## TRANSMITTALo f

OMAHALEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAI D # : 

# W^l ^ Date : I 

# < ; I Address : ^IV t^^M ^ f Remediatio nContractor : _Coasta l Environmenta l Group
_ Year : 2010ARR A
SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 01 / Vide o o f property (DVD ) Executiv e Summary EPA-provide dproperty sketc h 

# F Signe dAcces s Agreemen t for subjec t property Signe dAcces s Agreement(s ) for adjacent property Restoratio nAgreemen t Settlemen t document s (i.e. , for damag e o r to replac e plants , etc. ) -f r Confirmatio ndat a Photograph s \\ i tP^P(Xlai ^ -^ bcC^Ailgt ^ \^oi ^ / 

### As-buil t sketc h 

# F Satisfactory restoratio nsigne db y Property Owner 

# F
. 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 

## • D D



### 30218700 Superfun d

## Propert yAcces s Checklis t 1 Propert y ID : {„l\3\ ^ D WOR K STARTE D ON : / / 1 Propers-Addr«, : qp^^y ;r^,-^ , ^^ r . D WOR K COMPELIE D ON : / /
Owner : p^y^^ ' ^ /.////fjol^ n Address : ^ 

## "^DAM e Phone : 

## M ^ 5f> l ^Qft S Fax : Cell/Pager :

nNotificatio nLette r ^ Acces s Agreement [ ^ Restoratio nAgreement D Topsoil Samplin g (i f applicable ) Q Disposa l Sampling (i f applicable ) Q Garde nSamplin g (if applicable ) - ^ UtiUt y Clearanc e P ^ Video/Photo s (Before) D Video/Photo s (During ) D Video/Photo s (After)

• Video/Photo s (30-Day ) Q Property Completio nAgreement D Final Report Ai r Monitorin g (a s applicable ) nCommunit y Q Cre w On : Results : D Communit y Q Cre w On : Results :

• Conmiunit y • Cre w On : Results : Renter : Phone : Fax : Cell/Pager : Additional Information :

Sent : / / 

### Siened : 1 1 H / 1 0 Signed : T IZ^ I l O 1 1 1 1 1 1 CaUed:Ob / \V ) / V

O 

## On : SL'^IJ ^ On : / / On : / / On : / / Siened : / / Issued : / /
/ / 

### By :
/ / By :
/ / By : By : By : 

## Jiy.d-^Pi i By : By : By : By

= Oh/::i \/l o u^tvyiiimM b 

## ^r-DPc K I/ ) By : By : By : By : By :

Omah a Lea d Sit e 

### 1

## •' Dougla s Count y Accoun t Infoaa^o n Pag e 1 of3 >a||^ c Dougla s County , Nebrask a Propert yRecor d - R120492000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e fl) scal e 0-5 0 ft wes t o f52n d S t - VieWO 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 LITTLEJOH N BONNI E S blA L 482 7 ERSKIN E S T OMAH AN E 68104-000 0 Propert yInformatio n Ke yNumber : 049 2 000 0 1 2 Accoun t Type : Residentia l Parce l Number : 120492000 0 Parce l Address : 482 7 ERSKIN E S T OMAH AN E 68104-000 0 Lega l Description : GRAMMERC YPAR KLO T2 5 BLOC K2 4 2 X 12 8 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $ 5,900.0 0 $75,400.0 0 $ 81,300.0 0 200 8 $ 5,900.0 0 $75,400.0 0 $ 81,300.0 0 200 7 $5,900.0 0 $75,400.0 0 $ 81,300.0 0 200 6 $ 5,900.0 0 $75,400.0 0 $ 81,300.0 0 200 5 $ 5,900.0 0 $63,100.0 0 $ 69,000.0 0 200 4 $5,900.0 0 $57,400.0 0 $ 63,300.0 0 Sale s Informatio n Sale s Date : 1996-09-2 4 Dee d Type : D Book : 204 6 Page : 08 9 Price : $59,950.0 0 Grantor : Grantee : Validllnvalid : Vali d Exclusio n Reason : Sale s Date : 1992-04-1 0 Dee d Type : D Book : 192 5 Page : 31 6 Price : $35,000.0 0 Grantor :


