TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

pll SAID #: lf>?^ Date: 

Address: l^i' V ^ ^1 ^ 4 f 

Remediation Contractor: Coastal Environmental Group Year; 200 % 

SOIL REMEDIATION 

PROPERTY HLE FOLDER DOCUMENTS 

/ 

-IT 

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 

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

Confirmation data 

Photographs 

As-built sketch 

'A 

/ 

< / 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 

Property information from Douglas County Assessor's Office 

[! 

D 

n 

I m iff 

Date 

30054836 

Superfund 
Property Access Checklist 

Property ID: n?3M D WORK STARTED ON: __/__/ 

Property Addres |d^^ 3 ^ X ) f^ ' D WORKCOMPKLTBD ON: __/__/_

i 

Renter ^^""^^ tiOLA\p.e. ru\\crV 

Address 

Phone: 

Fax: 

Cell/Pager: 

Phone: Additional Information: 

Fax: 

CaVPastn 

^ Nitfification Letter Sent:A/_l3/Qy By: 

^ Access Agreenient Signed: 10./KL ^ Br 

" ^ Restoratton Agreonent Sipt^ ^ i i£_lCa. By: 

a TopsoO Sampling (irapplicable) / 1 By: 

a Disposal Sanqiling or applicable) 1 1 By: 

D Garden Sampling (ff applicable) 1 1 By: 

^ Utili^ aearance Caned: i^/T_/dg By:n/Q(0^ 

Q^deo/Photos (Before) On: \'=>IJ^I ^ By: /WD/ 

D Video/Photos (Dnrfng) On: / / By: 

D Videomiotos (Alter) On: / / By: 

D Videomifltos (30-Day) O K / / By: 

!>Q^ Pnper^ Completion Agreemoat Signed: Ji/_5Z/Ql By: 

fD Final Report Issned; / / By: 

Air Monitorine (aa amtlicable 

D Commnnity DCrew On: / / Br 1 

Results: 

D Commnnity D Creir | On: / / | By: 

ResnHs: 

OCommnnfty OCrcir | On: / / | By: 

ResnlU: 

Omaha Lead Stte 
Douglas County Account t^^rjj^tion Page 1 of2 

Douglas County, Nebraska Property Record - R0822880000 

Print Report 

NEW Featura - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - VlOW OH Ma p Information is valid as of 2009-9-15 Treasurer's Tax Report 

New Feature ^ ^ - • Auto Sales Search 

Owner 

FULLERTON HARRY E 

ETAL 

1923 8 37 ST 

OMAHA NE 68105-0000 

Property Informatio n 

Key Numtier: 2288 OOOO 08 

Account Type: Residential 

Parcel Number: 0822880000 

Parcel Address: 1923 S 37 ST 

OMAHA NE 68105-0000 

Legal Description: CLUB TERRACE LOT 15 BLOCK 2 50 X 125 

Value Informatio n 

Land Improvement Total 

2009 $14,100.00 $70,900.00 $85,000.00 

2008 $14,100.00 $70,900.00 $85,000.00 

2007 $14,100.00 $73,200.00 $87,300.00 

2006 $14,100.00 $73,200.00 $87,300.00 

2005 $14,100.00 $73,200.00 $87,300.00 

2004 $6,400.00 $73,200.00 $79,600.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.14 6250.0 1.0 125.0 50.0 No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R08... 9/17/2009 
Douglas County Account :^^n|ution Page 2 of2 

1923 5.37 St 

J79C4qll 

-jnrBsnnSlKkit 

1.5 story 

CLICK TO ENLARGE IMAGE 

Square Footage: 1132.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Fair 

Built As: I 1 1/2 Story Fin Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 5.0 

Exterior: Frame Siding Units: I 1.0 

Interior: | Drywall Baths: 1.0 

Roof Cover: ! Slate Bedrooms: j 3.0 

Roof Type: Gable Stories: 1.5 

Floorcover: I Allowance Foundation: 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1952 0% 1952 57 

Detail Type Detail Description Units 

Add On Fence 1.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 853.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Basement Single 1.0 

Porch Open Slab 100.0 

Porch Slab Roof Ceil 28.0 

User Attic Full Finish 279.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R08... 9/17/2009 
• • •

 

Property ID #

Property

Address:

Initial Contact:

Second Contact:

Final Contact:

Final Action: 

Comment: 

ONvner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

• 

CONTACT FORM 

 //^'J^ T 

 . ^ _ 

 A973 5 %-? ST 

 Pate: 9j^y Time: A/Of Action: /Ar T -f^/utn^ 

 Date: 5^ / Time: /^/ ^ Action: kAySc/A^'^^AjiXdAy 

 Date; Time: Action: '__ 

Transmit to EPA D Other Action: D 

^/ziJc/ 5^0^<^^ // ^ J d A^'^f^^^ 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet ] Send Email 

• YOUR TICKET NUMBER IS 2388344. 

