## TRANSMITTALof OMAHALEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R

SAID# : yl^i p IDat e 

### Address : l^<7l < H ^ Ol^\)\A h ^ f Remediatio nContractor : Coasta l Environmenta l Group

_Year : _2010ARRA
_ 

### SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 

# 1

/ Vide o o f property (DVD ) Executiv e Summary EPA-provide dproperty sketc h 

## 1 / Signe dAcces s Agreemen t for subjec t property -B ^ Signe dAcces s Agreement(s ) for adjacent property 0 Restoratio nAgreemen t -B

- Settlemen t document s (i.e. , for damag e b r t o replac e plants , etc. ) "B " Confirmatio ndat a

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Photograph s \k (>C0^Pch ^ > tr/AvM?0vi-) " ^oi ^ | / As-buil t sketc h M Satisfactory restoratio nsigne db y Property Owner ( ZPropert y close-ou t chec k lis t signe db y EP A -B

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# i Utilit y clearance s Propert y informatio nfro mDougla s Count y Assessor' s Offic e

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nNotificatio nLette r IS k Acces s Agreement [ ^ Restoratio nAgreement GTopsoil Samplin g (i f appUcable) Q Disposa l Samplin g (i f applicable ) 0 Garde nSamplin g (i f applicable )
^ UtiUt y Clearanc e D Video/Photo s (Before) nVideo/Photo s (During ) D Video/Photo s (After) D Video/Photo s (30-Day ) nPropert y Completio nAgreement D Final Report Sent : / / Sifinedp ^ / )'^l/ D 

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Omah a L.ead Sit e

## Douglas Coimt y Accoun t InfoaM^o n Pag e 1 of 4
Dougla s County , Nebrask a Propert yRecor d ­ R180394000 0
Informatio n i s vali d a s o f 2010-7- 1 Ne wFeatur e ••••• • Prin t Repor t Vie wInteractiv e GI S Ma p

Treasurer' s Ta xRepor t Subdivisio n Sale s Searc h Owne r SILVAANDRE S D ETA L 302 5 NICHOLA S S T OMAH AN E 68131-000 0 Propert yInformatio n Ke yNumber : 

### 039 4 000 0 1 8 Accoun t Type : Residentia l Parce l Number : 180394000 0 Parce l Address : Lega l Description : 302 5 NICHOLA S S T OMAH AN E 68131-000 0 MONTCLAI R AD D LO T18 0 BLOC K0 4 7 X 12 0 Valu e Informatio n


### 201 0 200 9 200 8 200 7 200 6 200 5 Lan d $2,500.0 0 $2,500.0 0 $2,500.0 0 $2,500.0 0 $2,500.0 0 $2,500.0 0 Improvemen t $72,600.0 0 $72,600.0 0 $72,600.0 0 $72,600.0 0 $72,600.0 0 $72,600.0 0 Tota l 

### $75,100.0 0 $75,100.0 0 $75,100.0 0 $75,100.0 0 $75,100.0 0 $75,100.0 0 Sale s Informatio n Sale s Date : 2009-09-1 4 Vie wDocumen t Dee d Type : Price : Grantor : W D $90,000.0 0 FENNEL L MADALIN E L Booilr : 200 9 Page : 11339 5

Grantee : SILVAANDRE S D ETA L Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 

### 1995-12-2 3 Dee d Type : Price : Grantor : $41,000.0 0 Book : 202 6 Page : 52 3



## http://douglasne.mapping-online.com/DouglasCoNe/static/accovmtinfo.jsp?accoimtno=R18..
. 7/14/201 0

### Dougla s County Accoun t In £^B^o n Pag e 2 of4

Grantee : Valid/Invalid : Exclusio n Reason : Vali d

Lan d Informatio n >4cre s 0.1 2 S F 5640. 0 Unit s 1. 0 Dept h 120. 0 Widt h 47. 0 Vacan t N o Improvement Buildin g 1 Informatio n

3Q: S t^choli : S t TW O STOR Y

IHM d

CLIC KTO ENLARG E IMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : 1712. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 2 Stor y Cond o Squar e Footage : 0. 0

