## TRANSMITTA Lof OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R

SAI D 

# «:JC0f ^ Address : 

# W ^ k \

H( ^ "! < Date : 

# i M i \( ?

Remediatio nContractor : Coasta l Environmenta l Grou p Year ; 20 i Of t
SOI LREMEDIATIO N PROPERT Y nLEFOLDE RDOCUMENT S



## fef

5 / Vide o o f property (DVD ) Executiv e Siunmai y EPA-provide dproperty sketch SignedAcces s Agreement fo r subject property SignedAcces s Agreement(s ) fo r adjacen t propert y Restoratio nAgreement Settlemen t document s (i.e. , fo r damag e o r to replac e plants , etc. ) Confinnatio ndata 

## t / 

# d 

# J Photograph s iU (^'^AVM 

### As-built sketch Satisfactor y restoratio nsigne db y Propert y Owner Propert y close-out diec k lis t signedb y EP A Descriptio no f area s no t meetin g RO D cleanup criteri a Utilit yclearance s 

### Propert y informatio nfro mDougla s Count y Assessor' s Office D U 

## n

Dat e ignature

### # • « •



## Propert yAcces s Checklis t Proper , LP : f;^05?i ^ Propcn vAddress : X l i Q N H* ^

5 ^ D n WOR K STAJITED WOR K COMPELTE D ON : ON : / / /_ /
_ 

# oxvnci : Y^csV^v ^ Addr.» : 5^V7Vfi > 

# ^>rSYY\3v n Rente r Phone : P«L\ : 

## Phone : C:^59p^qf ^ F«x : Cell/Page r Cell/Pager : Additiona l IntnrmHtion :

C

D Notificatio nL/Cttc r 

# wAcce u Agreemen t QZ' Reslontio D Agreemen t C ] Topsoi l Samplin g (if appllcuble ) Q DispoiiUSanaplin g (if ^applicable ) Q Gnrdc nSamplin g (i f applicable ) B " Utility Clearanc e 5^Video/Photo s (Before )

• Video/Photo s (During ) D Video/Pholo i (After ) D Viileo/Photo s (30-Diiy ) 

# W ^ Propert y Complelio nAgreemen t D fina l Repor t Sent : Bv : Signed : " 7 Ii Q I€f \ 

### By#--l^i Q Signed : JZ./i Q (22

- By : 

# ^fya n By : / / By : / / By : Called: 7 l" ^

l^ \ 

## on-X'^Q-' ^ On : / / Bv : On : By : OP : / / 

# 58 : 

# S By : Signe d By : Issued : / / By : 

## yOi a 

# Z I
Ai r Monitorin e (-A S jpplicable ^ D Communit y Q Cre w RuuJts : On : / / By :

C ! Community ' Resulls : D Cre w On : / / By :

O Communir i ResulU : D Cre w On : / / By :

Omah a Lea d Sit e• • • •



## CONTAC TFOR M Propert y ID #5^f)(-)& 0 Propert y Address : Z-12 D ts i M ^ JS i Initia l Contact : Date : Y-^^Time : 2,:| 0 Secon dContact : Date : Time : Fina l Contact : Date : Time : Fina l Action : Transmi t to EP AD

Comment : Owne r 

# P & / WhloM i Itn Commen t (s) :
Sit e Coordinato r Commen t (s) : Action : ' Action : Othe r Action : D



# cM o ^ a^f/ e• • 

## Dougla s Count y Accoun t I g^mM^o n Pag e 1 of 2
Dougla s County , Nebrask a Propert yRecor d - R241656000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t o f52n d S t - ViewO H Ma p Infomiatio n i s vali d a s o f2009-6-1 6 Treasurer' s Ta xRepor t Ne wFeatur e -•-»- •Aut o Sale s Searc h Owne r FORSMA N ROBER TA ETA L 272 0 N 4 8 S T OMAH AN E 68104-000 0 Propert yInformatio n Ke yNumber : 

