## TRANSMITTA Lof OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAID # Date 

# -.d L 0 Address : Remediatio nContractor : Coasta l Environmenta l Group
_ Year ; 20 i 0

^ SOI LREMEDIATIO N PROPERT Y HL EFOLDE RDOCUMENT S



# -a

# s i Vide o o f property (DVD ) Executiv e Summar y EPA-providedproperty sketch SignedAcces s Agreement fo r subject property SignedAcces s Agreement(s ) fo r adjacen t propert y Restoratio nAgreement Settlemen t document s (i.e. , fo r damag e or to replac e plants , etc. ) Confirmationdata Photograph s fo^^lTM^ I ff t ^TfU^l^^o ^ As-built sketch


# 4 Satisfactor y restoratio nsignedb y Propert y Owner Propert y close-out check lis t signedb y EP A Descriptio no f area s not meetin g RO D cleanup criteri a Utilit y ckarance s Propmyinformatio nfro mDougla s Count y Assessor' s Office



# " y— i 7 Signature Date " 3021775 9 Superifun d

# v v Propert yAcces s Checklis t Property ID : "^ U"jQd l Property Address : )^^2 , A/Y^ ^ S 

# ^"°" ' MA>-^liocolr i Address :



# 550 3 M 3 5 T Phone : 

# 5 5 a33£52z a Fax : Cell/Pager :

nNotificatio nLette r [ ^ Acces s Agreement ^ Restoratio nAgreement D Topsoil Samplin g (i f applicable ) GDisposa l Samplin g (i f applicable ) Q Garde nSamplin g (i f applicable ) J ^ Utilit y Clearanc e t ^ Video/Photo s (Before) D Video/Photo s (During ) D Video/Photo s (After ) D Video/Photo s (30-Day ) "fl

j Property Completio nAgreement nFinal Report Ai r Monitorin g (a s applicable ) r~ 1 Conununit y d l Cre w On : Results :
nCommunit y C H Cre w On : Results : C

H Communit y C D Cre w On : Results : Av/r^ , n nWORK STARTE D WOR K COMPELTED ON : / / ON : __/__/
_ Renter : Phone : Fax : Cell/Pager : Additional Information :

Sent : / / Signed:/ 1 / 5 O ^ Signed:) ) / 5 /C!P ^ / /

. /

/ / / CaUed: M /1 / /(I O On:LL/51/i2f ! On : / / On : / / On : / / Signed : 4L/^7 ^ 

### Issued : / /
/ / B y
/ / B y
/ / 

### By :

Omah a Lea d Sit e 

### By : By : By : By : By : By : By : ) By: / By : By : By : By : By : 

# in/m q jy:^o^i<\/Ar\d\/

### Dougla s County Accoun t InJ^a|atio n Pag e 1 of 2 iJ^H^t i Dougla s County , Nebrask a Propert yRecor d - R183964000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t o f52n d S t - VleWO n Ma p Informatio n I s vali d a s o f2009-10-1 5 Treasurer' s Ta xRepor t Ne wFeatur e - •• •^ Aut o Sale s Searc h Owne r LINCOL N THED AJ ETA L 550 3 N 3 S T OMAH AN E 68110-000 0 Propert yInformatio n Ke yNumber : 396 4 000 0 1 8 Accoun t Type : Residentia l Parce l Number : 183964000 0 Parce l Address : 146 3 AME S A V OMAH AN E 68110-000 0 Lega l Description : NIEL S AD D LO T2 0 BLOC K0 TRIANG - 6 1 X 12 5 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $2,600.0 0 $27,000.0 0 $29,600.0 0 200 8 $2,600.0 0 $27,000.0 0 $29,600.0 0 200 7 $2,600.0 0 $27,000.0 0 $29,600.0 0 200 6 $2,600.0 0 $27,000.0 0 $29,600.0 0 200 5 $2,600.0 0 $11,500.0 0 $14,100.0 0 200 4 $2,600.0 0 $10,400.0 0 $13,000.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 4 6500. 0 1. 0 125. 0 52. 0 N o Improvemen t Informatio n Buildin g 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=Rl.
. . 10/22/200 9 \ A

