TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID^: _y_lk_ . Date; ^ n(i i 

Addres.s: U? ^ 1^ ^ [ ^ ^ H Y 

Remediation Contractor; Coastal Environmenta) Group_ Year; 2010ARRA 

SOILREMEDIATJON 

PROPERTY FILE FOLDER DOCUMENTS 

A Video of property (DVD) 

/ Executive Summary 

/ EPA-provided property sketch 

Signed Access Agreement for subject properly 

y Signed Access Agreement(s) for adjacenl properly 

y 

Restoration Agreement 

Sefllemenl documents (i.e., for damage or to repJace plants, etc.) 

Confirmation data 

y Pholographs \(t 6^^/l"1l< ^ ^ t>^ <WAtu^o V ^G ^ 

As-buill sketch 

y Satisfactory restoration signed by Property Owner 

7 Property close-out check list signed by EPA 

• / 

Description ofareas not meeting ROD cleanup criteria 

/ . Utility clearances 

7 Property inforjnal ^ from Douglas County Assessor's Office 

y l 

30237422 

•11 

Superfund 
^v 

Property Access Checklist 

PropertylD^ j/]C^' [ D WORK STARTED ON: __/__/_ 

Propert D WORK COMPELTED ON: / l_ y AddressT jl^Zo/l/"5 1 '^zYF ^ 

Owner: IY \ ^ ^^ ^ SrnAddress: 

lists'^^1 -STPhone: (MQ Q ^ j'b ^ ^ 

Fax: 

Cell/Pager: 

D Notification Letter 

^!<^Access Agreement 

l^ r Restoration Agreement 

U Topsoil Sampling (if applicable) 

O Disposal Sampling (if applicable) 

D Garden Sampling (if applicable) 

^ UtiUty Clearance 

[^;3^ideo/Photos (Before) 

t ^ Video/Photos (During) 

D Video/Photos (After) 

n Video/Photos (30-Day) 

Q Property Completion Agreement 

D Final Report 

Air Monitoring (as applicable) 

• Community • Crew On:

Results: 

• Community • Crew On:

Results: 

• Community • Crew On:

Results: 

Sent:

Renter: 

Phone: 

Fax: 

Cell/Pager: 

Additional Information: 

/ / 

Signed: ijr^i^lfX) 

Svgned: _lJ2l ZZ/l O 

1 1 

1 1 

1 1 

Called: ^v / t; / vo 

On: ji^ii£^4yy 

On: / / 

On: / / 

On: / / 

Siened: / / 

Issued: / / 

/ / By:

 / / By:

 / / By: 

Omaha Lead Site 

By: 

By= Vi^c\-

By= \^\oiBy: 

By: 

By: 

y* Wf'\f\.(y li».«A.^. 

By: W'oL 

By: 

By: 

By: 

By: 

By: 

1 

1 
Douglas County Account In: Page 1 of2 

% " 

Douglas County, Nebraska Property Record

Information is valid as of 2010-8-30 

Owner 

JOHNSON MARY 

1618 N 31 ST 

OMAHA NE 68111-0000 

Property Informatio n 

­ R1627490000 

Print Report 

View Interactive GIS Mao 

Treasurer's Tax Reoort 

New Feature ••-•• • Subdivision Sales Search 

Key Number: 

Account Type: 

Parcel Number: 

Parcel Address: 

Legal Description: 

Value Informatio n 

Land 

2010 

2009 

2008 

2007 

2006 

2005 

Land Informatio n 

Acres SF 

2749 0000 16 

Residential 

1627490000 

1620 N 31 ST 

OMAHA NE 68111-OOOO 

LINDSAYS ADD LOT 3 BLOCK 0 31 X 104.5 

$500.00 

$500.00 

$500.00 

$500.00 

$500.00 

$500.00 

Improvement 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

Total 

$500.00 

$500.00 

$500.00 

$500.00 

$500.00 

$500.00 

Units Deptti Widtii Vacant 

0.07 3224.0 0.0 104.0 31.0 Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R162... 9/2/2010 
Page 1 of2 

^ 

"> 

y Create Another Ticket ] [ Back to Irth Internet Send Email 

• YOUR TICKET NUMBER IS 2635824. 

