TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAlD#:JiriL Date: ^(f^ (M 

Address: S^l ^ ^tC^ ^ < f 

Remediation Contiactor: Coastal Environmental Group_ Year: _2010ARRA_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

s/ . Video of property (DVD) 

[y E.xecutive Summary 

EPA-provided propeily sketch 

y Signed Access .Agreement for subject property 

-P ^ Signed Access .Agreement(s) for adjacent property 

y Restoration Agreement 

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

_U_ Confinnation data ;. r '. 

y Photographs fK^ t^^Qh/AtWvt •\ ho(^''^\\y ^ ­^ ^^ ^ 

y As-built sketch 

Iir Satisfactory restoration signed by Property Owner ; 

H Property close-out check list signed by EPA ­

-B" Description of areas not meeting ROD cleanup criteria 

Utility clearances 

Property iiilprfnainon from Douglas County Assessor's Office 

30218738 

Superfund 
• » ( • • 

v\ 

Property Access Checklist 

Property ID: ^L\0^-:^9>) 

Property Address: t^l^^o^ 'i>ecc^\^r ^ . 

D

n

 WORK STARTED

 WORK COMPELTED

 ON:

 ON:

 /

 /

 / 

/ 

^^"'^••= .Ue^.V ^ Lawn.P . 

Address: M^'l'^ ^ OlMi^ef-l'^'^ V/­

^-"^ o^n ^ ^ ^<'KI.HN^K 

Phone: 5^ \ ­ Sa-^-^ . 

Fax: 

Cell/Pager: 

Renter: 

Phone: 

Fax: 

Cell/Pager: 

Additional Information: 

n

f^

[^

•

•

•

S -

S

n

n

n

O

n

 Notification Letter 

 Access Agreement 

 Restoration Agreement 

 Topsoii Sampling (if applicable) 

 Disposal Sampling (if applicable) 

 Garden Sampling (if applicable) 

 UtiUty Clearance 

 Video/Photos (Before) 

 Video/Photos (During) 

 Video/Photos (After) 

 Video/Photos (30-Day) 

 Property Completion Agreement 

 Final Report 

Sent: / / 

Signed: G^ /d^'\ 1 \ 0 

Signed: CT^ /Q."^ A O 

/ / 

/ / 

/ / 

caUedDfe / 6M7 vn 

OmCTSy^R^ \ 0 

On: / / 

On: / / 

On: / / 

Signed: / / 

Issued: / / 

By: 

By: 

By: 

By: 

By: 

By: 

By:

By: 

By: 

By: 

By: 

By: 

/ 

Air Monitoring (as applicable) 

1 1 Conmiunity CU Crew 

Results: 

On: / / By: 1 

• Community

Results: 

• Crew On: / / By: 

• Community

Results: 

 C] Crew On: / / By: 

Omaha Lead Site 
Douglas County Account Inffim^jd^ i r Page 1 of2 

Dougla s County , Nebrask a Propert y Recor d - R241046000 0 

Print Report 

NEW Feature - Parcel Dimensions avaiiable @ scale 0-50 ft west of 52nd St - Vie w Ofl Ma p Information is valid as of 2009-10-15 Treasurer's Tax Report 

New Feature ->->- > Auto Sales Search 

Owne r 

t-AVOlE JOSEPH C 

ETAL 

5419 DECATUR ST 

OMAHA NE 68104-0000 

Propert y Informatio n 

Key Number: 1046 0000 24 

Account Type: Residential 

Parcel Number: 2410460000 

Parcel Address: 5419 DECATUR ST 

OMAHA NE 68104-0000 

Legal Description: WASHINGTON HILL SUB LOT 6 BLOCK 0 W 50 E 250 FT 

Valu e Informatio n 

Land Improvement Total 

2009 $9,600.00 $174,700.00 $184,300.00 

2008 $9,600.00 $174,700.00 $184,300.00 

2007 $9,600.00 $174,700.00 $184,300.00 

2006 $9,600.00 $155,600.00 $165,200.00 

2005 $9,600.00 $155,600.00 $165,200.00 

2004 $9,600.00 $155,600.00 $165,200.00 

Lan d Informatio n 

Acres SF Units Depth Width Vacant 

0.14 6350.0 1.0 127.0 50.0 No 

Impro vemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2... 10/23/2009 
Douglas County Account Inf< j^y|k)r Page 2 of2 

verified 

h t«v j 

JOf 

" ^.iw.r'l M r 

rnir 

Mf"' 1 «< 

-^iji^tvjiv_ TWO STORY 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1908.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 7.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 2.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1952 0% 1952 57 

