• • 

TRANSMITTAL of OMAH A LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: 41^4' ^ Date: 7_f2J.|o ^ 

Address: z-^i ^ Marti'ia ftve 

Remediation Contractor: Coastal Environmental Group_ Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

y Video of property (DVD) 

\ y Executive Summary 

y EPA-provided property sketch 

y Signed Access Agreement for subject property 

fdjiA Signed Access Agreement(s) for adjacent property 

y Restoration Agreement 

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

•/ Confirmation data 

B^ Photographs ^Ce^^ i.vr/;,)ahw\ ^ dXClJoLnf^ ^ jyTUjiso '^ 

0 As-built sketch 

0^ Satisfactory restoration signed by Property Owner 

H^ Property close-out check list signed by EPA 

^i||/V Description of areas not meeting ROD cleanup criteria 

B^ Utility clearances 

Q / Property information from Douglas County Assessor's Office 

40318165 

D Superfund 
Property Access Checklist 

PropertylD: ^ / ^ ^ (?" 

D WORK STARTED ON: / / 

D WORK COMPELTED ON: Property Address: X77 ^ M<^rf) n A/ P 

Owner: ]5^.^^^|v , /j|e ^ 

Renter 

Address: c i 

Phone: 

Fax: 

Cell/Pager: 

Phone Additional Information: : tjS 5 "^ 7 U?^ 

Fax: 

Ccll/Pager: 

D Notification Letter 

Sent: / / By: 

^ Access Agreement 

Signed:/ 0 l%\l Ot By: M c o tc^s ^ Restoration Agreement Signed: Z£ / 31/JM By: / / 

O Topsoil Sampling (if applicable) 1

 1 By: 

O Disposal Sampling (rf applicable) 1 1 By: 

n Garden Sampling (if applicable) 1

 1 By: 

J3 ' Utility Clearance 

Called: IL/^^/Oi: ^y-wj^^jb^k ^ Video/Photos (Before) On: /^/I/./ OS By= JJicolc^ ^ 

D Video/Photos (During) On: / / By: 

D Video/Photos (After) On: / / By: 

D Video/Photos (30-Day) On: / / By: 

n Property Completion Agreement Sipied: / / By: 

D Final Report 

Issued: / / By: 

Air Monitoring (as ai>plicable) 

Q Community L] Crew | On: / / By: 

Results: 

CD Community C] Crew On: / / Bv: 

Results: 

n Community O Crew On: / / By: 

ResulU: 

Omaha Lead Site 

1 
CONTACT FORM 

Propeny ID # 

Property 

Address: 

Initial Coniacl: 

Second Contact. 

Final Coniact: 

Final Action: 

Comment: 

0\vner 

! Comment (s): 

Site 

Coordinator 

Commenl (sj: 

^l^^9 

-2 71'-l hy m A^t 

Date: Time: Action: 

Date: Time: Action: 

Date: Time: Action; 

Tran.smit to EPA D Other Action: D 
Douglas County Account Infqaaation Page 1 of2 1 

Dauglas County, Nebraska Property Record - R l 117750000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50ft west of 90th St - Vie w o n Map Information is valid as of 2008-9-4 Treasurer's Tax Report 

