# l l

TRANSMITTA Lo f OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAID# : (^^22 M Date : lO/zfp/O^ ? Address : ao\(p H M? ; ff t 

## RemediationContractor : Coastal Environmenta l Group

_Year : 200 8 SOI LREMEDIATIO N PROPERT Y FIL EFOLDERDOCUMENT S B ^ 'M W ^ ^y ^ ^ll ^

\^ 3 ^Ji? ^ I K QK ^ QK ^ ^y ^ \^^ ^ y|| ^



## [ y
D D D 

## Video ofpropert y (DVD) Executive Summar y EPA-providedpropert y sketch Signe dAcces s Agreemen t fo r

subject propert y SignedAcces s Agreement(s ) fo r

adjacen t propert y RestorationAgreemen t Settlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) Confirmatio ndat a Photograph s ftx t/^^V^V
. \rrC ^ Y ^ ^\/y \^^• r As-buil t sketc h Satisfactory restoratio nsigne db y Property Owne r Property close-ou t chec k lis t signe db y EPA Descriptio nofarea s no t meetin g RO D cleanu p criteri a 

## Utilit y clearance s Propert y informatio nfromDouglas Coimt y Assessor' s Offic e

^ Signatur e Mgnafur e ­ ­ ­ ­

3005450 3 D J 

# i2i
. Dat e Superfun d

### •• « •


## Propert yAcces s Checl<iis t Propert y ID : {j^^Zl ^ Propert y Address : 201 ^ |\ 1 q ^
Owner : 

# 7!ux\} ^ Honx'i^ Address : ^^^^ ^ 

# Z^_S52Z315 5 Fax ; Ccll/Pascr : j n Notificatio n Lette r 1 Q j Acces s Agreemen t I 1 ^

Restoratio n Agreemen t n To;)Soi l Siunpiin " (i fa|)plicable ) Q Disposa l Samplin g (i fapplicable ) n Garde n Samplin g (i fapplicable ) [

^

Ltilit vClearanc e ^

Video/Photo s (Before ) g C'^'O l n Video/Photo s (During ) n Video/Photo s (After ) D Video/Phofo s (30-Day ) CD Propert ) Completio n Agreemen t 1 1 Fina l Repor t Ai rMonitorin g (a s applicable )

n Coinmiinit yD Cre w On : Results : L J Communit yd l Cre w On : Results : 1 n Communit yC ] Cre w On :

Results : nWOR K STARTE D D WORKCOMPELTE D 5 V
Renter : Phone : Fax : Cell/Pager : Additiona l Information :

Sent : / / 

### Signed : Jg. / ^ /i
_ Signed : i£_ / ^ 1 ^ / / / / / / 

## Called : J^/JX^ ^

0n:_^/j7/_ i On : / / On : / / On : / / Sinned : / / I.s.s'ueJ : / /

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Omah a Lea d Sit e

## Propert y I D # Propert y Address : Initial Contact : SecondContact : Fina l Contact : Fina l Action :

Comment : Owner Comment (s) : Site Coordinator Comment (s) : CONTACT FOR M
^ ^ 2Z M 

# goW o K ] H%3V Date : Time : Actio n

Dale : Time : Action Date ; Time : Action Transmit t

o EP AD Other Action : DDougla s Coimt yAccoi^feifoj^i l 

## itio n Page 1 of 2
Dougla s County , Nebrask a Propert yRecor d - R120504000 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 - ViewO n Ma p Informatio n i s vali d a s o f2009-5-1 2 Treasurer' s Ta xRepor t Ne wFeatur e - •• •^ Aut o Sale s Searc h Owne r MORRI S JERR YR ETA L 201 6 N 4 8 S T OMAH AN E 68104-000 0 Propert yInformatio n Ke yNumtier : 050 4 000 0 1 2 Accoun t Type : Residentia l Parce l Number : 120504000 0 Parce l Address : 201 6 N 4 8 S T OMAH AN E 68104-000 0 Lega l Description : GRAMMERC YPAR KLO T9 BLOC K3 5 0 X 134. 1 Valu e Informatio n 

