### TRANSMITTA Lo fOMAH ALEA D SIT E SOI LREMEDIATIO N FIL E FOLDE R SAID # 

# jqSB ^ DATE = ^/l/// U ADRESS : 2filV
- A ) J- i SI
REMEDIATIO N CONTRACTOR : COASTA LENVIRONMENTA LGROU P Contract : EP-R7-09-0 6

SOI LREMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENTS (

/ Executiv e Summar y [ j EPA-provide d propert ysketc h 1 ^

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Signe d Acces s Agreemen t fo rsubjec tpropert y iSTyfSigne d Acces s Agreemen t(s ) fo radjacen tpropert y

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• v l ^ Settlemen t document s (i.e. , fo rdamag e o rt o replac e plants , etc. )

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I/|lpon^''matio n dat a h * ^Photograph s SO D Pre-Excavatio n Excavatio n As-Buil t sketc h Satisfactor yrestoratio n signe d b yPropert yOwne r Propert yclose-ou t chec k lis tsigne d b yEP A Descriptio n o farea s o farea s no tmeetin g RO D cleanu p criteri a Utilit yclearance s Propert yInformatio n fro m Dougla s Count yAssessor' s Offic e D 

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D Notificatio nLette r Sent : / / By : 'Q l Acces s Agreemen t Sipicd ; Vt)/^k./> a »> = ViV. W /luLlrV-.,^^\ 0 Restoratio nAgreemen t Signed ; v o /:n 3 / ^ a By = o.o\L 1 h<\t\^. , V D Topsoil SampUng (i f appUcable ) 1 1 By : D Disposal Samplhi g (i f applicable ) / / By ; D Garde nSamplin g (if applicable ) / / By : D Utility Clearanc e Called : / / By : M Video/Pboto s (Before ) On:V 5 1 -z& J

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Ai r Monitorin e(a s applicabl e • D Community D Cre w On : / / By : Results : D Community QCre w On : / / By : Results : Q Community QCrc w On : / / By : Results :

Omaha Lead Sit e

### Dougla s County Accoun t Intea|tio n Pag e1 of 2

Dougla s County , Nebrask a Propert yRecor d - R200287000 0 Prin tReoor t Vie wInteractiv e GI S Ma o Informatio n i s vali d a s o f2010-8-3 0 Treasurer' s Ta xReoor t Ne wFeatur e ^ S > ^ Subdivisio n Sale s Searc h Owne r WATSO N RICHAR D W ETA L 262 5 MAPL E S T OMAH AN E 68111-000 0 Propert yInformatio n Ke yNumtier : 028 7 000 0 2 0 Accoun t Type : Residentia l Parce l Numtier : 200287000 0 Parce l Address : 281 7 N 2 7 S T OMAH AN E 68111-000 0 Lega l Description : PATRICK S - AS
- AD D LO T9 BLOC K2 S 3 0 FTLT S 8 & 3 0 X10 2 Valu e Informatio n Lan d Improvemen t Tota l 201 0 $200.0 0 $0.0 0 $200.0 0 200 9 $200.0 0 $0.0 0 $200.0 0 200 8 $200.0 0 $0.0 0 $200.0 0 200 7 $200.0 0 $0.0 0 $200.0 0 200 6 $200.0 0 $0.0 0 $200.0 0 200 5 $200.0 0 $0.0 0 $200.0 0 Lan d Informatio n Acre s S F Unit s Deptf i Widt h Vacan t 0.0 7 3060. 0 0. 0 102. 0 30. 0 Ye s



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R200.

. . 9/3/201 0

### Dougla s County Account I 

# w tio n 

### Pag e2 of 2

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### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R200.

. . 9/3/201 03/31/201 1 www.dhon.org/irthinternet/DHONNoti c 

### Create Anothe rTicl^et Bac k tffrt h Intemet | [Sen d Emai l 

# c

• YOURTICKE T NUMBE RI S 2700073

. Origina l Cal l Date : Wor k t o Begi n Date : 3/31/1 1 4/04/1 1 Time : 1:1 9 pm Time : 1:4 5 pm Op : ALFONSO1879 0

State : N E Address : 281 7 County : Street : DOUGLA S N27T H S T Place : OMAHA

Twp : 15 NRng : 13 E Sect-Qtr : 09-NE-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : Lea d Remediatio n Locatio n o f Work : LOCAT E ENTIR E PROPERTY , AL L EASEMENT S AN D T O TH E PEDESTAL Remarks : FA X AL L CLEAR S TO : (402)934-281 1 : PLEAS E INCLUD E AL L EASEMENT S Company: COASTA L ENVIRONMENTA L SERVIC E Contac t Name ; ALFONS O Phone : (402)934-283 7
Wor k Bein g Don e For : Coasta l Dept ho f Excavation : 4f t Corne r Lot ; NFront : Y Rear ; Involve s Tunnelin g o r Horizonta l Borin g ; NExplosives : N CXCATV MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac t Phon e Nimibe r Utilit y Typ e Day : 402934046 9 CXCATV CO X COMMUNICATIONS , IN C HEIDI Alt : 402934046 9 Emerg : 402932975 7

