## TRANSMITTA Lof OMAHA LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R 

# V^^0< , 

# \i,l')^ A SAI D # : Date 

# . Add,»s.: %^ ^ WWA(: , ^ t Remediatio nContractor : _Coasta l Environmenta l Group
_ Year ; 200 1 % 

### SOI LREMEDIATIO N PROPERT Y nLEFOLDE RDOCUMENT S Vide o ofproperty (DVD ) \ H ^ t^C^f^o' ^ 

# Y Executiv e Summar y 

# Y EPA-providedproperty sketch SignedAcces s Agreement fo r subject property SignedAcces s Agreement(s ) fo r adjacen t propert y < / Restoratio nAgreement 

# -a - Settlemen t document s (i.e. , fo r damag e or t

o replac e plants , etc. ) Confinnatio ndata Photograph s ^ > ^ ^^ P, k^^l^TlC M ^ fe tVOVAfK ^ As-built sketch 

# y Y Satisfactor y restoratio nsignedb y Propert y Owner Propert y close-out check lis t signedb y EP A -B r Descriptio nofarea s no t meetin g RO D cleanup criteri a Utilit y clearance s Propert y infonnatio nfro mDougla s Count y Assessor' s Office

Dat e 

### 30054529 Superfun d0 

### Propert yAcces s Checklis t
D D

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

Owner : ^^^^^^ ^ Address : p^^^^y-;^^^^^ ^ 

# UU2d Rente r Phone : P.L\ : Cell/Pager : Ptione : Fax : Ccll/Pager
. 

# fc D Notificatio nLette r Acce u Agrcemen i Restoratio nAgreemen t O Topsoi l Samplin g (i f applicuble ) dDisposa l Samplin g (r f applicable ) Q Gurdc nSamplio g (i f applicable ) D ^ Utility Clearanc e Video/Photo s (Before ) C

D Video/Photo s (During ) D VIdeo/Pholo s (After ) D Video/Photo s (30-D<y ) ' ""©—Propert y Complelio nAgreemen t

• Fina l Repor t Ai rMonilorint ; {u s applicable )

O Communit y C D Cre w On ; Results : D Communitj ' D Cre w On : Remits : C

D Communir i C D Crc>v On : Results : Additiona l InlormMtion-
.

Sent : 

### Signed : L P/ L^/GC\ Signed!^/5L/D 9

Called :

O n 

### M./.2J' X O n O n O n 

### Signed : $^J2&M ^ Issued :
/ / By :
/ / By :
Bv :

Omah a Lea d Sit e Bv : 

### ^yAS:i±j^n^^ ^ VdirAi ) By:,gjijj^j^faeiJr\vOy^u_dotA4t:>{A<^*

- By : By : By : By :
Bv ; By : By : By : By :

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

Comment : Owne r Comment (s) : Sit e Coordinato r Comment (s) : CONTACT FOR M
Z'TlOD ^ 

# HO?. ! L afav | f-rif " g ^ Date : Time : Action :

Date : Time : Action : Date ; Time ; Action ; Transmi t t

o EP A D Other Action : D

### Dougla s County Accovm t ]^~^—»atior i Pag e 1 of 3 ^ Dougla s County , Nebrask a Propert yRecor d - R240671000 0 Informatio n i s vali d a s o f 2009-5-1 2
Owne r POINDEXTE R ZEDEK AN 402 7 LAFAYETT E AV E OMAH AN E 68131-000 0 Propert yInformatio n Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f 52n d S t - Vle W O n Ma p Treasurer' s Ta xRepor t Ne wFeatur e -•->- •Aut o Sale s Searc h

Ke yNumber : Accoun t Type : Parce l Number : Parce l Address : Lega l Description : Valu e Informatio n Lan d 

### 200 9 200 8 200 7 

### 200 6 200 5 200 4 Sale s Informatio n Sale s Data : Dee d Type : Price : Grantor : Grantee : Valid/Invalid : Exclusio n Reason : Sale s Data : Dee d Type : Price : Grantor : 

### 067 1 000 0 2 4 Residentia l 240671000 0 402 7 LAFAYETT E A V OMAH AN E 68131-000 0 WALNU THIL L LO T7 BLOC K1 4 4 0 X 15 0 Improvemen t Tota l $2,500.0 0 $67,500.0 0 $70,000.0 0 $2,500.0 0 $67,500.0 0 $70,000.0 0 $2,500.0 0 $67,500.0 0 $70,000.0 0 $2,500.0 0 $67,500.0 0 $70,000.0 0 $2,500.0 0 $51,000.0 0 $53,500.0 0 $2,500.0 0 $51,000.0 0 $53,500.0 0



