## TRANSMITTA L of OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R

SAI D 

# #: 

# \%t) ^ Date : 

# 11 kl /^ ^
Address : 

# '^^'b ^ t n ^f Remediatio nContractor : _Coasta l Environmenta l Group
_ Year ; 200 1
SOI LREMEDIATIO N PROPERT Y nLEFOLDE RDOCUMENT S D 

### Vide oof propert y (DVD ) Executiv e Summar y EPA-providedproperty sketch SignedAcces s Agreement fo r subject propert y SignedAcces s Agreement(s ) fo r adjacen t propert y / Restoratio nAgreement 

## -a Settlemen t document s (i.e. , fo r damag e or to replac e plants , etc. ) Confinnatio ndata Photograph s i\i'^<^Oi\ ^ \r ^^^> ^ y^^ ^ As-built sketch Satisfactor y restoratio nsigned by Propert y Owne r Propert y close-out check lis t signed by EP A Descriptio nofarea s not meetin g ROD cleanup criteri a Utilit y clearance s Propert y infonnatio nfro mDougla s Count y Assessor' s Office


# 11 lf l 

# ^^ Date ' 3005451 4 Superfun d

## Propert yAcces s Checklis t Propert yID : ^<3(\^<^l ^ Propert yAddr.^

. p^'p.'^ X V\Y) e "S T D D WOR KSTARTE D

WOR KCOMPELTE D ON : ON : / / / /
0>vncr : l^^f^W.r^
- kelll J Address : ^ I ' TV^ri J ' UlJ^FiT Ph^ : 

### p-honc : ^02 ) F« v Ccll/Page r 

### \0^O
­ 2Q^ ^ P«LN : Cell/Pager : Additiona l Inlnrmxtion :

Q Notincatio n Lette r 1

^ Acces s Agrcemen i "K ] Restonitio o Agreemen t Q Topsoi l Samplin g (i fapplicublt ) O DisposA l Samplin g ( Kapplicable )

• Gnrdc n SAOiplin g (i fapplicable ) n Ulilit yClearanc e
^ Video/Photo s (Before)^-^2Z0 ^ Q Video/Photo s (During ) D Video/Photo s (After ) D ViJeo/Phofo s (30-Day ) ''3_,Propcrt yCompletio n Agreemen t

D Fina l Rcpo n Sent : / / 

### Signed:(jL/LS/Ci 9 Signed : l£_//^/Q ^ / / / / / / Called ; / / 

### On:t flZT.ia J O B : / / On : / / O D : / / 

### Sip.cd:i^/ ^ Issued : / / Bv : 

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# 1

i ^i rMoniiorin} > {a m ujtplicable ) D Communit yD Cre w| Results : On : / / By : • "

D ComraunitA ' Results : D Cre w| On : / / j By :

I ] Communir > Results : D Crv wOn : / / I Bv :

Dmah a Lea d Srt e

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

Comment : Owne r Commen t (s) : Sit e Coordinato r Comment (s) : CONTAC T FORM \^\oD^ ^
^'S' ^ 2 P\Y\ ^ ^" ^ Date:^,j]\jO<^ Time : \P,i ^ Action : 1 eft--(^Uiet ^

Date : Time : Actio n Date : Time : Action ; Transmi t t o EP A D Other Action : D

### Dougla s Count y Accoun t I 

## ijgg^tio n Pag e 1 of 2
Dougla s County , Nebrask a Propert yRecor d - R122096000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s avaiiabi e @ scal e 0-5 0 f t wes t o f52n d S t - Vle W O n Ma p Informatio n i s vali d a s o f 2009-5-1 2 Treasurer' s Ta xRepor t Ne wFeatur e -•••• • Aut o Sale s Searc h Owne r KELLYJ R ROBER TO ETA L 333 2 PIN E S T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumlter : 209 6 OOO O 1 2 Accoun t Type : Residentia l Parce l Numlter : 122096000 0 Parce l Address : Lega l Description : 333 2 PIN E S T OMAH AN E 68105-000 0 GRIFFI N & SMITH S 1S TSU B LO T1 1 BLOC K5 5 9 X 12 8 Valu e Informatio n


