## TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAI D # : g5^^ ^ Date : ;:^//^/r^. q Address : \{oO ^ K J ^ 5 ^- f Remediatio nContractor : Coasta l Environmenta l Grou p Year : 200 8
SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S 0 / Vide o o f propert y (DVD ) 

# y Executiv e Summary , 4031479 6 EPA-provide dproperty sketc h Superfun d 

### Signe dAcces s Agreemen t for subjec t property Signe dAcces s Agreement(s ) for adjacent property Restoratio nAgreemen t Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) 

# y Confirmatio ndat a Photograph s '^CQ^SLJ.C/i^(\h-ii(i ^ S.)LC^oko(l ^ ^AASd d As-buil t sketc h 

# y Satisfactory restoratio nsigne db y Property Owne r Property close-ou t chec k lis t signe db y EPA Descriptio no f area s no t meetin g RO D cleanu p criteri a 

# y Utility clearance s Property informatio nfromDougla s County Assessor' s Offic e 

# y

^ D 

### Ignatur e 

## • t)ate

### Propert yAcces s Checklis t Property'ID : 2.6'^^' ^ PropcnvAddre«:l^n 2 K l ^ ^ C5 ^ D D

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

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Owner : Zj ^ ,,.rAA ) ^S ^ \KK\ Ad d 

## '^"

­ 3 5 i O ^-etor
. Rente r Phone : FJLV : Phone : F«x : ^C^C^ ^ ^^C^ ^ Cell/Pager : Additionikl Infnnn»(ion : Ccll/Page n
D Notificatio nLette r B'^Acces s Agreemen t B'llestonitio nAgreemen t O Topsoi l Samplin g (i f applicable ) C ] Disposa J Samplin g (K applicable ) O Garde nSamplin g (i f applicable ) [^^Utilit y Clearanc e E2

f Video/Photo s (Before ) D Video/Photo s (During ) D Video/Photo s (After ) D Video/Photo s (30-Day ) D Propert y Completio nAgreemen t

• Fina l Repor t Sent : / / 

### Signed:/a,/_^/ ^ Signed : ^/2_/_ ^ / / / / / / 

### Called: 4Z/^/Ii B

On:j2iyiJ S On : / / On : / / On ; / / Siencd : / / Issued : / / By : By : By : 

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Omah a Lea d Sit e#


## CONTAC T FOR M Propert y ID # Propert y Address : Initia l Contact : Secon dContact : Fina l Contact : Fina l Action :

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

# yy^ )«D ? w y y Date : Time : Date ; Time : Date : Time : Transmi t t o EP AD Action : Action : Action : Othe r Action : D

### Dougla s County Accoun t InfMjmatio n Pag e 1 o f 1 [aam a 

# t
Dougla s County , Nebrask a Propert yRecor d - R164139000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t of90t h S t - ViewOt l Ma p Informatio n i s vali d a s o f2008-11- 5 Treasurer' s Ta xRepor t Ne wFeatur e -•-•- • Aut o Sale s Searc h Owne r YOUN G GERALDIN E L 351 0 SEWAR D S T OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumber : 413 9 000 0 1 6 Accoun t Type : Residentia l Parce l Number : 164139000 0 Parce l Address : 160 2 N 3 5 S T OMAH AN E 68111-000 0 Lega l Description : LOWE S AD D LOT1 2 BLOC KP S 4 4 FT4 4 X 6 0 Valu e Informatio n Lan d improvemen t Tota l 200 8 $500.0 0 $0.0 0 $500.0 0 200 7 $500.0 0 $0.0 0 $500.0 0 200 6 $500.0 0 $0.0 0 $500.0 0 200 5 $500.0 0 $0.0 0 $500.0 0 200 4 $500.0 0 $0.0 0 $500.0 0 200 3 $500.0 0 $0.0 0 $500.0 0 Sale s Informatio n Sale s Date : 1997-06-2 0 Dee d Type : Book : 206 6 Page : 04 2 Price : $662.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 6 2640. 0 0. 0 60. 0 44. 0 Ye s



