## TRANSMITTALof OMAHA LEAD SIT E SOI LREMEDIATIO NHL EFOLDE R
SAID # : l^at^- ^ Date : (Q/^^/0< ^ 

### Address : HT-OC ^ VJ\C\ 

### Remediatio nContractor : Coasta l Environmenta l Group

_ Year : _200i

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SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S
zTVide o ofpropert y (DVD ) \y Executiv e Summar y J ^ EPA-provide dproperty sketc h y f Signe dAcces s Agreemen t for subjec t property m ^ Signe dAcces s Agreement(s ) for adjacent property J^

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. E H Topsoi l Samplin g (i f applicable ) By : O Disposa J Samplio g (i f applicable ) By : Q Gnrdc n Samplia g (i f applicable ) By :

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### By=^gri^ M /gA^/w J Q Video/Photo s (During ) On : Bv : D Video/Pholo s (After ) On : By : D ViOeo/Photo j (30-Day ) On : By : D Propert yCompletio n Agreemen i Signed : / / By : D Fina l Repor t Issued : By : 

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Omah a Lea d Sit e

## Propert y I D # Propert y Address : Initial Contact : Secon dContact : Fina l Contact : Fina l Action :

Comment : Owner Comment (s) : Site Coordinato r Comment (s) : CONTACT FOR M
1 <^^\^" 1 

# 47.01 ^ W\fi^- \ Date : Time : Action :

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## Dougla s Coimt y Accoun t j||Drmatio n Pag e 1 of 2
Dougla s County , Nebrask a Propert yRecor d - R171187000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f52n d S t - VlevyO n Ma p Informatio n i s vali d a s o f2009-5-1 2 Treasurer' s Ta xRepor t Ne wFeatur e -•••- • Aut o Sale s Searc h Owne r M C DOUGL E EFFI E L ETA L 420 6 WIR TS T OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : 

### 118 7 000 0 1 7 Accoun t Type : Residentia l Parce l Number : 171187000 0 Parce l Address : Lega l Description : 420 6 WIR TS T OMAH AN E 68111-000 0 MAPLEWOO D LO T3 BLOC K1 W 53. 1 FTLT S 2 & Valu e Informatio n


### 200 9 200 8 200 7 200 6 200 5 200 4 Lan d $5,600.0 0 $5,600.0 0 $5,600.0 0 $5,600.0 0 $5,600.0 0 $5,600.0 0 Improvemen t $40,800.0 0 $47,700.0 0 $47,700.0 0 $47,700.0 0 $23,700.0 0 

### $21,500.0 0 Tota l $46,400.0 0 $53,300.0 0 $53,300.0 0 $53,300.0 0 $29,300.0 0 

### $27,100.0 0 Lan d Informatio n Acra s 

### 0.1 1 S F 4876. 0 Unit s 

### 1.0 Dept h 92. 0 Widt h 53. 0 Vacan t N o Improvement Informatio n Buildin g 1



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R171..
. 6/7/2009

### Dougla s Coimty Accoun t ijArmatio n Pag e 2 of 2

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CLIC KT O ENLARG E IMAG E CLIC KT Q ENLARG E IMAG E Squar e Footage : 1276. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Averag e

Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 6. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 3. 0

Roo fType : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Blocl < 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 192 3 0 % 192 3 8 6 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Blocl < 8 f t 816. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h En d Soli d Wal l 128. 0 Use r Atti cFul l Finis h 332. 0



### http://dougIasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R l 71..
. 6/7/200 9

### Pag e 1 o f 1

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### • YOURTICKE T NUMBE RI S 2326029
. Origina l Cal l Date : 7/24/0 9 Time : 5:4 9 pmOp : ELIZABETH1879 0 Wor k t o Begi n Date : 7/28/0 9 Time : 6:1 5 pm State : NE County : DOUGLA S Place : OMAH A Address : 420 6 Street : wiER T S T Twp : 15 NRng : 13 E Sect-Qtr : 08-NE-N 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 EASEMENT S LOCAT E ENTIR E PROPERTY Remarks : F7V X AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LOT . Compan y: COASTAL ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Being 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 Nuinbe r Utilit yTyp e
CXCAT V CO X COMMUNICATIONS , IN C 

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

MUDO l METROPOLITA NUTILITIE S DISTRIC T 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 RDISTRIC T 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://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 7/24/200 9

# r As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e
2996 7 Exterio rPain t Nort h Arro w Omah a Lea d Sit e • Goo d Sit e Sketc h [a^Poo r Samplin g Address : 420 6 WIR TS T

