TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: \^~\?f\ Date:: ///SS/O^ 

Address: ?P\ \ VyazAtOOf^H kKJfj 

Remediation Contractor: Coastal Environmental Group_ 

SOIL REMEDIATION 

PROPERTY nL E FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Summary 

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 

Photographs 

As-built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 

a/ Property information from Douglas County Assessor's Office 

• 

Year: 2001 

30055255 

Superfund 
Property Access Checklist 

Property ID: j q^ ? 3 C\ 

D WORKSTAJITED ON: _/ /_ 

D WORK COMPELTED ON: / / Property Address: -3,^^ ^ ^eJi,^^rH ^ Qyffe, 

Renter o>v"c.: p^^V^ r TVywwVfJi 

Address: 

Phone: 

FJLV: 

Cell/Pager: 

Phone Additional Int'ormMtion: : Ip-^l -qt^M Q 

Fax: 

Cell/Pager. 

D Notification Letter Sent: / / By: 

'{ J Access Agreement Signed: Jj/iL'Q? ! By: r>o«vxl> F«/-bt<- / ^ r 

3 ! Restomtion Agreement Sijmed:l^

 / U iC m »>-f>of^ri\«4 s;:^^ ^ /E O 

D Topsoil Sampling (if applicublc) 1 1 By: 

0 DisposaJ Sampling (if applicable) 1 1 By: 

• Garden Sampling (if applicable) 1 1 By: 

^Utilit y Clearance Called: \o 1 1 By: 

D Video/Photos (Before) On: C? I]^l( ^ By: 

D Video/Photos (During) On: / / By: 

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

D Video/Photos (3()-DMy) On: / / By: 

1 ^ Property Completion Agreement Signed: il/^/ ^ By: 

• Final Report Isjfued:

 / / By: 

Air Monitoring (»s applicable 

CD Community D Crew On: / / By: 

Results: 

D Comrounitj' D Crew On: / / By: 

Results: 

1 1 Community' CJ Crew On: / . / By: 

ResulU: 

Omaha Lead Site 
# 

CONTACT FORM 

Property ID # i^nm 

Property 

Address: ^Z\\ WPf^h/yjO/ ^ 

Initial Contact: Date:W///^ Time: \ 5'3t> Action: |efi- ^.ue. r 

Second Contact: Date: Time: Antinn Action:-_ ^3 

Final Contact: Date*. Time; Action: 

Final Action: Transmit lo EPA D Other Action: D 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 
Douglas County Accoimt InfqgiMio W n 

Page 1 of2 

Douglas County, Nebraska Property Record - R1220890000 

Print Report 

NEW Feature - Parcel Dimensions avaiiable @ scale 0-50 ft west of 52nd St - VJeW O n Ma p Information is valid as of 2009-5-12 Treasurer's Tax Report 

New Feature -•-•- • Auto Sales Search 

Owner 

FERBER DONALD L 

ETAL 

3311 WOOLWORTH AVE 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 2089 0000 12 

Account Type: Residential 

Parcel Number: 1220890000 

Parcel Address: 

3311 WOOLWORTH AV 

OMAHA NE 68105-0000 

Legal Description: 

GRIFFIN & SMITHS 1ST SUB LOT 3 BLOCK 5 W 42 N 85 FT & W 27 S 56.8 FT 

LOT 2 & E 48 FT 42 X 85 - 27 X 56.8 - 48 X 141.8 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$7,800.00 

$7,800.00 

$7,800.00 

$7,800.00 

$7,800.00 

$7,800.00 

Improvement 

$267,400.00 

$267,400.00 

$267,400.00 

$231,300.00 

$231,300.00 

$231,300.00 

Total 

$275,200.00 

$275,200.00 

$275,200.00 

$239,100.00 

$239,100.00 

$239,100.00 

Sales Informatio n 

Sales Date: 1990-07-03 

Deed Type: 

Price: 

Grantor: 

$88,000.00 

Book: 1885 Page: 162 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres 

0.21 

SF 

9153.0 

Units 

1.0 

Depth 

113.0 

Width 

81.0 

Vacant 

No 

Improvemen t Informatio n 

http://douglasne.mapping-online.coin/DouglasCoNe/static/accountinfo.jsp?accountno=R 122... 6/6/2009 
Douglas County Account InfcHflB|ion Page 2 of2 'W 

Building 1 

»» Rr« Floor 136S0sq ft Second Floor 1296 0sq.tl 

<0f 

XtlJlLt. 

