## TRANSMITTALof OMAH ALEAD SITE SOILREMEDIATIO NFIL EFOLDER
SAID # : 

# ^3Hl^ 3 Date : 

# 1 j'!> o

# j ^q Addres s 

# : 

# "^71 1 K \

# ^[' ^ ^ f Remediatio nContractor : Coasta l Environmenta l Group
_ Year : 200 8 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f property (DVD ) Executiv e Summar y EPA-provide dproperty sketc h Signe dAcces s Agreemen t for subjec t property Signe dAcces s Agreement(s ) for adjacent property Restoratio nAgreement Settlemen t document s (i.e. , fo r damag e or to replac e plants , etc. ) Confirmatio ndata Photograph s pr ^ -^.\^C^^j4|vt ^ g^^l/cAflvt , 5g-rWSdd. ^ -\ia£ A As-buil t sketc h Satisfactory restoratio nsigne db y Property Owner Property close-out chec k lis t signe db y EP A D 

### Descriptio no f area s no t meetin g RO D cleanup criteri a ffi/ 

### Utility clearance s Property informatio nfro mDougla s Count y Assessor' s Offic e D 

# ^fi/ y

## Propert yAcces s Checklis t

nWOUKSTARIE D ON : / /_ 

# ''':^*^'£Lj2aii3 3 D WOR K COMPELTE D ON : / /
_ 

# i>mpc.-. ; Addtcs; ; ^^^- ^ y q1 3 \^
Renter : .Address : J Phone : Fax : Cell/Pajfer : Additiona l Information : 

# ^ Ss^i-'^a^ L 2£i5n0i ^
1 nNotificatio nLetfci

- Sent :/ / 

# y ^
. . . __ J y^Acci's s Ajjrcenicn f Si!;ned:i^/l9:/ ^ 

# ^y-9AQi m 1 0'T^cs(()ralio nA<>reenien t Siuned : h/ [Ti Q\ 

# ''y%L(My_^. ^ 1 1 Top.soil .Sampling ; (if applicahle ) 11 By :

• Disposal Samplinj ; (if applicahle ) 1 1 By : [ UCarde n,Sani|)linj 4 (if a|)plical)lc ) 1 1 By : J^lJtilit vClearanc e 

### Called : ^/2_/6 ^ By : <^ C nVideo/Photo s (Bcfoi-e) On : / / By : D Video/Photo s (During ) On : / / By : nVideo/Photo s (After ) On : / / By : nVideo/Photo s (30-Day ) On : / / By : 1 1 Propert y Conifiletio nAfjreenient Siuned : / / By : 1 nFinal Report Issued : / / 

## By : Ai r IVIoin(orin< > (a. s applicahle ) 1 1 Comnuinit y Q Cre w On : / / By : Results : \ y Community C ] CfCM ' On : / / 

### By : _j Results : 1 L J Communit y d J CIC M On : / , / By : Results :
Omah a Lea d Sit e 

## 1

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

Comment : Owne r Commen t (s) : Sit e Coordinato r Commen t (s) : CONTAC TFORM 

# ^.WJ 3 3^ 7 Id
. 

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## Date:^~/7'^^Time : / 3 Action : S/'GA^
.



## Date : Time : Action : ^ Date : Time : Action : Transmi t t o EP AD Othe r Action : D



# T-Q'Ci ^ X>iea^ c cax l th ^ 6.00 4 tefore loeOr e

### Dougla s County Accoun t Infimriatio n Pag e 1 of 3 ^jm £
Dougla s County , Nebrask a Propert yRecor d - R161417000 0 Prin t Repor t Parce l Dimension s availabl e @ scal e 0-5 0 ft west o f14 4 S t ^

