## TRANSMITTA Lof OMAHA LEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAI D # : ^i^O ^Date : \\] \\ \ Address : l ( 1 ( 9 <4flM r ^ ( Remediatio nContractor : Coasta l Environmenta l Group

_Year : _2010ARR A
SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f propert y (DVD ) Executiv e Siunmary \ ZEPA-provide dproperty sketc h
^ Signe dAcces s Agreemen t for subjec t property

- & Signe dAcces s Agreement(s ) for adjacent property y Restoratio nAgreemen t 0 Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) —B Confinnatio ndat a

•Photograph s \U (X^^H^ n> ( t!^^.Al/Aruv i Y "^^ ^ As-buil t sketc h Satisfactory restoratio nsigne db y Propert y Owne r Property close-ou t chec k lis t signe db y EPA -B- ' Descriptio nofarea s no t meetin g RO D cleanu p criteri a Utility clearance s Property infonnatin nfromDougla s Coimt y Assessor' s Ofiic e

/ - • • - - 

### D 

# A y 

# /

y ° / 

# c Wn/ u < Signatur e *~ ^ ^ - 

## (Dat 4 

# y 3021808 7 

# MHIli i Superfun d

# v\ Propert yAcces s Checklis t PropertylD : T^^TjQf i D WOR K STARTE D ON : _/ I 

### Propert y AddrestJ \^OirAt & ^ t nWORKCOMPELTE D ON : / /


### Owner : Renter : 

# f.rnc:^ t fo^ Address : Phone : Fax : 

# Same Cell/Pager : Phone : -], ^ ^^j^g ^ Additional Inforniation : Fax : Cell/Pager :

nNotificatio nLette r Sent : / / By : )\\Acces s Agreement 

## Signed : i_/25/_/{ ) By : Q Restoratio nAgreement Signed:O l /^ A l\ 0 By : D Topsoil Samplin g (if applicable ) 1 / By : D Disposa l Samplin g (if applicable ) 1 1 By : D Garde nSamplin g (if applicable ) / 1 By : [ S Utilit y Clearanc e CaUed : CM/o« 5 / \ 0 Q/Video/Photo s (Before ) On:ji / T- / IC i 

### By : b(yiy^i( ^ nVideo/Photo s (During ) On : / / By : nVideo/Photo s (After) On : / / By : D Video/Photo s (30-Day ) On : / / By : nProperty Completio nAgreement Slimed : / / By : D Fina l Report Issued : / / By : Ai r Monitorin g (a s applicable ) Q Communit y Q Cre w On : / / By : Results :

• Communit y [H Cre w On : / / By : Results :

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

Omah a Lea d Sit e

## Dougla s Covmt y Accoun t I

n on Page 1 of 3
Dougla s County , Nebrask a Propert yRecor d - R091723000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e iS ; scal e 0-5 0 ft wes t o f 52n d S t - VIe W O H Ma p Infonnatio 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 ROYERNES TW ETA L • . . . . 151 0 GRAN TS T OMAH AN E 68110-000 0 Propert yInforniatio n Ke yNumber : 172 3 000 0 0 9 Accoun t Type : Residentia l Parce l Number : 091723000 0 Parce l Address : 151 0 GRAN TS T OMAH AN E 68110-000 0 Lega l Description : DAR R PLAC E LO T3 0 BLOC K0 4 0 X 96. 2 Valu e Informatio n Lan d /mproi^efnen f Tota l 200 9 $2,100.0 0 $1,000.0 0 $3,100.0 0 200 8 $2,100.0 0 $1,000.0 0 $3,100.0 0 200 7 $2,100.0 0 $1,700.0 0 $3,800.0 0 200 6 $2,100.0 0 $1,700.0 0 $3,800.0 0 200 5 $2,100.0 0 $1,700.0 0 $3,800.0 0 200 4 $2,100.0 0 $2,200.0 0 $4,300.0 0 Sale s Informatio n Sale s Date : 1998-07-2 9 Dee d Type : D Book : 209 7 Page : 66 0 Price : $6,000.0 0 Grantor : Grantee : Valld/lnvalld : Vali d Exclusio n Reason : Sale s Date : 1993-01-1 6 Dee d Type : D Book : 194 3 Page : 68 1 Price : $4,000.0 0 Grantor :


## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO..
. 11/25/2009

### Dougla s County Accoun t In^MM^o n Pag e 2 of 3

Grantee : Valid/lnvalid : Exclusio n Reason : Vali d

Lan d Informatio n Acre s 0.0 8 S F 3840. 0 Unit s 1. 0 Dept h 96. 0 Widt h 40. 0 Vacan t N o Improvement Buildin g 1 Informatio n

