TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

sAiD#: j^n^^Lg Date: \Z ^ Z'ZQI Q 

Address: gZ?! ^ pJ l\C> cSj 

Remediation Contractor: Coastal Environmental Group Year: 2008 

SOIL REMEDIATION 

PROPERTY nL E FOLDER DOCUMENTS 

Video ofproperty (DVD) 

Executive Summary 

EPA-provided property sketch 30217639 

Signed Access Agreement for subject property Superifund 

Signed Access Agreement(s) for adjacent property % 

Restoration Agreement 

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

Confinnation data 

Photographs f ft (y^gfViiVtigi/v \ ^ O ^hA^ Ifavf 

As-built sketch 

Bf Satisfactory restoration signed by Property Owner 

ar Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

% Utility clearances 

Property information from Douglas County Assessor's Office d 

[J 

D 

D 

^ ^ ^ ^m>^ Date 
Property Access Checklist 

Property ID: ^)CM1\S ) 

Property Addrcas: ^ : ^ M LJ O S l 

n

D

 WORK STARTED 

 WORKCOMPELTED 

ON:

ON:

 /

 /

 / 

/ 

^""•^ Sf.bca^n,Ci J^?craM 

Address: 

Phone: 

Fax: 

^ IP77 - (0i5 | 

Cell/Pager 

-hmp-oio^ 

Renter 

Pbone: 

Fax: 

Cdl/Pagen 

Additional Infonnation: 

D

O

Q

D

D

D

D

D

 Notification Letter 

Access Agreement 

Restoration Agreement 

Topsoil Sampling (if applicable) 

 Disposal Samplhig (if applicable) 

 Garden Sampling (if applicable) 

JUili^^ Clearance 

Video/Photos (Before) 

 Video/Photos (During) 

 Video/Photos (After) 

 Video/Photos (30-Day) 

 Property Completion Agreement 

 Final Report 

Sent: By: 

Signed; _ll/_U./O g EyilL 

Signed; _U_/JL/£ ^ »y-T,-C. By; 

By: 

/ /. By: 

Called: lL/iM/jQ 3 ^y-Ujl6lo^ 

On:Jl/_L|/_ 2 

By: ' 

C1>Ul^ 

On: 

On: By: 

On: By: 

Signed:. / / By: 

Issued: / / By: 

Air Monitorine (as applicable 

D Community DCrcw 

Results: 

On: / / By: 1 

D Conununity

Results: 

 QCre w On: / / |By: . _ . 

D Community

Results: 

 DCrew On: / / By: 

Omaha Lead Site 
Douglas County Accoimt InfQ||wtion Page 1 of2 m 

Douglas County, Nebraska Property Record - R2519200000 

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 

ANZALDO JANICE M 

910 S 37 ST 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 1920 0000 25 

Account Type: Residential 

Parcel Number 2519200000 

Parcel Address: 3237 N 40 ST 

OMAHA NE 68111-0000 

Legal Description: WESTMORELAND LOT 203 BLOCK 0 1/2 VAC ALLEY ADJ & LT 203 40 X 140.56 

Value Informatio n 

Land Improvement Total 

2009 $500.00 $0.00 $500.00 

2008 $500.00 $0.00 $500.00 

2007 $500.00 $0.00 $500.00 

2006 $500.00 $0.00 $500.00 

2005 $500.00 $0.00 $500.00 

2004 $500.00 $0.00 $500.00 

Sales Informatio n 

Sales Date: 2005-02-02 

Deed Type: WDM Book: 2005 Page: 012429 

Price: $2,000.00 

Grantor: HUDU INVESTMENTS 

Grantee: JANICE M ANZALDO 

ValidHnvalid: Invalid 

Exclusion Reason: Multiple Parcel Sale 

Sales Date: 2000-04-21 

Deed Type: Book: 2164 Page: 133 

Price: $270.00 

Grantor: 

http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=R2... 10/22/2009 
Douglas County Accotmt Inf^a^tion Page 2 of2 