ViewO H Ma p Informatio n i s vali d a s o f2008-4-1 7 Treasurer' s Ta xRepor t Ne wFeatur e ->-*- •Aut o Sale s Searc h Owne r CASKE YJASO N M ETA L 32 7 N 4 1 S T OMAH AN E 68131-000 0 Propert yInformatio n Ke yNumber : 141 7 000 0 1 6 Accoun t Type : Residentia l Parce l Number : 161417000 0 Parce l Address : 32 7 N 4 1 S T OMAH AN E 68131-000 0 Lega l Description : L AVET APLAC E LO T7 BLOC K1 1/ 2 VA C ALLE Y& 4 0 X 11 6 Valu e Informatio n Lan d Improvemen t Tota l 200 7 $ 5,500.0 0 $ 70,900.0 0 $ 76,400.0 0 200 6 $ 5,500.0 0 $ 70,900.0 0 $ 76,400.0 0 200 5 $ 5,500.0 0 $ 48,000.0 0 $ 53,500.0 0 200 4 $ 5,500.0 0 $ 48,000.0 0 $ 53,500.0 0 200 3 $ 5,500.0 0 $ 48,000.0 0 $ 53,500.0 0 200 2 $0.0 0 $0.0 0 $0.0 0 Sale s Informatio n Sale s Date : 2006-10-2 3 Dee d Type : W D Book : 200 6 Page : 12341 8 Price : $116,000.0 0 Grantor : Shurso n Elle n L Grantee : Caske yJaso n M eta l Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 1997-08-2 8 Dee d Type : D Book : 207 3 Page : 00 6 Price : $ 45,000.0 0 Grantor :


### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R161.
.. 5/7/200 8

### Dougla s County Account Inthnnatio n Pag e 2 o f 3 .^jm s
Grantee : Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 1993-06-2 6 Dee d Type : Book : 195 7 Page : 67 2 Price : $57,000.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 1991-05-2 8 Dee d Type : Book : 189 9 Page : 08 2 Price : $25,000.0 0 Grantor : Grantee : Valid/Invalid : Invali d Exclusio n Reason : Invali d Sal e Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0. 1 4640. 0 1. 0 116. 0 40. 0 N o Improvement Informatio n Buildin g 1

32 7 N 4 1 S T [Pfl?: ; fr a floo r 1 T« 4 5n | ft S«oni ! Floo r 52 0 g& q I t
2 1/2STORrUNFI N Bvnn l Bloc k 8 D . , it-. v

CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1284. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R161.
. . 5/7/200 8

### Dougla s Count y Account Infimriatio n Pag e 3 o f 3 iaan e

Uni t Type : Conditio r i : Ver yGoo d

Buil t As : 2 1/ 2 Stor yUnfi 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 fType : Hi p Stories : 2. 5 j 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 190 8 200 6 0 % 195 7 5 1 Detai l Typ e Detai l Descriptio n Unit s 1 Ad d O n Fenc e Woo d 1. 0 Ad d O n Unfinishe d Atti cW/floo r 520. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 545. 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 Porc h Woo d Dec k 36. 0 Porc h Woo d Roo f 130. 0 I I Use r ML S UPDAT E •1. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R161.
.. 5/7/200 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 TNUMBE RI S 2072947
. Origina l Cal l Date : 7/02/0 8 Time : 2:3 2 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 7/07/0 8 Time : 3:0 0 p m State : N E County : DOUGLA S Place : OMAH A Addres s : 32 7 Street : N41S T S T Twp : 15 NRng : 13 E Sect-Qtr : 17-SE,20-N E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : Lea d remidiatio n Locatio n o f Work : LOCAT E ENTIR E PROPERT Y AL L TH E WA Y T O TH E STREET . Remarks : FA 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 Alt . Contact : Phone : (402)991-119 9 Wor k Bein g Don e For : Coasta l Dept ho f Excavation : 4 f t Corne r Lot : NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N BSHPCLK S CXCAT V MCLEODN E MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac t Phone Numbe r Utilit y Typ e
BSHPCLK S NEBRASKAHEALT H SYSTEM NA 

### Day : 402552345 9 Alt : 402552334 7 Emerg : 402559511 1
CXCAT V COXCOMMUNICATIONS , INC HEID I 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
MCLEODN EMCLEODUS A N O NEE D T O CAL L OU T EMERGENC Y 

