TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: H% Date: 1 h \^ 

Address: "^^^ ^ f^lfPlieil ^ \JU/I^ 

Remediation Contractor: Coastal Environmeiital Group_ Year: 2009 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

A Video of property (DVD) 

Executive Stmimary 

A EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

Settlement doctmients (i.e., for damage or to replace plants, etc.) 

Confinnation data 

A Photographs \\ i t^lBHk?^/^ V ^gftVfr-Kg*^ 4 7 ^ 

As-built sketch 

Satisfactory restoration signed by Property 0>^er 

A Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 

Propertyinfi^ation from Douglas Coimty Assessor's Office 

XT* 

30217541 

illi 

Superfund 
Property Access Checklist 

PropertylD: S4-TC>«S 

D WOWC STARTED ON: / 

D WORKCOMPELTED ON: l _ J 1 . 

Property Addres,: ^Q5 g for.-h'T^ f \lf ^ ^ 

O^'-"^'-' ]eu «

Address: Z)CurvviL 

 Ha^rcKC^ 

Pfaonc:57y-q'5qi ' 

Fax: 

Cell/Pager 

D Notification Letter 

1 ^

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D

D

D

D

El

O

D

D

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 Access Agreement 

 Restoration Agreement 

 Topsoll Sampling (if applicable) 

 Disposal Samplhig Of applicable) 

 Garden Sampling (if applicable) 

 Utility Clearance 

 Video/Photos (Before) 

 Video/Photos (During) 

 Video/Photos (After) 

 Video/Photos (30-Day) 

 Property Completion Agreement 

 Final Report 

Air Monitorine (as anDlicable) 

n Community QCrc w | 

Results: 

On: /

D Commnnity

Results; 

D Crew On: /

D Commnnity

Results: 

 OCrc w | On: /

Renter: 

Phone: 

Fax: 

Ceil/Pager. 

AddMonal biformfttion: 

Sent: / / 

Signed: ii_/3D/_0 2 

Signed: iL/.2ii/IS . 

/ / 

/ / 

/ / 

Called: / / 

On:l2/J_/ M 

On: / / 

On: / / 

On: / / 

Slgncd:^/ii/^ f 

Issued: / / 

/ By:

 / By: 

/ By: 

By: 

By: E e 

By: E..C 

By: 

By: 

By: 

By: 

By: Giio /OdaN/^r ^ 

By: 

By: 

By: 

By: 

By: 

Omaha Ljead Site 

 I 
Douglas County Account Infow ; Page 1 of2 

Douglas County, Nebraska Property Record - R2401970000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - Vie w OP Ma p Information is valid as of 2009-11 -19 Treasurer's Tax Report 

New Feature -> - • r» Auto Sates Search 

Owner 

MARASCO LOUIS R 

2958 FONTENELLE BLVD 

OMAHA NE 68104-0000 

Property Informatio n 

Key Number: 0197 0000 24 

Account Type: Residential 

Parcel Number: 2401970000 

Parcel Address: 2958 FONTENELLE BD 

OMAHA NE 68104-0000 

Legal Description: VINELAND LOT 1 BLOCK 1 N 1/2 LT 2 & ALL 60 X 125 

Value Informatio n 

Land Improvement Total 

2009 $6,900.00 $67,600.00 $74,500.00 

2008 $6,900:00 $89,900.00 $96,800.00 

2007 $6,900.00 $89,900.00 $96,800.00 

2006 $6,900.00 $89,900.00 $96,800.00 

2005 $6,900.00 $59,100.00 $66,000.00 

2004 $6,900.00 $53,700.00 $60,600.00 

Sales Informatio n 

Sales Date: 2008-09-18 

Deed Type: WD Booiir: 2008 Page: 095791 

Price: $75,000.00 

Grantor: White Rosalie M Etal 

Grantee: Marasco Louis Robert 

Valld/lnvalld: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.17 7500.0 1.0 125.0 60.0 No 

Improvemen t Informatio n 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2... 11/24/2009 
Douglas County Account Inf«jj^^o t(^j|3^ ^ n Page 2 of2 

Building 1 

EmtStiwn 2»«F0MTENeLLEB0 

JS ­ tier 

JDET 

rrr tin 

Rrs t Boo r Second Ftoor nSB.OS Q ft. 

