## TRANSMITTA L of OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAI D#: 1y(^M < Date : '^\'?\\< ^ Address : lll l Wl\ i P ^ "^ ^ Remediatio nContractor : _Coasta I Environmenta l Group

_Year : _2OO0
SOI LREMEDIATIO N PROPERT Y nLEFOLDE RDOCUMENT S Vide oof property (DVD ) Executiv e Summar y EPA-providedproperty sketch IM SignedAcces s Agreement fo r subject propert y 'B SignedAcces s Agreeraent(s ) fo r adjacen t propert y 0 Restoratio nAgreement -B

- Settlemen t dociunent s (i.e. , fo r damag eor to replac e plants , etc. ) -G

r Confinnatio ndata Q / Photograph s ^ H b.^^^W»'\r^? ^ 

# y As-built sketc h ^ Satisfactor y restoratio nsigne d by Propert y Owner / Propert y close-out check lis t signed by EP A -B " Descriptio n of area s no t meetin g RO D cleanup criteri a U Utilit y clearance s !D / Propert y informatio nfro mDougla s Count y Assessor' s Offic e 

## a . __. D 

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# ^• I' hIu -t= ^ Dat e 3005527 0 Superfun d• •



## Propert yAcces s Checklis t Propert , ID : TJ^^dHf ^ nWORK STARTE D ON : _/ /_ D WORK COMPELTE D ON : / / Propc m Address : n )7 - Mll)-hry/9 w 

## o^^'"^' " \jY\rli n Rim(^. l Renter
. Address : Phone : 

## '" • ^amjL , FJL\ : Cell/Pager : Additional InformKtion : Phone : 20- S - P) H n ¥t\ : Cell/Pager
.
D Norificatio n Lette r Sent : / / By : IX / Acces s Agrccmcd f Signed : Jl/4i/ ^ By=^0:ie^\yi O (Q ^ RestonttiO D Agreemen t Siened : 1 1 \ [ l( A 

## By = r^rvai o 7 O Topsoi l Samplin g (i f applicublc ) 1 1 By : D DisposA i Samplin s ( W applicable ) 1 1 By : D Gnrdc n Smnplin g (i f applicable ) 1 1 By : D Utilit yCIcflrtnc c Called : / / By : Video/Photo s (Before ) On : / / By : D Video/Photo s (During ) On : / / By : D Video/Photo j (After ) On : / / By : D Video/Photo s (30-Day ) O D : / / By : / • \ "^^Pyopert yComplelio n Agreemen t Signcd/ Ti/y-tf^ ^ By : d l Fina l Repor t Issued : / / By : Ai rMonitorin e (a s upplicAble )

D Communit yD Cre wOn : / / By : Results : D ComrounitA ' D Cre wOn : / / By : Results :

• Communit yD Cre wOn : / 1 By : Results :

Omah a Lea d Stt e

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

Comment : Owne r Comment (s) : Site Coordinato r Comment (s) : #


## CONTACT FOR M 7.ko7.U S



# nn . M^i^AVN /

Pf V Date : Time : Action : Date : Time : Action : Date : Time : Action : Transmit t

o EP A D Othe r

Action : D

### Dougla s Coimty Accoun t InfornMiio n Pag e 1 of 3 •rnMiic Dougla s County , Nebrask a Propert yRecor d - R214655000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabi e @ scai e 0-5 0 f t wes t o f 52n d S t - Vievt f O H Ma p Informatio n i s vali d a s o f 2009-6-1 6 Treasurer' s Ta xRepor t Ne wFeatur e -•••- • Aut o Sale s Searc h Owne r RIME L LIND AL 171 2 MILITAR YAV E OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : 

### 465 5 OOO O 2 1 Accoun t Type : Residentia l Parce l Number : 

### 214655000 0 Parce l Address : 171 2 MILITAR YA V OMAH AN E 68111-000 0 Lega l Description : SAUNDER S & HIMEBAUGH S AD D LO T2 1 BLOC KB 5 0 X 159. 7 Valu e Informatio n


