# m
TRANSMITTALof OMAHALEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAI D #: \^\a{ c Date : 9/^/^ ^ Address : \^d 3 ^ "^ \ Remediatio nContractor : Coasta l Environmenta l Group

_Year : _2008
_ SOI LREMEDIATIO N PROPERT YFIL EFOLDE RDOCUMENT S y Vide o o f propert y (DVD ) 5 ^ Executiv e Summar y \ JEPA-provide dpropert y sketc h y Signe dAcces s Agreemen t fo r subjec t propert y AM * Signe dAcces s Agreement(s ) fo r adjacen t propert y M Restoratio nAgreemen t flfnSettlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) y Confirmatio ndat a H' Photograph s prg.-oy/^^.)4^.^ ^ ^y^/^J:rL w ft/Lci^q
. y As-buil t sketc h E ^ Satisfactor y restoratio nsigne db y Propert y Owne r y Propert y close-ou t chec k lis t signe db y EP A (ijf r Descriptio nofarea s no t meetin g RO D cleanu p criteri a y Utilit y clearance s y Propert y informatio nfro mDougla s Coimt y Assessor' s Offic e 

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## Propert yAcces s Checklis t Propert yID : V3t2,^ ^ Propert yAddress : \e 7 7- ^ 1? S ^ \ n D

WOR K STARTE D WORKCOMPELTE D ON : ON : _/ / /_ /


### Owner : ^t\arA<Cx Address : " ^ 

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# Phone : nrot^-uas^ Fax : Fa.\ : Cell/Pager : Additional Information : Ce»/Pager
. D NotificationLette r 0 ^ Acces s Agreement E T Restoratio nAgi-ecmen t GTopsoil Samplin g (i f applicable ) IZ

I Disposa l Samplin g (i f applicable ) C ] Garde nSamplin g (i f applicable ) |/ J Utilit y Clearanc e 0 ' Vidco/Photo s (Before) D Video/Photo s (During ) nVideo/Photo s (After) nVidco/Photo s (30-Day) nProperty ComplclionAgreement D Final Report Sent : / / Signed : ^Q/2L'a % Signed : iQ l 21' ^ 1 1 1 1 1 1 

### ca\\td.]Q.i22JC2 i

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Omah a Lea d Sit e

## Propert y I D # Propert y Address : 

## Initia l Contact : Secon dContact : Fina l Contact : Fina l Action :

Comment : Owne r I Commen t (s) :



## Sit e Coordinato r Commen t (s) : CONTAC T FOR M )^]2 U 

# ^'S^T

. 1 ^ ^ 1 Date Time : Action : Date Time : Action:
_ Dat e Time : Action : Transmi t t

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### Dougla s County Accoun t Informatio n Pag e 1 of 3
Dougla s County , Nebrask a Propert yRecor d - R190290000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f90t h S t - VJe WO n Ma p Informatio n i s vali d a s o f2008-9- 4 Treasurer' s Ta xRepor t Ne wFeatur e -»->- > Aut o Sale s Searc h Owne r CENTEN O ALEJANDR A 408 2 PARKVIE WD R BLAI R N E 68008-000 0 Propert yInformatio n Ke yNumber : 029 0 000 0 1 9 Accoun t Type : Residentia l Parce l Number : 190290000 0 Parce l Address : 1522BS T OMAH AN E 68108-000 0 Lega l Description : \ OA KHIL L - 2 LOT1 4 BLOC K0 E 2 5 FT2 5 X 10 7 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $2,200.0 0 $27,400.0 0 $29,600.0 0 200 7 $2,200.0 0 $27,400.0 0 $29,600.0 0 200 6 $2,200.0 0 $27,400.0 0 $29,600.0 0 200 5 $2,200.0 0 $19,800.0 0 $22,000.0 0 200 4 $2,200.0 0 $18,000.0 0 $20,200.0 0 200 3 $2,200.0 0 $18,000.0 0 $20,200.0 0 Sale s Informatio n Sale s Date : 2005-02-2 2 Dee d Type : Q C Book : 200 5 

