## TRANSMITTALo f

OMAHALEAD SITE SOILREMEDIATIO NFIL EFOLDER
SAID # : l^S^S^ aDate : ::^llnjn^ l Address : '^CTA ^

- ^ U ^S- J Remediatio nContractor : Coasta l Environmenta l Group

_Year : 200 8
SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S
a /

Vide o o f property (DVD ) 5 /

Executiv e Summary y EPA-provide dproperty sketc hSuperfun d \y Signe dAcces s Agreemen t fo r subjec t property )^P r Signe dAcces s Agreement(s ) fo r adjacent property y Restoratio nAgreemen t fs|| \Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) Q / Confirmatio ndat a 5 /

Photograph s prd^jg^r^jQilM ^ Qy)LCyii)cJli\A ^ -[cruUS'0< i ? ] As-buil t sketc h y Satisfactory restoratio nsigne db y Property Owner y Property close-ou t chec k lis t signe db y EPA Jtjf lDescriptio no f area s no t meetin g RO D cleanu p criteri a \MUtility clearance s 3

/ Property informatio nfro mDougla s County Assessor' s Offic e



# %CMtV9 h3/iry q Signatur e Dat e

## Propert yAcces s Checklis t Property ID : j L \g ^ 1 , D WOR K STARTE D ON : / / D WORKCOMPELTE D ON : / / Property Address : '^O Q ] 'i D 34 ^^ ' Rente r Owner : \W LC U O LQ J i r f Addrctis : ^ Phone : Fax : Ccll/Pager : Phone : ^ ^ ^ ) ^D30 2 Additional Infonnation : Fax : Ccll/Pager : D NotificationLette r Sent : / / By : r ^ Acces s Agreement Signed : _U2/_i3/J2 ^ 

## By:£( L Signed : iiI/i2L/. ^ By : ^.C
. D Topsoil Samplin g (if applicable ) / / By : Q Disposa l Samplin g (if applicable ) / / By : GGarde nSamplin g (if applicable ) / / By : 0 Utilit y Clearanc e Called : J0_/iD_/il 2 By : 10 / 5/(D ^ 0 Video/Photo s (Before ) On:l 0 /Ql3>/n9
. By^Uirk^Vi S nVideo/Photo s (During ) On : / / By : nVideo/Photo s (After) On : / / By : nVideo/Photo s (30-Day ) On : / / By : D Property Completio nAgreement Siened : / / By : D Final Report Issued : / / By : Air Monitorin g (a s applicable ) nCommunit y • Cre w On : / / By : Results :

• Conunnnit y • Cre w On : / / By : Results :
r~ 1 Communit y • Cre w On : / / By : Results :
Omah a Lea d Sit e

## CONTAC T FOR M Propert yID) ^ Propeit y Address : Initia l Contact : Secon d Contact : Fina l Conlact : Fina l Action :



## Comment : 0^vne ^ Commen t (s) : Sit e Coordinato r Commen t (sj : 

# N ^S ' 

# Z 3DD i 

# ^ 

# 3 M ^"T " Dale : Date : Dale ; Transmi t 

## Time : Time : Time : t o EP AD Action : Action : Aclion ; Othe r.Action : D

### JDougla s County Accoun t Informatio n Pag e I of 2
Dougla s County , Nebrask a Propert yRecor d - R194261000 0 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 - ViewO n Ma p Informatio n i s vali d a s o f2008-9- 4 Treasurer' s Ta xRepor t Ne wFeatur e -•->••Aut o Sale s Searc h Owne r MCGUIR E MIK E P ETA L 300 1 S 3 4 S T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 426 1 000 0 1 9 Accoun t Type : Residentia l Parce l Number : 194261000 0 Parce l Address : Lega l Description : 300 1 8 3 4 S T OMAH AN E 68105-000 0 PARKVAL E LOT1 4 BLOC K4 4 0 X 13 0 Valu e Informatio n
200 8 200 7 200 6 200 5 200 4 200 3 Lan d $5,800.0 0 $5,800.0 0 $5,800.0 0 $5,800.0 0 $5,800.0 0 $5,800.0 0 Improvemen t $110,300.0 0 $110,300.0 0 $94,100.0 0 $94,100.0 0 $94,100.0 0 $74,800.0 0 Tota l $116,100.0 0 $116,100.0 0 $99,900.0 0 $99,900.0 0 $99,900.0 0 $80,600.0 0 Sale s Informatio n Sale s Date : 2001-11-0 2 Dee d Type : Price : W D $90,000.0 0 Book : 219 6 Page : 50 4
Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 1 5200. 0 1. 0 130. 0 40. 0 N o Improvemen t Informatio n


### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19.
. . 10/7/200 8

### JPougla s County Accoun t Informatio n Pag e 2 of 2 rmai K

Buildin g 1

Secon d Floo r Fir^sFtooi r 85 6 0 5 0 f l 88 1 Os q t t

^ ajARisrCaln g -^y^ " Tw o Stor y

CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : i 1737. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 2 Stor y 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 : Drywal l Baths : 1. 5 Roo fCover : Compositio n Shingl e Bedrooms : 4. 0

Roo fType : Hi p Stories : 2. 0 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : ; 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 192 1 0 % 192 1 8 7 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Fenc e Chai n Lin k 1. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 863. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Fixtur e Bat h Hal f 1. 0 Garag e Detache d 198. 0 Porc h Sla b Roo fCei l 160. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19.
. . 10/7/200 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 2160976
. Origina l Cal l Date : 10/23/0 8 Time : 8:5 2 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 10/28/0 8 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 300 1 Street : S 34T H S T Twp : 15 NRng : 13 E Sect-Qtr : 33-NW 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 PROPERT Y INCLUDIN G TH E 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 : N Front : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F QWEST 2



### Servic e Are a Contac t Phon e Number UtiUt y Typ e Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEIDI Alt : 402934046 9 Emerg : 402932975 7 Day : 402504782 3 1V1UD02 

### METROPOLITA NUTILITIES DISTRIC T SAND Y Alt : Emerg : 402504794 6 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R RO NAlt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 OPPDGPR 6 OMAH APUBLI C POWE RDISTRIC T N AAlt : 888728934 3 Emerg : 406728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.
. . 10/23/200 8

### Pag e 2 of 2

QLNN E1 FQWES T LOCA LNETWOR K 

### M A Day : 406728934 3

Alt : Emerg : 888728934 3
QWEST 2 QWES T LON GDISTANC E 

### SAR A Day : 800283423 7

Alt : 303992192 6 Emerg : 800283423 7

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.
. . 10/23/200 8

# 0 As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e

Name : Aijdress : _ 30C I 

## 5
. ? a ^ r Phone :
Tea m 

## vli\{ii^jlh\ U \f ^ BVID # Sampl e Numbe r 

# m Omah a Lea d Sit e Stt e Sketc h


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### /2^=f-ul i PPf " 

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o •3 ' N

o ^ ^ p/VYes S ^ N o Ifi ^ ^ Ye s • N o •



# 5 , ? v y Omah aLea dSit e 4613 0 

### Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are a replace d wit h Are a replace d wit h Are a lef t bar e So d ' ' Rock/Mulc h 

### Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .Name ; Omah a Lea d Sit e 

# Date : iM a Nort h Arro w Address : _ 

### 300 1 Sit e Sketc h Time ; ^I.» / ^ A 

# ^.^^ r Phone :


### Team 

# A\iilyjih\ U \f'( ^ BviD#Ji^Ml i XR F Code^SS^^n
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### Date ; i M ( ^ Nort h Arro w Address ; _ •300 1 Sit e Sketc h 

### Time ; "? ! Zx j f^ ^ 

## 5,^^ ^ 

# f Phone ;

Omah aLea dSit e 4613 0Name ; Omah a Lea d Sit e 

# Date : nM^J Nort h Arro w Address ; _ 3017 1 Sit e Sketc h 

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.



# 5 , 5 vy . OmahaLea dSite 46130

# m M COASTA L INVIIONM fHTA l ca o u F , IN C 

## '*^^i^y 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 : pT^W e YV\'"G^iV e Daytim e Phone : i^a2,-^%l-o})(j ^ 

## 3oo | So
. h^' ^ St - Addres s o fPropert y 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 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 t)egins
. 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 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 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 f2

# 'wy i COASTA L (NVmOHtlFNTII l C I O U >
. IM 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 gran t acces s t o m ypropertie s D I d o no t gran t acces s t o m ypropertie s 

# M y

- n^yy-.. > l^l'=i[o ^ Signatur e Signatur e Dat e

QI 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 o f thi s agreemen t i s to provid e amutua l agreemen t a s t o condition s ofth e propert y prio r t o remediatio nactivities
. Thi s will als o serv e a s documentatio nfo r th e purpos e o f assurin g that restoratio n activitie s ar e complete dto th e satisfactio no f th e propeitv ' owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA)
. t Propert y ID : I H ^ Y ^ 

