### TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R 

## SAI D # : X)^ID7 

## Date : 5/23/0 ^ Address : _3W2D M^^DV ^ ^ V Remediatio nContractor : Coasta lEnvironmenta lGroup

_Year ; 200 8
SOI LREMEDIATIO N PROPERT YnLEFOLDE RDOCUMENT S S Vide o ofpropert y (DVD )
____ ^ ^

/ Executiv eSummar y [ 5 EPA-provide dpropert y sketc h I ^Signe dAcces s Agreemen t fo r subjec t propert y D Signe dAcces s Agreement(s ) fo r adjacen t propert y Q

/ RestorationAgreement D Settlemen t document s (i.e. , fo r damag eo r t

o replac eplants , etc. ) I v Confinnationdata S/ ' Photograph s ^<'e^-^>frAJllJ(zin i^ JLiPfu^dhm ^fi/l AJ-flA/Xi. ISd d Sy ^As-buil t sketc h D Satisfactor y restoratio nsigne db y Propert y Owne r "S

f Propert y close-ou t chec k lis t signe db y EP A D Descriptio nofarea s no t meetin g RO D cleanu p criteri a QUtilit y clearance s ^

j Propert y infonnatio nfro mDougla s Count y Assessor' s Offic e 4031646 1 g Superfun d

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## Propert yAcces s Checklis t PiODcrt yID : 2 jgfe ^ Propert y Address : ^^^^^ ^ K\a^tn,^ V • D WOR K STARTE D WOR K COIVIPELTED ON : ON : / / / /
Owner ; Addres s 

# yhzK)C{OQUmore n

" Fax :

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- -2t^Cy ^ Renter : Phone : Fax : Cell/Pase i Additiona l Information :

O Notificatio nLette r l/ f

Acces s Agreemen t 0 ^ Restoratio nAgreemen t O Top.soil Samplin g (if applicable ) 1 1 Dispo.sa l Samplin g (if applicahle ) 1 1 Garde nSamplin g (if applicable ) 0 Utility Clearanc e CZ ' Video/Photo s (Before ) nVideo/Photo s (During ) D Video/Photo s (After ) nVideo/Photo s (3(»-Day) 1 1 Propeit j Completio nAgrecineii t nFina l Repor t Sent : / / Signed : _5/,Sa/0X
_ Signed : 3^/3£/C8L / / / / / / Called : i/2L/Qt

On : ^/_L/_0 ^ On : / / On : / / On : / / Signed : / / Issued : / / 

# B>­ : By : Marco s 

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. 

## B.v:M^ A/e O By : By : By : By : By : 

# II

Ai r IVIonitoring (a s applicahle ) 1 1 Communit y UUCre w Results : On : / / By : \ 1 1 Community Results : UJCre w On : / / Bv : 1 O Communit y Results : • Cre w On : / / By :

Omah a Lea d Sit e

## CONTAC TFOR M Property I D #2.\^in l Property Address : 

# 9.y3 0 \J\o^t)v \ Initial Contact : Date : Time : Action : Secon dContact : Date : Time : Action : Final Contact : Date : Time : Action : Final Action : Transmi t t o EP AD Othe r Action : D 

# MMf^-?;,^qMoEA\a-si4 ^ Comment : Owne r Commen t (s) : Site:^/3 ^ Coordinato r Comment (s) :

### Dougla s County Accoun t Informatio n Pag e1 o f 3
Dougla s County , Nebrask a Propert yRecor d - R252125000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 f t wes t of90t h S t - VLev yO n Ma p Informatio n i s vali d a s o f2008-6-1 9 Treasurer' s Ta xRepor t Ne wFeatur e ->-•- •Aut o Sale s Searc h Owne r UMORE N ASUQUO B ETA L—^^• — 1035 3 REDIC KAV E OMAH AN E 68122-000 0 Propert yInformatio n Ke yNumber : 212 5 000 0 2 5 Accoun t Type : Residentia l Parce l Number : 252125000 0 Parce l Address : 362 0 MASO N S T OMAH AN E 68105-000 0 Lega l Description : WES TOMAH ALO T3 BLOC K2 1 E 4 2 W12 6 S 8 7 F T4 2 X 8 7 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $ 7,300.0 0 $ 123,600.0 0 $ 130,900.0 0 200 7 $ 7,300.0 0 $ 107,400.0 0 $ 114,700.0 0 200 6 $ 7,300.0 0 $ 107,400.0 0 $ 114,700.0 0 200 5 $ 7,300.0 0 $ 79,000.0 0 $ 86,300.0 0 200 4 $ 7,300.0 0 $ 79,000.0 0 $ 86,300.0 0 200 3 $ 7,300.0 0 $ 79,000.0 0 $ 86,300.0 0 Sale s Informatio n Sale s Date : 2004-06-1 5 Dee d Type : W D Book : 200 4 Page : 11234 2 Price : $80,000.0 0 Grantor : Dougla s Mille rEta l Grantee : Asuqu o Umore n Eta l Valid/lnvalid : Vali d Exclusio n Reason : Sale s Date : 1990-03-2 2 Dee d Type : Book : 187 4 Page : 26 9 Price : $ 31,000.0 0 Grantor :


### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R25.
. . 7/17/200 8

### Dougla s County Accoun t Informatio n Pag e2 o f 3

Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 8 3654. 0 1. 0 87. 0 42. 0 N o Improvemen t Informatio n Buildin g 1

Secon a Floo r t00 8 0 sq . t t ErclSctilW M no w n 7 3 0 M n Rmt Floo r ltH3. 0 9q.n
. _2U
_ ; en: i 901a : w m 

## 2 STORY
4 M I <s n CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 2040. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 2 Stor y Cond o Squar e Footage : 0. 0

HVAC : Force d Ai r Rooms : 8. 0 Exterior : Fram e Aluminu m Units : 2. 0 Interior : Drywal l Baths : 2. 0 Roo fCover : Compositio n Shingl e Bedrooms : 4. 0

Roo fType : Hi p Stories : 2. 0 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 189 0 0 0 % 189 0 11 8 Detai l Typ e Detai l Descriptio n Unit s 1. 0 Basemen t Bsmn t Con e 8 f t Applianc e Allowanc e 806. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 2. 0


### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R25.
. . 7/17/200 8

### Dougla s County Accoun t Informatio n Pag e3 o f 3

Porc h Porc h Porc h Use r Use r Use r En d Soli d Wal l En d Soli d Wal l En d Soli d Wal l 2 apts-362 0 & 363 0 1/ 2 200 2 BO E 7 7 Windo wA/C 160. 0 72. 0 72. 0

1. 0 1. 0 1. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R25.
. . 7/17/200 8

# I 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 2135002
. Origina l Cal l Date : 9/18/0 8 Time : 3:0 3 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 9/22/0 8 Time : 3:3 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 36 2 0 Street : MASO NS T TvTp : 15 NRng : 13 E Sect-Qtr : 20-SE , 21-S W 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 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 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 : 4f t Corne r Lot : N Front : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N BSHPCLK S CXCAT V LEVEL 3 MCLEODN E MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic eAre a Contac t Phon eNumbe r Utilit y Typ e
BSHPCLK S NEBRASKAHEALT H SYSTEM N A 

### Day : 402552345 9 Alt : 402552334 7 Emerg : 402559511 1
CXCAT V CO XCOMMUNICATIONS , IN C ^^^ ^ 

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

LEVEL 3 LEVEL 3 COMMUNICATIONS , LL C N A 

### Day : 877366834 4 Alt : Emerg : 877366834 4

MCLEODN EMCLEODUS A N O NEE D T O CALLOU T EMERGENC Y 

### Day : 800289190 1 Alt : Emerg : 800289190 1 http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 9/18/200 8

# i

MUDO l

OMAHACO F

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### QLNNEI C METROPOLITA NUTILITIE S DISTRIC T

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TRAFFICSEWE R

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### QWES T LOCAL NETWOR K 

# 0 Pag e2 of 2

SAND Y

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NA

N A Day : 402504782 3 Alt : Emerg : 402504794 6 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

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. . 9/18/200 8fl 4 } •r f 

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### I « Q I U I N < I U K I H H

# D Remot eID ; Rpag eo f

To : COASTA L ENVIRONMENTA L SERVIC E Attn : ELIZABET H Voice : 877662421 0 Fax : 877662421 1 Re : Respons e t o Di g Reques t Thi s i s a n Importan t Messag e fro mLeve l 3 Communication s (formerl yknow n a s Broadwing ) replyin g t o you r reques t t o locat e ou r undergroun d facilitie s i n th e are a describe d o n th e On e Cal l Cente r ticket .

