TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: \%t)^ Date: 11 kl /^^ 

Address: '^^'b^ t n ^f 

Remediation Contractor: _Coastal Environmental Group_ Year; 2001 

SOIL REMEDIATION 

PROPERTY nL E FOLDER DOCUMENTS 

D 

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.) 

Confinnation data 

Photographs i\i'^<^Oi\ ^ \r ^^^> ^ y ^^ ^ 

As-built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description ofareas not meeting ROD cleanup criteria 

Utility clearances 

Property infonnation from Douglas County Assessor's Office 

11 lfl ^^ 

Date' 

30054514 

Superfund 
Property Access Checklist 

Property ID: ^<3(\^<^l ^ 

Property Addr.^. p^'p.'^ X V\Y)e "ST 

D

D

 WORK STARTED

 WORK COMPELTED

 ON:

 ON:

 / 

/ 

/ 

/ 

0>vncr: l^^f^W.r^ - kelll J

Address: ^

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 UlJ^Fi T 

Ph^ : 

p-honc: ^02 )

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Ccll/Pager 

 \0^O ­ 2Q^ ^ 

P«LN: 

Cell/Pager: 

Additiona l Inlnrmxtion: 

Q Notincation Letter 

1 ^ Access Agrcemeni 

"K ] Restonitioo Agreement 

Q Topsoil Sampling (if applicublt) 

O DisposAl Sampling (K applicable) 

• Gnrdcn SAOipling (if applicable) 

n Ulility Clearance 

^ Video/Photos (Before)^-^2Z0 ^ 

Q Video/Photos (During) 

D Video/Photos (After) 

D ViJeo/Phofos (30-Day) 

''3_,Propcrty Completion Agreement 

D Final Rcpon 

Sent: / / 

Signed:(jL/LS/Ci9 

Signed: l£_//^/Q ^ 

/ / 

/ / 

/ / 

Called; / / 

On:tf lZT.ia J 

O B : / / 

On: / / 

O D : / / 

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Issued: / / 

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By:

By: 

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B.v: 

By: 

By: 

By: 

By: 

 Vo\\)^i 

 Vi}\i r ^ 

J 

1 i^ir Moniiorin}> {am ujtplicable) 

D Community D Crew |

Results: 

 On: / / By: •" 

D ComraunitA'

Results: 

D Crew | On: / / j By: 

I ] Communir>

Results: 

D Crvw On: / / I Bv: 

Dmaha Lead Srte 
Property ID #

Property 

Address:

Initial Contact:

Second Contact:

Final Contact:

Final Action:

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

 \^\oD^ ^ 

 ^'S' ^ 2 P\Y\ ^ ^"^ 

 Date:^,j]\jO<^ Time: \P,i^ Action: 1 eft--(^Uiet^ 

 Date: Time: Action 

 Date: Time: Action; 

 Transmit to EPA D Other Action: D 
Douglas County Account I ijgg^tion Page 1 of2 

Douglas County, Nebraska Property Record - R1220960000 

Print Report 

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

New Feature -•••• • Auto Sales Search 

Owner 

KELLY JR ROBERT O 

ETAL 

3332 PINE ST 

OMAHA NE 68105-0000 

Property Informatio n 

Key Numlter: 2096 OOOO 12 

Account Type: Residential 

Parcel Numlter: 1220960000 

Parcel Address: 

Legal Description: 

3332 PINE ST 

OMAHA NE 68105-0000 

GRIFFIN & SMITHS 1ST SUB LOT 11 BLOCK 5 59 X 128 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$6,900.00 

$6,900.00 

$6,900.00 

$6,900.00 

$6,900.00 

$6,900.00 

Improvement 

$96,200.00 

$168,700.00 

$168,700.00 

$96,200.00 

$96,200.00 

$96,200.00 

Total 

$103,100.00 

$175,600.00 

$175,600.00 

$103,100.00 

$103,100.00 

$103,100.00 

Sales Informatio n 

Sales Date: 2000-04-13 

Deed Type: 

