### TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAID # : 2^'6l ^ Date : 

# z /



# 'njo^ Address : llp i 2
- V\Of\ C ^t Remediatio nContractor : _Coasta l Environmenta l Group
_ Year : 200 8 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f property (DVD ) Executiv e Summary EPA-provide dproperty sketc h 5

/ 

### Signe dAcces s Agreemen t fo r subjec t property Signe dAcces s Agreement(s ) fo r adjacent property Restoratio nAgreemen t 

# m Settlemen t document s (i.e. , fo r damag e o r to replac e plants , etc. ) Confirmatio ndat a Photograph s prg-i>y/'^jQ4tt^ y J.)CrjMnDA ^ ^(u dSoA As-buil t sketc h Satisfactory restoratio nsigne db y Property Owne r Property close-ou t chec k lis t signe db y EPA Descriptio no f area s no t meetin g RO D cleanu p criteri a Utility clearance s Property informatio nfro mDougla s County Assessor' s Offic e

D



### ^ ^ Signature Date "

# m Propert yAcces s Checklis t Propert y ID : 2 ^ J?Ti ^ Propert y Address : ^^^ 9 Mft^lf>S\ n n

WOR K STARTE D WOR K COMPELTE D ON : ON : / / / / 1


### I Owner : C^^;^ ^

Cif\\\Q
. Address :


### Phone : ^q^2'^L\q^.'^2.? 0 Fa\ : Cell/Pai-er : Renter : Phone : Fa.\ : Cell/Pa"er : Additiona l Information :

O Notificatio nLette r l/ t

Acces s Agreemen t 0 " Restoratio n.Agreemen t O Top.soil Samplin g (i f applicable ) I C H Disposal Samplin g (i f a|)()licable ) 1 1 Garde nSamplin g (i f applicable ) 1 0 " Utility Clearanc e 1 D Video/Photo s (Before ) 1 nVideo/Photo s (During )

nVideo/Photo s (After ) ­- D Video/Photo s (30-Day ) d l Propert y Completio nAgreemen t nFina l Repor t Sent : / / Signed : ^/iX/£]i ^ Signed : X/il/OS : / / / / / / Called : ^ / ^ / O R On : / / On : / / On : / / On : / / Signed : / / Issued : / / By : By : P C By : <pc . By : By : By : 

# ^y^wcf k By : By : By : By : By : By : Ai r Monitorin g (a s applicable ) 1 n Communit y n Cre« '

Results : On : / / 

### By : 1 1 L J Communit y Results : n Cre« ' On : / / Bv :
L J Communit y Results : D Cre^i ' On : / / By : 1
Omah a Lead Sit e

# m

CONTAC T FOR M Property ID # •^0^^- ^ 

## Property Address : 

# JA A Mft^\f > f\ ^ Initial Contact : Date : Time : ActionL Secon dContact : Date : Time : Action:
_ Final Contact : Date : Time : Action : Final Action : Transmi t t o EP A D Othe r Action : D 

# ^rr^\W s QprpU g i^iL ) ^a l -1,1 ^ Comment : Owner Comment (s) : Site q-2 M Coordinato r ^.3 0 Comment (s) : 

# 1 K ^ Y

### Dougla s County Accoun t IrAamatio n Pag e 1 o f 1 rmmsri c # Dougla s County , Nebrask a Propert yRecor d - R174477000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f90t h S t • ViewO n Ma p Informatio n i s vali d a s o f 2008-6-1 9 Treasurer' s Ta xRepor t Ne wFeatur e ->-•- •Aut o Sale s Searc h Owne r SMIT H CECELI AP ETA L 455 2 JENKIN S D R PLAN O T X 75024-000 0 Propert yInformatio n Ke yNumber : 447 7 000 0 1 7 Accoun t Type : Multipl e Re s Parce l Number : 174477000 0 Parce l Address : 161 2 MAPL E S T OMAH AN E 68110-000 0 Lega l Description : MILLAR D & CALDWELL' S AD D LO T2 2 1 / 2 BLOC K0 N 71.62 5 F T71.62 5 X 18 0 Valu e Informatio n Lan d 200 8 $800.0 0 200 7 $800.0 0 200 6 $800.0 0 200 5 $800.0 0 200 4 $800.0 0 200 3 $800.0 0 Improvemen t $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 Tota l $800.0 0 $800.0 0 $800.0 0 $800.0 0 $800.0 0 $800.0 0 Lan d Informatio n Acre s 0.2 9 S F 12780. 0 Unit s 0. 0 

