## TRANSMITTALo f

OMAHA LEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAID # : ^0C) > 

## Date : ^ll^jc p Address : :QfSf^5 k\ f U^p^^^- V Ku e Remediatio nContractor : _Coasta I Environmenta l Group
_ Year : 200 8
SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f propert y (DVD ) 

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

## y Signe dAcces s Agreemen t fo r subjec t propert y Signe dAcces s Agreement(s ) for adjacent propert y 

## y Restoratio nAgreemen t Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) Confirmatio ndat a y 

## Photograph s pre..-cMCA^nhi^ ^ e.^x.ajrJlo^^ -h ^ ^' ^ 

# P As-buil t sketc h Satisfactory restoratio n signe db y Property Owne r 

## y Property close-ou t chec k lis t signe db y EPA 

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

# m Utility clearance s



## y Property informatio nfro mDougla s County Assessor' s Offic e 

# X imOei4u ^ 

## ffl^ C^^^hJr-(or/ ^ 4031818 4 D Superfun d 

# 2eC0 L 0o)cy o ' Dat e Signatur e 

# Si-^*^^ ^ 

# Y/^/^ f

## Propert yAcces s Checklis t Proptrt j ID : ^.^^-y^i- j ^ Propert y Addre..:^^ ^ W
. y-^ f r^^ V n D WOR K STARTE D WOR K COMPELTE D ON : ON : _/ / /_ / 

## 0>-"<^'--rr..^ \CxAs^
. Address :

Phone : ^)^^_0^n ^ Fax : /^N i^e_
. 

## ^Fax : ^S^-l(q U ^4- ^ Rcnfe n Phone : Cell/Pager : Additiona l Inform»tion : 

## \

Ccll/Pager
. D E B D Notificatio nLette r

Acces s Agreemen t Restomtio o Agreemen t Topsoi l Samplin g (i f applicuble ) Sent : / / Siened : \3i / I /Of t Siened : \5L / \/l^ Q / / By : By : By : By : 

## \0\ro\o^ S VO>\rr>V6- S

n Q .0 ' D O n Disposa l Samplin g (r f applicable ) Garde nSamplin g (i f applicable ) Lnlit y Clearanc e Video/Photo s (Before ) Video/Pholo s (During ) Video/Photo s (After ) 1 / / / 

### Called : 13/ 1 /O K

On : / / On : / / On : / / By : By : By : 

## \^l^ly ^ By : By : By : D Video/Photo s (30-Day ) On : / / By : D D Propert y Completio nAgreemen t

Fina l Repor t Signed : Issued : / / / / By : By : 

# 1
Ai r Monitorin g (» s applicabl e O Communit y E H Cre w Results : On : / / By : 

# 1

C

D Comraunit} ' Results : C ] Cre w On : / / By :

• Communit y Results : O Cre w On : / / By :

Omah aLea dSit e

## CONTAC T FOR M Propert y ID # 

# Mnn 7 Propert y Address : 

# 2^ % Ne,v.)pnr V A v Initia l Contact : Date : Time : Action : Secon dContact : Date : Time : Action : Fina l Contact : Date : Time : Action : Fina l Action : Transmi t t o EP A D Othe r Action : D

Comment : Owne r Commen t (s) :

