# f

TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID#:_SMSL _ 

# Date : ;x]^^\t> ^ Address : ^ U ^ t ^ 5 0 h\/<2 ^ RemediationContractor : Coastal Environmental Grou p Year : 200 8 SOI LREMEDIATIO N PROPERT YFIL EFOLDE RDOCUMENT S Vide o o f property (DVD ) Executiv e Summary EPA-provide dproperty sketc h Signe dAcces s Agreemen t fo r

subjec t property Signe dAcces s Agreement(s ) fo r

adjacent property Restoratio nAgreemen t Settlement document s (i.e. , fo r

damag e or to replac e plants , etc. ) Confirmatio ndat a Photograph s prg.-.^r.iJ/?Jieyi ^ {yYCaJAMm ^ fKLc JSd d 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

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## Propert yAcces s Checklis t Propert yID : £^|q^g > D WOR K STARTE D ON : / /_ Propert yAddress : QAT - 

## hsi c nWOR K COMPELTE D ON : / /_ 

# L^"i:lcYxJBDCclar r Renter : Addres s "^Prm C Phone : Fax : Cell/Pajjer : Phone : ^^^
- jg^ ^ Additiona l Information : Fax : Cell/Pase r 1 nNotificatio nLette r Sent : / / By : 1 0 Acces s Ajjrecnicn t Signed : ^/i/O S By:^ C j 0 ^ Re.storatio nA<«reemen t Signed : X/fi_/a ^ By: ^ 1 1 Topsoi l Samplin< ; (ifapplicable ) / / By : O Disposal Samplin g (if applicable ) / / By :
• Garde nSaniplin » (if applicable ) / / By : nUtility Clearanc e Called : / / 

# By : II 0 n Vi<leo/Photo s (Before ) Video/Photo s (During ) On : On : °\/ /t / (K / 

### B.v:llt^l/t 6 

## By : 

# /^' ^ II 1 nVi<lco/Phot<) s (After ) On : / / By : nVideo/Photo s (3(>-Day) On : / / By : nPi*opei-t y Completio nAgreemen t Signed : / / By : D Fina l Repor t Issued : / / By : Ai rIVIonitorin g (a s ap|)licable )

I I Communit y CH Cre w On : / / Bv : Results : I I Communit y LJ Cre w On : / / Bv : Results : d l Communit y [U Cre w On : / / Bv : Re.sults :
Omah a Lea d Sit e

## Propert y I D # Propert y Address : Initia l Contact : Secon dContact : Fina l Contact : Fina l Action : 

# g-ona U Comment : Owne r Commen t (s) : Sit e Coordinato r Commen t (s) : CONTAC TFOR M 51^?; ^ 

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# M5 \- \?.-^ ^ ^oe , I-T M- 7^7.f^< v

### Dougla s County Accoun t I nilMa i 

### atio n Pag e 1 o f 3
Dougla s County , Nebrask a Propert yRecor d - R075340000 2 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e ( > scal e 0-5 0 f t wes t o f90tt i S t - Vie WO P Ma p Informatio n i s vali d a s o f2008-6-1 9 Treasyrer! s Ta xRepor t Ne wFeatur e Aut o Sale s Searc h Owne r BOECKE R RONAL D F ETA L 1091 0 JOH N J PERSHIN G D R OMAH AN E 68112-000 0 Propert yInformatio n Ke yNumber : 534 0 000 2 0 7 Accoun t Type : Residentia l Parce l Number : 075340000 2 Parce l Address : 90 7 N 5 0 A V OMAH AN E 68132-000 0 Lega l Description : CARTHAG E AD D LO T1 2 BLOC K1 7 LT S 1 1 & 1 2 10 0 X12 6 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $ 9,300.0 0 $ 92,200.0 0 $ 101,500.0 0 200 7 $ 9,300.0 0 $ 92,200.0 0 $ 101,500.0 0 200 6 $ 9,300.0 0 $ 70,000.0 0 $ 79,300.0 0 200 5 $ 9,300.0 0 $ 70,000.0 0 $ 79,300.0 0 200 4 $ 9,300.0 0 $ 70,000.0 0 $ 79,300.0 0 200 3 $ 9,300.0 0 $ 70,000.0 0 $ 79,300.0 0 Sale s Informatio n Sale s Date : 2005-06-1 5 Dee d Type : W D Book : 200 5 Page : 07091 6 Price : $106,500.0 0 Grantor : MICHAE LG GOLTE R Grantee : RONAL D F BEECHE R ETA L Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 1998-04-2 9 Dee d Type : Book : 209 1 Page : 13 0 Price : $ 77,000.0 0 Grantor : 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R07. . . 7/17/200 8