### 165 6 000 0 2 4 Accoun t Type : Residentia l Parce l Number : 241656000 0 Parce l Address : 272 0 N 4 8 S T OMAH AN E 68104-000 0 Lega l Description : WEARN E PAR KLO T6 BLOC K1 4 0 X 106. 4 Valu e Informatio n Lan d Improvemen t Tota l 

### 200 9 $5,400.0 0 $67,200.0 0 $72,600.0 0 200 8 $5,400.0 0 $67,200.0 0 $72,600.0 0 200 7 $5,400.0 0 $67,200.0 0 $72,600.0 0 

### 200 6 $5,400.0 0 $67,200.0 0 $72,600.0 0 200 5 $5,400.0 0 $27,200.0 0 $32,600.0 0 200 4 $5,400.0 0 $27,200.0 0 $32,600.0 0 Sale s Informatio n Sale s Date : 

### 1993-06-0 6 Dee d Type : Book : 195 7 Page : 16 8 

## Price : $29,500.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 9 4240. 0 

### 1.0 106. 0 40. 0 N o Improvemen t Informatio n


## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R241..
. 7/7/2009• • 

### Dougla s County Accoun t Ii||ft||nM^o n 

### Pag e 2 of 2

Buildin g 1 1 1/ 2 StoryFi n 272 0 N 4 8 S t

= ?

•L 1 ; »H5i«i- i I S

10

4 i4 R
(t.nrt*»M*f n 91?D9sF : CLIC KT O ENLARG E IMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : 1315. 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 : Force d Ai r Rooms : 6. 0 Exterior : Fram e Viny l Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo fCover : 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 191 6 0 % 191 6 9 0 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 912. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 242. 0 Porc h En d Soli d Wal l 104. 0 Porc h Woo d Dec k 100. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R241.
. . 7/7/200 9

### Pag e 1 o f 1

" > [ Creat e Anothe rTicke t ][ " Bac k tolrt h Interne t | [ Sen d Emai l |



## YOU R TICKE T NUMBE R IS 2328271 . Origina l Cal l Date : 7/28/0 9 Time : 4:0 3 pmOp : ELIZABETH1879 0 Wor k t o Begi n Date : 7/30/0 9 Time : 4:4 5 pm State : N E County : DOUGLA S Place : OMAHA Address : 272 0 Street : N48T H S T Twp : 15 NRng : 13 E Sect-Qtr : 07-NE-SE,08-NW-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lead 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 Compan y: COASTAL ENVIRONMENTAL SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : Coasta l Dept ho f Excavation : 4 ft . Corne r Lot : NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCATV MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are aContac t Phon e Niunbe r Utility Typ e


### CXCAT V CO XCOMMUNICATIONS , IN C HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
MUDO l METROPOLITA NUTILITIE S DISTRIC TSAND Y Day :

Alt : 402504782 3

EmeiB : 402504797 0
OMAHACO FCIT Y O FOMAHA-TRAFFIC.SEWE RRO N Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0
OPPDGPR 5 OMAH APUBLI C POWE RDISTRIC TN A Day : 406728934 3

Alt : 406207149 4 Emerg : 888728934 3 QLNNEI C QWES TLOCA LNETWOR K

N A Day : 406728934 3

Alt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 7/28/200 9

# As-Buil t Drawin g ^ P

COASTA L 

# Omah aLea dSuperfun dSit e
8508 0 Exterio rPain t Nort h Arro w Omah a Lea d Sit e | ~ | Goo d Sit e Sketc h [3^oo r Sannplin g Address : 272 0 N 4 B ST I I No t pain t Sampl e Numbe r Lea d Sampl e Sample s Collecte d LJ^ B Concentratio n Collecte d Firm : R e TMT

