# TRANSMITTALo f

OMAHALEAD SITE SOI LREMEDIATIO NFIL EFOLDER 

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# ^1(1^ 1 SAI D # : Date : Address : 7^ 1 1 1 W\^]i^rv^O \ Remediatio nContractor : Coasta l Environmenta l Grou p Year : 200 8
SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f propert y (DVD ) 4031482 4 Executiv e Summar y EPA-provide dpropert y sketc h Superfun d 

### Signe dAcces s Agreemen t for subjec t propert y Signe dAcces s Agreement(s ) fo r adjacen t propert y Restoratio nAgreemen t Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) M Confirmatio ndat a Photograph s TjCt

- Jli.Cn^aks<\ ^ JL^CA^OhMj ^ 3 d-(LA J5< 3 d ^ jtnJUSc d 

# y As-buil t sketc h Satisfactor y restoratio nsigne db y Propert y Owne r Propert y close-ou t chec k lis t signe db y EP A 

# rl{ y Descriptio no f area s no t meetin g RO D cleanu p criteri a 

# y Utilit y clearance s Propert y infonjiatio nfro mDougla s Count y Assessor' s Offic e 

# F \ y Dat e 

# 0/^ ^

# Propert yAcces s CSiecklis t ProiK-rt ) ID : 2S\ ^ I D WOR K STARIK D ON ; / / 

### nWOR K COMPELTE D ON : / / 

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.-AddiTSs : Plione : 

### Fax : Cell/Pager : Additiona l Information : 

# r''""' ' ZLUQ-BJO O 

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### Si«ned : 4l\ 6 lo} ^ ^yydju ^ . ^.
_ 1 1 Topsoi l Sanipliiii ; (if applicahle ) 1 1 Bv : 1 1 Disposal Saniplin; 4 (if applicable ) 1 1 By : O Garde nSaniplin<> (if applicable ) 1 1 By : 11 r^Klliilit v Clearanc e 

### Called : ^//4^/0 ^ 

# ^y^XLJ^^'lll^C^ ^ 1 p^ Video/Photo s (Before ) On :/ / 

# B.v = /f c 1^Video/Pholo s (Dnrinj; ) On : / / 

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### Siuned : 1 1 ^ /6'S ^ 

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

1 Comment :

Owne r ! Commen t (s) : Sit e 1 Coordinato r

Commen t (s) : 

# 56-/^ / aV^ V %J,a ^ 5 A Date : 6.-/ ^ Tmt:l2' ^ Date : Time : Date : Time : Transmi t t o EP AD Action : ^y^y / Action : "^ Action : Othe r Action : D



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## Dougla s Count y Account Informatio n Pag e 1 o f 1 orm a Dougla s County , Nebrask a Propert yRecor d - R221061000 0 Prin t Repor t Parce l Dimension s availabl e @ scal e 0-5 0 f t west o f14 4 S t - VieWOT l Ma p Informatio n i s vali d a s o f2008-4-1 7 Treasurer' s Ta xRepor t Ne wFeatur e -•-•- •Aut o Sale s Searc h Owne r OMAH AECONOMI C DEVELOPMEN TC O 

## 2221 N 2 4 S T^^ ^

^ 3^6 " <t>^h ^ ^3^ 0 OMAH AN E 68110-000 0 PropertyInformatio n Ke yNumber : 106 1 000 0 2 2 Accoun t Type : Residentia l Parce l Number : 221061000 0 Parce l Address : 242 4 INDIAN AS T OMAH AN E 68131-000 0 Lega l Description : SHINN S ADDLOT5BLOCK1 3 S 1/ 2 60X71.1 5 Valu e Informatio n Lan d Improvemen t Tota l 200 7 $500.0 0 $0.0 0 $500.0 0 200 6 $500.0 0 $0.0 0 $500.0 0 200 5 $500.0 0 $0.0 0 $500.0 0 200 4 $500.0 0 $0.0 0 $500.0 0 200 3 $500.0 0 $0.0 0 $500.0 0 200 2 $0.0 0 $0.0 0 $0.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 9 4260. 0 0. 0 71. 0 60. 0 Ye s



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R221.
. . 5/7/200 8

### 519 1 

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e

Exterio rPain t Non n Arro w Omah a Lea d Sit e Owne rName : OMAH AECONOMI C DEVEL O 