### 200 9 200 8 200 7 200 6 200 5 200 4 Lan d $6,900.0 0 

### $6,900.0 0 $6,900.0 0 $6,900.0 0 $6,900.0 0 $6,900.0 0 Improvemen t $96,200.0 0 $168,700.0 0 $168,700.0 0 $96,200.0 0 $96,200.0 0 $96,200.0 0 Tota l $103,100.0 0 

### $175,600.0 0 $175,600.0 0 $103,100.0 0 $103,100.0 0 $103,100.0 0 Sale s Informatio n Sale s Date : 2000-04-1 3 Dee d Type : Price : Grantor : $103,000.0 0 Book : 215 3 Page : 20 1

Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s 0.1 7 S F 7552. 0 Unit s 1. 0 Dept h 128. 0 Widt h 59. 0 Vacan t N o Improvement Informatio n


### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RI22.
. . 6/6/200 9

### Dougla s County Accoun t Ini|^^tio n Pag e 2 of 2

n||^ t

Buildin g 1

n o r a J Thir d Ftoof 396 0 • " 1 Seoggggoc r

» " H P
»! r B O 1 1 I T 11 1 *•«»*£"''" 1 2 1/ 2 STORYFINISHE D an o CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 2468. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 2 1/ 2 Stor yFi n 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 fCover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Gabl e Stories : 2. 5 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 191 7 191 7 9 1 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 1264. 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 288. 0 Porc h Sla b Roo f Cei l 192. 0 Porc h Sla b Roo f Cel l 24. 0 Use r Atti cFul l Finis h 396. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=R122.
. . 6/6/200 9

### Pag e 1 of 2

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



### • YOU RTICKE T NUMBE RI S 2311559
. Origina l Cal l Date : 7/07/0 9 Time : 12:3 7 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 7/09/0 9 Time : 1:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 333 2 Street : PIN E S T Twp : 15 NRng : 13 E Sect-Qtr : 28-N W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n Locatio n o f Work : INCLUD E AL L EASEMENT S LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (877)662-421 1

: UNSUR E O F CORNE R LO 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 h o f Excavation : 4f t Corne r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V LEVEL 3 MUD0 2 OMAHACO F 0PPDGPR 6 QLNNEI F



### Service Area Contac t Phon e Numbe r Utilit y Typ e
CXCAT V CO XCOMMUNICATIONS , IN C HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
LEVEL 3 LEVEL S COMMUNICATIONS , LL C N A Day : 877366834 4

Alt : Emerg : 877366834 4
MUD0 2 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 : 402444516 0

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

### Pag e 2 of 2

OPPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T N A Day :

Alt : 406728934 3 406207149 4 Emerg : 888728934 3 QLNNEI FQWES T LOCA LNETWOR K

N A Day : 406728934 3

Alt : 406207149 4 Emerg : 888728934 3

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

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e

1960 4 Omati a Lea d Sit e Exteriorgain t No.t h Arro w Owne rName : ROBER TO KELL YJ R Sit e Sketc h O-Goo d Address : 333 2 PIN E S T l \ • Poo r 

# 1 Phone : H : W : I I No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r L A B Concentratio n Collecte d Firm : RYASCPXA-1960 4 F l 3 ) L D pp m Date : RYBSCPXA-1960 4 F 2 ^ D_S>PP m Time : RYCSCPXA-1960 4 8 1 pp m 

# U3 i ^ Sample s Analyze d RYDSCPXA-1960 4 B 2 ^ ^ pp m RDZSCPXA-1960 4 D Z 5
. O \ * - pp m X R F Unit : % \ \

Book:Q

_ "RGZeCPXA-1960 4 © ^ 1 _pp m Date : ^ • 2>j?^-ov ^ RPZSCPXA-1960 4 P Z i-^-^ ^ pp m Numbe ro f Sample s D3^ ^ 

## l y n 

# O Time : Staf f 

# B J ^ ^ 

# S BNTEREi ' (^AlZ-A-b- ^ 

# AU G

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# zoo ^ ZX D Z = 33PPM@1 " PLgff:19gQ 4 Date Excavate d :7 i 14/0 9 Date USEP ASigne d Off : B/S/Cf e 60 1 

## sof t

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Omah aLea dSit e 4613 0 Legen d Dri p Zon e Excavate d Concre't 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
.

