TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: lyy^J y Date: _ 

Address: ^^\\< l^nV^fif^ ^ < 

Remediation Contractor: Coastal Environmental Group_ Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

0 Video of property (DVD) 1H ^ ^/l^^n:lyv^ 

0 Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

<&• Signed Access Agreement(s) for adjacent property 

p ' Restoration Agreement 

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

-& Confinnation data 

Photographs jf^i^^lo ^ ^ fU^ bcC^^r(U^ 

^ As-built sketch 

^ Satisfactory restoration signed by Property Owner 

U Property close-out check list signed by EPA 

-S~ Description of areas not meeting ROD cleanup criteria 

Utility clearances 

^ / Property information from Douglas Coimty Assessor's Office 

Superfund 
\ 

Property Access Checklist 

Propert, ID: 2-'6 M Xl " 

D WORK STARTED ON: / / 

D WORK COMPELTED ON: Properly Addre»: y^\\f ^ DaVenfiDT ^ 

Renter Owner: H\(^hCtC^ \ CD^ . 

Address: Phone: "SavYut 

P«.\: 

Cell/Pager: 

Phone: l^y ^ - -]5C ^ 

Additional Inl'nrmittion: 

Fax: 

Ccll/Pager. 

D Notifieation Letter 

Sent: / / By: 

H i Accesjf Agreement 

Signed: JI/]3_/t]^ B>= ^hiAMe ^ 

H) Restoration Agreement Signed: J2/]3./Q9. ^y V^^hPtAHji 

D Topsoil Sempling (if applicublc) / / By: 

D Disposal Sampling (if applicable) / / By: 

D Garden Sampling (if applicable) / / By: 

• ^ ll|i lify Clearance 

Called: 7_/2j/£ 4 B>:7/5^/f79 

[5 ^ Video/Photos (Before) On-.Z.'JH'(2S ">•• Vcn-h/r\/ 

D Video/Pholos (During) On: / / By: ' 

D Video/Pholos (After) On: / / By: 

D Video/Photos (30-DJI>) On: / / By: 

D Property Completion Ajjreement Signed:

 / / By: 

D Final Report Issued: / / By: 

Air Monitorint! (*s applicable) 

D Community O Crew On: / / By: 1 

Results: 

D Community' D Crew On: / / By: 

Results: 

n Communit) D Crew On: / / By: 1 

Resulb: 

Omaha Lead Site 
Property ID #

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact:

Final Action:

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

l_7^^1.1_ 

^\^'^ V^v^yvyoH 

 Date: Time: Action: 

 Date: Time: Action: 

 Date; Time; Action; 

 Transmit to EPA D Other Action: D 
Douglas County Accoimt InfornM^on Page 1 of3 rnM^o 

Douglas County, Nebraska Property Record - R1315450002 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - Vie w Ofl Ma p Information is valid as of 2009-6-16 Treasurer's Tax Report 

New Feature ->••" • Auto Sales Search 

Owner 

COE MICHAEL D 

3115 DAVENPORT ST #7 

OMAHA NE 68131-0000 

Property Informatio n 

Key Number: 1545 0002 13 

Account Type: Multiple Comm 

Parcel Number: 1315450002 

Parcel Address: 3115 DAVENPORT ST 

OMAHA NE 68131-0000 

Legal Description: HILLSIDE ADD-1 LOT 10 BLOCK 6 LOTS 9 & 10 BLK 6 IRREG 

Value Informatio n 

Land Improvement Total 

2009 $18,300.00 $97,900.00 $116,200.00 

2008 $18,300.00 $97,900.00 $116,200.00 

2007 $18,300.00 $82,300.00 $100,600.00 

2006 $18,300.00 $82,300.00 $100,600.00 

2005 $18,300.00 $82,300.00 $100,600.00 

2004 $18,300.00 $82,300.00 $100,600.00 

Sales Informatio n 

Sales Date: 2000-07-27 

Deed Type: WD Sooilr; 2160 Page: 194 

Price: $3,000.00 

Grantor: 

Grantee: 

Valld/lnvalld: Invalid 

Exclusion Reason: 

Sales Date: 2000-07-27 

Deed Type: Book: 2160 Page: 197 

Price: $142,000.00 

Grantor: 

http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accoimtno=Rl31... 7/7/2009 
•• • 