Original Call Date: 10/17/09

Work to Begin Date: 10/21/09

 Time:

 Time:

 1:58 pm 

 7:15 am 

Op: ELIZABETH18790 

State: NE 

Address: 4022 

County: DOtJCLAS 

Street: BURT ST 

Place: OMAHA 

Twp: 15N

Twp:

 Rng: 13E 

 Rng: 

Sect-Qtr: 17-SE 

Sect-Qtr: 

Legal Given: C 


Type of Work: Lead Remediation 


Location of Work: INCLUDE ALL EASEMENTS LOCATE ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (877)662-4211 


: UNSURE 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 


ALTS72 ATTNEBRl CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number UtiHty Type 

ALT872 WINDSTREAM COMMUNICATION NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

ATTNEBRl ATT/T 

Day: 80024136249 

Alt: 

Emerg: 80024136249 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/17/2009 
Page 2 of2 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNE 1C QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/17/2009 
OLS#: 18383 As-Built Drawing Date Excavated: 10/26/09 

Date USEPA Signed Off: 11/5/09 COASTA L Omaha Lead Superfund Site Area Sodden: 3366 sa ft 

18383 

Owne Omaha Lead Site r Name : HARRY E & JANICE FULLERT 

Site Sketch Address : 1923 S 37 ST 

Phone : H: 402-341-1575 W; 

Lead Sample 

Concentratior Collected 

RYASCPXA-18383 F1 ^ ^ ppm 

f^VD3CPXA-18363 FS - ppm • 

n 

Sample Number 

• RYCSCPXA-18383 81 

RYDSCPXA-18383 82 

/^- ^ ppm ET n ^/ / ppm 0 : •

RDZSCPXA-18383 DZ /5-% - ppm ET n KOZ3Cf"XA-mjn,i—GZ- ppm 

..r?.PgCCPXA-16383 PZ- ppm • a

n • 

Number of Samples = >-/ 

4' RETAINER 

ENTERED 

: JUK 18 m n 

\AlZ^2i S3 7 

AA^'- /5':Zy 

; H 

F — ^ 

S^ . r:?r7 .yfr 

Omaha Lead Site 

Exterior Paint North Arrow 

B^Goo d 

• Poor < ^ 

I I Not painl 

Samples Collected 

Firm: yjS ^ y. ' f 

Date: £ A^Ap^ 

Time : -> - -^ ^ ?,'OC 

Samples Analyzed 

XRF Unit: -^/• ^ Book: ^Z

Date: e>A:^A^^ 

Time: yfy* ^ 

Staff: xy^T7»7 

. 

A^ 

-at-4 

EA=<L0D@1 " 

-r.-.•.;.;•;--•;•;.;.;.!.!.;.^;.;,;.!.;.!.;.!.;.;.!.;,•,;.;•;. ; 

Legend 

Concret e Dri p Zone Excavate d Quadrants Excavate d 

Area replaced with 

Sod ' ' 

Are a replace d wit h 

Rock/Mulch Are a lef t bar e 

Contract #: EP-R7-07-05 Coastal Environmental Group Inc . 

46130 
L L ' 10/^ \ 

Omaha Lead Site Owner Name: HARRY E & JANICE FULLERT 

Site Sketch Address: 1923 S 37 ST > 

Phone: H: 402-341-1575 W: 

Sample Number Lead 

Concentration 

Sample 

Collected LAE 

RYASCPXA-18383 F1 ppm D 

R^rD3CPXA-l0383

RYCSCPXA-18383

 F3­

 B1 A^ ^ 

ppm 

ppm ^ 

n 

RYDSCPXA-18383

RDZSCPXA-18383

 B2 

 DZ 

^/ / 

7 5" ^ 

ppm 

ppm ^ 

D 

D 

RGZSCPXA-mj^ J 62­ ppm D D . RPZCCPXA-16383 Pf­ ppm D n 

Number of Samples = y j 

ENI'ERED 

JUN 1 8 im 

.... -.j^yy. 

