## TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R

SAID# : ?>nn>M M Date : \7.l^l7T^\\ n Address : 7^7 ^ /\ i 2f ) ^ 4 RemediationContractor : Coastal Environmental Group

_Year : 2010ARR A
SOILREMEDIATIO N PROPERT YFIL EFOLDERDOCUMENT S

^ Video ofpropert y (DVD) • - . \ y Executiv eSvunmar y \Z ^ EPA-provide dpropert y sketc h

• 0 Signe dAcces s Agreemen t for subjec t propert y \jff ^ Signe dAcces s Agreement(s ) for adjacent propert y 10

^ Restoratio nAgreemen t 'o^ LSettlemen t document s (i.e. , for damag eo r t o replac eplants , etc. )
^ Contirmatio ndat a \ ^ Photograph s E' As-buil t sketc h y Satisfactory restoratio nsigne db y Property Owne r i2

f Property close-ou t chec k lis t signe db y EP A C/

V Descriptio no f area s no t meetin g RO D cleanu p criteri a y i Utilit y clearance s ^ Propert y infonnationfro mDouglas Count y Assessor' s Offic e D D D 

# fele ^^^

- ^/',

. JLl2j2dO

_ ,\

\Dat e
3021763 7 

# muni H Superfun d

### ^


# ^ v Propert yAcces s Checklis t PropertylD : 3^L| ^ D WORK STARTE D ON : __/__/

_ D WORKCOMPELTE D ON:__/__/

_ Property Address : ;> q2 ?> K l 2 5 5 ^
Owner : ^^,^1^U/lVn Q Renter : Address : Phone : 

# lc3^4 ^ Rea d6t Fax : Cell/Pager : Additional Information : Phone : Lir>2.fi-7|.q[()lU 7 Fax : Cell/Pager :
D NotificationLette r Sent : / / By : p ^ Acces s Agreement Signed : }Z_/2^/CQ

. By : 1 ^ Restoratio nAgreement 

# Signed : 12./2£?/0 3 By : D Topso USamplin g (if applicable ) / / 

### By : D Disposa l Sampling (i f applicable ) / / 

### By : GGarde nSampling (i f appUcable) / / 

### By : "5 3 UtiUt y Clearanc e CaUed<SL A/os/vrt ^y

- C^/Ofc l\ 0 VJOtnJlv ^ 

### Ij ^ Video/Photo s (Before) On:(Sj>/3i./Afi

. By : '
nVideo/Photo s (During ) On : / / By : nVideo/Photo s (After) On : / / By : D Video/Photo s (30-Day ) On : / / By : '^^ ^ Property Completio nAgreement Siened: ^ RM ll O By : fyu^cyy ^

• Ffaia l Report Issued : / / By : ^ Air Monitorin g (a s appUcable) nCommunit y D Cre w On : / / By : 1 Results : D Conununit y Q Cre w On : / / By : Results :

nCommunit y Q Cre w On : / / By : Results :

Omah a Lea d Sit e

## Douglas Count y Accoim t InfoniJ^io n Page1 of 1 rnl^p i
Dougla s County , Nebrask a Propert yRecor d - R l 14406000 0 Prin t Repor t NE WFnatur a - Parrn l DimRnsinn s availabl e (d fscal e 0-5 0 ft wes t o f52n d S t - VleWO n Ma p 

### Informatio n i s vali d a s o f2009-10-1 5 Treasurer' s Ta xRepor t Ne wFeatur e ->••>•Aut o Sale s Searc h Owne r WYN N MARL AM
624 4 REA D S T OMAH AN E 68152-000 0 Propert yInformatio n Ke yNumbe r 440 6 000 0 1 1 Accoun t Type : Residentia l Parce l Numbe r 114406000 0 Parce l Address : 292 8 N 2 5 S T OMAH AN E 68111-000 0 Lega l Description : GISE S AD D LOT10 5 BLOC K0 S 3 0 N 97.3 5 FTW107.8 2 F T3 0 X107.8 2 Valu e Informatio n
200 9 200 8 200 7 200 6 200 5 200 4 Lancf $300.0 0 $300.0 0 $300.0 0 $300.0 0 $300.0 0 $300.0 0 Improvemen t $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 Tota l $300.0 0 $300.0 0 $300.0 0 $300.0 0 $300.0 0 $300.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 7 3240. 0 0. 0 108. 0 30. 0 Ye s



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

. 10/22/2009

## Page 1 of 1

" > \ ._ _

CreatejAiriotherJ[icke t ^ [ Back^tqjrtt t Inteme t \ I i ^

Sen d Emai l ]

