TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: .^^^-5^3 

Date: d.\^ii^\Cfi 

Address: l^Qf b PmJ t ^"V" 

Remediation Contractor: Coastal Environmental Group_ Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

y 

Video of property (DVD) 

Executive Summary 

y EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

5 / Restoration Agreement 

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

Confirmation data 

Photographs V^^.^JjJjJlM^dh.cX^ PiL!l£xia}rLaa '3dd^ -^ruai-S<5cL 

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 

Utility clearances 

5 / Property information from Douglas County Assessor's Office 

^ -proparL^ dOL^J^ cJAejJ^lisr 

s/ fiwh^JP-fir. Av^ 

D 

m -

Q/&(^lCfi 

Signature 

Date Ignature 

yf^jtAckyi^i/ii^'^^^ 
% 

m 

Property Access Checklist 

Property ID: 3737 3 

Property Address: ^^ Q ^ Pr- Q f^ 

n

n

 WORK STARTED

 WORK COMPELTED

 ON:

 ON:

 /

 /

 / 

 /' 

OwncM-: ­^

Address: / 

 lr.ec(i,\c\ Renter: 

Phone: 

Fax: 

Phone: 

Cell/Pager: 

Additional Information: 

Pax: 

Ccll/Pager: 1 

D

0

0

O

 Notification Letter 

 Acces.s Agreement 

 Restoration Agreement 

 Top.soil Sampling (if ap|>lical)lc) 

Sent: / / 

Signed: 7 / 30 / OS" 

Signed:? 1'^ 1 ^ 

1 1 

By: 

By:

By: 

By: 

 II 

1 1 Dis()osal Sam|)ling (if applicable) 

CU Garden Sampling (if applicable) 

[ n lltilit.v Clearance 

] y Video/Photos (Before) 

D Video/Photos (During) 

n Video/Photos (After) 

n Video/Photos (3()-Day) 

1 1 Propertv Completion Agreement 

1 1 Final Report 

1 1 

1 1 

Called: / / 

On:£_/_L/jg 

On: / / 

On: / / 

On: / / 

Signed: / / 

Issued; / / 

Bv: 

•^

By: t/\VH 

By: 

By:

By:

By:

By: 

leclh o _ 1 

1 

1 

j 

 II 

Air IVIonitoring (as applicable) 

• Community [U Crew 

Resull.s:

On: _ / / By: 1 

1 

1 1 Community

Results:

 CU Cre« On: _ / / Bv: 

 II 

1 C] Community

Results: 

 CD Crew On: _ / / By: 

Omaha Lead Site 
Property ID #

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact:

Final Action:

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

 pS i'^3 

n b ^ P^y sf. 

 Date: 6?"'^^'^Time: Action: Dhtrdi 

 Date: Time: Action: 

 Date: Time: Action: 

 Transmit to EPA D Other Action: D 

io'^'O ^ - r^c^i-CrtU]! dy^/'^COryx ^A:4/U)''? A 

-y^ dick I z^^cA] y ^ ^yfy-)> 

f y y 

"^[^^ ^f^^ w/ h \u\P( V/iw ui ^ ^u' 
Douglas County Account Information Page 1 of 4 >xmal 

Dougla s County , Nebrask a Propert y Recor d - R152989000 0 

Print Report 

Parcel Dimensions available @ scale 0-50 ft west of 144 St -Vie w OH Ma p Information is valid as of 2008-4-17 Treasurer's Tax Report 

