## TRANSMITTALof OMAHALEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAID # : Orun- ^ Date : \h\7Ji^{C ^ Address : \? ^ *^
. 7 6 S \ Remediatio nContractor : Coasta l Environmenta l Group

_Year : 200 8
SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 5y ^
^ B ^ w U ^

B ^ M S y S ^ \ty B-^ ^
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### Vide o ofpropert y (DVD )

Executiv e Summar y EPA-provide dproperty sketc h Signe dAcces s Agreemen t for subjec t property Signe 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

Photograph s m-bYCe{/Ar\ ^ , f)<^ATltf n^ V * H 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 nofarea s no t meetin g RO D cleanu p criteri a Utility clearance s Property informatio nfro mDougla s Coimt y Assessor' s Offic e 4- ^

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^ Utilit yClearanc e | S Video/Photo s (Before ) ^o^e^W 0 Video/Photo s (During ) D Video/Photo s (After ) D Video/Photo s (30-Day ) Q Propert yCompletio n Agreemen t Sent : / / SIpicd : L ' / Lb l ^ Signed:,^ / l O / ^ / I 1 1 1 1 Called : ( / IV L /C ^ 

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## CONTAC T FORM Propert y I D U 

# ^^^n ^ Property Address : 

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# 2 S ^' ^ Initial Contact : Date : Time : Action : Secon dContact : Date : Time : Action : Final Contact : Dale : Time : Action : Final Action : Transmi t to EP A D Other Action : D

Comment : Owne r Commen t (s) : Sit e Coordinato r Comment (s) :



# ( i

## Douglas Coimt y Accoun t Inf i 

# ^"9^ " Pag e 1 of 2
Dougla s County , Nebrask a Propert yRecor d - R221950000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s avaiiabi e (5 ! scal e 0-5 0 ft wes t o f52n d S t - ViewO n Ma p Inforrnatio n i s vali d a s o f 2009-5-1 2 Treasurer' s Ta xRepor t Ne wFeatur e • * • ¥^ Aut o Sale s Searc h Owne r ANDERSO N MAR YD 130 9 S 2 5 S T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 195 0 OOO O 2 2 Accoun t Type : Residentia l Parce l Number : 221950000 0 Parce l Address : 130 9 S 2 5 S T OMAH AN E 68105-000 0 Lega l Description : SHULL S 2N D A D D LO T2 0 BLOC K1 2 N 1/ 2 2 5 X 12 6 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $3,600.0 0 $33,500.0 0 $37,100.0 0 200 8 $3,600.0 0 $33,500.0 0 $37,100.0 0 200 7 $3,600.0 0 $33,500.0 0 $37,100.0 0 200 6 $3,600.0 0 $33,000.0 0 $36,600.0 0 200 5 $3,600.0 0 $33,000.0 0 $36,600.0 0 200 4 $3,600.0 0 $33,000.0 0 $36,600.0 0 Saie s Informatio n Sale s Date : 2002-05-2 9 Dee d Type : Q C Bodk : 200 4 Page : 00898 2 Price : $0.0 0 Grantor : Lawrenc e S Anderso n Grantee : Mar yD Anderso n Valid/Invalid : Invali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Oeptf i Widt h Vacan t 0.0 7 3150. 0 1. 0 126. 0 25. 0 N o Improvemen t Informatio n 

## http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinft).jsp?accoimtno=R221..
. 6/6/2009 

# 1

### Dougla s County Accoun t Inf i 

# 'oj^ " Pag e 2 of 2

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. CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 832. 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 : Force d Ai r Rooms : 6. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Plaste r Baths : 1. 5 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 189 0 0 0 % 189 0 11 9 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fenc e Chai n Linl < 1. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 560. 0 Basemen t Minima l Finis h 200. 0 Fixtur e Additiona l Fixture s 1. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Fixtur e Bat h Hal f 1. 0 Garag e Detache d 240. 0 Porc h Enc l Soli d Wal l 240. 0 Porc h Sla b Roo fCei l 160. 0 Porc h Sla b Roo fCei l 160. 0 Use r Atti cFul l Finis h 272. 0


### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfi3.jsp?accountno=R221.
. . 6/6/200 9

