### TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID# : ;5g>aC)' 4 Date : ^jlQlm Address : ^Hl Q \vx\\rmC \"^3 ^ Remediatio nContractor : Coasta l Environmenta l Group

_Year : 200 8 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 0 ^ Vide o o f property (DVD ) 4031475 7 y " Executiv e Summary il l ill III II I II I II I 1^ ^ y EPA-provide dproperty sketc hSuperfun d y Signe dAcces s Agreemen t for subjec t property /lt|i T Signe dAcces s Agreement(s ) for adjacent property y Restoratio nAgreemen t /u/fi ' Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) WConfirmatio ndat a y Photograph s IN-t-JlXCJiJailSA ^ lYfyO^^JxCy^^ Sd-A/iy^ ^ ji/uj^^ ^ UAs-buil t sketc h^ y Satisfactory restoratio nsigne db y Property Owne r y Property close-ou t chec k lis t signe db y EPA /u) nDescriptio no f area s no t meetin g RO D cleanup criteri a [ 5 Utility clearance s WProperty informatio nfro mDougla s County Assessor' s Offic e D 1 D 

## 9Q(mmy \<3/^g/o ^ Signatur e Dat e 

# ^/l^o f

## Propert yAcces s Checklis t ProDCrt y ID : ^ISoi^ ^ Pio|)ert y Address : J^<// ^ ^^^,^^ ^ <^ ^ n n

WOR K STARTE D WOR K COMPELTE D ON : ON : / / / / 

### 0«ner : \\f\^^(J^^ [ JYlarOn ^ 

# '""^'^^^P5^ /

A^^/ ^ d^^^S . Phone : :^ ^ ^ ^ J< ^ Fax : Cell/Pager : Renter : Phone : Fa.v : Cell/Paser : Additiona l liit'ormation : 1

i • " '—— '

D Notificatio nLette r r ^ Acce.s s Agreemen t y( \Restoratio nA<>reemen t CH Topsoi l Samplin g (if applicable ) d l Disposa l Samplin g (if applicable ) CH Garde nSamplin g (if applicable ) I [E l Utility Clearanc e caVideo/Photo s (Before ) D Video/Photo s (During ) nVideo/Photo s (After ) nVideo/Photo s (3()-Day ) O Pro|)ert > Completio nAgreemen t 1 1 Fina l Re()or f Sent : / / Signed : 1/ 1 /O ^ Signed : " 7 / /

/<^ ^ / / / / / / 

### Called : i)l/ H /O ^

On : ^/\D / " ^ On : / / On : / . / On : / / 1 Signed : / / , Is.sued : / / By : 

## B.v : /4A 

## B-V : J A By : By : By : 

## Bv : t c 

## By : iC/\yifl ^ By : By : By : By : By : Ai r Monitorin g ( II EH Communit y as applicable ) D Cre> v Results : On : / / 

### By : 1

LJ Communit y Results : nCi-e> v On : / / B.v : E] Communit y Results : nCre^ v On : / / By :

Omah a Lea d Sit e

### Dougla s County Accoun t Informatio n Pag e 1 o f 1
Dougla s County , Nebrask a Propert yRecor d - R221051000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t o f90tt i S t - Viewo n Ma p Informatio n i s vali d a s o f2008-6-1 9 Treasurer' s Ta xRepor t Ne wFeatur e -•-»-* > Aut o Sale s Searc h Owne r OMAH AECONOIVII C DEVELOPMEN TC O 222 1 N 2 4 S T OMAH AN E 68110-000 0 Propert yInformatio n Ke yNumber : 1051000 0 2 2 Accoun t Type : Residentia l Parce l Number : 221051000 0 Parce l Address : 241 0 INDIAN AS T OMAH AN E 68131-000 0 Lega l Description : SHINN S AD D LO T2 BLOC K1 3 E 27. 5 W56. 5 S 46.2 5 F T& E 24. 5 W53. 5 N 2 6 F T Valu e Informatio n 200 8 200 7 200 6 200 5 200 4 200 3 Lan d $200.0 0 $200.0 0 $200.0 0 $200.0 0 $200.0 0 $200.0 0 Improvemen t $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 Tota l $200.0 0 $200.0 0 $200.0 0 $200.0 0 $200.0 0 $200.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 4 1872. 0 0. 0 72. 0 26. 0 Ye s