### • Goo d Sit e Sketc h Address : 242 4 INDIAN AST •Poo r

Phone : H 40245393 0 w f v fNo t pain t 

# i
Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : RYASCPXA-2519 1 F l ^RA pp m 

## D Date : i \ - r^- l - OCr , RYBSCPXA-2519 1 F 2 3o ^ pp m 

## D Time : RYCSCPXA-2519 1 B l •L3'^ H pp m 

# n Sample s Analyze d RYDSCPXA-2519 1 8 2 

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# n nozocrx A2010 1 D Z pp m 

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## D RPZSCPXA-2019 1 P 2 

### - pp m 

## D Time : 

# n Staf f y^o^ j Numbe ro fSample s = legen d F l = Fron t Left
. F 2 = Fron t Right , B 1 = Bacl < Left , B 2 = Bacl < Righ t D Z = Dri p Zone , G Z • Garden , P Z = Pla y A H quadrant s ar e a s viewe d fro m tii e stree t facin g propert y 

### OLS# : 2512 1 Dat e Excavated:6/25/0 8 Dat e USEP ASigne d Off:7/16/0 8 Are a Sodde d 44 0 s q f t

04<)I4 I 0 1 ; i 

### Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are areplace d So d wit h Are areplace dwit h Roclc/Mulc h Are alef t bar e Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .

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# U)6f k 2519 1 Exterio rPain t Nort h Arrow Omah a Lea d Sit e Owne rName : OMAH AECONOMI C DEVELO •Goo d Sit e Sketc h Address : 242 4 INDIAN AS T •Poo r

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### Owne rName : OMAH AECONOMI C DEVEL O Omah a Lea d sit e Q Goo d Address : 242 4 INDIAN A

ST^'* ® Sketc h •Poo r Phone : H 402453930 W: 0^No t paint 

# 1 Sampl e Numbe r RYASCPXA-2519 1 RYBSCPXA-2519 1 RYCSCPXA-2519 1 RYDSCPXA-2519 1 RDZGCPX A2010 1 ROZSCrXA-2S10 1 r;PZOCrXA-2519 1 F1 F2 81 82 DZ SZ P2 Lea d Concentratio n 

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COASTA L ENVIRONMENTfc l " 1 PBo-rt^ ^ C B O U r. 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 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 : (s^yY\Oi\y < ^C-or^r^)( L Owner' s Nam e Daytim e Phon e 

# S^ ^ 

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Addres s o fPropert y 

## ^V^-^ y ^Jndia^-Qi , y- ^ covere d b ythi s Agreement : PURPOS E O F RESPONS E ACTIVITIE S 

## Th e EPAi 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 byUSEPA , wil l contact th e Granto rin-perso n t o discus s th e wor k t o b e performed , th e Granto rwil l hav e a n opportunit yt o revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e i t begins
. 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 EPAtha 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 , at 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 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 f2,^v1 « St., , 

### >- * V**'*'^n * COASTA L

*^ , ,0^ ' ENVIRONMENTA L

^ < PSOT ^ CROU P IN 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
I gran t acces s t o m ypropertie sD I d o no t gran t acces s t o m ypropertie s


# ^^ ^

^oA^/^- s 91grntur e ' V TOat eSignatur e

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

# Restoratio n Agreemen t Th e purpos e ofthi s agreemen t i s t o provid e a mutua l agreemen t as t o condition s ofth e property ' prio rt o remediatio n activities
. Thi s v\il l als o serv e as documentatio n fo rth e purpos e o fassurin g tha t restoratio n activitie s ar e complete d t o th e satisfactio n ofth e propert youne ran d th e Unite d State s Environmenta i Protectio n Agenc y(EPA)
.

Propert yID : "2^ ^ j ^ I Propert yAddress : :^c/ ^ c / -^^Ji^^^ ^ 

## ^'""'"" ^ QnnaW?^ ^r^^onomjC'boeiop^TYvtvtJ ' C/ ^ Phone : L|()^ , 34 ^ , ^a^f^ p
O n th e attache d diagram(s ) indicat e area(s ) t o e.xcavate d an d dept h o fe,\ca\ation
. locatio n o fal i know n utilities , subsurfac e features , surfac e structure s an d landscapin g features , acces s location(s ) t o b e use d b y contractor , an d th e directio n o fNorth
. Indicat e distances , depths , materia l t>pes , etc
. Indicat e digita l photo s b yreferencin g th e photo-lo g numbe rwit h a n arro windicalin g directio n o f\ iew
. 

