TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: ;;)3f=>^^ Date: Qijl ^jtf l 

Address: 2 6 (^Ip AaCV>^CNr^ ?S^ 

Remediation Contractor: Coastal Environmental Group_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

Year: 2008 

40314822 

Superfund 

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

Confirmation data 

a/ Photographs pr-g^-g^VC^/?Jl&0^ 9)LfJiMx^^ Sad^ \iC\£XS6<X 

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 

/ 

J 

Utility clearances 

Property information from Douglas County Assessor's Office 

^ 

^ 

D 

9-oCmyi?oA 

Signature Date 

y/of 
» & ^ 

Property Access Checklist 

Pi-ODC-ty ID: g^ ^ 1^4 

n WORK STARTED ON: _/ /_ 

D WORKCOIMPELTED ON: / / Pn)|)eity Address: 3i~^6 . ZSkcJi^orK S/-. 

Owner: f^^ ^ ilok r 

Address: 

Phone: t^bd.'^^^-^'^O y 

Fax: 

Ceil/Paticr: 

^ 

C] Notification Letter 

1^ Access Agreement 

[^ Restoration Agreement 

CU Topsoil Samplinj; (if applicable) 

1 1 Disposal Sani|)lin)i (if applicable) 

1 1 Garden Sam|)lin<i (if applicable) 

1 IEI Utility Clearance 

II D Video/Photos (Before) 

n Video/Photos (Durinj^) 

1 D Video/Photos (After) 

1 n Video/Photos (3()-D:iy) 

1 1 Property Completion Ajjrcemcnt 

1 1 Final Report 

Renter: 

Phone: ^K Q 

Fax: C \ 

Cell/Paser: 

Additional Information; 

Sent: / / By: 

Si<4ned:_^/2f7 ^ By: t^h 

Si<:ncd: ^ 19^1^" ^ Bv: Ah 

1 1 By: 

' ' By: 

1 1 Bv: 

— - Called: X/' I 1 " 1 By: ( ^ / ^ V/> <? 'VK 

On: / / By: 

On: / / By: 

On: / / By: 

On: / / By: 

Signed: / / By: j 

Issued: / / By: 1 

Air Monitorinj; (as applicable 

n Community • Crew 

Results: 

) 

On: / / By: 

1 d j Community

Results: 

CU Cre>v On: / / Bv: 

CD Community

Results: 

CU Crew On: / / By: 

Omaha Lead Site 
Douglas County Account Information Page 1 of 3 immiE 

Dougla s County , Nebrask a Propert y Recor d - R233973000 0 

Print Report 

Parcel Dimensions available @ scale 0-50 tt 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 

HUBER PAMELA L 

ETAL 

3566 JACKSON ST 

OMAHA NE 68105-0000 

Propert y Informatio n 

Key Number: 3973 0000 23 

Account Type: Multiple Res 

Parcel Number: 2339730000 

Parcel Address: 3566 JACKSON ST 

OMAHA NE 68105-0000 

Legal Description: UNION SQUARE LOT 7 BLOCK 0 1/2 VAC ALLEY ADJ ON N & 50 X 132.25 

Valu e Informatio n 

Land Improvement Total 

2007 $6,500.00 $57,200.00 $63,700.00 

2006 $6,500.00 $41,000.00 $47,500.00 

2005 $6,500.00 $41,000.00 $47,500.00 

2004 $6,500.00 $41,000.00 $47,500.00 ij 

2003 $6,500.00 $41,000.00 $47,500.00 

2002 $0.00 $0.00 $0.00 

Sales Informatio n 

Sales Date: 2004-05-17 

Deed Type: WD Book: 2004 Page: 082810 1 

Price: $92,450.00 

Grantor: John Clark Etal 

Grantee: Pamela Huber 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: 2003-10-17 

Deed Type: WD Book: 2003 Page: 206912 

Price: $50,000.00 

Grantor: Harry Weiner 

http://douglasne.mapping-on]ine.com/DouglasCoNe/static/accountinfo.jsp?accountno=R233... 5/7/2008 
Douglas County Account InArmatio iTforn n Page 2 of 3 

Grantee: John Clark Etal 

Valid/Invalid: Valid 

Exclusion Reason: 

Lan d Informatio n 

Acres SF Units Depth Width Vacant 

0.15 6600.0 1.0 132.0 50.0 No 

Improvemen t Informatio n 

Building 1 

y -Iii—I 

5«cand Roor 

'V4J 11 i.j t 

Two Story 

CLICK TO ENLARGE IMAGE 

CLICK TO ENLARGE IMAGE 

Square Footage: 1507.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: End Condition: Fair 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 6.0 

Exterior: Frame Siding Units: 2.0 

Interior: Drywall Baths: 2.0 

Roof Cover: Composition Shingle Bedrooms: 4.0 

Roof Type: Gambrel Stories: 2.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1905 0 0% 1905 102 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 9 ft 548.0 

Fixture Additional Fixtures 1.0 

Fixture Base Fixtures 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R233... 5/7/2008 
Douglas County Account Informatio mjn n Page 3 of 3 r 

Fixture Bath Full 1 2.0 1 

Porch End Screen 160.0 1 

User 2 apt conv 1.0 

User code125tomodel 1.0 

User MLS UPDATE 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R233... 5/7/2008 
CONTACT FORM 

Property ID # 55rv^ 

Property 

Address: ss'fc^ y^ckio^ Sf, 

Initial Contact: Date: Time: Action: 

Second Contact: Date: Time: Action: 

Final Contact: Date: Time: Action: 

Final Action: Transmit to EPA D Other Action: D 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

' 
Page 1 of2 

Create Another Ticket Back to Irth Internet Send Email 

• YOUR TICKET NUMBER IS 2103711. 