. 1 I No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : RYASCPXA-2996 7 F 1 pp m 

## D Date : 7~-2.S-3 3 RYBSCPXA-2996 7 F 2 

## Z 5 1 pp m Time : IZ-
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# n RYCSCPXA-2996 7 B l ^ n q oo m Sample s Analyze d RYDSCPXA-2996 7 8 2 HH O pp m 

# n RDZSCPXA-2996 7 D Z 

## 6.2 0 pp m 

# n XR F Unit : <^agH< S Book : Z I " ^ RGZSCPXA-2996 7 G Z 

## Zi( o pp m 

# n Dale : ^ - tS'-0 & RPZSCPXA-2996 7 P Z 

# A ± pp m [E f 

## D Time : f\rr \ La b RYCSCPLA-2996 7 Staff : miU- > Numbe ro f Sample s 

# [ T / Resul t 51 0 pp m i-eyeiiu
. r i = rro mi_en , t-J : — 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 y Al l quadrant s ar e a s viewe d fro m th e street , facin g propert y



## : -" I n S ^' OLSff:2996 T Dat e Excavated : 11291^9 Dat e USEP ASigne d Off : 8/6/Q 9 Are a Sodden : 149 0 s q f t

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^m ) CroiKt l 0.t-May-<n i W«»\ sy (kMTD I 0 1 2. 1 Legen d Concret e Dri p Zon e Excavate d^< ^ Quadrant s Excavate d Are areplace d So d wit h Are areplace dwit h Rock/Mulc h Are alef t bar e Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc ,

# 1 2996 7 Exterio rPaiti t Nort h Arro w 

### Omah a Lea d Sit e • Goo d 

### Sit e Sketc h [3^Poo r Samplin g Address : 420 6 WIR TS T y Q Notpain t Lea d Sampl e Sample s Collecte d Sampl e Numt)e r LA B Concentratio n Collecte d Firm : ? E C-C - C-K - RYASCPXA-2996 7 F l

_pp m Q" ^ 

## 2 0 3 

## D Date : T-aS-'^ S RYBSCPXA-2996 7 F2 

## 2^- ?

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## D XR F Unit : ^o5Hf i Book : 2 H RGZSCPXA-2996 7 G Z 

### 11( 6 _pp m of 

## D Date : ^-/5"-D 6 RPZSCPXA-2996 7 P Z 

# i^ l

_pp m H ' 

## D Time : (\f n Lab RYCSCPLA-2996 7 1 _— 1 Staff : nit O : Result 51 0 pp m Numbe rof Sample s = / | / Lcytjiiu
. rI = t-ron i Len , i- 2 = Fron t Right , B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Play Al l quadrant s ar e a s viewe d fro m th e street , facin g property

Re v200 8 Creaied : 0.1-May 044701.01.2. ?

# 2996 7 

# m P Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e • Goo d 

### Sit e Sketc h i [g^Poo r SamDiin a Address : 420 6 WIR TS T £ ] Notpain t Sampl e Numt)e r Lea d Concentratio n 

### Sampl e Collecte d LA B Firm : Sample s Collecte d RYASCPXA-2996 7 F l 

### 2o 3 pp m 

# D Date: RYBSCPXA-2996 7 F 2 

### 23 1 pp m 

# D Time : RYCSCPXA-29967 RYDSCPXA-29967 8 1 B 2 

### iL!l3__PP m 

# Q ' D Sample s Analyze d RDZSCPXA-2996 7 D Z 

# n XR F Unit : Yt^SHf s Book : 21 ? RGZSCPXA-2996 7 G Z 

# D Date : A-lT'O B RPZSCPXA-2996 7 P Z 

# D Time : A m La b RYCSCPLA-2996 7 Resul t 51 0 pp m _ Numbe ro fSample s = | 7 | | / | Staff : P1itL > mymiu : ri = rro m Len , 1- 2 = Fron t Right , B 1 = Bac k Lefl , B 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 viewe d fro m th e street , fadn g propert y

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_- COASTA L bi , _tl ^ INYIIIONMEKT« L ' t PBOH * C > 0 U r. INC
. 

