TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: X)^ID 7 Date: 5/23/0 ^ 

Address: _3W2 D M^^DV ^ ^V 

Remediation Contractor: Coastal Environmenta l Group _ Year; 2008 

SOIL REMEDIATIO N 

PROPERT Y nL E FOLDER DOCUMENTS 

S Video ofproperty (DVD) ____ ^ 

^ / Executive Summary 

[5 EPA-provided property sketch 

I^ Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

Q / Restoration Agreement 

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

Iv Confinnation data 

S/' Photographs ^<'e^-^>frAJllJ(zini ^ JLiPfu^dhm ^ fi/lA J -flA/Xi.I Sd d 

Sy^ As-built sketch 

D Satisfactory restoration signed by Property Owner 

"Sf Property close-out check list signed by EPA 

D Description ofareas not meeting ROD cleanup criteria 

Q Utility clearances 

^ j Property infonnation from Douglas County Assessor's Office 

40316461 

g Superfund 

Date 

^/z^y 
% 

^H55-» 

Property Access Checklist 

PiODcrty ID: 2 jgfe ^ 

Property Address: ^^^^^ ^ K\a^t n ,^V 

•

D

 WORK STARTED

 WORK COIVIPELTED

 ON:

 ON:

 /

 /

 / 

/ 

Owner; 

Address 

yhzK)C{OQ Umoren 

" Fax: 

Cell/Pa«;cr: ^c^g - -2t^Cy^ 

Renter: 

Phone: 

Fax: 

Cell/Pasei 

Additional Information: 

O Notification Letter 

l/f Access Agreement 

0 ^ Restoration Agreement 

O Top.soil Sampling (if applicable) 

1 1 Dispo.sal Sampling (if applicahle) 

1 1 Garden Sampling (if applicable) 

0 Utility Clearance 

CZ' Video/Photos (Before) 

n Video/Photos (During) 

D Video/Photos (After) 

n Video/Photos (3(»-Day) 

1 1 Propeitj Completion Agrecineiit 

n Final Report 

Sent: / / 

Signed: _5/,Sa/0X _ 

Signed: 3^/3£/C8 L 

/ / 

/ / 

/ / 

Called: i/2L/Q t 

On: ^/_L/_0 ^ 

On: / / 

On: / / 

On: / / 

Signed: / / 

Issued: / / 

B>­: 

By: Marco s 

^y- Uatci s 

Bv: 

By: 

By: 

B>=X1D? . 

B.v:M^A /e O 

By: 

By: 

By: 

By: 

By: 

II 

Air IVIonitoring (as applicahle) 

1 1 Community UU Crew 

Results:

On: / / By: 

\ 

1 1 Community

Results:

 UJ Crew On: / / Bv: 

1 

O Community

Results: 

• Crew On: / / By: 

Omaha Lead Site 
CONTACT FORM 

Property ID # 2.\^in l 

Property 

Address: 9.y30 \J\o^t)v\ 

Initial Contact: Date: Time: Action: 

Second Contact: Date: Time: Action: 

Final Contact: Date: Time: Action: 

Final Action: Transmit to EPA D Other Action: D 

MMf^-?;,^qMoEA\a-si4^ 

Comment: 

Owner 

Comment (s): 

Site :^/3^ 

Coordinator 

Comment (s): 
Douglas County Account Information Page 1 of 3 

Douglas County, Nebraska Property Record - R2521250000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 90th St - VLevy On Ma p Information is valid as of 2008-6-19 Treasurer's Tax Report 

New Feature ->-•- • Auto Sales Search 

Owne r 

UMOREN ASUQUOB 

ETAL —^^• — 

10353 REDICK AVE 

OMAHA NE 68122-0000 

Property Information 

Key Number: 2125 0000 25 

Account Type: Residential 

Parcel Number: 2521250000 

Parcel Address: 3620 MASON ST 

OMAHA NE 68105-0000 

Legal Description: WEST OMAHA LOT 3 BLOCK 21 E 42 W 126 S 87 FT 42 X 87 

Value Information 

Land Improvement Total 

2008 $7,300.00 $123,600.00 $130,900.00 

2007 $7,300.00 $107,400.00 $114,700.00 

2006 $7,300.00 $107,400.00 $114,700.00 

2005 $7,300.00 $79,000.00 $86,300.00 

2004 $7,300.00 $79,000.00 $86,300.00 

2003 $7,300.00 $79,000.00 $86,300.00 

Sales Informatio n 

Sales Date: 2004-06-15 

Deed Type: WD Book: 2004 Page: 112342 

Price: $80,000.00 

Grantor: Douglas Miller Etal 

Grantee: Asuquo Umoren Etal 

Valid/lnvalid: Valid 

Exclusion Reason: 

