TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: Z%55 3 

Date: \2''^ \ ^T)% 

Address: 2^7 M K ^^^ ^-V 

Remediation Contractor: Coastal Environmental Group 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Video ofproperty (DVD) 

Executive' Summary 

a/ EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

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

Confirmation data 

Year: 2008 

40316437 

Illli 

Superfund 

Photographs pr^-.^)cr/?J^4DY>^ fi^zukkiso ^ SC<L^ \t(U^l So d 

As-built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description ofareas not meeting ROD cleanup criteria 

Utility clearances 

Property infOTmaHon from Douglas County Assessor's Office 

lie- Ihin'smiffal Shc.^V 

^(1^/^ ^ 

)ate 
• m • « k 

€m 

Property Access Checklist 

Proi,crtylP?2?5|^ 5 D WORK STARTED ON: / / 

Property Addre.s.s: ya^-J ^ M 3^^^^: ^ D WORK COIVIPELTED ON: / / 

Renter: 

Address: Phone: 

Fax: 

Cell/Pasei 

phon^^^I|gtT L\<^i-2q ^ Additional Information: 

Fax: 

Cell/Payer: 

n Notification Letter Sent: Bv: 

KAccess Asjreement Siuncd: J l'9 ^ I O ^ B.v: i\(^a.rr\ 

0 ^ Restoration A{»reement Siuncd: t> ISO I 6 I Bj^ , CLtrs_ 

EH Top.soil Sam|)lin<; (if applicahle) By: 

d l Di.sposal Samplinjj (if ap|)licahlc) Bv: 

rI I n Garden Sampling (if ap|)licable) Bv: 

B Utility Clearance Called: i^j^/^^j l ^X ^ c^Of^T^'^ V^DA ^ 

132 Video/Photos (Before) 0,1: l^ i3,S~i o % Bv: M 

n Video/Photos (During) On: Bv: 

n Video/Photos (After) On: By: 

n Video/Photos (30-Day) On: Bv: 

I I Proporty Coni|)letion Agreement Siuncd: By: 

I I Final Re|)or( Issued: Bv: 

Air IVloiiitonnu (as ap()lical)lc) 

1 IZ] Coninuinity CH Crew On: / / By: 

Results: 

1 n Coinniunity C] CrcM' On: / / Bv: 

Results: 

1 n Community Q CrtMv On: / / By: 

Results: 

Omaha Lead Site 
CONTACT FORM 

Property ID # ^g^^3 

Property 

Address: Qsa^ ^. ir^s^ 

Initial Contact: DateS-3tb-tyS Time:\9'^" Action:Aki\^ ^/| 0^11 Q^C /< 

Second Contact: Date: Time: Action: 

Final Contact: Date: Time: Action: 

Final Action: 

Transmit to EPA D Other Action: D 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

'-^ll/OS QJXSLUQC)- HV£ U Si^c / b^CJXsn o p dAA^4 
Douglas County Account :im£mm. ation Page 1 of 1 

Douglas County, Nebraska Property Record - R1918260000 

Print Report 

Parcel Dimensions available @ scale 0-50ft west of 144 St - Vie W On Ma p Information is valid as of 2008-4-17 Treasurer's Tax Report 

New Feature -•-•- » Auto Sales Search 

Owner 

MIAMI HEIGHTS DEVELOPMENT CO ft,^-JP^|g^, jfJAik ix^^^^^ 

1701N24ST#102 'Myd-^ ^ T^T n ^9 ^ 

OMAHA NE 68110-0000 (L/A'A N U<" / ^ ^ ^ O ' 

Property Information 

Key Number: 1826 0000 19 

Account Type: Residential 

Parcel Number: 1918260000 

Parcel Address: 2524 N 33 ST 

OMAHA NE 68111-0000 

Legal Description: OMAHA VIEW LOT 2 BLOCK 15 LTS 1 & 100 X 120 

Value Information 

Land Improvement Total 

2007 $1,000.00 $0.00 $1,000.00 

2006 $1,000.00 $0.00 $1,000.00 

2005 $1,000.00 $0.00 $1,000.00 

2004 $1,000.00 $0.00 $1,000.00 

2003 $1,000.00 $0.00 $1,000.00 

2002 $0.00 $0.00 $0.00 

Sales Informatio n 

Sales Date: 2003-06-30 

Deed Type: WD Book: 2003 Page: 130809 

Price: $7,000.00 

Grantor: Salem Baptist Church 

Grantee: Miami Heights Development 

Valid/lnvalid: Valid 

Exclusion Reason: Land Sale 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.27 12000.0 0.0 120.0 100.0 Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R191... 5/7/2008 
As-Built Drawing 

COASTA L Omaha Lead Superfund Site ENVIRONMENTAL 

CROUP , INC . 