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R221. . . 7/9/200 8

### Pag e 1 o f 2

Creat e Anothe rTicke t Bac k t o Irt h Interne t Sen d Emai l 

### YOU RTICKE T NUMBE RI S 2078208 . Origina l Cal l Date ; Wor k t o Begi n Date : 7/09/0 8 7/11/0 8 Time : Time : 5 6 4 1 p m 1 5 p m Op : ELIZABETH1879 0 State : N E Address : 241 0 County : Street : DOUGLA S INDIAN AS T Place : OMAH A Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 15-NW-SW,16-NE-S E Sect-Qtr : Typ e o f Work : Lea d Remidiatio n Locatio n o f Work : ENTIR E PROPERT Y AL L TH E WA Y T O TH E STREET . Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LOT . 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 h o f Excavation : 4f t Corne r Lot : NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V LEVEL S MAGELLANMCLEODN E MUDO l OMAHACO F 0PPDGPR 5 OWW C QLNNEI C

Servic e Are a Contac t Phon e Numbe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , INC HEID I 

### Day : Alt : 402934046 9 402934046 9 Emerg : 402932975 7
LEVEL 3 LEVEL 3 COMMUNICATIONS , LLC N A 

### Day : 877366834 4 Alt : 

### Emerg : 877366834 4
MAGELLA N MAGELLA NMIDSTREA M PARTNER S LP TONY A 

### Day : 918574709 8 Alt : Emerg : 918574709 8
MCLEODN EMCLEODUS A N O NEE D T O CAL L OU T EMERGENC Y 

### Day : 800289190 1 Alt : 

### Emerg : 800289190 1 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 7/9/200 8

### Pag e 2 o f 2 

# t

MUDO l

OMAHACO F

OPPDGPR 5

OWW C
QLNNEI C METROPOLITA NUTILITIE S DISTRIC T
CIT Y O FOMAHA
TRAFFICSEWE R
OMAH APUBLI C POWE R DISTRIC T
OMAH AWORL D HERAL D COMPAN Y
QWES T LOCA LNETWOR K EDWINA

RO N

NA

N

A

N A 

### Day : 402504782 3 Alt : Emerg : 402504794 6 Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 Alt : 888728934 3 Emerg : 406728934 3 Day : 402444316 9 Alt : 

### Emerg : 402444316 9 Day : 406728934 3 Alt : Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 7/9/200 8

### 2520 4 

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e

Exterio rPain t Nort h A/To w Omah a Lea d Sit e Owne rName : OMAHAECONOMI C DEVEL O Sit e Sl<etc h • Goo d Address : 241 0 INDIAN A ST •Poo r Phone : H 40245393 0 W: 

# i 0 * No l pain t Sampl e Number Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Firm : A^t^ l g&, \ (K T RYASCPXA-2520 4 Fl 

## 2 3 I pp m 

## D Date : ti-o-r-o c RYBSCPXA-2520 4 F2 H3 3 pp m 

## B- Tim e \-.w s p,v ^ RYCSCPXA-2520 4 Bl l&3< p ppm/ n 

### & 

## D Sample s Analyze d RYDSCPXA-2520 4B2 3-7 Q pp m 

## D RDZSCPXA-2520 4 DZ pp m 

## D D XR F Unit : /CX^ yBook : 11 3 nCZSCPX A2520 4 6 2 .pp m 

## D D Date : n-^n-t^ ^ nPZOCrXA-25204 - -PZ
­ pp m 

## D Time : AfY l 

# n .La b RYBSCPLA-2520 4 Staff : JhitL . Numbe rof Sample s = *1 2 Resul t 58 1 pp m

L-cyc^ j rI - riuii i Leu , r2 = Fron t Right , B1 = Bac k Left , B2 = Bac k Righ tDZ = Dri p Zone , GZ = Garden , PZ • Pla y Al l quadrant s ar e as viewe d from the street , facin g propeit y : OLS# : 2S20 4 Dat e Excavate d :7/12/0 8 Dat e USEP ASigne d Off : Are a Sodde d 186 5 sq ft



### Legen d Concret e /j/X J Dri p p Zon Zon e e Excavate Excavate d d |C)<X X Quadrant s Excavate d Are a replace d wit h 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 .