### Page : 02231 3 Price : $30,000.0 0 Grantor : ISIDR O ROGE L ETA L Grantee : ALEJANDR ACENTEN O Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 2003-08-2 1 Dee d Type : Q C Book : 200 3 Page : 16079 7 Price : $30,000.0 0 Grantor : Jua n D Corre a ETA L


### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19.
. . 10/7/200 8

### Dougla s County Accoun t Informatio n Pag e 2 of 3

Grantee : Valid/lnvalid : Exclusio n Reason : isidro Roge l ETA L Vali d
Sale s Date : Dee d Type : Price : Grantor : 2000-09-0 6 Q C $30,000.0 0 Book : 135 1 Page : 63 5

Grantee : Valid/Invalid : Exclusio n Reason : Invali d
Sale s Date : Dee d Type : Price : Grantor : 1990-10-0 3 D $16,350.0 0 Book : 189 0 Page : 47 1

Grantee : Valid/lnvalid : Exclusio n Reason : Vali d
Lan d Informatio n Acre s 0.0 6 S F 2675. 0 Unit s 1. 0 Dept h 107. 0 Widt h 25. 0 Vacan t N o Improvemen t Buildin g 1 Informatio n

Ranc h 151 ! vst B*Miai«k6 « 38 5 I

T

ilf-.-M i

CLIC KTO ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 585. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r 

### http://douglasne.mapping-onHne.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19.
. . 10/7/200 8

### Dougla s County Accoun t Informatio n Pag e 3 of 3 r Uni t Type : Buil t As :

HVAC : Exterior : Interior : Roo fCover :

Roo fType : Floorcover : Ranc h Force d Ai r Fram e Sidin g Drywal l Compositio n Shingl e Gabl e Allowanc e
Yea rBuil t 189 5 Detai l Typ e Applianc e Basemen t Fixtur e Fixtur e Porc h Porc h Yea r Percen t Remodele d Remodele d 0 0 % Detai l Descriptio n Allowanc e Bsmn t Bloc k 8 f t Bas e Fixture s Bat h Ful l En d Soli d Wal l En d Soli d Wal l Condition : Cond o Squar e Footage : Rooms :

Units : Baths : Bedrooms : Stories : Foundation : Sprinlde rSquar e Footage : Adjuste d Yea r Fai r 0. 0 4. 0 1. 0 1. 0 1. 0 1. 0
0. 0 Physica l Ag e Buil t 189 5 11 1 Unit s 1. 0 585. 0 1. 0 1. 0 90. 0 75. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19.
. . 10/7/200 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 2159965
. Origina l Cal l Date : 10/22/0 8 Wor k t o Begi n Date : 10/24/0 8 Time : Time : 3:0 4 p m 3:3 0 p m Op : ELIZABETH18 7 9 0
State : N E Address : 152 2 County : DOUGLA S street : B S T Place : OMAH A
Twp : Twp : 15 NRng : 13 E Rng : Sect-Qtr : 34-SE Sect-Qtr : -S W Lega l Given : C Typ e o f Work : lea d remediatio n Locatio n o f Work : LOCAT E ENTIR E PROPERT Y INCLtJDIN G HOUS E 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 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 ATTNEBR l CXCAT V LEVEL 3 MCLEODN E MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F QWEST 2

