TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATIO N FILE FOLDER 

SAID#: \SHg 3 Date: Q^j<:JOH 

Address: ?lnl\ ^ V\aSCi3A\ ^ 

Remediation Contractor: Coastal Environmental Group_ Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

JZ' Video of property (DVD) 

pf Executive Summary 

0 EPA-provided property sketch ... . ­" 

IZ Signed Access Agreement for subject property -' . ' 

K1|W Signed Access Agreement(s) for adjacent property 

H' Restoration Agreement 

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

0 Confirmation data 

0 Photographs I>rC>-.P^z-zgJljiJV) ^ ovrjaJoJityv^ scAj Y-n.cX S6^ 

J^r' As-built sketch 

) 0 Satisfactory restoration signed by Property Owner 

0 ' Property close-out check list signed by EPA 

tl(B Description of areas not meeting ROD cleanup criteria 

0 ^ Utility clearances 

0 ^ Property information from Douglas County Assessor's Office 

m^>e^. Qj'^tx^^ oVf^^lc^r 

B^ C^O^Wf fi^fr^ 40318147 

D 

Superfund 

^ Signaturee '^ DJ Date 
m 

Property Access Checklist 

PropertylD: ^,^qc, ^ 

Property Address: Sj^-^ ^ Un^n W :Si 

D

D

 WORK STARTED

 WORK COMPELTED

 ON: 

 ON:. 

o^^"^'n"\c3i\\a Pf^W 

Address: ^, „ 

"««'•• SS-^^-fM,.??-^ 

Fax: 

Cell/Pager: 

Renter: 

Phone: 

Fax: 

Cell/Pager. 

Additional Information: 

D Notification Letter 

^0'^Aceess Agreement 

j2 ^ Restoration Agreement 

D Topsoil Sampling (if applicable) 

Q Disposal Sampling (if applicable) 

D Garden Sampling (if applicable) 

J ^ Utility Clearance 

0^Video/Photos (Before) 

D Video/Photos (During) 

n Video/Photos (After) 

D Video/Photos (30-Day) 

D Property Completion Agreement 

D Final Report 

Sent: / / 

Signed: .3_/^/0 ^ 

Signed: _3_/2^/C2. 

/ / 

/ / 

/ / 

Called:^ /JC'/Q i 

On:^/^/i! ^ 

On: / / 

On: / / 

On: / / 

Sisncd: J 1 

Issued: / / 

By: 

By=K\irlinta.? 

By: W\(\\rk\s 

By: 

By: 

By: 

By= IO/.P/A? 

By= i/^rvi-i^rv 

By: / 

By: 

By: 

By: 

By: 

Air Monitoring (as applicable 

D Community • Crew 

1 

Results: 

On: / / By: 1 

• Coomiunit}'

Results: 

D Crew On: / / By: 

• Communit)'

Results: 

• Crew On: / / By: 1 

Omaha Lead Site 
CONTACT FORM 

Property ID # 

Property 

Address: 

Initial Contact: 

Second Contact: 

Final Contact; 

Final Action: 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

^^M-S ^ 

3\-«»^5 H<?i^0.c:^ll -

Date: 

Date: 

Dale: 

Time: 

Time: 

Time: 

Tran.smit to EPA D 

Action: 

Action: 

Action: 

Other .Action: D 
 1 

Douglas County Account Information Page 1 of2 

Dougla s County , Nebrask a Propert y Recor d - R173896000 0 

Print Report 

NEW Feature - Parcel Dimensions available &. scale 0-50 ft west of 90Vn St - Vie w O n Ma p Information is valid as of 2008-9-4 Treasurer's Tax Report 

1 New Feature -»-•- > Auto Sales Search 

Owne r 

BELL ROBERT B 

ETAL

3635 HASCALL ST 

OMAHA NE 68105-0000 

Propert y Informatio n 

Key Number: 3896 0000 17 

Account Type: Residential 

Parcel Number: 1738960000 || 

Parcel Address: 3635 HASCALL ST 

OMAHA NE 68105-0000 

Legal Description: MELROSE HILL LOT 9 BLOCK 6 50 X 124 

Valu e Informatio n 

Land Improvement Total 1 

2006 $14,000.00 $76,300.00 $90,300.00 

2007 $14,000.00 $76,300.00 $90,300.00 

2006 $14,000.00 $76,300.00 $90,300.00 

2005 $14,000.00 $76,300.00 $90,300.00 

2004 $6,400.00 $76,300.00 $82,700.00 

2003 $6,400.00 $76,300.00 $82,700.00 

Lan d Informatio n 

Acres SF Units Oeptfi Width Vacant 

0.14 6200.0 1.0 124.0 50.0 No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17... 9/27/2008 
Douglas County Account Information Page 2 of2 

