## TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R

SAID# : Date : Address : dAJ ! M UW RemediationContractor : Coastal Environmenta l Group

_Year : _2010ARRA

_ SOI LREMEDIATIO N PROPERT YFIL EFOLDERDOCUMENT S Video of propert y (DVD) Executive Summar y EPA-providedpropert y sketch SignedAcces s Agreemen t fo r

subject propert y Signe dAcces s Agreement(s ) fo r

adjacen t propert y RestorationAgreemen t Settlemen t documents (i.e. , fo r

damage or to replac e plants , etc. ) Confirmationdata Photograph s ife {p^f^\( ^ \\yC^P(^^\ ^ \^0' ^ As-built sketch Satisfactor y restorationsignedb y Propert y Owne r Propert y close-ou t chec k

lis t signedb y EP A Descriptionof areas not meeting RO D cleanu p criteri a Utilit y cle a iation fromDouglas Count y Assessor' s Offic e

3021846 6 Superfun d

# ^ v Propert yAcces s Checklis t Property ID : 

# 23& n ON : / / D WOR K STARTE D Property Addriss : 25Jf l Mapfo^^l D WORKCOMPELTE D ON : II
Owner : Renter : 

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/^ajj(3 t Address : Phone : Fax : Ceil/Pager : 

# Phone : Zj(!jft^Q|^ ^ Additional Information : Fax : Ceil/Pager : 

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D NotificationLette r Sent : / / By : ffi^ Acces s Agreement 

# Signed : i/ti/l Q By : D Restoratio nAgreement 

## Siened : I I By : D Topsoil Samplin g (if applicable ) 

## 1 1 By : D Disposa l Sampling (if applicable ) 

## 1 1 By : D Garde nSampling (if appUcable) 

## 1 1 By : E

. UtiUt y Clearanc e CaUed : CM/V3k A O ®y=ou/i:S/i o ix)cr\dy j H ' Video/Photo s (Before) 

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- f^cXx^i ^ D Video/Photo s (During ) On : / / By : nVideo/Photo s (After) On : / / By : nVideo/Photo s (30-Day ) On : / / By : nProperty Completio nAgreement Si&ned : / / By : nFinal Report Issued : / / By : Ai r Monitorin g (a s appUcable) f~

| Commuiut y Q Cre w On : / / 

## By : 1 Results :

nCommuiut y [UCre w On : / / By : Results :

• Communit y O Cre w On : / / By : Results :

Omah a Lea d Sit e

## Dougla s County Accoun t I n 

# mi^^ n Pag e 1 of 2

Dougla s County , Nebrask a Propert yRecor d - R200345000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s avaiiabi e @ scal e 0-5 0 f t wes t o f52n d S t - VJO WO n Ma p 

### Infonnatio n i s vali d a s o f2009-12-1 5 Treasurer' s Ta xRepor t Ne wFeatur e -•••- » Aut o Sale s Searc h Owne r EL-HAJJA R FAYE Z ETA L 1171 8 MEREDIT H AV E OMAH AN E 68164-000 0 Propert yInformatio n Ke yNumber : 034 5 000 0 2 0 

## Account Type : Residentia l Parce l Number : 200345000 0 Parce l Address : 251 8 MAPL E S T OMAH AN E 68111-000 0 Lega l Description : PATRICK S - AS
- AD D LO T5 BLOC K8 W3 0 F T3 0 X12 0 Valu e Informatio n



### 200 9 200 8 200 7 200 6 200 5 200 4 Lan d 

### $1,900.0 0 $1,900.0 0 $1,900.0 0 $1,900.0 0 $1,900.0 0 $1,900.0 0 Improvemen t $15,900.0 0 $17,400.0 0 $17,400.0 0 $17,400.0 0 $17,400.0 0 $9,200.0 0 Tota l $17,800.0 0 

### $19,300.0 0 $19,300.0 0 $19,300.0 0 $19,300.0 0 $11,100.0 0 Sale s Informatio n Sale s Date : 

### 2003-09-2 5 Dee d Type : Price : Grantor : W D Book : $20,000.0 0 JAME S HOLMO N ETA L 200 3 Page : 19666 0

Grantee : FAVE Z EL-HAJJA R ETA L Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s 0.0 8 S F 3600. 0 Unit s 1. 0 Dept h 120. 0 Widt h 30. 0 Vacan t N o Improvement Informatio n



## http ://douglasne.mapping-online.com/DouglasCoNe/static/accoxmtinfo. j sp?accountno=R2..

. 12/3 1 /200 9

## Dougla s County Accoun t In 

## te|7|^)n Pag e 2 of 2

Buildin g 1

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CLIC KTO ENLARG E IMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : 

### 1075. 0 Perimete r 0. 0 Uni t Type :

Buil t As : 1 1/ 2 Stor yUnfi n HVAC : Centra l Ai rt o Ai r Exterior : Fram e Sidin g Interior : Drywal l Roo fCover : Compositio n Shingl e

Roo fType : Gabl e Floorcover : Allowanc e

Yea rBuil t Yea r Remodele d Percen t Remodele d 

### 188 5 0 % Percen t Complete : 

### 100.0 % Quality : Averag e Condition : Fai r Cond o Squar e Footage : 0. 0 Rooms : 5. 0

Units : 

### 1. 0 Baths : 

### 1. 0 Bedrooms : 2. 0 Stories : 

### 1. 5 Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Adjuste d Yea r Buil t Physica l Ag e 

### 188 5 12 5 Detai l Typ e Applianc e Basemen t Fixtur e Fixtur e Porc h Detai l Descriptio n Allowanc e Bsmn t Bloc k 8 f t Bas e Fixture s Bat h Ful l Sla b Roo fCeilin g Unit s 

### 1. 0 901. 0 1. 0 1. 0 172. 0



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2.