18383 

Exterior Paint North Arrow 

B^Good 

• Poor A • Not paint 

Samples Collected 

Firm: AS< ^ C A 

Date: £ /?A? ^ 

Time: .roc ' 

Samples Analyzed 

XRF Unit: 0f2— Book: ^ 1 

Date: 0A^AP> ^ 

Time: 

Staff: 

L Omaha Lead Site 46130 
LL- 10/7 \ 18383 

Omah a Lea d Site Owner Name: H^RRY JJ,2ANICE_FULLER1 

Site Sketc h Address: 1923S ST^ST . 

Phone: H: 402-341-1575 W: 

Sample Lead Number 

Concentration 

RYASCPXA-18383 F1 

4 ^ 

T^YDSCPXA-18383 F^?-

RYCSCPXA-18383 B1 

RYDSCPXA-18383 82 

RDZSCPXA-18383 DZ 

RQZ9CPXA-I83flj © T 

,-RBZSCPXA 18383 PZExterior Paint Nortti Arrow 

g^Good 

Q Poor A 

Q Not paint 

Samples Collected 

Firm: AS'-A C A 

Date: £ /^/o ^ 

Samples Analyzed 

XRF Unit: 0/'^ — Book: 3^ 7 

Date: 0A:^AP ^ 

Omaha Lead Site 46130 

/6I ^ Ww^ 
18383 

Owne Omaha Lead SKe r Name: HARRT E & JANICE FULLERT 

Address: 1923 S 37 ST > 

Phone: H: 402-341-1575

Sample Number 

RYASCPXA-18383 

TOIT38GPXA-18383 

RYCSCPXAr18383

RYDSCPXA-18383

RDZSCPXA-18383

R029CPXA-I83B3

. nnZGODtA I03B3

F1 

 Bl 

B2 

 DZ 

 S T 

 PSENI'ERED 

JUN 18 i m 

^Ath / 

S,.:3^.str 

Omaha Lead Site 

Site Sketch 

 W: 

Lead 

Concentration 

" 9 ^ Dom 

_ppm 

A^ ^ .pp m 

_ppm *// / 

/S-Xy 

_ppm 

_ppm 

_ppm 

Sample 

Collected LAB 

D 

g­ a 

D 

^ n 

D D 

D D 

Numt>er of Samples = 

tl-f\,Jtu^ 

U2. 

.^7 / 

^A^KJmA<£^. 

AH^k: 

• ^ t ^ IL 

Exterior Paint North Anmr 

sr<^o°<i 

« -

Q Not paint 

Firm:

Date:

Time:

Samples Collected 

 /tS ^ c\ t 

 C/^/oH 

 """ ^:oC ^ 

Samples Analyzed 

m:i S 3 7 sr 

9& 

Z7H- /5'2 ^ 

AAI 

Q 

^1 

• 5 ^ -

XRF Unit: 01'^ — Book: ^ 1 

Date: 0A^AP ^ 

Time: ^** T 

Staff. 

A^^TT'f 

u 

/33 

46130 
v* 

IT — ' # 

COASTA l lltVlftONKIKIAl 

< > 0 tl r . IN C 

Consent for Access To Propefty 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consents to and authorizes the United States 

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

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

following described premises: 

Owner's Name: DaytimePhone: (^^7^ y^^|^^ j-xj y^ 

Address of Property 

covered by this V) •ru 

Agreement: hiy h '^ "ir 

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 confimi 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 worit. This access shall 

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

agrees to: 

Page 1 of 2 
• • • • 

,*^*^'"-^ 

COASTA L 

tNTINONH(KTAl 

•<l PBO^* " 

C R O U » IMC 

€ Remove obstructions including boats, trailers, vehicles, playscape items, wood 

piles, dog houses, etc; 

G 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; 

e 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. 

«6 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 (402) 991-1199 

^ 1 grant access to my properties 

D I do not grant access to my properties 

/i^ k /(f^ 

Signature Date Signature Date 

D

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

Page 2 of 2 
^^WK 

C O A * T A t 

C M O u r • M C 

Restoratsoci Agreement 

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

remediation activities. This will also serve as documentation for the purpose of assuring that restoration 

activities are completed to the satisfiiction of the property owner and the United States Environmental 

Protection Agency (EPA). 

