### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SA1D# : l^r H Date : ^jd-lplOP j Address : c^^^.^M
- C (KEk.\OJ C Sj " Remediatio nContractor : Coasta l Environmenta l Group

_Year : _200 8 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S a

/ Vide o o f property (DVD ) y ^ Executiv e Summar y Q

/ EPA-provide dproperty sketc h 0

/ Signe dAcces s Agreemen t fo r subjec t property ^ nSigne dAcces s Agreement(s ) fo r adjacent property Ci/ Restoratio nAgreemen t ^fHf } Settlemen t document s (i.e. , fo r damag e o r to replac e plants , etc. ) 5 k Confirmatio ndat a y Photograph s ^e'JLXCyL)l\tlc>Y\ ^ 0.^/fA(mJW\ ^ jt/La J ^/i d H As-buil t sketc h y Satisfactory restoratio nsigne db y Property Owner y Property close-ou t chec k lis t signe db y EPA ^jl\ ' Descriptio nofarea s no t meetin g RO D cleanu p criteri a \ y Utility clearance s \y ^ Property informatio nfro mDougla s County Assessor' s Offic e y ^ VxvfiAti
- tk^-PS S O^eeifis k S / C jJnJ i r(irtvy ^ D 

# ?X)CA!t^.)(b!. h^loU^lC ^ Signatur e Date1

0 

### Propert yAcces s Checklis t Propert y ID : \1\":\(: \ n WOR K STARTE D ON : / / D WORKCOMPELTE D ON : / Propert y Address : 2^2 ^ (JCVSAf-W r S V Rente r Owner : |0\(^.C-,^A\ V ^OK^ ^ Address : Phone : FJLV : Cell/Pager : Additiona l Informiition : 

# Phone:'^c7-t^qrf ^ Fax : Ccll/Page n
D Notificatio nLette r Sent : / / By : l^nAcces s Agreemen t 

### Signed : it/B-/( ^ By = K\\CVIC^V 6 Restoratio nAgreemen t 

### Signed : 1 1 / <^ C9 s By : W\\rVicA6< s
• Topsoi l Samplin g (i f applicable ) 1 1 By : D Disposa l Samplin g (i f applicable ) / / By : D Garde nSamplin g (i f applicable ) / 1 By : ,,0 ^ Utilit y Clearanc e 

### Called: Jl/^/Q ^ 

# ^y-\\i\^\c %

[JB'^Video/Photo s (Before ) 

### On:ii_/_^ ^ By = <5n^i ^ O Video/Photo s (During ) On : / / By : nVideo/Photo s (After ) On : / / By : D Video/Photo s (30-Day ) OD : / / By : D Propert y Completio nAgreemen f Sipicd : / / By : D Pina l Repor t Issued : / / By : Ai r Monitorin g (a £applicable ) (Z

J Communit y O Cre w On : / / By : Results : D ComraunitA ' C H Cre w 

### On : / / By : Results :

• Communir i • Cro v On : / / By : Results :
Omah a Lea d Sit e

### Propen y I D ?^ ' Propert y Atddress : Iniiia l Contacl : Secon dContact : Fina l Contact : Fina l Action : CO.KTAC T FORJv l 

# yi w 2(]? H (a^hle^ r 5 7 Dale . Time : Date : Time : Dale : Time : Tran.smi t t o EP A D Action : Aclion : Aclion : Othe r Action : D

Comment : ONvne r Commen t (s) :

