# TRANSMITTALof OMAHALEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAID# : 'clolS y Date : 9//^/n ^ 

# Address : M^l ^ [')nr\eYh^CfYi k\\e Remediatio nContractor : Coasta l Environmenta l Group

_Year : _2008
_ SOI LREMEDIATIO N PROPERT YFIL EFOLDE RDOCUMENT S y Vide o ofpropert y (DVD ) y Executiv eSummary \y EPA-provide dproperty sketc h [ r

Signe dAcces s Agreemen t for subjec t property fyjf \Signe dAcces s Agreement(s ) for adjacent property y Restoratio nAgreemen t /M ^Settlemen t document s (i.e. , for damag eo r t o replac eplants , etc. ) 5

K

Confirmatio ndat a Q / Photograph s TiT^

- p ^nJoi x O Ai > ^ /U)QMOa ^'^oA ^ {^AJiisd d 0 As-buil t sketc h M Satisfactory restoratio nsigne db y Property Owner y Property close-ou t chec k lis t signe db y EPA W ^ Descriptio nofarea s no t meetin g RO D cleanu p criteri a 5 /

Utility clearance s ^ 

## Property informatio nfromDougla s County Assessor' s Offic e 4031648 0 

# y 

# iiiiiiii i

• Superfun d

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^ Signatur eDat ef \



### Propert yAcces s Checklis t Property ID : (^^J^^
. Propert yAddress : q^/ Q |;^^^^, ^

n , 

### n n

WOR K STARTE D WOR K COIVIPELTE D ON : ON : / / /_ /_
Owne r 

# ^'"TF^omq ^

/^nphie r Address :


### Phone:(qp-^> ^ ^^j-^^^^ Fax : Cell/Pager : Renter : Phone : Fax : Cell/Pager : Additiona l Information :

O Notificatio nLette r Q ^ Acces s Agreemen t 0 ^ Restoratio nAgreemen t 1 1 Topsoi l Samplin g (if applicable ) O Disposal Samplin g (if applicable ) O Garde nSamplin g (if applicable ) nutilit y Clearanc e 0 ^ Vidco/Photo s (Before ) nVideo/Photo s (During ) D Video/Photo s (After ) nVideo/Photo s (30-Day) nPropert y Completio nAgreemen t C

HFina l Repor t Sent : / / Signed : _g_/it/ ^ Signed : _S_/(i_/ ^ / / / / / / Called : J ? /ll
. / Of i 

### On: B/2Z)/i3 0 On : / / On : / / On : / / Signed : / / Issued : / / By : By : By : By : By : By : By : By : 

### ft-\'^'C€> WM.-C C By : By : By : By : By : Ai r IVIonitorin g ( 1 1 Communit y a s applicabl e

D Cre w Results : On : / / 

# 1

1 1 Communit y D Results : Cre w On : / / B, :

1 1 Communit y Results : D Cre w On : / / By :

Omah a Lea d Sit e

## CONTAC TFOR M Propert y I D #{^(o'}'ii o Propert y Address : 

# M^i qvi/^rifKKimdmp

Initia l Conlact : Date:
_ Time : Action : Secon dContact : Date : Time : Action : Fina l Contact : Date : Time : Action : Fina l Action : Transmi t t o EP AD Olhe r Action : D 

# |\ln\n\frv^-e \\nf O Comment : Owne r Commen t (s) ;
Sit e Coordinato r Commen t (s) :

### Dougla s Count y Accoun t Informatio n Pag e 1 of 2

tifiann a
Dougla s County , Nebrask a Propert yRecor d - R095360000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft west o f90t h S t - ViewO n Ma p Informatio n i s vali d a s o f2008-6-1 9 Treasurer' s Ta xRepor t Ne wFeatur e - •^ - •Aut o Sale s Searc h Owne r LANPHIE R THOMA S M
481 9 UNDERWOO D AV E OMAH AN E 68132-000 0 Propert yInformatio n Ke yNumber : 536 0 000 0 0 9 Accoun t Type : Residentia l Parce l Number : 

### 095360000 0 Parce l Address : Lega l Description : 481 9 UNDERWOO D A V OMAH AN E 68132-000 0 DUNDE E PLAC E LO T1 0 BLOC K12 2 E 3 5 F T3 5 X12 8 Valu e Informatio n
200 8 200 7 

