## TRANSMITTA Lof OMAHALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R

SAI D # : 

# '24?'11' U Date : 

# M QAo ^ UM^XW i Address : Remediatio nContractor : _Coasta i Environmenta l Group
_ Year ; 200 i ^ 

### SOI LREMEDIATIO N PROPERT Y nLEFOLDE RDOCUMENT S Vide o o f propert y (DVD ) Executiv e Summar y EPA-providedproperty sketch SignedAcces s Agreement fo r subject propert y SignedAcces s Agreement(s ) fo r adjacen t propert y RestorationAgreement 

## -a- Settlement document s (i.e. , fo r damag e o r to replac e plants , etc. ) Confirmationdata Photograph s As-built sketch Satisfactor y restoratio nsignedb y Propert y Owner Propert y close-out check lis t signedby EP A

- & 

### Descriptio no f area s no t meeting ROD cleanup criteri a Utility clearance s / 

### Propert y informatio nfro mDougla s Count y Assessor' s Office



# </l ^

• ^^siii r Dite " 3005477 4 Superfun d

### Propert yAcces s Checklis t PropertyU) : 2^)^1l l Propert yAddress : 2^0 ^

Pnpp\e,\t^ n D DWOR K STARTE D WOR K COiVlPELTED ON : ON : / / /
_ /
_
Own c Rente r Address : 

### "oaynrv ^ Phone : F.L\ : 

## ^•'o"- ?)a

. -MW ^ Fax : Cell/Pager : Additiona l Inl'nrmxtion : Cell/Pager
.
D Notificatio n Lette r 15 ) Acces s Agreemen t 52 ^ Restoratio n Agreemen t O Topsoi l Samplin g (i fapplicable ) C 3 Disposa l Samplin g (i fapplicable ) O Gnrdc n Samplin g (i fapplicable )

•Ulilit yClearanc e •0 ^ Video/Photo s (Before )

•Video/Photo s (During ) n Video/Photo * (After ) D Vi(ko/Photo » (30-Day ) D Propert yCompletio n A(;reemen i Sent : / / 

### Signed: Jl/J|/S l S\gt,t6:J_l]\_l( M 1 1 1 1 1 1 Called : / / 

### On:l/LL/0 a On : / / On : / / On : / / Sipicd : / / By : 

# B>

= n(i^\i\ o By : /OMav i n By : By : By : By : 

### By=0cWi O / SY^aK \ By : By : By : By : D Fina l Repor t Issued : / / By : Ai rMonitorin g (aA
- applicable ) O Communit y d l Cre w Results : Oo : / / By :

n Communiri ' RMUHS : D Cre w On : / / By :

r~ l Community
ResulU : D Cre w On : / / Bv :

Omah a Lea d Sit e

## CONTACTFOR M Propert y I D #2 D 4" ] 1 Propert y Address : 

# 7-"lQ7 ) ?o^^\t^ n T W Initial Contact : Date : T-fl'O ^ Time : |:2 ^ Action : C^rcj^flwg r Secon dContact : Date : Time : Action : ^ Action : Fina l Contact : Date : Time : Fina l Action : Transmit t

o EP AD Othe r

Action : D

Comment : Owner Comment (s) :
Site f o ^c & U^i ^ lt^ + Ca^ K f1y.<|

- t J Q-X^y ^ Coordinato r Comment (s) :

\

## Douglas Count y Accoun t Informilifin Pag e 1 of3 tTaMa i
Dougla s County/Nebrask a Propert yRecor d - R123842000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e l ® scal e 0-5 0 f l wes t o f52n d S t - Vle WO P Ma p informatio n i s vali d a s o f2009-6-1 6 Treasurer' s Ta xRepor t Ne wFeatur e ••-•- •Aut o Sale s Searc h Owne r DYK E NATHA N P blA L 270 3 POPPLETO N AV E OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber - 384 2 000 0 1 2 Accoun t Type : Residentia l Parce l Number : 123842000 0 Parce l Address : 270 3 POPPLETO N AV OMAH AN E 68105-000 0 Lega l Description : HANSCO M PLAC E LOT2 BLOC K1 4 E 5 0 FTLT S 1 & 5 0 X10 0 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $4,400.0 0 $93,900.0 0 $98,300.0 0 200 8 $4,400.0 0 $93,900.0 0 $98,300.0 0 200 7 $4,400.0 0 $93,900.0 0 $98,300.0 0 200 6 $4,400.0 0 $70,400.0 0 $74,800.0 0 200 5 $4,400.0 0 $70,400.0 0 $74,800.0 0 200 4 $4,400.0 0 $70,400.0 0 $74,800.0 0 Sale s Informatio n Sale s Date : 2007-04-0 2 Dee d Type : W D BooJIr ; 200 7 Page : 03757 9 Price : $114,000.0 0 Grantor : Rogers Michae l eta l Grantee : Dyke Natha n P eta l Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 2005-04-2 2 Dee d Type : W D SooAr ; 200 5 Page : 04739 9 Price : $107,000.0 0 Grantor
- JOH N LLINCOL N ETA L


