### # 

## TRANSMITTALof OMAHALEAD SIT E SOI LREMEDIATIO NHL EFOLDE R
SAID # 

# : ^^(^ ^Date : ' ^ ( 5 / i ^ Address : Remediatio nContractor : Coasta l Environmenta l Group

_Year : _2010ARRA
_ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S / Vide o o f property (DVD ) W

r Executiv e Summary 0 EPA-provide dproperty sketc h p ^ Signe dAcces s Agreemen t for subjec t property -fl

- Signe dAcces s Agreement(s ) for adjacent property WRestoratio nAgreemen t ^ ^ Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) -^r

- Confirmatio ndat a

WPhotograph s ^ f ^ ^ 6> ^ 6\1//nW i Y ^C/^fing ^ } h" ^ gj / As-buil t sketc h y ( Satisfactory restoratio nsigne db y Property Owne r 0 Property 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 M Utility clearance s bf

Property informatio nfromDougla s Coimty Assessor' s Offic e D



### Signattire 3021765 5 Superfun d#



## Propert yAcces s Checklis t PropertylD : V^QX^'^ , Propert y Address : C^f S "X Z \ D D WOR K STARTE D WORKCOMPELTE D ON : ON : / // /
Owner : 

## 6iffft\ A toA< i Address : 

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Acces s Agreemen t Restoratio nAgreemen t Topsoi l Samplin g (i f appUcable ) Disposa l Samplin g (i f applicable ) Garde nSamplin g (i f applicable ) UtiUty Clearanc e Video/Photo s (Before ) Video/Photo s (During ) Video/Photo s (After ) Video/Photo s (30-Day ) Propert y Completio nAgreemen t Fina l Repor t Sent : / / Signed : 0^/^/V > Signed:aS_/aa/VA
_ / / / / / / CaUed:0 ^ / aH/V O On : C ^ / «a / \£

> On : / / On : / / On : / / Signed : / / Issued : / / By : 

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= v^i*.v^\«. ^ By

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## ^y

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nCommunit y Results : O Cre w On : / / By :
O Conununit y Results : O Cre w On : / / By :

Omah a L^a d Sit e

## Douglas Coimt y Accoun t Inf(»^Ko n Pag e 1 of 2 ' # ' Dougla s County , Nebrask a Propert yRecor d - R194747000 2 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f 52n d S t - ViewO H Ma p Informatio n i s vali d a s o f 2009-11-1 9 Treasurer' s Ta xRepor t Ne wFeatur e ->->• • Aut o Sale s Searc h Owne r TOD D GERAL D L ETA L 655 3 FLORENC E BLV D OMAH AN E 68112-000 0 Propert yInformatio n Ke yNumber : 474 7 000 2 1 9 Accoun t Type : Residentia l Parce l Number : 194747000 2 Parce l Address : 655 3 FLORENC E B D OMAH AN E 68112-000 0 Lega l Description : PARKWOO D LO T2 8 BLOC K1 -E X IRRE G E 263.7 1 FT - LO T2 8 BL K1 Valu e Informatio n Lan d Improvemen t Tota l 

### 200 9 $7,000.0 0 $93,100.0 0 $100,100.0 0 200 8 $7,000.0 0 $93,100.0 0 $100,100.0 0 200 7 $7,000.0 0 $82,300.0 0 $89,300.0 0 200 6 $4,000.0 0 $82,300.0 0 $86,300.0 0 200 5 $0.0 0 $0.0 0 $0.0 0 200 4 $0.0 0 $0.0 0 $0.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.2 5 