New Feature ^ -> - • Auto Sales Search 

Owne r ^. ^ 6CJU y 

EXTOL MORTGAGE SERVICES INC P^ y T-ATCCL I 

11103 PLUM DR #303 

URBANDALE IA 50322-6333 

Propert y Informatio n 

Key Number: 2989 0000 15 

Account Type: Residential Ii 

Parcel Number: 1529890000 

Parcel Address: 1805 PRATT ST 

OMAHA NE 68110-0000 

Legal Description: KOUNTZE PLACE LOT 2 BLOCK 39 W 10 FT LT 1 & E 30FT 40 X 125 

Valu e Informatio n [ 

Land Improvement Total 

2007 $4,300.00 $25,000.00 $29,300.00 

2006 $4,300.00 $45,500.00 $49,800.00 

2005 $4,300.00 $45,500.00 $49,800.00 

2004 $4,300.00 $10,400.00 $14,700.00 

2003 $4,300.00 $10,400.00 $14,700.00 

2002 $0.00 $0.00 $0.00 

Sales Informatio n 

Sales Date: 2007-09-05 

Deed Type: TRD Book: 2007 Page: 102294 

Price: $75,000.00 

Grantor: Jolley John J JR trustee 

Grantee: Extol Mortgage Services 

Valid/Invalid: Invalid 

Exclusion Reason: Sale to Mortgage - Bank 

Sales Date: 2006-12-12 

Deed Type: WD Book: 2006 Page: 141026 

Price: $140,000.00 

Grantor: Hansmeyer Wayne 

! 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R152... 5/8/2008 
Douglas County Account Information Page 2 of4 >rmat 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Sales Date: 

Deed Type: 

Ramirez I -uis 

Invalid 

Multiple 521-Parti Int Valid 

2006-12-08 

WD Book: 2006 Page: 141027 

$0.00 

Hansmeyer Norman V ETAL 

Luis Ramirez 

Invalid 

Multiple 521 Part! Int Invalid 

2005-03-17 

Q C M 

$30,000.00 

Constance Hansmeyer 

Wayne Hansmeyer 

Invalid 

Family Sale 

2003-05-28 

WD M

$85,000.00 

Erwin Investments 

Wayne Hansmeyer Etal 

Invalid 

Multiple Parcel Sale 

2001-06-29 

QC 

$27,000.00 

Invalid 

Family Sale 

1998-09-09 

D 

Book: 2005 Page: 057332 

 Soo*; 2003 Page: 105752 

Book: 2184 Page: 329 

Soo*: 2 101 Page: 720 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R152... 5/8/2008 
Douglas County Account Information Page 3 of4 >rmat i 

Price: 

Grantor: 

$16,000.00 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Valid 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

1996-09-19 

$12,995.00 

Book: 2046 Page: 369 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Valid 

Lan d Informatio n 

Acres 

0.11 

SF 

5000.0 

Units 

1.0 

Depth 

125.0 

Width 

40.0 

Vacant 

No 

Improvemen t

Building 1 

 Informatio n 

160-5 Pratt 

1 M2 UHFINISHED 

" O 

^•1 IntW 

e-wwl 6 ^ » ? fl pro? 0 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1076.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Good 

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

HVAC: Central Air to Air Rooms: 6.0 

Exterior: Frame Vinyl Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R152... 5/8/2008 
Douglas County Account Information Page 4 of4 

Roof Type: Gable 

Floorcover: Allowance 

Year Built Year 

Remodeled 

1911 0 

Detail Type 

Add On 

Appliance 

Basement 

Fixture 

Fixture 

Porch 

User 

User 

Percent 

Remodeled 

0% 

Detail Description 

Fence Chain Link 

Allowance 

Bsmnt Block 8 ft 

Base Fixtures 

Bath Full 

End Solid Wall 

Attic Full Finish 

See notes 

Stories: 1.5 

Foundation: Block 

Sprinkler Square Footage: 0.0 

Adjusted Year Physical Age Built 

1911 97 

Units 

1.0 

1.0 

1008.0 

1.0 

1.0 

180.0 

550.0 

1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R152... 5/8/2008 
D Remote IDi R page of # t 

Magellan 


One-Call 


P.O. Box 3448 


Tulsa, OK 74101 


Phone 918/574-7098 


Fax 918/574-7466 


The following One-Call Agency dig tickets called in by: 


Excavator: COASTAL ENVIRONMENTAL SERVICE 


Fax Number: 8776624211 


Phone Number: 8776624210 


Fax Date: 2008/07/30 


Batchid: 519297 


Will be CLEAR of underground facilities for: MAGELLAN PIPELINE 


State Ticket Number Excavator Contact Dig Address 


NE 2095048 ELIZABETH 1805 PRATT ST 


If you have any questions, please contact Magellan OneCall at 918/574-7098 

Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2095048. 

