• • 

TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: ^^^l O 

Date: ^/Zz/z^ i 

Address: ^fil ^ N ^[ p Pt^ t ^ 

Remediation Contractor: Coastal Environmental Group Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

\V 

Restoration Agreement 

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

Confirmation data 

Photographs 

As-built sketch 

o/ 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

0 / Utility clearances 

Property information from Douglas Coimty Assessor's Office 

D 

g/SA^f 

ate 

XH^ 
Property Access Checklist 

Property' ID: 3 ^ Lj / Q 

n WORK STARTED ON: _/ l_ 

Propert D WORK COMPELTED ON: I Iy Address: 4 5 D^: 1\ / -^( ^ gy / 

Owner: Rcnten yh^ ri^g? n Hr^lhntd 

Address; C 

Phone: ayy) ^ 

Fax: 

Cell/Pager: 

Phone: Additional Infonnation: 

l^\i -inoun 

Fax: 

Cell/Pager. 

D Notification Letter Sent: / / By: 

H^ Accesii Agreement Signed: ii/^/i ^ By: £ . C 

00^ Restoration Agreement Signed: Jf l _0_li25f By: r..<x 

Q Topsoil Sampling (if applicable) 1 1 By: 

0 Disposal Sampling (if applicable) 1 t By: 

Q Giirdcn Sampling (if applicable) 1 1 By: 

0 ^ Utility Clearance Called: IL/^/ ^ By:////5/CS 

STT Video/Photos (Before) On: _il/^/ ^ 

By: A/l(^V//$s/r^'v>;an 

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

n Video/Photos (After) On: / / By: 1 

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

D Property Completion Agreement Signed: / / By: 

D Final Report Issued: / / By: 

Air Monitoring (as applicable) 

n Community O Crew On: / / By: 1 

Results: 1 

CD Communitj' CU Crew | On: / / By: 1 

Results: 

n Community • Crew On: / / By: 

Results: 

Omaha Lead Site 
Property ID ^

Property 

Address: 

Inilial Contaci: 

Second ConLaci: 

Final Conlact: 

Final Action: 

Comment: 

ONvner 

Ccimmeni (s): 

Site 

Coordinator 

Commeni (s): 

C0NTAC7 FORivI 

 3^^1( 1 

f^ 

N 3fo Av 

Date: Time: Action: 

Date: Time: Action: 

Dale: Time; Action: 

Transmit to EPA D Other Action. D 

„-.J 
Douglas County Account InfqM|ation Page 1 of2 (jjl^t 

Douglas County, Nebraska Property Record - R1800190000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of SOth St - Vie w Ofl Ma p Information is valid as of 2008-9-4 Treasurer's Tax Report 

New Feature ->->- • Auto Sales Search 

Owner 

HOLLAND SHERMAN 

ETAL 

4518 N 36 AVE 

OMAHA NE 68111-0000 

Property Informatio n 

Key Number: 0019 0000 18 

Account Type: Residential 

Parcel Number: 1800190000 

Parcel Address: 4518N36AV 

OMAHA NE 68111-0000 

Legal Description: MOES SUB LOT 9 BLOCK 1 47 X 133 

Value Informatio n 

Land Improvement Total 

2008 $4,800.00 $29,700.00 $34,500.00 

2007 $4,800.00 $29,700.00 $34,500.00 

2006 $4,800.00 $29,700.00 $34,500.00 

2005 $4,800.00 $5,600.00 $10,400.00 

2004 $4,800.00 $5,100.00 $9,900.00 

2003 $4,800.00 $5,100.00 $9,900.00 

Sales Information 

Sales Date: 2007-04-16 

Deed Type: WD SooAr; 2007 Page: 049154 

Price: $38,000.00 

Grantor: Christensen Edward etal 

Grantee: Holland Sherman etal 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.14 6251.0 1.0 133.0 47.0 No 

Improvemen t Informatio n 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R18... 11/4/2008 
Douglas County Account Infqanatio nua n Page 2 of2 i 

Building 1 

SvccndFtosr 

»HM T J66.0 <q • 

1? ** '* 

i r 

FMFtoar « «0«Osq t 

u« 11/2 Ft 

! JU . KSOvi 1 

CLICK TO ENLARGE IMAGE 

Square Footage: 1173.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Average 

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

HVAC: Forced Air Rooms: 5.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 2.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

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 

1895 0% 1895 111 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 808.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 2.0 

Porch End Screen 140.0 

Porch Slab Roof Ceil 72.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R18... 11/4/2008 
Page 1 of2 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2172054. 