HVAC : Centra l Ai rt o Ai r Rooms : 8. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo fType : Hi p Stories : 2. 0 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 9 0 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 840. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bati i Ful l 1. 0


### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R18.
. . 7/14/201 0

### Dougla s County Accotmt In : 

# ijjgo n Pag e 3 of 4
Garag e Detache d 252. 0 Porc h Cvr d Woo d Dec k 166. 0 Porc h Woo d Dec k 28. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accoimtno=R18.
. . 7/14/201 0Pag e 1 of 2

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YOU RTICKE T NUMBE RI S 2546397
. Origina l Cal l Date : 7/17/1 0 Time : 3:1 4 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 7/21/1 0 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 302 5 Street : NICHOLA S S T Twp : 15 NRng : 13 E Sect-Qtr : 16-SE-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 : UNSUR E I F CORNE R LOT . Compan y: COASTA L ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : COASTA L Dept h o f Excavation : 4 F T 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 MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac t Phon e Numbe r UtiUt y Typ e
CXCAT V CO X COMMUNICATIONS , IN C HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7

LEVEL S LEVEL S COMMUNICATIONS , LL C N A Day : 877366834 4 Alt : Emerg : 877366834 4

MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y Day : 402504782 3 Alt : Emerg : 402504797 0

OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE RRICHA'RAFFI C Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 7/17/201 0

### Pag e 2 of 2

0PPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T Alt : 406207149 4

EL M LOCATIN G Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K Day : 406728934 3

EL M LOCATIN GAlt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 7/17/201 0

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e OLS# : 2486 1 Dat e Excavated : 7/22/201 0 Dat e USEP ASiane d Off : 9/9/201 0 Are a Sodden : 306 0 s o f t Name : /^/v^<r-^ /

. , , Omah a Lea d Sit e Date : 0td..^o ^ NorthArro w—i Address : 3<i>-ZjS
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Omah aLeadSit e 4613 0Name : f ^

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. , . Omah a l.ea d SK * Date : Nort h Ano w Address : 3<i>-Z S ytZ/cM/tails ' SttftSkotc h 

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Omaha Lea d Sit e 4613 0COASTA I ENVIROHHIHTA l ^ l PRO^ ^ C « 0 U rIM C 

## Consen t fc F Acces s T o Properi y RIGH TO F ENTRYTO PREMISE S 

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

Owner' s Nam e Daytim e Phone : 

# /J/Jrc ^ y'/ty < 

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Addres s o f Propert y covere d b ythi s 

# "ioT ^ /Urc/oi^^^^-^ ^T ' Agreement :
PURPOS E O F RESPONS E ACTIVITIE S 

## Th e EP Ai s requestin g acces s t o collec t soi l sample s an d remov e soi l that contain s elevate d concentration s oflea d an d ma ypos e a healt h hazard

. Th e area(s ) wil l be excavate d t o remove 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 Lead Superfun d Site remediatio n program . Arepresentative o f Coasta l Environmenta l Group , contracte d b yUSEPA , wil l contac t th e Granto rin-perso n t o discus s th e wor k t o b e performed , th e Granto rwil t hav e a n opportunit yt o reviewan d approve th e planne d soi l removal , an d restoratio n work before i t begins

. Once th e wor k i s finished , th e Granto rwil l b e aske d t o reviewth e work an d confir m tha t i t i s complet e an d meets wit h th e Grantor' s approval

. Upo n completion , th e Granto rwil l receive writte n documentatio n fro m EP Athat th e propert y has bee n remediated

.
ENVIRONMENTA L RESPONS E ACTION S 

## B

ysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , its employees , contractor s an d subcontractor s th e righ t t o ente rth e property , at al 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 wor k has bee n satisfactoril ycompleted

. Th e Granto rais o agree s to :

Pag e 1 o f2COASTA L tRVI«ONH(KTl l C KO U rIK C 

### t Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; G Remov e flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t ma ywis h t o save ; 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
. AGREEMEI ^ 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 equipment use d o n hi s property , o rt o undertak e an y action s regardin g th e us e o f sai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o f th e Grantee s o rth e environment , o rt o allo wother s t o us e th e propert yi n suc h a manner . Shoul d 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

M j gran t access t o m ypropertie s D I d o not gran t acces s t o m ypropertie s 

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DI woul d lik e t o b e presen t durin g an ysamplin g tha t i s required

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Pag e 2 o f 2C O AS TAL aMVIMONHBHTAt

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. 

