## TRANSMITTALof OMAHALEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R 

# l^f ) (i a , 'ZS^^ K SAID# : '^ ^ [ f ^ Date : Address : ^^g^ K 0H \0 ^ f Remediatio nContractor : Coasta l Environmenta l Group

_Year : _2010ARRA
_ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 7 ^ Vide o ofpropert y (DVD ) fc\^ff| \^ f 0 , Executiv e Summary Q EPA-provide dpropert y sketc h H Signe dAcces s Agreemen t for subjec t property Signe dAcces s Agreement(s ) for adjacent property / 

### Restoratio nAgreemen t J3

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### Satisfactory restoratio nsigne db y Property Owne r Property close-ou t chec k lis t signe db y EP A Descriptio no f area s not meetin g RO D cleanu p criteri a Utilit y clearance s 5

/ Property informatio nfromDougla s Coimty Assessor' s Offic e

Signatur e ' Dat e 3021765 2 Superfun d

## Propert yAcces s Checklis t Propert y ID : 

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^ Acces s Agreemen t Signed : H 1 Zl l 1 0 By : ^ Restoratio nAgreemen t Siened : H iZ-l l I O By : Q Topsoi l Samplin g (i f applicable ) 1 1 By : nDisposa l Samplin g (i f appUcable ) 1 1 By : O Garde nSamplin g (i f applicable ) 1 1 By : 1 2 Utilit y Clearanc e CaUed:O H /»! , / t o By = OH/a^/ o LL^Ln/i< ^ E ^ Video/Photo s (Before ) 

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Omah a Lea d Sit e

## Douglas Count y Accoim t I|^rmatio n Pag e 1 of 2 h ^ r
Dougla s County , Nebrask a Propert yRecor d ­ R092050000 0
Informatio n i s vali d a s o f2010-4-1 6 Ne wFeatur e - ^ - * - ^ Prin t Repor t Vie wInteractiv e GI S IMap

Treasurer' s Ta xReoor t Subdivisio n Sale s Searc h Owne r CITYO F OMAH A C/

O PLANNIN G DEPARTMEN T 181 9 FARNA M S T#111 1 OMAH AN E 68183-000 0 Propert yInformatio n Ke yNumber : 205 0 OOO O 0 9 Accoun t Type : E xGovemmen t Parce l Number : 092050000 0 Parce l Address : 220 8 OHI O S T OMAH AN E 68110-000 0 Lega l Description : DENISE S AD D LO T2 0 BLOC K1 5 0 X 12 2 Valu e Informatio n Lan d Improvemen t 200 9 $0.0 0 $0.0 0 200 8 $0.0 0 $0.0 0 200 7 $0.0 0 $0.0 0 200 6 $500.0 0 $0.0 0 200 5 $500.0 0 $0.0 0 200 4 $500.0 0 $0.0 0 Sale s Informatio n Sale s Date : 1993-11-1 9 Dee d Type : D Sooir : Price : $300.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h 0.1 4 6098. 0 1. 0 0. 0 Tota l $0.0 0 $0.0 0 $0.0 0 $500.0 0 $500.0 0 $500.0 0

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## • YOU RTICKE T NUMBE RI S 2473632
. Origina l Cal l Date : 4/23/1 0 Time : 1:1 3 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 4/27/1 0 Time : 1:4 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 220 8 Street : OHI O S T Twp : 15 NRng : 13 E Sect-Qtr : 09-SE,10-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATIO N Locatio n o f Work : LOCAT E ENTIR E PROPERTY , AL L EASEMENT S AN D T O TH E PEDESTA L Remarks : FAX 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 Come r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MAGELLANMUDO l OMAHACO F 0PPDGPR 5 QLNNEI C



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P DEBORA H Day : 918574709 8 Alt : Emerg : 918574709 8

MUDO l METROPOLITA NUTILITIES DISTRIC T SAND Y Day : 402504782 3 Alt : Emerg : 402504797 0
OMAHACO FGIT Y O FOMAHA-TRAFFIC.SEWE R RICH/TRAFFI C 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0

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

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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 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 : "^v^N ^ ^ 7 ^* 7 fC

Owner' s Name : 

# u}m M Daytim e Phone : 

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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 vi^it 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 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 

### 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 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 fperfomnin 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 o f2>^*^*'f

. 

