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

## ^ [ 0 SAI D # : Date : 

# M l
Addres s 

# : Wi q9 

# •^^' ^ m RemediationContractor : Coasta l Environmenta l Grou p Year ; 200 |
SOI LREMEDIATIO N PROPERT YHL EFOLDE RDOCUMENT S Vide o o f property (DVD ) 

# A Executiv eSummar y EPA-providedproperty sketch SignedAcces s Agreement fo r subject property SignedAcces s Agreement(s ) fo r adjacen t propert y RestorationAgreement T T Settlement docimient s (i.e. , fo r damag eo r to replac eplants , etc. ) Confinnatio ndata Photograpli s ^^^ ^ ^ f k ^^l^-n ^ 3 / As-built sketch Satisfactor y restoratio nsigne db y Propert y Owner 

# 7 Propert y close-out diec k lis t signedby EP A

• "-f r 

## Descriptio no f area s not meetin g ROD cleanup criteri a Utilit y clearance s 

# A Propert y informationfro mDougla s Count y Assessor' s Office

30054845 

## Superfun d

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# Piopert y Acces s Checklis t Property ID : )f^L\^ Q nWORKSTARTE D ON : / / D WORKCOMPELTKD ON : / / Property Acldresi:;<9; 9 <> . ^ fi^O
Rente n 0>vncr ; 

# 'rxtf\<s\ ^ V/»t;qV\ A Atldrcss : 

### Phone : Fax : Cell/Pager Additional Information : 

# Phone : ^Q^ ^.ujs.<^qaf t Fax : Ccll/Pager :
D NotiflcationLette r Sent : / / By : ^ Acces s Agreement Slg«cd:^/^/( ^ By : ^ Restoratio nAgreement 

# Signed : 5-/20/( 3 By : O Topsoil Samplin g (if applicable ) / / By : O Disposa l Samplmg (if applicable ) / / By : D Garde nSamplin g (if applicable ) / / By : " ^ Utilit y Clearanc e Called : < ^ lU^l( ^ 

# By:q/2ftM HC'.lllol M Cg ^VWeo/Photo s (Before ) On:l€ > / 5 / ? By : (^(j(^-^^ ; nVideo/Photo s (During ) On : / / By : D Video/Photo s (After) On : / / By : D Video/Photo s (30-Day ) On : / / By : Q Property Completio nAgreement Signed : / / By : D Pinal Report Issued : / / By : Ai r Monitorin e(a s applicabl e DCommuiut y Q Cnsw On : / / By : Results : D Communit y • Cre w On : / / By : ResnHs :

• Communtt y Q Cre w On : / / By : 

# 1 Results : 

# 1

OmahaLea dSite

### •• 

## ^Dougla s Count y Accoun t bi^rai^o n Pag e1 of 2
Dougla s County , Nebrask a Propert yRecor d - R254219000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f52n d S t - VJe WO n Ma p 

### Informatio n i s vali d a s o f2009-9-1 5 Treasurer' s Ta xRepor t Ne wFeatur e ->••- •Aut o Sale s Searc h Owne r VAUGH N TIMOTH YJ
191 9 S 3 5 AV E OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 421 9 000 0 2 5 Accoun t Type : Residentia l Parce l Number : 254219000 0 Parce l Address : 191 9 S 3 5 AV OMAH AN E 68105-000 0 Lega l Description : WINDSO R PLAC E EX TLOT3 6 BLOC K0 5 0 X 13 5 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $6,500.0 0 $94,000.0 0 $100,500.0 0 200 8 $6,500.0 0 $94,000.0 0 $100,500.0 0 200 7 $6,500.0 0 $94,000.0 0 $100,500.0 0 200 6 $6,500.0 0 $85,600.0 0 $92,100.0 0 200 5 $6,500.0 0 $85,600.0 0 $92,100.0 0 200 4 $6,500.0 0 $85,600.0 0 $92,100.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 5 6750. 0 1.0 135. 0 50. 0 N o Impro t vemen Informatio n Buildin g 1



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

. 9/17/2009•• 

## Dougla s County Accoun t L|£arn|^io n Pag e2 of 2

I i 5J t 0 S< J f l rwtrvx r 1 4 I T UP StOCS o F l ;
.50

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# %^*s * 1 1/ 2 stor y Bwim t Bloc k 8 < 7G0. 0 S<|

