% 

TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: ^mn Date: V^jo') 

Address: K o 1 ^^ ^ V 

Remediation Contractor: Coastal Environmental Group_ Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

a/ Video ofproperty (DVD) 

Executive Summary 

EPA-provided property sketcii 

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 pre^jDcO/lJaxiorx^ .CMCaJ/i.^ ci/\ 3o-Jcu^ ^thJi sod 

As-built sketch 

y Satisfactory restoration signed by Property Owner 

y Property close-out check list signed by EPA 

Description ofareas not meeting ROD cleanup criteria 

Utility clearances 

Property information from Douglas County Assessor's Office 

nryjQ-er-ia. f\.oj;esK QVie^lcXiSX: 

40316467 

D 

D Superfund 

15ate 

if/y/o 'ol 
Property Access Checklist 

1 Property ID: ^l/\^\ ^ n WORK STARTED ON: 

Property Addrc.s.s: j* ^ 0 \ \ fi^^iy n WORK COIVIPELTED

y 

ON: -H-1 

Owner: Renter: C/1T1 Of 0\AP^m 

Address: Phone: ^t)l \^t ^ Fax: 

Cell/Pager: 

Phone: Additional Information;

4qq ^%\l^ ^ CHMs 

Fax: 

Cell/Pasei : 

O Notitlcation Letter Sent: / / By: 

0 ^ Access Agreement Signed: ^/_L/: ^ By: ^ 

\ ^ Restoration Agreement Signed: ^ / \ / ^ By: Kh' 

1 1 Topsoil Sam|)ling (if a|)plicablc) / / By: 

O Disposal Sampling (if applicable) / / By: 

O Garden Sampling (if applicable) / 1 By: 

|[ ^ Utility Clearance Called: ^ / t) /V ^ By: ^ 0 

1 \2f Video/Photos (Before) On:3l/id/Oi ^yK{f\/\ 

n Video/Photos (During) On: / / By: 

n Video/Photos (After) On: / / By: 

n Video/Photos (30-Day) On: ,/ / By: 

CH Property Completion Agreement Signed: / / By: 1 

n Final Re|)ort Issued: / / By : II 

Air Monitoring (as applicable 

1 1 Community LU Crew 

) 

Results:

On: / / 1 

1 

LJ Community

Results: 

LU Crew On: / / Bv: 

LU Community

Results: 

LU Crew On: / / By: 

Omaha Lead Site 
Douglas County Account In^jamatio nf^jma n Page 1 of2 

Dougla s County , Nebrask a Propert y Recor d - R193499000 0 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 90th St - Vie w On Ma p Information is valid as of 2008-6-19 Treasurer's Tax Report 

New Feature -•-*- • Auto Sales Search 

Owne r 

CITY OF OMAHA 

PLANNING DEPT 

1819FARNAMST#1111 

OMAHA NE 68183-0000 ' 

Propert y Informatio n 

Key Number: 3499 0000 19 

Account Type: Ex Government 

Parcel Number: 1934990000 

Parcel Address: 1501 YATES ST 

OMAHA NE 68110-0000 

Legal Description: PADDOCK PLACE LOT 8 BLOCK 3 N 90 FT 

Valu e Informatio n 

Land Improvement Total 

2008 $0.00 $0.00 $0.00 

2007 so.oo $0.00 $0.00 

2006 $0.00 $0.00 $0.00 

2005 $0.00 $0.00 $0.00 

2004 $0.00 $0.00 $0.00 

2003 $0.00 $0.00 $0.00 

Sales Informatio n 

Sales Date: 2003-11-21 

Deed Type: SWD Book: 2004 Page: 030513 

Price: $0.00 

Grantor: LRC 

Grantee: City of Omaha 

Valid/lnvalid: Invalid 

Exclusion Reason: Sale by Govt Agency 

Sales Date: 2001-10-11 

Deed Type: SHD Book: 2004 Page: 030512 

Price: $0.00 

Grantor: Sheriff 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R193... 7/9/2008 
Douglas County Account InfiMmation Page 2 of2 i^jma 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

LRC 

Invalid 

Sale by Govt Agency 

Land Informatio n 

Acres 

0.1

SF 

 4500.0

Units 

 0.0 

Deptfi 

90.0 

Width 

50.0 

Vacant 

Yes 

Land Attributes 

Attribute Attribute Description 

Negative Influence Location 8 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl93... 7/9/2008 
Page 1 of2 

# # 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2078206. •2^1? 

Original Call Date: 7/09/08 Time: 5:34 pm Op: ELIZABETH18790 


Work to Begin Date: 7/11/08 Time: 6:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 1501 Street: YATES ST 


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


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: Lead Remidiation 


Location of Work: ENTIRE PROPERTY ALL THE WAY TO THE STREET. 