i 

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

### Dougla s County Accoun t Infcg^tio n Pag e 1 of 4 % 

# w
Dougla s County , Nebrask a Propert yRecor d - R175021000 0 Prin t Repor t NE

W Featur e - Parce l Dimensions availabl e @ scal e 0-5 0 ft wes t o

f 90th S t - Vje wOI L Ma p Informatio n i s vali d a s o f 2008-11- 5 Treasurer' s Ta xRejJor t Ne wFeatur e -*->- • Aut o Sale s Searc h Owne r COL E CARO L R 1582 1 WES TDODG E R D #16 3 OMAH AN E 68118-000 0 Propert yInformatio n Ke yNumber : 502 1 OOO O 1 7 Accoun t Type : Residentia l Parce l Number : 175021000 0 Parce l Address : Lega l Description : 255 5 NEWPOR TAV OMAH AN E 68112-000 0 MINN E LUS ALOT2 BLOC K1 0 4 4 X 12 0 Valu e Informatio n
200 8 200 7 200 6 200 5 200 4 200 3 Lan d $5,700.0 0 $5,700.0 0 $5,700.0 0 $5,700.0 0 $5,700.0 0 $5,700.0 0 Improvemen t $48,100.0 0 $56,200.0 0 $56,200.0 0 $56,200.0 0 $30,100.0 0 $30,100.0 0 Tota l $53,800.0 0 $61,900.0 0 $61,900.0 0 $61,900.0 0 $35,800.0 0 $35,800.0 0 Sale s Informatio n Sale s Date : 2008-08-0 6 Dee d Type : Price : Q C $0.0 0 SooAr : 200 8 Page : 07942 6
Grantor : Grantee : Pin k Propertie s Col e Caro l B Valid/Invalid : Invali d Exclusio n Reason : Famil ySal e Sale s Date : 2007-07-1 3 Dee d Type : Price : Q C $0.0 0 Book : 200 7 Page : 08054 4
Grantor : COL E CARO L R


### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl.
. . 11/26/200 8

### Dougla s County Accoun t Infomatio n Pag e 2 of 4 o ^ t
Grantee : Valid/Invalid : Exclusio n Reason : Sale s Date : Dee d Type : Price : Grantor : Grantee : Valid/Invalid : Exclusio n Reason : Sale s Date : Dee d Type : Price : Grantor : Grantee : Valid/Invalid : Exclusio n Reason : Sale s Date : Dee d Type : Price : Grantor : Grantee : Valid/Invalid : Exclusio n Reason : Sale s Date : Dee d Type : Price : Grantor : Grantee : Valid/Invalid : Exclusio n Reason : Sale s Date : Dee d Type : • PIN KPROPERTIE S LL C Invali d Famil ySal e 2007-06-1 1 W D Sooilr; 200 7 Page : 06663 0 $0.0 0 DEMESQUITAELLI S ETA L COL E CARO L Invali d
2006-10-1 7 Q C Book : 200 6 Page : 12104 3 $0.0 0 HSB C MORTGAG E SERVICE S IN C HOUSEHOL D FINANC E COR P II I Invali d Corporatio n T o Corporatio n 2006-10-1 3 W D Book : 200 6 Page : 12104 4 $52,500.0 0 HOUSEHOL D FINANC E COR P II I DEMESQUITAVICK I L Vali d
2006-05-2 5 TR D Book : 200 6 Page : 05812 4 $0.0 0 STEFF I ASWANSO N T R HSB C MORTGAG E SERVICE S IN C Invali d Sal e t o Mortgag e - Ban k 1997-04-1 4 D Book : 206 3 Page : 73 2 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl.
. . 11/26/200 8

### Dougla s County Accoun t Infif^atio n Pag e 3 of4 

## l^^ t • Price : $ 29,950.0 0 Grantor : Grantee : Validllnvalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 1 5040. 0 1. 0 120. 0 42. 0 N o Improvemen t Informatio n Buildin g 1 

## 1 2SS S Newpor t Ave
. 1 ^ a aof yUnft n ^^^^^^^^^^H r 

### ^l-ra ^ wfFTmJP-l:'^''^ ^ ^^^ H fWjKmJ ^ ^

^S^^ M 

# m g I I 

# T%

'.•'':':-:':?^^^H^ | 

### =n.!s r 

# HuBS|y|K|Bii i •!!«<W« « 1 ^^^^""" ^ ^ i ^ " 1 CLIC KT O ENLARG E IMAG E 1 CLIC KT O ENLARG E IMAG E | Squar e Footage : 912. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Averag e

Buil t As : 1 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 5. 0 Exterior : Fram e Aluminu m Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 2. 0