## 1960 4
Nort h Arro w Omah a Lea d Sit e Exteriorgain t Owne rName : ROBER TO KELL Y

JR Sit e Sketc h Address : 333 2 PIN E ST | \ • Poo r Phone : H: W: 

# 1 Q No t pain t Sampl e Numt)e r Lea d Concentratio n Sampl e Collecte d LA B Finn : Sample s Collecte d RYASCPXA-1960 4 Fl ^2 ) LP pp m 

# n Date : RYBSCPXA-1960 4 F2 '^ 0 ^ pp m 

# or D Time : RYCSCPXA-1960 4B1 U -^V^pp m 

# n RYDSCPXA-1960 4 RDZSCPXA-1960 4 'RGZSCPXA-1960 4 RPZSCPXA-1960 4 82 DZ Q^ PZ ^ O ?; 

# Am

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## 1960 4 Omah aLeadSit u Owne r lOaroe : ROBER T O Kax Y J R 

## Sit e Sketc h Address : 33gPlh EST

Phone : H : W : 

### Sampl e Numbe r RYASCPXA-1960 4 F l \jBBX i Concentratio n 

### LJJ^LDPP m Sampt e Colteastex l LA B 

# • RYBSCPXA-1B60 4 RYCSCPXA-19K) 4 F 2 8 1 

## _2XL^pp m D D RYDSCPXA-19B0 4 B 2 

## ;^S5_PP m D RDZSCPXA-10604 D Z 

## a.OlL [ pp m D 1^5Z5CPXA-I8B04 8 ^ pp m 

# -B - RPZSCPXA-19604 P Z pp m 

### ExteriorBsHn t Mort hArro w 

### Q}^6o ^ 

### • Poo r 

# t Q Notpain t 

### Sampte s CoUected Firm : 9-^
. n-T/ZA^^l J Date : ^ • M ' M Time : fkl-^C t a/> v Sample s Arotyss d XR FUni t S^\ l Boolc Q |

Omah aLea dSit e 4613 0%;^**«* > COASTA L * 3 ^

..1 ^ INVI«ONMtNT» l 'tPBOT«
- G » O 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 :

OwneF^ Name : Daytim e Phone :

Addres s o f Propert 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 i b e restore d t o it s origina l condition

. Thi s wor k i s bein g perfonme 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 i 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 i 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 f performin g th e work

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

. Th e Granto rals o agree s to :

Page l of 2

# iM
. Ji^»M^ / COASTA L ENVIIIONHENTA L %PBOl« ^ CROUP

. INC

.


### •Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; ^

Remov e flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t ma ywis h t o save ; •Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessarysubsequen t t o a n initia l waterin g perio d b yEPA ; •Abid e b yhealt h an d safet yguidanc e provide d b yEPA ; •I 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 TNOTT O INTERFER E 

### Th e Granto ragree s no t t o interfer e o rtampe rwit h an yo f th e wor k activities , o rwit h an y o 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 (402 ) 991-119 9 

# 4 gran t acces s t o m ypropertie s D i d o no t gran t acces s t o m ypropertie s 

# -^Jj\^KC ^ I , ^iSlK
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r.Lyf>/f/h 3 Cy^p^iAJ A(.']U-Q- 1 Signatur e Dat e Signatur eDat e

D I woul d lik e t o t>e presen t durin g an ysamplin g tha t i s required

.

Pag e 2 of2COASTA L 

## Restoratio n Agreemen t 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 tb e purpos e o f assurin g that restoratio n activitie s ar e complete dt o th e satisfBctiono f th e property owner an dth e Unite dState s Environmental Protectio nAgenc y (EPA)
.

Property ID : 

# 43k a Property AddfMs : %3'^' > PtM ^ ST
. Owner : ^^J/ ^ /^d ^ K^Jy^ y Phone : 

## ^Aoi O nth e attache ddiagram(s ) indicate area(s ) t o excavate , surfac e structure s andlandscapin g feature s and acces s location(s ) t o b e usedb y th e contractors . Indicate distances , depths , materia l types , etc . Photographicall y andVideographically document th e existin g condition s ofth e propert y an dth e basement if necessary . 

