## TRANSMITTALo f

OMAH ALEA D SITE SOILREMEDIATIO NFILEFOLDER

SAID # : 

## X 

# lu n Date : 

# 'i nh Address : Kl'A(^Wo h*^ t Remediatio nContractor : Coasta l Environmenta l Group

_ Year : 2010ARR A
SOI LREMEDIATIO N PROPERT YFIL EFOLDE RDOCUMENT S Vide o o f property (DVD ) Executiv e Summar y EPA-provide dproperty sketc h Signe dAcces s Agreement fo r subjec t property Signe dAcces s Agreement(s ) fo r adjacent property Restoratio nAgreement Settlement document s (i.e. , fo r damag e or to replac e plants , etc. ) Confirmatio ndat a 

# y Photograph s f k hf^O^^. ^ ^ V ^ ^jl^-fl ^ J^ ^O ^ As-buil t sketc h Satisfactor y restoratio nsigne db y Property Owner Property close-ou t chec k lis t signe db y EP A Descriptio nofarea s no t meetin g RO D cleanup criteri a Utility clearance s Propert y infonnatio nfro mDougla s Count y Assessor' s Offic e

3021852 3



# i Superfun d

# vv Propert yAcces s Checklis t Property ID : 

# .Vh?.- ] nWORK STARTE D ON : / / Property Address : ^ nWORKCOMPELTE D ON ; / / 

# Poinii'v ) Parn^ h ^'""'"'To^^ ^ ^I'CP r Address : Phon e 

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# \'but ' Mar-ii nAv e Fax : Cell/Pager : Additional Information : 

# ^"""^ ^ u^v'^^^. O Fax : Cell/Pager :

nNotificatio nLette r Sent : / / By : ' ^ Acces s Agreement Signed : 2 ^ ^//6 ^ By : /jll ' Signed: ^ 2 3 llC ) By : ^ Restoratio nAgreement D Topsoil Sampling (if applicable ) 1 1 By : D Disposa l Sampling (i f applicable ) 1 1 By : D Garde nSamplin g (if applicable ) 1 1 By : ^\W A0U/iV« o c\.t,^it. AOH/iM«c J, 

### Q : utilit y Clearanc e CaUed:CJ!>/a ^ l\ Q • ^ Video/Photo s (Before) 

### On:^f^l]g

_ By : nVideo/Photo s (During ) On : / / By : nVideo/Photo s (After) On : / / By : D Video/Photo s (30-Day ) On : / / By : nProperty Completio nAgreement Siened : / / By : D FinalRepor t Issued : / / By : Air Monitorin g (a s applicable )

• Conunuiiit y D Cre w On : / / By : . 1 1 Results :

D Communit y QCre w On : / / By : Results :
nCommunit y QCre w On : / / By : Results :

Omah a Lea d Sit e

## Douglas Count y Accoun t I ti|K|j^o n 

## Pag e 1 of 3
Dougla s County , Nebrask a Propert yRecor d - R l 13478000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s avaiiabi e @ scai e 0-5 0 f i wes t o f52n d S t - VlOWO n Ma p Informatio n i s vali d a s o f2009-12-1 5 Treasurer' s Ta xRepor t Ne wFeatur e ^ - •^ Aut o Sale s Searc h Owne r PARRIS H DANN Y ETA L 1511 2 MARTI N AV E OMAH AN E 68116-000 0 Propert yInformatio n Ke yNumber : 

### 347 8 000 0 11
. Accoun t Type : Residentia l Parce l Number : 113478000 0 Parce l Address : 257 4 ELLISO N A V OMAH AN E 68111-000 0 Lega l Description : FORTVIE WAD D LO T7 BLOC K0 5 0 X133. 7 Valu e Informatio n Lan d Improvemen t Tota l 

### 200 9 200 8 200 7 200 6 200 5 200 4 $2,600.0 0 $2,600.0 0 $2,600.0 0 $2,600.0 0 $2,600.0 0 $2,600.0 0 

### $29,900.0 0 $29,900.0 0 

### $23,100.0 0 $23,100.0 0 $23,100.0 0 $10,200.0 0 $32,500.0 0 $32,500.0 0 $25,700.0 0 $25,700.0 0 $25,700.0 0 $12,800.0 0 Sale s Informatio n Sale s Date : 2006-12-0 1 Oeec fType : GC M Book : 200 7 

### Pago ; 01465 7

Price : $0.0 0 Grantor : PARRIS H DANN YETA L Grantoe : PARRIS H DANN YETA L Valid/Invalid : Invali d Exclusio n Reason : Multipl e Parce l Sal e Sale s Date : 

