TRANSMITT.^L of OMAHA LEAD SITE 

.SOIL REMEDIATION FILE FOLDER 

SAID: . ^aj(^ < Date : J.l^^U 

Address: _ ZyhAlt^SZLA A 

Reniediaiion Conli;ictov: Coastal Enxironmental Group Yeai: JOUIARRA 

SOILREMEDIATJON 

PROPERTV FILE FOLDER DOCUMENTS 

Video of properly (DVD) 

Execulive Summan,' 

EPA-piovided properly sketcli 

7^ Sij^ned Access Agreement for subject propeny 

Signed Access Agreement(s) for adjacent properly 

7 Restoralion Agreement 

Setllemenl documenls (i.e., for damage or to replace plants, elc.) 

Confinnation data 7 

7 Photographs ff r fecW/mc^ < 6 c ^Ay^rn ^ ^ ^ov , 

As-buill sketch 

7 Satisfactory restoration signed by Properly Owner 

7 Property close-oul check list signed by EPA 

Description of areas not meeting ROD cleanup cntena 

7 Utility clearances 

7 Propeny inibfm^lion from Douglas Counly Assessor's Office 

Zr 

Date 

30237402 

Superfund 
; \ 

\ 

Property Access Checklist 

PropertylD: ^-^^t^u^ 

Property Address: ,-^•3. ^..rU>A>.^ <j^ 

D

D

 WORK STARTED

 WORK COMPELTED

 ON: / /_ 

 ON: __/__/_ 

Owner: 

Address: 

Renter 

Phone: 

Phone:

Fax: 

 U^^ ^^^^ o^^ ^ ^ 

F;L\: 

Ccll/Pager: 

Additiona] Inforroation: 

Ccll/Pager. 

n Notification Letter 

H Access Agreement 

(^ Restoration Agreement 

I I Topsoil Sampling (if applicable) 

Q Disposal Sampling (if applicable) 

Q Garden Sampling (if applicable) 

Q] Utility Clearance 

S Video/Photos (Before) 

D Video/Photos (During) 

D Video/Photos (After) 

D Video/Photos (30-Day) 

LD Property Completion Agreement 

D Final Report 

Sent: / 

Signed: \ o / \VA / x.o 

Signed: vo / \ H / \o 

/ / 

/ 

Called: u / "b / i.o 

On: vj / yvA. / \ o 

On: / 

On: 

On: 

Signed: / / 

ksued: 

Bv: 

By: 

By: 

By: 

By: 

By: 

By: 

By:

Bv: 

By: 

By: 

By: 

By: 

V> i«Jt, 

VJ XKA'VA 

Ulloki- I

 WcVi, 

 WcA/yXv! 

=1 

Air Monitoring (as applicable] 

• Community • Crew 

Results: 

On: / / By: 

D Communit}'

Results: 

O Crew On: / / By: 

D Community' D Crew On: / / By: 

Results: 

Omaha Lead Stte 
Douglas County Account Infifcaation Page 1 of2 l ^ a 

Douglas County, Nebraska Property Record - R2001680000 

Print Report 

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

New Feature -*-»- » Subdivision Sales Search 

Owner 

PHILLIPS JR FORREST 

2636 BURDETTE ST 

OMAHA NE 68111-0000 

Property Informatio n 

Key Number: 0168 0000 20 

Account Type: Residential 

Parcel Number: 2001680000 

Parcel Address: 2632 BURDETTE ST 

OMAHA NE 68111-OOOO 

Legal Description: PATRICKS 2ND ADD LOT 11 BLOCK 9 50 X 120 

Value Informatio n 

Land improvement 7ofa/ 

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.com/DouglasCoNe/static/accountinfo.jsp?accountno=R200... 9/3/2010 
Page 1 of 1 

[ Create Another Ticket [ Back to Irth Internet ] Send Email 

• YOUR TICKET NUMBER IS 2637699. 