Servic e Are aContac t Phon e Numbe r „ ^ Typ e ATTNEBR l ATT/T 

### Day : Alt : Emer g 8002413624 9 8002413624 9
CXCAT V CO X COMMUNICATIONS , IN C ^^^ ^ 

### Day : Alt : Emerg : 402934046 9 402934046 9 402932975 7
LEVEL 3 LEVEL S COMMUNICATIONS , ^ ^ 

### Day : Alt : 877366834 4 Emerg : 877366834 4

MCLEODN EMCLEODUS A N O NEE D T O CAL LOU T EMERGENC Y 

### Day : Alt : 800289190 1 Emerg : 800289190 1 

### http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.
. . 10/22/200 8

### Pag e 2 of 2

MUD0 2

OMAHACO F

OPPDGPR 6

QLNNEI F

QWEST 2 METROPOLITA NUTILITIE S DISTRIC T

CIT Y O FOMAHA

TRAFFICSEWE R

OMAH APUBLI C POWE R DISTRIC T

QWES T LOCA LNETWOR K

QWES T LON GDISTANC E SAND Y

RO N

N A

N A

SARA 

### Day : 402504782 3 Alt : Emerg : 402504794 6 Day : 402444719 7 Ah : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 Alt : 888728934 3 Emerg : 406728934 3 Day : 406728934 3 Ah : 

### Emerg : 888728934 3 Day : 800283423 7 Ah : 303992192 6 Emerg : 800283423 7

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.
. . 10/22/200 8

# D Remot eID : Rpag eo f

To : COASTA L ENVIRONMENTA L SERVIC E Attn : ELIZABET H Voice : 877662421 0 Fax : 877662421 1 Re : Respons e t o Di g Reques t Thi s i s a n Ixnportan t Messag e fro mLeve l 3 Coimnunication s (formerl yknow n a s Broadwing ) replyin g t o you r reques t t o locat e ou r undergroun d facilitie s i n th e are a describe d o n th e On e Cal l Cente r ticket .

Ticket : 215996 5 County : DOUGLA S Place : OdAM A Address : 152 2 B S T LEVELS : Leve l 3 Conmunication s ha s determine d ou r facilitie s ar e clea r pe r th e di g sit e informatio n provide d b yth e on e cal l cente r ticket .

Ticket : 215997 5 County : DOUGLA S Place : OMAH A Address : 221 4 R S T LEVEL3 : Leve l 3 Conmunication s ha s determine d ou r facilitie s ar e clea r pe r th e di g sit e informatio n provide d b yth e on e cal l cente r ticket .

Ticket : 215998 6 County : DOUGLA S Place : OMAH A Address : 332 2 S 19T H S T LEVELS : Leve l 3 Conmunication s ha s determine d ou r facilitie s ar e clea r pe r th e di g sit e informatio n provide d b yth e on e cal l cente r ticket .

I f yo u hav e an yquestions , pleas e contac t Leve l S' s Asse t Managemen t Teeu n a t 1-800-441-0223 .

### To : 

# D Remot eID : Rpag eo f

• 

### COASTA L ENVIRONMENTA L SERVIC E Attn : ELIZABET H Voice : 877-662-421 0 Fax : 877-662-421 1 •



### Re : Locatin g facilitie s i n th e are a o f you r excavatio n
Thi s i s a n inportan t Safet yMessag e fro mQWES T COMMUNICATIONS . W e ar e replyin g t o you r recjues t t o locat e ou r undergroun d facilitie s i n aj i are a wher e yo u ar e plannin g excavatio n work . Th e followin g i s th e curren t statu s o f ou r facilit ymarkin g i n th e are a specifie d i n you r notification . Ticke t numbe r 215996 5 is : You r excavatio n doe s no t p>os e a ris k t o Qwes t Worldwid e Networks , bu t ma yb e a ris k t o Qwes t Loca l Networks . I f yo u ar e i n t:h e 1 4 stat e are a previousl yserve d b yU S West , an d yo u hav e questions , pleas e cal l Qwes t Loca l Network s a t 1-800-833-0825 . Qwes t Wo . County : DOUGLA S Plac e : OMAH A Street : 152 2 B S T
Ticke t numbe r 215997 5 is : You r excavatio n doe s no t pos e a ris k t o Qwes t Worldwid e Networks , bu t ma yb e a ris k t o Qwes t Loca l Networks . I f yo u ar e i n th e 1 4 stat e are a previousl yserve d b yU S West , an d yo u hav e questions , pleas e cal l Qwes t Loca l Network s a t 1-800-833-0825 . Qwes t Wo . County : DOUGLA S Plac e : OMAH A Street : 221 4 K S T
Ticke t numbe r 215998 6 is : You r excavatio n doe s no t pos e a ris k t o Qwes t Worldwid e Networks , bu t ma yb e a ris k t o Qwes t Loca l Networks . I f yo u ar e i n th e 1 4 stat e are a previousl yserve d b yU S West , an d yo u hav e questions , pleas e cal l Qwes t Loca l Network s a t 1-800-833-0825 . Qwes t Wo . County : DOUGLA S Plac e : OMAH A Street : 332 2 S 19T H S T