Douglas County Account InfornM^on Page 2 of3 rnMgc 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: Multiple 451 -Parti Int Valid 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.26 11574.0 1.0 0.0 0.0 No 

Improvemen t Informatio n 

Building 1 

T T I 

./•I m • r h' 

1 W'onsPK*' * r 

1

t ­

„H " • * 

1 rn>rb«> " 

" • 1 •« 

• fcwrt •>•>>•• 

>• MNIV 

\• r 

„ 

CLICK TO ENLARGE IMAGE 

Square Footage: 4760.0 Percent Complete: 100.0% 

Perimeter 228.0 Quality: Average 

Unit Type: Condition: Fair 

Built As: Apartment <= 3 Stories Condo Square Footage: ' 0.0 

HVAC: i Forced Air Rooms: i 0.0 

Exterior: ; Masonry Common Brick Units: i 8.0 

Interior: Plaster Baths: 0.0 

Roof Cover: ! Built Up Rock Bedrooms: 0.0 

Roof Type: ; Flat Stories: 2.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: : 0.0 

Year Percent Adjusted Year YearBuiit Physical Age Remodeled Remodeled Built 

1910 1910 99 

Detail Type Detail Description Units 

Add On Porch Open 50.0 

Add On Porch Open Upper 40.0 

Add On Porch Open Upper 

40.0 

Add On Porch Open Upper Deck 

40.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl 31... 7/7/2009 
Douglas County Account Informano irnM^ n Page 3 of3 

Add On Porch Open Upper Deck 40.0 

Add On Porch Open Upper Deck 120.0 

Basement Bsmnt Block 8 ft 2380.0 

Basement Finished 1190.0 

http://douglasne,mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl31... 7/7/2009 
Page 1 of2 

"> 

Create Another ticket Back to Irth Internet I Send Email ,| 

YOUR TICKET NUMBER IS 2349962. 

Original Call Date: 8/26/09 Time: 9:51 am Op: ELIZABETH18790 

Work to Begin Date: 8/28/09 Time: 10:15 am 

State: NE County: DOUGLAS Place: OMAHA 

Address: 3115 Street: DAVENPORT ST 

Twp: 15N Rng: 13E Sect-Qtr: 21-NW 

Twp: Rng: Sect-Qtr: 

Legal Given: C 


Type of Work: LEAD REMEDTIATON 


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 Comer Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


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 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 8/26/2009 
Page 2 of2 

• 

OPPDGPR5 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... 8/26/2009 
As-Built Drawing ^ ^ 

COASTA L Omaha Lead Superfund Site 

23422 

Exterior Paint Nort h ArTCTW Omaha Lead Site n.«oo d Site Sketch 

Ul Poor 

Samplin q Address : 3115 DAVENPORT ST Q Not paint r 

Sample Number Lead Sample Samples Collected 

I 

LAB Concentration Collected Firm: F M V&A S 

RVASCPXA-23422 F1 113 p pm 

• Date: jp-Z.3-<^fo 

RVBSCPXA-23422 F2 p pm 

n Time: T^'-Z-o /yiv\ 

RVCSCPXA-23422 81 «0- 7 p pm 

n Samples Analyzed RVDSCPXA-23422 82 25a, p pm D 

RDZSCPXA-23422 DZ qftf ppm D XRF Unit: GSHr y Book: 2.2. H 

RGZSCPXA-23422 GZ 35<^ p pm D Date: 11 - 2. 0 -0 & 

RrZOCnXA-23422 PE ppm D Time: Prr ^ 

Staff: Number of Samp msu? 

Legend: F1 = Front Left, F2 = Front Right, 81 = Back Left, 82 = 8ack Right DZ = Drip Zone, GZ = Garden, PZ = Pla; AH quadrants are aa viewed from the street, facir>g property 

OLS#: 23422 

Date Excavated: 8/31/09 

NOV V 9 2008 

Date USEPA Signed Off: 9/22/09 

Area Sodden: 702 sa ft . 

