### TRANSMITTA L o fOMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R 

## SAID #iflJlO ^ DAT E

# = =>/«/u 3X2.1 ^ GhlME T %- r ADRESS : REMEDIATIO N CONTRACTOR : COASTA L ENVIRONMENTA L GROU P Contract : EP-R7-09-0 6

SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENTS KExecutiv e Summar y ^

EPA-provide d propert ysketc h S rSigne d Acces s Agreemen t fo rsubjec t propert y ^'^Signe d Acces s Agreemen t (s ) fo radjacen t propert y & Restoratio n Agreemen t IvK
. Settlemen t document s (i.e. , fo rdamag e o rt o replac e plants , etc. ) T l Confirmatio n dat a AoP * Photograph s SO D 

# i Pre-Excavatio n Excavatio n As-Buil t sketc h Satisfactor yrestoratio n signe d b yPropert yOwne r Propert yclose-ou t chec k lis t signe d b yEP A jVj < Descriptio n o farea s o farea s no t meetin g RO D cleanu p criteri a

s fUtilit yclearance s <4] Propert yinformatio n fro m Dougla s Count yAssessor' s Offic e ^

^ Signature - EP A ^ Date 

### 3026290 1 Supeifun d

# 9

Propert yAcces s Checklis t Propert y ID : '^{^y ? D WOR K STARTE D ON : Propert y Address : ^2M f^ ^ QJh^=f ^ WOR K COMPELTE D ON : Owner : ^y^C ^ lenter : / 

### ll/vyr^6^7rri 

# JimD^rt Address : Phone : 

# <^^l^ry\JL . Fax : Cell/Pager : 

### Phone : I/QZ^ 0' I 7.^/^^" ^ Additiona l Information : Fax : 

# 35^ 1 MW S Cell/Pager : C

UNotificatio nLette r Sent : / / By : \Acces s Agreemen t 

### Signed : ij_/j_/(i 2 By : Vi . CV L Restoratio nAgreemen t 

### Signed : JJt j_l/ 1 0 By : JoicA c r~ l Topsoi l Samplin g (if applicable ) / / By : r~l Disposal Samplin g (if applicable ) / / By : nGarde nSamplin g (if applicable ) / / By : si p Utility Clearanc e Called : W/ ? , / w y ' \ v / t

nk o W?.,vA ' \ ideo/Photo s (Before ) 

# On : Jj!_l_t J_ D By : V'^c-V;
­ Video/Photo s (During ) On : By : nVideo/Photo s (After ) On : By : D Video/Photo s (30-Day ) On : / By : I I Propert y Completio nAgreemen t Signed : / By : nFina l Repor t Issued : / / By : Ai r Monitorin g (a s applicable )
• Community • Cre w On : / / By : Results :

• Community • Cre w On : / / By : Results :

• Community • Cre w On : / / 

## B , : 

## 1 Results :
Omah a Lea d Sit e

## Douglas Count y Accoun t I

n Page 1 of 2 Dougla s County , Nebrask a Propert yRecor d Informatio n i s vali d a s o f2010-8-3 0 ­ R054298000 0
Ne wFeatur e - > ­ • ­^ Prin t Reoor t Vie wInteractiv e GI S Ma o

Treasurer' s Ta xReoor t Subdivisio n Sale s Searc h Owne r THOMPSON-BROW N BRIDGETT E 322 4 EMME TS T OMAH AN E 68104-000 0 Propert yInformatio n Ke yNumber : 429 8 000 0 0 5 Accoun t Type : Parce l Number : Parce l Address : Lega l Description : Residentia l 054298000 0 322 4 EMME TS T OMAH AN E 68111-000 0 BEDFOR D PLAC E LO T1 5 BLOC K8 W1/ 2 2 5 X 12 8 Valu e Informatio n 201 0 200 9 200 8 200 7 200 6 200 5 Lan d $500.0 0 $500.0 0 $500.0 0 $500.0 0 $500.0 0 $500.0 0 Improvemen t $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 Tota l $500.0 0 $500.0 0 $500.0 0 $500.0 0 $500.0 0 $500.0 0 

### Sho wAl l Transaction s

Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 7 3200. 0 0. 0 128. 0 25. 0 Ye s