## Consen t fo rAcces s T o Propert y RIGH TO F ENTRYTO 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 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 : no^Y^fn

Owner' s Name : Daytim e Phone : 

## 1^ 1 tot o l ^

iKc'^'^icj, ^
Addres s o f Propert y 

# 470

- w\i' X s-r 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 remove soi l that 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 remove 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 Lead Superfun d Sit e remediatio n program . Arepresentativ e of Coasta l Environmenta l Group , contracte d byUSEPA , 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 have a n opportunit yt o reviewan d approve th e planne d soi l removal , an d restoratio n wor k before i t begins
. Once th e wor k i s finished , th e Granto rwil l b e aske d t o reviewth e wor k an d confir m tha t i t i s complet e an d meets wit h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receive writte n documentatio n fro m EP Atha t th e propert y has 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 , contractors an d subcontractor s th e righ t t o ente rth e property , at al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e o fperformin g th e work
. Thi s acces s shal l remai n i n effec t unti l th e wor k has bee n satisfactoril ycompleted
. Th e Granto rals o agree s to:

Pag e 1 of2# #
' V 'T ^

COASTA L '< •PROT *C I I O U P , INC
. 

### •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 maywis h t o save ; •Wate 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 ; •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 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 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 his 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 . Should 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 1 gran t access t o m ypropertie sD I d o no t gran t access t o m ypropertie s

Signatur e ADat e SignawreDat e

G 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 f 2• nt o «r4
.

COASTA l tNVIItOHHEttTA l C I O U r. I h C 

# Kcce^s % • Corksen l fo fAcces s T o Pfopsfti ' RIGH TO F ENTRYT 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 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 :
ler' s Name :



# r\T p S^\r, V 1- H 

# - 'T-T S

Addres s o fPropert y covere d k> ythi s Agreement : 

# MZQ l \K)\c ^ R \ 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 that contain s elevate d concentration s oflea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l be excavate d t o remove 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 underth e Omah a Lead Superfun d Site remediatio n program . Arepresentative o fCoasta l Environmenta l Group , contracte d byUSEPA , 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 have a n opportunit yt o reviewan d approve th e planne d soi l removal , an d restoratio n wor k before i t begins
. Once th e wor k i s finished , th e Granto rwil l b e aske d t o reviewth e work an d confir m tha t i t i s complet e an d meets wit h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receive writte n documentatio n fro m EP Athat th e propert y has bee n remediated
. ENVIRONMENTAL-RESPONS E ACTION S 

## B

ysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , its 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 ofpertormin g th e work
. Thi s acces s shal l remai n i n effec t unti l th e wor k has bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :

Pag e 1 o f2COASTA L irrVtRONHIKTA t C 1 1 O U P tN 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 necessarysubsequen t t o a n initia l waterin g perio d b yEPA ; cAbid 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 wori<
. »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 f th 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 Coasta l Environmenta l Group , a t (402 ) 991-119 9
"^ i gran t access t o m ypropertie s D I d o not gran t acces s t o m ypropertie s 

## A 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 f 2C OA^ S T-A~t ­ • MvinoNM rMtA L cn o u p IN C 

## Restoratio n Agreemen t Th e purpos e o f thi s agreement i s t o provid e amutual agreement a s t o condition s o f th 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 andth e Unite dState s Environmental Protectio nAgenc y (EPA)
.

Property ID : 2j^<=^^ y Propert y Address : ^^- p ^ f^J/Z ^ ^' ^ 

### Owner : -^Q ^ h^)t Mr
. 'Da>U^ e
O nth e attache ddiagram(s ) indicate area(s ) t o excavate , surfac e structure s an dlandscapin g feature s an d acces s location(s ) to b e use db 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 an dth e basement if necessary . 

### Item s t o b e Remove d b yth e Owne rbefor e Star t o f Remediation : Th e removal , storage , disposal , and/o rretur n o fthes e Item s i s th e Owner' s responsibility
. 

### Item : Item :
ttem:
ttem:



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

# fvA V ^M^f^Ci+fcr G <^li,v, A ttem: /
Item : Item :

Page l of
.COASTA L rMVIAONM fMTAl
. C n O U r. IN C 

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



## Ite m Pre-existin g property area , tha t wil l b e excavated , that i s covere dwit hgrass . Number o f tree s > 2 inch trunk diamete r Number o f tree s < = 2 inch trunk diamete r Number o f Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Atiachasl^etcl i ul ' the sprinlvlo r lavout
. Number o f an dsir e o f eac hgarden/ flower be d area . Aiiacli asketcho f relativ e size s an dlocations
. Agree dupo nvalu e o f plant material s no t t o b e replace db v contractor . Note thi s \nlu e ^vil l h e use dt o issu e H plan t vouche r l o th e propert y o^^ne^
. Easement Area , to b e excavate d 