2 1/2 STORY FINISHED 

THrd Floor Bsntt Bb:«>. ^ ft 

718.0 K). n. 13M0U ] II 

Hn Bmrt na « i n Ta Li>' 

>»" rlt30 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 3382.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Good 

Unit Type: Condition: Average 

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

HVAC: Forced Air Rooms: 8.0 

Exterior: Frame Stucco Units: 1.0 

Interior: Drywall Baths: 2.0 

Roof Cover: Composition Shingle Bedrooms: 5.0 

Roof Type: Gable Stories: 2.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year 

year Built Physical Age Remodeled Remodeled Built 

1918 0% 1918 90 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 1344.0 

Basement Minimal Finish 336.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 2.0 

Garage Detached 440.0 

Porch End Solid Wall 60.0 

Porch Knee Wall 216.0 

Porch Slab Roof Ceil 187.0 

Porch Slab Roof Ceil 112.0 

User Attic Full Finish 718.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accoxintinfo.jsp?accountno=R122... 6/6/2009 
I) Haut^^Kiage of ^ ^ 

*«littfc 'A>i*M "^»*i i • ^^^^ ­

fliWHocating&UtilityServices 

STANDBYNOHFICATION 

"QMON^ELMLOCATTNGANDUnLTTY SERVICES HAS IJOCATIDT I 

FOLLOWING fflGHPROMIFACimY. PLEASE VERIFY YOURDIGAREAPRIORTO 

DIGGlNGTODEIERMlNEWHERE0URaM(S)HIGHPR0FIiJEFA(inYIS 

LOCATED. IFYOD ARE DIGGING WIlHlNSFEErOFODRfflGePROFILE 

LOaTtMARKSWEWANnOBEONSnETOPRQIECTimCABLEiS). (IF 

YOUWEBEDIGdNGFURTrnTHANSFEETFROMTHELOCAHMARKSWEDO 

NOTNEEDTOBEONSim) 

FLEAaCALLI)SATLEAST24HOPRSPRIORIt) DIGGING It) 

SCHEDDLEASTANDBY. 

*Apjiiti]iati IR Kt qi 01 i 6nt coiKfint tern Idi ; WI omot parnlee tt^ 

be in U K plew gire n aflBik iitfae b ^ ( ^ 11 pouiUt 

TKM mm 

SizeofFiiitY(Owest] FIBER 

Address 3311 WOOLWORTH AVE 

City_OMAHA ^Stale_NE_ 

ExciiYalor COASTALENVIRONMENTALSERVICE 

CdtactNme EUZABETH 

TjpeofWoi ^^AMREMEDIATTON, 

DateofNotificiition 6123/09 

Fax* 1877()62421I 

PliASEDOMEXCAVATEUM-YOUHAVECOORDINATlDAllMBFORAIlEPRESMATTVE 

FROMOURCOMPANYTOBEPREMWHM YOU EXCAVATE 

IBANK YOUFORYOICOOPERATON. 
• • • • 

Page 1 of2 

"> 

Create Another Ticket Backtolrth Internet Send Email 

YOUR TICKET NUMBER IS 2354272. 

Original Call Date: 9/01/09 Time: 11:30 am Op: ELIZABETH18790 

Work to Begin Date: 9/03/09 Time: 12:00 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 3311 Street: WOOLWORTH AVE 

Twp: 15N Rng: 13E Sect-Qtr: 28-NW 

Twp: Rng: Sect-Qtr: 

Legal Given: C 


Type of Work: lead remediation 


Location of Work: INCLUDE ALL EASEMENTS LOCATE ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (877)662-4211 


: UNSURE OF CORNER LOT 


Company : COASTAL ENVIRONMENTAL SERVICE 


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


Work Being Done For: coastal 


Depth of Excavation: 4ft Comer Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

LEVELS LEVELS COMMUNICATIONS, LLC NA Alt: 

Emerg: 8773668344 

Day: 4025047823 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RON Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/1/2009 
Page 2 of2 

# • • • 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK NA

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www,dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/1/2009 
As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

Name: ^^«5ta£7C. Omaha Lead SKe Date: 7//s/i>3 . North Arrow 

Address. 3 3 M H«e/tJ£<z.Tr///^•^ Site Sketch Time: 0 : "S-^/ ^ 

Phone: C^^-'^/-^^TC V 

Team ^SJ^A A <J : AH , j"^/ottfg-^BVI D # / f 73* 1 XRF Code ^ S C 

Sample Number Lead Concentration Confirmation Sample 

f/ve s a O 

^r:3Yes n No J ^ 

ppm NNo o

11 >'^ ^'' 5 ^ I'-^i PP' " 

ppm U\Yes a No y g 

ppm ^Ye s a No/g 

ppm feVes n No-g^^ 

/<.<h T-'^P)Ci 4 - i ^ ^ 3^ 1 ppm ^Ye s n No J2 r 

ppm Yes • No D 

OLS#: 1973 

DZ = 312PPM@13" 

