### TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAID# : Qf)^l< , Date : ^//R/c/ y Address : ?,c^\ hSPU^VT i ?^ l Remediatio nContractor : Coasta l Environmenta l Group

_Year : 200 8
SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S y y M y /Sift

y y y y 0 y ^ [ y l ^

s y y ^

Vide o o f property (DVD ) Executiv e Summary

EPA-provide dproperty sketc h 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 to replac e plants , etc. ) Confirmatio ndat a Photograph s Or^'fy^ryiJaJlLD^ j AJi^_^j)/tkiffl ^ .fid ^ As-buil t sketc h 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 Utility clearance s Property informatio nfro mDougla s County Assessor' s Offic e Sa d

D 

### S ^ CMJcQyA ^ -Wvt/v- ^

Signat u 'Dat e Ignature0 

### Propert yAcces s Checklis t Propert y ID : 2-^3 ^ " 7 ^ Propert y Address : ^^,P ^ 

### Owner : C: , ^^c , 1 d \ n i ' Address :


### Phone : Cb^ 5 - b2Cl? i F«x : Cell/Pager
.
D Notificatio nLette r

Acces s Agreemen l

• Restoratio nAgreemen t O Topsoi l Samplin g (i f applicuble ) C

D Disposi U Samplin g (i f applicable ) O GnrUc nSamplin g (i f applicable ) ffl. Utility Clearanc e li l Video/Phofo s (Before ) D Video/Photo s (During ) nVideo/Photo s (After ) D Video/Photo s (30-Day ) 1 1 Propert y Completio nAgreemen t D Fina l Repor t Ai r Monitorin K (a s applicabl e ) nCommunit y D Cre w On : RcsuJts : D Community ' Q Cre w 

### On : Results :

• Communit y D Cre w On : Results : C^p^^^^^S T 

### Yo»'^o^ \ J D D

WOR K STARTE D WOR K COMPELTE D ON : ON : / / /_ /
_ Rente r Phone : FiL\ : Cell/Pager : Additiona l Intormation :

Sent : / / 

### Signed : JL / ZV/O^ ) Signed : / / /V- t /O ^ 

### / / / / / / Called : i|_/2^/LJ ^



### On:JL/iii/a l On : On : On : Signed : Issued :
/ /


### / /

/ / / / / / / /

/ / / /

By : By : By : By : By : 

# ^ - C By : 

### £.( L By : By : By : By : 

### i7./n)/o ^ By : 

### KJ\0\ C /BriQ h By : By : By : By : By :

Omah a Lea d Sit e

### Propen yI D ^ Propert y Addres s Initia l Contaci : Secon d Conlact : Fina l Conlact : Fina l Aclion :

Commen t 0\vne r Cc^mmen t is ]
Sit e Coordinato r Commen i (s ! CONTAC I FOR M
eP^'^H ^

^ 

## < S.V
. Dat e

_Time : Aclion : Dale : Time : Action : Dal e Time ; Aclion ; Trans m t t o EP AD Othe rAction : D

### Dougla s County Accoun t Infonmtio n Pag e 1 of 2 )j|m t
Dougla s County , Nebrask a Propert yRecor d - R164135000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f90t h S t - Vle WO P Ma p Informatio n i s vali d a s o f2008-1 1 - 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 PropertyInformatio n Ke yNumber : 

### 413 5 000 0 1 6 Accoun t Type : Residentia l Parce l Number : 

### 164135000 0 Parce l Address : Lega l Description : 351 0 SEWAR D S T OMAH AN E 68111-000 0 LOWE S AD D LO T1 1 BLOC KP E 4 0 F T4 0 X 13 2 Valu e Informatio n
200 8 200 7 200 6 200 5 200 4 200 3 Lan d $2,400.0 0 $2,400.0 0 $2,400.0 0 $2,400.0 0 $2,400.0 0 $2,400.0 0 Improvemen t $46,900.0 0 $46,900.0 0 $46,900.0 0 $46,900.0 0 