## http://douglasne.mapping-online.coin/DouglasCoNe/static/accountinfo.jsp?accountno=R123..
. 7/7/2009

### Dougla s County Accoun t Info : rmgijig r Pag e 2 of 3

Grantee : MICHAE LRODGER S ETA L Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 1 5000. 0 1. 0 100. 0 50. 0 N o Improvemen t Informatio n Buildin g 1

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PJ!|I I B^c k fl fl 1 1/ 2 STOR YFINISHE D CLIC KTaENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1675. 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 : 6. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : I 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : ; 3. 0

Roo fType : Gabl e Stories : ; 1. 5 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 191 7 0 % 191 7 9 1 Detai l Typ e Detai l Descriptio n Unit s 1040. 0 Applianc e Allowanc e Ad d O n Unfinishe d Atti cW/floo r 1. 0 Basemen t Bsmn t Bloc k 8 f t 1040. 0 Fixtur e Bas e Fixture s 1. 0


### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R123.
. . 7/7/200 9

## Douglas Count y Accoun t Informajin n Pag e 3 of3 irn^^ r
Fixture Bat h Ful l 1. 0 Garag e Detache d 209. 0 Porc h Sla b RoofCei l 184. 0



## http://douglasne.mapping-online.com/DouglasCoNe/static/accoxmtinfo.jsp?accountno=R123..
. 7/7/2009

### Pag e 1 of 2

" > Create Anothe rTicket ] [ Back t o irt h Internet ] Sen d Emai l


### YOU RTICKE TNUMBE RI S 2332169
. Origina l Cal l Date : 8/03/0 9 Time : 12:0 2 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 8/05/0 9 Time : 12:4 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 270 3 Street : POPPLETO NAV E Twp : 15 NRng : 13 E Sect-Qtr : 28-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 : FAX AL L CLEAR S TO : (877)662-421 1 : UNSUR E ABOU T CORNE R LO T 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 : 4 F T Corne 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 e Are a Contac t Phon e Nunibe r Utilit y Typ e 

### Day : 402934046 9 CXCAT V CO XCOMMUNICATIONS , IN C 

### HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 877366834 4 LEVEL 3 LEVEL 3 COMMUNICATIONS , LL C 

### N AAlt : Emerg : 877366834 4 

### Day : 402504782 3 MUD0 2 METROPOLITA NUTILITIE S DISTRIC TSAND Y Alt : 

### Emerg : 402504797 0 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R 

### RO NAlt : 402444516 1 Emerg : 402444516 0

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 8/3/200 9

### Pag e 2 of 2

OPPDGPR 6 OMAH APUBLI C POWE RDISTRIC TN A Day :

Alt : 406728934 3 406207149 4 Emerg : 888728934 3 QLNNEI FQWES TLOCA LNETWOR K

N A Day : 406728934 3

Alt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 8/3/200 9

# As-Buil t Drawin g C OASTA L 

# Omah aLea dSuperfun dSit e ENVIRONnENTA L O R O U r, INC

.

Name : 'J'hfxt ^ /.

. LSr\e, o I ^ Omali a Lea d Sit e Address 3s :

: -^7^ 3 Popple-fo ^ A tT Sit e Sketc h Phone ::/Vto2j^6-i5-2- 7 

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### Legen d Concreti e Dri p Zon e Excavate d Quadrant s Excavate d
Are a replace d wit: h So d 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 .