### 200 9 200 8 200 7 200 6 200 5 200 4 Lan d $6,500.0 0 $6,500.0 0 $6,500.0 0 $6,500.0 0 $6,500.0 0 $6,500.0 0 Improvemen t $115,600.0 0 $115,600.0 0 $115,600.0 0 $115,600.0 0 $66,600.0 0 $60,500.0 0 Tota l $122,100.0 0 $122,100.0 0 $122,100.0 0 $122,100.0 0 $73,100.0 0 $67,000.0 0 Lan d Informatio n Acre s 0.1 5 S F 6700. 0 U nit s 1. 0 Dept h 134. 0 Widt h 5 0. 0 Vacan t N o Improvement Informatio n Buildin g 1



## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R120..
. 6/7/2009

### Dougla s County Accoi|^nfQ^^ i tio n 

### Pag e 2 of 2

1 1/ 2 STOR YFI N 2016N4BS T wmvOK X JMDiaf l

14 0 11
_ Secon d Floo r 

### ^^''^ k 8S3.0«q
. I t s o

• I j ;* v Bsim l Bloc k B « I0«9C« ) t CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1922. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 1 1/ 2 Stor yFi 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 : 1. 0 Interior : Drywal l Baths : 2. 0 Roo fCover : Compositio n Shingl e Bedrooms : 3. 0

Roo fType : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 190 9 0 % 190 9 100 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 1069. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 2. 0 Porc h Sla b Roo fCei l 24. 0 Porc h Woo d Dec k 354. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R120.
. . 6/7/200 9

### Pag e 1 o f 1

Creat e Anothe rTicke t Bac k t o Irt h Interne t Sen d Emai l


### YOU RTICKE T NUMBE RI S 2293376
. Origina l Cal l Date : Wor k t o Begi n Date : 6/12/0 9 6/16/0 9 Time : Time : 3:0 8 pm 3:4 5 pm Op : ELIZABETH1879 0
State : N E Address : 201 6 County : DOUGLA S Street : N48TH S T Place : OMAH A Twp : 15 NRng : 13 E Twp : Rng : Lega l Given : C Sect-Qtr : 07-SE,08-SW,17-NW,18-NE Sect-Qtr : Typ e o f Work : lead remediatio n Locatio n o f Work : LOCAT E AL L EASEMENTS . LOCAT E ENTIR E PROPERTY Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LOT . Compan y: COASTAL ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Being Don e For : Coasta l Dept h o f Excavation : 4f t Corne r Lot : N Involve s Tunneling o r Horizonta l Boring : N Front : Y Explosives : N CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C Rear :

Servic e Are a Contac t Phon e Number Utilit y Typ e
CXCAT V CO X COMMUNICATIONS , IN C HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
MUDO l METROPOLITA NUTILITIES DISTRICT SAND Y 

### Day : 402504782 3

Alt :



### Emerg : 402504797 0
OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO N 

### Day : 402444719 7 Alt : 402444516 1 Emerg : 4024445160
OPPDGPR 5 OMAH APUBLI C POWE RDISTRIC T N A 

### Day : 406728934 3 Alt : 4062071494 Emerg : 888728934 3 QLNNEIC QWES T LOCA LNETWOR K

N A 

### Day : 406728934 3 Alt : 4062071494 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 6/12/200 9

# n Pag e 1 o f 1

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


### YOU RTICKE T NUMBE RI S 2326025
. Origina l Cal l Date : 7/24/0 9 Time : 5:4 6 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 7/28/0 9 Time : 6:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 201 6 Street : N4ST H S T Twp : 15 NRng : 13 E Sect-Qtr : 07-SE,08-SW,17-NW,18-N 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 : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LOT . 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 : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g ; N Explosives : N CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac t Phon e Number Utilit y Typ e 

### Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C 

### HEID I Alt : 402934046 9 Emerg : 402932975 7 

### Day : 402504782 3 MUDO l METROPOLITA NUTILITIES DISTRICT SAND Y Alt : 

### Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFICSEWE RRO N 

### Alt : 402444516 1 Emerg : 4024445160 Day : 406728934 3 0PPDGPR5 OMAH APUBLI C POWE RDISTRICT N A 

### Alt : 4062071494 Emerg : 888728934 3 Day : 406728934 3 QLNNEI C QWES T LOCA LNETWOR K

N A 

### Alt : 4062071494 Emerg : 888728934 3

http://www.dhon.org/irthintemet^HONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 7/24/200 9

# As-Buil t Drawin g COASTA L 

# Omah aLea dSuperfun dSit e
6922 4 Exterio rPain t Nortt i Anx w Omah a Lea d Sit e •Goo d Sit e Sketc h Q'Poo r Samplin g Addrass : 20i 6 N 4 8 S T ["~ | No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : f g Xwr
. D 6 T \ RYASCPXA-6922 4 F l 