. . 12/31/200 9

### Pag e 1 o f 1 # •



# •

fiw^' '^'\^r ^ Creat e Anothe rTicke t Bac k t o Irt h Inteme t I Sen d Emai l ] 

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YOU RTICKE T NUMBE RI S 2475434

. Origina l Cal l Date : 4/26/1 0 Time : 3:2 7 pmOp : ELIZABETH1879 0 Wor k t o Begi n Date : 4/28/1 0 Time : 4:0 0 pm State : N E County : DOUGLA S Place : OMAH A Address : 251 8 Street : MAPL E S T Twp : 15 NRng : 13 E Sect-Qtr : 09-NE-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATION Locatio n o f Work : LOCAT E ENTIR E PROPERTY , AL L EASEMENT S AND T O TH E PEDESTA L Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E I F CORNE R LOT
. Compan y: COASTAL ENVIRONMENTAL SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Being Don e For : COASTAL Dept ho f Excavation : 4 F T Corne r Lot : N Front : Y Rear : Y Involve s Tunneling o r Horizonta l Boring : N Explosives : N CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac t Phon e Number Utilit y Typ e Day : 402934046 9 CXCAT V CO XCOMMUNICATIONS , IN C HEIDI Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUDO l METROPOLITA NUTILITIES DISTRICTSAND Y Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT YO FOMAHA-TRAFFICSEWE RRICH/TRAFFI C Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 OPPDGPR 5 OMAH APUBLI C POWE RDISTRICT EL M LOCATIN GAlt : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 QLNNEI C QWES TLOCA LNETWOR K EL M LOCATIN GAlt : 406207149 4 Emerg : 888728934 3

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

. . 4/26/201 0

# As-Buil t Drawin g

C OASTA L ENVIKONHENTA L 

# Omah aLea dSuperfun dSit e C KO U P , IN C OLS# : 2982 7 Dat e Excavated : 4/28/201 0 Dat e USEP ASigne d Off : 6/10/201 0 

## 29827 Are a Sodden : 292 5 s o f t Exterio rPaint Nort h Arro w Qmah a Lea d Sit e Owne rName:FAYEZ^UHAJjA R Sit e Sketc h •Goo d Address : 2518MAPI £S T •Poo r Ptione : H 402-49M11 1 W : 

### \ Q ^ No t paint Sampl e Numbe r Lead Sampl e j^ ^ Sample s Collecte d Ckmcentratio n Collecte d ^ ^ Fimi:Pt. A\RS\CJ O RYASCPXA-2982 7 F 1 Date : OS
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# An Staff : Numbe rofSample s = J 

## Kr^w ^ Legend : F 1 = Fron t Left , F 2 = Fron t Right , B l = Bac k Left

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### Legen d 

# D Concret e Dri p Zon e Excavate d Quadrant s Excavate d tt/?; Are a replace d wit h Are a replace d wit h Are a lef t bar e So d Rock/Mulc h 

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

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# 29827 Exterio rPain t Nort h Arro w 

### Omah a Loa d Sit e Owne rName : FAYEZ EL-HAJJA R 

## • Goo d Sit e Sketc h Address:.25i 8 MAPL E S T •Poor Phone : H : 402-498-811 1 W : \ ofNo t paint Sampl e Numbe r Lea d Sampl e Sample s Collecte d LAB Concentratio n Collecte d Fir m RYASCPXA-2982 7 F l ^3 Z pp m 

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# D Date : L- 5 - OC g 

# D RPZSCPX A2682 7 F * pp m 

# D Time : Af ^ 

# D 

# f Staff : f^r^ W Numbe ro fSample s = 5 " Legend : F l = Fron t Left , F2 = Fron t Right , B l = Bac k Left , B 2 = Bacl < Righ t DZ = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrants ar e as viewe d fro m tli e street , facin g property 3 irp m th e s 

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## 2982 7 Exterio rPain t NofthAiTo w1 

### Owne rName : FAYE Z EL-HAJJA R Omah a Lea d Sit e Q Goo d 

### Addre88:25i8iWAPLESTSit e Sketc h 

## •Poo r Phone : H : 402-498-811 1 W : 

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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 propertyowner) consent s t o an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA) o rits 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 : 

# "^nzi

Owner' s Name : Coi^e.'L
- ^ i fyiu 14/^ Daytim e Phone : Y* ^ 

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### Addres s o fPropert y covere d b ythi s 

