TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: \2lik Date: ll'" 

Add^ss: l|^0< ^ qO-^^ r 

Remediation Contractor: Coastal Environmental Group Year: 20 _20(|Ji L 

SOIL REMEDIATION 

PROPERTV nL E FOLDER DOCUMENTS 

Video ofproperty (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.) 

Confinnation data 

Photographs 

As-built sketch 

30217573 Satisfactory restoration signed by Property Owner lliliil 

Property close-out check list signed by EPA Superfund 

Description ofareas not meeting ROD cleanup criteria 

Utility clearances 

Property information from Douglas County Assessor's Office 

i "1 

Signature '5ate" 
# 

Property Access Checklist 

PropertylD: ) ^ f^^^ 

D WOBK STARTED ON: / / 

D WORKCOMPELTED ON: / /

Property Address: U,<^0, ^ (^ ^ 7. ,'^ , 

Owner Renten 

Address: IB. ' J Phone: 

Fax: 

Cell/Pagen 

Additional Information: 

"?5.VO:M5: 

Fax: ^ 

Cell/Pagen 

D Notification Letter 

Sent: / / By: 

Access Agreement Signed; tg/^/^ g By: 

j ^ Restoration Agreement Signed^D-ZSLOSl By: 

Q Topsoil Sampling (if applicable) By; 

D Disposal Samplhig (if applicable) / /. By: 

G Garden Sampling (if applicable) By: 

s Utility Clearance Called:/' / L l< ^ ^nJLiuiQi 

Q^ldeo/Photos (Before) On: W l T-l ^ »y- /JTM/r^^y^/j^/. ^ 

D Video/Pbotos (During) On: By: 

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

D video/Photos (30-Day) On: / / By: 

f Property Completion Agreenrat Signed: JL^^/.g | By: 

Final Report Issued: / By: 

Air Monitorine (as applicable] 

Q Commnnity QCrcw On: / / By: 

Results; 

nComnmntty DCncw On: / / By: 

ResDhs: | 

D Commnnity QCrcw On: / / By: 

Results: 

Omaha Lead Site 
Douglas Cotmty Account la rfiunati ion Page 1 of3 

Douglas County, Nebraska Property Record - R1435070000 

Print Report 

NEW Feature - Parcel Dimensions available fi) scale 0-50 ft west of 52nd St - VlOW O n IMap Information is valid as of 2009-10-15 Treasurer's Tax Report 

New Feature ->•*- > Auto Sales Search 

Owner 

ZARACKI RAYI^OND 

ETAL 

4130 S 41 AVE 

OI^AHANE 68107-0000 

Property Informatio n 

Key Number: 3507 OOOO 14 

Account Type: Residential 

Parcel Number: 1435070000 

Parcel Address: 4505 S 42 ST 

OMAHA NE 68107-0000 

Legal Description: KENTS ADD LOT 8 BLOCK 2 -EX IRREG W 9.2 FT- S 50 FT LOT 7 & S 50 FT 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$5,700.00 

$5,700.00 

$5,700.00 

$5,700.00 

$5,700.00 

$5,700.00 

Improvement 

$26,700.00 

$26,700.00 

$26,000.00 

$26,000.00 

$14,600.00 

$13,300.00 

Total 

$32,400.00 

$32,400.00 

$31,700.00 

$31,700.00 

$20,300.00 

$19,000.00 

Sales Informatio n 

Sales Date: 2007-04-27 

Deed Type: 

Price: 

Grantor: 

WD 

$35,000.00 

Jankowski Nicholas J 

Book: 2007 Page: 051656 

Grantee: 

Valid/lnvalid: 

Zaracki Raymond etal 

Valid 

Exclusion Reason: 

Sales Date: 2000-05-02 

Deed Type: 

Price: 

Grantor: 

D 

$19,000.00 

Book: 2151 Page: 207 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl... 10/17/2009 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl... 10/17/2009 
Douglas County Account InJugMdo iJujnMdc n Page 2 of3 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Valid 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

