### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAID # : hPliy O Date : l^Xiy i Address : t/Tpk X tol(^^ M£ > Remediatio nContractor : _Coasta l Environmenta l Group

_Year : 200 8 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S G

/ Vide o o f propert y (DVD ) 4031541 5 y Executiv e Summary iilliliii l Superfun d \ y EPA-provide dproperty sketc h S ^ Signe dAcces s Agreemen t fo r subjec t property fajf i Signe dAcces s Agreement(s ) fo r adjacent property \y Restoratio nAgreemen t fs| nSettlemen t document s (i.e. , for damag e o r to replac e plants , etc. ) WConfirmatio ndat a y Photograph s pn^^p^CAJ^gA ^ ejCCoJr k OA ^ ^Cic l -Sdc i 0 As-buil t sketc h y 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 Oljl ^ Descriptio no f area s no t meetin g RO D cleanu p criteri a y Utilit y clearance s WPropert y informatio nfro mDougla s Count y Assessor' s Offic e 

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### Propert yAcces s Checklis t Propen^ID : ;:i^^<^: ^ nWORK STARTE D ON . / /_ • WORKCOMPELTE D ON : / / Propert yAddress:^ ^ . V A .V
. . ^ iA-X. ^ . Rente r Owner : p^ ^ ^ ^ ^ v-^/^ ; ^C . Address : Phone : 

### d^n ^ ^ ^t3 . Fa.v : Cell/Pager : Phone : C^5:2,-a,0C|c i Additionu l Information : Fax : Ccll/Pager . D Notificatio n L/Cltc r Sent : / / By : ^ Acces s Agreemen t 

### Signed: il/ii/ci 3 By\o > Golem s B Restoratio n Agreemen t Signed : 1 1 / !?> / O B 

### ^ yvO\co\cx, 5 O Topsoi l Samplin g (i f applicable ) 

### / / By : [ H Disposa l Samplin g (i f applicable ) 

### / / By :
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### / / By : Q

^ Utilit yClearanc e 

### Called:!^/iii/DS
. 

### B>':l\jlSO ^ E S Video/Photo s (Before ) 

### 0n:_a/li/t2g ' ^y•^r-^^rKx ^

yy u cyy-^ n Video/Photo s (During ) On : / / By : ^ D Video/Photo s (After ) On : / / By : D Video/Photo s (30-Day ) On : / / By : 1 1 Propert yCompletio n Agreemen t Siened : / / By : n Fina l Repor t Issued : / / By : Ai r Monitorin e (a s applicabl e ) D Communit y • Cre w On : / / By : Results : L J Community ' L D Cre w On : / / By : Results : C

U Communit y O Cre w On : / / By : Resuiti :
Omah a Lea d Srt e

### Propert yI D t i Propert y Address : Initia l Contacl : Secon d Contacl : Fina l Conlact : Fina l Action :

Commeni : ONvne r Commen i (s) :
Sit e Coordinato r 

### Coinmen i (s) : 

## CONTAC T FOR M 

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. 

# A v Date : Time : Action : Date : Time : Aclion : Dale : Time : Action ; Tran.smi t t o EP AD Othe rAction : D

### Pougla s County Accoun t Infoouatio n Pag e 1 of 2 )jB^ t Dougla s County , Nebrask a Propert yRecor d - R143145000 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 2008-9- 4 Treasurer' s Ta xRepor t Ne wFeatur e -•-•• • Aut o Sale s Searc h Owne r PERE Z JUVENTIN O 211 3 J ST OMAH AN E 68107-000 0 Propert yInformatio n Ke yNumber : 314 5 000 0 1 4 Accoun t Type : Residentia l Parce l Number : 143145000 0 Parce l Address : 256 1 AME S AV OMAH AN E 68111-000 0 Lega l Description : KARR S SU B DI V LOT4 BLOC K0 3 8 X 125. 5 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $400.0 0 $0.0 0 $400.0 0 200 7 $400.0 0 $0.0 0 $400.0 0 200 6 $400.0 0 $0.0 0 $400.0 0 200 5 $400.0 0 $0.0 0 $400.0 0 200 4 $400.0 0 $0.0 0 $400.0 0 200 3 $400.0 0 $0.0 0 $400.0 0 Sale s Informatio n Sale s Date : 2004-02-1 0 Dee d Type : W D Book : 200 4 Page : 02087 2 Price : $1,000.0 0 Grantor : Tyneshi a Hyme s Grantee : Juventin o Pere z Valid/Invalid : Vali d Exclusio n Reason : Lan d Sal e Sale s Date : 2001-03-1 6 Dee d Type : SW D Book : 218 3 Page : 31 7 Price : $250.0 0 Grantor : 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accoimtno=R14. . . 11/4/200 8

