## TRANSMITTA Lof OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R

SAID # Date : 

# 1 

# n i W

Remediatio nContractor : Coasta l Environmenta l Group
_ Year : 200 1 

# n
SOI LREMEDIATIO N PROPERT Y nLEFOLDE RDOCUMENT S Vide o o f property (DVD ) 

# I f Executiv e Summar y 31 ' 

### EPA-provide dproperty sketch SignedAcces s Agreement fo r subject propert y SignedAcces s Agreement(s ) fo r adjacen t propert y 

# a

/ Restoratio nAgreement Settlement document s (i.e. , fo r damag e o r to replac e plants , etc. ) Confirmationdata Photograph s As-built sketc h Satisfactor y restoratio nsigne db y Propert y Owner Propert y close-out diec k lis t signedb y EP A Descriptio no f area s no t meetin g RO D cleanup criteri a Utilit y clearance s 

# c

/ Propert y informatio nfro mDougla s Count y Assessor' s Office D D D 

# vhA / 

# ] /
3005528 6 Superfun d

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## Propert yAcces s Checklis t Proper , U) : I^L ^ ^ 5 PropertyAddress : 2m^ 3 h J L^' p gW F D D

WOR K STARTED WOR K COMPELTE D ON
. ON : _/ / /_ / 

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D NofifiCiitio n Utte r ^Acces s Agreemen t Q J Restomtio n Agreemen t O Topsoi l Samplin g (i f applicublc ) D DisposaJ Samplin g ( Kapplicable ) D Garde n Samplin g (i f applicable ) G Ulilil yClearanc e S t Video/Photo s (Before ) D Video/Pholo s (During ) n Video/Photo s (After ) D Video/Photo s (30-Day ) D Propert yComplelio n Agreemen l Sent : / / 

### Signed:-!_/13'S ^ Signed : 2L/i2L/G ^ / / / / / / Called : / / 

### On : JZ/ifl/.2 3 On : / / On : / / On : / / Signed : / / By : 

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­ j On : / / Bv :

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Omah a Lea d Stt e

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

Comment : Owne r Commen t (s) :
Sit e Coordinato r Commen t (s) : CONTAC T FOR M Vp-^MB S 

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. Date : 'J mC ^ Time : 6-4 ^ Action : i^t l fi-V^ ^ Date : I ^ Time : Action : Date ; Time : Action : Transmi t to EP AD Othe r Action : D



## f( > MD l M-oWi^ , J 1^10 1

## Douglas Count y Accoim t Info i niat^ t 

## Pag e 1 of 2
Dougla s County , Nebrask a Propert yRecor d - R081119000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f52n d S t - VIe WO 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 PETERSO N RICHAR D L ETA L 246 3 N 4 5 AV E OMAH AN E 6810 4 Propert yInformatio n Ke yNumber : 111 9 000 0 0 8 Accoun t Type : Residentia l Parce l Number : 081119000 0 Parce l Address : Lega l Description : 246 3 N 4 5 A V OMAH AN E 68104-000 0 CLAIRMON TLO T3 8 BLOC K2 5 0 X 12 5 Valu e Informatio n


### 200 9 200 8 200 7 

### 200 6 200 5 200 4 Lan d $6,400.0 0 $6,400.0 0 $6,400.0 0 $6,400.0 0 $6,400.0 0 $6,400.0 0 Improvemen t $65,200.0 0 $65,200.0 0 $65,200.0 0 $65,200.0 0 $58,200.0 0 $52,900.0 0 Tota l $71,600.0 0 $71,600.0 0 $71,600.0 0 $71,600.0 0 $64,600.0 0 $59,300.0 0 Sale s Informatio n Sale s Date : 2000-05-1 5 Dee d Type : Price : Grantor : $61,000.0 0 Book : 215 2 Page : 15 9

Grantee : Valid/Invalid : Exclusio n Reason : Vali d

Lan d Informatio n Acre s 0.1 4 S F 6250. 0 Unit s 1. 0 Dept h 125. 0 Widt h 5 0. 0 Vacan t N o Improvement Informatio n


