## TRANSMITTA Lof OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAID# : V/^ 1 ^ Date : " ^ | \ l 

# k Address : ^I^ H f^t^j^eW C ^^j ^ Remediatio nContractor : _Coasta l Environmenta l Group

_Year : _20 i d ^
SOI LREMEDIATIO N PROPERT Y nLEFOLDE RDOCUMENT S / 

### Vide o o f property (DVD ) Executiv e Summar y 5

/ EPA-providedproperty sketch
^ SignedAcces s Agreement fo r subject property -B ^ SignedAcces s Agreement(s ) fo r adjacen t propert y B Restoratio nAgreement • ^ Settlemen t dociunent s (i.e. , fo r damag e o r to replac e plants , etc. ) -6

- Confinnatio ndata IZPhotograph s (T^^I^ITU ^ 

### ^ \ H tiO^>tl/l'<1W ^
^ As-built sketch 0 Satisfactor y restoratio nsignedb y Propert y Owner 5 /

Propert y close-out check lis t signedb y EP A G-
. Descriptio no f area s not meetin g RO D cleanup criteri a B Utilit y clearance s !u Propert y inflSrn^tionfro mDougla s Count y Assessor' s Office

Dat e
Superfun d#



## Propert yAcces s Checklis t PropcTT^l D :|^7)f)4\ Prcpcr,vAddre»:2nM M V^T}^Y\^\ ^ O DWOR K STARTED WOR K COMPELTE D ON ON : _ / / /_ /

0-- ' '31J\K) S \AJo\-ff Address ; ^ot^V\jl

_

Phon e 1^1-7 , -^Q-j ^ Fa^ : Ccll/Pager

. Rcnie r Phone : PAS : Cell/P»ger : Additiona l InlnrmKtion :

D Notificiilio n Lette r 

# w Acces i Agreemen t 

# ¥ Restoriitio n Agreemen t D Topsoi l Samplin g (i f ipplicuble ) Q Dispo5t U Samplin g ( K^applicable ) O Gnrdc n Snmplio g (i f applicable ) Q JUtilii yClearanc e 

# w^ Video/Phofo s (Before ) D Video/Pholo s (During ) D Video/Photo s (After ) Scnl : Signed : Jl/25/ ^ Signed : ^/2&/fl a

Called :



## On:'^/Z5^i2 ^ O n O n Bv : 

# g > O ^ 

# Wv' b ^y\(^V\\r\ { By : By : By : By : By : 

# J^ChM ^ Bv : By :

D tJeo/PholO J (30-Day ) ropcrt yCompletio n Agreemen t Fina l Repor t O D / / Signed:^?." ) Issued : / ^ By : By : By : Ai rMonitorint ; (ii a applicable )

D Communrt yD Cre w Results : OD : / / By :

D Comrounir c Results : Q Cre w On : / / Bv :

D Communir i RetulU : D CrL'»v On : / / Bv :

Omah a Lea d Srt e

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

Comment : Owner Commen t (s) :
Site Coordinato r Comment (s) : CONTAC T FOR M 

# U>1S5M \ 11M 4 fonVf.r^fAW^r > Date : Time : Action : Date : Time : Action : Date : Time : Action : Transmi t to EP A D Othe r Action : D

## Dougla s Count y Accoun t InfornMjio n Pag e 1 of 3 • rnu^c
Dougla s County , Nebrask a Propert yRecor d - R081183000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e ( ®

