## TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAI D # : [(^9^ ZDate : 2-/^-^/^ 1 Address : {(p3 3 Chliftyi j CXu hPN ^ Remediatio nContractor : Coasta l Environmenta l Group

_ Year : 200 8
SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S ly Vide o ofpropert y (DVD ) B ^ Executiv e Summary U K EPA-provide dproperty sketc h 0 ^ Signe dAcces s Agreemen t fo r subjec t property ^if V Signe dAcces s Agreement(s ) fo r adjacent property \y ^ Restoratio nAgreemen t ^[l ^ Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) Q

^ Confirmatio ndat a 

## B

^ Photograph s ?)C(i- jLYraj}(Li i S A^ £jf[r/iJr.itisri ^ fitUiAS O o K

As-buil t sketc h G K Satisfactor y restoratio nsigne db y Propert y Owne r SJ ^ Propert y close-ou t chec k lis t signe db y EP A {% ^ Descriptio nofarea s no t meetin g RO D cleanu p criteri a ( ^ Utilit y clearance s 5 K Propert y informatio nfro mDougla s Count y Assessor' s Offic e w fet>&r4<^ (LOJCA^ ^ 

### cJfxejddiST ' 4031647 9 

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Iiiil l ' •* • "^ llll l Superfun d D

ISienatu Date ' Ignr e 

# % My^4^.uy ^ ^ fp/y^ M•



## Propert y Acces s Checklis t Property'ID : (^q^C( ^ Properl y Address : {(j^ ^ Cni KX\\ x 

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• ^ O Ajr\ir \
. Idrcss ^ v j Address : : D WOR K STARTE D D WOR K COMPELTE D
Rente r Phone : PiL\ : ON : ON : _/ / /_ /



### Phonc:_^^^.q^^ ^ Fax : Cell/Pager : Additiona l Information : Cell/Page r
D ff

] ( 3 1 CNotificatio nLette r Acces s Agreemen l Restoratio nAgreemen t Topsoi l Samplin g (i f applicable ) Sent : / / 

### Signed : lL/c^/i2 6 Signed : i \7^^)^ / Of , 1 1 By : 

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^y P^/.a ^ By : [U [Z

l Disposa J Samplin g (if applicable ) Gnrdc nSflmpliog (i f applicable ) 1 1 1 1 By : By : HI D D D Utility Clearanc e Video/Photo s (Before ) VicJeo/Photo s (During ) Video/Photo s (After ) Called : On : On : On : \\ / / / l^^lC^ ) / / / 

### B}' = »QlOQ|n B By:/VidJc//Br.« ^ By : By : D n Video/Photo s (30-Day ) Propert y Completio nAgreemen t On : Signed : /

/ / / By : 

### By : 1 D Pina l Repor t Issued : / / By : Ai r Monitorin g {a s applicabl e nCommunit y d j Cre w Results : ) OD : / / By :

D ComraunitA ' Results : • Cre w On : / / By : 1

1 D Communit j Results : d ) Cro v On : / / By :

Omah a Lea d Sit e

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

Comment : Owner Comment (s) :
Site Coordinato r Comment (s) : %



## CONTAC T FOR M (c'-^^fj ^
U n^ ^ Pt^ e >^-r^V^.
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. Date : Time : Action :

Date ; Time : Action : Date : Time : Action : Transmi t t o EPAD Othe r Action : D

### " Dougla s County Accoun t Infi|«|atio n Pag e 2 of 2 

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CLIC KT O ENLARG E IMAQ E CLIC KT O ENLARG E IMAG E Squar e Footage : 1440. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Goo d Uni t Type : Condition : Averag e

Buil t As : 2 Stor y Cond o Squar e Footage : 0. 0

HVAC : Centra l Ai rt o Ai r Rooms : 7. 0 Exterior : Masonr yFac e Bric k Units : 1. 0 Interior : Drywal l Baths : 1. 5 Roo fCover : Slat e Bedrooms : 3. 0

Roo fType : Gabl e Stories : 2. 0 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 193 0 0 0 % 193 0 7 9 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fenc e Woo d 1. 0 Applianc e Allowanc e 1. 0 Applianc e Fireplac e Masonr y 1. 0 Basemen t Bsmn t Bloc k 8 f t 700. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Fixtur e Bat h Hal f 1. 0 Garag e Attache d 300. 0 Porc h En d Soli d Wal l 240. 0 Porc h Ope n Sla b 120. 0 Porc h Ope n Sla b 150. 0 40. 0 Use r Roo fleak s i n spot s Porc h Sla b w/Step s 1. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO.
. . 11/25/200 8fiMB£ 