28553^ 

Omah Exterior Paint North Arrow a Lead Site 

Site Sketch 

Owner Name: MIAMI HEIGHTS DEVELOPME • Good Address: 2524 N 33 ST • Poor Phone: H W 

[ 3 Not paint 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm. 

RYASCPXA-28653 F1 no ppm D Date: ll-H 0^ 

RYBSCPXA-28553 F2 _fiiL ppm D Time: i''Pi ^ Prfs RYCSCPXA-28553 Bl IH ^ ppm Samples Analyzed RYDSCPXA-28553 B2 -2.9^ 6 ppm • 

ft0^3CPXA 20053 DZ — ppm D D XRF Unit lOO l Boolt: J73 

RG20CPXA 20050 Q?- ~ ppm D D Date: /Z - // - ni , 

RPZSCPyuft 38663 di - ~ ppm D D Time: ^5**- D Staff Numtse /^^ ^ r of Samples = U 

Legend F1 = Front Left, F2 Front Right, 81 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden. PZ = Play 

All quadrants are as viewed from the streel, facir\g property ENTERED OLS#: 28553 

Date Excavated :7/2/2008 

Date USEPA Signed Off:9/10/2008 

Area Sodded 3366 sq ft 

Legend 


Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced with mi Area left bare Sod ' ' Rock/Mulch 


Contrac t #: EP-R7-07-05 Coastal Environmental Group Inc. 
28553 

Mi?u' CmoOMniVy ^^- g IcaSlW' i^ 

Omah Exterior Pairt North Arrow Owne a Lead Site r Name : MIAMI HEIGHTS DEVELOPME • Good Site Sketch Address : 2524 N 33 ST • Poor Phone: H;^MZ^/-W3?? ? [y] Not paint 

Sample Numtier Lead Sample Samples Cotlected LAB Concentration Collected Firm: fO^ 71 , ^r. RYASCPXA-28553 F1 no ppm D Date: //-/f'^y ^ 

RYBSCPXA-28553 F2 

RS ppm a, D Time: jl^Oia ^r*) 

RYCSCPXA-2S553 B1 [iijl . ppm D Samples Analyzed RYDSCPXA-28553 02 23±L± ppm 

RDgOCr)C/t-205G3 BZ n

ppm D XRF Unit: lOO l Book: il3 _

RQZOCrXA^20503 6?- D

ppm D Date: jZ - il - o L 

RPZSCP.YuA, 28553 9 ^ D

ppm D Time i/iO- D Staff: Numbe /^^t1 / r of Samples = U 

Legend: Fl = Front Left, F2 = Front Right, Bl = Back Left, 82 = Back Rigtit DZ = Drip Zone, GZ = Garden, PZ = Play 

Ait quadrants are as viewed from the street, facing property 

,012.1 
t 

28553 

f|?DC*"^.'r»i 

Omah Extfefkx Pair! NortC Arrcw/ a Lead Site Owner Name:MlAF<^l HEIGHTS DEVELOPME 

Site • Good Sketch Address: 2524 N 33 ST • POOi Phone: HV<I) ' "i^i-^^ij ] [ ^ Nol paint 

Sampl Lead Sample Sampies Collected e Numt)er 

Concentration Collected LAB Firm: F||3 J j q , 

RYASCPXA-78653 FT no ppm 13; D Date: \ l - n 'C'<// 

RYBSCPXA-28553 F2 Q ^ ppm D Time: ii i'ig '^in 

RYCSCPXA 28553 Bl \ H ^ ppm 

D Samples Analyzed RYDSCPXA-78553 82 Z^H 6 ppm a -ez ppm D XRF Unit: JOO l Book 

ROgOCrXA 200SO O? — ppm D D Dale: iZ - il - n L 

WaZSCP.Y»^> 38!>63 (2,2> — ppm D D Time ffy^ D Staff i^^i^ . Number of Samples = W 

Legend Fl = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ - Drip Zone GZ = Garden, 97. - Play 

All quadrants are as viewed from ttw ctraet. facing property 

ENTERKD 

(ti'.i n • 
28553 

Owne Omaha Lead Site r Name: MIAMI HtlGHTSDEyELOPME 

Address:.2524 N 33 ST 

Phone: H:

Sample Number 

RYASCPXA-28553 Fl N O

RYBSCPXA-28553 F2 fi^

RYCSCPXA-28553 B1 IH ^

RYDSCPXA-28553 B2 •^q^ 5

RDZOCPXA'20553 BZ "

RGHOCPXA 20550—Q?" 