# H/ii U 180. 0 

# Oe^A Vacan t 71. 0 Ye s



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17.
. . 7/17/200 8

### Pag e 1 of 2

" > Creat e Anothe rTicke t 

### Back to Irt hInterne t Sen d Emai l



### • YOU RTICKE T NUMBE RI S 2127339 . Origina l Cal l Date : 9/09/0 8 Time : 3:3 6 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 9/11/0 8 Time : 4:0 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 161 2 Street : MAPL E S T Twp : 15 NRng : 13 E Sect-Qtr : 10-NE-NW-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 AL L TH E WA Y T O TH E STREE T AN D TH E : HOUSE . 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 : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MAGELLAN MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C



### Servic e Are a Contac t Phon e Number Utilit y Typ e Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 918574709 8 MAGELLA NMAGELLA NMIDSTREA M PARTNER S L PTONY A Alt : Emerg : 918574709 8 Day : 402504782 3 MUDO l METROPOLITA NUTILITIES DISTRIC T SAND Y Alt : Emerg : 402504794 6 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R RO NAlt : 402444516 1 Emerg : 402444516 0

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

### Pag e 2 of 2 Day : 406728934 3 OPPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T 

### N AAlt : 888728934 3 Emerg : 406728934 3 Day : 406728934 3 QLNNE1 C QWES T LOCALNETWOR K 

### N A Alt : Emerg : 888728934 3

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

## a ( 0 ( 0 

## o U J 3 O 

## o (A 

### i 2 U i 3 O 

## o

# As-Buil t Drawin g C OASTA L ENVIRONMENTA L 

# Omah aLea dSuperfun dSit e CROUP , IN C 

# ^^^"1 ^ ] Name : C-cc^iic , S^-V-I^V A Omah a Lea d Sit e Date ; ^-/</ - " V Nort h Arro w\

Address ; l(r,I Z A^ip u 5 / - Sit e Sketc h Time : • ? •"•/: > Phone ; 

# f1

Tea m3i/lr , /U;,rv ^ CMS ^ BVID #'???!' $ XR F Cod e 

### gC>' \ Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e IC3 ^ pp m -P'Yes a N o E 3 

### -M^n . f^Ye s n N o E T 11^/'^' ^ pp m N o 13 ' pp m 6'Ye s C 3 ^ ^ pp m '?<:Ye s a N o 13 ^ pp m Ye s n N o C D pp m Ye s C D N o CD pp m Y e s • N o C D

Omah aLea dSite 4613 0 

### 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 aleft bar e 

### Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .D Remot e ID : Rpag e o f 

# k

Name : drili'r
. <>^,Ji n Address ; i(r,t Z A^jp k 5 / j Phone :
Tea m BtlUt/lU,.^or y(MeC ^ Sampl e Numbe r BVI D # Omah a Lea d Sit e Sit e Sketc h
^fg7 ^ Lead Concentratio n 

# L^a . pp m 

# i^^T ^

^ ­ ^ pp m pp m pp m pp m Date : S/^-c^ / Time : l:¥' y ^^^^^^ %
Nort h Arro w

XR F Cod e 

## SC" ^ Confirmatio n SampI * -P'Ye s n •r^Ye s ° •j'Ye s n e^Ye s D 

## Ye s n Ye s t= 3 Ye s • N o E 3 

### No 

### ^ 

### N

o 

### ta ' N

o S ^ N

o 

### D N

o 

### n N

o 

### • ^

—) V

V ^ 

# t^

<i > 

## -Lyl4Afl?-J
.

OmahaLea dSit e 4613 0

### '^^'%'^ % Name : C^rj h ^^/-ll n Omah a Lea d Sit e Date : S--/y - ^ V Nort h Arro w—i Address : /fe/ Z A^f k s i Sit e Si(etc h Time : ?•'•/: > Phone : 

# f

Tea m Me,/lL>fi,^or ^ CMe ^ BVI D # 'Zfdr B XR F Cod e ^^ ^ Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e 