151 0 Gran t

9t n<J 5 ! • FMPtoo r MO.flSq.n
. 1 2 f

E B 

### Ranc h et»«fiGfcifkd renj0f., , F I

CLIC KTO ENLARG E IMAG E 

### ] Squar e Footage : 860. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Fai r

Buil t As : Ranc h Cond o Squar e Footage : 0. 0

HVAC : Force d Ai r Rooms : 4. 0 Exterior : Fram e Viny l Units : 1. 0 

### Interior : Plaste r Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 2. 0

Roo f Type : Gabl e Stories : 1. 0 Floorcover : Allowanc e Foundation : ! Blocl < Sprinkle rSquar e Footage : i 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 5 Detai l Typ e Defai V Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 800. 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=RO.
. . 11/25/200 9

## Dojagla s Coimt y Accoun t Infgautio n^^ ^ Pag e 3 o f 3
Garag e I Detache d I 400. 0



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinf o .jsp?accountno=RO..
. 1 1 /25/200 9Pag e 1 of 2

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



## • YOU RTICKE T NUMBE RI S 2487502
. Origina l Cal l Date : 5/07/1 0 Time : 12:4 0 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 5/11/1 0 Time : 1:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 151 0 Street : GRAN T S T Twp : 15 NRng : 13 E Sect-Qtr : 10-SE-S W 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 Tvinneling o r 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 Numbe r Utilit y Typ e
CXCAT V CO X COMMUNICATIONS , IN C HEIDI Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7

MAGELLA N MAGELLA N MIDSTREA M PARTNER S L P DEBORA H Day : 918574709 8 Alt : Emerg : 918574709 8

MCINE B MC I N O CAL LPE R MEM O Day : 800289342 7 Alt : Emerg : 800289342 7

MUDO l METROPOLITA N UTILITIES DISTRIC T SAND Y Day : 402504782 3 Alt : Emerg : 402504797 0

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 5/7/201 0

### Pag e 2 of 2

OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRICH/TRAFFI C 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0

0PPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T EL M LOCATIN G 

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

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

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 5/7/201 0

# As-Buil t Drawin g ^
COASTA L 

# Omah aLea dSuperfun dSit e ENVIRONHCHTA L C a O U P
. IN C OLS# : 2820 5 Dat e Excavated : 5/21/201 0 Dat e USEP ASiqne d Off : 7/13/201 0 

## 2820 5 Are a Sodden : 305 0 s a f t Omah a Lea d Sit e Exterio rPain t Owne rName : ERNES TW RO Y Sit e Sketc h [ 3 Goo d Address : 151 0 GRAN TS T • Poo r PtMne : H : |~ | No t pain t

Omah aLea dSit e 4613 0 Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are areplace d So d wit h 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
.

# y^-^ y 

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­ 2820 5 Omah a Lea d Sit e Exterio rPain t Nort hArro w Owne rName : ERNES TW^O Y Goo d 

### Sit e Sketc h Address : 151 0 GRAN TST Phone : H

\ U/ /



## '^Y

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Omah aLea dSite 4613 02820 5 Omah a Lea d Sit e Exterio rPain t Noit i Arro w Owne rName : ERNESTW RO Y [5 l Goo d Sit e Sketc h Address : 151 0 GRAN TST • Poo r

Phone : H ; 

# f w [ 2 Notpain t Lea d Sampl e Sample s Collecte d Sampl e Numt>e r LA B Concentratio n Collecte d Firm : Ffeft \ft<.\t^fv ^ RYASCPXA-2820 5 F 1 £li_l.pp m 

## D Date : QT - a.e > -e ^ RYBSCPXA-2820 5 F 2 ka3.2iPP m 

## D Time : \a'
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## D D Sampie s Analyze d nvDoopxA-aoaoo—B S _pp m 

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. 

