## TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R
SA1D# : olf>^1 3 Date-.^Jd A1 , <20 H Address : 3c6c5 5 Cyhar/-^ ^ ?\ i RemediationContractor : Coastal Environmental Group

_Year : 2010ARR A
SOILREMEDIATIO N PROPERT YFIL EFOLDERDOCUMENT S y " Video o f propert y (DVD ) D Executive Summar y y EPA-providedpropert y sketch y ^ SignedAcces s Agreemen t fo r

subject propert y y ^ SignedAcces s Agreement(s ) fo r

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

damage or to replac e plants , etc. ) y Confirmationdat a y Photograph s y As-built sketch y Satisfactor y restorationsignedby Propert y Owne r y Propert y close-ou t chec k

lis t signedby EP A Jp|i

- Descriptiono f area s not meeting RO D cleanu p criteri a jy Utilit y clearance s y Propert y information fi-omDouglas Count y Assessor' s Offic e 

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nVideo/Photo s (30-Day ) Q Property Completio nAgreement D Final Report Air Monitorin g (a s applicable )

• community • Cre w On : Results :

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• community • Cre w On : Results : ^h n D

WOR K

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Renter : Phone : Fax : Cell/Pager : Additiona l Inforniation :

Sent : / / 

## Signed: i_/^// 2 Siened: -5* / f / / t 1 1 II I1 

## CaUed : 3 / 17 / ) n On : 7 lIZ l t o On : / / On : / / On : / / Siened : / / Issued : / /

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## By: 5/221^ 0 By : V j J 'AJlcl^P , c - Anj y r By : By : By : By : By :

Omah a Lea d Sit e

## Douglas Count y Accoun t In : 

# m Page 1 of 2

Dougla s County , Nebrask a Propert yRecor d - R164205000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s avaiiabl e @ scai e 0-5 0 ft wes t o f52n d S t - VJe WO n Ma p 

### Infomiatio 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 KIN G RILE Y ETA L 332 5 CHARLE S S T OMAH AN E 68131-000 0 Propert yInformatio n Ke yNumber, : 420 5 000 0 1 6 Accoun t Type : Residentia l Parce l Number : 164205000 0 Parce l Address : Lega l Description : 332 5 CHARLE S S T OMAH AN E 68131-000 0 LOWE S AD D LOT5 BLOC KTN 1/ 2 E 4 0 FT 4 0 X7 8. 5 Valu e Informatio n


### 200 9 200 8 200 7 

### 200 6 200 5 200 4 Lan d $1,800.0 0 $1,800.0 0 $1,800.0 0 $1,800.0 0 $1,800.0 0 $1,800.0 0 Improve men t $64,500.0 0 $64,500.0 0 $64,500.0 0 $64,500.0 0 $64,500.0 0 $28,000.0 0 Tota l $66,300.0 0 $66,300.0 0 $66,300.0 0 $66,300.0 0 $66,300.0 0 $29,800.0 0 Lan d Informatio n Acre s 0.0 7 S F 3120. 0 Unit s 1. 0 Dept h 78. 0 Widt h 4 0. 0 Vacan t N o Improvement Informatio n Buildin g 1



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

. 12/29/2009

## Dougla s County Accoun t Inf t Pag e 2 of 2 

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CLIC KT O ENLARG E IMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : 1664. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Fai r



### Buii t As : 2 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 8. 0 Exterior : Fram e Stucc o Units : 1. 0 interior : Drywal l Baths : 1. 5 Roo fCover : Compositio n Shingl e Bedrooms : 4. 0

Roo fType : 'Hi p Stories : 2. 5 Fioorcover : i 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 