# 26/ a M^ ^ 5 T Agreement :
PURPOS E O F RESPONS E ACTIVITIE S 

## Th e EPAi s requestin g acces s t o collect soi l sample s an d remove soi l tha t contain s elevate d concentration s o flea d an d maypos e a healt h hazard

. Th e area(s ) wil l b e excavate d t o remov e contaminate d soil

. Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o its origina l condition

. Thi s wor k i s bein g perfomie d unde rth e Omah a Lea d Superfun d Sit e remediatio n program
. Arepresentativ e o fCoasta l Environmenta l Group , contracte d byUSEPA , wil l contact th e Granto rin-perso n t o discus s th e wor k t o b e perfomned , th e Granto rwil l hav e a n opportunityt o revie wan d approv e th e planne d soi l removal , an d restoratio n wor k before i t begins

. Onc e th e wor k i s finished , th e Granto rwil l b e aske d t o revie wth e wor k an d confir m tha t i t i s complet e an d meet s wit h th e Grantor' s approval

. Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m EPAtha t th e property has 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 , its employees , contractors an d subcontractors th e righ t t o ente rth e property , a t al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e o fperfomnin g th e work

. Thi s acces s shal l remai n i n effect unti l th e woh< ha s bee n satisfactoril ycompleted

. Th e Granto rals o agree s to :

Pag e 1 o f2

## c V'^jfCOASTA l

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,rf C lUTIIIOHHtlcTA l ^ « PRO' ^ C « 0 U rI Kc



## « 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 ; cWate 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 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 perfon n th e work

. oAllo 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 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



# Big r D I d o not grant acces s to m yproperties I gran t acces s t o m yproperties

-r, 2 / i /t ? Dat e Signatur eDat e

DI 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

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COASTA L ENVIRONMENTA L GROUP

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# ADJACEN TPROPERT YACCESS REQUEST

WORKIN G PROPERTyADDRES S ol6\ S KiWOiC

. ^ ADJACEN TPROPERT YADDRES S Q.^99 ^ \<ACiS)\ P ^ OWNE R NAM E f^y/^. n V>V\\rV S ^^ ^ ACCES S REQUESTED :

OWNE R SIGNATUR E FOREMA N SIGNATUR E SUPERVISO R INITIA LCOASTA L 

## Restoratio n Agreemen t The purpos e of thi s agreemen t i s to provide amutua l agreemen t a s to condition s ofth e propert y prior to remediationactivities

. Thi s will als o serve a s documentationfo r

th e purpos eof assiiring tha t restoration activitie s ar e completedto the satisfactionof the propert y owne r an dthe UnitedState s Environmenta l ProtectionAgency (EPA)

.

Propert y ID : 

# 7^^ $ 2- 7 Propert y Address ; *^2^/ € Li4i9^^'^^ ' Owner : 

## fy^-^z ^ S LM>y.^

. ^y^^r ^ ^mfu ^ Phone : If^ ^ <f9Si/ U 

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nthe attacheddiagram(s ) indicat e aFea(s) to excavate , surface structure s an dlandscapin g feature s an d acces s location(s ) to b e usedby the contractors
. Indicat e distances , depths , materia l types , etc
. Photographicall y an dVideographicall y documen t the existing condition s ofth e propert y an dthe basemen t if necessary . Item s t o b e Remove d b yth e Owne rbefor e Star t o fRemediation : Th e removal , storage , disposal , and/o rretur n o fthes e item s i s th e Owner' s responsibility

. Item : 

# ijMe

. Item :
Kem :
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## Item s t o b e Remove d b y th e Contracto r Durin g Remediatio n an d No t Reolace d Hem : 

## M\yrn ^ Kem :
Kem :
Item :

Pag e 1 of

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## Item s t o B e Remove d B yContracto r Durin g Remediatio n an d Replace d Kem : 

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# So! ) Kem : 

## f<W\<^ ^ Kem :

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## Ite m
Pre-existin g property area , that wil l b e excavated , that i s coveredwithgrass . 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 , 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

. Agree dupo nvalu e o f plan t material s no t t o b e replace db v contractor
. Not e thi s valu e wil l b e use dt o issu e aplan t vouche r t o th e propert y owner . 

# y (lcJ^\3\/ C



## Landscap e Inventor y Quantit y Uni t Conditlon/Type/Specle s Quadrant s 

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### AddKiona l Comment s / Instructions : Th e cit yo fOmah a ordinance s ma yprohib Kyo u fro m usin g dir t o rgrave l areas o n you rproperty as driveway s o rvehicl e parkin g areas
. Th e Environmenta l Protectio n Agency(EPA ) ma yb e removin g an d replacin g soi l underiyin g a grave l o rdirt are a o n you rpropertytha t yo u ma yb e usin g a s a drivewa yo rvehicl e parkin g area
. I fthi s i s th e case , yo u shoul d understan d tha t thi s removin g an d replacin g o fsoi l doe s no t mea n tha t an yillega l drivewayo rparkin g are a o n you r propertyi s mad e legal

. T o th e contrary , yo u ma yb e cite d b yth e cit yI fyo u us e a grave l o rdir t are a a s a drivewayo rparkin g area , no t wKhstandin g an yremova l o rreplacemen t o fsoi l b yth e EPA

. I fyo u have an yquestio n abou t legalityo fa certai n drivewa yo rparkin g area , yo u ma ycontact th e cK yo fOmaha' s Plannin g Departmen t a t (402 ) 444-5150

. Pleas e chec k thi s bo xi fyo u understan d th e informatio n outline d above

. 

