TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#:_Mii_ _ Date: T/ V l7 

Address: M< U l^htlTC ^ ^1 ^ 

Remediation Contractor: _Coastal Environmental Group_ Year; _20^ ^ 

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 

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

Confirmation data 

Photographs li ^ V(^ft1W ^ \ \rfMvfir(]Q^ 

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 

Property information from Douglas County Assessor's OfTice 

D ..-:2 

D 

D 

Signature 

/r V 

Date 

/? 

30217768 

Superfund 
< 

Property Access Checklist 

Prcpcrt^LD: 5^ 3 3 

Property Addre.: ^c^/ ^ p^uA^^t^S t 

D

D

 WORK STARTED

 WORK COMPELTED

 ON. 

 ON: 

/ / 

^^^^^^^~^/74?Z^/ 5^/7^ 

Address: 52)36 s 9y 5f 

Renter 

Phone: 

FiLv: 

Phone: qC)t'^^-2lpn7 L 

Fav 

Cell/Pager. 

Cell/Pager: 

Additional Inlormittion'. 

Q Notirication Letter 

D Acceu Agreemenl 

1 1 RestontioD Agreement 

d Topsoil Sampling (if applicubic) 

D OisposaJ Sampling (if applicable) 

G Gnrdcn Snmpliog (if applicable) 

I S Utility Clearance 

[l|-''"^eo/Photos (Before) 

• Video/Photos (During) 

• Video/Pholoj (After) 

D Video/Photos (30-Day) 

p . Property Completion Agreemenl 

• Final Report 

Sent: / / 

Signed; / / l 3 id ^ 

S;enc6:_U_/3./6^ 

1 1 

1 1 

1 1 

Cu\\tii:JllM.lO^ 

On: l l l<5 1 ^ 

On: / / 

On: / / 

On: / / 

Signed: J_//I/0 5 

Issued: / / 

By: 

^y(TA6ViO 

^r-{0C-kX\^i6 

By: 

By: 

By: 

B>= ///^/n ^ 

By: A^ ^ 

By: / 

By: 

By­ . 

By:^k^J^ 0 

By: 

Air Monitorint! ( « U|)plicable 

D Community D Crew 

) 

1

Results: 

 On; / / By: 

D ComrounJtA'

Results: 

Q Crew On: / / By: 

• Communiri

Results: 

D Crc>v On: / / J By: 

Omaha Lead Srte 
^ugla s Coimty Accoimt In^UjiM^o nujiM^c n Page 1 of2 

Douglas County, Nebraska Property Record - R0533550000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - Vie w O n Ma p Information is valid as of 2009-9-29 Treasurer's Tax Report 

New Feature • • ^ ^ Auto Saies Searcii 

Owner 

ALSTATT EDWARD D 

ETAL 

5036 S 94 ST 

OMAHA NE 68127-0000 

Property Informatio n 

Key Number: 3355 0000 05 

Account Type: Residential 

Parcel Number: 0533550000 

Parcel Address: 4513BURDETTEST 

OMAHA NE 68104-0000 

Legal Description: BAKER PI^CE LOT 4 BLOCK 8 44 X 128 

Value Informatio n 

Land Improvement Total 

2009 

2008 

2007 

2006 

2005 

2004 

$6,000.00 

$6,000.00 

$6,000.00 

$6,000.00 

$6,000.00 

$6,000.00 

$40,400.00 

$40,400.00 

$40,400.00 

$40,400.00 

$25,600.00 

$25,600.00 

$46,400.00 

$46,400.00 

$46,400.00 

$46,400.00 

$31,600.00 

$31,600.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.12 5632.0 1.0 128.0 44.0 No 

Improvemen t Informatio n 

Buiiding 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accotmtinfo.jsp?accotmtno=RO... 10/13/2009 
- , Siouglas County Account In &m|B^o n Page 2 of2 

"P^iiri 

•—-*£•,-1 

Aw«Cn 

CLICK TO ENLARGE IMAGE 

Square Footage: 720.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Average 

Built As: Ranch Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 5.0 

Exterior: Frame Aluminum Units: 1.0 

interior: Drywall Batiis: 1.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Hip Stories: 1.0 

Floorcover: Allov»/ance Foundation: Block 

Sprinlder Square Footage: 0.0 

year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1925 0% 1925 85 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 720.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 216.0 

Porch End Screen 96.0 

Porch Slab Roof Ceil 128.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO... 10/13/2009 
0 Page 1 of 1 

"> 


|i •• Oreate^A^ ., j Send Email 


YOUR TICKET NUMBER IS 2400116. 


