TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAi: D#: i4Wi^t 

Date: i\n]cP\ 

Address: ^Oig O S ^ ^ S' T 

Remediation Contractor: _Coastal Environmental Group_ Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

y Video of property (DVD) 

40315463 

y Executive Summary 

y 

EPA-provided property sketch Superfund 

y 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

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

y Confirmation data 

y Photographs r^c-^^fjJcAvo^^ JL^c/iJayxch^^ fl«y. S^*^ 

a As-built sketch 

y Satisfactory restoration signed by Property Owner 

y Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

y Utility clearances 

y Property infonnation from Douglas County Assessor's Office 

y ?fT>|)<tr(u^ (U<ys,^ t\Nu\c\y 

y C^^uuy Wm, 

D 

^TOQ., Signature Ignature 

"^^^y^My^J ^ ^Mf 
Property Access Checklist 

Property m: \L^L\L\': ^ 

Pr„pcrtyAddress::^(^c;, . C^T,"^^ 

n

D

 WORK STARTED

 WORKCOMPELTED

 ON:

 ON:

 /

 /

 / 

/ 

Owner ^f^^,(-\ ^ ^VvmeS ^ 

Address: ^ ^ 

Phone: <^ai-'S&A 0 

Fax: 

Rcnten 

Phone: 

Fax: 

Cell/Pager. 

Additional Information: 

Cell/Pager. nt0^,O\U 3 

n Notification Letter 

0 " Access Agreement 

0 ^ Restoration Agreement 

Cl Topsoil Sampling (if applicable) 

Q Disposal Sampling (if applicable) 

D Garden Sampling (if applicable) 

jZ " Utility Clearance 

Q ^ Video/Photos (Before) 

n Video/Photos (During) 

n Video/Photos (After) 

D Video/Photos (30-Day) 

Q Property Completion Agreement 

Sent: / / 

Signed: iQ./£./Q i 

Signed: ]a/S_/Q & 

/ / 

/ / 

/ / 

Called: iD / 10 / fi^ 

On:iO/i^/^ 

On: / / 

On: / / 

On: / / 

Signed: / / 

By: 

By= KVvchnvav 

By:KUcW^\n^ 

By: 

By: 

By: 

^r'i(l\\^pl 

^yy^ti(\S. By: 

By: 

By: 

By: 

D Final Report Issued: / / By: 

Air Monitoring (as applicable) 

• Community Q Crew 

ResulU-: 

On: / / By: 

• Community

Results: 

• Crew On: / / By: 1 

Q Community

Results: 

D Crew On: / / By: 

Omaha Lead Site 
CONTACT FORJvl 

Property ID # IHi-lHl 

Property 

Address: .^ObD S ^ 3 -^-T 

Initial Contact: Date: Time: Action: 

Second Contact: Date: Time: Action: 

Final Conlact: Dale: Time: Action: 

Final Action: Transmit to EPA D Other .Action: D 

Comment: 

Owner 

Commeni (s): 

_ . J 

Site 

Coordinator 

Comment (s): 
Douglas County Account Information Page 1 of2 ra^i 

Douglas County, Nebraska Property Record - R1942890000 

Print JRep_ort 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 90th St - Vje w O n Ma p Information is valid as of 2008-9-4 Treasurer's Tax Report 

New Feature ->-•- > Auto Sales Search 

Owne r 

MORRIS JAMES G 

ETAL 

3060 S 33 ST 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 4289 0000 19 

Account Type: Residential 

Parcel Number: 1942890000 

Parcel Address: 3060 S 33 ST 

OMAHA NE 68105-0000 

Legal Description: PARKVALE LOT 3 BLOCK 8 41 X 130 

Value Informatio n 

Land Improvement Total 

2008 $5,900.00 $89,400.00 $95,300.00 

2007 $5,900.00 $89,400.00 $95,300.00 

2006 $5,900.00 $71,900.00 $77,800.00 

2005 $5,900.00 $71,900.00 $77,800.00 

2004 $5,900.00 $71,900.00 $77,800.00 

2003 $5,900.00 $62,000.00 $67,900.00 

Sales Informatio n 

Sales Date: 2001-12-21 

Deed Page: 157 Type: WD Book: I 2199 

Price: $71,000.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.12 5330.0 1.0 130.0 41.0 No 

Improvemen t Informatio n 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19... 10/7/2008 
Douglas County Account Informatio m^t n Page 2 of2 i 

Building 1 

MO 

f«iT 

• 1 

First ROOT 

92l0sq.I1. 

