## TRANSMITTA Lof OMAHALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAI D # : 

# t^KClp t Date : 

# W^i / 

# IK S 

# 4 \ y 

# m Address : Remediatio nContractor : Coasta l Environmenta l Group
_ Year : 2 0 

# oe^
. SOI LREMEDIATIO N PROPERT Y nLEFOLDE RDOCUMENT S / 

### Vide o o f propert y (DVD ) \\i ' ^(^^11 ^ <

/ 

### Executiv e Summar y EPA-provide dproperty sketch SignedAcces s Agreement fo r subject property 

# -t

r SignedAcces s Agreement(s ) fo r adjacen t propert y 

# 7 Restoratio nAgreement

- B Settlemen t document s (i.e. , fo r damag e o r t

o replac e plants , etc. ) 

## -a 

# 7 Confimiatio ndata Photograph s ^ ^ As-built sketch ^ \'^r>' > V HCP^^ ^ \^k > bfiCMPrXW ^ 

# > 7 Satisfactor y restoratio nsignedb y Propert y Owner Propert y close-out check lis t signedby EP A Descriptio nofarea s not meetin g ROD cleanup criteri a Utilit y clearance s Propert y iii^un^io nfro mDougla s Count y Assessor' s Office 

# y D D D


### Dat e Superfun d

## Propert yAcces s Checklis t Propcit ) ID : <-|< ^ 5(^-2 ^ Propert y Address : t-^(^f5 ^ t S ?>t > ftA/^ D D

WORK STARTE D WOR K

COMPELTE D ON : ON:
. _/ / /_ / 

## ! Owner : (^^ ^ Address:'5oirn ^ 

## Hav-Hmr v Rente r Phone : PiLv : 

# 1

Phone : 51/=5-q^^l ^ Fax : Cell/Pager : Additiona l Inlormntion : Ccll/Pager
. D Notificatio n Lette r 1 ETAcces s Agreemen l

[2 I Restoratio n Agreemen t D Topsoi l Samplin g (i fapplicable ) 1 D Disposa J Samplin g (i f applicable )

C U Gnrdc n Samplin g (i fapplicable ) " ^ Un'lit yClearanc e I e g Video/Photo s (Before )

D Video/Photo s (Durine ) Sent : / / 

### Signed : Ja./J:/ ^ Signed : ( ^

/

8

^

/0 i / / / / / / Called : j£./12,/ ^ On : ^ 1 J£ l QJ f On : / / By : 

## By:e. c B> : F.
. 

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. 

### ^yik-AJfc/t^VtJ(^fic,y , By : 1 D Video/Photo s (After ) On : / / By : D ^ Video/Photo s (30-Day ) Propert yCompletio n Agreemen t On : / / 

### Signed : ^/i^/ ^ By : By :

• Fina l Repor t issued : / /


### . . Ai rMonitorin e (a s applicabl e

n Communit yD Cre w 

### ) Results : On : / / By :

D Communit y Results : • CrcM v On : / / By : 1 1

• Communit y Results : • Crc w On : / / 'By : 1

Omah a Lea d Sit e

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

Comment : Owner Comment (s) : Site Coordinato r Comment (s) : CONTACT FOR M Hg5b ^ ^R5 ^ 5 ^ ^ av ^ Date : Time : Action :

Date : Time : Action : Date : Time : Action : Transmit t

o EP AD Other Action : D

## Douglas Count y Accoun t Info^^n n Pag e 1 of 3
Dougla s County , Nebrask a Propert yRecor d - R080968000 2 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t o f 52n d S t - Viewo n Ma p Informatio n i s vali d a s o f 2009-5-1 2 Treasurer' s Ta xRepor t Ne wFeatur e ••••- • Aut o Sale s Searc h Owne r MARTINE Z ROS E A ETA L 495 8 3 3 6 AV E OMAH AN E 68107-000 0 Propert yInformatio n Ke yNumber : 096 8 000 2 0 8 4ccoun f Type : Residentia l Parce l Number : 080968000 2 Parce l Address : 495 8 8 3 6 A V OMAH AN E 68107-000 0 Lega l Description : CHRISTI E HEIGHT S LO T3 BLOC K6 LT S 1 2 & 101. 6 X 11 0 Valu e Informatio n Lan d Improvemen t Toto l 200 9 $8,700.0 0 $150,000.0 0 $158,700.0 0 200 8 $8,700.0 0 $150,000.0 0 $158,700.0 0 200 7 $8,700.0 0 $122,400.0 0 $131,100.0 0 200 6 $8,700.0 0 $122,400.0 0 $131,100.0 0 200 5 $8,700.0 0 $94,700.0 0 $103,400.0 0 200 4 $8,700.0 0 $86,100.0 0 $94,800.0 0 Saie s Informatio n Sale s Dato : 2005-03-2 5 Dee d Type : W D SooIr ; 200 5 Page : 03470 9 Price : $133,900.0 0 Grantor : FRANCE S MERTZ Grantee : ROS AAMARTINE Z ETA L Validnnvalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unlt o Dept h Widti i Vacan t 0.2 5 11220. 0 1. 0 110. 0 102. 0 N o Improvement Informatio n 

## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R080..
. 6/7/2009

### Dougla s County Accoun t InfQfl^|o n Pag e 2 of 3

Buildin g 1 495 8 S 3 6 A v

*ra,' r 

## J ^ 1. 5 STORYFINIS H 78!
. O S o F l

CLIC KT O ENLARG E IMAG E Squar e Footage : 2038. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 7. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 2. 5 Roo fCover : Compositio n Shingl e Bedrooms : 4. 0

Roo fType : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Blocl < 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 197 8 0 % 197 8 3 1 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Applianc e Fireplac e Meta l 1. 0 Basemen t Bsmn t Bloc k 9 f t 2588. 0 Basemen t Finishe d 1200. 0 Basemen t Outsid e Entranc e 1. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 2. 0 Fixtur e Bat h Hal f 1. 0 Garag e Attache d 364. 0 Porc h Ope n Sla b 786. 0 Porc h Sla b Roo f Cei l 234. 0 Porc h Woo d Dec k 132. 0 Porc h Woo d Dec k 87. 0 Use r bsm t fi n afte rsal e 1. 0 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R080.
. . 6/7/200 9

## 1. 0 Dougla s Count y Accoun t Inf<gd^|o n^M k Pag e 3 o f 3
Use r

want s t o mak e daycar e

http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=R080..
. 6/7/2009

### Pag e 1 of 2

" > Creat e Anothe rTicke t Bac k t o Irt h Inteme t Sen d Emai l



### • YOU RTICKE T NUMBE RI S 2321712
. Origina l Cal l Date : 7/20/0 9 Time : 3:0 6 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 7/22/0 9 Time : 3:4 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 495 8 Street : S 36T H AV E Twp : 14 NRng : 13 E Sect-Qtr : 05-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n Locatio n o f Work : INCLUD E AL L EASEMENT S LOCAT E ENTIR E PROPERT Y 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 : 4ft qCorne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V METR O MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F



### Servic e Area Contact 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 MUD0 2 METROPOLITA NUnLITIES 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.
. . 7/20/200 9

### Pag e 2 of 2

0PPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T N A Day :

Alt : 406728934 3 406207149 4 Emerg : 888728934 3 QLNNEI FQWES T LOCA LNETWOR K

N A Day : 406728934 3

Alt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 7/20/200 9

# As-Buil t Drawin g C OAST AL 

# Omah aLea dSuperfiin dSit e 4856 2 Omah a Lea d Sit e Exterio rPain t Nort h Arro w Sit e Sketc h Q^oo d • Poo r Samolin a Address : 495 8 S 3 6 A V 1 1 No t pain t Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Firm : P E TN C pTST L RYASCPXA-4856 2 F l pp m 

# n Date : ft/ZT/ofl RYBSCPXA-4856 2 F 2 

## J i ^ pp m 

# n Time : I • M* ? ^
. M RYCSCPXA-4856 2 8 1 / I B pp m 

# n Sample s Analyze d RYDSCPXA-4856 2 8 2 

# JL5
_ pp m 

# \ y n RDZSCPXA-4856 2 D Z pp m 

# n XR F Unit : CQS^ O Book : 2f'= \ 

# xia
. RGZSCPXA-4856 2 G Z 5'H' 5 

# n pp m Date : ^•15-o e RPZSCPXA-4856 2 P Z 

# zn . pp m 

# n Time : 

# _arL
. Staff : Numbe ro f Sample s = | ~ J | | ^ | 

## cns( ^ Legend : F 1 Fron t Left
. F 2 = Fron t Right , B 1 = Bac k Left
. 8 2 = Bac k Righ t D Z = Dri p Zone , G Z •- Al l quadrant s ar e a s viewe d fro m th e street , facin g propert y Dat e Excavated:7/23/0 9

Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are areplace dwit hAre areplace dwit h Are alef t bar e So d' ' Rock/Mulc h Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
.