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

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f necessary . 

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

. Kem : 

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## Landscap e Inventor y Ite m Quantit y Uni t Condition/Type/Specie s Pre-existin g propert y area , that wil l b e excavated , that i s covere dwithgrass . Niunbe r o f tree s > 2 inc h trunk diamete r Numbe r o f tree s < = 2 inc h trunk diamete r Numbe r o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Attac hasketc ho f th e sprinkle r layout
. 

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### AddKiona 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 removing an d replacing 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 fthi s I s th e case , yo u shoul d underetan d tha t thi s removing an d replacing o f soi 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 cKe d b yth e cit yi fyo u us e a grave l o rdir t are a a s a drivewa yo rparidn g area , no t wKhstandin g an yremova l o r replacement o fsoi l b yth e EP A I f yo u have an yquestio n abou t legalK yo fa certai n drivewa yo rparkin g area , yo u ma ycontac t th e cK yo f Omaha' s Plannin g Departmen t a t (402 ) 444-5150

. [ V Pleas e chec k thi s bo xi fyo u understan d th e Informatio n outline d above

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. Includin g foundatio n crack s o rfissures

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## Ceitificat e o fVerificatio n

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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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## Certificat e o fVerificatio n

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## Certificat e o fVerificatio n

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pp m P b 146.80 9 Supervise d By : 

## Certificat e o f Verificatio n

21 1 SOI L 2011-01-2 4 15:2 2 30.2 2 Fina l 2486 1 302 5 NICHOLA S S T E A 1 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r
± 18.68 2

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

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

Supervise d By : 

## Certificat e o fVerificatio n

20 8 SOI L 2011-01-2 4 15:1 9 91.0 4 Fina l Av g o f205-20 7 302 5 NICHOU S S T B 2 4 " C.PADILL A CONFIRMATIO N CLEA R

# 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 176.98 6 Supervise d By : 

## Certificat e o f Verificatio n

20 5 SOI L 2011-01-2 4 15:1 7 30.5 7 Fina l 2486 1 302 5 NICHOLA S S T B 2 4 " C.PADILL A CONFIRMATIO N CLEA R

Erro r ± 17.75 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 180.24 3 Supervise d By : 

## Certificat e o f Verificatio n

20 6 SOI L 2011-01-2 4 15:1 8 30.1 9 Fina l 2486 1 302 5 NICHOLA S S T B 2 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r
± 20.54 7

# 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 199.48 4 Supervise d By : 

## Certificat e o fVerificatio n

20 7 SOI L 2011-01-2 4 15 : 1 9 30.2 8 Fina l 2486 1 302 5 NICHOLA S S T B 2 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r
± 21.81 5

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

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

Supervise d By : 

## Certificat e o f Verificatio n

20 4 SOI L 2011-01-2 4 15:1 6 91.0 3 Fina l Av g o f201-20 3 302 5 NICHOLA S S T B l 4 " C.PADILL A CONFIRMATIO N CLEA R

# 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 157.93 5 Supervise d By : 

## Certificat e o fVerificatio n

20 1 SOI L 2011-01-2 4 15:1 4 30.6 0 Fina l 2486 1 302 5 NICHOLA S S T B l 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r
± 17.42 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 125.96 0 Supervise d By : 

## Certificat e o f Verificatio n

20 2 SOI L 2011-01-2 4 15:1 5 30.2 5 Fina l 2486 1 302 5 NICHOLA S S T B l 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r
± 18.24 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 141.68 1 Supervise d By : 

## Certificat e o f Verificatio n

20 3 SOI L 2011-01-2 4 15:1 6 30.1 8 Fina l 2486 1 302 5 NICHOLA S S T B l 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r
± 18.74 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 AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

Supervise d By : 