### 2006-10-2 0 Dee d Type : WD M SooAr : 200 6 Page : 12172 0 Price : $ 36,000.0 0 Grantor : Baye rHele n G Estat e o f


## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl..
. 12/31/2009- f \ r

W •I 

### Dougla s County Accoun t I n|Ujj]^i ( 

### Pag e 2 of 3 tio n

Grantee : : parris h Dann yeta l Valid/Invalid : invali d Exclusio n Reason : Multipl e Parce l Sal e Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 5 6650. 0 1. 0 133. 0 50. 0 N o Improvemen t Informatio n Buildin g 1
257 4 ELLISO N A V

M

O

rmf-v y 9K>

0 t g t

;6nci5ic*i)»i» i ,_ ; 1 llOOsq n '" I 

## RANC H CLIC KT O ENLARG E IMAG E Squar e Footage : 960. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Fai r

Buil t As : Ranc h Cond o Squar e Footage : 0. 0

HVAC : Force d Ai r Rooms : 5. 0 Exterior : Fram e Viny l Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 2. 0

Roo fType : Hi p Stories : 1. 0 Floorcover : Allowanc e Foundation : Bloc k Sprinlde rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 190 7 0 0 % 190 7 10 1 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 ft 960. 0 Fixture Bas e Fixture s 1. 0 Fixture Bat h Ful l 1. 0


### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl.
. . 12/31/200 9

## Douglas Count y Accoun t I

i^uij^o n 

## Pag e 3 of 3
Garag e Detache d 216. 0 Porc h Enc I Soli d Wal l 165. 0 Porc h Enc I Soli d Wal l 120. 0



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl..
. 12/31/2009

### Pag e 1 of 2

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### • YOU RTICKE TNUMBE RI S 2460790
. Origina l Cal l Date : 4/12/1 0 Time : 1:4 6 p mOp : ELIZABETH1879 0 Wor k t o Begi n Date : 4/14/1 0 Time : 2:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 257 4 Street : ELLISO NAV E Twp : 16 NRng : 13 E Sect-Qtr : 33-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATIO N 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 : UNStJR E I F CORNE R LOT . 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 ho f Excavation : 4 F T Come r Lot : N Front : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MAGELLAN METR O MUDO l OMAHACO F OPPDGPR 5 QLNNEI C

Servic e Are a Contac t Phon e Numbe r 

### Utmt y Typ e
CXCAT V CO XCOMMUNICATIONS , IN C HEID I 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7

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### Day : 918574709 8 Alt : Emerg : 918574709 8

METR O METR O COMM
. COLLEG E CHRI S 

### Day : 402457230 7 Alt : 402672703 3 Emerg : 402457231 3

MUDO l METROPOLITA NUTILITIE S DISTRIC TSAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0

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. , 4/12/201 0

### Pag e 2 of 2

OMAHACO FCIT YO FOMAHA-TRAFFICSEWE R RICHJTRAFFI C 

### Day : Alt : 402444719 7 402444516 1 Emerg : 402444516 0

OPPDGPR 5 OMAH APUBLI C POWE RDISTRIC T ELM LOCATIN G 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3
QLNNEI C QWES TLOCALNETWOR K ELM LOCATIN G 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

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. . 4/12/201 0

# ^ As-Buil t Drawin g ^
COASTA L 

# Omah aLea dSuperfun dSrt e OLS# : 3762 7 Dat e Excavated : 4/16/201 0 Dat e USEP ASiqne d Off : 9/10/201 0 Are a Sodden : 259 0 s a f t Nanne : firlr cR.\.'i> r Oinah a Lea d Sit e Date : North Arro wi
Address : I-TI V 't/f.xj , ^ < Sit e Sketc h Time : Phone : y^T-VIS^ / 

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Omah aLea dSit e 4613 0 

### Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are areplace dwit 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
.

# ® ( .VPCArV V. 0^ \
. /» M Name : /i^A* i K,yo/
- Omah a Lea d Sit e Date : [o-Z\i'o-i

. Nortl i Arro w Addrei5s : 7.r7< / ^/Afi« , /fcJ t Sit e Sketc h Time : !-«'"! ' Phone : U^~m.<^ l

OmahaLea dSite 4613 0Name : //vZ-t , R.^/^ ^ Omah a Lea d Sit e Date : Nort h Arro w^ Address : 1s~? ^ 'f//,sc cA^ t Sit e Sketc h Time : Phone : Uf^-^Z'^ I 

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COASTA I INVIItONMIItTA l C « 0 1 1 r. IN C 

## Consen t fo rAcces s T o Propert y RIGH TO F ENTR YT O PREI^ISE 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 rits 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 : baVtim e Phone : 