Original Call Date: 8/11/08 Time: 11:44 am Op: ELIZABETH18790 


Work to Begin Date: 8/13/08 Time: 12:15 pm 


State: NE County: DOUGLAS Place: OMAHA 

Address: 3566 Street: JACKSON ST 

Twp: 15N Rng: 13E Sect-Qtr: 20-SE,21-SW 

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 


: UNStJRE OF CORNER LOT. 


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 


BSHPCLKS CXCATV LEVEL3 MCLEODNE MUDOl OMAHACOF 0PPDGPR5 


QLNNEIC 


Service Area Contact Phone Number 

Utility 

Type 

BSHPCLKS NEBRASKA HEALTH 

SYSTEM MA 

Day: 4025523459 

Alt: 4025523347 

Emerg: 4025595111 

CXCATV COX COMMUNICATIONS, jjEIDI 

Day:

Alt:

 4029340469 

 4029340469 

Emerg: 4029329757 

LEVEL3 LEVEL3 COMMUNICATIONS, 

LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MCLEODNE MCLEODUSA NO NEED TO CALL OUT 

EMERGENCY 

Day: 8002891901 

Alt: 

Emerg: 8002891901 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 8/11/2008 
Page 2 of2 

MUDOl 

OMAHACOF 

OPPDGPR5 

QLNNEIC

METROPOLITAN UTILITIES 

DISTRICT 

CITY OF OMAHATRAFFICSEWER 

OMAHA PUBLIC POWER 

DISTRICT 

 QWEST LOCAL NETWORK

EDWINA 

RON 

NA 

 NA 

Day: 4025047823 


Alt: 


Emerg: 4025047946 


Day: 4024447197 


Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


Alt: 8887289343 


Emerg: 4067289343 


Day: 4067289343 


Alt: 


Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 8/11 /2008 
22544 

W As-Built Drawing ^ 

COASTA L Omaha Lead Superfund Site 

Extsrior Paint 

[ J Good 

Omaha Lead Site 

Site Sketch • Poor 

Sampling Address: 3566 JACKSON ST r~l Not paint 

Sample Number Lead Sample LAB Samples Collected 

Concenlration Collected Fimi 

RYASCPXA-22544 Fl ^ 1 2. ppm 

D Date 17.-LB-07 

RYBSCPXA-22544 F2 C 7 3 ppm n Time 1;ML? 9-1^. RYCSCPXA-22544 B1 flfio ppm Samples Analyzed RYDSCPXA-22544 B2 J026 . ppm D 

RDZSCPXA-22544 DZ J'^t e ppm n 

XRF Unit: (If^H O Book: ^O ^ 

nogcor)(A-ee£i44—ee ppm n Date 0/-2 3 -OP. f^PZGCPXA-22&M PS- — ppm a n Time AJ!±. n Staff Number of Samples - O ^•stv 

Legend: F1 = Front Left, F2 = Front Right, B1 = Back Left, 82 = Back Right DZ = Drip Zone. GZ • Garden, PZ = Play Alt quadrants are as viewed from the street, facing property 

OLS#: 22544 

Date Excavated:8/25/08 

Date USEPA Signed Off: 10/15/08 

Area Sodded 1767 sq ft 

Legen d 

Concre'te Drip Zone Excavated Quadrants Excavated 

Area replaced with Are a replace d wit h 

Are a lef t bar e Sod ' ' Rock/Mulch 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
''SeAkmy 

22544 

Omteih Extarict Paint North Anow f I lahaa Lead Site 

[jJ Good Site Sketcli • Poor 

Sampling Address: 3566 JACKSON ST [~~) Not paint 

_ 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Firm 

Samples Collected 

RYASCPXA-22544 F1 5" T Z ppm D Date 

RYBSCPXA-22544 F2 47 3 ppm D Time 

RYCSCPXA-22544

RYDSCPXA-22544

 Bl 

B2 

flfio 

i026 . 

. ppm 

ppm 

D 

D Samples Analyzed 

RDZSCPXA-22544

•ROZOODCA £2544

 DZ 

e ? 

29«i8 ppm 

ppm D 

D 

D 

XRF Unit: CaFiHO Book: 

Date g/-2 3 -QF> 

2Q ^ 

RPZOCPXA-22544 P2­ — ppm D D Time A ^ 

Number of Samples • LiD Staff: f1*i W 

Legend: Fl = Front Left, F2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from Ihe street, facing property 
^'xC^mUft 

ljh)ff Qyd 

Omciha Lead Site 

Site Sketcti 

Sampling Address: 3566 JACKSON ST 

Sample Number Lead Sample 

Concentration Collected 

RYASCPXA-22544 F1 s i z ppm 

RYBSCPXA-22544 F2 

ppm d 

RYCSCPXA-22544 81 ppm a' RYDSCPXA-22544 B2 ppm 

RDZSCPXA-22544 DZ 2^^6 ppm 

•f^GZOCP)(A-22044 e ? ppm D 

RPZGCrXA-22544 P2- ppm D 

LAB 

D 

n 

n 

D 

22544 

Exterior Paint North Arrow 

[3^ Good 

• Poor 

• Not paint 

Samples Collected 

Firm 

Date 

Time 

^ 

Samples Analyzed 

Number of Samples = ^ [ Q 

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 the street, facing property 

•tlMvi^^ H\mm^ 

I ^ 

-Js: 

n XRF Unit: Qifi'iO Book: 2Q ^ 

D Date g/-23-C>P? 

n Time AM 

Staff M'^W 

Rev 5 \ (VCL iey^iv^,7^ ^^ an y 

lo'Oi 0? ^^ v fip\r^ 

'••-'"^ - v"->^^-'- — -•'• *|^'.e x ^ -••- ^ - '• ^ — -• 
22544 

Omah Exterior Paint North Arrow a Lead Site 

[^Goo d Site Sketch • Poor 

Sampling Address: 3566 JACKSON ST f~| Not paint 

Sample Number 

RYASCPXA-22544 F1 

Lead 

Concentration 

6" 7 Z ppm 

Sample 

Collected LAB 

D 

Firm: 

