## TRANSMITTA Lo f

OMAHA LEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID#: ^^0^ 3 Date : .$?)^e>/o q Address : ^yDl ^ MiOJm i 3 f 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 ) 4031479 7 

## y Executiv e Summary EPA-provide dpropert y sketc h Superfun d 

## y

^ Signe dAcces s Agreemen t fo r subjec t property Signe dAcces s Agreement(s ) for adjacent property Restoratio nAgreemen t Settlemen t document s (i.e. , fo r damag e o r to replac e plants , etc. ) 

# y Confirmatio ndat a Photograph s ^C^-^irjij)aMjS(\ ^ H XCuJaitCA ^ jfaru j ^ 0 < L As-buil t sketc h ^ 

### Satisfactory restoratio nsigne db y Property Owne r 

# y 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 Utility clearance s 

# y Property informatio nfromDougla s County Assessor' s Offic e 

# y Xi i vr-nvu . D 

### Signatur e 

# y£iM^.j^a>uusU t

## Propert yAcces s Checklis t PropcrtjlD : <:9^^0^ 3 D WOR K STARTE D 

### ON : / / 1 D WOR K COMPELTE D ON : / / Propert y Address : 2,0\ ^ V\ \r^..V^ v ^.t . > Rente r Owne r 

### L L ^.,<4~s ) q\o- ~ ^ > r-r^i-\ ( •. ^^ ^ O Cx C Address : " ^ Phone : Fax : Cell/Pager : Additiona l Information : Fax : Phone : A'i:>\ - \^i(J2X: > Cell/Pager
. D Notificatio nLette r Sent : / / 1 By : 1 3 Accesi i Agreemen t Sipricd : U / ft /Of= ^ By : i^ ( - , ^,r>->^cJ« V , ERestoratio nAgreemen t Siencd : \ l / 6 /Dg , By : f-\\.:]^.)r^o'kV- ^ 0 Topsoi l Samplin g (i f applicable ) / / By : D Disposa l Samplin g (i f applicable ) / / By : GGarde nSamplin g (i f applicable ) / / By : 0 Utilit y Clearanc e Called : V \/ '^ WC; & 

## By : Ull?.lnb S Video/Photo s (Before ) 

### On:JJ_/l^/Cl ^ By : e-rio^V ) nVideo/Photo s (During ) On : / / By : D Video/Photo s (After ) On : / / By : D Video/Photo s (30-Day ) On : / / By : dPropert y Completio nAgreemen t Signed : / / 

### By : 1 D Fina l Repor t Issued : / / By : Ai r Monitorin g (a s applicable ) nCommunit y Q Cre w On : / / 

### By : 1 Results : 1
nCommunit y C U Cre w OD : / / 

### By : 1 Results : 0 Communit y O Cre w On : ' / 

# 1 Results : Omah a Lea d Sit e

### Propen y I D # Propert y Address : Initia l Contaci : Secon dContact : Fina l Conlacl : Fina l Action :

Commeni : Owne r Commen i (s) ; Sit e Coordinato r Commen t (s ! 

## CONTACT FOR M
_2^Q13 _



# ^Di aMii^m t 

# 'y Dale : Time : Action : Date : Time : Aclion : Dale : Time : Aclion ; Tran.smi t l o EP A D Othe r Action ; D

### Dougla s County Accoun t Infcaaatio n Pag e 1 of 2 ^a||a l Dougla s County , Nebrask a Propert yRecor d - R191587000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e & scal e 0-5 0 ft wes t o f90t h S t - ViO W O H 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 ZUNIG AFRANCISC O J 301 4 MIAM I S T OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : 158 7 000 0 1 9 Accoun t Type : Residentia l Parce l Number : 191587000 0 Parce l Address : 301 4 MIAM I S T OMAH AN E 68111-000 0 Lega l Description : OMAH AVIE W LOT7 BLOC K3 5 0 X 12 0 Valu e Informatio n Lan d improvemen t Tota l 200 8 $2,500.0 0 $30,200.0 0 $32,700.0 0 200 7 $2,500.0 0 $30,200.0 0 $32,700.0 0 200 6 $2,500.0 0 $30,200.0 0 $32,700.0 0 200 5 $2,500.0 0 $30,200.0 0 $32,700.0 0 200 4 $500.0 0 $2,500.0 0 $3,000.0 0 200 3 $500.0 0 $2,500.0 0 $3,000.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 3 6000. 0 1. 0 120. 0 50. 0 N o Impro t vemen Informatio n Buildin g 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19. . . 11/4/200 8

