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# a / 4 SOI LREMEDIATIO N PROPERT YnLEFOLDE RDOCUMENT S Vide o o f propert y (DVD ) Executiv eSummar y EPA-provide dpropert y sketc h Signe dAcces s Agreemen t for subjec t propert y Signe dAcces s Agreement(s ) for adjacen t propert y Restoratio nAgreemen t Settlemen t document s (i.e. , for damag eo r to replac eplants , etc. ) Confimiatio ndat a Photograph s t;/^(^t\ni M ^ fab<<W<Vf\< M As-buil t sketc h Satisfactory restoratio nsigne db y Propert y Owne r Propert y close-ou t chec k lis t signe db y EP A Descriptio no f area s no t meetin g RO D cleanu p criteri a- Utilit y clearance s Propert y informatio nfro mDougla s Count y Assessor' s Offic e < 7

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^ Utilit y Clearanc e aVideo/Flioto s (Before ) aVideomioto s (Daring ) aVideo/Photo s (After) D Video/Photo s (30-Day ) " ^ Property Completio nAgreemeat D Final Report Ai r Monitorin e(a s appCcabi e L j Conunnnit y |_ JCre w On : Results : DCommnnit y DCrev r | On : RcsnHs : Sent:^/2./Q 9 Signed : |Q_/^/Q Q Signed : i£L/(iL/ ^ / / / / / / Called : \Q./2_/C H

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### Douglas Count y Accoun t b^rm^o n Pag e1 of 3

Dougla s County , Nebrask a Propert yRecor d - R082113000 2 Prin t Repor t NE WFeatur e - Parce l Dimension s avaiiabi e @ scai e 0-5 0 ft wes t o f52n d S t - Vle WO H Ma p 

### Informatio n i s vali d a s o f2009-9-2 9 Treasurer' s Ta xRepor t Ne wFeatur e ^ - •^ Aut o Sale s Searc h Owne r VASQUE Z EDUARD O J
170 9 N5 0 S T OMAH AN E 68104-000 0 Propert yInformatio n Ke yNumber : 211 3 000 2 0 8 Accoun t Type : Residentia l Parce l Number : 082113000 2 Parce l Address : 170 9 N5 0 S T OMAH AN E 68104-000 0 Lega l Description : CLOVERDAL E LO T1 5 BLOC K5 N 5 0 FTLOT S 13-14
- & 50X152. 1 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $ 6,200.0 0 $ 161,500.0 0 $ 167,700.0 0 200 8 $ 6,200.0 0 $ 161,500.0 0 $ 167,700.0 0 200 7 $ 6,200.0 0 $ 161,500.0 0 $ 167,700.0 0 200 6 $ 6,200.0 0 $ 134,500.0 0 $ 140,700.0 0 200 5 $ 6,200.0 0 $ 134,500.0 0 $ 140,700.0 0 200 4 $ 6,200.0 0 $ 134,500.0 0 $ 140,700.0 0 Sale s Informatio n Sale s Date : 2006-08-3 1 Dee d Type : W D Book : 200 6 Page : 10335 7 Price : $ 173,000.0 0 Grantor : Glase rHolli s F Grantee : Vasque z Eduard o J Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 1994-10-2 1 Dee d Type : Book : 199 2 Page : 50 7 

### Price : $ 95,500.0 0 Grantor :



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accoimtno=R08.

. . 10/1/200 9• • 

### Dougla s County Accoun t I

j Ij^rm^io n Pag e2 o f 3

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 7 7600. 0 

### 1. 0 152. 0 50. 0 N o Improvemen t Informatio n Buildin g 1
170 9 N5 0 ijr i ( D —mr­ ' 1 3 4M.DSq.n

. FimFloii r 1 0 133 3 n S q n j) U tw m ku r "Ljoo__a!i
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- ''r t L > CLIC KTO ENLARGEJMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : 1806. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 1 1/ 2 Stoi yFi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 6. 0 Exterior : Masonr yCommo n Bric k Units : 1. 0 Interior : Diywal i Baths : j 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 3. 0

Roo fType : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : i Bloc k Sprinkle rSquar e Footage : I 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 193 8 0 % 193 8 7 1 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Applianc e Fireplac e Masonr y 

### 1. 0 Basemen t Bsmn t Bloc k 8 f t 

### 1346. 0 Basemen t Minima l Finis h 800. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R08.

. . 10/1/200 9

### •• 

## Douglas Count y Accoim t I|^n||^io n Pag e3 of3

Fixtur e Fixtur e Fixtur e Garag e Porc h Porc h Use r Additiona l Fixture s Bas e Fixture s Bat h Ful l Basemen t Singl e En d Soli d Wal l Sla b w/Step s Atti cFul l Finis h 1. 0 1. 0 1. 0 1. 0 196. 0 40. 0 484. 0



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accoimtno=R08..