Ticket : 213500 2 County : DOUGLA S Place : a4AH A Address : 362 0 MASO NS T LEVELS : Leve l 3 Conmunication s ha s determine d ou r facilitie s ar e clea r pe r th e di g sit e informatio n provide d b yth e on e cal l cente r ticket .

I f yo u hav e an yquestions , pleas e contac t Leve l 3' s Asse t Managemen t Tea ma t 1-800-441-0223 .

# D Remot eID : Rpag eo f

To : COASTJ ^ ENVIRONMENTA L SERVIC E Attn : ELIZABET H Voice : 877662421 0 Fax : 877662421 1 Re : Respons e t o Di g Reques t Thi s i s a n Importan t Messag e fro mLeve l 3 Communication s (formerl yknow n a s Broadwing ) replyin g t o you r reques t t o locat e ou r undergroun d facilitie s i n th e are a describe d o n th e On e Cal l Cente r ticket .

Ticket : 213500 2 County : DOUGLA S Place : OMAH A Address : 362 0 MASO NS T LEVEL3 : Leve l 3 Conmunication s ha s determine d ou r facilitie s ar e clea r pe r th e di g sit e informatio n provide d b yth e on e cal l cente r ticket .

I f yo u hav e an yquestions , pleas e contac t Leve l 3' s Asse t Managemen t Tea ma t 1-800-441-0223 .

# D Remot eID iRpag eo f

To : COASTA L ENVIRONMENTA L SERVIC E Attn : ELIZABET H Voice : 877662421 0 Fax : 877662421 1 Re : Respons e t o Di g Reques t Thi s i s a n Importan t Messag e fro mLeve l 3 Communication s (formerl yknow n a s Broadwing ) replyin g t o you r reques t t o locat e ou r undergroun d facilitie s i n th e are a describe d o n th e On e Cal l Cente r ticket .

Ticket : 209475 8 County : DOUGLA S Place : OMAH A Address : 362 0 MASO NS T LEVEL3 : Leve l 3 Communication s ha s determine d ou r facilitie s ar e clea r pe r th e di g sit e informatio n provide d b yth e on e cal l cente r ticket .

I f yo u hav e an yquestions , pleas e contac t Leve l 3' s Asse t Managemen t Tea ma t 1-800-441-0223 .

### Pag e1 of 2

Create Anothe rTicket Back to Irt h Internet Sen d Emai l


### YOU RTICKE TNUMBE RI S 2094758
. Origina l Cal l Date : 7/30/0 8 Time : 11:5 5 a m Op : ELIZABETH18 7 9 0 Wor k t o Begi n Date : 8/01/0 8 Time : 12:3 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 362 0 Street : MASO NS T Twp : 15 NRng : 13 E Sect-Qtr : 20-SE,21-S W 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 : FAX AL L CLEAR S TO : (877)662-421 1 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 : 4f t Come r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N BSHPCLK S CXCAT V LEVEL 3 MCLEODN E MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic eAre a Contac t Phon eNumbe r Utilit y Typ e
BSHPCLK S NEBRASKAHEALT H SYSTEM N A 

### Day : 402552345 9 Alt : 402552334 7 Emerg : 402559511 1
r-v/^Ax w CXCAT V CO XCOMMUNICATIONS , „, „ IN C „^^ , HEID I 

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

LEVEL 3 LEVEL 3 COMMUNICATIONS , LL C N A 

### Day : 877366834 4 Alt : Emerg : 877366834 4

MCLEODN EMCLEODUS A N O NEE D T O CALLOU T EMERGENC Y 

### Day : 800289190 1 Alt : Emerg : 800289190 1
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 7/30/200 8

### Pag e2 of 2

MUDO l

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QWES TLOCA LNETWOR K EDWIN A

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### Day : 402504782 3 Alt : Emerg : 402504794 6 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.
. . 7/30/200 8Pag e 1 of 2