Grantee: 

ValidHnvalid: 

Exclusion Reason: 

Valid 

Land Informatio n 

Acres 

0.12 

SF 

5600.0 

Units 

0.0 

Depth 

140.0 

Width 

40.0 

Vacant 

Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2... 10/22/2009 
Page 1 of 1 m 

L : Q[g.g*g ^Another Tjcket ^^ ,. j [riLi^^v^Back tojrth^ Intemet - \ I |i L:S-'^ny'.^![PM:Dl 

YOUR TICKET NUMBER IS 2406916. 


Original Call Date: 11/14/09 Time: 11:51 am Op: ELI2;ABETH18790 

Work to Begin Date: 11/18/09 Time: 7:15 am 

State: NE County: DOUGLAS Place:. OMAHA 

Address: 3237 Street: N 40TH ST 

Twp: 15N Rng: 13E Sect-Qtr: 08-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: 4 FT Corner Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Nuniber Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 


OMAHACOF CITY OF OMAHA-TRAFFIC.SEWER RICH/TRAFFIC Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICTT NA Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 

QLNNE 1C QWEST LOCAL NETWORK NA Alt: 4062071494 

Emerg: 8887289343 

http://wvm.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11/14/2009 
OLS#: 30476 As-Built Drawing Date Excavated: 11/25/2009 

Date USEPA Signed Off: 4/15/10 

COASTA L Omaha Lead Superfund Site Area Sodden : 1422 s o ft 

30476 

Omali Exterior Paint a Lead Site 

• Good Site Sketcti 

• ^Poo r 

Samplin g Address: 3237 N 40 ST ( 3 Not paint 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm: FPA OBA J 

RYASCPXA-30476 F l __L5.5__ppm D Date: IO- n-cfi . 

RYBSCPXA-30476 F2 T 3 ? ppm d

Time: 1 MOprirt 

RYCSCPXA-30476 Bl ^ 7 PP"" D Samples Analyzed RYDSCPXA-30476 B2 ^ O ppm D 

nDZOOPJCA 3047C SZ ~~ Pom n D XRF Uni : (i>SHD Book: 22 0 

nOZOCrXA-30470 Qg ~ ppm n D Date: II ­ DHo e 

nPgCCPXA 30476 P2 ~ ppm a D Time: Pr ^ 

..Lab RYBSCPLA-30476 

j l Result 768 ppm Numtier of Samples = | l\ | [ I | Staff: . fn'iuJ> 

= Front Right. Bl= Back Left, B2 = Back Right DZ = Drip Zone, GZ = Ganjen, PZ = Pla; 

KcvliiW ("tcucd I7.,Sop-iix 

Legen d 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced witih Area replaced with 

Sod Rock/Mulch Area lef t bare 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
U'^ i l I

30476 

Exlerior Paint 

Q Good 

Omaha Lead Site 

Site Sketch 

sampling Address: 3237 N iO ST [3 Not paint 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm FPA DB AJ 

RyASCPXA-30476 F1 ppm d D 

Date: 10- n-oP, RYeSCPXA-30478 P2 13 5 .ppm Time: 1 -WO M 

RYCSCPXA-30476 Bl 

. ppm n -£1. Samples Analyzed RYDSCPXA-30476 B2 j±Q_ . ppm D 

RoncionxA 30470—ez ppm a D XRF Uni : G>SHO Book: 22 0 

ROHOOrXA 30*70 SS­ . ppm D D Dale I f • OH 0 6 

nngCCPXA 30476 P* 

. ppm n n Time' P r ^ 

RYBSCPlA-30476 ...Lflfc Staff: _ Number of Samples = I l i riiu ^ 

4 Resull 76epp»T> 

• Front Right, B1 = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden. PZ = Pla> 