Original Call Date: 11/09/08 Time: 4:21 pm Op: ELIZABETH18790 


Work to Begin Date: 11/13/08 Time: 7:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4518 Street: N 36TH AVE 


Twp: 15N Rng: 13E Sect-Qtr: 05-NE-SE . -


Twp: Rng: Sect-Qtr: 


Legal Given: C ^ 


Type of Work: lead remidiation ,,,• , 


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


: STREET. 


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


Company : COASTAL ENVIRONMENTAL SERVICE 


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


Work Being Done For: coastal 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV METRO MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 


CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 


Emerg: 4029329757 


Day: 4024572307 

METRO METRO COMM. COLLEGE CHRIS Alt: 4026727033 

Emerg: 4024572313 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11/9/2008 
Page 2 of2 

Day: 4067289343 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA Alt: 8887289343 

Emerg: 4067289343 

Day: 4067289343 

QLNNEIC QWEST LOCAL NETWORK m . Alt: 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11 /9/2008 
34410 

Omah Exterior Paint North Arrow Owner Name: EDWARD H CHRISTENSEN a Lead Site • Good Site Sketch Address: 4518 N36AV 

Phone: *^ 

W: 

|[] Not paint 

Sample Number Lead Sample Samples;

 Colleqte Collectedd LAB Concentration Collected Firm: 

RYASCPXA-34410 Fl Zl ^ ppm D Date: iQ|>^|Aq RYBSCPXA-34410 F2 5f ppm D Time: 17,' n 

RYCSCPXA-34410 81 J^ I ppm [IK D Samples Analyzed RYDSCPXA-34410 B2 ^^ ^ ppm 

RDZSCPXA-34410 DZ nK n

ppm XRF Unit: 0/"^ ^ Book: ^ S

RCZGGPXA 34410 G2- D

ppm D Date: /^-^/-^ ^

RPZSCPXA 34410 -RZ D

ppm Time: F^/* ^ D 

Staff: tPJT^ ^ Number of Samples = 

^NTEREB ,Woj'])lc W^'iii> c,/(. 

V//-S' 

<^&^ -f 

Omaha Lead Site 

, / • 

46130 
34410 

Omaha Exterior Paint North Arrow Owne Lead Site r Name: EDWARD H CHRISTENSEN • Good 

Address:4518N36AV Site Sketch 

QJxP^r 

Phone: •+ W: Q Not paint 

Sample Number 

RYASCPXA-34410

RYBSCPXA-34410

RYCSCPXA-34410

RYDSCPXA-34410

RDZSCPXA-34410

RGZCCPXA 34410

RPZSCPXA-34410 •

 Fl 

 F2 

 Bl 

 B2 

 DZ 

 GZ­

 -SZ 

Lead 

Concentration 

X2JX±— ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

Sample 

Collected 

nK 

GK 

D 

Number of Samples = G 

LAB 

D 

D 

D 

D 

D 

D 

D 

Samples Collei 

Firm: _ 

Date: _ 

Time: t?,: H 

; Collected 

04 )6^J 

iQh^lA q 

Samples Analyzed 

XRF Unit: ^/^^ ^ Book; ^ 

Date: /^-"^/-^ ^ 

Time: ^/> ^ 

Staff: JtP^:^ ^ 

^ 

OCT i 4 ;:uw 

<s^ K 

Omaha Lead Site 

%• • 

^ ^ 

.0^ 

u;ifv:uC 

KlA(ip. 

557 

AN/ 

46130 I 
COASTA L ENVIRONHtNTA L 

C II O U P . IM C 

Consent For Access To Property 

RIGHT OF ENTRY TO PREMISES 

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

Environmental Protection Agency (EPA) or Its authorized representatives, collectively 

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

following described premises: 

Owner's Name: Daytime Phone: 

Address of Property 

covered by this 

Agreement: VSIR M^t^M . 

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 
^^•**^ * COASTAL ENVIROMNENTAL 

6 I O U r . IN C 

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

piles, dog houses, etc; 

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

to save; 

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

necessary subsequent to an Initial watering period by EPA; 

• Abide by health and safety guidance provided by EPA; 

• If the property Is rented, assist EPA In obtaining tenant approval for access to 

the property to perform the work. 

• Allow videotaping and/or photographing of the property. 