Detail Type Detail Description Units 

Add On Brick Veneer 500.0 

Add On Fence Chain Link 1.0 

Appliance Allowance 1.0 

Appliance Fireplace Masonry 1.0 

Basement Bsmnt Block 8 ft 1022.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Attached 220.0 

Porch End Screen 128.0 

Porch Slab Roof Ceil 40.0 

Porch Wood Deck 176.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2... 10/23/2009 
Page 1 of 1 

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Create Another Ticket •^ UJ^ Back to Irth Internet -Send Email L_: 

YOUR TICKET NUMBER IS 2609950. 

Original Call Date: 10/06/10 Time: 9:25 am Op: ELIZABETH18790 


Work to Begin Date: 10/08/10 Time: 10:00 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 5419 Street: DECATUR ST 


Twp: 15N Rng: 13E Sect-Qtr: 18-NW 


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: Y 


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 CITYOFOMAHA-TRAFFICSEWER RICH/TRAFFIC Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING Alt: 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... 10/6/2010 
84978 

"IT 

As-Built Drawing 

COASTA

ENVIftOMHiNTA

L 

t Omaha Lead Superfund Site C II O U r . IN C 

OLS#: 84978 

Date Excavated: 10/12/2010 

Omah Extsrior Parnt a Lead Site 

[j f Good Site Sketch • Poor 

Sampling Address: 5419 DECATL^ ST n Not pamt 

Sample Lead Samples Collected Number LAB Concentration Firm 

RYASCPXA-84978 Fl J3_l_ 

Date; IO-l5-a/>, 

RYBSCPXA-84978 F2 

Time fn:So /i/y, 

RYCSCPXA-84978 Bl 

Samples Analyzed 

RYDSCPXA-84978 82 

RDZSCPXA-84978 DZ 

XRF Unit: h530Book:22JL 

RG2SCPXA-84978 GZ Date n i l QQ 

RrZOCP)(A-0<970 P * 

Time AL 

Staff: Number of Samples = | fc | | Q | mso 

Legerxj: F1 = Front Lefl, F2 = Front Right. 81 = Back Left. 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Plai 

AH quadrants are as viewed from the street, f^n g property 

NOV 1 2 

F2=103PPM@4" 

R«\':<*w Cnrjud. :7-.\ufrJ>8 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced

Sod 

 with Area replaced with 

Rock/Mulch Area lef t bare 

Contrac t #: EP-R7-07-05 Coasta l Environmental Group Inc . 
;W v 1(^3^-10 

CNeci^f yv^ cf\ll.-\ 84978 

Omaha Lead Site Ext«rior Paint 

Site Sketch (Tj Good 

• Poor 

Sampling Address: 5419 DECATUR ST Q] Not paint 

Sample Number Lead 

Concentration 

Sample 

Collectpd LAB 

Fimi:

Samples Collected 

 fh f DBA ^ 

RYASCPXA-84978 F1 . ppm n Date; IO-l5-^/?> 

RYBSCPXA-84978 F2 JLlfi. . PPnn D Time: j n .' SO a/<n 

RYCSCPXA-84978 

RYDSCPXA-84S78 

B1 

B2 

.ppm 

ppm 

D 

D Samples Analyzed 

RDZSCPXA-84978 DZ 611 ppm D XRF Unit: U5H 0 Book: ?7 4 

RGZSCPXA-84978 GZ S3 , ppm D Date: 11-1 1 • O B 

f^PZOOr'XA-04970 

I mi 

-pa­ ppm n 

Numt)er of Samples = | ^ [

D 

 | Q [ 

Time:

Staff:

 Anr \ 

 rnso 

Legend: F1 = Front Lefl, F2 = Front Right. 81 = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pla; 

