## TRANSMITTALof OMAH A LEAD SIT E SOILREMEDIATIO NFIL EFOLDE R SAID#: 2.0|l4 - Date : :2/^/p ^ Address : SCrP i PrfplgtP nftvP. Remediatio nContractor : Coasta l Environmenta l Group _ Year : 200 8 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f property (DVD ) 4031480 9 

### Executiv e Summar y EPA-provide dproperty sketc h Superfun d 

### Signe dAcces s Agreemen t for subjec t property Signe dAcces s Agreement(s ) for adjacent property ^ 

### Restoratio nAgreement Settlemen t document s (i.e. , for damag e or t o replac e plants , etc. ) Confirmatio ndata Photograph s pfy,-^r/-Jg>h_flrv ^ S6cl ^ \\(uJ < Sc4
. 

### As-buil t sketc h Satisfactor y restoratio nsigne db y Property Owner Property close-ou t chec k lis t signe db y EP A Descriptio no f area s no t meetin g RO D cleanup criteri a Utility clearance s Property informatio nfro mDougla s Count y Assessor' s Offic e PfOpff ^ CUre& s Qj{<LeU^S T doJrtlc f Jorr ^ D 

## P<pCAje5L\ ? ^ 

### Signatur e 

# y^/^auJ^ ^

## Propert yAcces s Checklis t Property ID : 

# Z<0^/ 4 D WOR K STARTE D ON : _/ l_ D WOR K COMPELTED ON : J I Propert yAddress : ^Qn^ ^ %pl^,k) n ^ 

# l^'*^"'
- druQ.e . Address : |l| ^ ^ 

# Th^mps-e n 5 ^^ ^-j " Rente r Phone : Fa.\ : Cell/Pager . 

## Phonc: -1^4 . 15^- ^ Additional Information : Fax : Cell/Pager .
nNotificationLette r Sent : / / By : pnAccesi i Agreement Siened : i Pt ^ 1 f= > 

## By:£C , 1^ Restoratio nAgreement Signed : | () / ^ l 9 

## By : r C Q Topsoil Samplin g (if applicable ) 1 1 By : O Disposa l Samplin g (if applicable ) 1 1 By : D Garde nSamplin g (if applicable ) 1 1 By : Q [ Utilit y Clearanc e 

### Called:^//a/-a i 

# ^T.}0/I5J[? ^ ^ Video/Photo s (Before ) On:/ ? 1 / / IS ^ 

## ny-M^/^^y^ ^ nVideo/Photo s (During ) On : / / By : 1 n Video/Photo s (After) On : / / By : D Video/Photo s (30-Day ) On : / / By : nProperty Completio nAgreement Siened : / / By : D Final Report Issued : / / By : Ai r Monitorin g (a s applicabl e 1 • Communit y • Crow > Results : On : / / 

# 1 1 EU Community 'IH Cre w Results : On : / / By :

• Communit) ' Q Crow Results : On : / / B, :

Omah a Lea d Sit e1 

## CONTAC T FOR M Property I D t f 

# -2tai i Propert y Address : 

# ^00' ^ poppV f

?!ro n hj t Initia l Contact : Dat e 

## Time : Action ; Secon dContact ; Dat e Time : Action : Fina l Conlact : Dat e _____ ^ Time : Aclion : Fina l Action ; Tran.smit t

o EP A D Othe r Action : D

Comment : Owne r 1 Commen t (s) : Sh e Coordinato r Commen t (s) :

1

### Dougla s County Accoun t Infq^tetio n Pag e 1 of 2 a ^ t Dougla s County , Nebrask a Propert yRecor d - R123744000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f 90t h S t - Vle W O n Ma p Informatio n i s vali d a s o f 2008-9- 4 Treasurer' s Ta xRepor t Ne wFeatur e -•-•- • Aut o Sale s Searc h 