MUDO l METROPOLIT/y ^ UTILITIES DISTRIC T 

## SAND Y MU D Day : 402504782 3 Ak : Emerg : 402504797 0

OMAHACO F CITY O FOMAHA

TRAFFICSEWE R RICH/TRAFFIC Day : 402444719 7 Ah : 402444516 1 Emerg : 402444516 0

0PPDGPR 5 OMAHAPUBLIC POWER DISTRIC T EL M LOCATIN G Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 dhon.org/irthinternet/.../MessageText.as.

. 1/ 23/31/201 1 

## QLNNEI C ^^www.dhon.org/irthinternet/DHONNoti c 

## FTM QWES TLOCALNETWORK rr^r^ATTxir ^ Day :

Alt : 406728934 3 406207149 4 Emerg : 888728934 3

dhon.org/irthinternet/. ../MessageText.as..

. 2/ 2

### 04/01/1 1 10:0 1 A M ^ ^ (111)111-1111 , QWES T ^^ ^ 01/0 2

To : COASTA L ENVIRONMESNTAL SERVIC E Attn : ALFONS O Voice : 402934283 7 Fax : 402934281 1 Re : Messag e fro mQwes t Messag e fro mQwes t ^^^ ^ -

Ticket : 270032 5 County : DOUGLA S Place : OMAH A Address : 262 6 PARKE R S T QLNNEIC : Th e describe d di g are a o f you r locat e reques t ha s bee n checke d an d i s clea r fo r Qwes t Communication' s Loca l Network
. I f yo u hav e an ycpiestion s pleas e cal l Qwes t a t 1-800-283-4237
.

Ticket : 270035 8 County : DOUGLA S Place : OMAH A Address : 220 2 FLORENC E BLV D QLNNEIC : Th e describe d di g are a o f you r locat e reques t ha s bee n checke d an d i s clea r fo r Qwes t Communication' s Loca l Network
. I f yo u hav e an yquestion s pleas e cal l Qwes t a t 1-800-283-4237
.

Ticket : 270007 3 County : DOUGLA S Place : OMAH A Address : 281 7 N27T H S T QLNmlC : Th e describe d di g are a o f you r locat e reques t ha s bee n checke d an d i s clea r fo r Qwes t Communication' s Loca l Network
. I f yo u hav e an yquestion s pleas e cal l Qwes t a t 1-800-283-4237
.

Messag e fro mQwes t

### 03/31/1 1 02:3 7 P M (402)934-0016 , CoxCommunication s 03/0 4

To:

- COASTAL ENVIRONMENTAL SERVIC E Attn : ALFONS O Voice : 402934283 7 Fax : 402934281 1 Re : Respons e t o Di g Reques t Thi s i s an ittportant messag e fromCo xCononunication s replying t o you r reques t t o locat e ou r underground facilitie s i n an are a describe d on th e on e cal l cente r ticket
. W e d o no t hav e an yunderground facilitie s i n you r di g are a 

# y'= i sB ^
Ticket : 270007 1 County : DOUGLA S Place : OMAH A Address : 150 7 OHI O S T CXCATV : Thi s i s a n importan t messag e fromCo xCommunication s replying t o you r reques t t o locat e ou r underground facilitie s i n a n are a describe d o n th e on e cal l cente r ticket
. W e d o no t hav e an yunderground facilitie s i n you r di g area . I f yo u hav e an yquestions , pleas e cal l ou r offic e a t 402-934-046 9

Ticket : 270007 3 County : DOUGLA S
_Place : OMAH A Address : 281 7 N27T H S T CXCATV : Thi s i s a n importan t messag e fromCo xCommunication s replying t o you r reques t t o locat e ou r underground facilitie s i n a n are a describe d o n th e on e cal l cente r ticket
. W e d o no t hav e an yunderground facilitie s i n you r di g area . I f yo u hav e an yquestions , pleas e cal l ou r offic e a t 402-934-046 9

Ticket : 270007 7 County : DOUGLA S Place : OMAH A Address : 161 2 CORB T S T CXCATV : Thi s i s a n importan t messag e fromCo xCommunication s replying t o you r reques t t o locat e ou r underground facilitie s i n a n are a describe d o n th e on e cal l cente r ticket
. W e d o no t hav e an yunderground facilitie s i n you r di g area . I f yo u hav e anyquestions , pleas e cal l ou r offic e a t 402-934-046 9

I f yo u hav e an yquestion s pleas e contac t ou r loca l Co xCommunication s offic e A T 934-0469
.