### 2006-05-1 6 Q C Book : 200 6 Page : 05435 7 $1.0 0 Velm a P Poindexte r Zedeka N Poindexte r Invali d Famil ySal e 

### 2005-10-2 6 Q C Book : 200 5 Page : 13504 7 $0.0 0 Velm a P Poindexte r


### http://douglasne.mapping-online.com/DouglasCoNe/static/accovmtinfo.jsp?accountno=R240.
. . 6/7/200 9 http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accoimtno=R240.
. . 6/7/200 9

### Dougla s County Accoun t L^M|^tio n 

### Pag e 2 o f 3

Grantee : Velm a P Poindexte r Valid/Invalid : Invali d Exclusio n Reason : Famil ySal e Sale s Date : 1997-09-2 9 Page : Dee d Type : D Book : 207 2 48 6 Price : $ 51,350.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit a Dept h Widt h Vacan t 0.1 3 6000. 0 1. 0 150. 0 40. 0 N o Improvemen t Informatio n Buildin g 1

X t 

# 7 A
M t 1 1 6 % x B r i "\/ ^

CLIC KTO ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1602. 0 Percen t Complete : 100.0 % Perimete r0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : ! 2 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 8. 0 Exterior : \ Fram e Sidin g Units : 1. 0 Interior : j Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 4. 0

Roo f Type : Hi p Stories : 2. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0


### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R240.
. . 6/7/200 9

## Douglas Cotmt y Accoun t I

, jj^a^tio n Pag e 3 of 3
yearSu// f 190 8 Detai l Typ e Ad d O n Applianc e Applianc e Basemen t Basemen t Fixtur e Fixtur e Garag e Porc h Yea r Remodele d 0 Percen t Remodele d 0 % Detai l Descriptio n Fenc e Chai n Lin k Allowanc e SecuritySyste m Bsmn t Bloc k 8 ft Outsid e Entranc e Bas e Fixture s Bat h Ful l Detache d Sla b Roo f Cei l Adjuste d Yea r Physica l Ag e Buil t 190 8 10 0 Unit s 1. 0 1. 0 1. 0 780. 0 1. 0 1. 0 1. 0 360. 0 166. 0



## http://douglasne.mapping-onIine.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=R240..
. 6/7/2009

### Pag e 1 o f 1 » •

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



### • YOU RTICKE T NUMBE RI S 2313918
. Origina l Cal l Date : 7/09/0 9 Time : 2:2 1 pm Op : ELIZABETH1879 0 Wor k t o Begi n Date : 7/13/0 9 Time : 3:0 0 pm State : N E County : DOUGLA S Place : OMAH A Address : 402 7 Street : LAFAYETT E AVE Twp : 15 NRng : 13 E Sect-Qtr : 17-NE Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lead remediatio n Locatio n o f Work : INCLUD E AL L EASEMENT S LOCAT E ENTIR E PROPERTY Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LO T Compan y: COASTAL ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Being 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 Boring : NExplosives : N CXCAT V

MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac t Phon e Niunbe r Utilit y Typ e
CXCAT V co x COMMUNICATIONS , IN C 

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

### Day : 402504782 3 MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y Alt : 

### Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCITY O FOMAHA-TRAFFICSEWE RRO N 

### Alt : 402444516 1 Emerg : 4024445160 Day : 406728934 3 0PPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T N A 

### Alt : 4062071494 Emerg : 888728934 3 Day : 406728934 3 QLNNEI C QWES T LOCA LNETWOR K N A 

### Alt : 4062071494 Emerg : 888728934 3

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

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e
• NVIRONHINTA L O R O U r, IN C 

### 2500 5 Omah a Lea d Sit e Owne rName : VELM AP POINDEXTE R Sit e Sketc h Address:_402 7 LAFAYETT E A V

l»lione : H : W : Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B RYASCPXA-2500 5 F 1 (f i O'Z ­ pp m 

