### • •


## TRANSMITTALo f

OMAHALEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAID # : ^^^l O Date : ^/Zz/z^ i Address : ^fil ^ N^[ p Pt ^ t ^ Remediatio nContractor : Coasta l Environmenta l Grou p Year : 200 8
SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f propert y (DVD ) Executiv e Summary EPA-provide dpropert y sketc h Signe dAcces s Agreemen t for subjec t property Signe dAcces s Agreement(s ) for adjacent property 

# \ V Restoratio nAgreemen t Settlemen t document s (i.e. , for damag e o r to replac e plants , etc. ) Confirmatio ndat a Photograph s As-buil t sketc h 

## o / Satisfactory restoratio nsigne db y Property Owne r Property close-ou t chec k lis t signe db y EPA Descriptio no f area s no t meetin g RO D cleanu p criteri a 0 / 

### Utility clearance s Property informatio nfro mDougla s Coimt y Assessor' s Offic e

D 

### g/SA^ f at e 

# XH ^

## Propert yAcces s Checklis t Property ' ID : 3 ^ L j / Q nWOR K STARTE D ON :

_/ l
_ D WOR K COMPELTED ON : I I Propert yAddress : 4 5 D^ : 1\ / -^( ^ gy / Owner : Rcnte n 

# yh ^ ri^g? n 

# Hr^lhnt d Address ; C Phone : 

## ayy) ^ Fax : Cell/Pager : Phone : Additional Infonnation : 

# l^\ i -inou n Fax : Cell/Pager
. D NotificationLette r Sent : / / By : H ^ Accesi i Agreement Signed : ii/^/i ^ 

## By : £
. C 00^ Restoratio nAgreement Signed : Jf l _0_li25 f 

## By : r..< x Q Topsoil Samplin g (if applicable ) 1 1 By : 0 Disposa l Samplin g (i f applicable ) 1 t By : Q Giirdc nSamplin g (i f applicable ) 1 1 By : 0 ^ Utilit y Clearanc e Called : IL/^/ ^ 

## By:////5/C S ST

TVideo/Photo s (Before) On : _il/^/ ^ 

## By : A/l(^V//$s/r^'v>;a n nVideo/Photo s (During ) On : / / By : nVideo/Photo s (After) On : / / By : 1 D Video/Photo s (30-Day) On : / / By : D Property CompletionAgreement Signed : / / By : D Fina l Report Issued : / / By : Air Monitorin g (a s applicable ) nCommunit y O Crew On : / / By : 

# 1 Results :1 C

D Communitj ' C U Crew | On : / / By : 1 Results :
nCommunit y • Crew On : / / By : Results :

Omah a Lea d Sit e

### Propert yI D ^ Propert y Address : Inilia l Contaci : Secon d ConLaci : Fina l Conlact : Fina l Action :

Comment : ONvne r Ccimmen i (s) :
Sit e Coordinato r Commen i (s) : 

## C0NTAC 7 FORiv I 3^^1( 1

f ^ 

# N 3f o 

# A v Date : 

### Time : Action : Date : Time : Action : Dale : Time ; Action : Transmi t t o EP AD Othe rAction
. D



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### Dougla s County Accoun t InfqM|atio n Pag e 1 of 2 (jjl^ t Dougla s County , Nebrask a Propert yRecor d - R180019000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o fSOt h S t - Vie wOf l Ma p Informatio n i s vali d a s o f2008-9- 4 Treasurer' s Ta xRepor t Ne wFeatur e ->->- •Aut o Sale s Searc h Owne r HOLLAN D SHERMA N ETA L 451 8 N 3 6 AV E OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : 001 9 000 0 1 8 Accoun t Type : Residentia l Parce l Number : 180019000 0 Parce l Address : 4518N36A V OMAH AN E 68111-000 0 Lega l Description : MOE S SU B LOT9 BLOC K1 4 7 X 13 3 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $4,800.0 0 $29,700.0 0 $34,500.0 0 200 7 $4,800.0 0 $29,700.0 0 $34,500.0 0 200 6 $4,800.0 0 $29,700.0 0 $34,500.0 0 200 5 $4,800.0 0 $5,600.0 0 $10,400.0 0 200 4 $4,800.0 0 $5,100.0 0 $9,900.0 0 200 3 $4,800.0 0 $5,100.0 0 $9,900.0 0 Sale s Informatio n Sale s Date : 2007-04-1 6 Dee d Type : W D SooAr ; 200 7 Page : 04915 4 Price : $38,000.0 0 Grantor : Christense n Edward eta l Grantee : Hollan d Sherma n eta l Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 4 6251. 0 1. 0 133. 0 47. 0 N o Improvemen t Informatio n


### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R18.
. . 11/4/200 8

### Dougla s County Accoun t Infqanatio n Pag e 2 of 2 nua i

Buildin g 1

SvccndFtos r »HMT J66. 0 < q • 

### 1? ** '* i r FMFtoa r« «0«Os q t

u « 11/ 2 F t ! JU
. KSOv i 1

CLIC KTO ENLARG E IMAG E Squar e Footage : 1173. 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 : 5. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 2. 0 Roo fCover : Compositio n Shingl e Bedrooms : 3. 0

Roo fType : Gabl e Stories : 1. 5 

### Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 189 5 0 % 189 5 11 1 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 808. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 2. 0 Porc h En d Scree n 140. 0 Porc h Sla b Roo fCei l 72. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R18.
. . 11/4/200 8

### Pag e 1 of 2

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


### YOU RTICKE T NUMBE RI S 2172054
. Origina l Cal l Date : 11/09/0 8 Time : 4:2 1 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 11/13/0 8 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 451 8 Street : N36T H AV E Twp : 15 NRng : 13 E Sect-Qtr : 05-NE-S E . - Twp : Rng : Sect-Qtr : Lega l Given : C ^ Typ e o f Work : lea d remidiatio n ,,, • , Locatio n o f Work : LOCAT E ENTIR E PROPERT Y INCLUDIN G HOUS E AL L TH E WA Y T O TH E : STREET . Remarks : FAX AL L CLEAR S TO : (877)662-421 1 . ,/ 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 : N Front : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V METR O MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

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

### Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C 

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

### Day : 402457230 7 METR O METR O COMM
. COLLEG E 

### CHRI S Alt : 402672703 3 Emerg : 402457231 3 Day : 402504782 3 MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y Alt : 

### Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO N 

### Alt : 402444516 1 Emerg : 402444516 0

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 11/9/200 8

### Pag e 2 of 2
Day : 406728934 3 0PPDGPR5 OMAH APUBLI C POWE RDISTRIC T N AAlt : 888728934 3 Emerg : 406728934 3 Day : 406728934 3 QLNNEIC QWES T LOCA LNETWOR K

m . Alt : Emerg : 888728934 3

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

## 3441 0 Exterio rPain t Nort h Arro w Omah a Lea d Sit e Owne rName : EDWAR D H CHRISTENSE N • Good Sit e Sketc h Address : 451 8 N36A V

Phone : *^ W: |[ ] No t paint Lea d Sampl e Sample s Colleqte Sampl e Numbe r ; Collecte d d LA B Concentratio n Collecte d Firm : RYASCPXA-3441 0 Fl 

# Zl ^ pp m 

## D Date : 

## iQ|>^|A q RYBSCPXA-3441 0 F2 pp m 

# 5f D Time : 

# 17,' 

# n RYCSCPXA-3441 0 81 pp m 

## [I K D 

# J^ 

# I Sample s Analyze d RYDSCPXA-3441 0 B2 ^^ ^ pp m 

# nK 

# n RDZSCPXA-3441 0 DZ pp m XR F Unit : 0/"^ ^ Book : ^ S 

## D RCZGGPX A3441 0 G2 - pp m 

## D Date : /^-^/-^ ^ 

## D RPZSCPXA3441 0 -R Z pp m Time : F^/* ^ 

## D Staff : tPJT^ ^ Numbe r ofSample s = 

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Omah aLea dSit e

, / • 4613 0

# 3441 0 Exterio rPain t North Arrow 

### Omah a Lea d Sit e Owne rName : EDWAR D H CHRISTENSE N •Goo d 

### Sit e Sketc h Address:4518N36A V QJxP^ r

Phone : • + W : Q No t pain t Sampl e Numbe r RYASCPXA-3441 0 RYBSCPXA-3441 0 RYCSCPXA-3441 0 RYDSCPXA-3441 0 RDZSCPXA-3441 0 RGZCCPX A3441 0 RPZSCPXA-3441 0 • F l F2 B l B 2 D Z GZ ­

