# TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAID # : ;;)3f=>^ ^ Date : Qij l ^jtf l Address : 2 6 (^I p AaCV>^CNr ^ ?S ^ Remediatio nContractor : Coasta l Environmenta l Group
_ SOI LREMEDIATIO N PROPERT YFIL EFOLDE RDOCUMENT S Vide o o f property (DVD ) Executiv eSummary EPA-provide dproperty sketc h Signe dAcces s Agreemen t for subjec t property Signe dAcces s Agreement(s ) for adjacent property Restoratio nAgreemen t Year : 200 8

4031482 2 Superfun d



## Settlemen t document s (i.e. , for damag eo r t o replac eplants , etc. ) Confirmatio ndat a 

# a

/ Photograph s pr-g^-g^VC^/?Jl&0 ^ 9)LfJiMx^ ^ Sad ^ \iC\£XS6< X As-buil t sketc h / 

## Satisfactory restoratio nsigne db y Property Owner 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 / 

# J Utility clearance s Property informatio nfro mDougla s County Assessor' s Offic e ^ ^ D



# 9-oCmyi?oA Signatur e Dat e 

# y/o f

### » & ^ 

# Propert yAcces s Checklis t Pi-ODC-t y ID : g^ ^ 1^ 4 nWOR K STARTE D ON : _/ /_ 

### D WORKCOIMPELTE D ON : / / 

### Pn)|)eit y Address : 3i~^6
. ZSkcJi^or K S/-
. 

### Owner : f^^ ^ ilok r Address :



### Phone : t^bd.'^^^-^'^O y Fax : Ceil/Paticr : ^ C] Notificatio nLette r 1^ Acces s Agreemen t [^ Restoratio nAgreemen t CUTopsoi l Samplinj ; (if applicable ) 1 1 Disposal Sani|)lin) i (if applicable ) 1 1 Garde nSam|)lin<i (if applicable ) 1 IE IUtility Clearanc e IID Video/Photo s (Before )

nVideo/Photo s (Durinj^ ) 1 D Video/Photo s (After ) 1 nVideo/Photo s (3()-D:iy )

1 1 Propert y Completio nAjjrcemcn t 1 1 Fina l Repor t Renter : Phone : ^K Q 

## Fax : 

## C \ Cell/Paser : Additiona l Information ;



### Sent : / / By : Si<4ned:_^/2f7 ^ By : 

# t^ h Si<:ncd : ^ 19^1^" ^ Bv : 

# Ah 1 1 By :

' ' By : 1 1 Bv :

—- 

### Called : X/'I1 " 1 By : ( ^ / ^ 

# V/ > <? 'V

K On : / / By : On : / / By : On : / / By : On : / / By : Signed : / / 

### By : j Issued : / / By : 

# 1
Ai r Monitorinj ; (a s applicabl e nCommunit y • Cre w Results : ) On : / / By :
1 d j Community

Results : CUCre> v On : / / Bv :
CD Communit y Results : CUCre w On : / / By :

Omah a Lea d Sit e

## Dougla s County Accoun t Informatio n Pag e 1 o f 3 immi E
Dougla s County , Nebrask a Propert yRecor d - R233973000 0 Prin t Repor t Parce l Dimension s availabl e @ scal e 0-5 0 tt west o f14 4 S

t - ViewO H Ma p Informatio n i s vali d a s o f2008-4-1 7 Treasurer' s Ta xRepor t Ne wFeatur e ->-*- » Aut o Sale s Searc h Owne r HUBE R PAMEL AL ETA L 356 6 JACKSO N S T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 397 3 000 0 2 3 Accoun t Type : Multipl e Re s Parce l Number : 233973000 0 Parce l Address : 356 6 JACKSO N S T OMAH AN E 68105-000 0 Lega l Description : UNIO N SQUAR E LO T7 BLOC K0 1/ 2 VA C ALLE YAD J O N N & 5 0 X132.2 5 Valu e Informatio n Lan d Improvemen t Tota l 200 7 $ 6,500.0 0 $ 57,200.0 0 $ 63,700.0 0 200 6 $ 6,500.0 0 $ 41,000.0 0 $ 47,500.0 0 200 5 $ 6,500.0 0 $ 41,000.0 0 $ 47,500.0 0 200 4 $ 6,500.0 0 $ 41,000.0 0 $ 47,500.0 0 i j 200 3 $ 6,500.0 0 $ 41,000.0 0 $ 47,500.0 0 200 2 $0.0 0 $0.0 0 $0.0 0 Sale s Informatio n Sale s Date : 2004-05-1 7 Dee d Type : W D Book : 200 4 Page : 08281 0 1 Price : $92,450.0 0 Grantor : Joh n Clar k Eta l Grantee : Pamel a Hube r Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 2003-10-1 7 Dee d Type : W D Book : 200 3 Page : 20691 2 Price : $ 50,000.0 0 Grantor : Harr yWeine r


## http://douglasne.mapping-on]ine.com/DouglasCoNe/static/accountinfo.jsp?accountno=R233.
. . 5/7/200 8iTfor n 

## Dougla s County Account InArmatio n Pag e 2 o f 3

Grantee : Joh n Clar k Eta l 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 5 6600. 0 

### 1. 0 132. 0 50. 0 N o Improvemen t Informatio n Buildin g 1



### y -Iii— I

5«can d Roo r 'V4

J 1 1 i. j t

Two Stor y CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 

### 1507. 0 Percen t Complete : 

### 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : En d Condition : Fai r

Buil t As : 2 Stor y Cond o Squar e Footage : 0. 0

HVAC : Centra l Ai rt o Ai r Rooms : 6. 0 Exterior : Fram e Sidin g Units : 2. 0 Interior : Drywal l Baths : 2. 0 Roo fCover : Compositio n Shingl e Bedrooms : 4. 0

Roo fType : Gambre l Stories : 2. 0 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 