### I

a ) COASTA L tHViaOHHIfTA l '-« < PftO** ' 

### t Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; cRemov e flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t ma ywis h t o save ; cWate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessar ysubsequen 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 fth 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 fth 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 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

^ \ I gran t acces s t o mypropertie s D i d o no t gran t acces s t o mypropertie s 

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## Restoratio n Agreemen t The purpos e ofthi s agreemen t i s to provid e amutua l agreemen t a s to condition s ofth e propert y prior to remediationactivities
. Thi s will als o serve a s documentationfo r the purpos e of assuring tha t restoration activitie s ar e completedto the satisfactionof the propert y owne r an dthe UnitedState s Enviromnenta l ProtectionAgenc y (EPA)
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nthe attacheddiagram(s ) indicat e area(s ) to excavate , surface structure s an dlandscapin g feature s an d acces s location(s ) to b e usedby the contractors . Indicat e distances , depths , materia l types , etc . Photographicall y an dVideographicall y documen t the existing condition s ofth e propert y an dthe basemen t if 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 rretu m o fthes e item s I s th e Owner' s responsibUity

. Hem : 

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

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

diamete r Numbe r of Sprinkle r Zones , Control Valves , Timers , Heads , etc . Attac hasketc ho f the sprinkle r layout
. Ntmibe r o f an dsize of eac hgarden / flower bed area . Attac hasketc ho f relative size s an dlocations
. Agree dupo nvalue of plan t material s not to b e replacedbv contractor . Not e thi s valu e will b e usedto issu e aplan t voucher to th e property owner . Easemen t Area , t o b e excavated 1 < 

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AddKlona l Comment s / Instructions : Th e cit yo fOmah 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 arecis

. Th e Environmenta l Protectio n Agenc y(EPA ) ma yb e removin g an d replacin g soi l underiyin 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 cKe 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 wKhstandin g an yremova l o rreplacemen t o fsoi i b yth e EP A 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 cKyo fOmaha' s Plannin g Departmen t a t (402 ) 444-5150

. |~ l Pleas e chec k thi s bo xi fyo u understan d th e informatio n outline d above

.

G Chec k th e bo xi f Owne rdoe s no t wan t CE G t o documen t interio rfoundatio n wall s an d possibl e pre-existin g damage

. B ycheckin g thi s bo xCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro fhouse , includin g foundatio n crack s o rfissures

. 

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## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 43 9 Mod e SOI L Tim e 2010-06-0 2 08:5 1 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 2899 5 ADDRES S 220 8 Ohi o s t QUADRAN T E A DEPT H 1 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D : 7.73 8 Z r 466.41 1 ± 15.45 8 S r 173.37 1 ± 8.74 6 U < LO D : 13.61 5 R b 66.97 1 ± 6.25 4 T h 12.12 9 ± 8.05 9 P b 197.03 4 ± 18.36 4 S e < LO D 5.92 0 A s < LO D 24.31 7 H g < LO D 11.68 1 Z n 164.69 1 ± 21.52 9 W < LO D 81.25 8 C u < LO D 29.08 7 N i < LO D 71.11 9 C o 271.66 1 ± 122.21 0 Fe 18588.80 3 ± 382.70 9 M n 520.58 9 ± 94.49 3 Supervise d By :

# 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 QUADRAN T DEPT H TYP E INSPECTO R

M o Z r S r U R b T h P b S e A s H g Z n W C u N i C o F e M n pp m < LO D 446.31 1 173.95 3

< LO D 67.56 0 12.20 4 208.76 6

< LO D < LO D < LO D 154.09 3

< LO D 41.84 1 < LO D < LO D 18596.41 4

554.01 5 Supervise d By : 

## Certificat e o f Verificatio n

44 0 SOI L 2010-06-0 2 08:5 2 30.1 1 Fina l 2899 5 220 8 Ohi o s t E A 1 " CONFIRMATIO N N

. LOPE Z

Erro r J 7.85 8 ± 15.10 6 ± 8.72 1

: 13.96 3 ± 6.28 8 ± 8.12 5 ± 18.73 6 5.51 0 24.66 2 11.64 1 ± 20.84 0

: 79.17 4 ± 20.32 5

I 68.30 3 : 176.33 7 ± 381.04 8 ± 95.76 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 QUADRAN T DEPT H TYP E INSPECTO R

M o Z r S r U R b T h P b S e A s H g Z n W C u N i C o F e M n pp m < LO D 454.66 0 173.57 4