CD 

078.0 m 1 r p BU 

mr 

1 V2 STORY 121 j II tr I4a 

BsffrtsiBateft 170 WOCKivcmnm 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1470.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: <' Average 

Built As: 1 1/2 Story Fin Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 7.0 

Exterior: Frame Vinyl Units: 1.0 

Interior: Drywall Batiis: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: ; Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1920 0% 1920 90 

DefafV Type Detail Description Units 

Appliance Allowance 1.0 

Appliance Fireplace Masonry 1.0 

Basement Bsmnt Block 8 ft 1152.0 

Basement Minimal Finish 400.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 288.0 

Porch End Screen 96.0 

Porch Knee Wall 24.0 

User MLS UPDATE 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2... 11/24/2009 
i» 

Page 1 of 1 

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[ Create Another Tjcket ][, Back to Irth Internet^ J iL.-Sgndprnajl :| 

• YOUR TICKET NUMBER IS 2415350. 

Original Call Date: 12/01/09 Time: 12:08 pm Op: ELIZABETH18790 


Work to Begin Date: 12/03/09 Time: 12:45 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address:. 2958 Street: FONTENELLE BLVD 


Twp: 15N Rng: 13E Sect-Qtr: 08-NW-SW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD REMEDIATION 


Location of Work: INCLUDE ALL EASEMENT LOCATE ENTIRE PROPERTY 


Remarks: PAX ALL CLEARS TO: (877)662-4211 


: tnJSURE OF CORNER LOT 


Company : COASTAL ENVIRONMENTAL SERVICE 


Contact Name: ELIZABETH Phone: (877)662-4210 


Work Being Done For: COASTAL 


Depth of Excavation: 4 FT Corner Lot: N Front: Y Rear: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Plione Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 12/1/2009 
OLS#: 84705 As-Built Drawing " Date Excavated: 12/4/09 

Date USEPA Sianed Off: 1/19/10 

COASTA L Omaha Lead Superfund Site Area Sodden: 1260 sa ft 

14705 

Omah Exlenor Paint a Lead Site 

Sit Q^Good e Sketch • Root 

Sampling Address: 2958 FONTENELLE BD n Not paint 

Sampl Lead Sample Samples Collected e Number LAB Concentration Collected Firm: P-£- Q.d ^ £< • 

RYASCPXA-84705 Fl 3(s2 ppm D Date: t: -g-rt^ 

RYBSCPXA-84705 F2 3 ? l ppm D Time: ^:0 5 P> • <^ 

RYCSCPXA-84705 B1 D Samples Analyzed RYDSCPXA-84705 B2 582 . ppm D 

RDZSCPXA-84705 DZ ^i25JL_PPm I D XRF Unit: JOBUT. Book: 2?- g 

RGZSCPXA 84706 -62 - ~ ppm n D Date: 'r-2.7-0') 

RPZSCPXA 847M -P2- ~ ppm D D Time: Am 

Staff: M j y Number of Samples = | S | | Q | 

Legend: Fl = Front Left, F2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pla; 

AH quadrants are as vieweslfronth d fron thee s street facing property 

ii yi ¥-

CnAii iJi>.S.iv-.« 

Legen d 

Concret e Dri p Zone Excavate d Quadrants Excavate d 

Area replaced with 

Sod ' ' 

Are a replace d wit h 

Rock/Mulch Are a lef t bar e 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
17 