YOU RTICKE T NUMBE RI S 2454457

. Origina l Cal l Date : 4/05/1 0 Time : 8:5 0 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 4/08/1 0 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 292 8 Street : N25T H S T Twp : 15 NRng : 13 E Sect-Qtr : 09-NE-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 : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR 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 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 QLNNEI C

Servic e Are a Contac t Phon e Nunibe r Utilit y Typ e Day : 402934046 9 CXCAT V CO XCOMMUNICATIONS , IN C HEIDI Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 MUDO l METROPOLITA NUTILITIES DISTRICT SAND Y Alt : Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFIC.SEWE R RICH/TRAFFI C Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 OPPDGPR 5 OMAH APUBLI C POWE RDISTRICT EL M LOCATIN GAlt : 406207149 4 Emerg : 888728934 3 Day : 406728934 3 QLNN E1 C QWES TLOCA LNETWOR K EL M LOCATIN GAlt : 406207149 4 Emerg : 888728934 3

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

. . 4/5/201 0

### OLS# : 3004 4 

# 1 9 As-Buil t Drawin g Dat e Excavated : 4/13/1 0 Dat e USEP ASigne d Off : 4/27/1 0 COASTA L 

# Omah aLea dSuperfun dSit e Are a Sodden : 192 9 s a f t



## 3004 4 Exterio rPain t Nort h Arro w Omah a Lea d Sit e 

### • Goo d Sit e SIcetc h •Poo r Samplin g Address : 2928 N 2 5 S T Q'No t paint Lea d Sampl e Sample s Collecte d Sanipl e Numbe r LA B Concentratio n Collecte d Fir m RYASCPXA-3004 4 F 1 2M 6 pp m 

## D Date : U>l2-^i0 6 RYBSCPXA-3004 4 F2 Zl n pp m 

## D Tim e 

### l-'V ) ? K RYCSCPXA-3004 4 8 1 S&° l pp m 

## D Sample s Analyze d RYDSCPXA-3004 4 8 2 n (oft pp m 

## D 'RD2SCPXA-3004 4 BS r
—pp m 

## D D XR F Unit : CS*J O Book : ZOf e ROZGCrXA-3004 4 G2
- ~ pp m 

## D D Dat e 

### 1-/7-0 & RPZSCPXA-3004 4 PS
- ~ pp m 

## D D Tim e 

# An

. Staf f Numbe ro fSample s = | ^ | | ( ^ | 

## ^sv / Legend : F l = Fron t Left , F2 = Fron t Right , B 1 = Bac k Left

. 8 2 = Bac k Righ t DZ = Dri p Zone , G Z = Garden , P Z = Play Al l quadrant s ar e a s viewe d fmi n th e street , facin g propert y

RevJdOX.J A(realcd : l.l-Mar^) S 

### Legen d Concret e Dri p Zon eExcavate d Quadrant s Excavate d Are areplace d So d wit h 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
.

# k 50044 

# c

\ eo\. r 

# iA

. n^/o ^ Exterio rPain t Nort h Arro w Omah a Lea d Sit e •Goo d Sit e SIcetc h •Poo r Samplin g Address

. 292 6 N 2 b : Q'No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : F E In o Pf>r, \ RYASCPXA-3004 4 F l 2H 6 pp m 

### D Dal e (fili-JlO U RYBSCPXA-3004 4 F 2 2.1^ ) pp m 

### D Tim e '•••v > fl"

- RyCSCPXA-3004 4 B 1 

# /»a qoo m D Sample s Analyze d RYDSCPXA-3004 4 B 2 ^fpf i pp m 

### D r^DZSCPXA-3004 4 Bi r —pp m 

### D D XR F Unit : GSH O Book : ZOf t RO2CiCPXA-3004 4 ^ - ~ pp m 

### D D Date : "7-/ 7 •<? & RPZGCPXA-3004 4 Pg
- ~ pp m 

### D D Time : 

# An

. Staff : Numbe ro t Sample s = | ^ [ | ( ^ \ 

# ^s\ / Legend : F l = Fron t Left , F 2 = Fron t Right , B l = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a

s viewed fro m th e street , facin g propert y



# '0^^^ ^

### • • # •

3004 4 Omah a Lea d Sit e Exterio rPain t Sit e SIcetc h • Goo d
•Poo r Samplin g Address : 292 8 N 2 5 ST QNot pain t Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Sample s Collecte d Firm : P E Irt cPftTA RYASCPXA-3004 4 F l 2.H & pp m 