Legen d 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced with 

Area lef t bare Sod ' ' Rock/Mulch 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
NQVVp^^ f 

23422 

Omaha Lead Site Exterior Paint 

Site Sketch • j6ood 

[0 Poor 

Sanipling Address: 3115 DAVENPORT ST Q Nol pamt \ 

Sampie Nurnber 

R>'ASCPXA-23422 

RVBSCPXA-23422 

RVCSCPXA-23422 

RVDSCPXA-23422 

F1 

F2 

B1 

82 

Lead 

Concentration 

[1 5 

2fi l 

ppm 

ppm 

ppm 

ppm 

Sample 

Collected I 

LAB 

D 

D 

n 

n 

Firm

Dale:

Time:

Sarnples Collected 

 n A t>0AJ 

 fP-li-g?: ) 

 T^'Z-u prv\ 

Samples Analyzed 

RDZSCPXA-23422 DZ ppm D XRF Unit: CxSHn Book: 2.2M 

RGZSCPXA-23422 GZ ppm D Date: \ l ­ Z O -Of i 

RrgCiCPXA-23422 -P2 ppm D Time: -JO^ 

Number of Samples = |_u | | Q [ Staff: r^L o 

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

AH quadrants are as viewed from the street, facing propefty 

Y^2(^>'S(^^S 

^fl-b l^€i.i-V' E)^'U^->-*t" 
3i IS [kmpor+S.-+ 

Omah Exterior Paint a Lead Site • j6ood Site Sketch 

[0 Poor 

Sampling Address: 3115 DAVENPORT ST • fvlot painl 

Sample Lead Sample Sarnples Collected Number 

i 

LAB Concentrafion Collected Firm fh^ P0AJ 

RVASCPXA-23422 Fl 11 3 ppm 

D Date 

lO'Z-i'Oh 

RVBSCPXA-23422 F2 2s 7 ppm D Time 

^•t o pr^ 

RVCSCPXA-23422 81 ^ flOl ppm D 

Samples Analyzed 

RVDSCPXA-23422 82 2 5 CP ppm D 

RDZSCPXA-23422 DZ -^r 9 fi I ppm D 

XRF Unit: GSH n Book: 2.2 ^ 

RGZSCPXA-23422 GZ ~ 3 5*^ ppm D

Date ;/ - zo-of i 

RPZOCnXA-23422 P2 ~ ppm D D Time: ' t ^ 

Numbe Staff: pr>SbJ r of Samples = I fcy | | f ) | 

Legend: Fl = Front Left, F2 = Front Right, 81 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Plav 

All quadrants are as viewed from tile street, facing property 

^,Vo : KDV ) 9Z0D8 

(^DrtCfeT^ 

4^ft ^^CH\^ 

:(*\% f'rcati:!! I'l-Scp'lS 

^/^3 K€H- ^ Ej^-v.z^vvl' 
# 

23422 

Omaha Exterior Paint Lead Site 

Sit • j6ood e Sketch 

[0 Poor 

Sampling Address: 31 IS DAVENPORT ST • Not paint 

Sample Lead Sample Sarnples Collected Number 

I LAB Conceniration Collected Firm 

RVASCPXA-23422 F1 

113 ppm D Date \0'li'O h 

RVBSCPXA-23422 F2 2R1 

ppm Time T-'-tO ;

RYCSCPXA-23422 B1 n

ppm 

Samples Analyzed 

RVDSCPXA-23422 B2 250> ppm D 

RDZSCPXA-23422 DZ ppm n XRF Unit: CtSt-i n Book: 22. H 

RGZSCPXA-23422 GZ -3S q ppm n Date: l l - 2. 0 -Of i 

RPZOCPXA-23422 -PZ ppm 

• Time: & n 

Staff: Number of Samples = [ fc> | | (-) | mts(^ 

Legend: Fl = Front Left, F2 • Front Right, Bl = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Plai 

All quadranis are as viewed from ttie street, facing property 

4^ft (^CH\t 

^f h Ke^vA' t~lp^-\.yJL.-y^ 
23422 

Omaha Lead Site Exterior Paint North AiTow 

Site SIcetch msoo d 

[£| Poor 

Sampling Address: 3115 DAVENPORT ST • Not paint 

Sample Numt)er Lead Sample Samples Collected 

I UB Concenlraiion Collected Finn: ftyl P^A J 

RYASCPXA-23422 F l ppm D Date: |P - Z.?>-/>h 

RYBSCPXA-23422 F2 ^ ppm D Time: l-'-Z-o p m 

RYCSCPXA-23422 B1 ftp 7 ppm D Samples Analyzed RYDSCPXA-23422 82 ppm D 

RDZSCPXA-23422 DZ p pm D XRF Untt: GSt4 n Book: 2.2 H 

RGZSCPXA-23422 GZ 3gq ppm D Date: l l - 2. 0 -Of e 

RPZaCPXA-23422 PE ppm D D 

Time: Pi ^ 

Numbe Staff: __CQSL2 r of Samples" I (y \ | Q

Legend : F l = Front Left, F2 = Front Right, B l = Back Left, B2 = Back Right DZ " Drip Zone, GZ - Gaiden, PZ = Pla; 