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

### ' Dougla s County Accoun t Infojj|Mtio n Pag e 2 o f 3 ra^i i # Grantee : Validllnvalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 2 5376. 0 1. 0 128. 0 42. 0 N o Improvement Informatio n Buildin g 1 1 1.' 2 STOR YFI N 462 7 ERSKIN E S T
. ^ - I V ] ft JBDO* * • tn i 5* < w m •. , « t r • V first Floo r " \ 72 7 0s q ftjs"
•^f.^'!-:' " Bim l BiK k a «
CLIC KT O ENLARG E IMAG E Squar e Footage : 1057. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : i 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : : 6. 0 Exterior : Fram e Aluminu m Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 3. 0

Roo fType : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Sprinkle rSquar e Footage : 0. 0 Yea rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 190 5 0 % 190 5 10 4 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 737. 0 Basemen t Minima l Finis h 200. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 

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

## Dougla s Coimt y Accoun t Infom^io n Pag e 3 of 3 ^jl|Utl l Garag e Detache d 396. 0 Porc h En d Soli d Wal l 119. 0 Porc h Sla b RoofCei l 126. 0 Use r Atti cFul l Finis h 320. 0



## http://douglasne.mapping-onUne.com/DouglasCoNe/static/accoimtinfo.jsp?accoimtno=Rl..
. 10/23/2009

### Pag e 1 o f 1

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

# ] [
YOU RTICKE T NUMBE RI S 2534157
. Origina l Cal l Date : 7/01/1 0 Time : 3:2 5 pmOp : ELIZABETH1879 0 Wor k t o Begi n Date : 7/06/1 0 Time : 4:0 0 pm State : N E County : DOUGLA S Place : OMAH A Address : 4 82 7 Street : ERSKINE S T Twp : 15 NRng : 13 E Sect-Qtr : 07-SE,08-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 ENVIRONMENTAL SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Being Don e For : COASTAL Dept h o f Excavation : 4 F T Corne r Lot : N Front : yRear : 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 ConUc t Phon e Numbe r Utilit y Typ e 

### Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I 

### Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Alt : 

### Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCITY O FOMAHA-TRAFFIC,SEWE R RICH/TRAFFI C Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 OPPDGPR 5 OMAH APUBLI C POWE RDISTRIC T ELM LOCATIN GAlt : 406207149 4 

### Emerg : 888728934 3 Day : 406728934 3 QLNN E1 C QWES T LOCA LNETWOR K 

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

http://www.dhon.org/irihintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 7/1/201 0OLS# : 6921 2 

# As-Buil t Drawin g A Dat e Excavated:7/6/201 0 Dat e USEP ASigne d Off : 8/19/201 0 COASTA L 

# Omah aLea dSuperfun dSit e Are a Sodden : 247 5 s o f t



### 6921 2 Exteno rPain t No m An-o w Omah a Lea d Sit e • Goo d Sit e Sketc h
• Poo r Samplin g Address : 482 7 ERSKIN E S T [^'^No t pam t 

# r Sampl e Numbe r Lea d Sampl e LA B Sample s Collecte d Concentratio n Collecte d 

# I Fir m RYASCPXA-6921 2 F l pp m D Dat e RYBSCPXA-6921 2 F 2 pp m D Tim e Z--1 0 pt n RYCSCPXA-6921 2 B l /^«^^ - pp m D Sample s Analyze d RYDSCPXA-6921 2 B 2 2 7 1 pp m D RDZSCPXA-6921 2 D Z 22^=1 ^ pp m D XR F Unit : (oSHC i Book : 27 n nC^SCPX A6021 J 62 ­ pp m D D Dat e 11-Ol
. -O R nrzocPXA-60Jia—PS - pp m D D Tim e -^Q
_ Staff : Numbe ro f Sample s = | 5 | | Q | 