### Pag e 1 of 2 /•Dougla s County Accoun t InfiMBatio n 

# t

Dougla s County , Nebrask a Propert yRecor d - R084377000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o fQOt h S t - ViewO P M a p Informatio n i s vali d a s o f2008-11- 5 Treasurer' s Ta xRepor t Ne wFeatur e - • • ^ - > Aut o Sale s Searc h Owne r CARRIGA N J O AN N
163 3 COUNTR YCLU B AV E OMAH AN E 68104-000 0 Propert yInformatio n Ke yNumber : 437 7 000 0 0 8 Accoun t Type : Residentia l Parce l Number : 084377000 0 Parce l Address : 163 3 COUNTR YCLU B A V OMAH AN E 68104-000 0 Lega l Description : COUNTR YCLU B DIS TLO T1 4 BLOC K2 8 L T1 3 & S 1 0 F T6 7 X 12 3 Valu e Info n rmatio
200 8 200 7 200 6 200 5 200 4 200 3 Lan d $22,300.0 0 $22,300.0 0 $22,300.0 0 $22,300.0 0 $22,300.0 0 $22,300.0 0 Improvemen t $149,300.0 0 $149,300.0 0 $149,300.0 0 $149,300.0 0 $124,900.0 0 $124,900.0 0 Tota l $171,600.0 0 $171,600.0 0 $171,600.0 0 $171,600.0 0 $147,200.0 0 $147,200.0 0 Lan d Infor m a n tio Acre s 0. 2 S F Unit s 8911. 0 

### 1. 0 Dept h Widt h 

### 133. 0 Vacan t 67. 0 N o Improvement Inf n ormatio Buildin g 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO.
. . 11/25/200 8

### Pag e 1 of 2 %
" > Create Anothe rTicke t Bac k to irt hInterne t Sen d Emai l


### YOU RTICKE T NUMBE RI S 2182227
. Origina l Cal l Date : 11/25/0 8 Time : 7:1 1 p m Op : ELIZABETH18 7 9 0 Wor k t o Begi n Date : 12/02/0 8 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 163 3 Street : COUNTR Y CLU B AV E Twp : 15 NRng : 13 E Sect-Qtr : 18-N E 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: 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 MCLEODN E MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Utilit y

Servic e Are aContac t 

### Plion e Number Typ e 

### Day : 402934046 9 _-.^.TM , CO X COMMUNICATIONS , „_„ , CXCAT V „, „ HEID I 

### Alt : 402934046 9 IN C 

### Emerg : 402932975 7 Day : 800289190 1 N O NEE D T O CAL LOU T MCLEODN EMCLEODUS A 

### Alt : EMERGENC Y 

### Emerg : 800289190 1 Day : 402504782 3 METROPOLITA NUTILITIE S MUDO l SAND Y 

### Alt : DISTRIC T 

### Emerg : 402504797 0 Day : 402444719 7 CIT Y O FOMAHA

- OMAHACO F RO N 

### Alt : 402444516 1 TRAFFICSEWE R 

### Emerg : 402444516 0
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.
. . 1 1 /25/200 8

### Pag e 2 of 2

OMAH APUBLI C POWE R 0PPDGPR 5 N A DISTRIC T

QLNNEI C QWES T LOCALNETWOR K N A 

### % 

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

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.
. . 11/25/200 8

# As-Buil t Drawin g C OAST AL 

# Omah aLea dSuperfun dSit e ENVIRONMCNTA L GROUP
. INC
. OLS# : 6489 2 Dat e Excavated : 12/5/200 8 Dat e USEP ASigne d Off : 12/12/200 8 Are a Sodden : 67 3 s q f t 

### 6489 2 Exterio rPain t Nortt i Arro w Omati a Lea d Sit e • Goo d Sit e Sketc h Q^Poo r Samolin a Address : 163 3 COUNTR YCLU B A V • No t pain t \ 

# X

— Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentrati o n Collecte d Fim, : P F IW C n & T A RYASCPXA-6489 2 F l

_pp m Q ^ D Date : 'I/l- S ID A RYBSCPXA-6489 2 F 2 .pp m Q ' 