. 10/1/2009

### Pag e1 o f 1

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### • YOU RTICKE TNUMBE RI S 2388335

. Origina l Cal l Date : 10/17/0 9 Time : 1:4 3 pm Op : ELIZABETH1879 0 Wor k t o Begi n Date : 10/21/0 9 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 170 9 Street : N50TH S T Twp : 15 NRng : 13 E Sect-Qtr : 18-N E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : Lead Remediatio n Locatio n o f Work : INCLUD E AL L EASEMENT S LOCAT E ENTIR E PROPERTY Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LO T Compan y: COASTAL ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 

### Wor k Being Don e For : Coasta l Dept ho f Excavation : 4f t Corne r Lot : N Front : YRear : 

### Involve s Tunneling o r Horizonta l Boring : N Explosives : N CXCAT V MUDO l OMAHACO F0PPDGPR 5 QLNNEI C

Servic eAre a Contac t 

### Phon e Numbe r Utilit y Typ e

CXCAT V CO XCOMMUNICATIONS , IN C HEID I 

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

MUDO l METROPOLITA NUTILITIE S DISTRIC TSAND Y 

### Day : 402504782 3 Alt : 

### Emerg : 402504797 0

OMAHACO FCITYO FOMAHA-TRAFFIC.SEWE R 

### RlCHn-RAFFl C Day : 402444719 7



### Alt : 402444516 1

Emerg : 4024445160

0PPDGPR 5 OMAH APUBLI C POWE RDISTRIC T N A 

### Day : 406728934 3 Alt : 4062071494 Emerg : 888728934 3

QLNNEI C QWES TLOCA LNETWOR K NA 

### Day : 406728934 3 Alt : 4062071494 Emerg : 888728934 3

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

. . 10/17/200 9OLS# : 6386 4 Dat e Excavated : 10/26/0 9 

# As-Buil t Drawin g Dat e USEP ASigne d Off : 10/24/0 9 COASTA L Are a Sodden : 30 3 s a f t ENVIKONHENTA L 

# Omah aLea dSuperfun dSit e G n O U P , IN C



### 6386 4 Omah a Lea d Sit e Exterio rPain t NorthArro w 

### Sit e Sketc h n Goo d n,Poo r Samolin a Address : 170 9 N 5 0 ST ip fNot pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r 

# i LA B Concentratio n Collecte d Firm_£E^_I2SJ_AI I RYASCPXA-6386 4 F l 

### J 4 3 pp m 

### D Date : S"—/-Q ? RYBSCPXA-6386 4 F 2 

### -732

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# a Time : ID'H O am RYCSCPXA-6386 4 8 1 

### S 9 pp m 

# n Sample s Analyze d RYDSCPXA-6386 4 B 2 

### F i l pp m RDZSCPXA-6386 4 D Z 

### *<Z I p p m 

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### _L Legend : F 1 = Fron t Lett

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. B 1 = Bac k Left

. B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P 2 = Pla ; Al l

I CKtfdrants are a s viewe d fro m th e street , facin g property ••j t XT C ' ^ 1 >*
-



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

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

.

# L LlO/.^ ^ 6386 4 Omah a Lea d Sit e Exterio rPain t Nort hArro w 

### Sit e Sketc h Q Goo d •^Poo r Samplin g Address : 170 9 N5 0 S T ly j No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r 

# I LA B Concentratio n Colieclp d Fir m 

### f^ AP/?•A^ T RYASCPXA-6386 4 F l pp m 

## D Dat e RYBSCPXA-6386 4 F 2 pp m 

## D Tim e RYCSCPXA-6386 4 B l pp m 

## D Sample s Analyze d RYDSCPXA-6386 4 B 2 

# 5 7 pp m 

# 2 r RDZSCPXA-6386 4 D Z 

### H2. I pp m 

# I D XR F Unit : 

### JOBit2

. Book : 235

. RGZGCPXA-6386 4 GZ
- pp m 

## D D Date ;
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### nz . pp m 

## D Time : La b RYDSCPLA-6386 4 

# n Staff : • Resul t on e 

### M^V ^ Numbe ro fSample s • 

### I 60. 6 pp m Legend : F 1 = Fron t Lett , \- ^ Fron t Right , B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z Pla ^ Al l qqadrant ^

Rtn ' :o i i « 114470 1 111.23

# LL ' 10 / 7. \ 

# 63864 Exterio rPaint Nortt i Arro w 

### Omah a Lea d Sit e •Goo d 

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# i LA B Concentratio n Collecte d 

