TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: i^ S'l^i Date: :'; l\ 0 ^ 

Address: ^Cl S ^\ H ^ 1 

Remediation Contractor: _Coastal Environmental Group_ Year: 200 ^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Video of property (DVD) 

5 / Executive Summary 

^ EPA-provided property sketch 

4 Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property > ^ ^ 

s/' Restoration Agreement 

Settlement documents (i.e., for damage or to replace plants, etc.) \^-lk 

\k'^ Confirmation data 

\^ Photographs f H hcC^P['^'<^ ."^ \y^(An^Qn V 'hv ^J ^ ^ ^ 

^ As-built sketch 

13' Satisfactory restoration signed by Property Owner 

W( Property close-out check list signed by EPA 

J0 ' Description of areas not meeting ROD cleanup criteria 

iZi Utility clearances 

0' Property information from Douglas County Assessor's Office 

D 

D ,. 7 

D 

l//#//^ v n'/. 

'' Signature Date 

30054 020 liili III llllllllllll ^ 

Super fund A 
Property Access Checklist 

Properr, LP jQ^'"?' ! 

D WORK STARTED ON _/ ;_ 

D WORK COMPELTED ON / ; Propcn\ Add^e^i ".>^<JOC ^\f\ P 

Renter 

AdJn;<$ Phone35) 6 ?inz S-r 

FiL\: 

Cell/Pager 

Phone Additionul Inlnrmxtion L/Q2- 5-^^-72^ 3 

F«^ 

Ccll/Piger 

• Notificjlion L.tltcr Sent: / / By: 

S l Aceesi AprceiricDl SlEiicd- Lf 1/ ^ 1 0 9 

^yOar\ Tfrh»chzv~ 

j ^ RenorvtioD Agreemenl Signed- lfi_/ia/fl3 By-D^in ^rb^^^W:/­

• Topjoil Stnipimg (if ipplicubic) / / By. 

0 DispoiaJ Sampling (rf jpplictble) / / B y 

• Ciirdcn SntnpliDg (if ipplicftble) /

 / By: 

• Uiiliiv Clc£ruicc Called- / / By: 

^ Video/Phoros (Before) On: ^ 12,1.1 g y 

^y nrlc^n/A^tr/i 

D Video/Phoios (During) On: / / B.V. 

D Video/Photo* (After) On: / / 

By 

D Vi(leo/Pho»oi (30-D«y) On: / / hy. 

D Property Complelion At;recineni Signed / / By: 

D Final Report Isiued:

 / / By: 

Air Moniloring {*!> jpplicable) 

[_J Communrty LJ Crcvi Do / / By: 

Rciuiti. 

D Comrounit)- D Crew On- / / By. 

Rem lis 

D Communiri D Cn;« On / / 

RMUIU: 

Omaha Lead Sue 
Douglas County Account IriMmatio .iMma n Page 1 of3 

Douglas County, Nebraska Property Record - R1221220000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - Vie w o n Ma p Information is valid as of 2009-5-12 Treasurer's Tax Report 

New Feature ->-•- • Auto Sales Search 

Owner 

ERLBACHER DANIEL R 

ETAL 

3518 PINE ST 

OMAHA NE 68105-0000 

Property Information 

Key Number: 2122 0000 12 

Account Type: Residential 

Parcel Number: 1221220000 

Parcel Address: 3518 PINE ST 

OMAHA NE 68105-0000 

Legal Description: GRIFFIN & SMITHS 1ST SUB LOT 17 BLOCK 6 E 44 FT LT 16 & W 6 FT 50 X 128 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land Improvement 

$6,400.00 $212,200.00 

$6,400.00 $212,200.00 

$6,400.00 $212,200.00 

$6,400.00 $93,500.00 

$6,400.00 $93,500.00 

$6,400.00 $93,500.00 

Total 

$218,600.00 

$218,600.00 

$218,600.00 

$99,900.00 

$99,900.00 

$99,900.00 

Sales Informatio n 

Sales Date: 2002-12-20 

Deed Type: 

Price: 

Grantor: 

WD 

$169,950.00 

SooAr; 2232 Page: 470 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 1990-09-17 

Deed Type: 

Price: 

Grantor: 

$43,000.00 

Book: 1884 Page: 680 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R122... 6/6/2009 
Douglas County Account InlJMmatio nMDi a n 

Page 2 of 3 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Lan d Informatio n 

Acres SF Units Depth Width Vacant 

0.14 6400.0 1.0 128.0 50.0 No 

Improvemen t Informatio n 

Building 1 

ai j aq ft ! WOMOKI. ' „ 

"l 

TWrd Floor 392 0sqfl H fHrstRoor •"