Price: 

Grantor: 

$103,000.00 

Book: 2153 Page: 201 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres 

0.17 

SF 

7552.0 

Units 

1.0 

Depth 

128.0 

Width 

59.0 

Vacant 

No 

Improvemen t Informatio n 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RI22... 6/6/2009 
Douglas County Account Ini|^^tio n||^ t n Page 2 of2 

Building 1 

no ra J Third Ftoof 

3960 •"1 Seoggggocr 

» " H P 

»!r BO 11 IT 

111 *•«»*£"''" 1 2 1/2 STORY FINISHED 

ano 

CLICK TO ENLARGE IMAGE 

CLICK TO ENLARGE IMAGE 

Square Footage: 2468.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

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

HVAC: Central Air to Air Rooms: 6.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.5 

Roof Cover: Composition Shingle Bedrooms: 3.0 

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 

1917 1917 91 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 1264.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Fixture Bath Half 1.0 

Garage Detached 288.0 

Porch Slab Roof Ceil 192.0 

Porch Slab Roof Cell 24.0 

User Attic Full Finish 396.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=R122... 6/6/2009 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Intemet Send Email 

• YOUR TICKET NUMBER IS 2311559. 

Original Call Date: 7/07/09 Time: 12:37 pm Op: ELIZABETH18790 


Work to Begin Date: 7/09/09 Time: 1:15 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 3332 Street: PINE ST 


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 Corner 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 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emerg: 4029329757 

LEVEL3 LEVELS COMMUNICATIONS, LLC NA

Day: 8773668344 

 Alt: 

Emerg: 8773668344 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY

Day: 4025047823 

 Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/7/2009 
Page 2 of2 

OPPDGPR6 OMAHA PUBLIC POWER DISTRICT NA

Day:

 Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK NA

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://vmvi^.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/7/2009 
As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

19604 

Omatia Lead Site Exteriorgaint No.th Arrow Owne r Name : ROBERT O KELLY JR 

Site Sketch O-Goo d 

Address : 3332 PINE ST l\ 

Phone : H: W: • Poor 1

I I Not paint 

Lea d Sampl e Sample s Collecte d Sampl e Numbe r L A B Concentratio n Collecte d Firm : 

RYASCPXA-1960 4 F l 3) LD ppm Date : 

RYBSCPXA-1960 4 F2 ^ D_S>PPm Time : 

RYCSCPXA-1960 4 8 1 U3 pp m i ^ Sample s Analyze d RYDSCPXA-1960 4 B2 ^ ^ pp m 

RDZSCPXA-1960 4 D Z 5. O \ *- ppm X R F Unit: % \ \ Book:Q _ 

"RGZeCPXA-1960 4 © ^ 1 _ pp m Date : ^ • 2>j?^-ov ^ 

RPZSCPXA-1960 4 PZ i-^-^ ^ pp m 

Numbe r of Sample s 

D3^ ^

ly 

n 

O 

Time : 

Staff 

B J^ 

^ S 

BNTEREi' (^AlZ-A-b-^ 

AUG 0' a zoo^ ZX 

DZ = 33PPM@1 " PLgff:19gQ4 

Date Excavated :7i 14/09 

Date USEPA Signed Off: B/S/Cfe 

601 soft 

F l = 74 PPM @ 6" 

Omaha Lead Site 46130 

Legen d 

Concre'te Drip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced with 

So Area left bar e d Rock/Mulch ' ' 

Contrac t # : EP-R7-07-05 Coasta l Environmenta l Group Inc . 
19604 

Omaha Lead Site Exteriorgaint North Arrow Owner Name: ROBERT O KELLY JR 

Site Sketch Address: 3332 PINE ST | \ • Poor 

Phone: H: W: 1

Q Not paint 

Sample Numt)er Lead 

Concentration 

Sample 

Collected LAB 

Finn: 

