TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: ifS?)^. I Date: ^ lO^SlCPj 

Address: 61^(1 ?^^2?S f 

Remediation Contractor: Coastal Environmental Group_ Year: _2008_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

GX Video of property (DVD) 40315406 

^ Executive Sun-^ary 11^1 1 W i 

H ^ EPA-provided pitiperty sketch Superfund 

s y Signed Access Agreement for subject property 

HJrr Signed Access Agreement(s) for adjacent property 

53^ Restoration Agreement 

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

Q / Confinnation data 

ffl^ Photographs OT^ - f ^r^i^hJlOA ^ OJ^CoMzKyK. 

0 As-built sketch 

W Satisfactory restoration signed by Property Owner 

^ y Property close-out check list signed by EPA 

fAtp- Description of areas not meeting ROD cleanup criteria 

W Utility clearances 

M Property information from Douglas County Assessor's Office 

^ tssktu 

D 

5^^* ^ 
Property Access Checklist 

Property ID; yf)'^2 . 

Property Address: 2, ^ 1 't) ?,>S^T 

n

D

 WORK STARTED 

 WORKCOMPELTED 

ON: 

ON: 

_/

/

 l_ 

/ 

Owner: S(Loi ^

Address: Say n t . 

 [j^')c,\\ct^^ Renter'' 

Phone: 

Fax: 

Phone:

Fax: 

3 ^ \ ­ 5Wlo 2 

Cell/Pager: 

Additional Information: 

Cell/Pager. 

D

[ZJ

[^

D

D

D

 Notification Letter 

 Access Agreement 

 Restoration Agreement 

 Topsoil Sampling (if applicable) 

 Disposal Sampling (if applicable) 

 Garden Sampling (if applicable) 

Sent: / / 

Signed: /Q/77/o ^ 

Signed: JO/22-/i ^ 

/ / 

/ / 

/ / 

By: 

By: 

By: 

By: 

By: 

By: 

0

^

D

D

D

0

D

 Utility Clearance 

 Video/Pliofos (Before) 

 Video/Pliotos (During) 

 Video/Photos (After) 

 Video/Photos (30-Day) 

 Property Completion Agreement 

 Final Report 

Called: ii/2S/O S 

On:j0_/22fl23 

On: / / 

On: / / 

On: / / 

Signed: / / 

Issued: / / 

By: iO/Zl/O h 

By-MtCLl^lOt?, 

By: 

By: 

By: 

By: 

By: 

Air Monitorine (as annlicable) 

D Community D Crew 

Results: 

On: / / By: 1 

D Communit)'

Results: 

D Crew | On: / / By. 1 

• Communit)'

Results: 

• Crew On: / / By: 

Omaha Lead Site 
CONTACT FORM 

Property ID M l^^2l 

Property 

Address: ^g'll r^ ^^^'^^ 31 

Initial Contact: Date: Time: Action: 

Second Contact: Date: Time: Action: 

Final Conlact". Dale: Time: Aclion: 

Final Action: Transmit lo EPA D Olher .Aclion: D 

Commeni. 

Owner 

Comment (s): 

-- J 

Site 

Coordinator 

Cornmeni (s): 
Douglas County Account Information Page 1 of3 

Douglas County, Nebraska Property Record - R1409670000 

Print Report 

NEW Fsatura - Parcel Dimensions available 6 scale 0-50 ft west of QOth St - Vie w OH IXlap Information is valid as of 2008-9-4 Treasurer's Tax Report 

New Feature ->->- > Auto Sales Search 

Owner 

WALKER JR SCOTT 

ETAL 

2811 8 33 ST 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 0967 0000 14 

Account Type: Residential 

Parcel Number: 1409670000 

Parcel Address: 2811 S 33 ST 

OMAHA NE 68105-0000 

Legal Description: ILER ADD LOT 15 BLOCK 3 50 X 114.5 

Value Informatio n 

Land improvement Total 

2008 $6,000.00 $80,900.00 $86,900.00 

2007 $6,000.00 $80,900.00 $86,900.00 

2006 $6,000.00 $79,900.00 $85,900.00 

2005 $6,000.00 $79,900.00 $85,900.00 

2004 $6,000.00 $79,900.00 $85,900.00 

2003 $6,000.00 $79,900.00 $85,900.00 

Sales Informatio n 

Sales Date: 1998-10-01 

Oeecf Type: Book: 2103 Page: 628 

Price: $83,500.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 1997-05-28 

Deecf Type: Book: 2061 Page: 483 

Price: $67,000.00 

Grantor: 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R14... 10/7/2008 
Douglas County Account Infonnation Page 2 of 3 