## Certificat e o fVerificatio n

20 0 SOI L 2011-01-2 4 15:1 3 90.8 7 Fina l Avg of 197-19 9 302 5 NICHOLA S S T D Z 13 " C.PADILL A CONFIRMATIO N CLEA R

# 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 390.75 7 Supervise d By : 

## Certificat e o f Verificatio n

19 7 SOI L 2011-01-2 4 15:1 1 30.3 3 Fina l 2486 1 302 5 NICHOLA S S T D Z 13 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r
± 30.07 5

# 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 316.65 9 Supervise d By : 

## Certificat e o fVerificatio n

19 8 SOI L 2011-01-2 4 15:1 2 30.2 7 Fina l 2486 1 302 5 NICHOLA S S T D Z 13 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r
± 26.30 1

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

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

pp m P b 302.41 7 Supervise d By : 

## Certificat e o f Verificatio n

19 9 SOI L 2011-01-2 4 15:1 3 30.2 7 Fina l 2486 1 302 5 NICHOLA S S T D Z 13 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r

. ± 26.23 3

# 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 5 Mod e SOI L Tim e 2011-03-0 1 14:2 5 Duratio n 90.9 1 Sequenc e Fina l Flag s AVERAG E Av g o f 2- 4 ADDRES S 302 5 NICHOLA S S T QUADRAN T F l DEPH T 4 " XR F TEC H C.PADILL A MIS C CONFIRMATIO N NOT E CLEA R

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 43.25 2 Supervise d By : 

## Certificat e o f Verificatio n

2 SOI L 2011-03-0 1 14:2 3 30.4 6 Fina l 2486 1 302 5 NICHOLA S S T F l 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r 11.31 1

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

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

pp m P b 28.62 9 Supervise d By : 

## Certificat e o f Verificatio n

3 SOI L 2011-03-0 1 14:2 4 30.3 2 Fina l 2486 1 302 5 NICHOLA S S T F l 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r
± 11.42 1

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

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

pp m P b 39.93 7 Supervise d By : 

## Certificat e o f Verificatio n

4 SOI L 2011-03-0 1 14:2 5 30.1 3 Fina l 2486 1 302 5 NICHOLA S S T F l 4 " C.PADILL A CONFIRMATIO N CLEA R

± Erro r
± 13.17 6

## /lA. \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 I ^^^y , I Coasta l Environmenta l Grou p Inc

. Sl^y^Z ^

www.coa8talhazmat.co m 'iiPHO ^ COASTA L eNVIHONHINTA L OROUP , INC

. 

# EXECUTIV ESUMMARY : BVID #24861-(306 5 NICHOLA S ST )
No Issue s o r Concern s Q Issues/Concern s Detail Explanation : -DO NBAHNK EWALKE D TH EPROPERT Y O N9/9/201 0

### S : ^ 

## EP AProperf y Clos e Ou t For m Propert yff : _ Propert y Address : Date/Time ; Owner' s Narae:
. / ^ Quad s Excavated : Contracto r Grou p Ye * N o Excavatio nGenera i I
.

I f necessaiy , wer e th e correc t quadrant(s ) excavate dan drestored ? 2
.I f necessary , wer e th e correc t area s o f dri p zon e excavaie dao drestored ? ^ ^ Gradin g So dan dVegetollo n Ye s No I
.Doe s th e gradin g aroun dth e perimeie r ofth e hous e i nexcavate darea s generall y slop e awa y 

# ly- ' fromtb e house ? 2
.Ha s so dbee nlai du i al l area s tha t wer e excavated ? 

# y y 3
.Doe s th e so dappea r t o b e ganerall y health y an djaowing ? (Onl y evalusAe i f iiupecte da t a30 ^ da y tim e period ) ()t<ittiu t /y/>/ > l^tk 'Sfytitt j .<ha/C l r^MlA , 4
.

AI C sodde darea s generall y firman devenl y graded ? C<r o ^	 ^ S
.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 propeny' ' l^- " 

# r 7
. Wa s damag e t o landscapin g o r plan t material s avoided ? Gates

. Fence s aa d Remaln g Wall s Ve s N o 

# r

' 1
. O o gate s ope nandclos e freely? (( f applicable ) 2
.