All quadrants are as viawad (nxn the street, bdng property 

| 

pqyct^fpr^. Rc\-2<»S (.-leaal: IO-Sei>Ji8 
COASTA L ENVIRONMENTAL ^ t PRO ^ Clour . 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: 

Owner's Name Daytime Phone: 

Mim^L C6^ 4o7 

Address of Property 2 A ^ 

covered by this l^A^e^^o^T 

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 will be restored to its original condition. This 

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

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

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

opportunity to review and 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 
COASTA L 

.<P* 

ENVIRONHENTAL 

CROUP , IN 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 woric 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 

[J\i grant access to my properties 

D I do not grant access to my properties 

1TKAJ- ^ 

Signature Date Signature Date 

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

Page 2 of 2 
C » H S T ^ L 

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). 

j Property IP: •'^J)^']fU 

. Property Address: ^^g , 'P%V^€V^\;)OCV ^= ^ 

\ Owner: >KArMr\ Cr^ 

p^o--- lAV^-^2 ^ 

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. 

Stoms to be Removed by the Owner befoic StsK of Remediation: 

I ii j .c-r.ovfi. g'iOfcce, c-is/ObLl, i.:\Ktl:^i iEt.;f."i o.' ttn..Vfe tifcmfc ii- Lfii^. Uwh£i i ic£f.:ciifci^>ii:i.y. 

j Item: 

^ "_lii^ 

ll Hem: 

ttem: 

Item: 

Items to be Removed by the Contraictor During Remediation and Not Replaced^ 

Item: 

A WW o-^^^'l U^^ (WkxK^- Item: 

-^^.w^v ^ ?0U ^ ^ N ^ T ^^^.-£^4 T^^AA^T^C ' 

Item: 

Item: 

Page 1 of. 
C _> ^ S T M L 

[tgiYtsjo Be Removed Ey Contractor During Remedtatioii and Reigtaced 

Landscape Inventory 

Item Quantity' Unit Condition/Type/Species 

Pre-existing property area, 

5' 

Quadrants 

that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch Each 

^ trunk diameter 

Number of trees <= 2 inch Each 

trunk diameter 3

Number of Sprinkler 

Zones, Control Valves, Each Timers

Aliach r

, Hearts

. skeicl

, etc

i u

. 

l llif v^ 

iftMUt'i l;;u-.u; 

Number of and size of 

each garden/ flower bed Each 

area. Square Feet ; 

Alliicli ;i ski'icli Cll rfliiiiM' 

iiZCf. Hltci l^>c;llillM.^ 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. S ••c:o !'-,:• .. le • .j , b' 

^ 

• C'li-.- . " • •(- . '':•• • |-.."(:!i-' ' -

Easement Area, to be V^ Each 

excavated s UU^^l^'^ ^ \

Page 2 of. 
' Additional Commente / Instructions: 

7^-3 pi^y •/^v\]CL f^^o^ ^ <^i^C^-l 

b 0,^y^y< V ^ ­ \ 1 ­ Y^n\\^^ ­

ffi'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. 

\ ^ I agree [U I do no* agree 

Owner's Signsture Dale Contractor^ Signature Date 

Page 3 of. 
Date 

Project 

XRFID# 

Shot# 

i

i&l «?S7

$53

Average

Shot# 

5aD. 1sm. 5s^ tl5A^ 

Average

Shot# 

ilao- H-S9A 

Average

Shot# 

Average 

lab sample # 

BVID#i22M2i 

XRF PROPERTY SAMPLE SHEET 

?|?)llO^ Address ?»^\ar)A\/ftr^p<^r4^a^ 

Omaha lead FP 2n(1 year opllon Sample time am/pm 

sample length ^7^8 ^ 30 sec 

Reading Sample area Shol# Reading Samplearea 

in'L.^\^\Z.'\<: 