New Feature ^ ^ ^ Auto Sales Search 

Owner 

ALLEN BEVERLY J 

2774 MARTIN AVE , i /- o r n / ^ 

OMAHA NE 68112-0000 lJO~Mv(g n 

Property Informatio n 

Key Number: 1775 0000 11 

Account Type: Residential 

Parcel Number: 1117750000 

Parcel Address: 2774 MARTIN AV 

OMAHA NE 68112-0000 

Legal Description: FLORENCE FIELD LOT 18 BLOCK 11 IRREG 

Value Informatio n 

Land Improvement Total 

2008 

2007 

2006 

2005 

2004 

2003 

$6,300.00 

$6,300.00 

$6,300.00 

$6,300.00 

$6,300.00 

$6,300.00 

$30,600.00 

$46,100.00 

$46,100.00 

$46,100.00 

$40,300.00 

$40,300.00 

$36,900.00 

$52,400.00 

$52,400.00 

$52,400.00 

$46,600.00 

$46,600.00 

Sales Informatio n 

Sales Date: 1995-03-31 

Deed Type: Book: 2001 Page: 453 

Price: $32,000.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Information 

Acres SF Units Depth Width Vacant 

0.14 6120.0 1.0 136.0 45.0 No 

Improvemen t Informatio n 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl... 10/29/2008 
Douglas County Account Infcauatio caua n Page 2 of2 ' 

building 1 

fT HPPS'. 

FmtFloot 

8U.0«).t. »o 

RANCH BawK Bloct< I fl 

TiV'i'i ^•110 wj n 

i«C44 t Sir 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 818.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Fair 

Built As: Ranch Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 4.0 

Exterior: Frame Siding Units: 1.0 

interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1941 0 0% 1941 68 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 778.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Attached 210.0 

Porch Open Slab 185.0 

Porch Slab w/Steps 15.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp ?accountno=Rl... 10/29/2008 
Page 1 of2 

• 

"> 

Create Another Ticket Back to Irth Internet Send Email 

• YOUR TICKET NUMBER IS 2167699. 

Original Call Date: 11/03/08 Time: 9:32 am Op: ELIZABETH187 90 

Work to Begin Date: 11/05/08 Time: 10:00 am 

State: NE County: DOUGLAS Place: OMAHA 

Address: 2774 Street: MARTIN AVE 

Twp: 16N Rng: 13E Sect-Qtr: 28-SE 

Twp: Rng: Sect-Qtr: 

Legal Given: C 


Type of Work: lead remediation 


Location of Work: LOCATE ENTIRE PROPERTY INCLUDING THE HOUSE ALL THE WAY TO 


: THE STREET. 


Remarks: FAX ALL CLEARS TO: (877)562-4211 


Company : COASTAL ENVIRONMENTAL SERVICE 


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


Work Being Done For: coastal 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MAGELLAN MUDOl OMAHACOF OPPDGPRS QLNNEIC 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 9185747098 

MAGELLAN MAGELLAN MIDSTREAM PARTNERS LP TONYA Alt: 

Emerg: 9185747098 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RON Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11/3/2008 
t Page 2 of2 

Day: 4067289343 

OPPDGPRS OMAHA PUBLIC POWER DISTRICT NA Alt: 8887289343 

Emerg: 4067289343 

Day: 4067289343 

QLNNE 1C QWEST LOCAL NETWORK NA Alt: 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11 /3/2008 
Remote ID: R page o^ ^ 

Magellan 


One-Call 


P.O. Box 3448 


Tulsa, OK 74101 


Phone 918/574-7098 


Fax 918/574-7466 


The following One-Call Agency dig tickets called in by: 


Excavator: COASTAL ENVIRONMENTAL SERVICE 


Fax Number: 8776624211 


Phone Number: 8776624210 


Fax Date: 2008/11/03 


Batchid: 540732 


Will be CLEAR of underground facilities for: MAGELLAN PIPELINE 


State Ticket Number Excavator Contact Dig Address 


NE 2167699 ELIZABETH 2774 MARTIN AVE 


If you have any questions, please contact Magellan OneCall at 918/574-7098 

As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

] Name: JS-'i " l y ^V i i Omaha Lead Site Date: / e vx-*'-* North Arrow IAddress: Z7 7y /-.^-/'•. Stte Sketch Time: 