## f2rA^pyA-g"7g 7 

# l^a
. -P'Ye s n 

### N o ^ d- 7 PP' " f^Ye s n 

### N o 3 ^ u'Ye s n 

### No ^^ r 

# jyi Tpp m '3<:Yes [ ^ 

### No C3 ^ —^- I pp m Ye s D 

### No n pp m Ye s n 

### N o O pp m Ye s • 

### N o • pp m



## „^^44i.^*j J

Omah aLea dSit e 4613 0D Remot e ID : R pag e o f 

### •

COASTA L IMViaONHTNTA ) < • O U r. IH C 

### Consen t Fo rAcces s T o Propeil 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 Environnnenta 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 : nn a -ir s
Owner' s Name : Daytim e Phone : 

# tSmilt , OMM A
Addres s o f Propert y covfire d b ythi s Agreement : 

## Ikl l Mft fi f S 4 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 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 dea n material s an d th e are a wil l b e restore d t o it s origina l condition
. Thi s wor k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o fCoasta l Environmenta l Group , contracte d b yUSEPA , wil l contact th e Granto rin-perso n t o discus s th e wor k t o b e perfonned , th e Granto rwil l hav e a n opportunit yt o revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e i t begins
. Onc e th e wor k I s finished , th e Granto rwil l b e aske d t o revie wth e wor k an d confir m tha t i t i s complet e an d meet s wit h th e Grantor' s approval
. Upo n completion , th e Granto rvwl l receiv e writte n documentatio n fro m EP Atha t th e propert y ha s bee n remediated
. ENVIRONMENTA L RESPONS E ACTION S 

### 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 , a t 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 2DRemot e ID : Rpag e o f # —<~,' \ 

# \

M I Io * COASTft L •*3i , .X ^ [NVIftONHrMTft l 'lr«crt« - t > 0 u 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 mayvws 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 EPAi 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 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 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 Envirc^nmenta l Group , a t (712 ) 352-018 8

Q] I gran t acces s t o mypropertie s G I d o not gran t acces s t o mypropertie s / 

# 'L,.Xi i ^it m ignatur e ' Data / / Signatur e

Dat e
G

1 woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.D Remot e ID : R pag e o f

C O AST AU C B O O ' 

### Restoratio n Agreemen t Th e purpos e otthi s agreemen t i s t o provid e a mutua l agreemen t a s l o condition s o f th e propert yprio rt o remediatio n activities
. Thi s wil l als o ser\' e a s d«Kumcntario n fo rth e purpos e o f assurin g tha t restoratio n activitie s ar e complete d C o th e satisfactio n o f th e propert yowne ran d th e Unite d Stale s Environmenta l Protectio n Agency(EPA)
.

PropLrtvID : 2(\^^ ^ J I P'^oP'^'^ yAddress : ^^^ ^ ^g,pt g S t

' Phon e 

# lau ) HH i
O n th e attache d diagram(s ) indicat e area(s ) t o excavate d an d deptl i oi ' excavation , locatio n o f al l know n utilhies , subsurface feattii^es , surfac e structure s an d landscapin g feature-s , access location(s ) t o b e use d b y contractor , an d tli e directio n o f North , Indicat e distances , depths , materia l types , etc
. indicat e digita l photo s byreferencin g th e photo-lo g numbe rwit h a n arro windicatin g directio n o 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
. Item : Ke m Item : item : Kem : Item : Item : Item :
Pag e 1 o f^D Remot e ID : Rpag e o f

COASTA L C n o u rI »« « 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 : / i Ite/h : 7 

# 7i^^-/ r/j - Tl// ) eKP/rv^ ^ ; ^ ;^/ ; Item : 

# 7^/fer yUd/Uti L Item : Item : Item : Item : Item : Item : I Item :

Item : Item : Item : Item :

Pag e 2 o f _ ^D Remot e ID : R pag e o f

C O AS T AI
. 

### 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 : 

### ^t l \f \P> \ft ^ 

### g>g . Item : 

## Srv l i nR i ari AP. 2 Item : Item : Item : Kem : Item : Hem : Item : Item : Item : Kem : Item : Item : Item :

Pag e 3o f ^D Remot e ID : Rpag e o f

COASTA L



### 1 Item
1 Prt-existin g propen y area ,

ihai wil l b e excavated , that i s covere dwit hgrass .

Numbe r o f tree s > 2 inc h HTin k

diamete r

Numbe r o f tree s < = 2 inch trunk diamete r

Numbe r o f Sprinkle r Zones . Contro l Valves , Timers
. Heads , etc . Attac hasketc ho f th e sprinkle r layout
.
Numbe r o f andsiz e o f eac hgarden / flowe r be d area . Attac hasketc ho f relativ e size s an dlocations
. 