Roo f Type : 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 192 5 0 0 % 192 5 8 3 Deta/ 7 Typ e Detai l Descriptio n Unit s Ad d O n Unfinishe d Atti cW/floo r 228. 0 Applianc e Allowanc e 1. 0 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl.
. . 11/26/200 8

### Dougla s County Accoun t Info^^tio n Pag e 4 of 4 Q^^ t 

# t

Basemen t Fixture Fixture Fixture Garag e Porc h Porc h Bsmn t Bloc k 8 ft Additiona l Fixture s Bas e Fixture s Bat h Ful l Detache d En d Soli d Wal l Sla b Roo f Cei l 912. 0 1. 0 1. 0 1. 0 216. 0 112. 0

16. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accovmtinfo.jsp?accountno=Rl.
. . 1 1 /26/200 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 2183971
. Origina l Cal l Date : 12/01/0 8 Wor k t o Begi n Date : 12/03/0 8 Time : Time : 1:5 4 p m 2:3 0 p m Op : ELIZABETH18 7 9 0
State : N E Address : 255 5 County : DOUGLA S Street : NEWPOR T AV E Place : OMAH A Twp : 16 N Twp : Rng : 13 E Rng : Sect-Qtr : 33-N E 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 : FA X AL L CLEAR S TO : (877)662-421 1 Compan y: COASTA L ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : coasta l Dept h o f Excavation : 4f t Corne r Lot : N Front : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MAGELLANMETR O MUDO l OMAHACO F OPPDGPR S QLNNEI C

Servic e Are a Contac t Phon e Numbe r Utilit y Typ e
CXCAT V CO X COMMUNICATIONS , IN C 

### HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7

MAGELLA NMAGELLA NMIDSTREA M PARTNER S LPTONY A 

### Day : 918574709 8 Alt : 

### Emerg : 918574709 8

METR O METR O COMM
. COLLEG E 

### CHRI S Day : Alt : 402457230 7 402672703 3 Emerg : 402457231 3

MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : 

### Emerg : 402504797 0

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText
. asp?ret=<RESULTS..
. 12/1/200 8• • 

### Pag e 2 of 2

OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R 

### RO N Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0

0PPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T 

### N A Day : 406728934 3

Alt : 406207149 4 Emerg : 406523771 7
QLNN E1 C QWES T LOCA LNETWOR K 

### N A Day : 406728934 3

Alt : 406207149 4 Emerg : 406523771 7

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 12/1/200 8

# ^ As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e

4007 1 E)rterio f Pain t Omah a Lea d Sit e • Goo d Sit e Sketc h O'Poo r Samplin g Address : 255 5 NEWPORTA V • No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concenlralio n Collectej ) Firm : P cTU C D B T \ RYASCPXA-4007 1 F 1 pp m 

### D 

## m a Date : lOh/of t RYBSCPXA-4007 1 F 2 pp m 

### D Time : iO-H b ^^ ^ RYCSCPXA-4007 1 B l 

# a3
_ pp m 

### D Sample s Analyze d RYDSCPXA-4007 1 B 2 pp m 

## \ X D RDZSCPXA-4007 1 D Z pp m 

### D XR F Unit ; (t^H O Book ; 2 2 D nOZOGrXA-4007 1 SZ - pp m 

## n D Date : 1 ^ ' l 3 • 0 6 nrgGCP)(A-4007 1 P Z pp m 

## n D Time : Rrr y Staff : im£>{J Numbe ro f Sample s = I 5 Legend ; F 1 = 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 quadrant s ar e a s viewe d fro m tti e street , facin g propert y


### OC T0 9 200 8 : OLS# : 4007 1 Dat e Excavated : 12/3/200 8 Dat e USEP ASigne d Off:1/27/200 8 Are a Sodden : 20 9 s q ft