### 190 5 0 0 % 190 5 

### 10 2 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 

### 1. 0 Basemen t Bsmn t Bloc k 9 f t 548. 0 Fixtur e Additiona l Fixture s 

### 1. 0 Fixtur e Bas e Fixture s 

### 1. 0


## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R233.
. . 5/7/200 8

## Dougla s County Account Informatio n Pag e3 o f 3 mjn r

Fixtur e Bat h Ful l 1 

## 2. 0 1 Porc h En d Scree n 

### 160. 0 

### 1 Use r 2 ap t con v 1. 0 Use r code125tomode l 1. 0 Use r ML S UPDAT E 1. 0



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R233.
.. 5/7/200 8

# CONTAC TFORM Propert y I D # 

# 55rv ^ Propert y Address : 

# ss'fc ^y^ckio ^Sf , Initia l Contact : Date : Time : Action : Secon dContact : Date : Time : Action : Fina l Contact : Date : Time : Action : Final Action : Transmi t t o EP AD Othe r Action : D

Comment : Owne r Commen t (s) :
Sit e Coordinato r Commen t (s) :

'

### Pag e1 of 2

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



### • YOU RTICKE TNUMBE RI S 2103711
. Origina l Cal l Date : 8/11/0 8 Time : 11:4 4 a m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 8/13/0 8 Time : 12:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 356 6 Street : JACKSO NS T Twp : 15 NRng : 13 E Sect-Qtr : 20-SE,21-S W Twp : Rng : 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 AL L TH E WA Y T O TH E STREE T Remarks : FAX AL L CLEAR S TO : (877)662-421 1 : UNStJR E O 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 ho f Excavation : 4f t Corne r Lot : NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N BSHPCLK S CXCAT V LEVEL 3 MCLEODN E MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C



### Servic eAre a Contac t Phon eNumber Utilit y Typ e
BSHPCLK S NEBRASK AHEALT H SYSTE M M A Day : 402552345 9 Alt : 402552334 7 Emerg : 402559511 1
CXCAT V CO XCOMMUNICATIONS , jjEID I Day : Alt : 402934046 9 402934046 9 Emerg : 402932975 7

LEVEL3 LEVEL 3 COMMUNICATIONS , LL C N A Day : 877366834 4 Alt : Emerg : 877366834 4
MCLEODN EMCLEODUSA N O NEE D T O CAL LOU T EMERGENC Y Day : 800289190 1 Alt : Emerg : 800289190 1
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 8/11/200 8

## Pag e2 of 2

MUDOl

OMAHACO F

OPPDGPR 5

QLNNEI C METROPOLITA NUTILITIE S DISTRIC T

CIT YO FOMAHA

TRAFFICSEWE R

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### Day : 402504782 3 Alt : Emerg : 402504794 6 Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 Alt : 888728934 3 Emerg : 406728934 3 Day : 406728934 3 Alt : 

## Emerg : 888728934 3

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

### 2254 4 

# WAs-Buil t Drawin g ^
COASTA L 

# Omah aLea dSuperfun dSit e

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### D Dat e 

### 17.-LB-0 7 RYBSCPXA-2254 4 F 2 

### C 7 3 pp m 

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### J'^t e pp m 

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### nogcor)(A-ee£i44—e e pp m 

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# a n Tim e 

## AJ!±
. 

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### ^•st v 

# O Legend : F 1 = Fron t Left , F 2 = Fron t Right , B 1 = Bac k Left , 8 2 = Bac k Righ t D Z = Dri p Zone
. G Z • Garden , P Z = Pla y Al t quadrant s ar e a s viewe d fro m th e street , facin g propert y OLS# : 2254 4 Dat e Excavated:8/25/0 8 Dat e USEP ASigne d Off : 10/15/0 8 Are a Sodde d 176 7 s q f t



### Legen d Concre't e Dri p Zon e Excavate d Quadrant s Excavate d
Are a replace d wit h Are areplace dwit h Are alef t bar e So d' ' Rock/Mulc h 

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

# ''SeAkm y 2254 4 Extaric t Pain t Nort h Ano w 

### Omteih fI lah a a Lea d Sit e [j J Good 

### Sit e Sketcl i •Poo r Samplin g Address : 356 6 JACKSO N ST [~~ ) No t pain t



## _ Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Fir m Sample s Collecte d RYASCPXA-2254 4 F1 

### 5" TZ pp m D Dat e RYBSCPXA-2254 4 F2 

### 47 3 pp m 

### D Tim e RYCSCPXA-2254 4 RYDSCPXA-2254 4 Bl B2 

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### D D Sample s Analyze d RDZSCPXA-2254 4 •ROZOODC A£254 4 DZ e ? 

## 29«i 8 pp m pp m 

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## 2Q ^ RPZOCPXA-2254 4 P2 ­ —pp m 

### D D Tim e A ^ Numbe r ofSample s • 

## LiD Staff : f1*iW Legend : Fl = Fron t Left , F2 = Fron t Right , B1 = Bac k Left , B2 = Bac k Righ t DZ = Dri p Zone , GZ = Garden , PZ = Play Al l quadrant s are as viewe d fro m Ih e street , facin g property

# ^'xC^mUf t ljh)f fQy d Omcih a Lea d Sit e Sit e Sketct i Samplin g Address : 3566 JACKSO N S T Sampl e Numbe r Lea d Sampl e Concentratio n Collecte d RYASCPXA-2254 4 F 1 

# s i z pp m RYBSCPXA-2254 4 F 2 pp m 

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## D RPZGCrXA-2254 4 P2 - pp m 

## D LA B 

## D 

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# • tlMvi^ ^ H\mm ^ 

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## D Dat e 

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### Omah a Lea d Sit e [^Goo d 

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### 6 " 7 Z pp m Sampl e Collecte d LA B 

## D Firm : Date : Sample s Collecte d 

## FD/ 1 CC,R\A / RYBSCPXA-2254 4 F 2 

# C>7 3 pp m 

## D Time : RYCSCPXA-2254 4 RYDSCPXA-2254 4 B l 8 2 

# 86 0 <026 » pp m pp m 

## D D Sample s Analyze d RDZSCPXA-2254 4 D Z pp m 

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## U 

# u D D Dat e Tim e 

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s viewed fro m tli e street , facin g propert y ^ 1^r •? '

