## TRANSMITTALo f

OMAHALEAD SITE SOILREMEDIATIO NFIL EFOLDER
SAI D # : 7" ] \ 'R7
_Date : ]!-' V ' 0" ^ Address : ZM?)' ^ Y)^t)nO\ n Remediatio nContractor : Coasta l Environmenta l Grou p Year : 200 8
SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 

# y Vide o o f property (DVD ) 40314 8 5 

# y Executiv e Summary 

# 1 1 1 I I I Superfun d 

### EPA-provide dproperty sketc h Signe dAcces s Agreemen t fo r subjec t property Signe dAcces s Agreement(s ) for adjacent property Restoratio nAgreemen t Settlemen t document s (i.e. , fo r damag e or t o replac e plants , etc. ) 

# y Confirmatio ndat a Photograph s '^C^-D:fnrn)nh.(?a ^ Ct\xA.cJlts dSO-cLu i S6d j fifl M ^c d As-buil t sketc h Satisfactor y restoratio nsigne db y Property Owner 

# y Property close-ou t chec k lis t signe db y EPA Descriptio no f area s not meetin g RO D cleanu p criteri a D 

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

# y 

# y D' 

# %>j^\l \ 

# \M^\Jf y Signature Dat e

## Propert yAcces s Checklis t ropertyID:^^|g2
. Propert y Address : ^ l\2,^^\^.^^^. ^ G DWOR K STARTE D WOR K COMPELTE D ON : ON : _ / / / /

Address : 

## Phone:^^2-2K9/ ^ Fax : Phone : Fa.\ : Cell/Pager : Additiona l Information : 

# Travel ^ a\Dr

D Notificatio nLette r Sent : / /

,, 0 Acces s Agreemen t Signed : 5^/^/( ^ ^^Restoratio nAgreemen t 

### Signed : 3 /S^-^/O S C

U Topsoi l Samplin g (i f applicable ) / / C

D Disposa l Samplin g (if applicable ) / / E

H Garde nSamplin g (if applicable ) / / Q^tility Clearanc e Called : ^ 1 1 1 1 Ot J ^ Video/Photo s (Before ) 

## On : U lULl M
nVidcH)/Photo s (During ) On : / / nVideo/Photo s (After ) On : / / nVideo/Photo s (30-Day ) On : / / C

D Propert y Completio nAgreemen t Signed : / / nFina l Repor t Issued : / / Ai r Monitorin g (a s applicabl e > nCommunit y Q Cre w On : / / 

### By : Results :

c nCommunit y C U Cre w On:
_ / / Bv : Rcsuhs :
c nCommunit y Q Cre w On : / / By : Results : By : By : By : By : By : By : 

## By:pr
. ^//
. 

### By : {\{fi^ ^ Bv : By : By : By : By : ^2< ^ 

# ^rar l

1

•

Omah a Lea d Sit e

## CONTAC T FORM Propert y I D #3 ~~ l I Z^ Propert y Address : 

# yj^ yy y Initia l Contact : DateiS'H" ^ Time : |Sl^''>p>v s Action: pK?n < - r-toug-^fek^ina^ W Secon dContact : Date : Time : Action : Fina l Contact : Date : Time : Action : Fina l Action : Transmi t t o EP AD Othe r Action : n

Comment : j Owne r Commen t (s) :
Sit e *£-\ l ' ^^l^' ^ ^Ou>yi y ovt r -Wi apKo>^e ^ U^-^CAVC^ ^ 

## Coordinato r 1 Commen t (s) :



# 1 1 1

### Dougla s Count y Accoun t Informatio n Pag e 1 o f 1 ^jm a
Dougla s County , Nebrask a Propert yRecor d - R194527000 0 Prin t Repor t Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t o f14 4 S t - VieWO P 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 MORELL O BERNAR D J
1141 3 HICKOR YR D OMAH AN E 68144-000 0 PropertyInformatio n Ke yNumber : 452 7 000 0 1 9 Accoun t Type : Residentia l Parce l Number : 194527000 0 Parce l Address : 243 3 BLOND O S T OMAH AN E 68111-000 0 Lega l Description : PARKER S AD D LO T6 BLOC K6 E 3 0 N 7 2 F T Valu e Informatio n Lan d Improvemen t Tota l 200 7 $100.0 0 $0.0 0 $100.0 0 200 6 $100.0 0 $0.0 0 $100.0 0 200 5 $100.0 0 $0.0 0 $100.0 0 200 4 $100.0 0 $0.0 0 $100.0 0 200 3 $100.0 0 $0.0 0 $100.0 0 200 2 $0.0 0 $0.0 0 $0.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 4 2160. 0 0. 0 72. 0 30. 0 Ye s