### 191 0 0 % 

### 191 0 10 0 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 

### 1. 0 Basemen t Bsmn t Bloc k 8 f t 832. 0 Basemen t Finishe d 400. 0 Fixtur e Bas e Fixture s 

### 1. 0 Fixtur e Bat h Ful l 1. 0 Fixtur e Bat h Hal f 

### 1. 0 Garag e Detache d 

### 264. 0 Porc h Sla b Roo fCeilin g 

### 154. 0



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

. . 12/29/200 9

## Douglas Count y Accoun t Inf i Page1 of 2 

# w
Dougla s County , Nebrask a Propert yRecor d - R180296000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scai e 0-5 0 ft wes t o f52n d S t - VJe 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 Saie s Searc h Owne r LARR YADMILE S ETA L 132 5 N 3 3 S T OMAH AN E 68131-000 0 Propert yInformatio n Ke yNumber : 029 6 000 0 1 8 Accoun t Type : Residentia l Parce l Number : 180296000 0 Parce l Address : 311 0 MYRTL E AV OMAH AN E 68131-000 0 Lega l Description : MONTCLAI R AD D LOT9 0 BLOC K0 4 8 X11 6 Valu e Informatio n Lan d Improvemen t Tota l 

### 200 9 $2,500.0 0 $26,300.0 0 $28,800.0 0 200 8 $2,500.0 0 $26,300.0 0 $28,800.0 0 200 7 $2,500.0 0 $26,300.0 0 $28,800.0 0 200 6 $2,500.0 0 $26,300.0 0 $28,800.0 0 200 5 $2,500.0 0 $26,300.0 0 $28,800.0 0 200 4 $2,500.0 0 $28,300.0 0 $30,800.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 2 5520. 0 1. 0 

### 115. 0 48; o N o Improvemen t Informatio n Buildin g 1



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

. 12/29/20099 0 

## Dougla s County Accoun t Inf i Pag e 2 of 2

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lOf f 3110MyllleA v 21/2Wlll| i 

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### Squar e Footage : 1512. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Poo r

Buil t As : 2 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 7. 0 Exterior : Fram e Sidin g Units : 1. 0 interior : Drywal l Baths : 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 4. 0

Roo fType : Gabl e Stories : 2. 5 Fioorcover : i Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 191 9 0 % 191 9 9 1 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 ft 764. 0 Fixture Bas e Fixture s 1. 0 Fixture Bat h Ful l 1. 0 Porc h En d Soli d Wal l 180. 0



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.js p ?accountno=Rl..

. 12/29/200 9

## Pag e1 of 2

" > jCreat e Anothe rTicke t | Bac k t o Irt h Inteme t Sen d Emai l J



## YOU RTICKE TNUMBE RI S 2440231

. Origina l Cal l Date : 3/17/1 0 Time : 9:2 6 p mOp : ELIZABETH1879 0 Wor k t o Begi n Date : 3/22/1 0 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 332 5 Street : CHARLE S S T Twp : 15 NRng : 13 E Sect-Qtr : 16-NW Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n Locatio n o f Work : LOCAT E ENTIR E PROPERTY , AL L EASEMENT S AN D T O TH E PEDESTA L Remarks : FAX AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LO T Compan y: COASTA L ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : coasta l Dept ho f Excavation : 4 f t Come r Lot : N Front : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL S MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac t Phon e Numbe r Utilit y Typ e

CXCAT V CO XCOMMUNICATIONS , IN C HEID I 

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

LEVEL S LEVEL S COMMUNICATIONS , LL C N A 

## Day : 877366834 4 Alt : Emerg : 877366834 4

MUDO l METROPOLITA NUTILITIE S DISTRIC TSAND Y 

## Day : 402504782 3 Alt : Emerg : 402504797 0

OMAHACO FCIT YO FOMAHA-TRAFFICSEWE RRICH/TRAFFI C 

## Day : 402444719 7 Ah : 402444516 1 Emerg : 402444516 0 Day : 406728934 3
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OPPDGPR 5 OMAH APUBLI C POWE RDISTRIC TELM LOCATIN G 

## Alt : 4062071494 Emerg : 888728934 3 Day : 406728934 3 QLNNEI C QWES TLOCALNETWOR K ELM LOCATIN GAlt : 406207149 4 

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# As-Buil t Drawin g
COASTA L 

# Omah aLea dSuperfun dSit e tNViaOHH fNTA L B •O U P , IN C OLS#:2557 3 Dat e Excavated : 4/20/201 0 Dat e USEP ASigne d Off : 5/18/201 0
Name : Address : ^= i 3 Phone : , - ^ cHAHlE S <.T