### $17,800.0 0 $17,800.0 0 Tota l $49,300.0 0 $49,300.0 0 $49,300.0 0 $49,300.0 0 $20,200.0 0 $20,200.0 0 Lan d Informatio n Acre s 

### 0.1 2 S F 5280. 0 Unit s 

### 1. 0 Dept h 

### 132. 0 Widt h 40. 0 Vacan t N o Improvement Informatio n Buildin g 1



### http://douglasne.mapping-online.eom/DouglasCoNe/static/accountinfo. j sp?accountno= R1..
. 1 1 /24/200 8

### Dougla s County Accoun t Infoij^tio n Pag e 2 of 2 »a|^ t

351 0 SEAAR O S T

O D i i
i SC r't«fta * no fMf f » v

I 1 0 STOR YFWI91E D

CLIC KTO ENLARG E IMAG E Squar e Footage : 

### 1142. 0 Percen t Complete : 

### 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Fai r

Buil t As : 1 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 5. 0 Exterior : Fram e Sidin g Units : 

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

### 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 3. 0

Roo fType : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 yea rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 190 0 0 0 % 190 0 

### 10 8 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Unfinishe d Atti cW/floo r 960. 0 Applianc e Allowanc e 

### 1. 0 Applianc e Allowanc e 

### 1. 0 Basemen t Bsmn t Bloc k 8 f t 840. 0 Fixtur e Bas e Fixture s 

### 1. 0 Fixtur e Bat h Ful l 

### 1. 0 Garag e Detache d 480. 0 Porc h Sla b Roo fCei l 

### 168. 0 Use r NE WROO F 3R D B R O N 2N D F L 

### 1. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl.
. . 11/24/200 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 2181426
. Origina l Cal l Date : 11/24/0 8 Wor k t o Begi n Date : 12/01/0 8 Time : Time : 8:5 2 p m 7:1 5 a m Op : ELIZABETH18 7 9 0
State : N E Address : 351 0 County : DOUGLA S Street : SEWAR D S T Place : OMAH A Twp : 15 N Twp : Rng : 13 E Rng : Sect-Qtr : 16-NW,17-N E Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n Locatio n o f Work : LOCAT E ENTIR E PROPERT Y INCLUDIN G HOUS E AL L TH E WA Y T O TH E : STREET . Remarks : FAX AL L CLEAR S TO : (877)662-421 1 Compan y: COASTA L ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : coasta l Dept h o f Excavation : 4f t Corne r Lot : NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V LEVEL S MCLEODN E MUDO l OMAHACO F OPPDGPR S 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 Alt : 402934046 9 Emerg : 402932975 7

LEVEL 3 LEVEL 3 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=<RESULT.
. . 11/24/200 8

### Pag e 2 of 2

CIT Y O FOMAHA

- OMAHACO F RO N TRAFFICSEWE R

OPPDGPR S gj^^^^^^^''^'°'^^ ^ N A

QLNNEIC QWES T LOCA LNETWOR K

N A 

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

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.
. . 1 1 /24/200 8

# As-Buil t Drawin g C O AST AL 

# Omah aLea dSuperfun dSit e ENVIRONMENTA L GROUP , INC
.

Name : QeTaV^fyv g '^' ^ * • Omah a Lea d Sit e Date : t^fa-XI-ta; ^ Nort h AfTo w —1 Address : "j-gic i c;«'«>ScMrf A%\ - Sit e Sicetc h Time : \:n a arr ^ Phone : t^n1. ~ <5S-i ^ MClg ? 

# 1 ? « 0 (vvjccciH ; Tea m C^r.ol A( <^V^/^Lt.^^r
. BVID#_2_59_rLS - XR F Cod e S'^0 \ Sampl e Numbe r Lea d Concentratio n Confimnatio n Sampl e ^^Am>x/ \ - zy f 75- ­ pp m p,Ye s n N o ^ pp m t^ye s a N o 9S I pp m ft,Yes • N o g pp m 

### ares a N o g pp m N o ? 3 pp m Ye s n N o • pp m Ye s n N o •

OLS# : 2597 S feate Excavated : 121/6/200 $ Dat 0 USEP ASigne d Off : 1/27/200 8

. i Are a [Sodde d 244gsqft i

B 2 = 3 8 PP M @ 6 " B l = 6 3 PP M (

D Z = 380PPM@13 "
F 2 = 4 2 PP M @ 6 "