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R194.
. . 5/7/200 8

### Prin t Previe w Pag e 1 o f 1 Dougla s County-Omaha , N E

Parce l I D Owne r Nam e Propert y Addres s Cit y Zi p Owne r Addres s Owne r Addres s 2 Owne r Cit y Owne r Stat e Owne r Zi p 194527000 0 MORELL O BERNAR D J 243 3 BLOND O S T OMAH A 6811 1

1141 3 HICKOR Y R D OMAH A
N E
6814 4 Sec-Twn Rn g Additio n Bloc k Lo t Lega l 1 Lega l 2 Lega l 3 Lega l 4 Treasure r Websit e Lin k Assesso r Websit e Lin k 16-15-1 3 PARKER S AD D 6 6 E 3 0 N 7 2 FT

http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp ? parc=194527000 0 http://douglasne.mapping online.com/DouglasCoNe/static/accountinfo.jsp ? accountno=R194527000 0 Disclaimer : Ma p an d parce l dat a ar e believe d t o b e accurate , bu t accurac yi s no t Ma p Scal e guaranteed
. Thi s i s no t a lega l documen t an d shoul d no t b e substitute d fo ra titl e search , 1 inc h = 7 2 fee t appraisal , survey , o rfo rzonin g verification
.


### http://www.dogis.org/dogi s alias/dogis/printPreview.aspx?PrintOptData=Dougla s County-..
. 6/21/200 8

### ( ^ 

# As-Buil t Drawin g
COASTA L 

# Omah aLea dSuperfun dSit e 2718 2 Exterio rPaint Omah a Lea d SH s Samplin g Address : 243 3 BLOND O S T Sit e Sketc h • Goo d
• Poor Phone : H (402)234-2820 AL T 

# i 0

^ No t paint Sampl e Numbe r Lea d Sampl e Sample s Collecte d Concentratio n Collecte d LA B 

### Firm : f M Fl^^ e RYASCPXA-2718 2 F 1 pp m 

## E f D Date: -? - jZ-C y RYBSCPXA-2718 2 F 2 3 Q I pp m 

### D Time : !C i '• ¥i > Q A ^ RYCSCPXA-2718 2 B 1 

## J±3 ± pp m 

### D Sample s Analyze d RYDSCPXA-2718 2 B2 2 0 7 pp m 

### D RDZQCPXA-g710 2 D * pp m 

### D D XR F Unit : (f,5H 2 Boo k /^ V RGgGCPX A2716 2 G3 - pp m 

### D D Dat e ft-/6-07 RPZOCPXA-2710 2 P 2 pp m 

### D D Time : 

# 2 ^ Staf f Numbe ro f Sample s = ^ 

### t^^w Legend : F l = Fron t Left
. F 2 = Fron t Rigtit , 8 1 = Bac k Left , B2 = Bac k Righ t DZ = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a s viewe d fro m th e street , facin g propert y 6LS#:2718 2 Dat e Excavated:6/21/200 8 Dat e USEP ASigne d Off:9/9/200 8 Are a Sodde d 180 0 s q f t 

# ENTERE D JU L 2 1 m i

B 1 = 16 6 PP M @ 1 2

F l = 36 9 PP M @ 1 2

Rev5 Crejic d Tif.^w n 1 1 0 6 1 5 

### Legen d Concret 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
.

### 2718 2 Exterio rPain t Nort h Arrow 

### Omah a Lea d Sit e Samplin g Address : 243 3 BLOND O S T 

### Sit e Sl(etc h • Goo d

• Poo r Phone : H (402)aS-282 0 ALT^^I ^ [y fNo t pain t Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Fir m Sample s Collecte d RYASCPXA-2718 2 F l 

