### TRANSMITTA L o fOMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R DATE : 

### SAID#3ll<^l/ ? 

# 1/23/lZ ADRESS:D^W i fefJ.S-f^ S^> ^ REMEDIATIO N CONTRACTGR : COASTA L ENVIRONMENTA L GROU P YEAR : 

# 2J$I Z

SOI L REMEDIATIO N PROPERT YFILE FOLDE R DOCUMENTS / Executiv e Summary 7 EPA-provided propert ysketc h 3 Signe d Acces s Agreemen t fo rsubjec t propert y Signe d Acces s Agreemen t (s ) fo radjacen t propert y 

# y Restoratio n Agreemen t ti$P l Settlemen t document s (i.e. , fo rdamag e o rt o replac e plants , etc. )

i V Confirmatio n dat a D Photograph s SO D 

# y Pre-Excavatio n Excavatio n i

/ As-Buil t sketc h V Satisfactor yrestoratio n signe d b yPropert yOw/ne r B Propert yclose-ou t chec k lis t signe d b yEP A ^J! ^ Descriptio n o farea s o farea s no t meetin g RO D cleanu p criteri a y

j Utilit yclearance s 3 Propert yInformatio n fro m Dougla s Count yAssessor' s Offic e D

Dat e 3026135 4 Superfun dy ^ ( y & ' ^ 

# vv <?- > 

## Propert yAcces s Checklis t Property ID : ^//<^ ^ n WOR K STARTE D ON : / /
_ Property Address : J^^^l / fbf/j'Sjh / ^t 3 D WOR K COMPELTED ON : I I Owner : Renter : 

# YMh y JbA< ^ Address : Phone :



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t By : [ ^ Restoratio nAgreemen t Signed : /D / 1^ 1 h By : tZ ] Topso U Samplin g (i f appUcable ) 1 1 By : 0 Disposa l Samplin g (i f appUcable ) 1 1 By :

• Garde nSampUn g (i f appUcable ) 1 1
. By = ^ UtiUt y Clearanc e CaUed : (O l f^ l f , 

## By : k^c^J ^ D Video/Photo s (Before ) On : / / ^ nVideo/Photo s (During ) On : / / By :

• Video/Photo s (After ) On : / / By : D Video/Photo s (30-Day ) On : / / By :

• Propert y Completio nAgreemen t Signed : / / By : nFina l Repor t Issued : / / By : Ai r Monitorin g (a s appUcable )

• Communit y Q Cre w On : / /
. By : Results :

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

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

Omah a Lea d Sit e

### Dougla s County Accoun t InfiMgiation t^m a Dougla s County , Nebrask a Propert yRecor d - Informatio n i s vali d a s o f201 1 -9-1 3 Owne r BATE S PHILLI P R 1230 2 N 12 7 L N E L MIRAG E A Z 85335-000 0 Propert yInformatio n 

### Pag e 1 of 2

R130322000 0 Prin t Repor t Vie wInteractiv e GI S Ma p

Treasurer' s Ta xRepor t Ne wFeatur e - » - » -f Subdivisio n Sale s Searc h

Ke yNumber : Accoun t Type : Parce l Number : Parce l Address : Lega l Description : Valu e Informatio n Lan d 201 1 201 0 200 9 200 8 200 7 200 6 032. 2 000 0 1 3 Residentia l 130322000 0 260 4 BRISTO L S T OMAH AN E 68111-000 0 HAWE S AD D LOT7 BLOC K0 W39.3 5 F T39.3 5 X 132 Improvemen t Tota l $500.0 0 $0.0 0 $500.0 0 $500.0 0 $0.0 0 $500.0 0 $500.0 0 $0.0 0 $500.0 0 $500.0 0 $0.0 0 $500.0 0 $500.0 0 $0.0 0 $500.0 0 $500.0 0 $0.0 0 $500.0 0 

### Sho wAl i Transaction s

Lan d Informatio n Acre s S F 0.1 3 5663. 0 Unit s Dept h Widt h Vacan t 0. 0 0. 0 0. 0 Ye s



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R13.
. . 9/22/201 1Coasta l Environmenta l Grou p 241 1 Marth a Stree t Onnaha , N E 6810 5 Phone : 402.991.119 9 Tol l Free : 877.662.421 0 Fax : 877.662.421 1 

### 10/04/201 1
Philli p Bate s 1230 2 N127 L n El Mirage , AZ8533 5 Re : 260 4 Bristo l S t Dear PBates : W e hav e receive dth e paperwork for th e property o n260 2 Bristo l St. , bu t hav e ye t t o receiv e th e paperwor k

for 260 4 Bristo l St
. Enclose dyo u wil l findth e paperwork tha t I reviewe dwit hyo u ove r th e phone
. Pleas e sig nan dretu mth e form s provide dt o th e addres s liste dabove
. If yo u hav e an y question s o r concerns , pleas e feel free t o cal l m e a t 402.991.119 9 ext . 3612
. Than k you .

