIRONMENTA L -t i clcet s SERVIC E csi l 1 e d -i n by : imbei" : 877662421 1 Number- : 877662421 0 . t e : d : 2 010/05/ 2 65283 9 6
>e CLEA R o- f under-gr-oun d -Pac i Ti t- i e s -For- : MAGELLA N PIPELIN E T - i cke- t Number - Ex-csiveitor - Con-ta.c:- t Di g Addr-es s 2 50344 5 ELIZABET H [^67^3 7 FLORENC E BLVDj ] I ba.v e st.rt yques-t i on s . plesLs e con-tsic- t Msige l ~1 a. n OneCa. ! 1 a.- t 918/574—709 8OLS# : 4053 0 

# ^ As-Buil t Drawin g Dat e Excavated:6/171 0 Dat e USEP ASigne d Off : 7/8/1 0 COASTA L tHVinOHMCHTA L Are a Sodden : 45 0 s q f t 

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O U P
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.

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Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are areplace dwit h Are a replace d wit h 

# • Are a lef t bar e So d Rock/Mulc h 

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

# 1^ , 0 ^ . C^er. ^ Name ; J4^\S & ^i^za r Address : < ? -

7 3 / f^toAe^^ i £>i > Phone : fvo ) ^r> ~ ?fS^i % Omah a Lea d Sit e Sit e Sketc h Date : Time : (d/y/o^ i Nort h Arro w ^ ^ Tea m /•)u}£^/rj2/fzi ! /^g* ^ Sampl e Numbe r
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## V :> ' ENVIROHHIKTA l

*<«
. PM'*^ ' c• 0 u rIN C 

## Consen t fo rAcces s T o Propert y RIGH TO F ENTRYTO PREMISE S 

## Granto r(th e propert yowner ) consents 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 : „ , ^ _ Owner' s Name : Daytim e Phone : y/p2
. ^f l S'S^O ^

Addres s o fPropert y covere d b ythi s 

# U)~ib \

V\actno u B D 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 that contain s elevate d concentration s of lea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l be excavate d t o remove 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 Lead Superfun d Site remediatio n program . Arepresentative o f Coasta 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 perfonmed , th e Granto rwil l have a n opportunit yt o reviewan d approve th e planne d soi l removal , an d restoratio n wor k before i t begins
. Once th e wor k i s finished , th e Granto rwil l b e aske d t o reviewth e work an d confim i tha t i t i s complet e an d meets wit h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receive vtn-itte n documentatio n fro m EP Athat th e propert y 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 , at al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e of performin g th e work
. Thi s acces s shal l remai n i n effect unti l th e wor k has bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :
Pag e 1 o f2> —* * COASTA L INriKONHtltT/t t C « 0 U rt KC 

### 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 ; cWate ran d maintai n replacemen t vegetation , Includin g fertilize rapplication , a s necessarysubsequen t t o a n initia l waterin g perio d b yEPA ; cAbid e b yhealt h an d safet yguidanc e provide d b yEPA ; •I f th e propert yi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propert yt o perfor m th e work
. >^

Allo wvideotapin g and/o rphotographin g o f th 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 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 . Should yo u hav e an yquestion s abou t thi s program , pleas e contac t Coasta l Environmenta l Group , a t (402 ) 991-119 9
^

I gran t access t o m ypropertie s D I d o not gran t acces s t o m ypropertie s

Dat e / Signatur e Dat e
DI woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.

Pag e 2 o f 2

### x ^

C O AS T AL • NVmONHS M TAL O I I O U r. INC
. 

## Restoratio n Agreemen t The purpos e of thi s agreemen t i s to 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 of assuring tha t restoration activitie s ar e completedto the satisfactionof the propert y owne r an dthe UnitedState s Enviroimienta l ProtectionAgency (EPA) .

Propert y ID : L\(y^g,( ^ PropertyAddressrYg-l^ y p^^^^p ^ 6 Q Owner ; ^a|V^g^ ^ \A9:s V 

## Phone ; l^^l ^ L f

g-^ f

/^-^J " Onthe attacheddiagram(s ) indicat e area(s ) to excavate , surface structure s an dlandscapin g feature s an d acces s location(s ) t o b e usedby the contractors . Lidicat 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 if necessary . 

## Item s t o b e Remove d b yth e Owne rbefor e Start o f Remediation : Th e removal , storage , disposal , and/o rretur n o f thes e item s i s th e Owner' s responsibility
. ttem : ' ^ ^ ^ ^ ttem : item : ttem :


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

# 5"^ ^ / / 

# ^k A 

# h I c 

# f f ich' ' 1^( 3 Kem : 

### j J Kem : Kem :

Pag e 

## io f 

# 5

### ^" ^

C O AS TAI
. • NVmONMENTA L GROUP , INC
. 