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

. Kem : 

# I..
. 3^l ( ^i^t \ Item : ^
Item :
Hem :



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

# ,X^ j 3^^xy^l l /^farf S Lcfreei^t J Item :
Item :
Item :

Page l of

.

### #

COASTA L rNVinONH F NTA I cn o u rIM C 

### Item s t o B e Remove d B yContracto rDurin g Remediatio n an d Replace d Item : 

# "yo^ ^

,^ \ ,B ^ 

# , 02 L

Landscap e inventory Ite m Pre-existin g property area , tfaa t wil l b e excavated , that i s covere dwit hgrass . Numbe r o f tree s > 2 inc h trunk diamete r Number o f tree s < = 2 inch trunk diameter Number o f Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Atiachasketchol ' the sprinkler lavou t Numbe r o f an dsiz e o f eac hgarden / flowe r be d area . Auachasketcho f relativ e size s andlocation.s
. Agree dupo nvalu e o f plant material s no t to b e replace db v contractor . Note thi s \alu c wili h e use dto issu e H plan l vouche r t

o th e propert > owner . Easnnen t Area , t o b e excavate d 

## Quantit y 

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\



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## Condition/Type/Specie s

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Pag e 2 of

.I COASTA L MVIHOMMI-MTA t O M O U P

. IN C

Additiona l Comment s / Instructions :



## (^^^urt-^ e ^^ ^ \>iPeei^ T 5^.(.> ^ "^^ ^ ^^
.

D Chec k th e bo xi f Owne 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 no t responsibl e fo ran ydamag e don e t o th e interio ro f house , includin g foundatio n crack s o rfissures

.

1 5 I agre e • I d o no t agre e

Owner' s Signature Dat e Contraaor' s Signatur e Dat e Pag e 3 o f

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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 Averag e La b resul t Sampl e are a XR F Avg

. Signature^^/^(2i?Qx ^ 

# Prin t

£ 1 ly )r^M7 \Cnr^Y/^

# 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 131 8 Mod e SOI L Tim e 2009-07-1 3 16:5 6 Duratio n 121.6 7 Sequenc e Fina l Flag s AVERAG E ADDRES S 333 ^ Fines t 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 123.083 " ± 13707 ^ Supervise d By : C^dj^£j^. 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 129.88 3 Supervise d By : 

## Certificat e o fVerificatio n

131 4 SOI L 2009-07-1 3 16:5 3 30.1 1 Fina l 1960 4 333 2 Pin e s t easemen t Nicola s 1 CLEARANC E

± Erro r 14.06 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 114.35 2 Supervise d By : 

## Certificat e o fVerificatio n

131 5 SOI L 2009-07-1 3 16:5 4 30.4 9 Fina l 1960 4 333 2 Pin e s t easemen t Nicola s 1 CLEARANC E

± Erro r
± 13.43 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 134.72 1 Supervise d By : 

## Certificat e o fVerificatio n

131 6 SOI L 2009-07-1 3 16:5 5 30.5 8 Fina l 1960 4 333 2 Pin e s t easemen t Nicola s 1 CLEARANC E

± Erro r 14.18 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 BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 113.37 4 Supervise d By : 

## Certificat e o f Verificatio n

131 7 SOI L 2009-07-1 3 16:5 6 30.4 9 Fina l 1960 4 333 2 Pin e s t easemen t Nicola s 1 CLEARANC E

± Erro r
± 13.13 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 132 3 Mod e SOI L Tim e 2009-07-1 3 16:5 9 Duratio n 121.8 8 Sequenc e Fina l Flag s AVERAG E jAygo f 4^19-132 2 rf ADDRES S 333 2 Pin e s t 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 73.94 5 ^1.504 # Supeivise d By : (^/LTQldo A

# 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 76.22 2 Supervise d By : 

## Certificat e o fVerificatio n

131 9 SOI L 2009-07-1 3 16:5 7 30.4 6 Fina l 1960 4 333 2 Pin e s t F l Nicola s 6 CLEARANC E