### 200 6 200 5 200 4 200 3 Lan d 

### $10,100.0 0 $10,100.0 0 $10,100.0 0 $11,200.0 0 $11,200.0 0 $11,200.0 0 Improvemen t 

### $131,400.0 0 $130,000.0 0 $130,000.0 0 $109,500.0 0 $109,500.0 0 $109,500.0 0 Tota l 

### $141,500.0 0 $140,100.0 0 $140,100.0 0 $120,700.0 0 $120,700.0 0 $120,700.0 0 Sale s Informatio n Sale s Date : 2008-03-2 5 Dee d Type : Price : W D 

### $0.0 0 Boolt : 200 8 Page : 02925 8

Grantor : LANPHIE R LAWRENC E AETA L Grantee : LANPHIE R THOMA S M Valid/Invalid : Invali d Exclusio n Reason : Famil ySal e Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 

### 0. 1 4480. 0 

### 1.0 128. 0 35. 0 N o Lan d Attribute s


### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R09.
. . 7/17/200 8

## Dougla s County Accoun t Informatio n Pag e 2 o f 2

Attribut e Attribut e Descriptio n Negativ e Influenc e Traffi c1 Improvement Informatio n Buildin g 1

481 9 Underv/oo d A v 

# '#S ^
16 0 io<rQ 10 1 

# ^ m



# n "aSSSTn? " 

# B^ H MI T nnlPl M »j>i r Svconi l Flo w <a a »( T MejDs«.n
. 744. 0 3^
. Fl
. JUE
. f7 ( 

# ^^^ 1 li e 

## ^^^^ H !" f •--jn r' 2 1/ 2 stor y eiima:cka n T44i]e g P L
CUCKIQENLARgEiiyiyj^g E Squar e Footage : 1936. 0 Percen t Complete : 

### 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 2 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 Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 5 Roo fCover : Compositio n Shingl e Bedrooms : 3. 0

Roo fType : Hi p Stories : 2. 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 191 4 0 % 191 4 9 5 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 744. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 

### 1. 0 Fixtur e Bat h Hal f 

### 1. 0 Garag e Detache d 360. 0 Porc h En d Scree n 58. 0 Use r Atti cful l finis h 252. 0 Use r Need s pain t 1. 0


## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R09.
. . 7/17/200 8

## Pag e1 of 2

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


## YOU RTICKE TNUMBE RI S 2105336
. Origina l Cal l Date : 8/12/0 8 Time : 3:4 0 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 8/14/0 8 Time : 4:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 481 9 Street : UNDERWOO D AV E Twp : 15 NRng : 13 E Sect-Qtr : 17-SW,18-S E 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 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 ho f Excavation : 4f t Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MCLEODN E MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic eAre a Contac t Phon e Numbe r Utilit y Typ e
CXCAT V CO XCOMMUNICATIONS , IN C HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7

MCLEODN EMCLEODUS A N O NEE D T O CALLOU T EMERGENC Y Day : 800289190 1 Alt : Emerg : 800289190 1

MUDO l METROPOLITA NUTILITIE S DISTRIC T 

## EDWIN A Day : 402504782 3 Alt : Emerg : 402504794 6

OMAHACO F CIT YO FOMAHA

TRAFFICSEWE R 

## RO N Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0

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

## Pag e2 of 2

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

### Day : 406728934 3 Ah : 888728934 3 Emerg : 406728934 3
QLNN E1 C QWES TLOCA LNETWOR K 

## N A Day : Alt : 406728934 3 

## Emerg : 888728934 3

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

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e
6678 6 Exterio rPain t Omah a Lea d Sit e •Goo d Sit e Sketc h g ] Poor Samplin g Address : 481 9 UNDERWOO D A V Q No l pain t Sampl e Numbe r Lead Sampl e LA B Sample s Collecte d Concentratio n Collecte d Fir m RYASCPXA-6678 6 F l ^di o pp m 