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


### YOU RTICKE TNUMBE RI S 2160986
. Origina l Cal l Date : 10/23/0 8 Time : 9:0 9 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 10/28/0 8 Time : 7:1 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 36 2 0 Street : MASO NS T Twp : 15 NRng : 13 E Sect-Qtr : 20-SE,21-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n Locatio n o f Work : LOCAT E ENTIR E PROPERT Y INCLUDIN G 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 Compan y: COASTA L ENVIRONMENTA L SERVIC E Contact Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : coasta l Dept ho f Excavation : 4f t Corne r Lot : N Front : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N BSHPCLK S CXCAT V LEVEL 3 MCLEODN E MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac t Phon e Numbe r UtiUt y Typ e
BSHPCLK S NEBRASK AHEALT H SYSTE M NA Day : 402552345 9 Alt : 402552334 7 Emerg : 402559511 1
CXCAT V CO XCOMMUNICATIONS , IN C HEIDI Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7

LEVEL3 LEVEL S COMMUNICATIONS , LL C N A Day : 877366834 4 Alt : Emerg : 877366834 4
MCLEODN EMCLEODUSA N O NEE D T O CAL LOU T EMERGENC Y Day : 800289190 1 Alt : Emerg : 800289190 1
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.
. . 10/23/200 8

### Pag e2 of 2

MUDO l

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QWES TLOCALNETWOR K SAND Y

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N A

N A 

### Day : 402504782 3 Alt : Emerg : 402504794 6 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=<RESULT.
. . 10/23/200 8

# As-Buil t Drawin g C OASTA L 

# Omah aLea dSuperfun dSit e ENVIRONMENTA L GROUP , INC
. 

## 2156 7 Exterio rPain t Omah a Lea d Sit e 0 Goo d Sit e Sketc h •Poo r Samplin g Address : 362 0 MASO N ST |~ 1 No t pain t Sampl e Numbe r Lea d Concentratio n Sampl e Collect e LA B Firm : Sample s Collecte d FD Arr.-W U RYASCPXA-2156 7 F l pp m 

### D Dat e 12.-2/^-6 7 RYBSCPXA-2156 7 RYCSCPXA-2156 7 RYDSCPXA-2156 7 F 2 B l B 2 

## ilfi 3 pp m pp m pp m 

### D D D Time : Z ' S( o fijn Sample s Analyze d RDZSCPXA-2156 7 D Z pp m 

### D XR F Unit : toS'H O Book : TJO' ^ RGZSCPX Aa i 68 7 G Z RPZOcrxA-aiso?—p e pp m pp m 

### D D Dat e Tim e /-get 

### /4 n -Og )
Numbe ro fSample s = [ S Staff : /^^ ^ Legend : F 1 = Fron t Left , F 2 = Fron t Right , B l = Bac k Left , 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 , facin g propert y OLS# : 2156 7 Dat e Excavated : 10/25/200 8 bat e USEP ASigne d Off : 1/28/0 9 

### JA N 0 i s 280 3 Are a Sodde d 214 2 s q f t



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

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

## 2156 7 Exterio rPain t Nort h Arro w 

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

### Sit e Sketci i • Poo r Samplin g Address : 362 0 MASO N S T \ 1 I No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Finn : 

### FMi-y-\A/L
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## 12,-28-6 7 Date : RYBSCPXA-2166 7 F 2 pp m 

## D Time : RYCSCPXA-2156 7 B l pp m 

## D 

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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 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 foilow^in g describe d premises : 

## AIQT^ ^

Owner' s Name : Daytim e Phone :



# . \jmortxi.B^uqoix
Addres s o fPropert y covere d b ythi s Agreement : 

# Omora n \^^o o ^ PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP Ai 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 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 v^^l h th e Grantor' s approval
. Upo n completion , th e Granto rwi Wreceiv e writte n documentatio n fro m EPAtha t th e property ha s bee n remediated
. ENVIRONMENTA LRESPONS E ACTION S 

### Bysignin 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 v»«Drk
. 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 of2V«i4«» / COASTA L T ^

< P INVIIONMfMTA t ' 1
. mot * c< o u F 1 •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

D I gran t acces s t o m ypropertie sD I d o no t gran t acces s t o m ypropertie s


# B f/y^y^f/y ^ -r—r ­ jnatur ^ ^ < Dat e / SignatureDat e

DI 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 epurpos eofthi s agreement i s to provid eamutual agreemen t a s to condition s ofth eproperty prio r to remediatio nactivities
. Thi s wil l als o serv ea s documentatio nfo r th epurpos eo f assurin g that restoratio n activitie s arecomplete dto th esatisfactio no f th epropert y owner andth eUnite dState s Environmental Protectio nAgenc y (EPA)
.

