## TRANSMITTAL of OMAHA LEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAI D#: \^~\?f \ Date : : ///SS/O ^ Address : ?P\\VyazAtOOf^ H kKJf j Remediatio nContractor : Coasta l Environmenta l Group
_ SOI LREMEDIATIO N PROPERT Y nLEFOLDE RDOCUMENT S Vide o of property (DVD ) Executiv e Summar y EPA-provide dproperty sketc h Signe dAcces s Agreemen t for subjec t property Signe dAcces s Agreement(s ) fo r adjacent property Restoratio nAgreemen t Settlemen t document s (i.e. , for damag eorto replac e plants , etc. ) Confirmatio ndat a Photograph s As-buil t sketc h Satisfactory restoratio nsigne d by Property Owne r Property close-ou t chec k lis t signe dby EPA Descriptio n of area s no t meetin g RO D cleanu p criteri a Utility clearance s 

# a/ Property informatio nfromDougla s County Assessor' s Offic e 

# • Year : 200 1

3005525 5 Superfun d

### Propert yAcces s Checklis t Propert yID : j q^ ? 3 C \ D WORKSTAJITE D ON : _/ /_ D WOR K COMPELTE D ON : / / Propert yAddress : -3,^^ ^ ^eJi,^^rH ^ Qyffe , Rente r 

### o>v"c. : p^^V^ rTVywwVfJ i Address : Phone : FJLV : Cell/Pager : Additiona l Int'ormMtion : 

### Phone: Ip-^ l -qt^M Q Fax : Cell/Pager
. D Notificatio n Lette r Sent : / / By : '{ J Acces s Agreemen t 

### Signed: Jj/iL'Q? ! By : r>o«vxl > F«/-bt< - / ^ r 3 ! Restomtio n Agreemen t Sijmed:l ^ /

U iC m 

### »>-f>of^ri\« 4 s;:^^ ^ /E O D Topsoi l Samplin g (i f applicublc ) 1 1 By : 0 Disposa J Samplin g (i f applicable ) 1 1 By :
• Garde n Samplin g (i f applicable ) 1 1 By : ^Utilit yClearanc e Called : \o 1 1 By : D Video/Photo s (Before ) On : C ? I]^l( ^ By : D Video/Photo s (During ) On : / / By : D Video/Photo s (After ) On : / / By
. D Video/Photo s (3()-DMy ) On : / / By : 1

^ Propert yCompletio n Agreemen t Signed : il/^/ ^ By :

• Fina l Repor t Isjfued :/ / By : Ai rMonitorin g (» s applicabl e

C D Communit yD Cre w On : / / By : Results : D Comrounitj ' D Cre w On : / / By : Results : 1 1 Community ' C J Cre w On : /
. / By : ResulU :

Omah a Lea d Sit e

### #



## CONTAC T FOR M Propert y I D # 

# i^n m Property Address : ^Z\ \WPf^h/yjO/ ^ Initial Contact : Date:W/// ^ Time : \5'3t > Action : |efi

- ^.ue.r Secon dContact : Date : Time : Antinn

- Action:
_ ^ 3 Final Contact : Date*
. Time ; Action : Final Action : Transmi t l o EP A D Othe r Action : D

Comment : Owne r Commen t (s) : Sit e Coordinato r Comment (s) :

### Dougla s County Accoimt InfqgiMio n Pag e 1 of 2 

# W
Dougla s County , Nebrask a Propert yRecor d - R122089000 0 Prin t Repor t NE W Featur e - Parce l Dimension s avaiiabl e @ scal e 0-5 0 ft wes t o f 52n d S t - VJe W O n Ma p Informatio n i s vali d a s o f 2009-5-1 2 Treasurer' s Ta xRepor t Ne wFeatur e -•-•- • Aut o Sale s Searc h Owne r FERBE R DONAL D L ETA L 331 1 WOOLWORT H AV E OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 208 9 000 0 1 2 Accoun t Type : Residentia l Parce l Number : 122089000 0 Parce l Address : 331 1 WOOLWORT H A V OMAH AN E 68105-000 0 Lega l Description : GRIFFI N & SMITH S 1S TSU B LO T3 BLOC K5 W 4 2 N 8 5 FT& W 2 7 S 56. 8 FT LO T2 & E 4 8 FT4 2 X 8 5 - 2 7 X 56. 8 - 4 8 X 141. 8 Valu e Informatio n 