Original Call Date: 11/05/10 Time: 12:29 pm Op: ELIZABETH18790 


Work to Begin Date: 11/09/10 Time: 1:00 pm 


State: NE County: DOUGLAS Plac e : OITIAHA 

Address: 162 0 Street: N 31ST ST 

Twp: 15N Rng: 13E Sect-Qtr: 16-lW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD REMEDIATION 


Location of Work: LOCATE ENTIRE PROPERTY, ALL EASEMENTS AND TO THE PEDESTAL 


Remarks: FAX ALL CLEARS TO: (877)662-421 1 

: UISrSURE I F CORNER LOT. 

Company : COASTAL ENVIRONMENTAL SERVICE 


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


Work Being Done For: COASTAL 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUDOl OMAHACOF OPPDGPRS QLNNEIC 


Service Area Contact Phone Number UtiUty Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

LEVEL3 LEVEL3 COMMUNICATIONS, LLC NA Alt: 

Emerg: 8773668344 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 


Day: 4024447197 


OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11/5/2010 
Page 2 of2 

m 

OPPDGPRS OMAHA PUBLIC POWER DISTRICT ELM LOCATING 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK

Day:

 ELM LOCATING Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11/5/2010 
As-Built Drawing *^ 

COASTA L Omaha Lead Superfund Site 

OLS#: 26196 

Date Excavated: 11/11/2010 

Date USEPA Siqned Off: 12/2/201C 

26196 Area Sodden: 1550 sa ft 

0«mer Name: MARY JOHNSON 

Address: 1620 N 31 ST 

Phone: H 

Sample Numtjer 

RYASCPXA-26196 F1 

RYBSCPXA-26196 F2 

RYCSCPXA-26196 Bl 

RYDSCPXA-26196 B2 

RDZSCPXA 20100 

•RGZ5CPXA-20I90 -xsz 

RPZccpxA-aGioe—PZOmaha Lead Site 

Site Sketch 

w: 

Lead 

Concentration 

Sample 

Collected LAB 

_jQj4_pp m n 

^M A ppm n 

ppm D 

ziziX ppm 

ppm D 

n 

D 

ppm D a 

ppm D 

Number of Samples = 

Exterior Paint Nonh Arrow 

• Good 

> • Poor 

PM Mot p£int 

Samples Collected 

Firm; FD/\ Ocl/>^ 

Date: SiflK/a ^ 

Time: °i:'iO 

Samples Analyzed 

XRF Unit: 7> i D Book: ^^ 3 

Date: %My ^ 

Time

Staff

: 

: WtENTERED 

AU6 2 3 2005 

Omaha Lead Site 46130 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with 

Sod ' ' 

Area replaced with 

Rock/Mulch Area lef t bare 

Contrac t #: EP-R7-07-05 Coasta l Environmental Group Inc . 
^ 

26196 c\^^ u wk 

e^ 

^ 

\ 

Owner Name: MARY JOHNSON 

Address: 1620 N 31^ ST 

Phone: H:

Sample Number 

RYASCPXA-26196 Fl 

RYBSCPXA-26196 F2 

RYCSCPXA-26196 81 

RYDSCPXA-26196 B2 

RDZSePXA 26106 B2­

-RGZ5CPXA-20I90 GZ 

RPZGCnXA 26106 F*­

"31 

f;e..).^=fcU". 

Ti 

Omaha Lead Site 

Site Sketch 

 W: 

Lead Sample LAB Concentration CollectejJ' n 

ppm D 

3 

* ppm D

Y

Hi ^ 

ppm D 

JHX ppm D

ppm 

D D 

ppm 

D D 

ppm 

D D 

Number of Samples = I / J 

W 

/21 - >. :r 

-y 

f l 

'34. 

Exterior Paint Nortti Arrow 

• Good 

n Poor 

C3^^ Not paint 

Samples Collected 

Firm: F.OA Oz/Z> ^ 

Date: fi//Klo / 

Time: ^ : 3 0 

Samples Analyzed 

XRF Unit : %\ b Book: ^ 

Date: _ 

Time

Staff: 