Very trul y yours , COASTA LENVIRONMENTA LGROUP , INC
.
^^nxT/^^pft a Sit e Coordinatio n 

# v(^ ^ COASTA L Solvin g problems
. Buildin g th e future
. Coasta l Environmenta l Group , Inc
. —8(a) , HU B Zone , MBE , DE E 241 1 Marth a Stree t Omaha , N E 6810 5 (402 ) 991-119 9 ext
. 361 2 offic e (877 ) 662-421 1 fa x (402)432-694 7 cel l w.lara(g)coastalqrp.ne t www.coastalgrp.ne t
wvvw.coastaigrp.ne t Certifie d MB E • DB E • 8(a ) • HU B Zon e

### CONFIDENTIALIT YNOTICE : Thi s e-mai l i s intende d onl yfo rth e us e o fth e person(s ) o rentit yt o who m i t i s addresse d an d maycontai n informatio n tha t i s privileged , confidential , an d exemp t fro m disclosur e unde rapplicabl e law
. Unles s state d t o th e contrary , an yopinion s o rcomment s ar e persona l t o th e write ran d d o no t represen t th e officia l vie wo fth e company . I fth e reade ro fthi s e-mai l i s no t th e intende d recipient , yo u ar e informe d tha t an ydissemination , copyin g o rdisclosur e o fth e materia l containe d herein , includin g attachments , i n whol e o rpart , i s strictl y prohibited
. I fyo u hav e receive d thi s e-mai l i n error , pleas e notif yth e sende rb y retur n e-mai l immediatel yan d delet e thi s messag e fro m you rsystem
. Than k you .

Coasta l Environmenta l Grou p vwtfw.coastalgrp.ne t Certifie d MB E • DB E • 8(a ) • HU B Zon e

### IRT H On e Cal l Pag e 1 o f 1
Digger s Hotlin * Of Nebrask a 

### Hom e Ticke t Ticke t Creatio n Logou t Creat e Anothe rTicke t G o t o Hom e Pag e Sen d Emai l

• YOU R TICKE TNUMBE R I S 2875570
. Origina l Cal l Date : 10/12/1 1 Time : 6:0 8 p m Op : WENDY1879 0 Wor k t o Begi n Date : 10/17/1 1 Time : 7:0 0 a m State : N E County : DOUGLA S Place : OMAH A Address : 260 4 Street : BRISTO L S T Twp : 15 NRng : 13 E Sect-Qtr : 09-NE,10-N W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATIO N Locatio n o f Work : ENTIR E PROPERTY , INCLUDIN G EASEMENT , AN D U P T O TH E : PEDESTAL . Remarks : FAX AL L CLEAR S TO : (877)662-421 1 : EMAI L AL L CLEAR S TO : WLARA@COASTALGRP.NE T : UNSUR E I F CORNE R LOT . Compan y COASTA L ENVIRONMENTA L SERVIC E Contac t Nam e WEND Y LAR APhon e : (402)991-119 9 Alt . Contac t JOS E CARDENA S Phone : (402)504-098 1 Wor k Bein g Don e For : COASTA L Dept h o f Excavation : 4 F T Corne r Lot : NFront : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N COXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Servic e Are a Utilit y Servic e Are a Nam e Contac t Phon e Number s Cod e Typ e COXCAT V coxCOMMUNICATION S ELMCO X ELMCO X Day : (406 ) 72 8 - 934 3 IN C All.
. fAr\/' \ -t-^- 7 -»r\-»/ ^



### http://www.dhon.org/IRTHOneCall/Ticket/TicketCreation.aspx?ViewTicketID=86053 1 10/12/201 1

### 0\{ f ^ \ ' 

# V Wend yLar a From : agt_comm(girth.co m Sent : Thursday , Octobe r13 , 201 1 6:3 8 A M To : Wend yLara Subject : Respons e t o Di g Reques t

To : COASTA L ENVIRONMENTA L SERVIC E Attn : WEND Y LAR A Voice : 402991119 9 Fax : 877662421 1 Re : Respons e t o Di g Reques t Thi s i s an importan t messag e fro mOmah a Publi c Work s replyin g t o you r reques t t o locat e ou r underground facilitie s i n an are a describe d o n th e on e cal l cente r ticket .

