### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAI D # : i'll ^ Date : Itj^fc ^ Address : ^^1 ^ O^ h^ f Remediatio nContractor : Coasta l Environmenta l Group

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Year : 200 1 SOI LREMEDIATIO N PROPERT Y HL EFOLDE RDOCUMENT S /



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damag e or to replac e plants , etc. ) Confirmationdata Photograph s

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### Dat e / 3005452 6 

# HIM I Superfun d

## Propert yAcces s Checklis t Propert yID : 2.'^^^ ^ D WOR K STARTE D D WOR K COMPELTE D Propert yAddress : ^ ' 5 y ^ QJ^^S S S ^ Rente r 

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. 1 D Notificatio nLette r Sent : / / Bv : I E f Acces s Agreemen t 

### Signed : Je./_2:/4 L 

## By:/T. e [Q ' Restonttio nAgreemen t Siened : ^ / ^ / ^ 

### By:p, C 1 D Topsoi l Samplin g (i f applicable ) / / By : C

D Disposal Samplin g (if applicable ) / / By : 1 GGnrdc nSamplin g (i f applicable ) / / By : ^ Utility Clearanc e Called : U / i Z/ C ^ 

### By=U/fe>/D« i 1 ^ Video/Photo s (Before ) 

### On: J£_ l JOl ^ 

## By: A/)0 ± 1 D Video/Photo s (During ) On : / / By : 1 D Video/Photo s (After ) On : / / By : 1 D Video/Photo s (30-Day ) 

### On: / / J By : Q Propert y Completio nAgreemen t j 

### Signcd:^/'l ^ JC ^ 

## By: D Pina l Repor t Issued : / > \ By : Ai rMonitorin e (i U ai>plicabl e ) 1 n Communrt yD Cre w On : / / By : • RciiuJts : 1 Q ComraunitA ' Q Cre w On : / / By : Results : 1 Q Communit yD Cre w On : / / Results : ON : _/ /_ ON : / /



## 1

1

1 

# 1

Omah a Lea d SH e

## Propert y I D # Property Address : Initial Contact : Secon dContact : Final Contact : Final Action :

Comment : Owner Commen t (s) : Sit e Coordinato r Comment (s) : CONTAC TFOR M 

## l-^9i^ U 

# M1M 7 

# ^ft^ 3 

# ^ ^ Date :

Date : Date : Transmi t to EP AD Time : Time : Time : Actio n Actio n Actio n Other Action : D

## Douglas Count y Accoun t tio n Pag e 1 of 2 Dougla s County , Nebrask a Propert yRecor d - R201840000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f52n d S t - ViewO H Ma p Infonnatio n i s vali d a s o f2009-5-1 2 Treasurer' s Ta xRepor t Ne wFeatur e ••-•• •Aut o Sale s Searc h Owne r RUTHERFOR D DAVI D R 432 0 CAS S S T OMAH AN E 68131-000 0 Propert yInformatio n Ke yNumber : 

### 184 0 OOO O 2 0 Accoun t Type : Residentia l Parce l Number : 201840000 0 Parce l Address : Lega l Description : 431 2 CAS S S T OMAH AN E 68131-000 0 POPPLETO N PAR KLO T1 8 BLOC K1 2 5 0 X 122.8 5 Valu e Informatio n 

### 200 9 200 8 200 7 200 6 200 5 200 4 Lan d $6,400.0 0 $6,400.0 0 $6,400.0 0 $6,400.0 0 $6,400.0 0 $6,400.0 0 Improvemen t $79,600.0 0 $79,600.0 0 $75,400.0 0 $75,400.0 0 $75,400.0 0 $54,700.0 0 Tota l $86,000.0 0 $86,000.0 0 

