## TRANSMITTA Lof OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R
SA1D # 

# : f^^^l ( Date : ^h<\\ o Addres s Remediatio nContractor : _Coasta I Enviromnenta l Group

_Year : 200 0 SOI LREMEDIATIO N PROPERT Y nLEFOLDE RDOCUMENT S / 

### Vide o o f property (DVD ) Executiv e Summar y p' EPA-provide dproperty sketch y SignedAcces s Agreement fo r subject property -B- , SignedAcces s Agreement(s ) fo r adjacen t propert y ^ Restoratio nAgreement -B- < Settlement document s (i.e. , fo r damag e o r to replac e plants , etc. ) -B ' Confinnatio ndata f / Photograph s yif^^p(^U>v \f WM^t)(\xr ^ n f As-built sketc h Satisfactor y restoratio nsigne db y Propert y Owner 

## 6

^ Propert y close-out diec k lis t signedb y EP A Descriptio no f area s not meetin g RO D cleanup criteri a Utilit y clearance s Propertyinformatio nfro mDougla s Count y Assessor' s Office

' Date ' 3005544 1 

# Bom i Superfun d

# m

Propert yAcces s Checklis t Prcpca,ID:fp<^H7 5 D WOR K STARTED ON : / / D WOR K COMPELTE D ON : / / Propen y Address : 2H1, 1 jV j Hf S aST P
Rcntt r Owne rHcx^o\ ^ S0>iVj\+7
. Phone : Addrcs:^^^ ^ T)\\\\CiY \ "D c P<L\ : Cell/Pager : Additionu l Inlnrrnntion : 

### Phon e 3CjC>.^^^^q i F«T : Ccll/Pager
.
Q Notiricatio n lifte r Sent : / / By : ^ Q l Acce u Agreemen l 

### Signed : 7 /23'C ? 

## B>=Di^v\ a ^

^ Restoratio n Agreemen t 

### Signed : :2./2 9 ^CQ 

### » yV e lrv\Y\/ O Topior l Samplin g (i f •pplicuble ) / / By : O Disposn J Strnplio g (i f ;ipplictble ) / / By : O Gnrdc n Sflmplin g (i f ap|)licabte ) / / By : ©'^Utilit yClearanc e Called : £l/-?/ / D^ 

### By : ^/Z5/0 ^ Qvideo/Photo s (Before ) 

### On:£/l^/Q ^ ^y-6c7Av/ o /t/^iA-fe^iz- Y D Video/Photo s (During ) O n : / / By : D Video/Pholo s (After ) O n : / / By : D Video/Photo s (30-Dj»y ) O D : / / B y : 1 1 Propert yComplelio n Agreemen t Signed : / / By : n fina l Rcpo n Issued : / / By : A i rMonitorint : (< U applicable )

D Communrt yD Cre w O n : / / By : RciuJls : D Communit yQ Crew - O n : / / By : Results : D Communit yD Cn:> v O n : / ' By : RjKulli :
Omah a Lea d Srt e

## Propert y ID U Propert y Address : Initia l Contact : Secon dContact : Fina l Contact : Fina l Action :

Comment : Owne r Commen t (s) : Site Coordinato r Commen t (s) : #


## CONTAC T FOR M 

# b^m 5 ZM2 \N

# "At ^ ^Vf
. Date : Time : Action : Date ; Time : Action : Date : Time : Action : Transmi t t o EP AD Othe r Action : D

## Dougla s Count y Accoim t Info : )ri|||jo n Pag e 1 of 2
Dougla s County , Nebrask a Propert yRecor d - R081109000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 H wes t o f52n d S t - VJe WO P Ma p Informatio n i s vali d a s o f2009-6-1 6 Treasurer' s Ta xRepor t Ne wFeatur e *•->• * Aut o Sale s Searc h Owne r SCHULTZ HAROL D D ETA L 110 1 DILLO N D R OMAH AN E 68132-000 0 Propert yInformatio n Ke yNumber : 110 9 000 0 0 8 Accoun t Type : Residentia l Parce l Number : 081109000 0 Parce l Address : Lega l Description : 242 1 N 4 5 A V OMAH AN E 68104-000 0 CLAIRMON TLO T2 8 BLOC K2 5 0 X 12 5 Valu e Informatio n 