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

### Quantit y i Unit Condition/Type/Specie s



# e> z Square fee t

• w 

### H-f t Each



### W' ^ Kac h



## Uf l Each



## M i n Each Square Feet

Pag e 4 of
.D Remot e ID : Rpag e o f


### * ^ C O AS TAL b KO U f • M C 

### Ite m Agree dupo nvalu e o f Dlant material s no t t o b e replace db v contractor . Not e thi s valu e wil l b e use dt o issu e aplan t vouche r t o th e propert y owner . Agree dupo nlis t o f plant material s tha t wil l b e replace dby contractor . B e very specifi c anddetailed
. Includ e asketc ho f were eac hplant wil l b e place d b y th e contractor . Agree dupo nare ao f propert y to b e replace d wit hgra.s s sod
. Includ e asketc ho f th e area(s ) to b e replace dwit h gras s sod
.
Are ao f City o r County propertv ' t o b e landscape d pe r thei r requirements
. Includ e asketc ho f th e aie a(s )

Easemen t Area , t o b e excavate d^ 

### #

Quantit y



# Q Urii t

$ 

# H m Condition/Type/Specie s



# B Eac h 

# H\f t

S F

S F 

## U|f l
T o V) e d€A«*^*«*< ^

S F 

## Pcndir ^ V^'OaKk S \

Pag e 5 o f^D Remot e ID ; Rpag e o f #

• Chec k th e bo xi f Owne rdoe s no t wan t CE G t o documen t interio rfoundation wall s an d possibl e pre-existin g damage
. Bycheckin g thi s bo xCE G i s rw t responsibl e foran ydamag e don e t o th e interio ro fhouse , includin g foundation cradc s o rfissures.

NTT J I^re e Q I d o no t agre e / 'ner' s Signs' ^ OW i SignatiMT I^t e / CoDtMctor' s Sigoatnr e Date Pag e 6 of
.Dat e Projec t XRFID #

Shot # 

## \ h 

# \ p m ty

c Averag e

Shot # iij ^



# .a i i 

# M 

# i Averag e

Shct #

Averag e

Shot #

Averag e la b sampl e # XR F PROPERT YSAMPL E SHEE T 

## ( ^

h 0 % Omah a lead F P 2n d yea roptio n '^0% ^ Readin g 

## ni.-v:> * ]\.i \ V-i^ - U ^ 9\-'6*? , t 10. K ^•^2
. i ^.^ M ^1-'^^ ; j Readin g 

## iLmt\i( K iSOi-^liZ
. 

# i'M- q ';a% t 

# k ^. h
^

.^ Q j Readin g

Readin g

La b resul t Sampl e are a 

# H Dept h



## t, " ^.^ ^ Sampl e are a 

## l { Dept h 

## M \(?\ \ Sampl e are a Dept h Addres s Sampl e tim e sampl e lengt h Shot # 

# s

il l 

# E Averag e

Shot #

Averag e Shot #

Averag e
RETES TAREA S Sampl e are a Shot # Dept h Averag e Sampl e are a XR F Avg
. Signature , BVI D 

# «_MM] L UT

_M^6 / 

# »r ~ l"^ : n am(pm
. 

# g 3 0 se c Readin g Sampl e are a m-l<,'L\<.- % 

### y^h(M \ 

## ni-n.3i : U- n IH3.q]^ t \\y ^ Dept h 

## nu^'j t ivx c -Ui
. |H(
. V t \^-< ^ Readin g Sampl e are a Dept h

Readin g Sampl e are a Dept h

Readin g Sampl e are a ^ ./-'Dept h ' / ^ ^ 

## X X
Prin t |AiM^6 i \Kfcvh n

# 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 18 6 Mod e SOI L Tim e 2008-09-1 9 15:1 0 Duratio n 129.7 8 Sequenc e Fina l Flag s AVERAG E • Av g o f182-18 5 ADDRES S 161 2 mapl e s t QUAD/ZON E INSPECTO R ^northcut t DEPT H SAMPL E TYP E 

# r 1 NOT E J_Cle a rane 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 71.33 2 Supervise d By : 

## Certificat e o f Verificatio n

18 2 SOI L 2008-09-1 9 15:0 7 30.8 8 Fina l 2987 8 161 2 mapl e s t 8 2 northcut t 6 Clearanc e