< LO D 71.09 1 < LO D 213.22 8

< LO D < LO D < LO D 165.80 5

< LO D 62.64 9 < LO D < LO D 19054.98 0

516.53 1 Supervise d By : 

## Certificat e o f Verificatio n

44 1 SOI L 2010-06-0 2 08:5 3 30.1 1 Fina l 2899 5 220 8 Ohi o s t E A 1 " CONFIRMATIO N N

. LOPE Z

Erro r : 7.86 7 ± . 15.30 2 ± 8.76 0

; 13.83 6 ± 6.42 2

: 12.11 7 ± 18.96 0

'. 4.90 6 '. 24.70 3 • 11.91 9 ± 21.67 1

: 81.32 2 ± 21.93 1

i 67.47 9 : 177.70 9 ± 387.68 2 ± 95.05 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-3208 9 Readin g N o 43 8 Mod e SOI L Tim e 2010-06-0 2 08:4 9 Duratio n 90.3 5 Sequenc e Fina l Flag s : " AVERAG E ^,„-VWg;o^35^437'^ " ADDRES S <-'^0 8 Ohi o s t QUADRAN T B 2 DEPT H 13 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D Z r 500.35 0 S r 150.07 9 U < LO D R b 73.11 8 T h < LO D <Pb^^^=:::==S3::^450^e^^^'^ ^

S e A s H g Z n W C u N i C o Fe M n 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-3208 9 Readin g N o 43 5 Mod e SOI L Tim e 2010-06-0 2 08:4 8 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 2899 5 ADDRES S 220 8 Ohi o s t QUADRAN T B 2 DEPT H 13 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D 8.14 2 Z r 500.44 9 ± 16.32 6 S r 152.83 4 ± 8.47 8 U < LO D 14.58 2 R b 76.29 4 ± 6.82 8 T h 16.88 3 ± 10.57 8 P b 452.44 2 ± 27.76 8 S e < LO D 5.73 6 A s < LO D 36.44 1 H g < LO D 12.18 1 Z n 143.85 5 ± 20.85 5 W < LO D 80.70 3 C u < LO D 30.66 9 N i < LO D 73.58 9 C o < LO D 183.88 8 F e 19331.54 7 ± 400.44 4 M n 615.22 6 ± 102.46 6 Supervise d By :

# 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 QUADRAN T DEPT H TYP E INSPECTO R

M o Z r S r U R b T h P b S e A s H g Z n W C u N i C o Fe M n pp m < LO D 501.87 3 144.81 5

< LO D 71.67 8 < LO D 443.54 7

< LO D < LO D < LO D 140.03 4

< LO D 39.20 5 < LO D < LO D 19232.34 6

584.61 9 Supervise d By : 

## Certificat e o f Verificatio n

43 6 SOI L 2010-06-0 2 08:4 9 30.1 2 Fina l 2899 5 220 8 Ohi o s t B 2 13 " CONFIRMATIO N N

. LOPE Z

Erro r : 8.13 3 ± 16.26 7 ± 8.25 0

I 14.15 0 ± 6.61 4

; 14.53 1 ± 27.44 0

I 6.21 5 : 36.02 2 ', 12.29 9 •± ­ 20.68 4

; 83.20 6 ± 21.13 5

: 72.54 4 : 181.61 5 ± 398.65 4 ± 100.65 7

# 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 QUADRAN T DEPT H TYP E INSPECTO R

M o Z r S r U R b T h P b S e A s H g Z n W C u N i C o F e M n pp m < LO D 498.72 8 152.58 7

< LO D 71.38 3 < LO D 456.17 2

< LO D < LO D < LO D 128.73 8

< LO D 51.85 8 < LO D < LO D 19249.16 2

555.06 3 Supervise d By : 

## Certificat e o f Verificatio n

43 7 SOI L 2010-06-0 2 08:4 9 30.1 2 Fina l 2899 5 220 8 Ohi o s t B 2 13 " CONFIRMATIO N N

. LOPE Z

Erro r : 8.09 4 ± 16.19 4 ± 8.41 9 \ 15.30 9 ± 6.70 6

; 15.43 6 ± 27.68 6

: 5.77 1 : 35.99 5 : 12.80 4 ± 20.05 4

: 85.35 2 ± 21.86 0

: 70.53 5 : 185.12 5 ± 397.07 4 ± 98.68 0

# 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 1 3 Mod e SOI L Tim e 2010-04-3 0 10:5 5 Duratio n 90.3 3 Sequenc e Fina l Flag s AVERAG E 