scal e 0-5 0 f t wes t o f52n d S t - ViewO H Ma p Informatio n i s vali d a s o f2009-6-1 6 Treasurer' s Ta xRepor t Ne wFeatur e - • ^ • • Aut o Sale s Searc h Owne r WOLF E JULIU S L ETA L 274 4 FONTENELL E BLV D OMAH AN E 68104-000 0 Propert yInformatio n Ke yNumber : 118 3 000 0 0 8 Accoun t Type : Residentia l Parce l Number : 081183000 0 Parce l Address : 274 4 FONTENELL E B D OMAH AN E 68104-000 0 Lega l Description : CLAIRMON TLO T3 BLOC K5 5 0 X 12 5 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $6,400.0 0 $83,000.0 0 $89,400.0 0 200 8 $6,400.0 0 $83,000.0 0 $89,400.0 0 200 7 $6,400.0 0 $83,000.0 0 $89,400.0 0 200 6 $6,400.0 0 $83,000.0 0 $89,400.0 0 200 5 $6,400.0 0 $77,000.0 0 $83,400.0 0 200 4 $6,400.0 0 $70,000.0 0 $76,400.0 0 Sale s Informatio n Sale s Date : 2001-11-1 2 Dee d Type : W D Book : 219 7 Page : 1 8 Price : $ 87,000.0 0 Grantor : GrantBe : Valid/Invalid : Vali d Exclusio n Reason : Multipl e 451-Part i In t Vali d Sale s Date : 2001-11-1 2 Dee d Type : W D Book : 219 7 Page : 1 9 Price : $1.0 0 Grantor

## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R081..
. 7/7/2009

### Dougla s County Accoun t Inforrmjo n Pag e 2 o f 3 rin^ c
Grantee : Valid/Invalid : Invali d Exclusio n Reason : Multipl e 45 1 Part i In t Invali d Sale s Date : 2000-09-0 5 Dee d Type : D Book : 216 2 Page : 19 3 Price : $6,506.0 0 Grantor : Grantee : Valid/Invalid : invali d Exclusio n Reason : Sal e byGovt Agenc y Sale s Date : 2000-08-2 9 Dee d Type : Book : 216 2 Page : 04 7 Price : $29,000.0 0 Grantor : Grantee : Valid/Invalid : Invali d Exclusio n Reason : Foreclosur e Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 4 6250. 0 1. 0 125. 0 50. 0 N o Improvemen t Informatio n Buildin g 1

I74 < FONTENEU EB D

nmROO T Secon d Roa r B M 0 « q*.

- 7 « a « I ft
2 STORY B«frr « Blac k B B OB.On)

. ft. i9it'<;n]'C M .i r < -fi ' P t q ( 1

CLICKJ O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1584. 0 Percen t Complete : 100.0 % Perinnete r 0. 0 Quality : Averag e


### http://douglasne.mapping-online.com/DouglasCoNe/static/accoiintinfo.jsp?accountno=R081.
. . 7/7/200 9

## Dougla s Count y Accoun t Infonn||io n Pag e 3 of 3 >n4|g c
Uni t Type :

Buil t As :

HVAC : Exterior : Interior : Roo fCover :

Roo fType : Floorcover :
Yea rBuil t 191 8 Detai l Typ e Applianc e Applianc e Basemen t Fixtur e Fixtur e Garag e Porc h Porc h 2 Stor y Centra l Ai rt o Ai r Fram e Sidin g Drywal l Compositio n Shingl e Gabl e Allowanc e
yea r Percen t Remodele d Remodele d 200 1 0 % Detai l Descriptio n Allowanc e Fireplac e Masonr y Bsmn t Bloc k 8 f t Bas e Fixture s Bat h Ful l Detache d En d Scree n Sla b RoofCei l Condition : Cond o Squar e Footage : Rooms :

Units : Baths : Bedrooms : Stories : Foundation : Sprinkle rSquar e Footage : Adjuste d Yea r Fai r 0. 0 7. 0 1. 0 1. 0 4. 0 2. 0 Bloc k 0. 0 Physica l Ag e Buil t 198 0 2 9 Unit s 1. 0 1. 0 836. 0 1. 0 1. 0 192. 0

42. 0 162. 0



## http://douglasne.mapping-online.com/DouglasCoNe/static/accoiintinfo.jsp?accovintno=R081..
. 7/7/2009

### Pag e 1 o f 1 %

[ Creat e Anothe rTicke t j [ Bac k t o Irt h Inteme t | I Sen d Emai l ]