## 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
.

Pag e 1 of
. 

# tCOASTA L 

## 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 : Item : Item :
Item : Item :
Item : Item : Item :
Item : Item : Item : Item :
Item : Item :
Item :

Pag e 2 o f^COASTA L 1 MVlNONrs f^T* l Q I I O U ' > 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 : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 3 of
.COASTA L 

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

## Ite m Quantit y Uni t Condition/Type/Specie s

Pre-existin g propert yarea , tha t wil l be excavated , that i s covere d wit h grass .

Numbe ro ftree s > 2 inc h trun k diainete r

Numbe ro ftree s •= 2 inc h trun k diamete r

Numbe ro fSprinkle r Zones
. Contro l Vah'es
. Timers
. Heads , etc
.

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.

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. 

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### Ite m Agree d upo n valu e o f plan t material s no t t o b e replace d b ycontractor
. Not e thi s \alu e «il l b e use d t o issu e a plan t >ouche rt o th e propert x owner . Agree d upo n lis t o fplan t material s tha t wil l b e replace d b ycontractor
. B e ver yspecifi can d detailed
. Includ e a sketc h o f\\er e eac h plan t \\il l b e place d h_

\ ih e comracioi"
. Agree d upo n are a o f prope m t o b e replace d v \ it h gras s sod
.

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.

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### Pag e 5 o f 

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### •Chec k th e bo xi fOwne rdoe s no t wan t CE G t o documen t interio rfoundatio n wall s an d possibl e pre-existin g damage
. B ycheckin g thi s bo xCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro fhouse , includin g foundatio n cracks o rfissures
.

O Id o no t agre e 

# / /

y ^ - ^ g ^ 4 (0-/6-Q ^ Date Contractor' s Signature Dat e 

### Pag e 6 o f

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Laboratories , In c 1361 1 B Stree t •Omaha , Nebrask a 68144-369 3 •(402 ) 334-777 0 •FA X (402 ) 334-912 1 •www.midwestlabs.co m ACCOUNTNUMBE R obifi b I p 

### CHAI N O F CUSTOD YRECORD : Ye s 

## N o PURCHASEORDERNUMBER 

### REPORT&BILLT O IDENTIFICATIO N COPYT O ^(^iUi^e O ^V^foY^lrWbv f 

## ^ ^ WW\af^^
. Hr^Vvx^U g ^'Pb>^lQ ^ ZI P 

### PHON E q;^g,)t^Qj_H^C ^ PHON E (

SAMPL E C/LOCATO N 

### 144009 3 

# as'/'}/-fe/-^ac^ ­
, 144009 4 

### lAOA-UJ-^
. ^^4009 5 

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O'?? o Dale/Tim e 'R^eiv/5 ^ by : (^jgipture ) lioole rarrive d intact ; Yes
. remperalureonArrival('/4C) ; 

# M i Kehrtc^uiShfe d by : (Hi^naluri j uaie/1 1 m e eceive d ty : (bigfaiure ) ^reserve d i n Field : Ye s _N o Remarks : Relinquishe d by : (Signature ) Date/Tim e Receive d i n La b by : (Signature ) Chain-of-Custod ywil l hav e a signatur e upo n receip t bu t n o subsequen t signature s Rev02/0 2 Distribution : Origina l accompanie s shipment ; cop yt o Coordinato rFiel d File s
• Matri xCcKJe : S O - Soil , WA- Water
. S L - Sludge
. O T- Othe r

Ou rreport s an o letter s Er e fo rth e exclusiv e ?n d confidentia l us e ofou rclient s an d ma yno t b e reproduce d i n whol e o ri n psrl , no rmo ven yreferenc e be mad e t o th e worli , th e results , o rtti e compan yi n an yadvertising , new s relesse , o rothe rpubli canriomcement s ft#ioui obtainin cou ! prio rwritte n EuthoritEfion
.

