### TRANSMITTA L o f OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R 

## sMDn3yDM[ Q DATE : 

# 3lb\ll 2 ADRESS : 3^5 ^

)^rA\7e.nu}nf4-lz \ ^ REMEDIATIO N CONTRACTOR : COASTA L ENVIRONMENTA L GROU P 

### YEAR : ^Q^ 2
SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENTS I Z Executiv e Summary 1 /

EPA-provide d propert ysketc h WSigne d Acces s Agreemen t fo rsubjec t propert y N n Signe d Acces s Agreemen t (s ) fo radjacen t propert y V Restoratio n Agreemen t /Sv^ Settlemen t document s (i.e. , fo rdamag e o rt o replac e plants , etc. )

" 3 Confirmatio n dat a # D Photograph s 

## V SO D 

# V Pre-Excavatio n Excavatio n As-Buil t sketc h I vSatisfactor yrestoratio n signe d b yPropert yOwne r [ yPropert yclose-ou t chec k lis t signe d b yEP A Descriptio n o farea s o farea s no t meetin g RO D cleanu p criteri a Utilit yclearance s / V I Propert yInformatio n fro m Dougla s Count yAssessor' s Offic e D

Superfun d

## Propert yAcces s Checklis t Property ID : D WOR K STARTE D ON : __/__ / '5&^->^W Property Address : D WOR K COMPELTED ON : / / " "^^S* ^ \ yci>v^Pr>i,^rvr-V\\^T Owner : , . v , » » Renter : VA > V_i (J(>f> ne - y^yj^ o Address : Phone : Fax : Cell/Pager : Additiona l Information : Phone : ^KO':i..-^\-\-U M P.f ^ Fax : Cell/Pager :

nNotificatio nLette r Sent : / / By : bl l Acces s Agreemen t Signed:- ^/^/^ ^ By : S I Restoratio nAgreemen t Signed : -T
- / ^a / ^ \ By : nTopsoi l Samplin g (i f applicable ) / / By : Q Disposa l Samplin g (i f applicable ) / / By : O Garde nSamplin g (i f applicable ) / / By : nutilit y Clearanc e 

### Called:" ! I^Z. 1 C U By : [J J Video/Photo s (Before ) On : / / By : D Video/Photo s (During ) On : / / By : nVideo/Photo s (After ) On : / / By : nVideo/Photo s (30-Day ) On : / / By : Ff

l Propert y Completio nAgreemen t Signed : o- s f^tt i N \ By=^^ . V^^Vr. ^ nFina l Repor t Issued : / / By : 

# 1 Ai r Monitorin g (a s applicable )
• Communit y [ H Cre w On : / / By : Results : 1
nCommunit y • Cre w On : / / By : 

# 1 Results : dCommunit y • Cre w On : / / 

### By : 1 Results :
Omah a Lea d Sit eUougla s Count yAccoun t iniormatio n http://douglasne.majming-onltne.com/DouglasCoNe/static/accountinf c Dougla s County , Nebrask a Propert yRecor d Informatio n Is vali d as of 2011-7-1 5 Owne r ANZALON E JON O A ! 110 1 WALNU TS T#50 9 : KANSA S CITYM O 64106-000 0

Propert yInformatio n - R103814000 0 Prin t Repor t Vie wInteractiv e GI S Ma p ;

Treasurer' s TaxRepor t Ne wFeatur e - 4 -• - > 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 Sale s Informatio n Sale s Date : Dee d Type : Price : Grantor : Grantee : Valid/Invalid : Exclusio n Reason : Sale s Date : Dee d Type : Price : Grantor : Grantee : 381 4 000 0 1 0 Residentia l 103814000 0 355 5 LEAVENWORT H ST OMAH AN E 68105-000 0 FEARO N PLAC E LO T7 BLOC K0 LT S 5 & 6 & E 1/ 2 5 5 X 12 1 Improvemen t Tota l $ 11,300.0 0 $ 79,500.0 0 $ 90,800.0 0 $ 11,300.0 0 $ 79,500.0 0 $ 90,800.0 0 $ 11,300.0 0 $ 79,500.0 0 $ 90,800.0 0 $ 11,300.0 0 $ 79,500.0 0 $ 90,800.0 0 $ 11,300.0 0 $ 79,500.0 0 $ 90,800.0 0 $ 11,300.0 0 $ 60,700.0 0 $ 72,000.0 0 