84705 

Omaha Exterior Paint Lead Site 

Sit [3^Good e Sketcii • Poor 

SmnfUWtfAadnm : 29SB FONTENELLE BD [|] Not paint 

Sample Number Lead Sample LAB Samples Collected 

Concentraflor Coilecled Firm: P-£• C. • d - £•< • 

RYASCPXA-84705 Fl JJCoZ ppm D Date: < -g-tf 

RYBSCPXA-84705 F2 3 3 I ppm 

D Time: ^.Q. ^ f\ . i ^ 

RYCSCPXA-84705 B1 I j T ppm D 

Samples Analyzed RYDoCPXA^a4.705 82 ^82 . Dwti D 

ROZSCPXA-M70S OZ I D

XRF Unit: JfiffCi-Z. Book: Z3 S 

-RCZ6CPXA 8470S 62 - ~ ppm D Date ^^-•^7•o' ^ •aP^SCPXA 84706 Pi - ~ ppm D a Time D Staff: <«iiu^ Number of Samples = | S \ \ Q | 

Legend: F1 = Front Left, F2 Front Right, 81 = Back Lefl, B2 = Back Right DZ = Drip Zone, GZ = Garden. PZ = Pla; 

M quadrants ars as viewed ffom ttie street, fadng propotyt 

Sc-A 
Uy ^^In 

84705 

Omaha Lead Site Exterior Paint 

Site Sketch g^Good 

• Poor 

Sampling Address: 2958 FONTENELLE BD [ ] Not paint 

Sample Number Lead Sample Samples Collected 

I 

LAB Concentration Collected Firm p. £• r..d . £.«:• 

RYASCPXA-84705 Fl ppm • Date RYBSCPXA-84705 F2 Jil l ppm D Time q-.Q 3 ft-^ 

RYCSCPXA-84705 81 ^ 1 ppm D Samples Analyzed RYDSCPXA-84705 82 382 , ppm D 

RDZSCPXA-84705 DZ ppm D XRF Unit: /fiff^l . Book: Z-JS 

RGZSCPXA 84706 GZ­ ppm D D Date: <--.27 0<? 

RPZSCPXA 84706 PZ- ppm D D Time:

 Ar y 

Staff: i*isy Number of Samples = | S \ \ Q | 

Legend: F1 = Front Left, F2 = Front Right, Bl = Back Lefl, B2 = Back Right DZ = Drip Zone, GZ = Garten. PZ = Pla; 

AB quadrants are as viewed from the ^^eet, fadng property 

^A^M^ 

KcvTiKi x i"n..il*.'«J •ir.-.S.iv-i 
^ 

,«_„ _ 84705 

Omah Exterior Paint North Amw a Lead Site H^Good Site Sketch • Poor 

Sampling Addreas: 2958 FONTENELLE BD, • Not paint 

Sample Number "-ead

Concenlration Sample Collected

 ^. ^ 

'^ ^ Fim,:

Samples Collected 

P.£. C C £.K. RYASCPXA-84705 Fl .^ 6i 2 pom \ ^ H Date: C-g-fP l 

RYBSCPXA-84705 F2 33 1 pom tTf H Time: <^:0 3 t\.t ^ 

RYCSCPXA-84705 Bl I<^ 1 Pom fTf H 

RYDSCPXA-84705 B2 S6 2 a m M p Samples Analyzed 

RDZSCPXA-84705 DZ 31^ 1 txttn ITT H XRF Unit: JPgbi . Book: 23 S 

Date: <--i7-O l 

Time: A m 

Number of Samples = S O Staff: **J^«/ 

Legend: Fl = Front Left, F2 " Front Right, Bl - Back Left, B2 = Back Right OZ - Drip Zone, GZ " Garden, PZ = Pla; 

^^ AKyadranls amaavtawedjwn the great,teeingpropaity 

' ' ENTERED: 

HAY 1 2 2089 

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COASTA l EHVIttONHIttTA l 

CROUP . IN C 

Consen t for Acces s To Propsrtj ' 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consents to and authorizes the United States 

Environmental Protection Agency (EPA) or its authorized representatives, collectively 

the Grantee, to enter and perfornri certain environmental response activities upon the 

following described premises: ^ ^ 

Owner's Name: ^ Daytime Phone: 

LtM6 M^y^iJb Ao^^yo^'7392. 