# 4856 2 Exterio rPain t Nort h Arro w Omah a Lea d Sit e Q^oo d Sit e Sl(etc h • Poo r Samplin g Address : 4958 S 3 6 A V Q No t pain t Sampl e Numbe r RYASCPXA-4856 2 F l Lea d Concentratio n pp m Sampl e Collecte d 

## Q ^ LA B 

## D Sample s Collecte d 

### Firm: PETN C QhX ^ Date ; 9,lZ~llo& RYBSCPXA-4856 2 RYCSCPXA-4856 2 RYDSCPXA-4856 2 RDZSCPXA-4856 2F2 B 1 8 2 D Z 

# 1 5 

# m pp m pp m pp m pp m 

# E T Q ; 

# a ' [

/ 

## D D D D Time : l»M g />. M Sample s Analyze d XR F Unit : foSH D Book : 2 f* ^ RGZSCPXA-4856 2 RPZSCPXA-4856 2 G Z P Z 

## ^^ 5 

# z n pp m pp m 

# n / (

^ 

## D D Date : Tim e ^-15-0 3 

# _an . Numbe rofSample s 

## 7 

# Jl Staff : 

## msL o Legend : F 1 = Fron t Left , F2 = Fron t Right , B l = Bac k Left , B2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Play Al l quadrant s are a s viewe d fro m th e street , facin g property, .. . .



## y y ^

## 4856 2 Exterio rPain t Nort h Arro w Omah a Lea d Sit e Q^Goo d Sit e Slcetc h • Poor Samollnf i Address : 495 8 S 3 6 A V • Notpain l Sampl e Numbe r Lead Sampl e Sample s Collecte d U B Concentratio n Collecte d Firm : Pe TN^
. pftT i RYASCPXA-48562 F 1 ^ i pp m 

# n Date: ft/ZT/flg RYBSCPXA-48562 F 2 

### G O pp m 

## D Time : |'H 5 /'•/rt
. RYCSCPXA-48562 B 1 

# n e pp m 

# n Sample s Analyze d RYDSCPXA-48562 8 2 pp m 

## D 1 ^ 

# I RDZSCPXA-48562 D Z pp m 

# n XR F Unit : roSH n Book : z n 

# ia
. RGZSCPXA-48562 G Z 

## J^-V f pp m 

# n Date : RPZSCPXA-48562 P Z 

## J l l pp m 

## D Time : 

## .fivi
. Staff : 

### msL j Numbe rof Sample s = | * 7 | | Q | Legend : F l = Fron t Left , F2 = Fron t Rigtit , B 1 = Bac k Left , B2 = Back Righ t D Z = Dri p Zone , G Z = Garden , PZ = Pla y Al l quadrant s ar e a s viewe d fro m th e street , teeing propert y

Re v200 8 CKated : 0.1-Ma)-0 8COASTA L ^ HOKOlinfNia i • • O U » . IN C 

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

### Granto r(th e propertyowner) 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 follov^n g describe d premises : . , ^ ^ 

# M^5(;.7
. Owner' s Name : Daytim e Phone : 

# gg ^

^Ka)c^ntl
. Addres s o fPropert y covere d b ythi s Agreement : 

# ^95 ^ ^ - 5 6 i^u o PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EPAI s requestin g acces s t o collect soi l sample s an d remov e soi l tha t contain s elevate d concentration s o f lea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t o remove contaminate d soil
. Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o 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 of Coasta l Environmenta l Group , contracte d byUSEPA , wil l contact th e Granto rin-perso n t o discus s th e wori ct 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 v^ri c befor e i t begins
. Once 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 vwitte n documentatio n fro m EP Athat th e property 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 subcontractors 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 f performin g th e work
. Thi s acces s shal l remai n i n effect unti l th e wor k ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :
Pag e 1 of2

### .»^^ % 

# V- COASTA L INViaODfirHT* ! (•our
. i l l 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 yv^s h t o save ; i •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 f th e propert yI s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propert yt o perfor m th e work
. • Allo wvideotapin g and/o rphotographin g o f th e pro|perty
. 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 f th 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 f sai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o f th 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 mypropertie s D I d o ho t gran t access t o m ypropertie s ^	 .