### Fimi : fP ADE-Ar J RYASCPXA-6386 4 F 1 pp m 

## D Date : 5'-j-^ ? RYBSCPXA-6386 4 F2 - . 

# 53 Z pp m 

## D Time : lO'-H 0 ary \ RYCSCPXA-6386 4 B 1 pp m 

## D Sample s Analyze d RYDSCPXA-6386 4 B 2 

# 5 1 pp m RDZSCPXA-6386 4 DZ 

### HZ I pp m 

# n XR F Unit : loQC* 1 Book : 2^ 5 nGZOCPXA-6386 4 —G2
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## D 

# D Date 

### S'HCP I mr-iTor^DV Aft' 

### pp m 

## D 

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. La b RYDSCPLA-6386 4 

## !zn

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Re\'2iii''l ! rrenle di»i-No v U47ri l 11 1 23

## 63864 Exterio rPain t Nort h Arra w 

### Omah a Lea d Sit e •Goo d Sit e Sketc h n^Poo r Samplin g Addraas : 170 9 N 5 0 S T Q No t pain t Sampl e Nuint)e r RYASCPXA-6386 4 F l RYBSCPXA-6386 4 F 2 RYCSCPXA-6386 4 B l RYDSCPXA-6386 4 B2 RDZSCPXA-e38e 4 D Z RQZOGPXA-6386 4 62
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b RYDSCP1A^386 4 •"»"" " 60.6pp m Legend : F l = Front Len , i-; i = 

# ENTERED Lea d Sampl e Samples Collected LAB Concentratio n Collected Fimi : FP APg.Av T pp m 

## D Date : G'-l-Q l .^32 Lpp m 

## D Time : tfWtf/r/ w

8 ^ po m 

## D Samples Analyzed __5L 3 pp m 

## E f J1*L I PP* n 

## D XR F Un» : J£a&2

. Book : 235

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—pp m 

## D Date:

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RevMi S Cnrnd : «6-Ni>v-0 8>—* *

COASTA I INVtRONKIRTA I C R 0 1 1 r
. IN C 

## 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 :

Owner' s Name : tCAUQ^Td O Daytim e Phone :

Addres s o fPropert y covere d b ythi s 

# no q 

# N 5 0 s t 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 vmtte 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 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 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 f28 COASTA L tNTINONHIKT& L t R 0 U rIN C 

### €

Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; cRemov e flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t ma ywis h t o save ;
« Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , as necessar ysubsequen t t o a n initia l waterin g perio d byEPA ;
« Abid e byhealt h an d safetyguidanc e provide d byEPA ; •I fth e propertyi s rented , assis t EPAi n obtainin g tenan t approva l fo racces s t o th e propertyt o perfor m th e work

. sAllo wvideotapin g and/o rphotographin g o fth e property

. AGREEMEN TNO TT o INTERFER E 

### Th e Granto ragree s not t o interfer e o rtampe rwit h an yo fth e wor k activities , o rwit h an y ofth 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 propertywhic 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 propertyi n suc h a manner
. Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contact Coasta l Environmenta l Group , at (402 ) 991-119 9 

# X' gran t acces s t o m yproperties D I d o no t grant acces s to m yproperties

Signatur e Signatur e Dat e

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

.

Pag e 2 o f2;:t ^
COASTA L C n o U r•M f 

## Restoratioi a Agreemen t Th epurpos eofthi s agreemen t i s to provideamutua l agreeme mas t o condition s ofth epropert y prior t

o remediatio nactivities

. Thi s will als o serv ea s documentationfo r th epurpos eo f assuring that restoration activitie s arecompletedto th esatisfactionofth epropert y owne r andtheUnitedState s Environmenta l Protectio nAgenc y (EPA)

. PropertylD

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nth eattacheddiagram(s ) indicat earea(s ) t o excavate , surfacestructure s an dlandscaping feature s an d acces s location(s ) t o beuse dby thecontractors
. Indicat edistances , depths , materia l types , etc
. Photographically an dVideographicall y documen t th

eexisting condition s ofthepropert y an dthebasemen t if necessary . 

### Item s t o b e Remove d b yth e Owne rbefor e Start o fRemediation : Th e renoval

. storage , disposal , and/o rretur n o fthes e Itom s i s th e Owner' s responEibility

. 

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Pre-existin g propert y area , that wil l b eexcavated , that 

### ^ \ ^ i s covere dwithgrass . Numbe r o f tree s > 2 inc h 

### ^ trun k diamete r Numbe r o f tree s < = 2 inc h 

### \ trun k diamete r Numbe r o f Sprinkle r Zones , Contro l Valves , Tnners , Heads , etc
. Aii.nt h11 sketci i D l il> e 

# V\ o

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### \ >i/fS.nii dloc;iiiiiM > Agree dupo nvalu eo f plan t material s no t t o b e replace db y contractor
. VOU ' ll'-i ' NMIII C ^\il t h i v:snL ' 1 0 ib'.u i

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### Landscap eInventor y Unit Condition/Type/Specie s Quadrant s

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### S 

# PevNi^iao , ?iU3\)\te Eac h



### Pag e 2

. >COASTA L



### ! Additiona l Comment s / Instructions :

Q Chec k th e bo xf 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 t)o xCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro fhouse , includin g foundatio n crack s o rfissures

.