Date: 

Samples Collected 

FD/1 CC,R\A/ 

RYBSCPXA-22544 F2 C>73 ppm D Time: 

RYCSCPXA-22544 

RYDSCPXA-22544 

Bl 

82 

860 

<026» 

ppm 

ppm 

D 

D Samples Analyzed 

RDZSCPXA-22544 DZ ppm D XRF Unit: CoFiHO Book: 20 ^ 

RGZOODC/i gig544 

RPZOCPXA-22544 

-Qg 

-PZppm 

ppm 

U 

u 

D 

D 

Date 

Time oi-zz-cp^ An. Number of Samples = ^ I Q Staff M^ur 

Legend: Fl = Front Left, F2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ • Play 

All quadrants are as viewed from tlie street, facing property 

^ 

1 ^ r •? :^ '

: ( • M. •? 2 i r 

^i 890 

^:i.^\ ^ ' 

s^' y 

Jl 

£ 0 ^ ^ ^ 

V—^ 

D2.= 2t*)8 

102 

5V # r 

j a . 

^ 

57Z 

Fl n 

67 J 

j"pcv<;s^^» 1?+ Creat«l 14-[VCJI7 
COASTA L invtaOMH f NfA i 

C • O U * 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: 'X'x^'i^ 

Owner's Name: Daytime Phone: 

ram %\dKy ^»-<3Tz)-5^ro7 

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 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 
^"^

 r-i '# 

< # 

COASTA L 

• 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 

[0^r gran a 

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

Q I would like to be present during any sampling that is required. 
m^ 

C r> A S T A L 

Restoration Agreement 

The purpose ofthis agreement is to provide a mutual agreement as to conditions ofthe propert>' prior to 

remediation activities. This wil l 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). 

Property ID: ^.Q^tf ^ 

Property Address: "S^U ^ cra(^/«^ ^ ^ 

Owner: pa\Y\ Uubgr- Phone: pQn •:^<:i>n 

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

utilities, subsurface features, surface structures and landscaping features, access location(s) to be used by 

contractor, and the direction of North. Indicate distances, depths, inaterial types, etc. Indicate digital photos 

by referencing the photo-log number v\ ith an arrow indicating direction of v iew. 

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

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

Item: 

"SW Ho/ztJ. Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 1 of. 

1 
<J 

COASTA L 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 2 of 
COASTA L f MVIMONM E » IM C 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

^___— j> 

Item: y 

Item: \ 

Item: \ 

Item: \ 

Item: \ 

Item: \ 

Item: \ 

Item: \ 

Item: \ 

Item: X 

Item: \ 

\ 

Item: 

\ 

Item: 

Page 3 of 
COASTA L 

Landscape Inventory 

(Use additional sheets as necessary) 

Item 

t 

Quantity Unit Condition/Type/Species 

Pre-existing property area, 

Ihat wil l be excavated, that 

is covered with grass. 

Square feel 

Number of trees

trunk diameter 

 > 2 inch 

^ 

Each 

Number of trees •'= 2 inch 

trunk diameter • ^ 

1 

Each 

i 

i 

1; 

Number of Sprinkler 

Zones. Control Vah'es. 

Timers. Heads, eic. 

•\i\iK'h a >keicli i.l i'H­

;.pri;',kler !a\ oul. 

X Each 1 

Number of and size ot^ 

each garden,' flower bed 

area. 

••.[.'.1^1 . ;. s.KCiC! : I'l , C ,i! l '. C 

--i/'es .'iiiJ localions 

^ ^ 

Each 

Square Feet 

Page 4 of 
C -O A S T A L 

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 

voucher to the propertv 

ow ner. 

" ^ ^ 

$ 

1 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketch of were 

each plant wil l he placed 

b_\ ihe coniracU'i: 

> 

Each 

Agreed upon area of 

property to be replaced 

with grass sod. 

•ijcliKir J ^(•eicli ..)', ii'c 

.uea(s! U-. he :eplacL-j A 'ih 

,-'-as> -cd 

SF 

y^M Uu y^u ^ 

.Area of City or County 

propeny to be landscaped

per iheir requirements. 

"• 

- ^ SF 

Easement .Area. lo be 

excavated SF 

Page 5 of 
COASTA L iMViaOMMIHTA L CROUP . IM C 

Additional Comments / Instructions: 

^ -Vr^^^ X r\ ^ ^ ^ ^ I'^vy ^ 

^ 3 5><Ui^/k. ',^4 4 ^ iy[d (jUo^ ) o-f-^^<,. 

~ c^f(x";rx-Vik jCforvf ^^ f 6oc^ver 0^ hoo^ a.l( -hkiZ 

^<^V 'f'o cJ^ i ^\(ijL\K)ai\^ . 

" poo-w^ 0>^ d -(^j;><- -^u*^ia' n 1 

^V.CM\yiUi t>r\ . 

- Wt^r^6:7 Vu r>^^^i^^ 1^ ^ % - ^ f-f- (jy^i^y^ ' "f^"' /•-^^r 

V : ^ ^ K "^^^ <^^ ^ V4u(,^ , 

^^phec k 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. 

