• •


### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID # : 41^4' ^Date : 7_f2J.|o ^ 

# Address : z-^ i ^ Marti'i aftve 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 ) \y Executiv e Summary y EPA-provide dpropert y sketc h y Signe dAcces s Agreemen t for subjec t property fdji

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

• /

Confirmatio ndat a B ^ Photograph s ^Ce^ ^ i.vr/;,)ahw \^ dXClJoLnf ^ ^ jyTUjis o ' ^ 0 As-built sketc h 0 ^ Satisfactory restoratio nsigne db y Property Owne r H ^ Property close-ou t chec k lis t signe db y EPA ^i||/ VDescriptio no f area s no t meetin g RO D cleanu p criteri a B

^ Utility clearance s Q

/ Property informatio nfromDougla s County Assessor' s Offic e 4031816 5 DSuperfun d

## Propert yAcces s Checklis t PropertylD : ^ / ^ ^ (? " D WOR K STARTE D ON : / / D WOR K COMPELTE D ON : Propert y Address : X77 ^ M<^rf) nA/ P Owner : ]5^.^^^|v , /j|e ^ Rente r Address : ci Phone : Fax : Cell/Pager : Additiona l Information : 

## Phone : tjS 5 "^ 7 U? ^ Fax : Ccll/Pager : D Notificatio nLette r Sent : / / By : ^ Acces s Agreemen t Signed: / 0 l%\ l O t 

## By : M c o tc^ s ^ Restoratio nAgreemen t Signed : Z£ / 31/J M By : / / O Topsoi l Samplin g (i f applicable ) 11 By : O Disposa l Samplin g (r f applicable ) 11 By : nGarde nSamplin g (i f applicable ) 11 By : J3 ' Utilit y Clearanc e 

## Called : IL/^^/Oi : 

## ^y-wj^^jb^ k ^ Video/Photo s (Before ) 

## On : /^/I/. / O S By = JJicolc^ ^ D Video/Photo s (During ) On : / / By : D Video/Photo s (After ) On : / / By : D Video/Photo s (30-Day ) On : / / By : nPropert y Completio nAgreemen t Sipied : / / By : D Fina l Repor t Issued : / / By : Ai r Monitorin g (a s ai>plicable ) Q Communit y L ] Cre w | On : / / By : Results : C

D Communit y C ] Cre w On : / / Bv : Results :
nCommunit y O Cre w On : / / By : ResulU : Omah a Lea d Sit e 

# 1

### CONTAC T FOR M Propen y I D # Propert y Address : Initia l Coniacl : Secon dContact . Fina l Coniact : Fina l Action :

Comment : 0\vne r ! Commen t (s) : Sit e 

### Coordinato r Commen l (sj : 

# ^l^^ 9

- 2 

# 71'- l hy mA^ t Date : Time : Action : Date : Time : Action : Date : Time : Action ; Tran.smi t t o EP A D Othe r Action : DDougla s Count y Accoun t Infqaaatio n Pag e 1 of 2 

# 1 Daugla s County , Nebrask a Propert yRecor d - R l 11775000 0 Prin t Repor t NE

W Featur e - Parce l Dimensions availabl e @ scal e 0-5 0 ft wes t o

f 90t h S t - Vie wo n Ma p Informatio n i s vali d a s of 2008-9- 4 Treasurer' s Ta xRepor t Ne wFeatur e ^ ^ ^ Aut o Sale s Searc h Owne r ALLE N BEVERLYJ 277 4 MARTI N AV E , i / - o rn / ^ OMAH AN E 68112-000 0 lJO~Mv(g n Propert yInformatio n Ke yNumber : 177 5 000 0 1 1 Accoun t Type : Residentia l Parce l Number : 111775000 0 Parce l Address : 277 4 MARTI N AV OMAH AN E 68112-000 0 Lega l Description : FLORENC E FIEL D LO T1 8 BLOC K1 1 IRRE G Valu e Informatio n Lan d Improvemen t Tota l 200 8 200 7 200 6 200 5 200 4 200 3 $6,300.0 0 $6,300.0 0 $6,300.0 0 $6,300.0 0 $6,300.0 0 $6,300.0 0 $30,600.0 0 $46,100.0 0 $46,100.0 0 $46,100.0 0 $40,300.0 0 $40,300.0 0 $36,900.0 0 $52,400.0 0 $52,400.0 0 $52,400.0 0 $46,600.0 0 $46,600.0 0 Sale s Informatio n Sale s Date : 1995-03-3 1 Dee d Type : Book : 200 1 Page : 45 3 Price : $ 32,000.0 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 4 6120. 0 1.0 136. 0 45. 0 N o Improvemen t Informatio n
http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl. . . 10/29/200 8

