## TRANSMITTALo f

OMAHA LEA D SIT E SOILREMEDIATIO NFIL EFOLDE R 

# SAID#.._i^AlJl__
. Date : • ; 

# 1' ^ l\ \ Address
. ^^' ^

^^(^ 1 ^ 1 Remediatio n Contractor : Coasta l Environmenta ) Grou p 

### Year : 20 1 O A RRA
SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 

# i / Vide o o f property (DVD ) (

/ 

### Executiv e Summar y / 

### EPA-provide dproperty sketc h Signe dAcces s Agreemen t fo r subjec t properl y Signe dAcces s Agreement(s ) fo r adjacent property Restoralio n Agreement Settlemen t document s (i.e. , fo r damag e o r to replac e planls , etc. ) Confirmatio n data 

### Photograph s ff e b^OO/^Yju ^ ^ ^<^^1(7t n\( ^ As-buil l sketc h Satisfactory restoratio nsigne dby Property Owner 

## t

/ Propert y close-ou t chec k lis t signe db y EP A Descriptio n o f area s not meetin g RO D cleanu p criteri a Utilit yclearance s 

### Property«)formatio n fro mDougla s County Assessor' s Offic e

^ ^ / ^ ' 

# I I Ignatur e Date 3021894 3 

# inini i Superfun d

## Propert yAcces s Checklis t

nWOR K STARTE D ON :

_ / I Propert y Address : f^ ^ ^^^ ^ ^ _ D WORKCOMPELTE D ON:
. I I O^vne n Rente r 

# "u ^ 

# uMi ^ Address : Phone: Fax : Celi/Pager : Phone : cf.^ ^ q^y ^ Additional Infomiation : Cell/Page r D Notification Lette r Sent : / / By : ^ Acces s Agreement Signed:/C^/// 5 By

- w.c v t ^ Restoratio nAgreemen t 

### Slgned:_JC(..2f/4 ^ By : »o.,_t [! ] Topsoil Samplin g (if applicable ) / / By : aDisposa l Samplhi g (if applicable ) / / By : D Garde nSamplin g (if applicable ) / / By : aUtilit y Clearanc e Called : w/i
. 1 ^ By : vv/c/. „ V^iM ^ {3 < Video/Photo s OBefore ) On;\ y /y»/> o Byv
. ^cv t aVideo/Pfaoto s (During ) On : / / By : D Video/Photo s (After) On : / / By : D Video/Photo s (30-Day ) On : / / By : D Propert y Completio n Agivement Sfpied : / / By : D Final Report Issued : / / By : Ai r Monitorin e (a s auolicabl e n Communit y DCrc w On : / / 

# 1 Rcsults : D Communit y Q Cre w On : / / By : 

# 1 Results :

• Communit y • Cre w On : / / By : Resulte :
Omah a Lea d Sit e

### Dougla s County Accoun t In ; |HB|^io n 

### Pag e 1 of 2 

# H
Dougla s County , Nebrask a Propert yRecor d - R191771000 0 Prin t Repor t Vie wInteractiv e Gi S Ma o Informatio n i s vali d a s o f 2010-8-3 0 Treasurer' s Ta xReoor t Ne wFeatur e "•• - • • • Subdivisio n Sale s Searc h Owne r WESTBROO KFLOY D ETA L 1144 4 SARATOG AS T OMAH AN E 68164-907 8 Propert yInformatio n Ke yNumber : 177 1 OOO O 1 9 Accoun t Type : Residentia l Parce l Number : 191771000 0 Parce l Address : 332 0 CORB YS T OMAH AN E 68111-000 0 Lega l Description : OMAH AVIE W LO T2 0 BLOC K1 2 5 0 X 12 0 Valu e Informatio n Lan d Improvemen t Tota i 201 0 $500.0 0 $0.0 0 $500.0 0 200 9 $500.0 0 $0.0 0 $500.0 0 200 8 $500.0 0 $0.0 0 $500.0 0 200 7 $500.0 0 $0.0 0 $500.0 0 200 6 $500.0 0 $0.0 0 $500.0 0 200 5 $500.0 0 $0.0 0 $500.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 3 6000. 0 0. 0 120. 0 50. 0 Ye s