. O B T \ RYASCPXA-8508 0 F 1 pp m 

### D Date : \^2Mc & RYBSCPXA-8508 0 F 2 

### i z t o pp m 

### D Time : i:HSm A RYCSCPXA-8508 0 B l 

### Hl ^ pp m 

### D Sample s Analyze d -RYDOCrXA-0500 0 B2 - pp m 

# n R DZSCPXA-8508 0 D 2 

### H*^L , pp m XR F Unit : jpSH O

_ Book : Z-'Z.'- f 

# • ROgOCrXA-0500 0 S2
- pp m 

### D Date : n~'2J[jr
- •C G RPZOCPXA-OGOe O P 2 

### — pp m 

### D 

# • Time : 

## _flcn
_ Staff : Numbe ro fSample s -• 

# r^c ^ Legend : F 1 = Fron t Left , F 2 = Fron t Righ t B l = Bac k Left

. 8 2 = Bac k Righ t D Z = Dri p Zone

. G Z = Garden , P Z = Pla > At ! quadrant s ar e a s viewe d fro m tti 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 So d Are areplace dwit h Rock/Mulc h Are alef t bar e 

### Contract : # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
.• *



### 8508 0 Exterio rPain t Omah a Lea d Sit e
•Goo d Sit e Sketc h Q^oo r Samplin g Address : 272 0 N 4 8 S

T •No t pain t Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Sample s Collecte d Firm : PEINC

. Dft T \ RYASCPXA-8508 0 F l pp m D Dale : \\llb\n ^ R YBSCPXA-8508 0 F 2 IZ/ O pp m D Time : J. - M S Pt K RYCSCPXA-8508 0

- R YDOCrXA-0500 0B l B?
­ pp m pp m 

## a D D Samples Analyze d R DZSCPXA-8508 0 D Z R OgOCrXA-0500 0 S2
- RP'gocr'XA-osooo—P i pp m pp m pp m 

## n D Numbero fSample s =|4 | 

## n D D | ^ | XR F Unit : Cp5H(l

_Book : Date : tl'2Jijr-O d Tim e firm Staff : rQ56> ^ ZZ ^

Legend ' F l = Front Left , F 2 = Front Right , B l = Bac k Left , B 2 = Bac k Right O Z = Dri p Zone , GZ = Garden , P Z = Pla ; Al l quadrant s ar e a s viewe d fro m th e street , facin g propert y



# -r^ - c d

­

### • • ^ »

8508 0 Exteno rPain t Sit e Sketc h Omah a Lea d Sit e •Goo d Q^oo r Samplin g Address : 272 0 N 48 S T Q No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : P^Twr , Df t T \ RYASCPXA-8508 0 F l ~ l °\" \ pp m 

## n Date : ll/za// ^ RYBSCPXA-8508 0 F 2 12-1 0 pp m 

## n Time : ;.'VSi m RYCSCPXA-8508 0 B l 

### _12^pp m D Sample s Analyze d • RYDOCPXA-Q500 0 B2 - ~ pp m 

## n R DZSCPXA-8508 0 D Z ^5Z c pp m 

## a XR F Unit : (p5H 0 Book : ZZ y ROZOCnXA-0508 0 S3
- ~ pp m 

### D Date : tt-2jj,-^-0 9 

### D R r^ZOCPXA-SSOBO P i " pp m 

### D Time : 

### flm 

## n Staff : < ^ ^ Numbe ro fSample s = I 4 | | ^ [ Legend : F l = 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 ; Al l quadrants ar e a s viewe d fro m th e street , facin g propert y

### 8508 0 Exterio rPain t Nort h Am w Omah a Lea d Sit e •Goo d Sit e Sketc h |3^oo r Samplin g Address : 2720_N4BST

_ •No t pain t Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Firm : Samples Collecte d feTur, D R T V RYASCPXA-8508 0 F 1 pp m ^ 

### D Date : li/yA/rtf t RYBSCPXA-8508 0 RYCSCPXA-8S08 0 -RVDOOPXA-OSOO O

F 2 B l B2 - IZI O pp m ppm pp m 

# g \

^ 

### D , D D D Time : j-WSff M Sample s Analyze d R DZSCPXA-8508 0 O Z pp m 

### \3 ( 

### D XR F Unit : (pSH O Book : ZZy ROZOOPXA-0500 0 62 - ppm 

### U D Date : I l-20 r0 0 RPZOOPXA-OSOeO P Z pp m 

### D D Time : flm Numbe rofSamples " I L | | j Q [ Staff : rOSf. ^ Legend : F l = Front Left , F 2 = Front Right , B 1 = Bac k Left , B 2 = Back Right D Z = Dri p Zone , G Z = Garden , P Z = Pla t Al l quadrant s ar e a

s viewa d tn m th a street , fadn g pnpeity 

### «fOV 2 

## laoo i

» * y? ^

T 

### B i :^7< ^ < 3

dftN L PfCl C


### DZ

- HSl k

M
. 