### 200 9 200 8 200 7 200 6 200 5 200 4 Lan d $6,400.0 0 $6,400.0 0 $6,400.0 0 $6,400.0 0 $6,400.0 0 $6,400.0 0 Improvemen t $66,100.0 0 $66,100.0 0 $66,100.0 0 $66,100.0 0 $67,100.0 0 $61,000.0 0 Tota l $72,500.0 0 $72,500.0 0 $72,500.0 0 $72,500.0 0 $73,500.0 0 $67,400.0 0 Sale s Informatio n Sale s Date : 

### 2000-06-1 6 Dee d Type : Price : Grantor ­ $95,000.0 0 Book : 215 7 Pago : 34 1

Grantee : Valld/lnvalld : Vali d Exclusio n Reason : Lan d Informatio n Acre s 0.1 4 S F 6250. 0 Unit s 1. 0 Dept h 125. 0 Widt h 50. 0 Vacan t N o Improvement Informatio n 

## http://douglasne.mapping-online.coin/DouglasCoNe/static/accoiintinfo.jsp?accoiintno=R081..
. 7/7/2009

### - Dougla s County Accoun t Inforrmip n Pag e 2 of 2 irtmip r
Buildin g 1

QpenS)> t Ji a I »( r[< J

" SccendFlaa r" l=irs i Floo r 7n. O iq
. tt a«RK»cnL_I r

CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1368. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

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

HVAC : Centra l Ai rt o Ai r Rooms : 6. 0 Exterior : Fram e Aluminu m Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 3. 0

Roo fType : Gambre l Stories : 2. 0 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 192 3 0 % 192 3 8 6 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fenc e Chai n Lin k 1. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 768. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h Enc I Scree n 119. 0 Porc h Ope n Sla b 119. 0 Porc h Sla b Roo fCei l 28. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R081.
. . 7/7/200 9

### Pag e 1 o f 1 • # • #
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### • YOU RTICKE T NUMBE RI S 2359224
. Origina l Cal l Date : 9/08/0 9 Time : 5:1 6 pm Op : ELIZABETH1879 0 Wor k t o Begi n Date : 9/10/0 9 Time : 5:4 5 pm State : NE County : DOUGLA S Place : OMAH A Address : 242 1 Street : N4STH AV E Twp : 15 NRng : 13 E Sect-Qtr : 08-S W 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 EASEMEN T LOCAT E ENTIR E PROPERTY Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R PROPERTY Compan y: COASTAL ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : coasta l Dept h o f Excavation : 4f t Corne r Lot : N Front : Y Rear : Involve s Tunnelin g 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 CXCAT V CO X COMMUNICATIONS , IN G HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
MUDO l METROPOLITA NUTILITIES DISTRICT SAND Y 

### Day : 402504782 3

Alt :



### Emerg : 402504797 0
OMAHACO FCIT Y O FOMAHA-TRAFFiC.SEWE RRO N 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 4024445160
OPPDGPR 5 OMAH APUBLI C POWE RDISTRICT N A 

### Day : 406728934 3 Alt : 4062071494 Emerg : 888728934 3 QLNNEI C QWES T LOCA LNETWOR K

N A 

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

http://vmw.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 9/8/200 9OLS# : 6347 5 Dat e Excavate d :9/10/0 9 

# As-Buil t Drawin g Dat e USEP ASigne d Off : 11/13/0 9 C OASTA L ENVIftONMENTA L Are a Sodden : 125 7 s a f t 

# Omah aLea dSuperfun dSit e GROUP
. IN C 

### 6347 5 Exterio rPain t Omah a Lea d Sit e • Goo d Sit e Sketc h g^Poo r Samplin g Address : 242 1 N 4 5 A V • Not pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Coflecte d Fir m _££
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### D D Time : 

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

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. F 2 = Fron t Right , B l = Bac k Left , 8 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla v Al l quadrant s ar e a s viewe d fro m lt] a atrac L facin g properl y