QId o no t agre e

Owner' s Signatur e Date Jtractor' s Signaturel)at e Pag e 3 o f

# . 6SS6(/ BVI D 

### XRF PROPERT Y SAMPL E SHEE T Dat e Addres s 

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RETES TAREA S 

### Sho t # Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h
Averag e Averag e 

### la b sampl e # La b resul t Sampl e are a XR F Avg

. Signatur e 

# Prin t rjb yheihOflrgre^;

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# Therm o

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

## Ceitificat e o fVerificatio n
XL3t-3207 5 Readin g N o 55 3 Mod e SOI L Tim e 2009-10-2 4 09:0 1 Duratio n 120.0 0 Sequenc e Fina l Flag s AVERAG E r^Av g orSt9=552r s LOCATIO N 170 9 iTSDrst— ^ INSPECTO R VENTR Y COR l e m CO R 2 1 MIS C clearenc e NOT E ep a gu n Use rLogi n EP A

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### pPB " -1387277

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### <rTOv r 19.51 6 A g < LO D 14.01 9 7.51 8 U < LO D 19.96 9 R b 46.21 2 ± 6.07 6 T h < LO D 14.30 9 S e < LO D 5.79 6 A s < LO D 22.45 2 H g < LO D 12.31 0 Z n 87.81 7 18.42 3 W < LO D 73.29 0 C u < LO D 28.98 5 N l < LO D 67.62 1 C o < LO D 147.59 7 F e 12566.44 6 ± 355.32 3 M n 298.04 5 ± 87.22 3 C r < LO D 131.74 9 < LO D 290.83 7 T l < LO D 705.25 1 S c < LO D 91.17 6 C a < LO D 1378.87 2 K < LO D 1562.64 2 S , < LO D 1305.45 0 S r 93.27 8

Supervise d By : V

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

XL3t-3207 5 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s SAMPL E LOCATIO N INSPECTO R CO R 1 CO R 2 MIS C NOT E Use rLogi n

P b C d A g S r U R b T h S e A s H g Z n W C u N l C o F e M n C r T i S c C a K S 