### u.3/ji/i i u^:^ o f M(1UZ ) ^'ii-//^u , Omah a Publi c Work s 06/1 0

To : COASTA L ENVIRONMENTA L SERVIC E Attn : ALFONS O Voice : '402934283 7 Fax : 402934281 1 Re : Respons e t o Di g Reques t Thi s i s a n importan t messag e fro mOmah a Publi c Work s replyin g t o you r reques t t o locat e ou r undergroun d facilitie s i n a n are a describe d o n th e on e cal l cente r ticket
. /- > ^ ,

Ticket : 270007 1 County : DOUGLA S Place : OMAH A Address : 150 7 OHI O S T
OMAHACO F (Sewer) : Cit yo f Omah a Sewer

- N o Conflic t pe r inf o o n th e on e cal l ticke t
OMAHACO F (Traffic) : Th e Cit yo f Omah a Traffi c Engineerin g Divisio n ha s determine d ou r facilit yi s no t i n conflic t wit hth e di g sit e provide d b yth e on e cal l center .

Ticket : 270007 3 County : DOUGLA S Place : OMAH A Address : 281 7 N27T H S T
OMAHACO F (Sewer) : Cit yo f Omah a Sewer

- N o Conflic t pe r inf o o n th e on e cal l ticke t
OMAHACO F (Traffic) : Th e Cit yo f Omah a Traffi c Engineerin g Divisio n ha s determine d ou r facilit yi s no t i n conflic t wit hth e di g sit e provide d b yth e on e cal l center .

Ticket : 270007 7 County : DOUGLA S Place : OMAH A Address : 161 2 CORB I S T
OMAHACO F (Sewer) : Cit yo f Omah a Sewer

- N o Conflic t pe r inf o o n th e on e cal l ticke t
OMAHACO F (Traffic) : Th e Cit yo f Omah a Traffi c Engineerin g Divisio n ha s determine d ou r facilit yi s no t i n conflic t wit hth e di g sit e provide d b yth e on e cal l center .

I f yo u hav e an yadditiona l question s pleas e contac t Omah a Publi c Works
.

## 2958 9 

# As-Buil t Drawin g ^

C OASTA L 

# Omah aLea dSuperfun dSit e ENVIItONHENTA L C « O U r
. IN C OLS# : 2958 9 Dat e Excavated : 4/7/201 1 Dat e USEP ASigne d Off : 7/12/201 1 Are a Sodden : 420 0 s o f t
Omah a Lea d Sit e Owne rName : RICHAR D WWATSO N Sit e Sketc h Address : 281 7 N 2 7 S T Phone : H : W :

Omah aLea dSit e 4613 0 

### Legen d

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

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

# iimiiiiMii H 2958 9
Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e Owne rName : RICHAR D V VWATSO N O ^ 

### Sit e Sketc h •Goo d Address : 281 7 N 2 7 S T •Poo r |~ } Not pain t

Omah aLeadSite 4613 0

# 2958 9

Nort h Arro w 

### Omah a Lea d Sit e Exterio rPain t Owne rName : RICHAR D WWATSO N 

### Sit e Sketc h •Good Address : 281 7 N 2 7 S T •Poo r Phone : H : W : •No tpain t

Omah aLea dSite 4613 0

# 2958 9 Omah a Lea d Sit e Exterio rPain t Owne rName : RICHAR D WWATSON 

### Sit e Sketc h •Goo d Address : 281 7 N 2 7 S T •Poo r Phone : H Q No tpain t

Omah aLeadSite 46130..ePSM ,

COASTA l SNVmONHtltlA l C K0 t l r
. IN 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 Agency(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 : 4->iyic"^xr ^

Owner' s Nam e 

# imm i

Addres s o fProperty covere d bythi s Agreement :
PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP Ai s requestin g acces s t o collec t soi l sample s an d remov e soi l tha t contain s elevate d concentration s o flea d an d ma ypos e a healt h hazard

. Th e area(s ) wil l b e excavate d t o remov e contaminate d soil

. Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o its origina l condition

. Thi s wor k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program
. Arepresentativ e o fCoasta l Environmenta l Group , contracte d b yUSEPA , wil l contac t th e Granto rin-perso n t o discus s th e wor k t o b e 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 rwil l receiv e writte n documentatio n fro m EP Atha t th e propert y ha s bee n remediated

.