-S Z Lea d Concentratio n 

# X2JX± — pp m pp m pp m pp m pp m pp m pp m Sampl e Collecte d



# n K G K D
Numbe ro fSample s = 

## G LA B 

## D D D D D D D Sample s Colle i Firm : _ Date : _ 

## Time: t?, : H ; Collecte d 

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AN/ 46130 ICOASTA L ENVIRONHtNTA L C I I O U P
. IM 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 i respons e activitie s upo n th e followin g describe d premises :

Owner' s Name : Daytim e Phone :

Addres s o fPropert y covere d b ythi s Agreement : 

# VSI R M^t^M
. 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 o f2^^•**^ * COASTA L ENVIROMNENTA L 6 I O U r . IN C



### •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 ywis 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
-TfN Q I gran t acces s t o mypropertie sQ I d o no t gran t acces s t o m ypropertie s 

# ;f^flQXj)^lj ^ 4[u^C<-^vA£ia^M ^ d^gjai^ X n/Qm ^ Signatur e Dat e SignatureDat e

OI woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.COASTA L ff r ' IHOHH nMTA l c no 1 ^ f

- IM C 

## Restoratio n Agreemen t Th e purpos e ofthi s agreement i s to provid e amutua l agreement a s t o condition s ofth e propert y prior t

o remediationactivities
. Thi s will als o serv e as documentationfo r th e purpos e of assurin g tha t restoratio n activitie s ar e completedt o the satisfactio nof th e propeiiy owne r an dthe UnitedState s Environmenla l Protectio nAgenc y (EPA)
. Propert y ID : ^C/C^f( ) Propert y Address : yj7 ^ /\ ) '^(Jl

- f\^/^
_ Owner : 

### .Q\^rjMa ^ /A//a,nr^
. Phone : 

# (pix-Cnnion

O

nthe attache ddiagram(s ) indicat e area(s ) t o excavatedan ddept ho f excavation , locationo f al l know n utilities , subsurface features , syrface structure s an dlandscaping features , acces s locaiion(s ) t o be use db y contractor , an dthe directionof North
. Indicat e distances , depths , materia l types , etc . Indicat e digita l photo s b

y referencin g th e photo-lo g numbe r wit ha narro w indicating directiono f view
. Item s T o B e Remove 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 : I t / y i /- s y/J/ X ~-- ^ rfr' ' ¥Ht/i^i J 

# -j p /l//)/y t ^^ \ Item : Item : ^ ^ Item : /



### / Item : /
Item : / Item :
Pag e 1 o f 

# c ^COASTA L C M O U r. IM C 

### Item s To 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 : 

# Uf / 

# M,. J

- ^ Item : i ^ /
Item : / Kem : / Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : /
Item : /

Pag e 2 

## o f( P< ^ ^ C p AS T AL CMVlNOMMfNTA L C n O u r> N C 

### Item s T o B e Remove d B yContracto rDurin q Remediatio n An d Replace d (Us e additiona l sheet s a s necessary ) l l Item : ,<;<., / 

# - FJ , C> £

Item : 

# SoJ ' r^pe
. 

# ^ i ^ ^ Item : ) Item : X Item : > / Item : / Item : / Item : / Item : / Item : /

/ Item : /

" / Item : / Item : 

### /

Pag e 3 

# of_ kCOASTA L



## Ite m

Pre-existin g propert y area , tha t will be excavated , tha t i s covere dwit hgrass .

i Number of tree s > 2 inch trun k

diameter

Numbe r o f tree s < = 2 inch trun k

diameter

Numbe r of Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Attachasketchof the sprinkler layout
.