## Certificat e o fVerificatio n

54 9 SOI L 

### 2009-10-2 4 08:5 9 30.0 0 Fina l 

### 6386 4 170 9 n5 0 s t VENTR Y e m 

### 1 clearenc e ep a gu n EP

A

pp m ± Erro r 

### 147.45 0 ± 

### 18.70 0

< LO D 

### 19.56 2 < LO D 

### 14.20 7 98.93 3 ± 

### 7.85 6 < LO D 

### 21.86 7 41.60 1 ± 

### 6.13 3 < LO D 

### 13.54 0 < LO D 

### 6.33 5 < LO D 

### 24.35 7 < LO D 

### 12.65 9 101.15 5 

### 19.75 8

< LO D 

### 71.93 0 < LO D 

### 29.48 1 < LO D 

### 66.32 7 < LO D 

### 149.62 6 12560.87 9 ± 

### 362.20 2

331.97 6 d b 

### 92.21 4

< LO D 

### 251.74 3 < LO D 370.08 8 < LO D 

### 859.18 9 < LO D 

### 40.68 4 < LO D 

### 1596.59 2 < LO D 

### 1233.49 6 < LO D 

### 1257.77 3 Supervise d By : V

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

## Certificat e o fVerificatio n
XL3t-3207 5 Readin g N o 55 0 Mod e SOI L Tim e 

### 2009-10-2 4 09:0 0 Duratio n 

### 30.0 0 Sequenc e Fina l Flag s SAMPL E 

### 6386 4 LOCATIO N 170 9 n 5 0 s t INSPECTO R VENTR Y COR l e m CO R 2 

### 1 MIS C clearenc e NOT E ep a gu n Use rLogi n EP A

pp m ± Erro r P b 

### 171.69 4 ± 

### 19.38 8 C d < LO D 

### 19.32 2 A g < LO D 

### 13.89 9 S r 98.91 4 

### 7.63 6 U < LO D 

### 20.51 5 R b 57.79 6 ± 6.58 2 T h < LO D 

### 14.71 0 S e < LO D 

### 5.23 5 A s < LO D 

### 23.57 8 H g < LO D 

### 11.75 3 Z h 94.28 1 

### 18.81 6 W < LO D 

### 75.22 0 C u < LO D 

### 27.70 3 N i < LO D 

### 70.38 9 C o < LO D 

### 153.24 2 F e 13778.69 7 ± 

### 368.93 6 M n 300.07 7 

### 87.14 1 C r < LO D 

### 122.62 4 V < LO D 

### 305.33 1 T i < LO D 

### 698.22 0 S c < LO D 

### 107.28 5 C a < LO D 

### 1082.74 1 K < LO D 

### 54.08 6 S < LO D 

### 824.99 9 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-3207 5 Readin g N o 55 1 Mod e SOI L Tim e 2009-10-2 4 09:0 1 Duratio n 30.0 0 Sequenc e Fina l Flag s SAMPL E 6386 4 LOCATIO N 170 9 n5 0 s t INSPECTO R VENTR Y COR l e m CO R 2 1 MIS C clearenc e NOT E ep a gu n Use rLogi n EP A

pp m Erro r P b 136.41 8 ± 17.68 5 C d < LO D 19.41 8 A g < LO D 13.94 3 S r 105.81 0 ± 7.88 0 U < LO D 19.48 6 R b 50.01 1 ± 6.17 7 T h < LO D 14.33 7 S e < LO D 5.90 5 A s < LO D 22.64 9 H g < LO D 12.26 9 Z n 93.44 0 18.67 4 W < LO D 69.02 7 C u < LO D 27.55 3 N i < LO D 63.74 4 C o < LO D 153.01 3 F e 13862.58 2 ± 371.36 7 M n 330.10 9 ± 89.55 8 C r < LO D 48.83 3 < LO D 476.88 9 T l < LO D 1195.18 3 S c < LO D 113.23 0 C a < LO D 1769.23 9 K < LO D 2207.86 2 S < LO D 1622.20 9 Supervise d By : V

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

## Certificat e o fVerificatio n
XL3t-3207 5 Readin g N o 55 2 Mod e SOI L Tim e 

### 2009-10-2 4 09:0 1 Duratio n 

### 30.0 0 Sequenc e Fina l Flag s SAMPL E 

### 6386 4 LOCATIO N 

### 170 9 n5 0 s t INSPECTO R VENTR Y CO R 1 e m CO R 2 

### 1 MIS C clearenc e NOT E ep a gu n Use rLogi n EP A

pp m ± Erro r P b 

### 97.54 8 ± 

### 15.44 6 C d < LO D 

### 19.76 2 A g < LO D 

### 14.02 8 S r 69.45 4 

### 6.69 9 U < LO D 

### 18.00 9 R b 35.44 0 ± 

### 5.41 3 T h 17.78 8 ± 

### 9.76 5 S e < LO D 

### 5.70 9 A s < LO D 

### 19.22 2 H g < LO D 

### 12.55 9 Z n 62.39 2 ± 

### 16.44 3 W < LO D 

### 76.98 2 C u 34.95 9 ± 

### 20.80 1 N

i < LO D 

### 70.02 5 C o < LO D 

### 134.50 8 F e 10063.62 7 ± 

### 318.78 5 M n 

### 230.01 9 79.97 7 C r < LO D 

### 103.79 7 V < LO D 

### 11.03 9 Tl < LO D 

### 68.41 3 S c < LO D 

### 103.50 4 C a < LO D 

### 1066.91 7 K < LO D 

### 2755.12 4 S < LO D 

### 1516.82 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 fVerificatio n
XL3t-3207 5 Readin g N o 54 8 

### Mod e SOI L Tim e 

### 2009-10-2 4 08:5 8 Duratio n 

### 120.0 0 Sequenc e Fina l Flag s

/ERA S 

### -Avq-ofl55754 7 ] LOCATIO N 

### 170 9 n5 0 s t INSPECTO R VENTR Y CO R 1 d z CO R 2 

### 1 3 MIS C clearenc e NOT E ep a gu n Use rLogi n EP A

Erro r 

# ^L J C d < LO D 19777 9 A g < LO D 14.22 4 S r 106.30 9 ± 7.97 9 U < LO D 20.90 4 R b 49.37 5 ± 6.31 9 T h < LO D 12.40 4 S e < LO D 5.61 9 A s < LO D 16.11 4 H g < LO D 12.51 0 Z n 117.37 5 ± 20.63 5 W < LO D 75.32 5 C u < LO D 29.87 1 N l < LO D 70.11 7 C o < LO D 155.35 4 F e 13775.20 9 ± 374.21 2 M n 427.71 0 ± 98.88 8 C r < LO D 55.29 7 V < LO D 222.64 7 T i < LO D 542.23 2 S c < LO D 34.68 0 C a < LO D 1366.17 0 K < LO D 2157.56 0 S < LO D 1418.93 1 Supervise d By : ( M ^ j 

