TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: 'l^ k)^ny

 Datc:_lmf_/ k 

Address: 

Remediation Contractor: Coastal Environmental Group_ Year: _2010ARRA 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) ^ 

y Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent pfoperty 

Restoration Agreement 

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

Confirmation data 

Photographs \ h (W^/VAUv ] Y (^0(\)fk\l^ ^ )^ 4(^V 

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 

y 

Utility clearances 

Property information from Douglas County Assessor's Office 

30218075 mil 

Superfund 
i 

• 

Property Access Checklist 

Property Addres!>: 'diJ^^^ ^ n

D

 WORK STARTED

 WORK COMPELTED

 ON 

 ON: 

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Ownc: ^y;f^ ^yC\(jfy,ffy^ 

Address: 

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F«x: *^ 

Ccll/Pager. 

Renter 

Phone: 

Fax: 

Cell/Pager: 

Additional Inlnrmxlion: 

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Q

D

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 Notification Letter 

 Acceu AgrcemcBt 

 ReitomtioD Agreement 

 Topsoil Sempling (if applicubic) 

 Disposal SaiopllDg (if applicable) 

 Gnrdcn Snmpliog (if applicable) 

 Utility Clearance 

 Video/Photos (Before) 

 Video/Photos (During) 

 Video/Photos (After) 

 Video/Photos (30-Day) 

 Property Completion Agreement 

Sent: / / 

Signed; J[//jf^/ ^ 

Signed: JJ ' ^^ >P^ 

1 1 

1 1 

1 1 

Called: \ \ 1 fO / ^ 

On:\JL/i}./i^ 

OD: / / 

On: / / 

On: / / 

Signed: / / 

By: 

By: 

By: 

By: 

By: 

By: , 

By: l/jf(g lo ^ 

By:OC\as[U^ 

By: 

By: 

By: 

By: 

D Finj'l Report Issued: / / By: 

Air Monitoring (4£ applicable) 

n Community C I Crew

Results: 

 On: / / By: 

D ComrounitA'

Results: 

D Crew On: / / By: 

• Community

ResulU: 

D Cru»v | On: / By: 

Omaha Lead Srte 
Douglas County Account Infoij|utio ]j|^i( n Page 1 of2 

Douglas County, Nebraska Property Record - R0952800000 

Print Report 

NEW Feature - Parcel Dimensions avallabie @ scale 0-50 ft west of 52nd St - VIe W O n Ma p Information is valid as of 2009-10-15 Treasurer's Tax Report 

New Feature ->••• • Auto Sales Search 

Owner 

ERICKSON NILS A 

4817 DAVENPORT ST #2 

OMAHA NE 68132-0000 

Property Informatio n 

Key Number: 5280 OOOO 09 

Account Type: Residential 

Parcel Number: 0952800000 

Parcel Address: 

Legal Description: 

4817 DAVENPORT ST 

OMAHA NE 68132-0000 

DUNDEE PLACE LOT 9 BLOCK 118 50 X 135 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$16,900.00 

$16,900.00 

$16,900.00 

$16,900.00 

$16,900.00 

$16,900.00 

Improvement 

$165,400.00 

$165,400.00 

$168,700.00 

$153,100.00 

$145,500.00 

$145,500.00 

Total 

$182,300.00 

$182,300.00 

$185,600.00 

$170,000.00 

$162,400.00 

$162,400.00 

Land Informatio n 

Acres 

0.15 

SF 

6750.0 

Units 

1.0 

Depth 

135.0 

Width 

50.0 

Vacant 

No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accoimtno=RO... 10/23/2009 
Douglas County Account Infoi|jMtio tjjj^ i n Page 2 of2 

4817 Davenport St D« C-arnsf V ' 1 • 

m^¥^' m^W'^ 

SAeaiHl F16W 

i:36 0Sq.n "91 i;«0.5 Sij. fl . 

J 

i 

2 1/2 Story Unfin 

CLICK TO ENLARGE IMAGE CLICJKjrO_ENLARGE IMAGE 

Square Footage: 2476.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

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

HVAC: Central Air to Air Rooms: 8.0 

Exterior: Frame Vinyl Units: 2.0 

Interior: Drywall Baths: 2.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 2.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: I 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1906 1993 0% 1906 103 

Deta/7 Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 1236.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 2.0 

Porch End Solid Wall 112.0 

Porch End Solid Wall 112.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO... 10/23/2009 
n Page 1 of2 

• 

[i J Greate Another Tjcket^^ ~ ] \i_ Back to Irth Internet J ![;_ Send Ernail i] 

• YOUR TICKET NUMBER IS 2404481. 