### $81,800.0 0 $81,800.0 0 $81,800.0 0 $61,100.0 0 Sale s Informatio n Sale s Data : 

### 1995-04-2 3 Dee d Type : Price : Grantor : $52,900.0 0 Book : 200 5 Page : 55 1

Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s 

### 0.1 4 S F 

### 6150. 0 Unlt a 

### 1.0 Dept h 

### 123. 0 Widt h 50. 0 Vacan t N o Improvement Informatio n 

## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R201.. . 6/6/2009

### Dougla s County Accoun t y|||fl^tio n Pag e 2 of 2
Buildin g 1 1 1/ 2 Stor y 431 2 Cas s s t

Fn t Fto w TSeOx) «

BwrtBlocHI I ns v CLIC KTO ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1252. 0 Percen t Complete : 

### 100.0% 0. 0 Quality : Averag e 

### Perimete r Uni t Type : Condition : Averag e

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

HVAC : Centra l Ai rt o Ai r Rooms : 6. 0 Exterior : Fram e Aluminu m Units : 

### 1. 0 Interior : Drywal l Baths : 

### 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 2. 0

Roo fType : Gabl e Stories : 

### 1. 0 Floorcover : Allowanc e Foundation : Bloc k Sprinkle 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 192 0 0 % 192 0 8 8 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 

### 1. 0 Basemen t Bsmn t Bloc k 8 f t 756. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 

### 1. 0 Garag e Detache d 324. 0 Porc h Sla b Roo fGei l 

### 128. 0 Use r Fence.do g 

### 1. 0

http://douglasne.mapping-online.com/DougIasCoNe/static/accountinfo.jsp?accovmtno=R201. . . 6/6/200 9Pag e 1 of 2

" > Creat e Anothe rTicke t Bac k t o Irt h Inteme t Sen dEmai l

• YOURTICKE T NUMBE RI S 2311570 . Origina l Cal l Date : 7/07/0 9 Time : 12:4 3 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 7/09/0 9 Time : 1:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 431 2 Street : CAS S S T Twp : 15 NRng : 13 E Sect-Qtr : 17-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n Locatio n o f Work : INCLUD E AL L EASEMENT S LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LO T Compan y: COASTA L ENVIRONMENTA L SERVIC E Contact 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 MUDO l OMAHACO F 0PPDGPR 5 PAETE C QLNNEI C

Servic e Are a Contac t Phone Niunbe r Utilit y Typ e CXCAT V ^° ^ COMMUNICATIONS , IN C HEIDI Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
MUDO l METROPOLITA NUTILITIES DISTRICT SAND Y Day : 402504782 3 Alt : Emerg : 402504797 0
OMAHACO F CIT Y O FOMAHA
TRAFFIC.SEWE R RO N Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0
OPPDGPR 5 OMAH A PUBLI C POWE R DISTRICT N A Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.. . 7/7/200 9

### Pag e 2 of 2 Day : 800289190 1 PAETE C PAETE C COMMUNICATION S £2^00^^"^^^ ^ ^* - Emerg : 800289190 1 Day : 406728934 3 QLNNEI C QWES T LOCA LNETWOR K

N AAlt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 7/7/200 9

# ^ As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e 2384 4 Exterio rPain t Nort h Arro w Omah a Lea d Sit e • Goo d Sit e Sketc h 

### i • Poo r Samolln a Address : 431 2 CAS S S T rO'No t pain t Sampl e Numbe r Lea d Sampl e Sample s Collecte d 

# i LA B Concentratio n Collecte d Firm : ? £ lo cCc c- ^ K ) RYASCPXA-2384 4 F 1 

### I Co 5 pp m 

# n Date : S-L , - <2r « RYBSCPXA-2384 4 F 2 

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### Legen d Concret e Dri p Zon e Excavate d 

### /: A i<'^A Q Quadrant s Excavate d Are a replace d wit h So d Are areplace dwit h Rock/Mulc h Are alef t bar e Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc ,

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## D Date : 5-l o - (2i Z RYBSCPXA-2384 4 F2 

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## 33f i pp m 

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## "M ^ pp m RDZSCPXA-2384 4 D Z 

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# • Date : ^5-210 $ RPZSCPXA-2384 4 P Z 