## 0 D Date RYBSCPXA-6678 6 F 2 (ti'- i I pp m 

### D Tim e RYCSCPXA-6678 6 B 1 _fljEL5_PP m 

# n Sample s Analyze d RYDSCPXA-6678 6 B2 

### IIB O pp m D RD2SCPXA-6678 6 DZ 

### 2*i(a Upp m XR F Unit : CaSH l Book : 79 3 

### D RGZSCPXA-6678 6 G Z ~ * Pom 

### D Date : //%•?/> •0 7 RP2SCPXA-6678 6 P Z ~ pp m 

### D D Time : /^/* f 

### D Staff : f*1^L / Numbe ro fSample s = 5 " Legend : F 1 = Fron t Left
. F 2 = Fron t Right
. B 1 = Bac k Lefl
. 8 2 = Bac k Righ t DZ = Dri p Zone , G Z = Garden , PZ = Play Al l quadrant s an t a s vwwe d fro m tti e straet
. facin g propert y 

### •dLS#:g62 M Dat e Excavate d :8/,28/200 8 Dat e USEP ASigne d Off:1/27/200» - Are a Sodde d 356 3 s q f : 

### 6c [ 2: 9 2G0 ?

B 2 = PPM117@6 "
B 1 =PP M 16 7 @ 6 " DZ=PPM117@12 "

F 2 = PP M 3 8 @ 6 "
EA=PPM120@ r Cnn d<>ill3JU7«.l«: :



### 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 Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
.

# 6678 6 Exterio rPain t 

## Omah a Lea d Sit e NorthArrow
•Goo d 

## Sit e Sketc h g l Poo r Samplin g Address : 481 9 UNDERWOO D A V r~ | No t pain t 

# I

Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Fir m 

# A5y ) /"toj/ZIM ) RYASCPXA-6678 6 F l 

## D Dat e 

# i s RYBSCPXA-6678 6 lr¥ 

## S I 

## D Tim e RYCSCPXA-6678 6 B 1 

## E l 

# n Sample s Analyze d RYDSCPXA-6678 6 8 2 

## 0 D RDZSCPXA-6678 6 D Z XR F Unit ; CoSH Z Book : /9 3 

## D RGZSCPXA-6678 6 G Z 

## D Dat e 

### /n-7/i0 7 

## D RPZSCPXA-6678 6 P Z 

## D Tim e 

## D 

# Ul
. Staff : 

## f^i\ J Numbe ro fSample s = ^ [ Q | 

### N ^ Legend : F l = Fron t Left , F 2 = Fron t Right
. B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y AH quadrant s ar e a s viewe d fro m th e slreet , facin g propert y 

# ENTERE POmah a Lea d Sit e Sit e Sketc h Samplin g Address : 481 9 UNDERWOO D A V ^ i - Sampl e Numbe r RYASCPXA-6678 6 RYBSCPXA-6678 6 RYCSCPXA-6678 6 RYDSCPXA-6678 6 RDZSCPXA-6678 6 RGZSCPXA-6678 6 RPZSCPXA-6678 6 Lea d Concentratio n Sampl e Collecte d LA B \CiC D pp m pp m pp m pp m pp m pp m pp m Numbe ro f Sample s = ^ j Q 

# 6678 6 Exterio rPain t NorthArro w •Goo d g l Poo r Q ] No t pain t Sample s Collecte d 

### A5IA 3 ^UOJ/^H ) 

## ^

3 TA M Sample s Analyze d XR F Unit : 65*^2
. Book : /9 3

Date : m-7/iQ 7 Time ; 

# m Staff ; 

# f\i\ J 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 y Al l quadrant s ar e a s viewe d fro m th e street , facin g propert y 

# ENTERE D OC T2; 9 2ua ? 

# f ^

~: i 

# '•.fi m4(/t7;[oi/ni^H ^ 

# y-fiku : V-^ X

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. 

## WfrT^^Afeiif ^ ^»^'7blfl^t '

# f 6678 6 Exterio rPain t NorthArro w 

### Omah a Lea d Sit e •Goo d 

### Sit e Sketc h g ] Poo r Samplin g Address : 481 9 UNDERWOO D A V Q No t pain t 

# I
I Sampl e Numbe r RYASCPXA-6678 6 F 1 Lea d Concentratio n 

# 366 ? pp m Sampl e Collecte d LA B 

### D Firm ; Date ; Sample s Collecte d 

# A5i o ry-jlhtA ) 3'S " A M RYBSCPXA-6678 6 F 2 

### CQH \ pp m 

### S I D Time ; 

# iDJ^ik ^ RYCSCPXA-6678 6 RYDSCPXA-6678 6 B 1 B 2 pp m pp m 

# m D D Sample s Analyze d RDZSCPXA-6678 6 D Z pp m 

### D XRF Unit : G>SH Z Book ; /9 3 RGZSCPXA-6678 6 G Z pp m 

### D D Date ; ir^-iA - Q l RPZSCPXA-6678 6 P Z pp m 

### D D Time; ?M Numbe ro fSample s = ^ [ Q | 

### Staff; fli U Legend ; F l = Fron t Left , F 2 • Fron t Right , B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z • Garden , P Z = Pla y Al l quadrant s ar e a s viewe d fro m th e street , facin g propertyw , • -5
. COASTA L *^ , .r«C ^ ENVIRONMENTA L