### Day : 800289190 1 Alt : 

### Emerg : 800289190 1
MUDO l METROPOLITA NUTILITIE S DISTRIC T EDWIN A 

### Day : 402504782 3 Alt : Emerg : 402504794 6 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 7/2/200 8

### Pag e 2 of 2

CIT Y O FOMAHA

- OMAHACO F RON TRAFFICSEWE R

OMAH APUBLI C POWE R OPPDGPR 5 N A DISTRIC T
QLNNEI C QWES TLOCALNETWOR K NA 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 Alt : 888728934 3 Emerg : 406728934 3 Day : 406728934 3 Alt : Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 7/2/200 8

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e ^3H'd 5 Exterio rPain t Nortt i Arrow Omah a Lea d Sit e [ 3 Goo d Samplin g Address : 3E 7 N ^ t <Sf
. Sit e Sicetc h •Poo r 

### Phone : ^ SOeSdQS^ ^ 3^/ ~ 363 1 [ ] No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r Concentratio n Collecte d Firm : FPl ^ V b CJ ^ RYASCPXA-2 3 V53F 1 pp m 

### D Date ; q-lM-C T RYBSCPXA-23V3 3 F 2 pp m 

### D Time : \V^ 5 RYCSCPXA-23VJ 5 B 1 pp m 

### B l Samples Analyzed RYDSCPXA-23V3 3 8 2 

### F.Z O pp m 

### D RDZSCPXA-£13>/3 3 D Z 

# I
pp m 

### D XR F Unit : LS'^ Z Book : 79 3 nozGonx A03*^3 3 o z pp m 

### D Date : lOIO I fo i 

### D La b RYCSCPLA-2343 3 pp m 

### D Time : /f/ V ' 

### D i Resul t 24 9 pp m Staff : M^yf Numbe rofSample s = 

### } Legend : F 1 = Fron t Left
. F 2 = Fron t Rigtit , B l = Bac k Left , B2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e as viewe d fro m tti e street , facin g propert y OLS# : 2343 3 : rp T* * \ ^ ^ t Dat e Excavated : 6/19/0 8 f.-' f t Dat e USEP ASigne d Off : 8/14/0 8 Are a Sodde d 104 7 s q f t

i4l-.!.ll.!)i:' | Legen d Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are a replace d wit h So d Are areplace dwit h Rock/Mulc h Are alef t bar e Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
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### Omah a Lea d Sit e g Goo d Satnplin g Address : 3^TA l ^ / <St
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# i i LA B Concentratio n Collecte d 

### Firm : ^Of\ 7 b C ^ 

### RYASCPX A 23^5 3 F l pp m 

## D Dat e 

### q-iM-0 ? RYBSCPXA
- 23*^3 3 F 2 pp m 

## D Tim e 

## W-^f i RYCSCPX A 23^3 3 B 1 pp m 

## 0 1 Sample s Analyze d 

### RYDSCPX A Z3*^3 3 B 2 pp m 

## D RDZSCPXA
- e3H3 3 D Z pp m 

## D XR F Unit : (QS^Z
. Book : i°l Z 

### nCZCCPX A pp m 

# u D Date : /g'/^//<? 7 Xa b RYCSCPLA-2343 3 pp m 

# u D Tim e 

## A/H
. 2 Resul t 24 9 pp m Staf f 

### MS\ M Numbe rofSample s = 3 / Legend : F l = Fron t Lett
. F 2 = Fron t Rigtit , B l - Bac k Lett , B 2 - Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a s viewe d fro m th e street , lacin g propert y


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# ^3^3. ^ Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e Q Goo d Samplin g Address : 36TMyfi l <Sf
. ^ Sit e Sketc h 

### • Poo r Phone : H SOe-ddGS^ ^ d^^l y dtS I Q No t pain t 

### Lea d Sample s Collecte d Sampl e Numbe r 

### LA B Concentratio n Firm : fPf\ 7 b Ci S RYASCPXA
- 23V33F 1 

## fiso Date : ^-l^-Q ? 

### RYBSCPXA
- e3H-3 3 F 2 L H l Time : \VMf ) 

### RYCSCPX A a3H3 3 Bl P H I Sample s Analyze d 

### RYDSCPX A 23V3 3 B 2 

## Pz a RDZSCPX A £3H3 3 D Z SHS - XR F Unit : ^VZ
. Book : 7 9 3 

### nCZCCPX A Q3*^33^ ^ Date : lOIO/fp- f — RYCS C PlA-2343 3 

### Time : JMJ
. .La b = Resul t 24 9 pp m M<^\A / Numbe ro fSample s = : 3 : I Legend : F l = Fron t Lett , F 2 = Fron t Right , B l = Bac k Left , 8 2 = Bac k Righ t D Z = Dn p Zone , G Z = Garden , P Z = Pla y Al l quadrant s are a s viewe d fro m th e street , facin g property 