### Dougla s County Accoun t Infoanatio n Pag e 2 of 2 ^B|a t

301 4 Miam i an ti [ tj r limes * n n r 101 ) Swa M FM r lU U w o TU I M P

• % S 1 1/ 2 Stor yR n
CLIC KT O ENLARG E IMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : 1452. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Poo r

Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 8. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : 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 188 5 0 % 188 5 12 3 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 1046. 0 Basemen t Outsid e Entranc e 2. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 525. 0 Porc h En d Scree n 212. 0 Use r Atti cFul l Finis h 406. 0 Use r Se e note s 1. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19. . . 11/4/200 8

### Pag e 1 o f 1

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

### YOU RTICKE T NUMBE RI S 2172060 . Origina l Cal l Date : 11/09/0 8 Time : 4:2 8 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 : 3 01 4 Street : MIAM I S T Twp : 15 NRng : 13 E Sect-Qtr : 09-SE-S W 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 : FA X 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 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 : 402504782 3 MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y Alt : 

### Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCITY O FOMAHA-TRAFFIC.SEWE R RO NAlt : 402444516 1 ,; , Emerg : 402444516 0 Day : 406728934 3 OPPDGPR 5 OMAH APUBLI C POWE RDISTRIC T N A Alt : 888728934 3 Emerg : 406728934 3 Day : 406728934 3 QLNNEI C QWES T LOCA LNETWOR K 

### W A' A M Emerg : 888728934 3

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

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e ENVIRONMENTA L GROUP
. INC
.

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. DDp^/ ^ 

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Omah aLeadSit e 4613 0 

### Legen d Concret e Dri p Zon e Excavate d^^t> | Quadrant s Excavate d Are a replace d wit h Are areplace dwit h Are alef t bar e So d Rock/Mulo h Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .

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Omah aLea dSit e 4613 0fitfacii v ^ COASTA L (NVIiONHtNTt t CROUP
. IH 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 i Protectio n Agency(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 : 

# T

Owner' s Name : Daytim e Phone :

Addres s o fPropert y covere d b ythi s 

# \fy\ ] 

# y 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 remove soi l that 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 worl < i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o f Coasta l Environmenta l Group , contracte d byUSEPA , vwl 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 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 meets wit h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m EPAtha 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 l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e ofperformin 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 o f2COASTA L
ca 0 u p . IM 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 T NOTT 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

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

Qirvnaf-iir aDat a 

### Signatur e Date Signatur eDat e
OI woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.COASTA L C • O U P IN C 

## Restoratio n Agreemen t Th e purpos e ofthi s agreement i s t o provid e amutua l agreement a s t o condition s o f the propert y prior to remediationactivities . Tlii s will als o serv e as documentatio nfo r the purpos e o f assurin g tha t restoratio n activitie s ar e complete dt o the satisfactio no f th e propert\ ' owne r an dthe UnitedState s Environmenla l ProtectionAgency (EPA) .

Propert y ID : ^C\Q^ 3 PropartyAddres. : Q^t>\L\U\CWV> V Owner : 

# 7-Am^c\ a1^Yr>y\c\<y n Phone : 

# ^-s\-^^^ Q O

nthe attache ddiagram(s ) indicat e area(s ) t o excavatedan ddept ho f excavation , locationof al l know n utilities , subsurface features , surface structure s an dlandscaping features , acces s location(s ) t o be 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-lo g numbe r wit ha narrow 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
. 