All quadrants are ss */Iewe<3 from the street, racing property 

•^e^•:r»l^ r-„.ni„i p.^c p nH 

I'O^^-^S i : ^ 
01 ML"/ 

• • « • 

Omaha Lead Site 

Site Sketch 

Sannpling Address: 3237 N 40 ST 

Sample Number 

RYASCPXA-30476

RYBSCPXA-30476

RYCSCPXA-30476

RYDSCPXA-30476

f?OZ00PXA 30470

Lead 

Concentration 

 Fl ppm 

 F2 ppm 

 Bl £ J _ ppm 

 B2 ppm 1 0 02 ppm 

nozoorxA'30470—ez- ppm 

nPZSCPXA 30476 P2 ppm 

^Lab RYBSCPlA-30476 

Sample 

Collected LAB 

D 

Ef 

D 

n 

D 

D 

D 

Number of Samples = | l\ \ \ I ) i Result 768 ppm _ 

30476 

Exterior Paint 

• Good 

• , Poor 

[3 Not paint 

Samples Collected 

Firm: FPA DBA J 

Date: iQ- 11'Cf, 

Time: I -W ptn 

Samples Analyzed 

XRF Unit: {QSHO Book: aZO 

Date: _ II0HO 8 

Time: _ r m 

Staff: rn*}U> 

Front Right. 81 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pla; 

Alt quadrants are as viewed from the street, facing propefly 

Tfi )C' • • X • [ ¥ 
30476 

Omah Exterior Paint North Arrow a Lead Site 

Sit • Good e Sketch 

D/Poor 

Samoiina Address: 3237 N 40 ST Q Not paint 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Fimi: FPA DBA 3 

RYASCPXA-30476 F l _L5J5 - ppm D Date: iQ - \1-Cf ^ 

RYBSCPXA-30478 F2 1 3 ^ ppm Ef Time: I -^Oprr \ 

RYCSCPXA-30476 B1 S J ppm D

- Samples Analyzed RYDSCPXA-30476 8 2 JLQ. ppm D 

nDZOOPXA 30470 BZ ppm D XRF Unit: (oSHO Book: 22 0 

nOZOOP)(A-30470 92- ppm D Date: // • OH • O S 

nPZSCPXA 30476 P2 ppm D Time: Pno 

Lab RYBSCPLA-30476 Staff: m'iU ? Number of Samples = | 1^ | | I | k Result 768 ppm 

• Front Right, 81 = Back Left, 8 2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pla; 

All quadrants ate as viewed ffom the street, faclngpropeity 

— X' ' ' •'.—>*''*—)^ ~ Pr 

NOV 0 3 ZOOS 

: t­

^2. .&!. 

SI. H O. -HftiV^ . 

• ) • — Hi 

3237 rJ.Mo 

t 

\ ^ . 1}5 

f 1 I f^ Br'iyc 

WA<J< 

.K.HP.5:t. <i« Ociled p.Scp. 
COASTA l IHVIKONn f KTAI 

<1 PdO " C I 0 U P IH 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: A Daytime Phone: 

\yr ^ A^-24^t>i 

Address of Property 

covered by this 5zj7 ^4o^ - 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 
A* f* 

•*. y 

COASTA L tNVIKONHIKTAL 

C II O U r IH C 

«

c

c

c

<

e

 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 wori( done, or with the eqiiipment 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

Environmental Group, at (402) 991-1199 

 this program, please contact Coastal 

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

Date Signature Date 

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

Page 2 of 2 
COASTA L 

C r» o 1/ •• 

RestoraHiSon 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 of the property owmer and the United States Environmental 

Protection Agency (EPA). 