Sales Date: 1990-03-22 

Deed Type: Book: 1874 Page: 269 

Price: $31,000.00 

Grantor: 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R25... 7/17/2008 
Douglas County Account Information Page 2 of 3 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Lan d Informatio n 

Acres SF Units Depth Width Vacant 

0.08 3654.0 1.0 87.0 42.0 No 

Improvemen t Informatio n 

Building 1 

Secona Floor t008 0 sq. tt ErclSctilWM 

now n 73 0 M n 

Rmt Floor ltH3.0 9q.n. 

_2U_ ; en:i 901a: wm 

2 STORY 4 M I <s n 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 2040.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 8.0 

Exterior: Frame Aluminum Units: 2.0 

Interior: Drywall Baths: 2.0 

Roof Cover: Composition Shingle Bedrooms: 4.0 

Roof Type: Hip Stories: 2.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1890 0 0% 1890 118 

Detail Type Detail Description Units 

1.0 

Basement Bsmnt Cone 8 ft 

Appliance Allowance 

806.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 2.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R25... 7/17/2008 
Douglas County Account Information Page 3 of 3 

Porch 

Porch 

Porch 

User 

User 

User 

End Solid Wall 

End Solid Wall 

End Solid Wall 

2 apts-3620 & 3630 1/2 

2002 BOE 77 

Window A/C 

160.0 

72.0 

72.0 

1.0 

1.0 

1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R25... 7/17/2008 
I Page 1 of2 

# 

"> 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2135002. 

Original Call Date: 9/18/08 Time: 3:03 pm Op: ELIZABETH18790 


Work to Begin Date: 9/22/08 Time: 3:30 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 362 0 Street: MASON ST 


TvTp: 15N Rng: 13E Sect-Qtr: 20-SE, 21-SW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remidiation 


Location of Work: LOCATE ENTIRE PROPERTY STARTING AT THE HOUSE ALL THE WAY 


: TO THE STREET. 


Remarks: FAX ALL CLEARS TO: (877)662-4211 


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: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


BSHPCLKS CXCATV LEVEL3 MCLEODNE MUDOl OMAHACOF 0PPDGPR5 


QLNNEIC 


Service Area Contact Phone Number 

Utility 

Type 

BSHPCLKS NEBRASKA HEALTH 

SYSTEM NA 

Day: 4025523459 

Alt: 4025523347 

Emerg: 4025595111 

CXCATV COX COMMUNICATIONS,

INC 

 ^^^ ^ 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVEL3 LEVEL3 COMMUNICATIONS, 

LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MCLEODNE MCLEODUSA NO NEED TO CALL OUT 

EMERGENCY 

Day: 8002891901 

Alt: 

Emerg: 8002891901 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/18/2008 
i 

MUDOl 

OMAHACOF 

OPPDGPR5 

QLNNEIC


METROPOLITAN UTILITIES 

DISTRICT 

CITY OF OMAHATRAFFICSEWER 

OMAHA PUBLIC POWER 

DISTRICT 

 QWEST LOCAL NETWORK


0 Page 2 of2 

SANDY 


RON 


NA 


 NA 


Day: 4025047823 


Alt: 


Emerg: 4025047946 


Day: 4024447197 


Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


Alt: 8887289343 


Emerg: 4067289343 


Day: 4067289343 


Alt: 


Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/18/2008 
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D Remote ID; R page of 

To: COASTAL ENVIRONMENTAL SERVICE Attn: ELIZABETH 

Voice: 8776624210 Fax: 8776624211 

Re: Response to Dig Request 

This is an Important Message from Level 3 Communications (formerly known as 


Broadwing) replying to your request to locate our underground facilities in the 


area described on the One Call Center ticket. 