## jn^L L 1 egend : F l = Fron l Left , F 2 = Fron t Rigtit , R l = Rac k I ef t R 9 = Ran k Ripti t 0 7 = Dri p 7nn P a ? = P:arf1a n P 7 = Pla ; Al l quadrant s ar

e a

s viewe d from the street , facin g propert y

Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are a replace d wit h So d Are areplace dwit h Rock/Mulc h Are alef t bar e Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
.• 

### if 

# u 0^ ' 

## 0 

# 4

6921 2 Exterio rPaint Q Good Omah a Lea d Sit e Sit e Sketct i gpoo i Samplin g Address : 482 7 ERSKIN E ST [ 0 No l pam t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentralio n Collecte d Fim i rp APB- m RYASCPXA-6921 2 F1 

### lLi° \ pp m D Date : /p - 3 -Q ^ RYBSCPXA-6921 2 F2 pp m Tim e /ly-l O pt n 

# n RYCSCPXA-6921 2 Bl pp m 

# i
D 

# r ple s Analyze d RYOSCPXA-6921 2 82 

## 27 1 pp m D S H O Book : 27 n RDZSCPXA-6921 2 DZ y-z<^° i pp m D nCZCCPX A60J1 J G2 - pp m Dat e D // • Cd • Of i nnzscPX Aeoj u P2 - pp m D Tim e D D _&n
. Staf f Numbe r o( Sample s = I 5 | (^ \ 

### nsi j Legend : Fl = Fron t Left , F2 = Fron t Rigtit
. Bl = Bac k Left , B2 = Bac k Righ tDZ = Dri p Zone , GZ = Garden , PZ •• Pla i Al l quadrant s area s viewe d fro m th e street , facir> g propert yAll^y



# P0PP ^ t

V :iM K Ctclo d•i.S.Sep-'i NM*'^ ' • • • M- • 

# AXV o6921 2 Omah a Lea d Sit e Exterio rPain t Sit e Sketc h Q Goo d
• Poo r Samplin g Address : 482 7 ERSKIN E S T [2 ^ No t pamt Lea d Sampl e Sample s Collecte d Sampl e Numbe r Ui, B Concentratio n Collecte d Fir m fPAPB-A J RYASCPXA-6921 2 F l 1 (i>° l pp m D Oat e in-3-of ^ RYBSCPXA-6921 2 F 2 I 8 ^ pp m D Tim e A L •t o p m RYCSCPXA-6921 2 B l /iH2 - pp m D j ~ 

# I Sample s Analyze d RYDSCPXA-6921 2 B 2 2 7 3 pp m D RDZSCPXA-6921 2 D Z 22^ ^ PPn n D XR F Unit : ^5V Q Book : 27 n ROZSCPX A6021 2 G2 ­ ~ pp m 

# • D Dat e I I • Ol , - Of i
. nnZGGPXA-60g1 g P2 - ~ pp m D Tim e £ca
. Staff : Numbe ro fSample s = |5 | | Q | msi j Legend : F l = Fron t Left
. F 2 = Fron t Rigtit
. B l = Bac k Left
. B 2 = Bac k Righ t D Z = Dri p Zone
. G Z = Garden
. P Z = Pla ; Al l quadrants ar e a

s viewe d fro m th e street , facin g propert yJL||^> y



## 6C C



## S*A^^'d^^
. s ^ 

# ?j.Idddd^^ m

### %



### 6921 2 Omah a Lea d Sit e Exterio rPain t Norti i Arrow Sit e Sketc h • Goo d npoo r Samplin g Address : 462 7 ERSKIN E S T [^Not pain t Sampl e Numbe r Lead Concentratio n Sampl e Collecte d LA B Fimi : Sample s Collecte d fPA rPB-A J RYASCPXA-6921 2 F 1 pp m 