### Dougla s County Accoun t Infcauatio n Pag e 2 of 2 caua '
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### fT HPPS' . FmtFloo t 8U.0«).t
. » o RANC H Baw KBloct < I f l TiV'i' i ^•11 0 w j n i«C44t Si r CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 818. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Fai r

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

HVAC : Force d Ai r Rooms : 4. 0 Exterior : Fram e Sidin g Units : 1. 0 interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 2. 0

Roo f Type : Gabl e Stories : 1. 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 194 1 0 0 % 194 1 6 8 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 778. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Attache d 210. 0 Porc h Ope n Sla b 185. 0 Porc h Sla b w/Step s 15. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.js p ?accountno=Rl.. . 10/29/200 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 2167699 . Origina l Cal l Date : 11/03/0 8 Time : 9:3 2 a m Op : ELIZABETH18 7 9 0 Wor k t o Begi n Date : 11/05/0 8 Time : 10:0 0 a m State : N E County : DOUGLA S Place : OMAH A Address : 277 4 Street : MARTI NAV E Twp : 16 NRng : 13 E Sect-Qtr : 28-S E 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 PROPERT Y INCLUDIN G TH E HOUS E AL L TH E WA Y T O : TH E STREET . Remarks : FAX AL L CLEAR S TO : (877)562-421 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 MAGELLAN MUDO l OMAHACO F OPPDGPR S QLNNEI C

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 : 918574709 8 MAGELLA NMAGELLA NMIDSTREA M PARTNER S LPTONY AAlt : 

### Emerg : 918574709 8 Day : 402504782 3 MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y Alt : 

### Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R 

### RO NAlt : 402444516 1 Emerg : 402444516 0
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 11/3/200 8

# t Pag e 2 of 2 Day : 406728934 3 OPPDGPR S OMAH A PUBLI C POWE RDISTRIC T 

### N AAlt : 888728934 3 Emerg : 406728934 3 Day : 406728934 3 QLNN E1 C QWES T LOCA LNETWOR K 

### N A Alt : Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 1 1 /3/200 8

# Remot eID : Rpag eo^^ Magella n One-Cal l P.O . Box 344 8 Tulsa , O K 7410 1 Phon e 918/574-709 8 Fa x 918/574-746 6 Th e following One-Cal l Agenc ydi g ticket s calle d i n by : Excavator : COASTA L ENVIRONMENTA L SERVIC E Fa x Number : 877662421 1 Phon e Number : 877662421 0 Fa x Date : 2008/11/0 3 Batchid : 54073 2 Wil l be CLEA R o f undergroun d facilitie s for : MAGELLA NPIPELINE Stat e Ticke t Numbe r Excavato r Contac t Di g Addres s

N

E 216769 9 ELIZABETH 277 4 MARTI NAVE I f yo u have an yquestions , pleas e contac t Magella n OneCal l a t 918/574-709 8

# As-Buil t Drawin g COASTA L 

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. Stt e Sketc h Time : Phone : Vf Z " ^yi - 77^ t Tea m "Tih y//t>w/> ^ '(j^ - ^^' ° * V / ^'^ fXR F Cod e 5'S' 0 4 Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e 

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### Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Axe areplace dwit h Are areplace dwit h 

## L J So d' ' Rock/Mulc h^ ^® ^ 1®^ ^ ^*^ ® Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .— ^ <- Addres s Z 7 Sit e Sketc h Time : Phone : ^e r - y^i - f7^ f 

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OmahaLea dSit e 4613 0Name : ^^/^<v/ / ^//f n Omah a Lea d Sit e Date : ' c-/j--^ ^ Nort h Arro w— i Address : Zll ^

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•—rt P IHVIIIOHHINTH I '•*W" ^ C i O U P . IM C 

### 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 :

Owner' s Name : Daytim e Phone : 