Original Call Date: 11/10/09 Time: 7:21 pm Op: ELIZABETH18790 


Work to Begin Date: 11/16/09 Time: 7:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4817 Street: DAVENPORT ST 


Twp: 15N Rng: 13E Sect-Qtr: 19-NE,20-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 Environmental Group 


Depth of Excavation: 4 feet Corner Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


BSHPCLKS CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number UtiUty Type 

BSHPCLKS NEBRASKA HEALTH SYSTEM NA 

Day: 4025523460 

Alt: 4025523347 

Emerg: 4025595111 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Ah: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICHATRAFFIC

Day: 4024447197 

 AU: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11/10/2009 
Page 2 of2 

• # 

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=<RESULT... 11/10/2009 
49632 

1 ^ As-Built Drawing 

COASTA L EMVIKONNKNTAL Omaha Lead Superfund Site e ft O U » . IN C 

OLS#: 49632 

Date Excavated:11/23/2009 

Date USEPA Siqned Off: 7/19/2010 

Area Sodden: 1575 sq ft 

Omah Exterior Paint North Arrow a Lead Site • Good Site Sketch 

B'Poo f 

Sampling Address: 4817 DAVENPORT ST • Notpaint J

Lead Sample Samples Collected Sample Number 

I 

LAB Concentration Collected Firm: ? £ • C-C . p.6 -

RYASCPXA-49632 F1 ~l2.~f ppm D Date: l-l-^-o t 

RYBSCPXA-49632 F2 H o h ppm D Time: '^'^ l R-'^- RYCSCPXA-49632 Bl 3 s O ppm D Samples Analyzed RYDOCPXA 4063a 83 ­ " ppm D D 

RD2SCPXA-49632 0 2 HBMq ppm \y D XRF Unit: 6i')H D Book: Z H 

fiCgSCPXA 10631! 6 2 ~ ppm D D Date: 6 II-Of c 

nPZSCPXA 1063a—P Z ~ ppm D D 

Time: Piv, 

Staff: fn-bl ^ Number of Samples = | H [ | Q \ 

Legend: F1 = Front Left, F2 = Front Right, Bl = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, fadng property 

Rev 2(XW C'reued: i:-Apt-l» 

Legen d 

Concre'te Drip Zone Excavated Quadrants Excavated 

Area replaced with 

Sod 

Area replaced with 

Rock/Mulch Axea lef t bare 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
Cyy^'/ 

49632 

Omaha Lead Site Exterior Painl 

Site Sketch n Good 

0'Poo r 

Sampling Address: 4817 DAVENPORT ST Q Not paint 

Sample Number 

RYASCPXA-49632 

RYBSCPXA-49632 

RYCSCPXA-49632 

Fl 

F2 

Bl 

m 

Lead 

Concentration 

~l2 n \ DOm 

HOP i DDm 

3S' 0 DDm 

^ 

Sample 

Collected I 

LAB 

D 

D 

D 

D 

Firm:

Date; 

Time: 

Samples Collected 

 ? £ . C- C 0-&­

7 ­

•^ 

2.'^ -

Ml 

or 

A.M . 

Samples Analyzed 

RDZSCPXA-49632 

RGgSCPXA 40633 

D2 

-G i 

qRM q Dom 

Dom 

\y 

u 

a 

D 

XRF Unit 

Date: 

6)'!H 0 Book: 

en-Ofc 

211 

nPZCCPXA 10633 PZ ppm D n Time: ?.-. 

Number of Samples = | M | | Q \ Staff: msu? 

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

All quadrants are as viewed from the street, facing property 

Rev lm » Crcntcd: 12-Apr 

^ o b 
tP m « 

49632 

Exterio North Arrow r Paint 

Site Sketch 

Omaha Lead Site 

• Good 

Q'Poor 

Sampling Address: 4817 DAVENPORT ST Q Notpaint 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm: ?£ • C-C. p.&-