### H 7 3 pp m 

### D Date : lM7a>lr>f t RYBSCPXA-6922 4 F 2 

### jJLZt L pp m 

### D Time : <0:3 g Ar ^ RYCSCPXA-6922 4 B l pp m 

# n Sample s Analyze d RYDSCPXA-6922 4 8 2 

### IG2
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### E f 

# t D Z 

### -2.01 0 pp m XR F Untt : CoSH O Book : 

## ZZO
. 'ROZOCrXA-6922 4 S Z pp m 

### D Date : 1 1 • Q ^ 

## .03
. nrZGCr'XA-6922 4 -PS

- pp m 

### D D Time : ffm 

### D D ^ La b RYDSCPLA-6922 4 Staff : Numlje ro t Sample s = | ^ 

### m<,i ^ i Resul t 16 7 pp m 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 < Al l quadrant s are a s viewac ffra m tti e slreet , facin g property :OLS# : 6922 4 Dat e Excavated : 7/30/0 9 Dat e USEP ASigne d Off : 8/11/0 9 Are a Sodden : 1 £3 7 sqf t



### Legen d Dri p Zon e Excava1:e d Concret e Quadrant s Excavate d Are areplace dwiti h Are areplace dwit h Are alef t bar e So d' ' Rock/Mulc h 

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

# rr r 

# ?/^^ 

# 20 U^f ^ ^ ^ 6922 4 Exterio rPain t Nort h An-c w 

### Omah a Lea d Sit e •Good 

### Sit e Sketc h Q'Poo r Sannplin g Address : 201 6 N 48 S T Q ] No t paint Sampl e Numbe r Lea d Sampl e Sample s Collecte d LA B Concentratio n Collecte d 

### Firm : f g iMf
. P 6 T X RYASCPXA-6922 4 F l pp m 

# a ' D Dat e I^l7^lf> » RYBSCPXA-6922 4 F 2 

# \\V \ pp m 

## D Tim e iP-3 S At A RYCSCPXA-6922 4 B 1 pp m 

## D Sample s Analyze d RYDSCPXA-6922 4 8 2 

## /6, Z pp m 

## E f RDZSCPXA-6922 4 D Z pp m 

## D 

# I Z07 0 XR F Unit : (oSH O Book : 22. 0 'RGZeCPXA-6922 4 S Z pp m Dat e i l O^ - oe , 

## D 

# n RPZOCPXA-6922 4 P£ ­ pp m 

## D Tim e 

### fr n La b RYDSCPLA-6922 4 Staf f 

### j23ijL2 ­ Numt}e ro fSample s = | ^ \ [ ) | • Resul t 16 7 pp m 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 ^ Al l quadrant s ar e a s vievi« d Iro m tti e street , facin g propert y

* - 

# m­ m OC T

## 2 7

. I . ' <

Re\:rtl f Creat dlU-Sep-c.i, ' 

## CoS ^

# 6922 4 Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e •Goo d 

### Sit e Sketc h [3 ^ Poo r Sainplin g Address : 2016 N 48 s i Q No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d 

### Fimi : FglNf
. V^T ^ RYASCPXA-6922 4 F t pp m 

### D 

# iLL L n f Dat e 

### ir>l^?>lo a RYBSCPXA-6922 4 F 2 

# 1 2 ± pp m Tim e 

### I0-3 5 AK
. 

# n RYCSCPXA-6922 4 8 1 

# IB
. pp m 

### D Sample s Analyze d RYDSCPXA-6922 4 8 2 pp m 

### E f 

# mi
. RDZSCPXA-6922 4 D Z 

### 207 Q pp m XR F Unit : (tSH O Bool e 22 Q 

# n 'RGZOCPXA-6922 4 S Z pp m 

### D Dat e 

### i/ojo e RPZOCPXA-6922 4 P? - pp m 

### D 

# n Tim e 

### j a m 

# n La b RYDSCPLA-6922 4 Staff : Numbe ro f Sample s = | ^ \ \ ) | 

### n^L j : Resul t 16 7 pp m Fron t Right , B l = Bac k Lett , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla ^ Al l quadrant s ar e a s viewe d fro m th e street , facin g propett y