Omaha Lead Site 46130 

Legend 

Concret e Drip Zone Excavated Quadrants Excavated 

Area replace d wit h Area replaced with 

Area left bare
 Sod Rook/Mulch 

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

• & ^o\V)OC^ r. r 

Name: fks^B^Cf^ Omaha Lead Site Date: V//s/^3 North Arrow 

Address"~33M Y'eolt^oa.rM I'iv^^ Site Sketch Time: ' g : "gg^ / M 

Phone; UttA-^i'tpl^ l i^ 

Team As\^/z A d//^,/ b /?U>fi^BVID # /fVS' j XRF Code '^' ^ 

Sample Number Lead Concentration Confirmation Sample 

ppm f'ves D No '<^ Ryg>f9<^vy-)-—iq-7 ^ 

ppm No ^ 

ppm No yg. 

ppm 5fYes a No ^ 

ppm No'g. ppm ^Yes a No JZr 

ppm Yes • No • 

-7i ^ 

:.-,^ ^ 

1. ' M '...-..-.y. y 

^ 

fl^^^^^^ ^ -a-T 

r j '^^r•|//^.^t ^ 

^ ^ 

..X—. T 

: : ^ 3 ; ».jL... , :».... . 

_, .' *t.

Tt > ; •< 

Omaha Lead Site 46130 
m 

Name: f^e^^ -

Address~33M Yieolt^otirM A^ ^ 

Phone: UoA-%<fl -l^l^ l 

Omaha Lead Site

Site Sketch

 Date: 

 Time: 

North Arrow 

^ ^ 

^ 

leam4s^/zAtJ:Ah/0tfi^E\t\:i * /fVS ^ XRF Code _^^L L 

Sample Number 

/if^Z3CPy a -/ 9 7J ^ 

Lead Concentration 

Mil ^/ 3 

1 ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

Confirmation Sample 

y 

No ^ 

No ^ 

No <2 

No-Q ^ 

No J2r 

No • 

f'Yes ° 

/T^Yes n 

!fi»\Yes n 

^Ye s a 

^Ye s n 

^Ye s n 

Yes • 

- 3 ^ 

^ 

^ 

^ 

^ 

Omaha Lead Site 46130 
Oirofllll ILiBMli AilB 

HmmttS^/zjtttA/Mik^fm^Wim* /^73 ^ OT«FOode_^^ 

OorffinniBlfionii 

7

RY^'^rfyk^a- ^ n ^ "? 

 Kf^3ref^<a -mi ^ 

^ ^ ^^//'tf 

ppm .^c kY«

rYes

rYes

Yes

Yes

 a 

O 

O 

O 

a 

Odn^ n ILcsd Site 460® 
COASTA L INVmONHENTAl 

C I O U P , INC . 

Consent for Access To Property 

RIGHT OF ENTRY TO PREMISES 

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

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

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

following described premises: 

Daytime Phone: 

V^xhtr T^Om\c\ 

Address of Property 

covered by this 

Agreement: 

3'^\\ W)00\\O0r\V->4NJe. 

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 wori( to be performed, the Grantor will have an 

opportunity to review and approve the planned soil removal, and restoration wori( 

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: 

Paget of2 
^ ^ 

\T»**^ / COASTAL ENVIKOHHENTAL 

' I PROI ^ C > O U P . I N 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 wori( 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 

iS(lgrant access to my properties D I do not grant access to my properties 

Signature Date 

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

Page 2 of 2 
COASTA L • MVtHONn r NTAt . 

G H O U r IM C 

Restoration Agreement 

The purpose of this agreement is to provide a mutual agreement as to conditions ofthe 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: ^ Q "^ >^C^ 

Property Address: S'SW XOf^Unnf-U ^ KvjP 

o^'^'-^^cvVo^r "Vy^riQV 

Phooe: L^\^LAm q 

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 responsibilrty. 

Item: 

<\VM\> ^rr\a\[ S;^\(\<\>Cs Am h P <^vlP(4 

Item: 

OrnampnV^ C\Yr^^^r^A TJ? . Item: 

Item: 

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

item: 

Kv\a SSXVV:A\\ ^\rvv\\^ \e ^ y^ev^'^^^ 

Item 

Item: 

Item: 

Page1 of. 
COASTA L 

Items to Be Removed By Contractor During Remediation and Replaced 

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 lavoui. 