### Legen d Concret e 

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

## 4007 1 Exterio rPaint Nort h Ano w 

### rOmah a Lea d Sit e • Good 

### Sit e Sketc h Q^Poo r SamDiin a Address : 255 5 NEWPOR TA V • No t pain t 

### \ \ Sampl e Numbe r Lea d Concentratio n Sampl e CollectM l LA B Sample s Collecte d Firm : Ve
. TtJ C P g T \ RYASCPXA-4007 1 RYBSCPXA-4007 1 F l F 2 

# a3
_ pp m pp m 

## D D Date : lOh/oft Time : IO-i4 b ^ K RYCSCPXA-4007 1 RYDSCPXA-4007 1 B l 8 2 pp m pp m [ ^ 

## D D Sample s Analyze d RDZSCPXA-4007 1 RGZOCPXA-4007 1 

### nrzGcrxA'4007 1 D Z S2 ­ -P 2

— pp m pp m pp m 

## D 

# a D D D (oS>^ 0 XR F Unit :

Date : 1 0 / 3 • Time : A m Book : 2 2 Q 

# o e Staff : PTSL J Numbe ro f Sample s = I 5 Legend : F l = Fron t Left , F 2 = Fron t Right , 8 1 = Bac k Left , 8 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla ; Al l quadrant s ar e a s viewe d fro m th e street , facin g propert y ->tTKyr ¥



### A V vf'- ' ^ ' ^

# 4007 1 Exterio r Pain t Nort h Arro w 

### Omah a Lea d Sit e • Goo d 

### Sit e Sketc h

Numbe rof Sample s = I 5 [2 ^ Poo r Samplin g Address : 255 5 NEWPOR TA V Q No t pain t \ Sampl e Numbe r RYASCPXA-4007 1 F l Lea d Concentratio n 

## l& p pp m Sampl e Collecte d LA B 

## D Sample s Collecte d 

### Firm: P g TtJ C P g T. N Date : lOh/oft RYBSCPXA-4007 1 RYCSCPXA-4007 1 RYDSCPXA-4007 1 RDZSCPXA-4007 1 F2 B l B 2 D Z 

## q q 

## \(. 2 

## 9."? 5 23f t pp m pp m pp m pp m 

## D D D D Time : \0•.^ b tA \ Sample s Analyze d XR F Unit : (eSH O Book : 2 2 Q ROZOGrXA-4007 1 RPZOCPXA-4007 1 SZ ­ P Z — pp m pp m 

## D D D D Dat e Tim e 

## 10

- / 3 ' kn
. 

## 0 6 Staff : 

## Kn3t ^ Legend : F l = Fron t Left , F2 = Fron t Right , B 1 = Bac k Left , B 2 = Bac k Righ t DZ = Dri p Zone , G Z = Garden , PZ = Pla ; Al l quadrants ar e as viewe d fro m tti e street , ^cin g propert y 

### -fr * -" x A <

:i«"i 8 Crejle dC)5-Se p 1)4470 1 01.2 3cJ ^ —* #

-J f ) ^ COASTA L 

## 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 :
D«rti TM Phone : ^^^^y^ ^



# c — ^••P^p/:.^ ^

Addres s o f Propert y covere d b ythi s 

# ^ff ^

/^/^^Ayf<=>r•i ' /r^ ^ 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 remov e 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 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 have a n opportunityt o revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e i t begins
. Onc e th e wor k i s finished , th e Granto rwil l b e aske d t o revie wth e wor k an d confir m tha t i t i s complet e an d 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 property ha s bee n remediated
.
ENVIRONMENTA L RESPONS E ACTION S 

### Bysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , it s employees , contractors an d 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 f performin 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 f 2COASTA L CNVtRONNINTA l C • 0 U P
. IM C



### •Remove obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; •Remove 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 byEPA ; •Abid e b yhealt h an d safetyguidanc e provide d byEPA ; •I f th e propertyi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propertyt o perfor m th e work
. •Allo wvideotapin g and/o rphotographin g o f th 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 f th e wor k activities , o rwit h an y o f th e wor k done , o rvAt 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 propertywhic 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 wothers t o us e th e propertyi n suc h a manner . Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contact Coasta l Environmenta l Group , a t (712 ) 352-018 8