EA=170PPM(ai "

Omah a Lea d Sit e 4613 0



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

### Name : C|eTaV«^ f|^ e '^feoN O L Omah a Lea d Sit e Date : fb^-\n-6' ^ Nort h Arro w 

### Address : -ggsv o cu»V)CMr A % ^ Sit e Sitetc h Time : _LlQajQJ n Phone : f^n'i. ^ g^t - t,'LC{ ^ 

# I

9 « D iVVjcocvX t Tea m C|ftol/ A( <^Vv/gJlVUe i BVID # Sampl e Numbe r k^^lL^CpX A­ (?)l't > *>^PX. R " 

### 2y*-/S - tS-TVS - /eD^S^rPxA - 2S^^7 r 2 ^^Q n C Lea d Concentratio 

### o n pp m pp m pp m pp m pp m pp m pp m XR F Cod e S"SO \ Confirmatio n Sampl e p,Ye s n t^e s n ft,Yes n 

# a^e s 

# n l^te s CD Yes n Ye s • No ?l No 9D No g 

# No g No ^ No a No • 2,


### rs 

# i 

# .|a.l.lfti;.i i

0 

# S 

# 1
0^ 

# 4

j *_J ^ ^ /• ^^^ / I i t / \ J -L j i
# 1 iicoCtz L OmahaLea dSite 4613 0

### Name : CieYaV«A fr> e VooN q L Omah a Lea d Sit e Date : r>^-\n-fe' ^ Nort h Arro w 

### Address : 'a.g5\c » <i^^ojr A% V Sit e Si^etc h Time : \'.n Q pT n Phone : Ai»rL - tS^-^ ^ (.. l tu e 

# 1

9 S 0 (WJOOCC^ C 

### Tea m C^ts^ \ A( <^Vv^gJLM ^ BV1D # 2 5 ^

-\' 5 XR F Cod e S"SO l Sampl e Numbe r Lea d Concentratio n Confirmatio n Sampl e ^?A5£PX A-2s-f75 ­ pyHi.cf'X A ­ 7-«r»-ry

R'}^t^<,cpxt ^ ­ •Zj^f-r S 1^*^^' ^ 

### fc?7t z v pp m pp m pp m P,Ye s ^jYe s ^,Ye s 1= 1 n n pp m pp m pp m Ye s n pp m Ye s • 

## 1 1 

# l l I i ii
. j-^e— ^ 

# -U

- SVv*- ^ 

# 7 i6'7 7 

# m , f qoiit - i z I 3 -^ft-«= ­ ' > i 6 

## V- 

# u te^ 0 ^ . - t b- 2 i/4'5 1 i^^ ^ 

# ; [ 

# S\o \ ^ 

# ^H""'* ^ I ; L -i)„?f c it>2
. TM



# r T : \^*? > l l

- \


### 4T<i f UiU^ D 

# 1 1
I i %\6e
. 

### S€ f^*^*"* ^ 

# S V wpc^^Ai
. " ;



# 1
Omah aLea dSit e 4613 0

### y^* * 

# m COASTA L ENVIKONntNTA l 

### %,« ^ C • O U '
. IM 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 : (^ev^cOs^vv\J L Daytim e Phone : 

## SS I ~(pff<ff i ^ Addres s o fPropert y covere d b ythi s Agreement : 

# cfb\ ^

%eju-^o~yC ^

% t
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 that contain s elevate d concentration s o f lea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t o remov e contaminate d soil
. Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o it s origina l condition
. Thi s wor k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o f Coasta l Environmenta l Group , contracte d byUSEPA , wil l 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 opportunityt o revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e i t begins
. Onc e th e wor k i s finished , th e Granto rwil l b e aske d t o revie wth e wor k an d confir m tha t i t i s complet e an d meet s wit h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m EP Atha t th e property ha s bee n remediated
. ENVIRONMENTA L RESPONS E ACTION S 

### Bysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , it s employees , contractors an d subcontractors th e righ t t o ente rth e property , a t al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e o f performin g th e work
. Thi s acces s shal l remai n I n effect unti l th e wor k has bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :

Pag e 1 o f2COASTA L INVIflOfinfNTA L cI o u r , IM C



### •Remove obstruction s Includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; •Remove flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t ma ywis h t o save ; • Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessar ysubsequen t t o a n initia l waterin g perio d byEPA ; •Abid e b yhealt h an d safetyguidanc e provide d b yEPA ; •I fth e propertyi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propertyt o perfor m th e work
. •Allo wvideotapin g and/o rphotographin g ofth e property
. AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s not t o interfer e o rtampe rwit h an yo fth e wor k activities , o rwit h an y ofth e wor k done , o rwit h th e equipmen t use d o n hi s property , o rt o undertake an y action s regardin g th e us e o fsai d propertywhic h woul d ten d t o endange rth e healt h o r welfar e ofth e Grantee s o rth e environment , o rt o allo wothers t o us e th e propertyi n suc h a manner . Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contac t Coasta l Environmenta l Group , at (712 ) 352-018 8 

# 1 ° 'gran t acces s t o m ypropertie s D I d o no t gran t acces s t o m ypropertie s

Signatur e Signa l afur e Dat e

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

## Restoratio n Agreemen t Th e purpos e ofthi s agreemen t i s t o provid e amutua l agreement as t o condition s of the propert y prio r t

o remediatio nactivities
. Thi s wil l 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 nof th e propertv ' owne r an dth e UnitedState s Environmenta l Protectio nAgenc y (EPA)
. Propert y ID : Qe^qq^ ^ Propert y Address : 5^> ^ ^ ^ ^ ^^^ ^ r rj ^ ^^ , . Owner : (:^ ^ ^^^3^^^^^, ^ ^^ ^ ^ Phone : c-r- ? - / TO O 

# ^T 3 -^;?9 e 0
O

nthe attacheddiagram(s ) indicat e area(s ) t o excavatedan ddept hof excavation , locationo f al l know n utilities , subsurface features , syrface structure s an dlandscaping features , acces s location(s ) t o be use db y contractor , an dth e directionof 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 directionof view
. Item s T o B e Remove d B yOwne rBefor e Star t 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 : / 

### y Item : 

### Item : 

# z : 7 Pag e i o fU ?COASTA L C AD WP
. IN C 

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

# Atic j ^'^hr^ s Hem : Ite m Item : Item : Item : Item : Item : Item : Item : Hem : Item : Item : Item : Hem ;

Pag e 2 

# o\Ap
_COASTA L C M O U rIN C 

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

# .<;^,/

- F-. a-Kl~fl2- b Item : 

# yy^'F^-RZ-I^l-O ^ Item : 

# Pf^n4 s fCTr-e<.ns ) Item :
Item :
Item :
Item :
Item :
Item :
Item :
Item :
Item :
Item :
Item :
Item :

Pag e 3 of_ ^COASTA L



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

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

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

Number of tree s > 2 inc h trunk diameter Eac h

Numbe r of tree s < = 2 inc h trxin k

diameter Eac h

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

Number o f an dsize of eac hgarden / flowe r bed area . Attachasketcho f relativ e size s an dlocations
. 

# ? Eac h Squar e Fee t 

### 'T o })• €

d'£.T^t^/yitnet /

Pag e 4 of
_- • - *» •

COASTA L 

## Ite m Agree dupo nvalu e o f Dlan t material s not to be replace dbv contractor . Note thi s valu e will b e usedto issu e aplan t vouche r to the propert y owner . Agree duponlist of plan t material s tha t will b e replace db y conrractor . B e ver y specifi c an ddetailed
. Include asketchof wer e eachplan t wil l b e placed b

y the contractor . Agree dupo nare aof propert y t o be replace d wit hgras s sod
. Include asketchof the area(s ) to b e replacedwit h gras s sod
.
Are ao f Cit y o r Count y propert y to be landscaped per their requirements
. Include asketcho f the aie a(s )

