## TRANSMITTALo f

OMAHALEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R

SAi : 

# D# : i4Wi^ t Date : 

# i\n]cP \ Address : ^Oig O S ^ ^ S' T Remediatio nContractor : _Coasta l Environmenta l Group
_ Year : 200 8
SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 

# y Vide o o f property (DVD ) 4031546 3 

# y Executiv e Summary 

# y EPA-provide dproperty sketc h Superfun d 

# y Signe dAcces s Agreemen t fo r subjec t property Signe dAcces s Agreement(s ) for adjacent property Restoratio nAgreemen t Settlemen t document s (i.e. , for damag e o r to replac e plants , etc. ) 

# y Confirmatio ndat a 

# y Photograph s r^c-^^fjJcAvo^ ^ JL^c/iJayxch^ ^ fl«y
. S^* ^ a As-buil t sketc h 

# y Satisfactory restoratio nsigne db y Property Owner 

# y Property close-ou t chec k lis t signe db y EPA Descriptio no f area s no t meetin g RO D cleanu p criteri a 

# y Utility clearance s 

# y Property infonnatio nfro mDougla s County Assessor' s Offic e 

# y ?fT>|)<tr(u ^ (U<ys, ^ t\Nu\c\ y 

# y C^^uu y Wm , D 

## ^TOQ. , Signatur e Ignature 

# "^^^y^My^J ^ ^M f

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. C^T,"^ ^ n D

WOR K STARTE D WORKCOMPELTE D ON : ON : / / / /
Owne r ^f^^,(-\ ^ ^VvmeS ^ Address : ^ ^

Phone : <^ai-'S&A 0 Fax : Rcnte n Phone : Fax : Cell/Pager
. Additional Information : Cell/Pager
. nt0^,O\U 3

nNotificationLette r 0 " Acces s Agreement 0 ^ Restoratio nAgreement C l Topsoil Samplin g (if applicable ) Q Disposa l Samplin g (if applicable ) D Garde nSamplin g (if applicable ) jZ " Utilit y Clearanc e Q ^ Video/Photo s (Before ) nVideo/Photo s (During ) nVideo/Photo s (After) D Video/Photo s (30-Day ) Q Property Completio nAgreement Sent : / / Signed : iQ./£./Qi Signed : ]a/S_/Q & / / / / / / Called : i D / 1 0 / fi^ 

## On:iO/i^/ ^ On : / / On : / / On : / / Signed : / / By : 

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. By : By : By : By : D Final Report Issued : / / By : Ai r Monitorin g (a s applicable )
• Communit y Q Crew ResulU- : On : / / By :

• Communit y Results : • Crew On : / / 

## By : 1
Q Communit y Results : D Crew On : / / By :

Omah a Lea d Sit e

## CONTAC T FORJvl Propert y I D # 

# IHi-lH l Propert y Address : 

# .^Ob D S ^ 3 

# -^- T Initia l Contact : Date : Time : Action : Secon dContact : Date : Time : Action : Fina l Conlact : Dale : Time : Action : Fina l Action : Transmi t to EP AD Othe r .Action : D

Comment : Owne r Commen i (s) :



# _ . J Sit e Coordinato r Commen t (s) :

### Dougla s County Accoun t Informatio n Pag e 1 of 2 ra^i
Dougla s County , Nebrask a Propert yRecor d - R194289000 0 Prin t JRep_or t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f90t h S t - VjewO n Ma p Informatio n i s vali d a s o f2008-9- 4 Treasurer' s TaxRepor t Ne wFeatur e ->-•- > Aut o Sale s Searc h Owne r MORRI S JAME S G ETA L 306 0 S 3 3 S T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 428 9 000 0 1 9 Accoun t Type : Residentia l Parce l Number : 194289000 0 Parce l Address : 306 0 S 3 3 S T OMAH AN E 68105-000 0 Lega l Description : PARKVAL E LOT 3 BLOC K8 4 1 X 13 0 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $5,900.0 0 $89,400.0 0 $95,300.0 0 200 7 $5,900.0 0 $89,400.0 0 $95,300.0 0 200 6 $5,900.0 0 $71,900.0 0 $77,800.0 0 200 5 $5,900.0 0 $71,900.0 0 $77,800.0 0 200 4 $5,900.0 0 $71,900.0 0 $77,800.0 0 200 3 $5,900.0 0 $62,000.0 0 $67,900.0 0 Sale s Informatio n Sale s Date : 2001-12-2 1 Page : 15 7 Dee d Type : W D Book : I 219 9 Price : $71,000.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 2 5330. 0 1. 0 130. 0 41. 0 N o Improvemen t Informatio n


### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19.
. . 10/7/200 8

### Dougla s County Accoun t Informatio n Pag e 2 of 2 m^t i

Buildin g 1

M O f«i T

• 1 Firs t ROO T 92l0sq.I1

. Secon d Fl i n r 3800sql t

• • » :

Hf f
w n a«>wn», .

1 1/ 2 STOR YFINISHE D
11 3 Ei q t

CLIC KT O ENlJkRG E IMAG E Squar e Footage : 1301. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : \ Averag e Uni t Type : Condition : Averag e

Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 5. 0 Exterior : Fram e Viny l Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 2. 0

Roo fType : Gabl e Stories : 1. 5 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 191 2 0 % 191 2 9 6 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 912. 0 Carpor t Attache d 260. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 280. 0 Porc h Sla b Roo fCei l 160. 0 Porc h Sla b w/Step s 24. 0 Use r Atti cFul l Finis h 380. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19.
. . 10/7/200 8

### Pag e 1 of 2

" > Creat e Anothe rTicke t Bac k t o Irt h Interne t Sen d Emai l


### YOU RTICKE T NUMBE RI S 2152724
. Origina l Cal l Date : 10/10/0 8 Wor k t o Begi n Date : 10/15/0 8 Time : 12:2 6 p m Time : 1:0 0 p m Op : ELIZABETH1879 0

State : N E Address : 306 0 County : DOUGLA S Street : S 33R D S T Place : OMAH A
Twp : 15 N Twp : Rng : 13 E Rng : Sect-Qtr : 33-NW Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remidiatio n Locatio n o f Work : LOCAT E ENTIR E PROPERT Y STARTIN G A T TH E HOUS E AL L TH E WA Y : T O TH E STREET . Remarks : FAX AL L CLEAR S TO : (877)662-421 1 Compan y: COASTA L ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : coasta l Dept h o f Excavation : 4f t Corne r Lot : N Front : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F QWEST 2

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

### Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C 

### HEID I Alt : 402934046 9 Emerg : 402932975 7 

### Day : 402504782 3 MUD0 2 METROPOLITA NUTILITIE S DISTRIC T SAND Y Alt : 

### Emerg : 402504794 6 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO N 

### Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 0PPDGPR 6 OMAH APUBLI C POWE RDISTRIC T N A 

### Alt : 888728934 3 Emerg : 406728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.
. . 10/10/200 8

### Pag e 2 of 2

QLNN E1 FQWES T LOCA LNETWOR K 

### M A Day : 406728934 3

Alt : Emerg : 888728934 3
QWEST 2 QWES T LON GDISTANC E 

### SAR A Day : 800283423 7

Alt : 303992192 6 Emerg : 800283423 7

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.
. . 10/10/200 8( ^ 

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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 YTO 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 : . , 

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# yJ J y Agreement :
PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP Ai 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 ma ypos e a healt h hazard

. Th e area(s ) wil l b e excavate d t o remov e contaminate d soil

. Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o it s origina l condition

. Thi s wor k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o 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 perfonned , th e Granto rwil l have 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 writte n documentatio n fro m EP Atha t th e property 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 , 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 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 f2s, % •" • «* COASTA L *3 ^