Original Call Date: 7/30/08 Time: 3:12 pm Op: ELIZABETH18790 

Work to Begin Date: 8/01/08 Time: 3:45 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 1805 Street: PRATT ST 

Twp: 15N Rng: 13E Sect-Qtr: 03-SW,10-NW 

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 Corner Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MAGELLAN MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 9185747098 


MAGELLAN MAGELLAN MIDSTREAM PARTNERS LP TONYA Alt: 


Emerg: 9185747098 


Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT EDWINA Alt: 

Emerg: 4025047946 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFIC.SEWER RON Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 


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

Alt: 8887289343 


0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Emerg: 4067289343 


Day: 4067289343 


QLNNE IC QWEST LOCAL NETWORK NA Alt: 


Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/30/2008 
32373 

( ^ As-Built Drawing 

C

EMVIROMHiNTA

 OAST A L 

L Omaha Lead Superfund Site C a O U P , IN C 

Omah Exterior Paint North Arrow Owner Name: WAYNE A HANSMEYER a Lead Site

Site 13^ Good Address: 1805 PRATT ST Sketch • Poor Phone: " 402-826-5260 W: r~) Not paint 

Sample Nunnber 

RYASCPXA-32373

RYBSCPXA-32373

RYCSCPXA-32373

nYDSCPXA 32373

 Fl 

F2 

81 

B? 

Lead 

Concentration 

^33-. 362. 

3(BI 

ppm 

ppm 

ppm 

ppm 

Sample 

Collected 

a' 

a 

LAB 

D 

D 

D 

Firm:

Date:

Time:

Samples Collected 

yXeo >^^((^Q 

\ I /o ' I0(J > 

i ^O'b ^ rv\ 

Samples Analyzed 

RDZSCPXA-32373 DZ I0Z2. ppm D XRF Unit lOO n Book jH ^ 

RGZSCPXA 32373

RPZSCPXA-32373

 GZPZ 8Z5 

ppm 

ppm 

D 

02^ 

D 

D 

Date: 

Time: 

// Zl

nr-> 

-Qffl 

Lab RYASCPLA-32373 

Result 426 ppm Number of Samples = 5 1 Staff: yi-iuy' 

— I luiti Lcu, r2 : Front Right. Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from ttie street, facing property 

qLS#: 32373 

Date Excavated: : 0&/20/2008 

Date USEP/ Signed Off: 1/13/2009 

Area Sodded 1246 sa ft 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced with 


Sod ' ' Rock/Mulc Area left bare h ' ' 

Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc . 
32373 

Omah Exterior Paint North Arrow Owne a Lead Site r Name: WAYNE A HANSMEYER 

Sit [^Good e Sketch Address: 1805 PRATT ST • Poor 

Phone: H: 402-826-5260 w [~~| Not paint 1 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Firm:

Samples Collected 

 v-V\fe-t> >^V^(t^Q 

RYASCPXA-32373 Fl .^^3. ppm Date: t i /o « /OCP 

RYBSCPXA-32373 F2 .^£ ^ ppm D Time: I VO ^ ^ r^ 

RYCSCPXA-32373

RYBSCPXA 32373

 B1 

 82 

M ^ ppm 

ppm a 

D 

D Samples Analyzed 

RDZSCPXA-32373 DZ ii^ ppm D XRF Unit: lOO l Book: JH ^ 

RGZSCPXA 32373 62- ppm D D Date: U -Z l - 0U> 

RPZSCPXA-32373 PZ 8^^ ppm D Time: _ Q m . Lab RYASCPLA-32373 I Staff: />7</ ^ Number of Samples = • 5 1 Result 426 ppm 

^^3^..^. . > - • .uiii Ldi, r2 = 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 

..t^'."^ 

Rev 4 
32373 

Omah Exterior Paint North Arrow Owne a Lead Site r Name: WAYNE A HANSMEYER 

Sit (3^Good e Sketch Address: 1805 PRATT ST • Poor 

Phone: » 402-826-5260 W: |~| Not paint 1 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Firm: 

Samples Collected 

RYASCPXA-32373

RYBSCPXA-32373

 Fl 

 F2 

3^ 3

362 L

 ppm 

 ppm IT 

\gr 

D 

Date: 

Time: 

RYCSCPXA-32373

RYDgCPXA 32373

 Bl 

 82 

30? !