Grantee: 

Valid/invalid: Valid 

Exclusion Reason: 

Lan d Informatio n 

Acres SF Units Depth Width Vacant 

0.13 5700.0 1.0 114.0 50.0 No 

Improvemen t Informatio n 

Building 1 

TWO STORY 

, tT 13 [T 

12 C 

if 

TKOSfl =: JJOOSf 

^1 1 

X t t 

TJ M ! 3 d 0 S F 

CLICK TO ENLARGE IMAGE 

CLICK TO ENLARGE MAGE 

Square Footage: 1456.0 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: 7.0 

Exterior: Frame Siding Units: 1.0 

interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 2.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1910 0 0% 1910 98 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 720.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R14... 10/7/2008 
Douglas County Accovmt Information Page 3 of3 

Fixture 

Fixture 

Fixture 

Garage 

Porch 

Porch 

Porch 

Porch 

Additional Fixtures 

Base Fixtures 

Bath Full 

Detached 

End Screen 

Slab Roof Ceil 

Slab Roof Ceil 

Wood Deck 

1.0 

1.0 

1.0 

240.0 

24.0 

160.0 

24.0 

216.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R14... 10/7/2008 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2160937. 

Original Call Date: 10/23/08 Time: 5:36 pm Op: ELIZABETH18790 

Work to Begin Date: 10/27/08 Time: 6:00 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 2811 Street: S 33RD ST 

Twp: 15N Rng: 13E Sect-Qtr: 28-SW,33-NW 

Twp: Rng: Sect-Qtr: 

Legal Given: C 


Type of Work: lead remediation 


Location of Work: LOCATE ENTIRE PROPERTY INCLUDING 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 LEVEL3 MUD02 OMAHACOF 0PPDGPR6 QLNNEIF QWEST2 


Service Area Contact Phone Number UtiUty Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

LEVELS LEVELS COMMUNICATIONS, LLC NA Alt: 

Emerg: 8773668344 

Day: 4025047823 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047946 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON Alt: 4024445161 

Emerg: 4024445160 

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

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 8887289343 

Emerg: 4067289343 

QLNNEIF QWEST LOCAL NETWORK NA 

Day: 

Alt: 

Emerg: 

4067289343 

; 8887289343 

QWEST2 QWEST LONG DISTANCE SARA 

Day: 

Alt: 

Emerg: 

8002834237 

3039921926 

8002834237 

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

COASTA L Omaha Lead Superfund Site 

Name: <ic v'tf U^/Zi'-*^ Omaha Lead Site Date: {^-6-c } North Arrow 

Address: 2 J?/I 5, 3 ?'^ A Site SIcetch Time: 

Phone: •?! ; - )yi, ~ C/7< r < 

Team ^^^( / X/ V .^^^^^VID# / T -^"^ / XRF Code BSO\ 

Sample Number Lead Concentration Confirmation Sample 

r<Yes a No 121 £lh r^Yes a No ca ppm 

a<i(g t 5 PP"! ^ ' Yes • No 53 

ppm ^»- Yes n No CS 

ppm i:»XYes n No 13 

ppm / Yes • No 1 ^ 

ppm / Yes • No • 

ppm 

.QJLS#:-15a21 i 

pate Excavated: 11/5/08 

gate; USEPA Sianted Off:[12/9/^^ 

Area Sodded 3628 siq JPt 

5 vJ'-;-

Legend 

Concrete Drip Zone Excavated 

Quadrants Excavated 

Area replaced wit^h Area replaced witli Area left bar e Sod ' ' Rock/Mulch 

Contract #: EP-R7-07-05 Coastal Environmental Group Inc . 
Name: <cdf f U^/^" ^ Omaha Lead Site Date: <^-4'C ) North Arrow 