** C ENVmOHMFNTi l t l»IIO " C •0 U '

. IN C



### •Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; •Remov e flowe rbulb s orplant s tha t th e Granto r orth 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 y is rented , assis t EP A in obtainin g tenan t approva l fo racces s to th e propert yto perfor m th e work

. • Allo 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 yofth e wor k activities , orwit h an y ofth e wor k 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 , orto 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 Environmenta l Group , at (712 ) 352-018 8

n I gran t acces sto mypropertie sD I do no t gran t acces s to mypropertie s

'^ ^ signatur ignatur e e/ / Dat Dat e e Signatur eDat e

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

.C O AS TAU 

## Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i s to provid e amutua l agreemen t a s to condition s ofth e propert y 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 re.storatio n activitie s ar e complete dto th e satisfactio nofth e propert> ' owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA)
. 

# IWyj Propert yAddress : ~^d^7 1 

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O nth e attache ddiagram(s ) indicat e area(s ) to excavate dan ddeptl i o f excavation , locatio no f all know n utilities , subsurfac e features , syrfac e structure s andlandscapin g features , acces s location(s ) to b e use dby contractor , an dth e directio no f North
. Indicat e distances , depths , material types , etc . Indicate digita l photo s by referencin g th e photo-lo g numbe r wit ha narro w indicatin g directio no f view
. 

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Pag e 3 of

.- - ( ^ COASTA L 

### Landscap e Inventor y (Us e additiona l sheet s a s necessary ) 

### Ite m Quantit y Uni t Condition/Type/Specie s

Pre-existing propert y area , tha t will b e excavated , tha t is coveredwit hgrass .

Numbe r o

f tree s > 2 inc h trun k

diamete r

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

diamete r

Numbe r of Sprinkler Zones , Control Valves , Timers , Heads , etc . Attachasketcho f the sprinkler layout
.

Numbe r o f an dsize of eac hgarden / flowe r bed area . Attachasketchof relativ e size s an dlocations
. 

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Pag e 4 of

.

### < ^ & COASTA L 

### Ite m Quantit y 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 be usedto issu e aplan t 

# y vouche r to th e propert y owner . Agree duponlis t of plan t material s tha t will be replace db y contractor . B e ver y specifi c an ddetailed
. 

# y Include asketchof wer e eachplani wil l b e placed b

y the contractor . Agreedupo nare aof propert y t o be replaced wit hgras s sod
. Include asketchof the 

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area(s ) t o be replace dwit h gras s sod
.
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r their requirements
. 

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### Urii t Condition/Type/Specie s

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Pag e 5 ofC O AS T AC

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Additiona l Comment s / instructions : 

# ^^ ^ "^-J > ^hMlyci i yr l

G Chec k th e boxi fOwne rdoe s not wan t CE G t o documen t interio rfoundatio n wall s an d possibl e pre-existin g damage

. Bycheckin g thi s boxCE 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 rfissiires.

I agre e Q I d o no t agre e

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## Prin t feOjUt^iiyAl (W0)f£ ^

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

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

pp m P b 35.19 5 Supervise d By : 

## Certificat e o fVerificatio n

178 5 SOI L 2008-10-2 1 15:5 8 31.5 7 Fina l 1444 7 306 0 s 3 3 s t B l Ventr y 6 CLEARANC E

± Erro r
± 8.71 9

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

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

pp m P b 51.52 8 Supervise d By : 

## Certificat e o fVerificatio n

178 6 SOI L 2008-10-2 1 15:5 9 30.5 5 Fina l 1444 7 306 0 s 3 3 s t B l Ventr y 6 CLEARANC E

± Erro r
± 9.79 9

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

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

pp m P b 40.13 8 Supervise d By : 

## Certificat e o fVerificatio n

178 7 SOI L 2008-10-2 1 16:0 0 30.4 6 Fina l 1444 7 306 0 s 3 3 s t B l Ventr y 6 CLEARANC E

±Erro r ±9.01 0

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

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

pp m P b 69.21 2 Supervise d By : 