### 200 9 200 8 200 7 200 6 200 5 200 4 Lan d Improvemen t $7,000.0 0 $72,300.0 0 $7,000.0 0 $72,300.0 0 $7,000.0 0 $72,300.0 0 $7,000.0 0 $72,300.0 0 $7,000.0 0 $32,100.0 0 $7,000.0 0 $32,100.0 0 Tota l $79,300.0 0 $79,300.0 0 $79,300.0 0 $79,300.0 0 $39,100.0 0 $39,100.0 0 Sale s Informatio n Sale s Date : 2003-02-2 5 Dee d Type : 

### Price : W D $72,900.0 0 Book : 223 7 Page : 51 0
Grantor : GREGOR YACOLLIN S ETA L Grantee : LIND AL RIME L Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 

### 1997-01-1 1 Dee d Type : Book : 205 5 Page : 31 9 Price : $ 33,500.0 0 Grantor :


### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R214.
. . 7/7/200 9

### Dougla s County Accoun t Inforn|||io n Pag e 2 o f 3 

## rnmi p
Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h 0.1 8 7950. 0 1. 0 159. 0 Lan d Attribute s Attribut e Negativ e Influenc e Improvemen t Informatio n Buildin g 1

i.',rj.i.iin.T.i<.i.ir^Kw.i.iiinMAMaTi: a CLIC KT O ENLARG E IMAG E Squar e Footage : 1477. 0 Perimete r 0. 0 Uni t Type :

Buil t As : 1 1/ 2 Stor yFi n HVAC : Centra l Ai rt o Ai r Exterior : Fram e Sidin g Interior : Drywal l Roo fCover : Compositio n Shingl e

Roo f Type : Gabl e Floorcover : Allowanc e Yea r Percen t Yea rBuil t Remodele d Remodele d 190 0 0 % Detai l Typ e Detai l Descriptio n Ad d O n Fenc e Chai n Lin k Widt h Vacan t 50. 0 N o
Attribut e Descriptio n Traffi c1

IZ]i '

•-ffi r

• Ta^-fl ' CLIC KT O ENLARG E IMAG E Percen t Complete : 100.0 % Quality : Averag e Condition : Averag e Cond o Squar e Footage : \ 0. 0 Rooms : 7. 0

Units : 1. 0 Baths : 1. 0 Bedrooms : 3. 0 Stories : 1. 5 Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Adjuste d Yea r Buil t Physica l Ag e 190 0 10 8 Unit s 1. 0


### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R214.
. . 7/7/200 9

## Dougla s Count y Accotm t Infornu|io n Pag e 3 of 3 Tiaib o Applianc e Basemen t Fixtur e Fixtur e Porc h Porc h Allowanc e Bsmn t Bloc k 8 ft Bas e Fixture s Bat h Ful l Sla b Roo f Cei l Woo d Dec k 1. 0 816. 0 1. 0 1. 0 144. 0 120. 0



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R214..
. 7/7/200 9

### Pag e 1 o f 1

1: - ::P'"ggte^notherJicket^ lL:_B8CJ<*oJjJhJr!Jg!ingJ_.:: J Sen d Emai l j ]


### YOU RTICKE T NUMBE RI S 2332211
. Origina l Cal l Date : Wor k t o Begi n Date : 8/03/0 9 8/05/0 9 Time : 12:1 9 p m Time : 1:0 0 p m Op : ELIZABETH1879 0
State : N E Address : 171 2 County : DOUGLA S Street : MILITAR Y AV E Place : OMAH A
Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 17-NW Sect-Qtr : 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 ABOU T CORNE R LO T 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 : 4 F T Corne r Lot : N Involve s Tunnelin g o r Horizonta l Borin g : N Front : Explosives : CXCAT V MUDO l OMAHACO F0PPDGPR 5 QLNNEI C Y N Rear :

Servic e Are a Contac t Phon e Numbe r Utilit y Typ e
CXCAT V CO X COMMUNICATIONS , IN C 

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

MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : 

### Emerg : 402504797 0

OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO N 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 4024445160

OPPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T N A 

### Day : 406728934 3 Alt : 4062071494 Emerg : 888728934 3
QLNNEI C QWES T LOCA LNETWOR K N A 

### Day : 406728934 3 Alt : 4062071494 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 8/3/200 9

### 2634 5 

# As-Buil t Drawin g ^
COASTA L 

# Omah aLea dSuperfun dSit e

Exterio rPain t Nort h Arro w Omah a Lea d Sit e Owne rName : LIND AL RIME L Sit e Sketc h • Goo d Address : 171 2 MiLrrAR YA V • ,Foo r