RtvIrtI S Created ; li;-S«pJi S

## 69224 ExfeafiorPain t Q Goo d 

### Onalu i Lea d St a St a Sketc h GTPoo f SainDftKlA<MrB^:2n6N48S T Q Notpain t Lea d Sampt e Colleate d Batnpt e Numbe r LA B ConcantTBUo n CoUBUto d RYASCPXA<6a22 4 F 1 

### _JlIJL_PP m 

# n Date : lM9i>.lrJ L RYBSCPXA<6822 4 F 2 

# n Tma : J&-.3 g Al* v RYCSCPXA«e22 4 8 1 2JL S pp" ) 

# n Sampt e AnalyzB d RYDSaPXA«B2 4 B 2 /& Z pp m 

### GZf RDZBCPXA-6B22 4 D Z Z07 Q Pon t 

# n XR F Unit : taS*f D Book : 2?, g uf^eaBap^MSBam—a z 

# a n Data : ilOHO ^ Rr'jnaoFw>«)2a 4 n z 

# n n TinBe : flrD ^Ls b RYDSCPLA.6ffi2 4 

### SWf:_JZ23LU J Numttt ro fSampte=1 ^ | | | | «ReBUl l 16 7 pp m ' Fron t RQM , B I « teok Left , K= Bm k Rig M D Z » Dri p Zone , G Z = GaidBn
. P Z " Pta « AflnuadBBntBafBS B vtaMfl d huiithBSliMt , fiBtlnB pmpBCty

niv2a S Cimtt d IO.Se|).< S^

COASTA L ^ fNVIIOMntNTi l '^i. ^ ••0 U f
. ( N C 

## Consen t Fo rAcces s T o Propert y RIGH TO F ENTR YTO 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 : 

# 9 ^ ' ^-* , ^ ^ 4 Daytim e Phone : ^ 

# ¥-t>Jh'jrjr^^^?^Jr- '
Addres s o fPropert y covere d b ythi s 

# ;>.o/7'A7' ' ^-^^- h Aoreement : 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 ma ypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t o remove 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 ofCoasta l Environmenta l Group , contracte d byUSEPA , vi/il 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 opportunityt o revie wan d approv e th e planne d soi l removal , an d restoratio n v^r k befor e i t begins
. Once th e wor k i s finished , th e Granto rvi/il 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 Athat th e property ha s bee n remediated
. ENVIRONMENTA L RESPONS E ACTION S 

### Bysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , it s employees , contractors an d subcontractors 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 ofperformin g th e work
. Thi s acces s shal l remai n i n effect unti l th e wor k ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :
Pag e 1 of2\

COASTA L CNVItOMiriiT* ! E •0 U rI • ) 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 tenant 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 to endange rth e healt h o r welfar e o fth e Grantee s o rth e environment , o rt o allo wother s t o us e th e propert yi n suc h a manner . Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contac t Coasta l Environmenta l Group , a t (712 ) 352-018 8
^

I gran t acces s t o mypropertie s O I d o no t gran t access t o m ypropertie s 

# .^^^y^^y^ ^ f-^' O 9 ' signatur e Date SignatureDat e

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

### # #

COASTA L 

## Restoratio n Agreemen t Th e purpos e ofthl s agreeme mi 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} ' owne r an dth e Unite dState s Environmenta l Protectio nAgenc y (EPA)
.

Propert y ID : Propert yAddress : ^ ^ / / / J ^ ^ ^ T " Owner : Phone :
O nth e attache ddiagram(s ) indicat e area(s ) t o excavate dan ddept ho f excavation , locatio no f al l know n utilities , subsurfac e features , surfac e structure s an dlandscapin g features , acces s location(s ) t o b e use db y contractor , an dth e directio no f North
. Indicat e distances , depths , materia l types , etc . indicat e digita l photo s b y referencing th e photo-lo g numbe r wit hanarro w indicatin g 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 : 

# f/oifi^ S -h y i< ^ S^^/uo^j<^' 7

Page l of
.

### • #

C O AS T^ AL cn o u » . * fc 

### 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 : 

# A^^yi ^ 

# - 7 Item : ' /
Item : /
Item : / Item : / Item : Item : / Item : / Item : / Item : / Item : / Item : /
Item : /
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Item : 1

Pag e 2 of
.

### • • # •

C p AS T AL C M O U rIN 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 ) 1 Item :

Item : 1 Item : ^ T D 

### f^T ^ 

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# D^ ­ 

# -v^ ­ Jo^o.'h^J i 

# fi-r t fl'F 2

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. 