# = V D *oesa\\£«Acc l X\v\ u <i^Y^rYt Uv\Gj{\\S\e^ \W>H,nd : ^ Ite m Item : Item : Item : Item : 

### Item : Item : Page l 

### o f ( Q^ ^ ^ COASTA L e « O V r. • KC 

### 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 : 

# r\^ u ^\^a\ \ p[CK\(\\?
. \e ^ V:^h\o d Item : 

# 3 ^f\m \ rtrbri.^ Ite m Kem : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 2 

## ofJjL
_( ^ COASTA L «NV•1lo^•n••«T* L C M O U » I N C Item s T o B e Remove d B yContracto rDurin g Remediatio n An d Replace d (Us e additiona l sheet s a s necessary ) Item : 

## S6N \ 

# Vf t Item : Item : item : Item : Item : Item : Item : Item : Item : Kem : Item : Item : Item : Item :

Page s o f( ^- • ^ -• - » COASTA L CM'VlRONntMTA L C * O U r. t M C



## Ite m

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

Number of tree s > 2 inc h trun k

diameter

Number o f tree s < = 2 inch trunk diameter

Number of Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Attachasketchof th e sprinkler layout .
Number of an dsiz e o f eachgarden / flower be d area . Attac hasketchof relativ e size s an dlocations . 

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

## Quantit y Unit Condition/Type/Specle s
Squar e fee t

• • ' . ,. i • 

# ?f i

•

. * * , , Eac h

Each ^

1 

# t > Eac h

Eac h Squar e Fee t ^

Pag e 4 o f(/ ?COASTA L c K

o u rI M e 

### Ite m Agree dupo nvalu e o f olan t material s no t to b e renlace dbv contractor . Note thi s valu e will b e usedto issu e aplan t vouche r to th e propert y owner . Agree dupo nlis t o f plan t material s tha t will b e replace db y contractor . B e ver y specifi c an ddetailed . Include asketchof wer e eachplan t wil l b e placed by th e contractor . Agree dupo nare aof propert y t o b e replace d wit hgras s sod . Include asketcho f th e area(s ) t o be replace dwit h gras s sod . Are ao f Cit y o r Count y propert y to be landscape d per thei r requirements . Include asketchof th e are a(s )

Easement Area , to b e excavate d 

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

^ $ 

## 1, 

# tl Each 

# v< \ S F

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# ^kx^m"^^^" i

Pag e 5 of ( j >C O AS T AL
• MV»«OMM<MTA L
I Additiona l Comment s / Instructions : ', 

# y i y^j >

D Chec k th e bo x ifOwne rdoe s no t wan t CE G to documen t interio rfoundatio n wall s an d possibl e pre-existin g damage
. Bycheckin g thi s bo xCE G is no t responsibl e fo ran ydamag e don e to th e interio r of house , includin g foundatio n crack s orfissures. 

### Qjllagre e Q Ido not agre e

Owoer' s Sigoature Contractor' s s Signatur e e Sknatar Date 

### Pag e 6 of I VBVID#^C^nf^?
. 

### XR F PROPERTY SAMPL E SHEE T Dat e 

## \y\c\-a & Addres s 3o\'- \ VA^ \ CX.«KA A<Sf c' Project Omah a lead F P 2n d yea ropllo n Sampl e tim e \ \ '
. \ 8 am/p m XRFID # sampl e lengt h 3 0 se c 

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1361 1 B Stree t • Omaha , Nebrask a 68144-369 3 ' (402 ) 334-777 0 • FA X (402 ) 334-912 1 • www.midwes1labs.corT ) ACCOUN TNUMBE R CHAI N OF CUSTOD YRECORD : Ye s No PURCHASEORDERNUMBER
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## Report Number : Dat e Reported : 08-354-203 8 

# •i^BVIidwes t 12/19/0 8 Account : Dat e Received : 2066 6 12/16/0 8 

# V| ^ Laboratories , Inc I Page : 1 o f 1 Dat e Sampled : 1361 1 B Stree t • Omaha , Nebrask a 68144-369 3 • (402 ) 334-777 0 • FA X (402 ) 334-912 1 • www.midwestlabs;p2)rri5/0 8 