## \$ l pp m 

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# r n D Staff: M S W Numbe ro fSample s = I ( o Legend : F 1 = Fron t Left , F2 = Fron t Rigtit , B 1 = Bacl^ Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Play Al l quadrant s ar e a s viewe d fro m th e street , facin g property



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# y Rev2008. N Created : 26-Fet)-0 8 04470 1 0 1 2. 1

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. • Goo d Sit e Sketc h 

# i • Poo r Samplin a Address : 431 2 CASS S T [ J No t pain t Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Coilecta d Firm : P £ In cfe e - 

### BK i RYASCPXA-2384 4 F 1 pp m 

# n Date : S'L, ' 

## (3' s RYBSCPXA-2384 4 F2 

# 23 3 pp m 

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### 9 r/ 3 cv"* i RYCSCPXA-2384 4 B l 

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. P Z = Play Al l quadrant s ar e a s viewe d fro m tti e street , fedng propert y 

### Irl'^.T'T' ' .r..y - yAP ' 

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# Cc^ 5 5t : Re v200S. N Created : 26-Feb-O S 044701.01.2 3COASTA L INVIIOMHIHTft l ^ ^ ' « • o u r . IN 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 :

Owner' s Name :

Addres s o fPropert y covere d b ythi s Agreement : 

# Ll^\ ^ PURPOS E O F RESPONS E ACTIVITIE S Daytim e Phone : 

# Qjas^ % <
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 ma ypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t b remove 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 ofCoasta l Environmenta i Group , contracte d byUSEPA , wil l contact th e Granto rin-perso n t o discus s th e worl ct o b e perfomned , th e Granto rwil l hav e a n opportunit yt o revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e i t begins
. Once th e wor k i s finished , th e Granto rwil l b e aske d t o revie wth e worl < an d confir m that 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 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 , contractor s 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 work
. Thi s acces s shal l remai n I n effec t 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

# V- COASTA L iiKiieiiKriii* !



### •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 necessar ysubsequen 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 tenant 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 rvynt 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

[^ 1 gran t acces s t o mypropertie s • I d o no t gran t access t o m ypropertie s

Signature Signatur e Dat e

DI 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 Th e purpos e ofthi s agreemen t is t o provide amutua l agreemen t as t o condition s ofth e propert y prio r t

o remediatio nactivities . Thi s wil i als o serv e as documentatio nfo r

the purpos e of assuring tha t restoration activitie s ar e complete dt o th e satisfactiono f

th e propert y owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA) . Propert y ID : ^gg'^J H Propert y Address : t|5\ 2 Oa< S fiV Owner : ^g^/ ^ \?oW^^v A Phon e O

nthe attache ddiagram(s) indicat e area(s ) t o excavate dan ddept ho f

excavation , locatio nof al l know n utilities , subsurfac e features , siirfac e structure s an dlandscapin g features , acces s location(s ) t o b e use db y contractor, an dth e directio nof North . Indicat e distances , depths , materia l types , etc . Indicat e digita l photo s b

y referencin g th e photo-log numbe r wit ha narro w indicatin g directio nof view . 

## Item s T O B e Remove d B yOwne rBefor e Star t OfRemediation : (Us e additiona l sheet s a s necessary) Th e removal , storage , disposal , and/o rretu m ofthes e item s I s th e Owner' s responsibility
. Item :

- > 

# An/ 1 .Syml l ninfi KA n top-^^.u^ W Item : J ' ' ' " ' ^ ^ Item : ^ ^ Item : ^ A Item : 

# A Item : 

# 1 / Item : Item : Pag e 10,: ^

## 7 COASTA L O R O U » , • N C 

### Item s T o B e Remove d B yContracto rDurin a Remediatio n An d No t Replace d (Us e additiona l sheet s a s necessary) Item : 

# OldJA KIpt-l-bfU'i^r l -N Item : Q ' ' ' " " Item : A Item : 

# A Item : 

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

Pag e 2 

# offe'C p AS T AL 

### 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 : 

# so ; 

# I -D ^ 

# f^7
. Item : 

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Page s o f( OCOASTA L INvlRONMiHTAI
. o n o u r. IN C



## Item

Pre-exisiin g propert y area , lha t wil l b e excavated , that i s covere dwit hgrass .