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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 : 

# 'X'x^'i ^

Owner' s Name : Daytim e Phone : 

# ra m

# %\dKy 

# ^»-<3Tz)-5^ro 7

Addres s o fPropert y covere d b ythi s Agreement :
PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP Ai s requestin g acces s t o collec t soi l sample s an d remov e soi l tha t contain s elevate d concentration s o flea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t o remov e contaminate d soil
. Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o 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 LRESPONS 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 right 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 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^" ^ r- i ' # 

### < # COASTA L



### •Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; • Remov 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 ; • 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 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 (712 ) 352-018 8

[0^r a D I d o no t gran t acces s t o m ypropertie s gran t acces s t o m ypropertie s

Q I woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.

# m ^

C r > AS TAL 

# Restoratio n Agreemen t Th e purpos e ofthi s agreemen t i s t o provid e a mutua l agreemen t a s t o condition s ofth e propert> ' prio rt o remediatio n activities
. Thi s wil l als o serv e as documentatio n fo rth e purpos e o fassurin g tha t restoratio n activitie s ar e complete d t o th e satisfactio n ofth e property ' owne ran d th e Unite d State s Environmenta l Protectio n Agenc y(EPA)

.

Propert yID : ^.Q^tf ^ Propert yAddress : "S^U ^ cra(^/«^ ^ ^ Owner : p 

### a\Y \ 

# Uubgr - Phone : 

# pQ n•:^<:i> n
O n th e attache d diagram(s ) indicat e area(s ) t o excavate d an d dept h o fexcavation , locatio n o fal l know n utilities , subsurfac e features , surfac e structure s an d landscapin g features , acces s location(s ) t o b e use d b y contractor , an d th e directio n o fNorth
. Indicat e distances , depths , inateria l types , etc
. Indicat e digita l photo s b yreferencin g th e photo-lo g numbe rv \ it h a n arro windicatin g directio n o fview
. 

## 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 fthes e item s i s th e Owner s responsibility
. 

### Item : 

# "S W Ho/ztJ

. Item : Item :
Item :
Item :
Item :
Item :
Item :
Pag e 1 of
. 1

# < J COASTA L 

## Item s T o 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 :
Item : Item : Item : Item : Item : Item : Item : Item :
Item : Item : Item :
Item :
Item :
Item :

Pag e 2 o fCOASTA L fMVIMONM E » IM C 

## Item s T o B e Remove d B yContracto rDurin g Remediatio n An d Replace d (Us e additiona l sheet s a s necessary ) Item : ^___ — j > 

### Item : y
Item : \
Item : \
Item : \
Item : \
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Item : \
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Item : X
Item : \

\ Item : \ Item :

Pag e 3 o fCOASTA L 

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

## Ite m t 

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

Pre-existin g propert yarea , Iha t wil l b e excavated , tha t i s covere d wit h grass . Squar e fee l

Numbe ro ftree s trun k diamete r > 2 inc h 

### ^ Eac h

Numbe ro ftree s •' = 2 inc h trun k diamete r
• ^ 1 Eac h 

## i

i

1 ; Numbe ro fSprinkle r Zones
. Contro l Vah'es
. Timers
. Heads , eic
. •\i\iK' h a >keicl i i. l i'H ­ ;.pri;',kle r!a \ oul
. 

# X Eac h 1

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••.[.'.1^1
. ; . s.KCiC! : I' l , C ,i! l'. C --i/'e s .'iii J localion s 

### ^ ^ Eac h Squar e Fee t



### Pag e 4 o fC - O AS TAL 

### Ite m Quantit y Uni t Condition/Type/Specie s Agree d upo n valu e o f plan t material s no t t o b e replace d b vcontractor
. . Not e thi s valu e wil l b e use d t o issu e a plan t vouche rt o th e propert v o wner . 

### " ^ ^ $ 

### 1

Agree d upo n lis t o fplan t material s tha t wil l b e replace d b ycontractor
. B e ver yspecifi can d detailed
. Includ e a sketc h o fwer e eac h plan t wil l h e place d b_

\ ih e coniracU'i : 

### > Eac h

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. •ijcliKi rJ ^(•eicl i ..)' , ii' c .uea(s ! U-
. h e :eplacL- j A'i h ,-'-as > -c d S F 

# y^ M 

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.Are a o fCit yo rCount y propen yt o b e landscape d pe rihei rrequirements
. "•



### - ^ S F

Easemen t .Area
. l o b e excavate d S F



### Pag e 5 o fCOASTA L iMViaOMMIHTA L CROUP

. IM C


### Additiona l Comment s / Instructions :



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^^phec k th e bo xi fOwne rdoe s no t wan t CE G t o documen t interio rfoundatio n wall s an d possibl e /pre-existin g damage
. B ycheckin g thi s bo xCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro fhouse , includin g foundatio n cracks o rfissures
.



# k Iagre eO Id o no t agre e 

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### Repor t Number : Dat e Reported : 

# • iNJMiciwes t 12/19/0 8 08-354-202 9 Account : Dat e Received : 2066 6 12/16/0 8 

# V | / Laboratories , Inc I Page : 1 o f 1 Dat e Sampled :

1361 1 B Stree t •Omaha , Nebrask a 68144-369 3 •(402 ) 334-777 0 •FA X (402 ) 334-912 1 •www.midwestlabs1:^/r15/0 8


### COASTALENVIRONMENTA LGROU P LEA D ANALYSI S MARCO S MATEU S 356 6 JACKSO N S T 241 1 MARTH AS T OMAH AN E6810 5 PO/Projec t # : OLS-200 8 Analysi s A s Detectio n Analys t Verifie r Performe d Receive d Unit s Limi t Metho d Dat e Dat e U b number : 151913 5 Sampl e ID : QC-2254 4 B l