# 25204 Exterio rPain t Nort h Arrow 

### Omah a Lea d Sit e Owne rName : OMAH AECONOMI C DEVELO 

### • Goo d 

### Sit e Sketc h Adldress:24i o INDIAN AS T 

### •Poo r Phone : H 40245393 0 W : 

# 1 0 * Not pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : A^v-i l Ka. ^ AT RYASCPXA-2520 4 F 1 

### 2 3 i pp m 

## D Date ; U-Q-T-O C RYBSCPXA-2520 4 F 2 

## H3 3 pp m Time : V.JA' Z prx . RYCSCPXA-2520 4 B 1 

### J 0 3 6 ? ppm/ n 

## B ' D Sample s Analyze d RYDSCPXA-2520 4 8 2 

### 3-7 0 pp m 

## D RDZSCPXA-2520 4 D Z pp m 

# n n XR F Unit : /OC H Book : \1 3



### — 

### nczccnx A25204—s ? pp m 

## D D Dat e 

### i|-30-(P6 '

— RPZOCPX A2520 4 -PZ - pp m 

## D D Tim e v m La b RYBSCPLA-2520 4 Staff : ^^Su / Numbe ro f Sample s = § Resul t 58 1 pp m

i-cycn u ri - riuii i Lcn , f l - FroH 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 as viewe d fro m th e street , facin g property 

# ENTERED NOV
. i 11.201)6
.

Re

v 4 04614 1 012 3

## 25204 Exterio rPaint Nort h Arro w Owne rName : OMAH AECONOMI C DEVEL O Omah a Lea d Sit e Address : 241 0 INDIANAS T Phone : » 402453930 Sampl e Numbe r RYASCPXA-2520 4 RYBSCPXA-2520 4 RYCSCPXA-2520 4 RYDSCPXA-2520 4 RDZSCPXA-2520 4 

## nczccnxi^'i 2520 4 RPZOCPX A2520 4 La b RYBSCPLA-2520 4 i Resul t 58 1 pp m ucycii u rI - riUM l LCTl , F l F 2 B l B 2 D Z € 2

f Z ^'* ® Sketc h W: Lea d Concentratio n Sampl e Collecte d LA B 

## £ 3 / pp m 

## D H3 3 pp m ppm/ n 

### & 

## D 3-7 0 pp m 

## B ' D pp m 

## D D pp m 

## D D pp m 

## D D Numbe ro fSample s = ^ •Goo d •Poo r 

# 1 0 * No t pain t Sample s Collecte d Firm : A»>J l g&. \ A X Date : ti-o-t-o c Time : r.^ s prv N Sample s Analyze d XR F Unit : /PO ^ Book : 11 3 Date : 

## l\-^D-0 ^ Time : <f) n Staff : >^Su / 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 a s viewed fro m th e street , facin g propert y

• 

# EKTERE D -.10. 1 .N.OV. i4 201)6... . 

# e

> \J5>2
­



## 2 ^ I D jAcliarv a$. r



# _._ 4 4^

...F J \..F 7



# ^ 3 i l.HS'^.... .1iii-f!1.

Rev4 .•-•-^-..-..5 5 iciido ^ . .ST . : _046I4 J 012 3COASTA L fNVIIONHINTk l C •O U rIH C 

## Consen t Fo rAcces s T o Propert y RIGH TO F ENTR YT O PREMISE S 

### Granto r(th e propert yowner ) consent s t o an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA ) o rIt s authorize d representatives , collectivel y th e Grantee , t o ente ran d perfor m certai n environmenta l respons e activitie s upo n th e followin g describe d premises : i \ ^ ^•- \ Kj v Owner' s Namer-j^^^^^^^^^,^^ ^ ( ^ 

### Daytim e Phone : ( { 0^-O^i ^ ~ 3^3Q O 

# 3i^/0 -iKvci^o m6/- . Addres s o fPropert y covere d b yttii s Agreement : PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP Ai s requestin g acces s t o collec t soi l sample s an d remov e soi l tha t contain s elevate d concentration s o flea d an d ma ypos e a healt h hazard . Th e area(s ) wil l b e excavate d t o remov e contaminate d soil . Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o it s origina l condition . Thi s wor k i s bein g performe d 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 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 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 

### B ysignin 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 of2COASTA L {NVII0MMfMT4 l



### •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 ma yv^s h t o save ; •Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessar ysubsequen 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 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 (712 ) 352-018 8
^" ^

I gran t acces s t o m ypropertie s D I d o no t gran t acces s t o m ypropertie s 

# ^-H t ^^y^ ^ 

# 7V-/0 9 Signatur e Signatur e Dat e
QI woul d lik e t o b e presen t durin g an ysamplin g tha t i s required .

## Restoratio n Agreemen t Th e purpos e ofthi s agreemen t i s to provid e amutua l agreemen t a s t o condition s o f th e propert> ' prio r t o remediatio nactivities . Thi s wil l als o serv e a s documentatio nfo r th e purpos e o f assurin g tha t restoratio n activitie s are complete dt o th e satisfactio no f the propert y oune r an dth e Unite dState s Environmental Protectio nAgenc y (EPA) .