### ^$12 , pp m 

### D Dat e 

### ^-12-0 7 RYBSCPXA-2718 2 F2 

### .3R L pp m 

### 0 / D Tim e RYCSCPXA-2718 2 RYDSCPXA-2718 2 RDZGCPX A2710 2 RGZGCnXA-2718 2 RPZOCrXA-2710 2 B l 8 2 D Z GZ ­ P Z 

# ^±31
. 2 o 7 pp m pp m pp m pp m pp m 

### D D D D 

# n D D Sample s Analyze d XR F Unit ; /p5V 2 Book : /ff V

Dat e Tim e 

### RI6-0 1 

# 2l ± Numbe ro t Sample s • Staff : 

### t^5\ l Legend : F 1 = Fron t Left , F2 = Fron t Right , B l = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , PZ = Pla y Al l quadrant s are as viewe d fro m th e street , facin g propert y 

# ENTERED ; . lu i
.0 7 9no 7
. 1
. i
. 1 tw« » 

### J o

- 

# • .OC>A;
. 

# lu9Bs> ^

H 5 9 ^0 1 

# B l^ B Z

I.H3 5

. . si

­

\ 

# n 

# n Z8T 2 3B i \



### B/o^^C'^-f-
. '

Cicale d 7,'9/'20() 7 1 1 0 6 1 5

# 2718 2 Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e • Goo d Samplin g Address : 243 3 BLOND O ST 

### Sit e SIcetc h
• Poo r Phone : ^ (402)aS-2820^LTt^^ ^ (v fNo t pain t Sampl e Numbe r RYASCPXA-2718 2 F l Lea d Concentratio n 

## 2g7 Z pp m Sampl e Collecte d 

# Ef LA B 

## D Fir m Dat e Sample s Collecte d 

# FM ?e>'pe > RYBSCPXA-2718 2 F 2 

# .3M
. pp m 

# n Tim e RYCSCPXA-2718 2 RYDSCPXA-2718 2 B 1 B 2 

# ±L33
. 2 0 7 pp m pp m 

## D 

# n Sample s Analyze d RDZOC^Xl ^ 2710 2 B i pp m 

# n D XR F Unit : f^5H l Book : 

## 1BJ! L RGZOCPXA-2718 2 -GZ ­ pp m 

## D 

# n Date : f ^

J6-0 1 RPZOCPXA-2710 2 P Z pp m 

## D Time : P/ ^ Numbe ro fSamples : 

# o Staff: f^W Legend : F 1 = Fron t Left , F 2 = 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 y Al l quadrant s are as viewe d fro m th e street , facin g propert y 

# ENTERED

,.. . mi
. .0
. 7 5n0 7 

## J o LL1 LUU f



### .. . /



# . 

# B l .10 1 

# u 1 y35tymc{ o .j[.
. .. . 

# 1 ^ ' n1
\ I• M 

# U i . '
. . .


## B h y\ d 

# tSf
.

Re v 5 Creale d7,-9/200 7 1 1 0 6 I 5
y]<» ' »D Tno ) X w joa i a» i xi r x rgK'KO'jai ' MO' xfi > xo J ja nK I'iir aATiiXB'x o V Ton' ia>

- xa r jai i xx nM^ :

## 2718 2 Omah a Lea d Sit e SamDiin a Address : 243 3 BLOND O S T 

### Sit e Sketc h Phone : H ; (402)234-282 0 ALT : Sampl e Numbe r RYASCPXA-2718 2 RYBSCPXA-2718 2 RYCSCPXA-2718 2 RYDSCPXA-2718 2 ROZOCPX A2710 2 ROZOCPX A2716 2 RPZOCPXA-2710 2 Lea d Sampl e LA B Concentratio n Collecte d F l 

### 2S7 Z ppm 

# D F2 

### 3 8 / ppm 

# D B l 

## W5 ^ pp m 

# D B2 

## 2o 7 pp m 

# 0 D 9 ^ pp m 

# D D SZ - pp m 

# D D PZ pp m 

# D D Numbe ro fSample s = ^ Exterio rPain t Nort h Arro w 

### • Goo d n Poo r 

# r 0

^

Not pain t Sample s Collecte d 

## Firm : F M F^'l> 0 Date : J- - /2-0 7 Time : It ) • ^5 ~ <:i , A ^ Sample s Analyze d XR F Unit : f^6H 2 Book : //^ Y

Date : 

### f^yj-o i Time : 

# 2l ± Staff : 

## M<^ w Legend : F 1 = Fron t Left , F2 = Fron t Right , B l = Bac k Left , B 2 = Bac k Righ t DZ = Dri p Zone , G Z = Garden , PZ = Play Al l quadrant s ar e a s viewe d fro m tti e street , facin g propert y 