### Dougla s County Accoun t InSua^tio n Pag e 2 o f 2 I^UMKl t

146 3 AME S A V ..:! ? •«. . Cet«:H? D C*mVl t T M -s o T T

•qkva ^ ' tn O SMt t W M >_, _

Fin t Floo r M a 0 sq . f t

1 1/ 2 Stor yUnfi n Ba^TI Bsrrr t Ned ^ 91 1 M S 0 sq . ft
CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 648. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Fai r

Buil t As : 1 1/ 2 Stor yUnfi n 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 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 190 6 0 % 190 6 10 3 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fenc e Chai n Linl < 1. 0 Ad d O n Unfinishe d Atti cW/floo r 648. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 648. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 324. 0 Porc h En d Soli d Wal l 144. 0 Porc h En d Soli d Wal l 144. 0 Storag e Woo d 121. 0 Use r DOG S 1. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl.
. . 10/22/200 9

### " > 

### Pag e 1 of 2

Create Anothe rTicke t Back to irt h Internet Sen d Emai l ] 

# ]

• YOU RTICKE T NUMBE RI S 2401799
. Origina l Cal l Date : 11/06/0 9 Wor k t o Begi n Date : 11/10/0 9 Time : 10:3 6 a m Time : 11:1 5 a m Op : ELIZABETH1879 0
State : N E Address : 146 3 County : DOUGLA S Street : AME S AV E Place : OMAH A Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 03-NE-S E Sect-Qtr : Typ e o f Work : LEA D REMEDIATIO N Locatio n o f Work : INCLUD E AL L EASEMENT S LOCAT E ENTIR E PROPERT Y Remarks : FAX AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LO T Compan y: COASTA L ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : COASTA L Dept h o f Excavation : 4 F T Corne r Lot : N Involve s Tunnelin g o r Horizonta l Borin g : N Front : Y Rear : Explosives : N CXCAT V MAGELLAN MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac t Phon e Numbe r UtiUt y Typ e
CXCAT V CO X COMMUNICATIONS , IN C HEID I 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
X

* Ar-c T T AX T MAGELLA NMIDSTREA M PARTNER S MAGELLA N
. _ T^T,T,^ „ A„ DEBORA H 

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

### Day : 402504782 3 Alt : Emerg : 402504797 0
OMAHACO FCIT Y O FOMAHA-TRAFFIC.SEWE R 

### RICH/TRAFFI C Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0


### http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 1 1 /6/200 9

### Pag e 2 of 2

OPPDGPR 5 OMAH APUBLI C POWE RDISTRIC T N A 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3
OLNNE1 C QWES T LOCA LNETWOR K 

### N A 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 11/6/200 9OLS# : 3428 2 Dat e Excavated:11/13/0 9 Dat e USEP ASigne d Off : 12/3/0 9 < ^ 

# As-Buil t Drawin g C OAST AL ENVIItONHENTA L Are a Sodden : 360 0 s a f t 

# Omah aLea dSuperfun dSit e C KO U P
. INC
. 

### 3428 2 Exterio rPain t Omah a Lea d Sit e •Goo d Sit e Sketc h 0 Poo r Samplin g Address : 146 3 AMES A V •No l pain t Sampl e Numbe r RYASCPXA-34282 RYBSCPXA-34282 RYCSCPXA-34282 RYDSCPXA-34282 F l F 2 B I B 2 Lead Concentratio n 

### loO \ -dlS L pp m pp m pp m pp m Sampl e Collecte d 

# i LA B 

### D D D D Fimn : Date : Time ; Sample s Collecte d F04 D&AT ll-7-gf l /1-2 P Ae A

Samples Analyze d RDZSCPXA-34282 DZ pp m 

### D XR F Unit : US^ D Book : 22 H RGZSCPX A3428 2 RP26CPXA-34a8 2 62 ­ PZpp m pp m 

### D D Date : Time : /l-Of i

.£C2
_ Of i Numbe rof Sample s = | ^ | | ( ^ \ Staff : mSL J Legend : F l = Fron t Left , F 2 = Fron t Right , B I = Back Left , 8 2 = Bac k Right DZ = Dri p Zone , G Z = Garden , P Z = Pla ; Al l quadratM s are as viewe d fro m th e street , facin g properl y