### 11319. 0 1. 0 0. 0 0. 0 N o Impro t vemen Informatio n Buildin g 1



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

### Dougla s County Accoun t Infqj^|tio n Pag e 2 of 2 

# w

555 3 FLORENC E 8 0 3 * '^J' ' >*»T g ait qB

first Floo r 921. 0 s o f t Sflooo o Floo r U 2 0 sq . f t

SieRoorCnIm g

lazu n 1 1/ 2 STOR Y Ssnm t Blocl l 8 t t 91J0wf t gSLtMgiBMiLU'imm CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1803. 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 : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 7. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 2. 0 Roo fCover : ! Compositio n Shingl e Bedrooms : 2. 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 191 5 0 % 191 5 9 4 Detai l Typ e Oefa/7 Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f l 912. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 2. 0 Garag e Detache d 480. 0 Porc h Sla b Roo f Ceilin g 192. 0 Porc h Sla b Roo f Ceilin g 96. 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 jfZ l ^§J^Ki°:'l!?J."Jg'"'?® J .^ \ 11^

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### YOU RTICKE T NUMBE RI S 2501393
. Origina l Cal l Date : Wor k t o Begi n Date : 5/24/1 0 5/26/1 0 Time : Time : 4:5 5 p m 5:3 0 p m Op : ELIZABETH1879 0
State : N E County : DOUGLA S Place : OMAH A Address : 655 3 Street : FLORENC E BLV D Twp : 16 NRng : 13 E Sect-Qtr : 34-NW 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 Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MAGELLANMUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac t Phon e Numbe r UtiUt y Typ e
CXCAT V CO X COMMUNICATIONS , IN C HEID I 

### Day : 402934046 9 Ah : 402934046 9 Emerg : 402932975 7

x>

r A /-C TT A X T MAGELLA NMIDSTREA M PARTNER S r,ciir. D AU MAGELLA N
. p DEBORA H 

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

MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0

OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R RICH/TRAFFI C 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 5/24/201 0

### Pag e 2 of 2

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

### Day : 406728934 3 AU : 406207149 4 Emerg : 888728934 3
QLNNEI C QWES T LOCA LNETWOR K ELM LOCATIN G 

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

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 5/24/201 0

# As-Buil t Drawin g ^ C OASTA L 

# Omah aLea dSuperfun dSit e ENVIBONMCNTA L CROUP
. INC
. OLS# : 4018 2 Dat e Excavated : 5/26/201 0 Dat e USEP ASigne d Off:6/10/201 0 Are a Sodden : 132 6 sof t I

- Name : C^^.J } Omah a Lea d SH e Date : l2--3i-- 3 Nort h Arro w—i Address : J£S3
. Sit e SIcetc h Time : Iz^'^-- ^ Phone :
Tea m^<r k 3." ^ [ i ^ * BVID # 

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### Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
.Name : GiL^t-.U
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# l3o^ OmahaLea dSit e 46130# # # # Name : Gi/-a.lr)
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### Date : lt-3l-^ 3 Nort h Arro w Address : ^ST 4 /Jorr^re
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### Time : l2tf~2- ^ Phone :
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COASTA l INVItONHtllU l cI t o u r> h c 

## 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 : ^D//^2 ^ 

# ^^^M^T W Owner' s Name : Daytim e Phone : 

# ^/S3

-
Addres s o f Propert y covere d b ythi s 

# ^g^-^ b p'Cm^'t ^ Hi/c L 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 lead an d ma ypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t o remove contaminate d soil
. Th e remove d contaminate d soi l wil l be replace d wit h clela n material s an d th e are a wil l b e restore d t o it s origina l condition
. Thi s work i s bein g performe d unde rth e Omah a Lead Superfun d Site remediatio n program . Arepresentative of 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 performed , th e Granto rwil l hav e a n opportunit yt o reviewan d approve th e planne d soi l removal , an d restoratio n work 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 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 i 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 has bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :

Pag e 1 o f 2^"to"«r

COASTA L IPfVmONHIKTA l C « O U rIN C 

### t Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; G Remov 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 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
. 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 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 . Shoul d you hav e ari yquestion s abou t thi s program , pleas e contac t Coasta l Environmenta l Group , a t (402 ) 991-119 9 \^gnnt acces s t o m y propertie sD I d o no t gran t acces s t o m y propertie s 

# AtuU)3Ll ^ <~i.x.~/f f Signatur e Dat e Signatur eDat 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 2C O A S T A L • MVIMONHBNTA L a I I O U P
. INC
. 