# ^Xl^ ^ 

# ^ '

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COASTA L fii>iteiiitiiiTt t t •e wp , I H c 

## 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 : ^ , ^

Owner' s Name : ' Daytim e Phone :

/ V 

## \Xei

. Addres s o fPropert y 

# 27o3 fovrL^^" ^
covere d b ythi s AQreement ;
PURPOS E O F RESPONS E 

### AcTiVmE 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($ ) 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 perfonne 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 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 wit h th e Grantor' s approval

. Upo n completion , th e Granto rvtnl 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 sut>confra€tor 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 fperformin g th e woric

. Thi s acces s shal l remai n i n effec t unl U th e wor k ha s bee n satrsfactorit yconnpleted

. Th e Granto rals o agree s fo :

Pagi e 1 iA 2COASTA L



### •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 s^ve ; •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 worit

. • Allo wvideotapin g and/o rphotographin g o fth e property
. /AGREEMEN TNO TT O INTERFER Ei 

### Th e Granto ragree s no t t o Interfer e o rtampe rwit h an yofth e wor k activities , o rwit h an y o fth e wor k done , o rv^t 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

G

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

# JMLI A / Date SignatureDat e plgrpdut e
QI woui d lik e t o b e presett t durin g an ysamplin g tha t i s required

.C \^

* S T^ L 

## RestoratlOFt Agreemen t Th e purpos e of thi s agreement is to provid e amutual agreement as to condition s ofth e propert y prio r to remediatio nactivities
. Thi s will als o serv eas documentatio nfor th e purpos e of assurin g that restoratio n activitie s ar e complete dto th e satisfactio n of th e propert y owner andthe Unite dState s Environmental Protectio nAgenc y CEPA)
.

Propert y ID : ^2jl^7'2
. Propert y Address : 7-7^2 ^ FOpr^tLrrO^N j /^s/ € Owner ;


### Onth e attache ddiagram(s ) indicate area(s ) to excavate , surfac e structure s andlandscapin g feature s an d acces s locatioii(s ) tobe used by th e contractors . Indicate distances , depths , materia l types , etc . Photographicall y andVideographically document the existin g condition s ofth e propert y andth e basement if necessary . Item s to be Remove d byth e Owne rbefbr e Star t ofRemediation : 1 ttem: % ^ ( 

# ^inU s --<Ji^- ^ V ttem: "^ /
ttem:
ttem:



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Item : : / J
Item :

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. C h O U ' IM C 

## Item s to B e Remove d ByContracto rDurin g Remediatio n an d Replace d

Ite m Pre-existin g propert y area , tha t wil l b e excavated , tha t i s cov^e dwit hgrass . 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 . Attac hnsketc hu l th e vpr!;iklc r I;VNCUI
. Numbe r o f an dsiz e o f eac hgarden / flowe r be d area . Attac hasketc ho f relativ e size s an dlocaiiiniN
. Agree dupo nvalu e o f plan t material s no t t o b e replace db v contractor . r-Jot c I'll.' , S!\lii e nii i h v
• jsr*c' '. c issu e H j)l«n < >oin.'i;e i id\',\ e prcpcr: ^ o « ntr . Easemen t Area , t o b e excavate d 

## Quantit y

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# K y ^ 

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Addttiona l Comment s / instructions :



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.

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Q Chec k th e boxi fOwne rdoe s not wan t CE G t o documen t interio rfoundatio n wall s an d possibl e pre-existin g damage

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pp m P b 596.64 6 Supervise d By : 

## Certificat e o fVerificatio n

369 3 SOI L 2009-08-2 1 13:2 0 30.3 1 Fina l 2047 2 270 3 poppleto n av e B 2 Ventr y 6 CLEARANC E

± Erro r
± 29.55 0

# 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 424.39 4 Supervise d By : 

## Certificat e o fVerificatio n

369 4 SOI L 2009-08-2 1 13:2 0 30.6 6 Fina l 2047 2 270 3 poppleto n av e B 2 Ventr y 6 CLEARANC E

± Erro r
± 24.52 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 370 5 Mod e SOI L Tim e 2009-08-2 1 13:2 8 Duratio n 121.7 3 Sequenc e Fina l Flag s AVERAG E ADDRES S po^'()iet6h ' 'a v 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 JS4.P77
. 