### F l 

## 1^ 1

WALy

. 

### .N.MB.Sf

. Re%':iJi| 8 Ciejud : I7-S<pJ »

# 9

COASTA L ENVIRONHENTA L C K0 U P , 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 : 

# ft. Daytim e Phone : Owner' s Name : ^O^Hft- j p2>A5^/U>fA ;

I I Addres s o fPropert y 

# 11X 6 

# A ) '\^ ^ 

# ^t covere d b ythi s I Agreement :
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 perfonned , 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 

### Bysignin 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

# f

- . /

I

U 

### %

< COASTA L ENVmOHHENTA L "^' V PROt*- ^ CROUP

. IH C


### •Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; e 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 necessarysubsequen t t o a n initia l waterin g perio d b yEPA ; eAbid 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 Coastal Environmenta l Group , a t (402 ) 991-119 9

\^ \ gran t acces s t o m ypropertie s G I d o no t gran t acces s t o m ypropertie s

Dat e ^ Signatur e Date

QI woul d lik e t o b e presen t durin g an ysamplin g tha t i s required

.

Pag e 2 o f2c » ns 

## Ros^toratCQPi
. Agreemen t Th e purpos e ofthi s agreement i s to provid e amutual agreement a s t o condition s ofth e propert y prior t

o remediatio nactivities
. Thi s will als o serv e a s documentatio nfo r th e purpos e of assurin g that restoratio n activitie s are complete dto th e satisfactio nofth e propert y owner an dthe UnitedState s Environmental Protectio nAgenc y (EPA)
.

Property ED : g^g ^ Property Address : ^/ ^ J ^ ^ ^ '^J ' IQ^'''"

- ^RE^Tf'^(L<,MA O

Phone : = O nth e attache ddiagram(s ) indicate area(s ) to excavate , surfac e structure s an dlandscaping feature s an d acces s location(s ) to b e usedby th e contractors . Indicat e distances , depths , materia ! types , etc . Photographicall y an dVideographically document the existin g condition s ofthe propert y andth e basement i

f necessary . 

## ItsifS S t o b e Remove db y th e Owne r befor e StarC : o f

Remediatioiri : ;.ii. 5 .c-riovf.i : g'iotccfc , c-isojtifcl , fc:io/ot ;e(.:i. i c ' ttifcf; ^ iiin'i & if

- ir\^
. Uwhsi f ii:£f.c;i{:ii..!i:iy
. Iteim : A '\^^<€ ^ 

# w?\A s t Kem : ^ 

### I Item :

Item :



## Item s t o b e Remove db y th e Contracto r Durin g Remediatio nan dNo t Replace d item : , . ,| |

Pag e 1 o fC J » 4 S TM L 

### \i<sm & to B e Remove d Ei^_Coin t 

### irscto rDurirv ^

Remediatio n en d Recsisce d i l£em :

Item : 

# 4.^ 4 -F \ Kem : 

# I I Item : 

# i

Item Pre-existin g propert y area , tha t wil l b e excavated , tha t i s covere dwit hgrass . Number o f tree s > 2 inch trunk diameter Number o f tree s <= 2 inch trunk diameter Number o f Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Aliac hr . sketc ho l tli c
Number o f an dsiz e of eac hgarden/ flower bed area . Alliicl i i

l ski'lcl ' 11 1 rtliiliv f siZi'f
. an dli'caiioii s Agree dupo nvalue o f plant material s no t to b e replace db v contractor .