Address of Property 

covered by this f f5S fOAe^K^OLE ^i> 

Agreement: 

PURPOSE OF RESPONSE ACTIVITIES 

The EPA is requesting access to collect soil samples and remove soil that contains 

elevated concentrations of lead and may pose a health hazard. The area(s) will be 

excavated to remove contaminated soil. The removed contaminated soil will be 

replaced with clean materials and the area will be restored to its original condition. This 

work is being performed under the Omaha Lead Superfund Site remediation program. 

A representative of Coastal Environmental Group, contracted by USEPA, will contact 

the Grantor in-person to discuss the work to be perfonmed, the Grantor will have an 

opportunity to review and approve the planned soil removal, and restoration work 

before it begins. Once the work Is finished, the Grantor will be asked to review the work 

and confinn that it is complete and meets with the Grantor's approval. Upon 

completion, the Grantor will receive written documentation from EPA that the property 

has been remediated. 

ENVIRONMENTAL RESPONSE ACTIONS 

By signing this Access Agreement, the Grantor is granting the EPA, its employees, 

contractors and subcontractors the right to enter the property, at all reasonable times 

and with prior notice, for the sole purpose of performing the work. This access shall 

remain in effect until the work has been satisfactorily completed. The Grantor also 

agrees to: 

Page 1 of 2 
y*^ \ 

COASTA L INTINOHHIKTAl Ki^cy Cft0 U r IMC 

« Remove obstructions including boats, trailers, vehicles, playscape items, wood 

piles, dog houses, etc; 

c Remove flower bulbs or plants that the Grantor or the Grantor's tenant may wish 

to save; 

c Water and maintain replacement vegetation, including fertilizer application, as 

necessary subsequent to an initial watering period by EPA; 

e Abide by health and safety guidance provided by EPA; 

• If the property is rented, assist EPA in obtaining tenant approval for access to 

the property to perform the work. 

/feT) Allow videotaping and/or photographing of the property. 

AGREEMENT NOT TO INTERFERE 

The Grantor agrees not to interfere or tamper with any of the work activities, or with any 

of the work done, or with the equipment used on his property, or to undertake any 

actions regarding the use of said property which would tend to endanger the health or 

welfare of the Grantees or the environment, or to allow others to use the property in 

such a manner. 

Should you have any questions about this program, please contact Coastal 

Environmental Group, at (402) 991-1199 

^

 I grant access to my properties D i do not grant access to my properties 

signature 

Signature Date 

D I would like to be present during any sampiins that is required. 

Page 2 of 2 
Coastal Environmental Group was awarded a contract from the EPA to remove Lead impacted soil from residential properties within the Omaha Area. 

Per this contract Sunday work activities can only be performed with written consent of the neighboring residents. By signing this form i acknowledge 

that I understand that excavation and backfill work will be performed at the adjoining address listed on Sunday December 6,2009. 

Address 2-^f?- ^ feyOrrg<^l^^^^-£r gg/ p Property Owner Signature 

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3101 K)- H7- .A^je % e.rry Cy/l^yAj. aCi' y 
fyCOASTA L 

Restoration Agreement 

The purpose of this agreement is to provide a mutual agreement as to conditions ofthe property prior to 

remediation activities. This will also serve as documentation for the purpose of assuring that restoration 

activities are completed to the satisfaction ofthe property owner and the United States Environmental 

Protection Agency (EPA). 

Property ID: (ZJ ^ 

Property Address: yp f.^ ^ T^^i^^AA^/?<. / Z fc~ ^A ) 

Owner; L(pLC/S AUf'heAlS/jo 

Phone; /;/ZPZ^J^^H ^ 3 <?-2-

On the attached diagram(s) indicate aiiea(s) tb excavate, surface structures and landscaping features and 

access location(s) to be used by the contractors. Indicate distances, depths, material types, etc. 

Photographically and Videographically document the existing conditions ofthe property and the basement if 

necessary. 

