TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATBOM FILE FOLDER 

SAID*; 2011 6 Date:li/^?)| n 

Address-135=!- 5 Z ] b { 

Remediation Contractor* Coastal Environmental Group Year: ij Q I \ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

iOA Video of property (DVD) 

'^^ Executive Summaiy 

\ / EPA-provided property sketch 

V Signed Access Agreement for subject property 

Signed Access Agreement(s} for adjacent property 

Restoration Agreement 

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

V Confinnation data 

iJ Photographs (^g ^cam-^)Qn,F.xcflm^cy7 . SoC? 

y As-built sketch 

!/ Satisfactory restoration signed by Property Owner 

V Property close-out check list signed by EPA 

\I ^ Description of areas not meeting ROD cleanup criteria 

tjf^ Utility clearances 

V Property information from Douglas County Assessor's Office 

30261348 

A ^ 
(D 

Property Access Checklist 

Properf) ID : • WORK STARTED ON: uQhS_ D WORK COMPELTED ON: Pt-opcrtv Addrc5V \'^^- \ 9 . y \ 5 f . 

.Ad(Jrc.<!s 

CclL'Piiger; 

n Notification Letter 

[&] Access Agrccmeol Signed; j£. / Ji)'' Ai 

ResiordtioD Agiecmen t Signed; _£/:i _ 

C J Toj)soil Sampling (if applicable) 

D Dispoiaj Sflmpling (if applicable) | / / 

I I G;irdcn Sampling (if applicable) 

f E f/tilirv' CIca 

i D Communit y [ j Crc « [ On: / ( Bv: 

Rr.sulr.v; 

L J Communii y L J Crew On: ! Bv: 

i Rcsiilis: 

[ L J Communit v I [ Crc " On: B\: 

Re.S'iilt.'; 

Omaha Lead Site 
(^ y J Douglas County Account Information(^: J^ 

Douglas County , Nebraska . ropcrt y Record - R2220980000 

4/17/2011 

Information is valid as of 2011-4-13 

Nev.* Feature -•=$=#'

Print Report 

View Interactive GIS Map 

Treasurer's Tax Report 

 Subdivision Sales Search 

Owne r 

JIMENEZ RENE 

ETAL 

13511 HASCALL ST 

OMAHA NE 68144-0000 

Propert y Informatio n 

Key Number: 2098 0000 22 

Account Type: Residential 

Parcel Number: 2220980000 

Parcel Address: 1357 S 21 ST 

OMAHA NE 68108-0000 

Legal Description: SHULLS 3RD ADD LOT 21 BLOCK 1 30 X 128.5 

VaOue InlTonnniattDon 

2010 

2009 

2008 

2007 

2006 

2005 

Land 

$3,900.00 

$3,900.00 

$3,900.00 

$3,900.00 

$3,900.00 

$3,900.00 

Improvement 

$52,600.00 

$52,600.00 

$53,400.00 

$53,400.00 

$68,400.00 

$68,400.00 

Total 

$56,500.00 

$56,500.00 

$57,300.00 

$57,300.00 

$72,300.00 

$72,300.00 

SaDes Informniation 

Sales Date: 2003-03-14 

Deed Type: WD Book: 2240 Page: 473 

Price: $45,000.00 

Grantor: CHALRES SMITH 

Grantee: HECTOR JIMENEZ-GALVAN 

Valid/Invalid: Valid 

Excluson Reason: 

Show All Transactions 

Land Infforonatoon 

Acres SF Units Depth Width Vacant 

0.08 3840.0 1.0 128.0 30.0 No 

.mappinq-online.com/.../accountinfo.js.. 1/3 
4/17/2011 Douglas County Account Informatio 

I Improvement Informatiot 

Building 1 

1 1/2 STORY FINISHED 

• e . 5 .1 . 1 J "•. I . , 

- " ' - J I -.-n " 

6ll»f!<fFfctT 

: ; c 

GOn C P.F 

L._ 

avTirt UIOCll G tt 

aooosF 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 840.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Awsrage 