• 'c;.-. ' !'•:•
. -,!(' • . i
. l-i:
. .'£•'( ' .( ' ':• ' : r . : .l.V.li '

' Cli'.' i V •'- , '':' • \:
. CH " , U.'
. f ' t l
. Easement Area , to b e excavate d J 

# f ^ ^ , 

# 5 1 D Z
»./^ ) V 1 1 1



## Landscap e inventory Quantity ' Uni t Quadrant s 

## Condclion/Type/Specie s

|'£<i*y ^ 

# P W Eac h
Each

Each

^ Each Square Fee t 

# k $



### \< > Each 

## TW^>a ^ ^'C'=>^ 6
Pag e 2 o , - ^C »- A, S 1 /•L



### Additional Comment s / instructionE :

Q Chec k th e bo x

ifOwne rdoe s not 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 GIs not responsibl e fo ran ydamag e don e to th e interio r ofhouse , includin g foundatio n crack s

orfissures

.

S] Iagre e nI do no t agre e

natur e e ^ Dat e / Contractor' s Dat e Pag e 3 of / 'wner' s Signatur - Contractcjf' s Signatur Signatur e eDat e Project XRFID #

Shot # 2.-\»( ^ 

## '2-n n • av? ; ^ m

Averag e

Shot # 

## 2-^q ^ ^ ^ ^^^ \ ^^'bT

. Averag e

Shot # 

### jl^r ^ 

# j25aa

­

x ^ ^ ^fts \ Averag e

Shot #

Averag e la b sampl e # 

# -sasjjQa

. Omah a lea d F P 2n d yea roptio n ^rLrSjO j

Readin g Sampl e are a ^-l.?flti o Mfc.iJQt\ 0 

# e> l H^.i^q t I O Dept h Z%.'b\ ±J , 

### l p 46.36* ^ \f )
Readin g Sampl e are a 

### OPiA'^- i * » 

# Ir l Dept h tflO.Cftj^i O 

## to-a.-^gx^ 

# 3_ 0*0»Dr \ Jc\ n
Readin g Sampl e are a 

## F-^

­ 4\..^1.- ^ S Dept h \a.^Qqi\g ; C£>%."\'?>' ^ \ V Addres s Sampl e tim e sampl e lengt h Shot # 

### ^•^O L 

# aip ^ jiAca

. jQfi ^

Averag e

Shot # 

### ZSiit3
. ggtp H ^f?^g ^ '^.^bt^CT )

Averag e

Shot #

Averag e

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

L^b resul t Sampt e are a Averag e XR F Avg

. BVID # Sg)D^ &
'in-L O U«48<5. A am/p m 3 0 se c Readin g Sampl e are a 

### \qg..'L'=^-v n 2iS^.i/>(/>-tl' 8 

# ep^ Dept h 

## ^cn^l'\•^\' i ^\itn"i*\' s "IXH^.V^J : \ %
Readin g Sampl e are a a.i-\it^-t\ ^ 

### y>-?7.- t \7 , 

# v ^ Dept h U>Qi^^'i= ^ \

\ 

## 40.0^1^
. 

# 13

­ ^^.H^J i \1

. Readin g Sampl e are a Dept h

Readin g Sampl e are a Dept h 

### XR F PROPERTY SAMPL E SHEE T

Signatur e CC^f^iJ^tr s 

## Prin t fixr^iro ^ rVlg>0?Q A

# 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 272 0 Mod e SOI L Tim e 2009-08-0 5 15:1 2 Duratio n 121.6 0 Sequenc e Fina l Flag s AVERAG E gAv.q.6f.i2r7.1.6.-2719 l ADDRES S 272 0 N 4 8 S t QUAD/ZON E B l INSPECTO R Nicola s DEPT H 6 SAMPL E VfP E RETES T NOT E

pp m ± P b ± Supervise d B y 

# :(^to £ 'JlJ^C A

# 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 57.39 2 Supervise d By : 

## Certificat e o fVerificatio n

271 6 SOI L 2009-08-0 5 15:1 0 30.5 7 Fina l 8508 0 272 0 N 4 8 s t B l Nicola s 6 RETES T