## Bt ^ gran t acces s t o m ypropertie s D I d o no t gran t acces s t o m ypropertie s 

# A:yfP/
. / ^ /-^;/ ^ Signatur e Dat e Signatur e Dat e

O I woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.COASTA L 

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

o remediatio nactivities
. Thi s wili 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 property ' owne r an dthe UnitedState s Environmenta l Protectio nAgenc y (EPA)
. Propert y ID : 

## HOo~i l Propert y Address : X55 5 M ^' ^ ('^^t ' ArJc
. Owner : Plione :


### O

n the attacheddiagram(s ) indicat e area(s ) t o excavatedan ddept hof excavation , locationo f al l know n utilities , subsurface features , syrface structure s an dlandscaping features , acces s location{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 directiono f view
. Item s T o B e Remove d B yOwne rBefor e Star t O f Remediation : (Us e additiona l sheet s a s necessary ) Th e removal , storage , disposal , and/o rretur n o f thes e item s i s th e Owner' s responsibility
. Hem : 

# Ayc > y c Item :
Item : 

### item :
Item :
Item : Item :
Item :
Pag e 1 o f 

# ACOASTA L V»>VI«OHP*tNTA L cM o u r. IN 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 : 

### PlA^rJ l fU>^^ S j o ie , Sc. { V^6^-g | ( f Item : Item : Item : Item : Item : Hem : Item : Item : Item : Item : Kem : Item : Item : Item : 

# 7

Pag e 2 

# A

### ( ^ COASTA L cI I e u p IM 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 )

Pag e 3 o f j ^—^t t
COASTA L C « O U P
. IM C 

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

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

# y^^ s 

# 9 \ u Pre-existin g propert y area , tha t will b e excavated , tha t Squar e fee t is covere dwit hgrass .

Number o

f tree s > 2 inc h trun k

diameter Eac h

Number of tree s < = 2 inc h trun k

diameter Eac h

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

Number of an dsize of eac hgarden / flowe r bed area . Attac hasketcho f relativ e size s an dlocations
. Eac h Squar e Fee t

Pag e 4 of ^

### ( ^ ^
COASTA L ( MVfMOMpttMTA l C " O U rIM C 

## Item Agree dupo nvalu e o f Dian t material s no t to b e renlace db v contractor . Note thi s valu e wil l b e usedto issu e D plan t vouche r t o th e propert y owner . Agree duponlis t of plan t material s tha t will be replace db y contractor . B e ver y specifi c an ddetailed
. Include asketchof wer e eachplant wil l b e placed b

y th e contractor . Agree dupo nare aof propert y t o be replace d wit hgras s sod
. Include asketcho f th e area(s ) t o be replace dwit h gras s sod
.
Are ao f Cit y o r Count y propert y t o be landscaped per thei r requirements
. Includ e asketcho f the ai^e a(s )

Easement Area , t o be excavate d 

## Quantity Unit Condition/Type/Specie s

^ $



# y 

# y Eac h

S F 

# {},P^^^^' ^ 

# 0 S F 

# f ' S F 

# >^y t ,^ 0

Page s 

# o. iC O AS T AI
. ««owr . IN C


### Additiona l Comment s / Instructions :

D Chec k th e bo x i f Owne r doe s no t wan t CE Gt o documen t interio r foundatio nwall s an dpossibl e pre-existin g damage
. B y checkin g thi s bo x CE Gi s no t responsibl e fo r an y damag e don e t o th e interio r o

f house , includin g foundatio ncxack s o r fissures.

Sla f nI d o no t agre e agre e



# /Up/y.1 ^ i^^l-d p (l(AHH^o- hl^^jljt) ^ Owner' s Signature Dat e Diitnctor' s Signatore Dat e Pag e So f ^

## BviD # ^Qon j XR F PROPERT YSAMPL E SHEE T Dat e Addres s ^fyy
. KV
. ^^f^^^r:K^^r , 

# la-n-op , Project Omah a lea d F P 2nc 3 yea ropiip n Sampl e tim e iPir^g
. am/p m XR F ID # sampl e lengt h 30 se c

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

## ,y>yo±R.c^ ' SQQ Q ,^i-H-? t a-t? >

y^\P , y^-9^y.i9
. 

