### TRANSMITTA Lo f OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAID # : 3(P H Date : Xll'gjo ^ Address : 1^) ^ (V\iarril ' SJ " Remediatio nContractor : _Coasta l Environmenta l Group

_Year : _2008
_ SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S \y Vide o o f property (DVD ) [[

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Executiv e Summary l y EPA-provide dproperty slcetc h sy Signe dAcces s Agreemen t fo r subjec t propert y /Sji r Signe dAcces s Agreement(s ) fo r adjacen t propert y H

^ Restoratio nAgreemen t H ^ Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. ) y Confirmatio ndat a 

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^ Satisfactor y restoratio nsigne db y Propert y Owne r y Propert y close-ou t chec k lis t signe db y EP A 1 ^ Descriptio no f area s no t meetin g RO D cleanu p criteri a y Utilit y clearance s C

r Propert y informatio nfro mDougla s Count y Assessor' s Offic e 

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### Dougla s Coimty Accoun t Informatio n Pag e 1 of 2 %

' Dougla s County , Nebrask a Propert yRecor d - R254482000 0 Prin t Repor t NE W Featur e - Parce l Dimenston s availabl e @ scal e 0-5 0 ft wes t of 90t h S t - ViewO n Ma p Informatio n i s vali d a s o f 2008-9- 4 Treasurer' s Ta xRepor t Ne wFeatur e -•-•- • Aut o Sale s Searc h Owne r BAILE YPAULET T 181 4 MIAM I S T OMAH AN E 68110-000 0 Propert yInformatio n Ke yNumber : 448 2 000 0 2 5 Accoun t Type : Residentia l Parce l Number : 254482000 0 Parce l Address : 181 4 MIAM I S T OMAH AN E 68110-000 0 Lega l Description : WRIGH TPLAC E LO T7 BLOC K0 E 6 F TL T8 & AL L 3 6 X 6 8 5/ 8 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $ 3,100.0 0 $ 15,500.0 0 $ 18,600.0 0 200 7 $ 3,100.0 0 $ 15,700.0 0 $ 18,800.0 0 200 6 $ 3,100.0 0 $ 15,700.0 0 $ 18,800.0 0 200 5 $ 3,100.0 0 $ 15,700.0 0 $ 18,800.0 0 200 4 $ 3,100.0 0 $ 6,400.0 0 $ 9,500.0 0 200 3 $ 3,100.0 0 $ 6,400.0 0 $ 9,500.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 5 2484. 0 1. 0 69. 0 36. 0 N o Improvemen t Informatio n Buildin g 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R25.
.. 9/27/200 8

### Dougla s County Accoun t Informatio n Pag e 2 of 2 %

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CLIC KTO ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 738. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Goo d

Buil t As : 1 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 Aluminu m Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 2. 0

Roo f Type : Gabl e Stories : 1. 5 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 190 3 0 % 190 3 10 5 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 672. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h En d Soli d Wal l 72. 0 Porc h Sla b Roo f Cei l 16. 0 Use r Es t - Do g 1. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R25.
. . 9/27/200 8

### Pag e 1 of 2 %

" > Create Anothe rTicke t Bac k t o irt h Internet Sen d Emai l



### • YOU RTICKE T NUMBE RI S 2142607
. Origina l Cal l Date : 9/29/0 8 Time : 10:2 8 a m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 10/01/0 8 Time : 11:0 0 a m State : N E County : DOUGLA S Place : OMAH A Address : 181 4 Street : MIAM I S T Twp : 15 NRng : 13 E Sect-Qtr : 10-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lead , remidiatio n Locatio n o f Work : LOCAT E ENTIR E PROPERT Y STARTIN G A T TH E HOUS E AL L TH E WA Y : T O TH E STREET . 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 Dept h o f Excavation : 4f t Corne r Lot : NFront : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V MAGELLANMUDO l OMAHACO F 0PPDGPR 5 QLNNEI C
Servic e Are a Contac t Phon e Numbe r Utilit y Typ e
CXCAT V CO X COMMUNICATIONS , IN C 

### HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
MAGELLA NMAGELLA NMIDSTREA M PARTNER S LPTONY A 

### Day : 918574709 8 Alt : 

### Emerg : 918574709 8
MUDO l METROPOLITA NUTILITIE S DISTRIC T SAND Y 

### Day : 402504782 3 Alt : 

### Emerg : 402504794 6
OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R 

### RO N Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 9/29/200 8

### Pag e 2 of 2
Day : 406728934 3 OPPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T N A 

### Alt : 888728934 3 Emerg : 406728934 3 Day : 406728934 3 QLNN E1 C QWES T LOCA LNETWOR K 

### N A Alt : 

### Emerg : 888728934 3

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# V As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e

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Omah aLeadSite 46904.783-0 1 

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# M ^l # COASTA L ENVIKONHENTA l ^ . l^oTt ^ C R O U r. IN C 

## Consen t Fo rAcces s To Propert y RIGH TOF ENTR YTO PREMISE S 

### Granto r(th e propert yowner ) consent s to an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA ) orit s authorize d representatives , collectivel y th e Grantee , to ente ran d perfor m certai n environmenta l respons e activitie s upo n th e followin g describe d premises : 

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Owner' s Name : Daytim e Phone : 

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Addres s of Propert y covere d bythi s / 

# /yy2yyi 7 y - Agreement : 

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. .. n.7' " T^Slt O PURPOS E OF RESPONS E ACTIVITIE S 

### Th e EP A is requestin g acces s to collec t soi l sample s an d remov e soi l tha t contain s elevate d concentration s of lea d an d maypos e a healt h hazard
. Th e area(s ) wil l be excavate d to remov e contaminate d soil
. Th e remove d contaminate d soi l wil l be replace d wit h clea n material s an d th e are a wil l be restore d to it s origina l condition
. Thi s wor k is bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e of Coastal Environmenta l Group , contracte d byUSEPA , wil l contac t th e Granto rin-perso n to discus s th e wor kto be performed , th e Granto rwil l hav e an opportunit yto revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor eit begins
. Onc e th e wor k is finished , th e Granto rwil l be aske d to revie wth e wor k an d confir m tha t itis complet e an d meet s wit h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m EP Atha t th e propert y ha s bee n remediated
. ENVIRONMENTA L RESPONS E ACTION S 

### Bysignin g thi s Acces s Agreement , th e Granto r is grantin g th e EPA , it s employees , contractor s an d subcontractors th e righ tto ente rth e property , at al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e of performin g th e work
. Thi s acces s shal l remai n in 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 of 2

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# M COASTA L *^ , . ^ ENVIRONMENTft l ^ l PROt * C • O U rINC
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### 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 maywis 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 f th 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 f th 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 f th e wor k activities , o rwit h an y o f th 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 f sai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o f th 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

Q^gran t access t o m ypropertie s D I d o not gran t access t o m ypropertie s 

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O i woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.COASTA L • : ' tNOMMSMTA i a « o wp tM C 

## 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 will als o serv e a s documentatio nfo r th e purpos e o f assurin g that restoratio n activitie s ar e complete dto th e satisfactio nofth e propert y owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA)
.

Propert y ID : f^l^ l 

### Propert y Address : /// / Mlc^.y^ l S 

# r Owne r Phone : 

# Q'^y^\ ^
O nth e attache ddiagram(s ) indicat e area(s ) to excavate dan ddeptho f excavation , locatio no f al l know n utilities , subsurfac e features , surfac e structure s andlandscapin g features , acces s location(s ) to b e use db y contractor , an dth e directio no f North
. Indicat e distances , depths , material types , etc . Indicat e digita l photo s b y referencin g th e photo-lo g numbe r witha narro w indicatin g directio no f view
. 

