## TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAID# : Date : 

# M i
Addres s 

# : 

# H<^ ^ ki^ ^ 9 r Remediatio nContractor : Coasta l Environmenta l Group

_Year : _2010ARR A
SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f property (DVD ) 

# y Executiv e Summar y 

# y EPA-provide dproperty sketc h 

# y Signe dAcces s Agreemen t fo r

subjec t property 

## -rr - Signe dAcces s Agreement(s ) fo r

adjacent property Restoratio nAgreement Settlement document s (i.e. , fo r

damag e or to replac e plants , etc. ) Confirmatio ndat a 

# y Photograph s ife

- (y'i^A'a ^ t CX^^AiU? ^ ^ >'^> 7 As-buil t sketc h Satisfactory restoratio nsigne db y Property Owner 

# y Property close-ou t chec k lis t signe db y EP A 43 - 

### Descriptio no f area s no t meetin g RO D cleanu p criteri a Utility clearance s 

# y Property informatio nfro mDougla s Count y Assessor' s Office D \ J D
/ 

# .-^yv , 3 L 

# 1 m u Signatur e Dat e 3023729 2 Superfun d

## Propert yAcces s Checklis t Propert y ID : g m*^ 0 Propert y Address : 14 ^ S>>^l H W n nWOR K STARTE D WOR K COMPELTE D ON : ON : / // / Owner:1^^,V ) R>,4pr S Address :

Ph^ne V S<^|-0^ ^ Fax : Cell/Pager : Renter : Phone : Fax : Cell/Pager : Additiona l Information :

E

D Notificatio nLette r M Acces s Agreemen t 1 1 Restoratio nAgreemen t 0 Topsoi l Samplin g (i f applicable ) Q Disposa l Samplin g (i f applicable ) 1 1 Garde nSamplin g (if applicable ) ffl Utilit y Clearanc e D Video/Photo s (Before ) nVideo/Photo s (During ) nVideo/Photo s (After ) nVideo/Photo s (30-Day ) Q Propert y Completio nAgreemen t nFina l Repor t Sent : / / 

## Signed : :2^/S_/I D Signed : / / / / / / / / CaUed:a t /\v \/ V

o On : / / On : / / On : / / *On : / / Signed : / / Issued : / / By : By : By : By : By : By : By : By : By : By : By : By : By : 

### <-.uA\oK o

Ai r Monitorin g (a s applicable ) I I Communit y C H Cre w Results : On : / / By :

r~ ] Communit y Results : d l Cre w On : / / By :

nCommunit y Results : [ H Cre w On : / / By :

Omah a Lea d Sit e

### D.ougla s County Accoun t Infij|[»|tio n Pag e 1 of 2
Dougla s County , Nebrask a Propert yRecor d - R214756000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s avaiiabi e @ scai e 0-5 0 ft wes t of 52n d S t - Vie wO H Ma p Informatio n i s vali d a s o f 2009-10-1 5 Treasurer' s Ta xRepor t Ne wFeatur e ->-•- » Aut o Sale s Searc h Owne r PETER S DAVI D C ETA L 72 5 N 5 7 S T OMAH AN E 68132-000 0 Propert yInformatio n Ke yNumber : 475 6 OOO O 2 1 Accoun t Type : Residentia l Parce l Number : 214756000 0 Parce l Address : 453 0 SEWAR D S T OMAH AN E 68104-000 0 Lega l Description : SAUNDER S & HIMEBAUGH S AD D LO T2 0 BLOC KH 5 0 X 15 0 Valu e Informatio n

200 9 200 8 200 7 200 6 200 5 200 4 Lan d $6,800.0 0 $6,800.0 0 $6,800.0 0 $6,800.0 0 $6,800.0 0 $6,800.0 0 Improvemen t $49,000.0 0 $49,000.0 0 $49,000.0 0 $49,000.0 0 $32,300.0 0 $32,300.0 0 Tota l $55,800.0 0 $55,800.0 0 $55,800.0 0 $55,800.0 0 $39,100.0 0 $39,100.0 0 Lan d Informatio n Acre s 0.1 7 S F 7500. 0 U nit s 1. 0 Dept h 150. 0 Widt h 50. 0 Vacan t N o Improvement Informatio n Buildin g 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2.
. . 10/23/200 9

### D.ougla s County Accoun t InfijMytio n Pag e 2 of 2 ^myti i

riT * tSjgp f CLICO0JNy»RG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1086. 0 Percen t Complete : 

### 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Averag e

Buil t As : 1 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 6. 0 Exterior : Fram e Sidin g 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 : 