 ; 1062.0s(] fl " i Second Floor TTF 

880 Osq tt •wr 

2 1/2 STORY FINISHED 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 2334.0 Percent Complete: 100.0% 

Perimeter 0.0 Quaiity: Average 

Unit Type: Condition: Good 

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

HVAC: Central Air to Air Rooms: 8.0 

Exterior: Frame Aluminum Units: 1.0 

Interior: Drywali Baths: 2.5 

Roof Cover: Composition Shingle Bedrooms: 5.0 

Roof Type: Gable Stories: 2.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

year Percent Adjusted Year Year Built 

Physical Age Remodeled Remodeled Built 

1915 0 0% 1915 93 

Detail Type Detail Description Units 

Add On Fence Chain Link 1.0 

Appliance Allowance 1.0 

Appliance Fireplace Masonry 10 

Basement Bsmnt Block 8 ft 940.0 

http://douglasne.mapping-onIine.com/DouglasCoNe/static/accountinfo.jsp?accountno=R122... 6/6/2009 
Douglas County Account Inigmatio nlams n Page 3 of3 

Fixture 

1 Fixture 

1 Fixture 

1 Fixture 

Garage 

Porch 

Porch 

User 

User 

Additional Fixtures 

Base Fixtures 

Bath Full 

Bath Half 

Detached 

End Solid Wall 

Wood Deck 

2002 BOE 195 

Attic Full Finish 

1.0 1 

1.0 

2.0 

1.0 

312.0 

170.0 

257.0 1 

1.0 

392.0 1 

http://douglasne.mapping-oiiline.com/DouglasCoNe/static/accountinfo.jsp?accountno=R122... 6/6/2009 
CONTACT FORM 

Property ID M \^5n 

Property 

Address: ^-^•\^ p>oc 

Initial Contact: Date: Wn/fl^ Time:_t5 ^ Action: | e^\-^y^;^ 

Second Contact: Date: Time: Action: 0 

Final Contact: Dale: Time: Action: 

Final Action: Transmit to EPA D Other Action: D 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator UP^-f fl.^t(l ^ ^ ^' ^ \f\ot^^, 

Comment (s): 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

• YOUR TICKET NUMBER IS 2311555. 

Original Call Date: 7/07/09 Time: 12:37 pm Op: ELIZABETH18790 

Work to Begin Date: 7/09/09 Time: 1:15 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 3518 Street: PINE ST 

Twp: 15N Rng: 13E Sect-Qtr: 28-NW,29-NE 

Twp: Rng: Sect-Qtr: 

Legal Given: C 

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: 4ft Corner Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


Service Area Contact Phone Nuinber Utility Type 

Day: 4029340469 

CXCATV co x COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

LEVEL3 LEVEL3 COMMUNICATIONS, LLC NA Alt: 

Emerg: 8773668344 

Day: 4025047823 

MUD02 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... 7/7/2009 
Page 2 of2 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNN E1F QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/7/2009 
remote ID: R page of 

.A.-e-en Z:XJ X z.n.^E:a7 H 

87766S-423. 0 877662421 1 


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>0—441—0223 . 

f 
As-Built Drawing ^ OLS#:19577 

Date Excavated:7/13/09 COASTA L Omaha Lead Superfund Site tNVIRONMENTAL Date USEPA Signed Off: 7/22/09 Q R O U r . IN C 

Area Sodden: 1900 sq ft 

19577 

Omati a Lea d Site Exterior Paint Owner Name: DANIEL R ERLBACHER 

Site Sketchi [3^ Good Address : 3518 PINE ST • Poor Phone: H: W: I I Not paint 

Omaha Lead Site 46130 

Legen d 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced

Sod 

 with Area replaced with 

Rock/Mulch Area left bare 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc , 
19577 

Owner Name: DANIEL^ ERLBACHER Omaha Lead Site Exterior Paint 

Address: 3518 PINE ST Site Sketch • Poor 

Phone: H: Q Not paint 

Omaha Lead Site 46130 

^C.<3L.5ef ^ 
19577 

Omaha Lead Site ExtBrior^Paint Owner tfame: PANEL R ERLBACHER Site SItetch Address: SIBPthEST • Poor TT 

Phone: H: W: Q Not paint 

SampleNumber Lead Sample S^ple s Colleoted LAB Concentration Collecled 

RYASCPXA-19577 F1 

n n ppm • Date: ^ g- ^ 

RYBSCPXA-19577 F2 Pi" ^ \ ppm D Time: lQ'M^g> kr ^ 

RYCSCPXA-19577 Bl \ "I S pom D Sample Analyzed RYE»SCPXA-19577 B2 4v^pp m S^ n 

RDZSCPXA-19577 DZ ppm n XRF Unit: 