Ticket: 2135002 


County: DOUGLAS Place: a4AHA 


Address: 3620 MASON ST 


LEVELS: 


Level 3 Conmunications has determined our facilities are clear per the dig site 


information provided by the one call center ticket. 


If you have any questions, please contact Level 3's Asset Management Team at 


1-800-441-0223. 

D Remote ID: R page of 

To: COASTJ^ ENVIRONMENTAL SERVICE Attn: ELIZABETH 

Voice: 8776624210 Fax: 8776624211 

Re: Response to Dig Request 

This is an Important Message from Level 3 Communications (formerly known as 


Broadwing) replying to your request to locate our underground facilities in the 


area described on the One Call Center ticket. 


Ticket: 2135002 


County: DOUGLAS Place: OMAHA 


Address: 3620 MASON ST 


LEVEL3: 


Level 3 Conmunications has determined our facilities are clear per the dig site 


information provided by the one call center ticket. 


If you have any questions, please contact Level 3's Asset Management Team at 


1-800-441-0223. 

D Remote IDi R page of 

To: COASTAL ENVIRONMENTAL SERVICE Attn: ELIZABETH 

Voice: 8776624210 Fax: 8776624211 

Re: Response to Dig Request 

This is an Important Message from Level 3 Communications (formerly known as 


Broadwing) replying to your request to locate our underground facilities in the 


area described on the One Call Center ticket. 


Ticket: 2094758 


County: DOUGLAS Place: OMAHA 


Address: 3620 MASON ST 


LEVEL3: 


Level 3 Communications has determined our facilities are clear per the dig site 


information provided by the one call center ticket. 


If you have any questions, please contact Level 3's Asset Management Team at 


1-800-441-0223. 

Page 1 of2 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2094758. 

Original Call Date: 7/30/08 Time: 11:55 am Op: ELIZABETH187 90 

Work to Begin Date: 8/01/08 Time: 12:30 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 3620 Street: MASON ST 

Twp: 15N Rng: 13E Sect-Qtr: 20-SE,21-SW 

Twp: Rng: Sect-Qtr: 

Legal Given: C 


Type of Work: lead remidiation 


Location of Work: LOCATE ENTIRE PROPERTY ALL THE WAY TO THE STREET. 


Remarks: FAX ALL CLEARS TO: (877)662-4211 


Company : COASTAL ENVIRONMENTAL SERVICE 


Contact Name: ELIZABETH Phone: (877)662-4210 


Work Being Done For: coastal 


Depth of Excavation: 4ft Comer Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


BSHPCLKS CXCATV LEVEL3 MCLEODNE MUDOl OMAHACOF 0PPDGPR5 


QLNNEIC 


Service Area Contact Phone Number 

Utility 

Type 

BSHPCLKS NEBRASKA HEALTH 

SYSTEM NA 

Day: 4025523459 

Alt: 4025523347 

Emerg: 4025595111 

r-v/^Axw CXCATV COX COMMUNICATIONS, „, „ INC  „^^ , HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVEL3 LEVEL3 COMMUNICATIONS, 

LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MCLEODNE MCLEODUSA NO NEED TO CALL OUT 

EMERGENCY 

Day: 8002891901 

Alt: 

Emerg: 8002891901 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/30/2008 
Page 2 of2 

MUDOl 

OMAHACOF 

OPPDGPR5 

QLNNEIC

METROPOLITAN UTILITIES 

DISTRICT 

CITY OF OMAHATRAFFIC,SEWER 

OMAHA PUBLIC POWER 

DISTRICT 

 QWEST LOCAL NETWORK

EDWINA 

RON 

NA 

 NA 

Day: 4025047823 


Alt: 


Emerg: 4025047946 


Day: 4024447197 


Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


Alt: 8887289343 


Emerg: 4067289343 


Day: 4067289343 


Alt: 


Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/30/2008 
Page 1 of2 

[ Create Another Ticket ^ [ Back to Irth Internet ] f Send Email 

YOUR TICKET NUMBER IS 2160986. 

Original Call Date: 10/23/08 Time: 9:09 pm Op: ELIZABETH18790 


Work to Begin Date: 10/28/08 Time: 7:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 362 0 Street: MASON ST 


Twp: 15N Rng: 13E Sect-Qtr: 20-SE,21-SW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remediation 


Location of Work: LOCATE ENTIRE PROPERTY INCLUDING THE HOUSE ALL THE WAY TO 


: THE STREET. 


