## TRANSMITTALof OMAHALEAD SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAI D # : 'l ^ k)^n yDatc:_lmf_/ k Address : Remediatio nContractor : Coasta l Environmenta l Group

_Year : _2010ARR A
SOI LREMEDIATIO N PROPERT YFIL EFOLDE RDOCUMENT S Vide o o f property (DVD ) ^ 

# y Executiv e Summary EPA-provide dproperty sketc h Signe dAcces s Agreemen t for subjec t property Signe dAcces s Agreement(s ) for adjacent pfopert y Restoratio nAgreemen t Settlemen t document s (i.e. , for damag e o r to replac e plants , etc. ) Confirmatio ndat a Photograph s \h(W^/VAUv ] Y(^0(\)fk\l^ ^ ) ^ 4(^ V As-buil t sketc h Satisfactory restoratio nsigne db y Property Owner Property close-ou t chec k lis t signe db y EPA Descriptio no f area s no t meetin g RO D cleanup criteri a 

# y Utility clearance s Property informatio nfromDougla s County Assessor' s Offic e

3021807 5 

# mi l Superfun d

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Utilit yClearanc e Video/Photo s (Before ) Video/Photo s (During ) Video/Photo s (After ) Video/Photo s (30-Day ) Propert yCompletio n Agreemen t Sent : / / Signed ; J[//jf^/ ^ 

### Signed : JJ ' ^ ^ >P ^ 1 1 1 1 1 1 Called : \ \ 1 f O / ^ 

## On:\JL/i}./i ^ OD : / / On : / / On : / / Signed : / / By : By : By : By : By : By : , 

### By : l/jf( g lo ^ 

## By:OC\as[U ^ By : By : By : By : D Finj' l Repor t Issued : / / By : Ai rMonitorin g (4£ applicable )

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### Dougla s County Accoun t Infoij|utio n Pag e 1 of 2 ]j|^i (
Dougla s County , Nebrask a Propert yRecor d - R095280000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s avallabi e @ scal e 0-5 0 ft wes t o f52n d S t - VIeWO n Ma p Informatio n i s vali d a s o f2009-10-1 5 Treasurer' s Ta xRepor t Ne wFeatur e ->••••Aut o Sale s Searc h Owne r ERICKSO N NIL S A 481 7 DAVENPOR TS T# 2 OMAH AN E 68132-000 0 Propert yInformatio n Ke yNumber : 528 0 OOO O 0 9 Accoun t Type : Residentia l Parce l Number : 095280000 0 Parce l Address : Lega l Description : 481 7 DAVENPOR TS T OMAH AN E 68132-000 0 DUNDE E PLAC E LO T9 BLOC K11 8 5 0 X 13 5 Valu e Informatio n
200 9 200 8 200 7 

### 2006 200 5 200 4 Lan d $16,900.0 0 $16,900.0 0 $16,900.0 0 $16,900.0 0 $16,900.0 0 $16,900.0 0 Improvemen t 

### $165,400.0 0 $165,400.0 0 $168,700.0 0 $153,100.0 0 $145,500.0 0 $145,500.0 0 Tota l $182,300.0 0 $182,300.0 0 $185,600.0 0 $170,000.0 0 $162,400.0 0 $162,400.0 0 Lan d Informatio n Acre s 0.1 5 S F 

### 6750. 0 Unit s 1. 0 Dept h 135. 0 Widt h 50. 0 Vacan t N o Improvement Informatio n Buildin g 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accoimtno=RO.
. . 10/23/200 9

### Dougla s County Accoun t Infoi|jMtio n Pag e 2 of 2 tjjj^ i

481 7 Davenpor t S t D « C-arns fV ' 1 • 

## m^¥^ ' m^W'^

SAeaiH l F16W i:3 6 0Sq. n "9 1 i;«0. 5 Sij
. fl
. J i 2 1/ 2 Stor yUnfi n CLIC KT O ENLARG E IMAG E CLICJKjrO_ENLARG E IMAG E Squar e Footage : 2476. 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 yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 8. 0 Exterior : Fram e Viny l Units : 2. 0 Interior : Drywal l Baths : 2. 0 Roo fCover : Compositio n Shingl e Bedrooms : 2. 0