### Pougla s County Accoun t Infooaatio n Pag e 2 of 2 >jjm t Grantee : Valid/Invalid : Exclusio n Reason : Vali d Lan d Sal e Lan d Informatio n Acre s 0. 1 S F 4750. 0 Unit s 0. 0 Dept h 125. 0 Widt h 38. 0 Vacan t Ye s



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R14. . . 11/4/200 8

### Pag e 1 of 2

" > Create Anothe rTicke t Bac k t o Irt h Internet Sen d Emai l
YOU RTICKE T NUMBE RI S 2175708 . Origina l Cal l Date : 11/14/0 8 Time : 12:0 3 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 11/18/0 8 Time : 12:3 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 256 1 Street : AME S AV E Twp : 15 NRng : 13 E Sect-Qtr : 04-NE-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 INCLUDIN G TH E 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 Corne r Lot : NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V MAGELLANMUDO l OMAHACO F 0PPDGPR 5 QLNNEI C SPRNTPC S


### 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 AAlt : Emerg : 918574709 8 Day : 402504782 3 MUDO l METROPOLITA NUTILITIES 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=<RESULT. . . 11/14/200 8

### Pag e 2 of 2 Day : 406728934 3 0PPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T 

### N AAlt : 888728934 3 Emerg : 406728934 3 Day : 406728934 3 QLNN E1 C QWES T LOCALNETWOR K 

### N A Alt : Emerg : 888728934 3 Day : 402537180 0 SPRNTPC S SPRIN T SPECTRU M LP 

### Alt : 402537181 0 Emerg : 800521057 9

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 1 1 /14/200 8

# D Remot eID : Rpag eo f Magella n One-Cal l P.O
. Bo x344 8 Phon e 918/574-709 8 Fa x918/574-746 6 Tulsa , O K 7410 1

Th e followin g One-Cal l Agenc ydi g ticket s calle d i n by : Excavator : COASTA L ENVIRONMENTA L SERVIC E Fa xNumber : 877662421 1 Phon e Number : 877662421 0 

### Fa x Date : 2008/11/1 4 Batchid : 54313 4 Wil l b e CLEA R o f undergroun d facilitie s for : MAGELLAN PIPELIN E Stat e Ticke t Numbe rExcavato rContac t Di g Addres s

N E 217570 8 ELIZABET H 256 1 AME S AV E I f yo u hav e an yquestions , pleas e contac t Magella n OneCal l a t 918/574-709 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 2181431 . Origina l Cal l Date : 11/24/0 8 Wor k t o Begi n Date : 12/01/0 8 Time : Time : 9:2 9 p m 7:1 5 a m Op : ELIZABETH1879 0
State : N E Address : 256 1 County : DOUGLA S Street : AME S AV E Place : OMAH A Twp : 15 N Twp : Rng : 13 E Rng : Sect-Qtr : 04-NE­ Sect-Qtr : S E Lega l Given : C Typ e o f Work : lea d remediatio n Locatio n o f Work : LOCAT E ENTIR E PROPERT Y INCLUDIN G 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 Corne r Lot : N Front : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MAGELLAN MtJDO 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 HEIDI Alt : 402934046 9 Emerg : 402932975 7 Day : 918574709 8 MAGELLA NMAGELLA NMIDSTREA M PARTNER S L PTONY AAlt : Emerg : 918574709 8 Day : 402504782 3 MUDO l METROPOLITA NUTILITIES DISTRIC T SAND Y Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y O F0MAHA-TRAFF1C,SEWE R RO NAlt : 402444516 1 Emerg : 402444516 0