^ .tl ^ flL,.<^U4r \\.x^ S 

 nf.u:^tirt.qj Depth Depth 

 h<:A^i-ll.Ci\ 

 S Q . \ I ±- U .^q . Average 

Reading Sample area Shot# Reading Sample area 

B\ iSb.^tH.gsr 

Depth Depth ^s.-wt \u^^. iaaWJ:17..0W iO— 

1 A ^ .S/ ^ t j^^.lf t Average 

Reading Sample area Shot# Reading Sample area 

Si.z3i <\.ni 

VAiPX iq.QU Pi 

\S\.TRJL\U.q^ Depth Depth 

2tfa.S3:Ll^.Sli> E 

 t\fl7.3^. ^ \S.ST Average 

RETEST AREAS 

Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average 

Lab result Samplearea XRF Avg. 

Signature. l£asi QfiJPh 

Print g,i;j^)Cfe^OQCftr< S 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 4554 

Mode SOIL 

Time 2009-08-31 09:33 

Duration 121.88 

Sequence Final 

Flags 

AVERAGE Bai;Qfeft550-.4553 il 

ADDRESS 3115 davenport st 

QUAD/ZONE easement 

INSPECTOR VENTRY 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm Error 

Pb f''84.110~--7 ± (^25^^— ^ 

Supervised By: Q^A&LJ^iih 
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 102.911 

Supervised By: 

Certificate of Verification 

4550 

SOIL 

2009-08-31 09:31 

30.56 

Final 

23422 

3115 davenport st 

easement 

VENTRY 

1 

CLEARANCE 

± Error 

± 12.354 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 4551 

Mode SOIL 

Time 2009-08-31 09:32 

Duration 30.59 

Sequence Final 

Flags 

BVID # 23422 

ADDRESS 3115 davenport st 

QUAD/ZONE easement 

INSPECTOR VENTRY 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 86.856 ± 11.589 

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 71.427 

Supervised By: 

Certificate of Verification 

4552 

SOIL 

2009-08-31 09:33 

30.19 

Final 

23422 

3115 davenport st 

easement 

VENTRY 

1 

CLEARANCE 

± Error 

10.912 
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 75.245 

Supervised By: 

Certificate of Verification 

4553 

SOIL 

2009-08-31 09:33 

30.54 

Final 

23422 

3115 davenport st 

easement 

VENTRY 

1 

CLEARANCE 

± Error 

± 11.014 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 4584 

Mode SOIL 

Time 2009-08-31 14:30 

Duration 122.23 

Sequence Final 

Flags 

AVERAGE 

ADDRESS "3115 davenport st 

QUAD/ZONE Bl 

INSPECTOR VENTRY 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

± Error 

Pb ± 

Supervised By: ^mj ^ 
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 136.974 

Supervised By: 

Certificate of Verification 

4580 

SOIL 

2009-08-31 14:28 

30.56 

Final 

23422 

3115 davenport st 

B l 

VENTRY 

6 

CLEARANCE 

± Error 

± 14.484 
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 130.886 

Supervised By: 

Certificate of Verification 

4581 

SOIL 

2009-08-31 14:28 

30.51 

Final 

23422 

3115 davenport st 

Bl 

VENTRY 

6 

CLEARANCE 

± Error 

± 14.547 
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 85.714 

Supervised By: 

Certificate of Verification 

4582 

SOIL 

2009-08-31 14:29 

30.59 

Final 

23422 

3115 davenport st 

Bl 

VENTRY 

6 

CLEARANCE 

± Error 

± 12.021 
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 80.667 

Supervised By: 

Certificate of Verification 

4583 

SOIL 

2009-08-31 14:30 

30.57 

Final 

23422 

3115 davenport st 

Bl 

VENTRY 

6 

CLEARANCE 

± Error 

± 12.058 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 4589 

Mode SOIL 

Time 2009-08-31 14:33 

Duration 122.32 

Sequence Final 

Flags 

AVERAGE Avg ot 4585-4588 

ADDRESS ^rrsTiavenport st 

QUAD/ZONE DZ 

INSPECTOR VENTRY 

DEPTH 13 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb [ri67J22 ^ ± fT^J ^ 

Supervised By: C/^A/* ! z£^A 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 4585 

