TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: Date: Mi 

Address : H<^^ ki^ ^ 9r 

Remediation Contractor: Coastal Environmental Group_ Year: _2010ARRA 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

y Executive Summary 

y EPA-provided property sketch 

y Signed Access Agreement for subject property 

-rr- Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

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

Confirmation data 

y Photographs ife- (y'i^A'a ^ t CX^^AiU?^ ^ >'^>7 

As-built sketch 

Satisfactory restoration signed by Property Owner 

y Property close-out check list signed by EPA 

43- Description of areas not meeting ROD cleanup criteria 

Utility clearances 

y Property information from Douglas County Assessor's Office 

D 

\J 

D 

/ 

.-^yv, 

3L 1 m u 

Signature Date 

30237292 

Superfund 
Property Access Checklist 

Property ID: g m*^ 0 

Property Address: 14 ^ S>>^l H W 

n

n

 WORK STARTED

 WORK COMPELTED

 ON:

 ON:

 /

 /

 / 

/ 

Owner:1^^,V ) R>,4pr S 

Address: 

Ph^neV S<^|-0^ ^ 

Fax: 

Cell/Pager: 

Renter: 

Phone: 

Fax: 

Cell/Pager: 

Additional Information: 

ED Notification Letter 

M Access Agreement 

1 1 Restoration Agreement 

0 Topsoil Sampling (if applicable) 

Q Disposal Sampling (if applicable) 

1 1 Garden Sampling (if applicable) 

ffl Utility Clearance 

D Video/Photos (Before) 

n Video/Photos (During) 

n Video/Photos (After) 

n Video/Photos (30-Day) 

Q Property Completion Agreement 

n Final Report 

Sent: / / 

Signed: :2^/S_/ID 

Signed: / / 

/ / 

/ / 

/ / 

CaUed:at /\v\ / Vo 

On: / / 

On: / / 

On: / / 

*On: / / 

Signed: / / 

Issued: / / 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

<-.uA\oKo 

Air Monitoring (as applicable) 

I I Community CH Crew 

Results: 

On: / / By: 

r~] Community

Results: 

 d l Crew On: / / By: 

n Community

Results: 

 [H Crew On: / / By: 

Omaha Lead Site 
D.ouglas County Account Infij|[»|tion Page 1 of2 

Dougla s County , Nebrask a Propert y Recor d - R214756000 0 

Print Report 

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

New Feature ->-•- » Auto Sales Search 

Owne r 

PETERS DAVID C 

ETAL 

725 N 57 ST 

OMAHA NE 68132-0000 

Propert y Informatio n 

Key Number: 4756 OOOO 21 

Account Type: Residential 

Parcel Number: 2147560000 

Parcel Address: 4530 SEWARD ST 

OMAHA NE 68104-0000 

Legal Description: SAUNDERS & HIMEBAUGHS ADD LOT 20 BLOCK H 50 X 150 

Valu e Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$6,800.00 

$6,800.00 

$6,800.00 

$6,800.00 

$6,800.00 

$6,800.00 

Improvement 

$49,000.00 

$49,000.00 

$49,000.00 

$49,000.00 

$32,300.00 

$32,300.00 

Total 

$55,800.00 

$55,800.00 

$55,800.00 

$55,800.00 

$39,100.00 

$39,100.00 

Lan d Informatio n 

Acres 

0.17 

SF 

7500.0 

Units 

1.0 

Depth 

150.0 

Width 

50.0 

Vacant 

No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2... 10/23/2009 
D.ouglas County Account InfijMytio ^mytii n Page 2 of2 

riT* 

tSjgpf 

CLICK CLICO0JNy»RGE IMAGE TO ENLARGE IMAGE 

Square Footage: 1086.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Average 

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

HVAC: Forced Air Rooms: 6.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1920 0% 1920 90 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 992.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 216.0 

Porch Slab Roof Ceil 112.0 

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

"> 

Create Another Ticket Back to Irth Internet Send Email | 

• YOUR TICKET NUMBER IS 2518900. 

Original Call Date: 6/14/10 Time: 1:58 pm Op: ELIZABETH18790 


Work to Begin Date: 6/16/10 Time: 2:30 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4530 Street: SEWARD ST 


Twp: 15N Rng: 13E Sect-Qtr: 17-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 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-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... 6/14/2010 
As-Built Drawing 

COASTAL Omaha Lead Superfund Site •MViaOIIHIHTAL I O U r. IMC. 