Grantee: 

Valid/lnvalid:

Exclusion Reason: 

1995-08-31 

$16,000.00 

', Valid 

Book: 2015 Page: 533 

Sales Date: 

Deed Type:

Price:

Grantor: 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

1995-06-14 

 I D 

 $8,000.00 

Invalid 

Invalid Sale 

Book: 2006 Pasre; 559 

Land Information 

Acres SF 

0.11 5000.0 

Improvemen t Information 

Building 1 

Units 

1.0 

Depth 

100.0 

Width 

50.0 

Vacant 

No 

Ranch 4505 S 42 St 

2a «« 

• ' ftrjIFlirr * " 

l,',>A^l•^.l.^•.Mll.^^J.^^.ll!?^w^.•H<sa8la 09MMiaiMN49 

CLIC K T O ENLARG E IMAG E 

CLICK TO ENLARGE IMAGE 

Square Footage: 442.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Low 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl... 10/17/2009 
Douglas County Account IniJujnMdo ^ n Page 3 of3 

Unit Type: 

Built As: 

HVAC: 

Exterior: 

interior: 

Roof Cover: 

Roof Type: 

Floorcover: 

Year Built Remodeled Remodeled 

1925 

Detail Type 

Appliance 

Basement 

Fixture 

Fixture 

Garage 

Porch 

User 

Ranch 

Forced Air 

Frame Vinyl 

Drywall 

Composition Shingle 

Gable 

Allowance 

Year Percent 

0 0% 

Detail Description 

Allowance 

Bsmnt Block 8 ft 

Base Fixtures 

Bath Half 

Detached 

Wood Roof 

Traffic -30 

Condition: 

Condo Square Footage: 

Rooms: 

Units: 

Baths: 

Bedrooms: 

Stories: 

Foundation: 

Sprinkler Square Footage: 

Adjusted Year 

Average 

0.0 

2.0 

1.0 

0.5 

1.0 

l-O 

Block 

0.0 

Physical Age Built 

1925 83 

Units 

1.0 

208.0 

1.0 

1.0 

252.0 

48.0 

1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl... 10/17/2009 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email ][ 

YOUR TICKET NUMBER IS 2397789. 


Original Call Date: 11/02/09 Time: 9:56 am Op: ELIZABETH18790 

Work to Begin Date: 11/04/09 Time: 10:30 am 

State: NE County: DOUGLAS Place: OMAHA 

Address: 4505 Street: S 42ND ST 

Twp: 14N Rng: 13E Sect-Qtr: 05-NE-NW 

Twp: Rng: 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: 4 FT Comer Lot: N Front: Y Rear: Y 


Involves Turmeling or Horizontal Boring : N Explosives: N 


ATTNEBRl CXCATV METRO MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


Service Area Contact Phone Number UtiUty Type 

ATTNEBRl ATT/T 

Day: 80024136249 

Alt: 

Emerg: 80024136249 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Ah: 4029340469 

Emerg: 4029329757 

METRO METRO COMM. COLLEGE CHRIS 

Day: 4024572307 

Ah: 4026727033 

Emerg: 4024572313 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11/2/2009 
Page 2 of2 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC

Day: 4024447197 

 Ah: 4024445161 

Emerg: 4024445160 

OPPDGPR6 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Ah: 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK NA 

Day: 4067289343 

Ah: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11/2/2009 
OLS#: 10156 As-Built Drawing Date Excavated:11/13/09 

Date USEPA Signed Off: 12/4/09 

COASTA

CNVmONNINTAI

L Omaha Lead Superfund Site Area Sodden: 531 so ft . C « O U P. IN C 

10156 

Omah Exterior Paint Nortti Arrow a Lead Site • Good Site Sketch 

• Poor 

Sampling Address: 4505 S 42 ST Q Not paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Firm:

Samples Collected 

> ^ Cft. .TH 

RYASCPXA-10156 Fl IH H ppm D Date; fi- 7­ ^& 

RYBSCPXA-10156

RYCSCPXA-10156

I^YOSCPXA 10166

 F2 

 B1 

 B2 

i U I f

58 9

 ppm 

 ppm 

ppm D 

D 

D 

D 

Time. /-/ ^ p/>1. 