## Certificat e o fVerificatio n

178 8 SOI L 2008-10-2 1 16:0 1 30.5 9 Fina l 1444 7 306 0 s 3 3 s t B l Ventr y 6 CLEARANC E

± Erro r
± 10.75 5

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 178 9 Mod e SOI L Tim e 2008-10-2 1 16:0 1 Duratio n 123.1 7 Sequenc e Fina l Flag s AVERAG E Av g o f1785-178 8 ADDRES S [306 0 s 3 3 s t QUAD/ZON E ^ 1 INSPECTO R Ventr y DEPT H SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b J,49.01 8 , ±9.57 1 Supervise d By :

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

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

pp m P b 184.54 0 Supervise d By : 

## Certificat e o fVerificatio n

179 0 SOI L 2008-10-2 1 16:0 2 31.2 3 Fina l 1444 7 306 0 s 3 3 s t D Z Ventr y 1 3 CLEARANC E

± Erro r
± 16.46 8

# Therm o SCIENTIFI C Therm o Fishe r Scientifi c 90 0 Middlese x Turnpik e Bilierica , M A0182 1

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

pp m P b 75.89 6 Supervise d By : 

## Certificat e o fVerificatio n

179 1 SOIL 2008-10-2 1 16:0 3 30.5 7 Fina l 1444 7 306 0 s 3 3 s t D Z Ventr y 1 3 CLEARANC E

± Erro r
± 11.18 3

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

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

pp m P b 171.72 3 Supervise d By : 

## Certificat e o fVerificatio n

179 2 SOI L 2008-10-2 1 16:0 4 31.3 0 Fina l 1444 7 306 0 s 3 3 s t D Z Ventr y 1 3 CLEARANC E

± Erro r
± 16.02 6

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

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

pp m P b 48.58 7 Supervise d By : 

## Certificat e o fVerificatio n

179 3 SOI L 2008-10-2 1 16:0 5 31.5 4 Fina l 1444 7 306 0 s 3 3 s t D Z Ventr y 1 3 CLEARANC E

±Erro r ±9.43 4

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 179 4 Mod e SOI L Tim e 2008-10-2 1 16:0 5 Duratio n 124.6 4 Sequenc e Fina l Flag s AVERAG E J|Av g o f1790-179 3 ADDRES S 306 0 s 3 3 st TM QUAD/ZON E |D Z INSPECTO R Ventr y DEPT H 4 1 3 SAMPL E P<P E CLEARANC E NOT E

pp m ± Erro r P b 120.18 6 ± 13.27 8 Supervise d By :

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

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

pp m P b 75.02 6 Supervise d By : 

## Certificat e o fVerificatio n

179 9 SOI L 2008-10-2 1 16:1 0 30.9 2 Fina l 1444 7 306 0 s 3 3 s t easemen t Ventr y 1 CLEARANC E

±Erro r ±11.30 0

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

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

pp m P b 43.52 6 Supervise d By : 

## Certificat e o fVerificatio n

180 0 SOI L 2008-10-2 1 16:1 0 30.8 2 Fina l 1444 7 306 0 s 3 3 s t easemen t Ventr y 1 CLEARANC E

± Erro r ± 9.29 1

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 180 1 Mod e SOI L Tim e 2008-10-2 1 16:1 1 Duratio n 30.2 0 Sequenc e Fina l Flag s BVI D # 1444 7 ADDRES S 306 0 s 3 3 s t QUAD/ZON E easemen t INSPECTO R Ventr y DEPT H 1 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 64.42 8 ±10.60 3 Supervise d By :

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

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

pp m P b 52.88 7 Supervise d By : 

## Certificat e o fVerificatio n

180 2 SOI L 2008-10-2 1 16:1 2 30.5 2 Fina l 1444 7 306 0 s 3 3 s t easemen t Ventr y 1 CLEARANC E