Built As: 1 1/2 Story Fin 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: 3.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year 

year Built Physical Age Remodeled Remodeled Built 

1942 0 0% 1942 69 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 680.0 

Fixture Base Fixtures 1,0 

Fixture Bath Full 1.0 

Garage Detached 280.0 

Porch End Screen 40.0 

Porch End Sdid Wall 160.0 

Porch Wood Deck 16.0 

.mapping-online.com/.../accountinfo.js.. 2/3 
4/17/2011 Douglas County Account Informatio 

J^SlfttSt (g 

^ /

PieroeSt PieroeSt PitrotiSt 

(0 

Poppleton Ave Ol 

I 5 

m CO 

i 

O) 

William St 

(A 

I CoJumtJus 

Wootworth Ave * Perk , 

(0 « l 

PiMSI 

-H«ofi Porei HiClwrySt 

I . : 

HJckery 

C>fi^^k Map data 42011 Gcxnie - Terrffe of Use 1 _Xi ifa»l 

The abo\« map is powered by Google, and is intended to provide a general idea of a property's location. If you 

require a more exact property location, you may use the Interactive GIS Maps that are maintained by our 

office. 

.mapping-online.com/.../accountinfo.js. 3/3 
• 

• 

• 

• 

As-Built Drawing 

OLS: 20115 

COASTAL DATE EXCAVATED: 8/24/2011 

EnvironmentarGroup DATE USEPA SIGNED OFF: 9/22/2011 , Omalia Lead Superfund Site 

AREA SODDED: 1350 

Inc. 

Samplin g Address : 13S7 S 2 1

Sampl e Numbe r 

RYASCPXA-2011 5

RYBSCPXA-2011 5

R YCSCPXA-2011 5

R YDSCPXA-2011 5

RDZSCPXA-2011 5

T^ozoopxA-goii s

RPZoopxA-ao i 1 s

 F l 

 F 2 

 B 1 

 B 2 

 D Z 

 e z 

 pa­

 S T 

Legend : F l = Fron t Left . F 2 • Fron t

SCRAPPED 

& SODDED 

DZ = 744PPM@13" 

K.;. Z"» i X •'reolcij »i-t.|-"ct>-

Omah a Lea d Sit e 

Sit e Sketc h 

Lea d Sampl e L A B Concentratio n Collecte d 

3 - » I p p m 

p p m 

3 I 3 

p p m 

p p m 

p p m 

p p m 

p p m 

• 

•

•

• 

Numbe r of Sample s = I 5 oJ 

HiiiiiniiininiiiiniiiiiiHi 201 15 Exterio r Patn l North Arrows 

r ^ Goo d 

I I Poo r 

I I No t pain t 

Sample s Collecte d 

Fir m 

Dat e 

Tim e 

X R F Unit:

Dat e 

Tim e 

Staf f 

f:3 0 f^n^ 

Sample s Analyze d 

 Cn5*i O Book : p_ CT I 

/ O -Q g 

^ d . 

rrsvi/ 

 Right , B l = Bac k Left . B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden . P Z = Pla y 

All quadrants ara aa vlawrad from the atreet. racing property 

MAY 2 9 ZU J3 

B2 = 190PPM@6" 

o 

$, Zl i t 

DRIP ZONE EXCAVATED 

QUADRANTS EXCAVATED CONCRETE 

AREA REPLACED WITH 

AREA LEFT BARE AREA REPLACED WITH SOD ROCK/MULCH 

CONTRACT #: EP-R7-09-06 COASTAL ENVIRONMENTAL GROUP, INC. 
^/^5 //./ 

Omaha Lead Site 

Site Sketch 

Sampling Address: 1357 s 21 ST 

Sample Lead Sample Number LAB Concentration Collected 

RYASCPXA-20115 Fl 3 1 1 ppm D 

RYBSCPXA-20115 F2 21 ^ ppm i D

RYCSCPXA-20115 B1 3 I 3 ppm D 

RYDSCPXA-20115 82 S £ S ppm D 

RDZSCPXA-20115 DZ ilfla__ppm D 

^GgGOPXA-20115 ©2 "" ppm D D 

RPZOCrXA-20115 P2- _Z____ppm D D 

Number of Samples = 5 

Legend: Fl = Front Left, F2 • Front Right, B1 = Back Left, B2 = Back Right 

All quadrants are as viewed from Itie street, facing 

.^,t,>rt. ;. 