### Owne r THOMPSE N BRUC E A ETA L 1119S3 1 S T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 374 4 000 0 1 2 Accoun t Type : Residentia l Parce l Number : 123744000 0 Parce l Address : 300 9 POPPLETO N AV OMAH AN E 68105-000 0 Lega l Description : HANSCO M PU\C E LOT1 BLOC K1 0 W 41. 3 E 14 2 F T41. 3 X 5 0 Valu e Informatio n 200 8 200 7 200 6 200 5 200 4 200 3 Lan d $3,700.0 0 $3,700.0 0 $3,700.0 0 $3,700.0 0 $3,700.0 0 $3,700.0 0 Improvemen t $60,100.0 0 $60,100.0 0 $31,400.0 0 $31,400.0 0 $31,400.0 0 $31,400.0 0 Tota l $63,800.0 0 $63,800.0 0 $35,100.0 0 $35,100.0 0 $35,100.0 0 $35,100.0 0 Lan d Informatio n Acre s 0.0 4 S F 2050. 0 U nit s 1. 0 Dept h 50. 0 Widti i 41. 0 Vacan t N o Improvemen t Informatio n Buildin g 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R12. . . 10/7/200 8

### iJougla s County Accoun t Infc^^tio n Pag e 2 of 2 

# V '

1 1/ 2 STORYFINISHE D
.„,.„Uj r ; ii r 1 •»• » " f j p JMllBIi m 7!f f lit 

## L.u J 3330 1 

# r r TfttOiq t 

# ' i n t rzat r u v ' H 1 1 2 1 ff

CLIC KTO ENLARG E IMAG E CUCKXaENLARG E IMAG E Squar e Footage : 1111. 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 Viny l Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Gambre l Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 189 0 0 0 % 189 0 11 7 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 8 f t 693. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h Ope n Sla b 256. 0 Porc h Sla b Roo f Cei l 35. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R12. . . 10/7/200 8Pag e 1 of 2

" > [ Creat e Anothe rTicke t j [ Bac k t o Irt h Interne t ] [ Sen d Emai l



### . YOU RTICKE T NUMBE RI S 2160984 . Origina l Cal l Date : 10/23/0 8 Time : 9:0 5 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 10/28/0 8 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 3 00 9 Street : POPPLETO NAV E Twp : 15 NRng : 13 E Sect-Qtr : 28-NE-N W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n Locatio n o f Work : LOCAT E ENTIR E PROPERT Y INCLUDIN G TH E 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: COASTT ^ 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 LEVEL 3 MCLEODN E MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F QWEST 2

Servic e Are a Contac t Phon e Numbe r UtiUt y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEIDI Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
LEVEL S LEVEL 3 COMMUNICATIONS , LL C N A Day : 877366834 4 Alt : Emerg : 877366834 4
MCLEODN E MCLEODUSA 

### N O NEE D T O CAL L OU T EMERGENC Y Day : 800289190 1 Alt : Emerg : 800289190 1
MUD0 2 METROPOLITA N UTILITIES DISTRIC T 

### SAND Y Day : 402504782 3 Alt : Emerg : 402504794 6
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 10/23/200 8

### Pag e 2 of 2

CIT Y O FOMAHA
- OMAHACO F RO N TRAFFIC,SEWE R
OMAH A PUBLI C POWE R 0PPDGPR 6 N A DISTRIC T
QLNNEI FQWES T LOCA LNETWOR K N A
QWEST 2 QWES T LON GDISTANC ESARA 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 Alt : 888728934 3 Emerg : 406728934 3 Day : 406728934 3 Alt : Emerg : 888728934 3 Day : 800283423 7 Alt : 303992192 6 Emerg : 800283423 7

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 10/23/200 8

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e

Name ; R.'vc t TK^Mp-,« A Omah a Lea d Sit e Date : 9'^~&-R j Nort h Arro w^ Address , 'i.cc^ i f^pfi'-^'- y Sit e SIcetc h Time : /d'/S - Phone : Tea m / AI/tv' , )J, ( (/^C j BVID # 7jOHl i XR F Cod e 