### http://www.dho i n^^jgi i ntemet/DHONNoticeCreation/MessageTexL.
.
Creat e Anothe rTicke t Bac k t o lit h Inteme t Sen d Emai l


### YOU RTICKE T NUMBE RI S  2300182
. Origina l Cal l Date : 6/22/0 9 Time : 12:5 2 p m Op : ELIZABETH18 7 9 0 Wor k t o Begi n Date : 6/24/0 9 Time : 1:3 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 130 9 Street : S 25T H S T Twp : 15 NRng : 13 E Sect-Qtr : 28-N E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : Lea mRemediatio n Locatio n o f Work : INCLUD E AL L EASEMENT . LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E O 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 : 4f t Corne r Lot : N Front : Y Rear : 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 lyp e CXCAT V CO X COMMUNICATIONS , IN C HEID I Day : 402934046 9 Ah : 402934046 9 Emerg : 402932975 7
LEVEL S LEVEL 3 COMMUNICATIONS , LL C N A Day : 877366834 4 Ah : Emerg : 877366834 4
MUD0 2 METROPOLITA NUTILITIE S DISTRIC T SAND Y Day : 402504782 3 Alt : Emerg : 402504797 0
OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO N Day : 402444719 7 Ah : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 0PPDGPR 6 OMAHAPUBLI C POWE RDISTRIC T N A Alt : 406207149 4

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### Emerg : 888728934 3 Day : 406728934 3 QLNNEI FQWES T LOCA LNETWOR K N A Ah : 406207149 4 Emerg : 888728934 3

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# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e
2047 3 Exterio rPain t Nort hArro w Omah a Lea d Sit e Owne rName : MAR YD ANDERSO N Sit e Sketc h • Goo d Address : 130 9 3 2 5 S T • Poo r

Phone : H : 402-345-872 8 W : 402-342-107 4 [^'-Tlo t pain t Sample s Collecte d Firm : _ ^f'<c,c ^

- / y y Date : . 6 yjy< o Y Time : Sample s Analyze d XR F Un i t : &l-2 ^

Book : 5*2 - Date : . 

## • 7//sy^tY - Time : _ /^y ^ Staff : . £P'^P'7* ^



### Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Aze areplace dwit h Are areplace dwi1: h 

# D Are alef t bar e So d Rock/Mulc h 

### Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
. 4613 0

## 2047 3

4613 0 

### 'puS"<-vM

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## 2047 3 Omah a Lea d Sit e Owne rName : M/kR YD ANDERSO N 

### Sit e Sketc h Address : 1309S^25^ T

Phone : H : 402-345-872 8 W : 402-342-107 4 Lea d Sampl e Sampl e Numbe r 

# I I LA B Concentratio n Collecte d RYASCPXA-2047 3 F 1 pp m 

## D RYBSCPXA-2047 3 F 2 pp m 

## D 

# to l RYCSCPXA-2047 3 B 1 pp m 

## D RYDSCPXA-2047 3 B 2 pp m 

## D RDZSCPXA-2047 3 D Z 

# 5i o pp m 

## D 

# 57/ R62SGP>(A=2IM73 - -02 - pp m 

## D RPZSCPXA-2047 3 P Z 

## -y^^ S pp m 

## D Numbe ro f Sample s = Exterio rPain t North Arro w 

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# < e [3'l^ t pain t Sample s Collecte d Firm : 

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OmahaLeadSite 4613 0 'puS"-<-'W \ t^» 4

## 2047 3 Omah a Lea d Sit e Extsrio rPain t htortt ) Arro w 

### rOwne rName : MAR YD ANC^RSO N 

### • Goo d 

### Sit e Sketc h Address : 1309 S 2 5 S T < - Phone : H : 402-345-872 8 W : 402-3C-107 4 rZk^ro t pain t 

### Sampl e Numbe r RYASCPXA.2047 3 F l RYBSCPXA.2D47 3 F 2 RYCSCPXA-2047 3 8 1 RYDSCPXA-2047 3 8 2 RD2SCPXA-2D47 3 D Z R6EB6PXA=2W7 3 Of RPZSCPXA-2047 3 P Z Lea d Sampl e Concentrafio n Collecte d pp m pp m 

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## i-^ ' COASTA L ENVIKONHENTA L Vp„o^<i ^ CIOUP
. IHC
. 