. R

CLIC KT O ENLARG E IMAG E O ENI^RG E IMAG E Squar e Footage : 1334. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : i Averag e Uni t Type : Condition : I Averag e

Buil t As : 1 1/ 2 Stor yR n Cond o Squar e Footage : j 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 6. 0 Exterior : •. Fram e Viny l Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 2. 0

Roo fType : Gabl e Stories : I 1. 5 Floorcover : i 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 192 6 0 % 192 6 8 3 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 790. 0 Fixtur e Bas e Fixture s 

### 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 720. 0 Porc h En d Soli d Wal l 70. 0



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

. . 9/17/200 9

### • •



# CONTACTFOR M Propert y I D # 

# jsH^ a Propert y Address : 

# \(\\0 \^rAbfK w Initial Contact : Date : Time : Action : Secon dContact : Date : Time : Action : Fina l Contact : Date ; Time : Action : Fina l Action : Transmit to EP AD Other Action : D 

# li^-u^xxa-y^A ^ Comment : Owner Comment (s) :

- ' • 

# Site Coordinato r

• 

# Comment (s) :

### • • • • Pag e1 of 2

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



### • YOU RTICKE TNUMBE RI S 2387335
. Origina l Cal l Date : 10/15/0 9 Time : 1:4 3 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 10/19/0 9 Time : 2:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 191 9 Street : S 35T H AV E Twp : 15 NRng : 13 E Sect-Qtr : 28-NW-SW,29-NE-S E 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 Dept ho f Excavation : 4 F T Come 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



### Servic eAre a Contac t Phon eNumber Utmt y Typ e
CXCAT V CO XCOMMUNICATIONS , IN C HEIDI Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7

LEVEL S LEVEL3 COMMUNICATIONS , LL C N A Day : 877366834 4 Alt : Emerg : 877366834 4

MUD0 2 METROPOLITA NUTILITIES DISTRIC TSAND Y Day : 402504782 3 Alt : Emerg : 402504797 0

OMAHACO FCIT YOFOMAHA-TRAFFIC,SEWE R RICH/TRAFFI C 

## Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0

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. . 10/15/200 9

## Pag e2 of 2

0PPDGPR 6 OMAH APUBLI C POWE RDISTRIC T N A 

## Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3
QLNNEI FQWES TLOCA LNETWOR K N A 

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

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. . 10/15/200 9

# As-Buil t Drawin g 

# w

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# Omah aLea dSuperfun dSit e

1845 9 Omah a Lea d Sit e Exterio rPain t Nort h Arro w Owne rName : TIMOTH YJ VAUGH N •Good Sit e Sketc h Address : 191 9 S 3 5 A V •Poo r 

## <d

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Phone : H:3«#a

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# 6^ 9 Firm : Date : Sample s Collecte d 

# ff\psy.u^A^. p RYBSCPXA-1845 9 F 2 Time : 

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### <=T't -os r RPZSCPXA-104G9
- Time : 

## At^ i Staff : 

## A=A
. OLS# : 1845 9 Dat e Excavated : 10/19/0 9 Dat e USEP ASigne d Off : 11/5/0 9 Are a Sodden : 66 6 s a f t

8 3



## Legen d
Concret e Dri p Zon e Excavate d Quadrant s Excavate d Are areplace dwit h So d Are areplace d Rock/Mulc h wit h Are alef t bar e 

## Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
. 4613 0

# 1 P m P m j 1845 9 Exterio rPain t Nort h Arrow 

### Omah a Lea d Sit e Owne rName : JJMQTH YAYj^yGH^^^^ ^ 

### •Goo d Sit e Sketc h Address : 191 9 S 3 5 AV 

### •Poo r 

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### Omah a Lea d Sit e Owne rName : TIMOTH Yj VAUGH N 

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# 1845 9 Omah a Lea d Sit e Owne rName : TIMOTHYJ VAUGH N 

### Sit e Sketc h Address : 191 9 S 3 5 A V 

### Phone : H:3^a>»g 7 vflS-MSf i Sampl e Numtie r Lea d Sampl e LA B Concentratio n Collecte d RYASCPXA-1845 9 F l (ti> ^ pp m 

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# 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 : jr> ^

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Addres s c fPropert 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 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 b yUSEPA , wil l contac t 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 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 EP Atha t th e propert y ha s bee n remediated

.
ENVIRONMENTA LRESPONS 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 fperfomiin g th e work

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

. Th e Granto rals o agree s to :

Pag e 1 o f2^<,« ) tv^

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### « Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; cRemov 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 ; cAbid 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 (402 ) 991-119 9

• ^ 1 

### ran t acces s t o m ypropertie s D I d o no t gran t acces s t o m ypropertie s 

# AA^-d ^ Dat e Signature Date

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

.