. Oinah a Ua d Sit e sn e Sketc h Date : Time : ^.J/c/ o ^ ^'.J D /Vr ? Nort h Airo w

Tea m HIAJ^

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## Legen d
Dri p Zon e Excavate d Quadrant s Excavate d 

### Concret e
Are a replace d wit hI 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 . 4613 0

# ^ ^ i/l//p 4 ^A ^ / ^ Wll ' ^ H i c; > 

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COASTA I IHVIIOMHtllU l cI o u r. IN C 

# Consen t fc fAcces s T o Property 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 Agency(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 : '2^57' ? 

# (2. 1 ten / Km ^ Owner' s Name : ^ Daytim e Phone : 55 ^

• 

# hm^ f ^»x) ^

Addres s o fPropert y covere d b ythi s 

# 332. S 6^l«l^^€5^"^ • 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 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 performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o fCoastal 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 perfonmed , 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 LRESPONS 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

# '>!:r«'*

.
COASTA L IKri>ONK>KT« l CIOU P i KC 

## *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 ; cWate 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 ; eAbid 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 tenari 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 wor k iactivities

. 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 wothers 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 contact Coasta l Environmenta l Group , a t (402 ) 991-119 9

[S< i gran t access t o m ypropertie s D I d o no t gran t acces s t o m ypropertie s

l o signatur e / ' v y iJate 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 f2C O AS T AL
•HViaONHaHTA L O I I O U P , INC

. 

# 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 the 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 ProtectionAgency (EPA)

.

Propert y ID : 25^*7/ ^ Propert y Address : ^^^gf S TJTVl f ^. S St Owner : 

# Ri'leu lEfYi ; \ \fgmi'iu kin g Phone : 

# } M O

nthe attacheddiagram(s ) indicat e area(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 dociunen 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 fRemediation : Th e removal , storage , disposal , and/o rretur n o fthes e item s i s th e Owner' s responsibility

. Item : 

# Pky s 

# y i/e ^



# r^y^ o Kem :
Kem :
Kem :



## Item s t o b e Remove d b yth e Contracto rDurin g Remediatio n an d No t Replace d Item : 

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Kem :
Kem :



### Pag e i o fyC O AS T AL 

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

# So- , 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 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 sprinkler 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 ewil l 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 excavate d ^ 

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### Additiona l Comment s / Instructions : Th e cK yo fOmah a ordinance s ma yprohib Kyo u fro m usin g dir t o rgrave i areas o n you rproperty 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 rpropertytha t yo u ma yb e usin g a s a drivewayo 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 EP A I fyo u have an yquestio n abou t legalityo fa certai n drivewayo rparkin g area , yo u ma ycontact th e cK yo fOmaha' s Plannin g Departmen t a t (402 ) 444-5150

. 

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

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Q 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

. 

## QId o no t agre e

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- XR F PROPERT Y SAMPL E SHEE T 

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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 fVerificatio n
XL3t-3208 9 Readin g N o 4 0 Mod e SOI L Tim e 2010-05-0 5 11:4 3 Duratio n 90.3 3 Sequenc e Fina l Flag s AVERAG E (^^vg3C37-39' " ADDRES S 332 5 Charle s s t QUADRAN T E A DEPT H 1 " TTP E CONFIRMATIO N INSPECTO R N

. LOPE Z



### pp m Erro r M o < LO D : 8.00 0 Z r 420.94 4 ± 15.23 5 S r 172.98 8 ± 8.98 4 U < LO D : 15.30 8 R b 74.10 6 ± 6.82 5 T h 14.38 1 ±. 9.11 5 S e —272:28 3 < LO D " ±c — Zfc»/ 4 5.80 7 - ^ A s < LO D 28.15 2 H g < LO D 12.59 0 Z n 263.33 3 ± 27.18 0 W < LO D : 90.12 9 C u 42.08 3 ± 21.55 3 N i < LO D : 74.71 4 C o < LO D : 191.63 2 F e 20720.61 9 ± 415.08 1 M n 477.613/ ^ ± 95.02 3 Supervise d By : {fy 