RazserxA-iwry—es- ppm D n Date: ;DI-O 

RPZSCPXA-19577 PZ g ^ ppm D Time: 

Staff: Number of Sampls = b O ^ 

>0 

(j-A.<LA;lr^ jf>(^.^ . 

y ^ ^ y^ 

sf)!'^^ *3 I -u.X^ 

V -.' • Vi 4 1 

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< 

3 Dir=usa^ 

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^N X EBJi,. iW^lH. ^ElTTTaw ;?: rOt-= sT: 

Omaha Lead Site 46130 

L 
^^tD Sr.,, 

COASTA L [NVIRONMENTA l 

'••tPROl* ^ C I O U r . IN 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 

follovi/ing described premises: //7r-*-7—. 

n^7 

Owner's Name: Daytime Phone: 

Ti^AJ ttV'tfiC>>\^(L ^33 7Z^3 

Address of Property y6\% ?lht> ^ r 

covered by 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 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 
.v*^""'"* . 

COASTA L ENVIRONHENTAL 

'^i.PKa^ff' c II o U r IH 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 (402) 991-1199 

grant access to my properties 

D I do not grant access to my properties % 

Signature Date 

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

Page 2 of 2 
COASTA L 

C H O U r IH C 

Restoration Agreement 

The purpose ofthis 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 of the property owner and the United States Environmental 

Protection Agency (EPA). 

Property ID: I Q<j '^ ^ 

Property Address: 7^) ^ pjN ^ Sf. 

Owner: T>?^>X ^^^6^(^V^ ^ 

Phooe: ;^-7,^ ^ • ^^^- ^ 

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 Videographlcally document the existing conditions ofthe property and the basement if 

necessary. 

items to 130 Removed by tiie Owner Isefbre Start of Remediation: 

fhe removal, storage, disposal, and/or return ofthese items is the Owner's responsibility. 

ttem: 

/L-^ S^ -/ / ?i^m^f9 

Hem: / 

Item: 

Item: 

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

Item: , 

•lh Item: 

Item: 

3 

Pagel of 
COASTA L rMvmoNMrHTA L e M e o r . IN C 

Items to Be Removed By Contractor During Remediation and Replaced 

Item: 

50^ ^ — r I . p " ^ 

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. 

Attach a sketch ol lhe 

.sprini<lcr lavciul. 

Number of and size of 

each garden/ flower bed 

area. 

Attach a sketch ol' relative 

sizes and locations. 

Agreed upon value of plant 

materials not to be 

replaced by contractor. 

'•ote tiiis saluc will ht 

uscd to Issue •A plunt 

voucher 10 the propertj 

owner. 

Easement Area, to be 

excavated 

Quantity 

n 

) 

^ / ^ 

\ 

Y^s 

Landscape Inventory 

Unit Condition/Type/Species 

Quadrants 

Each 

Each 

^^Eac h 

Each 

Square Feet 

$ 

Each 7^^)>^\yiJ Q^f^^ b 

Page 2 of 1_ 
C i j A S 1 A L 

Additional Comments / Instructions: 

^ 

• Check the box if Owner does not want GEG to document interior foundation waits and possible 

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

interior of house, including foundation cracks or fissures. 

not agree 

Y'^'^9 €, frxcnoD U-IA-rA 

Date Contractor's Signature Date 

Page 3 of \ 
Property Damage Settlement 


I property ID I 

PropW Address I 3518 Pine St 

owner I ERLBACEER DANIEL R 

I Phone I 

I have received from the contractor, Coastal Environmental Group Inc. (Coastal), the sum of $200.00 to 

compensate for water damage to the basement during the removal of lead impacted soil from the 

property. 

Compensation type I Cheek 1853 

Value of Cheek 1 $200.00 

I Check to the order of I ERLBACHER DANIEL R I 

After excavating 3518 Pine St (BVID 19577) property owner noticed water intrusion to the basement due 

to improper soil compacting. Property owner received a check for the amount of $200.00 dollars to 

compensate for the repairsof the paint damaged. 

My signature blow acknowledge8 the mpair of the paint damage; further, I acknowledge that this 

work wan completed MU.Faotoly and within my and rdoase Coastal Environmental Group, Inc. from 

further obligations or liability misted to thb propelty. 