# rVlAAv ^ Pflrns l

Addres s o fPropert y covere d b ythi s 

# i^n qEiii^f \a\ f Agreement :
PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EPAi 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 maypos e a healt h hazard

. Th e area(s ) wil l b e excavate d t o remov e contaminate d soil

. Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o It s origina l condition

. Thi s wori ( 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 perfomned , th e Granto rwil l hav e a n opportunityt o revie wan d approv e th e planne d sol i removai , an d restoratio n wor k before 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 wori t an d confim i 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

.
ENVIRONI>4ENTA LRESPONS E ACTION S 

### B

ysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , its employees , contractors an d subcontractors th e righ t t o ente rth e property , at al i reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e ofperformin g th e worit

. Thi s acces s shal l remai n i n effect unti l th e wori t ha s bee n satisfactoril ycompleted

. Th e Granto rals o agree s to :

Pag e 1 o f2

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V^^^^^^ yCOASTA L

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### « Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; cRemov 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 ; cWate 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 ; cAbid 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

. cAllo 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 wori t 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 (402 ) 991-119 9 

# V I gran t acces s t o mypropertie s D I d o no t gran t access t o mypropertie s

^-^-/ ^ Date Signature Date

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

.

Page 2 of 2C O AS T AL
• MVIRONMI M TAL O n O U P , INC

. 

## Restoratio n Agreemen t The purpos e of thi s agreemen t i s to provide amutua l agreemen t a s to condition s of the propert y prior to remediationactivities
. Thi s will als o serve a s documentationfo r

the piupos e of assuring tha t restoration activitie s ar e completedto the satisfactionof the propert y owne r an dthe UnitedState s Enviromnenta l ProtectionAgency (EPA)
.

PropertylD : "J/Wi^ ^ Propert y Address : 2.5r-i qf.lhV^/ NQ.\r
. Owner : 

## J 2 Q 

# ^(\rr\ ^ Phone : 

# m
Onthe attacheddiagram(s ) indicat e area(s ) to excavate , surface structure s an dlandscapin g feature s an d acces s location(s ) to b e usedby the contractors
. Indicat e distances , depths , materia l types , etc
. Photographicall y an dVideographicall y documen tthe existing condition s ofth e propert y an dthe basemen t if necessary . 

## Item s t o b e Remove d b yth e Owne rbefor e Start o fRemediation : Th e removal , storage , disposal , and/o rretu m o fthes e item s i s th e Owner' s responsibility

. Item : 

# J QwC ^ Item :
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## Item s t o b e Remove d b yth e Contracto rDurin g Remediatio n an d No t Reolace d Kem : 

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## IIte m

Pre-existing propert y area , tha t will b e excavated , tha t i s coveredwit hgrass . Numbe r of tree s > 2 inc h trun k

diamete r Numbe r of tree s < = 2 inc h trun k

diamete r Numbe r o f Sprinkle r Zones , Control Valves , Timers , Heads , etc
. Attac hasketc hof th e sprinkle r layout
. Numbe r of an dsize of eac hgarden / flower bed area . Attac hasketc ho f relative size s an dlocations
. Agree duponvalue of plan t material s not t o b e replacedb v contractor
. Not e thi s valu e will b e usedto issue aplan t voucher to th e property owner . Easemen t Area, to b e excavated 

## Landscap e Inventor y Quantity Unit Conditionrrype/Specie s Quadrants

Eac h
Eac h

Eac h 

# M U

Eac h Squar e Fee t

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Pag e 2 of

.COASTA L

AddKiona l Comment s / Instructions : Th e cit yo fOmah a ordinance s ma yprohib Kyo u fro m usin g dir t o rgrave l area s o n you rpropert y a s driveway s o rvehicl e parkin g areas . Th e Environmenta l Protectio n Agenc y(EPA ) ma yb e removin g an d replacin g soi l underiyin g a grave l o rdir t are a o n you rpropert ytha t yo u ma yb e usin g a s a drivewa yo rvehicl e parkin g area . I fthi s i s th e case , yo u shoul d understan d tha t thi s removin g an d replacin g o fsoi l doe s no t mea n tha t an yillega l drivewa yo rparkin g are a o n you r propert yi s mad e legal

. T o th e contrary , yo u ma yb e cite d b yth e cit yi fyo u us e a grave l o rdir t are a a s a drivewa yo rparkin g area , no t withstandin g an yremova l o rreplacemen t o fsoi l b yth e EP A I fyo u hav e an yquestio n abou t legalit yo fa certai n drivewa yo rparkin g area , yo u ma ycontac t th e cKyo fOmaha' s Plannin g Departmen t a t (402 ) 444-5150

. [ ^

Pleas e chec k thi s bo xi fyo u understan d th e infomiatio n outline d above

.