### http://douglasne.mapping-online.cotn/DouglasCoNe/static/accountinfo.jsp?accountno=R16.
. . 12/5/200 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 2186899
. Origina l Cal l Date : 12/05/0 8 Wor k t o Begi n Date : 12/09/0 8 Time : Time : 3:2 5 p m 4:0 0 p m Op : ELIZABETH1879 0
State : N E Address : 160 2 County : DOUGLA S Street : N35T H S T Place : OMAH A Twp : 15 N Twp : Rng : 13 E Rng : Sect-Qtr : 16-NW Sect-Qtr : Lega l Given : C Typ e o f Work : omah a lea d Locatio n o f Work : LOCAT E ENTIR E PROPERTY , AL L EASEMENT S AN D T O TH E PEDESTA L Remarks : FAX AL L CLEAR S TO : (877)662-421 1 Compan y: COASTA L ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : coasta l Dept h o f Excavation : 4f t Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL 3 MCLEODN E MUDO l OMAHACO F 0PPDGPR 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 : 402934046 9 

### M k 402934046 9 Emerg : 402932975 7
LEVEL 3 LEVEL S COMMUNICATIONS , LL C N A 

### Day : 877366834 4 Alt : Emerg : 877366834 4
MCLEODN EMCLEODUS A N O NEE D T O CAL LOU T EMERGENC Y 

### Day : 800289190 1 Alt : Emerg : 800289190 1
MUDO l METROPOLITA NUTILITIE S DISTRIC T 

### SAND Y Day : 402504782 3 

## Alt : Emerg : 402504797 0

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 12/5/200 8

### Pag e 2 of 2

CIT Y O FOMAHA

- OMAHACO F RO N TRAFFICSEWE R

OMAH APUBLI C POWE R 0PPDGPR 5 N A DISTRIC T
QLNNEI C QWES T LOCA LNETWOR K N A 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 Alt : 406207149 4 Emerg : 406523771 7 Day : 406728934 3 Alt : 406207149 4 Emerg : 406523771 7

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 12/5/200 8

# D Remot eID iRpag 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 Importan t Messag e fro mLeve l 3 CoRHRunication 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 : 218689 9 County : DOUGLA S Place : OMAH A Address : 160 2 N35T H S T LEVELS : Leve l 3 Coontunication s ha s detennine d ou r facilitie s ar e clea r o f th e di g sit e describe d b yyou r On e Cal l Cente r ticket . Leve l 3 Communication s wil l no t hav e t o locat e an yundergroun d utilitie s a t thi s di g site . I f yo u hav e an y questions , pleas e contac t Leve l 3 Communication s a t 1-800-441-0223 .

I f yo u hav e an yquestions , pleas e contac t Leve l 3' s Asse t Managemen t Tea ma t 1-800-441-0223 .

# As-Buil t Drawin g 9 COASTA L 

# Omah aLea dSuperfun dSit e
-2^* ? 3 3 Name : G-eA»/«<i/» e Vov/J ^ Omah a Lea d SK e Date : Nort h Arro w Address : /^<s a K > •hS'^ f Sit e Sketc h Time : Phone : SS^-C>Z'=t9 > t: *
Tea m <ra /^^ ^ ^a* ^ BVID # •Z.?^' ? Si XR FCod e /<03 7 gooK : 13 ^ Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e 

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# 3 B l PLS# : 2593 3 Dat e Ekcavated : 12/16/200 8 Dat e USEF ^ Sigrie d Off:l727/2$0 8 i Are a Sodde d 325 5 js q f t ; 

# E]S|fBB]^E?i
.

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

# a^-'TB S Name : frem/<<!/>e yo<//> 9 Omah a Lea d Sit e Date : Cf/ac/a c Nort h Arro w Address : tit^- s K / sS-^ y Sit e Sketc h Time : lJ'<^ ^ Phone ; S-g3-6e*? g
Tea m er*> /d.* ^

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### Address : Hos ^ K / 'hS'^' ^ Sit e SIcetc h Time : tj'<^ ^ 

### Phone ; ggS-^Z^ff i
Tea m «r a /</ ^ ^^-v / BVID # -2-,?^• ? 3 iS XR F Cod e /<93 7 ggoKnaa ^ Sampl e Numbe r Lea d Concentratio n Confimiatio n Sampl e ^<> ^ pp m /"/Ye s n N o ^ ^ 

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### (•&- ' COASTA L INVtHONHINTA t CROUP
. IH C 

# ^z > 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 Prbtectio 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 :

Owner' s Name : Daytim e Phone : 

### frer a loc - r t < fYo< < ^
Addres s o fPropert y covere d b ythi s Agreement : 

# y % 

# /C.O X /t/.jr^^- ^ 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 oflea 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
. Tfii 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 , \N\\ \ 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 ijegins
. 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 vwt h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m EP Athat 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 rrrotice , fo rth e sol e purpos e ofperformin 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