Property ID: j^V^^' j 

Property Address: \^^'^ ^^ 7 ^/"H- ^ f 

Owner; 'Tf(\^\(j c f^li4hs ^ 

^^°^^Jk^.y'^\- ^^^^ 

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

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

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

necessary. 

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

The lenoval. stora.qe. disposal, and/or return of these items Is the Owner's responEibiiity. 

I ttem: 

Item: 

Item: 

ttem: 

Items to be Removed by the Contractor During Remediation and Wot Replaced 

ttem: 

fr^^ h\Mm fjAm-^ ^ y XhM^^v 

ttem: 

ttem: 

Item: 

Pagel of J 
C2 COASTA L 

Items to Be Removed By Contractor During Remediation and Regjaced^ 

ttem: 

^[?1L IH 

item: 

h </v) \h \ 

ttem: 

Item: J 

I-andscape Inventory 

Item Quantity Unit Condition/Type/Specles 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. k Quadrants tii^i^ Uyxhh 

Number of trees > 2 inch 

trunk diameter I Each 

Number of trees <= 2 inch 

trunk diameter \ Each 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Aiiath ;i sketch ol llie 

sri'nkloi liiv'.uii 

y^ Each 

Number of and size of 

each garden/ flower bed 

area. 

Aiuich ;i skficli 1)1 a-liitivi' 

>i/os nnd lociiiiciiis 

^ 

Each 

Square Feet 

Agreed upon value of plant 

materiaJs not to be 

replaced by contractor. 

\0l c l!u' \M1IIC \\\\ \ til 

uscL- 10 Ist m .1 'ilaii! 

(Oiiclii'.'^ I(j (lie |iro))cil\ 

u» ner. 

r S 

Easement Area, to be 

excavated Each ^ \V ^i^^^^^A(^ 

% Page 2 of. 
COASTA L 

e h o u » . • •« c 

I Addttional Comments / Instructions: 

y^ k ^y^ ^ ^)H^/f^ l^q ^ 

^ Check the box tf 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. 

131 agree • I do not agree 

% zA.M.Ar^ ,old^j 

(yOwner's Signature Date Contractor's Signature 

Page 3 of. 
BVID# 1/3(^3 

XRF PROPERTY SAMPLE SHEET 


Date 10(?J^ /«9 Address 

Project Omatia.lead F V 2nd year opilon Sample time am/pm 

XRFID# sample length 30 sec 

Shot# Reading 

'WT' 

^ ^? . 

W

^ ^ 

 j; ^ 

^ 

Average Z^'ZA L ^ 

Shot# Reading 

Average 

Shot# Reading 

Average 

Shot# Reading 

Average 

lab sample # Lab result 

Sample area Shot# Reading Sample area 

3± li^ Zl^JS. /' ^ ^ ^ 

Depth Depth 

^ fil 3: t o 

W Average ^^^ ^ ^/ / 

Sample area Shot# Reading Samplearea 

Depth Depth 

Average 

Sample area Shot# Reading Samplearea 

Depth Depth 

Average 

RETEST AREAS 

Sample area Shot# Reading Sample area 

Depth Depth 

Average 

Sample area XRF Avfl. 

SianatureF^rAjgj^i2QA 

Print £ilAMtoA\^ COCfi^fS 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32075 

Reading No 715 

Mode SOIL 

Time 2009-10-26 09:22 

Duration 120.00 

Sequence Final 

Flags 

r^-AVERRi .AvgjoUAlJlA^ s r 

^OCAT roCATIOI N 1923 s 37 st 

INSPECTOR VENTRY 

COR 1 b2 

COR 2 6 

MISC clearence 

NOTE epa gun 

User Login EPA 

ppm Error 

r p h T C I C^fl d -T'LfifiS ~ 1 

Cd < LOD 22.634 

Ag < LOD 16.466 

Sr 102.237 ± 8.813 

U < LOD 23.545 

Rb 44.322 ± 6.866 

Th < LOD 18.221 

Se < LOD 6.701 

As < LOD 32.440 

Hg < LOD 15.165 

Zn 260.789 ± 32.808 

W < LOD 85.174 

Cu 43.543 ± 25.440 

Nl < LOD 84.460 

Co < LOD 203.614 

Fe 18622.352 ± 485.312 

Mn 461.692 ± 116.031 

Cr < LOD 97.149 

V < LOD 159.681 

Ti < LOD 430.833 

Sc < LOD 63.309 

Ca < LOD 949.984 

K < LOD 1629.498 

S < LOD 1086.391 

y \ 

Supervised By: // Y / ^ Mm 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32075 

