## TRANSMITTA Lof OMAHA LEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAID# : Date : 

# ^Mi M Address : 

# 1^" } \ ^ 

# \)' ^ ^ 1 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 ) Executiv e Summary EPA-provide dproperty sketc h Signe dAcces s Agreemen t for subjec t property Signe dAcces s Agreement(s ) for adjacen t property Restoratio nAgreemen t Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) Confirmatio ndat a Photograph s V d6>cO(Vi'^TL^ Y tv:6wAtl( M Y^^"

­ As-buil t sketc h Satisfactory restoratio nsigne db y Property Owne r Property close-ou t chec k lis t signe db y EPA Descriptio no f area s no t meetin g RO D cleanu p criteri a Utility clearance s Property informatio nfromDougla s County Assessor' s Offic e

3021845 3 Superfun d^ 

## Propert yAcces s Checklis t Propert y ID : ^^L ] ( L | nWOR K STARTE D ON : / / Propert y Addres8:^<l^^a , \ j jp ^ ^ f nWORKCOMPELTE D ON:__/__/
_ Owner : 5TA C j- p ^C^AA ; Renter : Address : Phone : Fax : Cell/Pager : Phone : <^^ ^ 5 ^ ' Additional Information : Fax : Cell/Pager : l~l Notificatio nLette r Sent : / / By : 

# A Acces s Agreemen t 

## Signed : Z_/3./i£ ) By : P^

l Restoratio nAgreemen t Signed:DH/O » / V o By : nTopsoi l Samplin g (i f applicable ) / / By : l~ l Disposa l Samplin g (i f applicable ) / / By : l~ l Garde nSamplin g (i f applicable ) / / By : Utilit y Clearanc e CaUed : 0 \lrf \l\ 0 °y

- OHIWA O VO^MV ^ Q^Video/Photo s (Before) On : 4 l ' ^ I ' ^ By : O^f/^v'tt ) D Video/Photo s (During ) On : / / By : nVideo/Photo s (After ) On : / / By : nVideo/Photo s (30-Day ) On : / / By : Propert y Completio nAgreemen t Signed : 

# d^KC Z By : fV(4:;^-v. C 

# f Fina l Repor t Issued : / / Ai r Monitorin g (a s applicable )
• Conmiunit y O Cre w On : / / 

### By : J Results :

• Communit y O Cre w On : / / 

### By : 1 Results :

• Communit y QCre w On : / / 

### By : 1 Results :

Omah a Lea d Sit s

### Qougla s Count y Accoun t InfdjBMio n Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R160124000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t o f 52n d S t - VIBWO n Ma p Informatio 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 PEA KSTACI E L 240 7 N 1 8 S T OMAH AN E 68110-000 0 Propert yInformatio n Ke yNumber : 012 4 000 0 1 6 Accoun t Type : Residentia l Parce l Number : 160124000 0 Parce l Address : 240 3 N 1 8 S T OMAH AN E 68110-000 0 Lega l Description : LAK E AD D LO T6 BLOC K5 S 1.6 6 FTLT7 & AL L 54.3 2 X 14 0 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $2,800.0 0 $54,100.0 0 $56,900.0 0 200 8 $2,800.0 0 $54,100.0 0 $56,900.0 0 200 7 $2,800.0 0 $56,200.0 0 $59,000.0 0 200 6 $2,800.0 0 $56,200.0 0 $59,000.0 0 200 5 $2,800.0 0 $56,200.0 0 $59,000.0 0 200 4 $2,800.0 0 $16,300.0 0 $19,100.0 0 Sale s Informatio n Sale s Date : 2007-06-0 4 Dee d Type : Q C Book : 200 7 Page : 06252 1 Price : $0.0 0 Grantor : WRIGH TDOROTH YM Grantee : PEA KSTACI E L Valid/Invalid : Invali d Exclusio n Reason : Famil ySal e Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 7 7560. 0 1. 0 140. 0 54. 0 N o Improvement Informatio n 