### 5-^ ^ Sampl e Numt>e r Lea d Concentratio n Confirmatio n Sampl e f?'//ffC/'x A- 2 o V^/• / /-/Ye s n N o 1 3 /V,Ye s C D N o E l eyve s • N o -E l <S^Ye s n N o E ! N o 1 3 pp m Ye s • N o C D Ye s • N o • 

# G ) Oli.S# : 2041 4 Dat e Exdavated : 10/24/0 8 XyatebSEPASTdheaOfniT/S/O g Are a Sodde d 22 Z sqif t

^Opflt
. ft>: n Omah a Lea d Sit e 4613 0 

### Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are a replace d wit h Are a replace d wit h So d ^— ^ Rook/Mulc h ^ Are a lef t bar e 

### Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .Name : Ri ' J C e i K*- ^

^yar ^ Omah a Lea d Sit e Date : 9-^' ^ Nort h Arro w[ • Address : ^<.c< ^

f^pf^'^" \ Sit e SIcetc h Time : (0H S
. Phone : Tea m /A)/AJ,)Jje ­ f>£ 7 BVID # ')jO^\' i XR F Cod e 

# 5-^^^^ Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e

pp m pp m /5'Ye s ;y,Ye s eyve s S^Ye s az^e s Ye s ° Q D 1 ^ t u D N o c a N o E ] N o - Q H o ^ N o 1 3 N o Q 

### N o n



## ^op^lt
. fp n OmahaLea dSit e 4613 0] Name : R^'yc e TK».Aps<y v Omah a Lea d Sit e Date : 9-^-^ 3 Nort h Arro w Address : o.cc' ^ p^p/^*+^ A Sit e SItetc h Time : /f?V ^ . Phone : 

# ^ ^ 1 V


## SS£>¥
- Tea m A\/U},)ht - if i El BVID#_2s2iid - XR F Cod e Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e 

# f?*/Afc/'x 4 - a o V / -f /yve s tu 

### No ca pp m pp m /y^Ye s Cl No S] pp m e/Ye s • No -E D 

## 7 3 t I S pp m &t>Yes n No ^ pp m -*2:/e s n No S pp m Ye s • 

## No 

## • pp m Ye s D 

## No 

## •



## l^op^lt . fa n OmahaLea dSit e 46130COASTA L ENVMONHIMTA l CROUP
. IN C 

## Consen t Fo rAcces s T o Propeit y RIGH TO F ENTR YT O 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 followin g describe d premises :

Own&f' s Name : ^— - > Daytim e Phone :

Addres s o f Propert y covere d b ythi s 

# 30oj/^^/¥'^J^T ^ 

# T J Agreement : PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP Ai 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 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 Lead Superfun d Sit e remediatio n program . Arepresentativ e o f Coasta l Environmenta l Group , contracte d byUSEPA , 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 have a n opportunityt 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 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 , contractors an d subcontractors th e righ t t o ente rth e property , a t al ! 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 effec t unti l th e wor k has bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :
Pag e 1 o f 2

# i	 * \^**** >COASTA L

**^ , 1*' ^ CNVIIOHMFNTA I * ^ O t *C • 0 U f , t » « 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 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 property . AGREEMEN TNO TT O INTERFER E Th e Granto ragree s no t t o interfer e o rtampe rwit h an yo f th 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
gran t acces s t o mypropertie s D I d o no t gran t acces s t o mypropertie s

>ignatur e j
. Da( ^ / Signatur eDat 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 o f thi s agreemen t i s t o provid e amutua l agreemen t a s t o condition s o f th e propert y prio r t o remediatio nactivities . Tlii s wil l als o serv e a s documentatio nfor 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 Protectio nAgenc y (EPA) .