RPZSCPXA 28563 i32> 

Legend: Fl = Front Left, F2 • 

ET^TEEED 

^0^.2. 1 Wk 

Site Sketch 

 W: 

Lead Sample 

Concentration Collected 

 ppm a" 

 ppm 

 ppm 

 ppm 

 ppm D 

___2L__pp m D 

_Z_PP m D 

Numt)er of Samples 

LAB 

D 

D 

D 

D 

D 

D 

D 

Exterior Paint tforfti Arrow 

• Good 

• Poor 

gf Not paint 

Samples Collected 

Firm: JM-JLUL ^ 

Date: __i/:iOk — 

Time: //'O ^ /?r) 

Samples Analyzed 

XRF Unit; 7/^)7 Book: iT i 

Date J ^ ' Jl ' O ^ 

Time 

^•PO -

Staff: /TVA / 

Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

Ail quadrants are as viewed from the street, facing property 

T~ 

h5. 

6\ . n. 

ISZ^ //33 ^f 

- % 

i 

ij.a B^. 

n v *j fz 

Wf^HL 

H"^ ^ 0461410123 
05-21-'08 11:59 FROM- T-491 P002/009 F-931 

<.'•" =•'•' , 

^ (4 J COASTAL 

< • c to * ' » r 

Consent For Access To Property A*^3^ ^ ^ ^ 

RIGHT OP ENTRY TO PREMISES 

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

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

the Grantee, lo enter and perform certain environmental response activities upon the 

following described premises: 

Owner's Namerv^ i ^ t /"' D.y«mePhon,: HcQ^^Ll ^ } ^ ^ J 

Address of Property 

covered by this 

Agre9m«nt: 

PURPOSE OF RESPONSE AcTivrriES 

The EPA is requesting access to collect soil samples and rennove 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 soli 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 ihe 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 wilh the Grantor's approval. Upon 

completk)n. 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 salisfactoriiy completed. The Grantor also 

agrees to: 

Page 1 of 2 
05-21-'08 11:59 FROM-	 T-491 P003/009 F-931 


V*****' / COASTAL 

• 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 photographir>g 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 urnjertake any 

actions regarding the use of sakl property which would lend to erKlanger 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 Q I do not grant access to my properties 

^ 

rJ^QfO. ^'-^ti'Oi^ 

Signature oaie 

O I would like to bo present during any sampling tttat is required. 
< # 

COASTA L INVIRONMIN^Al 

S • O a » . IN C 

Consent For Access To Property te^&3

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 Daytime Phone: ^QQ,-^ ^ \ - l ^ y 

Address of Property 

covered by this 

Agreement: 

PURPOSE OF RESPONSE ACTIVITIES 

The EPA is requesting access lo 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 
COASTA L 

(NVII0NMENT41 

«mf ^ C a O U ' > <• 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 

D I grant access to my properties 

D I do not grant access to my properties 

t^CJFX ^ -^'^b-O l 

Signature Date Signature Date 

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

491 P004/009 F931 
 05-21-'08 11:59 FROM­

.*• 

COASTA L 

Restoration Agreement 

The purpose ofthis agreement is to provide a mutual agreement as to conditions ofthe propeny prior to 

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

activities are completed to the satisfaction ofthe property owner and the United States Environmental 

Protection Agency (EPA). 

Property ID: ^^*^ ^ ' ^ 

Voperfy Address: -^r^ -^Lf tT^X V^^ ^ — —^—• • nr ^ ^ —*** — 

- -' - ' — ' ^" " * m^ ^ I I tifii l I f I • 

On the attached diagram($) indicate area(s) to excavaled and depth of excavation, locatkm of ail known 

utilities, subsurface features, surface structures and landscaping features, access location(s) ro be used by 

contractcr, and the direction of North. Indicate distances, depths, maicrial types, etc. indicate digital photos 

by referenc;r>g the photo-log '•mmber with 3.n arrGv; iridicating direction of view 

itvfTiS To Be Renrjoved By Owvnpr tu^ictr^ St?ft Of Remedist'cr** 

(Use auuitiufsoi »it«eis as ne&e&sary) 

•se removat, storaye. disposal, and/or return of tnese items •? t*^» 0»"»9r'f '^^•^mr.T.'b''.'^*'. 

Item: ^ \ 

i\jDn^ 

tteni: 

"^ 

Item: X 

\ 

"er Item: 

Kem: 

Item: 

Item; 

Item: 

Page - E 
05-21-'08 12:00 FROM- T-491 P005/009 F-931 


C O .-X S T A I. 