Second Fli nr 3800sqlt 

•• »: 

Hff 

wn 

a«>wn»,. 

1 1/2 STORY FINISHED 

113 Eiq t 

CLICK TO ENlJkRGE IMAGE 

Square Footage: 1301.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: \ Average 

Unit Type: Condition: Average 

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

HVAC: Central Air to Air Rooms: 5.0 

Exterior: Frame Vinyl Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1912 0% 1912 96 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 912.0 

Carport Attached 260.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 280.0 

Porch Slab Roof Ceil 160.0 

Porch Slab w/Steps 24.0 

User Attic Full Finish 380.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R19... 10/7/2008 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2152724. 

Original Call Date: 10/10/08

Work to Begin Date: 10/15/08

 Time: 12:26 pm 

 Time: 1:00 pm 

Op: ELIZABETH18790 

State: NE 

Address: 3060 

County: DOUGLAS 

Street: S 33RD ST 

Place: OMAHA 

Twp: 15N

Twp:

 Rng: 13E

 Rng:

 Sect-Qtr: 33-NW 

 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 


CXCATV MUD02 OMAHACOF 0PPDGPR6 QLNNEIF QWEST2 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 4025047823 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047946 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA Alt: 8887289343 

Emerg: 4067289343 

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

QLNNE 1F QWEST LOCAL NETWORK MA

Day: 4067289343 

 Alt: 

Emerg: 8887289343 

QWEST2 QWEST LONG DISTANCE SARA

Day: 8002834237 

 Alt: 3039921926 

Emerg: 8002834237 

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

COASTA L Omaha Lead Superfund Site 

Name: jQt^ y

Address"l~7p<gc^ ^

Phone: ^* ^ ­ 3 9 T

 u,,^y<r 

 y7"- ^ f-''. 

­ f^n^ f 

Omaha Lead Site

Site Sketch

 Date:

 Time: 

 Y~^-<:> 7 North Arrow 

^^n^^^^y^^y^£t^^ 

Sample Number 

iD# yrf^~ ? 

Lead Concentration 

XRF (Dode S'^OJ 

Confirmation Sample 

/2C> ? ! Sdi^J^/^ ­ / »^<^<^ 7 

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ppm 

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r^Ye s

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 a 

a 

n 

n 

n 

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• 

No g 

No t!3 

No ca 

No EJ 

No ca^ 

No O 

NO^T: 

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. 

\ 

i-*y 

• ^ 

Name: J0*^ > ^-f^^'-f Omaha Lead ^ite Date: Y'^'O J North Arrow 

Address: }O6C P < Jy ^ // . Site Sketch Time: 1 " ^ 

Phone: i'»/? - /vr - <?/^ ^ ^y yTeam "'A^ y X^^^-W^^I D # / ^ ^ Y 7 XRF Code ^^ ^ ^ 

Sample Number Lead Cor.jentration Confinnation Sample 

2

3

4

6

7 

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No 13 

No P-' 

No ^ 

_=—- 1^ i , ^ ..-••• . -J . - ~ ^ ' |- - -•• •<'.. . 
Name: y <?*«// A^^^'f Omaha Lead Site Date: Y'^'O l North Arrow 

Address: 3t>6cP ^. jy ^ // . Site Sketch Time: 

Phone: ^•^ ­ /vr - <^rO f y ^ 

Team ^^^ y yPyy^fi^yil ^ # / ^ ^^ 7 XRF Code S'^O i 

Sample Number Lead Concentration Confirmation Sample 

5

6

7 

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Omaha Lead Site 46130 fi^ 
Name: J <"^ y A^^/' ^ Omaha Lead Site Date: Y'^'O J North Arrow 

Address: 3o6cP < 7y ^ // . Site Sketch Time: 