# ENTERE D

, : . . . iUl
. 0 7 900 7
. LJ Luv r 

## J o \

y / 

# .45 ^ 20 7 

# ' u c ^\ ' / 

## I.H3 5 

# t\md o 1 ;^f
.

• s <^ / 

# F/ ^ jt ^ F 2 281 2 38 / \ > > ' 

# .BimdoS h;

Re v 5 Cieale d7/V/20O 7 11061 5 04614 1 012 3 0 * XD

* n r

im ' m ! m ' XK ' HO ' i i : 50C 1 XC ' wwi ' w rTptt - TM

Tice ' nr ' loc ' im ' rr fjoc ' 3 T300 ' X V nr > KO ' las n n B'»r 7 jxc-,' waofiTxv'nooc'roD rjacxorxcixwac'm^'iecTnrxc i xCOASTA L INVmOHn fNT« t C i O U » IM C 

# ^^nf^ ^ 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 : Bernar d iWoC-cMc i Daytim e Phone : (4o3. - 3>MS l - 7.%'^ 0

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 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 , 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 f2COASTA L FNVinONMEN'r& l C •O Li » ' l » C



### •Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; • Remov e flowe rbulb s 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 TTO 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

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


## 0.^ ^

^/7-0- i Signatur e Dat e

Q

I woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.COASTA L ENVIRO~=e-4TA L C R o I
. P I I N r . 

### Restoratio n Agreemen t Th e purpos e ofthi s agreemen t i s to provid e amutual agreemen t a s to condition s o f th e propert\ ' prio r to remediatio nactivities
. Thi s will als o serv e a s documentatio nfo r th e purpos e o f assurin g that restoratio n activitie s ar e complete dto th e satisfactio no f th e propert y owner andth e Unite dState s Environmental Protectio nAgenc y (EPA)
.

Property ID : ^T j \%9 ^ Property Address : ^t{5 3 ftlon^O V . Owner : i^cfnoT d ^or^U o 

### Phone : qj^g ^ , 3^9^"21*^^ 0
Onth e attache ddiagram(s ) indicate area(s ) to excavate danddept ho f excavation , locatio no f al l known utilities , subsurfac e features , surfac e structure s an dlandscaping , features , acces s location(s ) t o be usedb y contractor , andth e directio no f North
. Indicat e distances , depths , material types , etc . Indicate digita l photo s b

y referencin g the photo-lo g number wit ha narro w indicatin g directio no f view
. 

### Item s T o B e Remove d B yOwne rBefor e Star t O f Remediation : (Us e additiona l sheet s a s necessary ) Th e removal , storage , disposal , and/o rretur n o f thes e item s i s th e Owner' s responsibility
. Item : 

### H^V>€.
. Item : item : Item : Item : Item : Item :

• Item :
Pag e 1 of
.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 : 

## Wov)i L Item : Item : Item : Item : : Item : • Item : Item : Item : Item : Item : Item : Item : Item :
Item :

Pag e 2 of
. 1COASTA L 

### 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 : 

### UDVV L Item :
Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :
Item :

Pag e 3 of
.COASTA L 

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

## Ite m

Pre-existin g property area , that wil l b e excavated , tha t i s covere dwit hgrass .

Numbe r o f tree s > 2 inch trunk 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 , Timers , Heads , etc . Attac hasketc ho f th e sprinkle r layout
.

Numbe r o f an dsiz e o f eac hgarden/ flower be d area . Attac hasketc ho f relativ e size s an dlocations
. 

## Quantit y 

# Fi,e> i

I

- ^ s

^



# ^5 s Uni t

Square fee t

a 

## - Condition/Type/Specie s \e--t i ha.1 ^ D- C prcpp-er-fy
.

Each --

Each

Each

Each Square Feet

Pag e 4of
.COASTA L 

## Ite m Quantit y Uiii t Condition/Type/Specie s Agree dupo nvalu e of plan t material s no t t o b e replace db v contractor . Note thi s valu e will b e use dt o issu e aplan t vouche r t o th e propert y owner . - ^ 

## $ 0

Agree dupo nlis t o f plant material s that will b e replace dby contractor . B e very specifi c anddetailed
. Includ e asketc hof were eachplant will b e place d b

y th e contractor . 