Original Call Date: 11/04/09 Time: 11:52 am Op: ELIZABETH18790 


Worlc to Begin Date: 11/06/09 Time: 12:30 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4513 Street: BURDETTE ST 


Twp: 15N Rng: 13E Sect-Qtr: 08-SW 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Plione Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11/4/2009 
OLS#: 58033 

As-Built Drawing Date Excavated: 11/9/09 

Date USEPA Signed Off: 12/3/09 

COASTA L Omaha Lead Superfund Site Area Sodden: 639 so ft 

58033 

Omaha Exterior Paint Lead Site 

Sit • Good e Sketch • Poor 

Sampling Address: 4513 BURDETTE ST l^'^Not paint 

Samp)le Number Lead Sample Samples Collected 

I 

LAB Concentration Collected Firm 

RYASCPXA-58033 F1 _i9jy_pp m 

D Date i/oybi 

RYBSCPXA-58033 F2 .?ff2 - ppm D Time J:'^5t>yt, 

RYCSCPXA-58033 Bl 2 2 5 ppm D 

Samples Analyzed RYDSCPXA-58033 B2 ppm D _ai^ RDZSCPXA-58033 DZ 3^ 1 ppm D XRF Unit: W^ h Book: ZZ" ? 

nCZCCPXA 68033 62 - ppm D D Date: IJ^-O'S I 

RPZSCPy,A 580M i2Z- ppm D 

Time n ICEx. Staff pnrsL> Number of Samples = | 3 | [ Q | 

Legend: F1 = Front Left, F2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pla; 

All quadrants are as viewed fiwn the street, facing property Alley.. 

ENTERED 

Ri-\ ;i "K < rcalk'i] ' ic«N,A.' ft 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced

Sod 

 with Area replaced with 

Rock/Mulch Area left bare 

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

58033 

l/l ll/Di, 

Omah Exterior Paint a Lea d Site 

• Good Site Sketc h 

• Poor 

Sampling Address: 4513 BURDETTE ST 12'^^'ot paint 

Sampl Lead Sample Samples Collected e Number LAB Concentration Collected Firm: FV A . 

RYASCPM-58033 Ft ppm D Date: l/Of/Of 

RYBSCPXA-58033 F2 ppm 

Time: / '^5 t>/n 

RYCSCPXA-58033 B1 n 225 ppm D Samples Analyzed RYDSCPXA-58033 B2 \°\1 . ppm i 

RDZSCPXA-S8033 DZ D 3 H i ppm XRF Unit: (I'^ O Book: ZZ l 

nCgeCPXA 68033 -Ga- n " " ppm D Date: /•/.•^-/O ^ 

RPZSCPXA 6B033 Pi - D " ppm D Time Br 

Staff: Number of Samples = | 3 | | ( ^

n 

| pnrsLL 

Legend; F1 = Front Left. F2 = Front Right. B1 = Back Left, 82 = Back Right DZ = Drip Zone. GZ = Garden. PZ ' Pla; 

Ad quadrants are as viewsd from tt>e strpet. facing property Alky.. • )h—••• ' ' >[ .—— ^ 

ENTERED 

f?^ 
58033 

H Whi 

Omah Exterior Paint a Lead Site • Good Site Sketch • Poor 

Sampling Address: 4S13 BURDETTE ST l^'^Not paint 

Lead Sample Samples Collected 

Concentration Sample Number Collected LAB 

Firm: FVA im/AT) - RYASCPXA-58033 F1 n Date: 

RYBSCPXA-58033 F2 

L^B^PP m D Time: /••'/ s f> ^ 

RYCSCPXA-58033 Bl 2 2 5 ppm D 

Samples Analyzed 

RYDSCPXA-58033 82 3± ppm D ^ RDZSCPXA-58033 DZ 3 H 1 ppm i D XRF Unit: (rf^ O Book; 2Z 1 

•RCZSCPXA 68033 62 ­ ppm D Date: hlfj'Q ^ 

RPZSISPXA 68033 fO - ppm D •

Time: ftn-i D Staff: mSL ^ Number of Samples = | 3 \ \ O I 

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

All quadrants are as »ie«wed froni_tlie strMt. facing property A | Ig. . 