RYASCPXA-49632 "FT ' _iZX^PP' ^ 

D Date: 7 - Z.'^-Ot 

RYBSCPXA-49632 F2 

_H£ifiL_PP m D Time: V-A \ fl-^-

RYCSCPXA-49632 B1 3$' 0 ppm D 

Samples Analyzed 

-RYDSCPXA 40632 B3- . ppm D 

RDZSCPXA-49632 DZ H8Hq ppm a XRF Unit: 6^H D Book: 21 1 

RGZSCPXA 10632 GZ ppm D Date: 6 11 - Ofc D nPZCCPXA 10603 PZ ppm D D Time: Piv^ 

Staff: {f\^\ ^ Numt>er of Samples = | M | | Q 

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

All quadrants are as viewed from the street, facing property 
49632 

ExterkM- Paint North Arrow Omaha Lead Site • Good Site Sketch 

[g-Poor 

Samolina Addrass: 4817 DAVENPORT ST • Notpaint ^ 

Sampl Lead Sample Samples Collected e Number Concentration Collected LAB 

Firm ?£, CC. tt.fc- : 

RYASCPXA-49632 Fl 12. 1 ppm D Date: T-i-^-o r 

RYBSCPXA-49632 F2 

HOPt ppm D Time: V'^ l A.M. 

RYCSCPXA-49632 Bl 3^ 0 ppm I D

Samples Analyzed nvDecpxA 40Ma—sa- D 

RDZSCPXA-49632 DZ _Hfliia_PPm 3- D XRFUnit: £<'*fO Book: 2 H 

noascpxA loaaa—ez - ppm D Date: 6 • II - Ofc 

nPZBCPXA 4063a PZ D "• ppm D D Time: ? -

StafT:. jrcuo2 Number of Samples = | H | \ Q \ 

Legend: F1 = Front Left, F2 = Front Right. Bl = Back Lett. B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

AH qua^im are as viewed froni tw street ladng property 
...««,., 

COASTA I INVIItONn f KTAt 

**"< PBO't''* CROUP . IN C 

Consent foF Access To Pfoperty 

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: tacV-^ OVK 

Address of Property 

covered by this '^S^VpAv&vw^cX 5\- 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, vinjl 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 confinn that it is complete and meets with the Grantor's approval. Upon 

completion, the Grantor will receive vwitten 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 worit has been satisfactorily completed. The Grantor also 

agrees to: 

Page 1 of 2 
c

I 8 

COASTA L tHrmONHINTAl \ y C K 0 U r 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; 

t 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. 

<r 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 

X; grant access to my properties Q I do not grant access to my properties 

ihlQ'09 

Date Signature Date 

O I would iike to be present during any sampling that is required. 

Page 2 of2 
COASTA L 

C n o U ' 

Restoration Agreement 

The purpose ofthis 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: 

PropertyAddress: Z/^/ 7 QTsVOj^NpOf-V S V 

Owner: / ^ jXJ " ^.f j C^L^X^r^ 

\yy^^yyj'Y^- o\^ ^ 

On the attached diagram(s) indicate area(s) to excavate, surface structures and landscaping features and 

access Iocation(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 lernoval. storafie. di&posal, and/or return of ttiese items is the Owner's responeibility. 

ttem: 

pKv/"^yY^c^\^ y\ov<v y^ 

ttem: 

ttem: 

Item: 

X,. ^ 

Items to be Removed by the Contiactor During Remediation and Wot Repiaced 

ttem: 

[A Kv/ "^ VTX(-A\\ 01 (K/Y\V^ 

ttem: 

ttem: 

Item: 

Page 1 of _ 
<cy ^ 

COASTA L 

Items to Be Removed By Contractor During RemediationjntfjReplaced_ 

I ttem: 

ttem: 

?>o//,Son. fl , <rn^,^z- Item: 

ttem: 

Landscape Inventory 

Item Quantity Unit Condition/Type/Species 

Pre-existing property area, Quadrants that will be excavated, that 

is covered whh grass. 

Number of trees > 2 inch Each ) trunJc diameter 

Number of trees <= 2 inch Each 

trunk diameter 

Number of Spriokler 

Zones. Control Valves, Each Timers, Heads, etc. 

Minth il sketcli ol tilt­

"•rripklci l;«y!iLii 

Number of and size of 

each garden/ flower bed Each 

area. Square Feet 

All;\th il skclc-h 1)1 ri.!;iiivt' 

M/csmill loc;uiivi> 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

Vou- l!ii' \nluc \\i\ \ ni. 

csrc' 10 i5;u( .! ;;laii! 

^nll(.•iu•.• Id llie |;ro))Cil> 

DM ner. 

Easement Area, to be 

excavated 7^5 Each ^ijA^ ^K 

Page 2 of. 
I Addttional Comments / Instructions: 

I ^ t ^4 ^ Ub-ViOS^ 

L. 