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 11/24/200 8

### Pag e 2 of 2 Day : 406728934 3 0PPDGPR 5 OMAH A PUBLI C POWERDISTRIC T 

### N A Alt : 888728934 3 Emerg : 406728934 3 Day : 406728934 3 QLNN E1 C QWES T LOCA LNETWOR K 

### N A Alt : Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 11/24/200 8

# D Remot eID : Rpag eo f Magellan One-Cal l P.O . Box 344 8 Tulsa . O K 7410 1 Phon e 918/574-709 8 Fa x 918/574-746 6 Th e following One-Cal l Agenc ydi g ticket s calle d i n by : Excavator : COASTA L ENVIRONMENTA L SERVIC E Fa x Number : 877662421 1 Phon e Number : 877662421 0 Fa x Date : 2008/11/2 5 Batchid : 54464 6 Wil l be CLEA R o f undergroun d facilitie s for : MAGELLA NPIPELINE Stat e Ticke t Numbe r Excavato r Contac t Di g Addres s

N

E 218143 1 ELIZABETH 256 1 AME S AVE I f yo u have an yquestions , pleas e contac t Magella n OneCal l a t 918/574-709 8

### 125 0 C O AST AL ENVmONHiNTA L CROUP
. INC
. 

# As-Buil t Drawin g Omah aLea dSuperfiin dSit e

Omah a Lea d Sit e Owne rName : PERE Z JUVENTIN O Sit e Sketc h Address : 256 1 AME S A V Phone : H 402933389 9 W : Lea d Sampl e Concentratio n Collecte d RYASCPXA-3425 0 F l pp m 

### D RYBSCPXA-3425 0 F 2 pp m 

### D

Sampl e Numbe r LA B 

### \3 r RYCSCPXA-3425 0 B l 

## H32 . pp m 

### D RYDSCPXA-3425 0 8 2 

## 5 0 pp m 

### D nD^ccpx; ^ MSOO—0 2 pp m 

### D 0 ' nCZSOPX A3426 0 62 - 

### D RPZSCPXA-3425 0 P Z pp m 

### D pp m 

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## Z ^ ? D Numt>e ro f Sample s = 5 Exterio rPain t Nort h Arro w • Goo d • Poo r ^ 0 " No t pain t Firm : Date : Tim e Sample s Collecte d A-awlRs l ftJ11 - lf?-o£
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. t^«s^». ^ Sample s Analyze d XR F Unit : lOQ- yBoo k H " ^ Date : 12
. • I H -dj ) Tim e _^C Q Staf ff>1su ; Legen d F l = Fron t Left
. F 2 = Fron t Rigfit , B 1 = Bac k Left
. B 2 = Bac k Rigfi 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 OLS# : 3245 0 Dat e Excavated : 12/8/0 8 Dat e USEP AS gne d Off : 1/13/0 9 Are a Sodde d 292 ^ s q ft 

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### Legen d Dri p Zon e Excavate d Quadrant s Excavate d Concret e Are a replace d wit h Are a replace d wit h Are a lef t bar e So d Rock/Mulc h 

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

### ;425 0 Exterio rPain t Nort hArro w Omah a Lea d Sit e Owne rName : PEREZ JUVENTIN O 

### • Goo d Sit e SIcetc h Address : 256 1 AME S A V • Poo r 

# J Phone : H : 402933389 9 W: 0 ^

No t pain t Sampl e Numt)e r Lea d Concentratio n Sampl e Collecte d LA B Sample s Collecte d Firm : A-S^JIRS I ftX RYASCPXA-3425 0 RYBSCPXA-3425 0 RYCSCPXA-3425 0 RYDSCPXA-3425 0 F 1 F2 B l B 2 

### T 7 2-lL o 5Xl A pp m pp m pp m 

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# D D D D XR F Unit : IGQ- yBook : XJ3 - Dat e 

### 7 2 - I H 'CL e RPZSCPXA-3425 0 P Z TS S pp m 

# D Tim e 

# A ^ Staff : ^!vu J Numbe rof Sample s = i '5 Legen d F 1 = Fron t Left , F2 = Fron t Right , B 1 = Bac k Left , B2 = 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 

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### Omah a Lea d Sit e Owne rName : PEREZ JUVENTIN O • Goo d 

### Sit e Sketc h Address : 256 1 AME S A V • Poo r 

# J Phone : H : 4029333899 W : \7 f No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : A'&wlRs I ftr RYASCPXA-3425 0 F 1 