### YOU RTICKE T NUMBE RI S 2333471
. Origina l Cal l Date : 8/04/0 9 Time : 3:2 6 pm Op : ELIZABETH1879 0 Wor k t o Begi n Date : 8/06/0 9 Time : 4:0 0 pm State : N E County : DOUGLA S Place : OMAH A Address : 274 4 Street : FONTENELL E BLV D Twp : 15 NRng : 13 E Sect-Qtr : 08-NW-S W 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 ABOU T CORNE R LO T Compan y: COASTA L ENVIRONMENTAL 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 : 4 F t Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Boring : N Explosives : N CXCAT V MUDO l OMAHACO F 0PPDGPR 5 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

MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : 

### Emerg : 402504797 0

OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO N 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 4024445160

OPPDGPR 5 OMAH APUBLI C POWE RDISTRIC T N A 

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

### Day : 406728934 3 Alt : 4062071494 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 8/4/200 9

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e
6354 1 Exteno rPain t Nort h ArTCT W Oniah a Lea d Sit e ( 2 Goo d Sit e Sketc h • Poo r Samplin g Address : 274 4 FONTENELL E B D I I No fpain t Sampl e Numbe r Lea d Sampl e LA B Sample s Collectej J Concentratio n Collecte d Firm : fP AP g • AJ RYASCPXA-6354 1 F l 

# n pp m Date ; q -22 - - Of i RYBSCPXA-6354 1 F 2 

### i-iq 3 pp m 

# n Time : l2-'3 0 ^t A RYCSCPXA-6354 1 B 1 

### -LS-i

. pp m 

# a Sample s Analyze d RYDSCPXA-6354 1 B 2 

### 2 0 & pp m 

## D RDZSCPXA-6354 1 D Z 

# i 30,1 0 pp m 

# n XR F Unit : foSH O Book : 2.2 0 nOZCCPXA-63S4 1 Q2 - pp m 

### D Date : I O • 2 B "O S RPZSCPXA-6354 1 P Z 

## 6> 8 pp m 

# n Time : flm ^ Staff : <rTSL« > Numbe ro fSample s • 

# ra Legend : F l = Fron t Left

. F 2 = Fron t Right , B 1 = Bac k Left , 8 2 = Bac k Righ t D Z = Dri p Zone

. G Z = Garden , P Z = Pla i Al l quadrant s ar e a s viewe d fro m th e street , racin g propert y

Rv*\ ' :<«1 8 Crened : 27-,>ug


### Legen d 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
.

### 6354 1 Omah a Lead Sit e Extefio rPain t Sit e Sketc h 1 3 Goo d
• Poo r Samplin g Address : 2744 FONTENELL E B D [| ] No t pain t Lea d Sampl e Sample s Collectej J Sampl e Numbe r 

# I LA B Concentratio n Collecte d Fimi : fP An^A J RYASCPXA-6354 1 F t pp m 

### D Date : ^-U-OP , 102.
. RYBSCPXA-6354 1 F 2 pp m 

### D Time : lZ'-3 0 p^» ^ RYCSCPXA-6354 1 B l pp m 

### D —USJ L Sample s Analyze d RYDSCPXA-6354 1 8 2 pp m 

### D RD2SCPXA-6354 1 D Z pp m 

### D XR F Unit : foSH O Book:22 Q 3(P2 0 nCZCCPX A63S4 1 S2
- pp m 

### D Date : _ RPZSCPXA-6354 1 P Z pp m Time : _ flry, 

## n Staff : • ^^t ^ Numbe ro fSample s = | ( ^ \

\ Q | Legend : F l = Fron t Left , F 2 = Fron t Right , 8 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla ; Al l quadrant s ar e a

s viewe d from th e street , facin g propert y

^



# o

J D
irmi H '-rciKc t :7-.\ug-i> K


# e

^

^

## 6354 1 Omah a Lea d Sit e Sit e Sketc h BcterlorPain t ffl Goo d
• Poo r Nort h AfRM v
Samolin a Address : 274 4 FONTENELL E B D • Notpaint Lea d Sampl e Samples Collecte$ l Sampl e Numtw r 