### D Date ; iffl^-^iOH , RYBSCPXA-3004 4 F 2 2.l n pp m 

### D Time : l-^V ) F H RYCSCPXA-3004 4 RYDSCPXA-3004 4 'RDZSCrXA-3004 4 ROZOCPXA-3004 4 RPZOCPXA-3004 4 B 1 8 2 B2
­ SZ
­ PS
S&° l H(pf t pp m

pp m pp m pp m

, pp m 

### D D D 

# n D D D D Sample s Analyze d XR F Unit : GSH O Book :

Date : 1-/ 7 -gf e Time : /1A 1 Zo9 i

Numbe ro fSample s = | *- ) | | ^ [ Staff : /^SW Legend : F l = Fron t Left , F 2 = Fron t Right , 8 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a

s viewed fro m th e street , facin g propert y 

### 1^1^- ' y % T ^ v^ * 

### JU L0 7.. ;


# er-e s aV^o o

'€^'^

Re

v2(»)S„1, Afrcnlnl : l.!-M.i r

## 3004 4 Exterio rPain t Nort h Ano w 

## Omah a Lea d Sit e •Goo d 

## Sit e Sketc h a Poo r Samolln a Address : 292 8 N 2 5 S T 04jot pain t Sampl e Numt}e r RYASCPXA-3004 4 F 1 Lea d Concentratio n 

## 2H & oo m Sampl e Collecte d LA B 

# D Sample s Collecte d 

# Firm : fgJn C P6T: > 

## Date : talz^JQ ^ RYBSCPXA-3004 4 F 2 2-ir ) Dom 

# a Time : l^Tj Q m RYCSCPXA-3004 4 RYDSCPXA-3004 4 B l B 2 gft ^ H(pft Dom pp m 

# a n Sample s Analyze d T^DZOCPXA-3004 4 B2
­ - pp m 

# D 

# n XR F Unit : GS^ O Boole : ZOft 

## ROZOCrXA-3004 4 SZ

­ pp m 

# D 

# a Date : 1-/ 7 •O ^ RPZOCPXA-3004 4 PS
­ pp m 

# D 

# D Time : /1A 1 Numi}e ro fSample s = | *-) | | ^ | 

## Staff: AIS W Legend : F l = Fron t Left , F 2 = Fron t Right , B 1 = Bac k 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

. ' f 

# k

' U c f 

## JU L0 7c.: 3

/ •: 

# ?>\ 

# ^ z
2*^2 3 :



# Vi%

. 

# .fl

. IF 2


# I I U 

# J

. ^amr

y^::%'5

. .5.t

. Rev2008.3 ACreate dl3-Mar-0 8 0447U I 01.2. 1

# »*>'*!r' v
COASTA l ENVIItONfllKTA t C R O U rt H C 

# Consen t fo rAcces s T o Fropert y
RIGH TO F ENTR YT O PREI\/IISE S 

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

# 402^71 '
Addres s o fProperty covere d b ythi s Agreement :

PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP Ai s requestin g acces s t o collec t soi l sample s an d remov e soi l tha t contain s elevate d concentration s o flea d an d ma ypos e a healt h hazard

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

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

. Thi s wor k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o fCoasta l Environmenta l Group , contracte d b yUSEPA , wil l contac t 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 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

. 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 vmtte n documentatio n fro m EP Atha t th e propert y ha s bee n remediated

.

ENVIRONMENTA LRESPONS E ACTION S 

### B ysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , it s employees , contractor s an d subcontractor s th e righ t 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 :

Page 1 o f2COASTA L ^ > ^ ^ IttVtROHKIftTA L < l BROl * C « O U » 1 « C


### cRemov 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 ; e 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 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 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 (402 ) 991-119 9

JQL I 

### gran t acces s t o mypropertie sD ' d o no t gran t access t o mypropertie s 

# ^Jykyjjiu ^ /^/^^A ^ signatur e ( / Dat e Signature Date

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

.

Page 2 o f2COASTA L 

## Restoratio n Agreemen t Th epurpos eo f thi s agreemen t i s t o provid e amutua l agreemen t a s t o condition s ofth epropert y prio r t o remediatio nactivities

. Thi s wil l als o serv e a s documentatio nfo r th e purpos eo f assurin g tha t restoratio n activitie s ar e complete dt o th e satisfi&ctionofth eproperty owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA)

.