I f yo u hav e an yquestion s abou t thes e response s t o you r excavatio n notification , pleas e cal l 1-800-283-4237 .

# ^ As-Buil t Drawin g ^
C O AST AL 

# Omah aLea dSuperfun dSit e ENvmONHCNTA L G a o u r , IN C 

## 13126

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### Legen d Drx p Zon e Excavate d Concret e 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
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^ Owne rName : ISIDR O ROGE L Address : 152 2 B ST Phone : H : 402-813-647 3 Sampl e Nunnt)e r RYASCPXA-1312 6 nYDGCPXA-1312 0 

### Omah a Lea d Sit e Sit e Sketc h W402-813-647 3 Lea d Concentratio n



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## :2./ 7 Exterio rPain t
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Date : Tim e Staff : 

# ENTERE D JUN 

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# 'y^ 5ra6- \COASTA L [NVmONHEMTA l B •O U f
. IN C 

### 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 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 : 

# Ale-j^c^^o\r- q Cs_A\en o Owner' s Name : Daytim e Phone : ^</(^ ] 7(Df o ' ^ ^ ^^ ^

Addres s o fPropert y covere d b ythi s 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 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 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 meets 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 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 subcontractors 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 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 m V**'*^!*" ' COASTA L ^ * _._^« cn«»i«oii«riiT* i

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### •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 byhealt h an d safetyguidanc e provide d byEPA ; •I fth e propertyi s rented , assis t EPAi 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 fth e property
. AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s not t o interfer e o rtampe rwit h an yo fth e wor k activities , o rwit h an y o fth e wor k done , o rwit h th e equipmen t use d o n hi s property , o rt o undertake an y action s regardin g th e us e o fsai d propertywhic 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 wothers t o us e th e propertyi n suc h a manner . Shoul d yo u have an yquestion s abou t thi s program , pleas e contact Coasta l Environmenta l Group , a t (712 ) 352-018 8 

## >qi j I gran t acces s t o m ypropertie s••d o no t gran t acces s t o m ypropertie s 

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# ?yy^i^po)\\oki/r R • ^ Signatur eDat e Signature ' Dat e

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.COASTA L 

## Restoratio n Agreemen t Th e purpos e ofthi s agreement is t o provide ainutua l agreement a s t o condition s ofth e propert y prior t

o remediationactivities
. Thi s will als o serv e as documentatio nfo r the purpos e o f assurin g tha t restoration activitie s ar e completedt o the satisfactio nofth e propert y owne r an dthe UnitedState s Environmenta l ProtectionAgenc y (EPA)
. Propert y ID : j'^} 'X ( ^ PropertyAddress : j •yJ^'X \ ^

s f ~ 

### Owner : /ti p ^ » rv\ AA-ec vC - e ^^-V< L ^ yo 

# [h^fyyio cTH M Phone :
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nthe attache ddiagram(s ) indicat e area(s ) t o excavatedan ddept hof excavation , locationof 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 directiono f North
. Indicat e distances , depths , materia l types , etc . Indicat e digita l photo s b

y referencin g th e photo-lo g numbe r wit ha narrow indicating directionof view
. 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 rretu m o fthes e item s i s th e Owner' s responsibility
. Item : 

