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

SAID # 

## : '^<£?U 1 Date : 

# l/ l Address : ^>0 5 Vfe^f f ^ t
. RemediationContractor : Coastal Environmenta l Group
_ Year : 200 9

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# 1 / SOI LREMEDIATIO N PROPERT Y FIL EFOLDERDOCUMENT S Video of propert y (DVD) Executive Summar y EPA-providedpropert y sketch SignedAcces s Agreemen t fo r

subject propert y SignedAcces s Agreement(s ) fo r

adjacen t propert y RestorationAgreemen t Settlemen t docimients (i.e. , fo r

damage or to replac e plants , etc. ) Confirmationdata Photograph s \ H ^Cfif]/f\n» ^ V V^^C^lPr(\^y [ f i^A h As-built sketch Satisfactor y restorationsignedb y Propert y Owne r Propert y close-ou t chec k

lis t signedby EP A Descriptionof area s not meeting RO D cleanu p criteri a Utilit y clearance s Propert y inforaiationsfro mDouglas Coimt y Assessor' s Offic e

Signatur e 3021754 0 Superfun d

## Propert yAcces s Checklis t Propert y ID : nWOR K ST/VRTE D ON : _/ /_ 

# :s s Propert yAddress : D WOR K COMPELTE D ON : / / 

## CM

. Owner ; Rente r 

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D Notincatio n Lette r Sent : / / By : y j ^ Acces s AgrcemcB l Signed:^ / (^/ ^ By : 1

^ Restoratio n Agreemen t Signed : 4_/^/ ^ By : D Topsoi l Samplin g (i f applicuble ) / / By : Q Disposa J Samplin g (r f applicable ) / / By : Q Gnrdc n Sfloiplia g (i f applicable ) / / By : ' ^ Uiilit yClearanc e 

### Called : jl./je/£> 3 

## B> = //f/^/o ^ KVideo/Photo s (Before ) 

## On:JllS/ ^ ^y - O(?\av^ o

•Viileo/Photo s (During ) On : / / By : D Video/Photo i (After ) On : / / By : D Video/Photo s (30-Day ) On : / / By : D Propert yCompletio n Agreemen l Signed : / / By : D FinJi l Repor t Issued : / / By : Ai rMonitorin e (i U applicabl e )

C D Communit yQ Cre w Oo : / / |By : Results : C D Community ' D Cre w On : / / By : Results :
n Communit yD Crv> y On : / / 1 By : Resultj :

Omah a Lea d Sit e

## Douglas Count y Accoun t InfqB&atio n Pag e 1 of 2 jxa^ i
Dougla s County , Nebrask a Propert yRecor d - R141658000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s avaiiabl e @ scal e 0-5 0 f i wes t o f52n d S t - VJe WO H Ma p Informatio n i s vali d a s o f2009-10-1 5 Treasurer' s Ta xRepor t Ne wFeatur e ^ • • "•Aut o Sale s Searc h Owne r SMIT H DOROTH Y 430 8 BEDFOR D AV E OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : 

### 165 8 000 0 1 4 Accoun t Type : Residentia l Parce l Number : 141658000 0 Parce l Address : 430 8 BEDFOR D AV OMAH AN E 68111-000 0 Lega l Description : INSTITUT E PLAC E LO T1 5 BLOC K3 5 0 X 12 8 Valu e Informatio n Lan d Improvemen t Tota l 

### 200 9 200 8 200 7 

### 200 6 200 5 200 4 $6,400.0 0 $6,400.0 0 $6,400.0 0 $6,400.0 0 $6,400.0 0 $6,400.0 0 $47,700.0 0 $47,700.0 0 $47,700.0 0 $47,700.0 0 $31,700.0 0 $28,800.0 0 $54,100.0 0 $54,100.0 0 $54,100.0 0 $54,100.0 0 $38,100.0 0 $35,200.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 4 6400. 0 

### 1.0 128. 0 50. 0 N o Improvemen t Informatio n Buildin g 1



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl..
. 10/22/2009)r|^l i 

### Dougla s County Accoun t Infojj|^io n Pag e 2 of 2

43l»BEDfCR D A V

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- Firs t Floo r 3„ ^

1020. 0 x q ft lOt r

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CLIC KT O ENLARG E IMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : 1020. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Averag e