# ENTERE D SE P192( 1 'ic

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### Omah a Lea d Sit e 0 Goo d 

### Samplin g Address : 32 7 N H- l <S t Sit e Sketc h •Poo r 

### Phone : ^50£-d3.Q6y i 5t[~3S.3 l Q No t pain t Sampl e Numlje r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d 

### Firm : FPlf t 72 ) Ci ^ RYASCPXA-2 3 V33F 1 pp m 

### D Date : q-lM-O ; RYBSCPXA-23V3 3 F 2 pp m 

### D Time : \VA ^ RYCSCPXA-23V^ 5 B 1 pp m 

### EZI Sample s Analyze d 

# i RYDSCPXA-23^3 3 B 2 

## 7.Z O pp m 

### D RDZSCPXA-213V3 3 D Z pp m 

### D XRF Unit : (oS*fZ
. Book: /9 3 nozocPX AQ3H0 3 Qg pp m 

# n D Dat e 

### lOfO/fo- J

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b RYCSCPLA-23433 pp m 

### D Tim e 

## JU±
. s Result 24 9 pp m Staf f 

## MS W Numbe ro fSample s = 3 i [_ / Legend : F 1 = Fron t Left , F2 = Fron t Right , B 1 = Bac k Left , 6 2 = Bac k Righ t DZ = Dri p Zone , G Z = Garden , PZ = Play Al l quadrant s ar e a s viewe d fro m th e street , facin g property,v-^ « sr< .
COASTA L ENVIRONMENTA L C R O U » 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 : O'Xli'X' l

Owner' s Name : \L^f\i^^ ) Ccfokl ^ Daytim e Phone : ^^ ^ ^ 5" ^ 9
. " ^%ID ^

Addres s o fPropert y 

# 35^ 1 U - '<i^^­ covere d b ythi s Agreement :
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 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 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
. 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 EPAtha 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 subcontractors th e righ t t o ente rth e property , at 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 effect 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

### .* » 

# >*':^^ vww ifm> ^ I \^***" VCOASTA L

•* " -" ^ ENVIRONMENTA I 

### ^^ , PBO'T' - C R 0 U R , IN 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 sQ I d o no t gran t acces s t o m ypropertie s

Signatur e L yDate Signatur eDate

OI woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.COASTA L 

## Restoratio n Agreemen t Th e purpos e ofthi s agreemen t i s to provid e amutua l agreemen t a s t o condition s ofth e propert\prio r to remediatio nactivities
. Thi s wil l als o serv e a s documentatio nfo r th e purpos e o f assurin g tha t restoratio n activitie s are complete dto th e satisfactio nofth e propert> ' owner an dth e Unite dState s Environmental Protectio nAgenc y (EPA)
. I Propert yID : '^ ^

3> I j ^ 3 

### Propert y Address : ^^ ^ j< U4 / "S f Owner : 

## /<r>5 ^ (jd^hy - Phone : 

## Ht>A

- so?.

- ^i,ii,< ^
O nth e attache ddiagram(s ) indicate area(s ) t o excavate danddept ho f e.\ca\ation , locationof all know n utilities , subsurfac e features , surfac e structure s an dlandscapin g features , acces s location(s ) t o be usedb y contractor , andth e directio no f North
. Indicate distances , depths , material types , etc . Indicat e digita l photo s b

y referencin g th e photo-lo g number wit ha narrow indicating directio no f \iew
. 