D Chec k th e bo xi fOwne rdoe s no t wan t CE G t o documen t interio rfoundatio n wall s an d possibl e pre-existin g damage

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

. 

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 60 3 Mod e SOI L Tim e 2010-05-1 1 17:0 5 Duratio n 90.3 3 Sequenc e Fina l Flag s AVERAG E ^;;-Ava:o£fiQQ3tQ2i : ADDRES S 257 4 Elliso n av e QUADRAN T E A DEPT H 1 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D 7.81 6 Z r 393.28 7 ± 14.74 7 S r 176.18 6 ± 9.01 7 U < LO D 14.62 0 R b 70.35 5 6.59 0 Ti l 16^692 , -8.892 ­ -207146—— ^ je " < LO D 5.82 0 A s 108.69 4 ± 20.25 9 H g < LO D 12.56 3 Z n 226.21 2 ± 25.23 4 W < LO D 85.97 0 C u 32.15 2 ± 20.69 9 N l C o F e M n < LO D < LO D 18183.79 9

550.73 4 ± ± 74.98 7 179.66 9 387.27 8

98.27 5 Supervise d 

# sr.^yiMM y

# Therm o SCIENTIFI C Tiierm 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 60 0 Mod e SOI L Tim e 2010-05-1 1 17:0 4 Duratio n 30.1 2 Sequenc e Fina l Flag s BVI D 3762 7 ADDRES S 257 4 Elliso n av e QUADRAN T E A DEPT H 1 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D : 7.73 9 Z r 375.81 3 ± 14.42 1 S r 173.74 8 ± 8.92 5 U < LO D : 14.12 5 R b 67.05 3 ± 6.40 6 T h 19.30 8 ± 9.05 8 P b 231.90 1 ± 20.17 3 S e < LO D ; 6.04 1 A s 108.65 6 ± 20.24 9 H g < LO D : 12.82 6 Z n 233.71 9 ± 25.57 3 

## w < LO D 88.74 4 C u < LO D 30.75 6 N i < LO D 75.59 9 C o 188.41 7 ± 120.50 5 F e 17888.51 0 ± 382.74 5 M n 515.31 0 ± 95.90 5 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 60 1 Mod e SOI L Tim e 2010-05-1 1 17:0 4 Duratio n 30.1 0 Sequenc e Fina l Flag s BVI D 3762 7 ADDRES S 257 4 Elliso n av e QUADRAN T E A DEPT H 1 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D : 7.78 6 Z r 398.81 4 ± 14.91 1 S r 174.81 8 ± 9.04 1 U < LO D \ 14.48 1 R b 74.83 7 ± 6.75 9 T h < LO D \ 12.99 9 P b 231.33 3 ± 20.34 4 S e < LO D \ 6.08 8 A s 109.47 2 ± 20.45 2 H g < LO D : 12.31 4 Z n 223.89 7 ± 25.18 7 

## w < LO D J 82.95 4 C u 34.51 1 ± 21.08 6 N l < LO D \ 76.73 6 C o < LO D \ 180.05 1 Fe 18486.01 4 ± 392.95 6 M n 646.09 0 ± 104.69 4 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 60 2 Mod e SOI L Tim e 2010-05-1 1 17:0 5 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 3762 7 ADDRES S 257 4 Elliso n av e QUADRAN T EA DEPT H 1 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D

. ; 7.92 3 Z r 405.23 4 ± 14.90 9 S r 179.99 2 ± 9.08 5 U < LO D I 15.25 4 R b 69.17 5 ± 6.60 5 T h 18.09 5 ' ± 8.95 1 P b 226.39 5 ± 19.92 0 S e < LO D J 5.33 2 A s 107.95 3 ± 20.07 5 H g < LO D : 12.54 9 Z n 221.01 9 ± 24.94 3 W < LO D : 86.21 2 C u 31.62 2 ± 20.50 8 N i < LO D * 72.62 7 C o < LO D : 178.19 9 F e 18176.87 5 ± 386.13 3 M n 490.80 2 ± 94.22 5 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 59 9 Mod e SOI L Tim e 2010-05-1 1 17:0 2 Duratio n 90.3 2 Sequenc e Fina l Flag s AVERAG E 

## ^^vpfjSEssa- ^ ADDRES S yz^4'E\\\so n av e QUADRAN T D Z DEPT H 13 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