All quadrants are as vlevwd from ttie street, fqdng property 

NOV 1 2 2006 

^ 

Rr.-:<«i* '•n,"«cd ;7 Ai^J'R 

io-O-to 

P 
- I ••WH4IIX1-* 

^ 

84978 

Omaha Exterior Paint Nortti Arrcw Lead Site 

[jf Good Site Sl<etch • Poor 

Sampling Address: 5419 DECATUR ST Q Not paint 

Sample Number Lead Sample LAB 4 Samples Collected - Concenlration Collected Finn: fPfit b^'A J 

RYASCPXA-84978 Fl 2 . B I ppm D Date; 10-15-0 ^ 

RYBSCPXA-84978 F2 T "I R ppm D Time: / n iS d a m 

RYCSCPXA-84978 Bl ff2. ppm D 

Samples Analyzed RYDSCPXA-84978 82 "1 5 ppm D 

RDZSCPXA-84978 DZ ^.^ 1 ppm D XRFUnit: ffl.S'^ O Book: 2ZV _ 

RGZSCPXA-84978 GZ S3 ppm D Date: U • 1 1 • O B 

RrZOCPXA-04970 P * ~ ppm D Time: ftpg 

Staff: rnso Number of Samples = | ^ [ [ Q | 

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

All quadrants are as viewed rrom ttie street, r^ng property 

^ ^ 

^ ^ . <^ 

OS V 

Rc\:rt« Ci*nied :7-Aug-<'« 

# 
# 

84978 

Omaha Lead Site Extsrior Paint North An'ow 

Site Sketch (71 Good 

[ J Poor 

SamDiina Address: 5419 DECATUR ST [^ Not paint \ 

Sample Number 

RYASCPXA-84978 F1 

Lead 

Coficentration 

2.&1 ppm 

Sample 

Collected LAB 

D 

Fimi:

Date-.

Samples Collected 

 rZ)4 ^^-AT 

 I0~l5~0f^ 

RYBSCPXA-84978

RYCSCPXA-84978

RYDSCPXA-84978

RDZSCPXA-84978

 F2 

 B1 

 82 

 DZ 

£2_ 

1^_ 

ppm 

ppm 

ppm 

ppm 

D 

D 

D 

D 

Time: //•).' SO <tm 

Samples Analyzed 

XRF Unit: CiL^H O Book: ?9 ^ 

RGZSCPXA-84978 GZ ppm D Date: ll-l l 0 & 

RrZOCP)(A-04970 P2. ppm n Time; ftrn 

Number of Samples = | ^ [ [ Q [ Staff: m5t J 

Legend: F1 = Front Left, F2 = Front Right, 81 = Back Left, 82 = Back Right OZ = Drip Zone, GZ = Garden, PZ = Pla> 

All quadrants are as viewed from the street, fqcing property racini 

^ 

^3_ 2iLL 

NOV t 2 2008 

)< ) ' BZ. "75 

i\. .V. A 

J>2,-.637 

0 . JSHWDtM-fiti­ ^ t 118 

f^ 

v^ 

\ 

V 

.fl .UrW.^ 

o 

Re^' .«).'! irrtitcd: ;7-AugJ:iS P$o^r<?-t i\.ii 
> i* * * 

COASTA l tNVIKONKIKTA l 

c » 0 tj r . I h c 

Consent fof 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 

following described premises: ^ 

Owner's Name: / ^ ,, ,. -« \ ^ni A Daytime Phone: 

Lo^^o le y^os^f '^' m rzri' 

Address of Property 

I covered by this 

n/rp^ccch^T- y t 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 
.,*^^°""-^. 

COAST A L 

C K 0 U r t K C 

c Remove obstructions including boats, trailers, vehicles, playscape items, wo

piles, dog houses, etc; 

od 

e Remove flower bulbs or plants that the Grantor or the Grantor's tenant may w

to save; 

ish 

c Water and maintain replacement vegetation, including fertilizer application,

necessary' subsequent to an initial watering period by EPA; 

 as 

f Abide by health and safety guidance provided by EPA; 

t If the property' is rented, assist EPA in obtaining tenant approval for access

the property to perform the work. 

 to 

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 ^Ic grant access to my properties Q I do not grznt access to my properties 

7-c;^7-/^ 

Dste Signature Date 

• 1 would like to be present during any samplingi that Is required. 