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. 7 Item : Item : Item : Item : Item : Item : Item :

^ Pag e 1 o f( ^ ^ COASTA L CMOUP

. IM C Item s To B e Remove d B yContracto rDurin q Remediatio n An d No t Replace d (Us e additiona l sheet s a s necessary ) Item : / 

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Pag e 2 o f^C O AS T AL tMVlNOMMCMTA L CMOU P ( N C 

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### / / Item : / Item : / Item : 

### / Item : 

### / Item : / Item : /

Pag e 3 o f^—•* »
COASTA L C N T IRONPI K • » T* l C M O Wr t M C 

### Landscap e Inventory (Us e additiona l sheet s as necessary ) 

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

# 6 ^ Pre-existin g propert y area , tha t will be excavated , tha t Squar e fee t i s covere dwil hgrass . 

# p y

Numbe r of tree s > 2 inc h ,; / Eac h trun k

diameter

Number o f tree s <= 2 inc h trun k

diameter Eac h

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

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

Pag e 4 of
.COASTA L 

### Ite m Agree dupo nvalu e of plan t material s no t to b e renlace dbv contractor . Not e thi s valu e will b e usedto issue aplan t vouche r to th e propert y owner . Agreeduponlis t of plant material s tha t will b e replace db y conn-actor . B e ver y specifi c an ddetailed
. Include asketcii of were eachplant will b e place d b

y the contractor . Agreedupo n are aof projjert y t o b e 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 to b e landscape d per their requirements
. Include asketcho f the are a(s )

Easemen t Area , to b e excavate d 

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



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Pag e 5 of
.C O AS T AL
. • MVAKftMM>HTA L «M»W'
. IN C
Additiona l Comment s / Instructions :


# 'Z i U ^ he y r e

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. B ycheckin g thi s bo xCE G i s no t responsibl e fio ran ydamag e don e t o th e interio ro fhouse , includin g fourxiation crack s o rfissures.

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# 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 263 2 Mod e SOI L Tim e 2008-11-0 6 13:2 1 Duratio n 30.5 6 Sequenc e Fina l Flag s BVI D # 1312 6 ADDRES S 152 2 B s 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 58.20 9 ±10.40 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 126.00 3 Supervise d By : 

## Certificat e o fVerificatio n

263 3 SOI L 2008-11-0 6 13:2 2 31.6 1 Fina l 1312 6 152 2 B s t easemen t Ventr y 1 CLEARANC E

± Erro r
± 14.39 9

# 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 263 4 Mod e SOI L Tim e 2008-11-0 6 13:2 3 Duratio n 30.9 0 Sequenc e Fina l Flag s BVI D # 1312 6 ADDRES S 152 2 B s 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 82.83 2 ±11.92 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 fVerificatio n XL3t-3208 9 Readin g N o 263 5 Mod e SOI L Tim e 2008-11-0 6 13:2 3 Duratio n 31.5 5 Sequenc e Fina l Flag s BVI D # 1312 6 ADDRES S 152 2 B s 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 80.65 6 ±12.58 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 263 6 Mod e SOI L Tim e 2008-11-0 6 13:2 3 Duratio n 124.6 2 Sequenc e Fina l Flag s AVERAG E Av g o f2632-263 5 ADDRES S 152 2 B s 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 86.92 5 ±12.32 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 316.55 6 Supervise d By : 

## Certificat e o fVerificatio n

263 9 SOI L 2008-11-0 6 13:3 0 30.2 9 Fina l 1312 6 152 2 B s t G Z Ventr y 1 8 CLEARANC E

± Erro r
± 21.13 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 550.42 2 Supervise d By : 

## Certificat e o fVerificatio n

264 0 SOI L 2008-11-0 6 13:3 1 30.3 1 Fina l 1312 6 152 2 B s t G

Z Ventr y 1 8 CLEARANC E

± Erro r ± 28.13 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 347.88 8 Supervise d By : 