# A Each

Agree dupo nare ao f property to b e replace d wit hgras s sod
. Includ e asketc hof th e area(s ) to b e replace dwit h gras s sod
. , 

## Ft,l3>i
S F 

## - &-X \esi^cx^^ ^ Os<j> ~

Are ao f Cit y or Count y property t o b e landscape d pe r thei r requirements
. S F 1 1

Includ e are a(s ) a sketc ho f th e

Easemen t Area , t o b e excavate d ^£jfJLXf\lUtC i S F
1

Pag e 5 of
.C O AS TAI
. • N VMik O M M ^ M TAL CaOUr

. IM C 

# < ? Additiona i Comment s / Instructions : 

## y-5c?f e ^^ ^ ee-'^+''^e^ ^

areA<>
.

Wf\u K 

# c 

# 3 Q>ior^cU > Sf

n Chec 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
. Bycheckin 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 crack s o rfissures
.



### nI agre e nI d o no t agre e 

# Ce ^ yyy-c r Owner' s Signatur e Dat e Contractor' s Signatur e Dat e•
BVID # 

# (97^6 2 XR F PROPERT Y SAMPL E SHEE T Dat e 

# yj:i\jtfi > Addres s 

# 'M^\NorvcU'^SF : Projec t Omah a lea d F P 2n d yea roptio n Sampl e tim e ^ 

### T B am , XR F ID # 

## 'h'Xb^ ^ sampl e lengt h 3 0 se c



### Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a 

# H E '?iV< i h e 3>4 ^

- t 3 3 

# G / Y i 

# n . - t i2 > 1'5' i *
. -x ^ s<\ l ±^ D Dept h 

## u<ru> i -hH Dept h 

# 1 S/2 ) ^ ^ 

## y^n ^

±^' h \j > Averag e \D^I ^ 3 3 Averag e ^5? / ' t ^ U
Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h Averag e Averag e

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

RETES TAREA S Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a 

### ^ ^l a 

## 3 N i : /t ^ ^ \ ^ 

# m bi nk a ^ 

# r / 1 

# a . STSX ^ 

# ? / 3 3 / ^ a^ v Dept h 

# TT^ E Dept h ^ 

## ^g-^ a i l l -f cM 

## 7 ^ 

# S ^ i T Averag e 3^ ^

" ^ ^ ^ Averag e 

# ll ^ ~U<

­ Date^/;?y<Q 6 Signature

_ 

## Prin t |flW^ 6 if^-Z^O^

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

# 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 18 7 Mod e SOI L Tim e 2008-06-2 1 16:4 3 Duratio n 122.1 1 Sequenc e Fina l Flag s AVERAG E fAv g o f183-18 6 * ADDRES S 243 3 Blond o * QUAD/ZON E INSPECTO R MATTEU S DEPT H 6 SAMPL E TYP E P CLEARANCE ? NOT E

Supervise d By :

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

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

pp m P b 748.26 8 Supervise d By : 

## Certificat e o fVerificatio n

18 2 SOI L 2008-06-2 1 16:3 9 30.3 0 Fina l 2718 2 243 3 Blond o B 2 MATTEU S 6 CLEARANC E

± Erro r ± 34.52 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 665.19 4 Supervise d By : 

## Certificat e o fVerificatio n

18 3 SOI L 2008-06-2 1 16:4 0 30.4 0 Fina l 2718 2 243 3 Blond o 6 2 MATTEU S 6 CLEARANC E

± Erro r
± 32.63 0

# 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 591.26 4 Supervise d By : 

## Certificat e o fVerificatio n

18 4 SOI L 2008-06-2 1 16:4 1 30.6 5 Fina l 2718 2 243 3 Blond o B 2 MATTEU S 6 CLEARANC E

±Erro r ±29.70 5

# • I 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 18 5 Mod e SOI L Tim e 2008-06-2 1 16:4 2 Duratio n 30.6 7 Sequenc e Fina l Flag s BVI D # 2718 2 ADDRES S 243 3 Blond o QUAD/ZON E B 2 INSPECTO R MATTEU S DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P b 813.82 0 ± 35.33 7 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 18 6 Mod e SOI L Tim e 2008-06-2 1 16:4 3 Duratio n 30.3 9 Sequenc e Fina l Flag s BVI D # s 2718 2 ADDRES S 243 3 Blond o QUAD/ZON E B 2 INSPECTO R MATTEU S DEPT H 1^: 6 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 19 2 Mod e SOI L Tim e 2008-06-2 1 16:4 6 Duratio n 122.9 0 Sequenc e Fina l Flag s AVERAG E Avg of 188-191 ? ADDRES S 243 3 Blond o QUAD/ZON E F l INSPECTO R MATTEU S DEPT H 