# 1 7 pp m 

# D Date : \±:
_ 

### \^-o£ - RYBSCPXA-3425 0 F2 pp m 

# \ z D Time : ^o•.^^A ^ RYCSCPXA-3425 0 B l 

## ^31
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# D Sample s Analyze d RYDSCPXA-3425 0 B2 

# D .^/^ I pp m RDZGCPX A0420 0 & Z pp m 

# D D XR F Uni t lOQ- ? Book : H " ^ nOgCCPXA3426 0 G2 - pp m 

# D D Date : / 2 - I H -CL e RPZSCPXA-3425 0 P Z 

# Z S ^ pp m 

# D Time : ^rt \ Staf fjA^u ) Numbe rof Sample s = 5 Legend : F l = Fron t Left , F 2 = Fron t Right , B l = Bac k Left , B 2 = Bac k Righ t DZ = 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 

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# ..:- . 7:..:^y^^^i:l^ v •,,^^y_.--,. .> —* » COASTA L INVIItONHINTA I X^o^c ^ e • O U f
. IH C 

### Consen t Fo rAcces s T o Propert y RIGH TO F ENTR YTO PREMISE S 

### Granto r(th e propertyowner) consent s t o an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA ) o rit s authorize d representatives , collectivel y th e Grantee , t o ente ran d perfor m certai n environmenta l respons e activitie s upo n th e followin g describe d premises : Daytim e Phone :

Addres s o fPropert y covere d b ythi s 

# J^^ / AK M 6- 5 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 remove 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 b yUSEPA , 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 opportunityt o revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e i t begins
. Onc e th e wor k i s finished , th e Granto rwil l b e aske d t o revie wth e wor k an d confir m tha t i t i s complet e an d meet s wit h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m 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 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 fperformin g th e wori<
. 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 2

## i.^^r7 i 

# M S^^ / COASTA L ^ fNVtRONHENTA l • "i«io< * c• o u r . IN C



### •Remove obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; •Remove flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t ma ywis h t o save ; •Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessar ysubsequen t t o a n initia l waterin g perio d b yEPA ; •Abid e b yhealt h an d safetyguidanc e provide d b yEPA ; •I fth e propertyi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propertyt o perfor m th e work
. •Allo wvideotapin g and/o rphotographin g o 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 f th 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 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 hav e an yquestion s abou t thi s program , pleas e contact Coasta l Environmenta l Group , a t (712 ) 352-018 8

[Zfig i I gran t acces s t o m ypropertie sD I d o no t gran t acces s t o m ypropertie s

(_/Signatur B / ^ Dat eSi i Signatur eDat e

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

# r

Restoratio n Agreemen t The purpos e ot " thi s agreement i s t o provid e amutua l agreement as t o condition s of th e propert y prior to remediatio nactivities . Tlii s will als o serv e a s documentatio nfo r the purpos e o f assurin g tha t restoratio n activitie s ar e completedt o the satisfactio no f th e propei-t\' owne r an dthe UnitedState s Environmenta l Protectio nAgenc y (EPA) . Propert y ID : 1 ^ X fT } 

### Propert y Address : ^Vf/ / A l/v^^ f /j-y C Owner : 

## ove/ 1 "f/>ic ) JhiyeT s Phone : 

# 9? T

# 7 / 

# s

O

nthe attache ddiagram(s ) indicat e area(s ) t o excavatedan ddeptl i of excavation , locationof al l known utilities , subsurface features , surface structure s an dlandscaping features , acces s location(s ) t o be usedb 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 n arro w indicating directiono f view . 

### Item s T o B e Remove d B yOwne rBefor e Start O f Remediation : (Us e additiona l sheet s a s necessary ) 

### Th e removal , storage , disposal , and/o r returno f thes e item s i s th e Owner' s responsibility . Item : 

# yuc > / I <

_-^y y Item : y Item : / Item : / Item : / Item : / Item : y Item : / Pag e 1 of
.

# V COASTA L CROUP
. IM C 

### Item s To 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 : 

### y/4/L« c 

# i ( ( 7 / . ( 

# i y 7 yni>^ d Item : 

## t 

# c\A 

# J TU^c ^



# i f 

# d e 1 P 

# V I r Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : /

/ Item : / Item : / Item : / Kem : /

Pag e 2 

# ^ 0

### ( ^ C O AS T AL VMVtNONflCMTA L C M D U rIN C 

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# <o \ 

# ^ ( -f?2
. 

# ^ n Item : / 

# f& i (/y-^x - Item : ~ / 

### 1 item : /

Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item :
1 /

Pag e 3 

# o ffeCOASTA L c*«vinoNni M r* i



## Ite m

Pre-existin g propert y area , tha t will be excavated , tha t i s covere dwit hgrass .