Items To Be Removed By Contractor During Remediation And Not Rep'at 

(Use additional sheets a* necessary) 

Item: 

WRVH 

!- V 

«em: \ 

Hem: \ 

Item: 

; Item: 

Item: 

Hem:

\ , 

\ 

\ 

X 

Hem: \ 

-

1 Item; 

[ Item:

\ 

\ 1 

litem: 

Item: 

Item: 

ttem: 

1 

Page 2 oft ^ 
05-21-'08 12:00 FROM- T-491 P006/009 F-931 


^ «• A > 1 «% k 

< m * tm • • •> 4 

Items To Be Removed By Contractor During Rs^na^ii 

(Use additional sheets as necesssrj) 

iiS i iii . 

Hen-e 

Qeifi: 

\ 

Rem: X 

ttem: \ 

Rem: \ 

ttem: 

\ 

\ 

item: \ 

Item: 

\ 

Item: \ 

Item: \ 

\ 

Item: 

Item: 

Item: 

Htcfni 

Page 3 M 
05-21-'08 12:00 FROM- T-491 P007/009 F-931 


^ w «. a 1*1 . 

Landscape Inventory 

(Use additional sheets as necessary) 

Item Oiiantftv llni» Condition/Typs/SpecJes 

[i3 

Pre-evi5Ting properTy area, 

rhaf will be excavated, ihas Square feet 

rs covered with grass. 

Number of trees "> 2 inch 

-& - Each cruftk diainecer 

Number of nrees <* 2 inch 

trunk diaoiMef --On each 

Number of Sprinkler 

Zones. Control Valves. 

Timers. Heads, tic. 

.-j» - Each 

An;!ch a sketch of i*\e 

S|V(nkkr b> oui. 

Number of and size of 

each garden/ llower bed 

area. Each -" " [JJ ' Square feet 

Ansel- ?. .>kc'.c!-: or ie!p.;iv« 

>izcs ni>o jccaiions. 

Page 4 of £^ 2 
05-21-'08 12:00 FROM- T-491 P008/009 F-931 


C O A-fi T * L 

item Quantity Uriit Condttionrfype/Spectes 

A<7reed iinnn valitr nf 

nlanf iriHirridK Ant In h<- I ' .. . - — -' • 

ffRlA^Art hv rnnfrBrfnr 

i D Note (his value miU IK - ^ 

MSrd tn issue a plant 

voucher to ihe prapcm 

Owntr. 

Agreed upon list of plant 

{nateriais that witi be 

replaced by contractor. Be 

very specific and deiaiied. 

-a Each 

include a ifccich ot" we.-e 

cr<ch plant wiU t>c placed 

by the co»ytracior. 

6t>t^ a,iA esttav^^^ ar<^ Agreed upon area of fegi 

property ro be replaced 

with grass sod 

SF 

.'r.cltide »i ^l:.<;lcil ot' the 

;:!ea(i) ly he replaced «-rh 

i^fii SC'd. 

Area of City or County 

propert>- to be lartdscaped 

per ihcir requirements 

-a> SF 

Incttidi" ;'t s;-:eK!i y,' :'.:t 

\tiA- +«6+ dify ta'^f^miiMJr^ 

ieA6 ^jrrd ^ 

Eaiemem Area. !o be SF e.vcavated 

i 

Pages ofj ^ 
05-21-'08 12:00 FROtl- T-491 P009/009 F-931 

C O A S T A C 

k?f?rf1 C0fnfm*r! ^ / Er:struciiOfas: 

6a 

Ni. ir ^ ^ . 

! f rthA^ ^ th o h« W <FO>ajn»k« J_— _ ... A .. 

•m^t CEO t« doa.'.'T^e??! frnerfcr feundatiai wslfs ancf possible 

1/ AA> 

^ 9 6 6% 

Owner's Signalure A " 0sfe / 1 • h i 
05-21-'08 11:59 FROM- T-491 P001/009 F-931 


FACSIMILE TRANSMITTAL SHEET 

IKUM; 

i.i.>\t\'V.<\. U.vril: 

(.\'.isr.!! J-'iivminiiK-n?.!!<.'ir«.t»ji ^ - "310 ' O-i 

I \> : :>:i,Mi<i'.i».. TOTxt.No Ol- p\t;c-..»i t>:cn ii(>.r. '..ovi K. 

Mb^-^M^l-g^'V^ 

D!Ti;::s;' Di-'.M: srvn-vr- D r;.;-.\yi; = .:M\rtrs: D :=:.;:.\£i; r.\v Q:': ;;.;^;;: s­
Date 

Project 

XRF iD# 

Shot# 

Z l 

^2 i w 

^ ^ ? 