: _ mr S 

ENTERED 

AUG 2 3 2005 

T-pr y ^yyyyy:;A-^\iOP i ZZ 

iXT/yy 

Nsi ^ L 

Omaha Lead Site 

7 46130 
26196 

Omaha Lead Site 46130 
Name: , Omaha Lead Site Date: 6^ ^ North Arrow 

Address:y-" i%((7 iSif Ai I /7 ^ Sf. Site SIcetch Time: 3'V-St>/^ 1

Phone: c/d^-^l-fin^ l 

Team fiSWi/^^i^^T^Hk. BVID# i?6./fc 9 XRF Code ^^^Y 

Sample Number Lead Concentration Confirmation Sample 

/7^2-*-'^7' •
 ppm flYes No 5^ 70o±l ^ 

ppm f^Yes a No ca 

ppm ^ , Yes • No 3B¥-r:z.^ 

ppm • No 

ppm ^^Yes • No 


ppm •^ Yes • No • 

ppm Yes • No • 

x^ )( 4 X >( X 'n- , x ^ X A X 

p ^ i^f^-a ^ - ^ f P . 9^^-'i.ter 

y­ ^ ^ •^f . ^ . ~r '» -^—* ^ \ K \ \ -¥-

Omaha Lead Site 46130 
COASlA l 

[ftVIKONKIhU l 

c > 0 u r 1 h c 

CoiiJ?eri\ lol Acc(i$;i^ 'lo froptiit y 

RIGHT OF ENTRY TO PREMISES 

Grantoi (the property' owner) consents to and authorizes the United Stales 

Environmental Protection Agency (EPA) oi its authorized representatives, collectively 

the Grantee, to enter and perform certain environmental response activities upon the 

following described premises: .-7^ ty2 / 

, Z(£.17LL^ 

Ovmer's Name: AtV\^l 7 Daytime Phone: -^^ ^ ^^ ^ [Z^e ^ 

Address of Property 

covered by this \ y ^ ^ SUt. 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 rts original condition. This 

wori< 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 
Y' > /Yy'-'^ ^ ^ ^ 

\ yy7 f COA S 1 A i t • VtiOhh f f Ti l 

C « 0 L' ' 

Remove obstructions incluciing boats, traileis, vehicles, playscape items, wood 

piles, dog houses, etc, 

Remove flovv'er bulbs oi plants that the Grantoi oi the Grantoi's tenant may wish ( 

to save; 

Water and maintain leplacement vegetation, including fertili2ef application, as 

necesssP)' subsequent to an initial watering period by EPA; 

< Abide by health and safety guidance piovided by EPA, 

> If the property' is rented, assist EPA in obtaining tenant approval foi access to 

the property' to perform the work. 

I Allow videotaping and/or photographing of the property. 

AGREEMENT NOT To INTERFERE 

The Grantor agrees not to interfere or tampei with any of the v/ork activities, oi 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 

[0 I grant access to my properties • I do nol grant access to my propertleE 

.jhY^z/Zr^. Yy^STiMz JJ ) -<^i? -iO 

Signature Date Signature Oate 

O I would like to be piesent during any sampling thai is tequiied. 

1 •• c 

Paae 2 of 2 
•41 

COA S 

c p o u ^ 

Restoration Agreement 

The purpose ofthis agreeinent is to provide a mutual agreemem as lo conditions ofthe property prior to 

remediation activities. This will also ser\'e as documentation for the purpose of assuring ihal resloralion 

activities are completed to the satisfaction of the property owner and the United Stales Environmenial 

Protection Agency (EPA). 

Propertj 

Property 

Owner: 

Phone: 

ID: 

.\ddress: l(?lo p l)if 

P/A)J& McAT ee / Al^thi;*' 

Uo '\i'\S / Uc i^ iOl^K ^ JM )H/^ 

On lhe attached diagrani(s) indicate area(s) to e.xcavale, surface structures and landscaping features and 

access location(s) lo be used by lhe contractors. Indicate distances, depths, material types, etc. 

Photographically and Videographically document the existing conditions ofthe property and the basement if 

necessapv'. 

Items to be Removed by the Owner before Start of Remediation: 

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

Item: . 

P^3 fool /4K^ f^'f ^4 ^ M'^tCi; ^^fe fs> 4,6^ 

''^"'- ^ ^ ^ douy^ ,^ h /H J/..W, l^^ ^^^ ^„^ ^ 

/ 

*^'"'Xf lyc co^ dc? (T^ CALL ^^^UAA. / 

f Item: 

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

Item: 

-_^ ^ S^yQlr^y 

Item: ~ ^ 

Item: A ^ 

y ^ 

Item: ^^ ___— -

Page 1 of y 
Items to Be Removed By Contractor During Remediation and Replaced 

Item: 

Zou 

Item: 

£oP 

Item: 

Item: 

Item 

l're-e.\isting property area, 

that will be exca\ated. 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 

\Iliicll ;i skelc h i>l ihc 

spimklc i kiNoui 

Number of and size of 

each garden' flower bed 

area. 