Lea d (total ) 38. 7 mg/k g 5 EP A601 0 rrd/12-1 8 bab/12-1 9 

### La b number : 151913 6 Sampl e ID : B 2

Lea d (total ) 16 6 mg/k g 5 EP A601 0 rrd/12-1 8 bab/12-1 9 

### La b number : 151913 7 Sampl e ID : F l

Lea d (total ) 29 9 mg/k g 5 EP A601 0 rrd/12-1 8 bab/12-1 9 

### La b number : 151913 8 Sampl e ID : F 2

Lea d (total ) 39 8 mg/k g 5 EP A601 0 rrd/12-1 8 bab/12-1 9 

### La b number : 151913 9 Sampl e ID : D Z

Lea d (total ) 53 6 mg/k g 5 EP A601 0 n-d/12-1 8 bab/12-1 9 

### U b number : 151914 0 Sampl e ID : EASEMEN T

Lea d (total ) 21 0 mg/k g 5 EP A601 0 rrd/12-1 8 bab/12-1 9 

### La b number : 151914 1 Sampl e ID : L S Lea d (total ) 48 0 mg/k g 5 EP A601 0 rrd/12-1 8 bab/12-1 9



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. OarTOpons^rrcrletler S are to rth e exclusiv e an a conTidentia i us e ot ou rclient s ana fma yno ! b e reproduce d i n whol e o ri n part , no rma yan yreferenc e b e mad e t o th e work , th e results , o rth e compan yi n an yadvertising , news release , o rothe rpubli cannouncement s withou t obtainin g ou rprio rwritte n authorization
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### CHAI N O F CUSTODYRECORD : Ye s N o PURCHAS E ORDERNUMBER

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_ Relinquishe d by : (Signaiure ) Dale/Tim e Receive d i n La b by : (Signature ) Remarks : Chain-of-Cuslod ywil l hav e a signatur e upo n receip t bu t n o subsequen t signature s ^^ ^ 02/0 2 Distribution : Origina l accompanie s shipment ; copyto Coordinato rFiel d File s
• Matri xCofle : SO - Soil , W A- Water , S L - Sludge , O T- Othe r Ou i report s ari cisitsr s tr e fo rth e ejtcl'JsV e en d ccniideate ! 'js s c " o s Kiissti E tn: ' rct vno t [•• £reprooi-cec ! i n Vrhoi e o i v. : pjrt , r.r, rrfic yEn yrefsrerice be .T.CC S i cth e M'O'i: , th e results , o rvi e compan y!•' ; EH) ' cc'vertising , risws reiasse , o rcvi-ie. ' publi ccnricuncerrisnt s wif.i'icv ' obictn;.-i C ca r-..-io rwriter , ajtl-roriiciio r

# 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 

### 291 8 Mod e 

### SOIL Tim e 

### 2008-08-2 5 11:2 4 Duratio n 

### 120.9 0 Sequenc e Fina l Flag s AVERAG E I Av g o f2914-291 7 ADDRES S 356 6 Jackso n s t QUAD/ZON E F l INSPECTO R •LOPE Z DEPT H 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 , 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 230.72 4 Supervise d By : 

## Certificat e o fVerificatio n

291 4 SOI L 

### 2008-08-2 5 11:2 2 30.3 0 Fina l 2254 4 356 6 Jackso n s t F l LOPE Z 6 CLEARANC E

± Erro r
± 18.55 5

# 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 216.76 4 Supervise d By : 

## Certificat e o fVerificatio n

291 5 SOI L 

### 2008-08-2 5 11:2 2 30.2 8 Fina l 2254 4 356 6 Jackso n s t F l LOPE Z 6 CLEARANC E

± Erro r
± 18.46 1

# 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 254.47 2 Supervise d By : 

## Certificat e o fVerificatio n

291 6 SOI L 

### 2008-08-2 5 11:2 3 30.1 4 Fina l 2254 4 356 6 Jackso n s t F l LOPE Z 6 CLEARANC E

± Erro r
± 19.64 2

# 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 205.76 0 Supervise d By : 

## Certificat e o fVerificatio n

291 7 SOI L 

### 2008-08-2 5 11:2 4 30.1 8 Fina l 2254 4 356 6 Jackso n s t F l LOPE Z 6 CLEARANC E

± Erro r
± 17.84 2

# 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 

### 292 3 Mod e SOI L Tim e 

### 2008-08-2 5 11:2 7 Duratio n 

### 123.1 0 Sequenc e Fina l Flag s AVERAG E ! Av g o f2919-292 2 ADDRES S 356 6 Jackso n s t QUAD/ZON E ||> Z INSPECTO R LOPE Z DEPT H « 1 2 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 

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 

### 291 9 Mod e SOI L Tim e 

### 2008-08-2 5 11:2 5 Duratio n 

### 30.7 0 Sequenc e Fina l Flag s BVI D # 2254 4 ADDRES S 356 6 Jackso n s t QUAD/ZON E D Z INSPECTO R LOPE Z DEPT H 

### 1 2 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 332.92 7 ±22.64 2 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 321.09 3 Supervise d By : 

## Certificat e o fVerificatio n

292 0 SOI L 

### 2008-08-2 5 11:2 5 30.6 4 Fina l 2254 4 356 6 Jackso n s t D Z LOPE Z 

### 1 2 CLEARANC E

± Erro r
± 22.19 3

# 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 277.84 2 Supervise d By : 

## Certificat e o fVerificatio n

292 1 SOI L 

### 2008-08-2 5 11:2 6 30.9 8 Fina l 2254 4 356 6 Jackso n s t D Z LOPE Z 

### 1 2 CLEARANC E

± Erro r
± 20.73 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 267.39 5 Supervise d By : 