### 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 : 

### SWY^^l i 0\t^^< > oU)rxi^ rWiCK\A^<
. ^ ^ hi^i)
. Item : * Item : Item : Item : Item : Item : Item :
Pag e 1 o f 1

# i J COASTA L 

### Item s T o B e Remove d B yContracto rDurin g Remediatio n An d No t Replace d (Us e additiona l sheet s a s necessary ) Item : 

# VlnW £ Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : 1 Item :

Item :

Pag e 2 o f

# m COASTA L

r > "M c Item s T o B e Remove d B yContracto rDurin g Remediatio n An d Replace d (Us e additiona l sheet s a s necessary ) Item : 

# bh L Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item : Item :

Pag e 3 of
.COASTA L 

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

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

Pre-existin g propert yarea , tha t wil l b e excavated , tha t i s covere d wh h grass . Squar e fee t

Numbe ro f tree s trun k diainete r > 2 inc h 

# I Eac h 

# y

Numbe ro ftree s •= 2 inc h trun k diamete r 1 Eac h 

# y^ a •\(j2ji^yy c

Numbe ro f Sprinkle r Zones
. Contro l Valves
. Timers
. Heads , etc
. Anac h a s^^elci l ii f ih e ;.pii;ikle. - k; \ out
. " ^ Eac h 1 

# i

Numbe ro f an d siz e o f eac h garden / flowe rbe d area .
M:v ^ a n J
. k")ca;ions
. 

# i Eac h Squar e Fee l

Pag e 4 o fCOASTA L 

### Ite m Agree d upo n valu e o f plan t material s no t t o b e replace d b vcontractor
. Not e thi s valu e wil l b e use d t o issu e a plan t vouche rt o th e propert v o\ \

ner . Agree d upo n lis t o fplan t material s tha t wil l b e replace d b ycontractor
. B e ver yspecifi can d detailed
. Includ e a sketc h o fwer e eac h plan t v\il l b e place d b \

th e coniracioi'
. Agree d upo n are a o f propert yt o b e replace d wit h gras s sod
. ': ii.'li:(.1 e a Nkeicl i .> ; lii c .iieais ) U'
. h e :epl.ict.- J '. ^ 'i^ i

.Are a o fCir > o rCount ) propert yt o b e landscape d pe rthei rrequireinents
. ;!''>.l.!il r1 -,.v'UT ' ^'l " : ! c

Easemen t .Area , t o b e excavate d 

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

$

Eac h

S F

S F

S

F

Pag e 5 of
.C O AS TAL (MVIHOMMtMTA L GmO Ur . IN C


### Additiona l Comment s / Instructions :

•Chec k tti e l)O xi fOwne rdoe s no t wan t CE G t o documen t interio rfoundatio n wail 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 fhouse , includin g foundatio n cracks o rfissures
.

Iagre e O Id o no t agre e 

# UMA^^y y Q^viy ^ f,-/^^ r yF^^F^F7FF:^^f.c
. io-nyj h Owner' s Signatur e ( ^ Date Contractor' s Signature Date Pag e 6 of
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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 12 0 Mod e SOI L Tim e 2008-06-1 9 14:2 5 Duratio n 121.0 1 Sequenc e Fina l Flag s AVERAG E Av g o f116-11 9 , ADDRES S 32 7 n4 1 QUAD/ZON E easemen t INSPECTO R DETRIC H DEPT H SURFAC E SAMPL E TYP E NOT E

pp m ±yErro r y P b 168
. infyyy ' 16.20 3

~ yy 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 11 6 Mod e SOI L Tim e 2008-06-1 9 14:2 3 Duratio n 30.2 6 Sequenc e Fina l Flag s BVI D # 2343 3 ADDRES S 32 7 n 4 1 QUAD/ZON E easemen t INSPECTO R DETRIC H DEPT H SURFAC E SAMPL E TYP E NOT E

pp m ±Erro r P b 174.28 7 ±17.08 3 Supervise d By :

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

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

pp m P b 169.30 5 Supervise d By : 

## Certificat e o fVerificatio n

11 7 SOI L 2008-06-1 9 14:2 4 30.2 3 Fina l 2343 3 32 7 n 4 1 easemen t DETRIC H SURFAC E