### 2009 200 8 200 7 200 6 200 5 200 4 Lan d $7,800.0 0 $7,800.0 0 $7,800.0 0 $7,800.0 0 $7,800.0 0 $7,800.0 0 Improvemen t $267,400.0 0 $267,400.0 0 $267,400.0 0 $231,300.0 0 $231,300.0 0 $231,300.0 0 Tota l $275,200.0 0 $275,200.0 0 $275,200.0 0 $239,100.0 0 $239,100.0 0 $239,100.0 0 Sale s Informatio n Sale s Date : 1990-07-0 3 Dee d Type : Price : Grantor : $88,000.0 0 Book : 188 5 

### Page : 162

Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s 0.2 1 S F 9153. 0 Unit s 1. 0 Dept h 113. 0 Widt h 81. 0 Vacan t N o Improvemen t Informatio n 

### http://douglasne.mapping-online.coin/DouglasCoNe/static/accountinfo.jsp?accountno= R122..
. 6/6/200 9

### Dougla s County Accoun t InfcHflB|ion Pag e 2 of 2 

# 'W

Buildin g 1

» » Rr « Floo r 136S0s q f t Secon d Floo r 129

6 0sq.t l

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3 0 CLIC KT O ENLARG E IMAG E CLIC KTO ENLARG E IMAG E Squar e Footage : 3382. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Goo d Uni t Type : Condition : Averag e

Buil t As : 2 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 8. 0 Exterior : Fram e Stucc o Units : 1. 0 Interior : Drywal l Baths : 2. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 5. 0

Roo f Type : Gabl e 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 8 0 % 191 8 9 0 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 1344. 0 Basemen t Minima l Finis h 336. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 2. 0 Garag e Detache d 440. 0 Porc h En d Soli d Wal l 60. 0 Porc h Kne e Wal l 216. 0 Porc h Sla b Roof Cei l 187. 0 Porc h Sla b Roo f Cei l 112. 0 Use r Atti cFul l Finis h 718. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accoxintinfo.jsp?accountno=R122.
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_ ExciiYalo r COASTALENVIRONMENTALSERVIC E CdtactNm eEUZABET H TjpeofWo i^^AMREMEDIATTON , DateofNotificiition6123/0 9 Fax * 1877()62421 I

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.

### • • • • 

### Pag e 1 of 2

" > Creat e Anothe rTicke t Backtolrt h Interne t Sen d Emai l


### YOU RTICKE T NUMBE RI S 2354272
. Origina l Cal l Date : 9/01/0 9 Time : 11:3 0 a m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 9/03/0 9 Time : 12:0 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 331 1 Street : WOOLWORT H AV E Twp : 15 NRng : 13 E Sect-Qtr : 28-NW Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n Locatio n o f Work : INCLUD E AL L EASEMENT S LOCAT E ENTIR E PROPERT Y Remarks : FAX AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LO T Compan y: COASTA L ENVIRONMENTA L SERVIC E Contact Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : coasta l Dept h o f Excavation : 4f t Come r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL 3 MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F



### Servic e Area Contact Phon e Numbe r Utilit y Typ e Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 LEVEL S LEVEL S COMMUNICATIONS , LL C N A Alt : Emerg : 877366834 4 Day : 402504782 3 MUD0 2 METROPOLITA NUTILITIE S DISTRIC T SAND Y Alt : Emerg : 402504797 0 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.
. . 9/1/200 9

### Pag e 2 of 2 # • • •


### 0PPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T N A Day : 406728934 3

Alt : 406207149 4 Emerg : 888728934 3 QLNNEI FQWES T LOCA LNETWOR K

N A Day : 406728934 3

Alt : 406207149 4 Emerg : 888728934 3

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

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e

Name : ^^«5ta£7C
. Omah a Lea d SK e Date : 7//s/i>3
. Nort h Arro w Address
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### Contrac t #: EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .• & 

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. 