Samples Analyzed 

RDZSCPXA-10156 DZ 2^oH ppm n XRF Unit: taSHO Book: 2.19. nGZSCPXA'10156 GZ­ ppm D D Date: '^ -Z - OP, 

RPZGCrXA-10150 P2 .pprn D n Time: ft*., 

Number of Samples = | Y E Staff: i^^lA / 

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

All quadrants are as viewed from the street, facing property 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with 

Sod 

Area replaced with 

Rock/Mulch Area left bare 

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

^5 t5 77* 

Omaha Lead Site 

Site Sketch 

Sampling Address: 4505 S 42 ST 

Sample Number 

RYASCPXA-10156

RYBSCPXA-10156

RYCSCPXA-101S6

fIVDCCPXA 10166

RDZSCPXA-101S6

nOgSCPXA 10156

RPZOCPXA-IOIGO

Lead Sample 

Concentration Collected 

 Fl ppm 

 F2 ppm 

 81 5 8 ^ ppm 

 BS ppm n 

 DZ 2yoV ppm 

 G2- ppm D 

 P2 ppm D 

Number of Samples ^ 

LAB 

D 

D 

D 

D 

D 

D 

D 

H 

Legend; F1 = Front Left, F2 ^on t Right, 81 = Back Left, B2 = Back Right DZ

10156 

Eirterior Paint North Arrow 

Q] Good 

• Poor 

0 ^ Not paint 

Samples Collected 

•"TTfm: f ^ C&, JD 

Date: fi - 7- Og 

Time: /-•/ < p/<n . 

Samples Analyzed 

XRF Unit; (aSH O Book:

Date; ^-30f t 

Time: J o . Staff; i^'^l v 

 Z/ g 

= Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

c ^ ^'•^ f^ p 

>£2SS •4—tilgJ ^ZI^ILyy-yX RevJOOH iTCiKd: n.l-i^ay.OS 
10156 

It ]ily^ 

Omah Exterior Paint North Arrow a Lead Site 

Sit • Good e Sketch • Poor 

Sampling Address: 4505 S 42 ST \Z( Not paint 

Sampl Lead Sample Samples Collected e Number LAB Concentration Collected Firm: f ^ CB. .TH 

RYASCPXA-10156 Fl IHH ppm n 

Date: A3- 7 - '^ 3 

RYBSCPXA-10156 F2 

lltU ppm D Time: /-/ ^ pAl . 

RYCSCPXA-10156 Bl 5 8 9 ppm n 

Samples Analyzed 

•RYDSCPXA 10166 -Ba ppm D D 

RDZSCPXA-10156 2^oH ppm O^ n XRF Unit: (aSH O Book: 2/ g 

RGZSCPXA-10156 D ppm Z D n Date: 9-3 - OP , 

RPZOCPXA-10150 ppm 

D a Time: ?i>\ 

-P2 Staff: Al^U / Number of Samples = | Y [ | Q [ 

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

All quadrants are as viewed from the street, facing property 

Rev 2(K)« Crtalcd: 
10156 

Omaha Lead Site Exterior Paint North Anow 

Site Sketch • Good 

• Poor 

SamDlino Addrms: 4505 S 42 ST Q'No t paint 

Sample Number Lead Sample Samples Collected 

t 

LAB Concentration Collected Finn: ^X^ Ifi . .TO 

RYASCPXA-i0156 Fl _liia_ppm D 

Date: fir 7- o8 

RVBSCPXA-IOISe F2 llaf f oom 

D Time: /-/ ^ p-ZA. 