Easement Area , t o be excavate d 

## Quantity Urii t Condition/Type/Specie s

r 

## ^OO.^' ^ 

# T o b e ot^e^ c /H t

>-i^ ^ 

# f
. Each



# D5 : S F

/ S F 

# is'^ S F 

# ~r ^ 'o e d<2riQ<n \n^ ^

Pag e 5 of^C O AS T AL
• MVItkOKHCMTA L



### Q Chec k th e boxi fOwne rdoe s no t wan t CE G t o documerr t interio rfoundatio n wall s an d possibl e pre-existin g damage
. Bycheckin g Bii s boxCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro fhouse , indudin g foundation crack s o rfissures
.



### • I do not agre e

>ivner' s Sigoatur e / / DattP- , ' Contractc^ s Signatnr e Dat e 

### PageSof
.

### BVlD#c36^"7f r XR F PROPERT YSAMPL E SHEE T Dal e 

### \Q-i.-^- ^ Addres s .^f^||-- > Sf i yDCx^r\\4:
. Projec t Omati a lea d F P 2n a yea ropiio n Sampl e tim e am/p m 

## ii-g ^ XR F ID # sampl e lengt h 

### 3 0 se c 

# ,^^og^ , z r Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a ^8lD ^ ;^,^.~IH i iq-X D <^.^1 Q U 3
. .^ ^ tq-o a 

## F'Q ^^(oP > n s .«ct t u . 3 0 ft*^^"" A«'7.2 ; J T.>¥= > t - I ;^ q 

### ^AP^i^ H iu « if.^i
. Ki-;^? , Dept h 

### ^.B-? 4 .^T.^at «T 4 Dept h 

## ^Bio H Kv<^.^ t |-I.$ 3 1 

## HBl- ^ f,^.;.,F , "- vO..; > 

### O Averag e |^0
. ^'^ M J : l,(_ff.n ^ Averag e 4- ^ •;3 ^ t R Q U
Sho t # Readin g Sampl e are a Shot # Readin g Sampl e are a ^«TT .'., ; ,-^i^ ^ U-S- H 

## ^<^B 7 ..jt^r- , ..L-.^iq
. .ci- N ^4A-7 ^ (.o.l^^ i u.eQS - 

# ?> ! ^^:^B 8 ^T?s.-7Pt.l^.7 ^ 

# ti ^ Dept h ^/^-T ^ •^u-^^i , t lo.'^t ^ 

# 4 g ^ ^.c i • q q t .y.n ^ rDept h 

### ^fiB D - , 7.o^'--IO.O T (t ? 

### '^gy^t ^ k-.^.f>fei:--.!.>: : .22
_ Averag e (g ^ r^i i l \ .p ^ Averag e .^^^ H .€S^ , t <^.^
. ^< , Shot * Readin g Sampl e are a Shot* ' Readin g Sampl e are a '^g'^i © ^.-S.MH t 8? ^ ^ o u i
. ^
. O 

# & Q ^m. ^ 4.iiv<i, \ t
. '^i.af \ Dept h 

## AR^ a Dept h

^P^ct' ^ ^ 1 m^
. 8 7H - ( P

Averag e .^8.^ ^ t , 8 • " ^ A Averag e

RETES TAREA S Shot # Readin g Sampl e are a Sho1 # Readin g Sampl e are a Dept h Dept h Averag e Averag e la b sampl e M La b resul t Sampl e are a XR F Avg
. Signature , 

### Print yyf <^g > l< ^ 5 10/?( ^

# 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 142.79 1 Supervise d By : 

## Certificat e o fVerificatio n

486 7 SOI L 

### 2008-12-0 6 11:4 5 30.5 8 Fina l 

### 2597 5 351 0 sew^ar d easemen t Ventr y 

### 1 CLEARANC E

± 

### Erro r ± 

### 14.80 3

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

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

pp m P b 175.88 7 Supervise d By : 