Phone : H 402-933-173 7 W : 402-697-536 6 |T J No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Fir m RYASCPXA-2634 5 F l 57'2 , pp m 

# n Date : ^-'S-^-^-g - RYBSCPXA-2634 5 F 2 22* 3 pp m 

### D Time : t • \ o RYCSCPXA-2634 5 B 1 '2.(? 0 pp m 

## m/ 

# n p» w Sample s Analyze d RYDSCPXA-2634 5 B 2 • -Z-lo ^ pp m 

### D RDZSCPXA-2634 5 D Z 2ZZ S pp m 

# n XR F Unit : /03 7 Boo k I 3 Z RQZ3CPXA-2034 0 S2 - ~ pp m 

# n Date ; 

### / o -aS'-o ^ RPZSCPXA-2634 5 P Z & ^ pp m 

# n Time : 

### /^/r t Staff : 

### J = ^ Numbe ro f Sample s • Legend ; F 1 = Fron t Left , F 2 Fron t Right , B l = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a s viewe d fro m th e street , faan g propert y OLS# : 2634 5 Dat e Excavated:8/11/0 9 [!)at e USEP ASigne d Off : 10/6/0 9



### Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d 

# m

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 .

## 2634 5 Exterio rPaint Nort h Arro w Omah a Lea d Sit e Owne rName : LIND AL RIME L • Goo d Sit e Sketc h Address : 171 2 MILITAR YA V npoo r Phone : H ; 402-933-1737 W : 402-697-5366 [T j No t pain t Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Firm : M£ S c M ,^n^< ^ RYASCPXA-2634 5 F l 

## syz , pp m 

## D Date : ^~%'0 3 RYBSCPXA-2634 5 F 2 

## 2^Z 3 pp m 

## D Time : i • • ^ O p i w RYCSCPXA-2634 5 B 1 2.(9 0 pp m 

## D Sample s Analyze d RYDSCPXA-2634 5 8 2 

## -Z- M pp m 

## D RDZSCPXA-2634 5 D Z pp m XR F Unit : 

## /d3 7 Boo k

13 Z 

# Zzzs
_ 

# 1 / D ROZOCrXA-2034 5 pp m 

## D Date : RPZSCPXA-2634 5 P Z 

# m . pp m 

## D Time : 

## p/ n Staff : Numbe ro f Sample s =\( p • 

# AA
. Legend : F l = Fron t Left , F 2 = Fron t Right , B l = Bac k Left , B2 = Bac k Righ t DZ = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant ^ ar e a s viewe d fro m th e street , facin g propert y

Rev4 04614 1 012 3

## 2634 5 Exterio rPain t Nort h Ane w Omah a Lea d Sit e Owne rName : LIND AL RIME L D Goo d Sit e SIcetc h Address : 171 2 MILfTARYAV npoo r

Phone : H : 402-933-173 7 W : 402-697-536 6 Qrto t pain t Sampl e Nuinbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Finn : RYASCPXA-26345 F l 57 2 pp m 

## D Date RYBSCPXA-26345 F 2 2Z 3 Dp m Time : 

# n RYCSCPXA-26345 B l 2^ ^ pp m 

# w Sample s Analyze d RYDSCPXA-2e345 B2 

## D RDZSCPXA-26345 D Z 

### 222 5 pp m XR F Uni t /03 7 Book : i3 Z RQZ0CPXA'e094 5 0 2 pp m 

## D Date : /A-aS-'O ^ 

## D RPZSCPXA-26345 P Z 8 9 pp m Time : P/ft 

# i
. D D Staff : £. A Numbe ro fSample s = | ^ j Legend : F l = Fron t Left
. F 2 = Fron t Right , B l = Bac k Left , B2 = Bac k Righ t D Z = Dri p 2:one , G Z = Garden , PZ = Pla y Al l quadraQ ^ ar e a s viewe d fro m th e street , facin g propert y SE P 1 2

Ilev4 ' O46I410IZ 3^""^' o
COASTA L INVIIONHINTA l e I 0 wp . 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 Environnnenta l Protectio n Agenc y(EPA ) o rIts 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 : ^—> ^ " ^