' t PKOI ^ C « 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 Agenc y(EPA ) o rit s authorize d representatives , collectivel y th e Grantee , t o ente ran d perfor m certai n environmenta l respons e activitie s upo n th e followin g describe d premises : ^

Owner' s Name : Daytim e Phone :

Addres s o fPropert y covere d b ythi s Agreement : 

# M?I A\lMe.Y\y.ntY i ^^j g 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 EP Atha t th e propert y ha s bee n remediated
.
ENVIRONMENTA LRESPONS 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

### I V****^* " COASTA COASTA L L 'J^
. __e C ENVIRONMENTA L GROUP

. IN C



## •Remov e obstruction s includin g boats , trailers , vehicles , playscape items , woo d piles , do g houses , etc ; •Remov e flowe rbulb sorplant s tha t th e Granto r orth e Grantor' s tenan t maywis h to save ; •Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , as necessarysubsequen ttoan initia l waterin g perio d byEPA ; • Abid ebyhealt h an d safetyguidanc e provide dbyEPA ; • Ifth e propert y is rented , assis t EP A in obtainin g tenan t approva l fo racces s to th e propert y to perfor m th e work
. •Allo wvideotapin g and/o rphotographin g ofth e property
. AGREEMEN TNO T TO INTERFER E 

## Th e Granto ragree s no tto interfer e ortampe rwit h an yofth e wor k activities , orwit h an y ofth e wor k done , orwit h th e equipmen t use d on hi s property , or to undertak e an y action s regardin g th e us e ofsai d propert ywhic h woul d ten d to endange rth e healt h or welfar e ofth e Grantee s orth e environment , or to allo wother s to us e th e propert y in 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 , at (712 ) 352-018 8

I gran t acces s to mypropertie sG I do no t gran t acces s to mypropertie s 

# ^'/y^ ^ Signatur eDat e

nn I woul d lik e to be presen t durin g an ysamplin g tha t is required
.« ^ ^ COASTA L 

## 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 propert yprio rt o remediatio n acti\ities

. Thi s wil 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 yowne ran d th e Unite d State s Environmenta l Protectio n Agenc y(EPA)

.

Properl j ID : 

# U 1^ ^ Properl > Address : m\0 ^ [j\^yi:hJ^^ V 

## iM t Owner ; 

# W^^ i uwttie ^ Phone : 

### "^ ^ 

# ^^\-m ^

O n th e attache d diagram(s ) indicat e area(s ) t o excavate d an d dept h o fexcavation , locatio n o fal l 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 types , etc
. Indicat e digita l photo s b > referencin g th e photo-lo g numbe rwit h a n arro windicatin g directio n o fview
. 

### 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 c fthes e item s i s th e Ov^ne rs -esponsibility
. 

### Rem : 

# C

. /) , yWlVfu
. \W(v\1 h ^ ^ Item : y '
Item : ^ y Item : / ^
Item : y Item : / ^ Item : y Item :

Pag e 1 o f( ^COASTA 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 : 

# ^f\i ^

fuvif z Uf fy^^ ^ 11 0 Item : Hem :
Item : Kem :
Item :
item :
Item :
Item : Item ;
ttem: Item : Item : Item :
Item :


# t Pag e 2 of
.COASTA L C •O M ••M C 

## Item s To B e Remove d B yContracto rDurin g Remediatio n An d Replace d (Us e additiona l sheet s a s necessary ) Item : 

# 4oi L ^ fy\l\ Yf>2
. -v^ ^ Item : 

# \\\jy\> ft^ 2 e f \ Item : 

## %>0 y 

# \^i : ^ H '^ m c^ m Item : ^ ^ ^ 

# ^• ^

%i ^ W^ f ^ k^F v^\^ ^ Item : (^-

. 1 - v1 1 - '%-i' ^ 

# h^]^ \^ - yv \

YvX ""y ^ 1 Item : y ^
ttem : / Item : y Item : /
Item : /
Item : /
Item : /
Item : /
Item : /
Item : /

Pag e 3 o fCOASTA L CMOUP

. IN C 

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

## Ite m

Pre-existin g property area , tha t wil l b eexcavated , tha t i s coveredwit hgrass .

