### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAID # : \00 O Date : ^/!2^)Q 1 

### Address : g^l Q ^]br)C S St " Remediatio nContractor : Coasta l Environmenta l Group

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

^ B ^ Q ^ Q / fij p 15 ^ Htjn Q-/ 

# Q / [4

/ { y [ / t^ n

[y Q

/ Vide o o f property (DVD ) Executiv e Summary EPA-provide dpropeil y sketc h Signe dAcces s Agreemen t fo r subjec t property Signe dAcces s Agreement(s ) fo r adjacent property Restoratio nAgreemen t Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) Confirmatio ndat a 

# Photograph s pre,-£^_/iJ^tV| ^ ^JTyiJlltll^ , \i/u d As-buil t sketc h Satisfactory restoratio nsigne db y Property Owne r Property close-ou t chec k lis t signe db y EP A 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 i 

# so d

4031814 4 Superfun d 

# ^^te f ^^ ^ ^^^§3f y

## Propert y Acces s Checklis t Property ID : \(>£) Q PropertyAddress:Q^q^ ^ yy,p<; > 

## owneni;^^;^ ^ ConVTeTCv^ ^ Address :

Phone : 

# • ^?)H"X5 ^ Fax : Cell/Pager
.

nNotification Lette r jy f Acces s Agreement 0 ^ Restoratio n Agreement D Topsoil Samplin g (if applicable ) D Disposa l Samplin g (if applicable ) D Garde nSamplin g (if applicable ) 0 ^ Utilit y Clearanc e JE f Video/Photo s (Before ) D Video/Photo s (During ) D Video/Photo s (After) nVideo/Photo s (30-Day ) O Property Completio n Agreement D Fina l Report

nCommunit y • Cre w nWOR K STARTE D ON:
. _ / l
_ D WORKCOMPELTE D ON : / /
Renter : Phone: Fax : Cell/Pager
. Additional Infonnation :

Sent : / / By : Signed : [ 0 / 3 /fej ? 

### By=|^\\rVr^n< J Signed : IQ_/X//D£ 

## ^r'%ySr\!\C\0 ^ / / By : / / By ; / / By : Called : in/3:_/C ^ 

## ^r.\(^lOilO &

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## ^y

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Omah a Lea d Sit e

## CONTACT FOR M Propert y I D jf / Propert y Address : Initia l Contact : Secon dContact : Fina l Contact : Fina l Action :

Comment : Owner Comment (s) :
Site Coordinato r Comment (s) : 

# jnn n 3H1 0 \?Y^^ \ Date : Time ; Date : Time : Date : Time : Transmi t t o EP A D 

# ?^- T

Action : Action : Action : Othe r Action : D

### Dougla s County Accoun t Infonnatio n Pag e 1 of 3
Dougla s County , Nebrask a Propert yRecor d - R141926000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e & scal e 0-5 0 f t wes t o f 90tr i S t - Vie W O H 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 CONTRERA S PEDR O R 341 0 JONE S S T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 192 6 000 0 1 4 Accoun t Type : Residentia l Parce l Number : 141926000 0 Parce l Address : 341 0 JONE S S T OMAH AN E 68105-000 0 Lega l Description : ISAAC S & SELDEN S AD D LO T7 BLOC K1 0 W 1/ 2 3 3 X 12 4 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $5,400.0 0 $62,600.0 0 $68,000.0 0 200 7 $5,400.0 0 $62,600.0 0 $68,000.0 0 200 6 $5,400.0 0 $54,600.0 0 $60,000.0 0 200 5 $5,400.0 0 $54,600.0 0 $60,000.0 0 200 4 $5,400.0 0 $54,600.0 0 $60,000.0 0 200 3 $5,400.0 0 $54,600.0 0 $60,000.0 0 Sale s Informatio n Sale s Date : 2002-04-1 8 Dee d Type : W D Book : 221 1 Page : 18 8 Price : $60,000.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 2002-01-2 5 Dee d Type : W D Book : 220 1 Page : 73 7 Price : $32,000.0 0 Grantor :


### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R14.
. . 9/27/200 8

### Dougla s County Accoun t Informatio n Pag e 2 o f 3 orma l
Grantee : Valid/Invalid : Exclusio n Reason : Sale s Date : Dee d Type : 