- - . J 

### Sit e Coordinato r Commen t (s) :

### Dougla s County Accoun t Inf(M^|tio n Pag e 1 of 4 (|^ t Dougla s County , Nebrask a Propert yRecor d - R100047000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 l i wes t o f90t h S t - VlO 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 IVICGRAT H JAME S B ETA L 293 4 CASTELA R S T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 004 7 000 0 1 0 Accoun t Type : Residentia l Parce l Number : 100047000 0 Parce l Address : 293 4 CASTELA R S T OMAH AN E 68105-000 0 Lega l Description : DUPON TPLAC E LOT1 4 BLOC K4 W1 5 F TL T1 5 & E 1/ 2 4 0 X 12 5 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $5,700.0 0 $76,800.0 0 $82,500.0 0 200 7 $5,700.0 0 $76,800.0 0 $82,500.0 0 200 6 $5,700.0 0 $59,200.0 0 $64,900.0 0 200 5 $5,700.0 0 $59,200.0 0 $64,900.0 0 200 4 $5,700.0 0 $59,200.0 0 $64,900.0 0 200 3 $0.0 0 $0.0 0 $0.0 0 Sale s Informatio n Sale s Date : 2007-11-1 3 Dee d Type : W D Book : 200 7 Page : 12920 2 Price : $81,000.0 0 Grantor : DIERK S JOD I H ETA L Grantee : MCGRAT H JAME S B Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 2007-11-1 3 Dee d Type : Q C Book : 200 7 Page : 13766 6 Price : $0.0 0 Grantor : MCGRAT H JAME S B 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R10. . . 11/4/200 8

### Dougla s County Accoun t Infc|fc|tio n Pag e 2 of4 (|^ t
Grantee : Valid/lnvalid : Exclusio n Reason : Sale s Date : Dee d Type : Price : Grantor : Grantee : Valid/lnvalid : Exclusio n Reason : Sale s Date : Dee d Type : Price : Grantor : Grantee : Valid/lnvalid : Exclusio n Reason : Sale s Date : Dee d Type : Price : Grantor : Grantee : Valid/lnvalid : Exclusio n Reason : Sale s Date : Dee d Type : Price : Grantor : Grantee : Valid/lnvalid : Exclusio n Reason : Sale s Date : Dee d Type : MCGRAT H JAME S B ETA L Invali d Famil ySal e 2004-05-2 4 W D Book : $65,000.0 0 Sec
. Housin g an d Urba n Devel
. Jod i Dierk s Vali d Sal e b yGov t Agenc y 2003-11-0 5 TR D Book : $80,211.9 8 Eri cLindquis t LL C HU D Invali d Sal e t o Gov t Agenc y 2002-12-1 7 W D Book : $74,000.0 0 200 4

200 4

223 1 Page : 06793 4

Page : 00338 4

Page : 56 3

Vali d 1

1995-03-0 6 D $38,900.0 0 Book : 199 9 Page : 60 2

Vali d
1994-04-1 9 D Book : 197 7 Page : 31 8 

### http://douglasne.mapping-online.com/DouglasCoNe/stafic/accountinfo.jsp?accountno=R l 0.. . 1 1 /4/200 8

### Dougla s County Accoun t Info^totio n Pag e 3 of4 o ^ t
Price : $ 40,500.0 0 Grantor : Grantee : Valid/lnvalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 1 5000. 0 1. 0 125. 0 40. 0 N o Improvemen t Informatio n Buildin g 1
1 1 ^ Stor y F m 293 4 CasWa r S i

ff f EKMidr^ n iTiBs , n mne n
M r mf f
w »

> M W •» «««•» : J M . ••trtB» fftMt94 n CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1224. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Goo d

Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 7. 0 Exterior : Fram e Viny l Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo 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 r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 189 5 0 % 189 5 11 3 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 800. 0 Basemen t Bsmn t Bloc k 8 f t 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R10. . . 11/4/200 8

### Dougla s County Accoun t InfiUsatio n Pag e 4 of 4 

# V
Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h En d Scree n 80. 0 Use r Atti cFul l Finis h 374. 0 Use r Woo d Fenc e 1. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinf o .jsp?accountno=R10.. . 11/4/200 8

### Pag e 1 of 2

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

### YOU RTICKE T NUMBE RI S 2172058 . Origina l Cal l Date : 11/09/0 8 Time : 4:2 6 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 : 2 93 4 Street : CASTELA R S T Twp : 15 NRng : 13 E Sect-Qtr : 28-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 : 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 : NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V LEVEL 3 MCLEODN E MUD0 2 OI^AHACO F 0PPDGPR 6 QLNNEI F QWEST 2
UtiUt y Servic e Are aContac t Phon e Numbe r Typ e 

### Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , ^^ ^ 

### Alt : 402934046 9 IN C 

### Emerg : 402932975 7 Day : 877366834 4 LEVEL S LEVEL S COMMUNICATIONS , ^ ^ 

### Alt : Emerg : 877366834 4 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 MUD0 2 SAND Y 

### Alt : DISTRIC T 

### Emerg : 402504797 0 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 11/9/200 8

### Pag e 2 of 2

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

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

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

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e ENVIRONMENTA L t R O U P , INC
. 

# n m Exterio rPaint Nort h Arro w Omah a Lea d Sit e Own er Name : JOP I PIERK S • Goo d S+

_Sit e Sketc h Address : ^9S^^ • CASTEL-A R • Poo r

Phone : H W ; Q--t^o t paint Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Firm : fi ^ V

/ CF/T: ^ H RVASCPXA - /T/7 3 F l ?Z 1 pp m 

### D Date : ^O^ri h RVBSCPXA - / JIJ S F 2 / U(^ pp m Tim e ^ \0 6 P M RVCSCPXA - /7/T 3 B 1 _5i£ . pp m 

### D Sample s Analyze d 

### Jdi £ pp m 

### D RPZSCPX AB2 - pp m 

### D D XR F Unit : 90 ? Book : // 8 • RGZSCPX A62 - pp m 

# n D Date : £,-^-,s-OL
.

RPZSCPXA - I T/7 3 PZ 2 7 5 pp m 

# s y D Time : i4i M Staff : L a b RYBSCPI^-1717 9 Numbe ro f Sample s = S ^ I 

### hS\. / I —Resul t 23 5 pp m Fron t Right , B l = Bac k Left
. B 2 = Bac k Righ t DZ = Dri p Zone , G Z = Garden , PZ = Pla y A U quadrant s ar e a s viewe d fro m th e streel
. fadn g propeit y OLS# : 1717 9 I Dat e Excavated : 11/19^008
. Dat e USEP ASigne d Off : 1 H 2/i66 9 Are a Sodde d 134 6 s q f f t



### afiST £LBR . sr Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are areplace dwit hAre areplace dwit h__ _^^ ^ ^^^ ^ ^^^ ^ So dRock/Mulc h ^ ^ 

### Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .Exterio rPain t Nort h Arro w Omah a Lea d Sit e Ow n e rName : JOP I P^ERK S Q Goo d Address : 293.^ + CASTELA R S t Sit e Sketc h • Poo r

Phone : H : W: 

# I Q^o t pain t Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Finm ; Sample s Collecte d RVASCPXA ­ /7IT 3 F 1 ?2 1 pp m 

## D Date : ^•(P^-tii , RYBSCPXA - ITIT 3 '' 2 / L L pp m Time ; Z\66P ^ RVCSCPXA RVDSCPXA ­ /7/r 3 I TIT S B 1 B 2 5 U Qlo ^ pp m pp m 

## ^2 y 

## D D Sample s Analyze d RPZOCPXA - B2 ­ pp m 

## D D XR F Unit : 90" ? Book : // 6 

### nCZZQ^lk A -G2 - RPZSCPXA - 17/7 3 P Z La b I —Resul t RYBSCPLA-1717 9 23 5 pp m - 27 5 pp m pp m Numbe rof Sample s = 

# ° ysD D J Date : Time : Staff : ^/'rtS-OL o Ai A 

# hs w Fron t Right
. 8 1 = Bac k Left , B 2 = Bac k Rigti t DZ = Dri p Zone , G Z = Garden
. P Z = Pla y Al l quadrant s ar e as vievved fro m th e street , facin g property

# n m Exterio rPain t NorthArro w Omah a Lea d Sit e Ow n e rName : JQD l P\gRK S • Goo d Address : aQS ^

CASTELAF ? S+ , Sit e Sketc h • Poo r Phone : H : W ; \ Q^o t pain l Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Fir m RVASCPXA - 7717 3 f' l 