## Certificat e o fVerificatio n

486 8 SOI L 

### 2008-12-0 6 11:4 6 30.4 8 Fina l 

### 2597 5 351 0 sewar d easemen t Ventr y 

### 1 CLEARANC E

± Erro r 

### ± 16.20 4

# 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 168.78 4 Supervise d By : 

## Certificat e o fVerificatio n

486 9 SOI L 

### 2008-12-0 6 11:4 7 30.7 9 Fina l 

### 2597 5 351 0 sew/ar d easemen t Ventr y 

### 1 CLEARANC E

± 

### Erro r ± 

### 15.82 9

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

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



### pp m P b 

### 195.25 1 Supervise d By : 

## Certificat e o fVerificatio n

487 0 SOI L 

### 2008-12-0 6 11:4 7 31.3 4 Fina l 

### 2597 5 351 0 sewar d easemen t Ventr y 

### 1 CLEARANC E

± Erro r
± 17.22 2

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1 

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 

### 487 1 Mod e SOI L Tim e 

### 2008-12-0 6 11:4 7 Duratio n 

### 123.1 9 Sequenc e Fina l Flag s AVERAG E Av g o f4867-487 0 ADDRES S 351 0 sewar d 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 170.67 8 ± 16.01 5 Supervise d By :

# 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 42.34 5 Supervise d By : 

## Certificat e o fVerificatio n

487 2 SOI L 

### 2008-12-0 6 11:4 8 30.5 1 Fina l 

### 2597 5 351 0 sewar d F 2 Ventr y 6 CLEARANC E

± Erro r ± 9.01 9

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

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

pp m P b 27.88 4 Supervise d By : 

## Certificat e o fVerificatio n

487 3 SOI L 

### 2008-12-0 6 11:4 9 36.0 9 Fina l 

### 2597 5 351 0 sewar d F 2 Ventr y 6 CLEARANC E

±Erro r ±7.88 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 39.92 1 Supervise d By : 

## Certificat e o fVerificatio n

487 4 SOI L 

### 2008-12-0 6 11:5 0 30.0 9 Fina l 

### 2597 5 351 0 sewar d F 2 Ventr y 6 CLEARANC E

± Erro r
± 8.73 9

# 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 487 5 Mod e SOI L Tim e 2008-12-0 6 11:5 0 Duratio n 30.4 6 Sequenc e Fina l Flag s BVI D # 2597 5 ADDRES S 351 0 sewar d QUAD/ZON E F 2 INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 58.68 1 ±10.09 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 487 6 Mod e SOI L Tim e 

### 2008-12-0 6 11:5 0 Duratio n 

### 127.1 5 Sequenc e Fina l Flag s AVERAG E Av g o f4872-4875
_ ADDRES S 351 0 sewar d QUAD/ZON E |F 2 INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E ' CLEARANC E NOT E

P b Supervise d B y

# 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 66.02 9 Supervise d By : 

## Certificat e o fVerificatio n

487 7 SOI L 

### 2008-12-0 6 11:5 1 30.6 7 Fina l 

### 2597 5 351 0 sewar d B l Ventr y 6 CLEARANC E

± Erro r 

### ± 11.84 3

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

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

pp m P b 62.19 0 Supervise d By : 

## Certificat e o fVerificatio n

487 8 SOI L 

### 2008-12-0 6 11:5 2 30.7 3 Fina l 

### 2597 5 351 0 sewar d B l Ventr y 6 CLEARANC E

± Erro r ± 11.24 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 

### 487 9 Mod e SOI L Tim e 

### 2008-12-0 6 11:5 3 Duratio n 

### 30.8 9 Sequenc e 

### Fina l Flag s BVI D # 

### 2597 5 ADDRES S 351 0 sewar d QUAD/ZON E B l INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 66.88 7 ±10.95 1 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 488 0 Mod e SOI L Tim e 

### 2008-12-0 6 11:5 3 Duratio n 

### 30.8 8 Sequenc e Fina l Flag s BVI D # 

### 2597 5 ADDRES S 351 0 sewar d QUAD/ZON E B l INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 57.08 7 ±10.26 9 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1 