### http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R191.
. . 9/3/201 0Pag e 1 o f 1

CrstateAnoJBH^Sej l .Bg<»to,jr^;j|ijt!|ia | Sencj-jmafe ^

• YOU RTICKE T NUMBERI S 2601(>44
. Origina l Cal l Date : Wor k t o Begi n Date : 9/27/1 0 9/29/1 0 Time : 10:5 6 Time : 11:3 0 am am Op : ELIZABETH1879 0
State : N E Address : 432 4 County : Street : DOUGLA S MAPL E S T Place : OMAHA Twp : 15 NRng : 13 E Sect-Qtr : 08-NW-S W 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 AN D T O TH E PEDESTAL Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E I F CORNE R LOT . Compan y: COASTA L ENVIRONMENTAL SERV Contac t Name : ELIZABET H IC E Phone : (877)662-421 0 Wor k Bein g Don e For : COASTA L Dept h o f Excavation : 4 F T Corne r Lo Involve s Tunnelin g o r Horizonta l Borin g t : N : N Front : Y Rear : Explosives : N CXCATV MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Servic e Are a Contac t Phon e Numbe r Utility Typ e
CXCAT V COX COMMUNICATIONS , INC HEIDI Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
MUDO l METROPOLITA NUTILITIE S DISTRICT SANDY Day : 402504782 3 Alt : Emerg : 402504797 0
OMAHACOFCITYOFOMAHA-TRAFFIC.SEWERRICH/TRAFFIC Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0
0PPDGPR 5 OMAH A PUBLIC POWE RDISTRICT EL M LOCATIN G Day : 406728934 3

Alt : 406207149 4

Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWORK EL M LOCATIN G Day : 406728934 3

Alt : 406207149 4

Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 9/27/201 0

## 2931 4 

# As-Buil t Drawin g COASTA L 

# It 

# Omah aLea dSuperfun dSif e 

# e INVIItONMCHTA L CROUP
. IH C OLS# : 2931 4 Dat e Excavated : 11/5/201 0 Dat e USEP ASigne d Off : 11/23/201 0 Are a Sodden : 166 5 sa ft Exterio rPain t NorthAno w Omah a Lea d Sit e Owne rName : FLOY D WESTBROO K • Goo d Sit e Sketc h Address : 3f»oa)RBYJ T • Poo r

Phone : " 4CC-446:S07 8 W; 402-451-565 2 

# f ( U Notpai m Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Sample s Collecte d RYASCPXA-2931 4 F1 IS O pp m 

### El D Date : C>5"-27--o ^ RYBSCPXA-2931 4 RYCSCPXA-2931 4 RYDSCPXA-2931 4F2 B1 B2 } i H 13 1 1^ 2 ppm pp m pp m 

## or BT 

### D D D Time : Z - ?( ? /^A l Sample s Analyze d RDZSCPX A2031 4 BZ ­ pp m 

# n D XR F Unit : <^2
. Book : ll & RGZSCPX A2031 4 62 ­ pp m 

### D D Date : 5-2/i,-O0 , RPZaCPVA-Zq^l ^ EZ
. .ppm . 

### D D Time : A£ L Numbe rof Sample s = i4 - Staff : ±UW
_ Legend : F l = Fron t Lef t F2 = Fron t Right , B1 = Bac k Left , B2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden
. PZ = Pla y Al l quadrant s ar e as viewe d fro m th e stieet , lacin g piopert y

Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are areplace dwit hAre areplace dwit h Are alef t bar e So dRock/Mulc h Contrac t #: EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
.