'LIYloq 

Date 

Page 1 of I 
BVID # 1^*^77 

XRF PROPERTY SAMPLE SHEET 

Date 7-i?>- (yf Address Mni^Kczn: 

Project Omaha lead FP 2nd year option Sample time \?>'-XT am/[@ 

XRFID# _225^sa sample length 30 sec . 

Shot# Reading Sample area Shot# Reading Sample area 

\l.r i 228.^\ X \8RO \a°i? ''^\ \^ ^ H.^?> gfla><>' ^ nii% 20I.^J<tn.i:S IIL 113^ ^\'i.l.'i• \t,fi 

12^Q 21-n q^l\<^.u7 Depth jiau \\°[ Air i \'b.'\Lt Depth 

I'zqo IHS .'auJ\t). ^ I4^.u^i\ ^ 7'^ li. iias_ Average 2.0\p iL o t ^.^ ^ Average l<Vj.. HH t I'S. ^ 

Shot# Reading Sample area Shot# Reading Sample area 

l^O.q'MtM^S g'Ri 

5H.H'St tt^..XT T\ joa • ^ ^ H ?>^H Depth Depth ii^ i 

i^&Q IM.Ql t l\.-f)l :K 

Average 7?> .U U t 11.1^ ^ Average 

Shot# Readmg Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# Reading Sampte area 

Depth Deptti 

Average Average 

lab sample # Lab result Sample area XRF Avg. 

Signaturel^£M ! i m:L 

PrmtFi^OAbPi ^ OnC^YQ^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pt» 206.255 

Supervised By: 

Certificate of Verification 

1291 

SOIL 

2009-07-13 13:29 

121.94 

Final 

Avg of 1287-1290 

3518 Pine st 

DZ 

Nicolas 

12 

CLEARANCE 

± Error 

± 17.879 

U­
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 228.906 

Supervised By: 

Certificate of Verification 

1287 

SOIL 

2009-07-13 13:27 

30.47 

Final 

19577 

3518 Pine st 

DZ 

Nicolas 

12 

CLEARANCE 

± Error 

± 18.816 
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 202.579 

Supervised By: 

Certificate of Verification 

1288 

SOIL 

2009-07-13 13:27 

30.53 

Final 

19577 

3518 Pine st 

DZ 

Nicolas 

12 

CLEARANCE 

± Error 

± 17.733 
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 247.975 

Supervised By: 

Certificate of Verification 

1289 

SOIL 

2009-07-13 13:28 

30.36 

Final 

19577 

3518 Pine st 

DZ 

Nicolas 

12 

CLEARANCE 

± Error 

± 19.620 
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 145.560 

Supervised By: 

Certificate of Verification 

1290 

SOIL 

2009-07-13 13:29 

30.58 

Final 

19577 

3518 Pine st 

DZ 

Nicolas 

12 

CLEARANCE 

± Error 

± 15.347 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

152.438 

Certificate of Verification 

1296 

SOIL 

2009-07-13 13:32 

121.52 

Final 

Avg of 1292-1295 ? 

3518 Pine st 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

± 15.380 f 

Supervised By : ^CMM? ^ 
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 131.146 

Supervised By: 

f 

Certificate of Verification 

1292 

SOIL 

2009-07-13 13:30 

30.54 

Final 

19577 

3518 Pine st 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

± 14.328 
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 215.201 

Supervised By: 

Certificate of Verification 

1293 

SOIL 

2009-07-13 13:31 

30.05 

Final 

19577 

3518 Pine st 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

± 18.496 
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 119.980 

Supervised By: 

Certificate of Verification 

1294 

SOIL 

2009-07- 13 13:31 

30.52 

Final 

19577 

3518 Pine st 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

± 13.964 
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 143.425 

Supervised By: 

4 

Certificate of Verification 

1295 

SOIL 

2009-07-13 13:32 

30.41 

Final 

19577 

3518 Pine st 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

± 14.734 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm

Pi» 73.659

Supervised By: 

Certificate of Verification 

1301 

SOIL 

2009-07-13 13:57 

121.67 

Final 

Avg of 1297-1300 

3518 Pine st 

Fl 

Nicolas 

6 

CLEARANCE 

± Error 

± 11.293 
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 130.985 

Supervised By: 

Certificate of Verification 

1297 

SOIL 

2009-07-13 13:54 

30.61 

Final 

19577 

3518 Pine st 

Fl 

Nicolas 

6 

CLEARANCE 

± Error 

± 14.446 
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 54.426 

Supervised By: 