Items to be Removed by the Owner before Start of Remediation: 

The renoval. storage, disposal, and/or return of these Itoms Is the Owner's responsibilrty. 

ttem: 

!\t^^ / o^^^^// lU ^ 

item: -f 

ttem: 

ttem: 

items to be Removed by the Contractor During Remediation and Wot Replaced 

ttem: A ^ 

// PLy ^ U,^r ^U j 

ttem: 

ttem: 

Pagel of. 
' 'C %. 

COASTA L 

Items to Be Removed By Contractor During Remediation and Replaced 

hem: 

5c/i,

ttsm: 

^otP­ ttem: 

ttem: 

i „ TM 

Item 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch 

trunk diameter 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Atiath !i skficli ol \\\i 

sprirklci l;iyoLii 

Number of and size of 

each garden/ flower bed 

area. 

All;tth ;i sketch ol ri.-!;tlivf 

jizcs mid loc;llilMl^ 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

\cl c l!ii' \HIIIC «ill nv 

usro' IU li! U( .1 iiluit! 

>oiie;ii.': Ill (he liriipcrn 

OMnt;i-. 

Easement Area, to be 

excavated 

^ g z , P ^ 

/^ ^ tPr^ y 

Landscape Inventory 

Quantity Unit Condition/Type/Species 

feL,i)^ Quadrants 

2^ Each 

7 Fiinh 

^A ^ Fach 

i Each 

Square Feet 

S 

/ 

ia Each \^o^(^ ^ )(cS^ Ij 

Page 2 of. 
C O A S 1 A L 

O ft o u •• , • ** c 

I Addttionai Comments / Instructions: 

^ V-z Uv ^^' ^ 

ISJ check the box if Owner does not want CEG to document interior foundation walls and possible 

pre-existing damage. By checking this box CEG Is not responsible for any damage done to the 

interior of house, including foundation cracks or fissures. 

][ agree Q I do not agree 

Owner's Signature Date Cbntractor's Signature ' Date 

Page 3 of 
• • 

BVID# /VT^RS " 

XRF PROPERTY SAMPLE SHEET 


Date loJ^i^ Address 

Project Omaha Lead ARRA Sample time 

XRF ID# sample length 

Shot# Reading Sample area Shot# 

^9V /3t ^/4> ^A Z90 

^ ^S (S<l :tl 9 Depth Azn­ ^^( p /3^ ^\ L 1 " hoo 

Average N 2 ^ /?- Average

Shot# Reading Sample area Shot# 

2-^0 h'M- U ^2-

Z.^\ ^ ^ i )n Depth 

?A'2- q ^ i /f 

k^exeiQe hl"^j Z \\ Average 

Shot# Reading Sample area Shot# 

Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# 

Depth 

Average Average 

Signature ^(jMrn/) 

Print ?JunM h CAyQilflOl^ 

<^^S S Fit.Uc^4!£A fe^t^ 

am/pm 

30 sec 

Reading Sample area 

/ / / /5- De 

//f '^fC> Depth 

m ^ iS /3' 

 I3^f "i - Iff, 

Reading Sampie area 

Depth 

Reading Sample area 

Depth 

Reading Sample area 

Depth 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 297 

Mode SOIL 

Time 2009-12-05 08:07 

Duration 91.35 

Sequence Final 

Flags 

AVERAGE Avg of 294-296 

ADDRESS 2958 fontenelle 

QUADRANT em 

DEPHT 1 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm Error 

Pb 142.006 17.130 

Supervised By: ^MttA 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 136.064 

Supervised By: 

Certificate of Verification 

294 

SOIL 

2009-12-05 08:06 

30.52 

Final 

84705 

2958 fontenelle 

em 

1 

R. VENTRY 

clearence 

ngnc 

± Error 

± 16.137 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 153.800 

Supervised By: 

Certificate of Verification 

295 

SOIL 

2009-12-05 08:07 

30.29 

Final 

84705 

2958 fontenelle 

em 

1 

R. VENTRY 

clearence 

ngnc 

± Error 

± 18.952 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 136.153 

Supervised By: 