### 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 0 0 % 192 0 9 0 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 992. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 

### 1.0 Garag e Detache d 216. 0 Porc h Sla b RoofCei l 112. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2.
. . 10/23/200 9Pag e 1 o f 1

" > Creat e Anothe rTicke t Bac k t o Irt h Interne t Sen d Emai l |

• YOU RTICKE T NUMBE RI S 2518900
. Origina l Cal l Date : 6/14/1 0 Time : 1:5 8 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 6/16/1 0 Time : 2:3 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 453 0 Street : SEWAR D S T Twp : 15 NRng : 13 E Sect-Qtr : 17-N W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n Locatio n o f Work : INCLUD E AL L EASEMENT S LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LO T 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 : 4f t Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac 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 DISTRICT SANDY Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFICSEWER RICH/TRAFFIC Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 OPPDGPR 5 OMAH A PUBLI C POWE RDISTRICT EL M LOCATIN GAlt : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 QLNNEI C QWES T LOCA LNETWOR K EL M LOCATIN GAlt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 6/14/201 0

# As-Buil t Drawin g COASTA L 

# Omah aLeadSuperfun dSit e
• MViaOIIHIHTA L

I O U r . IMC

. OLS# : 8147 7 Dat e Excavated : 6/16/201 0 Dat e USEP ASiane d Off : 7/8/201 0 Are a Sodden : 121 5 s a 

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### D RDZSCPXA-81477 D Z 

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### D D Date : <l/2.H/o e RPgOCPXA-01477 PS ­ " ,..PP" « 

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. F 2 - Fron t Right , 8 1 = Bac k Left
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. G Z = Garelen

. PZ = Pla ;



### 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/Ma i ch Are alef t bar e 

### Contrac t # : EP-R7-07-0 5 Coast:a l Environmenta l Grou p Inc
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c\Qt\ rV vfj(/ b liiiiiimwi i Omah a Lea d Sit e Sit e Sketc h Samplin g Address : 453 0 SEWAR D S T Extftio t Pain t [7 ] Goo d
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. , 131 ? .pp m H D XR F Unit : (oSH O Book : 2 A y nOiIOOrXA-0147 7 -62 - - ppm n D Date : <i/^^/o e RrgOCPXA-9147 7 PZ ­ - ppm Numt)e ro fSample s = [ n 5 \ \ D O \ Time : Staff : 

### F/ H J^JL
. Legend : F l = Fron t Left
. F 2 = Fron ! Right
. B 1 = 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 th e street , facin g propert yAll^ V

# r

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. Niffnbe ro fSample s = [ 5 | | O \ Legend : F 1 = Fron t Lett , F 2 • Fron t Right , 8 1 - Bac k Left , B 2 = Bac k Righ t D Z •= Dri p Zone , G Z = Garden , P Z = Pla ; A H quadranl t ar e a s vievm d tra m th e straat
. racin g propert yA-JlS V

^ " ^ 

# ^^ c

Rrv^iO g rrc«ed : 'tf-Ai^-fi B

### 8147 7 ExUrio rPain t Omah a Lea d Sit e [J ] Goo d Sit e Sketc h • Poor Samplin g Address : 453 0 SEWAR D S T [ ] No t pain t Lea d Sampl e Sample s Collecte d Sampl e Ntimtie r LA B Concentratio n Collecte d Fimi : FD ADb-T D RYASCPXA-8147 7 F l ^^2
. ppm"M " ^ 

### D Date : f>-^5'0 b RYBSCPXA-8147 7 F 2 "^7 0 pp m 0 

### D Time : W-5 0 q m RYCSCPXA-8147 7 B l _aiiA.pp m 

### D Samples Analyze d RYDSCPXA-8147 7 B 2 ^2. B pp m 

## n RDZSCPXA-8147 7 D Z 

### 131 ? .pp m 

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## n Date : y/eV/o f • RrZOCPXA-ei47 7 PS - .pp m 

## n D Time : P M Staff : I. A• Numbe ro f Sample s = | 3 \ \ O 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 quadrants are a s viewe d fro m ttt e street , racin g propert yAfl^ V

Rcv2i"i 8 i,Vtr.ucJ : 'i.^-Auc-r- R^v^eosr,
.
COA S T AI ENVIKONHIhlA I
" < PRO^t " cKo u rI h c 

## Consen t fo rAcces s T o Fr o pert 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 Agency(EPA ) o rit s authorize d representatK'es , 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 : CVi/jn ^

Owner' s Name : ( \ ^ '^ /-T"/"^* ^ Daytim e Phone :