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• Poo r Q Notpain t Sample s Coilecte d Firm : Ffeft \ft&\I>rv > Date : O l - A O -e* i Time : \a'.Mr > Sample s Analyze d 

## ^ U Book : IX Owne rName : ERNES TwRO Y Address : 151 0 GRAN TS T Phone : H : Sampl e Numt>e r RYASCPXA-2820 5 RYBSCPXA-2820 5 fTYoecpxA-aeao s RYDOOPXA'aoaO B ROZSCPXA-2820 5 R6Z3CPXA'ge20 5
• RPZ3CPXA'2020 5 F l F 2 -fr i -B 2

D Z -O Z -P Z W : l.ea d Concentratio n SiLiPP m pp m pp m c 3 .^ n 1-pPP m pp m pp m Omah a Lea d Sit e Sit e SlieiC h Sampl e Collecte d 

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### D D D D D D D

Omah aLeadSite 4613 0if^^''*'t ^
COASTA I [HVItOHHIHTA I C K O U rIN C 

# \

y Consen t fo rAcces s T o Propert y RIGH TO F ENTRYTO 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 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 : C^Qyjs^ ^

Owner' s Name : f2/< i 1 / Daytim e Phone : ^ /L ( • "J ^ ^ Z ' ^

Addres s o f Propert y 

# \^[ G <^eAJ^ F covere d b ythi s Agreement :
PURPOS E O F RESPONS E A GTMTIE 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 i be excavate d t o remove 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 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 perfonned , 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 confir m 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 writte n documentatio n from 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 , It s 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 f 2

## .*^!1!'"*
. COASTA L HtVmOHHfltTA l • "iPROlt' - C R O U rIK C 

### 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 ; e Wate 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 ; c

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 approva l fo racces s t o th e propert yt o perfor m th e work
. cAllo 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 f th 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

\

^

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


## OAJL'^'f a signature Dat e Signatur e Oat 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

## 9830S -



# COASTA L ENVIRONMENTA L GROUP , INC
. 

# OWNE R CHANG E REQUES TFOR M \5i O 6rct^k6 + PROPERT YADRES S 

## owNE R NAM E c . rYie^S A l\y > y CHANGE S REQUESTED : 

# ll /

yf/,yiec/o^^y-^^-^ ^ y^ '

OWNE R SIGNATUR E <^Z ^

. , r ^

^^^j^^ ^ 'O^ ' (^ ^ ^/ U AaiO N TAKEN :

SUPERVISO R INITIA L /3 ^COA S T AL • NViaOHMBHTA L O • O U P , IH C 

## Restoratio n Agreemen t The purpos e ofthi s agreemen t i s to provide amutua l agreemen t a s to condition s ofth e propert y prior t o remediationactivities
. Thi s will als o serve a s documentationfo r th e purpos e of assuring tha t restoratio n activitie s ar e completedto the satisfactionof the propert y owner.andthe UnitedState s Environmenta l ProtectionAgenc y (EPA)
. PropertylD ; Z32^ ^ Propert y Address : |t5'( G(SiC^W T T T Owner ; -aCj^^^ TR-O ^ 

### Phone : 

## nitf c^ ^ % ^ O

nthe attacheddiagram(s ) indicat e area(s ) t o 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 , disposai , and/o rretu m ofthes e item s i s th e Owner' s responsibiiity
. Kem :
Item : 

## Mi^ , ( 00%
. Item : Kem :



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

. "^i/v ^ >v2^ut.H- ^ T^~2_ - Kem :
Kem :
Kem :



### Page l o f 

# 22
.COA S T AL 

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

## <A>^y > Kem : 

### \
Kem :
Kem :


## Landscap e Inventor y Item Quantity Unit Condition/Type/Specie s Pre-existing propert y area , Quadrants tha t wil l b e excavated , tha t i s coveredwit hgrass . Numbe r of tree s > 2 inc h Fflc h 

## A
. trun k

diamete r Numbe r of tree s < = 2 inc h Fflo h 

### tnm k

diamete r 

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

# \^l ^ Attac hasketc ho f die sprinkle r layout
. Numbe r o f an dsize of eac hgarden / flowe r bed Eac h area . Squar e Fee t 

# k Attac hasketc ho f relative size s an dlocations
. Agree duponvalue of plan t material s not t o b e replacedbv contractor . $
. 

### Not e thi s valu e wil l b e usedto issu e aplan t / 

### voucher t o th e property owner . Easemen t Area , to b e Eac h excavated 

## ^A D
Pag e 2 of
.C OAST AL • NViaONHeMTAl
. a I I o u p . IN C


### AddKiona l Comment s / instructions : Th e cit 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 i Protectio n Agency(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 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 fsoi l doe s no t mea n tha t an yiiiega i 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 cK 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 i o rreplacemen t o f soi l b yth e EP A 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 cK yo f Omaha' s Plannin g Departmen t a t (402 ) 444-5150
. iS^ieas e chec k thi s bo xi f yo u understan d th e informatio n outiine d above
.