R e injS ' •rented iXhN,,iv.<« 
• "N 

58033 

Omah Exterior Paint North Arrow a Lead Site 

Sit • Good e Sketch • Poor 

Sampling Address: 4513 BURDETTE ST Q^No \ t paint 

Sample Lead Sample Samples Collected Number 

I

I 

LAB Concentration Collected Firm: FP4 

RYASCPXA-58033 Fl ppm 

D Date: J M M 

RYBSCPXA-S8033 F2 .?^2 - ppm 

D Time: /:V5^/'} RYCSCPXA-58033 Bl 2 2 5 ppm D 

Samples Analyzed 

RYDSCPXA-58033 B2 I ^2 , pom D 

RDZSCPXA-58033 DZ 3 H i ppm 

D XRF Unit: (if^ h Book: 2.2"? 

nCZSCPXAi 68033 6Z- • ^ ppm D D Date: l^lf^'fy ^ 

RPZSCPXA 68033 BZ- " * ppm D D Time: 3r 

Staff: Number of Samples = | 3 I | (*) ] iraLL 

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

Al qi^tantoaranvlewed ltan\lhe street. Ikdng property 

Rev MtS >;cnl«l: 
fit" *Ur, 

COASTA l 

fHtrlKONHmiAl %t ,B0'*«' CROUP . 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 Phon^^ ^ ^ 7 ^ 7 ^ 21 ^ 07 _ td^or d AUK-HAddress of Property 

covered by this 

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 vtnll be restored to its original condition. This 

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

A represerYtative 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 
\'^i-^r v

 COASTAL *V^ ^ tNTtROHHIKTAL 

^ t PRO"** C t O U » » K 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; 

e Water and maintain replacement vegetation, including fertilizer application, as 

necessary subsequent to an initial watering period by EPA; 

c Abide by health and safety guidance provided by EPA; 

* If the property is rented, assist EPA in obtaining tenant approval for access to 

the property to perform the work. 

«t 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 

©fgrgran a t access to my properties D i do not grant access to my properties 

^^^/.^ ^ -' ' 3/oX 

Signature D6te ^ Signature Date 

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

Page 2 of 2 
^C£L :-%^ 

C O A » T__A t 

Restorataort 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: ^5 0 / 3 

Property Add;«s:T-/5"/3 ^^Q^dU^ ^ Sf T 

o^«"-f3rvo(xrd P^^t).^ 

Phone: f-/Q7,~ 7Q' 7 -7feO ^ 

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

Item: 

^—-/Z rL ^ 

item: 7" 

Item: 

Item: 

Items to be Removed by the Contractor During Remediation and l^ot Replaced 

item: 

i ,

S-. --^K 7Ly­ Ipi^-X ('xe/Utuos' '

ttem: 

Item: 

Item: 

Page 1 of. 
•• 

'(%' • • ••• > 

COASTA L 

items to Be Removed By Contractor During Remediatiorvandgeplaced 

Item: 

Itsm: 

^ 

$

O^ U 

0 0 

Kem: 

t 

i Item: 

Item 

Pre-existing piopeny area, 

that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch 

trunlc diameter 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Aiiat h ;i sketcli ol ilic 

>-ri'rklci l;>\;)iii 

Number of and size of 

each garden/ flower bed 

area. 

AlUich .1 slvi-'icli ol rt-!;ilivf 

<\'/t:s nnd loc;iii('Mi 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

Voir ll'.i' VHIIIC «fll n i 

i;si'C 10 b;u i .: iilaii; 

\ nin.;ii.'; Id (lie ijriipcrls 

iM> ner. 