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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

. 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 crack s o rfissures

.



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Sampl e are a Dept h

# 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 66 8 Mod e SOI L Tim e 2010-05-1 2 17:3 1 Duratio n 90.3 2 Sequenc e Fina l Flag s AVERAG E «Av g o f665-66 7 ADDRES S 251 8 Mapl e s t • QUADRAN T EA DEPT H 1 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D 

### : 8.23 1 Z r 405.42 2 ± 15.53 1 S r 197.00 4 ± 9.84 3 U < LO D 15.88 5 R b 71.08 8 ± 6.93 1 T h
- 13.82 1 ± 9.18 6 P b 253.21 4 ± 21.79 4 S e < LO D 6.23 7 A s 131.10 9 ± 22.26 7 H g < LO D 13.55 2 Z n 257.99 0 ± 27.86 6 W < LO D 

### :

_96.55 3 C u 56.61 1 

### ^< ^ / 23.72 9 N i C o Fe M n < LO D 

### < LO D 21802.33 8 561.93 5 

### X 

### / : ; / 

### / / 79.09 7 204.81 8 438.72 3 103.55 2 

# y
. v - Super v 

### se d By : 

### S^^ ^

# 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 QUADRAN T DEPT H TYP E INSPECTO R

M o Z r S r U R b T h P b S e A s H g Z n 

## w C u N i C o F e M n pp m
< LO D 418.81 6 194.03 6

< LO D 76.38 6 18.88 2 238.29 4

< LO D 137.99 6

< LO D 245.05 6

< LO D 62.56 8 < LO D < LO D 21388.63 9 544.26 9 Supervise d By : 

## Certificat e o fVerificatio n

66 5 SOI L 2010-05-1 2 17:2 9 30.1 1 Fina l 2982 7 251 8 Mapl e s t E A 1 " CONFIRMATIO N N

. LOPE Z

Erro r
: 8.27 7 ± 15.61 0 ± 9.68 7

: 15.57 6 ± 7.04 2 ± 9.41 1 ± 21.00 5

* 5.87 6 ± 21.84 2

I 13.39 6 ± 27.09 1

I 98.42 5 ± 23.98 1

: 80.64 7 : 199.76 6 ± 430.87 3 ± 101.62 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 QUADRAN T DEPT H TYP E INSPECTO R

M o Z r S r U R b T h P b S e A s H g Z n 

## w C u N I C o F e M n pp m
< LO D 386.06 0 200.09 0

< LO D 70.47 9 16.57 6 252.93 8

< LO D 121.22 8

< LO D 243.63 7

< LO D 41.75 8 < LO D < LO D 21917.04 5 601.77 9 Supervise d By : 

## Certificat e o fVerificatio n

66 6 SOI L 2010-05-1 2 17:3 0 30.1 0 Fina l 2982 7 251 8 Mapl e s t E A 1 " CONFIRMATIO N N

. LOPE Z

Erro r J 8.30 7 ± 15.28 8 ± 9.94 8

: 15.68 6 ± 6.90 2 ± 9.43 4 ± 21.83 9

I 5.84 2 ± 22.05 7

* 13.52 4 ± 27.19 2

: 93.15 8 ± 22.66 7

: 77.66 1 : 206.42 2 ± 441.21 2 ± 106.36 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 66 7 Mod e SOI L Tim e 2010-05-1 2 17:3 1 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 2982 7 ADDRES S 251 8 Mapl e s t QUADRAN T E A DEPT H 1 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D : 8.11 0 Z r 411.39 1 ± 15.69 6 S r 196.88 5 ± 9.89 4 U < LO D 16.39 4 R b 66.39 9 ± 6.84 8 T h < LO D 13.06 8 P b 268.41 0 ± 22.53 7 S e < LO D 6.99 3 A s 134.10 3 ± 22.90 1 H g < LO D 13.73 5 Z n 285.27 6 ± 29.31 5 

## w < LO D 98.07 7 C u 65.50 6 ± 24.53 9 N i < LO D 78.98 2 C o < LO D 208.26 6 F e 22101.32 8 ± 444.08 6 M n 539.75 7 ± 102.66 3 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 66 4 Mod e SOI L Tim e 2010-05-1 2 17:2 8 Duratio n 90.6 6 Sequenc e Fina l Flag s AVERAG E ^Av g o f661-66 3 ADDRES S "251 8 Mapl e s t QUADRAN T D Z DEPT H 13 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D 

### : 8.28 1 Z r 441.72 6 ± 16.00 0 S r 166.01 4 ± 9.07 4 U < LO D 15.12 6 R b 69.15 3 ± 6.80 4 T h 19.24 7 ± 12.05 4 >kM ^ 1^^^11.18 8 ±
_ ^