Ticket : 287557 0 County : DOUGLA S Place : Omah a Address : 260 4 BRISTO L S T OMAHACO F (Sewer) : Cit yo f Omah a Sewer
- N o Conflic t pe r inf o o n th e on e cal l ticke t OMAHACO F (Traffic) : Th e Cit yo f Omah a Traffi c Engineerin g Divisio n ha s determine d ou r facilit yi s no t i n conflic t wit h th e di g sit e provide d b yth e on e cal l center .

I f yo u hav e an yadditiona l question s pleas e contac t Omah a Publi c Works .

Thi s messag e wa s generate d b yan automate d system . Pleas e d o no t repl yt o thi s email ,

## Wend yLara 

# M ^ ^ From : I RTH.Net(g q west.co m Sent : Friday , Octobe r14 , 201 1 5:1 2 P M To : Wend yLara Subject : Messag e fro m Qwes t

To : COASTA L ENVIRONMENTA L SERVIC E Attn : WEND Y LAR A Voice : 402991119 9 Fax : 877662421 1 Re : Messag e fro mQwes t Messag e fro mQwes t

Ticket : 287557 0 County : DOUGLA S Place : Omah a Address : 260 4 BRISTO L S T QLNNEIC : Th e describe d di g are a o f you r locat e reques t ha s bee n checke d an d i s clea r fo r Qwes t Communication' s Loca l Network . I f yo u hav e an yquestion s pleas e cal l Qwes t a t 1-800-283-4237 .
Messag e fro mQwes t

Thi s messag e wa s generate d b ya n automate d system . Pleas e d o no t repl yt o thi s email .



### 5

90LS:3119 6 DAT E EXCAVATED:10/24/1 1 

# As-Buil t Drawin g DAT E USEP ASIGNE D OFF : 11/01/1 1 ARE ASODDED : 225 0 

## COASTAL 

# Oinah aLea dSuperfun dSite Envininmcnta l (Jroup , Inc
. 

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## n n p p m XR F Unit : tCiPirfL p Book : 26 8 

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### CONTRAC T #: EP-R7-09-0 6 COASTA L ENVIRONMENTA L GROUP , INC
.

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## D D RrZ6CPXA-3110 6 PZ - pp m 

## D D Date : 1 / -11-1 0 Time : p M Numbe ro fSample s 

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COASTA l E N V I R 0 KM £ N I At C « O U r' H C 

### Consen t fo fAcces s To
. Ffoptert y RIGH TO F ENTR YT O PREMISE S 

### Granto r(th e propert yowner ) consent s t o sn 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 :

Owner' s Name : ^\\\; ^

%v\e' b DaytimePhone : UC?^
. ^ \ SL
. "^MH ^

Addres s o fPropert y covere d b ythi s \^r;^\o ^ ^ ^ 

## '9-^0 ^ 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 unde rth 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 contact 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 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 fperformin 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 of2o r• " j 

### V^- ^ COASTA l IhVihOHt' , JKTt i '" l ..qol^' '


### cRemov 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 ; cWate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessary ' subsequen t t o a n initia l waterin g peno 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 property ' t o perfor m th e work
. cAllo wvideotapin g and/o rphotographin g o fth e property
. AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s no t t o interfer e o rtampe rwit h an yo fth e wor k activities , o rwit h an y o fth e wor k done , o rwit h th e equipmen t use d o n hi s property , o rt o undertak e an y action s regardin g th e us e o fsai d 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 —V) Q I gran t acces s t o mypropertie s n I d o no t gran t acces s t o mypropertie s

Signatur e Signatur e Date

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

Page 2 o f2COASTA L £MVIKONHIN7«kl
. C N O U P
. INC
. 

## 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 o f th e property prio r t o remediatio nactivities
. Thi s will als o serv e a s documentatio nfo f 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 property owner an dth e Unite dState s Environmental Protectio nAgenc y (EPA)
.