Propert yID : SCOf f 

### Propert y Address : ^f^ ^ ^ ^ ^ ^ T Owner : "3^.^/ ^ t\ ) 

## Phone: ^9 2 ^ ) •/W^4-W( ^ O nth e attache ddiag[am(s ) indicat earea(s ) t o excavate , surfac estmcture s an dlandscapin g feature s and acces s location(5 ) t o b e use db y th e contractors
. Indicatedistances , depths , material types , etc
. Photographicall y an dVideographicall y documen t th eexistin g condition s ofth eproperty an dth ebasemen t i f necessary . 

## item s t o b e Remove d b yth e Owne rbefor e Start o fRemediation : Th e tenoval

. storafie , di&posal , and/o rretur n o fthes e item s i s th e Owner' s responeibiiity

. 

# V^yv^ K ~^Uv U

Item :
Item :



## item s t o ia e Remove d b yth e Contracto rDurin g Remediatio n an d l^ct Replace d Kem : 

# y y ynj
- ji^y r (~UiM'\in A 

# w Item-^ ^ /
Item :
Item :

Pag e 1 o f'COASTA L 

### Item s t o B e Remove d B yContracto rDurin g Remediatio n an d Replace d item : 

# So dt 

# SoO

- t> { , ^ y item :
Item :
Kem :



## Ite m Pre-existin g propert y area , that wil l b eexcavated , tha t i s covere dwithgrass . 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
. Aiinthnsketc hol th e
• .ri'i'klc i liiNou i Numbe r o f an dsiz eo f eac hgarden / flowe r be d area . All;\thw skL'lci i DI ' rt-Iritivi. ' *i/c s niidloc;iiioM N Agree dupo nvalu eo f plan t material s no t t o b e replace db v contractor
. N'CI c l!ii " \HIII C vvil l ti t USI'L ' 1 0 is;u v . 1 fjlKii ! \oin.;uT , Idlh e|iropcil > o w ner; - Easemen t Area , t o b e excavate d 

## Ljindscap e Inventor y Quantit y Unit Condition/Type/Specie s Quadrant s 

# ^\^ Z

Eac h 

### \ 

# 1 Eac h

Eac h

F ^ h Squar eFee t



### S

Pjich



### Pag e 2 of

.C O AS 1 AL
n h o w'

. IN C



### y Additiona l Comment s / Instructions : 

# ^ 'Z- 3 ^> y Nor\C & B>^^y^ ^^^ ^

[/TChec k th e tx) XifOwne rdoe s no t wan t CE G to documen t interio rfoundatio n walls an d possibl e pre-existin g damage

. Bycheckin g thi s bo xCE G is no t responsibl e fo ran ydamag e don e to th e interio r ofhouse , includin g foundatio n crack s orfissures

. 

# X' Jagre e I l l do no t agre e 

# MJI( J Owner' s Signatur e Date e Sienatur Contractor' s s Signatur e e Date Pag e3 of

## BviD # P)nry-/ q XR F PROPERT Y SAMPL E SHEE T Dat e 

# .^':^-- M Addres s Projec t Omah a Lea d ARR A 

### Sampl e tim e am/p m XR F 1D # 

# -^py??^ ^ sampl e lengt h 3 0 se c Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a 

# 2%C L 'hW^^tt p 

# B
. ^Hk

. 

# ± M ^ ^ ^ 

# .^£ L Dept h 

# a^?

- ^»V /

t ^3^ Dept h 

# ^In^^-^l f 

# dk2 ^ "bfiot'dii ; 

# ^ ^

^W£^' / 7 ^ Averag e ?)9S' ^

; 3 ( ^ Averag e / ^

^ g X > ^-^ ^
Shot # 

# a^a

. .^i i 

# 2a

. Averag e Readin g 

# 3^ik±yb±

_ ^^t^ , 2z/^i ^ Sampl e are a 

# il l Dept h 

# BZ L ^^ ^

^

3(f i Shot #

Averag e Readin g Sampl e are a Dept h

Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h
Averag e Averag e

Shot # Readin g RETES TAREA S Sampl e are a Shot # Readin g Sampl e are a

Averag e 

# y^ ^ ^ 

# y Dept h
Averag e Dept h

Signatur e Prin t 

# MAf6 , H^n v 

# s

# 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 28 3 Mod e SOI L Tim e 2010-05-0 7 14:5 3 Duratio n 90.3 1 Sequenc e Fina l Flag s AVERAG E yg-of-280-282
- ADDRES S 292 8 N 2 5 S t QUADRAN T B 2 DEPT H 6 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