# I LA B Concentratio n Collecte d F\m : RYASCPXA-6354 1 F l /OZ ^

pp m 

# n Date : Q-2Z-0f t RYBSCPXA-6354 1 F 2 >~»q 3 pp m 

## D Time : IZ.3 0 Oi A RYC8CPXA-6354 1 B l pp m 

## D 

# xai
. Samples Analyze d RYDSCPXA-6354 1 B2 

## 2^) 8 ,PP m 

## D RDZSCPXA-6354 1 D Z pp m 

## D XR F Unit : &^H 0 Bool e 22 0 RCZSCPXA-6354 1 82 - .pp m 

## D Date : IO'2B-o S RPZSCPXA-6354 1 P Z pp m 

## D Time : flrv. Staff:

. msA ^ Numbe ro f Sample s = | ( ^ \

| ( ^ | Legend : F l = Fron t Left , F 2 = Fron t Right , B l == Bac KLeft , B 2 = Bac k Righ t D Z ^ Dri p Zone , G Z • > Garden , P Z = Pla ; Al l (|ijadrent d s n B & vlows d fro m th s tfreot, fsdn g praport y 

## OC T 2 7 208 B 6i B , ^ ' 

# yl

.
• ^ 1
Ont i 

# S^ flZ» 

## a^2<?
. 

# [ .27<r f: Bv

.

R<\':ini lCreated : 27-.\ut-l> SCOASTA L ENVmONHINTA l "t PHOtt ^ G • 0 U P

. IN C 

## 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 : /^M^PLA
- 

### UjCrUFEr ^ Daytim e Phone : (^11-^Ol ^

Addres s o fPropert y covere d b ythi s 

# 27'^c ffbore^^J^tJL e ^^^V2 ^ 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 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 underth 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 perfonned , 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 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 , 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 wori(

. 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^tt o «r4
.
COASTA L ENVrKOHMENTA L CROUP ,


### « Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; e 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 ; e Abid e b yhealt h an d safet yguidanc e provide d b yEPA ; e 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 Coastal Environmenta l Group , a t (402 ) 991-119 9 '!^fgran t access t o m ypropertie s Q I d o not gran t access t o m ypropertie s


# cn-a^-o' i Signatur e Dat e

O I woul d lik e t o b e presen t durin g an ysamplin g tha t I s required

. rN C



### Pag e 2 o f2^
. C .> l i S Ti- V I 1 •iHvmo*"^'*'"' ^



### Th e purpos e o f thi s agreement i s to provid e amutual agreemenl a s t o condition s ofth e propert y prior l o remediatio nactivities
. Thi s will als o serv e a s documentatio nfo r th e purpos e of assurin g that restoratio n activitie s are complete dt o th e satisfactio no f th e propert y owne r andthe UnitedState s Environmental Protectio nAgency (EPA)
.

Propert y m = Q.I^IC^^ T Property Addr^ s A^^,U u.^t;^F6 s Z7V^ V Tr^^^&^ U /) ^

O nth e attache ddiagram(s ) indicat e area(s ) to excavate , surfac e structure s an dlandscapin g feature s an d acces s location(s ) to b e usedb y th e contractors . Indicat e distances , depths , materia l types , etc . Photographicall y an dVideographically document th e existin g condition s ofthe propert y andth e basemen t i

f necessary . 