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

### Dougla s County Accoun t Infona||k) n Pag e 2 of 2 nu||^ r

Buildin g 1

! I ' J 0 « T : Rrj t Floo r 728. 0 «q . t ­

» » i L.iut. j 2 STOR Y «wtir t 5*^4 - ft t

CLIC KJ O ENLARG E IMAG E Squar e Footage : 1456. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Fai r

Buil t As : 2 Stor y Cond o Squar e Footage : 0. 0

HVAC : Centra l Ai rt o Ai r Rooms : 6. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 5 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo fType : Hi p Stories : 2. 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 3 0 % 192 3 8 6 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 728. 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 260. 0 Porc h En d Scree n 80. 0 Porc h En d Scree n 112. 0



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

### Pag e 1 o f 1

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

# ] [

• YOURTICKE T NUMBE RI S 2328269
. Origina l Cal l Date : 7/28/0 9 Time : 4:0 1 pm Op : ELIZABETH1879 0 Wor k t o Begi n Date : 7/30/0 9 Time : 4:4 5 pm State : N E County : DOUGLA S Place : OMAH A Address : 246 3 Street : N4STH AV E Twp : 15 NRng : 13 E Sect-Qtr : 08-S W Tv»p : 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 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 ft . 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 Nuinbe r Utilit y Typ e 

### Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C 

### HEID I 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 FCIT Y O FOMAHA-TRAFFICSEWE RRO N 

### Alt : 402444516 1 Emerg : 4024445160 Day : 406728934 3 OPPDGPR 5 OMAH APUBLI 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.
. . 7/28/200 9

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e
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. G Z = Garden

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### Legen d Concret e 'Y ADri p Zon e Excavate d Quadrant s Excavate d Are areplace dwit: h Are areplace dwit; h Are alef t bar e So d Rook/Mulc h 

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

## 6348 5 #

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## SJ- L pp m Time : 1-O u p-i ^ -nYCCCrXA6348 S &» - pp m 

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### D D Date : IOl(i-0 & -RPZSCPX A6848 6 PS
- — pp m 

### D D Time : R m 6 La b i Resul t RYBSCPLA-d348 5 81 0 pp m Numbe ro fSample s =|i£ j | / | Staff : /yhl. ) Fron t Right , B l = Bac k Left , B2 = Bac k Righ t D Z = Dri p Zone

. G Z = Garden , P Z • Pla i Al l quadrarte ar s a

s viewe d ftom th e (traat , tackle fop ^ • yf—-?*—n—) F

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. 27-AMg-<i 8COASTA L INVIIIONNtHTA i

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. IM C 

## Consen t Fo rAcces s T o Propert y RIGH TO F ENTR YT O PREMISE S 

### Granto r(th e propertyowner) consent s t o an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA ) o rit s authorize d representatives , collectivel y th e Grantee , t o ente ran d perfor m certai n environmenta l respons e activitie s upo n th e followin g describe d premises : Daytime Phone : [fj ^ l^^j
. (jip^^ ^

Owner' s Name 

# ^6iZi2^^'xto^^^

Addres s o fPropert y covere d b ythi s 

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# f^^^

- Agreement :
PURPOS E O F RESPONS E 

### AcTivmE s Th e EP Ai s requestin g acces s t o collect soi l sample s an d remov e soi l that contain s elevate d concentration s oflea d an d ma ypos e a healt h hazard

. Th e area(s ) wil l b e excavate d t o remove 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 byUSEPA , wil l contact 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

. Once 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 vwt h th e Grantor' s approval

. Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m EP Athat th e property ha s bee n remediated

.
ENVIRONMENTA L RESPONS E ACTION S 

### Bysignin g thi s Acces s Agreement , th e Granto rI s grantin g th e EPA , it s employees , contractors an d subcontractors th e right 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 ofperformin g th e work

. Thi s acces s shal l remai n i n effec t unti l th e work ha s bee n satisfactoril ycompleted

. Th e Granto rals o agree s to ;' «
COASTA L CHVItOftHmiA l B I 0 u r , I I t c



### « Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; « Remov e flowerbulb 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 , as necessar ysubsequen t t o a n initia l waterin g perio d byEPA ; eAbid e byhealt h an d safetyguidanc e provide d b yEPA ; •I fth e propertyi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propertyt o perfor m th e work