## Restoratio n Agreemen t Th e purpos e ofthi s agreemen t i s t o provid e amutua l agreemen t a s t o condition s ofth e propert y prio r t o remediatio nactivities
. Thi s wil l als o serv e a s documentatio nfo r th e purpos e o f assurin g tha t restoratio n activitie s ar e complete dt o th e satisfactio no f th e propert y owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA)
.

Propert y ID ; CfQ l ^'Q
_ Propert y Address : /^C-e;? ^ P^^^T ^ fh^^/r^L ^ Phone : 

# •^C^ - 9^'? ^ O nth e attache ddiagram(s ) indicat e 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 . Indicat e distances , depths , materia l types , etc . Photographicall y an dVideographicall y documen t th e existin g condition s ofth e propert y an dth e basemen t i f necessary . 

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

### Hem : 

# Sy ^ 

# 4 /7Jairr ' -/- o h ^ ^C K /(/O^C / e ^ 

### Kem: ' 0 item : item :



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

# /tv^s j sv^ ^ ^ 1 ^ U^f } fef ^ h^ l 7 nJ Ke m Hem : Kem :

Pag e l o f

### /C OASTA L • M V I R O N M • M T AL a I I O U P
. IHC
. 

### Item s t o B e Remove d B yContracto r Durin g Remediatio n an d Reolace d Kem : 

# ^ l FZ - 

# D ^ Kem : 

# 9x 1 

# ? t ' 

# P ^ Kem : Kem :


### Landscap e Inventor y Ite m Quantit y Uni t Condition/Type/Specie s Pre-existing propert y area , 

# f^O ? Quadrants tha t wil l b e excavated , tha t i s coveredwit hgrass . Numbe r of tree s > 2 inc h Eac h 

# Z

­ trun k

diamete r Numbe r o f tree s < = 2 inc h Eac h tnm k

diamete r / Numbe r o f Sprinkle r Zones , Control Valves , Eac h 

# M o Timers , Heads , etc . Attac hasketc ho f th e sprinkle r layout
. Ntmibe r of an dsiz e of eac hgarden / flowe r bed Eac h 

# ^ A ^ area . Squar e Fee t Attac hasketc ho f relative size s an dlocations
. Agree dupo nvalue of plan t material s not to b e replacedb v contractor . Not e thi s valu e will b e usedt o issue aplan t voucher t o th e property owner . Easemen t Area , t o b e excavated 

# 4 '2 ^ Eac h 

# i^d^fju ^ f\si.cMl4 s
Pag e 2 of ^C O AS TAL • MVmONMIMTAI
. O • O U P
. IM C


### AddKlona 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 parldn g areas . Th e Environmenta l 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 f sol i 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 cK yi f yo u us e a grave l o rdir t are a a s a drivewa yo rpartdn g area , no t withstandin g an yremova l o rreplacemen t o f soi i b yth e EP A I fyo u hav e an yquestio n abou t legalK yo f a certai n drivewa yo rparkin g area , yo u ma ycontac t th e cK yo fOmaha' s Plannin g Departmen t a t (402 ) 444-5150
. Q^leas e chec k thi s bo xi f yo u understan d th e informatio n outline d above
. /
. . 

# i o v\e ^ 

# ^1 ^W-> 

# p 

# Uv^ i V o 

# b

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
.