### j Propert y Address : ^ Q ^ ( S ^ ^ j ^ k S' T Owner : /M / A g / ^ c Q^ t Phone : 

# TfToro ^ •r e

O nth e attache ddiagrain(s ) indicat e area(s ) to excavate dan ddept ho f excavation , locatio no f al l know n utilities , subsurfac e features , syrfac e structure s an dlandscapin g features , acces s location(s ) to b e use db y contractor , an dth e directio no f North
. Indicat e distances , depths , material types , etc . Indicat e digita l photo s by referencin g th e photo-lo g numbe r wit hanarro w indicatin g directio no f 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 : 

# /U o 

# yjC

Pag e 1 o fCOASTA L FK.vtnoHi-'fM'rA L c« o wf
. t « 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 : 

## S (A A CL I 

# ctyi'TS ' / n:>c7^5>
. ^n d 

# f ci^lr.5 > I^P ^ Jyr-^lliino / Item : Item : Item : I Item :

Item : item : Item : Item : "7 ^ Item : Item : Item : Item : Item :

Pag e 2 

### o fJ- )< ^ C Q AS TAL rMVtNOMncNTA L cM e u rIN C

Item :
Item : 

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### y rs > 

### \ \ 

# y <>o X ^x

­ f l ­ D~ ^ ^

\ Item :

Item :
Item : Item : Item : Item : Item :
ttem :
Item : Item : Item :
Item :
Item : / /

Pag e 3 

### o f 1/ 7COASTA L f N*IKOI-"*l* < f* l



### Ite m

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

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

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

Numbe r o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Attac hasketc ho f th e sprinkle r layout
.

Numbe r o f an dsiz e o f eac hgarden / flowe r be d area . Attac hasketc ho f relativ e size s an dlocations
. 

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

### Quantit y Unit Condition/Type/Specle s

Squar e feet 

# 1 • . Eac h

Eac h 

# 1 

# y Eac h

Eac h 

# y ^ Squar e Fee t

Pag e 4 

# o^_(2 ­< ^ ^ C O / I S TAL 

### Ite m Quantit y Urii t Condition/Type/Specle s Agree dupo nvalu e of plan t material s no t t

o be renlace dbv contractor . Not e thi s valu e wil l be usedto issue aplant vouche r to th e propert y owner . Agreeduponlist of plan t material s tha t will b e replace db y contractor . B e ver y specifi c an ddetailed
. Include asketchof wer e eachplant wil l b e placed b

y the contractor . Eac h

Agreedupo n propert y t o b e wit hgras s sod
. are aof replaced Include asketchof the area(s ) t o be replace dwit h aras s sod
. 

# y <) y S F 

# Qr^ ^

Are aof Cit y o r Count y propert y to be landscaped per thei r requirements
. Include asketcho f the are a(s ) S F

Easemen t Area , to b e excavate d 

# 1 U 

# V S F 

# X t 

# V ^ 

# y .^y ^

Pag e 5 of
. 

# lC O AS T A1 -


### Additiona l Comments / Instructions :


# W'ici ^ f^\ y ^A^y

\ J 5 e Tc.* - c^cce 5 ^~'= > B - ^

D Chec k th e boxi fOwne rdoe s not wan t CE G t o documen t interio rfoundation wall s an d possibl e pre-existin g damage
. B ydieckin g thi s boxCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro fhouse , includin g foundatio n cxad< s o rfissures.
yC\I agre e D I d o no t agre e 

# A ^ ^"4^ - i^h/o ^ ?fmy^
. \y\j ^ Owner' s Signature Dat e Contractor' s Statur e Dat e Pag e 6 o fDat e Projec t XRFID #

Shot # 

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Averag e la b sampl e # 

### BVID # 

# 1^8)6'^ XR F PROPERT Y SAMPL E SHEE T Addres s 

# \\-n-o 8 y£>o \

S sa^st - Omah a lead F P 2n d yea ropilo n Sampl e tim e am/p m 

### '^-^C^Pf i sampl e lengt h 3 0 se c

Readin g Sampl e are a Sho t # Readin g Sampl e are a i7ft.\ \ t We.& \ 

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# y y ^.'^•(p^^Wlt ^ Dept h 

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Readin g Sampl e are a Shot * Readin g Sampl 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 

# y / Averag e La b resul t Sampl e are a XR F Avg
. Signatur e 

# l^m- ^ M^K Prin t

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

Supervise d By : 

## Certificat e o f Verificatio n

278 6 SOIL 2008-11-0 7 13:4 9 122.8 1 Fina l Av g o f 2782-278 5 300 1 s 3 4 s t easemen t Ventr y 1 CLEARANC E

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 178.10 9 Supervise d By : 

## Certificat e o fVerificatio n

278 2 SOI L 2008-11-0 7 13:4 7 30.6 4 Fina l 1488 2 300 1 s 3 4 s t easemen t Ventr y 1 CLEARANC E