### 0
. D Date : ID-3-O ^ RYBSCPXA-e921 2 RYCSCPXA.6921 2 RYOSCPXA-6e21 2 RDZ8CPXA-6921 2 F 2 B 1 8 2 D Z 

### 21- ^ pp m pp m pp m pp m 

# i D D D D Time : Z-Z O ^ Sample s Analyze d XR F Unit : 6>SH b Book : 7? o ncaecPX A8oaia—62 - RPZooPXA-goaia—P2 ­ pp m pp m 

# u u 

# • D Date Tim e iioi»-D( i 

## £m - Numbe ro fSample s = | 5 I | Q | Staff : 

## -casu - Legend : F l = Fron t Left
. F 2 = Fron t RiQht
. B 1 = Back Left , B2 - Bac k Rigtt t DZ = Dri p Zone
. G Z > Garden , P Z = Pla i A D quadrant s are a t iriawe d fro m tt wOrael.hcin g propert yAll^ y .CshC
. .Csdrtj f BV^; t '¥^ 

## iiova s '•CM O



# .rn - L 27 3 ^_ , DECK : ^ ^ 

# mi l

^:D2,'?2 n Hf : : St
. 

## .f l iS:: , .7(t:: ^ 

# .n ­ /6^

!(iUl $ llejie d i«-Sei>-< «• . 

# »*^'*lr*> *
COASTA I INVIXONHIttTA t CROUP
. IN C 

## Consen t fc fAcces s T o Propert y RIGH TO F ENTR YT O PREMISE S 

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

Owner' s Nam e Daytim e 

### Phone : ^^ , 55A/**'J ^ 

## f\eyr4 i X/A^/c/^/ij u
Addres s o fPropert y 

## ^^^ 7 cTrS^fj^f ^ ST : covere d b ythi s Agreement :
PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP Ai s requestin g acces s t o collec t soi l sample s an d remov e soi l tha t contain s elevate d concentration s o flea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t o remov e contaminate d soil
. Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o it s origina l condition
. Thi s wor k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o fCoasta l Environmenta l Group , contracte d b yUSEPA , wil l contac t th e Granto rin-perso n t o discus s th e wor k t o b e perfonned , 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 vmtte n documentatio n fro m EP Atha t th e propert y ha s bee n remediated
.
ENVIRONMENTA L RESPONS E ACTION S 

### B ysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , it s employees , contractor s an d subcontractor s th e righ t t o ente rth e property , a t al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e o fperformin 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

# t

COASTA L 

### : ^ INVmONHIKTA L '*'-<«,o^^'^" ' C « O U P IH C



### « Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; cRemov e flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t ma ywis h t o save ; « Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessar ysubsequen t t o a n initia l waterin g perio d b yEPA ; cAbid 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
. <- 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

H J gran t acces s t o mypropertie s D I d o no t gran t acces s t o mypropertie s

Signatur e yF yDat e Signature Date

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

Page 2 o f2C O AS TAL OROUP , IHC
. 

## Restoratio n Agreemen t The purpos e ofthi s agreemen t i s to provid e amutua l agreemen t a s to condition s ofth e propert y prior to remediationactivities
. Thi s will als o serve as documentationfo r

the purpos e of assuring tha t restoratio n activitie s ar e completedto the satisfactionof the propert y owne r an dth e UnitedState s Environmenta l ProtectionAgency (EPA)
.

Propert y ID ; (^0|;^\; ^ Propert y Address : U ? , T ?
. g-Sk.V^ , <r ^ Owne r 

## ' Kci-h A\ .vV\lgrjoV\<v Plione : 

## ^ 0 ^ 'b^ \ IQg)? ) 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 usedby the contractors . Indicat e distances , depths , materia l types , etc . Photographicall y an dVideographicall y documen t the existing condition s ofth e propert y an dthe basemen 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 rretu m o f thes e item s i s th e Owner' s responsibility
. Item : 

# /n d piU^f p 

# d^ > 

# h ^ <Fc^. l A<= ^ C
_ Item :
Item :
Item :



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

### Item : 

## eiMi& s o 

# k 0

Item : 

