## TRANSMITTALof OMAHALEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID#: Y^H H Date : ^h^ill b Address : I72 0 S 2" 7 c'^^ V Remediatio nContractor : _Coasta I Environmenta l Group

_ Year : _2009
_ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S
sr Vide o o f property (DVD ) X

AExecutiv e Summary fSl EPA-provide dproperty sketc h B Signe dAcces s Agreemen t for subjec t property v ASigne dAcces s Agreement(s ) for adjacent property & ' Restoratio nAgreemen t ^ Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) ^ Confirmatio ndat a N 2Photograph s E

f As-buil t sketc h H Satisfactory restoratio nsigne db y Property Owne r ^ Property close-ou t chec k lis t signe db y EPA • ^ Descriptio nofarea s not meetin g RO D cleanu p criteri a c

f Utility clearance s cf

Property informatio nfromDougla s Coimty Assessor' s OfiFic e D D D 

# A . ignatur e Dat e 3021754 3 

# liiniiiniiii i Superfun d

## Property Acces s Checklis t Propert y ID : j ^ 1 1 i4 D WOR K STARTED ON : / 1 D WORKCOMPELTE D ON : / / 

# 1'^'^*•"•" » n7- 0 5 7,1,"^
- Rente r 

## ^'''''
- IjLJmHy^ bJAmfclp
. Addrcds : Phone : Fax : Cell/Pager
. Addfttono l Information : Phone: L^ 2 ^S*?, . -4")^ ^ Fax : Cell/Pager
. D Notificatio nLette r Sent : / /
. By : J S | Acces s Agreemen t 

## Signed : JL/^Q/C Q By : Restoratio nAgreemen t 

## Signed : n_'t^/C2 Q By : D Topsoi l Samplin g (i f applicable ) / / By : Disposa l Samplin g (i f applicable ) By : 

## D Garde nSamplin g (if applicable ) By : 

# K Utilit y Clearanc e 

## Called: li_i2Q/Q 9 By:l2.MQ q {0 * Video/Photo s (Before ) 

## On:J^/J_/i2 S By-^i o /0(?JtQv/\i: ^ O Video/Photo s (During ) On : By : O Video/Photo s (After) On : / / . By : D Video/Photo s (30-Oay ) On : / By : Propert y Completio nAgreemen t 

### Signed ; nyiy'HO ^ 

## ^r-^^i/y ^ Final Repor t Issued : 

### / / By : Ai r Monitorin e (aaanDlicable ) I D Commnnity QCrc w On:__ / /
_ 

### By : Results : D Communit y Q Cre w On: . _/

_/
_ B-i'
. Results : D Commnnity QCrc w | On : / / 

### By : Results :
Omah a Lea d Stt e

## Douglas Count y Accotm t Inf i aaj^t^ t 

## Pag e 1 of3 Dougla s County , Nebrask a Propert yRecor d - R124027000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e (d ) scal e 0-5 0 ft wes t o f52n d S t - VlGWOi l Ma p Informatio n i s vali d a s o f2009-1 1 -1 9 Treasurer' s Ta xRepor t Ne wFeatur e - ^ • * - ^ Aut o Sale s Searc h Owne r WRINKL E WALTE R L ETA L 172 0 3 2 7 S T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 402 7 000 0 1 2 Accoun t Type : Residentia l Parce l Number : 124027000 0 Parce l Address : 172 0 S 2 7 S T OMAH AN E 68105-000 0 Lega l Description : HANSCO M PLAC E LOT6 BLOC K2 0 S 2 0 FTL T5 & N 2 0 FT4 0 X 145: 8 Valu e Informatio n Lan d Improvemen t Tota l 200 9 200 8 200 7 200 6 200 5 200 4 $4,500.0 0 $4,500.0 0 $4,500.0 0 $4,500.0 0 $4,500.0 0 $4,500.0 0 $63,200.0 0 $63,200.0 0 $63,200.0 0 $55,200.0 0 $55,200.0 0 $55,200.0 0 $67,700.0 0 $67,700.0 0 $67,700.0 0 $59,700.0 0 $59,700.0 0 $59,700.0 0 Sale s Informatio n Sale s Date : 1993-03-1 1 Dee d Type : D SooAr ; 194 9 Page : 36 0 Price : $ 31,500.0 0 Grantor : Grantee : Valld/lnvalld : Vali d Exclusio n Reason : Sale s Date : 1990-08-0 6 Dee d Type : D SooAr : 188 4 Page : 58 7 Price : $ 31,000.0 0 Grantor : 