~~

 ppm 

 ppm a 

D 

D Samples Analyzed 

RDZSCPXA-32373 DZ JQZ? - ppm D XRF Unit: ico n Book: n? i 

RGZSCPXA 32373 GZ­ - ^ ppm D D Date: IJ -ZJ 0L> 

RPZSCPXA-32373 PZ 8Z 5 ppm D Time: f^rm 

Lab RYASCPLA-32373 Staff: /<^<uy Number of Samples = | 5 I Result 426 ppm 

^v,av-.,«. . I - I luiii i-eii, r2 = 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 

i>c^:.i^ 

Rev 4 046141 0133 
32373 

Omah Exterior Paint North Arrow Owne a Lead Site r Name: WAYNE A HANSMEYER 

Q^Good Site Sketch Address: 1805 PRATT ST • Poor 

Phone: H: 402-826-5260 W: 

Q Not paint 1 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm: 

RYASCPXA-32373 Fl .^H ppm Date: 

RYBSCPXA-32373 F2 36^ ppm \2' n Time: 

RYCSCPXA-32373 Bl JLM. ppm 

Samples Analyzed 

nYDCCPXA 32373 82 ppm a • 

RDZSCPXA-32373 DZ ii^ ppm D XRF Unit: loo'^ Book: jn3_ RGZSCPy>A 32373 6Z- ppm D D Date: IJ -Z l -CiL> 

RPZSCPXA-32373 PZ 8Z5 ppm D 

Time: pfr\ 

Lab RYASCPLA-32373 Staff: /^<u y Number of Samples = 5 I Result 426 ppm 

^v,.,w.. . . - I luiu Lcii, r2 = 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 4 0461410123 
K-^^ " ="-</• , .^W %. 

m COASTA L tNVIBONMENTA l 

c n o u r . IN 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: 

Owner's Name: Daytime Phone: 

y^yyy ^y^Z^ 7T/ -^// s 

Address of Property 

covered by this 

Agreement: /fa's yyz^^yy 

PURPOSE OF RESPONSE ACTIVITIES 

The EPA is requesting access to collect soil samples and remove soil that contains 

elevated concentrations of lead and may pose a health hazard. The area(s) will be 

excavated to remove contaminated soil. The removed contaminated soil will be 

replaced with clean materials and the area will be restored to its original condition. 

This work is being performed under the Omaha Lead Superfund Site remediation 

program. 

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

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

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

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

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

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

has been remediated. 

ENVIRONMENTAL RESPONSE ACTIONS 

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

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

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

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

agrees to: 

Page 1 of 2 
5 V^ ^ y ./ s 

V / COASTAL *>.,, _-;0^^ ENVtHONMENTAl 

' '^o' ^ C • 0 U > . I « 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 T O 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 

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

Signs^me Date Signature Date 

d l I would like to be present during any sampling that is required. 
C O A S T A ;_ 

C H O U P IM C f y (,h V fk 

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 ofthe property owner and the United States Environmental 

Protection Agency (EPA). 

y^ y i -X I y ^ Property ID: •7y ^ 

y y y / Property Address: \id< f^y<~ 

Owner: ^ Zf^l^Ci 

Phone: M Q I "IH P>'C 

On the attached diagram(s) indicate area(s) to e.xcavated and depth of e.vcavation. location of all known 

utilities, subsuiface features, surface 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) 

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

Page 1 of 
m 

COASTA L 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

/Af^y^ fitA-1^ P2 

Item: 

^Unr/'^b^ny \ii-M^\^ \ ^iV i^i^O ^ — 

^ 

— 1 1 Item: 

/

/ 

Item: / 

Item: 

/ 

Item: / 

Item: / 

Item: 

/ 

Item: / 

Item: / 

Item: / 

[ 

Item: / 

Item: / 

/ 

Item: / 

Item: / 

y 

Page 2 of t/ 
C O A S T A I. fNvinoMnKNTA L 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: /> 

1^/ 

Item: . 

Y'^ 

Item: y . 

10 ^ y ^ - 1 

Item: / 

Item: , / 

Item: / 

Item: / 

Item: / 

Item: 

/ 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

1 /• 

Item: 

Page 3 of 
COASTA L 

Landscape Inventory 

(Use additional sheets as necessary) 

Item Quantity Unit Condition/Type/Species 

Pre-existing property area, 

that wil l be excavated, that 

is covered with grass. 

Number of trees > 2 inch 

trunk diameter 

Number of trees ' = 2 inch 

1 iruni< diameter 

Number of Sprini^ler 

Zones. Control Valves. 

1 Timers. Heads, etc. 

1 Auach a sketch >;!' liie 

ipririkle:" !i! \ out. 