Property ID : n^^^^ ^ Property Address : Zi\yyy< \^^\^c. \<. \ Owner : ^'AV^: ^ >^^e ^ 

### Phone : V-^7)-
. a\-5..^-V^ s O nthe attache ddiagram(s ) indicat e area(s ) to excavate , surfac e structure s andlandscaping feature s andacces s location(s ) to b e usedb y the contractors . Indicat e distances , depths , materia l types , etc . Photographically and Videographically documen t th e existing condition s o f the propert y andthe basemen t ifnecessary
. 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 f thes e item s i s th e Owner' s responsibility. Item : (Xx^v^ ^ «sW-vDv\ \ 

## Vr > 

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### Ve^ V WU^^c l Item :
Item :
Item :

Pag e 1 o f '3 >COASTA L 

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

### so W 

# i -^ A Item : Item : Item :



## Ite m Pre-existin g property area , tha t wil l b e excavated , tha t i s covere dwit hgrass . Numbe r o f tree s > 2 inc h trun k diamete r Numbe r o f tree s < = 2 inc h trun k diamete r Numbe r o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Attac hasketc ho f th e .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 e wil 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 

### Landscap e Inventor y Quantit y Uni t Conditjpn/Type/Specie s 

# e^jO ^ Quadrant s 

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Pag e 2 o f ! >COASTA L KNVIMONHCNTA L GROUP
. INC
.
Additiona l Comment s / Instructions : Th e cit yo fOmah 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 removing an d replacing 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 fthi s i s th e case , yo u shoul d understan d tha t thi s removing an d replacin g o fsoi l doe s no t mea n tha t an yillega l drivewa yo rparkin g are a o n you rpropert yi 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 drivewa yo rparkin g area , no t withstandin g an yremova l o rreplacement o fsoi l b yth e EP A I fyo u hav e an yquestio n abou t legalit yo fa certai n drivewa yo rparkin g area , yo u ma ycontac t th e cit yo fOmaha' s Plannin g Departmen t a t (402 ) 444-5150
. I I Pleas e chec k thi s bo xr fyo u understan d th e informatio n outline d above
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• Chec k th e bo xi fOwne rdoe s no t wan t CE G t o documen t interio rfoundatio n wall s an d possibl e 

### --t > pre-existin g damage
. B ycheckin g thi s bo xCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro fhouse , includin g foundatio n crack s o rfissures
.


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

## Certificat e o fVerificatio n

5 Soi l 2011-10-2 7 11:3 3 90.5 2 pp m 2 Fina l Av g o f2- 4 260 4 bristo l s t E A 1 " KIN G EX-SITU S confirmatio n

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1

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

pp m P b 62.28 8 Supervise d By : 

## Certificat e o fVerificatio n

2 Soi l 2011-10-2 7 11:3 2 30.1 7 pp m 2 Fina l 3119 6 260 4 bristo l s t E A KIN G EX-SITU S confirmatio n

± Erro r ± 13.63 4

# 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 Unit s Sigm a Valu e Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 61.21 9 Supervise d By : 

## Certificat e o fVerificatio n

3 Soi l 2011-10-2 7 11 : 3 3 30.1 8 pp m 2 Fina l 3119 6 260 4 bristo l s t E A 1 " KIN G EX-SITU S confirmatio n

± Erro r ± 13.44 6

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1

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pp m P b 74.55 1 Supervise d By : 

## Certificat e o fVerificatio n

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# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1

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

P b Supervise d By : 

## Certificat e o fVerificatio n

9 Soi l 2011-10-2 7 11:3 6 90.8 0 pp m 2 Fina l Av g o f6- 8 260 4 bristo l s t B l 13 " KIN G confirmatio n confirmatio n

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1

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

pp m P b 394.07 5 Supervise d By : 

## Certificat e o fVerificatio n

6 Soi l 2011-10-2 7 11:3 5 30.2 7 pp m 2 Fina l 3119 6 260 4 bristo l s t B l 13 " KIN G confirmatio n confirmatio n

± Erro r ± 29.25 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 Unit s Sigm a Valu e Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 372.14 6 Supervise d By : 

## Certificate-o fVerificatio n

7 Soi l 2011-10-2 7 11:3 5 30.2 4 pp m 2 Fina l 3119 6 260 4 bristo l s t B l 13 " KIN G confirmatio n confirmatio n

±Erro r ±29.82 0

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1

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

pp m P b 379.97 1 Supervise d By : 