Numbe r o f tree s > 2 inch trun k diamete r

Numbe r o f tree s < = 2 inch trun k diamete r

Numbe r o f Sprinl<le r Zones
. Contro l Valves , Timers
. Heads , etc . Anac hasketc ho f th e sprinkle r la

xout .

Numbe r o f an dsiz eo f eac hgarden/ flower bed area . Attac hasketc hof relativ e size s an dlocations
. 

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

# l^CU/^Cih& ^ Square feet 

# y

Each 

# 1 \y 

# y Each 

# y Each


# V i ^ \ Each \ Squar eFeet

Pag e 4o f^

# P

COASTA L 

## Ite m Quantit y Unit Condition/Type/Specie s .Agreedupo nvalu eof olan t material s no l to b e replace dbv contractor . ' Notethi s \alu ev\il l be use dt o issu eaplan t vouche r t o th epropert> owner . 

# y s

Agreeduponlist of plan t material s tha t ^\\ \be replace db y contractor . B e ver y specifi c anddetailed
. 

# y Eac h Include asketc hof wer e eachplant will b eplaced b \th econtractor . Agreeduponareao f propert y t o bereplaced wit hgras s sod
. Includeasketcho f the area(s ) to bereplacedwit h gras s sod
. 

# H )y h S F

Are ao f Cit y or Count y propert y to belandscaped per their requirements
. Includen«keicl i v' f tl-. e are a( s i S F 

# &f1r7fci^^ f

Easement .^rea
. t o be excavate d S F 

# ^ UP\mA\A(!f\ j

Pag e 5 

### of G?C O AS T A1
.

Additiona l Comment s / Instnictions :



# _'^yy\s}M t ^ f« ^

fun^r ^

i?5 rh ^ ft^
. Vwc%

- - fUK t \o(Ay\ % ^^y] x^^ ^ ^" ^

G Chec k th e tx> xi fOwne rdoe s not wan t CE G t o documen t interio rfoundatio n wall s arx l possibl e pre-existin g damage
. B ycheckin g thi s boxCE G i s not responsibl e fo ran ydamag e don e t o tti e interio rofhouse , includin g foundatio n cracks o rfissures
.


## QId o Bo t agre e



# - 9 y - c" & 9fCkHiso h y\y ''Owner' s Si^o^M ^ Dat e CoBoactor' s Signatar e Dat e 

### PageSof

.

# yyi^ij f BVID # XR F PROPERT Y SAMPL E SHEE T Dat e Projec t XRFID #

Shot # 

# 3Si :

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# -l u



# m k Averag e
Shot * V' K- ^ %1W W 

# kk Averag e

Sho t # 

## Zll S 

# HE

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# i ^i s -^ V Omah a lead FP 2n a yearopllo n ^^^ n

Readin g 

# ^-cqi t H.^r iKq^ i t iM>M ) 

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# wn yt y ^ Sampl e are a hPficx^tfA f Dept h 

# ]%. y t 

# \H-^ %

Readin g Sampl e are a lO^.Ol t (1..v.f < 

### iQ-qp ^ IVT^ ' 

# M IK.OO i 1^-S 1 Dept h 

# MMLjM I l' <

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. 15 ^- \^-P |
Readin g Sampl e are a l)g

. 5] j : l^.i^n " 

## t^ Z Ul-?;
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### Ui.^ ^ t IV I ^ 

# in.6 < ^^ lyi u Addres s 

# y\' i [j'M^iMUo'J ^ Sampl e tim e )\-\ y/rrT)/p m sampl e lengt h 30 se c^ Shot # Readin g Sampl e are a 

# Tn ^

'>1M I 

# PT Dept h 

# H Averag e "> i ^ 1 ^- ^-^ ^
Shot # Readin g Sampl e are a 

### IK.O Ulu.1 ^ ^^
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# r i
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. 