Property ID : 2^\^^ ^ Property Address : ^f^^? ^ K^HSi/^r ^ r\\

- 

## Phone : qqfi^<;;;^SRqr. ±' SQ^'-^q m
Onth eattache ddiagram(s ) indicatearea(s ) to excavate danddept ho f excavation , locationo f al l know n utilities , subsurfac efeatures , surfac estructure s andlandscapin g features , acces s bcation(s ) to b eusedb y contractor , andthedirectio no f North
. Indicatedistances , depths , materia l types , etc . Indicatedigital photo s b y referencing thephoto-lo g number wit ha narro w indicating directio no f view
. 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 : Item : Item : Item :
Pag e 1 of
. 

# 4COASTA L ENVIRONM E NTA 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 : y 

# ^p,p( y 

# ''y< h 

# yfT/^i w / Item : 

# j'yyfTt- yUxcr h t^ i ^ m / Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : / Item : / / Item : /
Item : y

Pag e 2 o f( 1COASTA L ENVIHONMENTA L GROUP
. IN C 

### Item s T o B e Remove d B yContracto rDurin g Remediatio n An d Replace d (Use additiona l sheet s as necessary) Item : 

# h m r 

# f ^ ll
. 

# h yh ^ yh' L item : 

# ho M \ ^ 

# hot - }?3 i 

# ' Item : / Item : / Item : / ftem : /
Item : / Item : / Item : / Item : 

# y Item : 

### / Item : / Item : / Item : /
Item : / 

### /

Pag e 3 o fi^
.COASTA L ENVIRONMENTA L CROUP
. INC ,



## Ite m

Pre-existin g property area , that wil l b eexcavated , that i s covere dwit hgrass .

Numbe r o f tree s > 2 inc h trunk diamete r
i

Numbe r o f tree s < = 2 inc h trunk diamete r

Numbe r o f Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Attac hasketc ho f th e sprinkle r layout
.

Numbe r o f an dsiz eo f eac hgarden/ flower be d area . Attac hasketc ho f relativ e size s an dlocations
. 

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

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

# < y Squarefee t 

# y\j\Jt (^m ^ y y 

# y Each



# y Each



## { ^ Eac h



# 1 Each SquareFeet 

# y -p y

Pag e 4 of
. 1COASTA L 

## Ite m Quantit y Uni t Condition/Type/Specie s Agree dupo nvalu eof plan t material s no t t o b e replace db v contractor . Not ethi s valu ewill b e use dt o issu eaplan t vouche r t o th epropert y owner . 

# B $

Agree dupo nlis t o f plant material s tha t will be replace dby contractor . B e ver y specifi c anddetailed
. Includ easketc ho f were eac hplan t will b eplace d by th econtractor . 

# J d Each

1 Agree dupo nare ao f property to b ereplace d wit hgras s sod
. Includ easketc ho f th e area(s ) to b ereplace dwit h gras s sod
. 

# h
S F 

## L\-
.

Are ao f Cit y o r County property t o b elandscape d pe r thei r requirements
. Includ easketc ho f th e are a(s ) S F 

# tM^^ <

Easemen t Area , t o b e excavate d S F 

# ^X ) \rt \iyybi ?

Pag e 5 of
.C O AS TAL •MViaOMMCMTA L G I t O U P
. IM C


### Additk>na l Comment s / Instructions :



# - \Vi^lV^ ^fmil h _\^^yiW v

^

­ Rff^ Kyy^ ^ 

# Y

# h \

D Chec k th e bo xi fOwne rdoe s no t wan t CE G t o documen t interio rfoundatio n wall s an d possibl e pre-existin g damage
. Bycheckin g thi s boxCE 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
.