Page 2 of 2

### *



## Restoratio n Agreemen t Th epurpos eo f thi s agreemen i i s t o provid eamutua l agreemen t a s t o condition s ofth epropert y prio r t o remediatio nactivities

. Thi s wil l als o serv ea s documentatio nfor th e purpos eo f assurin g tha t restoratio n activitie s ar e complete dt o th e satisfactio no f th eproperty owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA)
.

Propert y ID : 

# is^e ?
. ZZ I Propert y Address : \C j jC ^ '^
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. Indicatedistances , depths , material types , etc
. Photographicall y an dVideographicall y documen t th eexistin g condition s ofth eproperty an dth ebasemen t if necessary . 

## Item s t o b e Remove d b yth e Owne rbefor e Start o fRemediation : Th e ranoval

. storaqe , disposal , and/o rretur n o ftfies e item s i s th e Owner' s responeibility

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# MtiVlE ' Item :
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## Item s t o b e Remove dby th eContracto r During Remediatio nan dWo t Replace d Item :
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## Ite m Pre-existin g propert y area , that wil l b eexcavated , that i s covere dwithgrass . Numbe r o f tree s > 2 inc h trun k diamete r Numbe r o f tree s < = 2 inc h trun k diamete r Numbe r o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc
. Aiiath.- Iskeicl i ol tlif ^rripklc i t;iv'.iii i Numbe r o f an dsiz eo f eac hgarden / flowe r be d area . Alliit h; i vkL'lc h1) 1 ri.-!:ili\i ' MZi' S mi dlocal iiMi i Agree dupo nvalu eo f plan t replace db v contractor
. Voi r l!"ii' VHlii c «il l n t i;si't ' 10 i:;u (
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### I fOwne rdoe s no t wan t CE G t o documen t interio rfoundatio n wall s an d possibl e preHSxistin 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 crack s o rfissures

.



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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-3207 5 Readin g N o 24 8 Mod e SOI L Tim e 

### 2009-10-2 0 14:5 5 Duratio n 

### 120.0 0 Sequenc e Fina l Flag s AVERAG E LOCATIO N J5"av e INSPECTO R VENTR Y CO R 1 easemen t CO R 2 1 MIS C clearenc e NOT E ep a gu n Use rLogi n EP A

pp m Erro r ^P b

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: • A g < LO D \ 13.95 4 S r 108.68 1 ± 7.87 5 U < LO D : , 19.98 4 R b 49.77 6 ± 6.15 3 T h < LO D I 11.81 9 S e < LO D : 5.42 2 A s < LO D : 16.80 5 H g < LO D : 12.51 8 Z n 105.99 7 ± 19.60 5 W < LO D : 74.68 8 C u 42.92 8 ± 21.07 4 N l < LO D : 69.63 3 C o < LO D : 145.34 8 F e 12892.86 7 ± 354.41 4 M n 384.60 3 ±• 93.46 9 C r < LO D 147.99 7 V < LO D 217.25 9 T i < LO D 786.36 0 S c < LO D ^ 65.36 6 C a < LO D / 1149.96 4 K < LO D y 1596.75 0 S 1251.24 1 

# - y Supervise d By : / A 

# 7 ^ y1

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

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P b C d A g S r U R b T h S e A s H g Z n w C u N l C o F e M n C r T i S c C a K S pp m 75.25 5 < LO D < LO D 110.24 1

< LO D 48.91 0 < LO D < LO D < LO D < LO D 116.92 5

< LO D 42.33 9 < LO D < LO D 12828.25 1

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< LO D < LO D < LO D < LO D < LO D < LO D < LO D Supervise d By : 

## Certificat e o fVerificatio n

24 4 SOI L 2009-10-2 0 14:5 3 30.0 0 Fina l 1845 9 191 9 s 3 5 av e VENTR Y easemen t 1 clearenc e ep a gu n EP

A

±
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± ± Erro r 13.63 1 18.96 4 13.72 4 7.93 1 20.49 2

