TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#.._i^AlJl__. Date: 

• ; 1'^ l\\ 

Address. ^^' ^ ^^(^ 1 ^ 1 

Remediation Contractor: Coastal Environmenta) Group Year: 201 OA RRA 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

i/ Video of property (DVD) 

( / Executive Summary 

/ EPA-provided property sketch 

Signed Access Agreement for subject properly 

Signed Access Agreement(s) for adjacent property 

Restoralion Agreement 

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

Confirmation data 

Photographs ffe b^OO/^Yju^ ^ ^<^^1(7t n \ ( ^ 

As-buill sketch 

Satisfactory restoration signed by Property Owner 

t / Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 

Property«)formation from Douglas County Assessor's Office 

^ ^ 

/ ^ ' II 

Ignature Date 

30218943 ininii 

Superfund 
Property Access Checklist 

n WORK STARTED ON: _/ I 

Property Address: f^ ^ ^^^ ^ ^ _ D WORKCOMPELTED ON:. I I 

O^vnen Renter "u^ uMi ^ Address: 

Phone: 

Fax: 

Celi/Pager: 

Phone: cf.^ ^ q^y ^ Additional Infomiation: 

Cell/Pager 

D Notification Letter Sent: / / By: 

^ Access Agreement Signed:/C^/// 5 

By- w.cv 

t ^ Restoration Agreement Slgned:_JC(..2f/4^ By: »o.,_t 

[!] Topsoil Sampling (if applicable) / / By: 

a Disposal Samplhig (if applicable) / / By: 

D Garden Sampling (if applicable) / / By: 

a Utility Clearance Called: w/i . 1 ^ By: vv/c/.„ V^iM^ 

{3< Video/Photos OBefore) On;\y /y»/> o Byv. ^cvt 

a Video/Pfaotos (During) On: / / By: 

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

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

D Property Completion Agivement Sfpied: / / By: 

D Final Report Issued: / / By: 

Air Monitorine (as auolicable 

n Community DCrcw On: / / 1 

Rcsults: 

D Community Q Crew On: / / By: 1 

Results: 

• Community • Crew On: / / By: 

Resulte: 

Omaha Lead Site 
Douglas County Account In; |HB|^ion 

Page 1 of2 H 

Douglas County, Nebraska Property Record - R1917710000 

Print Report 

View Interactive GiS Mao Information is valid as of 2010-8-30 Treasurer's Tax Reoort 

New Feature "•• -• • • Subdivision Sales Search 

Owner 

WESTBROOK FLOYD 

ETAL 

11444 SARATOGA ST 

OMAHA NE 68164-9078 

Property Informatio n 

Key Number: 1771 OOOO 19 

Account Type: Residential 

Parcel Number: 1917710000 

Parcel Address: 

3320 CORBY ST 

OMAHA NE 68111-0000 

Legal Description: OMAHA VIEW LOT 20 BLOCK 12 50 X 120 

Value Informatio n 

Land Improvement Totai 

2010 $500.00 $0.00 $500.00 

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 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.13 6000.0 0.0 120.0 50.0 Yes 

http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R191... 9/3/2010 
Page 1 of 1 

CrstateAnoJBH^Sejl .Bg<»to,jr^;j|ijt!|ia| Sencj-jmafe^ 

• YOUR TICKET NUMBER IS 2601(>44. 

Original Call Date: 

Work to Begin Date: 

9/27/10 

9/29/10 

Time: 10:56

Time: 11:30

 am 

 am 

Op: ELIZABETH18790 

State: NE 

Address: 4324 

County: 

Street: 

DOUGLAS 

MAPLE ST 

Place: OMAHA 

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


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD REMEDIATION 


Location of Work: LOCATE ENTIRE PROPERTY, ALL EASEMENTS AND TO THE PEDESTAL 


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


: UNSURE IF CORNER LOT. 

Company : COASTAL ENVIRONMENTAL SERV

Contact Name: ELIZABETH 

ICE 

Phone: (877)662-4210 

Work Being Done For: COASTAL 

Depth of Excavation: 4 FT Corner Lo

Involves Tunneling or Horizontal Boring

t: N 

 : N 

Front: Y Rear: 

Explosives: N 

CXCATV MUDOl 
OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITYOFOMAHA-TRAFFIC.SEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/27/2010 
29314 

As-Built Drawing 

COASTA L INVIItONMCHTAL Omaha Lead Superfund SifItee CROUP . IH C 

OLS#: 29314 

Date Excavated: 11/5/2010 

Date USEPA Signed Off: 11/23/2010 

Area Sodden: 1665 sa ft 

Omah Exterior Paint NorthAnow Owner Name: FLOYD WESTBROOK a Lead Site

Sit • Good e Sketch Address: 3f»oa)RBYJT • Poor Phone: " 4CC-446:S078 W; 402-451-5652 