III 20115 

Exterio North Arrow r Paint 

[2f Good 

• Poor 

[~~) Not paint 

Samples Collected 

Firm: ^P ^ f^f^ 0 9 

Date: ^-iQ-o B 

Time: /:3 6 fr>^ 

Samples Analyzed 

XRF Unit: dbH O Book; ^Q"? 

Date Q-IO'OB 

Time £tL 

Staff MSW 

DZ = Drip Zone, GZ = Garden, PZ = Play 

property 

Rev :iA>« N Cftaied. iVt-FebJ-IH r>M701.0l : 
miwiiiiiiiy 20115 

Omaha Lead Site Exterior Paint Nortti Arrow 

Site Sketch [ ^ Good 

• Poor 

Sampling Address: 1357 S 21 ST • Not paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

RYASCPXA-20115

RYBSCPXA-20115

 Fl 

 F2 

3-7 1 

27 ^ 

ppm 

ppm 

O 

O 

RYCSCPXA-20115

RYDSCPXA-20115

 B1 

 B2 

3 / 3

55 ^

 ppm 

 ppm 

D 

D Samples Analyzed 

RDZSCPXA-20115 DZ ^ifi3 ppm D XRF Unit: Gi5H 0 Book: 20* 7 

^GZGCPXA-20115 S2 ~ ppm o O Date: G> • I P ­ O Q 

RrZOCPXA-20115 P* •"~ ppm o D Time: P M 

Number of Samples = 5 Staff: MS\ J 

Legend: Fl = Front Left, F2 = 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 
O P fefl^t' 

20115 

Omah a Lea d Site Exterior Paint Nortti Arrow 

Site Sketc h [ ^ Good 

• Poor 

Sampling Address: 1357 S 21 ST [~| Not paint 

Sample Number Lead Sample Samples Collected LAB Concentration Colleded Firm: /^PA? f^g Q B 

RYASCPXA-20115 Fl 311 ppm 0 Date: <,-\U-6 ^ 

RYBSCPXA-20115 F2 21H ppm i D 

Time: /.j<? f>fy^ 

RYCSCPXA-20115 B1 3 13 ppm O 

Samples Analyzed 

RYDSCPXA-20115 B2 ppm D 

RDZSCPXA-20115 DZ 

^ 8 ^ ppm If O XRF Unit: CobH O Book: 2c n 

^OZOGnXA-20115 GZ ppm O Date: _ 

RrZOCr)(A-20115 PS ppm 0 O Time: _ 2tL 

Staff: Number of Samples • 

D tISW 

Legend: F1 = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from ttie street, facing property • • r • • • •eS.t \ es t • • r r^— ENTEEKD ; 313 1 5SS . MAY i • 9 ZUJS 

^ a 82­

/ 

: Gft'^t' ; ^Xi* ^ 

Coioc : 

- : : ^ ^ : 

r^ i • J

F^ 

X : 

0 • w : • • • 

o ^ o 

X 

• ;0 

I. \UA 

21H 

Hd ,.. r — cr?... 3 . 1 • 

311 

1=' fl : 

^ 

WAL K 

$ 2/5t 

2.AI8.N Ore, lad (W-FebJ « 1447(11.(1 
^C;^ - ^ 

RIGHT Ot^ ENTRYio PREK/IISES 

Grantoi (the property' owner) consents to and authorlies the Unrted Slates 

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

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

follov/ing described premises: 

Owner's K'ame: Daytime Phone: v^ii^evvici Kcv\^ 

Addres 1351 ?)."9,\SV' s 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 

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 workbefore 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 
o o 