^ 1 

### Iagre e OId o no t agre e 

# ryy^ y^4,^^. ^ /'pAm i yayr,< / ^OwBer'srSignatUr e • ?te/ Conti^or' s Signatur eDate Pag e 6 of
.Dat e Projec t XRFID #

Shot # 

## H; ^ \^-H A \(ja n I^ M 1 Averag e Shot # 

# .^ae iq^ ^ 

## m^o o ,qs i Averag e

Shot #

Averag e

Shot #

Averag e la b sampl e # 

### XR F PROPERT Y SAMPL E SHEE T In-cQ^^'Of t Addres s Omah a lead F P 2n d yea ropllo n Sampl e tim e sampl e lengt h 

# z&yry x Readin g Sampl e are a Sho t # yy. ^ ,?> t [(\. y 

### l^l^-^- S ,-QH, o (poc
. i^'.q q 

# m )Cf4e 4 l^fi.e«L.^».o 3 Dept h 

## i^^ ^ 2, m ,^/«i<^ l X ^ 

### ( P )gr^(i ? cOSC g .1^1 - n^: > ^ ] Averag e Readin g Sampl e are a Shot # 9 3 ? 7 i : 7 -. a 

## T^^HT^ 2

­ Qhnf^t
. l-^ a .^^^^ " • ^P , ^
. S i 7^ 3 Dept h 

# g I'^v-ii,'; ^ 1 y \ \ 

### jQ^ A c? S ^Co l "~ 7 ' ^ Averag e Readin g Sampl e are a Shot * Dept h Averag e

RETES TAREA S Readin g Sampl e are a Shot # Dept h Averag e La b resul t Sampl e are a XR F Avg
. Signature
. 

### BVID My)yiy i S(p^ o VAo^^^fpC NbJ

lO'-^ ^ am/p m 3 0 se c Readin g Sampl e are a 1 7 ^ gS^K-^^- t ^> , (^ ^ >ii;j.c? S 

# ? a Dept h 

### va<^.aai ; n.g q h^'.^.yit;ZI^3 3 L 2
_ 18 ^ ^(j?- 1 K e Lo' ^
Readin g Sampl e are a 

### lUQ.^J:^'"^-?. , '^la.^-yiijr, ^ 

# b t C^^-^g ^ \o-'^l ) Dep t Dept h Ir. q ^b ^

iQ.q i ^f ^ .q U ^ \ ^ ^ ^
Readin g Sampl e are a Dept h

Readin g Sampl e are a Dept h



### Print ^A/ / cpy ^

# 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 263.13 4 Supervise d By : 

## Certificat e o fVerificatio n

193 8 SOI L 2008-10-2 5 10:5 9 30.3 2 Fina l 2156 7 362 0 maso n B 2 Ventr y 6 CLEARANC E

± Erro r ± 19.49 3

# 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 282.59 9 Supervise d By : 

## Certificat e o fVerificatio n

193 9 SOI L 2008-10-2 5 11:0 0 30.9 8 Fina l 2156 7 362 0 maso n 8 2 Ventr y 6 CLEARANC E

± Erro r ± 19.98 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 285.57 8 Supervise d By : 

## Certificat e o fVerificatio n

194 0 SOI L 2008-10-2 5 11:0 1 30.8 6 Fina l 2156 7 362 0 maso n B 2 Ventr y 6 CLEARANC E

± Erro r ± 21.01 5

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 194 1 Mod e SOI L Tim e 2008-10-2 5 11:0 2 Duratio n 30.9 3 Sequenc e Fina l Flag s BVI D # 2156 7 ADDRES S 362 0 maso n QUAD/ZON E B 2 INSPECTO R Ventr y DEPT H 6 SAMPL E PI'P E CLEARANC E NOT E

pp m±Erro r P

b 314.96 2 ±21.13 1 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 194 2 Mod e SOI L Tim e 2008-10-2 5 11:0 2 Duratio n 123.0 9 Sequenc e Fina l Flag s AVERAG E Av g o f1938-194 1 ADDRES S 362 0 maso n QUAD/ZON E INSPECTO R Ventr y DEPT H , 6 SAMPL E TYP E CLEARANC E NOT E

# 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 Mode 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 175.33 4 Supervise d By : 

## Certificat e o fVerificatio n

194 3 SOI L 2008-10-2 5 11:0 3 30.2 5 Fina l 2156 7 362 0 maso n F2 Ventr y 6 CLEARANC E

± Erro r ± 16.21 9

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 194 4 Mod e SOI L Tim e 2008-10-2 5 11:0 3 Duratio n 30.5 3 Sequenc e Fina l Flag s BVI D # 2156 7 ADDRES S 362 0 maso n QUAD/ZON E F2 INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 86.69 4 ±12.04 8 Supervise d By :• • 