ENVIRONMENTA LRESPONS E ACTION S 

### Bysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , it s employees , contractor s an d subcontractor s th e righ t t o ente rth e property , a tal l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e o fperformin g th e work

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

. Th e Granto rals o agree s to :

Pag e 1 o f2.\*' *>

COASTA L 

# \y--y f IHVmOMKfKTA l 6 I tO U rIN C 

### t Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; cRemov e flowe rbulb s o rplant s tha tth e Granto ro rth e Granlor' s tenan t maywis h t o save ; cWate ran d maintai n replacemen tvegetation , includin g fertilize rapplication , a s necessarysubsequen t t o a n initia l waterin g perio d b yEPA ; cAbid e b yhealt h an d safet yguidanc e provide d byEPA ;
« 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

. cAllo 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 equipmentuse 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 wothers t o us e th e propert yi n suc h a manner
. Should yo u hav e an yquestion s abou t thi s program , pleas e contact Coasta l Environmenta l Group , a t (402 ) 991-119 9

I gran t access t o m ypropertie s D I d o not gran tacces s t o m ypropertie s

Signatur e Dat e Signatur e Dat e

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

.

Pag e 2 o f2COASTA L C fl O U P , IN C 

## Restoratio n Agreemen t Th epurpos eo f thi s agreement i s t o provid eamutualagreement a s t o condition s o f th eproperty prio r t o remediatio nactivities

. Thi s wil l als o serv ea s dociimentatio nfo r th e purpos eo f assurin g tha t restoratio n activitie s are complete dt o th e satisfactio nofth eproperty owne r an dth e Unite dState s Environmental Protectio nAgenc y (EPA)

.

Property ID : r:^q^^ ^ Property Address : ppg^ ] 7 t\ l oil 7 ^ Owner : 

## R(Oy O

. \hr\r^(~ A Phone : O nthe attache ddiagram(s ) indicatearea(s ) t o excavate , surfac estructure s andlandscapin g feature s and acces s location(s ) to b e use dby th e contractors
. Indicatedistances , depths , materialtypes , etc
. Photographicall y andVideographicall y document th eexistin g condition s ofth epropert y andth ebasement if necessary . 

### Item s t o b e Remove d b yth e Owne rbefor e Star to fRemediation : Th e removal , storage , disposal , and/o rretur n o fthes e item s i s th e Owner' s responsibility

.



### Item s t o b e Remove d b yth e Contracto rDurin g Remediatio n an d No t Replace d Item : 

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Pre-existin g property area , tha t will b eexcavated , tha t i s covere dwit hgrass . Number o f tree s > 2 inch trunk diamete r Number o f tree s <= 2 inch trunk diamete r Number o f Sprinkler Zones , Contro l Valves , Timers , Heads , etc
. Attachasketc hof tlie .sprinkle r layout

. Number o f an dsiz eo f eac hgarden/ flower be d area . Atlacii askeicl i ot relaiiN C size s andlocations

. Agree dupo nvalu eo f plant material s no t t o b e replace db v contractor
. Notethi s \alu ewill he usf d(( » issu eaplan t %(»iiclie r I

O th epropcrl } owner . Easement Area , t o b e excavate d 

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### Pag e 2 of

.COASTA L C KO U P , INC

.

Additiona i Comment s / Instructions : Th e cit yo fOmah a ordinance s ma yprohibi tyo u fro m usin g dir to rgrave l area s o n you rpropert y a s driveway s o rvehicl e parkin g areas
. Th e Environmenta l Protectio n Agenc y(EPA ) ma yb e removin g an d replacin g soi l underlyin g a grave l o rdir tare a o n you rpropert ytha tyo u ma yb e usin g a s a drivewa yo rvehici e parkin g area
. I fthi s i s th e case , yo u shoul d understan d tha tthi s removin g an d replacin g o fsoi l doe s no t mea n tha tan yillega l drivewa yo rparkin g are a o n you r propert yi s mad e legal

. T o th e contrary , yo u ma yb e cite d b yth e cit yi fyo u us e a grave l o rdir tare a a s a drivewa yo rparkin g area , no t withstandin g an yremova l o rreplacemen to fsoi l b yth e EPA

. I fyo u hav e an yquestio n abou t legalit yo fa certai n drivewa yo rparkin g area , yo u ma ycontac t th e cit yo fOmaha' s Plannin g Departmen ta t(402 ) 444-5150

. 

# VPI

. Pieas e chec k thi s bo xi fyo u understan d th e informatio n outline d above

.

'Chec k th e bo xi fOwne rdoe s no t wan tCE G t o documen tInterio rfoundatio n wall s an d possibl e fe-existin g damage

. B ycheckin g thi s bo xCE G I s no tresponsibl e fo ran ydamag e don e t o th e Interio ro fhouse , includin g foundatio n crack s o rfissures

. 