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### / /
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### / /

Pag e 3 of
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e #

( o u p IN C



## ite m

Pre-existin g propert y area , tha t wil l b e excavated , that i s covere dwit hgrass .

Numbe r o f tree s > 2 inc h trunk diameter

Numbe r o f tree s < = 2 inch noin k

diamete r

Numbe r o f Sprinkle r Zones , Contro l Valves , Timers , Heads , etc . Attac hasketcho f th e sprinkle r layout
.

Numbe r o f andsiz e o f eac hgarden/ flowe r be d area . Attac hasketc ho f relativ e size s andlocations
. 

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

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

Square fee t 

# a •_ Each 

# z Eac h 

# 3

Each

Each 

# y " Square Feet

Pag e 4 of
.

rag e o or .

### # # • •

C OAST AI
. «»«wr . (Ma
.


### Additiona l Comment s / Instructions :



# j^^^y t ^^^ ^ Jjct^c t P I ^1

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
. Bycheckir^ thi s bo xCE G i s no t responsible fb ran ydamag e don e t o th e interio ro fhouse , indudin g foundatio n crack s o rfissures
.

*E3 1 agre e QI d o no t agre e 

# A/wt^.'^^^'^i f-f-'^P ' P3^7:m d^9/6 9 Owner' s Signatur e Date GontrBctor* s Sigaatar e Date Pag e 6 o f

# y

BVID#.^[2 M XR F PROPERT Y SAMPL E SHEE T Dat e 

### 7'2.b-T ^ Addres s 

### ^o\{ o ^ M % & i Project Omah a lea d F P Zn d yea roptio n Sampl e tim e 

### /o:*-/2 ra®p m XRFID # sampl e lengt h 3 0 se c 

# ^zoi ^ Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a 

# .2311 . Z32 n 3&2fftl2q.t ^ 

# m.zi t n.o i ZS2 ^ mMt\\o.\'i > 

# £ L .25 2 714.-71120.^ 5 

# XI
. Dept h Dept h 

# .252 R Vli^H.\ai\°\^ Z _25 2 ^ 

## H-^.y/ir?.? ^ 

# 7^2 ^ 2?iO.Dl^»CX p 

## J:S2iD
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# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1 

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 232 6 Mod e SOI L Tim e 2009-07-3 0 10:4 8 Duratio n 121.9 7 Sequenc e Fina l Flag s AVERAG E ADDRES S QUAD/ZON E Fl INSPECTO R Nicola s DEPT H 1 0 SAMPL E TYP E CLEARANC E NOT E

pp m ± P b / 201.19 0 i ± Supervise d By : QTCAPQJgfi A

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 179.26 8 Supervise d By : 

## Certificat e o fVerificatio n

232 2 SOI L 2009-07-3 0 10:4 6 30.5 7 Fina l 6922 4 201 6 N 4 8 s t F l Nicola s 1 0 CLEARANC E

± Erro r ± 17.01 6

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 159.02 3 Supervise d By : 

## Certificat e o fVerificatio n

232 3 SOI L 2009-07-3 0 10:4 6 30.5 4 Fina l 6922 4 201 6 N 4 8 s t F l Nicola s 1 0 CLEARANC E

± Erro r ± 16.14 5

# 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 236.45 9 Supervise d By : 

## Certificat e o fVerificatio n

232 4 SOI L 2009-07-3 0 10:4 7 30.3 3 Fina l 6922 4 201 6 N 4 8 s t F l Nicola s 1 0 CLEARANC E

± Erro r ± 19.52 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 230.00 9 Supervise d By : 

## Certificat e o fVerificatio n

232 5 SOI L 2009-07-3 0 10:4 8 30.5 3 Fina l 6922 4 201 6 N 4 8 s t F l Nicola s 1 0 CLEARANC E

± Erro r ± 19.05 8

# 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 233 1 Mod e SOI L Tim e 2009-07-3 0 10:5 2 Duratio n 121.7 4 Sequenc e Fina l Flag s AVERAG E ^:/g^g.or2327-2330. / ADDRES S 2016N?8st " "" ^ QUAD/ZON E F 2 INSPECTO R Nicola s DEPT H 4 SAMPL E TYP E CLEARANC E NOT E

pp m Erro r P b ' 779.11£L J ± i _21.^5 8 / Supeivise d By : ?(fAjnj(lQ A

# 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 352.54 5 Supervise d By : 

## Certificat e o fVerificatio n

232 7 SOI L 2009-07-3 0 10:4 9 30.4 5 Fina l 6922 4 201 6 N 4 8 s t F2 Nicola s 4 CLEARANC E