## Consen t fo rAcces 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 :

Owner' s Nam e Daytim e Phone : 

# Mlntr q 

# 4 firvlQ/y^T^A
Addres s o fPropert y covere d b ythi s Agreement : 

# /^.^^q^
. 2^. ^ 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 flea 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 it s 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 fCoastal 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 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 fmished , 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 

### B ysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , it s employees , contractor s an d subcontractors 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 perfomnin 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 satisfectoril ycompleted
. Th e Granto rals o agree s to :

Page l of 2o ' 

# f 

# M V"**!** ' •COASTA L

* J ^

_. ^ tN»l«OHHtNTA l • ' I PBO^ *CIOUP
. INC
. 

### •Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; •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 ; •Abid e b yhealt h an d safet yguidanc e provide d b yEPA ; •I f th e propert yi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propert yt o perfor m th e work
. •Allo wvideotapin g and/o rphotographin g o f th e property
. AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s no t t o interfer e o rtampe rwit h an yo f th e wor k activities , o rwit h an y o f th e wor k done , o rwit h th e equipmen t use d o n hi s property , o rt o undertak e an y action s regardin g th e us e o 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 wother s 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 ^^pL j gran t access t o m ypropertie sD I d o no t gran t access t o m ypropertie s

signatur e (yOat e Signatur e

Dat e

G I 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 AS S'. AL G n o u t 

## Restoratio n Agreemen t Th e purpos e o f thi s agreement i s t o provid e amutual agreement a s t o condition s o f th e property prio r to 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 propert y owner an dth e Unite dState s Environmenta] Protectio nAgenc y (EPA)
.

Property ID : 2JC^'^ ^ 

### Property Address : |a^ q^ 2 ^ ^ T Owner : U^^^ X C\vHerS^ n
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 ) to b e use db y th e contractors . Indicate distances , depths , materia l types , etc . Photographicall y andVideographically document th e existin g condition s ofth e propert y an dth e basement if necessary . 

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



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

# ^v^ k %nr M ph/i-h ' ut^p/ t

tip.kifn( i Item : Item : 

### Item :

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

# -g^i l 

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# -^'D ?

Ite m Pre-existin g property area , that wil l b e excavated , thfl t i s covere dwhhgrass . Nuinbe r o f tree s > 2 inch trunk diamete r Numbe r o f tree s < = 2 inch trunk diamete r Numl>e r o f Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Atiachasketcho f the sprinkler la\oui
. Numbe r o f andsiz e o f eac hgarden / flowe r be d area . AuachaskL-tc hof relativ e size s andlocations
. Agree dupo nvalu e o f plant material s no t t o b e replace db v contractor . Note thi s \alii e <vil l be use dt o issu e aplan t vouche r to th e propcrt \ owner . Easement Area , t o b e excavate d 

## Quantit y

% ^ \ 

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# V\ ^ vfe s Landscap e Inventory Un K Quadrant s

Eac h
Eac h

Each

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$ 

## Condition/Type/Specie s

'perPUhc Lt2Q^^»vi^H Eac h
Pag e 2 of
.COASTA L a n o u ' , IN C
Additiona l Comment s / Instructions ;

G Chec k th e bo xi f Owne rdoe s no t wan t CE G t o documen t interio rfoundatio n wail 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
. 

# M l agre e 

### G I d o no t agre e


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RETES T AREA S Readin g Sampl e are a Shot # Readin g Sampl e are a S(,.Mltl\&.2 H 

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 43 8 Mod e SOI L Tim e 2009-06-2 6 14:4 7 Duratio n 121.1 2 Sequenc e Fina l Flag s AVERAG E /Avg-of3C@337 D ADDRES S T:30 9 S 2 5 s t QUAD/ZON E easemen t INSPECTO R nicola s DEPT H 1 SAMPL E TYP E CLEARANC E NOT E

pp m Erro r P b \235.293 \ ± l l 8^27 5 Supervise d 

### By : ^^CQiSli^Ci A

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 249.53 8 Supervise d By : 

## Certificat e o fVerificatio n

43 4 SOI L 2009-06-2 6 14:4 4 30.2 6 Fina l 2047 3 130 9 s 2 5 s t easemen t nicola s 1 CLEARANC E