# 0 1 agre e [~ ] I d o no t agre e

Owner' s Signatur e Date Contractor'sSignatur e Date Pag e 3 o f _ S

### BVID # 

# IjOl S 2— XR F PROPERT Y SAMPL E SHEE T Dat e Projec t XR F ID #

Shot # 

# S2 E 

# ^ 1 Averag e

Shot # 

# 2S : 

# ^2 1 Averag e

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### Averag e

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### Averag e Signature ^ Acidres s 

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### Readin g Sampl e are a Shot # ^ 

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### Averag e 

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### Readin g Sampl e are a 

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.

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# ^ ^ f f ^ / ^ / / 

# 7 3 ^ ^^/ / Readin g Sampl e are a Dept h

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# 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 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

42 4 SOI L 2010-06-1 9 15:2 8 92.0 7 Fina l 655 3 Florenc e bl v D Z 13 " N
. LOPE Z confirmatio n non e

# 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 24.94 7 Supervise d By : 

## Certificat e o f Verificatio n

42 1 SOI L 2010-06-1 9 15:2 6 30.5 9 Fina l 4018 2 655 3 Florenc e blv d D Z 13 " N
. LOPE Z confirmatio n non e

± Erro r ± 10.45 7

# 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 42 2 Mod e SOI L Tim e 2010-06-1 9 15:2 7 Duratio n 30.5 1 Sequenc e Fina l Flag s BVI D 4018 2 ADDRES S 655 3 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 27.63 5 ±10.65 9 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 30.51 7 Supervise d By : 

## Certificat e o f Verificatio n

42 3 SOI L 2010-06-1 9 15:2 8 30.9 7 Fina l 4018 2 655 3 Florenc e blv d D Z 13 " N
. LOPE Z confirmatio n non e

± Erro r ± 10.94 2

# 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 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

42 8 SOI L 2010-06-1 9 15:3 1 91.1 4 Fina l 5-42 7 ' >55 3 Florenc e blv d E A 1 " N
. LOPE Z confirmatio n non e

# 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 116.14 2 Supervise d By : 

## Certificat e o f Verificatio n

42 5 SOI L 2010-06-1 9 15:2 9 30.4 8 Fina l 4018 2 655 3 Florenc e blv d E A 1 " N
. LOPE Z confirmatio n non e

± Erro r ± 16.04 2

# 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 125.57 1 Supervise d By : 

## Certificat e o f Verificatio n

42 6 SOI L 2010-06-1 9 15:3 0 30.1 7 Fina l 4018 2 655 3 Florenc e blv d E A 1 " N
. LOPE Z confirmatio n non e

± Erro r ± 18.70 1

# 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 126.31 5 Supervise d By : 

## Certificat e o f Verificatio n

42 7 SOI L 2010-06-1 9 15:3 1 30.4 9 Fina l 4018 2 655 3 Florenc e blv d E A 1 " N
. LOPE Z confirmatio n non e

± Erro r ± 16.67 5

# 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 40 0 Mod e SOI L Tim e 2010-06-1 9 15:1 2 Duratio n 91.9 6 Sequenc e Fina l Flag s AVERAG E Ava-^i39^=-:399l? ^ 1 ADDRES S esiSnorenc e blv d QUADRAN T F 2 DEPH T 6 " 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 97.38 4 Supervise d By : 

## Certificat e o f Verificatio n

39 7 SOI L 2010-06-1 9 15:1 1 30.5 1 Fina l 4018 2 655 3 Florenc e blv d F 2 6 " N
. LOPE Z confirmatio n non e

± Erro r ± 15.55 3

# 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 114.83 9 Supervise d By : 

## Certificat e o f Verificatio n

39 8 SOI L 2010-06-1 9 15 : 1 1 30.8 7 Fina l 4018 2 655 3 Florenc e blv d F 2 6 " N
. LOPE Z confirmatio n non e

± Erro r ± 16.31 2

# 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 105.06 0 Supervise d By : 

## Certificat e o f Verificatio n

39 9 SOI L 2010-06-1 9 15:1 2 30.5 8 Fina l 4018 2 655 3 Florenc e blv d F 2 6 " N
. LOPE Z confirmatio n non e