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 


CXCATV LEVELS MAGELLAN MCINEB MUDOl OMAHACOF 0PPDGPR5 


QLNNEIC 


Utility Service Area Contact Phone Number Type 

Day: 4029340469 


CXCATV COX COMMUNICATIONS, INC HEIDI ^yt 4029340469 

Emerg: 4029329757 


Day: 8773668344 


LEVELS LEVELS COMMUNICATIONS, LLC NA 

Emerg: 8773668344 


Day: 9185747098 


MAGELLAN MIDSTREAM MAGELLAN TONYA Alt: PARTNERS LP 

Emerg: 9185747098 


Day: 8002893427 


NO CALL PER 
 MCINEB MCI Alt: MEM O 


Emerg: 8002893427 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/9/2008 
Page 2 of2 

# # 

MUDOl METROPOLITAN UTILITIES 

DISTRICT EDWINA 

Day: 4025047823 

Alt: 

Emerg: 4025047946 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON 

Day:

Alt:

 4024447197 

 4024445161 

Emerg: 4024445160 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 8887289343 

Emerg: 4067289343 

QLNNE 1C QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/9/2008 
As-Built Drawing 

C OAST A L Omaha Lead Superfund Site 

ar^/T Nortti Arrow Omaha Lead Site Owner Name: C/f-y^l£^Oms/T S 

Site Sketch Address: j^O / >^/te S <S^. 

Phone: H; W: 

f 

Sample Number Lead Sample Samples Collecfed LAB Concentration Collected Firm ME/ i 

RYASCPXA- 2 7H / T F1 7 5 0 ppm D Date: 

RYBSCPXA-£>7-y/7" F2 J/ Q ppm IT D Time: 

RYCSCPXA-^7-y/7" B1 7¥. 9 ppm D 

Samples Analyzed RYDSCPXA-2>7-V/7- B2 ^ g ppm D 

nOgCCPXA B2- ~ ppm D D XRF Unit: _QQ3_ Book: _S3. nCgOCPXA 62- ppm D D Date: _ 

RPgOGPXA- -P2- ppm D D Time: AJkL 

Staff: Number of Samples = | lj . \ —• P. (/ahnfian 

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 the street, facing properly 

OLS#: 27417 

Date Excavated :7/15/2008 

. natellRFPA Signpri Off B/l A/^QQg 

Area Sodderr: 4590 sq (ft 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced witih Area replaced with 

Area left bare 
 Sod ' ' Rock/Mulch 


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

fe^^ ii^ii^^^ m ^ 

ar^/T 

Onrtah Exterior Rami North Arrow a Laad Site Owner Name: C//yJJl P Om^h a Good f Site Sketch Address: /SD J Y^fSS ^ (Sf. Poor 

Phone:H W: 

Not paint 

Sample Number 
 Lead Sample Samples Collected LAB Concentration Collected Firm: 

RYASCPXA- 2 7H/ T ^1 TS D ppm D Date: 

RYBSCPXA-^7V/7" F2 3f O ppm D Time: 

RYCSCPXA-^•^^/T' Bl 7^. 9 ppm 

D Samples Analyzed RYDSCPXA-^;riy/7- B2 i^i^ppn i D 

RDZSCPXA B2­ ~ ppm n D XRF Uni I: QOS Book: l^Q 

WGZSCnXA' -G^- " ppm D D Date: 

nrzsGPXA• -P2- ~ ppm D D Time: AM 

Number of Samples = At Staff F, (/cihn.'icin 

Legend: F1 = Front Left. F2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the streel, facing property 

llW4 04OI4I Oi.'? 
Exterior Paint North Arrow Omaha Lead Site Owner Name: Q/ y o P Qms/i a Good Site Sketch Address: /5K) / X9f&. ^ <9 A Poor 