# y\t6(\^ S d>i P dz ^ (5ci \

FZ- ^

item :
Page 

## lo f 3C O AS T AL • MVinONMINTA L O KO U P
. INC
. 

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

# 5-^'c l - f i,6lr.P ^ item : 

# < ^ i - f \,Q/,0 ^ item : Item :


## Landscap e Inventor y Ite m Quantit y Uni t Conditlon/Type/Specie s Pre-existin g propert y area , Quadrant s tha t wil l b e excavated , that i s coveredwithgrass . 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 

# > o 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 . Square Fee t Attac hasketc ho f relativ e 

# u
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 

# e r

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 

# 1 fe/iJ'M f i^<i}^id>
Pag e 2 

# 0 , 3C O AS T AL •NVtRONHINTA L a n o u p . INC
.
Additiona i 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 i Protectio n Agenc y(EPA ) ma yb e removin g an d replacin g soi i 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 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 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 l 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
. c n Pleas e chec k thi s bo xi fyo u understan d th e informatio n outline d above
. 

# (t/e
. Z-l
. P s no&y ^

•Chec k th e bo xi fOwne 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 fhouse , includin g foundatio n crack s o rfissures
. 

### O I do no t agre e 

# .j,rM^y^.d7Jy~-^';iB' P &Cjuny ^ ^A'' ' ivXer ' 

### Dat e Contractor' s Signatur e Dat e Pag e 3 o f >

# t

BVID #(o'^U L XR F PROPERT Y SAMPL E SHEE T Dat e 

### 9 ­ / ^

­ 2:^/ 0 Addres s fgz: ^

£^KIN £vS r Project Omah a Lea d ARR A Sampl e tim e am/p m XR F ID # 

## 3^oZ.Z
. sampl e lengt h 3 0 se c

Shot # 

## /8^ 5 /8i G

\'&^• ^ Readin g 

# /o r

# ±/s " I4^ 

## t / ^ /g- ^ t l^ r Sampl e are a 

# n Dept h 

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

## 13 4 i / 6 Averag e

Shot # 

## /01 ^ ['=\0 0 

# no ( Averag e Readin g 

### [ZZ
. i 1 6 

## lO

G t 1 5 /3 4 i 11 -

IZ l i 1 6 Sampl e are a 

# D 2 Dept h /3 " Shot #

Averag e Readin g Sampl e are a Dept h

Shot # 

# n^ 3 

# n ^ n^s Readin g 

## Z.Q i t iZ Z,^ 5 i Z ^ ^5 4 1 ^ f Sampl e are a 

# B i Dept h 

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

## Z Wt iZ
. Averag e

RETES TAREA S Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a \% ^ 

## /e y

## i i ^ ^ 

# - ^

E A 1^0 8 

# n ^ )6^iy1 % ISjP t l ^

y y y^Dept h ^ u Dept h Averag e 

# {\^by^ n Averag e Signatur e i 

# >^gf^ ^
Prin t 

# !\t^( d Mf^ s• 

# 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-3902 2 Readin g N o 189 8 Mod e SOIL Tim e 2010-08-1 7 18:5 1 Duratio n 91.6 9 Sequenc e Fina l Flag s AVERAG E Avg of 1895-189 7 ADDRES S 482 7 Erskln e s t QUADRAN T F l DEPH T 4 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e

Supervise d By :

# t Therm o

SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , 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 101.99 7 Supervise d By : 

## Certificat e o fVerificatio n

189 5 SOI L 2010-08-1 7 18:4 9 30.5 4 Fina l 6921 2 482 7 Erskln e s t F l 4 " N
. LOPE Z confirmatio n non e

± Erro r 15.30 2

# t Therm o

SCIENTIFI C Therm o Fishe r Scientifi c 90 0 Middlese x Turnpik e Billerica , M A0182 1 

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 189 6 Mode SOIL Tim e 2010-08-1 7 18:5 0 Duratio n 30.6 0 Sequenc e Fina l Flag s BVI D 6921 2 ADDRES S 482 7 Erskin e s t QUADRAN T F l DEPH T 4 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e