Original Call Date: 11/08/10 Time: 5:49 pm Op: ELIZABETH18790 


Work to Begin Date: 11/10/10 Time: 6:15 pm 


State: NE County: DOUGLAS Place; OMAHA 


Address: 2632 Street: BURDETTE ST 


Twp: 15N Rng: 13E Sect-Qtr: 09-SE 


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 SERVICE 


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


Work Being Done For: COASTAL 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 


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

Emerg: 4024445160 

Day: 4067289343 

OPPDGPRS OMAHA PUBLIC POWER DISTRICT ELM LOCATING Ah: 4062071494 

Emerg: 8887289343 

Day: 4067289343 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11/8/2010 
27895 

r As-Built Drawing 

COASTA L bmaha Lead Superfund Site 

OLS#:27895 

Date Excavated: 11/11/2010 

Date USEPA Sianed Off: 12/2/2010 

Area Sodden: 3520 sa ft 

Omaha Lead Site Exterior Paint North Amsw Owner Name: FORREST PHIUJPSJR 

Site Sketch • Good Address: 2632 BURDETTE ST L • Poor Phone: H: 402.346-9526 W: [g- ^ paint 

Sample Number Lead Sample Samples Collected 

Concentration Collected ^ ^ Fimi: m-T -\ Le 

RYASCPXA-27895 F1 3^ ^ ppm [B ^ D Date: CH-^S^-C^' ^ 

RYBSCPXA-27895 F2 Z.3 ^ ppm B ^ n Time: I ''^O p/w RYCSCPXA-27895 Bl __42.^9_ppm B^ D £f 

Samples Analyzed RYDSCPXA-27895 B2 -711^ ppm [B^ D 

RO20CPXA-27095 -B2 ~ ppm • • XRFUnit; fn'^ 7 Book: dSS- RQZ3CPXA-g7Q9S -62- POm n D Date: //-7-<?S ~ RP23CPXA>g7095 -9i - — ppm • • Time: Fm 

Staff: Numtier of Samples = J.A­ 'T 

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

AN quadrams are as viewed from Itw street, lacing property 

ENTERED 

SEP 3; 0 208S 

81 = 328 PPM @ 6" 

B2 = <LOD PPM ( 

Lumber fire wood 

f 

F\ f; L 

^•HH z ^ 

P * # • 

; ftuiM^CTT^ is r 

Legend 

Concret:e Drip Zone Excavated Quadrants Excavated 

Area replaced

Sod 

 with Area replaced with 

Rock/Mulch Area left bare 

Contract #: EP-R7-07-05 Coastal Enviroiunent:al Group Inc. 

L 27895 

Exterior Paint North Arrow Owne Omaha Lead Site r Name: fORR^ESj PHILLIPS JR 

Site • Good Sketch Address : 2632 BijRDiTTEST^ ( • Poor 

Phone: H: 402-345-9526 W: 

^^yioX paint 

Sample Numt>er Lead Sample LAB Samples Collected 

Concentration Collected Firm: Vf . rTTX \ i:>l 

RYASCPXA-27895 Fl 3^ ^ pom Date: Cr=\ y^ ^ - Cl ^ 

RYBSCPXA-27895 F2 ^^ ^ ppm Time: I ' H.O ^r ^ 

RYCSCPXA-27895 Bl 4J^9 ppm £ 

Samples Analyzed 

RYDSCPXA-27895 B2 11 ^ ppm 

r?02ocrxA 27095—BE •^ ppm 

XRF Unit: //9g 7 Book: /^ ^ 

ROZOCPXA-27Q95 62- ppm Date ll-7'C T 

RrZOCPXA-27095 P2~ ~ ppm 

Time Fy>i 

Numbe Staff J ^ r of Samples: 

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

All quadrants are as viewed from the street, facing property 

( v d Z7^ ) 
iln 27895 

Otnah Exterrar Paint North Arrow Owne a Lead Site r Name: FORREST PHILLIPS JR • Good Site Sketch Address: 2632 BURDETTE ST • Poor 4

Phone: H; 402-346-9526 W: (g-^ t paint 

Sample Lead Sample Samples Collected Number 

Concentration Collected LAB Firm: _2£._irG:AM_ RYASCPXA-27895 F1 _3i^pp m D Date: rF\yXS\-r^ ^ 