# y

2002-09-0 4 W D 8oo^ ; 222 4 ] Page : I 5 7 $ 79,000.0 0

Vali d
1995-05-1 6 D Book : I 200 8 Page : 1 02 2 $ 54,000.0 0
Valid/Invalid : I Vali d
1 of 4 7/19/201 1 1:1 2 P Nuougia s v_uunt y ACCOUI Umiormaiioi ) nttp://aougiasne.rnanping-oniine.com/UouglasCoNe/static/accounlinf ( .rnaiTp
Exclusio n Reason : Lan d Informatio n ^cre s ' S F 0.1 5 ; 6655. 0 Unit s 1. 0 ' Dept h 0. 0 Widt h 0. 0 Vacan t N o Improvement Informatio n Buildin g 1 

# Z\lzi^'^ 3 y l f :. 5 5Tc* i Ltj-:jishE:
. ••.••ll­ ' ll.;"M H •

CLIC KT O ENUVRG E IMAG E Squar e Footage : 1642. 0 

# ._.J__._. , Percen t Complete : Perimete r 0. 0 Quality : Unr t Type : Condrtion :

Buil t As : 2 1/ 2 Stor yUnfi n Cond o Squar e Footag e 

# L
. HVAC : Centra l Ai rt o Ai r Rooms : Exterior : Fram e Sidin g Unrts : Interior : Drywal l Baths : Roo f Cover : Compositio n Shingl e Bedrooms :

Roo fType : Gabl e Stories : Floorcover : Allowanc e Foundation : Sprinkle rSquar e Footag e Yea rBuil t Yea r Remodele d " T Percen t Remodele d Adjuste d Yea r Buil t 192 3 1 0 % L 192 3 I Detai l Typ e Detai l Descriptio n ! Ad d O n Fenc e Woo d ! Applianc e Allowanc e i Basemen t Bsmn t Bloc k 8 f t ; Basemen t Finishe d I Fixtur e Additiona l Fixture s I Fixtur e Bat h Ful l

2 o f4 7/19/201 1 1:1 2 PKuougla s count yAccoun t iniormaiio n nttp://dougiasne.manDing-oniine.com'UouglasCoNe/static/accountinf c 

# 9 '
Porc h Sla b Roo fCeilin g _225J 0 Porc h Woo d Dec k 120. 0

'-
. 3 o f4 7/19/201 1 1:12P \

# As-Buil t Drawin g OLS:5064 6 

## COASTA L DAT E EXCAVATED:8/15/1 1 DAT E USEP ASIGNE D OFF : 9/27/1 1 

# Omah aLea dSuperfun dSite ARE ASODDED : 247 5 Environmenta l (iniup . Inc .



### S<D<Z^< 2 Exterio i Patn t Nort h Arro w Omah a i_ea d Sit e Owno rName
. Af/'^ G y^n^sAjDn S • Goo d Sit e Sketc h Address : ^s'^TH ' As^\yer?£u.ja/''fA } cSy
. I I Poo r Phone : » ^/jSL'A3t3<3^y ^ (Z/a^OTs^jS
. [g-No < pain t 

# 4- Sample s Collecte d Sampl e Numbe r Les d Sampl e LA B Concentratio n Collecte d Firm : T^t^<\ \ Ci^ \ r> a RVASCPX A <S7 0 pp m 

## a Date : rT ^ C - ^- \ - ^ £
. RVBSCPXA - 2-2.- 1 

# • Time :
- p r-^ . RVCSCPXA - /8 ^ pp m 

# • pp m RVDSCPX A 5 5 ^ 

# • Sample s Analyze d pp m -RE>ZSGPX A pp m 

# • XR F Unit : ' ^ C) 7 Book : JoC ^ -RDZSCPX A pp m 

# • Date ; C=
. - /(T , - OC > -R-F»^ - pp m Time
. 

### yZ T Staf f A^I^W - 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
. F'Z
. = Pla y Al l quBfilrant s ar e a s vleM^e d fro m tr> e street , facin g propert y Numbe ro fSample s

B2=27 5 PP M @ 6 "