Erro r pp m P b ± 17.88 9 149.69 3 Supervise dBy :• 

# Therm o

SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , 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 150.62 0 Supervise d By : 

## Certificat e o fVerificatio n

189 7 SOI L 2010-08-1 7 18:5 1 30.5 5 Fina l 6921 2 482 7 Erskin e s t F l 4 " N
. LOPE Z confirmatio n non e

± Erro r ± 17.71 9

# t Therm o

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 190 2 Mod e SOI L Tim e 2010-08-1 7 18:5 3 Duratio n 91.6 2 Sequenc e Fina l Flag s AVERAG E Av g o f1899-190 1 ADDRES S 482 7 Erskin e s t 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 Billerica , 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 122.04 2 Supervise d By : 

## Certificat e o fVerificatio n

189 9 SOI L 2010-08-1 7 18:5 2 30.6 1 Fina l 6921 2 482 7 Erskin e s t D Z 13 " N
. LOPE Z confirmatio n non e

± Erro r ± 16.65 8• 

# Therm o

SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , 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 106.92 5 Supervise d By : 

## Certificat e o fVerificatio n

190 0 SOI L 2010-08-1 7 18:5 3 30.5 1 Fina l 6921 2 482 7 Erskin e s t D Z 13 " N
. LOPE Z confirmatio n non e

± Erro r ± 15.69 4• 

# Therm o

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 190 1 Mod e SOI L Tim e 2010-08-1 7 18:5 3 Duratio n 30.5 0 Sequenc e Fina l Flag s BVI D 6921 2 ADDRES S 482 7 Erskin e 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 134.48 1 17.14 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-3902 2 Readin g N o 190 6 Mod e SOI L Tim e 2010-08-1 7 18:5 6 Duratio n 92.2 9 Sequenc e Fina l Flag s AVERAG E Avg of 1903-190 5 ADDRES S 482 7 Erskin e s t QUADRAN T B l DEPH T 4 " 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 Billerica , 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 281.32 7 Supervise d By : 

## Certificat e o fVerificatio n

190 3 SOI L 2010-08-1 7 18:5 4 30.6 5 Fina l 6921 2 482 7 Erskin e s t B l 4 " N
. LOPE Z confirmatio n non e

± Erro r
± 22.53 8

# t Therm o

SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , 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 275.68 7 Supervise d By : 

## Certificat e o fVerificatio n

190 4 SOI L 2010-08-1 7 18:5 5 30.6 5 Fina l 6921 2 482 7 Erskin e s t B l 4 " N
. LOPE Z confirmatio n non e

± Erro r ± 22.09 5

# t Therm o

SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , 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 254.75 5 Supervise d By : 

## Certificat e o fVerificatio n

190 5 SOI L 2010-08-1 7 18:5 6 30.9 9 Fina l 6921 2 482 7 Erskin e s t B l 4 " N
. LOPE Z confirmatio n non e

± Erro r ± 21.47 3• 

# 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-3902 2 Readin g N o 191 0 Mod e SOI L Tim e 2010-08-1 7 18:5 9 Duratio n 91.8 6 Sequenc e Fina l Flag s AVERAG E Avg of 1907-190 9 ADDRES S 482 7 Erskin e s t QUADRAN T E A DEPH T 1 " XR F TEC H N
. LOPE Z MIS C insitu s NOT E non e

Supervise d B y

# t Therm o

SCIENTIFI C Therm o Fishe r Scientifi c 90 0 Middlese x Turnpik e Billerica , M A0182 1

XL3t-3902 2 Readin g N o Mode 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 156.69 1 Supervise d By : 

## Certificat e o fVerificatio n

190 7 SOIL 2010-08-1 7 18:5 7 30.6 5 Fina l 6921 2 482 7 Erskin e s t E A 1 " N
. LOPE Z insitu s non e

± Erro r ± 17.74 6

# t Therm o

SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , 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 163.87 4 Supervise d By : 