Propert y ID : '^S^O ^ Propert y Address=3L|)|^^^(]^>Qt ^ S f 

## Owner : Qpngt ^ ^^t>r)c^ y bex/LJopeym ^ C o Phone : MP S hm^-X}>C O O nth e attache ddiagram(s ) indicate area(s ) t o excavate danddept ho f excavation , locationof all know n utilities , subsurfac e features , surfac e structure s an dlandscapin g features , acces s location(s ) t o be usedby contractor , andth e directio no f North . Indicate distances , depths , material tvpes , etc . Indicat e digita l photo s b

y referencin g th e photo-lo g number wit ha narrow indicatin g directio no f view . 

### Item s T o B e Rennove d B yOwne rBefor e Star t O fRemediation : (Us e additiona l sheet s a s necessary ) Th e removal , storage , disposal , and/o rretur n o fthes e item s i s th e Owner' s responsibility . Item : Item : Item : Item : Item : Item : Item : Item : Pag e 1 of .COASTA L 

### Item s T o B e Remove d B yContracto rDurin g Remediatio n An d No t Replace d (Us e additiona l sheet s a s necessary ) Item: , Item : Item : Item : Item : \ Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 2 o fCOASTA L C « O u ' > N C 

### Item s T o B e Remove d B yContracto rDurin g Remediatio n An d Replace d (Us e additiona l sheet s a s necessary ) Item : 

# : x Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 3 of .COASTA L 

### Landscap e Inventor y (Us e additiona l sheet s a s necessary ) 

### Ite m Quantit y 

# 5 1 Pre-existin g propert yarea , tha t wil l b e excavated , tha t i s covere d wit h grass .

Numbe ro ftree s > 2 inc h ^ ^ trun k diamete r

Numbe ro ftree s •= 2 inc h 

# ^ § ^ irun k diamete r

Numbe ro fSprinkle r Zones . Contro l Valves." " Timers . Heads , eic . ^ ^ Anac h a >keic h o i in e ijiriiiklc : !a\Oui
.
Numbe ro fan d siz e o f eac h garden / flowerbe d area . " ^ •-.\..i^i
. :• : NKcici i ,' i .c..i;i\ c -l:'e ^ ruij . locanons . 

### Uni t Condition/Type/Specie s

Square fee t

Eac h

Eac h

Eac h

Eac h Square Feet

Pag e 4 o f 1•V^^S^^^" * COASTA L 

### Ite m Agree d upo n valu e o f plan t material s no t t o b e replace d b ycontractor . Not e thi s \alu e »il l b e use d t o issu e a plan t >ouche rt o th e propert v o»ner . Agree d upo n lis t o fplan t material s tha t wil l b e replace d b ycontractor . B e ver yspecifi can d detailed . Includ e a sketc h ol " wer e eac h plan t \\il l b e place d b_

\ ih e coiuiackM- . Agree d upo n are a o f propertv - t o b e replace d wit h gras s sod .

• 'U'liid e L- skeicl i yili c .iiea(S ! [ 0 h e ;epbci.- a ^v-il i ii'-as s >od .
.Are a o fCir \ o rCount ) propert ) t o b e landscape d pe rthei rrequireinents .