Properfy ID; -^ ^ 7 (^ 

Property Address: "^ Z ^~ 7 / U -4 ^ 

]^one: ^ 7 7 ^/g / 

On the attached diagram(s} indicate aiiea(s) to excavate, surface structures and landscapmg 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 lenoval. storage, disposal, and/or return of these items is the Owner's responsibility. 

ttem: ^wS -I ^^. ^ 

Item: 

ttem: 

ttem: 

u . 

jtems to be Removed by the Contractor During Remediation and Mot Replaced 

ttem: 

/ / rL/frJ UJ T Jy^U^^J 

ttem: 

ttem: 

ttem: 

Page 1 of_ 
• % ' 

COASTA L 

c . I. . t I 

Items to Be Removed By Contractor During Remediation and Replaced 

ttem: 

> o / t f^L 

item: 

'M> f 

Item: 

! ttem: 

Landscape Inventory 

Item Quantity Unit Condition/Type/Species 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

Quadrants 

Number of trees > 2 inch 

trunk diameter 

Each 

Number of trees <= 2 inch 

trunk diameter 

Each 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Aiinch !i skiMcli ol tlif 

•.rr'fl^loi iHV'.nii 

^k Each 

Number of and size of 

each garden/ flower bed 

area. 

AlMt h ;i SINC'ICII ol r<.-l:nivf 

si/i'S niid loc;iii(Mis 

Each 

Square Feet 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

VcK' ll"ii" *HIIIC will hi 

ijst'c' 10 is;ui .1 iilisn! 

lOticiif." Id the i;ropci"l> 

u>t nt;r. 

S 

Easement Area, to be 

excavated Each 

Page 2 of. 
C O A S 1 A L 

c ^ a u f , • N c 

I Additional Comments / Instructions: 1 

m 

[ j Check the tx)X 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. 

I do not agree 

\iy\9j:mMiyH^­

Contractor's Sienaturr Date 

Page 3 of. 
BVID# 3g>^- ^ 

XRF PROPERTY SAMPLE SHEET 


Date 

Project 

XRF ID# 

Shot# 

3^2 , 

3?7^ 

1 ^ 

Average

Shot# 

Average 

Shot# 

Average 

Shot# 

n-t<^'-cy Address f 

Omaha Lead ARRA Sample time 

• ^'^g^ ^ sample length 

Reading Sample area Shot# 

l^^d ICr f^2^ \>% . 

M Depth 2>-}S- i i9i, 3?^, i(^ lii. ifl 

 }2. ^ ^ /"p- Average

Readirig Sample area Shot# 

Depth 

Average 

Reading Sample area Shot# 

Depth 

Average 

RETEST AREAS 

Reading Sample area Shot# 

Average

Sianature

Print

^— 1 Depth 

y ^ y 

/ 

y Average 

>/ y ^ 

nUM- 6 |Ufrn^ 4 

.6^5? - A l HOf^ r 

am/pm 

30 sec 

Reading Sample area 

I7A> i . / ^ ^/i 

m ^ /s- Depth 

M^H / ­

 /^*? - /< ^ 

Reading Sample 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 376 

Mode SOIL 

Time 2010-03-26 10:09 

Duration 91.13 

Sequence Final 

Flags 

AVERAGE 

ADDRESS ^^35llN17s t 

QUADRANT F2 

DEPHT 6" 

XRF TECH N. LOPEZ 

MISC exitus 

NOTE none 

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 122.004 

Supervised By: 

Certificate of Verification 

373 

SOIL 

2010-03-26 10:07 

30.57 

Final 

33596 

3911 N 17 st 

F2 

6" 

N. LOPEZ 

exitus 

none 

± Error 

15.706 
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 129.082 

Supervised By: 

Certificate of Verification 

374 

SOIL 

2010-03-26 10:08 

30.06 

Final 

33596 

3911 N 17 st 

F2 

6" 

N. LOPEZ 

exitus 

none 

± Error 

± 18.145 
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 132.767 

Supervised By: 

Certificate of Verification 

375 

SOIL 

2010-03-26 10:09 

30.50 

Final 

33596 

3911 N 17 st 

F2 

6" 