Roo fType : Gabl e Stories : 2. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : I 0. 0 Yea rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 190 6 199 3 0 % 190 6 10 3 Deta/ 7 Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 1236. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 2. 0 Porc h En d Soli d Wal l 112. 0 Porc h En d Soli d Wal l 112. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO.
. . 10/23/200 9

# n Pag e 1 of 2 •
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### • YOU RTICKE TNUMBE RI S 2404481
. Origina l Cal l Date : 11/10/0 9 Time : 7:2 1 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 11/16/0 9 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 481 7 Street : DAVENPOR T S T Twp : 15 NRng : 13 E Sect-Qtr : 19-NE,20-NW 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 : FAX 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 Environmenta l Grou p Dept ho f Excavation : 4 fee t Corne r Lot : NFront : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N BSHPCLK S CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac t 

### Phon e Numbe r UtiUt y Typ e
BSHPCLK S NEBRASKAHEALT H SYSTEM 

### N A 

### Day : 402552346 0 Alt : 402552334 7 Emerg : 402559511 1

CXCAT V CO XCOMMUNICATIONS , IN C HEID I 

### Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7

MUDO l METROPOLITA NUTILITIE S DISTRIC TSAND Y 

### Day : 402504782 3 Ah : Emerg : 402504797 0

OMAHACO FCIT YO FOMAHA-TRAFFIC,SEWE R 

### RICHATRAFFI C Day : 402444719 7

AU : 402444516 1

Emerg : 402444516 0

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.
. . 11/10/200 9

### Pag e 2 of 2 • #

0PPDGPR 5 OMAH APUBLI C POWE RDISTRIC TN A 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3
QLNNEI C QWES TLOCALNETWOR K N A 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.
. . 11/10/200 94963 2 

# 1 ^ As-Buil t Drawin g COASTA L EMVIKONNKNTA L 

# Omah aLea dSuperfun dSit e e ft O U » . IN C OLS# : 4963 2 Dat e Excavated:11/23/200 9 Dat e USEP ASiqne d Off : 7/19/201 0 Are a Sodden : 157 5 s q f t Exterio rPain t Nort h Arro w Omah a Lea d Sit e •Good Sit e Sketc h B'Poo f Samplin g Address : 481 7 DAVENPOR TST 

# J

•Notpain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r 

# I LA B Concentratio n Collecte d Firm : ? £•C-C
. p.6 - RYASCPXA-4963 2 F 1 ~l2.~ fppm 

### D Date : l-l-^-ot RYBSCPXA-4963 2 F 2 H o h ppm 

### D Time : '^'^ l R-'^ - RYCSCPXA-4963 2 B l 3 s O pp m 

### D Sample s Analyze d RYDOCPX A4063 a 83 ­ " pp m 

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### D D Date : 6 II-Of c nPZSCPX A1063a—P Z
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### D D Time : Piv , Staff : fn-bl ^ Numbe ro fSample s = | H [ | Q \ Legend : F 1 = Fron t Left , F 2 = Fron t Right , B l = Bac k Left , 8 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 , fadn g propert y

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v2(X WC'reued : i:-Apt-l » Legen d Concre't e Dri p Zon e Excavate d Quadrant s Excavate d Are areplace dwit h So d Are areplace dwit h Rock/Mulc h Axe alef t bar e Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
.

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

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### D Date : 7 - Z.'^-O t _iZX^PP' ^ RYBSCPXA-4963 2 F 2 _H£ifiL_PP m 

### D Time : V-A \ fl-^- RYCSCPXA-4963 2 B 1 3$' 0 pp m 

### D Sample s Analyze d -RYDSCPXA40632 B3 - . pp m 

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### H8H q pp m XR F Unit : 6^H D Book : 21 1 

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### D Date : 6 1 1 - Of c 

### D nPZCCPXA1060 3 P Z pp m 

### D Time : Piv ^ 

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### 4963 2 ExterkM - Pain t Nort h Arro w Omah a Lea d Sit e •Good Sit e Sketc h [g-Poo r Samolin a Addrass : 481 7 DAVENPOR TS T •Notpain t ^ Lea d Sampl e Sample s Collecte d Sampl e Numbe r Concentratio n Collecte d LA B ?£ , CC
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s viewe d fron i t wstree t ladn g propert y...««,. , COASTA I INVIItONn fKTA t **" < PBO't'' * CROUP
. IN C 