F1 = 5 5 PP M @ 6 "

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CONCRET E DRI P ZON E EXCAVATE D QUADRANT S EXCAVATE D 

# m

ARE AREPLACE D WIT H ARE ALEF TBAR E ARE AREPLACE D WIT H SO D ROCK/MULC H 

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

# a / A 

# ZA t 

# fcZ o i r y Nort h Arro w 

### Omah a Lea d Sit e Exterio rPain t Owne rName : 

### Sit e Sketc h • Goo d Address : 

## <S7 . • Poo r 

# i Phone : »^/5--I3A A W ; Q^o t pain t Sampl e Numbe r Lea d Sampl e LA B Sample s Collecte d Concentratio n Collecte d Firm ; F^A_Lfi£iJ:if i RyASCPXk-50G*f G P 1 ^P^ O pp m 

## 0 D Date:Ai L -ot-og . RYBSCPXA-5-0Ci/< 3 F 2 21 1 pp m 

## D Time : ^ '.nhf^r ^ RYCSCPXA.S'0Qtp 2 B 1 

## _ifiil_PP m Q - D Sample s Analyze d RYDSCPXA-50 C V< S B 2 5 5 3 pp m 

## Q ^ D • RDZSCPX AJp(S<i»tC D Z pp m 

## D D XR F Unit : ^Q ? Book : lO L

RGZSCPXA-^^g^-GZ - pp m 

## D D Date: fi - /C o ' 0 6 .np26CPXA-50giy ^ P Z pp m 

## D D Time : 9 M Staff : /^-S W Numt>e ro fSample s = i 4 - Legend : F l = Fron t Left , F 2 = Fron t Right , B l = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e as viewe d fro m th e street , facin g propert y

# 50Q^ G Exterio rPain t Nort h Arro w Owne rName : Mi7< Q AnrriZdn e O^ah a Lea d Sit e • Goo d 

## Address : 3S^^Ll.£a)zeaLuQrf h cf/
. ^'*^ ^''^^^ ^ Q Poo r 

# i Phone : Hg/>f./.^rt< ^ wCja-Q73^
. g^Nlo t paint Sampl e Numbe r Lea d Sampl e 

### Sampie s Coiiecte d LA B Concentratio n Collecte d 

### Firm: HMlBnXia_ _ RYASCP'XA-50G ^ P 1 

## (P7 0 pp m 

## D Date:A; l -^T-^C > RrBSCPXA-.50C2y< S ^ ^ 

## Z Z 1 pp m 

## D Time : ;!

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• ^ p r ^ RYCSCPXA-SOGH ^ B l pp m 

## D Sample s Analyze d RYDSCPXA-5t>G¥< S B2 

## ^5 3 pp m 

## D pp m 

## D 

# • XR F Unit : ^0 ? Book : /OL , • RDZSCPXA-^raCy^G Z - pp m 

## D D Dat e pp m 

## D D Tim e 

# I '1 ^ Staff 

### /^^V ^ Numbe rof Sample s = ; 4 - Legend ; F l = Fron t Left
. F 2 = Fron t Right , B l = Bac k Left , B2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , PZ = Pla y Al l quadrant s are a s viewe d fro m th e street , facin g property

Re v 4 04614 1 .012 3Exterio rPaint Nort h Arro w 

## Owne rName ; Mik p Anra/on e °"l^.^ ^

^l^ f l'^ ^ • Goo d 

## Address : ^ff^f TLeaveo u tort h <S^
. Sit e Sketc h • Poo r 

### Phone : " g/^-/.?d d ' ^ Glt'Q7a2
. g^o t pain t \ Sampl e Numbe r Lea d Sampl e Sample s Coiiecte d LA B Concentratio n Collecte d RYASCPXA-dOG> ^ F 1 61 0 pp m 

# D Date:AiU-<:>T-oC
. RYBSCPXA-^DCy ^ F2 21 1 pp m 

# D Time : n_'.n^prv N RYCSCPXA-50C W B l / 8 ^ pp m 

# a Sample s Analyze d 5 5 3 pp m RYDSCPXA-^OCV G B 2 

# D pp m 

# D XR F Unit : 

## ^0 ? Book : Jj2U
. 

# D npz6Gr>X Asc^*i( Ao z pp m 

# D Date : 

## ' l a • CX Q 

# D pp m 

# D Time : 

# •2 5 D nPZSGPX AJOc ^ ^ ^ Staff : Numbe rof Sample s =14 - 

# n^y / Legend : F l = Fron t Left , F2 = Fron t Right , 8 1 = Bac k Left , 8 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a s viewe d from th e street , facing propert y 