6.17 0 12.34 3

5.23 9 17.40 9 12.49 9 20.37 9 73.97 0 21.03 6 69.82 8 146.12 1 354.03 3

99.95 5 37.98 5 128.08 6 662.45 2

96.97 0 982.04 2

49.19 5 809.57 3 V

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

XL3t-3207 5 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s SAMPL E LOCATIO N INSPECTO R CO R 1 CO R 2 MIS C NOT E Use rLogi n 

## Certificat e o fVerificatio n

24 5 SOI L 

### 2009-10-2 0 14:5 3 30.0 0 Fina l 

### 1845 9 191 9 s 3 5 av e VENTR Y easemen t 

### 1 clearenc e ep a gu n EP

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P b C d A g S r U R b T h S e A s H g Z n W C u N l C o F e M n C r T l S c C a K S pp m 

### 78.86 1 < LO D < LO D 105.61 0

< LO D 47.54 6 < LO D < LO D < LO D < LO D 97.16 2 < LO D 43.45 8 < LO D < LO D 12953.87 6



### 372.89 0

< LO D < LO D < LO D < LO D < LO D < LO D < LO D Supervise d By : ±
±

±
±

±
±

i : Erro r 

### 14.06 6 19.54 8 14.35 3 7.88 1 19.80 1 6.09 6 11.30 1

5.92 8 17.17 7 13.01 1 19.23 9 76.54 1 21.48 5 71.53 4 149.58 9 359.65 2

93.82 7 119.10 9 211.00 0 827.17 2

23.41 4 906.60 9 2849.79 8 1570.86 5 V

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

XL3t-3207 5 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s SAMPL E LOCATIO N INSPECTO R CO R 1 CO R 2 MIS C NOT E Use rLogi n

P b C d A g S r U R b T h S e A s H g Z n W C u N l C o F e M n C r T i S c C a K S pp m 62.36 1 < LO D < LO D 111.04 6

< LO D 55.33 3 < LO D < LO D < LO D < LO D 103.39 2

< LO D 39.99 0 < LO D < LO D 13364,00 1

398.09 4

< LO D < LO D < LO D < LO D < LO D < LO D < LO D Supervise d By : 

## Certificat e o fVerificatio n

24 6 SOI L 2009-10-2 0 14:5 4 30.0 0 Fina l 1845 9 191 9 s 3 5 av e VENTR Y easemen t 1 clearenc e ep a gu n EP

A

±
±

±
±

±
±

± ± Erro r 12.56 7 18.61 9 13.68 0 7.83 4 20.16 4

6.33 1 11.89 3

5.55 1 16.02 9 12.14 9 19.04 7 70.58 9 20.39 4 69.14 9 146.44 0 355.72 3

93.16 4 169.22 8 76.56 7 767.72 5 110.65 4 1536.29 8 1803.56 5 1438.45 6 V

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

XL3t-3207 5 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s SAMPL E LOCATIO N INSPECTO R COR l CO R 2 MIS C NOT E Use rLogi n

P b C d A g S r U R b T h S e A s H g Z n W C u N l C o F e M n C r T l S c C a K S pp m 76.11 3 < LO D < LO D 107.82 7

< LO D 47.31 4 < LO D < LO D < LO D < LO D 106.51 0

< LO D 45.92 5 < LO D < LO D 12425.34 4

300.88 4

< LO D < LO D < LO D < LO D < LO D < LO D < LO D Supervise d By : 

## Certificat e o fVerificatio n

24 7 SOI L 2009-10-2 0 14:5 5 30.0 0 Fina l 1845 9 191 9 s 3 5 av e VENTR Y easemen t 1 clearenc e ep a gu n EP

A

± Erro r
± 13.60 8 19.17 8 14.06 0 ± 7.85 2 19.47 9 ± 6.01 4 11.73 8 4.97 1 16.60 7 12.41 1 ± 19.75 7 77.65 3 ± 21.38 0 68.02 2 139.24 1 ± 348.25 0 ± 86.92 8 265.66 7 453.38 3 888.09 0

30.42 7 1174.90 6 1684.44 3 1186.07 1 V

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

## Certificat e o fVerificatio n XL3t-3207 5 Readin g N o 24 3 Mod e SOI L Tim e 2009-10-2 0 14:5 1 Duratio n 120.0 0 Sequenc e Fina l Flag s AVERAG E 1 Av q o f239-242 / LOCATIO N 191 9 s 3 5 av e INSPECTO R VENTR Y COR l f l CO R 2 1 3 MIS C clearenc e NOT E ep a gu n Use rLogi n EP A