Erro r pp m M o 8.38 9 Z r 16.71 0 S r 9.02 6 U 15.25 5 R b 6.91 7 T h 14.86 7 -Ptr
- 253m } ~Se " A s H g Z n W C u N i C o F e M n 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 QUADRAN T DEPT H TYP E INSPECTO R

M o Z r S r U R b T h P b S e A s H g Z n 

## w C u N i C o Fe M n pp m
< LO D 496.62 3 172.00 8

< LO D 77.64 0 < LO D 379.86 1

< LO D < LO D < LO D 511.84 0

< LO D 86.70 6 < LO D

. 227.36 1 22954.91 2 596.81 0 Supervise d By : 

## Certificat e o fVerificatio n

28 0 SOI L 2010-05-0 7 14:5 2 30.1 0 Fina l 3004 4 292 8 N 2 5 S t B 2 6 " CONFIRMATIO N N

. LOPE Z

Erro r
: 8.51 2 ± 16.73 2 ± 9.18 6

: 15.03 2 ± 7.05 0 J 14.73 5 d k 26.21 4 : 6.59 2 : 34.33 8 ; 13.96 9 ± 37.71 8

; 99.70 0 ± 25.57 3

: 79.68 9 ± 140.38 7 ± 447.29 4 ± 105.99 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 QUADRAN T DEPT H TYP E INSPECTO R

M o Z r S r U R b T h P b S e A s H g Z n 

## w C u N i C o Fe M n pp m
< LO D 502.71 0 165.43 3

< LO D 66.96 4 < LO D 369.44 9

< LO D < LO D < LO D 452.37 9

< LO D 62.59 8 < LO D < LO D 22600.63 9 568.97 4 Supervise d By : 

## Certificat e o fVerificatio n

28 1 SOI L 2010-05-0 7 14:5 2 30.1 0 Fina l 3004 4 292 8 N 2 5 S t B 2 6 " CONFIRMATIO N N

. LOPE Z

Erro r
: 8.36 4 ± 16.67 6 ± 8.95 5

: 15.02 2 ± 6.63 0 \ 14.71 5 ± 25.65 2

: 6.20 1 : 32.64 4 : 14.70 0 ± 35.40 5

: 100.59 3 ± 23.71 2

: 77.69 2 : 204.14 8 ± 440.47 2 ± 103.55 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 QUADRAN T DEPT H TYP E INSPECTO R

M o Z r S r U R b T h P b S e A s H g Z n W C u N i C o F e M n pp m
< LO D 498.97 6 162.44 7

< LO D 76.53 2 < LO D 376.45 7

< LO D < LO D < LO D 456.29 1

< LO D 60.14 7 < LO D < LO D 22455.84 8 582.90 3 Supervise d By : 

## Certificat e o fVerificatio n

28 2 SOI L 2010-05-0 7 14:5 3 30.1 1 Fina l 3004 4 292 8 N 2 5 s t B 2 6 " CONFIRMATIO N N

. LOPE Z

Erro r ; 8.29 1 ± 16.72 1 ± 8.93 6

: 15.71 0 ± 7.07 0

I 15.15 2 ± 26.07 4

: 6.16 5 ; 33.40 6 : 13.38 1 ± 35.51 6

• 89.37 4 ± 23.65 8

I 79.61 2 I 205.19 1 ± 441.74 8 ± 104.18 8

# 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 27 5 Mod e SOI L 

### Tim e 2010-05-0 7 14:4 5 Duratio n 

### 90.3 2 Sequenc e Fina l Flag s AVERAG E :^ygJb£-27-2=27-4 - ADDRES S ^^92 8 N 2 5 s t QUADRAN T B l DEPT H 

### 13 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D ; 8.39 2 Z r 449.45 1 ± 16.29 9 S r 173.05 0 ± 9.34 2 U < LO D : 15.95 1 R b 74.56 5 ± 7.14 2 T h < : LOD
- . • 19.19 2 CsPti— " 726.48 2 ± 36.28 3 ->

S e < LO D : 7.45 5 A s < LO D : 46.97 1 H g < LO D ; 14.40 0 Z n 640.82 9 ± 42.56 7 W < LO D ; 103:63 ^ C u 256.65 7 ± ^ 

# ^'ysy i N i < LO D 

# ^ y y.i\ 2 C o < LO D

. /^21.35 0 F e 25566.79 1 X : l 477.63 5 

# y : ^y M n 628.293 / • ^ 110.49 6 

# y
ise d By : y^ j Super v

# 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 QUADRAN T DEPT H TYP E INSPECTO R

M o Z r S r U R b T h P b S e A s H g Z n W C u N i C o F e M n pp m
< LO D 458.78 6 176.68 4