### Price : Grantor : Grantee : Valid/Invalid : Exclusio n Reason : Lan d Informatio n Acre s S F Vali d

2001-09-2 7 SH D $34,158.0 0 Book : 219 9 

### Page : 3 8

Invali d Foreclosur e
Unit s Dept h Widt h Vacan t 0.0 9 4092. 0 1. 0 124. 0 33. 0 N o Improvemen t Informatio n Buildin g 1

Squar e Footage : Perimete r Uni t Type :

Buil t As :

HVAC : Exterior : Interior : Roo f Cover :

Roo f Type : Floorcover : tuss q t

•H T

SmrtBuact t tiiO M • CLIC KTO ENLARG E IMAG E 832. 0 Percen t Complete : 100.0 % 0. 0 Quality : Averag e Condition : Goo d Ranc h Cond o Squar e Footage : 0. 0 Centra l Ai rt o Ai r Rooms : 5. 0 Fram e Aluminu m Units : 1. 0 Drywal l Baths : 1. 0 Compositio n Shingl e Bedrooms : 2. 0 Hi p Stories : 1. 0 Allowanc e Foundation : Bloc k


### http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R14.
. . 9/27/200 8

### Dougla s County Accoun t Informatio n Pag e 3 o f 3 orma l
Sprinkle rSquar e Footage : 0. 0 yea rBuil t Yea r Remodele d 189 0 0 Detai l Typ e Ad d O n Applianc e Basemen t Fixtur e Fixtur e Garag e Porc h Percen t Remodele d 0 % Detai l Descriptio n Fenc e Chai n Lin k Allowanc e Bsmn t Bloc k 8 f t Bas e Fixture s Bat h Ful l Detache d En d Scree n Adjuste d Yea r Buil t 189 0 Physica l Ag e 11 8 Unit s 1. 0 1. 0 832. 0 1. 0 1. 0 330. 0 135. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R14.
. . 9/27/200 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 2149512
. Origina l Cal l Date : 10/07/0 8 Wor k t o Begi n Date : 10/09/0 8 Time : 12:2 9 p m Time : 1:0 0 p m Op : ELIZABETH1879 0

State : N E Address : 341 0 County : DOUGLA S Street : JONE S S T Place : OMAH A
Twp : 15 N Twp : Rng : 13 E Rng : Sect-Qtr : 21-S W 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 STARTIN G A T 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 : 4 f t Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL S MCLEODN E MUDO l OMAHACO F DGPR 5 QLNNEI C

Servic e Are a Contac t Phon e Numbe r Utilit y Typ e
CXCAT V CO X COMMUNICATIONS , IN C HEID I 

### Day : Alt : Emer g 402934046 9 402934046 9 402932975 7

LEVEL 3 LEVEL S COMMUNICATIONS , LLC NA 

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

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

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

MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Day : Alt : Emerg : 402504782 3 402504794 6
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 10/7/200 8

### Pag e 2 of 2

CIT Y O FOMAHA

- OMAHACO F RO N TRAFFIC,SEWE R



### 0PPDGPR 5 SI^^^T"'^"^''' TM 

### N A

QLNNEI C QWES T LOCALNETWOR K N A 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 Alt : 888728934 3 Emerg : 406728934 3 Day : 406728934 3 Alt : Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 10/7/200 8

## f
^ 

# As-Buil t Drawin g C OASTA L 

# Omah aLea dSuperfun dSit e 100 0 Exterio rPain t Nort h Arro w Omah a Lea d Sit e Owne rName : • Goo d Sit e Sketc h Address : 341 0 JONE S S T • Poo r

Phone : H : W : 

# (S )
r~ 1 Not pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : _ Sverdru p RYASCPXA-100 0 Y A 373. 4 _pp m 

### D Date : _ RYBSCPXA-100 0 Y B 135. 1

_ pp m Time : _ 

# a RYCSCPXA-100 0 Y C 112. 6 _pp m Sample s Analyze d 

# n RYDSCPXA-100 0 Y D pp m 

### D 

# n RD2SCPXA-100 0 D Z 240 0 pp m XR F Un H t : Book : RGZSCPXA-100 0 G Z pp m 

# a n Date : _ 12/5/199 9 RPZSCPXA-100 0 P Z 431. 6 pp m 

### 0 Time : _ 10:2 7 

### 0 Staff : Numtse ro f Sample s = 5 Legend : Y A= Yar d (NE) , Y B = Yar d (SE) , Y C = Yar d (SW) , Y D = Yar d (NW) , D Z = Dri p Zone , G Z = Garden , P Z = Pla y OLS# : 100 0 Dat e Excavated : 10/14/200 8