.c^ ' <y* ^



# 4 $LoP ^ xpy^y -

Wc
. 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
.



# W agre e O I d o no t agre e 

# y . OZ-^'^'f O • ^ ^7 ^ Owner' s Signatur e Date Contractor' s Signatur e Date Pag e 3 of
.

# 7 

# 9 t

XR F PROPERTYSAMPL E SHEE T Date -y - / ^ - / O Addres s Projec t Omah a Lea d ARR A Sampl e tim e XRFID # .-^cy^a^i - sampl e lengt h

Shot # Readin g Sampl e are a Shot # 

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# /W 5 ^ /r 3 ' . ^ " . / V ^ —I O
Readin g Sampl e are a Depth

Readin g Sampl e area Depth

# 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 B y 

## Certificat e o f Verificatio n

54 6 SOI L 

### 2010-06-1 9 17:5 0 91.5 8 Fina l
151 0 Gran t s t F l 6 " 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 

## Certificat e o f Verificatio n XL3t-3902 2 Readin g N o 54 3 Mod e SOI L Tim e 2010-06-1 9 17:4 8 Duratio n 30.5 5 Sequenc e Fina l Flag s BVI D 2820 5 ADDRES S 151 0 Gran t s t QUADRAN T F l DEPH T 6 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e

pp m Erro r P b 112.67 0 ± 16.38 0 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 101.03 9 Supervise d By : 

## Certificat e o f Verificatio n

54 4 SOIL 2010-06-1 9 17:4 9 30.5 1 Fina l 2820 5 151 0 Gran t s t F l 6 " N
. LOPE Z confirmatio n non e

± Erro r 15.56 3

# 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 99.91 8 Supervise d By : 

## Certificat e o f Verificatio n

54 5 SOI L 2010-06-1 9 17:5 0 30.5 2 Fina l 2820 5 151 0 Gran t s t F l 6 " N
. LOPE Z confirmatio n non e

± Erro r ± 15.57 7

# 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 B y 

## Certificat e o f Verificatio n

55 4 SOI L 2010-06-1 9 17:5 6 91.9 9 Fina l
151 0 Gran t s t F 2 6 " N
. LOPE Z confirmatio n non e

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

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

pp m P b 96.38 0 Supervise d By : 

## Certificat e o f Verificatio n

55 1 SOI L 2010-06-1 9 17:5 4 30.5 6 Fina l 2820 5 151 0 Gran t s t F 2 6 " N
. LOPE Z confirmatio n non e

± Erro r ± 15.27 8^ 

# Therm o

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

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

pp m P b 97.15 2 Supervise d By : 

## Certificat e o f Verificatio n

55 2 SOI L 2010-06-1 9 17:5 5 30.8 5 Fina l 2820 5 151 0 Gran t s t F 2 6 " N
. LOPE Z confirmatio n non e

± Erro r ± 15.08 9

# 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 55 3 Mod e SOI L Tim e 2010-06-1 9 17:5 6 Duratio n 30.5 8 Sequenc e Fina l Flag s BVI D 2820 5 ADDRES S 151 0 Gran t s t QUADRAN T F 2 DEPH T 6 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e

pp m ±Erro r P b 92.67 1 ±14.99 7 Supervise d By :• • 

# Therm o

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

## Certificat e o f Verificatio n XL3t-3902 2 Readin g N o 55 8 Mod e SOI L Tim e 2010-06-1 9 18:0 0 Duratio n 91.9 5 Sequenc e Fina l Flag s AVERAG E C7gggaf-555r5 i ADDRES S 151 0 Gran t s t QUADRAN T B l DEPH T 13 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E non e

Supervise d B y# 

# Therm o

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

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

pp m P b 125.00 7 Supervise d By : 

## Certificat e o f Verificatio n

55 5 SOIL 2010-06-1 9 17:5 8 30.4 7 Fina l 2820 5 151 0 Gran t s t B l 13 " N
. LOPE Z confirmatio n non e

± Erro r ± 16.72 9• • 

# Therm o

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

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

pp m P b 125.80 4 Supervise d By : 

## Certificat e o f Verificatio n

55 6 SOIL 2010-06-1 9 17:5 9 30.9 1 Fina l 2820 5 151 0 Gran t s t B l 13 " N
. LOPE Z confirmatio n non e

± Erro r ± 16.58 5% 

### % 

# 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 128.02 5 Supervise d By : 

## Certificat e o f Verificatio n

55 7 SOIL 2010-06-1 9 18:0 0 30.5 7 Fina l 2820 5 151 0 Gran t s t B l 13 " N
. LOPE Z confirmatio n non e