## COASTA LENVIRONMENTA LGROUP MARCO S MATEU S 241 1 MARTH A ST OMAH A N E6810 5 LEA D ANALYSI S 301 4 MIAM I S T PO/Projec t # : OLS-200 8 Analysi s A s Detectio n Analys t Verifie r Performe d Receive d 

## Unit s Limi t 

## Metho d Dat e Dat e U b number : 151917 2 Sampl e ID : QC-2908 3 EASEMEN T

Lea d (total ) 10 4 mg/k g 5 EP A601 0 rrd/12-1 8 bab/12-1 9 

### La b number : 151917 3 Sampl e ID : P Z

Lea d (total ) 17 6 mg/k g 5 EP A601 0 rrcl/12-1 8 bab/12-1 9



# dyyn^^ ^ 'leathe rRami g Clien t Servic e Representative ^ heather@midwestlabs.co m (402)829-989 1 NELAQ.regulrements
. t o th e work , th e results , o rth e compan yi n an yadvertising , news release , o rothe rpubli cannouncement s withou t obtainin g ou rprio rwritte n authorization ,

# 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 By : 

## Certificat e o fVerificatio n

375 8 SOI L 2008-11-1 9 11:2 1 122.3 7 Fina l |Av g o f3754-375 7

301 4 mlam i "^ ^ |P Z jVentr y 1 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 142.39 2 Supervise d By : 

## Certificat e o f Verificatio n

375 4 SOI L 2008-11-1 9 11:1 8 30.6 1 Fina l 2908 3 301 4 miam i PZ Ventr y 6 CLEARANC E

± Erro r ± 14.78 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 141.99 3 Supervise d By : 

## Certificat e o fVerificatio n

375 5 SOI L 2008-11-1 9 11:1 9 30.5 5 Fina l 2908 3 301 4 miam i PZ Ventr y 6 CLEARANC E

± Erro r ± 14.79 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 383.43 3 Supervise d By : 

## Certificat e o f Verificatio n

375 6 SOI L 2008-11-1 9 11:2 0 30.4 1 Fina l 2908 3 301 4 miam i PZ Ventr y 6 CLEARANC E

± Erro r ± 23.97 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 BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E
pp m P b 137.68 4 Supervise d By : 

## Certificat e o f Verificatio n

375 7 SOI L 2008-11-1 9 11:2 1 30.8 0 Fina l 2908 3 301 4 miam i PZ Ventr y 6 CLEARANC E

± Erro r ± 14.77 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

P b Supervise d B y 

## Certificat e o fVerificatio n

376 3 SOI L 2008-11-1 9 11:2 4 122.7 9 Fina l _Av g o f3759-376 2 ^301 4 mlam i feasement

ventr y * " l

CLEARANCE *

# 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 120.48 1 Supervise d By : 

## Certificat e o f Verificatio n
375 9 SOI L 2008-11-1 9 11:2 2 30.5 4 Fina l 2908 3 301 4 mlam i easemen t Ventr y 1 CLEARANC E

± Erro r ± 13.45 2

# 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 123.53 2 Supervise d By : 

## Certificat e o f Verificatio n

376 0 SOI L 2008-11-1 9 11:2 3 30.9 2 Fina l 2908 3 301 4 mlam i easemen t Ventr y 1 CLEARANC E

±Erro r ±13.52 4

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 376 1 Mod e SOI L Tim e 2008-11-1 9 11:2 3 Duratio n 30.8 3 Sequenc e Fina l Flag s BVI D # 2908 3 ADDRES S 301 4 mlam i 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 114.26 4 ±13.14 7 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 95.14 2 Supervise d By : 

## Certificat e o fVerificatio n

376 2 SOI L 2008-11-1 9 11:2 4 30.5 0 Fina l 2908 3 301 4 miam i easemen t Ventr y 1 CLEARANC E

±Erro r ±11.86 8X 

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### 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