Buil t As : Ranc h Cond o Squar e Footage : 0. 0

HVAC : Centra l Ai rt o Ai r Rooms : : 5. 0 Exterior : Masonr yCommo n Bric k Units : 1. 0 Interior : Drywal l Baths : i 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 3. 0

Roo fType : Gabl e Stories : 1. 0 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 192 4 0 0 % 192 4 8 6 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k8 f t 1020. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h En d Soli d Wai l 120. 0 Porc h Sla b Roo fCei l 36. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl.
. . 10/22/200 9

### Pag e 1 o f 1

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• YOURTICKE T NUMBE RI S 2410274
. Origina l Cal l Date : 11/19/0 9 Time : 1:3 5 pm Op : ELIZABETH1879 0 Wor k t o Begi n Date : 11/23/0 9 Time : 2:1 5 p m State : NE County : DOUGLA S Place : OMAH A Address : 430 8 Street : BEDFORD AVE Twp : 15 NRng : 13 E Sect-Qtr : 08-N W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lead remediatio n Locatio n o f Work : INCLUD E AL L EASEMENT S LOCAT E ENTIR E PROPERTY Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LO T : RESEN T DU E T O WORK EXTENDING . PLEAS E REFRES H PAIN T AN D FLAG S Compan y: COASTAL ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Being Don e For : Coasta l Environmenta l Grou p Dept h o f Excavation : 4 fee t Corne r Lot : NFront : Y Rear : Involve s Tunneling o r Horizonta l Boring : NExplosives : N CXCAT V

MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servie e Are a Contac t Phon e Numbe r Utilit y Typ e
CXCAT V CO X COMMUNICATIONS , IN C HEIDI 

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

MUDO l METROPOLITA NUTILITIES DISTRICT SAND Y 

### Day : 402504782 3 Alt : 

### Emerg : 402504797 0

OMAHACO FCIT Y O FOMAHA-TRAFFIC.SEWE R 

### Ricnn-RAFFI C Day : 402444719 7



### Alt : 402444516 1

Emerg : 4024445160

OPPDGPR 5 OMAH APUBLI C POWE RDISTRIC T N A 

### Day : 406728934 3 Alt : 4062071494 Emerg : 888728934 3
QLNNEl C QWES T LOCA LNETWOR K N A 

### Day : 406728934 3 Alt : 4062071494 Emerg : 888728934 3
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.
. . 11/19/200 9OLS#:3062 7 

# As-Buil t Drawin g Dat e Excavated : 11/13/0 9 Dat e USEP ASiane d Off : 2/3/1 0 C OAST AL 

# Omah aLea dSuperfun dSit e ENVIRONMENTA L Are a Sodden : 459 0 s a f t CROUP

. IN C 

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### Legen d
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### Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
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### • • • •



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

### Granto r(th e propertyowner) 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 : Ai ^

^ 

## yiOlp^ZAA ^ Owner' s Name : Daytim e Phone : 

# H5\-Qzi ^ 

# 5 ^ Addres s o fPropert y covere d b ythi s Agreement : 

# HrbO ^ fi^lfr^n PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EPAi s requestin g acces s t o collect soi l sample s an d remove soi l tha t contain s elevate d concentration s o flea 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 its origina l condition

. Thi s wor k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o fCoasta l Environmenta l Group , contracte d b yUSEPA , wil l contact 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 opportunityt o revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e i t begins

. Onc e th e wor k I s finished , th e Granto rwil l b e aske d t o revie wth e wor k an d confir m tha t i t i s complet e an d meet s wit h th e Grantor' s approval

. Upo n completion , th e Granto rwil l receiv e viffitte n documentatio n fro m EPAtha t th e property 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 , contractors an d subcontractors 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 o fperformin g th e worit

. Thi s acces s shal l remai n i n effect unti l th e wor k ha s bee n satisfactoril ycompleted

. Th e Granto rals o agree s to :

Pag e 1 o f2COASTA L r. -t - INVmOMHfKTA l ^ i PRQl * C KO U rt H C



### « Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; cRemov e flowe rbulb s orplant s tha t th e Granto rorth e Grantor' s tenan t ma ywis h to save ; < Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , as necessar ysubsequen t to an initia l waterin g perio d byEPA ; <Abid e byhealt h an d safet yguidanc e provide d byEPA ; • Ifth e propert yis rented , assis t EP Ain obtainin g tenan t approva l fo racces s to th e propert y to perfor m th e work