### Item s T o B e Remove d B yOwne rBefor e Star t O f Remediation : (Us e additiona l sheet s a s necessary ) Th e removal , storage , disposal , and/o rretur n o f thes e item s i s th e Owner' s responsibility
. Item : Item : t ' ^ 

# r-rrfl l Item : Item : Item : Item : Item : Item : Pag e 1 o f< ^ ^ COASTA L a n o V r. IN C 

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

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Pag e 2 o f /_7• ^ C O AS T AL c« o u rIM 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 : Item : Item : Item : Item : Item : Item : Item : Item : Item : Hem : Item : Item : Item : Item : 

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Pag e 3 o f ( ^COASTA L
• ••'vinONnt M TA L C M O U P t N C



## Item

Pre-existin g propert y area , tha t will be excavated , tha t i s covere dwit hgrass .

Number of tree s > 2 inch trunl < diameter

Number of tree s < = 2 inch trunk diameter

Number of Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Attachasketchof the sprinkler layout
.
Number o f an dsize o f eachgarden / flowe r be d area . Attachasketchof relativ e size s an dlocations
. 

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

## Quantit y Unit Condition/Type/Specie s

Squar e fee t 

# Qt- y

Eac h 

# y • ­



## r\ ^ Eac h

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# y y 

# / y Eac h Squar e Fee t

Pag e 4o f
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### Ite m Quantit y Urii t Condition/Type/Specie s Agree dupo nvalu e of Dian t material s no t to b e renlace dbv contractor . Note thi s valu e will b e usedto issu e aplan t vouche r to th e propert y owner . 

# y $ \ Agree duponlis t o f plant material s tha t will b e replace db y contractor . B e ver y specifi c an ddetailed
. Include asketchof wer e eachplant wil l b e place d by th e contractor . 

# y Eac h

Agree dupo nare aof propert y t o b e replace d wit hgras s sod
. Include asketchof th e area(s ) to be replace dwit h gras s sod
. 

# f)x y S F 

# 1

1

Are aofCit y o r Count y propert y to b e landscaped per thei r requirements
. Include asketcho f the ai^e a(s ) 

# y y
S F

Easement Area , to b e excavate d 

### t / S F 

### /

Pag e 5 of /C O AS T A I. « <* e w r . INC
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Additiona l Comment s Instruction s lem s / / instrucaons :f.
. • 

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cn Chec k th e box if Owne rdoe s rra t wan t CE G to documen t interio rfoundatio n wail s an d possibl e pre-existin g damage
. Bycheckin g thi s boxCE G is no t responsibl e foran ydamag e don e to th e interio r ofhouse , indudin g foundatio n crack s orfissures. 

# y Q I do not agre e agre e yrag i

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. ADDRES S 181 4 miam i QUAD/ZON E INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

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

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151 4 SOI L 2008-10-1 6 12:4 6 30.2 7 Fina l 561 4 181 4 miam i F l Ventr y 6 CLEARANC E

± Erro r ± 18.89 4

# Tlierm 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 339.84 8 Supervise d By : 

## Certificat e o f Verificatio n

151 6 SOI L 2008-10-1 6 12:4 7 30.0 3 Fina l 561 4 181 4 miam i F l Ventr y 6 CLEARANC E

± Erro r ± 22.27 3

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 295.58 9 Supervise d By : 

## Certificat e o f Verificatio n

151 7 SOI L 2008-10-1 6 12:4 8 30.2 8 Fina l 561 4 181 4 miam i F l Ventr y 6 CLEARANC E

± Erro r ± 20.50 2

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

Supervise d By : 

## Certificat e o f Verificatio n

152 3 SOI L 2008-10-1 6 12:5 4 121.1 5 Fina l Av g o f 1519-152 2 181 4 miam i B l Ventr y 6 CLEARANC E

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 490.44 7 Supervise d By : 

## Certificat e o fVerificatio n

151 9 SOI L 2008-10-1 6 12:5 0 30.3 9 Fina l 561 4 181 4 miam i B l Ventr y 6 CLEARANC E

± Erro r ± 26.74 0

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 237.46 0 Supervise d By : 