Easemen t .Area , t o b e excavate d 

### Quantit y 

# - S ,

^

^ ^

^


# n o Uni t Condition/Type/Specie s

$ ^

Eac h

S F

S F

S F

Pag e 5 o fCOASTA L • MVIHOMMCHTA L C « O WP . IN C



### 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 . 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 cracks o rfissures . j<\\aLgTe t Q I d o no t agre e 

# 'yyu/,fy ^ /^/-'^i ^ /%y/^c yr-z-g ^ Owner' s Signatur e ]^ ^ Contractor' s Signatur e Dat e 

### PageSof
.Dat e Projec t XR F ID #

Shot # 

## ^I R l i t 

# 4 ^ Averag e

Shot #

Averag e

Shot #

Averag e

Shot #

Averag e la b sampl e # 

### 1<^9i ^ BVID # 

### XRF PROPERT Y SAMPL E SHEE T 

# ' I 1 ^ Addres s ^^\ o \\AI^I/!V> A Omah a lea d F P 2n d yea roptio n Sampl e tim e ll' . ><= ^

am;i) m sampl e lengt h 3 0 se c 

### y?^^" ] Readin g Sampl e are a Shot # Readin g Sampl e are a 

### HM . li t q. q ^Lt'^^ . lo-^ l 

# h 1121 . 

# 5" ' 

# \^ n Dept h 

### TM T Dept h ^ 

# ic-u t \y\ . 

# 21 1 ^1-^1 1 \o M Averag e JU^Il t j^.^ C

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

- — 1 Averag e La b resul t Sampl e are a XR F Avg .Signatur e 

# Prin t jMtol_MAl 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 73 3 Mod e SOI L Tim e 2008-07-1 2 11:4 1 Duratio n 121.3 6 Sequenc e Fina l Flag s AVERAG E Av g o f729-73 2 ADDRES S 241 0 INDIAN A QUAD/ZON E fF 2 INSPECTO R MATEU S DEPT H 6 SAMPL E TYP E CLEARANC E NOT E
pp m ''" ±/ Erro r P b 57.3 7 

## 4 10.32 4 Supervise d By : 

# yf ^

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 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 44.11 2 Supervise d By : 

## Certificat e o fVerificatio n
72 9 SOI L 2008-07-1 2 11:3 9 30.1 6 Fina l 2520 4 241 0 INDIAN A F2 MATEU S 6 CLEARANC E

± Erro r ± 9.52 1• • 

# Therm o

S C 1 E N T 1 F 1 C Therm o Fishe r Scientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 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 57.88 1 Supervise d By : 

## Certificat e o fVerificatio n

73 0 SOI L 2008-07-1 2 11:4 0 30.3 0 Fina l 2520 4 241 0 INDIAN A F2 MATEU S 6 CLEARANC E

±Erro r ±10.37 6

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 73 1 Mod e SOI L Tim e 2008-07-1 2 11:4 0 Duratio n 30.2 6 Sequenc e Fina l Flag s BVI D # 2520 4 ADDRES S 241 0 INDIAN A QUAD/ZON E F2 INSPECTO R MATEU S DEPT H 6 SAMPL E TYP E CLEARANC E NOT E
pp m ± Erro r P b 50.86 5 ± 9.83 7 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 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 76.65 4 Supervise d By : 

## Certificat e o fVerificatio n

73 2 SOI L 2008-07-1 2 11:4 1 30.6 4 Fina l 2520 4 241 0 INDIAN A F 2 MATEU S 6 CLEARANC E

± Erro r ± 11.56 3

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 73 8 Mod e SOI L Tim e 2008-07-1 2 11:4 6 Duratio n 125.1 9 Sequenc e Fina l Flag s AVERAG E Av g o f734-73 7 * ADDRES S 241 0 INDIAN A QUAD/ZON E 

### ve i INSPECTO R MATEU S DEPT H • € SAMPL E TYP E CLEARANC E NOT E 

# " 7 / Erro r pp m P b 112.71 7 13.45 5 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 51.64 7 Supervise d By : 

## Certificat e o fVerificatio n

73 4 SOI L 2008-07-1 2 11:4 3 30.5 4 Fina l 2520 4 241 0 INDIAN A B l MATEU S 6 CLEARANC E

± Erro r ± 9.79 1

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

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E
pp m P b 174.28 6 Supervise d By : 

## Certificat e o fVerificatio n

73 5 SOI L 2008-07-1 2 11:4 4 33.3 6 Fina l 2520 4 241 0 INDIAN A B l MATEU S 6 CLEARANC E

±Erro r ±16.47 4

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

XL3t-3208 9 Readin g N o Mode 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 128.64 1 Supervise d By : 

## Certificat e o fVerificatio n

73 6 SOI L 2008-07-1 2 11:4 5 30.2 7 Fina l 2520 4 241 0 INDIAN A B l MATEU S 6 CLEARANC E

± Erro r ± 14.63 0

# 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 73 7 Mod e SOI L Tim e 2008-07-1 2 11:4 6 Duratio n 31.0 2 Sequenc e Fina l Flag s BVI D # 2520 4 ADDRES S 241 0 INDIAN A QUAD/ZON E B l INSPECTO R MATEU S DEPT H 6 SAMPL E TYP E CLEARANC E NOT E
pp m ±Erro r P b 96.29 5 ±12.92 6 Supervise d By :

### Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc . www.coastalhazmat.co m COASTA L ENVIRONMENTA L C R 0 U r, INC
. 