### Stems t o b e Remove d b yth e Owne rbefor e StsK : ofRemediation : ! h e :c-riOVc.! : giofcce , ois>'Ofct.l

. j-no/o i -et./i.- t o. ' thc.^; b iifcirifc ' i?
- lrig ; Ov.-h£ i i lesf.ciiSi^.iiity , I tte m
^ ^ ) Kem : 

# 7 ^

ftem:
Kem :



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

Item : ^ ^ /

_, , ^ 

# ^our U NQ/ w 'E>OtiZ. <X\/^/ f 

# 1 iUci

- c s HSU-S i QkL ItecM : 

# 'f p 

# "02 ^ Item :

Pag e 1 o f^C v J i 4 S TM L r»<v<KONM(MtA I 

## ltgms_tc_B 6 Remove dEy Contracto r I g.nd,Repjace d ISem : 

### Kem :
-^ r , Item : 

## i i Item :



## lite m Pre-existin g propert y area , that wil l b e excavated , tha t i s covere dwit hgrass . Number of tree s > 2 inch trunl c diameter Number o f tree s <= 2 inch trunk diameter Number of Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Atiachnskeicli o l ih c >fi',il-lc i l;;\c.Li ! Number o f an dsiz e of eac hgarden / flowe r bed area . Alliic h< i skclcli (l l rfl;ili\f iixor

- ii!ic i Ior:lll0ll^
. Agree dupo nvalu e o f plant material s no t t o b e replace db v contractor . js'-i ' •.( • '!•;: : .• : .JIKH '

' C'li;'
. ."• • •,' ] '';
. |-, , r:ir " - Easement Area , to b e excavate d 

### -^——
_

Landscap e Inventor y 

## Quantity ' Uni t Condition/Type/Specie s Quadrant s 

# -p^,^ ^
^ Each
1 ^ Eac h

Each 

### ^ \ ^



# n ^ Each Square Feet

S



# •

sft ^ Each 

# F^-w ( ^ -- 3 (^s^^^v ^

^ Pag e 2 o fcff^ s 1 rL



### Additiona l Commente / InstrucQons : ! 

## ^ ^ ^^y- ? 

# N^T^C ^ 

# a l ^

BKk?) ^

o F t^t > KUL6 KJ FA^mCK

.

Chec k th e boxI fOwne rdoe s no t wan t CE G t o documen t interio rfoundatio n wall s an d possibl e pre-existin g damage

. B ycheckin g thi s bo xCE G i s not responsibl e fo ran ydamag e don e t o th e Interio ro fhouse , includin g foundatio n crack s o rfissures

. ;^he <

I agre e Q I d o no t agre e 

# i , ipl'^Cfl , Owner s Signatur e Dat e Contractor' s Signatur e Dat e 

### Pag e 3 o f {_

### BVI D # (cS^^ t XR F PROPERT YSAMPL E SHEE T Dat e 

# -^mm

- Addres s 

### •Zia U F<yH fpp(tf > <i.\ Projec t Omaha.lead F P 2n d yea roptio n Sampl e tim e am/p m XRFID # 

## ^?P?> q sampl e lengt h 

### 3 0 sec Shot # Readin g Sampl e are a Sho t # Readin g Sampl e are a 

## ?pn9\ vyt.<Ai\\^i 3 

# < 0 ^ 

# Mai
. -ivxo i gT;>,a>^vo.i ^ ^^^ M 

# P t .^?y 5 ^M.iV>:i^\\.\ 1 Dept h 

## a^<^^ Aft.QTi:ll.^< ^ Dept h 

### '}P)%\ IM-^S^WiSZ

. 

## I33q u 1^5.13^ ^ lUHw l (p Averag e ^'b-CfP ^ WA S Averag e MPv.T ^ J

. \<.Q 1
Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a 

# "W ^ 

# s x Dept h Dept h ^ 

## n.g>u>t^7?>\ g 339NV 0 -IS.ft-jiiUT A

Averag e P>\nn^- t M.QI A Averag e

Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a 

### n:^A<^^ii.(3 i 

# 23_a ^ , ^ 

### 33?V ^ \\^.^<^^\^.^' 7 r.P^ ' 3 3 V ^ ffflx.2t^J-lA.ft ^ Dept h Dept h 

### 35q i F;p>..^^fcv^/\ m Averag e -^\ o .Tkc ^

\\.(\9- ^ Avel^g e

RETES TAREA S Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h Averag e Averag e la b sampl e # La b iresul t Sampl e are a XR F Avg

. Signature

. 