# ^ M { ltd./)

# 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 3 7 Mod e SOI L Tim e 2010-05-0 5 11:4 2 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 2557 3 ADDRES S 332 5 Charle s 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 J 7.93 3 Z r 417.71 6 ± 15.10 7 S r 167.35 2 ± 8.80 8 U < LO D I 15.48 0 R b 73.59 7 ± 6.80 3 T h 17.08 2 ± 9.26 9 P b 271.56 4 ± 21.74 8 S e < LO D 5.47 2 A s < LO D 27.83 9 H g < LO D 12.20 8 Z n 267.41 6 ± 27.13 6 W < LO D : 86.18 1 C u 33.89 9 ± 20.83 1 N i < LO D \ 75.69 1 C o < LO D I 189.25 1 Fe 20655.64 5 ± 412.60 8 M n 509.49 3 ± 96.39 1 Supervise d By :

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 3 8 Mod e SOI L Tim e 2010-05-0 5 11:4 3 Duratio n 30.1 0 Sequenc e Fina l Flag s BVI D 2557 3 ADDRES S 332 5 Charle s s t QUADRAN T E A DEPT H 1 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

Erro r pp m M o < LO D J 8.03 7 Z r 417.60 3 ± 15.14 5 S r 176.03 9 ± 9.02 9 U < LO D : 15.25 2 R b 72.95 2 ± 6.76 3 T h 13.91 9 ± 9.04 3 P b 271.66 1 ± 21.79 1 S e < LO D 6.07 7 A s < LO D 27.91 3 H g < LO D 12.97 1 Z n 255.74 6 ± 26.83 6 W < LO D : 92.89 4 C u 40.77 2 ± 21.32 6 N i < LO D \ 72.45 9 C o < LO D : 189.49 9 F e 20723.09 4 ± 413.74 4 M n 452.06 7 ± 92.96 6 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 3 9 Mod e SOI L Tim e 2010-05-0 5 11:4 3 Duratio n 30.1 2 Sequenc e Fina l Flag s BVI D 2557 3 ADDRES S 332 5 Charle s 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 : 8.03 0 Z r 427.51 4 ± 15.45 5 S r 175.57 3 ± 9.11 6 U < LO D : 15.19 2 R b 75.76 8 • ± 6.90 9 T h < LO D : 13.55 0 P b 273.62 4 ± 22.08 4 S e < LO D : 5.87 1 A s < LO D 1 28.70 4 H g < LO D : 12.59 1 Z n 266.83 6 ± 27.56 8 W < LO D 91.31 2 C u 51.57 9 ± 22.50 2 N i < LO D I 75.99 2 C o < LO D 196.14 5 F e 20783.11 5 ± 418.89 1 M n 471.28 0 ± 95.71 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 3 6 Mod e SOI L Tim e 2010-05-0 5 11:4 0 Duratio n 90.3 4 Sequenc e Fina l Flag s -:= - AVERAG E c=A9f^F33-3 5 ADDRES S 332 5 Charle s 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 : 8.23 7 Z r 471.35 9 ± 16.37 0 S r 177.56 1 ± 9.31 9 U < LO D : 15.54 1 R b 77.91 7 ± 7.09 8 T h < LO D 14.09 5 _O W ^^ ^ "=^^^2887288 ± <= "i o r m S e < LO D 6.19 3 A s < LO D ; 29.46 0 H g < LO D : 13.18 8 Z n 232.58 8 ± 26.31 4 W < LO D : 89.35 5 C u 41.03 3 ± 22.23 1 N i < LO D i 76.58 0 C o < LO D : 198.99 6 F e 21189.45 5 ± 429.53 2 M n 423.86 7 / ^ ± 94.10 7 Supervise d By : (!// C 