Average 

Shot # 

Average 

Shot # 

Average 

Shot# 

Average 

lab sample # 

XRF PROPERTY SAMPLE SHEET 


n ste Address 

'Orrifeha lead FP 2nd year option Sample time 

sample length 

Reading Sample area Shot# 

8 A in^n tgi/3. Depth 

I'^^/o -La 

Average 

Reading Sample area Shot# 

Depth 

Average 

Reading Sample area Shot# 

Depth 

Average 

l(¥^/a 

RETEST AREAS 

Reading Sample area Shot# 

Depth 

Average 

Lab result Sample area XRF Avg. 

Signature. 

Print 

Qls-^ BVID# 

EaaZMZSZ!^ 

A K am& . i 

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-32089 

Reading No 424 

Mode SOIL 

Time 2008-07-02 15:56 

Duration 121.71 

Sequence Final 

Flags 

AVERAGE Avg of 420-423 

ADDRESS 2524 n 33 

QUAD/ZONE B2 

INSPECTOR DETRICH 

DEPTH 10 

SAMPLE TYPE CLEARANCE 

NOTE 

Error 

12.128 

^^:^ / 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 57.930 

Supervised By: 

Certificate of Verification 

420 

SOIL 

2008-07-02 15:54 

30.61 

Final 

28553 

2524 n 33 

B2 

DETRICH 

10 

CLEARANCE 

± Error 

± 10.743 
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 116.849 

Supervised By: 

Certificate of Verification 

421 

SOIL 

2008-07-02 15:55 

30.12 

Final 

28553 

2524 n 33 

B2 

DETRICH 

10 

CLEARANCE 

± Error 

± 14.040 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 422 

Mode SOIL 

Time 2008-07-02 15:56 

Duration 30.55 

Sequence Final 

Flags 

BVID # 28553 

ADDRESS 2524 n 33 

QUAD/ZONE B2 

INSPECTOR DETRICH 

DEPTH 10 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 80.182 ± 11.921 

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 79.238 

Supervised By: 

Certificate of Verification 

423 

SOIL 

2008-07-02 15:56 

30.43 

Final 

28553 

2524 n 33 

B2 

DETRICH 

10 

CLEARANCE 

± Error 

± 11.807 
f^QL\ Omalia Lead Site—Fixed Price EP-R7-07-05 

^J^^^ ' I Coastal Environmental Group Inc. 

^^^^^{ ? wvvw.coastalhazmat.com 

%P„o^t^ COASTA L INVIRONMENTAL 

CROUP . INC . 

EXECUTIVE SUMMARY: 

BVID # 28553 - (2524 N 33"'' St) 

'xl No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 
^^EPA 

EPA Property Close Out Form 

Property ,: 1^^^^ 

Date/Time 

Quad Contractor Group s Excavated -fc 

Excavatio Yes No n General v/AcAy^- , r /L0 r 

1, If necessary, were the correct quadrant(s) excavated and restored? / 

2. If necessary, were the correct areas ofdrip zone excavated and restored? M 

Grading Sod and Vecetation 

Yes No 

1. Does the grading around the perimeter ofthe house in excavaled areas generally slope away aM 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 .10 

day time period) 

4. 

Are sodded areas generally firm and evenly graded? t / 

5. 

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

time period) 

6. 

Was the property graded such that water will not pool on the property? ( ^ 

7. 

Was damage to landscaping or plant materials avoided'' 

/ 

Gates, Fences and Retaining Walls 

Yes No 

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

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 walls avoided? (Ifapplicable) s/ 

Foundation, SidiDg and Gutters Yes No 

1. Was damage to the siding or trim avoided? / / \ 

2. Was damage to the foundation avoided? ^^^o^> 

3. Was damage to windows avoided? * ] y

 KJA 

• 

4. Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspout extensions avoided? 

\ 

Sidewalks and Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfaces avoided? t / 

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

Inspection notes: 

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

EPA Representative/^'^^^^,,^^^^^,^^^^^^^^ Date: "T^Z/Q/^S 
4 

Property Completion Agreement 

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

will designate that I am satisfied with the restoration of iny property, and that no items are in questions, 

now, or at any time in the future, except those items listed below, ifany. 

Property ID: ^yfj ^ 

Property Address: J^j- ^ 1 A J 3 1> r X 5 + 

Owner: /JQ ^ C ot'^V^V n 'dy 9'^ vAcyf i^ ^ i^l Co ^ 

Phone: '-(flX'^l' ^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

agree restoration is completed, except as noted 

do not agree restoration is completed 

Owner's Signature Date (Comractor's Signature