# C^hBj(^ 6 Prin t ? \ i o n hPi- h CpOPfP ^

# 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 338 2 Mod e SOIL Tim e 2009-08-1 8 08:4 9 Duratio n 121.5 6 Sequenc e Fina l Flag s AVERAG E ADDRES S QUAD/ZON E D Z INSPECTO R nicola s DEPT H 1 0 SAMPL E TYP E CLEARANC E NOT E

pp m Erro r P b Supervise d By : 

# ^MJ^ata h

# 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 173.54 1 Supervise d By : 

## Certificat e o f Verificatio n

337 8 SOI L 2009-08-1 8 08:4 7 30.5 2 Fina l 6354 1 274 4 fontenell e blv d D Z nicola s 1 0 CLEARANC E

± Erro r
± 16.23 3

# 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 337 9 Mod e SOI L Tim e 2009-08-1 8 08:4 8 Duratio n 30.0 8 Sequenc e Fina l Flag s BVI D # 6354 1 ADDRES S 274 4 fontenell e blv d QUAD/ZON E D Z INSPECTO R nicola s DEPT H 1 0 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 57.82 5 ±10.27 9 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe r Scientifi c 90 0 Middlese x Turnpik 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 74.00 1 Supervise dBy : 

## Certificat e of Verificatio n

338 0 SOIL 2009-08-1 8 08:4 9 30.5 2 Fina l 6354 1 274 4 fontenell e blv d D Z nicola s 1 0 CLEARANC E

± Erro r ± 11.16 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 74.84 5 Supervise d By : 

## Certificat e o fVerificatio n

338 1 SOI L 2009-08-1 8 08:4 9 30.4 4 Fina l 6354 1 274 4 fontenell e blv d D Z nicola s 1 0 CLEARANC E

± Erro r
± 11.31 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 338 7 Mod e SOI L Tim e 2009-08-1 8 08:5 3 Duratio n 121.6 4 Sequenc e Fina l Flag s AVERAG E ADDRES S 

# em.(ssmm^^ ^ 274 4 fontenell e Div d QUAD/ZON E PZ INSPECTO R nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ± P b ± Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe r Scientifi c 90 0 Middlese x Turnpik 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 117.37 8 Supervise dBy : 

## Certificat e of Verificatio n

338 3 SOIL 2009-08-1 8 08:5 1 30.4 9 Fina l 6354 1 274 4 fontenell e blv d PZ nicola s 6 CLEARANC E

± Erro r ± 13.73 8

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

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

pp m P b 56.33 1 Supervise d By : 

## Certificat e o fVerificatio n

338 4 SOI L 2009-08-1 8 08:5 1 30.4 8 Fina l 6354 1 274 4 fontenell e blv d PZ nicola s 6 CLEARANC E

± Erro r
± 10.27 4

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 338 5 Mod e SOI L Tim e 2009-08-1 8 08:5 2 Duratio n 30.1 6 Sequenc e Fina l Flag s BVI D # 6354 1 ADDRES S 274 4 fontenell e blv d QUAD/ZON E PZ INSPECTO R nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r Pb 97.85 8 ±12.86 0 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe r Scientifi c 90 0 Middlese x Turnpik e Billerica , M A0182 1 

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 338 6 Mod e SOIL Tim e 2009-08-1 8 08:5 3 Duratio n 30.5 1 Sequenc e Fina l Flag s BVI D # 6354 1 ADDRES S 274 4 fontenell e blv d QUAD/ZON E PZ INSPECTO R nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m±Erro r P b 75.56 9 ±11.29 2 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 339 2 Mod e SOI L Tim e 2009-08-1 8 08:5 6 Duratio n 121.4 8 Sequenc e Fina l Flag s AVERAG E 