### <,.**;« % 

# m \"^***" VCOASTA L

' - 1 c• 0 u r . Ih 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 ma ywis 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 fth 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 fth e property
. AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s no t t o interfer e o rtampe rwit h an yo fth e wor k activities , o rwit h an y o fth e wor k done , o rwit h th e equipmen t use d o n hi s property , o rt o undertak e an y action s regardin g th e us e o fsai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o fth e Grantee s o rth e environment , o rt o allo wother s t o us e th e propert yi n suc h a manner . Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contac t Coasta l Environmenta l Group , a t (712 ) 352-018 8

^

[Zigra r D I d o no t gran t acces s t o mypropertie s I gran t access t o mypropertie s 

# WiA s SignatureDat e

Q

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

## Restoratio n Agreemen t The purpos e ofthi s agreement i s to provid e amutua l agreement a s t o condition s of the propert y prior to remediatio nactivities
. Thi s will als o serv e as documentatio nfo r the purpos e o f assurin g tha t restoratio n activitie s ar e completedt o the satisfactio no f the propert y owne r an dthe UnitedState s Environmenta l Protectio nAgenc y (EPA)
. Propert y ID : ^CHCJ?^ ^ Propert y Address : ^^p ^ M ^^S " 

## Owner : Qexfr^Arifn e ano/\( j Phone : Oc^.Cl.'i
. i - i nO " " J 

# ^^5

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nth e attache ddiagram(s ) indicat e area(s ) t o excavatedan ddept hof excavation , locationo f 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 referencing the photo-lo g numbe r wit ha narrow indicating directiono f view
. 

### Item s T o B e Remove d B yOwne rBefor e Start O fRemediation : (Us e additiona l sheet s a s necessary ) Th e removal , storage , disposal , and/o rretur n o fthes e item s i s th e Owner' s responsibility
. Item :



## CX^ ^ -S'^r(t O ^vruM<
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## OVw(X.\VULYV k item : Item : item : 

### Item : Item : Item :
Pag e 1 of
.^ ^ ^ COASTA L r^

VI«OHr < ( MTA L cAo u r. > M 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 : Item : ^ ' J 

# Sii^X^ f Ite m Item : Item : Item : Item : Item : Item : Item : Item : item : Item : Item : Item :

Pag e 2 o f(y i< ^ COASTA L CNVlMONnCNTA L C « O U P IH C 

### Item s T o B e Remove d B yContracto rDurin g Remediatio n An d Replace d (Us e additiona l sheet s a s necessary ) Item : 

# .W/-Rp-F [ Item : 

# • <;^-Ra-ri-FA-B A Item : item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 3 o fy .•« » C O A5 TAL K N V (HON*' t N T At C M O U ' '
. IM C 

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

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

# Usf

Pre-existin g propert y area , tha t will b e excavated , tha t Squar e fee t i s covere dwit hgrass .

Number of tree s > 2 inch trunk diameter Eac h

Number of tree s < = 2 inch trunk diameter Each

Number of Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Attac hasketchof the sprinkler layout
. Eac h

Numbe r of an dsiz e o f eachgarden / flowe r be d area . Attac h a sketc h o frelativ e size s an d locations
. Eac h Squar e Feet

Pag e 4 o f^C >^ ^ ^ COASTA L CMW|«ONr*tMT* L 

### Ite m Agree dupo nvalu e o f plan t material s no t to b e renlace dbv contractor . Note thi s valu e wil l b e usedto issu e aplan t vouche r to th e propert y owner . Agree duponlist of plan t material s tha t will b e replace db y contractor . B e ver y specifi c an ddetailed
. Include asketchof wer e eac hplan t wil l b e placed by th e contractor . Agree dupo nare aof propert y t o be 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 o r Count y propert y to be landscaped per thei r requirements
. Include asketchof the aj-e a(s )

Easement Area , t o be excavate d 

### Quantit y Uni t Condition/Type/Specle s

Eac h

S F 

# ^X^jje^QfcyS' ^

S F 

# y S F 

# -r h 

# \o^ck^i ^

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### Additional Comment s / instructions :

O Chec k th e bo x i f Owne r doe s rK> t wan t CE Gt o documen t interio r foundatio nwall s an dpossibl e pre-existin g damage
. B y checkin g thi s bo x CE Gi s no t responsibl e fio r an y damag e don e t o th e interio r o

f house , includin g foundatio ncrack s o r fissures
.
Q I d o no t agre e
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# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