;I( J^ 

\^/ / 

C O A S 1 H i 

< Rerriove obslructicns incl^dirto bosis, Uoilets, vt-hicSes, plcyscape items, vi'ood 

piles, dog houses, etc, 

' Remove flov^'si bulbs oi pianis thai ihe Grantoi or ihe Grantoi's lenani may wish 

to save; 

c Water and meintain leplacement vegetation, including fertilizer application, as 

necessary' subsequent to an initial watering period by EPA, 

• Abide by health and safety guidance provided by EPA; 

c If the property is rented, assist EPA in obtaining tenant approval for access to 

the property to perform the work 

I Allow videotaping and/or photographing of the properly 

AGREEMENT NOT T O INTERFERE 

The Grantor agrees not to interfere or tampei with any of the work 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 tc 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 

I grant access to my properties Q I do nol grant access to my properties 

^:A^dl 

Signature Date Signature Date 

O I would like lo be present during any sampling that is required. 

Page 2 of 2 
Restoration Agreement 

The purpose of this agreement is lo provide a mutual agreemenl as to conditions ofthe property prior lo 

remedialion acliviiies. This will also serve as documentation for Ihe purpose of assuring that restoration 

activities are compleled to the satisfaction of the propeny owner and the United Stales Environmental 

Protection Agency (EPA) 

'Property ID: ^QU ^ 

Property Address: [Z^c^-^ g . 1^[ S ^ 

Owner: \^^^e ^ .\\(Y\ar\e2 ^ 

Phone: 

On the attached diagram(s) indicate area(s) to excavate, surface structures and landscaping features and 

access localion(s) to be used by the contractors. Indicate distances, depths, material types, etc. 

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

necessary. 

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

The femoval, storage, dteposat, end/or return of thgse Vtame te the Ownsr-'g responsible 

Item: 

(\y<^A^ g f u^L^ 

Item: 

Hem: 

Item: 

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

j Item: 

' '^'A^ K P^Mr 

Mem: 

Item: 

Item: 

Page 1 of. 
o o 

C O A « 7 A t 

Items to Be Removed By Cointir3ctor_P'yirm£_Remediat»ofii and 

fhem: ^^^ 

Item: 

Item: 

Item; 

Landscape Inventory 

Item Quantity Unit Condition/Type/Species 

Prc-exisun^ property area, Quadrants thai will be excavated, ihat 

i.s covered with gra.ss. 

Number ol trees : 2 inch Each 

trunk diameter 

Number of trees <= 2 inch CD Each \>ce, Ai^^"^^ 

trunk diameter 

Number of Sprinlder 

Zones, Control Valves, 

Each Timers, Heads, etc. ^ 

Attach a sketch of the 

Sprinkler layout. 

Number of and size of 

each garden/ flower bed Each 

^ area. Square Feel 

Attach a sketch of relative 

sizes and locations. 

Agreed upon value of plant 

materials nol lo be 

replaced bv contractor. 

a 

Note this velue v/W\ be 

u$ed to issue t plcnf 

voucher to the property 

owner. 

Easement Area, to be 6 C

Each 

excavated f)^^' ' {/^^^-^^ 

Page 2 of. 
o o 

Additional Comments / Instructions: 

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

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

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

using as s drivevtray or vehicle parking area. >f 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 Vtfithstanding any removal or replacement of soil by the EPA 

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

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

[D Please check this box if you understand the information outlined above. 

:3L^." ^ ^O^- P 5/.^ ^ Tr ^ ' ^"^- ^ 

ii&<, ' 

^ 5^./7yei- /U/f^ "Sc^D fe I 

O Check the box if Owner does nol v^ant CEG to document interior foundation walls and possible 

pre-existing damage. By checking this box CEG is nol responsible for any damage done to the 

Jnterior of house, including foundation cracks or fissures. 

O 1 do not agree 

Owner's Signslure Date 

Page 3 of 
BVID# zjDi/y 

XRF PROPERTY SAMPLE SHEET 


Date 9-/0-f l Address I3>S 1 3 2-/ 3 T 

Project Omaha Lead ARRA Sample time am/pm 

XRF 1D# •?90P3 L sample length 30 sec 

Shot# Reading Sample area Shot# Reading Sample area 

y ^ n't' ^ 9 o B ^ V? 7(^¥t^ / ( 7 ^ 

J D 9(. 183 =^ ^ a Depth 1911 n Depth 

V7 l-7x i 9 0 / " 5 - / n y ^ /v ( ^ " 

Average /-7^-^? 6 Average 1%-^ / 9 

Shot# 

r? 

r¥ 

5~5 -

Average 

Reading 

77^7: ^ / / 

-7Z 7 2 39 ' 

-7Z 5 t J ? 