# m <yl^j2 ^

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

## Certificat e o fVerificatio n
XL3t-3207 5 Readin g N o 54 4 Mod e SOI L Tim e 

### 2009-10-2 4 08:5 6 Duratio n 

### 30.0 0 Sequenc e Fina l Flag s SAMPL E 

### 6386 4 LOCATIO N 

### 170 9 n5 0 s t INSPECTO R VENTR Y COR l 

### d z CO R 2 

### 1 3 MIS C clearenc e NOT E ep a gu n Use rLogi n EP A

P b C d A g S r U R b T h S e A s H g Z n W C u N i C o F e M n C r Ti S c C a K S pp m 

### 41.22 0 < LO D < LO D 106.78 2

< LO D 48.53 3 < LO D < LO D < LO D < LO D 79.81 3 < LO D < LO D < LO D < LO D 13803.87 3



### 414.30 8

< LO D < LO D < LO D < LO D < LO D < LO D < LO D ± ± '

±
±

± ± Erro r 

### 11.31 1 19.82 1 14.40 3 8.00 8 

### 21.60 0

6.35 8 11.66 7

5.77 5 14.52 2 11.60 5 17.80 5 72.07 4 28.32 1 71.63 9 153.95 8 375.35 2

99.02 6 19.29 1 224.37 5 592.78 5

31.00 0 1221.46 4 3017.50 1 1709.03 5 Supervise d By : V

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

## Certificat e o fVerificatio n
XL3t-3207 5 Readin g N o 54 5 Mod e SOI L Tim e 2009-10-2 4 08:5 6 Duratio n 30.0 0 Sequenc e Fina l Flag s SAMPL E 6386 4 LOCATIO N 170 9 n5 0 s t INSPECTO R VENTR Y CO R 1 d z CO R 2 1 3 MIS C clearenc e NOT E ep a gu n Use rLogi n EP A

pp m ± Erro r P b 46.15 1 ± 11.79 7 C d < LO D 19.72 9 A g < LO D 14.28 0 S r 109.34 5 ± 8.11 6 U < LO D 20.78 3 R b 52.38 7 ± 6.45 9 T h < LO D 12.97 1 S e < LO D 5.65 5 A s < LO D 15.04 1 H g < LO D 12.87 4 Z n 108.22 1 20.31 5 W < LO D 76.54 8 C u < LO D 30.37 9 N i < LO D 67.23 8 C o < LO D 162.98 4 F e 14697.05 6 ± 388.60 8 M n 438.07 3 ± 100.39 6 C r < LO D 114.15 1 < LO D 44.88 7 T i < LO D 449.59 5 S c < LO D 26.70 3 C a < LO D 1056.19 7 K < LO D 2130.90 1 S < LO D 1282.21 2 Supervise d By : V

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

## Certificat e o fVerificatio n
XL3t-3207 5 Readin g N o 

### 54 6 Mod e SOI L Tim e 

### 2009-10-2 4 08:5 7 Duratio n 

### 30.0 0 Sequenc e Fina l Flag s SAMPL E 

### 6386 4 LOCATIO N 

### 170 9 n5 0 s t INSPECTO R VENTR Y CO R 1 

### d z CO R2 

### 1 3 MIS C clearenc e NOT E ep a gu n Use rLogi n EP A

P b C d A g S r U R b T h S e A s H g Z n W C u N i C o F e M n C r T i S c C a K S pp m 