^.A/CT 

# z:2
. Owner' s Na i Daytim e Phone : 

# ^2-r// 7

Addres s o f Propert y covere d b ythi s 

# 1712 - J4,l l U^ l ;4\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 that contain s elevate d concentration s of 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 vyror 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 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
. 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 v^t h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m EP Athat th e property 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 subcontractors th e right t o ente rth e property , at 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 effec t unti l th e work ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :rf*^***.
COASTA L INVIIONNrNTft l S I 0 U r, I 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 that 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 , as necessar ysubsequen t t o a n initia l waterin g perio d b yEPA ; •Abid e b yhealt h an d safetyguidanc e provide d b yEPA ; •I f th e propertyi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propertyt o perfor m th e work
. eAllo wvideotapin g and/o rphotographin g of th e property
. AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s not t o Interfere o rtampe rwit h an yo f th e work activities , o rwit h an y of 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 propertywhic h woul d ten d t o endange rth e healt h o r welfar e of th e Grantee s o rth e environment , o rt o allo wother s t o us e th e propertyi n suc h a manner . Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contact 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

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
.

# y COASTA L 

## RestoralJson i AgFeemsn t Th e purpos e o f thi s agreement i s t o provid e amutual agreement a s t o condition s ofth e propert y prio r to remediatio nactivities
. Thi s wil l als o serv e a s documentatio nfo r th e purpos e o f assurin g that restoratio n activitie s ar e complete dt o th e satisfactio no f th e propert y owner an dth e Unite dState s Environmental Protectio nAgenc y (EPA)
.

Property Addr^>i;; 7 '' ^ ^3 ^ T ^ ' i{'^ ^ •H'W
. Owner : Phoi i 

# ^^v^.^-.^^/ / O nth e attache ddiagram(s ) indicate aFea(s ) t o excavate , surfac e structure s an dlandscapin g feature s an d acces s Iocation(s ) to b e usedby th e contractors . Indicat e distances , depths , materia l types , etc . Photographicall y an dVideographically document the existin g condition s ofth e propert y andth e basement if necessary . 

### item s to b e Remove d b yth e Owne rbefor e Starl^ o f Remediation : Th e ramoval
. stofEse
. dl&nub£l , ano/o rretur n o f thes e Itom s I s tht' ? Qyyner s responsiiiviiitj i Kem : 

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# 77/t y pk^' h /e-/ / P^k/^d P Hem :


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item :

Page 1 o f yCOASTA L 

### Item s to B e Remove d B yContracto rDurin g Remediatio n an d Replace d Item : 

# > o Item : 

# ^o A Kem : Item :



## Ite m Pre-existin g property area , that wil l b e excavated , that i s covere dwit hgrass . Numbe r o f tree s > 2 inc h tmnk diamete r Number o f tree s < = 2 inch trunk diamete r Number o f Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Aliac h; ) sketc ho t lli f spi'rklc i li'.NCHi;
. Number o f andsiz e o f eac hgarden/ flower be d area . An;vt hask..'ic ho f n.--:nivL ' size s an dlocaiidiK
. Agree dupo nvalu e o f plant material s no t t o b e replace db v contractor . >'o' ( i"!'.i ' \nUi Q v , ii

t ri

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. COASTA L t MWinOWMLNTA L anas*- - • • * c


### Additiona l Comments / instructions :



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# L
. Q Chec k th e bo xi f Owne rdoe s no t wan t CE G t o documen t interio rfoundatra n wall s an d possibl e pre-existin g damage
. Bycheckin g thi s boxCE G i s not responsibl e fo ran ydamag e don e t o th e interio ro fhouse , includin g foundatio n cracks o rfissures
.

nI d o no t agre e 

# ( lii^iidA
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. 

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pp m P b 346.97 0 Supervise d By : 

## Certificat e o f Verificatio n

299 5 SOI L 2009-08-1 1 15:1 3 30.2 7 Fina l 2634 5 171 2 Militar yav e easemen t Nicola s 1 CLEARANC E

±Erro r ±22.64 2

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

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pp m P

b 316.06 1 Supervise d By : 