Nil,Ik ll :i sl- cicl i 1^1 iclaii' . c 

•-]/.<.-• ;IIKI li \ alii'iis 

.Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

\()i i ilii v Milli e \\'\\\ h i 

;|vi>(l 1(1 issij c 11 |j|illl l 

.(HH'lui lo liu pmpcii x 

in\nil , 

Easement Area, to be 

excavated 

Quantity 

31 

82 

e ^ 

Landscape Inventory 

Unit 

Quadrants 

Each 

Each 

Each 

Each 

Square Feel 

Condition/Type/Species 

Each izy^^j y.jy 

Page 2 of 
COASTA L 

c R o 1.1 ^ p N r 

Additional Comments / Instructions: 

The city of Omaha ordinances may prohibit you from using dirt or gravel areas on your property 

as driveways or vehicle parking areas. The Environmental Protection Agency (EPA) may be 

removing and replacing soil underlying a gravel or dirt area on your property that you may be 

using as a driveway or vehicle parking area. If this is the case, you should understand that this 

removing and replacing of soil does not mean that any illegal driveway or parking area on your 

property is made legal. To the contrary, you may be cited by the city if you use a gravel or dirt area 

as a driveway or parking area, not withstanding any removal or replacement of soil by the EPA. 

If you have any question about legality of a certain driveway or parking area, you may contact 

the city of Omaha's Planning Department at (402) 444-5150. 

I i Please check this box if you understand the information outlined above. 

O 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 I I I do not agree 

i^liOuyaYn^ClZu. lO-^h'lD iQ^yTyyzyyy- //(/, 

Owner's Signature Date Contractor's Signature Date 

Page 3 of 2 ­
BVID# Z6l'i 6 

XRF PROPERTY SAMPLE SHEET 

Date 

Project 

XRF ID# 

/- Z'^- zon 

Omaha Lead ARRA 

3°lOZZ. 

Address 

Sample time 

sample length 

Kszyi Al s? ST 

30 sec 

am/pm 

Shot# 

8L 

95 

84 

Average 

Reading 

ZZ3 i ZL 

ZL"^ i 23 

K 5 ± 18 

na 

Sample area 

EA 

Depth 

/" . 

/ 

Shot# 

Average 

Reading j Sample area 

Depth 

Shot# 

1Z> 

^ ^ 

30 

Average 

Reading 

ZOl i ZL 

i'^5 i Z\ 

Zo l t LXA 

Sample area 

^ L 

Depth 

A\ 

ZQ\ i LL y 

Shot# 

Average 

Reading Sample area 

Depth 

Shot# 

^4 

15 

1 ^ 

Average 

Reading 

m i zo 

139 i 18 

m t le, 

l?4 i /I 

Sample area 

51 

Depth 

4" 

/ 

Shot# 

Average 

Reading Sample area 

Depth 

Shot# Reading 

RETEST AREAS 

Sample area Shot# Reading Sample area 

/

/ ­ ^ 

/ 

Depth Depth 

Average Average 

Signature_ 

Print V^WzU Mhl^^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Pb 198 

Supervised By: 

Certificate of Verification 

85 

SOIL 

2011-01-25 14:40 

90.77 

Final 

Avg of 82-84 

1620 N 31 ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 223.414 

Supervised By: 

Certificate of Verification 

82 

SOIL 

2011-01-25 14:39 

30.33 

Final 

26196 

1620 N 31 ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 22.936 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 229.619 

Supervised By: 

Certificate of Verification 

83 

SOIL 

2011-01-25 14:40 

30.23 

Final 

26196 

1620 N 31 ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 23.089 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRFTECH 

MISC 

NOTE 

ppm 

Pb 143.829 

Supervised By: 

Certificate of Verification 

84 

SOIL 

2011-01-25 14:40 

30.21 

Final 

26196 

1620 N 31 ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 18.937 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRFTECH 

MISC 

NOTE 

Supervised By: 

Certificate of Verification 

81 

SOIL 

2011-01-25 14:38 

90.62 

Final 

Avg of 78-80 

1620 N 31 ST 

B2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 201.309 

Supervised By: 