# K 3n < 1^(^
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### LIU - 

## ikH^ t M::^ ^ J y L Averag e W.V l ^ 1 U • (7 (p
Shot # Readin g Sampl e are a Dept h Averag e

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

# y y 

# yy Dept h

La b resul t Sampl e are a XR F Av g Signatur e 

# Pnn, " }hMy n f^ATfa - •?

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

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

Supervise d By : 

## Certificat e o fVerificatio n

313 9 SOI L 

### 2008-08-2 8 11:1 4 121.0 3 Fina l |Av g o f3135-313 8

481 9 Underwoo d av e teasemenl ^ *LOPE Z 

# f l

CLEARANC E

# 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 

### 313 5 Mod e 

### SOIL Tim e 

### 2008-08-2 8 11:1 2 Duratio n 

### 30.0 8 Sequenc e Fina l Flag s BVI D # 6678 6 ADDRES S 481 9 Underwoo d av e QUAD/ZON E easemen t INSPECTO R LOPE Z DEPT H 

### 1 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 126.90 5 ±14.95 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 115.94 2 Supervise d By : 

## Certificat e o fVerificatio n

313 6 SOI L 

### 2008-08-2 8 11 : 1 3 30.2 8 Fina l 6678 6 481 9 Underwoo d av e easemen t LOPE Z 

### 1 CLEARANC E

± Erro r
± 14.40 7

# 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 

### 313 7 Mod e SOI L Tim e 

### 2008-08-2 8 11:1 4 Duratio n 

### 30.3 4 Sequenc e Fina l Flag s BVI D # 6678 6 ADDRES S 481 9 Underwoo d av e QUAD/ZON E easemen t INSPECTO R LOPE Z DEPT H 

### 1 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 121.75 1 ±14.79 6 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 

### 313 8 Mod e SOI L Tim e 

### 2008-08-2 8 11:1 4 Duratio n 

### 30.3 3 Sequenc e Fina l Flag s BVI D # 

### 6678 6 ADDRES S 481 9 Underwoo d av e QUAD/ZON E easemen t INSPECTO R LOPE Z DEPT H 

### 1 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 117.99 1 ±14.57 3 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 

### 314 4 Mod e SOI L Tim e 

### 2008-08-2 8 11 : 1 8 Duratio n 

### 120.5 2 Sequenc e Fina l Flag s AVERAG E ^v g o f3140-314 3 ADDRES S 481 9 Underwoo d av e QUAD/ZON E F 2 INSPECTO R LOPE Z DEPT H 6 SAMPL E TYP E XLEARANCE f NOT E

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 47.78 3 Supervise d By : 

## Certificat e o fVerificatio n

314 0 SOI L 

### 2008-08-2 8 11:1 6 30.2 4 Fina l 6678 6 481 9 Underwoo d av e F 2 LOPE Z 6 CLEARANC E

± Erro r
± 10.15 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 39.87 7 Supervise d By : 

## Certificat e o fVerificatio n

314 1 SOI L 

### 2008-08-2 8 11 : 1 7 30.0 7 Fina l 6678 6 481 9 Underwoo d av e F2 LOPE Z 6 CLEARANC E

± Erro r
± 9.57 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 

### 314 2 Mod e SOI L 

### Tim e 2008-08-2 8 11:1 8 Duratio n 

### 30.1 8 Sequenc e Fina l Flag s BVI D # 

### 6678 6 ADDRES S 481 9 Underwoo d av e QUAD/ZON E F2 INSPECTO R LOPE Z DEPT H 

### 6 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P b 30.07 7 ± 8.77 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 35.34 1 Supervise d By : 

## Certificat e o fVerificatio n

314 3 SOI L 

### 2008-08-2 8 11:1 8 30.0 3 Fina l 6678 6 481 9 Underwoo d av e F2 LOPE Z 6 CLEARANC E

± Erro r
± 9.28 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 AVERAG E ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

Supervise d B y 

## Certificat e o fVerificatio n

316 7 SOI L 

### 2008-08-2 8 13:5 8 121.6 8 Fina l -i.Avg o f3163-316 6 481 9 Underwoo d av e 

## so z

LOPE Z % 2 ^ CLEARANC E

# 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 

### 316 3 Mod e SOI L Tim e 

### 2008-08-2 8 13:5 6 Duratio n 

### 30.3 3 Sequenc e Fina l Flag s BVI D # 

### 6678 6 ADDRES S 481 9 Underwoo d av e QUAD/ZON E D Z INSPECTO R LOPE Z DEPT H 

### 1 2 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 109.07 0 ±13.45 0 Supervise d By :

# 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 

### 316 4 Mod e SOI L Tim e 

### 2008-08-2 8 13:5 6 Duratio n 30.3 6 Sequenc e Fina l Flag s BVI D # 6678 6 ADDRES S 481 9 Underwoo d av e QUAD/ZON E D Z INSPECTO R LOPE Z DEPT H 