Erro r pp m M o < LO D 8.24 9 Z r 511.00 1 ± 16.61 5 S r 162.81 5 ± 8.79 1 U < LO D 15.04 4 R b 70.82 9 ± 6.70 4 T h 14.39 9 ± 7.44 6 ,753 ­ jle " < LO D 5.48 4 A s 69.81 6 

### ± 13.71 5 H g < LO D 12.60 3 Z n 92.01 0 

### ± 17.96 6 W < LO D 88.45 9 C u < LO D 31.16 8 N i < LO D 75.93 7 C o < LO D 194.53 3 F e 20598.35 4 ± 417.06 2 M n 576.94 3 101.98 3 Supervise d B y

# 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 59 6 Mod e SOI L Tim e 2010-05-1 1 17:0 1 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 3762 7 ADDRES S 257 4 Elliso n av e QUADRAN T D Z DEPT H 13 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D [ 8.12 2 Z r 514.20 2 ± 16.62 9 S r 163.41 6 ± 8.79 1 U < LO D 15.06 9 • R b 73.42 7 ± 6.78 8 T h 13.31 8 ± 7.36 2 P b 74.47 4 ± 12.51 4 S e < LO D 5.57 3 A s 59.80 4 ± 13.35 5 H g < LO D : 11.81 0 Z n 99.43 8 ± 18.23 2 < LO D : 82.55 3 

## w C u 35.11 5 ± 21.19 1 N i < LO D 76.92 6 C o < LO D ; 192.89 1 Fe 20242.39 3 ± 412.77 5 M n 615.12 5 ± 103.48 4 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 59 7 Mod e SOI L Tim e 2010-05-1 1 17:0 2 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 3762 7 ADDRES S 257 4 Elliso n av e QUADRAN T D Z DEPT H 13 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D 8.35 2 Z r 509.38 5 ± 16.58 2 S r 158.85 7 ± 8.69 0 U < LO D 15.13 6 R b 71.15 8 ± 6.72 6 T h 15.72 9 r b 7.58 8 P b 74.65 8 ± 12.46 8 S e < LO D 5.03 2 A s 73.72 2 ± 13.94 6 H g < LO D 12.71 6 Z n 87.19 9 i 17.62 5 < LO D 88.42 4 

## w C u < LO D 30.70 4 N i < LO D 76.18 3 C o < LO D 196.22 2 F e 20679.42 4 ± 417.82 3 M n 563.55 6 ^ 101.35 8 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 59 8 Mod e SOI L Tim e 2010-05-1 1 17:0 2 Duratio n 30.1 0 Sequenc e Fina l Flag s BVI D 3762 7 ADDRES S 257 4 Elliso n av e QUADRAN T D Z DEPT H 13 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D 8.27 4 Z r 509.41 5 ± 16.63 4 S r 166.17 1 ± 8.89 1 U < LO D 14.92 6 R b 67.90 2 ± 6.59 9 T h 14.15 1 ± 7.38 9 P b 69.12 4 ± 12.17 7 S e < LO D 5.84 5 A s 75.92 2 ± 13.84 4 H g < LO D 13.28 1 Z n 89.39 1 ± 18.04 1 

## w < LO D 94.39 9 C u < LO D 31.01 5 N i < LO D 74.70 1 C o < LO D 194.48 5 F e 20873.24 4 ± 420.58 8 M n 552.14 8 ± 101.10 8 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 58 3 Mod e SOI L Tim e 2010-05-1 1 16:5 1 Duratio n 90.6 6 Sequenc e Fina l Flag s AVERAG E ADDRES S j7 4 Elliso n av e QUADRAN T F 2 DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D 8.27 9 Z r 510.92 0 ± 16.60 5 S r 160.46 8 ± 8.73 7 U < LO D ; 15.60 9 R b 76.59 9 d : 6.96 5 T h S e ; ^J.D D "71

. Qii n / i.yt u < LO D ^ j_J—'.— ^ - 10.524u__ , 5.81 4 A s < LO D 16.79 3 H g < LO D 12.25 9 Z n 81.81 7 ± 17.15 6 

## w < LO D : 85.97 2 C u 35.52 0 ± 21.24 9 N i < LO D : 75.38 6 C o < LO D ; 187.53 1 F e 19843.02 3 ± 409.84 1 M n 756.71 1 ± 112.98 7 C r < LO D 677.43 2 V < LO D 1195.90 3 T i < LO D 5258.26 4 S c < LO D 490.88 5 C a < LO D 9130.32 4 K < LO D ] L8311.12 9 S 