## Quantit y 

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# i ^ Landscap e Inventory Uni t Quadrant s

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Each

Each

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$ 

## Condition/Type/Specie s

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# 5e^A^ ) b/VA.H >

Pag e 2 of
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. • MVIMONnC N T AI


### Addttlonal Comment s / Instructions : 

# ^ P^ ' of ^ c^^^-r voidb ^ ^ ^ ^ ^^'' ^
> (^p} \^' ^ '^^ y ^b^Q> ^ fe^T^M.ov^

D Chec k th e boxi fOwne rdoe s not wan t CE G t o docunnen t interio rfoundatio n wall s an d possibl e pre-existin g damage
. Bycheckin g thi s boxCE 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
.
Q I d o no t agre e ^ agre e 

# jynMti ner' s Signature te Contnunor' s Signarar e Dat e Pag e 3 of
.

### Dat e Proiec t XRFID #

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### 228 1 ^-^.S l T7.R6

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# Ji3 1 .ZZ£ i _2i£5
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### Average

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### BViD#J2aStial
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### l'Z^-^< ^ Addres s Omah a lea d F P 2n d yea roptio n 

### Sampl e tim e 1 7 '.^ ^ am/|fl & 

### ?)'K>^< \ sampl e lengt h 

### 3 0 se c Readin g Sampl e are a Shot # Readin g Sampl e are a 

### UM.u^»ir>.<^ l 2 1 & U 

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# iz n SH.-^*?±l2..V f Dept h 7-l.« S 

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## 72.Mmi.l- i 

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Readin g Sampl e are a 

### Shot # Readin g Sampl e are a 

### ma. 1 ± M.L.i f .ZZ^k L 

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

### Averag e
RETES TAREA S Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h Averag e La b resul t Sampl e are a XR F Avg
. Signature
. 

### ^ ^ A ^ ^ Prin t Pil y AoPJH ^ CMSJS ^

# 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 228 5 Mod e SOI L Tim e 2009-07-2 9 17:5 9 Duratio n 121.8 4 Sequenc e Fina l Flag s AVERAG E ADDRES S QUAD/ZON E B l INSPECTO R Nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m± Erro r P b /75.41 5 / ± Supervise d By : /W^/LC£y|2g< 0

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 228 1 Mod e SOI L Tim e 2009-07-2 9 17:5 7 Duratio n 30.4 8 Sequenc e Fina l Flag s BVI D # 2996 7 ADDRES S 420 6 Wir t s t QUAD/ZON E B l INSPECTO R Nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 64.64 3 ±10,91 7 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 SAMPLE TYP E NOTE

pp m Pb 69.51 3 Supervise d By : 

## Certificat e o f Verificatio n

228 2 SOI L 2009-07-2 9 17:5 7 30.4 8 Fina l 2996 7 420 6 Wir t s t B l Nicola s 6 CLEARANC E

± Erro r ± 11.19 7

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 228 3 Mod e SOI L Tim e 2009-07-2 9 17:5 8 Duratio n 30.4 3 Sequenc e Fina l Flag s BVI D # 2996 7 ADDRES S 420 6 Wir t s t QUAD/ZON E B l INSPECTO R Nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 84.38 5 ±12.33 7 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 83.11 9 Supervise d By : 

## Certificat e o f Verificatio n

228 4 SOI L 2009-07-2 9 17:5 9 30.4 5 Fina l 2996 7 420 6 Wirt s t B l Nicola s 6 CLEARANC E

± Erro r
± 12.10 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 229 0 Mod e SOI L Tim e 2009-07-2 9 18:0 2 Duratio n 121.3 6 Sequenc e Fina l Flag s AVERAG E ADDRES S 

## rewirtsT QUAD/ZON E B 2 INSPECTO R Nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m Erro r P b ^3 5 Supervise d 

## Bv : ^Cajgg^ M

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 228 6 Mod e SOI L Tim e 2009-07-2 9 18:0 0 Duratio n 30.3 9 Sequenc e Fina l Flag s BVI D # 2996 7 ADDRES S 420 6 Wir t s t QUAD/ZON E B 2 INSPECTO R Nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 65.04 3 ±11.03 1 Supervise d By :

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 228 7 Mod e SOI L Tim e 2009-07-2 9 18:0 1 Duratio n 30.4 8 Sequenc e Fina l Flag s BVI D # 2996 7 ADDRES S 420 6 Wir t s t QUAD/ZON E B 2 INSPECTO R Nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r Pb 50.59 0 ±9.97 8 Supervise d By :