< LO D 75.14 6 22.49 9 735.64 9

< LO D < LO D < LO D 632.13 1

< LO D 174.14 8

< LO D < LO D 26529.21 7 620.77 7 Supervise d By : 

## Certificat e o fVerificatio n

27 2 SOI L 2010-05-0 7 14:4 4 30.1 1 Fina l 3004 4 292 8 N 2 5 S t B l 13 " CONFIRMATIO N N

. LOPE Z

Erro r ; 8.44 7 ± 16.47 9 ± 9.44 3

: 15.50 3 ± 7.12 3 ± 13.14 3 ± 36.54 5 7.19 9 47.56 2 14.32 5 ± 42.27 0

: 103.30 7 ± 31.19 8

: 78.09 5 : 224.// / ± 486.98 3 ± 110.45 5

# 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 Dut'atio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPT H TYP E INSPECTO R

M o Z r S r U R b T h P b S e A s H g Z n W C u N i C o F e M n pp m
< LO D 446.03 7 174.67 3

< LO D 74.99 6 < LO D 727.30 0

< LO D < LO D < LO D 664.75 5

< LO D 345.75 9

< LO D < LO D 25707.14 8 617.89 8 Supervise d By : 

## Certificat e o fVerificatio n

27 3 SOI L 2010-05-0 7 14:4 4 30.1 0 Fina l 3004 4 292 8 N 2 5 s t B l 13 " CONFIRMATIO N N

. LOPE Z

Erro r
: 8.47 9 ± 16.32 6 ± 9.42 4

: 16.39 6 ± 7.23 3

: 19.02 7 ± 36.49 4

: 7.89 9 I 46.78 0 : 14.58 5 ± 43.65 6

: 109.27 7 ± 39.72 8

: 80.91 2 : 222.27 5 ± 481.28 9 ± 110.57 1

# 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 QUADRAN T DEPT H TYP E INSPECTO R

M o Z r S r U R b T h P b S e A s H g Z n W C u N i C o F e M n pp m
< LO D 443.52 8 167.79 4

< LO D 73.55 3 < LO D 715.59 9

< LO D < LO D < LO D 625.60 2

< LO D 250.06 4

< LO D < LO D 24464.01 2 646.20 4 Supervise d By : 

## Certificat e o fVerificatio n

27 4 SOI L 2010-05-0 7 14:4 5 30.1 1 Fina l 3004 4 292 8 N 2 5 S t B l 13 " CONFIRMATIO N N

. LOPE Z

Erro r I 8.24 9 ± 16.09 3 ± 9.15 8

: 15.95 3 ± 7.06 9

: 18.83 3 ± 35.81 1

I 7.26 8 \ 46.57 1 ; 14.29 1 ± 41.77 5 J 98.29 4 ± 34.76 9

; 77.13 1 ; 216.99 7 ± 464.63 1 ± 110.46 1

# 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 

### 27 9 Mod e SOI L Tim e 

### 2010-05-0 7 14:4 8 Duratio n 

### 90.3 3 Sequenc e Fina l Flag s AVERAG E FSfc278— ^ ADDRES S 2 8 N 2 5 s t QUADRAN T E A DEPT H 1 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z

pp m Erro r M o < LO D : 7.79 2 Z r 339.34 5 ± 13.87 0 S r 196.72 3 ± 9.45 4 U < LO D : 14.32 8 R b 64.36 9 ± 6.31 8 T h < LO D : 12.43 9 237:51 7 ± 207333

. 

## C2b__

_ Se
- < LO D : '5:886 ' A s < LO D : 26.73 1 H g < LO D ' 12.47 2 Z n 231.17 9 ± 25.31 7 W < LO D -—T83.47 5 C u 47.43 4 y21.56 3 N i < LO D / / 74.15 8 

# y: C o < LOD / 188.73 5 F e 20640.285 ^ 410.19 3 

# y ± 

# y M n 443.07 2 y 91.58 9 

# 1 y ^ '

— 

# 'y ^ Supervise d By : x- ^

# 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 27 6 Mod e SOI L Tim e 2010-05-0 7 14:4 7 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D 3004 4 ADDRES S 292 8 N 2 5 s t QUADRAN T E A DEPT H 1 " TYP E CONFIRMATIO N INSPECTO R N