Number of and size of 

each garden/ (lower bed 

area. 

.••.;.:i;,i; i; s.'-.eici'i •.<\ ic.^uw: 

-•i.'e> ::iiJ. ioc:iiio!ii. 

y 

-L 

\ 

r 

v 

Square feet 

Each 

• 

YT^ )ycy y ^\ u 

Each Y

p^i^y'y?^\y 

t 

1 

Each 1 

1 

Each 

Square Feet V &^ 

Page 4 of ^ 
.a^ 

COAST A 

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 

\oucher to ihe propert> 

owner. ^ 

$ 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketch (^i' ueie 

each plant will be placed 

b_\ t!ie coniracio!'. 

M Each 

1 

Agreed upon area of 

properr>' to be replaced 

1 with grass sod. 

'lii'lude Li "-kfu:!! of ihc 

area(s) [o be replaced '.\'ih 

•a''ass >.od. 

fl 

1 u 

SF 

1 Area of City or County 

property to be landscaped 

per their requirements. 1 SF X^rYyiAbA X \ 

\ .:: eo i-^! 

Easement .Area, to be 

e.xcavated SF 

1 

V V %irb 

Page 5 of 
C O A S T A L SNVmOMHK M T A1 . 6 • O U F . IN C 

Additional Comments / Instructions: 

4^ 

flK^f Miyo^A 4i^r- fti7£iy^ fev9 1^^^^^ 

bfui^ fe/f ^ /H ]M^th^ ~ 

n Checl< 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. 

0^1 agree C] I do not agree 

^ ^i - 77^- <:^^ 

l/Ownej^ Sigi y r yDate Contractor's Signature Date 

Page 6 of. 
BVID #S^ Si s 

XRF PROPERTY SAMPLE SHEET 


Date H-q o 0 & Address yy^ . k^rc^^yyr 

Project Omaha lead FP 2nd year opllon Sample time \y.{ . y am/pm 

XRFID# sample length 30 sec yi^y\ 

Shot# Reading Sample area Shot# Reading Sample area 

.OLPS ^ \2:-i.o^ i M.i,^-\ ^LeC-^O ^'i;.(.?o * \a.v ^ 

c^UM u \v3.SA'-\S.u- ^ y •i^o y \ «.UU T t ICl.Wi 

,-;?L?^n .a'-A.'o^ + iiA.^iLc Depth yy y fiG^ASi vQ. 3i<. Depth 

c3CcHA lo^.^\^ r V5-3Q CP CQLPC^ ^ Bu:t/.a to.?>c I 

Average \;P-,. vQ i : \ ^ 0'.3i Average •^^ - ^- ^ ^^ T 

Shot# Reading Sample area Shot# Reading Sample area 

yy D iVAit^ t \<A.U^\ l^^Av ^ -7 K1 ^m^l 

rQLoe:U> io7. yy-^ \'^.-23 b>' ^ ^if y .^^ .3\ i l.q ^ £i 

.yxo y 140. l l t y:,.\\ Depth i^^.3^t i,-'-|-? Depth 

a^A. y{Q^ ^ y^^y,'^y-\'A.^\ \ ^ f^i^ g 1.^1.^3!: T AST 1^ 

Average l5?^ . lg> t lA.qf b Average \^.DS t -7-?,? ^ 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Deptti 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# Reading Sample area 

! 

Depth Depth 

Average Average 

lab sample # Lab result Sample area XRF Avg. 

Signature. f^ii^Ms^ 

Print r,.Pj[4lkJh CMW(y] 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2649 

Mode SOIL 

Time 2008-08-20 15:12 

Duration 122.57 

Sequence Final 

Flags 

AVERAGE Avg of 2645-2648 

ADDRESS • 1805 Pratt st 

QUAD/ZONE PZ 

INSPECTOR LOPEZ 

DEPTH '6 

SAMPLE PT'PE CLEARANCE 

NOTE 

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 132.024 

Supervised By: 

Certificate of Verification 

2645 

SOIL 

2008-08-20 15:08 

30.27 

Final 

32373 

1805 Pratt st 

PZ 

LOPEZ 

6 

CLEARANCE 

± Error 

± 14.641 
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 PT'PE 

NOTE 

ppm 

Pb 112.981 

Supervised By: 