### 1 2 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 110.90 4 ±13.79 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 118.70 1 Supervise d By : 

## Certificat e o fVerificatio n

316 5 SOI L 

### 2008-08-2 8 13:5 7 30.3 8 Fina l 

### 6678 6 481 9 Underwoo d av e D Z LOPE Z 

### 1 2 CLEARANC E

± Erro r
± 13.89 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 132.47 5 Supervise d By : 

## Certificat e o fVerificatio n

316 6 SOI L 

### 2008-08-2 8 13:5 8 30.6 1 Fina l 6678 6 481 9 Underwoo d av e D Z LOPE Z 

### 1 2 CLEARANC E

± Erro r
± 14.92 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 

### 317 7 Mod e SOI L Tim e 

### 2008-08-2 8 14:0 9 Duratio n 

### 121.5 9 Sequenc e Fina l Flag s AVERAG E »Av g o f3173-317 6 ADDRES S 481 9 Underwoo d av e QUAD/ZON E INSPECTO R LOPE Z DEPT H 1 6 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 

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 

### 317 3 Mod e SOI L Tim e 

### 2008-08-2 8 14:0 7 Duratio n 

### 30.3 4 Sequenc e Fina l Flag s BVI D # 6678 6 ADDRES S 481 9 Underwoo d av e QUAD/ZON E B l INSPECTO R LOPE Z DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 185.02 9 ±16.73 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 149.16 2 Supervise d By : 

## Certificat e o fVerificatio n

317 4 SOI L 

### 2008-08-2 8 14:0 8 30.4 2 Fina l 6678 6 481 9 Underwoo d av e B l LOPE Z 6 CLEARANC E

± Erro r
± 15.23 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 166.17 7 Supervise d By : 

## Certificat e o fVerificatio n

317 5 SOI L 

### 2008-08-2 8 14:0 9 30.4 1 Fina l 6678 6 481 9 Underwoo d av e B l LOPE Z 6 CLEARANC E

± Erro r 16.22 3

# 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 168.74 4 Supervise d By : 

## Certificat e o fVerificatio n

317 6 SOI L 

### 2008-08-2 8 14:0 9 30.4 2 Fina l 

### 6678 6 481 9 Underwoo d av e B l LOPE Z 6 CLEARANC E

± Erro r
± 16.06 7

# 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 318 8 Mod e SOI L 

### Tim e 2008-08-2 8 14:2 4 Duratio n 

### 121.4 3 Sequenc e Fina l Flag s AVERAG E Av g o f3184-318 7 ADDRES S '481 9 Underwoo d av e QUAD/ZON E INSPECTO R LOPE Z 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 , 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 

### 110.51 0 Supervise d By : 

## Certificat e o fVerificatio n

318 4 SOI L 2008-08-2 8 14:2 2 30.3 5 Fina l 6678 6 481 9 Underwoo d av e B 2 LOPE Z 

### 6 CLEARANC E



### ± Erro r ± 13.47 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 121.76 0 Supervise d By : 

## Certificat e o fVerificatio n

318 5 SOI L 2008-08-2 8 14:2 3 30.0 5 Fina l 

### 6678 6 481 9 Underwoo d av e B 2 LOPE Z 6 CLEARANC E

± Erro r 

### ± 14.01 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 117.06 6 Supervise d By : 

## Certificat e o fVerificatio n

318 6 SOI L 2008-08-2 8 14:2 4 

### 30.3 1 Fina l 6678 6 481 9 Underwoo d av e B 2 LOPE Z 6 CLEARANC E

± Erro r
± 13.65 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 

### 318 7 Mod e SOI L Tim e 2008-08-2 8 14:2 4 Duratio n 30.7 2 Sequenc e Fina l Flag s BVI D # 6678 6 ADDRES S 481 9 Underwoo d av e QUAD/ZON E B 2 INSPECTO R LOPE Z DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b at21-26 7 ±13.91 1 Supervise d By :

## i,ML\ l^^^v ' I \y^^ ^ 

## 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 ENViRONNCNTA L C I I 0 U P
. INC

. 