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

### Dougla s County Accoun t Inf<j^a|io n Pag e 2 of 2

Buildin g 1 2416 N 1 8

•I T

1 1/ 2 storyFi n

CUC KTO ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1821. 0 Percen t Complete : 100.0 % Perimete r0. 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 : 8. 0 Exterior : Fram e Aluminu m Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : i 4. 0

Roo f Type : Gabl e Stories : i 1. 5 Floorcover : Allowanc e Foundation : i 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 190 5 0 % 190 5 10 5 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Bric k Venee r 300. 0 Ad d O n Fenc e Chai n Lin k 1. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 1157. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 400. 0 Porc h En d Soli d Wal l 160. 0 Porc h Sla b Roo f Ceilin g 16. 0 Use r Atti cFul l Finis h 664. 0



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

# t Pag e 1 of2

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

### YOURTICKE T NUMBE RI S 2459574
. Origina l Cal l Date : 4/09/1 0 Time : 3:5 8 p mOp : ELIZABETH1879 0 Wor k t o Begi n Date : 4/13/1 0 Time : 4:3 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 240 3 Street : N18T H S T Twp : 15 NRng : 13 E Sect-Qtr : 10-SW,12-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 : FA X AL L CLEAR S TO : (877)662-421 1 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 : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N ATTNEBR l CXCAT V MAGELLANMUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac t Phon e Numbe r UtiUt y Typ e
ATTNEBR l ATT/T Day : Alt : Emer g 8002413624 9 8002413624 9
CXCAT V CO X COMMUNICATIONS , IN C HEID I Day : Alt : Emerg : 402934046 9 402934046 9 402932975 7
»*A<-T:TTAX T MAGELLA N MAGELLA NMIDSTREA M PARTNER S ^ „ ri^r^uAu DEBORA H Day : Alt : Emerg : 918574709 8 918574709 8
MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y Day : Alt : Emerg : 402504782 3 402504797 0 

### Day : 402444719 7 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS..
. 4/9/201 0

### Pag e 2 of 2 •
OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRICH/TRAFFI C 

### Alt : 402444516 1 Emerg : 402444516 0
OPPDGPR 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.
. . 4/9/201 0

### Ticke t Tex t an dMap displa^^^Ticket : #246063 0 Pag e 1 of 2 # 

# w Origina l Cal l Date : 4/12/1 0 Time : 12:3 6 p m Op : BJ P Wor k t o Begi n Date : 4/14/1 0 Time : 12:4 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 240 3 Street : N18T H S T Twp : 15 NRng : 13 E Sect-Qtr : 10-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 : FA X AL L CLEAR S TO : (877)662-421 1 Compan y: COASTA L ENVIRONMENTA L SERVIC E Contac t Name : BRAND Y Phone : (877)662-421 0 Alt . Contact : ELIZABET H Wor k Bein g Don e For : COASTA L Dept h o f Excavation : 4 F T Come r Lot : N Front : Y Rear : Y 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 Ption e Numbe r UtiUty Typ e
CXCAT V CO X COMMUNICATIONS , IN C HEID I 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
»*A/-TrTTAX T MAGELLA N MAGELLA NMIDSTREA M PARTNER S

. „ T^CD^DA U 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-TRAFFICSEWE RRICH/TRAFFI C 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0
OPPDGPR 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 LOCA LNETWOR K EL M LOCATIN G 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3
http://www.dhon.org/irthintemet/MessageText/MessageTextAndMap.asp?NoticeID=DHO.
. . 4/12/201 0I 

### 2841 4 

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e NVmONHINTA L C KO U P
. INC
. Dat e Excavated : 4/14/201 0 Dat e USEP ASigne d Off : 4/27/201 0 Are a Sodden : 249 5 s a f t

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### Omah a Lea d Sit e Exterio rPain t North Arro w Owne rName : DOROTH YM PEAKWRIGH T • Goo d 