Dat e USEP ASigne d Off : 12/03/200 8 Are a Sodde d 60 7 s q f t P Z = 33 8 PP M (

D Z = 24 5 I

EA=168PPM (



### Legen d

Concret e Dri p Zon e Excavate d Quadrant s Excavate d
Are a replace d wit h Are a replace d wit h Are a lef t bar e So d ' ' RocJt/Mulc h 

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

# 100 0 Exterio rPain t Nort h Arro w ni^,..»-* iOmah a Lea d Sit e • Goo d Address : 341 0 JONE S S TSit e Sketc h • Poo r Phone : H : W 

# ( D Q No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B '( Concentratio n Collecte d Firm : Sverdru p RYASCPXA-100 0 YA 373. 4 Do m 

## M D Date : RYBSCPXA-100 0 Y B 135. 1 DP m 

# 0 D Time : RYCSCPXA-100 0 Y C 112. 6 Do m 

# D Sample s Analyze d RYDSCPXA-100 0 Y D pp m 

# D D RDZSCPXA-100 0 D Z 240 0 pp m 

## 0 0 XR F Unit : Book : RGZSCPXA-100 0 G Z DD m 

## D D Dat e 12/5/199 9 RPZSCPXA-100 0 P Z 431. 6 DP m 

## 0 0 Time ; 10:2 7 Staff : Numbe ro f Sample s = , 5 , 2 Legend ; Y A= Yar d (NE) , Y B = Yar d (SE) , Y C = Yar d (SW) , Y D = Yar d (NW) , D Z = Dri p Zone , G Z = Garden , P Z = Pla y



# f

Re v4 046141,0)2 3• 

## 1000 Exterio rPaint Nort h Arro w Omah a Lea d S t e Owne rName : • Goo d Sit e Sketc h Address : 341 0 JONE S S T 

# n ^° ^ 

# ( D W : Phone : H : Q ] No t pain t Sampl e Numbe r Lead Concentratio r Sampl e Collecte d LA B Firm : Sample s Collecte d Sverdru p

1 RYASCPXA-100 0 RYBSCPXA-100 0 RYCSCPXA-100 0 RYDSCPXA-100 0 Y A Y B Y

C Y D 373. 4 135. 1 112. 6 pp m pp m pp m pp m 0 0 0 n 

# a n a a Date : Time : Sample s Analyze d RDZSCPXA-100 0 D Z 240 0 pp m 0 

## 0 XR F Unit : Book : RGZSCPXA-100 0 RPZSCPXA-100 0 G Z PZ 431. 6 pp m

. pp m • 0 

# a = E Date : Time : 12/5/199 9 10:2 7 Numtje ro f Sample s = 5 2 Staff : Legend : Y A= Yard (NE) , Y B = Yard (SE) , YC = Yard (SW) , Y D = Yard (NW) , DZ = Dri p Zone , G Z = Garden , P Z = Pla y

046I4I.0I2 3

# n 100 0 Exterio rPain t Nort h Arro w 

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

### Sit e Sketc h Address : 341 0 JONE S S T • Poor Phone:_H ; W ; 

# ( D Q No t paint Sampl e Numbe r RYASCPXA-100 0 Y A Lea d Concentratio n

373. 4 Do m Sampl e Collecte d 

# 0 LA B 

# • Firm : Date : Sample s Collecte d Sverdru p RYBSCPXA-100 0 Y B 135. 1 oo m 

## 0 

# n Time : RYCSCPXA-100 0 RYDSCPXA-100 0 RDZSCPXA-100 0 RGZSCPXA-100 0 Y C Y D D Z G Z 112. 6 240 0 Do m Do m Do m Do m 

# 0 

# a 0 

# • a a 0 

# a Sample s Analyze d XR F Unit : Book :

Date : 12/5/199 9 RPZSCPXA-100 0 P Z 431. 6 Dp m 

## 0 0 Time : 10:2 7 Numbe ro f Sample s 

## - \ 5 1 ; 2 1 

### i Staff : Legend : Y A= Yar d (NE) , Y B = Yar d (SE) , Y C = Yar d (SW) , Y D = Yar d (NW) , D Z = Dri p Zone , G Z = Garden , P Z = Pla y