± Erro r ± 16.26 0

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

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

pp m P b 161.67 5 Supervise d By : 

## Certificat e o fVerificatio n

11 8 SOI L 2008-06-1 9 14:2 5 30.2 3 Fina l 2343 3 32 7 n 4 1 easemen t DETRIC H SURFAC E

± Erro r ± 15.80 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 167.20 1 Supervise d By : 

## Certificat e o fVerificatio n

11 9 SOI L 2008-06-1 9 14:2 5 30.2 9 Fina l 2343 3 32 7 n 4 1 easemen t DETRIC H SURFAC E

± Erro r ± 15.66 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 74 4 Mod e SOI L Tim e 2008-07-1 4 11:0 3 Duratio n 120.9 7 Sequenc e Fina l Flag s AVERAG E ' Av g o f740-74 3 ADDRES S 32 7 nort h 41s t stree t QUAD/ZON E F l INSPECTO R MATEU S DEPT H 6 SAMPL E TYP E NOT E

Supervise d B y

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

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

pp m P b 191.30 3 Supervise d By : 

## Certificat e o fVerificatio n

74 0 SOI L 2008-07-1 4 10:5 9 30.1 9 Fina l 2343 3 32 7 nort h 41s t stree t F l MATEU S 6

± Erro r ± 17.35 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 221.99 4 Supervise d By : 

## Certificat e o fVerificatio n

74 1 SOI L 2008-07-1 4 11:0 0 30.4 1 Fina l 2343 3 32 7 nort h 41s t stree t F l MATEU S 6

± Erro r ± 18.51 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 182.09 6 Supervise d By : 

## Certificat e o fVerificatio n

74 2 SOI L 2008-07-1 4 11:0 2 30.0 8 Fina l 2343 3 32 7 nort h 41s t stree t F l MATEU S 6

± Erro r ± 16.83 7

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

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

pp m P b 236.30 7 Supervise d By : 

## Certificat e o fVerificatio n

74 3 SOI L 2008-07-1 4 11:0 3 30.2 9 Fina l 2343 3 32 7 nort h 41s t stree t F l MATEU S 6

± Erro r ± 19.04 2

# 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 74 9 Mod e SOI L Tim e 2008-07-1 4 11:0 7 Duratio n 121.1 1 Sequenc e Fina l Flag s AVERAG E Av g o f745-74 8 ADDRES S 32 7 nort h 41s t stree t QUAD/ZON E F2 INSPECTO R MATEU S DEPT H «#
. - SAMPL E TYP E NOT E

Supervise d B y

# 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 183.19 1 Supervise d By : 

## Certificat e o fVerificatio n

74 5 SOI L 2008-07-1 4 11:0 5 30.1 6 Fina l 2343 3 32 7 nort h 41s t stree t F2 MATEU S 6

± Erro r ± 17.02 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 127.08 0 Supervise d By : 

## Certificat e o fVerificatio n

74 6 SOI L 2008-07-1 4 11:0 6 30.3 6 Fina l 2343 3 32 7 nort h 41s t stree t F2 MATEU S 6

± Erro r ± 14.49 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 151.92 7 Supervise d By : 

## Certificat e o fVerificatio n

74 7 SOI L 2008-07-1 4 11:0 7 30.3 0 Fina l 2343 3 32 7 nort h 41s t stree t F2 MATEU S 6

± Erro r ± 15.58 5

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

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

pp m P b 115.67 6 Supervise d By : 

## Certificat e o fVerificatio n

74 8 SOI L 2008-07-1 4 11:0 7 30.2 9 Fina l 2343 3 32 7 nort h 41s t stree t F2 MATEU S 6

± Erro r ± 13.49 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 75 4 Mod e SOI L Tim e 2008-07-1 4 11 : 1 2 Duratio n 121.1 2 Sequenc e Final Flag s AVERAG E Av g o f750-75 3 ADDRES S 32 7 nort h 41s t stree t QUAD/ZON E D Z INSPECTO R MATEU S DEPT H .2
. SAMPL E TYP E NOT E