# 3 L15-248 1 Supervise d By : FpQAJl^S^OJ S

# 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 116.14 3 Supervise d By : 

## Certificat e o fVerificatio n

370 1 SOIL 2009-08-2 1 13:2 6 30.5 5 Fina l 2047 2 270 3 poppleto nav e easemen t Ventr y 1 CLEARANC E

± Erro r
± 13.61 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 138.13 8 Supervise d By : 

## Certificat e o fVerificatio n

370 2 SOI L 2009-08-2 1 13:2 7 30.5 9 Fina l 2047 2 270 3 poppleto n av e easemen t Ventr y 1 CLEARANC E

± Erro r
± 14.78 0

# 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 182.42 1 Supervise d By ; 

## Certificat e o fVerificatio n

370 3 SOI L 2009-08-2 1 13:2 7 30.3 0 Fina l 2047 2 270 3 poppleto nav e easemen t Ventr y 1 CLEARANC E

± Erro r
± 16.28 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 180.20 5 Supervise d By : 

## Ceitlficat e o fVerificatio n

370 4 SOI L 2009-08-2 1 13:2 8 30.2 9 Fina l 2047 2 270 3 poppleto n av e easemen t Ventr y 1 CLEARANC E

± Erro r
± 16.31 2

# 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 370 0 Mod e SOI L Tim e 2009-08-2 1 13:2 4 Duratio n 122.1 8 Sequenc e Fina l Flag s AVERAG E 

## ^mm§^^99- x ADDRES S ^0 3 poppleto n av e QUAD/ZON E PZ INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P b Supervise d By : 

# (^C^^p^j?/^

# 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 369 6 Mod e SOI L Tim e 2009-08-2 1 13:2 2 Duratio n 30.5 5 Sequenc e Fina l Flag s BVI D # 2047 2 ADDRES S 270 3 poppleto n av e QUAD/ZON E PZ INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 96.84 4 ±12.80 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 114.83 6 Supervise d By : 

## Certificat e o fVerificatio n

369 7 SOI L 2009-08-2 1 13:2 3 30.5 9 Fina l 2047 2 270 3 poppleto n av e PZ Ventr y 6 CLEARANC E

± Erro r
± 13.53 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 97.31 8 Supervise d By : 

## Certificat e o fVerificatio n

369 8 SOI L 2009-08-2 1 13:2 3 30.5 4 Fina l 2047 2 270 3 poppleto n av e PZ Ventr y 6 CLEARANC E

± Erro r
± 12.69 1

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

## Ceitlficat e o fVerificatio n
XL3t-3208 9 Readin g N o 369 9 Mod e SOI L Tim e 2009-08-2 1 13:2 4 Duratio n 30.5 0 Sequenc e Fina l Flag s BVI D # 2047 2 ADDRES S 270 3 poppleto nav e QUAD/ZON E PZ INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m Erro r P b ± 94.65 4 12.52 0 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 369 0 Mod e SOI L Tim e 2009-08-2 1 13:1 7 Duratio n 121.5 3 Sequenc e Fina l Flag s AVERAG E rAvg^.3j68^-360 9 ADDRES S '-270 3 poppleto n av e QUAD/ZON E D Z INSPECTO R Ventr y DEPT H 1 2 SAMPL E TYP E CLEARANC E NOT E

pp m Erro r 

### P

b f"231.23r~ 7 Supervise d B y 

# : ^CaBJ(?Q 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 136.61 6 Supervise d By : 

## Certificat e o fVerificatio n

368 6 SOI L 2009-08-2 1 13:1 5 30.2 8 Fina l 2047 2 270 3 poppleto n av e D Z Ventr y 1 2 CLEARANC E

± Erro r
± 14.71 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 318.89 0 Supervise d By : 

## Certificat e o fVerificatio n

368 7 SOI L 2009-08-2 1 13:1 5 30.3 2 Fina l 2047 2 270 3 poppleto n av e D Z Ventr y 1 2 CLEARANC E

± Erro r
± 21.57 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 159.82 6 Supervise d By : 

## Certificat e o fVerificatio n

368 8 SOI L 2009-08-2 1 13:1 6 30.6 4 Fina l 2047 2 270 3 poppleto n av e D Z Ventr y 1 2 CLEARANC E

± Erro r
± 15.75 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 309.59 1 Supervise d By : 

## Certificat e o fVerificatio n

368 9 SOI L 2009-08-2 1 13:1 7 30.2 9 Fina l 2047 2 270 3 poppleto n av e D Z Ventr y 1 2 CLEARANC E

± Erro r
± 21.61 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 368 5 Mod e SOI L Tim e 2009-08-2 1 13:1 3 Duratio n 121.9 7 Sequenc e Fina l Flag s AVERAG E / Wofi6Sl'-.36.84 / ADDRES S 270 3 poppleto n av e QUAD/ZON E F l INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r Pb ^M.IOOJ ' ± & ! ^ Supervise d Bv : r/IOA 