k I agree O I do not agree 

(Le^ i^^^l^ ^ 

Contractor's Signature Date 

Page 6 of , _.„„ __^^, 
^t^'lij BVID# 

XRF PROPERTY SAMPLE SHEET 


Date ^nvrm 1 Address 'ki y i(\i-y ^ ._ 1 

Project Omaha'lead FP 2nd year option 1 Sample time ^•2 ^ fajjiypml 

XRF ID# sample length 30 sec 1 

Shot# Reading Sample area Shot # Reading Sample area 1 

^=l(^ 7U.^L-r -K-tlf ym 

ly^.Mt i\.c 

'L\(^-%<^ \i i y fl 1^1 ^ '^2l.,0^i n-11 \n 

'^v^i i \q.Tv Depth 

zpy\ J-11^H tol ^ Depth iy\^ Mn. 'lyvcyit \n.m 

V^VL ^V7. ^'i t 'ip-^i izi 

_i:^—1 

Average ^l^.^t \lhl. Average 'F\%% \ "^ Z\-<s'h 

Shot # Reading Sample area 1 Shot # Reading Sample area 

^^< l \>i.Di i h.11 ^^<(. •>iC.iVt ^^-< ^ 

'I'i'^Z KL^< + K.^< U ^1^n '^4r^>-!: ty- 0 1 ^ 

i^';"> yyy . i^.K Depth l^.^'^ y . t l +. 2^.2^1 Depth 1 

ti^ ^ N.ii 1 ^9s^ "/^^ 1^ 1 ^^.V> Mnt (^'^

l o' 1 

Average IHi.fi Average -Swi. ^l t Zl^.i^n ii 

Shot # Reading Sample area 1 Shot # Reading Sample area 1 

^HU MVl^^t ^.^7. y."] ^ t \^. y '^^H 

bf^it^y-^ y j y m.zu ^.^^ &I t ^ n y-y i y y 

tU8 Mo-14 i "l-X Depth 1 I'hU 1^0^.0% i ]^.Y\ Depth 

^t-2 ^ ^, 9.^1 \ yr ] ^tt(?y\) i ]\.i \ 

t^^ ^.^ 1 

r 1 

Average ^i.K i ^7 1 

Average ^y^.n i \\y^ y> 

RETEST AREAS 

1 Shot # Reading Sample area 1 Shot # Reading Sample area 1 

UU^HK .5^^ 

Depth 

Depth 

,yy 

Average Average 

lab sample # Lab result Sample area XRF Avg. 

-yyy < y r Signature 

J ^ ^Ty l<Ti\';v 

JVL yy •IM-

Print JM^^JW ^ ^7 l l -5 7;: 

- y Xi \<^vy\ 

i:? 

ISiHivi Tit P?: t^^. if 1 
BVID ll(.^\ # 

XRF PROPERTY SAMPLE SHEET 

y I 

Date Address -yioi. jncf^ 1>^^—\ tF<h 

Project Omaha lead FP 2ncl year opllon Sample time 12. farj^/pm 

XRFID# sample length 30 sec ->y'\ 

Shot# Reading 

lAi^-^i 1\.9^ y-\^n i\ry '%.k>vi 7.]-y ->n.q"[i^.^ " 

Sample area 

fyp^vu^o, \p<f^j 

Depth 

iW'^iTDl Shot# Reading Sample area 

Depth 

Average >o '->^ t- ^i.3n Average 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# Reading Sample area 

Depth ^^' 

,., y 

Depth 

Average Average 

lab sample* Lab result Sample area XRF Avg. 

Signature '/ / 

Print 
Report Number: Date Reported: 

08-354-2029 

•iNJMiciwest 12/19/08 

Account: Date Received: 

20666 V | 12/16/08 / Laboratories, IncI 

Page: 1 of 1 Date Sampled: 

13611 B Street • Omaha, Nebraska 68144-3693 • (402) 334-7770 • FAX (402) 334-9121 • www.midwestlabs1:^/r15/08 

COASTAL ENVIRONMENTAL GROUP LEAD ANALYSIS 

MARCOS MATEUS 3566 JACKSON ST 

2411 MARTHA ST 

OMAHA NE 68105 PO/Project #: OLS-2008 

Analysis As Detection Analyst Verifier 

Performed Received Units Limit Method Date Date 

U b number: 1519135 Sample ID: QC-22544 B l 

Lead (total) 38.7 mg/kg 5 EPA 6010 rrd/12-18 bab/12-19 

Lab number: 1519136 Sample ID: B2 

Lead (total) 166 mg/kg 5 EPA 6010 rrd/12-18 bab/12-19 

Lab number: 1519137 Sample ID: Fl 

Lead (total) 299 mg/kg 5 EPA 6010 rrd/12-18 bab/12-19 

Lab number: 1519138 Sample ID: F2 

Lead (total) 398 mg/kg 5 EPA 6010 rrd/12-18 bab/12-19 

Lab number: 1519139 Sample ID: DZ 

Lead (total) 536 mg/kg 5 EPA 6010 n-d/12-18 bab/12-19 

U b number: 1519140 Sample ID: EASEMENT 

Lead (total) 210 mg/kg 5 EPA 6010 rrd/12-18 bab/12-19 

Lab number: 1519141 Sample ID: LS 

Lead (total) 480 mg/kg 5 EPA 6010 rrd/12-18 bab/12-19 

ieather Ramig 

Client Service Representative^ 

heather@midwestlabs.com (402)829-9891 

TheH;e.SLjt(5li55Ll£jlJ>n this reDprt^nly. reflect.the analy^s of Vpe sample(s) submitted. For apdicable testparamaters, Midwest Laboratories is in compliance witti NELAC requirements. OarTOpons^rrcrletlerS are tor the exclusive ana conTidentiai use ot our clients anaf may no! be reproduced in whole or in part, nor may any reference be made 

to the work, the results, or the company in any advertising, news release, or other public announcements without obtaining our prior written authorization. 
t 

^[i ^ Lab@rat®)f i( !S:i, 

13611 B Street = Omaha, Nebraska 68144-3693 - (402) 334-7770 » FAX (402) 334-9121 » ww/w.midwestlabs.com 

ACCOUNTNUMBER 

CHAIN OF CUSTODY RECORD: Yes No 

PURCHASE ORDERNUMBER_ 

REPORT&BILLTO | IDENTIFICATION | COPYTO | 

C<jccs-W\ L,rvvv<v-OIX«n I «^\ 

^7// Mo-rH^ . f-^ 

^n..;,^ ZIP Mtf- ^^naos- PHONE ( ) ^^on^^VDaa-ixw 

PROJ. NO. PROJECT NAME/COMPANY: 