± Erro r ± 15.92 9

## /^OAOmah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 I ^^^^L I Coasta l Environmenta l Grou p Inc
. ^^^S? ^ V"^^! ^

www.coastalhazmat.co m "' ^ ^"tPRO^" ^ COASTA L ENVIIONHINTA l e 1 0 u P
. IN C 

# EXECUTIV ESUMMARY : BVID #40182-(655 3 FLORENC EBLVD )
No Issue s o r Concern s \ ^ Issues/Concern s Detail Explanation : -DA NGARVE Y WALKE D TH EPROPERT Y O N6/10/1 0

### Ip k 

## EP A Propert y Clos e Ou t For m Propert y# : 'AoVg>3 L Propert y Address : <T^^ ^ H^fPnC<' , Ri^ A Datc/Tlnic : Owner' s Name:,/L.^Kfg)f ^
. . TfgiH
. •.: — Quad s Excavated : Contmclo r Grou p Yes No Excavado nGenen I 1 • I f necessB/y , wer e th e correc t quadnuit(s ) excavate dan drestored' ? / 2
.

I f necessary , wer e th e correc l area s ofdri p zon e excavaie dao drestored ? Gradtn e So dan dVcceUtio n Ves N o 1 Doe s th e CFBdin g aroun dth e perimete r ofth e hous e inexcavaie darea s generall y slop e away 

## y fromth e house ? 2
. Ha s so dbee nlai di nal l area s that wer e excavated ? 

# y y __ _ 3
.

Doe s th e so dappea r t o b e generall y health y andgrowing ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period ) 4
.Ar e sodde darea s generall y firman devenl y graded ? 

## ^ y 5Ar 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 tjn w period ) 

# y 6
.Wa s th e propert y grade dsuc hthat wate r wil l no l poo l onth e property ^ / 7
.Wa s damag e t o landscapin g o r plan t material s avoided ? 

# y Gates
. Fence s aa d Retatoln g Wall s Ve s N o I 1
. D o gate s ope nan dcio.s e freely? (I f applicable ) 

# y 2
.

Wer e al l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinsuiied ? (I f applicabk ) 

# y 3
.

Wa s damag e t o gate s o r fence s avoided ? (f f applicable ) 

# y 4
.

Wa s damag e t o retaining wall s avoided ? (Ifapplicable ) / Foundation , SidlnKan dCaller 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 ? / Wa s damag e t o window s avoided ? 

### _ / ^Wa s damag e t o window s o r doo r screen s avoided ? 

# 7
3
.

Wa s damag e t o downspout s o r downspou l exiension s avoided ? 

# I
Sidewalk s an dDriveway s (Concrete ) Yes N o 1 •

Wa s damag e l o drivewa y surface s avoided ? 

# 7
2
. Wa s damag e t o waOcwa y surface s avoided ? 

# r

## Ort'oer s comnients :

j In.spectio nnoies :

Removal andresloratio nactivate s complete includin g the 30-da y so dwarranty : EP A Representaiiv e 9^ ^ An , Date : 6lll^"^
_

## Propert yCompletio n Agreemen t Thi s agreemen l documents lh e complclio n o l remedia l acliviue s perlbime d o n myproperl yM ysignalui e wil l designat e iha l I a m satisfie d wit h lh e restoraiio n o fm yproperly , an d tha i n o item s ar e i n questions , now , o ra l an ylim e i n th e futuie , except thos e ilem s liste d below , i fan y

Propert yID : ^|Q\jJ ^ Propert yAddress : ,^.g^ ^ VV.r^r. , ^ U Owner : ^ ^

£ a \ Phone : 

### C«^^^vA^^-^M?\t
. Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item :

OffTiigrc crcstordlio n i s completed , excep t a s note d [M^ l d o no l a|>re crestoratin n i s complete d 