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

### Dougla s County Accoun t Inf c .^K^gjo r Pag e 2 o f 3
Grantee : Valid/Invalid : Exclusio n Reason : Vali d
Lan d Informatio n Acre s 0.1 3 S F 5880. 0 Unit s 1. 0 Dept h 147. 0 Widt h 40. 0 Vacan t N o Improvemen t Buildin g 1 Informatio n

t^&iej r

atbDertO M —tiv »»iwtikocfcdr ; 1 1/ 2 STOR YUNFINISHE D CLIC KT O ENLARG E IMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : 1104. 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 yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 5. 0 Exterior : Fram e Stucc o Units : 1. 0 Interior : ! Drywal l Baths : 1. 0 Roo fCover : i 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 rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 192 0 0 0 % 192 0 8 8 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fence Woo d 1. 0 Ad d O n Unfinishe d Atti cW/floo r 864. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 ft 864. 0 

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

## Douglas Cotmt y Accotm t Inf i tom^^ t 

## Pag e 3 of3
Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h En d Soli d Wal l 200. 0 Porc h Sla b RoofCeilin g 132. 0



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl..
. 11/25/2009• • Pag e 1 of 2

" > [ Creat e AnQtherTicke t \ \ _iBackJoJrt h jnterne t - J [Sen d Emai l

• YOU RTICKE T NUMBE RI S 2414862 . Origina l Cal l Date : 11/30/0 9 Time : 5:0 5 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 12/02/0 9 Time : 5:4 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 172 0 Street : S 27T H S T Twp : 15 NRng : 13 E Sect-Qtr : 28-NE-S E 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 O F CORNE R 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 ho f Excavation : 4 f t Corne r Lot : N Front : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL 3 MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F

Servic e Are a Contac t Phon e Numbe r Utilit y Typ e Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEIDI Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 LEVEL3 LEVEL3 COMMUNICATIONS , LL C N A Alt : Emerg : 877366834 4 Day : 402504782 3 MUD0 2 METROPOLITA NUTILITIES DISTRIC T SAND Y Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRICH/TRAFFI C Alt : 402444516 1 Emerg : 402444516 0

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.
. . 11/30/200 9• • 

### Pag e 2 of 2

0PPDGPR 6 OMAH APUBLI C POWE RDISTRIC T N A

QLNNEI FQWES T LOCALNETWOR K 

### N A 

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

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.
. . 11/30/200 9OLS# : 1911 4 

# WAs-Buil t Drawin g Dat e Excavated : 12/5/0 9 Dat e USEP ASigne d Off : 1/18/0 9 COASTA L 

# Omah aLea dSuperfun dSit e Are a Sodden : 103 2 s a f t ENVIRONMCNTA L C R O U r , I N
Name : ^->^y£ ^ <j^iyiyt. £ Address : m x e 5 a. 9 s r Phone : 'JBi - VS^ V Omah a Lea d Sit e Sit e Sketc h Date : Time : y/>o/c i 1 •-:^o Nort h Arrow - >
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y INVIRONKINTA l C I 0 U P IH C "t PHO-'t* ' 

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

## Granto r(th e propert yowner ) consents to 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 : V C l I i t I

Owner' s Name : Daytim e Phone :



# \Kn-ie f

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# .- z n s- < PURPOS E O F RESPONS E ACTIVITIE S 

## Th e EP Ai s requestin g access t o collec t soi l sample s an d remov e soi l that contain s elevate d concentration s oflead 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 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 work i s bein g performe d unde rth e Omah a Lead Superfun d Site remediatio n program . Arepresentative 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 reviewan d approve th e planne d soi l removal , an d restoratio n wor k before i t begins
. Once th e work i s finished , th e Granto rwil l b e aske d t o reviewth e work an d confir m that 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 l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e ofperformin g th e work
. Thi s acces s shal l remai n i n effec t unti l th e work has bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :

Pag e 1 o f2_^>_".V ^
COASTA L 

### V ^ ^ tNVUOHHEKTA L C I t O U rI h C 

### ( Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; e Remov e flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t maywis h t o save ; cWate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessarysubsequen t t o a n initia l waterin g perio d b yEPA ; e Abid 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 wothers 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
gran t access t o m ypropertie s D I d o no t gran t acces s t o m ypropertie s ^ 

# ihAAAz ^ Signatur e Signatur e Dat e Dat e ^
D I woul d lik e t o b e presen t durin g an ysamplm g tha t i s required
.

Pag e 2 o f2

# c: ^
COASTA L C n O h < r•M r 

## Restoratio n Agreemen t Th e purpos e of thi s agreemen t i s to provide amutua l agreemen t as t o condition s ofth e propert y prior t

o remediatio nactivities
. Thi s will als o serv e a s documentationfo r th e puipos e o f assuring tha t restoration activitie s ar e completedt o th e satisfactionof th e propert y owne r andthe UnitedState s Environmenta l Protectio nAgenc y (EPA) . PropertylD ; JC ^ | L\ Propert y Address : \'-]^^ ^< ^ . 2A~ \ ' ^ Owner : (.o^py-^^-)C\nU p 

# Pt... . ^ 

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nth e attacheddiagram(s ) indicat e area(s ) t o excavate , surface structure s an dlandscaping feature s an d acces s location(s ) to be use dby th e contractors . Indicat e distances , depths , materia l types , etc . Photographically an dVideographicall y documen t th e existing condition s ofthe propert y an dthe basemen t i

f necessaiy
. 

### Item s t o b e Remove d b yth e Owne rbefor e Start o fRemediation : The lenoval , storage , oi&posal , and/o rretur n o fthes e itom s i s th e Owne rs responsibility
. 

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.

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. COASTA L 

### Item s t o B e Remove d ByContracto rDurin g Remediatio n an d Replaced
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### Ite m Quantit y Pre-existin g propen y area , tha t wil l b e excavated , tha t i s covere dwithgrass . Numbe r o f tree s > 2 inc h trun k diamete r ^ Numbe r o f tree s < = 2 inc h trun k diamete r ^ Numbe r o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Aiinthi l skcicl i ol lllf 

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# Y-OA^y ? / Pag e 2 of
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< Addttiona i Comment s / Instructions :

^iChec k th e tx) XifOwne rdoe s no t wan t CE G to documen t interio rfoundatio n walls an d possibl e / pre^lstin g damage
. Bycheckin g thi s bo xCE G is no t responsible fo ran ydamag e don e to th e

interio rofhouse , includin g foundatio n crack s orfissures
.

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. QUADRAN T E M DEPH T 1 XR F TEC H O
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pp m Erro r P b 136.37 2 19.57 8 Supervise d B y 

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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 BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 135.74 4 Supervise d By : 

## Certificat e o fVerificatio n

40 0 SOI L 2010-02-1 1 16:5 3 30.1 7 Fina l 1911 4 172 0 S 2 7 St
. E M 1 O
. BARAJA S 1 1

± Erro r ± 19.48 2• • 

# 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 40 1 Mod e SOI L Tim e 2010-02-1 1 16:5 4 Duratio n 30.1 9 Sequenc e Fina l Flag s BVI D 1911 4 ADDRES S 172 0 S 2 7 St . QUADRAN T E M DEPH T 1 XR F TEC H O
. BARAJA S MIS C 1 NOT E 1

pp m ± Erro r P b 138.01 3 ± 19.71 2 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 40 2 Mod e SOI L Tim e 2010-02-1 1 16:5 4 Duratio n 30.1 6 Sequenc e Fina l Flag s BVI D 1911 4 ADDRES S 172 0 S 2 7 St . QUADRAN T E M DEPH T 1 XR F TEC H O
. BARAJA S MIS C 1 NOT E 1

pp m Erro r P b 135.35 9 ± 19.54 0 Supervise d By :