# JUA/MJIA ^

# ^CCli^A A Addres s o fPropert y covere d b ythi s 

# J.77 Y .Mo.Al nAvc . 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 remov e soi l tha t contain s elevate d concentration s o f lea 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 byUSEPA , wil l contact th e Granto rin-perso n t o discus s th e wor k t o b e performed , th e Granto rwil l hav e a n opportunityt o revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e i t begins . Onc e th e wor k i s finished , th e Granto rwil l b e aske d t o revie wth e wor k an d confir m tha t i t i s complet e an d meet s wit h th e Grantor' s approval . Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m EPAtha 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 f performin g th e work . Thi s acces s shal l remai n i n effect unti l th e wor k ha s bee n satisfactoril ycompleted . Th e Granto rals o agree s to :
Pag e 1 o f 2COASTA L (NVIROHHfNTA l ^-t«K>*« ' C • 0 U P . I h C



### •Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; •Remov e flowerbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t ma ywis h t o save ; •Wate 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 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 . •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 f th e wor k activities , o rwit h an y o f th 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 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 (712 ) 352-018 8 

# f I gran t acces s t o m ypropertie s D I d o no t gran t acces s t o m ypropertie s 

# i lM± L 

# It^dt-D ^

Signatur e Dat e Signatur e Dat e
OI woul d lik e t o b e presen t durin g an ysamplin g tha t i s required .COASTA L HOMMINTA l 

## Restoratio n Agreemen t Th e purpos e ofthi s agreement is t o provid e amutua l agreement as t o condition s of tiie propert y prior t

o remediationactivities . Tlii s will als o serv e as documentatio nfo r the purpos e of assurin g tha t restoratio n activitie s ar e completedt o the satisfactio nof th e propert y owne r an dthe UnitedStale s Environmenta l ProtectionAgenc y (EPA) . Propert y ID : 

# "W W Propert y Address : ^ 7 / ^ yijo^^ i 'l y\A ^ ^ Owner : 

## '^ixjM e :C-\C K .S O CV W g-^/"~ - 

### Phone : ^^O , - q^^ l ^ 

### O

nthe attache ddiagram(s ) indicat e area(s ) t o excavatedan ddept hof excavation , locatio no f al l know n utilities , subsurface features , surface structure s an dlandscaping features , acces s location(s ) t o be use db y contractor , an dthe directiono f North . Indicat e distances , depths , materia l types , etc . Indicat e digita l photo s b

y referencin g th e photo-lo g numbe r wit ha narro w indicating directionof view . Item s T o B e Remove d B yOwne rBefor e Star t O fRemediation : (Us e additiona l sheet s a s necessary ) Th e removal , storage , disposal , and/o rretur n o f thes e item s i s th e Owner' s responsibility . Item : 

# /l/ ^ yi<t . Item : Item : Item : 

### Kem : item : item : Item : Pag e 1 o f 

# A .COASTA L C N O U P . IN C 

### Item s To B e Remove d B yContracto rDurin g Remediatio n An d No t Replace d (Us e additiona l sheet s a s necessary ) Item : 

# n 

# y .^ A ^ /^ / ^f i 

# be. ^ ' n dy ^ Item : Item : Item : Item : Item : Item : Kem : Item : Item : Kem : Kem : Item : Item : Kem :

Pag e 2 o f/ ^C Q AS TAL C M O U rIN C 

### Item s To B e Remove d ByContracto rDurin g Remediatio n An d Replace d (Us e additiona l sheet s a s necessary ) Item : 

## Sy > 

# \ 1 

# PZ'O ^ 

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# /

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# 1 Item : / Item : /

Pag e 3 of ^COASTA L Ct>t'VlRONr«tMTA L o n o u rIN C 

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

## Ite m

Pre-exislin g propert y area , tha t will be excavated , tha t is covere dwit hgrass .

Number of tree s > 2 inc h trun k

diameter

Number of tree s <= 2 inch trun k

diameter

Number of Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Attachasketchof the sprinkler layout .
Number of an dsize o f eac hgarden / flowe r be d area . Attachasketchof relativ e size s an dlocations . 