### U R D 

### Time : <^nnM ^ RYCSCPXA-6489 2 8 1 .pp m Q ^ D Sample s Arwiyze d RYDSCPXA-6489 2 B 2 Id H .pp m Q ^ D RDZSCPXA-6489 2 D Z .pp m Q ^ D XR F Unit : 6>S''V 0 Book ; 2/* ^ nz-'-Ff/*p\/ A/^Je/^' ^ .pp m n D Dat e /0-oZ-<^ & nrZECPX A6480 2 —P 2 .pp m • D Time : /?/» i Staff : mS U Numbe ro f Sample s = 5 

## 0 Legend : F l = Fron t Left
. F 2 = Fron t Rigtit , 8 1 = Bac k Lett , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla ; Al l quadrants ar e as viewe d fro m th e street , facin g propert y



### Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are a replace d wit h Are areplace dwit 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
.

## 6489 2 Omah a Lea d Sit e Exterio rPain t Nortt i Arro w 

### Sit e Sketc h • Goo d Q^Poo r Samplin g Address : 163 3 COUNTR YCLU B AV Q No t pain t Sampl e Numt)e r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d 

### Finm : PF IM COB T l RYASCPXA-6489 2 Fl pp m 

## D Date : ^/2'=^IOt ^ RYBSCPXA-6489 2 F2 

## LL8
_ pp m 

## D Time : q-inA M RYCSCPXA-6489 2 RYDSCPXA-6489 2 B1 82 pp m pp m 

## D 

# n Sample s Analyze d RDZSCPXA-6489 2 DZ 

# 8^ 1 pp m 

# u7 

# n XRF Unit : G^^ O Book : 2/* ^ RG20GrXA-6480 2 GS pp m 

# n D Dat e 

### /OOZ-02 > RPZSCPX A6480 2 -P 3 pp m 

# n D Tim e 

# A £n

Numbe r of Sample s = 5 Staff : 

# n^i ^ Legend : Fl = Fron t Left , F2 • Fron t Rigtit , Bl = Bac k Left , B2 = Bac k Righ tDZ = Dri p Zone , GZ = Garden , PZ = Pla> Al l quadrant s ar e as viewe d fro m th e street , facin g propert y

## 6489 2 Exterio rPain t Nortt i Arro w 

### Omah a Lea d Sit e • Goo d 

### Sit e Sketc h Q^Poo r 

# X X Samolin a Address : 163 3 COUNTRYCLU B AV Q No t pain t — Sampl e Numb>e r Lead Sampl e Sample s Collecte d LA B Concentratio n Collecte d Firm : P f IKJ C 0 & T A RYASCPXA-6489 2 F l 

## 13/ 5 pp m 

## D Date : ^/l^/p ^ RYBSCPXA-6489 2 F 2 

### 1L£ L pp m 

# u r D Time : q./OA M RYCSCPXA-6489 2 8 1 

## <^ b pp m 

# u r D Sample s Analyze d RYDSCPXA-6489 2 8 2 

## IQ' i pp m 

# u r D RDZSCPXA-6489 2 D Z 

## 86? ^ pp m 

# u / D XR F Unit : G^H ^ Book: 2.\° l ROZOCrX A0400 2 G i pp m 

## D D Date : 

## /oo z <g 8 nPZSCPXA6480 2 P 2 pp m 

## D D Time : 

# A DD Staff : 

## r?:5U ) Numbe rofSample s = I 5 > Legend ; F l = Fron t Left , F 2 = Fron t Rigtit , B l = Bac k Left , B 2 = Bac k Righ t DZ = Dri p Zone , G Z = Garden , P Z = Pla > Al l quadrants ar e a s viewed fro m tti e street , facin g propert y



### L f»i\irrvi
. y4fi?
. ^y
. • . Re \;ili;i S Crealed , 19-.\ug-ii S 114470 1 0 1 2. 3(•*"•«««•
.
COASTA L fNVinONflCNTft l CROUP , IN C 

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

### Granto r(th e propert yowner ) consent s t o an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA ) o rit s authorize d representatives , collectivel y th e Grantee , t o ente ran d perfor m certai n environmenta l respons e activitie s upo n th e followin g describe d premises :

Owner' s Name : Daytim e Phone : 