Number of an dsiz e o f eac hgarden / flowe r bed area . Attachasketchof relativ e size s an dlocations
. 

### Landscap e Inventory (Us e additiona l sheet s as necessary ) 

## Quantity Unit Condition/Type/Specie s 

# F^/i ^ Squar e fee t

Eac h 

# fi) • •

1 1' '
Each
^

Eac h
^

; . „ Eac h Squar e Fee t 

# f ^

Pag e 4 

# oiJj L^^ ^ COASTA L cM V t n o N r * t M rA( < , n o u rIM C 

### Ite m Quantit y Urii t Condition/Type/Specie s Agree dupo nvalu e o f plan t materia U no t to b e renlace dbv contractor . Not e thi s valu e will b e usedto issu e aplan t vouche r to th e propert y owner . Agreeduponlis t o f plan t material s tha t will be replace db y contractor . B e ver y specifi c an ddetailed
. Eac h Include asketcli of wer e eachplan t will b e placed by th e contractor . Agreedupon propert y t o b e wit hgras s sod
. are aof replace d Include asketchof the area(s ) to b e replace dwit h gras s sod
. SF 

# ^(Uie6ra^' >

Are ao f Cit y or Count y propert y to b e landscaped per thei r requirements
. S F Include aie a(s ) a sketchof the

Easement Area , to b e excavate d S F 

# Xi > 

# y, ^ J^-^^^'^"" ^

Pag e 5 o f 

# i ^C OASTA L ttMVANOI'MSMTAI. «*ewr
. IM C
Additiona l Comment s / Instructions : 

### SCCCXY^ C 'P^ l • t^v^CCro ^ aJ>Nj4l\'r^ aI y \uJojJ »

D Chec k th e bo xi f Owne 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 fb ran ydamag e don e t o th e interio ro f house , indudin g foundatio n crack s o rfissures.

"T C t34^Te e Did o no t agre e

(j r

Owner' s Sigaatur e Dat e Contne&tr' s S%;natore Dat e PaqeSo f V O
___ . ....--.--. . - ­

## BviD#;^<4m o XR F PROPERTY SAMPL E SHEE T Dat e Addres s -H^xta , \0
. ?2,Co ^ Kv^,
. 

## \\-\-i-oF > Project Omah a lea d F P 2nc] yea ropllo n Sampl e tim e ' ^
. 'O ^ am/p m XRFID # sampl e lengt h 3 0 se c 

## 5F^O@ q Shot # Readin g Sampl e are a Sho t # Readin g Sampl e are a 

## J-A3 1 'r?> 3 .«H t M.i o c^a?>( D i&o-.^ ^ Iba a 

## 7 ^ aa;2,- 3 ,\M.U-l^)U-0' S 

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## I S^Ss^S C P Averag e l^H
. 1^ 1 t ^^^.^l U Averag e cpQco.Co J t \- i .QC ^

Shot # Readin g Sampl e are a Shol # Readin g Sampl e are a 

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## 3^X ^ ^qa , !Ht^:^f a 

## \ 3

Averag e ^77~?-2oi - ^ 0 1 ^ Averag e

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

RETES TAREA S Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h Averag e Averag e la b sampl e # La b resul t Sampl e are a XR F Avg
. SiQnatureQ)r'^/tQl/^> ^ 

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pp m P b 133.93 7 Supervise d By : 

## Certificat e o fVerificatio n

343 1 SOI L 2008-11-1 7 09:5 9 30.6 3 Fina l 3441 0 451 8 n 3 6 av e easemen t Ventr y 1 CLEARANC E

± 

### "Eiror ± 14.10 0

# 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 169.46 9 Supervise d By : 

## Certificat e o fVerificatio n

343 2 SOI L 2008-11-1 7 10:0 0 30.3 0 Fina l 3441 0 451 8 n 3 6 av e easemen t Ventr y 1 CLEARANC E