Samples Collected 

RYASCPXA-19604 Fl ^2 ) LP ppm n Date: 

RYBSCPXA-19604 F2 '^ 0 ^ ppm or D Time: 

RYCSCPXA-19604 B1 U -^V^ppm n 

RYDSCPXA-19604

RDZSCPXA-19604

'RGZSCPXA-19604

RPZSCPXA-19604

 82 

DZ 

Q^ 

PZ 

^ O ?;

Am 

A ^ 

ppppmm 

ppm 

ppm 

ppm 

-Ba^ 

D 

D 

-BSamples Analyzed 

XRF Unit: %\ 1 Book:Q_ 

Number of Samples 

^ .....*. AUG 0 5 200^ 

}'r. . . . •• •, .T y' - y.'' : I r . ^ ^ I ^ - ., I y > 

^^s^ifeksi^r^l^*'. . 

^ 

:.-A:^r:.: V 

J2^4QiU. 

Omaha Lead Site 46130 
19604 

Omaha Lead Situ Owner lOaroe: ROBERT O KaxY JR Site Sketch Address: 33gPlhE ST 

Phone: H: W: 

Sample Number 

RYASCPXA-19604 Fl 

\jBBXi 

Concentration 

LJJ^LDPPm 

Sampte 

Colteastexl LAB 

• 

RYBSCPXA-1B604

RYCSCPXA-19K)4

 F2 

 81 _2XL^ppm D 

D 

RYDSCPXA-19B04 B2 ;^S5_PP m D 

RDZSCPXA-10604 DZ a.OlL[ ppm D 

1^5Z5CPXA-I8B04 8 ^ ppm -B- RPZSCPXA-19604 PZ ppm 

ExteriorBsHnt Morth Arrow 

Q}^6o^ 

• Poor 

Q Notpaint t

Samptes CoUected 

Firm: 9-^. n-T/ZA^^lJ 

Date: ^ • M ' M 

Time: fkl-^Ct a/>v 

Samples Arotyssd 

XRF Unit S^\l BoolcQ | 

Omaha Lead Site 46130 
%;^**«* > COASTAL * 3^ ..1 ^ INVI«ONMtNT»l 

'tPBOT«- G » O U P. 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: 

OwneF^ Name: Daytime Phone: 

Address 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 wili be restored to its original condition. This 

work is being perfonmed underthe Omaha Lead Superfund Site remediation program. 

A representative of Coastal Environmental Group, contracted by USEPA, wili contact 

the Grantor in-person to discuss the work to be performed, the Grantor will have an 

opportunity to review and approve the planned soil removal, and restoration work 

before it begins. Once the work is finished, the Grantor wili 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: 

Pagel of2 
iMJi^»M^. /

 COASTAL ENVIIIONHENTAL 

%PBOl« ^ CROUP . INC . 

• 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 (402) 991-1199 

4grant access to my properties D i do not grant access to my properties 

-^Jj\^KC^ I , ^iSlK- Lr\(o-0<=^ r.Lyf>/f/h3 Cy^p^iAJA (.']U-Q-1 

Signature Date Signature Date 

D I would like to t>e present during any sampling that is required. 

Page 2 of 2 
COASTA L 

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 tbe purpose of assuring that restoration 

activities are completed to the satisfBction of the property owner and the United States Environmental 

Protection Agency (EPA). 

Property ID: 43ka 

Property AddfMs: %3'^'> PtM ^ ST . 

Owner: ^^J/ ^ /^d ^ K^Jy^ y 

Phone: ^AoiOn 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. 

Kem: 

I... 3^l( ^i^t\ 

Item: ^ 

Item: 

Hem: 

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

Item: y-^ 

,X^ j 3^^xy^ll /^farfS Lcfreei^tJ 

Item: 

Item: 

Item: 

Pagel of. 
# 

COASTA L rNVinONH F NTAI c n o u r IM C 

Items to Be Removed By Contractor During Remediation and Replaced 

Item: 

"yo^^ ,^ \ ,B^ , 02L 

Landscape inventory 

Item 

Pre-existing property area, 

tfaat 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. 