### pp m Erro r ^§y

. - r?SiSi 9 , •± -—i—l12L574_ 7 C d < LO D 20.92 6 A g < LO D 15.03 0 S r114.51 7 d b 8.56 5 U < LO D 22.00 6 R b 52.14 4 ± 6.71 6 T h < LO D 13.25 4 S e < LO D 5.93 6 A s < LO D 22.23 5 H g < LO D 13.55 0 Z n 146.29 6 ± 23.61 5 W< LO D 77.97 6 C u < LO D 32.89 6 N i < LO D 78.69 2 C o < LO D 179.41 6 F e 16996.50 4 ± 431.12 9 M n 502.58 7 ± 111.46 2 C r< LO D 89.72 1

< LO D 

## rtsp.iv i T i < LO D y^^^.S^ R S c< LO D X81.06 5 

# y C a < LO D 

## A / 848.17 4 K< LO D / J / 1495.55 1 S < LOD / 7 1045.27 0 

# Vy n 

# 4 V 

# A /yy-^ ' Supervise d By : / > V

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

## Certificat e o fVerificatio n XL3t-3207 5 Readin g N o 23 9 Mod e SOI L Tim e 2009-10-2 0 14:4 9 Duratio n 30.0 0 Sequenc e Fina l Flag s SAMPL E 1845 9 LOCATIO N 191 9 s 3 5 av e INSPECTO R VENTR Y COR l f l CO R 2 1 3 MIS C clearenc e NOT E ep a gu n Use rLogi n EP A

pp m ± Erro r P b 89.77 8 ± 15.60 8 C d < LO D 20.46 5 A g < LO D 15.34 7 S r 108.58 2 ± 8.40 9 U < LO D 21.75 8 R b 49.58 0 ± 6.60 1 T h < LO D 11.95 1 S e < LO D 6.19 1 A s < LO D 19.50 6 H g < LO D 13.17 6 Z n 154.89 1 24.32 4 W < LO D 79.19 6 C u < LO D 31.16 6 N l < LO D 77.90 3 C o < LO D 168.82 9 F e 15103.52 5 ± 409.19 8 M n 511.07 0 112.31 9 C r < LO D 107.09 5 < LO D 275.75 1 T i < LO D 627.06 6 S c < LO D 20.83 8 C a < LO D 803.77 0 K < LO D 1155.26 2 S < LO D 839.16 5 Supervise d By : V

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

## Certificat e o fVerificatio n XL3t-3207 5 Readin g N o 24 0 Mod e SOI L Tim e 

### 2009-10-2 0 14:4 9 Duratio n 

### 30.0 0 Sequenc e Fina l Flag s SAMPL E 

### 1845 9 LOCATIO N 

### 191 9 s 3 5 av e INSPECTO R VENTR Y CORl 

### f l CO R 2 

### 1 3 MIS C clearenc e NOT E ep a gu n Use rLogi n EP A

P b C d A g S r U R b T h S e A s H g Z n W C u N i C o F e M n C r Tl S c C a K S pp m 

### 75.86 3 < LO D < LO D 118.45 7

< LO D 54.61 2 < LO D < LO D < LO D < LO D 108.50 3

< LO D 40.71 8 < LO D < LO D 16452.44 1



### 440.29 3

< LO D < LO D < LO D < LO D < LO D < LO D < LO D Supervise d By : ±

±
±

± ± Erro r 

### 14.52 1 21.08 7 15.05 2 8.59 6 21.55 8

6.72 8 11.98 9 6.66 7 18.54 7 12.76 5 20.66 7 73.66 6 22.29 8 75.94 6 174.06 4 420.56 5 104.90 0 43.79 4 50.97 7 508.52 1 100.25 6 1022.34 0 1686.86 8 1147.84 1 V

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

## Certificat e o fVerificatio n XL3t-3207 5 Readin g N o 

### 24 1 Mod e SOI L Tim e 

### 2009-10-2 0 14:5 0 Duratio n 

### 30.0 0 Sequenc e Fina l Flag s SAMPL E 

### 1845 9 LOCATIO N 

### 191 9 s 3 5 av e INSPECTO R VENTR Y CO R1 

### f l CO R 2 

### 1 3 MIS C clearenc e NOT E ep a gu n Use rLogi n EP A

P b C d A g S r U R b T h S e A s H g Z n W C u N i C o F e M n C r T l S c C a K S pp m 