# 'no ^Olfd A

# 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 3 3 Mod e SOI L Tim e 2010-05-0 5 11:3 9 Duratio n 30.1 2 Sequenc e Fina l Flag s BVI D 2557 3 ADDRES S 332 5 Charle s s t QUADRAN T D Z DEPT H 13 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m M o < LO D Z r 477.59 0 S r 178.00 7 U < LO D R b 78.92 3 T h < LO D P b 294.14 5 ^ < LO D A s < LO D H g < LO D Z n 215.84 2 W < LO D C u < LO D N i < LO D C o < LO D Fe 21511.42 0 M n 478.36 2 Supervise d By : Erro r 8.19 9 ± 16.47 6 ± 9.33 9 15.60 3 ± 7.14 1 14.25 2 ± 23.24 2 5.89 9 29.52 5 13.27 7 ± 25.45 1 87.36 8 32.41 1 78.32 8 200.72 4 ± 433.10 5 ± 98.31 8

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

## Certificat e o fVerificatio n
XL3t-3208 9 Readin g N o 3 4 Mod e SOI L Tim e 2010-05-0 5 11:4 0 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 2557 3 ADDRES S 332 5 Charle s 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 ; 8.27 2 Z r 485.38 6 ± 16.61 5 S r 178.58 3 ± 9.35 7 U < LO D : 15.77 3 R b 81.20 2 ± 7.25 0 T h 14.75 9 ± 9.56 3 P b 289.83 3 ± 23.15 5 S e < LO D 6.65 6 A s < LO D 29.78 7 H g < LO D 12.97 4 Z n 252.62 7 ± 27.41 5 W < LO D I 92.80 1 C u 55.60 6 ± 23.38 3 N i < LO D : 76.53 7 C o < LO D : 200.85 9 F e 21316.29 9 ± 431.60 5 M n 420.60 3 ± 94.22 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 3 5 Mod e SOI L Tim e 2010-05-0 5 11:4 0 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 2557 3 ADDRES S 332 5 Charle s 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 J 8.23 9 Z r 451.10 3 ± 16.01 9 S r 176.09 4 ± 9.26 0 U < LO D : 15.24 8 R b 73.62 5 ± 6.90 3 T h < LO D : 13.68 9 P b 280.88 6 ± 22.66 9 S e < LO D : 6.02 2 A s < LO D ; 29.06 7 H g < LO D 1 13.31 3 Z n 229.29 5 ± 26.07 5 W < LO D J 87.89 6 C u 35.64 5 ± 21.70 4 N i < LO D I 74.87 5 C o < LO D : 195.40 5 F e 20740.64 5 ± 423.88 6 M n 372.63 4 ± 89.78 1 Supervise d By :

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

## Certificat e o fVerificatio n
XL3t-3208 9 Readin g N o 3 2 Mod e SOI L Tim e 2010-05-0 5 11:3 6 Duratio n 90.3 4 Sequenc e Fina l Flag s •—-^^ ^ AVERAG E cr2Sg5«9-3r ^ ADDRES S 332 5 Charle s s t QUADRAN T B l DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

M o Z r S r U R b T h Cpb— ^

S e A s H g Z n W C u N i C o F e M n 

### pp m
< LO D 443.76 0 188.85 9

< LO D 70.37 6 < LDX > ^^583:567-' ^ < LO D < LO D < LO D 277.80 1

< LO D 50.51 0 < LO D < LO D 20931.23 2 364.224 ^ 

### Erro r
: 8.14 0 ± 15.78 1 ± 9.45 5

; 14.97 8 ± 6.71 2

: £:r:i5:62i=:= ^ ±. 22.50 5 J 5.70 4 J 29.33 6

• 12.33 2 ± 28.06 7

; 89.65 7 ± 22.53 1

: 77.02 1 : 194.26 5 ± 421.22 0 ± 87.95 0 Supervise d By : f/ J y 

# V7 i 

# ^ff M

# 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 2 9 Mod e SOI L Tim e 2010-05-0 5 11:3 4 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 2557 3 ADDRES S 332 5 Charle s s t QUADRAN T B l DEPT H 6 " TYP 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 F e M n pp m
< LO D 448.77 8 178.95 8