### Iagre e nId o no t agre e 

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# 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 4 9 Mod e SOI L Tim e 2011-04-0 7 2 1 :4 2 Duratio n 90.5 0 Sequenc e Fina l Flag s AVERAG E Av g o f46-4 8 ADDRES S 281 7 N 2 7 S T QUADRAN T EA DEPH T 1 " XR F TEC H M

. MATEU S MIS C CLEARANC E NOT E CLEA R

pp m Erro r M o < LO D 7.81 5 Z r 307.37 1 ± 13.71 2 S r 193.30 8 ± 9.66 3 U < LO D : 14.06 3 R b 66.60 7 ± 6.53 1 T h < LO D 14.09 8 P b 316.18 1 ± 24.30 1 S e < LO D 6.33 2 A s < LO D : 32.06 9 H g < LO D \ 13.26 8 Z n 379.64 6 ± 32.47 1 W < LO D 92.65 3 C u 55.61 7 ± 23.70 7 N i < LO D : 78.16 3 C o < LO D 1 214.21 7 Fe 24220.17 2 ± 452.29 4 M n 687.42 3 ± 119.07 2 Supervise d By :

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

## Certificat e o fVerificatio n
XL3t-3208 9 Readin g N o 4 6 Mod e SOI L Tim e 2011-04-0 7 21:4 1 Duratio n 30.1 7 Sequenc e Fina l Flag s BVI D 2958 9 ADDRES S 281 7 N 2 7 S T QUADRAN T EA DEPH T 1 " XR F TEC H M

. MATEU S MIS C CLEARANC E NOT E CLEA R

pp m Erro r M o < LO D 7.58 9 Z r 294.70 5 ± 13.20 5 S r 201.24 5 ± 9.63 2 U < LO D : 13.28 1 R b 65.46 5 ± 6.29 5 T h < LO D 13.56 7 P b 329.36 2 ± 24.21 4 S e < LO D : 6.22 8 A s < LO D 31.97 0 H g < LO D 13.16 3 Z n 370.76 4 ± 31.50 7 W < LO D : 93.53 0 C u 67.18 9 ± 23.80 7 N i < LO D 76.42 3 C o < LO D 201.95 9 Fe 22879.71 3 ± 430.06 6 M n 770.82 4 ± 120.62 9 Sup e rvise 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 QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m M o < LO D Z r 313.34 0 S r 188.37 2 U < LO D R b 64.19 9 T h < LO D P b 332.32 4 S e < LO D A s < LO D H g < LO D Z n 427.84 3 W < LO D C u 52.26 5 N i < LO D C o < LO D Fe 25762.97 1 M n 587.48 3 Supervise d By : 

## Certificat e o fVerificatio n

4 7 SOI L 2011-04-0 7 21:4 2 30.1 6 Fina l 2958 9 281 7 N 2 7 S T EA 1 " M

. MATEU S CLEARANC E CLEA R

Erro r
: 7.82 9 ± 13.87 6 ± 9.60 1 14.94 9 ± 6.55 7

: 14.54 8 ± 25.02 8 6.53 1 32.60 4 : 13.75 5 ± 34.51 9 \ 93.63 0 ± 23.74 3 81.44 3 223.05 2 ± 468.68 0 ± 113.82 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 QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m M o < LO D Z r 314.06 9 S r 190.30 8 U < LO D R b 70.15 7 T h < LO D P b 286.85 7 S e < LO D A s < LO D H q < LO D Z n 340.33 0 W < LO D C u 47.39 7 N i < LO D C o < LO D Fe 24017.83 0 M n 703.96 3 Supervise d By : 

## Certificat e o fVerificatio n

4 8 SOI L 2011-04-0 7 21:4 2 30.1 7 Fina l 2958 9 281 7 N 2 7 S T EA 1 " M

. MATEU S CLEARANC E CLEA R

Erro r
: 8.02 7 ± 14.05 5 ± 9.75 5 13.96 0 ± 6.73 9

: 14.17 8 ± 23.66 1

: 6.23 7 31.63 2 12.88 6 ± 31.38 8

1 90.79 8 ± 23.56 9 76.62 3 217.64 1 ± 458.13 8 ± 122.76 1

# 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 AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

M o Z r S r U R b T h P b S e A s H g Z n W C u N i C o F

e M n Supervise d pp m
< LO D 407.17 5 186.84 2

< LO D 67.73 6 14.58 9 ^87.69 3

< LO D < LO D < LO D 206.76 3

< LO D 42.89 0 < LO D < LO D 19992.92 4

564.95 3 By : 

## Certificat e o fVerificatio n

4 3 SOI L 2011-04-0 7 21:3 8 90.5 0 Fina l Av g o f40-4 2 281 7 N 2 7 S T F2 4 " M

. MATEU S CLEARANC E CLEA R

Erro r 7.88 4 ± 15.17 0 ± 9.39 9 15.21 6 ± 6.62 7 ± 8.62 5 ± 19.05 7 5.95 9 24.87 2 12.50 9 ± 24.46 7 \ 90.06 6 ± 22.32 0 75.38 7 : 193.06 5 ± 406.46 6 ± 108.79 2

