TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID# Date -.dL 0 

Address: 

Remediation Contractor: Coastal Environmental Group_ Year; 20i 0 ^ 

SOIL REMEDIATION 

PROPERTY HLE FOLDER DOCUMENTS 

-asi 

Video of property (DVD) 

Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

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

Confirmation data 

Photographs fo^^lTM^ I fft ^TfU^l^^o^ 

As-built sketch 

4 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility ckarances 

Propmyinformation from Douglas County Assessor's Office 

" y — 

i7 

Signature Date" 

30217759 

Superifund 
vv 

Property Access Checklist 

Property ID: "^ U "jQd l 

Property Address: )^^2 , A/Y^^ S

^"°"' MA>-^liocolri 

Address: 

550 3 M3 5T 

Phone: 55 a33£52za 

Fax: 

Cell/Pager: 

n Notification Letter 

[^ Access Agreement 

^ Restoration Agreement 

D Topsoil Sampling (if applicable) 

G Disposal Sampling (if applicable) 

Q Garden Sampling (if applicable) 

J^ Utility Clearance 

t ^ Video/Photos (Before) 

D Video/Photos (During) 

D Video/Photos (After) 

D Video/Photos (30-Day) 

"flj Property Completion Agreement 

n Final Report 

Air Monitoring (as applicable) 

r~1 Conununity dl Crew On:

Results: 

n Community CH Crew On:

Results: 

CH Community CD Crew On: 

Results: 

 Av/r^, 

n

n

 WORK STARTED

 WORK COMPELTED

 ON: / / 

 ON: __/__/_ 

Renter: 

Phone: 

Fax: 

Cell/Pager: 

Additional Information: 

Sent: / / 

Signed:/1 / 5 O ^ 

Signed:)) / 5 /C!P^ 

/ / 

. / / 

/ / 

CaUed:M /1 / /(IO 

On:LL/51/i2f! 

On: / / 

On: / / 

On: / / 

Signed: 4L/^7 ^ 

Issued: / / 

/ / By 

/ / By 

/ / By: 

Omaha Lead Site 

By: 

By: 

By: 

By: 

By: 

By: 

By: ) 

By: / 

By: 

By: 

By: 

By: 

By: 

in/mq 

jy:^o^i<\/Ar\d\/ 
Douglas County Account InJ^a|atio iJ^H^ti n Page 1 of2 

Douglas County, Nebraska Property Record - R1839640000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - Vle W O n Ma p Information Is valid as of 2009-10-15 Treasurer's Tax Report 

New Feature - • •• ^ Auto Sales Search 

Owner 

LINCOLN THEDA J 

ETAL 

5503 N 3 ST 

OMAHA NE 68110-0000 

Property Informatio n 

Key Number: 3964 0000 18 

Account Type: Residential 

Parcel Number: 1839640000 

Parcel Address: 1463 AMES AV 

OMAHA NE 68110-0000 

Legal Description: NIELS ADD LOT 20 BLOCK 0 TRIANG- 61 X 125 

Value Informatio n 

Land Improvement Total 

2009 $2,600.00 $27,000.00 $29,600.00 

2008 $2,600.00 $27,000.00 $29,600.00 

2007 $2,600.00 $27,000.00 $29,600.00 

2006 $2,600.00 $27,000.00 $29,600.00 

2005 $2,600.00 $11,500.00 $14,100.00 

2004 $2,600.00 $10,400.00 $13,000.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.14 6500.0 1.0 125.0 52.0 No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=Rl... 10/22/2009 

\A 
Douglas County Account InSua^tio I^UMKlt n Page 2 of 2 

1463 AMES AV 

..:!? •«. . Cet«:H? D C*mVl t T M -so TT 

• qkva ^ ' tnO SMtt W M >_,_ 

Fint Floor 

Ma 0 sq. ft 

1 1/2 Story Unfin Ba^ T IBsrrrt Ned^ 911 MS 0 sq. ft 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 648.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Fair 

Built As: 1 1/2 Story Unfin 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: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1906 0% 1906 103 

Detail Type Detail Description Units 

Add On Fence Chain Linl< 1.0 

Add On Unfinished Attic W/floor 648.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 648.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 324.0 

Porch End Solid Wall 144.0 

Porch End Solid Wall 144.0 

Storage Wood 121.0 

User DOGS 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl... 10/22/2009 
"> 

Page 1 of2 

Create Another Ticket Back to irth Internet Send Email ] ] 

• YOUR TICKET NUMBER IS 2401799. 