# EXECUTIV ESUMMARY : BVID #6678 6 - (481 9 UNDERWOO D AVE )

^ N o Issue s o r Concern s | ^ Issues/Concern s
Detai l Explanation : N O ISSUE S PENDING
.

# t ^^EP A EP APropert> ' Clos e Ou t For m Propert yP : 

# UUiTBU s Propert yAddrew : 48 ^

^ i ^rvC^Xjr-lX^C'ySc l lA^j/ C

. Date/Tlroe : Owner' s N«me:-^r.rr ^ 6 ^ s . y , ^Q\^\P.V - Quad s Excavated : ^ . ;^ \ ?^ 3 , \^ ^ Contracio rGrou p (^pr

. ^\f

. 5 1 yf^ yrcrrMy\x.\n.\c> 4 , Excavatio D Genera l V e s 

### No 1
. I fnecessa^'
. ^cr cth e correc t quadrant(s ) excavate d an d resiored ? 

# y 2 Ifnecessary , wer e th e correc t area s ofdri p zon e excavate d an d restored ? 

# 7 CradlD KSo d an d Vecetatio n Ye s N o 1 Doe s th e gradin g aroun d th e perimete rofth e hous e i n excavale d areas generall yslop e awa y 

### y fro m Ib e house ? 2
. Ha s so d bee n lai d i n al l areas tha i were excavated ? 

### y 3
. Doe s th e sod appea rl o be generall yhealth yan d growing ? (Onl yevaluat e i finspecte d a t a 3 0 

### y da ytim e period ) 4 Ar e sodde d areas generall yfirm an d evenl ygraded ? 

### y 5 Ar e th e joint s t)etwee n th e so d strip s generall ylight ? (Onl yevaluat e ifinspecte d a t a 3 0 da y 

### y lim e period ) 6 Wa s th e propertygrade d suc h tha i wate rwil l not poo l o n th e property" ' 

### / 7 Wa s damag e l o landscapin g o rplan t material s avoided ? 

### / Gates

. Fence s an d ReUiDlD £Wall s ^ e

s N u 1 D o gale s ope n an d clos e freely? (Ifapplicable ) 2
. Wer e al l gate s o rfence s take n dow n durin g restoratio n activitie s reinstalled ? (Ifapplicable ) 

### A\ r • • 

### ^ i 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 ) Foundation , Sidio Kan d Culler s Yes N c 1
. Wa s damag e l o th e sidin g o rtri m avoided ? 

### y 2 Wa s damag e l o th e foundatio n avoided ? 

### y 3 Wa s damag e l o window s avoided' ' 

### y 4 , Wa s damag e t o window s o rdoo rscreen s avoided ? 

### ^ 5 Wa s damag e t o dowTispout s o rdownspou l exiension s avoided ? 

### ^ Sidewalk s an d Driveway s (Concrete ) Yes 

### N o 1 Wa s damag e t o drivewa ysurface s avoided' ' 

### < / 2
. Wa s damag e t o wallcwa ysurface s avoided ? 

## i /

### # 

# O »Ders comments :

Inspectio nnotes :

L
.



# Removal andresloralio nactivate s completeincludin g the30-da y sodwarranty EPARepresentaiiv^.V^6^<^t.<^;^^:^^V:74^:^ ^ Dale : VZ^l/a ?

### • 

# t

Propert yCompletio n Agreemen t Thi s agreemen t documents th e completiono f remedia l activitie s perlbrmec l o nm y properly
. M y signalur e wil l designale llia t Ia msatLslie dwit hth e restorationo f m y property , an dtha t n< i item. s iii ei nqucstion.s , now . o r a

t an y tim ei

nthefuture , except thos eilem. s li.ste dbelow , ilany
. Propc^ly^n>:^^^g( ^
_ Propert y Address : C^g|C ^ OndteroJDod t Owner : nrV^^ ^ ^^^^j^^^ ^

Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item :

Jc-L ^ Iagrct
- resloralio ni. v coni|ilclc<l , excep t u s note d IIil o no l agre eresCorHlio ni s complie d 

# ^-yj^yy^ ^ yy i l(p Y Contractor' s .Si^^natiir e DalL

I