. eAllo wvideotapin g and/o rphotographin g ofth e property
. AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s not t o Interfer e o rtampe rwit h an yofth e work activities , o rwit h an y ofth e wor k done , o rvwth 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 ofsai d propertywhic h woul d ten d t o endange rth e healt h o r welfar e ofth e Grantee s o rth e environment , o rt o allo wother s t o us e th e propertyi n suc h a manner . Shoul d yo u have an yquestion s abou t thi s program , pleas e contact Coasta l EnvinDnmenta l Group , a t (712 ) 352-018 8

^

I gran t acces s t o m ypropertie s Q I d o no t gran t acces s t o m ypropertie s 

# CMc.mP.'in^l-ti-o ^ Signatur e Dat e Signatur eDat e

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

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# Kc^ ^ ^ r ny ^

COASTA l INVIItOHHIHTA I C I t 0 U r. IN C 

# H^^h^ ^ Consen t fo rAcces s T o Propert y RIGH TO F ENTR YT O PREMISE S 

# i>^< ^
Granto r(th e propertyowner) consent s t o an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA ) o rIts 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 fPropert y covere d b ythi s Agreement : 

# l^b' ^ U M:5fti/ e PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EPAi s requestin g acces s t o collect soi l sample s an d remove 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 its origina l condition

. Thi s wori ( 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 contact 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 opportunityt o revie wan d approv e th e planne d soi l removal , an d restoratio n wori ( 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 wori < 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 EPAtha t th e property 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 , contractors an d subcontractors th e righ t t o ente rth e property , a t al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e o fperfomnin 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 f2V^^^"^^ / COASTA l

• AJ ,r ^ tNri>0>IKIKT> L



### « Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; e Remov e flowe rbulb sorplant s tha t th e Granto r orth e Grantor' s tenan t maywis h to save ; t Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , as necessar ysubsequen t toan initia l waterin g perio d byEPA ; c

Abid e byhealt h an d safet yguidanc e provide dbyEPA ; • Ifth e property is rented , assis t EPA in obtainin g tenan t approva l fo racces s to th e propertyto perfor m th e work

. fi'Allo wvideotapin g and/o rphotographin g ofth e property
. AGREEMEN TNO T To INTERFER E 

### Th e Granto ragree s notto interfer eortampe rwit h an y ofth e wor k activities , orwit h an y ofth e wor k done , orwit h th e equipmen t use d on hi s property , or to undertak e an y action s regardin g th e us e ofsai d propertywhic h woul d ten d to endange rth e healt h or welfar e ofth e Grantee sorth e environment , or to allo wother s to us e th e property in suc h a manner . Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contact Coasta l Environmenta l Group , at (402 ) 991-119 9
gran t access to myproperties D ido not grant acces sto mypropertie s ^

ligimur

SigDMur e e

Dat Dat e e Signatur eDat e

D I woul d lih e tobe presen t durin g an ysamplin g tha t is required

.

Pag e 2 of 2

# r r ,v, V • •'i ^ COASTA L t NvmONM I M'A L C I I O U P I t
. C



### Th e purpos e o f thi s agreement i s to 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 andth e Unite dState s Environmental Protectio nAgenc y (EPA)
. 

# ^i^r r I Propert yAddress : Z

. H G 1 > M H T ~ /^^/g » 

### I Owner :

Phone : Onth e attache ddiagram(s ) indicate area(s ) t o excavate , surfac e stmcture 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 andVideographically document the existin g condition s ofth e propert y andth e basement if necessary . 

### item s t o b e Remove d b yth e Owne rbefoire Star t o fRemediation : Th e rerrioval

. storsfie , dispusel , and/o rfe>Lr n o fthes e itam s i s thf > Qy/ne rs '•esponsii.iiifty

.