Original Call Date: 11/06/09

Work to Begin Date: 11/10/09

 Time: 10:36 am 

 Time: 11:15 am 

Op: ELIZABETH18790 

State: NE 

Address: 1463 

County: DOUGLAS 

Street: AMES AVE 

Place: OMAHA 

Twp: 15N Rng: 13E

Twp: Rng:

Legal Given: C 

 Sect-Qtr: 03-NE-SE 

 Sect-Qtr: 

Type of Work: LEAD REMEDIATION 

Location of Work: INCLUDE ALL EASEMENTS LOCATE ENTIRE PROPERTY 

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

: UNSURE 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 

Involves Tunneling or Horizontal Boring : N 

Front: Y Rear: 

Explosives: N 

CXCATV MAGELLAN MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 

Service Area Contact Phone Number 

UtiUty 

Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

X* A r-cT T A XT MAGELLAN MIDSTREAM PARTNERS MAGELLAN . _ T^T,T,^„ A „ DEBORAH 

Day: 9185747098 

Alt: 

Emerg: 9185747098 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC.SEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11 /6/2009 
Page 2 of2 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

OLNNE1C QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11/6/2009 
OLS#: 34282 

Date Excavated:11/13/09 

Date USEPA Signed Off: 12/3/09 

< ^ As-Built Drawing 

C OAST A L ENVIItONHENTAL Omaha Lead Superfund Site Area Sodden: 3600 sa ft C K O U P . INC . 

34282 

Omah Exterior Paint a Lead Site 

Sit • Good e Sketch 

0 Poor 

Sampling Address: 1463 AMES AV • Nol paint 

Sample Number 

RYASCPXA-34282

RYBSCPXA-34282

RYCSCPXA-34282

RYDSCPXA-34282

 Fl 

 F2 

 BI 

 B2 

Lead 

Concentration 

loO\ 

-dlSL 

ppm 

ppm 

ppm 

ppm 

Sample 

Collected i 

LAB 

D 

D 

D 

D 

Fimn:

Date:

Time;

Samples Collected 

 F04 D&A T 

 ll-7-gf l 

 /1-2 P AeA 

Samples Analyzed 

RDZSCPXA-34282 DZ ppm D XRF Unit: US^ D Book: 22 H 

RGZSCPXA 34282

RP26CPXA-34a82

 62­

 PZppm 

ppm 

D 

D 

Date:

Time: 

 /l-Of i

.£C2_ 

 Of i 

Number of Samples = | ^ | | ( ^ \ Staff: mSL J 

Legend: Fl = Front Left, F2 = Front Right, BI = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pla; All quadratMs are as viewed from the street, facing properly 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced with 

Sod Rock/Mulch Area left bare 

Contract #: EP-R7-07-05 Coasta l Environmental Group Inc . 
14282 

Omah Exterior Paint a Lead Site 

Sit • Cood e SItetch 

0 Poor 

Sampling Address: 1^63 AMES AV Q Nol paint 

Lead Sample Samples Collected 

Concentration Collected 

Sample Number LAB 

Firm FW D&AJ-

RYASCPXA-34282 Fl 115 ppm D Date 11-7- Of) 

RYBSCPXA-34282 F2 ppm D Time H-2r. Af^ 

RYCSCPXA-34262 BI ppm 

n Samples Analyzed RYDSCPXA-34282 82 ppm n 

RDZSCPXA-34282 DZ ppm n XRF Unit: loSH O Book: 1V\ 

nOZCCPXA 34282 SS- ppm n Dale: IZ'O B • OQ 

r^PZSCPXA-34282 P2- ppm D Time flrv,

Staff prtS U NumbeM>f Samples = a E 

Legend: F1 = Front Lefl,F2 • Frpot^Right, 81 = Back Left, B^= Back Right DZ = Drip Zone, GZ = Garden, PZ = Pla; 