# MVQ ^

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 88.15 8 Supervise d By : 

## Certificat e o fVerificatio n

368 1 SOI L 2009-08-2 1 13:1 1 30.5 6 Fina l 2047 2 270 3 poppleto n av e F l Ventr y 6 CLEARANC E

± Erro r
± 12.00 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 368 2 Mod e SOI L Tim e 2009-08-2 1 13:1 2 Duratio n 30.3 1 Sequenc e Fina l Flag s BVI D # 2047 2 ADDRES S 270 3 poppleto n av e QUAD/ZON E F l INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m±Erro r P b 80.50 6 ±11.70 1 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 114.36 3 Supervise d By : 

## Certificat e o fVerificatio n

368 3 SOI L 2009-08-2 1 13:1 2 30.5 1 Fina l 2047 2 270 3 poppleto nav e F l Ventr y 6 CLEARANC E

± Erro r
± 13.50 6

# 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 368 4 Mod e SOI L Tim e 2009-08-2 1 13:1 3 Duratio n 30.5 9 Sequenc e Fina l Flag s BVI D # 2047 2 ADDRES S 270 3 poppleto n av e QUAD/ZON E F l INSPECTO R Ventr y DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m Erro r P b 73.37 2 ± 11.25 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 371 7 Mod e SOI L Tim e 2009-08-2 1 13:4 5 Duratio n 122.5 1 Sequenc e Fina l Flag s AVERAG E feycLgL371f3'^37t6,y ADDRES S 270 3 poppleto n av e QUAD/ZON E B 2 INSPECTO R Ventr y DEPT H 8 SAMPL E TYP E CLEARANC E NOT E

pp m ± Erro r P b ± /T2.91; 3 >. j Supervise d By : /^(ih^lo/ ^

# 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 159.86 6 Supervise d By : 

## Certificat e o fVerificatio n

371 3 SOI L 2009-08-2 1 13:4 3 30.9 5 Fina l 2047 2 270 3 poppleto nav e B 2 Ventr y 8 CLEARANC E

± Erro r
± 15.67 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 111.68 6 Supervise d By : 

## Certificat e o fVerificatio n

371 4 SOI L 2009-08-2 1 13:4 4 30.5 6 Fina l 2047 2 270 3 poppleto n av e B 2 Ventr y 8 CLEARANC E

± Erro r
± 13.26 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 371 5 Mod e SOI L Tim e 2009-08-2 1 13:4 5 Duratio n 30.4 6 Sequenc e Fina l Flag s BVI D # 2047 2 ADDRES S 270 3 poppleto nav e QUAD/ZON E B 2 INSPECTO R Ventr y DEPT H 8 SAMPL E TYP E CLEARANC E NOT E

pp m±Erro r P b 86.61 4 ±11.92 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 371 6 Mod e SOI L Tim e 2009-08-2 1 13:4 5 Duratio n 30.5 4 Sequenc e Fina l Flag s BVI D # 2047 2 ADDRES S 270 3 poppleto n av e QUAD/ZON E B 2 INSPECTO R Ventr y DEPT H 8 SAMPL E TYP E CLEARANC E NOT E

pp m±Erro r P b 65.99 4 ±10.78 5 Supervise d By :

## iyA^ \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 I ^^^ ^

I Coasta l Environmenta l Grou p inc

. \!^^^ ^

www.coastalhazmat.co m '^tPHOtt ^ COASTA L HKIIONHINTA l C lO U P

. IN C 

# EXECUTIV ESUMMARY : BVID #20472-(270 3 POPPLETO NAVE )
No Issue s o r Concern s Q Issues/Concern s
Detail Explanation :

# I
,St« t 

# EP APropert y Clos e Ou t For m 27£3 ^ X>or/>C^T< ^ ^" ^ Propert y # : 20^.72 ^ Propert y Addrcsr
. ^^ ^ '«gH ^ Datc/Tlmc : Owner' s Name:
. ^ 

# ^^E Quad s Excavated : Contracto r Group
. Ye s N o Excavatio nGenera l I
. If necessary , were th e correc t quadrant(s ) excavate dandrestored ? ( / ' 2
. If necessary , were th e correc t area s ofdri p zone excavate dandrestored ? 