] ^ Check the t)ox if Owner does not want CEG to document interior foundation walls and possible 

preexisting damage. By diecking this box CEG is not responsible for any damage done to the 

interior of house, including foundation cracks or fissures. 

Q I do not agree 

Date Obntractor's Signature Date 

Page 3 of 
BVID # ^( p ^0 ^ 

XRF PROPERTY SAMPLE SHEET 

Date 

Project 

XRF ID# 

Shot# 

fm 

list) 

USi 

Average

Shot# 

iL£3 

/fS2f 

UL^L 

Average

Shot# 

Average 

Shot# 

Average 

ll-Z3-G^ 

Omaha Lead ARRA I am/o am/pm r 

30 sec 

Reading Sample area 

'.LDt> -^ /Z. tff. P2-

Depth ^^i > ^ I?- J/c 

Z,U>t>i //.^ 3 13" 

 y^LOb ^ II.9 S 

Reading Sample area 

^/./.r:f- 13-12. / ^ 

/rS.^i^n.Sf Depth 

/P^-^f^/9'-9/^ / * 

 /OA .^'/'i - 13.9 ^ 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

-S9o3 ^ 

Reading 

y,u^-i^ii'9^ 

y.u>t>'t n^S3^ 

^LLobi- /^S^ 

^ Lp b J:. //•

Reading 

S/V S ^ /3.Qf 

(l^if.q/ -i lSi^C>^ 

(f(i,-1L'3J^/Q-/9­

 l„D . gt , :fc

Reading 

Reading 

Sample area 

^ \ 

Depth 

i" 

^ 2 -

Sample area 

£2. 

Depth T^ 

 / ?• ? ^ 

Sample area 

Depth 

Signature %^MJSQ/S 

Print Bx^^tb ^ Q,(^msi^ 

Address 

Sample time 

sample length 

Shot# 

U ^ ^ 

f f ^

lf99 

Average

Shot# 

II Gl 

/IC?. 

II k% 

Average

Shot# 

Average 

RETEST AREAS 

Sample area Shot# 

Depth 

Average 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Certificate of Verification 

1152 

SOIL 

2009-11-23 16:17 

91.53 

Final 

yg[of"U49.-11St 

1817 davenport 

Fl 

8" 

R. VENTRY 

clearence 

ngnc 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 1149 

Mode SOIL 

Time 2009-11-23 16:16 

Duration 30.52 

Sequence Final 

Flags 

BVID 49632 

ADDRESS 4817 davenport 

QUADRANT Fl 

DEPHT 8" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm Error 

Pb < LOD 11.752 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb < LOD 

Supervised By: 

Certificate of Verification 

1150 

SOIL 

2009-11-23 16:17 

30.50 

Final 

49632 

4817 davenport 

Fl 

8" 

R. VENTRY 

clearence 

ngnc 

Error 

11.517 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 1151 

Mode SOIL 

Time 2009-11-23 16:17 

Duration 30.51 

Sequence Final 

Flags 

BVID 49632 

ADDRESS 4817 davenport 

QUADRANT Fl 

DEPHT 8" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm Error 

Pb < 11.587 LOD 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 1156 

Mode SOIL 

Time 2009-11-23 16:20 

Duration 90.61 

Sequence Final 

Flags 

AVERAGE fAVg of llb3-llb b j 

ADDRESS *-4817 davenport 

QUADRANT F2 

DEPHT 8" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

Supervised 
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 51.450 

Supervised By: 

Certificate of Verification 

1153 

SOIL 

2009-11-23 16:19 

30.10 

Final 

49632 

4817 davenport 

F2 

8" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 13.081 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 64.910 

Supervised By: 

Certificate of Verification 

1154 

SOIL 

2009-11-23 16:19 

30.42 

Final 

49632 

4817 davenport 

F2 

8" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 12.662 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 66.224 

Supervised By: 

Certificate of Verification 

1155 

SOIL 

2009-11-23 16:20 

30.09 

Final 

49632 

4817 davenport 

F2 

8" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 14.174 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Supervised By 

Certificate of Verification 

1160 

SOIL 

2009-11-23 16:22 

91.65 

Final 

/^5fIi5Z=il59_J 

4817 davenport 

DZ 

13" 