Phone: H W: 

Not paint f

Sannple Lead Sample 

Samples Collected Number LAB Concentration Collected Firm: 

RYASCPXA-^ rV/ r F1 7 5 D ppm n Date: 

RYBSCPXA-^7Vy;/7 F2 ___i2/Q_Pp m \sr D Time: 

RYCSCPXA-<f7'y/7' B1 7^. 9 ppm n 

RYDSCPXA-^;ry/; Samples Analyzed r B2 D 

RDZSCPXA B2- -~ ppm D n XRF Unit; 60 3 Book; ^5231 

nozcopx/^ 

-G2- ppm D n Date: _ a -i ~o*^ 

RrZGCPXA- -«?- ppm D n 

Time: AM 

Numbe Staff; P. chhnaon r of Samples • 

Legend; F1 = Front Left, F2 = Front Right, B1 = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

046141 0123 

i 
Exterio North Arrow Omaha r Paint Owne Lead Site r Name: C/f y o P Omah a Good f Site Sketch Address: /S'O / y^/&. ^ c9/. Poor 

Phone: H W: Not paint 

Sample Lead Sample Samples Collected Number LA8 Concentration Collected Firm; 

RYASCPXA- 2 TH t T F1 7 5 0 ppm D Date: 

RYBSCPXA-^^-y/7" F2 _iM2_Ppm D Time; 

RYCSCPXA-^7"^/7 81 7^ Q ppm 

D Samples Analyzed RYDSCPXA-^T-y/T- 82 yy g ppm 

nDZCCPX/> 92- n JZ ppm u XRF Unit: A0 9 Book; 3^ 1 D nczccpxA -6 ^ _Z ppm D Date: Q- 1 - 0*A D nrzscpxA' - p ^ _ I ppm D Time; A M D 

Numbe Staff: P- dahnfion r of Samples = j f-/. 

Legend: Fl = Front Left, F2 = Front Right, 81 = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as vie>Med from the street, facing property 

B l Ba 

T*f3_ H-K. 

isor.y/^t&sT 

r 

F / ra 

ISO 3IG 

Rev 4' 046141 0123 
COASTA L EHVIRONHIMTAI, 

C • O U t . IH 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; i^QnUl'l ' 

Owner's Name: Qj\\ j ^ OrV^oWs. Daytime Phone: ^/y^-:^ / ^ a 

\£o (vy-e.^ ^ Address of Property 

covered by this 

Agreement: I 

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. 

J 

ENVIRONMENTAL RESPONSE ACTIONS 

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

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

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

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

agrees to: 

Page 1 of 2 
COASTA L EMViaONMINTItt, ^ '"IMIOT*' 

CROUP, . IM C 

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

piles, dog houses, etc; 

• Remove flower bulbs or plants that the Grantor or the Grantor's tenant may wish 

to save; 

• Water and maintain replacement vegetation, including fertilizer application, as 

necessary subsequent to an initial watering period by EPA; 

• Abide by health and safety guidance provided by EPA; 

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

the property to perform the work. 

• Allow videotaping and/or photographing of the property. 

AGREEMENT NOT TO INTERFERE 

The Grantor agrees not to interfere or tamper with any of the work activities, or with any 

of the work done, or with the equipment used on his property, or to undertake any 

actions regarding the use of said property which would tend to endanger the health or 

welfare of the Grantees or the environment, or to allow others to use the property in 

such a manner. , 

Should you have any questions about this program, please contact Coastal 

Environmental Group, at (712) 352-0188 

Ej^gran r t access to my properties 

D I do not grant access to my properties 

-y-yo^ 

Signature 

Dat^ 

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

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

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

activities are completed to the satisfaction ofthe property owner and the United States Environmental 

Protection Agency (EPA). 

Property ID: TPTri 

Property Address: l^ D \ yoJ^f< SP ^ 

Owner: C^,) ^ ^ Omx\^(K 

Phone: HD2'h^^i'/'<rKA ^ th y 

On the attached diagram(s) indicate area(s) to e.xcavated and depth of e.vcavation, 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, material t\pes, etc. Indicate digital photos 

by referencing the photo-log number with an arrow indicating direction of view. 

