TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: t^KClpt Date: W^i/ 

Address: IKS 4 \ y m

Remediation Contractor: Coastal Environmental Group_ Year: 20 oe^. 

SOIL REMEDIATION 

PROPERTY nL E FOLDER DOCUMENTS 

/ Video of property (DVD) \\i ' ^(^^11 ^ 

< / Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

-tr Signed Access Agreement(s) for adjacent property 

7 Restoration Agreement 

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

-a7 

Confimiation data 

Photographs ^ ^

As-built sketch 

^ \'^r>'> V HCP^^ ^ \ ^k> bfiCMPrXW^ 

>7 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description ofareas not meeting ROD cleanup criteria 

Utility clearances 

y Property iii^un^ion from Douglas County Assessor's Office 

D 

D 

D 

Date 

Superfund 
Property Access Checklist 

Propcit) ID: <-|<^ 5(^-2 ^ 

Property Address: t-^(^f5^ tS ?>t> ftA/^ 

D

D

 WORK STARTED

 WORK COMPELTED

 ON: 

 ON:. 

_/

/

 /_ 

/ 

! Owner: (^^ ^

Address:'5oirn ^ 

 Hav-Hmr v Renter 

Phone: 

PiLv: 

1 

Phone: 51/=5-q^^l ^ 

Fax: 

Cell/Pager: 

Additional Inlormntion: 

Ccll/Pager. 

D Notification Letter 

1 E T Access Agreemenl 

[2I Restoration Agreement 

D Topsoil Sampling (if applicable) 

1 D DisposaJ Sampling (if applicable) 

CU Gnrdcn Sampling (if applicable) 

" ^ Un'lity Clearance 

I eg Video/Photos (Before) 

D Video/Photos (Durine) 

Sent: / / 

Signed: Ja./J:/ ^ 

Signed: (^ / 8^ /0 i 

/ / 

/ / 

/ / 

Called: j£./12,/ ^ 

On: ^ 1 J£ l QJf 

On: / / 

By: 

By:e.c 

B>: F.. CL 

By: 

By: 

By: 

^y-?qQ. 

^yik-AJfc/t^VtJ(^fic,y, 

By: 

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

D

^

 Video/Photos (30-Day) 

 Property Completion Agreement 

On: / / 

Signed: ^/i^/ ^ 

By: 

By: 

• Final Report issued: / / . . 

Air Monitorine (as applicable 

n Community D Crew 

) 

Results: 

On: / / By: 

D Community

Results:

 • CrcMv On: / / By: 1 

1 

• Community

Results: 

• Crcw On: / / 'By : 1 

Omaha Lead Site 
Property ID #

Property 

Address:

Initial Contact:

Second Contact:

Final Contact:

Final Action:

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

 Hg5b ^ 

 ^R5 ^ 5 ^ ^ av ^ 

 Date: Time: Action: 

 Date: Time: Action: 

 Date: Time: Action: 

 Transmit to EPA D Other Action: D 
Douglas County Account Info^^nn Page 1 of3 

Douglas County, Nebraska Property Record - R0809680002 

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 

MARTINEZ ROSE A 

ETAL 

4958 3 36 AVE 

OMAHA NE 68107-0000 

Property Informatio n 

Key Number: 0968 0002 08 

4ccounf Type: Residential 

Parcel Number: 0809680002 

Parcel Address: 4958 8 36 AV 

OMAHA NE 68107-0000 

Legal Description: CHRISTIE HEIGHTS LOT 3 BLOCK 6 LTS 1 2 & 101.6 X 110 

Value Informatio n 

Land Improvement Totol 

2009 $8,700.00 $150,000.00 $158,700.00 

2008 $8,700.00 $150,000.00 $158,700.00 

2007 $8,700.00 $122,400.00 $131,100.00 

2006 $8,700.00 $122,400.00 $131,100.00 

2005 $8,700.00 $94,700.00 $103,400.00 

2004 $8,700.00 $86,100.00 $94,800.00 

Saies Informatio n 

Sales Dato: 2005-03-25 

Deed Type: WD SooIr; 2005 Page: 034709 

Price: $133,900.00 

Grantor: FRANCES MERTZ 

Grantee: ROSA A MARTINEZ ETAL 

Validnnvalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Unlto Depth Widtii Vacant 