Certificate of Verification 

2646 

SOIL 

2008-08-20 15:10 

31.85 

Final 

32373 

1805 Pratt st 

PZ 

LOPEZ 

6 

CLEARANCE 

± Error 

± 13.641 
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 PT'PE 

NOTE 

ppm 

Pb 124.539 

Supervised By: 

Certificate of Verification 

2647 

SOIL 

2008-08-20 15:11 

30.02 

Final 

32373 

1805 Pratt st 

PZ 

LOPEZ 

6 

CLEARANCE 

± Error 

± 14.463 
^ 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2648 

Mode SOIL 

Time 2008-08-20 15:12 

Duration 30.43 

Sequence Final 

Flags 

BVID # 32373 

ADDRESS 1805 Pratt st 

QUAD/ZONE PZ 

INSPECTOR LOPEZ 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 102.937 ± 13.317 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2654 

Mode SOIL 

Time 2008-08-20 15:16 

Duration 121.43 

Sequence Final 

Flags 

AVERAGE Avg of 2650-2653 

ADDRESS ' 1805 Pratt st 

QUAD/ZONE easement , 

INSPECTOR LOPEZ 

DEPTH 

SAMPLE TYPE a

CLEARANCE 

NOTE 

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 83.600 

Supervised By: 

Certificate of Verification 

2650 

SOIL 

2008-08-20 15: 14 

30.58 

Final 

32373 

1805 Pratt st 

easement 

LOPEZ 

1 

CLEARANCE 

± Error 

± 12.125 
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 96.667 

Supervised By: 

Certificate of Verification 

2651 

SOIL 

2008-08-20 15:14 

30.29 

Final 

32373 

1805 Pratt st 

easement 

LOPEZ 

1 

CLEARANCE 

± Error 

± 12.888 
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 PT'PE 

NOTE 

ppm 

Pb 85.481 

Supervised By: 

Certificate of Verification 

2652 

SOIL 

2008-08-20 15:15 

30.28 

Final 

32373 

1805 Pratt st 

easement 

LOPEZ 

1 

CLEARANCE 

± Error 

± 12.280 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2653 

Mode SOIL 

Time 2008-08-20 15:16 

Duration 30.28 

Sequence Final 

Flags 

BVID # 32373 

ADDRESS 1805 Pratt st 

QUAD/ZONE easement 

INSPECTOR LOPEZ 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 86.640 ± 12.297 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2659 

Mode SOIL 

Time 2008-08-20 15:24 

Duration 120.49 

Sequence Final 

Flags 

AVERAGE Avg of 2655-2658 

ADDRESS 1805 Pratt st 

QUAD/ZONE 

INSPECTOR OPEZ 

DEPTH 13-' 

SAMPLE TYPE CLEARANCE 

NOTE 

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 134.162 

Supervised By: 

Certificate of Verification 

2655 

SOIL 

2008-08-20 15:22 

30.03 

Final 

32373 

1805 Pratt st 

DZ 

LOPEZ 

13 

CLEARANCE 

± Error 

± 14.694 
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 PT'PE 

NOTE 

ppm 

Pb 107.953 

Supervised By: 

Certificate of Verification 

2656 

SOIL 

2008-08-20 15:23 

30.06 

Final 

32373 

1805 Pratt st 

DZ 

LOPEZ 

13 

CLEARANCE 

± Error 

± 13.381 
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 140.712 

Supervised By: 

Certificate of Verification 

2657 

SOIL 

2008-08-20 15:24 

30.08 

Final 

32373 

1805 Pratt st 

DZ 

LOPEZ 

13 

CLEARANCE 

± Error 

± 15.106 
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 PT'PE 

NOTE 

ppm 

Pb 133.892 

Supervised By: 

Certificate of Verification 

2658 

SOIL 

2008-08-20 15:24 

30.32 

Final 

32373 

1805 Pratt st 

DZ 

LOPEZ 

13 

CLEARANCE 

± Error 

± 14.609 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 5753 

Mode SOIL 

Time 2008-12-17 17:33 

Duration 121.06 

Sequence Final 

Flags 

AVERAGE Avg of 5749-5752 

ADDRESS '1805 Pratt st 

QUAD/ZONE rFi 

INSPECTOR 

DEPTH LOPEZ 

SAMPLE TYPE 

NOTE CLEARANCE 

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 15.911 

Supervised By: 