### Legen d
Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are a replace d wit h Are areplace dwit h So d Rock/Mulc h Are alef t bar e 

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

### 1428 2 Exterio rPain t Omah a Lea d Sit e •Coo d Sit e SItetc h 0 Poo r Samplin g Address : 1^6 3 AME S A V Q No l pain t Lea d Sampl e Sample s Collecte d Concentratio n Collecte d Sampl e Numbe r LA B Fir m 

### F WD&AJ - RYASCPXA-3428 2 F l 

### 11 5 pp m 

### D Dat e 11-7 - Of) RYBSCPXA-3428 2 F 2 pp m 

### D Tim e H-2r
. Af ^ RYCSCPXA-3426 2 B I pp m 

## n Sample s Analyze d RYDSCPXA-3428 2 8 2 pp m 

## n RDZSCPXA-3428 2 D Z pp m 

## n XR F Unit : loSH O Book : 

## 1V \ nOZCCPX A3428 2 SS - pp m 

## n Dale : IZ'O B •O Q r^PZSCPXA-3428 2 P2 - pp m Tim e flrv, 

### D Staf f prtS U NumbeM> fSample s = 

# a E Legend : F 1 = Fron t Lefl,F 2 •Frpot^Right , 8 1 = Bac k Left , B^ = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla ; Al l quadrant s ar e a s viewe d fro m tfl e street , facin g propert y

# U I I / / ^

3428 2 Omah a Lea d Sit e Exterio rPain t Sit e SItetc h •Goo d 0 Poo r Samplin g Address : 146 3 AMES A V [ ] No t pain t Sampl e Numbe r Lea d Sampl e Samples Collecte d 

# i LAB Concentratio n Collecte d Firm : F W DRA J RYASCPXA-34282 F l 11 5 pp m 

### D Dat e 11-7-Pi ^ RYBSCPXA-34282 F2 W5 ^ Do m 

### D Tim e (l-2 g i4/^
_ RYCSCPXA-34282 8 1 IQ O I pp m 

### D 

# M Samples Analyze d RYDSCPXA-34282 8 2 2p 9 pp m 

### D RDZSCPXA-34282 D Z ppm 

## n XR F Unit : ^5^ 0 Book : 2Z H nOZSCPX A34282 62 ­ , ppm 

### D Date : IT'O B •O Q RPZ6CPXA
. 34282 PS ­ , ppm 

## n Time : P\ m Staff : rnSU ) Numbe rofSamples = | g > | | Q | Legend : F 1 = Fron t Lef t F2 •Fron t Right , B I = Back Left , 8 2 = Bac k Right DZ = Dri p Zone , G Z = Garden , PZ = Pla- Al l quadrant s ar a a s viewe d frc m tti e street , facin g propert y



# msrm^i

­ pe-iie d 15-Scis'i H

## 3428 2 Exterio rPain t Nort h Ainiw Omah a Lea d Sit e m3oo d Sit e Sketc h 0 Poo r Samoiin a Address : 146 3 AME S AV Q No t pain t 

# f Sampl e Nunit>e r Lea d Sampl e LA B Sample s Collecte d Concentratio n Collecte d Fimi : Fb 4 gfi-A T RYASCPXA-3428 2 Fl 

# XH
. .pp m 

## D Date : f1-7-Of t RYBSCPXA-3428 2 F2 

# tl pp m 

## D Time : H-2 P At A RYCSCPXA-3428 2 B1 (QQ \ .pp m 

## D Sample s Analyze d RYDSCPXA-3428 2 B2 pp m 

## 2^3
. D RDZSCPXA-3428 2OZ pp m 

## D XR F Unit : l^SH O Booli : 22 M ROZSGPXA9428 2 GZ - pp m 

## D Date : iZ-O&O e nPZSCPX A3428 2 -PZ - .pp m 

## D Time : 

## Mca
. Staff : Numbe r of Samples ' 

# E JDiL L Legend : Fl = Fron t Left , F2 = Fron t Right
. B1 = Bacl ( Left , B2 = Bac k Rigli t DZ = Dri p Zone , GZ •• Garden
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COASTA L I NIrlltONHfRIA I 6 R O U r. > N c 