< LO D 70.11 7 < LO D 282.56 5

< LO D < LO D < LO D 280.98 9

< LO D 57.38 9 < LO D < LO D 21263.35 9

439.33 1 Supervise d By : : ± ± \ ±

: ±' \ : : ±

: dt

: : d b ± Erro r 8.10 8 15.84 7

9.23 7 14.97 9 6.71 4 13.48 8 22.51 6

6.04 9 29.35 2 12.47 5 28.31 0 91.39 0 23.04 4 75.72 2 195.15 3 425.38 8

93.76 5

# 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 3 0 Mod e SOI L Tim e 2010-05-0 5 11:3 5 Duratio n 30.1 2 Sequenc e Fina l Flag s BVI D 2557 3 ADDRES S 332 5 Charle s s t QUADRAN T B l DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

Erro r pp m M o < LO D : 8.26 1 Z r 444.71 8 ± 15.82 9 S r 205.86 0 ± 9.84 8 U < LO D : 15.06 7 R b 72.42 1 ± 6.78 6 T h < LO D : 13.44 9 P b 280.70 3 ± 22.36 4 S e < LO D : 5.51 8 A s < LO D : 29.41 9 H g < LO D 12.28 4

• : Z n 273.76 0 ± 27.85 3 W < LO D : 88.68 4 C u 51.71 3 ± 22.57 8 N i < LO D

. : 77.08 6 C o < LO D : 195.24 4 F e 20785.46 7 ± 419.49 8 M n 367.79 1 ± 88.47 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 3 1 Mod e SOI L Tim e 2010-05-0 5 11:3 6 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 2557 3 ADDRES S 332 5 Charle s s t QUADRAN T B l DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D : 8.05 2 Z r 437.78 4 ± 15.66 5 S r 181.75 7 ± 9.27 9 U < LO D : 14.88 8 R b 68.58 9 ± 6.63 7 T h 19.61 0 ± 9.68 3 P b 287.43 2 ± 22.63 6 S e < LO D 5.54 6 A s < LO D 29.23 8 H g < LO D 12.23 6 Z n 278.65 5 • ± 28.03 8 W < LO D : 88.89 6 C u 42.42 6 ± 21.97 1 N i < LO D ; 78.25 6 C o < LO D : 192.39 9 Fe 20744.86 9 ± 418.77 5 M n 285.55 0 ± 81.61 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 2 8 Mod e SOI L Tim e 2010-05-0 5 11:3 3 Duratio n 90.3 5 Sequenc e Fina l Flag s AVERAG E 

### p-AgL355=2 7 J ADDRES S ^^25^harle s 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 8.12 7 Z r 494.89 5 ± 16.21 3 S r 166.49 1 ± 8.78 3 U < LO D • 15.37 4 R b 78.13 1 ± 6.93 1 T h 15.29 6 ± 8.07 4 <rP B ^ ___138:49 5 " ± 16.032
- S e 

### < CO D 5.44 6 A s < LO D 21.13 8 H g < LO D 12.28 0 Z n 114.40 7 ± 19.17 1 W < LO D J 86.07 1 C u 33.96 9 ± 20.67 8 N i < LO D * 73.54 5 C o < LO D * 179.13 1 F e 17892.38 3 ± 384.37 5 M n 524.359 ^ ± 96.83 6 Supervise d By : c/v ^