### ~1 ^ 4lrvr Krr^nCiO^^ ^ 

# 5"S 3 

# -?/3 ^
Addres s o fPropert y covere d b ythi s Agreement : 

# Hn^ Z Cj^anJri j C/^J b A/e , PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP Ai s requestin g acces s t o collec t soi l sample s an d remov e soi l tha t contain s elevate d concentration s o flea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t o remov e contaminate d soil
. Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o it s origina l condition
. Thi s wor k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o fCoasta l Environmenta l Group , contracte d b yUSEPA , wil l contac t th e Granto rin-perso n t o discus s th e wor k t o b e performed , th e Granto rwil l hav e a n opportunit yt o revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e i t begins
. Onc e th e wor k i s finished , th e Granto rwil l b e aske d t o revie wth e wor k an d confir m tha t i t i s complet e an d meet s wit h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m EP Atha t th e propert y ha s bee n remediated
.
ENVIRONMENTA L RESPONS E ACTION S 

### B ysignin g thi s Acces s Agreement , th e Granto rI s grantin g th e EPA , it s employees , contractor s an d subcontractor s th e righ t t o ente rth e property , a t al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e o fperformin g th e work
. Thi s acces s shal l remai n i n effec t unti l th e wor k ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :

Pag e 1 o f2 

### X

# ./'^ u 

# m V**** ^ COASTA L 

### ^^^. ^ C I 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 fth e propert yi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propert yt o perfor m th e work
. •Allo wvideotapin g and/o rphotographin g o fth e property
. AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s no t t o interfer e o rtampe rwit h an yo fth e wor k activities , o rwit h an y o fth e wor k done , o rwit h th e equipmen t use d o n hi s property , o rt o undertak e an y action s regardin g th e us e o fsai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o fth e Grantee s o rth e environment , o rt o allo wother s t o us e th e propert yi n suc h a manner . Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contac t Coasta l Environmenta l Group , a t (712 ) 352-018 8 

# Jj^ g Ingrant access t o mypropertie sD I d o no t gran t acces s t o m ypropertie s



### fl-2:^.<.- g
• 7 

# 'Z l Signature ^ Dat e SignatureDat e

OI woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.COASTA L
a Ko u > • IM C 

### Restoratio n Agreemen t The purpos e of thi s agreement i s t o provid e amutua l agreement a s to condition s o f the propert y prior to remediatio nactivities
. Tlii s will als o seiA' e a s documentatio nfo r the purpos e o f assurin g tha t restoratio n activitie s ar e completedt o the satisfactio nofth e propert> ' owne r an dthe UnitedState s Environmenta l Protectio nAgenc y (EPA)
. PropertyID : jp^ ^ ^<^Q ^ PropertyAddress : /(^3 ^

/ ^ 

### cy ArX^t j 

# y/ u 

# b RTQ^
. Owner : 

# ^J^ a 0,>r- i 

# c Oop i 

## 901= ^ Phone : 

# sr^'^fS ^
O

nthe attacheddiagram(s ) indicat e area(s ) t o excavatedan ddeptl i o f excavation , locationo f al l known utilities , subsurface features , syrface structure s an dlandscaping features , acces s location(s ) t o be usedb y contractor , an dthe directionof North
. Indicat e distances , depths , materia l types , etc . Indicat e digita l photo s b

y referencing 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 Start O f Remediation : (Us e additiona l sheet s a s necessary ) Th e removal , storage , disposal , and/o rretu m o f thes e item s i s th e Owner' s responsibility
. Kem :

I fam - < ' Ite m Item : Item : Item : Item : Item : Item :
Pag e 1 o f ( ^ ICOASTA L r»>VIMOMr<IMTAI
. cM o u r. t M c 

### Item s To B e Remove d B yContracto rDurin g Remediatio n An d No t Replace d (Us e additiona l sheet s a s necessary ) Item : 

# fi^s^l <^^//p/<=^^y^ ^ /^y^ yh^y^^ ^ Item : Item : Kem : Kem : Item : Kem : Kem : Item : Item : Hem :
ttem:

ttem: Item : Kem :

Pag e 2 o f^• ^
C Q AS TAL

• MVinONmCNTA L CMOU PIN 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 : 

# <{r.yyi y Item : 

# sy-F/~ D Item : Item : Kem : Kem : Item : Kem : Item : Item : Kem : Kem : Item : Kem : Kem :

Pag e 3 

# ofA—< »
COASTA L 

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

### Ite m 

## Quantit y Uni t 

## Condition/Type/Specie s 

# F ( Pre-existin g propert y area , tha t will be excavated , tha t Squar e fee t i s covere dwit hgrass . 

# T5Ue6-^^3 ^

Number of tree s > 2 inch trun k

diameter Eac h

Number of tree s < = 2 inch trunk diameter Eac h

Number of Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Attachasketchof the sprinkler layout
. Eac h

Number o f an dsiz e o f eachgarden / flowe r be d
Attac hasketchof relativ e size s an dlocations
. 