± Erro r
± 10.38 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 Mode 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 46.49 2 Supervise d By : 

## Certificat e o fVerificatio n

271 7 SOI L 2009-08-0 5 15:1 1 30.4 8 Fina l 8508 0 272 0 N 4 8 s t B l Nicola s 6 RETES T

± Erro r 9.69 1

# 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 48.99 4 Supervise d By : 

## Certificat e o fVerificatio n

271 8 SOI L 2009-08-0 5 15:1 1 30.1 5 Fina l 8508 0 272 0 N 4 8 s t B l Nicola s 6 RETES T

± Erro r ± 10.12 5

# 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 28.53 1 Supervise d By : 

## Certificat e o fVerificatio n

271 9 SOI L 2009-08-0 5 15:1 2 30.4 0 Fina l 8508 0 272 0 N 4 8 s t B l Nicola s 6 RETES T

± Erro r
± 8.21 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 270 6 Mod e SOI L Tim e 2009-08-0 5 13:1 2 Duratio n 121.4 1 Sequenc e Fina l Flag s AVERAG E ADDRES S *^^72 0 N^4 8 s t ' QUAD/ZON E easemen t INSPECTO R Nicola s DEPT H 1 SAMPL E TYP E CLEARANC E NOT E

pp m Erro r P

b 

## CJO^MI ? ±[MM 3 Supervise d By : CJpCGi^Ji ^ HA

# 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 195.22 7 Supervise d By : 

## Certificat e o fVerificatio n

270 2 SOI L 2009-08-0 5 13:1 0 30.5 1 Fina l 8508 0 272 0 N 4 8 s t easemen t Nicola s 1 CLEARANC E

±Erro r ±17.19 0

# 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 209.65 9 Supervise d By : 

## Certificat e o fVerificatio n

270 3 SOI L 2009-08-0 5 13:1 1 30.3 1 Fina l 8508 0 272 0 N 4 8 s t easemen t Nicola s 1 CLEARANC E

± Erro r
± 17.77 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 207.78 7 Supervise d By : 

## Certificat e o fVerificatio n

270 4 SOI L 2009-08-0 5 13:1 1 30.2 7 Fina l 8508 0 272 0 N 4 8 s t easemen t Nicola s 1 CLEARANC E

± Erro r
± 17.72 5

# 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 212.46 8 Supervise d By : 

## Certificat e o fVerificatio n

270 5 SOI L 2009-08-0 5 13:1 2 30.3 2 Fina l 8508 0 272 0 N 4 8 s t easemen t Nicola s 1 CLEARANC E

± Erro r
± 17.71 4

# 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 255 3 Mod e SOI L Tim e 2009-08-0 4 09:0 8 Duratio n 121.0 4 Sequenc e Fina l Flag s AVERAG E rSv q o f2549-255 2 ADDRES S ^2 0 N 4 8 s t QUAD/ZON E F l INSPECTO R Nicola s DEPT H 8 SAMPL E TYP E CLEARANC E NOT E

Erro r P b 

### ±f 10.22 8 / Supervise d By : pp m

# 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 254 9 Mod e SOI L Tim e 2009-08-0 4 09:0 6 Duratio n 30.5 4 Sequenc e Fina l Flag s BVI D # 8508 0 ADDRES S 272 0 N 4 8 s t QUAD/ZON E F l INSPECTO R Nicola s DEPT H 8 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 66.91 0 ±10.97 9 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 29.93 1 Supervise d By : 

## Certificat e o fVerificatio n

255 0 SOI L 2009-08-0 4 09:0 7 30.1 2 Fina l 8508 0 272 0 N 4 8 s t F l Nicola s 8 CLEARANC E

± Erro r
± 8.47 2

# 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 255 1 Mod e SOI L Tim e 2009-08-0 4 09:0 7 Duratio n 30.2 1 Sequenc e Fina l Flag s BVI D # 8508 0 ADDRES S 272 0 N 4 8 S t QUAD/ZON E F l INSPECTO R Nicola s DEPT H 8 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P

b 60.05 3 ±10.46 0 Supervise d By :