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

## Certificat e o fVerificatio n

4 0 SOI L 2011-04-0 7 21:3 7 30.1 6 Fina l 2958 9 281 7 N 2 7 S T F2 4 " M

. MATEU S CLEARANC E CLEA R

Erro r
: 7.79 5 ± 15.18 0 ± 9.36 4 15.57 2 ± 6.80 2 ± 8.81 1 ± 18.80 2 6.38 0 24.27 7 12.19 1 ± 24.63 0 88.62 5 ± 23.26 7 77.46 5 196.60 6 ± 407.95 5 ± 105.61 2 XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

M o Z r S r U R b T h P b S e A s H g Z n W C u N i C o F

e M n pp m
< LO D 403.80 8 183.66 7

< LO D 70.92 4 17.12 1 178.55 2

< LO D < LO D < LO D 208.21 7

< LO D 53.20 4 < LO D < LO D 19956.42 0

504.94 7 Supervise d By :

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

## Certificat e o fVerificatio n
XL3t-3208 9 Readin g N o 4 1 Mod e SOI L Tim e 2011-04-0 7 21:3 7 Duratio n 30.1 7 Sequenc e Fina l Flag s BVI D 2958 9 ADDRES S 281 7 N 2 7 S T QUADRAN T F2 DEPH T 4 " XR F TEC H M

. MATEU S MIS C CLEARANC E NOT E CLEA R

pp m Erro r M o < LO D 8.11 6 Z r 400.16 2 ± 15.12 7 S r 186.57 0 ± 9.43 6 U < LO D \ 15.14 4 R b 70.06 7 ± 6.72 4 T h 14.65 4 ± 8.90 2 P b 214.07 9 ± 20.24 2 S e < LO D 5.55 0 A s < LO D 26.86 5 H g < LO D 13.15 1 Z n 236.55 2 ± 26.12 5 W < LO D 92.23 0 C u 39.30 3 ± 22.19 7 N i < LO D 76.26 2 C o < LO D 201.83 0 F

e 21562.06 4 ± 423.98 2 M n 665.23 1 ± 116.45 5 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 QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m M o < LO D Z r 417.55 3 S r 190.28 9 U < LO D R b 62.21 8 T h < LO D P b 170.44 6 S e < LO D A s < LO D H g < LO D Z n 175.51 9 W < LO D C u 36.16 2 N i < LO D C o < LO D Fe 18460.28 7 M n 524.68 1 Supervise d By : 

## Certificat e o fVerificatio n

4 2 SOI L 2011-04-0 7 21:3 8 30.1 7 Fina l 2958 9 281 7 N 2 7 S T F2 4 " M

. MATEU S CLEARANC E CLEA R

Erro r 7.74 0 ± 15.20 1 ± 9.39 8

* 14.93 3 ± 6.35 5 12.24 4 ± 18.12 8 \ 5.94 8 23.47 4 12.18 4 ± 22.64 7

; 89.34 3 ± 21.49 5

• 72.43 3 J 180.76 0 ± 387.46 3 ± 104.31 0

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

## Certificat e o fVerificatio n

3 7 SOI L 2011-04-0 7 21:3 4 90.5 0 Fina l Av g o f34-3 6 281 7 N 2 7 S T B 2 4 " M

. MATEU S CLEARANC E CLEA R

Erro r \ 7.98 8 ± 15.17 8 ± 9.90 6 14.87 3 ± 6.61 2 13.91 7 ± 23.44 0

: 6.05 4 30.99 1 12.19 4 ± 28.34 0 89.36 6 ± 22.51 4

1 76.03 2 : 199.61 1 ± 418.79 0 ± 108.56 6 XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

M o Z r S r U R b T h P b S e A s H g Z n W C u N l C o Fe M n pp m
< LO D 393.96 8 204.94 9

< LO D 66.61 5 < LO D ^92.57 5 < LO D < LO D < LO D 283.69 6

< LO D 41.23 4 < LO D < LO D 20789.88 1 539.02 6 Supervise d By :

# 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 3 4 Mod e SOI L Tim e 2011-04-0 7 21:3 2 Duratio n 30.1 7 Sequenc e Fina l Flag s BVI D 2958 9 ADDRES S 281 7 N 2 7 S T QUADRAN T B 2 DEPH T 4 " XR F TEC H M

. MATEU S MIS C CLEARANC E NOT E CLEA R

pp m Erro r M o < LO D 7.99 7 Z r 387.65 8 i 15.08 2 S r 170.25 5 : t 9.16 6 U < LO D 15.11 1 R b 67.79 2 i 6.71 6 T h < LO D 13.68 7 P b 279.49 6 ± 23.13 1 S e < LO D 5.97 8 A s < LO D 30.65 0 H g < LO D 13.23 6 Z n 267.47 1 i 27.91 0 W < LO D 92.76 2 C u < LO D 32.25 6 N i < LO D 79.12 0 C o < LO D 197.29 0 F

e 20294.75 8 i 417.10 1 M n 523.51 2 ± 108.08 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