## Certificat e o fVerificatio n

190 8 SOI L 2010-08-1 7 18:5 8 30.5 5 Fina l 6921 2 482 7 Erskin e s t E A 1 " N
. LOPE Z insitu s non e

± Erro r ± 17.60 7

# t Therm o

SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , 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 150.03 4 Supervise d By : 

## Certificat e o fVerificatio n

190 9 SOI L 2010-08-1 7 18:5 9 30.6 6 Fina l 6921 2 482 7 Erskin e s t E A 1 " N
. LOPE Z insitu s non e

± Erro r ± 17.48 5

## Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 ^^^w^ ^ , Coasta i Environmenta i Grou p inc , S^^^ ^

¥nww.coa8taihazmat.co m '"tPROtt'S ' COASTA L INVItOMHINTA l G IO U r . IN C 

# EXECUTIV ESUMMARY : BVID #69212-(482 7 ERSKIN EST )
No Issue s o r Concern s | ^ Issues/Concern s Detail Explanation : -DANGARVE Y WALKE D TH EPROPERT Y O N8/19/10
.

# EP AProperty Clos e Ou t For m • B T Propert y#:
. Propcrt y Address : (^"4fi l Date/Time : Owner' s Name:
. .& • yf*C
. j Quad i Excavated : Contracto r Grou p LA^ftJ /
Yes No Excaratio nGcnera i 1
. I f necessaiy , wer e th e correc t qtiadiant(s ) excavate dan drestored ? 2
. I f necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? 

### y Gradio ESo dan dVcffcUtlo n Ye s N o J Doe s th e padin g aroun dth e perimete r ofth e hous e i nexcavate darea s generall y slop e awa y 

## y fromtb e house ? 2
. Ha s so dbee nlai dInal l area s that wer e excavated ? 

# y 3
. Doe s th e so dappea r l o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 

## y da y tim e period ) 4
. Ar e sodde darea s generall y lin nan devenl y graded ? 

## y 5
. 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 

## y tim e period ) 6
. Wa s th e property grade dsuc htha t wate r wil l not poo l onth e properry ? / 7
. Wa s damag e t o landscapin g o r plant material s avoided ? 

## y Gates
. Fence s an dRetatoln g Wall s Ye s N o I 1
. D o gate s ope nan dclos e freely? (I f applicable ) 2
. Wer e ali gate s o r fence s take ndow ndurin g restotatio nactiviiie s reinstalled ? (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 retainin g wall s avoided ? (Ifapplicable ) 

## y Foundation , SidiOK an dGoiter s Ye s N o I Wa s damag e t o th e sidin g o r tri mavoided ? / 2
. Wa s damag e t o th e foundatio navoided ? / 3
. Wa s damag e t o window s avoided ? 

## y 4Wa s damag e t o window s o r doo r screen s avoided ? 

# y

— 5
. Wa s damag e t o downspout s o r downspou t extension s avoided ? 

## y Sidewalk s an dDriveway s (Concrete ) Ye s N o 1
. Wa s damag e t o drivewa y surface s avoided ? / 

# -t 2
. Wa s damag e t o walkwa y surface s avoided ?

## Ort'Dcr s comments :

|i!n.«:pectio nno<es :

Removal andrestoratio nactivale s complel e includin g the 30-da y so dwarranty : EP ARepresentativ e Qc» ^ ^^^F ^ Dale : Slitji o

## Propert yCompletio n Agreemen t This agreement documenl s lhe complclio no f remedia l acliviiie s perloime do nm y propert y M y signature wil l designat e lha l I a msatisfie dwil hlh e restoratio no f m y properly , an dlha l no items ar e i nqueslions , now , or a

l any lim e i nthe future , excep t Ihos e ilem s listedbelow , ifan y 

# Ji^E^y^MM X Propert y Address : ^^p ^ ^^^^ ^ ^ 

### Phone : 

### ^\ - 

### 1(9 ^ Restoratio nItem s i nQuestion : Item : item : item : item :

• x _ 

### item : Item :

^c\I aijirc c icttoralio ni % completed , excep t a s note d (._] ' '' 0 ')o ( a\>rtc resioratio ni s compleler i 