. eAllo wvideotapin g and/o rphotographin g ofth e property
. AGREEMEN TNO T TO INTERFER E 

### Th e Granto ragree s no t to interfer e ortampe rwit h an y ofth e wor k activities , orwit h an y ofth e wori ( done , orwit h th e equipmen t use d on hi s property , orto undertak e an y action s regardin g th e us e ofsai d propert ywhic h woul d ten d to endange rth e healt h or welfar e ofth e Grantee s orth e environment , or to allo wother s to us e th e propert yin suc h a manner . Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contac t Coasta l Environmerita l Group , at (402 ) 991-119 9

nt acces s to mypropertie sD I do no t gran t access to mypropertie s 

# P, ^/A J IH'6 f Dat Dat e e / / SignatureDate

DI woul d lik e to be presen t durin g an ysamplin g tha t is required

.

Page 2 of 2COASTA L 

### Restoratio n Agreemen t Th e puipos e o f thi s agreemen t i s t o provid e atnutuB 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 pmpos e o f assurin g tha t restoratio n activitie s ar e complete dt o th e satisfactio no f th e property ovme r an dth e Unite dStale s Environmenta l Protectio nAgenc y (EPA)
. 

# [ Propert yID : P ,

Proper ^ Address : 

# ^&^3E a ^ z ^ ­ 

### ^*^«^-XAncn^fM y-^mi-H o |Phone:L46\-CtZI< ^ O nlh e attache ddiagram(s ) indicat e area(s ) t o excavate , surfac e structure s an dlandscapin g feature s an d acces s Iocation(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 property 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 renoval

. stora.qe
. disposal , and/o rretur n o f t^^es & itom s i s th e Owner' s responsibility

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# J
Landscap e Inventor y 

## Item Quantity Uni t 

## Condition/Type/Specie s Pre-existing propert y area , 

### % Quadrants tha t will b e excavated , tha t i s covwe dwit hgass . 

### - ^ 

# P^

Numbe r o f

tree s > 2 inc h Eac h 

# ^i( \ trun k

diameter Numbe r o f tree s <= 2 inc h Eac h 

# M' R trun k

diamete r Numbe r o f Sprinkle r Zones , Control Valves , Each Ttma^ , Heads , et c 

# ^ y
vrrirkli,' ! I;;y',iii ; Numbe r o f andsiz e of eachgarden / flowo

- be d Each area . Squar e Feet ^ Aiiiti h ; i sketc h 1)1 relitiiv c >i/i' S nn d loc;ilinti \ Agreedupo nvalu e of plant material s no t to b e replace db v contractor . ACI r l!-|i ' \Hltic v\il l hi i;sri. ' 1 0 IS ; U l
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# 'MAJB ' Easemen t Area , t o b e Eac h 

# ^tndin a excavated
Pag e 2 of

.* Additiona l Comment s / Instructions :

Q Chec k th e bo xr fOwne rdoe s no t wan t CE G t o documen t interki rfoundatio n wall s an d possibl e pre-existin g damage

. B ycheckin g thi s t)o 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. pC65 ( u C GA AQjAQjSiJC^

r~ ] I d o no t agre e agre e 

## A

r e Dat e / Contractor' s Signatnr r 

# T Pag e 3 of

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# PrA'^S ^ mj ^ l-%iMfi(^^Pi ^ Averag e

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± 17.81 2

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 76.74 7 Supervise d By : 

## Certificat e o fVerificatio n

119 2 SOI L 2009-11-2 3 17:2 4 91.1 5 Fina l Avg o f 1189-119 1 430 8 bedfor d B 2 6 " R

. VENTRY clearenc e ngn c

± Erro r
± 13.61 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 84.75 8 Supervise d By : 

## Certificat e o fVerificatio n

118 9 SOI L 2009-11-2 3 17:2 3 30.1 7 Fina l 3062 7 430 8 bedfor d B 2 6 " R

. VENTR Y clearenc e ngn c

± Erro r ± 15.11 8

# 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 65.65 0 Supervise d By : 

## Certificat e o fVerificatio n

119 0 SOI L 2009-11-2 3 17:2 3 30.4 6 Fina l 3062 7 430 8 bedfor d B 2 6 " R

. VENTR Y clearenc e ngn c

± Erro r
± 12.39 6

# 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 119 1 Mod e SOI L Tim e 2009-11-2 3 17:2 4 Duratio n 30.5 2 Sequenc e Fina l Flag s BVI D 3062 7 ADDRES S 430 8 bedfor d QUADRANT B 2 DEPH T 6 " XR F TEC H R