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

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

Page 1 of 
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: 

L 

Page 2 of 
^^^^^~ 

^ ^ ^ 

COASTA L 

Items To Be Remove d By Contractor During Remediation An d Replaced 

(Use additional sheets as necessary) 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 3 of. 
MC 

COASTA L 

Landscape Inventory 

(Use additional sheets as necessary) 

Item Quantity Unit Condition/Type/Species 

Pre-existing property area, 

that wil l be excavated, that 

is covered with grass. 

Number of trees > 2 inch 

trunk diameter 

Number of trees •'= 2 inch 

irunk diameter 

Number of Sprinkler 

Zones. Control Valves. 

Timers. Heads, etc. 

Anach a sketch u!' ihe 

ipi'iiikle; !a\ oui. 

Number of and size of 

each garden flower bed 

area. 

•••.Uin-i: ;•. >^ciC! i KH .Ci::- , c 

^l;'e^ rm j localioni. 

h2 Square feet 

^ Each 

Each -6^ 

- ^ Each 

^ Each 

Square Feet 

i 

Page 4 of 

1 
COASTA L 

Item Quantity 

Agreed upon value of 

plant materials not to be 

replaced by contractor. 

Note this \alue will be ^ ^ 

used to Issue a plant 

\oucher to the proper!) 

owner. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

^ ^ 

Include a sketch ot" were 

each plant ^^ill he pbced 

b_\ ihe coniiacioi'. 

Agreed upon area of F 1 

propern to be replaced 

with grass sod. Bi 

':"iclude a ^keu:h o;' ihc Ba 

.iieais! U-. he :cpljcca ••^'ih 

ii'-ass >od. 

.Area of Cir> or Counrs 

propert> to be landscaped 

per their requireinents. -6-. !!"H.U;i.lc 1 ^i-,i'UT! i>; ;!:c 

.lie.: iSl 

Easemeni .Area, to be 

excavated 

Unit Condition/Type/Species 

$ ^ 

Each 

^6<^ aW -txcAYc^ arajK^ 

SF 

SF 

SF 

Page 5 of 
C O A S T A L • MVIROMNIMTAL amour , tn e 

LJ Check the box if Owner does not want CEG to document interior foundation walls and possible 

pre-existing damage. By checking this box CEG is not responsible for any damage done to the 

interior of house, including foundatipn cracks or fissures. 

Q I do not agree 

<7V'^ ^ 

Owner's Signatun Date Contractor's Signature 

PageSof. 
BVID# 11y

XRF PROPERTY SAMPLE SHEET 

Date 

Project 

XRF ID# 

Shot# 

:m 

y^ 

JSLL 

Average

1 Shot # 

iqq 

1 Ktt) 

? 0 | 

1 ^02^ 

Average

Shot # 

Average 

Shot# 

-Ifi 

n\ 2JL 

Average

1 lab sample # 

(|l</h t Address i^i iflxih "lY 1 

Omaha lead FP 2nd year option Sample time KHC am/|Prii 

sample length 30 sec ^ ^ ym^^ 

Reading Sample area 1 Shot # Reading Sample area 1 

'1^4 myy . UHT^ 'inw^ y.<y ^1 n^< 'ly'MAy \\\> U 

Depth -MC M'^^' l -^H.x Depth 1 

^oC'^M n.Qff 1 -1^1 'iMi^lt K-ii 6^ 1 

 l/O^.^lj [^ Average ^ 1 ^ . ^ 1 J: jj^ ^ 

Reading Sample area 1 1 Shot # Reading Sample area 1 

"704-^5 t ^. U 

{oM.H}^'^^^ , fl 

V)o.^%K lt.<^\ Depth 1 Depth 

%%.^nit%lA {.•• 1 

 ^gM V 1^ ^ - ^ 1 Average 

Reading Sample area | Shot # Reading Sample area 1 

Depth Depth 

Average 

RETEST AREAS 

Reading Sample area Shot # Reading Sample area 1 

^ ( y.'M'^ \d- ^ 

[,Q, {"{ i M.f) Depth Depth 

m.K t \^.\^ ^...-y^ 

\\l.l ^ ^ 1^>1 ^ Average 

Lab result Sample area XRF Avg. 1 

Signature, 

Print \Km ^ \\^fyh/^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 792 

Mode SOIL 

Time 2008-07-15 15:48 

Duration 30.05 

Sequence Final 

Flags 

AVERAGE ^Av g of 791-791 | 

ADDRESS 1501 yates st 

QUAD/ZONE fb l 

INSPECTOR MATEUS 

DEPTH | 6 

SAMPLE TYPE CLEARANCE 

NOTE 
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 225.784 

Supervised By: 