Remarks: FAX ALL CLEARS TO: (877)662-4211 


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: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


BSHPCLKS CXCATV LEVEL3 MCLEODNE MUDOl OMAHACOF 0PPDGPR5 


QLNNEIC 


Service Area Contact Phone Number UtiUty 

Type 

BSHPCLKS NEBRASKA HEALTH 

SYSTEM NA 

Day: 4025523459 

Alt: 4025523347 

Emerg: 4025595111 

CXCATV COX COMMUNICATIONS, 

INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVEL3 

LEVELS COMMUNICATIONS, 

LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MCLEODNE MCLEODUSA NO NEED TO CALL OUT 

EMERGENCY 

Day: 8002891901 

Alt: 

Emerg: 8002891901 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/23/2008 
Page 2 of2 

MUDOl 

OMAHACOF 

0PPDGPR5 

QLNNEIC

METROPOLITAN UTILITIES 

DISTRICT 

CITY OF OMAHATRAFFIC,SEWER 

OMAHA PUBLIC POWER 

DISTRICT 

 QWEST LOCAL NETWORK

SANDY 

RON 

NA 

 NA 

Day: 4025047823 


Alt: 


Emerg: 4025047946 


Day: 4024447197 


Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


Alt: 8887289343 


Emerg: 4067289343 


Day: 4067289343 


Alt: 


Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/23/2008 
As-Built Drawing 

C

ENVIRONMENTA

 OASTA L L Omaha Lead Superfund Site GROUP , INC . 

21567 

Omah Exterior Paint a Lead Site 

0 Good Site Sketch • Poor 

Sampling Address: 3620 MASON ST |~1 Not paint 

Sample Number Lead 

Concentration 

Sample 

Collecte LAB 

Firm:

Samples Collected 

 FDA rr.-WU 

RYASCPXA-21567 F l ppm D Date 12.-2/^-67 

RYBSCPXA-21567

RYCSCPXA-21567

RYDSCPXA-21567

 F2 

 Bl 

 B2 ilfi 3 

ppm 

ppm 

ppm 

D 

D 

D 

Time: Z ' S(o fijn 

Samples Analyzed 

RDZSCPXA-21567 DZ ppm D XRF Unit: toS'H O Book: TJO' ^ 

RGZSCPXA a i 687 GZ 

RPZOcrxA-aiso?—pe 

ppm 

ppm 

D 

D 

Date 

Time 

/-ge t

/4n 

 -Og ) 

Number of Samples = [ S Staff: /^^ ^ 

Legend: F1 = Front Left, 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 

OLS#: 21567 

Date Excavated: 10/25/2008 

bate USEPA Signed Off: 1/28/09 

JAN 0 is 2803 Area Sodded 2142 sq 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. 

21567 

Omah Exterior Paint North Arrow a Lead Site 

Site 0 Good Sketcii • Poor 

Sampling Address: 3620 MASON ST \ 1 I Not paint 

Sampl Lead Sample Samples Collected e Number LAB Concentration Collected Finn: FMi-y-\A/L. RYASCPXA-21567 Fl ppm D Date: 12,-28-67 

RYBSCPXA-21667 F2 ppm D Time: 

RYCSCPXA-21567 Bl ppm 2 D

Samples Analyzed RYDSCPXA-21567 B2 lift? ppm D 

RDZSCPXA-21567 02 ppm 

nCZSCPXA 21667 G2 ppm D 

^^9 D XRF Unit: GiS'H O Book: "ZJO' ? 

n Date / -Qo^ -oe> 

RrZOCr)CA-21507 PS ppm D Time Ar^ 

Staff Number of Samples = 5^ o msv^ 

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

All quadrants are as viewed from ttie sfreet, facing property 

: ENTERED 

JANOS280S 

m%y,(^A^\^om 

% \/p\y^-mn, 

! ^ 

5JS 

^ 

1 ^ 

tAciS.on.sy-y.^p^^^^^^ 
• • 

21567 

Omaha Exterior Paint North Arrow Lead Site 

0 Good Site Sl<etch • Poor 

Sampling Address: 3620 MASON ST [~| Not paint \ 

Sample Number Lead Sample LAB Samples Collected 

Concentration Collected Fimi: Ft>f\(LC\A/L. 