3 5 SOI L 2011-04-0 7 2 1 :3 3 30.1 7 Fina l 2958 9 281 7 N 2 7 S T B 2 4 " M

. MATEU S CLEARANC E CLEA R

Erro r 7.96 1 ± 14.68 4 ± 9.81 2 ] 14.21 7 ± 6.46 5

: 13.68 6 ± 22.55 5

I 5.99 7 : 29.38 1 11.12 9 ± 26.27 8 82.53 3 ± 22.30 3

1 72.56 6 194.45 0 ± 404.12 0 ± 103.85 9 XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

M o Z r S r U R b T h P b S e A s H q Z n W C u N i C o F

e M n pp m
< LO D 371.83 7 204.04 3

< LO D 65.77 6 < LO D 273.78 0

< LO D < LO D < LO D 246.28 4

< LO D 44.60 3 < LO D < LO D 19714.62 3

488.79 6 Supervise d By :

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

## Certificat e o fVerificatio n

3 6 SOI L 2011-04-0 7 21:3 4 30.1 6 Fina l 2958 9 281 7 N 2 7 S T B 2 4 " M

. MATEU S CLEARANC E CLEA R

Erro r 8.00 5 ± 15.76 8 ± 10.74 0 15.29 1 ± 6.65 5 14.37 9 ± 24.63 3 6.18 5 : t 21.96 1

: 12.21 8 ± 30.83 2 92.80 1 ± 23.73 5 76.41 2 207.09 2 ± 435.14 9 ± 113.75 1 XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

M o Z r S r U R b T h P b S e A s H g Z n W C u N i C o Fe M n pp m
< LO D 422.40 9 240.54 9

< LO D 66.27 7 < LO D 324.44 9

< LO D 33.14 1 < LO D 337.33 4

< LO D 56.43 7 < LO D < LO D 22360.26 0 604.77 1 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 AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m M o < LO D Z r 370.03 1 S r 199.52 3 U < LO D R b 72.83 8 T h 16.62 1 P b £66.20 8 S e < LO D A s < LO D H g < LO D Z n 460.09 6 W < LO D C u 59.20 3 N i < LO D C o < LO D F

e 37080.56 3 M n 856.23 0 Sup e •vise d By : 

## Certificat e o fVerificatio n

3 1 SOI L 2011-04-0 7 21:2 9 90.8 6 Fina l Av g o f28-3 0 281 7 N 2 7 S T B l 4 " M

. MATEU S CLEARANC E CLEA R

Erro r
: 8.44 5 ± 15.41 6 ± 10.21 5 16.16 4 ± 7.18 9 ± 9.95 4 ± 23.42 7 6.40 1 31.43 9 14.16 9 ± 37.04 4 100.58 9 ± 25.54 4 85.96 9 : 273.35 0 ± 581.77 7 ± 139.47 8

# 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 QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m M o < LO D Z r 372.27 7 S r 201.53 4 U < LO D R b 76.71 2 T h 22.76 4 P b 258.54 6 S e < LO D A s 38.62 3 H g < LO D Z n 468.17 8 W < LO D C u 60.20 7 N i < LO D C o < LO D Fe 36645.81 6 M n 903.63 2 Supervise d By : 

## Certificat e o fVerificatio n

2 8 SOI L 2011-04-0 7 21:2 7 30.1 7 Fina l 2958 9 281 7 N 2 7 S T B l 4 " M

. MATEU S CLEARANC E CLEA R

Erro r 8.43 2 ± 15.44 4 ± 10.24 4 16.25 1 ± 7.32 8 ± 10.36 5 ± 23.02 2 \ 5.34 3 ± 20.90 0 14.33 1 ± 37.31 0 102.03 8 ± 25.51 4

: 85.44 1 1 272.05 2 ± 577.33 0 ± 142.15 8

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

## Certificat e o fVerificatio n

2 9 SOI L 2011-04-0 7 21:2 8 30.1 7 Fina l 2958 9 281 7 N 2 7 S T B l 4 " M

. MATEU S CLEARANC E CLEA R

Erro r 8.33 9 ± 15.22 8 ± 10.25 3 15.66 2 ± 7.08 3 14.31 9 ± 23.37 4

: 6.18 7 30.92 4 13.71 5 ± 35.84 0 94.22 3 ± 25.35 2

: 82.89 7 262.82 2 ± 570.26 1 ± 134.87 6 XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XRFTEC H MIS C NOT E

M o Z r S r U R b T h P b S e A s H g Z n W C u N i C o F

e M n pp m
< LO D 360.73 8 201.57 5

< LO D 71.72 6 < LO D 266.30 1

< LO D < LO D < LO D 432.41 8

< LO D 59.22 1 < LO D < LO D 35719.83 2 788.21 2 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 QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m M o < LO D Z r 377.07 9 S r 195.46 0 U < LO D R b 70.07 5 T h 15.36 3 P b 273.77 7 S e < LO D A s 32.22 1 H g < LO D Z n 479.69 1 W < LO D C u 58.18 0 N i < LO D C o 304.13 8 Fe 38876.03 9 M n 876.84 4 Supervise d E iy : 