± Erro r ± 16.81 6• • 

# Therm o

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

## Certificat e o f Verificatio n XL3t-3902 2 Readin g N o 56 2 Mod e SOIL Tim e 2010-06-1 9 18:0 2 Duratio n 92.0 6 Sequenc e Fina l Flag s AVERAG E ADDRES S 151 0 Gran t 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 :

# t Therm o

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

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

pp m P b 141.43 1 Supervise d By : 

## Certificat e o f Verificatio n

55 9 SOI L 2010-06-1 9 18:0 1 30.5 6 Fina l 2820 5 151 0 Gran t s t D Z 13 " N
. LOPE Z confirmatio n non e

± Erro r ± 17.64 9• • 

# Therm o

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

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

pp m P b 149.86 8 Supervise d By : 

## Certificat e o f Verificatio n

56 0 SOIL 2010-06-1 9 18:0 2 30.5 6 Fina l 2820 5 151 0 Gran t s t D Z 13 " N
. LOPE Z confirmatio n non e

± Erro r ± 18.02 6% # 

# Therm o

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

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

pp m P b 144.63 1 Supervise d By : 

## Certificat e o f Verificatio n

56 1 SOI L 2010-06-1 9 18:0 2 30.9 4 Fina l 2820 5 151 0 Gran t s t D Z 13 " N
. LOPE Z confirmatio n non e

± Erro r ± 17.65 9

### y^j'*'^^
. 

## / jQk ^

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

I Coasta l Environmenta l Grou p Inc
. SL^^^J ^

www.coastalhazmat.co m ^pnattJ ^ COASTA L INVIIONNIIITA l Ciour
. IN C 

# EXECUTIV ESUMMARY : BVID #28205-(151 0 GRANT ST )
No Issue s o r Concern s | ^ Issues/Concern s
Detai l Explanation : • - DA NGARVE Y WALKE D THETROPERT Y O N 7/13/1 0 * .-^^-->.

­

### 0 % 

## EP A Propert y Clos e Ou t For m ;KV>I^, ^ Properl y # : "2
. ^^?P ^ Propert y Addresr
. -J-^i^^^T-- ^ Date/Time : Owner' s Nttm:
. /42t £rsiLDf£
. Quad s Excavated : ^ Contracto r Crou p fjy^V(7 ^
Ye s N o Excavatio nGenera l 1
. I f necessuy , wer e th e conec t quadnint(s ) excavate dan dreslored ? / 2
. I f necessary , wer e th e correc i area s o f dri p zon e excavate dan drestored ? 

### y Gradin c So dan dVcseUtio B Ye s ^ o Doe s Ih e gradin g aroun dth e perimete r ofth e hous e i nexcavale darea s generall y slop e away 

## y Gn mth e house ? — Ha s .so dbee nlai di nal l area s that wer e excavated ? 

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

### y Ar e sodde darea s generall y finman devenl y graded ? 

### y 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 y tin w period ) Wa s tb e property grade dsuc hthat wate r wil l no t poo l onth e propen y 

## y Wa s dainag e t o landscapin g o r plan t material s avoided ? y Gates
. Ftpce i an dRetataitn g Wal b Ve s N o I 1
. £> o gate s ope nan dclos e freely? (Ifappiicable ) y 2
. Wer e al l gate s o r fence s take ndow ndurin g restotatio nactiviiie s reinstalled ? (I f applicable ) j y 3
. Wa s damag e t o gate s o r fence s avoided ? (tfapplicable ] 4
. Wa s damag e t o retainin g wall s avoided ? (Ifappiicable ) 

## y . Foundation , SidiB K an dGttMer s Ye s .N o 1
. Wa s damag e t o th e sidin g o r tri mavoided ? 

## y 2
. Wa s damag e t o th e foundatio navoided ? 

### y 3
. Wa s damag e t o window s avoided ? • A Wa s damag e t o window s o r doo r screen s avoided ? / 2
. Wa s damag e t o downspout s o r downspou l extension s avoided ? 