0.25 11220.0 1.0 110.0 102.0 No 

Improvemen t Informatio n 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R080... 6/7/2009 
Douglas County Account InfQfl^|on Page 2 of3 

Building 1 

4958 S 36 Av 

*ra,'r 

J ^ 

1.5 STORY FINISH 

78!. O So Fl 

CLICK TO ENLARGE IMAGE 

Square Footage: 2038.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

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

HVAC: Central Air to Air Rooms: 7.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 2.5 

Roof Cover: Composition Shingle Bedrooms: 4.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Blocl< 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1978 0% 1978 31 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Appliance Fireplace Metal 1.0 

Basement Bsmnt Block 9 ft 2588.0 

Basement Finished 1200.0 

Basement Outside Entrance 1.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 2.0 

Fixture Bath Half 1.0 

Garage Attached 364.0 

Porch Open Slab 786.0 

Porch Slab Roof Ceil 234.0 

Porch Wood Deck 132.0 

Porch Wood Deck 87.0 

User bsmt fin after sale 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R080... 6/7/2009 
 1.0 

Douglas County Account Inf<gd^|on ^Mk Page 3 of 3 

User wants to make daycare

http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=R080... 6/7/2009 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Intemet Send Email 

• YOUR TICKET NUMBER IS 2321712. 

Original Call Date: 7/20/09 Time: 3:06 pm Op: ELIZABETH18790 

Work to Begin Date: 7/22/09 Time: 3:45 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 4958 Street: S 36TH AVE 

Twp: 14N Rng: 13E Sect-Qtr: 05-SE 

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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV METRO MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


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 

MUD02 METROPOLITAN UnLITIES 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... 7/20/2009 
Page 2 of2 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA

Day:

 Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK NA

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/20/2009 
As-Built Drawing 

C OAST A L Omaha Lead Superfiind Site 

48562 

Omaha Lead Site Exterior Paint North Arrow 

Site Sketch Q^oo d 

• Poor 

Samolina Address: 4958 S 36 AV 1 1 Not paint 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm: PE TN C pTSTL 

RYASCPXA-48562 Fl ppm n Date: ft/ZT/ofl 

RYBSCPXA-48562 F2 J i ^ ppm n Time: I • M*? ^ . M 

RYCSCPXA-48562 81 / I B ppm n 

Samples Analyzed 

RYDSCPXA-48562 82 JL5_ ppm \y n 

RDZSCPXA-48562 DZ xia ppm n XRF Unit: CQS^O Book: 2f'=\ . RGZSCPXA-48562 GZ 5'H'5 ppm n Date: ^•15-o e RPZSCPXA-48562 PZ zn. ppm n Time: _arL. Staff: Number of Samples = | ~J | | ^ | cns(^ 

Legend: F1 Front Left. F2 = Front Right, B1 = Back Left. 82 = Back Right DZ = Drip Zone, GZ •-

All quadrants are as viewed from the street, facing property 

Date Excavated:7/23/09 

Legen d 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced with 

Area left bare Sod ' ' Rock/Mulch 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
48562 

Exterior Paint North Arrow Omaha Lead Site 

Q^oo d Site Sl(etch • Poor 

Sampling Address: 4958 S 36 AV Q Not paint 

Sample Number 

RYASCPXA-48562 Fl 

Lead 

Concentration 

ppm 

Sample 

Collected 

Q^ 

LAB 

D 

Samples Collected 

Firm: PE TN C QhX ^ 

Date; 9,lZ~llo& 

RYBSCPXA-48562

RYCSCPXA-48562

RYDSCPXA-48562

RDZSCPXA-48562

 F2 

 B1 

 82 

 DZ 

15 

m 

ppm 

ppm 

ppm 

ppm 

ET 

Q ; 

a' 

[ / 

D 

D 

D 

D 

Time: l»Mg />. M 

Samples Analyzed 

XRF Unit: foSH D Book: 2 f*^ 

RGZSCPXA-48562

RPZSCPXA-48562

 GZ 

 PZ 

^^ 5 

zn 

ppm 

ppm 

n/ 

( ^ 

D 

D 

Date:

Time 

 ^-15-03 

_an. Number of Samples 7 J l Staff: msLo 

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

All quadrants are as viewed from the street, facing property , ... . 

y y ^ 
48562 

Omah Exterior Paint North Arrow a Lead Site 

Q^Good Site Slcetch • Poor 

Samollnfi Address: 4958 S 36 AV • Notpainl 

Sample Number Lead Sample 

Samples Collected UB Concentration Collected Firm: Pe TN^ . pftTi 

RYASCPXA-48562 F1 ^ i ppm n Date: ft/ZT/flg 

RYBSCPXA-48562 F2 GO ppm D 

Time: |'H 5 /'•/rt. 

RYCSCPXA-48562 B1 ne ppm n 

Samples Analyzed RYDSCPXA-48562 82 1 ^ ppm D

I RDZSCPXA-48562 DZ ppm n XRF Unit: roSHn Book: z n ia. RGZSCPXA-48562 GZ J^-Vf ppm n Date: 

RPZSCPXA-48562 PZ J l l ppm D 

Time: .fivi. 

Numbe Staff: msL j r of Samples = | *7 | | Q | 

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

All quadrants are as viewed from the street, teeing property 

Rev 2008 CKated: 0.1-Ma)-08 
COASTA L ^ 

HOKOlinfNia i 

• • O U » . INC 

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^ng described premises: . ,^ ^ 

M^5(;.7. 

Owner's Name: 

Daytime Phone: 

gg ^ ^Ka)c^ntl. 

Address of Property 

covered by this 

Agreement: 

^95 ^ ^- 56 i^uo 

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 woric to be performed, the Grantor will have an 

opportunity to review and approve the planned soil removal, and restoration v^ric 

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 vwitten 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 INViaODfirHT*! 

(•our . i ll 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 v^sh 

to save; i 

• 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 pro|perty. 

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 

^. I grant access to my properties 

D I do hot grant access to my properties 

4^A y^c^-fi'""^^^ 

Signature Date Signature 

Date 

Q I would like to be present during any sampling that is required. 
COA S T A L 

C H O U r IN C 

Restoration Agreement 

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

remediation activities. This will also serve as documentation for the purpose of assuring that restoration 

activities are completed lo the satisfaction of the propert\' owner and the United States Environmental 

Protection Agency (EPA). 

Property ID: 

Property Address: L^i^W S ^ U NKQ 

Phone: 61^ 

On the attached diagram(s) indicate area(s) to excavated and depth of excavation, location of all known 

utilities, subsurfiice features, surface structures and landscaping features, access location(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: 

NOMEL 

Item: 

Item: 

Item: 

" T^ Item: 

Item: 

Kem: 

Item: y 

y 

r 

Page 1 of. 
COASTA L 

o n o u p . t N c 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

u^ Item: 

zl y 

ttem: V 

Kem: 

Item: 

/ 

Kem: 

X 

Kem: 

Item: 

Item: 

Item: 

Page 2 ofj^ 
C p A S T A L f M V IMOMn l HTA l 

C « O U P IN C 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

1 Item: 

-bo's) c ^ l 

Item: 

i s d C^i ^ 

1 Item: 

""-V , 

I Item: 

) 

1 Kem: 

, / 

y Item: 

y 

y Item: 

y Kem: 

Item: y 

Kem: 

/ 

Kem: 

z 

Item: 

/ 

/ 

Item: / 

/ 

' Item: / 

/ 

/

Item: 

/ 

/ 

Page 3 of U 
COASTA L t N • IHONM t NTA L 

Q It O U P IN C 

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 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 

Square feet 

^ 

7 

•^ 

Each 

Each 

* 

\^«t> Each 

Each 

\ Square Feet 

Page 4of y 
COASTA L BNvmOMHtNTA l 

C H O U P IN C 

item 

Agreed upon value of 

Diant materials 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 conn-actor. Be 

very specific and detailed. 

Include a sketch of were 

each plant will be placed 

by the contractor. 