## AUf ^ JU N a 8 

# &.V .
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## 55.3 . \..^s^.^
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## ^v-^bL^i ^ G7 P ijiii< : i t t

• J_^a.c.'ej\w«T ^ ^y 044141.012 3 Rev4 .I 

# Go^Mi ^ ••z y (
. O A$ 1 / y C^OiuS'tili l ^n : /Xc.cui^;^ : 'i c > I'lDpHity R1GH 1 O F EKHRY'I O PREMISE S 

### Gfanlo i (th e piopert^ ' owner ) consent s t o an d authorize s th e Unite d Slate s Environmenta l Protectio n Agenc y(EPA ) 0 1 its 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 : Dzylinn e Phone : <~7/(/
. 7^7^77 ^ 

# f^/ZyJ4d» ^
Addres s o fPropert y 

# 59?$ ^ ^A^^<^^Q^. A' covere d bythi 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 be 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 progra m 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 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 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 wor k 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 of2i C 0 A5 1 *
.



### ' Remov e obstruction s includin g bosis
. tiaileis , vehicles , plcvscap e items , v»'oo d piles, do g houses , etc : Remov e flowe rbulb s o i plant s tha i th e Granto i o rth e Grantor' s tenan t maywis h t o save ; Wate ran d maintai n leplacemen t vegetation , includin g feiiilize rapplication , a s necessary ' subsequen t t o a n initia l waterin g perio d b yEPA , ' Abid e b yhealt h an d safet yguidanc e piovide d b yEPA ;
' I fth e propert yi s rented , assis t EP Ai n obtainin g tenan t approva l fo i acces s t o th e property / t o perfor m th e work
. I 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 i wit h an yo fth e worl ^ activities , o i wit 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
Q I gran t acces s t o m ypropertie s G ' d o no t gran t acces s t o m ypropertie s

Signatur e Dat e

Q I woul d lik e t o b e presen t duiin g an ysamplin g tha t i s requited
.

Pag e 2 o f 2

## Restorallioi n Agireemeini t Th e purpos e o f thi s agreemen t i s to provid e amutua l agreemen t a s to condilion s o f Ih e propert y prio r l o reinedialio nactivities . Thi s wil l als o serv e a s documentatio nfo r th e purpos e o f assurin g that restoratio n activitie s ar e complete dto th e satisfactio no f th e propert y owne r an dth e Unite dState s Environmenta l Proleclio nAgenc y (EPA) .

Propert y LP : ^50^^ ^ Propert . Address : ^^t ^ LgAvje&VLV^QlgXV l -^A Owner : 

### fiA^fj/ O l^^-7J^,LJZ>\AJ ^ Phone : 

## c(6-Z
- 1 H CTH.'Z ? O nth e attache ddiagram(s ) indicat e area(s ) to excavate , surfac e structure s andlandscapin g feature s an d acces s location(s ) to b e use db y th e contractors . Indicat e distances , depths , materia l types , etc . Photographicall y andVideographicall y documen t th e existin g condition s o f th e propert y an dth e basemen t i f necessary . 

### Item s t o b e Remove d b yth e Owne rbefor e Star t o fRemediation : TOe removsS, gtorage;'diisposal , an<fi/o r reSumoftfoas e ISksms. fc fiilte.Ota^ciiiBir's reaipoiiwtibillilty. Item : 

# ^*.A^C ( IX-AU-. 3 Item : 

# [a^ ^ Item : 

# Hd[c K (j)^ U 2>'^^ \ Item : 

# 'b^%- H

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

# ^q^^^ y( 

# PI^^KJ^T- ^ i Hem : Item : Item :

Pag e 1 of
.COASTA l c» o u r. I ^ f Item s t o B e Remove d B yContracto rDurin g Remediatio n an d Replace d