## '- I S3C i S^f^^ ^ o ^ Addres s o f Propert y covere d b ythi s Agreement : 

# d r\^a^ ' 

# T ) y

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 f lea 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 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 hav e a n opportunit yt o revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e i t begins
. Onc e th e wor k i s finished , th e Granto rwil l b e aske d t o revie wth e wor k an d confir m tha t i t i s complet e an d meet s wit h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m EP Atha t th e 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 , 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 f performin 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 f2K'-' I O * COASTA L

••• t PRo't ^ cn o u p t Kc 

### cRemov 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 necessary ' subsequen t t o a n initia l waterin g perio d byEPA ; cAbid e b yhealt h an d safet yguidanc e provide d byEPA ; fI fth e property ' i 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 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 wothers t o us e th e propert yi n suc h a manner . Shoul d you hav e an yquestion s abou t thi s program , pleas e contact Coasta l Environmenta l Group , a t (402 ) 991-119 9 jZ l I gran t access t o m ypropertie s G i d o not gran t acces s t o m ypropertie s

Signatur e Dat e Signatur e Dat e

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

Pag e 2 o f2COASTA L ENVIRONMCNTA L CROUP

. INC

. 

## Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o provid e amutual agreemen t a s t o condition s o f th e property prio r t o remediatio nactivities
. Thi s wil l als o serv e a s documentatio nfor th e purpos e o f assurin g that restoratio n activitie s ar e complete dt o th e satisfactio no f th e property owne r an dth e Unite dState s Envirormiental Protectio nAgenc y (EPA)
.

PropertylD : ^^L\"^ ^ Propert y Address : 1^5 ^ ^P^nQi A^ f Owner : 

# SiSISS S Phone : HQ ; 5^ 1 9^f< ^ O nth e attache ddiagram(s ) indicate area(s ) t o excavate , surfac e structure s an dlandscapin g feature s an d acces s location(s ) t o b e use db y th e contractors . Indicate distances , depths , material types , etc . Photographicall y an dVideographicall y document th e existin g condition s ofth e property an dth e basement i f necessary . 

### Item s t o b e Remove d b yth e Owne rbefor e Star t o fRemediation : Th e removal , storage , disposal , and/o rretur n o fthes e item s i s th e Owner' s responsibility
. Item :
Item : /
Item : ^^-v, ^
Item : /



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

# fAJ s Item : / 

### Item : I Item : j

Pag e 1 of
. 1COASTA L ENVIRONMENTA L GROUP , INC

. 

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

# ^^> l 

# ' f/.D Z Item : 

## ^CP 4 - F i 17Z^e»i - V 2 Or>l ^

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Item :



## Ite m Pre-existin g property area , that will b e excavated , tha t i s covere dwithgrass . Numbe r o f tree s > 2 inc h trunk diamete r Numbe r o f tree s < = 2 inc h trunk diamete r Numbe r o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Attac hasketc ho f the sprinkle r layout
. Numbe r o f an dsiz e o f eac hgarden/ flower be d area . Attac hasketc ho f relativ e size s andlocations
. 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 wil l b e use dt o issu e aplan t vouche r t o th e propert y owner . Easemen t Area , to b e excavate d 

## Landscap e Inventor y Quantit y Uni t Condition/Type/Specie s Quadrant s 

# n,i ^ '

- i l Eac h
Eac h (^*H,^ \

; » Eac h

Eac h Squar e Feet / 

# f $ 

# i«^
. Eac h ^>m^\V\c t
Pag e 2 of
.COASTA L CNVinONMENTAl

. CROUP , INC

.
Additiona l 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 l Protectio n Agenc y(EPA ) ma yb e removin g an d replacin g soi l underlyin g a grave l o rdir t are a o n you rpropert ytha t yo u ma yb e usin g a s a drivewa yo rvehicl e parkin g area . I 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 EP A 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
. IT I Pleas e chec k thi s bo xi fyo u understan d th e informatio n outline d above
.

^ 1 i e <

Z I 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
. 