AGREEMENT NOT TO INTERFERE 

The Grantor agrees not to interfere or tamper with any of the work activities, or with any 

of the work done, or with the equipment used on his property, or to undertake any 

actions regarding the use of said property which would tend to endanger the health or 

welfare of the Grantees or the environment, or to allow others to use the property in 

such a manner. 

Should you have any questions about this program, please contact Coastal 

Environmental Group, at (712) 352-0188 

-TfNQ I grant access to my properties Q I do not grant access to my properties 

;f^flQXj)^lj^ 4[u^C<-^vA £ia^M ^ d^gjai^X n/Qm^ 

Signature Date Signature Date 

O I would like to be present during any sampling that is required. 
COASTA L ff r ' IHOHH n MTA l 

c n o 1^ f- IM 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 propeiiy owner and the United States Environmenlal 

Protection Agency (EPA). 

Property ID: ^C/C^f() 

Property Address: yj7 ^ /\ ) '^(Jl- f\^/^_ 

Owner: .Q\^rjMa ^ /A//a,nr^ . 

Phone: (pix-CnnionOn the attached diagram(s) indicate area(s) to excavated and depth of excavation, location of all known 

utilities, subsurface features, syrface structures and landscaping features, access locaiion(s) to be used by 

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

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

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

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

Item: 

I t / yi /-s y/J/ X ~-- ^ 

rfr' ' ¥ Ht/i^i J 

-jp /l//)/yt ^^ \ Item: 

Item: ^ ^ 

Item: / 

/ 

Item: / 

Item: / 

Item: 

Page 1 of c ^ 
COASTA L 

C M O U r . IM C 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

Uf/ M,.J - ^ 

Item: i ^ / 

Item: 

/ 

Kem: 

/ 

Item: / 

Item: 

/ 

Item: 

/ 

Item: 

/ 

Item: 

/ 

Item: 

/ 

Item: / 

Item: / 

Item: 

/ 

Item: / 

Item: / 

Page 2 of (P 
< ^ ^ 

C p A S TA L CMVlNOMMfNTA L 

C n O u r > N C 

Items To Be Removed By Contractor Durinq Remediation And Replaced 

(Use additional sheets as necessary) 

ll Item: 

,<;<., / - FJ , C>£ 

Item: 

SoJ ' r^pe. ^ i ^ ^ 

Item: 

) 

Item: X 

Item: > / 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

/ 

Item: / 

" / 

Item: / 

Item: 

/ 

Page 3 of_k 
COASTA L 

Item 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

i 

Number of trees > 2 inch 

trunk diameter 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Attach a sketch of the 

sprinkler layout. 

Number of and size of 

each garden/ flower bed 

area. 

Attach a sketch of relative 

sizes and locations. 

Landscape Inventory 

(Use additional sheets as necessary) 

Quantity Unit Condition/Type/Species 

F^/i ^ 

Square feet 

fi) Each 

•• 

1 1' ' 

Each 

^ 

Each 

^ 

; . „ 

Each 

Square Feet 

f ^ 

Page 4 oiJjL 
^^ ^ COASTA L c M V t n o N r* t M r A ( <, n o u r IM C 

Item Quantity Uriit Condition/Type/Species 

Agreed upon value of 

plant materiaU not to be 

renlaced bv contractor. 

Note this value will be 

used to issue a plant 

voucher to the property 

owner. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. Each 

Include a sketcli of were 

each plant will be placed 

by the contractor. 

Agreed upon 

property to be 

with grass sod. 

area of 

replaced 

Include a sketch of the 

area(s) to be replaced with 

grass sod. 

SF 

^(Uie6ra^' > 

Area of City or County 

property to be landscaped 

per their requirements. SF 

Include

aiea (s) 

a sketch of the 

Easement Area, to be 

excavated SF Xi> y,^ J^-^^^'^""^ 

Page 5 of i^ 
C OASTA L ttMVANOI'MSMTAI. 

«*ewr . IM C 

Additional Comments / Instructions: 

SCCCXY^C 'P^ l • t^v^CCro ^ aJ>Nj4l\'r^a I y\ uJoj J » 

D 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 fbr any damage done to the 

interior of house, induding foundation cracks or fissures. 