± Erro r ± 24.64 2

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

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

pp m P b 274.71 7 Supervise d By : 

## Certificat e o fVerificatio n

232 8 SOI L 2009-07-3 0 10:5 0 30.5 6 Fina l 6922 4 201 6 N 4 8 St F 2 Nicola s 4 CLEARANC E

± Erro r ± 20.84 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 193.34 4 Supervise d By : 

## Certificat e o fVerificatio n

232 9 SOI L 2009-07-3 0 10:5 1 30.1 5 Fina l 6922 4 201 6 N 4 8 s t F2 Nicola s 4 CLEARANC E

± Erro r ± 17.82 5

# 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 295.87 0 Supervise d By : 

## Certificat e o fVerificatio n

233 0 SOI L 2009-07-3 0 10:5 2 30.5 8 Fina l 6922 4 201 6 N4 8 s t F2 Nicola s 4 CLEARANC E

± Erro r ± 21.71 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 233 6 Mod e SOI L Tim e 2009-07-3 0 10:5 6 Duratio n 121.5 0 Sequenc e Fina l Flag s AVERAG E ^Sg3E2332E23 ^ ADDRES S 201 6 N 4 8 s t QUAD/ZON E D Z INSPECTO R Nicola s DEPT H 1 5 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P b ± Supervise d By : Q)C^fI^J?py ^

# Therm o SCIENTIFI C Therm o Fishe r Scientifi c 90 0 Middlese x Turnpik e Blllerica , 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 191.95 5 Supervise dBy : 

## Certificat e o fVerificatio n

233 2 SOI L 2009-07-3 0 10:5 3 30.5 1 Fina l 6922 4 201 6 N4 8 s t D Z Nicola s 1 5 CLEARANC E

± Erro r ± 17.51 4

# 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 162.10 0 Supervise d By : 

## Certificat e o fVerificatio n

233 3 SOI L 2009-07-3 0 10:5 4 30.3 9 Fina l 6922 4 201 6 N 4 8 s t D Z Nicola s 1 5 CLEARANC E

± Erro r ± 16.01 5

# 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 144.81 6 Supervise d By : 

## Certificat e o fVerificatio n

233 4 SOI L 2009-07-3 0 10:5 5 30.5 3 Fina l 6922 4 201 6 N 4 8 s t D Z Nicola s 1 5 CLEARANC E

± Erro r ± 15.42 7

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

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

pp m P b 217.05 4 Supervise d By : 

## Certificat e o fVerificatio n

233 5 SOI L 2009-07-3 0 10:5 6 30.0 7 Fina l 6922 4 201 6 N 4 8 s t D Z Nicola s 1 5 CLEARANC E

± Erro r ± 18.71 1

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

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 234 1 Mod e SOI L Tim e 2009-07-3 0 11:0 0 Duratio n 121.8 1 Sequenc e Fina l Flag s AVERAG E 

### 3j^i&M233323AQ ] ADDRES S 201 6 N 4 8 s t QUAD/ZON E easemen t INSPECTO R Nicola s DEPT H 1 SAMPL E TYP E CLEARANC E NOT E

pp m Erro r P b 

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. 14.85 1 •7 Supervise d By : ^(^^^LCJU^ ^

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerlca , 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 138.72 4 Supervise d By : 

## Certificat e o fVerificatio n

233 7 SOI L 2009-07-3 0 10:5 7 30.5 5 Fina l 6922 4 201 6 N 4 8 s t easemen t Nicola s 1 CLEARANC E

± Erro r ± 15.18 5

# 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 147.17 1 Supervise d By : 

## Certificat e o fVerificatio n

233 8 SOI L 2009-07-3 0 10:5 8 30.5 6 Fina l 6922 4 201 6 N 4 8 s t easemen t Nicola s 1 CLEARANC E

± Erro r ± 15.53 4

# 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 146.17 2 Supervise d By : 

## Certificat e o fVerificatio n

233 9 SOI L 2009-07-3 0 10:5 9 30.5 7 Fina l 6922 4 201 6 N 4 8 s t easemen t Nicola s 1 CLEARANC E