## http://douglasne.niapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R05.. . 9/15/201 03/31/201 1 www.dlion.org/irthinternet/DHONNotic.
. Creat e Anothe rTicke t 

### [ Bac k t tOTH h Inteme t ^ Sen d Emai l



## • YOU RTICKE T NUMBE RI S 2700331 . Origina l Cal l Date ; 

### 3/31/1 1 Time : 3:4 0 pm Op : ALFONSO1879 0 Wor k t o Begi n Date ; 

### 4/04/1 1 Time : 4:1 5 pm State : N E 

### County : DOUGLA S Place : OMAHA Address : 322 4 

### Street : EMME T S T Twp : 15 NRng : 13 E Sect-Qtr : 09-N 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 : ( 4 02)934-281 1 : PLEAS E INCLUD E AL L EASEMENT S Compan y COASTA L ENVIRONMENTA L SERVIC E Contac t Name ; ALFONS O Phone : (402)934-283 7 Wor k Bein g Don e For : Coasta l Dept h o f Excavation : 4ft Corne r Lot : N Front : Y Rear ; Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C 

## Utilit y Servic e Are a Contac t Phon e Numbe r 

## Typ e Day : 402934046 9 

## CXCATV CO X COMMUNICATIONS , IN C HEIDI Ak : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 

## METROPOLIT/ ^ UTILITIES MUDO l SAND Y MU D Alt : 

## DISTRIC T Emerg : 402504797 0 Day : 402444719 7 

## CITY O FOMAHA
- OMAHACO F RICHAmAFFIC Ah : 402444516 1 TRAFFIC,SEWER Emerg : 402444516 0 Day : 406728934 3 

## OMAHAPUBLIC POWER EL M 0PPDGPR 5 Alt : 406207149 4 

## DISTRIC T LOCATIN G Emerg : 888728934 3 dhon.org/irthinternet/. ../MessageText.as.
.3/31/201 1 ^^www.dhon.org/irthinternet/DHONNotic..
. ^ ^ 

## F

I M ^Day : 406728934 3 QLNNEI C QWES T LOCALNETWORK rr^r^ATTxir ^ Ak : 406207149 4 LOC AUN O 

## Emerg : 888728934 3

dhon.org/irthinternet/.../MessageText.as..
. 2/ 2

### 04/02/1 1 10:00A M (111)111-1111 , QWES T ^^ ^ 04/0 6

To : COASTA L ENVIRONMENTA L SERVIC E Attn : ALFONS O Voice : 402934283 7 Fax : 402934281 1 Re : Messag e fro mQwes t Messag e fro mQwes t 

# -^^^^ z
Ticket : 270033 1 County : DOUGLA S Place : OMAH A Address : 322 4 EMME T S T QLNNEIC : Th e describe d di g are a o f you r locat e reques t ha s bee n checke d an d i s clea r fo r Qwes t Communication' s Loca l Network . I f yo u hav e an yquestion s pleas e cal l Qwes t a t 1-800-283-4237 .
Ticket : 270008 1 County : DOUGLA S Place : OMAH A Address : 150 7 BINNE T S T QLNNEIC : Th e describe d di g are a o f you r locat e reques t ha s bee n marked . Qwes t Communication s Loca l Networ k facilitie s ar e presen t i n th e di g area . I f yo u hav e an yquestions , pleas e cal l Qwes t a t 1-800-283-4237 .
Ticket : 270005 8 County : DOUGLA S Place : OMAH A Address : 241 8 N17T H S T QLNNEIC : Th e describe d di g are a o f you r locat e reques t ha s bee n checke d an d i s clea r fo r Qwes t Communication' s Loca l Network . I f yo u hav e an yquestion s pleas e cal l Qwes t a t 1-800-283-4237 .
Messag e fro mQwes t

# As-Buil t Drawin g ^ COASTA L 

# Omah aLea dSuperfun dSit e OLS# : 3120 2 Dat e Excavated : 4/11/201 1 Dat e USEP ASigne d Off : 5/3/2011 - Are a Sodden : 213 8 s a f t 

# niiiii i 3120 2 Exterio rPain t Nort h Arro w Omah a Lea d Sit e Owne rName : BRIDGETT E THOMPSON-B R • Goo d Sit e Sketc h 