± Erro r
± 11.52 7

# 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 132 0 Mod e SOI L Tim e 2009-07-1 3 16:5 8 Duratio n 30.4 3 Sequenc e Fina l Flag s BVID # 1960 4 ADDRES S 333 2 Pin e s t QUAD/ZON E F l INSPECTO R Nicola s DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r Pb 73.00 8 ±11.36 0 Supervise d By :

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 132 1 Mod e SOI L Tim e 2009-07-1 3 16:5 8 Duratio n 30.4 9 Sequenc e Fina l Flag s BVI D # 1960 4 ADDRES S 333 2 Pin e s t 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 61.53 0 ±10.89 3 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 132 2 Mod e SOI L Tim e 2009-07-1 3 16:5 9 Duratio n 30.5 0 Sequenc e Fina l Flag s BVI D # 1960 4 ADDRES S 333 2 Pin e s t 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 85.01 9 ±12.23 6 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 134 1 Mod e SOI L Tim e 2009-07-1 4 10:0 1 Duratio n 121.7 1 Sequenc e Fina l Flag s AVERAG E ADDRES S 333 2 Pin e s t QUAD/ZON E D Z INSPECTO R Nicola s DEPT H 1 SAMPL E TYP E insitu s NOT E

pp m Erro r Pb Supervise d 

# By : ^^C^tlZGU
.

# 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 133 7 Mod e SOI L Tim e 2009-07-1 4 09:5 9 Duratio n 30.1 4 Sequenc e Fina l Flag s BVI D # 1960 4 ADDRES S 333 2 Pin e s t QUAD/ZON E D Z INSPECTO R Nicola s DEPT H 1 SAMPL E TYP E insitu s NOT E

pp m ±Erro r P b 35.36 5 ±8.76 6 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 133 8 Mod e SOI L Tim e 2009-07-1 4 10:0 0 Duratio n 30.4 3 Sequenc e Fina l Flag s BVI D # 1960 4 ADDRES S 333 2 Pin e s t QUAD/ZON E D Z INSPECTO R Nicola s DEPT H 1 SAMPL E TYP E insitu s NOT E

pp m ±Erro r P b 14.17 8 ±6.82 3 Supervise d By :

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

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

pp m P b 47.62 2 Supervise d By : 

## Certificat e o f Verificatio n

133 9 SOI L 2009-07-1 4 10:0 1 30.5 0 Fina l 1960 4 333 2 Pin e s t D Z Nicola s 1 insitu s

± Erro r
± 9.58 9

# 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 134 0 Mod e SOI L Tim e 2009-07-1 4 10:0 1 Duratio n 30.6 4 Sequenc e Fina l Flag s BVID # 1960 4 ADDRES S 333 2 Pin e s t QUAD/ZON E D Z INSPECTO R Nicola s DEPT H 1 SAMPL E TYP E Insitu s NOT E

pp m ±Erro r Pb 36.56 6 ±8.90 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 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 134 6 SOI L 2009-07-1 4 10:1 3 121.7 2 Fina l [Ayron342-l3 ^ 333 2 Pin e s t DZ Nicola s 1 2 CLEARANC E

pp m ± Pb : 5 M Supervise d By :

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

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

pp m P b 254.66 5 Supervise d By : 

## Certificat e o fVerificatio n

134 2 SOI L 2009-07-1 4 10:1 1 30.3 8 Fina l 1960 4 333 2 Pin e s t D Z Nicola s 1 2 CLEARANC E

Erro r 19.92 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 140.11 9 Supervise d By : 

## Certificat e o f Verificatio n

134 3 SOI L 2009-07-1 4 10:1 2 30.1 2 Fina l 1960 4 333 2 Pin e s t D Z Nicola s 1 2 CLEARANC E

± Erro r
± 15.09 9

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

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

pp m P b 218.37 6 Supervise d By : 

## Certificat e o f Verificatio n

134 4 SOI L 2009-07-1 4 10:1 2 30.4 6 Fina l 1960 4 333 2 Pin e s t D Z Nicola s 1 2 CLEARANC E

Erro r 18.82 3

# 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 134 5 Mod e SOI L Tim e 2009-07-1 4 10:1 3 Duratio n 30.7 6 Sequenc e Fina l Flag s BVI D # 1960 4 ADDRES S 333 2 Pin e s t 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 65.17 6 ±10.97 8 Supervise d By :