Number of tree s > 2 inch trun k

diameter

Number o f tree s < = 2 inc h trunk diameter

Number o f Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Attachasketchof the Sprinkle r layout .
Number of an dsize o f eachgarden / flowe r be d area . Attachasketchof relativ e size s an dlocations . 

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

## Quantit y Unit Condition/Type/Specie s 

# §l(^ ^ Squar e fee t

1 

# y • ^ Eac h 

# y Eac h 

# y . Eac h 

# y Eac h Squar e Fee t

Pag e 4 

# o,i iCOASTA L 

## Item Agree dupo nvalu e of plan t material s no t to b e replace dbv contractor . Note thi s valu e wil l b e usedt o issu e aplan t vouche r t o th e propert y owner . Agree duponlis t o f plan t material s tha t will b e replace db y contractor . B e ver y specifi c an ddetailed . Include asketcho f wer e eachplan t will be placed b

y th e contractor . Agree duponare aof propert 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 aofCit y o r Count y propert y to b e landscaped per thei r requirements . Include asketcho f th e are a(s )

Easement Area , to b e excavate d 

## Quantity Unit Condition/Type/Specie s 

# y $

Each

' 

# y < y S F 

# y''^' ' 

# y S F 

# y y , S F

Pag e 5 of
. ^C O A S T A I.


### Additional Comment s / Instructions :

V 

# 1

yiaAAJ>y]i/0(/ y///^, ­

n Chec k th e bo x ifOwne rdoe s no t wan t CE G to documen t interio rfoundatio n wall s an d possibl e pre-existin g damage
. Bycheckin g thi s boxCE G is rus t responsibl e fo ran ydamag e don e to th e interio r of house , indudin g foundation crack s orfissures.

r agre e O I do no t agre e 

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# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 By : 

## Certificat e o fVerificatio n
497 2 SOIL 2008-12-0 8 17:1 1 122.8 6 Fina l Av g o f4968-497 1 256 1 ame s av e B l Ventr y 6 CLEARANC E

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 161.01 7 Supervise d By : 

## Certificat e o f Verificatio n
496 8 SOIL 2008-12-0 8 17:0 9 30.8 5 Fina l 3425 0 256 1 ame s av e B l Ventr y 6 CLEARANC E

± Erro r ± 16.06 2

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 73.62 9 Supervise d By : 

## Certificat e o f

Verificatio n

496 9 SOIL 2008-12-0 8 17:1 0 30.4 2 Fina l 3425 0 256 1 ame s av e B l Ventr y 6 CLEARANC E

± Erro r ± 11.24 9

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 99.69 3 Supervise d By : 

## Certificat e o fVerificatio n
497 0 SOIL 2008-12-0 8 17:1 1 30.8 0 Fina l 3425 0 256 1 ame s av e B l Ventr y 6 CLEARANC E

± Erro r ± 12.66 4

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 189.99 1 Supervise d By : 

## Certificat e o f Verificatio n
497 1 SOIL 2008-12-0 8 17:1 1 30.7 9 Fina l 3425 0 256 1 ame s av e B l Ventr y 6 CLEARANC E

± Erro r 16.87 2

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 By : 

## Certificat e o f Verificatio n
497 7 SOIL 2008-12-0 8 17:1 5 122.2 1 Fina l Av g o f4973-497 6 256 1 ame s av e B 2 Ventr y 6 CLEARANC E

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 262.83 4 Supervise d By : 

## Certificat e o fVerificatio n
497 3 SOIL 2008-12-0 8 17:1 3 30.7 5 Fina l 3425 0 256 1 ame s av e B 2 Ventr y 6 CLEARANC E

± Erro r ± 20.07 2

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 224.59 5 Supervise d By : 

## Certificat e o fVerificatio n

497 4 SOI L 2008-12-0 8 17:1 3 30.1 8 Fina l 3425 0 256 1 ame s av e B 2 Ventr y 6 CLEARANC E

± Erro r ± 18.70 8

# Therm o SCIENTIFI C Therm o Fishe r Scientifi c 90 0 Middlese x Turnpik e Bilierica , M A 0182 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 202.04 8 Supervise d By : 

## Certificat e o f

Verificatio n

497 5 SOIL 2008-12-0 8 17:1 4 30.9 8 Fina l 3425 0 256 1 ame s av e B 2 Ventr y 6 CLEARANC E

± Erro r ± 17.40 9

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 249.36 6 Supervise d By : 

## Certificat e o f Verificatio n
497 6 SOI L 2008-12-0 8 17:1 5 30.3 0 Fina l 3425 0 256 1 ame s av e B 2 Ventr y 6 CLEARANC E

± Erro r ± 19.36 3X 

# M 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 ^-iPKo- yCOASTA L ENVIItONHENTA L CROUP
. INC
. 

# EXECUTIV ESUMMARY : BVI D #3425 0 - (256 1 AME S AVE ) N o Issue s o r Concern s Issues/Concern s Detai l Explanation : N O ISSUE S PENDING .