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## 6347 5 Omah a Lea d Sit e Exterio rPain t Nort h Ant w Sit e SIcetc h • Goo d E^Poo r Samplin g Address : 242 1 N 4 5 A V Q No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Finn : p g . r.c . g.ig
. RYASCPXA-6347 5 F l pp m 

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### D D Time : 

### rP 7 

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## insiii
. 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 ; Al l quadrant s ar e a

s vievmd fte m th e atiBct , tacing propert y

v::0il 8 Creatwl : :7-.\ug ­COASTA L ENVIHONHENTA L " t PflOlt ^ C I 0 U P
. 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 : Daytim e Phone : 

# Md h'iG\u.ir7
. 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 underth 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 perfomied , 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 

### Bysignin 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 fperfomiin g th e work
. Thi s acces s shal l remai n i n effec t unti l th e wor k ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :

Pag e 1 o f2•-»---" ' J f COASTA L ENVUOHNEHTA L CROUP
. IN C 

### e Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; e 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 ; AWate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessarysubsequen t t o a n initia l waterin g perio d b yEPA ; e Abid e b yhealt h an d safet yguidanc e provide d b yEPA ; «> I fth e propert yi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propert yt o perfor m th e work
. • Allo wvideotapin g and/o rphotographin g o fth e property
. AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s no t t o interfer e o rtampe rwit h an yo fth e wort < 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 Coastal Environmenta l Group , a t (402 ) 991-119 9

^

I gran t access t o m ypropertie s D i d o no t gran t access t o m ypropertie s 

# 7'M-£> ^ Signatur e Dat e 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
.

Pag e 2 o f2COASTA L
• HVinONnrNrA L GROUP
. < M C 

## Restoratio n Agreemen t Th e purpos e o f thi s agreement i s to provid e amutual agreement a s t o condition s ofth e property prio r t o remediatio nactivities
. Thi s wil l als o serv e a s documentatio nfor th e purpos e o f assurin g that restoratio n activitie s ar e complete dt o th e satisfactio no f th e propert y owner an dth e Unite dState s Environmental Protectio nAgenc y (EPA)
.

Property ID ; {/p'^l{'] ^ Property Address : "2 , l^7^ \|> ^ 4^" $ /^-^ — Owner : 4-\UWZDU 7 

### Phone : ^C ^ {^{ ^ O nth e attache ddiagram(s ) indicate area(s } t o excavate , surfac e structure s andlandscapin g feature s an d acces s location(s ) to b e usedb y th e contractors . Indicate distances , depths , materia l types , etc . Photogr^hicall y andVideographically document th e existin g condition s ofth e propert y andth e basement 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 rretu m ofthes e item s I s th e Owner' s responsibility
. ftem : 

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## Landscap e inventory Ite m Quantit y Uni t Condition/Type/Specie s Pre-existin g property area , Quadrant s that wil l b e excavated , that 

# ^ 1 i s covere dwit hgrass . Number o f tree s > 2 inc h Eac h trunk diamete r ^ Number o f tree s < = 2 inch Fac h ^ trunk diameter
I t Number o f Sprinkler Zones , Contro l Valves , Eac h Timers , Heads , etc , Atiachasketchof the sprinklc i hi\oui
. Number o f andsiz e o f eac hgarden / flowe r be d 

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. Agree dupo nvalu e o f plant material s no t t o b e replace db v contractor . 

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. Bycheckin 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 cracks o rfissures
.

O I d o no t agre e 

# 7-2'^-rf i dco-fdi m H2Piioc> i Dat e Contractor' s Signature Dat e Pag e 3 o f 7BVI D 

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# 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-3208 9 Readin g N o 17 0 Mod e SOI L Tim e 2009-09-1 0 17:3 3 Duratio n 122.0 8 Sequenc e Fina l 'f^K^^\,?>ii

­ 

### :&iigj)fJ^^169 J ADDRES S 242 1 n 45t h av e QUAD/ZON E D Z INSPECTO R VENTR Y DEPT H 1 0 SAMPL E TYP E CLEARANC E NOT E

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

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pp m P b 256.80 6 Supervise d By : 

## Certificat e o fVerificatio n

16 6 SOI L 2009-09-1 0 17:3 0 30.6 8 Fina l 6347 5 242 1 n 45t h av e D Z VENTR Y 1 0 CLEARANC E