# ia
. ^C^.3-6t«.ft i 

## ey^^ ^ ^aa- ^ 

# '^av - l O SSt;:,
. A ^ Dept h 

## ^^^ 4 =^(.^..5! ^ t T A M Dept h • "^^r^ b \96.(oU>-y:y i 0^.
. ./
. i-i.T ^ \ 

# E ^a^' ^ Averag e ^Q^.^.^t H -€> R Averag e gJ> ^ .<^g> ^

^ , ^? ^
Shot * Readin g Sampl e are a Shot * Readin g Sampl e are a Dept h Dept h Averag e Averag e Sho t # Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h Averag e Averag e
RETES TAREA S Shot # Readin g Sampl e are a Shol # Readin g Sampl e are a Dept h Dept h Averag e Averag e la b sampl e # La b resul ! Sampl e are a XR F Av g Signatur e _/>0f ^ Pnn l /l/ rQi>/c^ S \^py ^

# 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 521 7 Mod e SOI L Tim e 2008-12-1 1 10:0 8 Duratio n 30.2 5 Sequenc e Fina l Flag s BVI D # 4007 1 ADDRES S 255 5 newpor t QUAD/ZON E 8 2 INSPECTO R Ventr y DEPT H 1 3 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 30.92 0 ±8.44 7 Supervise d By :

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

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

pp m P b 24.25 2 Supervise d By : 

## Certificat e o f Verificatio n

521 8 SOI L 2008-12-1 1 10:0 9 30.5 6 Fina l 4007 1 255 5 newpor t 8 2 Ventr y 1 3 CLEARANC E

±Erro r ±7.78 0

# 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 521 9 Mod e SOI L Tim e 2008-12-1 1 10:1 0 Duratio n 30.5 8 Sequenc e Fina l Flag s BVI D # 4007 1 ADDRES S 255 5 newpor t QUAD/ZON E B 2 INSPECTO R Ventr y DEPT H 1 3 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P b 10.88 3 ± 6.43 3 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 23.65 8 Supervise d By : 

## Certificat e o f Verificatio n

522 0 SOI L 2008-12-1 1 10:1 0 30.4 7 Fina l 4007 1 255 5 newpor t B 2 Ventr y 1 3 CLEARANC E

± Erro r ± 7.67 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 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 f Verificatio n

522 1 SOI L 2008-12-1 1 10:1 0 121.8 6 Fina l Av g o f 5217-522 0 255 5 newpor t 8 2 Ventr y 1 3 CLEARANC E

# 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 522 2 Mod e SOI L Tim e 2008-12-1 1 10 : 1 2 Duratio n 30.3 8 Sequenc e Fina l Flag s BVI D # 4007 1 ADDRES S 255 5 newpor t QUAD/ZON E easemen t INSPECTO R Ventr y DEPT H 1 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 31.97 3 ±8.42 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 36.32 9 Supervise d By : 

## Certificat e o f Verificatio n

522 3 SOI L 2008-12-1 1 10:1 2 31.0 3 Fina l 4007 1 255 5 newpor t easemen t Ventr y 1 CLEARANC E

± Erro r
± 8.81 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 26.24 5 Supervise d By : 

## Certificat e o f Verificatio n

522 4 SOI L 2008-12-1 1 10:1 3 30.7 3 Fina l 4007 1 255 5 newpor t easemen t Ventr y 1 CLEARANC E

± Erro r ± 7.93 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 25.15 6 Supervise d By : 

## Certificat e o f Verificatio n

522 5 SOI L 2008-12-1 1 10:1 4 31.0 1 Fina l 4007 1 255 5 newpor t easemen t Ventr y 1 CLEARANC E