### Repor t Number : Dat e Reported : 

# /l \

Midwes t 08-182-237 8 06/30/0 8 Account : Dat e Received : 2066 6 06/26/0 8 

# V | / Laboratories , inc l Page : 1 o f1 1361 1 B Stree t •Omaha , Nebrasl< a 68144-369 3 •(402 ) 334-777 0 •FA X (402 ) 334-912 1 •www.midwestlabs.co m 

### COASTA L ENVIRONMENTA L GROU P MARCO S MATEU S 241 1 MARTH AST OMAH AN E 6810 5 LEA D ANALYSI S PO/Project # : OMAH ALEA D Analysi s A s Detectio n Analys t Verifie r Perfonne d Receive d 

## Unit s Limi t Metiio d Dat e Dat e La b number : 144009 3 Sampl e ID : 25191-B1-062508-Q C

Lea d (total ) 15 5 mg/kg 5 EPA601 0 al<j/06-30 bab/06-3 0 

### La b number : 144009 4 Sampl e ID : 25191-B2-062508-Q C

Lea d (total ) 132 mg/kg 5 EPA601 0 akj/06-3 0 bab/06-3 0 

### U b number : 144009 5 Sampl e ID : 25191-F1-062508-Q C

Lea d (total ) 28 2 mg/kg 5 EPA601 0 akj/06-3 0 bab/06-3 0



### Fo rqjtj^^tion s copf&c t C^/ ^ Su e An n Seit z Clien t Servic e Representativ e sueann@midvtfestlabs.co m (402)829-989 2 The result(s) issue d on thi s repor t onl yreflec t th e analysi s o fth e sample(s ) submitted
. Forapplicabl e tes t paramaters , Midwes t Laboratorie s is i n complianc e wit h NELA C requirements
. Ou rreports an d letters ar e fo rth e exclusive an d confidentia l use o fou rclient s an d ma ynot b e reproduce d i n whol e o ri n part , no rma yanyreference b e mad e t o th e work , tti e results , o rth e compan yI n anyadvertising , new s release , o rothe rpubli cannouncements 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 

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 26 4 Mod e SOI L Tim e 2008-06-2 5 12:3 6 Duratio n 121.5 6 Sequenc e Fina l Flag s AVERAG E Av g o f260-26 3 ADDRES S 242 4 Indian a QUAD/ZON E F l INSPECTO R DETRIC H DEPT H 1 0 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 270.15 4 Supervise d By : 

## Certificat e o fVerificatio n

26 0 SOI L 

### 2008-06-2 5 12:3 3 30.7 0 Fina l 

### 2519 1 242 4 Indian a F l DETRIC H 

### 1 0 CLEARANC E

± Erro r ± 19.76 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 235.48 7 Supervise d By : 

## Certificat e o fVerificatio n

26 1 SOI L 

### 2008-06-2 5 12:3 4 30.3 1 Fina l 

### 2519 1 242 4 Indian a F l DETRIC H 

### 1 0 CLEARANC E

± Erro r ± 19.46 8

# 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 274.20 8 Supervise d By : 

## Certificat e o fVerificatio n

26 2 SOI L 2008-06-2 5 12:3 4 30.2 6 Fina l 

### 2519 1 242 4 Indian a F l DETRIC H 

### 1 0 CLEARANC E

± Erro r ± 19.87 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 431.96 8 Supervise d By : 

## Certificat e o fVerificatio n

26 3 SOI L 

### 2008-06-2 5 12:3 6 30.2 9 Fina l 

### 2519 1 242 4 Indian a F l DETRIC H 

### 1 0 CLEARANC E

± Erro r ± 24.42 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 

### 26 9 Mod e SOI L Tim e 

### 2008-06-2 5 12:4 0 Duratio n 

### 123.0 3 Sequenc e Fina l Flag s AVERAG E •^Av g o f265-26 8 ADDRES S 242 4 Indian a QUAD/ZON E B l INSPECTO R DETRIC H DEPT H 

### 1 1 0 SAMPL E TYP E fCLEARANC E NOT E

P b Supervise d B y

# 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 371.91 5 Supervise d By : 

## Certificat e o fVerificatio n

26 5 SOI L 

### 2008-06-2 5 12:3 7 30.3 9 Fina l 

### 2519 1 242 4 Indian a B l DETRIC H 

### 1 0 CLEARANC E

± Erro r ± 23.18 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 26 6 Mod e SOI L Tim e 