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

Wa s danug e t o gate s o r fence s avoided ? (Ifapplicable ) 

### u y ' 4
.

Wa s damag e t o reuinin g wall s avoided ? (Ifapplicable ) ^ ' Foupdation , Sidianaii dGnller s \ti .N o I
.Wa s damag e t o th e sidin g o r tri mavoided ? 2
.Wa s damag e t o th e foundatio navoided ? 

# y ?
.Wa s damag e t o window s avoided ? 6
.Wa s damag e t o window s o r doo r screen s avoided ? 

# y 5
.

Wa s damag e i o downspout s o r downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrcu ) Ye s No 1
.Wa s damag e l o drivewa y surface s avoided ? 

# X- i 2
.Wa s damag e t o waDrwa y surface s avoided ?I 

# 4 1 CM'oers comnients :

!!n.«!pectionnoies :

Remova l an drestorationactivale s fcludin g th e 30-da y so dwarranr y EP ARepresenlaiive h^Grtt ^

## Propert yCompletio n Agreemen t
riii s agreemen t documenl s lh e complclio n ofremedia i acliviiie s perloime d o n mypropert yM ysignature wil l designat e lha l I a m satisfie d wi( h (h e restorado n o fm ypropeily

. an d lha l n o item s ar e i n questions , now , o ra l an ylim e i n th e future , except Ihos e ilem s liste d below , ifan y

Propert y rP : ^^( g | Propert yAddress : ^Q(^ yyy/CJUy ^ ^rf " 

### Ownc : /^^yy^^^ji ^ %\y ^ Phone : 

# -^^• ^ ^zrrz ^ Restoratio n Itenn s i n Question :

Item : Item : Item ; Item : Item : Item :

••pCL l xyrc crestoralio n \ s completed , rirccp l as note d [_ J I d o no t a^rc crestoratio n i s complete d 

# ^6(hcyyu ^ ^/2yl(c ) Owner' s Signatiir rDate Con d actor' s Signatur e Dal e

### (4^ 1


# Propert y Owne r Assessmen t o f Performanc e For m America nRecover y an dReinvestment Act (ARJ^|yr;TpTyp| ^ Omah aLea dSuperfiindSit e 2009/201 0 AU G1 7 201 0 Remediatio nContractor : Coasta l Environmenta l Grou p - EP-RTSBBS^^^^^^^ ^ 

### DIVISIO N Propert y Identifie r Number : 'T^^l o I Propert y Address : ^^(pC ^ //A'^^.^^ ^ '^ ^ Propert y Owner' s Name : /yC-r^./^t^ ^ "^/( / ( ^ Instruction s t o th e Propert y Owner : Thi s for mserve s t o recor dth e Propert y Owner' s assessment o f perfonnanc e (Incentiv e 1

- Qualit y Assuranc e Surveillanc e Plan ) involvin g th e liste dremediatio ncontractor , a s applicabl e t o th e Omah aLea dSite
. Thi s for mdocument s th e timelines s o f punchlis t resolution , busines s relations , complaint resolutio nandth e overal l qualit y o f work
. Ifnee dbe , th e Propert y Owne r ma y utiliz e thi s for mto reoor dproblem s and/o r issue s no t specifically tie dto a nassigne d address , fo r example , busines s relation s that generally don' t follo w the guideline s set fort hinthe Performanc e Wor k

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

b y checkin g anumerica l ratin g o nth e tabl e belo w tisin g th e nimierica l definition s fro m th e ratin g scal e below , the nsig n& dat e fh e form
. 9-1 0 "excellent " 7- 8 "ver y good " 5- 6 "acceptable " 3- 4 "poor " 1-

2 "ver y poor " Propert v Owner' s Assessmen t o f Performanc e Regardin g th c Contractor' s Wor k 1 0 5 9
___ ^ 4 8 \X 3 7 2 6 1 Propert v Owne r Additiona i Comment s fro m(optional ; continu e o nbac k pag e if needed ) 

# y / 

## •fy/yjj/i ^ ^Date: S-/lohr \ Propert y Owne r Signature :