"TC t34^Te e Did o not agree 

(jr Owner's Sigaature Date Contne&tr's S%;natore Date 

PaqeSof VO ___ . ....--.--. . - ­
BviD#;^<4mo 


XRF PROPERTY SAMPLE SHEET 


Date Address -H^xta, \0 . ?2,Co^ Kv^, . \\-\-i-oF> 

Project Omaha lead FP 2nc] year opllon Sample time ' ^ . 'O ^ am/pm 

XRFID# 5F^O@q sample length 30 sec 

Shot# Reading Sample area Shot # Reading Sample area 

J-A31 'r?>3 .«H t M.i o c^a?>(D i&o-.^ ^ Iba a 

aa;2,-3 7 ^ ,\M.U-l^)U-0'S p.c4P,n .<H<3 •^u-t-lU.lM 

.=M?3 3 JY\.^<.-t\.^.0-7 Depth A^3 ^ gSt.iSH t )8. )o Depth 

,^?? M q^.-;? ^ i^a q \ c\?,.Qu±.\l.cn I S^Ss^S CP 

Average l^H . 1^1 t ^^^.^l U Average cpQco.CoJ t \-i .QC ^ 

Shot# Reading Sample area Shol# Reading Sample area 

jg^ l iH-^-^or. mfi D 

%r^.-r^tsQ,i q b^ 3^^ ^ 

3'44.3 :^i^'U^)RCS - Depth Depth 

3^X^ ^qa, !Ht^:^f a \ 3 

Average ^77~?-2oi - ^ 0 1 ^ Average 

Shot# Reading Sample area Shot* Reading Sample area 

Depth Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

lab sample # Lab result Sample area XRF Avg. 

SiQnatureQ)r'^/tQl/^> ^ 

Print rAAbs^ \ Crm)^f) 
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 133.937 

Supervised By: 

Certificate of Verification 

3431 

SOIL 

2008-11-17 09:59 

30.63 

Final 

34410 

4518 n 36 ave 

easement 

Ventry 

1 

CLEARANCE 

± "Eiror 

± 14.100 
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 169.469 

Supervised By: 

Certificate of Verification 

3432 

SOIL 

2008-11-17 10:00 

30.30 

Final 

34410 

4518 n 36 ave 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 16.083 
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 111.562 

Supervised By: 

Certificate of Verification 

3433 

SOIL 

2008-11-17 10:00 

30.59 

Final 

34410 

4518 n 36 ave 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 13.072 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 93.771 

Supervised By: 

Certificate of Verification 

3434 

SOIL 

2008-11-17 10:01 

30.63 

Final 

34410 

4518 n 36 ave 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 12.486 
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 

Certificate of Verification 

3435 

SOIL 

2008-11-17 10:01 

122.15 

Final 

,Avg of 3431-3434 

'4518 n 36 ave 

^asemen t 

Gentr y 

CLEARANCE 

ppm ± Error 

Pb 127.185 ± 13.935 

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 186.130 

Supervised By: 

Certificate of Verification 

3436 

SOIL 

2008-11-17 10:02 

30.28 

Final 

34410 

4518 n 36 ave 

F2 

Ventry 

6 

CLEARANCE 

± Error 

± 16.436 
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 192.755 

Supervised By: 

Certificate of Verification 

3437 

SOIL 

2008-11-17 10:03 

30.60 

Final 

34410 

4518 n 36 ave 

F2 

Ventry 

6 

CLEARANCE 

± Error 

± 16.735 
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 230.288 

Supervised By: 

Certificate of Verification 

3438 

SOIL 

2008-11-17 10:04 

31.04 

Final 

34410 

4518 n 36 ave 

F2 

Ventry 

6 

CLEARANCE 

± Error 

± 18.099 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 3439 

Mode SOIL 

Time 2008-11-17 10:04 

Duration 30.29 

Sequence Final 

Flags 

BVID # 34410 

ADDRESS 4518 n 36 ave 

QUAD/ZONE F2 

INSPECTOR Ventry 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 193.261 ± 16.965 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 3440 

Mode SOIL 

Time 2008-11-17 10:04 

Duration 122.21 

Sequence Final 

Flags 

AVERAGE tfiivg^ of 3436-3439 

ADDRESS 4518 n 36 ave 

QUAD/ZONE 

INSPECTOR 0Ventr ^ y 

DEPTH 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 200.609 ± 17.059 

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 149.502 

Supervised By: 

Certificate of Verification 

3441 

SOIL 

2008-11-17 10:06 

30.66 

Final 

34410 

4518 n 36 ave 

DZ 

Ventry 

13 

CLEARANCE 

± Error 

± 14.895 
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 340.586 

Supervised By: 