± Erro r ± 11.21 5

# 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 36.16 6 Supervise d By : 

## Certificat e o f Verificatio n

18 3 SOI L 2008-09-1 9 15:0 8 37.8 8 Fina l 2987 8 161 2 mapl e s t B 2 northcut t 6 Clearanc e

± Erro r ± 8.55 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 51.88 5 Supervise d By : 

## Certificat e o fVerificatio n

18 4 SOI L 2008-09-1 9 15:0 9 30.5 2 Fina l 2987 8 161 2 mapl e s t B 2 northcut t 6 Clearanc e

± Erro r 10.05 8

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

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

pp m P b 52.42 8 Supervise d By : 

## Certificat e o f Verificatio n

18 5 SOIL 2008-09-1 9 15:1 0 30.5 0 Fina l 2987 8 161 2 mapl e s t B 2 northcut t 6 Clearanc e

±Erro r ± 9.94 9

# 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

P b Supervise d B y 

## Certificat e o f Verificatio n

19 1 SOI L 2008-09-1 9 15:4 1 123.3 2 Fina l i;Av g o f 187-19 0 I F

161 2 mapl e s t I easemen t ^northcut t 

# J ' H^^Cle a rane e

# 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 18 7 Mod e SOI L Tim e 2008-09-1 9 15:3 9 Duratio n 30.9 0 Sequenc e Fina l Flag s BVI D # 2987 8 ADDRES S 161 2 mapl e s t QUAD/ZON E easemen t INSPECTO R northcut t DEPT H 1 SAMPL E Pr'P E Clearanc e NOT E
pp m ±Erro r P b 174.75 6 ±15.96 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 Pr'P E NOT E

pp m P b 131.03 9 Supervise d By : 

## Certificat e o fVerificatio n

18 8 SOI L 2008-09-1 9 15:4 0 31.1 5 Fina l 2987 8 161 2 mapl e s t easemen t northcut t 1 Clearanc e

± Erro r ± 13.97 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 Pi'P E NOT E
pp m P b 143.48 2 Supervise d By : 

## Certificat e o fVerificatio n

18 9 SOI L 2008-09-1 9 15:4 0 30.6 8 Fina l 2987 8 161 2 mapl e s t easemen t northcut t 1 Clearanc e

±Erro r ±14.39 5

# 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 19 0 Mod e SOIL Tim e 2008-09-1 9 15:4 1 Duratio n 30.5 9 Sequenc e Fina l Flag s BVI D # 2987 8 ADDRES S 161 2 mapl e s t QUAD/ZON E easemen t INSPECTO R northcut t DEPT H 1 SAMPL E TYP E Clearanc e NOT E

pp m Erro r P b 132.34 2 ± 13.85 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 20 0 Mod e SOI L Tim e 2008-09-2 3 11:1 6 Duratio n 128.3 3 Sequenc e Fina l Flag s AVERAG E I Av g o f196-19 9 ADDRES S QUAD/ZON E 161 2 mapl e s t 

### Ib l INSPECTO R , northcut t DEPT H ; 6 SAMPL E r/P E • CLEARANCEjj f NOT E

Supervise d B y

# 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 19 6 Mod e SOI L Tim e 2008-09-2 3 11:1 3 Duratio n 30.7 5 Sequenc e Fina l Flag s BVI D # 2987 8 ADDRES S 161 2 mapl e s t QUAD/ZON E b l INSPECTO R northcut t DEPT H 6 SAMPL E TYP E CLEARANC E NOT E
pp m ±Erro r P b 70.48 3 ±11.05 7 Supervise d By :

# 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 19 7 Mod e SOI L Tim e 2008-09-2 3 11:1 4 Duratio n 31.3 1 Sequenc e Fina l Flag s BVI D # 2987 8 ADDRES S 161 2 mapl e s t QUAD/ZON E b l INSPECTO R northcut t DEPT H 6 SAMPL E TYP E CLEARANC E NOT E
pp m ±Erro r P b 50.97 8 ±9.80 9 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 19 8 Mod e SOI L Tim e 2008-09-2 3 11:1 5 Duratio n 30.8 5 Sequenc e Fina l Flag s BVI D # 2987 8 ADDRES S 161 2 mapl e s t QUAD/ZON E b l INSPECTO R northcut t DEPT H 6 SAMPL E TYP E CLEARANC E NOT E
pp m ±Erro r P b 50.81 2 ±9.68 4 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 52.92 6 Supervise d By : 