### Consen t fo F Acces s T o Propeftj / RIGH TO F ENTR YT O PREMISE S 

### Granto r(th e propertyowner) consent s t o an d authorize s th e Unite d State s Environnnenta 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 : oi n /X o

Owner' s Name : Daytim e Phone : 

# ^NS^Wb^^Oi W "db'h

- S2Z 8

Addres s o fPropert y 

# /4£ 3 ^iAiL S fXlQ^ , covere d ti ythi s Agreement : PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EPAi 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 maypos 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 perfonned , 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 

### B

ysignin 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 , a t 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 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 f2\^-^'.f0r-' ' COASTA L tKVIMOHKINTA L C H O U rI WC 

### t Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; cRemov 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
. c^

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 f sai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o f th e Grantee s o rth e environment , o rt o allo wother s t o us e th e propert yi n suc h a manner . Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contac t Coasta l Environmenta l Group , a t (402 ) 991-119 9 

# y i gran t acces s t o mypropertie s G ' d o no t gran t access t o mypropertie s 

# ihos^ l Signature Dat e Signature Date
Q I woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.

Page 2 o f2c .> * S T> L C h O ^


### Th e purpos e o f thi s agreement i s t o provid e amutual agreement a s t o condition s o f th e propert y prio r to remediatio nactivities
. Thi s will als o serv e a s documentatio nfo r th e purpos e of assurin g that restoratio n activitie s ar e complete dt o th e satisfactio no f th e propert y owner andthe UnitedState s Environmenta l Protectio nAgenc y (EPA)
.

Property Address : />^^ 3 /^^i ^ /tc ^ 

# \^[IMH^-Mm M [Phone : ^3^

- 53 ^ O nth e attache ddiagram(s ) indicat e area(s ) to excavate , surfac e structure s an dlandscapin g feature s an d acces s location(s ) to b e usedby th e contractors . Indicat e distances , depths , materia l types , etc . Photographically andVideographically document the existin g condition s o f th

e propert y andth e basemen t if necessary . 

### itsm s t o b e R .emove d b yt h e Owne rbefor e Stat l o fRemediation : "li-i c .c-riovcsi
. storsqe , PlSOOsEi , £nG/O t i-etci n 0. ' fhes- e Item s I F th e Owne i s rEspcnEitdliiy
. item : 

# d'U d ^ d / ' ^ Item : ^ 

### • > 

### Item : Item :

Item s t o b e Remove d b yth e Contracto rDurin g Remediatio n an d No t Rejplace d 

# /U/TLeX^ A

Item : Ite m

^ Pag e 1 o fC J
. AS TAL



## Landscap e Inventory Ite m Quantit y Uni t Condttion/Type/Specie s Pre-existin g propert y area , Quadrant s that wil l b e excavated , that 

# I> 1 

# -Kfv lS(/v r

Uh^i
. i s covere dwit hgrass . Number o f tree s > 2 inch Each 

# I \\tdk ^ ^\J ^'- f trun k

diamete r Number o f tree s <= 2 inch Each 

# l

e trunk diameter Number o f Sprinkler Zones , Contro l Valves , Each Timers , Heads , etc . ^ Atiachr . skeicli o l th e Numbe r of andsiz e o f eac hgarden/ flowe r bed Eac h area . 

# J> Square Feet Aiincl i J skcicl) o l reiniivL' si7.cs andlor;iiii>n>
. Agree dupo nvalu e of plant material s no t to b e replace db v contractor . ^ $ .••'Ct O Tii'
. 1 ;il l ' '- ' ii i h'
. js-t ' : c i<s'j r ;• : y.-^.n < \oir.lr f ( 1( 1 I'l v r.iT.p'.' i : \ o i \ntr . Easement Area , t c b e excavate d Each 

# ^ < ^ Ufnfi^iu^ ^
^ Pag e 2 of
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# r Additional Comment s / instructions :

^Chec k th e boxi fOwne rdoe s not w/an t CE G t o documen t interio rfoundatio n wall s an d possibl e /preexistin g damage
. B ycheckin g thi s bo xCE G i s not responsibl e fo ran ydamag e don e t o th e interio ro fhouse , includin g foundatio n crack s o rfissures.

Q I d o no t agre e

Owner' i Signature Contractor' s Signatur e Dat e Pag e 3 of
.