RCT 4 046141.012 3\T*'TJ f COASTA L ^ , _-fe' rtNvmOWHfNTA l

^t^OT * fl • O U f

. IH 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 :
ner' s Name : Daytim e Phone :

Addres s o f Propert y covere d b ythi s 

# :^y O Javxe s ft 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 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 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 byUSEPA , wil l contact th e Granto rin-perso n t o discus s th e wor k t o b e performed , th e Granto rwil l hav e a n 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 EPAtha 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 , at 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 28

, ,• „ - COASTA L • ^

ENVIItONHrMTA t cI 0 u r . IM 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 byhealt h an d safetyguidanc e provide d byEPA ; •I f th 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 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 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 f sai d propertywhic 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 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

^

I gran t acces s t o m ypropertie s n • d o no t gran t acces s t o m ypropertie s 

# f W ^ /C^^i^ , ^yu^mj/ ^ Signatur e Dat e Signatur eDat e

QJ woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.COASTA L

• : ' (MOMmaNTA i C NO O PIN C 

## Restoratio n Agreemen t Th e purpos e o f thi s agreement i s to provid e amutua l agreement a s t o condition s o f the propert y prior t

o remediationactivities
. Tlii s wil t als o serv e as documentatio nfo r the purpos e of assurin g tha t restoratio n activitie s ar e completedt o th e satisfactio nof th e propert> ' owne r an dthe Unite dState s Environmenta l ProtectionAgenc y (EPA)
.

O

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 usedb y contractor , an dth e directionof 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 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
.

Pag e 1 of

. 

# £^ ^ ^ COASTA L f » « V I AOHM « WTA L C f l O U P
. IN C 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 :
^ ^M-CK
. 

# I I C cy t 

# •^ 5 

# l-^r ^ )p<.L> n J Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : 

# 7

Pag e 2 O f /C p AS TAL 

### 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 )

^ Pag e 3 o f- — * > •
COASTA L CVvlHONHtf * TA L



## Ite m

Pre-existin g propert y area , tha t wil l be excavated , tha t is covere dwit hgrass .

Number of tree s > 2 inc h trun k

diameter

Number o f tree s < = 2 inch trun k

diameter

Number o f Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Attachasketcho f th e sprinkler layout
.

Number o f an dsize o f eac hgarden / flowe r bed 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



# •pz . Squar e fee t 

# y • ^ Eac h 

# y y Eac h 

# 0 Eac h 

# y Eac h Squar e Fee t

Pag e 4of ^COASTA L [NVIKONHtNTA I 

## Item Quantity Unit Condition/Type/Specie s Agree dupo n valu e of plan t material s no t t o b e replace dbv contractor . Note thi s valu e will b e usedt o issu e aplan t vouche r to th e propert y owner . Agree dupo nlis t o f plan t material s tha t will b e replace db y conn-actor . B e ver y specifi c an ddetailed
. Include asketchof wer e eachplan t wil l b e place d b

y th e contractor . Agreedupo n are aof propert y t o b e replace d wit hgras s sod
. Include asketchof the area(s ) t o be replace dwit h gras s sod
.
Are ao f Cit y or Count y propert y t o be landscape d per their requirements
. Include asketcho f the aie a(s )

Easement Area , to be excavate d 

# y $

Eac h
^

S F 

# j ^ S F

S F 

# K. \^,..y

Pag e 5 o f ^C O AS T AI
. MMVAkOMMCMTA L


### Additiona l Comments / Instructions :

• Chec k th e boxi f Owne rdoe s no t wan t CE G t o documen t interio r foundation wall s an d possibl e pre-existin g damage
. Bycheckin g thi s boxCE G i s no t responsibl e fb ran ydamag e don e t o th e interio ro f house , includin g foundation crack s o rfissures

. 