### 6 SAMPL E TYP E 'CLEARANC E NOT E

# 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 343.98 6 Supervise d By : 

## Certificat e o fVerificatio n

18 8 SOI L 2008-06-2 1 16:4 4 30.6 4 Fina l 2718 2 243 3 Blond o F l MATTEU S 6 CLEARANC E

± Erro r
± 22.13 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 758.54 7 Supervise d By : 

## Certificat e o fVerificatio n

18 9 SOI L 2008-06-2 1 16:4 5 30.3 1 Fina l 2718 2 243 3 Blond o F l MATTEU S 6 CLEARANC E

± Erro r
± 34.41 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 456.15 7 Supervise d By : 

## Certificat e o fVerificatio n

19 0 SOI L 2008-06-2 1 16:4 6 30.6 5 Fina l 2718 2 243 3 Blond o F l MATTEU S 6 CLEARANC E

± Erro r ± 25.82 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 366.93 4 Supervise d By : 

## Certificat e o fVerificatio n

19 1 SOI L 2008-06-2 1 16:4 6 31.3 0 Fina l 2718 2 243 3 Blond o F l MATTEU S 6 CLEARANC E

± Erro r
± 23.33 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

Supervise d By : 

## Certificat e o fVerificatio n

19 7 SOI L 2008-06-2 1 16:5 6 122.2 1 Fina l Av g o f193-19 6 243 3 Blond o F l MATTEU S 1 2 RETES T^ 

# 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 19 3 Mod e SOI L Tim e 2008-06-2 1 16:5 3 Duratio n 30.6 3 Sequenc e Fina l Flag s BVI D # 2718 2 ADDRES S 243 3 Blond o QUAD/ZON E F l INSPECTO R MATEU S DEPT H 1 2 SAMPL E TYP E RETES T NOT E

pp m ± Erro r P b 23.89 2 389.11 9 ± 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 323.85 5 Supervise d By : 

## Certificat e o fVerificatio n

19 4 SOI L 2008-06-2 1 16:5 4 30.3 0 Fina l 2718 2 243 3 Blond o F l MATTEU S 1 2 RETES T

± Erro r
± 22.31 9

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

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

pp m P b 231.47 1 Supervise d By : 

## Certificat e o fVerificatio n

19 5 SOI L 2008-06-2 1 16:5 5 30.9 7 Fina l 2718 2 243 3 Blond o F l MATTEU S 1 2 RETES T

± Erro r
± 18.50 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 532.31 3 Supervise d By : 

## Certificat e o fVerificatio n

19 6 SOI L 2008-06-2 1 16:5 6 30.3 1 Fina l 2718 2 243 3 Blond o F l MATTEU S 1 2 RETES T

± Erro r
± 29.31 6

# 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 20 2 Mod e SOI L Tim e 2008-06-2 1 17:0 0 Duratio n 123.7 7 Sequenc e Fina l Flag s AVERAG E Av g o f198-20 1 ADDRES S 243 3 Blond o - - QUAD/ZON E INSPECTO R MATTEU S DEPT H 1 2 SAMPL E TYP E RETES TI NOT E

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 214.20 0 Supervise d By : 

## Certificat e o fVerificatio n

19 8 SOI L 2008-06-2 1 16:5 8 30.6 5 Fina l 2718 2 243 3 Blond o B l MATTEU S 1 2 RETES T

± Erro r
± 18.03 2

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

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

pp m P b 271.86 5 Supervise d By : 

## Certificat e o fVerificatio n

19 9 SOI L 2008-06-2 1 16:5 9 31.0 0 Fina l 2718 2 243 3 Blond o B l MATTEU S 1 2 RETES T

±Erro r ±20.69 6

# 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 20 0 Mod e SOI L Tim e 2008-06-2 1 16:5 9 Duratio n 31.2 2 Sequenc e Fina l Flag s BVI D # 2718 2 ADDRES S 243 3 Blond o QUAD/ZON E B l INSPECTO R MATTEU S DEPT H 1 2 SAMPL E TYP E RETES T NOT E

pp m ±Erro r P b 78.92 6 ±11.77 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 98.41 3 Supervise d By : 

## Certificat e o f Verificatio n

20 1 SOIL 2008-06-2 1 17:0 0 30.9 0 Fina l 2718 2 243 3 Blond o B l MATTEU S 1 2 RETES T

± Erro r ± 12.73 6

### ?lfiL, \ i }^^ ^

I \^*^^ ^ ^-•iPHot* ^ 

### Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
. www.CGastalha2mat.co m COASTA L ENVIKONMENTA L G n o u r . INC

. 