### jPl I agre e . FIl-dL o no t agre e

Owner' s Signatur e Dat e Contractor' s Signatur e Dat e Pag e 3 of
.BVID # 

# M M XR F PROPERTYSAMPL E SHEE T Dat e 

## H T^O\ 0 Addres s 

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## Prin t UM^C ^

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 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 XRFTEC H MIS C NOT E

pp m P b 33.81 5 Supervise d By : 

## Certificat e o fVerificatio n

159 1 SOI L 2010-07-2 1 13:4 1 92.0 9 Fina l Av g o f1588-159 0 453 0 Sewar d s t D Z 13 " N
. LOPE Z confirmatio n non e

± Erro r
± 11.39 4

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1 

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 158 8 Mod e SOI L Tim e 2010-07-2 1 13:4 0 Duratio n 30.4 9 Sequenc e Fina l Flag s BVI D 8147 7 ADDRES S 453 0 Sew/ar d 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 33.90 6 ±11.33 0 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 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 XRFTEC H MIS C NOT E

pp m P b 32.99 3 Supervise d By : 

## Certificat e o fVerificatio n

158 9 SOI L 2010-07-2 1 13:4 1 30.9 2 Fina l 8147 7 453 0 Sewar d s t D Z 13 " N
. LOPE Z confirmatio n non e

± Erro r
± 11.25 6

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 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 34.54 6 Supervise d By : 

## Certificat e o fVerificatio n

159 0 SOI L 2010-07-2 1 13:4 1 30.6 8 Fina l 8147 7 453 0 Sewar d s t D Z 13 " N
. LOPE Z confirmatio n non e

± Erro r
± 11.59 5

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 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

pp m P b 195.54 6 Supervise d By : 

## Certificat e o fVerificatio n

157 3 SOI L 2010-07-2 1 13:2 7 91.6 6 Fina l Av g o f1570-157 2 453 0 Sewar d s t EA 1 " N
. LOPE Z confirmatio n non e

± Erro r
± 19.60 3

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 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 207.44 0 Supervise d By : 

## Certificat e o fVerificatio n

157 0 SOI L 2010-07-2 1 13:2 6 30.5 4 Fina l 8147 7 453 0 Sewar d s t EA 1 " N
. LOPE Z confirmatio n non e

± Erro r
± 20.21 1

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 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 188.35 0 Supervise d By : 

## Certificat e o fVerificatio n

157 1 SOI L 2010-07-2 1 13:2 6 30.6 0 Fina l 8147 7 453 0 Sewar d s t EA 1 " N
. LOPE Z confirmatio n non e

± Erro r ±

19.29 2

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 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 190.84 8 Supervise d By : 

## Certificat e o fVerificatio n

157 2 SOI L 2010-07-2 1 13:2 7 30.5 2 Fina l 8147 7 453 0 Sewar d s t EA 1 " N
. LOPE Z confirmatio n non e

± Erro r ±

19.30 6

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 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

pp m P b 87.16 6 Supervise d By : 

## Certificat e o fVerificatio n

157 7 SOI L 2010-07-2 1 13:3 0 91.5 5 Fina l Av g o f1574-157 6 453 0 Sewar d s t F l 4 " N
. LOPE Z confirmatio n non e

± Erro r
± 14.33 5

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 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 XRFTEC H MIS C NOT E

pp m P b 84.69 0 Supervise d By : 

## Certificat e o fVerificatio n

157 4 SOI L 2010-07-2 1 13:2 9 30.5 2 Fina l 8147 7 453 0 Sewar d s t F l 4 " N
. LOPE Z confirmatio n non e

±Erro r ±14.20 7

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 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 92.24 5 Supervise d By : 

## Certificat e o fVerificatio n

157 5 SOI L 2010-07-2 1 13:3 0 30.5 6 Fina l 8147 7 453 0 Sewar d s t F l 4 " N
. LOPE Z confirmatio n non e

± Erro r
± 14.62 7

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 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 84.56 4 Supervise d By : 

## Certificat e o fVerificatio n

157 6 SOI L 2010-07-2 1 13:3 0 30.4 7 Fina l 8147 7 453 0 Sewar d s t F l 4 " N
. LOPE Z confirmatio n non e

± Erro r ±

14.17 0X ^^^'^^
. 

# m Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
. www.coastalhazmat.co m \ COASTA L ENVIRONHENTA L CROUP , IN C 

# EXECUTIV ESUMMARY : BVI D #81477(453 0 SEWAR D ST )
N o Issue s o r Concern s Issues/Concern s
Detai l Explanation : -DANGARVE Y WALKE D TH EPROPERT Y ON7/8/201 0