Erro r ± 18.88 8

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P

b 230.77 8 Supervise d By : 

## Certificat e of Verificatio n

43 5 SOIL 2009-06-2 6 14:4 5 30.2 8 Fina l 2047 3 130 9 s 2 5 s t easemen t nicola s 1 CLEARANC E

± Erro r ± 18.24 2

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 223.96 0 Supervise d By : 

## Certificat e o f Verificatio n

43 6 SOI L 2009-06-2 6 14:4 6 30.2 7 Fina l 2047 3 130 9 s 2 5 s t easemen t nicola s 1 CLEARANC E

± Erro r ± 17.74 2

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 236.89 7 Supervise d By : 

## Certificat e o f Verificatio n

43 7 SOI L 2009-06-2 6 14:4 7 30.3 1 Fina l 2047 3 130 9 s 2 5 s t easemen t nicola s 1 CLEARANC E

±Erro r ±18.22 9

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s AVERAG E ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 

## Certificat e o fVerificatio n

44 8 SOI L 2009-06-2 6 16:3 3 121.3 8 Fina l
130 9 s 2 5 s t B l nicola s 6 CLEARANC E

Erro r 

### {JMI S Supervise d 

# BrL2CMm^

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 144.77 9 Supervise d By : 

## Certificat e o fVerificatio n

44 4 SOI L 2009-06-2 6 16:3 1 30.2 6 Fina l 2047 3 130 9 s 2 5 s t B l nicola s 6 CLEARANC E

Erro r ± 14.80 9

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 210.31 6 Supervise d By : 

## Certificat e o fVerificatio n

44 5 SOI L 2009-06-2 6 16:3 2 30.5 6 Fina l 2047 3 130 9 s 2 5 s t B l nicola s 6 CLEARANC E

± Erro r ± 17.80 8

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVID # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 182.97 1 Supervise d By : 

## Certificat e o fVerificatio n

44 6 SOI L 2009-06-2 6 16:3 3 30.3 1 Fina l 2047 3 130 9 s 2 5 s t B l nicola s 6 CLEARANC E

± Erro r ± 16.56 8

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 241.24 0 Supervise d By : 

## Certificat e o fVerificatio n

44 7 SOI L 2009-06-2 6 16:3 3 30.2 5 Fina l 2047 3 130 9 s 2 5 s t B l nicola s 6 CLEARANC E

± Erro r ± 18.90 1

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 47 6 Mod e SOI L Tim e 2009-06-2 7 10:3 8 Duratio n 120.3 1 Sequenc e Fina l Flag s AVERAG E AAVTO F 4Z2=4J5 ^ ADDRES S ^130 9 s 2 5 s t QUAD/ZON E D Z INSPECTO R nicola s DEPT H 1 2 SAMPL E TYP E CLEARANC E NOT E

± Erro r Pb ± /24:492J 3 Supervise d By : pp m

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 311.70 2 Supervise d By : 

## Certificat e o fVerificatio n

47 2 SOI L 2009-06-2 7 10:3 6 30.0 5 Fina l 2047 3 130 9 s 2 5 s t D Z nicola s 1 2 CLEARANC E

± Erro r ± 21.09 3

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 307.40 8 Supervise d By : 

## Certificat e o fVerificatio n

47 3 SOI L 2009-06-2 7 10:3 7 30.1 0 Fina l 2047 3 130 9 s 2 5 s t D Z nicola s 1 2 CLEARANC E

± Erro r ± 21.32 3

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 579.64 5 Supervise d By : 

## Certificat e o fVerificatio n

47 4 SOI L 2009-06-2 7 10:3 7 30.1 1 Fina l 2047 3 130 9 s 2 5 s t D Z nicola s 1 2 CLEARANC E

± Erro r ± 28.82 2

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPLE TYP E NOTE

pp m Pb 462.74 4 Supervise d By : 

## Certificat e o fVerificatio n

47 5 SOI L 2009-06-2 7 10:3 8 30.0 5 Fina l 2047 3 130 9 s 2 5 s t D

Z nicola s 1 2 CLEARANC E

± Erro r i : 26.73 1

# f 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-3208 9 Readin g N o 48 5 Mod e SOI L Tim e 2009-06-2 7 11:0 6 Duratio n 120.9 3 Sequenc e Fina l Flag s AVERAG E Av g o f 481-484 ^ ADDRES S T30 9 s 2 5 sr^ ^ QUAD/ZON E D Z INSPECTO R nicola s DEPT H 1 5 SAMPL E TYP E RETES T NOT E

pp m Erro r Pb ^^1.98 5 Supervise d 

# By : feC0Jm m

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P

b 56.41 0 Supervise d By : 