# EXECUTIV ESUMMARY : BVI D #2520 4 - (241 0 INDIAN AST ) I I N o Issue s o r Concern s X 

# Issues/Concern s Detai l Explanation : CIT Y CONTRACTO RMOWE D ARE A& DISTURBE D TH ESOD .

# ^^EPA EP APropert y Clos e Ou t For m |Wl^/l^» V Propert y# : Date/Time : Contracto rGrou p LyOttHy H Quad s Excavated : p | ^ rZ ^ Ye s N o Excavatio nGenera l 

# \[ArAhi r

Lo r 1 .If necessary , were th e correc t quadrant(s ) excavate dandrestored? 

## y 2 .If necessary , wer e th e correc t area s o f dri p zon e excavate dandrestored ? ^ Gradin( ; So dan dVetetatio n Ye s N o 1 .Doe s the gradin g aroun dth s pBrimotc r uf llic hou.^ t i

nexca^iatcd-atea s generall y slop e vnv , 

# y 2 . Ha s sodbee nlai di nall area s tha t were excavated ? / 3 . Doe s the so dappear to be generall y healthy an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 day time period ) ^ 4 . Ar e soddedarea 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 ? (Only evaluat e i f inspecte da t a3 0 da y 

# y tim e period ) 6 Wa s the propert y grade dsuchtha t water will not poo l o nthe property ? 

# y 7 . Wa s damag e t o landscapin g or plan t material s avoided ? 

# iJ ^ Gales , FeDce s an d Retainin g Wall s ^ 'e s N c 1 . D o gate s ope n an d clos e freely? (Ifapplicable ) 2 Wer e al l gates o rfence s take n dow n durin g restoratio n activitie s reinstalled ? (Ifapplicable ) 1 3 . Wa s damag e t o gate s o rfence s avoided ? (Ifapplicable ) 

## 1 1 4 , Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) 

# 1

FouDdation , Sidiof ; an d Gutter s Ye s N o I .Wa s damag e t o th e sidin g o rtri m avoided ? 2 .Wa s damag e t o th e foundatio n avoided ? 3 .

Wa s damag e t o window s avoided ? 

# V * 4 .

Wa s damag e t o window s o rdoo rscreen s avoided ? 5 .Wa s damag e t o downspout s o rdownspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 .

Wa s damag e to driveway surface s avoided ? 

## iJ A 2 .Wa s damag e to walkway surface s avoided ? 

## Ai A

## Owner s comments :

Inspectso nnotes : (_yi\x ^ (LCN^Vc^l^Vcv
- ywOvOe^ l GLTL/ ^ dAi^TU f i^c ^ So< i

Removal andrestoratio nactivate s complete includin g the 30-da y so dwarranty EPARepresentati ve^,,^;/^^^^^^^^,^4 ^ Date: „ 9^^ ^

## Propert yCompletio n Agreemen t Ihi s agreemen l documeni s ih e complclio n o l remedia l activiiie s perioime d n n m yproperl yM ysignalur e wil l designal e tha i I a m satisfie d wit h (h e restoratio n o i m yproperly , an d iha l n o ilem s ar e i n queslions . now , o ra l an ylim e i n ih e future , excep i thos e item s liste d below , ifan y

Propert yI D ^S'JLO'- I Propert yAddre.. : ^ l j { Q j / ) ^ ) CK
. ^V( \ s \ Qwn e 

## ' /Airiicv^ l A^o^r o ne ^ Phon e 

# -^Hr. 'X^d O Restoratio n Item s i n Question :

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

l^ n I afjrc cresloralio n i s complcled , cxctp l a s nole d I I rio no l a^; i c crestoratio n i s complele d 

# f-i y Ownc i ' s Signalui e Con n actor' s Signatur e Dat e I