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

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

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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 515 9 Mod e SOI L Tim e 2008-12-1 0 16:5 5 Duratio n 122.9 3 Sequenc e Fina l Flag s AVERAG E »Av g o f5155-515 8 ADDRES S 160 2 n 3 5 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 241.02 6 ± 18.47 # Supervise d By : 

# QJM^VQ X

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

## Certifi c XL3t-3208 9 Readin g N o 515 5 Mod e SOI L Tim e 2008-12-1 0 16:5 3 Duratio n 30.6 1 Sequenc e Fina l Flag s BVI D # 2593 3 ADDRES S 160 2 n 3 5 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 241.00 0 18.57 4 Supervise d By : C , llLjQtJpcJdr^
. IA/IAJUL ^

# 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 515 6 Mod e SOI L Tim e 2008-12-1 0 16:5 4 Duratio n 30.9 5 Sequenc e Fina l Flag s BVI D # 2593 3 ADDRES S 160 2 n 3 5 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 232.27 8 ±17.87 2 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 257.61 0 Supervise d By : 

## Certificat e o fVerificatio n

515 7 SOI L 2008-12-1 0 16:5 4 30.8 9 Fina l 2593 3 160 2 n 3 5 s t easemen t Ventr y 1 CLEARANC E

± Erro r ± 19.18 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 BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 233.21 8 Supervise d By : 

## Certificat e o fVerificatio n

515 8 SOI L 2008-12-1 0 16:5 5 30.4 8 Fina l 2593 3 160 2 n 3 5 S t easemen t Ventr y 1 CLEARANC E

± Erro r ± 18.25 6

# 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 516 9 Mod e SOI L Tim e 2008-12-1 0 17:0 3 Duratio n 121.4 7 Sequenc e Fina l Flag s AVERAG E Av g o f5165-5JLfi a ADDRES S 160 2 n 3 5 s t QUAD/ZON E F l INSPECTO R Ventr y DEPT H 1 3 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P b 134.19 8 ± 14.45 1 Supervise d By : 

# fm^nso \

# 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 516 5 Mod e SOI L Tim e 2008-12-1 0 17:0 0 Duratio n 30.5 0 Sequenc e Fina l Flag s BVI D # 2593 3 ADDRES S 160 2 n 3 5 s t QUAD/ZON E F l INSPECTO R Ventr y DEPT H 1 3 SAMPL E TYP E CLEARANC E NOT E

pp m± Erro r P b 107.16 5 ± 13.12 8 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 125.67 2 Supervise d By : 

## Certificat e o fVerificatio n

516 6 SOI L 2008-12-1 0 17:0 0 30.1 6 Fina l 2593 3 160 2 n 3 5 s t F l Ventr y 1 3 CLEARANC E

± Erro r ± 14.12 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 149.71 4 Supervise d By : 

## Certificat e o f Verificatio n

516 7 SOI L 2008-12-1 0 17:0 2 30.2 9 Fina l 2593 3 160 2 n 3 5 s t F l Ventr y 1 3 CLEARANC E

± Erro r ± 15.01 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 154.24 1 Supervise d By : 

## Certificat e o fVerificatio n

516 8 SOI L 2008-12-1 0 17:0 3 30.5 2 Fina l 2593 3 160 2 n 3 5 s t F l Ventr y 1 3 CLEARANC E

± Erro r ± 15.53 6\ %«c^<^'= ^ 

### 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 ENVritONMENTA l CROUP , INC
. 

# EXECUTIV ESUMMARY : BVI D #2593 3 - (160 2 N3 5 ST )
I I N o Issue s o r Concern s X 

# Issues/Concern s Detai l Explanation: HOMEOWNE RRECEIVE D FO RTH ESUM $35.0 0 FO RTH EREPLACEMEN T COS T O F PLANT S DESTROYE D DURIN GTH EREMOVA LO FLEA D IMPACTE D SOIL
.I 

# P^EP A EPAPropert > Clos e Ou t For m Property« : r^SQ?) ^ Propert yAddress : SjpOi; ^ V \ y,S\ ­ D««e/Tlroe : Owner' s NaiDt : fajefOVJI X\j^CipT^Yi n Quad s Excavaird : P \ (ViPd
. fto Contracto rGrou p CfXmf ? ^Fi ^

u\js}^j^^ ^ Excavatio n Ctnera l Ye s N o I I fnecessary , were th e co rrect quadra ni(s ) ex cavate d a n d restored ? 