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

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

pp m P b 63.38 4 Supervise dBy : 

## Certificat e o fVerificatio n

255 2 SOI L 2009-08-0 4 09:0 8 30.1 7 Fina l 8508 0 272 0 N 4 8 s t F l Nicola s 8 CLEARANC E

± Erro r ± 11.00 1

# 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 256 7 Mod e SOI L Tim e 2009-08-0 4 10:5 9 Duratio n 121.5 6 Sequenc e Fina l Flag s AVERAG E "Av g o f2563-256 t ADDRES S 272 0 N4 8 s t QUAD/ZON E D Z INSPECTO R Nicola s DEPT H 1 3 SAMPL E TYP E CLEARANC E NOT E

Erro r P b Supervise d By : QoO/l^ C PD A

# 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 217.16 0 Supervise d By : 

## Certificat e o fVerificatio n

256 3 SOI L 2009-08-0 4 10:5 7 30.6 4 Fina l 8508 0 272 0 N4 8 s t D Z Nicola s 1 3 CLEARANC E

± Erro r
± 18.47 6

# 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 256 4 Mod e SOI L Tim e 2009-08-0 4 10:5 8 Duratio n 30.2 0 Sequenc e Fina l Flag s BVI D # 8508 0 ADDRES S 272 0 N4 8 s t QUAD/ZON E D Z INSPECTO R Nicola s DEPT H 1 3 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 80.21 9 ±11.71 2 Supervise d By :

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 256 5 Mode SOIL Tim e 2009-08-0 4 10:5 9 Duratio n 30.2 2 Sequenc e Fina l Flag s BVI D # 8508 0 ADDRES S 272 0 N4 8 s t QUAD/ZON E D Z INSPECTO R Nicola s DEPT H 1 3 SAMPL E TYP E CLEARANC E NOT E

pp m±Erro r P

b 60.37 7 ±10.62 0 Supervise dBy :

# 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 256 6 Mod e SOI L Tim e 2009-08-0 4 10:5 9 Duratio n 30.5 0 Sequenc e Fina l Flag s BVI D # 8508 0 ADDRES S 272 0 N4 8 s t QUAD/ZON E D Z INSPECTO R Nicola s DEPT H 1 3 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 40.05 5 ±9.04 4 Supervise d By :

# 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 258 2 Mod e SOI L Tim e 2009-08-0 4 14:0 6 Duratio n 121.8 9 Sequenc e Fina l Flag s AVERAG E ^mjfj^78-2S8 1 ] ADDRES S ^iON48s t QUAD/ZON E F 2 INSPECTO R Nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

± Erro r pp m P b ± Supervise d B y 

# : $?Che

. 'X2S ^

# 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 46.88 1 Supervise d By : 

## Certificat e o fVerificatio n

257 8 SOI L 2009-08-0 4 14:0 5 30.4 7 Fina l 8508 0 272 0 N 4 8 s t F 2 Nicola s 6 CLEARANC E

± Erro r
± 9.77 1

# 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 257 9 Mod e SOI L Tim e 2009-08-0 4 14:0 5 Duratio n 30.5 8 Sequenc e Fina l Flag s BVI D # 8508 0 ADDRES S 272 0 N 4 8 s t QUAD/ZON E F2 INSPECTO R Nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r Pb 60.73 7 ±10.73 8 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 41.32 3 Supervise d By : 

## Certificat e o fVerificatio n

258 0 SOI L 2009-08-0 4 14:0 6 30.5 5 Fina l 8508 0 272 0 N 4 8 s t F 2 Nicola s 6 CLEARANC E

± Erro r
± 9.24 5

# 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 258 1 Mod e SOI L Tim e 2009-08-0 4 14:0 6 Duratio n 30.2 9 Sequenc e Fina l Flag s BVI D # 8508 0 ADDRES S 272 0 N 4 8 s t QUAD/ZON E F2 INSPECTO R Nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

Erro r pp m P b 125.99 4 ± 14.56 2 Supervise d By :