Phone: VfZ " ^yi - 77^ t 

Team "Tih y //t>w/>^ '(j^ - ^^' ° * V / ^'^ f XRF Code 5'S'0 4 

Sample Number Lead Concentration Confirmation Sample 

-ai-

ppm /f'Yes a No E l T H ^ No CB ' 1 ^ 

ppm // Yes n No H _L^o_ ppm /^Yes CD No l a ±L2fi_ ppm ^?Ye s CD No E 

ppm 

Rp-2-scPy.A- ^ 19M9 

_i££^ ppm No 123 /«Yes CD 

ppm No • Yes n 

I 'OLS#:4i84S 

iDate Excavaited:11/18/2068 

Date USEPA Srgned dff:1/13/2009 

i Area Sodded 3672 sq ft 

>- 1 - ->-­

— f - <-­

: 1 1-­

iMt^A. DZ=71 PPM @ 13" nap • 4 -

Tui iSi'li!'ii!!!^!;:|ia : : EA = 91 PPM@1" 

|£L..i.4J£;L.. 83 ! j m 

sf.i.i^^.tJiiiiiihBmMtiiaaiiiiiiiii.. 

\ i 

/ ^ Irfi ^ It^C. 

Omaha Lead Site 

46130 

Legend 

Concret e Drip Zone Excavated Quadrants Excavated 

Axea replace d wit h Are a replace d wit h L J Sod ' ' Rock/Mulch ^ ^® ^ 1®^^ ^*^® 

Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc . 
—^ <- Address Z 7 Site Sketch Time: 

Phone: ^er - y^i - f7^f T 

Team '7^^i>y yA'^-^y .(^7^ J BVID # V / T'^ f XRF Code 5'^C4 

Sample Number Lead Concentration Confirmation Sample 

\2.^ASC/>XPK -H I ^H ^ 8. /='Yes D No ta R^p,sc^xA ppm - A//ay^ J M 

ppm No ra RS^Sr.J^XA - ^ 16H9 11£ L 

ppm / / Yes n No ca 

\ ^ 0 ppm /2Yes CD No ta 

ppm 'fries D No ts 

ppm FPiYes. n No IS 

ppm Yes • No • 

^ 

4 

^ 

Ti 

Omaha Lead Site 46130 
• • 

( 

Name: J^^yr^^ly ^//f i 

Omaha Lead Site Date: / e -/s-*'.^ North Arrow A- rl Address: Z7 7 y t^Jt^-f'^ Site Sketch Time: 

Phone: V^2 - VTi - f/^Sf 

Team-r^^^v- yyCv^y^ >(J£»^ / BVID# HI?V f XRF Code 5'S'O ^ 

Sample Number Lead Concentration Confirmation Sample 

sa. 

/=/Yes ° No ta 

r^fw ppm 

ppm F^e% tn No S RSCSCJ^XA - mbH 9 11£ L 

ppm / /

 Yes 1=1 No 12 fZ.'iJ>^cP/^A- HieH* ^ l^o_ ppm /2Yes ^ No ta 

rZiyZ.SCPXA- ^ifiV 9 113K ppm r-/?7Yes CD No ta 

- H^(p ppm /%Yes 1=1 No ta 

ppm Yes • No • 

Omaha Lead Site 46130 
Name: ^^/^<v// ^//f n Omaha Lead Site Date: ' c -/j--^ ^ North Arrow —i 

Address: Zll ^ /^^^y-» Site Sketch Time: 

Phone; Vg2 ' *f^}-f7i" y T 

Team-w^y^ /^Vv ^ .(^£<^/ BVID# ^IT^ f XRF Code 5'S'Oi^ 

Sample Numtier Lead Concentration Confirmation Sample 

rz.^iA^cfiy.A -H I ^ H 

ppm /='Yes t=l No 12 J M ppm /^^e s O No t3 RHCScj^y^A - ty j e t/ 9 j_La_ ppm gi Yes n No ca F.-ij>scpy^A' yygy ? Ilo. ppm ^ 2 Yes t=l No la 

lias. ppm ^?Yes 1=1 No IS 

vg<^ ppm /%Yes 1=1 No E 

ppm Yes • No • 

? ^ J!f r 

;,:. .?'. 

- 7 i 

+— .-;:: .^/.. Air... 

i//g I BO 

.Hi. ^:4:. -/ ^ 

t > ' , f..-±. 