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

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

pp m P b 69.34 1 Supervise d By : 

## Certificat e o f Verificatio n

228 8 SOI L 2009-07-2 9 18:0 1 30.1 0 Fina l 2996 7 420 6 Wir t s t B 2 Nicola s 6 CLEARANC E

± Erro r
± 11.12 2

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Blllerica , 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 72.43 0 Supervise d By : 

## Certificat e o f Verificatio n

228 9 SOI L 2009-07-2 9 18:0 2 30.3 9 Fina l 2996 7 420 6 Wirt s t B 2 Nicola s 6 CLEARANC E

± Erro r ± 11.75 4

# Therm o SCIENTIFI C Therm o Fishe r Scientifi c 90 0 Middlese x Turnpik e Blllerica , M A0182 1 

## Certificat e of Verificatio n XL3t-3208 9 Readin g No 229 5 Mod e SOIL Tim e 2009-07-2 9 18:0 5 Duratio n 121.7 1 Sequenc e Fina l Flag s AVERAG E fA^*6?>2291^229 # ADDRES S 420 6 WIr t s t QUAD/ZON E D Z INSPECTO R Nicola s DEPT H 1 2 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P

b 108.676 ' ± 1'3.6(6 & Supervise d 

# >teA i

# 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 229 1 Mod e SOI L Tim e 2009-07-2 9 18:0 3 Duratio n 30.3 7 Sequenc e Fina l Flag s BVI D # 2996 7 ADDRES S 420 6 WIr t s t QUAD/ZON E D Z INSPECTO R Nicola s DEPT H 1 2 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r Pb 70.31 0 ±11.66 0 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Blllerica , 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 132.06 3 Supervise d By : 

## Certificat e o f Verificatio n

229 2 SOI L 2009-07-2 9 18:0 4 30.5 2 Fina l 2996 7 420 6 WIr t s t D Z Nicola s 1 2 CLEARANC E

± Erro r
± 14.85 0

# 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 229 3 Mod e SOI L Tim e 2009-07-2 9 18:0 5 Duratio n 30.4 0 Sequenc e Fina l Flag s BVI D # 2996 7 ADDRES S 420 6 Wir t s t QUAD/ZON E D Z INSPECTO R Nicola s DEPT H 1 2 SAMPL E TYP E CLEARANC E NOT E

pp m Erro r P b 117.50 6 ± 14.21 9 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe r Scientifi c 90 0 Middlese x Turnpik e Billerlca , M A 0182 1

XL3t-3208 9 Readin g No Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTOR DEPT H SAMPL E TYP E NOT E

pp m P

b 114.82 5 Supervise dBy : 

## Certificat e of Verificatio n

229 4 SOIL 2009-07-2 9 18:0 5 30.4 2 Fina l 2996 7 420 6 WIr t s t D Z Nicola s 1 2 CLEARANC E

± Erro r ± 13.94 4

# 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 230 0 Mod e SOI L Tim e 2009-07-2 9 18:0 9 Duratio n 121.4 5 Sequenc e Fina l Flag s AVERAG E 3ygof229 & ADDRES S •'420S'WlrFs t QUAD/ZON E easemen t INSPECTO R Nicola s DEPT H 1 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P b ^54 " ± 

## |i5^i3 g Supervise d 

## By : (QOMk. \ Qjd ^

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 140.94 6 Supervise d By : 

## Certificat e o f Verificatio n

229 6 SOI L 2009-07-2 9 18:0 7 30.5 6 Fina l 2996 7 420 6 WIr t s t easemen t Nicola s 1 CLEARANC E

i
. Erro r ± 15.45 1

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Blllerica , 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 119.79 5 Supervise d By : 

## Certificat e o f Verificatio n

229 7 SOI L 2009-07-2 9 18:0 8 30.5 4 Fina l 2996 7 420 6 Wirt s t easemen t Nicola s 1 CLEARANC E

± Erro r 14.08 9

# Therm o SCIENTIFI C Therm o Fishe r Scientifi c 90 0 Middlese x Turnpik e Blllerica , M A0182 1

XL3t-3208 9 Readin g No Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTOR DEPTH SAMPLE TYP E NOTE

pp m Pb 140.34 4 Supervise dBy : 

## Certificat e o f

Verificatio n

229 8 SOIL 2009-07-2 9 18:0 8 30.1 9 Fina l 2996 7 420 6 Wirt s t easemen t Nicola s 1 CLEARANC E