## Certificat e o fVerificatio n

8 Soi l 2011-10-2 7 11 : 3 6 30.2 9 pp m 2 Fina l 3119 6 260 4 bristo l s t B l 13 " KIN G confirmatio n confirmatio n

±Erro r ±30.46 8

# 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 Unit s Sigm a Valu e Sequenc e Flag s AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

P b Supervise d B y 

## Certificat e o fVerificatio n

1 3 Soi l 2011-10-2 7 11:3 9 90.4 1 pp m 2 Fina l Av g o f10-1 2 260 4 bristo l s t B 2 13 " KIN G confirmatio n confirmatio n

# 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 Unit s Sigm a Valu e Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 59.84 8 Supervise d By : 

## Certificat e o fVerificatio n

1 0 Soi l 2011-10-2 7 11:3 7 30.0 8 pp m 2 Fina l 3119 6 260 4 bristo l s t B 2 13 " KIN G confirmatio n confirmatio n

± Erro r ± 13.99 8

# 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 Mode Tim e Duratio n Unit s Sigm a Valu e Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 62.46 2 Supervise d By : 

## Certificat e o fVerificatio n

1 1 Soi l 2011-10-2 7 11:3 8 30.2 0 pp m 2 Fina l 3119 6 260 4 bristo l s t B 2 13 " KIN G confirmatio n confirmatio n

± Erro r ± 14.41 7

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 1 2 Mod e Soi l Tim e 2011-10-2 7 11:3 9 Duratio n 30.1 3 Unit s pp m Sigm a Valu e 2 Sequenc e Fina l Flag s BVI D 3119 6 ADDRES S 260 4 bristo l s t QUADRAN T B 2 DEPH T 13 " XR F TEC H KIN G MIS C confirmatio n NOT E confirmatio n

pp m ±Erro r P b 99.56 3 ±18.61 5 Supervise d By :X 

### Omah a Lea d Site—Fixe d Pric e EP-R7-09-0 6 Coasta l Environmenta l Grou p Inc
. . \

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• .^p * www.coastalhazmat.co m " ""•'«'"*' ' COASTA L 

# EXECUTIV ESUMMARY : BVID #31196(2604 BRISTO LST )
No Issue s o r Concern s Issues/Concern s Detai l Explanation: COASTA LI S UNABLET O PROVID EPRE-EXCAVATIO NAND EXCAVATIO NPHOTO S A S PART O FTHI S FINALPROPERT Y FOLDER
. THES EPHOTO S WER EI NTH EPOSSESSIO NO F ASUBCONTRACTO RTHA T WA S CONTRACTE D T O PERFORM ALLO FTH ESITE COORDINATIO NREQUIRE D B Y TH ESCOPEO FWOR K AN D TH ESUBCONTRACTO RHA S SINC ELEFT TH EPROJECT
. THEREFORE , TH EPHOTO S AREN O LONGE RAVAILABLE
.COASTA L 

## Propert y Completio nAgreemen t Thi s agreenien i document s lhe completio nof remedial activiiie s performe don m y property . M y signature will designate tha i 1 a msatistle dwit hthe resioratio nof m

y property , andtha i n o item s ar e i

n question , no w o r a

i an y lime i n the future , excep t ihos c iierru s liste dbelow , if any Propen y ID : ".^W^l p Propen y Address : QCoO M ]lr \<^\r , i 

## -Sd

- Owner : y V 

# y^y^ ^ Phone : 

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Restoratio n Item s in Question : Item : Item : Item : Item : Item : item :

Additiona l Comments :

Q I agre e restoratio n i n completed , excep t as note d I jLA-rt n no t agre e restoratio n i s complete d