## Certificat e o fVerificatio n

152 0 SOI L 2008-10-1 6 12:5 3 30.2 6 Fina l 561 4 181 4 miam i B l Ventr y 6 CLEARANC E

± Erro r ± 18.81 7

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 239.67 2 Supervise d By : 

## Certificat e o f Verificatio n

152 1 SOI L 2008-10-1 6 12:5 3 30.2 3 Fina l 561 4 181 4 miam i B l Ventr y 6 CLEARANC E

± Erro r ± 19.29 0

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 257.10 7 Supervise d By : 

## Certificat e o fVerificatio n

152 2 SOI L 2008-10-1 6 12:5 4 30.2 7 Fina l 561 4 181 4 miam i B l Ventr y 6 CLEARANC E

± Erro r ± 20.40 2

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

Supervise d By : 

## Certificat e o f Verificatio n

152 8 SOI L 2008-10-1 6 12:5 8 121.1 5 Fina l 4 Av g o f 1524-152 7

181 4 miam i .(fe z • Ventr y .1 3 iCLEARANC E

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 155.02 7 Supervise d By : 

## Certificat e o f Verificatio n

152 4 SOI L 2008-10-1 6 12:5 5 30.2 7 Fina l 561 4 181 4 miam i D Z Ventr y 1 3 CLEARANC E

± Erro r ± 15.16 4

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 226.76 8 Supervise d By : 

## Certificat e o f Verificatio n

152 5 SOI L 2008-10-1 6 12:5 6 30.3 0 Fina l 561 4 181 4 miam i D Z Ventr y 1 3 CLEARANC E

± Erro r ± 18.06 9

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 274.34 2 Supervise d By : 

## Certificat e o fVerificatio n

152 6 SOI L 2008-10-1 6 12:5 7 30.3 0 Fina l 561 4 181 4 miam i D Z Ventr y 1 3 CLEARANC E

± Erro r ± 19.92 2

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 226.93 8 Supervise d By : 

## Certificat e o f Verificatio n

152 7 SOI L 2008-10-1 6 12:5 8 30.2 8 Fina l 561 4 181 4 miam i D Z Ventr y 1 3 CLEARANC E

± Erro r ± 18.29 2

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

Supervise d B y 

## Certificat e o f Verificatio n

153 7 SOI L 2008-10-1 6 13:1 0 121.0 8 Fina l l^v g o f 1533-153 ^

181 4 miam i W Z Ventr y "^ 6

CLEARANC E *

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

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

pp m P b 74.76 7 Supervise d By : 

## Certificat e o f Verificatio n

153 3 SOI L 2008-10-1 6 13:0 7 30.1 9 Fina l 561 4 181 4 miam i PZ Ventr y 6 CLEARANC E

±Erro r ±11.22 8

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 294.87 4 Supervise d By : 

## Certificat e o f Verificatio n

153 4 SOI L 2008-10-1 6 13:0 9 30.2 9 Fina l 561 4 181 4 miam i PZ Ventr y 6 CLEARANC E

± Erro r ± 20.69 4

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 328.90 6 Supervise d By : 

## Certificat e o fVerificatio n

153 5 SOI L 2008-10-1 6 13:1 0 30.2 8 Fina l 561 4 181 4 miam i PZ Ventr y 6 CLEARANC E

± Erro r ± 21.85 2

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Bilierica , 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 196.57 2 Supervise d By : 

## Certificat e o f Verificatio n

153 6 SOI L 2008-10-1 6 13:1 0 30.3 2 Fina l 561 4 181 4 miam i PZ Ventr y 6 CLEARANC E

± Erro r ± 17.12 5^*-^* % 

### ir>A^ \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 (fiflQ « % ^^^ 7 S Coasta l Environmenta l Grou p Inc
. ' V^^ ^ V^^^T ^

www.coastalhazmat.co m ^^ip^ y COASTA L ENVIRONMENTA L CROUP
. INC
. 