33.04 5 S e < LO D



### . 6.75 9 A s < LO D 

### : 43.01 0 H q < LO D 13.54 0 Z n 374.61 6 ± 32.70 9 W < LO D : 94.29 2 C u 83.10 0 ± 25.41 4 N i < LO D 78.05 3 C o < LO D 203.84 7 Fe 22290.61 7 ± 442.45 1 M n 739.20 1 ± 114.29 3 C r < LO D 172^ 1 V < LO D 

### : ^
-- - 404^0 3 T i < LO D 2102.36 8 S c < LO D y y ^

. /134.64 2 C a < LOQ / 

## : y ^

4276.32 9 K < LO O / T 6089.94 4 S < LO D 174.25 4 

### ^ Super v ise 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 66 1 Mod e SOI L Tim e 2010-05-1 2 17:2 6 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 2982 7 ADDRES S 251 8 Mapl e s t QUADRAN T D Z DEPT H 13 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D : 8.28 9 Z r 431.68 5 ± 15.91 1 S r 163.81 9 ± 9.06 0 U < LO D : 15.05 4 R b 69.72 8 ± 6.83 5 T h 21.19 8 • ' ± 12.35 1 P b 632.08 1 ± 33.76 3 S e < LO D 7.12 3 A s < LO D 44.02 2 H g < LO D 14.04 0 Z n 363.29 8 ± 32.40 5 

## w < LO D 93.02 2 C u 89.27 2 ± 25.96 8 N I < LO D ; 78.53 0 C o < LO D ; 204.39 4 F e 22417.70 3 ± 445.46 3 M n 759.27 1 ± 116.36 5 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 66 2 Mod e SOI L Tim e 2010-05-1 2 17:2 7 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 2982 7 ADDRES S 251 8 Mapl e s t QUADRAN T D Z DEPT H 13 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D : 8.30 4 Z r 440.60 9 ± 15.95 8 S r 167.00 5 ± 9.07 9 U < LO D J 15.48 9 R b 67.95 5 ± 6.78 8 T h 21.30 7 ± 11.80 0 P b 554.27 5 ± 31.47 0 S e < LO D 6.45 4 A s < LO D 41.18 5 H g < LO D 13.56 1 Z n 337.25 1 ± 31.21 1 

## w < LO D : 96.08 6 C u 77.15 4 ± 25.00 1 N i < LO D : 78.77 3 C o < LO D : 202.89 0 F e 22315.53 7 ± 441.86 9 M n 698.09 8 ± 111.69 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 66 3 Mod e SOI L Tim e 2010-05-1 2 17:2 8 Duratio n 30.4 4 Sequenc e Fina l Flag s BVI D 2982 7 ADDRES S 251 8 Mapl e s t QUADRAN T D Z DEPT H 13 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z



### pp m Erro r M o < LO D 8.25 2 Z r 452.88 2 ± 16.13 2 S r 167.21 9 d b 9.08 4 U < LO D 14.83 5 R b 69.77 7 ± 6.79 0 T h < LO D 18.01 6 P b 647.20 8 ± 33.90 0 S e < LO D 6.70 0 A s < LO D 43.82 3 H g < LO D 13.01 8 Z n 423.29 8 ± 34.51 1 

## w C u < LO D 82.87 3 ± 93.76 9 25.27 2 N i < LO D 76.85 4 C o < LO D 204.25 7 F e 22138.61 1 ± 440.02 1 M n 760.23 6 ± 114.82 4 C r < LO D 517.50 3 V < LO D 1212.00 9 T l < LO D 6307.10 3 S c < LO D 403.92 5 C a < LO D 12828.98 6 K < LO D 18269.83 2 S < LO D 522.76 1 Supervise d By :

# 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 66 0 Mod e SOI L Tim e 

### 2010-05

- 1 2 17:2 3 Duratio n 

### 90.3 1 Sequenc e Fina l Flag s AVERAG E ^v g o f657-659

. ADDRES S 251 8 Mapl e s t QUADRAN T B 2 DEPT H 13 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r

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 QUADRAN T DEPT H TYP E INSPECTO R

M o Z r S r U R b T h P b S e A s H g Z n 

## w C u N I C o F e M n pp m
< LO D 408.18 0 196.00 2

< LO D 67.21 5 < LO D 965.97 0

< LO D 170.67 4

< LO D 302.19 3

< LO D 62.68 1 < LO D < LO D 22270.09 6 717.42 9 Supervise d By : 

## Certificat e o fVerificatio n

65 7 SOI L 2010-05-1 2 17:2 1 30.1 1 Fina l 2982 7 251 8 Mapl e s t B 2 13 " CONFIRMATIO N N

. LOPE Z

Erro r 8.47 7 ± 15.90 3 ± 10.00 3

: 16.14 8 ± 6.96 3

I 21.59 3 ± 42.07 2

: 7.92 2 J : 38.44 4

: 13.93 1 ± 30.20 9

: 92.96 6 ± 24.81 8

: 83.41 6 : 209.58 0 ± 450.05 5

•± ­ 115.57 1

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPT H TYP E INSPECTO R

M o Z r S r U R b T h P b S e A s H g Z n 

## w C u N i C o F e M n pp m
< LO D 423.94 8 186.75 1

< LO D 66.95 0 < LO D 1026.51 5

< LO D 181.79 4

< LO D 370.85 8

< LO D 57.06 3 < LO D < LO D 22410.32 4 651.01 4 Supervise d By : 