RYASCPXA-21567 F1 

ZQH ppm D Date: \2.-ZH"6 1 

RYBSCPXA-21567 F2 

y±LSL- ppm D Time: 2 ' 5 ^ pp ^ 

RYCSCPXA-21567 B1 ppm D 

Samples Analyzed 

RYDSCPXA-21567 B2 lift? ppm D 

RDZSCPXA-21567 DZ ppm D XRF Unit: GiS'HO Book: ZD" ? 

nCZSCPXA 21667 GZ ppm D Date / -Oo\ '02 > 

RPZGCPXA-21567 P? ppm D 

Time /in 

Staff: Number of Samples = I S o ms\^ 

Legend: F1 = Front Lett, 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 

ENTEREJD 

JANO 8 2003 

^ 

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COASTA L FHVIIIONnf NTAL 

f. t 0 U » . I » f 

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 

foilow^ing described premises: 

AIQT^ ^ 

Owner's Name: Daytime Phone: 

. \jmortxi.B^uqoix 

Address of Property 

covered by this 

Agreement: 

Omoran \^^oo ^ 

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 v^^lh the Grantor's approval. Upon 

completion, the Grantor wiW 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 v»«Drk. This access shall 

remain in effect until the work has been satisfactorily completed. The Grantor also 

agrees to: 

Page 1 of 2 
V«i4«» / COASTAL T ^ <P INVIIONMfMTAt 

' 1 . mot* c < o u F 1 • 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 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 (712) 352-0188 

D I grant access to my properties D I do not grant access to my properties 

B f /y^y^f/y ^ -r—r­ jnatur ^ ^ < Date / Signature

 Date 

D I would like to be present during any sampling that is required. 
COASTA L 

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: 2^\^^ ^ 

Property Address: ^f^^? ^ K^HSi/^r^ r\\-

Phone: qqfi^<;;;^SRq r.± ' SQ^'-^qm 

On the attached diagram(s) indicate area(s) to excavated and depth of excavation, location of all known 

utilities, subsurface features, surface structures and landscaping features, access bcation(s) to be used by 

contractor, and the direction of North. Indicate distances, depths, material types, etc. Indicate digital photos 

by referencing the photo-log number with an arrow indicating direction of view. 

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

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

Item: 

Item: 

Item: 

Item: 

Page 1 of. 4 
COASTA L ENVIRONM E NTA L 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: y 

^p,p(y ''y<h y f T/^iw / 

Item: 

j'yyfTt- y Uxcrh t^i ^m / 

Item: / 

Item: / 

Item: 

/ 

Item: /

Item: / 

Item: / 

Item: 

/ 

Item: / 

Item: / 

Item: / 

Item: / 

/ 

Item: / 

Item: y 

Page 2 of ( 

 1 
COASTA L ENVIHONMENTA L 

GROUP . IN C 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

hm r f^ ll. h y h^ yh' L 

item: 

hoM \ ^ hot- }?3i ' 

Item: / 

Item: / 

Item: / 

ftem: / 

Item: 

/ 

Item: 

/ 

Item: / 

Item: 

y 

Item: 

/ 

Item: / 

Item: 

/ 

Item: / 

Item: 

/ 

/ 

Page 3 of i^. 
COASTA L ENVIRONMENTA L 

CROUP . INC , 

Item 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch 

trunk diameter 

i 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Attach a sketch of the 

sprinkler layout. 

Number of and size of 

each garden/ flower bed 

area. 

Attach a sketch of relative 

sizes and locations. 

Landscape Inventory 

(Use additional sheets as necessary) 

Quantity Unit Condition/Type/Species 

<y 

Square feet 

y\j\Jt (^m^ 

yy 

y Each 

y Each 

{ 

^ Each 

1 Each 

Square Feet 

y -py 

Page 4 of. 

1 
COASTA L 

Item Quantity Unit Condition/Type/Species 

Agreed upon value of 

plant materials not to be 

replaced bv contractor. 

Note this value will be 

used to issue a plant 

voucher to the property 

owner. 

B $ 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketch of were 

each plant will be placed 

by the contractor. 