P b Supervise d B y

# 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 4172.11 4 Supervise d By : 

## Certificat e o fVerificatio n

75 0 SOI L 2008-07-1 4 11:1 0 30.3 3 Fina l 2343 3 32 7 nort h 41s t stree t D Z MATEU S 1 2

± Erro r ± 81.45 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 1513.28 6 Supervise d By : 

## Certificat e o fVerificatio n

75 1 SOI L 2008-07-1 4 11:1 1 30.2 7 Fina l 2343 3 32 7 nort h 41s t stree t D Z MATEU S 1 2

± Erro r ± 47.11 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 1726.60 0 Supervise d By : 

## Certificat e o fVerificatio n

75 2 SOI L 2008-07-1 4 11:1 1 30.2 8 Fina l 2343 3 32 7 nort h 41s t stree t D Z MATEU S 1 2

± Erro r ± 50.44 1

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

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

pp m P b 398.97 9 Supervise d By : 

## Certificat e o fVerificatio n

75 3 SOI L 2008-07-1 4 11:1 2 30.2 4 Fina l 2343 3 32 7 nort h 41s t stree t D Z MATEU S 1 2

± Erro r ± 24.66 0

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

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

pp m P b 495.24 6 Supervise d By : 

## Certificat e o fVerificatio n

78 1 SOI L 2008-07-1 4 18:3 8 120.7 6 Fina l

—- Av g o f777-78 0 32 7 n 4 1 s t D Z MATEU S 1 3 RETES T

' Erro r 24.88 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 1311.69 4 Supervise d By : 

## Certificat e o fVerificatio n

77 7 SOI L 2008-07-1 4 18:3 6 30.3 0 Fina l 2343 3 32 7 n 4 1 s t D Z MATEU S 1 3 RETES T

± Erro r ± 44.27 8

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

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

pp m P b 340.71 3 Supervise d By : 

## Certificat e o fVerificatio n

77 8 SOI L 2008-07-1 4 18:3 7 30.0 5 Fina l 2343 3 32 7 n 4 1 s t D Z MATEU S 1 3 RETES T

± Erro r ± 23.22 4

# 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 77 9 Mod e SOI L Tim e 2008-07-1 4 18:3 8 Duratio n 30.0 4 Sequenc e Fina l Flag s BVI D # 2343 3 ADDRES S 32 7 n 4 1 s t QUAD/ZON E D Z INSPECTO R MATEU S DEPT H 1 3 SAMPL E TYP E RETES T NOT E

pp m Erro r P b 186.17 1 ± 17.02 8 Supervise d By :

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

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

pp m P b 142.40 4 Supervise d By : 

## Certificat e o fVerificatio n

78 0 SOI L 2008-07-1 4 18:3 8 30.3 7 Fina l 2343 3 32 7 n 4 1 s t D Z MATEU S 1 3 RETES T

± Erro r ± 15.02 5

### /lfi|/ i Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 I ^^^ , 5 Coasta l Environmenta l Grou p Inc
. 

### ^y^^ ^

www.c0astaiha2mat.co m ^^tPBoT* ^ COASTA L ENVIDONHENTA L CROUP
. INC
. 

# EXECUTIV ESUMMARY : BVI D #2343 3 - (32 7 N41' * St. )


# IINo Issue s o r Concern s [ ^ Issues/Concern s Detai l Explanation : Th e Cleanu p activitie s wen t well ; however , a$300.0 0 Gif t Certificate fi-omIndianCree k Nursery was issue dt o th e property owne r to compensat e for plant s that wer e remove dfromth e D Zwhil e removin g impacte dsoi l fi-omthi s property .

## ^#C«rjp A- ^ EP APropert \Clos e Ou t For m 

# y v i y y Propert y 

# ^-.yyii
.



# __ „-— 7 '^r-^rr;jEBs;^ — Date/Tim e Quad s ExcaValfd : V\\

- Y V \"^ ^ Contracto r Grou p LoiK^TPn

Ye s M o Excavatio n Genera l 1
.

i fnecessary , wer e th e correct quadrant(s ) excavate d an d restored ? 