RYCSCPXA-10156 Bl __Sj@L3_ppm D 

Samples Analyzed 

f^VDSCPXA 10166 B2 - oom D

RDZSCPXA-10156 DZ 2HO H oom D D XRF Unit: (^^t y Book: 2/ g 

noz60PXA-ioi56—ea- oom D D Date:_ 

RPZOCPXA-iOISO PZ 

D n Time: _ h ^ 

Staff: Numtw f*1SlV r of Samples = | Y | |Q ^ 

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

All quadrants are as viewed from the street, being property 

Rev 2008 Crated: m-Ma>-08 .01.23 
COASTA l iHVIItONHIHTAt 

C K O U P IHC 

Consent for Access To Propefty 

RIGHT OF ENTRY TO PREI^ISES 

Grantor (the property owner) consents to and autliorizes 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: fTslcr 

Owner's Nante: Daytime Phone: 

^M. 

Address of Property 

covered Iiy 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 soii. The removed contaminated soil will be 

replaced with clean materials and the area vi/ili 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 perfomned, 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 wori( 

and confirm that it is complete and meets with the Grantor's approval. Upon 

completion, the Grantor will receive v^rritten 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 lNVINONH»KTA t 

C K O U r IN C 

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

piles, dog houses, etc; 

c 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. 

e Allow videotaping and/or photographing of the property. 

AGREEINENT 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 

I grant access to my properties 

D I do not grant access to my properties :K' 

nature / / Date Signature 

Date 

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

Page 2 of 2 
A 

l•.M;>^'• 

RESTORATION CHANGE ORDER 

OMAHA LEAD 

Property ID # i6i^G 

Property Address H5Q 5 $:> ^^^ AS4 

Owner Name C((^r=Hy> U gV f 

Date \\l\?,lo^ 

Comiment i s 

Idl ^ T 9 ^ 

Owner Signature 

Contractor Signature 

0.0 
••TlCOASTA L 

Restoration Agreement 

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

romediation 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). 

PropertylD: ]{)\^( ^ 

jproperty Address: ^Q 5 ^ Jl^'^'^ -

Phone: '^'b'h-O^i'l 

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

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

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

necessary. 

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

The tenoval. stora.qe, di&posal, and/or return of these itoms is the Owner's responsibiiity. 

«-X^'K5*' lj pu y 

item: 

Item: 

Item; 

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

Item: 

I VT i r J.

y^^^JI . v/^J ' , . „ . Up f .. K^AA^^J ,_, 

Item: / 

item: 

Item: 

Page 1 of. 
;_/fv;:~^.'|U 

COASTA L 

C k I, U I 

Items to Be Removed By Contractor During Remediation and Replaced^ 

(Item: 

^Ol/ ^ '^t , D 

Item: 

^^'> - ^1 , n 

Item: 

Item: 

Landscape inventory 

Item Quantity Unit Condition/Type/Species 

Pre-existing propeity area, ~S'\p'^_ Quadrants diet will be excavated, that 

is covered with grass. 

Number of trees > 2 inch z Each 

trunk diameter 

Nuniber of trees <= 2 inch T Each 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves. 

^J/^^ Each Timers, Heads, etc. 

Aiinih !i skeicli ol litf 

•.r'''''i.lLM ii<v'.)iii 

Number of and size of 

each garden/ flower bed F4«rh 

area. Square Feet 

Atiiich ;i skcicli 1)1 ro!:iiiv(.' ( 

M/fS mid loc;llilM1^ 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. S 

\0U- llii' NHIUC VMII ni 

i;sc(,' 1(1 is'.Ui .1 SIHH ; 

>oiii.;ii.': l(i ili€ |;ro))cil> 

u« ner. </ 

Easement Area, to be Each 

excavated M fi<,^., ^ |_^^^' 

^ 

Page 2 of. 
COASTA L 

! AddKional Comments / Instructions: 

- -2^ THy NlOTtC^ 

L. 

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

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

Interior of house, including foundation cracks or fissures. 