## Certificat e o f

Verificatio n

48 1 SOIL 2009-06-2 7 11:0 3 30.1 4 Fina l 2047 3 130 9 s 2 5 s t D Z nicola s 1 5 RETES T

± Erro r ± 10.24 3

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 71.91 9 Supervise d By : 

## Certificat e o fVerificatio n

48 2 SOI L 2009-06-2 7 11:0 4 30.1 1 Fina l 2047 3 130 9 s 2 5 s t D Z nicola s 1 5 RETES T

± Erro r 11.08 5

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 147.96 5 Supervise d By : 

## Certificat e o fVerificatio n

48 3 SOI L 2009-06-2 7 11:0 5 30.3 3 Fina l 2047 3 130 9 s 2 5 s t D Z nicola s 1 5 RETES T

± Erro r ± 15.37 0

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequence Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPLE TYP E NOTE

pp m P b 75.63 0 Supervise dBy : 

## Certificat e o f

Verificatio n

48 4 SOIL 2009-06-2 7 11:0 6 30.3 5 Fina l 2047 3 130 9 s 2 5 s t D

Z nicola s 1 5 RETES T

±Erro r ±11.24 2#

^••''"'•^'*! , 

### /^A^ \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 8 ^^^ ^

a Coasta l Environmenta l Grou p Inc
. V^^^rj ? www.coastaIhazmat.co m '^tpRoi*'^ " COASTA L INVIIOHNINTA l GROUP
. IH C 

# EXECUTIV ESUMMARY : BVID #2047 3 - (130 9 S 2 5 ST )

X 

# No Issue s o r Concern s [ ^ Issues/Concern s Detail Explanation : Owne r

claimedCoasta l crackedhe r

sidewal k

i

nthe backyar dan dafte r

reviewing the pre excavationphoto s Coasta l determinedtha t the damage s wer e pre-existing
.

# 0 §
Wate rBil l Settlemen t

Propert y ID 2047 3 Propert y Addres s 130 9 S 25 ST
. Tenan t Miss
. Mar y D. Anderso n

I hav e receive dfromth e contractor , Coasta l Environmenta l Grou p Inc
. (Coastal) , th e su m of $ 21.4 1 fo r wate r usag e require d to maintai nth e sod
.
Chec k Numbe r 171 2 Valu eof Chec k $21.4 1 Mad e Ou t To Mar y Anderso n Descriptio n of Settlemen t To reimburs e tenan t fo restimate d wate rcharge s on thei rMU D monthl yinvoices
. Mysignatur e belo w is acknowledgemen t of th e receip t ofth e su m liste d above , whic h I furthe r acknowledg e to be fai rcompensatio n an d ful l paymen t fo rth e above , an d releas e Coasta l Environmenta l Grou p inc
. fro m furthe robligation s orliability
.



# A7^/-^^^^'^-^-» ^ tO-^-O yF^O/JLtJ^n h lojnirf ) Owner' s Signatur e Dat e Sienatur Dat e Contractor' s s Signatur e e

" I I,
. " H J =wr5 * T T -^'•4'^:.'••'?'^!JI>!^!.1!^}!-'^'^ v COASTA L ENVIRONMENTA L GROU P INC
. 

## 171 2 241 1 MARTH ASTREE T 27-6/104 0 003 OMAHA , NE 6810 S 624737290 4 

# ^ Kl I o^

PA

Y TO TH E ORDE ROF
. 

# Um^ "im^ DAT E 

# IWfotft ] OK

VMI i Farg o BtnkN A Nibmk i wH1sfirgo.CDn i FO R



# iriouoooosai : &21.737E^OUM-'^OI?i s

# w % 

# EP A ^ 

# EP A Propert y Clos e Ou t For m Propert y # : "ZCM ^ Propert y Address:

- \^rA?^
. 7rf S ^ •.>- Datc/Tlmc : Owner' s Name:
. /JS/JQ ^ Qt^OOTfifi n. Quad s Excavated : ' ^ PZ
. Contracto r Grou p ClTcHMk X V'-YWi^f/ytfiVnt ^ Excavatio nGenera l I
.If necessary , were th e correc t quadrant(s ) excavate dandrestored ? 