COMPANY: rs/gna,.rej^^^^ ) ^ ^ ^ ^ 

Ol^-Wi 

SAMPLER: (Signaiure) 

SAMPLE ID/LOCATION 

g?C-a3>5Hi 01 / ^ ; / 7 

J 5U jo^\c9ot^sf /?a 

^ 

F.;i 

PH 

eo^jCK^ g »i ^ 

L5 

Relinquished by: Date/Time^ 

Temperature on Arrival (>^C): Keiinquisnea^j>i^/gna(L/re; uaie/1 ime ^reserved in Field: Yes_ 

Relinquished by: (Signaiure) Dale/Time Received in Lab by: (Signature) Remarks: 

Chain-of-Cuslody will have a signature upon receipt but no subsequent signatures ^^^ 02/02 

Distribution: Original accompanies shipment; copy to Coordinator Field Files 

•Matrix Cofle: SO - Soil, WA - Water, SL - Sludge, OT - Other Oui reports aric isitsrs tre for the ejtcl'JsVe end ccniideate! 'jss c" os KiisstiE tn:' rctv not [••£ reprooi-cec! in Vrhoie oi v.: pjrt, r.r,r rficy Eny refsrerice be .T.CCS 

ic the M'O'i:, the results, or vie company !•'; EH)' cc'vertising, risws reiasse, or cvi-ie.' public cnricuncerrisnts wif.i'icv' obictn;.-iC car -..-ior writer, ajtl-roriiciior 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2918 

Mode SOIL 

Time 2008-08-25 11:24 

Duration 120.90 

Sequence Final 

Flags 

AVERAGE I Avg of 2914-2917 

ADDRESS 3566 Jackson st 

QUAD/ZONE Fl 

INSPECTOR • LOPEZ 

DEPTH 

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 230.724 

Supervised By: 

Certificate of Verification 

2914 

SOIL 

2008-08-25 11:22 

30.30 

Final 

22544 

3566 Jackson st 

Fl 

LOPEZ 

6 

CLEARANCE 

± Error 

± 18.555 
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 216.764 

Supervised By: 

Certificate of Verification 

2915 

SOIL 

2008-08-25 11:22 

30.28 

Final 

22544 

3566 Jackson st 

Fl 

LOPEZ 

6 

CLEARANCE 

± Error 

± 18.461 
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 254.472 

Supervised By: 

Certificate of Verification 

2916 

SOIL 

2008-08-25 11:23 

30.14 

Final 

22544 

3566 Jackson st 

Fl 

LOPEZ 

6 

CLEARANCE 

± Error 

± 19.642 
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 205.760 

Supervised By: 

Certificate of Verification 

2917 

SOIL 

2008-08-25 11:24 

30.18 

Final 

22544 

3566 Jackson st 

Fl 

LOPEZ 

6 

CLEARANCE 

± Error 

± 17.842 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2923 

Mode SOIL 

Time 2008-08-25 11:27 

Duration 123.10 

Sequence Final 

Flags 

AVERAGE ! Avg of 2919-2922 

ADDRESS 3566 Jackson st 

QUAD/ZONE ||>Z 

INSPECTOR LOPEZ 

DEPTH « 12 

SAMPLE TYPE CLEARANCE 

NOTE 

Supervised By 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2919 

Mode SOIL 

Time 2008-08-25 11:25 

Duration 30.70 

Sequence Final 

Flags 

BVID # 22544 

ADDRESS 3566 Jackson st 

QUAD/ZONE DZ 

INSPECTOR LOPEZ 

DEPTH 12 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 332.927 ± 22.642 

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 321.093 

Supervised By: 

Certificate of Verification 

2920 

SOIL 

2008-08-25 11:25 

30.64 

Final 

22544 

3566 Jackson st 

DZ 

LOPEZ 

12 

CLEARANCE 

± Error 

± 22.193 
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 277.842 

Supervised By: 

Certificate of Verification 

2921 

SOIL 

2008-08-25 11:26 

30.98 

Final 

22544 

3566 Jackson st 

DZ 

LOPEZ 

12 

CLEARANCE 

± Error 

± 20.738 
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 267.395 

Supervised By: 

Certificate of Verification 

2922 

SOIL 

2008-08-25 11:27 

30.78 

Final 

22544 

3566 Jackson st 

DZ 

LOPEZ 

12 

CLEARANCE 

± Error 

± 20.572 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2955 

Mode SOIL 

Time 2008-08-25 14:14 

Duration 122.16 

Sequence Final 

Flags 

AVERAGE Avg of 2951-2954 

ADDRESS 3566 Jackson st 

QUAD/ZONE f B2 

INSPECTOR LOPEZ 

DEPTH 6 

SAMPLE TYPE T 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 131.020 

Supervised By: 

Certificate of Verification 

2951 

SOIL 

2008-08-25 14:12 

30.49 

Final 

22544 

3566 Jackson st 

B2 

LOPEZ 

6 

CLEARANCE 

± Error 

± 14.779 
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 156.953 

Supervised By: 

Certificate of Verification 

2952 

SOIL 

2008-08-25 14:13 

30.33 

Final 

22544 

3566 Jackson st 

B2 

LOPEZ 

6 

CLEARANCE 

± Error 

± 15.953 
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 149.422 

Supervised By: 

Certificate of Verification 

2953 

SOIL 

2008-08-25 14:14 

30.38 

Final 

22544 

3566 Jackson st 

B2 

LOPEZ 

6 

CLEARANCE 

± Error 

± 16.058 
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 129.877 

Supervised By: 

Certificate of Verification 

2954 

SOIL 

2008-08-25 14:14 

30.96 

Final 

22544 

3566 Jackson st 

B2 

LOPEZ 

6 

CLEARANCE 

± Error 

± 14.766 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

Pb 

Supervised By: 