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COASTA l 

### v > INVItONHIMM l c * " C I 0 U rI h C 

## Consen t fo f Acces s T o Propert y RIGH TO F ENTR YT O PREMISE S 

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

Owner' s Name : Daytim e Phone : 

# .^W3Pl3 H ^^S > N U IS3 T Addres s o f Propert y covere d b ythi s Agreement : PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP Ai s requestin g acces s t o collec t soi l sample s an d remov e soi l tha t contain s elevate d concentration s o f lea d an d maypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t o remov e contaminate d soil
. Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o it s origina l condition
. Thi s wori < i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o f Coastal Environmenta l Group , contracte d b yUSEPA , wil l contac t th e Granto rin-perso n t o discus s th e wori t t o b e performed , 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 wori ( befor e i t begins
. Onc e th e wort ( 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 right 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 wort(
. Thi s acces s shal l remai n i n effec t unti l th e wori ( ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :

Pag e 1 o f 2

### #

COASTA L tl<ri«ONK(KT< l C R 0 U rI Kc 

### €

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 ; 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 ; 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
. eAllo wvideotapin g and/o rphotographin g o f th e property
. AGREEMEF ^ NO 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
I gran t access t o m ypropertie s Q I d o not gran t acces s t o m ypropertie s ^ .

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. 

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### Pag e 2 o f 2C O AS TAL o n o u p , INC
. 

## Restoratio n Agreemen t The purpos e of thi s agreemen t i s to provide amutua l agreemen t a s to condition s of the propert y prior to remediationactivities
. Thi s will als o serve a s documentationfo r th e purpos e of assuring tha t restoration activitie s ar e completedto the satisfactionof the propert y owne r an dth e UnitedState s Environmenta l ProtectionAgency (EPA)
.

Propert y ID : Z'^L j i Q Propert y Address ; ^L/QfJ ^ N/9 i ^V T O^er : S^T^jp r fe^^ Phone : q*^\\-'y:>,C, H O

nthe attacheddiagram(s ) indicat e area(s ) to excavate , surface structure s an dlandscapin g feature s an d acces s location(s ) to b e usedb y the contractors . Indicat e distances , depths , materia l types , etc . Photographicall y an dVideographicall y documen tthe existing condition s of the propert y an dthe basemen t if necessary . 

### Item s t o b e Remove d b yth e Owne rbefor e Start o f Remediation : Th e removal , storage , disposal , and/o rretur n o f thes e item s i s th e Owner' s responsibility
. Item : Item : Kem : Kem :



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

# KlVi^ - Kem : Kem : Kem :

Pag e l o t ^C OA S T AL 

### Item s t o B e Remove d B yContracto rDurin g Remediatio n an d Reolace d Kem : 1 

### c>o \ Item : Hem : Kem :



### Ite m Pre-existing propert y area , tha t wil l b e excavated , tha t i s coveredwit hgrass . Numbe r of tree s > 2 inc h trun k

diamete r Numbe r of tree s <= 2 inc h trun k

diamete r Numbe r of Sprinkle r Zones , Control Valves , Timers , Heads , etc . Attac hasketc ho f th e sprinkle r layout
. Numbe r of an dsize of eac hgarden / flower bed area . Attac hasketc ho f relative size s an dlocations
. Agree duponvalue of plan t material s not t o b e replacedb v contractor . Not e thi s valu e wil l b e usedto issue aplan t voucher to th e property owner . Easemen t Area , t o b e excavated 

# So D

Landscap e Inventor y Quantit y Uni t Conditlon/Type/Specie s 

# ^1,62^ Quadrants
Fach Eac h

Eac h 

# ^[( ^

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$ 

### /

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Pag e 2 o f ^C O AS TAL • MViaONMBNTA L a « O U P , INC
. 

### Additiona 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 l Protectio n Agency(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 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 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 f soi l b yth e EPA
. I f yo 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 cHyo f Omaha' s Plannin g Departmen t a t (402 ) 444-5150
. Q Pleas e chec k thi s bo xi f yo u understan d th e informatio n outline d above
. 