### r-5ya5£io-i2- ^ ADDRES S 220 8 Ohi o s t QUADRAN T E A DEPT H 1 " TYP E 

### iNsrru s INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D \ 7.08 1 Z r 318.30 2 ± 12.44 8 S r 120.83 0 ± 7.06 0 

### u < LO D : 12.04 5 R b 48.85 7 ± 5.23 8 T h < Lor > 10.67- 7 rp b 1A 1 09 S
—± tfi-fiQ Q

S e < LO D 4.90 8 A s < LO D : 22.22 0 H g < LO D : 10.04 8 Z n 147.11 6 ± ^,.-^44 9 

### w • v ^ < LO D " ^ 70.06 7 C u 36.91 7 /18.72 6 N i < LO D / : / 64.04 7 C o < LO D 149.24 8 / • / F e 13821.72 7 / _315.97 5 

# V M n 327.70 1 f / 74.89 2 / " Supervise d By : y ^' /

# 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 1 0 Mod e SOI L Tim e 2010-04-3 0 1 0 5 3 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 2899 5 ADDRES S 220 8 Ohi o s t QUADRAN T E A DEPT H 1 " TYP E 

## iNsrru s INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D : 7.11 6 Z r 314.35 9 ± 12.31 6 S r 109.11 2 ± 6.72 6 < LO D : 12.03 9 

## u R b 50.26 9 ±• 5.28 4 T h < LO D 10.16 6 • P b 173.63 0 ± 16.41 8 S e < LO D : 4.32 5 A s < LO D : 21.53 3 H g < LO D '. 10.12 2 Z n 150.61 7 d b 19.66 6 < LO D : 72.34 4 

## w C u 36.06 3 ± 18.72 6 N i < LO D I 65.15 8 C o < LO D J 140.42 8 F e 12633.85 4 ± 301.84 1 M n 297.37 9 ± 71.94 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 f Verificatio n XL3t-3208 9 Readin g N o 1 1 Mod e SOI L Tim e 2010-04-3 0 10:5 4 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 2899 5 ADDRES S 220 8 Ohi o s t QUADRAN T E A DEPT H 1 " TYP E 

## iNsrru s INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D : 7.04 9 Z r 328.59 8 ± 12.65 9 S r 124.12 0 ± 7.16 8 < LO D J 11.68 8 

## u R b 50.06 9 ± 5.24 8 T h 13.87 8 ± 7.13 7 P b 123.34 1 ± 14.31 3 S e < LO D I 5.34 3 A s 19.96 7 ± 12.82 1 H g < LO D : 9.74 4 Z n 127.33 2 ± 18.28 1 < LO D : 66.06 6 

## w C u 32.89 9 ± 18.50 5 N i < LO D I 65.39 3 C o < LO D : 149.88 9 F e 13905.44 7 ± 317.76 2 M n 288.57 2 ± 72.43 0 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-3208 9 Readin g N o 1 2 Mod e SOI L Tim e 2010-04-3 0 10:5 5 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 2899 5 ADDRES S 220 8 Ohi o s t QUADRAN T E A DEPT H 1 " TYP E 

## iNsrru s INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D : 7.07 8 Z r 311.95 0 ± 12.37 0 S r 129.25 9 ± 7.28 6 U < LO D 12.41 0 R b 46.23 3 ± 5.18 1 T h < LO D 11.15 8 P b 246.31 4 ± 19.36 6 S e < LO D 5.05 5 A s 30.40 9 ± 17.26 4 H g < LO D 10.27 8 Z n 163.40 0 ± 20.39 9 W < LO D 71.79 0 C u 41.78 9 ± 18.94 6 N i < LO D 61.59 1 C o 218.35 4 ± 104.95 3 F e 14925.88 0 ± 328.32 3 M n 397.15 3 ± 80.29 9 Supervise d By :

## i^fjQL \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 I ^^^^ ^

I Coasta l Environmenta l Grou p Inc

. ^'^g^p ­ \7^~Jsfwww.coastalhazmatco m '' ^ %PROrtJ ^ COASTA L IN*tlONHIIIT* l C 1 0 U P