# y ' 2
.I fnecessary , wer e th e correct area s o fdri p zon e excavate d an d restored': ' 

# y Gradin g So dan dVegetalio n Ye s N o Doe s the gradin g aroun dthe perimeter ofth e hous e i nexcavaie darea s generall y slop e awa y 

## y fromthe house ? 2
.

Ha s sodbee nlai di nall area s tha t wer e excavated ? 

## y 3
.

Doe s the sodappear to be generall y healthy an dgrowing' ' (Only evaluat e i f inspecte da t a3 0 , day time period ) 4Ar e soddedarea s generall y firman devenly graded ? 

### y 5Ar e th e joint s betwee nthe so dstrip s generall y tight ? (Only evaluat e i f inspecte da t a3 0 da y 

### y tim e period ) 6 Wa s the propert y grade dsuchtha t water will not poo l o nthe properr\ ' 

### y 7Wa s damag e t o landscapin g or plan t material s avoided" ^ y Gales , Fence s an dRetainin g Wall s Ve s N o D o gate s ope nan dclos e freely ? (Ifapplicable ) l y 2
.Wer e all gate s or fence s takendowndurin g restoratio nactivitie s reinstalled ? (Ifapplicable ) 

# p Wa s damag e to gate s o r fence s avoided ? (Ifapplicable ) 4
.Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) Foundation , Sidipj ; an dGutter s Ye s .N o 1Wa s damag e t o th e sidin g o rtri m avoided ? 

## y 2 Wa s damag e t o th e foundatio n avoided ? y 3 Wa s damag e l o window s avoided ? t . y 4 Wa s damag e t o window s o rdoo rscreen s avoided ? t^ " 5
.Wa s damag e t o downspout s o rdownspou t extension s avoided ? t y Sidewalk s an dDriveway s (Concrete ) Ve s N o 1 Wa s damag e to driveway surface s avoided'/ 2
.

Wa s damag e to walkway surface s avoided ? 

## y

y• 

# m Propert yCompletio n Agreemen t riii s agreement docuinenl s the completio nof remedia l activilie s performedo nm y property . M y signature wil l designai e tha t Ia msatisfie dwit hIh e restoratio no f m y properly , andtha t n

o ilem s ar e i nquestions , now , o r a

l any lim e i nIh e future , excep t thos e item s listedbelow , ifany
. IPropert y ID : ^^^^' ^

Propert y Address : 3^ 7 //
. Hj-J- i st " Owner: ^ c X S 1 < ^ y ^yyKn, \ Phone : ^r ^ 1 -o' o r C —? 3 1 - 1 

# ^0^-9'^£. ^ - /^ l -"^^7 1 Restoratio n Item s i n Question :

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

yC/iS' ' agre e restoratio ni s completed , excep i a s note d I Id o no t afjrec restoratio ni s complete d 

# etii[o / Owner' s Sigin. 1 Dat e I

## Propert yDamage Settlemen t

Propert y I D 2343 3 Propert y Addres s 32 7 N41 " Stree t Owne r Kriste nCaske y Phon e 402-502-986 5

I hav e receive dfromth e contractor , Coastal Environmental Grou p Inc
. (Coastal) , th e sumo f $300.0 0 to compensat e fo r plant s tha t were remove ddurin g th e removal o f lead-impacte dsoi l fro mth e property . Compensatio nTyp e Gif t Card Valu e of Gif t Car d $300.0 0 Redeemabl e a t India nCree k Nurser y Descriptio n o fDamag e Coasta l remove d severa l smal l plant s locate d i n th e dri p zon e "DZ " t o b e abl e t o remov e lea d impacte d soi l withi n th e DZ
. Coasta l agree d t o compensat e th e homeowne rbyissuin g a $300.0 0 gift certificat e t o th e homeowner
. M ysignatur e belo wacknowledge s th e receip t o fth e gif t car d liste d above ; further , I acknowledg e tha t th e compensatio n amoun t i s fai rfo rth e replacemen t cos t o fth e plant s remove d an d releas e Coasta l Environmenta l Group , Inc
. fro m furthe robligation s o rliabilit yrelate d t o thi s property
.



### (?!( ( 

# le y Owner' s Signaiw e Date Contractor' s Signature Dat e

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