Atiach a sketch ol' the 

sprinkler lavout 

Number of and size of 

each garden/ flower bed 

area. 

Auach a sketch of relative 

sizes and location.s. 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

Note this \aluc wili he 

used to issue H planl 

voucher to the propert> 

owner. 

Easnnent Area, to be 

excavated 

Quantity 

Pijj) ^ 

\ 

•v 

H/ff ^ 

3 

^ 

iBS 

Unit 

Quadrants 

Each 

Each 

Each 

Each 

SquareFeet 

i 

Each 

Condition/Type/Species 

^CAAA^^ p^f^n 

Page 2 of. 
I

COASTA L MVIHOMMI-MTA t O M O U P . IN C 

Additional Comments / Instructions: 

(^^^urt-^e ^^ ^ \>iPeei^T 5^.(.> ^ "^^ ^ ^^ . 

D 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. 

15 I agree • I do not agree 

Owner's Signature Date Contraaor's Signature Date 

Page 3 of 
BVID# fiuDH 

XRF PROPERTY SAMPLE SHEET 


Date 

Project 

XRFID# 

Shot# 

ms­ \?>1S. 

i-aiig 

jSi l 

Average

Shot# 

_i32a. A221. 

_L33i 

13HQ 

Average

Shot# 

Average 

Shot # 

Average 

lab sample # 

"7-n-n^ Address ^^^2 Vine . ^

Omaha lead FP Tnd year option Sample time am/fSftr iLLiSi­ sample length 30 sec 

Reading Sample area Shot# Reading Sample area 

i2t.«<i w.r^ tTtfJ^ JSR iu,.ni w.^^ 

it^^5j:w.M M gsxa^' PI 1^ ^ 75,01-tjl . 31 / 

I3M.-77 t Depth Depth J32=L 

ll-^-^7JJ^: iV.IM 1 1^11 

 IT."^ D% ± \?>.'?\ Average 73.<t t -^^ ff. ^ 

Reading Sample area Shot# Reading Sample area 

as.^int.n DT. insi-hs ITM I 2'&^.Lntioi.^^ 

nijtjf.n jaaa. /^O. IT ± K I VT. 

Miuz-J^.'iy? Depth JSiifi 2J8.-a>»t t^.g9 Depth 

^ to.Slir^.q i 1 /3^5 k^i^tlO. ^ JL 

 ^ ^ M^ ± ^.^ 7 Average \\ti'^.^ % t JU. 21 

Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average 

RETEST AREAS 

Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average 

Lab result Sample area XRF Avg. 

Signature^^/^(2i?Qx^ 

Print £1 l y )r^M7\ Cnr^Y/^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1318 

Mode SOIL 

Time 2009-07-13 16:56 

Duration 121.67 

Sequence Final 

Flags 

AVERAGE 

ADDRESS 333^ Finest 

QUAD/ZONE easement 

INSPECTOR Nicolas 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm Error 

Pb 123.083" ± 13707^ 

Supervised By: C^dj^£j^. 4 
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 129.883 

Supervised By: 

Certificate of Verification 

1314 

SOIL 

2009-07-13 16:53 

30.11 

Final 

19604 

3332 Pine st 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

14.062 
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 114.352 

Supervised By: 

Certificate of Verification 

1315 

SOIL 

2009-07-13 16:54 

30.49 

Final 

19604 

3332 Pine st 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

± 13.437 
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 134.721 

Supervised By: 

Certificate of Verification 

1316 

SOIL 

2009-07-13 16:55 

30.58 

Final 

19604 

3332 Pine st 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

14.189 
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 113.374 

Supervised By: 