## Certificat e o fVerificatio n

292 2 SOI L 

### 2008-08-2 5 11:2 7 30.7 8 Fina l 2254 4 356 6 Jackso n s t D Z LOPE Z 

### 1 2 CLEARANC E

± Erro r
± 20.57 2

# 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 

### 295 5 Mod e SOI L Tim e 

### 2008-08-2 5 14:1 4 Duratio n 

### 122.1 6 Sequenc e Fina l Flag s AVERAG E Av g o f2951-295 4 ADDRES S 356 6 Jackso n s t QUAD/ZON E f B 2 INSPECTO R LOPE Z DEPT H 6 SAMPL E TYP E TCLEARANC 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 131.02 0 Supervise d By : 

## Certificat e o fVerificatio n

295 1 SOI L 

### 2008-08-2 5 14:1 2 30.4 9 Fina l 2254 4 356 6 Jackso n s t B 2 LOPE Z 6 CLEARANC E

± Erro r
± 14.77 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 156.95 3 Supervise d By : 

## Certificat e o fVerificatio n

295 2 SOI L 

### 2008-08-2 5 14:1 3 30.3 3 Fina l 2254 4 356 6 Jackso n s t B 2 LOPE Z 6 CLEARANC E

± Erro r
± 15.95 3

# 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 149.42 2 Supervise d By : 

## Certificat e o fVerificatio n

295 3 SOI L 

### 2008-08-2 5 14:1 4 30.3 8 Fina l 2254 4 356 6 Jackso n s t B 2 LOPE Z 6 CLEARANC E

±Erro r ±16.05 8

# 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 129.87 7 Supervise d By : 

## Certificat e o fVerificatio n

295 4 SOI L 

### 2008-08-2 5 14:1 4 30.9 6 Fina l 2254 4 356 6 Jackso n s t B 2 LOPE Z 6 CLEARANC E

± Erro r
± 14.76 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 AVERAG E ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

P b Supervise d By : 

## Certificat e o fVerificatio n

296 0 SOI L 

### 2008-08-2 5 14:2 7 121.5 3 Fina l Av g o f2956-295 9 356 6 Jackso n s t F 2 LOPE Z 

### 6 CLEARANC E

# 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 325.18 5 Supervise d By : 

## Certificat e o fVerificatio n

295 6 SOI L 

### 2008-08-2 5 14:2 4 30.4 7 Fina l 2254 4 356 6 Jackso n s t F 2 LOPE Z 6 CLEARANC E

± Erro r
± 22.53 0

# 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 344.33 6 Supervise d By : 

## Certificat e o fVerificatio n

295 7 SOI L 

### 2008-08-2 5 14:2 5 30.0 7 Fina l 2254 4 356 6 Jackso n s t F2 LOPE Z 6 CLEARANC E

± Erro r
± 23.20 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 314.22 1 Supervise d By : 

## Certificat e o fVerificatio n

295 8 SOI L 

### 2008-08-2 5 14:2 6 30.3 3 Fina l 2254 4 356 6 Jackso n s t F2 LOPE Z 6 CLEARANC E

± Erro r
± 22.21 0

# 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 385.13 2 Supervise d By : 

## Certificat e o fVerificatio n

295 9 SOI L 

### 2008-08-2 5 14:2 7 30.6 6 Fina l 2254 4 356 6 Jackso n s t F2 LOPE Z 6 CLEARANC E

± Erro r
± 24.33 2

# 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 

### 297 0 Mod e SOI L Tim e 

### 2008-08-2 5 15:4 5 Duratio n 

### 121.8 8 Sequenc e Fina l Flag s AVERAG E : Av g o f2966-296 9 ADDRES S 356 6 Jackso n s t QUAD/ZON E 

### iB l INSPECTO R LOPE Z DEPT H 6 SAMPL E TYP E !

_CLEARANC E 1 NOT E

Erro r P b 

### 42.153 , 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 

### 296 6 Mod e SOI L Tim e 

### 2008-08-2 5 15:4 2 Duratio n 

### 30.6 1 Sequenc e Fina l Flag s BVI D # 2254 4 ADDRES S 356 6 Jackso n s t QUAD/ZON E B l INSPECTO R LOPE Z DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P b 43.39 8 ± 9.42 2 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 296 7 Mod e SOI L Tim e 2008-08-2 5 15:4 3 Duratio n 30.3 2 Sequenc e Fina l Flag s BVI D # 2254 4 ADDRES S 356 6 Jackso n s t QUAD/ZON E B l INSPECTO R LOPE Z DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 42.28 8 ±9.35 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 fVerificatio n XL3t-3208 9 Readin g N o 296 8 Mod e SOI L Tim e 2008-08-2 5 15:4 4 Duratio n 30.6 1 Sequenc e Fina l Flag s BVI D # 2254 4 ADDRES S 356 6 Jackso n s t QUAD/ZON E B l INSPECTO R LOPE Z DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 40.72 4 ±9.35 0 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 42.20 3 Supervise d By : 

## Certificat e o fVerificatio n

296 9 SOI L 

### 2008-08-2 5 15:4 5 30.3 4 Fina l 2254 4 356 6 Jackso n s t B l LOPE Z 6 CLEARANC E

± Erro r
± 9.37 5

# 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 

### 299 0 Mod e SOI L Tim e 2008-08-2 6 08:3 7 Duratio n 

### 122.3 6 Sequenc e Fina l Flag s AVERAG E I Av g o f2986-298 9 ADDRES S 356 6 Jackso n s t QUAD/ZON E easemen t INSPECTO R lOPE Z DEPT H SAMPL E TYP E CLEARANCE ' NOT E



### ppn y ±. yErro r P b 

### 214^2 7 ±18.20 8 

### ( 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 fVerificatio n XL3t-3208 9 Readin g N o 

### 298 6 Mod e SOI L Tim e 2008-08-2 6 08:3 5 Duratio n 30.3 7 Sequenc e Fina l Flag s BVI D # 2254 4 ADDRES S 356 6 Jackso n s t 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 210.94 1 ±17.95 8 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 218.48 1 Supervise d By : 

## Certificat e o fVerificatio n

298 7 SOI L 2008-08-2 6 08:3 6 30.5 3 Fina l 2254 4 356 6 Jackso n s t easemen t LOPE Z 