OLS#: 81477 

Date Excavated: 6/16/2010 

Date USEPA Sianed Off: 7/8/2010 

Area Sodden: 1215 sa 81477 

E;Mfioc Paint 

EJ Good 

Omaha Lead Site 

SHaSlwlGh • Poor Sanmlino Address: 4530 SEWARD ST Q NotpaiM 

Sample Number 

Sample Samples Collected LAB Concentration Collected Fimn: FpA l>R-TP 

RYASCPXA-81477 Fl W 4 ^ pcm-M- ^ D Date ^-ay-gg> 

RYBSCPXA-81477 F2 37 ^ pp^ EL D Time: 11-5^ q/*^ 

RYCSCPXA-81477 Bl aMA-ppm D Samples Analyzed RYOSCPXA-81477 B2 D 

RDZSCPXA-81477 DZ D XRF Unit CaSVO Boole Zt f 

rtCZOOrXA 81477 8Z- D D Date: <l/2.H/oe 

RPgOCPXA-01477 PS­ " ,..PP"« D D 

Time: PJ*1 

Staff: I. A • Number of Samples = [ 5 | | O \ 

Legend: F1 = Front Left. F2 - Front Right, 81 = Back Left. B2 = Back Right DZ > Drip Zone. GZ = Garelen. PZ = Pla; 

Legen d 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with 

Sod 

Area replaced with 

Rock/Mai ch Area left bare 

Contrac t #: EP-R7-07-05 Coast:al Environmenta l Group Inc . 
fe^ 

. ^ M tev{ 

c\Qt\r Vv fj(/b liiiiiimwii 

Omah a Lea d Site 

Site Sketc h 

Sampling Address: 4530 SEWARD ST 

Extftiot Paint 

[7] Good 

• Poor 

Q Nol pamt 

81477 

Sample Numlier Lead Sample „ Samples Collected 

Concentration Collected Fimi: FCA l>h-7t> 

RYASCPXA-81477 F1 __ii^2 ^ ppm-'M­ ^ D Dale: ?)-^5'0t> 

RYBSCPXA-81477 F2 ^7 0 ppm 0^ D Time: \V-50 qn^ 

RYCSCPXA-81477 

RYOSCPXA-81477 

81 

B2 

dJiB - ppm

iZ- ^ PP"i

 ^

 ^

 D 

D Samples Analyzed 

ROZSCPXA-81477 OZ ., 131? .ppm H D XRF Unit: (oSH O Book: 2 Ay 

nOiIOOrXA-01477 -62 - - ppm n D Date: <i/^^/oe 

RrgOCPXA-91477 PZ­ - ppm

Numt)er of Samples = [

 n

 5 \ \

 D 

O \ 

Time: 

Staff: 

F/H 

J^JL. 

Legend: Fl = Front Left. F2 = Fron! Right. B1 = Back Left. B2 = Back Right DZ = Drip Zone, GZ = Garden. PZ = Pla; 

All quadrants are as viewed from the street, facing property All^ V 
r 

81477 

Omah ExUrior Paint North Arrow a Lead Site 

g ] Good Site Sketch • Poor 

Sampling Address: 4530 SEWARD ST • Not paint \ 

Sampl Lead Sample Samples Collected e Numtier LAB 

Concentration Collected Firm F£>A Dh-JI> RYASCPXA-81477 F1 ^4^2. opm-M" ^ D Date: 0-35--<?& 

RYBSCPXA-61477 F2 iZ ^ ppm 0 , D Time \\'-50 gr^ 

RYCSCPXA-81477 81 _ai£j3-ppm D 

Samples Analyzed 

RYDSCPXA-81477 B2 __i2J_ppm D 

RDZSCPXA-81477 DZ I3t ? Dom i 

D XRF Unit: 6 g y p Book: 2 ^ 

ROZ00rXA-ei477 8Z­ ppm Date: _ u n nPZCOPXA-61477 P2­ .ppm n Time: _ P/H 

Staff: Niffnbe J^A. r of Samples = [ 5 | | O \ 

Legend: F1 = Front Lett, F2 • Front Right, 81 - Back Left, B2 = Back Right DZ •= Drip Zone, GZ = Garden, PZ = Pla; 