## Certificat e o fVerificatio n

65 8 SOI L 2010-05-1 2 17:2 2 30.1 0 Fina l 2982 7 251 8 Mapl e s t B 2 13 " CONFIRMATIO N N

. LOPE Z

Erro r
: 8.58 0 ± 16.40 3 ± 9.94 4

I 15.02 2 ± 6.94 2

: 22.14 1 ± 44.08 3

: 8.30 5 ± 40.30 6

I 14.76 7 ± 33.97 0 107.74 3 ± 25.05 1

: 80.19 9 ; 212.32 2 ± 459.36 6 ± 113.30 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 QUADRAN T DEPT H TYP E INSPECTO R

M o Z r S r U R b T h P b S e A s H g Z n W C u N I C o F e M n pp m
< LO D 408.23 6 183.95 7

< LO D 70.28 6 22.26 1 950.67 5

< LO D 140.16 7

< LO D 355.27 0

< LO D 54.16 3 < LO D < LO D 22633.52 5 600.45 0 Supervise d By : 

## Certificat e o fVerificatio n

65 9 SOI L 2010-05-1 2 17:2 3 30.1 0 Fina l 2982 7 251 8 Mapl e s t B 2 13 " CONFIRMATIO N N

. LOPE Z

Erro r
: 8.26 2 ± 15.76 3 ± 9.64 3 16.43 6 ± 7.07 3 ± 14.33 2 ± 41.47 8

J 7.99 4 ± 37.44 7

: 13.95 8 ± 32.31 6

J 95.71 0 ± 23.89 0

J 80.02 8 209.66 6 ± 450.53 3 ± 108.25 0

# 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 65 2 Mod e SOI L Tim e 2010-05-1 2 17 : 

### 1 7 Duratio n 90.3 3 Sequenc e Fina l Flag s AVERAG E ^Av g o f649-651

. ADDRES S 251 8 Mapl e s t QUADRAN T F2 DEPT H 6 " Pi'P E CONFIRMATIO N INSPECTO R N

. LOPE Z

M o Z r S r U R b T h P b S e A s H g Z n W C u N i C o Fe M n pp m
< LO D 440.47 9 174.35 1

< LO D 69.19 5 19.22 9 341.04 3

< LO D 356.42 9

< LO D 637.34 3

< LO D 198.74 5

< LO D < LO D 24953.26 & / 682.64 6 Supervise d By : ± ±

: ± ± ±
±

: ±

### : 

### ^y-

. / 

### ± Erro r 8.26 8 16.05 0 9.30 9 15.24 4

6.81 4 10.28 1 25.12 2

6.72 5 29.61 9 13.97 0 42.14 6 ^..-if»ft66 6 32.35 2 /80.69 3 //216.81 9 

### / 0,469.70 1 

# r
. //112.96 6 

# z y > 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 QUADRAN T DEPT H TYP E INSPECTO R

M o Z r S r U R b T h P b S e A s H g Z n 

## w C u N i C o F e M n pp m
< LO D 437.66 4 177.77 5

< LO D 68.69 6 17.29 1 351.74 4

< LO D 358.94 5

< LO D 663.78 5

< LO D 214.86 7

< LO D < LO D 25120.20 7 663.11 6 Supervise d By : 

## Certificat e o fVerificatio n

64 9 SOI L 2010-05-1 2 17:1 5 30.1 1 Fina l 2982 7 251 8 Mapl e s t F 2 6 " CONFIRMATIO N N

. LOPE Z

Erro r
: 8.26 2 ± 16.02 2 ± 9.39 5

: 14.63 9 ± 6.73 9 ± 10.22 1 ± 25.48 6

I 6.69 8 ± 29.90 5

: 13.86 9 ± 43.03 3

: 103.40 9 ± 33.21 9

I 79.77 8 I 216.09 9 ± 471.49 7 ± 112.45 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 65 0 Mod e SOI L Tim e 2010-05-1 2 17:1 6 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 2982 7 ADDRES S 251 8 Mapl e s t QUADRAN T F2 DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D : 8.32 0 Z r 449.28 5 ± 16.18 1 S r 172.06 0 ± 9.25 2 U < LO D : 15.67 8 R b 69.53 6 ± 6.86 7 T h 23.67 7 ± 10.55 1 P b 334.58 0 ± 24.91 9 S e < LO D : 6.81 0 A s 362.45 0 ± 29.60 2 H g < LO D : 14.20 5 Z n 621.49 3 ± 41.59 6 < LO D : 98.08 9 

## w C u 179.82 5 ± 31.29 2 N I < LO D 79.99 1

•: C o < LO D : 218.57 6 Fe 24771.99 0 ± 467.85 4 M n 730.65 2 ± 115.42 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 QUADRAN T DEPT H TYP E INSPECTO R

M o Z r S r U R b T h P b S e A s H g Z n 

## w C u N i C o Fe M n pp m
< LO D 434.48 7 173.21 6

< LO D 69.35 2 16.71 8 336.80 5

< LO D 347.89 2

< LO D 626.75 3

< LO D 201.54 1

< LO D < LO D 24967.60 7 654.17 0 Supervise d By : 