R. VENTRY 

clearence 

ngnc 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 1157 

Mode SOIL 

Time 2009-11-23 16:21 

Duration 30.55 

Sequence Final 

Flags 

BVID 49632 

ADDRESS 4817 davenport 

QUADRANT DZ 

DEPHT 13" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm Error 

Pb < 12.464 LOD 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 1158 

Mode SOIL 

Time 2009-11-23 16:22 

Duration 30.56 

Sequence Final 

Flags 

BVID 49632 

ADDRESS 4817 davenport 

QUADRANT DZ 

DEPHT 13" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm Error 

Pb < LOD 12.161 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 1159 

Mode SOIL 

Time 2009-11-23 16:22 

Duration 30.54 

Sequence Final 

Flags 

BVID 49632 

ADDRESS 4817 davenport 

QUADRANT DZ 

DEPHT 13" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm Error 

Pb < LOD 11.226 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Fiags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Supervised By: 

Certificate of Verification 

1164 

SOIL 

2009-11-23 16:24 

91.71 

Final 

4817 davenp~ort 

em 

1" 

R. VENTRY 

clearence 

ngnc 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 1161 

Mode SOIL 

Time 2009-11-23 16:23 

Duration 30.56 

Sequence Final 

Flags 

BVID 49632 

ADDRESS 4817 davenport 

QUADRANT em 

DEPHT 1" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm ± Error 

Pb 91.154 ± 13.115 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 105.552 

Supervised By: 

Certificate of Verification 

1162 

SOIL 

2009-11-23 16:24 

30.57 

Final 

49632 

4817 davenport 

em 

1" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 13.811 
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 128.907 

Supervised By: 

Certificate of Verification 

1163 

SOIL 

2009-11-23 16:24 

30.58 

Final 

49632 

4817 davenport 

em 

1" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 14.976 
/ JCk^ \T> Omah Omahaa I Lea . d Site—Fixe .. d Price EP-R7-07-0 . , . __5 

%^^|^|^ Coastal Environmental Group Inc. V T - • •'^S^ST' 

\ ^ • J? www.coastalhazmat.com 

Xp„ott.<i*^ COASTAL I««IIOIINIIITAl 

eio u r. m c 

EXECUTIVE SUMMARY: 

BVID #49632-(4817 DAVENPORT ST) 

No Issues or Concerns Q Issues/Concerns 

Detail Explanation: 
% 

EPA Property Close Out Form 

Property U: ^^(^^'^ Property 

Datenime; OwBer'i 

Quads Excavated: Contractor < 

Excavation General 

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

2. If necessary, were the correci areasofdrip zone excavaled and restored? 

Grading Sod and Vegetetton 

I Does Ihe fiading around the perimeter ofthe house in excavaled areas generally slope away 

from tlie house? 

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

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

day time period) 

4. Are sodded areas genetally flrm 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 that water will not pool on the properry' 

7. Was damage to landscaping or plant materials avoided? 

Gates. Fences and Retaining Walb 

r I.

 Do gates open and close freely? (Ifappiicable) 

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

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

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

Foundation, Siding and Gnllert 

I. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? 

Was danmge to windows avoided? 

4 Was dainage to windows or door screens avoided? 

5. Was damage to downspouts or downspoul extensions avoided? 

Sidewalks and Driveways (Concrete) 

I. Was damage to driveway surfaces avoided? 

2. Was damage to waDcway surfaces avoided? 

Yei No 

l / ^ 

\ y ^ 

lyy 

- ^ -

Vcs No 

\ y ^ 

c^-^ 

Ves .No 

[ y ^ 

\y^_ 

y^ 

Yes No 

^ 

-y' 
OM'oers comments: 

I 

jlnspection notes: 

Removal and resloration activates coinplete«inckiding the 30-day sod warranry: 

EPA Representative U^J K Ijajl^ ^ Date: "] [ ^ 2^1 0 
i

1% # 

Property Compietion Agreement 

This agreement documenls Ihe complclion ol remedial aclivilies perloimed on my properly My signature 

will designale Ihal I am satisfied with Ihe restoration of my properly, and lhat no items are in questions, 

now, or al any lime in the fuluie, excepl Ihose ilems lisled below, if any 

PropertylD : ^ ( ^ 5 ^ 

PropertyAddress: qtM ^ t^lyr ^ ^ Vf ^ 

Phone: '^f ^ rj^TS ^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

 I J flgrcc «Mfor«(ion i% completed, cxccpi «s noleri 

[_| I rio nol ai;rec restoration is compleled 

Owner's Signature Date Cdnti artor's Signature Date