## BviD#_3M2S S XR F PROPERT Y SAMPL E SHEE T Dat e Projec t 

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 21 6 Mod e SOI L Tim e 2010-02-0 9 13:2 7 Duratio n 90.4 0 Sequenc e Fina l Flag s AVERAG E <j ^ o f213-21 5 ^ ADDRES S 146 3 Ame s Ave
. QUADRAN T B I DEPH T 6 XR F TEC H E
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# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Blllerica , M A0182 1

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pp m P b 48.92 9 Supervise d By : 

## Certificat e o f Verificatio n

21 3 SOI L 2010-02-0 9 13:2 5 30.2 1 Fina l 3428 2 146 3 Ame s Ave
. B I 6 E
. CACERE S 1 1

± Erro r ± 13.99 5

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 21 4 Mod e SOI L Tim e 2010-02-0 9 13:2 7 Duratio n 30.0 5 Sequenc e Fina l Flag s BVI D 3428 2 ADDRES S 146 3 Ame s Ave
. QUADRAN T B I DEPH T 6 XR F TEC H E
. CACERE S MIS C 1 NOT E 1

pp m ±Erro r P b 50.84 6 ±14.32 7 Supervise d By :

# 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 BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 54.99 6 Supervise d By : 

## Certificat e o fVerificatio n

21 5 SOI L 2010-02-0 9 13:2 7 30.1 4 Fina l 3428 2 146 3 Ame s Ave
. B I 6 E
. CACERE S 1 1

± Erro r ± 14.79 9• • 

# Therm o

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 50 8 Mod e SOI L Tim e 2009-11-1 3 12:1 0 Duratio n 91.5 4 Sequenc e Fina l Flag s AVERAG E 

## cSvg=35o5lioi-- ^ ADDRES S 146 3 ame s av e QUADRAN T e m DEPH T 1 " XR F TEC H R
. VENTR Y MIS C clearenc e NOT E ngn c
pp m ± Erro r P b ± ( 12.81 2 I Supervise d 

# By.^cMm x

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 50 5 Mod e SOI L Tim e 2009-11-1 3 12:0 9 Duratio n 30.5 0 Sequenc e Fina l Flag s BVI D 3428 2 ADDRES S 146 3 ame s av e QUADRANT e m DEPHT 1 " XR F TEC H R
. VENTR Y MIS C clearenc e NOTE ngn c
pp m ±Erro r Pb 77.18 5 ±12.91 6 Supervise d By :• • • • 

# 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 BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 75.42 3 Supervise d By : 

## Certificat e o fVerificatio n

50 6 SOI L 2009-11-1 3 12:1 0 30.5 8 Fina l 3428 2 146 3 ame s av e e m 1 " R
. VENTR Y clearenc e ngn c

± Erro r ± 12.63 4

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 50 7 Mod e SOI L Tim e 2009-11-1 3 12:1 0 Duratio n 30.4 6 Sequenc e Fina l Flag s BVI D 3428 2 ADDRES S 146 3 ame s av e QUADRAN T e m DEPH T I " XR F TEC H R
. VENTR Y MIS C clearenc e NOT E ngn c
pp m ± Erro r Pb 77.38 1 ± 12.88 5 Supervise d By :

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 50 0 Mod e SOI L Tim e 2009-11

­ 1 3 12:0 6 Duratio n 91.6 8 Sequenc e Fina l Flag s AVERAG E [;gy g o f497-49 9 ADDRES S 146 3 ame s av e QUADRAN T F 2 DEPH T 6 " XR F TEC H R
. VENTR Y MIS C clearenc e NOT E ngn c
pp m ± Erro r P b [134.92 2 ~ ^ ± Supervise d By :

# 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 BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 120.82 4 Supervise d By : 

## Certificat e o fVerificatio n

49 7 SOI L 2009-11-1 3 12:0 5 30.5 5 Fina l 3428 2 146 3 ame s av e F2 6 " R
. VENTR Y clearenc e ngn c

± Erro r ± 15.15 1

# 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 BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 146.15 3 Supervise d By : 

## Certificat e o fVerificatio n

49 8 SOI L 2009-11-1 3 12:0 5 30.5 9 Fina l 3428 2 146 3 ame s av e F 2 6 " R
. VENTR Y clearenc e ngn c