# < 1 Address : 322 4 EMME TST •Poo r

Phone : » 402-612-195 0 W : Q^o t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : RYASCPXA-3120 2 F 1 35( o pp m 

### D Date : 

### 0 9 „L5-0 3 RYBSCPXA-3120 2 F 2 3*^ 0 pp m 

### D Time : \0.<SJ 5 Ar< - RYCSCPXA-3120 2 B l 19 0 pp m 

# n Sample s Analyze d RYDSCPXA-3120 2 B 2 ^*^ ^ pp m RDZ9CPXA-31g02- - -B Z ~ pp m 

### D D XR F Un i : t03 1 Book : 13 ^ RQZSCPXA-3120 2 - 8 2 ~ pp m 

### D D Date : 1 0 -2.lt>-£) S RPZ3CPXA-3I20 2 -P Z ~ pp m 

### D D p m Time : 

### D Staff : Numbe ro f Sample s = i Legend : F l = Fron t Left , F 2 = Fron t Rigtit , B l = Bac k Left
. B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , V Z = Pla y A H quadrant s ar e a s viewe d fro m th e street , facir> g propert y



### Legen d Concre't e Dri p Zon e Excavate d Quadrant s Excavate d
Are a replace d wit h Are areplace dwit h^^_ S o d ' ' Rock/Mulc h^ *^« * 1«^ ^ ^'^^ ^ 

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

## 3120 2 

# c c 

# v^ v Exterio rPairr i Nort h AiRM r 

### Omah a Lea d SH e Owne rName : BRIDGETT E THOMPSON-B R 

### Sit e Sketc h •Goo d 

# 4 Address : 32 M EMME TS T •Poor Phone : ^ 402-612-196 9 W Q4Wpain l 

# 1 Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B CoTKentratio n Collecte d Firm : RYASCPXA-3120 2 F 1 

### 33 ^ pp m 

## D Dat e 

## O S RYBSCPXA-3120 2 F 2 

### $'4 0 pp m 

## D Time : 

### lO:> ^

Ar ^ RYCSCPXA-3120 2 B l 

### 7 S o pp m 

## D Sample s Analyze d RYDSCPXA-3120 2 B 2 

## !iil ^

pp m 

## D RPZ3CPXA-31g0 g B Z " " pp m 

# a D XR F Unit : ID2>' 7 Book ; f3 a RQZ8ePXA-91202—-S Z " pp m 

## D Dat e 

## D RP28CPXA-3120 2 P Z " " pp m 

## D D Tim e Staff : Numbe ro fSample s = '•H Legend : F l = Fron t Left , F 2 = Fron t Right
. B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone
. G Z = Garden
. PZ = Pla y A l qvadranl * at e a s vieww l fro m th e clHMt , (acin g propert y 

# ; ^i7? ni m



# ./f/....; i -f>^
. i1 ­ 'cc/^yeX :<!5 r lUv j M«t4IUIJ ) 

## A}r/<r A

## 31202 

# L C y/ y Nort hArro w Exterio rPain t Omah a Lea d Sit e Owne rName : BRIDGETT E THOMPSON-B R Sit e Sketc h •Goo d < Address : 322 4 EMMET ^ •Poor

Phone : H : 402-612-195 9 W : [3^o t paint Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : _ RyASCPXA-3120 2 F 1 

### 33(e > pp m 

## D Date : . 

## O S ^5-0- 5 RYBSCPXA-3120 2 F 2 3^ g pp m 

## D Time : _ 

## fo/v3^/w - RYCSCPXA-3120 2 B 1 7gf l pp m 

## D Sample s Analyze d

Numbe ro fSample s = RYDSCPXA-3120 2 B2 

### 4^ ^

PP ^ 

## D

" " pp m 

## D D XR F Un i 1 0 3 1 Book : \37 > RQZ3CPXA-3120 2 -"-6 £ • " pp m 

## D D Date : _ 1 0 -2.to-i) S RPZ3CPXA-3120 2 P 2 • ~ pp m 

## D D Time : _ pyy \ Staff : Legend : F 1 = Fron t Left , F2 = Fron t Right
. 8 1 = Bac k Left , 8 2 = Bac k Righ t DZ = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a s viewed fro m th e street , facin g propert y 