# A \yyx\A^ s cf< ^ QucrM- ^ Sc>D
.

[^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
. 

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. 

# O\l\-^l^o Owner' s Signatur e Dat e Contractor' s Signatur e Dat e Pag e 3 of
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# ShL 

# 3/ y t ^< r Dept h 

# 3^4 > ^ ^S ' Ipf ' 2 ) ( D ~ c^5 ^ Readin g Sampl e are a Dept h

Readin g Sampl e are a Dept h

Readin g Sampl e are a Dept h

# 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

P b Supervise d By : 

### Certificat e o f Verificatio n

10 8 SOI L 2010-04-1 4 06:5 7 91.3 5 Fina l Av g o f105-10 7 240 3 N 1 8 s t easemen t 1 " N
. LOPE Z confirmatio n non e

± Erro r ± 25.09 7 fcgg/ j^OE^ j

# Therm o S C I E N TI F I 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 336.08 9 Supervise d By : 

### Certificat e o f Verificatio n

10 5 SOI L 2010-04-1 4 06:5 6 30.5 8 Fina l 2841 4 240 3 N1 8 s t easemen t 1 " N
. LOPE Z confirmatio n non e

± Erro r ± 23.70 6

# 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 365.70 9 Supervise d By : 

### Certificat e o f Verificatio n

10 6 SOI L 2010-04

- 1 4 06:5 6 30.2 0 Fina l 2841 4 240 3 N 1 8 s t easemen t 1 " N
. LOPE Z confirmatio n non e

± Erro r ± 27.72 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 341.31 3 Supervise d By : 

### Certificat e o f Verificatio n

10 7 SOI L 2010-04-1 4 06:5 7 30.5 7 Fina l 2841 4 240 3 N 1 8 s t easemen t 1 " N
. LOPE Z confirmatio n non e

± Erro r ± 23.86 4

# 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 18 5 Mod e SOI L Tim e 2010-04-1 4 16:2 1 Duratio n 91.6 0 Sequenc e Fina l Flag s AVERAG E Av g o f 182-18 4 ADDRES S 240 3 N 1 8 s t QUADRAN T B 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 309.64 4 ±24.74 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 308.87 1 Supervise d By : 

### Certificat e o f Verificatio n

18 2 SOI L 2010-04-1 4 16:1 9 30.6 0 Fina l 2841 4 240 3 N 1 8 s t B l 6 " N
. LOPE Z confirmatio n non e

±Erro r ±24.69 0

# 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 313.80 1 Supervise d By : 

### Certificat e o f Verificatio n

18 3 SOI L 2010-04-1 4 16:2 0 30.4 9 Fina l 2841 4 240 3 N 1 8 s t B l 6 " N
. LOPE Z confirmatio n non e

± Erro r ± 24.81 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 306.26 0 Supervise d By : 

### Certificat e o f Verificatio n

18 4 SOI L 2010-04-1 4 16:2 1 30.5 1 Fina l 2841 4 240 3 N 1 8 s t B l 6 " N
. LOPE Z confirmatio n non e

± Erro r ± 24.74 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 AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E 

### Certificat e o f Verificatio n

18 9 SOI L 2010-04-1 4 16:2 3 91.5 0 Fina l I Av g o f 186-18 8

240 3 N 1 8 s t B 2 6 " N
. LOPE Z confirmatio n non e
Erro r pp m ± P b 152.15 3 18.52 5 Supervise d By : 

# ^ m w

# 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 148.67 8 Supervise d By : 

### Certificat e o f Verificatio n

18 6 SOI L 2010-04-1 4 16:2 2 30.4 8 Fina l 2841 4 240 3 N 1 8 s t B 2 6 " N
. LOPE Z confirmatio n non e

± Erro r ± 18.50 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 145.86 7 Supervise d By : 