# ^/} / 

# Vf(^ ^

# 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 2 5 Mod e SOI L Tim e 2010-05-0 5 11:3 1 Duratio n 30.1 2 Sequenc e Fina l Flag s BVI D 2557 3 ADDRES S 332 5 Charle s 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 : 8.22 1 Z r 503.00 6 ± 16.41 2 S r 165.44 8 ± 8.80 7 U < LO D ; 15.71 2 R b 80.38 3 ± 7.07 0 T h 13.61 8 ± 7.97 2 P b 136.24 2 ± 16.00 6 S e < LO D 5.49 9 A s < LO D 21.37 2 H g < LO D 12.33 3 Z n , 126.47 8 ± 20.05 9 W < LO D * 86.44 8 C u 51.64 6 ± 22.17 1 N i < LO D : 74.40 7 C o < LO D : 181.72 7 F e 18009.92 4 ± 387.79 4 M n 545.56 6 ± 98.91 2 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 2 6 Mod e SOI L Tim e 2010-05-0 5 11:3 2 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 2557 3 ADDRES S 332 5 Charle s 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 : 8.07 6 Z r 484.77 7 ± 16.01 7 S r 166.19 5 ± 8.74 0 U < LO D \ 15.80 1 R b 79.39 4 ± 7.00 1 T h 19.25 1 ± 8.33 5 P b 132.82 7 ± 15.70 8 S e < LO D 5.45 5 A s < LO D 20.85 7 H g < LO D 11.92 7 Z n 104.35 3 ± 18.45 9 W < LO D : 86.38 2 C u 32.20 8 ± 20.51 4 N i < LO D 74.61 0 • C o < LO D I 177.82 7 F e 17645.56 1 ± 380.28 6 M n 510.08 3 ± 95.34 2 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 2 7 Mod e SOI L Tim e 2010-05-0 5 11:3 3 Duratio n 30.1 2 Sequenc e Fina l Flag s BVI D 2557 3 ADDRES S 332 5 Charle s s t QUADRAN T F l DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m M o < LO D Z r 496.90 1 S r 167.83 0 U < LO D R b 74.61 5 T h 13.01 9 P b 146.41 7 S e < LO D A s < LO D H g < LO D Z n 112.39 1 W < LO D C u < LO D N i < LO D C o < LO D F e 18021.66 2 M n 517.42 7 Supervise d By : Erro r 8.08 4 ± 16.21 0 ± 8.80 3 14.61 0 ± 6.72 2 ± 7.91 5 ± 16.38 3 5.38 4 21.18 4 12.57 9 ± 18.99 5 85.38 1 29.02 4 71.61 9 177.83 9 ± 385.04 3 ± 96.25 4

### % % 

## o^^2Z"-* , / jOk ^

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

. V^M^; ^ 

### ^

www.coastalhazmat.co m *>iPHo^' ^ COASTA L ENVIIDNMEIITA l CIOUP , IN C 

# EXECUTIV ESUMMARY : BVID #25573-(332 5 CHARLE S ST )
No Issue s o r Concern s Q Issues/Concern s
Detail Explanation : -COASTA LT O REPAI RDAMAG ET O ARBOR

. (COMPLETE D 5/18/10 ) -COASTA LT O REPLAC EGRAS S O NTH ESOUTHSID EO FPROPERT Y(COMPLETE D 5/18/10 ) -COASTA LT O DRO POFFMOREDIR TFO RPLANTER

. (COMPLETE D 5/18/10 ) -COASTA LT O REPLAC ESMALLSTRI PALON GTH EFENC ELINEO NTH EEAS TSIDE

. (COMPLETE D 5/18/10 ) -COASTA LT O COVE RTH EROOT S O FPLANT S O NTH ESOUTHSID EO FTH EBUILDING

. (COMPLETE D 5/18/10 ) -DANGARVE YWALKE D TH EPROPERT YO N5/18/1 0

# EP APropert y Clos e Ou t For m Propert y U:2^n ^
. . P-«rt v A^6r^

. .y^?.' ^ (llAQr)f?^ ^ Propert y Address ^ Datc/Tline : Owner' s Name : j ^ Contracto r Grou p 

# m Quad i Excavated : Yes No Excavatio nGenera l 1

. I f neccssaiy , wer eth e correc t quadranKs ) excavate dan drestored ? 2

. I f necessary , wer e th ecorrec t area s o r dri p zon e excavale dan drestored ? 

## y Ye s r*i i Gradin c So dan dVcmtalio n 

### I
. Doe s th e gradin g aroun dth e perimete r ofth e hous e inexcavale darea s generall y slop eaway 

### / fromth ehouse ? 

### — 2

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

# y 3

. Doe s th eso dappea r t o b egenetall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 

# y da y timejeriod ) 

### 4

. Ai c sodde darea s generall y (irman devenl y graded ? 