Propert y ID : ^ Q Propert y Address : J(9 ^ f /^^^ ^ ^-^ ^ ^ Owne r Phone : 

# T E ruc ^ 

# 7/ ^ 

# ^^^" ^ y ^ ASt^ n 

# -pO nth e attache ddiagram(s ) indicat e area(s ) t o excavate dan ddept ho f excavation , locatio no f ai l know n utilities , subsurfac e features , syrfac e structure s an dlandscapin g features , acces s location(s ) to b e use db y contractor , an dth e directio no f North . Indicat e distances , depths , material types , etc . indicat e digita l photo s by referencin g th e photo-lo g numbe r wit hanarro w indicatin g directio no f 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 : 

# Jjj_ ^ Item : Item : Item : Item : Item : Item : Item : 

### Pag e 1 o f / C

# ^ f ^ C O AS TAU r»

H V I NONt^ C *«TA L C R O U « • , • 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 ) Item : Item : 

# §rcJi^rc^^( J ' 3 S/^c^' l T>'ee- x o A• :
Item : 

# lo^c) ^ o Tnke
. k<.iJi ^ - ^
/ Item : / Item : / Item : / / Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : /

Pag e 2 o f ^

# i^ ^ COASTA L C M O U P > N C 

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

# 3'y [ ^ / 

# -I ^ i - 5 ^ d Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 3 o f ^—•<•> • COASTA L c« o u ) • I M <:



## Ite m

• Pre-existin g propert y area , tha t will b e excavated , tha t is covere dwit hgrass .

Numbe r of tree s > 2 inch trun k

diamete r

Numbe r of tree s <= 2 inch trun k

diameter

Numbe r of Sprinkler Zones , Control Valves , Timers , Heads , etc . Attachasketcho f the sprinkle r layout .
Numbe r o f an dsize of eac hgarden / flowe r be d area . Attachasketchof relativ e size s an dlocations . 

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

## Quantity Unit Condition/Type/Specie s

. Squar e fee t ^

1

. , • ^ Eac h

Eac h

Eac h ^

Eac h ^ Squar e Fee t

Pag e 4 

# o^X 1< ^ ^ C O AS TAL EMVlMOIsHkNIA l 

## Ite m Agree dupo nvalu e o f plan t material s no t to b e renlace dbv contractor . Note thi s valu e wil l b e usedto issu e aplan t vouche r f

o th e propert y owner . Agree duponlis t of plan t material s tha t will be replace dby contractor . B e ver y specifi c an ddetailed . Include asketchof wer e eachplant wil l b e placed b

y th e contractor . Agree dupo nare aof propert y t o b e replace d wit hgras s sod . Include asketchof the area(s ) t o b e replace dwit h gras s sod . Are ao f Cit y o r Count y propert y to be landscaped per thei r requirements . Include asketchof the are a(s )

Easement Area , to be excavate d 

## Quantity Uiiit Condition/Type/Specie s

^ 

# r $

Each j "

y • 

# r . S F

^ S F

i S F 

# Y
­ , -{ ^

Pag e 5 o f ;C O AS T AI Additiona l Comment s / Instructions : 

## I? CX. V 

# V O ^ P ^ ^ ^ <)T^)f> ^ c\/\c i <^ a d 

# /lo^^Cc J of l -Vli^-/^"^ ^

^ >

• 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 fo ran ydamag e don e t o th e interio ro f house , includin g foundatio n cradc s o rfissures.



### nI d o not agre e agre e

Owner' s Signatur e / Dat e Contractor' s Statur e Date Pag e 6 of
.XR F PROPERTY SAMPL E SHEE T Dat e k->-(Q-l - of t Addres s Projec t Omah a lead F P 2n d yea roptio n Sampl e lim e XR F ID # 

### .^^D8 S sampl e lengt h

Shot # Readin g Sampl e are a Shot # OX30 4 cSooS " r^an.^nTn.^ a iq'Uu \ t : U..r^, i 

### 1^ \ cQoo q cSo v0 C3DD W •AuiX).U'i,i:Da.,-, A Dept h c^{-i \ \ CSDO ^ ?,o^''^'^'^Qon o IJ B ^s}^^? ) Averag e o)G2^,;:)b t \q.^ M Averag e