### • • # • 

## Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc

. www.coa8talhazmat.co m COASTA L ENVIIONHINTA L c( 0 u r , IN C 

# EXECUTIV ESUMMARY : BVID #85080-(272 0 N4 8 ST )

No Issue s o r Concern s Issues/Concern s
Detail Explanation : -COASTA LTO REPLAC ETH ECLOTHES LIN EPOL E
. (COMPLETE D 8/10/09 )4 

### % 

## 0 % 

# EP A 

# 0
EP APropert y Clos e Ou t For m Property # : 'R,^K(2 i Datc/nme : Contracto r Grou p <^Of\5^ \grtVl'TOOnnCni^ ' Quad s Excavated : f \, Tv ? [<,•?
. ^\yt Ye s N O Excavatio nGeaen l 1
. i f necessary , were th e correc t quadrant(s ) excavate dandrestored ? 2
. If necessary , were th e correc t area s ofdri p zone excavate dandrestored ? ^ ^ Gradin g So d an d Vegetatio a 1
. Doe s the gradin g aroun dth e perimeicr ofth e hous e i nexcavate darea s generally slop e awa y ^ fromth e house ?
. 2
. Ha s so dbee nlai di nall area s tha t wer e excavated ? 3
. Doe s th e sodappear to b e generally healthy an dgrowing ? (Only evaluate if inspecteda t a3 0 ^ " day tun e period ) 4
. Arc soddedarea s generally fu man devenl y graded ? 

# l? ^ 5
. Ar e th e joint s betwee nth e so dstrip s generally tight ? (Only evaluate if inspecte da t a3 0 da y 

# y tim e period) 6
. Wa s the propert y grade dsuchtha t wale r will no t poo l o nthe propert>' ? 7
. Wa s damage t o landscapin g o r plan t material s avoided ? 

# I? "
Gates , Fence s an dRetainin g Wall s ^ I
. D o gate s ope nan dclos e freely? (If applicable ) 2
. Were all gate s or fence s takendow ndurin g restoratio nactivitie s reinstalled ? (If applicable ) ^ - ^ 3
. Wa s damage t o gate s or fence s avoided ? (If applicable ) 

# T?- ; 4
. Wa s damage t o retainin g wall s avoided ? (I f applicable ) Foundation , Sidin g an dGutter s Ye s N o I
. Wa s damage t o th e sidin g o r tri mavoided ? 

## \y ' 2
. Wa s damage t o the foundationavoided ? 

# T 7 3
. Wa s damag e t o window s avoided ?

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

## i X Sidewalk s an dDriveway s (Coocrelc ) Vc s N o 1
. Wa s damage to drivewa y surface s avoided ? 2
. Wa s damage to walkwa y surface s avoided ? ^

### « % 

## Ovf'ner s comments :

Inspectio nnotes :

Remova l an drestorationactivate s complej e ijjjicludin g th e 30-da y so dwarranty : EP ARepresentativ e P(yM /Sr,//
. Da.e : pjuld j

## Propert yCompletio n Agreemen t
I'hi s agieemen i documeni s th e complelio n ofremedia l aclivme s perl'oimc d nn myproperl y Mysignaiur e wil l designat e llia i I am satisfie d wit h Ih e restoralio n ofmyproperly , an d iha i no ilem s ar e m questions , now , oral an ylim e m th e fuluie , excep t thos e item s liste d below , ifan y

Propert yrp : ^ ^Q^ Q Propert yAddress : ^-^2/ 1 j J ^8Sf Owner : ^g^^^ ^ /^>g^>^ ^ 

## Pho..c: 55/
. ^^5 ^ Restoratio n Item s in Question :

Item : 

## ^c c 

# ci }o /^OMCr t dense r/j'n£
- 

# A/ ^ 

# kr 1 1 Item : f• / Item : Item : Item : Item : !

|V ] 1 ayrc cI fstorjilio n i< complcird , fxccp i »s nnier i [ I I rto t>tt ^ *(!ie crcKiorjitio n is romplelcf t

cr' s Signiwiii' r J Signaffiu fDat e ont i actor' s Signatur Dal e fnalur e e