Address: 2 }?/ l 5. J ?-^ A Site Sketch Time: 

Phone: ^ ; ­ 5W - ^/7 0 < 

Team ^^/( / X/^ / ^;^^VI D # / ^ i^ / XRF Code .S50 

Sample Number Lead Concentration Confirmation Sample 

r^Yes D No Kl 

/TiYes a No 05 

/7 / Yes n No ^ 

/ I Yes n No f? ' 

d.^Pi Z 9K ppm 

i?7,Yes

/ Yes

 n

 tn

 No 121 

 No |* r 

ppm Yes D No • 

.-<t> ' , A:--i< / 'A /A y 1 

i -vli— , t-yp T •" y--;A-^y yyy\y 

"'"91 ^lEfTT'"" 
• # 

Name: ^coi f U^fA ^ 

Address: 2 ;f// 5. ??t^ A 

Phone: fe; - 3 VK - <f/ 7 0 

Team ^>ik f X/^ / x^^^^VID #

Sample Number 

LaS6£Kfi—U ^ 

JS3i 

:A /5^ ^ 

Omaha Lead Site 

Site Sketch 

/ ^ ) ^ / 

Lead Concentration 

jato i: 5a. PP"^ 

'3E| M ppm 

g ^ ^ — gC . ppm 

ppm 

Date: ^-^-^ ^ North Arrow 

Time: 

< 

XRF Code .^6^P I 

Confirmation Sample 

/^/Yes n No BI 

/^^Yes n No C& 

/ ? ' Yes • No ^ 

/ ^ Yes n No •5' 

^T^Yes a No 13^ 

/ Yes n No ^ 

Yes • No • 

i 
# • 

Name: <coi f i^^fH^ ^ Omaha Lead Site Date: ^-€'0 } North Arrow 

Address: 2 ;P// 5. J i^^f^ Site Sketch Time: 

Phone: foi ­ Jr^ ­ ^/'7 0 < 

s.yy-p 
COASTA L CNVIRONHENTAl 

H«in' ^ C • O U p. IN C 

Consent For Access To Property 

RIGHT OF ENTRY TO PREMISES 

Grantor (tlie property owner) consents to and autfiorizes the United States 

Environmental Protection Agency (EPA) or its autfiorized representatives, collectively 

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

following described premises: 

vbAcOvKLA/^/^. WcOfi^' ^ 

Daytime Phone: ^^^ , iSkJ/d^ 

Address of Property 

covered by this 

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 worl< 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 
COASTA L ENVIRONniNTAL 

GROUP , I h 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 

^\gI gran n 

t access to my properties Q i do not grant access to my properties 

Signature Date 

Q

 1 would like to be present during any sampling that is required. 
COASTA L t t ' (KOMMINTAi a « « u ' . 1 r c 

Restoration Agreement 

The purpose of this agreement is to provide a mutual agreement as to conditions of the property prior to 

remediation activities. Ihis 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: /S3 ^ I 

Property Address: ^^^If S Z2>^^ S V 

O'^"'''"- XWxn ^ ^.UJcxU^ n 

Phone: 3>?ri-s^G>c.X 

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

utilities, subsurface features, su/face 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 Befoi^ Start Of Remediation: 

(Use additional sheets as necessary) 

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

5
lar Ifgld-S /^> y ^>^^/A24^/ c 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 1 of Qp 
C O A S T A L ftitvlHOH««|MTA L 

O « O W P , I Mt C 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: . 

/^y . W / / p^^ ^ fe^T Ae.Jjii^y 

Item: 

Item: 

Item: 

Item: 

Item: 

item: 

Item: 

Item: 

item: 

Kem: 

Kem: 

Kem: 

Item: 

Kem: 

Page 2 of h 
C O A S T A L 

C A O U P ^ I NtC 

Items To Be Removed Bv Contractor Durina Remediation And Replaced 

(Use additional sheets as necessary) 

Item: / 

&3 PJ h ? 

item: hz. -hPi y Item: ' / 

Item: / 

Item: / 

/ 

item: / 

item: y Item: 

Kem: 

y 

/ 

Kem: 

y

ttem: y item: 

item: y ^ 

y

Item: / 

Page 3 of (p 
COASTA L 

0 II e u p , ' *t ^ 

Item 

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, Cohtrol 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 

isizes and locations. 