. VENTR Y MIS C clearenc e NOTE ngn c
pp m ±Erro r P

b 79.83 4 ±13.33 5 Supervise d By :

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

P b Supervise d B y 

## Certificat e o fVerificatio n

118 8 SOI L 2009-11-2 3 17:2 1 91.9 3 Fina l Avg o f 1185-118 7 430 8 bedfor d B l 6 " R

. VENTRY clearenc e ngn c

# 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 118 5 Mod e SOI L Tim e 2009-11-2 3 17:2 0 Duratio n 30.7 9 Sequenc e Fina l Flag s BVI D 3062 7 ADDRES S 430 8 bedfor d QUADRAN T B l DEPH T 6 " XR F TEC H R

. VENTR Y MIS C clearenc e NOT E ngn c

Erro r pp m Pb 68.31 4 ± 13.16 1 Supervise d By :

# 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 118 6 Mod e SOI L Tim e 2009-11-2 3 17:2 1 Duratio n 30.5 4 Sequenc e Fina l Flag s BVI D 3062 7 ADDRES S 430 8 bedfor d QUADRAN T B l DEPH T 6 " XR F TEC H R

. VENTR Y MIS C clearenc e NOT E ngn c

pp m±Erro r Pb 78.61 0 ±13.81 8 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 118 7 Mod e SOI L Tim e 2009-11-2 3 17:2 1 Duratio n 30.6 0 Sequenc e Fina l Flag s BVI D 3062 7 ADDRES S 430 8 bedfor d QUADRAN T B l DEPH T 6 " XR F TEC H R

. VENTR Y MIS C clearenc e NOT E ngn c

pp m ±Erro r Pb 92.06 8 ±14.53 0 Supervise d By :

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m Pb 406.60 7 Supervise d By : 

## Certificat e o fVerificatio n

118 4 SOI L 2009-11-2 3 17:1 9 91.9 4 Fina l Av g of 1181-118 3 430 8 bedfor d D Z 13 " R

. VENTR Y clearenc e ngn c

± Erro r
± 27.11 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 Sequence Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOTE

pp m Pb 398.44 0 Supervise d By : 

## Certificat e o fVerificatio n

118 1 SOI L 2009-11-2 3 17:1 8 30.9 8 Fina l 3062 7 430 8 bedfor d DZ 13 " R

. VENTR Y clearenc e ngn c

± Erro r ± 25.63 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 386.86 6 Supervise d By : 

## Certificat e o fVerificatio n

118 2 SOI L 2009-11-2 3 17:1 8 30.3 0 Fina l 3062 7 430 8 bedfor d D Z 13 " R

. VENTR Y clearenc e ngn c

± Erro r
± 28.66 9

# 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 434.51 6 Supervise d By : 

## Certificat e o fVerificatio n

118 3 SOI L 2009-11-2 3 17:1 9 30.6 6 Fina l 3062 7 430 8 bedfor d D Z 13 " R

. VENTR Y clearenc e ngn c

± Erro r
± 27.04 0

### # # 

## iy^JL \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 ^f^S m ^ Coasta l Environmenta l Grou p inc

. \^^^ ^

www.coa8taihazmat.co m ^^tpnoit ^ COASTA L tNVIIOIIHEIITA L Clo u r , IM C 

# EXECUTIV ESUMMARY : BVID #30627-(430 8 BEDFORD AVE )

~x \No Issue s o r Concern s Q Issues/Concern s Detail Explanation :4 

### #


## EP APropert y Clos e Ou t For m 

# 7^(^^ 1 ,, <4m&J>AJ(U u Propert y #; Propert y Address : Date/Time ; Owner' s Name:
. n Quad s Excavated ; ^^ ^ f^^ r jy ^ ^ ^ Contracto r Grou p (_^^ , Excavatio nGenen I 1.If necessmy , wer e th e correc t quadrant(s ) excavate dan drestored ? 2.If necessary , wer e th e correc t area s ofdri p zon e excavaie dao drestored ? GradlD C So dan dVcRetatioB 1. Doe s th e gradin g aroun dth e perimeie r ofth e hous einexcavaie darea s generall y slop e away fromth e house ? 2. Ha s so dbee nlai d bi al l area s that wer e excavated ? 3. Doe s tt e so dappea r to be generall y health y andgrowing ? (Onl y evaluat eif Inspecte d at