### yi i pp m 

# D Date : RVBSCPXA-/7"/7" ^ F2 

## 1 L L pp m Tim e RVCSCPXA-/?-/7" ^ 8 1 

### 5 L pp m 

# D Sample s Analyze d W^XiSCPyjK - f7IT 3 B2 

# m. ^ pp m 

# D RDZSCPXA ' BE ­ pp m 

# D D XR F Unit : 

## .20 2 Book : i/a
. - nCZCCPX AGZ - pp m 

# D Date : ^-r-^S-OL a 

### RPZSCPXA
- /7/7 3 P Z 2 7 5 pp m Trme : A M 

# n Staff
. M^ w La b RYBSCPLA-1717 9 Numbe ro fSample s = | S ^ \ Resul t 23 5 pp m Fron t Right , 8 1 = Bac k Left , B2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden
. P Z = Pfa y A

U quadrant s are a s viewe d fro m th e street , facin g property

^ 

# C i 

# i

t^^ ^ /a« '

# 11 1 

# n Exterio rPain t NorthArro w Owne rName : JOD I DIERK S Omah a Lea d Sit e • Goo d Address : 29SA f CASTEUA R S+ , Sit e Sketc h • Poo r Phone : » vv: \ Q^o t pain t Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d Firm : RVASCPXA - /7I7 3 P 1 

## 2.2 1 pp m 

# n Date : RVBSCPXA - / 7/J S F 2 

## ! I' L pp m Time : RVCSCPXA-/7"/7" ^ B 1 pp m 

## D 

# .31 ^ Sample s Analyze d

Fron t Right , B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = PJa y RVDSCPXA-ZT'/T'o ? B 2 ^/^ ^ pp m 

## D RDZGCPXA ­ B ^ pp m 

## D D XR F Unit : 

## .202 Book : iiS
. nozscpxA ­ -GZ ­ pp m 

## D Date : ^-r-^S-'OL c RPZSCPXA - /7/7 3 P Z 

## 27 5 pp m 

## D Time : AM La b RYBSCPLA-1717 9 Numbe ro f Sample s = I S " 

## J Staff : M^ W -Resul t 23 5 pp m Al l quadrant s ar e a s viewe d fro m th e street , facin g propert y



# - ¥

r— ^

Re v 4 046)41.012 3S^^j f COASTA L ^^f gMnt** ^ IHVKIOHMINTA l ca 0 u P
. 

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

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

Owner' s Name : 

# ^ 5hQ/^ > °^y*"" ^

'^""^ ^ 3^'^^^ ^

Addres s o fPropert y covere d b ythi s 

# ;L7J /

C^j-I^lc^y - sf 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 tha t contain s elevate d concentration s o f lea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t o remov e contaminate d soil
. Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o it s origina l condition
. Thi s wor k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o f Coasta 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 have a n opportunityt o revie wan d approve th e planne d soi l removal , an d restoratio n wor k befor e I t begins
. Onc e th e wor k i s finished , th e Granto rwil l b e aske d t o revie wth e wor k an d confir m tha t i t i s complet e an d meet s wit h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m EP Atha t th e property ha s bee n remediated
. ENVIRONMENTA L RESPONS E ACTION S 

### B ysignin 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 of performin g th e work
. Thi s acces s shal l remai n i n effect unti l th e wor k has bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :
Pag e 1 o f 2^^•** >COASTA L '•^•ff'* ^ C • O U rIN T



### •Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; •Remov e flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t ma ywis h t o save ; •Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessar ysubsequen t t o a n initia l waterin g perio d b yEPA ; •Abid e b yhealt h an d safet yguidanc e provide d b yEPA ; •I f th e propert yi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propert yt o perfor m th e work
. •Allo wvideotapin g and/o rphotographin g o f th e property . AGREEMEN TNO TTO 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 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
I gran t acces s t o mypropertie s D I d o no t gran t acces s t o mypropertie s 13 ^ g i