RYBSCPXA-27895 F2 2.3g ? ppm D Time: t • H. O prv^ 

RYCSCPXA-27895

RYDSCPXA-27895

 Bl 

 B2 

4? ^ 9 ppm 

a-- D 

D Samples Analyzed 

ROZOCPXA-2709G B2 •^ ppm D D XRF Unit: //93 7 Book: \^ % 

ROZOCrXA-27095 6*- ~ ppm D D Date: 11-7-0 ^ 

RPZOCrXA'27095 P2~ ~ ppm D D Time F'/^i 

Number of Samples • TT Staff: J ^ 

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

AN quadrants are as viewed from the street, facing property 
27895 

Exterior Paint North Arrow Owne Ortiaha Lead Site r Name: FORREST PHILLIPS JR 

Site • Good Sketch Address: 2632 BURDETTE ST • Poor 4

Phone: H: 402-346-9526 W: 

[g-^ t paint 

Sample Number Lead

Concentration

 Sample 

 Collected LAB 

Firm:

Samples Collected 

 V f ^ mT- \ Ue . 

RYASCPXA-27895

RYBSCPXA-27895

 Fl 

 F2 

__3i^pp m

2. ?>h ppm

 E ^ 

 0 ^ 

D 

D 

Date:

Time:

 (^i=\y^S\. C^^ 

i ' H, 0 p/vv 

RYCSCPXA-27895

RYDSCPXA-27895

 Bl 

 B2 ^1 4 ppm \sr 

D 

D Samples Analyzed 

RDZGCPXA-27095 Bg •^ • ppm D D XRF Unit: tn3 7 Book: /^ ^ 

RGZOCPXA-^27095 62­ "" ppm D a Date: l(-7'0^ 

RPZ3CPXA-27095 Pi - ~ ppm D n Time /=V»7 

Numtwr of Samples = ; M Staff: .yA. 

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

All quadrants are as viewed from the street, facing pro(>erty 

SEP 0 200! 

I 

'^\^X '^J^oma: 

c/ \­

f 

9^-

P\ F9~ 

^ H ^ ^3^ 

1 LJMy : 

Rev 6ua^£xrs-. ^ 046141.023 4 
'w. COASTA l .<P ENVtRONKfMIA L 

'•<< PBO^f-' ' c * o ti r . 1 h C 

Consent fcf Access To Properti' 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property ovi/ner) 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 : Daytime Phone: ers Name Name: ^ i_

/i/A'u2iA7_hirejT • ^ 

Address of Property 

covered by this y^^ Z f^o-rdetV^ , f

Agreement: 

PURPOSE OF RESPONSE ACTIVITIES 

The EPA is requesting access to collect soil samples and remove soil that contains 

elevated concentrations of lead and may pose a health hazard. The area(s) will be 

excavated to remove contaminated soil. The removed contaminated soil will be 

replaced with clean materials and the area will be restored to its original condition. This 

work is being performed under the Omaha Lead Superfund Site remediation program. 

A representative of Coastal Environmental Group, contracted by USEPA. will contact 

the Grantor in-person to discuss the work to be performed, the Grantor will have an 

opportunity to review and approve the planned soil removal, and restoration work 

before It begins. Once the work is finished, the Grantor will be asked to review the work 

and confirm that it is complete and meets with the Grantor's approval. Upon 

completion, the Grantor will receive written documentation from EPA that the property 

has been remediated. 

ENVIRONMENTAL RESPONSE ACTIONS 

By signing this Access Agreement, the Grantor is granting the EPA, its employees, 

contractors and subcontractors the right to enter the property, at all reasonable times 

and with prior notice, for the sole purpose of performing the work. This access shall 

remain in effect until the work has been satisfactorily completed. The Grantor also 

agrees to; 

Page 1 of 2 
c

.yj"'r. m 

»:K -- * ^ o* COASTA L . .< - IhVmONMrKlA t 

' ' "RO'*- C « 0 U » 1 " 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; 

c 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. 

c 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 n grant access to my properties Q I do not grant access to my properties 

Date^ y Signature Date 

loyH-io 

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

Page 2 of 2 
COASTA L CNVIflONMCNTA L 

C R O U r . INC . 

Restoration Agreement 

The purpose of this agreement is to provide a mutual agreement as to conditions of the 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: Z^-jy% f \ 

PropertyAddress: ^ ^ J ^ f } O r Je^fY^ ' ^T 

Owner: fh l (hi ^ S J rf^ . P ^ OT ^ 5 T 

Phone: j^ ^ Y S^ 7^/ . 