± Erro r ± 16.20 5

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 141.34 5 Supervise d By : 

## Certificat e o f Verificatio n

278 3 SOIL 2008-11-0 7 13:4 8 30.6 3 Fina l 1488 2 300 1 s 3 4 s t easemen t Ventr y 1 CLEARANC E

± Erro r ± 14.74 7

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 132.53 0 Supervise d By : 

## Certificat e o f Verificatio n

278 4 SOIL 2008-11-0 7 13:4 9 30.5 9 Fina l 1488 2 300 1 s 3 4 s t easemen t Ventr y 1 CLEARANC E

± Erro r ± 14.03 4

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 142.35 1 Supervise d By : 

## Certificat e o fVerificatio n

278 5 SOI L 2008-11-0 7 13:4 9 30.9 5 Fina l 1488 2 300 1 s 3 4 s t easemen t Ventr y 1 CLEARANC E

± Erro r ± 14.73 3

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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

Supervise d By : 

## Certificat e o f Verificatio n

279 1 SOIL 2008-11-0 7 13:5 3 122.7 2 Fina l Avg o f 2787-279 0 300 1 s 3 4 s t F l Ventr y 6 CLEARANC E

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 44.60 9 Supervise d By : 

## Certificat e o fVerificatio n

278 7 SOI L 2008-11-0 7 13:5 1 30.8 8 Fina l 1488 2 300 1 s 3 4 s t F l Ventr y 6 CLEARANC E

± Erro r ± 9.35 8

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 55.78 4 Supervise d By : 

## Certificat e o fVerificatio n

278 8 SOI L 2008-11-0 7 13:5 1 30.5 5 Fina l 1488 2 300 1 s 3 4 s t F l Ventr y 6 CLEARANC E

±Erro r ±10.08 5

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 278 9 Mod e SOI L Tim e 2008-11-0 7 13:5 2 Duratio n 30.4 1 Sequenc e Fina l Flag s BVI D # 1488 2 ADDRES S 300 1 s 3 4 s t QUAD/ZON E F l INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 35.99 8 ±9.03 1 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 60.92 7 Supervise d By : 

## Certificat e o fVerificatio n

279 0 SOI L 2008-11-0 7 13:5 3 30.8 8 Fina l 1488 2 300 1 s 3 4 s t F l Ventr y 6 CLEARANC E

± Erro r ± 10.55 9

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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

Supervise d By : 

## Certificat e o fVerificatio n

279 6 SOI L 2008-11-0 7 13:5 6 121.7 1 Fina l Av g o f2792-279 5 300 1 s 3 4 s t D Z Ventr y 1 3 CLEARANC E

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 108.45 5 Supervise d By : 

## Certificat e o fVerificatio n

279 2 SOI L 2008-11-0 7 13:5 4 30.3 0 Fina l 1488 2 300 1 s 3 4 s t D Z Ventr y 1 3 CLEARANC E

± Erro r ± 13.22 3

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 140.76 5 Supervise d By : 

## Certificat e o fVerificatio n

279 3 SOI L 2008-11-0 7 13:5 5 30.6 2 Fina l 1488 2 300 1 s 3 4 s t D Z Ventr y 1 3 CLEARANC E

± Erro r ± 14.92 0

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 89.67 3 Supervise d By : 

## Certificat e o fVerificatio n

279 4 SOI L 2008-11-0 7 13:5 6 30.5 6 Fina l 1488 2 300 1 s 3 4 s t D Z Ventr y 1 3 CLEARANC E

± Erro r ± 12.14 2

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 203.13 3 Supervise d By : 

## Certificat e o fVerificatio n

279 5 SOI L 2008-11-0 7 13:5 6 30.2 3 Fina l 1488 2 300 1 s 3 4 s t D Z Ventr y 1 3 CLEARANC E

± Erro r ± 17.78 3

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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

Supervise d By : 

## Certificat e o fVerificatio n

280 1 SOI L 2008-11-0 7 14:0 0 122.5 3 Fina l Av g o f2797-280 0 300 1 s 3 4 s t B 2 Ventr y 6 CLEARANC E

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 71.26 5 Supervise d By : 

## Certificat e o f Verificatio n

279 7 SOIL 2008-11-0 7 13:5 7 30.8 9 Fina l 1488 2 300 1 s 3 4 s t B 2 Ventr y 6 CLEARANC E

± Erro r ± 11.18 9

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 279 8 Mod e SOI L Tim e 2008-11-0 7 13:5 8 Duratio n 30.5 0 Sequenc e Fina l Flag s BVI D # 1488 2 ADDRES S 300 1 S 3 4 St 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 84.85 6 ±12.11 4 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 105.59 6 Supervise d By : 