SignatureDat e [ U I woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.COASTA L • : ' IHOM'^t'^TA l C • O U rIN C 

## Restoratio n Agreemen t Th e purpos e ofthi s agreememis t o provid e amutua l agreement as t o condition s ofth e propert y prior t

o remediationactivities . Thi s will als o serv e as documentatio nfo r the purpos e of assurin g tha t restoratio n activitie s ar e completedt o the satisfactio nofth e propert y owne r an dthe UnitedState s Environmenta l Protectio nAgenc y (EPA) . Propert y ID : \^\C | Propert y Addres s % 

# n i (^.-feU.> r y Owner : 

# "I »-tA, e ^ 

## Phone : jH hO^0S ~ O

nthe attacheddiagram(s ) indicat e area(s ) t o excavatedan ddept ho f excavation , locatio no f al l known utilities , subsurface features , syrface structure s an dlandscaping features , acces s !ocation(s ) t o be use db y contractor , an dthe directionof North . Indicat e distances , depths , materia l types , etc . Indicat e digita l photo s b

y referencing the photo-lo g numbe r wit ha narro w indicating directionof 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
. Item : 

# ^ /id ^ Item : Item : Item : 

### Item : Item : Item : Item : Pag e 1 o fUCOASTA L cn o wr. IM C Item s T o B e Remove d B yContracto rDurin g Remediatio n An d No t Replace d (Us e additiona l sheet s a s necessary ) Item : 

# ^ ^e ^ Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : / . Item : Item :

Pag e 2 

# o f GCOASTA L 

### 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 : 

### 5C! 5 ( \ 

# ^ y ^ Item : 

# ^ y / 

## 5< 5 

## 6 Item : / item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : /

Pag e 3 o f ^C O A S TA L CNvinONMEMTAI
. C • O O rIM C 

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

## Item

Pre-existing propert y area , tha t wil l be excavated , tha t i s covere dwit hgrass .

Numbe r of tree s > 2 inc h trun k

diameter

Numbe r of tree s < = 2 inch trun k

diameter

Numbe r of Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Attachasketcho f th e sprinkler layout ,
Numbe r of an dsiz e o f eac hgarden / flowe r bed area . Attachasketc hof relativ e size s an dlocations . 

## Quantity 

# 0 * 

# 7 

# V y

y Unit
Squar e fee t 

## Condition/Type/Specie s

Eac h j • .

Eac h

Eac h

Eac h Squar e Fee t

Pag e 4 

# y

### ( ^ ^ COASTA L EMVIKONHtMTA l r

_^ O U PIM C 

### Ite m Agree dupo nvalu e o f plan t material s no t to b e replace db v contractor . Note thi s valu e will b e usedt o issu e aplan t vouche r to th e propert y owner . Agreedupo nlis t o f plan t material s tha t wil l b e replace db y conn-actor . B e ver y specifi c an ddetailed . Include asketchof wer e eachplan t wil l b e placed by th e contractor . Agreedupo nare aof prop>ert y t o b e replace d wit hgras s sod . Include asketchof th e area(s ) t o b e replace dwit h gras s sod . Are ao f Cit y o r Count y propert y t o be landscaped per their requirements . Include asketchof th e are a(s )

Easement Area , t o be excavate d 

### Quantit y Urii t 

# r $ 

# y Each



# d > S F 

# y S F



# f' S F 

### Condition/Type/Specie s



# WyU'-'^ ^

Pag e 5 of 

# QC O AS T A1 . • MVftROMMCMTA L «M»UP
. IM C



### Q Chec k th e boxi f Owne rdoe s no t wan t CE G t o documen t interio rfbundatio n wail s an d possibl e pre-existin g damage
. Bycheckin g thi s boxCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro f house , indudin g foundatio n cracks o rfissures
.