## Certificat e o fVerificatio n

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± Erro r
± 21.64 7

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

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pp m P b 256.88 7 Supervise d By : 

## Certificat e o fVerificatio n

299 7 SOI L 2009-08-1 1 15:1 4 30.2 9 Fina l 2634 5 171 2 Mllitar / av e easemen t Nicola s 1 CLEARANC E

± Erro r
± 19.38 6

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

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pp m P

b 281.04 2 Supervise d By : 

## Certificat e o f Verificatio n

299 8 SOI L 2009-08-1 1 15:1 5 30.2 9 Fina l 2634 5 171 2 Militar y av e easemen t Nicola s 1 CLEARANC E

± Erro r ± 20.26 9

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 298 9 Mod e SOI L Tim e 2009-08-1 1 15:0 7 Duratio n 121.2 5 Sequenc e Fina l Flag s AVERAG E ADDRES S 171 2 Militar yav e QUAD/ZON E F l INSPECTO R Nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P b (^JoUsO ? ± Supervise d By : (^/h/'OP'Oj O

# 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 129.18 1 Supervise d By : 

## Certificat e o f Verificatio n

298 5 SOI L 2009-08-1 1 15:0 6 30.2 3 Fina l 2634 5 171 2 Militar yav e F l Nicola s 6 CLEARANC E

± Erro r ± 14.45 4

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 125.33 7 Supervise d By : 

## Certificat e o f Verificatio n

298 6 SOI L 2009-08-1 1 15:0 6 30.2 4 Fina l 2634 5 171 2 Military av e F l Nicola s 6 CLEARANC E

± Erro r ± 13.96 2

# 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 74.26 4 Supervise d By : 

## Certificat e o f Verificatio n

298 7 SOI L 2009-08-1 1 15:0 7 30.1 8 Fina l 2634 5 171 2 Militar yav e F l Nicola s 6 CLEARANC E

± Erro r ± 11.41 0

# Therm o SCIENTIFI C Therm o Fishe r Scientifi c 90 0 Middlese x Turnpik e Billerlca , M A 0182 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 79.81 7 Supervise dBy : 

## Certificat e o f Verificatio n

298 8 SOIL 2009-08-1 1 15:0 7 30.6 0 Fina l 2634 5 171 2 Military av e F l Nicola s 6 CLEARANC E

± Erro r ± 11.82 0

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g No 299 4 Mod e SOI L Tim e 2009-08-1 1 15:1 1 Duratio n 121.4 1 Sequenc e Fina l Flag s AVERAG E CTYg-or299a-2g93J ADDRES S T:/l'2'r5iriH:aryave ' QUAD/ZON E D Z INSPECTO R Nicola s DEPT H 1 2 SAMPL E TYP E CLEARANC E NOT E

Erro r pp m± P b Supervise d B y

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 299 0 Mod e SOI L Tim e 2009-08-1 1 15:0 9 Duratio n 30.5 7 Sequenc e Fina l Flag s BVI D # 2634 5 ADDRES S 171 2 Militar yav e QUAD/ZON E D Z INSPECTO R Nicola s DEPT H 1 2 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 80.09 4 ±11.71 0 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 80.73 3 Supervise d By : 

## Certificat e o fVerificatio n

299 1 SOI L 2009-08-1 1 15:1 0 30.1 9 Fina l 2634 5 171 2 Militar yav e D Z Nicola s 1 2 CLEARANC E

± Erro r ± 11.66 4

# 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 299 2 Mod e SOI L Tim e 2009-08-1 1 15:1 0 Duratio n 30.1 7 Sequenc e Fina l Flag s BVI D # 2634 5 ADDRES S 171 2 Militar yav e QUAD/ZON E D Z INSPECTO R Nicola s DEPT H 1 2 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 60.03 8 ±10.57 9 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 299 3 Mod e SOI L Tim e 2009-08-1 1 15:1 1 Duratio n 30.4 8 Sequenc e Fina l Flag s BVI D # 2634 5 ADDRES S 171 2 Militar yav e QUAD/ZON E D Z INSPECTO R Nicola s DEPT H 1 2 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P

b 66.75 5 ±10.91 4 Supervise d By :