# 4^ Ay^c^-fi'""^^ ^

Signature Dat 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
.COA S T AL C H O U rIN C 

## Restoratio n Agreemen t Th e purpos e o f thi s agreemen t i

s t o provide amutua l agreemen t as l o condition s ofth e propert y prio r t

o remediatio nactivities
. Thi s wil l als o serv e a s documentationfo r th e purpos e o f assuring tha t restoration activitie s ar e complete dl o th e satisfactiono f th e propert\ ' owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA)
. Propert y ID : Propert y Address : L^i^W S ^ U NK Q Phone : 

# 61 ^
O

nth e attache ddiagram(s ) indicat e area(s ) t o excavate dan ddept ho f excavation , locatio nof al l know n utilities , subsurfiic e features , surfac e structure s an dlandscapin g features , acces s location(s ) t o b e use db y contractor, an dthe directio no f North
. Indicat e distances , depths , materia l types , etc . Indicat e digita l photo s b

y referencin g th e photo-log numbe r wit ha narro w indicatin g directio nof view
. Item s T O B e Remove d B yOwne rBefor e Star t O f Remediation : (Us e additiona l sheet s a s necessary) Th e removal , storage , disposal , and/o rretur n o f thes e item s i s th e Owner' s responsibility
. 

### Item : NOME L Item : 

### Item : Item : " T ^ Item : 

### Item : Kem : Item : y y 

# r Pag e 1 of
.COASTA L o n o u p . t N c 

### 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)



## u ^ Item : 

# z l y ttem: 

# V
Kem : Item : / Kem : 

# X Kem : Item : Item : Item :

Pag e 2 

# ofj ^C p AS TAL fM V IMOMn l HTA l C « O U P IN 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 ) 1 Item : 

# -bo's ) c ^ l

Item : i 

# s d C^ i 

# ^ 1 Item :

""-V , 

### I Item : ) 1 Kem : 

### , / y Item : y 

# y Item : 

# y Kem : Item : 

### y Kem : 

### / Kem : 

# z Item : 

### / / Item : 

### / /

' Item : 

### / / / Item : 

### / /

Pag e 3 

## o f UCOASTA L t N • IHONM t NTA L Q I t O U P IN C



## ite m

Pre-existin g propert y area , tha t wil l b e excavated , Tha t i s covere dwit hgrass .

Numbe r o f tree s > 2 inc h trunk diamete r

Numbe r o f tree s <= 2 inc h trunk diamete r

Numbe r o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Attac hasketc ho f th e sprinkle r layout
.

Numbe r o f andsiz e o f eac hgarden/ flowe r be d area . Attac hasketc hof relativ e size s an dlocations
. 

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

## Quantit y Uni t Condition/Type/Specie s

Square fee t 

### ^ 

# 7 •^ Eac h

Eac h 

### * 

# \^«t > Each

Eac h 

### \ Squar e Feet

Pag e 

## 4of 

## yCOASTA L BNvmOMHtNTA l C H O U P IN C 

## ite m Agree dupo nvalu e of Diant material s no t t o b e renlace db v contractor . Note thi s valu e wil l b e use dt o issu e aplan t vouche r t o th e propert y owner . Agree dupo nlis t o f plant material s tha t wil l b e replace db y conn-actor . B e very specifi c anddetailed
. Includ e asketc ho f were eac hplant wil l be place d b y th e contractor . Agree dupo nare ao f property to b e replace d wit hgras s sod
. Includ e asketc ho f th e arca(s ) t o b e replace dwit h gras s sod
.
Are ao f City o r County property t o b e landscape d pe r thei r requirements
. Includ e asketc ho f th e are a(s )

Easemen t Area , to b e excavate d 

## Quantit y Uni t Condition/Type/Specie s

# $



### / » , Eac h



### ^ ^ S F 

# 1 S F

S F 

# %n^^i M?^'/- h

Page s 

# 0, 0C O AST AI
.



### D Chec k th e bo x i f Owner doe s no t wan t CE Gt o documen t interior foundatio nwall s an dpossibl e pre-existin g damage
. B y checkir ^ tiiis bo x CE Gi s no t responsibl e fo r an y damag e don e t o th e interior o

f house , indudin g foundatio ncrack s o r fissures.