# 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 199.21 7 Supervise dBy : 

## Certificat e o fVerificatio n

194 5 SOI L 2008-10-2 5 11:0 5 30.9 8 Fina l 2156 7 362 0 maso n F2 Ventr y 6 CLEARANC E

^ I

_Cw.^.^ ^ Erro r 17.28 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 Pi'P E NOT E

pp m P b 295.79 3 Supervise d By : 

## Certificat e o fVerificatio n

194 6 SOI L 2008-10-2 5 11:0 5 30.3 3 Fina l 2156 7 362 0 maso n F2 Ventr y 6 CLEARANC E

± Erro r ± 21.22 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 194 7 Mod e SOI L Tim e 2008-10-2 5 11:0 5 Duratio n 122.0 9 Sequenc e Fina l Flag s AVERAG E .Av g o f1943-194 6 ADDRES S 362 0 maso n QUAD/ZON E (F 2 INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

P b a^-^2
_ 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 23.76 8 Supervise d By : 

## Certificat e o fVerificatio n

194 8 SOI L 2008-10-2 5 11 : 0 7 30.5 2 Fina l 2156 7 362 0 maso n easemen t Ventr y 1 CLEARANC E

± Erro r ± 7.51 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 20.74 8 Supervise d By : 

## Certificat e o fVerificatio n

194 9 SOI L 2008-10-2 5 11:0 8 30.3 4 Fina l 2156 7 362 0 maso n easemen t Ventr y 1 CLEARANC E

± Erro r ± 7.37 5

# 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 195 0 Mod e SOI L Tim e 2008-10-2 5 11:0 8 Duratio n 30.5 6 Sequenc e Fina l Flag s BVI D # 2156 7 ADDRES S 362 0 maso n QUAD/ZON E easemen t INSPECTO R Ventr y DEPT H 1 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 28.82 6 ±7.92 3 Supervise d By :

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 195 1 Mod e SOI L Tim e 2008-10-2 5 11:0 9 Duratio n 30.7 1 Sequenc e Fina l Flag s BVI D # 2156 7 ADDRES S 362 0 maso n QUAD/ZON E easemen t INSPECTO R Ventr y DEPT H 1 SAMPL E Pi'P E CLEARANC E NOT E

pp m ±Erro r P b 19.69 2 ±7.28 7 Supervise d By :

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 195 2 Mod e SOI L Tim e 2008-10-2 5 11:0 9 Duratio n 122.1 3 Sequenc e Fina l Flag s AVERAG E Av g o f1948-195 1 ADDRES S 362 0 maso n QUAD/ZON E .easemen t INSPECTO R Ventr y DEPT H f l SAMPL E TYP E CLEARANC E NOT E

P b 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 162.89 3 Supervise d By : 

## Certificat e o fVerificatio n

197 8 SOI L 2008-10-2 5 14:4 4 30.2 8 Fina l 2156 7 362 0 maso n s t D Z Ventr y 1 3 CLEARANC E

± Erro r
± 15.72 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 PI'P E NOT E

pp m P

b 93.57 1 Supervise d By : 

## Certificateo f

Verification

197 9 SOI L 2008-10-2 5 14:4 5 30.6 1 Fina l 2156 7 362 0 maso n s t D Z Ventr y 1 3 CLEARANC E

± Erro r ± 12.50 9

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 198 0 Mod e SOI L Tim e 2008-10-2 5 14:4 6 Duratio n 30.1 9 Sequenc e Fina l Flag s BVI D # 2156 7 ADDRES S 362 0 maso n s t QUAD/ZON E D Z INSPECTO R Ventr y DEPT H 1 3 SAMPL E PI'P E CLEARANC E NOT E

pp m ±Erro r P b 62.42 0 ±10.41 4 Supervise d By :

# 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 PI'P E NOT E

pp m P b 64.96 3 Supervise d By : 

## Certificat e o fVerificatio n

198 1 SOI L 2008-10-2 5 14:4 6 30.5 0 Fina l 2156 7 362 0 maso n s t D Z Ventr y 1 3 CLEARANC E

±Erro r ±10.90 7

# 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 198 2 Mod e SOI L Tim e 2008-10-2 5 14:4 6 Duratio n 121.5 8 Sequenc e Fina l Flag s AVERAG E Av g o f1978-198 1 ADDRES S 362 0 maso n s t QUAD/ZON E iO Z INSPECTO R Ventr y DEPT H SAMPL E PI'P E t1 3 CLEARANC E NOT E

P b . f ^ Supervise d By :

### Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
. www.coastalhazmat.co m COASTA L ENVmONHENTA L CROUP , INC
. 