Certificate of Verification 

1298 

SOIL 

2009-07-13 13:55 

30.09 

Final 

19577 

3518 Pine st 

Fl 

Nicolas 

6 

CLEARANCE 

± Error 

± 10.370 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1299 

Mode SOIL 

Time 2009-07-13 13:55 

Duration 30.62 

Sequence Final 

Flags 

BVID # 19577 

ADDRESS 3518 Pine st 

QUAD/ZONE Fl 

INSPECTOR Nicolas 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 35.212 ± 8.841 

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 74.011 

Supervised By: 

Certificate of Verification 

1300 

SOIL 

2009-07-13 13:57 

30.35 

Final 

19577 

3518 Pine st 

Fl 

Nicolas 

6 

CLEARANCE 

± Error 

± 11.514 
p 

i^.J^\ Omaha Lead Site—Fixed Price EP-R7-07-05 (ffl & 

g N^R / g Coastal Environmental Group Inc. X^^ ^ 

^^^^T ^ www.coastalhazmat.com 

XPHO.'^- ^ COASTAL ENVIRONHENTAL 

CROUP . IN C 

EXECUTIVE SUMMARY: 

BVID # 19577 - (3518 PINE ST) 

pv] No Issues or Concerns \ ^ Issues/Concerns 

Detail Explanation: 

NO ISSUES PENDING 
^^EPA 

EPA Property Close Out Form 

Property«: \*^?."^. . Property Address:;^'? > J < O ^ ^ 

Date/Tine: Owner's N.me: ,JnQ, . F-'Cnyyi^ ' 

Quads Excavated: -p?_ F ^ Contractor Group rr(:^?^ \ ' 9 in\i \Ytb AOOen-U 

ExcavattoD General Yes No

1 If necessvy. were the correct quadrant(s) excavated and restored? ly 

2 If necessary, were the correct areas of drip zone excavated and restored'' W^ 

GmdluK Sod and VetclatioB Ves No 

1 Does lhe grading around the perimeter ofthe house in excavated areas generally slope away 

fix)m tbe house? u-^ 

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

3 Does the sod appear Jo be generally healthy an ' ^Onl evaluat^ ins|Deci^ a 30

idd growing' growing'' (Onlyy evaluatrjff inspeciodd aatt a 

day time period) 

4 Are sodded areas generally firm and evenly graded? L ^ 

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

L ^ ' time period) 

6. Was the property graded such thai water will not pool on lhc propeny'' U - " 

7 Was damage to landscaping or plant materials avoided? 

Gates. Fences anti Relaining Walls 

Ves No 

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

2. Were all gates or fences taken down during restoration activities reinstalled'' (ifappltcable) 

3. Was damage to gates or fences avoided? (If applicable) ( / " 

4. Was damage to retaining walls avoided'' (If applicable) -L?^

Fouadatioa, SidinK and Cullers 

Yes .No 

I. Was damage to the siding or trim avoided? 

2 Was damage to the foundation avoided? 

I/- " 

3 Was damage to windows avoided** 

\ y ' 

4 Was damage to windows or door screens avoided'' 

I/ " 

5 Was damage to downspouts or downspout extensions avoided'^ \ . ^ 

Sidewalks and Driveways (Concrete) Ves >o 

I Was damage to driveway surfaces avoided? 

2. Was damage lo walkway surfaces avoided? 

^ ' 
Owners comments: 

Inspection notes: 

Removal and resloratiorv^itMivales compiele^ncluding lhe 30-day sod wananry: 

EPA Representiiiive ^-^O/^lJjJlM- ^ Date: '^I'^^l^ l 
'tS ^ 

Property Completion Agreement 

Tins iigrccinciK cidciimcnls tlic complelion of remedial iictivilics pei roniiecl on my properly M y .siyiMltiif 

will ciesij^naie llial t am .siili.slJcil wilh lhe rcstoralion df my properly, atul lluil no itctiis iire in c|itv.Ntioi>s, 

now. oral any fimc in tlie liiliire, except tlicxse Hems lisleil below, ifaiiy 

Pniperty It>: li.f77 __._ ._ .._ Property Ad.hcvss: ^ 5-/ f P ( ^T^ _ T. L _ . 

Owner: p <f ^ o. c W £ N ^ 

Phone: 

Restoration Items in Question: 

Item: 

Additional Comments: 

bjj-^'llrc ru;rci t reslornlion is coniplclcil, except as noted 

 I I <1<> m»t atjici' i-i-MorHtiiin Is i-oniplelcd 

7-/ r"^ 9 L/\ Vim TvTier's .Si(>nnrure Date ilrjictor's .Si|>ii.'itiire Dtite 

1 

I