AH quadranlt are as vievmd tram the straat. racing property A-JlS V 

^ " ^ 

^^c 

Rrv^iOg rrc«ed: 'tf-Ai^-fiB 
81477 

Omah ExUrior Paint a Lead Site 

[J] Good Site Sketch • Poor 

Sampling Address: 4530 SEWARD ST [ ] Not paint 

Sample Lead Sample Samples Collected Ntimtier LAB 

Concentration Collected Fimi: FDA Db-TD 

RYASCPXA-81477 Fl ^^2 . ppm"M " ^ D Date: f>-^5'0b 

RYBSCPXA-81477 F2 "^7 0 ppm 0 D Time: W-50 q m 

RYCSCPXA-81477 Bl _aiiA.ppm D 

Samples Analyzed 

RYDSCPXA-81477 B2 ^2. B ppm n 

RDZSCPXA-81477 DZ 131? .ppm n XRF Unit: (oSHO Book: ZAy 

•nGZOcrxA-ei477 -ez- ppm n Date: y/eV/of 

•RrZOCPXA-ei477 PS- .ppm n D Time: PM 

Staff: I. A • Number of Samples = | 3 \ \ O 

Legend: F1 = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pla< 

All quadrants are as viewed from ttte street, racing property Afl^ V 

Rcv2i"i8 i,Vtr.ucJ: 'i.^-Auc-r-R 
^v^eosr,. 

COA S TA I ENVIKONHIhlA I 

"< PRO^t" c K o u r I h c 

Consent for Access To Fro perty 

RIGHT OF ENTRY TO PREMISES 

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

Environmental Protection Agency (EPA) or its authorized representatK'es, collectively 

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

following described premises: CVi/jn^ 

Owner's Name: ( \ ^ '^ /-T"/"^* ^ Daytime Phone: 

'-I S3Ci S^f^^^ o^ Address of Property 

covered by this 

Agreement: d r\^a^' T) y 

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 perfonned, 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 
K'-' I O* COASTA L 

•••t PRo't ^ c n o u p t K c 

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

piles, dog houses, etc; 

c Remove flower bulbs or plants that the Grantor or the Grantor's tenant may wish 

to save; 

c 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; 

f 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 

jZl I grant access to my properties G i do not grant access to my properties 

Signature Date Signature Date 

G I would like to be present during any sampling thet is required. 

Page 2 of 2 
COASTA L ENVIRONMCNTA L CROUP . 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 Envirormiental 

Protection Agency (EPA). 

PropertylD: ^^L\"^ ^ 

Property Address: 1^5 ^ ^P^nQi A ^ f 

Owner: SiSISSS 

Phone: HQ ; 5^ 1 9^f<^ 

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: 

Item: / 

Item: ^^-v,^ 

Item: / 

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

Item: 

fAJs 

Item: /

Item: I 

Item: j 

Page 1 of. 

 1 
COASTA L ENVIRONMENTA L GROUP , INC . 

Items to Be Removed By Contractor During Remediation and Replaced 

Item: 

^^>l ' f/.DZ 

Item: 

^CP4 - Fi 17Z^e»i- V2 Or>l^ 1 

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. 

Easement Area, to be 

excavated 

Landscape Inventory 

Quantity Unit Condition/Type/Species 

n,i^ Quadrants 

' - il Each 

Each 

(^*H,^ \ 

; » Each 

Each 

Square Feet 

/ 

f $ 

i«^. Each ^>m^\V\ct 

Page 2 of. 
COASTA L CNVinONMENTAl . 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. 

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

^ 1 

i e < 

ZI 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. 

jPl I agree . FIl-dLo not agree 

Owner's Signature Date Contractor's Signature Date 

Page 3 of. 
BVID# MM 

XRF PROPERTY SAMPLE SHEET 

Date H T^O\0 Address 4^30 JCiA/a.rM s r 

Project maha Lead ARRA Sample time am/pm 

XRF ID# '^^D^- ^ sample length 30 sec 

Shot# Reading Sample area Shot# Reading Sample area 

\5ftg 3-^ ^ u DZ 

^m 32- ^ W Depth Depth 

\^^ v 34 ^ I \ 3 " 