O I do not agree 

Date ' / Contractor's Sienaturr Datt 

Page 3 of. 
BVID# (ofsG 

XRF PROPERTY SAMPLE SHEET 


Date //'/$-o q Address VfTo-T S . V Z S4 -

Project Omaha Lead ARRA Sample time am/pm 

XRF ID# ^^02.2 . sample length 30 sec 

Shot# Reading Sample area Shot# Reading Sample area 

^ ( O ll' \ ^ liD e m 3 ^ 35-'.? J>£ 

<^n /52 t IC Depth 3>S 55 * '3 Depth 

q/e IZI t IS f" 3 ^ •5H i 15 '?' 

Average tZH ' 15 Average 3 5 - /S 

Shot# Reading Sample area Shot# Reading Sample area 

^02 ­ 75i/3 51 

<^07 ^S^( ^ Depth Depth 

CiOH 17-^iZ 3" 

Average n ^ ^ IZ Average 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# Reading Sample area 

, Depth Depth 

y ^ / 

Average / ' / Average 

Signature /^ / ^ ^ -

Print flaf ^ kmj ^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 40 

Mode SOIL 

Time 2010-02-16 16:05 

Duration 90.37 

Sequence Final 

Flags 

AVERAGE ffA^o ot 3/-J9

) 

T 

ADDRESS 4505 S 42 St. 

QUADRANT DZ 

DEPHT 13 

XRF TECH 0. BARAJAS 

MISC 1 

NOTE 1 

Supervised By 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 35.035 

Supervised By: 

Certificate of Verification 

37 

SOIL 

2010-02-16 16:04 

30.18 

Final 

10156 

4505 S 42 St. 

DZ 

13 

O. BARAJAS 

1 

1 

± Error 

± 13.019 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 35.185 

Supervised By: 

Certificate of Verification 

38 

SOIL 

2010-02-16 16:04 

30.06 

Final 

10156 

4505 S 42 St. 

DZ 

13 

O. BARAJAS 

1 

1 

± Error 

± 12.852 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 39 

Mode SOIL 

Time 2010-02-16 16:05 

Duration 30.13 

Sequence Final 

Flags 

BVID 10156 

ADDRESS 4505 S 42 St. 

QUADRANT DZ 

DEPHT 13 

XRF TECH O. BARAJAS 

MISC 1 

NOTE 1 

ppm Error 

Pb 34.352 ± 12.613 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 913 

Mode SOIL 

Time 2009-11-19 13:06 

Duration 92.01 

Sequence Final 

Flags 

AVERAGE jAyg of.91Uj-9T2^ 

ADDRESS 4505 s"?2 ^ 

QUADRANT em 

DEPHT 1" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm ± 

Pb ± 

Supervised By : ^cnrwiL 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 119.177 

Supervised By: 

Certificate of Verification 

910 

SOIL 

2009-11-19 13:05 

30.55 

Final 

10156 

4505 s 42 st 

em 

1" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 15.588 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 132.421 

Supervised By: 

Certificate of Verification 

911 

SOIL 

2009-11-19 13:06 

30.92 

Final 

10156 

4505 s 42 st 

em 

1" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 16.123 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 121.375 

Supervised By: 

Certificate of Verification 

912 

SOIL 

2009-11-19 13:06 

30.54 

Final 

10156 

4505 s 42 st 

em 

1" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 15.654 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

rori-lflr 

XL3t-39022 

Reading No 905 

Mode SOIL 

Time 2009-11-19 13:00 

Duration 91.96 

Sequence Final 

Flags 

AVERAGE fAVg^2f902?904— 

ADDRESS ^?f505 s 42 st 

QUADRANT Bl 

DEPHT 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm Error 

Pb CZ7E99SL—-^ ± Q334Q— ^ 

Supervised By: ^ Q A ^ ^ J ^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 902 

Mode SOIL 

Time 2009-11-19 12:59 

Duration 30.57 

Sequence Final 

Flags 

BVID 10156 

ADDRESS 4505 s 42 st 

QUADRANT B l 

DEPHT 8" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm ± Error 

Pb 78.871 d: 13.190 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 85.892 

Supervised By: 