Paae 2 of 2 
COASTA L 

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). 

Property ID: If^n 

Property Addressrj-Y/ ^ , ^ p gc ^ "j- U C C~f' 

Owner V 

Phone: 

On the attached diagram(s) indicate area(s) to excavate, surface structures and landscapmg 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: 

A-flv ^ Ui^^3 'To i f^ rcK I K^o^^ (g_ Item: 

Item: 

Item: 

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

Item: 

1 

[pUy^ h /. f-h P^A 'fn j 

Item:.-/ f 1) 

Item: 

Item: 

Page 1 of 2 ­
COASTA L CNVinONMEMTA L 

CROUP . INC . 

Items to Be Removed By Contractor During Remediation and Replaced 

Item: 

^ o ) 

Item: 

^ ^ 

i

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 property 

owner. 

fZ-,P z. 

F ^ 

Landscape Inventory 

Quantity Unit Condition/Type/Species 

Quadrants f ^ 

Each 

Each 

^ 

Each 

Each 

Square Feet 

y> 

Easement Area, to be Each 

excavated ^Ik Jv/<?^ [ji^foWj t IAC> /^ ^ 

Page 2 o, ^ 
COASTA L eNVmONHCNTAI . CROUP , INC . 

Additional Comments / Instructions: 

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

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

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

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

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

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

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. 

r~l Please check this box if you understand the information outlined above. 

A ( ce^ ^ ^^,^ e ^Ifk r 

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

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

interior of house, including foundation cracks or fissures. 

n I do not agree 

ryyf^ 

Contractor's Signature Date 

Page 3 of ^ 
8<i'=iig 

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iveraoe 

I 4

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Shot # 

r 

S! : 

Readii Sample are; 

loij: \^ I F2^ 

_.__JaLl.J^ 

Shot .!i Readir^C! oainoie area 

Dep!h 

S^n^ni o ^r:; 

jepi n 

[____ i 

I 

lil^A ltm^<. 
Thernno 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Supervised By: 

Certificate of Verification 

326 

SOIL 

2011-02-08 16:00 

90.52 

Final 

Avg of 323-325 

5419 DECATUR ST 

DZ 

13" 

C.PADILLA 

CONFIRMATION 

CLEAR 
Thernno 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 323 

Mode SOIL 

Time 2011-02-08 15:59 

Duration 30.18 

Sequence Final 

Flags 

BVID 84978 

ADDRESS 5419 DECATUR ST 

QUADRANT DZ 

DEPHT 13" 

XRF TECH C.PADILLA 

MISC CONFIRMATION 

NOTE CLEAR 

ppm Error 

Pb < LCD 14.414 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 324 

Mode SOIL 

Time 2011-02-08 15:59 

Duration 30.19 

Sequence Final 

Flags 

BVID 84978 

ADDRESS 5419 DECATUR ST 

QUADRANT DZ 

DEPHT 13" 

XRF TECH C.PADILLA 

MISC CONFIRMATION 

NOTE CLEAR 

ppm Error 

Pb < LOD 14.771 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 325 

Mode SOIL 

Time 2011-02-08 16:00 

Duration 30.15 

Sequence Final 

Flags 

BVID 84978 

ADDRESS 5419 DECATUR ST 

QUADRANT DZ 

DEPHT 13" 

XRF TECH C.PADILLA 

MISC CONFIRMATION 

NOTE CLEAR 

ppm Error 

Pb < LOD 14.723 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Supervised By 

Certificate of Verification 

322 

SOIL 

2011-02-08 15:57 

90.83 

Final 

Avg of 319-321 

5419 DECATUR ST 

F2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 109.146 

Supervised By: 

Certificate of Verification 

319 

SOIL 

2011-02-08 15:56 

30.18 

Final 

84978 

5419 DECATUR ST 

F2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 17.039 
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 123.250 

Supervised By: 

Certificate of Verification 

320 

SOIL 

2011-02-08 15:57 

30.55 

Final 

84978 

5419 DECATUR ST 

F2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 15.777 
• 

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 79.305 

Supervised By: 

Certificate of Verification 

321 

SOIL 

2011-02-08 15:57 

30.10 

Final 

84978 

5419 DECATUR ST 

F2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 15.616 
^*^'-^ * 

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

Coastal Environmental Group Inc. 