# 2931 4 CUgv rL vU/ H NorthArro w Exterio rPain t Omah a Lea d Sit e Owne rName : pLOy o WESTBROO K 

### • Goo d Sit e Sketc h Address : 3320COf?B YS T • Poo r Phone : " : 402-445-9078 W : 402-451-^5 2 

# r Q No t pair « Sampl e Numbe r RYASCPXA-2931 4 F 1 Lea d Concentratio n }5 0 pp m Sampl e Collecte d LA B 

# D Firm : Dale : Sample s Collecte d f[?f i • /)fi/^/ V 05" - Z Z -o ^ RYBSCPXA-2931 4 F2 )H ^

pp m 

## \3 f 

# D Time : 2 ­' 3 0 fX-M
. RYCSCPXA-2931 4 RYDSCPXA-2931 4 B l B 2 j3 } _j m pp m pp m 

# 0 ' 

# H ' D D Sample s Analyze d RDZ-SGPX A3034 4 B* ­ •Qpo n 

# D D XR F Unit : 0^ 2 Book : // ^ RGZSCPXA2031 4 RPZSCPXA.?9?1< 1 62 - P 7 ppm , 

# D D D D Date : iZip'OC ^ Time : 

## l£ L Numbe rof Sample s = j if - Staff : 

### M3 W Legend : F 1 = Fron t Left , F2 = Fron t Right , B 1 = Bac k Left , 8 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a s vievne d fro m th e street , facin g propert y

# 2931 4 Exterio rPaint NorthArro w Omah a Lea d Sit e Owne rName : FLOY D MSTBROPi S 

### • Goo d Sit e Slcetc h Address : 3320CORBYST • Poo r

Phone : H : 402-445-9078 W: 402-451-5652 

# r Q * No t pain t Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d 

### Firm : JEQ^IM/OL
. RYASCPXA-2931 4 F 1 }3 0 pp m 

## D Date : O^ - 2 Z ~o ^ RYBSCPXA-2931 4 F 2 }H H pp m 

## D Time : 2 ­' 3 o ff.M
. RYCSCPXA-2931 4 RYDSCPXA-2931 4 B l B2 

# Jl l Jhl
. pp m pp m 

# 0 ' 

# o r D 

# a Sample s Analyze d RDZSCPX A203 1 l l B2 ­ 

# n XR F Unit : ^TtT L Bod e M
_ RGZSCPX A2031 4 G* ­ 

# n D Date : S-2U'C ^ RPZSCPXA.2931 4 EZ
. , ppm , 

## D D Time : 

## .Ail
. Numbe ro f Sample s = j t ^ I Staff : 

### ±LiW l Legend : F 1 = Fron t Left , F2 = 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 A H quadrant s ar e a s viewe d fro m th e street , facin g propert y 

# ENTEREI / 2;

l>.^M.^.^.^^^jr
. —il--

­ 

# 0
. F. \

• ^ ' 

# 150 

# s . 0 ^ 

# eP' : 'p ­ • A.^r C 

# g > y/yv>y7'^-wViK/v/ ' 

# I Coyk yo-f
. Re v4 04AI4IOI2 3 

# 0

## 2931 4 Exterio rPain t NorthArro w 

### Omah a Lea d Sit e Owne rName : FLOY D WESTBROO K • Good 

### Sit e Sketc h Address : 332 0 CORB YS T • Poo r Phone : ^ 402-445-9078 W : 402-451-5652 

# r Q ' No t pain t Sannpl e Numbe r Lea d Sampl e Sampte s Collecte d Concentratio n Collecte d LA B 

# f\m : fa\''p(^/c M RYASCPXA-2931 4 F l 

## J50
_ pp m 

## D Date : 05'-2Z-s3 ^ RYBSCPXA-2931 4 F 2 

## J± L pp m 

# o r 

# a Time : 2 - ? P ^^M - RYCSCPXA-2931 4 8 1 

# JI L pp m 

## B T 

# a Sample s Analyze d RYDSCPXA-2931 4 8 2 pp m 

## B T 

# n ni L RDZSCPX A2031 1 DZ ­ 

# n XR F Uni t CV^2
. Book : // & RGZSCPX A2031 4 6Z ­ -pp m 

# a D Date : 

## 5ZU'C?( ^ D R9Z9CPXA^ni ABZ
. rJUm L 

## D Time : 

## M L D Staff : J±&W L Numbe ro f Sample s = | if - j Legend : F l = Fron t Left , F 2 = Fron t Right , B l = Bac k Left
. B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y A H quadrant s ar e a s vieiMe d fro m th e street , facin g propert y 