### <m D 483.66 1 Supervise d By:L-^AJL X 

# Mfly i

# 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 58 0 Mod e SOI L Tim e 2010-05-1 1 16:5 0 Duratio n 30.1 2 Sequenc e Fina l Flag s BVI D 3762 7 ADDRES S 257 4 Elliso n av e QUADRAN T F 2 DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D 8.35 4 Z r 516.97 7 ± 16.67 1 S r 161.49 6 i 8.74 7 U < LO D 15.15 3 R b 79.49 6 ± 7.00 7 T h 12.15 7 i 7.20 3 P b 65.85 1 ± 11.98 2 S e < LO D 5.96 5 A s 17.14 8 ± 10.95 6 H g < LO D 11.74 2 Z n 85.69 5 ± 17.32 8 

## w < LO D 84.13 2 C u < LO D 30.75 3 N i < LO D 74.59 4 C o < LO D 187.50 9 Fe 20153.35 7 ± 412.39 9 M n 788.99 1 ± 114.55 6 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 58 1 Mod e SOI L Tim e 2010-05-1 1 16:5 1 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 3762 7 ADDRES S 257 4 Elliso n av e QUADRAN T F 2 DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m M o < LO D Z r 505.03 8 S r 159.57 3 U < LO D R b 76.41 2 T h < LO D P b 78.19 8 S e < LO D A s < LO D H g < LO D Z n 71.36 1 < LO D 

## w . C u < LO D N i < LO D C o < LO D Fe 19809.33 0 M n 727.82 0 Supervise d By : Erro r 8.30 3 ± 16.55 1 ± 8.73 6 15.40 0 ± 6.94 1 10.61 6 ± 12.80 0 5.75 0 17.11 4 13.05 7 ± 16.44 3 86.73 5 31.03 6 77.59 5 189.04 0 i 410.26 2 ± 111.34 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 58 2 Mod e SOI L Tim e 2010-05-1 1 16:5 1 Duratio n 30.4 3 Sequenc e Fina l Flag s BVI D 3762 7 ADDRES S 257 4 Elliso n av e QUADRAN T F 2 DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D 8.17 9 Z r 510.74 5 ± 16.59 4 S r 160.33 5 ± 8.72 7 U < LO D 16.27 3 R b 73.89 0 ± 6.94 5 T h < LO D 10.30 0 P b 71.77 0 i 12.32 4 S e < LO D 5.72 7 A s < LO D 16.83 0 H g < LO D 11.97 7 Z n 88.39 6 ± 17.69 7 W < LO D 87.05 1 C u 53.71 7 ± 22.55 4 N i < LO D 73.97 0 C o < LO D 186.04 2 Fe 19566.38 3 i 406.86 3 M n 753.32 1 ± 113.06 0 C r < LO D 484.78 0 V < LO D 1000.67 8 T i < LO D 4403.04 0 S c < LO D 507.72 2 C a < LO D 9973.79 4 K < LO D 15822.03 5 S < LO D 444.47 0 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 57 9 Mod e SOI L Tim e 2010-05-1 1 16:4 9 Duratio n 90.6 6 Sequenc e Fina l Flag s AVERAG E 

### CAvf-of-57i52aII~;;;;;~ 7 ADDRES S 257 4 Elliso n av e QUADRAN T F l DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D 8.27 8 Z r 503.68 0 16.63 0 S r 156.02 0 8.69 1 U < LO D 14.78 1 R b 70.44 5 6.70 5 T h 13.31 6 7.16 6 rP b :49.S31 ~ 10.820; ? 

### —se— ­ ^TJD D 5.62 3 A s 114.80 4 14.68 0 H g < LO D 12.67 4 Z n 80.12 8 17.21 8 < LO D 87.87 4 

## w C u < LO D 31.20 5 N i < LO D 76.54 0 C o < LO D 192.57 5 Fe 20370.03 3 ± 418.21 5 M n 482.90 5 ± 96.51 9 C r < LO D 401.18 9 V < LO D 676.96 1 T i < LO D 3060.01 7 S c < LO D 258.45 0 C a < LO D 4900.91 9 K 16974.49 4 ± 7952.30 7 S < LO D 2912.11 5 SupervisedBy: ( M /! ( 

# u (/Of \

# 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 57 6 Mod e SOI L Tim e 2010-05-1 1 16:4 7 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 3762 7 ADDRES S 257 4 Elliso n av e QUADRAN T F l DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D : 8.16 1 Z r 502.66 8 ± 16.51 6 S r 156.37 2 ± 8.64 2 U < LO D : 15.28 0 R b 69.47 4 ± 6.69 6 T h 14.06 6 ± 7.15 6 P b 45.66 8 ± 10.48 2 S e < LO D 5.80 2 A s 118.87 9 ± 14.59 5 H g < LO D 12.11 8 Z n 76.81 8 ± 16.85 9 