# y^p/^p o £CdF^^y'^->

- H I Con dartot' s Signatur e Uaic

### % 

### 'yys ) 

# Propert y Owne r Assessmen t of Performanc e For m America nRecover y an dReinvestmen t Act (ARRA) OmahaLea dSuperfun dSit e 2009/201 0 Remediatio nContractor : Coasta l Einvironmental Grou p - EP-R7-09-0 6 Propert y Identifie r Number ; (Q^ykip>. , Propert Address : <-tk^ ^ fim,i/d.o '^TT propert y y Aaaress : ^K^- h(^ymAU^ o ^ r Propert y Owner' s Name ; iLlit W"%44^ g UJA>V > 

### Instruction s to th e Propert v Owner ; Thi s for msave s to recor dth e Propert y Owner' s assessment of perfomianc e (Incentiv e 1

- Qualit y Assuranc e Surveillanc e Plan ) involvin g th e liste dremediatio ncontractor , as applicabl e to Ui e Omah aLea dSite
. Thi s formdocument s th e timelines s of punchlis t resolution , busines s relations , complaint resolutio nandth e overal l qualit y

of work
. If needbe , the Propert y Owne r ma y utiliz e thi s for m

to recor dproblem s and/o r issue s no t specifically tie dto anassigne d address , for example , busines s relation s tha t generally don' t follo w the guideline s set fort h

inthe Poformanc e Wor k

Statement
. Th e Propert y Owner wil l indicate his/her assessment of perfomianc e wit hth e contractor' s wor k

by checkin g anumerica l ratin g onth e tabl e beio w usin g th e numerica l definition s fiom th e ratin g scal e below , thensign& dat e tiie form
. 9-1 0 "excellent " 7- 8 "ver y good " 5- 6 "acceptable " 3- 4 "poor " 1-

2 "ver y poor " Propert v Owner' s Assesament of Performanc e Regardin g th e Contractor' s Wor k 

## 10 

## X 5 9 4 8 3 7 2 

### 6 1 Propert y Owne r Additiona l Comment s fro m(optional ; oontiau e onbac k pag e if needed )
Propert y Owne r Signatut^^^ / (>dd(d ^ y£i^P/yC.y~ ^ Pate ; A^^d " ^ O 

# ' .' 

# P /

# Wate r Bil l Settlemen t

Property I D 6921 2 Property Addres s 4827 Erskin e S t Tenan t Bonni e S
. Littlejohn

I have receivedfromthe contractor , Coasta l Environmenta l Grou p Inc
. (Coastal) , the su mo f $ 93.5 1 fo r wate r usag e requiredto maintai n the sod
.
Check Niunber 210 8 Valu e o f Check $93.5 1 Mad e Out To Bonni e S
. Littlejoh n Descriptio n o fSettlemen t T o reimburs e tenan t fo restimate d wate rcharge s o n thei rMU D monthl yinvoices
. M ysignatur e belo wi s acknowledgemen t o f th e receip t o f th e su m liste d above , whic h I furthe r acknowledg e t o b e fai rcompensatio n an d ful l paymen t fo rth e above , an d release Coasta i Environmenta l Grou p Inc
. fro m furthe robligation s o rliability
.


# (^/j^iU^t ^ ^/z^ A y L Contractor' s Signatur e Dat e 

## PF- Z 210 8 COASTA L ENVIRONMENTA L GROU P INC
. 27-S/1O4O0O 3 241 1 MARTH ASTREE T 624737290 4 OMAHA , N E 6810 5 

# Q|n|) Q ^ DAT E 

# J $q5 ' .

^ 

# a •••Hin t

« Misn>goaBik.HA
. Nrtnll a
FO R

i : 101,00005ai : &Bi, 7 37E=i0UN ' OEio a