## A 

## |/& L

- ^ 

# ENTJERE D • 

# n^i i 3 / 

# I K ^J
. ^ 2 > 

# 33.2q'.6>ri^.S f

e • ' —<•• • • • V



# F l F2 

# 15 0 

# m
wTi r Cork y S'l
. Re v 4' 04«I410I2 3COASTA l IHVItOHHIhlA L C > 0 U r. I i l 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 follov^in g describe d premises : 

# ^3/ /

Owner' s Name : Daytim e Phone : 

# W/d i UW^dc ^

Addres s o f Propert y covere d b ythi s 

# ^ ^ ^ C. ^ 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 f lea 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 materiai 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 f Coasta 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 i 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 f perfomiin 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 f 2COASTA L lNVIiONH>KTA l C « 0 U P IM 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 , a s necessar ysubsequen t t o a n initia l waterin g perio d b yEPA ; ( Abid e b yhealt h an d safet yguidanc e provide d b yEPA ; • I f th e propert yi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propert yt o perfor m th e work
. »Allo wvideotapin g and/o rphotographin g o f th 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 f th e wor k activities , o rwit h an y o f th e wor k done , o rwit h th e equipmen t use d o n hi s property , o rt o undertak e an y action s regardin g th e us e o f sai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o f th e Grantee s o rth e environment , o rt o allo wother s t o us e th e propert yi n suc h a manner . Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contac t Coasta l Environmenta l Group , a t (402 ) 991-119 9

0< g gran t acces s t o mypropertie s D I d o no t gran t acces s t o mypropertie s

Signatur e Date Signature Date

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

Page 2 o f 2COA S T AL • NViaONHB H TAL GROUP , INC
. 

## Restoratio n Agreemen t The purpos e ofthi s agreemen t i s t o 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 e of assuring tha t restoration activitie s ar e completedto the satisfactionof th e propert y owne r an dthe UnitedState s Environmenta l Protection Agenc y (EPA)
. PropertylD : ^Pf^jf- j Propert y Address;-g'52( ^ <gc^ y E' V Owner : ^]^^ ^ [,k>sUrcr./ ^ Phone : fdP-^^3--^^/ ^ O

n the attacheddiagram(s ) indicat e area(s ) to excavate , surface structure s an dlandscapin g feature s an d acces s location(s ) t o b e usedb y 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 Start o f Remediation : Th e removai , storage , disposal , and/o rretu m o f thes e item s i s th e Owner' s responsibility
.



## 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 : 

## /U/me y item : Kem : item :

Pag e 1o f ^

### *4 COA S T AL • MVmONHB N TAL OROUP
. INC
. 

### Item s t o B e Remove d B yContracto rDurin g Remediatio n an d Replace d

Ite m Landscap e Inventor y Quantit y Uni t Condition/Type/Specie s Pre-existin g propert y area , that wil l b e excavated , that i s coveredwithgrass . 

# /O : Quadrant s
Numbe r o f tree s > 2 inc h trun k diamete r 

# J r- f Eac h
Nimibe r o f tree s < = 2 inc h trun k diamete r 

# I P - h Eac h
Numbe r o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Attac hasketc ho f th e sprinkle r layout
. Eac h

Nimibe r o f an dsiz e o f eac hgarden/ flower be d area . Attac hasketc ho f relativ e size s an dlocations
. Eac h Squar e Fee t
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 will b e use dt o issu e aplan t vouche r t o th e propert y owner . Easemen t Area , t o b e Eac h 

### ^ 

# ^n excavate d 

# W

# o^<y ^ Pag e 2 of
. 

# 3COA S T AL O • O U P , INC
.
Additiona l Comment s / Instructions : Th e cit yo f Omah a ordinance s ma yprohibi t yo u fro m usin g dir t o rgrave l area s o n you rpropert y a s driveway s o rvehicl e parkin g areas . Th e Environmenta l Protectio n Agenc y(EPA ) ma yb e removin g an d replacin g soi l underlyin g a grave l o rdir t are a o n you rpropert ytha t yo u ma yb e usin g a s a drivewa yo rvehicl e parkin g area . I f thi s i s th e case , yo u shoul d understan d tha t thi s removin g an d replacin g o f soi l doe s no t mea n tha t an yillega l drivewa yo rparkin g are a o n you r propert yi s mad e legal
. T o th e contrary , yo u ma yb e cite d b yth e cit yI f yo u us e a grave l o rdir t are a 2ff i a drivewa yo rparkin g area , no t withstandin g an yremova l o rreplacemen t o f soi l b yth e EP A I f yo u hav e an yquestio n abou t legalit yo f a certai n drivewa yo rparkin g area , yo u ma ycontac t th e cit yo f Omaha' s Plannin g Departmen t a t (402 ) 444-5150
. O Pieas e chec k thi s bo xi f yo u understan d th e informatio n outiine d above
. 