# ENTEREj b



# F. l F ^ 3 3 ^ ^ 

# 3^ 0 

# "Fy ^ :^^5r: R< v 4 046MI.UI2. 1 

# A/rrr A

# Ilii i 31202 

# IPIEiil i
Nort h Arro w

Exterio rPaint 

### Omah a Lea d Sit e Owne rName : BRIDGETT E THOMPSON-B R 

### Sit e Sketc h •Goo d < Address : 322£EMME TS T •Poo r

Phone : ": 402-612-195 9 W : (P^o t paint Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Firm : 9f = A\ T 4-t. ^ RYASCPXA-3120 2 F 1 33( o pp m 

# D Date : 0 9 A 3 Q- 5 RYBSCPXA-3120 2 F2 

# 3^40 pp m 

# D Time : iQ'-^^y S Arr ^ RYCSCPXA-3120 2 B 1 

## 7S 0 pp m 

# D Sample s Analyze d RYDSCPXA-3120 2 B 2 ^ ^ ^ pp m RDZ3CPXA-3120 2 B Z pp m 

# D 

# n XR F Unit : 

### iO^ y Book : |?, g RGZ3CPXA-31202—-9 2 - pp m 

# D D Date : _ 

### f O -2,(o-£> S
— 

# D RPZ3CPXA-3120 2 P E pp m 

# D Time : 

# F ^ D Staff : Numbe ro fSample s = Legend : F l = Fron t Left , F 2 = Fron t Right
. 8 1 = Bac k Left
. 8 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , PZ = Pla y Al l quadrant s are as viewe d fro m th e street , facin g property 

# ENTEBE L %^l i 200 5

KL
. 

# y^<< ^ ^^5r: Rev4 ' 046141.012 3 

# A/o^rA

# 3120 2 Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e Owne rName : BRIDGETTE THOMPSON-B R •Goo d 

### Sit e Sketc h < Address : 3224 EMME TS T •Poo r Phone : ^ 402-612-195 9 W : Q^o t paint Sampl e Numbe r Lea d Sampl e 

### Sample s Collecte d LA B Concentratio n Collecte d 

### Firm : Pg ' A\ T4-b ^ RYASCPXA-3120 2 F l 33( o pp m 

# B " D Date : O S • A 3 0- 5 RYBSCPXA-3120 2 F2 a^ g pp m 

# D Time : \0'>^y ^ Arr - RYCSCPXA-3120 2 8 1 

## Id O pp m 

# D Sample s Analyze d RYDSCPXA-3120 2 8 2 

## _Jifi^pp m % - 

# D RDZ3CPXA^0120 2 B Z 

# D " •pp m 

# D XR F Unit : 

# ^^3 7 Book : jLa a RQZ3CPXA-3120 2 6 Z " pp m 

# D D Date : _ RPZSCPXA-3120 2 PZ
-~ 

# D pp m 

# D Time : 

# E m Staff : Numbe rofSample s • 

# W y ^ Legend : F 1 = Fron t Left , F 2 = Fron t Right , 8 1 = Bac k Left , 8 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , PZ = Pla y Al l quadrant s ar e a s viewe d fro m tti e street , facin g propert y 

# ENTEREi > %l f1 7 i?flfl 5

6J i



# % z ^4a M di^r^vfi ^


# I F. I 

# f3
­ 33 6 

# ^ 3^ 6 

# £r^/Yv£r r ^^5r Rev4 - 046141.UI2 3COASTA l [hVlltDNHIhlA l cI 0 t l r\ h c 

## Cons&ri t fo fAccess - Y o Pioperi 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 i it 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 :

Ovifner' s Name : Daytim e Phone : ^C)Z~l^(Sl-^' ^ 

### D r ^ i^oW M C I koAvpStiy v

Addres s o fPropert y covere d b ythi s 

### ""S^- ^ L ^fr^rre ^ ^ 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 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 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 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 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 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 fperfonTiin 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 satisfactoril ycompleted
. Th e Granto rals o agree s to ;