### y 2 I fnecessary , wer e th e correct area s o fdri p zon e excav ate d an d restored' ; 

# /^ f Gradlo I t KSo d an d Vecetatio n r ^
. 1 J ' from tb e house ? J i L ' rI I « . 4 I I I Ye s t

/ N o

2
. Ha s so d bee n lai d i n al l area s tha t wer e excavated ? ^ 1 3
. Doe s th e so d appea rt o b e generall yhealth yan d growing' ' (Onl yevaluat e i finspecte d a ( a 3 0 { da ylim e period ) 

### v / 4 Ar e sodde d area s generall yFir m an d evenl ygraded ? / 5 Ar e th e joint s betwee n th e so d strip s generall ytight ? (Onl yevaluat e ifinspecie d a i a 3 0 da y 

# y tim e period ) 6 Wa s Ih e propert ygrade d suc h tha i wate rwil l no t poo l o n ih e propeny' ' 

### y 7 Wa s damag e t o landscapin g o rplan i maierial s avoided' ' 

## ^ j ^ 1 Gales , FcDce s an d RcUinin cWall s le s N o 1
. D o gale s ope n an d clos e freely ? (Ifapplicable ) 2 Wer e al l gate s o rfence s take n dow n durin g restoralio n aciiviiie s rcinsialled' ' (Ifapplicable ) 

# 0^ 3 , Wa s dam«g e t o gale s o rfence s avoided ? (Ifapplicable ) 

## r A
. Wa s damtg e t o retainin g wall s avoided ? (Ifapplicable ) Foundalton , Sidia g an d Gutter s Ye s N o I Wa s damtg e t o th e sidin g o rtri m avoided ? 2 Wa s damag e l o ih e foundatio n avoided ? 

# VP ^ 

# H ^ i ^ 3 Wa s damag e l o window s avoided' ' 4 Wa s damag e t o window s o rdoo rscreen s avoided' ' 5 Wa s darrag e t o downspout s o rdownspou l exiension s avoided' - Sidewalk s an d Drivewty s (Concrete ) Ve s No Wa s damag e l o drivewa ysurface s avoided ' 

### A ) ^ 2 Wa s damag e l o walkva vsurface i a\oided ? 

## tJ hj 

## O »Den s comments :

Inspectio nnotes :

>


## Removal andresloraiio naclivale s complel e includin g ihe 30-da y sodwarrani y
F P ARenrespn1;il,v<*^^'^^*-^2^^^<i-^'S.^^'^ ^ HQU 

# /i 7 fc ^

## Propert yCompletio n Agreemen t Tlii s agreemen t document s th e complclio no f remedial activilies perfonnec i onm y properly
. M y signaiur e will designai e thai I a msalislie dwilli ih e resloraiio no f m y property , an dtha i n o item s ar e i nquestions , now , o r at an y tim e inth e future , excep t thos e item s liste dbelow , if any . Propert y ID T0 3 ^ ^ ~ ^ 

### PropcTtTAddr^ss : ^ Q'Q ^ AJ_IJ^^ ^ 

### I'honc : ^-Y~ b C X^ l Restoratio nItem s i nQuestion :

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


# L

y\I ajjret ' resturafio ni s completed , excep t a s note d I I I d o not agre e restoratio ni s complete d 

# \l\^\jc ^ Contractor', s Signatur e Dat e

## Propert yDamag e Settlemen t

Propert y I D 2593 3 1 Propert y Addres s 160 2 N3 5 S T

Owne r Geraldin e Youn g Phon e 402.553.629 8 |
I hav e receive dachec k fromth e contractor , Coasta l Environmenta l Grou p Inc
. (Coastal) , for th e su mo f $35.0 0 for th e replacemen t cos t o f plant s that wher e destroye ddurin g th e removal o f lead-impacte dsoi l fromth e property .

Compensatio nTyp e Chec k 168 7 Valu e o f Chec k $35.0 0 Chec k t o th e Orde r o f Geraldin e Youn g Descriptio n o f Damag e Coasta l Environmenta l Grou p wil l reimburs e Ms
. Youn g fo rth e plant s destroye d durin g th e remediatio n fo r Lea d a t 160 2 N 3 5 S T M ysignatur e belo wacknowledge s th e receip t o f th e chec k liste d above ; further , I acknowledg e tha t th e compensatio n amoun t i s fai rfo rth e replacemen t cos t o f th e plant s an d releas e Coasta l Environmenta l Group , Inc
. fro m furthe robligation s o rliabilit yrelate d t o thi s property
.



# m. ^ ^^Mioi Dat / ^ ntractor' s Signatur e Date

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