Phone: <^^2 - /vr - <^$1?^ ' ^ ^ 

Team ^Tl^-K^ y^yy^f ^ Jiil\^ # / ^ ^ ^ 7 XRF Code S'^O ^ 

'T- Sample Number Lead Concentration Confinnation Sample 

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Omaha Lead Site 46130 
>*^^!:r*>. ^

iMr COASTA L tNVmONHtHTAl 

e • o u f . t H 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: . , 

5>^7 .&s9cy ry / ^:ii\S 

OwnerXMame: Daytime Phone: 

MJU ^ Mjuy? C 4 \ 7<:^9 0/6P 3 

7 

Address of Property 

covered by this j^^ ^ y J J y 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 perfonned, the Grantor will have an 

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

before it begins. Once the work is finished, the Grantor will be asked to review the 

work and confirm that it is complete and meets with the Grantor's approval. Upon 

completion, the Grantor will receive written documentation from EPA that the property 

has been remediated. 

ENVIRONMENTAL RESPONSE ACTIONS 

By signing this Access Agreement, the Grantor is granting the EPA, its employees, 

contractors and subcontractors the right to enter the property, at all reasonable times 

and with prior notice, for the sole purpose of performing the work. This access shall 

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

agrees to: 

Page 1 of 2 
s, 

% •" • «* COASTAL *3^ **C ENVmOHMFNTil t l»IIO " C • 0 U ' . 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 ofthe 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 

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

'^^ signatur ignaturee // Dat Datee Signature

 Date 

Q I would like to be present during any sampling that is required. 
C O A S T A U 

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 the purpose of assuring that re.storation 

activities are completed to the satisfaction ofthe propert>' owner and the United States Environmental 

Protection Agency (EPA). 

IWyj 

Property Address: ~^d^7 1 T7y~yyr 

>390y/yys cf/l 70 ? 016:^ :d 

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

utilities, subsurface features, syrface structures and landscaping features, access location(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: 

o y)ic^^fuec(Ts 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 1of ^ 
^ ^ ^ 

C O A S T A L 

c A o <^ r IH C 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

* Item: 

///) V S yy^l I y?7c^ /^(7/ u y p -t k 1 nd 

Item: 

yy 7 1 

Item: ^ y d ^L^ / j 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

/ 

Item: / 

Item; / 

Item: / 

Item: 

/ 

Page 2 of h 
^^ ^ 

C Q A S T A L 

c M o u r IN C 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

; Item:

Item: 

Item: 

/

So {/

Mo\c ^

 y

 . 

 ^^ 4 

 o>i (^

/7/-^ ^ 

-z-

' Item: 

Item: 

ttem: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 3 of. 
--

( ^ 

COASTA L 

Landscape Inventory 

(Use additional sheets as necessary) 

Item Quantity Unit Condition/Type/Species 

Pre-existing property area, 

that 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. 

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. 

y

y 

n 

/ 

y, 

y 

-'Square feet 

Each 

Each 

Each 

Each 

Square Feet 

Page 4 of. 
< ^ & COASTA L 

Item Quantity 

Agreed upon value of 

plant materials not to be 

replaced bv contractor. 

Note this value will be 

vouche

used t

r

o

 t

 issu

o th

e

e

 a

 propert

 plan

y 

t y owner. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketch of were y

each plani will be placed 

by the contractor. 

Agreed upon area of 

property to be replaced 

with grass sod. 

gras

area(s

Includ

s sod

)

e

 t

 a

o

. 

 b

 sketc

e replace

h o

d

f

 wit

 th

h 

e y

Area of City or County 

property to be landscaped 

are

pe

Includ

r

a

 thei

 (s

e

) 

 a

r requirements

 sketch of

. 

 the y

Easement Area, to be 

excavated 

^ ' 

Uriit Condition/Type/Species 

$ 

Each 

SF 

SF 

SF 

Page 5 of 
C O A S T A C • MW^HOI'MCMTA L 

Additional Comments / instructions: 

^^^ "^-J> ^hMlycii yr l 

G 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 fissiires. 