. LOPE Z



### pp m Erro r M

o < LO D : 7.83 1 Z r 347.94 3 

### ± 13.89 1 S r 188.47 9 

### ± 9.21 1 U < LO D : 14.13 0 R

b 63.86 1 

### ± 6.24 5 Th < LO D : 11.91 0 Pb 227.16 2 

### ± 19.79 9 S e < LO D • 5.98 6 A s < LO D • 26.00 9 H

g < LO D ; 13.01 1 Zn 213.48 3 

### ± 24.36 8 W < LO D I 

### 84.51 0 Cu 44.75 7 d b 

### 21.24 5 N

i < LO D : 73.98 2 C o < LO D : 186.11 9 Fe 20830.85 9 

### ± 409.62 8 M

n 463.72 7 

### ± 92.65 9 Supervise dBy :

# 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 QUADRAN T DEPT H TYP E INSPECTO R

M o Z r S r U R b T h P b S e A s H g Z n W C u N i C o F e M n pp m
< LO D 334.63 9 199.67 7

< LO D 65.36 4 15.35 6 241.29 3

< LO D 29.96 4 < LO D 233.66 0

< LO D 60.82 0 < LO D < LO D 20657.78 5 385.52 9 Supervise d By : 

## Certificat e o fVerificatio n

27 7 SOI L 2010-05-0 7 14:4 7 30.1 1 Fina l 3004 4 292 8 N 2 5 s t E A 1 " CONFIRMATIO N N

. LOPE Z

Erro r \ 7.80 4 ± 13.87 7 ± 9.55 9

: 13.97 4 ± 6.34 1 ± 8.85 1 ± 20.59 1

; 5.88 2 ± 18.32 0

: 12.11 7 ± 25.54 4

: 83.33 1 ± 22.63 1

: 74.21 2 : 189.28 1 ± 412.03 5 ± 88.18 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 QUADRAN T DEPT H TYP E INSPECTO R

M o Z r S r U R b T h P b S e A s H g Z n W C u N i C o F e M n pp m
< LO D 335.45 1 202.01 1

< LO D 63.88 2 < LO D 244.09 6

< LO D < LO D < LO D 246.39 4

< LO D 36.72 5 < LO D < LO D 20432.21 1 479.95 9 Supervise d By : 

## Certificat e o fVerificatio n

27 8 SOI L 2010-05-0 7 14:4 8 30.1 1 Fina l 3004 4 292 8 N 2 5 S t E A 1 " CONFIRMATIO N N

. LOPE Z

Erro r
: 7.74 2 ± 13.84 1 ± 9.59 1

: 14.88 1 ± 6.36 8

: 12.12 9 ± 20.60 9 5.79 0 : 26.70 5 : 12.28 6 ± 26.03 9

: 82.58 5 ± 20.81 3

: 74.27 9 : 190.80 5 ± 408.91 5 ± 93.92 5.*•'*"'''>

. 

## f^A ^

\

Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 I ^^^ ^

I ^

­ j ^ '^tPBoT*^ " 

### Coasta l Environmenta l Grou p Inc

. vvvvw.coastalhazmat.co m v l
COASTA L •NVIIONHCHTA L clo u r , IN C 

# EXECUTIV ESUMMARY : BVID #30044-(292 8 N2 5 ST )
No Issue s o r Concern s Q Issues/Concern s
Detail Explanation :

# EP APropert y Clos e Ou t For m 

# S S ^ Propert y #:.200^i£L x Propert y 

### Date/Time ; Owner ' 

### Qiifldi Excavated : Contracto r 

# TTT ^ Ye s N o Eicavatto nCenera l I
.I f necessaiy , wer eth ecorrec t quadrant(s ) excavate dan drestored ? 

## 0 - '
2

.I f necessary , wer eth econec i area s o f dri p zon eexcavate dan drestored ? Yes No GradJD K So daw dVegetatio B 1

.Doe s th egnulin g aroun dth eperimele r ofth ehous e inexcavate darea s generall y slop e away fromth ehouse ? 2

.Ha s so dbee nlai dfai al l area s that wer eexcavated ? 3

.Doe s th eso dappea r t o b egenerall y health y an dgrowing ? (Onl y evaluat ei f inspecte da t a3 0 da y tim eperiod ) 4

.Ar esodde darea s genet«ll y firman devenl y graded ? 

# y 5

.