Mode SOIL 

Time 2009-08-31 14:31 

Duration 30.08 

Sequence Final 

Flags 

BVID # 23422 

ADDRESS 3115 davenport st 

QUAD/ZONE DZ 

INSPECTOR VENTRY 

DEPTH 13 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 51.228 ± 9.705 

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 239.777 

Supervised By: 

Certificate of Verification 

4586 

SOIL 

2009-08-31 14:31 

30.64 

Final 

23422 

3115 davenport st 

DZ 

VENTRY 

13 

CLEARANCE 

± Error 

± 19.038 
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 151.780 

Supervised By: 

Certificate of Verification 

4587 

SOIL 

2009-08-31 14:32 

30.64 

Final 

23422 

3115 davenport st 

DZ 

VENTRY 

13 

CLEARANCE 

± Error 

± 14.913 
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 226.503 

Supervised By: 

Certificate of Verification 

4588 

SOIL 

2009-08-31 14:33 

30.96 

Final 

23422 

3115 davenport st 

DZ 

VENTRY 

13 

CLEARANCE 

± Error 

± 18.555 
 v 

f \A ^ \ Omaha Lead Site—Fixed Price EP-R7-07-05 

I Coastal Environmental Group Inc.

V j ^ www.coa8talhazmat.com 

^-"t^oit" ^ COASTAL 

Clou p. m c 

EXECUTIVE SUMMARY: 

BVID #23422-(3115 DAVENPORT ST) 

No Issues or Concerns Q Issues/Concerns 

Detail Explanation: 

-COASTAL TO REPAIR YARD ON THE NE CORNER DAMAGED BY 

EQUIPMENT.(COMPLETED 9/20/09) 
^ 

EPA Property Close Out Form 

Property AddTM«r.3}iiJ^VfiWL ^ 

Datc/Tlmc: 

Owner's Name; .^jj^jOjifl^/CTg . 

Quad Contractor Group /^jfVr^ATgv^viVnAmflVVl \ OrOOf . s Excavated: 

Yes /No Excavation General 

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

i — 

2. If necessary, were the correct areas ofdrip zone excavated and restored? cy 

Gradln Yes JNo £ Sod and Vegetetion 

1. Doe

from

s

 th

 th

e

e

 house

 gradin

? 

g around the perimeter ofthe house in excavated areas generally slope away M

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 

day tune period) 

4. Are sodded areas generally finn 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 property? ly' ' 

7. Was damage to landscaping or plant materials avoided? -i? ' 

Gates, Fences and Retaining Walls Ye5 No 

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

2. Were all gates or fences taicen down during restoration activities reinstalled? (Ifapplicable) 7?^ 

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

4. Was damage to retaining wails avoided? (Ifapplicable) T;^ 

Foundation, Siding and Gmiers 

Yes .No 

t. Was damage to the siding or trim avoided? LX^ 

2. Was damage to the foundation avoided? 

Was damage to windows avoided? I'

4. Was damage to windows or door screens avoided? I/" 

5. Was damage to downspouts or downspoul extensions avoided? u^ 

Sidewalks and Driveways (Concrete) 

Yes » r 

1. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 
0>»'ners comments: 

Inspection notes: 

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

EPA Representative Uc ^ IJ A^^J L Date: ^ %>( 0 ^ 
L 

Property Completion Agreement 

ihis agreemenl documenis lhe complclion oi remedial acliviiies perloimed on my pioperly My signalure 

will designale llial I am satisfied with lhe rc«!toralion of my property, and that no items are in questions, 

now, or ai any lime in the future, except ihose items listed below, tf any 

Property fD: ^ ^H^ Z 

Property Address: ^;^ ^ P^^^^^^^ f ^A 

Owner: ]fl^.^^^i ^ 

Phone •

 LB' lC»-{< {H31]H15-'7^1 H 

Restoration Items in Question: 

item: 

Item: 

Item: 

Item: 

Item: 

item: 

Additional Comments: io./^(^fexi ^y e^tcipme^-h, ^fAS3 

I rJ I ngrcc icstoriition i« complcltd, fxccpl as noleri 

[_J Irto nol ji(»rec rcjuomtion is completed 

L^ ^- W-0<? i ikl 

Owiic*'.« Signatiirr D«tc Contt mtftr'j Slennliirc Date