± Erro r
± 16.08 3

# 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 111.56 2 Supervise d By : 

## Certificat e o f Verificatio n

343 3 SOI L 2008-11-1 7 10:0 0 30.5 9 Fina l 3441 0 451 8 n 3 6 av e easemen t Ventr y 1 CLEARANC E

± Erro r ± 13.07 2

# 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 93.77 1 Supervise d By : 

## Certificat e o fVerificatio n

343 4 SOI L 2008-11-1 7 10:0 1 30.6 3 Fina l 3441 0 451 8 n 3 6 av e easemen t Ventr y 1 CLEARANC E

± Erro r
± 12.48 6

# 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 AVERAG E ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E 

## Certificat e o fVerificatio n

343 5 SOI L 2008-11-1 7 10:0 1 122.1 5 Fina l ,Av g o f3431-343 4 '451 8 n 3 6 av e ^asemen t Gentr y

CLEARANC E

pp m ± Erro r P b 127.18 5 ± 13.93 5 Supervise d By :

# 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 186.13 0 Supervise d By : 

## Certificat e o fVerificatio n

343 6 SOI L 2008-11-1 7 10:0 2 30.2 8 Fina l 3441 0 451 8 n 3 6 av e F2 Ventr y 6 CLEARANC E

± Erro r ± 16.43 6

# 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 192.75 5 Supervise d By : 

## Certificat e o fVerificatio n

343 7 SOI L 2008-11-1 7 10:0 3 30.6 0 Fina l 3441 0 451 8 n 3 6 av e F2 Ventr y 6 CLEARANC E

± Erro r ± 16.73 5

# 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 230.28 8 Supervise d By : 

## Certificat e o fVerificatio n

343 8 SOI L 2008-11-1 7 10:0 4 31.0 4 Fina l 3441 0 451 8 n 3 6 av e F2 Ventr y 6 CLEARANC E

± Erro r ± 18.09 9

# 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 343 9 Mod e SOI L Tim e 2008-11-1 7 10:0 4 Duratio n 30.2 9 Sequenc e Fina l Flag s BVI D # 3441 0 ADDRES S 451 8 n 3 6 av e QUAD/ZON E F 2 INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 193.26 1 ±16.96 5 Supervise d By :

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 344 0 Mod e SOI L Tim e 2008-11-1 7 10:0 4 Duratio n 122.2 1 Sequenc e Fina l Flag s AVERAG E tfiivg ^ o f3436-343 9 ADDRES S 451 8 n 3 6 av e QUAD/ZON E INSPECTO R Ventr y 

# 0

^ DEPT H SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P b 200.60 9 ± 17.05 9 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 149.50 2 Supervise d By : 

## Certificat e o fVerificatio n

344 1 SOI L 2008-11-1 7 10:0 6 30.6 6 Fina l 3441 0 451 8 n 3 6 av e D Z Ventr y 1 3 CLEARANC E

± Erro r ± 14.89 5

# 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 340.58 6 Supervise d By : 

## Certificat e o fVerificatio n

344 2 SOI L 2008-11-1 7 10:0 6 31.0 0 Fina l 3441 0 451 8 n 3 6 av e D Z Ventr y 1 3 CLEARANC E

± Erro r ± 22.19 3

# 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 226.91 0 Supervise d By : 

## Certificat e o fVerificatio n

344 3 SOI L 2008-11-1 7 10:0 7 30.6 9 Fina l 3441 0 451 8 n 3 6 av e D Z Ventr y 1 3 CLEARANC E

± Erro r ± 18.55 3

# 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 393.78 5 Supervise d By : 

## Certificat e o fVerificatio n

344 4 SOI L 2008-11-1 7 10:0 8 30.3 1 Fina l 3441 0 451 8 n 3 6 av e D Z Ventr y 1 3 CLEARANC E

± Erro r ± 23.52 1

# 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 344 5 Mod e SOI L Tim e 2008-11-1 7 10:0 8 Duratio n 122.6 6 Sequenc e Fina l Flag s AVERAG E ^Avg o f3441-344' ! ADDRES S 451 8 n 3 6 av e QUAD/ZON E INSPECTO R Ventr y DEPT H # 3 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P b 19.79 1 277.69 6 ± Supervise d By :