### 1 CLEARANC E

±Erro r ±18.70 5

# 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 209.08 1 Supervise d By : 

## Certificat e o fVerificatio n

298 8 SOI L 2008-08-2 6 08:3 7 

### 31.0 2 Fina l 2254 4 356 6 Jackso n s t easemen t LOPE Z 

### 1 CLEARANC E

± Erro r
± 17.95 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 220.80 7 Supervise d By : 

## Certificat e o fVerificatio n

298 9 SOI L 2008-08-2 6 08:3 7 30.4 4 Fina l 2254 4 356 6 Jackso n s t easemen t LOPE Z 

### 1 CLEARANC E

± Erro r
± 18.21 3

# 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 AVERAG E ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

Supervise d By : 

## Certificat e o fVerificatio n

299 5 SOI L 2008-08-2 6 08:4 6 121.3 0 Fina l Avg of 2991-299 4 356 6 Jackso n s t Retainin g wal l L S o n B I ^ LOPE Z " « 1 CLEARANC E INSITU S

# 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 296.68 7 Supervise d By : 

## Certificat e o fVerificatio n

299 1 SOI L 

### 2008-08-2 6 08:4 3 30.4 4 Fina l 2254 4 356 6 Jackso n s t Retainin g wal l LS o n B I LOPE Z 

### 1 CLEARANC E INSITU S

± Erro r
± 21.04 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 301.68 4 Supervise d By : 

## Certificat e o fVerificatio n

299 2 SOI L 2008-08-2 6 08:4 4 30.0 6 Fina l 2254 4 356 6 Jackso n s t Retainin g wal l LS o n B I LOPE Z 1 CLEARANC E INSITU S

± Erro r
± 21.23 2

# 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 295.62 7 Supervise d By : 

## Certificat e o fVerificatio n

299 3 SOI L 2008-08-2 6 08:4 5 30.3 2 Fina l 2254 4 356 6 Jackso n s t Retainin g wal l LS o n B I LOPE Z 1 CLEARANC E INSITU S

± Erro r
± 21.73 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 311.49 8 Supervise d By : 

## Certificat e o fVerificatio n

299 4 SOI L 2008-08-2 6 08:4 6 30.4 8 Fina l 2254 4 356 6 Jackso n s t Retainin g wal l LS o n B I LOPE Z 

### 1 CLEARANC E INSITU S

± Erro r
± 21.50 1< r— \

^

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,< ^ 

## 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 ENVIItONHENTA L CROUP

. INC

. 

# EXECUTIV ESUMMARY : BVI D #2254 4 - (356 6 JACKSO NST )
N o Issue s o r Concern s x Issues/Concern s Detai l Explanation : DAMAGESETTLEMEN TFO RCARPE TCLEANIN GAN D WATE RBILL
. NEE D MOREFILLDIRTI NTH EFRONT
.

### ^

# 4EPA EP APropert y Clos e Ou t For m Propert y ft : '• Date/Time : ^ 

# iK^ ^ Quad s Excavated : ^ \Y^ \'( tl

- > r \: ^ Propert y Address;

- -TrT r ;—-T-r v OwVer' s Namer , ,^
. ffi^^.H^,^^.,^ Contracto r Grou p 'y^vyi Excavatio nGenera l 1
. If necessary , wereth ecorrec t quadrBnt(s ) excavate dandreslored? Ye * M o
2
. If necessary , wereth ecorrec t area s o f drip zoneexcavate dandrestored ? Gradin g So dan dVegetatio n Doe s thegradin g aroun dtheperimeter ofth ehous ei nexcavate darea s generall y slop eawa y fromth ehouse ? 2
. Ha s sodbee nlai di nall area s tha t wereexcavated ? Ye * y .N o

3
. Doe s the sodappear to begenerall y healthy an dgrowing ? (Onl y evaluat ei f inspecte da t a3 0 day timeperiod ) 4
. A.r esoddedarea s generall y fir man devenly graded ? 5
. Aji eth ejoint s betwee ntheso dstrip s generall y tight ? (Only evaluat ei f inspecte da t a3 0 da y tim e pyeriod ) 6 Wa s thepropert y grade dsuchtha t water will not poo l o nthepropert) ' 

### y y

7 Wa s damag et o landscapin g or plan t material s avoided'^ ' Gales , Fence s an d Retainin g Wall s 1
. D o gate s ope n an d clos e freely':' (Ifapplicable ) 2
. Wer e al l gates o rfence s take n dow n durin g restoratio n activitie s reinstalled ? (Ifapplicable ) Ye s 

### y
% y N o

3
. Wa s damag e t o gate s o rfence s avoided ? (Ifapplicable ) ty 4
. Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) 

## y Foundation , Sidiii|;an dGutter s 1 

### 1
. Wa s damag eto th esidin g o r tri mavoided ? 2 Wa s damag eto thefoundatio navoided ? Ye s y Sb



### 3
. Wa s damag eto window s avoided'^ ' 4
. Wa s damageto window s o r door screen s avoided ?

. ^ 5
. Wa s damag eto downspout s or downspou l extension s avoided ? y Sidewalk s an dDriveway s (Concrete ) 1
. Wa s damag eto driveway surface s avoided ? Ye s
cy 

### N o
2
. Wa s damag eto walkway surface s avoided ? i 

### y

# [ Owner s comments :

Inspectio nnotes :

Removal andrestoratio naclivale s complete includin g the30-da y so dwairanty : EP ARepresental 'yd-^^^:<
_ 

# Date ; /^JT ^^ ^ ^ 

# Propert yCompletio n Agreemen t Thi s agreement document s thecompletio n of remedia l activitie s performed on my property .My .signatur e wil l designate tha t I

amsatisfie dwit htherestoratio n of my property , andtha t no item s are inquestions , now , or at any tim e inthefuture , except thos eitem s Hste dbelow , ifany
. Propert y ID : 2_?.5 M <­ Property_Addrcss:,3^fi,^^^- ^ ^Yl^|^^^ ^ S^ ^ Owner : J-^^ ^ \ ^ j ^ ^ 

## Phone : "^C^^- ^ - X^Q" ^ Restoratio n item s in Question :

Item : Item : Item : 

### Item : Item : Item :
Additiona na l l Comments :

Comment s y? y / / / '^z ? 