## C o •?/'< / 

# f o ^ y z r^^^lgnat i 

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## EP APropert y Clos e Ou t For m Propert y ^,,r.^yCO±U^^lA ^ ^ Propert y # : , 7 J l 1 C>
. Date/Time : Owner' s Namt:
. £.?^,\).L [ F
. ..U^r^ ^ Quad s Excavated : j 3 Lg ? ~ Contracto r Grou p Z Zc«. 3 •T~ C
Excavatio nCenera l 1
.I f ncccssBiy , wer e th e correc t quadrant(s ) excavate dan drestored ? 2
.If necessary , wer e th e correc l area s o f dri p zon e excavaie dan drestored ? GradIn K So dan dVcRctatio n 1 Doe s th e gradin g aroun dth e perimete r ofth e hous e incxcaviaier i area s generall y slop e awa y fromth e Iiouse ? 2
. Ha s so dbeenlai di nal l area s that wer e excavated ? 3
. Doe s th e so dappea r t o b e generall y health y andgrowing ? (Onl y evaluat e i f inspecte da t a3 0 da y tLmej)eriod ) 4
. Ar e sodde darea s generall y firman devenl y graded ? 5
. Ar e th e joint s betwee nth e so dsirip s generall y tight ? (Onl y evaluat e if inspecte da t z 3 0 da y tim e period ) 6
. Wa s th e property grade dsuc htha t wate r wil l no t poo l onth e propeny ? 7
. Wa s damag e t o landscapin g o r plant material s avoided ? 

# r

' Gates
. Fence s an dRctaJnlp g Wal b 1
. D o gate s openan dclo-se freely? (Ifapplicable ) 2
.Wer e al i gate s or fence s take ndow ndurin g restoratio nactiviiie s reinstalled ? (I f applicable ) 3
.Wa s damag e t o gate s or fence s avoided ? (I f applicable ) 4
.Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) FoupdationTSidiiiRfln dCntter s I
.Wa s damag e t o th e sidin g o r tri mavoided ? 2
.Wa s damag e t o th e foundatio navoided ? Wa s damag e to window s avoided ? 4

Wa s damag e t o window s or doo r screen s avoided ? Wa s damag e t o downspout s o r downspou i extension s avoided ? Sidewalk s an dDriveway s (Concrete ) 1
.Wa s damag e t o drivewa y surface s avoided ? 2
.Wa s damag e t o walkwa y surface s avoided ? ^

Ye s N o / / Ye s N o 

# y 

# 3 

# 3 y y 

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# 7 7 

# 7
Yes , .N o 

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# 1

## O^'tier s comisents :

I Inspectio nnotts :

Removal andrestoratio nactivate s complel e includin g the 30-da y sodwarranty : EP ARepresenlatjv e Qy_y \Date : ^^^ ^

### Propert} ' Owne r Assessmen t o f Performanc e For m AmericanReco\er y an dReinvestmen t Act (ARRA ) Omah aLeadSuperfundSite 201 1 Remediatio nContractor : COASTA LEnvironmental Grou p - EP-R7-09-0 6 Property Identifier Number : Property Address : '^V^y^
. % i Property Owrier' s Name : ._ r .h—Li

I \li;i\ c inlbmiaiio nto b e filJe doo t b y th e retiiediatio ncontracto r prlur t o utilizatio nb y th e EP A( t )f

< i
• •••••••oaBB««««««««BBDBBBiBa«vBaa*o««a>BaaBB*aBoaBiiH'•••••••••.••••••BoeBB***** ! 

### Instruction s t o th e Propert y Owner : Tlii s fonnserve s to recor dth e Propert y Owner' s assessmen t o f performanc e (Incentiv e 1

- Qualit y

. • • • • • ( 

### Assuranc e Surveillanc e Plan ) irivolvin g th e liste dremediatio ncontractor , as applicabl e to th e Omah a Lea dSite
. Thi s for mdocument s the timelines s o f punc hlis t resolution , busines s relations,,complain t resolutio nandth e overal l quality o f work
. If nee dbe , th e Property Owne r ma y utiliz e thi s for mto record problcrn s and'o r issue s not specificall y tie dto a nassigne daddress , fo r example , busines s relation s tha t generall y don' t follo w guideline s set fort hi nth e Performanc e Wor k

Statement
. Th e Property Owne r will indicate his'hc r assessmen t o f performanc e wit hth e contractor' s wor k b y checkin g anumerica l ratin g o nth e tabl e belo w usin g th e numerical definition s fro mth e ratin g scal e below , th e sig n& dal e th e fonn
. 9-1 0 "excellent " 7- 8 "ver> ' good " 5- 6 "acceptable " 3- 4 "poor " 1-

2 "very poor " Propert y OH'ner' s Assessmen t o

f Performanc e Regardin g tb e Contractor' s Wor k

Additiona l Comment s fro mEP ACORCoptional ; continu e o nbac k pag e if needed )

Property Owner Signature : ' ' /