## Certificat e o fVerificatio n

3 0 SOI L 2011-04-0 7 21:2 9 30.5 2 Fina l 2958 9 281 7 N 2 7 S T B l 4 " M

. MATEU S CLEARANC E CLEA R

±

± ±: ± ± ±
±
±
±
± ± ± Erro r 8.56 3 15.57 4 10.14 9 16.58 0

7.15 5 9.95 1 23.88 6

7.67 4 21.36 2 14.46 2 37.98 3 105.50 6

25.76 5 89.56 9 190.11 8 597.74 1 141.39 9

## Propert yCompietio n Agreenfien t
Jhi i agieemen i documenis

. Ih ecomplclionol remedia lacliviiie s perroimedo nm y properly M y signalur e wil l designatellia l Ia msatisfiedwit hIh erestoralio nof m y properly , an dIha ln o ilems ar ei nqueslions

. now , or a

lany innei nth efuluie , excep l ihos eilems listedbelow , i f an y Propert yID : ^c^^^^c y Propert y Address : >^^ ^ ^ ^ ^ ^ ^ Q""'=' ^ ^-.cWrAVO^V^cr^

- 

### Phone : ^^ ^ ^ UK*3\.^0,V, V
Restoratior t Item s i n Question :

Item : Item : Item ; Item : Item : item :

\j6 l ayrc crestoralio n i < complcltd , rxccp l a s nnler i [ I I rio no t ii|;re crcfioratin n i s conipieler i 

# 7^,..oy.M/^ ^ 7^-v?^/ /

L^ ^ -?-'8 y Owner' s Signatnr fDat e Cont i arlor' s Signadii e Dat e

## ^ 1 

## EP APropert y Clos eOu t For m _aSii2s__u_^2^:i ^ Propert y Addrwji^-g^ " ^ ^— ^ » Property» : Q?Vt>'£;P\.

. Add i

• aPiT N Date/Time : Owiicr* s Name:

. /^XV^.rf)!

. Wpv^ : Quad s Excavated : _ Contraclo r Crou p Yes No Excavatio nGenera l I. Ifnecessuy , wer eth c correc t quadrant(s ) excavate dan drestored ? 

## y 2. Ifnccessary , wer eth ecorrec l area s ofdri p zon eexcavale dan drestored ? 

# y
Gradin g So dan dVenetatioi i Ye s No 1 Doe s Ihegradin g aroun dth eperimete r ofth ehous eincKcavsle darea s generall y slop eawa y 

## y fromth ehouse ?

__ ^ 2. Ha s so dbeenlai dinal l area s that wer eexcavated ? 

# y i. Doe s th esodappea r to begenerall y health y an dgrowing ? (Onl y evaluat e if

inspecte d at

a

30 

# y da y tim eperiod ) 4. Ar esodde darea s generall y firman devenl y graded ? 

# -y 5 Ar ethejoini s berwee nth eso dstrip s generall y tight ? (Onl y evaluat e if

inspecte d at

230 da y

_tim eperiod ) 

# y

6. Wa s th eproperty grade dsuc hthat wate r wil l nol poo l onth epropeny' ' I 7. Wa s damag e to landscapin g or plant material s avoided ? 

# A

Gates , Fence s an dRetainin g Wall s Ye s No 

# r 1. Do gate s openan dclos efreely? (Ifapplicable ) 

# ~y
2. Wer eal l gate s or fence s take ndow ndurin g restoratio nactiviiie s reinstalled ? (If applicable ) 

# -y
3. Wa s damag e to gate s or fence s avoided ? (If appiicable ) 

# y 4. Wa s dainag e to rciainin g wall s avoided ? (I f applicable ) 

# 71
Foupdation , Sidio g an dGnMer s Ye s No IWa s damag e to th esidin g or tri mavoided ? 

# y J 2. Wa s damag e to th efoundationavoided ?

- — .*

. Wa s damag e to window s avoided ? 

# y 1 4 Wa s dainag e to window s or doo r screen s avoided ? 

# y y Wa s damag e lo downspout s or downspou i extension s avoided ? Sidewalk s an d Driveway s (Concrete ) Ves ^ No 1 Wa s damag eto drivewa y surface s avoided ? 

# - y 2. Wa s damag e to walkwa y surTace s avoided ?

## Ort-ncr s comments :

I 

## j Inspectio nnotes :

Removal andresloratio naclivale s completeincludin g the30-da y sodwarranry ;
EPARepresentativ e9» " ^ ^ Date : 7lit) n