# 7 Eac h Squar e Feet 

# M 8- P0 ^

.#
. Pag e 4 o fyg '-' - *•
COASTA L
> M O U P 

## Item Quantity Uni t Condition/Type/Specie s Agree dupo nvalu e o f plan t material s no t to b e renlace dbv contractor . Note thi s valu e will b e use dt o issu e aplan t vouche r to th e propert y owner . Agree duponlis 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 asketcii of wer e eachplant wil l b e placed b

y the contractor . Agree dupo nare ao f property to b e replace d wid i gras s sod
. Include asketcho f the area(s ) t o b e replace dwit h gras s sod
.
Are ao f Cit y or Count y propert y to b e landscaped per their requirements
. Include asketcho f the are a(s )

Easement Area , to b e excavate d 

# f $ 

# < f Eac h 1 

# f^m S F 

# -gluLeCr^^^ s 

# f S F 

# L)e' > S F 

# 1 -y^e-Aifi-eJi^insJ

Pag e 5 of
. 

### ( f fC O AS T A I. KMVUMOMHCMTA L


### Additiona l Comments / Instructions :

D Chec k th e bo x ifOwne rdoe s no t war\ t CE G to documerr t interio rfbundatio n wall s an d possibl e pre-existin g damage
. Bycheckin g thi s boxCE G is no t responsibl e fo ran ydamag e don e to th e interio r ofhouse , indudin g foundatio n crack s orfissures. 

# 5^
. agre e Q Ido not agre e

^ OCT' S Signatur ire

e / Dat e Contractor' s Sffinature Dat e 

### Pag e 6 of
.BVID # (r.AB^/ ^ XR F PROPERT YSAMPL E SHEE T Dat e 

### 10 - (o-Of t Addres s I LC.3,- ^ C,r < JL^^^- \ T^ x0 i ) U V lAs/'e ^ Projec t Omah a lea d F P 2n d yea roptio n Sampl e tim e O am/p m '^n-.^^- ^ XRFID # '<^i^P> ^ sampl e lengt h 3 0 se c

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

## ^8^ ^ a^.ip. * ~?.u a 

### M^^ ^ \Ci,.c-\Rtn,a « 

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. n.'-^' T11.\ \ 

# eu^^ y Mft?,( o M<-...3^tS.o^ \ Dept h 

### H-H^i o i^H.<4yyi.ic B Dept h 

### c^gSRiSo Q a\.^\y^n.^ ^ 

## 1 

## ^8^ 1 ^ ^ 

## ^8a n Averag e c-^ J - I ^ , ^ S CI S Averag e Jdh. j o:3^ i "1 - a U
Shot # 

### '^B<A H 

### ^B?. 0 ^BS l ^^G ^ Averag e Readin g I'AiD.J Q t-ia-^i o \>?..n«t\?>fA e i^-^^.ft ^ t\?>.'\ i IfiS.ul-lU'.U? ^ Sampl e are a 

## ] ^ \

Dept h 

### t 0 14^^
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Averag e Readin g Sampl e are a Dept h

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

Shot # Readin g RETES TAREA S Sampl e are a Shot # Readin g Sampl e are a Dept h
7 Dept h Averag e Averag e la b sampl e # La b resul t Sampl e are a XR F Avg
. Signature
_ 

## Prin t M/H^< ^ M'W^ i

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

Supervise d By : 

## Certificat e o f

Verificatio n

485 8 SOI L 2008-12-0 6 10:2 2 122.3 2 Fina l |Av g o f 4854-485 7 nL63 3 countr yclu b av e # Z