Jd Each 

1 

Agreed upon area of 

property to be replaced 

with grass sod. 

Include a sketch of the 

area(s) to be replaced with 

grass sod. 

h 

SF 

L\-. 

Area of City or County 

property to be landscaped 

per their requirements. 

Include a sketch of the 

area (s) 

SF tM^^< 

Easement Area, to be 

excavated SF ^X) \r t \iyybi? 

Page 5 of. 
C O A S T A L • MViaOMMCMTA L G It O U P . IM C 

Additk>nal Comments / Instructions: 

- \Vi^lV^ ^fmil h _\^^ y iWv 

^ ­ Rff^K y y ^ ^ 

Y h\ 

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. 

^ 1 I agree O I do not agree 

ryy^ y ^4,^^.^ /'pAmi yayr,</ 

^OwBer'srSignatUre •?te / Conti^or's Signature Date 

Page 6 of. 
Date 

Project 

XRFID# 

Shot# 

H;^ 

\^-HA 

\(jan 

I^M 1 

Average

Shot# 

.^ae iq^ ^ 

m^oo 

,qs i 

Average

Shot# 

Average 

Shot# 

Average 

lab sample # 

XRF PROPERTY SAMPLE SHEET 


In-cQ^^'Oft Address 

Omaha lead FP 2nd year opllon Sample time 

sample length z&yryx 

Reading Sample area Shot # 

yy. ^ ,?>t [(\. y l^l^-^-S 

,-QH,o (poc. i^'.qq m )Cf4e 4

l^fi.e«L.^».o 3 Depth i^^^ 

2,m ,^/«i<^ l X ^ (P )gr^(i ?

 cOSCg .1^1 - n^: > ^ ] Average

Reading Sample area Shot# 

93 ? 7 i: 7 -.a T^^HT^ 2­ Qhnf^t . l-^ a .^^^^ " 

•^P, ^. S i 7^ 3 Depth g I'^v-ii,';^ 1 y \ \ jQ^ A 

 c? S ^Co l "~7 ' ^ Average

Reading Sample area Shot* 

Depth 

Average 

RETEST AREAS 

Reading Sample area Shot# 

Depth 

Average 

Lab result Sample area XRF Avg. 

Signature. 

BVID My)yiy i 

S(p^ o VAo^^^fpCN bJlO'-^ ^ 

am/pm 

30 sec 

Reading Sample area 

1 7 ^ gS^K-^^- t 

 ^> , (^^ >ii;j.c?S ?a 

Depth va<^.aai; n.gq h^'.^.yit;ZI^33 L 2 _ 

 18 ^ ^(j?- 1 Ke Lo'^ 

Reading Sample area 

lUQ.^J:^'"^-?., '^la.^-yiijr,^ bt 

C^^-^g ^ \o-'^l) Dept Dept h 

Ir.q ^b ^ iQ.q i 

 ^f ^ .q U ^ \ ^ ^ ^ 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Print ^A// cpy ^ 
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 263.134 

Supervised By: 

Certificate of Verification 

1938 

SOIL 

2008-10-25 10:59 

30.32 

Final 

21567 

3620 mason 

B2 

Ventry 

6 

CLEARANCE 

± Error 

± 19.493 
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 282.599 

Supervised By: 

Certificate of Verification 

1939 

SOIL 

2008-10-25 11:00 

30.98 

Final 

21567 

3620 mason 

82 

Ventry 

6 

CLEARANCE 

± Error 

± 19.988 
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 285.578 

Supervised By: 

Certificate of Verification 

1940 

SOIL 

2008-10-25 11:01 

30.86 

Final 

21567 

3620 mason 

B2 

Ventry 

6 

CLEARANCE 

± Error 

± 21.015 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1941 

Mode SOIL 

Time 2008-10-25 11:02 

Duration 30.93 

Sequence Final 

Flags 

BVID # 21567 

ADDRESS 3620 mason 

QUAD/ZONE B2 

INSPECTOR Ventry 

DEPTH 6 

SAMPLE PI'PE CLEARANCE 

NOTE 

ppm ± Error 

Pb 314.962 ± 21.131 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1942 

Mode SOIL 

Time 2008-10-25 11:02 

Duration 123.09 

Sequence Final 

Flags 

AVERAGE Avg of 1938-1941 

ADDRESS 3620 mason 

QUAD/ZONE 

INSPECTOR Ventry 

DEPTH , 6 

SAMPLE TYPE CLEARANCE 

NOTE 
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 175.334 

Supervised By: 