### Certificat e o f Verificatio n

18 7 SOI L 2010-04-1 4 16:2 3 30.5 5 Fina l 2841 4 240 3 N 1 8 s t B 2 6 " N
. LOPE Z confirmatio n non e

± Erro r ± 18.20 0

# 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 161.91 4 Supervise d By : 

### Certificat e o fVerificatio n

18 8 SOI L 2010-04-1 4 16:2 3 30.4 7 Fina l 2841 4 240 3 N 1 8 s t B 2 6 " N
. LOPE Z confirmatio n non e

± Erro r ± 18.87 3

### ^^•- ^ ijOL \ I
.. . _. __ Omah a a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
. vl ^ V • J? www.coastalhazmat.co m Vp„ott< ^ COASTA L iNTIIONHINTA L c 1 0 u r, IN C 

# EXECUTIV ESUMMARY : BVID #28414-(240 3 N 18 ST ) No Issue s or Concern s | ^ Issues/Concern s Detail Explanation :4 

# SEPA EP A Propert y Clos e Ou t For m Propert y# : -^^.^( H Propert y Address:--—-—s—"Z i i ,- . <ii
. * ^ DatemiDc : l^y]IX0l O Quad s Excavated : ? U g- ^Contracto r Grou p rf^,<^JX-C^ \

' / Excavatio nGenera l Ye s N o 1
. I f necessBiy , wer e th e correc t quadrant(s ) excavate dan drestored ? ' y ^ 2
. I f necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? 

## \ y ' Cradln £ So d an d Vegelatio B Ye s N o 1
.

Doe s th e gradin g aroun dth e perimete r o f th e hous e i nexcavate darea s generall y slop e away fromth e house ? 

# U ^ 2
.Ha s so dbee nlai di nal l area s tha t wer e excavated ? 3
.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 generall y fir man devenl y graded ? L^ ' 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 day ^ ^ tim e period ) 6 . Wa s th e propert y grade dsuc hthat wate r wil l no t poo l o nth e propen>' ? l y ' 7 . Wa s damag e t o landscapin g o r plan t material s avoided ? iy ' Gates
. Fence s an dRetainin g Wal b Ye s N o I . D o gate s ope nan dclos e freely? (I f applicable ) 

### t^ ^ 2
.

Wer e al l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (I f applicable ) l^ " 3
.

Wa s damag e t o gate s o r fences avoided ? (I f applicable ) C ^ ^ 4
.

Wa s damag e t o retainin g wall s avoided ? (I f applicable ) Foundation , Sidin g an dGatter s Ye s N o I .Wa s damag e t o tli e sidin g o r tri mavoided ? ^ y ' 2
.Wa s damag e t o th e foundatio navoided ? 

### U- ' 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 downrispouts o r downspou t extension s avoided ? 

# \ A Sidewalk s an d Driveway s (Concrete ) Ye s N o 1
.

Wa s damag e t o drivewa y surface s avoided ? 2
.Wa s damag e t o walkwa y surface s avoided ? ^ ^

## OvYJoer s comments :

Inspectio nnotes :

Remova l an drestorationactivate s complete including the 30-da y so dwarranty : EP A Representativ e L J/TK/L>^1 ^ Date : ^ y]h(]it )

## Propert yCompletio n Agreemen t Ihi s agreemen t documents th e completio n o l remedia l activitie s perroime d o n mypropert yM ysignature wil l designat e tha t I a m satisfie d wit h th e restoralio n o f m yproperly , an d tha t n o item s ar e i n questions , now . o ra t an ylim e i n th e future , except thos e item s liste d below , i fan y Propert yID : ^ ^ t.- ) j L. J Propert yAddress : 2- M O" ^ ( ^ • ^2 , fsl" ' 0^ncr:^r/\(I A ^ "P^Ak
. Phone : Restoratio n Item s i n Question :

Item : Item : ininiwaiiimniiiiii i i •! • ii i i'»iiiiin.wii i i^iiimia i Item : item : Item : Item : Additiona l Comments ;