Certificate of Verification 

2960 

SOIL 

2008-08-25 14:27 

121.53 

Final 

Avg of 2956-2959 

3566 Jackson st 

F2 

LOPEZ 

6 

CLEARANCE 
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 325.185 

Supervised By: 

Certificate of Verification 

2956 

SOIL 

2008-08-25 14:24 

30.47 

Final 

22544 

3566 Jackson st 

F2 

LOPEZ 

6 

CLEARANCE 

± Error 

± 22.530 
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 344.336 

Supervised By: 

Certificate of Verification 

2957 

SOIL 

2008-08-25 14:25 

30.07 

Final 

22544 

3566 Jackson st 

F2 

LOPEZ 

6 

CLEARANCE 

± Error 

± 23.209 
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 314.221 

Supervised By: 

Certificate of Verification 

2958 

SOIL 

2008-08-25 14:26 

30.33 

Final 

22544 

3566 Jackson st 

F2 

LOPEZ 

6 

CLEARANCE 

± Error 

± 22.210 
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 385.132 

Supervised By: 

Certificate of Verification 

2959 

SOIL 

2008-08-25 14:27 

30.66 

Final 

22544 

3566 Jackson st 

F2 

LOPEZ 

6 

CLEARANCE 

± Error 

± 24.332 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2970 

Mode SOIL 

Time 2008-08-25 15:45 

Duration 121.88 

Sequence Final 

Flags 

AVERAGE : Avg of 2966-2969 

ADDRESS 3566 Jackson st 

QUAD/ZONE iBl 

INSPECTOR LOPEZ 

DEPTH 6 

SAMPLE TYPE !_ CLEARANCE 1 

NOTE 

Error 

Pb 42.153, 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2966 

Mode SOIL 

Time 2008-08-25 15:42 

Duration 30.61 

Sequence Final 

Flags 

BVID # 22544 

ADDRESS 3566 Jackson st 

QUAD/ZONE Bl 

INSPECTOR LOPEZ 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 43.398 ± 9.422 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2967 

Mode SOIL 

Time 2008-08-25 15:43 

Duration 30.32 

Sequence Final 

Flags 

BVID # 22544 

ADDRESS 3566 Jackson st 

QUAD/ZONE Bl 

INSPECTOR LOPEZ 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 42.288 ± 9.350 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2968 

Mode SOIL 

Time 2008-08-25 15:44 

Duration 30.61 

Sequence Final 

Flags 

BVID # 22544 

ADDRESS 3566 Jackson st 

QUAD/ZONE Bl 

INSPECTOR LOPEZ 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 40.724 ± 9.350 

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 42.203 

Supervised By: 

Certificate of Verification 

2969 

SOIL 

2008-08-25 15:45 

30.34 

Final 

22544 

3566 Jackson st 

Bl 

LOPEZ 

6 

CLEARANCE 

± Error 

± 9.375 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2990 

Mode SOIL 

Time 2008-08-26 08:37 

Duration 122.36 

Sequence Final 

Flags 

AVERAGE I Avg of 2986-2989 

ADDRESS 3566 Jackson st 

QUAD/ZONE easement 

INSPECTOR lOPEZ 

DEPTH 

SAMPLE TYPE CLEARANCE' 

NOTE 

ppny ±.y Error 

Pb 214^27 ± 18.208 

( 

Supervised By: 

y 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2986 

Mode SOIL 

Time 2008-08-26 08:35 

Duration 30.37 

Sequence Final 

Flags 

BVID # 22544 

ADDRESS 3566 Jackson st 

QUAD/ZONE easement 

INSPECTOR LOPEZ 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 210.941 ± 17.958 

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 218.481 

Supervised By: 

Certificate of Verification 

2987 

SOIL 

2008-08-26 08:36 

30.53 

Final 

22544 

3566 Jackson st 

easement 

LOPEZ 

1 

CLEARANCE 

± Error 

± 18.705 
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 209.081 

Supervised By: 

Certificate of Verification 

2988 

SOIL 

2008-08-26 08:37 

31.02 

Final 

22544 

3566 Jackson st 

easement 

LOPEZ 

1 

CLEARANCE 

± Error 

± 17.957 
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 220.807 

Supervised By: 

Certificate of Verification 

2989 

SOIL 

2008-08-26 08:37 

30.44 

Final 

22544 

3566 Jackson st 

easement 

LOPEZ 

1 

CLEARANCE 

± Error 

± 18.213 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, 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 

2995 

SOIL 

2008-08-26 08:46 

121.30 

Final 

Avg of 2991-2994 

3566 Jackson st 

Retaining wall LS on BI ^ 

LOPEZ "« 

1 

CLEARANCE 

INSITUS 
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 296.687 

Supervised By: 

Certificate of Verification 

2991 

SOIL 

2008-08-26 08:43 

30.44 

Final 

22544 

3566 Jackson st 

Retaining wall LS on BI 

LOPEZ 

1 

CLEARANCE 

INSITUS 

± Error 

± 21.047 
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 301.684 

Supervised By: 

Certificate of Verification 

2992 

SOIL 

2008-08-26 08:44 

30.06 

Final 

22544 

3566 Jackson st 

Retaining wall LS on BI 

LOPEZ 

1 

CLEARANCE 

INSITUS 

± Error 

± 21.232 
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 295.627 

Supervised By: 

Certificate of Verification 

2993 

SOIL 

2008-08-26 08:45 

30.32 

Final 

22544 

3566 Jackson st 

Retaining wall LS on BI 

LOPEZ 

1 

CLEARANCE 

INSITUS 

± Error 

± 21.736 
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 311.498 

Supervised By: 

Certificate of Verification 

2994 

SOIL 

2008-08-26 08:46 

30.48 

Final 

22544 

3566 Jackson st 

Retaining wall LS on BI 

LOPEZ 

1 

CLEARANCE 

INSITUS 

± Error 

± 21.501 
<r —

\ ^ •

\no^^

 *» 

 ,<^

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

Coastal Environmental Group Inc. 

 www.coastalhazmat.com 

 COASTA L ENVIItONHENTAL 

CROUP . INC . 