# Thernn 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 40.79 4 Supervise d By : 

## Certificat e o fVerificatio n

33 2 SOI L 2009-12-0 5 15:4 7 92.6 7 Fina l Av g o f329-33 1 172 0 s 2 7 s t F2 10 " R
. VENTRY clearenc e ngn c

±Erro r ±11.72 1

# 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 32 9 Mod e SOI L Tim e 2009-12-05,15:4 6 Duratio n 30.7 8 Sequenc e Fina l Flag s BVI D 1911 4 ADDRES S 172 0 s 2 7 s t QUADRAN T F2 DEPH T 10 " XR F TEC H R
. VENTR Y MIS C clearenc e NOT E ngn c
pp m ±Erro r P b 41.22 4 ±11.80 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 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 42.76 0 Supervise d By : 

## Certificat e o fVerificatio n

33 0 SOI L 2009-12-0 5 15:4 7 30.5 0 Fina l 1911 4 172 0 s 2 7 s t F2 10 " R
. VENTR Y clearenc e ngn c

± Erro r ± 11.82 8

# 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 33 1 Mod e SOI L Tim e 2009-12-0 5 15:4 7 Duratio n 31.3 9 Sequenc e Fina l Flag s BVI D 1911 4 ADDRES S 172 0 s 2 7 s t QUADRAN T F2 DEPH T 10 " XR F TEC H R
. VENTR Y MIS C clearenc e NOT E ngn c
pp m ±Erro r P b 38.39 8 ±11.52 7 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 32 8 Mod e SOI L Tim e 2009-12-0 5 15:4 5 Duratio n 91.7 7 Sequenc e Fina l Flag s AVERAG E Av g o f325-32 7 ADDRES S 172 0 s 2 7 s t QUADRAN T F l DEPH T 10 " XR F TEC H R
. VENTRY MIS C clearenc e NOT E ngn c
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# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

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pp m P b 56.42 6 Supervise d By : 

## Certificat e o fVerificatio n

32 5 SOI L 2009-12-0 5 15:4 4 30.8 5 Fina l 1911 4 172 0 s 2 7 s t F l 10 " R
. VENTRY clearenc e ngn c

± Erro r ± 12.16 4

# 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 55.33 6 Supervise d By : 

## Certificat e o fVerificatio n

32 6 SOI L 2009-12-0 5 15:4 4 30.5 3 Fina l 1911 4 172 0 s 2 7 s t F l 10 " R
. VENTR Y clearenc e ngn c

± Erro r ± 12.13 1

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A01821
.

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 52.59 6 Supervise d By : 

## Ceitificat e o fVerificatio n

32 7 SOI L 2009-12-0 5 15:4 5 30.3 9 Fina l 1911 4 172 0 s 2 7 s t F l 10 " R
. VENTR Y clearenc e ngn c

± Erro r ± 11.82 8

# ( A 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
• NVIIOmilllTA L clour , m c 

# EXECUTIV ESUMMARY : BVID #19114-(172 0 S 2 7 ST ) No Issue s o r Concern s I I Issues/Concern s Detail Explanation :4 

# t

EP APropert y Clos e Ou t For m Propert y # : 

# 1 ^ 1 /

iV^^.'A'^&i^r^^ ^ Dnte/Tlme : Owner' s Name : ,nj , Quad s Excavated : Contracto r Group . Excavatio nGenera l I .I f necessaiy , vtrer e th e correc t quadrant(s ) excavate dan drestored ? 2 .I f necessary , wer e th e correc t area s ofdri p zon e excavaie dan drestored ? Gradin g So dan dVcgelatto n I .Doe s Ih e gredin g aroun dth e perimete r ofth e hous e i nexcavaie darea s generall y slop e away fromth e liouse ? 2 .Ha s so dbee nlai di nal l area s tha t wer e excavated ? J .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 ) 4 .Ar e sodde darea s genetvll y firman devenl y graded ? 5 .

Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period ) 6 .Wa s th e property grade dsuc hthat wate r wil l not poo l o nth e propeny ? 7 .

Wa s damag e t o landscapin g o r plant material s avoided ? Gates . Fence s an dReuinin g Wall s 1 .D o gate s openan dclos e fteely? (I f applicable ) 2 .Wer e al l gate s o r fence s taice ndow ndurin g restoratio naclivilie s reinstalled ? (I f applicable ) 3 .

Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) 4 .Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) Foundation , Sidin g aa dGvtter s I .Wa s damag e t o di 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 ? Wa s damag e t o window s o r doo r screen s avoided ? 5 .

Wa s damag e t o downspout s o r downspou l extension s avoided ? Sidewalk s an dDrivtway s (Concrete ) 1 .

Wa s damag e t o drivewa y surface s avoided ? 2 .Wa s damag e t o waOcwa y surftce s avoided ? Ye s N o / / Yes No /
i y > 

## A y A A 

## A Ye s N o 

## A y y i / Ye

a N o 

## J 

# J A A A Ye s N o / 

## A% 

## Ort'oer s comments :

[ 

## pgnspectio nnotes :

Removal andresloratlo nactivate s complete includin g the 30-da y so dwarranry : EP ARepresentativ e ^ ^ Date : !:!L *
_ _•


## Propert yCompletio n Agreemen t Thi s agreemen l documenl s lh e complclio no f remedia l aclivme s perrorine donm y propert y M y signalur e wil l designat e Ihal Ia msatisfie dwil hlh e restoratio no f m y propeily
. an dIha l n o item s ar e inquestions , now , o r a l an y lim e infh e ftilure, excep l Ihos e ilem s liste dbelow , ifan y I Propert yID : | ( ^ ) ( ^ Propert y Address : iHOrNS 7 " ^ "^^4-
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### Owner : (jj^^W rIx^lAJCr Q Phone : q^a^q-7C ^ Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item : Additiona l Commenls :

l/\ l Agre e ftxtoralio n i xcompleted , excep t a s note d [_ J I ri o no t a|>re crestoratio n i s complete d

Owner' s Signatur r Cbi Date ,ontrarlor' $ Signatur e Dal e

# i ^

f'ropert vOv/ne rSetisfadio n Surve y Omah a Lea d Superfun d Si t 

# DE C 

# 2 9 » 200 8 Remediatio n Contractor:
. Coasta l Environmenta l Grou p 

# SUPERFUN D DIVISIO N Propert yIdentifie rfVumber : ) A\ \'~ \ Propert yAriHri>« : P?< 0 .' ^ 2 1 ^ Propert yOwner' s Name:(lin[-tf v\Mfi\Ay^(( ^ (abov e informatio n t o b e fille d ou t b yremediatio n contracto rprio rt o deliver yo ( for m l o Properl yOwner ) Instruction s t o Propert yOw^rier ; 1 Thi s for m i s provide d t o yo u as a mean s o ftryin g t o captur e you rleve l o fsatisfactio n wit h th e wor k o fth e above-identifie d remediatio n contractor , a s applicabl e t o th e soi l cleanu p actio n a t you r property
. Th e U.S
. Environmenta l Protectio n Agenc y(EPA ) i s ver yintereste d i n you ropinio n regardin g th e wor k performe d b yit s contractors
. Thi s for m i s intende d t o provid e a n eas ymean s fo ryo u t o expres s you ropinio n abou t th e wor k performe d o n you rproperty
. Pleas e indicat e you rleve l o fsatisfactio n wit h th e contractor' s wor k byselectin g a numerica l ratin g (rangin g fro m 1 t o 10 ) usin g th e followin g ratin g scale , the n pleas e sig n an d dat e th e for m an d retur n i t t o th e USEP Ai n th e attache d self-addresse d & stampe d envelope , (additiona l comment s ma y als o b e provide d i n th e spac e below , a t th e optio n o fth e propert yowner ) [s-ie ^

"excellent " 7: 8 "ver ygood " 5- 6 "acceptable " 3- 4 "poor " i 1-

2 "verypoor "
I Propert yOwner' s Satisfactio n Ratin g Regardin g Contractor' s Wor k 5 

### ^1 0 A 

### 9 3 8 2 7 1 

### 6 Additiona l Commet^^ fronvPH>fierty^<jmcr(optional : continu e t o bac k o

fpag e i fneeded ) 

### ^^P
. 

# 3 . 

# D.U : / > 

# ^^-^ O "T Propert yOwner' s Signature :