### E f D RYBSCPXA-2500 5 F 2 2.05 * pp m 

### D B " RYCSCPXA-2500 5 B 1 

### E f D RYDSCPXA-2500 5 RD2SCPXA-2500 5 B 2 D Z l " 2Y b "2
. ^ / pp m pp m 

### D 

# • «easewcA-36©©6—az ­ " • pp m 

### D 

# n RPZSCPXA-2500 5 P Z 'Z - 3 ^

pp m 

### E f 

# n La b RYBSCPLA-2500 5 Numbe ro f Sample s = | 3 ~ / I
—Resul t 21 4 pp m Exterio rPain t Nort hArro w H^Goo d 1~ 1 Poo r I I No t pain t Sample s Collecte d Firm : 

### .4j'-v-

- ^u-/i A A < Date : Time : Sample s Analyze d XR F Unit : 8/( g Book : 5 - 5

Date : 

## &Az-<pAo y Time : 

### Af- ^ Staff : 

### /•AY
. OLS# : 2500 5 Dat e Excavated:7/16/p 9 Dat e USEP ASiane d Off:!/11/0 9 Are a ggddgn ; 792 g g

K.ji
. • Aij G • rf JCfC e

Omah aLea dSit e 4613 0

Are a Concret e replace d So d wit: h 

### Legen d Dri p Zon e Excavate d Are areplace dwitJ i Rock/Mulc h Quadrant s Excavate d Are aleft bar e 

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

## 2500 5 Nort h Arro w 

### Omah a Lea d Sit e Exterio rPain t Owne rName : VELM AP POINDEXTE R I^Goo d 

### Sit e Sketc h Address : 402 7 LAFAYETT E A V 

### • Poor Phone : H : W: Q ] No t pain t Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Fin m Sample s Collecte d 

## •45'^

­ U-!if-AA
. RYASCPXA-2500 5 RYBSCPXA-2500 5 F 1 F 2 pp m pp m 

### E T 

## D D Dat e Tim e 

## j££
. 9:H Y cAl
_ RYCSCPXA-2500 5 RYDSCPXA-2500 5B 1 8 2 pp m pp m 

## E f E f D D Sample s Analyze d

l

_ RDZSCPXA-2500 5 D Z fiegSGf?X A2600 5 GZ RPZSCPXA-2500 5 P Z La b RYBSCPLA-2500 5 Resul t 21 4 pp m 

## •2-3 ^ pp m pp m pp m 

## E f D Ef Numbe ro f Sample s = j 3 ~ 

# n D D \ XR F Unit : Date : _ Time : _ Staff : 

### 2>/ 0 Book : 

## S 3 0AZ(^Ae^ y

yfA Y 

# i./y
.

^AiAlJAikA'A-^A'}
. A ' ^•1A/£LA1
. 

# mAAYAA A ^.'^{wA-k
. .-A A
. Omah aLea dSite 4613 0Owne rName : VELM AP POINDEXTE R Address : 402 7 LAFAYETT E A V Phone : H : W : Sampl e Numbe r Lead Concentratio n RYASCPXA-2500 5 F 1 LtOT , RYBSCPXA-2500 5 F 2 

### 2.0 5 RYCSCPXA-2500 5 8 1 RYDSCPXA-2500 5 B 2 RDZSCPXA-2500 5 DZ 

### -2.^ 7 nozocPX Aa6oofr• a z RPZSCPXA-2500 5 P Z 

### -2-^' ? La

b RYBSCPLA-2500 5 Resul t 21 4 pp m 

## 2500 5 Exterio rPaint Nort h Arro w Q^Goo d
• Poo r Q Notpain t Sample s Collecte d 

### Fimi : .^ ^ US/ AA Date : ^ < A ' Time : 9. ' Vo T Sample s Analyze d XR F Unit : 8/< yBook : ^ 3 Date:
_ 

## 9/z,(pyo y Time:
. 

### A/? j Staff : pp m pp m pp m pp m pp m pp m pp m

Omah a Lea d Sit e Sit e Sketc h Sampl e Collecte d 

## E f D E T ^
. 

## E f D Ef LA B 

## D ^ 

## D D 

## n n n

Omah aLea dSit e 4613 03 > >« - COASTA L ENVIRONMENTA L CIOUP , INC

. 