Ventr y *^1 3

CLEARANCEJ I

# 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 22.15 0 Supervise d By : 

## Certificat e o fVerificatio n

485 4 SOI L 2008-12-0 6 10:2 0 30.4 3 Fina l 6489 2 163 3 countr yclu b av e D Z Ventr y 1 3 CLEARANC E

± Erro r
± 7.41 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 25.92 9 Supervise d By : 

## Certificat e o fVerificatio n

485 5 SOI L 2008-12-0 6 10:2 1 30.6 7 Fina l 6489 2 163 3 countr yclu b av e D

Z Ventr y 1 3 CLEARANC E

± Erro r ± 7.57 9

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 485 6 Mod e SOI L Tim e 2008-12-0 6 10:2 1 Duratio n 30.4 4 Sequenc e Fina l Flag s BVI D # 6489 2 ADDRES S 163 3 countr yclu b av e QUAD/ZON E D Z INSPECTO R Ventr y DEPT H 1 3 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P b 40.28 6 ± 9.08 5 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 28.38 1 Supervise d By : 

## Certificat e o fVerificatio n

485 7 SOI L 2008-12-0 6 10:2 2 30.7 8 Fina l 6489 2 163 3 countr yclu b av e D Z Ventr y 1 3 CLEARANC E

±Erro r ±8.01 8

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 484 8 Mod e SOI L Tim e 2008-12-0 6 10:1 5 Duratio n 122.8 7 Sequenc e Fina l Flag s AVERAG E fAv g o f4844-484 7 ADDRES S 163 3 countr yclu b av e QUAD/ZON E easemen t INSPECTO R Ventr y DEPT H 1 1 SAMPL E TYP E .CLEARANC E NOT E

P b 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 19.48 2 Supervise d By : 

## Certificat e o fVerificatio n

484 4 SOI L 2008-12-0 6 10:1 3 30.3 8 Fina l 6489 2 163 3 countr yclu b av e easemen t Ventr y 1 CLEARANC E

±Erro r ±7.48 0

# 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 17.47 3 Supervise d By : 

## Certificat e o fVerificatio n

484 5 SOI L 2008-12-0 6 10:1 3 30.9 9 Fina l 6489 2 163 3 countr yclu b av e easemen t Ventr y 1 CLEARANC E

± Erro r
± 7.11 3

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

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

pp m P b 24.45 4 Supervise d By : 

## Certificat e o fVerificatio n

484 6 SOI L 2008-12-0 6 10:1 4 30.6 8 Fina l 6489 2 163 3 countr yclu b av e easemen t Ventr y 1 CLEARANC E

± Erro r
± 7.67 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 21.09 6 Supervise d By : 

## Certificat e o fVerificatio n

484 7 SOI L 2008-12-0 6 10:1 5 30.8 2 Fina l 6489 2 163 3 countr yclu b av e easemen t Ventr y 1 CLEARANC E

± Erro r ± 7.49 5

# Therm o SCIENTIFI C Therm o Fishe r Scientifi c 90 0 Middlese x Turnpik e Billerica , M A0182 1 

## Certificat e of Verificatio n XL3t-3208 9 Readin g N o 485 3 Mod e SOIL Tim e 2008-12-0 6 10:1 9 Duratio n 122.5 9 Sequenc e Final Flag s AVERAG E |Av g o f 4849-485 2 ADDRES S '163 3 countr y clu b av e QUAD/ZON E 

### P= l INSPECTO R Ventr y DEPT H SAMPL E TYP E ^.CLEARANC E NOT E

Supervise dBy :

# 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 140.21 5 Supervise d By : 

## Certificat e o fVerificatio n

484 9 SOI L 2008-12-0 6 10:1 7 30.5 7 Fina l 6489 2 163 3 countr yclu b av e F l Ventr y 6 CLEARANC E

± Erro r
± 14.89 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 113.08 0 Supervise d By : 

## Certificat e o fVerificatio n

485 0 SOI L 2008-12-0 6 10:1 7 30.5 6 Fina l 6489 2 163 3 countr yclu b av e F l Ventr y 6 CLEARANC E

± Erro r ± 13.56 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 121.81 7 Supervise d By ; 

## Certificat e o fVerificatio n

485 1 SOI L 2008-12-0 6 10:1 8 30.8 4 Fina l 6489 2 163 3 countr yclu b av e F l Ventr y 6 CLEARANC E