/'Z H 

/•»v/4 

^^' C 

/' ^ • X MlLULl 

i - f / 

|i:y^ i^vi^ 

/ ^ / \yh 

gg i /j^tf 

j-lif^ hi.f^.J. 

/ ^ <K// V <«>^d:. 

Omaha Lead Site 46130 
<» — * • 

'\^**** > COASTAL *%/ •—rtP IHVIIIOHHINTHI '•*W" ^ C i O U P . IM C 

Consent For Access To Property 

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 perform certain environmental response activities upon the 

following described premises: 

Owner's Name: Daytime Phone: 

JUA/MJIA^ ^CCli^AA 

Address of Property 

covered by this J.77Y .Mo.Aln Avc. 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 performed, 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 confirm 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 
COASTA L 

(NVIROHHfNTAl ^-t«K>*«' C • 0 U P. I h C 

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

piles, dog houses, etc; 

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

to save; 

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

necessary subsequent to an initial watering period by EPA; 

• 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. 

• 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 (712) 352-0188 

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

ilM±L It^dt-D^ 

Signature Date Signature Date 

O I would like to be present during any sampling that is required. 
COASTA L HOMMINTA l 

Restoration Agreement 

The purpose ofthis agreement is to provide a mutual agreement as to conditions of tiie property prior to 

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

activities are completed to the satisfaction of the property owner and the United Stales Environmental 

Protection Agency (EPA). 

Property ID: "WW 

Property Address: ^ 7 / ^ yijo^^ i 'l y\ A ^ ^ 

Owner: '^ixjMe :C-\CK .S O CVW g-^/"~ -

Phone: ^^O , - q^^ l ^ 

On the attached diagram(s) indicate area(s) to excavated and depth of excavation, location of all known 

utilities, subsurface features, surface structures and landscaping features, access location(s) to be used by 

contractor, and the direction of North. Indicate distances, depths, material types, etc. Indicate digital photos 

by referencing the photo-log number with an arrow indicating direction of view. 

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

The removal, storage, disposal, and/or return of these items is the Owner's responsibility. 

Item: 

/l/ ^ yi<t. 

Item: 

Item: 

Item: 

Kem: 

item: 

item: 

Item: 

Page 1 of A. 
COASTA L 

C N O U P . IN C 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

n y .^A ^ /^ / ^fi be.^ ' nd y^ 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Kem: 

Item: 

Item: 

Kem: 

Kem: 

Item: 

Item: 

Kem: 

Page 2 of / ^ 
C Q A S T A L 

C M O U r IN C 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

Sy> \ 1 PZ'O ^ -) 

Item: 

Item:

S O C) fZj-OZ-­ / 

/ 

1 Item: / 

Item: / 

Kem: / 

Item: / 

/ 

Item: / 

Item: / 

Item: / 

Kem: 

/ 

Item: / 

Item: 1 

Item: / 

Item: 

/ 

Page 3 of ^ 
COASTA L Ct>t'VlRONr«tMTA L 

o n o u r IN C 

Landscape Inventory 

(Use additional sheets as necessary) 

Item 

Pre-exisling 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. 

Attach a sketch of the 

sprinkler layout. 

Number of and size of 

each garden/ flower bed 

area. 

Attach a sketch of relative 

sizes and locations. 

Quantity 

9^ 

y 

0^ 

tf 

iT 

Unit Condition/Type/Species 

Square feet VV ' '^^ ^ 

Each 

•• 

Each 

. 

Each 

Each 

Square Feet 

Page 4of_ ^ 
COASTA L 

• MVtMONMftMIA t 

Item 

Agreed upon value of 

plant materials not to be 

renlaced bv contractor. 

Note this value will be 

used to issue a plant 

voucher to the property 

owner. 

Agreed upon list of plant 

materials that will be 

replaced by conrractor. Be 

very specific and detailed. 

Include a sketch of were 

each plant will be placed 

by the contractor. 

Agreed upon area of 

property to be replaced 

with grass sod. 