## Certificat e o f Verificatio n

19 9 SOIL 2008-09-2 3 11:1 6 35.4 2 Fina l 2987 8 161 2 mapl e s t b l northcut t 6 CLEARANC E

± Erro r ± 9.90 1

### Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
. \ ^"tPBOT* ^ .<P * www.coastalhazmat.co m COASTA L ENVIRONMENTA L GROUP
. IN C 

# EXECUTIV ESUMMARY : BVI D #2987 8 - (161 2 MAPL EST ) 

# I I No Issue s o r Concern s X 

# Issues/Concern s Detai l Explanation : SOM EDEA D SO D I NEAS T PORTIO NO FLOT . IT APPEAR S T O HAV EBEENDRIVE N ONAN D POSSIBL Y HA D SOMETHIN GPARKE D ONIT .

# «EPA EP APropert y Clos e Ou t For m Propert y ft : C:>)^o D Propert y Address ^ — Date/Time : Owner' s Name : ^ f , rf' ^'^^_^_~trj i , - ' .'
—. Q Quad s Excavated : ^\^ P ^ Contracto r GronoCxncxJ^lSl ^ ^fxu \^o^^^^^^-^^^^ ^ Ye s N o Excavatio nGeneral 

# \/^gAi ^ Lo1 " 1 .

I f ncccssBiy , wer e th e correc t quadrant(s ) excavate dan dreslored ? 

# L 2 .i f necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? 

# O i Gradin g So dan dVegetatio n Ye s N c 1 Doe s th e gradin g aroun dth e perimete r o f th e hous e inexcavate darea s generall y slop e aittaif
. 

### ^ 2 .Ha s so dbee nlai dinal l area s tha t wer e excavated ? 

## X 3 .Doe s th e so dappea r to b e generall y health y andgrowing ? (Onl y evaluat e i f inspecte da t a3 0 

### ^ da y tim e period )__^___ ^ 

### ^1 ^ 4 .Ar e sodde darea s generall y firman devenl y graded ? 

### ^ 5Ar c th e joint s t>etwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period ) 

### ^ 6 .Wa s th e propert y grade dsuc hthat wate r wil l no l poo l o nth e property ? 7 .

Wa s damag e t o landscapin g o r plan t material s avoided ? 

### y Gates . Fence s an dRclainin g Wall s Ye s N o D o gate s ope nan dclo.s e freely ? (I f applicable ) 2 .Wer e al l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (Ifapplicable ) 

### > 3 .Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) 4 .Wa s damag e t o retainin g wall s avoided ? (I f applicable ) FouodatioD , SidioKan d Gutter s Ye s N o 1
.

Wa s damag e t o th e sidin g o rtri m avoided ? 2
.Wa s damag e t o th e foundatio n avoided ? 

## f/V fIs^Mt " 3
.

Wa s damag e t o window s avoided ? \ 

# ^ ^ u> X t) k 4 Wa s damag e t o window s o rdoo rscreen s avoided ? 5
.Was damag e t o dovkTispout s o rdownspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 Wa s damag e to drivewa y surface s avoided ? 

# 1 ^ 2 .Wa s damag e t o walkwa y surface s avoided ?

## Ort'oer s comments :

Inspectio nnotes :

Remova l an drestoratio nactivate s complet e includin g the 30-day so dwarranty : EP A Repres e Date : ^2/^/^ ^

## Propert yCompletio n Agreemen t Thi s agreement documeni s th e completio no f remedial activitie s perlbrmet l o n m y pioijerly
. My signatur e will designat e that I amsatislie dwilhth e restoratio no f m y property , an dtha i n o item s ar e i n qucstion.s , now , or a

t an y tim e in th e future , excep t thos e ilenv s liste dbelow , i f any . Propc^tyjD : cOS'SHg ) 

## Pr«pe7trATd^ £i k\ Q JSC^JU
- 

## -S L.. _ Phone : (^^QX^^X^H^rLQ
- Restoratio n Item s i n Question :

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

l/ Q I agre t restoratio nis * complcled , excep t » s note d ^fjd o no t agre e resloratio ni s complete d/

^ Q\ ^ Owner' s Sienatiir r DaK / Omtractor' s .Signature Date