I agree Q I do not agree 

Owner's SigDatWre Date extractor's Statur e Date 

Page 6 of . 
f 

Date 

Project 

XRFID# 

Shot# 

pBfS 

llftC p 

n^n n B» 

Average

Shot# 

[BOO 

&0\ 

\P>^ ^ 

Average

Shot# 

f^73'^ 

^22a . .^Ir^ ^ 

fS"?.^?^ 

Average

Shot# 

Average 

lab sample # 

BVID# flf/^l^ J 

XRF PROPERTY SAMPLE SHEET 


lrv-5>\-oR Address .^OLp,n ^-^-^.sc. . Omaha lead FP 2nc1 year opilon Sample time IS'-^' S am/pm 

c5£itoRC^ sample length 30 sec 

Reading Sample area Shot # Reading Sample area 

.:^-vato^©-73 \-/c\ 0 HA^.'3^-Vi\i...^7 

S\So-^bC ) B>\ 1-1^^ i "?:> '=\oil^.\ e 

b^ 

i^O JA^^-O \ Depth ri^\ 0 iTv . l<3 t \UQ i Depth 

LDC-t-5i\ t \n.Ttp •^ft-Sqir ^ ,42, 

/( ^ n-H?. ^6 

 ^ Q .(-JQ ^ "^ f:?~1 Average \a<0. \ Q t \? ^ .O^ ^ 

Reading Sample area Shot# Reading Sample area 

7^.0 a ^1 ^ ?y> cV i^ S fTri.-i6iq.l R 

LK-h.-y,^. '^•OP\ ^O^ ^ i^<^(p "78.-11 t \\.'o 8 f€? 

(oi.\.^3^\Q)- ^ Depth l>^ T ^2,<>.,3^ tiUUS " Depth 

L<a.»<R^^--iq l^fS ^ (jiyy\']c^ y C^ 

S ^ -Q~1 ^ IQ-Qf ^ Average fi,\ .l l i: U .Le \ 

Reading Sample area Shot* Reading Sample area 

<4SH'-^ t S-t-A,o 

•^j5.<^q^ Ip.cx:^ y^ 

c^^.7ftX voS ^ Depth Depth 

If^.g^&t in.S>0 

 fio^(n t \{:\.n9 b Average 

RETEST AREAS 

Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average 

Lab result Sample area XRF Avg. 

Signature ^r/',<^y(Z ^ 

Print feOjUt^iiyAl (W0)f£^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 35.195 

Supervised By: 

Certificate of Verification 

1785 

SOIL 

2008-10-21 15:58 

31.57 

Final 

14447 

3060 s 33 st 

Bl 

Ventry 

6 

CLEARANCE 

± Error 

± 8.719 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TfPE 

NOTE 

ppm 

Pb 51.528 

Supervised By: 

Certificate of Verification 

1786 

SOIL 

2008-10-21 15:59 

30.55 

Final 

14447 

3060 s 33 st 

Bl 

Ventry 

6 

CLEARANCE 

± Error 

± 9.799 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 40.138 

Supervised By: 

Certificate of Verification 

1787 

SOIL 

2008-10-21 16:00 

30.46 

Final 

14447 

3060 s 33 st 

Bl 

Ventry 

6 

CLEARANCE 

± Error 

± 9.010 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE Pi'PE 

NOTE 

ppm 

Pb 69.212 

Supervised By: 

Certificate of Verification 

1788 

SOIL 

2008-10-21 16:01 

30.59 

Final 

14447 

3060 s 33 st 

Bl 

Ventry 

6 

CLEARANCE 

± Error 

± 10.755 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1789 

Mode SOIL 

Time 2008-10-21 16:01 

Duration 123.17 

Sequence Final 

Flags 

AVERAGE Avg of 1785-1788 

ADDRESS [3060 s 33 st 

QUAD/ZONE ^ 1 

INSPECTOR Ventry 

DEPTH 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb J,49.018 , ± 9.571 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 184.540 

Supervised By: 

Certificate of Verification 

1790 

SOIL 

2008-10-21 16:02 

31.23 

Final 

14447 

3060 s 33 st 

DZ 

Ventry 

13 

CLEARANCE 

± Error 

± 16.468 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE PI'PE 

NOTE 

ppm 

Pb 75.896 

Supervised By: 

Certificate of Verification 

1791 

SOIL 

2008-10-21 16:03 

30.57 

Final 

14447 

3060 s 33 st 

DZ 

Ventry 

13 

CLEARANCE 

± Error 

± 11.183 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 171.723 

Supervised By: 

Certificate of Verification 

1792 

SOIL 

2008-10-21 16:04 

31.30 

Final 

14447 

3060 s 33 st 

DZ 

Ventry 

13 

CLEARANCE 

± Error 

± 16.026 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 48.587 

Supervised By: 