### Consen t fo F Acces s T o Pfopert 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 :

Owner' s Name : Daytim e Phone : 

# tacV-^OV K

Addres s o fPropert y covere d b ythi s 

# '^S^VpAv&vw^c X5\ - 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 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 wor k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o fCoasta l Environmenta l Group , contracte d b yUSEPA , vinj 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 wor k before 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 confin n 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 vwitte 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 , its employees , contractors 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 wori t ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :

Pag e 1 o f2

### c 

## I 8 COASTA L tHrmONHINTA l 

# \

y C K0 U rIN 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 ; t 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
. <rAllo 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 (402 ) 991-119 9 

# X ; gran t acces s t o mypropertie s Q I d o no t gran t acces s t o mypropertie s 

# ihlQ'0 9 Date Signature Date

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

Page 2 of 2COASTA L C no U' 

## Restoratio n Agreemen t Th e purpos e ofthi s agreemen t i s t o provid e amutua l agreemen t a s t o condition s ofth e propert y prio r t o 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 ar e complete dt o th e satisfactio no f th e propert y owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA)
.

Propert y ID : PropertyAddress : Z/^/ 7 QTsVOj^NpOf- V S V Owner : / ^ jXJ " ^.f j C^L^X^r ^ 

# \yy^^yyj'Y^ - o\^ ^ O nth e attache ddiagram(s ) indicat e area(s ) t o excavate , surfac e structure s andlandscapin g feature s and acces s Iocation(s ) t o b e use db y th e contractors . Indicate distances , depths , material types , etc . Photographicall y an dVideographicall y documen t th e existin g condition s ofth e property an dth e basemen t i f necessary . 

### Item s t o b e Remove d b yth e Owne rbefor e Star t o fRemediation : Th e lernoval
. storafie
. di&posal , and/o rretur n o ftties e item s i s th e Owner' s responeibility
. ttem: 

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Landscap e Inventor y 

### Ite m Quantit y Uni t 

## Condition/Type/Specie s Pre-existin g propert y area , Quadrant s tha t wil l b e excavated , tha t i s covere dwh hgrass . Numbe r o f tree s > 2 inc h Eac h 

### ) trunJ c diamete r Numbe r o f tree s < = 2 inc h Eac h trun k diamete r Numbe r o f Spriokle r Zones
. Contro l Valves , Eac h Timers , Heads , etc . Mint h i l sketcl i o l tilt ­ "•rripklc i l;«y!iLi i Numbe r o f an dsiz e o f eac hgarden / flower be d Eac h area . Squar e Fee t All;\t h i l skclc- h 1) 1 ri.!;iiivt ' M/csmil l loc;uiivi > Agree dupo nvalu e o f plan t material s no t t o b e replace db v contractor . Vou - l!ii ' \nlu c\\i\ \ ni
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### Page 2 of
.IAddttiona l Comment s / Instructions : 

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# L
. ] ^ Chec k th e t)o xi fOwne rdoe s no t wan t CE G t o documen t interio rfoundatio n walls an d possibl e preexistin g damage
. B ydieckin 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 crack s o rfissures
.

QId o no t agre e

Date Obntractor' s Signature Date Pag e 3 o f

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E 

## Certificat e o fVerificatio n

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 114 9 Mod e SOI L Tim e 2009-11-2 3 16:1 6 Duratio n 30.5 2 Sequenc e Fina l Flag s BVI D 4963 2 ADDRES S 481 7 davenpor t QUADRAN T F l DEPH T 8 " XR F TEC H R
. VENTR Y MIS C clearenc e NOT E ngn c

pp m Erro r P b < LO D 11.75 2 Supervise d By :

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

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pp m P b < LO D Supervise d By : 

## Certificat e o fVerificatio n

115 0 SOI L 2009-11-2 3 16:1 7 30.5 0 Fina l 4963 2 481 7 davenpor t F l 8 " R
. VENTR Y clearenc e ngn c