Agreed upon area of 

property to be replaced 

with grass sod. 

Include a sketch of the 

arca(s) to be replaced with 

grass sod. 

Area of City or County 

property to be landscaped 

per their requirements. 

Include a sketch of the 

area (s) 

Easement Area, to be 

excavated 

Quantity Unit Condition/Type/Species 

# 

$ 

/ 

», 

Each 

^ ^ SF 

1 SF 

SF 

%n^^ i M?^'/-h 

Pages 0,0 
C O AST A I. 

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

pre-existing damage. By checkir^ tiiis box CEG is not responsible for any damage done to the 

interior of house, induding foundation cracks or fissures. 

P7<^% Q I do not agree agree 

^ ^ ^A^i^'^( z.. (6-1) -@^ 2pf^?^Lm Lpk/rA^ 

Owner's Signature Date Cbntnctor's Signabire Date 

Page 6 ^..y..... 
BVID# -\%^t 

XRF PROPERTY SAMPLE SHEET 


Date 

Project 

XRFID # 

Shot# 

3 1 ^ 

\^?i ^ 

\%b'o 

\%5u^ 

Average

Shot# 

4X12­ jU2a 

J1S2CL 

\?:M 

Average

Shot# 

Average 

Shot# 

Average 

lab sample # 

^ h?>ic^ 

Omaha lead FP 2nd year opilon 

3 ^ ^ 

Reading Sample area 

%%,Z?.^\l,\i^ Depth 

q\.q^t\7.v> 

 ^^,M^ t i^C^ ^ 

Reading Sample area 

f;^.a3^iD.trg ^ 5 . M<t,.'3,git^€» 

?>\\i^n,i3 Depth 

•«>'^,>lig.i^ 

4 2.yMU' l ^ M ^ 

Reading Sample area 

Depth 

Address Mq^pX 's.'?j^t.^^ 

Sample time am/pm 

sample length 30 sec 

Shol# Reading Sample area 

Depth 

Average 

Shot# Reading Sample area 

Depth 

Average 

Shot# Reading Sample area 

Depth 

Average 

Reading 

RETEST AREAS 

Sample area Shot# Reading Sample area 

Depth Depth 

Lab result 

Average 

Sample area XRF Avg. 

Signature 

Print 

?^M\Ub 

i"t^.6./)Aibf^;^r/rp.^g^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1837 

Mode SOIL 

Time 2009-07-23 14:29 

Duration 122.12 

Sequence Final 

Flags 

AVERAGE 

ADDRESS *t958 s 36 ave 

QUAD/ZONE easement 

INSPECTOR Nicolas 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm Error 

Pb 

Supervised By: QCijtM^fi^ 
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 87.779 

Supervised By: 

Certificate of Verification 

1833 

SOIL 

2009-07-23 14:27 

30.66 

Final 

48562 

4958 s 36 ave 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

± 12.245 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 73.999 

Supervised By: 

Certificate of Verification 

1834 

SOIL 

2009-07-23 14:28 

30.50 

Final 

48562 

4958 s 36 ave 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

± 11.044 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1835 

Mode SOIL 

Time 2009-07-23 14:28 

Duration 30.52 

Sequence Final 

Flags 

BVID # 48562 

ADDRESS 4958 s 36 ave 

QUAD/ZONE easement 

INSPECTOR Nicolas 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 88.220 ± 12.164 

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 91.934 

Supervised By: 

Certificate of Verification 

1836 

SOIL 

2009-07-23 14:29 

30.44 

Final 

48562 

4958 s 36 ave 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

± 12.331 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1832 

Mode SOIL 

Time 2009-07-23 14:26 

Duration 121.34 

Sequence Final 

Flags ———^ 

AVERAGE iMM^s^B ^ ADDRESS "^-^JlBfTseave QUAD/ZONE GZ 

INSPECTOR Nicolas 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb r42.463" 

Supervised By: Z^Md] ^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1828 

Mode SOIL 

Time 2009-07-23 14:24 

Duration 30.47 

Sequence Final 

Flags 

BVID # 48562 

ADDRESS 4958 s 36 ave 

QUAD/ZONE GZ 

INSPECTOR Nicolas 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 58.232 ± 10.648 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1829 