# W' ' agre e O I do not agre e

Owner' s Signatur e Dat e CSntractoi^ s S^ator e Dat e 

### Pag e 6 o fBVI D 

# #

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# \<^^\ ^ h i Omah a lea d F P 2nc l yea roptio n ''y-U?^' ^ Readin g Sampl e are a ii^i-M/J ^ \<•^ ^ 

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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 f Verificatio n XL3t-3208 9 Readin g N o 128 1 Mod e SOI L Tim e 2008-10-1 4 11:3 5 Duratio n 120.8 1 Sequenc e Fina l Flag s AVERAG E |Av g o f 1277-1280
_ ADDRES S 341 0 Jone s s t QUAD/ZON E ieasemerj t INSPECTO R jVentr y DEPT H • 1 SAMPL E TYP E J.CLEARANCE" P NOT E

Supervise d B y

# 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 161.48 4 Supervise d By : 

## Certificat e o f Verificatio n

127 7 SOI L 2008-10-1 4 11:3 2 30.2 9 Fina l 100 0 341 0 Jone s s t easemen t ventr y 1 CLEARANC E

± Erro r
± 15.44 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 127 8 Mod e SOI L Tim e 2008-10-1 4 11:3 3 Duratio n 30.2 9 Sequenc e Fina l Flag s BVI D # 100 0 ADDRES S 341 0 Jone s s t QUAD/ZON E easemen t INSPECTO R ventr y DEPT H 1 SAMPL E TI'P E CLEARANC E NOT E

pp m ±Erro r P b 174.19 4 ±15.86 0 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 TYP E NOT E

pp m P b 159.63 8 Supervise d By : 

## Certificat e o f Verificatio n

127 9 SOI L 2008-10-1 4 11:3 4 30.2 2 Fina l 100 0 341 0 jone s s t easemen t ventr y 1 CLEARANC E

± Erro r
± 15.09 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 176.88 0 Supervise d By : 

## Certificat e o f Verificatio n

128 0 SOI L 2008-10-1 4 11:3 5 30.0 1 Fina l 100 0 341 0 jone s s t easemen t ventr y 1 CLEARANC E

± Erro r
± 16.05 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 128 7 Mod e SOI L Tim e 2008-10-1 4 11:4 0 Duratio n 121.5 6 Sequenc e Fina l Flag s AVERAG E |Av g o f 1283-128 6 ADDRES S 341 0 jone s s t QUAD/ZON E INSPECTO R j ^ ventr y DEPT H SAMPL E TYP E I CLEARANCE ! NOT E

Supervise d B y

# 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 197.95 5 Supervise d By : 

## Certificat e o f Verificatio n

128 3 SOI L 2008-10-1 4 11:3 7 30.3 1 Fina l 100 0 341 0 jone s s t D Z ventr y 1 3 CLEARANC E

± Erro r
± 16.98 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 419.16 5 Supervise d By : 

## Certificat e o f Verificatio n

128 4 SOI L 2008-10-1 4 11:3 8 30.6 7 Fina l 100 0 341 0 jone s s t D Z ventr y 1 3 CLEARANC E

±Erro r ±24.66 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 200.50 2 Supervise d By : 

## Certificat e o f Verificatio n

128 5 SOI L 2008-10-1 4 11:3 9 30.3 1 Fina l 100 0 341 0 jone s s t D Z ventr y 1 3 CLEARANC E

± Erro r
± 17.66 6

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

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

pp m P b 162.46 5 Supervise d By : 

## Certificat e o f Verificatio n

128 6 SOI L 2008-10-1 4 11:4 0 30.2 7 Fina l 100 0 341 0 jone s s t D Z ventr y 1 3 CLEARANC E

± Erro r
± 15.53 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 129 2 Mod e SOI L Tim e 2008-10-1 4 11:4 5 Duratio n 121.1 8 Sequenc e Fina l Flag s AVERAG E lAv g o f 1288-129 1 ADDRES S 341 0 jone s s t QUAD/ZON E |P 2 INSPECTO R ventr y DEPT H SAMPL E TYP E • CLEARANC E NOT E

Supervise d B y

# 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 287.25 4 Supervise d By : 

## Certificat e o f Verificatio n

128 8 SOI L 2008-10-1 4 11:4 3 30.3 4 Fina l 100 0 341 0 jone s s t PZ ventr y 6 CLEARANC E

± Erro r
± 20.50 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 361.46 2 Supervise d By : 

## Certificat e o f Verificatio n

128 9 SOI L 2008-10-1 4 11:4 4 30.2 9 Fina l 100 0 341 0 jone s s t PZ ventr y 6 CLEARANC E

±Erro r ±22.94 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 TYP E NOT E

pp m P b 272.40 6 Supervise d By : 

## Certificat e o f Verificatio n

129 0 SOI L 2008-10-1 4 11:4 5 30.2 3 Fina l 100 0 341 0 jone s s t PZ ventr y 6 CLEARANC E