EXECUTIVE SUMMARY: 

BVID # 22544 - (3566 JACKSON ST) 

No Issues or Concerns x Issues/Concerns 

Detail Explanation: 

DAMAGE SETTLEMENT FOR CARPET CLEANING AND WATER BILL. 

NEED MORE FILL DIRT IN THE FRONT. 
^4EPA 

EPA Property Close Out Form 

Property ft: '• 

Date/Time: ^ 

iK^^ 

Quads Excavated: ^\ Y ^ \ '( tl - >r \:^ 

Property Address;- -TrTr ;—-T-rv 

OwVer's Namer, ,^. ffi^^.H^,^^.,^ 

Contractor Group 'y^vy i 

Excavation General 

1. If necessary, were the correct quadrBnt(s) excavated and reslored? 

Ye* Mo 

2. If necessary, were the correct areas of drip zone excavated and restored? 

Grading Sod and Vegetation 

Does the grading around the perimeter ofthe house in excavated areas generally slope away 

from the house? 

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

Ye*

y 

 .No 

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

day time period) 

4. A.re sodded areas generally firm and evenly graded? 

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

time pyeriod) 

6 Was the property graded such that water will not pool on the propert)' 

y 

y 

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

Gales, Fences and Retaining Walls 

1. Do gates open and close freely':' (Ifapplicable) 

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

Yes 

y 

%y 

No 

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

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

Foundation, Sidiii|;and Gutters 

1 

1. Was damage to the siding or trim avoided? 

2 Was damage to the foundation avoided? 

Yes 

y 

S b 

3. Was damage to windows avoided'^' 

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

5. Was damage to downspouts or downspoul extensions avoided? y 

Sidewalks and Driveways (Concrete) 

1. Was damage to driveway surfaces avoided? 

Yes

c y 

 No 

2. Was damage to walkway surfaces avoided? 

i 

y 
[ Owners comments: 

Inspection notes: 

Removal and restoration aclivales complete including the 30-day sod wairanty: 

EPA Represental 'yd-^^^:<_ Date; /^JT ^ 
^ ^ ^ 

Property Completion Agreement 

This agreement documents the completion of remedial activities performed on my property. My .signature 

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

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

Property ID: 2_?.5M <­

Property_Addrcss:,3^fi,^^^-^ ^Yl^|^^^ ^ S^^ 

Owner: J-^^ ^ \ ^ j ^ ^ 

Phone: "^C^^-^ - X^Q" ^ 

Restoration items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additionanall Comments Comments : y? y / / / '^z? 

Lyjfiyiy _Jlys2.^y<.udLj ..-djyy^ 

agree restoration is completed, except as noted 

I I do not agree restoration is completed 

i^ m 5 

Signature Date Cmiitractor's Signature Date 

I
Property Damage Settlement 

Property ID 22544 

Property Address 3566 Jackson St 

Owner Pam Huber 

Phone 402.290.2507 

I have received from the contractor, Coastal Enviroimiental Group Inc. (Coastal), the sum of $191.29 to 

compensate for plants that were removed during the removal of lead-impacted soil from the property. 

Compensation Type Check ! 

Value of Check $191.29 

Check to the Order of Pam Huber 

Description of Damage 

Property owner dogs tracked mud on her carpet due to rain after excavation. Coastal Environmental Group 

offer to pay for the carpet cleaning. In addition, Coastal has agreed to pay for the difference in her water bill 

for the 30 day Sod period. 

My signature below acknowledges the receipt of the check listed above; further, I acknowledge that 

the compensation amount is fair for the replacement cost of the sidewalk and release Coastal 

Environmental Group, Inc. from further obligations or liability related to this property. 

Contractor's Signature 

Page 1 of 1 
0.00 

Account: 137576-1186960 

PAM L. HUBER 

Service address: 3566 JACKSON ST 

Gal! 811 before your dig in your yard, build a 

fence, etc. Call at least two working days in 

advance. Utilities will mark gas, water, 

electric, cable and phone lines. No charge for 

this service. 

SEP OCT NOV DEC JAN FEB MAH APR MAY JUN JUL AUG 


Your Gas Use 

Past 12 Months 0 Past 13-24 Months 

Billing units: 

Use per day: 

Average cost per day: 

Number of days In billing cycle: 

This Month 

6 

0.2 

$0 80 

29 

Last Year 

11 

0.4 

$0.77 

28 

2&I 

ia 

. 1 Jhfclinil h i l Hfl ° SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG 

Your Water Use 

B Past 12 Months ^ Past 13-24 Months 

This Month Last Year 

Billing units: 7 9 

Use per day: 0.2 0.3 

Average cost per day: $0.47 $0.46 

Number of days In billing cycle: 29 28 

1723 Harney St . Omaha. NE mK 2 • 402.554.6666 

e-mail: customer_service@mudomaha.com • website: www mudomaha.com metropolitan 

« UTILITIES DISTRICT 

Billing date Aug 11, 2008 

Previous balance $175.00 

Payment received 

Current charges 175.00 

New balance 350.00 

• Total due Aug 26, 2008 $350.00 

Your budget payment of $ 350.00 will be paid by your financial institution Aug 26, 2008. 