Certificate of Verification 

78 

SOIL 

2011-01-25 14:36 

30.18 

Final 

26196 

1620 N 31 ST 

B2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 22.058 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 195.738 

Supervised By: 

Certificate of Verification 

79 

SOIL 

2011-01-25 14:37 

30.26 

Final 

26196 

1620 N 31 ST 

B2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 21.861 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 207.299 

Supervised By: 

Certificate of Verification 

80 

SOIL 

2011-01-25 14:38 

30.18 

Final 

26196 

1620 N 31 ST 

B2 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 22.879 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Supervised By 

Certificate of Verification 

77 

SOIL 

2011-01-25 14:35 

90.69 

Final 

Avg of 74-76 

1620 N 31 ST 

Bl 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 179.486 

Supervised By: 

Certificate of Verification 

74 

SOIL 

2011-01-25 14:34 

30.35 

Final 

26196 

1620 N 31 ST 

Bl 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 20.623 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 138.608 

Supervised By: 

Certificate of Verification 

75 

SOIL 

2011-01-25 14:35 

30.16 

Final 

26196 

1620 N 31 ST 

Bl 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 18.786 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 76 

Mode SOIL 

Time 2011-01-25 14:35 

Duration 30.18 

Sequence Final 

Flags 

BVID 26196 

ADDRESS 1620 N 31 ST 

QUADRANT Bl 

DEPHT 4" 

XRF TECH C.PADILLA 

MISC CONFIRMATION 

NOTE CLEAR 

ppm ± Error 

Pb 144.132 ± 18.816 

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

Coastal Environmental Group Inc. v\ 

\ "'" Z^ www.c0astaiha2mat.com '^i P„o^ y COASTA L ENVIRONMENTA L 

CROUP , IN C 

EXECUTIVE SUMMARY: 

BVID #26196-(1620 n 31 st) 

No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 
EPA Property Close Out Form 

\^Vo •^^ "yY Y 

Proptrty #: t G 11 (. Date/Time: 

Quads Excavated: V | if Contractor Croup (y^W ^ _ 

Excavatio Yes No n General 

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

2. If necessary, were the correct areas ofdrip zone excavaled and restored'' / 

Yes No 

Does the grading around the pcrimeier ofthe house in excavaicri areas generally slope away 

Grading Sod and Vegetation 

/

from the house? 

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

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

y day time period) 

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

5 Are the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day 

time period) .. „ . 

yy 6.

 Was the property graded such thai water will not pool on the property'' 

y - V 7. Was damage to landscaping or plant materials avoided? 

Gates, Fences and Retaining Walk 

Ves Ncj 

I. Do gales open and close freely? f If applicable) 

2. Were all gates or fences taken down during restoration acliviiies reinstalled? (Ifapplicable) Y 

I '^ Was damage to gates or fences avoided? (If applicable) ~y 

'I Was damage to retaining walls avoided? (Ifapplicable) 

' Y 

Foundation, Siding and GuMers 

1 Was damage to the siding or trim avoided? 

2. Was damage to (he foundation avoided? 

Ves 

/ 

/ 

No 

1^

Was damage lo windows avoided'' 

 Was damage to windows or door screens avoided? 

/ 

/ 

5 Was damage io down.spoiits or downspoui extensions avoided'' / 

Sidewalks and Driveways (Concrete) 

I 1 Was damage lo driveway surfaces avoided? 

Yes

y 

 No 

2. Was damage to walkway surfaces avoided'' / 
Owners comments: 

j !n.";pectiion notes: 

Removal and restoiation activates complete including the 30-daY sod warranry: 

HPA Representaiivt Qc^ ^ Date: i:z44ic.__. 
% 

-% 

Property Completion Agreement 

This ajiiecmeni documents lhe complclion ol remedial aclivmes perlonned on my pioperiy My signaluie 

will designate ihal I am satisfied wilh lhe restoration of my propeity. and Ihal no items are m questions 

now, or al any lime m the future, excepl ihose ilems hsled below, ifany 

'?D^f^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

F v l I a(;rcc ir^toriiljo n is complcled, rxctp l its noleri 

l._J ' '^^ "" ' a^if c rfsloration is completed 

/c2 - / . /c? t / Iy . Owner' s Signatnr natnr ee Dal e C^nf i ailo i 's SicnaliiM' Dale