### Dougla s County Accoun t Informatio n Pag e 2 o f 3 rorma
Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.2 8 12600. 0 1. 0 126. 0 100. 0 N o Improvemen t Informatio n Buildin g 1 

## Verifie d ;^ ^

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l>120-S< | F t



## r^r ' CLIC KTO ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 912. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e 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 : 5. 0 Exterior : Fram e Stucc o 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 rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 192 0 0 % 192 0 8 7 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Applianc e Fireplac e Masonr y 1. 0 Basemen t Bsmn t Bloc k 8 f t 888. 0 Fixtur e Bas e Fixture s 1. 0 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R07. . . 7/17/200 8

### Dougla s County Account Infonnatio n Pag e 3 o f 3

Fixtur e Bat h Ful l 1. 0 Porc h En d Scree n 96. 0 Porc h Sla b Roo fCei l ' i 128. 0 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R07. . . 7/17/200 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 TNUMBE RI S 2098688 . Origina l Cal l Date : Work , t o Begi n Date : 8/04/0 8 8/07/0 8 Time : Time : 7 7 1 1 p m 1 5 a m Op : ELIZABETH18 7
State : N E Address : 90 7 County : Street : DOUGLA S N50T H AV E Place : OMAH A Twp : 15 NRng : 13 E Sect-Qtr : 18-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remidiatio n Locatio n o f Work : LOCAT E ENTIR E PROPERT Y AL L TH E WA Y T O TH E STREET . Remarks : FA XAL LCLEAR S TO : (877)662-421 1 : tJNStJR EOFCORNE RLO T 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 : 4f t Corne r Lot : N Involve s Tunnelin g o r Horizonta l Borin g : N Front : Y Explosives : N Rear : ALT87 2 ATTNEBR l CXCAT V MCLEODN E MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac t Phon e Numbe r UtiUty Typ e ALT87 2 WINDSTREA M COMMUNICATIO N N A 

### Day : 406728934 3 Alt : 888728934 3 Emerg : 406728934 3
ATTNEBR l ATT/T 

### Day : 8002413624 9 Alt : Emerg : 8002413624 9
/-v/
- AT^ / CXCAI V CO XCOMMUNICATIONS , ^ ^ 

### HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
MCLEODN EMCLEODUS A 

### N O NEE D T O CAL L OU T EMERGENC Y Day : 800289190 1 Alt : 

### Emerg : 800289190 1 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS. . . 8/4/200 8

### Pag e 2 of 2

MUDO l

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### Day : 402504782 3 Alt : Emerg : 402504794 6 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=<RESULTS. . . 8/4/200 8

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e ENVIRONM I NTA L CROUP
. IN C $«=^8 S Exterio rPain t Nkjrt h Arro w Omah a Lea d Sit e Owne rName : RcnQ/cj fOoQcJ/^ T •Goo d Sit e Sketc h Address : '=^q2_l±
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Phone : H ; y^/ - fSJSy^JSJ-Qa^ G r~ | No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : »V\<-S c>t^f(^ C RYASCPX A.57^5 8 F l IW O pp m 

### 0 Date : ^(bjo^ - RYBSCPXA-57^5a a F 2 _LTa__Pp m 

# a Time : '2 : $ S r»yv^
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# n Sample s Analyze d RYDSCPXA-tf-Z^a g 8 2 9fi l pp m D RDZSCP-KA-P fISQ Q D Z 1 1 y> o pp m 

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. -E 2 pp m D Time : /^r m Staff : /^hty ^ Numbe ro fSample s •
OLS#:S198 8 [ lat e Excavated : 9/16/0 8 Dat e USEP ASigne d Off : 1/28/0 9 Are a Sodde d 211 9 s q f t

Omah aLeadSite 4613 0 

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Dri p Zon e Excavate d Concret e Quadrant s Excavate d Are areplace dwit h Are areplace dwit h Are alef t bar e So d Rock/Mulc h 

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

## 5<^S S Nort h Arro w 

### Omah a Lea d Sit e Exterio rPain t 

### Owne rName : Ronal d OOQCMe r •Goo d 

### Sit e Sketc h Address : ^O l » ^ "S O AVJt ­ ( 3 Poo r 

### Phone : ^:Mi-133 5 ^ vT^I'QaZ Q Q Not pain t Lea d Sampl e 

### Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d 

### Firm : RVASCPXA-S'/Sd Q F 1 

## IS O pp m 

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# -tit e ^ur6 tft^mC-vi Y 4613 0