± Erro r ± 15.03 2

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

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

pp m P b 158.73 0 Supervise d By : 

## Certificat e o f Verificatio n

229 9 SOI L 2009-07-2 9 18:0 9 30.1 6 Fina l 2996 7 420 6 Wir t s t easemen t Nicola s 1 CLEARANC E

Erro r 15.96 5c r— * * 

## i^^Af \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 I ^^^ ^

I Coasta l Environmenta l Grou p Inc
. M ^ 7 V"^^! ^

www.coastaIhazmat.co m ^^tpnoT*! ^ COASTA L INVmONNINTA L CIOUP
. IN C 

# EXECUTIV ESUMMARY : BVID #2996 7 - (420 6 WIR T ST )

~x | No Issue s o r Concern s Q Issues/Concern s Detail Explanation : NO ISSUES PENDIN G^ % 

## EP A Propert y Clos e Ou t For m Propert y# : 2^^JL>~1
. Date/Tine : ~ 7 ZOwner' s Waiae;.,^, Rfi£i,^ j .M&UT ' " ^ Quad s Excavattd : 61 j pX^jl X rnntmrto r Crou p C„ftA<Ntr% | Ff \ 

## iiAOrrrveri+ q 1
Ye s N o Excavatio nGcBeral 1
.I f necessaiy , wer e th e correc t quadrant(s ) excavate dan drestored ? 

# y 2
.I f necessary , wer e th e correc t area s ofdri p zon e excavate dan drestored ? 

# u- ^

Ye s N o GradlB ESo dan dVegetatio n I
.Doe s th e gradin g aroun dth e perimete r ofth e hous e inexcavate darea s generall y slop e awa y fromth e house ? ___^___ ^ 

# \ y 2
.Ha s so dbee nlai di nal l area s tha t wer e excavated ? 

# U- ^ 3
.

Doe s th e so dappea r t o b e generall y health y an dgrowing ? (pnl y evaluat e i f inspecte dat a3 0 da y tim e period ) 

# \y ^ % 

## ^f^^ S Sotrv^lOnf^ ^ 4
.Ar e sodde darea s generall y firman devenl y graded ? 

## ly 5
.

Ar c th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte dat a3 0 da y 

### 1 / ' tim e period ) 6
.

Wa s th e propert y grade dsuc htha t wate r wil l no t poo l o nth e prnpert>' ' 

# -y 7
.

Wa s damag e t o landscapin g o r plan t material s avoided ? Gates , Fence s an dRetoinin g Wall s Ye s N o I
.£> o gate s ope nan dclos e freely? (Ifapplicable ) [ y ' 

# k l I
.Wer e al l gate s o r fence s lake ndow ndurin g restoralio nactivitie s reinstalled ? Act ! (Ifapplicable ) 

# 17 ' 3
.

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

# y 4
.Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) Foundation , Sidin g an dGaiter s Ye s N o I
.Wa s damag e t o th e sidin g o r tri mavoided ? 

# 17 ' 2
.

Wa s damag e t o Ih e foundatio navoided ? 7
.Wa s damag e t o window s avoided ? 

# 1 ^ ' 

# y <l

.Wa s damag e t o window s o r doo r screen s avoided ? 

# y 5
.

Wa s damag e t o downspout s o r downspou l extension s avoided ? Sidewalk s nn dDriveway s (Concrete ) Ye s N o 1
.

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

# y 2
.Wa s damag e t o walkwa y surface s avoided ?

## Ovt'oers comments :

Inspectio nnotes :

Remova l an dresloratio nactivate s complet e includin g th e 30-da y so dwarranty : EP ARepresentative J^JT ^ DYJAI ^ 

## Date : 9Jf()l6 f

# i

Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio no l remedial activitie s perlbime do nm y properl y M y signatur e will designat e (ha i I a msatisfie dwit hth e restoralio nofm y properly , andIha l n o item s ar e i nquestions , now , o r a

t an y time i nth e future , excep t ihos e ilem s liste dbelow , ifan y Propert yIP : 2 ^ ^ 6 7 Propert y AddrcM : ^^.C A lO \J " f- *^ 4 Owner : C.^J^ ^ ^ Phone : Restoratio n Item s i n Question :

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

[ j S I nyrc cI c.ttoralio n i % complded , rxccp t a j note d
t
. I I d o no t a(;re cresloratio n it , complete d

Contrarlor' s Signature Dal e