Average ???) "^ \ \ ^ Average 

Shot# Reading Sample area Shot# Reading Sample area 

\51D '2^01 ^ ZO V.f\ 

i$ni 186 *^ ^^ Depth Depth 

\^-lz 1^10 r. 1^ \ " 

/ Average \^ S ^ 1 ^ Average 

Shot* Reading Sample area Shot# Reading Sample area 

ISIH P)M il M f I 

ISIS '^^ ^^\M Depth Depth 

>S1W e)M' ^-^ IH- 4 " 

/ Average CT J 1 ^ Average 

RETEST AREAS 

Shot# Reading Sample area Shot# Reading Sample area 

^ - 7 Depth Depth 

/ / 

Average Average 

Signature 

Print UM^C ^ 
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 

XRFTECH 

MISC 

NOTE 

ppm 

Pb 33.815 

Supervised By: 

Certificate of Verification 

1591 

SOIL 

2010-07-21 13:41 

92.09 

Final 

Avg of 1588-1590 

4530 Seward st 

DZ 

13" 

N. LOPEZ 

confirmation 

none 

± Error 

± 11.394 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 1588 

Mode SOIL 

Time 2010-07-21 13:40 

Duration 30.49 

Sequence Final 

Flags 

BVID 81477 

ADDRESS 4530 Sew/ard st 

QUADRANT DZ 

DEPHT 13" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm ± Error 

Pb 33.906 ± 11.330 

Supervised By: 
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 32.993 

Supervised By: 

Certificate of Verification 

1589 

SOIL 

2010-07-21 13:41 

30.92 

Final 

81477 

4530 Seward st 

DZ 

13" 

N. LOPEZ 

confirmation 

none 

± Error 

± 11.256 
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 34.546 

Supervised By: 

Certificate of Verification 

1590 

SOIL 

2010-07-21 13:41 

30.68 

Final 

81477 

4530 Seward st 

DZ 

13" 

N. LOPEZ 

confirmation 

none 

± Error 

± 11.595 
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 

ppm 

Pb 195.546 

Supervised By: 

Certificate of Verification 

1573 

SOIL 

2010-07-21 13:27 

91.66 

Final 

Avg of 1570-1572 

4530 Seward st 

EA 

1" 

N. LOPEZ 

confirmation 

none 

± Error 

± 19.603 
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 207.440 

Supervised By: 

Certificate of Verification 

1570 

SOIL 

2010-07-21 13:26 

30.54 

Final 

81477 

4530 Seward st 

EA 

1" 

N. LOPEZ 

confirmation 

none 

± Error 

± 20.211 
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 188.350

Supervised By: 

Certificate of Verification 

1571 

SOIL 

2010-07-21 13:26 

30.60 

Final 

81477 

4530 Seward st 

EA 

1" 

N. LOPEZ 

confirmation 

none 

± Error 

± 19.292 
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 190.848

Supervised By: 

Certificate of Verification 

1572 

SOIL 

2010-07-21 13:27 

30.52 

Final 

81477 

4530 Seward st 

EA 

1" 

N. LOPEZ 

confirmation 

none 

± Error 

± 19.306 
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 

ppm 

Pb 87.166 

Supervised By: 

Certificate of Verification 

1577 

SOIL 

2010-07-21 13:30 

91.55 

Final 

Avg of 1574-1576 

4530 Seward st 

Fl 

4" 

N. LOPEZ 

confirmation 

none 

± Error 

± 14.335 
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 84.690 

Supervised By: 

Certificate of Verification 

1574 

SOIL 

2010-07-21 13:29 

30.52 

Final 

81477 

4530 Seward st 

Fl 

4" 

N. LOPEZ 

confirmation 

none 

± Error 

± 14.207 
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 92.245 

Supervised By: 

Certificate of Verification 

1575 

SOIL 

2010-07-21 13:30 

30.56 

Final 

81477 

4530 Seward st 

Fl 

4" 

N. LOPEZ 

confirmation 

none 

± Error 

± 14.627 
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 84.564

Supervised By: 

Certificate of Verification 

1576 

SOIL 

2010-07-21 13:30 

30.47 

Final 

81477 

4530 Seward st 

Fl 

4" 

N. LOPEZ 

confirmation 

none 

± Error 

± 14.170 
X 

^^^'^^ . 