## Certificat e o fVerificatio n

264 1 SOI L 2008-11-0 6 13:3 3 30.3 1 Fina l 1312 6 152 2 B s t G

Z Ventr y 1 8 CLEARANC E

± Erro r
± 22.27 9

# 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 264 2 Mod e SOIL Tim e 2008-11-0 6 13:3 4 Duratio n 30.2 9 Sequenc e Fina l Flag s BVI D # 1312 6 ADDRES S 152 2 B s t QUAD/ZON E G Z INSPECTO R Ventr y DEPT H 1 8 SAMPL E TYP E CLEARANC E NOT E

pp m±Erro r P b 275.08 6 ±19.80 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 AVERAG E ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P

b 372.48 8 Supervise d By : 

## Certificat e o fVerificatio n

264 3 SOI L 2008-11-0 6 13:3 4 121.2 0 Fina l Avg of 2639-264 2 152 2 B s t G Z Ventr y 1 8 CLEARANC E

± Erro r
± 22.84 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 Mode 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 224.25 0 Supervise d By : 

## Certificat e o f Verificatio n

264 4 SOIL 2008-11-0 6 13:3 7 30.2 9 Fina l 1312 6 152 2 B S t 6 1 Ventr y 6 CLEARANC E

± Erro r
± 18.20 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 276.49 8 Supervise d By : 

## Certificat e o fVerificatio n

264 5 SOI L 2008-11-0 6 13:3 8 30.9 9 Fina l 1312 6 152 2 B s t B l Ventr y 6 CLEARANC E

± Erro r
± 20.13 5

# 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 449.04 6 Supervise d By : 

## Certificat e o fVerificatio n

264 6 SOI L 2008-11-0 6 13:3 8 34.0 2 Fina l 1312 6 152 2 B s t B l Ventr y 6 CLEARANC E

± Erro r
± 25.13 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 125.10 3 Supervise d By : 

## Certificat e o fVerificatio n

264 7 SOI L 2008-11-0 6 13:3 9 30.8 9 Fina l 1312 6 152 2 B s t B l Ventr y 6 CLEARANC E

± Erro r
± 14.05 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 AVERAG E ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 268.72 4 Supervise d By : 

## Certificat e o fVerificatio n

264 8 SOI L 2008-11-0 6 13:3 9 126.1 9 Fina l Av g o f2644-264 7 152 2 B s t B l Ventr y 6 CLEARANC E

± Erro r
± 19.38 5

# 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 156.21 8 Supervise d By : 

## Certificat e o fVerificatio n

265 4 SOI L 2008-11-0 6 14:1 0 30.9 7 Fina l 1312 6 152 2 B s t PZ Ventr y 1 0 CLEARANC E

± Erro r
± 15.51 2

# 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 265 5 Mod e SOI L Tim e 2008-11-0 6 14:1 0 Duratio n 32.3 4 Sequenc e Fina l Flag s BVI D # 1312 6 ADDRES S 152 2 B S t QUAD/ZON E PZ INSPECTO R Ventr y DEPT H 1 0 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P

b 239.98 7 ±18.97 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 120.79 5 Supervise d By : 

## Certificat e o fVerificatio n

265 6 SOI L 2008-11-0 6 14:1 1 30.9 4 Fina l 1312 6 152 2 B S t P

Z Ventr y 1 0 CLEARANC E

± Erro r
± 13.78 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 174.66 4 Supervise d By : 

## Certificat e o fVerificatio n

265 7 SOI L 2008-11-0 6 14:1 2 30.9 7 Fina l 1312 6 152 2 B s t P

Z Ventr y 1 0 CLEARANC E

± Erro r ± 15.63 2

# 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

pp m P b 172.91 6 Supervise d By : 

## Certificat e o fVerificatio n

265 8 SOI L 2008-11-0 6 14:1 2 125.2 2 Fina l Av g o f2654-265 7 152 2 B s t PZ Ventr y 1 0 CLEARANC E

± Erro r
± 15.97 5

### 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 INVmOHHENTA L G I O U P , INC

. 