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### 1 4 O Do m RYBSCPXA RYCSCPX A RYDSCPX A RDZSCPXA RGZSCPXA ­ £'/36 a 

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Date: R-/i'0 7 Time : Ah n Staff : Wru ^



### Omah aLea dSit e 4613 0

# A

COASTA L fMVJtONNlMTA l 

### 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 fProperty 

# K) ^ 5 0 y/ v covere d bythi s Agreement : 

# mil 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 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 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 writte 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 ; Pag e 1 o f2COASTA L tHVIIONHfNTi t e V o u rin 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 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
. •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 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 (712 ) 352-018 8
I ^s l gran t acces s t o m ypropertie s Q I d o no t gran t acces s t o m ypropertie s

h/ii::>- ^ Signatur e Signatur e Dat e

Q

I woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.C O AS TAI 

### Restoratio n Agreemen t The purpos e o f thi s agreemen t i s to provide amutua l agreement a s to condition s o f the propert y prior to remediatio nactivities . Thi s will als o serv e a s documentatio nfo r th e purpos e o f assurin g tha t restoratio n activitie s are completedto the satisfactio nof the propert y owner andthe Unite dState s Environmenta l Protectio nAgency (EPA) .

Propert yID : 

# s w Propert y Address : qfy- ) |^\^ ' ^ l ^ j Owner : 

# f-o hUic\ ^ Phone : 

# f­ (^^^ - i ^ O

nthe attacheddiagram(s ) indicat e area(s ) to excavatedan ddept hof excavation , locationo f all known utilities , subsurfac e features , surfac e structure s an dlandscaping features , acces s location(s ) to be use db y contractor , an dth e directionof North . Indicat e distances , depths , materia l types , etc . Indicat e digita l phiMo s b > referencing the photo-lo g numbe r wit ha narro w indicating directionof view . 

### Item s T o B e Remove d B yOwne rBefor e Start O fRemediation : (Us e additiona l sheet s a s necessary ) Th e removal , storage , disposal , and/o rretur n ofthes e iien s i s th e Owner s responsibilit y Item : 

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# \T^ c

# ' ^ Item : / Item : ^ ^ Item : ^ ^ Item : / Item : y ^ Item : ^. ^
Item : ^y ^
^ Pag e 1 of
. 

# LCOASTA L 

### 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 : 

# tfimif ^ f//t^r > li ^ Umn ^ Item : Item : Item : item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : 

# c Pag e 2 o fC O AS TAI
. 

### Item s T o B e 1 Remove dBy ( 

### [Contracto rDurin q Remediatio n An d Replace d (Us e a( jditiona l sheet s a s necessary ) Kem : 

# )V)\;L ^ rtem: 

## ^0 1 

## L 

# 1? ^ 

# y ^^' ^ Item : 

### ^<7l ^ \ ^ ^ ^ Item : 

# 1 ) Item : / Item : / Item : / Item : / Item : / Item : / rtem: / Item : / rtem: / , Item : / rtem: 

### /

Pag e 3 o f 

# k

# 1 COASTA L



## Ite m

Pre-existin g property area , tha t wil l b e excavated , that i s coveredwit hgrass .

Numbe r o f tree s > 2 inch trun k diamete r

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

Numbe r o f Sprinkle r Zones . Contro l Valves . Timers . Heads , etc . Attac hasketc hof th e sprinkle r laxout .
Numbe r o f andsiz e o f eac hgarden/ flower be d area . Attac hasketc ho f relativ e size s andlocations . 

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

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

Square feet

Each ^



# 'h

# 1 Each

i Each


# \^ 0 t ? Each Square Feet >

Pag e 4 of
.COASTA L 

## Ite m Agree dupo nvalu e o f plan t inaterial s no l t o b e reolace db v contractor . Not e thi s \alu e wil l b e use dt o issu e aplan t \ouche r t o th e propert > owner . Agree dupo nlis t o f plan t material s tha t wil l b e replace db y contractor . B e very specifi c an ddetailed . Includ e asketc ho f s^er e eac hplan t wil l b e place d b > th e contractor . Agree dupo nare ao f propert y t o b e replace d withgras s sod . Includ e asketc ho f th e area(s ) t o b e replace d\ ^ it h gras s sod .
Are ao f Cit ) o r County propert y t o b e landscape d pe r thei r requirements . Includ e a-keicl r ol ' tli e are a(s i