Certificate of Verification 

1943 

SOIL 

2008-10-25 11:03 

30.25 

Final 

21567 

3620 mason 

F2 

Ventry 

6 

CLEARANCE 

± Error 

± 16.219 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1944 

Mode SOIL 

Time 2008-10-25 11:03 

Duration 30.53 

Sequence Final 

Flags 

BVID # 21567 

ADDRESS 3620 mason 

QUAD/ZONE F2 

INSPECTOR Ventry 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 86.694 ± 12.048 

Supervised By: 
• • 

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 199.217 

Supervised By: 

Certificate of Verification 

1945 

SOIL 

2008-10-25 11:05 

30.98 

Final 

21567 

3620 mason 

F2 

Ventry 

6 

CLEARANCE 

^ I _ Cw.^.^ ^ Error 

17.285 
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 Pi'PE 

NOTE 

ppm 

Pb 295.793 

Supervised By: 

Certificate of Verification 

1946 

SOIL 

2008-10-25 11:05 

30.33 

Final 

21567 

3620 mason 

F2 

Ventry 

6 

CLEARANCE 

± Error 

± 21.224 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1947 

Mode SOIL 

Time 2008-10-25 11:05 

Duration 122.09 

Sequence Final 

Flags 

AVERAGE .Avg of 1943-1946 

ADDRESS 3620 mason 

QUAD/ZONE (F2 

INSPECTOR Ventry 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

Pb 

a^-^2_ 

Supervised By 
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 23.768 

Supervised By: 

Certificate of Verification 

1948 

SOIL 

2008-10-25 11: 07 

30.52 

Final 

21567 

3620 mason 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 7.519 
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 20.748 

Supervised By: 

Certificate of Verification 

1949 

SOIL 

2008-10-25 11:08 

30.34 

Final 

21567 

3620 mason 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 7.375 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1950 

Mode SOIL 

Time 2008-10-25 11:08 

Duration 30.56 

Sequence Final 

Flags 

BVID # 21567 

ADDRESS 3620 mason 

QUAD/ZONE easement 

INSPECTOR Ventry 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 28.826 ± 7.923 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1951 

Mode SOIL 

Time 2008-10-25 11:09 

Duration 30.71 

Sequence Final 

Flags 

BVID # 21567 

ADDRESS 3620 mason 

QUAD/ZONE easement 

INSPECTOR Ventry 

DEPTH 1 

SAMPLE Pi'PE CLEARANCE 

NOTE 

ppm ± Error 

Pb 19.692 ± 7.287 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1952 

Mode SOIL 

Time 2008-10-25 11:09 

Duration 122.13 

Sequence Final 

Flags 

AVERAGE Avg of 1948-1951 

ADDRESS 3620 mason 

QUAD/ZONE .easement 

INSPECTOR Ventry 

DEPTH f l 

SAMPLE TYPE CLEARANCE 

NOTE 

Pb 

Supervised By: 
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 162.893 

Supervised By: 

Certificate of Verification 

1978 

SOIL 

2008-10-25 14:44 

30.28 

Final 

21567 

3620 mason st 

DZ 

Ventry 

13 

CLEARANCE 

± Error 

± 15.729 
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 PI'PE 

NOTE 

ppm 

Pb 93.571 

Supervised By: 

Certificate of Verification 

1979 

SOIL 

2008-10-25 14:45 

30.61 

Final 

21567 

3620 mason st 

DZ 

Ventry 

13 

CLEARANCE 

± Error 

± 12.509 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1980 

Mode SOIL 

Time 2008-10-25 14:46 

Duration 30.19 

Sequence Final 

Flags 

BVID # 21567 

ADDRESS 3620 mason st 

QUAD/ZONE DZ 

INSPECTOR Ventry 

DEPTH 13 

SAMPLE PI'PE CLEARANCE 

NOTE 

ppm ± Error 

Pb 62.420 ± 10.414 

Supervised By: 
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 PI'PE 

NOTE 

ppm 

Pb 64.963 

Supervised By: 