Landscape Inventory 

(Use additional sheets as necessary) 

Quantity Unit Condition/Type/Species 

Square feet 

•^ 

Each 

/ 

Each 

/ 

f Each 

^ Each 

3KS 

Square Feet 

Page 4 of (a 
COASTA L (NVIHOMrVftNTA I 

C M O W P t M C 

Item 

Agreed upon value of 

plant materials not to, be 

renlaced bv contractor. 

Note this value will be 

used to issue a plant 

voucher to the property 

owner. 

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. 

Agreed upon area of 

property to be replaced 

with grass sod. 

Include a sketch of the 

area(s) to be replaced with 

grass sod. 

Area ofCity or County 

property to be landscaped 

per their requirements. 

Include a sketch of the 

area (s) 

Easement Area, to be 

excavated 

Quantity 

0 

Unit 

s 

Condition/Type/Species 

V 

-. 

i 

Each 

SF 

SF 

y0 

y SF 

y 

Page 5 of. 
C OAST A 1. 

AddKionai Comments / Instructions: 

p/o A«5 4395.. 

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. 

Contiactor is S^oatar Skoatare Date 

Page 6 of. 
BVID# \6^9 \ 

XRF PROPERTY SAMPLE SHEET 

Date 

Proiect 

XRFID# 

Shot# 

rO&^n 

cPfiSb 

c^6S ^ 

-JSte-O 

Average

Shot# 

C58L«--» 

c58G.f^ 

=?g(a'^ 

^gno 

Average

Shot# 

Average 

Shot# 

Average 

lab sample # 

U-8-nR 

Omaha lead FP 2n() year opilon 

.^oaq 

Reading Sample area 

ifcpi.c^6t jci.aT 

:0«?, (.-^iciq.qn 

iCflt^.^nti-Q.-ifi Depth 

-aou.ftt„-l:\8.av I 

 c^S-^g^X \f i •a.Ct 

Reading 

.'SaQ. asi:^T«.asr 

tACio.anta-j.Kf. 

5.\a.o^ tOT.s u 

fo^m*,tsa.oB 

Sample area 

te 

Depth 

1?. 

 5(p.V.c31J; 0'5.'g> \ 

Reading Sample area 

Depth 

Address 

Sample time 

sample length 

Shot# 

c98(j,3 

^f?io3 

^Bu ^ 

c?8(pS 

Average

Shol# 

c^PnsL 

<^fi-i5 

6I8H 

c^-l S 

Average

Shot# 

Average 

RETEST AREAS 

Reading Sample area 

Depth 

Lab result Sample area XRF Avg. 

Signature 

:Q8\\ "k.^T, ^V, liS'.SC> am/pm 

30 sec 

Reading 

<os.-A-a-8.il 

cO\.<^<^in.iiL?, 

^'^•~..i.^^t\o,.u^ 

5?,.i«dS.'4i 

Sample area 

ra 

Depth 

Uf 

 8^^\8 t \C^.Cl.'^ 

Reading 

JSf^.lD i 18.^ \ 

avQ.o3^vf!„3M 

s-w.'^f^t.ao.s'A 

^a.q&*-iC4.y « 

Sample area 

^ 

Depth 

LP 

 ^Mc.vU t \ci.;^g ; 

Reading Sample area 

Depth 

Print Hm^ MWy4 
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 

Supervised By 

Certificate of Verification 

2861 

SOIL 

2008-11-08 13:33 

121.57 

Final 

^Av g of 2857-^84^ 

2811 s 33st ^ ^ 

I easement 

Ventry 

1 

[CLEARANCE 
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 259.646 

Supervised By: 

Certificate of Verification 

2857 

SOIL 

2008-11-08 13:30 

30.26 

Final 

15321 

2811 s 33st 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 19.472 
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 285.694 

Supervised By: 