Certificate of Verification 

788 

SOIL 

2008-07-15 15:45 

30.07 

Final 

27417 

1501 yates st 

bl 

MATEUS 

6 

CLEARANCE 

± Error 

± 18.658 
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 207.372 

Supervised By: 

Certificate of Verification 

789 

SOIL 

2008-07-15 15:46 

30.34 

Final 

27417 

1501 yates st 

b l 

MATEUS 

6 

CLEARANCE 

± Error 

± 17.949 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 790 

Mode SOIL 

Time 2008-07-15 15:47 

Duration 30.17 

Sequence Final 

Flags 

BVID # 27417 

ADDRESS 1501 yates st 

QUAD/ZONE bl 

INSPECTOR MATEUS 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 341.980 ± 22.598 

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 205.487 

Supervised By: 

Certificate of Verification 

791 

SOIL 

2008-07-15 15:48 

30.05 

Final 

27417 

1501 yates st 

bl 

MATEUS 

6 

CLEARANCE 

± Error 

± 18.004 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 798 

Mode SOIL 

Time 2008-07-15 15:54 

Duration 121.10 

Sequence Final 

Flags 

AVERAGE |Av g of 794-797 

ADDRESS 1501 yates st 

QUAD/ZONE B2 

INSPECTOR MATEUS 

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 288.551 

Supervised By: 

Certificate of Verification 

794 

SOIL 

2008-07-15 15:50 

30.25 

Final 

27417 

1501 yates st 

82 

MATEUS 

6 

CLEARANCE 

± Error 

± 20.822 
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 245.902 

Supervised By: 

Certificate of Verification 

795 

SOIL 

2008-07-15 15:51 

30.31 

Final 

27417 

1501 yates st 

B2 

MATEUS 

6 

CLEARANCE 

± Error 

± 19.156 
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 408.057 

Supervised By: 

Certificate of Verification 

796 

SOIL 

2008-07-15 15:52 

30.32 

Final 

27417 

1501 yates st 

82 

MATEUS 

6 

CLEARANCE 

± Error 

± 24.757 
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 148.985 

Supervised By: 

Certificate of Verification 

797 

SOIL 

2008-07-15 15:54 

30.22 

Final 

27417 

1501 yates st 

B2 

MATEUS 

6 

CLEARANCE 

± Error 

± 15.241 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 803 

Mode SOIL 

Time 2008-07-15 15:58 

Duration 120.48 

Sequence Final 

Flags 

AVERAGE fAv g of 799-802 

ADDRESS 

QUAD/ZONE 

1501 yates st iFl 

INSPECTOR MATEUS 

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 304.408 

Supervised By: 

Certificate of Verification 

799 

SOIL 

2008-07-15 15:55 

30.21 

Final 

27417 

1501 yates st 

Fl 

MATEUS 

6 

CLEARANCE 

± Error 

± 21.611 
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 612.502 

Supervised By: 

Certificate of Verification 

800 

SOIL 

2008-07-15 15:56 

30.07 

Final 

27417 

1501 yates st 

Fl 

MATEUS 

6 

CLEARANCE 

± Error 

± 30.966 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 330.682 

Supervised By: 

Certificate of Verification 

801 

SOIL 

2008-07-15 15:57 

30.01 

Final 

27417 

1501 yates st 

Fl 

MATEUS 

6 

CLEARANCE 

± Error 

± 22.817 
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 358.278 

Supervised By: 

Certificate of Verification 

802 

SOIL 

2008-07-15 15:58 

30.19 

Final 

27417 

1501 yates st 

Fl 

MATEUS 

6 

CLEARANCE 

± Error 

± 23.294 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 822 

Mode SOIL 

Time 2008-07-16 09:58 

Duration 120.85 

Sequence Final 

Flags 

AVERAGE J Avg of 818-821 » 