## 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 : Daytim e Phone : 

# V^xht r T^Om\c\
Addres s o f Propert y covere d b ythi s Agreement : 

# 3'^\ \ W)00\\O0r\V->4NJe
. PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP Ai 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 maypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t o remov e contaminate d soil
. Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o it s origina l condition
. Thi s wor k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o f Coasta l Environmenta l Group , contracte d b yUSEPA , wil l contac t th e Granto rin-perso n t o discus s th e wori ( 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 wori ( 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 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 subcontractors th e right 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 effec t unti l th e wor k ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :
Page t of 2^ ^ \T»**^ / COASTA L ENVIKOHHENTA L ' I PROI ^ C > O U P
. I N 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 maywis h t o save ; •Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessarysubsequen t t o a n initia l waterin g perio d b yEPA ; •Abid e b yhealt h an d safet yguidanc e provide d b yEPA ; •I f th e propert yi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propert yt o perfor m th e work
. •Allo wvideotapin g and/o rphotographin g o f th e property
. AGREEMEN TNO 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 wori ( done , o rwit h th e equipmen t use d o n hi s property , o rt o undertak e an y action s regardin g th e us e o f sai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o f th e Grantee s o rth e environment , o rt o allo wother s t o us e th e propert yi n suc h a manner . Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contac t Coasta l Environmenta l Group , a t (402 ) 991-119 9

iS(lgran t acces s t o m ypropertie sD I d o no t gran t access t o m ypropertie s

Signatur eDat e

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

Pag e 2 o f 2COASTA L
• MVtHONn rNTAt
. G H O U rIM C 

## Restoratio n Agreemen t Th e purpos e o f thi s agreement i s t o provid e amutual agreement a s t o condition s ofth e property prio r t o remediatio nactivities
. Thi s wil l als o serv e a s documentatio nfor th e purpos e o f assurin g tha t restoratio n activitie s ar e complete dt o th e satisfactio no f th e propert y owner an dth e Unite dState s Environmental Protectio nAgenc y (EPA)
.

Property ID : ^ Q " ^ >^C^ Property Address : S'S WXOf^Unnf-U ^ Kvj P 

# o^'^'-^^cvVo^ r "Vy^riQ V Phooe : L^\^LAm q O nth e attache ddiagram(s ) indicate area(s ) t o excavate , surfac e structure s an dlandscapin g feature s an d acces s location(s ) t o b e use db y th e contractors . Indicate distances , depths , materia l types , etc . Photographicall y andVideographically document th e existin g condition s ofth e propert y an dth e basement if necessary . 

### Item s t o b e Remove d b yth e Owne rbefor e Star t o f Remediation : Th e removal , storage , disposal , and/o rretur n o f thes e Item s i s th e Owner' s responsibilrty
. 

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.COASTA L 

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## Ite m Pre-existin g property area , that wil l b e excavated , that i s covere dwit hgrass . Numbe r o f tree s > 2 inch trunk diamete r Numbe r o f tree s < = 2 inch trunk diamete r Number o f Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Attachasketcho f the sprinkler lavoui
. Numbe r o f an dsiz e o f eac hgarden / flowe r be d area . Atiachasketchof relativ e size s andlocations
. Agree dupo nvalu e o f plant material s no t t o b e replace db v contractor . INot c thi s \Hlii e will he use dt o issu e H plan t ^ouche r t o th e propert y owner . Easranent Area , t o b e excavate d 

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Pag e 2 of
.I COASTA L NVIMONnl-MTA l
Additiona l Comment e / Instructions :

n Chec k th e bo xi f Owne 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 f house , includin g foundatio n crack s o rfissures
.

Q I d o no t agre e 

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# ?{fMmi \ (J/l(0 9 Owner' s Siniatur e Contractor' s Signatur e Dat e Pag e 3 of
.XR F PROPERT YSAMPL E SHEE T 

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# Prin t gkngbibH ^ O/ipere s

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

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 2 Mod e SOI L Tim e 2009-09-1 0 07:4 8 Duratio n 31.1 5 Sequenc e Fina l Flag s BVI D # 1973 9 ADDRES S 331 1 wooiwort h QUAD/ZON E F 2 INSPECTO R VENTR Y DEPT H 5 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 53.71 9 ±10.09 6 Supervise d By :