Numbe r o f tree s > 2 inc h trunk diamete r

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

Numbe r o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Attac hasketc ho f th e sprinkle r layout .
Numbe r o f an dsiz e o f eac hgarden/ flowe r be d area . Attac hasketc ho f relativ e size s an dlocations . 

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

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

Square fee t



### • , t Each 

# 1

Eac h 

# ^/f l

Each 

# ^0

Each 

### \ Square Feet

Pag e 

# 4of_ kCOASTA L 

## Ite m Quantit y Uni t Condition/Type/Specie s Agree dupo nvalu e o f plan t material s no t t o b e renlace db v contractor . Not e thi s valu e wil i b e use dt o issu e aplan t vouche r t o th e propert y owner . Agree dupo nlis t o f plant material s tha t wil l b e replace db y connector . B e very specifi c anddetailed . 

### / / / $

Eac h Includ e asketc ho f were eac hplant will be place d b y th e contractor . 

### /
Agree dupo nare ao f property t o b e replace d wit hgras s sod . Includ e asketcho f th e area(s ) t o b e replace dwit h gras s sod . 

### S F

Are aofCit y o r County proper ^ t o b e landscape d pe r thei r requirements . Includ e asketc ho f th e aie a(s ) 

### ^ S F 

# T o Vo e d^t\ccmue d Easemen t Area , t o b e excavate d 

### S F



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### 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 damag a B ycheddn 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 , indudin g foundatio n crack s o rfissufes
.
lagre e QLd o no t agre e 

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## -7-\i^- m Addres s 

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RETES TAREA S Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h Averag e Averag e la b sampl e # La b resul t Sampl e are a XR F Avg
. Sianatur e ^iajQMa>A Prin t 

# Pii^Jne^r/rrr^ ^

# 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 159 3 Mod e SOI L Tim e 2009-07-1 8 15:0 2 Duratio n 122.2 3 Sequenc e Fina l Flag s AVERAG E ^vg:^f;i58i9rl5p ^ ADDRES S 431 2 cas s s t QUAD/ZON E DZ INSPECTO R Nicola s DEPT H 1 2 SAMPLE TYP E CLEARANC E NOTE
pp m ± Erro r Pb ^17;25 5 f ^190.77 9 f ± Supervise d By : (AY'/MWLA ^

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 290.82 8 Supervise d By : 

## Certificat e o fVerificatio n

158 9 SOI L 2009-07-1 8 15:0 0 30.6 5 Fina l 2384 4 431 2 cas s s t D Z Nicola s 1 2 CLEARANC E

± Erro r ± 21.25 4

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Blllerica , 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 184.00 9 Supervise d By : 

## Certificat e o fVerificatio n

159 0 SOI L 2009-07-1 8 15:0 1 30.6 0 Fina l 2384 4 431 2 cas s s t D Z Nicola s 1 2 CLEARANC E

± Erro r ± 17.28 7

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 146.17 2 Supervise d By : 

## Certificat e o fVerificatio n

159 1 SOI L 2009-07-1 8 15:0 1 30.5 6 Fina l 2384 4 431 2 cas s s t D Z Nicola s 1 2 CLEARANC E

± Erro r ± 15.45 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 142.10 9 Supervise d By : 

## Certificat e o f Verificatio n

159 2 SOI L 2009-07-1 8 15:0 2 30.4 2 Fina l 2384 4 431 2 cas s s t D Z Nicola s 1 2 CLEARANC E

± Erro r ± 15.02 2

# f f Therm o

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

## Certlfi c XL3t-3208 9 Readin g N o 159 8 Mod e SOI L Tim e 2009-07-1 8 15:0 6 Duratio n 121.2 9 Sequenc e Fina l Flag s AVERAG E flv g o f1594-1597 ^ ADDRES S *43T2xa5S-s t QUAD/ZON E B 2 INSPECTO R Nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E
pp m Erro r Pb 