Certificate of Verification 

2858 

SOIL 

2008-11-08 13:31 

30.26 

Final 

15321 

2811s 33st 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 19.900 
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 165.368 

Supervised By: 

Certificate of Verification 

2859 

SOIL 

2008-11-08 13:32 

30.64 

Final 

15321 

2811 s 33st 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 15.781 
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 226.859 

Supervised By: 

Certificate of Verification 

2860 

SOIL 

2008-11-08 13:33 

30.41 

Final 

15321 

2811s 33st 

easement 

Ventry 

1 

CLEARANCE 

± Error 

± 18.413 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2866 

Mode SOIL 

Time 2008-11-08 13:36 

Duration 122.15 

Sequence Final 

Flags 

AVERAGE IAV Q of 2862-2865 

ADDRESS 2811 s 33st 

QUAD/ZONE ^ 2 

INSPECTOR Ventry 

DEPTH 6 

SAMPLE TYPE CLEARANCE f 

NOTE 

Pb 

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 25.330 

Supervised By: 

Certificate of Verification 

2862 

SOIL 

2008-11-08 13:34 

30.33 

Final 

15321 

2811 s 33st 

F2 

Ventry 

6 

CLEARANCE 

± Error 

± 8.108 
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 21.991 

Supervised By: 

Certificate of Verification 

2863 

SOIL 

2008-11-08 13:35 

30.38 

Final 

15321 

2811 s 33st 

F2 

Ventry 

6 

CLEARANCE 

± Error 

± 7.632 
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 255.625 

Supervised By: 

Certificate of Verification 

2864 

SOIL 

2008-11-08 13:36 

30.95 

Final 

15321 

2811 s 33st 

F2 

Ventry 

6 

CLEARANCE 

± Error 

± 19.634 
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 33.783 

Supervised By: 

Certificate of Verification 

2865 

SOIL 

2008-11-08 13:36 

30.49 

Final 

15321 

2811s 33st 

F2 

Ventry 

6 

CLEARANCE 

± Error 

± 8.410 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2871 

Mode SOIL 

Time 2008-11-08 13:40 

Duration 122.00 

Sequence Final 

Flags 

AVERAGE i Avg of 2867-2.870, 

ADDRESS .2811 s 33st 

QUAD/ZONE *DZ 

INSPECTOR Ventry 

DEPTH 13 

SAMPLE TYPE i CLEARANCE 

NOTE 

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 542.920 

Supervised By: 

Certificate of Verification 

2867 

SOIL 

2008-11-08 13:37 

30.68 

Final 

15321 

2811s 33st 

DZ 

Ventry 

13 

CLEARANCE 

± Error 

± 28.451 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2868 

Mode SOIL 

Time 2008-11-08 13:39 

Duration 30.61 

Sequence Final 

Flags 

BVID # 15321 

ADDRESS 2811 s 33st 

QUAD/ZONE DZ 

INSPECTOR Ventry 

DEPTH 13 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 492.472 ± 27.163 

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 512.246 

Supervised By: 

Certificate of Verification 

2869 

SOIL 

2008-11-08 13:39 

30.40 

Final 

15321 

2811s 33st 

DZ 

Ventry 

13 

CLEARANCE 

± Error 

± 27.560 
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 697.450 

Supervised By: 

Certificate of Verification 

2870 

SOIL 

2008-11-08 13:40 

30.31 

Final 

15321 

2811s 33st 

DZ 

Ventry 

13 

CLEARANCE 

± Error 

± 32.075 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2876 

Mode SOIL 

Time 2008-11-08 13:45 

Duration 122.13 

Sequence Final 

Flags 

AVERAGE ^ Avg of 2872-2875 

ADDRESS 2811 s 33st 

QUAD/ZONE 

INSPECTOR Ventry 

DEPTH (6 

SAMPLE TYPE |CLEARANCE| 

NOTE 

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 238.701 

Supervised By: 

Certificate of Verification 

2872 

SOIL 

2008-11-08 13:42 

30.67 

Final 

15321 

2811s 33st 

B2 

Ventry 

6 

CLEARANCE 

± Error 

± 18.910 
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 210.019 

Supervised By: 