## EP APropert y Clos e Ou t For m Propert y tf : Propert y Address : Dote/Tlroe : Owner' s Nam e 

# ZJ^ & Quad s Excavated : Contracto r Grou p Excavatio nGenera l I
.i f necessaiy , wer e th e correc t qtutdrant(s ) excavate dan drestored ? 2
.If necessary , wer e th e correc i area s o f dri p zon e excavale dan drestored ? Gradin e So dan dVcKeUlio n 1 Doe s th e gradin g aroun dth e perimeie r ofth e hous e inexcavaicr i area s generall y slop e away fromtb e house ? 2
. Ha s so dbeenlai dinall area s tha t wer e excavated ? 3
. Doe s th e so dappea r to b e generall y health y andgrowing ? (Onl y evaluat e if iaspecie da t a3 0 da y tim e period ) 4
. Ar e sodde darea s generall y firmandevenl 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 htha i wate r wil l nol poo l o nlh e property" '

• 7
. Wa s damag e t o landscapin g o r plant material s avoided ? Gates
. Fence s an dRetainin g Wall s I 1
. D o gate s openandclo-s e freely? (I f applicable ) 2
.Wer e al l gate s or fence s take ndowndurin g restoralio nacliviiie s reinstalled ? (I f applicable ) 3
.Wa s damag e t o gate s or fence s avoided ? (Ifapplicable ) 4
.Wa s damag e t o reuinin g wall s avoided ? (Ifapplicable ) Foundation , Sidin g an dGutter s t .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 t o window s avoided ? 4 Wa s damag e to window s or doo r screen s avoided' ] Wa s damag e i o downspout s or downspou i extension s avoided ? Sidewalk s an dDriveway s (Concrete ) 1
. Wa s damag e to drivewa y surface s avoided ? 2 , Wa.- ; damag e t o walkwa y surface s avoided ? Ye * N o 

### / y Ye s N o / 

## y y y 

# y y
Ve s N o 

### / 

## y y y Ye s .N o 

### y 

## y y 

## y

^

Ye s N o 

### y 

## - y• 

# f Ort'ner s comments :



# Hn. ' spectso nno<es :

Removal andresloralio naclivale s complel e includin g the 30-da y so dwarranr)' ; tP ARepreseniativ e fl»« 4H
. Date : ll^l^ L

## Propert yCompletio n Agreemen t (hi s agreeme m clocuinen(s

. (h e completio n o f remedia l acliviiie s perlbime d o n m yproperly
. M ysignatur e wil l designat e iha l i a m salisfie d wit h th e restoratio n o f m yproperty , an d tha t n o item s ar e i n questions , now , o rat an ytim e i n th e future , excep l thos e item s liste d below , i f an y

PropertylD : ^/t f^- ^ Propert yAddress : (JC^^y Q S^UJO^J i ^ Phone : 

# ^C)^-g^->^.g ^ Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : item :
Additiona l Comments :

[2 5 I agre e I rsforalio n i s completed , excep l a s noler i [ I I rio no t a(;re crestoratio n wcomplclcr i

Cont i actor' s Signatur e Dat e ^

## RECEIVE8'*<*P*'" ^ 

# Owne r Assessmen t of Performanc e For m America nRecover y an dReinvestment Ac t (ARRA) JU L1 2 201 0 OmahaLea dSuperfundSit e SUPERFUN D DIVISIO N2009/201 0 Remediatio nContractor : Coasta l Environmenta l Grou p - EP-R7-Q9-Q6 Propert y Identifie r Number ; Wl^y ^ ^ Propert y Address : l( ^ ^ .b>2o ( ^g^^^$ ^ Propert y Owner' s Name ; Y^O-yi- ^ Y^LUy^dr - Instruction s t o th e Propert y Owner ; Thi s for mserve s to recor dth e Propert y Owner' s assessment of perfonnanc e (Incentiv e 1

- QuaUt y Assuranc e Surveillanc e Plan ) involvin g th e liste dremediatio ncontractor , as applicabl e t o th e Omah aLea dSite
. Thi s for mdocument s th e timelines s of punchlis t resolution , busines s relations , complaint resolutio nandth e overal l qualit y o f work
. I f nee dbe , the Propert y Owne r ma y utiliz e thi s for mt o recor dproblem s and/or issue s not specifically tie dto a nassigne d address , fo r example , busines s relation s tha t generally don' t follow the guideline s set fort hi nthe Perfonnanc 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 the numerica l definition s fro m the ratin g scal e below , thensign& date th e form
. 9-1 0 "excellent " 7- 8 "ver y good " 5- 6 "acceptable " 3- 4 "poor " 1-

2 "ver y poor " Property ' Owner' s Assessment of Performanc e Regardin g th e Contractor' s Wor k 1 0 / 5 9 4 8 3 7 2 6 1 Propert y Owne r Additiona l Comment s fro m(optional ; continu e onbac k pag e i f needed )
Propert y Owne r Signature ; 

# y)- j CUA J D..e:7/77/^^