## w < LO D 88.79 8 C u 33.29 9 ± 21.47 9 N i 120.89 3 ± 54.55 5 C o < LO D I 190.21 6 F e 20455.32 8 ± 416.49 9 M n 481.78 5 ± 95.81 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 57 7 Mod e SOI L Tim e 2010-05-1 1 16:4 8 Duratio n 30.1 2 Sequenc e Fina l Flag s BVI D 3762 7 ADDRES S 257 4 Elliso n av e QUADRAN T F l DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D 8.32 5 Z r 501.80 0 ± 16.61 3 S r 156.29 5 ± 8.70 6 U < LO D 14.41 3 R b 73.27 1 ± 6.77 2 T h < LO D ; 10.32 7 P b 51.01 0 ± 10.91 4 S e < LO D I 5.73 9 A s 118.85 3 ± 14.90 9 H g < LO D J 13.16 3 Z n 72.57 5 ± 16.82 8 

## w < LO D : 91.31 1 C u < LO D : 29.99 4 N i < LO D : 73.39 3 C o < LO D : 193.90 6 F e 20265.27 3 ± 417.55 9 M n 469.81 6 ± 95.79 4 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 57 8 Mod e SOI L Tim e 2010-05-1 1 16:4 9 Duratio n 30.4 3 Sequenc e Fina l Flag s BVI D 3762 7 ADDRES S 257 4 Elliso n av e QUADRAN T F l DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D 8.34 8 Z r 506.57 2 i 16.76 1 S r 155.39 2 ± 8.72 4 U < LO D 14.65 0 R b 68.58 9 ± 6.64 8 T h 15.69 8 ± 7.45 6 P b 51.91 5 ± 11.06 4 S e < LO D 5.32 8 A s 106.67 9 ± 14.53 7 H g < LO D 12.74 2 Z n 90.98 9 i 17.96 6 

## w < LO D 83.51 3 C u < LO D 31.40 3 N i < LO D 74.39 4 C o < LO D 193.60 4 F e 20389.50 0 i 420.58 8 M n 497.11 6 ± 97.94 6 C r < LO D 773.75 8 V < LO D 1293.51 5 T i < LO D 5685.87 5 S c < LO D 482.46 6 C a < LO D 8708.58 9 K < LO D 19555.67 6 S < LO D 503.25 6 Supervise d By :

### 1 ^

KA; \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 o ^^^T LI Coasta l Environmenta l Grou p Inc

. V~^^!jfwww.coastalhazmat.co m

^"ipmy ^ COASTA L [NVIIOHHINTA l c•0 u r , rN c 

# EXECUTIV ESUMMARY : BVID #37627-(257 4 ELLISO NAVE )
No Issue s o r Concern s [ ^ Issues/Concern s
Detai l Explanation: ] -DO NBAHNK EWALKE D TH EPROPERT YO N9/10/201 0

# SEPA EP APropert y Clos e Ou t For m Propert y Addmr /
. ; • • n ^ ,>^Tl l Propert y #:3!Zjfc2: 2 Date/Time : ZZZ: ^ OwTe?
. N,«e ; .^B>r^tlV
. Vg-'^^fe ^ 'Contracto r Grou p ' ' Quad s Excavated : Ye s N o Eicavatio nGenera l 1
.I f necessBiy , wer eth ecoirec t quadrant(s ) excavate dan drestored ? 

# y r 2
. I f necessary , wer eth ecorrec t area s ofdri p zon eexcavaie dan drestored ? 

## 6 - ^ Ye s Cl o Gradin g So dan dVegetatio n 1
.Doe s th egradin g aroun dth eperimeie r ofth ehous einexcavate darea s generall y slop eaway 

# y y fromIh ehouse ?
. 

# y 2
.Ha s so dbee nlai di nal larea s tha t wer eexcavated ? 3
.Ooe s th eso dappea r t o b egenerall y health y an dgrowing ? (Onl y evaluat ei f inspecte dat a3 0 

## l y ^ da y tim eperiod ) 4
.

Ar esodde darea s generall y flrman devenl y graded ? c y ^ 5
.Ar eth ejoint s betwee nth eso dstrip s generall y tight ? (Onl y evaluat ei f inspecte dat a3 0 day tim eperiod ) __^
. 6
.Wa s th eproperty grade dsuc hthat wate r wil lno t poo lo nth eproperty ? 