## Quantity 

# 9 ^ 

# y 0 ^ t f i T Unit Condition/Type/Specie s
Squar e fee t 

# VV ' 

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Eac h • •

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Pag e 4of_ ^COASTA L • MVtMONMftMIA t 

### Ite m Agree dupo nvalu e o f plan t material s no t to b e renlace dbv contractor . Not e thi s valu e will b e usedto issu e aplan t vouche r to th e propert y owner . Agree duponlis t o f plan t material s tha t will b e replace db y conrractor . B e ver y specifi c an ddetailed . Include asketchof wer e eachplan t wil l b e place d b

y th e contractor . Agreedupo nare ao f propert y t o be replace d wit hgras s sod . Include asketcho f th e area{s ) t o b e replace dwit h gras s sod . Are ao f Cit y o r Count y propert y to b e landscape d per their requirements . Include asketcho f th e aie a(s )

Easemen t Area , to be excavate d 

### Quantit y Urii t 

### Condition/Type/Specie s

Eac h 

# 6^ ' $ S S F

S F 

# 7 .' l 

# A

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Pag e 5 o f^C O A£ T AL KMVAkOHHaMTA L

G Chec k th e bo x if Owne rdoe s no t wan t CE G to documen t irrterio rfoundatio n wall s an d possibl e pre-existin g damage . Bycheckoi g thi s bo xCE G is no t responsibl e fo ran ydamag e don e to th e interio r of house , includin g foundation crack s orfissures.



## [iHa j agre e dI do no t agre e

Owner' s Signatur e Dxt e Contractor' s s Signato r » iton^ctor' Signater e t ^ "^Dat e Pag e 6 of
.BVID* / 

# i M XR F PROPERT Y SAMPL E SHEE T Dat e 

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 369 8 Mod e SOI L Tim e 2008-11-1 8 11:4 7 Duratio n 122.0 3 Sequenc e Fina l Flag s AVERAG E fAv g o f 3694-369 7 ADDRES S 277 4 marti n av e QUAD/ZON E easemen t INSPECTO R LOPE Z DEPT H 1 SAMPL E TYP E : CLEARANC E NOT E

Supervise d By :

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 369 4 Mod e SOI L Tim e 2008-11-1 8 11:4 5 Duratio n 30.4 6 Sequenc e Fina l Flag s BVI D # 4184 9 ADDRES S 277 4 marti n av e QUAD/ZON E easemen t INSPECTO R LOPE Z DEPT H 1 SAMPL E TYP E CLEARANC E NOT E
pp m ±Erro r P b 89.82 7 ±11.77 8 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 QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E
pp m P b 93.34 7 Supervise d By : 

## Certificat e o f Verificatio n
369 5 SOI L 2008-11-1 8 11:4 6 30.4 7 Fina l 4184 9 277 4 marti n av e easemen t LOPE Z 1 CLEARANC E

± Erro r ± 12.11 6

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , 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 90.72 2 Supervise d By : 

## Certificat e o fVerificatio n
369 6 SOI L 2008-11
- 1 8 11:4 7 30.5 4 Fina l 4184 9 277 4 marti n av e easemen t LOPE Z 1 CLEARANC E

± Erro r ± 12.08 2

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 369 7 Mod e SOI L Tim e 2008-11-1 8 11:4 7 Duratio n 30.5 6 Sequenc e Fina l Flag s BVI D # 4184 9 ADDRES S 277 4 marti n av e QUAD/ZON E easemen t INSPECTO R LOPE Z DEPT H 1 SAMPL E TYP E CLEARANC E NOT E
pp m ±Erro r P b 92.00 3 ±12.13 1 Supervise d By :

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 370 3 Mod e SOI L Tim e 2008-11-1 8 11:5 5 Duratio n 122.5 2 Sequenc e Fina l Flag s AVERAG E Av g o f 3699-370 2 ADDRES S 277 4 marti n av e QUAD/ZON E tP Z INSPECTO R LOPE Z DEPT H 6 SAMPL E TYP E * CLEARANCE " NOT E

Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , 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 457.45 5 Supervise d By : 

## Certificat e o fVerificatio n
369 9 SOI L 2008-11-1 8 11:5 3 30.2 6 Fina l 4184 9 277 4 marti n av e PZ LOPE Z 6 CLEARANC E

± Erro r ± 27.57 8

# 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 QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E
pp m P b 244.57 6 Supervise d By : 

## Certificat e o fVerificatio n

370 0 SOI L 2008-11-1 8 11:5 4 30.5 9 Fina l 4184 9 277 4 marti n av e PZ LOPE Z 6 CLEARANC E

± Erro r ± 19.98 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 QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E
pp m P b 260.03 8 Supervise d By : 

## Certificat e o fVerificatio n

370 1 SOI L 2008-11-1 8 11:5 5 30.8 5 Fina l 4184 9 277 4 marti n av e PZ LOPE Z 6 CLEARANC E