### 51.30 3 < LO D < LO D 100.57 3

< LO D 52.06 6 < LO D < LO D < LO D < LO D 97.32 8 < LO D < LO D < LO D < LO D 13479.83 8



### 460.42 0

< LO D < LO D < LO D < LO D < LO D < LO D < LO D Supervise d By : ±

±

± ± Erro r 

### 12.02 8 19.94 4 13.94 5 7.72 3 20.09 9

6.32 4 13.07 4

5.51 8 15.13 8 12.83 0 19.36 2 81.38 1 29.87 1 72.81 5 152.06 3 366.92 7

99.87 4 39.91 2 300.80 9 628.62 5

39.04 6 1529.61 7 1275.32 8 1156.90 0 V

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

## Certificat e o fVerificatio n
XL3t-3207 5 Readin g N o 54 7 Mod e SOI L Tim e 

### 2009-10-2 4 08:5 8 Duratio n 

### 30.0 0 Sequenc e Fina l Flag s SAMPL E 

### 6386 4 LOCATIO N 

### 170 9 n5 0 s t INSPECTO R VENTR Y CO R 1 

### d z CO R 2 

### 1 3 MIS C clearenc e NOT E ep a gu n Use rLogi n EP A

P b C d A g S r U R b T h 

### S e A s H g Z n W C u N i C o F e M n C r T i S c C a K S pp m 

### 93.75 5 < LO D < LO D 108.53 6

< LO D 44.51 5 < LO D < LO D < LO D < LO D 184.13 9

< LO D 32.08 4 < LO D < LO D 13120.07 0



### 398.03 8

< LO D < LO D < LO D < LO D < LO D < LO D < LO D ±
±

±
±

±
±

± ± Erro r 

### 15.21 4 19.62 3 14.26 9

8.06 9 21.13 6

6.13 4 11.90 4

5.53 0 19.75 7 12.73 1 25.05 8 

### 71.29 9 20.60 8 68.77 3 152.41 2 365.96 0

96.25 7 47.83 4 320.51 6 497.92 2

41.97 2 1657.40 4 2206.50 9 1527.57 8 Supervise d By : V

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

## Certificat e o fVerificatio n
XL3t-3207 5 Readin g N o 54 3 Mod e SOI L Tim e 2009-10-2 4 08:5 4 Duratio n 120.0 0 Sequenc e Fina l Flag s AVERAG E 1 Av a o fS39-54 2 ••; LOCATIO N 170 9 n 5 0 s t INSPECTO R VENTR Y COR l f 2 CO R 2 1 3 MIS C clearenc e NOT E ep a gu n Use rLogi n EP A

pp m Erro r P b nfi/wf i 1 '•17:58 2 •1 C d < LO D 19769 2 A g < LO D 14.02 4 S r 96.10 7 ± 7.b/ / U < LO D 20.55 1 R b 50.20 0 ± 6.27 9 T h < LO D 13.42 1 S e < LO D 5.56 5 A s 60.31 9 ± 16.90 1 H g < LO D 12.13 8 Z n 129.61 7 •± 21.32 1 W < LO D 71.92 8 C u < LO D 29.66 1 N i < LO D 70.59 7 C o < LO D 151.16 7 F e 13746.48 9 ± 369.52 8 M n 337.39 0 ± 90.75 4 C r < LO D 141.23 5 < LO D 280.11 2 T l < LO D 656.65 5 S c < LO D 100.92 5 C a < LO D 785.31 1 K < LO D 1889.55 2 S < LO D 1153.45 0 Supervise d By/^pW

. 

# m O D V

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

## Certificat e o fVerificatio n
XL3t-3207 5 Readin g N o 

### 53 9 Mod e SOI L Tim e 

### 2009-10-2 4 08:5 2 Duratio n 

### 30.0 0 Sequenc e Fina l Flag s SAMPL E 

### 6386 4 LOCATIO N 

### 170 9 n5 0 s t INSPECTO R VENTR Y CO R 1 f 2 CO R 2 

### 1 3 MIS C clearenc e NOT E ep a gu n Use rLogi n EP A

P b C d A g S r U R b T h S e A s H g Z n W C u N i C o F e M n C r T i S c C a K S pp m 