### 2008-06-2 5 12:3 8 Duratio n 

### 30.9 9 Sequenc e Fina l Flag s BVI D # 

### 2519 1 ADDRES S 242 4 Indian a QUAD/ZON E B l INSPECTO R DETRIC H DEPT H 

### 1 0 SAMPL E TYP E CLEARANC E NOT E
pp m ±Erro r P b 306.48 5 ±21.72 7 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 335.46 2 Supervise d By : 

## Certificat e o fVerificatio n

26 7 SOI L 

### 2008-06-2 5 12:3 9 31.0 3 Fina l 

### 2519 1 242 4 Indian a B l DETRIC H 

### 1 0 CLEARANC E

± Erro r ± 21.75 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 367.87 2 Supervise d By : 

## Certificat e o fVerificatio n

26 8 SOI L 

### 2008-06-2 5 12:4 0 30.6 2 Fina l 

### 2519 1 242 4 Indian a B l DETRIC H 

### 1 0 CLEARANC E

± Erro r ± 22.89 5

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 27 4 Mod e SOI L Tim e 

### 2008-06-2 5 12:4 4 Duratio n 

### 122.5 3 Sequenc e Fina l Flag s AVERAG E Av g o f270-27 3 ADDRES S 242 4 Indian a QUAD/ZON E B 2 INSPECTO R DETRIC H DEPT H 1 0 SAMPL E TYP E I CLEARANC E NOT E — ^ ppr p ±/ Erro r 

### / P b 

# 'X y 119.18 1 

### ±13.99 4 y 

## y . 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 111.15 8 Supervise d By : 

## Certificat e o fVerificatio n

27 0 SOI L 

### 2008-06-2 5 12:4 1 30.2 0 Fina l 

### 2519 1 242 4 Indian a B 2 DETRIC H 

### 1 0 CLEARANC E

± Erro r ± 13.96 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 130.75 1 Supervise d By : 

## Certificat e o fVerificatio n

27 1 SOI L 

### 2008-06-2 5 12:4 2 30.7 9 Fina l 

### 2519 1 242 4 Indian a B 2 DETRIC H 

### 1 0 CLEARANC E

±Erro r ±14.87 6

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 27 2 Mod e SOI L Tim e 2008-06-2 5 12:4 2 Duratio n 30.6 0 Sequenc e Fina l Flag s BVI D # 2519 1 ADDRES S 242 4 Indian a QUAD/ZON E B 2 INSPECTO R DETRIC H DEPT H 1 0 SAMPL E TYP E CLEARANC E NOT E
pp m ±Erro r P b 84.38 8 ±12.13 7 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 150.42 9 Supervise d By : 

## Certificat e o fVerificatio n

27 3 SOI L 

### 2008-06-2 5 12:4 4 30.9 4 Fina l 

### 2519 1 242 4 Indian a B 2 DETRIC H 

### 1 0 CLEARANC E

± Erro r ± 15.00 0

# 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 

### 27 9 Mod e SOI L Tim e 

### 2008-06-2 5 13:5 2 Duratio n 

### 121.4 2 Sequenc e Fina l Flag s AVERAG E I Av g o f275-27 8 ADDRES S 242 4 Indian a QUAD/ZON E INSPECTO R DETRIC H DEPT H 

### 1 3 SAMPL E TYP E RETES T NOT E ^ ppnTM/ ' ±/ Erro r / ' P b 134.12 9 ±14.63 6 

# y^^y
. Supervise d By : y y

# 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 146.72 3 Supervise d By : 

## Certificat e o fVerificatio n

27 5 SOIL 2008-06-2 5 13:5 0 30.8 4 Fina l 

### 2519 1 242 4 Indian a B l DETRIC H 

### 1 3 RETES T

± Erro r ± 15.48 4

# 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 104.42 6 Supervise d By : 

## Certificat e o fVerificatio n

27 6 SOI L 

### 2008-06-2 5 13:5 0 30.1 9 Fina l 

### 2519 1 242 4 Indian a B l DETRIC H 

### 1 3 RETES T

± Erro r ± 13.09 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 161.96 9 Supervise d By : 