Easemen t .Area , t o b e excavate d 

## Quantit y Unit Condition/Type/Specie s 

# t s


# \^Jl(^)^ Eac h 

# H S F 

# %UKb\ i S F

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1



### Page s 

# ».- tC O AS T At .


### Additiona l Comment s / Instnictions : 

# l(A \ 

# k^f^ hph^' w (^m^t

Q Chec k th e boxi fOwne rdoe s not wan t CE G t o documerr t interio rfoundatio n wall s an d possibl e pre-existin g damage
. B ycheckin g thi s boxCE G i s not responsibl e fb ran ydamag e don e t o th e interio rofhouse , indudin g fourxlatio n crack s o rfissures
.

agre e Q Id o no t agre e

^ 

# ^C^ffi^A ^ 

# :s/n :f*sSigiuitur e Dat e 

### Contractor' s Signatare Dat e PageSof
.Dat e Projec l XRFID *

Shot # (j > W 

## M Averag e Shot * l / p 

# ' 7 1 / ^ 

### (^

^ Averag e Shot *

Averag e

Shot *

Averag e la b sampl e * 

# BVID#5J3S S XR F PROPERT Y SAMPL E SHEE T 

## q-ii^-os ^ Addres s 

## qonK^ . -H^)- ^ Au-p , Omah a lea d F P 2n d yea ropilo n Sampl e tim e am/p m \'^\^' ^ 

## r-SQr^A q sampl e lengt h 3 0 se c Readin g Sampl e are a Shot # Readin g Sampl e are a pA-BS i lo-i-7 ^ 

### i \ 4^.<Q | ±q n ^ Z-O./. i i)»,^ ^ ^ 4?3.Aeh^.S' ^ 

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# b ^ i?^.a« l l\V O Dept h 

### 1 5 ^3-^0^^9.7 ^ Dept h 

### ^'^•HfttlO--?' ^ — ^ 

# n ^.c^ t p.q i 

## l< ^ {o l ^^ ±llOQ ^ Averag e ^ \ .0<= i t ^ .^S Q Readin g Sampl e are a Shot * Readin g Sampl e are a 

## a^qitsa s -V J r>'; * q.q ^ 

## ^oJ^* ^ [a i <^b> t iD-^ a Dept h Dept h ^TUSi l ---t.^i D 

### I ^\Jp8t ^..Lg< 9 Averag e Readin g Sampl e are a Shot * Readin g Sanrtpl e are a Dept h Dept h Averag e
RETES TAREA S Readin g Sampl e are a Shot * Readin g Sampl e are a Dept h Dept h Averag e La b resul t Sampl e are a XR F Av g Signature , Prin l AJ' i cofcL. ^ / ^yye-Z ^

# 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 6 Mod e SOI L Tim e 2008-09-1 6 13:5 5 Duratio n 30.0 5 Sequenc e Fina l Flag s BVI D # 5198 8 ADDRES S 90 7 N 5 0 ave . QUAD/ZON E B 2 INSPECTO R lope z DEPT H 6 SAMPL E Pr'P E CLEARANC E NOT E
pp m ±Erro r P b 64.84 9 ±10.64 1 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 72.60 6 Supervise d By : 

## Certificat e o fVerificatio n

7 SOI L 2008-09-1 6 13:5 5 30.5 3 Fina l 5198 8 90 7 N 5 0 ave . 8 2 lope z 6 CLEARANC E

± Erro r 11.23 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 68.47 9 Supervise d By : 

## Certificat e o fVerificatio n

8 SOI L 2008-09-1 6 13:5 6 30.3 6 Fina l 5198 8 90 7 N 5 0 ave . B 2 lope z 6 CLEARANC E

± Erro r ± 11.10 3

# 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 63.48 3 Supervise d By : 

## Certificat e o fVerificatio n

9 SOI L 2008-09-1 6 13:5 7 30.4 7 Fina l 5198 8 90 7 N 5 0 ave . B 2 lope z 6 CLEARANC E

± Erro r ± 10.74 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 1 0 Mod e SOI L Tim e 2008-09-1 6 13:5 7 Duratio n 121.4 1 Sequenc e Fina l Flag s AVERAG E * Av g o f6- 9 » ADDRES S 90 7 N 5 0 ave . QUAD/ZON E INSPECTO R lope z DEPT H •. 6 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 1 1 Mod e SOI L Tim e 2008-09-1 6 13:5 8 Duratio n 30.0 4 Sequenc e Fina l Flag s BVI D # 5198 8 ADDRES S 90 7 N 5 0 ave . QUAD/ZON E D Z INSPECTO R lope z DEPT H 1 2 SAMPL E TYP E CLEARANC E NOT E
pp m ± Erro r P b 46.20 8 ± 9.79 3 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 42.42 1 Supervise d By : 