# Lyjfiyi y _Jlys2.^y<.udL j ..-djyy ^

agre erestoratio n is completed , excep tas note d II do no t agre erestoratio n is complete d 

# i^ m 5
Signatur e 

### Dat e Cmiitractor' s Signature Dat e I

# Propert yDamag e Settlemen t

Propert y I D 2254 4 Propert y Addres s 356 6 Jackso nS t Owne r Pa mHube r Phon e 402.290.250 7

Ihav e receive dfromth e contractor , Coasta l Enviroimiental Grou p Inc
. (Coastal) , th e su mo f $191.2 9 t o compensat e for plant s that wer e remove ddurin g th e removal o f lead-impacte dsoi l fromth e property . Compensatio nTyp e Chec k ! Valu e o f Chec k $191.2 9 Chec k t o th e Orde r o f Pa mHube r Descriptio n o fDamag e Propertyowne rdog s tracke d mu d o n he rcarpe t du e t o rai n afte rexcavation
. Coasta l Environmenta l Grou p offe rt o pa yfo rth e carpe t cleaning
. I n addition , Coasta l ha s agree d t o payfo rth e differenc e i n he rwate rbil l fo rth e 3 0 daySo d period
. M ysignatur e belo wacknowledge s th e receip t o fth e chec k liste d above ; further , I acknowledg e tha t th e compensatio n amoun t i s fai rfo rth e replacemen t cos t o fth e sidewal k an d releas e Coasta l Environmenta l Group , Inc
. fro m furthe robligation s o rliabilit yrelate d t o thi s property
.

Contractor' s Signatur e

Pag e 1 o f10.0 0 

### Account : 137576-118696 0 PA M L
. HUBE R Servic e address : 356 6 JACKSO N S T 

### Gal ! 81 1 befor eyour di g inyour yard , buil da fence , etc . Call at leas t tw o workin g day s i n advance
. Utilitie s will mar k

gas , water , electric , cabl eandphonelines
. N o charg efo r thi s service
.

SE P OC T NO V DE C JA NFE B MA H AP R MAYJU NJU L AU G You rGa s Us e Pas

t 1 2 Months 0 Pas t 13-2 4Months Billin g units : Us e pe rday : Averag e cos t pe rday : Numbe ro fday s I n billin g cycle : Thi s Mont h 6 0. 2 $ 0 8 0 2 9 Las t Yea r 1 1 0. 4 $0.7 7 2 8 2& I 

### i a



# . 1 Jhfclinil h i l

# Hf l

° SE P OC TNOVDE C JA N FE B MA R AP R MAYJU N J U LAU G You rWate rUs e
B Pas t 1 2 Month s ^ Pas t 13-2 4 Month s Thi s Mont h Las t Yea r Billin g units : 7 9 Us e pe rday : 0. 2 0. 3 Averag e cos t pe rday : $0.4 7 $0.4 6 Numbe ro fday s I n billin g cycle : 2 9 2 8 172 3 Harne yS t
. Omaha

. N E mK 2 •402.554.666 6 e-mail : customer_service@mudomaha.co m •website : ww wmudomaha.co m 

# metropolita n « UTILITIE S DISTRIC T Billin g dat e Au g 11 , 200 8 Previou s balanc e $175.0 0 Paymen t receive d Curren t charge s 175.0 0 Ne wbalanc e 350.0 0 

## •Tota l du e Au g 26 , 200 8 $350.0 0 You rbudge t paymen t o f$ 350.0 0 wil l b e pai d b yyou rfinancia l institutio n Au g 26 , 2008
. Budge t Variances : Curren t =-124.4 6 Tota l =-234.7 5 

## 1 Detail s o ( curren t charges : ' 

### GA S RESIDENTIA LRAT E A : Ju l 7 t o Au g 5

Meter Numbe r 41774,'> Curren t rea d(estimoie) : 123. 3 - Previou s read(actual) : 1227 = 6 CC F 

### Ga s Use : 6 CC F x1.01 0 (hea t value ) = 6.06 0 therm s

4 day s 0.83 6 therm s a t 0.974 3 = $0.8 1 2 5 day s 5.22 4 therm s a t 1.342 7 = 7.0 2 Servic e Charg e 12.0 0 

### Ga s Cos t • $19.8 3 Ga s Infrastructur e Replacemen t 3.0 0

WATE R RESIDENTIA LRAT E W-1 : Ju l 7 t o Au g 5

Meter Numbe r 286.')96 6 Size : 5/ 8 -inch Curren t read(oiiimaie) : 12 0 - Previou s rea d(actual) : 11. 3 = 7 CC F 

### Wate rUse : 7.00 0 CC F o r5,23 6 gallon s 7.00 0 CC F a t 0.9156 = $6.4 1 Servic e Charg e 4.6 2 

### Wate rCos t • Wate rInfrastructur e Replacemen t " 2.0 0 CityofOmahi a Sewe r 11.3 7 Sale s Tax 3.3 1 •Curren t Charge s $50.5 4

Pleas e retur n thi s portio n o fth e bil l wit h payment
. •Pleas e d o no t stapl e paymen t t o bill
. 172 3 Harne yS t •Omaha , N E 6810 2 •402.554.666 6 e-mail : customer_service@mudomah a co m 

# A

1 metropolita n website : www.mudomaha.co m M rUTILITIES DISTRIC T 

## 000137576118696000000035000 5
Du e o n o rbefor e Au g 26 : $350.0 0 You rbudge t paymen t o f$ 350.0 0 wil l b e pai d b y 