± Erro r ± 15.38 6

# 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 102.29 4 Supervise d By : 

## Certificat e o fVerificatio n

234 0 SOI L 2009-07-3 0 11:0 0 30.1 3 Fina l 6922 4 201 6 N 4 8 s t easemen t Nicola s 1 CLEARANC E

± Erro r ± 13.30 1

## /1A. \ 8 ^^^ ^

I V/^^ljf ^tinatf ^

## Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
. www.coastalhazmatco m COASTA L ENVI>ONHINTA l 6 I O U P
. IH C 

# EXECUTIV ESUMMARY : BVID #69224 - (201 6 N4 8 ST ) "y j No Issue s o r Concern s [ ^ Issues/Concern s Detail Explanation : NO ISSUES PENDING
.

# EP APropert y Clos e Ou t For m Propert yff : 

# 1.^1-l H Propert y Addr«r.

- JgHM nT^H ) >^4-. ^ Datemme : Owaer^ s Name;
. .{.A^VQ ^ .i.VW f C^ ^ t ^ 1 Quad s Excavated ; p\ ^ p 2 |t>T

- Contracto r Grou p f*^^^ ^ FrvV/ l f\TmiLy\-T ^ I Ye s N o Excavatlo D Gcaeni l 1
.If necessaiy , were th e correc t quBdiant(s ) excavate dandrestored ? 

## ly 2
.If necessary , were th e correc t area s ofdri p zone excavale dandrestored ? Ve s IN » GradJD K So dan dVegetatio n 1
.Doe s the gradin g aroun dthe perimeier ofth e hous e i nexcavate darea s generally slop e awa y fromth e house ? 

# y 2
.Ha s so dbee nlai dinall area s tha t wer e excavated ? 3
.

Doe s th e sodappear to b e generally healthy an dgrowing ? (Only evaluate if inspecteda t a3 0 

# -v ^ day time period ) 4
.

Ar e soddedarea s generally fir man devenly graded ? 

# T7- " 5
.

Ar e th e joint s l)etweenth e so dstrip s generally tight ? (Only evaluate if inspecte da t a3 0 da y 

# 1}' , tim e period) 6
.Wa s the propert y grade dsuchtha t wate r will no t poo l o nthe property ? 

# y
1
.Wa s danug e t o landscapin g o r plan t material s avoided ? 

# V

Gates
. Fence s an dRetainin g Wall s Ve s N IMK I
.D o gate s ope nan dclos e freely? (If applicable ) 

# y 2
.Were all gate s or fence s takendow ndurin g restoralio nactivitie s reinstalled ? (If applicable ) 

# y ^ 3
.

Wa s damage t o gate s o r fence s avoided ? (Ifapplicable ) 

# y 4
.Wa s damage t o retainin g wall s avoided ? (Ifapplicable ) Foundation , Sidinx an dGutter s 

### Ye s , > 1
.Wa s damage t o th e sidin g o r tri mavoided ? 

# \ y / 2
.Wa s damag e t o th e foundationavoided ? 

### L / / 3
.Wa s damage to window s avoided ? 

## \ y ' / 4
.Wa s damage to window s or doo r screen s avoided ? 

# v/ / 5
.Wa s damage to downspout s o r downspoul extension s avoided ? 

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

# V

## Owner s comments :

Inspectio nnotes :

Removal andrestoratio naclivale s completeincludin g the30-da y so dwarranty : EPARepresentativ e^(T H UOMJL ^

## Date : ^jll(0 ^

## Propert yCompletio n Agreemen t
I hi s agreemen t document s th e completio n o l remedia l activitie s peribnne d o n m yproperl yM ysignalur e wil l designat e tha t I a m satisfie d wit h th e restoratio n o fm ypropeity , an d tha i n o item s ar e i n questions , now , o ra l an ylim e i n th e fulure , excep l ihos e Hem s liste d below , ifan y

Propert y ID : (^°\'2'2' ^ Propert yAddress : 2,6Z^ - / / Q ^ ^ f Owner : 

## SefC y j/i/l<syn<
. Phone : 

### ^ B L 

# ] ^ Restoratio n Item s i n Question :

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

flfjrecrestoralio n i t complclrd , cxccp l a s nOltt l ^ I rio no t aijrc crescoratia n i s complete d 

# < /

h Q ^
Ownci''.< : Sicnatiir rDat e ' / ^ J ntrarlor' s Signatur e Dat e