±Erro r ±9.78 8

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 180 3 Mod e SOI L Tim e 2008-10-2 1 16:1 2 Duratio n 122.4 6 Sequenc e Fina l Flag s AVERAG E I Av g o f1799-180 2 ADDRES S 306 0 s 3 3 s t QUAD/ZON E ^easemenL

. INSPECTO R Ventr y DEPT H SAMPL E PI'P E CLEARANC E NOT E

pp m ± Erro r P b 158.96 7 ± 10.24 5 Supervise d By :

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

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

pp m P b 50.74 9 Supervise d By : 

## Certificat e o fVerificatio n

185 5 SOI L 2008-10-2 4 12:3 5 30.1 8 Fina l 1444 7 306 0 s 3 3 s t F2 Ventr y 6 CLEARANC E

± Erro r
± 9.77 5

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 185 6 Mod e SOI L Tim e 2008-10-2 4 12:3 6 Duratio n 30.5 3 Sequenc e Fina l Flag s BVI D # 1444 7 ADDRES S 306 0 s 3 3 St QUAD/ZON E F2 INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 78.70 5 ±11.58 3 Supervise d By :

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

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

pp m P b 135.20 9 Supervise d By : 

## Certificat e o fVerificatio n

185 7 SOI L 2008-10-2 4 12:3 7 30.6 4 Fina l 1444 7 306 0 S 3 3 s t F2 Ventr y 6 CLEARANC E

± Erro r
± 14.45 3

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

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

pp m P b 62.18 7 Supervise d By : 

## Certificat e o fVerificatio n

185 8 SOI L 2008-10-2 4 12:3 7 30.5 5 Fina l 1444 7 306 0 s 3 3 s t F2 Ventr y 6 CLEARANC E

±Erro r ±10.60 7

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

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

pp m P b 81.71 2 Supervise d By : 

## Certificat e o fVerificatio n

185 9 SOI L 2008-10-2 4 12:3 7 121.9 0 Fina l Av g o f1855-185 8 306 0 s 3 3 s t

entr y CLEARANC E

±Erro r ±11.60 5

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

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

pp m P b 45.83 5 Supervise d By : 

## Certificat e o fVerificatio n

573 3 SOI L 2008-12-1 7 13:2 5 30.8 5 Fina l 1444 7 306 0 s 3 3 s t PZ Ventr y 6 CLEARANC E

± Erro r
± 9.40 0

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

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

pp m P b 55.49 1 Supervise d By : 

## Certificat e o fVerificatio n

573 4 SOI L 2008-12

- 1 7 13:2 6 31.0 3 Fina l 1444 7 306 0 s 3 3 s t PZ Ventr y 6 CLEARANC E

±Erro r ±10.00 2

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 573 5 Mod e SOI L Tim e 2008-12-1 7 13:2 6 Duratio n 30.4 9 Sequenc e Fina l Flag s BVI D # 1444 7 ADDRES S 306 0 s 3 3 s t QUAD/ZON E PZ INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 63.78 0 ±10.59 4 Supervise d By :

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

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

pp m P b 59.93 4 Supervise d By : 

## Certificat e o fVerificatio n

573 6 SOI L 2008-12-1 7 13:2 7 30.7 9 Fina l 1444 7 306 0 s 3 3 s t PZ Ventr y 6 CLEARANC E

± Erro r
± 10.30 3

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

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

## Certificat e o fVerificatio n

573 7 SOI L 2008-12-1 7 13:2 7 123.1 6 Fina l f Av g o f5733-573 6 ' 306 0 s 3 3 s t #P Z

Ventr y 1 6 CLEARANC E

pp m ± Erro r P b 456.26 0 ± 10.07 5 Supervise d By :X 

# M Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc

. www.coastalhazmat.co m \ COASTA L

''"IPHO^ " ENVIRONMENTA L C •O U r. INC

. 