# /:^ju.JU7J^.JUI/ ^ ^^s^/£ ? Owner' s Signatur e Dal e 

# (§>G<Ujuifi ^ Cuntrarlor' s Signalnr c 

# G'S-f d Dal e

# (zi^ J Propert y Owne r Assessment of Performanc e f oriik /

i^ ^ i/^r ) America nRecover y an dReinvestmen t Act (ARRA ) /^.. ^ ^-^L / Omah aLea dSuperfun dSit e

'^ ^ J

- 2G W 2009/201 0 ^"^'/^E/^^i/^y, , . Remediatio nContractor : Coastal Environmenta l Grou p - EP-R7-09-0 6 Property Identifie r Number : \-\0Vy3 > Propert y Address : US' S ?
. ^\r.e-^^ ^ "^V A Propert y Owner' s Name : fa^^^\ A"^cA A ****^i^l^i^i^i^i^i^ii|l^i^l^c**^i^i*i^^iil^^iil^^liiil^:t^^^i^i^iii^iii^^ii^^i:^Ll^il^l*^iil^******** ^ 

## Instruction s t o th e Propert v Owner ; Thi s for mserve s to recor dthe Propert y Owner' s assessmen t o f performance (Incentive 1

- Qualit y Assuranc e Surveillanc e Plan) involving the liste dremediationcontractor , as applicable t o the OmahaLea dSite
. Thi s for mdocimients the timelines s o f punchlis t resolution , busines s relations , complain t resolutionan dthe overall qualit y o f work
. I f

needbe , the Propert y Owne r ma y utiliz e thi s for mto recor dproblem s and/o r

issue s not specificall y tiedto a nassigned address , fo r

example , busines s relation s tha t generall y don' t follow the guideline s se t fort hi nthe Perfonnanc e Wor k

Statement
. The Propert y Owne r

will indicat e his/he r

assessmen t o f performance v^t hthe contractor' s wor k

b y checkin g anumerica l ratin g onth e tabl e belo w using the numerica l definition s fi'om the ratin g scal e below , thensig n& dat e the form
. ^9-10 ^ "excellent " 7- 8 "ver y good " 5- 6 "acceptable " 3- 4 "poor " 1-

2 "ver y poor " Propert v Owner' s Assessment o

f

Performanc e Regardin g th e Contractor' s Work 1 0 C ^ 5 9 4 8 3 7 2 6 1 Propert v Owne r Additiona l Comment s fro m(optional ; continu e o nbac k pag e if needed )
Propert y Owne r Signature ; jC^JLy.,*^^Jf^^lh^^j / ^Date : ^—S'"^ ^

### « » 

## Propert yDamag e Settlemen t

Property ID 4018 2 Property Addres s 655 3 Florenc e Blvd Owner Geral dTodd Phon e (402)453-749 6 1 receive dfromth e contractor , Coasta l Environmenta l Grou p Inc
. (Coastal) , th e sumof $40.0 0 to compensat e for th e soi l treatmen t don e to th e property . Compensatio ntyp e Chec k 203 0 Valu e of Check $40.00 Check to th e orde r of Geral dTodd Descriptio n of Damao e 

### Property owne r receive dachec k for th e amoun t of $40.0 0 dollar s to cove r for th e so dtreatment . Mysignatur e belo wacknowledge s th e issu e pendin g wit h myproperty ; further , I acknowledg e tha t thi s wor k wa s complete d satisfector yan d withi n myan d releas e Coasta l Environmenta l Group , Inc
. fro m furthe robligation s orliabilit yrelate d to thi s property
.


# fMMHir~

' w ^ ^ •' • •••"•' • i i i '••••• • >• i , • " '^V : .' ^ '



### illOi^OOOOSai : E.EU 7 37E'10I.II ' 

### 0E03 0

Owner' s Signature »a>at e Contractor' s Signatur Signatur e e Date
Pag e 1 of1