Certificate of Verification 

903 

SOIL 

2009-11-19 13:00 

30.54 

Final 

10156 

4505 s 42 st 

Bl 

8" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 13.656 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 72.235 

Supervised By: 

Certificate of Verification 

904 

SOIL 

2009-11-19 13:00 

30.85 

Final 

10156 

4505 s 42 st 

Bl 

8" 

R. VENTRY 

clearence 

ngnc 

db Error 

± 12.874 
mm 4m 

/^A. \ Omaha Lead Site—Fixed Price EP-R7-07-05 

I ^^^ ^ I Coastal Environmental Group inc. 

S^^^^ ^ www.coa8taihazmat.com '^i PR(jtt.c^ COASTA L INViaONHINTAL 

GROUP , INC . 

EXECUTIVE SUMMARY: 

BVID #10156-(4505 S 42 ST) 

No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 
EPA Property Close Out Form 

Properly #: iOi^p Property Address:- .U.7> ^ f^^A C 

Datc/Tlmc: Owncr's Name:. ^ 

Quads Excavattd: j ^ t ^ D g-" Contractor Group (^(J 

Yes No £xcavatlaii GeHeral 

1. if necessary, were the connect quadrant(s) excavated and restored? / 

2. If necessary, were the correcl areas ofdrip zone excavaied and restored? y 

Grading Sod and Vcgctatioa 

Yes No 

1. 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 tlut were excavated? 

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? ^ 

S. 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 propertj'? y 

7. Was damage to landsoq>ing or plant materials avoided? •' 

Gates, Feoces and Retaining Walls 

Yes No 

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

2. Were all gates or fences taken down during restoraiion aclivities reinstalled? (Ifapplicable) / 

3. Was damage to gates or fences avoided? (If applicable) / 

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

Foundation, SidioK and Gnllers Yes No 

1. Was damage to the siding or trim avoided? y 

2. Was damage to Ihe foundation avoided? y 

3. Was damage to windows avoided? y 

4 Was damage to windows or door screens avoided? y 

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

Sidewalks and DrKeways (Concrete) Ves No 

I. Was damage lo driveway surfaces avoided? y 

2. Was damage to walkway surfaces avoided? y 
Ovf'oers comments: 

Inspection notes: 

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

EPA Represenialive ^ ^ j± Date: /z/'//oj 
November 16, 2009 

Octavio Barajas 

Coastal Environmental Group, Inc 

2411 Martha Street 

Omaha, NE 68105 

Dear Octavio, 

To refresh your memory, we met approximately three weeks ago at my house 

at 4130 South 41^* Ave regarding the soil removal at my rental property at 

4505 South 42nd street. 

First of all, it was very nice meeting you and your partner that day. I really 

enjoyed the conversation. 

Since that meeting, your men have been out to do the job and I just wanted 

to say that we were VERY pleased with the crew that you sent. My brother 

rents that property and he said that everyone was especially nice, and that 

they did a great job. 

We want to take this time to thank you and to let you know that if you ever 

need a recommendation, we would be honored to give you one. You, and your 

men are the best! Take care and God bless you richly! 

4130 South 41st Ave 

Omaha, NE 68107 

402-733-0315 
Property Completion Agreement 

I his agreemenl documenls the completion of remedial aelivilies perlbimed on my properly My signalure 

will designale Ihal I am salisfied with lhe restoration of my properly, and thai no ilems are in questions, 

now, or al any lime in the future, except Ihose ilems listed below, if any 

Property ID: ^^^fj p 

Property Address: li'VN ^ " S LJ ? *^ ­

'^""'"-^-_m KfAuri^nrJ r . l ~1 grcuck ... l 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Addttional Comments: 

i^ I Hgrcc I'c.^taralion u complettd, rxccpl as noteit 

Jnnt ai;rcc resiomtion is complcled 

^Jj.^^a/>^ ^ Hh'///A 

nrr's Signatiirr Dnlc