## Certificat e o fVerificatio n

1 2 SOI L 2008-09-1 6 13:5 9 30.5 9 Fina l 5198 8 90 7 N 5 0 ave . D Z lope z 1 2 CLEARANC E

±Erro r ±9.53 6

# 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 42.69 2 Supervise d By : 

## Certificat e o fVerificatio n

1 3 SOI L 2008-09-1 6 13:5 9 30.3 8 Fina l 5198 8 90 7 N 5 0 ave . D Z lope z 1 2 CLEARANC E

± Erro r ± 9.78 7

# 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 33.04 8 Supervise d By : 

## Certificat e o fVerificatio n

1 4 SOI L 2008-09-1 6 14:0 0 30.3 3 Fina l 5198 8 90 7 N 5 0 ave . D Z lope z 1 2 CLEARANC E

± Erro r d b 8.96 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 AVERAG E ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

P b Supervise d By : 

## Certificat e o fVerificatio n

1 5 SOI L 2008-09-1 6 14:0 0 121.3 4 Fina l TAV J o fll-14i«i j "90 7 N 5 0 ave . 

## w

z lope z 1 2 CLEARANC E

# 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 1 6 Mod e SOI L Tim e 2008-09-1 6 14:0 1 Duratio n 30.4 1 Sequenc e Fina l Flag s BVI D # 5198 8 ADDRES S 90 7 N5 0 ave . QUAD/ZON E easemen t INSPECTO R lope z DEPT H 1 SAMPL E TYP E CLEARANC E NOT E
pp m ±Erro r P b 43.96 6 ±8.92 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 54.06 5 Supervise d By : 

## Certificat e o fVerificatio n

1 7 SOI L 2008-09-1 6 14:0 2 30.4 0 Fina l 5198 8 90 7 N 5 0 ave . easemen t lope z 1 CLEARANC E

± Erro r ± 9.92 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 61.26 0 Supervise d By : 

## Certificat e o fVerificatio n

1 8 SOI L 2008-09-1 6 14:0 2 30.4 8 Fina l 5198 8 90 7 N 5 0 ave . easemen t lope z 1 CLEARANC E

± Erro r ± 10.44 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 47.42 5 Supervise d By : 

## Certificat e o fVerificatio n

1 9 SOI L 2008-09-1 6 14:0 3 30.4 2 Fina l 5198 8 90 7 N 5 0 ave . easemen t lope z 1 CLEARANC E

±Erro r ±9.20 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 AVERAG E ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

P b Supervise d By : 

## Certificat e o fVerificatio n

2 0 SOI L 2008-09-1 6 14:0 3 121.7 1 Fina l Av g o f16-1 9 90 7 N 5 0 ave . easement— , lope z 1 CLEARANC E^ - ^ ST^ ^ 

### Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
. www.coastalhazmat.co m COASTA L ENVIRONMENTA L CROUP
. INC
. 

# EXECUTIV ESUMMARY : BVI D #51988
- (90 7 N5 0 AVE ) IIN o Issue s o r Concern s X 

# Issues/Concern s Detai l Explanation : HOMEOWNE RRECEIVE D COMPENSATIO NFO RTHESUM O F$300.0 0 FO RPLANT S REMOVE D DURIN GTH EREMOVA LO FLEA D IMPACTE D SOIL .1 

# .^EP A EPAPropert ) Clos e Ou t For m Propert y« : ^\Q
. ?0? ^ Propert yAddrcM : ^Q l XT ) ^Q^- ^ /^V^ ­ Datc/Tlroc : Owner' s Namt : ^-g n ISoflCVgr " Quad s Excav.ud : ^ ^ ^ VT^ ^ Coniracio rCrou p T- r^n
. '/-^u 'LV: r\ y \ rnAVUL/V^ ^
Excavatio n Genera l Ye * N o I fnecessary , >vere th e correc t quadrant(s ) excavate d an d restored ? ^ 2

I fnecessary , wer e Ih e correc t area s o fdri p zon e excavate d an d restored* ^ 