# EXECUTIV ESUMMARY : BVI D #2718 2 - (2433 BLOND O ST )

~x \N o Issue s o r Concern s | ^ Issues/Concern s
Detai l Explanation: N O ISSUE S PENDING
.

# ^^EPA ^ - 

# EP APropert y Clos e Ou t For m 24^ ^ gjte ^ 3

^ Propert y tt : Z^l^Z, , . Propert y Address : Date/Time : Owner' s Name : /, 

### ^ ,____ ^ „ij[m£i= — Quad s Excavated : 2' j & 1 Contracto rGrou p (jQOLS|<g d Pji^U\fftmvOfyVh^ l
Ye s N o Excavatio n Genera l ^f\Cf{hf \ LPT ^ I
.If necessary , were th e correc t quadrant(s ) excavate dandrestored ? 2
.I f necessary , were th e correc t area s o f dri p zon e excavate dandrestored ? L ^ Ye s N o Gradin g So dan dVegetatio n Doe s the gradin g aroun dth e perimete r ofth e hous e i nexcavate darea s generall y slop e awa y 

## A/ A fromth e house ? 2
.Ha s so dbee nlai di nal ! area s tha t were excavated ? 

## y 3
.Doe s the sodappear to t> e generall y healthy an dgrowing ? (Only evaluat e i f inspecte da t a.3 0 

### y day time period ) 4
.Ar e soddedarea s generall y firman devenl y graded ? 

### y 5
.

Ar e th e joint s betwee nth e so dstrip s generall y tight' ' (Only evaluat e i f inspecte da t a3 0 da y "Scxn^-

­ tim e period ) W; ^ \>ee^ ^ rewo/tuA- (2-£^ GI'-'l U '^-s ^ 6
. Wa s the propert y grade dsuchtha t water will no t poo l o nthe properT) ' 7 W£i s damag e t o landscapin g or plan t material s avoided'^ ' 

## 0 h Gates , Fence s an d Retainin e Wall s \ e s N o 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 activilie s reinstalled ? (Ifapplicable ) — 1 /y> ­ 3
. Wa s damag e t o gate s o rfence s avoided ? (ifapplicable ) 4
. Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) 

## 4 Foupdation , Sidin g an dGutter s Ye s .N o 1
. Wa s damag e t o th e sidin g o rtri m avoided ? 2
. Wa s damag e t o th e foundatio n avoided ? 

## l-rP*^ ^ J
. Wa s damag e t o window s avoided ? 

# y^ y A/A 4
. Wa s damag e t o window s o rdoo rscreen s avoided ? 5
. Wa s damag e l o downspout s o rdownspou l extension s avoided ? i Sidewalk s an d Driveway s (Concrete ) Yes N o 1
.

Wa s damag e t o drivewa ysurface s avoided' ^ 

## A/, t 2
.Wa s damag e t o walkwa ysurface s avoided ? 

## (vA

## 'Owner s comments :

Inspectio nnotes :

Removal andrestoratio nactivate s complete includin g the 30-da y so dwarranty : EP ARepresentati^.r^'^J^X^^y^.^^^X ^ Date:__£/f^4 ^

## Propert yCompletio n Agreemen t Tlii s agreement document s the completio no f remedia l activitie s performe do nm y property . M y signature wil l designate tha t I a msatisfie dwit hth e restoratio no f m y property , an dtha t n o item s ar e i nquestions , now , o r a

t any tim e i nth e future , except thos e item s liste dbelow , ifany
. Propert y ID : j -t i (7 0 Propert y Address : X H' ^ ^ C3\«^A o 

# s- \I 0^"^'- = 6e.... y Mo.-^A( ^ i Phone : J ., ^ ^ ^ ^ ^ ^ Restoratio n Item s i n Question :

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

T I I aiijrc e restoratio nIs completed , excep t a s note d I I d o no t agreeTestoratlo ni s complete d

y ' ' Owner' s SigniUm- c Date / Contractor' s Signatur e Dat e

. / I