Reading No 711 

Mode SOIL 

Time 2009-10-26 09:19 

Duration 30.00 

Sequence Final 

Flags 

SAMPLE 18383 

LOCATION 1923 s 37 st 

INSPECTOR VENTRY 

COR 1 b2 

COR 2 6 

MISC clearence 

NOTE epa gun 

User Login EPA 

Pb 

Cd 

Ag 

Sr 

U 

Rb 

Th 

Se 

As 

Hg 

Zn 

W 

Cu 

Ni 

Co 

Fe 

Mn 

Cr 

Ti 

Sc 

Ca 

K 

S 

ppm 

184.248 

< LOD 

< LOD 

95.051 

< LOD 

50.835 

< LOD 

< LOD 

< LOD 

< LOD 

257.592 

< LOD 

38.434 

< LOD 

< LOD 

23313.484 

526.224 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

± 

± 

db 

± 

± 

± 

± 

Error 

22.989 

22.854 

16.718 

8.648 

23.251 

7.184 

17.013 

6.201 

28.529 

15.313 

32.784 

77.518 

25.064 

80.820 

229.202 

549.167 

125.452 

30.011 

229.196 

486.253 

105.865 

895.821 

2207.461 

1310.310 

Supervised By: 

V 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32075 

Reading No 712 

Mode SOIL 

Time 2009-10-26 09:20 

Duration 30.00 

Sequence Final 

Flags 

SAMPLE 18383 

LOCATION 1923 s 37 st 

INSPECTOR VENTRY 

COR l b2 

COR 2 6 

MISC clearence 

NOTE epa gun 

User Login EPA 

ppm Error 

Pb 169.720 ± 21.422 

Cd 26.166 ± 15.118 

Ag < LOD 16.543 

Sr 99.304 ± 8.480 

U < LOD 22.261 

Rb 40.661 ± 6.434 

Th < LOD 15.717 

Se < LOD 6.668 

As < LOD 27.687 

Hg < LOD 14.458 

Zn 272.296 ± 32.524 

W < LOD 80.721 

Cu < LOD 34.729 

Ni < LOD 81.232 

Co 232.208 ± 134.790 

Fe 18637.201 ± 474.404 

Mn 500.699 ± 116.394 

Cr < LOD 159.818 

V < LOD 37.448 

Ti < LOD 370.808 

Sc < LOD 15.424 

Ca < LOD 617.230 

K < LOD 1232.824 

S < LOD 805.088 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32075 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

SAMPLE 

LOCATION 

INSPECTOR 

COR 1 

COR 2 

MISC 

NOTE 

User Login 

Pb 

Cd 

Ag 

Sr 

U 

Rb 

Th 

Se 

As 

Hg 

Zn 

W 

Cu 

Ni 

Co 

Fe 

Mn 

Cr 

Ti 

Sc 

Ca 

K 

S 

ppm 

455.651 

< LOD 

< LOD 

109.222 

< LOD 

40.402 

27.529 

< LOD 

< LOD 

< LOD 

246.227 

< LOD 

54.370 

< LOD 

< LOD 

15778.408 

422.811 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

Supervised By: 