± Erro r ± 21.51 6

# 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 QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E
pp m P b 237.23 8 Supervise d By : 

## Certificat e o f Verificatio n

370 2 SOI L 2008-11-1 8 11:5 5 30.8 2 Fina l 4184 9 277 4 marti n av e PZ LOPE Z 6 CLEARANC E

± Erro r ± 20.17 7

# 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 370 8 Mod e SOI L Tim e 2008-11-1 8 11:5 9 Duratio n 122.3 0 Sequenc e Fina l Flag s AVERAG E Av g o f3704-370 7 ADDRES S 277 4 marti n av e QUAD/ZON E INSPECTO R LOPE Z DEPT H 

### 1 3 SAMPL E TYP E CLEARANC E NOT E

Supervise d B y

# 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 QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E
pp m P b 59.72 2 Supervise d By : 

## Certificat e o f Verificatio n

370 4 SOI L 2008-11-1 8 11:5 7 30.5 3 Fina l 4184 9 277 4 marti n av e D Z LOPE Z 1 3 CLEARANC E

± Erro r ± 10.31 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 QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E
pp m P b 32.29 6 Supervise d By : 

## Certificat e o fVerificatio n

370 5 SOI L 2008-11-1 8 11:5 7 30.8 1 Fina l 4184 9 277 4 marti n av e D Z LOPE Z 1 3 CLEARANC E

± Erro r ± 8.29 2

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , 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 72.82 1 Supervise d By : 

## Certificat e o fVerificatio n

370 6 SOI L 2008-11-1 8 11:5 8 30.4 5 Fina l 4184 9 277 4 marti n av e D Z LOPE Z 1 3 CLEARANC E

±Erro r ±10.99 1

# 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 QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E
pp m P b 118.83 0 Supervise d By : 

## Certificat e o f Verificatio n

370 7 SOI L 2008-11-1 8 11:5 9 30.5 1 Fina l 4184 9 277 4 marti n av e D Z LOPE Z 1 3 CLEARANC E

± Erro r ± 13.45 2

### Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc . V > ^ www.coastalhazmat.co m

www.coasTainazmat.co m ^"tPHO ^ COASTA L ENVItONMENTA L CROUP , IN C 

# EXECUTIV ESUMMARY : BVI D #4184 9 - (277 4 MARTI NAVE ) 

# I I No Issue s o r Concern s [ ^ Issues/Concern s Detai l Explanation: EXHAUS T FUME S DAMAGED/COATE D FOUNDATIO NWAL LO F277 8 MARTI NAV E HOMEOWNE RRECEIVE D COMPENSATIO NFO RTH ECOS T T O REPLAC EO R REPAI RANALUME^U M SIDIN GCORNE RPIEC EDAMAGE D DURIN GTH E REMOVA LO FLEA D IMPACTE D SOIL .

# ^^EP A EP APropert y Clos e Ou t For m Propert y# : 

# ^]] m Propert yAddress : ^7 2 ^ ^

UPr^fl ^ Datc/Ttroc : Owner' s Name : ^&V^t ^ lUl/ ^ Quad s Excavaied : I S I ^ 1 5 "Z - ~ Contracto rGrou p Excavatio n Genera l Ye s 1 . Ifnecessary , wer e th e correc t quadrant(s ) excavate d an d restored ? 

## y 2 . I f necessary , wer e th e correc t areas o f dri p zon e excavate d an d restored ? 

### y Gradin g So d an d Vecetatio n Ye s 1 .

Doe s th e gradin g aroun d th e perimeie ro f th e hous e i n excavate d areas generall yslop e away 

## y from ib e house ? 2 . Ha s so d bee n lai d i n al l areas tha i wer e excavated ? i ^ 3 .

Doe s th e sod appea rt o be generall yhealth yan d growing ? (Onl yevaluat e i f inspecte d a t a 3 0 da ylim e period ) 4 Ar e sodde d areas generall yfu m an d evenl ygraded ? 