Include a sketch of the 

area{s) to be replaced with 

grass sod. 

Area of City or County 

property to be landscaped 

per their requirements. 

Include a sketch of the 

aiea (s) 

Easement Area, to be 

excavated 

Quantity Uriit Condition/Type/Species 

Each 

6^ ' $S 

SF 

SF 

7 

.'l 

A^ V SF 

K " ^^• ^ 

Page 5 of ^ 
C O A £ T A L KMVAkOHHaMTAL 

G Check the box if Owner does not want CEG to document irrterior foundation walls and possible 

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

interior of house, including foundation cracks or fissures. 

[iHaagre j e d I do not agree 

Owner's Signature Dxt»e Contractor' iton^ctor'ss Signater Signatore t ^ "^Date 

Page 6 of. 
BVID*/ iM 

XRF PROPERTY SAMPLE SHEET 


Date \\l\)i\9)i Address ^^ML t^M-rw^ m 

Project Omaha lead FP 2nfl year opllon Sample time W^-' far^/pm 

XRFID# ^^oY^ sample length 30 sec V-.''-'^— 

Shot n J Reading Sample area Shot# Readini Sarriple area 

-^b^AM f\.ni 11-11 WW 'j^1.^<:t?i-<-i 

'dUfV^CHf 1CH< ^^-^?M+ 17.. M I'•f-^it H-^\ t yio2_ M,Ci (, ^(7.11 1 r-c-\ Depth p-oi^j: tj-^ i Depth no( -^^^1 4Z-j ^ 5 l^-l ^ r ^102. Ityi-i'^-t ^o.n 

Average ^l-Hn -t \^.oi^ 

Average ^^ 9 . f 1 ^ U.> i 

Shot* Reading Sample area Shot# Reading Sample area 

1^1 Oj ';H-l2.i 'g-^j 

S^0> ^i-T-q i x.t^ \ } ^ 

g^'^t^ i^-tt t \^m Depth Depth 

yy<n HS-^^i IV-H El 

Average To-^ l ^ lo.lf. Average 

Shot* Reading Sample area Shot* Reading Sample area 

Depth Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot* Reading Sample area 

Depth L, Depth 

^'"'^^ / 

Average Average / X 

/ 

lab sample # Lab result Sample area XRF Avg. 

Signature yyy P,in, lA^ ^ iVlfruVS 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 3698 

Mode SOIL 

Time 2008-11-18 11:47 

Duration 122.03 

Sequence Final 

Flags 

AVERAGE fAvg of 3694-3697 

ADDRESS 2774 martin ave 

QUAD/ZONE easement 

INSPECTOR LOPEZ 

DEPTH 1 

SAMPLE TYPE : CLEARANCE 

NOTE 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 3694 

Mode SOIL 

Time 2008-11-18 11:45 

Duration 30.46 

Sequence Final 

Flags 

BVID # 41849 

ADDRESS 2774 martin ave 

QUAD/ZONE easement 

INSPECTOR LOPEZ 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 89.827 ± 11.778 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 93.347 

Supervised By: 

Certificate of Verification 

3695 

SOIL 

2008-11-18 11:46 

30.47 

Final 

41849 

2774 martin ave 

easement 

LOPEZ 

1 

CLEARANCE 

± Error 

± 12.116 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 90.722 

Supervised By: 

Certificate of Verification 

3696 

SOIL 

2008-11- 18 11:47 

30.54 

Final 

41849 

2774 martin ave 

easement 

LOPEZ 

1 

CLEARANCE 

± Error 

± 12.082 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 3697 

Mode SOIL 

Time 2008-11-18 11:47 

Duration 30.56 

Sequence Final 

Flags 

BVID # 41849 

ADDRESS 2774 martin ave 

QUAD/ZONE easement 

INSPECTOR LOPEZ 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 92.003 ± 12.131 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 3703 