( U Notpaim f

Sample Number Lead 

Concentration 

Sample 

Collected LAB Samples Collected 

RYASCPXA-29314 F1 ISO ppm El D Date: C>5"-27--o ^ 

RYBSCPXA-29314

RYCSCPXA-29314

RYDSCPXA-29314

 F2 

B1 

B2 

} i H

131

1^ 2

 ppm 

ppm 

ppm 

or 

BT 

D 

D 

D 

Time: Z - ?(? /^Al 

Samples Analyzed 

RDZSCPXA 20314 BZ­ ppm n D XRF Unit: <^2 . Book: ll & 

RGZSCPXA 20314 62 ­ ppm D D Date: 5-2/i,-O0 , 

RPZaCPVA-Zq^l^ EZ. .ppm. D D Time: A£L 

Number of Samples = i4- Staff: ±UW_ 

Legend: F l = Front Lef t F2 = Front Right, B1 = Bac k Left, B2 = Bac k Right D Z = Drip Zone, G Z = Garden . PZ = Play 

All quadrants are as viewed from the stieet, lacing pioperty 

Legen d 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced with 

Area lef t bare Sod Rock/Mulch 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
29314 

CUgvr Lv U/ H 

Exterio NorthArrow Omah r Paint Owne a Lead Site r Name: pLOyo WESTBROOK • Good Site Sketch Address: 3320COf?BY ST • Poor 

Phone: ": 402-445-9078 W: 402-451-^52 Q Not pair« r

Sample Number 

RYASCPXA-29314 F1 

Lead 

Concentration 

}5 0 ppm 

Sample 

Collected LAB 

D 

Firm:

Dale:

Samples Collected 

 f[?fi • /)fi/^/ V 

05"- ZZ -o ^ 

RYBSCPXA-29314 F2 )H ^ ppm \3f D Time: 2 ­' 30 fX-M. 

RYCSCPXA-29314

RYDSCPXA-29314

 Bl 

 B2 

j3 }

_j m

 ppm 

 ppm 

0' 

H' 

D 

D Samples Analyzed 

RDZ-SGPXA 30344 B*­ •Qpon D D XRF Unit: 0^ 2 Book: // ^ 

RGZSCPXA 20314

RPZSCPXA.?9?1<1

 62-

 P7 ppm, 

D 

D 

D 

D 

Date: iZip'OC ^ 

Time: l£L 

Number of Samples = j if- Staff: M3W 

Legend: F1 = Front Left, F2 = Front Right, B1 = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as vievned from the street, facing property 
29314 

Exterior Paint NorthArrow 

Owne Omaha Lead Site r Name: FLOYD MSTBROPiS 

Sit • Good e Slcetch Address: 3320CORBYST • Poor 

Phone: H: 402-445-9078 W: 402-451-5652 Q* Not paint r

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm: JEQ^IM/OL . RYASCPXA-29314 F1 }3 0 ppm D Date: O^ - 2Z ~o ^ 

RYBSCPXA-29314 F2 }HH ppm D Time: 2 ­' 3o ff.M. 

RYCSCPXA-29314

RYDSCPXA-29314

 Bl 

 B2 

Jl l 

Jhl . 

ppm 

ppm 

0' 

or 

D 

a Samples Analyzed 

RDZSCPXA 2031 ll B2­ n XRF Unit: ^TtTL Bode M _ 

RGZSCPXA 20314 G*­ n D Date: S-2U'C ^ 

RPZSCPXA.29314 EZ. , ppm, D D Time: .Ail. 

Number of Samples = j t^ I Staff: ±LiW l 

Legend: F1 = Front Left, F2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

AH quadrants are as viewed from the street, facing property 

ENTEREI/ 

2; 

l>.^M.^.^.^^^jr. 

—il--­

0. F.\ • ^ '

150 . 0 ^ s eP': 'p­ •A.^rC 

g> 

y/yv>y7'^-wViK/v/' 

I 

Coyky o-f. 

Rev 4 04AI4IOI23 

0 
29314 

Omah Exterior Paint NorthArrow Owne a Lead Site r Name: FLOYD WESTBROOK 

Site • Good Sketch Address: 3320 CORBY ST • Poor Phone: ^ 402-445-9078 W: 402-451-5652 

Q ' Not paint r

Sannple Number Lead Sample Samptes Collected 

Concentration Collected LAB f\m: fa\''p(^/cM 

RYASCPXA-29314 Fl J50_ ppm D Date: 05'-2Z-s3 ^ 

RYBSCPXA-29314 F2 

J±L ppm or a Time: 2 - ?P ^^M -

RYCSCPXA-29314 81 

JIL ppm BT a Samples Analyzed RYDSCPXA-29314 82 niL ppm BT n

RDZSCPXA 20311 DZ­ n XRF Unit CV^2. Book: //& 

RGZSCPXA 20314 6Z­ -ppm 

a 

D D Date: 5ZU'C?(^ 

R9Z9CPXA^niA BZ. rJUmL D D Time: M L 

Numbe Staff: J±&WL r of Samples = | if- j 

Legend: Fl = Front Left, F2 = Front Right, Bl = Back Left. B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