Easement Area, to be 

excavated 

£ 1 

^ 

Quantity 

n 

1 

h A 

^ 

/ 

ItS 

Landscape Inventory 

Unit 

Quadrants 

Each 

Each 

Condition/Type/Species 

Fi\rh 

Each 

Square Feet 

S 

Each ^-n-.^^- ^ 

Page 2 of. 
C O A S 1 A L 

O k O U " . IN C 

! Additional Comments / Instructions: 

[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. 

0^1 agree CI I «*o no* sg*** 

Owner's Signature Date < Contractor's Signature Date 

Page 3 of 
BVID , g-goS^ 

XRF PROPERTY SAI^PLE SHEET 

Date 

Project 

XRF ID# 

Shot# 

fiCf 

ISO 

1^1 

Average 

Shot# 

Average 

Shot# 

Average 

Shot# 

Average 

Signature 

ll-'^'O ^ Address 

Omaha Lead ARRA Sample time 

-^^ozn. sample length 

Reading Sample area Shot# 

lOltiT , ^rK l ^ l 

^8^ a Depth n ^ 

^'Z t}2 . \ " 7J 

^n- t/j Average

Reading Sample area Shot# 

Depth 

Average 

Reading Sample area Shot# 

Depth 

Average 

RETEST AREAS 

Reading Sample area Shot# 

Depth 

Average 

^f;| ^ p>ur^^44^ s^' 

am/pm 

30 sec 

Reading Sample area 

i'2.0 t IQ 1^1 

m t IB Depth 

loH^fB h ' 

' ' ^ "I Q 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Reading Sample area 

Depth 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 74 

Mode SOIL 

Time 2010-02-03 19:03 

Duration 90.56 

Sequence Final 

Flags 

AVERAGE i;;A^jf)f71-73 \ 

ADDRESS 4513 Burdette St. 

QUADRANT Fl 

DEPHT 6 

XRF TECH 0. BARAJAS 

MISC 1 

NOTE 1 

ppm Error 

Pb "ISTOTT 

Supervised ^r.^mimo. 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 71 

Mode SOIL 

Time 2010-02-03 19:01 

Duration 30.19 

Sequence Final 

Flags 

BVID 58033 

ADDRESS 4513 Burdette St. 

QUADRANT Fl 

DEPHT 6 

XRF TECH O. BARAJAS 

MISC 1 

NOTE 1 

± Error 

Pb ± 18.474 

ppm 

120.368 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 114.163 

Supervised By: 

Certificate of Verification 

72 

SOIL 

2010-02-03 19:02 

30.20 

Final 

58033 

4513 Burdette St. 

Fl 

6 

O. BARAJAS 

1 

1 

± Error 

± 18.185 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 73 

Mode SOIL 

Time 2010-02-03 19:03 

Duration 30.17 

Sequence Final 

Flags 

BVID 58033 

ADDRESS 4513 Burdette St. 

QUADRANT Fl 

DEPHT 6 

XRF TECH O. BARAJAS 

MISC 1 

NOTE 1 

ppm ± Error 

Pb 103.538 ± 17.553 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 152 

Mode SOIL 

Time 2009-11-09 13:40 

Duration 91.55 

Sequence Final 

Flags 

AVERAGE (3.vgof 14<9-I5p 

ADDRESS 4513 burdette 

QUADRANT em 

DEPHT 1" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm Error 

Pb L-37,652^ / 13.1727 

Supervised BV: F^A/^mA 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 101.354 

Supervised By: 

Certificate of Verification 

149 

SOIL 

2009-11-09 13:39 

30.54 

Final 

58003 

4513 burdette 

em 

1" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 13.421 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 150 

Mode SOIL 

Time 2009-11-09 13:39 

Duration 30.48 

Sequence Final 

Flags 

BVID 58003 

ADDRESS 4513 burdette 

QUADRANT em 

DEPHT 1" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm ± Error 

Pb 98.678 ± 13.183 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 92.924 

Supervised By: 

Certificate of Verification 

151 

SOIL 

2009-11-09 13:40 

30.53 

Final 

58003 

4513 burdette 

em 

1" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 12.912 
fyjQLi Omaha Lead Site—Fixed Price EP-R7-07-05 

I ^^^ ^ I Coastal Environmental Group Inc.