### 161.88 2

< LO D < LO D 103.87 0

< LO D 54.17 3 < LO D < LO D 53.00 3 < LO D 144.80 1

< LO D < LO D < LO D < LO D 14934.62 2

384.07 2

< LO D < LO D < LO D < LO D < LO D < LO D < LO D Supervise d By : ±

±
±

±
±

± ± Erro r 

### 18.98 9 19.76 8 13.88 0

7.82 6 

### 19.95 9 6.40 1 14.38 2

5.46 1 17.62 3 11.81 4 22.34 0 71.67 9 28.59 0 68.13 7 153.60 4 385.49 8

95.68 0 157.07 6 424.47 2 718.51 8

98.16 2 600.10 8 1685.82 9 1051.55 9 V

### # 

# Therm o

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

## Certificat e o fVerificatio n
XL3t-3207 5 Readin g N o 54 2 Mod e SOI L Tim e 

### 2009-10-2 4 08:5 4 Duratio n 

### 30.0 0 Sequenc e Fina l Flag s SAMPL E 

### 6386 4 LOCATIO N 

### 170 9 n5 0 s t INSPECTO R VENTR Y CO R 1 f 2 CO R 2 

### 1 3 MIS C 

### clearenc e NOT E ep a gu n Use rLogi n EP A

pp m ± Erro r P b 

### 126.33 0 17.42 6 C d < LO D 

### 19.99 0 A g < LO D 

### 14.17 1 S r 96.19 1 ± 

### 7.71 8 U < LO D 

### 20.37 9 R b 44.58 4 ± 

### 6.09 2 T h < LO D 

### 14.18 4 S e < LO D 

### 6.03 7 A s 79.67 6 ± 

### 17.57 3 H g < LO D 

### 12.34 8 Z n 142.86 3 ± 

### 22.43 3 w < LO D 

### 66.02 6 C u < LO D 

### 31.05 0 N

i < LO D 

### 70.95 6 C o < LO D 

### 147.89 4 F e 12805.74 6 ± 

### 363.16 8 M n 

### 309.56 4 ± 

### 89.25 0 C r < LO D 

### 129.40 9 V < LO D 

### 353.27 9 Ti < LO D 828.48 0 S c < LO D 

### 101.57 8 C a < LO D 

### 632.93 1 K < LO D 

### 1234.34 9 S < LO D 

### 835.99 7 Supervise d By :

## /1^. \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 I ^^^ ^

° Coasta l Environmenta l Grou p Inc , S!~^j ^ www.coastalhazmat.co m <*tPBO^" ^ COASTA L cto u r , I N C 

# EXECUTIV ESUMMARY : BVID #63864-(170 9 N5 0 ST )
No Issue s o r Concern s | | Issues/Concern s Detai l Explanation :

# a ^ 

# EP A # 

# EP APropert y Clos eOu t For m Prt»pen y# : LP'?^ ^ Propert y Address: * - t Datc/Tlme : 

### Owner' s Nane : Quad s Excavated : J ) ^ ^ 9^2 ^ Contracto r Grou p
Excavatio nGcnen I 1

.If necessaiy , wereth ecorrec t quadtant(s ) excavate dandrestored ? 2

.If necessary , wereth ecorrec t area s ofdri p zoneexcavate dandrestored ? Ye s N o 

### Gradin g So dan dVegetatio n 1

.Doe s thegradin g aroun dth eperimeter of th ehous ei nexcavate darea s generally slop eawa y fromth ehouse ? 2

.Ha s so dbee nlai dinall area s tha t wer eexcavated ? 3

.Doc s th esodappear to b egenerally healthy an dgrowing ? (Only evaluateif inspecteda t a3 0 ^ - ^ 

### day timeperiod ) 4

.Ar c soddedarea s generally Hr man devenly graded ? ^ " 

### 5

.

Ar c th ejoint s betweenth eso dstrip s generally tight ? (Only evaluateif inspecte da t a3 0 da y 

# T7 " tim eperiod) 6

. Wa s thepropert y grade dsuchtha t water will not poo l o nth eproperty ? 

# p-^ 7

. Wa s danug et o landscapin g o r plan t material s avoided ? ,^' ' Gates , Fence s an d Retainin g Wall s Ye s N o 

### I

.D o gate s ope nan dclos efi-eely? (Ifapplicable ) 2

.Wereall gate s or fence s takendow nduring restoratio nactivitie s reinstalled ? (If applicable ) ^ ^ 

### 3

.Wa s damaget o gate s o r fence s avoided ? (Ifapplicable ) 

# -Z' ^
4

.Wa s damaget o retainin g wall s avoided ? (Ifapplicable ) 

# P "

Foundation , Sidin g aa dGutter s Ye s N o I

.Wa s damaget o th esidin g o r tri mavoided ? 

## i^ ' 2

.Wa s damag et o thefoundationavoided ? ^ ^ 

### 3

.

Wa s damageto window s avoided ? 4

.Wa s damageto window s o r door screen s avoided ? 5

.Wa s damaget o downspout s o r downspoui extension s avoided ? ^ ' ^ Sidewalk s an d Driveway s (Concrete ) Vcs N o 

### 1

.Wa s damageto driveway surface s avoided ? 2

.Wa s damaget o walkwa y surface s avoided ? 

# w

## Ov^'oers comments :

Inspectio nnotes :

Remova l an drestoratio o

n n

activate

activate s s complet

complet e eincludin including g th th

e e30-da

30-da y y so so d dwarranty warranty : : EP ARepresentativ e 

# Ucn ^ KJJJL

# Dale : Iff/j/o f

## Propert yCompletio n Agreemen t
ihi i agreement documenl s th e complelio n o l remedia l acliviiie s perloime d o n m yproperl yM ysignalure wil l designat e Iha l I am satisfie d wit h th e resloratio n o fm yproperly , an d tha i n o ilem s are i n questions , now
. o ra l an ylim e i n th e fiilui-e , excep l ihos e ilem s lisle d below , ifan y

PropertylD : ^3a\j^L ( Propert yAddress : Y^QO J ^ 3 ^ Q S T Owner : p^)^,f,^l n Na<V-^V^^7 ^ 

### Phone : ^<;0..-^^-^< ^ Restoratiort Item s i n Question :

Item : Item : Item : Item : Item : item :

|V ] I Ayrc rrestoralio n i fcompleted , excep t a s note d [_ } I rfo no t a(;re crc$lor«tin n i s complele d 

# /i v^2 ^ 

# ^ (%i^

. iHf ^
Dat e Contrartor' s Signatur e Dal e