Certificate of Verification 

5749 

SOIL 

2008-12-17 17:31 

30.43 

Final 

32373 

1805 Pratt st 

Fl 

LOPEZ 

6 

CLEARANCE 

± Error 

± 7.192 
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 19.214 

Supervised By: 

Certificate of Verification 

5750 

SOIL 

2008-12-17 17:32 

30.31 

Final 

32373 

1805 Pratt st 

Fl 

LOPEZ 

6 

CLEARANCE 

± Error 

± 7.426 
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 P/PE 

NOTE 

ppm 

Pb 15.248 

Supervised By: 

Certificate of Verification 

5751 

SOIL 

2008-12-17 17:32 

30.31 

Final 

32373 

1805 Pratt st 

Fl 

LOPEZ 

6 

CLEARANCE 

± Error 

± 6.966 
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 21.834 

Supervised By: 

Certificate of Verification 

5752 

SOIL 

2008-12-17 17:33 

30.01 

Final 

32373 

1805 Pratt st 

Fl 

LOPEZ 

6 

CLEARANCE 

± Error 

± 7.954 
X 

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

\ , • ^

'^•"•pftoy

Coastal Environmental Group Inc. 

 www.coastalhazmat.com 

 COASTA L ENVmONnENTAL 

C R O U r . INCEXECUTIVE SUMMARY: 

BVID # 32373 - (1805 PRATT ST) 

No Issues or Concerns Q Issues/Concerns 

Detail Explanation: 

NO ISSUES PENDING. 
- -

^EPA 

EPA Property Close Out Form 

Property #: ^y l ^ Property Address: \ BO- b Pt - ('^-rVV 

Date/Time: Owner's Name: Utu,^ ( ^.t.,V(x . .ir . -\j ^ Quads Excavaied: P \ ^ ly^'y^ ^P'Zri Contractor Group Cor^^c^-Yi.A "^_^-\v;v O^*"* 

Excavation General Yes No 

1. If nccessiry, were the correct quadrant(s) excavated and reslored? y 

2 If necessary, were (he correct areas of drip zone excavated and reslored? i ^ 

Grading Sod and VcceUtioo Yes No 

1. Does the grading around the perimeier ofthe house in excavated areas generally slope away . y ^ 

from the house? 

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

3. Does the sod appear lo be generally healthy and growing? (Only evaluate if inspected at a 30 i ^ 

day time period) 

4 ^ Are sodded areas generally firm and evenly graded? 

5 Are the Joints t^etween the sod strips generally tight? (Only evaluate ifinspecied at a 30 day • ^ 

time period) 

*^ 

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

7 ^ y ^ Was damage to landscaping or plant materials avoided']' 

Gates, Fences and ReUinlng Walls Ves No 

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

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

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

4. Was damage to retaining walls avoided? (Ifapplicable) iJk 

Foundation, Siding and Gullcrs Yes No 

1. Was damage to the siding or trim avoided? \y ^ 

2 Was damage to the foundation avoided? y ^ 

3 . ^ . Was damage to windows avoided? 

i ^ 4. Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspout exiensions avoided? O ' 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to driveway surfaces avoided? L ^ 

2. Was damage to walkway surfaces avoided? ^ 
O »ners comments: 

Inspection notes: 

L_ 

Removal and restoration aai^'ate i O ^ s complete including the 30-day sod warranty: 

EPA Representalivey^^^^^^w^^.^^?^^^*^:^^^^^^ Dat ^ //yo f 
Property Completion Agreement 

This agieemenl cicicumenis llie eoiriplclion ol remedial aclivmes perloi med nn my pioperiy My signaiure 

u'lli designate thai 1 am satisfied with Ihe restoration of my property, and thai no items are in questions, 

now, or ai an\' lime m the future, except Ihose items listed below, ifany 

P'"pc- ry in 7 ^ J 7 J 

Property Address: / f'^ J ^ ro^tF sJ^ 

Qwnci Ao.^ C-.CKr~a~ cfC t' 

Phone 731 our 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

\ y \ I a{;rcc r c^toration i>; completed, rxctp l HS noltr 

[ ly^ o fo i aj^icc restoration i.s cornpletcrl 

'j^jy^y ym amimy^liiM. w !K I s Sign/wii f Date _onlra ( roi 's Signature Oaic