Number of and size of 

each garden/ flower bed 

area. 

Atiach a sketch of relative 

sizes and locations. 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

INotc this \Hliie will he 

used to issue H plant 

^oucher to the property 

owner. 

Easranent Area, to be 

excavated 

Quantity 

1fT, 

^ 

^ 

wo 

ru 

/ 

Ncs 

Landscape Inventory 

Unit 

Quadrants 

Each 

Each 

Each 

Each 

Square Feet 

$ 

Condition/Type/Species 

^:^M\oa ^eao\As 

Each 

Page 2 of. 
I

COASTA L NVIMONnl-MTA l 

Additional Commente / Instructions: 

n 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. 

Q I do not agree 'ij agree 

?{fMmi\ (J/l(09 

Owner's Siniature Contractor's Signature Date 

Page 3 of. 
XRF PROPERTY SAMPLE SHEET 

BVID#lBT ^ 

Date 

Project 

XRFID# 

OfAaha lead FP 2n2nci l year option 

Address; 

Sample time 

sample length 

<b^\ \ W)0d|u3far4ti t^i . 

am/pm 

30 sec 

Shot# Reading Sample area Shot# Reading Sample area 

^ 5h.ftatq.ftt4 

K^nxJs^ln.QOj 

3S. 7/) i ft.SJD 

PT. 

Depth Depth 

Average Lj^.S^ t ^,[^ 5 Average 

Shot# 

1 

« 

<\ 

10 

Reading 

33M.OLU22--as­

.•Vlft.^ii7.Inl 

3U 1.^1*1.11 

inr'&\i^YhL*i 

Sample area 

D^ 

Depth 

»•% 

Shot# Reading Sample area 

Depth 

Average 3JLLI1Q_L-2L^»^. ^ Average 

Shot# Reading Sample area Shot# Reading Sample area 

l/^.A?si n-.oi n\'h ?f9).ftli.Hq1 OA--" ^ 

ii. l'rc\ \<:i-li: ^ Depth Depth 

\ & PiS". \cf\ * 11.^6 \ 

Average ^ft.Ul t \7.U ^ Average 

RETEST AREAS 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

lab sample # Lab result Sample area XRF Avg. 

Signature hOA^ff^ ^ 

Print gkngbibH^ O/iperes 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 6 

Mode SOIL 

Time 2009-09-10 07:50 

Duration 122.37 

Sequence Final 

Flags 

AVERAGE i^w^i. ADDRESS jji i wooiworth 

QUAD/ZONE F2 

INSPECTOR VENTRY 

DEPTH 5 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± 

Pb ± 

Supervised By: (pCfl^UlJ2 A 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2 

Mode SOIL 

Time 2009-09-10 07:48 

Duration 31.15 

Sequence Final 

Flags 

BVID # 19739 

ADDRESS 3311 wooiworth 

QUAD/ZONE F2 

INSPECTOR VENTRY 

DEPTH 5 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 53.719 ± 10.096 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 3 

Mode SOIL 

Time 2009-09-10 07:49 

Duration 30.42 

Sequence Final 

Flags 

BVID # 19739 

ADDRESS 3311 wooiworth 

QUAD/ZONE F2 

INSPECTOR VENTRY 

DEPTH 5 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 50.878 ± 9.842 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 4 

Mode SOIL 

Time 2009-09-10 07:50 

Duration 30.42 

Sequence Final 

Flags 

BVID # 19739 

ADDRESS 3311 wooiworth 

QUAD/ZONE F2 

INSPECTOR VENTRY 

DEPTH 5 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 53.711 ± 10.087 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 35.197 

Supervised By: 

Certificate of Verification 

5 

SOIL 

2009-09-10 07:50 

30.38 

Final 

19739 

3311 wooiworth 

F2 

VENTRY 

5 

CLEARANCE 

± Error 

± 8.555 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 11 

Mode SOIL 

Time 2009-09-10 07:55 

Duration 123.47 

Sequence Final 

Flags 

AVERAGE 

ADDRESS 3311 wooiworth 

QUAD/ZONE DZ 

INSPECTOR VENTRY 

DEPTH 13 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm Error 

Pb 

Supervised By: CpCOJ^qJ ^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 334.026 

Supervised By: 