### / 5

. Ar eth ejoint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e if inspecte da t a3 0 da y 

# y tin> eperiod ) 

### 6
. Wa s th eproperty grade dsuc hthat wate r wil l no l poo l onth e property ' 

### / 7
. Wa s damig e t o landscapin g o r plan t material s avoided ? 

# J
Gates , Fence s an dRetateln g Wall s Ye s N o I1

. D o gate s openan dclois efieely? (I f applicable ) 

### / 2

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

### / 3

. Wa s damag et o gate s o r fence s avoided ? (I f applicable ) 

### / 4

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

# z Foundation , SidiOK an dGntler v 

### Ye s N o I
. Wa s damag et o th esidin g o r tri mavoided ? 

### / 2

. Wa s damag et o th efoundatio navoided ? 

### / 3

. Wa s damag et o window s avoided ? 

### / 4 Wa s damag et o window s o r doo r screen s avoided ? 

### / 5

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

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

. Wa s damag et o drivewa y surface s avoided ? 

### / 2 , Wa s damag et o waDcwa y surface s avoided ? 

### /

# Ox'Dcrs conmients :

. 

# pjinspectionnotes :

Remova l an drestorationactivate s complet e includin g ih e30-da y so dwarranty : EP ARepresentativejSmmjSL yDate : </»/ o

### %

u ^ 

# Propert yCompletio n Agreemen t

riii s agreemen t document s Ih e complclio n o l remedia l activitie s peribime d o n m yproperl yM ysignatur e wil l designat e tha t I a m satisfie d wi( h th e restoralio n o fm yproperly , an d (ha l n o item s ar e i n queslions

. now , o ra l an ytim e i n th e future , excep t Ihos e item s liste d below , i fan y

Propert yID : 

# •2ssi a Propert yAddress : 3^;><: ^ O.iOQrlP ^

^ Owne r 

## Pho»e:/j|Q^^^^,^^q- ^
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# Propert y Owne r Assessmen t of Performmcp-Fo^m

. America nRecover y an dReinvestmen t Ac t (AfQ|j| Ti * f " I\/PF l Omah aLea dSuperfun dSit e ^ » « 2 ¥ L
. tJ 2009/201 0 MA y 1 2 201 0 Remediatio nContractor : Coasta l Environmenta l Grou p - EP-Rg><iBl?PP | | jV/ nH h/i nii-»

. Propert y Identifie r Number : ^SfTl ^ "^'^ ^ fJiVlSlO N Propert y Address : ?>?^Z S C\nrjr/07 ^ ^ ^ Propert y Owner' s Name ; thrif t j / FW) , Iu J-CjA c Instruction s t o th e Propert y Owner : Thi s for mserve s t o recor dth e Properly Owner' s assessmen t of perfonnanc e (Incentive 1

- Qualit y Assuranc e Stirvallanc e Flan ) involvin g th e liste dremediationcontractor , a s applicable to th e Omah aLea dSite

. Thi s for mdocimient s th e timelines s of punchlis t resolution , busines s relations , complaint resolutio nandth e overal l qualit y o f work

. If needbe , th e Propert y Owne r ma y utiliz e thi s for mto recordproblem s and/o r issue s not specifically tie dto a nassigned address , for example , busines s relation s that generally don' t follow the guideline s set fort hi nthe Performanc e Wor k

Statement , Th e Propert y Owne r wil l indicate his/her assessment o f perfoimanc e wit hth e contractor' s wor k

b y checkin g anamerica l ratin g onth e tabl e belo w tising the numerical definition s fro m the ratin g scal e below , thensign& date th e form

. fi^l O -^excellent " i

7- 8 "ver y good " 5- 6 "acceptable " 3- 4 "poor " 1-

2 "ver y poor " Propert v Owner^ s Assessmen t o f Performanc e Regardin g th e Contractor' s Work 1 0 t. ^ 5 9 4 8 3 7 2 6 1 Propert v Owne r Additiona l Comment s fro m(optional ; continu e onbac k pag ei f needed^
Propert y Owne r Signature : [f\Ai/Cu j f\yy.'\jl l ^Date : 5/ ^ 11 0 

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