# J '^grc crestoralio n i s completed , except a t note d [ J I d o no t «i;re crestoratio n i s complelcr i 

# i j ^ ^-Ul-\ 0 S'&e^. ^ ^^U{~f d tier' s Signatur e Dat e Cunt i arlor' s Signatur e Dal e

## ^P R2 9 2m Propert y Owne r Assessmen t of PerformaiMj e Pur m America nRecover y an dReinvestmen t Act (ARKPfjTenF(j/\|[ ) QI\/IQI ^ 

## Omah aLea dSuperfun Superfun d d Sit e ^'o/(J/V ' 2009/201 0 Remediatio nContractor : Coasta l Environmenta l Grou p - EP-R7-09-0 6 Propert y Identifie r Number : '2.& M i \r j Propert y Address : ^WD 3 M • J?^'^

- Propert y Owner' s Name ; fVToai-l^
. Vi^jtxlZ
. Instruction s to tli 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 Surveillanc e Plan ) involvin g th e liste dremediatio ncontractor , as applicabl e to th e Omah aLea dSite
. Thi s for mdocument s th e timelines s of punc hlis t resolution , busines s relations , complaint resolutio nan dth e overall qualit y of work
. If nee dbe , th e Propert y Owne r ma y utiliz e thi s for m

to recordproblem s and/o r issue s no t specifically tie d toanassigne d address , fo r example , busines s relation s tha t generally don' t follo w th e guideline s set fort h

inth e Performanc e Wor k

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

by clieckin g anumerica l ratin g ontli e tabl e belo w usin g th e nimierica 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 y Owner' s Assessmen t of Performanc e Regardin g th e Contractor' s Wor k 10 9 ^ ^ 2r- ^ 4 8 Isg ^ 3 7 2 6 1 Propert y Owne r Additiona l Comment s fro m(optional ; continu e onbac k pag e if needed ) 

# 'jiL ^ j,.u4^-( ^ Propert y Owne r Signature :

## EP A Assessmen t of Performanc e For m America nRecover y an dReinvestmen t Ac t (ARRA ) Omah aLea dSuperfun dSit e 2009/201 0 Remediatio nContractor : Coastal Environmental Group - EP-R7-Q9-06 Propert y Identifier Number : •g , ^ ^ / H Property Address : "ZJ-jC ZA/ , i^^

- Propert y Owner' s Name : ^A^cxC-lQ ^ .QJP.(KI <

(Abov e informatio nt o b e fille dou t b y th e remediatio ncontracto r prio r t o utilizatio nb y th e EPA COR) 

### Instruction s to EP A COR : Thi s for mserve s t o recor dth e COR' s assessmen t o

f

performanc e (Incentive 1 - Qualit y Assurance Surveillanc e Plan ) involving the listedremediatio ncontractor, as applicabl e t o th e Omah aLea dSite
. Thi s for mdocuments th e timelines s of ptmc hlist resolution , busines s relations , complain t resolutionan dthe overal l qualit y o f

work
. I f

nee dbe , EP A ma y utilize thi s for mt o recor dproblems and/o r

issue s no t specificall y tie dto a nassigne daddress , fo r

example , busines s relation s tha t generall y don' t follo w th e guideline s se t forfl i i

nthe Performanc e Wor k Statement
. Th e CO Rwil l indicat e his/he r

assessmen t o

f

perfonnance wit hthe contractor' s wor k

b

y checking anumerical ratin g o nth e tabl e belo w usin g the numerica l definition s fix> mth e ratin g scal e below , the nsig n& dat e the form
. 9-1 0 "excellent " 7- 8 "ver y good " 5- 6 "acceptable ' 3- 4 "pooi^ ' 1-

2 "very poor " 

### EPA' s Assessmen t o

f

Performanc e Regardin g th e Contractor' s Wor k


## < 4 8 3 7 2 6 1 

### Additional Comment s fro mEP A CO R(optional ; continu e o nback pag e if needed)

EP A CORSignatur e