# EXECUTIV ESUMMARY : BVI D #1312 6 - (152 2 B ST )

X 

# No Issue s o r Concern s I I Issues/Concern s
Detai l Explanation: N O ISSUE S PENDING
.

# sn . 

# EP A EP APropert y Clos e Ou t For m Propert y If : IQVQ.LP^ , Date/Tlinc : Quad s Excavated : g,i , <i=x7 r ^ ^7 ^ Contracto r Grou p f^/S^ljSbiXiS ^ '^f^xJ\\^PTMWy^^ ^
Ye s N o Excavatio nGeneral 1
.

I f necessary , wer e th e correc t quadrant(s ) excavate dan dresiored ? 2
.I f necessary , wer e th e correc t area s ofdri p zon e excavate dan drestored ? 

## y Gradin g So d•n dVegetatio n Ye s N o 1 Doe s th e gradin g aroun dth e perimeic r ofth e hous e inexcavate darea s generall y slop e away fromth e house ? 

### y 2
.Ha s so dbee nlai di nal l area s tha t wer e excavated ? 

## y 3
.Doe s th e so dappea r to b e generall y health y an dgrowing ? (Onl y evalual e i f inspecte da t a3 0 da y tim e period ) 4
.Ar e sodde darea s generall y firman devenl y graded ? 

## y 5
.

Ar c th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da l a3 0 day tim e period ) 6
.Wa s th e propert y grade dsuc hthat wate r wil l no l poo l o nth e propeny ? 

### y ^ 7Wa s damag e t o landscapin g o r plan t material s avoided ? 

# y Gates , Fence s an d Rctainini ! Wall s Yes N o I D o gates ope n an d clos e freely? (Ifapplicable ) 

### y 2
.Wer e al l gate s o rfence s lake n dow n durin g restoralio n activitie s reinstalled ? (Ifapplicable ) 

## y y 3
.Wa s damage t o gate s o rfence s avoided ? (Ifapplicable ) 

### y A
.

Wa s damag e t o relainin g wall s avoided ? (Ifapplicable ) Foundation , Sidin g an dGutler s Yes N o 1
.Wa s damag e l o th e sidin g o r tri mavoided ? 

## y 2
.Wa s damag e l o th e foundatio navoided ? 

### l y 3
.Wa s damag e t o window s avoided ? 

## y Wa s damag e t o window s o r doo r screen s avoided ? 

## y 5
.

Wa s damag e t o downspout s o r downspou l extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Ve s No 1
.Wa s damag e to drivewa y surface s avoided ? 

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

### y 4

## 0>*'Der s comments :

Inspectio nnotes : 

## C9?y^^^X.^^.M ^ y^t^^.,7^&cy ^ yiOy ^

Remova l an drestorationactivate s complet e including th e 30-da y sodwarranty : EP ARepresentalive-;2^^^^cl^e^±X^f l Date : AV > X^-r "

# m ^ Propert yCompletio n Agreemen t
Thi s agreemen l document s th e complclio n o fremedia l activitie s performe d o n m yproperty
. M ysignatur e wii l designat e tha t I a m satisfie d wit h th e restoratio n o fm yproperty , an d tha i n o item s ar e i n questions , now , o ra l an ytim e i n th e future , excep t thos e item s liste d below , ifany
.

>ropertyID : ^2,\^|_ p 

### Property Address : y^ ^ B Si 3 > Owner : 

# ^W\pkjr\c\<y ^ Qj^nyp.n o I Phone : ^^l^-^Q'^:Q Q Restoratio n Item s i n Question :

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

y i I agre e restoratio n i s completed , excep t a s note d I I d o no t a}>re e restoratio n i s complete d 

# //-si{-o ? /yy l l 

# WU y Conti^tor' s Signatur e Dat e I