# EXECUTIV ESUMMARY : BVI D #2908 3 - (301 4 MIAM I ST ) N o Issue s o r Concern s | ^ Issues/Concern s Detai l Explanatio n r/Mi ^
COASTA L ENVIItONHENTA L CROUP
. IN C

# s ^ 

# EP A EP APropert y Clos e Ou t For m Propert y*t : r9'^bB ^ Propert yAddress : ^\'A^-A\Oo^A I "^V , Date/Time : Owner' s Name : "g ^ . r^ \ cxr . ^ ^rrv.\r\f AI %QJ D Quad s Excavaied : Vf c Contraclo rGrou p (f,rxcgyWx.Q , "Fr^s^rrnoiMJuA^i^e
. Excavatio n Genera l Ye s N o 1 . I f necessary , wer e th e correc t quadrant(s ) excavaie d an d restored ? I-' " 2 . I f necessary , wer e th e correc t areas o fdri p zon e excavate d an d restored ? - ^ Gradin g So d an d Vecetatio n Ye s N o 1 . Doe s th e gradin g around th e perimete ro f th e hous e i n excavate d areas generall yslop e away ^ from th e house ? 2 . Ha s so d bee n lai d i n al l area s tha t wer e excavated ?

. X 3 . Doc s th e so d appea rt o be generall yhealth yan d growing ? (Onl yevaluat e i finspecte d a t a 3 0 ^ da ytim e period ) 4 . Ar e sodde d areas generall yfir m an d evenl ygraded ? • ^ 5 Aji e th e joint s betwee n th e so d strip s generall ytight ? (Onl yevaluat e ifinspecie d a t a 3 0 da y ^ tim e period ) 6 . Wa s th e propert ygrade d suc h that wate rwil l no t poo l o n th e property ? 

### y 7 Wa s damag e t o landscapin g o rplan t material s avoided ? ^ Gates , Fence s an d RcUininf ; Wall s Ye s N o 1 . D o gate s ope n an d clos e freely? (Ifapplicable ) c ^ 2 . Wer e al l gates o rfence s take n dow n durin g restoratio n activilie s reinstalled ? (Ifapplicable ) ^ 3 . Wa s damag e t o gate s o rfence s avoided ? (Ifapplicable ) y 4 . Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) ^ FouDdatioD , Sidio Kan d Gutter s Ye s N o I
. Wa s damag e t o th e sidin g o rtri m avoided ? ^ 2 . Wa s damag e t o th e foundatio n avoided ? ^ 3 . Wa s damag e t o window s avoided ? ^ 4 , Wa s damag e t o window s o rdoo rscreen s avoided ? i ^ 5 . Wa s damag e t o downspout s o rdownspou l extension s avoided ? ^ Sidewalk s an d Driveway s (Concrete ) Ye s N o 1 . Wa s damag e t o drivewa ysurface s avoided ? - ^ 2 . Wa s damag e t o walkwa ysurface s avoided ? u ^

## O vner s comments :

Inspectio nnotes :

Removal andrestoratio nactivate s complel e includin g the 30-da y so dwarranty : EPA Representative ^..-7^^]^;;?l-w^^^^wW:z ^ Date : /^//f/^i ^

# '' m Propert yCompletio n Agreemen t Tlii s agreement documeni s th e complclio no f remedial activilie s performe do nm y property . My signaiur e wil l designai e Iha t I a msatisfie dwii hth e restoratio no f m y property , an dtha t n o item s ar e i nquestions , now , o r at

an y tim e inth e future , excep t thos e ilem s liste dbelow , ifany . Prope^tyJD:^^^^ ^ Propert y Address : 3^^C ^ /^^ ^ / __^ ^ Owner : fy^^^}^^ ^ 2^.o ^ Phone : " ^ Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item :

-TSTufj l agre e restoratio ni s completed , excep t a s note d I I d o not agre e resloratio ni s complete d

« ' Owner' s SiKnaliir e ll^| r XContractor' s Signatur e ' Da^ c I