± Erro r
± 7.74 0

# 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 522 6 Mod e SOI L Tim e 2008-12-1 1 10:1 4 Duratio n 123.1 5 Sequenc e Fina l Flag s AVERAG E ^Av g o f 5222-522 5 ADDRES S 255 5 newpor t QUAD/ZON E easemen t INSPECTO R Ventr y DEPT H 1 SAMPL E TYP E CLEARANC E NOT E

P b Supervise d By :c> * —< * 

### Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
. v V • .<s< ^

www.coastalhazmat.co m ^•'Lno ACOASTA L ENVIRONHENTA L C R 0 U f , INC
. 

# EXECUTIV ESUMMARY : BVI D #4007 1 - (255 5 NEWPOR T AVE )
I I N o Issue s o r Concern s ^ Issues/Concern s Detai l Explanation : CONCERNABOU T TH ESO D GROWIN GI NTH ESPRING
. WIL LREVIS EI NSPRIN GO F2009
.

# s ^ 

# E( % • 

## EP A Propert y Clos e Ou t For m fi<>k^L^nQo>ct: fV.v e . Propert y H : y^rnT I , \ Propert y Addre»:->- ' • » -'^ ^ Date/Time : Owner' s Name : LhiXd
. ^jQ^f e Contracto r Grou p f^.VAJKWxi l ^.r\A \f(SOi>-UL^ y Quad s Excavated : Ye s N o Excavatio nGenera l 1
. Ifnecessary , wer e th e correc l quadrant(s ) excavate dari drestored ? 

# y 2
. I f necessary , were th e correc l area s o f drip zone excavate dandrestored ? 

# l i ^ Gradio K So dan dVegetatio n Ye s N o 1
. Doe s the gradin g aroun dth e perimeier ofth e hous e i nexcavaie darea s generall y slop e awa y 

### y fromth e house ? 2
. Ha s sodbee nlai di nall area s tha t wer e excavated ? 

### y 3
. Doe s the so dappea r t

o b e gencTBll y healthy an dgrowing ? (Only evaluate i f inspecte da t a3 0 

## y day time period ) 4
. Ar e soddedarea s generally firman devenl y graded ? 

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

### y tim e period) 6
. Wa s the propert y grade dsuchtha t wate r wil l no t poo l o nthe property ? 

## y y 7
. Wa s damage t o landscapin g o r plan t material s avoided ? Gates , Fence s an dRetainin g Wail s Ve s N o 1
. D o gate s ope nan dclos e freely ? (Ifapplicable ) 

## A 2
. Wer e al l gate s o r fence s takendow ndurin g restoratio nactivitie s reinstalled ? (Ifapplicable ) 

### K A 3
. Wa s damage t o gate s o r fence s avoided ? (Ifapplicable ) 

# y 4
. Wa s damage t o retainin g wall s avoided ? (Ifapplicable ) 

# fi h Foundation , SidioK an dGuller s Yes N o t . Wa s damage t o th e sidin g o r tri mavoided ? 

## y 2
. Wa s damage t o the foundationavoided ? sy 3
. Wa s damage t o window s avoided ? L ^ 4 Wa s damage to window s o r door screen s avoided ? i ^
, y ^ 5
. Wa s damage l o downspout s o r downspoul extension s avoided ? Sidewalk s an d Driveway s (Concrete ) Ye s N o 1 Wa s damag e t o drivewa ysurface s avoided ? y 

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

## Owner s comments : 

# t

Inspectio nnotes :

Remova l an drestoratio nactivate s complete includin g th e 30-da y so dwarranty : EP A Represenlatiy^-^T^SL^^^;^^.^ ^ Date: Yir^/zi f

### nuiii.iUHim L hNVIHUNflhNIA L 57? 66 2 421 1 3 ^ 

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n th e ftrttifE, excep l rhos e item s lisfcdbelow , ifany
. Properly lU : d/Q^^ ^ rrap.7ty/Wldrc^v^<;^^;q-

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