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

# '^^.D ^ ttem : ( 

# 5 ^c i 

# -^^ ; 

# Q ^ - Kem : Item : 

## Landscap e Inventory Ite m Quantit y Uni t Condition/Type/Specie s Pre-existin g propert y area , C/-£y|/- ^ Quadrant s that wil l b e excavated , that i s covere dwithgrass . Numbe r o f tree s > 2 inc h Eac h 

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

### / Numbe r o f Sprinkle r Zones , Contro l Valves , Eac h 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 Eac h area . Squar e Fee t 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 will 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 Eac h excavate d 

# J pm^ ^ Nc^^ ^ Pag e 2 

# M 7COASTA L


### AddKiona 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 fthi s i s th e case , yo u shoul d understan d thsr 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 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 have an yquestio n abou t tegatityo f a certai n drivewa yo rparkin g area , yo u ma ycontac t th e cK yo 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
. 

# tyc c ^ ^ i o 1 j j e, ^ ' n

G 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
. 

### ^ 1 agre e dI d o no t agre e
Ow6£r' s Signatur e Date Contractor' s Signatur e Date Page s ^ ^

## BVID#M(QSQ
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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 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

123 1 SOI L 2010-06-2 3 12:5 4 91.4 7 Fina l lor^ r E A 1 " N
. LOPE Z confirmatio n non e

# 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 75.51 3 Supervise d By : 

## Certificat e o f Verificatio n

122 8 SOI L 2010-06-2 3 12:5 2 30.5 0 Fina l 4053 0 673 1 Florenc e blv d E A 1 " N
. LOPE Z confirmatio n non e

± Erro r ± 13.72 6

# 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 122 9 Mod e SOI L Tim e 2010-06-2 3 12:5 3 Duratio n 30.4 8 Sequenc e Fina l Flag s BVI D 4053 0 ADDRES S 673 1 Florenc e blv d QUADRAN T E A DEPH T 1 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e
pp m ±Erro r P b 86.82 2 ±14.45 6 Supervise d By :

# 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 123 0 Mod e SOI L Tim e 2010-06-2 3 12:5 4 Duratio n 30.4 9 Sequenc e Fina l Flag s BVI D 4053 0 ADDRES S 673 1 Florenc e blv d QUADRAN T E A DEPH T 1 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e
pp m ±Erro r P b 89.78 5 ±14.55 9 Supervise d By :

# 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 124 3 Mod e SOI L Tim e 2010-06-2 3 13:0 2 Duratio n 91.1 9 Sequenc e Fina l Flag s AVERAG E t:Avg^^^:i2?teiJ235 ^ ADDRES S 673 1 Florenc e blv d QUADRAN T D Z DEPH T 13 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e

Supervise d By :

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E
pp m P b 74.16 1 Supervise d By : 

## Certificat e o f Verificatio n

124 0 SOI L 2010-06-2 3 13:0 1 30.5 2 Fina l 4053 0 673 1 Florenc e blv d D Z 13 " N
. LOPE Z confirmatio n non e

± Erro r ± 13.95 3

# 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-3902 2 Readin g N o 124 1 Mod e SOI L Tim e 2010-06-2 3 13:0 1 Duratio n 30.5 7 Sequenc e Fina l Flag s BVI D 4053 0 ADDRES S 673 1 Florenc e blv d 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 74.96 5 ±14.01 0 Supervise d By :

# 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 124 2 Mod e SOI L Tim e 2010-06-2 3 13:0 2 Duratio n 30.1 0 Sequenc e Fina l Flag s BVI D 4053 0 ADDRES S 673 1 Florenc e blv d 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 80.05 6 ±16.16 8 Supervise d By :

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

Supervise d B y 

## Certificat e o f Verificatio n

124 7 SOI L 2010-06-2 3 13:0 5 92.0 1 Fina l 3rt244- l 673r?iorenc e flv d G Z 8 " N
. LOPE Z confirmatio n non e

# 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 196.80 3 Supervise d By : 

## Certificat e o f Verificatio n

124 4 SOI L 2010-06-2 3 13:0 4 30.5 6 Fina l 4053 0 673 1 Florenc e blv d G Z 8 " N
. LOPE Z confirmatio n non e

± Erro r ± 20.09 7

# 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-3902 2 Readin g N o 124 5 Mod e SOI L Tim e 2010-06-2 3 13:0 4 Duratio n 30.9 0 Sequenc e Fina l Flag s BVI D 4053 0 ADDRES S 673 1 Florenc e blv d QUADRAN T G Z DEPH T 8 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e
pp m Erro r P b 187.24 1 ± 19.42 7 Supervise d By :

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

## Certificat e o f Verificatio n XL3t-3902 2 Readin g N o 124 6 Mod e SOI L Tim e 2010-06-2 3 13:0 5 Duratio n 30.5 5 Sequenc e Fina l Flag s BVI D 4053 0 ADDRES S 673 1 Florenc e blv d QUADRAN T G Z DEPH T 8 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e
pp m Erro r P b 211.46 9 ± 20.69 2 Supervise d By :

## iyjOL \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 I J^^^ l I Coasta l Environmenta l Grou p Inc
. 

## S!^^j ^ www.c0astaiha2mat.co m ^^tpno^*" ^ COASTA L C n o U p . I I I c 

# EXECUTIV ESUMMARY : BVID #40530-(673 1 FLORENC EBLVD ) No Issue s o r Concern s Q Issues/Concern s Detail Explanation : -DA NGARVE Y WALKE D TH EPROPERT Y O N7/8/201 0

### tf% 

## EP A Propert y Clos e Ou t For m Propert y # : M053 Q Propert y Address:, , DateHlme : Owner' s Nanc : Quad s Excavated : Contracto r Grou p CjnQS\Ct 

# 1

Excavatio nGeaera l 1 .