All quadrants are as viewed from tfle street, facing property 
U II / / ^ 

34282 

Omaha Lead Site Exterior Paint 

Site SItetch • Good 

0 Poor 

Sampling Address: 1463 AMES AV [ ] Not paint 

Sample Number Lead Sample 

Samples Collected 

i 

LAB Concentration Collected Firm: FW DRA J 

RYASCPXA-34282 Fl 11 5 ppm D Date 11-7-Pi^ RYBSCPXA-34282 F2 W5 ^ Dom D Time (l-2g i4/^_ RYCSCPXA-34282 81 IQO I ppm D 

M 

RYDSCPXA-3428 Samples Analyzed 2 82 2p 9 ppm D 

RDZSCPXA-34282 DZ 

ppm n XRF Unit: ^5^ 0 Book: 2Z H 

nOZSCPXA 34282 62­ , ppm D 

Date: IT'O B • OQ 

RPZ6CPXA. 34282 PS­ , ppm n 

Time: P\m 

Staff: rnSU ) Number of Samples = | g> | | Q | 

Legend: F1 = Front Left F2 • Front Right, BI = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ =Pla- All quadrants ara as viewed frcm ttie street, facing property 

msrm^i­ pe-iied 15-Scis'iH 
34282 

Omaha Lead Site Exterior Paint North Ainiw

Site m3oo d Sketch 

0 Poor 

Samoiina Address: 1463 AMES AV Q Not paint f 

Sample Nunit>er Lead Sample LAB Samples Collected 

Concentration Collected 

Fimi: Fb4 gfi-AT 

RYASCPXA-34282 Fl 

XH. .ppm D Date: f 1-7-Of t 

RYBSCPXA-34282 F2 

tl 

ppm D Time: H-2 P AtA 

RYCSCPXA-34282 B1 (QQ\ .ppm D 

Samples Analyzed

RYDSCPXA-34282 B2 2^3. ppm D 

RDZSCPXA-34282 OZ ppm D XRF Unit: l^SHO Booli: 22M 

ROZSGPXA 94282 GZ- ppm D Date: iZ-O&O e 

nPZSCPXA 34282 -PZ- .ppm D Time: Mca. Staff: Number of Samples' E JDiLL 

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

All quaikamt are •« vimed fian tha itrael, (aobio property 

: 2$,S<p-08 
.^toflu. 

COASTA L I NIrlltONHfRIAI 

6 R O U r . > N c 

Consent foF Access To Propeftj/ 

RIGHT OF ENTRY TO PREMISES 

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

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

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

following described premises: oi n /X o 

Owner's Name: Daytime Phone: ^NS^ W b^^OiW "db'h- S2Z8 

Address of Property /4£3 ^iAiLS fXlQ^, covered tiy this 

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 perfonned, 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 
\^-^'.f0r-'' COASTA L tKVIMOHKINTA L 

C H O U r I W C 

t 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; 

« 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. 

c^ 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 

yi grant access to my properties G ' do not grant access to my properties 

ihos^ l 

Signature Date Signature Date 

Q I would like to be present during any sampling that is required. 

Page 2 of 2 
c .> * S T > L 

C h O ^ 

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

remediation activities. This 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 States Environmental 

Protection Agency (EPA). 

Property Address: />^^ 3 /^^i ^ /tc ^ 

\^[IMH^-MmM 

[Phone: ^3^ - 53 ^ 

On the attached diagram(s) indicate area(s) to 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 of the property and the basement if 

necessary. 

itsms to be R.emoved by th e Owner before Statl of Remediation: 

"li-ic .c-riovcsi. storsqe, PlSOOsEi, £nG/Ot i-etcin 0.' fhes-e Items IF the Ownei s rEspcnEitdliiy. 

item: 

^d d'Ud 

/ ' ^ Item: ^ • > 

Item: 

Item: 

Items to be Removed by the Contractor During Remediation and Not Rejplaced 

/U/T LeX^A 

Item: 

Item 

^ Page 1 of 
C J .A S T A L 

Landscape Inventory 

Item Quantity Unit Condttion/Type/Species 

Pre-existing property area, Quadrants that will be excavated, that I>1 -Kfv lS(/vr Uh^i. is covered with grass. 