Certificate of Verification 

3442 

SOIL 

2008-11-17 10:06 

31.00 

Final 

34410 

4518 n 36 ave 

DZ 

Ventry 

13 

CLEARANCE 

± Error 

± 22.193 
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 226.910 

Supervised By: 

Certificate of Verification 

3443 

SOIL 

2008-11-17 10:07 

30.69 

Final 

34410 

4518 n 36 ave 

DZ 

Ventry 

13 

CLEARANCE 

± Error 

± 18.553 
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 393.785 

Supervised By: 

Certificate of Verification 

3444 

SOIL 

2008-11-17 10:08 

30.31 

Final 

34410 

4518 n 36 ave 

DZ 

Ventry 

13 

CLEARANCE 

± Error 

± 23.521 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 3445 

Mode SOIL 

Time 2008-11-17 10:08 

Duration 122.66 

Sequence Final 

Flags 

AVERAGE ^Avg of 3441-344'! 

ADDRESS 4518 n 36 ave 

QUAD/ZONE 

INSPECTOR Ventry 

DEPTH #3 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 277.696 ± 19.791 

Supervised By: 
X 

X 

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

Coastal Environmental Group Inc. 

www.coastalhazmat.com 

%«,oX«^'^ COASTAL ENVIRONMENTAL 

G R O U r , INC . 

EXECUTIVE SUMMARY: 

BVID # 34410 - (4518 N 36 AVE) 

No Issues or Concerns I I Issues/Concerns 

Detail Explanation: 
.®^EPA 

EPA Propert>' Close Out Form 

Property«: .•^M-^V O Property Address: <Q?S\P) K^ - ^o^ ^ IW^ ­

Datc/riroe: Owner's Name: cSV\5Un(Y\(X.ir\ \\f:>VVGLnci 

Quads Excavated: ^; ^ ^ t^'fc Contractor Group 0 f^CLS^C^^ "p- rwXrQf^**-'''-^^*'''^'^^^^ 

Excavation General Yes No 

1. If necessary, wert the correct quadrant(s) excavated and reslored? / 

2 I f necessary, were the correct areas of drip zone excavated and reslored? 

^ 

GradiDK Sod and VeteUtio a Yes No 

1 Does the grading around the perimeier ofthe house in excavaied areas generally slope away . ^ 

from tbe house? 

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

3. Does the sod appear lo be generally healthy and growing? (Only evaluate if inspecied at a 30 ^ 

day lime period) 

4 Are sodded areas generally fu m and evenly graded? 

1 ^ 

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

lime period) 

6 Was the properry graded such thai water wil l not pool on Ihe propeny'' 

7 Was damage to landscaping or plant materials avoided? 

Gates, Fences and ReUinlD£ Walls

1 Do gates open and close freely? (Ifapplicable) 

2 Were all gates or fences taken down during restoration activities reinstalled?

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

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

Foundation , SidioK and Gutler s

1. Was damage to the siding or trim avoided? 

2 Was damage to the foundation avoided? 

3 Was damage 10 windows avoided? 

4 Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspoul extensions avoided? 

Sidewalks and Driveways (Concrete)

1. Was damage to driveway surfaces avoided'' 

2. Was damage to walkway surfaces avoided? 

\ y 

y 

, / j 

 Ves No 

/ 

 (Ifapplicable) ^/*• 

\ 

• 

 Yes No 

<y^ 

^ 

^ 

y ' 

1 ^ 

 Yes No 

1 / 

y 
O •ners comments: 

Inspection notes: 

Removal and resloration aclivales complele including the 30-day sod v^arranty: 

EPA Representativeqdj^Ax^^^X^^^^^^^^J^^^^ Dale: //3/c)j 
Property Completion Agreement 

I'liis agreemenl documents the completion of remedial activities perlbimed on my properly^ My signature 

will designate that I am satisfied wilh the restoration of my properly, and that no items are in questions, 

now, or al any time in the future, excepi those ilems listed below, ifany. 

Property ID: 3mm Q 

Property Address: L/g-^ ^ ^ ^^-H . ^ ^ ^ , 

Q"" " •<;Ker/)^r, ^ an\la.^n l 

Phone: (^l^~(fO(nn 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item; 

Item: 

Item: 

•TR' [y-fagre c restoration is completed, except as noted 

 I I rio not a^jrec restoration is compleled 

Owner's Signature Date Conti atlw's Signature Dale 

I