160:4r 

Enak>Md Scmn Wat 

64sqt 

3*Jg 

8M0S.F 

Me 

34,9 

•MUklDtf), 

RANCH 

Btmnl Block «It 

804.0 S F 

CLICK TO ENLARGE IMAGE CLICK TO_ENLARGE IMAGE 

Square Footage: 884.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Good 

Built As: Ranch Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 4.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.0 

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 Fence Chain Link 1.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 884.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 240.0 

Porch End Screen 64.0 

Porch Slab Roof Ceil 32.0 

Porch Slab Roof Ceil 160.0 

Porch Wood Deck 66.0 

Porch Wood Deck 120.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=R17... 9/27/2008 
Page 1 of2 

Create Another Ticket Back to Irth Internet C Send Email 

YOUR TICKET NUMBER IS 2144097. 

Original Call Date: 9/30/08 Time: 11:31 am Op: ELIZABETH18790 

Work to Begin Date: 10/02/08 Time: 12:00 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 363 5 Street: HASCALL ST 

Twp: 15N Rng: 13E Sect-Qtr: 32-NE,33-NW 

Tv/p: Rng: Sect-Qtr: 

Legal Given: C 


Type of Work: lead remidiation 


Location of Work: LOCATE ENTIRE PROPERTY STARTING FROM THE HOUSE ALL THE 


: WAY TO THE STREET. 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUD02 OMAHACOF 0PPDGPR6 QLNNEIF QWEST2 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emerg: 4029329757 

MUD02 METROPOLITAN UTILmES DISTRICT SANDY

Day: 4025047823 

 Alt: 

Emerg: 4025047946 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RON

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA

Day: 4067289343 

 Alt: 8887289343 

Emerg: 4067289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/30/2008 
Page 2 of2 

QLNNE 1F QWEST LOCAL NETWORK HA

Day: 4067289343 

 Alt: 

Emerg: 8887289343 

QWEST2 QWEST LONG DISTANCE SARA

Day: 8002834237 

 Alt: 3039921926 

Emerg: 8002834237 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/30/2008 
As-Built Drawing 

C

ENVmONHENTA

 OAST A L 

t Omaha Lead Superfund Site C « O U P , INC . 

Name; IMI L J^/ / Omaha Lead Site Date: ^////^ S North Arrow —i 

Address: Site Sketch Time: /j'.'/'7 ~ 

Phone: •,55-3--.5^;?^ 

\i/ 

tP^ 

Team f./^i)M)fZ^V^ BVID # / O vO* ^ XRF Ccxle 7^^ 

Sample Number Lead Concentration Confirmation Sample 

No ^^'^ 

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No '' ^ 

ppm •^^^^r 

ppm No g.y&t 3 ? 

ppm 

<VK£L.fyft-l345S 

ppm ooYes CD No . ~ -t 3g ppm gYes • No J2r 

ppm ^ sg: i^Yes Q No ^ 

ppm •^ Yes D No ^i—a \ 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with 

Sod 

Area replaced with 

Rock/Mulch Area lef t bar e 

Contrac t #: EP-R7-07-05 Coasta l Environmental Group Inc . 
Cl ^^^//, A /f*?*^^.^c? ispoo^^.^ i-<^<S^ 

Omaha Lead Site Date: '^0///^~S North Arrow —i 

Address: ?5 Mf<v^ Site Sketch Time: /j'./-T"' 

Phone: 4^^-,^^3--J5^^ ^ V 

5p ^ 

•i Team j\/^ifi^Jn/Zl^l/ ^ BVID # fSy^ . XRF Code 71^^ 

Sample Number Confimiation Sample 

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Name; 'H^l/ U jSf/ / Omaha Lead Site Date: ^///^ S North Arrow —i 

Address: ^ 5 /t»ffV/l^ Site Sketch Time: /J*./"? ~ 

Phone: ^/} ^ -75^3--J5^P ^ \ i/ 

Team j\/^ai^jn/Z^i/^ T ^ 

BV1D# /^^^ , XRF Code 7^? 

Sample Number Lead Concentration Confirmation Sample 

;'Y(1S<!>V!^ ­ 1^453 

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Date ^////as 

Time; /J' r 

North Arrow

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Sample Number Lead Concentration Confirmation Sample 

-/345'3 -T/Yes 1^ No ^ 

\^455 

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COASTA L INVIIIONHENTAl 

e • O u » . IN C 

Consent For Access To Property 

RIGHT OF ENTRY TO PREMISES 

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

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

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

following described premises: 

Owner's Name: Daytime Phone: 

TwjVa. /yi?p7/^ S6S^GID<^1 3 

Address of Property 

covered by this 

Agreement: 

%L%^ "^^jm^K ;sf 

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 appnDve 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 
!f='^'* . 