Mode SOIL 

Time 2008-11-18 11:55 

Duration 122.52 

Sequence Final 

Flags 

AVERAGE Avg of 3699-3702 

ADDRESS 2774 martin ave 

QUAD/ZONE tPZ 

INSPECTOR LOPEZ 

DEPTH 6 

SAMPLE TYPE * CLEARANCE" 

NOTE 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 457.455 

Supervised By: 

Certificate of Verification 

3699 

SOIL 

2008-11-18 11:53 

30.26 

Final 

41849 

2774 martin ave 

PZ 

LOPEZ 

6 

CLEARANCE 

± Error 

± 27.578 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 244.576 

Supervised By: 

Certificate of Verification 

3700 

SOIL 

2008-11-18 11:54 

30.59 

Final 

41849 

2774 martin ave 

PZ 

LOPEZ 

6 

CLEARANCE 

± Error 

± 19.987 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 260.038 

Supervised By: 

Certificate of Verification 

3701 

SOIL 

2008-11-18 11:55 

30.85 

Final 

41849 

2774 martin ave 

PZ 

LOPEZ 

6 

CLEARANCE 

± Error 

± 21.516 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 237.238 

Supervised By: 

Certificate of Verification 

3702 

SOIL 

2008-11-18 11:55 

30.82 

Final 

41849 

2774 martin ave 

PZ 

LOPEZ 

6 

CLEARANCE 

± Error 

± 20.177 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 3708 

Mode SOIL 

Time 2008-11-18 11:59 

Duration 122.30 

Sequence Final 

Flags 

AVERAGE Avg of 3704-3707 

ADDRESS 2774 martin ave 

QUAD/ZONE 

INSPECTOR LOPEZ 

DEPTH 13 

SAMPLE TYPE CLEARANCE 

NOTE 

Supervised By 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 59.722 

Supervised By: 

Certificate of Verification 

3704 

SOIL 

2008-11-18 11:57 

30.53 

Final 

41849 

2774 martin ave 

DZ 

LOPEZ 

13 

CLEARANCE 

± Error 

± 10.319 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 32.296 

Supervised By: 

Certificate of Verification 

3705 

SOIL 

2008-11-18 11:57 

30.81 

Final 

41849 

2774 martin ave 

DZ 

LOPEZ 

13 

CLEARANCE 

± Error 

± 8.292 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 72.821 

Supervised By: 

Certificate of Verification 

3706 

SOIL 

2008-11-18 11:58 

30.45 

Final 

41849 

2774 martin ave 

DZ 

LOPEZ 

13 

CLEARANCE 

± Error 

± 10.991 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 118.830 

Supervised By: 

Certificate of Verification 

3707 

SOIL 

2008-11-18 11:59 

30.51 

Final 

41849 

2774 martin ave 

DZ 

LOPEZ 

13 

CLEARANCE 

± Error 

± 13.452 
Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

V >^ www.coastalhazmat.com www.coasTainazmat.com 

^"tPHO^ COASTA ENVItONMENTAL L 

CROUP , IN C 

EXECUTIVE SUMMARY: 

BVID # 41849 - (2774 MARTIN AVE) 

I I No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 

EXHAUST FUMES DAMAGED/COATED FOUNDATION WALL OF 2778 MARTIN AVE 

HOMEOWNER RECEIVED COMPENSATION FOR THE COST TO REPLACE OR 

REPAIR AN ALUME^UM SIDING CORNER PIECE DAMAGED DURING THE 

REMOVAL OF LEAD IMPACTED SOIL. 
^^EPA 

EPA Property Close Out Form 

Property #: ^]]m Property Address: ^7 2 ^^ UPr^fl ^ 

Datc/Ttroc: Owner's Name: ^&V^t ^ lUl/ ^ 

Quads Excavaied: IS I ^ 15 "Z- ~ Contractor Group 

Excavation General 

Yes 

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

y 

2. If necessary, were the correct areas of drip zone excavated and restored? 

y 

Grading Sod and Vecetation 

Yes 

1. Does the grading around the perimeier of the house in excavated areas generally slope away y from ibe house? 

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

i ^ 

3. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 

day lime period) 