AH quadrants are as vieiMed from the street, facing property 

A |/&L - ^ ENTJERED 

• n^i i 

3/ IK 

^J. ^2 

> 

33.2q'.6>ri^.Sf 

—<•• e •' • • • V 

Fl F2 

150 m 

wTir 

Corky S'l. Rev 4' 04«I410I23 
COASTA l IHVItOHHIhlAL 

C > 0 U r . I il 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 

follov^ing described premises: ^3// 

Owner's Name: Daytime Phone: W/di UW^dc^ 

Address of Property 

covered by this ^ ^ ^ C.^ s+ 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 materiais 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 wili 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 perfomiing 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 lNVIiONH>KTAl 

C « 0 U P IMC 

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

piles, dog houses, etc; 

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

to save; 

< 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 

0< g grant access to my properties 

D I do not grant access to my properties 

Signature Date Signature 

Date 

D I would tike to be present during any sampling that Is required. 

Page 2 of 2 
COA S T A L • NViaONHB H T A L GROUP , INC . 

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). 

PropertylD: ^Pf^jf-j 

Property Address;-g'52(^ <gc^y E'V 

Owner: ^]^^ ^ [,k>sUrcr./^ 

Phone: fdP-^^3--^^/ ^ 

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 ofthe property and the basement if 

necessary. 

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

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

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

Hem: 

/U/mey 

item: 

Kem: 

item: 

Page 1of ^ 
*4 

COA S T A L • MVmONHB N T A L OROUP . INC . 

Items to Be Removed By Contractor During Remediation and Replaced 

Item 

Landscape Inventory 

Quantity Unit Condition/Type/Species 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. /O: Quadrants 

Number of trees > 2 inch 

trunk diameter 

J r-f Each 

Nimiber of trees <= 2 inch 

trunk diameter 

IP -h Each 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Attach a sketch of the 

sprinkler layout. 

Each 

Nimiber of and size of 

each garden/ flower bed 

area. 

Attach a sketch of relative 

sizes and locations. 

Each 

Square Feet 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

Note this value will be 

used to issue a plant 

voucher to the property 

owner. 

Easement Area, to be Each 

^ ^n excavated 

W o^<y^ 

Page 2 of. 3 
COA S T A L 

O • O U P , INC . 

Additional Comments / Instructions: 

The city of Omaha ordinances may prohibit you from using dirt or gravel areas on your property 

as driveways or vehicle parking areas. The Environmental Protection Agency (EPA) may be 

removing and replacing soil underlying a gravel or dirt area on your property that you may be 

using as a driveway or vehicle parking area. If this is the case, you should understand that this 

removing and replacing of soil does not mean that any illegal driveway or parking area on your 

property is made legal. To the contrary, you may be cited by the city If you use a gravel or dirt area 

2ffi a driveway or parking area, not withstanding any removal or replacement of soil by the EPA 

If you have any question about legality of a certain driveway or parking area, you may contact 

the city of Omaha's Planning Department at (402) 444-5150. 

O Piease check this box if you understand the information outiined above. 

\i ^ s ^^^r^A H 

lAn u ^ ^^A e.J ^^^^ "^^ 

~^ Check the box if Owner does not want CEG to document interior foundation walls and possible 

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

interior of house, including foundation cracks or fissures. 

H' l agree CH I do not agree 

y<JiyV^ (OMlc 'Uic ) 

Owner's Signature Date Contractor's Signature Date 

Page 3 of y 
XRF PROPERTY SAMPLE SHEET 

Date / - /i ' LOd Address 

Project Omaha Lead ARRA Sample time 

XRF ID# .^-=1(9^2. sample length 

Shot# Reading Sample area Shot # 

139 /9L t Zl BA 

(5 ^ I'li i a Depth 

IbO I66 i Z-\ / " 

Average m. u / Average 

Shot# Reading Sample area Shot# 

I U 5 5 i 14 RL 

l ^ 54 i 15 Depth 

164- 55 ^- 13 6" 

Average 55 ^ 1^ / Average 

Shot# Reading Sample area Shot# 

Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# 

^^^7 Depth 

/ / 

Average Average 

Signature 

(1^)^ ^ |W/1 ^ 

Print 

BVID# 21^=1314 

2K^Z O C^z&y B r 

am/pm 

30 sec 

Reading Sample area 

Depth 

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 161 

Mode SOIL 

Time 2011-01-12 18:38 

Duration 90.62 

Sequence Final 

Flags 

AVERAGE Avg of 158-160 

ADDRESS 3320 CORBY ST 

QUADRANT EA 

DEPHT 1" 