### 113.43 5

< LO D < LO D 109.37 8

< LO D 51.84 7 < LO D < LO D < LO D < LO D 141.78 8

< LO D < LO D < LO D 206.72 6 20542.37 7 553.02 4

< LO D < LO D < LO D < LO D < LO D < LO D < LO D Supervise d By : ±
±

±
±

± ± Erro r 

### 16.98 6 20.79 4 14.69 4

8.40 0 21.95 4

6.69 2 12.59 9

5.13 3 21.66 9 14.14 5 23.38 1 78.59 6 32.36 4 80.11 3 133.31 6 474.09 5 116.10 5

52.11 6 396.58 0 927.83 0 187.18 2 928.06 9 1864.73 8 1323.12 3 V

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

## Certificat e o fVerificatio n XL3t-3207 5 Readin g N o 24 2 Mod e SOI L Tim e 2009-10-2 0 14:5 1 Duratio n 30.0 0 Sequenc e Fina l Flag s SAMPL E 1845 9 LOCATIO N 191 9 s 3 5 av e INSPECTO R VENTR Y CO R 1 f l CO R 2 1 3 MIS C clearenc e NOT E ep a gu n Use rLogi n EP A

pp m ± Erro r P b 223.00 0 23.18 3 C d < LO D 21.35 9 A g < LO D 15.02 8 S r 121.65 3 • ± 8.85 4 U < LO D 22.75 4 R b 52.53 6 ± 6.84 5 T h < LO D 16.47 7 S e < LO D 5.75 3 A s < LO D 29.21 9 H g < LO D 14.11 5 Z n 180.00 3 ± 26.08 7 W < LO D 80.44 5 C u 40.78 6 ± 23.07 1 N l < LO D 80.80 9 C o < LO D 174.79 6 F e 15887.66 9 ± 420.65 9 M n 505.96 0 ± 112.52 3 C r < LO D 155.88 1 < LO D 227.56 9 T i < LO D 394.93 3 S c < LO D 15.98 3 C a < LO D 638.51 8 K < LO D 1275.33 6 S < LO D 870.95 2 Supervise d By : V

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

. Vv ^ vinww.coa8talhazmat.co m ^<iPH0T« ^ COASTA L
•NVOONHINTA l C 1 0 U P

. IN C 

# EXECUTIV ESUMMARY : BVID #18459-(191 9 S 3 5 AVE )
No Issue s o r Concern s Q Issues/Concern s
Detail Explanation : -COASTA LT O REIMBURS EFO RPLANT S REMOVE D FRO M DZ
. 3-ROS EBUSHE S -$40.00,4

­ LILYS-$15.00,2-LAVANDER-$15.00,1-STILBE-$15.00,1-COROBELF-$15.0 0 AN D 3- 5 GALLON S POTS
. (COMPLETE D 2/23/10 ) -COASTA LT O REPLAC EBROKENCONCRETE
. (COMPLETE D 10/29/09 ) -COASTA LT O SCRAPETH EEASEMENT , LEVELOU TAN D RE-SO D (10/29/09 )

# f^ - EP A EP AProperty Clos eOu t For m Propert y #:_LViSa ^ Propert y Addr^j g ^ ^ V^^
. gy^^^-^ ^ Detc^ne : Quad s Excavated : F \ Contracto r Grou p (VQSctQ V F.V^V J irtsm f ntt > I
Ye s N o Excavatio nGenera l 1
. If necessaiy , were th e correc t quadrant(s ) excavate dandrestored ? 

# y
2
. If necessary , were th e correc t area s ofdri p zone excavate dandrestored ? 

# y
Ye s N o Gradin g So dan dVcgctatio a 1
. Doe s th egradin g aroun dth e perimete r ofth ehous einexcavate darea s generall y slop eawa y 

# y fix)mth ehouse ? ______^__

_ 2
. Ha s so dbee nlai di nal l area s tha t wer eexcavated ? 

# Z" ^
3
. Doe s th eso dappea r t o b e generall y healdi y an dgrowing ? (Onl y evaluat ei f inspecte da t a3 0 

# Z' ^ da y tim eperiod ) ^_

_ 4
. Ar e sodde darea s generall y nr man devenl y graded ? 

# y 5
. Ar e th ejoint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat ei f inspecte dat a3 0 day 

# v ^ tim eperiod ) 6
. Wa s th epropert y grade dsuc htha t wate r wil l no t poo l o nth e propeny" ! \ y ^ 7
. Wa s danug e t o landscapin g o r plan t material s avoided ? 