± Erro r ± 19.50 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 16 7 Mod e SOI L Tim e 2009-09-1 0 17:3 1 Duratio n 30.4 0 Sequenc e Fina l Flag s BVI D # 6347 5 ADDRES S 242 1 n45t hav e QUAD/ZON E D Z INSPECTO R VENTR Y DEPT H 1 0 SAMPL E TYP E CLEARANC E NOT E

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

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pp m P b 252.65 5 Supervise d By : 

## Certificat e o fVerificatio n

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± Erro r ± 19.62 0

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

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

pp m P b 201.46 8 Supervise d By : 

## Certificat e o fVerificatio n

16 9 SOI L 2009-09-1 0 17:3 3 30.5 2 Fina l 6347 5 242 1 n 45t h av e D Z VENTR Y 1 0 CLEARANC E

± Erro r ± 17.43 7

# 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-3208 9 Readin g N o 16 5 Mod e SOI L Tim e 2009-09-1 0 17:2 9 Duratio n 122.8 8 Sequenc e Fina l Flag s AVERAG E ,Av g of 161-16 4 ADDRES S 242 1 n 4SfFrave ~ QUAD/ZON E B l INSPECTO R VENTR Y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P b 105.81 5 ± 13.04 5 Supervise d By : 

# 'pCmM h

# 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 95.95 4 Supervise d By : 

## Certificat e o f Verificatio n

16 1 SOI L 2009-09-1 0 17:2 7 30.8 1 Fina l 6347 5 242 1 n 45t h av e B l VENTR Y 6 CLEARANC E

± Erro r ± 12.64 2

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 16 2 Mod e SOI L Tim e 2009-09-1 0 17:2 8 Duratio n 30.2 7 Sequenc e Fma l Flag s BVI D # 6347 5 ADDRES S 242 1 n 45t h av e QUAD/ZON E B l INSPECTO R VENTR Y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m Erro r P b 82.42 0 ± 11.75 0 Supervise d By :

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

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

pp m P b 126.20 2 Supervise d By : 

## Certificat e o fVerificatio n

16 3 SOI L 2009-09-1 0 17:2 9 30.9 0 Fina l 6347 5 242 1 n 45t h av e B l VENTR Y 6 CLEARANC E

± Erro r ± 14.00 4

# 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 118.68 3 Supervise d By : 

## Certificat e o fVerificatio n

16 4 SOI L 2009-09-1 0 17:2 9 30.9 0 Fina l 6347 5 242 1 n 45t h av e B l VENTR Y 6 CLEARANC E

± Erro r ± 13.78 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 17 5 Mod e SOI L Tim e 2009-09-1 0 17:3 6 Duratio n 122.9 9 Sequenc e Fina l Flag s AVERAG E 

### ^Av q of171-174 J ADDRES S 242 1 n 45t h av e QUAD/ZON E easemen t INSPECTO R VENTR Y DEPT H 1 SAMPL E TYP E CLEARANC E NOT E
Erro r P b Supervise d B y

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

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

pp m P b 80.01 4 Supervise d By : 

## Certificat e o fVerificatio n

17 1 SOI L 2009-09-1 0 17:3 4 30.4 7 Fina l 6347 5 242 1 n 45t h av e easemen t VENTR Y 1 CLEARANC E

± Erro r 11.61 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 QUAD/ZON E INSPECTO R DEPT H SAMPLETYP E NOT E

pp m P b 78.86 3 Supervise d By : 

## Certificat e o f Verificatio n

17 2 SOI L 2009-09-1 0 17:3 4 30.9 3 Fina l 6347 5 242 1 n 45t h av e easemen t VENTR Y 1 CLEARANC E

± Erro r ± 11.33 6

# 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-3208 9 Readin g N o 17 3 Mod e SOI L Tim e 2009-09-1 0 17:3 5 Duratio n 30.6 3 Sequenc e Fina l Flag s BVI D # 6347 5 ADDRES S 242 1 n 45t h av e QUAD/ZON E easemen t INSPECTO R VENTR Y DEPT H 1 SAMPL E TYP E CLEARANC E NOT E

pp m± Erro r P b 88.99 0 ± 11.97 0 Supervise d By :