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 

### 488 1 Mod e SOI L Tim e 

### 2008-12-0 6 11:5 3 Duratio n 

### 123.1 7 Sequenc e Fina l Flag s AVERAG E Av g o f4877-488 0 ADDRES S 351 0 sewar d QUAD/ZON E 

## I B l INSPECTO R Ventr y DEPT H SAMPL E TYP E CLEARANC E NOT E

P b 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 488 7 Mod e SOI L Tim e 

### 2008-12-0 6 11:5 9 Duratio n 

### 30.9 0 Sequenc e Fina l Flag s BVI D # 

### 2597 5 ADDRES S 351 0 sewar d QUAD/ZON E D Z INSPECTO R Ventr y DEPT H 

### 1 3 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 265.59 7 ±19.20 6 Supervise d By :

# 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 273.69 8 Supervise d By : 

## Certificat e o fVerificatio n

488 8 SOI L 

### 2008-12-0 6 12:0 0 30.6 5 Fina l 

### 2597 5 351 0 sewar d D Z Ventr y 

### 1 3 CLEARANC E

± Erro r ± 19.78 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 469.48 8 Supervise d By : 

## Certificat e o fVerificatio n

488 9 SOI L 

### 2008-12-0 6 12:0 0 30.6 5 Fina l 

### 2597 5 351 0 sewar d D Z Ventr y 

### 1 3 CLEARANC E

± Erro r ± 25.74 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 513.57 7 Supervise d By : 

## Certificat e o fVerificatio n

489 0 SOI L 

### 2008-12-0 6 12:0 1 30.6 1 Fina l 

### 2597 5 351 0 sewar d D Z Ventr y 

### 1 3 CLEARANC E

± Erro r ± 27.11 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 489 1 Mod e SOI L Tim e 2008-12-0 6 12:0 1 Duratio n 122.8 1 Sequenc e Fina l Flag s AVERAG E Av g o f4887-489 0 ADDRES S 351 0 sewar d QUAD/ZON E ?D Z INSPECTO R Ventr y DEPT H : 1 3 SAMPL E TYP E CLEARANC E NOT E

P b Supervise d B y

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1 

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 

### 489 2 Mod e SOI L Tim e 

### 2008-12-0 6 12:0 2 Duratio n 

### 31.9 6 Sequenc e Fina l Flag s BVI D # 

### 2597 5 ADDRES S 351 0 sewar d QUAD/ZON E B 2 INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 33.49 2 ±8.49 5 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1 

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 489 3 Mod e SOI L Tim e 2008-12-0 6 12:0 3 Duratio n 30.9 7 Sequenc e Fina l Flag s BVI D # 2597 5 ADDRES S 351 0 sewar d QUAD/ZON E B 2 INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 40.11 3 ±9.12 0 Supervise d By :

# 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 44.90 6 Supervise d By : 

## Certificat e o fVerificatio n

489 4 SOI L 

### 2008-12-0 6 12:0 4 30.9 5 Fina l 

### 2597 5 351 0 sewar d B 2 Ventr y 6 CLEARANC E

± Erro r ± 9.38 5

# 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 

### 489 5 Mod e SOI L Tim e 

### 2008-12-0 6 12:0 4 Duratio n 

### 31.1 9 Sequenc e Fina l Flag s BVI D # 

### 2597 5 ADDRES S 351 0 sewar d QUAD/ZON E B 2 INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P b 37.06 6 ± 8.74 1 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 

### 489 6 Mod e SOI L Tim e 

### 2008-12-0 6 12:0 4 Duratio n 

### 125.0 7 Sequenc e Fina l Flag s AVERAG E Av g o f4892-489 5 ADDRES S 351 0 sewar d QUAD/ZON E fB 2 INSPECTO R Ventr y DEPT H SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P b |_38.89 4 ± 8.93 6 Supervise d By :

### f>^fJL \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 ^

J^^^ L I Coasta l Environmenta l Grou p Inc
. C^^^T^ * www.coastalhazmat.co m ^"iPHoT*" ' COASTA L ENVIRONHENTA L G t

t 0 U r, INC
. 