a

30 da y tim e period ) 4. Ar e sodde darea s generall 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 if

inspecte d at

a

30 da y tim e period ) 6. Wa s th e property grade dsuc hthat wate r wil l not poo l onth e property' ' t 7. Wa s damag e to landscapin g or plant material s avoided ? Gates , Fence s an d Retainio cWall s 1. Do gate s ope n an d ciois e freely? (Ifapplicable ) 2.Wer e al l gate s orfence s take n dow n durin g restoratio n activitie s reinstalled ? (I fapplicable ) 3.Wa s damag e to gate s orfence s avoided ? (Ifapplicable ) 4.Wa s damag e to retambg wall s avoided ? (Ifapplicablc ) Foundation , Sidio K an dGatler s t.

Wa s damag e to th e sidin g or tri mavoided ? 2.Wa s damag e to th e foundatio navoided ? 3.Wa s damag e to window s avoided ? Wa s damag e to window s or doo r screen s avoided ? 5.

Wa s damag e to downspout s or downspou l extension s avoided ? Sidewallt s an dDrheway s (Concrete ) 1.We s damag e to drivewa y surface s avoided ? 2.Wa s damag e to walkwa y surface s avoided ? Yt s No / 

## A Ye s No / 

### A A A y 

### y 

## y Ye

s No 

### y 

### A 

# A

_ 

# y Yes No 

# y y A y 

# y Ye s No 

# y 

# y

## Ort'Dcr s comnients :

nn.«!pectio nnotes : ^



# . yV

Removal andresloralio naclivate s complel e includin g the 30-da y so dwarranry : EP ARepresentativ e ^o ^ jy v Date : \Vl\* »

# I

Propert yCompletio n Agreemen t rin s agreement documenl s the complcliono f remedia l aclivilie s perloime do nm y properly M y signalure wil l designate Iha l I a msatisfiedwil hlhe resloralio nofm y propeily
. an diha l n o items ar e i nqueslions
. now , or a

l an y lim e i nthe future , excep l thos e ilem s listedbelow , ifan y PropertylD : 3^}/^ ^ Property Address : l\p ^ Y)^A^AOlJUe. , Owner : Q^^yQ^^ g C'SYV I tH \ 

### Phone : 

# M<c\
- cir\» > Restoratio n Item s i n Question : j item :

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



# y ^ 1 ayrc crestoratio n i. « completed , oxccp l a s note d 

### IK

T1 ayr i [_ J I rio no t ai;rt crestoratio n i< t complete d 

# ^ - /J^-19"A> 9 (^{y^'*'^ ^ r^^^ w Owner' s Signat/n-p ? Dat e I Contrarfor' s Signatur e Dal e 'Propert yOwne rSatisfactio n Surve y Omah a Lea d Superfunc J Si t 200 8 

### JA M 

### 0 4 2011 ) Remediatio n Contractor : Coasta l Environmenta l Grou p Propert yIdentiFie rNumber: ^ 

# SUPERFUN D DIVISIO N Propert yAddress: M riAjT ) Propert yOwner' s Nam e (abov e informatio n t o b e fille d remediatio n contracto rprio rt o deliver yo f(or m l o Propert yOwner )
instruction s t o Propert yOwner : 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 Agency(EPA ) i s veryintereste d i n you ropinio n regardin g th e wor k performe d byit s contractors
. Thi s for m i s intende d t o provid e an easymean 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 b yselectin 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 may als o b e provide d i n th e space below , a t th e optio n o fth e propert yowner. ) 

### 9-1 0 "excellent " 

### 7- 8 "ver ygood " 

### 5- 6 "acceptable " I ' .......t l 

### 3-4 poo r 

### 1-

2 "verypoor " Propert yOvi^ner' s Satisfactio n Ratin g Regardin g Contractor' s Wor k 

### 5 ( ^ 

### 4 8 3 7 2 6 1 Additiona l Comment s fro m Propert yOwne r(optional ; continu e t o bactt o fpag e i fneeded )

Propert yOwner' s Signatu n 

# JhiM ~ Dat e 

# .r?^ 

# ^f^ f