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

Sho t # Readin g Sampl e are a Shot # Dept h Averag e Averag e
RETES T AREA S Shot # Readin g Sampl e are a Shot # Dept h Averag e Averag e la b sampl e # La b resul t Sampl e are a XR F Avg
. Signatur e 

## BviD#0(:M\ M .2,0o l Pof)vpl9\cy ^ A:V
. am/p m 3 0 se c Readin g Sampl e are a 6 U u' ^ £

- ' ^ .'D ^ Ml.x\+
. ?i.-1 8 CCOajJOrvA X Sn.-otN ^ o^-U' S Dept h 5 a .u\! : < \
. 5 3 \ :^?
. • M ^

t '^.^.' ^ Readin g Sampl e are a Dept h

Readin g Sampl e are a Dept h

Readin g Sampl e are a 

# ' 7 ,'- ' /Dept h / ^ ^

# 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 204.56 5 Supervise d By : 

## Certificat e o f Verificatio n

200 4 SOI L 2008-10-2 7 09:0 7 30.9 4 Fina l 2041 4 300 9 poppleto n B l Ventr y 6 CLEARANC E

± Erro r ± 17.22 1

# 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 200 5 Mod e SOI L Tim e 2008-10-2 7 09:0 8 Duratio n 31.3 2 Sequenc e Fina l Flag s BVI D # 2041 4 ADDRES S 300 9 poppleto n QUAD/ZON E B l INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E
pp m ±Erro r P b 199.60 6 ±16.81 2 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 362.65 3 Supervise d By : 

## Certificat e o f Verificatio n

200 6 SOI L 2008-10-2 7 09:0 8 30.6 1 Fina l 2041 4 300 9 poppleto n B l Ventr y 6 CLEARANC E

± Erro r ± 22.61 7

# 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 309.99 3 Supervise d By : 

## Certificat e o f Verificatio n

200 7 SOI L 2008-10-2 7 09:0 9 30.3 4 Fina l 2041 4 300 9 poppleto n B l Ventr y 6 CLEARANC E

± Erro r ± 20.70 2

# 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

Supervise d B y 

## Certificat e o f Verificatio n

200 8 SOI L 2008-10-2 7 09:0 9 123.2 1 Fina l "S T U v g o f 2004-200 7 -300 9 poppleto n i B l Ventr y 6 ^CLEARANC E

# 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 56.69 2 Supervise d By : 

## Certificat e o f Verificatio n
200 9 SOI L 2008-10-2 7 09:1 0 30.9 1 Fina l 2041 4 300 9 poppleto n easemen t Ventr y 1 CLEARANC E

± Erro r ± 9.53 8

# 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 47.11 0 Supervise d By : 

## Certificat e o f Verificatio n
201 0 SOI L 2008-10-2 7 09:1 1 30.5 5 Fina l 2041 4 300 9 poppleto n easemen t Ventr y 1 CLEARANC E

± Erro r ± 8.78 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 201 1 Mod e SOI L Tim e 2008-10-2 7 09:1 2 Duratio n 30.5 6 Sequenc e Fina l Flag s J , BVI D # 2041 4 ADDRES S 300 9 poppleto n QUAD/ZON E easemen t INSPECTO R Ventr y DEPT H 1 SAMPL E TYP E CLEARANC E NOT E
pp m ±Erro r P b 57.58 8 ±9.68 2 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 52.41 3 Supervise d By : 

## Certificat e o f Verificatio n
201 2 SOI L 2008-10-2 7 09:1 3 31.2 3 Fina l 2041 4 300 9 poppleto n easemen t Ventr y 1 CLEARANC E

± Erro r ± 9.31 7

# 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 201 3 Mod e SOI L Tim e 2008-10-2 7 09:1 3 Duratio n 123.2 5 Sequenc e Fina l Flag s AVERAG E I^Av g o f 2009-201 2 ADDRES S 300 9 poppleto n QUAD/ZON E ^easemen t INSPECTO R Ventr y DEPT H SAMPL E TYP E ^CLEARANC E NOT E