# p f
2
. I f necessary , were th e correc t area s ofdri p zone excavate dandrestored? 

# y CmdlB g So dan dVcgetatio B Ye s N o I
.Doe s the gradrng aroun dthe perimeter of the hous e i nexcavate darea s generally slop e awa y 

# ^ y fromth e house ? 2
.Ha s so dbee nlai dinal l area s tha t wer e excavated ? 

# U ^ 3
.

Doe s th e sodappea r to b e generally health y an dgrowing ? (Onl y evaluate i f inspecteda t a3 0 day tim e period ) 4
.Are soddedarea s generall y fir man devenly graded ? 5
.

Arc th e joint s l>etwee nth e so dstrip s generally tight ? (Only evaluate i f inspecte da t a3 0 da y - ^ ^ time period) ._ 6
.

Wa s the propert y grade dsuc htha t wate r will not poo l o nth e propeny ' 

# -:3 ^ 7
.

Wa s damage t o landscapin g o r plan t material s avoided ? Gates , Fence s an dRetainin g Wall s Yes N o 1
.D o gate s ope nandclos e freely ? (Ifapplicable ) 2
.Were all gate s or fence s takendow ndurin g restoratio nactivitie s reinstalled ? (Ifapplicable ) 

# w^ 3
. Wa s damag e t o gate s o r fence s avoided ? (tf applicable ) 

# l y '

. _ ^ 4
.Wa s damage t o retainin g wall s avoided ? (Ifapplicable ) Foupdation , Sidin g an dGutter s Ye s N o I
.Wa s damag e t o th e sidin g o r tri mavoided ? 2
.Wa s damage to the foundationavoided ? 

# 2 : 

# t^ 3
.

Wa s damage to window s avoided ? 4Wa s damage to window s o r doo r screen s avoided ? 5
.Wa s damage to downspout s or downspoul extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ve s yS o 1
.Wa s damage to drivewa y surface s avoided ? 

# 'v t
2
.Wa s damage to walkwa y surface s avoided ? 

# V­

# F % 

## Owner s comments :

Inspectio nnotes :

Remova l an drestorationactivate s complet e including th e 30-da y so dwarranty : EP A Representaiiv e iUw i UQJVIJL ^ 

## DaXt. S 1 3 0 ^

# « i

Propert yCompletio n Agreemen t riii s agreemen i documenl s th e completio no f remedial activilies performe do nm y pmperty . M y signalui e will designat e lhat 1 amsalislie dwilhth e restoratio nofm y property , an dtha t n o item s ar e i nquestions , now , o r at an y tim e inth e future , excep l thos e item s liste dbelow , ifany
. Propert y ID : ^.CH^ B Propert y Address : \2NrC i ^ '7«' & S T 

# ^'"'"

- NAar aV\YY\a&o n
Restoratio n Item s i n Question :

Ite m Item : Ite m Ite m Ite m Item : Additiona l Comments : 

### -d>L.A«/»U4
. (yy i Int^c AtptytJ COL
. (yiyjuf^U ^ f {yiy^-A-^h\y 

# J

LJI agre e re<itorntto ni.s completed , excep t a s note d I I ct o no t agre e restoratio ni s complete d

Owner' s Si];i/atur o Daf c Cohtriictor' s Signatur e ' Dat e I

## Wate rBII I Settlemen t

Propert y ID 2047 3 

# G rcey v Propert y Addres s 1309S2SS t Tenan t Mary D
. Anderso n

I have receivedfiomth e contractor , Coasta l Environmenta l Grou p Inc
. (Coastal) , th e su mof $ 27.6 2 fo r wate r usag e require dt o maintain th e sod
.
Chec k Number 182 5 Valu e o f Chec k $27.6 2 Mad e Ou t T o Mar y D
. Anderso n Descriptio n o f Settlemen t T o reimburs e tenan t fo restimate d wate rcharge s o n thei rMU D monthl yinvoices
. M ysignatur e belo wi s acknowledgemen t o f th e receip t o f th e su m liste d above , whic h I furthe r acknowledg e t o b e fai rcompensatio n an d ful l paymen t fo rth e above , an d releas e Coasta l Environmenta l Grou p inc
. fro m furthe robligation s o rliability
.