Sample area 

PZDepth 

IJ' ' 

7y</^yo 

Shot# 

Average 

Reading Sample area 

Depth 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

Shot# Reading 

RETEST AREAS 

Sample area Shot# Reading Sample area 

Depth Depth 

Average 

Slgnature_ ,Sl^Ci^ 

Print ~\^c.^.'eJ rk-^c^ ^ 

Average 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 178.271 

Supervised By: 

Certificate of Verification 

48 

Soil 

2011-08-25 16:44 

90.64 

ppm 

2 

Final 

Avg of 45-47 

1357 s 21 st 

EA 

1" 

KING 

EX-SITUS 

confirmation 

± Error 

± 20.554 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 179.193 

Supervised By: 

Certificate of Verification 

45 

Soil 

2011-08-25 16:43 

30.19 

ppm 

2 

Final 

20115 " 

1357 s 21 st 

EA 

1" 

KING 

EX-SITUS 

confirmation 

± Error 

± 20.601 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 183.620 

Supervised By: 

Certificate of Verification 

46 

Soil 

2011-08-25 16:44 

30.25 

ppm 

2 

Final 

20115 

1357 s 21 st 

EA 

1" 

KING 

EX-SITUS 

confirmation 

± Error 

± 20.850 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 172.001 

Supervised By: 

Certificate of Verification 

47 

Soil 

2011-08-25 16:44 

30.20 

ppm 

2 

Final 

20115 

1357 s 21 st 

EA 

1" 

KING 

EX-SITUS 

confirmation 

± Error 

± 20.211 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 190.259 

Supervised By: 

Certificate of Verification 

52 

Soil 

2011-08-25 16:48 

91.29 

ppm 

2 

Final 

Avg of 49-51 

1357 s 21 st 

B2 

6" 

KING 

confirmation 

confirmation 

± Error 

± 19.693 

Ji ^ n^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 204.162 

Supervised By: 

Certificate of Verification 

49 

Soil 

2011-08-25 16:46 

30.16 

ppm 

2 

Final 

20115 

1357 s 21 st 

82 

6" 

KING 

confirmation 

confirmation 

± Error 

± 21.789 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 191.524 

Supervised By: 

Certificate of Verification 

50 

Soil 

2011-08-25 16:48 

30.54 

ppm 

2 

Final 

20115 

1357 s 21 st 

82 

6" 

KING 

confirmation 

confirmation 

± Error 

± 19.121 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 175.090 

Supervised By: 

Certificate of Verification 

51 

Soil 

2011-08-25 16:48 

30.59 

ppm 

2 

Final 

20115 

1357 s 21 st 

B2 

6" 

KING 

confirmation 

confirmation 

± Error 

± 18.169 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 56 

Modp ^ _ Snil 

Time 2011-08-25 ] 

Duration 90.67 

Units ppm 

Sigma Value 2 

Sequence Final 

Flags 

AVERAGE Avg of 53-55 

ADDRESS 1357 s 21 st 

QUADRANT DZ 

DEPHT 13" 

XRF TECH KING 

MISC confirmation 

NOTE confirmation 

± Error 

Pb 40.375 

ppm 

744.223 ± 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 779.666 

Supervised By: 

Certificate of Verification 

53 

Soil 

2011-08-25 16:50 

30.01 

ppm 

2 

Final 

20115 

1357 s 21 st 

DZ 

13" 

KING 

confirmation 

confirmation 

± Error 

± 41.655 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 727.360 

Supervised By: 

Certificate of Verification 

54 

Soil 

2011-08-25 16:51 

30.32 

ppm 

2 

Final 

20115 

1357 s 21 st 

DZ 

13" 