Kem :
Item :



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

Hem : 

# J ^ fr- r

. o K 

# hronn - c^ T-hhc

. l\^o9e ^ W Item :
Item : 

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- ^ Pag e 1 of

.• r.-- '
COASTA L 

### Stem s t o B e Remove d B yContracto rDurin g Remedeatio n an d Replace d item : 

# ;^-. ( 9\-^Z-^z-\) ^ Kem : 

# < . i Fl-(^^-B^'P^-
- Kem :
Item :


### Landscap e Inventor y Ite m Quantit y Uni t Condition/Type/Specie s Pre-existin g property area , Quadrant s that wil l b e excavated , that i s covere dwit hgrass . Number o f tree s > 2 inch Eac h ' ^ trun k

diamete r Numbe r o f tree s < = 2 inch Each 

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

# J ^ Atl.T.hn sketcho f th e spiM'klc i li'.\',Hi;
. Number o f an dsiz e o f eac hgarden/ flowe r be d Eac h area . Square Feet Annt hi l skcicli ol ' FL-'.-itivL ' ^ M7.e s an dloc;llillll.^
. Agree dupo nvalu e o f plant material s no t t o b e replace db v contractor . $ >'o' < ilii " \nlu c ^ul ! ti L ^ • jsr

t i o i^^'u ; <• . ••,\-<'.\; \

0 « 1 "^ l
. Easement Area , t o b e Each excavate d 

# k \^L\tr^'''^ ^

Pag e 2 o , ^COASTA L
• MVIHOMMLNTA l O N O U P , IN C


### Additional Comment s / Instructions :



# ' Q 0 Wio f

compad



# L

.

n Chec k th e boxI fOwne rdoe s not wan t CE G t o documen t interio rfoundatio n wall s an d possibl e pre-existin g damage

. Bycheckin g thi s boxCE G i s not responsibl e fo ran ydamag e don e t o th e interio ro fhouse , includin g foundatio n cracks o rfissures

.

\ % I agre e Q I d o no t agre e

Owner' s Signature Dat e Contractor' s Signatur e Dat e Pag e 3 o f7Dat e Project XRFID #

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. XR F PROPERT Y SAMPL E SHEE T 

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# 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 283 6 Mod e SOI L Tim e 2009-08-0 6 15:2 5 Duratio n 121.7 6 Sequenc e Fina l Flag s AVERAG E J * R?^Sgfof'2832-283 5 .- £ ADDRES S 246 3 N 4 5 av e ' QUAD/ZON E easemen t INSPECTO R Nicola s DEPT H 6 SAMPL E TYP E RblhS T NOT E

pp m ±Erro r P b i

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# 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 54.83 4 Supervise d By : 

## Certificat e o fVerificatio n

283 2 SOI L 2009-08-0 6 15:2 3 30.4 7 Fina l 6348 5 246 3 N 4 5 av e easemen t Nicola s 6 RETES T

± Erro r 10.01 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 53.33 6 Supervise d By : 

## Certificat e o f Verificatio n

283 3 SOI L 2009-08-0 6 15:2 4 30.5 7 Fina l 6348 5 246 3 N 4 5 av e easemen t Nicola s 6 RETES T

± Erro r 9.99 9

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 283 4 Mod e SOI L Tim e 2009-08-0 6 15:2 4 Duratio n 30.5 4 Sequenc e Fina l Flag s BVI D # 6348 5 ADDRES S 246 3 N 4 5 av e QUAD/ZON E easemen t INSPECTO R Nicola s DEPT H 6 SAMPL E TYP E RETES T NOT E

pp m ±Erro r P b 48.14 4 ±9.79 9 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 283 5 Mod e SOI L Tim e 2009-08-0 6 15:2 5 Duratio n 30.1 8 Sequenc e Fina l Flag s BVI D # 6348 5 ADDRES S 246 3 N 4 5 av e QUAD/ZON E easemen t INSPECTO R Nicola s DEPT H 6 SAMPL E TYP E RETES T NOT E

pp m ±Erro r P b 50.90 9 ±9.91 7 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 277 5 Mod e SOI L Tim e 2009-08-0 6 09:4 2 Duratio n 121.6 2 Sequenc e Fina l Flag s AVERAG E ltAvi.iiL2Zzil2Z74 ] ADDRES S 246 3 N 4 5 av e 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 L392JD5a i Supervise d