Erro r 11.51 7

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 115 1 Mod e SOI L Tim e 2009-11-2 3 16:1 7 Duratio n 30.5 1 Sequenc e Fina l Flag s BVI D 4963 2 ADDRES S 481 7 davenpor t QUADRAN T F l DEPH T 8 " XR F TEC H R
. VENTR Y MIS C clearenc e NOT E ngn c

Erro r pp m P b 11.58 7 < LO D Supervise d By :

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 115 6 Mod e SOI L Tim e 2009-11-2 3 16:2 0 Duratio n 90.6 1 Sequenc e Fina l Flag s AVERAG E fAV g o fllb3-llb b j ADDRES S *-481 7 davenpor t QUADRAN T F 2 DEPH T 8 " XR F TEC H R
. VENTR Y MIS C clearenc e NOT E ngn c

Supervise d

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 51.45 0 Supervise d By : 

## Certificat e o fVerificatio n

115 3 SOI L 2009-11-2 3 16:1 9 30.1 0 Fina l 4963 2 481 7 davenpor t F2 8 " R
. VENTR Y clearenc e ngn c

± Erro r
± 13.08 1

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 64.91 0 Supervise d By : 

## Certificat e o fVerificatio n

115 4 SOI L 2009-11-2 3 16:1 9 30.4 2 Fina l 4963 2 481 7 davenpor t F2 8 " R
. VENTR Y clearenc e ngn c

± Erro r
± 12.66 2

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 66.22 4 Supervise d By : 

## Certificat e o fVerificatio n

115 5 SOI L 2009-11-2 3 16:2 0 30.0 9 Fina l 4963 2 481 7 davenpor t F2 8 " R
. VENTR Y clearenc e ngn c

± Erro r
± 14.17 4

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

Supervise d B y 

## Certificat e o fVerificatio n

116 0 SOI L 2009-11-2 3 16:2 2 91.6 5 Fina l 

### /^5fIi5Z=il59_ J 481 7 davenpor t D Z 13 " R
. VENTR Y clearenc e ngn c

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 115 7 Mod e SOI L Tim e 2009-11-2 3 16:2 1 Duratio n 30.5 5 Sequenc e Fina l Flag s BVI D 4963 2 ADDRES S 481 7 davenpor t QUADRAN T D Z DEPH T 13 " XR F TEC H R
. VENTR Y MIS C clearenc e NOT E ngn c
Erro r pp m P b 12.46 4 < LO D Supervise d By :

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 115 8 Mode SOIL Tim e 2009-11-2 3 16:2 2 Duratio n 30.5 6 Sequenc e Fina l Flag s BVI D 4963 2 ADDRES S 481 7 davenpor t QUADRAN T D Z DEPH T 13 " XR F TEC H R
. VENTR Y MIS C clearenc e NOT E ngn c

pp m Erro r P b < LO D 12.16 1 Supervise d By :

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 115 9 Mod e SOI L Tim e 2009-11-2 3 16:2 2 Duratio n 30.5 4 Sequenc e Fina l Flag s BVI D 4963 2 ADDRES S 481 7 davenpor t QUADRAN T D Z DEPH T 13 " XR F TEC H R
. VENTR Y MIS C clearenc e NOT E ngn c

Erro r pp m P b < LO D 11.22 6 Supervise d By :

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Fiag s AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

Supervise d By : 

## Certificat e o fVerificatio n

116 4 SOI L 2009-11-2 3 16:2 4 91.7 1 Fina l
481 7 davenp~ort e m 1 " R
. VENTR Y clearenc e ngn c

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

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 116 1 Mod e SOI L Tim e 2009-11-2 3 16:2 3 Duratio n 30.5 6 Sequenc e Fina l Flag s BVI D 4963 2 ADDRES S 481 7 davenpor t QUADRAN T e m DEPH T 1 " XR F TEC H R
. VENTR Y MIS C clearenc e NOT E ngn c

pp m ±Erro r P b 91.15 4 ±13.11 5 Supervise d By :

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 105.55 2 Supervise d By : 

## Certificat e o fVerificatio n

116 2 SOI L 2009-11-2 3 16:2 4 30.5 7 Fina l 4963 2 481 7 davenpor t e m 1 " R
. VENTR Y clearenc e ngn c

± Erro r
± 13.81 1

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

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 128.90 7 Supervise d By : 