### fTb.sis j ± Supervise d By : (AQiMllJ )

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Blllerica , 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 60.91 1 Supervise d By : 

## Certificat e o fVerificatio n

159 4 SOI L 2009-07-1 8 15:0 4 30.2 0 Fina l 2384 4 431 2 cas s s t B 2 Nicola s 6 CLEARANC E

± Erro r ± 10.76 5

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Blllerica , 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 87.87 5 Supervise d By : 

## Certificat e o fVerificatio n

159 5 SOI L 2009-07-1 8 15:0 5 30.5 1 Fina l 2384 4 431 2 cas s s t B 2 Nicola s 6 CLEARANC E

± Erro r ± 12.60 2

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 79.64 5 Supervise d By : 

## Certificat e o fVerificatio n

159 6 SOI L 2009-07-1 8 15:0 6 30.1 4 Fina l 2384 4 431 2 cas s s t B 2 Nicola s 6 CLEARANC E

± Erro r ± 11.93 0

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 159 7 Mod e SOI L Tim e 2009-07-1 8 15:0 6 Duratio n 30.4 4 Sequenc e Fina l Flag s BVI D # 2384 4 ADDRES S 431 2 cas s s t QUAD/ZON E B 2 INSPECTO R Nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E
pp m Erro r ± P b 54.84 0 10.51 9 Supervise d By :

# 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 160 7 Mod e SOI L Tim e 2009-07-1 8 15:1 6 Duratio n 121.5 5 Sequenc e Fina l Flag s AVERAG E Av g of 1603-1606 ] ADDRES S ^raT 2 cas s s t QUAD/ZON E easemen t INSPECTO R Nicola s DEPT H 1 SAMPL E TYP E CLEARANC E NOT E
pp m ± Erro r P b 416.80 2 ± 24.81 1 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 398.95 7 Supervise d By : 

## Certificat e o fVerificatio n

160 3 SOI L 2009-07-1 8 15:1 4 30.3 1 Fina l 2384 4 431 2 cas s s t easemen t Nicola s 1 CLEARANC E

± Erro r ± 24.29 0

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Blllerica , 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 425.99 9 Supervise d By : 

## Certificat e o fVerificatio n

160 4 SOI L 2009-07-1 8 15:1 5 30.3 3 Fina l 2384 4 431 2 cas s s t easemen t Nicola s 1 CLEARANC E

± Erro r 24.55 8

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 426.57 4 Supervise d By : 

## Certificat e o fVerificatio n

160 5 SOI L 2009-07-1 8 15:1 6 30.2 7 Fina l 2384 4 431 2 cas s s t easemen t Nicola s 1 CLEARANC E

± Erro r ± 25.44 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 415.68 0 Supervise d By : 

## Certificat e o fVerificatio n

160 6 SOI L 2009-07-1 8 15:1 6 30.6 4 Fina l 2384 4 431 2 cas s s t easemen t Nicola s 1 CLEARANC E

± Erro r ± 24.95 2

## >^ ' QAOmah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 3 ^^^^ ^

I Coasta l Environmenta l Grou p Inc
. M ^ ^ ^^^^Tt ?

^tPBO** ' www.coastalhazmat.co m COASTA L ENVI>ONNENT* l S t o U r . IN C 

# EXECUTIV ESUMMARY : BVID #23844 - (431 2 CAS S ST ) No Issue s o r Concern s [ ^ Issues/Concern s Detail Explanation :4 

# EP A ^ 

# EPAPropert y Clos e Ou t For m Propert y # : 7^Vi ^ Propert yAddress: - Datemme : -JfT^Cfi K Owncr* s Name : / ^ Quad s Excavated : uL . y> 7 Contracto rGrou p Ye s N o Excavatio nGenera l I .I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 2 .If necessary , wer e th e correc t area s ofdri p zon e excavate dan drestored ? 