## Consen t fo rAcces s T o Propert y RIGH TO F ENTR YT O PREMISE 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 : _ ^ ^ ^
Owner' s Name : Daytim e Phone :

Addres s o f Propert y 

# 402- 7 Lv^hKe^-r-r ^

U J 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 f lea 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 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 Coastal 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 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 EP Atha t th e propert y ha s bee n remediated
.
ENVIRONMENTA L RESPONS 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 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 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 f 2

### f ^TH ­ V*"iTe"' / COASTA L

* K-, AtNYI«0«HINTA L 'IPnOT* ^ CIOUP

. IN C


### •Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; •Remov e flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t ma ywis h t o save ; •Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessarysubsequen t t o a n initia l waterin g perio d b yEPA ; •Abid e b yhealt h an d safet yguidanc e provide d b yEPA ; •I f th e propert yi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propert yt o perfor m th e work
. •Allo wvideotapin g and/o rphotographin g o f th 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 f th e wor k activities , o rwit h an y o f th 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 f sai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o f th 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
I gran t access t o m ypropertie s D I d o no t gran t access t o m ypropertie s 

# loA-b< \ Signatur eDat e Signatur e / Dat e

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

Pag e 2 o f 2C.J 3 A
. S r-ii
. L
w a^t ^ § mntt M m

m0 u rjh l 

## Restoratio n Agreemen t

Th e purpos e ofthi s agreement i s t o provid e amutual agreement a s t o condition s ofth e propert y prio r to remediatio nactivities
. Thi s wil l als o serv e a s documentatio nfor th e purpos e o f assurin g tha t restoratio n activitie s ar e complete dt o th e satisfactio no f th e propert y owner an dth e Unite dState s Environmental Protectio nAgenc y (EPA)
.

Property ID : -gg y T^C^CtZ) S Property Address : ^^^.^ y L^t^JrfiA<^jr6
. AuA Owner : 

### Yf^i^u - fY?lMpey-T<5<2 - Phonc ; ^y ^ • C ^ 3 ^ j O nth e attache ddiagram(s ) indicate area(s ) t o excavate , surfac e structure s andlandscapin g feature s an d acces s location(s ) t o b e use db y th e contractors . Indicate distances , depths , materia l types , etc . Photographicall y andVideographically document th e existin g condition s ofth e propert y an dth e basement if necessary . 

### Item s t o b e Remove d b yth e Owne rbefor e Star t o f Remediation : Th e removal , storage , disposal , and/o rretur n o f thes e item s i s th e Owner' s responsibility
. Item : 

# S.^1 1 YLi^ A Item : " "
Item : Item :



### Item s t o b e Remove d b yth e Contracto rDurin g Remediatio n an d No t Replace d Item : 

# ^^ v 9^---^/ ' PA/Y/O r Lo^Y ^r^J Item : Item : Item :

Pag e 1o f ^C O AS T ^ L C • O U » . IM C 

### Item s to B e Remove d B y ' Contracto rDurin c 1 Remediatio n an d Reolace d Item : Kem : 

# r^oo - ^ i Item : Item : •


## Landscap e Inventory Ite m Quantit y Uni t Condition/Type/Specie s Pre-existin g property area , Quadrant s tha t wil l b e excavated , that 

# • P I i s covonedwit hgrass . Numbe r o f tree s > 2 inch Eac h trunk diamete r 

# 1
Number o f tree s < = 2 inch Each 

# 1 trunk diamete r Number o f Sprinkler Zones , Contro l Valves , Each Timers , Heads , etc . AttachasketchA the 

# A sprinkler layout
. Numbe r o f andsiz e o f eac hgarden / flowe r be d Eac h area . 

# ' A SquareFee t Attachasketcho f relativ e size s an dlocations
. Agree dupo nvalu e o f plant material s no t t o b e replace db v contractor . $ Note thi s \HIII C wil l h e use dto Issue H pl^n t vouche r l o th e propcrt \ owner . 

# \k^4^y^ ^ lls2^^l'r'= > . Easement Area , t o b e Eac h 

# ie s excavate d
Pag e 2 o f ^C^ O /k S T^ L

Additiona l Comment s / Instructions : 

## ^ \ (*P<Vy^ l f^/^AJ T9< ^ J\eXKJ.\A d

Q Chec k th e box rf Owne rdoe s not wan t CE G to documen t interio rfoundatio n wall s an d possibl e pre-existin g damage
. Bycheckin g thi s t>o 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
.