± Erro r
± 13.91 4

# 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 185.60 5 Supervise d By : 

## Certificat e o fVerificatio n

485 2 SOI L 2008-12-0 6 10:1 9 30.6 2 Fina l 6489 2 163 3 countr yclu b av e F l Ventr y 6 CLEARANC E

± Erro r
± 16.67 9

### 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 COASTA L ENVIRONMENTA L CROUP , IN C 

# EXECUTIV ESUMMARY : BVI D #6489 2 - (1633 COUNTR Y CLU B AV EST )
I I N o Issue s o r Concern s X 

# Issues/Concern s
Detai l Explanation: CONCERN S ABOU T TH ESOD
. WIL LREVIS EI NSPRIN G2009
.

### # S30S
. 

# EP A EP APropert y Clos e Ou t For m Propert y # : 

# oAe ^ 

# Q Propert y Address : |(g?^ 3 CooorvVyO AC'^V ^ /W^-
. Date/Time : Owner' s Name : r'c>.^r"vcAOof x . '^^'NPV^•^ ^ Q Quad s Excavaled : P\
. ^ ^Tvf c Contracto r Grou p eJOO^-VcoQ , feov^^ reoJt^^A^^^^-o ^
Excavatio n Genera l Ye s N o 1
.

Ifnecessary , wer e th e correc t quadrant(s ) excavate d an d restored ? 

### y 2
.Ifnecessary , wer e th e correc t area s ofdri p zon e excavate d an d restored ? ^ Gradin g So d an d Vegetatio nYe s N o 1
.

Doe s th e gradin g around th e perimete rofth e hous e i n excavate d areas generall yslop e away [ ^ from tb e house ? 2
.Ha s so d bee n lai d i n al l areas tha i were excavated ? 

### y 3
.

Doe s th e sod appea rt o be generall yhealth yan d growing ? (Onl yevaluat e i finspecte d a t a 3 0 da ytim e period ) 4Ar e sodde d areas generall yfir m an d evenl ygraded ? y 5Ar e th e joint s tietwee n th e so d strip s generall ytight ? (Onl yevaluat e i finspecte 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 not poo l o n th e properry" ' 7
.Wa s damag e l o landscapin g o rplan t material s avoided ? ^ Gates , Fence s an d ReUinlo g Wall sYe s N o 1
.

D o gate s ope n an d clos e freely? (Ifapplicable ) y y 2
.Wer e al l gates o rfence s take n dow n durin g restoratio n activitie 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 ) # Foundation , SidiD Kan d Gutter s Ye s N o 1
.

Wa s damag e t o th e sidin g o rtri m avoided ? y 2
.Wa s damag e t o th e foundatio n avoided ? L ^ 3
.

Wa s damag e t o window s avoided ? 

## y 4
.

Wa s damag e t o window s o rdoo rscreen s avoided ^ y 5
.Wa s damag e t o dowTispoul s o rdownspou l extension s avoided ? 

# A
Sidewalk s an d Driveway s (Concrete )Ye s N o I
.Wa s damag e t o drivewa ysurface s avoided ? y 2
. Wa s damag e t o walkwa ysurface s avoided ? 

# y

## O fner s comments : #



## Inspectio nnotes : 

# ,y^yl^]U^U^^c9M
. <^y ^ ^ /

Remova l andrestoratio nactivate s complet e includin g the 30-da y so dwarrant}' : EPARepresentative^^;^^^^^£^;^^^t74 ^ Date : 7yy7Py^ ^

### %



## Propert yCompletio n Agreemen t Tlii s iigreeineni document s th e complclio no f remedial activilies perrorme do nm y properly
. M y signalur e will designal e Iha t I a msalislie dwilhth e restoralio no f m y properly , an dthat a o ilem s ar e i nquestions , now , or a

t any tim e i nth e future , excep t thos e item s lisle dbelow , ifany
. 

### Propc
. lyJD^j^t/g9P ^ Propert y ATdrcss : /( ^ 3.3 , Qc ^ ^, , Owner : —r * „ /" Phone : - - - '- ' 5r3rJlZ3
_ Restoratio n Item s i n Question :

Item : ttem : Item : Item : Item : Item :
Additiona l Comments : . CL M 4 ^ •

• 7* ' ly ^ aurct ' rr.storalio ni. s completed , excep t a s note d I I d o no t agre e rcslnrntio nk complete d
^•2--/51-o g r«nitractor' s .Sij^natur e I