# y ^ Gates , Fence s an d Retainin g Wall s Ves N o 1
. D o gate s ope nan dclos efinely? (Ifappiicable ) 

# y ^ 2
. Wer eal l gate s o r fence s take ndow ndurin g restoratio nactivitie s reinstalled ? (Ifappiicable ) 

# y ^ 3
. Wa s damag e t o gate s o r fence s avoided ? (Ifappiicable ) 

# y 4
. Wa s damag et o retainin g wall s avoided ? (Ifappiicable ) 

# y Foundation , Sidin g an dGutter s Ves N o 1
. Wa s damag et o th e sidin g o r tri mavoided ? 

# y 2
. Wa s damag e t o th e foundatio navoided ? 

## y ^ 3
. Wa s damag et o window s avoided ? 

# y 4
. Wa s damag e t o window s o r doo r screen s avoided ? 5
. Wa s damag et o downspoul s o r downspou l extension s avoided ? c y Sidewalk s an d Driveway s (Concrete ) Ves N o 1
. Wa s damag el o drivewa y surface s avoided ? 

# y 

# 7y ^ 2
. Wa s damag e t o walkwa y surface s avoided ?

# 0

Propert yCompletio n Agreemen t
Dil i agreemen t documeni s lh e compielio n o fremedia l aclivmes.perroime d o n m yproperl yM ysignaiur e wil l designal e Iha l I a m satisfie d wit h lh e re.<itoralio n o fm yproperly , an d iha l n o item s ar e i n quesfion.*;

. now . o rat an ylim e i n th e future , excep l ihos e item s liste d below , ifan y^

Propert y ID ; / ft '

V C ^ Propert y AiAAresr

. / ^ f ^ 3 . 35'A</'f c Owner : ->* i c-

_o « 5» o y Phon e 

# -^H5'

- 8<\Z ^
Restoratio n Item s i n Question :

Item : ft, ^ » . \ ^ i 

### ^

^.TK^^VVN^^W V S^CACK^ P 

### \/:^€i \ O\\ \ 

### OiWi ^ rz-Ao A Item : Item : Item :
Additiona l Comments : .

^^H-'lTyrc crestoratio n Kcomplcttd , excep t as note d l_ J I rto no l ^K^e crtsioratio n i s comptelcr i

gnatur r Dat e I Otnliitrioi' s Signaiur e Dal e

# Propert yDamag e Settlemen t

PropertyID 1845 9 Property Addres s 191 9 S 35 Av e Owner Timothy Vaughn Phon e (402) 345.893 8 

## Ihave received fiomthecontractor , Coasta l Enviromnenta l Grou p Inc
. (Coastal) , thesu m

of $200.00to compensat efo r plant s tha t wer eremovedduring the removal of lea dimpactedsoil fix)m theproperty
. Compensatio ntyp e Check 188 5 Value of Check $200.00 Check to th eorde r of Timothy Vaughn Descriptio n ofDamag e 

## Whileexcavating 191 9 S35 Ave(BVI D 18459 ) Coasta l damage dsom eplant s beyondsalvage

. Propert y owne r receivedachec k

fo r theamoim t of $200.00 dollars fo r thereplacemen t ofth eplants

. Mysignatur e belo wacknowledge s th e replacemen t of myplants ; further , I acknowledg e tha t thi s wor k wa s complete d satisfactor yan d withi n myan d releas e Coasta l Environmenta l Group , Inc

. fro m furthe robligation s orliabilit yrelate d to thi s property

. 

## 188 5 COASTA LENVIRONMENTA LQROU P ING

. 241 1 MARTH ASTREE T 27-5/104 0 00 3 OMAHA , NE 6810 S 6247372904 

# • ^llll Q DAT E S<2

_ PA YTO THE ' ORDE R OF

. 

# 'TimMii ' V/iugw n $aoo ' M m ' 

# Tlo o ^m)f\6JJU JQjnd ^ '/BU

. DOLLAR S OataUto n «MbFwB0B«*,HA

. 

# fevtp \^^9 ^Bi ^s S6^^^ ^^4Wst w c B^i-v^ FO R



## i: 101*00005Bi : E.Et, 7 37 2'10l.ii ' 0 1BB 5

Owner' s Sign a ur i A^Dat eCJhtractor' s Signatur eDat e
Pag e 1 of1