# 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 444.53 2 Supervise d By : 

## Certificat e o fVerificatio n

277 1 SOI L 2009-08-0 6 09:3 9 30.3 0 Fina l 6348 5 246 3 N 4 5 av e easemen t Nicola s 1 CLEARANC E

± Erro r
± 25.33 4

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

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

pp m P b 375.15 3 Supervise d By : 

## Certificat e o fVerificatio n

277 2 SOI L 2009-08-0 6 09:4 0 30.2 9 Fina l 6348 5 246 3 N 4 5 av e easemen t Nicola s 1 CLEARANC E

± Erro r
± 22.94 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 396.17 2 Supervise d By : 

## Certificat e o fVerificatio n

277 3 SOI L 2009-08-0 6 09:4 1 30.7 1 Fina l 6348 5 246 3 N 4 5 av e easemen t Nicola s 1 CLEARANC E

± Erro r
± 23.15 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 372.35 5 Supervise d By : 

## Certificat e o fVerificatio n

277 4 SOI L 2009-08-0 6 09:4 2 30.3 2 Fina l 6348 5 246 3 N 4 5 av e easemen t Nicola s 1 CLEARANC E

± Erro r
± 22.76 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 276 5 Mod e SOI L Tim e 2009-08-0 6 09:3 5 Duratio n 121.3 9 Sequenc e Fina l Flag s AVERAG E fA^.g*of€*7&l-276 4 3 ADDRES S QUAD/ZON E B 2 INSPECTO R Nicola s DEPT H 8 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P b 57:;44 r ± Tra.44 8 

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# 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 276 1 Mod e SOI L Tim e 2009-08-0 6 09:3 3 Duratio n 30.5 6 Sequenc e Fina l Flag s BVID # 6348 5 ADDRES S 246 3 N 4 5 av e QUAD/ZON E B 2 INSPECTO R Nicola s DEPT H 8 SAMPL E TYP E CLEARANC E NOT E

pp m±Erro r P b 48.86 0 ±9.85 9 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 69.12 0 Supervise d By : 

## Certificat e o fVerificatio n

276 2 SOI L 2009-08-0 6 09:3 3 30.2 1 Fina l 6348 5 246 3 N 4 5 av e B 2 Nicola s 8 CLEARANC E

± Erro r
± 11.12 7

# 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 276 3 Mod e SOI L Tim e 2009-08-0 6 09:3 4 Duratio n 30.1 1 Sequenc e Fina l Flag s BVI D # 6348 5 ADDRES S 246 3 N4 5 av e QUAD/ZON E B 2 INSPECTO R Nicola s DEPT H 8 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 64.44 4 ±10.97 8 Supervise d By :

# f 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 276 4 Mod e SOI L Tim e 2009-08-0 6 09:3 5 Duratio n 30.5 1 Sequenc e Fina l Flag s BVI D # 6348 5 ADDRES S 246 3 N 4 5 av e QUAD/ZON E B 2 INSPECTO R Nicola s DEPT H 8 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P b 47.37 3 ± 9.82 7 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 277 0 Mod e SOI L Tim e 2009-08-0 6 09:3 8 Duratio n 121.3 0 Sequenc e Fina l Flag s AVERAG E rAvg~bl

- 2/bb-2J69 ] ADDRES S ^-2463-N-45-av e QUAD/ZON E D Z INSPECTO R Nicola s DEPT H 1 2 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P b 304.678 ^ ± 

# L^;^ ^ Supervise d 

# By : QOAj^j/r^js ^

# 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 260.56 2 Supervise d By : 

## Certificat e o fVerificatio n

276 6 SOI L 2009-08-0 6 09:3 6 30.2 8 Fina l 6348 5 246 3 N 4 5 av e D Z Nicola s 1 2 CLEARANC E

± Erro r
± 20.16 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 295.75 2 Supervise d By : 

## Certificat e o fVerificatio n

276 7 SOI L 2009-08-0 6 09:3 7 30.3 2 Fina l 6348 5 246 3 N 4 5 av e D Z Nicola s 1 2 CLEARANC E