# P7<^ % Q I d o no t agre e agre e 

# ^ ^ ^A^i^'^ ( z. . (6-1 ) -@ ^ 2pf^?^L mLpk/rA ^ Owner' s Signatur e Dat e Cbntnctor' s Signabir e Dat e Pag e 6 

# ^..y....
.BVID # 

# -\%^ t XR F PROPERT Y SAMPL E SHEE T Dat e Project XRFID #

Shot # 

# 3 1 ^ \^?i ^ 

## \%b' o \%5u ^ Averag e

Shot # 

## 4X12

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\?: M Averag e

Shot #

Averag e

Shot #

Averag e la b sampl e # 

## ^ h?>ic ^ Omah a lea d F P 2n d yea ropilo n 

## 3 ^ ^

Readin g Sampl e are a Dept h 

### %%,Z?.^\l,\i ^ 

## q\.q^t\7.v > ^^,M^ t i^C^ ^ Readin g Sampl e are a 

## f;^.a3^iD.tr g ^ 5
. M<t,.'3,git^€ » Dept h 

## ?>\\i^n,i 3 • «>'^,>lig.i ^

4 2.yMU' l ^ M ^ Readin g Sampl e are a Dept h Addres s 

## Mq^pX 's.'?j^t.^ ^ Sampl e tim e am/p m sampl e lengt h 3 0 se c Shol # Readin g Sampl e are a Dept h Averag e

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

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

Readin g RETES TAREA S Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h

La b resul t Averag e Sampl e are a XR F Avg
. Signature Prin t 

# ?^M\U b i"t^.6./)Aibf^;^r/rp.^g ^

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 183 7 Mod e SOI L Tim e 2009-07-2 3 14:2 9 Duratio n 122.1 2 Sequenc e Fina l Flag s AVERAG E ADDRES S *t958 s 3 6 av e QUAD/ZON E easemen t INSPECTO R Nicola s DEPT H 1 SAMPL E TYP E CLEARANC E NOT E

pp m Erro r P b Supervise d 

# By : QCijtM^fi ^

# 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 87.77 9 Supervise d By : 

## Certificat e o fVerificatio n

183 3 SOI L 2009-07-2 3 14:2 7 30.6 6 Fina l 4856 2 495 8 s 3 6 av e easemen t Nicola s 1 CLEARANC E

± Erro r ± 12.24 5

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

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

pp m P b 73.99 9 Supervise d By : 

## Certificat e o f Verificatio n

183 4 SOI L 2009-07-2 3 14:2 8 30.5 0 Fina l 4856 2 495 8 s 3 6 av e easemen t Nicola s 1 CLEARANC E

± Erro r ± 11.04 4

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 183 5 Mod e SOI L Tim e 2009-07-2 3 14:2 8 Duratio n 30.5 2 Sequenc e Fina l Flag s BVI D # 4856 2 ADDRES S 495 8 s 3 6 av e QUAD/ZON E easemen t INSPECTO R Nicola s DEPT H 1 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 88.22 0 ±12.16 4 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 91.93 4 Supervise d By : 

## Certificat e o fVerificatio n

183 6 SOI L 2009-07-2 3 14:2 9 30.4 4 Fina l 4856 2 495 8 s 3 6 av e easemen t Nicola s 1 CLEARANC E

± Erro r ± 12.33 1

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

## Certificat e of Verificatio n XL3t-3208 9 Readin g N o 183 2 Mod e SOI L Tim e 2009-07-2 3 14:2 6 Duratio n 121.3 4 Sequenc e Fina l Flag s ——— ^ AVERAG E 

## iMM^s^B ^ ADDRES S 

## "^-^JlBfTseav e QUAD/ZON E G Z INSPECTO R Nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

±Erro r pp m Pb 

### r42.463 " Supervise dBy : Z^Md] ^

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 182 8 Mod e SOI L Tim e 2009-07-2 3 14:2 4 Duratio n 30.4 7 Sequenc e Fina l Flag s BVI D # 4856 2 ADDRES S 495 8 s 3 6 av e QUAD/ZON E G Z INSPECTO R Nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 58.23 2 ±10.64 8 Supervise d By :

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 182 9 Mod e SOI L Tim e 2009-07-2 3 14:2 4 Duratio n 30.0 9 Sequenc e Fina l Flag s BVI D # 4856 2 ADDRES S 495 8 s 3 6 av e QUAD/ZON E G Z INSPECTO R Nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r Pb 43.38 0 ±9.53 7 Supervise d By :

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 183 0 Mod e SOI L Tim e 2009-07-2 3 14:2 5 Duratio n 30.4 5 Sequenc e Fina l Flag s BVI D # 4856 2 ADDRES S 495 8 s 3 6 av e QUAD/ZON E G Z INSPECTO R Nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 33.12 8 ±8.73 0 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 35.11 1 Supervise d By : 

## Certificat e o fVerificatio n

183 1 SOI L 2009-07-2 3 14:2 6 30.3 3 Fina l 4856 2 495 8 s 3 6 av e G Z Nicola s 6 CLEARANC E