## Certificat e o fVerificatio n

116 3 SOI L 2009-11-2 3 16:2 4 30.5 8 Fina l 4963 2 481 7 davenpor t e m 1 " R
. VENTR Y clearenc e ngn c

± Erro r
± 14.97 6

### T> I
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## / JCk ^

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## Omah a 

## a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
. V %^^|^|^ T- • •'^S^ST ' \ ^

• J? www.coastalhazmat.co m Xp„ott.<i* ^ COASTA L I««IIOIINIIITA l eio u r. m c 

# EXECUTIV ESUMMARY : BVID #49632-(481 7 DAVENPORTST )
No Issue s or Concern s Q Issues/Concern s Detail Explanation :

### % 

## EP APropert y Clos e Ou t For m Propert y U : ^^(^^' ^ Propert y Datenime ; OwBer' i Quad s Excavated : Contracto r < Excavatio nGenera l 1
.

I f necessaiy , wer eth ecorrec t quadrant(s ) excavate dan drestored ? 2
.

I f necessary , wer eth ecorrec i areasofdri p zon eexcavale dan drestored ? Gradin g So dan dVegetetto n IDoe s Ih efiadin g aroun dth eperimete r ofth ehous ei nexcavale darea s generall y slop eawa y fromtli ehouse ? 2
.

Ha s so dbee nlai di nal larea s tha t wer eexcavated ? 3
.

Doe s th eso dappea r t o b egenerall y health y an dgrowing ? (Onl y evalual eif inspecte dat a3 0 da y tim eperiod ) 4
.Ar esodde darea s genetall y flrman devenl y graded ? 5
.Ar eth ejoint s betwee nth eso dstrip s generall y tight ? (Onl y evaluat ei f inspecte da t a3 0 day tim eperiod ) • 6
.

Wa s th epropert y grade dsuc hthat wate r wil lnot poo lonth eproperry ' 7
.

Wa s damag et o landscapin g o r plan t material s avoided ? Gates
. Fence s an dRetainin g Wal b 

# r I
.D o gate s ope nan dclos efreely? (Ifappiicable ) 2
.

Wer eal lgate s o r fence s take ndow ndurin g restoralio nactiviiie s reinsulied ? (I f applicable ) 3
.Wa s damag et o gate s o r fence s avoided ? (Ifappiicable ) 4
.

Wa s damag et o retainin g wall s avoided ? (Ifappiicable ) Foundation , Sidin g an dGnller t I
.

Wa s damag et o th esidin g o r tri mavoided ? 2
.

Wa s damag et o th efoundationavoided ? Wa s danmg et o window s avoided ? 4 Wa s dainag et o window s o r doo r screen s avoided ? 5
.Wa s damag et o downspout s o r downspou lextension s avoided ? Sidewalk s an dDriveway s (Concrete ) I
.Wa s damag et o drivewa y surface s avoided ? 2
.Wa s damag et o waDcwa y surface s avoided ? Ye i N o 

### l / ^


### \ y ^ 

# ly y

- ^ - Vc s N o 

### \ y ^ 

# c^- ^
Ve s .N o 

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# y ^
Ye s N o ^ 

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## OM'oer s comments :

I 

## jlnspectio nnotes :

Removal andresloratio nactivate s coinplete«inckidin g the 30-da y so dwarranry : EP ARepresentativ e U^J K Ijajl^ ^ Date : " ] [ ^ 2^1 0i 

# 1 % #



## Propert yCompietio n Agreemen t
Thi s agreemen t documenl s Ih e complclio n o l remedia l aclivilie s perloime d o n m yproperl yM ysignatur e wil l designal e Iha l I a m satisfie d wit h Ih e restoratio n o fm yproperly , an d lha t n o item s ar e i n questions , now , o ra l an ylim e i n th e fuluie , excep l Ihos e ilem s lisle d below , i fan y

PropertylD : ^ ( ^ 5 ^ PropertyAddress : qtM ^ t^lyr ^ ^ Vf ^
Phone : '^f ^ rj^TS ^ Restoratio n Item s i n Question :

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

I J flgrcc«Mfor«(io n i % completed , cxccp i «s noler i [_ | I rio no l ai;re crestoratio n i s complele d

Owner' s Signatur e Dat e Cdnt i artor' s Signatur e Dat e