I do no t agre e

Dat e ' Sie i PageSo f£_ Owner' s Signatur e Contractor' s s Signajnre Dat e

### BVID # X^OC) S XR F PROPERTYSAMPL E SHEE T Dat e 

### Project XRFID #

Shot # 

### 15-4 L, )6H- 7 \'=>H t 

### 15^ 4 Averag e

Sho t #

Averag e

Shot #

Averag e

Shot #

Averag e la b sampl e # 

# n/n\(y i imah a a lea lea d

d F

F P 2n d yea ropilo n Dmah 

### ^^n^^g )

Readin g Sampl e are a 41c,^ M ±q.i^ q L^.HUtll.D O 

# Fl ^^.u,i^±^.^ q Dept h 

### yi-iV-n,!?
. 10 ^ l o -? q ±iD.^ g Readin g Sampl e are a Dept h

Readin g Sampl e are a Dept h Addres s Sampl e tim e sampl e lengt h Shol # )5H I 

### Iiiil
. JSii i

/S^ ^ Averag e

Shol #

Averag e Shot #

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

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. Averag e 

# Mean igfrMjTfft ^ am/p m 

### 30 se c Readin g 

### i2M.o«±n. ^ 137
. 0MJ-)5.7 q ID ^ M^±l?.1 3 /Z/ 5?qi:y^D= ^ Sampl e are a <jas e ^M* ^ Dept h

1 I 21
. ?^U t
Readin g \^.%[ n Sampl e are a Dept h

Readin g Sampl e are a Dept h

Readin g Sampl e are a Dept h

Signatur e 

### (^^M^JP/ ) 

# Prin t

PlionhPU ^ Oyfeye ^

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 155 0 Mod e SOI L Tim e 2009-07-1 7 14:3 9 Duratio n 121.6 2 Sequenc e Fina l Flag s AVERAG E ^VQof 1546rl54 9 j ADDRES S 402 7 Lafayett e av e QUAD/ZON E F l INSPECTO R Brya n DEPT H 1 0 SAMPL E TYP E CLEARANC E NOT E

Erro r pp m P b ~56!79 6 ^ ± Supervise d By : C^{hyf'S>JYyoY S

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 154 6 Mod e SOI L Tim e 2009-07-1 7 14:3 7 Duratio n 30.3 4 Sequenc e Fina l Flag s BVI D # 2500 5 ADDRES S 402 7 Lafayett e av e QUAD/ZON E F l INSPECTO R Brya n DEPT H 1 0 SAMPLE TYP E CLEARANC E NOTE

pp m ±Erro r P

b 46.33 9 ±9.69 0 Supervise d By :

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 154 7 Mod e SOI L Tim e 2009-07-1 7 14:3 8 Duratio n 31.1 5 Sequenc e Fina l Flag s BVI D # 2500 5 ADDRES S 402 7 Lafayett e av e QUAD/ZON E F l INSPECTO R Brya n DEPT H 1 0 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 63.46 3 ±11.00 3 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 49.65 8 Supervise d By : 

## Certificat e o f Verificatio n

154 8 SOI L 2009-07-1 7 14:3 9 30.0 5 Fina l 2500 5 402 7 Lafayett e av e F l Brya n 1 0 CLEARANC E

± Erro r
± 9.99 6

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 154 9 Mod e SOIL Tim e 2009-07-1 7 14:3 9 Duratio n 30.0 8 Sequenc e Fina l Flag s BVI D # 2500 5 ADDRES S 402 7 Lafayett e av e QUAD/ZON E F l INSPECTO R Brya n DEPT H 1 0 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 67.72 4 ±11.22 2 Supervise d By :

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 154 5 Mod e SOIL Tim e 2009-07-1 7 14:3 5 Duratio n 121.9 1 Sequenc e Fina l Flag s AVERAG E (^\vg]ofJL541^154 4 | ADDRES S ^D'2 7 Lafayett e av e QUAD/ZON E easemen t INSPECTO R Brya n DEPT H 1 SAMPL E TYP E CLEARANC E NOT E

pp m ± Pb 121.86 1 ) ± Supervise d 

# By : j^r/iemA ^

# 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 124.08 2 Supervise d By : 

## Certificat e o f Verificatio n

154 1 SOIL 2009-07-1 7 14:3 3 30.6 0 Fina l 2500 5 402 7 Lafayett e av e easemen t Brya n 1 CLEARANC E

± Erro r
± 14.40 0

# Therm o SCIENTIFI C Therm o Fishe r Scientifi c 90 0 Middlese x Turnpik e Billerlca , M A 0182 1

XL3t-3208 9 Readin g No 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 137.04 2 Supervise d By : 

## Certificat e o f Verificatio n

154 2 SOIL 2009-07-1 7 14:3 4 30.4 7 Fina l 2500 5 402 7 Lafayett e av e easemen t Brya n 1 CLEARANC E