## y Cradlo KSo d an d Vcsctalio D Ye s N o I Doe s th e gradin g aroun d th e perimete ro fth e hous e i n excavate d area s generall yslop e awa y ^ from tb e house ? 2 Ha s so d bee n lai d i n al l area s tha t wer e excavated ? < ^ 3
.Doe s th e so d appea rt o b e generall yhealth yan d growing' ' (Onl yevaluat e i finspecte d at a 3 0 da ylim e period ) iy ^ 4Ar e sodde d area s generall yrir m an d evenl ygraded ? t ^ 5 Ar e th e joint s betwee n th e so d strip s generall ytight ? (Onl yevaluat e i finspecte d a t a 3 0 da y U ^ tim e period ) 6 Wa s th e properr ygrade d suc h tha i wate rwil l no t poo l o n ih e property' ' U ^ 7Wa s damag e t o landscapin g o rplan t material s avoided' ' 4 ^ Gam , FeDcc s an d RCUIDID KWall s > e s N o 1 D o gate s ope n an d clos e freely? (I fapplicable ) 2Wer e al l gate s o rfence s take n dow n durin g resloratio n aclivilie s rcinsialled ? (Ifapplicable ) 

### r l 3 Wa s damag e t o gate s o rfence s avoided ? (Ifapplicable ) 

# W' 4Wa s damig e t o retainin g wall s avoided ? (Ifapplicable ) FouDdalioD , Sidio Kan d Gutter s Ye s N o 1 , Wa s damag e t o th e sidin g o rtri m avoided ? l / 2 Wa s damag e l o th e foundatio n avoided' ' l y 3 Wa s damag e l o window s avoided ? L- ^ 4
. Wa s damag e t o window s o rdoo rscreen s avoided' ' i.- ^ 5 Wa s damag e t o downspout s o rdownspou l extension s avoided' ' X ^ Sidenalk a an d Driveway s (Concrete ) Yes No Wa s damag e t o drivewa ysurface s avoided' ' 2Wa s damag e t o walkva ysurface s avoided' / ^

i\\
. ly i V :5^_iii.a i I V > . / l . i i- \ 1

## Propert yCompletio n Agreemen t Thi s agreemen l documeni s Ih e complclio n o fremedia l aclivilie s perloime d o n m yproperly
. M ysignalui e wil l designat e iha l I a m salisfie d wil h Ih e restoratio n o fm yproperly , an d iha l n o item s ar e m questions , now , o ra l an ylim e i n ih e fuluie , excep t Ihos e item s liste d below , ifan y

Propert yI D ^- j C^i^t ^ Propert yAddress : q Q ^ ^y j ^^•U
. ,|< \ ^/ ^ 

## Q-""^c. o i^r^ e r " 

# ^^°-^9^-/9^-<; - Restoratio n Item s i n Questio n

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

-j

^ If^ J I ayre crc,<;roralio n i. s completed , excep t u s note d I I d o np)-imie crestoratio n i s complele d 

# 'Jh/ M iic i ' s Si^n*rrtr e m\fi ' Con d actor' s Sipnahir cDat e I

## Propert yDamag e Settlemen t

Propert y I D 5198 8 Propert y Addres s 90 7 S 50' " S t Owne r Ro nBoecke r Phon e 402-699-195 5

I hav e receive dfromth e contractor , Coastal Envirorunental Grou p Inc . (Coastal) , th e sumo f $ 300.0 0 a s compensatio nfor plant s remove dfromth e dri p zon e whil e removin g lea dimpacte dsoi l fromth e property .

Chec k Numbe r 151 8 Valu e of Chec k $300.0 0 Mad e Ou t T o Ro nBoecke r Descriptio n o fMiscellaneou s Settlemen t Coasta l accesse d th e propertyat 90 7 S 50'^ St
. t o remove d lea d impacte d soil
. Durin g excavatio n at thi s propertyal l th e smal l plant s tha t wer e lotDate d insid e th e Dri p Zon e wer e remove d an d discarded
. Coasta l an d th e P O hav e agree d tha t $300.0 0 i s fai ran d sufficien t compensatio n fo rthes e plants
. Th e P O wil l replac e th e plant s t o pre-existin g condition s at his/he row n leisure
. M ysignatur e belo wi s acknowledgemen t o ftli e receip t o fth e sui n liste d above , whic h I furthe r acknowledg e t o b e fai rcompensatio n fo rth e miscellaneou s settlemen t describe d abov e an d releas e Coasta l Environmenta l Grou p In cfro m furthe robligation s o rliabilit yrelate d t o thi s settlement
.



# 31910^ 1 L.- ^ wrier' s Signatur e Contractor' s Signatur e Dat e

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