± Erro r
± 21.34 7

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

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

pp m P b 326.17 8 Supervise d By : 

## Certificat e o fVerificatio n

276 8 SOI L 2009-08-0 6 09:3 7 30.6 9 Fina l 6348 5 246 3 N 4 5 av e D Z Nicola s 1 2 CLEARANC E

± Erro r
± 22.79 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 336.22 1 Supervise d By : 

## Certificat e o fVerificatio n

276 9 SOI L 2009-08-0 6 09:3 8 30.0 1 Fina l 6348 5 246 3 N 4 5 av e D Z Nicola s 1 2 CLEARANC E

± Erro r 22.62 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 280 0 Mod e SOI L Tim e 2009-08-0 6 14:2 3 Duratio n 121.0 6 Sequenc e Fina l Flag s AVERAG E 

## LAvgj)ii7S[^ES]~ 7 ADDRES S 246 3 N 4 5 ave~~~ ^ QUAD/ZON E F l INSPECTO R Nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b i 47.i0 6 / ± [_9.7^0' J Supervise d By : 

# (^/^J?/P^ ^

# 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 22.35 8 Supervise d By : 

## Certificat e o fVerificatio n

279 6 SOI L 2009-08-0 6 14:2 1 30.3 1 Fina l 6348 5 246 3 N 4 5 av e F l Nicola s 6 CLEARANC E

± Erro r
± 7.75 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 56.89 1 Supervise d By : 

## Certificat e o fVerificatio n

279 7 SOI L 2009-08-0 6 14:2 2 30.1 4 Fina l 6348 5 246 3 N 4 5 av e F l Nicola s 6 CLEARANC E

± Erro r
± 10.48 1

# 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 48.12 0 Supervise d By : 

## Certificat e o f Verificatio n

279 8 SOIL 2009-08-0 6 14:2 2 30.4 7 Fina l 6348 5 246 3 N 4 5 av e F l Nicola s 6 CLEARANC E

± Erro r
± 9.94 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 279 9 Mod e SOI L Tim e 2009-08-0 6 14:2 3 Duratio n 30.1 4 Sequenc e Fina l Flag s BVI D # 6348 5 ADDRES S 246 3 N 4 5 av e QUAD/ZON E F l INSPECTO R Nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 61.05 3 ±10.86 3 Supervise d By :

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

## Certificat e of Verificatio n XL3t-3208 9 Readin g No 280 5 Mod e SOI L Tim e 2009-08-0 6 14:2 6 Duratio n 121.0 3 Sequenc e Fina l Flag s AVERAG E ^g^i£giOf2801-2|| 4 ADDRES S 246 3 N 45 av e QUAD/ZON E F2 INSPECTO R Nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r Pb 30.48 6 ± 8.56 8 Supervise d By 

# •• f^C0& M

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 280 1 Mod e SOI L Tim e 2009-08-0 6 14:2 4 Duratio n 30.2 0 Sequenc e Fina l Flag s BVI D # 6348 5 ADDRES S 246 3 N 4 5 av e 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 36.57 9 ±8.89 0 Supervise d By :

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

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

pp m P b 33.33 6 Supervise d By : 

## Certificat e o fVerificatio n

280 2 SOI L 2009-08-0 6 14:2 5 30.1 5 Fina l 6348 5 246 3 N 4 5 av e F 2 Nicola s 6 CLEARANC E

± Erro r
± 9.02 1

# 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 25.46 0 Supervise d By : 

## Certificat e o fVerificatio n

280 3 SOI L 2009-08-0 6 14:2 5 30.0 5 Fina l 6348 5 246 3 N 4 5 av e F 2 Nicola s 6 CLEARANC E

± Erro r
± 8.33 9

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 280 4 Mod e SOI L Tim e 2009-08-0 6 14:2 6 Duratio n 30.6 3 Sequenc e Fina l Flag s BVID # 6348 5 ADDRES S 246 3 N 4 5 av e 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 26.57 0 ±8.02 2 Supervise d By :