## y Sidewall u an dDriveway s fCoocrcte ) Ye s N o 1
. Wa s damag e l o drivevra y surface s avoided ? 

## y 2
. Wa t damag e t o wallcwa y surftce s avoided ? 

### y

## OM'oer s comments :

jlnspectio nnotes :

Remova l an drestorationactivate s complet e includin g th e 30-da y so dwarranty : EP A Representative Qf^^^ ^ Date : r/is/i o

## Propert yCompletio n Agreemen t riii s agreemen t documenl s lh e complclio n o l remedia l acliviiie s perfonne d o n mypropert yM ysignature wil l designat e lhat I a m satisfie d wil h th e restoralio n o f m ypropeily
. an d tha i n o item s ar e i n queslions
. now , o ra l an ylim e i n th e future , except thos e ilem s liste d below , i f an y

Propert yID : g^-^og " Propert yAddress : /^ / Q QjCCKyr ^ f S J^ ' Owner : ^rH-g. ^ 

# I 

# M Phone : nf H " "5^ 3 S " Restoratio n Item s i n Question :

Item : 

## Pl\/^+ - f\ y4^>4W) ^ 6 ^ 

## 6.s>iA W -s>)ckz ^

ocPkc3i^<,s ^ Item : * Item : Item : Item : Item : Additiona l Comments :

. ^

^ 1 H^rc e rtuto rti l io n Kcompleted , rxccp i a s noter i [_ | I rio no t acre cresipmtio n i t complete d 

## oC-IJ^-i<a > 

# y.^y - Dat e !^nt i arior' s Signatur e Dal e Owner' s SiQnatnr e V ^

# @l /
Propert y Owne r Assessmen t of Performanc e For m America nRecover y an dReinvestmen t Ac t (ARRA ) Omah aLea dSuperftin dSite -DvnvjXTVT ^ 

# 2009/201 0 luacis i VlS D JU N 

## 18 201 0 Remediatio nContractor : Coasta l Environmenta l Grou p - EP-R7-09-0 6 X.05 " SIH^ERFUN D DIVISIO N Propert y Identifie Identifie r Nnmber ; "2- ^ Z.05 ^ Propert rropert y y Address

Address : : /.'^/0 ~ inrrKi/\J^ ^ C:nnrM/\-V

- ' ^ /A^/ O ^y r Propert y Owner' s Name ; ^^^^1^5^+

- (^-C^ ~ Instruction s to th e Propert y Owner ; Thi s for mserve s to recordth e Propert y Owner' s assessment of performanc e (Incentiv e 1

- Qualit y Assuranc e Siuveillanc e Plan ) involvin g th e liste dremediatio ncontractor , as applicabl e to th e Omah aLea dSite
. Thi s for mdoctmient s th e timelines s of punc hlis t resolution , busines s relations , complaint resolutio nan dth e overal l qualit y of work
. If nee dbe , th e 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 dtoanassigne d address , fo r example , busines s relation s that generally don H follo w the guideline s set fort h

inthe Perfomianc e Wor k

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

by checkin g anumerica l ratin g onth e tabl e belo w usin g th e numerica l definition s from th e ratin g scal e below , the nsig n& dat e th e 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 Assessmen t of Performanc e Regardin g th e Contractor' s Wor k 10
. 5 9 y 4 8 3 7 2 6 1 Propert v Owne r Additiona l Comment s fro m(optional ; continn eonbac k pag eif needed )
Propert y Owne r Signature : 

## <^^y^>^^^ y* ^ ^Date ; _^4o^5V f

# b Wate rBil l Settlemen t

Property ID 28205 PropertyAddres s 151 0 Gran t St Tenan t Ernes t Ro y

I hav e receive dfromth e contractor , Coasta l Environmenta l Grou p Inc
. (Coastal) , th e sum of $ 7.1 4 for wate r usag e require d to maintai nth e sod
. Check Number 196 5 Value of Check $7.1 4 Mad e Ou t To Ernes t Ro y Description of Settlemen t To reimburs e tenan t fo restimate d wate rcharge s on thei rMU D monthl yinvoices
. Mysignatur e belo w is acknowledgemen t of th e receip t of th e su m liste d above , whic h I furthe r acknowledg e to be fai rcompensatio n an d ful l paymen t fo rth e above , an d releas e Coasta l Environmenta l Grou p Inc
. fro m furthe robligation s orliability
.



### Iwner' s Signatur e Date Contractor' Contractor' s s Signatur

Signatur e e Date

COASTA L ENVIFtONMENTA L GROU P INC
. 241 1 MARTH ASTREE T 27-5/104 0 00 3 624737290 4 OMAHA/N E eSIOf r 

# U\99J^ 0 DAT E PA

Y TO TH E ORDER Of 

## '^ F'^Afts V \M
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# $ 1 ^ §fj)giAOLnd'^lj» i 

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. «WtliFagciBanlt,UA ^ ftofmil u

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