KING 

confirmation 

confirmation 

± Error 

± 39.600 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 725.644 

Supervised By: 

Certificate of Verification 

55 

Soil 

2011-08-25 16:52 

30.34 

ppm 

2 

Final 

20115 

1357 s 21 st 

DZ 

13" 

KING 

confirmation 

confirmation 

± Error 

± 39.870 
i^QL\ Omaha Lead Site—Fixed Price EP-R7-09-06 

o ^^^ ^ I Coastal Environmental Group Inc. ^'^S?'^^ 

V^^^Tp * www.coastalhazmat.com "'^^^^ 

%PBOi«^ COASTA L EHVmONHENTAL 

GROUP . IN C 

EXECUTIVE SUMMARY: 

BVID #20115-(1357 S 21 ST) 

~x\ No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation: 
0 o 

Property Completion Agreement 

This a^ireemeni duciiments lhe complclion ol remedial acliviiies perl'oimed on my propeny My signaiuie 

will designate ihai I am satisfied with lhe restoration of my properly, and ihal no items are m questions, 

now, or al any lime m the future, excepl those items listed below, if any 

JVopcrty ID^_^^^^ ^ 

Property Address: y-. c^-^ <: ^ v ? . \ 

Ownci': Q „ \-

Phone: 

r 

KO^ -

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

1 ^ I ayrcc icstoialion is completed, cxccpl as nnleri 

I _J I rio not x]iitc rrsioratinn is completed 

Q, 7> .. W/' 

Owner',"; Signature r Dale Dale Conti atlfuys Signaliire 
o 

EPA. Property Close Out Farm 

Frcpirfy#: AC A I I A? 

Quids Esnvstfd; (j '^j S)~i- CcPitrtrlcr Gniir CoOv S TCVi \ 

E;,cE^•tiloE ^ ts No Gtren.! 

1 If nccessiT), ^'^^re liit. cnrrtcl qiiadrenlfs) txc«vfied &nd restored'' 

? If neccsssry, v,erc the cornel Ere&5 ofdrip 2onc e>iC8valed and restoird'' 

Grr filpg Sod ted VeyeUilioc 

1 Docs Iht greding around the perimeter ofthe hou« in e«ci!\aifri Brcss ftntrally sl(if>f B^^av 

frorr the house? _ 'AD 

2 HBS sod been leid in all artts Ihal were excevsied? A 

Does lhe sod appear to be generally healthy end growing'' (Only esTiluaie if msprrird ei p *n 

dey time period) 

^ Are sodded areas generally firm and evenly graded? 

J_ A "^ Ar t thejoints berween the sod strips penerzlly tight? fOnl)' f valu^K if inspected 2i c "0 d3N 

time period) 

6 Vi'as the property graded such thai waitr will not pool en the propeny'' 

7 W2S dfimigt Vo landscaping or plant msieritils avoided'' 

Gales, Ftncca apd Rtuinin g Walls Vt-< .N(. 

r" Do gates open and close freely'' (Ifapplicable) 

Were all gates or fences taken down during resloration acliviiies reinstalled? (I) applirahlr) 

". Was damage to gates or fences avoided? (Ifapplicable) 

'7 

4 WSLS dam»ge 10 retaining walls avoided? (Ifapplicable) 1 /I" 

f oupdaiion, SidinR and Gu<t»rs 'les .N'c 

1 Vr'as damage to the siding or trim avoided? 

7. Was damage to the foundation avoided? 

Was damage to windows avoided'' A 

r ^ Wa.s damage to windows or door screens avoided'' 

\Va."i damage to downspouls or downspoul exiensions aviudcd'' 

Sidewalks and Driveways (Concrete) Vcs N(' 

1 Was damage tc driveway surfaces avoided'' 

2. Wa.s damage lo walkway surfaces avoided'' 
o 

O'-^.TiP.vt camiJifnH: 

] n.'-nfc<inn no(f«^: 

Reniova) and re,sinrali()fi rictivate.s coniplcle including (he JO-day .sod warrnnr)' 

\-.PA Rcpresentalive _^ ^ Dale: <=i\z^i>