± Erro r ± 16.10 2

# 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 BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 137.79 0 Supervise d By : 

## Certificat e o fVerificatio n

49 9 SOI L 2009-11-1 3 12:0 6 30.5 4 Fina l 3428 2 146 3 ame s av e F 2 6 " R
. VENTR Y clearenc e ngn c

± Erro r ± 15.80 8

## / ^^A ^ \ I
. _. .. . _. __ Omah a 

## Lea d Site—Fixe d Pric e EP-R7-07-0 5 Sd^^Z ^ Coasta l Environmenta l Grou p Inc
. www.coastalhazmatco m v\ ^ ^ Pno^< ^ COASTA L ENVIIOIIHEIITA l 6 1 0 U P. IN C 

# EXECUTIV ESUMMARY : BVID #34282-(146 3 AME S AVE ) No Issue s or Concern s [^ Issues/Concern s Detail Explanation :

### 4 ^ 

# EP A EP APropert y Clos e Ou t For m 

# m Properl y # : 3^3iP$ r Propert yAddress: ­ Owncr' s Name: , ^ 

### DatcH'inic : Contracto r 

### Quad s Excavated ; 1^'2 ' ^ ^T Ye s N o Excavatio nGenera l 1 , I f necessery , wer e th e con^c t quadiant(s ) excavate dan drestored ? 1 / 2
. I f necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? / Gradin g So dan dVegetatio n Ye s N o I
. Doe s th e gradin g aroun dth e perimete r o f th e hous e inexcavate darea s generall y slop e away 

## d fromtb e house ? 2
. Ha s so dbee nlai di nel l area s tha t wer e excavated ? / 3
. Doe s th e so dappea r t o 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 Fir man devenl y graded ? / S
. Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte dat a3 0 day 

## d tim e period ) 6 , Wa s th e propert y grade dsuc hthat wate r wil l no t poo l o nth e property ' 

## d 7
. Wa s damag e t o landscapin g o r plan t malerial s avoided ? / Gates , Fence s an dRetainin g Wall s 

### Ve s N o I
. D o gate s ope nan dclos e freely? (I f applicable ) 

## d 2
. Wer e al l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (I f applicable ) 

### J 3
. Wa s damag e t o gate s o r fence s avoided ? ( 1 f applicable ) 

## d 4
. Wa s damag e t o retainin g wall s avoided ? (I f applicable ) 

## d Foundation , Sidin g an dGutter s 

### Ye s N o I
. Wa s damag e t o th e sidin g o r tri mavoided ? 

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

## d 3
. Wa s damag e t o window s avoided ? 

### / 4
. Wa s damag e t o window s o r doo r screen s avoided ? 

## d 5
. Wa s damag e t o downspout s o r downspou t extension s avoided ? 

# J Sidewalk s an dDriveway s (Concrete ) Ye s N o I
. Wa s damag e t o drivewa y surface s avoided ? / 2
. Wa s damag e t o walkwa y surface s avoided ?

## Owner s comments :

Inspectio nnotes :

Remova l an drestoratio nactivate s complet e includin g th e 30-day so dwarranty : EP ARepresentativ e ^'^A ^ Date : iz/y/oy

## Propert yCompletio n Agreemen t fhi s agreemei n dociimen( $ (h e complcdo n o fremedia l acliviiie s performe d o n m yproperl yM ysignatur e wil l designat e Iha l I a m satisfie d wit h th e rcsloralio n o fm ypropeily , an d tha i n o ilein s ar e i n quesiion s now . o ra l an ylim e i n th e future , excep t thos e item s liste d below , i fan y

Propert yfP
. fd-A?Q)2
. Propert y Address : j(_)(pg ^ AyV^^. S ^K>
. Otvncr : 

# idOr X 4AfX_UiXi3Ji a Phone : Restoratio n Item s i n Question :

Item : Item :

. . . J Item : Item : Item : Item ;
Additiona l Comments :

Vff' i «(>rc cic.^torjilio n i < complcltd , cxccp l a s nnie d [ I I rto no l acrt crcsiorfltio n h compleic d 

# 0 %

QwnM^ S Siqnatnr e Dat e .ont i ario i ' s Signatur e Dal e