Pag e 1 c f2

# o o

C 0 A S 1 Ai lhri*ONhfKTi. i C R D U r> I * C 

### I Remov e obstruction s includin g boats , trailers , vehicles , playscap e ilems , woo d piles , do o houses , etc ; <•Remov e flov/e rbulb s o i plant s tha t th e Granto ro rth e Granlor' s tenan t ma ywis h t o save ; I Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , necessary ' subsequen t t o a n initia l waterin g perio d b yEPA ; a s

« Abid e b yhealt h an d safet yguidanc e provide d b yEPA ; t I fth e property ' i s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s th e property / t o perfor m th e work
. l o t Allo wvideotapin g and/o rphotographin g o fth e properly
. AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s no t t o interfer e o rtampe rwit h an yo fth e wor k activities , o rwit h an y o fth e wor k done , o rwit h th e equipmen t use d o n hi s property' , o rt o undertak e an y action s regardin g th e us e o fsai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o fth e Grantee s o rth e environment , o rt o allo 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
gran t acces s t o mypropertie s •I d o no t gran t acces s t o mypropertie s

.'•-• •/ 

# > U '=^^^
. 

# '(ik'yyQ^^yTyyyyM n l ( J Signatu , / Dat e Signatur e Date
Q i vi^oul d lik e l o b e presen t duriri Q an ysamplin g tha t I s required
.

Paa e 2 o f2

## Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s t o provid e amutual agreemen t a s t o condition s o f th e property prio r t o 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 are complete dt o th e satisfactio no f th e property owne r an dth e Unite dState s Environmental Protectio nAgenc y (EPA) .

Property ID:3 1 ;^ ^ Property Address:-57^2 ^ £^,v^jV <i''^fOSiri \ 

### Phone:^/^^^/;!,/^^" / 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 ) t o b e use db y th e contractors . Indicate distances , depths , material types , etc . Photographicall y an dVideographicall y document th e existin g condition s ofth e property an dth e basement i f necessary . 

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

# """• • yy ^ Item : Item : Item : 

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

Pag e 1o f^

# o o
COASTA L CNVIRONMINTA L C KO U r, INC
. 

### item s to B e Remove d B yContractlo rDurin g Remediatio n an d Replace d Item : 

# 5 , Item : 

# s=. y Hem : Item :

Pre-existin g property area , tha t will b e excavated , tha t i s covere dwit hgrass . Number o f tree s > 2 inch trunk diameter Number of tree s < = 2 inc h trunk diameter Numbe r o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Attac hasketc ho f th e sprinkle r layout . Numbe r o f an dsiz e o f eac hgarden / flowe r be d area . Attac hasketc ho f relativ e size s andlocations . Agree dupo nvalu e o f plan t material s no t to b e replace db v contractor . Not e thi s valu e wil l b e use dt o issu e aplan t vouche r t o th e propert y owner . Easement Area , to b e excavate d 

### Landscap e Inventor y Uni t Condition/Type/Specie s Quadrant s 

# B'/B 2 

# y ^ Each Each

Eac h

Each Square Feet

Each



## .J ct/yt^^.^ ^ <^5^?^ ^ 

# 3 Pag e 2 of
.

# o o
COASTA L tNVinONMENTA L C I I O U P
. INC
.
Additiona l Comment s / Instructions : Th e cit yo fOmah a ordinance s ma yprohibi t yo 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 Agenc y(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 fthi 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 fsoi l b yth e EPA
. I fyo u hav e an yquestio n abou t legalit yo fa certai n drivewa yo rparkin g area , yo u ma ycontac t th e cit yo fOmaha' s Plannin g Departmen t a t (402 ) 444-5150
. r~ l Pleas e chec k thi s bo xi fyo u understan d th e informatio n outline d above
.

O Chec k th e bo xi fOwne 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 fhouse , includin g foundatio n crack s o rfissures
.