I f necessuy , wer e th e correc t quadrant(s ) excavate dan drestored ? 2 .I f necessary , wer e th e conrc l area s o f dri p zon e excavate dao drestored ? Gmdio K So dan dVcucUtki B 1 .Doe s th e gradin g aroun dth e perimete r o f th e hous e i nexcavate darea s generall y slop e away fromth e house ? 2 .Ha s so dbee nlai di nal l area s tha t wer e excavated ? 3 .Doe s th e w dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e if inspecte da t a3 0 da y tim e period ) 4 .Ar e sodde darea s generall y firman 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 tim e period ) 6 .Wa s th e property grade dsuc hthat wate r wil l no t poo l onth e property' ' 7 .

Wa s danug e t o landscapin g o r plan t material s avoided ? Gates . Fence s an dRetainin g Wall s 

# r i .D o gate s ope nan dcio.s e fively? (I f applicable ) 2 .Wer e al l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (I f applicable ) 3 .Wa s damag e t o gate s o r fence s avoided ? (Ifappiicable ) 1 .

Wa s damag e t o reuining wall s avoided ? (Ifappiicable ) Foundation , Sidin g an dGnller * 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 l o window s avoided ? A Wa s damag e t o window s o r doo r screen s avoided ? Wa s damag e i o downspout s o r downspou l extension s avoided ? Sidewalk s an dDriveway s (Concrete ) I • Wa s damag e t o drivewa y surface s avoided ? 2 .Wa s damag e t o walkwa y surface s avoided ? Ye s N o 

### ^ Yes N o • / ^ ^ ^ / 

## y Vc s N o 

### ^ .y

^ •

^ 

### ^ Ye s N o 

## y ^ 

# 7
Ye s N o 

### / ' y

## Ort'Der s comments :

[Jn.'ipectio nno<es :

Removal andresloratio naclivale s complete includin g ihe 30-da y so dwarranry : EP A Representativ e A^^i U Date : 7/p/, o

## Propert yCompletio n Agreemen t riii s agreeme m documenl s lli e completio n o l remedia l activitie s perloime d o n myproperl yM ysignature wil l designat e tha t I a m satisfie d wit h Ih e restoralio n o fm ypropeily
. an d tha t n o item s ar e i n questions , now . o ra i an ylim e i n th e future , excep l Ihos e item s lisie d below , i fan y

Propert yID : L^Q^cy ^ 

### Propert y Address:^- ! 3, ^ HoT^.YVg . ftO Owner : ^Q^p ^ ^.p ^
Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : 

# L Item :

Additiona l Connments :

^ 1 I agre e restoralio n n completed , rxccp i as note d [_ J I d o no l «|>rr cresloratio n is , complete d

/yfwncr' s Signatiir r'Dale / Cun d arior' s Signatur e Dal e

### S'i ) 

# p-jiyg£ > Propert y Owae r AssesEmeiit of FerfGrmsiEic e F©r m KJS^* ^ America nRecover y an dReinvestmen t Ac t (ARRA ) ^y) ^ 3 0 20^ 0 Omah aLea dSuperfun dSit e Remediatio nContractor : Coasta l Environmenta l Grou p - EP-R7-Q9°0 6 Propert y Identifie r Number : ^065 Q Propert y Ad&rtssk7^^ \PjAff-nr / Propert y Owaer' s Name : dOt^.! b i 1 ^'S'V^^ ^ Instruction s t o th e Prope r Thi s for mserve s to recordth e Propert y Owner' s assessment of performanc e (Incentive 1

- Qualit y Assiiranc e Surveillanc e Plan ) involvin g th e liste dremediatio ncontractor , as applicabl e to th e Omah aLea dSite . Thi s for mdocument s th e timelines s o f punc hlis t resolution , busines s relations , complaint resolutio nan dth e overal l qualit y o f work . I f nee dbe , the Propert y Owne r may utiliz e thi s for mto recordproblem s and/or issue s no t specifically tie dto a nassigne d address , fo r example , busines s relation s tha t generally don' t follo w th e guideline s set fort hi nthe Performanc e Wor k

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

b y checkin g anumerica i ratin g o nth e tabl e belo w usin g the numerical definition s fro m th e ratin g scal e below , the nsig n& dat e th e form . 9-1 0 "excellent " 7- 8 "very good " 5- 6 "acceptable " 3- 4 "poor " 1-

2 "ver y poor " Propert y Owner' s Assessmen t o f Performanc e Regardin g th e Contractor' s Wor k 1 0 5 9 4 

# 8 X 3 7 2 6 I Propert y Owne r Additiona l Commeiat s fro m(optional ; coatinu e o nbac k pag e if f needed ) Propert y Owne r Signature : 

# 4 ^ Date: (ff/X^// 0