# Ii i 

# ^

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\ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 I ST^^^ ^ Coasta l Environmenta l Grou p Inc

. www.coastalhazmat.co m v l ^^ ^ %p„o*< ^ COASTA L ENTIIOMHIIITA l C lO U r , IN C 

# EXECUTIV ESUMMARY : BVID #63485-(246 3 N4 5 AVE )

No Issue s o r Concern s [ ^ Issues/Concern s
Detail Explanation :

# I^EP A 

# m

EP APropert y Clos e Ou t For m Pn.p,rt yAddr,,s:J^M(r?^^aH, 5 Uf , . ^ Propert y#:_i^[^HSS L Datc/Tlne : Owner' s Nane:

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## \oS

- Quad s Excavated : P ^ f^ ^ %1

- Q l Contracto rCronpCjptV^rJ l jiici::jr\T*^fl ^ Excavatioi i Genera l Ye s N o 1
.If necessuy , were th e correc t quadrant(s ) excavate dandrestored ? 2
.If necessary , were th e correc t area s ofdri p zone excavate dandrestored ? Gradin g So dan dVegetatto n Ye s N o I
.

Doe s th e gradin g aroun dth e perimeter ofth e hous e i nexcavale 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 sodappea r to b e generally healthy an dgrowing ? (Only evaluate if inspecte da t a3 0 

### ( / ^ da y time period ) 4
.Ar e soddedarea s generall y fir man devenly graded ? 5
.

Ar e th e joint s betwee nth e so dstrip s generally tight ? (Only evaluate if inspecte da t a3 0 da y 

# 17 " tim e period) / 6
.Wa s th e propert y grade dsuc htha t wate r will not poo l o nth e property* ] C^ ' 7
.Wa s damag e t o landscapin g o r plan t material s avoided ? Gates , Fence s an dRetainin g Wal b 

### Ye s Ji o 1
.D o gate s ope nandclos e freely? (Ifapplicable ) 2
.Wer e all gate s or fence s takendow ndurin g restoratio nactivitie s reinstalled ? (Ifapplicable ) 3
.Wa s danug e t o gate s o r fence s avoided ? (Ifapplicable ) 

## u - ^ 4
.

Wa s danug e t o retainin g wall s avoided ? (Ifapplicable ) 

# 1? ^
Foundation , Sidin g an dGutter s Ye s N o I
.Wa s danug e t o tli e sidin g o r tri mavoided ? 

### 1 ^ ^ 2
.Wa s damag e t o th e foundationavoided ? 

## i^ " 3
.Wa s damag e to window s avoided ? 

# ly ' 4
.Wa s damag e t o window s or doo r screen s avoided ? 

### l^ ^ 5
.Wa s damag e t o downspout s o r downspoul extension s avoided ? 

# T- ^
Sidewalk s an dDriveway s (Concrete ) Ye s N o 1
.Wa s damag e to driveway surface s avoided ? 

# U^

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

## Owner s comments :

Inspectio nnotes : 

# ^A/Q^ ^

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Remova l an dresloratio nactivate s complet e includin g th e 30-da y so dwarrant y EP ARepresentativ e LJ(J ^ IjkJlJL ^ Date : ^ 2Q j

## Propert yCompietio n Agreemen t
f hi s agreemen l document s th e completio no f remedial acliviiie s perCormcdo nm y properl y M y signatur e will designat e ihal I amsatisfie dwit hth e re.<;toralio no f m y propeiiy
. andIha l n o item s ar e i nquestions , now , o r at an y lime i nth e future , excep t thos e item s liste dbelow , ifan y Propert y ID : l/]6 ^ Propert y Address : 'Z-^f^' hi j A^ O ^'^ ^ Owner : ^anc(^t ^ ^JJ^Fd^O ^ 

### Phone : (yT 7 • yblM ) Restoratio nItem s inQuestion :

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

«3A Ji )i(,'rcr mtoratio nM completed , excep t «

$ nater i [_

j I d o no l a|>re c re$toratui nis complele d 

# ?\\^\o \
OwncV' s Sicnatiir f Contrarlor' s Signatur e Dat e