### [Y

I I agre e nI d o no t agre e
•// / 

# ni l H O J Owner' s Signpture Contractor' s Signature Dat e Pag e 3 

# o , 3BVID # 

### ?>l^ o -^ 

### XR F PROPERT Y SAMPL E SHEE T Date 

### 0 bi t \I 7.0 T '-52.-Z M F.^m^ vS ^ Wject ' Omah a Lea d ARR A am/p m 

### W f W 3"lo-^7 ^ sarngf e 3 0 se c



### sm0 ' Readii g y "^m^y ^ :Shpf# : •RieiilJri : ;" } "SatTTfjI e are a 

### O l 

### \iy \y \ R B l 0- 2 Vo?^^\ ^ .©letfe
- • -; . 'Crepth 

### Q 3 ai^ ^ r ^ y iv" ' Averag e 

# iki_M:\
_ Averag e 

# wm . V S ^0?-:^-Z^ \ ^ y 0( p 

### ^^U ) "^^ 3 

# W^^ M m i ^ ^ 

### m. o ^ _^Z/ 1 '^^ l l^^ ' Averag e 

### ^\ A ^.1^ ^ Averag e 

# m

i - J .4 4 M J S 4 Averag e Averag e
RETES TAREA S 

### ..;3^tt'^::^>l^^iW^! ^ 

# ,'^s m fe5^;^^l

^ Averag e I Averag e Signature

# • ^B^p ^
Prin t

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , I^ 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
pp m P b 164.26 5 Supervise d By : 

## Certificat e o fVerificatio n

4 SOI L 2011-05
- 1 1 10:3 0 90.6 4 Fina l Av g o f1- 3 322 4 EMME TS T B l 6 " CPADILL A CONFIRMATIO N CLEA R

± Erro r ± 19.90 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 BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E
pp m P b 127.70 1 Supervise d By : 

## Certificat e o fVerificatio n

1 SOI L 2011-05-1 1 10:2 8 30.1 9 Fina l 3120 2 322 4 EMME TS T B l 6 " CPADILL A CONFIRMATIO N CLEA R

± Erro r 18.29 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 165.04 7 Supervise d By : 

## Certificat e o fVerificatio n

2 SOI L 2011-05-1 1 10:2 9 30.1 7 Fina l 3120 2 322 4 EMME TS T B l 6 " CPADILL A CONFIRMATIO N CLEA R

±

Erro r ±

19.69 3

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , MA0182 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 200.04 8 Supervise d By : 

## Certificat e o f Verificatio n

3 SOI L 2011-05-1 1 10:3 0 30.2 8 Fina l 3120 2 322 4 EMME TS T B l 6 " CPADILL A CONFIRMATIO N CLEA R

± Erro r ± 21.71 9

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Blllerica , 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
pp m P b 219.94 8 Supervise d By : 

## Certificat e o fVerificatio n

8 SOI L 2011-05-1 1 10:3 2 90.6 8 Fina l Av g o f5- 7 322 4 EMME TS T B 2 6 " CPADILL A CONFIRMATIO N CLEA R

± Erro r ± 22.67 0

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , MA0182 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 203.57 8 Supervise d By : 

## Certificat e o fVerificatio n

5 SOI L 2011-05-1 1 10:3 1 30.2 0 Fina l 3120 2 322 4 EMME TS T B 2 6 " CPADILL A CONFIRMATIO N CLEA R

±Erro r ±21.89 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 226.51 5 Supervise d By : 

## Certificat e o fVerificatio n

6 SOI L 2011-05-1 1 10:3 1 30.2 0 Final 3120 2 322 4 EMME TS T B 2 6 " CPADILL A CONFIRMATIO N CLEA R

± Erro r ± 23.07 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 BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E
pp m P b 229.75 2 Supervise d By : 

## Certificat e o fVerificatio n

7 SOI L 2011-05-1 1 10:3 2 30.2 8 Fina l 3120 2 322 4 EMME TS T B 2 6 " CPADILLA CONFIRMATIO N CLEA R

±Erro r ±23.04 6

## /x^^^ \ Omah a Lea d Site—Fixe d Pric e EP-R7-09-0 6 \

^

• o J ? Coasta l Environmenta l Grou p Inc , www.coastalhazmat.co m A 

### """"'' * COASTA L 

# EXECUTIV ESUMMARY : BVID #31202
- (3224 EMME T S T )

^ No Issue s o r Concern sQ Issues/Concern s Detai l Explanation : •COASTA LI S UNABL ET O PROVID EPRE-EXCAVATION , EXCAVATION , AN D SO D PHOTO S A S PAR T O FTHI S FINALPROPERT Y FOLDER . THES EPHOTO S WER EI N TH EPOSSESSIO NO FA SUBCONTRACTO RTHA T WA S CONTRACTE D T O PERFORM AL LO FTH ESITECOORDINATIOI NREQUIRE D B Y TH ESCOPEO FWOR K AN D TH E SUBCONTRACTO RHA S SINC ELEFT TH EPROJECT . THEREFORE , TH EPHOTO S AREN O LONGE RAVAILABLE .
DANGARVE Y WALKE D AN D SIGNE D OFFO NTH EPROPERT Y A S COMPLET EO N 5/3/2011 .