Number of trees > 2 inch Each I \\tdk^ ^\ J ^'-f trunk diameter 

Number of trees <= 2 inch Each le trunk diameter 

Number of Sprinkler 

Zones, Control Valves, Each Timers, Heads, etc. ^ Atiach r. skeicli ol the 

Number of and size of 

each garden/ flower bed Each 

area. J> Square Feet 

Aiincli J skcicl) ol reiniivL' 

si7.cs and lor;iiii>n>. 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. ^ $ .••'CtO Tii' . 1 ;il l ' '-' ii i h' . 

js-t ' :c i<s'jr ;•: y.-^.n< 

\ oir.lrf ( 1(1 I'lv r.iT.p'.'i :\ 

o i\ ntr . 

Easement Area, tc be 

excavated Each ^ <^ Ufnfi^iu^^ 

^ 

Page 2 of. 
I - f\S T r L 

r Additional Comments / instructions: 

^Check the box if Owner does not w/ant CEG to document interior foundation walls and possible 

/preexisting damage. By checking this box CEG is not responsible for any damage done to the 

interior of house, including foundation cracks or fissures. 

Q I do not agree 

Owner'i Signature Contractor's Signature Date 

Page 3 of. 
BviD#_3M2SS 

XRF PROPERTY SAMPLE SHEET 


Date 

Project 

//-i3-o<^ 

Omaha Lead ARRA 

Address 

Sample time 

XRF ID# 7>^OZ'2. sample length 

Shot# Reading Sample area Shot# 

.^o5 m t (2_ ^JT A e/3 

t^O(j 75t| Z Depth ^/ ^ 

f?o7 77 ^- '2. i"^ •?/^ 

Average

r? /

/ c?

 i i n 

' ^ Average

Shot# 

'V^T 

H^S 

Reading 

ilD*- IS 

i¥6^/ 6 

Sa inple area 

p-^ 

Depth 

Shot# 

H^^i /^^t/ s (f l 

Average /^H 'i S Average 

Shot# Reading Sample area Shot# 

Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# 

Depth 

Average 

NCd^ Afrui<: Au^, 

am/pm 

30 sec 

Reading Sample area 

^^*/V 1?,i 

f^l ^ H Depth 

5S^/? C" 

 3^ ^ ^ ^M 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Reading Sample area 

Depth 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 216 

Mode SOIL 

Time 2010-02-09 13:27 

Duration 90.40 

Sequence Final 

Flags 

AVERAGE <j ^ of 213-215 ^ 

ADDRESS 1463 Ames Ave. 

QUADRANT BI 

DEPHT 6 

XRF TECH E. CACERES 

MISC 1 

NOTE 1 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 48.929 

Supervised By: 

Certificate of Verification 

213 

SOIL 

2010-02-09 13:25 

30.21 

Final 

34282 

1463 Ames Ave. 

BI 

6 

E. CACERES 

1 

1 

± Error 

± 13.995 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 214 

Mode SOIL 

Time 2010-02-09 13:27 

Duration 30.05 

Sequence Final 

Flags 

BVID 34282 

ADDRESS 1463 Ames Ave. 

QUADRANT BI 

DEPHT 6 

XRF TECH E. CACERES 

MISC 1 

NOTE 1 

ppm ± Error 

Pb 50.846 ± 14.327 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 54.996 

Supervised By: 

Certificate of Verification 

215 

SOIL 

2010-02-09 13:27 

30.14 

Final 

34282 

1463 Ames Ave. 

BI 

6 

E. CACERES 

1 

1 

± Error 

± 14.799 
• • 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 508 

Mode SOIL 

Time 2009-11-13 12:10 

Duration 91.54 

Sequence Final 

Flags 

AVERAGE cSvg=35o5lioi--^ 

ADDRESS 1463 ames ave 

QUADRANT em 

DEPHT 1" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm ± Error 

Pb ± ( 12.812 I 

Supervised By.^cMmx 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 505 

Mode SOIL 

Time 2009-11-13 12:09 

Duration 30.50 

Sequence Final 

Flags 

BVID 34282 

ADDRESS 1463 ames ave 

QUADRANT em 

DEPHT 1" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm ± Error 

Pb 77.185 ± 12.916 

Supervised By: 
• • • • 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 75.423 

Supervised By: 