# EXECUTIV ESUMMARY : BVI D #2156 7 - (362 0 MASO NST )
N o Issue s o r Concern s X 

# Issues/Concern s Detai l Explanation :

- P O HA S NO T SIGNE D FOR TH E PROPERTY UNTI L COASTAL PLACE S SO D O NTH E EASEMENT .



# L> •> . 

# I»EPA • « 

## EP APropert ) Clos e Ou t For m Prop«rt > tt : 2 i ^Ir ? I Proptrt ) Addre« : ^j g I H HO,^) ^ Sf Dalc/Tlrec : Owner' s Name : LTrno/^-f.V ^ Af^v ; Quad s Excavatrd : Coniracto rCrou p
Eicavatio D Gtnera l 1 I fnecessijy , wer t th e corrtc t quadrani(s ) excavate d an d resiored ? 1 Ye s ^ N o

2 I fnece5s«r> , wer e th e correc t area s ofdri p zon e excavale d an d restored' ' 

## y CradlD KSo d an d VctcUlto n 1 Doe s th e gradin g aroun d th e perimele rofth e hous e i n excavate d area s generall yslop e awa y from tb e house ? Ye s
w ^ N o

2 3
. Ha s so d bee n lai d i n al l area s tha i wer e excavaled ? Doe s th e so d appea rt o b e generall yhealth yan d growing' ' (Onl yevaluat e i finspecte d a t a 3 0 da ylim e period ) y ^ 4 5 Ar e sodde d area s generall yfir m an d evenl ygraded ? Ar e th e joint s betwee n th e so d strip s generall ytight ? (Onl yevaluat e ifinspecte d a i a 3 0 da y tim e period ) 

### y

i ^ 6 Wa s th e prof>crrygrade d suc h tha i wate rwil l no t poo l o n th e property' ' ^ 7 Wa s damag e t o landscapin g o rplan t material s avoided' '

- ^ 1 Gatef , 1 2 FcDce s an d RclaiolD C Wall s

D o gate s ope n an d clos e freely? (Ifapplicable ) Wer e al l gate s o rfence s take n dow n durin g rtstor^tio n activitie s reinstalled' ' (Ifapplicable ) Ve s
u ^ ^ N o

3 Wa s damtg e 1 0 gate s o rfence s avoided ? (Ifapplicable ) t ^ 4 Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) y Foupdalion , Sidia n an d Culler s I
. Was damtg e t o th e sidin g o rtri m avoided ? Ve s N o

2 3 Wa s damag e t o th e foundatio n avoided ?

Was damag e t o window s avoided' ' tX

4 Wa s damag e t o window s o rdoo rscreen s avoided' ' 5 Wa s danDag e l o downspout s o rdownspou l extension s avoided' ? 

### y Sidewalk s an d Driveway s (Concrete ) Wa s damag e t o drivewa ysurface s avoided ' 2 Wa s damag e t o v^alkwaysurface s avoided' ' Ve s 

### # 

# y No

# M * 

### O tner s commenls :



## Inspectio nnote s



# %<^[a ^ - ^ D la s tJ ^i^^ ^ -^ -^^-'^ ^

^^ ^ ^ ^^s^A-^- ^

Remova l an d resloralio n aclivale s complel e incluciin g ih e 30-da yso d uarrani y
F P ARpnrpspnlaKvf i HQW^



## Propert yCompletio n Agreemen t Thi s agreemen l documeni s lli ecomplclio no f remedia l activitie s perlbime do nm y property . M y signatur e will designat ethat Ia msatisfiedwit hth e restoratio no f my property , an dthai n o item s ar e i nquestions , now , o r al an y limei nth e future , excep t thos eilem s liste dbelow , ifan y Propert y ID : l\^\^~ l Propert y Addres. : ^^^j ^ WASOV I Own c 

# " A^t;^vj n\Jm^itX \ ^^•""^-ftolqMe-SSq H Restoratio n Item s i n Question :

IIIagre erestoratio nis completed , cxccp la s note d I I I ri o no t a(;ie cresloratio n i s complete d

Owner' s Signatur e Dat e Contractor' s Signatur e Dat e