# 4
i^jQL; \ I
.. . . . ._ Omah a a Lea d Site—Fixe d Pric e EP-R7-07-0 5 8 ^^^ ^

° S^y^y ^ l l Grou p Inc
. Coasta l Environmenta

Environmenta l Group ' www.coa8talhazmat.co m >) ^ ^ ^"tpRCfrtJ ^ COASTA L mfllOMIIIIITA l 6 •our . IN C 

# EXECUTIV ESUMMARY : BVID #26345-(171 2 MILITAR Y AVE )
No Issue s or Concern s | ^ Issues/Concern s Detail Explanation : -COASTA L

TO CHEC K ONTH EBRIC K SIDEWAL K

NOTE D

BY TH E

POAS SUNKE N

BY TRUCKS
. (COMPLETE D 3/26/10) -DO NBAHNK EWALKE D TH EPROPERT Y 10/06/09

### « 

# SER A# EP A Propert y Clos e Ou t For m Propert y# : fff'^^^
. Date/Time : Quad s Excavated ; f^ J j Q f 

# „ Excavatio nGeaem l I
.I f necessuy , were th e correc t quadnint(s ) excavate dandrestored ? 

# y 2
.If necessary , wer e th e conec t area s ofdri p zone excavate dandrestored ? Gradin g So d an d Vegetetto a Ye s No I
.Doe s tii e gradin g aroun dth e perimeter of th e hous e i nexcavate darea s generally slop e awa y 

# U f fix)mtli e house ? 

# y 2
.Ha s so dbee nlai dinal l area s tha t wer e excavated ? 3
.Doe s th e sodappear to b e generall y healthy an dgrowing ? (Onl y evaluate if inspecte da t a3 0 day time period ) 4
.

Are soddedarea s generally fir man devenly graded ? 

# T:; ^ 5
.

Ar e di e joint s betwee nth e so dstrip s generally tight ? (Only evaluate if inspecte da t a3 0 da y 

# y tim e period) 6
.Wa s the propert y grade dsuchtha t wate r will no t poo l o n(h e propert>' ' 

# - y 7
.

Wa s damag e t o landscapin g o r plan t material s avoided ? 

# T-^
Gates , Fence s aa dRettiala g Wall s Ye s N o 1
. O o gate s ope nan dclos e freely? (Ifapplicable ) 

## \ y ' Wer e all gate s o r fence s take ndow ndurin g restoratio nacliviiie s reinstalled ? (Ifapplicable ) t / " 3
.Wa s damage t o gate s o r fence s avoided ? (Ifapplicable ) 

## 1/ ^ 4
.Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) Foundation , Sidin g an dCutler s Ve s N o I
.Wa s dainag e l o th e sidin g o r tri mavoided ? 

# y 2
.Wa s damag e t o th e foundatio navoided ? 

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

# -y 5
.Wa s damage t o downspout s o r downspoul extension s avoided ? 

# x>'^
Sidewalk s nn dDriveway s (Concrete ) Ye s ^ 0 1
.Wa s damag e to driveway surface s avoided ? ^ / 2
. Wa s damage t o wallcwa y surface s avoided ? ^ '

## J Owner s comments : 

# #t

iDspectionnotes :

Remova l an drestoratio nactivate s complet e includin g th e 30-da y so dwarranty : EP A Representativ e jJfl ^ IXKAJL

- 

## Date : 1({QI0 ^# #



## Propert yCompletio n Agreemen t Ihi s agreeincn l documeni s th e completio no f remedial activilie. s perlbmie donm y properly
. M y sigiuidir e will designal e that I a msatisiie dwilhth e restorationoi'm y pr()perty , an dtha t n o item s ar e i nquestions , now ; or a

t an y tim e inth e fulure , excep t thos e item s liste dbelow , ifany
. PiopcrJyJ^) : ^^^<^ ^ Propert y A,idres.s:"/^ ^ /^jj^^j^^^~A^ ^ Owner : U^^^_t^;^^ ( '^ 

## Phone : 2p^_-_3.V/?;
_ Restoratio nItem s i nQuestion :

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

I agrc o restornho ni.s completed , excep t a s note d |_ | I d o not acre c restoratio n is ' complete d

tncr' s Si(>nalur c Dat e rorrfriich)r' s .Siijnatiir e Dat e