Ar eth eJoint s betwee nth eso dstrip s generall y tight ? (Onl y evaluat ei f inspecte da t a3 0 day tim eperiod ) 

# y 6
.Wa s th eproperty grade dsuc hthat wate r wil l not poo l onth e propeny' ' 

### t^- ^ 7
.

Wa s damag et o landscapin g o r plan t maierial s avoided ? i^ ^
Gates , Fence s an dRetnfailn g Wall s Ye s N o I1

. D o gate s openan dclos efreely? (I f applicable ) Wer eal l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (If applicable ) 3

. Wa s damag et o gate s o r fence s avoided ? (I f applicable ) 

### ( / ^ A

. Wa s damagiet o retainin g wall s avoided ? (I f applicable ) 

# t/^ Foupdatloa , SldUi K

an dGatlef s Ye s N o I
.Wa s damag et o tlt t sidui g o r tri mavoided ? 2

.Wa s damag et o th efoundatio navoided ? ^ ^ Wa s damag et o window s avoided ? AWa s damag eT O window s o r doo r screen s avoided ? 

# y_ S

.Wa s damag et o downspout s o r downspou t extension s avoided ? 

### 1 / Sidewalk s an dDriveway s (Concrete ) Ye s N o I
.Wa s damag et o drivewa y surface s avoided ? 

# y 2 ,

Wa s damag et o walkwa y surface s avoided ? 

# ly ^

## OM'oer s comments :

lln.spectio nnotes :

Removal andrestoratio nactivate s complel e includin g the 30-da y so dwarranty : EP ARepresentativ e 

# T UULo...i(JrLl^^ y

# Propert yCompletio n Agreemen t
Thi s agreemen t documenl s lh e completio n o l remedia l acliviue s perloime d o n mypropertyM ysignature wil l designat e ihat I a m satisfie d wil h th e restoraiio n o fm ypropeily

. an d tha t n o item s ar e i n questions , now , o ra t an ytim e i n th e future , except thos e item s liste d below , i fan y PropertylD : rj^^/L ^ Propert yAddress : ;7^2.f ^ A / 2J>

. ^S^ ^ 

# Q""^' = Mr^rl O V\\lY\r \ 

# i::^! : ^oi-57/-^b-i( ^ Restoratio n Item s i n Question :

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

Jr \ I agre e rcttoralio n \ s complcled , excep t a s note d [_ J I d o no t «i;re crestoratio n i s rompleter i

OwnW' s Signatiir e J J Dat e Contrarlor' s Signamr e Dal e

# Propert y Owne r Assessment of Performanc efmfS/ ^ America nRecover y an dReinvestmen t Act (ARRA) ^ K J^ OmahaLea dSuperfun dSit e^p ^ 2009/201 0 „ ^^9 % 

# SUP t Remediatio nContractor : Coasta l Environmenta l Grou p - EP-R7-09-0 6 ^'y U Propert y Identifie r Number : 5on*A ^ '-^/O/j / Propert y Address : Z<^ ^9
. k ) 2F S '^ ^ Propert y Owner' s Name : \Jnr\n\/\\\i)f\V\
Instruction s t o th ePropert y Owner ; Thi s for mserve s t o recor dth eProperty Owner' s assessmen t o f performanc e(hicentiv e1

- Quality Assuranc eSurveillanc ePlan ) involvin g th eliste dremediatio ncontractor , a s applicabl e t o th eOmah aLeadSite

. Thi s for mdocument s th etimelines s o f punc hlis t resolution , busines s relations , complain t resolutio nan dth eoveral l quality o f work

. I f nee dbe , th eProperty Owner ma y utiliz ethi s for mt o recor dproblem s and/o r issue s no t specificall y tie dt o a nassigne d address , fo r example , busines s relation s that generall y don' t follo w th e guideline s set fort hi nth e Performanc eWork Statement

. Th eProperty Owne r wil l indicatehis/he r assessmen t o f performanc ewithth e contractor' s work b y checkin g anumerica l ratin g o nth etabl ebelo w usin g th e ntmierical definition s from th eratin g scal ebelow , the nsig n& dat eth eform

. 9-1 0 "excellent " 7- 8 "very good " 5- 6 "acceptable " 3- 4

. "poor " 1-

2 "very poor " Propert y Owner' s Assessmen t o f Performanc eRegardin g th eContractor' s Wor k 1 0 ^ 5 8 3 7 2 6 1 Propert y Owne r Additiona l Comment s fro m(optional ; continu e o nbac k pag ei f needed )

Propert y Owne r Signature : yi/l y^lyh^"^ ^ _Date : ^y^ly^l' ^