Certificate of Verification 

1793 

SOIL 

2008-10-21 16:05 

31.54 

Final 

14447 

3060 s 33 st 

DZ 

Ventry 

13 

CLEARANCE 

± Error 

± 9.434 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1794 

Mode SOIL 

Time 2008-10-21 16:05 

Duration 124.64 

Sequence Final 

Flags 

AVERAGE J|Av g of 1790-1793 

ADDRESS 3060 s 33 st TM 

QUAD/ZONE |DZ 

INSPECTOR Ventry 

DEPTH 413 

SAMPLE P<PE CLEARANCE 

NOTE 

ppm ± Error 

Pb 120.186 ± 13.278 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 75.026 

Supervised By: 

Certificate of Verification 

1799 

SOIL 

2008-10-21 16:10 

30.92 

Final 

14447 

3060 s 33 st 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 11.300 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 43.526 

Supervised By: 

Certificate of Verification 

1800 

SOIL 

2008-10-21 16:10 

30.82 

Final 

14447 

3060 s 33 st 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 9.291 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1801 

Mode SOIL 

Time 2008-10-21 16:11 

Duration 30.20 

Sequence Final 

Flags 

BVID # 14447 

ADDRESS 3060 s 33 st 

QUAD/ZONE easement 

INSPECTOR Ventry 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 64.428 ± 10.603 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 52.887 

Supervised By: 

Certificate of Verification 

1802 

SOIL 

2008-10-21 16:12 

30.52 

Final 

14447 

3060 s 33 st 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 9.788 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1803 

Mode SOIL 

Time 2008-10-21 16:12 

Duration 122.46 

Sequence Final 

Flags 

AVERAGE I Avg of 1799-1802 

ADDRESS 3060 s 33 st 

QUAD/ZONE ^easemenL. INSPECTOR Ventry 

DEPTH 

SAMPLE PI'PE CLEARANCE 

NOTE 

ppm ± Error 

Pb 158.967 ± 10.245 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 50.749 

Supervised By: 

Certificate of Verification 

1855 

SOIL 

2008-10-24 12:35 

30.18 

Final 

14447 

3060 s 33 st 

F2 

Ventry 

6 

CLEARANCE 

± Error 

± 9.775 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1856 

Mode SOIL 

Time 2008-10-24 12:36 

Duration 30.53 

Sequence Final 

Flags 

BVID # 14447 

ADDRESS 3060 s 33 St 

QUAD/ZONE F2 

INSPECTOR Ventry 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 78.705 ± 11.583 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 135.209 

Supervised By: 

Certificate of Verification 

1857 

SOIL 

2008-10-24 12:37 

30.64 

Final 

14447 

3060 S 33 st 

F2 

Ventry 

6 

CLEARANCE 

± Error 

± 14.453 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE PI'PE 

NOTE 

ppm 

Pb 62.187 

Supervised By: 

Certificate of Verification 

1858 

SOIL 

2008-10-24 12:37 

30.55 

Final 

14447 

3060 s 33 st 

F2 

Ventry 

6 

CLEARANCE 

± Error 

± 10.607 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE PI'PE 

NOTE 

ppm 

Pb 81.712 

Supervised By: 

Certificate of Verification 

1859 

SOIL 

2008-10-24 12:37 

121.90 

Final 

Avg of 1855-1858 

3060 s 33 st 

entry 

CLEARANCE 

± Error 

± 11.605 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE Pi'PE 

NOTE 

ppm 

Pb 45.835 

Supervised By: 

Certificate of Verification 

5733 

SOIL 

2008-12-17 13:25 

30.85 

Final 

14447 

3060 s 33 st 

PZ 

Ventry 

6 

CLEARANCE 

± Error 

± 9.400 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 55.491 

Supervised By: 

Certificate of Verification 

5734 

SOIL 

2008-12- 17 13:26 

31.03 

Final 

14447 

3060 s 33 st 

PZ 

Ventry 

6 

CLEARANCE 

± Error 

± 10.002 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 5735 

Mode SOIL 

Time 2008-12-17 13:26 

Duration 30.49 

Sequence Final 

Flags 

BVID # 14447 

ADDRESS 3060 s 33 st 

QUAD/ZONE PZ 

INSPECTOR Ventry 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 63.780 ± 10.594 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 59.934 