Budget Variances: Current =-124.46 Total =-234.75 

1 

Details o( current charges: ' 

GAS RESIDENTIAL RATE A: Jul 7 to Aug 5 

Meter Number 41774,'> 

Current read (estimoie): 123.3 - Previous read (actual): 1227 = 6 CCF 

Gas Use: 6 CCF x 1.010 (heat value) = 6.060 therms 

4 days 0.836 therms at 0.9743 = $0.81 

25 days 5.224 therms at 1.3427 = 7.02 

Service Charge 12.00 

Gas Cost • $19.83 

Gas Infrastructure Replacement 3.00 

WATER RESIDENTIAL RATE W-1: Jul 7 to Aug 5 

Meter Number 286.')966 Size: 5/8 -inch 

Current read (oiiimaie): 120 - Previous read (actual): 11.3 = 7 CCF 

Water Use: 7.000 CCF or 5,236 gallons 

7.000 CCF at 0.9156= $6.41 

Service Charge 4.62 

Water Cost • 

Water Infrastructure Replacement " 2.00 

City of Omahia Sewer 11.37 

Sales Tax 3.31 

• Current Charges $50.54 

Please return this portion of the bill with payment. • Please do not staple payment to bill. 

1723 Harney St • Omaha, NE 68102 • 402.554.6666 

A e-mail: customer_service@mudomaha com 

1 metropolitan website: www.mudomaha.com Mr UTILITIES DISTRICT 

0001375761186960000000350005 


Due on or before Aug 26: $350.00 

Your budget payment of $ 350.00 will be paid by l.ll..l..l....llll.,..l.l....lll.l....l.l..l.ll.l..l.l..l..l.l your financial institution Aug 26. 

PAM L. HUBER 

Amount Paid: 3566 JACKSON ST 

OMAHA NE 68105-1922 

P O BO X 360 0 

OMAH A N E 68103-0600 

Give to (lie Heat Aid Fund. See reverse side. 

Monthly donation ­ Add: U%1 U%1> QSS Other $ _ Account: 137576-11869 30 00020 

EAPL 
274 

Account: 137576-1186960 
 1723 Harney St • Omaha, NElP'D =Wm2 2 • 402.554.6666 

e-mail: customer service@mudomaha.com • website: www.mudomaha.com H metropolitan 

PAM L HUBER M f UTILITIES DISTRICT 

Service address: 3566 JACKSON ST 

Billing date Sep 10,2008 

Previous balance $350.00 

Call 554.7777 if you smell gas. Payment received -Thank you 350.00 CR 

The new DEX phone book omitted M.U.D.'s 24/7 Current charges 197.00 

New balance 197.00 emergency number. 

Please write the 554.7777 emergency phone • Total due Sep 25, 2008 $197.00 

number under the M.U.D. listing on page 108 ofthe 

Your budget payment of $ 197.00 will be paid by your financial institution Sep 25, 2008. 

white business pages in your DEX phone book. Budget Variances: Current =-90.06 Total =-324.81 

Details of current charges: 

54&I GAS RESIDENTIAL RATE A: Aug 5 to Sep 4 

Meter Number 417745 

Current read (actual): 1254 - Previous read (oiimaie): 1233 = 21 CCF 

. ll l i . . _ Gas Use: 21 CCF x 1.010 (heat value) =21.210 therms ^ OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP 

3 days 2.121 therms at 0.8479 = $1.80 

Your Gas Use 

27 days 19.089 therms at 0.9743 = 18.59 

Service Charge 12.00 1 Past 12 Months Q Past 13-24 Montlns Gas Cost • $32.39 

This Month Last Year Gas Infrastructure Replacement 3.00 

Billing units: 21 22 

Use per day: 0.7 0.7 

Average cost per day: $1.22 $0.99 

Number of days in billing cycle: 30 30 

WATER RESIDENTIAL RATE W-1: Aug 5 to Sep 4 

Meter Number 2865966 Size: 5/8 -inch 

Current read (actual): 143 - Previous read (estimate): 120 = 23 CCF iij.i^J«.,LBiiL Water Use: 23.000 CCF or 17,204 gallons OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP 


9.000 CCF at 0.9156 = $8.24 

Your Water Use 14.000 CCF at 1.2810= 17.93 

Service Charge 4.62 

I Past 12 Months Q Past 13-24 Months Water Cost • /|30.79^ 

This Month Last Year Water Infrastructure Replacement v 2.00, Billing units: 23 2 

Use per day: 0.7 0.0 

Average cost per day: $1.16 $0.21 City of Omaha Sewer 11.37 

Number of days In billing cycle: 30 30 Insufficient Funds Charge 22.00 

Sales Tax 5.58 

Budget Payment Plan Interest 0.19 CR 

• Current Charges $106.94 

Please return this portion of the bill with payment. • Please do not staple payment to bill. 

1723 Harney St • Omaha, NE 68102 • 402.554.6666 

e-mail: customer_service@mudomaha.com 

4) metropolitan website: www.mudomalia.com iW UTILITIES DISTRICT 

0001375761186960000000197005 


Due on or before Sep 25: $197.00 

Your budget payment of $ 197.00 will be paid by l.ll..l..l....llll....l.l....lll.l....l.l..l.li.l..l,l..l..l.l 

your financial institution Sep 25. 

PAM L. HUBER Amount Paid: 3566 JACKSON ST 

OMAHA NE 68105-1922 

PO BOX 3600 

OMAHA NE 68103-0600 

Give to the Heat Aid Fund. See reverse side. 

Monthly donation ~ Add: QSZ a$ 3 a$ 5 Other $ _ Account: 137576-1186960 00015 

EAPL 
INVOICE 

September 8, 2008 

Job: 

Pam Huber 

3566 Jackson 

Omaha, NE 68105 

Phone: 290-2507 

Carpet Cleaning: 

I

!

I

 12x16 

14x18 

12x14 

Dining Room 

Living Room 

Bedroom 

Cost: $150.00 

Tax: 10.50 

Total: 

Credit Card # 

Visa 

Expiration Date 

MasterCard 

$160.5 

• \ 

160.500

\ \^\.d-^ 

, r yky-^ ^ 

Check # 

Cash ^''/^/ ^ y