## ^O ^

\ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 ^^^^ ^

I Coasta l Environmenta l Grou p Inc

. ^^^yj ? www.c0astaiha2mat.co m

>,.p„(flt< ^ COASTA L
• NVIIO NNINTA L a no u P , IN C 

# EXECUTIV ESUMMARY : BVID #19604

- (333 2 PIN EST )
No Issue s o r Concern s [ ^ Issues/Concern s Detail Explanation :

# 4>EP A EP A Propert y Clos e Ou t For m Propert ytt : l^igt ^
. . Propert y Addr.«:

- ^^^ ^ J"}!^^

- ^ ^ Datc/Tlne : Owner' s Name:
. ,CTYKirV V XA'LSV t ' - —. v Quad s Excavated : f \, T>£
. 

## contmcto r

Crou p Qgyiljgr V gHAidotngA*^ *
Ye s N o Excavatio nGenera l I
.If necessary , were th e correc t quadrant(s ) excavate dandrestored ? 2
.I f necessaty , were th e correc t area s ofdri p ron e excavate dandrestored? Gradin g So dan dVegetotio a Ve s N o 1
.

Doe s the gradin g aroun dthe perimeier ofth e hous e inexcavale darea s generally slop e awa y fromth e house ? 2
.Ha s sodbee nlai dinall area s tha t wer e excavated ? 3
.

Doe s the so dappear t

o b e generally healthy an dgrowing ? (Onl y evaluate i f inspecteda t a3 0 itnyanagrowmg.M i 

## i/ ' da y tim e period ) 

## Jt^3cnr>
. Q : 4
.

Are soddedarea s generally nrman devenly graded ? 

## (y ' 5
.

Are th e joint s l)etweenth e so dstrip s generally tight ? (Only evaluate i f inspecte da t a3 0 da y 

## iy ^ tim e period) 6
.Wa s the propert y grade dsuchtha t wate r will no t poo l o nth e property ? 7
.Wa s damage t o landscapin g o r plan t material s avoided ? Gales , Peace s aa dRctaiDln g Wal b Ves N o 1
.D o gate s ope nan dclos e freely ? (Ifapplicable ) 

# -y ^ 2
.Wer e all gate s or fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (If applicable ) 3
.

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

# y 4
.Wa s damag e t o retaining wall s avoided ? (Ifapplicable ) FouDdatioa , Sidia g an dGatter s Ves N o I
.Wa s damage to th e sidin g or trimavoided ? 

# y ' 2
.Wa s damage to the foundationavoided ? 

# i; ­ 3
.

Wa s damage to window s avoided ? 4Wa s damage to window s o r doo r screen s avoided ? 5
.Wa s damage l o downspout s o r downspou l extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ye s 1
.Wa s damage to drivewa y surface s avoided ? 2
.Wa s damage t o walkwa y surface s avoided ?

## Owner s comments :

Inspectio nnotes :

Remova l an drestorationaclivale s complete indudin g th e 30-da y so dwarranty : EP A Represenlaliv e _Ljay \f>/^iJ LDale : p/^/Q f

## Propert yCompletio n Agreemen t Jhi s agreeme m documenl i ih e completio n o fremedia l acliviiie s perloime d o n m yproperl yM ysignalure wil l designat e tha i 1 am satisfie d wil h th e restoralio n o fm ypropeily , an d Iha l n o item s are i n questions , now . o ra l anylim e i n th e fulure , excep l those ilem s liste d below , ifan y

Propert yID : \ %(jJ ^ Propert y Address : ^^0^ 2 ^ i ^ • ?5 ^ 

## Phone : (MQ^ ^ ^g^^^ ^ Restoratio n Item s i n Question :

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



# Ve; m Vx^^ a \oji(v a w)G)c t

l/

j I agre e lextortilia n i * completed,rxccp l a s noier i [_ | I d o no t «i;re creitoratio n i i eomplele d 

# 3^>x^JKf A7-2-^-0 1 FnOiM>m ^ -^fzst; Owner' s Sicnatiir e Dat e Cont i arlor' s Signatur e Dal e