# ' mgwms^mm' , ADDRES S ,£./H H roriLeneii e oiv d QUAD/ZON E easemen t INSPECTO R nicola s DEPT H 1 SAMPL E TYP E CLEARANC E NOT E

pp m Erro r
± 

# : ^dfPj M

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 338 8 Mod e SOI L Tim e 2009-08-1 8 08:5 4 Duratio n 30.1 5 Sequenc e Fina l Flag s BVID # 6354 1 ADDRES S 274 4 fontenell e blv d QUAD/ZON E easemen t INSPECTO R nicola s DEPT H 1 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P

b 73.99 0 ±11.00 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 114.88 5 Supervise d By : 

## Certificat e o fVerificatio n

338 9 SOI L 2009-08-1 8 08:5 5 30.4 7 Fina l 6354 1 274 4 fontenell e blv d easemen t nicola s 1 CLEARANC E

± Erro r
± 13.26 8

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

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

pp m P b 58.24 1 Supervise d By : 

## Certificat e o fVerificatio n

339 0 SOI L 2009-08-1 8 08:5 5 30.4 6 Fina l 6354 1 274 4 fontenell e blv d easemen t nicola s 1 CLEARANC E

± Erro r
± 10.02 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 339 1 Mod e SOI L Tim e 2009-08-1 8 08:5 6 Duratio n 30.4 0 Sequenc e Fina l Flag s BVI D # 6354 1 ADDRES S 274 4 fontenell e blv d QUAD/ZON E easemen t INSPECTO R nicola s DEPT H 1 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 58.35 0 d k 10.03 5 Supervise d By :

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

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 339 7 Mod e SOI L Tim e 2009-08-1 8 08:5 9 Duratio n 122.0 7 Sequenc e Fina l Flag s AVERAG E ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m ± Erro r P b 1^8.733 : ± ij|l5;668' | Supervise d 

## By : C^Jl/^ 1 ''JU2 ^

# Therm o SCIENTIFI C Therm o Fishe r Scientifi c 90 0 Middlese x Turnpik 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 247.85 1 Supervise dBy : 

## Certificat e of Verificatio n

339 3 SOIL 2009-08-1 8 08:5 7 30.5 9 Fina l 6354 1 274 4 fontenell e blv d F 2 nicola s 6 CLEARANC E

± Erro r ± 19.04 8

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

## Certificat e of Verificatio n XL3t-3208 9 Readin g N o 339 4 Mod e SOI L Tim e 2009-08-1 8 08:5 8 Duratio n 30.5 1 Sequenc e Fina l Flag s BVI D # 6354 1 ADDRES S 274 4 fontenell e blv d QUAD/ZON E F 2 INSPECTO R nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m±Erro r Pb 93.28 3 ±12.37 6 Supervise dBy :

# 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 339 5 Mod e SOI L Tim e 2009-08-1 8 08:5 8 Duratio n 30.4 9 Sequenc e Fina l Flag s BVID # 6354 1 ADDRES S 274 4 fontenell e blv d QUAD/ZON E F 2 INSPECTO R nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 88.07 2 ±12.38 9 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe r Scientifi c 90 0 Middlese x Turnpik 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 165.72 6 Supervise dBy : 

## Certificat e of Verificatio n

339 6 SOIL 2009-08-1 8 08:5 9 30.4 8 Fina l 6354 1 274 4 fontenell e blv d F 2 nicola s 6 CLEARANC E

± Erro r ± 16.46 1

# JM # •
i Jfk ^ \ , Omah 

## mah a 

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

. .. . _. __ Coasta l Environmenta l Grou p Inc

. V V"*^ ^

www.coastalhazmat.co m ^ ^ %PBOi« ^ COASTA L IIIVIIOIINEMTA l SIO U r, IN C 

# EXECUTIV ESUMMARY : BVID #63541-(2744 FONTENELL EBLVD )

No Issue s or Concern s [^ Issues/Concern s Detail Explanation : -COASTA LTO BRIN G2 BAG S OFRE D MULCH
. (COMPLETE D 9/1/09 )• 