# A
Ye s N o Gradin g So dan dVegetatio n I .Doe s th e gradin g aroun dth e perimete r ofth e hous e inexcavate darea s generall y slop e away 

# 'A T fromth e house ? 

# 1 ^ ^ 2 .Ha s so dbee nlai di nal l area s tha t wer e excavated ? 3 .Doe s th e so dappea r t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period ) 4 .Ar e sodde darea s genetall y fin nan devenl y graded ? 5 .

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

# AY- ' 7 .

Wa s damag e t o landscapin g o r plan t material s avoided ? Gates , Fence s an dRetainin g Wall s Ve s No I .D o gate s ope nan dclos e freely? (Ifapplicable ) 

# YA A 2 .Wer e al l gate s o r fence s lake ndow ndurin g restoratio nacliviiie s reinstalled ? (Ifapplicable ) 

# A 3 .

Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) 

# A 4 .Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) 

# 17 "
Foundation , Sidia g an dGmttr t 

### Ye s Jj a I .

Wa s damag e t o th e sidin g o r tri mavoided ? 2 .Wa s damag e t o th e foiuidatio navoided ? 

# A 3 .

Wa s damag e t o window s avoided ? Wa s damag e t o window s o r doo r screen s avoided ? 5 .

Wa s damag e l o dov^spout s o r downspou l extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ve s W b 1 .Wa s damag e t o drivewa y surface s avoided ? 2 .Wa s damag e t o walkwa y surface s avoided ?

## 0>*'Dcr s comments :

Inspectio nnotes :

Remova l an drestorationactivate s complete including th e 30-da y sodwarranty : EP ARepresentativ e jUgV y UcJLl ^ Date : 1 1 ^10 ^

## Propert yCompletio n Agreemen t I hi s agreemen i documenl s th e complclio n ofremedia l acliviiie s perloime d on myproperl y Mysignatur e wil l designat e tha t 1 am satisfie d wit h th e restoralio n ofm yproperly , an d lhat no Hem s arein questions , now , or al an ylim ein fh e future , excep l ihos e ilem s liste d below , ifan y Propert)'ID : 2.*5^HL \ Propert y Address : ^a^^> ^ (»^^ ^ ^ ^ Owne. : ^^^j ^ ^Q^flffecA
. Phone : (H02^^f^lo-<HQt.- & Restoratio n Item s in Question : I Item : "

Item : I •• « I • I LJ L Item ; Item : Item : Item : Additiona l Comments :

^K l 1 tt^rc e rcntoralio n is compleied , excep l as noter i [ I I rl o nn i Dtrre e restoralio n is complete d 

# 7 U- AA^Mp h -^hA M Owner' s Sicnahir r Dat Dat e ff e Sen d arlor' s Sicnalur c Centrarlor' s Si g Dal e

# ( 0 4 ^ Propert yDamag e Settlemen t

Property I D 2384 4 Property Addres s 431 2 Cas s St . Owne r Dave Rutherford Phon e 402-556-906 8

Coasta l Environmenta l Grou p Inc . (Coastal) , ha s agree dt o pa y Mr . Dave Rutherfordtfa e stu no f $1000.0 0 a s compensatio nfo r al l property damage s includin g bu t no t limite dt o basemen t wate r damage s whic h occurre dat : 431 2 Cas s St . Omaha , NE . Mr . Rutherfor daccept s thi s a s 'Taymen t I nFull " i nlie u o f an y an dal l repair s and/o r an y an dal l replacemen t inaterial s required . Coastal Environmental 178 3 Grou p In c Check s Valu e of Chec k $1000.0 0 Mad e Ou t T o Dav e Rutherfor d DescriDtio n o fMiscellaneou s Prooert vDamaoe

• Al l damages are "Pak l i n Full ' t o includ e anyan d al l uncollecte d rent M ysignatur e belo wi s acloiawtot^men t o fttie receipt o ftti e su m liste d alxive , whict i I furthe r acknowledg e t o li e fai rcompensatio n fo rth e mlscailaneou s propert ydamag e describe d abov e an d release Coasta l Environmenta l Grou p in cfro m furthe roliligation s o rliabilit yrelated t o thi s pippert y damage
.

Witnes s Signatur e Dat e Pag e 1 o f1