## 01 a Q I d o not agre e lagre e 

# U'69-Of i i L Dat e Contractor' s Signatur e Dat e 

### PageSof ,

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

# \\'\^-Of i Addres s Projec t Omah a lead F P 2n d yea ropllo n Sampl e tim e XRFID # sampl e lengt h 

# f^aoft ^ Shot # Readin g Sampl e are a Sho t # 3'?(.g ^ £p o ^"-iO.'S M .SlL^^ l '^n^gy •-•x^^.Ls.y-\9>'^i \ 

# "h ^ ,^T7 n Dept h .^- 1 - r\ 

## .^Tipvi ^ ^a^.i.i.ty'^r. o 3-7(/)- i i^a^af^s b 

## i b ^ 

# ^n ^ Averag e \"?rv.n? , J " \<A . .^^i~\ Averag e Shot # Readin g Sampi e are a Shot # Dept h Averag e Averag e

Shot # Readin g Sampl e are a Shot # Dept h Averag e Averag e
RETES TAREA S Shot # Readin g Sampl e are a Shot # Dept h Averag e Averag e la b sampl e # La b resul t Sampl e are a XR F Avg
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_ BVI D # n\nQ [ ,:^^i ACr^y^pAy^^y
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# o^\ o 3 0 se c Readin g Sampl e are a Q^-l.O-^ c\1. ^ \-. ^ .a^t^'fvo S i'AJ , i^ o t lA-R C Dept h \^i3
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Readin g Sampl e are a y / Dept h

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# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1 

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 376 8 Mod e SOI L Tim e 2008-11-1 9 12:1 2 Duratio n 123.5 5 Sequenc e Final Flag s AVERAG E I Av g o f 3764-376 7 ^ ADDRES S ^3 4 casterla rs t QUAD/ZON E 

## p 2 ' INSPECTO R Ventr y DEPT H SAMPL E TYP E % CLEARANC E NOT E

Supervise d By :

# 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 60.30 2 Supervise d By : 

## Certificat e o fVerificatio n

376 4 SOI L 2008-11-1 9 12:1 0 30.8 4 Fina l 1717 9 293 4 casterla rs t B 2 Ventr y 6 CLEARANC E

± Erro r ± 10.53 7

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 376 5 Mod e SOI L Tim e 2008-11-1 9 12:1 0 Duratio n 30.7 6 Sequenc e Fina l Flag s BVI D # 1717 9 ADDRES S 293 4 casterla r s t QUAD/ZON E B 2 INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E
pp m ±Erro r P b 224.64 7 ±18.91 1 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 223.63 4 Supervise d By : 

## Certificat e o fVerificatio n

376 6 SOI L 2008-11-1 9 12:1 1 30.9 1 Fina l 1717 9 293 4 casterla rs t B 2 Ventr y 6 CLEARANC E

± Erro r ± 19.50 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 42.33 0 Supervise d By : 

## Certificat e o fVerificatio n

376 7 SOI L 2008-11-1 9 12:1 2 31.0 4 Fina l 1717 9 293 4 casterla rs t B 2 Ventr y 6 CLEARANC E

±Erro r ±9.20 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 AVERAG E ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

P b Supervise d By : 

## Certificat e o fVerificatio n

377 3 SOI L 2008-11-1 9 12:1 5 124.0 5 Fina l |Av g o f3769-377 2

293 4 casterla rs t feasement
. j Ventr y

* • ! .CLEARANC E f

# 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 207.03 0 Supervise d By : 

## Certificat e o f Verificatio n
376 9 SOI L 2008-11-1 9 12:1 3 30.7 9 Fina l 1717 9 293 4 casterla rs t easemen t Ventr y 1 CLEARANC E

± Erro r ± 17.30 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 154.21 0 Supervise d By : 

## Certificate o f

Verification

377 0 SOI L 2008-11-1 9 12:1 3 31.2 4 Fina l 1717 9 293 4 casterla r s t easemen t Ventr y 1 CLEARANC E