Certificate of Verification 

1317 

SOIL 

2009-07-13 16:56 

30.49 

Final 

19604 

3332 Pine st 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

± 13.139 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1323 

Mode SOIL 

Time 2009-07-13 16:59 

Duration 121.88 

Sequence Final 

Flags 

AVERAGE jAygof 4^19-1322 rf 

ADDRESS 3332 Pine st 

QUAD/ZONE Fl 

INSPECTOR Nicolas 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm Error 

Pb 73.945 ^1.504# 

Supeivised By: (^/LTQldo A 
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 76.222 

Supervised By: 

Certificate of Verification 

1319 

SOIL 

2009-07-13 16:57 

30.46 

Final 

19604 

3332 Pine st 

Fl 

Nicolas 

6 

CLEARANCE 

± Error 

± 11.527 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1320 

Mode SOIL 

Time 2009-07-13 16:58 

Duration 30.43 

Sequence Final 

Flags 

BVID# 19604 

ADDRESS 3332 Pine st 

QUAD/ZONE Fl 

INSPECTOR Nicolas 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 73.008 ± 11.360 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1321 

Mode SOIL 

Time 2009-07-13 16:58 

Duration 30.49 

Sequence Final 

Flags 

BVID # 19604 

ADDRESS 3332 Pine st 

QUAD/ZONE Fl 

INSPECTOR Nicolas 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 61.530 ± 10.893 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1322 

Mode SOIL 

Time 2009-07-13 16:59 

Duration 30.50 

Sequence Final 

Flags 

BVID # 19604 

ADDRESS 3332 Pine st 

QUAD/ZONE Fl 

INSPECTOR Nicolas 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 85.019 ± 12.236 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1341 

Mode SOIL 

Time 2009-07-14 10:01 

Duration 121.71 

Sequence Final 

Flags 

AVERAGE 

ADDRESS 3332 Pine st 

QUAD/ZONE DZ 

INSPECTOR Nicolas 

DEPTH 1 

SAMPLE TYPE insitus 

NOTE 

ppm Error 

Pb 

Supervised By: ^^C^tlZGU. 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1337 

Mode SOIL 

Time 2009-07-14 09:59 

Duration 30.14 

Sequence Final 

Flags 

BVID # 19604 

ADDRESS 3332 Pine st 

QUAD/ZONE DZ 

INSPECTOR Nicolas 

DEPTH 1 

SAMPLE TYPE insitus 

NOTE 

ppm ± Error 

Pb 35.365 ± 8.766 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1338 

Mode SOIL 

Time 2009-07-14 10:00 

Duration 30.43 

Sequence Final 

Flags 

BVID # 19604 

ADDRESS 3332 Pine st 

QUAD/ZONE DZ 

INSPECTOR Nicolas 

DEPTH 1 

SAMPLE TYPE insitus 

NOTE 

ppm ± Error 

Pb 14.178 ± 6.823 

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 47.622 

Supervised By: 

Certificate of Verification 

1339 

SOIL 

2009-07-14 10:01 

30.50 

Final 

19604 

3332 Pine st 

DZ 

Nicolas 

1 

insitus 

± Error 

± 9.589 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1340 

Mode SOIL 

Time 2009-07-14 10:01 

Duration 30.64 

Sequence Final 

Flags 

BVID# 19604 

ADDRESS 3332 Pine st 

QUAD/ZONE DZ 

INSPECTOR Nicolas 

DEPTH 1 

SAMPLE TYPE Insitus 

NOTE 

ppm ± Error 

Pb 36.566 ± 8.907 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

1346 

SOIL 

2009-07-14 10:13 

121.72 

Final 

[Ayron342-l3 ^ 

3332 Pine st 

DZ 

Nicolas 

12 

CLEARANCE 

ppm ± 

Pb : 5 M 

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 254.665 

Supervised By: 