## X

X 

### 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 %«,oX«^' ^ COASTA L ENVIRONMENTA L G R O U r, INC
. 

# EXECUTIV ESUMMARY : BVI D #3441 0 - (451 8 N3 6 AVE )
N o Issue s o r Concern s I I Issues/Concern s Detai l Explanation :

# .®^EP A EP APropert> ' Clos e Ou t For m Property« : .•^M-^V O Propert y Address : <Q?S\P ) K^

- ^o^ ^ IW^

­ Datc/riroe : Owner' s Name : cSV\5Un(Y\(X.ir \\\f:>VVGLnc i Quad s Excavated : ^; ^ ^ t^'f c Contracto r Grou p 0 f^CLS^C^ ^ "p

- rwXrQf^**-'''-^^*'''^'^^^ ^
Excavatio n Genera l Ye s N o 1
. I fnecessary , wer t th e correc t quadrant(s ) excavate d an d reslored ? / 2 I fnecessary , wer e th e correc t area s o fdri p zon e excavate d an d reslored ? ^ GradiD KSo d an d VeteUtio a Ye s N o 1 Doe s th e gradin g aroun d th e perimeie rofth e hous e i n excavaie d area s generall yslop e awa y . ^ from tb e house ? 2
. Ha s so d bee n lai d i n al l area s tha i wer e excavaied ? y 3
. Doe s th e so d appea rl o b e generall yhealth yan d growing ? (Onl yevaluat e i finspecie d at a 3 0 ^ da ylim e period ) 4 Ar e sodde d area s generall yfu m an d evenl ygraded ? 1 ^ 5 Ar e th e joint s betwee n th e so d strip s generall ytight ? (Onl yevaluat e ifinspecie d at a 3 0 da y lim e period ) 6 Wa s th e properr ygrade d suc h tha i wate rwil l no t poo l o n Ih e propeny' ' 7 Wa s damag e t o landscapin g o rplan t material s avoided ? Gates , Fence s an d ReUinlD £Wall s 1 D o gate s ope n an d clos e freely? (Ifapplicable ) 2 Wer e al l gate s o rfence s take n dow n durin g restoratio n activitie s reinstalled ? 3
. Wa s damag e t o gate s o rfence s avoided ? (Ifapplicable ) 4
. Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) Foundation , Sidio Kan d Gutler s 1
. 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 1 0 window s avoided ? 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 l extension s avoided ? Sidewalk s an d Driveway s (Concrete ) 1
. Wa s damag e t o drivewa ysurface s avoided' ' 2
. Wa s damag e t o walkwa ysurface s avoided ? \ y y

, / j Ve s N o / (Ifapplicable ) ^/* • \ 

# • Ye s N o
<y

^ ^ ^ y'
1 ^ Ye s N o 1 / y

## O •ner s comments :

Inspectio nnotes :

Removal andresloratio naclivale s complel e includin g the 30-da y sodv^arranty : EPARepresentativeqdj^Ax^^^X^^^^^^^^J^^^ ^ Dale: //3/c) j

## Propert yCompletio n Agreemen t
I'lii s agreemen l document s th e completio n o fremedia l activitie s perlbime d o n m yproperly^ M ysignatur e wil l designat e tha t I a m satisfie d wil h th e restoratio n o fm yproperly , an d tha t n o item s ar e i n questions , now , o ra l an ytim e i n th e future , excep i thos e ilem s liste d below , ifany
.

Propert yID : 3mm Q Propert yAddress : L/g-^ ^ ^ ^^-H
. ^ ^ ^ , Q"" " •<;Ker/)^r, ^ an\la.^n l Phone : 

## (^l^~(fO(n n Restoratio n Item s i n Question :

Item : Item : Item : Item ; Item : Item :

• TR '[y-fagre crestoratio n i s completed , excep t a s note d I I rio no t a^jre crestoratio n i s complele d

Owner' s Signatur e Dat e Cont i atlw' s Signatur e Dal e I