## Certificat e o fVerificatio n

27 7 SOI L 

### 2008-06-2 5 13:5 1 30.2 0 Fina l 

### 2519 1 242 4 Indian a B l DETRIC H 

### 1 3 RETES T

± Erro r ± 16.03 3

# 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 27 8 Mod e SOI L Tim e 2008-06-2 5 13:5 2 Duratio n 30.1 9 Sequenc e Fina l Flag s BVI D # 2519 1 ADDRES S 242 4 Indian a QUAD/ZON E B l INSPECTO R DETRIC H DEPT H 1 3 SAMPL E TYP E RETES T NOT E
pp m ±Erro r P b 123.39 9 ±13.92 7 Supervise d By :^it o sr< . 

## 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 ENVIKONMENTA L C R O U r. INC - 

# EXECUTIV ESUMMARY : BVI D #2519 1 - (242 4 Indiana )

X 

# N o Issue s o r Concern s IIIssues/Concern s Detai l Explanation :

### S30L 

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

# iC\ ^ Propert yAddress : l/^y\AK'lAy] A Date/Time : Owner' s Name : (f/lMr^ m ffgy^^i C HVdlofMt^f Quad s Excavated : f| ^ U < ^t Contracto rGrou p O/A'^'P^ u 

### Excavatio nGenera l NACA-MTLoT Ye s No 1
. If necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 

## y 2
. If necessary , wer e th e correc t area s o f drip zon e excavate dan drestored ? 

# y Gradin g So dan dVecetatio n Ye s N o 1
.Doe s th e gradin g aroun dth e perimete r ofth e hous e i nexcavate darea s generall y slop e awa y 

# y fromth e house ? 2
.Ha s so dbeenlai dinal l area s tha t were excavated ? 

# y 3
.Doe s th e sodappear t o b e generall y healthy andgrowing ? (Onl y evaluat e if inspecte da t a3 0 da y time period ) 4
.

Ar e soddedarea s generall y firmandevenl y graded ? ^ 5
.Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e if inspecte 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 nth e property ? y 7 .

Wa s damag e t o landscapin g o r plan t material s avoided ? fX^ Gates , Fence s an d Retainin g Wall s Ve s N o I
.

D o gate s ope n an d clos e freely? (Ifapplicable ) 

## iJ ^ 2
.Wer e al l gates o rfence s take n dow n durin g restoratio n activitie s reinstalled ? (Ifapplicable ) il ^ 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 ) 

## | J ^ Foundation , Sidin g an dGutter s Ye s N o 1
.Wa s damag e t o th e sidin g o r tri mavoided ? 

# A/ A < 2
.Wa s damag e to th e foundatio navoided ? 

# l A 

# J ^ ^ 3
.

Wa s damag e t o window s avoided ? 

# UA 4
.

Wa s damag e t o window s o rdoo rscreen s avoided ? 

# (0 ^ 5
.Wa s damag e t o downspout s o r downspout extension s avoided ? 

# K i Sidewall u an d Driveway s (Concrete ) Ye s N o 1
.

Wa s damag e t o drivewa ysurface s avoided ? 

## AJ A 2
.Wa s damag e t o walkwa ysurface s avoided ? 

# y

# O vner s comments :

Inspectio nnotes : cu^. . 

### CU. , 

# 7

Removal andrestoralio nactivate s complet e includin g the 30-da y so dwarranty : EPARepresentati ; 

# yU^yc^W^ ^ Date : 7^f/(}/^ ,

# (P > Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio no f remedia l activitie s perfonne do nmy property . M > signatur e will designat e tha t Iamsatisfie dwit hth e restoratio no f m y property , an dtha t n o item s ar e in questions , now . o r at an y tim e inth e fulure
. excep t thos e item s liste dbelow , ifany
. Propert y ID : ^^/( j / Propert y Addres.s : g^l/-^i / ^^^'Q^ ^ S/
. Owner : Q^/ ^

^C^ytCM ybtl/drp p ^^^ d ^ C 

## pii^tno - 11
. n Try
. y~y^
. < Restoratio n Item s i n Question :

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

l* nIiiKi'o e restonitio ni s completed , excep t a s note d IId o no t iigre e restoiiitio ni s complete d 

# vyj > Owner' s Signatur e iJDat e Contractor' s Signatur e Dat e I