Landscap e inventor y Ite m 

### Quantit y Uni t Co n dition/Type/Specie s Prc-exisiin g propen y area , Quadrant s tha i «'il l h e excavated , iha t i s covere dwit hgrass . Numbe r o f tree s > 2 inc h Eac h 

# I trunk diameter Numbe r of tree s <= 2 inc h Each 

# 0 UTjn k

diameter Number of SprinkJe r Zones , Contro l Valves , Eac h Timers , Heads , etc . Attac hasketcho f the sprinlde r layout . Numbe r of an dsiz e o f eac hgarden / flowe r be d Eac h area . Square Feet 

# A Attac h a sketc h o f relativ e size s an dJocations . Agree dupo nvalue of plan t material s not t o be replace db y contractor . Note thi s valu e wil l b e use dt o issu e s plcn t vouche r t o th e propert y owner . Easemeni Area , t o b e Eac h 

# o 0o>y
excavate d
Pag e 2 o fI 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 as driveway s o rvehicl e parkin g areas . Th e Environmenta l Protectio n Agency(EPA) ma yb e removin g an d replacin g soi l underlyin g a grave l o rdir t are a o n you rpropert ytha t yo u ma ybe 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 removin g an d replacin g o f soi l doe s no t mea n tha t an yillega l drivewa yo rparkin g are a o n you r propert yi s mad e legal
. T o th e contrary , yo u mayb e cite d b yth e cit yi fyo u us e a grave l o rdirt are a a

s a drivewa yo rparkin g area , no t withstandin g an yremova l o rreplacemen t o fsoi l b yth e EPA
.

I fyo u have an yquestio n abou t legalit yo fa certai n drivewa yo rparkin g area , yo u ma ycontact th e cit yo fOmaha' s Plannin g Departmen t a t (402 ) 444-5150
. I Pleas e chec k thi s boxI fyo u understan d th e informatio n outline d above
.


# D o 7 7 yZxs^iZ^ .

^.y . • Chei ^ 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-e»fetin 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 inte^ ro fhouse , includin g foundatio n crack s o rfissures
. 

### I agre e

/Owner' s Signaiur e 

# I% 

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# : Z / Certificat e o fVerificatio n

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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 64.42 8 Supervise d By : 

## Certificat e o fVerificatio n
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± Erro r ± 14.68 9

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

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pp m P b 58.85 9 Supervise d By : 

## Certificat e o f Verificatio n

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# Therm o

S C I E N TI F I C Therm o Fishe rScientifi c 90 0 Middlese xTumpik e Billerica , M A0182 1

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pp m P

b 44.47 2 Supervise d By : 

## Certificat e o f Verificatio n

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± Erro r 13.21 5

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

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P b Supervise d By : 

## Certificat e o fVerificatio n

1 6 Soi l 2011-08-1 6 16:4 2 90.5 2 pp m 2 Fina l Av g o f13-1 5 355 5 leavenwort h s t B 2 6 " 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 279.07 1 Supervise d By : 

## Certificat e o fVerificatio n

1 3 Soi l 2011-08-1 6 16:4 0 30.2 7 pp m 2 Fina l 5064 6 ' 355 5 leavenwort h s t 6 2 6 " KIN G confirmatio n confirmatio n

± Erro r ± 25.43 9

# 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 279.79 6 Supervise d By : 

## Certificat e o f Verificatio n

1 4 Soi l 2011-08-1 6 16:4 1 30.2 2 pp m 2 Fina l 5064 6 355 5 leavenwort h s t B 2 6 " KIN G Confirmatio n confirmatio n

± Erro r ± 25.46 2

# 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 268.72 8 Supervise d By : 

## Certificat e o f Verificatio n

1 5 Soi l 2011-08-1 6 16:4 2 30.0 3 pp m 2 Fina l 5064 6 355 5 leavenwort h s t B 2 6 " KIN G confirmatio n confirmatio n

± Erro r ± 25.33 8X 

# o Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 o ^^^^_ ^

Coasta l Environmenta l Grou p Inc
. .. . 