# \ i ^ s ^^^r^A H lAn 

## u ^ 

# ^^ A e. J 

# ^^^ ^ "^ ^

~ ^

Chec k th e bo xi f Owne 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 f house , includin g foundatio n crack s o rfissures
.



### H' l agre e C H I do no t agre e 

# 'Uic y<JiyV ^ (OMlc ) Owner' s Signatur e Dat e Contractor' s Signatur e Dat e Pag e 3 o f yXR F PROPERTYSAMPL E SHEE T Dat e 

### / - /i ' LO d Addres s Project Omah a Lea d ARR A Sampl e tim e XR F ID # 

### .^-=1(9^2
. sampl e lengt h

Shot # Readin g Sampl e are a Shot # 

### 13 9 /9 L t Z l B A (5 ^ I'li i a Dept h 

### Ib O I66 i Z- \ / " Averag e 

# m . u / Averag e

Shot # Readin g Sampl e are a Shot # 

### I U 5 5 i 1 4 R L l

^ 5 4 i 1 5 Dept h 

### 164- 5 5 ^- 1 3 

# 6 " Averag e 

## 5 5 

## ^ 1^ 

## / Averag e

Shot # Readin g Sampl e are a Shot # Dept h Averag e Averag e
RETES TAREA S Shot # Readin g Sampl e are a Shot # 

## ^^^ 7 Dept h / / Averag e Averag e Signatur e 

# (1^)^ ^|W/1 ^ Prin t 

### BVID #21^=131 4

2K^Z O 

### C^z& yB r am/p m 3 0 se c Readin g Sampl e are a Dept h

Readin g Sampl e are a Dept h

Readin g Sampl e are a Dept h

Readin g 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 f Verificatio n XL3t-3902 2 Readin g N o 16 1 Mod e SOI L Tim e 2011-01-1 2 18:3 8 Duratio n 90.6 2 Sequenc e Fina l Flag s AVERAG E Av g o f 158-16 0 ADDRES S 332 0 CORBYS T QUADRAN T E A DEPH T 1 " XR F TEC H C.PADIL U MIS C CONFIRMATIIO N NOT E CLEA R

Supervise d B y

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 182.66 0 Supervise d By : 

## Certificat e o f Verificatio n

15 8 SOI L 2011-01-1 2 18:3 6 30.1 9 Fina l 2931 4 332 0 CORBYS T E A 1 " C.PADILL A CONFIRMATIIO N CLEA R

± Erro r 21.00 7

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 193.60 6 Supervise d By : 

## Certificat e o f Verificatio n

15 9 SOI L 2011-01-1 2 18:3 7 30.2 1 Fina l 2931 4 332 0 CORBYS T E A 1 " C.PADILL A CONFIRMATIIO N CLEA R

± Erro r ± 21.54 5

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 186.08 9 Supervise d By : 

## Certificat e o f Verificatio n

16 0 SOI L 2011-01-1 2 18:3 8 30.2 2 Fina l 2931 4 332 0 CORBYS T E A 1 " C.PADILL A CONFIRMATIIO N CLEA R

± Erro r ± 21.33 6

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

Supervise d B y 

## Certificat e o f Verificatio n

16 5 SOI L 2011-01-1 2 18:4 1 90.2 9 Fina l Av g o f 162-16 4 332 0 CORBYS T B 2 6 " C.PADILL A CONFIRMATIIO N CLEA R

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P

b 55.91 5 Supervise d By : 

## Certificat e o f Verificatio n

16 2 SOI L 2011-01-1 2 18:3 9 30.1 0 Fina l 2931 4 332 0 CORBYS T B 2 6 " C.PADILL A CONFIRMATIIO N CLEA R

Erro r 14.04 7

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 54.16 0 Supervise d By : 