« ^ ^ ; 

V " • >" COASTAL 

C • 0 U r . IH 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 

^ I grant access to my properties D • do not grant access to my properties 

;;V-^^ ^ -j^iLiLsD T-^ 9-6 ^ 

Signature Date Signature Date 

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

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

remediation activities. Tliis 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: i

yi n 

Property Address: T' ^ T ^ 2 ex 5" C CK V 

Phone: 5£,^-f;(ng3 

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

utilities, subsurface features, syrface 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: /i/^^^ — —­— J 

Item: 

/ 

Item: / 

Item: / 

Item: / 

Item: / 

Item: 

/ 

Item: / 

Page l o f ( ^ 
^ ^ ^ 

COASTA L 

o n o u r . IM C 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

' ^ 

Item: 

Item: 

Kem: 

Item: 

item: 

Item: 

Item: 

Item: 

Item: 

Nem: 

Item: 

Item: 

Item: 

Kem: 

Page 2 of. 
C O A S T A L 

C M O U P IN C 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

^<? ' I 0 s^d av i &

Item: 

Item: 

Item: 

Hem: 

Kem: 

Item: 

Kem: 

Kem: 

Kem: 

Kem: 

Kem: 

Item: 

Kem: 

Kem: 

Page 3 of/ > 
COASTA L 

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 

Each 

Each 

Each 

Each 

Square Feet 

Page 4of fe­
COASTA L 

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 

area(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 

0 

0 

Unit 

$ 

Each 

Condition/Type/Species 

K • ' 

f\ SF \,\o^^^^' ' 

0 SF 

SF 1 , . • " 

Pages o f ^ 
C O A.S T A L KMVUHOHMKMTAL ai»*wr . IM C 

D Check the box if Owner does not want CEG to document intenor 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. 

JP T agree Q I do not agree 

L2iM. 3/2 ^ Owner's Signature Date Contractor's Signature 

Page 6 oF. 
XRF PROPERTY SAMPLE SHEET 


Date U n jH Address 

Project Omaha lead FP 2nd year option Sample time 

XRF ID# ^)'Lci<^ sample length 

Shot# Reading Sample area 

Shot# 

IM. 

mo ^ 

C^i iiilL 

SA: Depth <'^L 

W ui]<?i I'i^^ <^'> 

Average ^^Z t ^>H ^ ^1-^ ^ 

Average

Shot# Reading Sample area 

Shot# 

^i. K 

HI t K & l 'O^li . m -t h 

'iy^n 

2^ + 14 Depth 

Z-G + H

i(.\l \P 

Average li^ t y Average 

Shot # Reading Sample area Shot# 

Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# 

Depth 

Average Average 

lab sample # Lab result Sample area XRF Avg. 

Signature_ 

BVID# \y\0b 

^<^^< \W7CPriL, 

am|^n> l^-^'^ 

30 sec 

Reading Sample area 

io^.Uj ; (5.(1 i^sei^6^f \^.|.(,1: I'^.^t 

{,%^Ht \0-^^ Depth 

^•1 1 t ^ '^n r 

 [^(-^ ^ ^ l^-^ f 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

„..---) 
T:I—Mgn^WJiMV , j 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1589 

Mode SOIL 

Time 2008-10-17 12:56 

Duration 121.57 

Sequence Final 

Flags 

AVERAGE Avg of 1585-1588 

ADDRESS 3635 hascall ~ 

QUAD/ZONE 

INSPECTOR 

fpz 

DEPTH Ventry 

SAMPLE TYPE 

NOTE f CLEARANCE T ^ 

Supervised By: 
_ Ti-^ij;.l:,. .^ ; .-.^.•f':^^'^;-77^^- : '••' 

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 281.226 

Supervised By: 

Certificate of Verification 

1585 

SOIL . : 

2008-10-17 12:54 

30.68 

Final 

13453 

3635 hascall 

PZ 

Ventry 

6 

CLEARANCE " 

± Error 

± 19.824 
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 335.092 

Supervised By: 

Certificate of Verification 

1586 

SOIL 

2008-10-17 12:55 

30.33 

Final 

13453 

3635 hascall 

PZ 

Ventry 

6 

CLEARANCE 

± Error 

± 21.569 
'••^r*— - "•••"' " 