# EXECUTIV ESUMMARY : BVI D #561 4 - (181 4 MIAM I ST ) 'x l N o Issue s o r Concern s | ^ Issues/Concern s Detai l Explanation:

## Propert yCompletio n Agreemen t Tliis agreemen i docuinenl s th e completio noi " remedial activitie s perlbrmec l on my property . My .signature wil l designal e Iha l 1 amsatisfie dwilhth e restoralio nof my properly , an dtha t no item s ar e inqucstion.s , now . or al any tim e inth e fiiUire , excep t thos e ilem s liste dbelow , ilany
. Properl yID : ^^/ / Propert y Addre.ss : 'i4^r) i <-J/ Owner : P^J- e ^S^'7 ^ ' 

# Phone : vz)z^

- f 3 ^yyy^ .. Restoratio n Item s in Question :

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

X I I aj;rc4 ' restoratio ni. \coni|tlr(c(l , cxccp l as note d I I <l o no t Wtte e rcslorHtiu ni. v complete d 

# yuyyyy ^ l^'Zi'o r 

# \A'^'^\ (py\y Y Owner' s Si]>na(iir c Dal e riinlractor' s Signatur e Date I7

4 

### f*! L 

# EP A EP A Propert y Clos e Ou t For m Propert y# : ^M l Propert y Addr».

- llj'^j^l' ^ ^^
- Datcrrtinc : ' ' [ OwVer' s Name;.fe.
. t^'^grT.
. . (^ ^ ^ Quad s Excavated : '(^ l -< ' f 3^ ^ V k \

- ^ I Contracto r Crou p ^ft^TVy V Ye s N o Excavatio nGenera l 1
.If necessary , wer e th e correc t quadrant(s ) excavate dandrestored ? 2
.I f necessary , were th e correc l area s ofdri p zone excavate dan drestored ? Gradin g So dan dVegetatio n Ye s N o 1
.Doe s the gradin g aroun dth e perimeier ofth e hous e i nexcavate darea s generally slop e awa y fromthe house ? 2
.Ha s sodbee nlai di nall area s tha t wer e excavated ? 3
.

Doe s th e so dappea r t

o b e generally health y an dgrowing ? (Only evaluate i f inspecteda t a3 0 y day tim e period)
__ ^ 4
.Are sodde darea s generally firman devenly graded ? y 5
.

Are th e joint s txtwee nth e so dstrip s generally tight ? (Only evaluate i f inspecte da t a3 0 da y tim e period) 6 .Wa s the propert y grade dsuchtha t wate r wil l nol poo l o nth e property ? y ^ Wa s damage t o landscapin g o r plan t material s avoided ? t y Gates , Fence s an dRcUinin g Wall s Ve s N o 1
.D o gate s ope nan dclos e freely? (I f applicable ) y 2
. Wer e al l gate s o r fence s lakendow ndurin g restoratio nacliviiie s reinstalled ? (Ifapplicable ) . ^ 3
.Wa s damage to gate s o r fence s avoided ? (Ifapplicable ) y 4
.

Wa s damage to retainin g wall s avoided ? (Ifapplicable ) 

## A , ^ Foundation , SidioK an dGutter s Ye s N o I .Wa s damage l o th e sidmg o r trimavoided ? y 2
.Wa s damage to the foundationavoided ? y 3
.Wa s damage to window s avoided ? y

Wa s damage to window s o r door screen s avoided ?

- ^ 5
.

Wa s damage to downspout s or downspoul extension s avoided ? 

### y Sidewalk s an dDriveway s (Concrete ) Ye s N o 1
. Wa s damage t o drivewa y surface s avoided ? y 2
. Wa s damage to walkwa y surface s avoided ? y

## 0>*'Dcr s comments :

Inspectio nnotes :

Remova l an drestorationaclivale s complete including the 30-da y so dwarranty : 

# EP A Represenlaii '^t-yycy77i7^ ^ y^/icyyr Date : 7 ^ /y /)//) ^