Supervised By: 

Certificate of Verification 

5736 

SOIL 

2008-12-17 13:27 

30.79 

Final 

14447 

3060 s 33 st 

PZ 

Ventry 

6 

CLEARANCE 

± Error 

± 10.303 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

Certificate of Verification 

5737 

SOIL 

2008-12-17 13:27 

123.16 

Final 

fAvg of 5733-5736 

' 3060 s 33 st 

#PZ 

Ventry 

16 

CLEARANCE 

ppm ± Error 

Pb 456.260 ± 10.075 

Supervised By: 
X 

M 

Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

www.coastalhazmat.com \ COASTA L ''"IPHO^" ENVIRONMENTAL 

C • O U r . INC . 

EXECUTIVE SUMMARY: 

BVID # 14447 - (3060 S 33 ST) 

No Issues or Concerns I I Issues/Concerns 

Detail Explanation: 

NO ISSUES PENDING. 
.^EPA 

EPA Propert) Close Out Form 

Proptrty *: l^^C-!^^" ! Property AddrcM^DI^' Q ^ . d^ ^ ^" ^ ' 

Dalc/Tlroc: Owner's Nam.: ":^tr<A-P ^ W^gy f OV ' ^ 

Quads Excavated: T^S? , "t>i : g?\ ,jlto> Contractor CrouprV. Q ^cW,. S^T-'O.V'^V'CY^^K^VJLA' ^ 

LxcavatloD General Yes No 

1 If necessary, were the corrtO quadranl(s) excavaied and resiored? y 

2 If necessary, were the correcl areas of drip zone excavaied and restored'' y 

GradJDK Sod and VctctalioD Ves No 

1 Does the grading around the perimeier of ihe house in excavated areas generally slope away 

from Ibe house? y 

2 Has sod been laid in all areas Ihat were excavated? y 

3 Does the sod appear lo be generally healthy and growing'' (Only evaluate if mspecied ai a 30 

day lime period) y 

4 Are sodded areas generally firm and evenly graded? (./ 

5 Are the joints berween the sod strips generally light'' (Only evaluate if inspecied ai a 30 day 

time period) l y 

6 Was the property graded such thai waler wiW nol pool on the property'' y 

7 Was damage lo landscaping or plani materials avoided'' 

^ 1 

Gales, FeDcnand RcUinlns Walls Ves No 

1 Do gates open and close freely? (Ifapplicable) i ^ 

2 Were all gates or fences taken down during restoralion acliviiies reinsulled'' (If app icablf) i y i 

3 Was damage lo gates or fences avoided? (Ifapplicable) i ^ 

4 Was damage to reuining walls avoided? (Ifapplicable) L ^ 

Foundation, Sidiax and Guliers Ves No 

1 Was damage to the siding or trim avoided? 

y 

2 Was damage lo the foundation avoided'' 

y 

3 Was damage to windows avoided'' t t - ^ 

4 Was danwge to windows or door screens avoided'' L y 

5 Was damage lo downspouts or downspoul exiensions avoided'' ^ 

Sidewalks and Driveways (Concrele) Ves No 

Was damage lo driveway surfaces avoided'^ 

2 Was damage to ualk\*ay surfaces avoided? y 
M 

O • ner? comm€nls: 

Inspection notes: 

Removal and resloration aclivales compleie including the 30-day sod warranty 

/iyiye^ FFA Represenlaiive Dale: 
m 

Property Compietion Agreement 

This agreement documenls the completion of remedial activities perroimed on my property My signature 

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

now, or at any time in the future, except those items listed below, ifany 

PropcrtyTD: |O^C\L^ ^ 

Properly Address:3^^ I i^ Q ' ^ , .S?>-=^ '>sh 

o>^n«' KorrN ^ ^Sboio^jUN 

Phone: QQ,^ _ Q^C^ ^ . 1 C^% ^ C>\ U ^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

^\ } I agrf c restoration is completed, except as noled 

 I I rio not ai;rec restoration is completed 

HU.0 /hc^^-oS 9^rj)j^po/\ 

f)alc Conlractor's Signature Date 

I