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

Item: 

j \ j p Tjzy. 

Item: 

Item: 

Item: 

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

Item: 

y 3 Aye___ Item: 

Item: 

Item: 

Page 1of 2. 
^ « ^ 

COASTA L CNVIROHMENTA L 

C K O U P , INC . 

Items to Be Removed By Contractor During Remediation and Replaced 

Item: 

^'O W 

Item: 

S <^ (y 

Item: 

Item: 

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. 

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 propertj' 

owner. 

Easement Area, to be 

excavated 

Quantity 

i}lj$^ 

y 

y 

0 

7 

Landscape Inventory 

Unit Condltlon/Type/Species 

Quadrants 

Each 

Each 

Each 

Each 

Square Feet 

• 

$ 

Each 

lfc^a>>^^ (rvei^ 

Page 2 . 1 
COASTA L ENVIRONMENTAI . 

C R O U I 

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 

as 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. 

I I Please check this box if you understand the information outlined above. 

c C I 7(^ y ((f 1.76^ YHUr- noY I 7<3 

n e 71 d ao y^ 

ZI Check the box if Owner does not want CEG to document inte;iorfound^tion walls and possible 

pre-existing damage. By checking this box CEG is not resppnsible fgr^ny damage done to the 

interior of house, including foundation cracks or fissures. 

' I agree Q I do not agree 

Jj fO-l^-iQ 

Owner's Signature Contractor's Signature Date 

3 

Page 3 of. 
BVID#_Z£8351 

XRF PROPERTY SAMPLE SHEET 

Date 1- ^i-zoa 

Project Omaha Lead ARRA 

XRF ID# ^"lOZ Z 

Shot# Reading Sample area 

m S3^ t Z6 5( 

48 3^4 i ^6 Depth 

m 3^4 i ^6 ^ " 

Average 3^ g i ^6 / 

Shot# Reading Sample area 

ISL i-LO^ : I f 5^ 

163 UJD ^ : 4- Depth 

)5 ^ ^LOQ '. 13 ^ " 

Average ZO Q /4 / 

Shot# Reading Sample area 

Depth 

Average 

Address 

Sample time 

sample length 

Shot# 

Average 

Shot# 

Average 

Shot# 

Average 

Shot# Reading 

RETEST AREAS 

Sample area 

/

-^-" y 

/ 

^ Depth 

Shot# 

Z65>L t5oB.oc-!r£ ZfT 

am/pm 

30 sec 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Average Average 

Signature A / 

P„„, Who, U^P' 
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 

Pb 

Supervised By 

Certificate of Verification 

150 

SOIL 

2011-01-21 13:43 

90.95 

Final 

Avg of 147-149 

2632 BURDETTE ST 

Bl 

6" 

C.PADILLA 

CONFIRMATION 

CLEAR 

Error 

26.336 
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 337,628 

Supervised By: 

Certificate of Verification 

147 

SOIL 

2011-01-21 13:41 

30,31 

Final 

27895 

2632 BURDETTE ST 

Bl 

6" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 26.639 
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 

XRFTECH 

MISC 

NOTE 

ppm 

Pb 324.461 

Supervised By: 

Certificate of Verification 

148 

SOIL 

2011-01-21 13:42 

30.31 

Final 

27895 

2632 BURDETTE ST 

Bl 

6" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 26.295 
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 324.006 

Supervised By: 

Certificate of Verification 

149 

SOIL 

2011-01-21 13:43 

30.33 

Final 

27895 

2632 BURDETTE ST 

Bl 

6" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 26.073 
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 

Certificate of Verification 

155 

SOIL 

2011-01-21 13:47 

90.46 

Final 

Avg of 152-154 

2632 BURDETTE ST 

B2 

6" 

C.PADILLA 

CONFIRMATION 

CLEAR 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 152 

Mode SOIL 

Time 2011-01-21 13:46 

Duration 30,14 

Sequence Final 

Flags 

BVID 27895 

ADDRESS 2632 BURDETTE ST 

QUADRANT B2 

DEPHT 6" 