Certificate of Verification 

506 

SOIL 

2009-11-13 12:10 

30.58 

Final 

34282 

1463 ames ave 

em 

1" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 12.634 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 507 

Mode SOIL 

Time 2009-11-13 12:10 

Duration 30.46 

Sequence Final 

Flags 

BVID 34282 

ADDRESS 1463 ames ave 

QUADRANT em 

DEPHT I " 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm ± Error 

Pb 77.381 ± 12.885 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 500 

Mode SOIL 

Time 2009-11­ 13 12:06 

Duration 91.68 

Sequence Final 

Flags 

AVERAGE [;gyg of 497-499 

ADDRESS 1463 ames ave 

QUADRANT F2 

DEPHT 6" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm ± Error 

Pb [134.922 ~^ ± 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 120.824 

Supervised By: 

Certificate of Verification 

497 

SOIL 

2009-11-13 12:05 

30.55 

Final 

34282 

1463 ames ave 

F2 

6" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 15.151 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 146.153 

Supervised By: 

Certificate of Verification 

498 

SOIL 

2009-11-13 12:05 

30.59 

Final 

34282 

1463 ames ave 

F2 

6" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 16.102 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 137.790 

Supervised By: 

Certificate of Verification 

499 

SOIL 

2009-11-13 12:06 

30.54 

Final 

34282 

1463 ames ave 

F2 

6" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 15.808 
/ ^^A^ \ Omaha I Lea . d Site—Fixe _. d Price EP-R7-07-0 ... _. __5 

Sd^^Z^

Coastal Environmental Group Inc.

 www.coastalhazmatcom 

v\ 

^ ^ 

Pno^<^ COASTAL ENVIIOIIHEIITAl 

6 1 0 U P. IN C 

EXECUTIVE SUMMARY: 

BVID #34282-(1463 AMES AVE) 

No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 
4 ^ EPA 

EPA Property Close Out Form 

Properly #: 3^3iP$ r 

Property Address:­ m

DatcH'inic Owncr's Name:, ^ : 

Contractor Quads Excavated; 1^'2' ^ ^ T 

Excavatio Yes No n General 

1, If necessery, were the con^ct quadiant(s) excavated and restored? 1 / 

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

/ 

Grading Sod and Vegetation 

Yes No 

I. Does the grading around the perimeter of the house in excavated areas generally slope away d from tbe house? 

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

/ 

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

/ day time period)

 — 

4. Are sodded areas generally Firm and evenly graded? / 

S. Are the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day d time period) 

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

d 

7. Was damage to landscaping or plant malerials avoided? / 

Gates, Fences and Retaining Walls Ves No 

I. Do gates open and close freely? (If applicable) d 

2. Were all gates or fences taken down during restoration activities reinstalled? (If applicable) J 

3. Was damage to gates or fences avoided? (1 f applicable) d 

4. Was damage to retaining walls avoided? (If applicable) d 

Foundation, Siding and Gutters 

Yes No 

I. Was damage to the siding or trim avoided? d 

2. Was damage to the foundation avoided? d 

3. Was damage to windows avoided? 

/ 

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

5. Was damage to downspouts or downspout extensions avoided? 

J 

Sidewalks and Driveways (Concrete) 

Yes No 

I. Was damage to driveway surfaces avoided? / 

2. Was damage to walkway surfaces avoided? 
Owners comments: 

Inspection notes: 

Removal and restoration activates complete including the 30-day sod warranty: 

EPA Representative ^'^A ^ Date: iz/y/oy 
Property Completion Agreement 

f his agreemein dociimen($ (he complcdon of remedial acliviiies performed on my properly My signature 

will designate Ihal I am satisfied with the rcsloralion of my propeily, and thai no ileins are in quesiions 

now. or al any lime in the future, except those items listed below, if any 

Property fP. fd-A?Q)2 . 

Property Address: j(_)(pg ^ AyV^^. S ^K> . 

Otvncr: idOr 4AfX_UiXi3Ji X a 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

. . . J 

Item: 

Item: 

Item: 

Item; 

Additional Comments: 

Vff' i «(>rcc ic.^torjilion i< complcltd, cxccpl as nnied 

[ I I rto nol acrtc rcsiorfltion h compleicd 

0% 

QwnM^S Siqnatnre Date .onti arioi 's Signature Dale