# EXECUTIV ESUMMARY : BVI D #1444 7 - (306 0 S 3 3 ST )


# No Issue s o r Concern s I I Issues/Concern s
Detai l Explanation : N O ISSUE S PENDING
.

# .^EP A EP APropert ) Clos e Ou t For m Proptrt y* : l^^C-!^^" ! Propert yAddrcM^DI^' Q ^
. d^ ^

^" ^

' Dalc/Tlroc : Owner' s Nam. : ":^tr<A-P ^ W^gy fO V ' ^ Quad s Excavated : T^S? , "t>i : g? \ ,jlto > Contracto rCrouprV. Q ^cW,

. S^T-'O.V'^V'CY^^K^VJLA' ^
Lxcavatlo D Genera l Ye s N o 1 I fnecessary , were th e corrt O quadranl(s ) excavaie d an d resiored ? 

## y 2 I fnecessary , were th e correc l area s o fdri p zon e excavaie d an d restored' ' 

## y GradJD KSo d an d Vctctalio D Ves N o 1 Doe s th e gradin g aroun d th e perimeie ro fih e hous e i n excavate d area s generall yslop e awa y from Ib e house ? 

### y 2 Ha s so d bee n lai d i n al l area s Ihat were excavated ? 

### y 3 Doe s th e sod appea rl o b e generall yhealth yan d growing' ' (Onl yevaluat e i fmspecie d a i a 3 0 da ylim e period ) 

## y 4 Ar e sodde d areas generall yfir m an d evenl ygraded ? (. / 5 Ar e th e joint s berwee n th e so d strip s generall ylight' ' (Onl yevaluat e i finspecie d a i a 3 0 da y tim e period ) ly 6 Wa s th e propert ygrade d suc h tha i wale rwi Wno l poo l o n th e property' ' y 7 Wa s damag e l o landscapin g o rplan i material s avoided' ' ^ 1 Gales , FeDcnan d RcUinln s Wall s Ve s N o 1 D o gate s ope n an d clos e freely ? (Ifapplicable ) i ^ 2 Wer e al l gate s o rfence s take n dow n durin g restoralio n acliviiie s reinsulled' ' (I fap p icablf ) iy i 3 Wa s damag e l o gate s o rfence s avoided ? (Ifapplicable ) i ^ 4 Wa s damag e t o reuinin g wall s avoided ? (Ifapplicable ) L ^ Foundation , Sidia xan d Gulier s Ves N o 1 Wa s damag e t o th e sidin g o rtri m avoided ? 

### y 2 Wa s damag e l o th e foundatio n avoided' ' 

### y 3 Was damag e t o window s avoided' ' t t - ^ 4 Wa s danwg e t o window s o rdoo rscreen s avoided' ' L y 5 Wa s damag e l o downspout s o rdownspou l exiension s avoided' ' ^ Sidewalk s an d Driveway s (Concrele ) Ve s N o Wa s damag e l o drivewa ysurface s avoided' ^ 2 Wa s damag e t o ualk\*a ysurface s avoided ? 

# y

# M O • ner ? comm€nls :

Inspectio nnotes :

Remova l an dresloratio naclivale s complei e includin g th e 30-day so dwarrant y 

## /iyiye ^ FF ARepresenlaiiv e Dale :

# m

Propert yCompietio n Agreemen t
Thi s agreemen t documenl s th e completio n o f remedia l activitie s perroime d o n m ypropert yM ysignatur e wil l designat e tha t 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 i n questions , now , o ra t an ytim e i n th e future , excep t thos e item s liste d below , ifan y PropcrtyTD : |O^C\L^ ^ 

### Properl y Address:3^ ^ Ii^ Q ' ^ , .S?>-= ^ '>s h 

## o>^n« ' KorrN ^

^Sboio^jU N Phone : QQ, ^
_Q^C ^ ^
. 1 C^ % ^ C> \ U ^ Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item :

^\ } I agrf crestoratio n i s completed , excep t a s nole d
I I rio no t ai;re crestoratio n i s complete d 

# HU. 0 /hc^^-o S 9^rj)j^po/ \ f)al cConlractor' s Signatur e Dat e I