± Erro r ± 15.02 9

# 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 144.60 3 Supervise d By : 

## Certificat e o fVerificatio n
377 1 SOI L 2008-11-1 9 12:1 4 30.8 2 Fina l 1717 9 293 4 casterla rs t easemen t Ventr y 1 CLEARANC E

± Erro r ± 14.84 9

# 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 192.70 1 Supervise d By : 

## Certificat e o fVerificatio n

377 2 SOI L 2008-11-1 9 12:1 5 31.2 0 Fina l 1717 9 293 4 casterla rs t easemen t Ventr y 1 CLEARANC E

± Erro r ± 16.90 0

### 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 ^-ino y COASTA L ENVIRONMENTA L CROUP , INC
. 

# EXECUTIV ESUMMARY : BVI D #1717 9 - (293 4 CASTELA RST )

^ N o Issue s o r Concern s | ^ Issues/Concern s Detai l Explanation :- - 

# ^EP A EP APropert y Clos e Ou t For m Propert y tt : \ 1 \~ 7 ' ^ Propert y Address : c^Q^M C CA-^'Ve-l(SX/' S3
- Date/Time : Owner' s Name : '^V_INVJU ^ ^ A( <cTrcoH^-~ ' « Quad s Excavated ; p^Q . Coniracto r Grou p y-^fxyTtuyL'Cr>\f\'rorv^^-^^''^^^^'~ ^ Excavatio nGenera l Ye s N o I . i f necessary , were th e corre aquadrant(s ) excavate dan drestored ? ^ 2 . Ifnecessary , were th e correc t area s ofdri p zone excavate dandrestored? 

# y Gradin g So dan dVecetatio n Ye s N o I Doe s the gradin g aroun dth e perimete r ofth e hous e i nexcavale darea s generall y slop e awa y 

### y fromIbe house ? 2 . Ha s so dbee nlai dinall area s tha t were excavated ? 3 . Doe s th e sodappear t o b e generall y healthy an dgrowing ? (Onl y evaluat e ifinspecte da t a3 0 

### y da y lime period ) 4 Ar t soddedarea s generall y fir man devenl y graded ? l y 5 Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evalual e ifinspecte da t a3 0 da y ^ tim e period ) 6 Wa s the propert y grade dsuc htha t water will not poo l o nthe property' ' i ^
i ^ 7 Wa s damag e t o landscapin g o r plan t material s avoided ? Gates , Feoce s an d Retainin g Wall s Ves N o 1 . D o gate s ope n an d clos e freely ? (Ifapplicable ) ^ 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 ) - ­ 4 . Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) 

## A/ A Foundalion , Sidin g an d Culler 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 ? y 3 Wa s damag e 1 0 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 downspout s o rdownspou t extension s avoided ? ^ Sidewalk s an d Driveway s (Concrete ) Ye s No 1 . Wa s damag e t o drivewa ysurface s avoided ? y 2 . Wa s damag e t o walkwa ysurface s avoided ? 

### y

## O »'ncrs comments :

Inspectio nnotes :

Removal andrestoralio nactivate s complet e includin g the 30-da y so dwarrant) ' EPARepresentativ e 

# auA-aL^^yy^^c^hJ^^ ^ Date : l/z^^ f

# w ^ Propert yCompletio n Agreemen t Thi s agreemen t documeni s th e completionof remedia l activilie s perlbrmedo n m y property . M y signalur e wil l designale llia t I a msalisliedwil hth e restoratio nof m y property , an dtha t n o items are i n questions , now , o r a

t an y tim e i

nthe future , excepl thos e item s listedbelow , ifany . Propert y ID : j y j-^ Q 

### PropeTtTATdrcs^^Q^ y Ca^JdaVS ^ . _ Phone : ^-^^ S - OH0T_ , Restoratio n Item s i n Question :

Item : Item : Item : Item : Hem : Item :

I I I agrc t resitoralio ni. s completed , excep t a s nole d ^ I I I d o no t agre e resfaqitio nhcomplete d 

## V y ^ . Contractor' s SiKnatur e 

# '^In y Hat e 

# /y/X'O ^