Certificate of Verification 

1981 

SOIL 

2008-10-25 14:46 

30.50 

Final 

21567 

3620 mason st 

DZ 

Ventry 

13 

CLEARANCE 

± Error 

± 10.907 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1982 

Mode SOIL 

Time 2008-10-25 14:46 

Duration 121.58 

Sequence Final 

Flags 

AVERAGE Avg of 1978-1981 

ADDRESS 3620 mason st 

QUAD/ZONE iOZ 

INSPECTOR Ventry 

DEPTH 

SAMPLE PI'PE t13 

CLEARANCE 

NOTE 

Pb 

. f ^ 

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

Coastal Environmental Group Inc. 

www.coastalhazmat.com 

COASTA L ENVmONHENTAL 

CROUP , INC . 

EXECUTIVE SUMMARY: 

BVID # 21567 - (3620 MASON ST) 

No Issues or Concerns X Issues/Concerns 

Detail Explanation: 

- PO HAS NOT SIGNED FOR THE PROPERTY UNTIL COASTAL PLACES SOD ON THE 


EASEMENT. 


L 
> • > . 

I»EPA • 

« 

EPA Propert) Close Out Form 

Prop«rt> tt: 2 i ^Ir ? I Proptrt) Addre«: ^j Ig H HO,^) ^ S f 

Dalc/Tlrec: Owner's Name: LTrno/^-f.V^ Af^v ; 

Quads Excavatrd: Coniractor Croup 

EicavatioD Gtneral 

1 If necessijy, wert the corrtct quadrani(s) excavated and resiored? 

1 

Yes 

^ 

No 

2 If nece5s«r>, were the correct areas ofdri p zone excavaled and restored'' y 

CradlDK Sod and VctcUlto n 

1 Does the grading around the perimeler ofthe house in excavated areas generally slope away 

from tbe house? 

Yes 

w ^ 

No 

2

3.

 Has sod been laid in all areas thai were excavaled? 

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

day lime period) 

y 

^ 

4

5

 Are sodded areas generally firm and evenly graded? 

 Are the joints between the sod strips generally tight? (Only evaluate ifinspected ai a 30 day 

time period) 

y 

i ^ 

6 Was the prof>crry graded such thai water wil l not pool on the property'' ^ 

7 Was damage to landscaping or plant materials avoided'' - ^ 1 

Gatef,

1

2

 FcDces and RclaiolDC Walls 

 Do gates open and close freely? (Ifapplicable) 

 Were all gates or fences taken down during rtstor^tion activities reinstalled'' (Ifapplicable) 

Ves 

u ^ 

^ 

No 

3 Was damtge 10 gates or fences avoided? (Ifapplicable) t ^ 

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

Foupdalion, Sidian and Cullers 

I. Was damtge to the siding or trim avoided? 

Ves No 

2

3

 Was damage to the foundation avoided? 

 Was damage to windows avoided'' 

t X 

4 Was damage to windows or door screens avoided'' 

5 Was danDage lo downspouts or downspoul extensions avoided'? y 

Sidewalks and Driveways (Concrete) 

Was damage to driveway surfaces avoided' 

2 Was damage to v^alkway surfaces avoided'' 

Ves

# 

y 

 No 
O tners commenls: 

* M

Inspection notes 

%<^[a^ - ^ D las t J ^i^^ ^ -^ -^^-'^^ ^^^ ^ ^^s^A-^-^ 

Removal and resloralion aclivales complele incluciing ihe 30-day sod uarraniy 

F PA RpnrpspnlaKvfi HQ W 
^ 

Property Completion Agreement 

This agreemenl documenis llie complclion of remedial activities perlbimed on my property. My signature 

will designate that I am satisfied with the restoration of my property, and thai no items are in questions, 

now, or al any lime in the future, except those ilems listed below, ifany 

Property ID: l\^\^~ l 

Property Addres.: ^^^j ^ WASOV I 

Ownc " A^t;^vjn \Jm^itX\ 

^^•""^-ftolqMe-SSqH 

Restoration Items in Question: 

I I I agree restoration is completed, cxccpl as noted 

I I I rio not a(;iec resloration is completed 

Owner's Signature Date Contractor's Signature Date