± Erro r ± 8.81 8

### # # 

## ^O. \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 ^^^ ^

I Coasta l Environmenta l Grou p Inc
. v ^ j ^

www.coastalhazmat.co m '^iPRot*'' ^ COASTA L EN«IIOHHINT* l Clour , IH C 

# EXECUTIV ESUMMARY : BVID #48562

- (495 8 S 3 6 AVE ) py ] N o Issue s o r Concern s Q Issues/Concern s Detail Explanation : -COASTA LTO REPLAC EWATE RHOSE
. (COMPLETE D 8/2/09 )4 

# EP A % 

## EP APropert y Clos e Ou t For m Property» : H^^CoT
. PropertyAddressi-^- ; ' ^ ^t^t^i'^Za. ^ DatcHlroe : O^^er' s Name : /L ^ H^r , t:WV ^

^ Quad s Excavated : ( ^ j . 

### Contracto rGrvu p ^i^rw<iA>v \ yjr\\/\fMnnr>cr\-^Q i Yes rio y Eicavatio nGenera l 1
. If necessary , were th e correc t quadrant(s ) excavate dandrestored ? 

# 'zr i

^ 2
. If necessary , were th e correc t area s o f drip zone excavate dandrestored ? ^ Gradin g So dan dVegetatio n I
. Doe s the gradin g aroun dth e perimeter ofth e hous e i nexcavate darea s generally slop e awa y 

# w fromtb e house ? 2
. Ha s so dbee nlai dinall area s tha t wer e excavated ? 

# d * ^ 

# T:; ^ T
. Doc s th e sodappear to b e generall y health y an dgrowing ? (Only evaifet e if insf^e da t a3 0 

# ly ^ day time period ) • 4
. Ar e soddedarea s generally finnan devenly graded ? 5
. Ar e th e joint s betwee nth e so dstrip s generally tight ? (Only evaluate if inspecte da t a3 0 da y 

# U'- ' tim e period) [
_ . 

# p ^ 6
. Wa s th e propert y grade dsuchtha t wate r will no t poo l o nth e propert>' ? 7
. Wa s danug e t o landscapin g o r plan t material s avoided ? Gates , Fence s an dRetainin g Wall s /^^i * I
. D o gate s ope nan dclos e freely? (If app l 2
. Were all gate s or fence s takendow ndurin g restoratio nactivitie s reinstalled ? (Ifapplicable ) 3
. Wa s damage t o gate s o r fence s avoided ? (Ifapplicable ) 4
. Wa s damage t o retainin g wail s avoided ? (Ifapplicable ) 

# T/'' - Foundation , Sidin g an dGutier s Ye s N o I
. Wa s damage l o th e sidin g o r trimavoided ? 

### t y. ^ ^ 2
. Wa s damag e to th e foundationavoided ? 3
. Wa s damag e to window s avoided ?

Wa s damag e to window s or doo r screen s avoided ? 5
. Wa s damage to downspout s o r downspou t extension s avoided ? 

# y
Sidewalk s an dDriveway s (Concrete ) Vc s yKit t 1
. Wa s damage t o drivewa y surface s avoided ? 2
. Wa s damag e t o walkwa y surface s avoided ? 

# v '

# • % Owner s comments :

Inspectio nnotes :

Remova l an drestoratio nactivate s C(Mnplet e including th e 30-da y so dwarranty : EP A Represenlativ e L J(D o . UAjJLILDate : ff//fO f% %



## Propert yCompietio n Agreemen t
Thi s agreemen t document s th e completio n o f remedia l activitie s performe d o n m yproperl yM ysignatur e wil l designat e iha l 1 a m satisfie d wit h th e restoratio n o f m ypropeily
. an d iha i n o item s ar e i n queslions
. now , o ra l an ylim e i n th e future , excep t thos e ilem s hsle d below , ifan y

Piopcrf yID : 

# 4^6^ ^ Propert y Address : ^ ^ C,f ^ ^ •? , |[^ '^^t ? Owner : j ^ ^ ^ ^fA^gTT/nJ^ ^ Phone : ^^^-^f^i ^ Restoratio n Item s i n Question :

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

# L

iCy i Agre e rcstor»liot \ i s complcied , excep t a s note d [_ J I rto no i «(;re crestorntio n i s complete d 

# Q ^ [uyjy ^ Pkl'A^^- L ly^^^- ^ 'r\77777yci777777 L Owner' s Signatnr r r\.t
. (mtlactor' s Signatur e