## \ y ^ Gradin g So dan dVegetatio n Ye s N o 1
.I>oe s the grading aroundthe perimeter ofth e hous e i nexcavate darea s generally slop e awa y Gro mth e house ? 2
.Ha s sodbee nlai dinall area s tha t wer e excavated ? 3
.

Doc s the sodappear to b e generally healthy an dgrowing ? (Only evaluate if inspecteda l a3 0 day time period) ^_
_ 4
.Ar e soddedarea s generally fir man devenl y graded ? 

## tX ^ 5
.

Ar e th e joint s betweenth e so dstrip s generally tight ? (Only evaluate if inspecteda t a3 0 da y tim e period) • 6 ,Wa s the propert y grade dsuchtha t waie r wil l no t poo l o nihe property' ? 7
.

Wa s damage t o landscapin g o r plan t material s avoided ? 

# w Gates , Fence s an dRetainin g Wal b Yes N o I
.D o gate s ope nan dclos e freely ? (Ifappiicable ) 2
.

Were all gate s or fence s takendow ndurin g restoratio nacliviiie s reinstalled ? (If applicable ) 1 ^ ' 3
.Wa s damage t o gate s or fence s avoided ? (Ifappiicable ) t ^ " 4
.Wa s damage t o retainin g wall s avoided ? (Ifappiicable ) Foundation , Sidin g an dGutter s Ye s N o I
.Wa s damage t o th e sidin g o r tri mavoided ? 

### i / " 2
. Wa s damage to the foundationavoided ? tX ' Wa s damage l o window s avoided ? 4
.Wa s damage to window s o r doo r screen s avoided ? 

### 1 ^ ^ 5
. Wa s damage l o downspoul s o r downspou t extension s avoided ? ^ ^ Sidcwallt s an dDrKcway s (Concrete ) Ye s N o 1
. Wa s damage l o drivewa y surface s avoided ? \^ ' 2
. Wa s damage t o walkwa y surface s avoided ? < ^ '

## 0>»'ncr s comments :

inspectio nnotes :

Remova l an drestorationaclivale s complet e including th e 30-da y so dwarranty : EP ARepresenlaliv e i^& K lJi[/ k A ^ Date : T/^/ /

## Propert yCompletio n Agreemen t
riii s agrecincn l documeni s th e compielio n o fremedia l activitie s perCormec i o n m yproperly

. M ysignatur e wil ] desijjnal cIha l I a m .salislle d wit h th e restoratio n o fm yproperly , an d Iha l n o item s ar e i n questions , now . o rat an ytim e i n th e future , excep t thos e ilem s lisie d below , ifany

.

Properl y II) : 2/i*'l7 ^ Property Address : ^^ j I ? 

### ^l^.fp> ^ 4^

. Phon e Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item :
Additiona l Comments :

[ J ^ I acrc cre.sfoi/irio n i. s completed , excep t a s nofe< l |_ | I d o not acic crcslomtio n i s complete d

liA ^ 

## ?//-i ^ C)^vna('s

- SiRnadirc Dat e 

# ? U

## Wate rBil l Settlemen t

Property I D 2047 2 Property Addres s 270 3 Poppleto nAv e Tenan t NathanDylc e

Ihav e receive dfromth e contractor , Coastal Environmental Group Inc
. (Coastal) , th e su mo f $ 103.8 6 for wate r usag e require dt o maintai nth e sod
.
Checi c Number 182 8 Valu e o f Checi c $ 103.8 6 Mad e Ou t T o Natha nDyke Descriptio n o fSettlemen t T o reimburs e tenan t fo restimate d wate rcharge s o n thei rMU D monthl yinvoices

. M ysignatur e belo wi s acltnowledgemen t o f th e receip t o f th e su m liste d above , whic h i furthe r aclcnowledg e t o b e fai rcompensatio n an d ful l paymen t fo rth e above , an d releas e Coasta l Environmenta i Grou p inc

. fro m furthe robligation s o rliability

.



### ^ Signature ( Date Q>ntractor' s Signature * ' Date

• ^"i
. 'gr*""^^«y' j 

# --•. - " • •w'-'^"?'t^.^'-js^ass5g!^v*>/^^-^iy:''''4 v COASTA L ENVIRONMENTA LQROU P INC

. 

## 182 8 241 1 MAm>I A STREE T 27-5/104 0 00 3 OMAHA , N E 68105 624737290 4 

### \\\\\ ^ DAT E PA

YT O T ORDE R O F 

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