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 3 Mod e SOI L Tim e 2009-09-1 0 07:4 9 Duratio n 30.4 2 Sequenc e Fina l Flag s BVI D # 1973 9 ADDRES S 331 1 wooiwort h QUAD/ZON E F 2 INSPECTO R VENTR Y DEPT H 5 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 50.87 8 ±9.84 2 Supervise d By :

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 4 Mod e SOI L Tim e 2009-09-1 0 07:5 0 Duratio n 30.4 2 Sequenc e Fina l Flag s BVI D # 1973 9 ADDRES S 331 1 wooiwort h QUAD/ZON E F 2 INSPECTO R VENTR Y DEPT H 5 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 53.71 1 ±10.08 7 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Blllerica , 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 35.19 7 Supervise d By : 

## Certificat e o f Verificatio n

5 SOI L 2009-09-1 0 07:5 0 30.3 8 Fina l 1973 9 331 1 wooiwort h F 2 VENTR Y 5 CLEARANC E

± Erro r ± 8.55 5

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 1 1 Mod e SOI L Tim e 2009-09-1 0 07:5 5 Duratio n 123.4 7 Sequenc e Fina l Flag s AVERAG E ADDRES S 331 1 wooiwort h QUAD/ZON E D Z INSPECTO R VENTR Y DEPT H 1 3 SAMPL E TYP E CLEARANC E NOT E

pp m Erro r P b Supervise d By : CpCOJ^qJ ^

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Blllerica , 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 334.02 6 Supervise d By : 

## Certificat e o f Verificatio n

7 SOI L 2009-09-1 0 07:5 2 30.5 9 Fina l 1973 9 331 1 wooiwort h D Z VENTR Y 1 3 CLEARANC E

± Erro r ± 22.34 8

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

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

pp m P b 348.69 8 Supervise d By : 

## Certificat e o f Verificatio n

8 SOI L 2009-09-1 0 07:5 3 30.9 2 Fina l 1973 9 331 1 wooiwort h D Z VENTR Y 1 3 CLEARANC E

± Erro r ± 22.60 5

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 346.19 9 Supervise d By : 

## Certificat e o f Verificatio n

9 SOI L 2009-09-1 0 07:5 4 30.6 3 Fina l 1973 9 331 1 wooiwort h D Z VENTR Y 1 3 CLEARANC E

Erro r 22.76 6

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Blllerica , 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 Pb 217.89 3 Supervise d By : 

## Certificat e o f Verificatio n

1 0 SOI L 2009-09-1 0 07:5 5 31.3 3 Fina l 1973 9 331 1 wooiwort h D Z VENTR Y 1 3 CLEARANC E

± Erro r ± 18.25 1

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 1 6 Mod e SOI L Tim e 2009-09

- 1 0 07:5 8 Duratio n 122.7 2 Sequenc e Fina l Flag s AVERAG E ADDRES S 331 1 wooiwort h 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 ± Supervise d B y : ^ 

# HJM ^

# Therm o SCIENTIFI C 

### Therm o Fisher Scientifi c 90 0 Middlesex Turnpik e Blllerica , M A 0182 1 

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

### 1 2 Mod e 

### SOI L Tim e 2009-09-1 0 07:5 6 Duratio n 30.6 4 Sequenc e Fina l Flag s 

### BVI D # 1973 9 ADDRES S 

### 331 1 wooiwort h QUAD/ZON E easemen t INSPECTO R VENTR Y DEPT H 

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


### pp m±Error P b 

### 109.95 1 ±12.89 9 Supervise d By :

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 1 3 Mod e SOI L Tim e 2009-09-1 0 07:5 7 Duratio n 30.7 5 Sequenc e Fina l Flag s BVID # 1973 9 ADDRES S 331 1 wooiwort h QUAD/ZON E easemen t INSPECTO R VENTR Y DEPT H 1 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r Pb 88.86 6 ±11.96 8 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 100.15 1 Supervise d By : 

## Certificat e o f Verificatio n

1 4 SOI L 2009-09

- 1 0 07:5 7 30.5 5 Fina l 1973 9 331 1 wooiwort h easemen t VENTR Y 1 CLEARANC E