N. LOPEZ 

exitus 

none 

± Error 

± 15.772 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 380 

Mode SOIL 

Time 2010-03-26 10:13 

Duration 91.51 

Sequence Final 

Flags 

AVERAGE &ig-of-377-379-—^ 

ADDRESS 3911 N 17 st 

QUADRANT easement 

DEPHT 1" 

XRF TECH N. LOPEZ 

MISC exitus 

NOTE none 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific i 

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 120.103 

Supervised By: 

Certificate of Verification 

377 

SOIL 

2010-03-26 10:12 

30.50 

Final 

33596 

3911 N 17 st 

easement 

1" 

N. LOPEZ 

exitus 

none 

± Error 

± 15.142 
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 104.221 

Supervised By: 

Certificate of Verification 

378 

SOIL 

2010-03-26 10:13 

30.47 

Final 

33596 

3911 N 17 st 

easement 

1" 

N. LOPEZ 

exitus 

none 

± Error 

± 14.549 
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 103.565 

Supervised By: 

Certificate of Verification 

379 

SOIL 

2010-03-26 10:13 

30.54 

Final 

33596 

3911 N 17 st 

easement 

1" 

N. LOPEZ 

exitus 

none 

± Error 

± 14.316 
/^A^ \ Omaha Lead Site—Fixed Price EP-R7-07-05 

I ^^^ ^ I Coastal Environmental Group Inc. V\ 

\~^j ^ wvmw.coastalhazmatcom 

^"iPBoT* ^ COASTA L 

G I O U P, IN C 

EXECUTIVE SUMMARY: 

BVID #30476-(3237 N 40 ST) 

No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 
EPA Property Close Out Form 

Proptrty #: C^PlL^ ^ 

Dste/Tlme: — j;:re?;s;ir::^^^isi^ 

Quads Excavated: Contractor Croup /^PgL^WL ^ ^j^tjt ^ 

Excavation Yes No General 

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

2. I r necessary, were the correct areas of drip zone excavated and restored? / 

Grading Sod and VegeteHoB Yes No 

I Does lhe trading around the perimeter ofthe house in excavaieri areas generally slope away / from the house? 

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

h. 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? 

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

/ time period) _ r 6. Was the property graded such that water will not pool on the property"' I 

r 7 Was damage to landscaping or plant maierials avoided? 

Cates. Fenccj aad Reu<BlP£ Watit Yes No 

Do gates open and close freely? (If applicable) 

2 Were all gates or fences taken down during restoraiion activiiies reinsuiied? (ir applicablrl 

.1. Was damage to gates or fences avoided? (ir applicable} _ - 1 

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

Foundation, SidJBK and Cntter^ — Ves .No 

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

2. Was damage tn the foundation avoided? / 

.'. Was damage to windows avoided? 

A Was damage to windows or door screens avoided?' 

5. Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) Ves No 

1. Was damage to driveway surfaces avoided? 

n2. Was damage to walkway surfaces avoided? v 
O^-ncrs coromcnlts: 

I fnsT>ection notes: 

Removal and resloration activates complele including the 30-day sod warranry: 

EPA Representative Q"^ ^ Dale: HI'^^'^ 
I

<k 

Property Completion Agreement 

Ihis agreemenl documenls lhe complclion of remedial aclivities perloimed on my properly My signaiuie 

will designate that I am satisfied wilh the restorahon of my propeily. and thai no items are in questions, 

now, or al any lime in the fiiluie, except those ilems listed below, if any 

PropertylD: ^Ur\\ ^ 

Property Address: 3^ . 2, ^

Owner: 5eb^f^lO A

Phone:|Q-^7^(0)|aj 

 k ) ^-T)

 AnTY

 < ^ 

xU p 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

item: 

Item: 

Additional Comments: 

I 1 agree rrcxtoralio « n is completed, except as noted 

[_j l/rfo not ai;rec restorati«n is tpinpitteri 

^CAi^mP 

itrarlor' s Signature Dale