## Certificat e o fVerificatio n

65 1 SOI L 2010-05-1 2 17:1 7 30.1 1 Fina l 2982 7 251 8 Mapl e s t F 2 6 " CONFIRMATIO N N

. LOPE Z

Erro r J 8.22 2 ± 15.94 8 ± 9.27 8

; 15.41 6 ± 6.83 7 ± 10.07 0 ± 24.96 2

: 6.66 7
• ± 29.35 0

: 13.83 7 ± 41.80 9

: 100.50 0 ± 32.54 6

: 82.31 0 : 215.78 2 ± 469.75 1 ± 111.02 3

# 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 64 8 Mod e SOI L Tim e 2010-05-1 2 17:1 4 Duratio n 90.3 5 Sequenc e Fina l Flag s AVERAG E Av g o f645-64 7 ^ ADDRES S ^"251 8 Mapl e s t QUADRAN T F l DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D 8.14 3 Z r 425.73 1 ± 15.63 1 S r 170.45 3 ± 9.10 9 U < LO D 15.15 7 R b 69.86 2 ± 6.77 0 T h 17.69 8 ± 10.25 1 P b M ^^•367.72 4 ± 25.73 9 S e < LO D 6.76 1 A s 276.07 5 ± 28.23 1 H g < LO D 13.53 4 Z n 264.38 1 ± 27.84 0 W < LO D 92.45 4 C u 60.72 3 ± ^--23.56 3 N i < LO D - ^ 76k3 6 C o < LO D 206.71 8 Fe 23965.60 4 / 

## y± /455.22 2 M n 612.764 / ± y106.84 6 

# : y 

# y c 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 64 5 Mod e SOI L Tim e 2010-05-1 2 17:1 2 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 2982 7 ADDRES S 251 8 Mapl e s t QUADRAN T F l DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r
M o < LO D 8.11 0 Z r 405.45 6 

### ± 15.39 6 S r 163.10 9 ± 8.98 3 U < LO D 15.32 2 R b 76.20 5 ± 7.04 5 T h 19.04 3 ± 10.69 5 P b 404.56 5 ± 27.13 5 S e < LO D 6.94 5 A s 257.89 7 ± 28.83 1 H g < LO D 13.28 7 Z n 289.04 8 ± 29.01 0 W < LO D 89.23 4 C u 62.23 0 ± 24.03 4 N

i 85.28 0 ± 54.34 0 C o < LO D 205.96 1 F e 23053.79 3 

### ± 449.36 9 M n 687.84 6 

### ± 111.95 3
Supervised 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 64 6 Mod e SOI L Tim e 2010-05-1 2 17:1 3 Duratio n 30.1 2 Sequenc e Fina l Flag s BVI D 2982 7 ADDRES S 251 8 Mapl e s t QUADRAN T F l DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D * 8.17 1 Z r 433.60 2 ± 15.59 6 S r 178.00 6 i : 9.20 2 U < LO D 14.83 1 R b 70.28 6 ± 6.69 5 T h < LO D 14.52 0 P b 362.47 9 ± 25.30 1 S e < LO D 6.78 0 A s 276.00 1 ± 27.81 9 H g < LO D 13.35 5 Z n 245.02 7 ± 26.64 6 W < LO D 90.49 7 C u 58.74 5 ± 23.00 9 N i < LO D 75.13 3 C o < LO D 208.39 0 F e 23846.88 1 ± 449.36 4 M n 573.12 3 ± 102.92 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 QUADRAN T DEPT H TYP E INSPECTO R

M o Z r S r U R b T h P b S e A s H g Z n 

## w C u N i C o F e M n pp m
< LO D 438.13 5 170.24 6

< LO D 63.09 4 22.41 6 336.12 7

< LO D 294.32 6

< LO D 259.06 7

< LO D 61.19 4 < LO D < LO D 24996.13 9 577.32 3 Supervise d By : 

## Certificat e o fVerificatio n

64 7 SOI L 2010-05-1 2 17:1 4 30.1 2 Fina l 2982 7 251 8 Mapl e s t F l 6 " CONFIRMATIO N N

. LOPE Z

Erro r
: 8.14 6 ± 15.90 1 ± 9.14 3

: 15.31 9 ± 6.57 0 ± 10.37 8 ± 24.78 0 \ 6.55 9 ± 28.04 4

: 13.96 0 ± 27.86 3

: 97.63 2 ± 23.64 6

: 72.66 6 : 211.80 2 ± 466.93 2 ± 105.66 3

## Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc

. SL~^^J ^

www.coastalhazmatco m ^^iPHO^" ^ COASTA L mVIIOIIHiNTA L Clour , II I c 

# EXECUTIV ESUMMARY ; BVID #29827-(251 8 MAPLEST )

No Issue s o r Concern s Q Issues/Concern s
Detail Explanation : DA NGARVE YWALKE D TH EPROPERT YO N6/10/1 0

# 4

C^d L 

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

### Property» : "Z^^Zl 

# ^.oer^.^\ % ^P}Q;\, y Date/Time : Owne r 

# • « Nam. : /

. FH V f. T

. C^M^^ ' ^ Quad s Excavated:

. Contracto r
Yes No Excavatio nCcneta t 1

. I f neccssuy , wer e th e correc t quadranl(s ) excavate dan drestored ? 