4 Are sodded areas generally fum and evenly graded? y 

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

time period) 

6 Was the property graded such that water will not pool on the property'' 

y 

7 Was damage to landscaping or plant materials avoided? y 

Gates, Fences and ReUinlng Walls Yes 

I Do gates open and close freely? (Ifapplicable) y 

2. Were all gates or fences taken down during restoration activities reinstalled? (Ifapplicable) . y 

3 Was damage to gates or fences avoided? (Ifapplicable) ^ 

4. Was damage to retaining walls avoided? (Ifapplicable) iJk 

FouDdatioD, Sidiof; and Gutters 

Yes 

I. Was damage to the siding or trim avoided? (^^^^^ ^ J^^"-^^^ - ^^''^ ^ '^ L ^ h 

2. Was damage to the foundation avoided? i / 

3. Was damage 10 windows avoided? y 

4. Was damage to windows or door screens avoided? .y 

5. Was damage to downspouts or downspoul extensions avoided? J 

Sidewalks and Driveways (Concrete) 

Yes 

I. Was damage to driveway surfaces avoided? y 

2. Was damage to walkway surfaces avoided? \y 

No 

No 

No 

No 

No 

d-ue^ u)^l( of ^1 1 & M^r4-ivv 
O sners comments: 

Inspection notes: 

E P A v/Lsp^^4 j pniy y -\ o r ^ ^i^-o ^ 

Removal and restoration activates complete including the 30-day sod warrant)' 

EPA Representative %^^^t^\^yU^-^^JL^ Date: /^/?/Dt 
Property Completion Agreement 

riiis agreemeni documenis Ihe coinplclion oi remedial aciiviiies perfonned nn my pioperiy My s^ignalure 

wili designale llial I am saiisfied wilh Ihe restciraiion of my properly, and ihai no ilems are in queslions. 

now, or al any hme in ihe fulure, excepl llioseiiems listed below, if any 

P.opc.ry ID Lj j ^^ ^ 

Property Addrcv. ^77 ^ / H c. ^" f 1/1 A KJ<^ 

Owner f?ever\ y /tlU n 

Phone t./^ 3 ^'/^ f 

Rpstoralion Items in Question 

Item 

Item 

Item 

Item, 

Item: 

Item: 

Additional Comments; 

5io<"^^ o n Conne r O- ^ houJ^ _ oic^>-^ci^ ^jjl% 

Co-<tl>rU IV^<^^ llU^utty^ A^ ^ (y'-U^Z.^^ 

1^1 I a(;rcc 1 coloration is compleied, rxctp l as noleri 

[ ) I flo nol a^icc rcslpradnn is compleied 

I-L'n o 

Ccmlr »( lor' s SiQnaliirc V>Mc 
Property Damage Settlement 

Property ID 41849 

Property Address 2774 Martin Avenue 

Owner Beverly Allen 

Phone 402-453-9769 

I have received from the contractor, Coastal Environmental Group hic. (Coastal), a sum of $ 500.00 as 

compensation for the cost to replace or repair an aluminum siding comer piece. The aluminum siding 

comer piece was damaged while removing lead-impacted soil from the property. 

Check Number 1692 

Value of Check $500.00 

Made Out To Beverly Allen 

Description of Miscellaneous Replacement 

Coastal damaged an aluminum siding corner piece at the south-east corner of the property at 2774 Martin 

Ave. while removing contaminated soil from the property described above. Coastal has agreed to pay the 

homeowner $500.00 as a buyout for the homeowner to replace or repair the aluminum siding corner piece at 

her leisure. 

My signature below is acknowledgement of the receipt of the sum listed above, which I further 

acknowledge to be fair compensation for the repair or replacement described above and release 

Coastal Environmental Group, Inc. from further obligations or liability related to this property. 

<^y/f,,. yy^f im 

-^- ^ilJ­ Owner's Signature Date Contractor's Signature Date 

Page 1 of 1