## y 5 Ar e th e joint s betwee n th e so d strip s generall ytight ? (Onl yevaluat e i f inspecte d a t a 3 0 da y tim e period ) 6 Wa s th e propert ygrade d suc h that wate rwil l no t poo l o n th e property' ' 

### y 7 Wa s damag e t o landscapin g o rplan t material s avoided ? 

## y Gates , Fence s an d ReUinln g Wall s Ye s I D o gate s ope n an d clos e freely ? (Ifapplicable ) y 2 .Wer e al l gates o rfence s take n dow n durin g restoratio n activitie s reinstalled ? (Ifapplicable ) .y 3Wa s damag e t o gate s o rfence s avoided ? (Ifapplicable ) ^ 4 .Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) 

## iJ k FouDdatioD , Sidiof ; an d Gutter s Ye s I .Wa s damag e t o th e sidin g o rtri m avoided ? (^^^^^ ^ J^^"-^^^ - ^^''^ ^ '^ L ^ 

# h 2 .Wa s damag e t o th e foundatio n avoided ? i / 3 .

Wa s damag e 1 0 window s avoided ? y 4 .Wa s damag e t o window s o rdoo rscreen s avoided ?


## . y 5 .Wa s damag e t o downspout s o rdownspou l extension s avoided ? 

# J Sidewalk s an d Driveway s (Concrete ) Ye s I .

Wa s damag e t o drivewa ysurface s avoided ? 

## y 2 .Wa s damag e t o walkwa ysurface s avoided ? 

# \ y N o

N o

N o

N o

N o



## d-ue ^ u)^l ( o f^1 1 & M^r4-iv v

## O sner s comments :

Inspectio nnotes :

E P A v/Lsp^^4 j pniy y -\ o r ^ ^i^-o ^

Removal andrestoratio nactivate s complet e includin g the 30-da y so dwarrant) ' EP A Representativ e 

# %^^^t^\^yU^-^^JL ^ Date : /^/?/D t

## Propert yCompletio n Agreemen t riii s agreemen i documeni s Ih e coinplclio n o i remedia l aciiviiie s perfonne d n n m ypioperi yM ys^ignalure wil i designal e llia l I a m saiisfie d wil h Ih e restciraiio n o f m yproperly , an d iha i n o ilem s ar e i n queslions . now , o ra l an yhm e i n ih e fulure , excep l llioseiiem s liste d below , i f an y

P.opc.ryI D L j j ^^ ^ Propert yAddrcv . ^77 ^

/ H c . ^" f 1/ 1 AKJ< ^ 

## Owne rf?ever \ y/tlU n Phon e t./^ 3 ^'/^ f Rpstoralio n Item s i n Questio n

Ite m Ite m Ite m Item , Item : Item : Additiona l Comments ; 5io<"^ ^ o n Conne r O- ^ houJ^

_ oic^>-^ci ^ ^jjl % 

# Co-<tl>r U IV^<^ ^ llU^utty ^ A^ ^ (y'-U^Z.^^

1^ 1 I a(;rc c1 coloratio n i s compleied , rxctp l as noler i [ ) I fl o no l a^ic crcslpradn n i s compleie d 

# I-L'n o Ccml r» ( lor' s SiQnaliir c V>Mc

## Propert yDamag e Settlemen t

Propert y I D 4184 9 Propert y Addres s 277 4 Marti nAvenu e Owne r Beverl y Alle n Phon e 402-453-976 9

I hav e receive dfromth e contractor , Coasta l Environmenta l Grou p hic . (Coastal) , asu mo f $ 500.0 0 a s compensatio n for th e cos t t o replac e o r repai r an aluminu msidin g come r piece . Th e aluminu msidin g come r piec e wa s damage dwhil e removin g lead-impacte dsoi l fromth e property . Chec k Numbe r 169 2 Valu e o f Chec k $500.0 0 Mad e Ou t T o Beverl y Alle n Descriptio n o f Miscellaneou s Replacemen t Coasta l damage d a n aluminu m sidin g corne rpiec e at th e south-eas t corne ro f th e propertyat 277 4 Marti n Ave . whil e removin g contaminate d soi l fro m th e propertydescribe d above . Coasta l ha s agree d t o payth e homeowne r$500.0 0 a s a buyou t fo rth e homeowne rt o replac e o rrepai rth e aluminu m sidin g corne rpiec e at he rleisure . M ysignatur e belo wi s acknowledgemen t o f th e receip t o f th e su m liste d above , whic h I furthe r acknowledg e t o b e fai rcompensatio n fo rth e repai ro rreplacemen t describe d abov e an d releas e Coasta l Environmenta l Group , Inc . fro m furthe robligation s o rliabilit yrelate d t o thi s property . 

# <^y/f,,
. yy^ f 

# i m -^

- ^ 

## ilJ
­ Owner' s Signatur e Date Contractor' s Signatur e Date

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