## Certificat e o fVerificatio n

279 9 SOI L 2008-11-0 7 13:5 9 30.5 7 Fina l 1488 2 300 1 s 3 4 s t B 2 Ventr y 6 CLEARANC E

± Erro r ± 13.22 7

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 93.21 8 Supervise d By : 

## Certificat e o f Verificatio n

280 0 SOI L 2008-11-0 7 14:0 0 30.5 7 Fina l 1488 2 300 1 s 3 4 s t B 2 Ventr y 6 CLEARANC E

±Erro r ±12.26 7X 

# •

M 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 ENVIIONnENTA L %PBo^ ^ COASTA L INC
. CROUP
. 

# EXECUTIV ESUMMARY : BVI D #1488 2 - (300 1 S 3 4 ST )
N o Issue s o r Concern s | ^ Issues/Concern s Detai l Explanatio n

## sti
. 

# EP A EP APropert y Clos e Ou t For m m<^A GP-~rt v Addr«.^

- .300\ , " ^ ' ^ ^ Propert yff : Propert y Address: ^ Date/Time : -j=-A ­ Owner' s Nam e Quad s Excavaied : -^ \iRc Q ^ ^?r Contracto r Gro u Ye s N o Excavatio nGenera l 1
.I f necessary , wer e th e correc t quadrant(s ) excavaie dan drestored ? 2
.If necessary , wer e th e correc l area s ofdri p zon e excavate dan drestored ? 

### y ^ Gradin g So dan dVctctatio n Yes N o I Doe s th e gradin g aroun dth e perimete r ofth e hous e inexcavate darea s generall y slop e away u ^ fromth 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 to b e generall y health y andgrowing ? (Onl y evaluat e i f inspecte da t a3 0 da y tim e period ) 4
.Ar e sodde darea s generall y firman devenl y graded ? 5Ar c di e joint s t)erwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da t a3 0 day tim e period ) 6
.Wa s th e propert y grade dsuc hthat wale r wil l no l poo l onth e propeny ? 7
.

Wa s damag e t o landscapin g o r plan t material s avoided ? 

## y Gates , Fence s an d RcUinin e Wail s Ye s N o 1
.D o gate s ope n an d clo.se freely? (Ifapplicable ) 

### y 2
.Wer e al l gate s o rfence s take n c\owr \ durin g restoratio n acliviiie s reinstalled ? (I fapplicahle ) 

### y 3
.Wa s damag e t o gate s o rfence s avoided ? (Ifapplicable ) 

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

## y Foundation , Sidio can d Gutter s Yes N o I
.

Wa s damag e l o th e sidin g o rtri m avoided ? t ^ 2
.Wa s damag e t o th e foundatio n avoided ? y 3
.Wa s damag e l o window s avoided ? y 4Wa s damag e t o window s o rdoo rscreen s avoided ? y 5
.Wa s damag e t o dowTispouts o rdownspou l extension s avoided ? y Sidewalk s an dDriveway s (Concrete ) Ye s No 1
.Wa s damag e l o drivewa y surface s avoided ? 2
.Wa s damag e t o walkwa y surface s avoided ? 

### y

## OMoer s comments :

Inspectio nnotes :

Remova l an dresloratio naclivale s complei e includin g th e 30-day so dwarranry : HP ARepresenlali><;7^I^4^^^^^<^^Xfe ^ Dale : ^y^S^yd y

# If »

Propert yCompletio n Agreemen t Thi s agreemen i documenl s th e completio no f remedia l activitie s performe donm y properl y M y signalur e wil l designal e that 1 a msatisfie dwil hth e restoratio no f my property , an dtha t no ilem s ar e i nquestions , now , or a

t an y tim e i nth e future , excep i thos e item s lisle dbelow , ifan y PropcrtyTD : \u\p ^ Q Propert y Address : 2,^^ ^ ^
. .--^gi ^ ^^
. Owner : |V^',S ^ ^ApCAlA:^r- e Phone : C^ ^ _ Q 

# g ^
Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item : 

# J

J/\ [ I agre e restoratio nI s complcled , excep i a s nole d I I d o no l a(;re c resloralio ni s complete d 

# ynz n ( / \< \o l Owner' s Signatur e Dat t ^ Contractor' s Signatur e Dat e I

# 3o<i> i y j^ i ^ ^ y 

# 1 ^
Punchlis t Item s 

### ID # 

# ii^ y Dat e 

# ; (y X 

# i-o E Name /^ ( 1 ^ /^C QO \T<e
. Descnption :