ner' s Sieiratur e Dat e Owner' s Sig i

27-5/10* 0 00 3 824737290 4 COASTA L ENVIRONMENTA L GROU P INC
. MIIMARTHASTREE T OMAHA , N E 68105

PA

Y T O TH B ORDE RO F 

# 2,0^0 2 -^—" — i:iouoooo5fli : E.su7i^t;iu H39 1 Account : 126429-112756 4 MAR YD
. ANDERSO N Servic e addreaa : 1309S2STHS T Cal l SMi m i f yo u smel l gas . N o charg e t o chec k ga s leaks
. Hav e heatin g syste m checke d ever yyea rb ya qualifie d heatin g contractor
. Kee p chimney s an d flue s fre e o fdebris
. 

# "LiUlt A No

vDecJa n Fab MarAp t Ma yJu n Ju l Au g Se p Oc t You rGa s Us e

• Past 1 2 MorMi * B Past13« 4 Monlli a Thi s Mont h Las t Yea r Billin g units : Us e pe rday : 3 0. 1 1 9 0. 6 Averag e cos t pe rday : $0.5 7 $1.0 3 Numtie ro f day s i n tMllin g cycle : 2 9 3 2
2 0 " 

# 1 10 ­ 

# 1 I
0
. No vDe cJa n Fe b Ma rAp rMayJu n Ju l Au g Sa p Oc t You rWate rUs e

• PBttUMonUi s • Past13««Monlt n Till s Montt i Las t Yea r Billin g units : 1 8 3 Us e pe rday : 0. 6 0. 1 Averag e cos t pe rday : $1.0 1 $0.3 1 Numtie ro fday s I n tiillln g cycle : 2 9 3 2 

# J8 L 172 3 Harne yS t • Omaha , N E 6810 2 • 402.554.666 6 e-mail : (XJStomer_servic8@mudomaha.co m • website : www.muclomaha.co m 

## METROPOLITA N UTILITIE S DISTRICT Billin g dat e Oc t 6 , 200 9 Liv e Green
. 7/iM5to
. Prevlou a balanc e $114.0 0 Paymen t receive d -Than k yo u 114.0 0 C R Cunen t charge a 114.0 0 Ne wbalanc e 114.0 0 

## • Tota l du e Oct 21,200 9 $114.0 0 Yourbudge t paymen t o f$114.0 0 i s du e Oc t 21,2009
. Budge t variances :

Curren t = -$^.7 6 Tota l = -$36.0 4 Oetait o ofourren t oliarges : 

## GA S RESIDENTIA L RAT E A : Au g 3 1 t o Se p 2 9

Mete rNumbe r37117 9 Curren t rea d (aotuao : 536 0 - Previou a rea d (estimate) : 535 7 > •3 CC F Ga s Use : 3 CC F x1.02 3 (hea t value ) = 3.06 9 therm s

1 day s 0.10 6 therm s a t 0.528 3 - < $0.0 6 2 8 day a 2.96 3 therm a a t 0.463 2 - 1.3 7 Service Charg e 12.0 0 Ga s Cos t > $13.4 3 Ga s Infrastructur e Replacemen t 3.0 0



## WATE R RESIDENTIA L RAT E W-1 : Au g 3 1 t o Se p 2 9

Mete rNumbe r282278 6 Size : 5/ 8 -inc h Cunen t rea d (actual) : 33 9 - Previou s rea d (estinwte) : 32 1 » 1 8 CC F

Wate rUse : 18.00 0 CC F o r13,46 4 gallon s 9.00 0 CC F a t 0.9614 - $8.6 5 9.00 0 CC F a t 1.345 1 ­ 12.1 1 Servic e Cheirg e 4.8 6 Wate rCos t • $25.6 2 Wate rInfrastructur e Replacemen t2.0 0 Git yo f Omah a Sewe r 10.3 8 Sale s Ta x 3.8 1 V Curren t Charge s $58.2 4 

# \il ^ 

# i