Certificate of Verification 

713 

SOIL 

2009-10-26 09:21 

30.00 

Final 

18383 

1923 s 37 st 

VENTRY 

b2 

6 

clearence 

epa gun 

EPA 

± 

± 

± 

± 

± 

± 

± 

Error 

33.806 

21.682 

15.745 

8.835 

23.571 

6.592 

14.848 

6.638 

42.056 

13.944 

31.096 

79.654 

25.656 

82.240 

178.473 

436.917 

107.881 

34.545 

318.284 

326.060 

109.527 

1398.663 

1802.620 

1280.771 

V 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32075 

Reading No 714 

Mode SOIL 

Time 2009-10-26 09:22 

Duration 30.00 

Sequence Final 

Flags 

SAMPLE 18383 

LOCATION 1923 s 37 st 

INSPECTOR VENTRY 

COR l b2 

COR 2 6 

MISC clearence 

NOTE epa gun 

User Login EPA 

ppm ± Error 

Pb 196.660 ± 24.436 

Cd < LOD 23.322 

Ag < LOD 16.859 

Sr 105.371 ± 9.291 

U < LOD 25.099 

Rb 45.389 ± 7.255 

Th < LOD 17.884 

Se < LOD 7.299 

As < LOD 31.490 

Hg < LOD 16.945 

Zn 267.041 ± 34.830 

W < LOD 102.803 

Cu 51.023 27.887 

Ni < LOD 93.549 

Co < LOD 204.596 

Fe 16760.311 ± 480.760 

Mn 397.032 ± 114.394 

Cr < LOD 164.223 

V < LOD 53.798 

Ti < LOD 540.212 

Sc < LOD 22.421 

Ca < LOD 888.222 

K < LOD 1275.089 

S < LOD 949.394 

Supervised By: 
p 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32075 

Reading No 720 

Mode SOIL 

Time 2009-10-26 09:25 

Duration 120.00 

Sequence Final 

Flags 

AV^RAGE= ]Avg^'7i6^7r9-2 l 

'tOCAT^ON^ 1923T37-st- ^ 

INSPECTOR VENTRY 

COR 1 em 

COR 2 1 

MISC clearence 

NOTE epa gun 

User Login EPA 

ppm Error 

•::.-. : • •'. •• V . . t • " -PC " ^ '< LOD T^r: ; 13:543 

ca^ < LOD " 227594 

Ag < LOD 16.509 

Sr 113.774 ± 9.308 

U < LOD 23.453 

Rb 49.082 ± 7.123 

Th < LOD 12.692 

Se < LOD 6.568 

As < LOD 12.668 

Hg < LOD 14.817 

Zn 47.498 ' ± 17.209 

W < LOD 89.166 

Cu < LOD 35.739 

Ni < LOD 83.284 

Co < LOD 150.002 

Fe 9987.912 ± 360.694 

Mn 315.415 ± 99.339 

Cr < LOD 134.132 

V < LOD 182.200 

Ti < LOD 490.134 

Sc < LOD 51.896 

Ca < LOD 1015.971 

K < LOD 767.001 

S < LOD 881.073 

y ^ 

Supervised By: CA P •Mi m 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32075 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

SAMPLE 

LOCATION 

INSPECTOR 

COR 1 

COR 2 

MISC 

NOTE 

User Login 

Pb 

Cd 

Ag 

Sr 

U 

Rb 

Th 

Se 

As 

Hg 

Zn 

W 

Cu 

Ni 

Co 

Fe 

Mn 

Cr 

Ti 

Sc 

Ca 

K 

S 

Supervised By: 