# ^-^EP A EP APropert > Clos e Ou t For m Propert yft : .^Ao)^:! ^ Propert yAddrew : Q)6 U j ftj(VV-e.S AT.V P
. Dalc/Tiroc : Owner' s Name : .^ t . ^^p_rA^ vr^cp . Y^JT^ ^ Quad s Excavated : R V , fe^ Conlraclo rCrou p (}tOa<^Vr AQ ^

'F^v j .rcsiTM^eM^ A Excavatio n Genera l ^//V(^A^i < l-^ ^ Ye s N o 1 I f necessary , were Ihe correc l quadrant(s ) excavaie dan drestored ? 

# y 2I f necessary , were th e correc t area s o f dri p zone excavate dan drestored' ' 

# /(r/ 3 GradlD KSo d an d Vctctalio n Ve s N o from tb e house ? / 2
.Ha s so d bee n lai d i n al l areas tha t wer e excavated ? / 3
.Doe s th e so d appea rt o be generall yhealth yan d growing ? (Onl yevaluat e i f inspecie d a l a 3 0 da ylim e period ) / 4 Ar e sodde d areas generall yfir m an d evenl ygraded ? 

## y 5 Ar e th e joint s betwee n th e so d strip s generall ytight ? (Onl yevaluat e i f inspecie d a t a 3 0 da y tim e period ) 

## y 6 Wa s th e propert ygrade d suc h tha i wale rwil l not poo l o n th e property' ' 

## y 7Wa s damig e t o landscapin g o rplan t material s avoided ? 

## y Gales
. Feoce a an d RcUinln g Wall s ^ e s N o ID o gale s ope n an d clos e freely? (Ifapplicable ) 2Wer e al l gate s o rfence s lake n dow n durin g restoratio n acliviiie s reinstalled ? (Ifapplicable ) 

# f k 3Wa 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 Gutter s Y e s N o 1
.

Wa s damag e t o th e sidin g o rtri m avoided ? 2Wa s damag e t o th e foundatio n avoided ? / 1 1 3Wa s damag e l o window s avoided ? \ (/ ­ ^ ! ^ 

### \v.( y 4Wa s damag e t o window s o rdoo rscreen s avoided'^ ' 

# 1 5Wa s damag e t o dowTispout s o rdownspou l extension s avoided ? 

# 1 Sidewalk s an d Driveway s (Concrete ) Ye s N o 1
.Wa s damag e l o drivewa ysurface s avoided'! ' 

## y 2
.

Wa s damag e l o walkwa ysurface s avoided ? 

## y

## r o • D er s comments :

Inspectio nnotes :

Removal an drestoratio nactivate s complet e includin g the 30-da y so dwarranty 

# EP ARt^;>x^-,zvs\zyty2yiyyy!^^^y^^^^^yy^ ^ Dale : y7y ^ 7

# f ^m ^ Propert yCompletio n Agreemen t Tiii s agreemen i documenl s th e complclio no f remedial activities perlbrmec l o nm y property . M y signalur e wil l designal e Iha t 1 a msalislie dwili i th e resloratio no f m y property , an dthat n o item s ar e i nquestions , now . or a

t an y tim e i nth e future , excep t thos e ilem s liste dbelow , ifany . Propc^t^ID:^^^ ^ Propert y Address : Jjg- ^ 1 ^.rv . 6 C » OsJJ L• Owne r 

# 2"'" " Oai/eni^ o 2ex£2 _ Restoratio nItem s inQuestion :

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

r K L J I agre e rrstoralio ni.s completed , excep t a s nole d I I d o no < agre e reslorxtiu ni s t-oniplele d 

# bj..^^^-^ ^ qy^^p y ?^AmQ \\aj/4/Dc : M)wncr \.Signatur e 1 / Dat e Contractor' s .SiKnatiin
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