± Erro r d b 15.28 8

# Therm o SCIENTIFI C Therm o Fishe r Scientifi c 90 0 Middlese x Turnpik e Billerlca , M A 0182 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 104.43 1 Supervise dBy : 

## Certificat e o f Verificatio n

154 3 SOIL 2009-07-1 7 14:3 5 30.1 9 Fina l 2500 5 402 7 Lafayett e av e easemen t Brya n 1 CLEARANC E

± Erro r ± 13.72 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 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 121.88 8 Supervise d By : 

## Certificat e o f Verificatio n

154 4 SOI L 2009-07-1 7 14:3 5 30.6 5 Fina l 2500 5 402 7 Lafayett e av e easemen t Brya n 1 CLEARANC E

Erro r 14.02 7

## / ^^/ % Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 I Coasta l Environmenta l Grou p Inc
. ^ 7 jf www.coastalhazmat.co m "'tPnoT*' ^ COASTA L
• NVOONHENTA l a • 0 U r . IN C 

# EXECUTIV ESUMMARY : BVID #25005

- (402 7 LAFAYETT EAVE ) No Issue s o r Concern s Q Issues/Concern s Detail Explanation :SMI L 

# EP A EP A Propert y Clos e Ou t For m Property Add«..mLi^%^ ^ Propert y #:_250Q5L ^ Datc/Tlne : Owner' s Name;
. ^f^lYY f ic?i.rVlf:?^-<: : - Quad s Excavated : _£ CoRtractor Group f>-x/i^-4-A \XZr^/1/tiA)/\i ^ A ^ fiY\VExciv«ttoB Genertl 1
.I f necessaiy , wer e th e correc t quadrant(s ) excavate dan drestored ? 

# z A

2
. I f necessary , wer e th e conect areas ofdrip zon e excavate dan drestored ? 

# -A ^
Gmdlo g So dan dVcteUtio B Ye s N o I
.Doe s th e gradin g aroun dth e perimete r ofth e hous e i nexcavale darea s generall y slop e awa y 

# T A 6x> mtb e house ? 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 dat a3 0 da y tim e period ) 4
.Ar e sodde darea s generall y fin nan devenl y graded ? 

# T/^ S
.Ar 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 A tim e period ) 6
.Wa s th e propert y grade dsuc hthat wale r wil l no t poo l o nth e property ? 7
.

Wa s danug e t o landscapin g o r plan t material s avoided ? Gates
. Fcnce aan dRetelnln i Wall s Ye s N o I
.D o gate s ope nan dclos e &eely ? (I f applicable ) 2
.Wer e al l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (I f applicable ) 

# ~A ^ 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 ) 

# A ^
Foundation , Sidin g an dGnHcr s Ve s N o I
.Wa s damag e t o th e sidin g o r tri mavoided ? 

# I A 2
.

Wa s damag e t o di e foundatio navoided ? 

# A 3
.

Wa s damag e t o window s avoided ? 

# T^ ^ 4
.Wa s damag e t o window s o r doo r screen s avoided ? (/ ^ 5
.Wa s damag e l o downspout s o r downspou l extension s avoided ? 

## iA ^ Sidewalk s an dDriveway s (Concrete ) Ye s N o 1
.

Wa s damag e l o drivewa y surface s avoided ? 2
.Wa s damag e t o walkwa y surface s avoided ?

## CM'oer ^ comments :

Inspectio nnotes :

Remova l an dresloratio naclivale s complete includin g the 30-da y so dwarranty : EP A Representaiiv e [ Jrrw/C^JL/

- Dale:^//6 9

## Propert yCompletio n Agreemen t Thi s agreemen i document s th e completio no f remedial acliviiie s perloime donm y properl y M y signatur e will designat e lha t I a msatisfie dwit hth e restoratio nofm y propeily , andtha i n o item s ar e i nquestions , now , o r at an y lime i nIhe fulure , excep l thos e ilem s liste dbelow , ifan y Propert y ID : 25<S^ 5 Propert y Addrew : ijj^j ? LAfA^E^y e Owner : &j^>,;,d,^ r Phone : 

### ^t< ^ -^y^"^ ^ Restoratio n Item s i n Question :

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



### 0 i 1 <i(;rc r restoralio ni t complded , excep t a s note d [_

J I d o no t liccc c resl«rAtiai ) is complete d 

# MiHA'rkAuL
. Y2ilf ] 9frma, ^ MMlnO i Owner' s Signatur rDat e Cbnt i actor' s Signalur e ' 'Dal e