# 4»EP A EP APropert y Clos e Ou t For m Property# : ^35U l
. , 

# P,^«,_.^pdHJagiea£Jl£fo»« » Date/Tine : ^ Owacr* s Name : A^JiUj^y.'QVTi W •< • ^ 

### Quad s Eicavattd : FLP? : P ^ -C J Contracto r C.rouf^X't^*?AaJ i FrU/l'n P Ye s 

# 'tA Excavatio nGenera l 1
.If necessaiy , were th e correc t quadrant(s ) excavate dandrestored ? 2
.If necessary , were th e correc t area s ofdri p zone excavale dandrestored ? Ye s N Gradin g So dan dVegctetlo B I
.Doe s the gnulin g aroun dthe perimeter ofth e hous e i nexcavate darea s generally slop e awa y fromth e house ? 2
.Ha s so dbee nlai dinal l area s tha t wer e excavated ? 3
.

Doe s th e sodappear to b e geiKraliy healthy an dgrowing ? (Only evaluate if inspecte da t a3 0 day time period )
______ ^ 4
.Ar e soddedarea s generall y finnan devenly graded ? 5
.

Ar c th e joint s betwee nth e so dstrip s generally tight ? (Only evaluate if inspecte da t a3 0 da y tim e period) 6
.

Wa s the propert y grade dsuchtha t wate r will not poo l o nthe propert>' ? 7
.Wa s damag e t o landscapin g o r plan t material s avoided ? Gates
. Feace aaa dRetainin g Wall s Ye s !X » 1
.D o gate s ope nan dclos e freely? (Ifapplicable ) 2
.Wer e all gate s or fence s takendow ndurin g restoratio nactivilie s reinstalled ? (Ifapplicable ) ^ 3
.

Wa s damag e t o gate s or fence s avoided ? (Ifapplicable ) 

# l y / 4
.

Wa s damage t o retainin g wall s avoided ? (Ifapplicable ) Foupdatton , Sidta g an dGoiter s Ye s N o I
.Wa s damag e t o th e sidin g o r tri mavoided ? ^ 2
.Wa s damag e t o th e foundatio navoided ? A 3
.Wa s damag e to window s avoided ? 

### 1 / 4
.Wa s damag e to window s or doo r screen s avoided ? 5
.Wa s damage to downspout s o r downspoul extension s avoided ? ^	 ' Sidewalk s «n dDriveway s (Concrete ) Vcs/N o 1
.Wa s damage to drivewa y surface s avoided ? 

# T f
2
.Wa s damag e t o walkwa y surface s avoided ? 

# V '

## Owner s comments : #



## Inspectio nnotes :

Remova l an drestorationactivate s complete including the 30-da y so dwarranr y EP ARepresentativ e J_)G ^ ijjcJkJ ^ Date : X / ^

# 9

Propert yCompletio n Agreemen t

• fill s aBrecmcnl document s th e complclio no f remedial activili& s performe donm y properly
. M y signalur e will designal e that I a msatisJie dwilhlli e restoraliono f m

y properly , an dllial n o item s ar e i n questions , now , o r a l an y tim e i ntii e fulure , excep l thos e item. s li.sle dbelow , ifany
. Pi-opcrlyJID : J^5^^ ^
_ _ 

### Propert y Address: " "2,7^^ " /jgj ^ tC^^U<^S^J>_
_ Owner : ^^\Z^_\,(^oi/^C ^ I'honc : ^-77
. 3^7 ^ Restoratio n Item s i n Question :

Item : ^

Item : Item :
Additiona l Comments : 1 A1 , I / 

# 1 \


# -Ssr;.s r aurci - restomtio n i. s completed , excep t a s note d L l I d o noe.ji(;i-pc-»-cs(orHti« n i s complete d

Cnntriicfor' s .Siijnatur o H)at c