Certificate of Verification 

2873 

SOIL 

2008-11-08 13:43 

30.27 

Final 

15321 

2811 s 33st 

B2 

Ventry 

6 

CLEARANCE 

± Error 

± 18.340 
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 272.975 

Supervised By: 

Certificate of Verification 

2874 

SOIL 

2008-11-08 13:44 

30.56 

Final 

15321 

2811 s 33st 

B2 

Ventry 

6 

CLEARANCE 

± Error 

± 20.288 
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 262.929 

Supervised By: 

Certificate of Verification 

2875 

SOIL 

2008-11-08 13:45 

30.63 

Final 

15321 

2811 s 33st 

B2 

Ventry 

6 

CLEARANCE 

± Error 

± 19.875 
^*-'*°"->, i^^^^\ Omaha Lead Site^Flxed Price EP-R7-07-05 i 

5 ^^^ y 8 Coastal Environmental Group inc. >5i ^ ^ ^ ^^"^^JJ ^ www.coastalhazmat.com na ^ COASTAL EHVIIONHCNTAL 

G • 0 U P, IN C 

EXECUTIVE SUMMARY: 

BVID # 15321 - (2811 S 33 ST) 

^ No Issues or Concerns \ ^ Issues/Concerns 

Detail Explanation 
£>£, EPA 

EPA Property Close Out Form 

Property tt: \^?>Q \ Property Address: c^B U "^ . '^' Z 'b^ . 

Date/Time: Owner's Name: ^coV ^ { x ^r,^\.\L»-ij ^ . „ 

Quads Excavated: f j ,t^9: , ?> ^ Contractor Croup Oi'-,r\c^\~r-^Ji. X=Li^^\:u^Sr\V'-^i^''''^^ 

ExcavatloB General 

Yes No 

1. If necessary, were the conect quadrant(s) excavated and restored? ^ 

2. I f necessary, were the cooect areas ofdrip zone excavated and restored? .--' 

GradiuK Sod and VccctatioB 

Yes No 

1. Does the grading around the perimeter of the 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 to be generally healthy and growing? (Onlv evaluate if inspected at a 30 t ^ 

day time period) 

4. Are sodded areas generally fum and evenly graded? • 

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

time period) y 

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

7. Was damage lo landscaping or plant materials avoided? 

i ^ 

Gates, Fences and RcUinin£ Walls 

Ves No 

1. Do gates open and close freely? (If applicable) w ^ 

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

3. Was damage to gates or fences avoided? (Ifapplicable) < ^ 

4. Was damage to retaining walls avoided? (Ifapplicable) t J ^ 

Foundation, SidioK and Cullers 

Yes No 

1. Was damtge to the siding or trim avoided? j . ^ 

2. Was damage to the foundation avoided? ly ^ 

3. Was damage to windows avoided? y 

4. Was damage to windows or door screens avoided? • y 

5. Was damage to downspouts or downspoul extensions avoided? 

Sidewalks and Driveways (Coacrele) 

Ves No 

1. Was damage to driveway surfaces avoided'' ^ 

2. Was damage to walkway surfaces avoided? t ^ 
O rners comments: 

Inspection notes: 

Removal and restoration activates compleie including the 30-day sod warranty: 

EPA ^^\iT^%^i\\2X\\yd,^jUyy^^yyUi^^^-^^ jSfl^ ffp ^ 
Property Completion Agreement 

This agreemeni documents the complclion of remedial activities perlbrmed 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 time in the future, except those items lisled below, if any 

Property ID: \f^g ^ \ 

Property Address: ^f i ^^ ^ ^E: ^ ^ ^ 

Q"""=5Vr-rW \>:^o^\^y ~ 

P"""^- ^^\-fS(olo ^ 

Restoration items in Question: 

A-i-ep f/l4bMi-/A/- I'l^m /Crv/ 'rCtt'^aitln S/t>r/j^ . • 

Item: ' ^ ^ ' J 

item: 

item: 

item: 

Item: 

Additional Comments: 

^ r 0 1 agree r restoration i.f completed, excepi as noted 

I I I rto nol atjree restoration is 

i^hU 

Contractor's Signature Dale