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

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

pp m P b 89.32 9 Supervise d By : 

## Certificat e o f Verificatio n

17 4 SOI L 2009-09-1 0 17:3 6 30.9 6 Fina l 6347 5 242 1 n 45t h av e easemen t VENTR Y 1 CLEARANC E

± Erro r ± 11.98 0

# m0
iJOLi \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 1 ^^^^ ^

I Coasta l Environmenta l Grou p Inc
. M ^ ^ ^

www.coastalhazmat.co m '*^L,^a ^ COASTA L ENVItONHINTA L CROUP , IH C 

# EXECUTIV ESUMMARY : BVID #63475-(242 1 N4 5 AVE ) No Issue s o r Concern s [ ^ Issues/Concern s Detail Explanation :4 ^i^BBfflli^^ S 

# EP APropert y Clos e Ou t For m Properl y # : l^'^Ur\ ^ Datc/Tlne : Owner' s Name: . .feB^'./JDJd.ifi'^t^^*

- ^ ^ ^ Quad s Excavated : Contracto r Grou p ^ 

# xmo\ ) Ye s N o Excavatio nGenera l 1
.If necessuy , were th e correc t quadrant(s ) excavate dandrestored ? ' ^ 2
. If necessary , were th e correc t area s ofdri p zone excavate dandrestored ? 

# I P ^ Ye s N o Gradlp g So dan dVegetatio n 1
.Doe s the gradin g aroun dthe perimeier ofth e hous e i nexcavate darea s generall y slop e awa y fromth e Iiouse ? 

# 1/ ' 2
.Ha s so dbee nlai dinall area s tha t wer e excavated ? 3
.Doe s th e sodappear to b e generall y healthy an dgrowing ? (Onl y evaluate if Inspecteda t a3 0 da y tim e period ) 4
.Are soddedarea s generaii y Hr man devenly graded ? 

# v 5
.

Ar e th e joint s betwee nth e so dstrip s generally tight ? (Only evaluate if inspecte da t a3 0 da y tim e period) 

# I/ ' 6 .Wa s the propert y grade dsuchtha t wate r will not poo l o nthe pTopert>'' ! 

## 1 / ' 

# X/ ' 7 .Wa s damage t o landscapin g o r plan t material s avoided ? Gates , Fence s an dRctainln j Wall s Ye s N o 1
.D o gate s ope nan dclos e freely? (Ifapplicable ) 2
.Were all gate s or fence s takendow ndurin g restoratio nactivitie s reinsulled ? (If applicable ) 3
.Wa s damag e t o gate s or fence s avoided ? (Ifapplicable ) i / 4
.Wa s damage t o retainin g wall s avoided ? (Ifapplicable ) 

### iX " Foundation , SidlaKan dGutter s Ye s N o t .Wa s damag e t o th e sidin g o r tri mavoided ? 

# V 2
.Wa s damage t o the foundationavoided ? 

# U ' 3
.

Wa s damag e to window s avoided ? 

# V- \ Wa s damag e to window s o r doo r screen s avoided ? 5
.Wa s damag e t o downspout s o r downspoul extension s avoided ? Sidewalk s an dDrh'eway s (Concrete ) Vc s N o I .Wa s damag e l o driveway surface s avoided ? ^ 2
. Wa s damage t o walkwa y surface s avoided ? 

# u^

## Ov»'ner s comments :

Inspectio nnotes :

Remova l an drestoratio nactivate s complet e includin g th e 30-da y so dwarranty : EP ARepresentativ e UGyxDoAf^I y Date : I[j/ 3 O ^I 

## Propert yCompietio n Agreemen t ih) S agreemen l documeni s lh e complclio n o fremedia l acliviiie s perloime d o n m ypioperl yM ysignatur e wil l designal e iha l I a m satisfie d wit h lli e restoralio n o fm ypropeiiy , an d iha l n o uems are m questions , now , o ra l anylim e i n Ih e future , excep l those ilem s liste d below , ifan y