XRF TECH C.PADILU 

MISC CONFIRMATIION 

NOTE CLEAR 

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 182.660 

Supervised By: 

Certificate of Verification 

158 

SOIL 

2011-01-12 18:36 

30.19 

Final 

29314 

3320 CORBY ST 

EA 

1" 

C.PADILLA 

CONFIRMATIION 

CLEAR 

± Error 

21.007 
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 193.606 

Supervised By: 

Certificate of Verification 

159 

SOIL 

2011-01-12 18:37 

30.21 

Final 

29314 

3320 CORBY ST 

EA 

1" 

C.PADILLA 

CONFIRMATIION 

CLEAR 

± Error 

± 21.545 
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 186.089 

Supervised By: 

Certificate of Verification 

160 

SOIL 

2011-01-12 18:38 

30.22 

Final 

29314 

3320 CORBY ST 

EA 

1" 

C.PADILLA 

CONFIRMATIION 

CLEAR 

± Error 

± 21.336 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Supervised By 

Certificate of Verification 

165 

SOIL 

2011-01-12 18:41 

90.29 

Final 

Avg of 162-164 

3320 CORBY ST 

B2 

6" 

C.PADILLA 

CONFIRMATIION 

CLEAR 
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 55.915 

Supervised By: 

Certificate of Verification 

162 

SOIL 

2011-01-12 18:39 

30.10 

Final 

29314 

3320 CORBY ST 

B2 

6" 

C.PADILLA 

CONFIRMATIION 

CLEAR 

Error 

14.047 
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 54.160

Supervised By: 

Certificate of Verification 

163 

SOIL 

2011-01-12 18:40 

30.05 

Final 

29314 

3320 CORBY ST 

B2 

6" 

C.PADILLA 

CONFIRMATIION 

CLEAR 

± Error 

± 13.723 
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 55.688 

Supervised By: 

Certificate of Verification 

164 

SOIL 

2011-01-12 18:41 

30.14 

Final 

29314 

3320 CORBY ST 

B2 

6" 

C.PADILLA 

CONFIRMATIION 

CLEAR 

Error 

± 13.856 
Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

www.coastalhazmat.com 

COASTA L INVIIONMINTAL 

C I 0 U P. IN C 

EXECUTIVE SUMMARY: 

BVID #29314 -(3320 Corby St) 

py] No Issues or Concerns Issues/Concerns 

Detail Explanation: 

NO ISSUES PENDING 
4

ft K EPA 

EPA Property Close Out Form 

Property it: 

^M/'/ a Property Address: 

Date/Tine: OwBcr's Name: 

Quads Excavated: ^'l ^ Contractor Group 

Excavation General 

1. If necessaiy, were thc correct quadrant(s) excavated and restored? 

2. If necessary, were the correcl areas ofdrip zone excavaled and restored? 

GradioK Sod and VcRctation 

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

from the house? 

2. Has sod been laid in all 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? 

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

time period) 

6. Was the property graded such that waler will not pool on the property'? 

7. Was damage to landscaping or plant materials avoided? 

Gates, Fences and Retainins Walls 

1. Do gates open and close freely? (Ifapplicable) 

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

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

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

Foundation, SidiDK and Gutters 

1. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? 

3. Was damage to windows avoided? 

 Was damage to windows or door screens avoided? 

S. Was damage to downspouts or downspoui extensions avoided? 

Sidewalks and Driveways (Concrete) 

1. Was damage lo driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

Yes No 

t / 

y 

Yes No 

y 

/ 

y 

/ 

y 

/ 

/ 

Yes No 

/ 

/ 

/ 

y 

Ves No 

/ 

y 

y 

y 

y 

Yes No 

/ 

y 
Mfi­ 0>«'Ders comments: 

Inspection notes: 

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

EPA Representative ^'^] ^ Date: j^i,^, 
Property Completion Agreement 

This agreemenl documenls. Ihe compiclion ot remedial aclivmes perloimed on my pioperty My signalure 

will designate llial I am satisfied wilh Ihe resloralion of my properly, and ihal no ilems are in quesiions. 

now, or al any lime in the fuluie, excepl those ilems listed below, if any 

Propcrf>rD: ^^^/i ^ 

Property Address: 3^0-/ 5 Sd Owner: @McLJil 

Phone: c/,9^-^g?P? 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Addrtional Comments: 

&l» Ugrcc restoralion n completed, except as noted 

[_J I do not ai;rec reparation is completed 

Owner's Sicnatiirr Date Conti arfor's Signatur Sicnalnre Dale