Certificate of Verification 

716 

SOIL 

2009-10-26 09:23 

30.00 

Final 

18383 

1923 s 37 st 

VENTRY 

em 

1 

clearence 

epa gun 

EPA 

ppm ± 

16.595 ± 

< LOD 

< LOD 

104.381 

± 

< LOD 

47.630 ± 

< LOD 

< LOD 

< LOD 

< LOD 

40.631 

< LOD 

< LOD 

< LOD 

< LOD 

10124.795 ± 

284.357 ± 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

Error 

9.210 

21.075 

15.360 

8.322 

20.957 

6.474 

10.815 

5.937 

11.294 

11.763 

14.964 

77.547 

33.079 

76.229 

139.006 

338.095 

91.069 

154.870 

289.781 

388.971 

136.610 

1267.222 

63.250 

903.932 

V 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32075 

Reading No 717 

Mode SOIL 

Time 2009-10-26 09:24 

Duration 30.00 

Sequence Final 

Flags 

SAMPLE 18383 

LOCATION 1923 s 37 st 

INSPECTOR VENTRY 

COR 1 em 

COR 2 1 

MISC clearence 

NOTE epa gun 

User Login EPA 

ppm Error 

Pb < LOD 12.336 

Cd < LOD 26.868 

Ag < LOD 19.121 

Sr 114.366 ± 10.825 

U < LOD 27.525 

Rb 50.074 ± 8.319 

Th < LOD 14.822 

Se < LOD 8.419 

As 21.885 i 9.794 

Hg < LOD 19.302 

Zn 55.767 ± 21.101 

W < LOD 106.451 

Cu < LOD 44.581 

Nl < LOD 97.813 

Co < LOD 163.981 

Fe 8584.067 ± 389.274 

Mn 219.674 ± 104.011 

Cr < LOD 21.764 

V < LOD 42.081 

Ti < LOD 423.593 

Sc < LOD 14.313 

Ca < LOD 566.979 

K < LOD 28.373 

S < LOD 492.299 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32075 

Reading No 718 

Mode SOIL 

Time 2009-10-26 09:25 

Duration 30.00 

Sequence Final 

Flags 

SAMPLE 18383 

LOCATION 1923 s 37 st 

INSPECTOR VENTRY 

COR l em 

COR 2 1 

MISC clearence 

NOTE epa gun 

User Login EPA 

ppm Error 

Pb < LOD 13.136 

Cd < LOD 20.964 

Ag < LOD 15.822 

Sr 132.054 ± 9.459 

U < LOD 22.235 

Rb 47.188 ± 6.694 

Th < LOD 12.533 

Se < LOD 6.473 

As < LOD 12.500 

Hg < LOD 13.764 

Zn 37.594 ± 15.157 

W < LOD 83.474 

Cu < LOD 28.957 

Nl < LOD 82.152 

Co < LOD 145.243 

Fe 10467.077 ± 354.171 

Mn 473.336 i 109.759 

Cr < LOD 164.090 

V < LOD 344.410 

Ti < LOD 624.140 

Sc < LOD 27.039 

Ca < LOD 1055.620 

K < LOD 1743.083 

S < LOD 1111.032 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32075 

Reading No 719 

Mode SOIL 

Time 2009-10-26 09:25 

Duration 30.00 

Sequence Final 

Flags 

SAMPLE 18383 

LOCATION 1923 s 37 st 

INSPECTOR VENTRY 

COR 1 em 

COR 2 1 

MISC clearence 

NOTE epa gun 

User Login EPA 

Pb 

Cd 

Ag 

Sr 

U 

Rb 

Th 

Se 

As 

Hg 

Zn 

W 

Cu 

Ni 

Co 

Fe 

Mn 

Cr 

Ti 

Sc 

Ca 

K 

S 

ppm 

20.675 

< LOD 

< LOD 

104.297 

< LOD 

51.436 

< LOD 

< LOD 

< LOD 

< LOD 

56.001 

< LOD 

41.242 

< LOD 

< LOD 

10775.706 

284.292 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

< LOD 

Supervised By: 

± 

± 

± 

± 

± 

± 

Error 

9.923 

21.468 

15.734 

8.626 

23.093 

7.007 

12.598 

5.442 

12.185 

14.438 

17.613 

89.191 

24.226 

76.941 

151.778 

361.235 

92.518 

195.803 

52.528 

523.834 

29.621 

1174.065 

1233.296 

1017.028 

V 
m 

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

Coastal Environmental Group inc. ^ ^ wvvw.coastaihazmat.com 

COASTAL 

SIO U p. m c 

EXECUTIVE SUMMARY: 

BVID #18383-(1923 S 37 ST) 

No Issues or Concerns Issues/Concerns 

Detail Explanation: 
5

0 

EPA Property Close Out Form 

Property Addres-1^? ^ ^ S^.. ^ ^ Property #:_ia2i2l£L _ Date/Time: OwVer'sNamet .^.OrXmrrf fdirT r . -

Quads Excavated: j^Z . Contractor Croup QQQ^itil -

Yes No Excavation General 

I. If necessary, were the correct quadrant(s) excavated and restored? ZA 

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

y 

Grading Yes No Sod and Venctation 

I. Does the grading around die perimeier ofthe house In excavated areas generally slope away zzr 

from the house? 

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

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

day time period) 

4. Are sodded areas generally firm and evenly graded? 

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

time period) 

6.

 Was the property graded such that water will not pool on the property? y 

7. Was damage to landscaping or plant materials avoided? 

Gates, Fences aad Retaining Walls 

i. Oo gates open and close h-eely? (Ifappiicable) 

Were all gates or fences taken down during restoration activilies reinstalled?