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

Coastal Environmental Group Inc. 

www.coastalhazmat.com \ 

COASTA L ENVIRONHENTA L 

CROUP , IN C 

EXECUTIVE SUMMARY: 

BVID #81477(4530 SEWARD ST) 

No Issues or Concerns Issues/Concerns 

Detail Explanation: 

-DAN GARVEY WALKED THE PROPERTY ON 7/8/2010 
EPA Property Close Out Form 

Property tf: Property Address: 

Dote/Tlroe: Owner's Name ZJ^ & 

Quads Excavated: 

Contractor Group 

Excavation General 

I. if necessaiy, were the correct qtutdrant(s) excavated and restored? 

2. If necessary, were the correci areas of drip zone excavaled and restored? 

Gradine Sod and VcKeUlion 

1 Does the grading around the perimeier ofthe house in excavaicri areas generally slope away 

from tbe house? 

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

3. 

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

day time 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 thai water will nol pool on lhe property"' 

• 

7. 

Was damage to landscaping or plant materials avoided? 

Gates. Fences and Retaining Walls 

I 1. Do gates open and clo-se freely? (If applicable) 

2. Were all gates or fences taken down during restoralion acliviiies reinstalled? (If applicable) 

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

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

Foundation, Siding and Gutters 

t. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? 

.'. Was damage to windows avoided? 

4 Was damage to windows or door screens avoided'] 

Was damage io downspouts or downspoui extensions avoided? 

Sidewalks and Driveways (Concrete) 

1. Was damage to driveway surfaces avoided? 

2, Wa.-; damage to walkway surfaces avoided? 

Ye* No 

/ 

y 

Yes No 

/ 

y 

y 

y 

y 

y 

Ves No 

/ 

y 

y 

y 

Yes .No 

y 

y 

y 

y^ 

Yes No 

y 

- y 
• f 

Ort'ners comments: 

Hn.' spectson no<es: 

Removal and resloralion aclivales complele including the 30-day sod warranr)'; 

tPA Represeniative fl»« 4H. Date: ll^l^L 
Property Completion Agreement 

(his agreemem clocuinen(s. (he completion of remedial acliviiies perlbimed on my properly. My signature 

will designate ihal i am salisfied with the restoration of my property, and that no items are in questions, 

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

PropertylD : ^/t f ^- ^ 

Property Address: (JC^^yQ S^UJO^Ji ^

Phone: ^C)^-g^->^.g^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

item: 

Additional Comments: 

[25 I agree I rsforalion is completed, excepl as noleri 

[ I Irio not a(;rec restoration w complclcri 

Conti actor's Signature Date 

^ 
RECEIVE8'*<*P*'" ^ Owner Assessment of Performance Form 

American Recovery and Reinvestment Act (ARRA) 

JUL 12 2010 Omaha Lead Superfund Site 

SUPERFUND DIVISION 2009/2010 

Remediation Contractor: Coastal Environmental Group - EP-R7-Q9-Q6 

Property Identifier Number; Wl^y ^ ^ 

Property Address: l( ^ ^ .b>2o( ^g^^^$ ^ 

Property Owner's Name; Y^O-yi- ^ Y ^LUy^dr-

Instructions to the Property Owner; 

This form serves to record the Property Owner's assessment of perfonnance (Incentive 1 

- QuaUty Assurance Surveillance Plan) involving the listed remediation contractor, as applicable 

to the Omaha Lead Site. This form documents the timeliness of punch list resolution, business 

relations, complaint resolution and the overall quality of work. If need be, the Property Owner 

may utilize this form to record problems and/or issues not specifically tied to an assigned 

address, for example, business relations that generally don't follow the guidelines set forth in the 

Perfonnance Work Statement. 

The Property Owner will indicate his/her assessment of perfonnance with the contractor's 

work by checking a numerical rating on the table below using the numerical definitions from 

the rating scale below, then sign & date the form. 

9-10 "excellent" 

7-8 "very good" 

5-6 "acceptable" 

3-4 "poor" 

1-2 "very poor" 

Property' Owner's Assessment of Performance Regarding the Contractor's Work 

10 / 5 

9 4 

8 3 

7 2 

6 1 

Property Owner Additional Comments from (optional; continue on back page if needed) 

Property Owner Signature; y)-j CUAJ D..e:7/77/^^