XRF TECH C.PADILLA 

MISC CONFIRMATION 

NOTE CLEAR 

ppm Error 

Pb < LOD 14.936 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 153 

Mode SOIL 

Time 2011-01- 21 13:47 

Duration 30,19 

Sequence Final 

Flags 

BVID 27895 

ADDRESS 2632 BURDETTE ST 

QUADRANT B2 

DEPHT 6" 

XRF TECH C.PADILLA 

MISC CONFIRMATION 

NOTE CLEAR 

ppm Error 

Pb < LOD 14.740 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 154 

Mode SOIL 

Time 2011-01-21 13:47 

Duration 30,13 

Sequence Final 

Flags 

BVID 27895 

ADDRESS 2632 BURDETTE ST 

QUADRANT B2 

DEPHT 6" 

XRF TECH C.PADILLA 

MISC CONFIRMATION 

NOTE CLEAR 

ppm ± Error 

Pb < LOD 13.943 

Supervised By: 
X 

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

Coastal Environmental Group Inc. 

V • -o* www.coastalhazmat.com 

%PR0^t<:''^ COASTA L ENVIKONnENTA L 

GROUP , IN C 

EXECUTIVE SUMMARY: 

BVID # 27895 - (2632 BURDETTE ST) 

No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation: 
EPA Propertj' Close Out Form 

Property #: . JiZSSJ.. Proptrty Adtlrtjs: 

Uate/Tlrot: Owntr's Namr: /.-. 

Quads ExcBvtiifd; Confractor Group - Co»tTl*L 

Excavation General _J^t; ^ No 

I 1. If necc.^sao', ^'ere the corrtcl quadrantfs) excavated and resiored? J / 

' 2. If netcbsar>', were the correci areas ofdnp /one excavaled and restored'' \y_ 1 -

Grading Sod and Vrgetation ..Y£5__IM':­ ! 1 Does the grading around the pcrimeier ofthe house in excavaled area? generally SIUIK- a\vay i 

;_ _ from the Iiouse? _ 1 ^ J 

2. Has sod been laid in all arrss thai were excavated? y 

S Docs the sod appear to be generally healthy and growing? (Only evaluate if inspected ai a 30 I y day time period) 

I 4. .\re sodded areas generally firm and evenly graded? 

i. 1 ._ i "5 /Vre the joints between the sod strips generally tight? (Only evaluate if inspccied at a ?n day 

y time period) _ 

6. Was the property graded .^uch thai water will nol pool <in ihr prnpeny'-' ' y

1

i . 

7. Was damage to landscaping or plani materials avoided';' i y 

Gatei. Ff oces aod Retjinlng Walls 

Do gates open and clo.<;e freely? (If applicable) 

2 Were all gates ot fences taken down during resloralion activiiies reinsialled;' (II apDlicahk;! 

"1. Was damage to gates or fences avoided'' (IfapplicablcJ 

"1 Was damage 10 retaining walls avoided'' (Ifapplicable) 

r oundaiion, Siding an d GuKfr; _ Ves .N^c 

1 Was darrage to the siding or trim avoided? 

7 Was damage to the foundation avoided'' yz ~. Was damage lo windows avoided'' 

' 'I Wa.<; damage to windows ot door screens avoided'' y I 

•t -• • 

Wa.-, damage to dowiispouis ni downspoui txiensiuns avoidci.1'' / ! 

Sidewalks and Driveway.i (Concrete) Ves _^f• 

1 Was damage to driveway surfaces avoided.' 

~y­ 2. Was damage to walkway surfaces avoided'' 

y I 
O M ners comrT?en<s: 

[p.^Dection notes: 

Reniovii! iin(j rfsuualiun Hi.livyif..'s ctunplPie including ihc 3U-day .sod vv'ananry 

[.-PA Rc[jrospnUitivf _ __ _Q ^ ^ _ .n^le: ij/j/r . 
V 

Property Completion Agreement 

I'his agieemeni documenls lhe LOinplclion cl remedial aclivmes perlonned on my properly My signature 

will de.signale ihal I am sali.sfied wilh lhe resloralion of my propeily. and ihai no iiem.<; are in queslion,«.. 

now, or al any iinte MI ihe fuiure, excepl ihose Hems listed below, ifany 

Property ID: 

-y^ ryi. vi 

Property' Address: ^^^^ ^ 'bV^ytVr t ^ f 

Phone: 

Restoration Items in Question: 

I Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

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