# EXECUTIV ESUMMARY : BVI D #2597 5 - (351 0 SEWAR D ST )
I I N o Issue s o r Concern s ^ Issues/Concern s Detai l Explanation : MS
. YOUN GRECEIVE D A$20 0 FO RTH EREPLACEMEN T O FPLANT S THA T WHERE DESTROYE D DURIN GTH EREMOVA LO FLEA D IMPACTE D SOI LFRO M TH EHOME
.

# ^^EP A EP APropert y Clos e Ou t For m Propert y # : 

### rO^q^nC T Propert y A6Ar^.<^\^ \ ^ ^ ^ff^ ^ ' Datc/Tinic : Owner' s Name : Quad s Excavated : F^ , 'g^V^F.c ^ ^ ^^?- , Contracto r Grou p Ye s N o Excavatio nGenera l 1
. I f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 

## y 2
. I f necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? 

### y Ye s N o 1 , Doe s th e gradin g aroun dth e perimete r o f th e hous e inexcavate darea s generall y slop e awa y Gradin g So dan dVegetatio n y fromth e house ? 2
. Ha s so dbee nlai di nal l area s tha t wer e excavated ? 

### y 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 y da y tim e period ) 4
. Ar e sodde darea s generall y fu man devenl y graded ? 

### / 5
. Aji e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 da y 

### y tim e period ) 6
. Wa s th e propert y grade dsuc hthat wate r wil l no t poo l onth e propeny ? 

### y 7
. Wa s damag e t o landscapin g o r plan t material s avoided ? 

## y Gates , Fence s an dRetainin g Wail s 

### Yes N o I
. D o gate s ope nan dclo.s e freely ? (Ifapplicable ) 2
. Wer e al l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (Ifapplicable ) 

## iJ^ 3
. Wa s damag e t o gate s o r fence s avoided ? (Ifapplicable ) 4
. Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) 

### / Foundation , Sidin g an dGutter s 1 I
. Wa s damag e t o th e sidin g o r tri mavoided ? 

### Ye s 

### y N o
2
. Wa s damag e t o th e foundatio navoided ? 

# y 3
. Wa s damag e l o window s avoided ? 4 Wa s damag e t o window s o r doo r screen s avoided ? 

# y y 5
. Wa s damag e t o downspout s o r downspou l extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Yes N o 1
. Wa s damag e t o drivewa y surface s avoided ? 2
. Wa s damag e t o walkwa y surface s avoided ? 

## y 

# V

## Ov^ner s comments :

Inspectio nnotes :

Remova l an dresloratio nactivate s complet e includin g th e 30-day so dwarranry : EP ARepresentati v;^^;^.^?}!,^^^^^ ^ JL ^ 

# Date : '/jiy/s?

### Propert yCompletio n Agreemen t Thi s agreemen t documents the complcliono f remedia l activitie s perlbrmai o n m y property . M y signatur e wil l designat e Iha t 1 a m.salislie dwit hth e restorationo f m y property , an dtha t n o item. s ai e i nqucstion-s , now , o r a

t an y tim e i

n the future , except thos e item. s li.sle dbelow , ifany
. P.opc.tyjIh^<2-^j
. 

### ll!Il!''l'^11JSV 0 Seu^r J ^ f
_ ^.^'""' ^ 6
. ^rc^U.:^s
. Vocet>3__
. Restoratio nItem s i n Question : I Item :

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



### VoacJoe C 

# n

L "FHla tttrc e restoratio ni. s complotcd , excep i a s note d I l/yd o no t agro o resloratio ni s complete d 

# /^//o/^ f f'jjmractor' s .Signatur e Dat e

## Propert yDamag e Settlemen t

Propert y I D 2597 5 Propert y Addres s 351 0 Sewar dS 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 sumo f $200.0 0 for th e replacemen t cos t o f plant s tha t wher e destroye ddurin g th e remova l o f lead-impacte dsoi l fromth e property .

Compensatio nTyp e Chec k 168 6 Valu e o f Chec k $200.0 0 Chec k t o th e Orde r of 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 at 351 0 Sewar d St
. 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
.

Pag e 1 o f 1