. IN C 

# EXECUTIV ESUMMARY : BVID #28995-(220 8 OHI O ST )
No Issue s o r Concern s [ ^ Issues/Concern s Detail Explanation : DA NGARVE Y WALKE D TH EPROPERT Y O N5/20/1 04 

# s ^ EP AProperty Clos e Ou t For m
Date/Time ; Owner' s Name:,i^>V>\y.^W'_ri.Vf t itr V , • ^— Quad s Excavated : Contracto r Croo p CrOL^ci X
Yes No Excavatio nGenera i I
. I f necessaiy , wer e th e correc t quadiant(s ) excavate dan drestored ? / 2
. I f necessary , wer e th e correc t area s ofdri p zon e excavaie dan drestored ? / Gradln v Sa dan dVMetafio n Ye s N o I
. Doe s th e gradui g aroun dth e perimete r ofth e hous e inexcavate darea s generall y slop e away 

### • fromth e house ? 2
. Ha s so dbee nlai di nal l area s that wer e excavated ? 

## • 3
. Doe s th e so dappea r to b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 ^ da y tim e period ) 4 , Ar e sodde darea s generall y llr man devenl y graded ? / 5
. Ar e th e Joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 da y 

## y tim e period ) 6
. Wa s th e propert y grade dsuc hthat wate r wil l not poo l onth e property ' / 7
. Wa s danug e t o landscapin g o r plan t material s avoided ? /
Gates , Fence s an d RetaiDln s Wall s Ye s N o 1

. D o gate s ope n an d clos e finely? (i fapplicable ) / 2

. Wer e al l gate s o rfence s take n dow n durin g restoratio n activitie s reinstalled ? (I fapplicable ) 

### • / 3

. Wa s damag e t o gate s o rTences avoided ? (tfapplicable ) 4

. Wa s damag e t o retainin g wall s avoided ? (I fapplicable ) 

### • Foundation , Sidio K an dGntter s Ye s N o t . Wa s damag e 1 0 th e sidin g o r tri mavoided ? » / 2
. Wa s damag e t o th e foundationavoided ? 

### y 3
. Wa s damag e t o window s avoided ? • ^
^ Wa s damag e t o window s o r doo r screen s avoided ? 5
. Wa s damag e t o downspout s o r downspou t extension s avoided ? ^ Sidewalk s an dDriveway s (Concrete ) Ye s N o 1
. Wa s damag e t o drivewa y surface s avoided ? 0 ^ 2 , Wa s damag e t o walkwa y surface s avoided ? ^

## Ort'oer s commenfs :

_^ 

## jlnspectio nnotes :

Removal andresloratio nactivate s complel e includin g the 30-da y so dwarranty : EP ARepreserjlaiiv e $c m}( ^ Dale : t/i»/tt >

### • • # •



## Propert yCompletio n Agreemen t Ihi s agreemen l documenl s the complclio no l remedia l aclivitie s perionne do nm y properly M y signature wil l designat e tha t I a msatisfie dwit hthe restoratio no f m y propeity , an dtha t no item s ar e i nquestions , now , or a

l an y tim e i nthe future , except thos e item s listedbelow , i f an y PropertylD : 28^<^5 ~ Propert y Address : •2.2.0<g > 0\\\ 0 S V Owner : 5 ; ^ LuKcL^V x di^ AO ^ PMAHf i Phone : UU^

- MZ,H 6 

### Restoratio nItem s inQuestion :

item : Item : 

### Item ; item : Item : 

### Item : AddHionai Comments :

i Dgre c restoraiio nis completed , except as noted [J I do no l a|>rt c restoratio nis completed

Cont i arlor' s Signatnr e Date

## (2i \ 

# ^^CEIVE D
^^' f 24 201 0 Propert y OwEne r

Asgessmen t o f F£ir|M"m£BiC e F©r m America nRecover y anc i Reinvestmen t ^^i'^SSi^/y/ ^ ni\/IQir\ Omah aLea( i Superfun dSit e " ^'^'^iU N 2009/201 0 Remedistio nContractor : Coasta l EnviroBmenta l Grou p - EP-R7-Q9-0 6 Propert y Identifie r NuBmber: 2fV^^f5 ^ Propert y Address : '^iLr>9 \<DW\ 0 f? T ^__. ^ Piroperty Owaer' s Name ; W WLvAVXtSy NC \\\Ar^QiUAW\y ^ Instruction s t o th e Propert v Owner ; Thi s for mserve s to recor dth e Propert y Owner' s assessmen t of performanc e (Incentive 1