### / 2

. I f necessary , wer e th e correc i area s o f dri p zon e excavate dan drestored ? 

# y
Yes N o Gradin g So dan dVegctatlo B 1

. Doe s th e tradin g aroun dth e perimete r ofth e hous e i nexcavale darea s generall y slop e away 

### / fromth e house ? _____^

_ _ _ 2

. Ha s so dbee nlai di nal l area s that wer e excavated ? 

# y
rr

Doe s th e so dappea r to b e generall y health y an dgrowing?~(Onl y evaluat e i f inspecte da t a3 0 

# 7 da y tim e period ) 4

. Ar e sodde darea s generall y firman devenl y graded ? 

# y 5 , Ar e th e Joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 da y 

# y tim e period ) 6

. Wa s th e property grade dsuc hthat wate r wil l not poo l onth e property' ' 

# y I7

. Wa s damig e t o landscapin g o r plan t material s avoided ? Gates

. Fence s an dRctatoin g Wal b _^

_ Ye s N o I1

. D o gate s openan dclo.<s e fiieely? (I f applicable ) 

# y 2

. Wer e al l gate s o r fence s take ndow ndurin g restoratio nactiviiie s reinsulled ? (I f applicable ) 

# y 3

. Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) 

### ^ A

. Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) 

# y
Foundation , Sidin g an dGnHer s Ye s N o t
. Wa s damag e t o th e sidin g o r tri mavoided ? 

## • 2

. Wa s damag e t o th e foundatio navoided ? 

## y Wa s damag e t o window s avoided ? 

## y AWa s damag e t o window s or doo r screen s avoided ? 2

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

## y Sidewalk s an dDriveway s (Concrete ) Ye s N o 1

. Wa s damag e t o drivewa y surface s avoided ? 

## y 2

. W&s damag e t o walkwa y surface s avoided ? 

## y

# Ort'Dcrs comments :

Inspectio nnotes :

Remova l an drestorationactivate s complet e includin g th e 30-da y so dwarranry : EP ARepresentative jfL^ ^ Date : e://a/) a

# Propert yCompletio n Agreemen t
Jhi i agieemen l documenl s ihe complclio no f remedia l acliviiie s perloime do nm y properly M y signalui e wil l designate iha i Ia msatisfiedwil hthe restoratio no f m y propeily

. andiha l no ilem s ar e i nqueslions

. now , or a

l any nine i nthe fuluie , except thos e ilem s listedbelow , i f any Property ID : <2

_0 \??'7" 7 Property Address : 2.S\ V M^pk S J 

# owoc. : p^,yp ^ 61-HQ)jgt r 

# I

Restoratio n Item s i n Question :

Item : Item : 

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



# y restoratio n Kcompleted , excep t a s note d I ^ 1 I ngrc cI I \J I rio no t acre cresloratio n i s complete d

attir rDaf cCondflcfor' s Signnhir cOftf c

### @


# Propert y Owne r Assessment o f

Perform ! AmericanRecover y an dReinvestmen t Act (ARRA)j^) w Q-i y m Omah aLea dSuperfun dSit e 2009/201 0 SUPERFUN D DIVISIO N Remediatio nContractor : Coasta l Environmenta l Grou p - EP-R7-09-0 6 Propert y Identifie r Number : " 7 C \^ 2" 7 Propert y Address : Z'^i g Mgip|- e ^ ^ Propert y Owner' s Name : p aKj^l

. G^

. 1 - MCi jCl^

- '
Instruction s t o th e Propert y Owner : Thi s fomi serve s t o recordth e Property Owner' s assessmen t o f performanc e (hicentiv e 1

- Quality Assuranc e Surveillanc e Plan ) involvin g th e liste dremediatio ncontractor , a s applicabl e to th e Omah aLeadSite

. Thi s for mdocument s th e timelines s o f punc hlis t resolution , busines s relations , complain t resolutio nandth e overal l quality o f work

. I f nee dbe , th e Property Owner may utiliz e thi s for mt o recordproblem s and/o r issue s no t specificall y tie dt o a nassigne d address , for example , busines s relation s that generall y don' t follo w th e guideline s se t fort hinth e Performanc e Work Statement

. Th e Property Owner wil l indicat e his/he r assessmen t o f performanc e withth e contractor' s wor k

b y checkin g anumerica l ratin g o nth e tabl e belo w usin g th e numerical definition s fro m th e ratin g scal e below , the nsig n& dat e th e form

. 9-1 0 "excellent " 7- 8 "very good " 5- 6 "acceptable " 3- 4 "poor " 1-

2 "very poor " Propert y Owner' s Assessmen t of Performanc e Regardin g th e Contractor' s Wor k 1 0 

# s Z ty 5 9 4 8 3 7 2 6 1 Propert y Owne r Additiona l Comment s fro m(optional ; continu e o nbac k pag ei f needed )

Propert y Owne r Signature : ~^T//^ ^ Date : _^_^_^_^ ^ ^