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 428.938 

Supervised By: 

Certificate of Verification 

1587 

SOIL 

2008-10-17 12:55 

30.30 

Final 

13453 

3635 hascall 

PZ 

Ventry 

6 

CLEARANCE 

± Error 

± 24.357 
.a)^,r. » r :• Y • 

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 268.110 

Supervised By: 

Certificate of Verification 

1588 

SOIL 

2008-10-17 12:56 

30.26 

Final 

13453 

3635 hascall 

PZ 

Ventry 

6 

CLEARANCE 

± Error 

± 19.382 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1594 

Mode SOIL 

Time 2008-10-17 13:00 

Duration 120.73 

Sequence Final 

Flags 

AVERAGE ^Avg of 1590-1593 

ADDRESS 3635 hascall 

QUAD/ZONE easement * 

INSPECTOR Ventry 

DEPTH 

SAMPLE TYPE I CLEARANCE 

NOTE 

Pb 

Supervised By 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1590 

Mode SOIL 

Time 2008-10-17 12:58 

Duration 30.18 

Sequence Final 

Flags 

BVID # 13453 

ADDRESS 3635 hascall 

QUAD/ZONE easement 

INSPECTOR Ventry 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 62.409 ± 10.188 

Supervised By: 
:><^"' Vff'f-7-' "i^^ - ~'TZ~ • '^•- 'Ww ^ '*f 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1591 

Mode SOIL 

Time 2008-10-17 12:59 

Duration 30.21 

Sequence Final 

Flags 

BVID # 13453 

ADDRESS 3635 hascall 

QUAD/ZONE easement 

INSPECTOR Ventry 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 59.668 ± 10.063 

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 69.654 

Supervised By: 

Certificate of Verification 

1592 

SOIL 

2008-10-17 13:00 

30.21 

Final 

13453 

3635 hascall 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 10.668 
l ^ •*:- • 

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 Pt'PE 

NOTE 

ppm 

Pb 55.791 

Supervised By: 

Certificate of Verification 

1593 

SOIL 

2008-10-17 13:00 

30.13 

Final 

13453 

3635 hascall 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 9.943 
m Omaha Lead Site—Fixed Price EP-R7-07-05 . ^ Coastal Environmental Group Inc. 

\~^^ ^ www.coastalhazmat.com 

^^tPROtt'^ COASTA L INVItONHENTAL 

C « O U P, INC . 

EXECUTIVE SUMMARY: 

BVID # 13453 - (3635 HASCALL ST) 

No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 

NO ISSUES PENDING. 
^ i ^ EPA 

EPA Property Close Out Form 

Property #: \^^5 ^ Property Address: 

Date/Time: Owner's Name:~^ ^ 

Quads Excavated: ^-^N^^'S^t Contractor Group (^jfYll^ nvtronnoen^ 

Excavation General 

Yes No 

I. If necessary, were the correct quadrant(s) excavated and restored? • ^ 

2. If necessary, were the correct areas of drip zone excavated and restored? 

^ 

GradinK Sod and VeccUtion Yes No 

1. Does the grading around the perimeter of the house in excavated areas generally slope away 

from the house? 1 ^ 

2. Has sod been laid in all areas that were excavated? 0 

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

day tmic period) 

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

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? 0 

Gates, Fences and Rctainini; Walls Yes No 

1. Do gates open and close freely? (If applicable) 

u ^ 

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

3. Was damage to gates or fences avoided? (If applicable) x ^ 

4. Was damage to retaining walls avoided? (If applicable) AM 

Foundation, Siding and Gutters Yes No 

1. Was damage to the sid'mg or trim avoided? c / 

2. Was damage to the foundation avoided? . ^ 

3. Was damage to windows avoided? 

^ 

4. Was damage to windows or door screens avoided? ^ 

5, Was damage to downspouts or downspout extensions avoided? 1 ^ 

Sidewaltis and Driveways (Concrete) Yes No 

1. Was damage to driveway surfaces avoided? a ^ 

2. Was damage to walkway surfaces avoided? 1 ^ 
O •'ners comments: 

Inspection notes: 

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

EPA '^^VT^^^i\\2.\\v^^,^0J^j0^^^^ Date: ///^/s . 
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 my property, and that no items are in questions, 

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

Property ID: / J ^^ J 

Property Address:

Owner: fujiUc .

Phone: ^J J ^

 1 C T S^ 

 Bal l 

 J^^ J 

rra^yccj/ f T 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

]0\ I agree restoration is completed, except as noted 

 I I do not agree restoration is completed 

Owner's Signature Date Contractor's Signature Date 

I