..o* www.coastalhazmat.com \ 

\no^ ^ COASTA L ENVI>ONHENT*L 

C • O U r. I H C 

EXECUTIVE SUMMARY: 

BVID #84978 - (5419 DECATUR ST) 

X No Issues or Concerns I I Issues/Concerns 

Detail Explanation: 
EPA 

EPA Property Close Out Form 

Property Addrws;.-" ^ M S ^ VVr^^WAr,- ^ Property tf: ^'-ASS f^ R 

Date^lme: Owner's Name: AJTjt^.f.j^V:).. .' '^\fr>\1 ' 

Quads Excavated: Contractor Group , 

Excavation Yes No General 

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

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

Grading Sod and Vegetation Yes No 

I Does the grading around the perimeter ofthe house in excavaieri areas generally slope away y from the house? 

2. Has sod been laid in all areas that were excavated? y 

3. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 

day time period) y 

4. Are sodded areas generally firm and evenly graded? 7 

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 propeny? y 

7. Was damage lo landscaping or plant materials avoided? 

Gates, Fences and Retaining Walls 

Ves Nu 

r 1.

 Do gates open and clo.se freely? (If applicable) y 

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

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

"y 

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

7 

Foundation, SidioK and Gut(«r« 

t. Was damage to the sidmg or trim avoided? 

Yes 

y 

No 

2. Was damage to the foundation avoided? ^ 

?. Was damage lo windows avoided? 

4 Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspoul extensions avoided? 

y 

y 

A 

Sidewalks and Driveways (Concrete) 

1. Was damage to driveway surfaces avoided? 

Ves

y 

 No 

2. Was damage to walkway surfaces avoided? 
OM'ncrs comments: 

tin .spection no<es: 

Removal and restoration activates cornplele including the 30-day sod warranry: 

EPA ^Cr- ^ff ^ Rcpresentalive Date: '•/'«'"> 
Property Completion Agreement 

This aj^reemeni clocumenls; Ihe complclion o\ remedial acliviiies perloimed on my pioperiy My signalure 

will designate ihal f am satisfied wilh (he resloralion of my property, and (hal no items are m queslion,«,. 

now, or al any lime in the fulure, excepi ihose ilems listed below, if any 

Property Address: ^^^c v Deeo^Vw r t>V. 

Owner: -^b^\:^ V^ex ^ o-\e. 

Phone; CMf^^^s's\-s9^a 

Restoration Items in Question; 

Item: 

Item; 

Item: 

Item; 

Item; 

Item: 

Additional Comments: 

I ai;rrc rc.^foralfon is completed, occp l as noleri 

[_J I rio nol ajjifc resloration is complcled 

ignatiirf Dale Cdnlrailoi' s Sipnaliiit Date 
Property Damage Settlement 

Property ID 84978 

Property Address 5419 Decatur 

Owner Joseph Lavoie 

I received from the contractor, Coastal Environmental Group Inc. (Coastal), the sum of $110.00 for 

compensation for plants removed. 

Compensation type Check 2257 

Value of Check $110.00 

Check to the order of Joseph Lavoie 

Description of Damage 

While excavating 5419 Decatur Street (BVID 84978), Coastal presumably removed plants from the 

property. Property owner received a check in the amount of $110.00 dollars for the plants. 

My signature below acknowledges the damage; further, I acknowledge that this work was completed 

satisfactory and within my and release Coastal Environmental Group, Inc. from further obligations or 

liability related to this property. 

COASTAL ENVIRONMENTAL GROUP INC. 2257 

2411 IVIARTHA STREET 

OMAHA, NE 68105 

27-5/1040 003 

6247372904 

iP|N)/o 

DATE 

PAY TO THE 

ORDER OF Joseph l^vou 

.*« » $ DO" 

^n^ ^,jii/r\dA£d ijLyi-ajnd^//ffv 

WHIs Fargo Bank, N.A. 

Nebraska 

weHsfargacom 

•:iOU00005ai : E>Eii737BqOUii* Oe257 

i-'^^-n ^E^ M,fZ-qiA / Uid ZOlO 

Owner's Signature Date Contractor's Signature Date 

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