3. Was damage to gates or fences avoided? (Ifappiicable) 

 (Ifappiicable) 

Ves No 

y

zAA 

y ' 

4. Was damage to retaining walls avoided? (Ifappiicable) 

Foupdation, Sidiag and Cutlers 

1. Was damage to die siding or trim avoided? 

2. Was damage to Ihe foundation avoided? 

zA 

y ^ 

3. Was damage to windows avoided? 

4 Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspoul extensions avoided? Z ' 

Sidewalks and Driveways (Concrete) 

1 Was damage lo driveway surfaces avoided? 

Ves / No 

~y 

2. Was damage to walkway surfaces avoided? 

y 
I 

owners comments: 0- 0

pinspect ion noies: 

Removal and resloration aclivates complete including the 30-day sod warranty: v/ii av,iivait 3 v,uiiij./icic; iii\.iuuiiig iijc .j\j-uay su u w a 

EPA Representative L^CTh Y)aji,l^ Date:il/£/ 
0 

Property Compietion Agreement 

this agreement documenis the completion ol remedial activities perioimed on my properly My signature 

will designate Ihal I am satisfied with lhe rcstoralion of my propeily. and thai no items are in questions, 

now, or al any lime in the future, excepl Ihose ilems listed below, ifany 

Property ID: \^^<^ ^ 

Property Address: .|(^; ^ S 3 1 "Sf -

Owner: (.)a^{c ^ FT^IlP.r-tPhone: ^0 ^ .O^J-j I . \S 1 S 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Commei 

^jSyir y ynj2yyey^^<ry^ '^^y/^yxji^:^^^-^ ^VP 

] nfiTee rentoraiion it completed, except a$ noted 

I 1 do not «|>rcc restorntion is completed 

AT 

wncr*s Signatiit-f Date Conti ftcfoi's Signature Dale 

I
PB m 

/ jQk^ \fc Omahaa L ea . d Site—Fixe ..._.. d Price EP-R7-07-0_5 .

I ^^^AI Coasta Coastall Environmenta Environmentaii Grou Groupp inc. vl 

SLyyA ^ wvitw.coa8taihazmat.com 

^-•tpnoT*^ COASTA L 

sao u r. m c 

EXECUTIVE SUMMARY: 

BVID #18383-(1923 S 37 ST) 

No Issues or Concerns Q Issues/Concerns 

Detail Explanation: 
0 

EPA Property Close Out Form 

Property it: ]9Pi9)? i . . Property Address;- V^/ < ^\t,^ L 

Date/Time: OwVer'sNamer ..Ol^hyrf , ^0U£^ = 

Quads Excavated: J^^2^ Contractor Group rVYT-^x l 

Excavatio Yes No n Genera) 

1. If necessary, were the correct quadrant(s) excavated and restored? y f 

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

Gradin Yes No g Sod and VegetatioB 

I. Does the grading around die perimeter ofthe house in excavaied areas generally slope away zy 6x)m the house?

 _______ ^ 

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

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

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) 

6. Was the property graded such that water will not pool on the propeny' y 

7. Was damage to landscaping or plant materials avoided? 

Gates, Fences and Rctainlnij Walls 

Ves No 

i. Do gates open and close freely? (Ifappiicable) y 

2. Were all gates or fences taJien down during restoration activilies reinstalled? (Ifappiicable) zA 

3. Was damage to gates or fences avoided? (Ifappiicable) y^ 

4. Was damage to retaining walls avoided? (Ifappiicable) 

Foupdation, Sidiag and Gutlers 

Yes /Jo 

1. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? 

Was damage to windows avoided? 

4 Was damage to windows or door screens avoided? 

5. Was damage lo downspouts or downspoul extensions avoided? A' 

Sidewallts and Driveways (Concrete) 

Yes / No 

1. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

y 
: 0 0 

0>»'Dcrs comments: • ^ ^ 

Inspection notes: 

Removal and restoration activates complete including the 30-day sod warranry: 

EPA Representative *—'{yY\ ]y)Of^J^.,y Date: / 1 / 6 / 
0 

Property Completion Agreement 

fhis agreement documenis the completion of remedial aclivmes perioimed oh my properly My signature 

will designale ihal I am satisfied with the re.<iloralion of my propeily. and Ihal no ilems are in questions, 

now. or ai any lime in the future, except Ihose ilems listed below, ifany 

PiopcrryfD: )^39) ^ 

Property Address: ']0^2.?J 'S 3^7 "^V 

Owner: f^a/Mr g R)llP.r->-

Phone: /^ QZ • ?3M I > 1 5 7 S" 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comiriei 

o. Ceffy/ y^yy ^ A\jA^yy^cy-<r^^ '^^^^,,,^^,..^,..0^^ 

I Agree rcstoralion in comptcted, rxccpt as noted 

y I I rfo not i|>rec restoration is compleled 

AT 

^^ljJL7/r<^lllv^7 9^?^^^mjD \\\^\ct\ 

wncr's Sienature Date Conti arlor's Signature Date