Certificate of Verification 

7 

SOIL 

2009-09-10 07:52 

30.59 

Final 

19739 

3311 wooiworth 

DZ 

VENTRY 

13 

CLEARANCE 

± Error 

± 22.348 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID# 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 348.698 

Supervised By: 

Certificate of Verification 

8 

SOIL 

2009-09-10 07:53 

30.92 

Final 

19739 

3311 wooiworth 

DZ 

VENTRY 

13 

CLEARANCE 

± Error 

± 22.605 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 346.199 

Supervised By: 

Certificate of Verification 

9 

SOIL 

2009-09-10 07:54 

30.63 

Final 

19739 

3311 wooiworth 

DZ 

VENTRY 

13 

CLEARANCE 

Error 

22.766 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 217.893 

Supervised By: 

Certificate of Verification 

10 

SOIL 

2009-09-10 07:55 

31.33 

Final 

19739 

3311 wooiworth 

DZ 

VENTRY 

13 

CLEARANCE 

± Error 

± 18.251 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 16 

Mode SOIL 

Time 2009-09- 10 07:58 

Duration 122.72 

Sequence Final 

Flags 

AVERAGE 

ADDRESS 3311 wooiworth 

QUAD/ZONE easement 

INSPECTOR VENTRY 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb ± 

Supervised By : ^ HJM^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 12 

Mode SOIL 

Time 2009-09-10 07:56 

Duration 30.64 

Sequence Final 

Flags 

BVID # 19739 

ADDRESS 3311 wooiworth 

QUAD/ZONE easement 

INSPECTOR VENTRY 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 109.951 ± 12.899 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 13 

Mode SOIL 

Time 2009-09-10 07:57 

Duration 30.75 

Sequence Final 

Flags 

BVID# 19739 

ADDRESS 3311 wooiworth 

QUAD/ZONE easement 

INSPECTOR VENTRY 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 88.866 ± 11.968 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 100.151 

Supervised By: 

Certificate of Verification 

14 

SOIL 

2009-09- 10 07:57 

30.55 

Final 

19739 

3311 wooiworth 

easement 

VENTRY 

1 

CLEARANCE 

± Error 

± 12.564 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 15 

Mode SOIL 

Time 2009-09-10 07:58 

Duration 30.78 

Sequence Final 

Flags 

BVID # 19739 

ADDRESS 3311 wooiworth 

QUAD/ZONE easement 

INSPECTOR VENTRY 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 95.693 ± 12.304 

Supervised By: 
«i 

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

Coastal Envlronmentel Group Inc. 

www.coastalhazmat.com 

"i-pnii ^ COASTA L ENVIRONHENTAL 

GROUP . IN C 

EXECUTIVE SUMMARY: 

BVID # 19739- (3311 WOOLWORTH AVE) 

No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 

-COASTAL TO GIVE PO MULCH. (COMPLETED 9/23/09) 
^ % 

EPA Property Close Out Form 

^^\\\)0M9%^W 

Property tf: V^ \7\ . 

Property Address: 

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

QuadJ Excavattd: ^ X V€^ Contractor Group 

Excavation GcHeral 

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

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

Grading Sod and Vegetation 

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

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 evaluale if inspected at a 30 

day time period) 

4. Are sodded areas generally firm and evenly graded? 

5. Arc 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 propertj'? 

7. Was damage to landscaping or plant materials avoided? 

Gates. Fences ami Retaining Walls 

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

2. Were all gates or fences lalcen down during restoration activities reinstalled? (if applicable) 

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

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

Foupdation, Siding and Gutters 

1. Was damage to the siding or trim avoided? 

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 downspoul extensions avoided? 

Sidewalks and Driveways (Concrete) 

1 Was damage to driveway surfaces avoided? 

2. Was damage to wallcway surfaces avoided? 

Yes INo 

ITT 

^' 

Yes ^ o 

- ^ ^ 

_^^ _ 

iX 

V 

Yes No 

77" 

• ^•• j 

i^ 

7t1 

Vcs No 

• 7 " 
Ov^ncrs comments: 

[inspection notes: 

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

EPA Representative 
Property Completion Agreernent 

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

will designate that I am satisfied with Uie restoration of my properly, and that no items are in questions, 

now, or at any lime in the future, except those items iisled below, if any 

Property ID: \^'^ ^ 

Property Address: ^^] \ 06t^^^ l /fs/e. 

o^"" ThnM PerUr 

Phone: ^^ ^ •i^^^<i 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

' 1 ayrcc I'cstoralion \% complcltd, except as nnleri 

1 

Coi^i arlor's Signature Dale