± Erro r ± 12.56 4

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 1 5 Mod e SOI L Tim e 2009-09-1 0 07:5 8 Duratio n 30.7 8 Sequenc e Fina l Flag s BVI D # 1973 9 ADDRES S 331 1 wooiwort h 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 95.69 3 ±12.30 4 Supervise d By :

# « i
Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Envlronmente l Grou p Inc
. www.coastalhazmat.co m "i-pnii ^ COASTA L ENVIRONHENTA L GROUP
. IN C 

# EXECUTIV ESUMMARY : BVID #19739

- (331 1 WOOLWORT H AVE ) N o Issue s o r Concern s [ ^ Issues/Concern s
Detai l Explanation: -COASTA LTO GIV EPO MULCH
. (COMPLETE D 9/23/09 )^ % 

# EP A Propert y Clos e Ou t For m 

# ^^\\\)0M9%^ W V ^ \7\
. Propert y Address : Propert y tf : Date/Time : ^ ^ ^ ^ Owner' s Name:./ ^ Quad J Excavattd : ^ X V€ ^ Contracto r Grou p Excavatio nGcHera l 1
.If necessary , wer e th e correc t qiuidrant(s ) excavate dan drestored ? 2
.I f necessary , were th e correc t area s o f drip zon e excavate dandrestored ? Gradin g So dan dVegetatio n 1
.

Doe s the grading aroun dthe perimeter ofth e hous e i nexcavate darea s generally slop e awa y fromth e house ? 2
.Ha s so dbee nlai di nall area s tha t wer e excavated ? 3
.

Doe s th e so dappea r t

o b e generally health y an dgrowing ? (Only evalual e if inspecteda t a3 0 day tim e period ) 4
.Are soddedarea s generally fir man devenly graded ? 5
. Arc th e joint s betweenth e so dstrip s generally tight ? (Only evaluate i f inspecteda t a3 0 da y

__tim e period)

6
.Wa s the propert y grade dsuchtha t wate r wil l no t poo l o nthe propertj' ? 7
.

Wa s damage t o landscapin g o r plan t material s avoided ? Gates
. Fence s am i Retainin g Wall s 1
.

D o gate s ope nan dclos e freely? (If applicable ) 2
.Wer e all gate s o r fence s lalce ndow ndurin g restoratio nactivitie s reinstalled ? (i f applicable ) 3
.Wa s damage t o gate s o r fence s avoided ? (If applicable ) 4
.Wa s damag e t o retainin g wall s avoided ? (I f applicable ) Foupdation , Sidin g an dGutter s 1
.Wa s damage t o th e sidin g or tri mavoided ? 2
.Wa s damag e t o the foundationavoided ? 3
. Wa s damage t o window s avoided ? 4 Wa s damag e t o window s o r door screen s avoided ? 5
.

Wa s damage to downspout s or downspou l extension s avoided ? Sidewalk s an dDriveway s (Concrete ) 1 Wa s damag e t o drivewa y surface s avoided ? 2
.Wa s damage to wallcwa y surface s avoided ? Ye s IN o 

# ITT ^	 ' Ye s ^ o
- ^ ^ _^^
_ 

# i X 

# V
Ye s N o 

# 77 "

• ^•• j 

# i^ 7t 1

Vc s N o



## • 7 "

## Ov^ncr s comments :

[inspectio nnotes :

Remova l an drestorationactivate s complet e including th e 30-da y so dwarranty : EP A Representativ e

## Propert yCompletio n Agreernen t Thi s agreemen t document s th e completio no f remedial activitie s perloime do nm y properl y M y signatur e will designat e tha t I a msatisfie dwit hUi e restoratio no f my properly , an dtha t n o item s ar e i nquestions , now , o r a

t an y lime i nth e future , excep t thos e item s iisle dbelow , if an y Propert y ID : \^'^ ^ Propert y Address : ^^]\06t^^^ l /fs/e
. 

## o^" " Thn M PerU r Phone : ^^ ^ •i^^^< i Restoratio nItem s inQuestion :

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

' 1 ayrc c I'cstoralio n\ % complcltd , excep t a s nnler i 

# 1

Coi^ i arlor' s Signatur e Dal e