Propert yIP : {^'^^'^ 5 Propert yAddress : 2,L\X \ \ 4 l^ ^

KyJ ^ Owner : Y\(.j^^^^ ^ ^^jy^^^^ ^ 

### Phone : ^^- ^ ^^ Q ^ Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : ttem:

I I agre e I'C^fortirio n Kcomplcltd , excep t a s noler i [_ J I H o no l »\trt crestomtio n i s complele d

Ovlncr' s SicnatU rDntc U ^ Oentraclor' s Signatur e Dat e

## Wate rBil l Settlemen t

Property ID 6347 5 Property Addres s 242 1 N4 5 S t Tenan t Mr . Shultz Harol d

I hav e receive d fromth e contractor , Coasta l Environmenta l Grou p Inc . (Coastal) , th e su mo f $ 12.6 3 for wate r usag e require dt o maintai nth e sod
. Chec k Number 187 5 Valu e o f Check $12.6 3 Mad e Ou t T o Haiol dShult z Descriptio n o fSettlemen t T o reimburs e tenan t fo restimate d wate rcharge s o n thei rMU D monthl yinvoices
. M ysignatur e belo wi s acknowledgemen t o fth e receip t o fth e su m liste d above , whic h I furthe r acknowledg e t o b e feircompensatio n an d fui i paymen t fo rth e above , an d releas e Coasta l Environmenta l Grou p inc
. fro m furthe robligation s o rliability
.


# hlS'^iol o Ofwner' s Signatur e V ^ Dat e «j>ntractor' s Signatu r 

### Date
T^.
. ^ ir-TT ^ 

### 187 5 COASTA L ENVIRONMENTA L GROU P INC
. 241 1 MARTH ASTREE T 27-V104000 3 OMAH AN E 681( » 624737290 4 

# \\\'-\\\c: ) DAT E 

# S S siMnAd_Sbiit ^ $ \z^ ­ -Y\i^-tflA/^(XAA^^ig D

« IMbPBrgo>wli.NA
. IWnBil a iMnniyoucon i 

# u..'^\^\^i' ^ ^^2.\t\^<>f^g
. *^K/v<g<?w ^

C&t^-w ^ i:iOl«00005Bi : e.EitTSTB'iOitii * QLB7 5

## Propert yDamag e Settlemen t

Property ID 6347 5 Property Addres s 242 1 N4 5 Ave
. Owner Harol dSchultz Phon e (402 ) 350-669 1 1 hav e receive dfromth e contractor , Coastal Environmenta l (jrou p Inc . (Coastal) , th e sim i o f $200.0 0 t o compensat e fo r plant s tha t wer e remove ddurin g th e remova l o f lea dimpacte dsoi l fromth e property . Compensatio ntyp e Check 1874 Valu e o f Chec k $200.00 Chec k to th e orde r o

f Harol dSchultz Descriptio n o fDamag e 

### Whil e excavatin g 242 1 N4 5 A v (BVI D 63475 ) Coasta l damage dsom e plant s beyon dsalvag e an d remove dsom e river rock
. Propert y owne r receive dachec k for th e amoimt o f $200.0 0 dollar s for th e replacemen t ofth e plants
. M ysignatur e belo wacknowledge s th e replacemen t o fm yplants ; further , i acknowledg e tha t thi s wor k wa s complete d satisfactor yan d withi n m yan d releas e Coasta l Environmenta l Group , Inc
. fro m furthe robligation s o rliabilit yrelate d t o thi s property
.



# w^wmm . ~ i COASTA L ENVIRONMENTA L GROU P INC
. 

## 187 4 241 1 MARTH ASTREE T 27-S/104000 3 624737290 4 OMAHA , N E 68105 

# \\\^\\ o DAT E PA

Y ORDE R 

## >^5^iiiQJcMJ^ruxtt ^ $ 200 ^ T\)0O\\KVA(V M (W^'^lto b

. DOLLAR S I' l Daiil U < «MIlFtoVOBwli,N A
FO

R 

## ^v\DVi.5^n6^^^^^'^^^ ^ "^^TA/u ^ 11101*0000sa n E.Bi, 7 37Eqoi.ii ' oiav u 

# /-/S'^0/ 0 over' s Signafur T Dat e ontractor' s Signatur e Dat e Pag e 1 o f1