- Quality Assuranc e Surveillanc e Plan ) involvin g th e liste dremediationcontractor , a s applicabl e to th e Omah aLea dSite
. Thi s foinn ndocument s th e timelines s o f punc hlis t resolution , busines s relations , complaint resolutio nan dth e overal l qualit y o f work
. I f nee dbe , the Propert y Owne r may utiliz e thi s for mto recor dproblem s and/o r issue s not specificall y tie dto a nassigne d address , for example , busines s relation s tha t generally don' t follo w th e guideline s set fort hi nthe Performanc e Wor k

Statement.
. Th e Propert y Owne r will indicat e his/her assessment of performanc e wit hth e contractor' s wori c b y checkin g anumerica l retin g o ntii e tsbi e beio w using the numerica l definition s fro m th e ratin g scal e below , thensign & date th 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 Assessment of Performanc e Regardin e th e Contractor' s Wor k 1 0 5 9 A 8 7 

# ¥ V __!

_ 

### 3 2 6 1 

### Propert y Owne r Additiona EComment s fro m(optional ; continiu e o nbac k pag e i f needed )
Propert y Owne r Signature : v^l//f/^X// ^ /AAA ^ ^Date : _lJ_J^yHZs^/ 0

# EP AAssessment of Performanc e For m America nRecover y an dReinvestmen t Ac t (ARRA ) Omah aLea dSuperfim dSit e 2009/201 0 Remediatio nContractor : Coasta l Environmenta l Grou p - EP-R7-09-0 6 Propert y Identifie r Number : Q?R<^AP S 

## Property Address : 2£OP > OU\ nST T Propert y Owner' s Name : ^AV \^i..VCri.^V \P:ih ^ ^S-nrYVlV\CN (Above informationto b e filledou t by the remediationcontracto r prior to utilizationb y the EP ACOR ) 

## Instruction s t o EP ACOR : Thi s for mserve s to recor dth e COR' s assessmen t o f perfonnanc e (Incentive 1 - Qualit y Assxiranc e Svirveillance Plan) involving the listedremediationcontractor , a s applicable to the Omah aLea dSite
. Thi s for mdocmnent s the timelines s o f punchlis t resoliition , busines s relations , complaint resolutio nandth e overall qiialit y o f work
. If needbe , EP Ama y utiliz e thi s for mt o recordproblem s and/or issue s no t specificall y tie dto a nassignedaddress , fo r

example , busines s relation s tha t generally don' t follow the guideline s se t fort hinthe Performance Wor k Statement
. Th e CO Rwil l indicat e his/her assessmen t o f performanc e wit hthe contractor' s wor k

b y checkin g anumerica l ratin g o nth e tabl e below using th e niunerica l definition s fix)mth e rating scale below , thensign& dat e the form
. 9-1 0 "excellent " 7- 8 'Ver y good " 5- 6 "acceptable " 3- 4 "poor " 1-

2 "ver y poor " EPA' s Assessment of Performanc e Regardin g th e Contractor' s Work 1 0 / 5 9 -^^^

­ 4 8 • 3 7 2 6 1 Additional Comment s fro mEP ACO R(optional ; continu e o nbac k pag e if needed )

EP ACO RSignature : fliiM A
. Date : ,\*» "

## 2899 5 

# m NOTE S

RE : 220 8 OHI O ST 220 4 OHI O S T

JUL Y 17 , 201 0

- W E RECEIVE D INFORMATIO N FRO M TOD D (TODD' S SOD ) STATIN G THA TH E SA WABULLDOZE R O N TH E SOD , O N PROPERT Y220 8 OHI O ST

.

Jul y 19 , 201 0 -ON E O F OU R SIT E COORDINATOR S WEN TT O TH E HOUS E T O INSPEC TTH E CLAI M AN D NOTICE D THA TTH E GROUN D HA D BAR E SOIL,WA S LEVELED , AN D AL L TH E SO D WA S REMOVED , FRO M PROPERT Y220 8 OHI O STAN D ALS O FRO M TH E NEIGHBORIN G PROPERTY , 220 4 OHI O ST , WHIC H I S ANOTHE R PROPERT YTHA TCOASTA L DI D TH E LEA D REMEDIATIO N FOR

.

"SUPERVISOR S WER E NOTIFIE D IMMEDIATELY *