Supervise d By :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

^-BO^--^ * COASTA L ENVIItONHENTA L C I t O U r , IN C 

# EXECUTIV ESUMMARY : BVI D #2041 4 - (300 9 POPPLETO NAVE ) N o Issue s o r Concern s I I Issues/Concern s Detai l Explanation :2 

## 5> t 

# EP A EP A Propert y Clos e Ou t For m Propert y # : c^O'-AV'- A Propert y Address : 30O ^ PcrfipJhrVr^VX.-Ary ' Date/Time : Owner' s Name : ?:>ri>oCJ L"TVSnVY^pS^r N Quad s Excavated : lj> \ Contracto r Crou p Q oOi^V-v- i 0 . Excavatio nGenera l Ye s N o 1 .If necessary , were th e correc t quadrant(s ) excavate dan drestored ? 

### ( X I f necessary , wer e th e correc t area s o f drip zone excavate dan drestored? u ^ Gradin K So dan dVecetatio n Ye s N o I .Doe s th e gradin g aroun dth e perimete r o f th e hous e i nexcavate darea s generall y slop e awa y fromth e house ? { ^ 2 .Ha s so dt>ee nlai dinall area s that were excavated ? c- ^ 3 .Doe s th e sodappear t o b e generall y health y an dgrowing ? (Onl y evaluat e if inspecte da t a3 0 da y time period ) 4 .Ar e soddedarea s generall y fir mandevenl y graded ? . ^ 5 .

Ar e th e Joint s t)etwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period ) 6 .Wa s the propert y grade dsuc htha t water will not poo l o nth e property ? u ^ 7 .

Wa s damag e t o landscapin g or plan t material s avoided ? u ^ Gates , Fence s an dRcUininf ; Wall s Yes N o 1 .

D o gate s ope nan dclos e freely? (Ifapplicable ) 2 .Wer e all gate s or fence s take ndow ndurin g restoratio nactivities reinstalled ? (Ifapplicable ) 

## [ \ l j(// r 3 .Wa s damag e t o gate s or fence s avoided ? (Ifapplicable ) 4 .Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) Foundation , Sidin g an dGutter s Ye s N o 1 .Wa s damag e t o th e sidin g o r tri mavoided ? ^ 2 . Wa s damag e t o th e foundatio navoided ? ly ^ 3 . Wa s damag e t o window s avoided ? 1 ^

. ^ 4 .Wa s damag e t o windows o r doo r screen s avoided ? 5 .

Wa s damag e t o downspout s or downspou t extension s avoided ? ^ Sidewalk s an dDriveway s (Concrete ) Yes N o 1 .Wa s damag e t o drivewa y surface s avoided ? u ^ 2 , Wa s damag e t o walkwa y surface s avoided ? 

# y

## O flier s comments :

Inspectio nnotes :

Remova l an drestoratio nactivate s complet e includin g the 30-da y so dwarranty ; EPA Representali^</^^fe^^;;^,^^<tJ4.^ ^ Date : ///<i/dJ ^

### Propert yCompletio n Agreemen t I'lii s agreemen t documeni s th e completio no f remedial activitie s performe do n m y property . My signatur e will designai e Iha t 1 a msatisfie dwilii tli e restoratio no f m y property , an dthat n o item s ar e i n qucstioii.s , now . n r a

l an y tim e i n th e fulure , excep t thos e item s liste dbelow , ifany . 

### piopcit^u) : _^(9y; Y kyJ C Owiic i 

### (J_r^c^

_ TWoyt/A p ;e* \ Phone: 

# li' i 15^ 3 Restoratio n Item s i n Question :

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

1/ ^ I a{;re c re\lorafio n i s completed , excep t a s iiolec l I I J o no t agre e rrsloratio n i s complete d 

# ^-^- ^ ^ ^ -J/'^ ^ Owner' s Si{ » Date I