Mode SOIL 

Time 2009-07-23 14:24 

Duration 30.09 

Sequence Final 

Flags 

BVID # 48562 

ADDRESS 4958 s 36 ave 

QUAD/ZONE GZ 

INSPECTOR Nicolas 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 43.380 ± 9.537 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1830 

Mode SOIL 

Time 2009-07-23 14:25 

Duration 30.45 

Sequence Final 

Flags 

BVID # 48562 

ADDRESS 4958 s 36 ave 

QUAD/ZONE GZ 

INSPECTOR Nicolas 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 33.128 ± 8.730 

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 35.111 

Supervised By: 

Certificate of Verification 

1831 

SOIL 

2009-07-23 14:26 

30.33 

Final 

48562 

4958 s 36 ave 

GZ 

Nicolas 

6 

CLEARANCE 

± Error 

± 8.818 
# # 

^O. \ Omaha Lead Site—Fixed Price EP-R7-07-05 

^^^ ^ I Coastal Environmental Group Inc. v ^ j ^ www.coastalhazmat.com 

'^iPRot*''^ COASTA L EN«IIOHHINT*l Clour , IH C 

EXECUTIVE SUMMARY: 

BVID # 48562- (4958 S 36 AVE) 

py] No Issues or Concerns Q Issues/Concerns 

Detail Explanation: 

-COASTAL TO REPLACE WATER HOSE. (COMPLETED 8/2/09) 
4

EPA 

% 

EPA Property Close Out Form 

Property»: H^^CoT . PropertyAddressi-^-; ' ^ ^t^t^i'^Za. ^ 

DatcHlroe: O^^er's Name: /L ^ H^r , t:WV ^ ^ 

Quads Excavated: ( ^ j . Contractor Grvup ^i^rw<iA>v\ yjr\\/\fMnnr>cr\-^Qi 

Eicavatio Yes rio y n General 

1. If necessary, were the correct quadrant(s) excavated and restored? 'zri ^ 2. If necessary, were the correct areas of drip zone excavated and restored? ^ 

Grading Sod and Vegetation 

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

from tbe house? 

2. Has sod been laid in all areas that were excavated? d *^ T:; ^ 

T. Docs the sod appear to be generally healthy and growing? (Only evaifete if insf^ed at a 30 ly^ day time period) • 

4. Are sodded areas generally finn and evenly graded? 

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

time period) [ _ . 

6. Was the property graded such that water will not pool on the propert>'? p^ 

7. Was danuge to landscaping or plant materials avoided? 

Gates, Fences and Retaining Walls /^^i * 

I. Do gates open and close freely? (If appl 

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

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

4. Was damage to retaining wails avoided? (Ifapplicable) T/''-

Foundation, Siding and Gutiers Yes No 

I. Was damage lo the siding or trim avoided? t y . 

^ ^ 2. Was damage to the foundation avoided? 

3. Was damage to windows avoided? 

 Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspout extensions avoided? y 

Sidewalks and Driveways (Concrete) Vcs yKitt 

1. Was damage to driveway surfaces avoided? 

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

• %

Inspection notes: 

Removal and restoration activates C(Mnplete including the 30-day sod warranty: 

EPA Represenlative L J (Do . UAjJLI L Date: ff//fOf 
% % 

Property Compietion Agreement 

This agreement documents the completion of remedial activities performed on my properly My signature 

will designate ihal 1 am satisfied with the restoration of my propeily. and ihai no items are in queslions. 

now, or al any lime in the future, except those ilems hsled below, ifany 

Piopcrfy ID: 4^6^ ^ 

Property Address: ^ ^ C,f^ ^ •?, |[^ '^^t? 

Owner: j ^ ^ ^ ^fA^gTT/nJ^ ^ 

Phone: ^^^-^f^i ^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

L 

iCy i Agree rcstor»liot\ is complcied, except as noted 

[_J I rto noi «(;rec restorntion is completed 

Q ^ [uyjy^ Pkl'A^^-L ly^^^-^ 

'r\77777yci777777 Owner's SignatnrLr r\.t. (mtlactor's Signature