# y 7
.Wa s danug et o landscapin g o r plant material s avoided ? 

# y Gates , Feace s an dRetainin g Wal b Ye s N o I
.D o gate s ope nan dclos efreely? (I f applicable ) 

# y 2
.

Wer eal lgate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (I f applicable ) C / " 3
.Wa s damag et o gate s o r Fence s avoided ? (Ifappiicable ) 

# y 4
.

Wa s danug et o retainin g wall s avoided ? (Ifappiicable ) Foundation , Sidia g an dGnMcr s Ye s N o I
. Wa s damag el o th esidin g o r tri mavoided ? t y ^ 2
.

Wa s damag et o th efoundatio navoided ? 

# y 3
.Wa s damag et o window s avoided ? 4
.

Wa s damag et o window s o r doo r screen s avoided ? 

# ~Z? ^ S
.Wa s damag et o downspout s o r downspou lextension s avoided ? 

## y ' Sidewalk s nn dDriveway s (Concrete ) Ye s N o 1
.Wa s damag et o drivewa y surface s avoided ? t y 

### 2
.

Wa s damag et o walkwa y surface s avoided ? 

# y

## Owner s comments :

Inspectio nnotes :

Remova l an dresloratio naclivale s eomplet e includin g th e 30-da y so dwarrant y EP ARepresentativ e j ) ^ /C.j£j

- Date:y//6^o/ ^

## Propert yCompletio n Agreemen t
I hi i agreemen l documenl s Ih e complclio n ol remedia l aciiviiie s perlbime d on myproperl y Mysignalur e wil l designate iha l I am satisfie d wit h th e restoralio n of myproperly , an d Iha l no ilem s arein questions , now , or ai an ynm e in th e ftjlure, excep t (hos e ilem s liste d below , ifan y Propert y ID : 3^^^ ^ ddrcssy2^Z^r[ U ^ C\' ( ( fgoy> , c Propert yAd d ress y^'/^riL i J t (jyjf? ^ Owner : P^^^y^ w'^^.<\^ ' Phone : qg^ ) ^^^c^f ) Restoratio n Item s in Question :

Item : Item : Item :

' Hem :

Item : Item :
Additiona l Comments :

J^ l ayrc cI cstoralio n i% completed , rxccp l as noiei l I J I rio no t a^re cresloratio nis complete d

^ VJkX K ' ^ Sicnalurc Dal e Owner' s Sijpnann e IJat c Con darlor' Condarior' s s Sienatur e

# Propert y Owne r Assessmen t of Performanc e For m America nRecover y andReinvestment Ac t (ARRA) OmahaLeadSuperfun dSit e 2009/201 0 

# RECEIVE D Remediatio nContractor : Coasta l Environmenta l Grou p - EP-R7-09-0 6 -«. - . ^ «-. - Propert y Identifie r Number : ^ 1 G'ZJ l UU I 10 ^Ul U ^^Z-^ ^ '^LS^L jeUr^^pjr ^ lzll'/^CLr \ f\)(^:

_SUPERFUN D DIVISIO N Propert y Address Address : MV€
. Propert y Owner' s Name ; "Dr>.rm ^ \^( ^ "^ ^ ' '^' ^ Instruction s to th e Propert v Owner ; Thi s for mserve s to recor dth e Propert y Owner' s assessment of performanc e (Incentiv e 1

- Quality Assuranc e Surveillanc e Plan ) involvin g th e liste dremediatio ncontractor , as applicabl e to th e Omah aLea dSite
. Thi s for mdocument s th e timelines s of punc hlis t resolution , busines s relations , complaint resolutio nandth e overal l qualit y

of work
. If nee dbe , th e Propert y Owne r may utiliz e thi s for m

to recor dproblem s and/o r issue s not specifically tie d toanassigned address , for example , busines s relation s that generally don' t follo w th e guideline s set fort h

inthe Performanc e Wor k

Statement
. Th e Propert y Owne r will indicate his/her assessment df performanc e wit hth e contractor' s wor kby checkin g anumerica l ratin g onth e tabl e belo w usin g th e nmnerica l definition s iix) m th e ratin g scal e below , thensign& dat e th e form. i "excellent " 7- 8 'Ver y good " 5- 6 "acceptable " 3- 4 "poor " 1-

2 "ver y poor " Propert v Owner' s Assessment of Performanc e Regardin g th e Contractor' s Wor k 10 ^^ ^ 5 9 4 8 3 7 2 6 1 

### Propert v Owne r Additiona l Comment s fro m(optional ; continu e onbac k pag e if needed )
Propert y Owne r Signature : ^^^ ^ ^'^i?-^g^'^^> ^ Date ; O^ / ^ / O".*.*J

.



# mot e ID : Rpag e o f 

# rCei-mit e ^ k Pes t dTontz-o l Inc
. 1-433 0 Oortvy Strec:* : ­ Omab a^ I>4E : 

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### i>i*icr E



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