ADDRESS 1501 YATES 

QUAD/ZONE iF l 

INSPECTOR MATEUS 

DEPTH ft 10 SAMPLE TYPE RETEST NOTE CLEARANCE SAMPLE @ 10 inches 

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 85.133 

Supervised By: 

Certificate of Verification 

818 

SOIL 

2008-07-16 09: 55 

30.04 

Final 

27417 

1501 YATES 

Fl 

MATEUS 

10 

RETEST 

CLEARANCE SAMPLE @ 10 inches 

± Error 

± 11.993 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 819 

Mode SOIL 

Time 2008-07-16 09:56 

Duration 30.57 

Sequence Final 

Flags 

BVID # 27417 

ADDRESS 1501 YATES 

QUAD/ZONE Fl 

INSPECTOR MATEUS 

DEPTH 10 

SAMPLE TYPE RETEST 

NOTE CLEARANCE SAMPLE @ 10 inches 

ppm ± Error 

Pb 60.488 ± 10.635 

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 160.196 

Supervised By: 

Certificate of Verification 

820 

SOIL 

2008-07-16 09:58 

30.12 

Final 

27417 

1501 YATES 

Fl 

MATEUS 

10 

RETEST 

CLEARANCE SAMPLE @ 10 inches 

± Error 

± 17.231 
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 143.159 

Supervised By: 

Certificate of Verification 

821 

SOIL 

2008-07-16 09:58 

30.12 

Final 

27417 

1501 YATES 

Fl 

MATEUS 

10 

RETEST 

CLEARANCE SAMPLE @ 10 inches 

± Error 

± 15.141 
Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

wvvw.coastalhazmat.com 

COASTA L INVmONMENTAL 

GROUP , IN C 

EXECUTIVE SUMMARY: 

BVID # 27417 - (1501 YATES ST) 

I I No Issues or Concerns X Issues/Concerns 

Detail Explanation: 
smL. EPA 

EPA Property Close Out Form 

7"](In

Property H ______ ^

 '• H i .1 __^ , Dateyriroe: t'\ f T i EAE 

Quads Excavated: 

_ 

 No 

No 

 No 

 .No 

 No 

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

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

Foundation, Siding and Gutteni 

1. 

Was damage lo the siding or trim avoided? 

2. 

Was damage to the foundation avoided? 

3. 

Was damage lo windows avoided? 

4. 

Was damage to windows or door screens avoided? 

5. 

Was damage lo downspouts or downspoul extensions avoided? 

Sidewalks and Driveways (Concrete) 

I. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

. ^"^^ 1A^^ yf. Property Address;- j ; DKAAHf^ 

 Owner's Name:. ./^>1^TT /I. . .P^.P' ^ 

Contractor Group OvpCyXf^ 

Yes Excavation General VAPAhf T L^ T 

I. If necessary, were the correct quadrant(5) excavated and restored? 

y 

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

Gradinf Ves ; Sod and Vegetation 

1. Does the grBding around the perimeter ofthe house in excavated areas generally slope away A/>­ 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 

dav time period) 

4. Are sodded areas generally firm and evenly graded? y 

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

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? 

y 

Gates, Fences and Retaining Walls 

Yes

1. Do gates open and close freely? (Ifapplicable) ± 

Were all gates or fences taken down during restoration activilies reinstalled? (Ifapplicable) Pr 

Ves

< 

• /' 

Aj ^ {/\ " y

/ \ 

Ves

^ > 

j J ^ 

1 
Owners comments: 

Inspection notes: 

So J ^rn-uf) /dis-f-icUci t>^ A^y^ (^A^/^ i 

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

EPA Represental>vg;^I^^^^^.X7 ^ Date: ^^ ^ 
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 ftiture, except those items listed below, ifany. 

Property ID: 3. 1 Hi J 

Property Address: JSO f y t^j- ^ S rf . 

Owner: ^. | ^ f ^ ,^^0 . 

Phone: ^ ^ ^ - $-1 ^ O if^ C ky i S 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

jy ] I agree restoration is completed, except as noted 

fQ/i I do not agree restoration is completed 

/luy.^yy^..r ^-^y y^ ~ 

Owner's Signature i Date infractor's Signature