## l.ll..l..l....llll.,..l.l....lll.l....l.l..l.ll.l..l.l..l..l. l you rfinancia l institutio n Au g 26
. 

### PAM L
. HUBE R Amoun t Paid : 

### 3566 JACKSO N S T OMAHAN E 68105-192 2
P O BO X 360 0 OMAHAN E 68103-060 0 

### Giv et

o (li e Hea t Ai dFund
. Se erevers eside
. Monthl y donation­ Add : U% 1 U%1 > QS S Othe r $ _ Account : 137576-1186 9 3 0 0002 0 EAP L27 4 

### Account : 137576-118696 0 172 3 Harne yS t •Omaha , NElP'D 2 •402.554.666 6 

## =Wm 2 e-mail : custome rservice@mudomaha.co m •website : www.mudomaha.co m 

# H metropolita n PA M L HUBE R MfUTILITIE S DISTRIC T Servic e address : 356 6 JACKSO N S T Billin g dat e Se p 10,200 8 Previou s balanc e $350.0 0 Cal l 554.777 7 i f yo u smel l gas . Paymen t receive d -Than k yo u 350.0 0 C R Th ene w DEXphon eboo k omitte dM.U.D.' s 24/ 7 Curren t charge s 197.0 0 Ne wbalanc e 197.0 0 emergenc y number
. Pleas e writ e th e 554.777 7 emergenc y phon e 

## •Tota l du e Se p 25 , 200 8 $197.0 0 numbe r unde r th e M.U.D
. listin g o npag e10 8 ofth e You rbudge t paymen t o f$ 197.0 0 wil l b e pai d b yyou rfinancia l institutio n Se p 25 , 2008
. whit ebusines s page s i nyour DEXphon ebook
. Budge t Variances : Curren t =-90.0 6 Tota l =-324.8 1
Detail s ofcurren t charges : 54& I 

### GA S RESIDENTIA LRAT E A : Au g 5 t o Se p 4 Mete r Numbe r 41774 5 Curren t read(actual) : 125 4 - Previou s read(oiimaie) : 123 3 = 2 1 CC F 

# . l ll i
. . _ Ga s Use : 2 1 CC F x1.01 0 (hea t value ) =21.21 0 therm s ^ OC TNO VDE C JA N FE B MA R AP R MAYJU N JU LAU G SE P 3 day s 2.12 1 therm s a t 0.847 9 = $1.8 0 You rGa s Us e 2 7 day s 19.08 9 therm s a t 0.974 3 = 18.5 9 Servic eCharg e12.0 0 1 Pas t 1 2 Month s Q Pas t 13-2 4 Montln s 

### Ga s Cos t •$32.3 9 Thi s Mont h Las t Yea r 

### Ga s Infrastructur e Replacemen t 3.0 0 Billin g units : 2 1 2 2 Us e pe rday : 0. 7 0. 7 Averag e cos t pe rday : $1.2 2 $0.9 9 Numbe ro fday s i n billin g cycle : 3 0 3 0 

### WATE R RESIDENTIA LRAT E W-1 : Au g 5 t o Se p 4

Mete r Numbe r 286596 6 Size : 5/ 8 -inc h Curren t rea d(actual) : 14 3 - Previou s read(estimate) : 12 0 = 2 3 CC F 

# iij.i^J«.,LBii L Wate rUse : 23.00 0 CC F o r17,20 4 gallon s OC T NO V DE C JA NFE B MA R AP R MA Y JU NJU L AU G SE P 9.00 0 CC F a t 0.915 6 = $8.2 4 You rWate rUs e 14.00 0 CC F a t 1.2810 = 17.9 3 Servic eCharg e4.6 2 I Pas t 1 2 Months Q Pas t 13-2 4 Months 

### Wate rCos t •/|30.79 ^ Thi s Mont h Las t Yea r 

### Wate rInfrastructur e Replacemen t v2.00 , Billin g units : 2 3 2 Us e pe rday : 0. 7 0. 0 Averag e cos t pe rday : $1.1 6 $0.2 1 

### CityofOmah a Sewe r 11.3 7 Numbe ro fday s I n billin g cycle : 3 0 3 0 

### Insufficien t Fund s Charg e 22.0 0 Sale s Ta x 5.5 8 Budge t Paymen t Pla n Interes t 0.1 9 C R •Curren t Charge s $106.9 4
Pleas e retur n thi s portio n o fth e bil l wit h payment
. •Pleas e d o no t stapl e paymen t t o bill
. 172 3 Harne yS t •Omaha , N E 6810 2 •402.554.666 6 e-mail : customer_service@mudomaha.co m 

# 4

) metropolita n website : www.mudomalia.co m i WUTILITIE S DISTRIC T 

## 000137576118696000000019700 5
Du e o n o rbefor e Se p 25 : $197.0 0 You rbudge t paymen t o f$ 197.0 0 wil l b e pai d b y 

## l.ll..l..l....llll....l.l....lll.l....l.l..l.li.l..l,l..l..l. l you rfinancia l institutio n Se p 25
. 

### PAM L
. HUBE R Amoun t Paid : 356 6 JACKSO N S T OMAHAN E 68105-192 2 P O BO X3600 OMAHAN E 68103-060 0 Giv e t o th e Hea t Ai dFund
. Se e revers e side
. Monthl y donatio n~ Add : QS Za$ 3 a$ 5 Othe r $
_ 

### Account : 137576-118696 0 0001 5 EAP L

# INVOIC E
September 8, 200 8 Job : PamHuber 356 6 Jackso n Omaha , NE6810 5 Phone : 290-250 7 Carpe t Cleaning : I ! I 12x1 6 14x1 8 12x1 4 Dinin g Roo m Livin g Roo m Bedroo m Cost : $150.0 0 Tax : 10.5 0 Total :
Credi t Card# Vis a Expiratio n Dat e MasterCard 

## $160.5

• \ 

## 160.5 0 0 

# \\^\.d- ^ , r yky-^ ^

Chec k # Cas h^''/^/ ^ 

# y