Certificate of Verification 

296 

SOIL 

2009-12-05 08:07 

30.54 

Final 

84705 

2958 fdntenelle 

em 

1 

R. VENTRY 

clearence 

ngnc 

± Error 

± 16.303 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 293 

Mode SOIL 

Time 2009-12-05 08:04 

Duration 91.56 

Sequence Final 

Flags 

AVERAGE Avg of 290-292 

ADDRESS 2958 fontenelle 

QUADRANT B2 

DEPHT 6" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm Error 

Pi 37.073 10.669 

Supervised By: (J}CCU*iVDj ^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 290 

Mode SOIL 

Time 2009-12-05 08:03 

Duration 30.66 

Sequence Final 

Flags 

BVID 84705 

ADDRESS 2958 fontenelle 

QUADRANT B2 

DEPHT 6" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm ± Error 

Pb 39.089 ± 10.638 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 28.960 

Supervised By: 

Certificate of Verification 

291 

SOIL 

2009-12-05 08:04 

30.37 

Final 

84705 

2958 fontenelle 

B2 

6" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 10.205 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 43.171 

Supervised By: 

Certificate of Verification 

292 

SOIL 

2009-12-05 08:04 

30.53 

Final 

84705 

2958 fontenelle 

B2 

6" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 11.164 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 301 

Mode SOIL 

Time 2009-12-05 08:10 

Duration 91.26 

Sequence Final 

Flags 

AVERAGE Avg of 298-300 

ADDRESS 2958 fontenelle 

QUADRANT DZ 

DEPHT 13" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm ± Error 

Pb 121.255 ± 16.480 

Supervised By •.^^:MM L 
SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 110.683 

Supervised By: 

Certificate of Verification 

298 

SOIL 

2009-12-05 08:08 

30.51 

Final 

84705 

2958 fontenelle 

DZ 

13" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 15.317 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 119.412 

Supervised By: 

Certificate of Verification 

299 

SOIL 

2009-12-05 08:09 

30.56 

Final 

84705 

2958 fontenelle 

DZ 

13" 

R. VENTRY 

clearence 

ngnc 

± Error 

15.742 
y ^ . 

— 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 133.670 

Supervised By: 

Certificate of Verification 

300 

SOIL 

2009-12-05 08:10 

30.19 

Final 

84705 

2958 fontenelle 

DZ 

13" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 18.382 
# # 

iAOL .^mA^o\

ST^^y K ^^ ^^tpfioTt^

Omaliaa i Lea . d Site—Fixe .. d Price EP-R7-07-0 ._. ._5 

Coastal Environmental Group inc.

 www.coastalhazmat.co www.coasiainazmat.comm

EXECUTIVE SUMMARY: 

BVID #84705-(2958 FONTENELLE BLVD) 

No Issues or Concerns Issues/Concerns 

Detail Explanation: 

V 

-"^^-^ 

COASTA L EHVItONHENTAL 

C • 0 U P, IN C 
• • 

^ 

EPA Property Close Out Form 

Property #: _ .'.... , Property Address: /fy^^ ^ JtO>^sS ^ 

Daten-lme: Owner's N.me: fi--^^^^ ^ fyA:^^^^== ^ 

Quads Excavated: g,^, , I ^ ^ f^ M Contractor Group C:^^'of ^ ^ 

Excavatio Yes No n General 

1. If necessary, were the correct quadrant(s) excavated and restored? 

2. If necessary, were the correct areas ofdrip zone excavated and restored? y 

Grading Sod and VcgetalioB Yes No 

I Does the grading around the perimeter ofthe house in excavaied areas generally slope away 

from the house? 