± Erro r
± 20.18 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 432.90 1 Supervise d By : 

## Certificat e o f Verificatio n

129 1 SOI L 2008-10-1 4 11:4 5 30.3 2 Fina l 100 0 341 0 jone s s t PZ ventr y 6 CLEARANC E

± Erro r
± 25.02 5V • .ci ^ ^•".PHO ^ 

### 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 fNVmONMENTA L 0 > 0 U P
. IN C 

# EXECUTIV ESUMMARY : BVI D #100 0 - (341 0 JONE S ST )

~x \N o Issue s o r Concern s [ ^ Issues/Concern s
Detai l Explanation : N O ISSUE S PENDING
.

# EP A EP A Propert y Clos e Ou t For m Propert y # : [CPC^ Q , , Propert y Addrr^:-^-"^^^ ^ ^S^r^ ^ S ^ Dfltc/Tlme : Owner' s Name : /i^.,4rtt > ^^^^'^^^:c> ^ n Contracto r Grou p O^ n<:.-W-l a"£.yNv / ^ rorx^'-^-J^^'^^^ ^ Quad s Excavated : 1^ ^ ^ "PT ^ Ye s N o Excavatio nGeoere l 1
.I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? i ^ 2
.I f necessary , wer e th e correct area s of drip zon e excavale dan drestored ? ^ Ye s N o Gradin g So dan dVegetatio n 1
.Doe s the grading aroundthe perimeier ofth e hous e i nexcavate darea s generally slop e awa y fromthe house ? 2
.Ha s so dbee n laidi n al l area s tha t wer e excavated ? t - ^ 3
.

Doe s the so dappea r t

o be generall y healthy an dgrowing ? (Onl y evaluate i f inspecteda t a3 0 day tim e period ) 4
.Al t soddedarea s generally Fir man devenly graded ? 5
.

Ar e th e joint s betweenthe so dstrip s generally tight ? (Only evaluate if inspecteda t a3 0 da y tim e period) 6
.Wa s the propert y grade dsuc htha t wate r will nol poo l o nth e property' ^ • ^ 7
.

Wa s damage t o landscapin g o r plan t material s avoided ? i X Gates , Fence s an dReUinln e Wall s Yes N o 1
. D o gate s ope n an dclos e freely? (I f applicable ) ty 2
. Were al l gate s o r fence s laiie ndow ndurin g restoratio naclivitie s reinstalled ? (If applicable ) j _ ^ 3
. Wa s damage t o gate s o r fence s avoided ? (If applicable ) i ^ 4 , Wa s damage to retainin g wall s avoided ? (If applicable ) y ^ Foundation , SidiDKan d Gudcr s Ye s N o 1
.

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

Wa s damag e t o th e foundatio n avoided ? uy 3
.Wa s damag e t o window s avoided ? t^ ­ Wa s damag e t o window s o rdoo rscreen s avoided ?

. ^ 5
.Wa s damag e t o downspout s o rdownspou t extension s avoided ? l y Sidewalk s an dDriveway s (Concrete ) Vc s N o 1
.Wa s damage t o drivewa y surface s avoided ? 2
.Wa s damage to walkwa y surface s avoided ? 4» • 

## 0>^'ner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complet e includin g th e 30-day so dwarranty : .jiuiauui i aciivciLC i Lumpictc iDCJuuin g IH C ju-ua y su u wairuiiiy ; EP A Representali i ^live^^^^^L^^^^^^.^^X ^ Date : /yysA ^

## Propert yCompletio n Agreemen t Tiii s agreemen t document s th e complclio no f remedial activilies perlbrina l onm y property . M y signatur e will designat e thai I a msatisfie dwit hth e restoraiio no f m y property , an dthat n o item s ar e i nquestions , now , o r a

t an y tim e inth e fiiUire , excep t thos e itenx s liste dbelow , i f any . Propert y ID : 

## I OO O Propert y Atidrcss : _J > IfJ ^ J ^n-e.-^
_ 

# ,-r Owner : Phone : 

# rr^i ^i5c )
Restoratio n Item s i n Question :

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



## STT K agre e restoratio ni. v conipletcil , excep t a s note d I I tl o no t agre e rcsloralio ni s complete d 

# w 

# h ^ n Owner' s .Si)>nalur e ©•t o yX"oDtractor' s Sij^natur e Date I