# D O

Propert yCompletio n Agreemen t I'hi s agreeme m ducumenls
. th e coinpiclio n o l remedia l aclivme s perlbime d o n m ypioperi yM ysignatur e wil l designat e iha l I a m satisfie d wit h th e restoratio n o f m yproperty , an d tha t n o item s ar e m queslions
. now , o ra l an ylim e ii i Ih e fuluie , excep t llios e item s liste d below , i f an y

Propert yID : "^ j Z^Q ^ TT^crryAddress : "^^^-cf ' ^ ^ ^ r^y^-^t^
. ^^^f^^ ^ Ovvnci' : 

## P)W^£fe
. -ruyyytjynrK ^

Jy^ , 'fyi/y\ — Phone : Restoratio n Item s i n Question :

Item : llem : Item : Item : Item : Item : Additiona l Comments :

jjy j ayrc cI csto i a(io n is complcied , cxccp l a s note d [_ J I rio no l xylit e restoratio n is complcie d 

## >^^^jr ^ Ow'iie i 'vJSignatiir e Dat e Cont i ailovT s Signatur e

## (m i 

# ^ A 

# C D
EF APropert y Clos e Ou t For m Propert y W : Q (^07 ^ DBte/Tlroe : Quad s Excavattd ; Contracto r Grou p Ve5 N o Excavatio nGenera l 1 . i f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? / 2 . If necessary , wer e th e correc l area s ofdri p zon e excavate dan drestored ? 

# y Ye s N o Gradin g So dan dVeffeUtio n 1 Doe s th e gradin g aroun dth e perimete r ofth e hous e i ncxcavaierl area s generall y slo(.> e awa y 

# y fromth e house ? . 2 , Ha s so dbeenlai dinall area s tha t were excavated ? 

### / J . Doe s th e sodappea r to b e generall y health y andgrowing ? (Onl y evaluat e i f inspecte da t a? 0 

# V da y tim e period ) 4 , Ar e sodde darea s generall y Hr man devenl y graded ? 

# y — 5 . Ar e th e joint s berwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 da y 

### / tim e period ) 6 . Wa s th e property grade dsuc htha t water will no t poo l o nth c property' ' — I 7 . Wa s damag e 1 0 landscapin g o r plant material s avoided ? Gates . Ftpce s an dRetainin g Wall s Vcj N u I 1 . D o gate s openandclos e freely ? (Ifapplicable ) / 2 . Wer e all gate s or fence s take ndowT i durin g restoratio nacliviiie s reinsialled ? (I f applicable ) / r 1

, V Wa s damag e t o gale s or fence s avoided ? (Ifapplicable ) 

# y 4 . Wa s damag e t o retainin g wall s avoided"! * (Ifapplicable ) " 

# ^y Foupdation , Sidin g an dCutler s Ve s .N o 1 Wa s damag e t o th e sidin g o r tri mavoided ? 

# y 2 . Wa s damag e t o th e foundatio navoided ? 

## y Wa s damag e l o window s avoided* * 

### / ^ Wa s damag e to window s or doo r screen s avoided ? 

### / 5 . Wa s damag e t o downspout s or downspou i extension s avoided ? Sidevyalk s an dDriveway s (Concrete ) Ye s N o 1 Wa s damag e to drivewa y surface s avoided ?



## ~ y 2 , Wa s damag e t o walkwa y surface s avoided' '

# -CO - Owner s comraenils :

Inspectio nnoies :

Removal 'an dresloratio naclivale. s complel e includin g the 30-da y so dwarranry : EP ARepresenlaiiv e ^' ^ ^ Date : i'^l' L