V"^^ ^ www.coastalhazmat.com

Xp„o^«<^

EXECUTIVE SUMMARY: 

BVID #58033-(4513 BURDETTE ST) 

No Issues or Concerns Q Issues/Concerns 

Detail Explanation: 

 ^^s^ ^ 

 "^^^ 

 COASTA ENVIROHHCHTAL L 

G t O U P, IM C 
4

EPA Property Close Out Form 

Property #: ^63 3 Property Address: 

Datc/Tlroe: Owner's Name 

Quads Excavated: Contractor Group 

Excavation General 

I. If necessaiy, were the correct quadrant(s) excavated and restored? 

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

Grading Sod and Vegetation 

I. Docs the grading around the perimeter ofthe house in excavated areas generally slope away 

from the house? 

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

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

day time period) 

4. Are sodded areas generally Tirm and evenly graded? 

5. Are the joints ijetween 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? 

Gates, Fences and Retotning Walls 

I. Do gates open and clo.se fteely? (Ifappiicable) 

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

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

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

Foundation, SidioK and Culler s 

1. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? 

3. Was damage to windows avoided? 

 Was damage to windows or door screens avoided? 

5. Was damage lo downspouts or downspoul extensions avoided? 

Sidewalks and Drivtways (Concrete) 

I. Was damage lo driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

Yes No 

/ 

y 

Yes No 

y 

yL 

y 

y 

y 

/ 

Yes No 

/ 

y 

y 

y 

Yes No 

y 

y 

y 

y 

y • 

Yes No 

-y ­
I 

owners comments: 

Inspection notes: 

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

EPA Representalive Q^J ^ Date: »*}'' 
Properly Completion Agreement 

riiis agreemenl documents the completion of remedial acliviiies perloimed on my properly My signalure 

will designate ihal I am satisfied with Ihe restoralion of my properly, and Ihal no ilems are in questions, 

now, or at any lime in the fiilure, excepl ihose ilems listed below, if any 

Property ID: 2 ^ 

Property Address: -L^^e^^ 3 ftivd fcU 

Owner: EduOai^ d AI-SHTU T 

Phone: {MOVJ-^nTX - 1 UC^ l • X 

Restoration Items \x\ Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

lf\/nj-^ 

[y r Hjjrcc It rcstortilion i.s completed, rxccpi as noted 

l_J I rto nol jjjrec restoration is compleled 

kji4^^ nilIn) 10k ^ 

Owner's Signatnrr 'ontrartnr's Signature Date 
Property Owner Satisfaction Survey 

Omalia Lead Superfund Sit 

2008 m ^^ * 

Remediation Contractor: Coastal Environmental Group rviv/lCin M 

Prnpertv Identifier Number: .^ft O Pj' ^ OllPFRFUN D UW\o\VJi v 

Property Addr.« : U.-S\ ^ iftny-^^^l P -^^k,, ^ SUrtnrU l 

Property Owner's Name: ^r U tY^r A JX) Trrrt h 

(above information lo be filled out by remediation contractor prior to delivery of form lo Property Owner) 

Instructions to Property Owner: 

This form is provided to you as a means of trying to capture your level of satisfaction with the 

work of the above-identified remediation contractor, as applicable to the soil cleanup action at your 

property. The U.S. Environmental Protection Agency (EPA) is very interested in your opinion regarding 

the worl( performed by its contractors. This form is intended to provide an easy means for you to 

express your opinion about the work performed on your property. 

Please indicate your level of satisfaction with the contractor's work by selecting a numerical 

rating (ranging from 1 to 10) using the following rating scale, then please sign and date the form and 

return it to the USEPA in the attached self-addressed & stamped envelope, (additional comments may 

also be provided in the space below, at the option of the property owner.) 

C^9 ^ "excellent" 

7-8 "very good" 

5-6 "acceptable" 

3-4 "poor" 

1-2 "very poor" 

Property Owner's Satisfaction Ratine Regarding Contractor's Worit 

10 5 

9 4 

8 3 

7 2 

6 1 

Additional Comments from Property Owner toptionat: continue to bacit of page If neededl 

Property Owner's Signature.: ^^Uyfl^JgL eMl: y^ Date: / / '/Z/^Q ^