## Sy^^ ^

www.c0astaiha2mat.co m ' ^ ^"^"" ^ COASTA L 

# EXECUTIV ESUMMARY : BVID #50646(355 5 LEAVENWORT H ST ) 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 WEREI N TH EPOSSESSIO NO F ASUBCONTRACTO RTHA T WA S CONTRACTE D T O PERFORM AL LO FTH ESITE COORDINATIO NREQUIRE D B Y TH ESCOPEO FWOR K AND TH ESUBCONTRACTO RHA S SINC ELEFT TH EPROJECT . THEREFORE , TH EPHOTO S AREN O LONGE RAVAILABLE . 9/26/11
- P O NOTE D I N COMPLETIO NAGREEMENT ; KEE PSO D ALIVE , I FDEA D REPLACE . AD D MOREDIRT T O TH EHILLAN D PAC K DOWN . 9/27/11
- DANGARVE Y SIGNE D OFFO N TH EPROPERT Y A S COMPLETE .O ^ ^»-«be . Op-V^oA l

COASTA L 

## Propert y Completio nAgreemen t Thi s agreemen t document s th e completio no f remedial activitie s performe do nm y property . My signature wil l designat e that 1 a msatisfie dwit hth e restorationo f my property , andtha t n o item s are i nquestion , no w o r a

t an y time inth e future , excep t thos e item s liste dbelow , i f an y Propert y ID : 

# so(y7( ^ Propert y Address : 3^"^ ^ Z-CyiC^.^e^z-^ y Owner : ZHyf- ^ AZ/)2.i^/y^. ^ Phone : cZt I 7/ ^ (i^VS' S Restoratio nItem s i nQuestion : 

# /^^ p ^ 3 cf/^'Z ^ , I T cJ7e s r^W^td t Item : . . , 1 

## /WAUfif ^ 3y7
- T o hfl l4' Item
Item : Item :

• 

### Item :
Additiona l Comments :

I agre e restoratio n i n completed , excep t a s note d I I I d o no t agre e restoratio n i s coniDlete d 

# f'^'/ / 

# y z y Owner' s Signatur e Dat e Contractor' s Signatur e Oat e

# E EP APropert y Clos e Ou t For m Propert y Addrew.-'^'^^' ^ lfrow^r.^J='rV\ ^ iS V Propert yff : ^Q>ia':r\^
. Date/Tine : Owner' s Name:./,-.VA ^ Af. . ..f^JQ^ P?P-r^ f • - Quad s Excavated : Contracto r Grou p Yes N o Excavatio nGenera l 1 .I f necessaiy , were th e correc t quadrant(s ) excavate dan drestored ? 

# y 2 .I f necessary , wer e th e correc l area s o f drip zon e excavate dan drestored ? 

# y Gradin g So dan dVmelatio n Ye s N o I Doc s th e gradin g aroun dth e perimete r oftti e hous e inexcavaie darea s generall y slop e awa y fromth e house ? 

# y 2 .Ha s so dbeenlai dinall area s that wer e excavated ? 

# y 3 .Doe s th e so dappea r t o b e generall y health y andgrowing ? (Onl y evaluat e if iaspecte da t a3 0 da y tim e period ) 

# y 4 .Ar e sodde darea s generall y fir man devenl y graded ? 

# y 5 Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period ) / 

# A ' 6 .Wa s th e property grade dsuc hthat 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 ? 

# y Gales . Fence s an dRetaialn g Wall s Ve s .N o ! .D o gate s openan dclos e freely? (Ifapplicable ) 

# r 

# yr r 2 .Wer e all gate s or fence s take ndow ndurin g restoratio nactivitie s reinsialled ? (I f appiicablc ) 3 .Wa s damag e t o gate s or fence s avoided ? (Ifapplicable ) 

# yy4 .Wa s damag e t o retainin g wali s avoided ? (I f applicable ) Foundation , Sidiatan dCotter s Ye s /N o Wa s danuig e t o th e sidin g o r tri mavoided ? 2 .Wa s damag e t o Ihe foundatio navoided ? 

# y 3 . Wa s damag e t o window s avoided ? 4 Wa s damag e t o window s or doo r screen s avoided ? 5 .

Wa s damag e t o downspout s o r downspou i extension s avoided ? / Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 .Wa s damag e to drivewa y surface s avoided ? 

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

# y1 

## Owner s comments :

T.n.<;pectio nnotes :

Removal andrestoratio nactivate s complete includin g th e 30-da y so dwarranry : HP ARepresentaiiv e ,6U^6 ^ Date : 9/27// /