2. Has sod been laid in all areas that were excavated? y 

S. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 y day time period) 

4. A n sodded areas generaUy firm and evenly graded? 

5 Are die joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day 

time period) ] ________.. y r 6. Was the property graded such that water will nol pool on the propertv'"' y 

I 7. Was damage to landscaping or plant materials avoided? y 

Gates. Fencea and Retaining Waitt Yes 

r D 1 o gates open and close freely? (Ifapplicable) 

2. Were all gates or fences taken down during restoration activities reinsulled? (If applicable! y 

3. Was damage to gates or fences avoided? (Ifapplicable) y ' 1 

Was damage to retaining walls avoided? (Ifapplicable) 1 

Foundation, Siding and Gatlers Yes No 

I Was damage to the siding or trim avoided? y 

2. Was damage to the foundation avoided? y 

Was damage to windows avoided'' JA 

4 Was damage to windows or door screens avoided? yi 

5 Was damage to downspouts or downspoul extensions avoided'' y 

Sidewalks and Driveways (Concreie) Vcs No 

1. Was damage to driveway surfaces avoided? y 

2, Wa.< damage to walkway surfaces avoided" y 
J»#_ • • 

OM'ners comments: 

Fn.spection nolcs: 

-*' ' gP(^'5 

,t»»i ^ •jftt^' 

i- cV'SC'' ' 

Removal and resloralion activates complele including the 30-day sod warranty: 

EPA Representittive B^-^^an Date: ,|ii(fo 
• • • • 

Property Completion Agreement 

I his agieemeni documenls. lhe complclion ol remedial aclivmes perloimed on my property My signature 

will designate Ihal 1 am satisfied with lhe restoration ofmy properly, and Ihal no items are in questions, 

now, or al any time in the fxiluie. excepl those items listed below, ifany 

PropertylD: g Lj'^ Q ^ 

Property Addres.- ^^c^-t ^ fnY^ r A)f^\t?. 8\Vr j 

^""^'- i ouiS yAora'AL.o. Phone: ^oD^lfK-'\^c(x 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

1 ^ 1 ajjrcc I c.<itortilion is completed, except as noleri 

[_J I rto not ayiec restoration is compleled 

wncr's Signatiiif Date [ Con^iarlor's Signature Dale 
# • 

Punch List Items 

BVID.: g^^ ^ Name of PO: ^ U i S ynf^r^ZS C C) 

Date: I Si I lb lo ^ Address: fl^ ^ fl9r]^^eM ^ 

dfS9r-i39Al 

Description: 

l». |;i,/o'i ^:0 , ^,'V'^ ^'"•'SA'"^ ^ ^^' ^ ^•"'^ ^ UlniAJA lfk£. ( ^ tl-fa 

I 

u 

\A 

^ 

xAC 

Signed off by: 
@ 

PiFP '^ 9 2209 

= ropeilv Ov-'ner Setisfaciiyri Survey ^"-^ 

O^ahauac^superfunds:. gUPERFUN D DIVISIO N 

Remediation Contractor; Coastal Enviror^mental Group 

PropertY Identifier Mumber: 9^ M "?r> f T 

Property Af<rir.^s.: ^c^^S'^ N FvS>0-k'j>V>/)[3^ BlV ^ 

Property Ov^ner's IMamc: ^r^Vy I S M^ f / ) S r Q 

(above information to be filled out by remediation contractor prior to delivery of form lo Property Owner) 

Instructions to Property Owner: 

This form is provided to you as a means of trying to capture your level of satisfaction with the 

work of the above-identified remediation contractor, as applicable to the soil cleanup action at your 

property. The U.S. Environmental Protection Agency (EPA) is very interested in your opinion regarding 

the work performed by its contractors. This form is intended to provide an easy means for you to 

express your opinion about the wort< performed on your property. 

Please indicate your level of satisfaction with the contractor's work by selecting a numerical 

rating (ranging from 1 to 10) using the following rating scale, then please sign and date the form and 

return it to the USEPA in the attached self-addressed & stamped envelope, (additional comments may 

also be provided in the space below, at the option of the property owner.) 

^•'^' 9-lo}y^ "excellent" 

'^~ -T-'B "verygood" 

5-6 "acceptable" 

3-4 "poor" 

1-2 "very poor" 

Property Owner's Satisfaction Rating Regarding Contractor's Work 

5 

9 4 

8 3 

7 2 

6 1 

Additional Comments from Property Owner (optionai; continue to back of page if needed) 

Prnpprty Ou/ner's SignatureT^W ^ N^-^' ^ V"^>-r^ T Date: J^^jA^ZlQil.