## Certificat e o f Verificatio n

16 3 SOI L 2011-01-1 2 18:4 0 30.0 5 Fina l 2931 4 332 0 CORBY S T B 2 6 " C.PADILL A CONFIRMATIIO N CLEA R

±

Erro r ±

13.72 3

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 55.68 8 Supervise d By : 

## Certificat e o f Verificatio n

16 4 SOI L 2011-01-1 2 18:4 1 30.1 4 Fina l 2931 4 332 0 CORBYS T B 2 6 " C.PADILL A CONFIRMATIIO N CLEA R

Erro r ± 13.85 6

## Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
. www.coastalhazmat.co m COASTA L INVIIONMINTA L C I 0 U P
. IN C 

# EXECUTIV ESUMMARY : BVID #2931 4 -(332 0 Corb y St )
py ] No Issue s o r Concern s Issues/Concern s Detai l Explanation : N O ISSUE S PENDIN G4 

### ft K 

# EP A EP A Propert y Clos e Ou t For m Propert yit : Propert yAddress : 

# ^M/' / a Date/Tine : OwBcr' s Name : Quad s Excavated : ^'l ^ Contracto rGrou p Excavatio nGenera l 1
.I f necessaiy , were th c correc t quadrant(s ) excavate dandrestored ? 2
.If necessary , were th e correc l area s ofdri p zone excavale dan drestored ? Gradio K So dan dVcRctatio n I
.Doe s th e gradin g aroun dth e perimeter ofth e hous e i nexcavale darea s generall y slop e awa y fromth e house ? 2
.Ha s so dbee nlai din al l area s that were excavated ? 3
.Doe s th e sodappear to b e generall y healthy an dgrowing ? (Onl y evaluate if inspecte da t a3 0 da y time period ) 4
.Ar e soddedarea s generall y fir man devenly graded ? 5
.Ar e th e joint s betwee n th e so dstrip s generally tight ? (pnl y evaluate if inspecte da t a3 0 da y tim e period ) 6
.Wa s the propert y grade dsuchtha t waler will no t poo l o nth e property' ? 7
.Wa s damag e t o landscapin g o r plan t material s avoided ? Gates , Fence s an dRetainin s Wall s 1
.D o gate s ope nan dclos e freely ? (Ifapplicable ) 2
.Were all gate s or fence s lakendow ndurin g restoratio nactivitie s reinstalled ? (Ifapplicable ) 3
.

Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) 4
.Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) Foundation , SidiD Kan d Gutter s 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 ? 3
.

Wa s damag e t o window s avoided ? Wa s damag e t o window s o rdoo rscreen s avoided ? S
.Wa s damag e t o downspout s o rdownspou i extension s avoided ? Sidewalk s an d Driveway s (Concrete ) 1
.Wa s damag e l o drivewa y surface s avoided ? 2
.Wa s damage t o walkwa y surface s avoided ? Ye s N o t

/ 

### y Yes N o 

## y / 

# y / 

## y / / Ye s N o / / / 

## y Ve s N o / 

# y y y 

# y Ye s N o 

### / y

# Mfi

­ 0>«'Ders comments :

Inspectio n notes :

Remova l an dresloratio n activate s complete including the 30-da y so dwarranty : EP A Representativ e ^'^] ^ Date : j^i,^ ,

## Propert yCompletio n Agreemen t This agreemen l documenls
. Ih e compiclio n ot remedia l aclivme s perloime d on my pioperty My signalur e wil l designat e llia l I amsatisfie dwil hIh e resloralio n of my properly , an diha l no ilem s ar e inquesiions
. now , or al an y lim e in th e fuluie , excep l thos e ilem s listedbelow , if any Propcrf>rD : ^^^/i ^ Propert y Address : 3^0-/ 5 

# Sd Owner : 

# @M 

# cLJi l Phone : 

# c/,9^-^g?P ? Restoratio n Item s in Question :

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

### Addrtiona l Comments :

&l»U grc c restoralio nncompleted , except as noted [_

J I do not ai;re c reparatio n is completed

Owner' s Sicnatiir r Dat e Cont i arfor' s Signatur e Sicnalnr Dal e