Certificate of Verification 

1342 

SOIL 

2009-07-14 10:11 

30.38 

Final 

19604 

3332 Pine st 

DZ 

Nicolas 

12 

CLEARANCE 

Error 

19.928 
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 140.119 

Supervised By: 

Certificate of Verification 

1343 

SOIL 

2009-07-14 10:12 

30.12 

Final 

19604 

3332 Pine st 

DZ 

Nicolas 

12 

CLEARANCE 

± Error 

± 15.099 
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 218.376 

Supervised By: 

Certificate of Verification 

1344 

SOIL 

2009-07-14 10:12 

30.46 

Final 

19604 

3332 Pine st 

DZ 

Nicolas 

12 

CLEARANCE 

Error 

18.823 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1345 

Mode SOIL 

Time 2009-07-14 10:13 

Duration 30.76 

Sequence Final 

Flags 

BVID # 19604 

ADDRESS 3332 Pine st 

QUAD/ZONE DZ 

INSPECTOR Nicolas 

DEPTH 12 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 65.176 ± 10.978 

Supervised By: 
^O ^ \ Omaha Lead Site—Fixed Price EP-R7-07-05 

^^^^ ^ I Coastal Environmental Group Inc. 

^^^yj ? www.c0astaiha2mat.com 

>,.p„(flt<^ COASTA L • NVIIONNINTAL 

a no u P, IN C 

EXECUTIVE SUMMARY: 

BVID #19604- (3332 PINE ST) 

No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 
4>EPA 

EPA Property Close Out Form 

Property tt: l^igt ^ . . Property Addr.«:- ^^^ ^ J"}!^^ - ^ ^ 

Datc/Tlne: Owner's Name:. ,CTYKirVV XA'LSVt ' - — . v 

Quads Excavated: f \ , T>£. contmctor Croup QgyiljgrV gHAidotngA*^* 

Excavation Yes No General 

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

2. If necessaty, were the correct areas ofdrip rone excavated and restored? 

Grading Sod and Vegetotioa 

Ves No 

1. Does the grading around the perimeier ofthe house in excavaled 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 evaluate if inspected at a 30 itnyanagrowmg.Mi i/' day time period) Jt^3cnr>. Q: 

4. Are sodded areas generally nrm and evenly graded? (y' 

5. Are the joints l)etween the sod strips generally tight? (Only evaluate if inspected at a 30 day iy^ 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? 

Gales, Peaces aad RctaiDlng Walb Ves No 

1. Do gates open and close freely? (Ifapplicable) 

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

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

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

FouDdatioa, Sidiag and Gatters 

Ves No 

I. Was damage to the siding or trim avoided? y' 

2. Was damage to the foundation avoided? 

3. Was damage to windows avoided? i;­

4 Was damage to windows or door screens avoided? 

5. Was damage lo downspouts or downspoul extensions avoided? 

Sidewalks and Driveways (Concrete) 

Yes 

1. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 
Owners comments: 

Inspection notes: 

Removal and restoration aclivales complete induding the 30-day sod warranty: 

EPA Represenlalive _Ljay \ f>/^iJ L Dale: p/^/Qf 
Property Completion Agreement 

Jhis agreemem documenli ihe completion of remedial acliviiies perloimed on my properly My signalure 

will designate thai 1 am satisfied wilh the restoralion of my propeily, and Ihal no items are in questions, 

now. or al any lime in the fulure, excepl those ilems listed below, ifany 

Property ID: \ %(jJ ^ 

Property Address: ^^0^ 2 ^ i ^ • ?5 ^ 

Phone: (MQ^ ^ ^g^^^ ^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

Ve;m Vx^^a \oji(va w)G)ct 

l/ j I agree lextortilian i* completed,rxccpl as noieri 

[_| I do not «i;rec reitoration ii eompleled 

3^>x^JKfA 7-2-^-01 FnOiM>m^ -^fzst; 

Owner's Sicnatiire Date Conti arlor's Signature Dale